Objective To evaluate the application of CT myelography (CTM) in detecting the site of spontaneous cerebrospinal fluid (CSF) leaks and analyze it's imaging features.Methods Six patients (3 women and 3 men) with spontaneous intracranial hypotension (SIH) were included, who met the criteria of the International Headache Classification (2nd edition, 2004). Five patients subsequently underwent whole spine MRI and all 6 patients underwent CTM. Autologous blood mixed with omnipaque (300 mg/ml) was injected followed by selective puncture at the leak site indicated by CTM. Results MRI was failed to find leak site in the 5 patients, whereas CTM successfully found leak sites in all 6 patients. There were 1 to 7 leak sites respectively with an average of 4.2 sites (totally 25 points). Leak sites at cervical (12 sites) and thoracic (12 sites) were more frequent than at lumbar (1 site). CTM was featured by linear leakage of the contrast medium along the spinal nerve roots, paraspinal collections of hyper-density contrast medium and beak-like enlargement of the nerve sleeves. All patients responded well to the treatment, with complete resolution of symptoms. Conclusion CTM has been shown to be a study of choice to accurately define the location and extent of a CSF leak.

Objective To assess intraplaque hemorrhage before carotid artery stenting (CAS)by use of 3D-MPRAGE and DWI sequence.Methods Thirty-two symptomatic patients who had carotid artery plaque suspected by color Doppler ultrasonography and prepared for CAS underwent 3.0T carotid high-resolution MR scans,including regular sequence,T1-weighted gradient echo three-di-mensional magnetization prepared (3D-MPRAGE ) sequence,diffusion-weighted imaging (DWI ) sequences.According to 3D-MPRAGE sequence hemorrhage and non-hemorrhage groups were divided,and measured the mean ADC values of the two groups, hemorrhage and non-hemorrhage part in the hemorrhage group.Meanwhile preoperative cerebral hemorrhage group underwent brain DWI scans.Independent samples t-test analysis was utilized by SPSS V20.0 statistical software.Results High-resolution MRI dis-played 40 plaques,fourteen hemorrhagic plaques showed by 3D-MPRAGE sequence.The mean ADC values of hemorrhage and no-hemorrhage group were(1 233.5±283.5)× 10 -6 mm2/s,(1 688.9 ± 449.6)× 10 -6 mm2/s respectively,the difference of both was significant (t=3.43,P <0.05).The mean ADC values of hemorrhage and non-hemorrhage parts in the hemorrhage group mean ADC values were (934.0 ± 387.9)× 10-6 mm2/s,(1 313.9 ± 295.0)× 10-6 mm2/s respectively;the difference of both was statistically significant (t=2.92,P < 0.05 ).The difference of mean ADC values between non-hemorrhage part in the hemorrhage group and hemorrhage group was statistically significant (t=2.80,P <0.05).Conclusion 3D-MPRAGE and DWI sequences can be evaluated intraplaque hemorrhage before CAS,and provided a reliable basis for timely clinical interventions to prevent stroke.

Objective In this study,functional magnetic resonance imaging(fMRI)is performed to visualize what type of brain activity correlates with writer's cramp.Methods Ten patients with writer's cramp and ten age-and gender-matched control subjects participated in this study.fMRI block design is used.Subjects were scanned while performing three visually instructive tasks with MR Vision 2000:(1)suppositional writing;(2)writing with finger;(3)writing with a pencil.Data were analyzed with Analysis of Functional Neuroimaging(AFNI)software for groups of patients versus controls.Results Compared with controls,patients with writer's cramp showed greater activation of contralateral basal ganglion(especially the putamen,864 activated voxels in patients versus 54 in controls),ipsilateral cerebellar hemisphere,and contralateral sensorimotor,supplementary motor,premoter,primary sensory cortex in the task of writing with a pencil.There is no obvious difference in the task of writing compared with finger writing.Furthermore,these differences existed in the subtractive activated maps for “writing with pencil” minus “writing with finger”,while the activation of subcortical area and insula in controls disappeared.Conclusion These results indicate that the dysfunction of basal ganglion and subcortical-cortical loop might play a pathophysiologic role in the writer's cramp.

This study firstly reviews the history and current situation of course construction, then combines closely with the objectives and the summary of current situation of the standardized residency training, and finally puts forward concrete countermeasures from the several angles, such as teaching objectives, teaching team development, teaching content and forms, as well as evaluation mechanism, advocating the promotion of problem-based learning (PBL), medical simulation teaching (MST), literature discussion and other teaching methods, encouraging the integration of humanities education and clinical guidelines into teaching, and adopting objective structured clinical examination + standardized patient (OSCE+SP) assessment method and conducting two-way assessment, so as to assist in the education development of the standardized residency training.

