An Overlooked Entity in Diagnosing Hip Pain with Neuropathy in an Athletic Young Adult: A Case Report

@#Hip pain is frequently encountered in the athletic community. Femoro-acetabular impingement (FAI) is a common cause of hip pain in young adults. However, it is important to appreciate the uncommon diagnosis and the role of imaging for unexplained hip pain. The pathology behind a posterior hip pain is often misdiagnosed as the cause of hip pain is non-specific, extensive and elusive. We managed to detect the pathology through magnetic resonance arthrography (MRA) of hip with gadolinium enhancement after a series of inconclusive history, physical examination and imaging findings were completed. This particular case vignettes an overlooked osteoid osteoma that leads to the delay in diagnosis and increase morbidity.

A Prospective Study of Correlatio of Magnetic Resonance Imaging of Brain Including MR Angiogram and Carotid Vertebral Arterial Doppler Study with the Clinical Features in Ischemic Stroke

Introduction: Stroke is a global health problem. In this study we evaluated the risk factors, clinical features and their correlation with Magnetic Resonance Imaging (MRI) brain including Magnetic Resonance Angiogram (MRA) and Carotid Verteberal (CV) Doppler findings in patients presenting with acute ischemic stroke. Material and methods: Seventy five patients of the age group 20 to 80 years admitted with acute ischemic stroke were enrolled for the study. A detailed history, clinical examination and blood investigations were done. MRI, MRA and CV Doppler were done in all patients. Serum Homocysteine levels and Anti-nuclear antibody assay (ANA) by Immunofluorescence (IF) were done in selected patients. Statistical analysis was done using SSPS version 16.0 for microsoft windows. Results: In this study, there were more males than females. The mean age was 59 years. Young stroke population (<40 years) was 5%. Anterior circulation was predominantly involved than posterior circulation. Right Middle Cerebral Artery was the most common artery involved. There was positive correlation for clinical presentation and area of infarct and for areas of infarct and the vessels involved. Most common clinical presentations were weakness and slurring of speech. There were 3% intracranial anomalies. 56% had significantly elevated levels of homocysteine. 24% had ANA- IF positivity. Recurrence of stroke was seen in 17%; National Institute of Health Stroke Scale (NIHSS) score was higher in patients with recurrent stroke and right hemisphere infarcts. Conclusion: There was positive correlation for clinical presentation and area of infarct and for areas of infarct and the vessels involved.

Discussion on Japanese Nursing Contributions for Quality Improvement of Nursing in the ASEAN Region: Meeting Report / 国際保健医療

  One of the characteristics of nursing in Southeast Asia is the ASEAN Mutual Recognition Arrangements on Nursing Services, which strengthens professional capabilities through four objectives include facilitating mobility of nursing professionals within ASEAN.  The Japanese government supports human resources for health in the ASEAN region, as a member country of ASEAN+3. A meeting was held at the Annual Meeting of the Japan Association for International Health 2017. The meeting objectives were as follows: (1) to share three nursing research findings regarding nursing migration, regulatory framework, and in-service training that may affect quality of nursing and (2) to discuss Japan’s role in improving the quality of nursing in the ASEAN region. This report aims to summarize the presentations and points of that meeting.   The academic level of nursing education and nursing regulations have improved in ASEAN member countries. All member countries have university nursing education, and some have master’s and doctoral degree nursing programs. In lower middle income ASEAN countries, such as Cambodia, Laos, and Vietnam, the nursing education system is in the process of transition, from the technical to professional level of nursing. The next step for these countries is to strengthen the capabilities of nursing teachers who are responsible for professional nursing education at universities. The ASEAN University Network and universities in neighboring Thailand could also contribute to this end. In-service training is also needed because the guidance of more experienced nurses is crucial in nursing service as well as nursing practicums. Japan’s experience of developing an in-service training system could be useful for some ASEAN countries.   The objective of mobility among nursing professionals within the ASEAN has yet to be accomplished. However, there are pull and push factors of nurse migration due to economic conditions within the ASEAN. It is predicted that nurse migration will occur with mixed-skill caregivers to high income countries out of the ASEAN countries, because of the lack of caregivers for the aging population. In order to ensure quality nursing in the ASEAN region, it is not only necessary to share country-level experiences to improve nursing education and regulations but also crucial to develop systems that promote the circulation of nursing professionals through wide regional cooperation.

