超选择性颈外动脉栓塞术在颌面部大出血急救中的应用

目的探讨超选择性颈外动脉栓塞术在颌面部大出血急救中的应用价值。方法对7例颌面部大出血患者紧急行超选择性颈外动脉栓塞术,通过数字血管减影造影技术,选择性地栓塞舌动脉、颌外动脉、颌内动脉等颈外动脉分支,观察止血的效果。结果应用超选择性颈外动脉栓塞术后,5例患者完全止血,2例患者基本止血,未出现栓塞术并发症。结论超选择性颈外动脉栓塞术是一种快速、安全、有效治疗颌面部大出血的新方法。     

Errors in Patient Positioning for Bone Mineral Density Assessment by Dual X-Ray Absorptiometry: Effect of Technologist Retraining

Improper positioning is one of the factors that can lead to incorrect bone mineral density (BMD) results. This study aimed to assess the frequencies of erroneous positioning during three periods: before retraining of the technologists (BR), after retraining (AR), and at the current timepoint 8 years after retraining (C). The BMD images of the first 150 consecutive patients who underwent DXA of the lumbar spine and hip during each of the three periods were retrospectively reviewed. Patients were excluded if they had severe scoliosis, rendering proper positioning impossible. Each BMD image was assessed by an International Society of Clinical Densitometry certified clinical densitometrist who was blinded to the date of the initial examination. For the lumbar spine in the BR group, the criteria frequently not met were inclusion of both iliac crests (33.8%), straightness (30.3%), and midline positioning (20.4%); the respective frequencies were significantly reduced to 0.8%?5.6%, 2.1%?3.0%, and 0%?2.8% in the AR and C groups (p < 0.05). For the hip in the BR group, the criteria frequently not met were straightness (52.8%) and internal rotation (21.8%); the respective frequencies were significantly reduced to 0%?4.2% and 8.3%?8.4% in the AR and C groups (p < 0.05). Overall improper positioning in the BR group was 49.3% and 57.3% at the lumbar spine and the hip, respectively; the respective frequencies were reduced to 9.3% and 12.7% in the AR group, and to 2.7% and 7.3% in the C group. The least significant change values for the lumbar spine, femoral neck, and total hip also became smaller after retraining. Retraining the technologists improved patient positioning, as evidenced by the decreased frequencies of erroneous positioning and the improved least significant change values after the retraining.     

Noise-Optimized Virtual Monoenergetic Dual-Energy CT Improves Diagnostic Accuracy for the Detection of Active Arterial Bleeding of the Abdomen

Purpose

To evaluate diagnostic accuracy of a noise-optimized virtual monoenergetic imaging (VMI+) reconstruction technique for detection of active arterial abdominal bleeding on dual-energy (DE) CT angiography compared with standard image reconstruction.

蛛网膜下腔出血临床与数字减影血管造影术分析(附23例报告)

目的 分析自发性蛛网膜下腔出血（ＳＡＨ）的临床与数字减影血管造影术（ＤＳＡ）的特点。方法 回顾性分析２３例ＳＡＨ患者症状、病因、预后及ＤＳＡ检查。结果 头痛、呕吐、脑膜刺激征阳性是ＳＡＨ主要症状。经ＤＳＡ发现,２３种中２０例有脑动脉瘤,２例为多发;共计２２个动脉瘤,２１个位于Ｗｉｌｌｉｓ环,１４个位于前交通动脉。９例行手术治疗,５例行介入治疗,７例内科保守治疗,除２例死亡外,２１例均痊愈。接受ＣＳ     

PACS诊断工作站匹配小型DSA在介入治疗中的应用

目的 探讨PACS诊断工作站与小型DSA匹配在介入治疗中的应用价值。方法 PACS诊断工作站通过视频采集一转换方式采集岛津公司的WHA-50N／S小型DSA的PH-DSA方式获得的视频图像，使用DIGOM 3．0国际标准。对采用该系统检查治疗的67例图像资料进行分析，评价该工作站的使用效能。结果 将PACS诊断工作站与小型DSA相接后，将原来的PH-DSA视频图像转变为10～25帧／S的数字DSA图像，可上传输至PACS，达到资料共享。提高了图像后处理的功能。应用该系统获得的数字图像能够保持原设备的清晰程度，无明显失真，可以显示1～2mm的3～4级血管。结论采用小型DSA与PACS诊断工作站相匹配，可以为介入治疗的开展提供可靠的保障。     

二氧化碳肝动脉造影在显示肝癌门脉癌栓中的作用

目的:探索二氧化碳肝动脉造影造影在显示肝癌患者门脉癌栓中的作用。材料与方法:120例肝癌患者二氧化碳和碘造影剂肝动脉造影,比较两组门静脉显示情况以及门脉癌栓的显示率。结果:二氧化碳造影显示门静脉41例,碘造影剂显示19例,该19例门脉均被二氧化碳造影所发现,两组有显著性差异(χ2=43.497,P=0.000)。二氧化碳显示门脉癌栓者27例,而碘造影剂显示13例,两组有显著差异(χ2=5.880,P=0.015)。结论:二氧化碳肝动脉在显示HCC患者门静脉及其癌栓方面优于碘造影剂。     

