高度近视黄斑区脉络膜新生血管的相关危险因素研究

=0.629,P=0.000)、屈光度(r=0.725,P=0.000)、眼轴(r=0.236,P=0.013)、后巩膜葡萄肿(r=0.344,P=0.000)、后极部大片视网膜脉络膜萎缩(r=0.421,P=-0.000)、漆裂纹(r-=0.421,P=0.000)和FucKs斑(r=0.519,P=0.000)与CNV的发生显著相关.结论 高度近视患者黄斑区CNV的发生率高,后巩膜葡萄肿、后极部大片视网膜脉络膜萎缩、漆裂纹、Fuchs斑、年龄、屈光度和眼轴是高度近视黄斑区CNV形成的相关危险因素.     

3D-OCT直视引导法提高激光诱导兔脉络膜新生血管模型的成功率

目的探讨在3D光学相干断层扫描仪(3D-OCT)直视引导下,提高氪激光诱导兔脉络膜新生血管(CNV)模型成功率的可行性。方法青紫蓝兔20只随机分2组,选取右眼进行激光诱导CNV:A组为非3D-OCT引导组,B组为3D-OCT引导组。A组在每只兔视乳头下方2PD处氪激光光凝10点,出现气泡或少量出血即停止光凝。B组在眼底激光光凝的同时,3D-OCT同步扫描显示光凝点击穿Bruch膜为止。光凝21 d后行眼底照相、3D-OCT及眼底血管造影检查,随后处死动物,摘取眼球,观察光凝处视网膜组织学病理改变。结果光凝后21 d,A、B两组兔视网膜水肿基本消退、灰白色斑、出血斑周围见黄白色渗出物,均可见荧光素渗漏。A组64点出现Bruch膜破裂、45点出现CNV;B组100点Bruch膜破裂、86点出现CNV。两组比较差异有非常显著意义(P<0.01)。Bruch膜破裂与CNV出现率呈高度正相关。结论 Bruch膜的破坏是诱导CNV模型的关键,3D-OCT直视引导法可提高诱导兔CNV模型的成功率。     

早期增殖性糖尿病视网膜病变全视网膜激光光凝术后脉络膜结构的变化

目的探讨早期增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者在接受全视网膜激光光凝术(panretinal photocoagulation,PRP)后脉络膜结构的变化。方法回顾性分析2021年10月至2022年10月,早期PDR患者62例62只眼,行PRP治疗,使用氪黄激光在视网膜四个象限上均匀分布总数为1000~1200个的激光斑,每只眼完全的PRP治疗分2次进行,每次500~600个激光点,光斑均位于血管弓外,功率140~280 mW光斑大小为200~300μm,脉冲持续时间为200 ms,光斑间距为350~450μm。所有患者治疗前以及完成治疗后1、3、6和12个月行常规眼科检查,并采用增强深度扫描光学相干断层扫描仪(enhanced-depth imaging optical coherence tomography,EDI-OCT)检测黄斑中央凹下脉络膜厚度(subfoveal choroidal thickness,SFCT)改变,利用Image-J软件对EDI-OCT图像进行二值化处理,计算脉络膜总面积(total choroidal area,TCA)、脉络膜基质面积(stromal area,SA)、脉络膜血管面积(luminal area,LA)及脉络膜血管指数(choroidal vascular index,CVI),分析早期PDR患者PRP后脉络膜结构参数变化。结果治疗前,62例早期PDR患者SFCT为(264±40.1)μm,TCA为(0.77±0.2)mm^(2),SA为(0.29±0.1)mm^(2),LA为(0.48±0.1)mm^(2),CVI为(62.6±2.5)%。(1)治疗后1个月,SFCT为(274.2±39.3)μm,与治疗前比较厚度增加;治疗后3个月SFCT为(252.3±40.2)μm且低于治疗前;治疗后6个月(241.4±39.0)μm和治疗后12个月(235.0±37.2)μm,厚度变化趋于平稳,与治疗前比较差异具有统计学意义(P<0.05)。(2)治疗后1个月TCA(0.78±0.2)mm^(2)较治疗前增加,治疗后3个月TCA(0.76±0.2)mm^(2)低于治疗前,治疗后6个月TCA(0.73±0.1)mm^(2)及治疗后12个月TCA(0.72±0.2)mm^(2)呈现继续下降并趋于平稳的改变,与治疗前比较差异具有显著意义(P<0.001)。(3)治疗后1个月LA(0.48±0.1)mm^(2)高于治疗前,治疗后3个月LA(0.49±0.1)mm^(2)较治疗后1个月降低并低于治疗前,治疗后6个月LA(0.44±0.1)mm^(2)及治疗后12个月(0.43±0.1)mm^(2)呈现继续下降并趋于平稳的改变,与治疗前比较差异具有显著意义(P<0.001)。(4)治疗后1个月CVI(62.8±2.5)%高于治疗前(P<0.001),治疗后3个月CVI(62.1±2.5)%较治疗后1个月降低并低于治疗前(P<0.001),治疗后6个月CVI(60.5±2.6)%和治疗后12个月CVI(60.1±2.6)%继续下降(P<0.001)。结论早期PDR的眼睛在PRP治疗后脉络膜结构发生变化,随访12个月中SFCT、TCA、LA及CVI均显著降低,提示早期PDR眼进行PRP可对脉络膜带来有益影响。     

