缺血性脑血管病的MRA诊断

目的:评价磁共振血管成像(MRA)对诊断缺血性脑血管病的能力和意义。材料和方法:分析109例经临床及CT、MRI诊断为缺血性脑血管病患者的MRA影像。使用1.0T超导磁共振机,在常规T_1、T_2加权成像后,用三维TOF法以willis环为中心进行轴位成像。结果:MRA能较为清晰地显示颈内动脉、椎、基底动脉、大脑前、中、后动脉主干的中度以上狭窄或闭塞。109例患者中共显示动脉狭窄75支,动脉闭塞108支,均与梗塞区域及临床症状相符合。结论:MRA对脑动脉的显示具有清晰、准确、对比度好、绝大多数(82％)无伪影等优点。与MRI结合使用,能更为准确地判定缺血性脑血管病的类型、范围及程度。     

Relationship between renal capsular artery feeding and size of VX-2 carcinoma implant in the rabbit kidney

When regional intraarterial infusion is applied in the treatment of malignant tumors it is essential to reach the tumor via all its major feeder vessels. In this study VX-2 carcinoma was implanted into the lower pole of the left kidney in 24 rabbits to investigate whether the renal capsular artery takes part in tumor feeding. The rabbits were divided into four groups that were followed for 8, 10, 12 or 14 days after tumor implantation. At that time the renal artery was ligated close to the kidney and subsequently silicone rubber or barium sulfate/gelatin suspension was injected into the capsular artery. The tissue was cleared, and the tumor carefully removed and examined microscopically for traces of silicone rubber. When barium sulfate had been injected, the kidney was examined radiographically in order to detect possible presence of contrast medium in the tumor. This study revealed no vascular supply to the implanted VX-2 carcinoma from the capsular artery when the tumor was confined intracapsularly, i.e., up to 12 days after tumor implantation in untreated rabbits.This investigation was performed at the Oncological Research Laboratory, Department of Diagnostic Radiology, University of Bergen, Bergen, Norway     

MSCT支气管动脉三维成像对中心型肺癌的血供研究

目的：探讨多层螺旋CT(MSCT)三维支气管动脉成像在中心型肺癌中的影像学表现．为显示中心型肺癌的血供来源及介入治疗提供理论依据。方法：对18例中心型肺癌的患者行MSCT造影增强检查，采用实时螺旋薄层CT扫描，在独立工作站行支气管动脉三维重建，使用不同的旋转轴观察支气管动脉的空间解剖细节。结果：其中6例(33．33％)中心型肺癌的支气管动脉三维图像能够清晰显示出支气管动脉的起源、走行的路径(肺内段和纵隔段)和血管直径等。有肺动脉明显狭窄截断的病例支气管动脉显示率最高，且明显增粗，表明此类肺癌的血供来源主要以支气管动脉为主。三维成像中以容积再现(VR)技术显示最佳。结论：MscT三维支气管动脉成像能够准确、直观地显示支气管动脉的空间解剖特点，为中心型肺癌的血供研究及介入治疗提供理论基础。     

肺癌侵犯中央肺动脉继发肺低灌注的CT与DSA对照研究

目的　探讨肺癌侵犯中央肺动脉继发肺低灌注的CT特征及其诊断价值。方法　对2 0例手术及病理证实的肺癌侵犯中央肺动脉 (cancerousinvasionofcentralpulmonaryarteriesinlungcancer,CICPA)患者术前肺血管DSA及增强螺旋CT(含高分辨率CT ,即HRCT)征象行前瞻性对照研究。根据DSA和CT胸膜下末梢肺动脉分布和数量变化 ,即肺血管征、肺毛细血管充盈度和肺实质强化后密度及时间 密度曲线变化 (即肺实质征 ) ,行两者间的盲法对照 ,统计学分析CT与DSA征象及其一致性 ,评估CT对CICPA继发肺低灌注的诊断价值。结果　 2 0例手术病理证实的CICPA病例中 ,共3 0支肺叶动脉受累 ,DSA显示 90 % (2 7/3 0 )出现肺叶低灌注征象 ,CT诊断肺低灌注敏感度为 78%(2 1/2 7) ,特异度 10 0 % (3 /3 ) ,准确度 80 % (2 4/3 0 )。肺低灌注与CPA狭窄程度无明显相关性 (rs=0 40 ,P =0 0 73 )。CT与DSA的肺血管征一致性较好 (Kappa =0 69,P <0 0 0 1) ,而肺实质征一致性稍差 (Kappa =0 3 7,P =0 0 11)。结论　肺低灌注是肺癌侵犯中央肺动脉的常见表现 ,CT对其定性诊断具有重要价值 ,而定量判断有一定限度     

选择性冠状动脉造影评价常规心电图ST-T改变在冠心病中的诊断价值

目的:评价常规心电图检查中ST-T改变在冠心病诊断中的价值。方法:以选择性冠状动脉造影为对照,研究连续194例病人临床症状及心电图ST-T改变与造影结果的关系。结果:造影发现136例病人有明显的冠状动脉狭窄性病变,58例未发现明显病变。非典型心脏症状的病人无论是否有ST-T的异常,冠状动脉造影的阳性率仅4%～14％,而典型症状伴有ST-T异常的病人阳性率较高(89.4％)。结论:ST-T异常伴有典型心脏症状的诊断冠状动脉病变的可靠指标。     

