精神分裂症脑电分析技术研究的进展

讨论了精神分裂症脑电分析技术,包括脑电图,脑诱发电位和脑电地形图在人的几种主要技术的研究进展和应用现状,并对其应用前景做了展望。     

Co-Registration of EEG and MRI Data Using Matching of Spline Interpolated and MRI-Segmented Reconstructions of the Scalp Surface

Accurate co-registration of MRI and EEG data is indispensable for the correct interpretation of EEG maps or source localizations in relation to brain anatomy derived from MRI. In this study, a method for the co-registration of EEG and MRI data is presented. The method consists of an iterative matching of EEG-electrode based reconstructions of the scalp surface to scalp-segmented MRIs. EEG-electrode based surface reconstruction is achieved via spline interpolation of individually digitized 3D-electrode coordinates. In contrast to other approaches, neither fiducial determination nor any additional provisions (such as bite bars, other co-registration devices or head shape digitization) are required, and co-registration errors associated with inaccurate fiducial determination are avoided. The accuracy of the method was estimated by calculating the root-mean-square (RMS) deviation of spline interpolated and MRI-segmented surface reconstructions in 20 subjects. In addition, the distance between co-registered and genuine electrode coordinates was assessed via a simulation study, in which surface reconstruction was based on virtual electrodes determined on the scalp surface of a high-resolution MRI data set. The mean RMS deviation of surface reconstructions was 2.43 mm, and the maximal distance between any two matched surface points was 5.06 mm. The simulated co-registration revealed a mean deviation of genuine and co-registered electrode coordinates of 0.61 mm. It is concluded that surface matching using spline interpolated reconstructions of scalp surfaces is a precise and highly practicable method to co-register EEG and MRI data.     

SPM在外关穴针刺脑功能成像中的应用研究

目的:研究统计参数图(SPM)对同一腧穴在病理生理状态下针刺效应脑功能成像的作用,并为经穴特异性的界定的研究奠定基础。方法:健康志愿者6例和左脑缺血性中风患者6例,分别接受右侧外关穴针刺,采用捻针-留针的组块设计。数据采集基于GE公司3.0T超导MRI扫描仪,数据后处理采用基于MATLAB软件的SPM图软件包。经过统计分析最后得到病理生理状态下外关穴真假针刺的统计参数图和对比激活情况。结果:与左脑缺血性中风患者比较,统计参数图结果显示针刺健康志愿者外关穴,升高的激活脑区全部集中在左侧,而右侧脑区没有明显升高或降低的激活变化。针刺健康志愿者和左脑缺血性中风患者存在着一定的作用差异,其差异相对指向性地集中在与视觉、听觉、语言情感、空间定位等相关功能脑区。结论:SPM软件包为腧穴针刺效应的研究及病理状态下受伤脑区机制的研究和治疗提供了重要依据。     

全心电生理建模及体表电位标测图的仿真

虚拟心脏建模是连接心脏宏观和微观研究的有效手段之一。本研究利用微型计算机和可视人断层数据,通过图像增强、组织分割和三维重建,建立了分辨率为0.5 mm×0.5 mm×0.5 mm的心脏结构和胸前表面几何模型;以单细胞动作电位仿真为基础,使用改进的规则型算法,基于惠更斯原理的各向同性和各相异性波面型算法,分别完成了特殊传导系统、心房和心室电活动的仿真,时间精度可达1 ms;结合双域模型理论,使用偶极子等效心脏的电活动,同时结合躯体模型,完成了心脏电活动到体表心电的映射,进行正常和异常情况下体表电位标测图(BSPM)及12导联心电图的仿真。通过此模型得到的由窦房结起搏的体表12导联心电图,满足正常心电的诊断标准,证明了模型的真实性和可靠性,为进一步探讨传导和起搏异常的体表心电建立基础。     

Prognostic Significance of Remote Myocardium Alterations Assessed by Quantitative Noncontrast T1 Mapping in ST-Segment Elevation Myocardial Infarction

Objectives

This study assessed the prognostic significance of remote zone native T1 alterations for the prediction of clinical events in a population with ST-segment elevation myocardial infarction (STEMI) who were treated by primary percutaneous coronary intervention (PPCI) and compared it with conventional markers of infarct severity.

Noncontrast Myocardial T1 Mapping by Cardiac Magnetic Resonance Predicts Outcome in Patients With Aortic Stenosis

Objectives

The aim of this study was to evaluate whether native T1 value of the myocardium on cardiac magnetic resonance (CMR) could predict clinical events in patients with significant aortic stenosis (AS).

