Objective: The end plate plays an important role in maintaining the structural integrity, balancing biomechanical and supplying nutrition, how dose it changes with the reduced bone mineral density (BMD) remains unknown. The objective of this study is to investigate the relationship between lumbar end plate degeneration and normal BMD, osteopenia and osteoporosis. Methods: A retrospective analysis of 362 patients equal or over 55 years old who underwent both lumbar MRI and dual-energy x-ray absorptiometry(DXA) examinations due to lumbar discomfort or a healthy physical examination. Two Radiologists reported the Modic changes, Schmorl node, and end plate irregularities of 11 end plates from L1 to S1. Data were separated by sex, and then the summed results were grouped in age matching. Results: In women, with the decrease of hip BMD, the positive rate and severity of Modic changes and the severity of end plate irregularities showed an increasing trend; Among men, the number of Modic changes and end plate irregularities increased in osteoporosis subjects and osteopenia subjects compared with normal BMD subjects. While the positive rate of Schmorl nodes incremental trend was not obvious in female and male subjects. Conclusions: Osteoporosis in the elderly will aggravate the degeneration of the lumbar end plate Modic changes and end plate irregularities.

目的 利用泪道造影及多层螺旋CT测量慢性泪囊炎者泪囊的体积,并探讨其与性别、年龄的关系.方法 收集溢泪、溢脓患者109例(共126眼),先行X线透视下泪道造影,随后立即行CT扫描.结果 泪囊的轴位长度和宽度分别为(7.48±1.87)mm和(5.11±1.35)mm,冠状位长度和宽度分别为(11.32±2.60)mm和(5.10±1.31)mm,体积为(289.10±182.39)mm3.男女五个参数差异均无统计学意义(均P＞0.05).不同年龄泪囊的轴位宽度差异有统计学意义(P＜0.05).结论 影像学方法能准确测量慢性泪囊炎患者泪囊的大小体积及变化情况,不同患者泪囊变异较大,术前个体化扫描对于临床医生了解泪囊及确定手术方式很有必要.

BACKGROUND:The importance of identifying osteoporotic vertebral endplate or/and cortex fracture (ECF), which primarily includes endplate fracture (EPF) and vertebral anterior cortex buckling, has been recognized. However, some old traumatic ECFs with healing process in the elderly may be mistaken as osteoporotic. This study analyzes the radiological features of traumatic EPF. METHODS:This was a retrospective analysis of 194 spine trauma patients with 263 vertebral fractures (mean age: 42.11 ± 9.82 years, 118 males and 76 females). All patients had traumatic EPF identified by X-ray/CT/MRI. RESULTS:The involved vertebra was mostly L1 (29.7%), followed by T12 and L2. Except EPFs involved both superior and inferior endplates (12.6%), only 1.9% involved inferior endplate alone, with the majority involved superior endplate. If each endplate was divided into five segments of equal lengths (from anterior to posterior: a1, a2, m, p2, p1), the most depressed point of superior EPFs was mostly at segment-a2 (approximately 45%), followed by segment-a1 (approximately 20%) or segment-m (approximately 20%), and very rarely at segment-p1. The upper 1/3 of anterior vertebral wall was more likely to fracture, followed by middle 1/3 of anterior wall. For posterior vertebral wall fracture, 68.5% broke the bony wall surrounding the basivertebral vain. 58.6%, 30.0%, and 11.4% of vertebral fractures had <1/5, 1/5-1/3, and >1/3 vertebral body height loss. As the extent of vertebral height loss increased, the chance of having both superior and inferior EPFs also increased; however, the chance of having inferior EPF alone did not increase. CONCLUSION:Traumatic EPF features are characterized, which may help the differentiation of traumatic and osteoporotic EPFs.

