化疗所致心脏毒性的影像学研究进展

化疗药物对心脏的毒性损害逐渐成为影响患者预后和生活质量的突出问题, 在肿瘤患者化疗过程中利用影像技术早期监测和准确评估心肌损伤及心脏功能, 对患者进行个体化治疗及时调整给药方案, 最大限度地减少或防止继发的心脏损害尤为重要。超声、心脏MR、CT及核医学等影像学检查方法对化疗所致心脏毒性的筛查、诊断、评估和监测等的价值各有所长。笔者总结各种影像学检查方法及其新技术对化疗所致心脏毒性的应用价值及最新研究进展, 为临床进行早期干预和改善预后提供参考。     

遗传性出血性毛细血管扩张症的影像学诊断和介入治疗研究进展

遗传性出血性毛细血管扩张症是一种以鼻出血、皮肤黏膜毛细血管扩张、内脏损害和伴有家族史为特征的常染色体显性遗传病。然而许多临床和影像学医师缺乏对本病的认识,仍将本病视为少见病。由于本病的动静脉畸形持续不断的发展所造成的内脏损害需要及时早期做出正确诊断、选择合适的介入治疗技术,并对患者家族成员进行监测和随访,因此,全面了解本病的影像学表现和栓塞治疗是十分必要的。     

前列腺癌骨转移影像诊断方法研究进展

前列腺癌具有很高的骨转移倾向,在初次诊断时即有较高的骨转移率,所以前列腺癌患者早期筛查骨转移对前列腺癌的分期、治疗及预后判断具有重要意义。放射性核素骨显像是临床常用的骨转移影像学检查方法,对骨转移瘤早期即有较高的检出率,辅以X线平片、CT、MRI等手段,有助于进一步提高诊断的准确性。笔者就前列腺癌骨转移的影像学检查的研究现状做一综述,为临床早期诊断骨转移瘤提供影像学依据。     

乳腺癌骨转移的影像学诊断进展

乳腺癌是“嗜骨性癌肿”,极易伴发骨转移,由骨转移引发的骨相关事件可明显影响晚期乳腺癌患者的生存质量及预后转归。因此,早期、准确诊断骨转移对乳腺癌的临床分期及治疗计划制定具有决定作用,对预后改善亦有重要意义。该文综述了乳腺癌骨转移影像学诊断的研究进展,为临床早期诊断骨转移提供影像学依据。     

刺激性气体引起急性肺部损害的X线影像学表现

目的：分析刺激性气体致急性肺部损害的X线影像学表现，及时、准确的提出X线影像学诊断，指导临床治疗，挽救生命，改善预后。方法：对6例因吸入刺激性气体氯化氢与三氯化磷混合气体急性中毒的患者，进行X线平片和CT平扫跟踪观察，详细分析影像学表现。结果：刺激性气体吸入致急性肺部损害的X线影像学表现，按损害程度分为刺激反应、轻度中毒、中度中毒、重度中毒四类，CT检查优干X线平片。结论：根据X线平片和CT平扫影像学表现，对刺激性气体吸入致急性肺部损害能做出及时、准确的诊断，对指导临床及时、有效的治疗有重要的意义。     

特发性软骨溶解症并文献复习

目的 :探讨髋关节特发性软骨溶解症的临床及X线、CT和MRI影像学特点 ,为诊断提供依据。材料和方法 :分析本例自发病以来的系列临床及综合影像学资料 ,结合文献总结其临床和影像学特点。结果 :软骨溶解症起病隐匿 ,发展缓慢 ,早期临床及影像学诊断极为困难 ,后期关节毁损严重 ,系列影像学资料有利于早期明确诊断。影像学特点为 :髋关节间隙变窄或消失 ,股骨头骺板提前闭合 ,直至内陷 ,同时髋臼内突 ,股骨头颈逐渐溶解、碎裂、消失。结论 :髋关节软骨溶解症早期诊断困难 ,发病机制不明 ,临床目前尚无有效治疗方法 ,系列影像资料并结合临床有利于早期诊断。     

