肝癌的影像学评价:1.5T MRI与常规CT、US比较

目的：探讨三种非创伤性影像检查方法ＭＲＩ、ＣＴ和ＵＳ在肝癌诊断中的敏感性和准确性。方法：５２例经病理及临床证实的ＨＣＣ行ＭＲＩ,ＣＴ和ＵＳ检查。结果：ＭＲＩ常规序列与ＦＭＰＳＰＧＲ相比,敏感性以ＳＥＴ２Ｗ及ＦＭＰＳＰＧＲ序列为高。对ＨＣＣ检出总的敏感性依次为ＭＲＩ（ＳＥ＋ＦＭＰＳＰＧＲ）８５．８９％,ＣＴ７５．６４％,ＵＳ７１．７９％,＜３ｃｍＨＣＣ,ＭＲＩ检出的敏感性为７１．４２％明显高于ＣＴ（５１．４２％）和ＵＳ（４５．７１％）,对于＞３ｃｍＨＣＣ,三者敏感性相似。ＨＣＣ定性准确性依次为动态增强ＦＭＰＳＰＧＲ（９２．０６％）,常规ＳＥ序列（８５．９３％）,ＣＴ（８４．７４％）,ＵＳ（７５．００％）,ＳＥ序列结合动态增强ＦＭＰＳＰＧＲ对肝癌定性准确性可达９５％,明显优于ＣＴ和ＵＳ。结论：在ＨＣＣ的检出敏感性和定性诊断上,１．５ＴＭＲＩＳＥ序列结合动态增强ＦＭＰＳＰＧＲ明显优于常规ＣＴ和ＵＳ,为肝癌重要的影像学检查手段。     

OSTEOCLASTIC RESORPTION OF CANCELLOUS BONE TISSUES OF FEMORAL NECK IN HIP FRACTURE PATIENTS (A SCANNING ELECTRON MICROSCOPIC STUDY)

ＯＳＴＥＯＣＬＡＳＴＩＣＲＥＳＯＲＰＴＩＯＮＯＦＣＡＮＣＥＬＬＯＵＳＢＯＮＥＴＩＳＳＵＥＳＯＦＦＥＭＯＲＡＬＮＥＣＫＩＮＨＩＰＦＲＡＣＴＵＲＥＰＡＴＩＥＮＴＳ（ＡＳＣＡＮＮＩＮＧＥＬＥＣＴＲＯＮＭＩＣＲＯＳＣＯＰＩＣＳＴＵＤＹ）ＣＨＡＩＢｅｎ－ｆｕ（...     

A Comparison in Healing of Skull Defect Repaired with Four Different Kinds of Graft Materials in Rabbits

ＡＣＯＭＰＡＲＩＳＯＮＩＮＨＥＡＬＩＮＧＯＦＳＫＵＬＬＤＥＦＥＣＴＲＥＰＡＩＲＥＤＷＩＴＨＦＯＵＲＤＩＦＦＥＲＥＮＴＫＩＮＤＳＯＦＧＲＡＦＴＭＡＴＥＲＩＡＬＳＩＮＲＡＢ┐ＢＩＴＳＤＩＮＧＺｈｅｎ－ｑｉ（丁真奇）１，ＴＡＮＦｕ－ｓｈｅｎｇ（谭富生）２，...     

HIP PAIN FOLLOWING REPLACEMENT OF ARTIFICIAL BIPOLAR FEMORAL HEAD:AN ANALYSIS OF 13 CASES

ＨＩＰＰＡＩＮＦＯＬＬＯＷＩＮＧＲＥＰＬＡＣＥＭＥＮＴＯＦＡＲＴＩＦＩＣＩＡＬＢＩＰＯＬＡＲＦＥＭＯＲＡＬＨＥＡＤ：ＡＮＡＮＡＬＹＳＩＳＯＦ１３ＣＡＳＥＳＫＯＮＧＲｏｎｇ（孔荣），ＦＡＮＧＳｈｉ－ｙｕａｎ（方诗元），ＫＯＮＧＦａｎ－ｊｉｎ（孔繁锦）．...     

