Usefulness of three-dimensional phase contrast MR angiography on arteriovenous malformations

Prospective three-dimensional phase contrast (3D-PC) MR angiography was obtained in 34 patients with arteriovenous malformations (AVM) and comparison was made between digital substraction angiography (DSA) and three-dimensional time-of-flight (3D-TOF) methods. Velocity encoding (VENC) for 3D-PC was adjusted to 60 and 10 cm/sec., and was changed only when adequate information was not obtained. VENC 60 cm/sec. demonstrated the main feeders in 100 % of cases and the nidus in 86 % of cases whereas VENC 10 cm/sec. showed the draining vein in 78 % of cases. The detection rate of feeder, nidus and drainer was 60 %, 40 % and 13 % respectively by the TOF technique. The mean size of the nidus as compared with DSA as standard was 130 % with MRI,108 % with 3D-PC and 92 % with the TOF technique and this difference was not statistically significant. 3D-PC was clearly superior in detecting AVM in the presence of hemosiderin, hematoma or surgical clips. It also showed gradual disappearance of the lesion after radiosurgery We found 3D-PC superior to 3D-TOF in the diagnosis, therapeutic planning and follow-up of AVM.     

Synthesized surface anatomy scanning (SSAS) for surgical planning of brain metastasis at the sensorimotor region: Initial experience with 5 patients

Summary Surface anatomy scanning (SAS) is a powerful technique that uses T2-weighted magnetic resonance images (MRI) to visualize brain surface structures, and to precisely localize subcortical lesions. To overcome technical limitations of this method, synthesized SAS (SSAS) superimposes MR angiography (MRA) data on the SAS images. We describe our initial experience with surgical planning for the resection of metastases at the sensorimotor region in 5 patients using SSAS. Neurological deficits were assessed before and after surgical resection. Although 4 of 5 patients had mild to severe neurological deficits before surgery, three became symptom-free and no patient had an increased deficit after surgery. Our results undoubtedly provide palliative surgery for sensorimotor metastases. As SSAS is non-invasive and requires a short scanning time, this method could become a useful technique for the routine pre-operative simulation for surgery on brain surface lesions such as sensorimotor metastases.     

A review of the surface and internal anatomy of the caudal canal in children

The anatomy of the sacral hiatus and caudal canal is prone to significant variation, yet studies assessing this in the pediatric population remain limited. Awareness of the possible anatomical variations is critical to the safety and success of caudal epidural blocks, particularly when image guidance is not employed. This systematic review analyzes the available evidence on the clinical anatomy of the caudal canal in pediatric patients, emphasizing surface anatomy and internal anatomical variations. A literature search using three electronic databases and standard pediatric and anatomy reference texts was conducted yielding 24 primary and seven secondary English‐language sources. Appreciating that our current landmark‐guided approaches to the caudal canal are not well studied in the pediatric population is important for both clinicians and researchers.     

三维时间飞跃法磁共振血管成像显示健康成人Willis环变异

目的探讨健康成人体格检查时接受三维时间飞跃法磁共振血管成像(3D-TOF MRA)中Willis环各组成动脉段的变异情况,探讨MRA评价Willis环各段动脉变异的临床意义。方法收集接受3D-TOF MRA检查的健康成人体检者442名,统计Willis环各段动脉的变异情况,并将变异分为大脑前动脉(ACA)第1段(A1段)变异、ACA第2段(A2段)变异、大脑前交通动脉(ACoA)变异、大脑后交通动脉(PCoA)变异及大脑后动脉(PCA)第1段(P1段)变异。结果442名体检者中,Willis环变异者占34.39%(152/442),其中A1段变异占50.00%(76/152),A2段变异占15.13%(23/152),ACoA段变异者占4.61%(7/152),PCoA段增粗者占66.45%(101/152),P1段变异占44.74%(68/152)。结论3D-TOF MRA对检出健康成人Willis环变异具有重要作用,可为临床诊断相关疾病提供依据。     

Comparison of treatment plans for lower extremity arterial occlusive disease made with electrocardiography-triggered two-dimensional time-of-flight magnetic resonance angiography and digital subtraction angiography.

