Objective:To explore the value of quantitative parameters of dynamic CT myocardial perfusion imaging (CT-MPI) in evaluating coronary microcirculation dysfunction (CMD) in a porcine model.Methods:Ten Chinese miniature pig age of 5 to 8 months were randomly selected in this experimental study. After anesthesia, a micro guide wire was introduced via a percutaneous direct puncture through superficial femoral artery. Then 1 ml of microsphere mixture, which contained 0.5×10 5/0.5 ml of microsphere, was slowly injected into the distal of anterior descending artery to establish a CMD animal model. Resting and stress CT-MPI were performed 60 min before and 10 min after CMD. The quantitative parameters of dynamic CT-MPI including myocardial blood flow (MBF) and myocardial blood volume (MBV) were measured. Using the changes of MBF and MBV before and after CMD as self-references, a paired-sample t test was used to compare the differences of MBF and MBV of resting and stress CT-MPI before and after CMD. The animals were sacrificed for myocardial histopathological examination after the imaging examination. Results:Of the 10 experimental animals, two pigs died, and CMD model was successfully established in the other 8 pigs. The MBF and MBV of CMD myocardial segments in resting CT-MPI were (98.6±20.9) ml·100 ml -1·min -1 and (9.0±2.8) ml/100 ml, respectively. The MBF and MBV of CMD myocardial segments in stress CT-MPI were (87.6±14.6) ml·100 ml -1·min -1 and (8.0±1.8) ml/100 ml, respectively. Both of the MBF and MBV of CMD myocardial segments in resting CT-MPI were significantly reduced, compared with those of the normal myocardial segments ( P<0.001). HE staining showed myocardial infarcts interspersed with normal myocardial foci at low magnification. Pathological alterations, including myocardial cytoplasm cohesion, eosinophil level variations, stripe disappearance, nuclear relocation, and cardiomyocyte interstitial edema, were displayed at high-magnification by microscopy. Conclusions:In this experimental study of CMD animal models, MBF and MBV of dynamic CT-MPI were significantly decreased in CMD myocardial segments compared with those before CMD. The changes of MBF or/and MBV can be used as dynamic CT-MPI quantitative parameters for evaluation of CMD.

OBJECTIVE:To assess the effects of statin treatment on mild coronary plaque progression by serial coronary CT angiography.METHODS:A total of 120 consecutive patients (74 men, ages(58.9±8.1)years) with mild (≤50%luminal narrowing and lesion length<20 mm) non-calcified plaque detected by coronary CT angiography during September 2012 and December 2013 were prospectively enrolled in this study.Subjects were divided into three groups: no statin (n=36), statin lowering LDL-C <50% (n=43), and statin lowering LDL-C ≥50%(n=41). Serial scans were performed after a median interval of 705 (interquartile range: 467, 803) days.Total plaque volume, percent plaque volume for both baseline and follow-up were measured.Baseline and follow-up data were compared.RESULTS:Compared with baseline, total plaque volume in no statin group showed increasing trend by the end of follow-up ((97.3±57.8) mm(3) vs. (82.2±57.7) mm(3,) P=0.075). However, no significant change was observed as for total plaque volume ((78.5±45.2) mm(3) vs.(77.6±50.5) mm(3), P=0.910) in the statin lowering LDL-C <50% group.Total plaque volume was significantly reduced by the end of follow-up ((61.5 ± 46.1) mm(3) vs.(77.7±48.1) mm(3), P=0.024) in the statin lowering LDL-C ≥50% group.Percent plaque volume in no statin group was significantly increased by the end of follow-up ((51.9±16.5)% vs.(45.9±12.8)%, P=0.036). However, no significant change was observed as for percent plaque volume ((49.1±13.7)% vs.(47.5±14.9)%, P=0.554) in the statin lowering LDL-C <50% group. Percent plaque volume was significantly reduced by the end of follow-up ((39.1±17.1)% vs.(48.2±15.0)%, P=0.003) in the statin lowering LDL-C ≥50% group. Multivariable linear regression analysis showed that both higher baseline total plaque volume(β=-0.50, P<0.001) and statin lowering LDL-C ≥50%(β=-0.32, P=0.001) were independent determinants of plaque regression.CONCLUSION:This study suggests that LDL-C reduction ≥50% post statin treatment can retard plaque progression, and even induce regression of mild non-calcified coronary plaque, patients with greater baseline coronary plaque volume are more likely to benefit from statin therapy.

