Application of magnetic resonance diffusion tensor imaging in rat C 6 glioma grading / 重庆医学

Objective To explore the application value of fractional anisotropy(FA)values of magnetic resonance diffusion tensor imaging(DTI)parameters in rat rat glioma grading.Methods Sixty-seven female Wistar rats were divided into the experi-mental group(n=57)and control group(n=10)according to the random number table method.All the surviving rats were exam-ined by 3.0T DTI at 1-2 weeks(22 cases)and 3-4 weeks(35 cases)after inoculation,and the FA values of the tumor were ob-tained and compared with the pathological results.Results Among 57 tumor-loading rats,there were 18 low-grade gliomas and 39 high-grade gliomas.DTI showed that the FA value of high-grade gliomas was higher than that of the low-grade glioma,the differ-ence was statistically significant[(0.167 ± 0.035)vs.(0.147 ± 0.015),t=2.34,P<0.05].Conclusion The FA value of DTI pa-rameters can provide accurate,reliable and noninvasive imaging information for preoperative glioma grading.

Correlation research of multi-b value DWI combined with PSA on the effect of endocrinotherapy for prostate cancer / 实用放射学杂志

Objective To investigate the value of multi-b value DWI combined with PSA evaluation on the effect of endocrinotherapy for prostate cancer (PCa), and to study the correlation between the signal intensity(SI), apparent diffusion coefficient(ADC) with PSA.Methods Forty patients with PCa diagnosed by pathology or biopsy were tested for serum PSA levels before and after endocrine therapy.All patients underwent DWI at b-value of 300,800 and 1 000 s/mm2 by using a GE Signa HDx 3.0T MRI scanner.The serum PSA,the value of SI and ADC at different b values before and after endocrine therapy,and their correlation with PSA were observed and measured, respectively.Results (1)The serum PSA before and after endocrine therapy were (35.63±20.91) ng/mL and (5.98±3.84) ng/mL, respectively.The difference was statistically significant (P0.05).(3)Pearsoncorrelation analysis showed that ADC value was negatively correlated with serum PSA (r300=-0.58,P<0.01;r800=-0.60,P<0.01;r1 000=-0.66,P<0.01) before endocrine therapy.ADC value was also negatively correlated with serum PSA (r300=-0.55,P<0.01;r800=-0.52,P<0.01;r1 000=-0.61,P<0.01) after endocrine therapy.In addition,SI was negatively correlated with serum PSA (r300=-0.09,P<0.01;r800=-0.18,P<0.01;r1 000=-0.28,P<0.01) before the treatment, as well.Conclusion ADC value at different b values increased after endocrine therapy in Pca, and is negatively correlated with serum PSA.The correlation is the most significant at b value of 1 000 s/mm2.The combination of DWI and serum PSA could be used to monitor and evaluate the effect of endocrinotherapy for Pca, and better guide the clinical treatment of Pca.

Value of liver perfusion imaging of 256-slice CT in evaluation of the cirrhosis / 中南大学学报(医学版)

