210例脑血管疾病患者的康复治疗分析

目的降低脑血管疾病的致残程度,提高患者的生活质量。方法对210例脑血管病患者早期及时干预及康复锻炼。结果所有患者的各项功能均有所好转。结论对脑血管疾病患者康复治疗可提高患者生活质量。     

多层螺旋CT血管成像在烟雾病诊断中的应用

目的探讨多层螺旋CT血管成像（MSCTA）在烟雾病诊断中的价值以及应用前景。方法回顾性分析10例烟雾病患者的MSCTA及数字减影血管造影（DSA）的影像学资料。结果MSCTA可清晰显示狭窄、闭塞以及异常增多的脑血管。容积重建有利于显示病变血管与周围结构的空间关系,综合最大密度投影法重建和多曲面重建图像分析可清晰显示异常增多的脑血管,即烟雾状血管。MSCTA对狭窄及闭塞血管的检出率为66．2％（53/80）;DSA对狭窄及闭塞血管的检出率为67．5％（54／80）,两者比较差异无统计学意义（P〉0．05）。MSCTA对颅底异常血管网的显示及分布情况与DSA大致相似。结论MSCTA诊断烟雾病的灵敏度高,是早期诊断烟雾病的重要依据,早期诊断、及时治疗是改善烟雾病患者预后的有效方法。     

Use of multidetector computed tomography for evaluating coronary artery disease in patients undergoing dialysis

Aim: Cardiovascular disease is the most common cause of death in patients undergoing dialysis. The accuracy of multidetector computed tomography (MDCT) for detecting coronary disease has not been determined, and little information is available regarding the performance of MDCT in patients undergoing dialysis. Methods: Twenty‐nine patients undergoing dialysis were analyzed and MDCT and coronary angiography (CAng) were performed consecutively. The coronary arteries were divided into four segments for analysis. We compared the significant stenosis lesions (≥50% luminal narrowing) identified by MDCT with those found by CAng. The total coronary artery calcium (CAC) score was determined by summing the individual lesion scores from each of the coronary branches. Results: One hundred and sixteen coronary artery branches in 29 patients were analyzed. The sensitivity, specificity, and positive and negative predictive values of MDCT for detecting significant coronary artery stenosis (≥50% stenosis) were 68%, 94%, 71% and 93%, respectively. The CAC scores were significantly higher in subjects with coronary artery disease (CAD) (514.0 ± 493.6 vs 254.3 ± 375.3, P = 0.05). The severe CAC score (>500) was related to the presence of significant CAD (P = 0.05) and the sensitivity and specificity for detecting significant CAD were 50% and 80%, respectively. Conclusion: MDCT is a useful and non‐invasive approach for detecting or excluding CAD in patients undergoing dialysis.     

腹部手术对老年心脑血管病患者的影响

目的探讨老年患者腹部手术后心脑血管意外的发病特点及防治体会。 方法回顾性分析2011年1月至2013年12月本科室诊治的64例腹腔手术后发生心脑血管意外的老年患者临床资料,其中32例伴有心脑血管疾病为A组,同期无心脑血管疾病的32例行腹腔手术的患者为B组,探讨其发病的原因及防治方法。 结果A组术后11例发生了脑梗死,其中6例为脑栓塞,4例发生脑出血,心肌梗死6例,心电图有心肌缺血5例,ST段改变9例,急性心力衰竭2例,心律失常5例; B组术后3例发生了脑梗死,其中1例为脑栓塞,1例发生脑出血,心肌梗死1例,心电图有心肌缺血2例,ST段改变2例,心律失常1例。A组术后心脑血管疾病的发生率明显高于B组,组间差异有统计学意义(P < 0.05)。 结论患有腔隙性脑梗死、陈旧性脑梗死、心肌梗死、心肌缺血、ST段改变等心脑血管疾病的患者手术风险高,易出现猝死及心脑血管意外,必须引起临床医师的注意和重视。     

