高分辨MRI对颈动脉粥样硬化斑块成分显示的病理对照研究

目的分析和评价高分辨MRI对颈动脉粥样硬化斑块不同成分的显示效果,为颈动脉内膜切除术术前判断斑块稳定性提供参考。方法对26例行颈动脉内膜切除术的颈动脉粥样硬化性狭窄患者术前高分辨MRI 4种不同序列的影像(T1WI、T2WI、PDWI和3D TOF)与斑块标本病理进行逐层对照,分析斑块内不同成分的MRI影像特点。结果获得斑块28块,切为238段,主要分布于颈总动脉和颈内动脉,以复杂斑块为特征的Ⅳ～Ⅴ型58段(24.37%)和Ⅵ型79段(33.19%)为主;斑块内纤维帽主要表现为TOF序列的带状低信号,钙化和纤维化组织分别表现为在各序列影像上的不规则低信号和不特定信号,脂质池和坏死核呈T1WI、PDWI和3D TOF序列的等至稍高信号,近期出血表现为T1WI、T2WI和PDWI序列的明显高信号。结论高分辨MRI不仅可以清晰显示动脉粥样硬化斑块,进行动脉管腔狭窄程度的测定,通过多序列影像联合分析还可以分辨斑块内部不同成分,有助于术前对斑块稳定性的判断。     

Effect of Short-Term Ethanol Feeding on Rat Testes as Assessed by 31P NMR Spectroscopy, 1H NMR Imaging, and Biochemical Methods

31P Nuclear magnetic resonance (NMR) spectroscopy and 1H NMR imaging were used to examine the effect of short-term ethanol feeding on the rat testis. Weanling rats were pair-fed for 10 weeks either on ethanol containing liquid diet (36% ethanol of total calories) or a diet in which dextrimaltose was isocalorically substituted for the ethanol of the alcohol-containing diet. In vivo 31P NMR of the testes was used to determine the intratesticular pH and the relative concentrations of various phosphorus-containing metabolites. The integrity of the blood-testes barrier was evaluated using 1H NMR imaging following a gadolinium diethylene tetramine pentaacetic acid derivative (Gd-DTPA) administration as a vascular contrast agent. After the completion of NMR studies, the testis and the liver were freeze-clamped to allow for the assay of their adenosine-5'-triphosphate (ATP) contents. Serum was assayed for its content of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alcohol and testosterone. Ethanol feeding resulted in the following: (a) a reduction in the body weight (p less than 0.05), (b) a reduction in the testicular phosphodiesters (PDE) PDE/ATP ratio (p less than 0.05), (c) an increased change in the testis image intensity difference between pre- and post-iv Gd-DTPA images, (c) a reduction in the testicular and hepatic content of ATP, and (d) increased serum levels of AST and ALT.(ABSTRACT TRUNCATED AT 250 WORDS)     

CT仿真结肠内窥镜的临床应用研究

目的:研究CT仿真结肠内窥镜(CT Virtual Colonoscopy,CTVC)的使用价值,应用方法及镜下表现。方法:使用Hispeed FX/i扫描机,扫描层厚3～5mm,螺距1～2,重叠重建率50％～67％。利用Navigator Smooth软件对容积扫描数据进行三维重建,获得仿真结肠内窥镜的影像,并与纤维肠镜和/或手术所见对照分析,全部病例经病理证实。结果:通过选择不同的观察方位,角度和阈值,CTVC能清楚显示靶器官内正常解剖结构的立体影像和病变的部位、大小、形态及其侵犯范围。CTVC对结肠病变形态的显示与FC或/和标本显示具有良好的对应性,另外,CTVC能从闭塞和狭窄的远端观察病变。但CTVC不能显示组织的颜色变化,不能活检。结论:CTVC作为一种新的非侵袭性结肠检查方法,可以作为纤维结肠镜的有效补充手段,有较好的临床应用价值。     

原发性高血压病在平衡法核素心血池显像中的表现(与超声心动图及心机械图比较)

用44例原发性高血压(EH)患者及15例健康人对照组(N)的平衡法心血池显像(MGBP)心功能参数,对比分析了EH组多普勒超声心动图(UCG)及心机械图(MCG)的心脏检测指标.结果示,MGBP检测中 EH 组的左室高峰充盈率(PFR)、右室射血分数(RVEF)、局部射血分数_4(EF_4)及局部轴缩短率_4(RS_4)明显低于对照组(P<0.05～0.01).反映左室舒张功能的PFR与E/A峰比值(UCG)之间呈正相关(r=0.44,P<0.05),PFR与a/Eo(MCG)之间呈负相关(r=-0.87 P<0.01),PFR与左房内径(UCG)之间呈负相关(r=-0.48 P<0.05),反映左室间隔部位改变的EF_4,RS_4与室间隔厚度(UCG)均呈负相关(r=-0.3 P<0.05,;γ=-0.47 P<0.05).     