Evaluation of Computer-Assisted Quantification of Carotid Artery Stenosis

The purpose of this study was to evaluate the influence of advanced software assistance on the assessment of carotid artery stenosis; particularly, the inter-observer variability of readers with different level of experience is to be investigated. Forty patients with suspected carotid artery stenosis received head and neck dual-energy CT angiography as part of their pre-interventional workup. Four blinded readers with different levels of experience performed standard imaging interpretation. At least 1 day later, they performed quantification using an advanced vessel analysis software including automatic dual-energy bone and hard plaque removal, automatic and semiautomatic vessel segmentation, as well as creation of curved planar reformation. Results were evaluated for the reproducibility of stenosis quantification of different readers by calculating the kappa and correlation values. Consensus reading of the two most experienced readers was used as the standard of reference. For standard imaging interpretation, experienced readers reached very good (k = 0.85) and good (k = 0.78) inter-observer variability. Inexperienced readers achieved moderate (k = 0.6) and fair (k = 0.24) results. Sensitivity values 80%, 91%, 83%, 77% and specificity values 100%, 84%, 82%, 53% were achieved for significant area stenosis >70%. For grading using advanced vessel analysis software, all readers achieved good inter-observer variability (k = 0.77, 0.72, 0.71, and 0.77). Specificity values of 97%, 95%, 95%, 93% and sensitivity values of 84%, 78%, 86%, 92% were achieved. In conclusion, when supported by advanced vessel analysis software, experienced readers are able to achieve good reproducibility. Even inexperienced readers are able to achieve good results in the assessment of carotid artery stenosis when using advanced vessel analysis software.     

上矢状窦旁桥静脉的显微解剖与影像学观察

目的:通过对上矢状窦(SSS)旁大脑桥静脉的显微解剖、影像学观察及其对照研究,为各种纵裂间手术入路中桥静脉的保护提供基础。方法:分别对30例(60侧)上矢状窦和颈内静脉内灌注蓝色乳胶的成人头颅湿标本、40侧DSA静脉相和16侧CTV进行显微解剖和影像学观察。结果:上矢状窦前部和后部分别有一缺乏桥静脉注入段,显微解剖、DSA和CTV观察上矢状窦旁桥静脉的数量分别为11.2支、8.9支和7.0支,DSA和CTV观察发现桥静脉注入上矢状窦处常显示不清。结论:熟悉和比较上矢状窦旁桥静脉的解剖学和影像学特征有利于各种纵裂间手术入路和手术过程中桥静脉的保护。     

血管DSA中路图图像质量控制的研究

目的解决在腹部出现的血管DSA路图图像中影响诊断和治疗的图像质量问题,主要包括血管失真、边缘模糊、背景减影程度不够、成像区域中过饱和、注入药物路图不清晰等情况。方法组1肝癌患者30例,其中男性23例,女性7例;年龄32～65岁,平均年龄51岁。组2肝癌患者30例,其中男性18例,女性12例;年龄27～54岁,平均年龄48岁。组1采用调整前造影方案。针对肝癌的患者DSA过程中的路图图像,分析影响其质量下降的因素,并对这些因素进行调整,用于组2造影。具体包括路图中透视图像血管图像叠加的数量由3调整为1、实时背景衰减因素由1.4调整为1.0、透视减影增益步长由14调整为11、整体图像的亮度由0.63调整为0.76、对比度由1.00调整为0.94等,同时请3位介入临床医生评价调整后的图像质量,达到满意为止。结果组1患者30例中,路图图像质量优0例（0%）,良6例（20%）,差24例（80%）;组2病例中,优27例（90%）,良3例（10%）,差0例（0%）。调整的这些参数确实使路图图像得到了改善,调整后的路图图像血管清晰、边缘清楚及背景、亮度、对比度、成像区域过饱和情况得到改善,图像能够满足医生的诊断和治疗要求。结论由于在腹部特别是横膈附近运动幅度比较大,原先预置的与路图相关参数不能满足临床图像要求,这些参数的调整解决了路图图像质量的问题,达到了临床诊断的要求。     

一种免疫荧光图像减影技术在鉴定drebrin E亚型的应用

目的:在缺乏drebrin E抗体的情况下利用一种新的免疫荧光计算机图像减影技术的方法鉴定drebrinE亚型。方法:应用drebrin非特异性抗体M2F6和drebrin A特异性抗体DAS2对成年大鼠脑冰冻切片进行双重免疫荧光染色,然后用计算机图像处理软件对同一切片的两种染色照片进行图像减影技术处理,观察drebrin E在成年大鼠脑中的分布情况。结果:通过免疫荧光计算机图像减影技术得到了drebrin E亚型的图像,确认了drebrin E在成年大鼠脑中吻侧迁移流、海马齿状回、梨状皮质的分布。结论:利用免疫荧光图像减影技术可以实现对drebrin E亚型的鉴定,为类似drebrin这样存在两种亚型的蛋白质鉴定提供了一种新的方法。