针灸是中医学的一种重要治疗方法,在长期临床实践中,疗效确切已被国内外医学界认可,但其调节中枢神经系统的作用机制尚未完全阐明.目前,功能磁共振成像(fMRI)等神经影像技术已广泛用于脑功能研究,为针刺作用机制的探讨开辟了新的途径.本文对针刺腧穴的特异性、针灸的治病机制、针刺效应的影响因素、腧穴配伍的效应机制等方面研究进展进行综述.

医学影像学为针灸脑效应及其机制研究提供了依据.针灸影像交叉学科研究已成为国内外中西医结合研究的热点课题.拟从针灸脑效应的影像学研究现状、面临的挑战与机遇3个方面进行概述.在脑科学计划及针灸多学科不断发展的背景下,影像学在针灸脑效应的应用研究将大有可为.特别以本期针灸影像学专栏的6篇相关论文作为具体范例,供大家学习参考.

目的 对照分析钙化上皮瘤(CEM)和表皮样囊肿(EC)的临床特点与超声表现,了解CEM的临床与超声特点,提高超声诊断的准确率.方法 选取术前超声检查并术后病理证实的45例CEM和178例EC患者资料.通过单因素及多因素分析,评估超声诊断CEM的危险因素,建立诊断模型,明确各超声征象在诊断中的价值.结果 两组在年龄、发病时间、皮肤颜色、位置以及病变长、宽、厚、回声、实质回声、边界、后方回声、钙化特点、CDFI、特殊征象、结节周围是否有低回声晕等比较,差异有统计学意义(P＜0.05).将单因素分析结果有统计学意义的变量(P＜0.05)作为自变量纳入多因素logistic回归模型,结果显示差异有统计学意义(模型x2=142.956,P＜0.001,R2=0.746).后方回声衰减、结节周围低回声晕是钙化上皮瘤的危险因素(OR=9.277,10.254),年龄、厚径、后方回声增强是保护性因素(OR=0.936,0.302,0.156).结论 患者年龄越小,结节厚度越小、后方回声衰减并伴有低回声晕时,诊断CEM的准确率更高.

目的:探讨结节性筋膜炎(NF)的超声和MRI表现,以提高影像诊断水平,为临床治疗提供依据.方法:回顾性分析经病理证实的17例NF患者,13例行超声检查,4例行MRI检查.结果:17例中,11例位于上肢,1例位于下肢,2例位于颈部,1例位于胸壁,1例位于腹壁,1例位于乳腺.病灶最大径0.4～3.2 cm,平均(1.5±0.7)cm.行超声检查13例中,11例病灶以低回声为主,4例低回声病灶内伴片状高回声,3例低回声病灶内同时伴片状高回声和无回声区;7例病灶后方回声增强;行CDFI 8例中,3例病灶内见少量血流信号.4例MRI检查示:病灶在T1WI呈等、略低信号;T2WI呈高信号,其中1例病灶见囊变区,3例病灶周围见水肿信号.结论:NF的超声和MRI表现有一定的特征性,均有助于该病的诊断和鉴别诊断.

Vertebrobasilar dolichoectasia (VBD) is a rare vascular disease, which is characterized with vertebral basilar artery circuity and expansion. At present, the data on research of VBD data are very limited. To provide earlier diagnosis for clinical doctors and improve the detection rate of the disease, we review the epidemiology, etiology, pathogenesis, clinical manifestation, classification, image diagnosis and prospects of VBD.

目的:通过超声引导下兔膝关节出血模型的建立,为临床研究膝关节炎症提供可利用的动物模型.方法:使用健康级别成年新西兰大白兔8只,3月龄,性别不限,体质量2.0～2.5 kg,在超声引导下于兔左右侧膝关节髌上囊分别注射兔心脏血、生理盐水,高频超声下观察双侧膝关节注射后及吸收情况,间隔3 d注射一次,共注射3次,14 d后取材行组织病理学检查,观察关节滑膜增生情况.结果:第1次注射后即刻检查,全部兔左膝髌上囊均见液性暗区;再次注射前行超声检查,仅第7天第3次注射前2只、第10天3只髌上囊见液性暗区.病理检查:注射兔心脏血组兔左侧膝关节滑膜局灶性轻度增生,间质内小淋巴细胞、浆细胞、嗜酸性粒细胞弥漫性浸润并伴含铁血黄素沉积;注射生理盐水的右侧兔膝未见异常.结论:超声引导下兔膝关节造模的方法重建了关节出血对关节及滑膜造成的影响,为关节出血类疾病的病理改变、实验干预及后期疗效评价提供了可操作、有效的方法.

