Balance-FFE序列在胆管磁共振检查中的应用

目的:探讨磁共振平衡式稳态自由进动梯度回波序列(Balance-FFE)在胆管疾病中的应用价值.方法:92例胆管病变患者均进行了冠状面的Balance-FFE序列扫描和磁共振胰胆管造影(MRCP).将Balance-FFE的图像和3D MRCP像及MRCP原始图像对病变的显示率进行x2检验.结果:胆管系统在Balance-FFE序列中呈明显高信号,并能直接显示胆管结石和胆管狭窄,还能显示胆管外病变和胰腺病变,对周围淋巴结的显示也比较清楚.经x2检验,Balance-FFE序列和MRCP原始像对胆管系统病变的显示没有统计学意义(P0.05),而3DMRCP像对病变的显示能力不如Balance-FFE序列和MRCP原始像,对胆道病变的显示能力具有统计学意义(P<0.05).结论:Balance-FFE序列对胆道病变能清晰显示,成像速度快,图像信噪比高,伪影较少,与MRCP结合能提高对胆管系统病变的诊断率,因此Balance-FFE序列应作为胆管疾病磁共振扫描的常规序列,可作为MRCP序列的有效补充.     

MR水激励序列显示膝关节软骨的临床应用研究

目的：探讨三维快速梯度回波水激励膝关节软骨成像序列（3D-FFE-WATS）相对于三维快速梯度回波预饱和反转恢复法脂肪抑制序列（3D-FFE-SPIR）在显示膝关节软骨方面的优势,选择显示膝关节软骨的最佳序列。方法：应用3D-FFE-WATS及3D-FFE-SPIR序列组合对20名志愿者及30例疑诊关节软骨损伤的单膝关节进行检查,获得膝关节各软骨的3D图像,并利用3D最大密度投影法（MIP）进行横断面和冠状面3D重建。分析上述2种序列对软骨病变的显示及检出能力,计算其对关节软骨的信噪比（SNR）和对比噪声比（CNR）,并进行统计学分析。结果：两序列在显示膝关节软骨SNR方面,无统计学意义（P〉0.05）;两种序列在显示软骨与关节液的CNR、软骨与骨皮质的CNR、软骨与骨髓的CNR、软骨与肌肉的CNR差异方面t值分别为（-30.619;2.348;-2.408;2.216）,有统计学意义（P〈0.05）。结论：3D-FFE-WATS序列可作为膝关节软骨成像的首选序列。     

金丝猴属(RHINOPITHECUS)脊神经丛的组成

在灵长类中,脊神经丛通常分为颈丛、臂丛和腰骶丛,均出脊神经的腹侧支组成。各神经丛的组成似随种类不同而存在明显的差异,它直接反映了肌肉的起源和演化进程。灵长类在演化过程中,经历了树栖、地栖和直立生活三个阶梯。由于运动方式不同,肌肉也发生了相应的变化。树栖攀缘生活促使了上肢肌特别是肩带肌的飞跃发展,而支配这些肌肉的一些神经也发展成为单独的神经。随着手肌的分化逐步完善,支配手肌的一些神经最后发展成单独的,而且是臂丛中最粗的神经。所以,深入研究猿猴类各神经丛演化的全貌,对于探索灵长类的进化,尤其是猿类如何实现手足分工和手的解放,最后演化为人类这一理论将提供具体资料。     

三种叶猴脊神经丛的比较研究

本文首次报道3种叶猴脊神经丛的组成,并与其他灵长类作了比较研究。结果表明:颈丛由C_(1-4)组成,多数标本不存在枕小神经和多数标本存在舌下袢;臂丛由C_4—T_2组成,形成典型的三干三索结构,后索形成两个神经袢;腰骶丛由L_(2-7)和S_(1-2)组成,存在屈股神经和耻坐股神经,与猴超科共同特征相一致。     

Balance—FFE序列在胆管磁共振检查中的应用

目的：探讨磁共振平衡式稳态自由进动梯度回波序列（Balance—FFE）在胆管疾病中的应用价值。方法：92例胆管病变患者均进行了冠状面的Balance—FFE序列扫描和磁共振胰胆管造影（MRCP）。将Balance-FFE的图像和3DMRCP像及MRCP原始图像对病变的显示率进行X。检验。结果：胆管系统在Balance—FFE序列中呈明显高信号,并能直接显示胆管结石和胆管狭窄,还能显示胆管外病变和胰腺病变,对周围淋巴结的显示也比较清楚。经x^2检验,Balance—FFE序列和MRCP原始像对胆管系统病变的显示没有统计学意义（P〉0．05）,而3DMRCP像对病变的显示能力不如Balance．FFE序列和MRCP原始像,对胆道病变的显示能力具有统计学意义（P〈0．05）。结论：Balance-FFE序列对胆道病变能清晰显示,成像速度快,图像信噪比高,伪影较少,与MRCP结合能提高对胆管系统病变的诊断率,因此Balance-FFE序列应作为胆管疾病磁共振扫描的常规序列,可作为MRCP序列的有效补充。     