NERVE DEFECT REPARATION BY VEIN BRIDGING WITH SCHWANN CELL IMPLANTATION

ＮＥＲＶＥＤＥＦＥＣＴＲＥＰＡＲＡＴＩＯＮＢＹＶＥＩＮＢＲＩＤＧＩＮＧＷＩＴＨＳＣＨＷＡＮＮＣＥＬＬＩＭＰＬＡＮＴＡＴＩＯＮＣＨＥＮＺｈｅｎｇ－ｒｏｎｇ（陈峥嵘），ＣＨＥＮＺｈｏｎｇ－ｗｅｉ（陈中伟），ＺＨＡＮＧＦｅｎｇ（张峰），ＣＨＥＮＧＧａｎｇ（...     

三维增强磁共振肺动脉血管造影诊断急性肺栓塞的实验研究

目的 探讨钆喷替酸葡甲胺（Ｇｄ－ＤＴＰＡ）三维增强共振肺动脉血管造影成像（３ＤＣＥＭＲＰＡ）在急性肺栓塞（ｐｕｌｍｏｎａｒｙ ｅｍｂｏｌｉｓｍ,ＰＥ）中的诊断价值。方法 对１７只自体血栓引发的犬急性肺栓塞模型,利用３Ｄ快速扰相梯度回波序列（ＦＳＰＧＲ）行３Ｄ ＣＥＭＲＰＡ检查和Ｘ线肺动脉血管造影（Ｘ－ｒａｙ ｐｕｌｍｏｎａｒｙ ａｎｇｉｏｇｒａｐｈｙ,ＸＰＡ）检查,并与病理解剖对照。     

Effects of Level Changes of 5-HT and Dopamine in Cerebral Microvasculature on Occurrence of Secondary Damages in Traumatic Brain Injury in Rats

ＥＦＦＥＣＴＳＯＦＬＥＶＥＬＣＨＡＮＧＥＳＯＦ５┐ＨＴＡＮＤＤＯＰＡＭＩＮＥＩＮＣＥＲＥ┐ＢＲＡＬＭＩＣＲＯＶＡＳＣＵＬＡＴＵＲＥＯＮＯＣＣＵＲＲＥＮＣＥＯＦＳＥＣＯＮＤＡＲＹＤＡＭＡＧＥＳＩＮＴＲＡＵＭＡＴＩＣＢＲＡＩＮＩＮＪＵＲＹＩＮＲＡＴＳＫＥ...     

CHANGES OF BETA-ADRENERGIC RECEPTORS OF PERIPHERAL BLOOD LYMPHOCYTE IN PATIENTS WITH ACUTE CEREBRAL TRAUMA AND THEIR CLINICAL SIGNIFICANCE

ＣＨＡＮＧＥＳＯＦＢＥＴＡ┐ＡＤＲＥＮＥＲＧＩＣＲＥＣＥＰＴＯＲＳＯＦＰＥＲＩＰＨＥＲＡＬＢＬＯＯＤＬＹＭＰＨＯＣＹＴＥＩＮＰＡＴＩＥＮＴＳＷＩＴＨＡＣＵＴＥＣＥＲＥＢＲＡＬＴＲＡＵＭＡＡＮＤＴＨＥＩＲＣＬＩＮＩＣＡＬＳＩＧＮＩＦＩＣＡＮＣＥＨＵＸｉ...     

PERIPHERAL NERVE REPAIR IN RATS USING VASCULARIZED FROZEN IN-SITU MUSCLE AUTOGRAFT

ＰＥＲＩＰＨＥＲＡＬＮＥＲＶＥＲＥＰＡＩＲＩＮＲＡＴＳＵＳＩＮＧＶＡＳＣＵＬＡＲＩＺＥＤＦＲＯＺＥＮＩＮ┐ＳＩＴＵＭＵＳＣＬＥＡＵＴＯＧＲＡＦＴＷＡＮＧＹａｎ（王岩）１，ＺＨＵＳｈｅｎｇ－ｘｉｕ（朱盛修）１，ＨＵＮＧＬＫ２，ＬＥＵＮＧＰＣ２１．Ｄｅｐ...     