Objective To determine the utility of musculoskeletal ultrasound imaging to support physical findings in different stages of recovery and in recommending treatment regimens.Methods Forty-three hemiplegic stroke survivors with shoulder pain were enrolled.Physical examinations were performed 3 and 6 months after the stroke using a visual analogue scale (VAS),a modified Ashworth scale,measurements of passive range of motion and Brunnstrom staging.This was coupled with sonography of the long head of the biceps,the subscapularis tendon,the supraspinatus tendon,the infraspinatus tendon,the acromioclavicular joint and the subacromial-subdeltoid bursa.Results Three months after the stroke the average VAS score correlated negatively with the average Brunnstrom stage of the shoulders (r=-0.39,P≤0.01),with the range of passive abduction (r=-0.56,P≤ 0.01),the range of passive external rotation (r=-0.36,P≤ 0.02),and the range of passive flexion (r=-0.37,P≤ 0.02).It was positively correlated with abnormal sonographic findings of the long head tendon of the biceps (r=0.32,P≤ 0.04),the subscapularis tendons (r=0.31,P≤0.04) and the supraspinatus tendons (r=0.53,P≤0.01).However,3 months later the VAS results were negatively correlated with Brunnstrom stage (r=-0.45,P ≤ 0.01),range of passive shoulder abduction (r=-0.60,P≤0.01),range of passive external rotation (r=-0.41,P≤0.01),and passive range of flexion (r=-0.52,P≤ 0.01),but positively correlated with spasticity (r=0.34,P≤ 0.03),biceps tendinopathy (r=0.45,P≤0.01),subscapularis tendinopathy (r=0.33,P≤ 0.03) and supraspinatus tendinopathy (r=0.56,P≤ 0.01).Rotator cuff injury was significantly more severe 6 months after stroke than at 3 months.The incidence of pain in the hemiplegic shoulder and abnormal sonographic findings of the biceps tendon and subscapularis tendon were significantly higher at 6 months than at 3 months after the stroke.Supraspinatus tendon problems were notable both at 3 and 6 months.Conclusions Pain in a hemiplegic shoulder is positively correlated with abnormal sonographic findings but negatively correlated with Brunnstrom stages and passive range of motion 3 and 6 months after stroke.Six months after stroke,pain is positively correlated with muscle tone.The tendon at the long head of the biceps and the rotator cuff are vulnerable to injury,especially at 6 months after stroke.

Objective To investigate CT and MRI imaging of Warthin tumor of parotid gland.Methods CT and MRI character-istics of 5 1 patients confirmed as Warthin tumor by operation and pathology were analyzed retrospectively.Results Among 5 1 cases, 43 patients were males,and 8 patients were females.A total of 84 lesions were found in all cases,20 cases had at least 2 lesions.The margins of lesions were well-defined.68 lesions were round or elliptical.45 lesions located in the posterior and inferior quadrant of the parotid gland completely or premodinantly.The density and signal of most lesions were homogeneous.The parenchymal area of most lesions showed an early moderate-remarkable enhancement.Small blood vessels surrounded the lesions in 1 9 cases.Conclusion CT and MRI are important and valuable for the diagnosis of Warthin tumor.

Objective To investigate the features of variation of sympathetic skin response(SSR)in depression patients and to clarify the correlation between SSR and the effect of antidepressant therapy in first episode depression.Methods The sample comprised 50 first visit patients,who fulfilled the ICD-10 criteria in a structured interview for depressive disorder.These 50 patients received antidepressant therapy for 6 weeks.Clinical response was defined as ≥50%reduction in total 17-item Hamilton depression rating scale(HAMD).Remission was defined as HAMD score ≤7 at week 6.SSR waveforms were classified into three patterns based on the amplitudes of positive and negative components:P pattern,N pattern and M pattern.Another 50 healthy subjects were involved in this study as controls.Results (1)SSR could be obtained in all normal subjects but couldn't be recorded in 5 of 50 patients whose HAMD scores>28.SSR waveforul patterns were analyzed in these 45 patients P pattern in 7 cases,N pattern 21,M pattern 17.(2)Depression patients had longer latency and lower amplitude than the controls(P<0.01).P pattern had shorter latency and higher amplitude than N pattern.There were no difference in age,course and HAMD scores among the patients with 3 different SSR patterns.(3)Nine of 21 patients of N pattern treated with fluoxetine were remitters.6 patients were clinical responders.These 15 patients had shorter latency and higher amplitude after treatment than that at the initial stage,but there were still differences in latency and amplitude compared with the controls.Conclusion There were significant damages on sympathetic function of depression patients.N pattern was the most SSR pattern among 45 patients recorded SSR.P pattern had shorter latency and higher amplitude than N pattern.SSR is a sensitive and feasible measure inder for neurocardiac electrophysiologic autonomic regulation examination,which could be used to measure clinical therapeutic efficacy for antideppressant in depression patients.

