CT血管造影联合CT灌注在缺血性脑卒中的临床应用

目的探讨血管造影联合CT灌注在缺血性脑卒中的临床价值。方法选择2012-03—2014-03在我院诊治的缺血性脑卒中患者42例,采用东芝320排CT行头部CTA及CTP检查。观察两种检查方法对缺血性脑卒中的诊断情况,探讨颅内及颈部血管的狭窄与脑组织灌注异常区的关系。结果 CTP检查发现与临床症状相符的异常灌注区36例,感兴趣区的脑血容量及脑血流量较镜像区显著降低(P0.05);感兴趣区的平均通过时间显著延长(P0.05)。CTA检查发现颈部及颅内血管狭窄32例,10例未发现有血管狭窄。CTA有责任血管狭窄患者CTP阳性率(71.43%)显著高于CTA无责任血管狭窄者(14.29%)。结论缺血性脑卒中行CT血管造影联合CT灌注能准确反映脑组织血流动力学变化,有效判定颈部及颅内责任血管是否存在狭窄,为临床诊断提供依据。     

640层螺旋CT脑灌注成像与CT血管成像在超早期脑梗死中的应用

目的探讨东芝Aquilion ONE 640层CT脑灌注成像(CTP)与CT血管成像(CTA)在超早期脑梗死患者中的应用价值。方法我院2014-06—2015-12收治的28例超早期脑梗死患者,均在发病后6h内实施CT平扫、CTP与CTA检查,分析平扫及灌注CT表现,计算CTP的达峰时间(TTP)、脑血流量(CBF)、脑血容量(CBV)各参数值,并与对侧及半暗带周边相应区灌注参数相对比;重建颈段和脑内动脉CTA图像,采用图像后处理技术显示病变血管情况,对动脉狭窄程度进行分级评价。所有患者3~7d内行多层螺旋CT复查,评估CTP与CTA在超早期脑梗死诊断中的临床价值。结果 28例患者经头颅CT平扫发现,11例有可疑脑缺血区,其余17例未见明显异常。行CT脑血管灌注成像发现,患者感兴趣区内rCBF、rCBV、rTTP(病变侧与对照侧灌注参数的相对比值)明显改变,脑梗死区较边缘区TTP更高,CBF、CBV更低,差异均有统计学意义(P0.01);半暗带区CBF、TTP与对侧比较差异有统计学意义(P0.01),而CBV对比差异无统计学意义(P0.05)。CTA检查发现,10例患者大脑中动脉闭塞,7例大脑中动脉狭窄,11例一侧颈内动脉狭窄或闭塞。结论 CTP早期发现脑梗死患者脑组织中的缺血半暗带,CTA检查可准确判断狭窄或闭塞血管,在脑梗死患者的早期诊断和指导溶栓治疗中有重要临床价值。     

进展性与完全性脑梗死患者CT灌注成像及CT血管造影分析

目的 观察进展性和完全性脑梗死患者在CT灌注成像(CTP)及CT血管造影(CTA)方面的差异.方法 对患者进行CTP及CTA检查,获取相对CBF(rCBF)、相对CBV(rCBV)数据,并获得脑动脉狭窄情况.结果 2组rCBF、rCBV和颈动脉系统中度以上狭窄检出率差异有统计学意义(P<0.05).结论 对于脑梗死患者,可采用CTA及CTP检查来明确脑动脉狭窄程度和脑灌注情况,辨别潜在病情进展患者.     

多层CT评价颈动脉重度狭窄性病变的初步研究

目的探讨多层CT脑灌注技术和头颈部CT灌注成像(CTA)技术联合应用评价颈动脉重度狭窄性病变的临床价值。方法对23例有症状的颈动脉重度狭窄性病变进行颅脑平扫、脑CT灌注和头颈部CTA联合检查。利用CTA对血管的狭窄程度、狭窄部位进行评价,利用CT灌注对脑血流动力学状态进行评价。选10名年龄相匹配的志愿者行CT灌注检查,作为CT灌注的对照组。结果CTA显示一侧颈内动脉闭塞12例,一侧颈内动脉重度狭窄11例。7例为单侧颈内动脉病变,16例为多血管多部位狭窄,包括对侧颈动脉狭窄,单侧或双侧椎动脉狭窄或闭塞,颅内血管狭窄或闭塞。脑CT灌注显示病变同侧灌注异常17例,闭塞组(8例)和重度狭窄组(9例)在灌注异常的发生率上差异无统计学意义。单发组(3例)和多发组(14例)在灌注异常发生率上差异有统计学意义(P<0·05)。结论颈动脉重度狭窄性病变多伴有同侧脑灌注的异常(17/23),多血管病变脑内灌注异常的发生率多于单发的颈动脉狭窄或闭塞。CTA和CT灌注技术联合应用可更加全面地评价颈动脉狭窄性病变,具有较高的临床应用价值。     