OSTEOGENIC POTENTIAL OF RABBIT DERMAL FIBROBLASTS CULTURED IN VITRO: A HISTOCHEMICAL AND RADIOAUTO-GRAPHICAL STUDY

ＯＳＴＥＯＧＥＮＩＣＰＯＴＥＮＴＩＡＬＯＦＲＡＢＢＩＴＤＥＲＭＡＬＦＩＢＲＯＢＬＡＳＴＳＣＵＬＴＵＲＥＤＩＮＶＩＴＲＯ：ＡＨＩＳＴＯＣＨＥＭＩＣＡＬＡＮＤＲＡＤＩＯＡＵＴＯ┐ＧＲＡＰＨＩＣＡＬＳＴＵＤＹＣＨＡＩＢｅｎ－ｆｕ（柴本甫），ＴＡＮＧＸｕｅ－...     

Perioperative monitoring of flow and patency in native and grafted internal mammary arteries using a combined MR protocol

The objective of this study was to evaluate graft flow (f) and patency (p) in patients with internal mammary artery (f,p) and venous (p only) grafts using a combined MR protocol with phase-contrast technique and MR angiography. 42 patients with 42 left internal mammary artery (LIMA) and 63 venous grafts were examined pre and 6 months post coronary artery bypass graft (CABG) surgery. Phase-contrast flow measurements were applied to the IMA. Post-operatively, a contrast enhanced MR angiogram was performed to assess bypass patency. LIMA/venous grafts were occluded in 3/42 and 13/63, respectively. Flow in LIMA decreased from 19.4+/-10.4 ml min(-1) m(-2) pre-operatively to 13.4+/-9.7 ml min(-1) m(-2) post-operatively (p<0.002). In contrast, flow in the native right IMA increased from 17.6+/-8.7 ml min(-1) m(-2) pre-operatively to 24.8+/-9.0 ml min(-1) m(-2) post-operatively (p<0.001). MRI allows a combined assessment of bypass patency and flow. This study protocol may be applicable to perioperative follow-up studies in patients after CABG surgery.     

Evaluation of coronary artery bypass graft patency using three-dimensional reconstruction and flow study on electron beam tomography

OBJECTIVES: To establish and evaluate two protocols for the noninvasive visualization and assessment of coronary artery bypass graft (CABG) patency on electron beam tomography (EBT). METHODS: Two hundred fourteen consecutive patients who underwent CABG surgery were scanned using both EBT angiography with three-dimensional reconstruction and EBT flow study with time-density curve analysis. RESULTS: There was a total of 589 CABGs evaluated in this study (10 grafts were excluded because of artifacts); 133 (98.5%) of 135 arterial grafts were patent, 345 (77.7%) of 444 saphenous vein grafts were patent. Within 5 years or 5-10 years after surgery, arterial graft patency exceeded venous graft patency (p<0.001). Three-dimensional EBT angiography achieved higher sensitivity, specificity, and accuracy (97.7%, 94.1%, and 96.7%, respectively) than EBT flow study (88.4%, 82.4%, and 85.2%, respectively) for evaluating occlusion or patency of CABGs. The intragraft flow of patent arterial and venous grafts were 4.9+/-2.2 ml/min/g and 6.9+/-2.8 ml/min/g, respectively (p<0.001). CONCLUSION: The combination of EBT three-dimensional reconstruction and flow study can be more effectively performed in the assessment of CABG anatomy and quantification of patent CABG flow.     

双源CT冠状动脉成像评价冠状动脉搭桥术后桥血管通畅情况

目的探讨双源 CT 冠状动脉成像对冠状动脉搭桥术后桥血管通畅状况的诊断价值.资料与方法38例患者于冠状动脉搭桥术后行双源 CT 冠状动脉成像与冠状动脉造影检查,以冠状动脉造影作为“金标准”,对双源 CT 冠状动脉成像结果进行分析.结果38例患者共检出桥血管92支,其中内乳动脉桥31支,大隐静脉桥61支;31支内乳动脉桥中,26支(83.9%)桥血管通畅,5支(16.1%)管腔狭窄、闭塞;61支大隐静脉桥血管中35支(57.4%)桥血管通畅;26支(42.6%)管腔狭窄、闭塞.大隐静脉桥血管狭窄、闭塞的发生率明显高于内乳动脉桥血管(P<0.05).双源 CT 冠状动脉成像评价桥血管狭窄、闭塞的敏感性为93.9%,特异性为100.0%.结论双源 CT 冠状动脉成像对冠状动脉搭桥术后桥血管通畅状况的评价有较高的诊断价值,是一种快速、无创、准确、安全的检查方法.     

