下腔静脉畸形的影像学诊断（附15例报告）

本文报道下腔静脉畸形１５例，其中下腔静脉后输尿管３例，双下腔静脉畸形３例及下腔静脉膜性梗阻９例。作者根据有无下腔静脉回流障碍对该组疾病进行了分型，并结合本文病例分析，着重探讨了该组疾病的影像学表现，评价了超声、下腔静脉造影等影像学检查方法对该组疾病的诊断价值。     

新西兰兔下腔静脉内置入125I粒子条的实验研究

目的评估兔下腔静脉腔内置入125I粒子条的可行性、安全性,以及影像学的诊断价值。材料与方法将24只新西兰兔随机分成两组:A组(2枚粒子)和B组(4枚粒子),各12只。将6711型125I粒子制成粒子条。备好的粒子条经下腔静脉前壁荷包中央置入并悬挂固定在下腔静脉内壁。比较125I粒子条置入前后血常规及肝功能的变化;分别饲养1周、2周、4周、2个月、4个月后称体重,行实验室、多层螺旋CT(MDCT)增强扫描、DSA及组织病理学检查,两组间做比较。结果两组均未发现与125I粒子辐射相关的腹泻及死亡。各组125I粒子条置入前后及两组间体重、血常规、肝功能差异无统计学意义(P>0.05)。MDCT增强及DSA显示下腔静脉血流通畅,但CT显示粒子金属伪影严重、计数困难。大体标本示下腔静脉无穿孔、血栓形成。两组光镜下均见血管内皮细胞坏死、脱落,中膜及外膜无明显改变。两组邻近125I粒子旁肝细胞坏死明显,B组较A组严重,但随着时间的延长有所修复;远处肝脏及其他组织无异常。结论兔下腔静脉管腔内置入线状排列125I粒子条是安全、可行的。影像学尤其DSA是粒子置入术对血管影响较好的评价手段。     

CT肺动脉造影对急性肺栓塞严重程度的评估价值

目的 探讨CT肺动脉造影(CTPA)的影像学特征与肺栓塞严重指数(PESI)之间的相关性。方法 共有150例确诊为肺栓塞(PE)的患者纳入本研究。CTPA影像学特征包括阻塞指数(Qanadli指数)、肺动脉干直径、下腔静脉对比剂返流、室间隔形态、右心室(RV)和左心室(LV)直径以及RV/LV比值。应用PESI评分评估PE的严重程度,检验CTPA影像学特征与PESI评分之间的相关性,P<0.05为差异具有统计学意义。结果 阻塞指数与PESI评分呈正相关(r=0.45,P<0.05),肺动脉干直径越大者PESI评分越高(r=0.20,P<0.05)。在PESI评分较高的患者中,下腔静脉对比剂返流和室间隔形态异常更为常见(P<0.05)。在RV及LV直径、RV/LV比值和PESI评分之间无显著相关性。肺动脉干扩张是高危PE患者的最佳预测因素,其优势比为4.4。结论 较高的阻塞指数、肺动脉主干扩张、对比剂返流、异常的室间隔形态与较高的PESI评分相关。     

肾癌合并肾静脉及下腔静脉癌栓的影像学诊断

目的：提高肾癌合并肾静脉及下腔静脉癌栓的诊断水平。方法：对25例肾癌肾静脉及下腔静脉癌栓病人的影像学检查结果进行分析并与手术结果对照。结果：25例影像学检查结果与手术结果符合率：B超64.0％（16/25），CT88.2％（15/17），MRI100％（14/14）。结论：肾癌合并肾静脉及下腔静脉癌栓的诊断应综合应用B超、CT及MRI等检查，以提高诊断符合率。     

下腔静脉先天变异的影像诊断

目的 分析下腔静脉先天变异的不同类型,为临床诊断治疗提供参考.方法 回顾性分析20例影像学诊断为下腔静脉先天变异的病例.结果 20例下腔静脉先天变异中,双下腔静脉14例,布加综合征4例,下腔静脉后输尿管1例,左侧下腔静脉1例.结论 下腔静脉先天变异发生有其胚胎学的基础,明确其变异类型对临床工作有重要指导意义.     

