高分辨磁共振成像在缺血性脑卒中临床应用中的价值

目的探讨缺血性脑卒中双侧大脑中动脉(MCA)粥样硬化管壁特点及动脉硬化脑卒中发生的危险因素。方法选取起病72 h确诊为MCA供血区梗死患者,行头部高分辨率磁共振成像(HRMRI)检查。分别测量及计算入组患者双侧MCA的最窄层面及参考层面的血管面积(VA)、管腔面积(LA)、管壁面积(WA)、斑块面积(PA)、斑块负荷、狭窄率、重塑指数等参数及评估斑块分布、斑块内出血等特征。结果比较入组患者卒中侧及卒中对侧MCA,最窄层面VA两者差异无统计学意义(P>0.05);最窄层面LA卒中侧小于卒中对侧(P<0.05);而最窄层面WA、斑块面积(PA)、斑块负荷及狭窄率卒中侧大于卒中对侧(P<0.05)。两侧MAC重塑方式比例不同(χ~2=14.166,P<0.05),且卒中正性重塑比例大于卒中对侧。MCA分布于下壁和腹侧壁斑块明显多于上壁或背侧壁;卒中侧分布于上壁和背侧壁斑块多于卒中对侧(χ~2=8.929,P<0.05)。两侧MCA发生斑块内出血的比例不同(χ~2=10.637,P<0.05),卒中侧要高于卒中对侧。结论动脉粥样硬化的斑块负荷、血管正性重塑、斑块分布及斑块内出血与缺血性脑卒密切相关。HRMRI能够更加准确评估动脉硬化血管状态,预测缺血性脑卒中发生风险。     

基于3.0T高分辨率磁共振成像观察大脑中动脉狭窄患者血管壁斑块变化情况

背景 动脉粥样硬化引起的颅内动脉狭窄是造成缺血性脑卒中的主要原因,而常规影像学检查仅能显示管腔形态,无法显示管壁结构.高分辨率磁共振成像(HR-MRI)可用于观察动脉粥样硬化斑块形成及发展,辅助判断斑块稳定性,进而评估相关疾病发生风险.目的 基于3.0T HR-MRI观察大脑中动脉狭窄患者血管壁斑块变化情况,以为脑卒中...     

HR-MRI检测在大脑中动脉与基底动脉脑梗死患者中的应用

目的分析3. 0T高分辨率磁共振成像(HR-MRI)在有症状性脑桥旁正中梗死(PPI)与大脑中动脉梗死(MCAI)患者脑血管壁改变模式中的应用。方法将本院确诊的24例PPI和26例MCAI患者作为研究对象,行磁共振血管成像(MRA)、扩散加权成像(DWI)、HR-MRI检查,分别测量基底动脉(BA)与大脑中动脉(MCA)管壁,并对参考层面与最狭窄层面的血管面积指数分别进行计算。若该指数高于1. 05则定义为阳性改变,指数为0. 95～1. 05则为无改变,指数低于0. 95则为阴性改变,比较阳性改变组与阴性改变组最窄层面与参考层面的血管特点。结果在50例患者中,在BA处发现阳性改变15例,无改变4例,阴性改变5例;在MCA处发现阳性改变16例,无改变5例,阴性改变5例。阳性改变组最狭窄层面斑块面积、斑块负荷、血管面积、管壁面积及管腔面积较阴性改变组均有统计学意义(均P 0. 05);而两组在参考处血管面积、管壁面积及管腔面积的比较,均无统计学意义(均P 0. 05)。结论HR-MRI在评估MCAI与PPI患者病变指数中具有重要作用,BA与MCA的阳性改变较为常见,多伴有较大的动脉粥样硬化斑块,其斑块面积与斑块负荷较阴性改变者明显增大。     

老年颅内动脉硬化的发生与脑白质疏松的关系

目的探讨老年患者颅内动脉硬化的发生与脑白质疏松(LA)的关系。方法在该院神经内科住院的患者中,收集符合研究条件且经头MRI检查和依据Fazekas评分确诊为LA的87例作为病例组;确诊无LA的93例作为对照组。记录TCD检查结果,包括颅内左侧各血管即大脑中动脉(MCA)、大脑前动脉(ACA)、大脑后动脉(PCA)、椎动脉(VA)及基底动脉(BA)的收缩期血管流速和脉动指数(PI)。结果 LA组与对照组比较,LA组患者左侧MCA、ACA、PCA、VA及BA的PI均较对照组高(P相似文献   

