目的 探讨256排冠状动脉CT血管成像(CCTA)用于慢性阻塞性肺疾病(COPD)患者自由呼吸下检查的可行性.方法 回顾性分析自2017年1月至2019年10月收治的74例COPD患者和74例无屏气困难患者的临床资料.两组患者均行256排CCTA,其中,COPD患者在自由呼吸状态下完成,而无屏气困难患者则在标准屏气状态下完成.比较两组患者的辐射剂量相关指标(有效辐射剂量、容积CT剂量指数、剂量长度乘积)、图像质量可判读性指标(每位受试者、每支血管、每个节段)及冠状动脉图像质量评分.结果 两组患者的辐射剂量相关指标、图像质量可判读性指标及图像质量主观评分比较,差异均无统计学意义(P>0.05).结论 COPD患者在自由呼吸状态下行256排CCTA,图像质量和辐射剂量均与标准屏气状态接近.

目的 探讨纳米t-PA基因载体涂层支架对犬冠状动脉血栓形成和支架再狭窄的影响.方法 选取健康雄性家犬22只制作冠状动脉内膜损伤模型后,立即随机分为观察组12只和对照组10只,分别置入载纳米t-PA基因涂层支架和裸金属支架.术后动物均不用抗凝治疗.两组分别于术前及术后1、2、4、8周取血检测t-PA和D-二聚体含量,术后8周行冠状动脉造影和血管内超声检查;超声检查后处死动物,苏木素-伊红染色法染色显微镜下观察局部血管腔内血栓形成、支架内血栓形成和血管壁病理改变.结果 两组术前血液t-PA、D-二聚体水平比较差异无统计学意义(P均>0.05);观察组置入支架后1、2、4、8周t-PA、D-二聚体水平均高于对照组(P均<0.05).支架置入术后8周观察组支架管腔丢失、内膜增生面积、内膜增生容积均优于对照组,两组比较差异均有统计学意义(P均<0.05).术后8周肉眼及显微镜下观察,对照组支架冠状动脉内膜明显不规则增厚,内膜中增生细胞不规则,排列紊乱,细胞间基质堆积多,见散在炎性细胞.与对照组比较,观察组支架冠状动脉内膜明显变薄,内膜细胞多为长梭形,PCNA阳性细胞少;对照组血栓形成率100％,观察组血栓形成率16.67％,两组血管支架内血栓形成率比较差异有统计学意义(P<0.05).结论 纳米t-PA基因载体涂层支架可有效携带和释放药物,抑制术后冠状动脉支架内再狭窄发生.

目的 观察心房肌纤维化延迟钆增强-心脏磁共振成像(LGE-CMR)检测与CARTO-3三维标测左心房纤维化区域相关性和房颤患者射频消融术后复发情况.方法 入选接受射频消融术阵发性房颤患者38例,全部给予心房LGE-CMR检测,根据LGE-CMR检查结果,将左房纤维化定量/左房壁提及百分比分两组,A组为轻度心房肌纤维化,左房纤维化定量/左房壁提及百分比<25％;B组为重度心房肌纤维化,左房纤维化定量/左房壁提及百分比≥25％.检测结束后全部患者给予环肺静脉隔离+二尖瓣峡部线/房顶线隔离(CPVI+MI/ROOF)射频消融术.术后随访1年,观察房颤复发率.结果 38例患者全部成功行射频消融术,并完成1年随访.LGE-CMR和CARTO系统重建图像的心肌纤维化区域以及分级情况相符合,具有一致性,诊断准确率为92.11％(35/38).无论是LGE-CMR检测,还是CARTO系统重建图像评价,左心房心肌纤维化轻的患者室早射频消融术后1年复发率均较左心房心肌纤维化严重的患者低(P<0.001).结论 心房LGE-CMR检测与CARTO-3三维标测左心房纤维化区域相关性强,且心肌纤维化严重患者房颤射频消融术后复发率高.