膝关节挫伤的磁共振影像表现

目的 :探讨磁共振短时的反转恢复序列 (STIR)在膝关节骨挫伤中的临床应用。方法 :通过 32例膝关节外伤病例在常规SE序列、FSE序列和STIR序列中的影像表现 ,分析STIR序列的优越性。结果 :32例共 45个骨挫伤病灶 ,T1W发现 38个 (占 84% ) ,T2W发现 37个 (占 82 % ) ,STIR序列病灶全部显示( 1 0 0 % )。结论 :STIR序列对骨挫伤的敏感性较高 ,能显示微小的骨髓水肿 ,充血及骨小梁的微骨折及其周围的骨软骨、关节囊的细微变化 ,对膝关节外伤具有较高价值。     

膝关节挫伤的磁共振影像表现

目的：探讨磁共振短时的反转恢复序列(STIR)在膝关节骨挫伤中的临床应用。方法：通过32例膝关节外伤病例在常规SE序列、FSE序列和STIR序列中的影像表现,分析STIR序列的优越性。结果：32例共45个骨挫伤病灶,T1W发现38个(占84％),T2W发现37个(占82％),STIR序列病灶全部显示(100％)。结论：STIR序列对骨挫伤的敏感性较高,能显示微小的骨髓水肿,充血及骨小梁的微骨折及其周围的骨软骨、关节囊的细微变化,对膝关节外伤具有较高价值。     

扩散加权成像在宫颈癌诊断中的应用及与病理相关性分析

目的:分析宫颈癌扩散加权成像特征及与病理相关性。方法:选取100例宫颈癌患者为观察组,100例健康志愿者为对照组,均接受磁共振检查。观察组患者均行病理学检查,并测定微血管密度。观察宫颈癌磁共振特征,并分析其与病理相关性。结果:1.磁共振共确诊宫颈癌97例,诊断符合率为97.0%。与病理分期比较,磁共振分期正确84例,正确率为84%。2.观察组宫颈癌病变区ADC值平均为(0.893±0.098)s/mm2,显著低于对照组的(1.623±0.132)s/mm2,差异具有统计学意义(P0.05)。病理分期Ⅲ、Ⅳ其病变ADC值及MVD值显著低于Ⅰ、Ⅱ期病变,差异具有统计学意义(P0.05)。经pearson相关分析,宫颈癌ADC值与MVD值间呈显著负相关(r=-0.502,P=0.011)。结论:在宫颈癌的诊断中,磁共振具有很高应用价值。宫颈癌病变于扩散加权成像呈高信号,其ADC值显著低于正常宫颈组织,且与MVD呈显著负相关。     

超声联合神经刺激仪定位腰丛－－骶丛神经阻滞对高龄股骨头置换术患者血流动力学、心理状态及认知功能的影响

摘要 目的：探讨超声联合神经刺激仪定位腰丛－－骶丛神经阻滞对高龄股骨头置换术患者血流动力学、心理状态及认知功能的影响。方法：选取2017年4月~2020年3月期间我院收治的行股骨头置换术的高龄患者98例,采用随机数字表法分为对照组和研究组,各49例,对照组给予神经刺激仪定位腰丛－－骶丛神经阻滞,研究组在此基础上联合超声引导,比较两组血流动力学、心理状态、认知功能、临床指标及不良反应。结果：两组T1~T4时间点收缩压（SBP）、心率（HR）、舒张压（DBP）组间及组内比较均未见明显差异（P>0.05）。研究组阻滞起效时间、阻滞持续时间、术后镇痛持续时间长于对照组,阻滞完成时间、术后下床活动时间短于对照组（P<0.05）。两组术后1 d回忆能力、瞬时记忆力、注意力和计算力、定向力、语言能力评分均下降,但研究组高于对照组（P<0.05）,研究组的术后认知功能障碍（POCD）发生率低于对照组（P<0.05）。两组术后1 d焦虑自评量表（SAS）和抑郁自评量表（SDS）评分均下降,且研究组低于对照组（P<0.05）。两组不良反应发生率比较无差异（P>0.05）。结论：超声联合神经刺激仪定位腰丛－骶丛神经阻滞对高龄股骨头置换术患者阻滞效果确切,对其血流动力学影响轻微,可减轻其认知功能损害,改善其负性情绪。     

