Purpose:To assess the practicality and utility of employing dual post-label delay (PLD) arterial spin labeling (ASL) in transient ischemic attack (TIA) individuals exhibiting Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH). Materials and methods:We conducted a retrospective review of clinical data from TIA patients presenting with unilateral severe atherosclerotic stenosis or obstruction of either the intracranial internal carotid artery or the middle cerebral artery. Participants were categorized into two groups based on the presence or absence of FVH: FVH positive and FVH negative. All individuals underwent pseudo-continuous ASL perfusion imaging, utilizing distinct PLD durations (1,525 and 2,525 ms) alongside qualitative visual assessments of ASL perfusion irregularities. Standardized TIA evaluations, which included medical history reviews, neuropsychological assessments, and ABCD2 scoring, were performed on all subjects. We explored the correlations between FVHs, clinical manifestations, vascular risk factors, and perfusion metrics. Results:A total of 50 patients were included in this investigation, with FVH detected in 16 subjects (32.0%). The ABCD2 score was notably elevated within the FVH positive cohort compared to the FVH negative group. At a PLD of 1,525 ms, cerebral blood flow (CBF) values for the affected and healthy hemispheres in the FVH positive group were recorded at 19.55 ± 6.67 and 40.32 ± 6.83, respectively; corresponding values in the FVH negative group were 23.74 ± 5.03 and 46.43 ± 7.91. For a PLD of 2,525 ms, the CBF values for the affected and healthy sides in the FVH positive group were 34.11 ± 5.87 and 50.27 ± 8.57, while the FVH negative group recorded values of 42.79 ± 7.03 and 52.07 ± 7.29, respectively. The differential CBF (ΔCBF) for the affected side in the FVH positive and negative groups was 14.57 ± 4.34 and 19.05 ± 6.10, respectively. A significant negative correlation was established between ΔCBF and ABCD2 scores (Kendall's tau-b = -0.578, p < 0.001). Conclusion:The findings of this study indicate a strong association between the presence of FVH signs and a marked reduction in cerebral blood flow, as well as diminished blood flow reserve. This underscores the potential role of FVH as a biomarker for hemodynamic impairment in TIA patients.

To analyze the value of the combined test of the cardiac color Doppler ultrasound, the serum middle receptor pro-atrial natriuretic peptide (MR-ProANP) and the N-terminal pro-brain natriuretic peptide (NT-ProBNP) in forecasting the hypertensive left ventricular hypertrophy (LVH) and left heart failure (LHF). All patients were subjected to cardiac color Doppler ultrasound examination to obtain left atrium volume index (LAVI), left ventricular end-diastolic diameter (LVEDD), early-diastolic peak flow velocity (E), early-diastolic mean flow velocity (e'), early-diastolic peak flow velocity/early-diastolic mean flow velocity (E/e') and left ventricular ejection fraction (LVEF). Biomarkers were performed to obtain serum MR-ProANP and NT-ProBNP concentrations, and statistical analysis was performed. The LVEF was obviously lower than that in the control group (P<0.01). The area under the receiver operating characteristic (ROC) curve (AUC) values of LVEF, E/e', serum MR-ProANP and NT-ProBNP alone were in the range of 0.7-0.8. The AUC, sensitivity and specificity of LVEF and E/e' combined with MR-ProANP and NT-ProBNP to diagnose hypertensive LVH and LHF were 0.892, 89.14% and 78.21%, which were higher than those of single diagnosis. In the heart failure group, LVEF was negatively correlated with serum MR-ProANP and NT-ProBNP concentrations (P<0.05), and E/e' was positively correlated with serum MR-ProANP and NT-ProBNP concentrations (P<0.05). Pump function and ventricular remodeling in patients with hypertensive LVH and LHF are closely related to serum MR-ProANP and NT-ProBNP levels. Combination of the two testing can improve the prediction and diagnostic efficacy of LHF.

