Fast magnetic resonance imaging-based thrombolysis in patients with wake-up ischemic strokes / 中华神经科杂志

Objective To investigate the value of magnetic resonance imaging (MRI)-based intravenous thrombolysis in patients with wake-up ischemic strokes (WUIS).Methods Patients presenting within 12 hours of acute stroke symptom onset and those with WUIS confirmed by CT,excluding intracranial hemorrhage,were encouraged to perform an emergent brain MRI scan to confirm the diagnosis of hyperacute ischemic stroke (hyper-intense in DWI without hyper-intense change in T2WI or fluid attenuated inversion recovery (FLAIR)).These patients then received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).All patients were divided into either stroke presenting within 12 hours or WUIS.The clinical outcomes were assessed by the modified Rankin scale (mRS) and the Barthal index (BI) at baseline and at 90 days after the thrombolysis therapy.Results Two hundred and sixty-one patients (261/563,56.4％) had confirmed diagnosis of hyperacute ischemic stroke (WUIS,n =73,73/121 =60.3％ vs within 12 hours,n =188,188/342 =55.0％).Altogether,192 patients (139 in within 12 hours group,and 53 in WUIS group) received intravenous thrombolytic therapy with rt-PA.No significant differences were found between the 2 groups at the baseline characteristics and at 90 days outcomes after the thrombolysis therapy(x2 =1.296 and 1.473,P =0.538 and 0.489,respectively).Also no significant differences were found in the incidence rate of secondary hemorrhage (including both of asymptomatic and symptomatic) and mortality rate between the 2 groups.Conclusion MRI-based intravenous thrombolysis is safe and effective in the treatment of patients with hyperacute WUIS.

Imaging diagnosis of gallstone ileus / 中华消化外科杂志

Gallstone ileus is a rare and potentially serious complication of cholelithiasis.Its clinical symptoms are nonspecific.From March 2005 to September 2012,19 patients with gallstone ileus confirmed by surgery or endoscopy were admitted to the Pudong New Area People's Hospital.The accuracies of X-ray,uhrasonography,CT and magnetic resonance imaging (MRI) were 0/10,0/5,19/19 and 9/9,respectively.CT examination might be the first choice for diagnosing gallstone ileus ; the classical computed tomography (CT) presentation of gallstone ileus was the Rigler triad,including pneumobilia,ectopic stone and mechanical ileus; MRI examination was superior to CT examination in exposing the fistula,and can provide abundant information,which is important for designing the surgical procedures and judging the prognosis; X-ray and ultrasonography are beneficial in screening the diseases.

Imaging diagnostic features of adrenal injury / 中华泌尿外科杂志

Objective To discuss the imaging diagnostic features of adrenal injury. Methods The imaging features of the 29 patients of adrenal bruise and hernatoma (20 male and 9 females, average age 37) were retrospectively analyzed. The clinical appearances were all flank and hack pain, local sensitive to percus-sion and associated injury appearance. Among the 29 cases, 25 cases(86%) had adrenal injuries on right side, 2 cases(7%) on left side, and 2 cases(7%) on both sides, and no apparent abnormality was found in the relevant endocrine examination after injury. CT (n=29), MRI (n=5) and ultrasonography (n=6) were checked. CT follow-up were taken in 23 eases. MRI (n=1) and ultrasonography (n=l) were followed as well. Results The first-time exam coincidences of CT, MRI and sonography were 28/29 (97%), 5/5 (100%) and 3/6 (50%) respectively. One case of simple right-side adrenal hematoma 3 weeks after injury wasn't clearly diagnosed by CT, which was later diagnosed by MRI. The CT features of adrenal bruise were local or diffuse intumescence and focus high-density hemorrhage shadow. The CT appearances of acute stage adrenal hematoma were round-like high-density shadow without enhancement and the diameters were 1-3 cm. MRI appearances of 5 cases of subacute and chronic phase hematoma were typical high signal of T1WI, T2WI and DWI and toroid low signal around T2WI. Hematorna was not be enhanced when CT or MRI en-hancement scanning, and formed characteristic "nut-like" image feature with toroid high-density or high sig-nal enhanced shadow forming around. Uhrasonography appearances of 3 cases of hematoma were abnormal shadow of the adrenal gland. Conclusions CT is the prior imaging method for adrenal bruise and hemato-ma. MRI has the characteristic appearance for the few cases which are difficult to be identified by CT and ul-trasonography. Characteristic "nut-like" image feature is helpful for the diagnosis and differential diagnosis.

The application of multi-modal MRI in venous thrombolysis therapy for hyperacute cerebral arterial thrombosis / 中华放射学杂志

Objective To investigate the value of MRI in thmmbolytic thempy of hyperacute cerebral arterial thrombosis.Methods One hundred and sixteen patients with acute cerebral arterial thrombosis were recruited.plain CT and multi.modal MRI were performed in all patients.Thirty-three patients with hyperacute cerebral infarction were treated bv recombinant tissue plasminogen activator(rt-PA) and followed-up periodically using MRI.Results The 33 patients with thrombolysis selected by MRI demonstrated clinical improvement.90 d moclified Rankin scale scores(mRs)were less than 2 and life quality Barthal indexes(BI)were from 80 to 100.The complication included one asymptomatic parenchymal hematoma(PH1)one weeks after thrombolytic therapy and 4(12.2%)hemorrhagic infarction(HI)6 to 24 hours after thrombolytic therapy.Condusions MRI has significant clinical value for the screening and follow-up of intravenous thrombolytic therapy of hyperacute ischemic stroke.MRI-based thrombolysis is a safe and effective method for hyperacute ischemic stroke.