Diagnosis of arterial occlusive disease of the upper extremities: comparison of color duplex sonography and angiography

PURPOSE: The aim of this study was to assess the abilities of color duplex sonography (CDUS) to detect and characterize arterial occlusive disease of the upper extremities. METHODS: We prospectively compared the results of CDUS with those of intra-arterial digital subtraction angiography, which were considered definitive, in patients with symptomatic arterial occlusive disease of the upper extremities. In each extremity, we visualized 9 arterial segments, which were each evaluated for stenoses and occlusions. Each segment was categorized on each imaging modality as not significantly narrowed (narrowed by <50%), significantly narrowed (narrowed by > or =50% but <100%), or occluded (100%). RESULTS: We examined a total of 578 segments in 57 patients (34 men and 23 women) with a mean age of 50 years (range, 20-74 years). CDUS had a sensitivity, a specificity, a positive predictive value, a negative predictive value, and an accuracy of 98%, 99%, 97%, 99.5%, and 99%, respectively, for detecting occluded lesions and 79%, 100%, 100%, 99%, and 99%, respectively, for detecting hemodynamically significantly stenotic lesions. Notably, the sensitivity of CDUS for diagnosing significantly stenotic lesions (79%) was lower than that for diagnosing occlusive disease (98%). CONCLUSIONS: With high sensitivity and accuracy rates, CDUS is a reliable screening method for detecting arterial occlusive disease of the upper extremities. This modality efficiently provides anatomic and hemodynamic data that are useful in cases of such disease.     

Pharmacological prevention of atherothrombotic events in patients with peripheral arterial disease

Peripheral arterial disease (PAD) is strongly associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of myocardial infarction, ischaemic stroke and cardiovascular death. Fortunately, pharmacological interventions in large clinical trials have been as effective in subgroups of patients with PAD as in subjects with other atherosclerotic disease. Antiplatelet treatment is indicated in virtually all patients with PAD. Aspirin 75-325 mg day(-1) is considered as first-line treatment, and clopidogrel 75 mg day(-1) is an effective alternative. Statin therapy is indicated to achieve a target low-density lipoprotein cholesterol level of < or = 2.5 mmol L(-1) in patients with PAD and there is emerging evidence that even lower levels are beneficial. Lowering of plasma homocysteine by supplementing folic acid, vitamin B(12) and vitamin B(6) is not recommended in patients with mild to moderate hyperhomocysteinaemia in the 12-25 micromol L(-1) range, since it does not reduce the incidence of cardiovascular events. Antihypertensive treatment is indicated to achieve a goal blood pressure of < or = 140/90 mmHg or < or = 130/80 mmHg in the presence of diabetes or chronic kidney disease. All classes of antihypertensive drugs are acceptable for treatment of hypertension in patients with PAD, but angiotensin-converting enzyme inhibitors ramipril or perindopril are especially appropriate because they reduce the incidence of cardiovascular events beyond their blood pressure-lowering effects. Beta-blockers should not be used as first-line antihypertensive treatment. Diabetic patients with PAD should reduce their glycosylated haemoglobin to < or = 7%. In conclusion, pharmacological secondary prevention of cardiovascular morbidity and mortality in patients with PAD should be as comprehensive as that in patients with established coronary or cerebrovascular disease.     

Advances in diagnostic imaging for peripheral arterial disease

Refinements in both noninvasive and invasive imaging techniques have led to significant improvements in both the diagnosis and treatment of peripheral arterial disease. Multiple complementary imaging modalities are available for evaluating these patients. This article reviews the advantages, disadvantages and recent advances in the commonly used clinical applications of duplex ultrasonography, magnetic resonance angiography, computed tomographic angiography, digital subtraction angiography and intravascular ultrasound for arterial imaging in the lower extremities. It also discusses experimental imaging techniques more recently applied to peripheral arterial disease such as PET, hyperspectral imaging and molecular imaging of atherosclerosis. As more is understood about both lesion and patient characteristics that affect their response to peripheral interventions, clinician selection of the various imaging modalities as well as different peripheral interventions will allow for more effective treatment of patients with peripheral arterial disease.     

