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1.
PURPOSE: To define regional function impairment in airway obstruction (AO) and pulmonary embolic (PE) dogs with a combination study of noncontrast electrocardiogram (ECG)-gated perfusion and gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) aerosol magnetic resonance (MR) images. METHODS: After acquisition of multiphase fast-spin-echo (FSE) MR images during cardiac cycles in 14 AO dogs and 19 PE dogs, ECG-gated perfusion-weighted (PW) images were obtained by subtraction between two-phase images of the minimum lung signal intensity (SI) during systole and maximum SI during diastole. Each dog subsequently inhaled Gd-DTPA aerosol for 20 minutes, and subtracted Gd-DTPA aerosol images were obtained from precontrast and maximally enhanced images. ECG-gated PW images were compared with intravenous Gd-DTPA-enhanced pulmonary arterial perfusion phase (PAPP) images. RESULTS: ECG-gated PW images were consistent with Gd-DTPA-enhanced PAPP images in all dogs, with significant correlations in the affected-to-unaffected lung perfusion ratios (P < 0.005). Gd-DTPA aerosol images showed sufficient and uniform enhancement in the unaffected lungs. In all the AO areas, these combined images showed the matched perfusion and aerosol deposition defects. These images showed perfusion defects without aerosol deposition defects in the relatively small embolized areas, but showed the matched defects in the widely embolized areas probably due to hypoxic bronchial constriction. CONCLUSION: The combination MR studies may be acceptable for noninvasively defining regionally impaired lung function in AO and PE.  相似文献   

2.
Pulmonary ventilation-perfusion MR imaging in clinical patients   总被引:2,自引:0,他引:2  
The purpose of this study was to evaluate the feasibility of comprehensive magnetic resonance (MR) assessment of pulmonary perfusion and ventilation in patients. Both oxygen-enhanced ventilation MR images and first-pass contrast-enhanced perfusion MR images were obtained in 16 patients with lung diseases, including pulmonary embolism, lung malignancy, and bulla. Inversion recovery single-shot fast spin-echo images were acquired before and after inhalation of 100% oxygen. The overall success rate of perfusion MR imaging and oxygen-enhanced MR imaging was 94% and 80%, respectively. All patients with pulmonary embolism showed regional perfusion deficits without ventilation abnormality on ventilation-perfusion MR imaging. The results of the current study indicate that ventilation-perfusion MR imaging using oxygen inhalation and bolus injection of MR contrast medium is feasible for comprehensive assessment of pulmonary ventilation-perfusion abnormalities in patients with lung diseases.  相似文献   

3.
RATIONALE AND OBJECTIVE: To assess the feasibility of combining magnetic resonance (MR) perfusion, angiography, and 3He ventilation imaging for the evaluation of lung function in a porcine model. MATERIALS AND METHODS: Fourteen consecutive porcine models with externally delivered pulmonary emboli and/or airway occlusions were examined with MR perfusion, angiography, and 3He ventilation imaging. Ultrafast gradient-echo sequences were used for 3D perfusion and angiographic imaging, in conjunction with the use of contrast-agent injections. 2D multiple-section 3He imaging was performed subsequently via the inhalation of hyperpolarized 3He gas. The diagnostic accuracy of MR angiography for detecting pulmonary emboli was determined by two reviewers. The diagnostic confidence for different combinations of MR techniques was rated on the basis of a 5-point grading scale (5 = definite). RESULTS: The sensitivity, specificity, and accuracy of MR angiography for detecting pulmonary emboli were approximately 85.7%, 90.5%, and 88.1%, respectively. The interobserver agreement was very strong (k = 0.82). There was a clear tendency for confidence to increase when first perfusion and then ventilation imaging were added to the angiographic image (Wilcoxon signed ranks test, P = 0.03). CONCLUSION: The combination of the three methods of MR perfusion, angiography, and 3H ventilation imaging may provide complementary information on abnormal lung anatomy and function.  相似文献   

