Clinical study of drug-eluting stents in acute coronary syndrome patients with diabetes and multivessel disease / 中华老年医学杂志

Objective:To investigate the safety and efficacy of drug-eluting stents(DES)in patients with acute coronary syndrome(ACS)complicated with diabetes and multivessel disease.Methods:A total of 80 patients with ACS who received XIENCE V Everolimus stent implantation in the heart center of the 82nd army hospital from January 2017 to October 2018 were retrospectively enrolled and analyzed.Patients were divided into the diabetic group(35 cases)and the non-diabetic group(45 cases)according to whether they were complicated with diabetes or mltivessel lesions.Stent implantation status within 12 months after PCI were compared between the groups.Results:(1)All stents were successfully implanted in the two groups.After coronary angiography re-examination within 12 months, there were no significant differences in the rate of stent restenosis(0.0% vs 2.2%), non-fatal myocardial infarction(2.9% vs.2.2%), or MACEs(2.9% vs.4.4%)between the diabetic and non-diabetic groups(all P>0.05). No patients died from cardiogenic causes in the two groups.(2)During the follow-up period, one patient was hospitalized for acute myocardial infarction in the diabetic group and one case died of an ascending aorta rupture. Conclusions:The safety and efficacy of XIENCE V DES in patients with diabetes and multivessel lesions are good, and the incidence of MACEs is low.

Efficacy of a combination of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MR T1 mapping and liver volume to standard liver volume ratio for estimation of liver function / 中华放射学杂志

Objective@#To investigate the feasibility of a combination of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced MR T1 mapping and liver volume to standard liver volume ratio in quantitative assessment of liver function.@*Methods@#Eighty patients who underwent Gd-EOB-DTPA enhanced MR T1 mapping were prospectively enrolled, and the Child-Pugh score and the model for end-stage liver (MELD) score were evaluated and grouped. Patients were divided into three groups according Child-pugh score as follows: normal liver function (NLF, n=26), liver cirrhosis with Child-Pugh A (LCA,n=30), liver cirrhosis with Child-Pugh B+C (LCB+LCC, n=24), and were also divided into two groups according MELD, MELD≤8 (n=57) and MELD≥9 (n=23). Variable flip angle T1 mapping sequences were performed before and 20 minutes after Gd-EOB-DTPA administration. T1pre, T1 post were measured on T1 maps and ΔT1 were calculated. The images of hepatobiliary phase were transferred to the workstation to measure liver volume (LV). Standard liver volume (SLV) were calculated with the heights and weights of patients, and then liver volume to standard liver volume ratio (LV/SLV) was calculated. One-way ANOVA was used to compared the indexes (T1post, T1 post×LV/SLV, ΔT1, ΔT1×LV/SLV) in different liver function groups of NLF,LCA,LCB+LCC. The t tests were used to compare the indexes (T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV) in MELD≤8 and MELD≥9 groups. ROC curve analysis was used to compare the diagnostic performance of T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV.@*Results@#T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV showed significant difference between different liver function groups (P<0.05). All the indexes can distinguish different groups. Multiplied by LV/SLV,the AUC of ΔT1×LV/SLV were 0.902 in the MELD≤8 and MELD≥9,which was slightly higher than that of ΔT1 (AUC=0.886). The AUCs of ΔT1×LV/SLV were 0.771, 1.000, 0.924 in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups, which were slightly higher than that of ΔT1 (0.764, 0.992, 0.904). The AUCs of T1post, T1post×LV/SLV were 0.824, 0.789 in the MELD≤8 and MELD≥9, respectively. The AUCs of T1post in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups were 0.713,0.987,0.915, respectively, and the AUCs of T1post×LV/SLV were 0.687,0.973,0.871.The AUCs of T1post×LV/SLV had a slightly lower AUC amongthe different liver function groups than T1post.@*Conclusion@#Gd-EOB-DTPA enhanced MRI T1 mapping is useful for estimating liver function. T1 relaxation times and reduction rates of T1 relaxation times with a combination of the LV/SLV may more reliably estimate liver function.

Efficacy of a combination of gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid enhanced MR T1 mapping and liver volume to standard liver volume ratio for estimation of liver function / 中华放射学杂志