椎体血管瘤的影像表现(附8例报告)

目的:讨论椎体血管瘤的X线平片、CT、MRI及DSA的影像学特征及其应用价值。材料与方法:经手术和病理证实的椎体血管瘤8例。全部病例均经X线平片、CT、MRI检查,其中2例进行了DSA诊断及介入治疗。结果:X线平片显示6个病灶,CT和MRI显示全部8个病灶,DSA检查2例,皆显示其特征性改变。结论:X线平片的椎体栅栏、网格状改变可帮助诊断椎体血管瘤。CT及MRI上均有特征性表现,对椎体血管瘤的检出率高于X线平片。DSA可显示椎体血管瘤的供血动脉,具有特征性表现,并且对介入治疗及外科手术有极大帮助。     

颈动脉体瘤的综合影像诊断

目的：探讨劲动脉体瘤的超声、ＣＴ、ＭＲＩ、血管造影影像学表现及诊断价值。材料与方法,９例颈本瘤中５例经手术病理证实,４例经血管造影证实,其中２例为双侧。回顾性分析颈动脉体瘤的各种影像学表现,评价其临床价值。结果：各种检查均可显示肿瘤部位及其形态,颈动脉体瘤的Ｂ超超声特点为中等低实质回声,大于３．０ｃｍ的肿瘤可见管道结构,但肿瘤上级观察欠清,２例行彩色多普勒超声显示瘤内网状血管,ＣＴ增强显示为富血管     

64层螺旋计算机断层扫描血管造影与数字减影血管造影在下肢动脉病变诊断中的应用价值对比

目的对比64层螺旋计算机断层扫描血管造影(CTA)与数字减影血管造影(DSA)在下肢动脉病变诊断中的应用价值。方法回顾性分析本院62例下肢动脉病变患者,均先行CTA再行DSA,比较2种方法显示的下肢动脉狭窄分级情况,并以DSA为标准,计算CTA诊断下肢动脉狭窄的灵敏度、特异度、准确度、阳性及阴性预测值。结果 CTA与DSA结果符合率为91.20%。以DSA为标准,CTA检查共低估12段,高估26段。CTA诊断下肢动脉狭窄程度≥50%的灵敏度、特异度、准确度、阳性及阴性预测值分别为98.21%、96.15%、97.22%、96.49%及98.04%。结论 CTA在下肢动脉病变的诊断中具有较高的灵敏度、特异度、准确度、阳性及阴性预测值,且无创、方便、安全,可作为该病术前检查、评估以及随访的有效方法之一,并在一定程度上可取代DSA。     

超声造影和增强磁共振在不同大小肝癌肝动脉化疗栓塞术后的疗效评价

目的:探究超声造影(contrast-enhanced ultrasonography,CEUS)、增强磁共振(contrast-enhanced MRI,CE-MRI)在不同大小原发性肝癌TACE(transcatheter arterial chemoembolization)术后疗效评估的价值与意义,以期为原发性肝癌(hepatocellular carcinoma,HCC)患者在TACE后复查中影像学方法的选择提供依据。方法:本研究收集2018年1月至2018年12月在徐州医科大学附属医院介入放射科接受TACE治疗的33例HCC患者(共83个病灶),TACE术后1个月1周内依次行CEUS,CE-MRI,数字减影血管造影(digital subtraction angiography,DSA)检查,如发现病灶再次TACE,以DSA结果为金标准分别对三者的检查结果进行Kappa检验以及Mc Nemar检验,比较三者其对TACE术后肿瘤残存、复发病灶检出的敏感性,特异性,诊断准确性及检查结果的一致性。结果:CEUS和CEM R I的诊断准确性分别为91.6%和100%,CE-MRI的诊断准确性优于CEUS,差异有统计学意义;但CEUS与CE-MRI检查一致性较强(Kappa=0.794);CE-MRI敏感度、特异度比均为100%,CEUS的分别为88.9%,100%;在>3 cm的病灶中,CEUS与CE-MRI的一致性强(Kappa=0.891),CEUS的准确性、敏感度及特异度分别为96.1%,95.0%和100%。在≤3 cm的病灶中,CEUS与CE-MRI的一致性一般(Kappa=0.669),CEUS的准确性、敏感度及特异度分别为84.4%,78.3%和100%。结论:CEUS,CE-MRI与金标准DSA对于原发性肝癌TACE治疗后的诊断一致性相当,CEUS可作为原发性肝癌TACE短期复查的替代影像学检查方法。     

