经皮腰椎间盘切割术与显微内镜腰椎间盘摘除术的远期随访分析

目的 回顾性分析经皮腰椎间盘切割术(PLD)与显微内镜腰椎间盘摘除术(MED)治疗腰椎间盘突出症的远期疗效与生活质量,探讨每种术式的临床应用优势.方法 采用查阅原始病案、信函与电话相结合的随访方式,对2000年1月至2002年3月间来东南大学附属中大医院接受PLD治疗的患者共104例及MED治疗的患者82例进行远期随访研究,随访的内容包括Oswestry功能障碍指数(ODI)、JOA腰痛疗效评定标准(JOA)、SF-36量表(SF-36)的评分,使用配对t检验χ2检验及Fisher精确概率法等方法进行统计学分析.结果 PLD组和MED组评价随访时间分别为5.2～7.3(6.6±0.7)年和5.3～7.2(6.4±0.5)年.MED组的远期ODI、SF-36评分要好于PLD组(秩和检验,P值分别为0.0397和0.0582),JOA信函问卷评分组间差异无统计学意义(秩和检验,P值为0.9742);而MED组的住院时间、住院费用则明显长于或多于后者(方差分析,均P<0.01);远期并发症发生率分别为MED组3.49%,PLD组未出现手术相关并发症.结论 MED或PLD治疗腰椎间盘突出症均具有创伤小、恢复快、疗效好且稳定的特点.MED的临床远期疗效高于PLD,但是其并发症稍高,住院时间和费用也有所提高.     

听觉功能MRI研究的实验设计

目的探讨听觉fMRI研究的有效数据采集方式。方法对13例健康年轻受试者分别采用纯音及调幅音两种听觉刺激条件，刺激分别采用组块和事件相关设计进行听觉呈现，以比较连续及稀疏两种采集方式下听觉皮层的fMRI响应，运用SPM2软件进行数据分析和脑功能区定位，并分析两种不同实验数据采集方式下听觉皮层激活的差异。结果调幅声较纯音更易激发听觉皮层的激活；两种刺激条件下，稀疏采集时听觉皮层的fMRI响应明显多于连续采集，比较听觉皮层各区，以初级听觉皮层fMRI响应为著。结论调幅音是听觉fMRI研究中的合适刺激；稀疏采集方式有助于克服环境噪声的负面影响，结合物理衰减方法，可实现听觉功能的fMRI研究。     

64层螺旋CT诊断小儿法洛四联症

目的探讨64层螺旋CT心血管成像技术对小儿法洛四联症(TOF)的诊断价值,并与超声心动图(ECG)对比。方法对26例临床诊断TOF患儿进行64层螺旋CT增强心脏检查,并用多平面重建(MPR)、最大密度投影(MIP)及容积成像(VR)进行图像重建。所有病例均作ECG对照,以24例手术为金标准比较64层螺旋CT和ECG对心血管畸形的诊断准确率。结果手术证实的心血管畸形152处,64层螺旋CT的诊断准确率93.42%,明显高于ECG的诊断准确率69.74%(χ2=14.18,P<0.01)。对手术证实的18例小儿TOF,64层螺旋CT的诊断准确率达到100%。64层螺旋CT对TOF伴发畸形的诊断准确率为86.67%,ECG为33.33%(χ2=17.78,P<0.01)。结论64层螺旋CT对心血管畸形的诊断准确率优于ECG,能准确诊断小儿TOF,同时能评价肺动脉和冠状动脉,对术前手术方案的制定具有重要价值。     

肝细胞移植技术新进展

与传统的原位肝移植相比,肝细胞移植具有简单易行、应用灵活等优点,因而引起了临床上的广泛关注。现已证明,肝细胞移植对生物(病毒)、化学(肝毒性药物)、物理(外伤)等各种原因引起的急性肝功能衰竭起着代偿和支持作用;又可以纠正由于肝代谢酶缺陷引起的遗传性代谢疾病。微载体技术的应用和肝细胞体外转化的成功,使肝细胞作为基因治疗的受体细胞成为可能。随着介入放射学的发展,可运用经导管技术进行肝细胞移植术,对介入放射学而言,这是一极富吸引力和挑战性的新领域.     