多层螺旋CT冠状动脉成像在冠状动脉搭桥术后随访中的价值

目的：评价多层螺旋CT在冠状动脉搭桥术后随访的价值。方法：32例冠状动脉成像病例中有3例冠状动脉搭桥术后病人（共有搭桥血管7根）。分析搭桥血管及冠状动脉通畅性，评价狭窄及狭窄程度。结果：7根搭桥血管都在VR、MPR及Curved上很好地显示，其中有1根可见约75%-90％之狭窄；其余均通畅。结论：多层螺旋CT对冠状动脉搭桥术后随访有很高的价值。     

Coronary flow reserve evaluated by 201Tl myocardial perfusion SPECT after coronary artery bypass grafting (CABG) for angina pectoris

We compared the flow reserves of the coronary bypass vessels between arterial and venous grafts by 201Tl myocardial perfusion SPECT on the patients with angina pectoris who had no past history of myocardial infarction or intervention therapy such as PTCA. Thirty two patients had undergone a total of 70 bypass grafts and 66 of them were proved to be patent at postoperative CAG. Reversible defects were observed in 6 of 40 segments (15.0%) covered by patent venous grafts, and in 11 of 26 segments (42.3%) by patent arterial grafts. The rate of postoperative reversible defects was higher in the areas grafted by artery but this had no relation with the severity of coronary artery stenosis before CABG. This reversible defect is most likely to be caused by the character of artery graft itself and this should not be considered to highly suggest the restenosis or occlusion of the graft vessel.     

MR angiography and flow quantification of the internal mammary artery graft after minimally invasive direct coronary artery bypass

OBJECTIVE: Six patients who had undergone minimally invasive direct coronary artery bypass surgery were examined to evaluate an MR imaging protocol that provided information about cardiac function, bypass graft patency, and flow characteristics with a single examination. CONCLUSION: Preliminary results suggest that our imaging protocol allows accurate follow-up of patients after minimally invasive direct coronary artery bypass surgery. Bypass graft patency was correctly determined in all patients. In four patients, anastomoses were visualized by MR angiography, and flow measurements revealed a volume range of 28-84 ml/min (native and grafted internal mammary arteries) and a trend for the flow values of bypass grafts to be lower than those of native vessels. Interobserver reproducibility was good (r = .99; slope, .98).     

Sixty four multi-detectors CT coronary angiography: An easy and accurate method to detect graft patency post CABG

Objective

To assess the accuracy of coronary CTA in detection of coronary artery bypass graft patency, occlusion and stenosis.

Patients and methods

Twenty-four patients with past history of coronary bypass surgery were included in this study and underwent MDCT coronary angiography. Invasive coronary angiography was done within 2 weeks of MDCT coronary angiography. All grafts considered patent were then evaluated for the presence of significant stenosis. Significant stenosis was defined as reduction in diameter of more than 50%.

Results

All the MDCT scans were interpretable and a total number of 78 CABG conduits were analyzed. At MDCT angiography 4 (5.2%) grafts were classified as occluded and 74 (94.8%) grafts were patent. Significant stenosis was detected in 7 (9.4%) out of the 74 patent grafts. At invasive coronary angiography; when occlusion and significant stenosis pooled together they were 9 grafts; 4 arterial and 5 venous. All these 9 grafts were detected at MSCT (sensitivity is 100%). In 67 out of 69 grafts occlusion or significant stenosis was correctly ruled out (specificity 97.1%). The diagnostic accuracy of MDCT angiography when compared with invasive angiography was 97.4%. The negative predictive value was 100% and positive predictive value was 81.8%.

Conclusion

MDCT coronary angiography is an accurate imaging technique for the evaluation of CABG patency and in detection of graft stenosis and confirms of previous studies using 64 MDCT.     

