组织运动二尖瓣位移技术评价急性心肌梗死患者左心室收缩功能

目的 应用组织运动二尖瓣环位移技术(TMAD)评价急性前壁心肌梗死患者左心室收缩功能并探讨其临床应用价值.方法 选择经冠状动脉造影确诊的急性前壁心肌梗死患者30 例,健康者30 例,常规行超声心动图检查,测量左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)和左心室射血分数(LVEF),采用TMAD 技术,测量二尖瓣环6 个位点的收缩期最大位移(Ds),计算6 个位点的收缩期最大位移平均值,与用简化的双平面Simpson 法计算的LVEF 进行相关分析.结果 与对照组相比,AMI 组的LVEDV 、LVESV 均显著增加(均P ＜0.01 ),LVEF 显著减低(P ＜0.01 ).AMI 组前室间隔、前壁二尖瓣环2 个位点的Ds 较对照组显著减低(均P ＜0.001 );其他4 个位点的Ds 及平均Ds 较对照组亦减低(均P ＜0.01 ).正常组二尖瓣环6 个位点平均Ds 与LVEF 呈正相关(r ＝0.833,P ＜0.01 ),AMI 组二尖瓣6 个位点平均Ds 与LVEF 亦呈正相关(r ＝0.678,P ＜0.01 ).结论 TMAD 是一种快速估测左心室收缩功能的半定量方法 ,可作为评价急性前壁心肌梗死患者左心室收缩功能的一种新的简便方法 .     

组织运动二尖瓣环位移自动追踪技术评价充血性心力衰竭患者左心室收缩功能

目的 探讨定量组织运动二尖瓣环位移技术(TMAD)对充血性心力衰竭患者(CHF)左心室收缩功能的评价作用.方法左心衰患者和健康志愿者各40例,二维测量左心室舒张末期内径(LVEDd)、舒张末期容积(LVEDV)、收缩末期容积(LVESV)和射血分数(LVEF).使用TMAD技术,测量二尖瓣环6个位点的收缩期最大位移(Ds)、最大位移达峰时间, 并将平均Ds与简化双平面Simpson法计算出的左心室射血分数(LVEF)进行相关分析.结果与对照组相比,HF组的LVEDd、LVEDV、LVESV均显著增加(P<0.01),LVEF显著减低(P<0.01).HF组二尖瓣环6个位点DS比正常组显著减低,差异有统计学意义(P<0.01).HF组二尖瓣环6个位点DS的达峰时间与正常对照组相比显著增加(P<0.01).正常组二尖瓣环6个位点平均Ds与LVEF呈显著正相关(r＝0.853,P<0.01),HF组二尖瓣环6个位点平均Ds与LVEF呈正相关,但较正常组低(r=0.419,P<0.05).结论 TMAD作为一种新技术成为简单、准确、客观地评价心力衰竭患者左心室收缩功能的新途径.     

肥厚型心肌病左心室整体与节段纵向收缩功能及同步性的组织运动瓣环位移研究

目的 采用组织运动瓣环位移技术(TMAD)定量分析肥厚型心肌病(HCM)患者左室整体与节段纵向收缩功能及同步性,探讨其应用价值和可行性.方法 连续选择非梗阻型肥厚型心肌病患者(nHCM)39例,同期选择性别、年龄相匹配的健康人39例作为对照组.采用二维斑点追踪技术(2D-STI)测量左室整体与节段纵向应变(LSR)以及采用QLAB8.1软件测量二尖瓣环6个位点(室间隔,侧壁,前间隔,后壁,前壁和下壁)二尖瓣环位移(MAD)以及达峰时间,计算二尖瓣环整体位移(MADglobal)以及左心室收缩期不同步化指数(SDI).分析LSR与MAD的相关性,比较两组MAD、SDI等参数.结果 TMAD有效跟踪节段数显著高于STI(98.7％对77.9％,P＜0.001).TMAD测量MAD与STI测量左室节段纵向应变(r=-0.784,P＜0.001)和整体应变(r=-0.897,P＜0.001)显著相关.与对照组比较,nHCM患者左室六个位点MAD以及MADglobal均显著减低(P均＜0.001),SDI显著增加(P＜0.001).结论 TMAD是评价nHCM患者左室纵向整体与节段收缩功能以及同步性的新方法.     

