目的 分析含囊腔性肺癌的MSCT表现,提高诊断准确率.方法 回顾性分析经病理确诊的20例含囊腔性肺癌的临床及CT图像资料.结果 20例均为单发,右肺14例,左肺6例,囊腔呈类圆形或椭圆形15例,囊腔不规则5例.囊壁均匀11例,厚薄不均9例.2例表现为单纯囊腔,囊腔周围磨玻璃密度影4例,囊腔周围实性密度影6例,囊腔周围混杂密度影8例.囊腔周围伴壁结节5例,囊腔内有分隔13例,囊腔内血管穿行8例,囊腔内支气管穿行5例,囊腔内支气管截断或闭塞5例,分叶征15例,毛刺征12例,胸膜牵拉征9例.7例增强患者囊腔周围壁结节或实性成分呈中度强化.20例肺癌的病理类型:腺癌19例,腺鳞癌1例.结论 含囊腔性肺癌的MSCT主要表现为囊腔内有分隔、囊腔周围伴实性、磨玻璃或混杂密度影、囊腔伴壁结节、囊腔内血管穿行等,部分患者需结合CT随访观察囊腔的动态变化以提高诊断率.

患者女,6岁3月.因“头痛呕吐伴食欲减退2天”入院.患者2天前无明显诱因出现头痛,伴进食后呕吐,呕吐物为胃内容物.颅脑CT表现:左颞部颅骨内板下见梭形等高密度肿块,密度不均匀,边界清楚,截面大小约38mm×75 mm,相应部位颞骨骨质增厚毛糙,并见垂直针状骨(图1,2).MRI表现:左颞部颅板下见宽基底肿块影,其内信号混杂,以等T1长T2信号为主,其间可见短T1短T2信号影,T2Flair序列呈高-低混杂信号,边缘光整,分界清楚,大小约52mm×36mm×52mm,临近硬膜下间隙增宽,左颞叶受压变形,左侧脑室受压变窄,中线向右侧移位.左颞部肿块呈环形强化,中央区无强化(图3～8).手术所见:左侧颞骨可见直径约8cm肿物,黄白色,豆腐渣样外观,肿物压迫硬脑膜凹陷5cm,肿物与颅骨内板粘连紧密且与硬脑膜粘连,血供丰富.病理诊断左颞骨尤文氏肉瘤.

目的 探讨颅内非典型畸胎瘤样/横纹肌样瘤(AT/RT)的影像表现,提高对该病的认识.方法 回顾性分析5例经手术病理及免疫组化确诊的AT/RT患者的临床及影像资料,2例行CT平扫,5例行MRI平扫及增强.结果 男4例,女1例,年龄9个月～1岁,肿瘤位于幕上4例,幕下1例,最大径30 ～ 100mm,平均径(56±25)mm.2例CT平扫呈稍高密度肿块,密度不均,可见囊变及出血伴小点状钙化.6例MRI平扫呈长T1长T2信号,信号不均匀,5例均可见囊变,且3例囊变区位于病灶边缘,3例瘤周水肿,增强扫描2例呈环状强化,3例呈不均匀强化.DWI肿瘤呈不均匀高信号.结论 AT/RT以幕上多见,密度(信号)不均匀,囊变、坏死常见,部分可见出血及钙化,囊变区位于肿瘤边缘具有一定特点,增强呈环状强化或不均匀强化,确诊需依靠组织病理学.

恶性横纹肌样瘤临床比较少见,好发于婴幼儿,发生于成年人者亦有报道[1],发生部位主要为中枢神经系统,其次为肾脏.肾恶性横纹肌样瘤(malignant rhabdoid tumor of the kindey, MRTK)约占儿童肾脏肿瘤的2％[2 ].我们收集了武汉儿童医院3例临床及影像资料完整的MRTK病例,并结合相关文献进行分析,旨在提高对本病的认识,现报告如下.

早发型先天性骨梅毒是由母体血液中梅毒螺旋体经胎盘进入胎儿血液循环到达骨骼,引起骨组织感染所致,常侵犯四肢长骨,可累及骨骺、骨膜及髓腔等.近年来随着我国性传播疾病发病率的上升,婴儿先天性梅毒发病率呈上升趋势.婴儿先天性梅毒能侵犯全身多个系统,其临床表现具有多样性,容易误诊和漏诊,但其四肢长骨的X线影像征象具有一定特征.