BACKGROUND: The purpose of the study was to determine whether preoperative treatment plans for patients with lower extremity ischemia can be made with electrocardiography (EKG)-triggered two-dimensional (2D) time-of-flight (TOF) magnetic resonance angiography (MRA) as accurately as digital subtraction angiography (DSA). METHODS: Forty patients were prospectively evaluated with the combination of EKG-triggered 2D TOF MRA, DSA, and pulse volume recordings. Blinded reviewers graded arterial segments for disease severity. Accuracy of separate MRA- and DSA-based treatment plans was compared with the procedures performed based on all available information. RESULTS: There was an 86% exact match between MRA- and DSA-based plans (92% MRA and 94% DSA accuracy). The MRA-based plan accurately predicted 90% of suprainguinal and 95% of infrainguinal procedures, whereas the DSA-based plan accurately predicted 100% of suprainguinal and 85% of infrainguinal procedures. Two-year primary patency was 83% for all procedures. Radiologists' review of disease severity resulted in a mean exact correlation between studies of 81% (kappa = 0.64). The agreement between radiologists interpreting the MRA was 84% (kappa = 0.7) compared with 82% (kappa = 0.66) for the DSA. CONCLUSIONS: MRA- and DSA-based preoperative management plans were of comparable efficacy. Significant interobserver variability was seen with the interpretations of both preoperative studies. EKG-triggered 2D TOF MRA can be used to plan arterial reconstructions; however, all patients require arterial pressure measurements prior to suprainguinal repair and confirmatory intraoperative angiography during infrainguinal revascularization.     

Diagnosis of carotid-cavernous fistulas with magnetic resonance angiography—demonstrating the draining veins utilizing 3-D time-of-flight and 3-D phase-contrast techniques

This study assessed the ability to diagnose carotid-cavernous fistulas (CCFs) non-invasively using magnetic resonance angiogrphy (MRA). Both three-dimensional time-of-flight (3-D TOF) MRA and three-dimensional phase-contrast (3-D PC) MRA were compared with conventional cerebral angiography in nine patients with CCFs. CCFs were grouped according to Barrow's classification. In all cases, 3-D TOF MRA revealed an inferior petrosal sinus as a draining vein. 3-D PC MRA demonstrated a dilated and tortuous superior ophthalmic vein (SOV) and reflux of the SOV in seven patients. In conclusion, CCFs can be diagnosed with MRA alone by demonstrating the drainging veins.     

Applied anatomy of the calcaneocuboid articular surface for internal fixation of calcaneal fractures

Background

Many types of steel plates are used for internal fixation of calcaneal fractures through extensive lateral approach. The fixation screw at the anterior calcaneal process must be placed into the dense compression trabeculae located directly under the calcaneocuboid articular surface to achieve a stable fixation.

Methods

The transverse diameter and inner tilt angle of the calcaneocuboid articular surface were measured and the inner structures near the calcaneocuboid articular surface were observed in forty adult calcaneus bone specimens to provide an anatomical basis for internal fixation of calcaneal fractures.

Results

The transverse diameter was 22.67 ± 2.14 mm and the inner tilt angle was 60.4 ± 7.1°.

Conclusion

Screws should be implanted under the calcaneocuboid articular surface and the length and direction of the screw should be selected according to the transverse diameter of the calcaneal articular surface and the inner tilt angle, respectively.     

Use of two-dimensional projection for estimating hand surface area of Chinese adults

Accurate estimates of the surface area of burns are important for initial fluid resuscitation and prognosis of burn victims. The area of the surface of the open hand is often used to estimate the area of a burn. Although it is accepted that hand surface area is generally equal to 1% of total body surface area among Caucasians, this ratio has not been verified for Chinese people. We used two-dimensional projection to estimate the hand surface areas of Chinese adults. The area of the palm was 0.44% of total body surface area among men and 0.42% among women. The area of the hand, including that of the thumb and fingers, was 0.76% of total body surface area among men and 0.73% among women. We conclude that the ratio between hand and total body surface area among Chinese adults differs from the ratio among Caucasians, and suggest an adjustment of the ratio for use with Chinese people.     

A prospective study of the predictive power of spiral computed tomographic angiography for defining renal vascular anatomy before live-donor nephrectomy