组织多普勒超声心动图测量瓣环运动判断移植心脏急性排异反应

目的 探讨应用组织多普勒超声心动图检测移植心脏二、三尖瓣环的运动判断移植心脏急性排异反应的价值.方法 对8例心脏移植受者共进行52次超声检查,其中5次出现急性排异反应,47次无排异反应.记录心尖长轴、四腔及两腔切面的组织多普勒图像,测量二尖瓣环的后间隔、侧壁、下壁、前壁、后壁及前间隔6个位点以及三尖瓣环侧壁位点的收缩期、舒张早期峰值速度(Vs、Ve)、收缩期位移(Ds),并计算二尖瓣环6个位点收缩期及舒张早期峰值速度、收缩期位移的平均值.结果 急性排异反应的心脏移植受者二尖瓣环各位点的Vs、Ve、Ds均较无排异反应的心脏移植受者减低,但仅后间隔位点的Ve、Ds及前间隔、前壁位点的Vs、Ve、Ds减低具有统计学意义(P<0.05),二尖瓣环6个位点舒张早期峰值速度的平均值、收缩期位移的平均值也较无排异反应的心脏移植受者显著减低(P<0.05);急性排异反应的心脏移植受者三尖瓣环的Vs、Ve、Ds均较无排异反应的心脏移植受者显著减低(P<0.05).结论 应用组织多普勒超声心动图测量二、三尖瓣环运动速度及位移可简便无创监测心脏移植后急性排异反应,三尖瓣环运动异常对于急性排异反应的诊断可能更有价值.     

组织运动二尖瓣环位移自动追踪技术对心脏再同步化治疗短期疗效的评价

目的 探讨定量组织运动二尖瓣环位移技术(TMAD)对心脏再同步化治疗(CRT)患者短期疗效的评价作用.方法 使用TMAD技术测量26例慢性充血性心力衰竭(CHF)患者CRT前和CRT 1个月后左室壁二尖瓣环6个位点的收缩期最大位移(Ds)、二尖瓣环6个位点达峰时间的标准差(Td-sd)以及任意两位点收缩期最大位移达峰时间的最大差值(Tds-diff),并将平均Ds与简化双平面Simpson法计算的左室射血分数(LVEF)、左室收缩末容积(LVESV)及左室面积变化分数(FAC)进行相关分析.结果 CRT 1个月后二尖瓣环6个位点Ds及平均Ds比CRT前显著增高,差异有统汁学意义(P<0.01);Tds-diff较CRT前减少,差异有统汁学意义(P<0.05);二尖瓣环6个位点Td-sd较CRT、前减少,差异有统计学意义(P<0.05);二尖瓣环6个位点平均Ds与LVEF、LVESV、FAC呈正相关(r分别为0.419,0.529,0.567,P<0.05).结论 TMAD可以用来评价CRT患者的短期疗效.     

