TCD与DSA,MRA,CTA蛛网膜下腔出血中应用对比研究

应用经颅多普勒超声（ＴＣＤ）、数字减影血管造影（ＤＳＡ）、磁共振血管成像（ＭＲＡ）、ＣＴ血管造影（ＣＴＡ）对２４例蛛网膜下腔出血（ＳＡＨ）病人进行了对照研究。通过ＴＣＤ诊断血管痉挛和狭窄性病变１９例（７９％），治疗前后动态观察发现脑底动脉平均流速（Ｖｍ）增高。诊断颅内压增高２例（８．３％）Ｖｍ降低。血管造影等放射影像学检查，发现动脉瘤８例，动脉炎样改变６例，动脉痉挛２例，正常者８例，总异常率为６６．６％。通过超声与放射影像学比较发现，两者可以从不同角度显示脑血管的功能或病理状态。     

3D—CTA,MRA和DSA对脑动静脉畸形成像的对照性研究

目的：评价数字减影血管造影（ＤＳＡ）、三维计算机断层扫描血管造影（３Ｄ－ＣＴＡ）和磁共振血管成像技术（ＭＲＡ）对于脑动静脉畸形（ＡＶＭ）甩像的价值。方法 ４３例ＡＶＭ前瞻性对照研究,结果 ３Ｄ－ＣＴＡ阳性率１００％,与ＤＳＡ比较;供血动脉的来源,数目和形态１００％吻合,引流静脉３３例完全吻合（７８．６％）,９例部分吻合（２１．４％）;病灶部位、大小以及深度１００％吻合。ＭＲＡ阳性率９５．８％,１例假阴性（４．２％）。与ＤＳＡ影像比较,供血动脉１７例完全吻合（７０．８％）,６例部分吻合（２５．０％）;引流静脉１４例完全吻合（５８．３％）,９例部分吻合（３７．５％）,病灶部位、大小以及深度９８．５％吻合。结论 ＤＳＡ是脑ＡＶＭ成像的“金标准”。３Ｄ－ＣＴＡ和ＭＲＡ技术的发展为ＡＶＭ影像不诊断提供了高准确性,无创性的     

磁共振血管成像诊断脑血疾病（10例MRA和DSA对照）

１０例做ＭＲＡ的患者与其中同时做ＤＳＡ（９例）及手术（１例）的患者进行对照分析，５例ＭＲＡ结果与ＤＳＡ一致，包括２例大脑中动脉起始部闭塞，１例大脑中动脉主干狭窄，２例血管畸形。另５例中，１例ＭＲＡ检查结果显示大脑中动脉主士闭塞，但ＤＳＡ仅显示该段动脉狭窄，２例ＭＲＡ显示两侧颈内动脉虹吸部闭塞，ＤＳＡ除有上述发现外，还检出肪底部异常血管网，１例ＭＲＡ显示左侧颈内血流来自前、后交通动脉，ＤＳＡ检查结果     

磁共振血管成像诊断脑血管疾病(10例MRA和DSA对照)

０例做ＭＲＡ的患者与其中同时做ＤＳＡ（９例）及手术（１例）的患者进行对照分析，５例ＭＲＡ结果与ＤＳＡ一致，包括２例大脑中动脉起始部闭塞，１例大脑中动脉主干狭窄，２例血管畸形。另５例中，１例ＭＲＡ检查结果显示大脑中动脉主干闭塞，但ＤＳＡ仅显示该段动脉狭窄，２例ＭＲＡ显示两侧颈内动脉虹吸部闭塞，ＤＳＡ除有上述发现外，还检出脑底部异常血管网，１例ＭＲＡ显示左侧颈内血流来自前、后交通动脉，ＤＳＡ检查结果为左侧主动脉弓颈总动脉起始部的闭塞，１例ＭＲＡ显示前交通动脉的动脉瘤，瘤腔大小为１．０ｃｍ×０．９ｃｍ，手术中证实为２．０ｃｍ×１．０ｃｍ，部分瘤腔内有血栓样物质充填。本组资料说明ＭＲＡ能较清晰地显示颅内血管畸形、动脉瘤、Ｗｉｌｉｓ动脉环和大动脉的闭塞和狭窄病变，不足之处为（１）ＭＲＡ可因血管闭塞或动脉瘤腔内有血栓样物质不能准确反映瘤腔大小。（２）目前ＭＲＡ仅能检出大动脉及其一、二级分枝。（３）ＭＲＡ显示动脉狭窄可有病变“夸大现象”。     

磁共振扩散成像诊断急性脑梗死

目的：评价扩散成像（ＤＷＩ）磁共振对急性脑梗死的诊断价值。方法：用ＤＷＩ诊断急性脑梗死１０例，并与传统ＣＴ扫描及常规ＭＲＩ结果比较。结果：ＤＷＩ在发病６小时之内已能明确发现脑内相应对高信号灶，常规ＭＲＩ需在发病１２小时后才能显示病灶，其中Ｔ２ＷＩ较Ｔ１ＷＩ敏感，而ＣＴ则需２４小时左右才能显示脑内病灶的存在。ＤＷＩ显示的病灶较Ｔ２ＷＩ稍大，所有新病灶在ＤＷＩ上均为高信号。结论：ＤＷＩ对诊断超早期脑梗     