对比PETRA-MRA、TOF-MRA及CTA评估颅脑前循环动脉狭窄

目的 对比径向采集逐点编码缩短时间MR血管成像(PETRA-MRA)、时间飞跃法MRA(TOF-MRA)及CT血管成像(CTA)评估颅脑前循环动脉狭窄程度及长度的效能。方法 回顾性分析56例经颅脑数字减影血管造影(DSA)确诊颅脑前循环动脉狭窄患者的颅脑PETRA-MRA、TOF-MRA和CTA资料,采用组内相关系数(ICC)及Bland-Altman法观察PETRA-MRA与TOF-MRA、CTA评估颅脑前循环动脉狭窄程度及长度与DSA结果的一致性,以及分析上述评估结果与DSA的相关性。结果 Bland-Altman分析显示,以DSA为标准,PETRA-MRA评估颅脑前循环动脉狭窄程度的变异系数、偏差及一致性限度范围分别为13.30%、1.04及(-13.37,15.46),TOF-MRA分别为15.89%、2.81及(-14.68,20.29),CTA分别为20.17%、11.19及(-12.66,35.04)。PETRA-MRA、TOF-MRA及CTA评估颅脑前循环动脉狭窄程度(ICC=0.92、0.89、0.80),以及PETRA-MRA、TOF-MRA评估颅脑前循环动脉狭窄长...     

彩色多普勒超声与数字减影血管造影评估糖尿病外周血管病变的对比研究

目的探讨彩色多普勒血流显像（CDFI）评估糖尿病外周血管病变（PVD）的价值。方法对22例2型糖尿病患者的右下肢胫前动脉（ATA）和胫后动脉（PTA）共44条血管分别进行了CDFI和数字减影血管造影（DSA）检查。以DSA检查结果为诊断金标准，计算CDFI取不同截断点时诊断的敏感性、特异性、阳性预测值、阴性预测值和符合率。结果当患者ATA最狭窄处收缩期峰值速度（Vs）与非狭窄处Vs的比值为1．3时，CDFI诊断ATA显著狭窄的敏感性为75．0％，特异性为92．9％，阳性预测值为85．7％，阴性预测值为86．7％，诊断符合率为86．4％。当患者PTA最狭窄处Vs与非狭窄处Vs的比值为1．3时，CDFI诊断PTA显著狭窄的敏感性为100％，特异性为76．5％，阳性预测值为55．6％，阴性预测值为100％，诊断符合率为81．8％。结论与DSA相比，CDFI诊断糖尿病PVD有较好的符合率，可作为糖尿病PVD筛选的首选影像学方法。     

Human leucocyte-endothelial interactions in peripheral arterial occlusive disease

Abstract. This ex vivo study determined the expression of leucocyte adhesion receptors for endothelial adhesion molecules in 10 patients with peripheral arterial occlusive disease (PAOD) and in 10 healthy controls before and after treadmill exercise. Granulocytes from venous blood samples were separated on a Ficoll-Hypaque gradient and the phenotypical expression of CD11a/CD18 (LFA-1), CD11b/CD18 (Mac-1) and CD11c/CD18 (p150,95) was observed by double indirect immunofluorescence using specific monoclonal antibodies. The total and differential white blood cell counts were monitored before and after exercise. In the PAOD patients a significant reduction in the number of granulocytes expressing CD11b/CD18 (Mac-1) and CD11c/CD18 (p150,95) associated with a significant neutropenia was observed after exercise, suggesting that leucocyte-endothelial interactions occur during ischaemia.     