大脑中动脉狭窄的TCD与DSA检查比较研究

目的 :通过大脑中动脉狭窄的TCD检查与DSA检查方法比较 ,为临床提供方便可靠的检查方法。方法 :对经TCD检查确诊为大脑中动脉狭窄 6 0例做DSA检查 ,对两种检查结果进行比较分析。结果 :经TCD确诊为大脑中动脉狭窄病例 ,病变侧狭窄处的血流速度(Vm)均明显高于健侧一倍以上 ,在动脉硬化性狭窄中多伴有“海鸥鸣”或“铁锅炒沙”样杂音 ,且频谱形态呈圆钝或脉动指数值增高的阻力波形。该 6 0例在DSA的检查中均出现不同部位的不同狭窄。结论 :TCD检查具有快速方便、安全、经济、确诊率高的优点 ,可作为脑血管病首选检查手段     

Transorbital penetrating head injury with a hunting arrow: Case report

The development of more complex and diverse hunting weapons may result in an increase of uncommon forms of penetrating injury to the brain. We present a case of non-fatal transorbital arrow injury to the brain. High velocity projectile injuries merit certain management adaptations from gunshot or low velocity stab wounds. This case highlights the necessity for anterograde removal of the arrow in the direction of its line of trajectory. Early assessment of the patient with cerebral angiography to identify surgically correctable vascular injury is recommended.     

腹部CTA检查的质量保证

目的:探讨螺旋CT血管造影(Spiral CT angiography,SCTA)技术,以期提高SCTA造影的质量。材料与方法:采用Somatom Plus 4螺旋CT扫描系统对10例病人行腹部SCTA检查。扫描技术和造影剂参数按病变范围和性质而定,三维重建采用最大强度投影法(MIP)或表面阴影显示法(SSD)或弯曲平面重建法(CPR)。结果:SCTA检查技术能可靠地显示血管形态和病变,评价腹部肿瘤与邻近血管关系。结论:SCTA是无创伤性的血管成像术,在很大范围可替代创伤性的血管造影。     

三维时间飞跃法MR血管造影血液铸型诊断颈内动脉系颅内动脉瘤的优势

目的　与多层面螺旋CT三维血管造影 (MS 3D CTA)和DSA比较 ,探讨三维时间飞跃法MR血管造影 (threedimensionaltimeofflightMRA ,3DTOFMRA)图像后处理血液铸型技术 (fly around)诊断颈内动脉系颅内动脉瘤的优势和临床应用价值。方法　 18名疑诊颈内动脉系颅内动脉瘤病人 ,男 4例 ,女 14例 ;年龄 17～ 76岁 ,平均 4 9 8岁 ;其中蛛网膜下腔出血 (SAH) 14例、动眼神经麻痹 4例。所有病人均接受 3DTOFMRA和MS 3D CTA检查 ,17名接受DSA检查 ,确诊后均经手术治疗。 3DTOFMRA用Toshiba 1 5T超导型MR系统VISART的 3D TOF序列采集原始数据。其参数为 :TR 30ms,TE 6 8ms ,反转角 2 0° ,视野 (FOV) 17cm× 19cm ,矩阵 16 0× 2 5 6 ,采集层块厚度 5 0～ 6 0mm ,层厚 1 2mm ;原始图像后处理方法采用最大密度投影 (MIP)和血液铸型。MS 3D CTA用Toshiba多层螺旋CT Aquilion采集原始数据。其参数为 :扫描速度 0 5s/r,层厚 1 0mm ,螺距 3 5 ;用高压注射器静脉注射非离子型对比剂 ,注射剂量 2 0ml/kg体重 ,注射流率 4 0～ 5 0ml/s ,延迟时间 15～ 18s ;原始图像后处理方法同 3DTOFMRA。图像后处理工作站均用SGIO2 ,后处理软件为Alatoview ,版本 1 4 2。DSA用SiemensMulti StartOT经股动脉插管行常规脑动脉四血管造影     

Comparison of Asymmetry in Cerebral Blood Flow Between Brain Hemispheres Using Digital Subtraction Angiography

BACKGROUND AND PURPOSE: Recently, endovascular techniques have gained significant therapeutic potential for both treatment and prevention of stroke. Cerebral angiography, which is an essential component of these procedures, has been used to provide morphological information regarding condition of blood vessels. In this study, we propose to determine the possibility of acquiring information regarding cerebral blood flow (CBF) in addition to morphologic information from data routinely available during angiography. METHODS: Digital subtraction angiography sequences were obtained for eight patients having occlusive disease in internal carotid artery (ICA) territories. Two regions-of-interest (ROIs) corresponding to the two brain hemispheres on AP view were delineated. For each image, the average pixel value within each ROI was calculated and used to generate time-density curves. Indices obtained from each curve were compared with each other and with the results obtained from the single photon emission computed tomography (SPECT) studies performed a pre- or postangiography procedure. RESULTS: Comparison between ICA stenosis and cerebral perfusion measurements revealed that cerebral perfusion deficit can be independent of arterial occlusive disease. The indices obtained from the time-density curves exhibit a correlating trend with the results from SPECT studies. However, lack of sufficient sample data prevented any meaningful statistical analysis to be conducted. CONCLUSIONS: We have developed a technique for utilizing the angiographic data for the important task of routinely and easily measuring CBF. Availability of CBF measurements during cerebral angiography may favorably impact upon the appropriate use of endovascular procedures and potentially contribute to the reduction of morbidity and mortality associated with stroke.