磁共振检查在幼年特发性关节炎早期诊断中的应用价值

目的:探讨磁共振在幼年特发性关节炎早期诊断中的应用价值。方法:回顾性分析我院49例经临床确诊为幼年特发性关节炎且X线平片无异常患儿早期膝关节、髋关节和骶髂关节的磁共振影像,观察受累关节早期改变。结果:49例膝关节中有47例发现有影像异常,31例髋关节中有17例有影像异常,31例骶髂关节中有13例有影像异常。受累关节以炎性改变为主,包括滑膜增生、关节积液和骨髓水肿等。结论:磁共振扫描可以清晰呈现JIA初期X线平片不易显示的关节滑膜增生、积液和骨髓水肿等早期改变,对其临床早期确诊和治疗具有重要参考价值。     

成人髋臼发育不良继发骨关节炎的影像学分析

目的 :分析成人髋臼发育不良(Acetabular dysplasia,AD)继发骨关节炎的影像学特点。方法 :分析217例AD患者影像资料,比较继发与未继发组患者影像学参数,并探讨X线片、CT、MRI的诊断价值。结果:217例患者中,共确诊继发骨关节炎者59例,占27.19%。继发关节炎组平均年龄为(51.43±6.98)岁,大于未继发组的(39.62±7.15)岁,差异有统计学意义。继发关节炎组CE角、髋顶切线角、髋臼指数、股骨头覆盖率、髋关节上间隙小于未继发组,其Sharp角、髋关节内侧间隙大于后者,差异有统计学意义。X线对继发性骨关节炎的检出率为50.84%,低于CT的69.49%,亦低于MRI的100.00%,差异有统计学意义。CT轴位图像可检出X线无法检出的髋关节脱位;MRI可检出CT图像无法显示的软骨下小囊变与关节软骨退变。结论:X线平片可为成人AD继发骨关节炎的诊断提供一定依据但检出率较低,在此基础上结合CT、MRI图像能够进一步明确髋关节脱位情况、发现软骨下小囊变,从而提高诊断准确率。     

基于ASiR平台的动态500排技术对颞下颌关节紊乱病诊断价值

目的:探讨具有自适应统计迭代重建平台的动态500排扫描技术对颞下颌关节紊乱病诊断价值。方法 :随机选择临床拟诊的颞下颌关节紊乱病患者23例,采用GE Healthcare Optima CT660扫描仪,VHS扫描模式,扫描结束后对7~10个穿梭序列图像进行薄层0.625mm,90%~100%ASi R重建,随后将其图像传至GE AW4.6工作站,进行薄层冠状位、矢状位及横轴位连续动态观察,并行多平面重组、最大密度投影、容积再现重组及4D动态显示。结果 :23例患者均成功建立了颞下颌关节的静态三维影像及动态4D运动影像。其3D静态影像学表现有髁突表面骨皮质模糊15例;髁突表面局限性硬化8例;关节面下小囊性密度影5例;骨皮质局部缺损4例;前斜面磨损1例。一般是几种征象常同时伴发,骨质未见异常2例。其4D运动影像征象有:3例患者张口不同程度受限,运动轨迹未见异常改变,运动幅度减小;6例患者张口时髁突短暂性向一侧异常滑行、偏斜;14例患者张口时髁突明显移向关节结节前方,关节间隙不对等,其中4例闭口时髁突不能完全回位,位于关节结节后下方。结论 :基于ASIR平台的动态500排技术不仅能够再现颞下颌关节各骨性结构形态,而且可以建立颞下颌关节运动轨迹,对于TMD诊断提供了更为有效方法。     

在子宫内膜增厚妇女细胞学筛查和超声检查中应用子宫内膜取样器的研究

目的:探究负压子宫内膜取样器获取细胞学超声检查在子宫内膜增厚妇女子宫内膜癌早期筛查中的应用价值。方法:采集43例查体患者超声检查≥5mm符合子宫内膜取材适应症的患者,取得负压子宫内膜取样器(细胞病理)标本,再进行诊断性刮宫(D&G,分段诊刮)取材,对比两种诊断结果,包括标本取材满意度及两者的灵敏度、特异度、阳性预测值、阴性预测值、符合率。结果:本实验以分段诊刮为金标准,两者取材标本取材在满意度方面无统计学差异(P≥0.05),灵敏度为80.00%、特异度为90.63%、阳性预测值和阴性预测值分别为72.73%、93.55%,符合率为88.10%。结论:负压子宫内膜取样器在在子宫内膜增厚妇女中,细胞学筛查和超声检查具有良好的病理诊断价值。     