Objective To investigate the characteristic of MRS in patients suffered diffuse axonal injury (DAI)in acute and suba-cute stage,and the correlation between MRS changes and the severity of disease.Methods We reported MRI and proton magnetic resonance spectroscopy studies of 3 6 head-inj ured patients in acute and subacute stage.Proton magnetic resonance spectra were ac-quired from the white matter and gray matter of bibateral frontal lobe that on conventional MRI appeared normal by using 2D MRSI at 3.0T MRI .30 volunteers as contronl were studied at the same time.Results In patient group,N-acetylaspartate/creatine ratios were (2.14±0.15)and (1.71±0.08)choline/creatine ratios were(1.35±0.13)and (1.03±0.08)for the white matter and the gray matter,respectivily.The brain N-acetylaspartate/creatine ratio was reduced and the choline/creatine ratio was increased in pa-tient group compared with the controls.The increase in the choline/creatine ratio was significant even in the moderate and severe in-j ured groups.Furthermore,there was a significantly correlation between the severity of head inj ury and the N-acetylaspartate/cho-line ratio,and changes in patients with metabolite ratios of the GCS score had a strong correlation.Conclusion We conclude that DAI patients with normal conventional imaging manifestations of the frontal lobe appear metabolite ratio change,suggesting the existence of local cerebral inj ury,and it has a strong correlation between the prognosis and MRS changes.MRS may provide an useful method that can tell us the severity of the brain inj ury in patients with DAI .

Objective To determine whether the different pathological types of astrocytic tumours can be differentiated by diffusion tensor MR imaging. Methods In this study, diffusion tensor MR imaging was performed preoperatively in 67 patients with different pathological types of astrocytic tumours. Furthermore , T1WI, T2WI, FLAIR and T1WI enhancement scanning by GD-DTPA were performed preoperatively in all patients. The Mean diffusivity (ADC) values in the tumor parenchyma and normal white matter from different pathological types of astrocytic tumours were measured and analyzed. The ADC with the tumor parenchyma and normal white matter from the tumours were statistically analyzed by SPSS 19.0. The results were expressed as ± s and P < 0.05 was regarded as statistically significant differences. Results There were many differences with ADC (< 10-9 mm2/s) in the tumor parenchyma between fibrillary astrocytoma (1.48 ± 0.12、0.72 ± 0.05) from fat cell astrocytoma (1.31 ± 0.07, 0.69 ± 0.03), There were also many differences with ADC ( < 10-9 mm2/s) in the tumor parenchyma between fibrillary and fat cell astrocytoma from anaplastic astrocytoma (1.06 ± 0.11, 0.71 ± 0.04) and giant cell glioblastoma (0.98 ± 0.09, 0.73 ± 0.04). There were not differences with ADC in the tumor parenchyma between anaplastic astrocytoma from giant cell gliobastona. Conclusion Measurement of tumor parenchyma′s ADC values can identify different pathological types of astrocytic tumours , but not between anaplastic astrocytoma and giant cell glioblastoma. DTI is essential to preoperative evalution of astrocytic tumours.

Objective To explore the imaging features of appendiceal mucinous neoplasms and their correlation with the pathology results.Methods The imaging data of 1 6 patients with histopathology proved appendiceal mucinous neoplasms were analyzed retrospectively including mucinous adenoma in 2,low-grade appendiceal mucinous neoplasm (LAMN)in 10,and appendiceal adenocarcinoma in 4. The imaging features were correlated with the result of pathology.Results Mucinous cystadenoma was usually a long oval or strip low density cystic structures with smooth capsule wall and well defined border.Mucinous adenocarcinoma usually presented as a irregular solid-cystic mass with ill-defined border and nodular or separation enhancement.The tumor often infiltrated adjacent bowels,and some of them were accompanied with pseudomyxoma peritonei (PMP)and abdominal implantation metastasi.LAMN had low potential malignancy.The imaging features were between cystadenoma and cystadenocarcinoma.Most cases were similar to mucinous cystadenoma, and some were like to mucinous cystadenocarcinoma.Conclusion The appendiceal mucinous neoplasms have various imaging manifestations. Some cases show some CT and MRI characteristics,which are benefit to the diagnosis of these diseases.