重建层厚对64层螺旋CT冠状动脉钙化积分值的影响

目的:评价重建层厚对64层螺旋CT扫描冠状动脉钙化积分值的影响。材料和方法:对50例冠状动脉钙化患者行64层螺旋CT冠状动脉造影,按1．5、3．0和5．0mm层厚重建,分别计算冠状动脉各段钙化斑块的Agatston积分、体积积分和钙质量积分,比较3种层厚重建之间积分测量值差异。结果:同一患者冠状动脉钙化斑块Agatston积分、体积积分及钙质量积分值于不同重建层厚获得不同结果:重建层厚1．5mm时Agatston积分、钙化斑块体积积分及钙质量积分值分别为(435．3±531．4)、(348．6±418．6)mm3、(89．1±111．9)mg;重建层厚3．0mm时分别为(355．3±465．9)、(304．2±384．8)mm3、(67．8±89．3)mg;重建层厚为5．0mm时积分值分别为(295．9±409．8)、(234．8±315．9)mm3、(54．3±74．6)mg。1．5mm重建层厚钙化积分值高于层厚3．0、5．0mm重建。结论:重建层厚影响冠状动脉钙化积分值的大小,薄层重建图像冠脉钙化积分值高于厚层重建图像。     

64MSCTA对冠状动脉变异的诊断及临床评价

目的评价64层螺旋CT冠状动脉血管成像（CTCA）对冠状动脉变异的诊断价值及临床评价。方法回顾性分析3529例临床疑为心肌缺血患者及常规体查者冠状动脉CTA影像检查结果并对发现的变异冠状动脉进行分类。结果3529例冠状动脉CTA受检者中,共检出冠状动脉变异42例（1．19％,42／3529）,MIP、VRT、CPR重建图像均明确显示其开口及走行;其中右冠状动脉起自主动脉左冠状窦者9例,左冠状动脉起自主动脉右冠状窦者2例,左回旋支异位开口于右冠窦1例,冠状动脉高位开口于升主动脉壁者6例．并行左主干3例（前降支、旋支分别开口于左冠窦）,左主干开口于肺动脉伴右冠状动脉瘤1例,左旋支-冠状静脉瘘者2例,副冠状动脉9例,右冠状动脉-左心室瘘合并右冠状动脉瘤l例。冠状动脉发育不良8例。结论冠状动脉CTA能准确显示各种类型冠状动脉变异,可作为无创性诊断冠状动脉变异的首选方法。     

左室电极导线植入不同冠状静脉分支血管与 左室起搏部位关系

目的探讨左室电极导线植入在不同冠状静脉分支血管与左室起搏部位的关系。方法回顾性分析自2011年1月至2015年12月在北部战区总医院因心力衰竭植入心脏再同步治疗起搏器或心脏再同步治疗除颤器的112例患者的临床资料。分析术中留取的左前斜45°及右前斜30°冠状静脉逆行造影影像,按冠状静脉分支走向将植入血管分为心大静脉、左室前侧静脉、左室侧静脉、左室后静脉、心中静脉。右前斜30°将左室起搏部位三等分为心尖部起搏、左室中部起搏和基底部起搏,并将心尖部起搏归类为左室心尖部组(n=22),左室中部和基底部起搏共同归类为左室非心尖部组(n=90)。分析两组植入冠状静脉各分支情况。结果 112例患者左室电极所植入各冠状静脉分支分别为心大静脉2例(1.8%)、左室前侧静脉9例(8.0%)、左室侧静脉85例(75.9%)、左室后静脉14例(12.5%)、心中静脉2例(1.8%)。其中,左室心尖组植入左室前侧静脉1例(4.5%)、左室侧静脉13例(59.1%)、左室后静脉8例(36.4%);左室非心尖组植入心大静脉2例(2.2%)、左室前侧静脉8例(8.9%)、左室侧静脉72例(80.0%)、左室后静脉6例(6.7%)、心中静脉2例(2.2%)。电极导线植入后静脉分支位于心尖部比例高达57.1%(8/14),植入侧静脉分支位于心尖部的比例仅15.3%(13/85);非心尖部起搏的患者植入靶血管大多数分布在左室侧静脉、左室前侧静脉。结论左室单极或双极电极导线植入左室后静脉更容易起搏心尖部。     

