脑缺血性病变中各种血管成像方法的价值及其局限性

脑缺血性病变是由脑动脉或／和颈动脉的狭窄或阻塞所致。随着对脑缺血性病变治疗工作的深入，临床对脑缺血性病变的诊断提出了更高的要求。本综述了各种血管成像方法，包括ＭＲ成像成像，ＣＴ血管成像，ＤＳＡ，ＴＣＤ和ＴＣＩ在脑缺血性病变中的价值、局限性及解决的办法。     

MRA与CDS对头颈部动脉狭窄或闭塞的对照研究

目的：探讨ＴＯＦ法ＭＲ血管成像（ＭＲＡ）所箜呈闭塞与彩色多普勒超声（ＣＤＳ）所探查的血流状态的关系,为提高ＭＲＡ诊断狭窄或闭塞的准确性提供依据。材料与方法：地３２例脑缺血性疾病患者（１３５支动脉）进行ＭＲＡ和ＣＤＳ的双盲法对照研究,同时以ＤＳＡ为对照标准,对８例患者进行ＭＲＡ、ＣＤＳ的对照分析。结果：在ＭＲＡ诊断的动脉狭窄中,ＣＤＳ表现为高速血流的占５２．５％,低束 流者占４７．５％;ＴＯＦ法ＭＲ     

脑血管畸形的MRI及MRA诊断

目的：研究脑动静脉畸形与海绵状血管瘤的ＭＲＩ及ＭＲＡ特征，评价不同的成像方法对脑血管畸形的诊断价值。材料与方法：对２１例脑动静脉畸形及６例海绵状血管瘤分别作了常规ＭＲ成像及ＭＲ血管成像，ＭＲＩ采用ＳＥＴ１和Ｔｕｒｂｏ ＳＥ Ｔ２加权序列，ＭＲＡ采用２Ｄ－ＦＬＡＳＨ及３Ｄ－ＦＩＳＰ序列，６例海绵状血管瘤ＭＲＡ仅使用２Ｄ－ＦＬＡＳＨ序列。所有成像以环形激化头线圈在１．０Ｔ ＭＲ仪上完成。结果：Ｔ１及Ｔ     

MK-801对脑缺血保护作用的扩散加权成像研究

目的 通过观察ＭＫ－８０１对兔大脑中动脉阻塞模型（ＭＣＡｏ）局灶缺血扩散加权像（ＤＷＩ）的影响。分析缺血区水分子扩散下降以及ＤＷＩ异常区容积增长双峰的机制,讨论ＤＷＩ在脑缺血神经保护药物中疗效与作用机制保的价值。方法 共１２只新西兰大白兔,随机分为２组,结扎左侧大脑中动脉形成局灶脑缺血,在结扎前１０ｍｉｎ分别经耳缘静脉注入ＭＫ－８０１与生理盐水。动态进行ＭＲＤＷＩ与常规序更的扫描。结果 ＭＣＡｏ后     

急性脑缺血及再灌注磁共振扩散加权成像的特点

目的 用改良的线栓法制作大脑中动脉阻塞（ＭＣＡＯ）动物模型,探讨急性脑缺血及再灌注的磁共振扩散加权成像（ＤＷＩ）的特点。方法 １８只Ｓｐｒａｇｕｅ－Ｄａｗｌｙ大白鼠,随机分为４组：Ａ组（６只）,非再通组;Ｂ、Ｃ、Ｄ组（各４只）,分别是于ＭＣＡＯ３０分钟、１小时、２小时后再通,于不同时间点作ＤＷＩ和Ｔ２ＷＩ,通过后处理得到表观扩散系数（ＡＤＣ）像并计算感兴趣区的ＡＤＣ、相对ＡＤＣ（ｒＡＤＣ）及ＤＷＩ     

门静脉3D DCE MRA成像的价值与常规门静脉造影对照研究

与常规门静脉造影对照,评价门静脉三维动态态增磁共振血管成像（３－ｄｉｍｅｎｓｉｏｎａｌｄｙｎａｍｉｃｃｏｎｔｒａｓｔｅｎｈａｎｅｄＭＲＡ,３ＤＤＣＥＭＲＡ）显示门静脉开放性及侧支循环的能力。材料与方法：共有２０例患者做了门静脉ＤＤＣＥＭＲＡ成像,分析门静脉３ＤＤＣＥＭＲＡ上门脉主干,肝内门脉     

