MR metal artifact reduction in patients with anterior cruciate ligament reconstruction: comparison of MAVRIC-SL with conventional FSE sequences / 中华放射学杂志

Objective:To explore the value of metal artifact reduction in oblique sagittal multi-acquisition with variable resonance image combination slab selectivity (MAVRIC-SL) inversion recovery (IR) sequence compared with conventional fast spin-echo (FSE) fat saturation (FS)-T 2WI and proton density weighted imaging (PDWI) on the postoperative review of patients with metal-fixed anterior cruciate ligament reconstruction (ACLR) at 3.0 T MR. Methods:From June to November 2018, 27 patients with metal fixtures in ACLR were prospectively recruited in the First Hospital of China Medical University. The FSE sequences (FS-T 2WI and PDWI) and the MAVRIC-SL IR were performed at 3.0 T MRI system. The maximum artifact slice was selected and ROI was drawn, then the implant and artifact area and the number of artifact-influence slices were recorded. Image signal-to-noise ratio (SNR) was calculated. The degree of image artifacts (artifact degree of spiked ligament staple and its influence on the diagnosis of surrounding structures), measurability (measurability of distance between the upper edge of the staple and the lower edge of the graft entrance on tibia), and other degree of artifacts (whether there were metal artifacts other than implants that affect the observation of other structures within the scanning range) were scored. The Friedman M test and pairwise comparison were used to compare and analyze the quantitative and qualitative data. Results:The differences in artifact area, the number of artifact-influence slices and SNR among FS-T 2WI, PDWI and MAVRIC-SL IR images were statistically significant (all P<0.001). Pairwise comparison analysis suggested that the metal implant artifact area and the number of artifact-influence slices in the MAVRIC-SL IR image were smaller, and the SNR was higher than those of FS-T 2WI and PDWI (all P<0.05 after correction). The differences of the three scores among FS-T 2WI, PDWI and MAVRIC-SL IR were statistically significant (all P<0.001). Pairwise comparison analysis suggested that the degree of image artifacts score of MAVRIC-SL IR sequence was lower, and the measurability and other degree of artifacts scores were higher than FS-T 2WI and PDWI (all P<0.05 after correction). Conclusion:MAVRIC-SL can significantly reduce the metal artifacts and improve image quality in the postoperative MRI review of the patients with metal-fixed ACLR. Therefore, oblique sagittal MAVRIC-SL IR sequence can be used for assisting the diagnosis of conventional FS-T 2WI and PDWI.

Value of calcium-based quantitative spectral CT imaging in differential diagnosis of benign and malignant thyroid nodules / 实用放射学杂志

Objective To evaluate the value of calcium-based quantitative spectral CT imaging in differential diagnosis of benign and malignant thyroid nodules.Methods Totally 82 patients with 98 thyroid nodules confirmed by pathology underwent unenhanced and dual-phase enhanced spectral CT scans before operation.Thyroid nodules were divided into malignant group (61 nodules) and benign group (37 nodules),according to histopathologic results.Besides,contralateral normal thyroid tissue of 50 patients was selected as normal group.The calcium concentration of malignant,benign and normal group in non-enhanced scanning was analysed.The optimal threshold to predict malignancy and the corresponding diagnostic sensitivity and specificity were obtained by ROC curve.Results The calcium concentrations for malignant, benign and normal group in non-enhanced scanning were (5.52±2.72) mg/cm3, (10.72±4.68) mg/cm3 and (24.66±7.58) mg/cm3 respectively.There were significant differences statistically in any two groups (P<0.001).For malignant thyroid nodules, the best diagnostic threshold of calcium concentration was 6.065 mg/cm3,and the diagnostic sensitivity and specificity were 65.6% and 91.9% respectively.Conclusion Spectral CT imaging can quantitatively assess the calcium concentration of thyroid nodules,which provides promising quantitative approach for distinguishing malignant thyroid nodules from benign nodules.