神经外科学生脑血管病临床见习课的教学方法探讨及效果评价

目的：探讨神经外科学生脑血管病临床见习课的教学方法及应用效果。方法回顾性总结在我院进行脑血管病课程见习的神经外科学生共计90例资料,分别在不同教学方法教学后统计教学满意度调查问卷和考核结果,最后通过统计学方法比较组间差异性。结果出科考试结果方面：观察组学生脑动脉瘤课程的理论成绩均值为（88.2±6.8）分,实践成绩均值为（94.7±5.1）分,明显高于对照组学生考核成绩,脑动脉畸形内容的考核成绩也具有类似规律;在教学满意度方面：观察组学生学习后对教学方法感到非常满意者20例（44.4%）,不满意者只有1例（2.2%）,明显优于对照组满意度结果（P＜0.05）。结论传统教学基础上结合问题教学法进行教学有利于提高学习效果。     

Evaluation of extracranial-to-intracranial bypass surgery using iodine 123 iodoamphetamine single-photon emission computed tomography

Eleven patients with occlusive cerebrovascular diseases were imaged with N-isopropyl-p-I-123 iodoamphetamine. Preoperative and postoperative single-photon emission computed tomography was performed in 10 patients undergoing extracranial-to-intracranial bypass procedures. New images were reconstructed from the two images obtained on the different days by superimposition and division in each pixel to get the ratio of cerebral perfusion change. All patients with bypass procedures had an increase in cerebral blood flow in the affected areas, and nine of 10 had an increase in cerebral blood flow in the contralateral cortex. There was no increase in cerebral blood flow in one case with no operation. Neither our procedure nor the results in this small series prove that recovery of function is due to an increase in blood flow, but we believe this is the case.     

Computed tomography findings and early cognitive outcome after traumatic brain injury

Primary objective: To examine the relationship between CT abnormalities and early neuropsychological outcome following traumatic brain injury (TBI) using quantitative CT analyses, data reduction methods for neuropsychological results and specific hypotheses based on literature review.

Research design: Observational, prospective cohort study using acute (emergency) CT data and neuropsychological test data from 89 participants with TBI who were hospitalized for rehabilitation.

Methods and procedures: Principal components analysis with varimax rotation was used to reduce data from a standard battery of eight neuropsychological tests administered after clearance of post-traumatic amnesia (1 month post-TBI on average). Bivariate correlations were used to examine relationships of three factors (verbal memory, cognitive processing speed and verbal working memory) to quantitative volumetric analysis of CT scan abnormalities (size, number and location). Specific hypotheses as to CT predictors of poor performance on each factor were tested using multivariable linear regression that included injury severity and demographic variables.

Main results: Eighty-nine per cent of participants had some pathology on initial CT. Age, education and time to follow commands (TFC), an index of overall injury severity, were significantly associated with the neuropsychological factors. However, none of the specific hypotheses about CT scan variables and cognitive outcome were strongly supported by the data. There was a trend for any CT abnormality to predict slower speed of processing and for higher number of brain lesions to predict worse memory performance.

Conclusions: Despite the precision added by quantitative CT analysis, CT findings did not improve on demographic factors and TFC in predicting early cognitive outcome of TBI. Imaging methods that are more sensitive to white matter integrity may be needed to develop pathophysiologic predictors of TBI outcome.     

Detection of experimental brain tumor in rat by computed tomography

The feasibility of the use of computerized tomographic (CT) scanning for detecting an experimental brain tumor in rats was evaluated. Tumors were induced in newborn rats by intracerebral inoculation of Rous sarcoma virus. At varying times contrast-enhanced scans were obtained on an Ohio Nuclear 2010 scanner, the brains examined, and the findings at autopsy correlated with the CT findings. Five tumors were demonstrated by CT scans and their presence confirmed at autopsy. Four small tumors were not detected by CT scans. In 1 animal, multiple tumors were demonstrated by a CT scan, and in another a large cyst was correctly diagnosed. It is concluded that the technology currently available can be used to identify some tumor-bearing animals and should be useful for following the change in size of tumors in response to therapy. Further improvements in scanner resolution should make this technique more useful for animal research.     

