Wall Imaging for Unilateral Intracranial Vertebral Artery Hypoplasia with Three-dimensional High-isotropic Resolution Magnetic Resonance Images

Background:

There are few studies for evaluating wall characteristics of intracranial vertebral artery hypoplasia (VAH). The aim of this study was to determine wall characteristics of VAH with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA) images and differentiate between acquired atherosclerotic stenosis and VAH.

Methods:

Thirty patients with suspicious VAH by luminograms were retrospectively enrolled between January 2014 and February 2015. The patients were classified as “acquired atherosclerotic stenosis” or “VAH” based on 3D VISTA images. The wall characteristics of VAH were assessed to determine the presence of atherosclerotic lesions, and the patients were classified into two subgroups (VAH with atherosclerosis and VAH with normal wall). Wall characteristics of basilar arteries and vertebral arteries were also assessed. The clinical and wall characteristics were compared between the two groups.

Results:

Five of 30 patients with suspicious VAH were finally diagnosed as acquired atherosclerotic stenosis by 3D VISTA images. 25 patients were finally diagnosed as VAH including 16 (64.00%) patients with atherosclerosis and 9 (36.00%) patients with normal wall. In the 16 patients with atherosclerosis, plaque was found in 9 patients, slight wall thickening in 6 patients, and thrombus and wall thickening in 1 patient. Compared with VAH patients with normal wall, VAH patients with atherosclerosis showed atherosclerotic basilar arteries and dominant vertebral arteries more frequently (P = 0.000).

Conclusions:

Three-dimensional VISTA images enable differentiation between the acquired atherosclerotic stenosis and VAH. VAH was also prone to atherosclerotic processes.     

彩色多普勒超声在椎动脉粥样硬化诊断中的研究进展

后循环缺血（PCI）是一种临床常见病和多发病,系指椎基底动脉系统短暂性脑缺血发作和脑梗死。椎动脉粥样硬化是PCI常见的病因之一。 PCI的影像学检查包括经颅多普勒超声（TCD）、数字减影血管造影术（DSA）、计算机控制体层摄影造影术（CTA）、磁共振血管造影术（MRA）及彩色多普勒超声（CDU）等。TCD可作为PCI的初步筛查工具,DSA是目前椎动脉疾病诊断的“金标准”;CTA和DSA同属有创检查,且都需要造影剂,不易被患者接受;MRA属于无创检查,但其可能夸大血管狭窄程度;CDU可较准确测量椎动脉内径及评价血流动力学参数,可作为PCI无创伤性的检查手段,具有直接、准确、方便及可重复性等优点,为PCI的明确诊断和疗效评价提供客观依据。就CDU在椎动脉粥样硬化患者诊断中的研究进展作一综述。     

Reinforcing effect of calcium sulfate cement bovine bone morphogenetic protein on vertebral in the rabbit model of osteoporosis

ObjectiveTo observe reinforcing effect of calcium sulfate cement (CSC) bovine bone morphogenetic protein (bBMP) on vertebral in the rabbit model of osteoporosis.MethodsA total of 48 New Zealand white rabbits were randomly divided into group I (blank control group), group II (CSC injection group), group III (CSC/bBMP injection group) and control group. White rabbit osteoporosis model was established rapidly by using castration method+methylprednisolone candidate. After modeling, groups II, III were given corresponding vertebral body injection material, and 4 animals were sacrificed respectively at 24 h, 6 weeks, 12 weeks after vertebral plasty. Tissue pathological status, vertebral mineral density and vertebral body bone mechanical strength were observed.ResultsVertebral body structure form was normal in the groups II and III. Trabecular bone coarsens, connection and repair were observed in micro fracture and bone defects, bone trabecular connectivity was superior to group I significantly; vertebral body compression strength in the groupI was on the decline, vertebral compression strength in the groups IIand III was on the rise, the largest vertebra. Postoperative BMC and BMD in groups IIand III were incresed, and significantly higher than group I after 6 weeks (P<0.05), BMC and BMD in group III after 12 weeks were higher than the other three groups.ConclusionCompound bBMP CSC has good bone induction. It can improve the three-dimensional construction effect for osteoporosis vertebral trabecula, and can significantly improve the vertebral strength, as a vertebral packing material with good application prospect.     

