Clinical Efficacy of Tongqiao Huoxuetang in Treating Blood Stasis Type Vascular Cognitive Impairment / 中国实验方剂学杂志

Objective:This study aims to observe the clinical efficacy of Tongqiao Huoxuetang in treating blood stasis resistance type vascular cognitive impairment, and explore its mechanism of action. Method:A total of 60 patients who met the inclusion standards and were diagnosed as blood stasis resistance type vascular cognitive impairment were randomly divided into treatment group and control group, 30 patients in each group. Donepezil hydrochloride was administered orally in control group based on internal medicine treatment at an initial dose of 5 mg/day, changed to 10 mg/day 4 weeks later. Patients in treatment group additionally received Tongqiao Huoxuetang based on donepezil hydrochloride. Both groups were treated for 3 months. Changes of symptoms were assessed by syndrome scores; cognitive function was assessed by the mini-mental scale (MMSE); daily living ability was assessed by the activity of daily living scale (ADL), and changes of local blood perfusion (CBF value) was assessed by brain magnetic resonance perfusion imaging arterial spin labeling (MRI-ASL). Changes of homocysteine levels in plasma were measured by using an automated biochemical analyzer. Result:① The values of traditional Chinese medicine(TCM) syndrome scores (SDSVD) were significantly improved in both groups after treatment, and the improvement was more obvious than that of control group (PPPPP P Conclusion:The combination of Tongqiao Huoxuetang combined with donepezil hydrochloride can effectively improve the cognitive ability and daily living ability of the patients with vascular dementia, improve the cerebral blood flow perfusion and decrease the level of homocysteine, so it is worth popularizing in clinical practice.

The research and application advances of medical imaging techniques in early renal function assessment of chronic kidney disease / 生物医学工程学杂志

Chronic kidney disease (CKD) is now recognized as a worldwide public health challenge, and the incidence rate and hospitalization rate have significantly increased in recent years. Without prompt diagnoses and effective treatment in the early renal function damage of CKD, the symptoms will continue to worsen and eventually develop into end-stage renal disease. Functional imaging techniques such as single photon emission computed tomography (SPECT), contrast-enhanced ultrasound (CEUS), computerized tomography perfusion (CTP), and magnetic resonance perfusion weighted imaging (MR-PWI) could be used to quantitatively analyze renal perfusion and renal filtration function. Their diagnostic values are increasingly evident and have become the research hotspot in evaluating renal function. The aim of this review is to briefly evaluate the research and application advances in the early renal function damage assessment of CKD, so as to raise the efficiency of clinical applications.

Progress in imaging evaluation of ischemic penumbra in acute ischemic stroke / 第二军医大学学报

Acute ischemic stroke (AIS) is the most common cerebrovascular disease with high morbidity, mortality and disability. The imaging evaluation of ischemic penumbra has great clinical implication for early diagnosis and reperfusion therapy of AIS. Here, we reviewed the evaluation methods, advangtages and disadvangtages of computed tomography (CT) and magnetic resonance imaging for ischemic penumbra, and discussed the advantages of one-stop multi-modal CT.

A clinical study of perfusion weighted magnetic resonance imaging in recombinant human endostatin combined with chemotherapy and radiotherapy for locally advanced nasopharyngeal carcinoma / 中华放射医学与防护杂志

