Objective: To compare MUSE-DWI with conventional DWI in assessing lesions of invasive breast cancer and evaluating the ADC values for preoperative histological grading. Methods: A retrospective analysis was conducted on 63 lesions confirmed as invasive breast cancer by surgical or biopsy pathology. Preoperatively, all patients underwent MUSE-DWI, conventional DWI, and dynamic contrast-enhanced (DCE) scans. Two radiologists with over 5 years of experience (intermediate and senior levels, respectively) subjectively evaluated the images for clarity, image artifacts, and distortion. Objective evaluation included signal-to-noise ratio (SNR) of lesions and fibrous tissue, as well as the ADC values of both imaging techniques. Due to the limited number of cases classified as grade I and the insignificant difference in disease-specific survival and recurrence scores between grades I and II tumors, grades I and II were grouped as low-grade, while grade III was classified as high-grade. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of ADC values in preoperatively predicting the grading of invasive breast cancer. Results: The SNR and subjective quality scores of MUSE-DWI images were significantly higher than those of conventional DWI (p < 0.05). For the same case, the ADC values of MUSE-DWI were lower than those of conventional DWI. The AUC values for predicting the grading of invasive breast cancer were 0.849 for MUSE-DWI and 0.801 for conventional DWI. Conclusion: Compared to conventional DWI, MUSE-DWI significantly reduces artifacts and distortions, greatly improving image quality. Moreover, MUSE-DWI demonstrates higher diagnostic efficacy for preoperative histological grading of invasive breast cancer.

目的 探讨益肾健骨方结合三色敷药治疗膝半月板损伤的临床疗效.方法 选取自2015年1月至2018年1月上海交通大学医学院附属第九人民医院黄浦分院收治的92例膝关节半月板损伤患者为研究对象.采用随机数字表法将患者分为观察组与常规组,每组各46例.常规组患者给予三色敷药外用,观察组在常规组治疗基础上进行益肾健骨方内服辅助治疗.比较两组患者治疗前、后的膝关节关节活动度(ROM)、患肢肌力、Lysholm膝关节评分情况.结果 治疗后,两组膝关节ROM、患肢肌力、Lysholm膝关节评分均较治疗前明显改善,且观察组改善程度优于常规组,组间比较,差异有统计学意义(P<0.05).结论 益肾健骨方结合三色敷药治疗膝半月板损伤疗效确切,可显著提高三色敷药的治疗效果.

Objective To investigate the diagnostic value of 64-slice spiral CT plain scan and three-dimensional urography for urologic obstructive diseases.Methods The clinical data of 80 patients with suspected urologic obstructive diseases who were diag-nosed and treated in our hospital were analyzed retrospectively.The 64-slice spiral CT plain scan and three-dimensional urography were performed.The value of 64-slice spiral CT plain scan and three-dimensional urography in the diagnosis of urologic obstructive diseases was evaluated with the postoperative histopathological results as the golden standard.Results Of the 80 patients,75 were detected as urologic obstructive diseases by the 64-slice spiral CT and three-dimensional urography,in which there were 24 cases with urinary cal-culi,26 renal pelvic and ureteral tumors,3 bladder tumors,10 chronic inflammations,8 tuberculosis,2 external urethral obstructions and 2 congenital ureteral stenosis.The diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value and the Youden index were 94.87%,50.00%,93.75%,98.67%,20.00% and 0.449,respectively.Conclusion The accuracy of CT plain scan and three-dimensional urography is high in the diagnosis of urologic obstructive diseases.They can be used for accurate classifica-tion of the diseases,which is of certain reference value for guiding the formulation of reasonable clinical treatment plan.

Objective:To explore the clinical value of 64 line 128 layer spiral CT and 1.5T MRI in aortic dissection.Method:Sixty patients were diagnosed the aortic dissection by DSA.Among them,30 were detected by CT and another 30 by MRI.According to the DSA results,we compared CT and MRI application value in aortic dissection.Result:Diagnostic accuracy of CT and MRI were 100％ in diagnosis,classification,true and false lumen,inner diaphragm in aortic dissection.CT/DSA group showed that 15/19 crevasse,crevasse 6/11 place again,vascular branches affected 44/45,22/0 false lumen mural thrombus,ulcer 24/25,12/0 aortic calcification.MRI / DSA group showed the 6/15 crevasse,crevasse 5/10 place again,vascular branches affected 24/39,20/0 false lumen mural thrombus,ulcer 10/21,0/0 aortic calcification.CTA showed aortic intramural hematoma in 2 cases,but DSA not shown.MRI/DSA group did not show aortic intramural hematoma.Conclusion:CT and MRI in diagnosis of aortic dissection and classification present high sensitivity,specificity and accuracy,but in breach display and branching vascular involvement exist certain differences.They can complement each other for contraindication.

