FLASH proton density imaging for improved surface coil intensity correction in quantitative and semi-quantitative SSFP perfusion cardiovascular magnetic resonance

Background

A low excitation flip angle (α < 10°) steady-state free precession (SSFP) proton-density (PD) reference scan is often used to estimate the B₁-field inhomogeneity for surface coil intensity correction (SCIC) of the saturation-recovery (SR) prepared high flip angle (α = 40-50°) SSFP myocardial perfusion images. The different SSFP off-resonance response for these two flip angles might lead to suboptimal SCIC when there is a spatial variation in the background B₀-field. The low flip angle SSFP-PD frames are more prone to parallel imaging banding artifacts in the presence of off-resonance. The use of FLASH-PD frames would eliminate both the banding artifacts and the uneven frequency response in the presence of off-resonance in the surface coil inhomogeneity estimate and improve homogeneity of semi-quantitative and quantitative perfusion measurements.

Methods

B₀-field maps, SSFP and FLASH-PD frames were acquired in 10 healthy volunteers to analyze the SSFP off-resonance response. Furthermore, perfusion scans preceded by both FLASH and SSFP-PD frames from 10 patients with no myocardial infarction were analyzed semi-quantitatively and quantitatively (rest n = 10 and stress n = 1). Intra-subject myocardial blood flow (MBF) coefficient of variation (CoV) over the whole left ventricle (LV), as well as intra-subject peak contrast (CE) and upslope (SLP) standard deviation (SD) over 6 LV sectors were investigated.

Results

In the 6 out of 10 cases where artifacts were apparent in the LV ROI of the SSFP-PD images, all three variability metrics were statistically significantly lower when using the FLASH-PD frames as input for the SCIC (CoV_MBF-FLASH = 0.3 ± 0.1, CoV_MBF-SSFP = 0.4 ± 0.1, p = 0.03; SD_CE-FLASH = 10 ± 2, SD_CE-SSFP = 32 ± 7, p = 0.01; SD_SLP-FLASH = 0.02 ± 0.01, SD_SLP-SSFP = 0.06 ± 0.02, p = 0.03). Example rest and stress data sets from the patient pool demonstrate that the low flip angle SSFP protocol can exhibit severe ghosting artifacts originating from off-resonance banding artifacts at the edges of the field of view that parallel imaging is not able to unfold. These artifacts lead to errors in the quantitative perfusion maps and the semi-quantitative perfusion indexes, such as false positives. It is shown that this can be avoided by using FLASH-PD frames as input for the SCIC.

Conclusions

FLASH-PD images are recommended as input for SCIC of SSFP perfusion images instead of low flip angle SSFP-PD images.     

平衡计分卡在医院成本控制中的应用研究

平衡计分卡作为一种先进的战略管理工具,在医院成本控制中的应用有利于达成成本管理的目标,为医院的战略管理服务.本文综述了平衡计分卡在医院成本控制中的应用研究.     

基层卫生监督所绩效评价BSC＆KPI的建立

目的：把BSC＆KPI工具引入基层卫生监督所的绩效评价,设计出适合基层卫生监督所的组织绩效评价指标体系。方法：采用访谈、参与式调查等方法对某基层卫生监督所的组织内外环境、人员现状、组织结构、工作职责、管理相对人现状、目标体系等进行深入分析;借鉴平衡记分卡（BSC）的逻辑框架设计关键绩效指标（KPI）;采用模糊评价法对平衡记分卡进行量化和直观评价。结果：借鉴平衡记分卡的理念,设计基层卫生监督所组织绩效评价的BSC＆KPI体系,可以全面衡量基层卫生监督所的组织绩效。结论：成功建立基层卫生监督所绩效评价BSC＆KPI体系。     

张力平衡针法对脑卒中后足下垂内翻患者运动功能及生活能力的影响

目的:比较张力平衡针法与常规针刺对脑卒中后足下垂内翻患者运动功能及生活能力影响的差异。方法:将70例患者随机分为张力平衡针法组和常规针法组,每组35例。张力平衡针法组先取伸肌侧穴位三阴交、太溪,行弱化手法,再取屈肌侧穴位解溪、申脉、阳陵泉,行强化手法;常规针法组穴取足三里、三阴交、悬钟等行常规针刺,两组均每日治疗1次,10次为一疗程,治疗3个疗程。两组均于治疗前后评定患侧下肢Fugl-Meyer运动功能评分、Barthel指数评分的变化。结果:治疗3个疗程后,两组患者Fugl-Meyer运动功能评分、Barthel指数评分均增加(均P<0.01),张力平衡针法组优于常规针法组(均P<0.05),张力平衡针法组于第2疗程后即改善明显(均P<0.01),且改善优于常规针法组(均P<0.05)。结论:两种针法均能改善脑卒中后足下垂内翻患者的运动功能及生活能力,且张力平衡针法见效快,疗效更优。     

