1ml剂量团注试验在椎动脉CE-MRA的应用分析

增强磁共振血管造影(CEMRA)利用对比剂造成血管组织间的对比进行血管成像,因其具有简便易行、图像清晰的特点在临床上应用越来越广。在椎动脉CEMRA中,正确测算扫描延迟时间是CEMRA成败的关键,小剂量团注试验有利于更准确地把握延迟时间,获得较好的血管对比。但小剂量团注试验存在增加背景信号的缺陷,文献报道小剂量团注试验对比剂用量多为2～3ml[1～3],本文对30例椎动脉CEM-RA病例作1ml剂量团注试验,并对图像质量进行分析,评价其在椎动脉磁共振血管造影中的临床应用价值。1材料与方法30例椎动脉病例,男13例,女17例,年龄32～81岁,平…     

透视触发技术在椎动脉三维增强磁共振血管成像的应用分析

三维增强磁共振血管造影(three dimensiona contrast-enhanced MR angiography,3DCE-MRA)利用对比剂造成血管组织间的对比进行血管成像,因其具有简便易行、图像清晰的特点在临床上应用越来越广。在椎动脉3DCE-MRA     

急性串联型椎基底动脉闭塞伴对侧椎动脉闭塞或发育不良患者血管内开通策略

【摘要】 目的 探讨急性串联型椎基底动脉闭塞伴对侧椎动脉闭塞或发育不良患者血管内开通治疗策略。方法 回顾性分析2021年1月至12月在空军军医大学第一附属医院接受急诊血管内开通治疗的6例急性基底动脉闭塞伴双侧椎动脉闭塞或优势侧椎动脉闭塞且对侧椎动脉发育不良患者临床资料。根据病变类型和侧支循环条件差异,选择采用不同的开通治疗策略。结果 6例患者均为男性,中位年龄62.7岁。其中经颈深动脉逆向开通椎动脉1例,经颈升动脉逆向造影并在椎动脉闭塞远端滞留对比剂影指引下正向开通椎动脉1例,经优势侧正向开通椎动脉4例;随后均接受基底动脉取栓治疗。术后6例基底动脉改良溶栓治疗脑梗死（mTICI）血流分级达到2b/3,基底动脉开通成功率为6/6。术后3例患者因非手术因素死亡,其余3例改良Rankin量表（mRS）评分分别为0分、0分和3分,预后良好率为2/6。结论 对于急性串联型椎基底动脉闭塞伴对侧椎动脉闭塞或发育不良患者,积极的椎动脉正向或逆向再通术是治疗急性基底动脉闭塞的可行方法。     

后循环缺血的MR电影相位对比法血流定量研究

目的:探讨MR电影相位对比法测量后循环缺血患者双侧椎动脉血流流速、血流量等血流动力学参数的准确性及后循环缺血的原因。方法:28例经临床诊断为后循环缺血的患者及5例同年龄组健康志愿者,使用头部线圈和周围脉搏门控技术,采用MR电影相位对比法测量双侧椎动脉的血流动力学参数,并与经颅多普勒(TCDU)检查,结果进行比较,同时分析椎动脉血流量与血管狭窄程度的相关性。结果:MR电影相位对比和TCDU两种技术所测量的双侧椎动脉流速呈高度相关(左侧r=0.887,P=0.013;右侧r=0.785,P=0.027)。MR电影相位对比法测得病变组左右椎动脉平均流速分别为(16.16±7.99)和(15.72±9.92)cm/s,平均血流量分别为(66.63±45.23)和(68.57±38.84)ml/min。MR电影相位对比法所测血流量正常对照组与后循环缺血组之间差异有统计学意义。椎动脉血流量与血管狭窄程度无明显相关性(r=-0.144,P=0.654)。结论:使用MR电影相位对比法可无创性准确评价后循环缺血患者血流动力学改变,后循环的平均椎动脉血流量与血管狭窄程度低度相关。     

透视触发三维动态增强MR椎动脉成像的临床应用

椎基底动脉供血不足在临床非常常见,病因较复杂.椎动脉病变引起是病因之一,过去椎动脉病变主要依靠血管造影的方法诊断.常规磁共振血管造影技术(MRA)如2D、3D TOF法,PC法出现后,使MRA在椎动脉血管病变诊断中得以广泛应用[1,2].它无需造影剂,非侵袭性,也曾获得较好效果,但由于其空间分辨率不高,图像信噪比差,影响了其在临床的应用.近年来,随着三维动态增强磁共振血管造影(three-dimensional dynamic contrast-enhancement magnetic resonance angiography,3D CE-MRA)的出现,为MRA在椎动脉血管病变的诊断提供了新的手段.     