Objective To assess the antiangiogenic role of recombinant human endostatin combined with chemoradiotherapy and the capacity,and to explore the early tumor response as measured by comparing the change of MRI perfusion parameter.Methods From May 2012 to March 2013,22 locally advanced nasopharyngeal carcinoma patients who received recombinant human endostatin combined with chemoradiotherapy following induction chemotherapy,were included in the prospective study group.The other 25 patients,who received chemoradiotherapy following induction chemotherapy alone in the same period,were included in the control group.The perfusion parameters including blood volume(BV),blood flux(BF),mean transit time (MTT) were obtained by carrying out MR perfusion scanning at 3 time points:before induction chemotherapy,after induction chemotherapy,the end of concurrent chemoradiotherapy.Results Compared with before induction chemotherapy,the perfusion parameters including BV and BF obviously decreased in the study group (F =3.05,3.85,P ＜ 0.05).The parameter of MTT had no obviously change in the study group(P ＞0.05).In the control group,the change of BV,BF and MTT of nasopharyngeal lesions area during the treatment showed no significant difference (P ＞ 0.05).To make comparison between the two groups,at the end of concurrent chemoradiotherapy,BF of nasopharyngeal lesions area in the study group was 0.72 ± 0.56 and 1.92 ± 1.26 in the control group,the former showing significantly declined results (t =-3.056,P =0.012).Conclusions Recombinant human endostatin might be a good indicator of local tumor microvascular changes and the treatment-related toxicity could be tolerated.Magnetic resonance perfusion imaging maybe assessed the capacity of anti-angiogenesis therapy to induce early tumor response.Clinical trial registration Chinese clinical trial registry,ChiCRTONRC-12002394.

Discrimination between Metastatic and Non-metastatic Regional Lymph Nodes in Rectal Cancer Using Quantitative Dynamic Contrast-enhanced Parameters / 中山大学学报(医学科学版)

[Objective]To investigate the diagnostic value of quantitative perfusion parameters of dynamic contrast-enhanced im?aging for discriminating metastatic from non-metastatic regional lymph nodes in rectal cancer.[Methods]122 patients of our depart?ment were collected from 2015.01 to 2016.08, and 203 lymph nodes, including metastatic lymph nodes (MLNs, n=95) and non-meta?static lymph nodes (NMLNs, n=108), were analyzed. The short-axis diameter (S), long-axis diameter (L), short-to long-axis diameter ratio (S/L), volume transfer constant (Ktrans), rate constant (Kep) and extravascular extracellular space (EES) fractional volume (Ve) were compared between two groups respectively. Then using S=5 mm as a cutoff value, these parameters were compared between subgroups. Receive operating characteristic curve (ROC) was used to analyze the diagnostic efficiency and find the optimal cutoff values.[Re?sults]The metastatic group exhibited higher S and L, but lower S/L, Ktrans and Kep than the non-metastatic group (P<0.01). However, the Ve did not differ significantly between two groups (P=0.308). Optimal cutoff values [area under the curve (AUC), sensitivity, speci?ficity] of Ktrans for discriminate metastatic lymph nodes from non-metastatic were 0.088 min-1 (0.69, 58.3%, 78.9%). When S>/=5 mm, subgroup analysis revealed that Ktrans and Kep of MLNs were significant higher than those of NMLNs (P<0.001), but Ve was lower (P=0.039). Optimal cutoff values (AUC, sensitivity, specificity) of Ktrans were 0.088 min-1 (0.675, 57.1%, 77.9%). However, when S<5 mm, MLNs showed lower Ktrans than NMLNs (P=0.001), but there were no significantly statistic differences of Kep and Ve between these two groups (P>0.1). Optimal cutoff values (AUC, sensitivity, specificity) of Ktrans were 0.087 min-1 (0.732, 60.5%, 81.5%).[Conclusion]Ktrans can be used to discriminate regional MLNs from NMLNs in rectal cancer, especially when the short-axis diameter is less than 5 millimeters.

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

PURPOSE: This study investigated the MRI, MR angiography (MRA) and MR perfusion findings of seizure-related cerebral cortical lesions during the periictal period. MATERIALS AND METHODS: From a retrospective review of the institutional database between 2011 and 2014, a total of 21 patients were included in this study. Two radiologists assessed periictal MRI, including MRA and MR perfusion, in patients with seizure-related cortical lesions. The parameters examined include: location of cortical abnormality, multiplicity of the affected cortical region, cerebral vascular dilatation, perfusion abnormality and other parenchymal lesions. RESULTS: All patients showed T2 hyperintense cerebral cortical lesions with accompanying diffusion restriction, either unilateral (18/21, 85.7%) or bilateral (3/21, 14.3%). Of the 21 patients enrolled, 10 (47.6%) had concurrent T2 hyperintense thalamic lesions, and 10 (47.6%) showed hippocampal involvement. Of the 17 patients (81%) who underwent MRA, 13 (76.5%) showed vascular dilatation with increased flow signal in the cerebral arteries of the affected cortical regions. On MR perfusion, all 5 patients showed cortical hyperperfusion, corresponding to the region of cortical abnormalities. CONCLUSION: Seizure-related cerebral cortical lesions are characterized by T2 and diffusion hyperintensities, with corresponding cerebral hyperperfusion and vascular dilatation. These findings can be helpful for making an accurate diagnosis in patients with seizure.

