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??Abstract??Cerebrovascular dissection??including carotid arterial dissection and vertebral arterial dissection??is an important cause of stroke??especially in young and mid-adult patients.With the widespread use of noninvasive imaging (i.e.magnetic resonance angiography and computed tomographic angiography)??the diagnostic rate of arterial dissection has increased.Treatment methods for cerebral arterial dissection include antiplatelet or anticoagulation therapy??thrombolysis??and endovascular or surgical interventions.Endovascular methods have several advantages??i.e.??a low proportion of perioperative complications and immediate reconstruction of the vessels.Especially in certain cases??endovascular therapy is a safe and useful method.     

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??Abstract??Cerebral arterial dissection (CAD) has been recognized as one of the most common causes of ischemic stroke in young people??and it occurs when there is a tear in the intimal layer of the carotid or vertebral arteries with subsequent extravasation of blood into the subintimal layers.Clinical diagnosis is often difficult for the signs and symptoms vary and are similar to etiologies that are encountered far more frequently.But computed tomographic angiography??magnetic resonance angiography??and digital subtraction angiography may aid in diagnosis.Management options include antiplatelet therapy??anticoagulation??thrombolysis and endovascular procedures.With the progress of the diagnosis and treatment technologies in recent years??early recognition of dissection and timely medical intervention are clinically feasible??which can improve the cure rate and reduce morbidity and mortality of the stroke from CAD.     

Cardiac Imaging in the Diagnosis of Coronary Artery Disease

Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality worldwide. Although invasive coronary angiography has previously been the gold standard in establishing the diagnosis of CAD, there is a growing shift to more appropriately use the cardiac catheterization laboratory to perform interventional procedures once a diagnosis of CAD has been established by noninvasive imaging modalities rather than using it primarily as a diagnostic facility to confirm or refute CAD. With ongoing technological advancements, noninvasive imaging plays a pre-eminent role in not only diagnosing CAD but also informing the choice of appropriate therapies, establishing prognosis, all while containing costs and providing value-based care. Multiple imaging modalities are available to evaluate patients suspected of having coronary ischemia, such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging. These imaging modalities can variably provide functional and anatomical delineation of coronary stenoses and help guide appropriate therapy. This review will discuss their advantages and limitations and their usage in the diagnostic pathway for patients with CAD. We also discuss newer technologies such as CT fractional flow reserve, CT angiography with perfusion, whole-heart coronary magnetic resonance angiography with perfusion, which can provide both anatomical as well as functional information in the same test, thus obviating the need for multiple diagnostic tests to obtain a comprehensive assessment of both, plaque burden and downstream ischemia. Recognizing that clinicians have a multitude of tests to choose from, we provide an underpinning of the principles of ischemia detection by these various modalities, focusing on anatomy vs physiology, the database justifying their use, their prognostic capabilities and lastly, their appropriate and judicious use in this era of patient-centered, cost-effective imaging.     

高分辨率磁共振血管壁成像在脑动脉夹层分离诊断中的价值

目的 探讨高分辨率磁共振(high-resolution magnetic resonance imaging,HR-MRI)血管 壁成像对脑动脉夹层分离(cerebral artery dissection,CAD)的诊断价值.方法 回顾性纳入确诊为CAD且完成CT血管造影(computed tomography angiography,CTA)、磁共振血管造影(magnetic resonance angiography,MRA)、数字减影血管造影(digital subtraction angiography,DSA)和HR-MRI检查的患者,比较和分析4种影像学技术对CAD的检出率和诊断价值.结果 共纳入15例患者,其中颈内动脉夹层分离5例,椎动脉夹层分离7例,大脑中动脉夹层分离2例,基底动脉夹层分离1例.HR-MRI可见壁内血肿11例,内膜瓣9例,双腔征3例,假性动脉瘤2例.15例CAD患者共检出CAD18处,HR-MRI、DSA、CTA和MRA分别检出17处(94.44％)、14处(77.78％)、5处(27.78％)和6处(33.33％),检出率存在显著差异(x2=24.939,P＜0.001),HR-MRI(P均＜0.01)和DSA(P均＜0.05)检出率均显著高于CTA和MRA,但HR-MRI与DSA之间无显著差异.结论 HR-MRI是一种敏感性较高的CAD诊断方法.     

Improved detection of coronary artery disease by stress perfusion cardiovascular magnetic resonance with the use of delayed enhancement infarction imaging.

OBJECTIVES: We tested a pre-defined visual interpretation algorithm that combines cardiovascular magnetic resonance (CMR) data from perfusion and infarction imaging for the diagnosis of coronary artery disease (CAD). BACKGROUND: Cardiovascular magnetic resonance can assess both myocardial perfusion and infarction with independent techniques in a single session. METHODS: We prospectively enrolled 100 consecutive patients with suspected CAD scheduled for X-ray coronary angiography. Patients had comprehensive clinical evaluation, including Rose angina questionnaire, 12-lead electrocardiography, C-reactive protein, and calculation of Framingham risk. Cardiovascular magnetic resonance included cine, adenosine-stress and rest perfusion-CMR, and delayed enhancement-CMR (DE-CMR) for infarction imaging. Matched stress-rest perfusion defects in the absence of infarction by DE-CMR were considered artifactual. All patients underwent X-ray angiography within 24 h of CMR. RESULTS: Ninety-two patients had complete CMR examinations. Significant CAD (> or =70% stenosis) was found in 37 patients (40%). The combination of perfusion and DE-CMR had a sensitivity, specificity, and accuracy of 89%, 87%, and 88%, respectively, for CAD diagnosis, compared with 84%, 58%, and 68%, respectively, for perfusion-CMR alone. The combination had higher specificity and accuracy (p < 0.0001), owing to incorporating the exceptionally high specificity (98%) of DE-CMR. Receiver operating characteristic curve analysis demonstrated the combination provided better performance than cine, perfusion, or DE-CMR alone. The accuracy was high in single-vessel and multivessel disease and independent of CAD location. Multivariable analysis including standard clinical parameters demonstrated the combination was the strongest independent CAD predictor. CONCLUSIONS: A combined perfusion and infarction CMR examination with a visual interpretation algorithm can accurately diagnose CAD in the clinical setting. The combination is superior to perfusion-CMR alone.     