64层螺旋CT血管成像诊断椎动脉起源异常

目的 分析椎动脉起源异常的64层CT血管成像(CTA)表现,提高对该血管变异的认识.方法 回顾性分析135例经64层CTA诊断为椎动脉起源异常病人的影像学资料,分析椎动脉起源异常的发生率,起始血管及部位、起源异常椎动脉的行径及其合并症.结果 2757例行头颈64层CTA检查的病人中椎动脉起源异常的发生率为4.9%(135例病人136支椎动脉),其中左侧椎动脉起源异常133支(4.8%),右侧椎动脉起源异常3支;左侧椎动脉起源异常中,129支起源于主动脉弓,2例为重复畸形,1支起源于左侧颈内动脉,1支起于左锁骨下动脉根部.3支右侧椎动脉起源异常中,2支起自右侧颈总动脉,1支起源于头臂干.37例病人合并椎动脉行径异常(进入第4、5和7椎间孔);28支异常起源的椎动脉发育不良;5支起源异常椎动脉的远端游离(未与对侧椎动脉汇合);3例合并椎动脉-基底动脉成窗畸形,1例合并对侧椎动脉瘤.结论 64层CTA能清晰、快速、无创、准确地诊断椎动脉起源变异.     

椎动脉夹层的影像诊断及血管内介入治疗(附19例报告)

目的总结椎动脉夹层的影像诊断和评价血管内介入治疗方案的选择与效果。方法回顾性分析19例椎动脉夹层的影像学特点(CTA、DSA)。采用血管内介入椎动脉夹层19例:颅外段椎动脉夹层所致血管狭窄行支架成形术3例,颅内段夹层动脉瘤累及小脑下后动脉(PICA)采取支架结合弹簧圈栓塞4例,PICA位于夹层动脉瘤以远采取夹层动脉瘤及近端载瘤动脉闭塞12例。结果颅外段椎动脉夹层表现为血管腔狭窄、内膜瓣,颅内段椎动脉夹层的影像特点CTA表现为动脉瘤样扩张、壁内血肿等,DSA为珠线征、瘤样扩张等。术后造影:单纯支架置入病例狭窄消失;支架结合弹簧圈治疗病例动脉瘤腔消失,载瘤动脉通畅;血管闭塞病例显示椎动脉夹层均完全闭塞。术中未发生死亡、破裂出血及其它严重并发症,术后随访3-36个月,未发生再出血及缺血等并发症。结论 DSA及CT、CTA椎动脉夹层具有诊断价值;夹层动脉瘤的准确诊断对于介入治疗方案的选择至关重要;血管内介入治疗椎动脉夹层安全、有效、效果良好。     

容积重建术和表面成像术在椎动脉CT血管造影中的应用

目的：探讨容积重建术（VR）和表面成像术（SSD）在椎动脉CT血管（CTA）成像中的应用价值。方法：对65例临床疑诊为椎动脉椎病患者作椎动脉CTA检查，采用VR和SSD两种方法重建图像，VR通过容积漫游，SSD通过设置双阈值来显示椎动脉。结果：65例，130例血管显示129例，1支全程闭塞不显示，发现先天变异31支；血管因骨质增生受压移位17处，血管狭窄21例；颅内段血管呈串珠状45处；钙化3处，讨论：VR能清晰显示椎示椎动脉全貌和伴行骨骼的解剖关系，大大提高椎动脉病变的检出阳性率。SSD优良图像仅占50％左右，约半数的病人椎动脉显示不满意，实用价值有待进一步研究。     

多层螺旋CT头颈部低剂量对比剂血管成像的可行性研究

目的 探讨16排多层螺旋CT低剂量对比剂头颈部血管成像的可行性。资料与方法 30例头颈部CT血管成像(CTA)分为3组．采用不同的对比剂量：100ml、80ml和60ml。根据原始图像和最大强度投影(MIP)重建像评价3组病例颈部动脉、颅内动脉的显示程度、静脉充盈程度以及伪影;并测量动脉内对比剂的浓度。结果 颈动脉、椎动脉及颅内动脉在3组病例中均清晰显示．显示程度评分上3组间无统计学差异。静脉充盈程度和伪影的主观评分亦无显著性差异。3组动脉内的对比剂浓度均维持在较高的水平,统计学无显著性差异。结论 16排多层螺旋CT头颈部血管成像使用低剂量对比剂可以满足临床需要。     

椎动脉扭曲的MRA定位、定向方法探索

因颈椎病、颈椎间盘突出而行颈椎手术十分常见,临床医师期望对椎动脉及其周围组织结构有清楚了解,以帮助诊断及治疗[1～3].椎动脉磁共振血管成像(MRA)为无创伤检查,图像清晰,较好地反映了椎动脉解剖形态,临床上已广泛应用,国内外均有报道[4～8].但对椎动脉病变的定位及扭曲的定位、定向问题均未见明确阐述.本研究总结了32例椎动脉扭曲的磁共振血管造影的定位、定向诊断经验.     