目的 探讨CT在脾脏占位性病变鉴别诊断中的价值.方法 回顾性分析27例经手术病理证实的脾脏占位性病变的CT及病理学资料,分析脾脏占位性病变的CT特征.结果 27例脾脏占位性病变,其中良性占位16例,包括脾囊肿7例,脾脓肿3例,脾血管瘤4例,脾血管淋巴管瘤1例,脾淋巴管瘤1例;恶性占位11例,包括转移瘤8例,淋巴瘤3例.结论 CT对脾脏占位性病变有较高的诊断价值,可作为首选的影像学检查方法.

患者男,34岁.间断性上腹胀痛半月余.患者于半月前无明显诱因出现上腹疼痛,为左上腹及剑突下胀痛,进食后加重,不向他处放射,伴恶心,无呕吐.心、肺、腹查体未见明显异常.肿瘤标志物阴性.超声检查:左上腹脊柱左侧见一大小约11.9cm×10.8cm×9.8cm低回声包块,边界尚清,形态规则,内部回声细密、均匀,可见膜样结构,厚0.5cm, CDFI包块内血流信号不明显.CT检查:脾脏增大,近脾门区见大小约11.5cm×10.6cm类圆形低密度影,密度尚均匀, CT值约26HU,边缘可见点片状致密影(图1a);增强后未见明显强化(图1b,1c).

BACKGROUND:Stem cell transplantation has been used in the clinical treatment of spinal cord injury.However,the efficacy and safety are still controversial.Although there are many approaches for stem cell transplantation,which one is better is unclear as yet.OBJECTIVE:To systematically evaluate the efficacy and safety of stem cell transplantation for spinal cord injury,and to compare the therapeutic difference in stem cell transplantation via different approaches.METHODS:A computer-based online search was conducted in PubMed,The Cochrane Library (Issue 4,2016),Embase,CNKI,VIP,CBM,and Wan-Fang databases up to May 13,2016 to screen the relevant randomized clinical controlled trials of stem cells in the treatment of spinal cord injury.Two reviewers independently selected the studies,extracted information,and assessed the quality of included trials.Data extracted from eligible studies was pooled and meta-analyzed using Stata13.1 and Gemtc0.14.3 software.RESULTS AND CONCLUSION:A total of 10 randomized controlled trials involving 546 patients (294 in stem cells group and 252 in rehabilitation treatment group) were included.The results of meta-analysis showed that stem cell transplantation had an advantage over rehabilitation treatment in increasing American Spinal Cord Injury Association (ASIA) motor score,ASIA sensory score,Barthel Index,and decreasing the bladder residual urine volume.The incidence of low fever,abdominal distension,headache,lower limb numbness,and meningeal irritation was 14％,7％,7％,8％,and 7％,respectively.Taking the rehabilitation treatment as a common reference,the results of the network meta-analysis showed that there were no significant differences in ASIA motor score,ASIA sensory score,Barthel Index,and incidence of complications among subarachnoid injection,intravenous injection,and intralesional injection.Compared with the rehabilitation treatment,only stem cell transplantation via subarachnoid injection had significant differences in ASIA motor score [MD=9.77,95％CI (0.26,21.46)],and ASIA sensory score [MD=25.79,95％CI (10.07,45.27)].To conclude,the stem cells transplantation via subarachnoid injection is considered the most effective transplantation method.Due to the limitations of the included studies,more high-quality randomized controlled trials are required to verify the above conclusion.In addition,future studies should focus on the long-term efficacy and safety of stem cell transplantation in the treatment of spinal cord injury,and should investigate the clinical effects on spinal cord injury with different ASIA grades,types of stem cells,and transplantation time.