与TIPSS相关的影像学解剖关系的研究

目的应用多种医学影像学及解剖学方法，研究与经颈静脉肝内门腔静脉内支架分流术（ＴＩＰＳＳ）密切相关的解剖学改变，以提高操作的成功率、可靠性及安全性，并探索新的导向方式及分流途径。材料与方法采用ＭＲＩ、ＣＴ、血管造影、肝脏血管铸型等手段，研究肝动脉、胆管和门静脉的伴行情况及相互空间关系，估计各种穿刺途径对其损伤的可能性。分析肝段下腔静脉与门静脉的空间关系。结果胆管和肝动脉主要位于门静脉分叉及主干的前方、前上方；在右干分叉部及左干角部、矢状部分布不规则，可位于其后上或左右方。肝动脉，特别是肝右动脉和门静脉关系密切，可作为穿刺导向。肝段下腔静脉距门静脉分叉及左右干均较近，穿刺有较大的安全范围，可作为新的分流途径。结论熟悉肝脏血管解剖、应用有效导向、避免胆道和肝动脉损伤可提高ＴＩＰＳＳ疗效     

盆腔淤血综合征的影像学研究进展

盆腔淤血综合征(PCS)是慢性盆腔静脉淤血引起的常见妇科疾病。典型临床表现为"三痛二多一少", 即下腹部坠痛、腰背部疼痛、性交痛, 月经量增多、白带增多, 阳性体征少, 妇科检查可扪及卵巢触痛。PCS的病因尚未完全明确, 临床症状特异性低, 和其他妇科疾病有重叠, 因此漏诊率较高。影像学检查在该病诊疗过程中发挥重要作用, 通过侵入或非侵入成像评估盆腔静脉情况, 可为该病的治疗和疗效评估提供精准依据, 但目前缺乏完善的诊断标准。本文从PCS的发病原因、影像学检查方法选择、影像诊断要点和困惑等方面进行综述, 旨在提高对该病的认识。     

42例Budd－Chiari综合征影像学分析

报告４２例Ｂｕｄｄ－Ｃｈｉａｒｉ综合征．其中膜性梗阻７例，膜性狭窄５例，节段性梗阻１２例，节段性狭窄１４例，下腔静脉正常肝静脉狭窄４例。４２例中９例（２１．４％）合并肾后段下腔静脉瘤。本文着重通过对本组病例超声与下腔静脉造影资料的对比分析，进一步评价超声与下腔静脉造影对本征的诊断价值。本文同时对影响下腔静脉瘤形成的因素进行了详细研究，并对下腔静脉瘤的影像学表现进行了探讨。     

布-加综合征介入治疗技术操作规范的几点建议

布 加综合征已成为我国农村的高发病之一。介入治疗已替代了传统的外科手术。对介入治疗的操作技术 ,不少学者都有一定的成功经验。我们仅就几年来的诊治经验 ,提出几点建议。一、影像学诊断(一 )要提高超声征象的综合识别能力　首选彩超检查中 ,最易于将下腔静脉闭锁 (包括膜性闭锁和节段性闭锁 )误诊为狭窄。其主要原因是过度重视回声这一直接征象 ,忽视了血流频谱的血流特征和下腔静脉搏动这一重要间接征象。(二 )下腔静脉造影要区别假性下腔静脉狭窄布 加综合征肝尾状叶肥大压迫肝后段下腔静脉 ,出现假性下腔静脉狭窄。这种压迫表现为…     

超声在麻醉与围术期应用新进展

超声检查是一种基于超声波的影像学检查技术，具有安全、便携、价廉、可重复和提供实时动态图像等优点。近年来，随着超声设备智能化、小型化、信息化以及研究的不断深入，在麻醉与围术期中的应用愈加广泛。目前，超声在动静脉穿刺和外周神经阻滞领域早已广泛开展，然而，在围术期中对患者进行超声检查评估或诊断仍处于起步阶段。为了麻醉医师能够更好的优化围术期管理，保障患者安全，本文就近几年气道超声、胃内容物评估、超声引导下穿刺和容量反应性的新进展进行综述，从而为麻醉与围术期中应用超声技术提供参考。     

Blood volume analysis: a new technique and new clinical interest reinvigorate a classic study

Blood volume studies using the indicator dilution technique and radioactive tracers have been performed in nuclear medicine departments for over 50 y. A nuclear medicine study is the gold standard for blood volume measurement, but the classic dual-isotope blood volume study is time-consuming and can be prone to technical errors. Moreover, a lack of normal values and a rubric for interpretation made volume status measurement of limited interest to most clinicians other than some hematologists. A new semiautomated system for blood volume analysis is now available and provides highly accurate results for blood volume analysis within only 90 min. The availability of rapid, accurate blood volume analysis has brought about a surge of clinical interest in using blood volume data for clinical management. Blood volume analysis, long a low-volume nuclear medicine study all but abandoned in some laboratories, is poised to enter the clinical mainstream. This article will first present the fundamental principles of fluid balance and the clinical means of volume status assessment. We will then review the indicator dilution technique and how it is used in nuclear medicine blood volume studies. We will present an overview of the new semiautomated blood volume analysis technique, showing how the study is done, how it works, what results are provided, and how those results are interpreted. Finally, we will look at some of the emerging areas in which data from blood volume analysis can improve patient care. The reader will gain an understanding of the principles underlying blood volume assessment, know how current nuclear medicine blood volume analysis studies are performed, and appreciate their potential clinical impact.     