磁探针标记人内皮型一氧化氮合酶基因修饰的内皮祖细胞及其体外磁共振成像实验研究

目的 人内皮型一氧化氮合酶(heNOS)基因体外修饰兔外周血来源的内皮祖细胞(EPC)后,应用纳米磁探针三氧化二铁(Fe2O3)-精氨酸(arginine)复合物体外标记基因修饰的EPC,磁共振(MR)进行标记细胞成像.方法 制备Fe2O3-arginine复合物.分离兔外周血单个核细胞,贴壁法筛选出EPC,传代培养,用脂质体LipofectamineTM2000体外转染heNOS基因至EPC,转染后48 h对基因修饰EPC进行磁探针标记,普鲁士蓝染色显示细胞内铁,Western blot检测heNOS基因表达情况,四氮噻唑蓝(MTT)比色试验评价磁探针标记基因修饰EPC后对细胞生长状况的影响,流式细胞分析检测标记、未标记细胞的凋亡,应用磁共振的T1WI、T2WI、T2*WI3个序列进行细胞群成像.结果 普鲁士蓝染色可见铁颗粒位于细胞质内,标记率与标记的未修饰基因组EPC相似,都接近100%.MTT比色试验示Fe2O3-arginine标记后3、4、5天,标记的基因修饰细胞组、未修饰基因细胞组的吸光度值与未标记者比较,差异无统计学意义.流式细胞分析结果 显示Fe2O3-arginine标记后细胞凋亡与未标记细胞间差异无统计学意义.磁共振成像显示标记的基因修饰细胞群信号强度的变化与标记的未修饰基因细胞相似,两者之间差异无统计学意义,且两者均较未标记细胞群信号低,以T2*WI的信号强度变化率最大,标记后7 d的信号强度变化率均较标记后1 d者下降.结论 使用脂质体可以成功地将外源heNOS基因转染进兔外周血EPC中并在某中有效表达,Fe2O3-arginine可以有效标记heNOS基因修饰的EPC,其对细胞的活力、增殖等生物学特性无明显影响.临床应用型1.5T MR可在体外进行标记细胞群成像,间接反映干细胞的数量和分裂增殖状态.     

抑郁症患者识别负性表情的脑磁源性影像动态变化

目的 利用磁源性影像技术以及表情事件相关识别实验范式探讨抑郁症患者识别负性动态表情的神经网络磁源性影像动态变化的特点.方法 利用脑磁图检测12例抑郁症患者(患者组)及12名年龄、性别、受教育年限近似匹配的健康对照者(对照组)识别负性动态表情视频时的脑部反应.设P＜0.01时,差异均具有统计学意义.结果 与对照组相比,患者组识别负性面部表情时,活动异常主要出现在双侧钩回、双侧颞上回、右额中回、右杏仁核、右颞回下、左梭状回、左枕下回、右海马旁回、左枕舌回、双侧楔前叶、左楔叶等脑区,这些脑区组成的神经网络在识别负性动态表情过程有相应脑区激活异常.结论 抑郁症患者识别负性表情的功能网络的脑磁源性影像动态变化特点与正常人比较差异有统计学意义.     

选择性血管造影及栓塞治疗胆系术后大出血

目的评价选择性血管造影及栓塞治疗胆系术后大出血的有效性。方法回顾性分析9例胆道术后大出血患者的临床资料。9例患者急诊行腹腔动脉、选择性肝动脉及肠系膜上动脉造影,并以明胶海绵颗粒或钢圈栓塞治疗。结果血管造影显示肝动脉假性动脉瘤3例、肝动脉分支出血3例、胃十二指肠分支出血2例、空肠动脉分支出血1例。所有患者均经血管造影迅速明确诊断,并成功栓塞出血动脉8例。1例患者因出血复发行二次栓塞止血成功。经3个月-2年的随访未见出血复发及严重并发症的发生。1例患者因血管加压素灌注止血失败改行手术治疗。结论选择性血管造影及栓塞安全、可靠、创伤小,是诊断和治疗胆系术后大出血的有效方法。     