OBJECTIVE: To determine the accuracy of spiral computed tomography (CT) imaging of donor venous anatomy by comparing CT angiography (CTA) and operative findings, for both laparoscopic (LDN) and open donor nephrectomy. PATIENTS AND METHODS: LDN presents unique surgical challenges, particularly with complex venous or arterial anatomy. The limitations of surgical access, poor visibility of the superior and posterior borders of the renal vein during LDN, and the variability of venous anatomy in this region, contribute to the difficulty of LDN, underlining the importance of imaging beforehand. Forty live donors (mean age 46 years, sd 11; 65% female) were assessed by CTA before donation. Scans were reported by the same radiologist. The number and diameter of 'predicted' renal arteries, veins and renal vein tributaries were documented. The donor kidney was removed by two consultant surgeons, and after back-table perfusion the same details were recorded and taken as the 'reference' findings. Tributaries of <1 mm diameter were not recorded. The right kidney was retrieved in seven patients; 25 of the 40 kidneys were retrieved by LDN and the other 15 by open surgery. RESULTS: In all, 48 actual renal arteries were identified at nephrectomy; of these, 47 were predicted by CTA. Likewise, 41 actual renal veins were found at nephrectomy, 40 of which were predicted. The overall accuracy of spiral CTA in predicting the presence or absence of renal vein tributaries was 83% for gonadal and adrenal veins, and 75% for lumbar veins. There were seven false-negative lumbar veins found at nephrectomy; in these cases the CTA films were retrospectively examined, and five of these seven veins were identified. The predicted renal vein tributary diameter correlated poorly with the measured diameter at nephrectomy. CONCLUSIONS: Assessing potential renal donors before surgery with spiral CTA provides an accurate prediction of the presence or absence of the gonadal and adrenal vein, but is less accurate for predicting lumbar veins. This is especially pertinent as the posterior lumbar tributaries have the most intra-individual variation, and are the most difficult to display and control at LDN. This highlights the need for meticulous dissection of the renal vein, particularly along its posterior wall.     

喉返神经隧道解剖法结合神经监测在腔镜甲状腺手术中的应用

目的:探讨喉返神经隧道解剖法结合神经监测在腔镜甲状腺手术中的应用价值。方法:回顾分析2014年11月至2018年12月施行的141例腔镜甲状腺手术,术中均采用喉返神经隧道解剖法结合神经监测技术。其中甲状腺良性结节93例,甲状腺恶性肿瘤48例;行单侧腺叶切除术52例,单侧甲状腺癌根治术44例,双侧甲状腺癌根治术4例,41例部分切除术。结果:140例手术顺利完成,1例因喉返神经横断伤转开放手术行神经对端吻合;术后9例(9/141,6.38%)暂时性神经麻痹,无永久性声音嘶哑患者。结论:腔镜甲状腺手术中采用喉返神经隧道解剖法结合神经监测技术可快速定位喉返神经,降低手术难度,提高手术安全性,利于腔镜甲状腺手术更好地在基层医院推广普及。     

Comparison of two-dimensional methods versus three-dimensional scanning systems in the assessment of total body surface area estimation in burn patients

Background

Accurate measurement of percent total body surface area (%TBSA) burn is crucial in the management of burn patients for calculating the estimated fluid resuscitation, determining the need to transfer to a specialized burn unit and probability of mortality. %TBSA can be estimated using many methods, all of which are relatively inaccurate. Three-dimensional (3D) systems have been developed to improve %TBSA calculation and consequently optimize clinical decision-making. The objective of this study was to compare the accuracy of percent total burn surface area calculation by conventional methods against novel 3D methods.

电磁导航支气管镜联合支气管内径向超声引导肺活检诊断肺外周结节

目的探讨电磁导航支气管镜联合支气管内径向超声引导肺活检对肺外周结节的诊断价值和安全性。方法回顾性分析2020年6月至2021年6月期间就诊于南京大学医学院附属鼓楼医院行电磁导航支气管镜联合支气管内径向超声引导肺活检的60例患者的76枚肺外周结节的临床影像、手术及病理资料,分析总结病理诊断率及并发症情况。其中男23例、女37例,年龄46~78(62.8±10.3)岁。肺结节按直径大小分为肺小结节组(10枚肺小结节,直径≤1 cm)和肺结节组(66枚肺结节,1 cm<直径≤3 cm),比较两组在手术及病理诊断率方面的差异。结果76枚肺结节直径为(1.8±0.6)cm,手术时间(29.8±8.6)min,导航(2.9±0.9)次,活检(9.5±1.9)块。76枚肺结节中55枚活检病理确诊,总诊断率72.4%,其中恶性病变32例、良性病变23例。76枚肺结节中59枚0级出血,17枚1级出血,无2级及以上出血;8例患者术后出现气胸,肺压缩程度均<30%,吸氧对症处理后好转。肺小结节组手术时间长于肺结节组(P<0.05),两组诊断率、并发症方面的差异无统计学意义(P>0.05)。结论电磁导航支气管镜联合支气管内径向超声引导肺活检是诊断肺外周结节的一种安全、有效的方法,且对直径≤1 cm的肺小结节也具有较高的诊断率,值得临床推广应用。     

