扩张型心肌病和缺血性心肌病心肌灌注,代谢及功能的综合评价

目的 探讨核素显像在扩张性心肌病（ＤＣＭ）的缺血性心肌病（ＣＡＤ－ＤＭ）诊断及鉴别诊断中的作用。方法 对２８例ＤＣＭ和５５例ＣＡＤ－ＣＭ均行＾９９Ｔｃ＾ｍ－甲氧基异丁基异腈（ＭＩＢＩ）静息心肌灌注ＳＰＥＣＴ及＾１８Ｆ－脱氧葡萄糖（ＦＤＧ）心肌代谢ＰＥＴ显像，其中７３例行核素心室显像，６８例做冠状动脉造影。结果 心肌灌注显像２３例（８２％）ＤＣＭ为不呈节段分布的、散在的稀疏，４例（１４％）有灌注缺损     

静脉动脉化对下肢动脉广泛性闭塞症患者血液流变学的影响

目的：观察两种手术方法对下肢动脉闭塞性病变血液流变学的影响。方法：下肢动脉广泛闭塞症Ⅱ期患者２８（３０肢）例,随机分为治疗组１（静脉动脉化）１８肢,组２（带蒂大网膜移植）１２肢,对照组选健康人３５例,分别于治疗前、治疗后７ｄ、１４ｄ取患肢股静脉血检测。结果：下肢动脉闭塞组治疗前ＢＶ、ＰＶ、ＰＦＣ、ＭＥＴ、ＡＩ均显著高于对照组（Ｐ〈０．０５～０．０１）,静脉动脉化治疗后上述各指标明显下降（Ｐ〈００５     

顺行性下肢深静脉造影表现及临床意义

目的：评价顺行性下肢深静脉造影对下肢静脉疾病诊断、分类及治疗的临床价值。材料与方法：327例病人（447条病肢）采用顺行性下肢深静脉造影，适时点片。结果：原发性深静脉瓣膜功能不全226条（59。5％），深静脉血栓形成后综合征110条（24．6％），原发性浅静脉瓣膜功能不全26条（5．9％），急性深静脉血栓形成23条（5．1％），先天性静脉发育异常13条（2．9％），静脉瘤样病变7条（1．5％）。结论：顺行性下肢深静脉造影对下肢静脉疾病的诊断、分类、治疗有重大指导意义。     

门电路~（99m）Tc－MIBI心肌断层显像法评价心肌血流灌注和室壁功能

门电路~（９９ｍ）Ｔｃ－ＭＩＢＩ心肌断层显像可同时评价心肌血流灌注及心室室壁功能。左室射血分数（ＬＶＥＦ）、室壁收缩分数（ＷＣＦ）、室壁功能低下相对容积（ＤＦＡ）与室壁灌注低下相对容积（ＰＤ）的相关系数分别为－０．７７８３、－０．６３５３和０．９１２５。ＷＣＦ、ＬＶＥＦ和ＶＣＦ值对冠状动脉性心脏病的诊断灵敏度分别为８４．６％、６５．４％和３４．６％。除严重冠脉狭窄时ＬＶＥＦ较低外，不同程度冠脉狭窄或单支、双支、三支冠脉狭窄时各功能参数及ＰＤ值无统计差别。     