二尖瓣环位移自动追踪技术定量评价左心室心肌致密化不全患者左心室收缩功能的初步研究

目的应用组织运动二尖瓣环位移自动追踪技术(TMAD)评价左心室心肌致密化不全(LVNC)患者左心室收缩功能。方法正常对照组39例,LVNC患者43例。常规二维超声心动图技术测量左心室舒张末期容积(EDV)、左心室收缩末期容积(ESV)、左心室舒张末期内径(LVDd)。应用TMAD技术,测量二尖瓣环侧壁、室间隔、前壁和下壁等4个位点的收缩期最大位移(MAD)、心尖四腔观、两腔观的二尖瓣环中点位移(MADmid4、MADmid2)及其百分比(MADmid4%、MAD-mid2%)。将上述指标进行两组间对比分析,分析二尖瓣环位移参数与简化双平面Simpson法计算出的左心室射血分数(LVEF)之间的关系。结果 (1)与正常对照组比,LVNC组LVEF显著减低(P<0.01),EDV、ESV、LVDd测量值均显著增大(P<0.01)。(2)LVNC组二尖瓣环4个位点的MAD、MADmid4、MADmid2、MADmid4%、MADmid2%均低于正常对照组(P<0.05)。(3)LVNC组二尖瓣环4个位点的MAD、MADmid4、MADmid2、MADmid4%、MADmid2%与LVEF均呈显著正相关(P<0.01),其中MADmid4%、MADmid2%与LVEF的相关系数较高(r=0.753、0.794)。结论应用TMAD法测量LVNC患者的左心室收缩功能与简化双平面Simpson法的相关性良好,TMAD作为一种新技术能简单、准确、客观地评价LVNC患者左心室收缩功能。     

组织运动二尖瓣环位移技术评价扩张型心肌病患者左心室收缩同步性

目的探讨应用组织运动二尖瓣环位移技术(TMAD)评价扩张型心肌病(DCM)患者左心室收缩同步性的价值。方法选取2013年10月至2016年5月吉林大学中日联谊医院收治的DCM患者38例,作为扩张型心肌病组(DCM组),30名健康志愿者作为健康对照组,对DCM组与健康对照组行常规超声心动图检查,测量2组左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF),应用TMAD技术测量二尖瓣环6个位点(前间隔、后间隔、前壁、侧壁、后壁、下壁)的位移达峰时间(TP),计算出二尖瓣环位移达峰时间标准差(TP-SD)、二尖瓣环位移达峰时间最大差(TP-DIF),比较2组患者超声参数,并分析TP-SD、TP-DIF与LVEF的相关性。采用实时三维超声心动图(RT-3D)获取DCM组左心室16个节段的收缩末期容积达峰时间标准差(Tmsv16-SD),16节段收缩末期容积达峰时间最大差(Tmsv16-DIF)并分别与DCM组TP-SD、TP-DIF进行相关性分析。结果 DCM组LVEDV、LVESV测值显著高于健康对照组[(209.87±44.23)mm vs(93.12±12.29)mm,(158.45±41.32)mm vs(32.16±4.03)mm],差异有统计学意义(t=14.023、16.643,P均0.01),DCM组LVEF测值与健康对照组相比明显减低,差异有统计学意义(t=26.112,P0.01);DCM组6个位点的TP、TP-SD、TP-DIF测值均较健康对照组增加,差异有统计学意义(t=7.628、6.869、7.507、6.616、5.631、4.738、7.368、5.777、6.781,P均0.01),TP-SD、TP-DIF与LVEF测值均呈负相关,差异有统计学意义(r=-0.645、-0.513,P均0.05);TP-SD与Tmsv16-SD、TP-Dif与Tmsv16-Dif测值均呈正相关,差异有统计学意义(r=0.643,P0.01;r=0.563,P0.05)。结论本研究通过应用TMAD技术测量二尖瓣环位移达峰时间来评价左心室运动同步性,简便易行,无角度依赖性,有望成为评价左心室同步性的新方法。     

组织二尖瓣环位移在尿毒症心肌病患者中的应用价值

目的 评估组织二尖瓣环位移(TMAD)在尿毒症心肌病(UM)中的应用价值。方法 选择尿毒症患者44例,根据左心室射血分数(LVEF)是否减低分为正常组(NEF组)和减低组(DEF组)。测量常规超声参数、TMAD参数及左心室整体纵向应变(GLS)等。评估TMAD、GLS与LVEF参数的获取率,测量所需要的时间,以及比较各组间TMAD、GLS与LVEF 3种参数的差异,并探讨这3种参数之间的相关性。结果 与LVEF及GLS相比,TMAD参数获取率高,且分析平均时间显著缩短(P<0.05);尿毒症患者LVEF、GLS及TMAD参数均明显小于对照组(P<0.05),且DEF组GLS及TMAD减低更显著(P<0.05);TMAD参数与GLS及LVEF的相关性良好(P<0.001)。结论 TMAD参数可识别UM患者左心室收缩功能障碍,具有参数获取率高,分析简捷、快速等优势。     