Objective To study the application value of magnetic resonance imaging (MRI) for children with inner ear malfor-mation. Methods From July 2013 to December 2015, a total of 30 cases suspected with inner ear deformity in Shenzhen Longhua New District People’s Hospital and Peking University Shenzhen Hospital were enrolled, which included 13 males and 17 females, aged 1-14 years old with mean age of 9 years old. Six inner ear normal volunteers were set as control group, which in-cluded 3 males and 3 females, aged 1-16 years old with mean age of 10 years old. The Philips Achieva 1.5 T MRI scanner was used to detect MRI and hydrography for patients with sensorineural hearing loss (SNHL), and normal volunteers were performed MRI as control detection. Results In 30 cases, 9 cases (30%) of inner ear severe deformity, which included 7 ears of Michel deformity in 4 cases, 4 ears of Mondini deformity in 2 cases and 5 ears of cochlear nerve agenesis in 3 ears;The inner ear was relatively slight deformity in 21 cases (70 %), which include 4 ears of cavity deformity in 2 cases, 4 ears of scroll hypoplasia deafness in 2 cases, 10 ears of scheibe malformation in 5 cases, 19 ears of vestibular aqueduct in 10 cases and 3 ears of inter-nal auditory canal malformation with cochlea and cochlear nerve normal or dysplasia. Three in these 30 cases were cross-mul-tiple deformities in 2 groups, which were severe and relatively slight deformity in different inner ear. Conclusion It is demon-strated that MRI could determine the growth of inner ear deformity and cochlear nerve accurately, which classify deformity severity and provide imaging evidence for indications and contraindications in cochlear implatation, so it is plays important value in diagnosis of SNHL.

Objective To evaluate the MRI manifestations of testicular epidermoid cyst. Methods Contrast-enhanced MRI of 8 patients with pathologically confirmedtesticular epidermoid cysts was reviewed. Results In all 8 patients, the cysts had uniform 1-2 mm thick rimsof low T1 and T2 signal intensities. The T1 signal intensities of the cyst content were intermediate-low or intermediate-high (5), with target sign (1). The onion peel appearance of the internal content was noted on T2-weighted images in 6 and indistinct in 1 patients. In the remaining patient with a 4.8 cm cyst , no onion peel sign was evident. There was no contrast enhancement in all 8 cysts. Conclusion Testicular epidermoid cysts have characteristic MRI features that allow accurate imaging diagnosis.

目的 探讨MRI成像在低颅压综合征中诊断价值.方法 选择经临床拟诊低颅压综合征30例,其中男性13例,女性17例;年龄29～57岁,平均年龄45岁.脑脊液压力均＜0.588 kPa(60 mmH2O).进行脑(其中7例增加脊髓)常规MRI成像,采用矢状位及轴位T2加权三维驱动平衡(T2WI-3D-DRIVE)序列成像,增强扫描,综合分析其影像特点,进行临床分型.结果 原发性19例占63.3％,继发性11例占36.7％.原发性和继发性共同表现为双侧额颞顶枕部硬脑膜及大脑镰、小脑幕均匀增厚(26例),双侧额顶颞枕部及小脑幕下硬膜下积液(15例).原发性:硬脑膜均匀增厚19例,硬膜下积液11例,脑室缩小、蛛网膜下腔狭窄10例,脑下垂6例,垂体增大5例,5例后颅窝拥挤结构.增强扫描显示硬脑膜弥漫性增厚及明显强化9例,脊柱MRI扫描显示硬脊膜弥漫增厚并明显强化3例.内科治疗1～2个月后复查全部病例基本恢复正常.继发性:双侧额颞顶枕部硬脑膜及大脑镰、小脑幕均匀增厚7例,双侧额顶颞枕部及小脑幕下硬膜下积液4例.脑脊液鼻漏5例;脊椎脑脊液漏6例.显示脑脊液漏管漏口11例.11例继发性手术后复查均见漏管闭塞.结论 低颅压综合征具有一定的MRI特征表现,结合脑脊液压测定,可以明确诊断,并可进行临床分型,提供可行治疗方案和对治疗效果准确判断.