用创伤性和非创伤性方法检测双哌达莫对不同程度缺血心脏的作用

在２４ 条急性开胸犬上,用微米狭窄器造成冠状动脉左旋支不同程度的狭窄,分别在轻度狭窄和临界狭窄基础上,静脉给予双哌达莫（０ ．５６ ｍｇ／ｋｇ） 。用创伤性和非创伤性方法检测用药前后的左心室收缩功能的改变。轻度狭窄时,给于双哌达莫后,左室舒张压（ Ｌ Ｖ Ｄ Ｐ） 射血前期与左室射血时间的比值（ Ｐ Ｅ Ｐ／ Ｌ Ｖ Ｅ Ｔ） ,等容收缩时间与左室射血时间的比值（ Ｉ Ｃ Ｔ／ Ｌ Ｖ Ｅ Ｔ） 分别下降３３ ％ ,３０ ％ ,５２ ％ , 冠 脉血 流量（ Ｃ Ｂ Ｆ） , 室内 压最 大上 升速 率［（ｄｐ／ｄｔ） ｍ ａｘ］ ,室内压最大下降速率［（ ｄｐ／ｄｔ） ｍａｘ］ 有升高趋势,心功能得到改善。冠状动脉临界狭窄时, 给予双哌达莫后, Ｌ Ｖ Ｄ Ｐ, Ｐ Ｅ Ｐ／ Ｌ Ｖ Ｅ Ｔ 和 Ｉ Ｃ Ｔ／ Ｌ Ｖ Ｅ Ｔ 分别下降５５ ％ ,２６ ％ 和８７ ％ ,而 Ｃ Ｂ Ｆ, Ｌ Ｖ Ｓ Ｐ,（ｄｂ／ｄｔ） ｍ ａｘ 和（ ｄｐ／ｄｔ） ｍａｘ 分别下降２５ ％ ,３３ ％ ,３８ ％ ,５０ ％ ,心功能进一步恶化。本实验可部分解释临床冠心病做双哌达莫试验所表现的不同结果,为临床合理使用双哌达莫提供了新的依据并提出测量左心室收缩时间间期（ Ｓ Ｔ Ｉ） 结合双哌达莫试验用于诊断冠心病的新?     

超声检查下肢深静脉血栓形成的临床应用

超声检查下肢深静脉血栓形成的临床应用邬青林仙方本文总结了应用二维（２Ｄ），彩色多普勒（ＣＤＦＩ）及脉冲多普勒（ＰＷ）检查下肢深静脉血栓形成（ＤＶＴ）的临床应用。１资料与方法１１５１例ＤＶＴ患者。男２８例，女２３例，年龄１９～８３岁，平均５１岁。病...     

冠心病患者运动时左室容积及压力－容积比值变化的研究

采用放射性核素心室造影结合卧式踏车运动试验，对１５例正常人及４２例冠心病患者左室舒张末容积指数（ＥＤＶＩ）、收缩末容积指数（ＥＳＶＩ）及收缩血压／收缩末容积（Ｐ／ＥＳＶ）等血液动力学参数的运动变化进行了研究．结果，正常人运动时ＥＤＶＩ增加，ＥＳＶＩ降低；冠心病患者ＥＤＶＩ增加，ＥＳＶＩ增加．劳累性心绞痛病人ＥＤＶＩ的增加幅度明显高于正常人及陈旧性心肌梗塞病人．以Ｐ／ＥＳＶ表示左室收缩末压力－容积关系，其运动变化对冠心病诊断的灵敏度为９５％，特异性９３％，准确性９５％．     

数字化顺行性下肢静脉造影的诊断价值

目的用数字化顺行性下肢造影的应用情况,评价其诊断价值。方法采用德国SiemensAx-iomIeonosR200Fleom数字化x线胃肠机对2011年12月至2013年3月158例（172条）下肢进行顺行性静脉造影检查。结果单纯性下肢浅静脉瓣膜关闭功能不全80条（46．5％）,交通静脉瓣膜关闭功能不全12条（7．0％）,深静脉瓣膜关闭功能不全33条（19．8％）,下肢深静脉血栓36条（20．9％）,髂静脉受压综合征5条（2．9％）,静脉畸形骨肥大综合征2条（1．2％）,静脉瘤3条（1．7％）。结论数字化下肢静脉造影是一种安全易行、图像清晰度高、对比度好、分辨率高、检查结果直观、确切的检查方法,能给临床明确诊断及治疗提供可靠的影像诊断依据。     