组织运动瓣环位移技术评价冠状动脉旁路移植术患者左心室纵向收缩功能

目的 应用组织运动二尖瓣瓣环位移技术（tissue mitral annular displacement,TMAD）测量收缩期二尖瓣环位移（mitral annular displacement,MAD）,评价冠心病患者行冠状动脉旁路移植术（coronary artery bypass graft,CABG）F前、后左心室纵向收缩功能变化。方法 成功行CABG术冠心病患者47例（冠心病组）,分别于术前、术后7d及术后6个月行超声心动图检查获取心尖四腔观、心尖二腔观图像,应用TMAD技术测量二尖瓣环室4个位点（室间隔侧、侧壁侧、下壁侧、前壁侧）MAD,应用双平面法测量二尖瓣环中点收缩期标准化位移（mid-point of mitral annular biplanar normalized displacement,MABND-midpt）,并与同期40例体检健康者（对照组）进行比较。结果 冠心病组术前、术后7d及术后6个月二尖瓣环4个位点MAD及二尖瓣环中点MABND-midpt均低于对照组（P〈0.05）;冠心病组术后7d二尖瓣环室间隔侧、侧壁侧、下壁侧、前壁侧MAD（（9.1±1.0）、（9.6±0.6）、（9.0±1.2）、（9.2±1.0）mm）及二尖瓣环中点MABND-midpt（（10.1±1.0）%）均低于术前（（10.2±1.1）、（11.1±0.9）、（10.7±1.0）、（11.1±1.2）mm和（12.7±1.2）%）（P〈0.05）,术后6个月二尖瓣环室间隔侧、侧壁侧、下壁侧、前壁侧MAD（（12.1±0.7）、（12.6±0.6）、（12.3±1.0）、（12.6±1.2）mm）及二尖瓣环中点MABND-midpt（（14.5±1.1）%）均高于术前（P〈0.05）。结论 CABG术后冠心病患者左心室长轴收缩功能改善,但仍低于正常水平,TMAD可用于评价CABG治疗冠心病的效果。     

三维斑点追踪成像评价2型糖尿病患者左心室应变

目的 应用三维斑点追踪技术评价2型糖尿病(DM)患者左心室应变。方法 对30例2型DM患者(DM组)及30名健康志愿者(对照组)行三维斑点追踪成像,比较两组左心室整体及各节段应变。结果 DM组左心室收缩期整体应变(GS)、整体环向应变(GCS)、整体径向应变(GRS)及整体纵向应变(GLS)均低于对照组(t=2.18、3.27、2.05、3.76,P均<0.05)。DM组左心室前壁及侧壁环向收缩期峰值应变均低于对照组(P均<0.05);前壁基底段、中间段及侧壁径向收缩期峰值应变均低于对照组(P均<0.05);前间隔基底段、前壁基底段和中间段、侧壁中间段和心尖段、下壁心尖段纵向收缩期峰值应变均低于对照组(P均<0.05)。DM组基底段径向及纵向收缩期峰值应变均低于心尖段,中间段纵向收缩期峰值应变低于心尖段(P均<0.05)。对照组基底段环向、径向及纵向收缩期峰值应变均低于心尖段,中间段纵向收缩期峰值应变低于心尖段(P均<0.05)。结论 三维斑点追踪技术可用以评价2型DM左心室整体及节段收缩功能的早期改变。     