目的 通过Meta分析和试验序贯分析(TSA)系统评价血管紧张素Ⅰ转换酶(ACE)基因插入/缺失(I/D)多态性与骨性关节炎(OA)患病风险之间的关联性.方法 计算机检索PubMed、EMbase、CNKI、CBM、VIP和WanFang Data数据库,搜集ACE基因I/D多态性与OA发病风险关联性的病例-对照研究或队列研究,检索时间均为建库至2016年10月12日.由2位评价者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 13.1软件进行Meta分析,运用TSA v0.9软件进行试验序贯分析(TSA).结果 纳入6个病例-对照研究,合计1 165例OA患者和1 029例健康对照.Meta分析结果显示,ACE基因I/D多态性与OA患病风险存在关联性[DD+DⅠvs.Ⅱ:OR=1.72,95％CI(1.02,2.90),P=0.04;DⅠvs.Ⅱ:OR=1.65,95％CI(1.06,2.56),P=0.03].按种族进行亚组分析,结果显示:在高加索人种中,ACE基因I/D多态性与OA患病风险存在关联性[DDvs.DⅠ+Ⅱ:OR=2.10,95％CI(1.54,2.85),P＜0.01;DD+DⅠvs.Ⅱ:OR=3.11,95％CI(2.20,4.39),P＜0.01;DDvs.Ⅱ:OR=4.01,95％CI(2.68,6.00),P＜0.01;DⅠvs.Ⅱ:OR=2.65,95％CI(1.45,4.87),P＜0.01;Dvs.Ⅰ:OR=2.11,95％CI(1.72,2.58),P＜0.01];TSA结果显示累积Z值均跨过了传统界值和TSA界值,说明ACE基因I/D多态性与高加索人种OA患病风险关联性Meta分析结果是可靠的.在亚洲人种中,ACE基因I/D多态性与OA患病风险不存在关联性[DD vs.DⅠ+Ⅱ:OR=0.80,95％CI (0.60,1.07),P=0.13;DD+DⅠvs.Ⅱ:OR=1.08,95％CI (0.87,1.35),P=0.49;DDvs.Ⅱ:OR=0.86,95％CI(0.62,1.20),P=0.38;DⅠvs.Ⅱ:OR=1.18,95％CI(0.93,1.50),P=0.19;D vs.Ⅰ:OR=0.93,95％CI (0.83,1.14),P=0.73],TSA结果显示除DD vs.DⅠ+Ⅱ遗传模型外,其余遗传模型累积Z值均未跨过TSA界值和期望信息量(RIS),提示样本量不足.结论 当前证据显示ACE D等位基因是高加索人种OA的危险因素,但ACE基因I/D多态性是否与亚洲人种OA存在关联性,尚需更多试验予以明确.

Objective: To discuss appearance of solitay plasmacytoma of spine (SPS) using Multi-slice computed tomography (MSCT) and promote the cognition of this disease. Methods: Combination with literature, one case with pathologically proved SPS and clinical data as well as the image features of MSCT was retrospective reviewed. Results: The imaging features of SPS is that residual crest bone with linear,wedge and irregular-shaped in centrum bone destruction area. This case show fractured vertebral endplate with multiple crack sample and one side accessories involved, vertebral body and accessories display expansion bone destruction, and soft tissue mass adjacent to vertebral body. MSCT can visually display imaging features of SPS lesions. Conclusion: MSCT can clear display imaging features of SPS lesions and higher diagnostic value to SPS.

患者女，24岁。体重减轻1个半月入院。查体：心肺听诊无异常，腹软，无压痛、反跳痛及腹肌紧张，肝脾肋下未及，移动性浊音（-），未触及包块。患者既往体健，无肝炎及外伤史。彩超示脾脏囊性包块。肿瘤标志物 CA19-9662.4 U／ml。入院后两次复查CA19-9结果分别为1573.4 U／ml、14547 U／ml。 CT平扫示脾脏内见大小约9.0 cm ×7．0 cm囊性肿块，边缘可见钙化，CT值约45HU，与正常脾脏分界欠清。增强扫描脾脏内病灶未见强化。术前诊断：脾脏囊性占位病变（真假性囊肿、淋巴管瘤均有可能）。术中所见：脾脏无明显增大，脾脏中间可见一大小约7cm ×8cm囊性肿块，边界清楚。腹腔镜下行脾脏完整切除术，病理结果示：原发性脾脏间皮囊肿。

1.病例资料<br>　　患者，男性，45岁。反复头痛头晕数月，加重数天入院。查体：神志清楚，双瞳孔等大，直径约3mm，对光反射存在。嘴角右偏，伸舌左偏。心肺无异常，肝脾肋下未及，生理反射存在，双侧病理征阴性。血尿常规、肝肾功能及心电图均正常。MRI平扫及增强：右侧额颞叶见大片状长T1长T2信号，边界不清。增强后上述病灶呈环形及结节状强化，囊变区及周围水肿无强化（图①、②、③）。术前诊断：胶质瘤？术后病检：间变性室管膜瘤（ WHOⅢ级），免疫组化：GFAP （＋）， S-100（＋），EMA（-）（图④）。