Objectives:To study the computed tomography features of banded adhesions(BA) and matted adhesions(MA) of adhesive small bowel obstruction(ASBO).Methods:We enrolled 150 patients operated on for ASBO. According to intraoperated findings, ASBO were classified into those caused by BA or MA. A multivariable logistic regression was established to analyze independent risk factors on Computed Tomography features.Results:There were significant differences in closed-loop sign (36.8% vs. 14.3%, P=0.002) mesenteric haziness (43.7% vs. 17.5%, P=0.001), beak sign (48.3% vs. 17.5%, P<0.001), fat notch sign (39.1% vs. 9.5%, P<0.001) and peritoneal fluid (54.0% vs. 34.9%, P=0.015) between the two groups. The presence of beak sign [ OR=6.15, 95% CI (2.55-14.84), P<0.001], fat notch sign [ OR=6.19, 95% CI (2.16-17.82), P=0.001] and mesenteric haziness [ OR=3.34, 95% CI (1.34-8.32), P=0.009] were independent risk factors with BA. Conclusion:Beak sign, fat notch sign and mesenteric haziness were independent risk factors for diagnosing BA.

Objective:To investigate the efficacy and safety of endovascular treatment for ruptured lobulated anterior communicating artery aneurysm (ACoAA).Methods:Patients with ruptured lobulated ACoAA received endovascular treatment in Sanming First Hospital Affiliated to Fujian Medical University from June 2020 to June 2022 were retrospectively included. Their demographic, clinical and imaging characteristics, endovascular treatment methods and follow-up results were collected.Results:A total of 24 patients with ruptured lobulated ACoAA were included, including 9 males (37.5%) and 15 females (62.5%). Their age was 56.2±8.9 years old (range 39-74). The time from rupture to endovascular treatment was 10.9±12.5 h. The maximum diameter of the aneurysms was 5.1±1.0 mm and neck width was 3.0±0.7 mm. Nineteen patients (79.2%) were double-lobed and 5 (20.8%) were multilobed. Fisher's grade: grade 2 in 16 cases (66.7%), grade 3 in 6 cases (25%), and grade 4 in 2 cases (8.3%). Hunt-Hess grade: grade 0-2 in 5 cases (20.8%), grade 3-5 in 19 cases (79.2%). Glasgow Coma Scale score: 9-12 in 14 cases (58.3%), 13-15 in 10 cases (41.7%). Immediately postprocedural Raymond-Roy grade: grade 1 in 23 cases (95.8%), grade 2 in 1 case (4.2%). Raymond-Roy grade in imaging follow-up for 2 weeks to 3 months: grade 1 in 23 cases (95.8%), grade 2 in 1 case (4.2%). Follow-up for 2 to 12 months showed that 21 patients (87.5%) had good functional outcomes (modified Rankin Scale score ≤2), and there were no deaths.Conclusion:Endovascular treatment is a safe and effective treatment for ruptured lobulated AcoAA.

Objective:To explore the technical advantages of MR cholangiopancreatography (MRCP) with single breath holding high parallel acquisition factor 3-D variable flip angle fast spin echo (3D-SPACE) sequence.Methods:From November 2018 to March 2019, 75 patients who underwent MRCP examination in our hospital were prospectively enrolled, with single breath holding high parallel acquisition factor 3D-SPACE sequence and free breathing navigation gated 3D-SPACE sequence. Three experienced radiologists scored the overall image quality, artifacts, CBD visibility, left and right hepatic ducts, right anterior and posterior branches, second and third branches, main pancreatic duct and gallbladder duct with four scales. Paired t test was used for statistical analysis. Results:The scanning time of single breath holding method (18 s) was significantly shorter than that of free breathing diaphragm navigation method［264（226，313）s］, and the difference between the two methods was statistically significant ( Z=-7.520， P<0.001). The SNR, CR and CNR (8.31±4.23, 0.92±0.30, 11.46±5.77) of single breath holding method were lower than those of free breathing diaphragm navigation method (11.23±5.70, 0.93±0.38, 15.06±7.37), and the differences between the two methods were also statistically significant ( t=4.378, 3.429, 4.063, P<0.05). The overall image quality, artifact, the CBD, left and right hepatic duct, right anterior and posterior branchs, the second and third branches, main pancreatic duct and cystic duct of single breath holding method were higher than those of free breathing diaphragm navigation method, and the differences between the two methods were statistically significant ( P<0.001). Conclusions:Compared with the free breathing diaphragm navigation gated 3D-SPACE MRCP imaging method, the single breath holding high parallel acquisition factor 3D-SPACE MRCP imaging method has less artifacts and examination time, but higher visibility to pancreaticobiliary tree and work efficiency, which is worthy of further promotion.

