双源CT冠状动脉成像对冠状动脉支架内再狭窄的评价

背景：传统的CT在冠心病介入治疗后随访中难以普及,寻找无创、有效的检查方法对支架内再狭窄的评价就成了影像科医生非常关心的课题。 目的：通过在不控制心率下双源CT冠状动脉成像与选择性冠状动脉造影对支架评估的对比,探讨双源CT冠状动脉成像对冠状动脉支架内再狭窄的诊断价值。 方法：收集53例患者共75枚支架在不控制心率情况下同期行双源CT冠状动脉成像及冠状动脉造影检查的患者影像资料,分析双源CT冠状动脉成像诊断支架内再狭窄的敏感性等各项指标。 结果与结论：①双源CT冠状动脉成像能清楚显示全部支架,96%（72/75）支架图像达到良好以上。②双源CT冠状动脉成像对支架内再狭窄诊断的敏感性、特异性、阳性预测值、阴性预测值及准确性,与冠状动脉造影结果比较差异无显著性意义(P > 0.05)。③双源CT冠状动脉成像分别对心率< 70次/min和≥70次/min的患者支架再狭窄检测的敏感性、特异性、阳性预测值、阴性预测值、准确性比较差异无显著性意义 (P > 0. 05 )。④双源CT冠状动脉成像对直径< 3.0 mm支架再狭窄检测的敏感性、特异性、阳性预测值、阴性预测值、准确性低于≥3.0 mm的支架再狭窄(P < 0. 05 )。结果说明,双源CT冠状动脉成像对诊断冠状动脉支架内再狭窄具有较高的应用价值,且不受心率的影响,可作为大直径支架通畅情况的评估方式及小直径支架的初步筛查方法。     

64层螺旋CT冠状动脉成像在冠状动脉支架置入术前评价及术后随访中的临床应用

探讨64层螺旋CT冠状动脉成像在冠状动脉支架置入术前评价及术后随访中的临床应用价值.收集2006年7月～2007年5月在我院因拟行冠状动脉支架置入术而接受64层螺旋CT冠状动脉成像检查的46例患者的影像资料,以及同期内冠状动脉支架置入术后进行随访的21例患者共34个支架的影像资料,评估CT冠状动脉成像在冠状动脉支架置入术前评价及术后随访中诊断价值.结果发现64层螺旋CT对冠状动脉支架置入术前评估狭窄≥50%的敏感度、特异度、准确度分别为92.11%、95.64%和94.97%.64层螺旋CT评价支架通畅23个(67.65%),支架轻度狭窄8例(23.53%),重度狭窄3例(8.83%).因此,利用64层螺旋CT可以准确的评价冠状动脉支架置入术前及术后管腔的情况.     

双源CT血管成像在主动脉夹层腔内隔绝术后随访的应用

目的探讨双源CT血管成像对主动脉夹层腔内隔绝术后并发症的诊断价值。方法回顾性分析40例主动脉夹层腔内隔绝术后双源CT血管成像资料,其中男性33例,女性7例,年龄32~72岁,平均年龄49.05岁。所有患者的图像分析及后处理工作均在Syngo MMWP后处理工作站上完成,重建方法为容积再现(VR)、多平面重建(MPR)、最大密度投影(MIP)多种后处理技术。22例患者的术中数字减影血管造影(DSA)资料和术后双源CT血管成像资料进行对照分析。重点观察和分析了支架的位置、支架有无内漏、重要分支血管的通畅程度及真假腔情况。结果 40例均可清楚显示支架位置、形态、个数、对假腔的封闭情况。真、假腔内径在手术前、后差异均具有统计学意义(P0.05)。40例患者中术后发生支架内漏8例,发生逆行性夹层1例,支架内血栓形成1例。57支腹部分支及髂总动脉受累,其中腔内隔绝术后23支受累血管真腔管径不同程度扩大,假腔管径变小,34支变化不明显,3支无名动脉受累,腔内隔绝术后修复。双源CT血管成像与DSA资料对照分析,1例内漏DSA未能显示。结论双源CT血管成像是一种方便、快捷、无创的检查手段。综合原始及后处理资料,双源CT血管成像可以明确主动脉夹层腔内隔绝术后并发症的诊断,应作为主动脉夹层腔内隔绝术后诊断并发症的重要影像学检查方法。     

