Objective To assess the feasibility of intestitial MR lymphangiography (MRL) with subcutaneous injection of a commercially available,non-ionic,extracellular paramagnetic contrast agent,to visualize lymphatic vessels in patients with primary lymphedema.Methods Forty lower extremities in 31 patients with clinically advanced stages of primary lymphedema were examined with magnetic resonance lymphangiography.A 1 ml mixed liquor of gadobenate dimeglumine and mepivacainhydrochloride were injected subcutaneously into the dorsal aspect of both feet For MRL,a 3D fast spoiled gradient-recalled echo T1-weighted images with a fat saturation technique (T1 high resolution isotropic volume excitation,THRIVE) were performed after subcutaneous application of the contrast material To outline lymphatic vessels,source images were used to reconstruct images of MIP.The SNR and CNR of enhanced lymphatic vessels and veins were measured and calculated respectively.The significance of the differences of the data comparisons was assessed using an unpaired student t teat.Results Of the 40 lower extremities,the beaded appearance of dilated lymphatic vessels was detected in 36 lower legs (90.0%) and 17 upper legs (42.5%).The numbers of the dilated lymphatic vessels displayed in all segments of lower extremities added up to 365 and its mean diameter was (3.4 ± 0.1) mm on MRL MIP image.The average SNR and CNR were 257 ±130,207 ± 113 in the dilated lymphatic vessels and 218 ± 129,152 ± 113 in the vein respectively,which was statistically significant (SNR t = -2.649,CNR t = -3.404,P <0.01).Contrast enhancement was observed in 30/40 inguinal lymph node groups (75.0%).In 26 lower extremities (65.0%) collateral vessels with dermal back-flow areas between lymphatic vessels were seen.Conclusions As a novel tool to image the pathologically modified lymphatic vessels in patients with clinically advanced stage of primary lymphedema,magnetic resonance lymphangiography is a safe,useful technique.

Background and purpose: With the development of therapy equipments and technology, the treatment for nasopharyngeal carcinoma(NPC) has entered into the era of precision radiotherapy, and setup errors have become a very important factor affecting treatment effects. The purpose of this study was to analyze the set-up errors detected by the kilovoltage cone beam CT(EPID) and the megavoltage electronic portal imaging device(CBCT) using 2 kinds of different immobilization techniques (pillow+head neck shoulder mask and vacuum bag+head neck shoulder mask) for NPC patients. Methods:A total number of 40 NPC patients were randomly assigned into 2 groups (pillow+head neck shoulder mask group and vacuum bag+neck shoulder mask group). Then each group was further divided into CBCT scan group and EPID group for veriifcation before treatment delivery. We matched the EPID images with the DRRs and acquired the set-up errors in x, y, z axis. Setup errors of CBCT were calculated according to its matched and planned CT images in left-right (x), superior-inferior (y) and anterior-posterior (z) directions. Paired t-test was used to evaluate the differences. Results:In the pillow+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.67±2.01)mm, y (0.51±1.71)mm and z (0.57±2.04)mm, respectively. The errors of EPID were x (0.69±2.19)mm, y (0.54±2.03)mm and z (0.61±2.11)mm. In the vacuum bag+head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x (0.42±1.81)mm, y (0.33±1.55)mm and z (0.50±1.75)mm, respectively. The errors of EPID were x (0.44±1.87)mm, y (0.43±1.70)mm and z (0.54±1.77)mm. The vacuum bag+head neck shoulder mask ifxed technique was more accurate when compared to the pillow + head neck shoulder mask ifxation method (P<0.05). Conclusion:CBCT and EPID were similar in detecting set-up errors for the NPC patients. However, the vacuum bag+neck shoulder mask ifxed technique was more accurate when compared to the pillow+head neck shoulder mask ifxation method.