4.
OBJECTIVES: To clarify cerebral perfusion distribution and cognitive functions in patients with chronic obstructive pulmonary disease (COPD) according to the hypoxia levels and to assess if there is a relationship between cognitive impairment and cerebral perfusion index. Patients and METHODS: Eight patients with stable hypoxemic COPD (HC), 10 patients with stable nonhypoxemic COPD (NHC), and 10 age-matched healthy volunteers participated in the study. All subjects underwent a complete neuropsychological assessment with the mental deterioration battery (MDB), Wechsler memory scale-revised (WMS-R), color trail test (CCT), and grooved pegboard test (GPT). SPECT examination with Tc-99m HMPAO was performed in all patients and controls. Quantitative analysis was performed by a region of interest (ROI)-based method. RESULTS: The scores of verbal memory, delayed recall and attention were significantly lower in COPD patients (p < 0.01). The scores of other subtests were similar in patients and controls. Comparing NHC patients to HC groups showed that verbal memory was impaired in both groups, but delayed recall and attention scores were significantly worse in HC patients than NHC patients. Perfusion indexes on frontal ROIs in NHC patients and frontal and parietal ROIs in HC patients showed significant decreases. Our scintigraphic findings were correlated with the results of neuropsychological tests. CONCLUSIONS: Our results demonstrate that cerebral perfusion is significantly altered in COPD patients. Hypoxemic patients showed more deterioration in cerebral perfusion and cognitive performance than nonhypoxemic patients. The relationship between decreased perfusion and cognitive impairment and the clinical significance of these results require further studies in larger populations.  相似文献   

5.
PURPOSE: To evaluate the effect of ventilatory impairment on MR signal intensity of the lung parenchyma. MATERIALS AND METHODS: Subjects were five normal volunteers (age = 30 +/- 7.9 years, mean +/- SD) and 19 male patients with chronic obstructive lung disease (COPD) (mean age = 70.4 +/- 6.5 years). Coronal MR images were obtained over entire lung fields at full inspiration and full expiration with cardiac triggering on a 1.5T system. Changes in the mean lung intensity between the two respiratory states were normalized by each intercept of the linear regression lines of the signal changes, and the slope of the relationship was calculated. Computed tomography (CT) images were also obtained in COPD patients at full inspiration using a multidetector row CT scanner. Attenuation values less than -950 Hounsfield units (HU) (RA-950) represented the percentage of relative lung area on the CT. RESULTS: The mean slope of COPD patients (0.365 +/- 0.074) was less steep than that of the normal subjects (0.570 +/- 0.124, P < 0.001). In COPD patients, the slope correlated significantly with forced expiratory volume in one second (FEV1, r = 0.508, P = 0.026), but not with RA-950. CONCLUSION: In COPD patients, lung signal change measured by MRI correlates with airflow obstruction, but not with volume of the emphysema measured by lung CT.  相似文献   

6.
RATIONALE AND OBJECTIVES: The purpose of this study was to implement ultrafast, multiphase three-dimensional (3D) magnetic resonance (MR) angiography and perfusion imaging after bolus injection of contrast medium to generate preliminary validation of parameters in a pig model and to illustrate potential applications in patients with lung abnormalities. MATERIALS AND METHODS: Five healthy volunteers, five patients, and three pigs underwent rapid, time-resolved pulmonary MR angiography and perfusion imaging on a 1.5-T MR imager. All patients had undergone correlative computed tomographic or conventional angiography. The pulse sequence was a 3D spin-warp, gradient-echo acquisition with a repetition time of 1.6 msec and an echo time of 0.6 msec. Each 3D acquisition lasted 2-3 seconds, and 8-16 sequential measurements were made in each study. Artificial pulmonary emboli were generated in pigs with gelatin sponge. All patients had diseases of the pulmonary circulation (as confirmed with other studies). RESULTS: Multiphasic, time-resolved pulmonary parenchymal enhancement was demonstrated in all healthy subjects and animals. All segmental (n = 100) and subsegmental (n = 200) branches were identified in the healthy subjects. Perfusion deficits were clearly demonstrated in all pigs after gelatin embolization. Perfusion defects were identified in two patients with lung disease. Abnormalities of the pulmonary vasculature were clearly identified in the patient group. CONCLUSION: Dynamic time-resolved 3D pulmonary MR angiography and perfusion imaging is feasible in humans as well as in animals. Induced perfusion deficits are identifiable after artificial embolization in pigs. Combined pulmonary MR angiography and parenchymal (perfusion) imaging may improve evaluation of the pulmonary circulation in a variety of conditions.  相似文献   

