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Objective:To explore the difference of the vessel and plaque characteristics, myocardial perfusion and cardiac function between patients with ischemia with non-obstructive coronary artery disease (INOCA) and obstructive coronary artery disease (CAD).Methods:From July 2021 to June 2022, 101 patients with angina were referred to dynamic computed tomography myocardial perfusion (CTP) and coronary computed tomography angiography (CCTA) and retrospectively included in our hospital. Based on the results of CTP and CCTA, patients were divided into INOCA (27 cases), moderate obstructive CAD (26 cases) and severe obstructive CAD (48 cases). The anatomical coronary artery stenosis, plaque characteristics and myocardial perfusion features of all patients were analyzed. Furthermore, left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained on full-phase reconstruction CCTA image by using Medis Suite 3.2 postprocessing software. Multigroup analysis used one way ANOVA or Kruskal Wallis H test. Results:Patients with INOCA were younger than patients with moderate and severe obstructive CAD ( P<0.001). INOCA patients (7.4%, 2/27) had lower rate of positive remodeling than both moderate (57.7%, 15/26, P<0.001) and severe obstructive CAD patients (33.3%, 16/48, P=0.017). The percentage of ischemic myocardium volume in patients with INOCA were similar with those in patients with severe CAD (all P>0.05), but significantly higher than those in patients with moderate CAD (all P<0.05). No significant difference in terms of GLS was detected between patients with INOCA [-17.4% (-21.6%, -11.6%)] and severe CAD [-17.6% (-21.9%, -14.8%), P=0.536], however, patients both with INOCA and severe CAD also had higher GLS than patients with moderate obstructive CAD [-22.3% (-29.8%, -19.0%), all P<0.05]. Conclusions:Based on"one-stop-shop"CTP combined with CCTA imaging, early cardiac functional changes including abnormal myocardial perfusion and myocardial strain in INOCA patients were similar to those in patients with severe obstructive CAD and more severe than those in patients with moderate obstructive CAD.
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Objective:To investigate the feasibility and clinical value of 4D flow magnetic resonance imaging (MRI) in evaluating hemodynamics of ischemic stroke patients with intracranial artery stenosis.Methods:Ischemic stroke patients with unilateral middle cerebral artery stenosis admitted from March 2017 to June 2018 in Beijing Tsinghua Changgung Hospital Stroke Center were prospectively enrolled. Time of flight magnetic resonance angiography was used to evaluate vascular stenosis, 4D flow MRI was used to measure net forward flow at the proximal of stenosis, and brain tissue perfusion was acquired simultaneously to validate flow.Results:A total of 33 patients with symptomatic middle cerebral artery stenosis were included [mean age: 56 years; male: 63.6% ( n=21)]. The flow rates among patients with stenosis of <30%, 30%-49%, 50%-69% and ≥70% were (3.56±1.08), (2.96±0.94), (3.72±0.60) and (2.50±1.03) ml/s individually, demonstrating a decreased flow in subjects with severe (≥70%) stenosis ( F=4.34, P=0.008). Further analysis about forward flow and brain tissue perfusion showed that the significant negative correlation between absolute flow rate or relative flow rate and relative time to peak could only be established in subjects with poor collateral (collateral score: 0-2), with r=-0.76 and -0.61 individually, both P<0.05. Conclusion:4D flow MRI could be used as a quantitative flow assessment in subjects with intracranial artery stenosis, and its association with distal brain tissue perfusion depends on collateral status.
