Background and purpose The best method for selecting patients with acute vertebrobasilar artery occlusion (VBAO) who would benefit from endovascular treatment (EVT) is still the key question. This study aimed to assess the efficacy of magnetic resonance imaging (MRI) for selecting patients with acute VBAO for EVT. Materials and methods A total of 14 patients with suspected acute VBAO on MR angiography (MRA) in the EVT database (from April 2016 to August 2019) were enrolled. Acute Stroke Prognosis Early Computed Tomography Score (ASPECTS) and pons–midbrain index were assessed on diffusion-weighted imaging (DWI). EVT included a stent retriever and a rescue treatment (angioplasty and/or stenting). The proportion of successful reperfusion and favorable functional outcomes (modified Rankin Scale ≤ 3) at 90 days was documented. Results A total of 11 patients were included in the final analysis. The median DWI-ASPECTS and pons–midbrain index were 7 and 2, respectively. Underlying stenosis was detected in 10 of 11 (90.9%) patients. Balloon angioplasty and/or stenting were used as rescue therapy for five patients and two patients, respectively. A total of nine patients (81.8%) achieved successful reperfusion (mTICI, 2b, or 3). The 90-day mRS score of 0–3 was achieved in six (54.5%) patients. The mortality rate within 90 days was 18.2% (two of 11 patients). Conclusion DWI plus MRA could help select the patients with acute VBAO for EVT by assessing ASPECTS and the pons–midbrain index. Patients could achieve good reperfusion and favorable functional outcomes.

Background and Purpose Diagnosing cervical artery dissection (CAD) is still a challenge based on the current radiographic criteria. This study aimed to assess the value of three-dimensional high-resolution magnetic resonance imaging (3D HRMRI) in the detection of the signs of CAD and its diagnosis. Materials and Methods Patients with CAD from January 2016 to January 2021 were recruited from our 3D HRMRI database. The signs of dissection (intramural hematomas, intimal flap, double lumen), length and location of the dissection, thickness of the intramural hematoma, intraluminal thrombus, and percentage of dilation of the outer contour of the dissection on 3D HRMRI were assessed. Results Fourteen patients with 16 CADs, including 12 carotid CADs and 4 vertebral CADs, were finally diagnosed in this study. On 3D HRMRI, intramural hematomas were detected in 13/16 (81.3%) lesions with high sensitivity (100%) and high specificity (100%). Intimal flaps were found in 9/16 (56.3%) lesions with moderate sensitivity (64.3%) and high specificity (88.9%). Double lumen signs were observed in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). In addition, concomitant intraluminal thrombus were detected in 4/16 (25.0%) lesions with high sensitivity (80.0%) and high specificity (100%). The mean length of dissection was (25.1 ± 13.7) mm. The mean thickness of the intramural hematoma was (4.3 ± 2.3) mm. The mean percentage of dilation for the outer contour of the dissection was (151.3 ± 28.6)%. Conclusion The 3D HRMRI enables detection of the dissecting signs, such as intramural hematoma, intimal flap, double lumen, and intraluminal thrombus with high sensitivity and specificity, suggesting a useful, and non-invasive tool for definitively diagnosing CAD.

目的 以高分辨率MRI(HRMRI)观察颅内管腔非狭窄性脑卒中患者动脉粥样硬化斑块的特点.方法 纳入41例MR血管造影(MRA)未见明显异常的动脉粥样硬化性缺血性脑卒中患者,根据HRMRI所见分析其颅内动脉粥样斑块,比较责任斑块与非责任斑块位置、强化、血管重构及斑块负荷的差异.结果 41例中,于33例(33/41,80.49％)中检出50个颅内斑块,平均负荷值(12.96±8.03)％;斑块所在血管正性重构率72.00％(36/50).8例(8/41,19.51％)未见明确斑块.50个斑块中,17个为责任斑块,33个为非责任斑块,责任斑块位于前循环的比例明显高于非责任斑块(P<0.05),其强化状态、负荷及血管重构差异均无明显统计学意义(P均>0.05).结论 颅内管腔非狭窄性脑卒中患者斑块负荷较低,且斑块所在血管易发生正性重构,前循环斑块更多导致脑血管病事件.