Accelerated Time-of-Flight Magnetic Resonance Angiography with Sparse Undersampling and Iterative Reconstruction for the Evaluation of Intracranial Arteries

OBJECTIVE: To compare the image quality of three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA) with sparse undersampling and iterative reconstruction (sparse TOF) with that of conventional TOF MRA. MATERIALS AND METHODS: This study included 56 patients who had undergone sparse TOF MRA for intracranial artery evaluation on a 3T MR scanner. Conventional TOF MRA scans were also acquired from 29 patients with matched acquisition times and another 27 patients with matched scanning parameters. The image quality was scored using a five-point scale based on the delineation of arterial vessel segments, artifacts, overall vessel visualization, and overall image quality by two radiologists independently, and the data were analyzed using the non-parametric Wilcoxon signed-rank test. Contrast ratios (CRs) of vessels were compared using the paired t test. Interobserver agreement was calculated using the kappa test. RESULTS: Compared with conventional TOF at the same spatial resolution, sparse TOF with an acceleration factor of 3.5 could reduce acquisition time by 40% and showed comparable image quality. In addition, when compared with conventional TOF with the same acquisition time, sparse TOF with an acceleration factor of 5 could also achieve higher spatial resolution, better delineation of vessel segments, fewer artifacts, higher image quality, and a higher CR (p < 0.05). Good-to-excellent interobserver agreement (κ: 0.65–1.00) was obtained between the two radiologists. CONCLUSION: Compared with conventional TOF, sparse TOF can achieve equivalent image quality in a reduced duration. Furthermore, using the same acquisition time, sparse TOF could improve the delineation of vessels and decrease image artifacts.

Evaluation of Inferior Capsular Laxity in Patients with Atraumatic Multidirectional Shoulder Instability with Magnetic Resonance Arthrography

OBJECTIVE: To compare inferior capsular redundancy by using magnetic resonance arthrography (MRA) images in patients with multidirectional instability (MDI) of the shoulder and control subjects without instability and thereby develop a screening method to identify the presence of shoulder MDI. MATERIALS AND METHODS: The MRA images of patients with MDI of the shoulder (n = 65, 57 men, 8 women; mean age, 24.5 years; age range, 18–42 years) treated over an eight-year period were retrospectively reviewed; a control group (n = 65, 57 men, 8 women; mean age, 27.4 years; age range, 18–45 years) without instability was also selected. The inferior capsular redundancy was measured using a new method we named the glenocapsular (GC) ratio method. MRA images of both groups were randomly mixed together, and two orthopedic surgeon reviewers measured the cross-sectional areas (CSAs) and sagittal capsule-head ratios on oblique sagittal images, as well as the axial capsule-head ratios on axial images and GC ratios on oblique coronal images. RESULTS: The CSAs and GC ratios were significantly higher in patients than in controls (both, p 1.42 was found to be most suggestive of MDI of the shoulder, owing to its high sensitivity (92.3%) and specificity (89.2%). CONCLUSION: GC ratio can be easily measured and used to accurately screen for MDI of the shoulder.

Mismatch between TOF MR Angiography and CT Angiography of the Middle Cerebral Artery may be a Critical Sign in Cerebrovascular Dynamics

PURPOSE: Although time-of-flight (TOF)-magnetic resonance angiography (MRA) can clearly depict intracranial arteries, the arterial flow of middle cerebral artery (MCA) is occasionally not detected. We evaluated this phenomenon with reference to cerebrovascular dynamics. MATERIALS AND METHODS: Seventeen patients with suspected occlusion of MCA or internal carotid artery on TOF-MRA were enrolled. All patients underwent CT angiography (CTA) and quantitative cerebral blood flow (CBF) examination for measurement of resting CBF and cerebrovascular reactivity (CVR). Depending on appearance, patients were categorized into three groups. Group A (n=6) had MCA delineation on both MRA and CTA, while groups B (n=6) and C (n=5) had no signal on MRA, but Group B had a MCA delineation on CTA.