核素心室显像对急性心肌梗塞远期预后的预测价值

目的：探讨平衡法核素心室显像（ＥＲＮＶ）对急性心肌梗塞（ＡＭＩ）远期预后的预测价值。方法：对８９例于发病后４—６周行ＥＲＮＶ检查的ＡＭＩ患者进行了２３（１２—４２）个月的随访。参照病人预后，将其分为２组：第一组为出院后出现心脏猝死（ＳＣＤ）和（或）心力衰竭（ＮＦ）者（ｎ＝２０）；第二组为出院后无心脏事件者（ｎ＝６９）。并按年龄、性别进行１：２配对。对可能影响其远期预后的１７个参数进行了分析。结果：ＳＣＤ发生率为２．２％；去除年龄及性别因素，左室侧壁射血分数（ＬＡＴ－ＥＦ）、血清肌酸磷酸激酶同工酶（ＣＫ－ＭＢ）是判断ＡＭＩ远期预后的独立有效的危险因子；建立了一预后指数公式：Ｚ＝２．４７６（ＬＡＴ－ＥＦ）＋０．７６０（ＣＫ－ＭＢ），Ｚ越大，ＳＣＤ或ＨＦ发生率越高。结论：ＥＲＮＶ在ＡＭＩ远期预后的预测中有重要作用。     

下肢顺行静脉造影在下肢静脉疾病的应用

目的：分析下肢顺行静脉造影结果与临床诊治下肢静脉疾病的应用价值。材料和方法：我院1991－1996年间112例135条下肢,对临床主要表现下肢静脉曲张或伴溃疡,疑为血管瘤患者进行了肢顺静脉造影。结果：造影表现正常26条（19．26％）,深静脉瓣膜功能不全65条（48．15％）,单纯浅脉瓣膜功能不全13条（9．63％）,交通静脉瓣膜功能不全9条（6．66％）,静脉瘤5条（3．7％）,深静脉血栓形成17条（12．6％）。结论：顺行静脉造影是种简便、安全,创伤小效果好,为临床提供准确的诊治住处,可作为诊治下肢静脉疾病的首选方法,给临床血管外科治疗提供有效依据,对海绵状血管瘤需同时配用瘤体直接穿策造影来确诊。     

Symptomatic lower extremity deep venous thrombosis: accuracy, limitations, and role of color duplex flow imaging in diagnosis

Color duplex flow imaging (CDFI) permits pain- and risk-free direct imaging of the deep venous system of the lower extremities. To prospectively ascertain the accuracy and limitations of this technique, CDFI was performed in 75 lower limbs of 69 consecutive patients referred for venographic evaluation of clinically suspected lower extremity deep venous thrombosis (DVT). The CDFI study was obtained within 24 hours of the contrast venogram. Both studies were interpreted without knowledge of the patient's clinical findings or the results of the other test. Contrast venography was regarded as the standard for diagnosis of DVT. Accuracy was 99% for detection of DVT above the knee and 81% below the knee. Sonographic evaluation of the calf veins was technically adequate in 60% of limbs; accuracy was 98% in this group. In the 40% of limbs with technically limited CDFI studies of the calf, accuracy decreased to 57%. Although small nonocclusive thrombi occurred infrequently in this series of symptomatic patients, CDFI missed three of four such thrombi. It is concluded that CDFI, when not technically compromised, is sufficiently accurate to definitively diagnose symptomatic lower extremity DVT.     

外伤致下肢深静脉血栓的二维及彩色多谱勒超声诊断

目的 :探讨二维及彩色多谱勒超声 (2D CDFI)在下肢深静脉血栓 (DVT)诊断中的应用。方法 :对 30例 5 2条DVT进行 2D CDFI检查 ,平卧位检查股静脉、俯卧位检查静脉及小隐静脉。记录分析每一静脉节段纵切和横切观察资料。结果 :DVT超声可表现为腔内强弱不等回声和充盈缺损 ;CDFI示无血流信号或血流频谱变直。超声诊断符合率为6 0 % (18/30 )。结论 :2D CDFI是临床诊断双下肢深静脉血栓 (DVT)的一个有效方式。     

Colour Doppler flow imaging ultrasonography versus venography as screening method for asymptomatic postoperative deep venous thrombosis

Objective: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on thromboprophylaxis. Methods: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on postoperative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol. Results: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%. Conclusion: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.     