7.
PURPOSE: To investigate three different contrast agents at different injection volumes for repetitive quantitative multislice myocardial perfusion imaging using the prebolus technique. MATERIALS AND METHODS: Two consecutive prebolus perfusion measurements were performed on a 1.5 T scanner using identical injection volumes for the first and second examination to test the reproducibility for possible rest and stress examination in normal volunteers. Either 1-8 mL, 1-12 mL Gd-DTPA, 1-4 mL, 1-6 mL, 1-9 mL Gd-BOPTA, or 1-4 mL, 1-6 mL gadobutrol were applied. RESULTS: In cases where injection volumes were sufficiently small, there was no indication of significant differences in quantitative perfusion values with respect to the different contrast agents. Increasing the bolus volume improved the contrast-to-noise ratio (CNR) but led to saturation effects and underestimation of the true perfusion. The highest CNR was measured for gadobutrol (6 mL, p < 0.0005 compared to 8 mL Gd-DTPA). The smallest difference of perfusion values between the first and the second prebolus examination was found for Gd-BOPTA (p < or = 0.006 compared Gd-DTPA). CONCLUSION: Prebolus examinations for quantitative myocardial perfusion imaging are possible with all three contrast agents for sufficient small injection volumes. Gd-BOPTA was found to be advantageous for a combined quantitative rest and stress examination.  相似文献   

8.
PURPOSE: To determine whether the injection rate of contrast agent affects the dynamics of enhancement of the pulmonary parenchyma on magnetic resonance (MR) pulmonary perfusion imaging. MATERIALS AND METHODS: Fifteen healthy volunteers underwent enhanced MR pulmonary perfusion imaging to evaluate the effects of different injection rates. Injection rates were 1, 3, or 5 mL/second. Regions of interest (ROIs) were chosen in the lung and aorta to analyze the change in signal intensity over time. RESULTS: As the injection rate increased, the peak enhancement occurred significantly earlier (P = 0.0012), but the peak enhancement signal-to-noise ratio (SNR) value was not affected (P = 0.25). With the 3- and 5-mL/second injection rates, images of both the pulmonary circulation and systemic circulation were obtained separately. However, with 1 mL/second, higher enhancement of the aorta was overlapped with peak enhancement of the lung tissue. CONCLUSION: The injection rate affects the enhancement profiles of the pulmonary parenchyma.  相似文献   

9.
The purposes of this work were to estimate regional and global pulmonary perfusion and display pulmonary vasculature in 10 postoperative lung transplant patients using breath‐hold, contrast‐enhanced (0.2 mmol/kg, Gd DTPA‐BMA, Omniscan, Nycomed, Inc., Princeton, NJ), three‐dimensional (3D) magnetic resonance angiography (MRA) with specially designed double‐variable‐angle uniform signal excitation (VUSE) radio frequency (RF) pulses. Double‐VUSE scans imaged both lungs simultaneously during contrast agent injection and provided both qualitative and quantitative information about pulmonary perfusion. Double‐VUSE pulses clearly displayed healthy and diseased vessels. There was a strong correlation between contrast‐enhanced double‐VUSE MRA flow estimates and those measured from nuclear scans for global or whole lung (R2 = 0.95; P = 0.000002) and upper, central, and lower thirds of the lung (R2 = 0.89, 0.92, and 0.86, respectively; P < 0.001 for each region). In conclusion, 3D MRA using VUSE pulses in combination with a contrast agent is a valuable tool for the assessment of pulmonary perfusion that simultaneously acquires data for both the qualitative display of pulmonary vessels and the quantification of regional and global differential pulmonary blood flow. J. Magn. Reson. Imaging 2001;14:734–740. © 2001 Wiley‐Liss, Inc.  相似文献   

10.
慢性阻塞性肺疾病(COPD)是临床常见的慢性呼吸系统疾病,常继发右心功能不全,增加病人死亡风险。COPD病人右心室功能改变的精准及多方式影像评价已成为研究的热点。超声心动图、CT、心脏MR成像、放射性核素等成像技术是目前无创性评价COPD右心室功能改变的主要方法。就COPD导致右心室功能改变的机制以及各种影像技术的应用进展及其优劣予以综述。  相似文献   

11.