动态增强MRA的临床研究

目的与常规ＭＲＡ比较，并以手术或ＤＳＡ作为金标准，评估动态增强磁共振血管成像（ＤＣＥＭＲＡ）的图像质量和应用价值。方法４０例共１３２条体部血管同时作了常规ＭＲＡ和ＤＣＥＭＲＡ检查，前者以二维时间飞跃法（２ＤＴＯＦ）ＭＲＡ为主，后者以三维（３Ｄ）ＤＣＥＭＲＡ为主，部分病例屏气扫描（２０～３０秒），快速注射ＧｄＤＴＰＡ２０ｍｌ（０．１５～０．２ｍｍｏｌ／ｋｇ），造影剂注射速度和扫描时间依据靶血管的性质、部位、范围而定。结果４０例中３５例发现有血管病变，与手术或其他影像学方法检查结果一致。３０例主动脉弓及弓上分支、腹主动脉、腔静脉及门静脉的显示满意率，２ＤＴＯＦＭＲＡ为４０％，ＤＣＥＭＲＡ为９６％，颈动脉及下肢血管则分别为９０％、７０％。利用配对计数资料χ２检验，前者两种方法有显著性差异（χ２＝１６．６５，Ｐ＜０．００１），后者无显著性差异（精确卡方检验：χ２＝０．５８，Ｐ＞０．０５）。结论ＤＣＥＭＲＡ为新的磁共振血管成像技术，克服了常规ＭＲＡ的许多缺点，尤其对胸腹部血管，两种方法血管显示满意率有极显著性差异。屏气薄层３ＤＤＣＥＭＲＡ技术，几乎达到与ＤＳＡ相仿的结果，其临床应用潜能极大。     

MR血流成像（MRA）在肺部的应用

ＭＲＡ能用于肺内疾病的诊断。成像以横断面为主，常用梯度回波脉冲（ＧＲＥ）序列和２ＤＴＯＦ、３Ｄ ＴＯＦ及电影ＭＲ成像。ＭＲＡ可直接显示血栓信号；电影ＭＲ可准确显示中央性肺栓塞；肺ＭＲＡ还可显示胸部肿瘤所致的改变；ＭＲＡ上，肺ＡＶＭ与肺血管高信号相似，电影ＭＲ可观察到异常引流血管。ＭＲＡ对肺动脉夹层动脉瘤、肺隔离症、肺动脉高压的诊断也极有意义。肺ＭＲＡ具有核素和普通血管造影所不具备的许多优点。     

磁共振技术在血管成像中的应用

传统的血管造影术创伤重 ,并发症多 ,亦有死亡报道。随着成像技术的不断发展 ,常规ＭＲＡ ,动态增强磁共振血管成像(ｄｙｎａｍｉｃｃｏｎｔｒａｓｔ -ｅｎｈａｎｃｅｄｍａｇｎｅｔｉｃｒｅｓｏｎａｎｃｅａｎｇｉｏｇｒａｐｈＤＣＥＭＲＡ) ,ＭＲ数字减影血管成像 (ＭＲｄｉｇｔａｌｓｕｂｔｒａｃｔｉｏｎａｎｇｉｏｇｒａｐｈＭＲＤＳＡ)等无创性或微创性检查手段先后应用于临床 ,取得了相当大的进展。现将磁共振技术在血管成像中的应用综述如下 :1　成像原理与方法1.1　常规的ＭＲＡ血液的流动相关增强效应和相位效应是ＭＲＡ的两个基…     

Gd-DTPA增强的T1W与T2W MR尿路成像对比

目的 :评价Ｇｄ ＤＴＰＡ增强的Ｔ1Ｗ排泄性ＭＲ尿路成像(ＥＭＲＵ )与Ｔ2 Ｗ (ＨＡＳＴＥ)ＭＲ尿路成像在儿童上尿路疾病中的应用。材料和方法 :在前瞻性研究中 ,共有 63位年龄在 3周～ 15岁之间的儿童接受 1.5Ｔ的ＭＲ成像仪的ＭＲＵ检查。在静脉注射 0 .0 5ｍｇ/ｋｇ(按体重计 )的速尿前后 ,获得经呼吸触发的ＨＡＳＴＥ图像。随后在经呼吸门控下的ＥＭＲＵ检查中 ,静注Ｇｄ ＤＴＰＡ对比剂 ,获得冠状位 3Ｄ梯度回波序列图像。结果 :如与Ｔ2 Ｗ (ＨＡＳＴＥ)ＭＲ尿路成像相比 ,Ｇｄ ＤＴＰＡ增强的Ｔ1ＷＭＲ尿路成像在诊断非扩张性集合管…     

