3.0T磁共振血管造影普查对颅内动脉开窗畸形的诊断价值

目的通过大样本病例研究颅内动脉开窗畸形磁共振血管造影(MRA)的检出率、好发部位及其临床意义。方法2009年10月至2011年3月行MRA 2 036例患者,确诊动脉开窗畸形25例(开窗畸形组),其中男性14例,女性11例;年龄30~81岁,平均年龄60.5岁。全部行头颅三维时间飞跃MRA(3D-TOF MRA)扫描,将原始图像经工作站处理,得到最大密度投影(MIP)和容积重组(VR)图像,分析颅内动脉开窗畸形的影像学特点,与伴发动脉瘤之间的相关性。结果 2 036例患者中,发现动脉开窗畸形共计25例(检出率1.23%,25/2 036),其中位于基底动脉11例;位于椎动脉颅内段4例;位于前交通动脉区6例;位于大脑中动脉3例;位于大脑后动脉1例。25例开窗畸形中有6例合并动脉瘤,4例位于颈内动脉颅内段,2例位于大脑前动脉。结论 3D-TOF MRA检查能准确诊断、显示颅内动脉开窗畸形。     

磁共振血管成像和数字减影血管造影在烟雾病诊断中的应用

目的分析磁共振血管成像（MRA）和数字减影血管造影（DSA）影像表现与临床特点之间的关系,探讨对烟雾病（MMD）的诊断价值。方法回顾性分析30例烟雾病MRA和DSA表现,分析其临床和影像学特征。结果 MRA与DSA均发现颈内动脉、大脑前、中、后动脉狭窄或闭塞性病变;DSA对双侧病变检出率较MRA高,还可检测出基底动脉狭窄、椎动脉闭塞及动脉瘤,临床表现与MRA及DSA检测结果有不一致性。结论 MRA是烟雾病筛选诊断、随访的重要方法;临床表现与MRA不一致及疑似病例应及早进行DSA检查。     

三维动态对比增强磁共振肝门静脉造影成像效果及解剖学分析

目的：探讨三维动态对比增强磁共振肝门静脉造影(3DDCEMRP)的成像质量并观测肝内肝门静脉的解剖和变异。方法：共进行61例门静脉3DDCEMRP检查，通过对MPV、LPV、RPV，SV及SMV显示情况和对门脉右支显示能力的分析，评价3DDCEMRP的成像质量。测量门脉系统各主要干支的径线并对门静脉的解剖和变异做分型，计算各型的构成比。结果：所有病例均完整显示门静脉主干及肝内4级以上分支。61次成像中，4例(6．6％)显示门脉主干呈三叉状，3例(4．9％)门脉主干先发出右后支，继续上行分为左支和右前支，2例(3．3％)门脉右前支起自左支，l例(1．6％)门脉右支缺如，其余5l例(83．6％)显示正常门脉分支。结论：肝内门脉变异并不少见，3D DCE MRP是一种有效、微创技术。能方便而清楚地显示肝内门脉的解剖和蛮异。     

磁共振成像在颈动脉狭窄中的诊断价值

目的探讨磁共振成像在颈动脉狭窄诊断中的价值。方法对30例患者行磁共振检查（MRA和MRI）,其中23例行数字减影血管造影（DSA）,以颈总动脉法（CC法）计算狭窄率。结果以DSA检查结果为金标准,磁共振诊断颈动脉狭窄及闭塞的敏感性、特异性、假阴性率及假阳性率分别为97.06%、70.59%、2.94%、29.41%。结论MRA结合MRI可作为诊断颈动脉狭窄的筛选检查。     

婴幼儿复杂性先天性心脏病CT血管成像研究现状

CCTA诊断CHAD快速高效,心内畸形诊断效力与TTE类似,但心外畸形的检出率明显优于TTE;CCTA和TTE结合使用既能提高心内外畸形的检出率又可以有效的评估心脏血流动力学以及心脏瓣膜等精细结构,为手术提高全面准确的信息。婴幼儿对X射线的敏感程度远高于成人,前瞻性门控和大螺距技术可以有效减低辐射剂量。对比剂注射部位、流量和流速对CCTA图像质量都有一定影响,低浓度对比剂使用可有效防止造影剂肾病的发生。     