Correlation between DTI features of compressed nerve roots and clinical symptoms in patients with lumbar disc herniation / 中国医学影像技术

Objective To explore changes of parameters of compressed nerve roots on diffusion tensor imaging (DTI) and relationship between the parameters and symptoms assessed with Oswestry disability index (ODI) and visual analogue score (VAS) in patients with lumbar disc herniation.Methods Twenty-five patients confirmed by surgery for single compressed nerve root with lumbar disc herniation who underwent DTI scanning before operation were enrolled.All patients were scored using ODI and VAS,and the areas of characteristic leg pain were compared with compressed nerve root for ODI and VAS.Results FA values of the compressed and normal nerve roots of these patients were 0.26 ±-0.05 and 0.36-±-0.05,while ADC values were (1.69 ±-0.32) × 10-3 mm2/s and (1.56 ± 0.21) × 10-3 mm2/s,respectively.Negative correlation was found between FA values of the compressed nerve roots and ODI (r=-0.88,P＜0.01) as well as VAS (r=-0.66,P＜0.01),but no correlation between ADC values and ODI (r=0.30,P =0.15) nor VAS (r=0.36,P =0.08) was found.Conclusion FA values derived from DTI maybe vital parameters of quantifying changes of structure of nerve root.Injury of nerve root structure in patients with lumbar disc herniation could be crucial for clinical symptoms.

Application of 3.0T Dynamic Contrast-enhanced MRI in the Grading of Gliomas / 中国医科大学学报

Objective To explore the clinical significance of 3.0T dynamic?contrast enhanced MRI scan in the grading of intracranial glioma. Methods The magnetic resonance examination were performed in 40 cases of patients of brain tumors confirmed by surgery pathology(29 pa?tients with glioma),including conventional MRI and dynamic contrast?enhanced MRI. Using Kinetic Modeling?version 3.0 software on the GE 3.0T magnetic resonance workstation calculation of intracranial tumor parenchyma area corresponding quantitative parameters Ktrans and Ve values. The quantitative parameters between any two classification were compared ,and the difference was statistically analyzed. The characteristics of the different level of intracranial glioma's dynamic enhanced scan parameters were preliminary analyzed. The receiver?operating characteristic curve (ROC)analysis of Ktrans value and Ve value was performed,and the diagnosed threshold,sensitivity and specificity were acquired. Results While applying dynamic?contrast enhanced MRI scan acquired Ktrans and Ve values ,both values of high grade gliomas include gradeⅢandⅣwere significantly higher than that of low grade gliomas include gradeⅠandⅡ(P0.05). To identify low grade gliomas with high grade glioma ,Ktrans and Ve diagnosis threshold was 0.204/min and 0.099 respectively. To distinguish between gradeⅡandⅢglioma,Ktrans and Ve diagnosis threshold was 0.247/min and 0.176 respectively. Conclusion Combining quantitative parameters Ktrans and Ve value that come from 3.0T dynamic con?trast enhanced MRI scan with regular enhancement MRI can distinguish low grade gliomas with high grade gliomas glioma ,as well as distinguish gradeⅡwithⅢglioma;However,it is still difficult to identify low grade gliomaⅠwithⅡ,as well as high grade gliomaⅢwithⅣ. The Ktrans and Ve value plays an important role in discriminate different grade intracranial tumors in a preoperative noninvasive way.

Posterior laminoplasty combined with foraminotomy in treatment of mixed cervical spondylosis / 局解手术学杂志

Objective To study the clinical efficacy and safety of posterior laminoplasty combined with foraminotomy in the treatment of mixed cervical spondylosis.Methods A total of 70 patients with mixed type cervical spondylosis from January 2012 to January 2014 in our hospital were randomly divided into observation group and control group.Patients in observation group received posterior laminoplasty com-bined with foraminotomy,and patients in control group received anterior cervical discectomy and fusion surgery.The operation time,intraoper-ative blood lossing,postoperative JOA scores and NDI scores between two groups were compared.The cervical curvature and range of motion were measured by X-ray.Results There was no significant difference in postoperative JOA scores,cervical curvature and range of motion be-tween two groups(P >0.05).The operative time and intraoperative blood loss of observation group was less than those of control group,the difference was no significance.The NDI scores of carrying and drive in observation group were higher than those in control group,while the NDI scores of other items between two groups had no significant difference(P >0.05).The incidence of complications in observation group was 10.81% (4 /37),the control group was 24.42% (8 /33),the difference between two groups was statistically significant,(χ2 =3.428, P <0.05).Conclusion The posterior laminoplasty combined with foraminotomy have good clinical effect for mixed type cervical spondylosis with advantages of a shorter operation time,simple operation,less intraoperative bleeding,lower incidence of complications,which is a kind of safe and effective surgical method.

