螺旋CT平扫在腔隙性脑梗塞诊断中的应用价值

目的：探讨螺旋CT平扫在腔隙性脑梗塞诊断中的应用价值。方法：回顾性分析本院螺旋CT扫描,分别采用5 mm及10 mm不同层厚观察临床及其它检查诊断为腔隙性脑梗塞病例200例。结果：5 mm层厚扫描100例,诊断为腔隙性脑梗塞95例,共发现病灶120个;10 mm层厚扫描100例,诊断腔隙性脑梗塞50例,发现病灶51个。结论：螺旋CT、5 mm以下层厚扫描是诊断腔隙性脑梗塞的可靠方法。     

CT脑灌注成像在基底节区腔隙性脑梗死的初步应用

目的 探讨CT脑灌注成像在基底节区腔隙性脑梗死的应用价值.资料与方法 对35例超早期(发病＜6 h)基底节区腔隙性脑梗死患者行常规CT头颅平扫及CT脑灌注成像.在常规轴位CT扫描后选取基底节区层面,经肘静脉团注45 ml非离子型对比剂,同时开始持续40 s的单层连续动态扫描,重组的40幅动态图像使用CT脑灌注软件进行处理,获得灌注图像.测量双侧基底节区感兴趣区的局部脑血流量(CBF)及局部灌注达峰时间(TTP),并进行定量分析.结果 35例基底节区腔隙性脑梗死患者中有29例被后期追踪CT或MRI证实为基底节区腔隙性脑梗死,其中20例梗死灶直径＞5 mm(＜20 mm),9例病灶＜5 mm;余6例CT复查为阴性而临床诊断为脑梗死.20例梗死灶直径＞5 mm(＜20 mm)中有17例CT灌注为阳性,表现为CBF明显低于正常侧,TTP明显长于正常侧;另外3例未发现灌注异常区.20例梗死灶直径＞5 mm(＜20 mm)患者患侧及对侧的局部灌注平均CBF分别为(384.9±118.7)ml·min-1·L-1和(256.2±80.3)ml·min-1·L-1,两者比较差异有统计学意义(t=5.898,P＜0.01);患侧及对侧的局部平均TTP分别为(12.8±3.4)s和(9.6±3.8)s,双侧对比差异亦有统计学意义(t=7.104,P＜0.01).9例病灶＜5 mm患者中,仅2例CT灌注为阳性,患侧及对侧局部灌注平均CBF分别为(448.0±137.8)ml·min-1·L-1和(422.2±229.6)ml·min-1·L-1,两者比较差异无统计学意义(t=0.664,P＞0.5);患侧及对侧局部平均TTP分别为(10.1±2.0)s和(9.3±1.3),两侧之间差异无统计学意义(t=1.039,P＞0.5).结论 CT脑灌注成像能为基底节区腔隙性脑梗死提供有价值的脑血流动力学信息,为临床超早期诊断和治疗提供依据.     

MRI在脑微出血与腔隙性脑梗死相关性研究中的应用

目的:利用MRI研究脑微出血(CMBs)与腔隙性脑梗死的相关性。方法:收集颅脑MRI受检者284例,行常规MRI序列及磁敏感加权成像(SWI)序列扫描。记录CMBs及腔隙性脑梗死位置、数目,分析CMBs、腔隙性脑梗死分布位置以及病变程度,分别统计皮层-皮层下区(CSC区)、基底节-丘脑区(DGM区)、幕下区(IT区)的CMBs、腔隙性脑梗死数目并进行相应分级;再根据脑内所有CMBs及腔隙性脑梗死数目总和对每例患者进行分级,分析两者在发病部位、病变等级之间相关性,统计各年龄组CMBs、腔隙性脑梗死发生率。利用SPSS 13.0软件对数据进行统计分析。结果:284例受检者中腔隙性脑梗死215例,CMBs 97例,腔隙性脑梗死患者CMBs发生率约40%。CMBs、腔隙性脑梗死数目分别为1～93、1～41个不等;CMBs、腔隙性脑梗死具有共同的好发部位,CSC区rs=0.450,P=0.004;DGM区,rs=0.406,P=0.000;IT区,rs=0.441,P=0.000。CSC区、DGM区、IT区的CMBs病变程度随腔隙性脑梗死病变程度的升高而升高(P=0.000);脑内所有CMBs与腔隙性脑梗死病变程度呈显著相关性(P=0.000);腔隙性脑梗死、CMBs的发生率随年龄的增大而升高。结论:颅脑MRI常规扫描序列结合SWI序列检测腔隙性脑梗死和CMBs,可以更加科学指导脑血管患者的诊断治疗、跟踪观察及预后判断。     