Objective:To explore the display quality of complementarity of MSCT,MRI in the same anal fistula patients,pro-viding more detailed and more accurate information for clinical doctors and preventing the recurrence of anal fistula. Materials:30 anal fistula adults without any other anorectal diseases received MRI and MSCT scanning. Results:The internal openings of anal fistulas of the total 30 patients were completely displayed by CT and MRI. Small fistulas of 8 patients and small hidden cysts of 2 patients were completely displayed by CT images,but were not by MRI images. Fistula cavities and fistula walls of 4 patients were clearly distinguished by CT,while were not by MRI. Expansion scopes of granulation tissue of 6 patients were clearly displayed by MRI,but were not by CT. The obstructed fistulas of 3 patients were displayed by MRI,but were not be seen by CT. Conclusion:Both CT and MRI have their own advantages,combining the two in the diagnosis of the anal fistula can make the best of their merits,provide the clinical doctors the information as complete as possible,and provide a strong guarantee for the radical cure of anal fistula.

中国中西医结合学会医学影像专业委员会 (Chinese Imaging Society of Inte-grative Medicine,CISIM)(简称专委会)是经中华人民共和国民政部、中国科协、中国中西医结合学会(简称总会)批准,以促进中医传承和发展为目的,由主要从事中西医结合影像学研究的学者组成的全国性学术组织,创建于 1989 年,经历五次换届,共产生六届专委会.

目的:探讨髌股关节不稳定(PI)诊疗过程中影像学的应用价值.方法:对36例PI的影像学资料进行回顾性分析、总结.结果:36例(48膝)中股骨滑车Dejour分型:A型31膝,B型9膝,C型5膝,D型3膝;Caton-Deschamps指数平均1.18±0.15;CT测量TT-TT值,平均(20.3±5.8)mm;29例存在不同程度的骨水肿信号,11例存在游离骨片,17例出现韧带损伤,13例明显积血积液.结论:发育的骨性解剖异常及软组织结构损伤是造成PI的主要因素,综合分析病史、临床表现及相关影像学资料可提高诊断准确性、尽早明确诊断和治疗.

目的:探讨MSCT及其后处理技术在肩胛骨复杂骨折诊疗中的临床应用价值. 方法:收集我院门(急)诊肩胛骨复杂骨折患者42例,均行常规X线检查、MSCT及后处理.通过Ada-Miller分型划分骨折损伤类型.比较分析X线平片与MSCT技术对肩胛骨复杂骨折的诊断差异.结果:42例均经手术治疗,确定骨折情况,MSCT扫描误诊率4.76%,低于X线平片的23.53%.结论:MSCT及其后处理技术对肩胛骨复杂骨折的诊疗有辅助作用,值得临床推广.

Objective:To investigate the clinical value of dual-source CT (DSCT) in optimizing normal gastric images. Methods:62 patients without gastric diseases confirmed by endoscopy underwent abdominal plain scan and enhanced scan. Among them ,a total of 32 cases underwent DSCT scanning was regarded as an experimental group (DE group). 30 patients underwent conven-tional scanning were treated as a control group (NDE group). The lesser curvature of fundus was chosen as gastric ROI 1,the greater curvature of stomach as gastric ROI 2,the lesser curvature of antrum as gastric ROI 3. And the three fat regions near to the gastric ROIs were chosen as fat ROI 1,fat ROI 2,fat ROI 3,respectively. The differences of signal to noise ratio (SNR), contrast to noise ratio (CNR),subjective scoring,volume CT dose index,the dose length product (DLP) and effective dose (ED) between DE group and NDE group were compared. Results:①In DE group,the images in 100 kV compared with those in 140 kV, SNR of the former of gastric ROI 1 and 3 were higher than that in 140 kV ,and there were statistically significant differences (P<0.05). Gastric ROI 2 existed large measurement error,there was no statistically significant differences (P>0.05). SNR in 100 kV of fat ROI 1 and 2 were higher than that in 140 kV,and there were statistically significant differences (P<0.05). Fat ROI 3 exist-ed large measurement error,there was no statistically significant difference (P>0.05). ②In DE group,the images of arterial phase compared with those of venous phase,SNR in 100 kV of gastric ROI 1 and 3 were higher than that in 140 kV (P<0.05),while there was no significant difference for SNR of ROI 2 (P>0.05). SNR in 100 kV of fat ROI 1,2 and 3 were compared with that in 140 kV,there were no significant differences (P>0.05). ③The baseline characteristics and subjective scores between DE group and NDE group had no statistically significant differences. The radiation dose in 100 kV significantly reduced than that in 140 kV (t=-12.58,P=0.000). Conclusions:This study shows that DSCT can assess the T staging of gastric cancer from parameter quan-tization through different objective and subjective evaluation of the gastric ROI and fat ROI. Low-voltage imaging can improve the image quality,reduce the radiation dose,so that optimize the image.