小切口白内障囊外摘除术后黄斑区光学相干断层扫描观察

目的:应用光学相干断层扫描(optical coherence tomography,OCT)观察白内障术后黄斑区视网膜的变化。方法:回顾性分析对2013-01~2014-03因单纯老年性白内障在我院行白内障联合人工晶状体植入术的患者56例(75眼),术前、术后1、术后4及术后12周对所有术眼行视力和黄斑区OCT检查,观察术眼黄斑中心视网膜的变化。结果:单纯老年性白内障患者术后1、4和12周BCVA较术前均有不同程度的提高;术前OCT检查显示黄斑中心厚度(central fovea thickness,CFT)为(229.03±10.76)μm;术后1、4及12周OCT检查CFT分别为(258.33±10.87)μm,(253.13±12.97)μm,差异有显著统计学意义(P<0.01)。黄斑区中心凹的神经上皮层视网膜厚度、色素上皮层视网膜厚度在术后12周与术前相比有统计学意义(P<0.05)。结论:单纯老年性白内障患者成功施行小切口白内障摘除联合人工晶体植入,术后短期内平均CFT较术前有所增加,术后OCT检查未发现黄斑囊样水肿。     

改变参数光动力疗法治疗黄斑区脉络膜新生血管性疾病的短期疗效分析

目的 分析改变参数光动力疗法治疗黄斑区脉络膜新生血管性疾病的短期疗效.方法 9例(12只眼)脉络膜新生血管患者进行改变参数光动力疗法治疗.改变的参数包括:(1)药物静脉推注时间,由标准的10 min缩短至5 min以内;(2)激光照射时间,由标准的83 s减至42 s;余治疗参数不变.治疗后3个月内随访患者糖尿病性视网膜病变早期治疗研究(ETDRS)视力表最佳矫正视力、眼部裂隙灯检查情况,并在治疗后3个月行眼底血管荧光造影(fun-dus fluorescein angiography,FFA)、光学相干断层扫描(optical coherence tomography,OCT)等检查.结果 在治疗后3 d 12只眼(100.0%)均未出现视力下降,其中4只眼ETDRS视力提高接近或大于3行;治疗后3个月11只眼(91.7%)视力保持稳定或提高,1只眼视力下降3行.全部患眼中,7只眼(58.3%)在治疗后3个月复查FFA和(或)OCT检查呈现较治疗前好转改变.5只眼治疗前为边界清楚的典型性病灶.治疗后3个月复查FFA,2只眼造影晚期荧光渗漏停止,1只眼荧光渗漏减少,2只眼仍见荧光渗漏;5只眼为轻微典型性及隐匿性病灶,2只眼治疗前有视网膜色素上皮脱离,治疗后3个月均明显好转;2只眼为近瘢痕期病灶,治疗前已伴有广泛视网膜色素上皮纤维血管化形成的病灶,治疗后FFA检查无明显改变.结论 光动力疗法缩短静脉给药时间及局部激光照射时间,治疗后短期内患者视力下降较少出现,可能对视网膜色素上皮脱离患者有较好治疗作用,但能否对新生血管起剑抑制作用仍不十分明确.     

