冠状动脉MSCTA成像在冠心病诊断中的应用

目的评价多层螺旋CT冠状动脉成像对冠心病病变的临床诊断价值。方法对57例临床初诊或可疑冠心病患者行多层螺旋CT冠状动脉成像(MSCTA),并且与常规冠状动脉造影(CAG)做对照分析。结果 57例患者的228支冠脉分支中,冠脉CTA成像检出病变冠脉213支(93.4%),MSCTA诊断冠状动脉血管狭窄≥50%的均有较高的灵敏度、特异度、阳性预测值、阴性预测值和准确度,分别为88%、99%、91%、98%和99%。钙化斑块组的CT值(415.2±221.1)HU明显高于非钙化斑块的CT值(68.4±47.5)HU(P<0.01)。结论 MSCTA对显示有临床意义的冠状动脉狭窄(≥50%)具有优良诊断价值,几乎可以代替有严重并发症的冠状动脉造影,能够结合密度测定判定斑块的性质,对判断冠脉斑块的稳定性具有重要的临床意义,是安全、准确、可靠的冠心病诊断方法。     

CTA与DSA评估冠心病冠状动脉狭窄程度的临床价值

目的 探讨CT血管成像(CTA)与数字减影血管造影(DSA)评估冠心病(CHD)冠状动脉狭窄程度的临床价值。方法选取78例疑似CHD患者，首先行CTA检查，并在随后7天内行DSA检查。将DSA作为诊断金标准，分析CTA对冠状动脉阳性病变的诊断结果。结果 经DSA金标准诊断阳性65例，阴性13例，其中CTA诊断阳性64例，阴性12例。CTA对冠状动脉阳性病变诊断的阴性预测值为92.31%、阳性预测值98.46%、灵敏度98.46%、特异度92.31%、符合率97.44%,一致性分析Kappa值分别为0.890,0.932,0.890,0.932,0.928。DSA与CTA对CHD冠状动脉狭窄程度的检查结果比较，差异无统计学意义(P>0.05)。结论 CTA对于CHD具有较高的诊断价值，能够有效识别冠状动脉狭窄程度与斑块类型。     

多层螺旋CT冠状动脉成像在冠心病中的临床应用

目的　评价多层螺旋CT冠状动脉造影 (MSCTA)在冠心病中的应用价值。方法　对4 0例冠心病患者 (35例拟诊冠心病 ,5例冠状动脉支架或搭桥术后患者 )进行了心电门控螺旋CT(MSCT)增强扫描 ,所得数据传到工作站进行三维重建 ,并与冠状动脉造影结果相对照。结果　 4 0例患者中对 16 0支冠状动脉 (简称冠脉 )进行了MSCT三维重建 ,35例拟诊者中 4例MSCTA和DSA排除了冠脉疾病 ;31例 12 4支冠脉中 ,MSCTA对于显示近中段≥ 5 0 %的狭窄有一定的准确性 (敏感性 81 8% ,特异性 90 1% ) ,不能显示轻度狭窄病变、远端或细小分支病变 ;可以发现并判断粥样硬化斑块的类型 ,显示斑块的形态及引起狭窄的程度。钙化斑块特别是钙化范围广者可引起管腔轻度狭窄 (冠状动脉腔径狭窄 <5 0 % ) ,非钙化斑块则引起较明显的狭窄 (冠状动脉腔径狭窄≥ 5 0 % )。 4例冠状动脉支架和 1例冠状动脉搭桥术后均可清晰显示支架和血管桥的位置及远端血流情况。结论MSCTA是有效可靠的冠心病诊断方法 ,对病变血管管腔狭窄、粥样硬化斑块的评价有一定的应用价值。它作为一种非创伤性检查方法 ,可替代DSA用于易碎软斑块的早期检查。     