Magnetic resonance imaging of the coronary arteries

Despite progress in prevention and early diagnosis, coronary artery disease (CAD) remains one of the leading causes of mortality in the world. For many years, invasive X-ray coronary angiography has been the method of choice for the diagnosis of significant CAD. However, up to 40% of patients referred for elective X-ray coronary angiography have no clinically significant stenoses. These patients still remain subjected to the potential risks of X-ray angiography. As an alternative, magnetic resonance imaging (MRI) is currently one of the most promising techniques for noninvasive imaging of the coronary arteries. Over the past two decades, many technical developments have been implemented that have led to major improvements in coronary MRI. Nowadays, both anatomical and functional information can be obtained with high temporal and spatial resolution and good image quality. In this review we will discuss the technical foundations and current status of clinical coronary MRI, and some potential future applications.     

心脏腺苷负荷磁共振成像在冠心病早期诊断中的应用

目的:评价心脏腺苷负荷磁共振成像在冠心病早期诊断中的作用。方法: 选择临床无急性冠脉综合征,选择性冠状动脉造影（CAG）证实冠脉有不同程度狭窄的患者34例,根据CAG结果将患者分为3组,第1组管腔狭窄＞75%、第2组狭窄50%~75%以及第3组狭窄<50%。在3.0T磁共振成像仪上分别行静息和腺苷负荷磁共振心脏灌注扫描和延迟增强成像,对比分析不同状态下磁共振（MR）成像心肌灌注变化。结果: 在未发生急性冠脉综合征患者,静息磁共振心肌灌注成像显示心肌缺血主要表现为心肌灌注减少,总阳性率38%(13/34),不同冠状动脉狭窄组间无显著性差异。磁共振腺苷负荷试验可增加患者心肌灌注降低检测的阳性率［62%(21/34)］。统计结果显示,对于心肌缺血的检测,心脏磁共振腺苷负荷试验与静息心脏磁共振心肌灌注之间有显著性差异(P<0.01)。延迟扫描成像在34例患者中无延迟增强改变。结论: 腺苷负荷MR灌注成像可以显著提高心肌缺血诊断的阳性率,有助于冠心病的早期诊断。     

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??Abstract??Cerebral artery dissection (CAD) implies an intimal tear in the wall of cerebral artery leading to the intrusion of blood into layers of the arterial wall (intramural haematoma).CAD has been reported in association with genetic factors??infections??migraine??hypertension and trauma.Clinical manifestations of CAD include headache??Horner’s syndrome??ipsilateral cranial nerves palsy??transient ischemic attack or stroke.Imaging examinations are very important for diagnosis of CAD.Digital subtraction angiography is the golden standard of CAD.Treatment of CAD is essentially depends on pharmacological approaches??and anticoagulant and antiplatelet agents are commonly used.Anticoagulant treatment of six month may fail in a small proportion of patients??and carotid aneurysms??surgical treatment should be performed in refractory patients with high-grade or worsening stenosis.     

Magnetic resonance imaging and two-dimensional echocardiography. Alternative approach to aortography in diagnosis of aortic dissecting aneurysm

Unrecognized acute dissection of the aorta requires rapid and accurate diagnosis for appropriate management. The “gold standard” for diagnosis has been invasive angiography, but this diagnosis can be achieved noninvasively via two-dimensional echocardiography, computed tomographic scanning, and magnetic resonance imaging. Two patients are described in whom echocardiography and magnetic resonance imaging were complementary diagnostic aids. The advantages and disadvantages of echocardiography, computed tomographic scanning, magnetic resonance imaging, and aortography in aortic dissection are discussed. It is anticipated that a combination of noninvasive diagnostic aids will eliminate the need for invasive angiography in many instances in the future.     

Knochen(mark)?dem in der MRT – Befund oder nur Signal?

An ill-defined area of increased signal intensity in bone marrow seen on water-sensitive magnetic resonance (MR) sequences (e.?g. T2, short TI inversion recovery STIR) is usually referred to as ??bone marrow edema??. It may be observed with traumatic (e.g. bone bruise), inflammatory, osteoarthritic as well as neoplastic processes. Therefore, it can be confusing if the term ??bone marrow edema?? is used to describe a clinicoradiologic condition or diagnosis. Addressing these imaging findings as ??edema equivalent?? or ??edema-like increased signal intensity?? helps to restrict this phenomenon to a magnetic resonance sign and to avoid using it as a radiologic diagnosis. To illustrate this three case examples with corresponding MR images are presented to point out the intention of this article.