危重新生儿心肌酶谱变化临床观察

目的探讨危重新生儿各病种间心肌酶谱的临床变化，为临床早期治疗提供依据。方法对2008年7月～2009年1月治疗的321例危重新生儿患者进行了心肌酶的检测，并对其检测结果进行统计学分析。结果①新生儿肺炎，新生儿窒息并多器官功能损害、新生儿高胆红素血症为危重新生儿病例的前三位（见表1）。②新生儿窒息并多器官功能损害、新生儿高胆红素血症和HIE并颅内出血肺炎为危重新生儿病例心肌酶变化的前三位（见表6）。各病种间心肌酶变化经分析有统计学意义（，=57．01，P〈0．01）。③心肌酶LDH、CK、CK-MB三项指标的检测结果在各病种间有显著性，（卡方值分别为：X^2=38．345，P〈0．005；X^2=43．838，P〈0．005；Y2=38．345，P〈0．005）。结论危重新生儿疾病的心肌酶谱变化可作为心肌损害的早期、灵敏和特异性的诊断指标，可以作为诊断危重性的依据，心肌酶谱的检测为临床提供诊断和治疗依据，便于早期干预。     

轻度认知功能障碍的磁共振成像研究

轻度认知功能障碍是指介于痴呆和正常健康老龄之间的以偶然发生的记忆减退为主要表现的一种功能损害状态。本文综述了近年来结构磁共振影像学和功能磁共振影像学在轻度认知功能障碍研究中的应用现状,旨在对其早期临床诊断和治疗提供参考,继而一定程度上延缓其向老年性痴呆的转化。     

CMRI影像诊断皮肌炎合并心肌损害的扫描技术分析

目的 探讨CMRI扫描技术在皮肌炎合并心肌损害患者影像诊断中的应用价值。方法 选取临床确诊的皮肌炎合并心肌损害患者1例,通过CMRI扫描序列的选取和组合,结合心功能后处理分析,分享扫描经验和技术要点。结果CMRI中T2-mapping和T2WI STIR可证实急性期心肌水肿损伤,CE-SSFP可分析受损心肌室壁运动异常,增强后T1-mapping和LGE验证不可逆急性心肌损伤的存在。结论 CMRI可全方位、无创性地显示皮肌炎合并心肌损害,为治疗和预后提供重要影像依据。     

颅内静脉窦血栓形成的影像学研究进展

颅内静脉窦血栓形成（CVST）是以脑静脉回流障碍为核心的特殊类型脑血管疾病,因该疾病临床表现多样且缺乏特异性,故临床早期诊断较为困难。患者若不能在早期得到诊断与治疗,轻者表现为头痛,严重者可引起瘫痪甚至死亡。综合的影像学检查对该病的诊断具有重要价值,有利于该病的早期诊断。笔者就该疾病的影像学研究进展予以综述。     

The relationship between clinical stage,prognosis and myocardial damage in patients with Duchenne-type muscular dystrophy: five-year follow-up study

The evaluation of myocardial damage by [123I] 15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) imaging, which represents free fatty acid metabolism, has not been reported in patients with Duchenne-type muscular dystrophy (DMD). To date, the relationship between clinical stage, prognosis and myocardial damage has not been evaluated by radionuclear cardiac imaging. The main goal of this study was to elucidate the relationship of quantitative indices of myocardial damage obtained by radionuclear cardiac imaging ([201Tl] and [123I] BMIPP) to clinical stage and incidence of severe cardiac events in patients with Duchenne-type muscular dystrophy (DMD). METHODS: The study population consisted of 28 male patients with DMD. The average age at the beginning of observation was 19.1 +/- 7.4 yrs. Nuclear tomographic imaging was performed using [201Tl] and [123I] BMIPP. The mid-ventricular short axial slices were classified into four anatomical regions, and the normalized count data in these areas (TL, BM) were obtained. The endpoint was the occurrence of heart failure during the follow up period. RESULTS: Thirteen cases of heart failure occurred during the 5-year follow-up period, including three cases with cardiac death due to congestive heart failure. Clinical staging correlated directly with TL (p = 0.0118) and BM (p = 0.0401) in the whole left ventricle. In regional TL analysis, an association was observed only in the septum (p = 0.0151), and in the anterior (p = 0.0361) region. The only discrepancy between the tracer parameters (TL - BM) in the septum was observed with the radionuclear cardiac values, which exhibited a relationship with cardiac events (p = 0.0124). This discordance, TL < BM, was contrary to that usually observed in patients with ischemic heart disease. CONCLUSION: The septum is the critical area of significance for cardiac events and outcome in patients with DMD. The uptake of [201Tl] in this area was representative of the clinical stage, and TL-BM correlated well with the prognosis.     

