钆喷酸葡胺对比剂不良反应3例报告及文献复习

目的　加深对磁共振成像钆喷酸葡胺对比剂不良反应的认识。方法　报道 3例钆喷酸葡胺对比剂不良反应 ,观察 1例重度不良反应及抢救经过 ;复习钆对比剂不良反应的相关文献。结果　钆喷酸葡胺对比剂有不良反应 ,我院发生率为 0 .2 0 6%。结论　钆喷酸葡胺对比剂不良反应发生率虽低 ,但在患者对医疗质量要求较高的今天也应引起足够的重视     

口服钆喷酸葡胺MRCP协助诊断十二指肠憩室

目的:探讨口服钆喷酸葡胺(gadopentetate dimeglumine,Gd-DTPA)作为阴性对比剂协助MRCP诊断十二指肠憩室的可行性。方法:对11例意外检出12个十二指肠内侧面纯液性或有不确定小气泡液性信号为主的囊性病灶,拟诊憩室的患者口服稀释Gd-DTPA前后采用屏气厚层半傅立叶采集单激发TSE和前瞻性采集矫正呼吸导航(prospective acquisitioncorrection,PACE)TSE两种序列行MRCP,比较憩室在口服稀释Gd-DTPA前后信号变化。结果:12个病灶中4个表现为纯液性囊状影,8个表现为含不确定少量气泡液性为主的囊状影。在未口服稀释Gd-DTPA的MRCP表现为与十二指肠内侧面的囊状高信号影,口服Gd-DTPA后的MRCP全部12个病灶因充盈对比剂消失,揭示其起源于十二指肠并与肠腔相通,从而明确诊断为憩室。结论:口服稀释Gd-DTPA作为阴性对比剂有助于MRCP获得十二指肠憩室的明确诊断。该方法是可行的,可以作为诊断模棱两可情况下的一种补充,值得在临床推广应用。     

钆喷酸葡胺副反应的预防措施及护理

磁共振增强扫描，常用的对比剂有顺磁性钆螯合剂和铁磁性氧化物，临床常用药为钆喷酸葡胺(Gd—DTPA)，此药进入人体后能缩短组织中质子的T，弛豫时间；从而增强正常组织与病变组织的对比，有利于病变显示和定性。     

国产钆喷酸葡胺在脑肿瘤诊断中的作用

目的：探讨国产钆喷酸葡胺在脑肿瘤诊断中的价值。材料和方法：回顾分析８２例脑肿瘤的ＭＲＩ增强表现,其中脑胶质细胞瘤２８例;脑膜瘤１３例;垂体微腺瘤１６例;脑转移瘤１５例;颅咽管瘤２例;松果体瘤２例;三叉神经瘤２例;听神经瘤３例;颅底脊索瘤１例。结果：８２例脑肿瘤病人注射造影剂后,有轻度强化９例,中度强化２９例,明显强化２３例,增强效果达７４．４％,其中脑膜瘤、胶质细胞瘤、脊索瘤强化明显;垂体微腺瘤不强化,而正常垂体组织强化明显,从而把肿瘤组织勾描清楚,与ＣＴ的增强表现相类似。增强病例中有轻微反应３例。结论：国产钆喷酸葡胺在脑肿瘤诊断中是一种较为理想的造影剂     

口服静脉用钆喷酸葡胺稀释液改善MRCP质量的研究

目的　口服静脉用钆喷酸葡胺 (Gd DTPA)稀释液作为胃、十二指肠阴性对比剂 ,改善磁共振胰胆管成像(MRCP)质量。资料与方法　实验部分 :取Gd DTPA静脉注射液 1、2、3、4、5、6和 7ml分别加温开水配制成浓度分别为 4 .6 4、9.2 7、13.91、18.5 4、2 3.19、2 7.82和 32 .4 6mg/ml稀释液各 80ml,并依次分组。设立 80ml温开水对照组。行T1WI(SE)和重T2 WI(IR EXPRESS )成像 ,测量各组在不同成像序列的信号强度 ,并计算增强率。临床应用 :对 2 1例经多方位MRCP不能避开胃、十二指肠内高信号背景干扰者 ,行口服稀释液前和后立即、5和 10min放射状多角度MRCP ,然后对各解剖结构显示情况加以判定。结果　浓度为 2 3.19、2 7.82和 32 .4 6mg/ml稀释液在重T2 WI(IR EXPRESS)成像序列中信号强度和增强率最小 ,且无明显差别。口服稀释液前与后 5、10minMRCP图像对胆总管、胰管、胆囊结构的显示具有显著性差异 (P <0 .0 5 ) ;而口服稀释液后 5与 10minMRCP图像对上述结构的显示无明显差异 (P >0 .0 5 )。结论　可选用浓度为 2 3.19mg/mlGd DTPA稀释液 80ml,作为胃、十二指肠阴性对比剂抑制高信号背景 ;口服稀释液后 5min成像可获得较为理想的MRCP图像。     

