关于16层螺旋CT冠状动脉成像最佳重建相位窗选择的探讨

目的探讨16层螺旋CT冠状动脉造影的最佳重建相位窗。方法32例健康受检者行16层CT冠状动脉成像检查,在6个相位窗（心动周期的R波后40％、50％、60％、70％、80％、90％）上对冠状动脉进行CT图像重组,对这6个时相的薄层图像进行最大密度投影、二维曲面重建、多平面重建和容积再现重建。结果每位受检者的4条冠状动脉分支（左冠状动脉主干、左前降支、左回旋支、右冠状动脉）分别用于图像质量分析。左主干在6个R—R时相均显示良好,左前降支、左回旋支在70％相位窗的图像质量最佳,右冠状动脉在80％相位窗的图像质量最佳,整体图像在70％相位窗的重组图像质量最佳。结论16层螺旋CT冠状动脉成像,应首先选择70％相位窗。选择最佳相位窗进行图像重建可以明显提高图像质量和工作效率。     

16层CT冠状动脉成像最佳R-R时相初探

目的：初步探讨16层螺旋CT在不同心率、不同冠状动脉分支最佳重建R—R时相特点。材料和方法：根据心率将89例患者分为四组：A组，心率〈60次／min；B组，心率60—69次／min；C组，心率70—79次／min；D组，心率≥80次／min。行16层螺旋CT，0．4s／周扫描，以回顾性心电门控重建10％一90％R—R时相的横断面图像，再进行冠状动脉容积重建，分析不同心率、不同R—R时相冠状动脉各支图像质量。结果：不同的心率冠状动脉各支最佳重建时相不同。A、B组最佳重建窗较宽，左前降支（LAD）、左回旋支（LCX）和右冠状动脉（RCA）大多能在70％和80％R—R时相获得最佳显像；C组LCX最佳重建时相在50％或80％。RCA最佳重建时相在40％-50％，LAD在80％；D组最佳重建窗较窄，RCA、LCX最佳重建时相均在50％，LAD在40％-90％R—R时相得分差异不明显。结论：以0．钆伺的16层螺旋CT冠脉显像，根据心率不同选择重建时相。有助于获得较高图像质量。     

心率对16层螺旋CT冠状动脉造影图像质量的影响

目的探讨心率对16层螺旋CT冠状动脉造影图像质量的影响。方法80例健康体检者行16层螺旋CT回顾性心电门控条件下冠状动脉造影。每位患者的4条冠状动脉分支(左冠状动脉主干、左前降支、左回旋支、右冠状动脉)分别用于图像质量分析。结果心率≤65次/m in有89.3%(100/112支)的图像可用于诊断;心率66~80次/m in有81.1%(198/244支)的图像可用于诊断;心率>80次/m in有64.3%(36/56支)的图像可用于诊断;心律不齐或前后波动>5次/m in有25%(8/32支)的血管可用于诊断。结论MSCTCA图像质量受心率影响,并与之呈负相关。     

重组相位窗对16层螺旋CT冠状动脉成像图像质量的影响

目的:探讨不同重组相位窗对16层螺旋CT冠状动脉成像质量的影响。方法:对28例健康体检者采用回顾性心电门控的16层螺旋CT冠状动脉成像,将其扫描原始数据分别按45%、55%、65%、70%、75%、85%R-R间期的不同相位的横断面进行重组。结果:左主干在6个R-R时相均显示良好;左前降支在70%R-R时相的重组图像质量最佳;左回旋支及右冠状动脉在75%R-R时相的重组图像质量最佳,整体图像在75%R-R时相的重组图像质量最佳。结论:重组相位窗对多层螺旋CT冠状动脉成像图像质量有重要影响作用。     