Objective To evaluate the radiation dose levels and image quality of personalized ECG-gated low-dose coronary computed tomography angiography (CCTA) based on iterative reconstruction algorithm (IRA) and body weight in-dex (BMI). Methods One hundred patients with heart rate less than 65 bpm were randomly divided into conventional group (n=50) and low dose group (n=50). In the conventional group, CCTA was performed at regular dose (a voltage of 120 kV and a currency of 800 mAs) and images were reconstructed using filter back projection (FBP). In the low dose group, CCTA was performed at a currency of 280 mAs and a voltage of 80-120 kVp tailored to BMI. The images were reconstructed with FBP and iterative reconstruction algorithm (IRA) at iDOS-5. In both groups, prospective ECG-gated CCTA was employed. CT dose index volume (CTDI), dose-length product (DLP), effective radiation dose (ED), and image quality were compared between conventional group and low dose group. Results Compared with conventional group, CTDI, DLP and ED of the low dose group decreased obviously with statistical significance (P＜0.01). The image quality of the low dose group with FBP was 3.72 ± 0.24, which was statistically less than 3.86 ± 0.23 of the conventional group (P＜0.01). Using IRA with iDOS-5, the image quality of low dose group increased to 3.81 ± 0.20, which was less than the conventional group with no statistical significance (P＞0.05). Conclusion Personalized ECG-gated low-dose CCTA based on IRA and BMI can decrease radiation dose without sacrifice of image quality significantly. It is a cost-effective technique and worth recommending.

Objective To assess paraspinal muscles fat infiltration by using Dixon MR imaging and investigate the relationship of fat infiltration with age.Methods Two radiologists measured signal intensity (SI) of right side paraspinal muscles by manual drawn ROI on fat and water images of Dixon sequence twice independently in 135 patients. The fat signal fraction (FSF) of paraspinal muscles was calculated. ICCs were used to evaluate inter- and intra-observers reliability. The relationship between FSF of paraspinal muscles and age was assessed using ANCOVA with adjustment of gender.Results FSF of paraspinal muscles increased with age. After adjusting gender, the association between FSF of paraspinal muscles and age was statistical significant (P=0.016). Inter- and intra-observer reliability was excellent with ICC of 0.83 and 0.86, respectively.Conclusion Dixon MR imaging can be used to monitor degeneration of paraspinal muscles with aging with excellent reliability.

Objective: To investigate the relationship between vertebral endplate Modical changes and adjacent intervertebral disc degeneration. Materials and Methods: Lumbar structure and quantitative MR images of 66 patients were retrospectively analyzed. Disc degeneration was semi-quantitatively assessed using Pfirrmann grading system and quantitatively assessed using T2 and T2* values. Association between Pfirrmann scores, T2 and T2* values of intervertebral discs with adjacent endplate Modic changes was analyzed. Results: Nineteen intervertebral discs with adjacent endplate Modic changes were detected in fourteen patients (14/66, 21.2%), which included 2 discs with Modic type 1 changes and 17 discs with type 2 changes. Pfirrmann scores of the discs adjacent to normal endplates, Modic type 1 endplates and Modic type 2 endplates were 2.40±0.96、4±1.41 and 4.12±1.27, respectively. T2 values were (95.38±51.88) ms, (70.50±36.06) ms and (58.65± 38.47) ms. T2* values were (34.43±19.16) ms, (24.00±1.41) ms and (28.65±23.00) ms. The differences of disc Pfirrmann scores, T2 and T2* values among different endplate changes were statistical significant with P values of 0.000, 0.000 and 0.023, respectively. Comparing to discs adjacent to normal endplates, discs adjacent to Modic type 2 endplates had severe degeneration with increased Pfirrmann scores and decreased T2 and T2* values. The differences were statistical significant (P values were 0.000, 0.000 and 0.006, respectively). Conclusions: Modic changes of vertebral endplate are associated with adjacent intervertebral disc degeneration. Both of them should be regarded as a facet of the "whole-organ" pathologic conditions in the procession of spinal degeneration.