脑动静脉畸形的MRI及MRA诊断

目的 分析脑动静脉畸形（AVM）的MRI有MRA特征，评价MRI及MRA的方法对AVM的诊断价值。方法对49例AVM进行常规MRI及3D－TOF法MRA，应用MOTSA（Multiple overlapping thin slab acquisitiion）和MTC（Magnetization transfer contrast）方法经MKP重建后成像。结果 MRI能显示AVM的确切解剖结构有继发改变，MRA能显示AVM的三维立体结构的全貌。结论 MRI有MRA皆是无创性而有效的方法，MRI结合MRA可对AVM作出全面评价。     

磁共振血管成像Willis环的变异及其意义

目的：调查在MRA下Willis环的变异情况，并探讨MRA评价Willis环的临床意义。方法：回顾性分析204例MRI检查脑内无明显异常的3D－TOF MR血管成像图像，统计各个动脉的变异情况。MRA未被显示的动脉被判断为缺如，对称性动脉一侧直径为对侧直径1／2以下者被认为发育不全。结果：A1段的缺如上8．3％，发育不全占10．8％，A1段的发育不良或缺如与同侧PCoA增粗呈正相关；ACoA显示率41．7％，且男性大于女 性；PCoA的显示率41．2％，女性大于男性，胚胎型PCoA发生率29．9％，永存三叉动脉发生率0．5％。结论：MRA评价Willis环变异有重要的临床意义。     

超声在先天性胎儿畸形诊断中的应用

目的探讨产前超声检查对胎儿畸形的诊断价值。方法回顾性分析我院产科就诊并行常规超声检查5236例,其中检出胎儿畸形61例。结果通过常规超声检查,胎儿畸形检出率为1.16%（61/5236）。结论超声诊断先天性胎儿畸形的基础是胎儿形态上结构的改变,大多数先天性胎儿畸形均可以超声诊断,使一些致死性和非致死性畸形及早发现。超声检查是产前诊断胎儿畸形的首选方法。     

颈腰椎磁共振脊髓造影技术及临床应用

目的探讨颈腰椎磁共振脊髓造影(MRM)扫描技术及其临床应用价值.方法 46例患有腰腿疼痛,颈部疼痛,肢体麻木的颈腰椎疾病患者行MRM检查,均行矢状位T1WI,T2WI,横断位T2WI扫描,随后行MRM扫描,所有MRM均以冠、矢状位及斜位显示.结果正常颈腰椎MRM12例,硬膜囊、脊髓、神经根和神经根鞘袖显示清晰.椎间盘突出31例,中央型间盘突出的硬膜囊正中有弧形压迹,侧突型表现一侧神经根受压移位.髓核脱出表现为充盈缺损.1例转移瘤,2 例神经鞘瘤各有其MR特征.结论 MRM是诊断颈腰椎疾患可靠的、无创性的技术,能代替传统的脊髓造影.     

磁敏感成像技术在脑内血管畸形诊断中的应用

目的分析磁敏感成像技术（T2 Star Weighted Angiography,SWAN）在脑血管畸形的应用优势及脑血管畸形的SWAN影像特征。材料与方法17例疑有脑血管畸形患者,分别应用常规MR扫描和SWAN序列扫描。其中,常规MR序列包括SE T1WI、T2WI、T2FLAIR、DWI。将所得SWAN数据进行最小信号强度投影法图像重建。结果17例患者均获得了清晰的畸形血管图像,其中动静脉畸形7例、静脉畸形3例、海绵状血管瘤5例、毛细血管扩张1例、脑颜面血管瘤综合征1例。结论SWAN对脑内血管畸形诊断较敏感．较其他序列提供更多诊断信息。     

Incidental extraspinal findings on magnetic resonance imaging of intervertebral discs

Introduction

We aimed to evaluate pathological extraspinal findings and congenital anomalies/anatomical variations that were incidentally detected on the magnetic resonance imaging (MRI) scans of intervertebral discs, to find the frequencies of these incidental findings, and to emphasise the clinical importance of them.