Effects of Septal Pacing on P Wave Characteristics: The Value of Three-Dimensional Echocardiography

SZILI-TOROK, T., et al .: Effects of Septal Pacing on P Wave Characteristics: The Value of Three-Dimensional Echocardiography. Interatrial septum (IAS) pacing has been proposed for the prevention of paroxysmal atrial fibrillation. IAS pacing is usually guided by fluoroscopy and P wave analysis. The authors have developed a new approach for IAS pacing using intracardiac echocardiography (ICE), and examined its effects on P wave characteristics. Cross-sectional images are acquired during pullback of the ICE transducer from the superior vena cava into the inferior vena cava by an electrocardiogram- and respiration-gated technique. The right atrium and IAS are then three-dimensionally reconstructed, and the desired pacing site is selected. After lead placement and electrical testing, another three-dimensional reconstruction is performed to verify the final lead position. The study included 14 patients. IAS pacing was achieved at seven suprafossal (SF) and seven infrafossal (IF) lead locations, all confirmed by three-dimensional imaging. IAS pacing resulted in a significant reduction of P wave duration as compared to sinus rhythm (   99.7 ± 18.7   vs   140.4 ± 8.8  ms; P < 0.01   ). SF pacing was associated with a greater reduction of P wave duration than IF pacing (   56.1 ± 9.9   vs   30.2 ± 13.6  ms; P < 0.01   ). P wave dispersion remained unchanged during septal pacing as compared to sinus rhythm (   21.4 ± 16.1   vs   13.5 ± 13.9  ms; NS   ). Three-dimensional intracardiac echocardiography can be used to guide IAS pacing. SF pacing was associated with a greater decrease in P wave duration, suggesting that it is a preferable location to decrease interatrial conduction delay. (PACE 2003; 26[Pt. II]:253–256)     

High Density Endocardial Mapping of Shifts in the Site of Earliest Depolarization During Sinus Rhythm and Sinus Tachycardia

BETTS, T.R., et al. : High Density Endocardial Mapping of Shifts in the Site of Earliest Depolarization During Sinus Rhythm and Sinus Tachycardia. Previous mapping studies of sinus rhythm suggest faster rates arise from more cranial sites within the lateral right atrium. In the intact, beating heart, mapping has been limited to epicardial plaques or single endocardial catheters. The present study was designed to examine shifts in the site of the earliest endocardial depolarization during sinus rhythm and sinus tachycardia using high density activation mapping. Noncontact mapping of the right atrium during sinus rhythm was performed on ten anesthetized swine. Recordings were made during sinus rhythm, phenylephrine infusion, and isoproterenol infusion. The hearts were then excised and the histological sinus node identified. The mean minimum and maximum cycle lengths recorded were   355 ± 43   and   717 ± 108 ms   . A median of three (range two to five) sites of earliest endocardial depolarization were documented in each animal. With increasing heart rate the site of earliest endocardial depolarization remained stationary until a sudden shift in a cranial or caudal direction, often to sites beyond the histological sinoatrial node. The endocardial shift was unpredictable with considerable variation between animals; however, faster rates arose from more cranial sites   (r = 0.46, P = 0.023)   . There was no difference in the mean cycle length of sinus rhythm originating from specific positions on the terminal crest   (r = 0.44, P = 0.17)   . Cranial sites displayed a more diffuse pattern of early depolarization than caudal sites. In the porcine heart the relationship between heart rate and site of earliest endocardial depolarization shows considerable variation between individual animals. These findings may have implications for clinical mapping and ablation procedures. (PACE 2003; 26[Pt. I]:874–882)     

Electroanatomic mapping of endocardial right ventricular activation as a guide for catheter ablation in patients with arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia is a structural heart disease characterized by fibrofatty degeneration of right ventricular myocardium and arrhythmias of right ventricular origin. The aim of this study was to characterize endocardial right ventricular activation by electroanatomic mapping as a guide for catheter ablation in patients with arrhythmogenic right ventricular dysplasia. Electroanatomic mapping and entrainment procedures were performed in 5 patients with arrhythmogenic right ventricular dysplasia. Endocardial mapping during ventricular tachycardia demonstrated a focal activation pattern with radial spreading of activation from a site of earliest ventricular activation in all directions. Right ventricular activation time (127 +/- 34 ms) was markedly shorter than tachycardia cycle length (415 +/- 92 ms). The site of earliest ventricular activation was found in an aneurysmal outflow tract (n = 2), at the border of aneurysms near the tricuspid annulus (n = 2), and at the apex of the right ventricle (n = 1). Entrainment mapping criteria of these areas of earliest endocardial activity were consistent with exit sites of a reentrant circuit in an area of abnormal myocardium. Fractionated potentials were found 61 +/- 29 ms before the onset of the QRS complex at these sites. Catheter ablation rendered the "clinical" ventricular tachycardia noninducible in four patients but "nonclinical" faster ventricular tachycardias were inducible in three patients. During the follow-up of 7 +/- 3 months after ablation, the frequency of therapies in 4 patients with an implantable cardioverter defibrillator decreased from 49 +/- 61 episodes per month before ablation, to 0.3 +/- 0.5 episodes per month after ablation (P < 0.05). Electroanatomic mapping during ventricular tachycardia facilitates localization of exit sites in relation to aneurysms in diseased right ventricle and may guide catheter ablation in patients with arrhythmogenic right ventricular dysplasia.