MR扩散加权成像和CT及MR灌注成像对不同程度肝硬化患者的诊断价值

目的:研究MR扩散加权成像(DWI)和CT及MR灌注成像对不同程度肝硬化患者的诊断价值。方法:选择从2015年8月到2017年2月在我院治疗的肝硬化患者60例作为研究对象,根据Child-Pugh分级进行分组,其中A级32例为轻度肝硬化(记为A组),B级16例、C级12例为中重度肝硬化(记为B组),另选同期在我院进行体检的健康志愿者30例记为C组,对三组受试者分别进行DWI检查、CT及MR灌注成像,对比各组ADC值、肝脏动门脉灌注比率[SSr(ct)及SSr(mr)],采用Spearman相关性分析各指标之间的相关性。结果:三组ADC值整体比较无统计学差异(P0.05),A、B两组的ADC值较C组降低,但差异无统计学意义(P0.05)。A、B两组的ADC值比较无统计学差异(P0.05)。三组SSr(ct)、SSr(mr)整体比较,差异有统计学意义(P0.05),B组的SSr(ct)及SSr(mr)较A、C两组明显升高,差异均有统计学意义(均P0.05)。A、C两组的SSr(ct)及SSr(mr)比较无统计学差异(P0.05)。Spearman相关性分析显示,不同程度肝硬化患者的SSr(ct)与SSr(mr)呈正相关(r=0.687,P=0.000)。结论:CT以及MR灌注成像均可较好地反映出肝硬化的病变程度,且二者较DWI成像的诊断效果更佳,值得临床推广。     

In lumbosacral plexus injuries can we identify indicators that predict spontaneous recovery or the need for surgical treatment? Results from a clinical study on 72 patients

Background

Post-traumatic lumbosacral plexus injuries seem to be rare events, spontaneously recovering in high percentage: as surgery is often challenging and results in poor outcome, many Authors have advocated conservative treatment only. Nevertheless surgery should not be ruled out: in invalidating injuries, it can restore basic function in the lower extremities. Therefore, it might be necessary to establish guidelines for the management and the indication to surgery in such cases. This study aims to identify indicators predicting spontaneous recovery or the need for surgery.

Method

The clinical and radiological data of 72 patients with a post-traumatic lumbosacral plexus injury were reviewed. A follow up equal or superior to 3 years is available in 42 cases.

Results

Lumbosacral plexus injuries mostly occurred during road accidents. The incidence of associated lesions was relevant: bone injuries were found in 85% of patients, internal lesions in 30% and vascular injuries in 8%. Lumbosacral trunk and sacral plexus palsies were the most frequent injury patterns. Root avulsions were revealed in 23% of cases and only in sacral plexus and complete lumbosacral plexus injuries: L5 and S1 were the roots more prone to avulsions. About 70% of cases recovered spontaneously, mostly in 18 months. Spontaneous recovery was the rule in lumbar plexus and lumbosacral trunk injuries (where root avulsions never occurred) or in sacral and complete lumbosacral plexus palsies due to compression injuries. The causative mechanism correlated with the injury pattern, the associated bone injury being often predictive of the severity of the nerve injury. Lumbosacral plexus injuries occurred in car crashes were generally associated with fractures causing compression on the nerves, thus resulting in injuries often amenable of spontaneous recovery. Motorcycle accidents implied high kinetic energy traumas where traction played an important role, as the high percentage of sacroiliac joint separations demonstrated (found in more than 50% of cases and always associated to root avulsions). Loss of sphincteral control and excruciating leg pain were also invariably associated with avulsions.

Conclusions

Clinical and radiological data can help to predict the occurrence of spontaneous recovery or the need for surgery in post-traumatic lumbosacral plexus injuries.     