Practical selection criteria for unenhanced cranial CT in patients with acute headache

We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p<1.5 – 10⁻¹⁰). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable initial guidelines to select for CT patients with an acute headache.     

SARS胸部影像表现与评价(附75例分析)

目的：回顾分析75例严重急性呼吸综合症(SARS)病例，探讨该病影像学表现及其与临床治疗有关的问题。方法：全部75例患者均行胸片检查，一般隔日行影像追踪复查。结果：胸部X线表现为肺实质渗出病灶为主，肺内网状改变及肺门片块影较少。影像表现与临床病程有一定关系。结论：胸部影像表现以肺实质渗出病灶较常见。胸片检查是进行本病诊断和评估病程及疗效的重要方法。     

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目的 探讨辅助检查在诊断亚急性甲状腺炎中的作用。方法 回顾分析372例亚急性甲状腺炎病人所做的各项辅助检查结果。结果 血沉，B超，彩色多普勒，甲状腺核素扫描，甲状腺吸^131I率测定，细针穿刺细胞学，TMA，TGA等项检查诊断本病的阳性率分别为93.75%,81.63%,95.62%,89.66%,69.70%,89.41%,13.46%和9.62%。T3，T4，TSH检查结果随着病程的进展变化较大。结论 血沉检查对诊断本病缺乏特异性；彩色多普勒，细针穿刺细胞学检查诊断率高，特异性强，是首选的检查手段；甲状腺核素扫描可以准确地反映甲状腺功能状态；检测血清中T3，T4，TSH水平可以协助诊断本病，判断疾病所处时期。     

Benefits of the DICOM Structured Report

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change. Biography Rita Noumeir is a professor at the Department of Electrical Engineering of the University of Quebec, école de Technologie Superieure in Montreal. A founding member of the Imaging, Vision, and Artificial Intelligence Laboratory (LIVIA), her main research interest is the Healthcare Information Technology, specifically, Interoperability, Electronic Patient Record, Security, Information Confidentiality, and Image Processing. As a member of both Technical and Planning International IHE Radiology Committees, Dr. Noumeir took part over the last 5 years in developing many Integrating the Healthcare Enterprise (IHE) Integration Profiles in Radiology and in organizing several Integration Demonstrations. She is a cofounder of IHE Canada. Dr. Noumeir contributed to many research and development projects in collaboration with several Canadian and international companies in medical imaging and healthcare information. Currently, she collaborates with the Diagnostic Imaging Team of Canada Health Infoway to define the principles and architecture for sharing imaging information between multiple healthcare institutions. She plays a leading role in the development of this solution that is published as an IHE Integration Profile for which she is the editor. Rita Noumeir holds a Ph.D. and a Masters degree in Biomedical Engineering from école Polytechnique of Montreal specializing in Medical Imaging. She is a professional engineer, and a member of the Ordre des ingénieurs du Québec.     

In vivo fluorescence spectroscopy and imaging of human skin tumours

The feasibility of using in vivo autofluorescence for the diagnosis of skin cancer was evaluated. In vivo fluorescence measurements were performed on healthy human volunteers, and patients with different types of benign and malignant skin tumours. Fluorescence spectra as well as fluorescence images were acquired. The excitation-emission matrix of normal skin (n=3) showed a broad peak at the shortest excitation wavelength (365 nm) and at 440 nm fluorescence wavelength, smoothly decreasing towards longer excitation and fluorescence wavelengths. Non-melanoma skin tumours (n=31) and control skin excited with 375 nm showed a broad fluorescence band from 400 to 700 nm, peaking around 436 nm. No significant differences in measurements between tumours and the corresponding control sites were found. A large spatial variation in the fluorescence intensity was observed both in the tumours and in the control sites. Standard deviations found ranged from 0.15 to 1.5 times the mean fluorescence. Fluorescence images, excited with 375 nm and taken with an image intensified CCD camera, on eight malignant melanomas and eight benign pigmented lesions did not indicate any fluorescence intensity distribution specific to the malignancy of the lesion. Neither the shape of the fluorescence spectra, nor the spatial distribution of the fluorescence intensity showed any signature specific to the histopathological nature of the lesions investigated. Optical diagnostics of skin tumours using the autofluorescence does not seem to be feasible at the present time.     

八例巨大型颈静脉球瘤的影像学研究

目的提高对颈静脉球瘤的影像学认识和诊断。方法对8例经病理明确诊断的颈静脉球瘤的影像学资料进行回顾性分析。结果6例巨大型颈静脉球瘤MRI出现特异型表现,即典型的“盐和胡椒”征;DSA检查不仅能够术前明确肿瘤供血血管,而且同时进行栓塞治疗可减少随后术中出血。结论MRI DSA是巨大型颈静脉球瘤术前最有价值的影像学检查工具。