Objective To summarize the clinical features of intracranial aneurysms of posterior cerebral artery (PCA) ,and the surgical approaches and operative skills to treat them . Methods The aneurysms arose from the P1 segme...Objective To summarize the clinical features of intracranial aneurysms of posterior cerebral artery (PCA) ,and the surgical approaches and operative skills to treat them . Methods The aneurysms arose from the P1 segment in 3 patients,the P2 segment in 5 patients and the P3 segment in 2 patients.展开更多
Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels. Intraoperative microvascular Doppler （IMD） is an attractive, noninv...Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels. Intraoperative microvascular Doppler （IMD） is an attractive, noninvasive, and inexpensive tool. The present study aimed to evaluate the usefulness and reliability of IMD for guiding clip placement in aneurysm surgery. Methods A total of 92 patients with 101 intracranial aneurysms were included in the study. IMD with a 1.5-mm diameter, 20-MHz microprobe was used before and after clip application to confirm aneurysm obliteration and patency of parent vessels and branching arteries. IMD findings were verified postoperatively with digital subtraction angiography （DSA） or dual energy computed tomography angiography （DE-CTA）. Ninety consecutive patients, harboring 108 aneurysms, who underwent surgery without IMD was considered as the control group. Results The microprobe detected all vessels of the Circle of Willis and their major branches. Clips were repositioned in 24 （23.8%） aneurysms on the basis of the IMD findings consistent with incomplete exclusion and/or stenosis. IMD identified persistent weak blood flow through the aneurismal sac of 11 of the 101 （10.9%） aneurysms requiring clip adjustment. Stenosis or occlusion of the parent or branching arteries as indicated by IMD necessitated immediate clip adjustment in 19 aneurysms （18.8%）. The mean duration of the IMD procedure was 4.8 minutes. The frequency of clip adjustment （mean： 1.8 times per case） was associated with the size and location of the aneurysm. There were no complications related to the use of IMD, and postoperative angiograms confirmed complete aneurysm exclusion and parent vessel patency. About 8.3% （9/108） aneurysms were unexpectedly incompletely occluded, and 10.2% （11/108） aneurysms and parent vessel stenosis without IMD were detected by postoperative DSA or DE-CTA. IMD could reduce the rate of residual aneurysm and unanticipated vessel stenosis which demonstrated statistically significant advantages compared with aneurysm surgery without IMD. Conclusion IMD is a safe, easily performed, reliable, and valuable tool that is suitable for routine use in intracranial surgery, especially in complicated, large, and giant aneurysms with wide neck or without neck.展开更多
目的探讨联合超微血流成像(superb microvascular imaging,SMI)和彩色多普勒血流显像(color Doppler flow imaging,CDFI)在乳腺影像学报告和数据系统(breast imaging reporting and data system,BI-RADS)分级为4类的微小结节诊断中的应...目的探讨联合超微血流成像(superb microvascular imaging,SMI)和彩色多普勒血流显像(color Doppler flow imaging,CDFI)在乳腺影像学报告和数据系统(breast imaging reporting and data system,BI-RADS)分级为4类的微小结节诊断中的应用,并与超声造影(contrast-enhanced ultrasound,CEUS)结果比较。方法前瞻性纳入乳腺BI-RADS分级4类、最大径≤1 cm,并经术后病理检查证实的165例乳腺微小结节患者共165例病灶,其中良性病灶125例、恶性病灶40例,每例病灶均进行CDFI、SMI及CEUS检查,分析其声像图资料。采用Adler半定量法进行血流分级评价,比较CDFI和SMI显示微小结节内血流情况的差异。制定了CDFI、CDFI+SMI联合两种方式预测结节性质的诊断标准,分析了CDFI、CDFI和SMI联合及CEUS三种血流显像方法对乳腺微小结节性质的诊断价值。结果恶性乳腺微小结节患者患病年龄大于良性患者,CDFI及SMI对乳腺微小结节血流检出能力不同,CDFI血流显示率为47.3%(78/165)、SMI为83.6%(138/165)。以病理结果为金标准,CDFI、联合CDFI和SMI、CEUS三种方法诊断乳腺微小结节的灵敏度分别为72.5%、87.5%、72.5%,特异度分别为60.8%、59.2%、82.4%,准确性分别为63.6%、66.1%、80.0%,曲线下面积(area under the curve,AUC)分别为0.665、0.771、0.772,且三种方式对微小结节诊断的差异有统计学意义,表明联合应用CDFI和SMI的方式优于单独使用CDFI。结论对于诊断为BI-RADS 4类的乳腺微小结节,联合应用CDFI和SMI,可有助于提高判断结节性质的灵敏度,并减少有创性检查超声造影的使用。展开更多
文摘Objective To summarize the clinical features of intracranial aneurysms of posterior cerebral artery (PCA) ,and the surgical approaches and operative skills to treat them . Methods The aneurysms arose from the P1 segment in 3 patients,the P2 segment in 5 patients and the P3 segment in 2 patients.