OBJECTIVE@#To investigate the value of liver perfusion imaging of 256-slice CT in evaluating the compensated and decompensated cirrhosis. 
@*METHODS@#A total of 20 patients with liver cirrhosis, who were confirmed by liver biopsy, clinical symptoms and imaging, were selected from December 2012 to June 2014. According to the results of liver biopsy and the Child-Pugh classification, the patients were divided into a compensated cirrhosis group (n=8) and a decompensated cirrhosis group (n=12). Eleven cases without liver and spleen diseases were served as a control group. All subjects were under the 256-CT liver perfusion (256-CTP). The data of CTP [hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP), hepatic perfusion index (HPI)] were obtained according to liver perfusion type, and the data of CTP [liver perfusion (LP), peak enhanced (PE), time to peak (TTP), blood volume (BV)] were obtained according to general perfusion type. Spearman rank correlation was used to analyze the correlation of liver cirrhosis with perfusion parameters. The receiver operating characteristic (ROC) curve was used to predict liver cirrhosis, and the maximized Youden index was served as the optimal cutoff value, then the area under curve, sensitivity and specificity were calculated.
@*RESULTS@#The PVP, TLP and PE values in the control group, the compensated cirrhosis group and the decompensated cirrhosis group were (76.63±37.26), (38.78±16.13) and (36.14±
15.31) mL/(100 mL·min); (98.48±43.58), (55.63±14.47) and (54.41±20.81) mL/(100 mL·min); 
(55.62±18.25), (44.11±5.79) and (41.08±7.74) HU, respectively, showing a gradual downward trend and a significant difference among the 3 groups (all P 0.05). PVP, TLP, PE and LP were negatively correlated with the process of liver cirrhosis (r=-0.592, -0.567, -0.409, -0.569, all P<0.05), but HPI and TTP were positively correlated with the process of liver cirrhosis (r=0.434 and 0.538, both P<0.05). 
@*CONCLUSION@#256-CTP could provide useful information for the assessment of liver cirrhosis by measuring a plurality of perfusion parameters. The hepatic microvascular changes in patients with liver cirrhosis could be quantitatively assessed by perfusion CT. TTP shows high efficiency in prediction of liver cirrhosis and decompensated liver cirrhosis.

Feasibility study on liver CT contrast-enhanced scan with low dose of radiation and contrast agent / 中南大学学报(医学版)

OBJECTIVE@#To explore the feasibility for liver contrast-enhanced CT scan with low dose of radiation and contrast agent in clinical.
@*METHODS@#A total of 180 cases were randomly divided into group I (low concentration of contrast agent, 270 mgI/mL of iodixanol) and group II (high concentration of contrast agent, 320 mgI/mL of iodixanol). Three scan conditions (A: 120 kV, 300 mA; B: 100 kV, 400 mA; and C: 100 kV, 300 mA) were randomly distributed in 3 phases (arterial phase, venous phase and delay phase) for liver scans in each group. The effective radiation dose (ED), image CT values and quality of images (image of noise (NI), the image signal to noise ratio (SNR), contrast to noise ratio (CNR), and overall image quality (OIQ) scores were recorded and analyzed. 
@*RESULTS@#ED values for the group C in the total samples were decreased by 38%, 40% and 41%, respectively compared to the group A in contrast-enhanced scan for 3 phases. The image quality was significantly different (P0.05) in image quality. There were significant differences between the group I and the group II in CT values at the same scanning parameters and scanning phases (P0.05); however the differences in image quality were statistically significant between the group A-II and the group C-I (P<0.05).
@*CONCLUSION@#Reduction of the tube voltage (to improve the tube current) combined with the low-dose contrast agent can not only reduce the radiation dose and contrast agent dose but also meet the needs of double-low liver contrast-enhanced CT scan.

MR investigation in evaluation of chronic whiplash alar ligament injury in elderly patients / 中南大学学报(医学版)

OBJECTIVE@#To observe the imaging features for chronic whiplash alar ligament injury in elderly patients and to provide an effective diagnostic method for long-term neck pain and headaches due to alar ligament injury in elderly patients.@*METHODS@#A total of 134 elderly patients, who engaged in the work or activities related to whiplash motion and suffered from chronic neck pain, were enrolled for the study. All patients were performed comprehensive health examination (CT, MR, ultrasound and laboratory examination) and high resolution PDWI. The patients were divided into 2 groups according to the results of comprehensive health examination: a clear etiology group(CE group, n=96) and an unknown etiology group(UE group, n=38). Th e characteristics of PDWI signal in the ligament were analyzed between the 2 groups.@*RESULTS@#Th e anatomy and signal characteristics of the alar ligament were clearly displayed by high resolution PDWI. Th e alar ligaments were effectively displayed by oblique coronal image. In the CE group, 7 patients (7/96) showed the positive sign of ligament injured, while 21 (21/38) patients showed positive sign of ligament injured in the UE group (P<0.01). Chronic whiplash ligament injury was proved to be the reason for long-term neck pain and headaches in 15.7% patients.@*CONCLUSION@#Th e whiplash injury of alar ligament is an important reason for chronic neck pain in elderly patients. High resolution PDWI is an effective method to evaluate the image features of alar ligament and can provide an accurate diagnosis for chronic neck pain and headaches caused by the alar ligament whiplash injury.