Assessment of cardiac abnormalities in Duchenne's muscular dystrophy by (99m)Tc-MIBI gated myocardial perfusion imaging

Cardiac abnormalities in Duchenne's muscular dystrophy (DMD) are often detected in adult patients and their early detection is warranted. Studies have suggested that myocardial damage may be detected by cardiovascular magnetic resonance imaging or by echocardiography at the early stage of DMD. We aimed to identify early changes of cardiac abnormalities in children with DMD by technetium 99m-methoxyisobutylisonitrile ((99m)Tc-MIBI) gated myocardial perfusion imaging (GMPI). Forty-three boys aged 3 to 14 years (mean age 8.2±3.6 years) with DMD and 12 age-matched normal boys as control were studied by G-MPI. These patients were at early stage according to previous studies on DMD. Uptake of (99m)Tc-MIBI in 7 regional walls and 17 segments of the left ventricle were visually analyzed. Quantitative gated single photon emission tomography (QGSSPET) analysis of myocardium was performed to evaluate left ventricular function (LVEF). Gated myocardial perfusion imaging revealed cardiac abnormalities in 81.4% of all patients. Regional perfusion decrease involving multiple walls of LV was present. Four of the patients demonstrated mild abnormalities (11.4%), 7 moderate (20.0%) and 24 severe abnormalities (68.6%). Evident LV ejection fraction (EF) decrease (42.1±6.4%) and dilation with globally poor perfusion were found in three patients, aged 10 to 14, which had significant difference compared with the control group (EF=58.4±4.7%, P=0.001). The rest cases, aged 3 to 9 years, had normal LVF. In conclusion, from the 35 cases of DMD patients (aged 3 to 14 years), regional myocardial perfusion decrease was detected in multiple walls by (99m)Tc-MIBI G-MPI at an early stage, while left ventricular function decrease (3/35, 8.6%) appeared late at about 10 years of age or older as compared with the control group in this study.     

Nuclear imaging in detection and monitoring of cardiotoxicity

Cardiotoxicity as a result of cancer treatment is a novel and serious public health issue that has a significant impact on a cancer patient’s management and outcome. The coexistence of cancer and cardiac disease in the same patient is more common because of aging population and improvements in the efficacy of antitumor agents. Left ventricular dysfunction is the most typical manifestation and can lead to heart failure. Left ventricular ejection fraction measurement by echocardiography and multigated radionuclide angiography is the most common diagnostic approach to detect cardiac damage, but it identifies a late manifestation of myocardial injury. Early non-invasive imaging techniques are needed for the diagnosis and monitoring of cardiotoxic effects. Although echocardiography and cardiac magnetic resonance are the most commonly used imaging techniques for cardiotoxicity assessment, greater attention is focused on new nuclear cardiologic techniques, which can identify high-risk patients in the early stage and visualize the pathophysiologic process at the tissue level before clinical manifestation. The aim of this review is to summarize the role of nuclear imaging techniques in the non-invasive detection of myocardial damage related to antineoplastic therapy at the reversible stage, focusing on the current role and future perspectives of nuclear imaging techniques and molecular radiotracers in detection and monitoring of cardiotoxicity.     

Use of coronary anatomy and late enhancement information both derived from contrast-enhanced whole-heart coronary MRA at 3 T for the assessment of ischemic left ventricular dysfunction

Recognizing the etiology of patients with left ventricular dysfunction (LVD) is essential for the risk stratification and treatment selection. We report the case of a 59-year-old man suspected of ischemic LVD with non acute symptoms studied with whole-heart cardiac magnetic resonance imaging including noninvasive coronary angiography and in whom we obtained comprehensive information of both coronary artery stenosis and myocardial tissue damage.     

早期检测蒽环类药物心脏毒性的影像学研究进展

随着治疗手段的进步,肿瘤患者的生存率及生存时间明显改善,但肿瘤治疗相关心功能不全严重威胁着肿瘤幸存者的健康,其中蒽环类药物（ANTs）引起的心脏毒性极其常见,并可导致不可逆的心脏损伤。ANTs心脏毒性的早期发现和及时治疗对于心脏功能的恢复至关重要,因此早期检测心脏毒性具有重要的临床意义。笔者主要探讨有助于早期检测ANTs心脏毒性的影像学新方法,包括超声心动图心肌应变成像、心脏磁共振心肌应变成像和心肌组织定量成像以及PET/CT显像,以期为临床早期发现ANTs心脏毒性提供有价值的信息。     