目的 观察原发性睾丸淋巴瘤(primary testicular lymphoma,PTL)的磁共振成像(magnetic resonance imaging,MRI)特点,探讨原发性睾丸淋巴瘤的磁共振成像影像诊断思路及鉴别诊断.方法 回顾性分析经手术病理证实的9例PTL的MRI表现,术前均行平扫及增强检查,分析影像特点,并与手术病理结果对照分析.结果 原发性睾丸淋巴瘤形态欠规则,T2WI上呈混杂等高信号,T1WI上呈等或稍低信号,可见小片状T1WI高信号出血灶,增强后可见不均匀中度-明显强化,呈渐进性,ADC呈低信号.结论 磁共振成像上原发性睾丸淋巴瘤具有一定的特异性,掌握MRI特点有助于疾病的诊断和鉴别诊断.

目的 探讨朝向不同的后交通动脉瘤显微手术治疗.方法 回顾性分析34例采用翼点入路显微手术治疗后交通动脉瘤病人的临床资料,其中瘤顶朝向后外侧下方30例,朝向后外侧上方2例,朝向后内侧下方2例.结果 术后0.5～1个月常规行CTA检查,动脉瘤完全夹闭33例,瘤颈残留1例.病人术前症状均不同程度好转,留有肢体偏瘫2例,不同程度眼裂增宽及瞳孔改变10例.出院时GOS评分:5分27例,4分5例,3分2例.28例获随访3～24个月,动脉瘤残留1例,余无复发.结论 术前行320排头颅CTA充分评估动脉瘤的朝向,术中合理运用手术技术,有利于手术安全,减少术后并发症.

目的:分析开颅治疗在小脑出血破入第四脑室并发急性梗阻性脑积水治疗中的价值.方法:选取2016年1月-2017年12月笔者所在医院神经外科共接收的64例小脑出血破入第四脑室并发急性梗阻性脑积水患者,随机分为A组和B组,每组32例,A组行双侧侧脑室额角外引流+后颅窝开颅血肿清除治疗,B组单纯行双侧侧脑室额角外引流治疗,观察两组的手术效果.结果:A组手术时间长于B组,住院时间短于B组,差异均有统计学意义(P<0.05).术后3个月,A组GOS评分整体分级优于B组,差异有统计学意义(P<0.05);A组预后不佳率低于B组,差异有统计学意义(P<0.05).结论:小脑出血破入第四脑室并发急性梗阻性脑积水患者治疗时,除引流外,增加开颅治疗可促进治疗效果升高,有效地改善患者预后.

目的 分析神经外科术后颅内感染的临床特征及危险因素,为颅内感染的防控提供依据.方法 回顾性分析神经外科收治的1046例手术患者的临床资料,将发生术后颅内感染的患者纳入感染组,未发生术后颅内感染的患者纳入对照组,进行因素分析.结果 1046例手术患者中,发生术后颅内感染45例(4.30％);病原菌主要为凝固酶阴性球菌、鲍曼不动杆菌、表皮葡萄球菌等.感染组手术时间、ICU停留时间均长于对照组(P<0.01).感染组患者开颅手术、急诊手术、分期手术、后颅窝手术、脑室外引流、术后脑脊液漏、围术期使用激素的比例均高于对照组(P<0.01).多因素Logistic回归分析显示,手术时间、开颅手术、后颅窝手术、脑室外引流为神经外科术后颅内感染的独立影响因素(P<0.05或P<0.01).结论神经外科术后颅内感染危害较大,是ICU住院时间延长、普通病房转ICU的重要原因,感染多见于术后早期,病原菌类型较多,耐药率高特别是ICU内耐药率极高;神经外科术后颅内感染的影响因素较多,需要重视手术时间控制,推广微创手术,加强脑室外引流的技术管理.