糖尿病并发脑梗塞的CT表现与临床分析

１临床资料１．１一般资料选自经ＣＴ确诊的脑梗塞１６３例,其中伴糖尿病者为伴糖尿病脑梗塞组（ＣＩＣＤＭ）４１例,非糖尿病脑梗塞为对照组（ＣＧ）１２２例。ＣＩＣＤＭ组：男２４例,女１７例,年龄４６～８１岁,平均６６岁;糖尿病史３～２６年,平均１２年;Ⅰ型１例,Ⅱ型４０例。ＣＩＣＤＭ组全部根据１９８０年ＷＨＯ关于糖尿病诊断标准明确诊断,病后首次血糖６．９～２３．２ｍｍｏｌ／Ｌ,平均１３．３ｍｍｏｌ／Ｌ。合并高血压２５例。ＣＧ组：男７７例,女４５例,年龄４０～７８岁,平均６５岁,既往无糖尿病史,其中血糖…     

缺氧复氧对血管内皮细胞ICAM-1表达及内皮-白细胞粘附的影响

目的：评价缺氧／复氧后血管内皮细胞ＩＣＡＭ－１表达及内皮－白细胞粘附率的变化。方法：体外培养大鼠骨髓血窦内皮细胞,缺氧９０ｍｉｎ,分别给予复氧１ｈ,２ｈ,４ｈ,８ｈ,１２ｈ,２４ｈ,用半定量ＥＬＩＳＡ法测ＩＣＡＭ－１的表达量,同时人皮细胞对中性粒细胞的粘附率。     

伽玛刀治疗脑动静脉畸形

目的评估伽玛刀（γ刀）治疗脑动静脉畸形（ＡＶＭ）的疗效。方法用Ｌｅｋｓｅｌγ刀手术治疗脑ＡＶＭ２１６例并随访１２～３４个月。患者年龄１１～８３岁,ＳｐｅｔｚｌｅｒＭａｒｔｉｎ分级：Ⅰ级４２例,Ⅱ级６８例,Ⅲ级９５例,Ⅳ级７例,Ⅴ级４例。ＡＶＭ体积０３～４３．９ｃｍ３,治疗用周边剂量１２～３０Ｇｙ。结果γ刀治疗后的ＡＶＭ闭塞情况和并发症的发生与其体积、分级、定位方法、周边剂量、剂量规划及质量控制等因素有关。对体积≤５．０ｃｍ３或ＳｐｅｔｚｌｅｒＭａｒｔｉｎ分级＜Ⅲ级及周边剂量≥２０Ｇｙ者,其２年闭塞率超过７８５％。本组有４例γ刀术后再出血,９例并发有明显症状的放射性脑水肿。结论γ刀是治疗脑ＡＶＭ的一种安全、有效的方法,特别是ＳｐｅｔｚｌｅｒＭａｒｔｉｎⅠ～Ⅱ级或体积≤５０ｃｍ３的ＡＶＭ及周边剂量≥２０Ｇｙ者疗效较好。数字减影血管造影（ＤＳＡ）结合磁共振血管造影（ＭＲＡ）联合定位对提高ＡＶＭ的闭塞率、降低并发症有帮助     

丹参对大鼠脑缺血再灌注损伤保护机制的实验研究

目的进一步了解丹参的神经保护作用是否与它能抑制白细胞的粘附有关。方法ＳＤ大鼠大脑中动脉（ＭＣＡ）栓塞２ｈ再灌注１ｈ后，给予丹参（１５ｇ／ｋｇ，ｉｐ）或同等容量的生理盐水（ＮＳ），用激光多谱勒血流仪及流式细胞仪分别测量给药或ＮＳ后１ｈ、６ｈ、１２ｈ脑缺血区的血流量及１２ｈ外周血中白细胞表面ＣＤ１８、ＣＤ１１ｂ免疫阳性细胞数，在再灌注２４ｈ后行脑组织ＨＥ染色。结果丹参明显增加缺血侧ＭＣＡ分布区血流量，降低外周血中白细胞ＣＤ１８及ＣＤ１１ｂ免疫阳性细胞数，抑制ＭＣＡ缺血区白细胞浸润及神经元的坏死。结论丹参的神经保护作用机制可能与封闭外周血中白细胞粘附分子结合位点，抑制白细胞与血管内皮细胞的粘附有关。     

脑底动脉环闭塞症的DSA、CT和MR对照分析

作者报导了７３例脑底动脉环闭塞症的ＤＳＡ、ＣＴ和ＭＲ表现，对照分析其诊断价值。本症ＤＳＡ表现为颈内动脉及其分支狭窄，闭塞，主要累及虹吸部Ｃ１－２段，大脑前，中动脉起始部。脑底部显示纲状异常血管影，有广泛烟雾状侧支循环形成，有时伴有颅内血肿。ＣＴ表现为多发性脑梗塞，平均显示散在性斑点状，片状低密度影。伴脑出血时显示高密度影。ＭＲ表现为病变区为斑片状，点状异常信号，显示长Ｔ１长Ｔ２信号，部分病例局部脑萎缩，脑沟变深变宽，无占位效应。作者对照分析它们各自特点，提出ＤＳＡ是诊断本症的安全可靠的首选检查方法。     

Advanced CT imaging (functional CT).