Objective To analyze CT findings and histological features of pulmonary sclerosing hemangioma (PSH), and to improve the diagnostic accuracy of this disease. MaterialsandMethods CT images and pathological characteristics of 9 cases with PSH confirmed pathologically were analyzed retrospectively. Results PSH mainly showed in middle-aged women. The diameter of lesions was 2-5.5cm. The lesions were oval or round (6 cases) or lobulated(3 cases) with peripheral scattered stippled calcification(4 cases), showed homogeneous or heterogeneous enhancement. The characteristic findings such as bypass vascular sign(5 cases), halo sign(2 cases), local emphysema area surrounded the mass or air meniscus sign(3 cases) were found. The neoplasms have four histological components in different regions: hemorrhagic region, papillary region, solid region, and sclerotic region. Conclusion There is great application value in clinical diagnosis and differential diagnosis of insolitary pulmonary nodule to familiar with CT imaging features of PSH.

患者 女,34岁.双眼视力下降半年,间断头痛、头晕伴呕吐3个月,于1日前突然加重,无抽搐乏力、大小便失禁.急诊入院.体温37.2℃,心率71次/min,呼吸22次/min,血压124/75 mmHg(1 mmHg=0.133 kPa),神志尚清,精神躁动,双眼视乳头边缘模糊,苍白,视力下降.颈项强直(+),Babinski征(-).白细胞:5.0×109/L.

病例1男,29岁。左侧隐睾29年,右侧阴囊逐渐肿大29年,既往从未进行任何影像学(如 B 超及 CT)检查。临床拟诊：左侧隐睾,右侧阴囊肿物？<br>　　MR 表现：右侧阴囊体积显著增大,其内填充一“长葫芦状”异常信号影,由腹腔沿扩大的腹股沟管伸入右侧阴囊,于腹股沟外口呈“狭颈征”,病灶主要呈短 T1长 T2信号影,T2 WI SPAIR 呈低信号,与皮下脂肪信号相仿,其中央伴点条状长 T1短 T2信号影,但未见肠管及气体信号影,同侧睾丸受压位于阴囊底部,大小约3.6 cm×2.0 cm×2.3 cm。阴茎及左侧阴囊受压并向左上方移位,左侧睾丸大小约2.3 cm ×2.0 cm ×1.8 cm,左侧精索增粗、迂曲,左侧阴囊见少许液体信号影, DWI 序列示左侧精索呈迂曲条状异常高信号。扫描范围内双侧腹股沟未见明显肿大的淋巴结。增强扫描双侧睾丸均匀强化,“长葫芦状”异常信号影主体病灶无强化,其中央见多发条状迂曲强化血管影,囊壁呈薄壁较均匀增厚强化,左侧精索血管迂曲条状强化(图1)。

Objective:To investigate the MRI characteristics of neonatal bilirubin encephalopathy(NBE),in order to strengthen the knowledge of the disease.Methods:The MRI of 31cases with clinically diagnosed NBE were enrolled and retrospectively analyzed.The MRI characteristics and the value in diagnosis and differential diagnosis were studied.Results:The level of total bilirubin and non-conjugated bilirubin were elevated in all the 31patients.In the 20NBE cases of acute stage,high signal intensity on SE T1WI with distinct edge were assessed symmetrically in bilateral globus pallidus(15cases);and similar features were showed in bilateral globus pallidus,ventral nuclei of thalamus(3cases)and bilateral globus pallidus,ventral nuclei of thalamus and brainstem(2cases).Iso-intensity was assessed on TSE T2WI(20cases),no abnormal signals were identified on FLAIR and DWI.Of the 11cases with chronic stage NBE,high signal intensity on T2WI,FLAIR and DWI(ADC)were showed in 8cases.On T1WI,slightly high T1WI signal intensity was assessed in bilateral globus pallidus and ventral nuclei of thalamus(6cases),while the other 2cases showed isointensity.Of 3cases had NBE in combination with neonatal hypoxic-ischemic encephalopathy,lesions with high signal intensity on T1WI with blurred margin could be revealed in bilateral globus pallidus,ventral nuclei of thalamus,bilateral internal capsule,putamen,caudate nucleus and scattered in grey/white matter of bilateral temporal-parietal lobes,high signal intensities on T2WI and FLAIR,yet no abnormal signals were showed on DWI.Conclusions:Characteristic high signal intensity on T1WI in bilateral globus pallidus and/or bilateral thalamus and ventral nuclei of brainstem with distinct edge could be revealed in the acute stage of NBE,the signal intensities of chronic stage were relatively complicated.MRI provided helpful information in the diagnosis and differential diagnosis of NBE and neonatal hypoxic-ischemic encephalopathy.