糖尿病足是2型糖尿病的常见严重并发症之一,发病率逐年上升,严重影响患者的生存质量,尤其是发生经久不愈的溃疡或者伴发感染后可能面临截肢风险,甚至危及患者生命,糖尿病足的发生、发展与多种因素有关,其中涉及局部微循环障碍,而影像学是评价血管病变的主要手段,可为临床诊断、治疗和预防提供有价值信息.本文对近年来超声、磁共振成像(magnetic resonance imaging,MRI)、计算机断层扫描(com-puted tomography,CT)等影像技术在评价糖尿病足血管、软组织及骨骼等方面的研究进展进行综述.

目的 探讨超声造影(CEUS)在 2 型糖尿病足溃疡(DFU)患者足部微循环评价中的应用价值.方法 纳入 2 型DFU患者 86 例,根据是否合并外周动脉病变(PAD)分为单纯DFU组(47 例)和DFU合并PAD(DFU-PAD)组(39 例),另选取非糖尿病且不伴有PAD 20 例为对照组.所有研究对象行足踝部 CEUS,运用定量技术评价足踝部软组织微循环灌注,获取时间-强度曲线(TIC),分析峰值强度(PI)、曲线下面积(AUC)、平均通道时间(MTT)以及软组织-足背动脉达峰时间差(T-A TTP),比较 3 组之间的灌注差异.结果 PI、AUC值在对照组、单纯DFU组和DFU-PAD组表现为依次减低,差异有统计学意义(P<0.05);T-A TTP 在对照组、单纯DFU组和 DFU-PAD 组表现为依次延长,差异有统计学意义(P<0.05);MTT 在 3 组间差异无统计学意义(P>0.05).结论 CEUS及其定量分析技术可以反映DFU患者足部微循环受损程度,对临床全面评估 DFU 合并 PAD肢端血流灌注具有一定应用价值.

Objective To investigate the application value of PI ratio of quantitative parameter of contrast-enhanced ultrasound（CEUS） in determining the survival activity of diabetic foot ulcer tissue.Methods From January to December 2021, 52 patients with diabetic foot ulcer admitted to Affiliated Hospital of Chengdu University of Traditional Chinese Medicine were selected as the study subjects. General clinical data, related laboratory data and quantitative analysis data of contrast-enhanced ultrasound were collected. According to the growth of ulcer marginal tissue, they were divided into survival group（34 cases） and necrotic group（18 cases）. Factors related to ulcer healing were screened by univariate analysis and multivariate Logistic regression, and the odds ratio（OR） of PI ratio between the two groups for marginal survival of diabetic foot ulcers were analyzed. According to receiver operating curve（ROC）,the predictive efficiency and optimal cut-off value of PI ratio for survival of diabetic foot ulcer were analyzed.Results Compared with the age, fasting blood glucose and HbA1c between survival group and necrosis group, the difference was statistically significant（P＜0.05）; the ratio of PI in the survival group（0.74±0.15） was higher than that in the necrosis group（0.53±0.14）, and the difference was statistically significant（P＜0.001）. Multivariate Logistic regression analysis showed that PI ratio [OR=10.012, 95%CI（7.048-15.224）], HbA1c[OR=0.856, 95%CI（0.758-0.895）] and age [OR=0.912, 95%CI（0.815-0.954）] were independent factors influencing ulcer margin survival in diabetic foot patients（P＜0.05）. The maximum area under curve（AUC） for predicting tissue survival in diabetic foot ulcer patients was 0.881,the sensitivity was 94.1%, the specificity was 72.2%, and the optimal cutoff value was 0.59.Conclusion The ratio of PI, a quantitative parameter of contrast enhanced ultrasound, can be used to predict the survival activity of the marginal tissue of diabetic foot ulcer. The higher the ratio, the higher the probability of tissue survival, can provide an objective basis for clinical decision-making.

