基于冠状动脉CT造影的生物机械应力在斑块评估及不良心血管事件预测中的应用

冠状动脉长期暴露于危险因素会引起粥样硬化,进而导致斑块形成与进展。通过早期识别高危斑块特征将有助于预防斑块破裂或糜烂,从而避免急性心血管事件的发生。而生物机械应力(biomechanical stress)在动脉粥样硬化斑块进展及破裂中发挥重要的作用。近些年,已经可以通过无创冠脉CT血管造影(coronary computed tomography angiography, CCTA)利用计算流体力学(computational fluid dynamic, CFD)进行建模,从而得到相应的生物机械应力参数,尤其是壁面剪切应力(wall shear stress, WSS)将有助于更好地构建临床模型从而预测斑块进展及主要不良心血管事件(major adverse cardiac events, MACE)。本文重点介绍生物机械应力以及CCTA所计算得出的WSS在动脉粥样硬化中的作用,并讨论有关CCTA生物机械应力与冠心病相关的研究。     

16层螺旋CT冠状动脉图像质量评估

目的量化评估16层螺旋CT冠状动脉各分支图像质量,探讨冠状动脉CT成像的临床应用效果。方法采用16层螺旋CT对102例患者行回顾性心电门控冠状动脉成像,男60例,女42例,平均年龄（57．8±9．4）岁,平均心率（62．8±10．2）次／min。心率〈60次／min（n=40）为I组,60～70次／min（n=35）为Ⅱ组,〉70次／min（n=27）为Ⅲ组。4条冠状动脉分支（左主干、左前降支、左回旋支、右冠状动脉）分别用于图像质量分析。扫描原始数据以间隔10％在20％～80％时相分别回顾性重建冠状动脉图像,用横断面、曲面重建、容积再现等方法对冠状动脉显示率评估。用曲面重建方法测量冠状动脉各分支长度及近段和远段对比噪声比。结果①冠状动脉各分支平均显示长度：左主干（10．9±3．0）mm,左前降支（130．3±29．7）mm,左回旋支（82．8±19．8）mm,右冠状动脉（150．5±27．5）mm;②Ⅰ组60％和70％为最佳时相图像质量优,Ⅱ组60％时相为最佳时相图像质量优,Ⅲ组RCA较优的时相为40％,LM、LAD、LCX较优时相为60％。③所有冠状动脉分支平均对比噪声比10．9±3．2。结论16层螺旋CT有较好质量的冠状动脉图像,心率和时相影响冠状动脉的成像质量。     

Prognostic Value of Renal Function for Cardiac Events in Patients Without Significant Stenosis on Coronary Computed Tomography Angiography

This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m²) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

Graphical Abstract

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拟行CT冠脉造影患者焦虑抑郁状态

目的研究拟行CT冠脉成像患者焦虑和抑郁情绪状况,评估该检查对病患的情绪影响。方法选取拟行CT冠脉造影的患者为研究组,选取普通内科冠心病患者为对照组,采取焦虑自评量表(SAS)和抑郁自评量表(SDS)分组做测试和评估。结果①拟行CT冠脉造影的患者抑郁自评量表(SDS)、焦虑自评量表(SAS)测试结果与对照组有明显差异,均高于中国常模,有统计学意义(t=10.94,10.17,P<0.01);②在精神情感症状条目下,研究组明显高于对照组,有显著性差异(t=2.78,P<0.05);③在躯体性障碍症状条目下,研究组明显高于对照组(t=3.47,P<0.01),有显著性差异;④在精神运动症状条目下,比较研究组和对照组,两组没有显著差异。结论拟行CT冠脉造影的患者存在以焦虑、抑郁为主的心理症候群,且在精神情感、躯体感觉症状方面症状明显,而精神运动方面的症状表现不明显。     