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Objective:To assess the value of coronary CT angiography(CCTA) based vessel characteristics and plaque features in diagnosing ischemic stenosis.Methods:From April 2014 to June 2021, 129 patients (including a total of 158 coronary arteries) who underwent CCTA, then completed invasive coronary angiography (ICA) as well as fractional flow reserve(FFR) within 30 days were retrospectively enrolled. All coronary arteries were divided into ischemic group (FFR≤0.80, n=77) and non-ischemic group (FFR>0.80, n=81). Vascular characteristics, high-risk plaque features, quantitative parameters and the morphology of plaque were obtained from CCTA images. Independent samples t-test, Wilcoxon rank sum test and χ 2 test were used to compare afore-mentioned variables between the ischemic group and the non-ischemic group. The logistic regression model was used to analyze the risk predictors for ischemic stenosis. Results:Compared with non-ischemic group, the stenosis degree of coronary arteries in ischemic group was more serious(72.09%±8.55% vs. 63.52%±13.49%; t=4.765, P<0.001). The proportion of left anterior descending artery(LAD) lesions in ischemic group was higher than that of non-ischemic group [88.31%(68/77)vs. 55.56%(45/81); χ 2=20.793, P<0.001]. In terms of CCTA plaque characteristics, the ischemic group demonstrated longer plaque length, smaller minimum lumen area, larger plaque burden, increased percent plaque diffuseness, and diffuse lesions were more common. As for morphological characteristics of plaque, the proportions of plaques with rectangle shape, proximal longitudinal eccentric shape and distal longitudinal eccentric shape were higher than those of non-ischemic group, whereas cosine eccentric plaques were more common in the non-ischemic group( P<0.001). Multivariate logistic regression analysis showed that the stenosis severity(OR =1.09, 95 %CI 1.04-1.14, P<0.001), LAD involvement(OR =4.23,95 %CI 1.01-17.72, P=0.049), diffuse lesion(OR =6.71,95 %CI 1.43-31.52, P=0.016), proximal longitudinal eccentric shape (OR =3.77,95 %CI 1.27-11.16, P=0.017), and distal longitudinal eccentric shape (OR =3.91,95 %CI 1.19-12.85, P=0.025) were the independent influence factors for ischemic stenosis. Conclusion:The CCTA-based stenosis degree of coronary artery, LAD involvement, diffuse lesion, proximal longitudinal eccentric shape, distal longitudinal eccentric shape were important influence factors for ischemic stenosis.
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Objective:To explore the feasibility and effectiveness of 3D printing aortic model for preoperative evaluation and surgical simulation, and to assist interventional treatment of coarctation of the aorta(CoA).Methods:From December 2017 to January 2019, 8 patients with congenital coarctation of the aorta who underwent percutaneous balloon dilatation and covered stent placement in Xijing Hospital of Air Force Military Medical University were analyzed retrospectively. Among them, 7 cases were male and 1 case was female. The age was(32.00±14.93) years old. Before operation, CT data of patients' heart and aorta were collected, reconstructed with Mimics software, and 3D printing technology was used to make the model of patients' aortic lesions. Before operation, the operation simulation was carried out to determine the best operation scheme and estimate the possible situation, and the relevant clinical data of patients during hospitalization and follow-up were collected.Results:One stent graft was successfully implanted into CoA through femoral artery in all 8 patients. The mean diameter of CoA increased from(3.70±2.94) mm before operation to(18.01±1.51) mm immediately after operation( P<0.05), and the mean systolic pressure difference decreased from(83.75±25.44) mmHg before operation to(14.63±8.09) mmHg after operation( P<0.05). The mean systolic blood pressure of the right upper extremity decreased from(204.13±22.31) mmHg before operation to(145.63±32.08) mmHg after operation( P<0.05), and there was no significant difference between the two groups. During the period of hospitalization and follow-up, no corresponding cardiovascular complications were found. Conclusion:The short-term effect of percutaneous balloon dilatation covered stent implantation on CoA in adolescents and adults is obvious. 3D printing model can reproduce the anatomical model of CoA site of patients individually, which is feasible and effective for the preoperative evaluation of CoA and the preparation of operation plan.
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Objective To analyze the effect of different stress levels noninvasive mask BiPAP ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with type Ⅱ respiratory failure.Methods From January 2015 to June 2017,120 patients of AECOPD with type Ⅱ respiratory failure in Jincheng People's Hospital were randomly divided into three groups by the random number table,with 40 cases in each group.The suction pressure of A group was set to 10-14cmH2O.The suction pressure of B group was set to 15-19cmH2O,while the suction pressure of C group was set to 20-25cmH2O.The clinical curative effect of three groups was compared.Results The PaO2 level of three time points among the three groups were compared by repeated measurements of variance.The results showed that after treatment for 24h,the PaO2 levels of A group,B group and C group were (57.15 ± 5.03) mmHg,(60.28:±:5.21) mmHg and (58.38 ± 6.06) mmHg,respectively.After treatment for 72h,the PaO2 levels of A group,B group and C group were (63.02 ± 6.08) mmHg,(80.16 ± 5.28) mmHg and (70.07 ± 5.23)mmHg,respectively.After treatment for 168h,the PaO2 levels of A group,B group and C group were (70.11 ±60.28)mmHg,(86.35 ± 5.01) mmHg,(79.26 ±5.16) mmHg,respectively.The results showed that the difference in PaO2 of different groups was statistically significant (F =8.514,P ＜0.001),and there was significant difference in PaO2 at different time points (F =13.681,P ＜ 0.001),and there was interaction between groups (different processing formulas) and time points (F =9.872,P ＜ 0.001).There was an interaction between PaCO2 and PaO2/FiO2 in the groups and time points (P ＜ 0.001).The rank sum test was used to compare the curative effect among the three groups.The Z value was 17.512 (P ＜0.001),and the comparison with the cutting probability method showed that the effective rate of B group was significantly higher than that of A group and C group (P ＜ 0.012).Conclusion 15-19cmH2O inhalation pressure can significantly improve the effect of non invasive mask BiPAP treatment for AECOPD with type Ⅱ respiratory failure,and the improvement of blood gas index is better with time.