64层CT冠状动脉成像对冠心病的诊断价值

目的:分析64层CT冠状动脉造影(MSCTA)在冠心病诊断中的价值及不足。方法:对90例临床怀疑冠心病患者行MSCTA。利用先进的后处理软件对血管进行评估并作出诊断。其中40例诊断为不同程度狭窄的患者行冠状动脉DSA,并以此为金标准,评析MSCTA对冠状动脉病变的诊断一致性。结果:所有MSCTA和DSA图像均有诊断价值。MSCTA显示97.4%血管的狭窄闭塞程度与DSA一致。MSCTA诊断有血流动力学意义的冠状动脉狭窄(≥50%)的敏感性为99.6%,特异性为99.7%,准确度为98.6%,阳性预测值为99.6%,阴性预测值为99.7%。结论:MSCTA是一种安全、可靠、无创的影像学技术,可作为诊断冠心病及介入治疗前预案制定的首选方法。     

64层容积CT在冠心病诊断中的临床应用

目的:初步探讨64层容积CT在冠状动脉成像中的临床应用价值。方法:同时行冠状动脉CTA检查和冠状动脉造影检查的40例患者。利用曲面重建、三维重建,了解冠状动脉病变的情况,并与冠状动脉造影对比。结果:40例共160支血管同时行CTA和DSA成像,DSA发现血管狭窄96节段,CTA发现血管狭窄101节段。CTA与DSA结果相符的血管有94节段,CTA诊断冠心病的敏感性为97.92%,特异性为89.06%,阳性预测率为93.07%,阴性预测率为96.61%。结论:CTA可以作为冠状动脉狭窄的一种安全、简便、无创的筛查方法。     

320排容积CT冠状动脉血管造影诊断飞行人员冠心病应用价值研究

目的:初步探讨320排容积CT冠状动脉血管造影在诊断飞行人员冠状动脉疾病中的应用价值。方法:回顾分析2014年1月—2019年8月于某医院影像科接受320排容积CT检查的92例飞行人员的冠状动脉CT血管造影(CTA)结果,其中,16例飞行人员接受冠状动脉数字减影血管造影(DSA)检查;以DSA检查结果为"金标准",分析冠状动脉CTA诊断飞行人员冠心病的敏感度、特异性和准确度。结果:92例飞行人员均顺利完成冠状动脉CTA检查,其中CTA正常36例,管腔狭窄27例,心肌桥25例,钙化斑块22例。以DSA检查结果为准,冠状动脉CTA检出冠状动脉狭窄的敏感度为75.9%,特异性为86.8%,准确率为83.1%。CTA组共检出43支狭窄冠状动脉,DSA组共检出38支狭窄冠状动脉,两组检出冠状动脉狭窄分布情况差异不显著(P>0.05);CTA检出0～Ⅳ级狭窄患者分别为11例、19例、5例、7例、1例;DSA检出0～Ⅳ级狭窄分别为8例、16例、7例、6例、1例,两组检出冠状动脉狭窄程度比较,差异不显著(P>0.05)。结论:320排容积CT冠状动脉CTA检查能够较准确显示飞行人员冠状动脉...     

冠状动脉病变自身因素对CTA评价冠状动脉狭窄准确性的影响

目的 探讨冠状动脉病变自身因素对CTA评估血管狭窄程度准确性的影响. 资料与方法 60例临床拟诊疑为冠状动脉狭窄的患者同期行冠状动脉CT血管造影(CTA)和冠状动脉血管造影检查(CAG).CTA扫描采用64层螺旋CT及回顾性心电门控技术,以CAG结果 为金标准,采用双盲法评价CTA诊断冠状动脉狭窄的准确性,并分析各种冠状动脉病变自身因素对评价狭窄准确性的影响. 结果 CTA诊断冠状动脉轻、中、重度狭窄的敏感性分别为76.47%、77.97%和85.71%,钙化斑块是导致64层螺旋CT评价冠状动脉狭窄假阳性最重要的自身因素(18/28,占64.29%),对于冠状动脉和其分支的狭窄程度的低估占假阴性结果 的66.67%(20/30),壁冠状动脉和心肌桥的漏诊占假阴性结果 的23.33%(7/30). 结论 64层螺旋CT诊断冠状动脉重度狭窄具有较高的准确性,钙化斑块、心肌桥和小血管的狭窄病变本身均影响CTA评价狭窄的准确性,而非钙化斑块和支架/冠状动脉旁路移植术(CABG)后狭窄的诊断准确性较高.     