双源 CT 冠状动脉成像诊断冠心病的临床应用

目的:研究双源CT冠状动脉成像检查在冠心病诊断中的临床应用价值.方法:选取2018年3月2021年9月本院心内科就诊的疑似冠心病患者82例为研究对象,对比不同检查方法检查结果,分析双源CT冠状动脉成像方法检出结果效能,分析冠状动脉造影与双源CT冠状动脉成像方法检查的一致性.结果:冠状动脉造影检查结果:确诊冠心病75例,发现126支冠状动脉狭窄,其中左主干10支,前降支68支,回旋支28支,右冠状动脉20支;双源CT冠状动脉成像检查结果:确诊冠心病71例,发现110支冠状动脉狭窄,其中左主干8支,前降支60支,回旋支23支,右冠状动脉19支.两种检查方法结果相符病变血管109支,且双源CT冠状动脉成像检出软斑块56例.双源CT冠状动脉成像准确度、灵敏度、特异度分别为93.71％、86.51％、99.37％.双源CT冠状动脉成像与冠状动脉造影在冠状动脉狭窄程度≥50％的中、重度冠脉狭窄的显示一致性较高(K值=0.877,P<0.05).结论:双源CT冠状动脉成像检查在冠心病诊断中的临床应用价值确切,且具有一定安全性,为临床治疗方案提供依据.     

影响颅内支架CT血管成像的相关因素分析

目的:探讨影响颅内支架CT血管造影(CTA)成像质量的相关因素。方法:回顾性研究。纳入首都医科大学附属北京朝阳医院2016年7月—2019年10月颅内动脉置入支架、均行CTA及数字减影血管造影(DSA)检查的35例患者的临床资料,其中男28例、女7例,年龄37～83(60.6±7.9)岁,共留置支架35枚。以DSA为金...     

DSA低剂量在神经介入手术中应用研究进展

数字减影血管造影(DSA)已广泛应用于神经介入检查和治疗。随着DSA成像设备的改善及中国脑血管病发病率的不断增加,潜在地增加神经介入手术的术者和患者的辐射损伤。如何减少患者和术者的辐射剂量的同时并获得满足诊断的图像质量是当前临床研究的热点。文章从目前国内外DSA低剂量在神经介入手术中应用研究现状出发,对低剂量研究图像质量的评价、数据的采集方式、不同病种剂量的区别,以及实现低剂量的不同方法进行了总结。低剂量技术在神经介入手术中的应用还存在着很多问题,需要进一步研究。     

新型生物全降解药物支架置入小型猪冠状动脉的安全性

背景：目前冠状动脉支架的主要研究方向是高生物相容性的全降解生物材料及药物控释体系。 目的：评价2种新型生物全降解药物支架置入小型猪冠状动脉后的安全性。 方法：普通生物全降解支架为在聚左旋乳酸本体中融入抗增殖药物紫杉醇,新型生物全降解支架为在聚左旋乳酸及紫杉醇的基础上融入一种新型纳米材料无定形磷酸钙。①将普通生物全降解支架和新型生物全降解支架各5枚在冠状动脉造影下分别随机置入小型猪的冠状动脉,每种支架5头。于置入前和置入后28 d行血生化及C-反应蛋白水平检测;术后28 d冠状动脉造影观察支架置入段管腔通畅情况。②在微创显微镜辅助下于兔右髂外动脉分别置入普通生物全降解支架和新型生物全降解支架管状半成品(材料成分与上述支架一致),每种支架7只,在术前和术后28 d检测血尿素氮及肌酐水平。 结果与结论：置入后28 d两组猪谷丙转氨酶、谷草转氨酶、三酰甘油、总胆固醇、低密度脂蛋白及C-反应蛋白水平与置入前相比均无明显变化,但尿素氮、肌酐水平均明显高于置入前(P < 0.05);两组支架置入段血管均血流通畅、无血栓迹象和狭窄形成。支架置入前后两组兔肌酐和尿素氮水平无明显变化。表明新型生物全降解药物支架置入健康小型猪冠状动脉后是相对安全的,并且支架具有良好的组织相容性。     