树鼩(Tupaia belangeri chinensis)的脊神经丛

由于树鼩在系统发育方面所具的特殊性,以及当今实验动物的小型化趋向,树鼩正在被开发成为新型的实验动物,其生物学特性的研究随之蓬勃开展,如对染色体(陈宜峰等,1981)、神经生理(刘世熠等,1982)、血象(邹如金等,1983)、骨髓象(张耀平等,1986)、血液生化(彭燕章等,1986;陈保生等,1983)、皮纹(Haines,1955;张耀平等,1984)、解剖(Le Gros Clark,1924、1926;George,1977)、     

Nerves and nerve plexuses of the human vertebral column

The origin, distribution, and termination pattern of nerves supplying the vertebral column and its associated structures have been studied in the human fetus by means of an acetylcholinesterase whole-mount method. The vertebral column is surrounded by ventral and dorsal nerve plexuses which are interconnected. The ventral nerve plexus consists of the nerve plexus associated with the anterior longitudinal ligament. This longitudinally oriented nerve plexus has a bilateral supply from many small branches of the sympathetic trunk, rami communicantes, and perivascular nerve plexuses of segmental arteries. In the thoracic region, the ventral nerve plexus also is connected to the nerve plexuses of costovertebral joints. The dorsal nerve plexus is made up of the nerve plexus associated with the posterior longitudinal ligament. This nerve plexus is more irregular and receives contributions only from the sinu-vertebral nerves. The sinu-vertebral nerves originate from the rami communicantes and, in the cervical region, also from the nerve plexus of the vertebral artery. Thick and thin sinu-vertebral nerves are found. Most frequently three types of thick sinu-vertebral nerves are observed, i.e., ascending, descending, or dichotomizing ones. Finally, the distribution of the branches of the ventral and dorsal nerve plexuses and of the sinu-vertebral nerves is described.     

三通道电刺激仪的研制及对臂丛神经损伤的临床疗效

目的:研制可用于臂丛神经损伤治疗的三通道电刺激仪,并且将之应用于临床臂丛神经损伤患者,观察该仪器治疗臂丛神经损伤的临床效果。方法:由主控模块、显示模块、键盘模块、三个通道的电刺激发生器模块以及电源模块组成系统,可以连续交替释放脉冲刺激,针对不同神经和肌肉,选择不同的刺激位点。将60例臂丛神经损伤术后的患者随机分成试验组(30例)和对照组(30例),试验组术后第三周使用三通道电刺激仪治疗,对照组不做处理,患者术后随访6-12月后,观察患者上肢肩部、肘部功能恢复情况。结果:试验组治疗后上臂丛、全臂丛、下臂丛的肩部、肘部功能均好于治疗前,差异明显,均有统计学意义(P0.05);试验组上臂丛、全臂丛、下臂丛的肩部、肘部治疗效果均显著优于对照组,差异有统计学意义(P0.05)。结论:三通道电刺激仪可以有效地促进臂丛神经损伤后上肢功能的康复,可以对三组神经和肌肉交替进行电刺激,使用方便,并且便于携带,患者较为满意。     

The location and distribution of neural crest-derived Schwann cells in developing peripheral nerves in the chick forelimb.

The location and distribution of neural crest-derived Schwann cells during development of the peripheral nerves of chick forelimbs were examined using chick-quail chimeras. Neural crest cells were labeled by transplantation of the dorsal part of the neural tube from a quail donor to a chick host at levels of the neural tube destined to give rise to brachial innervation. The ventral roots, spinal nerves, and peripheral nerves innervating the chick forelimb were examined for the presence of quail-derived neural crest cells at several stages of embryonic development. These quail cells are likely to be Schwann cells or their precursors. Quail-derived Schwann cells were present in ventral roots and spinal nerves, and were distributed along previously described neural crest migratory pathways or along the peripheral nerve fibers at all stages of development examined. During early stages of wing innervation, quail-derived Schwann cells were not evenly distributed, but were concentrated in the ventral root and at the brachial plexus. The density of neural crest-derived Schwann cells decreased distal to the plexus, and no Schwann cells were ever seen in advance of the growing nerve front. When the characteristic peripheral nerve branching pattern was first formed, Schwann cells were clustered where muscle nerves diverged from common nerve trunks. In still older embryos, neural crest-derived Schwann cells were evenly distributed along the length of the peripheral nerves from the ventral root to the distal nerve terminations within the musculature of the forelimb. These observations indicate that Schwann cells accompany axons into the developing limb, but they do not appear to lead or direct axons to their targets. The transient clustering of neural crest-derived Schwann cells in the ventral root and at places where axon trajectories diverge from one another may reflect a response to some environmental feature within these regions.     

