请分析病变性质

患儿男,2岁.右下肢无力、跛行1周,加重4天.患儿为足月顺产,余无特殊.体检:神清,对光反射存在,双眼球活动自如,颈软,右下肢较左下肢无力且变细,左侧肢体肌力V级,右侧肢体Ⅳ级.肌张力不高.     

前门控技术在复杂先天性心脏病的应用价值

目的 探讨128层CT前门控技术在复杂先天性心脏病的临床应用价值。方法 收集我院进行小儿先天性心脏病CTA检查并进行手术治疗的56例患者,随机分为2组,A组为前门控扫描模式28例,B组为非门控扫描模式28例。比较两种扫描方式在复杂先天性心脏病中显示心内结构和病变的能力、图像质量、辐射剂量的差异。结果 A组有效辐射剂量为0.91±0.16msv,B组为1.05±0.25msv,A组患儿所受的有效辐射剂量低于B组;A组图像质量主观评分高于B组,A组术前诊断准确率为96.0%,漏诊3例,B组诊断准确率为86.8%,漏诊12例,误诊1例,A组术前CT诊断准确率大于B组。结论128层MSCT前门控技术在小儿复杂先心病中既可以降低患儿所受的有效辐射剂量,又能清楚显示心内外结构和病变,提倡推广使用。     

3T磁共振增强全心冠状动脉成像技术临床应用价值

Objective To investigate the clinical application, feasibility and value of 3 T wholeheart contrast enhanced free-breathing navigator-gated three-dimensional coronary magnetic resonance angiography (CE-CMRA). Methods 3 T CE-CMRA was used to examine patients with suspected coronary heart disease (CAD). Gd-BOPTA(0. 2 mmol/kg) was injected intravenously with slow infusion rate(0. 3ml/s) to perform enhancement. Data were post-processed to obtain principal branches of coronary artery and picture quality was evaluated. According to results of selective coronary arteriography ( SCAG ), the diagnostic accuracy of CE-CMRA for diagnosing CAD was judged by means of detecting significant stenosis ( ＞50% ) of the principal branches based on the 9 segments of coronary artery. Results Twenty-three out of 26 patients successfully completed the examination. The mean scanning time was ( 10. 4 ± 2. 1 ) minutes,178 out of 202 (88. 1% ) SCAG demonstrated segments could be evaluated by CE-CMRA. The imaging quality was superior in proximal and middle segments of coronary artery principal branches than in distal segments. Based on patient-level, there were 9 positive cases and 14 negative cases examined by CE-CMRA compared with 11 positive cases and 12 negative cases examined by SCAG, respectively. The whole diagnose accordance rate of CE-CMRA was 91.3% (21/23)compared with SCAG. The sensitivity, specificity and negative predictive values were 81.8% (9/11), 88.5% (169/191) and 98.8% (9/31)respectively. Conclusions 3 T CE-CMRA is a feasible non-invasive imaging modality for diagnosing CAD,especially to detect significant stenosis in proximal and middle segments of coronary artery principal branches. However, the detecting efficacy is limited in assessing stenosis of distal segment and small branches of coronary artery.     

一站式心脏MRI对心肌病的评价

心肌病的一站式心脏MRI扫描包括梯度回波序列、自旋回波序列及反转恢复快速自旋回波序列平扫,梯度回波序列电影扫描,梯度回波序列首过灌注及延迟增强扫描和冠状动脉扫描等,可综合评价心脏解剖结构、心肌病理特点、心脏功能及冠状动脉状态等,从而达到使多种影像学检查综合起来的共同目的。心肌延迟强化的特点还可对部分心肌病进行危险度分级、病因分析、治疗指导、穿刺定位等,在临床中对心肌病的诊治具有举足轻重的作用。     

常规MRI和三维对比增强MR血管成像对门肠系膜静脉血栓的诊断

目的 探讨常规MRI和三维对比增强MR血管成像(3D CE MRA)在门肠系膜静脉血栓诊断中的价值.资料与方法 回顾性分析经临床、手术证实的14例门肠系膜静脉血栓的平扫、增强MRI和3D CE MRA资料.结果 14例中,门肠系膜静脉及分支累及10例,门静脉及分支累及2例,2例仅累及肠系膜上静脉及分支;其中5例并发侧支血管形成.3D CE MRA准确地显示了相应病理解剖改变;平扫MRI能够显示门静脉、肠系膜上静脉主干内的血栓,但难以确切显示门肠系膜静脉属支、门静脉肝内分支血栓和较小血栓;增强后快速扰相稳态梯度回复采集序列(FSPGR)图像由于血管内和血管壁的强化及更高信噪比可更好地显示血栓.结论 平扫时重视对血管形态的观察有利于发现血栓,同时行3D CE MRA及增强后FSPGR,可以准确地诊断门肠系膜静脉血栓,为临床提供重要的诊断信息.     

3.0T磁共振在臂丛神经成像中的应用研究

目的 探讨3.0T磁共振扫描仪3D-STIR序列增强扫描在臂丛神经成像中的可行性,以及临床应用的效果和价值.方法 对26例志愿者及35例臂丛神经病变的患者,采用3.0T磁共振成像(MRI)常规扫描序列、3D-STIR序列平扫及3D-STIR序列增强扫描,观察所得图像,评价显示情况和对比噪声比.结果 3.0T MRI 3D-STIR序列及其增强扫描可清楚明确地显示所有志愿者臂丛神经的构成、走行、连续性、形态及信号,可以清楚地显示外伤或肿瘤累及臂丛神经所致的各种征象.结论 3.0T磁共振扫描仪3D-STIR序列增强扫描对臂丛神经病变的诊断和治疗有非常重要的价值.