Pancreatic tumors: role of imaging in the diagnosis, staging, and treatment

Because most patients with pancreatic cancer present with biliary obstruction, percutaneous transhepatic cholangiopancreatography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) is often performed first to relieve obstruction. Fine needle biopsy (FNA) provides a tissue diagnosis, but is often nondiagnostic due to sampling error. Computed tomography (CT) is the workhorse of oncology, but is poor at defining the nature of pancreatic lesions. Small primary tumors are often not visualized. Fast magnetic resonance imaging (MRI) techniques allowing dynamic imaging after IV gadolinium and new contrast agents allow better characterization of the lesions for patients having contraindications for IV CT contrast agents. Magnetic resonance cholangiopancreatography (MRCP) allows noninvasive visualization of the biliary tree. Endoscopic ultrasonography (EUS) allows evaluation of the detailed regional anatomy with the possibility of FNA. ¹⁸F-Fluorodexoglucose (FDG) is the most common tracer used in positron emission tomography (PET), and most malignant tumors, including pancreatic carcinoma, have increased FDG uptake compared with normal cells. This functional imaging does not replace but is complementary to morphological imaging. FDG PET is particularly helpful: (1) for the diagnosis in patients with suspected pancreatic cancer in whom CT fails to identify a mass, or those in whom FNAs are nondiagnostic; (2) for staging by detecting CT-occult metastases; (3) for detecting recurrence; and (4) for monitoring therapy. Limitations include false-positive inflammatory processes and false-negative carcinoma in patients with diabetes and hyperglycemia, and islet cell tumors.     

Systematic review & meta-analysis of positron emission tomography/computed tomography and bone scan in the diagnosis of prostate lesions

BackgroundTo date, the results of studies into the effectiveness of positron emission tomography (PET) combined with computed tomography (CT) and bone scan (BS) in the diagnosis of malignant prostate lesions have been inconsistent, and the advantages and disadvantages of the two methods cannot be accurately judged.MethodsArticles were retrieved from the China National Knowledge Infrastructure (CNKI) database, Wan Fang Medical Network, PubMed, Excerpta Medica data BASE (EMBASE), Medline, and Cochrane database. The keywords used in the search were: ⁶⁸Ga-prostate specific membrane antibody (⁶⁸Ga-PSMA), PET/CT, prostate lesions, prostate adenocarcinoma, bone metastasis, and BS.ResultsUltimately, 3 publications were selected for inclusion in the meta-analysis. A total of 215 patients were considered in the 3 articles that met the inclusion criteria. All of the included articles were small sample studies, with sample sizes ranging from 28 to 113 cases. In this study, from the 3 randomized controlled trials, only 2 (66.67%) randomized controls described the correct randomized allocation method, and only 1 (33.33%) described the hidden allocation scheme in detail. The highest sensitivity for ⁶⁸Ga-PSMA PET/CT was 0.96, with 95% CI: 0.87, 1.00, and the highest specificity was 1.00, with 95% CI: 0.96, 1.00. The highest sensitivity and specificity of BS were 0.92 with 95% CI: 0.81, 0.98 and 0.96 with 95% CI: 0.78, 1.00, respectively. The results of meta-analysis of ⁶⁸Ga-PSMA PET/CT diagnosis with confirmation by surgical and histopathological examination showed that the area under the summary receiver operating characteristics (SROC) curve (AUC) =0.826 and standard error (SE) (AUC) =0.0425. The results of meta-analysis of BS diagnosis with confirmation by surgical and histopathological examination showed that the area under the SROC curve (AUC) =0.714 and SE (AUC) =0.0034.DiscussionThe meta-analysis showed that ⁶⁸Ga-PSMA PET/CT has clear advantages over BS in the diagnosis of bone metastases of malignant prostate tumors, and could improve the diagnostic accuracy of bone metastases.     