皮层下脑梗死体积演变及其与临床预后关系的MRI研究

目的:探讨磁共振测量皮层下脑梗死患者梗死灶体积变化,及其对于判断临床预后的价值。方法:搜集40例首次单发皮层下脑梗死患者,腔隙性脑梗死组患者19例,非腔隙性脑梗死组21例。全部研究对象均在症状出现后7天、15天、1月、3月、6月进行五次MRI检查。患者每次MRI检查前或检查后由两名有经验的神经内科医师,应用NIHSS量表对患者进行临床评分。比较腔隙性脑梗死组及非腔隙性皮层下脑梗死组内不同时间点脑梗死灶体积、NIH-SS评分的差异;对腔隙性脑梗死组及非腔隙性皮层下脑梗死组病灶体积与NIHSS评分进行相关性分析。结果:腔隙性脑梗死患者的病灶体积,随检查时间延长而逐渐减小;不同时间点的体积之间有显著性差异(P0.01);患者的NIHSS评分,随检查时间延长而逐渐降低;不同时间点的评分之间有显著性差异(P0.01)。非腔隙性皮层下脑梗死患者的病灶体积,虽然随检查时间延长而逐渐减小,但不同时间点的体积之间无显著性差异(P0.05);患者的NIHSS评分,随检查时间延长而逐渐降低,不同时间点的评分之间有显著性差异(P0.01)。腔隙性脑梗死患者第1次检查的病灶体积,与随访的NIHSS评分均无明显相关(P0.05)。非腔隙性皮层下脑梗死患者第1次检查的病灶体积,与随访第4次和第5次的NIHSS评分均呈明显正相关(P0.01)。结论:磁共振成像对监测皮层下脑梗死灶体积演变及其与临床预后的关系有重要价值。     

磁共振扩散加权成像对急性腔隙性脑梗死的诊断价值

目的 :探讨急性腔隙性脑梗死患者的脑部磁共振扩散加权成像 (MRDWI)表现及其ADC值变化。方法 :搜集急性脑梗死病例 5 4例 ,根据MRI显示病灶的位置、形态和最大直径 ,分为急性腔隙性脑梗死组 ( 3 9例 )和急性大面积脑梗死组 ( 15例 )。选正常对照组 5例。结果 :3 9例急性腔隙性脑梗死病例均有不同程度MRDWI表现 ;其ADC值与急性大面积脑梗死组之间差异无显著性意义。结论 :MRDWI对急性腔隙性脑梗死的诊断具有很好的敏感性和特异性 ,结合ADC图和ADC值则可作出更准确的诊断     

自拟温肾和血汤治疗腔隙性脑梗死69例临床观察

腔隙性脑梗死的诊断主要为CT或MRI检查。笔者对69例腔隙性脑梗死患者配合使用自拟方温肾和血汤治疗,取得了良好疗效。     

腔隙性脑梗死应用CT与核磁共振检查的诊断价值对比评价

目的 分析CT以及核磁共振(MRI)对于腔隙性脑梗死(lacunar infarction, LI)的诊断价值。方法 选择2018年4月-2022年4月入院诊断的66例腔隙性脑梗死患者。予以随机数字表分组,观察组33例实行MRI检查,对照组33例实行CT检查,对比病灶位置检出率、病灶定位准确度、检查指标和诊断精准度。结果 观察组对于病灶位置的检出率接近于对照组(P>0.05)。观察组对于发病短于24 h的病灶定位几率高出对照组(P<0.05),观察组对于其他发病时间的病灶定位几率接近于对照组(P>0.05)。观察组的检查时间长于对照组,检出病灶直径小于对照组,检查费用高于对照组(P<0.05)。观察组的诊断准确率、敏感度高于对照组,观察组的漏诊率低于对照组(P<0.05)。观察组的诊断特异度与漏诊率对比于观察组无差异(P>0.05)。结论 MRI对于腔隙性脑梗死的病灶定位准确度更高,诊断精准度更高,可以减少疾病漏诊情况,但其检查时间偏长,费用偏高,可以结合患者的经济条件和主观意愿合理选择诊断方式。     