CAG正常伴心绞痛症状患者行核素心肌灌注显像的临床意义

目的:探讨核素心肌显像在冠状动脉造影(CAG)正常伴心绞痛症状患者中的临床意义。方法:应用99Tcm-MIBI负荷/静息门控心肌灌注断层显像(MPT)分析上述患者显像特点。A组(心血管神经症)15例,B组(原发性高血压)24例,C组(X综合征)20例,D组(Ⅱ型糖尿病)18例。结果:A组有2例3个节段可逆性缺损,评分均为1;B、C、D组均有多节段可逆性或部分可逆性缺损,异常机率明显高于A组(P<0.001),评分为1.12±0.28、1.08±0.36、1.42±0.56,B、C组无明显差异(P>0.05),D组与B或C组有差异(P<0.01)。比较静息LVEF,A组与B、C组无明显差异(P>0.05),D组略低于A组(P<0.01)。结论:MPT可反映CAG正常伴心绞痛患者心肌血流的分布状况,显示病变的范围及程度。     

电子束CT冠状动脉血管造影与冠状动脉造影结果的关联性研究

目的　探讨电子束CT冠状动脉血管造影 (eletronbeamcomputedtomographicangiography ,EBA)与冠状动脉造影结果的关联性。方法　 2 4例临床怀疑冠心病患者分别行EBA及冠状动脉造影 (coronaryangiography,CAG) ,所有EBCT图像均经三维重建显像 ,按照AHA分段方法进行分段 ,每套重建显像血管分成左主干 (leftmainartery ,LM)及前降支 (leftanteriordescendingcoronaryartery ,LAD)、左旋支 (leftcircumflexartery ,LCx)、右冠脉 (rightcoronaryartery,RCA)各近、中、远三段共 10段血管 ,由 2名医生对LM和LAD、LCx、RCA的近、中段共 16 8段血管进行分析 ,其结果与CAG结果对比 ,比较EBA与CAG所示冠状动脉狭窄间的关系。结果　在 16 8个近段和中段血管中有 147段 (87.5 0 %)EBA能够清楚显像 ,其中LAD近段和中段清晰显像的百分比都为 95 .83%,而RCA近段和中段分别为 91.6 7%和 5 8.33%,LCx近段和中段为 91.6 7%、79.17%,而在 16 8个近段和中段血管中CAG全部清晰显像 ;如果以 >5 0%狭窄作为有意义狭窄 ,则EBA与CAG比较发现狭窄的敏感性和特异性是 83.33%和 92 .13%,其中LM是 10 0 .0 0%和 95 .6 5 %,LAD近段是 10 0 .0 0 %和 75 .0 0 %,LAD中段是 82 .35 %和 6 6 .6 7%,RCA近段是 80 .0 0 %和 71.43%,RCA中段是 5     

影响冠状动脉造影术患者焦虑的因素分析

心脏介入诊断治疗前后相关心理问题的研究报告介入术前焦虑者约为60%左右[1].本文就导致冠状动脉造影术前后焦虑产生的因素进行调查分析以期为进一步的心理干预措施提供参考.     

Deauville Scores 4 or 5 Assessed by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Early Post-Allotransplant Is Highly Predictive of Relapse in Lymphoma Patients

The impact of early fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET-CT) status on survival after allogeneic transplantation for lymphoma is poorly reported. This retrospective study included all adult Hodgkin lymphoma (HL) or non-Hodgkin lymphoma(NHL) patients (>18 years old) who benefited from FDG PET-CT before (within 1 month) and/or early (+3 months and within +6 to 9 months) after allogeneic stem cell transplantation in our institution between 2005 and 2015 and who were still without documented progression or relapse at the time of the FDG PET-CT. All FDG PET-CT were reviewed by a nuclear medicine expert in hematology and restaged according to the Deauville scale. FDG-PET CT was considered positive when the uptake was higher than liver background (Deauville score ≥ 4). The primary objective was to study the impact of pre- and post-transplant FDG PET-CT on lymphoma-free survival (LFS) and overall survival (OS). Inclusion criteria were fulfilled for 103 patients (69 men; median age, 51.6 years old; range, 22 to 67). Diagnoses were high-grade NHL (n = 47), low-grade NHL (n = 6), T cell lymphoma (n = 34), and HL (n = 16). More than half of the patients were in complete remission at the time of transplant (n = 56). A reduced-intensity conditioning regimen was applied in most cases (n = 90). With a median follow-up of 49.5 months (range, 6 to 140.5) for alive patients, median 3-year OS and LFS were, respectively, 81% (range, 71% to 87%) and 65% (range, 54% to 74%) for the entire cohort. In multivariate analysis, positive FDG PET-CT at 3 months was the strongest independent factor significantly associated with poorer LFS (hazard ratio, 9.22; 95% confidence interval, 1.88 to 645.2; P = .006). FDG PET-CT positivity at 3 months appears to be highly predictive of LFS in patients after allogeneic transplantation and may help to guide strategies to prevent relapse. These results need to be validated prospectively.     