彩色多普勒血流显像在检查下肢深静脉血栓中的应用

目的：探讨彩色多普勒血流显像在诊断下肢深静脉血栓中的价值。材料和方法：对３５例下肢深静脉血栓患者进行彩超检查，年龄２５～７２岁，平４６８岁，其中２６例被Ｘ线静脉造影证实，２例手术证实。结果：下肢深静脉血栓的声像图特征是静脉管腔内出现实性回声，探头加压管腔不能被压瘪；彩色多普勒显示病变处缺乏血流信号或血流信号消失；脉冲多普勒显示频谱异常，即不随呼吸变化。结论：彩色多普勒血流显像具有操作简单，无创伤，可重复检查等优点，是检查下肢深静脉血栓的敏感方法。     

急性下肢深静脉血栓形成的多普勒超声诊断与手术对照

目的 :探讨常规超声和彩色多普勒超声 (CDFI)对急性下肢深静脉血栓形成 (DVT)诊断的价值。方法 :对 94例急性DVT病例进行了常规超声和CDFI检查并经手术证实。结果 :DVT声像表现为静脉内径增宽 ,腔内实质回声 ,按压静脉未变形 ,静脉瓣固定等 ,彩色多普勒可无血流信号或腔内充盈缺损确诊。本组病例均经手术证实 ,无一误诊。结论 :彩色多普勒与常规超声联合应用为诊断急性DVT的首选方法     

Computerized strain-gauge plethysmography - An alternative method for the detection of lower limb deep venous thrombosis?

AIM: To test the ability of computerized strain-gauge plethysmography to act as a screening test for lower limb deep venous thrombosis (DVT). MATERIALS AND METHODS: Over an 8-month period, all patients referred to our Medical Assessment Unit with suspected lower limb DVT were considered for inclusion in the study. Each patient underwent both plethysmography and ascending venography within 24 h, and the presence or absence of thrombus in the popliteal, superficial femoral or iliac veins was noted. The results of the two tests were then used to determine the accuracy of computerized strain-gauge plethysmography in detecting above knee DVT. RESULTS: The screening tests and venograms of 239 patients referred with clinically suspected lower limb DVT were compared. The false negative rate of plethysmography was 15.4%, which is significantly different from the 4.8% claimed by the manufacturers of this device (P = 0.00003). CONCLUSIONS: In a population of acute admissions with suspected lower limb DVT, computerized strain-gauge plethysmography is not suitable for use as a screening test due to an unacceptably high proportion of false negative screens.     

Deep venous thrombosis: withholding anticoagulation therapy after negative complete lower limb US findings

PURPOSE: To establish the safety of withholding anticoagulation therapy after negative findings at a complete lower limb ultrasonographic (US) examination of the symptomatic leg for suspected deep venous thrombosis (DVT). MATERIALS AND METHODS: Regional ethics committee approval and patient consent were obtained. A total of 542 consecutive ambulatory patients presented to the emergency department and were prospectively recruited from April 2001 to May 2003. Of these patients, 16 were excluded, and radiology residents and sonographers performed a complete lower limb US examination by means of compression and Doppler US in 526 patients. Patients with negative US findings received no anticoagulation therapy, and they were observed for occurrence of any thromboembolic event for 3 months. Patients with progressive or new symptoms that were indicative of thromboembolism within the follow-up period underwent objective testing with US, computed tomographic (CT) pulmonary angiography, or both. RESULTS: There were 413 patients (78.5%) with US findings that were negative for DVT and 113 patients (21.5%) with findings that were positive. There were 64 patients (56.6%) with DVT isolated to the calf and 49 (43.4%) with proximal DVT. Of the 413 patients with negative initial US findings, 16 (3.9%) underwent a second US examination for new or progressive symptoms of DVT, one patient (0.25%) underwent CT pulmonary angiography for suspected pulmonary embolism, and one patient (0.25%) underwent both US and CT pulmonary angiography during the 3-month follow-up period. One of these patients (0.24%; 95% confidence interval: 0.01%, 1.3%) developed pulmonary embolism, which was diagnosed with CT pulmonary angiography. DVT was not diagnosed in any patient, and no patient died during follow-up. The negative predictive value of a complete single lower limb US examination to exclude clinically important DVT is 99.6% (95% confidence interval: 98.4%, 99.9%). CONCLUSION: A single negative complete lower limb US examination is sufficient to exclude clinically important DVT, and it is safe to withhold anticoagulation therapy after negative complete lower limb US findings were obtained in patients suspected of having symptomatic lower limb DVT. New or progressive symptoms require further objective imaging.     