Left Gastric Vein Visualization with Hepatopetal Flow Information in Healthy Subjects Using Non-Contrast-Enhanced Magnetic Resonance Angiography with Balanced Steady-State Free-Precession Sequence and Time-Spatial Labeling Inversion Pulse

OBJECTIVE: To selectively visualize the left gastric vein (LGV) with hepatopetal flow information by non-contrast-enhanced magnetic resonance angiography under a hypothesis that change in the LGV flow direction can predict the development of esophageal varices; and to optimize the acquisition protocol in healthy subjects. MATERIALS AND METHODS: Respiratory-gated three-dimensional balanced steady-state free-precession scans were conducted on 31 healthy subjects using two methods (A and B) for visualizing the LGV with hepatopetal flow. In method A, two time-spatial labeling inversion pulses (Time-SLIP) were placed on the whole abdomen and the area from the gastric fornix to the upper body, excluding the LGV area. In method B, nonselective inversion recovery pulse was used and one Time-SLIP was placed on the esophagogastric junction. The detectability and consistency of LGV were evaluated using the two methods and ultrasonography (US). RESULTS: Left gastric veins by method A, B, and US were detected in 30 (97%), 24 (77%), and 23 (74%) subjects, respectively. LGV flow by US was hepatopetal in 22 subjects and stagnant in one subject. All hepatopetal LGVs by US coincided with the visualized vessels in both methods. One subject with non-visualized LGV in method A showed stagnant LGV by US. CONCLUSION: Hepatopetal LGV could be selectively visualized by method A in healthy subjects.

Risk factors and MRA observation in the patients with cortical watershed infarcts or internal watershed in-farcts / 实用医学杂志

Objective To investigate the risk factors and MRA manifests in the patients with cortical wa-tershed infarcts(CWSI)or internal watershed infarcts(IWSI).Methods We collected the patients with acute wa-tershed infarcts in our hospital from January 2013 to April 2016.According to the Bogousslavsky classification stan-dard,the patients were divided into two groups:CWSI and IWSI. The two groups were compared in terms of risk factors and MRA manifests. Results We included 36 CWSI and 11 IWSI patients in the study.There were signifi-cant differences in smoke,diabetes mellitus,fasting blood glucose levels and carotid atherosclerotic plaque be-tween the two groups,and so it was with the stenosis of ICA,MCA,ACA,PCA,VA and BA:The stenosis of ICA in the CWSI group was more serious than in the IWSI group,but the stenosis of MCA,ACA,PCA,VA and BA in the IWSI group was more serious than in the CWSI group. Conclusions The pathogenesis of CWSI may be related to the formation of carotid atherosclerotic plaques,carotid stenosis and arterial artery embolism,or plaque shedding and micro emboli removal.The pathogenesis of IWSI may be related to the decrease of the perfusion pres-sure at the end of the intracranial artery.The ratio of IWSI to diabetes mellitus is higher than that of CWSI,suggest-ing that the damage of diabetes to intracranial arteriole is earlier than that of intracranial and extracranial arteries.

The diagnostic value of 3D-TOF-MRA in combination with 3D-FIESTA-C in preoperative evaluation of vascular compressive trigeminal neuralgia / 实用放射学杂志

Objective To investigate the diagnostic value of three-dimensional time-of-flight magnetic resonance angiography(3D-TOF-MRA)in combination with three-dimensional fast imaging employing steady-state acquisition with phase cycling (3D-FIESTA-C),using multiplanar reconstruction and image fusion technology in preoperative evaluation of vascular compressive trigeminal neuralgia (TN) and to improve the diagnostic accuracy.Methods 3D-TOF-MRA and 3D-FIESTA-C images using MPR and image fusion technology of 70 patients with TN confirmed by surgery were reviewed retrospectively,and compared with intraoperative findings separately and together.Results Microvascular decompression (MVD)surgery was performed in all 70 patients.Compared with surgical results, 3D-TOF-MRA showed presence of the offending vessel around the cisternal segment of trigeminal nerve in 55 cases with a positive rate of 79%.3D-FIESTA-C showed the presence of the offending vessel in 60 cases with a positive rate of 85%.65 cases were found when combining both 3D-TOF-MRA and 3D-FIESTA-C images,with a positive rate of 93%.No positive imaging findings were seen in 5 cases.Operation showed that offending vessels were small arteries in 3 cases and were petrosal veins in 2 cases.The main offending vessels were superior cerebellar artery and basilar artery.Conclusion Combining images of 3D-TOF-MRA and 3D-FIESTA-C using MPR and image fusion technology can show the relationship between offending vessels and the trigeminal nerve clearly in patients,and provide guidance for MVD surgery.There are still some deficiencies in the display of venules,and other sequences of MRI (such as CE-3D-FIESTA sequences)may be helpful.

