Streaking artifact reduction for quantitative susceptibility mapping of sources with large dynamic range

Quantitative susceptibility mapping (QSM) is a novel MRI technique for the measurement of tissue magnetic susceptibility in three dimensions. Although numerous algorithms have been developed to solve this ill‐posed inverse problem, the estimation of susceptibility maps with a wide range of values is still problematic. In cases such as large veins, contrast agent uptake and intracranial hemorrhages, extreme susceptibility values in focal areas cause severe streaking artifacts. To enable the reduction of these artifacts, whilst preserving subtle susceptibility contrast, a two‐level QSM reconstruction algorithm (streaking artifact reduction for QSM, STAR‐QSM) was developed in this study by tuning a regularization parameter to automatically reconstruct both large and small susceptibility values. Compared with current state‐of‐the‐art QSM methods, such as the improved sparse linear equation and least‐squares (iLSQR) algorithm, STAR‐QSM significantly reduced the streaking artifacts, whilst preserving the sharp boundaries for blood vessels of mouse brains in vivo and fine anatomical details of high‐resolution mouse brains ex vivo. Brain image data from patients with cerebral hematoma and multiple sclerosis further illustrated the superiority of this method in reducing streaking artifacts caused by large susceptibility sources, whilst maintaining sharp anatomical details. STAR‐QSM is implemented in STI Suite, a comprehensive shareware for susceptibility imaging and quantification. Copyright © 2015 John Wiley & Sons, Ltd.     

单孔双管闭式引流治疗硬膜下血肿的疗效探讨

目的 探讨单孔双管闭式引流治疗慢性硬膜下血肿的临床疗效.方法 将104例慢性硬膜下血肿患者随机分为三组:单孔双管引流组(观察组,37例)、单孔单管额部引流组(对照组1,34例)及单孔单管顶枕部引流组(对照组2,33例).观察两组患者手术情况及住院时间、术后恢复情况及复发情况等指标.结果 三组患者在手术时间、术中出血量、平均住院时间、术后住院时间及住院费用差异均无统计学意义(均P＞0.05).观察组中线恢复情况均明显高于对照组1、对照组2(均P＜0.05)；颅内积气量由低到高依次为观察组、对照组2、对照组1,残留液体量由低到高依次为观察组、对照组1、对照组2,差异均有统计学意义(均P＜0.05).全部患者均无严重并发症发生.结论 单孔双管闭式引流具有较好的临床疗效,可显著减少术后残留液体量和颅内积气.     

Relationship of plasma matrix metalloproteinase-9 and hematoma expansion in acute hypertensive cerebral hemorrhage

In the present study, we aimed to investigate the relationship of plasma matrix metalloproteinase-9 (MMP-9) and hematoma expansion (HE) in acute hypertensive cerebral hemorrhage (AHCH) (HE-in-AHCH). Patients with hypertensive cerebral hemorrhage, confirmed by head computed tomography (CT) within 12 h of onset, were prospectively collected. Venous blood was sampled within 4 h of the confirmation to determine the serum MMP-9 concentration. The blood pressure and National Institute of Health Stroke Score of the patients were recorded on hospital admission. CT re-scanning was performed within 42–54 h of the first head CT examination or immediately after worsening of the patients’ consciousness disorder. The relationship between MMP-9 level and HE was analyzed. A total of 186 patients were included. Of these patients, 41 had HE (22.0%). Multivariate logistic regression analysis showed that, in addition to the short interval between onset and the first CT examination, and the irregularity of hematoma shape, increasing MMP-9 level was an independent risk factor for HE-in-AHCH (OR value = 15.65, 95% CI: 5.30–46.15). Moreover, increasing plasma MMP-9 level was identified as an independent risk factor in patients with HE-in-AHCH.     