Application of Diffusion Tensor Image in Diagnosis of Vascular Parkinsonism / 中国医科大学学报

Objective To study the pathogenesis of lower limb motor disorder in vascular parkinsonism(VP)using diffusion tensor image(DTI). Methods A case?control study was performed in a cohort of 16 VP patients and 32 PD patients. Patients were all recruited from the first affiliated hospital of China Medical University from Dec. 2011 to Dec. 2012. The lower limb motor function of those patients was assessed using measurement scales. All patients received magnetic resonance image(MRI)and diffusion tensor image(DTI). Results Patients in VP group showed more seri?ous movement disorders such as freezing of gait(gait ignition failure)than these in PD group,and the movement disorders of their lower limbs prog?ress more rapidly in VP group than the PD group. Movement disorders of their lower limbs in VP group were related to fibers in bilateral frontal lobes (P=0.008). Movement disorder of their lower limbs in PD group were related to fibers in substantia nigra(P=0.030). There are statistically signifi?cant differences in both the FA values of substantia nigra,bilateral frontal lobes and the ADC values of frontal lobes,and the pars compacta and pars reticulata of substantia nigra between these two groups(all P<0.05). Conclusion Movement disorders of bilateral lower limbs are more seriously manifested in VP patients than in PD patients. The onset movement dysfunction of bilateral lower limbs is closely related to fibers in the frontal lobe.

The role of multi-slice spiral CTA and serum S-100B protein in the evaluation of brain damage and cerebral vasospasm in SAH patients / 重庆医学

Objective To investigate the diagnostic value of multi‐slice spiral CTA on the SAH patients ,and serum S‐100B pro‐tein in the evaluation of brain damage and cerebral vasospasm in SAH patients .Methods One hundred and sixty six patients with SAH were selected ,and all underwent CTA examination ,the serum S‐100B protein level were detected 1 d ,2 d ,3 d and 7 d after ad‐mission .Results In the 166 patients ,CTA showed 119 aneurysms .With the treatment ,on day 1 S‐100B protein level of Ⅰ - ⅡHunt‐Hess grade patients was (0 .71 ± 0 .11)μg/L ,on day 7 the level was (0 .62 ± 0 .09)μg/L ;S‐100B level of Hunt‐Hess Ⅳ stage patients on day 1 and 7 were (2 .12 ± 0 .23)μg/L and (1 .97 ± 0 .06)μg/L .After treatment ,S‐100B level was proportional to Hunt‐Hess grade .S‐100B protein level of GCS(3-8) score patients were (1 .87 ± 0 .23)μg/L on day 1 and (1 .87 ± 0 .23)μg/L on day 7 .S‐100B protein level of GCS(13-15) score patients were(0 .63 ± 0 .17)μg/L on day 1 ,(0 .44 ± 0 .15)μg/L on day 7 .After treat‐ment ,the S‐100B level was inversely proportional to GCS score .Conclusion CTA could display three‐dimensional structure and the surrounding relations ,and could contribute to the choice of treatment and assessment of the degree of difficulty .Serum and cerebro‐spinal fluid concentration of S‐100B protein level could be used to assess the gravity of the secondary brain damage and the possibili‐ty of cerebral vasospasm .