Material and methods

A retrospective study including 1031 consecutive patients (730 females and 301 males, with a median age of 46 years) was conducted by evaluating a total of 1106 MRI examinations of intervertebral discs. Examinations were performed with a 1.5 T MRI unit. Incidental findings were classified as pathological findings and congenital anomalies/anatomical variations.

Results

The percentages of incidental extraspinal pathological findings and congenital anomalies/anatomical variations were 16.6% (95% confidence interval (CI): 14.4–18.8) and 3.7% (95% CI: 2.6–4.3), respectively. The percentage of incidental extraspinal pathological findings on cervical spinal MRI was 25.7% (95% CI: 20.1–31.7), thyroid nodules being the most common incidental findings. On thoracic spinal MRI (n = 19), inferior pole thyroid nodules were demonstrated as incidental extraspinal pathological findings, with a percentage of 10.5% (95% CI: 9.6–11.5). On lumbar spinal MRI, incidental pathological findings were detected with a percentage of 14.2% (95% CI: 11.9–16.6), while the percentage of congenital anomalies/anatomical variations was 4.8% (95% CI: 3.4–6.3). Eventually, 6.5% (95% CI: 2.6–9.4) of all cases with incidental extraspinal pathological findings underwent surgery.

Conclusions

On MRI examination of intervertebral discs, paying attention to incidentally detected pathological extraspinal findings and congenital anomalies/anatomical variations is very important due to the fact that they can alter the treatment of the patient or affect the patient''s life.     

正常人与青少年特发性脊柱侧凸患者椎弓根磁共振对比

目的:应用MRI成像技术对正常人与青少年特发性脊柱侧凸(AIS)患者椎弓根的不对称性进行对比分析,评价AIS患者是否表现出一致的形态学特点。方法:分析8位正常人的76个椎弓根和10例AIS早期患者的80个椎弓根的MRI成像。测定并比较正常人和AIS早期患者椎弓根不对称的程度和方向。结果:正常人表现出椎弓长度的不对称,左侧椎弓根和椎板长度较长,差异无统计学意义。AIS患者也表现出不对称,两者相比后者的不对称性更明显并有统计学意义。AIS患者的这种椎弓根不对称在侧凸凸侧和凹侧之间没有一致的分布。结论:研究AIS椎骨形态学的标准应该重新考虑,AIS椎骨形态不对称的类型依赖于特定的病因。     

Double aortic arch anomalies in Children: A Systematic 20‐Year Single Center Study

Aortic arch anomalies underlie numerous congenital disorders. Effectively diagnosing and treating them requires close understanding of cardiovascular embryology. As our Center serves the entire pediatric population of our country, we performed a comprehensive retrospective analysis of all aortic arch anomalies diagnosed at our Center over the past 20 years. We analyzed 40 children with aortic arch anomalies, distinguishing two defect types: Group 1 displayed ring‐forming anomalies, and Group 2 other types of aortic arch anomalies that did not form a vascular ring. We performed detailed morphological analyses using echocardiography, angiography, computed tomography, or magnetic resonance imaging and generated a catalog of all aortic arch anomalies present. Group 1 was represented by 25 patients; 40% with persistent both aortic arches, and 60% with various forms of right aortic arch and an incomplete left aortic arch. Group 2 was represented by 15 patients with complex heart defects. On the basis of our dataset, the incidence of all aortic arch anomalies was 0.033%, and of ring‐forming pathologies 0.021%. Although aortic arch anomalies are rare, it is important to diagnose them correctly. It is critical to distinguish ring‐forming types. Although in complex defects the aortic arch anomaly represents only an additive diagnosis, its correct definition could be crucial for further management. Cumulatively, this unique, long‐term study provides a systematic patient registry and offers critical epidemiological data to aid the study of rare congenital cardiovascular defects. Clin. Anat. 30:929–939, 2017. © 2017 Wiley Periodicals, Inc.     