CTA与心脏磁共振成像对冠心病的诊断价值

目的 探讨MSCT冠状动脉CT血管成像(CTA)与心脏磁共振成像(CMR)对冠心病(CHD)的诊断价值。方法 选取我院80例采用MSCT行CTA检查的疑似CHD患者作为观察对象,以冠状动脉造影(CAG)检查结果作为金标准,分析CT对CHD的诊断效能。对40例临床确诊为CHD且冠状动脉狭窄≥1支的患者行CMR检查,测量正常心肌和病变心肌的延迟强化信号强度、最大上升斜率、首过灌注时间。结果 本组80例采用128层MSCT行CTA检查的CHD患者,发现斑块235个,其中150个为钙化斑块(63.83%),32个为脂质斑块(13.62%),35个为纤维斑块(14.89%),18个为混合斑块(7.66%)。以CAG为金标准,CTA检查诊断CHD的灵敏度为93.33%、特异度为95.00%、准确度为93.75%。以CAG为金标准,CTA对中度狭窄、轻度狭窄及正常的评估中存在不同程度的高估现象。40例经CAG检查确诊为CHD的患者行CMR检查,被评估的冠状动脉共计120支,其中23例为单支冠状动脉病变,17例为2支及以上冠状动脉病变; 8例左前降支重度狭窄,6例左旋支重度狭窄,6例右冠状动脉重度狭窄...     

冠状动脉狭窄和粥样硬化斑块血管造影、MRA和CTA的对比研究

目的以冠状动脉血管造影(CA)为参照,比较冠状动脉MRA和CTA诊断狭窄的准确性,探讨斑块的MRA表现.材料和方法30例冠心病患者在2周内接受冠状动脉MRA、CTA和CA检查.MRA使用呼吸导航触发的高分辨三维FIESTA序列,CTA检查使用64排螺旋CT.以CA为诊断金标准,评价MRA和CTA检测≥50%狭窄血管的患者,回顾性分析冠状动脉斑块的MRA表现.结果MRA和CTA判断狭窄的敏感性、特异性和准确性分别为83.0%、86.9%、86.1%和85.1%、87.2%、86.8%.斑块的MRA复杂信号是MRA高、低估冠脉狭窄的主要原因,钙化是导致CTA高估狭窄的主要原因,MRA可以校正CTA对钙化所致狭窄的错误判断.结论高分辨三维FIESTA序列MRA显示冠状动脉狭窄的效能与CTA接近,MRA对显示钙化斑块导致的管腔狭窄比CTA有优势;斑块的MRA表现比较复杂,给狭窄的判断带来困难,也为斑块性质的判断提供机会.     

非增强MRA和CTA在颈内动脉狭窄的临床诊断价值

目的:评估非增强MRA(TOF-MRA)联合CT血管成像(CTA)在颈内动脉狭窄诊断中的应用价值。方法:回顾性分析54例行颈内动脉起始段TOF-MRA、CTA、数字减影血管造影(DSA)的影像学资料,分析3种检查方法对狭窄部位管腔直径、斑块性质、斑块表面形态的判断,比较TOF-MRA、CTA、DSA、TOF-MRA联合CTA在颈内动脉狭窄诊断中的优缺点。结果:以DSA为金标准,TOF-MRA诊断颈内动脉起始段狭窄的敏感性为82.6%,特异性为88.6%,准确性为92.6%;CTA的敏感性为90.5%,特异性为94.3%,准确性为96.3%;TOF-MRA联合CTA的敏感性为95.2%,特异性为97.1%,准确性为98.1%。CTA对斑块性质、斑块表面形态的判断更具优势。结论:TOF-MRA联合CTA可以提高颈内动脉近端狭窄程度、斑块性质及表面形态的准确性。     

Trends in the surgical treatment of articular cartilage defects of the knee in the United States

Purpose

The purpose of this study was to evaluate trends in surgical treatment of articular cartilage defects of the knee in the United States.

Methods

The current procedural terminology (CPT) billing codes of patients undergoing articular cartilage procedures of the knee were searched using the PearlDiver Patient Record Database, a national database of insurance billing records. The CPT codes for chondroplasty, microfracture, osteochondral autograft, osteochondral allograft, and autologous chondrocyte implantation (ACI) were searched.