双源CT冠状动脉血管成像在心肌桥和壁冠状动脉诊断中的应用

目的：探讨双源CT冠状动脉血管成像诊断心肌桥（MB）和壁冠状动脉（MCA）的价值.方法：767例疑冠心病患者行双源CT冠状动脉血管成像,对其中401例诊断为MB-MCA者的CT表现进行回顾性分析,并测量其MB的长度和厚度.其中32例同时在DSA下进行冠状动脉造影（CAG）检查,并用双源CT Inspace软件中的4D工具对所有期相的数据进行动态重组,以电影模式重组和回放,与DSA对照分析两者显示MB-MCA的价值.结果：本组MB-MCA的发生率为52.3%,其中前降支占86.3%,左旋支占9.7%,右冠状动脉最少占1.7%.MB长（20.2±2.3）mm,厚（2.6±0.2）mm.结论：双源CT冠状动脉成像综合各种后处理技术是目前诊断MB-MCA最有价值的无创性检查.     

冠状动脉内可吸收的镁合金支架

背景：目前以钴铬合金为基础的冠状动脉内药物洗脱支架不能从根本上解决亚急性血栓形成和再狭窄问题,于是生物可吸收支架成为关注的焦点。 目的：评估自行设计制作冠状动脉内可吸收镁合金支架的生物相容性、有效性和安全性。 方法：35只犬均于冠状动脉和/或股动脉置入可吸收镁合金支架1枚,分别于支架置入后24 h、3 d、5 d、1周、2周、3周、4周(n=5)复查冠状动脉及血管造影后取材,分离支架段血管行组织病理观察及计算机图像分析,测量内弹力板面积、管腔面积、内膜增生面积及内膜增生面积百分比。 结果与结论：51枚支架成功置入35只犬的冠状动脉和股动脉,支架置入后不同时点各组冠状动脉及股动脉造影均证实管腔通畅,无狭窄病变,无血栓形成,置入后1周左右支架完全降解。组织病理学结果显示,支架置入后2周开始出现轻微内膜增生,内膜增生面积百分比随着时间的推移逐渐增高。提示自行研发的冠状动脉内可吸收镁合金支架1周内降解,置入早期未见明显炎症反应及血栓形成,再狭窄程度轻,具有良好的生物相容性,安全有效。     

DebakeyⅢ型主动脉夹层腔内隔绝术后移植物及血管特征的双源CT血管成像研究

采用双源CT评价DebakeyⅢ型主动脉夹层腔内隔绝术后移植物及血管变化的特点。对39例DebakeyⅢ型主动脉夹层腔内隔绝术后患者的双源CT血管成像图像进行分析。发现39例患者术后均无支架断裂及移位,术后内漏15例(Ⅰ型12例、Ⅱ型2例、不明原因1例),17例假腔大量血栓形成,1例支架段假腔完全吸收。术前15例肾灌注异常病例,术后肾灌注改善9例,并且越靠近原发破口封堵部位,其血管重塑情况越明显。因此,双源CT血管成像可准确评价DebakeyⅢ型主动脉夹层腔内隔绝术后移植物情况及血管的解剖病理特点。     

Multislice CT angiography in cardiac imaging: prospective ECG-gating or retrospective ECG-gating?