高分辨率磁共振血管成像在内囊预警综合征临床应用中的价值

目的利用高分辨率磁共振血管成像(HR-MRI)探讨内囊预警综合征(CWS)的发病机制及脑梗死发生风险。方法符合CWS诊断标准的短暂性脑缺血发作(TIA)患者,根据脑磁共振弥散加权成像分为脑梗死组和非脑梗死组。比较两组HRMRI血管成像表现,分析大脑中动脉(MCA)粥样硬化管壁特点、斑块负荷、斑块分布特点及强化程度。结果共收集15例CWS患者,其中12例在HR-MRI可见到明确的大脑中动脉粥样硬化斑块,斑块位置分布及强化程度不一,9例患者在1 w内进展为永久性脑梗死,斑块检出率梗死组大于非梗死组(100%vs 50%,P=0.044),斑块负荷梗死组大于非梗死组[(32.1±2.9)%vs(20.9±0.4)%;t=3.536.P=0.021)],斑块强化率梗死组明显高于非梗死组(P0.001),血管狭窄程度梗死组大于非梗死组[(78.5±8.7)%vs(63.4±5.2)%;t=2.970.P=0.035)],斑块分布于前下壁者梗死组多于非梗死组(P0.05)。结论 CWS可能由于大动脉硬化斑块所致,且脑卒中进展风险与斑块分布位置及强化程度有关。HR-MRI可以作为一种有效的管壁动脉硬化观察手段探讨CWS的发病机制,且对于相关治疗有指导意义。     

HR MR-VWI在脑缺血性疾病中应用价值

目的 分析高分辨率磁共振脑动脉血管壁成像(HR MR-VWI)在脑缺血性疾病中的应用价值。方法 选择经临床与影像学确诊的100例脑缺血性疾病患者纳入缺血组;将同期经临床与影像学确诊的50例非脑缺血性疾病患者纳入非缺血组。全部患者接受HR MR-VWI检查,并设计患者基线资料调查表,比较两组基线资料,重点观察两组HR MR-VWI的影像学特征及参数;分析HR MR-VWI对脑缺血性疾病的评估价值。结果 缺血组斑块位于腹侧壁、斑块表面不光整、斑块内出血、斑块明显强化、血管壁正性重构占比明显高于非缺血组(P<0.05);缺血组血管壁均为偏心性增厚;最狭窄处管腔面积(LA)显著低于非缺血组,管壁面积(WA)、斑块面积(PA)明显高于非缺血组(P<0.05);其他参数及基线资料比较差异无统计学意义(P>0.05);绘制受试者工作特征(ROC)曲线,结果显示,WA、PA单独及二者与LA联合评估脑缺血性疾病的AUC>0.80,具有一定的评估价值;当LA、WA、PA的cut-off值分别取10.750 mm²、10.450 mm²、5...     

采用高分辨率核磁共振评价颅内动脉粥样硬化斑块稳定性与卒中复发风险的关系

目的探讨颅内动脉粥样硬化斑块稳定性与卒中复发风险的关系。方法回顾性分析广东省中医院48例由颅内动脉粥样硬化引起的急性缺血性卒中患者,采用Essen卒中风险评分量表(ESRS)将患者进行危险因素评估后,分为ESRS≥3分组(高危复发风险组21例)和ESRS3分组(低危复发风险组27例)。两组患者均接受颅内责任血管(基底动脉或单侧大脑中动脉)的高分辨率核磁共振(HR-MRI)检查,依据HR-MRI在T1加权成像、T2加权成像及T1压脂序列等的信号强弱,区分颅内动脉粥样硬化稳定性斑块与不稳定性斑块。比较两组患者颅内动脉粥样硬化斑块稳定情况。结果两组患者的年龄、高血压病、糖尿病及不稳定性斑块的发生率差异有统计学意义(均P0.05)。将这四个因素进一步进行多因素Logistic回归分析显示,年龄、高血压病、糖尿病及颅内动脉粥样硬化不稳定性斑块是缺血性卒中复发的高危因素。其OR值分别为87.114、159.423、8.942、11.551,95%CI分别为4.218~1 799.078、3.235~7 855.957、1.054~75.857、1.011~132.043(均P0.05)。结论除年龄、高血压病、糖尿病传统危险因素外,颅内动脉粥样硬化不稳定性斑块是缺血性卒中高危复发的独立危险因素。     

