核素肺灌注显像对搏动性双向Glenn术肺血流的评估

目的探讨核素肺灌注显像定性定量评估搏动性双向Glenn术肺血流情况。方法11例肺血少、复杂先天性心脏病患者均接受搏动性双向Glenn术。术前经上肢静脉、术后分别由上下肢静脉注射显像剂，示踪剂在肺内达到平衡后，取前后位及后前位行肺灌注显像，每个体位采集5×105放射性计数。若肾脏显影，则勾划两肾感兴趣区，分别计算术前和术后两肺与双肾放射性计数。结果在搏动性双向Glenn术后两肺放射性计数比值差异无显著性，两肺血基本对称。右向左分流指数较术前明显下降。结论核素肺灌注显像能无创性定性定量评估搏动性双向Glenn术前后肺血流情况，并观察疗效。     

Seven-degree head-down tilt reduces choroidal pulsatile ocular blood flow

INTRODUCTION: We investigated the effects of head-down tilt (HDT), which simulates microgravity during spaceflights, on the choroidal pulsatile ocular blood flow (POBF). This investigation is important because alterations in the choroidal blood flow can affect the function of retinal rods and cones that rely totally on the choroid for metabolites. METHODS: Nineteen healthy adults between 20 and 38 yr of age participated in this study. The POBF was compared for: 1) baseline, wherein subjects were declined 30 degrees from vertical; 2) microgravity simulation where subjects were in a 7 degrees HDT for 2 min; 3) 90 min of the 7 degrees HDT; and 4) recovery, i.e., back at 30 degrees for 2 min. RESULTS: The group averaged POBF (Mean +/- SEM values: 828.43 +/- 48.88 microL x min(-1)) decreased immediately during the 2-min microgravity simulation (582.18 +/- 43.62 microL x min(-1)), remained at that inferior level at the 90-min mark of HDT (542.26 +/- 45.35 microL x min(-1)), and came back toward baseline POBF during the recovery period (760.11 +/- 46.03 microL x min(-1)) (p = 0.0001). DISCUSSION: The results show that simulated-microgravity of relatively short duration induces retinal hypoperfusion throughout the microgravity interval through the reduction in the POBF. This finding may have important implications regarding visual performance in space crewmembers placed in prolonged microgravity environments.     

Portal blood flow: measurement with MR imaging

Portal blood flow was measured by means of direct bolus imaging (DBI), a method of measuring flow velocity with magnetic resonance imaging. DBI allows immediate visualization of fluid movement, thereby enabling calculation of a flow velocity from fluid displacement. In a study of 14 healthy male volunteers, portal blood flow was measured with electrocardiographic gating during the 18 seconds subjects could suspend respiration. These measurements showed a close correlation (r = .968) with those obtained by means of Doppler ultrasound (US). Increases in portal blood flow after oral administration of ethanol and glucose were measured with DBI. Glucose caused a statistically greater increase in portal blood flow volume in healthy control subjects than in patients with chronic hepatitis. Blood sugar, on the other hand, showed a significantly greater increase in these patients, possibly reflecting the greater vascular resistance of the liver. DBI is a useful noninvasive method of measuring portal blood flow without the limitations imposed on Doppler US by obesity and intestinal gas.     

Cardiac flow measurement by ultrafast CT: validation of continuous and pulsatile flow.

To gauge the accuracy of ultrafast CT in measuring cardiac output and myocardial perfusion in humans, measurements of continuous and pulsatile flow were made in a large asymmetrical phantom. The variation in the relationship between Hounsfield number and contrast concentration was assessed in a human thorax phantom. Radiopaque contrast medium was injected during perfusion of the phantom at a range of flow rates between 1.5 and 8 L/min. The phantom was scanned in two modes (50 and 100 ms) during continuous and pulsatile flow and with the phantom surrounded by air and by water. Flow in the tubes was calculated using indicator dilution theory, and flow in the tissue-equivalent chamber was calculated by applying first-pass distribution principles. The standard deviation of the difference between calculated and measured flow varied from 0.2 to 0.6 L/min, giving 95% limits of agreement from 0.4 to 1.2 L/min. The constant (K) relating Hounsfield unit number to iodine concentration varied widely both in different locations within the phantom and under different scan conditions (17.2-27.6 HU/mg I). Within a human thorax phantom, K varied from 14.15 to 23.18 HU/mg I and was dependent on location within the thorax phantom, the scan mode, and the cross-sectional diameter of the phantom. These data suggest that though the ultrafast CT scanner can measure continuous and pulsatile flow accurately in tubes, precise measurements of cardiac output in humans will require K to be assessed for each subject. Measurements of flow in tissue should be possible.     

Comparison of PET with radioactive microspheres to assess pulmonary blood flow.

Microsphere technique is the reference for assessment of pulmonary blood flow (PBF) but is destructive; PET, however, can determine PBF noninvasively. Comparisons of these 2 methods are scanty. Our study aimed at comparing these 2 techniques using a mathematic model taking into account the right ventricle in determining the transit time of a tracer through lung tissue. METHODS: Ten normal pigs were investigated at baseline, during dobutamine infusion, and during 10 cm H(2)O of positive end-expiratory pressure. Under each condition, PBF was successively measured with PET (PET-PBF) and radioactive microspheres (MS-PBF). For PET-PBF, 2 mCi (74 MBq) (15)O-labeled water were injected intravenously over 20 s and PET scanning was performed for 10 min. The input function was determined noninvasively from PET and invasively from mixed venous blood withdrawals. PET-PBF was computed using a mathematic model taking into account the right ventricle in determining the transit time of the tracer through lung tissue. For MS-PBF, 1 given isotope was injected under a given condition. PET-PBF and MS-PBF for 5 lung regions were compared. RESULTS: PET-PBF significantly correlated with MS-PBF both over all experimental points (PET-PBF = 0.79. MS-PBF + 1,538; r = 0.79; P < 0.001) and in separate lung regions. Invasive and noninvasive input functions also correlated significantly (r = 0.90; P < 0.001). Simulations stressed the crucial role of the right ventricle to the transit time of tracer through lung tissue in the determination of PET-PBF. CONCLUSION: PBF can accurately be assessed using PET and a mathematic model taking into account the right ventricle in determining the transit time of a tracer through lung tissue. Noninvasive determination of the input function of the right ventricle is accurate and can readily be used for clinical applications.     