目的 应用超声造影技术评价不同中医证型糖尿病足患者踝部微循环,探讨微血管损害与辨证分型的相关性.方法 纳入2型糖尿病患者72例,Wagner分级1～4级,中医辨证分为气阴两虚型24例、气虚血瘀型32例及湿热壅盛型16例,正常对照组20例.所有病例采用常规超声评价动脉斑块与狭窄情况,超声造影定量评价踝部软组织微循环灌注,获取时间-强度曲线(TIC),分析峰值强度(PI)、曲线下面积(AUC)、达峰时间(TTP)、峰值降半时间(DT/2)及平均通道时间(MTT).结果 ①常规超声:动脉斑块发生率气虚血瘀组高于气阴两虚组及湿热壅盛组(P＜0.05);动脉狭窄发生率气虚血瘀组和湿热壅盛组高于气阴两虚组(P＜0.05).②超声造影:病例组与对照组比较,TTP、DT/2及MTT病例组均高于对照组,PI、AUC病例组均低于对照组,差异有统计学意义(P＜0.05);病例组三种中医证型间比较,PI、AUC由高到低依次为湿热壅盛组、气阴两虚组和气虚血瘀组,差异有统计学意义(P＜0.05),TTP、DT/2及MTT在不同中医证型间差异无统计学意义(P＞0.05).结论 糖尿病足不同中医证型足部微循环损害程度存在差异,超声造影可提供客观化评价依据.

A 70-year-old female with poorly controlled diabetes mellitus was admitted to the emergency department. She had a complaint of syncope, fever, general malaise, dysuria, and abdominal pain for 20 days. The patient's body temperature was 38.9 °C. Percussion in the right flank region elicited pain. Her laboratory tests were significant for the following: white cell count, 24.37 109 /L, with 92% segmented neutrophils; glucose, 18.80 mmol/L; glycosylated hemoglobin, 11.3%; blood urea nitrogen, 38 mmol/L; creatinine, 530 μmol/L. C-reactive protein, 176.4 mg/L.

Purpose We aimed to investigate the prevalence of fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs) and the clinical–radiological correlation in transient ischemic attack (TIA) patients. Materials and Methods We performed a retrospective analysis of TIA patients who had undergone magnetic resonance imaging (MRI) within 24 h of symptom onset. Two independent neuroradiologists investigated the presence of FVHs, large-artery severe stenosis or occlusion (LASO) in magnetic resonance angiograms, and the nature of factors associated with FVH. Results A total of 207 patients were enrolled in this study. FVHs were detected in 42 (20.3%) patients, in whom atrial fibrillation (AF) was confirmed in 25 (59.5%) cases and LASO was confirmed in 30 (71.4%) cases. The corresponding figures were 33 (20.0%) and 10 (6.1%), respectively, for the 165 FVH-negative patients. Logistic regression analysis showed that time from symptom onset to MRI (odds ratio [OR] = 0.82, 95% CI 0.76–0.97, p = 0.042), previous stroke (OR = 2.95, 95% CI 1.58–6.74, p = 0.002), AF (OR = 5.83, 95% CI 2.24–9.46, p < 0.001), and LASO (OR = 4.28, 95% CI 2.96–10.28, p < 0.001) were independently associated with FVH. Overall, the sensitivity and specificity of FVH for predicting LASO were 0.75 and 0.93, respectively, and the positive predictive value, negative predictive value, and accuracy were 0.71, 0.94, and 0.89, respectively. The area under the receiver operating characteristic curve was 0.839. FVH-positive TIA patients with LASO had less AF (14 [46.7%] versus 11 [91.7%], p = 0.019) and longer times from symptom onset to MRI (6.8 ± 2.8 h versus 4.8 ± 1.3 h, p = 0.004) than those without LASO. Conclusion The presence of FVH could be an important marker in TIA patients. Many factors, including LASO, AF, and time from symptom onset to MRI, are associated with the detection of FVH.