Objective To investigate the effects of left atrial appendage occlusion on cardiac function and neuroendocrine function in patients with nonvalvular atrial fibrillation. Methods Thirty patients with nonvalvular atrial fibrillation,who were treated by left atrial appendage occlusion in the Department of Cardiology,Renmin Hospital of Wuhan University and Department of Cardiology,Shenzhen Municipal People's Hospital between September 2015 and April 2016,were included in the study. The operation and complications were recorded. The transthoracic echocardiography (TTE) was performed at baseline and at 1 d,1 month and 6 months after the operation. The left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD),left ventricular end diastolic volume (LVEDV),and left ventricular ejection fraction(LVEF)at different time points were compared. The levels of plasma endothelin 1(ET-1),tumor necrosis factor α(TNF-α)and N-terminal pro-brain nitric peptide(NT-proBNP)were examined at baseline and at 1 d,1 month and 6 months after the operation. Results Thirty patients successfully underwent the left atrial appendage occlusion,and no serious complications occurred. There were left atrial appendage and left atrial residual shunt in 12 cases,and no residual shunt in 18 cases at the end of operation. There were no statistically significant differences in the levels of LAD,LVEDD,LVEDV and LVEF at baseline and at 1 d,1 month and 6 months after the operation(all P>0.05). The levels of plasma ET-1,TNF-αand NT-proBNP at 1 d,1 month and 6 months after the operation were significantly decreased as compared with those at baseline (all P<0.05). Conclusion The success rate of left atrial appendage occlusion is high in the treatment of nonvalvular atrial fibrillation,which shows no significant effect on cardiac function,and can significantly reduce the related plasma indicators of neuroendocrine.

Objective To correlate T2 and T2* value of intervertebral disc (IVD) with Pfirrmann grades of IVD degeneration in patients with low back pain, in order to identify whether T2 and T2* value can be imaging biomarkers for quantitative assessment of IVD degeneration.Methods Sixty-six patients with low back pain underwent conventional structure imaging and quantitative imaging (T2 and T2* mapping) of lumber IVD using 3 Tesla MR system. Pfirrmann grades were performed by two diagnostic radiologists in concensus on the basis of the sagittal T2-weighted images. T2 and T2* values of IVD were measured by one diagnostic radiologist through manual drawing region-of-interest (ROI) on midsagittal T2 and T2* maps to cover the nucleus pulposus and inner annulus fibrosus. The correlation between Pfirrmann grades and the two quantitative parameters of IVD was assessed by Pearson correlation test. The difference in T2 and T2* values of contiguous Pfirrmann grades were compared using t test.Results T2 and T2* values of IVD were of negative correlation to Pfirrmann grades with correlation coefficients of -0.612 and -0.354 (P<0.001), respectively. Except grades Ⅳ andⅤ, T2 and T2* values of contiguous Pfirrmann grades showed statistical significant differences.Conclusion T2 and T2* values of IVD could be potential imaging biomarkers for quantitative assessment of IVD degeneration, which might be helpful of early diagnosis and objective evaluation of degeneration. For the end stage degeneration, the decrease of T2 and T2* values is slow down, and morphological changes become obvious.

Objective To explore the correlation of dynamic contrast-enhanced MRI(DCE-MRI)parameters with clinicopathological features in patients with nasopharyngeal carcinoma.Methods Totally 102patients with pathologically proved nasopharyngeal carcinoma underwent DCE-MRI scanning,and parameters of ROI were obtained.The relationship between DCE-MRI parameters and clinicopathological features of nasopharyngeal carcinoma were statistically analyzed.ResultsThe differences of maximum slope(MS)among patients with different genders and ages were not statistically significant(both P0.05),but were statistically significant among different T-stage,N-stage and clinical stage(all P0.05).No significant difference of time to peak(TTP)nor area under curve(AUC)was observed among tumors with different clinicopathological features(all P0.05).Conclusion DCE-MRI parameters of nasopharyngeal carcinoma are correlated with tumor development.DCE-MRI may contribute to auxiliary diagnosis and clinical staging for patients with nasopharyngeal carcinoma.