光动力疗法联合不同激光及抗VEGF药物(Bevacizumab)治疗黄斑部CNV的安全性和临床疗效观察

目的:观察光动力疗法(PDT)联合不同激光及抗VEGF药物(Bevacizumab)治疗黄斑部CNV的安全性和临床疗效。方法:经直接或间接眼底镜、彩色眼底照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光学相干断层扫描(OCT)检查确诊为黄斑部CNV的患者,其中AMD者102例105只眼,PM者53例53只眼,中渗者25例26只眼,     

息肉样脉络膜血管病变患者脉络膜血管系统及涡静脉影像学表现分析

目的 探讨息肉样脉络膜血管病变(polypoid choroidal vasculopathy, PCV)患者血流动力学改变。方法 选取我院就诊的53例PCV患者(53只眼)作为观察组,另选取25例同期健康体检者(50只眼)作为对照组,所有观察对象均给予相关影响学检查,对比影像学表现。结果 观察组在黄斑中心凹下脉络膜厚度(subfoveal choroidal thickness, SFCT)、脉络膜血管分布指数(choroidal vascular distribution index, CVI)上显著高于对照组,在脉络膜毛细血管层密度(choroidal capillary layer density, CCVD)上显著低于对照组(P<0.05),观察对象眼动脉各项血流动力学参数无显著差异(P>0.05),观察组涡静脉血流速度、视网膜中央动脉及睫状后短动脉收缩期峰值流速(PSV)低于对照组,视网膜中央动脉阻力指数(RI)高于对照组(P<0.05),观察对象睫状后短动脉的PSV及涡静脉血流速度与SFCT、CVI呈负相关,与CCVD呈正相关,睫状后短动脉的舒张末期血流...     

基于深度学习的OCT医学图像研究进展

近年来,深度学习的研究和应用价值在学术领域和工业领域中扮演着越来越重要的角色,并且在生物医学领域也开始崭露头角。光学相干断层扫描成像(Optical Coherence Tomography,OCT)技术具有无损和分辨率高的特点,在临床诊疗与科学研究中得到了广泛的应用。本文首先介绍了深度学习和OCT技术,然后阐释了深度学习的卷积神经网络和OCT成像的基本机制,最后概述了基于深度学习技术的OCT医学图像研究,主要包括卷积神经网络在眼科、泌尿科、心血管科和肿瘤科等相关医学研究中的应用。     

玻璃体腔注射抗VEGF联合激光光凝治疗缺血型视网膜中央静脉阻塞的临床观察

目的:观察玻璃体腔注射抗VEGF联合视网膜激光光凝治疗缺血型视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)伴黄斑水肿(macular edema,ME)及视网膜新生血管(retinal neovascular)的临床疗效。方法:回顾分析经眼底检查、眼底荧光造影(FFA)、光学相干断层扫描(OCT)检查确诊缺血型CRVO伴ME及视网     

急性和慢性中心性浆液性脉络膜视网膜病变光动力治疗前后视力及OCT分析

目的：分析光动力疗法（Photodynamic Therapy,PDT）治疗急性和慢性中心性浆液性脉络膜视网膜病变后的最佳矫正视力及OCT下黄斑中心凹厚度变化。     

原发性肝癌TACE前后血清VEGF与CT灌注参数间相关性的研究

目的 探讨原发性肝癌(HCC)患者TACE前后血清血管内皮生长因子(VEGF)水平和CT灌注参数之间的关系. 资料与方法 对17例HCC患者于TACE术前1天及术后7～10天测量血清VEGF水平,同时行CT灌注扫描,计算肝血流量(HBF)、肝动脉灌注分数(HAF),肝动脉灌注量(HAP)、门静脉灌注量(PVP). 结果 原发性肝癌TACE前后HBF、HAP差异有统计学意义,血清VEGF与HBF、HAF、HAP呈正相关. 结论 血清VEGF水平及CT灌注可帮助评价肝癌TACE疗效.     

CT在颅内血肿微创治疗前后的应用价值(附32例报告)

目的探讨CT在颅内血肿微创治疗前后的临床应用价值. 资料与方法对32例颅内血肿患者于微创术前做CT定位和术后CT复查评价.32例中,外伤性硬膜外血肿12例,外伤性硬膜下血肿5例,高血压脑出血12例,其他原因致颅内血肿3例. 结果外伤性颅内血肿17例(硬膜外12例,硬膜下5例)微创治疗满意,无后遗症,尤其是硬膜外血肿效果更佳.高血压及其他原因所致颅内血肿15例中,微创治疗成功12例,死亡2例,1例因术后有活动性出血且出血量大而行手术开颅清除血肿.成功的12例中5例有后遗症. 结论术前CT定位和选择最佳适应证是微创治疗成功的术后CT复查是评价微创治疗效果的有效方法.     