横纹肌肉瘤的影像诊断和病理分析比较

目的:探讨横纹肌肉瘤影像学表现及其与病理学的关系。方法:对34例(男26例,女8例)横纹肌肉瘤的B超、CT、MRI和病理学资料进行回顾性分析。结果:34例中起源于泌尿生殖道12例,腹腔和后腹膜8例,头面颈部6例,四肢6例,躯干2例。B超肿瘤表现为实质性均匀或混杂回声团块影。CT肿块表现为强化的等低密度、稍高密度或混杂密度肿块,有或无局部侵润。MRI T1加权像表现为和软组织等信号或接近等信号,T2加权像表现为高信号,增强后有不同程度强化。病理学上,34例中胚胎型30例,腺泡型2例,多形型2例。结论:横纹肌肉瘤的影像学表现反映其病理改变,但缺乏特异性,在诊断和鉴别中需结合患者的年龄、发生部位等临床资料。     

Bioresorbable scaffolds in peripheral arterial disease

The risk of in-stent restenosis has been dramatically reduced with the use of thin-strut nitinol and balloon-expandable drug-eluting stents in the peripheral arterial territory. However, the presence of a permanent endovascular device is linked to a series of events that can lead to restenosis and stent thrombosis. Significant advances in the technology of bioresorbable materials have delivered the potential for fully bioresorbable scaffolds (BRS), which are able to mechanically support the artery wall and elute an anti-restenotic drug for a predetermined time period after which the scaffold becomes fully absorbed into the vascular wall. Currently, several vascular BRS are available, undergoing evaluation either in clinical trials or in preclinical settings. The aim of this review is to present the new developments in BRS technology, describe the mechanisms involved in the resorption process, and discuss the current and potential future prospects of this innovative treatment option for peripheral arterial disease.     

Quantitative contrast enhanced magnetic resonance imaging for the evaluation of peripheral arterial disease: a comparative study versus standard digital angiography

Objective The purpose of this study is to evaluate the accuracy of semiautomated analysis of contrast enhanced magnetic resonance angiography (MRA) in patients who have undergone standard angiographic evaluation for peripheral vascular disease (PVD). Background Magnetic resonance angiography is an important tool for evaluating PVD. Although this technique is both safe and noninvasive, the accuracy and reproducibility of quantitative measurements of disease severity using MRA in the clinical setting have not been fully investigated. Methods 43 lesions in 13 patients who underwent both MRA and digital subtraction angiography (DSA) of iliac and common femoral arteries within 6 months were analyzed using quantitative magnetic resonance angiography (QMRA) and quantitative vascular analysis (QVA). Analysis was repeated by a second operator and by the same operator in approximately 1 month time. Results QMRA underestimated percent diameter stenosis (%DS) compared to measurements made with QVA by 2.47%. Limits of agreement between the two methods were ± 9.14%. Interobserver variability in measurements of %DS were ± 12.58% for QMRA and ± 10.04% for QVA. Intraobserver variability of %DS for QMRA was ± 4.6% and for QVA was ± 8.46%. Conclusions QMRA displays a high level of agreement to QVA when used to determine stenosis severity in iliac and common femoral arteries. Similar levels of interobserver and intraobserver variability are present with each method. Overall, QMRA represents a useful method to quantify severity of PVD.     

联体儿的影像学评估及应用

目的：通过对以往病例的回顾，发现适用于联体儿诊断的影像学检查方法，为手术做准备，提高术后生存率。方法：观察以往病例的影像学检查，对照手术及病理进行比较。结果：6例联体儿中5例胸腹联体，1例坐骨联体，5例胸腹联体均为肝脏及胸骨融合，所有患儿均有不同程度的先天性心脏病， 1例坐骨联体两个患儿共用一条直肠，手术结果与影像诊断大致一致。结论：通过适用的影像学检查，能够全面的了解联体儿内部的结构异常情况，对手术的难度、手术的选择、术前准备、预后评估有重要意义。     

Additional value of B‐flow imaging in arterial wall calcifications

The accuracy of color Doppler ultrasonography (CDU) is hampered by the presence of arterial wall calcifications. B‐flow imaging may overcome these limitations. We present a case of a severely calcified stenosis of the right common femoral artery (CFA) diagnosed with the aid of B‐flow imaging. Both the CT angiography scan and CDU were limited by the presence of diffuse dense arterial calcifications. B‐flow imaging showed a >75% stenosis of the CFA. B‐flow imaging appears to improve the accuracy of CDU in the presence of calcified stenosis of the CFA. It is of clinical relevance to improve the duplex sonographic accuracy, ideally reducing the need for other imaging modalities prior to surgery. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46 :136–139, 2018     