Balloon vertebroplasty repairs vertebral compression fractures:biomechanical analysis / 中国组织工程研究

BACKGROUND:For vertebral compression fractures treated by bal oon vertebroplasty, there were stil controversies in biomechanical and clinical studies about adjacent vertebral fractures is the result of osteoporosis progress, or the result of vertebral intervention and strengthening by injecting bone cement. More accurate conclusions can be obtained through more in-depth research and long-term fol ow-up. OBJECTIVE:To evaluate the effect of bal oon vertebroplasty on biomechanical properties of vertebral body with compression fractures and unstrengthened adjacent vertebral body. METHODS:Total y 40 pig specimens with vertebral compression fractures were prepared and randomly divided into study and control groups. Specimens in the study group were subjected to bal oon vertebroplasty. Specimens in the control group only wrapped with normal saline gauze. The biomechanical properties (vertebral height, maximum load), stress, strain and displacement values of specimens under 500 N loading in these two groups were compared. The stress and strain values of unstrengthened adjacent vertebral body before and after the bal oon vertebroplasty in the study group were measured, and compared with the control group. RESULTS AND CONCLUSION:Compared with the original height, specimens in the study group can restore to its original height after bal oon vertebroplasty, the differences were not significant (P>0.05). The former, back, left and right vertebral height in the study group were significantly higher than those in the control group (P0.05). There were no significant differences in the strain and stress values of the unstrengthened adjacent vertebral body after the bal oon vertebroplasty between study group and control group (P>0.05). These results suggest that vertebral maximum loading and stiffness recover wel after the treatment of bal oon vertebroplasty for vertebral compression fractures, which can achieve the effect of preventing vertebral fractures again. Meanwhile, bal oon vertebroplasty treatment can not alter the biomechanical properties of adjacent vertebrae, and it is difficult to influence and lead vertebral fractures again, with a better security.

The analysis of the sacroiliac joint CT examination in the detection rate and missed diagnosis of sacral canal cyst / 中国医师进修杂志

Objective To investigate the detection rate and missed diagnosis reason of sacral canal cyst with sacroiliac joint CT scan.Methods Retrospectively analyzed the changes of sacral canal in 1 286 cases with sacroiliac joint CT scan.CT scanning included bone algorithm reconstruction and standard algorithm reconstruction.Results Among 1 025 patients who had negative sacroiliac joint CT scan were found in 36 cases of sacral canal cyst,the detection rate was 3.5％ (36/1 025).Single cyst in 34 cases and multiple cysts in 2 cases.Cyst in S1 level 5 cases,S1-2 level 4 cases,S2 level 22 cases,S2-3 level 4 cases,S3 level 3 cases.The minimal short diameter of the cysts was 0.5 cm and the maximal diameter was 3.2 cm,average 1.2 cm.CT scan showed a round uniform cystic low density,and combined with sacral canal expansion in 19 cases.CT scan used bone algorithm reconstruction in 29 cases,used standard and bone algorithm reconstruction in 7 cases.Clinical findings and correctly diagnosed in 11 cases,accounted for 30.6％ (11/36),about 69.4％ (25/36) cases were missed diagnosis.Conclusions About 3.5％ patients are found sacral canal cyst who have negative sacroiliac joint CT scan.Both the standard and bone algorithm reconstruction should be used to avoid the missed diagnosis of sacral canal cyst.

Three-dimensional computed tomography in postoperative evaluation of the knees after anterior cruciate ligament reconstruction / 生物医学工程学杂志

This study evaluated the clinical value of three-dimensional computed tomography (3D-CT) images in the knees following arthroscopic anterior cruciate ligament (ACL) reconstruction. Sixty-five consecutive patients underwent arthroscopic ACL reconstruction with single-incision and single-tunnel techniques. Preoperative and postoperative (12 months in between) clinical evaluation were performed using the Lysholm knee score and a KT-1000 arthrometer (side to side). Computed tomography (CT) of the knees was performed in a week after operation in all cases and at mean follow-up of 12 months. All of the clinical evaluation scales performed showed an overall improvement. 3D-CT images can display not only the bone tunnels of the knees including femoral and tibia very distinctly, but also the contour of the reconstructed ACL including adjacent structures. The average femoral tunnel diameter increased significantly (3%) from (9.15 +/- 0.03) mm postoperatively to (9.48 +/- 0.5) mm after 12 months; tibial tunnel increased significantly (12%) from (9.11 +/- 0.09) mm to (10.2 +/- 0.3) mm. There was no statistical difference between tunnel enlargements. So multi-slices spiral CT can evaluate the contour and changes of contour and changes of the knee after ACL reconstruction, which will be helpful in the intraoperative location and postoperative assessment of the knees.