Results

A total of 163,448 articular cartilage procedures of the knee were identified over a 6-year period. Microfracture and chondroplasty accounted for over 98 % of cases. There was no significant change in the incidence of cartilage procedures noted from 2004 (1.27 cases per 10,000 patients) to 2009 (1.53 cases per 10,000 patients) (p = 0.06). All procedures were performed more commonly in males (p < 0.001). This gender difference was smallest in patients undergoing chondroplasty (51 % males and 49 % females) and greatest for open osteochondral allograft (61 % males and 39 % females). Chondroplasty and microfracture were most commonly performed in patients aged 40–59, while all other procedures were performed most frequently in patients <40 years old (p < 0.001).

Conclusions

Articular cartilage lesions of the knee are most commonly treated with microfracture or chondroplasty in the United States. Chondroplasty and microfracture were most often performed in middle-aged patients, whereas osteochondral autograft, allograft, and ACI were performed in younger patients, and more frequently in males.

Level of evidence

Cross-sectional study, Level IV.     

Trends in the diagnosis of SLAP lesions in the US military

Purpose

Shoulder pathology, particularly SLAP (superior labrum anterior-posterior) lesions, is prevalent in overhead athletes and physically active individuals. The aim of this study is to quantify the burden of SLAP lesions in the military and establish risk factors for diagnosis.

Methods

A retrospective analysis of all service members diagnosed with a SLAP lesion (International Classification of Disease, Ninth Revision code 840.70) in the Defense Medical Epidemiological Database between 2002 and 2009 was performed. Available epidemiological risk factors including age, sex, race, military rank, and branch of service were evaluated using multivariate Poisson regression analysis, and cumulative and subgroup incidence rates were calculated.

Results

During the study period, approximately 23,632 SLAP lesions were diagnosed among a population at risk of 11,082,738, resulting in an adjusted incidence rate of 2.13 per 1,000 person-years. The adjusted annual incidence rate for SLAP lesions increased from 0.31 cases per 1,000 person-years in 2002 to 1.88 cases per 1,000 person-years in 2009, with an average annual increase of 21.2 % (95 % CI 20.7 %, 22.0 %, p < 0.0001) during the study period. Age, sex, race, branch of military service, and military rank were independent risk factors associated with the incidence rate of SLAP lesion (p < 0.01). Male service members were over twofold more likely (IRR, 2.12; 95 % CI 2.01, 2.23) to sustain a SLAP lesion when compared with females. Increasing age category was associated with a statistically significant increase in the incidence rate for SLAP lesions in the present study (p < 0.001). After controlling for the other variables, those individuals of white race, enlisted ranks, or Marine Corps service experienced the highest incidence rates for SLAP.

Conclusion

This is the first study to establish the epidemiology of SLAP lesions within an active military cohort in the American population. Sex, age, race, military rank, and branch of military service were all independently associated with the incidence rate of SLAP lesions in this physically active population at high risk for shoulder injury.

Level of evidence

II.

     

Experimental study of the influence of the counter and scintillator on the universal curves in the cross-efficiency method in LSC

The cross-efficiency method in LSC is one of the approaches proposed for the extension of the Système International de Référence (SIR) to radionuclides emitting no gamma radiation. This method is based on a so-called “universal cross-efficiency curve”, establishing a relationship between the detection efficiency of the radionuclide to be measured and the detection efficiency of a suitable tracer. This paper reports a study at LNHB on the influence of the scintillator and of the LS counter on the cross-efficiency curves. This was done by measuring the cross-efficiency curves obtained for ⁶³Ni and ⁵⁵Fe vs. ³H, using three different commercial LS counters (Guardian 1414, Tricarb 3170 and Quantulus 1220), three different liquid scintillator cocktails (Ultima Gold, Hionic Fluor and PicoFluor 15 from Perkin Elmer^®), and for chemical and colour-quenched sources. This study shows that these cross-efficiency curves are dependent on the scintillator, on the counter used and on the nature of the quenching phenomenon, and thus cannot definitively be considered as “universal”.     