Clinics in diagnostic imaging (187). Popliteal artery entrapment syndrome (PAES) Type II

A 26-year-old male patient was referred for exercise-induced claudication that had interfered with his military duties for the past two years. He was an occasional smoker with no other significant cardiovascular risk factors. Initial Doppler ultrasonography showed narrowing of the popliteal artery. Further evaluation with magnetic resonance angiography demonstrated a short segment occlusion of the popliteal artery secondary to an anomalous origin of the medial head of the gastrocnemius muscle from the lateral femoral condyle. Based on the clinical presentation and imaging findings, he was diagnosed with popliteal artery entrapment syndrome. In this article, we discussed the typical presenting signs and symptoms of popliteal artery entrapment syndrome, the different imaging modalities available to aid diagnosis, classification of the condition and the available treatment options.

Initial experience of using improved motion sensitized driven equilibrium prepared balanced steady-state free precession / 实用医学杂志

Objective To assess the application value of NCE-MRA using iMSDE prepared bSSFP sequence in lower limb in patients with diabetes. Methods This prospective study included a total of 35 patients with type II diabetes who underwent CE-MRA on the 1.5T MR scanner after the NCE-MRA. The obtained MIP images were independently rated by two radiologist with a four score table and using CE-MRA as a reference standard to evaluate the diagnostic accuracy of NCE-MRA for the narrowed arteries. The difference of the percent age of diagnostic arterial segments between NCE-MRA and CE-MRA on diabetic patients was evaluated by the χ2 test. Results Compared with CE-MRA, the diagnostic-value arterial segment ratio of pelvic arteries on NCE-MRA is decreased significantly. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of two readers in NCE-MRA were 95%/87%, 96%/95%, 57%/72%, 99%/99%, and 96%/95%(k=0.76), respectively. Conclusions The NCE-MRA using iMSDE prepared bSSFP sequence is capable of depicting vascu-lar lesions for the lower extremities in diabetic patients with the advantages of contrast agent free, short scan times and good diagnostic value in the thigh and calves.

A study on serum ascitic fluid cholesterol gradient in differentiating cirrhotic and malignancy related ascites

Background: Ascites is defined as the collection of excessive amount of free fluid within the peritoneal cavity. For the purpose of lubrication normally at least 50 ml of free fluid is present in the peritoneal cavity. Objectives: This study was done to investigate the level of efficiency of various conventional parameters in differentiating cirrhotic ascites from malignancy related ascites and to propose serum ascites cholesterol gradient as a new diagnostic parameter. Materials and methods: This study was conducted among 100 patients of both sexes who have clinically significant ascites admitted in the wards of General medicine, Medical Gastroenterology and medical oncology in Govt. Rajaji Hospital, Madurai. Age group of 20-60 years of both sexes were included. Results: The mean (±SD) of ascitic fluid cholesterol concentration for cirrhosis group was 56.4 mg% (±7.76) and that for MRA group is 76.26 mg% (±8.27). The p value was <0.001 which was significant. The mean (±SD) of serum ascites cholesterol gradient (SACG) for cirrhosis group was 67.52 (±4.46) and that for MRA group was 60.16 (±3.38). The p value was <0.001 which was significant. The MRA group has low SACG compared to patients with cirrhosis. SACG has shown high specificity in this study which supports the findings of other similar studies. Conclusion: This study has shown that conventional parameters like ascitic fluid total protein, ascitic fluid albumin, serum ascites albumin gradient are still good at differentiating cirrhotic ascites from Chelliah Dharmaraj, Sigamani Saranya, Hibu Juli. A study on serum ascitic fluid cholesterol gradient in differentiating cirrhotic and malignancy related ascites. IAIM, 2017; 4(7): 139-143. Page 140 malignancy related ascites. SACG with a cut off level of 62.5 mg% has shown to be a better marker in terms of diagnostic accuracy to differentiate MRA from cirrhotic ascites. Thus ascitic fluid cholesterol level and SACG has been proposed as a new diagnostic marker which are more reliable and cost effective to differentiate MRA from cirrhotic ascites.