哌醋甲酯治疗前后注意缺陷多动障碍儿童语义工作记忆功能MRI研究

目的:研究哌醋甲酯治疗后注意缺陷多动障碍(ADHD)儿童完成语义工作记忆任务下脑区功能状态的改变,评价fMRI用于研究ADHD治疗机制的可行性.方法:ADHD组儿童6例,男性4例,女性2例,平均年龄12.50±1.87岁,符合DSM-Ⅳ诊断标准.ADHD儿童在治疗前后(检查前3h口服哌醋甲酯,0.2～0.3mg/kg)两种情况下进行行为学评估和功能MRI检查,两次间隔2～4周.刺激任务采用N-BACK模式下的语义工作记忆任务,BLOCK设计方法.fMRI扫描采用GE 3.0T磁共振机,采用配对t检验统计方法.结果:ADHD患儿治疗后脑功能区的激活多于治疗前,1-BACK任务下左侧额中回、双侧额下回、左顶下小叶、双侧基底节等脑区激活与治疗前差异有统计学意义,在2-BACK任务下同时有左颞叶和扣带回激活不同,与认知测试成绩改善具有一定的相关性.结论:哌醋甲酯能增加ADHD患儿的工作记忆功能脑区的激活,fMRI是研究哌醋甲酯治疗ADHD机制的新方法.     

肺癌CT动态增强参数与预后因子的相关性研究

目的 初步探讨CT动态增强参数与肺癌预后因子的相关性.资料与方法对24例肺癌进行CT动态增强扫描,分别计算肺癌的强化率、强化斜率、1200 s廓清率及1200 s廓清率线性斜率等强化参数;并用免疫组织化学方法分析病理标本中的癌胚抗原(CEA)、Ki67、c-erbB-2和p53等表达,采用非参数统计中的Spearman等级相关分析评价肺癌动态增强参数与各预后因子间的相关性.结果 24例肺癌平扫CT值为(42.0±5.3)HU,强化值为(42.2 ±17.6)HU,强化率为(103.9±48.1)%,平均达峰时间为(135.2±191.7)s,1200 s廓清值为(19.2 ±15.6)HU,1200 s廓清率为(21.3 ±12.8)%,对比剂流入斜率为(2.1±2.1)%/s,1200 s流出斜率为(0.0214±0.0155)%/s;CEA阳性表达19例(19/24,79.2%),Ki67阳性表达13例(13/23,56.5%),c-erbB-2阳性表达15例(15/21,71.4%),p53阳性表达20例(20/23,87.0%).经统计学分析,强化值与p53表达有相关性(r=0.419,P=0.047＜0.05).结论 肺癌的CT强化参数与预后因子有一定的相关性,一定程度上能反映其预后.     

Correlation of Tumor Immunohistochemistry with Dynamic Contrast-Enhanced and DSC-MRI Parameters in Patients with Gliomas

BACKGROUND AND PURPOSE:Tumor CBV is a prognostic and predictive marker for patients with gliomas. Tumor CBV can be measured noninvasively with different MR imaging techniques; however, it is not clear which of these techniques most closely reflects histologically-measured tumor CBV. Our aim was to investigate the correlations between dynamic contrast-enhanced and DSC-MR imaging parameters and immunohistochemistry in patients with gliomas.MATERIALS AND METHODS:Forty-three patients with a new diagnosis of glioma underwent a preoperative MR imaging examination with dynamic contrast-enhanced and DSC sequences. Unnormalized and normalized cerebral blood volume was obtained from DSC MR imaging. Two sets of plasma volume and volume transfer constant maps were obtained from dynamic contrast-enhanced MR imaging. Plasma volume obtained from the phase-derived vascular input function and bookend T1 mapping (Vp_Φ) and volume transfer constant obtained from phase-derived vascular input function and bookend T1 mapping (K^trans_Φ) were determined. Plasma volume obtained from magnitude-derived vascular input function (Vp_SI) and volume transfer constant obtained from magnitude-derived vascular input function (K^trans_SI) were acquired, without T1 mapping. Using CD34 staining, we measured microvessel density and microvessel area within 3 representative areas of the resected tumor specimen. The Mann-Whitney U test was used to test for differences according to grade and degree of enhancement. The Spearman correlation was performed to determine the relationship between dynamic contrast-enhanced and DSC parameters and histopathologic measurements.RESULTS:Microvessel area, microvessel density, dynamic contrast-enhanced, and DSC-MR imaging parameters varied according to the grade and degree of enhancement (P < .05). A strong correlation was found between microvessel area and Vp_Φ and between microvessel area and unnormalized blood volume (r_s ≥ 0.61). A moderate correlation was found between microvessel area and normalized blood volume, microvessel area and Vp_SI, microvessel area and K^trans_Φ, microvessel area and K^trans_SI, microvessel density and Vp_Φ, microvessel density and unnormalized blood volume, and microvessel density and normalized blood volume (0.44 ≤ r_s ≤ 0.57). A weaker correlation was found between microvessel density and K^trans_Φ and between microvessel density and K^trans_SI (r_s ≤ 0.41).CONCLUSIONS:With dynamic contrast-enhanced MR imaging, use of a phase-derived vascular input function and bookend T1 mapping improves the correlation between immunohistochemistry and plasma volume, but not between immunohistochemistry and the volume transfer constant. With DSC-MR imaging, normalization of tumor CBV could decrease the correlation with microvessel area.