16层螺旋CT冠状动脉造影成像技术及临床应用

目的:探讨16层螺旋CT冠状动脉造影的成像技术特点及对冠状动脉的显示能力.材料和方法:46例窦性心律患者,按心率分为6组:组1心率为＜60次/min,组2心率为60～69次/min,组3心率为70～79次/min,组4心率为80～89次/min,组5心率为90～99次/min,组6心率为≥100次/min.经肘前静脉注射造影剂,平静吸气后屏气进行扫描.采用回顾性心电门控技术.并将图像传送到SUN图像工作站进行二维曲面重建、最大密度投影重建、容积再现重建.结果:46例患者中,左冠状动脉主干、左前降支、第一对角支、左回旋支、左缘支、右冠状动脉及后降支显示较好并能用于影像学诊断者分别为46例(100%),46例(100%),41例(89%),43例(94%),24例(52%),39例(85%),27例(59%).在相位窗的选择方面,36例(78%)患者在75%相位窗上显示较好.在不同的心率组中,16层螺旋CT对左冠状动脉主干、左前降支及后降支的显示没有明显差别(P＞0.05).左冠状动脉主干和左前降支的显示受心脏搏动的影响很小,显示率都是100%.心脏搏动主要影响右冠状动脉、左旋支及第一对角支的显示,组间差异具有统计学意义(P＜0.05).当心率小于70次/min时,右冠状动脉显示较好,显示率为100%.当心率小于80次/min时左旋支的显示率在93%以上.结论:16层螺旋CT可以准确可靠地进行冠状动脉显影,是冠状动脉疾病筛选和诊断中很有潜力的非侵袭性检查方法,部分冠状动脉分支显影与心率有一定的相关性.     

影响多层面螺旋CT冠状动脉成像质量因素的分析

目的 :分析影响多层面螺旋CT冠状动脉成像质量的因素。材料和方法 :5 0例患者分为心率≤ 60次 /min和心率 >60次 /min 2组 ,进行多层面螺旋CT扫描。根据重建冠状动脉图像质量 ,分为能用于评价和不能用于评价两类。结果 :心率≤ 60次 /min 2 2例 ,88支冠状动脉和心率 >60次 /min 2 8例 ,112支冠状动脉 ,不能评价的分别为 12 ( 14 % )支和 41( 3 7% )支。不能评价的 5 3支包括右冠状动脉 2 4( 4 5 % )支、左冠状动脉回旋支 14 ( 2 6% )支、左冠状动脉前降支 9( 17% )支、左冠状动脉主干 6( 11% )支。不能评价的因素包括运动伪影、未完全屏气、心律不齐、相位窗和延迟时间不当。结论 :运动伪影是影响图像质量的主要因素。     

16层CT冠状动脉造影的技术及影响图像质量的因素

目的探讨16层CT冠状动脉造影的成像技术及影响图像质量的因素。方法52例受检者按心率≤70次/min和>70次/min分为2组,分别行16层螺旋CT心电门控条件下冠状动脉造影,预览R-R间期0%～100%的21幅图像(间隔5%),选择显示左、右冠状动脉最清晰的一幅,应用原始数据重建该时相的薄层图像,再进行MIP、MPR、CPR、VR重建。2组图像质量均分为能用于冠状动脉评价和不能用于冠状动脉评价2类。结果16层CT冠状动脉成像的最佳重建时相多位于55%～65%R-R间期。心率≤70次/min组,有87%(301/346支)的图像可用于诊断,心率>70次/min组,有78.8%(134/170支)的图像可用于诊断。结论影响冠状动脉评价的因素主要有冠状动脉运动、冠状动脉钙化、心率波动等。     

多层螺旋CT冠状动脉成像:心律及其波动与重建相位窗关系初探

目的：探讨心律及其波动与重建相位窗的关系。方法：268例疑似冠心病病人进行冠脉成像,按检查时心率及其波动分为以下四组：平均心率小于等于65次／min、心率波动小于等于6次组（A组）;平均心率小于65次／min、心率波动大于6次／min组（B组）;平均心率大于65次／min、心率波动小于等于6次／min组（C组）;平均心率大于65次／min、心率波动大于6次／min组（D组）;接受40层螺旋CT冠状动脉成像术,统计其最佳重建相位窗。结果：A组重建相位窗集中分布于60％～70％。B组及C组RCA重建相位窗主要分布于30％～40％及60％～70％,LAD及LCX主要分布于60％～80％。D组RCA重建相位窗主要分布于30％～40％,LAD及LCX重建相位窗不规律。结论：心率及其波动对40层螺旋CT冠状动脉成像的最佳重建相位窗有重要影响,心率控制在65次／min及以下,心率波动控制在6次／min及以下,最佳重建相位窗通常在60％～70％。心率在65次／min以上或波动大于6次／min的,一定要多时相重建。     