Magnetic resonance angiography versus digital subtraction angiography in diagnosing inferior vena cava diseases of Budd-Chiari syndrome / 中华肝胆外科杂志

Objective To compare the clinical value of three-dimensional dynamic contrast enhanced magnetic resonance angiography (3D DCE MRA) and digital subtraction angiography (DSA) in diagnosing inferior vena cava diseases in suspected case of Budd-Chiari syndrome (BCS).Methods Radiological findings of 91 suspected BCS cases obtained from 3D DCE MRA and DSA in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.DSA test was considered as golden standard,which assess the capacity of 3D DCE MRA in diagnosing inferior vena cava diseases,including sensitivity,specificity and accuracy.Kappa test was utilized to compare the coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases.Results Among 91 suspected BCS cases with 3D DCE MRA,a total of 17 cases without inferior vena cava diseases were misdiagnosed as inferior vena cava stenosis,two patients with inferior vena caval obstruction was misdiagnosed as falsely negative.Seventy-two patients with 3D DCE MRA were confirmed via DSA in diagnosing inferior vena cava diseases,sensitivity was up to 97.7％ (58/60),false positivity 54.8％ (17/31),specificity 45.2％ (14/31),respectively.Fair coincidence ratio of 3D DCE MRA and DSA in diagnosing inferior vena cava diseases (Kappa =0.474,P ＜ 0.05).Conclusions There could be clinical value of 3D DCE MRA for its high sensitivity and low specificity in diagnosing inferior vena cava diseases,and favorable coincidence ratio was discovered between 3D DCE MRA and DSA.Comprehensive consideration is needed for suspected cases of inferior vena cava stenosis detected by 3D DCE MRA,and further analysis may figure out potential causes of misdiagnosis and decline false positive events.

Evaluation of Hemodynamics of Posterior Circulation Distal Ischemia with Perfusion-weighted MR Imaging / 实用医学杂志

Objective To explore the way to evaluate hemodynamics of posterior circulation distal ischemia with PWI. Methods Thirty-two patients with vertebral basilar artery severe stenosis were reviewed and compared with thirty normal persons. Information and data of PWI and MRA were collected and analyzed. Following parameters were observed, index of vascular stenosis, collateral vessels, cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT). Results All the patients had at least one vertebral basilar artery with more than 70% stenosis. There were 17 cases with severe vertebral artery stenosis , 20 cases with severe basal artery stenosis , 8 cases with severe superior cerebellar artery stenosis , 17 cases with posterior cerebral artery stenosis , 22 cases with after the traffic artery open , 11 cases with soft meningeal arteries show and 12 cases with small artery show. The ratio of ROI with frontal white matter was lower than the rCBF and rCBV in the country group. MTT value was extended and P value of the parameters in both groups was less than 0.05, reflecting the statistical difference. Conclusions PWI combined with MRA can effectively evaluate the posterior circulation distal ischemia area and tissue perfusion , as well as the hemodynamic status of ischemia area.