右冠状动脉-冠状静脉窦瘘1例

患者 男,52岁。反复胸闷、胸痛10余年,加重2年。多次动态心电图检查未见异常;无高血压、高血脂及糖尿病病史。 冠状动脉 CT 血管成像(CTA)检查：右冠状动脉增粗,近段直径约0.67 cm,右冠状动脉左室后支走行扭曲,最宽处直径约1.0 cm;心大静脉增粗,冠状静脉窦瘤样扩张,最大直径约1.7 cm,与右冠状动脉左室后支间可见交通,瘘口直径约0.6 cm (图1,2);左前降支中段长约0.3 cm 钙化斑块,管腔未见明显狭窄。冠状动脉 CTA 诊断：右冠状动脉-冠状静脉窦瘘。     

双源CT冠状静脉系统成像在心房颤动射频消融术中的应用价值

目的 探讨双源CT(dual source computed tomography,DSCT)冠状静脉成像对指导心房颤动(简称房颤)射频消融术的应用价值.方法 116例患者(房颤组56例,对照组60例)行双源CT冠状静脉系统成像,比较房颤组及对照组冠状静脉包括心大静脉(GCV)、心中静脉(MCV)及冠状静脉窦(CS)解剖学变异的发生率,并测量各主要属支冠状静脉开口的径线、形态及汇入冠状静脉窦的角度.结果 DSCT冠状静脉系统成像显示冠状静脉解剖变异占总样本数的37.9%(44/116).房颤组及对照组中各主要属支冠状静脉开口的径线、形态及汇入冠状静脉窦的角度差异无统计学意义(P值均＞0.05).结论 DSCT冠状静脉系统成像对介入治疗具有重要的指导意义.     

基于低辐射剂量全模型迭代CTP的颅脑侧支循环研究

【摘要】目的：探讨基于全模型迭代重建技术（IMR）低辐射剂量CT灌注（CTP）容积数据重组的多期相CT血管成像（CTPA）在单侧大脑中动脉（MCA）狭窄患者侧支循环的评估价值。方法：收集68例单侧MCA狭窄行CTP、CTA检查的患者,利用CTP原始数据重组出多期相CTPA图像,评估CTP伪彩图主观图像质量,比较CTPA与CTA血管强化CT值、图像噪声、信噪比（SNR）、对比噪声比（CNR）、主观图像质量及侧支循环评分。结果：CTP伪彩图图像质量主观评分为7.28±1.09分,56例（83%）患者伪彩图图像质量良好。CTPA主观图像质量良好,血管强化CT值（390.94±78.02 vs. 116.13±52.66）、SNR（17.07±10.11 vs. 13.00±6.80）及CNR（14.95±8.74 vs. 5.42±2.87）高于CTA组（均P＜0.05）,图像噪声高于CTA组（30.25±16.24 vs. 12.34±10.88,P＜0.001）。CTPA组的侧支评分高于CTA组( 1.79±0.64 vs. 1.22±0.77,P＜0.001)。结论：源于低辐射剂量CTP的多期相CTA,图像质量能满足临床需求,能全面评估单侧MCA狭窄患者侧支循环状态。     

CTA判断壁冠状动脉管腔狭窄程度最佳重建时相及管腔狭窄与MB-MCA特征相关性研究

目的:探讨CTA判断壁冠状动脉(MCA)管腔狭窄程度的最佳重建时相及管腔狭窄与心肌桥(MB)-MCA特征的相关关系。方法:回顾性分析42例深在型MB-MCA患者128层螺旋CT冠状动脉CTA资料。测量MB厚度、MCA长度及MCA管腔狭窄近端、最窄处及远端管径,计算MCA管腔狭窄程度,记录图像最佳重建时相,应用直线相关分析壁冠状动脉管腔狭窄程度与最佳重建时相、MB厚度、MCA长度及MCA长度与MB厚度间的关系,对其中两者间有线性关系的进行直线回归分析并绘制回归直线图。结果:42例MB-MCA患者MB平均厚度为(2.39±1.48)mm,MCA平均长度为(23.07±12.40)mm,MCA管腔平均狭窄程度为(26.62±16.47)%,最佳重建时相(66.9±3.7)%R-R间期。MCA管腔狭窄程度与最佳重建时相、MB厚度、MCA长度之间均有线性关系,相关系数r分别为0.3977、0.4291、0.5656(P均<0.01),回归系数b分别为1.7632、4.7711、0.7511。MCA长度与MB厚度间无相关性(r=0.1592,P>0.05)。结论:CTA判断MCA缩窄可持续到舒张中晚期,且MCA管腔狭窄程度与MB-MCA特征有关,MB和MCA是一种既独立又相互依存的解剖学变异。     