MR Findings of Seizure-Related Cerebral Cortical Lesions during Periictal Period

PURPOSE: This study investigated the MRI, MR angiography (MRA) and MR perfusion findings of seizure-related cerebral cortical lesions during the periictal period. MATERIALS AND METHODS: From a retrospective review of the institutional database between 2011 and 2014, a total of 21 patients were included in this study. Two radiologists assessed periictal MRI, including MRA and MR perfusion, in patients with seizure-related cortical lesions. The parameters examined include: location of cortical abnormality, multiplicity of the affected cortical region, cerebral vascular dilatation, perfusion abnormality and other parenchymal lesions. RESULTS: All patients showed T2 hyperintense cerebral cortical lesions with accompanying diffusion restriction, either unilateral (18/21, 85.7%) or bilateral (3/21, 14.3%). Of the 21 patients enrolled, 10 (47.6%) had concurrent T2 hyperintense thalamic lesions, and 10 (47.6%) showed hippocampal involvement. Of the 17 patients (81%) who underwent MRA, 13 (76.5%) showed vascular dilatation with increased flow signal in the cerebral arteries of the affected cortical regions. On MR perfusion, all 5 patients showed cortical hyperperfusion, corresponding to the region of cortical abnormalities. CONCLUSION: Seizure-related cerebral cortical lesions are characterized by T2 and diffusion hyperintensities, with corresponding cerebral hyperperfusion and vascular dilatation. These findings can be helpful for making an accurate diagnosis in patients with seizure.

The Use of MR Perfusion Imaging in the Evaluation of Tumor Progression in Gliomas

OBJECTIVE: Diagnosing tumor progression and pseudoprogression remains challenging for many clinicians. Accurate recognition of these findings remains paramount given necessity of prompt treatment. However, no consensus has been reached on the optimal technique to discriminate tumor progression. We sought to investigate the role of magnetic resonance perfusion (MRP) to evaluate tumor progression in glioma patients. METHODS: An institutional retrospective review of glioma patients undergoing MRP with concurrent clinical follow up visit was performed. MRP was evaluated in its ability to predict tumor progression, defined clinically or radiographically, at concurrent clinical visit and at follow up visit. The data was then analyzed based on glioma grade and subtype. RESULTS: A total of 337 scans and associated clinical visits were reviewed from 64 patients. Sensitivity, specificity, positive and negative predictive value were reported for each tumor subtype and grade. The sensitivity and specificity for high-grade glioma were 60.8% and 87.8% respectively, compared to low-grade glioma which were 85.7% and 89.0% respectively. The value of MRP to assess future tumor progression within 90 days was 46.9% (sensitivity) and 85.0% (specificity). CONCLUSION: Based on our retrospective review, we concluded that adjunct imaging modalities such as MRP are necessary to help diagnose clinical disease progression. However, there is no clear role for stand-alone surveillance MRP imaging in glioma patients especially to predict future tumor progression. It is best used as an adjunctive measure in patients in whom progression is suspected either clinically or radiographically.