<正>患者女,30岁。清宫术时术者突然感到有脱空感,失去宫壁阻力,发觉所用器械进入宫腔的深度明显超过检查时所估计的宫腔深度。术后1d,腹痛及肛门坠胀感伴发热,盆腹部压痛,体温38.6℃。实验室检查:白细胞18.3×109/L,中性粒细胞80%。怀疑子宫穿孔。B超疑子宫穿孔伴浆膜层组织嵌顿,不排除大网膜及脂肪垂吸入宫

病例资料 患者 女，43岁，因“发现左大腿肿块3年”入院。患者于3年前始发现左大腿部一肿物，约花生米大小，按之无疼痛，不伴其他相关症状，未予特殊处理，肿物至今逐渐增大至鹅卵大小，按之有酸胀感，遂来我院就诊，外院彩超提示左大腿皮下实性肿物。为求进一步诊治，门诊拟以“左大腿肿块查因”收入院。起病来精神，胃纳、睡眠可，大小便正常，体重无明显变化。T 37.0℃，P 86次/分，R 20次/分，BP 153/92 mmHg，神志清楚，步入病房，查体合作。专科情况：左大腿见一肿物，约9 cm×6 cm大小，表面见静脉怒张，表面皮温增高，质稍韧，边界较清，活动度尚可，按之有酸胀感，末梢血运尚可，左下肢感觉无明显异常。

支气管异物多发生于3岁以下儿童,Siegel等[1]统计占79%,在美国发生率约为1.4/10万,发病峰值年龄为 1 ～2 岁[2],是耳鼻喉科的常见急诊之一,只要诊治及时不会造成严重后果.而成人支气管异物比较少见,相关报道文献并不常见,特别是隐匿性支气管异物经常性地发生漏诊和误诊.本文收集2007-12-2011-12诊治的成人慢性隐匿性支气管异物6例,对其临床、影像及纤维支气管镜检查情况进行回顾性分析,报告如下.

1 病例资料 患者,女,30岁,已婚,孕13周,曾有流产史1次.自行服药流产,每日饭前服用米非司酮20～30 mg,2次/d,服用3d,后又改服用米索前列醇600～800 μg,2h后到妇产科门诊检查,仅发现单纯羊毛囊排出,考虑流产不完全或流产失败.清宫术时术者突然感到有脱空感,失去宫壁阻力,发觉所用器械进入宫腔的深度明显超过检查时所估计的宫腔深度.术后1d,患者出现腹痛伴肛门坠胀感伴发热,盆腹部压痛,体温38.6℃,白细胞18.3×109/L,中性粒细胞0.8.

<正>粟粒性脑结核是中枢神经系统结核的一种特殊形式,常是由体内其他部位结核菌经血液途径播散而来。临床上粟粒性脑结核比较少见,有时表现不典型,特别是原发结核病灶不在肺部或肺部结核影像学表现不典型时,容易误诊。本文报告1例亚急性粟粒性脑结核并急性粟粒性肺结核。