Using digitized 3Dmodel for assessing characteristics of pelvic and abdominal vessel imaging of CTA and MRA / 重庆医学

Objective To construct the digitalized 3 dimensional(3D)model by using the CTA and MRA original images and to assess the differences in the pelvic and abdominal vessel display between CTA and MRA.Methods The original data set in 25 healthy youth female cases of CTA and MRA were collected.The datasets,reconstructed the 3D models of arteries and venous on 3D reconstruction software Mimics10.0 was used to construct the 3D model of pevic and abdominal vessels.The reconstruction situation of abdominal aorta,inferior vena cava,common iliac artery and common iliac venous,internal and external iliac artery and iliac venous,uterine artery,obturator artery and obturator venous,hip artery and its branches,internal pudendal artery,middle sacral artery and venous,ovarian artery and venous and sacral venous plexus were observed.Moreover the chi-square test was used to analyze whether the above vessel display rate having differences between the two kinds of model.Results The abdominal aorta,inferior vena cava,common iliac artery and common iliac venous,internal and external iliac artery and iliac venous and uterine artery almost reached 100 ％ display.The display rates of CTA model for right and left obturator artery and venous were 92 ％,80 ％,44 ％ and 32 ％ respectively,while which of MRA model were 84 ％,72 ％,36 ％ and 4％ respectively,the difference was not statistically significant(P =0.382,P=0.508,P =0.564,P =0.382).The sacral venous plexus,including S1,2,3,4 transverse vein,the display rates in 25 cases of CTA 3D models were 4％,8％,0％and 4％respective,while which of MRA models were 76％,92％,96％and 44％respectively,the differences between them were statistically significant(P＜0.01,P＜0.01,P＜0.01,P=0.01).Conclusion Based on the observation of 3D models,the displaying rate of grade 4 pelvic and abdominal vessels has no statistical difference between MRA imaging technology and currently widely used CTA technology,moreover the MRA technology is superior to the CTA technology in presacral vessel net display.

Susceptibility Vessel Sign for the Detection of Hyperacute MCA Occlusion: Evaluation with Susceptibility-weighted MR Imaging

PURPOSE: Susceptibility vessel sign (SVS) on gradient echo image, which is caused by MR signal loss due to arterial thrombosis, has been reported in acute middle cerebral artery (MCA) infarction. However, the reported sensitivity and diagnostic accuracy of SVS have been variable. Susceptibility-weighted imaging (SWI) is a newly developed MR sequence. Recent studies have found that SWI may be useful in the field of cerebrovascular diseases, especially for detecting the presence of prominent veins, microbleeds and the SVS. The purpose of this study was to evaluate the diagnostic values of SWI for the detection of hyperacute MCA occlusion. MATERIALS AND METHODS: Sixty-nine patients (37 males, 32 females; 46-89 years old [mean, 69.1]) with acute stroke involving the MCA territory underwent MR imaging within 6 hours after the symptom onset. MR examination included T2, FLAIR (fluid-attenuated inversion recovery), DWI, SWI, PWI (perfusion-weighted imaging), contrast-enhanced MR angiography (MRA) and contrast-enhanced T1. Of these patients, 28 patients also underwent digital subtraction angiography (DSA) within 2 hours after MR examination. Presence or absence of SVS on SWI was assessed without knowledge of clinical, DSA and other MR imaging findings. RESULTS: On MRA or DSA, 34 patients (49.3%) showed MCA occlusion. Of these patients, SVS was detected in 30 (88.2%) on SWI. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of SWI were 88.2%, 97.1%, 96.8%, 89.5% and 92.8%, respectively. CONCLUSION: SWI was sensitive, specific and accurate for the detection of hyperacute MCA occlusion.

The comparative study of showing the responsible blood vessels for neurovascular compression in trigeminal neuralgia by 3D-FIESTA-C and 3D-TOF-MRA / 实用放射学杂志