CT征象早期诊断周围型小腺癌的价值

目的：探讨CT征象对周围型小腺癌（SPN）的早期诊断价值。方法回顾性分析经手术病理证实的267例孤立性肺结节SPN的CT表现,并计算各个征象及组合征象的灵敏度、特异度,绘制ROC曲线。结果细短毛刺征、胸膜凹陷征、深分叶征、支气管血管集束征及纵隔淋巴结转移等征象的出现对周围型小腺癌的诊断具有统计学差异（χ2分别=8.08、15.58、7.31、7.12、4.82, P均＜0.05）;随着组合征象的增多,阳性预测值增高;组合征象诊断准确性ROC曲线下面积为0.71,当取征象数≥3为截点时诊断准确性最高。结论 SPN所表现出的CT征象及其组合情况有利于提高早期诊断周围型小腺癌的准确性。     

MR时间分辨对比剂动态增强技术在糖尿病足下肢血管病变中的诊断价值:与DSA对照

目的 探讨MR时间分辨对比剂动态增强技术(TRICKS)在诊断糖尿病足下肢动脉病变中的临床价值.方法 回顾性分析18例糖尿病足双侧下肢血管病变患者的TRICKS及DSA资料,将研究血管分为腘动脉、胫腓动脉干、胫前动脉、胫后动脉、腓动脉、足背动脉6个节段,以DSA作为标准进行分析.结果 在216个动脉节段中,187个节段两种检查显示一致,TRICKS高估21个节段,低估8个节段.TRICKS对于下肢狭窄动脉的判断平均准确率为86.57%,平均敏感度为90.98%,平均特异度为75.79%.TRICKS和DSA对血管狭窄程度分级的总符合率为86.57%.结论 TRICKS是诊断下肢血管病变的可靠方法.     

烟雾病8例临床分析

目的 探讨烟雾病的临床特征、影像学诊断价值及治疗。方法 回顾性分析8倒烟雾病患者的临床特征和辅助检查结果及治疗。结果 本组成人（5例）多于儿童（3例）;儿童临床表现以脑缺血症状为主;脑磁共振血管成像（MRA）或数字减影血管造影（DSA）检查显示颈内动脉虹吸部末端和大脑前或中动脉近端狭窄或闭塞,并有脑基底部异常血管网形成。内科保守治疗5倒。合并手术治疗3倒,进行0．5—5．0年随访,1例遗留轻度神经系统异常后遗症。结论烟雾病儿童主要表现为脑缺血症状;脑MRA或DSA的异常征象是早期诊断烟雾病的重要依据。早期诊断、及时治疗是改善烟雾病预后的有效方法。     

Successful revascularization with percutaneous coronary intervention using a combination of the subintimal transcatheter withdrawal technique and coronary artery fenestration for spontaneous coronary artery dissection

The combination of the STRAW technique and coronary artery fenestration using a cutting balloon could be effective in SCAD patients, especially with dissection to the distal end of the coronary artery.     

3.0T 3D高分辨率对比增强MR血管成像显示豆纹动脉的可行性

目的 观察3.0T 3D高分辨率对比增强MR血管成像(3D HR CE-MRA)显示豆纹动脉(LSA)的可行性。方法 回顾性分析60例因疑诊脑血管疾病而接受头部3.0T 3D HR CE-MRA及数字减影血管造影(DSA)患者,根据年龄将其分为老年组(≥60岁,n=21)和中青年组(＜60岁,n=39)。对3D HR CE-MRA图像进行最大密度投影(MIP)重建,比较3D HR CE-MRA与DSA显示LSA主要分支(直线长度＞5 mm)数目及其长度的差异。结果 3D HR CE-MRA及DSA所示组间双侧LSA主要分支数目之和及LSA长度之和差异均无统计学意义(P均＞0.05)。3D HR CE-MRA与DSA所示左侧LSA及右侧LSA主要分支数目亦均无统计学意义(P均＞0.05);3D HR CE-MRA显示左侧LSA长度及右侧LSA长度均短于DSA。结论 3.0T 3D HR CE-MRA技术可用于显示LSA。