2014年11月30日至12月5日，第100届北美放射学会（RSNA）年会于美国芝加哥召开，本届会议的主题是“医疗变革的百年（A century of transforming medicine）”。其内涵是RSNA的百年历史，见证了医学影像学技术的进步，并推动了临床医疗的变革与发展。来自130多个国家的超过5.6万名医学放射从业者参加了此次盛会。本届会议共有225个知识更新课程、81个多学科合作课程、2703个学术发言以及2151个教育展览。关于心血管影像的学术发言共301个（11%），排在神经系统、消化系统和骨骼肌肉系统之后列第4位。本次会议心血管CT和MR影像领域的科研亮点有以下几个方面。

目的 探讨左冠状动脉异常起源于肺动脉(ALCAPA)的CT表现特征.方法 回顾性分析CT诊断为ALCAPA并经手术矫正治疗的29例患者的临床和影像资料,着重观察左冠状动脉开口位置、冠状动脉管腔扩张、侧支血管的建立及分布、以及左房室大小、心肌灌注情况.结果 CT对29例ALCAPA均做出明确诊断,清晰显示左冠状动脉起源于主肺动脉,其中21例起源于肺动脉左后窦,2例起源于肺动脉右后窦,1例起源于肺动脉前窦,5例起源于主肺动脉右侧壁;19例可见左冠状动脉向肺动脉内供血,其中13例呈喷射样改变;右冠状动脉迂曲扩张27例,单纯扩张1例,1例管径无扩张,左冠状动脉迂曲扩张13例,单纯扩张14例,2例管径无扩张;10例无明确侧支血管或仅少量侧支血管,19例侧支血管丰富,分布于室间隔、圆锥前、右室侧壁及心脏膈面;心外侧支13例,均为支气管动脉侧支,12例与回旋支相通,1例与前降支相通;13例左室壁心内膜下灌注减低;2例室壁变薄;左心室扩大26例,左心房增大20例;12例左心室乳头肌或腱索钙化;16例肺动脉增宽.结论 CT能够直观显示ALCAPA异常起源的部位,并能够显示出肺动脉内对比剂的喷射征像及染色样改变等提示左向右分流的特征性征象,同时可显示冠状动脉扩张、心内外侧支血管、心肌缺血及左房室增大等伴随的间接改变.

目的：以无创的CT冠状动脉造影（CCTA）作为检测工具，评价他汀类药物干预冠状动脉粥样硬化斑块进展的效果。<br>　　方法：连续入选初次CCTA 结果为单支非梗阻性（狭窄≤50％）非钙化为主斑块病变的患者，收集基线资料并进行随访。根据患者治疗情况分为对照组（未接受他汀类药物治疗）、非强化他汀组、强化他汀组。1.5~2年后复查CCTA，测量基线和随访的斑块总体积、斑块体积百分比、低密度斑块（脂质为主）体积等指标。

目前冠心病的诊断以冠状动脉造影显示管腔狭窄≥50％为标准.临床实践证明,仅仅根据管腔的狭窄程度决定治疗方案是不正确的,还须评估该狭窄冠状动脉的血液动力学状况、微血管和心肌缺血的情况等.对于冠状动脉中度狭窄的临界病变(狭窄程度＜70％),管腔的狭窄不一定均有血液动力学意义,冠心病风险也不一定均与狭窄程度相关.越来越多的证据显示,冠状动脉管腔狭窄与心肌缺血之间的关系复杂,单纯依靠狭窄程度判断心肌是否存在缺血并不可靠[1-2].

目的：通过双源动态负荷心肌灌注扫描观察中华小型猪慢性心肌缺血模型的CT表现，探讨以导管测得FFR为金标准，动态CT负荷心肌灌注扫描诊断心肌缺血的准确性。

目的：描述重度主动脉瓣狭窄二瓣化（BAV）患者与三瓣（TAV）患者主动脉根部的差异，分析两者的区别以及TAVI术人工瓣膜支架要求符合率差异。

目的：描述性别对主动脉瓣狭窄患者主动脉瓣钙化的影响和差异，分析影响主动脉瓣膜钙化的各因素的作用。

目的：该研究为了确定MDCT测量主动脉瓣环不同方法重复性大小，及与经超声心动图比较差异大小。

目的：评价中重度主动脉瓣狭窄患者主动脉瓣环大小及左心室结构的差异，并分析影响主动脉瓣环及左心室室壁厚度的不同因素。

例1,患者男性,60岁.因发作性胸痛1个月,疑诊冠心病拟行冠状动脉造影(CAG)检查,于2013年1月22日入院.否认高血压、高脂血症和糖尿病史,吸烟40年,每日平均20支;饮酒40年,每日平均250 g.入院时查体无特殊.心脏超声未见明显异常.心电图为窦性心律,完全性右束支传导阻滞.患者于1月23日行经导管CAG和冠状动脉血流储备分数(fractional flow reserve,FFR)测量,CAG示前降支中段局限性狭窄约50％(图1a),FFR值为0.92(图1b),无血液动力学意义,故未行介入治疗.

20世纪人类的3种重要疾病是:结核、癌症、心脑血管病.说明癌症发病率排在前3位,但在我国已居首位,且每年发病人数约200万,死亡超过150万人,如不防控,未来20年死亡人数将翻番.在众多的癌症患者中,约51%-61%的患者伴有疼痛,目前每天忍受癌痛患者大于100万.