Gapping phenomenon of longitudinal meniscal tears

OBJECTIVE: To investigate the gapping behaviour of longitudinal meniscal tears. DESIGN: The gap size of longitudinal meniscal tears was measured in porcine knee joints under various joint loading conditions. BACKGROUND: Many meniscal fixation implants have low pull out forces. However, it is unknown if these forces are less than the forces the implants must resist in vivo. It is also unknown if gapping occurs in longitudinally torn menisci and what joint loads induce gapping. METHODS: Longitudinal tears were set in the medial menisci of eight porcine knee joints. To observe the tears an opaque placeholder of the same shape as the original articular surface replaced the medial tibial plateau. The knees were exposed to flexion-extension cycles in a loading and motion simulator under 30 and 200 N axial joint load without external moments, under tibial rotation moments, varus or valgus moments, and combined moments. For each load condition the maximum gap of the tear was registered. RESULTS: Maximum gapping (1.59 mm, SD 0.47) occurred in the 3 cm tear at 200 N axial joint load under the combination of a valgus and external rotation moment. An internal tibial rotation moment produced the smallest gaps in tears of any length and at any axial joint load. CONCLUSIONS: The maximum gap size found in this study and the previously published pull out stiffnesses of meniscal fixation implants reveal maximum forces on the implant in vivo of only 8.4 N. This explains why meniscal tears fixed with implants of low pull out strength can heal. RELEVANCE: The current study shows that moderate joint loads only lead to small gaps of meniscal tears. Clinically, this means that fixation implants of low pull out strength are not in danger of failure in a normal rehabilitation regimen.     

Consistent sulcal parcellation of longitudinal cortical surfaces

Automated accurate and consistent sulcal parcellation of longitudinal cortical surfaces is of great importance in studying longitudinal morphological and functional changes of human brains, since longitudinal cortical changes are normally very subtle, especially in aging brains. However, applying the existing methods (which were typically developed for cortical sulcal parcellation of a single cortical surface) independently to longitudinal cortical surfaces might generate longitudinally-inconsistent results. To overcome this limitation, this paper presents a novel energy function based method for accurate and consistent sulcal parcellation of longitudinal cortical surfaces. Specifically, both spatial and temporal smoothness are imposed in the energy function to obtain consistent longitudinal sulcal parcellation results. The energy function is efficiently minimized by a graph cut method. The proposed method has been successfully applied to sulcal parcellation of both real and simulated longitudinal inner cortical surfaces of human brain MR images. Both qualitative and quantitative evaluation results demonstrate the validity of the proposed method.     

大脑纵裂硬膜下血肿的影像学诊断

目的探讨大脑纵裂硬膜下血肿的CT及MRI表现和诊断价值。方法回顾性分析我院收治的11例外伤性大脑纵裂硬膜下血肿患者的CT及MRI表现。结果11例大脑纵裂硬膜下血肿位于前纵裂5例,后纵裂4例,全纵裂2例,血肿量最大的28ml,最小的6ml。CT表现为大脑中线部位的带状高密度,一侧贴附于大脑镰,另一侧凸向大脑半球。2例行MRI检查,T1WI呈现为中线部位的带状高信号,T2WI血肿呈等信号。结论CT及MRI检查能对大脑纵裂硬膜下血肿做出正确诊断。     

Modeling longitudinal data in acute illness

Biomarkers of sepsis could allow early identification of high-risk patients, in whom aggressive interventions can be life-saving. Among those interventions are the immunomodulatory therapies, which will hopefully become increasingly available to clinicians. However, optimal use of such interventions will probably be patient specific and based on longitudinal profiles of such biomarkers. Modeling techniques that allow proper interpretation and classification of these longitudinal profiles, as they relate to patient characteristics, disease progression, and therapeutic interventions, will prove essential to the development of such individualized interventions. Once validated, these models may also prove useful in the rational design of future clinical trials and in the interpretation of their results. However, only a minority of mathematicians and statisticians are familiar with these newer techniques, which have undergone remarkable development during the past two decades. Interestingly, critical illness has the potential to become a key testing ground and field of application for these emerging modeling techniques, given the increasing availability of point-of-care testing and the need for titrated interventions in this patient population.     