Optimization of the system of medical service of students of Cadet Schools of the Ministry of Defense of the Russian Federation

One of the factors of the successful military career guidance Cadet schools students is preserving and promoting their health. Medical support of children and adolescents aged 10-17 years should include the full range of medical and preventive measures defined for this group. The state of providing outpatient care for pupils at the Cadet School in St. Petersburg was studied. These results show that full medical care in accordance with the standards can be based only on children's health clinics. It is important that the organization of medical support pupils cadet schools should be cooperate with civilian health care.     

带状疱疹83例误诊原因分析

带状疱疹是由水痘—带状疱疾病毒引起的皮肤科常见疾病。其主要的病理损害,一是受累神经的严重炎症性浸润,继而导致受侵犯神经节内神经细胞变性、坏死;二是皮肤的水泡。迅速抑制神经节和相应的感觉神经纤维的充血、水肿和坏死,防止粘连形成,达到迅速镇痛、改善皮损,缩短病程及防止后遗症的发生是治疗的关键。因而,尽早明确诊断,     

Estimation of accumulated dose of radiation by method of ESR-spectrometry of dental enamel of mammals

ESR-spectrometry was used to investigate radiation-induced paramagnetic centers in enamel of mammals: carnivores (polar bear and fox), ungulates (reindeer, European bison, moose), and man. Values at half the microwave power saturation of the radiation signal, P_1/2, evaluated at room temperature, was found to range from 16 to 26 mW for animals and man. A new approach to discrimination of the radiation induced signal from the total ESR spectrum of reindeer enamel is proposed. ‘Dose-response’ dependencies of enamel of different species mammals were measured within the dose range from 0.48 up to 10.08 Gy. Estimations of ‘radiosensitivity’ enamel of carnivores and ungulates showed good agreement with radiosensitivity enamel of man by ESR method.     

Analysis of the results of the international comparison of activity measurements of a solution of Fe

The results of an international comparison of activity measurements of a solution of ⁵⁵Fe organized by the BIPM in 2005 are reported and analysed. This exercise, which follows the procedures of the CIPM mutual recognition arrangement to update older comparisons, is a renewal of the comparison organized by the BIPM that took place in 1978. A EUROMET comparison was organized in 1996 specifically to compare activity measurements of a ⁵⁵Fe solution by means of liquid-scintillation techniques. Results of these three comparisons are presented and discussed in this paper.

The radionuclide solution was provided by the NPL, which also distributed the samples to the participants. The activity of the ampoules was measured by 16 laboratories using 12 methods producing 25 results. Some general considerations on uncertainty assessments pertaining to the different techniques used are drawn. The outcome of four different estimators is compared from which the presence of at least one outlier can be confirmed. Further measurements should be made to try to reduce the discrepancy between the results. To date the outcome of the present comparison does not show an improvement to that of the 1996 comparison.     

Evaluation of the results of various technics of non-surgical therapy of varicocele

A new method of non-surgical treatment of varicocele syndrome is described: it consists in sclerotherapy of spermatic vein by trans-femoral percutaneous catheterization with balloon-catheters. In 8 cases venous thrombosis has been induced by direct electric clotting. The techniques and a 6 months follow-up are discussed. It is pointed out that this procedure should be considered as the method of choice for tubular lesions and sub-fertility prophylaxis in young people and in childhood.     

延迟性脾破裂误漏诊原因分析

目的探讨延迟性脾破裂误漏诊原因和预防措施.方法回顾性分析总结12例延迟性脾破裂中的诊断和误漏诊的经验与教训.结果本组延迟性脾破裂的误漏诊5例(41.66%).对多发伤与脾破裂并存可能认识不足,外伤史轻微或伤员隐瞒外伤史,缺乏腹痛-缓解-突然再腹痛的典型病史,缺乏“对冲性脾破裂”力学分析和整体化诊断思路等为其误漏诊的主要原因.结论详细的外伤史和全面系统检查,重视腹以外多发伤掩盖腹内脏器伤及延迟性脾破裂可能.确立外伤-腹内脏器伤-脾破裂整体化诊断思路.不间断地辅以B超检查脾形态学变化和腹内有无积液,腹腔穿刺确定有无血腹、X线胸腹部检查观察左侧胸肋角和膈肌运动情况、必要时CT检查以尽早发现脾包膜下血肿,降低延迟性脾破裂误漏诊率.