Effect of osteoporosis and intervertebral disc degeneration on endplate cartilage injury in rats

Objective:To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.Methods:A total of 48 female Sprague Dawley rats(3 months)were randomly divided into Groups A,B,C and D with 12 rats in each group.Osteoporosis and intervertebral disc degeneration composite model,simple degeneration model and simple osteoporosis model were prepared in Groups A,B and C respectively.After modeling,four rats of each group at 12th.18th and 24th week were sacrificed,Intervertebral height of cervical vertebra C6/C7 was measured.Micro-CT was used to image the endplate of cephalic and caudal cartilage at C6/C7 intervertebral disc.Abraded area rate of C6 caudal and C7 cephalic cartilage endplate was calculated,and then C6/C7 intervertebral disc was routinely embedded and sectioned.stained with safranin O to observe histological changes microscopically.Results:At 12,18 and24 weeks,intervertebral disc height of C6/C7 were(0.58±0.09)mm,(0.53±0.04)mm and(0.04±0.06)mm in Group A rats,(0.55±0.05)mm,(0.52±0.07)mm and(0.07±0.05)mm in Group B rats.At 24th week.intervertebral disc height of Group A rats was significantly lower than that of Group B rats(P0.05);intervertebral disc height of Groups A and B rats at each time point were significantly lower than that of Groups C and D(P0.05).There was no significantly statistical difference of intervertebral disc height between Groups C and D(P0.05).At 12 and 18 weeks,the abraded rate of C6 caudal and C7 cephalic cartilage endplate in Group A rats were significantly higher than that in Groups B.C and D rats(P0.05);the abraded rate in Group B was significantly higher than that in Groups C and D(P0.05).Microscopic observation of CT showed that ventral defects in C6caudal or C7 cephalic cartilage endplate in Groups A and B appeared after 12 weeks of modeling;obvious cracks were found in front of the C6 and C7 vertebral body,and cartilage defect shown the trend of"repairing"at 18 and 24 weeks after modeling.Conclusions:Intervertebral disc degeneration and osteoporosis can cause damage to the cartilage endplate.Co-existence of these two factors can induce more serious damage to the endplate.which has possitive correlation with intervertebral disc degeneration.Osteoporosis plays a certain role in intervertebral disc degeneration process,and accelerates the degeneration of intervertebral disc in a specific time window.     

椎动脉起始部迂曲对血管性眩晕的影响及其临床危险因素

目的 探讨椎动脉起始部迂曲对血管性眩晕的影响及其临床危险因素. 方法 连续入选神经内科病房住院的老年眩晕患者206例,记录脑血管病相关的临床危险因素、眩晕分级、治疗缓解天数,检测血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(Hcy)、超敏C-反应蛋白(hsCRP),进行颈部CT血管成像(CTA)或对比增强磁共振血管成像(CEMRA)检查.将眩晕患者分为椎动脉起始部迂曲组(137例)与非迂曲组(69例),采用Logistic回归分析探讨椎动脉起始部迂曲的临床危险因素. 结果 椎动脉起始部迂曲组合并椎动脉优势者多于非迂曲组,差异有统计学意义(75例比26例,x2 =2.496,P＜0.01).椎动脉起始部迂曲患者眩晕级别:1级17例,2级36例,3级79例,4级4例,5级1例;治疗缓解天数为1～1o d.非迂曲组眩晕级别:1级18例,2级35例,3级10例,4级3例,5级1例,治疗缓解天数1～6 d,两组比较差异均有统计学意义(t=2.014,2.849,均P＜0.01).单因素分析结果表明,年龄、高血压病、高LDL-C、糖尿病、吸烟、脑卒中史、椎动脉优势及颈椎病等两组之间差异有统计学意义(x2=7.498、5.182、3.724、10.461、6.883、2.748、4.496、8.265,均P＜0.05).Logistic回归分析表明,年龄＞65岁(95％CI:5.36～18.23,OR=4.84)、高血压病(95％CI:2.79～16.45,OR=3.21)、椎动脉优势(95％CI:3.25～13.49,OR=5.48)和颈椎病(95％ CI:4.38～21.28,OR=3.57)为椎动脉起始部迂曲的临床高危因素. 结论 椎动脉起始部迂曲者眩晕级别高、治疗缓解天数延长;年龄＞65岁、高血压病、椎动脉优势和颈椎病为椎动脉起始部迂曲的临床高危因素.     

Cervical Compressive Myelopathy due to Anomalous Bilateral Vertebral Artery

We report a very rare case of cervical compressive myelopathy by an anomalous bilateral vertebral artery (VA) entering the spinal canal at the C1 level and compressing the spinal cord. A 70-year-old woman had been suffering from progressive gait disturbance. Magnetic resonance imaging revealed that a bilateral VA at the V4 segment had abnormal courses and caused compression to the high cervical cord. VA repositioning was performed by anchoring a suture between the artery and around the arachnoid membrane and dentate ligament, and then, microvascular decompression using a Teflon sponge was done between the VA and the spinal cord. The weakness in the patient improved in the lower extremity after the operation. Anomalous VA could be one of the rare causes of cervical compressive myelopathy. Additionally, an anchoring suture and microvascular decompression around the VA could be a sufficient and safe method to indirectly decompress the spinal canal.     