Three-dimensional imaging and cone beam volume CT in C-arm angiography with flat panel detector

We evaluated a new 3D angiography system with a flat panel detector (FPD) for its capabilitiy to acquire volume sets during a single rotation scan and to reconstruct high spatial resolution three-dimensional and cross sectional images, namely cone beam volume computed tomography (CBVCT) images. Present status of the technique, advantages and potential applications are discussed.     

Amygdalohippocampal MR volume measurements in the early stages of Alzheimer disease.

PURPOSETo evaluate the accuracy of hippocampal and amygdala volume measurements in diagnosing patients in the early stages of Alzheimer disease.METHODSMeasurements of the hippocampal formation, amygdala, amygdalohippocampal complex (the two measurements summed), caudate nucleus, and ventricles, normalized for total intracranial volume, were obtained on coronal sections (1.5 T, 400/13 [repetition time/echo time], 5 mm) of 13 patients in the mild (minimental status > or = 21) and five patients in the moderate stages of Alzheimer disease (10 < minimental status < 21), and eight age-matched control subjects.RESULTSFor patients with a minimental status score of 21 or greater, atrophy was significant for the amygdala and hippocampal formation (-36% and -25% for amygdala/total intracranial volume and hippocampal formation/total intracranial volume, respectively), but not for the caudate nucleus. No significant ventricular enlargement was found. For patients with a minimental status score less than 21, atrophy was more severe in all structures studied (amygdala/total intracranial volume, -40%; hippocampal formation/total intracranial volume, -45%; caudate nucleus/total intracranial volume, -21%), and ventricles were enlarged (63%). No overlap was found between Alzheimer disease and control values for the amygdalohippocampal volume, even in the mild stages of the disease. In Alzheimer disease patients, hippocampal formation volumes correlated with the minimental status.CONCLUSIONHippocampal and amygdala atrophy is marked and significant in the mild stages of Alzheimer disease. Volumetric measurements of the amygdala and the amygdalohippocampal complex appear more accurate than those of the hippocampal formation alone in distinguishing patients with Alzheimer disease.     

Effects of exercise on soluble transferrin receptor and other variables of the iron status

BACKGROUND: Soluble transferrin receptor (sTfr) is a new marker of iron status and erythropoietic activity. It has been included in multivariable blood testing models for the detection of performance enhancing erythropoietin misuse in sport. OBJECTIVE: To evaluate the effect of different types and volumes of physical activity on sTfr concentration, variables of iron status (ferritin, transferrin, iron, and protein), and haematological indices. METHODS: Thirty nine subjects were divided into three groups: 1, untrained (n = 12); 2, moderately trained (n = 14); 3, highly trained (n = 13, seven men, six women). Groups 1 and 2 carried out two exercise tests: an incremental running test until exhaustion (test A) and a 45 minute constant speed running test at 70% VO(2)MAX (test B). Group 3 performed three days (women) or four days (men) of prolonged aerobic cycling exercise. The above variables together with haemoglobin and packed cell volume were analysed in venous blood samples before and after exercise. Changes in blood and plasma volume were estimated. RESULTS: sTfr levels were slightly increased in trained and untrained subjects immediately after test A. Test B and aerobic exercise had no significant effect on sTfr. Ferritin levels were increased after the laboratory tests for trained and untrained subjects and after prolonged aerobic exercise in male cyclists. Transferrin was increased significantly in trained and untrained subjects after both laboratory tests, but remained unchanged after prolonged exercise. Plasma and blood volumes were decreased after the laboratory tests but increased after aerobic exercise. No differences in the variables were observed between trained and untrained subjects with respect to response to exercise. CONCLUSION: The changes in sTfr and the variables of iron status can be mainly attributed to exercise induced changes in volume. Taking these limitations into account, sTfr can be recommended as a marker of iron deficiency in athletes.     