Abstract：

Objective To investigate the feasibility of imaging brachial plexus in enhanced scan of 3D-STIR sequence in 3.0T MRI and the practical value of clinical application. Methods Twenty-six healthy volunteers and 35 patients with brachial plexus lesions underwent imaging of the brachial plexus with 3.0T MRI conventional scanning sequence,3D-STIR sequence scanning and 3D-STIR sequence of enhanced scan. The obtained images were observed to evaluate the image quality and signal to noise ratio. Results 3D-STIR sequence and enhanced scan could clearly display the components,course,continuity,shape and signals of the brachial plexus in all the healthy volunteers. The enhanced scan could improve the suppression effects of the background,and therefore could clearly visualize trauma and tumor involving the brachial plexus due to a variety of signs. Conclusion 3.0T MRI enhanced scan of 3D-STIR sequence has potential values in the diagnosis and treatment of brachial plexus diseases.     

3.0 T MR对比增强全心冠状动脉成像与CTA的对照研究

目的评价3.0TMR对比增强全心冠状动脉成像(CE-CMRA)对冠状动脉病变的诊断价值。资料与方法搜集21例已行冠状动脉CTA(CCTA)检查病例,行3.0TMRCE-CMRA,以CCTA为对照,按照AHA9段法评价冠状动脉显示情况。结果 21例患者顺利完成MRI检查,平均扫描时间为(10.6±2.3)min,CE-CMRA可评价冠状动脉节段164个。冠状动脉近段及中段显示良好,与CCTA比较差异无统计学意义(P>0.05)。12例有意义狭窄(狭窄程度(50%),CE-CMRA显示10例。在狭窄段长度比较中两者差异无统计学意义(P>0.05)。狭窄程度比较,CE-CMRA较CCTA偏高。结论 CE-CMRA对冠状动脉近、中段显示良好,对狭窄的评估可靠,可作为冠状动脉近、中段有意义狭窄的一种筛选手段。对不适于CCTA检查的病例,CE-CMAR可作为一种好的替代方法。但对冠状动脉远段及小分支狭窄的评估有一定限度。     

3T磁共振增强全心冠状动脉成像技术临床应用价值

Objective To investigate the clinical application, feasibility and value of 3 T wholeheart contrast enhanced free-breathing navigator-gated three-dimensional coronary magnetic resonance angiography (CE-CMRA). Methods 3 T CE-CMRA was used to examine patients with suspected coronary heart disease (CAD). Gd-BOPTA(0. 2 mmol/kg) was injected intravenously with slow infusion rate(0. 3ml/s) to perform enhancement. Data were post-processed to obtain principal branches of coronary artery and picture quality was evaluated. According to results of selective coronary arteriography ( SCAG ), the diagnostic accuracy of CE-CMRA for diagnosing CAD was judged by means of detecting significant stenosis ( ＞50% ) of the principal branches based on the 9 segments of coronary artery. Results Twenty-three out of 26 patients successfully completed the examination. The mean scanning time was ( 10. 4 ± 2. 1 ) minutes,178 out of 202 (88. 1% ) SCAG demonstrated segments could be evaluated by CE-CMRA. The imaging quality was superior in proximal and middle segments of coronary artery principal branches than in distal segments. Based on patient-level, there were 9 positive cases and 14 negative cases examined by CE-CMRA compared with 11 positive cases and 12 negative cases examined by SCAG, respectively. The whole diagnose accordance rate of CE-CMRA was 91.3% (21/23)compared with SCAG. The sensitivity, specificity and negative predictive values were 81.8% (9/11), 88.5% (169/191) and 98.8% (9/31)respectively. Conclusions 3 T CE-CMRA is a feasible non-invasive imaging modality for diagnosing CAD,especially to detect significant stenosis in proximal and middle segments of coronary artery principal branches. However, the detecting efficacy is limited in assessing stenosis of distal segment and small branches of coronary artery.     

一站式MRI对复杂先天性心脏病的诊断价值

目的 评价一站式MRI对复杂先天性心脏病的诊断价值.资料与方法 对33例复杂先天性心脏病患儿进行MRI扫描,包括梯度回波序列及自旋回波序列平扫,梯度回波序列电影扫描及三维增强磁共振血管成像(3D-CE MRA)扫描.将患儿MRI影像资料分为平扫+电影(A组)及平扫+电影+3D-CE MRA(B组)两组图像分别进行分析诊断,以手术作为参考标准,评估其诊断价值,并与B超结果进行对照.结果 22例成功完成一站式MRI扫描并经手术证实,共计109处心脏大血管异常,包括心内结构异常46处,心外结构异常63处.A组整体正确诊断率为84.4%,其中心内结构异常及心外结构异常的正确诊断率分别为82.6%、85.7%.B组整体正确诊断率为90.8%,其中心内结构异常及心外结构异常的正确诊断率分别为82.6%、96.8%.B超整体正确诊断率为82.6%,其中心内结构异常及心外结构异常的正确诊断率分别为87.0%、79.4%.结论 一站式MRl扫描能明显提高心外大血管异常的正确诊断率,对心内结构异常诊断无明显帮助.与B超比较,MRI平扫+电影及一站式.MRI平扫对心内结构异常的诊断均不如B超,对心外结构异常的诊断均比B超更具优势.