犬腹主动脉瘤一种新模型的建立

为建立一种供腔内隔绝术 (EVGE)研究的稳定的腹主动脉瘤 (AAA)动物模型的方法 ,采用了 15只犬 ,体重平均 13 5kg ,以牛颈静脉间置法形成保留腰动脉的肾下型腹主动脉瘤。结果动脉瘤形态良好 ,接近临床形态。动脉瘤参数 :近端瘤颈直径为 (6 0± 0 8)mm ;远端瘤颈直径为 (5 7± 0 6 )mm ;瘤体直径为 (2 2 7± 13 3)mm ,长度 (36 1± 17 9)mm。表明本模型设计针对性强 ,制作规范 ,是进行EVGE器具研制开发、AAA血流动力学研究、EVGE围手术研究的有价值的动物模型     

三维增强磁共振血管成像对颅内小动脉瘤的诊断价值

目的:评价三维增强磁共振血管成像(3DCE MRA)对颅内小动脉瘤的诊断价值.方法:47例3D CE MRA检查提示颅内小动脉瘤的患者,以随后的DSA检查结果为准,分析3DCE MRA的诊断价值.在工作站上用三维容积再现(3D-VR)、最大强度投影(MIP)和多平面重组(MPR)等技术进行观察,并比较MRA和DSA对动脉瘤瘤体最大经线和瘤颈的测量值.结果:47例患者,3D CE MRA共提示有49个颅内小动脉瘤.DSA检查证实其中的40例有小动脉瘤,共50个颅内小动脉瘤.3D CE MRA正确诊断42个(84%),漏诊8个;另7例3D CE MRA提示的颅内小动脉瘤,DSA未见动脉瘤.MRA VR重组时瘤颈的显示率高于MIP及MPR重组,三种方法的显示率分别为76.1%、64.3%和69.1%.50个动脉瘤,MRA、DSA均能清晰显示和测量瘤体最大径线及瘤颈大小的有26个(MRA数据均由3D-VR法测得),VR法测量26个动脉瘤瘤体最大径线及瘤颈均明显大于DSA测量数值(P＜0.0001).结论:3D CE MRA能无创有效地诊断颅内小动脉瘤,对瘤颈的显示效果VR法优于MPR及MIP.对2.5 mm以下小动脉瘤及周边的动脉瘤诊断准确率不高,对动脉分叉处小动脉瘤及动脉圆锥的诊断应谨慎.     

双源CT血管成像在腹主动脉瘤中的临床应用价值

目的：评价双源CT血管成像在腹主动脉瘤中的临床应用价值。方法：回顾性分析33例接受双源CT血管造影及主动脉造影检查确诊为腹主动脉瘤患者的影像资料。所有图像均行三维重建后处理及分析,观察腹主动脉瘤的部位、形态、分型、范围,并对腹主动脉瘤进行分型及相关测量。结果：33例腹主动脉瘤中,5例为近肾型,28例为肾下型。双源CT对瘤体长度、大小,近端及远端瘤颈长度、直径。近端瘤颈与动脉瘤长轴夹角测量准确。结论：双源CT可准确诊断腹主动脉瘤,并且可以提供详细而准确术前信息,是腹主动脉瘤术前诊断和术前评价的首选影像学检查方法。     

智能化血管跟踪MRA在胰肾联合移植中的应用

目的：探讨智能化血管跟踪MRA在胰肾联合移植(SPKT)中的应用。方法：搜集我院SPKT病例5例，采用GE1.5TMR扫描机，先行常规扫描，再行MRCP和MRU检查。在此基础上行Smart Prep MRA成像。所有智能化血管跟踪MRA的源影像均采用IVI软件包进行分析处理。结果：5例SPKT的智能化血管跟踪MRA的腹主动脉远端、髂内外动脉、主要移植动脉及其1～2级分支均清晰显示，其中3例患者血管异常被DSA证实。1例胰腺急性排斥反应者显示胰腺分支血管闭塞，另1例显示脾动脉的动脉瘤形成及血管连接处和胰十二指肠下动脉的近端狭窄。第3例为急性肾脏排斥反应伴肾梗死者显示肾动脉的近端及远端血管闭塞。结论：智能化血管跟踪MRA能显著提高动脉的信噪比，减少流动伪影，进而提高MRA的图像质量。     

颅内动脉瘤栓塞术后的DCE-MRA随访

目的：评价DCE—MRA在颅内动脉瘤栓塞术后随访中的应用价值。方法：回顾分析了56例颅内动脉瘤患者血管内栓塞治疗后的DCE—MRA和DSA随访图像,以DSA为诊断标准,比较两者的随访结果,评价DCE—MRA随访的准确性。DCE—MRA的原始图像减影后行VR、MIP重建,并结合原始图像。结果：56例患者共61个动脉瘤进行了栓塞治疗,随访中发现40个动脉瘤完全栏塞,12个瘤颈残留,9个瘤体复发,动脉瘤的复发率为14．75％。DCE-MRA与DSA随访结果有良好的一致性（k=0．871,P〈0．005）,DCE—MRA随访的准确率达到93．4％,假阳性和假阴性各2例。结论：DCE—MRA是颅内动脉瘤栓塞术后的一种无创、可靠、快速的影像随访方法,有助于监测术后瘤颈残留和瘤体复发,指导临床进一步治疗。     

MRI及三维增强MR血管成像对鞍区动脉瘤的诊断价值

目的 评价MRI及三维增强MR血管成像(3D CE MRA)对鞍区动脉瘤的诊断价值.方法 18例鞍区动脉瘤患者行头颅MRI检查,其中14例行头颅MRI及3D CE MRA检查,1例行DSA检查.3D CE MRA原始图像减影后至工作站用实时三维容积显示技术进行三维重组.结果 18例MRI检查均诊断为鞍区动脉瘤.14例行3D CE MRA检查明确显示动脉瘤的位置、形态、大小,位于颈内动脉虹吸段共12例,左侧6例,右侧6例,位于颈内动脉颅内段2例,左侧1例,右侧1例.结论 MRI及3D CE MRA对鞍区动脉瘤能无创性准确定位定性,基本满足临床需求,为临床治疗提供更准确的依据,可作为首选的影像检查方法.     