目的 探讨鼻咽癌动态对比增强磁共振扫描(DCE-MRI)参数与乏氧诱导因子-1α(HIF-1α)表达的相关性,并分析两者与鼻咽癌临床病理特征之间的关系.方法 对62例鼻咽癌患者行DCE-MRI扫描,获取感兴趣区域的DCE-MRI参数,并在标记处行鼻咽镜活检,用免疫组化方法检测鼻咽癌组织中HIF-1α的表达水平,另检测20例鼻咽慢性炎性组织的HIF-1α表达用于对照;观察DCE-MRI曲线特征,并对DCE-MRI参数和HIF-1α表达情况以及两者与患者临床病理特征的相关性进行分析.结果 鼻咽癌DCE-MRI参数中,增强剂流入肿瘤时间(T1 on set)和最大上升斜率(MS)在不同患者性别、年龄间差异无统计学意义(P>0.05),在T分期、N分期和临床分期间差异有统计学意义(P<0.05).鼻咽癌组织和鼻咽慢性炎性组织中HIF-1α蛋白的阳性表达率分别为79.0%和0,两组间比较差异有统计学意义(P<0.05);HIF-1α表达在不同患者年龄、N分期间差异有统计学意义(P<0.05),而在不同患者性别、T分期和临床分期间差异无统计学意义(P>0.05).HIF-1α的阳性表达与T1 on set和曲线下面积有明显相关(回归系数分别为-1.817和0.014,P<0.05),而与MS和达峰时间无明显相关性(回归系数分别为0.005和1.009,P>0.05).结论 在鼻咽癌中,DCE-MRI相关参数与癌组织HIF-1α蛋白的阳性表达密切相关,且与鼻咽癌的临床病理特征密切相关.DCE-MRI技术的应用有助于评估鼻咽癌组织的乏氧状况,并在鼻咽癌的辅助诊断、临床分期及预后判断中有一定的临床价值.

目的 探讨严重妊娠高血压疾病的颅脑影像学变化及特征,分析并发脑血管病变的临床高危因素.方法 回顾性分析我院近8年来100例重度子痫前期及子痫患者的颅脑CT及临床资料.①根据入院诊断分为:子痫组,43例;重度子痫前期组,57例;②根据颅脑CT结果分为3组:出血组7例;缺血组47例;无异常组46例.结果 子痫组脑缺血率为76.8%(33/43),高于重度子痫前期组24.6%(14/57)(χ2＝26.739,P＜0.01);两组颅内出血率无明显差异(F=0.113,P＞0.05).出血组平均动脉压156.0±22.4mmHg,高于缺血组133.6±19.9mmHg(t=2.731,P＜0.01)及无异常组136.1±19.9mmHg(t＝2.416,P＜0.05).血清乳酸脱氢酶含量出血组及缺血组均明显高于无异常组(Z值分别为2.435、2.327,均P＜0.05).出血组并发弥散性血管内凝血及HELLP综合征的发生率为42.9%,明显高于缺血组的10.6%(χ2＝5.011,P＜0.05).预后:死亡2例;植物人状态1例,2例脑缺血患者遗留视力减退.结论 子痫组比重度子痫前期组患者颅脑异常的发生率高.当平均动脉压接近156mmHg左右、乳酸脱氢酶异常增高及合并HELLP综合征、弥散性血管内凝血患者应警惕颅内出血发生.严重脑缺血或颅内出血患者预后不良.

脑血管意外是妊娠期高血压疾病的严重并发症之一,几乎均发生于重度子(癎)前期(preeclampsia)及子痢(eclampsia)患者,是导致孕产妇死亡的主要原因之一[1].目前国内外关于妊娠期高血压疾病并发脑血管病的影像学研究资料较少,更鲜有系统的、大样本的临床研究资料.

目的:探讨磁共振氢质子波谱(1H-MRS)是否有助于四肢骨与软组织良性恶性肿瘤的诊断及鉴别。方法:对10例肢体正常骨与肌肉组织、20例四肢肿瘤患者进行1H-MRS检查,应用8通道相控阵线圈,并采用单体素波谱(SVS)的点分辨表面定位序列(PRESS):TE35、144m s和288m s。结果:四肢骨与软组织良、恶性肿瘤和正常组织的1H-MRS波谱明显不同,恶性肿瘤的胆碱(Cho)含量明显升高。结论:应用1H-MRS可以在骨与软组织恶性肿瘤中检测到明显升高的胆碱,可以作为临床良、恶性肿瘤诊断、鉴别及指导治疗的重要手段。

目的:探讨原发性骨恶性纤维组织细胞瘤的影像表现。方法:回顾性分析9例经病理证实的原发性骨恶性纤维组织细胞瘤的X线平片和CT、MRI表现。结果:全部病例均发生于长骨,其中,长骨干骺端或骨端8例,骨干1例。X线主要表现为溶骨性骨质破坏,部分病例呈膨胀性骨质破坏,软组织肿胀或肿块,骨膜反应少见。结论:骨恶性纤维组织细胞瘤影像表现多样,在长骨干骺端或骨端有溶骨性破坏,伴有较大软组织肿块且无明显骨膜反应的,应考虑本病可能。