首发抑郁症患者海马容积与磁共振波谱的研究

目的:探讨抑郁症患者海马容积与氢质子波谱(1H-MRS)的相关性。方法:对50例首发抑郁症患者和50例健康志愿者行磁共振海马容积测量和磁共振波谱检查,将采用相除法标准化海马容积与N-乙酰天门冬氨酸(NAA)、胆碱(Cho)和肌酸(Cr)的比值对照分析。结果:抑郁症患者海马容积不同程度缩小,其中31例重度抑郁症者海马容积明显缩小。抑郁症患者NAA峰高度降低、Cho峰增高,NAA/Cr比值不同程度减小、Cho/Cr值增高,31例重度患者NAA/Cr值明显减小;重度抑郁症患者海马容积缩小与NAA/Cr降低幅度呈正相关。结论:重度抑郁症患者海马容积缩小、NAA丢失严重,提示神经递质N-乙酰天门冬氨酸-谷氨酸在抑郁症发展中起重要作用。     

Airway Morphology From High Resolution Computed Tomography in Healthy Subjects and Patients With Moderate Persistent Asthma

Models of the human respiratory tract developed in the past were based on measurements made on human tracheobronchial airways of healthy subjects. With the exception of a few morphometric characteristics such as the bronchial wall thickness (WT), very little has been published concerning the effects of disease on the tree structure and geometrical features. In this study, a commercial software package was used to segment the airway tree of seven healthy and six moderately persistent asthmatic patients from high resolution computed tomography images. The process was assessed with regards to the treatment of the images of the asthmatic group. The in vivo results for the bronchial length, diameter, WT, branching, and rotation angles are reported and compared per generation for different lobes. Furthermore, some popular mathematical relationships between these morphometric characteristics were examined in order to verify their validity for both groups. Our results suggest that, even though some relationships agree very well with previously published data, the compartmentalization of airways into lobes and the presence of disease may significantly affect the tree geometry, while the tree structure and airway connectivity is only slightly affected by the disease. Anat Rec, 296:852–866, 2013. © 2013 Wiley Periodicals, Inc.     

心电门控双源CT血管造影在评价主动脉缩窄中的临床价值

探讨心电门控双源CT血管造影(DSCTA)在评价主动脉缩窄(CoA)中的临床价值。对23例临床怀疑CoA的患者行DSCTA和经胸超声心动图(TTE)检查,将手术结作为金标准。经手术证实23例病例均有主动脉缩,其中12例患者为局限性狭窄,11例为管状缩窄;19例患者伴有其他心血管畸形,其中主动脉弓发育不良5例,动脉导管未闭9例,室间隔缺损10例,二叶主动脉瓣2例,合并侧枝循环形成4例,迷走左锁骨下动脉及2例,残存左上腔静脉2例。23例CoA最窄处直径约(7.0±3.7)mm;9例管状缩窄患者,缩窄段直径约(6.2±7.3)mm,长度约(29.2±5.9)mm。DSCTA和TTE对CoA诊断的准确性分别为100%和91.3%(P>0.05)。本研究结果证明心电门控DSCTA可以准确评价CoA及合并心血管畸形,为术前提供详细的解剖学信息。     

Early Differential Changes in Coronary Plaque Composition According to Plaque Stability Following Statin Initiation in Acute Coronary Syndrome: Classification and Analysis by Intravascular Ultrasound-Virtual Histology

Purpose

The aim of this study was to demonstrate the early effects of statin treatment on plaque composition according to plaque stability on Intravascular Ultrasound-Virtual Histology at 6 months after a coronary event. Previous trials have demonstrated that lipid lowering therapy with statins decreases plaque volume and increases plaque echogenicity in patients with coronary artery disease.

Materials and Methods

Fifty-four patients (54 lesions) with acute coronary syndrome were prospectively enrolled. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=14) and non-TCFA (n=40). The primary end point was change in percent necrotic core in the 10-mm subsegment with the most disease.