With the advent of multislice CT more than a decade ago, multislice CT angiography has demonstrated a huge potential in the less invasive imaging of cardiovascular disease, especially in the diagnosis of coronary artery disease. The diagnostic accuracy of multislice CT angiography has been significantly augmented with the rapid technical developments ranging from the initial 4-slice, to the current 64-slice and 256 and 320-slice CT scanners. This is mainly demonstrated by the improved spatial and temporal resolution when compared to the earlier type of CT scanners. Traditionally, multislice CT angiography is acquired with retrospective ECG-gating with acquisition of volume data at the expense of increased radiation dose, since data is acquired at the entire cardiac cycle, although not all of them are used for postprocessing or reconstructions. Recently, there is an increasing trend of utilising prospective ECG-gating in cardiac imaging with latest multislice CT scanners (64 or more slices) with significant reduction of radiation dose when compared to retrospective ECG-gating method. However, there is some debate as to the diagnostic value of prospective ECG-gating in the diagnosis of coronary artery disease, despite its attractive ability to reduce radiation dose. This article will review the performance of retrospective ECG-gating in the diagnostic value of coronary artery disease, highlight the potential applications of prospective ECG-gating, and explore the future directions of multislice CT angiography in cardiac imaging.     

冠状动脉追踪冻结技术对高心率儿童冠状动脉成像质量的改善

目的:探索第二代冠状动脉追踪冻结（SSF2）技术是否可以提升高心率儿童冠状动脉的形态分辨能力。方法:对53例心率≥75次/min患儿行冠状动脉CT血管成像,年龄平均（17.5±18.7）个月,平均体质量（10.68±5.13） kg,扫描电压80、100 kV,采用智能心电门控技术自动选择曝光期相。将原始数据分别重建为3组图像:A组为常规图像;B组为采用SSF1技术的重建图像;C组为采用SSF2技术的重建图像。对3组冠状动脉图像的质量评分及可诊断率进行评估。结果:53例共评价534个冠状动脉节段。B组与C组右冠状动脉、左前降支、冠状动脉起源和冠状动脉评分及可诊断率差异均有统计学意义（P均<0.05）,左回旋支（LCX）评分差异有统计学意义（P<0.05）,LCX可诊断率无统计学意义（P=0.05）。A组与B组左前降支、LCX和冠状动脉起源评分差异均无统计学意义（P=0.07、0.14、0.43）。结论:采用SSF2技术可进一步改善高心率患儿冠状动脉CT血管成像质量。     

Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction.

BACKGROUND: When administered in conjunction with primary coronary stenting for the treatment of acute myocardial infarction, a platelet glycoprotein IIb/IIIa inhibitor may provide additional clinical benefit, but data on this combination therapy are limited. METHODS: We randomly assigned 300 patients with acute myocardial infarction in a double-blind fashion either to abciximab plus stenting (149 patients) or placebo plus stenting (151 patients) before they underwent coronary angiography. Clinical outcomes were evaluated 30 days and 6 months after the procedure. The angiographic patency of the infarct-related vessel and the left ventricular ejection fraction were evaluated at 24 hours and 6 months. RESULTS: At 30 days, the primary end point--a composite of death, reinfarction, or urgent revascularization of the target vessel--had occurred in 6.0 percent of the patients in the abciximab group, as compared with 14.6 percent of those in the placebo group (P=0.01); at 6 months, the corresponding figures were 7.4 percent and 15.9 percent (P=0.02). The better clinical outcomes in the abciximab group were related to the greater frequency of grade 3 coronary flow (according to the classification of the Thrombolysis in Myocardial Infarction trial) in this group than in the placebo group before the procedure (16.8 percent vs. 5.4 percent, P=0.01), immediately afterward (95.1 percent vs. 86.7 percent, P=0.04), and six months afterward (94.3 percent vs. 82.8 percent, P=0.04). One major bleeding event occurred in the abciximab group (0.7 percent); none occurred in the placebo group. CONCLUSIONS: As compared with placebo, early administration of abciximab in patients with acute myocardial infarction improves coronary patency before stenting, the success rate of the stenting procedure, the rate of coronary patency at six months, left ventricular function, and clinical outcomes.     