Objective In this study, an immunhistochemical analysis was carried out to clarify the correlation of CD34, CD105, Ⅷ R Ag, LN and collagen Ⅳ expression with human endometrial functional status. Methods Ten proliferative phase human endometrial sections were stained immunhistologically for three endothelial markers (CD34, CD105, factor Ⅷ related antigen) and two basement membrane markers (Laminin, collagen Ⅳ). Results At the same sample and the same cut of the sections,Significant differences were found in the microvessel density and morphosis.Conclusion\ CD34 and CLIV are the best markers for the microvessel density.\;[

Objective To explore the relationship between structure and function in the diseases of posterior visual pathways as well as the anatomic mechanism of the abnormal visual responses.Methods Eleven cases of diseases of posterior visual pathways(3 gliomas,4 meningiomas,3 metastasis,1 stroke) involving either cortical or subcortical visual pathways were investigated by combining fMRI and DTI.fMRI was performed by using flashing checkerboard at 8 Hz.For imaging processing,fMRI analysis was performed with SPM99,and DTI and tractography with DTVⅡ.Fractional anisotropy(FA) of optic radiations and activated volume(VOXELs) of primary visual cortices(V1 and V2) were measured and analyzed at the affected side and the contralateral side.Relative FA(rFA) and relative activated volume(rVOXELs) were also calculated.3D tractography of optic radiations was performed successfully in 11 patients.Results In the patients with brain tumors,FA values in the affected side of optic radiations were significantly different with the contralateral side(P

Objective To investigate effects of volume,distribution and leakage of bone cement in ver- tebroplasty on the adjacent intervertebral bodies using an experimentally calibrated and anatomically accurate fi- nite-element model of elderly L4-L5 vertebral bodies.Methods Computed tomography(CT)scanning was done,at 1 mm intervals,on L4-L5 vertebral bodies of the lumbar spine of an old man cadaver that had no abnormal findings on rnentgenograms.The L4-L5 motion segment data were obtained from the CT scans to establish in computer a three-dimensional finite element model of L4-L5 functional spinal unit(FSU)with the software Ansys 7.0.Compressive load after virtual vertebroplasty on the damaged model,unipedicular and bipedieolar injections and leakage of cement into the intervertebral space,and the resulting endplate and disc stresses of the adjacent vertebral bodies were analyzed in various spatial distributions of the filling material and different loading conditions. An anatomically accurate finite-element model of elderly L4-L5 vertebral bodies was developed.Results The FSU study suggested that changes in stress and strain at adjacent levels were minimal.Furthermore,endplale and disc stresses of the adjacent vertebral bodies were not influenced by bone cement filling volumes or distributions except under bending,whereas asymmetric distribution and leakage of bone cement to the disk increased the stress of adjacent endplates.Conclusion Since asymmetric distribution and significant leakage of cement into the intervertebral space can increase the stresses of endplates of adjacent vertebral bodies and may lead to a fracture, symmetric placement of cement in operation should be achieved and leakage of cement avoided.

Objective To explore status quo of Shanghai community health services based on the investigation of rural community doctors in Shanghai suburb,and to propose measures on training rural doctors. Methods Retrospective investigation was carried out in 114 rural community health service centers and 1 563 clinics.Primary investigation included the registration,distribution,age,academic titles and education background. Results The results showed insufficient number of human resources and inadequate investment in human capitals in the primary medical services of Shanghai suburbs,and there was a serious shortage of general practitioners.The other problems included older age,insufficient academic qualifications,and without professional titles. Conclusion We should improve the status and treatment of rural doctors.Job training and well-trained professional students should be encouraged for the primary health services.More and more doctors should be attracted to work in community health service centers.General practitioners' personnal information network and general medical training network should be established,and the general medical education system gets improvement.

ObjectiveTo access the value of combined application of high-resolution interstitial MR lymphangiography (MRL) and heavily T2WI for the visualization of lymphatic vessels in patients with primary lymphedema.Methods Forty lower extremities in 31 patients with primary lymphedema were examined by heavily T2 WI and interstitial MRL with a 3.0 T MR unit (Philips Medical Systems,Best,the Netherlands).Two experienced radiologists analyzed the images and tried to determine the differences in number of lymphatic vessels,and their maximum diameters,SNR and CNR,and accumulated lymph fluid in the tissue.Statistical analyses were conducted by using Wilcoxon test and t test.ResultsDilated lymphatic vessels in 73 leg segments of 40 lower extremities were visualized on heavily T2WI (median 5,1 to 24),which were more than those on MRL ( median 3,1 to 16) (Z =-2.92,P ＜ 0.01 ).The maximum diameter of lymphatic vessels was (4.3 ± 1.5 ) mm on heavily T2 WI,whereas it was ( 3.4 ± 1.0) mm on MRL ( t =6.90,P ＜ 0.0 1 ).The average SNR and CNR in the dilated lymphatic vessels were 257 ± 130,207 ± 113 on MRL and 169 ± 91,135 ± 82 on heavily T2 WI,which was statistically significant ( SNR t =- 5.95,CNR t =-5.10; P ＜ 0.01 ).The visualization of regions of accumulated lymph fluid on heavily T2WI (median 1 ) had a higher score than that on MRL ( median 0 ) ( Z =- 5.64,P ＜ 0.01 ).Conclusions The heavily T2WI has greater sensitivity and the MRL image has better SNR and CNR.Combining these two MR techniques can provide adequate information for clinicians in the therapeutic planning of patients with advanced stages of lymphedema.