Purpose:

To investigate the correlation between the metabolite ratios obtained from proton magnetic resonance (MR) spectroscopy and those obtained from MR perfusion parameters (relative cerebral blood volume [rCBV]) in a cohort of low‐grade glioma (LGG).

Materials and Methods:

Patients underwent prospectively conventional MR, proton magnetic resonance spectroscopy (1HMRS), and perfusion‐weighted images (PWI). Statistical analyses were performed to determine the correlative and independent predictive factors of rCBVmax and the metabolite ratio thresholds with optimum sensitivity and specificity.

Results:

Thirty‐one patients were included in this study. Linear correlations were observed between the metabolic ratios (lactate [Lac]/creatine [Cr], choline [Cho]/N‐acetyl‐aspartate [NAA], free‐lipids/Cr) and rCBVmax (P < 0.05). These metabolic ratios were determined to be independent predictive factors of rCBVmax (P = 0.027, 0.011 and 0.032, respectively). According to the receiver operating characteristic curves, the cutoff values of the metabolic ratios to discriminate between the two populations of rCBVmax (<1.7 versus = 1.7) were 1.72, 1.54, and 1.40, respectively, with a sensitivity = 75% and a specificity >95% for Lac/Cr.

Conclusion:

This study demonstrated consistent correlations between the data from 1HMRS and PWI. The Lac/Cr ratio predicts regional hemodynamic changes, which are themselves a useful biomarker of clinical prognosis in patients with LGG. As such, this ratio may provide a new parameter for making improved clinical decisions. J. Magn. Reson. Imaging 2012;35:543‐550. © 2011 Wiley Periodicals, Inc.  相似文献   

12.
高可飞  许洪磊  张永 《武警医学》2021,32(10):847-851
 目的 探讨慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者肺功能对单孔胸腔镜肺部手术相关指标的影响,并评估中重度COPD应用单孔胸腔镜进行肺手术的安全性。方法 回顾性分析上海市肺科医院胸外科2020年1-9月1030例COPD患者行单孔胸腔镜的临床资料。根据慢性阻塞性肺疾病全球倡议解读(GOLD)分级标准将肺功能分为轻度、中重度两组,比较不同程度下患者术中失血量(intraoperative blood loss,IBL)、麻醉时间(anesthesia time,AT)、手术时间(operation time,OT)及术后并发症(postoperative complications,PC)、术后住院天数(postoperative hospital stay days,POD)。结果 所有患者均成功完成手术,安全出院。轻度组与中重度组在术中IBL、AT、OT、POD、PC等指标上差异无统计学意义(P>0.05)。轻度组与中重度组患者术后并发症的差异无统计学意义。结论 中重度COPD患者较轻度COPD患者术中、术后相关指标改变不明显,应用单孔胸腔镜行肺部手术是安全、可行的。  相似文献   

13.
肺栓塞MR增强肺灌注成像与核素肺灌注显像对比实验研究   总被引:1,自引:0,他引:1  
目的:比较MR及SPECT核素肺灌注显像诊断肺栓塞的价值。方法:24只大白兔建立肺栓塞模型,栓塞后6h采用3D-FLASH序列,从耳缘静脉注入Gd-DTPA行肺灌注扫描,应用Evaluation自动生成肺灌注曲线,在冠状位原始图像上两侧对称性选取正常与病变区肺实质的ROI测量时间-信号强度曲线。从耳缘静脉注入99Tcm-MAA111-148MBq0·3ml8体位显像。病理学检查:分别于栓塞后分批处死实验动物,光学显微镜下观察栓塞肺组织及正常肺组织的表现。统计学采用t检验和χ2检验。结果:成功建立20只兔肺栓塞模型,栓塞后6hMR增强肺灌注成像正常和栓塞区肺实质增强率分别为317·5%和45·1%;正常肺组织灌注曲线峰值明显,栓塞区灌注曲线低平或峰值延迟(t=11·52,P<0·01)。MR增强肺灌注成像对肺栓塞模型检测的敏感性为95%,特异性为85%;SPECT肺灌注显像敏感性100%,特异性65%,统计学分析二者检查结果差异不具有统计学意义(χ2=2·06,P>0·05)。病理显示:梗死区可见大量的纤维素渗出,肺间质增厚,动脉腔内可见红细胞和血栓形成,其周围白细胞浸润伴肺淤血,部分可见点状出血及肺淤血。结论:Gd-DTPAMR增强肺灌注成像诊断肺栓塞是可行的;MR诊断肺栓塞与SPECT具有较好的一致性。  相似文献   