Traumatic end plate fractures (EPFs) refers to the EPF caused by trauma, rather than the pathological status of the end plate (EP). However, some old traumatic EPFs may be mistaken as osteoporotic in the elderly. The objective of this study is to describe the radiological features of traumatic EPF in different traumatic fracture type patients presenting in the Emergency department setting. And to compare the result with osteoporotic vertebral fracture (VF).This study retrospectively analyzed the anatomical location of acute thoracolumbar vertebral traumatic EPFs in males (age≤55 years) and females (age≤50 years). The anatomic distribution of EPFs, the anterior and posterior wall fracture were analyzed in patients, who were scanned with 1 or more of the following methods: radiography, CT, and magnetic resonance imaging.There were 194 cases of acute spine trauma involving at least 1 EPF, including 118 males and 76 females. The involved vertebra was mostly at L1 (29.7%), followed by T12 (18.3%), and then by L2 (12.9%). Excluding those with both upper and lower EP involvements, the ratio of superior EPF to inferior EPF was 33.5 for males and 45.5 for females. With the EP divided into 5 segments of equal length in the anteroposterior direction in different fracture types, fractures occurred mostly at a2 segment (71.48% for superior EPs and 7.60% for inferior EPs), followed by a1 segment (66.16% for superior EPs). The upper third of the anterior and posterior walls were most prone to fracture in traumatic vertebral fracture.Traumatic EPFs more likely involve the anterior EP more than the posterior EP and is correlated with fracture type. These characteristics may help radiologist differential diagnosis between traumatic and osteoporotic EPF.

Osteoporotic vertebral fracture (OVF) is the most common osteoporotic fracture.Prevalent OVFs increase the risk of future vertebral and non-vertebral osteoporotic fracture independent of bone mineral density (BMD) (1-4).OVFs are associated with poor life quality, impaired bending and rising, difficulties in the activities of daily living, frailty, higher risk of hospitalization, and higher mortality (4-8).Appropriate interventions for VF can reduce the occurrence of hip fractures, preventing further OVF, reducing pain and related disabilities (1,(9)(10)(11).It is important to identify and report OVF, so that appropriate investigation and treatment can be instigated.However, the diagnosis of OVF has no golden standard, particularly for the minimal or mild grade OVF, reader's subjectivity plays a role (12-17).Genant's SQ (semiquantitative) method has been the most commonly used criteria (18,19).Recent reports emphasize the importance of identifying osteoporotic endplate/cortex fracture (ECF) (also called ABQ fracture) (20-27).Recently, Wang emphasized the importance of identifying OVF with less than 20% vertebral body height loss, which would be equivalent to Genant's SQ 0.5 grade (13,14).Wang et al. also attempted to classify Genant's SQ grade-2 OVF into two sub-grades, those with 25-34% height loss and those with 34-40% height loss (26,27).It was noted that OVFs with vertebral height loss >34% are always associated with .In this letter, we argue that, according to the many published data, there is a high possibility that OVF at mid-thoracic level (T7-T9) has been over-diagnosed in many cases.This has been noted in one our letter (28).Compared with some other literature reports, the proportion of mid-thoracic OVF was relatively low for both men and women in our studies (29) (Figure 1).Hereby we put forward another argument for this point.Recently, we analyzed traumatic endplate fracture (EPF) in 118 males and 76 females patients (mean: 42.11±9.82years; range: 13-55 years).The causes of the trauma included 69.1% with traffic accident, 16.5% with fall from >2 meters height; the rest were caused by sports injury and heavy subject contusion.There were a total of 263 VFs, with 191 EPFs confirmed by CT, 52 EPFs confirmed by MRI, and 20 EPFs confirmed by X-ray.The

鼻腔泪囊造口术是治疗慢性泪囊炎、鼻泪管阻塞的主要方式[1]，手术关键在于术前准确确定泪囊的大小、位置及其与邻近结构的关系，以便准确无误地去除泪囊窝骨质而不损伤鼻泪管、眶样纸板及筛窦等结构[2]，同时充分开放泪囊使脓液得以引流，从根本上解决泪道梗阻问题[3]。笔者对溢泪、溢脓患者同时行泪道X线造影及鼻窦MSCT扫描，以探讨泪囊的位置及大小，为临床医生手术提供参考依据。