Results

After 6 months of statin therapy, no change was demonstrated in the mean percentage of necrotic core (18.7±8.5% to 20.0±11.0%, p=0.38). There was a significant reduction in necrotic core percentage in patients with TCFA (21.3±7.2% to 14.4±8.9%, p=0.017), but not in patients with non-TCFA. Moreover, change in percent necrotic core was significantly correlated with change in high-sensitivity C-reactive protein levels (r=0.4, p=0.003). Changes in low-density lipoprotein cholesterol levels and lipid core percentage demonstrated no significant associations.

Conclusion

A clear reduction of lipid core was observed only for the TCFA plaque type, suggesting that changes in plaque composition following statin therapy might occur earlier in vulnerable plaque than in stable plaque; the effect may be related to the anti-inflammatory effects of statins.     

冠状动脉粥样硬化的CTA成像及其常见危险因素的临床分析

目的探讨冠状动脉粥样硬化的CTA成像技术及其临床常见危险因素。方法首先对2005年6月-2009年1月入住本院的276例疑诊冠心病患者用16层螺旋CT进行冠脉CTA检查,然后根据CTA结果将资料分为冠心病组和非冠心病组,以卡方检验及二项分类Logistic回归分析影响冠状动脉狭窄程度的常见危险因素。结果 CTA成像一次检查可完成冠状动脉钙化积分和狭窄的评价,图像清晰,方便、安全。卡方检验结果显示：冠状动脉狭窄程度受年龄（χ2=13.560,P=0.001）、抽烟（χ2=4.243,P=0.039）、TC（χ2=8.260,P=0.004）、TG（χ2=5.718,P=0.017）、LDL（χ2=6.375,P=0.012）影响;Logistic回归分析发现：吸烟（OR=3.136,P=0.003）、TC（OR=2.370,P=0.004）、高血压（OR=2.247,P=0.015）、年龄（OR=1.064,P=0.000）与冠状动脉的狭窄程度相关性更密切。结论本研究发现冠脉CTA成像可作为常规的冠心病筛选影像技术;吸烟、总胆固醇、高血压和年龄与冠状动脉的狭窄程度临床相关性更密切,LDL、TG相关性相对较小。     

Measurement of Kidney Volume with Multi-Detector Computed Tomography Scanning in Young Korean

Purpose

Kidney volume is regarded as the most precise indicator of kidney size. However, it is not widely used clinically, because its measurement is difficult due to the complex kidney shape. We attempted to evaluate the normal kidney volume in young Korean men by using multi-detector computed tomography (MDCT).

Materials and Methods

We retrospectively reviewed MDCT data of young Korean men (113 patients). After data processing, we measured the volume and length of the kidneys. Body parameters (height, body weight, body-surface area, and total body water) and laboratory data were collected. Glomerular filtration rate (GFR) was calculated using Cockcroft-Gault (CG) equation.

Results

The mean kidney volume was 205.29 ± 36.81 cm³; and mean kidney length was 10.80 ± 0.69 cm. The former correlated significantly with height, body weight, body-surface area, and total body water (p < 0.05, correlation coefficient : γ = 0.328, 0.649, 0.640, and 0.638, respectively). The latter also correlated significantly with all body indexes, however the correlation was weaker, except with height (p < 0.05, correlation coefficient : γ = 0.457, 0.473, 0.505, and 0.503, respectively). Only kidney volume significantly predicted estimated GFR (adjusted R² = 0.431, F = 85.90 and p < 0.05).

Conclusion

The kidney volume measured with MDCT is correlated well with body parameters, and is useful to predict renal function.     

多排CT血管成像显示脑循环血管变异研究进展

目的:探讨多排CT血管成像(MD-CTA)显示脑循环血管变异的价值.方法:查阅国内外相关文献,对各种脑循环血管变异影像学表现、发生率及临床意义进行总结分析.结果:脑循环血管变异包括:颅内动脉开窗和重复、Willis环变异、永存颈动脉-基底动脉吻合、颅底部动脉变异等.有些与动脉瘤形成有关,具有重要临床意义.结论:MD-CTA可检出大多数脑循环血管变异,有利于颅内动脉瘤、脑出血的检查和治疗计划的制定.