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Objective@#To analyze the effect of different stress levels noninvasive mask BiPAP ventilation in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with type Ⅱ respiratory failure.@*Methods@#From January 2015 to June 2017, 120 patients of AECOPD with typeⅡrespiratory failure in Jincheng People's Hospital were randomly divided into three groups by the random number table, with 40 cases in each group.The suction pressure of A group was set to 10-14cmH2O.The suction pressure of B group was set to 15-19cmH2O, while the suction pressure of C group was set to 20-25cmH2O.The clinical curative effect of three groups was compared.@*Results@#The PaO2 level of three time points among the three groups were compared by repeated measurements of variance.The results showed that after treatment for 24h, the PaO2 levels of A group, B group and C group were (57.15±5.03)mmHg, (60.28±5.21)mmHg and (58.38±6.06)mmHg, respectively.After treatment for 72h, the PaO2 levels of A group, B group and C group were (63.02±6.08)mmHg, (80.16±5.28)mmHg and (70.07±5.23)mmHg, respectively.After treatment for 168h, the PaO2 levels of A group, B group and C group were (70.11±60.28)mmHg, (86.35±5.01)mmHg, (79.26±5.16)mmHg, respectively.The results showed that the difference in PaO2 of different groups was statistically significant (F=8.514, P<0.001), and there was significant difference in PaO2 at different time points (F=13.681, P<0.001), and there was interaction between groups (different processing formulas) and time points (F=9.872, P<0.001). There was an interaction between PaCO2 and PaO2/FiO2 in the groups and time points (P<0.001). The rank sum test was used to compare the curative effect among the three groups.The Z value was 17.512 (P<0.001), and the comparison with the cutting probability method showed that the effective rate of B group was significantly higher than that of A group and C group (P<0.012).@*Conclusion@#15-19cmH2O inhalation pressure can significantly improve the effect of non invasive mask BiPAP treatment for AECOPD with type II respiratory failure, and the improvement of blood gas index is better with time.
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The diagnostic codes of diagnosis-related groups system used in our country are different from the clinical diagnostic criteria of burns. The author suggests that the diagnostic codes should be improved according to clinical criteria in terms of the total area and depth of burns and inhalation injury, and the diagnosis of burns with related special causes and sites should be added to the clinical criteria.
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Objective To analyze preoperative CT angiography (CTA)imaging features of cervical arteries in patients with acute type A aortic dissection followed by postoperative neurological dysfunction (ND),and the correlations between risk factors and ND.Methods Clinical and imaging data of 110 patients who underwent repair of acute type A aortic dissection were analyzed retrospectively.The samples were categorized into two groups based on the presence or absence of ND.The clinical,perioperative and imaging data were compared between the ND group and the non ND (NND)group.Univariate and multivariate analyses were performed to identify predictors related with ND.Results A total of 100 patients were finally included in this study,and 18 patients(18%)developed with ND after aortic surgery.No significant differences in clinical and perioperative variables were observed between the ND group and the NND group (P＞0.05).However,on preoperative CT images,a dissection entry localized in the aortic arch (94.4% in the ND group), common carotid artery tear (83.3% in the ND group)and unilateral internal carotid artery density decrease (44.4% in the ND group) were all significantly higer than those in th NND group (P＜0.05 ).No significant difference were observed in true lumen stenosis of ascending aorta (P=0.053),retrograde dissection (P=0.913)and intimal tear (P=0.267)between ND group and NND group.The Logistic regression analysis revealed that a dissection entry localized in aortic arch (OR=21.325,P=0.008),common carotid artery tear (OR=14.441,P=0.022)and unilateral internal carotid artery density decrease (OR=9.141,P=0.024)were independent determinants of postoperative ND.Conclusion Preoperative CTA of cervical arteries can provide more imaging features,that may be indicative of postoperative ND.
