关节软骨磁共振成像的研究进展

关节软骨损伤是临床常见病，可以导致关节疼痛、积液和功能障碍，严重者可致残。外伤、骨性关节炎( osteoarthritis，OA )、剥脱性骨软骨炎等原因均可造成关节软骨的损伤，并且一旦损伤极难修复。在长期大量运动的人群和老年人中，关节软骨的退变、损伤几乎都不同程度的存在。早期的软骨损伤易被忽视，临床诊断也缺乏特异性。关节镜虽是关节软骨损伤诊断的“金标准”，但有创伤、视野小、有盲区、无法显示软骨下骨损伤程度等局限；常规X线、CT检查无法直观显示关节软骨。MRI凭借其多方位、多序列、多参数成像及组织分辨率高、对比度好等诸多优势，不仅能无创性地观察软骨损伤的部位、范围、程度、软骨表面的病理变化，而且能准确观察软骨内部、软骨下骨及骨髓的病变情况，被公认为目前评价软骨损伤的佳无创检查方法[1]。尤其是近年来定量磁共振成像技术的快速发展，使得关节软骨无创性检查从形态学发展到了分子生化水平，为早期关节软骨损伤的检测以及修复效果的评估提供了更多行之有效的技术手段[2]。但在临床工作中，对于关节软骨的 MRI 序列选择及优化组合、软骨损伤在不同 MRI 序列中的表现和诊断等方面尚无统一标准[3]。

We report brain imaging and genetic diagnosis in a family from Wuhan, China, with a history of Huntington’s disease. Among 17 family members across three generations, four patients (II2, II6, III5, and III9) show typical Huntington’s disease, involuntary dance-like movements. Mag-netic resonance imaging found lateral ventricular atrophy in three members (II2, II6, and III5). Moreover, genetic analysis identiifed abnormally ampliifed CAG sequence repeats (>40) in two members (III5 and III9). Among borderline cases, with clinical symptoms and brain imaging features of Huntington’s disease, two cases were identiifed (II2 and II6), but shown by mutation analysis for CAG expansions in the important transcript 15 gene, to be non-Huntington’s disease. Our ifndings suggest that clinical diagnosis of Huntington’s disease requires a combination of clinical symptoms, radiological changes, and genetic diagnosis.

[Summary] Parathyroidectomy is the first choice for primary hyperparathyroidism(1 HPTH). With the help of pre-operation imaging modalities, focused parathyroidectomy is now widely used. However, the imaging tests play no role in the diagnosis of 1 HPTH, and negative imaging results should not preclude the pursuit of a surgical cure.

计算机辅助阅片与单纯人工阅片在宫颈液基细胞学诊断中对比观察

目的 探讨计算机辅助阅片系统(ThinPrep imaging system,TIS)在宫颈液基细胞学诊断中的应用价值.方法 对10 000例宫颈液基细胞学标本运用TIS辅助阅片+人工阅片进行诊断,记录阅片时间及诊断结果,并分别与2011年同期10 000例单纯人工阅片的阅片时间及诊断结果进行比较.结果 单纯人工阅片平均时间为4.8 min/片,TIS辅助阅片后的人工阅片平均时间为2.6 min/片,阅片速度提高84.62%,二者差异有统计学意义(P＜0.001).两种阅片方法对比鳞状上皮细胞异常标本检出率显示:使用TIS后非典型鳞状上皮细胞(atypical squamous cells,ASC)以上的细胞增加9.82%,其中未明确诊断意义的非典型鳞状上皮细胞(atypical squamous cells-undetermined significance,ASC-US)增加12.01%;低级别鳞状上皮内病变(low-grade squamous intraepithelial lesion,LSIL)增加6.71%;高级别鳞状上皮内病变(high-grade squamous intraepithelial lesion,HSIL)增加22.73%,不除外高级别鳞状上皮内病变的非典型鳞状上皮细胞(atypical squamous cells-cannot exclude HSIL,ASC-H)降低27.78%,两组相比差异无显著性(P＞0.05).两种阅片方法对比细胞学与组织学的诊断符合率显示:细胞学诊断为LSIL以上的与组织学诊断为子宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)的符合率分别为90.32%和91.47%,使用TIS后诊断为LSIL的、组织学诊断为CIN1的符合率由71.59%升至74.45%,HSIL组织学诊断为CIN2以上的符合率由77.78%升至82.05%,差异无统计学意义(P＞0.05).结论 TIS能显著提高阅片速度,降低诊断医师的劳动强度,提高工作效率,并具有与单纯人工阅片相似的病变检出率,是一种具有较高应用价值的子宫颈癌筛查技术手段.TIS对HSIL的高敏感性,有待探讨.