双源CT对心肌桥-壁冠状动脉的检测及其临床意义

目的:用双源CT(DSCT)观察心肌桥-壁冠状动脉(MB-MCA)的检出率及解剖学特征,探讨DSCT对MB-MCA的诊断价值。方法:用DSCT对450例可疑冠心病(CHD)和部分体检者行冠状动脉血管成像(CTA),2名CT诊断医师独立判断MB-MCA的存在,结果一致时确定为MB-MCA。测量壁冠状动脉(MCA)的长度、心肌桥(MB)的厚度,结果用x±s表示。采用多平面重组(MPR)、曲面重组(CPR)、容积再现(VR)多种后处理技术相结合观察MCA近端及远端血管形态变化。结果:450例可疑CHD和体检者,冠状动脉CTA发现MB-MCA 163例(36.2%,163/450),192处。MB-MCA位于左前降支者153处,占79.7%(153/192)。合并MB-MCA近端血管管腔内粥样硬化斑块形成者107例(55.7%,107/192),合并近端及远端均形成斑块者3例(1.6%,3/192)。MCA长度为(20.0±10.1)mm,MB厚度为(2.1±0.9)mm。结论:临床怀疑CHD者MB-MCA检出率为36.2%,DSCTCA是一种无创而且直观准确诊断MB-MCA的方法。     

用64层CT血管成像探讨冠状静脉系统的解剖特征

目的 研究64层螺旋CT在冠状静脉系统成像中的价值及冠状静脉窦(CS)及其属支的CT影像特征.方法 利用64层螺旋CT进行300例受检者的冠状静脉成像,观测CS及其属支的形态、数目、直径、角度及相邻冠状动脉的伴行关系.以年龄、性别及有无冠心病作为可能的影响因素对各冠状静脉主要分支的直径进行析因设计的方差分析.结果 所有受检者均可见CS、心大静脉(GCV)及心中静脉(MCV),273例受检者(91.0%)可见1～3支PVLV,心小静脉(SCV)及左房斜静脉分别显示56例(18.7%)、24例(8.0%).3例显示永存左上腔静脉畸形引流,1例显示CS憩室.后降支(PDA)与MCV伴行189例(63.0%),相交96例(32.0%).左旋支(LCX)与CS伴行122例(40.7%),与MCV相交15例(5.0%),LCX与PVLV相交104例(34.7%).CS口(CSO)、MCV、PVLV 3项指标,不存在年龄、性别及有无冠心病之间的交互作用,不同年龄、性别或有无冠状动脉疾患组的CSO前后径、MCV及PVLV值差异无统计学意义(P＞0.05).男性与女性的CSO上下径差异有统计学意义(F=6.67,P＜0.05).结论 冠状静脉系统解剖变异较大,64层螺旋CT可以作为显示CS及其属支的无创检查方法,可为心脏电生理治疗提供有用信息.     

脑静脉系统64层螺旋CT血管成像研究

目的 探讨CTA减影技术对脑静脉(窦)的显示能力及优势.方法 采用64层螺旋CT双能量同步扫描CTA技术,先行平扫,再行CTA容积扫描的动静脉同期显示全脑血管成像.随机抽取50例血管显示正常的病例,回顾性分析常规CTA和减影CTA脑静脉(窦)的显示率.结果 减影CTA中上矢状窦、直窦、大脑大静脉、透明隔静脉、大脑内静脉、基底静脉、横窦、乙状窦、蝶顶窦、岩下窦、小脑幕窦、大脑浅静脉、Labbe静脉显示率为100%,下矢状窦为99%,Trolard静脉为95%,岩上窦为90%,海绵窦为60%.除岩上窦、岩下窦、海绵窦外,常规CTA和减影CTA在上述脑静脉(窦)显示率上并无明显差别,但在显示程度方面有所不同.结论 减影CTA是显示脑静脉系统影像可行、有效的方法.常规CTA与减影CTA恰当的互补,具有很高的临床应用价值.     

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 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.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.