膀胱充盈状态对宫颈癌调强放疗子宫及危及器官的影响

目的 通过研究膀胱充盈状态对子宫、宫颈的移位、靶区和危及器官（OAR）体积的影响,为宫颈癌调强放疗（IMRT）个体化内靶区（ITV）及临床靶区（CTV）到计划靶区（PTV）界定提供理论基础。方法 获取宁夏医科大学总医院27例局部进展期初治宫颈癌患者膀胱排空、膀胱充盈1.0 h、充盈1.5 h定位CT图像,分别勾画宫颈、宫体、OAR,以及膀胱充盈1.0 h的CTV、PTV,分析不同膀胱充盈间宫颈、宫体的移位,不同充盈状态下子宫、直肠、小肠、PTV内小肠、PTV内膀胱、PTV内直肠体积的差异;分析膀胱充盈与子宫移位及OAR体积的相关性。分析膀胱排空与充盈1.5 h靶区脱出PTV的体积。结果 膀胱充盈状态个体差异较大,子宫颈和子宫体随膀胱充盈状态变化引起的最大移动范围分别为0~3.04 cm、0~4.31 cm。不同充盈间子宫体在前方移位差异有统计学意义（F=7.818,P<0.05）;不同充盈状态下膀胱体积、PTV内膀胱及小肠体积差异有统计学意义（F=46.197、44.609、29.546,P<0.05）;膀胱的充盈状态与子宫体前缘的移位、小肠体积、PTV内膀胱体积、PTV内小肠体积间有相关性（r=-0.232、-0.298、0.915、-0.336,P<0.05）。在膀胱排空及充盈1.5 h时,宫颈、宫体脱出PTV的体积差异均具有统计学意义（t=-1.326、-1.559,P<0.05）。结论 膀胱充盈状态具有较大的个体差异,膀胱充盈状态对子宫前缘的影响较大,扩大CTV-PTV前方外放范围可能降低靶区的漏照,控制膀胱充盈状态的一致性对宫颈癌精确调强放疗是必要的。     

A review of the stroke volume response to upright exercise in healthy subjects

Traditionally, it has been accepted that, during incremental exercise, stroke volume plateaus at 40% of Vo(2)max. However, recent research has documented that stroke volume progressively increases to Vo(2)max in both trained and untrained subjects. The stroke volume response to incremental exercise to Vo(2)max may be influenced by training status, age, and sex. For endurance trained subjects, the proposed mechanisms for the progressive increase in stroke volume to Vo(2)max are enhanced diastolic filling, enhanced contractility, larger blood volume, and decreased cardiac afterload. For untrained subjects, it has been proposed that continued increases in stroke volume may result from a naturally occurring high blood volume. However, additional research is needed to evaluate the importance of blood volume, or other mechanisms, that influence the stroke volume response to exercise in untrained subjects.     

Operational budgeting and budgetary control in diagnostic radiology

This article is concerned with establishing a revenue and expense budget for a diagnostic radiology department. It deals with setting up a breakout of examinations into specific categories and projecting the volume in each category. The volume should be expressed in RVUs rather than examinations. The volume predictions for the upcoming year would then be decided by factoring in such things as new procedures, new technology, patient day projections, ER projections, and any known outside influences. Once the volume is projected, expenses should be matched to these increases or decreases. These expenses would be prior to adding inflationary impacts. Finally, a follow-up should be performed on a monthly basis to ensure that the percentage change in volume is being matched by the same percentage change in expenses.     

单期和多期CT血管造影评估缺血性脑卒中患者侧支状态与CT灌注参数的对比性研究

目的 对于急性缺血性脑卒中(AIS)大脑中动脉闭塞患者,比较单时相、多时相CT血管造影(sCTA、mC-TA)评估的侧支循环评分与定量灌注参数之间的关联性及在预测临床预后中的价值.方法 搜集2019年12月至2020年12月于急救中心行一站式CT检查的发病时间在24 h内的大脑中动脉闭塞患者的临床资料及影像学资料,从C...     

Macromolecular contrast agents for MR mammography: current status

Macromolecular contrast media (MMCM) encompass a new class of diagnostic drugs that can be applied with dynamic MRI to extract both physiologic and morphologic information in breast lesions. Kinetic analysis of dynamic MMCM-enhanced MR data in breast tumor patients provides useful estimates of tumor blood volume and microvascular permeability, typically increased in cancer. These tumor characteristics can be applied to differentiate benign from malignant lesions, to define the angiogenesis status of cancers, and to monitor tumor response to therapy. The most immediate challenge to the development of MMCM-enhanced mammography is the identification of those candidate compounds that demonstrate the requisite long intravascular distribution and have the high tolerance necessary for clinical use. Potential mammographic applications and limitations of various MMCM, defined by either experimental animal testing or clinical testing in patients, are reviewed in this article. Electronic Publication     

Theoretical basis of hemodynamic MR imaging techniques to measure cerebral blood volume, cerebral blood flow, and permeability

Cerebrovascular hemodynamic assessment adds new information to standard anatomic MR imaging and improves patient care. This article reviews the theoretic underpinnings of several potentially quantitative MR imaging-based methods that shed light on the hemodynamic status of the brain, including cerebral blood flow (CBF), cerebral blood volume (CBV), and contrast agent permeability. Techniques addressed include dynamic susceptibility contrast (which most simply and accurately estimates CBV), arterial spin labeling (a powerful method to measure CBF), and contrast-enhanced methods to derive permeability parameters such as the transport constant Ktrans.