Inhibition by Forskolin of Excitatory Amino Acid-Induced Accumulation of Cyclic AMP in Guinea Pig Hippocampal Slices

Left sciatic nerves of adult male Sprague-Dawley rats were crushed and allowed to recover for 0, 1, 2, 4, 7, or 14 days. At each of these times both L-5 dorsal root ganglia were injected with 100 microCi of [3H]glucosamine. Two days later, dorsal root ganglia, lumbosacral trunks, and sciatic nerves were removed bilaterally. The amounts of radiolabelled ganglioside in crushed lumbosacral trunks were consistently higher than in the controls, with the largest difference occurring within 2 days from simultaneous crush and injection to killing (specimens labelled day 0). The largest difference in the amount of radiolabelled ganglioside between crushed and control sciatic nerve (4-9 days from crush to killing) occurred later than that of lumbosacral trunk, but no significant difference occurred within the first 3 days following crush. There was only a slightly higher radioactivity in gangliosides totalled from all three anatomical specimens of crushed than in control nerves. The neutral nonganglioside lipid and acid-precipitable fraction followed patterns of synthesis and accumulation similar to those of the gangliosides. These findings indicate that after nerve crush gangliosides, glucosamine-labelled neutral nonganglioside lipids, and glycoproteins accumulate close to the proximal end of the regenerating axon. This accumulation could serve as a reservoir to increase the ganglioside concentration in the growth cone membrane.     

Accidental finding of an anomalous spinal nerve root during lumbar-disc surgery: a case report and a review of literature

Anomalies of lumbosacral nerve roots, even though are rare, have been well documented so far in the medical literature. The early diagnosis of these anomalies may be difficult and it is crucial to develop specific methods for depicting them. Preoperative diagnosis of anomalous lumbosacral spinal nerve roots using the magnetic resonance imaging is essential to facilitate thorough surgical planning in order to avoid unnecessary complications for the patient during surgery. The operative management of these anomalies depends on the patient's neurological problems and while asymptomatic and accidentally diagnosed cases do not require treatment, patients who suffer low back or sciatic pain need surgical intervention in order to decompress nerve roots. We report a 45-years old woman presented with severe low back pain associated with left lumboischialgia. Intraoperative finding of an aberrant L5/S1 nerve root, optimal surgical therapy and different classifications are discussed together with a review of literature.     

Anatomy of the spinal accessory nerve plexus: relevance to head and neck cancer and atherosclerosis

The term spinal accessory nerve plexus may be defined as the spinal accessory nerve with all its intra- and extracranial connections to other nerves, principally cranial, cervical, and sympathetic. The term is not new. This review examines its applied anatomy in head and neck cancer and atherosclerosis. Over the centuries, general studies of neural and vascular anatomy and embryology formed a basis for the understanding upon which the plexus is described. During the past century, its anatomy and blood supply have come to be better understood. The importance of almost all of the plexus to head, neck, and upper extremity motor and sensory functions has come to be realized. Because of this understanding, surgical neck dissection has become progressively more conservative. This historical progression is traced. Even the most recent anatomic studies of the spinal accessory nerve plexus reveal configurations, new to many of us. They were probably known to classical anatomists, and not recorded in readily available literature, or not recorded at all. Human and comparative anatomic studies indicate that the composition of this plexus and its blood supply vary widely, even though within the same species their overall function is very nearly the same. Loss of any of these structures, then, may have very different consequences in different individuals. As a corollary to this statement, data are presented that the spinal accessory nerve itself need not be cut during surgical neck dissections for severe impairment to occur. In addition, data are presented supporting the theory that atherosclerosis by obstructing vessels to this plexus and its closely connected brachial plexus will very likely result in their ischemic dysfunction, often painful. Finally evidence, as well as theory, is stated concerning anatomic issues, methodology, outcome, and possible improvements in surgical procedures emphasizing conservatism.     

Quantitative analysis of the density and pattern of adrenergic innervation of blood vessels

Summary Automated quantitative image analysis (QIAF) was used to measure and compare the adrenergic nerve plexuses of 4 blood vessels from the guinea pig, demonstrated by glyoxylic acid fluorescence (GAF). The results showed considerable quantitative variation of plexus density, size of bundles, and numbers of varicosities. A range of alternative procedural and anatomical sources of variability were investigated and assessed. The carotid artery was found to have a dense plexus with more nerves than that of the mesenteric artery; the mesenteric vein and abdominal aorta had sparse plexuses. The carotid artery plexus, despite the density of its nerves, possessed only half the number of varicosities of the mesenteric artery plexus. This sparse varicosity population was shown to have a similar density to the varicosities demonstrated by QIAF in the scattered nerves of the mesenteric vein and abdominal aorta. QIAF confirmed visual estimates of adrenergic plexus density, and was able to demonstrate less obvious differences of nerve density and size, and varicosity populations, between the different plexuses studied. The method is applicable to stretch preparations and transverse sections of many adrenergically innervated tissues.