The role of nuclear procedures in the diagnosis of intracranial disease

Summary Transmission computerized axial tomography (T-CAT) has proven to be an effective non-invasive method for detecting intracranial tumours, traumatic intracranial disorders and severe changes in cerebral perfusion. The use of further non-invasive methods to assess intracranial changes seemed to be restricted to special cases. Nuclear procedures are still in a stage of development. Cerebral serial scintigraphy with^99mTc-compounds has shown its effectiveness particularly in diagnosing intracranial tumours and cerebrovascular disease. Moreover, by employing similar algorithms as in T-CAT, the principle of emission computerized axial tomography (E-CAT) has been developed. Assessment of regional cerebral blood flow (rCBF) with¹³³Xenon by inhalation has become a non-invasive procedure. This review is aimed at determining the value of nuclear procedures in comparison to T-CAT, Doppler sonography (DS) and cranial radiographic angiography.The following methods are described and critically evaluated: (a) computer assisted radionuclide angiography (CARNA; semi-quantitative determination of global hemispherical perfusion following an intravenous injection of 10 mCi^99mTc-DTPA), (b) computer assisted assessment of regional cerebral flow (quantitative determination (ml/min.) of regional blood flow, derived from the vertex projection, following an i.v.-injection of 15 mCi^99mTc-HSA), (c) cerebral serial scintigraphy (CSS; radionuclide angiography (RNA), early and late static imaging of intracranial distribution of^99mTc; visual evaluation of perfusion, extent of regional blood-pool and integrity of the blood-brain barrier for type-specific classification of intracranial tumours and cerebrovascular disease), (d) static nuclear brain imaging with various other^99mTc-compounds, (e) imaging of florid atherosclerotic disease in the neck vessels with¹¹¹In-labelled platelets, (f) single photon E-CAT (^99mTc-compounds,¹³³Xe) and (g) positron E-CAT (radioactive carbon, oxygen, CO and CO₂₂ and¹⁸F-desoxyglucose for axial tomographic imaging of cerebral blood volume, oxygen extraction and glucose metabolism). Furthermore, (h) invasive and non-invasive determination of rCBF with¹³³Xe and (i) nuclear cisternography are included. Radiation doses in cranial diagnostic nuclear medicine and X-ray diagnostic procedures are illustrated in a table.CSS in detection of intracranial tumours was correct in 92% of the cases. T-CAT was superior by revealing more than 98%. Since there is agreement that T-CAT sensitivity is 98.6% in the detection of intracranial tumours, CSS has to play a supplemental role to T-CAT by its high accuracy in obtaining type-specific tumour diagnosis. Combined evaluation revealed a histologically confirmed rate of correct tumour-type diagnosis of 94% in meningioma and of 86% in malignant gliomas. In non-blastomatous disorders (haematoma, a. v. angioma, brain abscess), CSS was less efficient in differentiating such findings. In cerebrovascular disease, nuclear procedures were highly effective. 94% of patients with completed stroke were diagnosed as regards the main cerebral artery involved and the disease as such independent of the period of time after the ictus. Combined evaluation (CSS and T-CAT) achieved a rate of 97% correct positives. Nuclear procedures were found to be superior to T-CAT in patients with transient ischaemic attacks (TIA). CARNA yielded a sensitivity of 75%. In addition, methods to assess rCBF were found to be highly effective in such cases. These methods were also effective in determining haemodynamic disorders associated with subarachnoid haemorrhage. Nuclear procedures can be used in both the selection and follow-up of patients after vascular procedures. As compared to Doppler sonography (DS) nuclear procedures were found to be more valuable the more intracranial vascular changes were included in the study.The value and role of nuclear procedures within the sequence of non-invasive diagnostic measures are characterized by the complementary role of CARNA (and of CSS) to T-CAT in cerebrovascular disease. Since the efficieny of further nuclear procedures as screening methods is not yet established, such procdures may be used after T-CAT, DS and CSS. A schema included illustrates an approved sequence of non-invasive procedures. The aim of further development is to reach a similar diagnostic accuracy with non-invasive methods alone as has been achieved by the combined use of non-invasive and invasive procedures.     

Computed tomography in the assessment of suspected large bowel obstruction

BACKGROUND: The aim of this study was to assess the efficacy of computed tomography (CT) scanning in the diagnosis of acute large bowel obstruction. METHODS: Forty-four patients (22 men; 22 women, ages 39-94 years, mean 71 years) with clinical features and abdominal radiographic findings suggesting acute large bowel obstruction (LBO) or pseudo-obstruction were examined with CT. Supine scans were obtained with i.v. contrast medium (unless contraindicated), but (in the majority) without oral contrast. Additional prone and/or decubitus scans were obtained in 33 patients when clarification of a possible transition point on the supine scan was required. CT diagnosis of LBO was made by finding a transition point +/- mass. Final diagnosis was confirmed by surgery, further imaging and/or clinical course. RESULTS: Twenty-two patients had proven mechanical acute LBO of whom 18 had an obstructing carcinoma; 22 patients had no mechanical obstruction. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value of CT for diagnosis of mechanical LBO were each 91%. Positive and negative likelihood ratios were 10.1 and 0.1, respectively. There were two false-negative CT scans, although one of these was reported as showing segmental mural thickening. A mass was identified on 14 of 17 patients with true-positive CT, subsequently found to have carcinoma. CONCLUSION: Computed tomography with additional selective prone and/or decubitus scanning is highly effective in the diagnosis of mechanical LBO. It is suggested that it replace contrast enema as the initial imaging method.     

