CTA成像在下肢血管闭塞病变中的应用及与血管腔内疗效的关系

本文探讨计算机体层扫描血管造影(CTA)检查在下肢血管闭塞病变中的应用价值及与血管腔内疗效的关系。选取经数字减影血管造影(DSA)确诊的93例下肢血管闭塞病变患者,采用CTA检查,分析CTA诊断病变部位结果、血管狭窄程度及与DSA诊断结果的一致性,并探讨CTA征象与患者血管腔内疗效的关系。结果显示,CTA诊断下肢血管闭塞病变部位、狭窄程度与DSA诊断结果均具有较高一致性(P<0.05);病变血管长度>1.41 cm、血管狭窄程度4级、病变血管远端CT值>62.65 Hu、钙化性斑块是下肢血管闭塞病变血管腔内治疗失败的危险因素(P<0.05)。CTA检查是诊断下肢血管闭塞病变的可靠方法,通过检查患者病变血管长度、血管狭窄程度、远端CT值及管腔内粥样斑块性质,有助于降低治疗盲目性,提高血管腔内治疗成功率。     

CTA联合CTP在预测急性脑梗死预后中的价值

本研究探讨CT血管成像(CTA)联合CT灌注成像(CTP)在预测急性脑梗死预后的价值。选取急性脑梗死患者102例,分为预后良好组和不良组,分析预后良好和不良患者ASPECTS、CTP参数差异。预后不良患者CTA图像ASPECTS评分<3分明显高于预后良好患者(P<0.05);预后不良患者病灶处脑血容量(CBV)和脑血流量(CBF)明显低于预后良好患者(P<0.05),达峰时间(TTP)和平均通过时间(MTT)明显高于预后良好患者(P<0.05);ASPECTS评分联合CBV、CBF及MTT预测预后不良的ROC曲线下面积为0.895(P<0.05),灵敏性和特异性分别为90.00%和84.10%。CTA联合CTP预测急性脑梗死患者预后有一定应用价值。     

Flow properties of fast three-dimensional sequences for MR angiography

To reduce the scan time of time of flight or phase contrast angiography sequences, fast three-dimensional k-space trajectories can be employed. The best 3D trajectory depends on tolerable scan time, readout time, geometric flexibility, flow/motion properties and others. A formalism for flow/motion sensitivity comparison based on the velocity k-space behavior is presented. It consists in finding the velocity k-space position as a function of the spatial k-space position. The trajectories are compared graphically by their velocity k-space maps, with simulations and with an objective computed index. The flow/motion properties of various 3D trajectories (cones, spiral-pr hybrid, spherical stack of spirals, 3DFT, 3D echo-planar, and shells) were determined. In terms of flow/motion sensitivity the cones trajectory is the best, however, it is difficult to use it for anisotropic resolutions or fields of view. Tolerating more flow sensitivity, the stack of spirals trajectory offers more geometric flexibility.     

Blood flow dynamics and fluid–structure interaction in patient‐specific bifurcating cerebral aneurysms

Hemodynamics plays an important role in the progression and rupture of cerebral aneurysms. The current work describes the blood flow dynamics and fluid–structure interaction in seven patient‐specific models of bifurcating cerebral aneurysms located in the anterior and posterior circulation regions of the circle of Willis. The models were obtained from 3D rotational angiography image data, and blood flow dynamics and fluid–structure interaction were studied under physiologically representative waveform of inflow. The arterial wall was assumed to be elastic, isotropic and homogeneous. The flow was assumed to be laminar, non‐Newtonian and incompressible. In one case, the effects of different model suppositions and boundary conditions were reported in detail. The fully coupled fluid and structure models were solved with the finite elements package ADINA. The vortex structure, pressure, wall shear stress (WSS), effective stress and displacement of the aneurysm wall showed large variations, depending on the morphology of the artery, aneurysm size and position. The time‐averaged WSS, effective stress and displacement at the aneurysm fundus vary between 0.17 and 4.86 Pa, 4.35 and 170.2 kPa and 0.16 and 0.74 mm, respectively, for the seven patient‐specific models of bifurcating cerebral aneurysms. Copyright © 2008 John Wiley & Sons, Ltd.     

Non‐Newtonian blood flow dynamics in a right internal carotid artery with a saccular aneurysm

Flow dynamics plays an important role in the pathogenesis and treatment of cerebral aneurysms. The temporal and spatial variations of wall shear stress in the aneurysm are hypothesized to be correlated with its growth and rupture. In addition, the assessment of the velocity field in the aneurysm dome and neck is important for the correct placement of endovascular coils. This work describes the flow dynamics in a patient‐specific model of carotid artery with a saccular aneurysm under Newtonian and non‐Newtonian fluid assumptions. The model was obtained from three‐dimensional rotational angiography image data and blood flow dynamics was studied under physiologically representative waveform of inflow. The three‐dimensional continuity and momentum equations for incompressible and unsteady laminar flow were solved with a commercial software using non‐structured fine grid with 283 115 tetrahedral elements. The intra‐aneurysmal flow shows complex vortex structure that change during one pulsatile cycle. The effect of the non‐Newtonian properties of blood on the wall shear stress was important only in the arterial regions with high velocity gradients, on the aneurysmal wall the predictions with the Newtonian and non‐Newtonian blood models were similar. Copyright © 2005 John Wiley & Sons, Ltd.     