Computed tomography can provide anatomic and functional information about the brain. The conventional CT of the brain can be coupled with a cerebral blood flow examination using the stable xenon CT technique and with a CT angiography. Distinct subgroups of patients based on variations in cerebral blood flow and vascular pathology have been demonstrated. The addition of the functional information has become extremely important in triaging and determining the appropriate intervention in the patient with an acute neurological deficit.     

Fetal CT

Introduction Fetal CT is helpful in the diagnosis of bony anomalies, particularly with 3D reconstructions.Discussion Because of the potential risks of irradiation, CT should not be performed before 32 weeks' gestation and should be restricted to a carefully selected group of patients.     

Diagnosing Brain Death by CT Perfusion and Multislice CT Angiography

Introduction

Although the diagnosis of brain death (BD) is usually based on clinical criteria, in sedated patients, ancillary techniques are needed. This study was designed to assess the accuracy of cerebral multislice computed tomographic angiography (CTA) and CT perfusion (CTP) in diagnosing BD.

Methods

Prospective observational study in 27 BD patients.

Results

All patients were diagnosed as BD based on clinical and electroencephalogram findings. After BD diagnosis, CTP was performed followed by 64-detector multislice CTA from the aortic arch to the vertex. Images were reconstructed from 0.5 mm sections. In 24 patients, a lack of cerebral blood flow (CBF) was detected by CTP, and CTA revealed luminal narrowing of the internal carotid artery in the neck and absence of anterior and posterior intracranial circulation (sensitivity 89%). CTA detected CBF exclusively in extracranial portions of the internal carotid and vertebral arteries. Two patients with anoxic brain injury and decompressive craniectomy showed CBF in the CTA such that the CTP results were considered false negatives, given BD had been confirmed by clinical and EEG findings, along with evoked potentials. In one clinically BD patient, in whom an alpha rhythm was detected in the electroencephalogram, CBF was only observed in the intracranial internal carotid with no posterior circulation noted. This patient was therefore considered exclusively brain stem dead.

Conclusions

The radiological protocol used shows a high sensitivity and excellent specificity for detecting the cerebral circulatory arrest that accompanies BD. As a rapid, non-invasive, and widely available technique it is a promising alternative to conventional 4-vessel angiography.     

Brain CT perfusion improves intracranial vessel occlusion detection on CT angiography

Background and purpose

To evaluate whether brain CT perfusion (CTP) aids in the detection of intracranial vessel occlusion on CT angiography (CTA) in acute ischemic stroke.

Pediatric metrizamide CT cisternography and CT ventriculography (author's transl)]

We have studied the diagnostic value of computed tomography with metrizamide CSF enhancement in 37 infants. According to the method of injection, we called CT cisternography, CT ventriculography and CT cystography. These methods were useful for the morphologic and dynamic evaluation of the CSF pathways. We used them especially for the evaluation of hydrocephalus, skull base tumor, infantile subdural hematoma and its allied diseases, or congenital cystic lesion such as Dandy-Walker syndrome. The side effects in children are much less than those in adults.     

Processing and interpretation times of CT angiogram and CT perfusion in stroke

OBJECTIVE: To determine the mean time for acquiring computed tomogram perfusion (CTP) and CT angiogram (CTA) images in acute stroke. To determine and compare processing and interpretation times amongst three groups of radiologists with varying degree of expertise: two radiology residents (Group I), two neuroradiology fellows (Group II) and four consultant neuroradiologists (Group III). METHODS: The mean time of acquisition of CTA and CTP studies was calculated among ten patients presenting with acute stroke. All readers had to process the CTA and CTP images, interpret them (for presence or absence of thrombus and penumbra) and save them on the GE Advantage Windows workstation. The mean time for processing and interpreting these studies was calculated. RESULTS: The mean time for acquisition of CTA and CTP studies in the ten patients was 14.6 +/- 5.9 minutes. The time taken for CTA processing and interpretation in Groups I, II and III was 2.3 +/- 1.3 min, 1.6 +/- 0.4 min and 1.5 +/- 0.7 min respectively. The time required for CTP processing and interpretation by the same groups was 5.2 +/- 1.7 min, 4.5 +/- 1.5 min and 4.1 +/- 1.1 min respectively. There was a statistically significant difference of means between Groups I and III in the CTA and CTP processing and interpretation times (p=0.02, p=0.01 respectively) but no statistical difference between Groups I and II (p=0.15, p=0.22 respectively) or Groups II and III (p=0.31, p=0.30 respectively). CONCLUSION: The CTA and CTP studies can be performed, processed and interpreted quickly in acute stroke.