目的 气管内肿瘤病人需急诊手术时,通过对其麻醉安全性的评估,进一步探讨气管内插管的位置及管径大小选择的合理性.方法 回顾性研究近几年来典型气管内肿物手术麻醉病例共85例,其中急诊14例,本文旨在对14例急诊手术麻醉病例的经验进行总结分析,供大家参考.结果 14例手术均在纤维支气管镜引导下成功插管,6例从CT、胸片看气管被阻塞1/2～2/3,插管顺利通过肿瘤,8例气管被阻塞2/3～3/4,在纤维支气管镜下看到气管腔较窄,其中5例导管顺利通过狭窄管腔,另3例未敢插入.所选择的支气管导管为6.5～7.0的单腔管.结论 气管内肿瘤的急诊病人,需要急诊手术时,除了准确评估手术麻醉的风险性外,选择合适的气管内导管非常重要,在光导纤维镜引导下,插管尽量通过肿物,是保障术中充分供氧,顺利完成手术麻醉的较好方法 .

To unravel the relation of HLA-DRB1*15 with childhood acute lymphoblastic leukemia (ALL), 162 childhood patients with ALL were selected for this investigation. 1 000 normal umbilical cord blood samples were used as control.HLA-DRB1*15 and HLA-DRB5* were typed by polymerase chain reaction (PCR) analysis. The relation of HLA-DRB1*15 with childhood ALL was studied by calculating the chi-square test and relative risk. The results showed that the antigen frequencies and allele frequencies of HLA-DRB1*15 in childhood patients with ALL were 40.12% and 22.62% respectively, while the antigen frequencies and allele frequencies of HLA-DRB1*15 in control were 30.80% and 16.81% respectively, there were significant difference between them (chi(2) = 5.560, p = 0.018, RR = 1.506). In conclusion, the antigen frequencies and allele frequencies of HLA-DRB1*15 in childhood patients with ALL were higher than those in control, so the HLA-DRB1*15 gene is one of the genetic risk factors for childhood ALL. These preliminary data may be useful for further study on the pathogenesis of childhood ALL.

目的 探讨癌症患者手术麻醉前焦虑的发生情况及其与患者个性特征的关系.方法 采用焦虑自评量表(SAS)及艾森克人格问卷(EPQ)对164例癌症患者进行手术麻醉前问卷调查.结果 164例癌症患者中存在焦虑45例,发生率为27.44%;EPQ神经质(N)个性特征与焦虑得分之间存在显著的正相关关系(r＝0.644,P＜0.01),内-外向(E)个性特征与焦虑得分之间存在显著的负相关关系(r＝-0.251,P＜0.05);焦虑组患者的N高于无焦虑组(P＜0.01),而E分低于无焦虑组患者(P＜0.05).结论 癌症患者的个性特征是手术前焦虑的重要影响因素.

恶性肿瘤是严重的心理应激,对患者打击很大,他们普遍存在抑郁和焦虑情绪,根据国内外的报道约34%～58%[1,2].而非精神科医师对这些情绪问题识别率低,不能及时处置,致患者生命质量下降,给社会、家庭、个人均带来负担,不利于肿瘤的治疗.本研究对拟进行手术治疗的恶性肿瘤患者存在的情绪障碍进行观察,并探讨有效的干预措施,现将结果报告如下.

1病例介绍 患者,男性,37岁.2001年3月因肢端肥大至天津中医学院附属医院就诊.MRI提示:垂体瘤.手术切除后结合病理诊断为:分泌性垂体腺瘤.术后,患者接受垂体放射治疗1个月(共30Gy).

术后谵妄是一组急性器质性脑综合征[1].有报道在老年病人更为多见,是术后严重并发症之一,应引起临床医生重视[2].本文总结了全麻术后出现的77例典型谵忘临床表现及治疗情况.

目的:观察米托蒽醌(MTZ)治疗初治、复发急性白血病(AL)的临床疗效和毒副作用.探索以MTZ为主要药物作为一线治疗药物的可行性.方法:急性髓细胞白血病(AML)诱导治疗采用MTZ和阿糖胞苷(Ara-C).急性淋巴细胞白血病(ALL)诱导治疗采用长春新碱(VCR)、MTZ、异环磷酰胺(IFO)和强的松(Pred),条件允许时加用左旋门冬酰胺酶(L-ASP).结果:37例患者中29例取得完全缓解(CR),CR率78.4%.对20例AML患者进行了随访,治疗多于6疗程以上的10例患者,有8例持续CR(CCR),中位缓解期15.5月.结论:米托蒽醌联合用药治疗急性白血病有较好的疗效,其毒副作用可以耐受.该方案可以作为一线方案用于AL的诱导治疗.