口服钆喷替酸葡甲胺溶液行MR胰胆管成像的初步临床应用

目的　应用口服钆喷替酸葡甲胺 (Gd DTPTA)溶液作为胃肠道阴性对比剂 ,以降低胃肠道背景高信号 ,提高磁共振胰胆管成像 (MRCP)的图像质量。方法　用 5 0ml药瓶将Gd DTPA溶液稀释成不同浓度 (分别稀释为 5倍、10倍、15倍、2 0倍 ) ,并设空白对照组 ,行常规及MRCP扫描 ,以选择最佳的对比剂浓度。对 15例疑有胰胆管系统疾病的病人行口服对比剂前后MRCP检查 ,对比剂为稀释 5倍的Gd DTPA溶液 ( 1 488g/L) 2 5 0ml,磁场强度为 1 5T。MRCP成像方法有二维单层快速自旋回波 (FSE)序列及半傅立叶单次激发快速自旋回波 (HASTE)序列。结果　实验部分结果表明稀释 5倍的Gd DTPA溶液T2 WI信号降低最明显 ,达 5 9 3 % ,HASTE序列信号强度降低 82 45 % ,单层MRCP时所有稀释倍数液体信号强度均下降达 90 %以上。所有病例口服对比剂后MRCP扫描胃及十二指肠内液体高信号均较前有明显下降 ,图像质量明显提高 ,以单层MRCP序列胃肠道液体高信号抑制最明显。口服Gd DTPA溶液前后 ,胆总管、胰管及胆囊结构的显示程度等级评分差异有显著性意义 (P <0 0 5 )。结论　稀释 5倍的口服Gd DTPA溶液是一种安全有效地降低胃肠道液体高信号强度、改善MRCP图像质量的胃肠道阴性对比剂     

钆塞酸二钠和钆喷酸葡胺肝脏多期动态增强呼吸伪影对比研究

目的:比较静脉注射钆塞酸二钠(Gd-EOB-DTPA)和钆喷酸葡胺(Gd-DTPA)的动脉期呼吸伪影,寻求减少Gd-EOB-DTPA动脉期呼吸伪影的可能方案.方法:搜集在1年内行Gd-EOB-DTPA和Gd-DTPA磁共振动态增强扫描的患者75例,由两位有经验的磁共振医师采用盲法对两种对比剂扫描方案的动脉期、门脉期及延迟期图像采用5分法评分,以≤3分定义为中重度伪影.两种对比剂扫描方案的呼吸伪影比较采用Wilcoxon秩和检验和配对卡方检验.结果:Gd-EOB-DTPA组发生动脉晚期呼吸伪影的比例明显高于Gd-DTPA组(分别为49.3％和6.7％,Z=-5.058,P＜0.001),其中中重度伪影的比例亦明显高于Gd-DTPA(分别为33.33％和2.67％,x2=21.04,P＜0.001);而Gd-EOB-DT-PA组动脉早期出现呼吸伪影和中重度呼吸伪影的比例与Gd-DTPA组差异无统计学意义(Z=-1.513,P=0.130;x2=0.25,P=0.625).结论:静脉注射Gd-EOB-DTPA较Gd-DTPA更易引起动脉期伪影,减少单期屏气时间和采用动脉期监测技术可能提高Gd-EOB-DTPA动脉期采集的图像质量.     