MRI诊断中枢神经系统脱髓鞘性假瘤的价值分析

目的探讨磁共振成像技术(Magnetic Resonance Imaging,MRI)对中枢性神经系统脱髓鞘性假瘤(Demyelinating Pseudo Tumor Lesion,DPT)的诊断价值.方法选取本院2019年1月—2022年1月接诊的疑似DPT患者120例,收集其治疗前后MRI(平扫+增强)影像资料,以病理结果为标准,分析MRI检查的诊断效能,并总结DPT的影像特点.结果120例患者MRI共检出162个病灶,其中单发患者101例,多发患者19例.治疗前MRI检测出145个DPT病灶;MRI平扫显示脑部局部肿块,112个病灶长度均一的长.T1长T2,47个病灶呈不均匀长T1长T2,3个呈等长T1长T2,122个病灶增强扫描显示不同程度的强化,可呈条状、火焰状、环状、非闭合环形强化等,40个病灶未见明显强化.MRI诊断DPI的敏感性为97.30%,特异性为77.78%,准确率为95.83%,阳性预测值为98.18%,阴性预测值为70.00%.结论DPT的增强MRI扫描图像具有一定的特点,如非闭合环形增强和垂直于侧脑室的线性增强,有利于DPT和颅内肿瘤的鉴别.MRI检查,尤其是增强扫描,具有较高的临床价值,可用于DPT的术前诊断和术后复查.     

64层CT三维重建对肾癌分期及后腹腔镜肾癌手术的应用价值

目的 :探讨分析64层CT三维重建对确定肾癌分期、了解肾脏血管变异情况价值,为肾癌术前诊断和后腹腔镜手术治疗提供参考依据和指导。方法 :选取2012年2月到2014年2月我院收治的70例肾癌患者为研究对象,均行Somatom Sensation40/64螺旋CT检查,参考Robson分期方法对64-SCT扫描结果肾癌患者进行分期,与手术病理结果进行比较。统计分析肾脏血管变异情况。结果:CT分期结果总准确率为95.71%(67/70),其中Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期准确率分别为92.00%、94.12%、95.65%、100.00%;CT分期Ⅲa期、Ⅲb期、Ⅲc期准确率分别为100.00%、100.00%、50.00%;对肾癌患者静脉栓诊断准确率为100.00%,对淋巴结转移诊断准确率仅为66.67%,对临近器官或远处转移诊断符合率为100.00%。70例患者35只肾脏发生动脉血管解剖异常。结论 :64-SCT多期扫描及三维重建可以对肾癌患者进行准确术前分期,为术前手术方案选择提供准确信息;同时可清楚显示肾脏肿块血供情况,及肿块与周围器官、血管、收集系统关系,为实施后腹腔镜手术提供丰富信息。     

MRI多技术扫描在缺血性心肌病变患者中运用

目的 :探讨核磁共振成像(MRI)多技术扫描在心肌病患者中应用价值。方法 :选取我院收治资料完整的14例缺血性心肌病患者为研究对象,所有患者均经心电图和心脏超声检查并得到临床确诊。均行MRI平扫、MRI电影成像、MRMPI、延迟增强扫描。观察MRI扫描结果,分析图像并评价其诊断价值。结果 :共分析心肌节段230段,其中室壁异常70段(30.43%),56段MRMPI信号降低,24段MRMPI信号正常。其中延迟强化64段(91.43%),所有运动异常节段中室壁增厚率均降低。结论 :MRI多技术扫描能够准确评价心肌病变,鉴别存活与坏死心肌,有效评价心肌活力。     

尘肺病并发肺结核的CT表现特征分析

目的 探讨尘肺病并发肺结核的CT表现特征,以期提高其诊断水平。方法 回顾性收集广州市胸科医院2022年1—12月诊治的尘肺病患者92例,其中并发肺结核患者46例为研究组,未并发肺结核患者46例为对照组。通过对两组患者的CT征象对比研究,分析尘肺病并发肺结核的CT表现特征。结果 研究组空洞、实变、树芽征、蜂窝状影、斑片影及胸膜增厚、积液的检出率分别是36例(78.26%)、18例(39.13%)、29例(63.04%)、7例(15.22%)、18例(39.13%)、17例(36.96%),高于对照组[分别是4例(8.70%)、2例(4.35%)、6例(13.04%)、0例(0.00%)、4例(8.70%)、6例(13.04%)],差异均有统计学意义(P均<0.05)。结论 相比单纯尘肺病,尘肺病并发肺结核CT上更易检出空洞、实变、树芽征、蜂窝状影、斑片影及胸膜增厚、积液。     

