颅底富血供肿瘤术前超选择性颈外动脉插管栓塞9例报告

目的：探讨超选择性颈外动脉插管栓塞术在颅底富血供肿瘤手术治疗中的作用。方法：对９例颅底富血供肿瘤患者术前先作双侧颈内、颈外及椎动脉造影后再行栓塞治疗。结果：９例栓塞后,肿瘤供血网显影消失,术中出血量明显减少,术后病理检查,镜下均见瘤体微血管及血窦内充满大量明胶海绵。结论：超选择性颈外动脉插管造影,在明确肿瘤血供类型后辅以术前栓塞治疗,既可缩小瘤体又能减少术中出血,是肿瘤围手术期处理的重要手段之一。     

非增强门静脉磁共振成像技术研究

目的 通过使用不同成像序列及接收线圈,寻找最佳非增强门脉磁共振成像技术。方法 对２０例上腹部受检者行门静脉成像。以轴位为定位像,行冠状位扫描。其中１０例ＧＲＡＳＳ、ＧＲＡＳＳ＋ＥＡＴＳＡＴ、ＳＰＧＲ、ＳＰＧＲ＋ＦＡＴＳＡＴ４种序列扫描;１０例以体线圈、ＧＰＦ线圈及胸腰椎线圈和ＧＲＡＳＳ扫描。所得图像均进行ＭＩＰ重建,并对ＭＩＰ重建图像门静脉显示效果进行对比评价。结果 ＳＰＧＲ,ＧＲＡＳＳ信噪比、对     

Noninvasive three-dimensional computed tomographic angiography in preoperative detection of intracranial arteriovenous malformations

Ｃｏｎｖｅｎｔｉｏｎａｌｉｎｔｒａ ａｒｔｅｒｉａｌｄｉｇｉｔａｌｓｕｂｔｒａｃｔｉｏｎａｎｇｉｏｇｒａｐｈｙ (ＤＳＡ)ｕｓｅｄｔｏｂｅｒｅｇａｒｄｅｄａｓｔｈｅｇｏｌｄｓｔａｎｄａｒｄｆｏｒｄｉａｇｎｏｓｉｓｏｆｉｎｔｒａｃｒａｎｉａｌａｒｔｅｒｉｏｖｅｎｏｕｓｍａｌｆｏｒｍａｔｉｏｎｓ(ＡＶＭｓ) Ｒｅｃｅｎｔｌｙ ,ｎｅｗｔｅｃｈｎｉｑｕｅｓｏｆｎｅｕｒｏｉｍａｇｉｎｇａｎｄｃｏｍｐｕｔｅｒａｓｓｉｓｔｅｄｔｈｒｅｅ ｄｉｍｅｎｓｉｏｎａｌｒｅｃｏｎｓｔｒｕｃｔｉｏｎｍａｋｅｉｔｐｏｓｓｉｂｌｅ…     

DIAGNOSIS AND TREATMENT OF INSIDIOUS RECURRENT SMALL INTESTINAL HEMORRHAGE

Objective. To improve the localized diagnosis of insidious recurrent small intestinal hemorrhage. Methods. This retrospective analysis include 64 cases of such diseases, which were admitted from 1988 to 1998 toour hospital. Result. Ultrasonography, CT, small bowel pneumobariunlgraphy, diluted barium enema, isetopic examination, DSA and intraoperafive small-bowel endoscopy were used for diagnosis of hemonrrhagic site, and 37 cases got a defirfite location before operation, while 10 cases were confirmed the diagnosis during the operation. Forty-seven cases were treated surgically, while the other 17 cases had non-surgical treatment. Of the 47 cases,39 cases underwent partial en-terectomy, 5 cases had suture and ligature of vascular deformity, 2 cases had Whipple‘s operation, and one patient had ectomy of the end of ileum and right colon. Conclusion. DSA, Isotopic examination and intraoperafive enteroscopy are of considerable importance for the lo-cation judgement of recurrent small intestinal hemorrhage.     

Hypofluorescent spots in indocyanine green angiography of peau d‘orange and fundus

Purpose. Hypofluorescent spots were seen inindocyanine green (ICG) angiography of peau dorangefundus in eyes with angioid streaks. Origin of the hypofluorescentspots were examined with attention to their correlationwith a peau dorange appearance of the central fundususing a computer-assisted image comparison system. Methods. ICG angiography was performed in 5 patientshaving peau dorange appearance of fundus using ascanning laser ophthalmoscope (SLO) and a digitalvideo-fundus camera. The same central fundus areas corresponding to hypofluorescent spots in an ICGangiogram were then digitally identified in afluorescein angiogram and in a red-free picture in all10 eyes of the 5 patients. Monochromatic lightobservation was also performed with a dark fieldobservation using a SLO to see subretinal orintrachoroidal pigment clumping. Results. In no patient, the areas identified withhypofluorescent spots did show relevant changes ina fluorescein angiogram or a red-free picture. SLOexamination revealed not perfusion defect at the sameareas. The dark field observation showed no pigmentclumping at the peripapillary and papillomacularbundle regions where hypofluorescent spots were seen.Conclusions: Hypofluorescent spots seen in ICGangiograms did not show exact consistency with peau dorange changes in their location and shape. Perfusion defects or blocking by pigments were not acause of hypofluorescent spots. The scatteredhypofluorescent spots were considered to be relevantwith irregular affinity of the fundus to ICG dye.     