Tumor CBV has been found to be a prognostic and predictive marker for patients with gliomas.^1–5 Measurements of blood volume can be obtained by using dynamic contrast-enhanced (DCE) MR imaging or dynamic susceptibility contrast MR imaging. Both techniques have their own advantages and disadvantages.DSC-MR imaging can provide a semiquantitative measurement of cerebral blood volume, but measurement reliability depends on image acquisition and postprocessing approaches such as normalization techniques.⁶ DCE-MR imaging requires an accurate measurement of the vascular input function (VIF) and T1 mapping for absolute quantification of the plasma volume (Vp) and volume transfer constant (K^trans).⁷ Recently, phase-based VIFs have been used in DCE-MR imaging to circumvent the limitations of magnitude-based VIFs, such as signal saturation and inflow artifacts.^8–11 MR imaging signal data are complex numbers, composed of magnitude and phase. The magnitude is the strength of the signal and is affected by T1, T2, proton density, inflow, and magnetic field inhomogeneity. The phase is an angle that is proportional to the nuclear MR frequency of the signal. In routine clinical MR imaging, images are composed of just the magnitude, with the phase discarded. Contrast agents change the nuclear MR frequency (and therefore the phase) of nearby tissue via a physical, spatial effect, which depends only on the contrast agent concentration and the geometry of the nearby tissue. In blood vessels running parallel with the main magnetic field, the relationship between phase and concentration is linear and can be calculated from first principles. The magnitude part of the signal, on the other hand, saturates at a high concentration and can be severely affected by inflow. The phase, therefore, has the potential to provide more reliable measures of the arterial input function than the magnitude.To our knowledge, correlation between DCE-MR imaging–derived parameters by using phase-derived VIFs with microvessel density (MVD) and microvessel area (MVA) from immunohistochemistry has not been investigated in patients with gliomas. The purpose of this study was to investigate the correlations among MR imaging contrast enhancement, DSC parameters, DCE parameters, and immunohistochemistry, by using both phase-derived VIFs (with T1 mapping) and magnitude-derived VIFs (without T1 mapping).     

X线平片动态观察慢性肾功能衰竭血液透析前后的心胸表现

目的：对３９例慢性肾功能衰竭（ＣＲＦ）尿毒症患者心胸异常Ｘ线改变者血液透析（ＨＤ）前后Ｘ线平片动态观察，以评价血液透析疗效。材料与方法：本组３９例ＣＲＦ尿毒症患者经摄胸片发现心胸异常Ｘ线改变的病例作ＨＤ前后对照；包括ＨＤ前后摄全胸Ｘ线平片测血管蒂宽度（ＶＰＷ）及查血液中代谢毒素Ｂｕｍ、Ｓｃｒ含量作比较。结果：３９例于血液透析前Ｂｕｎ和Ｓｃｒ值均高度升高，透析后有明显降低，前后对照于统计学有显著差异     

MR磁敏感加权成像在脑梗死治疗前后随访中的应用价值

目的探讨MR磁敏感加权成像(SWI)在脑梗死治疗前后随访中的应用价值。资料与方法搜集经临床及影像学检查证实的脑梗死患者资料30例,急性13例,亚急性17例。所有患者治疗前后均行常规MR平扫、扩散加权成像(DWI)及SWI扫描。对比分析治疗前后MRI图像变化特点。结果治疗前常规MRI检出脑梗死灶内出血4例,SWI检出9例,治疗后SWI显示5例发生出血性转化。治疗前30例脑梗死灶SWI图像相对信号强度为0.97±0.09,治疗后相对信号强度为1.06±0.12,治疗前后相对信号强度差异有统计学意义(t=-3.579,P<0.05)。治疗前后脑梗死灶内血管的显示差异有统计学意义(P<0.05)。结论SWI对于显示脑梗死伴发出血、治疗后出血性转化、侧支血管构建等方面优于常规MRI序列,在脑梗死治疗后随访中具有重要的临床应用价值。