Evaluation of alar ligament injury with MR proton-weighted imaging / 中华放射学杂志

Objective To investigate the imaging features of alar ligament and its extent, and provide the basis forclinical treatment.Methods 3.0 T superconducting MRI was used to scan the alar ligament with high resolution PDWI sequence (Proton density weighted imaging, PDWI)in 109 patients of emergency admissions due to head and neck trauma. Based on imaging features, ligamentous injury was classified into three degrees(Ⅰ to Ⅲ degrees).Patients with Ⅰ degree ligamentous injury were treated conservatively, andⅡtoⅢdegree injury patients were treated with surgery, then follow-up was performed with MRI for the recovery of ligaments and clinical evaluation for symptoms (6 months follow-up period). Results High-resolution PDWI showed 78 patients with no ligament injury.On follow-up, patients recovered well (atlantoaxial joint motor function and clinical symptoms). Thirty one patients had alar ligament injury in varying degrees, of which 18 patients had grade Ⅰ injury, nine patients had degree Ⅱinjury, and four patients had degreeⅢinjury .All gradeⅠinjury patients received conservative treatment. Follow-up of patients showed good recovery, MR revealed the lesions shrank in varying degrees or disappear. Six gradeⅡinjury patients had surgical treatment, and three received conservative treatment. On follow-up, seven patients had a good recovery, two patients underwent surgical treatment within 3 months after injury and recovered well.Three gradeⅢpatients treated by surgery, and all with good recovery postoperative, and a patient died of respiratory failure. Conclusions High resolution PDWI is an effective tool to evaluate the extent of the alar ligament injury. Grade Ⅰ ligamentous injury patients treated conservatively can achieve good results, GradeⅡandⅢligamentous injury patients should receive surgical treatment early.

Symptomatic splanchnic artery dissection：imaging diagnosis and interventional treatment / 介入放射学杂志

Objective To summarize the experience in the diagnosis and treatment of symptomatic splanchnic artery dissection. Methods A total of 21 patients with symptomatic splanchnic artery dissection, who were admitted to the Affiliated First Hospital of China Medical University during the period from June 2006 to March 2014, were included in this study. Combined with the literature, the clinical data, including the diagnosis and treatment, were analyzed. Results Contrast-enhanced abdominal CT and CT angiography revealed superior mesenteric artery dissection in 15 cases, celiac artery dissection in 5 cases and splenic artery dissection in one case. Conservative therapy was employed in 5 patients; among them one was complicated with hepatic artery thrombosis. Of the 16 patients who received endovascular stent placement, additional intestinal resection was performed in 2 and transcatheter thrombolysis treatment in other 2. No procedure-related severe complications occurred in perioperative period. All the patients were followed up for 2-74 months (mean of 19.1 months). In patients who received endovascular stent placement, the abdominal pain and the bloody stool were relieved or disappeared, and no abdominal pain recurred. CT angiography showed that in-stent blood flow was fluent, the stent was in good position, and neither stenosis nor thrombosis was observed. One patient with superior mesenteric artery dissection died of stroke three months after the treatment. Conclusion It is very important to make early diagnosis and to adopt early treatment for symptomatic splanchnic artery dissection. CT angiography can confirm the diagnosis in most cases, but attention should be paid to some atypical manifestations. For the treatment of splanchnic artery dissection, endovascular stent placement is mini-invasive, safe and reliable.