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Objectives To assess the effect of nicorandil and trimetazidine on myocardial microcirculation reperfusion in patients with NSTEMI after elective PCI. Methods 80 patients with NSTEMI were randomly assigned to four groups: normal medicine group (CON), nicorandil group (NIC), trimetazidine group (TMZ) and Combination group (NIC+TMZ). The coronary angiography and PCI were performed after 10 days. MCE was taken since 72 hours after operation. Results There were no significant differences in baseline characteristics between the four groups (P > 0.05). The A, β and A ·β of group NIC were significantly higher than group CON (P 0.05). The A,βand A·βof group NIC+TMZ were significantly higher than group NIC or TMZ (P<0.05). Conclusions Nicorandil can improve the situation of myocardial reperfusion after elective PCI in patients with NSTEMI, and it has some synergetic effect when combined with trimetazidine.
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Objective To investigate the pathophysiological features of rat hemorrhagic shock under high temperature conditions.Methods A total of 128 SD rats were assigned to high temperature group and normal temperature group according to the random number table,with 64 rats per group.Rats in high temperature group were pretreated at 342 for 12 h,and in normal temperature group were kept at 25℃.Hemorrhagic shock models in rats were produced by withdrawing 40％ of the total blood volume via the femoral artery.Parameters of the two groups were measured including blood electrolytes (Na +,K +),plasma osmotic pressure,liver function [aspartate aminotransferase (AST),alanine aminotransferase (ALT)],kidney function [creatinine (CREA)],arterial blood gases (pH,PO2 and PCO2) and cardiac function [heart rate (HR),cardiac output (CO),cardiac index (CI) and DO2].Animal survival time and survival rate were detected.Results Before shock,high temperature group versus normal temperature group showed higher detections of Na+ concentration [(142.3 ± 2.2) mmol/L:(139.1 ±1.5) mmol/L],plasma osmotic pressure [(304.8 ± 4.7) mmol/L:(300.0 ± 1.9) mmol/L],HR [(462 ±30) times/min:(402 ± 44) times/min],CO [(0.892 ± 0.190) L/min:(0.713 ± 0.090) L/min] and CI [(0.0030±0.0006)L·min-1 · cm-2:(0.0023 ±0.0002)L· min-1 · cm-2] (P＜0.05).After shock,normal temperature group showed further increased concentrations of Na + and K + and significantly enhanced AST,ALT and CREA compared to normal temperature group (P ＜ 0.05).After shock,CO,CI and DO2 in high temperature group were decreased by 63％,63％ and 69％ respectively compared to those before shock,but less decrease was observed in normal temperature group.Rat survival rate and survival time were significantly reduced in high temperature group compared to normal temperature group (P ＜ 0.05).Conclusion Pathophysiological changes of hemorrhagic shock in rats under high temperature are mainly manifested as impaired cardiac function,significantly increased concentrations of Na + and K + and significantly shortened survival time.
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Objective To evaluate the low-dose dual-source whole-body CT angiography in assessing the arteries of Takayasu’s arteritis (TA).Methods Low-dose whole-body CT angiography(CTA)was performed in 57 consecutive patients with suspected TA. The scanning parameters were performed with tube voltage 80 kV and attenuation-based tube current modulation with a referenced tube current at 300 mAs.The volume CT dose index (CTDIvol)and dose-length product (DLP)were obtained for all scans.Subjec-tive and objective image quality of different arteries were assessed in seven anatomic territories,including intracranial,cervical,tho-racic,abdominal,upper extremity,thigh and shank.In addition,CT findings of whole-body arteries were recorded.Results Forty out of fifty-seven patients with definite diagnosis of TA enrolled in this study.Mean CTDIvol and DLP for all patients were (2.5± 0.9)mGy and (403.7±91.4)mGy·cm,respectively.The scoring order of subjective and objective iamge quality was neck,chest, abdomen,thigh,upper extremity,head and shank.5.9% of intracranial arteries,3.3% of lower extremity arteries and 0.5% of upper extremity arteries were extra detected.Conclusion The extra CT findings of intracranial,lower extremity and upper extremity arter-ies provides a more comprehensive evaluation of whole-body arteries involvement.