ObjectiveTo investigate the feasibility of a combination of gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA) enhanced MR T1 mapping and liver volume to standard liver volume ratio in quantitative assessment of liver function. Methods Eighty patients who underwent Gd?EOB?DTPA enhanced MR T1 mapping were prospectively enrolled, and the Child?Pugh score and the model for end?stage liver (MELD) score were evaluated and grouped. Patients were divided into three groups according Child?pugh score as follows: normal liver function (NLF, n=26), liver cirrhosis with Child?Pugh A (LCA,n=30), liver cirrhosis with Child?Pugh B+C (LCB+LCC, n=24), and were also divided into two groups according MELD, MELD≤8 (n=57) and MELD≥9 (n=23). Variable flip angle T1 mapping sequences were performed before and 20 minutes after Gd?EOB?DTPA administration. T1pre, T1 post were measured on T1 maps and ΔT1 were calculated. The images of hepatobiliary phase were transferred to the workstation to measure liver volume (LV). Standard liver volume (SLV) were calculated with the heights and weights of patients, and then liver volume to standard liver volume ratio (LV/SLV) was calculated. One?way ANOVA was used to compared the indexes (T1 post, T1 post×LV/SLV, ΔT1, ΔT1×LV/SLV) in different liver function groups of NLF,LCA,LCB+LCC. The t tests were used to compare the indexes(T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV) in MELD≤8 and MELD≥9 groups. ROC curve analysis was used to compare the diagnostic performance of T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV. Results T1post, T1post×LV/SLV, ΔT1, ΔT1×LV/SLV showed significant difference between different liver function groups (P<0.05). All the indexes can distinguish different groups. Multiplied by LV/SLV,the AUC of ΔT1×LV/SLV were 0.902 in the MELD≤8 and MELD≥9,which was slightly higher than that of ΔT1 (AUC=0.886). The AUCs of ΔT1×LV/SLV were 0.771, 1.000, 0.924 in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups, which were slightly higher than that of ΔT1 (0.764, 0.992, 0.904). The AUCs of T1post, T1post×LV/SLV were 0.824, 0.789 in the MELD≤8 and MELD≥9, respectively. The AUCs of T1post in the NLF and LCA, NLF and LCB+LCC, LCA and LCB+LCC groups were 0.713,0.987,0.915, respectively, and the AUCs of T1post×LV/SLV were 0.687,0.973,0.871.The AUCs of T1post×LV/SLV had a slightly lower AUC amongthe different liver function groups than T1post. Conclusion Gd?EOB?DTPA enhanced MRI T1 mapping is useful for estimating liver function. T1 relaxation times and reduction rates of T1 relaxation times with a combination of the LV/SLV may more reliably estimate liver function.

The application value of liver volume measurement and Gd-EOB-DTPA enhanced MRI to evaluate hepatic reserve function / 实用放射学杂志

Objective To probe the value of both liver volume(LV)measurement and Gd-EOB-DTPA enhanced MRI to evaluate hepatic reserve function in order to obtain a better assessment method.Methods Clinical and imaging data of 42 patients with hepatic focal lesions were analyzed retrospectively.Gd-EOB-DTPA enhanced MRI scan,Child-Pugh scoring and ICG clearance tests were performed in all patients,and the liver relative enhancement (RE)and LV were used to assess the hepatic reserve function.The differences of LV, LV/standard liver volume (SLV)and RE between the Child-Pugh class A and B were compared using independent student's t-test. Spearman correlation analysis was applied to analyze the relationship of indocyanine green retention rate at 1 5 minutes (ICG-R1 5) with the LV,LV/SLV,RE,RE×LV and RE×LV/SLV.Results There was no significant difference in LV between two groups(P>0.05), whereas the RE had significant difference(P=0.039).There were no significant correlations between ICG-R15 and LV,LV/SLV(P>0.05). ICG-R1 5 was negatively correlated with RE,RE×LV and RE×LV/SLV,and RE×LV/SLV showed significant correlation with ICG-R15 (r=-0.524,P=0.000).Conclusion Gd-EOB-DTPA enhanced MRI can assess the status of hepatic reserve function, while the combination of RE with LV is a more effective method.

Clinical application value of MRI combined with DWI sequence in the diagnosis and follow-up of patients with meningioma / 重庆医学

Objective To explore the performance of meningiomas in MRI dynamic enhancement and DWI sequence,and to improve the accuracy of differential diagnosis of benign and malignant meningiomas.Methods Meningioma MRI data,which were pathology proved by the Guilin medical college affiliated hospital at different levels(Ⅰ,Ⅱ and Ⅲ),were retrospectively analyzed.The enhancement of meningiomas at all levels and the extent of edema were summarized,at the meantime the dynamic enhancement perfusion parameters and ADC values of meningioma MRI meningioma were contrastively analyzed.Results There were 30 cases of meningioma located in the brain falcus,27 cases of meningioma located in the sagittal sinus,10 cases of meningioma located in the cerebellopontine angle and 6 cases of meningioma located in other parts.The difference of ADC value between grade Ⅰ meningiomas and grade Ⅲ meningiomas was statistically significant different[(1.253±0.123)×10-3 mm2/s vs.(0.891±0.103)×10-3 mm2/s,P<0.05].The relative blood flow(rCBF)and relative blood volume(rCBV)of grade Ⅰ meningiomas were significantly lower than those of grade Ⅲ meningiomas(P<0.05).Conclusion MRI dynamic enhancement combined with DWI can accurately identify grade Ⅰ meningiomas and grade Ⅲ meningiomas,and it is necessary that the assessment of its classification should be appropriately considered to the higher level for patients who do not have a characteristic manifestation of meningioma in the preoperative.