目的 探讨3D高分辨率磁共振成像(HRMRI)评估症状性基底动脉粥样硬化性重度狭窄重构模式的价值.方法 搜集2015年1月至2017年12月经颅脑磁共振血管造影(MRA)显示症状性基底动脉重度狭窄(70～99％)的患者44例,使用VISTA技术对颅内动脉进行轴位扫描,获得容积数据进行后处理重建,得到基底动脉最窄层面、近端参考层面的短轴横断面图像,并分别测量其血管面积和管腔面积,计算重构指数(RI)(最窄层面血管面积/参考层面血管面积),RI≥1为阳性重构,RI＜1为阴性重构.然后比较阳性重构和阴性重构组之间临床资料及血管参数的差异.结果 2例患者因图像质量差而被排除,最终42例患者纳入分析.其中22例(52.4％)为阳性重构,20例(47.6％)为阴性重构.在最窄层面,阳性重构组比阴性重构组有更大的血管面积、管壁面积、斑块面积及斑块负荷(P均＜0.05).临床基线数据无统计学差异(P均＞0.05).结论 3D HRMRI可以准确评估症状性基底动脉粥样硬化性狭窄的血管重构模式,具有重要的临床意义.

The association between fenestrations and neurovascular pathology is not well defined. The morphology of vessel wall plays an important role in the development of neurovascular pathology. We sought to explore the plaque distribution around basilar artery fenestration (BAF) by three-dimensional high-resolution MR vessel wall imaging (3D HRMRI). Patients with BAF on 3D HRMRI images were enrolled. All cross-sectional slices of basilar arteries were assessed and categorized based on the location of fenestration as proximal segment, in-bifurcation segment, and distal segment. Furthermore, plaques in the in-bifurcation segment were classified according to their orientation being centered on the lateral, interior, dorsal, or ventral wall of the vessel. In all, 12 cases with BAF involving 661 cross-sectional image slices in entire basilar arteries were included. Plaques were found in 190 image slices, with the distribution of 41 slices in the proximal segment, 144 slices in the in-bifurcation segment and 67 slices in the distal segment. Plaques were found more frequently in the proximal and in-bifurcation segments than in the distal segment (P < 0.001), but there was no statistical difference between the proximal and in-bifurcation segment (P = 0.11). In the in-bifurcation segment, plaques were more frequently located at the lateral (50.0%) than other interior (16.0%), dorsal (21.0%), and ventral (13.0%) wall (P < 0.001).Plaques of BAF tend to locate in the proximal and in-bifurcation segments, especially at the lateral wall of the in-bifurcation segment.

It is usually difficult to identify stroke pathogenesis for single lenticulostriate infarction with nonstenotic middle cerebral artery (MCA). Our aim is to differentiate the two pathogeneses, non-branch atheromatous small vessel disease and branch atheromatous disease (BAD) by high-resolution magnetic resonance imaging (HR-MRI).

Two-dimensional high-resolution MRI (2D HRMRI) faces many technical challenges for fully assessing morphologic characteristics of inherent tortuous basilar arteries. Our aim was to investigate remodeling mechanisms and plaque distribution in symptomatic patients with basilar artery stenosis on three-dimensional (3D) HRMRI.

Objective:To investigate correlation factors of abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients with refractory secondary hyperparathyroidism(rSHPT).Methodology:From May 2014 to January 2016,rSHPT patients without parathyroidectomy,in China-Japan Friendship Hospital were enrolled.The demographic data and biochemical data were collected,including intact parathyroid hormone (iPTH),calcium (Ca),phosphorus (P),Bone mineral density (BMD) were measured using dual X-ray absorptiometry (DXA),AAC was evaluated using lateral X-ray plain films of abdomen.AAC severity was classified as absent (AAC =0),mild (1 ≤ AAC score ≤ 5),and moderate to severe (AAC score＞6).Results:Eighty-two rSHPT patients were included,63.4％ of them had AAC.Compared with absent calcification group,patients in the other two groups were elder (P＜0.001),the dialysis time was longer (P＜0.05),and C-telopeptide of type Ⅰ collagen(CTX) level in the absent calcification group was higher than the other groups (P＜0.05).AAC was more severe in males (P＜0.05).Multiple linear regression analysis shows that AAC was positively correlated with age (r =0.042,P ＜ 0.001) and serum phosphorus (r =0.438,P =0.045),and negatively with CTX (r=-0.100,P =0.035).Conclusion:63.4％ of MHD patients with rSHPT presented with AAC,and AAC may correlate with age,male,serum phosphorus and CTX.

