定量磁敏感加权成像在急性缺血性脑卒中中的应用

磁敏感加权成像(susceptibility weighted imaging,SWI)是一种利用组织磁敏感性不同而成像的技术,对缺氧缺血及颅内矿物质沉积非常敏感,已被广泛应用于急性缺血性脑卒中的诊断,但SWI不能对磁化率进行定量测定,随着定量磁敏感图(quantitative susceptibility mapping,QSM)的发展,这一缺陷逐步被弥补。QSM是基于梯度回波磁共振相位数据的一种新型的可以非侵入性地评估体内磁性组织之间磁敏感性差异的技术,它通过测量磁性物质的磁化率值来实现对体内磁性物质的定量,目前它在量化体内铁含量、钙化及静脉氧饱和度变化等方面已有了多种多样的应用。本文将就定量磁敏感加权成像的基本原理及其在急性缺血性脑卒中中的应用进行概述。     

磁敏感加权成像在中枢神经病变中的应用进展

磁敏感加权成像(susceptibility weighted imaging,SWI)是在T2*WI基础上加以改进的新技术[1]。该技术对脑微出血灶(cerebral microbleeds,CMBs)、静脉血管、钙、铁沉积等高度敏感[2]。基于该技术的设计特点及在脑组织的应用优势,SWI在脑血管疾病、脑血管畸形、脑肿瘤、外伤以及神经变性疾病方面均有较大的临床实用价值[3]。现对SWI的基本原理和神经系统病变中应用进展综述如下。     

磁敏感加权成像在中枢神经系统的临床应用新进展

<正>磁敏感加权成像(susceptibility?weighted?imaging,?SWI)是一种利用组织间磁敏感性差异及血氧水平依赖(blood?oxygenation?level?dependent,?BOLD)效应成像的磁共振新技术,成像原理首先由Jurgen-Reichenbach博士等提出,2002年12月SWI技术获得美国专利,SWI最初叫高分辨率Bold     

磁敏感加权成像对于急性缺血性脑卒中患者脑内微出血的临床诊断价值分析

目的:探讨针对罹患急性缺血性脑卒中的患者运用磁敏感加权成像(susceptibility weighted imaging,SWI)技术对脑内微出血诊断的价值.方法:选取2019年6月—2021年6月阳谷县人民医院收治的罹患急性缺血性脑卒中且疑似脑内微出血的患者50例,运用磁敏感加权成像技术实施检查,并就检查结果与常规...     

封面文章

正阿尔茨海默病(Alzheimer's disease,AD)的主要病理改变是神经细胞外Aβ蛋白聚集形成的淀粉样斑块和神经元内tau蛋白过度磷酸化聚集形成的神经纤维缠结。三维增强磁敏感成像(3D-enhanced susceptibility weighted angiography,ESWAN)是一种改良的磁敏感技术,它采用梯度回波的自由感应衰减和回波采样序列进行三维图像采集,消除了水等异常信号对铁沉积信号的影响,并且应用高通滤波等后处理技术,去除了由于场强不均造成的噪声     

多模态MRI在阿尔茨海默病早期诊断中的研究进展

阿尔茨海默病(Alzheimer's disease,AD)是发生于中老年人中最常见的中枢神经系统退行性疾病,以进行性认知障碍和行为非认知功能能力的减低为主要症状。近年来,随着磁共振成像(magnetic resonance imaging,MRI)多种序列的逐渐成熟,多模态MRI诊断在AD早期诊断中占有越来越重要的角色;作者就磁共振成像中结构性磁共振(structural magnetic resonance imaging,s MRI)、磁共振波谱成像(magnetic resonance spectroscopy,MRS)、磁共振弥散张量成像(diffusion tensor imaging,DTI)和磁共振扩散峰度成像(diffusion kurtosis imaging,DKI)、磁敏感加权成像(susceptibility weighted imaging,SWI)和定量磁敏感成像(quantitative susceptibility mapping,QSM)及静息态功能磁共振(functional MRI,f MRI)在AD早期诊断中的应用进行综述。     

磁敏感加权成像探测新生儿局灶性脑白质损伤

应用磁敏感加权成像(susceptibility weighted imaging, SWI)探测局灶性脑白质损伤(punctate white matter lesions, PWML)是否含有微出血成分,以明确PWML的病变性质~([1-2]).     

不同磁共振成像序列在颈髓损伤中的应用比较

目的 比较常规MRI序列、梯度回波T2*加权成像(T2*WI)及磁敏感加权成像(susceptibility weighted imaging,SWI)在急性颈髓损伤(SCI)中的应用价值.方法 对16例有急性颈椎外伤病史的患者,均采用3T MRI (TrioTim,Siemens Medical Solution)行...     

磁敏感加权成像临床应用研究进展

磁敏感加权成像（susceptibility weighted imaging,SWI）对于显示静脉血管、血液成分（如出血后各期代谢产物）、钙化、铁沉积等非常敏感。已广泛应用于各种出血性病变、异常静脉血管性病变、肿瘤及变性类疾病的诊断及铁含量的定量分析。本文对SWI在脑血管病、脑外伤、脑肿瘤、神经变性类疾病、脱髓鞘性病变及其在体部的临床应用进行文献回顾,同时提出SWI技术的优势与不足。     

磁敏感加权成像在坏死性脑胶质瘤与脑脓肿鉴别诊断中的价值

目的探讨磁敏感加权成像(susceptibility weighted imaging,SWI)在坏死性脑胶质瘤与脑脓肿鉴别诊断中的价值。材料与方法回顾性分析23例坏死性脑胶质瘤患者和16例脑脓肿患者,所有患者均在3.0 T磁共振成像仪上进行了常规磁共振成像和SWI,通过是否检出病灶内磁敏感信号(intralesional susceptibility signal,ILSS)来评价SWI对鉴别坏死性脑胶质瘤与脑脓肿的价值。结果 23例坏死性胶质瘤患者中,22例患者检出ILSS(95.7%),16例脑脓肿患者中6例检出ILSS(37.5%),利用ILSS区分坏死性胶质瘤和脑脓肿敏感性96%,特异性63%,坏死性脑胶质瘤患者ILSS检出率显著大于脑脓肿患者(OR=36.67,P=0.002)。结论 SWI在坏死性脑胶质瘤与脑脓肿的鉴别诊断中具有重要价值。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.