Non-invasive assessment of coronary artery bypass graft with retrospectively ECG-gated four-row multi-detector spiral computed tomography

The purpose of this study was to assess the accuracy of four-row multi-detector CT (MDCT) in the evaluation of coronary artery bypass graft (CABG) in patients with at least a left internal mammary artery (LIMA) grafted to the left anterior descending artery (LAD), because of the conduit of choice in bypass surgery and the greater difficulty of evaluation with non-invasive diagnostic tools. Included in the study were 57 patients with a total of 122 grafts (95 arterial and 27 venous) who underwent MDCT (4×2.5-mm detector-collimation, 3-mm slice width, 1.5-mm reconstruction increment) with retrospective ECG gating. Twelve patients (21%) with high heart rates were given beta-blockers in order to obtain a heart rate 70 bpm in all patients. The ECG-synchronized axial images, reconstructed in the mid-diastole, MPR, MIP and 3D-VR images were independently and blindly assessed by two radiologists for graft patency and presence of high grade stenosis. Conventional angiography was the standard of reference. MDCT correctly classified 92/94 patent grafts and 26/28 occluded grafts (sensitivity/specificity 93%/97.8%); sensitivity and specificity of MDCT for assessment of arterial grafts were 100 and 98.7% (77/78 patent grafts and 17/17 occluded grafts). Image quality was considered adequate for assessment of significant stenoses in 62/92 (67%) patent grafts, with a significant differences between LIMA and non-LIMA conduits (44/57 vs. 18/65; P=0.002), according to the coronary vessel area supplied (anterior>lateral>posterior-inferior wall; P=0.002). In the remaining 30 patent grafts (33%), the assessment of stenoses was hampered by surgical clips, calcifications and motion artifacts. Sensitivity and specificity of MDCT for detection of significant graft stenoses were 80 and 96%, respectively. Inter-observer agreement was good (K=0.73). MDCT seems to be a valuable diagnostic tool for non-invasive assessment of patency of both venous and arterial grafts. An accurate evaluation of distal anastomoses and native coronary arteries may still represent a limitation of four-row MDCT, which will improve with the newest MDCT scanner.     

64层螺旋CT在冠状动脉搭桥术后的应用价值

目的:探讨64层螺旋CT在冠状动脉搭桥术后的临床应用价值。方法:采用西门子Somatom Sensation Cardiac64螺旋CT对22例冠脉搭桥术后的患者(共计44根桥血管)进行了扫描,其中11例患者同时进行了冠状动脉造影检查。结果:64层螺旋CT显示22例患者发现44支桥血管,显示率100%。44支桥血管中,33支(75%)通畅、5支(11.4%)闭塞、3支(6.8%)中重度狭窄、3支(6.8%)轻度狭窄。与冠脉造影对照,诊断桥血管明显狭窄及闭塞的敏感性100%,特异性92.9%,阳性预测值87.5%,阴性预测值100%,准确率95.2%。结论:64层螺旋CT是评价桥血管闭塞及狭窄的可靠方法。     

A study of coronary artery bypass graft patency using MR imaging

This is a prospective study comparing selective angiography and magnetic resonance (MR) imaging in the evaluation of the patency of coronary artery bypass grafts (CABGs). Twenty-eight patients with 52 grafts were studied (10 internal mammary artery grafts, 19 saphenous vein grafts including 2 sequential grafts, and 15 right coronary artery saphenous vein grafts). The mean interval between MR imaging and the surgical procedure was 13.2 months. Results obtained with angiography were as follows: 39 patent grafts; 4 patent but stenotic (greater than 50%); 9 occluded CABGs. Magnetic resonance imaging was performed with axial imaging, spin echo images, and electrocardiographic gating. Grafts that were normal on angiographic examination appeared without a signal on both the first and the second echoes in 38 of 39 cases. Grafts that were patent but presented significant stenosis as evidenced by angiography presented the same appearance. In one case, there was an aspect corresponding to a decreased blood flow (presence of a signal on the first echo that became stronger on the second echo). The CABG occlusion was determined in seven of nine cases. Occluded grafts twice presented a signal variation corresponding to an old thrombus formation. In two cases, only the origin of the graft was visible without any visualization of its distal portion. In three other cases, neither the proximal nor the distal portions of the graft were identified. Among six CABGs that could not be identified, three were patent. This study demonstrated that MR imaging makes it possible to correctly identify patent CABGs, but this modality has significant limitations because patent but stenotic CABGs may present in the same way as patent CABGs without stenosis. On the other hand, the correct identification of occluded grafts may be accurately performed using MR imaging.