早期先兆流产合并绒毛膜下血肿的影响因素及中医证型分布规律

目的探讨早期先兆流产合并绒毛膜下血肿的影响因素,及中医证型在早期先兆流产合并绒毛膜下血肿患者不同孕周的分布规律。方法选取2017年3月～2018年3月期间江西省妇幼保健院确诊的100例早期先兆流产合并绒毛膜下血肿并住院治疗的患者为研究组,另选择100例本院待产人群中孕早期无先兆流产症状者为对照组。比较两组不良生活习惯(包括接触化学污染物、严重负面情绪、服用激素药物)、流产次数及早期先兆流产合并绒毛膜下血肿的中医证型分布规律(包括血瘀阻滞证、湿热内蕴证、阴虚血热证、血热证、气血虚弱证、肾气亏虚证)。结果研究组不良生活习惯明显高于对照组(P0.05);研究组流产次数与对照组比较有明显差异(P0.05);早期先兆流产合并绒毛膜下血肿患者不同孕周的中医证型分布规律差异有统计学意义(P0.05)。结论患者的不良生活习惯和流产次数是早期先兆流产合并绒毛膜下血肿的主要影响因素;孕妇的孕周和早期先兆流产合并绒毛膜下血肿的中医证型分布有密切关系,且肾气亏虚证是早期先兆流产合并绒毛膜下血肿中医证型的主要证型。     

A Patient with Classical Polyarteritis Nodosa Evolving into End Stage Renal Failure

Classical polyarteritis nodosa (c-PAN) is a form of systemic necrotizing vasculitis mainly affecting medium-size arteries, is not associated with renal glomerular disease and acute renal failure. Perirenal hematoma can be seen in up to fifty percent of c-PAN patients and minority of them develop mild renal impairment. Herein, we describe a 34-year-old male with c-PAN who presented with rapidly progressive renal failure and evolved into end stage renal disease.     

大脑中动脉瘤伴侧裂区血肿的诊治策略

目的 探讨大脑中动脉动脉瘤(MCAAs)伴侧裂区血肿的诊断及手术治疗经验. 方法 同顾性分析解放军总医院神经外科自2006年11月至2011年5月收治的21例MCAAs伴侧裂区血肿患者的临床资料,探讨显微外科手术治疗MCAAs伴侧裂区血肿的经验. 结果 本组患者中12例行单纯动脉瘤夹夹闭,8例行动脉瘤重新塑形并多枚动脉瘤夹夹毕,1例行动脉瘤孤立、颞浅动脉大脑中动脉架桥术;患者出院时GOS评分:4～5分16例;3分3例;2分1例;1分1例,其中神经功能障碍好转者15例,神经功能障碍无变化4例,神经功能障碍加重者1例,死亡1例. 结论 MCAAs伴侧裂区血肿,应防止误诊为高血压脑出血,显微外科手术中行载瘤动脉血流监测及体感诱发电位监测可提高治疗效果.     

颅内血肿微创清除术联合亚低温治疗高血压脑出血的临床疗效研究

目的探讨颅内血肿微创清除术联合亚低温治疗高血压脑出血的临床疗效。方法将符合标准的51例高血压脑出血患者,随机分成观察组(26例)和对照组(25例),观察组使用微创清除术联合亚低温进行治疗,对照组使用单独微创清除术进行治疗。比较2组患者治疗后的疗效及格拉斯哥(GCS)评分神经功能缺损(CSS)程度评分。结果观察组治愈率与总有效率分别为23.1%,88.5%,均显著性高于对照组的4.0%,48.0%(P0.05)。术后7d与14d观察组GCS评分为6.77±1.80与9.38±2.92,均显著性高于对照组的4.62±1.74与4.55±2.85(P0.05)。术后7d、14d、21d观察组患者CSS评分分别为28.3±6.1、20.1±6.9与13.5±6.1,均显著性低于对照组的34.8±5.7、30.9±6.5与27.5±7.8(P0.05)。结论使用微创血肿清除术联合亚低温治疗HICH具有明显的疗效,同时对患者的预后具有较为明显的改善作用,值得临床推广使用。     

Acute Spontaneous Spinal Subdural Hematoma with Vague Symptoms

Spinal subdural hematoma is a rarely reported disease and spontaneous spinal subdural hematomas (SSDH) without underlying pathological changes are even rarer. The patients usually show typical symtoms such as back pain, quadriplegia, paraplegia or sensory change. But rarely, patients may show atypical symptoms such as hemiparesis and misdiagnosed to cerebrovascular accident. We recently experienced a case of SSDH, where the patient initially showed vague symptoms, such as the sudden onset of headache which we initially misdiagnosed as subarachnoid hemorrhage. In this case, the headache of patient improved but the neck pain persisted until hospital day 5. Therefre, we conducted the MRI of cervical spine and finally confirmed SSDH. The patient was managed conservatively and improved without recurrence. In this case report, we discuss the clinical features of SSDH with emphasis on the importance of an early diagnosis.