Application value of kissing stenting for the treatment of bilateral brachiocephalic-superior vena cava obstruction / 中华放射学杂志

Objective To evaluate the clinical value of the kissing stenting in bilateral brachiocephalic-superior vena cava obstruction syndrome.Methods Analysis the clinic effect in 17 patients who received interventional treatment retrospectively.All patients with bilateral brachiocephalic vein-superior vena cava obstruction were caused by malignant tumor.Each patient was implanted two stents by kissing stenting style.Among them,1 patient accompanied thrombosis in brachiocephalic vein was conducted with catheter-directed thrombolysis before stenting.The symptoms,pathological signs and complications were observed after the treatment,patients were underwent follow-up to see whether symptom recurred.Results All 17 patients received successful kissing stenting in bilateral brachiocephalic vein-superior vena cava.The symptoms and pathological signs eliminated after the operation.No serious complications occurred.Seventeen patients were underwent follow-up (1 to 16 months) with no obstructive symptom recurred including 5 patients died of the end-stage of malignant tumor.Conclusion Kissing stenting is a safe and effective methods for the treatment of bilateral brachiocephalic-superior vena cava obstruction.

Value of endovascular stents placement for treating symptomatic spontaneous isolated dissection of splanchnic artery / 中华放射学杂志

Objective To evaluate the safety and effectiveness of treating the endovascular stents placement for spontaneous isolated dissection of splanchnic artery ( SIDSA).Methods Sixteen consecutive patients with diagnosis of SIDSA through CTA and DSA were retrospectively analyzed .All patients had acute persistent abdominal pain and treated by endovascular stents placement.The serious complications and symptoms improvement were reviewed after the operation.The symptoms recurrence and repeated color doppler ultrasonography and CTA were also reviewed in the follow up.Results Twelve superior mesenteric artery ( SMA) dissection and four celiac artery ( CA) dissection were diagnosed among sixteen patients.The dissection length was 1.07 to 11.87 cm and the median length was 3.93 cm.The distance from the original dissection to the orifice of superior mesenteric artery or celiac artery was 0.50 to 6.44 cm and the median was 1.98 cm.Eight stent-grafts and 3 bare stents were successfully implanted in 11 patients.One case with celiac dissection was failed to treat because of the severe compression of true lumen and the guide wire cann′t cannulate to the distal true lumen.Four patients with superior mesenteric artery dissection gave up interventional therapy , Among these 4 patients , 2 patients had small tear site and small false lumen , 1 patient had extremely long dissection , and one case had blood supply of target organs from both true and false lumen.No severe complications such as hemorrhage , intestinal necrosis , hepatic failure and splenic necrosis occurred during the eleven successful endovascular interventions.The abdominal pain in 10 cases was disappeared or significantly relieved , 1 case with superior mesenteric vein thrombosis and severe intestinal ischemia before intervention underwent intestinal resection for necrosis.The follow up period was 1 to 74 months in eleven successful cases , and the median follow-up period was 16 months.One patient with SMA dissection after endovascular treatment was died of sudden stroke three months later .Others had satisfactory outcome and the repeated color doppler ultrasonography and CTA were normal .Conclusions Endovascular stents placement is a safe and effective therapy for symptomatic spontaneous isolated dissection of splanchnic artery.

3.0T-MR high resolution proton density weighted imaging for transverse cervical ligament in healthy adolescents / 中南大学学报(医学版)

OBJECTIVE@#To explore the imaging characteristics of the transverse ligament in healthy adolescents, and further understand the imaging characteristics of the ligament injury.@*METHODS@#We used 3.0T-MR to scan the transverse ligament with proton-weighted sequence in 32 young volunteers, scanned coronally, horizontally and sagittally, and then observed the morphology, thickness, running and signal characteristics of the ligament.@*RESULTS@#The anatomy and signal characteristics of the transverse cervical ligament were clearly displayed by high resolution proton density weighted imaging (PDWI). The whole picture of the transverse ligament was effectively displayed by coronal combined with horizontal image. The transverse ligament was located in the rear of the odontoid, and connected to the inside of both sides of the block like half-arc. The length was (20.4±3.3) mm, the ligament center was the thickest, and both sides gradually became thinner. The middle width of the ligament was (7.3±0.6) mm, the ligament ends narrowed down, and the middle was (2.1±0.4) mm thick; 75% of the transverse ligament showed homogeneous low signal in PDWI, while 25% of the local transverse ligament had high signal.@*CONCLUSION@#High resolution PDWI with 3.0T-MR is a effective method to evaluate the structure of the transverse cervical ligament. Local high signal may not necessarily be the sign of ligament injure. There may also be some high signal in the normal adolescent ligament, so we must pay much attention to clinical diagnosis and treatment.