MSCTU及MRU对梗阻性尿路疾病的诊断价值

目的 :比较多层螺旋CT尿路成像(MSCTU)、磁共振尿路成像(MRU)在梗阻性尿路疾病临床诊断中的应用价值。方法 :选取我院2013年8月~2014年12月28例确诊为梗阻性尿路疾病患者为研究对象,对比MSCTU与MRU诊断结果准确性。结果 :MSCTU检查诊断为输尿管结石、输尿管癌、肾输尿管结核、肾输尿管畸形、输尿管良性狭窄等梗阻性病变的检出率均为100%,准确率高于MRU检查结果(P<0.05)。结论 :对于梗阻性尿路疾病MSCTU有较高空间分辨率,可准确判断结石直径、形态,准确率优于MRU。     

三维超声成像在乳腺肿块诊断中应用价值

目的探讨三维超声成像技术对乳腺肿块的诊断价值。方法以我院2010年1月~2012年6月收治的60例女性患者为研究对象,所有患者均行二维、三维超声检查,对比2种检查方式的诊断准确率及检出率。结果超声诊断结果与手术及穿刺病理结果进行对照,60例患者共71个肿块。二维超声对59个乳腺肿块诊断正确,诊断准确率为83.1%(59/71),三维超声对68个乳腺肿块诊断正确,诊断准确率为95.8%(68/71),三维超声诊断准确率率高于二维超声,差异有统计学意义(P<0.05)。二维超声血流检出率63.41%(26/41),三维超声血流检出率97.56%(40/41),三维超声血流检出率高于二维超声血流检出率,差异有统计学意义(P<0.05)。结论三维超声诊断乳腺肿块准确率和血流检出率高于二维超声,使用三维超声可提高乳腺肿块鉴别诊断水平。     

Biomechanical analysis of rheumatoid arthritis of the wrist joint

The wrist is the most complex joint for virtual three-dimensional simulations, and the complexity is even more pronounced when dealing with skeletal disorders of the joint such, as rheumatoid arthritis (RA). In order to analyse the biomechanical difference between healthy and diseased joints, three-dimensional models of these two wrist conditions were developed from computed tomography images. These images consist of eight carpal bones, five metacarpal bones, the distal radius and ulna. The cartilages were developed based on the shape of the available articulations and ligaments were simulated via mechanical links. The RA model was developed accurately by simulating all ten common criteria of the disease related to the wrist. Results from the finite element (FE) analyses showed that the RA model produced three times higher contact pressure at the articulations compared to the healthy model. Normal physiological load transfer also changed from predominantly through the radial side to an increased load transfer approximately 5% towards the ulnar. Based on an extensive literature search, this is the first ever reported work that simulates the pathological conditions of the rheumatoid arthritis of the wrist joint.     

Exploring possible connections between tribology and osteoarthritis

This paper is part of a continuing study aimed at exploring possible connections between tribology and mechanisms of synovial joint lubrication and degeneration. In a separate paper, the focus was on the tribological behaviour of natural and ‘normal’ synovial joints. The central thrust or purpose of the present paper is to stimulate discussion of ‘abnormal’ joint behaviour, in particular, degenerative joint disease or osteoarthritis, from the point of view of a tribologist, and in the light of our findings on cartilage wear. Some provocative questions are raised. For example, can a lack of ‘proper’ synovial joint lubrication or a specific biochemical ‘anti-wear’ agent lead to degeneration of the joint or more rapid removal of articular cartilage? Does osteoarthritic articular cartilage have poorer resistance to wear than ‘normal’ cartilage? It is not argued that arthritis is a tribological problem. However, it would seem that tribological connections with degenerative joint disease — and possibly other forms of arthritis — are indeed possible, but complex.     

Application of ferrography to the study of wear and arthritis in human joints

Modifications in the ferrographic technique now permit its application to the analysis of synovial fluids. Studies of synovial fluid aspirated from artificial joint replacements have confirmed the usefulness of ferrography in the analysis of wear in prosthetic devices in situ. With natural joints, ferrography appears to be a highly sensitive monitor of the erosion of intraarticular surfaces. In addition, it holds promise as a diagnostic tool, with the potential to shed new light on the pathophysiology of various forms of arthritis.     