Objective To investigate the imaging features of intraosseous ganglion.MethodsImaging features of 14 cases of intraosseous ganglia were retrospectively analyzed.All the 14 patients underwent radiolography,while 5 patients received CT examination and two patients received MR imaging at the same time.Results16 lesions were detected in the 14 patients,which located in acetabula(n=9),lunate,(n=3),scaphoid(n=1),humeral head(n=1),femora head(n=1)and distal end of tibia(n=1).Radiological features included a unilocular or multilocular cyst surrounded by a full and thin rim of sclerotic bone in the subchondral epiphysis without any signs of degenerative joint disease.CT showed that 6 lesions had round or irregular cystic erosions with clear sclerosis edge with an average CT value of 38Hu in the center of the lesions.2 lesions had hypointensity and hyperintensity signal with hypointensity rim on T1W and T2W respectively.ConclusionIntraosseous ganglion cysts have characteristic imaging features.Combined with clinical manifestations,it is possible to make a correct diagnosis of intraosseous ganglion.

Objective:To evaluate the clinical values of multi-slice spiral CT angiography in diagnosis of aortic aneurysm.Methods:CT angiography were performed in 9 patients with aortic aneurysm.The data of all patients were reconstructed with the 3D technique including multiple plane reformation(MPR),maximum intensity projection(MIP) and volume rending(VR).Results:9 cases included 6 cases with aortic aneurysms,2 with aortic dissection and 1 with bracket in sertion.The anatomical characters and the relationship between aneurysm and adjacent organs could be visualized clearly and directly by the reconstructed images combined with the original images.Conclusion:MSCT is predominant in diagnosis,classification and typing of aortic aneurysm,it plays important role in selecting curative methods and observing efficacy.

主动脉弓离断(interrupted aortic arch,IAA)是一种少见的先天性心血管畸形,常合并有心内及心外多系统的畸形,发生率在新生儿中约为1:10 000,在先天性心脏病患儿中约占1%[1].目前国内外未见利用多层螺旋CT(multislice computed tomography,MSCT)血管造影诊断IAA的报道.笔者利用MSCT诊断IAA 1例,并经血管造影及手术证实,报道如下.

Objective To investigate the influence of reconstruction time and heart rate on image quality of multi-slice CT (MSCT) coronary angiography, and to confirm the optimal reconstruction time in patients of different heart rate. Methods MSCT coronary angiography were performed in 93 patients. Images were reconstructed at 20%-80% of the cardiac cycle in increments of 10%. Patients were classified three groups according to heart rate (groupⅠ:≤60 bpm, groupⅡ:60-70 bpm, group Ⅲ:≥70 bpm), image quality was evaluated by two investigators. Results The best reconstruction time of left anterior descending artery (LAD) were 50%-70%, 60%-70%,60% respectively from groupⅠto group Ⅲ; that of left circumflex artery (LCX) were 50%-60%,60%,40% respectively; that of right coronary artery (RCA) were 60%, 50%-60%, 40% respectively. The proximal segments of LM, LAD were not statistically significant in all groups, the mid and distant segments of LAD, all segments of LCX, proximal segments of RCA were not statistically significant between group Ⅰand group Ⅱ, but those are statistically significant compared to group Ⅲ; the mid segments of RCA are statistically significant in any group. Conclusion With multi-reconstruction time, 16-slice CT coronary angiography can achieve good image quality in patients whose heart rates are below 70 beats per minute.

Objective To evaluate the value of 16 slice helical CT postprocessing technique for diagnosis of scoliosis.Materials and Methods 23 cases of scoliosis were performed with multiple CT scan to be reconstructed by multiple planner reconstructed (MPR), surface shading display (SSD) and volume rendering (VRT), which were used to evaluate the value of the various images. Results MPR was easily used for sagittal and coronary, but not so continuity for bend of the scoliosis at sagittal and coronary while it could display the structure in the vertebral canal. SSD was suitable to show the whole of the spinal structure and the angle of scoliosis, but failed to display the content of the vertebral canal. VRT could inform all of the anatomy of scoliosis through adjusting the density threshold, such as the spine, osteal pathological changes, and related condition about scoliosis, it was especially suitable for the classification of scoliosis and displaying the status of the vertebral canal.Conclusion MSCT can be used for scanning of the whole spine in one time, the axial imaging combined with various reconstruction technique can provide the space structure of scoliosis which may help doctor to set down therapy project.