关于钆塞酸二钠及钆喷酸葡胺增强MRI对肝癌诊断效能的1∶1匹配的病例对照研究

目的 通过1∶1匹配的病例对照研究,比较钆塞酸二钠(Gd-EOB-DTPA)和钆喷酸葡胺(Gd-DTPA)增强MRI对肝癌(HCC)的诊断效能,并且明确Gd-EOB-DTPA增强MRI的肝胆期是否具有补偿作用.方法 搜集行Gd-EOB-DTPA以及Gd-DTPA增强MRI检查且有肝硬化、存在肝占位性病变的患者,按年龄±...     

钆喷酸葡胺致严重过敏反应一例

病例资料 患者,男,40岁.平素健康,无药物过敏史.因头痛2天,伴呕吐、意识模糊1天入院.因患者不配合,MRI检查前给予安定10 mg静脉注射,入睡后扫描.     

钆喷酸葡胺行冠状动脉CTA一例

病例资料 患者,男,53岁,因反复胸闷、痛13天,再发5h入院.既往有甲亢病史,未规律服药.查体:心前区闻及 3～4级收缩期杂音.心电图检查提示窦性心律,V5见Q波;心肌酶谱及肌钙蛋白阴性;肝肾功能无明显异常;甲状腺功能检查:TT3 6.57 nmol/l,TT4＞320 nmol/l,FT323.68 nmol/l,FT4 84.99nmol/l.心脏彩超示左房黏液瘤,甲状腺超声示右侧甲状腺低回声团.临床诊断:左房黏液瘤,甲亢,右侧甲状腺瘤.拟行冠状动脉CTA评估冠状动脉血管情况.     

Oral superparamagnetic contrast agent (ferumoxsil): Tolerance and efficacy in MR imaging of gynecologic diseases

The purpose of this study was to determine the tolerance and the efficacy of the oral contrast agent ferumoxsil in the assessment of gynecologic diseases. Twenty patients underwent MR imaging at 1.5 T. T1-weighted spin-echo (SE) and T2-weighted fast SE images were obtained before and after ingestion of 600900 mL of the Superparamagnetic negative contrast agent ferumoxsil. No side effects were observed. No statistically significant increase in artifact generation was present in the postcontrast images. The efficacy in bowel marking was significant for the small bowel (P = 0.0001) and the cecum (P < 0.01), but not significant in all sequences for the sigmoid. In the postcontrast images, delineation of the uterus, the right-sided adnexa, the lymph nodes, and the pathologic lesions was significantly better (P < .01), but not all sequences showed an improvement in delineation of the other pelvic organs. After administration of ferumoxsil, the level of confidence in diagnosis was significantly higher (P = .0001), but no change in diagnosis was made from the preto the postcontrast images. We found the oral contrast agent ferumoxsil to be well tolerated and effective in marking the bowel and in delineating the normal organs as well as the pathologic lesions on pelvic MR images.     

MR imaging of orbital mass lesions with contrast agent: A preliminary report

To investigate the advantage and limit of contrast enhancement in the examination of orbital mass lesions, precontrast T1- and T2-weighted, and postcontrast T1-weighted spin-echo images were retrospectively compared by two experienced observers. Using contrast material, intraocular tumors were well detected and characterized, and several orbital tumors were characterized as to whether cystic or necrotic and intracranial involvement was better evaluated. On the other hand, tumor-fat interface lost conspicuity when tumors showed enhancement. We conclude that gadopentetate-dimeglumine-administered T1-weighted images were helpful in detecting, differentiating and characterizing tumors of the orbit. However, the loss of contrast with fatty tissue is a disadvantage to be considered.     

不明原因消化道出血的DSA诊断(附22例报告)

目的：评价ＤＳＡ对不明原因消化道出血的诊断作用。方法：２２例不明原因的消化道出血患者进行ＤＳＡ检查,其中１７例经手术病理证实。结果：１４例ＤＳＡ发现病变,阳性率６３．６％,８例未发现异常。在１４例ＤＳＡ阳性患者中肿瘤６例,血管畸形５例,静脉曲张１例,溃疡１例,多发性息肉１例。８例ＤＳＡ阴性患者６例进行了手术探查,共５例发现病变,其中憩室２例,溃疡、息肉和腺瘤各１例。结合手术情况,在总结１９例阳性病例中有１０例病变位于小肠。结论：小肠疾病是引起不明原因消化道出血的主要原因,其中以肿瘤性病变多见。ＤＳＡ是诊断不明原因消化道出血的一种有用的方法     