单针骨水泥技术治疗老年椎体压缩骨折的临床分析

目的探讨单针经单侧椎弓根经皮椎体成形术（percutaneous vertebroplasty,PVP）治疗老年人新鲜胸腰椎骨折的方法及临床疗效。方法将2010年3月～2011年9月治疗胸腰椎骨折100例110椎,分为两组,A组50例60椎行单针经单侧椎弓根PVP术,B组50例50椎行经双侧椎弓根PVP术。两组均行术前及术后进行疼痛视觉模拟评分（visual analoguescale,VAS）、活动能力评分（locomotor activityscale,LAS）、椎体前后缘高度比及两组间骨水泥注入量、骨水泥渗漏及手术时间进行比较。结果两组术前与术后2天VAS评分、LAS评分及椎体前后缘高度比均有显著差异,症状改善明显（P〈0．01）;两组平均随访时间6．5个月,患者术后骨折椎体无疼痛,复查X线片显示术后6月与术后2天椎体前后缘高度比无明显差异（P〉0．05）。A组平均单椎体手术时间20．1min,注入骨水泥2．8ml（2-4．5m1）;B组手术时间35．2min,注入骨水泥3．7ml（2．5～6ml）。两组间平均单椎体手术时间及平均骨水泥注入量均有明显差异（P〈0．05）。两组发生骨水泥渗漏情况为椎间盘渗漏A组5例、B组6例,椎旁渗漏A组7例、B组7例,无严重并发症发生,两组骨水泥渗漏发生率无显著差异（P〉0．05）。结论单针骨水泥技术可即刻缓解疼痛,恢复伤椎高度,提高患者的活动能力,明显缩短手术时间,降低住院费用及X线暴露时间,是一种微创、安全、有效的治疗老年人新鲜胸腰椎骨折的技术。     

超声电导经皮治疗联合氟比洛芬酯在椎体后凸成形术后急性疼痛中的应用

目的探讨超声电导经皮治疗联合氟比洛芬酯注射液在椎体后凸成形术后急性疼痛中的应用效果。方法选取2008年1月至2011年5月在我院行椎体后凸成形术后急性疼痛的患者60例,随机分为超声电导组(A组)、氟比洛芬酯组(B组)以及超声电导联合氟比洛芬酯组(C组)各20例。A组予以超声电导经皮治疗30min;B组予以氟比洛芬酯注射液静推50mg;C组予以超声电导经皮治疗联合氟比洛芬酯,方法同A、B组;均于术后急性疼痛6h内完成。对患者治疗前、治疗后的疼痛症状按视觉模拟评分法(VAS)进行评分及临床观察。结果 3组术后急性疼痛都得到不同程度的缓解。按VAS对3组患者进行评分,C组较A、B组改善更加明显(P<0.01);3组均未发生不良反应。结论超声电导靶向给药、氟比洛芬酯对椎体后凸成形术后急性疼痛都有效,但是二者联合应用的止痛效果更佳,疗效确切,值得临床应用推广。     

ABCD2评分对后循环短暂性脑缺血发作患者椎基底动脉狭窄的预测价值:回顾性病例系列研究

目的:探讨ABCD2评分与后循环短暂性脑缺血发作(transient ischemic attack,TIA)患者椎基底动脉主干血管狭窄的相关性.方法 回顾性纳入行脑血管造影的后循环TLA患者,对其ABCD2评分和影像学资料进行分析.结果 共纳入后循环TIA患者108例.不同ABCD2评分的后循环TIA患者椎基底动脉主干血管狭窄程度存在显著性差异(P =0.005),总体狭窄程度随着ABCD2评分的增高而增高(P =0.000).在校正其他血管危险因素后,ABCD2评分对后循环是否存在狭窄[优势比(odds ratio,OR)1.771,95％可信区间(confidence interval,CI)1.234～2.542;P =0.002]及是否存在中至重度狭窄(OR2.083,95％ CI1.336 ～3.176;P =0.001)均具有显著的预测能力,其受试者工作特征曲线下面积分别为0.693(95％ CI0.586～0.800)和0.755(95％ CI0.661～0.849).当ABCD2评分≥3分时,预测后循环狭窄的敏感性为62.6％(95％ CI 53.4％～71.7％),特异性为70.6％(95％ CI62.0％ ～79.1％),预测后循环狭窄程度＞50％的敏感性为78.7％(95％ CI 70.9％～86.4％),特异性为67.5％ (95％ CI 58.7％ ～76.3％).结论 在后循环TIA患者中,椎基底动脉主干血管狭窄程度随着ABCD2评分的增高而增高.ABCD2评分在一定程度上能预测后循环主干血管是否存在狭窄及是否存在中至重度狭窄.