Objective To compare the diagnostic efficiency in showing the responsible blood vessels for neurovascular compression in patients with trigeminal neuralgia by 3D‐FIESTA‐C and 3D‐TOF‐MRA sequences .Methods The imaging data of 60 patients with primary trigeminal neuralgia were analyzed retrospectively .After MRI examination ,all of the patients underwent micro‐vascular de‐compression (MVD) .3D‐TOF‐MRA and 3D‐FIESTA‐C sequences were performed to evaluate the three‐dimensional relationship be‐tween trigeminal nerve and blood vessels through the original and reconstructed image .The intraoperative endoscopic findings were set as the gold standard comparing to the manifestations of 3D‐TOF‐MRA and 3D‐FIESTA‐C .Results The sensitivities of 3D‐TOF‐MRA and 3D‐FIESTA‐C for the diagnosis of the existence of responsible vessels were 85 .7% ,89 .3% ,the specificities were 75 .0% , 100% ,and the accuracies were 85 .0% ,90 .0% ,respectively (P=1 .000) .Furthermore ,the sensitivities of 3D‐TOF‐MRA and 3D‐FIESTA‐C for the diagnosis of the existence of responsible arteries were 94 .1% ,88 .2% (P=0 .244) ,while the sensitivities of the responsible veins were 0 .00% and 88 .2% (P=0 .009) .Conclusion Both the 3D‐FIESTA‐C and 3D‐TOF‐MRA sequences can accurately deter‐mine the existence of responsible vessels in trigeminal neuralgia before surgery .3D‐FIESTA‐C sequence is superior to 3D‐TOF‐MRA for presenting the responsible veins ,which can be used as a supplemental diagnostic tool before operation .

ASEAN mutual recognition arrangement for Indonesian nurses: is it a promise.

Nurse surplus, nurse shortage, nurse migration, unequal distribution, and multiple backgrounds of nurses are challenges being faced by Indonesian government and nurse leaders. ASEAN mutual recognition arrangement is expected to address these challenges by facilitating nurses‟ mobility, exchanging knowledge and best practice, and providing a scheme to develop nurse competency in Indonesia. However, there are some concerns need to consider related to the policy and the context of Indonesian nurses, and the objectives and requirements of MRA.

Scan parameter optimization of renal artery with inflow-sensitive inversion recovery magnetic resonance angiography / 医学研究生学报

Objective Non-contrast enhanced magnetic resonance angiography ( MRA) has become the focus of research at home and abroad .The aim of the article was to optimize the scan parameters of renal artery with inflow-sensitive inversion recovery ( IF-IR) MRA. Methods 30 cases of renal artery patients into two groups were collected from December 2013 to May 2014 in our hospi-tal.They were divided into stenosis group(n=12) and non-stenosis group(n=48).IFIR-MRA sequences were carried out on each patient by using various BSP-TI with 1200,1300 and 1400 ms, all other parameters were identical .The image signal to noise ratio, a renal artery branch and venous artifact were evaluated by two experienced radiologists , and the best BSP-TI was obtained from different groups. Results BSP-TI=1400 ms was optimal for renal artery stenosis group while 1200 ms was the most suitable for non-stenosis group. Conclusion IFIR-MRA of renal artery can achieve better image quality of renal artery and its branches and it is feasible in clinical routine practice , especially for those patients with renal insufficiency .

MRI and MRA in Detecting Wrist Triangular Fibrocartilage Tear：A Meta-analysis / 中国医学影像学杂志

Purpose Accurate diagnosis of triangular fibrocartilage (TFC) tear is very important for treatment. MRI is most used for diagnosing TFC tear. This paper aims to evaluate MRI and MR arthrography (MRA) for diagnosing TFC tear by meta-analysis. Materials and Methods The articles were searched in the databases such as Wanfang, VIP, CNKI, Cochrane Library, Medline, Embase and PubMed. The QUADAS items were used to evaluate the quality of the included studies. Heterogeneity of the included articles was tested. The pooled weighted sensitivity and specificity of MRI and MRA in diagnosing TFC tear were calculated, and the pooled receiver operation curve was drawn. Results Fifteen articles met the inclusion criteria, 2 were Chinese articles and 13 were English articles. The subjects and methods of the articles were different and existed heterogeneity. The sensitivity and specificity of MRI for diagnosing TFC tear were 0.66 (95% CI 0.61-0.71) and 0.75 (95% CI 0.69-0.81), and those of MRA were 0.80 (95% CI 0.73-0.87) and 0.86 (95% CI 0.74-0.93). The area under curve and Q* index of SROC of MRI were 0.8566 and 0.7875, respectively. The area under curve and Q* index of SROC of MRA were 0.9123 and 0.8446, respectively. Conclusion The accuracy of TFC tear avulsion for MRA are higher than for MRI, when there is unclear of TFC avulsion using MRI, MRA can be used for diagnosis.