目的 观察基层神经外科应用显微手术治疗脑前循环动脉瘤的效果,为基层医院应用提供参考.方法 方便选择该院2016年1月-2017年12月接收的脑前循环动脉瘤患者96例,均给予显微手术治疗,依照入院后手术开展时间分组,A组手术于入院后1～3 d开展,共33例,B组手术于人院后3～8 d开展,共42例,C组手术于入院后8d后开展,共21例,观察治疗效果及并发症发生情况.结果 经治疗后,A组优良率97.0％,B组优良率76.2％,C组优良率47.6％,A高于B组、C组,且B组高于C组,差异有统计学意义(P＜0.05);A组、B组、C组术后并发症发生率分别为9.1％、11.9％、14.3％,3组差异无统计学意义(P＞0.05).结论 基层神经外科应用显微手术治疗脑前循环动脉瘤患者时,具有较好的治疗效果,可减少患者术后并发症,但越晚开展手术时,治疗效果越差,因此应在确诊后尽早实施手术治疗,以提升治疗效果,改善患者预后.

临床上肾功能不全、服用潴钾药物、静脉给予大量钾盐、溶血性疾病或输入贮存过久的血液等可导致高钾血症.高钾血症虽不多见,但一旦发生则可出现缓慢型心律失常,常危及生命.笔者针对临床中1例高钾血症,心电图未呈典型的高钾血症心电图改变,出现了窦室传导(sinoventricular conduction)[1]、缓慢心律,在纠正高血钾的过程中,心电图出现一系列演变,报告如下.

Objective To evaluate the risk of in-stent restenosis (ISR) after coronary artery stenting according to features of plaques on coronary artery CTA.Methods Totally 166 patients underwent coronary artery CTA before and 6-18 months after stent placement.Then the patients were divided into ISR group (n=16) and non-ISR group (n=150).The stenosis degree and plaque features were observed and compared between the two groups.Multivariate Logistic regression analysis was performed to evaluate ISR risk factors,and ROC curve was used to evaluate the diagnostic efficacy of plaques features in prejudgement of ISR.Results The lesion length,the ratio of noncalcified plaque,spotty calcium,positive remodeling and positive remodeling index in ISR group were higher than those in non-ISR group (all P ＜ 0.05).Multivariate Logistic regression analysis showed that noncalcified plaque (B=1.89,odd rate [OR] =6.63,P=0.01),spotty calcium (B=1.28,OR=3.59,P=0.01),positive remodeling (B=2.17,OR=8.71,P＜0.01) and lesion length (B=0.05,OR=1.05,P=0.04) were the risk factors of ISR.The area under the ROC curve (AUC) of lesion length and positive remodeling index for diagnosing ISR was 0.70 and 0.82 (both P＜ 0.01),respectively.The AUC of the combination of above plaque features for prejudgement of ISR was 0.87 (P＜0.01).Conclusion Lesion length,positive remodeling,noncalcified plaque and spotty calcium can be used to evaluate ISR after coronary artery stent placement.

目的：总结单纯表现为颅内血肿的破裂动脉瘤的治疗经验。方法回顾分析8例单纯表现为颅内血肿的破裂动脉瘤病例资料，均采用扩大额颞部切口动脉夹闭术+血肿清除术。结果8例动脉瘤均夹闭成功，血肿清除满意。无死亡病例。随访3个月~2年，生活自理6例，遗留单侧肢体瘫痪2例。结论术前准确判断，合理运用手术技术，成功夹闭动脉瘤，清除血肿，尽早解除颅内高压，可使病人恢复良好。

目的：探讨颅骨缺损钛网修补术后切口感染及修补材料外露预防及应对措施。方法对2009年1月~2013年1月收治的86例金属钛网颅骨修补术患者进行回顾性分析。结果86例颅骨缺损患者均使用数字塑形钛网行修补术，术后感染3例、经合理使用抗生素、加强换药后、切口乙级愈合。钛网外露3例、1例行皮瓣转移愈合良好、1例取出钛网后切口愈合。1例行颅骨修补同时同侧行V-P分流术，术后因分流管感染致颅骨外露并伴有破口处脑脊液漏，拔除引流管+持续腰大池引流后，破口愈合。结论选择适当大小的塑形钛网，针对不同部位的颅骨缺损选择适当的操作方法，严格无菌操作，术后对并发症的正确处理方法，能有效地预防及控制术后感染。

孤立性纤维性肿瘤(solitary fibrous tumor,SFT)是一种少见的肿瘤,全身各部位均可发生,但多见于胸膜,发生于颅内的甚为少见,术前很难做出正确的诊断[1-5]本文回顾性分析5例经手术病理证实的颅内SFT的临床及磁共振影像学资料,以期提高对颅内SFT的诊断水平。