Our aim was to investigate wall thickening (WT) pattern of atherosclerotic basilar artery stenosis with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA), and the relationship with clinical characteristics. Twenty consecutive patients with atherosclerotic basilar artery stenosis were prospectively enrolled. All cross-sectional slices on VISTA images of basilar arteries were assessed, and classified as eccentric or concentric WT. Clinical characteristics and degree of stenosis were compared between the patients with different wall WT pattern. Wall abnormalities were identified in 568 cross-sectional slices in basilar arteries of 20 patients including eccentric WT in 497 (87.5 %) slices, and concentric WT in 71 (12.5 %) slices. In 11 of 20 patients, all the cross-sectional slices (293 slices) showed eccentric WT. In 9 of 20 patients, the cross-sectional slices (275 slices) showed both eccentric WT (204 slices, 74.2 %) and concentric WT (71 slices, 25.8 %). No lesion showed only concentric WT. At the slices of maximum luminal narrowing sites, only one patient showed concentric WT. Symptomatic stenosis was more common in the patients with mixed WT (eccentric and concentric), compared to patients with only eccentric WT (100 vs 54.5 %, p = 0.038). Atherosclerotic basilar artery stenosis could show both eccentric and concentric WT based on each slice analysis. Concentric WT was found in near half of the patients, but tended to locate in minimal slices. No lesion was entirely concentric. Lesions with mixed WT (concentric and eccentric) might represent advanced atherosclerosis with high risk of ischemic event.

Objective To investigate the imaging features of chest CT and characteristics of laboratory tests in microscopic polyangitis (MPA) with pulmonary infection. Methods Based on the results of sputum culture, 42 patients with MPA were divided into two groups, MPA with pulmonary infection (16 cases)and MPA without pulmonary infection (26 cases). The results of chest CT images and laboratory tests were compared between the 2 groups by χ2 test (or Fisher exact test) and student t test (or Mann-Whitney U test), respectively. Results Compared with patients without pulmonary infection, patients with pulmonary infection showed patchy opacities(15/16 cases versus 14/26 cases,χ2=5.631,P=0.018)and consolidations(7/16 cases versus 2/26 cases,χ2=5.657,P=0.017)more frequently. Patchy opacities showed peripheral distribution less frequently in the MPA with pulmonary infection group than in the MPA without pulmonary infection group (6/15cases versus 12/14 cases,P=0.021). Patients with pulmonary infection showed the same frequent as the patients without pulmonary infection in the following CT findings including ground glass opacities, pleural effusions, mediastinal adenopathy and pulmonary fibrosis (P>0.05). The MPA with pulmonary infection group had higher neutrophil ratio than the MPA without pulmonary infection group (0.84 ± 0.12 versus 0.74 ± 0.11,t= 2.845,P= 0.007). Conclusions The MPA patients with pulmonary infection show patchy opacities and consolidations more frequently, and have higher neutrophil ratio than the MPA without pulmonary infection. The characteristics can be helpful in the diagnosis of pulmonary infection in the MPA patients and guild the treatment.

目的 探讨维持性血液透析(MHD)患者腹主动脉钙化(AAC)的相关危险因素.方法 通过X线腹部侧位片对177例MHD患者进行AAC评分,按腹主动脉钙化有无将患者分为钙化组和非钙化组,比较两组患者的人口学特征、透析龄、心血管事件、高血压病史、高脂血症病史、糖尿病痛史、碳酸钙及活性维生素D用药史以及血钙、血磷、全段甲状旁腺激素(iPTH)、高敏C反应蛋白(hs-CRP)等实验室指标的不同,通过Logistic回归分析AAC发生的相关危险因素,并比较不同PTH水平组患者AAC的发生率.结果 177例MHD患者中58.2％(103例)存在腹主动脉钙化,钙化组患者心血管事件的发生率显著高于非钙化组(33.3％vs 9.4％,P=0.001).单因素分析显示钙化组患者高龄、长透析龄、高hs-CRP、高脂血症、高血压、碳酸钙用药史、活性维生素D用药史人数显著高于非钙化组,差异有统计学意义(P ＜0.005).Logistic回归分析显示:高龄、高脂血症、高血压、长透析龄、高iPTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素.随着血清iPTH水平的增高,AAC的发生率也随之增加,即使在矫正了年龄、性别、吸烟、透析龄、高血压、糖尿病、高hs-CRP、活性维生素D用药史、碳酸钙用药史等影响因素后,这种作用依然存在.结论 MHD患者腹主动脉钙化发生率明显高于正常人群.研究发现年龄、高脂血症、高血压、透析龄、高PTH、高hs-CRP、活性维生素D和碳酸钙用药史是AAC的危险因素,其中高iPTH水平是MHD患者AAC的独立危险因素.