目的 分析先天性肺结核患儿的临床及影像学表现,提高对该病的认识水平.方法 回顾性分析18例先天性肺结核患儿的临床及影像学资料,其中男性10例,女性8例,年龄17～180天,平均年龄85.5天,18例患儿行X线胸片检查,16例行胸部CT检查,6例行头颅MRI检查.结果 临床症状主要为发热咳嗽(18例),实验室检查白细胞增高2例,胃痰液和脑脊液中抗酸杆菌阳性率较低(2/18 vs 0/9),PPD阳性率低(2/18),T-SPOT阳性率较高(3/3).X线表现为弥漫粟粒结节10例,广泛分布结节-斑片影6例,且分布右肺多于左肺,上肺多于下肺,多伴肺实变(10例),肺门增大(11例).CT表现中,弥漫粟粒结节9例,结节密度较低,6例伴结节融合,融合结节密度高,边界清；广泛分布结节-斑片影5例,多为类圆形,密度较高,边界可清或伴淡薄样渗出；7例纵隔及肺门淋巴结肿大且伴蛋壳样或沙粒状钙化.6例头颅MRI中,4例有脑皮质或实质病变.结论 先天性肺结核的临床表现及结核生化指标检测均缺乏特异性,而影像学表现虽复杂多样,却有一定的规律和特征,能为临床早期诊断及治疗提供帮助.

Objective To evaluate MRI characteristics of choroidal lesions misdiagnosed as melanoma in 13 cases,and to deepen the understanding of it.Methods The clinical and radiological data of 13 cases choroidal lesions misdiagnosed as melanoma in affiliated hospitals of Wenzhou medical college from January 2007 to December 2011 were included in the study.11 cases were confirmed by surgical or biopsy pathology,2 cases of osteoma were confirmed by imaging or clinic follow-up.The imaging characteristics were retrospectively analyzed.Results Among 13 cases,there were choroidal metastatic carcinoma(n=2),choroidal hemangioma(n=2),choroidal osteoma(n=2),choroidal ciliary body schwannoma(n=1) and retinal or choroidal hemorrhage(n=6).12 cases located in the posterior wall of eyeball and 1 case in ciliary body.6 cases had well-defined marges,7 cases had not.13 cases did MRI examination,while 1 case did CT,metastasis,hemangioma and schwannma demonstrated iso-intensity or slight high signal intensity on T1WI and iso-intensity or low signal intensity on T2WI,Osteoma demonstrated iso-intensity or low signal intensity on T1WI and iso-intensity on T2WI,high density in CT images.Retinal or choroidal hemorrhage demonstrated iso-intensity or high signal intensity on T1WI and iso-intensity or low signal intensity on T2WI.The lesions enhanced obviously in 5 cases with Gd-DTPA enhancement scan.9 cases did ultrasonic examination,2 cases were misdiagnosed,2 cases did not have sure result and 5 cases were diagnosed correctly.Conclusion When MRI T1 WI signal of choroidal lesions is higher or equivalent to T2WI,clinical and other imaging data should be comprehensively considered if you want to differentiate it from choroidal melanoma.

由于十二指肠位置较深,在腹部闭合性损伤中受伤儿率较低(3.7％～5.0％)[1],故十二指肠血肿临床少见,且由于症状不典型,多发生于儿童,疼痛部位、程度及发病时间常不确定,诊断比较困难,易漏误诊并导致严重并发症[2].早期诊断及合理治疗对于十二指肠血肿的预后非常重要[3],本研究回顾性分析经手术和(或)临床随访证实的16例十二指肠血肿的影像学表现,探讨多层螺旋CT (MSCT)对十二指肠血肿的诊断价值. 1资料与方法 1.1研究对象收集温州医学院附属第二医院2006-03～2010-03诊治的十二指肠血肿16例,男11例,女5例;年龄5～71岁,平均(33.4±5.2)岁,12岁以下儿童5例.受伤原因:车祸伤8例,上腹挤压伤(机器挤压及坠落)2例,锐器伤2例,胆道取石术后3例,误服盐酸后1例.临床症状:腹痛14例,呕吐9例,呼吸困难2例.16例中采取手术治疗6例,保守治疗10例;死亡2例,康复14例.