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Objective To estimate the application value of dual-source CT on preoperational evaluating new type of three branches aortic arch covered stent graft implantation on DeBakey type I aortic dissection.Methods 20 cases with DeBakey type I aortic dissec-tion prepared to performe three branches aortic arch covered stent graft implantation were reviewed,and their CT findings were ana-lyzed in order to evaluate the guiding value for operation.Results The location and size of entries were determined and the diameter of aortic arch and three branchesas well as the intervals of three branches were also measured by dual-source CT.Furthermore, blood-supply for main vessel and complications related with covered stent were further analyzed prior to operation.The surgical pro-tocols were designed according to preoperational CT findings.Among all cases,13 cases were fit for new type of three branches aor-tic arch covered stent graft implantation.While the rest cases (N=7)were adopted other operations due to non-fitted indications. Conclusion Dual-source CT is of significance for preoperational evaluating new type of three branches aortic arch covered stent graft implantation on DeBakey type I aortic dissection.
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Objective To construct four types of glucagon-like peptide-1 (GLP-1) and human serum albumin (HSA) fusion proteins that can be realeased at different rate in vivo by introducing protease cleavage sites between these two moieties.The therapeutic effect and release rate are studied to achieve balanced pharmacokinetics ( PK) and pharmacody-namics ( PD) of GLP-1 and HSA fusion proteins.Methods The gene with different polypeptide joint of GLP-1 and HSA fusion proteins were synthesized by overlap extension PCR amplification, cloned into expression vector pPIC9 and transformed into Pichia pastoris GS115.Then, fusion proteins were obtained by protein purification after being induced by methanol.The preliminary PK and PD of the fusion proteins were studied after purification.Results The fusion protein Gly2-GLP-1-GGGGG-HSA showed no release while Gly2-GLP-1-VTR-HSA, Gly2-GLP-1-SARSVRA-HSA, and Gly2-GLP-1-GRSRVTRSV-HSA showed a slow, medium and fast release rate, respectively, after incubation with furin.In vitro biological activity test results dispalyed that each type of fusion protein promoted insulin secretion of MIN6 cells.In vivo PK test indicated the half-life size of fusion proteins was the largest in Gly2-GLP-1-GGGGG-HSA, followed by Gly2-GLP-1-VTR-HSA, Gly2-GLP-1-SARSVRA-HSA, and Gly2-GLP-1-GRSRVTRSV-HSA.In vivo PD test exhibited hypoglycemic activity that was the highest in Gly2-GLP-1-VTR-HSA, followed by Gly2-GLP-1-SARSVRA-HSA, Gly2-GLP-1-GRSRVTRSV-HSA, and Gly2-GLP-1-GGGGG-HSA.Conclusion GLP-1 can be released from fusion proteins with full activity after the introduction of protease cleavage sites.Releasable fusion proteins at an appropriate release rate have the most balanced PK and PD.
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Objective To investigate the accuracy of the new trauma scoring method:Glasgow coma score (GCS),age and systolic pressure score (GAP),in diagnosing patients' traumatic condition and predicting fatality rate in department of emergency.Methods The chnical data of 27 706 traumatic patients in department of emergency were collected.The observation was categorized into three kinds:death within 24 h after reaching department of emergency (24 h death);death from 24 h after reaching department of emergency to 7 d (death after 24 h);survival.On the basis of the trauma mechanism,GCS,age and systolic pressure score (MGAP),the GAP method was used for judging traumatic condition and predicting fatality rate of traumatic patients in department of emergency.The accuracy of GAP in predicting fatality rate was compared with revised trauma score (RTS),trauma and injury severity score (TRISS) and MGAP.The C-statistics method was used to calculate the accuracy in predicted the fatality rate.Results The C values (0.936 and 0.961) of GAP in predicting fatality rate after 24 h and in 24 h were higher than RTS (0.917 and 0.958) and MGAP (0.920 and 0.950),but slightly lower than TRISS (0.950 and 0.970).The traumatic condition in GAP was defined in this way:severity 3-10 scores,moderation 11-18 scores,and slightness 19-24 scores.Conclusions The GAP is simple,practical and accurate in diagnosing patients' traumatic condition and predicting their fatality rate.It is helpful in physicians' decision of a proper treatment plan.