十六排螺旋CT血管造影对颅内病变的应用价值初探

目的：探讨十六排螺旋CT血管造影在颅内病变中的应用价值及其技术优势。材料和方法：采用GE公司的Lightspeed十六排螺旋CT对自发性脑内出血、动脉瘤、脑肿瘤等共76例病人行CTA检查，对血管显示情况进行评价。其中1例AVM和2例动脉瘤进行了DSA检查并与CTA结果比较，另外7例颅内及颜面部AVM及7例脑肿瘤病人与手术结果比较。结果：76例病人CTA检查结果如下：脑血管主干及其1～3级分支显示率为100％，大脑中动脉4～5级分支显示率为94．7％(72／76)。发现动脉瘤6例，清晰显示了瘤体、瘤颈、载瘤动脉及其详细关系；9例AVM，清楚地显示了AVM的畸形团及其供血动脉和引流静脉；7例脑肿瘤显示了肿瘤与周围血管、颅骨间的三维关系；Moyamoya病1例，清晰显示了基底节区的烟雾血管。结论：十六排螺旋CT血管造影重建图像质量明显提高，可显示更细小分支，对颅内各种血管性病变的诊断及显示血管与颅内其他病变三维空间关系具有重要价值，可作为动脉瘤等其他血管性病变筛选的首选方法。     

Acute massive subdural hematoma caused by rupture of internal carotid artery aneurysm during angiography: a case report

We present a case of acute, massive subdural hemorrhage caused by rupture of an internal carotid artery aneurysm during the procedure of cerebral angiography. To our knowledge, a case like the present one has been reported only once in the English-language literature. The incidence, mechanisms, treatment, and prognosis of (1) subdural hematoma, caused by rupture of cerebral aneurysm, and (2) re-rupture of aneurysm during the angiography procedure are discussed. Electronic Publication     

Measurement of regional cerebral blood flow and oxygen utilisation in patients with cerebral tumours using 15O and positron emission tomography: Analytical techniques and preliminary results

Summary Regional cerebral blood flow and oxygen utilisation have been studied in 8 patients with brain tumours using continuous inhalation of C¹⁵O₂ and ¹⁵O₂ and positron emission tomography. The methods used to analyse the regional cerebral pathophysiology are presented. A relative uncoupling between oxygen consumption and blood flow was observed in all tumours as indicated by a decreased regional fractional extraction of oxygen (rOER). This suggests that a major proportion of these tumours had sufficient blood supply to meet oxygen metabolic demand. A decrease of blood flow in grey matter was found both in the affected and contralateral hemispheres of the brain. Matched reductions of flow and oxygen utilisation were observed in oedematous tissue.     

新生儿缺氧缺血性脑病的MRI评价

目的：评价MRI对新生儿缺氧缺血性脑病（HIE）的诊断价值。资料与方法：采用SE序列对61例（65例次）HIE患儿进行了MRI检查，分析MRI表现。结果：56例新生儿期检查中脑水肿42例，内囊后肢信号异常22例，脑出血11例，脑室出血4例，脑室旁白质软化2例。9例婴儿期检查者中表现有脑室扩大7例，脑外间隙增宽9例，髓鞘发育延迟3例。结论：MRI有助于明确HIE的脑损伤情况，对于预后的评估有价值。     

脑分水岭梗死血管造影分析

目的:分析脑分水岭梗死(CWI)血管造影的表现,探讨脑分水岭梗死与脑血管狭窄的相关性。方法:回顾性分析32例经CT或MR证实的CWI患者的脑血管造影表现。结果:32例CWI患者中发现28例(87.5%)有脑血管狭窄或者闭塞,4例(12.5%)血管造影正常。前循环大脑中动脉和颈内动脉受累最为常见。后循环受累的血管中以椎动脉最为常见。结论:脑分水岭梗死血管造影显示大部分患者有肯定的脑血管狭窄或者闭塞,及时行脑血管造影检查有利于指导治疗,判断预后。     

脑血管病患者血清一氧化氮合酶水平变化的临床观察

 目的探讨血清中NOS水平的变化与脑血管病发病的关系.方法利用比色法测定27例脑梗塞、15例脑出血和30例健康人血清中NOS水平.结果脑梗塞组与对照组比较,脑出血组与对照组比较,血清中NOS均明显降低,经统计学处理有显著差异(P＜0.01);脑梗塞组与脑出血组比较则无明显差异(P＞0.05).结论脑血管病的发生与血清中NOS水平的降低有关.     