Evaluation of sinus meningiomas in the region of interest by high-resolution three dimensional contrast-enhanced magnetic resonance venography / 中南大学学报(医学版)

OBJECTIVE@#To determine the value of high-resolution three dimensional contrast enhanced magnetic resonance venography (3D CE-MRV) in evaluating sinus meningiomas in the region of interest (ROI).@*METHODS@#Twenty patients with sinus meningiomas underwent 3D CE-MRV with ROI preoperatively (including 9 patients postoperatively). We observed the changes of venous sinus adjacent the tumor.@*RESULTS@#All patients received high-resolution image, the single acquisition time was about 11.4 s, and the voxel value was about 1.3 mm3. The images of 20 patients showed the change of the sinus clearly, 6 of which with integral sinus, 14 with sinus invaded at various degrees, including 5 with sinus occlusion and 9 with stenosis. CE-MRV also showed 4 patients with clear sinuses, 1 with narrow sinus, partial interruption, and 4 with sinus removed after the surgery.@*CONCLUSION@#Application of high-resolution 3D CE-MRV in ROI in sinus meningiomas may help obtain a series of high-resolution images in a short time, show the relationship between the tumor and venous sinus, display the degree of invasion of venous sinus clearly, provide information for the surgical treatment, and evaluate the change of sinus after the surgery.

Correlation between cerebral microbleed and hemorrhage transformation after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke: a prospective case series study / 国际脑血管病杂志

Objective To investigate the correlation between cerebral microbleed (CMB) and hemorrhage transformation (HT) after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.Methods The patients with acute cerebral infarction treated with intra-arterial urokinase were enrolled.They were divided into either an HT group or a non-HT goup according to whether they had HT or not.Conventional MRI sequences,susceptibility-weighted imaging (SWI),and CT scan were performed before procedure.CT or MRI was reexamined within 48 hours after procedure.The patients' demographic data,vascular risk factors,and the SWI sequences showed the numbers of CMB were documented in detail and they were compared and analyzed.Results A total of 62 patients were included,22 in HT group and 40 in non-HT group.Univariate analysis showed that the proportions of hypertension (81.8％ vs.57.5％ ; x2 =3.125,P =0.048),diabetes (63.6％ vs.40.0％ ; x2 =4.019,P =0.042),smoking (72.7％ vs.37.5％ ; x2 =4.971,P =0.030),and presence of CMB (x2 =5.297,P =0.018) of patients in the HT group were significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that hypertension (odds ratio [OR]1.51,95％ confidence interval [CI]1.102-2.954; P =0.028),diabetes (OR 1.48,95％ CI 1.09-2.825; P =0.039),and CMB (OR 1.867,95％ CI 1.103-3.158; P =0.020) were the independent risk factors for HT after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.Conclusions CMB was one of the independent risk factors for occurring HT after urokinase intra-arterial thrombolysis in patients with acute ischemic stroke.