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Objective To compare radiation dose and image quality of prospectively ECG-triggered sequence acquisition mode and Flash(high-pitch spiral acquisition)mode in DSCT angiography of children with congenital heart disease.Methods Sixty children with clinically suspected congenital heart disease and undertook DSCT prospectively ECG-triggered scan were enrolled in the study and randomly divided into two groups.The Flash mode and prospective sequence scanning mode were applied in group A and B,respectively.The CT dose index(CTDIvol),dose length product(DLP),effective dose(E),and image quality were compared between two groups.Refered to surgery or cardiac angiography(DSA),the diagnostic coincidence rates were compared between two groups.Results The CTDIvol in group A and B was(0.32 ± 0.10)and(1.40 ± 0.43)mGy(t=13.32,P＜0.05),respectively.The DLP was(6.46 ±1.92)and(17.91 ±4.80)mGy·cm(t=7.97,P＜0.05).E was(0.19±0.05)and(0.45±0.12)mSv (t=16.64,P＜0.05).The image quality score in group A(4.03 ± 1.15)was higher than that in group B (3.13 ± 1.38)(t=3.55,P＜0.05).The total diagnostic coincidence rates were 100％(A)and 93％ (B).But the deformity diagnostic coincidence rates in group A(91％)was higher than that in group B (75％)(x2=7.72,P＜0.05).Conclusions In DSCT diagnosis of congenital heart disease in children,using flash scan mode can reveal more cardiac deformities than using prospective sequence scanning mode,and could reduce the radiation dose.
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Objective To observe the role of dual-source CT (DSCT) in the diagnosis of coronary artery fistula. Methods Nine patients with coronary artery fistula were examined with dual-source CT coronary artery angiography. Then the source images were post processed using volume rendering (VR), multiple planar reformation (MPR), maximum intensity projection (MIP) and curved planar reformation (CPR), and sequential segmental analysis of the intracardiac and extracardiac anomalies was performed. Results Coronary artery fistula in all the 9 patients were accurately displayed with DSCT, including 2 with left main trunk to right ventricle fistula, 7 with left main trunk and (or) left anterior descending artery to main pulmonary trunk fistula, 5 with complex coronary-pulmonary artery fistula. Conclusion Dual-source CT coronary artery angiography is convenient, fast, non-invasive, and may be the preferable method for diagnosis of coronary artery fistula.
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Images of 812 patients undergoing dual-source CT coronary angiography were analyzed retrospectively. Effectively nursing can be improved to guarantee the quality of coronary angiography and diagnosis of diseases.
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Objective To investigate the optimum threshold value of tracking and triggering technique (surestart) in imaging of coronary artery by 16-slice row CT. Methods 60 patients enrolled in the enhanced scan of coronary artery imaging were divided into 2 groups (group a : heart rate 70 beats/per minute ). The quality of images collected under different threshold value and heart rate was compared. The image quality of coronary artery was ranked by 3 levels, namely, level A, B and C. The data were statistically analyzed. Results The image quality triggered by 160 HU of group b was level A. The image quality triggered by 180 HU of group a was level A. Conclusion The optimum surestart is 180 HU when the heart rate 70 beats/per minute.
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Objective To investigate the CT findings and guidance significance of multi-slice computed tomography(MSCT) in aortic intramural hematoma(IMH).Methods The clinical data and MSCT findings of 35 cases of aortic intramural hematomas diagnosed by MSCT with continuous volume scanning were analyzed.Results The direct signs of IMH were crescent or circular thickening of aortic wall without intimal flap and true and false lumens in all 35 patients.The indirect signs were penetrating ulcer(18 cases),calcification ingression(7 cases),atherosclerosis(16 cases)and single or bilateral pleural effusion(21 cases).The complicated signs were aneurysms(5 cases) and typical type B aortic dissection(3 case).Conclusion MSCT is a fast and noninvasive examinational technique,by which the direct,indirect and complicated signs of aortic IMH can be clearly revealed.All these signs have important guidance values for clinical diagnosis and management.
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Objective To prospectively evaluate the effects of heart rate and heart-rate variability on dual-source computed tomographic coronary image quality in patients with high heart rates,and to determine retrospectively the accuracy of dualsource computed tomographic diagnosis of coronary artery stenosis in the same patients.Methods The image quality and diagnostic accuracy were compared between the normal group of 40 patients whose heart rates exceeded 70 beats/min and the control group of 40 patients whose heart rates were 70 beats/min or slower.Results No statistically significant differences between the groups were found in diagnostic-image quality scores of total segments or of any coronary artery,nor were any significant differences found between the groups in the accurate diagnosis of angiographically significant stenosis.Calcification was the chief factor that affected diagnostic accuracy.In high -heart -rate patients,heart -rate variability was significantly related to the diagnostic image quality of all segments(P=0.001) and of the left circumflex coronary artery(P=0.016).Heart-rate variability more than 5 beats/min most strongly contributed to an inability to evaluate segments in both groups.When heart rates rose,the optimal reconstruction window shifted from diastole to systole.Conclusion The image quality of dual -source computed tomographic coronary angiography at high heart rates enables sufficient diagnosis of stenosis,although variability of heart rates significantly deteriorates image quality.