缺血性卒中患者高分辨磁共振血管壁成像特点及价值

目的　分析缺血性卒中患者高分辨磁共振血管壁成像（HR-VWI）特点及价值。方法　选取2020年10月至2021年12月聊城市第三人民医院收治的60例缺血性卒中患者为研究对象进行前瞻性研究，其中男34例，女26例，年龄25～75（53.27±6.22）岁。根据患者症状、病史、实验室检查及常规影像学检查进行初步中国缺血性卒中亚型（CISS）分型，且经HR-VWI检查后再次行CISS分型，对比HR-VWI检查前后CISS分型，分析血管壁成像特点，并根据患者斑块与缺血区责任动脉的关系分为责任斑块组（20例）与非责任斑块组（16例）。计量资料采用t检验，计数资料行χ²检验，分析两组的HR-VWI特征。结果　初步CISS分型为：大动脉粥样硬化型（LAA）20例（33.33%），心源性卒中型（CS）6例（10.00%），穿支动脉病变型（PAD）17例（28.33%），其他病因型（OE）1例（1.67%），病因不确定型（UE）16例（26.67%）。60例患者HR-VWI检查后60.00%（36/60）分型一致，40.00%（24/60）分型不一致。HR-VWI检查后大动脉粥样硬化型所占的比例升高了35.00%，穿支动脉病变型所占的比例下降23.33%，不明原因型所占的比例降低了13.33%，HR-VWI检查前后CISS分型率比较，差异有统计学意义（χ²=17.833，P<0.05）。60例患者经HR-VWI检查颅内血管，30.00％（18例，25支）患者颅内血管壁未见明显异常，10.00％（6例，11支）患者发现管壁增厚，60.00％（36例，96支）患者颅内血管上发现粥样硬化斑块存在。责任斑块组管腔狭窄≥50％、斑块位置位于大脑中动脉、斑块明显强化者比例为40.00％（8/20）、55.00％（11/20）、50.00％（10/20），均高于非责任斑块组［6.25％（1/16）、25.00％（4/16）、6.25％（1/16）］，差异均有统计学意义（χ²=5.400、8.730、8.048，均P<0.05）；责任斑块组管壁面积为（14.33±2.87）mm²，高于非责任斑块组的（11.76±1.14）mm²；管腔面积为（2.96±0.40）mm²，低于非责任斑块组的（5.44±1.29）mm²；狭窄率为（70.44±3.96）％，高于非责任斑块组的（39.15±2.04）％，差异均有统计学意义（t=3.368、8.147、28.654，均P<0.05），责任斑块组管腔狭窄以<50％位置，斑块位置多见大脑中动脉与基底动脉，斑块强化成明显强化，管壁面积较大，管腔面积较小，狭窄率较高。结论　HR-VWI可识别缺血性卒中患者颅内动脉病变，评估动脉硬化血管状态，为指导临床治疗决策及预后判断提供一定依据。     

下肢血管旁路移植术后的彩色多普勒超声检查

目的 研究彩色多普勒超声（Ｃｏｌｏｒ Ｄｏｐｐｌｅｒ Ｕｔｒａｓｏｕｎｄ以下简称ＣＤＵＳ）检查下肢移植血管的价值、方法、阳性指标的出现时间以及阳性率。方法 运用ＣＤＵＳ诊断仪检查下肢血管旁路移植术后病人３５２例。在检查中需密切注意血流色彩、多普勒频谱及流速的改变以及血管内径的变化，以流速改变最为重要。根据血流速度的变化确定狭窄的程度。结果 超声诊断为血管狭窄的有１２５例（１３０处）。其中，狭窄５０     

Efecto de la acetazolamida en la vasculatura retiniana y coroidea de la mácula y el disco óptico mediante angiografía OCT

Introduction and objectivesTo investigate the effect of acetazolamide (AZ) on the retinal and choroidal ocular microvasculature in the macula and radial peripapillary capillaries (RPC) of the optic disc with OCT Angiography (OCTA).Materials and methodsNine-month observational cross-sectional study. Forty-five eyes from 45 healthy participants who underwent cataract surgery were recruited. Macular retina and choriocapillaris vessel density (VD) and RPC VD in the optic disc area were compared before and 60 minutes after 250 mg acetazolamide per os. Intraocular pressure (IOP) and systemic blood pressure (BP) were also measured before each scan.ResultsMean age was 73.1 ± 6.9 years. VDs in the superficial (SCP) and deep (DCP) capillary plexus of the retina and the choriocapillaris (CC) in the macular area showed no significant change (p > 0.5, for all parameters). VD in the RPC showed no significant change with AZ (p > 0.5, for all parameters). Foveal and parafoveal thickness increased from 248.98 (±23.89) to 250.33 (±23.74) and from 311.62 (±16.53) to 311.98 (±16.38) (p < 0.001 and p = 0.046), respectively. IOP decreased from 13.2 (±3.0) mmHg to 11.8 (±3.2) mmHg (p < 0.001), while systolic and diastolic BP decreased from 144.8 (±21.8) to 137.7 (±19.0) and from 80.0 (±12.7) to 76.2 (±11.7) (p = 0.021 and p = 0.030), respectively.ConclusionsOCTA imaging did not reveal any significant changes in the VD of the optic disc or the retinal and choroidal VD in the macula with oral AZ one hour after its administration in otherwise healthy participants who underwent cataract surgery.     

Elevated Hypoperfusion Intensity Ratio (HIR) observed in patients with a large vessel occlusion (LVO) presenting in the evening

BackgroundCircadian variability has been implicated in timing of stroke onset, yet the full impact of underlying biological rhythms on acute stroke perfusion patterns is not known. We aimed to describe the relationship between time of stroke onset and perfusion profiles in patients with large vessel occlusion (LVO).MethodsA retrospective observational study was conducted using prospective registries of four stroke centers across North America and Europe with systematic use of perfusion imaging in clinical care. Included patients had stroke due to ICA, M1 or M2 occlusion and baseline perfusion imaging performed within 24h from last-seen-well (LSW). Stroke onset was divided into eight hour intervals: (1) Night: 23:00-6:59, (2) Day: 7:00-14:59, (3) Evening: 15:00-22:59. Core volume was estimated on CT perfusion (rCBF <30%) or DWI-MRI (ADC <620) and the collateral circulation was estimated with the Hypoperfusion Intensity Ratio (HIR = [Tmax>10s]/[Tmax>6s]). Non-parametric testing was conducted using SPSS to account for the non-normalized dependent variables.ResultsA total of 1506 cases were included (median age 74.9 years, IQR 63.0-84.0). Median NIHSS, core volumes, and HIR were 14.0 (IQR 8.0-20.0), 13.0mL (IQR 0.0-42.0), and 0.4 (IQR 0.2-0.6) respectively. Most strokes occurred during the Day (n = 666, 44.2%), compared to Night (n = 360, 23.9%), and Evening (n = 480, 31.9%). HIR was highest, indicating worse collaterals, in the Evening compared to the other timepoints (p = 0.006). Controlling for age and time to imaging, Evening strokes had significantly higher HIR compared to Day (p = 0.013).ConclusionOur retrospective analysis suggests that HIR is significantly higher in the evening, indicating poorer collateral activation which may lead to larger core volumes in these patients.