A new design concept for wrist arthroplasty

The wrist joint is frequently affected by arthritis, which leads to pain, loss of function and ultimately deformity. Various designs of wrist arthroplasty have been introduced to attempt to relieve pain and provide a functional range of motion. The first generation of wrist implant was a one-piece silicone elastomer. Later generations have designs that have two parts that articulate against each other. However, wrist implants have not achieved the same clinical success to date, compared with hip and knee implants, and there is a high revision rate associated with them. This paper describes a new design concept for wrist arthroplasty, based around the idea of combining the principles of an articulating implant with that of a flexible elastomer implant. The design consists of assembling a radial, carpal/metacarpal, plate and flexible parts together. The radial and carpal/metacarpal parts are to be made from ultra high molecular weight polyethylene. The bearing surfaces of the radial and carpal/metacarpal parts articulate against the flat surfaces of the plate, made from cobalt chrome molybdenum alloy. The radius on the bearing surface of the radial part enables flexion/extension, while the radius on the carpal/metacarpal surface enables radial/ulnar deviation. The articulation of the carpal/metacarpal part against the plate also allows for rotation as well as flexion/extension. The flexible part, made from Elast-Eon, which is a silicone polyurethane elastomer, is inserted through the hole of the plate and into the holes of the radial and carpal/metacarpal parts.     

Comparative study by computed radiography,histology, and scanning electron microscopy of the articular cartilage of normal goats and in chronic infection with caprine arthritis‐encephalitis virus

In the northeast of Brazil, caprine arthritis‐encephalitis (CAE) is one of the key reasons for herd productivity decreasing that result in considerable economic losses. A comparative study was carried out using computed radiography (CR), histological analysis (HA), and scanning electronic microscopy (SEM) of the joints of CAE infected and normal goats. Humerus head surface of positive animals presented reduced joint space, increased bone density, and signs of degenerative joint disease (DJD). The carpal joint presented no morphological alterations in CR in any of the animals studied. Tarsus joint was the most affected, characterized by severe DJD, absence of joint space, increased periarticular soft tissue density, edema, and bone sclerosis. Histological analysis showed chronic tissue lesions, complete loss of the surface zone, absence of proteoglycans in the transition and radial zones and destruction of the cartilage surface in the CAE positive animals. Analysis by SEM showed ulcerated lesions with irregular and folded patterns on the joint surface that distinguished the limits between areas of normal and affected cartilage. The morphological study of the joints of normal and CAE positive goats deepened understanding of the alteration in the tissue bioarchitecture of the most affected joints. The SEM finding sustained previous histological reports, similar to those found for rheumatoid arthritis, suggesting that the goat infected with CAE can be considered as a potential model for research in this area. Microsc. Res. Tech. 77:11–16, 2014. © 2013 Wiley Periodicals, Inc.     

Ferrography: Its application to the study of human joint wear

Synovial fluid aspirates of 20 arthroplastic and 150 osteoarthritic joints were analyzed for evidence of wear particles. Ferrography, an industrial technique for the separation of particulate matter from samples of lubricating solutions, allows extraction of wear particles from synovial fluid. Bichromatic polarized microscopy and scanning electron microscopy permit identification and characterization of metallic, polyethylene and acrylic wear particles from arthroplastic joints as well as biological wear fragments of bone, cartilage, meniscus and synovium from osteoarthritic joints. With both techniques, the number and morphology of the wear particles within the synovial fluid specimens correlate with the rate and mechanism of wear as confirmed by examination of the joint implant or articular surfaces. Toxicity of the various types of wear particles was assessed by cytological examination of the fluid aspirate. Of significant interest is the identification of active phagocytosis of wear particles by synovial fluid white blood cells. This finding may implicate the particles as initiators of secondary inflammatory responses, as occurs in other arthritic diseases.Analysis of aspirated synovial fluid appears to be a useful method for studying the rates, mechanisms and biological responses to wear in both arthroplastic and degenerative joints. In surgical joint replacement, this technique holds much promise, not only as a test for wear and toxicity, but also as a means of assisting in the selection of materials and designs for superior articular implants. In osteoarthritic joints, this analysis provides a method for early diagnosis, serial assessment of therapy and prognostication concerning the future course of the disease. Possibly of most significance, in contrast to previous studies on intact articular surfaces, is the ability to study the principal site of degenerative changes, namely the wear particles. This ability may aid in the elucidation of the underlying cause of osteoarthritis.     