A new anatomic approach of the ventricular septal defect in the interruption of the aortic arch

The aim of this study was to analyse the anatomy of the ventricular septal defect (VSD) in heart specimens with interruption of the aortic arch (IAA) in order to explore the hypothesis of different embryologic mechanisms for the different anatomic types of IAA. We examined 42 human heart specimens, 25 with IAA as the main disease with concordant atrioventricular and ventriculo‐arterial connections and two distinct great arteries, and 17 hearts with IAA associated with other malformations [six common arterial trunk (CAT), five double‐outlet right ventricle (DORV), three transposition of the great arteries (TGA), three atrioventricular septal defect (AVSD)]. The interruption was classified according to Celoria and Patton. We focused on the anatomy of the VSD viewed from the right ventricular side. There were 15 IAA type A, 27 type B, no type C. The VSD in IAA type B was always an outlet VSD, located between the two limbs of the septal band, with posterior malalignment of the outlet septum in hearts with concordant ventriculo‐arterial connections, without any fibrous tricuspid‐aortic continuity. In addition, the aortic arch was always completely absent. Conversely, the VSD in IAA type A could be of any type (outlet in six, muscular in four, central perimembranous in two, inlet in three) and the aortic arch was either atretic or absent. In addition, IAA type B, when found in the setting of another anomaly, was always associated with neural crest‐related anomalies (CAT and DORV), whereas IAA type A was found in association with anomalies not related to the neural crest (TGA and AVSD). These results reinforce the hypothesis that different pathogenic mechanisms are responsible for the two types of IAA, and the inclusion of IAA type B in the group of neural crest defects. Conversely, IAA type A could be due to overlapping mechanisms: flow‐related defect (coarctation‐like) and neural crest contribution.     

3.0T 3D-TOF MRA对颅内动脉瘤检出率的临床应用研究

目的评价3.0 T时间飞跃法磁共振血管成像(3.0 T 3D-TOF MRA)对颅内动脉瘤的诊断价值。方法选择25例有颅内动脉瘤相关症状患者,其中男性14例,女性11例;年龄25～74岁,平均年龄57岁。对其3.0 T 3D-TOF MRA诊断为颅内动脉瘤患者的磁共振资料进行回顾性分析,并与数字减影血管造影(DSA)对照。结果3.0 T 3D-TOF MRA共显示28个动脉瘤,其中单发22例,3例为多发动脉瘤,起自颈内动脉系统25个;起自基底动脉系统3个;DSA检查共显示27个动脉瘤。结论3.0 T 3D-TOF MRA虽然对于直径≤3 mm的微小动脉瘤的诊断存在一定的误诊及漏诊率,但其诊断颅内动脉瘤时能比较全面地显示动脉瘤,三维信息对临床确立治疗方案有很大帮助。3.0 T 3D-TOF MRA不失为高危人群或临床怀疑颅内动脉瘤患者筛查及随诊观察的有效手段。     