14.
PURPOSE: To determine the appropriate concentration for quantitative assessment of dynamic contrast-enhanced pulmonary MR imaging. MATERIALS AND METHODS: A total of 40 consecutive patients with small bronchioalveolar carcinoma underwent perfusion single-photon emission tomography (SPECT) and three-dimensional (3D) dynamic MR imaging with a 3D radiofrequency spoiled gradient-echo sequence. In each patient, 5 mL of contrast media with 0.1, 0.3, and 0.5 mmol/mL were administered at a rate of 5 mL/second. All patients were divided into two groups (<70 kg and > or =70 kg) for assessment of appropriate concentration to quantitatively assess regional perfusion parameter in routine clinical practice. Pulmonary blood flow (PBF) in each protocol was calculated from a signal intensity (SI)-time course curve. Differences and limits of agreement of PBF between dynamic MR imaging (PBF(MR)) using three different concentrations and perfusion SPECT (PBF(SPECT)) were statistically compared in both patient groups. RESULTS: PBF(MR) using 0.3 mmol/mL in the <70-kg group and 0.5 mmol/mL in the > or =70-kg group showed no significant difference compared with PBF(SPECT) (P > 0.05). Limits of agreements in 0.3 mmol/mL in the <70-kg group and 0.5 mmol/mL in the > or =70-kg group were smaller than those of the other concentrations and small enough for clinical purposes. CONCLUSION: Appropriate concentrations provide accurate and reproducible assessments of regional pulmonary perfusion parameters on 3D dynamic MR perfusion imaging. We suggest using 5 mL of contrast media with 0.3 mmol/mL for patients weighing less than 70 kg and 0.5 mmol/mL for patients weighing 70 kg or more.  相似文献   

15.
RATIONALE AND OBJECTIVES: Because the nature and time course of changes in early, nontraumatic osteonecrosis at perfusion and magnetic resonance (MR) imaging are unknown, the authors evaluated this technique in the assessment of early osteonecrosis with a nontraumatic model. MATERIALS AND METHODS: Five rabbits underwent intravenous injection of lipopolysaccharide endotoxin followed by intramuscular injection of methylprednisolone. MR imaging of the femora was performed before and at weekly intervals after endotoxin injection. Histologic findings from the areas of osteonecrosis were correlated with the findings of MR imaging and MR perfusion studies. RESULTS: Histologic evaluation showed osteonecrosis in six femora of four animals 2-4 weeks after endotoxin injection. Findings on T1-weighted images of the femur were normal in all animals; T2-weighted images of one femur showed equivocal changes. On MR perfusion images, the baseline mean peak percentage of enhancement was 52.7% +/- 12.6. In the six areas without osteonecrosis, the mean percentage of enhancement was similar to the baseline percentage of enhancement at 1 week (62.2% +/- 31.2). In the four areas with diffuse osteonecrosis, there was essentially no contrast enhancement 1-4 weeks after endotoxin injection. CONCLUSION: T1- and T2-weighted MR imaging is insensitive to the presence of early nontraumatic osteonecrosis. MR perfusion imaging might be useful to detect early nontraumatic osteonecrosis.  相似文献   

16.
Purpose: To assess the value of the combined use of dynamic susceptibility contrast-enhanced perfusion magnetic resonance imaging (MRI) and conventional contrast-enhanced MRI for the follow-up of treatment of glioblastoma multiforme (GBM).