Biodynamics of the wrist in rheumatoid arthritis--the enigma of stiffness

The wrist has been moved rhythmically in the horizontal plane by sinusoidal torques provided by a printed motor. Measurements have been made on normal subjects and subjects with rheumatoid arthritis. Both groups exhibited a resonance, the oscillations being greatest when the applied torque was of certain frequency. In both groups the resonant frequency fell to approximately the same constant value when the torque was raised. While the main relationships were similar a somewhat lower torque resulted in the lowering of resonant frequency in the patients. The relationship between applied torque and peak velocity at resonance was also studied. For a given torque the motion was greater in the patients. No objective signs of increased viscous or elastic stiffness were demonstrable at the wrist in patients with rheumatoid arthritis.     

The interface region between articular cartilage and bone by μMRI and PLM at microscopic resolutions

This dual-modality microscopic imaging study quantifies the interface region between the noncalcified cartilage and the subchondral bone plate, which includes the deep portion of the noncalcified articular cartilage and the zone of calcified cartilage (ZCC). This interface region is typically not visible in routine MRI but becomes visible in MRI with the application of an ultra-short echo time (UTE) sequence. A number of cartilage-bone blocks from a well-documented canine humeral head were harvested for imaging by microscopic MRI (μMRI) and PLM (polarized light microscopy). In μMRI, T2 anisotropic images were acquired by 2D gradient-echo, magnetization-prepared spin-echo and UTE sequences at the 0° and 55° (the magic angle) orientations at 11.7 μm/pixel resolution. In PLM, quantitative optical retardation (nm) and collagen orientation (°) were mapped from the thin sections from the same μMRI specimens at 0.5–2 μm pixel resolutions. The orientational and organizational architecture of the collagen matrix in this interface region was quantified and correlated between the complementary imaging. The magic angle effect as seen in the noncalcified cartilage was statistically confirmed in ZCC in μMRI, which was further supported by quantitative PLM. With an enhanced understanding of the tissue properties in this important interface region, it will potentially be possible to monitor the changes of this tissue region which is instrumental to the initiation and development of osteoarthritis and other joint diseases.     

A finite element model of an idealized diarthrodial joint to investigate the effects of variation in the mechanical properties of the tissues

The stiffness of articular cartilage increases dramatically with increasing rate of loading, and it has been hypothesized that increasing the stiffness of the subchondral bone may result in damaging stresses being generated in the articular cartilage. Despite the interdependence of these tissues in a joint, little is understood of the effect of such changes in one tissue on stresses generated in another. To investigate this, a parametric finite element model of an idealized joint was developed. The model incorporated layers representing articular cartilage, calcified cartilage, the subchondral bone plate and cancellous bone. Taguchi factorial design techniques, employing a two-level full-factorial and a four-level fractional factorial design, were used to vary the material properties and thicknesses of the layers over the wide range of values found in the literature. The effects on the maximum values of von Mises stress in each of the tissues are reported here. The stiffness of the cartilage was the main factor that determined the stress in the articular cartilage. This, and the thickness of the cartilage, also had the largest effect on the stresses in all the other tissues with the exception of the subchondral bone plate, in which stresses were dominated by its own stiffness. The stiffness of the underlying subchondral bone had no effect on the stresses generated in the cartilage. This study shows how stresses in the various tissues are affected by changes in their mechanical properties and thicknesses. It also demonstrates the benefits of a structured, systematic approach to investigating parameter variation in finite element models.     

Arch-shaped versus flat arthrodesis of the ankle joint: strength measurements using synthetic cancellous bone

The aim of this study was to see if preservation of the arch shape of the ankle at arthrodesis contributes to stability. The ankle joint was simulated by paired blocks of a synthetic material corresponding to rheumatoid cancellous bone with low stiffness and strength. Flat end constructs with and without subchondral bone were compared with arch-shape constructs with and without subchondral bone. The pairs were fixed with two screws simulating an arthrodesis. These constructs were then tested to failure in four-point bending and torque. In four-point bending the subchondral bone increased the strength, regardless of shape. Stiffness was higher in the arch-shaped specimens but was not influenced by the subchondral bone. In torque, both arch-shape and subchondral bone increase the strength. Stiffness was increased by arch-shape but not subchondral bone. The results imply that the arch-shape and subchondral bone should be preserved when performing an ankle arthrodesis, especially in weak rheumatoid bone.