ObjectiveTo evaluate the ability of high resolution magnetic resonance (MR) imaging at 3.0 tesla to depict the characterization of human carotid arterial vessel wall and detect atherosclerotic lesions ex vivo in comparison to histopathologic results. MethodsEighteen carotid arteries obtained from 9 elderly donors underwent fat-suppressed T1 - and T2-weighted MR imaging at 3.0 tesla MR system with a mouse coil. Corresponding histological sections were obtained for the comparison. Correlation between MR images and histopathologic slices was obtained by Pearson or Spearman correlation coefficient.Cohen K was computed to quantify the agreement between MRI and histopathologic findings.Results Lumen area,intima and media area measured on fat-suppressed T2-weighted images showed stronger correlation with the corresponding histopathologic slices [ MRI vs.histopathology:( 27. 53 ± 6. 77 ) mm2 vs.( 25.83 ±6. 69 ) mm2, r2 ＝ 0. 91,P2 ＝ 0. 024, ( 12.31 ± 3. 31 ) mm2 vs.( 12. 28 ± 3.71 ) mm2, r2 ＝ 0. 70, P2 ＝ 0. 020,Median 12. 29 mm2(Min 1.12 mm2, Max 33.18 mm2) vs.Median 11.62 mm2(Min 0.89 mm2, Max 32. 84 mm2 ), r2 ＝ 0. 74, P2 ＝ 0. 016, respectively]. The Cohen K score between the MR imaging and American Heart Association classifications was 0. 74, which corresponds to a good agreement. Conclusions 3.0 T high-resolution multi-sequence MRI can clearly show the structure of ex vivo carotid artery wall and allow quantitative assessment.Fat-suppressed T2Wimaging has a greater advantagein presenting atherosclerotic lesions.

Objective To analyze the effects and the complications of partial splenic artery embolization(PSE)and splenectomy offering a feasible way to choose different therapeutic methods for hypersplenism. Methods Forty-six patients treated with PSE and thirty-three undergone splenectomy were compared for their effectivenesses and complications in treating hypersplenism. Results Thrombocyte and leucocyte counts increased markedly after the two kinds of treatment(P 0.05). The complication rate of the PSE was far more than that of the splenectomy(P

Background and purpose:Correct target positioning is an important factor affecting the precision of stereotactic body radiotherapy (SBRT) in patients with lung tumors. This study investigated the setup errors in patients with malignant lung tumors receiving SBRT with cone-beam CT (CBCT) and analyzed the factors influencing setup errors.Methods:Twenty-nine patients with solitary malignant lung tumors were enrolled in the study. Each patient underwent SBRT with CBCT before each treatment. Setup errors in CBCT were obtained according to the matched and planned CT images in anterior-posterior (AP), superior-inferior (SI) and left-right (LR) directions. The expanding margins of clinical target volume (CTV) to planning target volume (PTV) according to the analyzed setup errors were then calculated. And the influencing factors of setup errors were analyzed.Results:A total of 155 CBCT images from 29 patients were obtained during the treatment. The setup errors were (-1.68±3.62), (-1.34±3.90) and (0.36±2.15) mm in the AP, SI and LR directions, respectively. The absolute setup errors were (3.16±2.42), (3.29±2.48) and (1.74±1.30) mm in the AP, SI and LR directions, respectively. The suggested expanding margins of CTV to PTV were 9.6, 10.0 and 5.3 mm in the AP, SI and LR directions according to the setup errors. The setup errors in the AP direction of peripheral lesions and in the SI direction of inferior, right and metastatic lesions were relatively larger(P=0.007, 0.008, 0.000 and 0.000)..Conclusion:In patients with malignant lung tumors receiving SBRT, the setup errors were more obvious in the SI and AP directions. Tumor motion management techniques including CBCT, breath-holding technique are required to reduce the setup error in patients with lung tumors receiving SBRT.