肘关节急性外伤临床常见,又以儿童多见.X线平片是诊断创伤骨折最有效、最简单、最常用的方法[1].对于怀疑有骨折或有明确骨关节损伤的患者,均应首先行X线检查.肘关节外伤摄片时,体位摆放较困难,这就要求技师合理设计投照体位.现分析山东中医药大学附属医院2012年1月至2013年3月256例有随访资料的急诊肘关节X线片,旨在评价数字摄影在肘关节创伤中的应用价值,同时探讨合理的投照体位.

冠心病发病率较高,对其诊断有多种影像及实验室方法.冠状动脉CTA是一种无创、准确的检查方法,目前在冠心病的筛查中占有相当重要的地位[1].该项检查中对比剂峰值时间的把握尤为重要,决定着检查的成败及图像的质量.应用常规头皮针注射对比剂会引起渗漏,以致冠状动脉CTA不能获得满意的图像效果;使用静脉留置针会提高成功概率.本研究现比较18 G及22 G静脉留置针对冠状动脉CTA图像质量的影响.

衰老是机体发展的必然过程,而脑衰老常伴随众多症状和体征的出现,甚至是严重疾病的发生(如老年痴呆、中风病等).早期观察到能反映脑衰老程度的可干预性指标,可指导人们早期进行预防治疗,减少因年龄增加造成机体功能降低所致的疾病.为了探讨客观化指标与脑衰老之间的关系,我们观察了321例不同脑衰老程度的患者,现总结如下.

1111111111 Objective:To investigate the characteristic and distinction of blood stasis type and damp invasion of lower energizer type ASO in MSCTA.Methods:Lower extremity artery of 98 ASO patients including blood stasis type 70 examples and damp invasion of lower energizer type 28 examples were examined with MSCTA,ranging from the lower abdominal aorta to the middle of tibial artery.The slice thickness was 2 mm,pitch was 2.0625,reconstruction thickness was 2 mm,the interval was 1 mm.Image of VRT,MPR,MIP and the axis ones were processed and statistics with logistic regression analysis.Results: MSCTA signs intensely related with the blood stasis type including:①right common iliac artery and external iliac artery mix plaques;②left femoral artery pipe wall harden thickening;③the vascular occlusions were relatively few,or was common by the one-sided.The damp invasion of lower energizer type intense related MSCTA signs were as follows:①aorta ventralis wall locally became softened thickening;②right common iliac artery lumen was moderate narrowed,external iliac artery circularity soften,femoral artery branches formed and popliteal wall locally became thicker and softer;③left femoral artery was mildly narrowed or occlusion,popliteal artery branches formed;④the vascular occlusion were relatively more,and two-sided common. Conclusion:There are certain differences between blood stasis and damp invasion of lower energizer type of ASO in the lower limb artery MSCTA performances,which may provide ASO Chinese medicine diagnosis and treatment the objective basis.

医学影像学是以医学影像为依据,对疾病进行分析诊断和治疗的医学科学.经过100多年的发展医学影像学的范畴不断扩大,诊治水平明显提高,已成为运用先进科技手段最多,在临床医学中发展最快,作用重大,不可或缺的学科之一[1].

膀胱癌是泌尿系统常见的恶性肿瘤,对其有效治疗,膀胱癌的准确诊断和术前分期十分重要.笔者收集本院2002年3月～2008年3月经膀胱镜及手术病理证实的38例膀胱癌患者的MRI资料及临床病理资料,进行回顾分析.

目的:探讨卡托普利对肾阴虚和阴虚阳亢型原发性高血压大鼠的疗效。方法:SPF级雌性Wistar大鼠60只,造模后随机分为肾阴虚组和阴虚阳亢组,每组再分为模型对照组、模型未处理组和模型给药组,每组10只。测量两模型未作处理组的全血低切黏度,对其他四组大鼠测血压后,两模型给药组施以卡托普利治疗,两模型对照组给以同剂量的生理盐水,一周后测血压及全血低切黏度。结果:通过检测血压和全血低切黏度,发现卡托普利对肾阴虚和阴虚阳亢型高血压动物模型在降低血压和全血低切黏度的疗效上均有差异(P<0.05)。结论:卡托普利对不同中医证型高血压和全血低切黏度具有不同的疗效,卡托普利在降血压效果上阴虚阳亢模型效果优于单纯肾阴虚模型,为临床按中医理论辨证应用西药提供了一定的实验依据。

针灸是中国传统医学的一种重要治疗方法,其疗效已被国内外医学界所认可,但其作用机制尚未完全明了.脑功能成像技术的出现使无创性研究针灸对人脑活动的效应成为可能,为针灸作用机制的研究打开一扇新的窗口,开辟了新的途径.

X线计算机体层成像(X-ray computed tomography,CT)自1972年问世以来,得到了快速发展和普及,其检查范围在逐步扩大.多层螺旋CT容积扫描的实现提高了病变的检出率和诊断的准确率,临床应用日益广泛,受检群体的有效受照剂量也在增加,如何在最大限度地满足CT诊断前提下,降低CT剂量,已受到越来越多的关注[1-3].