APP/PS1转基因阿尔茨海默病小鼠的MR波谱定量分析

Objective To explore changes of metabolites in APP/ PS1 double transgenie mice of Alzbeimer disease (AD) by 1H-MR spectroscopy (1H-MRS) and the application value of in early diagnosis of AD.Methods 1H-MRS was performed in 35 APP/PS1 transgenie mice of AD ( study group) and 20 wild type mice ( control group) at age of 3, 6 and 9 months using a 7.0 T MR system.Sub-peak areas of N-acetyl aspartate (NAA), myo-inositol (mI) and creatine (Cr) in the cerebral cortex and hippocampus were measured, and the NAA/Cr and mI/Cr ratios were calculated.The changes in pathology between the two groups were compared.Using the lower limit of 95% confidence interval (CI) of the ml/Cr ratio and the upper limit of 95% CI of the NAA/Cr ratio of AD mice as the threshold, their influences on sensitivity,specificity and accuracy of various age groups of AD animals were compared.Comparison of the 1H-MRS indexes between study mice and wild type mice at each time point were conducted by a two-sample t test.Results The mean mI/Cr ratios of AD mice were 0.68± 0.03, 0.72± 0.04, and 0.77 ± 0.04 respectively at 3, 6 and 9 months of age; while they were 0.63 ± 0.04, 0.64 ± 0.03, and 0.64 ± 0.04 respoetively in control group, the difference was significant ( t = 2.814, 5.146, 14.437, P < 0.01 ).Compared with the control group, the mI/Cr ratio of the 3-month-old AD mice of the study group was significantly increased,and histological examination showed proliferation and activation of neuroglial cells in the cerebral cortex and hippoeampus.The mean NAA/Cr ratio were 1.17 ±0.08, 1.04 ±0.05, and 0.90 ±0.05 respectively at 3,6 and 9 months of age in study group, while they were 1.18 ±0.07, 1.16 ±0.07, and 1.18 ±0.08respectively in control group.There were no significant difference ( t = 0.752, P > 0.05 ) between the study group and control group at 3 months of age, and the NAA/Cr ratio decreased significantly only at 6 and 9 months of age ( t = - 8.514, - 5.646, P < 0.01 ).The immunohistochemical exam demonstrated the appearance of Aβ plaque.According to threshold of mI/Cr, the sensitivity of AD mice of 3, 6 and 9 months of age was 80% (28/35), 84% ( 26/31 ) and 85% ( 23/27 ), and the specificity was 85% ( 17/20 ),94% (17/18) and 100% ( 16/16), and the accuracy was 82% (45/55), 88% (43/49) and 91% (39/43),respectively.For NAA/Cr, the sensitivity of AD mice of 6 and 9 months of age was 84% (26/31) and 89% (24/27), and the specificity was 89% (16/18) and 100% (16/16), and the accuracy was 86% (42/49) and 93% (40/43), respectively.Conclusions NAA and mI are the most sensitive and specific markers for early assessment of AD, and change of mI is earlier than that of NAA.Quantitative analysis of mI may provide important clues for early diagnosis of AD.     

胎儿大脑皮质层状结构发育的MRI分析

目的:用3.0T与7.0T胎儿标本MRI分析大脑皮质发育过程中层状结构的变化.方法:46例14～37周胎儿标本,3.0T MRI扫描;并从中选取11例14～27周标本行7.0T MRI扫描,选取不同场强中成像清晰的图像,观察在此阶段内胎脑皮质层状结构的发育变化.结果:在3.0T或7.0T标本MRJ上,14～16周时,可观察到4～6层结构;18～23周时,层状结构发育典型,MRI与组织学切片上均显示为7层结构,且此时连续的室周层和外囊纤维可以观察到;24～28周时,层状结构变得不典型;30周后,脑皮质层状结构消失并逐渐成熟.发育中的层状结构在MRI及组织学切片上都以枕叶及海马周围区最明显.3.0T MRJT1加权图像上,不同孕龄皮质下层内正在迁移的丘脑皮质纤维分别显示为其下、中、上部的高信号条带.结论:胎脑皮质层状结构的发育遵循特定时空规律,且应用较高场强的标本MRI冠状位顶枕叶部图像可以最佳的显示其发育变化.     

应用心电脉冲技术降低64层螺旋CT冠状动脉成像的辐射剂量

Objective To evaluate the value of reducing radiation dose with ECG-pulsing and image quality in 64-row multi-alice CT coronary angiography.Methods Fifty-nine consecutive patients whose heart rates were less than 80 beat per minute and cardiac rhythm was regular were randomly divided into two groups from October 26, 2007 to March 12, 2008.Conventional technique of CT coronary angiography was employed in group 1, while ECG-pulsing technique was applied in group 2.CT dose index volume (CTDIvol) and dose length product (DLP) were obtained automatically, and then the corresponding effective dose (ED) were calculated.The quality scores were performed on obtained imaging by using double blind method.Student t-test was applied in the comparison of value of CTDIvol, value of ED and quality of imagiugbetween two groups.Results The value of CTDIvol was (70.0±1.1) and (39.0±2.7) mGy, the value of ED was (16.8±2.0) and (9.5±1.7) rosy in group 1 and group 2, respectively, which reached statistically significant differences between the groups(t=57.675,15.346 ,P <0.01, respectively). The quality scores of coronary images were 3.8±0.2 and 3.8±0.1 in the groups, which did not reach the statistical significance (t=-0.222, P 0.05).Conclusions The proper application of ECG-Pulsing technology in 64-slice spiral CT coronary angiography can reduce radiation dose significantly while having no influence on the quality of the imaging.