MR imaging of the small bowel with increasing concentrations of an oral osmotic agent

The aim of this study was to assess the quality of MR imaging and level of adverse effects with increasing concentrations of gastrografin. This is a prospective study with 24 healthy volunteers which were randomised into four groups receiving 50%, 25%, 10% and 0% gastrografin. The endpoint was bowel image quality based on distension, signal homogeneity and wall delineation evaluated by three independent radiologists, and the maximum bowel diameter at three different levels. The subjects also scored any adverse events on a 1–5 scale. The interradiologist agreement was relatively good, with kappa values varying between 0.81 and 0.41. Improved bowel distension and image quality were achieved with increasing concentrations. But significant dose-response effects were found between increasing osmolalities and the bowel diameters and also versus the score of adverse events. The most frequent adverse reactions were diarrhea, nausea and lack of palatability. There is a gradient relationship between increasing osmolality of gastrografin and improved image quality and the score of adverse effects. The optimum concentration of gastrografin is dependent of the tolerance of the adverse events.     

Gadopentetate-dimeglumine-enhanced MR imaging of osteonecrosis and osteochondritis dissecans of the elbow: initial experience

Magnetic resonance imaging (MRI) was performed on seven patients with aseptic osteonecrosis (n=4) and osteochondritis dissecans (OCD;n=3) of the elbow. Precontrast MRI was superior to plain radiographs, which did not show any abnormality in three cases of osteonecrosis. On gadopentetate-dimeglumine-enhanced T1-weighted images, which were obtained in three patients with osteonecrosis and three patients with OCD, all cases of osteonecrosis demonstrated homogeneous enhancement of the lesions. All cases of OCD were diagnosed on plain radiographs. On MRI one showed significant enhancement of the loose body. In another case an incompletely enhancing loose body was surrounded by a diffusely enhancing region. In the third patient only a small marginal enhancement of the defect was observed. Our results suggest that MRI can improve the accuracy in diagnosis of aseptic osteonecrosis of the elbow. The use of gadopentetate dimeglumine allows the viability of the lesions or the loose bodies to be demonstrated and reparative tissue to be detected.     

莫迪司、马根维显在乳腺动态增强MR扫描中的应用价值研究-Meta分析

目的 采用Meta分析方法综合评价莫迪司和马根维显在乳腺MRI筛查中的诊断价值,旨在为对比剂选择提供更加确信的依据.方法 检索2013年1月前所有已经发表的中英文文献,主要来源于the Cochrane Librar-y,PUBMED,EMBASE,中国生物医学文献数据库,中国科技期刊全文数据库等.根据纳入和排除标准,全面检索关于莫迪司、马根维显在乳腺动态增强MR扫描中的相关英文和中文文献.纳入文献质量评价采用QUADAS,数据分析采用Meta-Disc 1.4软件.结果 按照纳入和排除标准共纳入文献17篇,涉及1934例患者.莫迪司和马根维显的总敏感性分别为0.924 (0.902,0.943)和0.838 (0.817,0.858).两种对比剂合并的特异度为0.974(0.969,0.979)和0.935 (0.927,0.942),用卡方检验比较P值;与此同时,汇总受试者工作特征曲线(SROC)的曲线下面积(AUC)分别为0.9781和0.9215,用Z检验比较P值.结论 与马根维显相比,莫迪司具有更敏感的诊断性能以及更有效的对比效应.鉴于其许多固有的缺陷以及纳入研究方法的局限性,因此,迫切需要更高质量的研究,以进一步确认莫迪司的诊断价值.     

磁共振胆胰管成像(MRCP)中成像方法的选择

目的：研究磁共振胆胰管成像（MRCP）时,应用胃肠道阴性对比剂（葡萄糖酸亚铁糖浆）后,不同成像方法的优,缺点。方法：50例受检者口服12％ V／V葡萄糖酸亚铁糖浆后进行MRCP检查;采用GE1．5T MRI扫描机,常规薄层MIP成像及厚层单次激发成像（Single-Shot),薄层单次激发MIP成像。结果：随着TE时间的延长,葡萄糖酸亚铁糖浆对胃肠道液体信号的抑制作用增强,使MRCP时胆胰管显影更加清晰,尤其在单次激发成像时,结合MIP与厚层单次激发图像可以得到更多信息。结论：口服胃肠道4阴性对比剂后行MRCP检查,能够抑制胃肠道内液体信号,使胆胰管显影更加清晰,特别是在单次激发成像时。     

Usefulness of MR Imaging for Diseases of the Small Intestine: Comparison with CT

Objective

To evaluate the usefulness of MR imaging for diseases of the small intestine, emphasizing a comparison with CT.