Material and Methods: 79 examinations were performed in six surgically and immunogene-treated patients and two surgically treated patients. Ratios of the relative cerebral blood volume (rCBV) in lesions and in the contralateral normal-appearing white matter were calculated. The regions with elevated rCBV were compared with those with contrast enhancement. Tissue specimens from surgical biopsies and autopsies were studied histopathologically.

Results: The lesion-to-normal rCBV ratios were high in the tumors prior to operation (7.3 to 18.2) as well as in the recurrent tumors (1.6 to 13.2). The volumes of the regions with elevated rCBV were similar to those with contrast enhancement in 63 of the 79 examinations. However, in 11 of 79 examinations, the regions with high rCBV were smaller than the regions with contrast enhancement (“mismatch”). In two samples from the immunogene-treated patients this was correlated with the histopathological finding of malignant tumor with numerous proliferating GBM vessels with multiple minimal lumina, sometimes thrombotized or ruptured. These vessels may have increased permeability with contrast enhancement not accompanied by increased microvascular volume.

Conclusion: 1) Elevated rCBV on perfusion MRI corresponding to the contrast-enhancing lesion supports the diagnosis of recurrent malignant tumor. 2) A mismatch showing a volume of rCBV elevation smaller than that of contrast enhancement can be seen in particularly aggressive tumor growth and is thus not always a sign of reactive non-tumor changes. 3) The combination of perfusion MRI and conventional contrast MRI provides useful information in the follow-up of glioblastoma multiforme treatment.  相似文献   

17.
PURPOSE: To compare the sensitivity of contrast-enhanced magnetic resonance imaging (MRI) and arterial spin labeling to perfusion deficits in the lung. MATERIALS AND METHODS: A rabbit model of pulmonary embolism was imaged with both flow-sensitive alternating inversion recovery with an extra radiofrequency pulse (FAIRER) arterial spin labeling and Gd-DOTA enhanced MRI. The signal-to-noise ratio (SNR) was measured in the area of the perfusion deficit and the normal lung for both techniques. RESULTS: The defect was readily visible in all images. The normal lung had an average of 3.8 +/- 1.2 times the SNR of the unperfused lung with the arterial spin labeling technique, and approximately 13.7 +/- 3.3 times the SNR with the contrast-enhanced technique. CONCLUSION: Gd-DOTA enhanced MRI provides higher SNR in pulmonary perfusion imaging; however, arterial spin labeling is also adequate and may be used when repeated studies are indicated.  相似文献   

18.
 目的 用沙美特罗/丙酸氟替卡松(商品名:舒利迭)联合噻托溴铵(商品名:思力华)治疗分析慢性阻塞性肺疾病(chronic obstructive pulmoriary disease, COPD)的效果。方法 选择2013-2015年确诊为COPD且接受诊治的患者60例,其中接受常规COPD对症治疗方案的患者30例为对照组,另采取沙美特罗/丙酸氟替卡松联合噻托溴铵治疗的30例为观察组。对比两组疗效。结果 对照组总有效率83.3%,观察组总有效率96.7%;观察组高于对照组,差异有统计学意义(P<0.05);观察组FEV1和FEV1/FVC均大于对照组,差异有统计学意义(P<0.05);治疗后5个月检测6 min步行距离和生活质量情况,观察组均优于对照组,差异有统计学意义(P<0.05)。结论 用沙美特罗/丙酸氟替卡松联合噻托溴铵方案治疗COPD能提高临床疗效和促进身体功能恢复。  相似文献   

19.
目的 研究慢性阻塞性肺疾病(COPD)患者海马氢质子磁共振波谱(1H-MRS)的特点.方法 随机选取32例COPD患者和30例健康志愿者分别纳入研究组和对照组.采用1H-MRS检测双侧海马的N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)和肌酸复合物(Cr).结果 研究组左右侧海马NAA/Cr值均显著低于对照组,差异有统计学意义(t=4.963,P=0.007和t=4.856,P=0.023);研究组左右侧海马Cho/Cr值均显著高于对照组,差异有统计学意义(t=3.469,P=0.013和t=3.019,P=0.047).结论 COPD患者存在海马神经元的代谢异常.  相似文献   

20.
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