目的 探讨MRI与MR扩散成像在颞叶癫痫中临床应用价值.方法 选取30例癫痫患者行MRI常规序列(含垂直于海马长轴斜冠状位FLAIR序列)及扩散加权成像(DWI)检查,分析海马大小形态信号影像表现,并与脑电图、手术病理对照.结果 30例患者经手术病理证实均为单侧海马硬化,右侧18例,左侧12例,脑电图表现提示相应颞叶慢波或嵴波,MRI表现患侧海马体积缩小26例,4例海马双侧体积无明显变化,T2WI序列高信号11例,FLAIR序列高信号16例,DWI序列异常高信号4例,ADC值升高26例,1例同时有DI高信号和ADC值升高；海马头部浅沟消失26例,患侧颞叶及邻近白质萎缩10例,患侧颞角扩大12例,环池增宽10例.结论 综合运用MRI常规序列,FLAIR颞叶斜冠状位序列,DWI和测定海马体积、ADC定量分析中,对癫痫诊疗可提供比较准确定侧、定位、定性诊断.

Objective To discuss the etiology,pathology and imaging characteristics of upper ureteral stenosis or obstruction,to improve understanding of the disease.Methods One hundred and eighty cases of upper ureteral stenosis or obstruction confirmed by clinical diagnosis or by surgery and pathology during July 2009 and June 2012 from Shenzhen Longhua People's Hospital were collected,the imaging findings of KUB plain film,IVP,CT,MRI were retrospectively analyzed,the etiology,pathology and image-related characteristics were explored,classified and typed.Results Among the 180 cases,according to etiology,there were 36 cases of congenital anomalies(including 8 cases of ureteral stenosis) which made up 20% of the total,144 cases of acquired or secondary stenosis which made up 80%;according to lesion number,there were 178 cases of single stenosis(limitations diaphragm or valvular stenosis,segmental stenosis) which made up 99% and 2 cases of multiple narrow which made up 1%;according to diseased region,there were 140 cases of cavity narrowness which made up 78%,35 cases of wall stenosis which made up 19% and 5 cases of stenosis of the external wall of oppression which made up 3%;according to pathological feature,there were 180 cases of organic narrowness,one case of functional narrowness which was not included.Conclusion KUB plain film can clarify the calculi diagnosis of the upper ureter.IVP can show the causes of stenosis or obstruction in upper ureter segment cavity and function of renal excretory,which can be regarded as a supplement diagnosis of the retrograde pyelography for the ones who have poor renal function.CT scan and the enhancement can display the reason for oppression on/outside the cavity wall.MRI can find the narrow site of obstruction and distinct intrinsic stenosis and external stenosis.MRU has good effect in directly showing the slight,moderate and severe hydrocephalus of renal function.

Objective To evaluate the diagnostic value of CT and MRI in thoracic yellow ligament ossification(TOLF).Methods A retrospective analysis of 15 cases with thoracic yellow ligament ossification confirmed by pathology,DR,CT,MRI findings,clinical diagnosis,choice of procedure,the efficacy of surgery follow up were discussed,the relationship between efficacy ratings and spinal stenosis after surgery was compared to evaluate the final grade ratings efficacy standard.Results Diagnosis of 15 cases with TOLF was consistent with clinical surgery pathological results,TOLF occurred in the lower thoracic spinal(Th7-12),2 cases in single segment(Th9-10) for the outside and nodular type;13 cases were multisegment continuity yellow ligament ossification,which were diffuse type(Th9-10-Th10-11-Th11-12 in 6 cases,Th9-10-Th10-11 in 3 cases,Th7-8-Th9-10-Th10-11-Th11-12 in 1 cases,Th10-11-Th11-12 in 3 cases).Ⅰ degree of spinal stenosis was seen in 5 cases,Ⅱ degree of stenosis was seen in 9 cases,Ⅲ degree of stenosis was seen in 1 case.15 cases were treated by posterior lumbar decompression and selective pedicle screw fixation,among them,excellent in 5 cases(33%),good in 6 patients(40%),ordinary in 3 cases(20%),and poor in 1 case.No major complications or sequelae was found in postoperative follow up of patients(7%)(24-36 months).Conclusion CT and MRI are useful diagnostic methods in thoracic yellow ligament ossification,which can clearly depicted lesions range,morphology,canal compromise and spinal cord compression,degeneration of the situation,and it have important role in determining the surgical approach and follow up.

<正>上海石氏伤科是我国近代中医骨伤科学重要的流派之一,石仰山教授是石氏伤科第四代传人,从事伤骨科临床50余年,对各类骨伤疾病有着丰富的治疗经验,我有幸聆听石老的教导,