文摘Background Surgical treatment of intracranial aneurysms is often compromised by incomplete exclusion of the aneurysm or stenosis of parent vessels. Intraoperative microvascular Doppler （IMD） is an attractive, noninvasive, and inexpensive tool. The present study aimed to evaluate the usefulness and reliability of IMD for guiding clip placement in aneurysm surgery. Methods A total of 92 patients with 101 intracranial aneurysms were included in the study. IMD with a 1.5-mm diameter, 20-MHz microprobe was used before and after clip application to confirm aneurysm obliteration and patency of parent vessels and branching arteries. IMD findings were verified postoperatively with digital subtraction angiography （DSA） or dual energy computed tomography angiography （DE-CTA）. Ninety consecutive patients, harboring 108 aneurysms, who underwent surgery without IMD was considered as the control group. Results The microprobe detected all vessels of the Circle of Willis and their major branches. Clips were repositioned in 24 （23.8%） aneurysms on the basis of the IMD findings consistent with incomplete exclusion and/or stenosis. IMD identified persistent weak blood flow through the aneurismal sac of 11 of the 101 （10.9%） aneurysms requiring clip adjustment. Stenosis or occlusion of the parent or branching arteries as indicated by IMD necessitated immediate clip adjustment in 19 aneurysms （18.8%）. The mean duration of the IMD procedure was 4.8 minutes. The frequency of clip adjustment （mean： 1.8 times per case） was associated with the size and location of the aneurysm. There were no complications related to the use of IMD, and postoperative angiograms confirmed complete aneurysm exclusion and parent vessel patency. About 8.3% （9/108） aneurysms were unexpectedly incompletely occluded, and 10.2% （11/108） aneurysms and parent vessel stenosis without IMD were detected by postoperative DSA or DE-CTA. IMD could reduce the rate of residual aneurysm and unanticipated vessel stenosis which demonstrated statistically significant advantages compared with aneurysm surgery without IMD. Conclusion IMD is a safe, easily performed, reliable, and valuable tool that is suitable for routine use in intracranial surgery, especially in complicated, large, and giant aneurysms with wide neck or without neck.
文摘目的探讨联合超微血流成像(superb microvascular imaging,SMI)和彩色多普勒血流显像(color Doppler flow imaging,CDFI)在乳腺影像学报告和数据系统(breast imaging reporting and data system,BI-RADS)分级为4类的微小结节诊断中的应用,并与超声造影(contrast-enhanced ultrasound,CEUS)结果比较。方法前瞻性纳入乳腺BI-RADS分级4类、最大径≤1 cm,并经术后病理检查证实的165例乳腺微小结节患者共165例病灶,其中良性病灶125例、恶性病灶40例,每例病灶均进行CDFI、SMI及CEUS检查,分析其声像图资料。采用Adler半定量法进行血流分级评价,比较CDFI和SMI显示微小结节内血流情况的差异。制定了CDFI、CDFI+SMI联合两种方式预测结节性质的诊断标准,分析了CDFI、CDFI和SMI联合及CEUS三种血流显像方法对乳腺微小结节性质的诊断价值。结果恶性乳腺微小结节患者患病年龄大于良性患者,CDFI及SMI对乳腺微小结节血流检出能力不同,CDFI血流显示率为47.3%(78/165)、SMI为83.6%(138/165)。以病理结果为金标准,CDFI、联合CDFI和SMI、CEUS三种方法诊断乳腺微小结节的灵敏度分别为72.5%、87.5%、72.5%,特异度分别为60.8%、59.2%、82.4%,准确性分别为63.6%、66.1%、80.0%,曲线下面积(area under the curve,AUC)分别为0.665、0.771、0.772,且三种方式对微小结节诊断的差异有统计学意义,表明联合应用CDFI和SMI的方式优于单独使用CDFI。结论对于诊断为BI-RADS 4类的乳腺微小结节,联合应用CDFI和SMI,可有助于提高判断结节性质的灵敏度,并减少有创性检查超声造影的使用。