A 19-week exercise program for people with chronic stroke enhances bone geometry at the tibia: a peripheral quantitative computed tomography study

Background We assessed the impact of a 19-week exercise program on bone health in chronic stroke.Results Those who underwent the program reported significantly more gain in tibial trabecular bone content and cortical bone thickness on the affected side.Conclusion Regular exercise is thus beneficial for enhancing bone health in this population.No commercial party having a direct financial interest in the results of the research supporting this paper has or will confer a benefit upon the author(s) or upon the organization with which the author(s) is/are associated.     

Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis

Chronic kidney disease (CKD) negatively affects bone strength; however, the osteoporotic conditions in patients with CKD are not fully understood. Moreover, the changes in bone microstructure between pre-dialysis and dialysis are unknown. High-resolution peripheral quantitative computed tomography (HR-pQCT) reveals the three-dimensional microstructures of the bone. We aimed to evaluate bone microstructures in patients with different stages of CKD. This study included 119 healthy men and 40 men admitted to Nagasaki University Hospital for inpatient education or the initiation of hemodialysis. The distal radius and tibia were scanned with HR-pQCT. Patient clinical characteristics and bone microstructures were evaluated within 3 months of initiation of hemodialysis (in patients with CKD stage 5 D), patients with CKD stage 4–5, and healthy volunteers. Cortical bone parameters were lower in the CKD group than in healthy controls. Tibial cortical and trabecular bone parameters (cortical thickness, cortical area, trabecular volumetric bone mineral density, trabecular-bone volume fraction, and trabecular thickness) differed between patients with CKD stage 5 D and those with CKD stage 4–5 (p < 0.01). These differences were also observed between patients with CKD stage 5 and those with CKD stage 5 D (p < 0.017), but not between patients with CKD stage 4 and those with CKD stage 5, suggesting that the bone microstructure rapidly changed at the start of hemodialysis. Patients with CKD stage 5 D exhibited tibial microstructural impairment compared with those with CKD stage 4–5. HR-pQCT is useful for elucidation of the pathology of bone microstructures in patients with renal failure.     

Weight-bearing radiographs and cone-beam computed tomography examinations in adult acquired flatfoot deformity

BackgroundOptimal characterization of Adult acquired flatfoot deformity (AAFD) on two-dimensional radiograph can be challenging. Weightbearing Cone Beam CT (CBCT) may improve characterization of the three-dimensional (3D) structural details of such dynamic deformity. We compared and validated AAFD measurements between weightbearing radiograph and weightbearing CBCT images.Methods20 patients (20 feet, right/left: 15/5, male/female: 12/8, mean age: 52.2) with clinical diagnosis of flexible AAFD were prospectively recruited and underwent weightbearing dorsoplantar (DP) and lateral radiograph as well as weightbearing CBCT. Two foot and ankle surgeons performed AAFD measurements at parasagittal and axial planes (lateral and DP radiographs, respectively). Intra- and Inter-observer reliabilities were calculated by Intraclass correlation (ICC) and Cohen’s kappa. Mean values of weightbearing radiograph and weightbearing CBCT measurements were also compared.ResultsExcept for medial-cuneiform-first-metatarsal-angle, adequate intra-observer reliability (range:0.61?0.96) was observed for weightbearing radiographic measurements. Moderate to very good interobserver reliability between weightbearing radiograph and weightbearing CBCT measurements were observed for the following measurements: Naviculocuneiform-angle (ICC:0.47), Medial-cuneiform-first-metatarsal-gapping (ICC:0.58), cuboid-to-floor-distance (ICC:0.68), calcaneal-inclination-angle(ICC:0.7), axial Talonavicular-coverage-angle(ICC:0.56), axial Talus-first-metatarsal-angle(ICC:0.62). Comparing weightbearing radiograph and weightbearing CBCT images, statistically significant differences in the mean values of parasagittal talus-first-metatarsal-angle, medial-cuneiform-first-metatarsal-angle, medial-cuneiform-to-floor-distance and navicular-to-floor-distance was observed (P < 0.05).ConclusionModerate to very good correlation was observed between certain weightbearing radiograph and weightbearing CBCT measurements, however, significant difference was observed between a number of AAFD measurements, which suggest that 2D radiographic evaluation could potentially underestimate the severity of AAFD, when compared to 3D weightbearing CT assessment.     