颅内大动脉狭窄患者Wingspan支架置入前后高分辨率核磁共振影像的变化

目的采用高分辨率MRI(HR-MRI)技术,评价Wingspan支架置入前后,颅内大动脉病变部位管壁和管腔影像的变化。方法回顾性连续纳入2013年12月至2014年12月,首都医科大学宣武医院神经介入诊断治疗科收治的症状性颅内动脉重度狭窄(狭窄率70%~99%)患者9例,病变位置包括大脑中动脉、基底动脉和椎动脉颅内段。采用头部三维HR-MRI成像技术,通过影像注册和匹配,分析和比较Wingspan支架释放前后,病变部位管壁强化面积变化;通过Pearson相关性分析以及Bland-Altman统计图,比较HR-MRI与DSA测量狭窄率的一致性。结果支架置入技术成功率为100%,无相关并发症。(1)Wingspan支架置入术后狭窄部位管壁钆剂强化较术前明显减弱,置入术后比术前强化面积下降了(87±16)%,差异有统计学意义(t=2.325,P=0.049)。(2)支架置入术前,HR-MRI和DSA测量的平均狭窄率分别为(82±6)%和(82±8)%,差异无统计学意义(t=0.051,P=0.961);术后HR-MRI和DSA的平均狭窄率分别为(16±12)%和(21±12)%,差异无统计学意义(t=1.345,P=0.216)。(3)支架置入术前与术后,HR-MRI和DSA测量狭窄率的Pearson相关系数分别为0.347(P=0.361)和0.545(P=0.129)。Bland-Altman统计图显示,大多数据点位于一致性界限内(x-±1.96 s)。结论 HR-MRI作为一种体内无创性成像手段,可用于评估颅内支架释放后病变部位管壁、管腔和原有斑块的变化,可用于评价颅内动脉管壁影像重建。     

磁共振单次扫描多组织对比序列对颈动脉粥样硬化斑块评价的临床初步研究

目的评价MR 3D单次扫描多组织对比序列(MATCH)定量评价颈动脉血管形态学和定性评价斑块内成分的价值。方法选择超声检查发现颈动脉狭窄>50%且拟行颈动脉内膜剥脱术患者30例,术前分别行MATCH(5min)及MRI常规多序列扫描(T1WI,T2WI,三维时间飞跃和质子密度加权像,18min),扫描范围以颈动脉分叉为中心覆盖全部斑块。用MRI-Plaque View软件分析斑块形态学参数:管腔面积(LA)、管壁面积(WA)、标准化管壁指数(NWI),定性评价斑块内成分,包括斑块内出血(IPH)、斑块钙化(CA)、斑块脂质核心(LRNC)。用Cohen kappa分析2种序列对斑块内成分定性的一致性。结果 30例患者双侧颈动脉入选898个图像层面,MATCH和常规序列LA[(36.27±24.23)mm2 vs(35.72±20.12)mm2,t=1.87,P=0.062],WA[(42.80±20.67)mm2 vs(43.64±24.87)mm2,t=1.74,P=0.082],NWI[(59.21±13.90)vs(59.81±13.96),t=1.80,P=0.072]无显著差异。MATCH与常规序列判断斑块内成分有中到高度的一致性(LRNC:κ值=0.840,CA:κ值=0.802,IPH:κ值=0.773)。结论 MATCH有可能成为评估颈动脉易损斑块成分及斑块破裂危险程度的新方法。     

动脉搏动指数对评价糖尿病脑血管病变的意义

目的 采用经颅多普勒(TcD)评价糖尿病患者的脑血流动力学改变。方法 对120例无脑卒中、血压正常的2型糖尿病(T2DM)患者，100名年龄和性别相匹配的健康志愿者，检测了大脑中动脉(MCA)、颈内动脉颅外段(ICA)、基底动脉(BA)的血流速度和Gosling搏动指数(PI)。结果 糖尿病组ICA血流速度明显高于对照组。有并发症患者MCA和ICA的PI明显高于无并发症患者和对照组，BA的PI也显著高于对照组。PI与糖尿病病程密切相关(r=0．48)。结论 糖尿病患者脑血流动力学改变的TCD所见，提示PI可反映脑血管病变。     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.