激光三维立体扫描模型牙及其准确性验证

目的:验证三维激光外轮廓扫描对标准模型牙颈部形态扫描测量及形态重构的可靠性,为CAD/CAM研制种植体牙龈美学成型基台做准备。方法:我院修复科实验室保存的全颌国人标准模型牙,取上颌5--5共10个,通过三维激光扫描获得模型牙颈部外轮廓点云数据,利用Surfacer图形处理软件对图像旋转及基本处理后测量模型牙的颈宽、颈厚、冠宽、冠厚;精密游标卡尺手工测量各牙位相应指标,手工与计算机测量结果做统计学差异性检验(SPSS11.5)。结果:激光三维扫描模型图像清晰、完整,无盲点及缺损,图像相关部分经软件测量与手工测量相比较无统计学差异。结论:使用高精度激光扫描系统对标准模型牙进行立体扫描,方法简便易行,图形较好地复制了原物形态,与模型精度一致。激光立体扫描后所得三维图形作为牙颈部CAD/CAM的基础数据,可用于设计并制作种植体美学牙龈成型基台。     

MR血管成像在介入诊疗Budd-Chiari综合征合并肝静脉血栓中的应用

目的探讨MRA在介入诊疗Budd-Chiari综合征（BCS）合并肝静脉血栓中的应用价值。方法 20例患者经DSA证实为BCS合并肝静脉血栓并接受介入治疗,均于术前1周内接受MRA检查,对比分析MRA与DSA对显示肝静脉血栓的能力及BCS合并肝静脉血栓的影像学表现。结果 20例患者中,MRA共显示肝脏静脉51支,包括肝静脉血栓40支,副肝静脉血栓8支,肝静脉通畅3支;对其中40支肝脏静脉行DSA检查,发现肝静脉血栓33支,副肝静脉血栓4支,3支肝静脉通畅。与DSA对比,MRA诊断BCS合并肝静脉血栓的敏感度为97.22%（35/36）,特异度为75.00%（3/4）,准确率为95.00%（38/40）。两种检查方法诊断BCS合并肝静脉血栓的一致性良好（Kappa=0.722,P〈0.01）,临床检出率差异无统计学意义（χ2=0.5,P〉0.05）。结论 MRA能全面、准确诊断BCS合并肝静脉血栓,对介入治疗有重要指导作用。     

解剖钢板内固定治疗跟骨关节内骨折

目的探讨应用跟骨解剖钢板内固定治疗不同类型跟骨关节内骨折的临床疗效。方法对56例跟骨关节内骨折患者行切开复位跟骨解剖钢板内固定治疗,其中36例予以自体髂骨植骨。结果 56例均获随访,时间12~32（21.1±3.5）个月。未发现关节面塌陷、复位丢失、螺钉固定不良现象。根据Maryland足部评分系统：优25例,良22例,可7例,差2例,优良率为83.9%。结论切开复位解剖钢板内固定治疗跟骨关节内骨折,能早期功能锻炼,减少并发症,降低病残率。     

对比人工与人工智能图像后处理冠状动脉CT血管造影显示冠状动脉解剖及其病变

目的 对比人工与人工智能(AI)后处理用于冠状动脉CT血管造影(CCTA)显示冠状动脉解剖及病变的效能。方法 回顾性分析158例疑诊冠心病患者的CCTA资料,分别以人工(人工组,含1名负责图像后处理的影像科主任医师和2名负责分析图像的影像科主治医师)及深睿、数坤AI软件(记为A₁组、A₂组)行后处理,于容积再现(VR)图像中测量冠状动脉分支数目,于曲面重组(CPR)图像中测量左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)管腔拉直长度;观察LAD(近、中、远段)、LCX(近、中远段)、RCA(近、中、远段)有无管腔狭窄及其程度、有无斑块及其性质,分析3组评估结果的差异及一致性。结果 3组所示冠状动脉分支数总体差异有统计学意义(P＜0.01),A₁组、A₂组所示数目均多于人工组(P=0.04、＜0.01)。A₁组(P=0.04、0.03)、A₂组(P均＜0.01)所测LAD和RCA长度均大于人工组,其余组间LAD和RCA长度差异均无统计学意义(P均＞0.05)。3组所测LCX长度(P=0.18)及评估LAD、LCX及RCA狭窄程度及斑块性质结果差异均无统计学意义(P均＞0.05)。A₁组、A₂组评估LAD、LCX、RCA狭窄程度(Kappa=0.58、0.51、0.57),以及A₁组(Kappa=0.55、0.57、0.62)、A₂组(Kappa=0.56、0.58、0.67)与人工组评估结果的一致性均为一般。结论 CCTA图像经AI后处理后显示冠状动脉分支较人工后处理更为完整;人工与AI后处理评估冠状动脉狭窄程度及钙化结果的一致性均不高。     