Background: There are few studies for evaluating wall characteristics of intracranial vertebral artery hypoplasia (VAH). The aim of this study was to determine wall characteristics of VAH with three-dimensional volumetric isotropic turbo spin echo acquisition (3D VISTA) images and differentiate between acquired atherosclerotic stenosis and VAH.Methods: Thirty patients with suspicious VAH by luminograms were retrospectively enrolled between January 2014 and February 2015. The patients were classified as "acquired atherosclerotic stenosis" or "VAH" based on 3D VISTA images. The wall characteristics of VAH were assessed to determine the presence of atherosclerotic lesions, and the patients were classified into two subgroups (VAH with atherosclerosis and VAH with normal wall). Wall characteristics of basilar arteries and vertebral arteries were also assessed. The clinical and wall characteristics were compared between the two groups.Results: Five of 30 patients with suspicious VAH were finally diagnosed as acquired atherosclerotic stenosis by 3D VISTA images. 25 patients were finally diagnosed as VAH including 16 (64.00%) patients with atherosclerosis and 9 (36.00%) patients with normal wall. In the 16 patients with atherosclerosis, plaque was found in 9 patients, slight wall thickening in 6 patients, and thrombus and wall thickening in 1 patient. Compared with VAH patients with normal wall, VAH patients with atherosclerosis showed atherosclerotic basilar arteries and dominant vertebral arteries more frequently (P = 0.000).Conclusions: Three-dimensional VISTA images enable differentiation between the acquired atherosclerotic stenosis and VAH. VAH was also prone to atherosclerotic processes.

Objective To evaluate the value of 256 slices CT angiography (CTA) in the diagnosis of in‐stent restenosis (ISR) for the patients with extracranial artery stenting .Methods Between Dec .2010 and Nov 2012 ,endovascular stent‐ing angioplasty was performed in 16 patients with carotid artery stenosis ,15 patients with vertebral artery stenosis and 6 patients with subclavian artery stenosis .256‐slice CTA was performed to evaluate the stent patency ,and the ISR was clas‐sified into 4 patterns .Results ISR was found in 11 patients with carotid artery stents (6 cases with pattern Ⅰ B ,2 cases with pattern Ⅰ C ,2 cases with pattern Ⅱ ,and 1 case with pattern Ⅳ ) ,and 10 patients with vertebral artery stents (1 case with pattern Ⅰ A ,pattern Ⅰ B ,pattern Ⅰ C ,respectively ;5 cases with pattern Ⅱ ;1 case with pattern Ⅲ and pat‐tern Ⅳ ,respectively) ,and 5 patents with subclavian artery stents ( 1 case with pattern Ⅰ A and pattern Ⅰ C ,respective‐ly ;3 cases with pattern Ⅱ) .Conclusion 256‐slice CTA is favorable for demonstrating the ISR and help to investigate the reason of ISR ,which becomes one of preferred imaging methods for the follow‐up after stenting .