目的 探讨CT值在定量评价齿状突加冠综合征(CDS)患者疼痛的应用价值.方法 连续收集我院2015年1月至2019年12月诊断CDS患者.采用视觉模拟评分(VAS)对CDS患者进行疼痛学评分,收集患者C-反应蛋白(CRP)、体温等临床资料.采用64层多排螺旋CT扫描,分别由两名有经验的放射科医师测量齿状突周围韧带及软组织的高密度病灶CT值.分析CDS患者高密度区平均CT值与VAS评分、CRP水平、体温等临床资料的相关性.结果 共纳入25例CDS患者,其中男性11例,女性14例,年龄58.3～89岁,平均年龄75.8岁.患者均为急性起病,发病时间1～5d,平均时间3.5d;伴有颈部活动明显受限15例,发热18例.CRP:(12.5±6.3)mg/dL,体温:(37.5±0.8)℃,VAS评分:6.2±3.3.两观察这测量一致性检验结果:κ值为0.8,提示两观测者测量值具有较好一致性.患者的齿状突周围高密度病灶平均CT值为(552.3±120.4)HU.统计分析显示其平均CT值与CRP水平呈中等正相关(r=0.635,P=0.001),与VAS评分及体温均无明显相关性(P>0.05).结论 CT在评价CDS患者具有重要临床价值,齿状突周围韧带CT值与血清C反应蛋白水平呈正相关,但与患者疼痛评分无明显相关性,患者疼痛可能与多种因素相关.

目的:运用超声血流向量成像(Vector Flow Imaging,V Flow)技术探讨颈动脉球部自体解剖结构及血流动力学因素对壁面剪切应力(Wall Shear Stress,WSS)的影响.方法:选取颈动脉超声检查正常患者70例,将V Flow感兴趣区置于颈总动脉分叉部及颈内动脉起始段.测量颈动脉球部与颈总动脉间角度(θ)、测量收缩末期颈动脉球部(Carotid Bulb,CB)膨大最明显处内径(DCB)与颈总动脉末段内径(DCCA)的比值(DCB/DCCA)、测量颈动脉球部分流量(QCB)与颈总动脉末段流量(QCCA)的比值(QCB/QCCA)、描记颈动脉球部血流紊乱区可视化面积(ACB)以及测量颈动脉球部起始段内侧平均壁面剪切应力(WSSI-CB)和外侧平均壁面剪切应力(WSSE-CB),并对上述各项参数进行统计学分析.结果:(1)颈动脉球部起始段WSSI-CB值为(0.88±0.30)Pa,外侧WSSE-CB值为(0.32±0.15)Pa,外侧壁明显小于内侧壁,差异有统计学意义(P<0.01).(2)颈动脉球部与颈总动脉夹角θ值为(24.5±12.1)°,与WSSE-CB相关系数为r=?0.171,二者无相关性且差异无统计学意义(P>0.05);颈动脉球部膨大最明显处内径与颈总动脉末段内径比值DCB/DCCA为(0.66±0.09),与WSSE-CB值呈负相关,相关系数为r=?0.312,差异有统计学意义(P<0.05).(3)颈动脉球部分流量与颈总动脉末段流量比值QCB/QCCA为(0.69±0.15),与WSSE-CB值呈正相关,相关系数为r=0.428,差异有统计学意义(P<0.01);颈动脉球部血流紊乱区面积ACB为(0.27±0.17)cm2,与WSSE-CB值呈负相关,相关系数分别为r=?0.545,差异有统计学意义(P<0.01).结论:颈动脉球部血流量、血流紊乱区面积及膨大程度是影响外侧壁面剪切应力WSS的主要因素,而与颈动脉球部发出角度的关系并不密切.

Neuroradiological methods play important roles in neurology, especially in cerebrovascular diseases. Fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) is frequently encountered in patients with acute ischemic stroke and significant intracranial arterial stenosis or occlusion. The mechanisms underlying this phenomenon and the clinical implications of FVH have been a matter of debate. FVH is associated with large-vessel occlusion or severe stenosis, as well as impaired hemodynamics. Possible explanations suggested for its appearance include stationary blood and slow antegrade or retrograde filling of the leptomeningeal collateral circulation. However, the prognostic value of the presence of FVH has been controversial. FVH can also be observed in patients with transient ischemic attack (TIA), which may have different pathomechanisms. Its presence can help clinicians to identify patients who have a higher risk of stroke after TIA. In this review article, we aim to describe the mechanism and influencing factors of FVH, as well as its clinical significance in patients with cerebrovascular disease.