MRI与CT在多发性脑梗死中诊断价值比较

目的探讨MRI与CT应用于多发性脑梗死诊断价值。方法选取武汉市汉口医院自2015年2月至2017年2月收治的87例多发性脑梗死患者为研究对象,所有患者均行MRI及CT检查,观察MRI与CT对不同发病时间、部位及病变大小患者的梗死灶检出结果及血管性痴呆检出结果。结果患者发病时间<24 h,MRI检出率为96.4%(27/28),高于CT的14.3%(4/28),差异有统计学意义(P<0.05)。患者发病时间>24 h时,两种检查方法检出率比较,差异无统计学意义(P>0.05)。MRI检出病变大小≤2 mm、>2 mm梗死灶分别为76处、43处,CT则分别为28处、42处。MRI检出凹陷部位梗死灶8处,CT仅2处。MRI与CT的血管性痴呆者检出率分别为94.7%(54/57)、93.0%(53/54),差异无统计学意义(P>0.05);MRI非血管性痴呆检出率为90.0%(27/30),高于CT的66.7%(20/30),差异有统计学意义(P<0.05)。结论 MRI及CT检查均是诊断多发性脑梗死的重要辅助诊断方法,但MRI对于发现早期病灶、小病灶、凹陷部位梗死灶等有明显优势,可为痴呆病因提供参考依据,为疾病的治疗提供指导意见。     

神经精神狼疮的MRI诊断

目的:探讨神经精神狼疮(NPSLE)的MRI表现特点.方法:回顾性分析2007年3月～2011年6月本院98例SLE患者头颅磁共振成像表现.结果:有36例诊断为神经精神狼疮,其头颅MRI改变主要有脑梗死14例,多发腔隙性缺血灶6例],梗死伴出血5例,脑萎缩5例,单纯脑出血4例等.患者颅内病灶数量多1～2个,可累及各脑叶、侧脑室旁、基底节区、脑干等,而发生在额叶和顶叶的病灶数量明显多于其他部位.结论:神经精神狼疮的脑MRI影像表现多样.对于无临床症状但高度怀疑为神经精神狼疮的SLE患者,进行头颅MRI检查在辅助诊断中可起到重要作用.     

DWI对急性脑梗死病情及预后的评估价值

目的 :探讨DWI对急性脑梗死病情及预后的评估价值。方法 :选择92例急性脑梗死患者,根据脑梗死面积分为大面积梗死组、中小面积梗死组和腔隙性梗死组;根据脑梗死数量分为单发性梗死组、多发性梗死组;根据脑梗死部位分为幕上梗死组、幕下梗死组、幕上幕下梗死组。采用神经功能缺损评分评价患者的疗效及预后。结果:大面积梗死组的疗效显著低于中小面积梗死组和腔隙性梗死组,死亡率和神经功能缺损评分显著高于中小面积梗死组和腔隙性梗死组,差异有统计学意义(均P0.05);中小面积梗死组和腔隙性梗死组的疗效、死亡率和神经功能缺损评分比较,差异均无统计学意义(均P0.05)。多发性梗死组的疗效显著低于单发性梗死组,死亡率和神经功能缺损评分显著高于单发性梗死组,差异均有统计学意义(均P0.05)。幕上幕下梗死组的疗效显著低于幕上梗死组和幕下梗死组,死亡率和神经功能缺损评分显著高于幕上梗死组和幕下梗死组,差异均有统计学意义(均P0.05);幕上梗死组和幕下梗死组的死亡率和神经功能缺损评分比较,差异均无统计学意义(均P0.05)。结论:急性脑梗死患者的疗效及预后与DWI的脑梗死面积、数量及部位有关,DWI表现可指导急性脑梗死患者的疗效及预后。     

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     

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.     

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.