平衡镇痛在肛肠病术后的临床应用

为探讨平衡镇痛的效果,将190例肛肠病手术患者随机分为两组,平衡镇痛组采用平衡镇痛（98例）,常规镇痛组采用常规镇痛（92例）,观察其术后疼痛、不良反应、疗程等。结果表明,平衡镇痛组在术后镇痛效果和减少部分并发症方面优于常规镇痛组。     

Early interventions and lessons from Harvard Business Review

Aim: To describe the establishment and development of an Early Psychosis Intervention Programme in Singapore that is based on a business model and with concepts drawn from the corporate world. Methods: The author who directed this programme describes the circumstances that led to this initiative, the ideas borrowed and adapted from the corporate world, and the lessons learnt in setting up this intervention programme. The modus operandi of the programme is based on the Balanced Scorecard – a model which stresses four equally important components: customers, internal processes, financial health and learning and innovation. Other complementary actions like creating a sense of urgency, forging a vision with a core ideology, empowerment of team members, creating short‐term wins, anchoring the changes and finding meaning in the work are vital for the programme to thrive. Results: This model also emphasizes the importance of accountability through the measurability of indicators. These indicators included a significant reduction in the duration of untreated psychosis, a positive change in the referral patterns with better engagement of the primary health‐care sector and an improvement in the quality of care for the patients. Conclusions: Much can be learnt from the business world in building and maintaining a public mental health programme. Effective change also requires effective leadership, and the successful implementation of certain strategic steps.     

Two chromosomal syndromes in the same family: Monosomy and trisomy for part of the short arm of chromosome 10

A grandfather with balanced translocation t(110) gave rise to three possible combinations involving chromosome 10: balanced translocation and trisomy for part of the short arm 10p13pter in the second generation, and mono- and trisomy 10p13pter in the third generation.The clinical signs and symptoms of the present case with monosomy 10p13pter are compared with those of 9 earlier reported cases with a deleted 10p. Together they represent a clinically recognizable syndrome with antimongoloid eye slant, ptosis, epicanthus, high arched or cleft palate, flat nasal bridge, micrognathia, small round and low-set ears, wide spaced nipples, cardiac and urinary tract abnormalities, hand and foot anomalies, hypoplasia/absence of the olfactory bulbs/tracts, psychomotor and growth retardation.More than 20 cases of the trisomy 10p syndrome have been described earlier. The most constant clinical findings are mental retardation, dolichocephaly, frontal bossing, broad nasal bridge, cheilo-palatoschisis, retrognathia and variable internal malformations. We found, however, the clinical characteristics in this syndrome more variable than for the monosomy 10p13pter syndrome. Our two cases, representing the eldest and the youngest described, have rather few of the typical characteristics, and few in common with each other. This indicates the difficulty in making this diagnosis on clinical features only without a cytogenetic verification.Corresponding author     

New chromosomal dysmorphic syndromes

This is the report of two independent families in which a balanced maternal translocation led to trisomy 12p in one of each their offspring. Evaluation of 21 further case reports indicates that this is a phenotypically well defined syndrome which leads to severe developmental retardation. It can be recognized by a characteristic combination of craniofacial anomalies which are summarized in a phantom picture. The gene sequences which produce the typical features in the trisomic state must be localized distally to band 12p 12, which is the breakpoint in the partial trisomies. The specific craniofacial anomalies are not visibly modified by the length of the trisomic segment or additional small monosomies or trisomies of recipient chromosomes. However, the frequency and severity of organ malformations and the resulting probability of survival seem to decrease with increasing degrees of chromosomal imbalance. A cytogenetic classification of the 21 inherited translocations and a segregation analysis from the pedigree data was performed. For the different types of translocations the calculated risk figures are given.     

平衡膳食对脂肪肝干预效果的实验研究

目的:采用临床流行病学方法研究平衡膳食与脂肪肝的治疗效果。方法:采用临床实验方法将脂肪肝患者随机分为干预组和对照组,干预组给予低胆固醇、低热能、高维生素、高膳食纤维的治疗膳食,对照组不控制饮食。分别观察2组干预1个半月前后的临床症状、体征,同时监测血脂、肝功能及肝脏B超和CT形态学变化。结果:干预后饮食治疗组的肝功、血脂及肝脏B超和CT形态学改变与对照组比较差异有统计学意义(P<0.01),干预组总有效率(显效 有效)为87.89%,对照组总有效率16.32%。两组比较差异有统计学意义(P<0.01)。结论:饮食对脂肪肝有确切疗效,低热能、低脂、高维生素、高膳食纤维持续的平衡膳食治疗即可达到治疗脂肪肝目的,并可明显改善肝功能、血脂及肝脏组织影像学结果。     

A de novo translocation in a family with a balanced reciprocal chromosomal translocation

A carrier of a reciprocal translocation between chromosomes 10 and 18 had a child with a reciprocal translocation involving different segments of the same chromosomes. The categories of possible meiotic errors in carriers of balanced rearrangements must, therefore, be expanded to include new reciprocal translocations.