基于GPU加速的磁共振血管造影图像的并行分割与追踪算法

在应用磁共振血管造影图像进行临床诊断时,临床医生往往需要提取感兴趣区域(Region Of Interest,ROI)的部分血管.这个工作传统上需要手工进行,费时费力.该文提出一种并行的血管分割与追踪算法,利用现代图形处理器(Graphics Processing Unit,GPU)所具备的大规模并行计算能力进行快速的血管分割.首先将三维图像网格化为共面的立方体,并行处理每个立方体,确定立方体中哪些表面有血管通过,以及立方体中哪些体素包含血管.之后再将该结果用于串行的全局分割与血管追踪处理.实验结果表明,利用这种先并行后串行的方法,可以在1 s之内完成全脑血管的分割,分割的结果也更准确.     

Three-dimensional fluid-suppressed T2-prep flow-independent peripheral angiography using balanced SSFP

Accurate depiction of the vessels of the lower leg, foot or hand benefits from suppression of bright MR signal from lipid (such as bone marrow) and long-T1 fluid (such as synovial fluid and edema). Signal independence of blood flow velocities, good arterial/muscle contrast and arterial/venous separation are also desirable. The high SNR, short scan times and flow properties of balanced steady-state free precession (SSFP) make it an excellent candidate for flow-independent angiography. In this work, a new magnetization-prepared 3D SSFP sequence for flow-independent peripheral angiography is presented. The technique combines a number of component techniques (phase-sensitive fat detection, inversion recovery, T2-preparation and square-spiral phase-encode ordering) to achieve high-contrast peripheral angiograms at only a modest scan time penalty over simple 3D SSFP. The technique is described in detail, a parameter optimization performed and preliminary results presented achieving high contrast and 1-mm isotropic resolution in a normal foot.     

Automated vessel segmentation using cross-correlation and pooled covariance matrix analysis

Time-resolved contrast-enhanced magnetic resonance angiography (CE-MRA) provides contrast dynamics in the vasculature and allows vessel segmentation based on temporal correlation analysis. Here we present an automated vessel segmentation algorithm including automated generation of regions of interest (ROIs), cross-correlation and pooled sample covariance matrix analysis. The dynamic images are divided into multiple equal-sized regions. In each region, ROIs for artery, vein and background are generated using an iterative thresholding algorithm based on the contrast arrival time map and contrast enhancement map. Region-specific multi-feature cross-correlation analysis and pooled covariance matrix analysis are performed to calculate the Mahalanobis distances (MDs), which are used to automatically separate arteries from veins. This segmentation algorithm is applied to a dual-phase dynamic imaging acquisition scheme where low-resolution time-resolved images are acquired during the dynamic phase followed by high-frequency data acquisition at the steady-state phase. The segmented low-resolution arterial and venous images are then combined with the high-frequency data in k-space and inverse Fourier transformed to form the final segmented arterial and venous images. Results from volunteer and patient studies demonstrate the advantages of this automated vessel segmentation and dual phase data acquisition technique.     

A 3D balanced-SSFP Dixon technique with group-encoded k-space segmentation for breath-held non-contrast-enhanced MR angiography

A three-dimensional balanced steady-state free precession (b-SSFP)-Dixon technique with a novel group-encoded k-space segmentation scheme called GUINNESS (Group-encoded Ungated Inversion Nulling for Non-contrast Enhancement in the Steady State) was developed. GUINNESS was evaluated for breath-held non-contrast-enhanced MR angiography of the renal arteries on 18 subjects (6 healthy volunteers, 12 patients) at 3.0 T. The method provided high signal-to-noise and contrast renal angiograms with homogeneous fat and background suppression in short breath-holds on the order of 20 s with high spatial resolution and coverage. GUINNESS has potential as a short breath-hold alternative to conventional respiratory-gated methods, which are often suboptimal in pediatric subjects and patients with significant diaphragmatic drift/sleep apnea.     

Use of cine phase-contrast MRI in the assessment of distal splenorenal shunt function

Magnetic resonance imaging (MRI) features of a surgical splenorenal shunt in a 28-year-old girl are described. The woman underwent color doppler ultrasonography during follow up for the shunt, which was inconclusive. MR was used to investigate the function of the shunt. Velocity and flow direction in splanchnic vessels and in the shunt were evaluated using cine fast phase-contrast sequences. MR findings could be of help in the evaluation of patients undergoing surgical shunts during follow up.