Idiopathic esophageal varices with longitudinal erosion

A 60-year-old man with idiopathic esophageal varices is presented. Endoscopy and endoscopic ultrasonography clearly demonstrated a longitudinal erosion on one of two straight varices. There was no evidence of portal hypertension, and no abnormality in the superior vena cava system. Peritoneoscopy and liver biopsy were normal. These varices with longitudinal erosion represent unique endoscopic findings as compared with previously reported cases. There has been no variceal bleeding during a 6-year follow-up.     

Data management issues in longitudinal research

Much of the existing literature about the research process has neglected data management. While design, instrumentation, sampling, and analysis are important parts of the process, paying attention to the issues surrounding data management is crucial to the success of the study. Data entry and analysis are facilitated when the details of data structure and management are decided before data collection begins.     

Measuring longitudinal nerve motion using ultrasonography

While it is known that peripheral nerves slide longitudinally in response to limb movements, the clinical relevance of this phenomenon remains largely speculative. This technical note introduces a new application for noninvasive measurement of longitudinal movement of peripheral nerves. The rationale for developing the technique is given including a brief overview of nerve motion theories and how these are related to clinical practice. Current ultrasound applications for nerves and tissue motion are outlined and details of the Doppler measurement procedure are described. Limitations of the technique and potential future applications are discussed. Spectral Doppler ultrasound may provide an effective method for noninvasive quantification of longitudinal nerve motion.     

Global longitudinal strain (GLS)

The International Journal of Cardiovascular Imaging -     

Self-supervised learning of neighborhood embedding for longitudinal MRI

In recent years, several deep learning models recommend first to represent Magnetic Resonance Imaging (MRI) as latent features before performing a downstream task of interest (such as classification or regression). The performance of the downstream task generally improves when these latent representations are explicitly associated with factors of interest. For example, we derived such a representation for capturing brain aging by applying self-supervised learning to longitudinal MRIs and then used the resulting encoding to automatically identify diseases accelerating the aging of the brain. We now propose a refinement of this representation by replacing the linear modeling of brain aging with one that is consistent in local neighborhoods in the latent space. Called Longitudinal Neighborhood Embedding (LNE), we derive an encoding so that neighborhoods are age-consistent (i.e., brain MRIs of different subjects with similar brain ages are in close proximity of each other) and progression-consistent, i.e., the latent space is defined by a smooth trajectory field where each trajectory captures changes in brain ages between a pair of MRIs extracted from a longitudinal sequence. To make the problem computationally tractable, we further propose a strategy for mini-batch sampling so that the resulting local neighborhoods accurately approximate the ones that would be defined based on the whole cohort.We evaluate LNE on three different downstream tasks: (1) to predict chronological age from T1-w MRI of 274 healthy subjects participating in a study at SRI International; (2) to distinguish Normal Control (NC) from Alzheimer’s Disease (AD) and stable Mild Cognitive Impairment (sMCI) from progressive Mild Cognitive Impairment (pMCI) based on T1-w MRI of 632 participants of the Alzheimer’s Disease Neuroimaging Initiative (ADNI); and (3) to distinguish no-to-low from moderate-to-heavy alcohol drinkers based on fractional anisotropy derived from diffusion tensor MRIs of 764 adolescents recruited by the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA). Across the three data sets, the visualization of the smooth trajectory vector fields and superior accuracy on downstream tasks demonstrate the strength of the proposed method over existing self-supervised methods in extracting information related to brain aging, which could help study the impact of substance use and neurodegenerative disorders. The code is available at https://github.com/ouyangjiahong/longitudinal-neighbourhood-embedding.