Materials and Methods

Thirty-four patients who underwent both CT and MR imaging using FLASH 2D and HASTE sequences were analyzed. All patients had various small bowel diseases with variable association of peritoneal lesions. We compared the detectabilities of CT and MR imaging using different MR pulse sequences. The capability for analyzing the characteristics of small intestinal disease was also compared.

Results

MR imaging was nearly equal to CT for detecting intraluminal or peritoneal masses, lesions in the bowel and mesentery, and small bowel obstruction, but was definitely inferior for detecting omental lesions. The most successful MR imaging sequence was HASTE for demonstrating bowel wall thickening, coronal FLASH 2D for mesenteric lesions, and axial FLASH 2D for omental lesions. MR imaging yielded greater information than CT in six of 12 inflammatory bowel diseases, while it was equal to CT in six of seven neoplasms and inferior in five of seven mesenteric ischemia. In determining the primary causes of 15 intestinal obstructions, MR imaging was correct in 11 (73%) and CT in nine (60%) patients.

Conclusion

MR imaging can serve as an alternative diagnostic tool for patients with suspected inflammatory bowel disease, small intestinal neoplasm or obstruction.     

上消化道多原发癌X线诊断(附44例报告)

目的 分析上消化道多原发癌的X线表现，探讨其生物学特征及X线诊断价值。资料与方法 44例上消化道多原发癌，均行上消化道低张气钡双对比造影，所有病例均经内镜或术后病理证实。结果 44例中，食管多原发癌22例，占50%；食管-胃多原发癌19例，占43.2%；胃多原发癌3例，占6.8%，除1例食管发现3处癌灶外，其余皆为双灶，22例食管多原发癌共发现45个癌灶，其中增生型病变20个，髓质型9个，溃疡型和浸润型各7个，混合型2个，病变位于食管上段者15个，中段者17个，下段者13个，19例食管-胃多原发癌中，食管癌灶皆位于中下段，其中中段11个，下段8个；胃部病变贲门占13个，胃底和胃体各1个，胃窦4个，食管病变以增生型和髓质型居多，分别为7和5个；胃部病变以增生型最多，有14个，结论 上消化道多原发癌以食管多源和食管-胃多源多见，食管癌灶以增生型为多，其次为髓质型，病变部位以中下段较多见，胃部病变多发生于贲门。增生型最多见，X线气钡双对比造影是诊断上消化道多原发癌的重要手段。     

Stability of osteochondral fragments of the femoral condyle: magnetic resonance imaging with histopathologic correlation in an animal model

The stability of surgically induced osteochondral fragments of the femoral condyle was examined by magnetic resonance imaging (MRI) using T1- and T2-weighted spin echo sequences in 7 dogs; contrast-enhanced T1-weighted spin-echo sequences were also obtained. Animals were sacrificed between the 34th and 196th day after surgery. MR images were compared with the histopathologic findings. Two loose and five stable fragments were found after injection of contrast medium. With the loose fragments, a well-defined line of high signal intensity between the fragment and the epiphysis showed marked enhancement. Histological examination revealed vascularized granulation tissue at the interface. Stable fragments also showed a similar, but irregularly defined line on plain sequences, but no enhancement after injection of contrast medium; histological examination showed no granulation tissue at the interface but intact bone trabeculae within the completely repaired fracture. Fibrocartilaginous repair at the articular cartilage surface also showed enhancement. Contrast-enhanced MR imaging allowed an exact delineation of the line of separation of unstable osteochondral fragments in this animal model with differentiation from a similar line occurring in stable fragments. However, this interface line in relation to stable fragments could not be explained histologically and probably reflects differences of binding or distribution of protons in healing osteochondral fragments.