Decrease in the numbers of mechanoreceptors in rabbit ACL: the effects of ageing

It is proposed that there is a positive correlation between the numbers of mechanoreceptors and proprioceptive function. On the other hand, normal aging process is associated with deficits in proprioception. This study is designed to test the hypothesis that aging resulted in decreased numbers of mechanoreceptors. Anterior cruciate ligaments of 14 male rabbits (2 months, n=5; 12 months, n=4 and 60 months, n=5) were extracted and the total numbers of Ruffini, Pacini and Golgi tendon-like receptors were accounted. As a result, the numbers of mechanoreceptors, especially Ruffini receptors, decreased with aging (p<0.05). Increased age was associated with changes in the morphology of mechanoreceptors. In conclusion, aging results in both diminished numbers and changed morphology of mechanoreceptors.     

Ultrasonography in the evaluation of the mid-palatal suture in rapid palatal expansion

Objectives:

Orthodontists usually evaluate the mid-palatal sutural opening with occlusal radiography. The purpose of this article is to evaluate the sutural opening with ultrasonography (USG) in a series of patients undergoing rapid palatal expansion (RPE).

Methods:

The study included 87 USG images and 87 occlusal radiographs from 29 healthy patients (mean age, 13.9 years; range, 11–20 years; boys, 12; girls, 17) who required RPE treatment. The sutural opening was assessed with USG, and the amount of sutural expansion as mesiodistal length was measured immediately after appliance practice (T₀), 10 turns (T₁) and 20 turns (T₂) during the expansion period. Sutural expansion evaluated by occlusal radiographs was scored at every stage. Measurements obtained by USG and scores observed in the occlusal radiographs were compared by non-parametric Kendall''s tau test.

Results:

Both USG and radiographic images revealed normal anatomical structure during pre-expansion (stage T₀). On USG, sutural expansion was seen in 19 patients at stage T₁. There was no expansion at this stage in ten patients. At stage T₂, on USG and radiography, an increase in the amount of expansion was observed in 19 patients with sutural expansion at stage T₁ and sutural expansion was observed in 5 patients without sutural expansion at stage T₁. No expansion was observed at both stages T₁ and T₂ in five patients. USG measurements and occlusal scores in both T₁ and T₂ turns showed statistically significant correlation (p < 0.001).

Conclusions:

The results indicate that USG might be a useful method to assess mid-palatal sutural opening in patients undergoing RPE.     

Variations in the height of the odontoid process

Summary The height of the odontoid process is discussed with respect to the anterior arch of the atlas. Three situations are considered, viz. the normal odontoid process, the hypoplastic odontoid process, a minor form of dens aplasia showing a predisposition to luxation, and the hypertrophic odontoid process, which occurs in two forms, depending on whether it lies above the basilar line of below it.

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Variationen der Höbe des Os odontoideum

Zusammenfassung Die unterschiedliche Höhe des Os odontoideum wird in Hinsicht auf den vorderen Atlasbogen diskutiert. Dabei müssen 3 verschiedene, Gegebenheiten erwähnt werden: das normale Os odontoideum, die hypoplastische Form (eine angedeutete Aplasie, die eine Prädisposition zur Luxation aufweist) und die hypertrophe Form des Os odontoideum. Dieser Hypertrophie erscheint in 2 Formen, die davon abhängig ist, ob sie ober-oder unterhalb der Basilar-Linie liegt.

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Variations de la hauteur de l'odontoide

Rrésumé La hauteur de la dent de l'axis est mesurée par rapport à l'are antérieur de l'atlas. Trois circonstances sont evisagées:-1. hauteur normale de l'odontoide-2. hypoplasie de l'odontoide, une forme mineure de densaplasie prédisposant a la luxation-3. hypertrophie de l'odontoide avec deux formes selon qu'il dépasse ou non le niveau de la ligne basilaire.

     

Variations in the drainage of the basal vein

Summary After depicting various drainages of the basal vein, the authors explain most of them by reference to their embryonic formation. They point out the phlebographic features allowing easy recognition of these variants.

