IDose^4迭代重建技术应用于低剂量CT肾动脉血管造影的临床分析

为探讨IDose 4迭代重建技术在低剂量CT肾动脉血管造影中的应用价值,选取205例拟行肾动脉CT血管造影患者,随机将其分为4组,A组(51例)采用管电压100 kV、管电流100 mA,碘海醇370 mg I/mL及IDose 4迭代重建技术,B组(51例)采用管电压100 kV、管电流150 mA,碘海醇270 mg I/mL及IDose 4迭代重建技术,C组(51例)采用管电压80 kV、管电流180 mA,碘海醇270 mg I/mL及IDose 4迭代重建技术,D组(52例)管电压120 kV、管电流120 mA,碘海醇370 mg I/mL及滤波反投影(FBP)重建技术。分析各组图像肾主动脉干CT值、噪声(SD)、信噪比(SNR)和噪声比(CNR),受检者接受CT有效剂量(ED)、容积CT剂量指数(CTDI vol)、剂量长度乘积(DLP)、碘摄入量以及重建图像评分差异和诊断效能。结果显示,A、B、C组重建图像评分优于D组,肾动脉主干CT值、SD、SNR、CNR均高于D组,B、C组肾动脉主干CT值、SD略低于A组。A、B、C组CTDI vol、DLP、ED均低于D组,B组CTDI vol、DLP、ED高于A组。A、B、C、D组诊断肾主动脉狭窄准确率分别为92.68%、86.49%、84.62%、82.86%。证实IDose 4迭代重建技术能降低受试者受辐射和造影剂剂量,提高成像质量,在低剂量CT肾动脉血管造影中具有较高可行性和实用性。     

DSA、CTA联合MR影像评估AIS患者脑支循环及预后性关系

探讨数字减影血管成像(DSA)、计算机断层扫描血管成像(CTA)联合磁共振(MR)影像评估急性缺血性卒中(AIS)患者脑支循环及预后性关系。选取60例大脑中动脉M1段急性闭塞所致AIS患者为研究对象,根据DSA、CTA与MR影像对其脑侧支循环评估,比较患者基线资料、结局指标等,并分析预后性。结果发现:基于DSA、CTA与MR影像对AIS患者脑侧支循环评估结果一致性良好;3种影像模式下脑侧支循环良好组与不良组结局资料差异显著(P<0.05);多因素分析显示,FVH-ASPECTS评分、rLMC评分、ASITN/SIR分级量表均为AIS患者神经功能预后的独立影响因素。总之,DSA、CTA、MR影像对AIS患者脑侧支循环评估具有一致性,且FVH-ASPECTS评分、rLMC评分、ASITN/SIR分级量表均为AIS患者神经功能预后的独立影响因素。     

多层CT与DSA对急性冠状动脉综合征患者冠状动脉支架置入术后通畅性及狭窄程度的影响

研究多层CT与DSA对急性冠状动脉综合征患者冠状动脉支架置入术后通畅性及狭窄程度的影响。以我院2017年8月-2018年11月在我院诊断治疗的急性冠脉综合征患者80例作为研究对象,对所有患者进行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)手术后,分别进行DSA检查以及64排螺旋CT检查。分析不同检查的冠状动脉狭窄、通畅性之间的差异以及不同检查的一致性。通过对CT检查结果以及DSA检查结果的配对卡方检验,两组患者的检查结果之间的差异不存在统计学意义,两种检查对患者的冠状动脉的狭窄情况诊断一致性较好;两种检查方法对患者的管壁厚度以及管径直径诊断之间的差异不存在统计学意义,两种检验方法对患者的管壁厚度以及管径直径诊断一致性较好。总之,多层CT与DSA对急性冠状动脉综合征患者冠状动脉支架置入术后通畅性及狭窄程度的诊断具有较高的一致性,建议临床推广。     

A Small-Molecule Diketopyrrolopyrrole-Based Dye for in vivo NIR-IIa Fluorescence Bioimaging

Organic small-molecule fluorophores with near-infrared IIa (NIR-IIa) emission have great potential in pre-clinical detection and inoperative imaging due to the high-spatial resolution and deep penetration. However, developments of the NIR-IIa fluorophores are still facing considerable challenges. In this work, a series of diketopyrrolopyrrole (DPP)-based fluorophores were designed and synthesized. Subsequently, nanomaterial T25@F127 with significant NIR-IIa emission properties was rationally prepared by encapsulating DPP-based fluorophore T25 , and was selected for fluorescence angiography and cerebral vascular microscopic imaging with nearly 800 μm penetrating depth and excellent signal-background ratio of 4.07 and 2.26 (at 250 and 400 μm), respectively. Furthermore, the nanomaterial T25@cRGD with tumor targeting ability can image tiny metastatic tumor on intestine with a small size of 0.3 mm×1.0 mm and high-spatial resolution (SBR=3.84). This study demonstrates that the nanomaterials which encapsulated T25 behave as excellent NIR-IIa fluorescence imaging agents and have a great potential for in vivo biological application.     