Objective To explore the feasibility and efficiency of two dimensional speckle tracking imaging(2D-STI) to the quantification on the global level of left ventricle infarct size in patients with chronic myocardial infarction.Methods Forty-three consecutive patients with chronic myocardial infarction underwent 2D-STI and delayed-enhanced MRI(DE-MRI).On the global level of left ventricle,global longitudinal strain(GLS),rotation and torsion were separately measured.Global infarct size was calculated as infarct volume ratio and infarct mass.Results On the global level of left ventricle,GLS significantly correlated with infarct volume ratio(r=0.620,P=0.008).GLS and maximal apical rotation rate were significant predictors of infarct volume ratio(P=0.005,0.014),while the standard regression coefficient(Beta) was 0.720 and 0.592,respectively.GLS was the significant predictor of infarct masses(P=0.024),while the Beta was 0.545.Conclusion On the global level of left ventricle,GLS correlated significantly with global infarct size,while apical rotation rate could also predict global infarct size exactly.

Purpose To investigate the feasibility of two-dimensional-speckle tracking imaging (2D-STI) in evaluating the left ventricle apical segmental transmurality of chronic myocardial infarction.Materials and Methods A randomized,simultaneous and blind study was performed in 43 consecutive chronic myocardial infarction patients undergoing 2D-STI and delayed-enhanced MRI (DEMRI).Segments were divided into transmural myocardial infarction (TMI) and nontransmural (NTMI) groups.Results In TMI group,diastolic wall thickness,SR (ES),SC (ES),SR Peak P,SL (ES),SC Peak,SL Peak G,SL Peak and SC Peak G significantly decreased in anterior segments compared with NIMI group (P 0.05).Significant decrease was also observed in SC (ES),SC Peak G,SC Peak and SL (ES) in lateral segments (P 0.05);SL Peak,SL Peak G,SC Peak,SL (ES),SC (ES) and SR (ES) in anteroseptal segments (P 0.05);SR Peak P,SR (ES) and SL (ES) in posterior segments (P 0.05);SC Peak G,SC Peak and SC (ES) in inferior segments (P 0.01);diastolic wall thickness in posteroseptal segments (P 0.01).ROC analysis showed diastolic wall thickness had the best ability to identify transmural infarction both in anteroseptal and posteroseptal segments,while SC (ES) was the best index in lateral segments,SL Peak in anteroseptal segments,and SR Peak P in posterior segments,both SC Peak G and SC Peak in inferior segments.Conclusion On the segmental level of apex,various strain indices discriminate between NTMI and TMI in different segments respectively.The discriminating ability is heterogeneous for different indices.

Objective To observe the value of diffusion weighted imaging(DWI) and apparent diffusion coefficient(ADC) in the diagnosis of renal angiomyolipoma.Methods Fifteen patients of renal angiomyolipoma proved pathologically and 15 normal control subjects underwent DWI and conventional MRI,the ADC values(b=50-1000 s/mm2) were measured.Results ADC values(×10-3 mm2/s) in the typical renal angiomyolipoma,the atypical benign lesions(renal angiomyolipoma absent of fat) and normal kidney of volunteers was(0.87±0.08),(1.55±0.34),(1.82±0.18),respectively.There were significant differences among the three groups(P0.05).Conclusion DWI combined with ADC value may do some help to the diagnosis of renal angiomyolipoma at 3.0T MR.

目的 评价对比-增强(cRT3DE)和常规(rRT3DE)实时三维超声心动图在评估右室舒张末(RVEDV)及收缩末容积(RVESV)和射血分数(RVEF)的准确性和可重复性.方法 35例健康志愿者中符合入选要求者30例,在24 h内进行rRT3DE、声诺维cRT3DE和心脏电影磁共振成像(cMRI).分别采用Tom-Tec 4D RV-Function CAP软件对RT3DE及Argus软件对cMRI图像进行脱机分析,获得右室容积及功能测值.结果 与rRT3DE比较,cRT3DE右室图像质量指数显著增加(3.2±0.7对2.5±0.8,P＜0.001).与cMRI比较,rRT3DE高估RVESV、低估RVEDV及RVEF(P均＜0.05);而cRT3DE仅有高估RVESV、低估RVEDV及RVEF的趋势,但差异无统计学意义.较之rRT3DE,cRT3DE右室容积及功能测值与cMRI的相关性更强(RVEDV,r=0.95对0.85;RVESV,r=0.95对0.81;RVEF,r=0.91对0.81).Bland-Altman分析显示,较之rRT3DE,cRT3DE和cMRI右室容积及功能测值一致性界限更窄,cRT3DE测值在观察者间及观察者内的变异更小.结论 声诺维对比增强造影显著改善实时三维超声心动图评价右心室容积和射血分数的准确性及可重复性.