CT血管成像及灌注成像与前循环脑梗死

目的 探讨CT血管成像(CTA)联合CT灌注成像(CTP)在前循环脑梗死中的临床应用价值.方法 回顾性分析542例经头MRI DWI证实大脑半球有新发梗死灶的缺血性脑卒中患者资料,所有病例均具备头CTA及CTP检查,分析责任血管病变程度与病灶大小、病灶部位血流灌注异常情况的关系.结果 在本组病例中责任血管多见于大脑中动脉(58.6％),其次是颈内动脉颅外段(32.9％).不同的责任血管病变部位、狭窄程度及其支配区灌注异常情况,其梗死灶的大小均具有显著性差异(P分别为0.015、0.000和0.000),其中以大脑中动脉病变、血管闭塞或中重度以上的狭窄以及灌注程度低的病例梗死灶相对大(＞ 15mm).但仍有28例(12.6％)责任血管为重度狭窄或闭塞的患者表现为腔隙性脑梗死.此外,337例CTP异常患者中,86例(25.5％)存在低灌注区大于梗死灶.结论 本研究显示前循环脑梗死的责任血管多见于大脑中动脉.影像学显示的梗死灶的大小并不完全与血管病变程度一致.此外,约25％患者存在梗死面积与灌注降低不匹配现象.因此,对前循环脑梗死患者进行CTA联合CTP检查,对临床缺血性脑卒中的综合性评估和个体化治疗具有较重要的参考价值.     

CT脑灌注成像与CT血管成像对颈动脉狭窄性短暂性脑缺血发作的诊断价值

目的探讨CT脑灌注成像与CT血管成像对颈动脉狭窄所致短暂性脑缺血发作的诊断价值。方法对我院2012-01—2014-01收治的36例临床诊断为短暂性脑缺血发作患者的影像学资料进行回顾性分析,所有患者均行颅CT平扫、CT脑灌注成像和CT血管成像检查,测定兴趣区及对侧相应区域局部脑血流量(rCBF)、局部脑血容量(rCBV)、平均通过时间(MTT)和达峰时间(TTP),评价颈动脉的狭窄程度与斑块的性质。结果 36例患者行CT平扫均未发现与临床症状相对应的病灶,CT血管造影显示责任血管狭窄28例,发现颈动脉斑块54块,而CT灌注成像显示异常24例,阳性率85.71%,其中病灶侧TTP、rCBF、MTT值与对照侧比较差异均有统计学意义(P0.05),而rCBV与对照侧对比差异无统计学意义(P0.05);CT血管造影显示责任血管无狭窄8例,而CT灌注成像异常3例,阳性率37.5%,二者比较差异有统计学意义(P0.05)。Ⅰ期患者MTT低于Ⅱ期,rCBF高于Ⅱ期,差异均有统计学意义(P0.05);Ⅰ期、Ⅱ期rCBV相似,差异无统计学意义(P0.05)。经半年随访,其中5例发展成为脑梗死。结论 CT脑灌注成像结合CTA可同时观察短暂性脑缺血发作患者脑组织的血流动力学变化与颈内动脉的血管形态变化,对短暂性脑缺血发作的诊断具有重要价值,值得临床推广应用。     

CT脑灌注与血管造影在急性缺血性脑卒中的临床应用与分析

目的探讨CT脑灌注(CTPI)与血管造影在急性缺血性脑卒中中的临床应用价值。方法选择29例急性缺血性脑卒中患者为研究对象,采用东芝Aquilion 64排CT行头颈部CTA及CTPI检查,观察两者对急性缺血性脑卒中诊断情况,分析CTPI与CTA对急性缺血性脑卒中诊断的一致性。结果①29例患者CT灌注图上发现与临床症状相对应的灌注异常区共25例,阳性率为86.2%(25/29),高于普通CT扫描的27.6%(8/29),差异具有统计学意义(P0.05)。②灌注异常区的CBF、CBV、MTT三组参数值与镜像健侧相比差异有显著统计学意义(P0.05);③CTA血管检查结果发现单纯颈内动脉狭窄5处;单纯颅内动脉狭窄10处;颈内动脉及颅内动脉均狭窄4例。④病例组CTPI联合CTA检查结果比较,病例组存在责任血管的患者CTPI检查阳性率为65.51%(19/29)高于无责任血管者的20.69%(6/29),差异具有统计学意义(P0.05)。结论 CTPI与CTA可以清晰的显示缺血性脑卒中脑内病灶及责任动脉,能够提高更多有价值的信息。     