磁共振血管成像在颈动脉狭窄检查中的对比研究

目的研究在颈动脉狭窄检查中采取磁共振血管成像的诊断价值。方法回顾性分析惠州市中心人民医院自2015年12月至2016年12月期间收治的39例颈动脉狭窄患者所有资料,将减影血管造影检查结果作为金标准实行磁共振血管成像检查,分析狭窄检测敏感性、准确性以及特异性。结果磁共振血管成像检查狭窄检测敏感性、准确性以及特异性发生率分别为97.43%、92.31%、94.87%。结论将磁共振血管成像应用在检查颈动脉狭窄中具有显著效果,可以提升准确符合率,值得广泛应用与研究。     

Noncontrast dynamic MRA in intracranial arteriovenous malformation (AVM), comparison with time of flight (TOF) and digital subtraction angiography (DSA)

Digital subtraction angiography (DSA) remains the gold standard to diagnose intracranial arteriovenous malformations (AVMs) but is invasive. Existing magnetic resonance angiography (MRA) is suboptimal for assessing the hemodynamics of AVMs. The objective of this study was to evaluate the clinical utility of a novel noncontrast four-dimensional (4D) dynamic MRA (dMRA) in the evaluation of intracranial AVMs through comparison with DSA and time-of-flight (TOF) MRA. Nineteen patients (12 women, mean age 26.2±10.7 years) with intracranial AVMs were examined with 4D dMRA, TOF and DSA. Spetzler-Martin grading scale was evaluated using each of the above three methods independently by two raters. Diagnostic confidence scores for three components of AVMs (feeding artery, nidus and draining vein) were also rated. Kendall's coefficient of concordance was calculated to evaluate the reliability between two raters within each modality (dMRA, TOF, TOF plus dMRA). The Wilcoxon signed-rank test was applied to compare the diagnostic confidence scores between each pair of the three modalities. dMRA was able to detect 16 out of 19 AVMs, and the ratings of AVM size and location matched those of DSA. The diagnostic confidence scores by dMRA were adequate for nidus (3.5/5), moderate for feeding arteries (2.5/5) and poor for draining veins (1.5/5). The hemodynamic information provided by dMRA improved diagnostic confidence scores by TOF MRA. As a completely noninvasive method, 4D dMRA offers hemodynamic information with a temporal resolution of 50-100 ms for the evaluation of AVMs and can complement existing methods such as DSA and TOF MRA.     

A technique for flow-enhanced magnetic resonance angiography of the lower extremities

A two-dimensional, flow-enhanced gradient echo pulse sequence for nuclear magnetic resonance angiography is described. It employs interleaved, presaturated slices to acquire data efficiently on imagers which favor interleaved acquisition over sequential acquisition for multislice imaging. It is useful on any imager when the effective TR is extended to enhance the sensitivity to slow flow. The technique was applied to the region from aortic bifurcation to the iliac bifurcations of three normal volunteers. The right and left common iliac arteries and veins, the separation of the external and internal iliac arteries, and secondary branches were clearly depicted.     

Collateral circulation prevents masticatory muscle impairment in rat middle cerebral artery occlusion model

The rat suture middle cerebral artery occlusion (MCAO) is a frequently used animal model for investigating the mechanisms of ischemic brain injury. During suture MCAO, transection of the external carotid artery (ECA) potentially restrains blood flow and impairs masticatory muscle and other ECA‐supported territories, consequently influencing post‐operation animal survival. This study was aimed at investigating the effect of ECA transection on the hemodynamic alterations using a novel synchrotron radiation (SR) angiography technique and magnetic resonance imaging in live animals. Fifteen male adult Sprague‐Dawley rats were used in this study. Animals underwent MCAO, in which the ECA was transected. SR angiography was performed before and after MCAO. Rats then underwent magnetic resonance imaging (MRI) to detect the tissue lesion both intra‐ and extra‐cranially. Animals with SR angiography without other manipulations were used as control. High‐resolution cerebrovascular morphology was analyzed using a novel technique of SR angiography. The masticatory muscle lesion was further examined by hematoxylin and eosin staining. MRI and histological results showed that there was no masticatory muscle lesion at 1, 7 and 28 days following MCAO with ECA transection. In normal condition, the ECA and its branch external maxillary artery were clearly detected. Following ECA transection, the external maxillary artery was still observed and the blood supply appeared from the anastomotic branch from the pterygopalatine artery. SR angiography further revealed the inter‐relationship of hemisphere extra‐ and intra‐cranial vasculature in the rat following MCAO. Transection of the ECA did not impair masticatory muscles in rat suture MCAO. Interrupted blood flow could be compensated by the collateral circulation from the pterygopalatine artery.     

Comparison of haemodynamics in cerebral aneurysms of different sizes located in the ophthalmic artery

Haemodynamics plays an important role in the progression and rupture of cerebral aneurysms. The temporal and spatial variations of the wall shear stress in the aneurysmal sac 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 patient‐specific models of saccular aneurysms of different sizes located in the ophthalmic artery. The models were 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 unsteady laminar flow were solved with commercial software using nonstructured fine grid sizes. The intra‐aneurysmal flows show complex vortex structures that change during one pulsatile cycle. A relation between the aneurysm aspect ratio and the mean wall shear stress on the aneurysmal sac is showed. Copyright © 2006 John Wiley & Sons, Ltd.     

微量元素与眼底病

目前已知有十多种微量微元素与眼的正常生理功能有密切关系。且对多种眼病的发生有很大影响，本文综合介绍微量元素锌、铜、硒与视觉功能的密切关系，以及近年来在脉络膜，视网膜、视神经的几种疾病中有关锌、铜、硒的测定研究进展。