[Absttract] Objectire:To explore the diagnostic value of CT-guided puncture biopsy in spinal lesions.Methods:The clinical data of 103 patients with spinal lesions confirmed by surgery and pathology were retrospectively analyzed.All pa-tients underwent CT-guided percutaneous puncture biopsy.Of 103 cases,there were 60 benign lesions and 43 malignant le-sions.The level of spinal biopsy was cervical segment in 7 cases,thoracic in 34 cases,lumbar in 52 cases and sacral in 10 ca-ses.The key points of puncture biopsy included precise selection of cross-section and point of puncture and multipoint punc-ture.The patient′s position (supine or prone)and puncture path were designed according to the location of each lesion. Ackermann needle was used for all patients,sometimes (n=17)combined with the aspiration needle.Biopsy specimens were sent for cytopathology.Results:All lesions were safely biopsied with successful rate of 100%.89 cases were diagnosed cor-rectly by the biopsy with false-negative result in 11 cases and false-positive result in 3 cases.The diagnostic accuracy for all, malignant and benign lesions was 86.4%,90.69% and 83.33%,respectively,there was no statistic difference between ma-lignant and benign group (χ2 =1.157,P >0.05).The diagnostic accuracy was 85.71%,79.41%,90.38%,and 90.00% for the lesions located in the cervical,thoracic,lumbar and sacral spine.No severe complications were observed in this series. Conclusion:CT-guided spinal biopsy is a safe and effective method for diagnosis and differential diagnosis of spinal lesions.

Objective To evaluate the diagnostic value of Full-field digital mammography(FFDM) for breast diseases.Methods The authors retrospectively reviewed the records of 215 patients of breast disease who underwent FFDM and surgical excision or biopsy.The imaging appearance was compared with pathology.Results Among the 215 cases with pathological diagnosis by surgical excision or biopsy,132 cases were proved breast carcinoma.83 cases were proved benign breast lesions.14 cases proved breast carcinoma by pathological diagnosis were misdiagnosed in benign.Conclusion Full-Field digital mammography is a important diagnose methods for breast lesions.It has an important value in finding and screening breast carcinoma.To some benign breast lesions,its diagnosis accuracy is low and additional clinical diagnostic methods are integrant.

目的 探讨肝纤维化和肝硬化病人磁化传递率(MTR)与血清学指标的相关性,以及对肝硬化早期诊断的价值.方法 分别对44例肝纤维化病人、49例肝硬化病人及46例正常对照组利用磁共振磁化传递成像(MTI)进行检查,并对MTR与血清学指标对照,采用Kruskal-Waills进行非参数统计分析,采用Pearson相关性检验及偏相关性检验进行相关性分析.结果 对照组、肝纤维化组、肝硬化组磁化传递率差别无统计学意义(H=3.558, P=0.169);肝纤维化组Pearson相关分析显示磁化传递率与透明质酸(HA)(r=0.724, P=0.000)和IV型胶原(r=0.425,P=0.038)正相关;偏相关显示磁化传递率仅与透明质酸(HA)相关(r=0.8748,P=0.000).结论 磁化传递率可间接反映肝纤维化胶原沉积情况,MTI技术和透明质酸等血清学检查指标相结合,在预测肝纤维化和肝硬化等弥漫性病变的早期诊断中有一定价值.

OBJECTIVE:To evaluate the effects of computed tomography (CT) guided percutaneous fine-needle aspiration biopsy (FANB) in examination of pancreas and Vater's ampulla. METHODS:One hundred and six patients, 71 males and 35 females, aged 21 approximately 74, with lesions located in the pancreas and Vater's ampulla, 1.5 approximately 5 cm in size (< 3 cm in 32 cases and >or= 3 cm in 74 cases), underwent CT guided percutaneous FANB with 22-gauge needle (in 84 cases) or 20-gauge needle (in 22 cases) by anterior approach. The biopsy sites included the head of pancreas and ampulla (n = 70), body of pancreas (n = 24), and tail of pancreas (n = 12). The key points of FANB included selection of appropriate cross-section, entry of needle, and multiple insertion in fan-like fashion with fast puncture and aspiration. Pathological examination was done to all biopsy specimens. RESULTS:All lesions were safely accessed with an accuracy rate of 100% and without major complications. Pathological examination showed that 83 lesions were malignant, 5 of which were confirmed as false-positive, and 20 lesions were benign 2 of which were confirmed as false-negative, and 3 lesions were true-negative. The accuracy rates of diagnosis of malignant lesions and of diagnosis of benign lesion were 94% and 90% respectively (P > 0.05). The accuracy rate of diagnosis was 96% for the lesions >or= 3 cm was 96% and 88% for the lesions < 3 cm (P > 0.05). The accuracy rates of diagnosis were 93%, 92%, and 100% for the lesions located in the head of pancreas and ampulla of Vater, body of pancreas, and tail of pancreas (P > 0.05). CONCLUSION:CT guided percutaneous FANB is a safe and effective method for the diagnosis and differential diagnosis of lesions in the pancreas.