Computed tomography and cystic fibrosis: promises and problems

Computed tomography (CT) has two potential roles in the evaluation of patients with cystic fibrosis (CF) lung disease: as a diagnostic test primarily for the detection of supervening complications and as a monitoring tool in clinical research. Interest in the latter role has gained momentum in the last 5 years because of two factors: (1) therapeutic options for CF lung disease are developing rapidly, hence the need for an outcome measure that can be applied in clinical intervention trials; and (2) it has become clear that traditional outcome measures such as pulmonary function tests are relatively insensitive to the early structural damage that occurs in CF. Several recent studies have shown that CT can be used as a potential surrogate outcome measure, although its suitability for this specific role is controversial and still under investigation. This review summarises current concepts relating to the research applications of CT in CF, with particular emphasis on the evidence supporting the use of CT as a surrogate outcome measure in clinical trials.     

Intraoperative ultrasound in determining the extent of resection of parenchymal brain tumours – a comparative study with computed tomography and histopathology

Summary ¶Background. Radical excision of parenchymal brain tumours is generally associated with a better long-term outcome; however, it is difficult to ascertain the extent of resection at surgery. We used intra-operative ultrasound [IOUS] to help detect residual tumour and define the tumour-brain interface. Methods. Thirty-five patients with parenchymal brain lesions including 11 low-grade and 22 high-grade tumours and 2 inflammatory granulomata were included in the study. The IOUS was used to localize tumours not seen on the surface, define their margins and assess the extent of resection at the end of surgery. Multiple samples from the tumour-brain interface which were reported as tumour or normal tissue on IOUS were submitted to histopathology. The IOUS findings were compared with a postoperative contrast enhanced computed tomogram [CT] and with histopathology. Results. All tumours irrespective of histology were hyperechoic on IOUS. IOUS was useful in localizing those tumours not seen on the surface of the brain. In 71.4% of cases IOUS was useful in defining their margins, however in the remaining cases the margins were ill-defined. The tumour margins were ill-defined in those treated previously by radiation. With regard to the extent of excision, after excluding the cases who were irradiated, it was found that in the 28 patients who had parenchymal neoplasms, there was concordance between the ultrasound findings and the postoperative CT scan in 23 cases. Of the 79 samples taken from the tumor-brain interface which were reported as tumour on ultrasound, 66 had histopathological evidence of tumour while 13 samples were negative for tumour. On the other hand, in the tissue sent from 17 sites where the IOUS showed no residual tumour, 2 were positive for tumour on histopathology while 15 were negative. Interpretation. In conclusion, IOUS is a cheap and useful real-time tool for localizing tumours not seen on the brain surface, for defining their margins and for determining the extent of resection.Published online May 19, 2003     

A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma

BACKGROUND: Multidetector-row computed tomography (MDCT, or multislice CT) is a new modality with four detectors, which makes examination time shorter and produces higher resolution and multiplanar reformation of the images. Its diagnostic role in patients with rectal carcinoma has not been determined. METHODS: Twenty-one patients with rectal carcinoma were preoperatively examined by both MDCT and magnetic resonance imaging (MRI). Diagnostic accuracies of both modalities were compared regarding depth of tumor invasion and lymph node metastasis based on the pathologic findings. RESULTS: Both examinations detected all tumors. Regarding depth of tumor invasion, the concordance was 95.2% (20 of 21) for MDCT and 100% (21 of 21) for MRI. Regarding lymph node metastasis, the overall accuracy was 61.9% for MDCT and 70.0% for MRI. CONCLUSIONS: Multidetector-row computed tomography was equal to MRI in the preoperative local staging of rectal carcinoma.