主动脉弓分支变异螺旋CT三维成像解剖学研究

目的：探讨多层螺旋CT（MSCT）血管成像对主动脉弓分支变异的诊断能力及其三维影像解剖特征。方法：对500例接受MSCT胸部及头颈部增强扫描的患者进行回顾性动脉期三维重建，结合横断面、容积重建（VR）、多平面重建（MPR）及最大密度投影（MIP）观察主动脉弓分支变异情况。结果：84．4％（422例）为正常型，即头臂干、左颈总动脉、左锁骨下动脉从右向左分别起自于主动脉弓，15．6％（78例）为变异型。本组共发现8种不同类型的变异，包括头臂干与左颈总动脉共干分出9．4％（47例），左侧椎动脉于左颈总动脉和左锁骨下动脉之间起源于主动脉弓3．6％（18例），头臂干与左颈总动脉共干分出伴左侧椎动脉起源于主动脉弓1．0％（5例），左右颈总动脉共干伴迷走右锁骨下动脉0．6％（3例），左右颈总动脉分别从主动脉弓发出伴迷走右锁骨下动脉0．4％（2例），左侧椎动脉与左锁骨下动脉从主动脉弓共干分出0．2％（1例），右位主动脉弓伴相关结构变异0．4％（2例）。结论：主动脉弓分支的解剖变异较为复杂，CTA三维成像能予以较好的评价。     

腰骶神经根变异的三维MR-PROSET影像观察

目的探讨三维MR-PROSET序列对腰骶神经根变异的显示能力,观察腰骶神经根变异的三维影像学解剖。方法采用常规MRI序列和三维PROSET序列扫描108例腰腿痛患者,所得PROSET序列原始图像行三维MIP后处理,结合原始图像及MIP图像观察腰骶神经根的解剖形态。结果在获得优良图像的105例病例中发现14例腰骶神经根变异,发现率为13.33%。14例腰骶神经根变异中,Ⅱ型变异为10例(71.43%);其中Ⅱ-1型4例(28.57%),Ⅱ-2、Ⅱ-3、Ⅱ-4型各2例(各14.29%);Ⅲ型及Ⅵ型变异各2例(各14.29%)。结论三维MR-PROSET序列对腰骶神经根变异的显示具有独特的优势,有助于腰骶神经根变异的诊断。     

Noninvasive mapping of endothelial dysfunction in myocardial ischemia by magnetic resonance imaging using an albumin‐based contrast agent

Noninvasive preclinical methods for the characterization of myocardial vascular function are crucial to an understanding of the dynamics of ischemic cardiac disease. Ischemic heart disease is associated with myocardial endothelial dysfunction, resulting in leakage of plasma albumin into the extravascular space. These features can be harnessed in a novel noninvasive three‐dimensional magnetic resonance imaging method to measure fractional blood volume (fBV) and vascular permeability (permeability–surface area product, PS) using labeled albumin as a blood pool contrast agent. C57BL/6 mice were imaged before and 3 days after myocardial infarction (MI). Following the quantification of endogenous myocardial R₁, the dynamics of intravenously injected albumin‐based contrast agent, extravasating from permeable myocardial blood vessels, were tracked on short‐axis magnetic resonance images of the entire heart. This study successfully discriminated between infarcted and remote regions at 3 days post‐infarct, based on a reduced fBV and increased PS in the infarcted region. These findings were confirmed using ex vivo fluorescence imaging and histology. We have demonstrated a novel method to quantify blood volume and permeability in the infarcted myocardium, providing an imaging biomarker for the assessment of endothelial dysfunction. This method has the potential to three‐dimensionally visualize subtle changes in myocardial permeability and to track endothelial function for longitudinal cardiac studies determining pathophysiological processes during infarct healing.     

Predicting anxiety in magnetic resonance imaging scans

This study evaluated a brief screening instrument for predicting psychological distress in patients undertaking magnetic resonance imaging (MRI) scans. The scale is adapted from Wolpe and Lang’s (1964) Fear Survey Schedule (FSS; see Lukins, Davan, & Drummond, 1997). Noise and/or confinement were identified as the most unpleasant feature of the MRI by 48.3% of 118 outpatients. The MRI-FSS (Lukins et al., 1997; 9 items) significantly predicted the number of panic attack symptoms and state anxiety experienced during MRI scan better than a range of other measures. There was a significant increase in MRI-FSS scores from prescan to postscan among those who experienced high levels of anxiety during the scan. The MRI-FSS appears to be a useful indicator of likely adverse psychological reactions in the MRI scan that is sensitive to the sequelae of the MRI procedure.