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Variationen im Abfluß der V. basalis

Zusammenfassung Verschiedene Abflußwege der Vena basilaris werden beschrieben und durch die Embryologie erklärt. Ihre Morphologie ist eindeutig und phlebographisch leicht erkennbar.

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Variantes dans le drainage de la veine basale

Résumé Les auteurs illustrent quelques variantes de drainage de la veine basale et se réfèrent à l'embryologie pour expliquer leur morphologie. Ils insistent sur leurs aspects caractéristiques, permettant une identification aisée sur les incidences phlébographiques.

     

Progress in the Elucidation of the Mechanisms of Radiation-Induced Vomiting

Summary

Four closely-related cis-platinum (Pt) complexes of 4(5)-nitroimidazole have been examined with respect to properties of radiobiological interest, to test the hypothesis that targeting a nitroimidazole (NO₂Im) to DNA could enhance its radiosensitizing ability: I [PtCl₂(5-NO₂Im)₂]; II [PtCl₂(4-NO₂Im)₂]; III [PtCl₂(NH₃)(5-NO₂Im)]; IV [PtCl₂(NH₃)(4-NO₂Im)]. The reduction potential was affected to the same extent on metal binding in all of the complexes (ΔE_1/2 = + 200 mV, cf. ligand measured polographically). Higher sensitization by 5-NO₂ complexes I, III (cf. II, IV) was found. Only the mono complexes III and IV bind to DNA (in an assay using inhibition of restriction endonuclease activity); these radiosensitize as well as, or better than, free ligand in hypoxic CHO cells, and better than the bis complexes (I and II). The toxicity of the mono complexes is higher than ligand, and parallels the binding (III, IV, mono bis analogues). The complexes are compared with 4-nitroimidazole complexes of ruthenium, with respect to toxicity, binding and radiosensitization.     

Yield of head CT in the alcohol-intoxicated patient in the emergency department

We aimed to determine the yield of positive head computed tomography (CT) findings among suspected alcohol-intoxicated patients presenting to the emergency department (ED). Our secondary aim was to determine if elderly intoxicated patients were more likely to have an intracranial injury. We identified patients suspected of alcohol intoxication who underwent CT scanning in the ED over a 4-year period. Pre-determined data elements including demographics, diagnosis, and disposition were extracted using a pre-formatted data sheet by blinded abstractors. “Positive” CT was defined as evidence of any type of intracranial hemorrhage. A total of 2,671 subjects with suspected alcohol intoxication and a head CT were identified. Fifty out of the 2,671 (1.9%) had a positive CT. Among CT scans of elderly (≥60 years of age) subjects, 15/555 (2.7%, 95% CI = 1.4–4.1%) were positive compared with 35/2,116 (1.7%, 95% CI = 1.1–2.2%) among those <60 years of age (p = 0.11). The yield of positive head CT among alcohol-intoxicated patients was low, at 1.9%. An age cutoff of 60 years in this population did not predict a significantly higher positive rate.     

Distribution of the radionuclide Cs in the soils of a wet mountainous forest in Taiwan

The behavior of ¹³⁷Cs was studied in the Yuanyang lake ecosystem, a wet mountainous forest in subtropical Taiwan. Soils investigated are either partially podzolic soils or nearly pure peats with a high organic matter concentration in the surface layer. Concentration of ¹³⁷Cs was highest in the organic surface layers, particularly in the Oe horizon or in the underlying A horizon. The downwards migration to the mineral horizons is limited, in spite of the high rainfall. Topography is a critical factor for the distribution of ¹³⁷Cs. It is shown that the concentration of ¹³⁷Cs is highest at the foot of the slope and lower near the summit and near the lakeshore. The variation of the concentration along the landscape has been attributed to erosion–deposition in combination with surface run-off of the undisturbed forest. The amount of ¹³⁷Cs in the site studied is significantly higher than at any other place in Taiwan. The accumulation of ¹³⁷Cs is attributed to the high rainfall, which brought large amounts of ¹³⁷Cs with the precipitation in the early 1960s. A very remarkable feature of the ecosystem is that ¹³⁷Cs is not leached to the subsoils, but is stored in the biomass. Due to permanent recycling it remains available, without being leached downward.