颅内静脉窦血栓形成的主要特点及诊治策略

 目的 探讨颅内静脉窦血栓形成(cerebral venous sinus thrombosis, CVST)的主要特点及诊治。方法 对我院收治的14例CVST患者进行回顾性分析。结果 CVST是一种少见的脑血管疾病,通常以中青年多见,往往急性起病,临床表现主要有颅高压症状或者局灶性神经功能缺损,如头痛、头晕、恶心、呕吐,癫痫、偏瘫等。早期使用抗凝治疗是取得良好预后的关键。结论 CVST临床表现复杂多样,利用MRV、CTV或DSA发现静脉窦狭窄、闭塞是确诊CVST的关键之一;有助于临床工作的要做到早期诊断和规范有效治疗。     

MRI quantification of rheumatoid arthritis: Current knowledge and future perspectives

The international consensus on treatment of rheumatoid arthritis (RA) involves early initiation of disease modifying anti-rheumatic drugs (DMARDs) for which a reliable identification of early disease is mandatory. Conventional radiography of the joints is considered the standard method for detecting and quantifying joint damage in RA. However, radiographs only show late disease manifestations as joint space narrowing and bone erosions, whereas it cannot detect synovitis and bone marrow oedema, i.e., inflammation in the synovium or the bone, which may be visualized by magnetic resonance imaging (MRI) months to years before erosions develop. Furthermore, MRI allows earlier visualization of bone erosions than radiography. In order to allow early treatment initiation and optimal guidance of the therapeutic strategy, there is a need for methods which are capable of early detection of inflammatory joint changes. In this review, we will discuss available data, advantages, limitations and potential future of MRI in RA.     

What can imaging tell us about cognitive impairment and dementia?

Dementia is a contemporary global health issue with far reaching consequences, not only for affected individuals and their families, but for national and global socio-economic conditions. The hallmark feature of dementia is that of irreversible cognitive decline, usually affecting memory, and impaired activities of daily living. Advances in healthcare worldwide have facilitated longer life spans, increasing the risks of developing cognitive decline and dementia in late life. Dementia remains a clinical diagnosis. The role of structural and molecular neuroimaging in patients with dementia is primarily supportive role rather than diagnostic, American and European guidelines recommending imaging to exclude treatable causes of dementia, such as tumor, hydrocephalus or intracranial haemorrhage, but also to distinguish between different dementia subtypes, the commonest of which is Alzheimer’s disease. However, this depends on the availability of these imaging techniques at individual centres. Advanced magnetic resonance imaging (MRI) techniques, such as functional connectivity MRI, diffusion tensor imaging and magnetic resonance spectroscopy, and molecular imaging techniques, such as 18F fluoro-deoxy glucose positron emission tomography (PET), amyloid PET, tau PET, are currently within the realm of dementia research but are available for clinical use. Increasingly the research focus is on earlier identification of at risk preclinical individuals, for example due to family history. Intervention at the preclinical stages before irreversible brain damage occurs is currently the best hope of reducing the impact of dementia.     

Multislice computed tomography cardiac imaging: current status

Non-invasive CT coronary artery imaging has previously had little relevance to most UK radiologists due to the limited availability of electron beam CT scanners. Major advances in CT technology have promoted new applications for helical CT, which include cardiac imaging. Widespread installation of 'multislice' helical CT scanners will make CT coronary artery imaging available for the first time in many UK hospitals. The technical advances and early clinical trial data are reviewed and multislice helical CT cardiac imaging in general is discussed.     

Quantitative MR relaxometry study of muscle composition and function in duchenne muscular dystrophy

Magnetic resonance imaging and maps of T1 and T2 values were used to study muscle composition in Duchenne muscular dystrophy (DMD). The mean T2 of anterior tibial muscle was 27 msec in healthy control subjects and 43 msec with increased fatty infiltration in DMD patients. In stronger DMD patients, the distribution of muscle T2 values was narrow, centered at 27 msec as in the controls, with a nonoverlapping fat peak centered at 49 msec. In weaker DMD patients, the width of the muscle T2 peak increased and the peak shifted toward the fat peak. Mean muscle T1 decreased from 1.7 to 0.6 second with increasing fatty infiltration. These results show that quantitative T1 and T2 maps may be used to assess muscle status and monitor DMD progression.