Neoplastic encephalopathy: dynamic CT of cerebral gliomata

Summary Intravenous contrast enhanced dynamic computed tomography of cerebral gliomata reveals a spectrum of patterns which reflect different degrees of neovascularity as well as a variable breakdown in the blood-tumor-barrier both intratumorally as well as between individual tumors. Phenomena not generally associated with gliomas including intrinsic neoplastic and peripheral cerebral hypoperfusion, hyperperfusion, and indications of vascular stealing are also demonstrated with this technique which conceivably explain and are partially responsible for certain aspects of the encephalopathy accompanying cerebral neoplasia. A comparison of the dynamic sequences with conventional selective cerebral angiography further indicates that the more contrast-sensitive dynamic method is potentially superior in the detection of subtle neovascularity.     

Angiographic manifestations of intracerebral cavernous hemangioma

Summary A case of intraventricular cavernous hemangioma is reported, with a review of the literature, especially that dealing with angiography of intracerebral lesions. Dense venous poolings and a localized area of venous stain were observed in this case.     

去铁胺对大鼠脑室出血后慢性脑积水的疗效观察

Objective To discuss the effect of deferoxamine in the treatment of chronic hydrocephalus (CH) after intraventricular hemorrhage (IVH) in rats. Methods A total of 184 female Sprague Dawley rats were randomly divided into normal saline group ( NS group), intracerebroventricular blood infusion group (Group A ) and deferoxamine plus intracerebroventricular blood infusion group ( Group B). The rat CH models were made by infusing autologous whole blood ( 130 μl) into the right lateral cerebral ventricle. The escape latency time was detected by Morris water maze at days 14 and 28.The rats were sacrificed 1,3, 7, 14, 28 days later, the transverse diameter of the lateral ventricle on the coronal slice of rat brain 0.4 mm posterior to the bregma was measured for evaluation of hydrocephalus and the index of ventricle. Pathological changes of the brain were observed. Results No CH was found in the NS group. The incidence of CH in the Group A was 73% (11/15), which was significantly higher than 27% (4/15) in Group B at day 28. The escape latency time in the NS group was (8.21 ± 2.00) s,which was significantly shorter than ( 16.36 ±5.93 ) s of the Group A ( P ＜0.01 ). There was no significant difference in the escape latency time between the NS group and Group B [(11.38 ± 2.57 )s] (P ＞0.05 ). The index of ventricle in the NS group was 1.05 ± 0.41, which was smaller than 4.53 ± 1.70 in Group A and 2.77 ± 1.53 in Group B (P ＜ 0.05 ). There were no obvious pathological changes in the NS group at different time points. There found edema of white matter surrounding the ventricle, twist and engorged callosum, proliferation of rhagiocrine cell as well as hemosiderin deposit in Group A. However, no hemosiderin deposit was found in Group B. Conclusions The content of iron in the cerebrospinal fluid may be correlated with hydrocephalus after IVH. Preventive use of deferoxamine can reduce incidence of hydrocephalus after ICH.     

脑白质疏松与脑梗塞和脑萎缩之间关系的探讨

目的：探讨脑白质疏松，脑梗塞与脑萎缩合并或独立发生的规律，原因和临床意义，材料与方法：对２５６例头颅ＣＴ显示三合并或单独存在的住院病人进行回顾性分析，同时找出脑白质疏松和脑萎缩发现率与年龄增长的关系。结果：在脑白质疏松，脑梗塞与脑萎缩中，一病与二病合并率分别为８９．６％，６５．８％和６１．６％，脑白质疏松与脑萎缩合并出现时，轻，中，重程度同步的占５３．２％二的发现率与年龄增长呈高度正相关，γ值