Application of MR perfusion imaging in evaluation of hemodynamic of patients with moyamoya disease / 吉林大学学报(医学版)

Objective:To evaluate the hemodynamic situation of the patients with moyamoya disease using MR perfusion imaging,and to explore the relationship between compensatory collateral circulation and perfusion. Methods:Seventy-two hospitalized patients with moyamoya disease were selected as typical moyamoya disease group,including 37 males and 35 females,aged 10 - 62 years old,all patients underwent cerebral angiography (DSA)and MR perfusion imaging.And 20 patients with out neurological history were used as control group.With mean transit time (MTT)image as a standard,the abnormal perfusion ranges were classified as region of interest (ROI),and the corresponding perfusion parameter values,including cerebral blood flow (CBF),cerebral blood volume (CBV),MTT and time to peak (TTP)were recorded,respectively.The cerebellum was used as a reference in this study,the perfusion parameters were standardized,and the relative ratios of the perfusion parameters (rMTT,rTTP,rCBF,rCBV)were obtained.Results:Compared with control group,the rMTT and rTTP of the patients in typical moyamoya disease group were prolonged and the rCBF was reduced (P 0.05).②Compared with the contralateral side,the rMTT and rTTP of the suffered side were prolonged,and the rCBF and rCBV were reduced (P 0.05).There were no significant differences in all parameters between hemorrhagic moyamoya disease group and ischemia group (P > 0.05 ). Conclusion:MR perfusion imaging can accurately evaluate the hemodynamic condition of moyamoya disease;MTT and TTP hve higher sensitivities than CBF and CBV.MR perfusion imaging can evaluate the compensation of collateral circulation of moyamoya disease and provide the objective basis for the clinician to select the proper surgical timing and the best operation methods.

Quantitative perfusion parameters of dynamic contrast-enhanced magne-tic resonance imaging in patients with rectal cancer:estimation of the mi-crovascular perfusion and permeability / 中国病理生理杂志

AIM:To investigate the perfusion parameters using dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) in rectal cancer patients so as to explore its potential value in estimating the microvascular condition including perfusion and permeability .METHODS:The data of 38 rectal cancer patients examined with DCE-MRI was ret-rospectively analyzed .The perfusion parameters of carcinoma and normal rectal wall in each case were calculated , inclu-ding volume transfer constant (Ktrans), rate constant of back flux (Kep), extravascular extracellular space fractional volume (Ve) and initial area under curve (iAUC).The mean values of tumor and normal rectal wall , mucinous and nonmucinous carcinoma, poorly and moderately-to-well differentiated carcinoma , case with or without lymph node metastasis were com-pared.RESULTS:All the parameters of rectal cancer were higher than normal rectal wall (P<0.01).No significant difference was found between poorly and moderately-to-well differentiated carcinoma in terms of K trans, Kep and Ve, neither was the case with or without lymph node metastasis .The cases with lymph node metastasis had lower iAUC than those with-out (P<0.05).CONCLUSION:Quantitative perfusion DCE-MRI answered the microvascular perfusion and permeability change of rectal cancer compared with normal rectal wall , besides it could be used to distinguish between mucinous and nonmucinous carcinoma , which demonstrated its value in the evaluation of rectal cancer .However , it should not be recom-mended to predict the degrees of tumor cell differentiation and lymph node metastasis just according to the perfusion param -eters.

Clinical and image study of pancreatic hemocirculatory change in patients with acute pacreatitis / 中华消化杂志

Objective To study the change of pancreatic hemocirculation in patients with acute pancreatitis by magnetic resonance perfusion (MRP) and to explore its relationship with pancreatic severity. Methods With a prospective investigation method, APACHEⅡscores, systemic inflammatory response syndrome (SIRS) scores, Binder scores and C-reactive protein (CRP) values were recorded within 72 h in patients with severe acute pancreatitis (SAP,n=15) and mild acute pancreatitis (MAP,n=17), while other 19 volunteers were as controls. MRP were performed on 32 patients and 19 controls. Patients in SAP group were evaluated by above criteria after two-weeks treatment and MRP were performed in 12 of them. All cases with bolus injection of Gd-DTPA (0.2 mol/kg) were scanned by transversal same slice and fast spoil phase gradient echo. Three groups datum of MIR and MSR were gained by ROI time-signal graphy of pancreatic head, body and trail which were calculated by Perfxproject software. Results ① The rates of MIR and MSR in SAP group were lower than MAP group (P0.05).Conclusion MRP is an objective imaging technique, which can reflect the hemocirculatory variety in acute pancrea-titis.It may have a considerable value in evaluating the severity of acute pancratitis.