The interleukin 1B-511 polymorphism is associated with the risk of developing restenosis after coronary stenting in Mexican patients

Inflammation is the primary response to vessel wall injury caused by stent placement in coronary arteries. Cytokines of the interleukin-1 family are central regulators in immunoinflammatory mechanisms. The objective of this study was to test for association between IL-1 family gene polymorphisms and risk for restenosis after coronary stent placement. The IL-1B-511, IL-1F10.3, RN.4T>C, RN.6/1C>T, RN.6/2C>G, and IL-1RN VNTR polymorphisms were analyzed by 5' exonuclease TaqMan genotyping assays and polymerase chain reaction in a group of 165 patients who underwent coronary artery stenting. Basal and procedure coronary angiography were analyzed in search of angiographic predictors of restenosis and follow-up angiography was analyzed in search of binary restenosis. Patients with IL-1B-511 TT genotype had a 1.89-fold increased risk of developing restenosis. The analysis considering the lesions treated demonstrated that the lesions of patients with IL-1B-511 TT genotype had a 3.44-fold increased risk of developing restenosis. When the analysis considered the type of stent, the risk of developing restenosis was increased in lesions of patients with TT genotype (odds ratio = 4.50) who underwent coronary bare-metal stent implantation. Multiple logistic analysis identified IL-1B-511 TT genotype as an independent predictor for restenosis. The results suggest that IL-1B-511 polymorphism could be involved in the risk of developing restenosis after coronary stent placement.     

A registration based approach for 4D cardiac micro-CT using combined prospective and retrospective gating

Recent advances in murine cardiac studies with three-dimensional cone beam micro-computed tomography (CT) have used either prospective or retrospective gating technique. While prospective gating ensures the best image quality and the highest resolution, it involves longer sampling times and higher radiation dose. Sampling is faster and the radiation dose can be reduced with retrospective gating but the image quality is affected by the limited number of projections with an irregular angular distribution which complicate the reconstruction process, causing significant streaking artifacts. This work involves both prospective and retrospective gating in sampling. Deformable registration is used between a high quality image set acquired with prospective gating with the multiple data sets during the cardiac cycle obtained using retrospective gating. Tests were conducted on a four-dimensional (4D) cardiac mouse phantom and after optimization, the method was applied to in vivo cardiac micro-CT data. Results indicate that, by using our method, the sampling time can be reduced by a factor of 2.5 and the radiation dose can be reduced 35% compared to the prospective sampling while the image quality can be maintained. In conclusion, we proposed a novel solution to 4D cine cardiac micro-CT based on a combined prospective with retrospective gating in sampling and deformable registration post reconstruction that mixed the advantages of both strategies.     

Assessment of subacute inflammatory and proliferative response to coronary stenting in a porcine model by local gene expression studies and histomorphometry

The aim of the study was to analyse inflammatory and proliferative response early after coronary stenting by angiography, histomorphometry and local gene expression analysis using quantitative rt-PCR. Therefore, eight German domestic pigs underwent stenting of the left coronary artery. Selective coronary angiography was performed after 14 days. Explanted coronary arteries were examined histomorphometrically after methacrylate-embedding. Snap-frozen samples were examined for local gene expression of TGF-beta, TNF-alpha, GM-CSF, VEGF, PDGF and Fas Ligand (FasL) by real-time quantitative rt-PCR normalized to the housekeeping gene GAPDH and compared to unstented coronary arteries. All stented coronaries were patent with only little neointima formation. The median vessel diameter was 2.55 mm (range 2.43-2.68 mm). Histopathology revealed little inflammatory response limited to the tissue surrounding the stent struts; luminal area ranged from 84% to 91%. Compared to unstented control arteries, no significant differences in local gene expression were detected for VEGF, PDGF, TGF-beta, TNF-alpha and GM-CSF. Expression of FasL was upregulated as little as 1.7-fold (p=0.01). We conclude that, in native coronary arteries, no significant upregulation of investigated genes regulating vascular remodelling, inflammation or fibrogenesis was demonstrated 14 days after stenting. Whether upregulation of FasL as a marker gene of apoptosis is transient and biological significant requires further investigation.     