Facial haemangioma,agenesis of the internal carotid artery and dysplasia of cerebral cortex: case report

We describe a girl with a facial haemangioma, associated with other vascular anomalies: agenesis of the internal carotid artery, cerebral cortical dysplasia and hypoplasia of the cerebral hemisphere on the same side of the angioma. We studied the patient by conventional arteriography, T1- and T2-weighted MRI and magnetic resonance angiography.     

Additional value of thallium-201 SPECT to a conventional exercise test for the identification of severe coronary lesions after an episode of unstable coronary artery disease

The additional value of thallium-201 SPECT to a conventional exercise test for the identification of patients with severe coronary lesions was evaluated in 170 men, one month after an episode of unstable coronary artery disease. Severe coronary lesions at coronary angiography — defined as three vessel disease, left main stenosis or proximal left anterior descending artery stenosis as part of two vessel disease — were observed in 45.9%. In the SPECT image, the left ventricular myocardium was divided into nine segments and each segment was classified as either normal (=0), reduced uptake (=1) or uptake defect (=2). The sum of gradings in all segments post-exercise was denoted SPECT score. The patients were divided into nine different groups regarding ST-depression during exercise (no ST-depression, ST-depression in 1–2 leads or 3 leads) and SPECT score (no SPECT score, 1–3 scores or 4 scores). Severe coronary lesions were, in 68% identified by SPECT score 4 and in 65% by ST-depression in 1 lead at exercise test. The specificity for identification of severe coronary lesions was, for both tests, 65%. SPECT score 4 and/or ST-depression in 3 leads identified 82% of the patients with severe coronary lesions with a specificity of 63%. Furthermore, SPECT score 3 identified more patients with isolated proximal left anterior descending artery stenosis than ST-depression alone at exercise test.     

食道心房调搏心负荷试验诊断冠心病的价值

目的探讨食道心房调搏心负荷试验（ＴＥＡＰ）诊断冠心病的价值,并与活动平板运动试验（ＴＭＥＴ）进行对比,同时对冠状动脉病变程度进行评估。方法自１９９３年５月～１９９７年１０月,８０例拟诊冠心病的住院病人同期行ＴＥＡＰ、ＴＭＥＴ及ＣＡＧ检查;以ＣＡＧ为诊断标准,确诊为ＣＨＤ者６０例,另２０例为ＣＡＧ正常者。ＣＡＧ均为右股动脉Ｓｅｌｄｉｎｇｅｒ法穿刺,ＪｕｄｋｉｎＳ法进行。ＴＥＡＰ、ＴＭＥＴ以心率达到次极限水平,二阶梯运动试验方法记录ＥＣＧ。结果ＴＥＡＰ诊断ＣＨＤ的敏感性、特异性为８１．６７％、９０％,并且与ＣＨＤ患者冠状动脉病变支数呈正相关。其与ＴＭＥＴ的敏感性、特异性相比更可靠（Ｐ＜０．０１）。结论食道心房调搏心负荷试验可以作为一种无创伤性、有效、简便的诊断ＣＨＤ的方法。并可对冠状动脉病变程度进行初略评估。     

脑动静脉畸形影像学诊断方法的评价

目的评价数字减影血管造影（ＤＳＡ）、磁共振成像（ＭＲＩ）及磁共振血管造影（ＭＲＡ）在脑动静脉畸形（ＡＶＭ）诊断中的价值。②方法对病理证实的１１３例ＡＶＭ病人皆行ＤＳＡ及ＭＲＩ检查,其中６７例行ＭＲＡ检查。③结果ＤＳＡ表现为密集成球、相互交叉缠绕的血管团或块状血管;ＭＲＩ表现为蜂窝状、葡萄状和条索状流空血管,无明显占位效应;ＭＲＡ显示局部纡曲的血管团,血管分支增多,缠绕在一起。ＤＳＡ及ＭＲＩ对ＡＶＭ的诊断率远高于ＭＲＡ（χ２＝１０６．７,Ｐ＜０．０１）。④结论ＤＳＡ与ＭＲＩ结合使用,对ＡＶＭ的诊断及治疗有重要价值。ＭＲＡ可作为ＭＲＩ的补充用于筛选及ＡＶＭ切除术后随访检查。     

Survey on the use of pulmonary scintigraphy, spiral CT and conventional pulmonary angiography for suspected pulmonary embolism in the British Isles

AIM: To determine current clinical practice in the radiological diagnosis of acute pulmonary embolism and assess the use of spiral volumetric computed tomography. METHOD: A survey of 327 acute hospitals including cardiothoracic and orthopaedic tertiary referral centres was undertaken to assess current utilization of lung scintigraphy, spiral computed tomography and pulmonary angiography in the investigation of suspected pulmonary embolism. Responses were received from 215/327 (66%) centres. RESULTS: Lung scintigraphy was provided by 208 hospitals (144 on-site and 64 off-site). Spiral CT services were provided by 111 (52%) hospitals (on- or off-site), 142 (66%) units had access to angiographic facilities. Sixty-three centres out of 215 (29%) offered both on-site lung scintigraphy and spiral CT while only 41/215 (19%) hospitals were able to undertake all three tests on-site. On average, 501 perfusion (Q) or ventilation-perfusion (V/Q) scintigrams were performed per hospital per year with 26 spiral CT studies and just 4.6 pulmonary angiograms. CONCLUSION: These data suggest that lung scintigraphy is frequently the only imaging test in patients other than chest radiography, despite the large number of indeterminate results reported in most series.