Preoperative application of three-dimensional angiography in elderly patients with meningioma / 中华老年医学杂志

Objective To study the preoperative application value of the three-dimensional angiography in surgical strategy for the elderly patients with meningioma. Methods Forty-two elderly patients aged 60 years and over with meningioma were examined preoperatively with multi-slice spiral CT angiography(MSCTA) and (or) 3 dimensional contrast-enhancement MR angiography(3D CE-MRA)as simulation group.In three-dimensional post-processing workstation,the oppression and invasion degree of the intracranial important blood vessels,nervous running zone and sinus,as well as surgical risks were evaluated. 28 elderly patients without the above examination were as control group. The operation time, blood transfusions and postoperative complications were compared between the two groups. Results All 42 cases of simulation group completed reasonable surgical plan and approach.The incidence of postoperative complications were lower in simulation group than in control group (35.7％ vs.50.0％,P＞0.05),intra-operative blood transfusion were significantly decreased in simulation group as compared with control group [(5301.0± 150.6) ml vs.( 621.4±226.7)ml,t=2.01,P=0.049],operation time after three-dimensional simulation were reduced as compared with control group [(257.1 ±72.6) min vs.(307.5±88.2)min,t=2.61,P=0.011].Conclusions Application of three-dimensional angiography in elderly patients with meningioma to evaluate the operative risk may help make reasonable surgical strategy,thus reducing the surgical trauma and complications.

MRS and diffusion tensor image in mild traumatic brain injuries

OBJECTIVE@#To analyze characters of magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) in the diagnosis of mild trauma brain injuries (MTBI) in frontal lobe and to compare with conventional magnetic resonance imaging (MRI).@*METHODS@#A total of 21 patients were selected, who all aged 12-51 years old and had injury within 24 hours. Computer tomography (CT) and the Glasgow Coma Scale were used to evaluate the degree of injury. All patients were diagnosed as MTBI, and 19 had conventional MRI, MRS and DTI. The major parameters of MRS were Probe-P sequence, TE = 144 or 35 ms, and both single voxel spectrum and chemical shift imging were included. The major parameters of DTI were diffusion directions =15, b value = 1 000 s/mm(2). Frational anisotropic (FA) map and average ADC map were obtained to evaluate DTI result. Positive detetion ratio was observed and the imaging changes were compared between injured side and normal side.@*RESULTS@#All 21 patients had CT scan and Glasgow scale. A total of 19 patients had conventional MRI, DTI and MRS. Results of CT and conventional MRI showed no significant abnormality in lobe, and Glasgow scale showed mild type. MRS result showed significant decrease in N-acetyl aspartate (NAA) and NAA/creatine (Cr) in 13 cases (68.4%) (P<0.001), and increase in lactic acid (Lac) in 7 cases (36.8%). FA mapping of the frontal lobe displayed significant changes in 7 cases (36.8%), with 5 out of the 7 cases having increase in FA value. And there was no significant difference in average ADC.@*CONCLUSIONS@#MRS and DTI might be more sensible than other methods, such as CT and conventional MRI in diagnosis of MTBI. The particular changes were reduced NAA and increased Lac for MRS, and increased FA values for DTI.

Application of CT angiography in operation of cranial base meningioma / 中国医学影像技术

Objective To probe the value of multi-slice spiral CT angiography (MSCTA) in decreasing surgical trauma of the cranial base meningioma. Methods Thirty-two patients with cranial base meningioma were examined preoperatively with MSCTA to observe the shape and the relationship with the adjacent vessels and the skull base. Three-dimensional images were reconstructed to imitate the approach of operation and compared with surgical findings. Meanwhile, 22 patients withnot MSCTA were selected randomly as control group. The amount of blood transfusion and the occurrence rate of complications were compared between the two groups. Results MSCTA depiceted clear three dimensional images of the meningioma and the relationship with the adjacent vessels and the skull base, corresponded very well to the surgery. By imitating the operation, all patients were designed the incision size of bone appropriately, the vessels of peritumoral were kept off effectively and the risk of the embedded vascular were assessed accurately. The conventional surgical approach and method were changed in 9 patients, 4 formulated the planning of the sub-total resection and radiotherapy preoperatively. Compared with control group, the amount of blood transfusion reduced significantly (P<0.05) and postoperative complications decreased. Conclusion MSCTA can imitate the surgical operations in multi-angle and supply the vital information for choosing the proper surgical approach, thereby reducing surgical trauma and postoperative complications.