多层螺旋CT回顾性心电门控冠状动脉重建的最佳R-R时相及其临床应用

目的 探讨多层螺旋CT回顾性心电门控冠状动脉重建的最佳R-R时相，评价多层螺旋CT冠状动脉重建的临床应用价值。方法 对20例拟诊冠心病患者多层螺旋CT扫描后，利用回顾性心电门控重建出37．5％、50．0％、62．5％、75．0％R-R时相的横断面图像。然后进行冠状动脉容积重建及仿真血管内窥镜重建，分析不同R-R时相各支冠状动脉的显示情况。以选择性冠状动脉造影结果为对照，评价多层螺旋CT冠状动脉重建图像诊断冠状动脉≥50％管径狭窄的临床应用价值。结果 左前降支、左回旋支和右冠状动脉重建的最佳时相为50．0％和62．5％R-R时相；多层螺旋CT冠状动脉重建图像诊断冠状动脉≥50％管径狭窄的敏感度、特异度、阳性预测值、阴性预测值和诊断正确率分别为91．7％、83．3％、28．2％、99．3％和83．9％。结论 选择回顾性心电门控最佳R-R时相重建冠状动脉可以最大限度减轻心脏运动伪影，提高图像质量；多层螺旋CT冠状动脉重建图像具有很高的敏感度和阴性预测值，可以作为选择性冠状动脉造影前的筛选检查。     

64层螺旋CT冠状动脉成像:不同心率下最优相位窗的探讨

目的:探讨64层螺旋CT冠状动脉成像在不同心率下最优成像相位窗.方法:对112例病例行64层螺旋CT冠状动脉成像,扫描后数据分别按R-R间期10%、20%、30%、40%、50%、60%、70%、80%及90%的相位进行后处理重组,对后处理图像按5级评分,记录扫描期间心率,112例患者心率＜60次/min者为Ⅰ组,60～69次/min为Ⅱ组,70～79次/min为Ⅲ组,≥80次/min为Ⅳ组,绘制不同心率组的冠状动脉成像质量评分随时相位变化的线图,分析观察不同心率组的各时相冠状动脉评分趋势.结果:Ⅰ、Ⅱ、Ⅲ组80%相位图像质量最优,Ⅳ组RCA最优的相位窗为50%相位,LMA、LAD、LCX最优的相位窗为40%,Pearson相关分析在R-R 40%相位,冠状动脉的图像质量评分与心率无显著相关性.结论:在不同心率下,64层螺旋CT冠状动脉成像各相位的图像质量有差别,高心率下,可用40%、50%相位的图像来用于诊断.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

The role of interventional radiology in trauma

Introduction Interventional Radiology has evolved into a specialty having enormous input into the care of the traumatized patient.In all hospitals,regardless of size,the Interventional Radiologist must consider their relationships with the trauma service in order to     

Diagnóstico ecográfico del neumotórax

The ultrasonographic diagnosis of pneumothorax is based on the analysis of artifacts. It is possible to confirm or rule out pneumothorax by combining the following signs: lung sliding, the A and B lines, and the lung point. One fundamental advantage of lung ultrasonography is its easy access in any critical situation, especially in patients in the intensive care unit. For this reason, chest ultrasonography can be used as an alternative to plain-film X-rays and computed tomography in critical patients and in patients with normal plain films in whom pneumothorax is strongly suspected, as well as to evaluate the extent of the pneumothorax and monitor its evolution.     

Carbohydrate Supplementation during Exercise: Does It Help? How Much is Too Much?

KEY POINTS· Carbohydrate intake during exercise can delay the onset of fatigue and improve performance of prolonged exercise as well as exercise of shorter duration and greater intensity (e.g., continuous exercise lasting about 1h and intermittent high-intensity exercise), but the mechanisms by which performance is improved are different.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.