急性缺血性脑血管病76例多模式CT影像学分析

目的探讨76例急性缺血性脑血管病(AICVD)的多模式CT影像学特点。方法采用320排多层螺旋CT对76例AICVD(发病时间24h)患者急诊进行CT平扫(NCCT)+CT灌注成像(CTP)+CT血管成像(CTA)一站式扫描检查,分析灌注区脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数变化及CT血管成像(CTA),并于入院后3d内行头颅MRI,评估其脑灌注特点及血管影像。结果在获取的76例CTP数据中,通过感兴趣区识别划分筛查,有59例患者有明确的异常CTP,有17例患者未发现明确感兴趣区。59例异常CTP中包括急性脑梗死47例,短暂性脑缺血发作(TIA)12例。急性脑梗死患者异常CTP特点:发病在4.5h以内的4例患者CTP表现为患侧CBF均较健侧下降,CBV正常或者轻度增高,MTT、TTP延长;发病时间在4.5~6h内的4例:其中2例CTP表现为CBF降低,CBV正常,MTT、TTP延长,2例表现为CBF降低,CBV轻度降低,MTT、TTP延长;发病时间在6~24h内的39例:其中30例梗死区与CTP异常脑灌注区部位一致,均表现CBF明显降低,CBV明显降低,MTT、TTP延长;12例TIA患者CTP均发现与临床症状相对应的灌注异常:MTT、TTP延长,CBF正常或减低,CBV升高。CTA发现责任动脉重度狭窄5例,血管闭塞10例,7例可见血流缓慢,排空延迟及侧支血管形成。结论多模式CT能够对AICVD提供血流灌注参数的变化及血管情况、供血区的血流动力学变化,对临床诊治具有一定参考价值,主要用于评估大脑半球卒中,多模式CT有临床价值。     

CT灌注成像联合CT血管造影在颈内动脉系统短暂性脑缺血发作中的应用研究

目的探讨CT灌注成像联合CT血管造影在颈内动脉系统短暂性脑缺血发作中的应用价值。方法颈内动脉系统短暂性脑缺血发作患者63例,于症状发作后7d内采用东芝320排螺旋CT行头部CT灌注成像以及CT血管造影,观察并比较感兴趣区以及镜像区CT灌注成像各参数,以及两种影像学检查的符合情况。结果比较感兴趣区与镜像区CT灌注成像各参数发现,感兴趣区与镜像区脑血容量无显著性差异(P0.05);感兴趣的脑血流量显著低于镜像区(P0.05);感兴趣区的造影剂通过时间显著短于镜像区(P0.05)。CT血管造影发现责任血管狭窄54例,其中灌注异常患者43例,CT血管造影未发现责任血管狭窄9例,灌注异常3例,CT灌注异常在有责任血管狭窄的阳性率显著高于无责任血管狭窄(P0.05)。结论 CT灌注成像可反映颈内动脉系统短暂性脑缺血发作的脑灌注状态,CT血管造影可用于检测责任血管的病变情况,CT灌注成像联合CT血管造影可为颈内动脉系统短暂性脑缺血发作的病因以及为诊断提供影像学依据。     

颅内血管狭窄与短暂性脑缺血早期发展为脑梗死的相关性

目的研究颅内血管狭窄与短暂性脑缺血早期发展为脑梗死的相关性。方法收集128例于我院确诊为短暂性脑缺血的患者,通过颅脑磁共振弥散加权成像(DWI)判断患者住院1周内有无新鲜脑梗死及计算转化为脑梗死的百分率。通过头颈CT血管造影(CTA)检查所有患者颅内血管的狭窄程度、狭窄数量以及狭窄部位,分析颅内血管异常与短暂性脑缺血转化为脑梗死的相关性。结果 128例短暂性脑缺血患者发展为早期脑梗死的发生率为29.68%,短暂性脑缺血患者的血管狭窄程度与短暂性脑缺血后早期脑梗死发生率呈正相关(P0.001),责任血管狭窄患者的短暂性脑缺血后早期脑梗死发生率显著高于非责任血管狭窄患者(P=0.002);动脉近端狭窄患者的短暂性脑缺血后早期脑梗死发生率显著高于动脉远端狭窄患者(P0.001),颅内动脉狭窄数量与短暂性脑缺血后早期脑梗死发生率相关(P0.001)。结论颅内血管狭窄是短暂性脑缺血早期发展为脑梗死的独立危险因素,通过头颈CT血管造影检查有利于评估短暂性脑缺血患者早期发展为脑梗死的风险。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.