Combination of fMRI and DTI in the Assessment of Cortical Visual Impairment in the Children with Periventricular Leukomalacia / 中国医学影像学杂志

Purpose:To investigate fMRI and DTI in the assessment of cortical visual impairment in children with periventricular leukom-alacia ( PVL).Materials and Methods: Twenty-four children with PVL were enrolled.Meanwhile,24 age-matched normal controls were recruited for comparison.fMRI scan was performed using a 3.0T MR scanner.Data analysis was performed by statistical parametric mapping software (SPM2).Activated voxels were identified in both groups,t test was used for statistical analysis.DTI was performed by MedlNRIA software and DTI color maps were created from fractional anisotropy (FA) values and the three vector elements,FA values on diffusion tensor color maps were compared between the patients and the controls.AH the FA values of these WM fibers were analyzed by paired t test.The correlation was calculated between FA values and activated voxels of visual cortex for PVL children using SPSS10.0.Results: In all 24 normal children,the maximum response of blood oxygen level-dependent (BOLD) signal was located in the primary visual cortex ( PVC).However,some of the 24 cases of PVL had deviated activation.The active voxels of patients in visual cortex were less than that of controls.All 24 cases of PVL showed a significant mean FA reduction in ICPL and PTR in comparison to the ipsilateral regions of healthy controls.The significantly positive correlation was shown between FA values and activated voxels of visual cortex for PVL children.Conclusion:fMRI and DTI play an important role in the assessment of cortical visual impairment in children with PVL.

Initial exploration of clinical value for diagnosing in tracranial aneurysms with multi-slice helical CT three-dimensional angiography / 中华放射学杂志

Objective To evaluate the clin ical value of Multi-slice helical CT three dimensional angiography (3D-MSCTA) as first method for diagnosing intracr anial aneurysms. Methods We studied patients with clinical suspected intracranial aneurysms (13 patients with subarachnoid hemorrhage among cases). All these patients under went 3D-MSCTA and Digital Subtraction Angiography (DSA), 16 patients of them accepte d operation treatment. Row data was acquired by Multi-slice helical CT-AQUILION (Toshiba): scan speed 0.5 s/rot, image slice thickness 1.0 mm, helical pitch 3 .0/5.0. Contrast media (Angiografin) was injected intravenously (1.0-2.0 ml/kg) at spee d of 2.5-3.0 ml/s, delay time was 15-23 sec, reconstruction interval 0.5 mm, recons truction slice thickness 1.0 mm. Source images were processed using a workstation SGI-O2 , images post-processing software was ALATOVIEW,Version 1.21. The reconstructed images were then processed into shaded volume rendering (SVR) and maximal intensity projection (M IP) and Fly-through images. Entire brain DSA was performed obtaining anterioposteri or, lateral, and oblique images. Images of 3D-MSCTA and DSA were analysed by 3 radiologists and 2 neurosurgeons. Results 25 aneurysms were d etected by 3D-MSCTA. Aneurysms′s body, neck, source vessel and the relationship between the aneurysm and surrounding structures was clearly and surely displayed. 22 of 25 aneurysms were detected by DSA,another 3 were (1 anterior communicating artery aneurysm and 2 left middle cerebral artery aneurysm) was not detected. Sixteen of patients un derwent operation treatment, and the results of 3D-MSCTA corresponded very well to those of operation. Maximal diameter of aneurysms body was 14.0 mm and minimal diameter w as 1.7 mm. Conclusion 3D-MSCTA is a high sensitivity and rapid and no ninvasive method for detecting intracranial aneurysms. We suggest that 3D-MSCTA may be the first cho ice for diagnosing intracranial aneurysms.

Oxygen affinity and 2, 3-diphosphoglycerate level of erythro-cytes in patients with cor pulmonale / 第三军医大学学报

Arterial blood gases,intraerythrocytic pH(pHi),2,3-diphosphoglycerate,standard P50(P50(aid))and in vivo P50(P50iv)were determined in 54 patients with cor pulmonale and in 23 normal subjects.It was found that there was no significant change of pHi but the difference between pHi and extraerythrocytic pH was decreased.P50aid was decreased(P