Sonography and venography of the lower extremities for diagnosing deep vein thrombosis in symptomatic patients

The purpose of this study was to investigate the efficacy of sonography and the frequency of indeterminate sonographic examinations in the evaluation of patients with suspected lower extremity deep vein thrombosis (DVT). We prospectively evaluated 136 symptomatic patients (157 extremities) with suspected DVT using sonography and contrast-enhanced venography (n=106 patients, 115 extremities). Using venography as the reference standard for diagnosing DVT, the sensitivity and specificity of sonography was 92.8% and 98%, respectively, yielding an accuracy of 96.8%. The frequency of indeterminate examinations for calf DVT was 32.4%. One (0.7%) fatal pulmonary embolus occurred in our patients. The pulmonary embolism (PE) rate was 1.6% after lower extremity sonography with negative results. Sonography is highly accurate in detecting lower extremity DVT in symptomatic patients. Because of the high frequency of indeterminate studies in the calf and the associated possible risk of pulmonary emboli, we urge radiologists exercise additional caution when evaluating symptomatic patients with clinically suspected lower extremity DVT.     

下肢深静脉血栓的彩色多普勒超声诊断

目的：探讨彩色多普勒超声(CDFI)对下肢深静脉血栓(DVT)的诊断要点和临床价值。方法：对30例共34条患肢进行彩超检查，分析其类型、声像图特征，并与X线血管造影进行对照。结果：30例患者中左侧血栓22例(73．0％)，右侧4例(13．3％)，左右侧同时发病4例(13．3％)。34条患肢中中心性血栓18条(53．0％)，外周性8条(23．5％)，广泛性8条(23．5％)。34条受累静脉均有不同程度的扩张且探头加压无管腔压瘪(100％)。急性血栓为均匀低回声，不均匀偏高回声多提示为慢性血栓。CDFI显示受累静脉内血流信号消失或仅有少量溪流。结论：CDF1可为下肢DVT的检出、分类等提供可靠的诊断依据。     

Deep venous thrombosis: complete lower extremity venous US evaluation in patients without known risk factors--outcome study.

PURPOSE: To determine the diagnostic value of venous ultrasonography (US) that includes examination of calf veins in symptomatic patients suspected of having deep venous thrombosis (DVT) of the lower extremities. MATERIALS AND METHODS: A retrospective cohort study of the prevalence of DVT included 977 consecutive patients with possible DVT but without known risk factors for DVT. Color flow and compression US were performed. The outcome was the frequency of overlooked, clinically important DVT after negative initial results from bilateral venous US of above- and below-the-knee veins. Patient records (904 patients), mailed questionnaires (61 patients), and telephone contacts (12 patients) were used to establish a diagnosis of clinically relevant DVT. RESULTS: The prevalence of DVT was 15% (142 of 977), with DVT in 15% (21 of 142) restricted to the below-the-knee veins. Follow-up (median, 34 months) in 835 patients with negative US findings showed one occurrence of venous thrombosis (superficial thrombophlebitis) during the first 3 months of follow-up. Three other cases of venous thrombosis occurred at 17, 18, and 48 months of follow-up but were believed not to be linked to the initial complaint. The incidence of overlooked DVT was 0% (95% CI, 0.0%, 0.4%). CONCLUSION: In patients without risk factors for DVT, a negative venous US study can help exclude the presence of clinically important DVT if the examination includes careful evaluation of the calf veins.