Percutaneous computed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a valuable procedure for obtaining tissue or cells for diagnosis, which is especially indispensable in thoracic oncology. Pneumothorax and hemoptysis are the most common complications of percutaneous needle biopsy of the lung. According to reports published over the past decades, pneumothorax incidence in patients who underwent TTNB greatly varies. The morbidity of pneumothorax after CT-guided TTNB depends on several factors, including size and depth of lesions, emphysema, the number of pleural surfaces and fissure crossed, etc. Attention to biopsy planning and technique and post-biopsy precautions help to prevent or minimize potential complications. Many measures can be taken to help prevent the progression of a pneumothorax, which in turn might reduce the number of pneumothoraces requiring chest tube placement. A multitude of therapeutic options is available for the treatment of pneumothorax, varying from observation and oxygen treatment, simple manual aspiration, to chest tube placement. When a pneumothorax develops during the biopsy procedure, it can be manually aspirated after the needle is retracted back into the pleural space or by inserting a separate needle into the pleural space. Biopsy side down positioning of the patient after biopsy significantly reduces the incidence of pneumothorax and the requirement of chest tube placement. Aspiration in biopsy side down position is also recommended for treating pneumothorax when simple manual aspiration is unsuccessful or delayed pneumothorax occurred. Chest tube placement is an important treatment strategy for patients with a large or symptomatic pneumothorax. Clinicians are encouraged to understand the development, prevention, and treatment of pneumothorax. Efforts should be made to reduce the incidence of pneumothorax in biopsy planning and post-biopsy precautions. When pneumothorax occurs, appropriate treatment should be adopted to reduce the risk of worsening pneumothorax.

阿尔茨海默病( AD)是常见的神经退行性疾病,其发生、发展严重影响患者生活质量,造成巨大社会经济负担,其在65岁以上人群发生率约11％,85岁以上老年人群发生率达32％.AD的发生及进展病理机制尚不明确,可能与β-淀粉样斑块过量沉积、脑血管病变等因素有关〔1〕.轻度认知障碍( MCI)表现为神经功能的损害,是发展为AD的一个重要早期阶段,但临床中并非所有MCI患者最终都进展为AD,因此了解MCI及AD的关系具有重要的临床意义.磁共振成像( MRI)是检出神经系统疾病的一项重要的影像检查方法,具有无辐射、多参数成像等优点,常规MRI检查在AD诊断中的价值有限,广义的功能MRI( fMRI)包括动脉自旋标记成像( ASL)、弥散张量成像( DTI )、磁共振波谱成像( MRS )及血氧水平依赖功能成像( BOLD)等,近年fMRI技术发展迅速,可从多个角度研究AD患者的影像学变化,其研究结果可能对 AD 早期预防及治疗提供重要价值.本文对fMRI在MCI及AD中的应用技术进展进行综述.

To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy. Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed. Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P<.05). No serious side effects were detected in the period of aspiration procedure. Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.

目的 探讨磁共振成像(MRI)与超声对肝内外胆管结石的诊断价值.方法 收集2017年6月～2018年6月我院疑似胆管结石病(bile duct stone,BDS)患者124例,均行MRI及超声检查,以手术结果为金标准,计算并比较两种检查方法诊断的敏感度、特异度、准确度,并绘制两种方法诊断效能的ROC曲线.结果 124例疑似病例,7 5例接受手术治疗;手术证实,单纯肝内胆管结石(intrahepatic lithiasis,IHL)8例,单纯肝外胆管结石(extrahepatic lithiasis,EHL) 36例,IHL与EHL同时存在31例,即最终IHL共39例,EHL共67例.对于IHL,MRI诊断的敏感度、特异度、准确度及ROC曲线下面积分别为89.74％、94.44％、92.00％、0.968,与超声的84.62％、91.67％、88.00％、0.956对比均无统计学差异(P＞0.05).对于EHL,MRI诊断的敏感度、准确度及ROC曲线下面积分别为94.03％、92.00％、0.849,均明显优于超声的65.67％、65.33％、0.768 (P＜ 0.05).结论 对于IHL,MRI与超声诊断效能相当;而对于EHL,MRI相较于超声具有更优的诊断效能.