Cine-CT measurement of cortical renal blood flow

A modified indicator-dilution technique using radiographic contrast material and a cine-CT scanner was used to measure blood flow in the renal cortex of dogs. To validate this technique, CT measurements were correlated with simultaneous measurements of flow determined by radioactive microspheres. Measurements were taken during euvolemic conditions and after hemorrhage. Thirty-nine measurements were compared, covering a flow range from 1 to 7 ml min-1 g-1, and a good correlation was found between the cine-CT and microsphere results (r = 0.93; p less than 0.001). Additionally, cine-CT measurements were made of the mean transit time (MTT) of contrast material through the renal cortex, and the reciprocal of these MTT values was also well correlated to microsphere determined flow (r = 0.94; p less than 0.001). Thus, cine-CT appears to be a promising new technique for measuring renal blood flow.     

MR measurement of coronary blood flow.

The functional significance of coronary arterial stenosis can be evaluated by measuring the pharmacological flow reserve. Magnetic resonance (MR) imaging has a unique potential for noninvasive measurement of coronary blood flow and flow reserve in the native coronary artery and bypass graft. Restenosis after coronary balloon angioplasty and stenting in the left anterior descending artery can be detected noninvasively with serial MR measurements of the coronary flow reserve. Further refinement of the MR pulse sequences to improve spatial and temporal resolutions may permit accurate quantification of blood flow volume and flow reserve in all major coronary arterial branches. MR assessments of blood flow volume and flow pattern allow noninvasive detection of significant stenosis in the coronary artery bypass graft as well. By integrating MR blood flow measurement in the coronary sinus and cine MR assessment of left ventricular myocardial mass, altered myocardial micro-circulation in patients with diffuse myocardial diseases, such as hypertrophic cardiomyopathy and cardiac transplant, has been documented. J. Magn. Reson. Imaging 1999;10:728-733.     

Fluid equations applied to blood flow measurement using digital videodensitometry.

RATIONALE AND OBJECTIVES. Time-dependent fluid flow is computed from projection radiographs without bolus tracking by applying the fluid equations of continuity and incompressibility. METHODS. The fluid equations are combined and integrated to yield an equation that describes instantaneous mass conservation within a vessel segment. The technique is demonstrated using phantom images and patient data obtained using a digital subtraction angiography (DSA) system. RESULTS. Instantaneous and mean flow rates are successfully computed with this algorithm, but the uncertainties are overestimated. In a 1.0-cm diameter tube, instantaneous and mean velocities corresponding to 7.3 cm per frame are computed within 13% uncertainty using a 4.0-cm segment length. Mean flow rates computed from standard diagnostic angiograms taken from three different projections agree within 16%. CONCLUSIONS. This technique can successfully compute time-dependent flow rates from DSA image sequences with large fluid displacements between frames. The accuracy is strongly dependent on the magnitude of the contrast density gradient.     

MR measurement of pulsatile pressure gradients

A magnetic resonance (MR) imaging method for evaluating pulsatile pressure gradients in laminar blood flow is presented. The technique is based on an evaluation of fluid shear and inertial forces from cardiac-gated phase-contrast velocity measurements. The technique was experimentally validated by comparing MR and manometer pressure gradient measurements performed in a pulsatile flow phantom. Analyses of random noise propagation and sampling error were performed to determine the precision and accuracy of the method. The results indicate that a precision of 0.01–0.03 mmHg/cm and an accuracy of better than 8% can be achieved by using standard clinical pulse sequences in tubes exceeding 6 mm in diameter. The authors conclude that MR measurement of pressure gradients is feasible and that additional hemodynamic information may be derived from conventional phase-contrast imaging studies.     

Altered cerebral blood flow in patients with unilateral venous pulsatile tinnitus: an arterial spin labeling study

Objectives:Abnormal neuronal activity and functional connectivity have been reported in patients with venous pulsatile tinnitus (PT). As neuronal activity is closely coupled to regional brain perfusion, the purpose of this study was to investigate the cerebral blood flow (CBF) alterations in patients with unilateral venous PT using arterial spin labeling (ASL).Methods:This study included patients with right-sided PT between January 2018 and July 2019. A healthy control (HC) group matched 1:1 for gender and age was also recruited. All subjects underwent ASL scanning using 3.0T MRI. The correlation between altered CBF and Tinnitus Handicap Inventory (THI) score as well as PT duration was analyzed.ResultsTwenty-one patients with right-sided PT and 21 HCs were included. The mean PT duration of the patients was 35.9 ± 32.2 months, and the mean THI score was 64.1 ± 20.3. Compared with the HCs, the PT patients exhibited increased CBF in the left inferior parietal gyrus and decreased CBF in the bilateral lingual gyrus (family-wise error corrected, p < 0.05). The increased CBF in the left inferior parietal gyrus showed a positive correlation with the THI score in PT patients (r = 0.501, p = 0.021).ConclusionsPT patients exhibit regional CBF alterations. The increased CBF in the left inferior parietal gyrus may reflect the severity of PT.Advances in knowledge:This study not only presents evidence for the potential neuropathology of PT from the perspective of CBF alterations but also offers a new method for investigating the neuropathological mechanism of PT.