基于MR血管成像数据和快速原型技术建立类似于人颈内动脉虹吸段动脉瘤的犬模型

目的 建立载瘤动脉类似于人体颈内动脉虹吸段形态的犬动脉瘤模型.方法 用3.0 T MR行3维(3D)-时间飞跃(TOF)-MR血管成像(MRA)序列采集人头颅横断面医学数字图像通讯(DICOM)格式图像,导人Materialise Mimics和Pro-E软件重组,做出带孔管状3D数字模型.根据该文件利用快速原型技术制作出 TangoPlus材料的实体模型并硅胶涂层.分别将6只实验犬左侧颈总动脉远端和右侧颈总动脉近端结扎离断.将游离的左侧颈总动脉通过黑线牵引从下而上,游离的右侧颈总动脉从右剑左穿过模型,并从模型上的孔牵出.处理游离的双侧颈总动脉外膜后,行端侧吻合,得到形态类似于人颈内动脉虹吸段动脉瘤形态的动脉瘤模型.动物模型完成后即刻及1周MRA随访,1周行血管造影并置入测试支架测试.结果 6只犬均成功建立了形态类似于人颈内动脉虹吸段动脉瘤的动脉瘤模型.MRA显示6只犬的载瘤动脉通畅,显影良好.置人支架后1只犬死亡;5只术后1个月随访,模型内血管均通畅,其中3只弯曲处血管变扁,2 只无明显管腔形态改变.结论 制作的模型弯曲血管与人体颈内动脉虹吸段形态高度相似,可作为颅内神经介入材料及其输送系统的研究测试以及神经介入医师培训的工具.     

3D DSA在颅内动脉瘤介入诊疗中的应用价值

目的评价3D DSA在颅内动脉瘤诊疗中的作用,并与2D DSA比较。方法50个破裂的颅内动脉瘤均行2D DSA及3DDSA检查。观察2D DSA及3D DSA(VR)对颅内动脉瘤瘤颈和瘤体形态的显示,评估血管内栓塞治疗的可行性。获取血管内栓塞治疗的参考图像。通过对瘤颈和瘤体的测量,正确选择第1枚弹簧圈的直径及长度。结果50个破裂的颅内动脉瘤中,2D DSA能清楚显示14个动脉瘤的瘤颈;VR能清楚显示所有动脉瘤的瘤颈。2D DSA能清楚显示26个动脉瘤的形态;VR能清楚显示所有动脉瘤的形态。2D DSA认为6例不能行血管内栓塞治疗;3D DSA显示全部能行血管内栓塞治疗并栓塞成功。49个颅内动脉瘤行血管内栓塞治疗时均从3D DSA获取参考图像。48个第1枚弹簧圈选择正确。结论3D DSA在评估颅内动脉瘤血管内栓塞治疗的可行性、获得参考图像、动脉瘤精确测量等方面具有重要的临床价值。     

三维对比增强MRA诊断股动脉假性动脉瘤的价值

目的 评价三维对比增强MR血管成像技术对股动脉假性动脉瘤的诊断价值.方法 对19例临床拟诊断为股动脉假性动脉瘤的患者(其中1例破裂)行三维对比增强MRA检查,并与手术病理结果进行对照.结果 19例患者共显示假性动脉瘤瘤体18个(1例破裂未显示瘤体),呈囊袋状与母体血管相连,其中11例呈宽基底与母体血管相连,6例显示窄颈与母体血管相连,1例未显示瘤颈.动脉瘤起始部位分别为股动脉主干7例、股动脉与股深动脉根部10例,股深动脉1例.6例显示病变血管周围侧枝循环血管建立.结论 三维对比增强MRA对股动脉假性动脉瘤的临床诊断和治疗具有重要的参考价值.     

椎基底动脉开窗畸形的CTA和MRA诊断

目的 探讨椎基底动脉开窗畸形的影像学特点及其临床意义.资料与方法回顾性分析22例椎基底动脉系统开窗畸形的影像学表现和临床表现.22例中,15例行头颈联合CT血管造影(CTA)检查,6例行头部MR血管造影(MRA)检查,1例行颈部MRA检查,其中4例同时行数字减影血管造影(DSA)检查.结果 22例椎基底动脉开窗畸形均为单发,9例位于椎动脉,其中5例位于颅外段,4例位于颅内段;其余13例均位于基底动脉近段.根据血管窗形态分型:10例为裂隙型,9例为凸透镜型,3例为重复型.所有病例均表现为椎基底动脉局限性重复,22例中4例伴有颅内动脉瘤,1例伴有左侧颈总动脉起源异常.结论 CTA和MRA可以准确显示椎基底动脉开窗畸形的位置、形态和毗邻关系,诊断开窗畸形时应注意有无伴发其他血管性病变.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.