64层螺旋CT血管造影及融合技术对胃周动脉的评价

目的探讨64层螺旋CT血管成像（64-MSCTA）及融合技术对胃周动脉的显示能力和临床应用价值。方法对2011年4—8月间收治的53例患者行腹部64层螺旋CT扫描．其中26例胃癌患者行手术治疗。采用容积再现（VR）技术分别重建胃周动脉和胃,并使之相融合,观察腹腔干分型和10条胃周动脉的起源和走行及其与胃的空间关系：将手术患者的术前MSCTA资料与术中所见对比,评价64-MSCTA的准确性、敏感性和特异性。结果53例MSCTA均清晰显示腹腔干,其中MichelsI型（肝脾胃干型）46例（86．8％）。通过融合技术可任意角度清晰显示胃周动脉和胃的空间解剖关系,胃左动脉和胃网膜右动脉显示率均为100％（53／53）,胃网膜左动脉94_3％（50／53）．胃右动脉83．0％（44／53）,胃短动脉58．5％（31／53）,胃后动脉49．1％（26／53）,替代肝左动脉15．1％（8／53）。副肝左动脉、副胃左动脉及替代肝右动脉显示率均为7．5％（4／53）。CTA术前预测各动脉的准确性为84．6％。100％．敏感性为82．6％～100％．特异性均为100％。结论64．MSCTA可清晰显示胃周动脉．采用融合技术使胃周动脉和胃相融合．可真实显示活体胃及胃周血管解剖,指导手术安全进行。     

右美托咪定用于1岁以内先天性心脏病患儿放射学检查补救镇静的疗效分析

目的 与传统镇静药物比较,评估1岁以内(1个月～1岁)先天性心脏病(congenital heart disease,CHD)患儿放射学检查时,右美托咪定(dexmedetomidine,Dex)作为首剂口服水合氯醛镇静失败后补救用药的疗效及安全性. 方法 根据意向性治疗原则,前瞻性、随机、单盲临床随机对照试验分析2016年3月29日～6月2日于我院行心血管放射学检查且需镇静的患儿225例,采用随机均衡分组法分为3组(每组75例):A组(5 mg/kg苯巴比妥肌内注射)、B组(25 mg/kg水合氯醛口服)、C组(1 μg/kg Dex滴鼻).比较首剂口服水合氯醛失败后3组补救镇静的成功率及副作用发生情况,同时分析家属满意度,比较起效时间、苏醒时间及总镇静时间,评估给药前(T0)、给药后5 min(T1)、给药后10 min(T2)、给药后20 min(T3)、起效时(T4)、检查结束时(T5)、苏醒时(T6)患儿SpO2及HR的变化. 结果 A组、B组及C组放射学检查补救镇痛成功率分别为75.8％、83.3％、90.7％,C组与A组成功率比较,差异有统计学意义(P＜0.05).分层研究后发现,C组右向左分流型CHD患儿放射学检查成功率较A组高(P＜0.05).C组起效时间与B组比较,差异有统计学意义(P＜0.05).C组苏醒时间及总镇静时间与A组及B组比较,差异有统计学意义(P＜0.05).A组、B组及C组副作用发生率分别为3.2％、7.6％、4.0％,差异无统计学意义(P＞0.05).3组HR及SpO2变化差异无统计学意义(P＞0.05). 结论 1μg/kg Dex滴鼻可以有效用于CHD患儿放射学检查补救镇静,具有起效快,效果持久的特点,其对右向左分流的紫绀型CHD患儿镇静效果较苯巴比妥更好,且不增加CHD患儿副作用的发生率.     

“呼吸针控”在CT引导下经皮肺穿刺近膈小病灶中的应用

目的探讨"呼吸针控"在CT引导下经皮肺穿刺近膈小病灶中的应用价值。方法对53例肺部疾病患者[肺内近膈小病灶共53个(直径3cm)]进行CT引导下经皮肺穿刺活检(n=34)或微波消融术(n=19),穿刺时全部采用"呼吸针控"法,术后及时行CT复查,随访1~5天。结果 53个病灶一次穿刺成功率为100%(53/53)。3例(3/53,5.66%)术后CT复查发现少量气胸,未予特殊处理自行吸收;未发现大量气胸等严重并发症,无穿刺相关死亡病例。术后随访未出现迟发型气胸。结论 "呼吸针控"法用于CT引导下经皮肺穿刺近膈小病灶安全可行,值得推广。