The value of DCE-MRI quantitative parameters in the differential diagnosis of hepatocellular carcinoma from benign liver tumors / 实用放射学杂志

Objective To study the values of quantitative parameters of DCE-MRI in diagnosis of benign and malignant liver tumors and to explore its diagnostic efficacy.Methods Consecutive 25 patients with benign or malignant liver tumors underwent plain scanning and dynamic contrast-enhanced MRI,and total 28 lesions were confirmed by pathology or follow-up.The DCE-MRI quantitative parameters (Ktrans ,Kep ,Ve and iAUC)of the lesions and the surrounding normal liver tissue were acquired.The inde-pendent sample t test was used to compare the quantitative parameters between different tumors.The optimal parameters values of benign and malignant liver tumors were determined by plotting ROC curves.Results The mean quantitative parameters of HCC and benign lesions were larger than those of the surrounding normal liver tissue.Ktrans ,Kep and iAUC between HCC and surrounding nor-mal liver tissue had significant differences (P <0.05),Ktrans and iAUC between benign lesions and surrounding normal liver tissue had a significant difference (P <0.05).Ktrans ,Kep and iAUC between HCC and benign lesions had significant differences (P <0.05). The diagnostic effectiveness of Ktrans = 0.21 5 min-1 ,with sensitivity of 81.3% and specificity of 66.7%,was greater than that of Kep =0.477 and iAUC=24.706.Conclusion The DCE-MRI quantitative analysis can provide a reference for the differential diagnosis of HCC from benign liver tumors.

The application study of multi-b value diffusion weighted imaging in preoperative histological grading of supratentorial glioma / 实用放射学杂志

Objective To investigate the optimal b value of diffusion-weighted imaging (DWI)in predicting the grade of cerebral gliomas.Methods 38 patients with pathologically-proved brain gliomas (24 high-grade gliomas and 14 low-grade ones)were studied retrospectively.All patients received conventional MRI and DWI examination with three different b values (1 000 s/mm2 ,2 000 s/mm2 and 3 000 s /mm2 ).The signal features of the tumor on DWI with three different b values were evaluated and compared.The minimum ADC values of the tumors were calculated and compared between each other.Through drawing the ROC curve of different b values, the best diagnostic threshold was found.The sensitivity and specificity in predicting the grade of brain gliomas were assessed using Chi-square test.Results On DWI with b value of 3 000 s/mm2 ,91.6% (22/24)of high-grade tumors showed hyper-intensity, while 85.7%(12/14)of low-grade tumors presented hypo-intensity signals.Regarding hyper-intensity signals as diagnostic criterion for high-grade tumors,the sensitivity and specificity were 91.6% and 100% respectively.When the b value was similar,the minimum ADC value of high-grade glioma was significantly lower than that of low-grade glioma,and statistically significant differences in differentiating high-grade glioma from low-grade glioma existed among three b values (P <0.05).When the ADC 3 000 value<0.74×10 -3 mm2/s was regarded as a standard for the identification of high-grade and low-grade glioma,the sensitivity and specificity were 100% and 87.3%respectively.Conclusion DWI with high b value is more useful than standard moderate b value in preoperative grading the gliomas.When DWI with b value of 3 000 s/mm2 is used,the minimum ADC value will provide quantitative indicators in preoperatively precisely predicting grading glioma.

CT perfusion imaging in the diagnosis of hepatocellular carcinoma / 中华肝胆外科杂志

Objective To evaluate the value of CT perfusion imaging (CTPI) in the diagnosis of hepatocellular carcinoma (HCC). Method CTPI was carried out on 21 patients with 26 lesions to obtain the following perfusion parameters: hepatic blood flow (HBF), hepatic blood volume (HBV),mean transit time (MTT), permeability surface area product (PS), and hepatic arterial fraction (HAF). The parameters from the lesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein (AFP) level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver,and 1 hepatic focal nodular hyperplasia (FNH). On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the lesion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non-nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypical on contrast CT.

Effect of estrogen on pathogenesis of osteoporosis in women with maintenance hemodialysis / 中华内分泌代谢杂志

To explore the effect of estrogen on pathogenesis of osteoporosis in women with maintenance hemodialysis. One hundred and twenty women aged 18-45 years had been undergoing maintenance hemodialysis for ≥ 3 months were included. Of them ,60 women without osteoporosis served as control group and the other 60 women with osteoporosis as observation group. Serum concentrations of estradiol, tumour necrosis factor-α (TNF-α), parathyroid hormone (PTH), and calcium were determined, meanwhile bone mineral density (BMD)was measured by quantitative computed tomography. Serum estradiol levels in the observation group were lower while TNF-α level were higher than those in control group (all P<0. 05). PTH and calcium levels were not significantly different (P= 0.567 and P = 0. 588). In the observation group, linear correlation analysis revealed positive correlation (r = 0. 865 ,P<0. 01)between estradioi and BMD,while multiple linear regression analysis showed that serum estradiol and calcium levels were positively correlated with BMD, and the concentrations of TNF-α and PTH were negatively correlated with BMD (F= 140.32 ,P<0.01). Estradiol levels were found to have greater effect on BMD(t=5. 386, P<0. 01). Lowered serum concentration of estradiol in women with maintenance hemedialysis seems to be a major factor related to osteoporosis,it accelerates the pathogenesis of osteoporosis by modulating TNF-α.