药物洗脱冠状动脉支架系统动物实验研究

目的通过观察在猪动脉中置人心畅可降解聚合物涂层药物洗脱冠状动脉支架（天津百畅公司开发）及对照组支架后的植入后管腔丢失、内皮化、炎症反应、损伤及血栓形成情况来评价国产可降解聚合物涂层药物洗脱支架临床应用的可行性。方法将2种共60枚支架分别置入30头猪冠状动脉的前降支、回旋支以及右冠状动脉。支架植入后的2,5,12,25周,将不同数量的猪处死行组织形态学检查,观察炎症、血栓形成情况和内皮化评价。结果支架置入术后的冠脉通畅,无明显狭窄;支架贴血管内壁良好,血管内腔表面光滑;2种支架均无血栓形成,心畅可降解聚合物涂层药物洗脱支架炎症反应及内皮化与对照组无明显差异,其管腔丢失较对照组轻或无明显差异。结论实验提示心畅可降解聚合物涂层药物洗脱支架置入后有良好的血液相容性,生物性能稳定,支架内表面迅速内皮化,血管有良好的开通率。说明可降解聚合物涂层药物洗脱支架是安全、有效的。     

Angle-independent measure of motion for image-based gating in 3D coronary angiography

The role of three-dimensional (3D) image guidance for interventional procedures and minimally invasive surgeries is increasing for the treatment of vascular disease. Currently, most interventional procedures are guided by two-dimensional x-ray angiography, but computed rotational angiography has the potential to provide 3D geometric information about the coronary arteries. The creation of 3D angiographic images of the coronary arteries requires synchronization of data acquisition with respect to the cardiac cycle, in order to minimize motion artifacts. This can be achieved by inferring the extent of motion from a patient's electrocardiogram (ECG) signal. However, a direct measurement of motion (from the 2D angiograms) has the potential to improve the 3D angiographic images by ensuring that only projections acquired during periods of minimal motion are included in the reconstruction. This paper presents an image-based metric for measuring the extent of motion in 2D x-ray angiographic images. Adaptive histogram equalization was applied to projection images to increase the sharpness of coronary arteries and the superior-inferior component of the weighted centroid (SIC) was measured. The SIC constitutes an image-based metric that can be used to track vessel motion, independent of apparent motion induced by the rotational acquisition. To evaluate the technique, six consecutive patients scheduled for routine coronary angiography procedures were studied. We compared the end of the SIC rest period (rho) to R-waves (R) detected in the patient's ECG and found a mean difference of 14 +/- 80 ms. Two simultaneous angular positions were acquired and rho was detected for each position. There was no statistically significant difference (P = 0.79) between rho in the two simultaneously acquired angular positions. Thus we have shown the SIC to be independent of view angle, which is critical for rotational angiography. A preliminary image-based gating strategy that employed the SIC was compared to an ECG-based gating strategy in a porcine model. The image-based gating strategy selected 61 projection images, compared to 45 selected by the ECG-gating strategy. Qualitative comparison revealed that although both the SIC-based and ECG-gated reconstructions decreased motion artifact compared to reconstruction with no gating, the SIC-based gating technique increased the conspicuity of smaller vessels when compared to ECG gating in maximum intensity projections of the reconstructions and increased the sharpness of a vessel cross section in multi-planar reformats of the reconstruction.