Myocardial bridging analysis by coronary computed tomographic angiography in a Saudi population

AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography(CCTA). METHODS: A total of 350 CCTA of Saudi patients were included in this study(236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications(typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association. RESULTS: Myocardial bridging was found in 89 of 350(22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending(LAD)(24.6%), followed by distal LAD(3.7%), diagonal branches(2%), ramus intermedius artery(1.4%) and obtuse marginal artery(0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females(P = 0.14). Coronary artery atherosclerosis was found in 51 of 89(57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35(94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries. CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.

Feasibility of Subtraction Coronary Computed Tomographic Angiography and Influencing Factor Analysis: a Retrospective Study

Objective To investigate the feasibility of subtraction coronary computed tomographic(CT)angiography(SubCCTA)to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and analyze the factors that influence SubCCTA.Methods A total of 294 patients suspected of having coronary artery diseases underwent coronary computed tomographic angiography(CCTA)and SubCCTA.Coronary stenoses were blindly evaluated by two experienced radiologists,which were compared with invasive coronary angiography(ICA).Multiple statistical indexes were adopted to analyze the value of SubCCTA for the diagnosis of calcium stenoses.Results The diagnosable rate of SubCCTA was 67.2%(n=197),and the non-diagnosable rate was 32.8%(n=97).Using SubCCTA,the false positive rate decreased from 56.5%to 17.4%,and the corresponding diagnostic accuracy was increased from 83.6%to 92.9%.Univariate logistic regression analysis showed that height(OR=1.029,95%CI=1.001–1.058),weight(OR=1.025,95%CI=1.004–1.046),left ventricular size(OR=1.018,95%CI=1.007–1.030),cardiothoracic ratio(OR=39.917,95%CI=1.244–1281.098),the average heart rate(OR=0.866,95%CI=0.836–0.896)and heart rate range(OR=0.882,95%CI=0.853–0.912)might be the factors influencing SubCCTA.Conclusion This study suggested that SubCCTA could help improve diagnostic accuracy in the presence of calcium plaques.Moreover,several factors were discovered for the first time to possibly influence SubCCTA,which will be helpful in improving the subtracted image quality.

Incremental value of preprocedural coronary computed tomographic angiography to classical coronary angiography for prediction of PCI complexity in left main stenosis

Introduction: The aim of our study was to assess the incremental value of Coronary Computed Tomography Angiography (CCTA) added to classical coronary angiography, for complex characterization of coronary lesions and prediction of procedural complexity in patients with significant left main (LM) stenoses. Material and Methods: Thirty-six patients with LM disease were enrolled in the study, and each subject underwent CCTA followed by coronary angiography and percutaneous revascularization. Results: Logistic regression analysis indicated a good correlation between the angiographic-calculated and the CCTA-derived Syntax scores for the whole group (r = 0.87, p < 0.0001) and for the high risk subgroup (r = 0.86, p < 0.0001), but not for the low and intermediate risk (r = 0.38, p = 0.21 and r = 0.62, p = 0.07 respectively). In cases which required complex PCI procedures, both angiographic and CCTA Syntax score were significantly higher than those who did not require complex revascularization procedures (24.5 +/-11.5 vs 32.2 +/-14.6, p = 0.09 for Angio Syntax, 35.3 +/-11.5 vs 25.2 +/-11.3, p = 0.01 for CCTA). In the same time, Ca scoring was significantly higher and plaque volumes were significantly larger in cases requiring complex revascularization procedures (299.5 +/-359.6 vs 917.3 +/-495.4, p = 0.04 for calcium score, 79.7 +/-28.5 vs 108.7 +/-25.3 mm3, p = 0.002 for plaque volumes). Multivariate analysis identified the following CCTA parameters as significant predictors of increased risk for complex intervention in LM lesions: plaque volume (OR 8.00, p = 0.008), Ca scoring (OR 6.37, p = 0.02) and CCTA Syntax score (OR 6.87, p = 0.01). Conclusions: CCTA derived parameters provide incremental information to classical coronary angiography for preoperative assessment of lesion severity in complex left main stenosis. CCTA derived Syntax score significantly correlates with the classical Coronary Angiography Syntax score and identifies the subgroup of patients who will be more exposed to procedural complications during the revascularization interventions.

The value of three-dimensional computed tomographic angiography in the early diagnosis and treatment of spontaneous subarachnoid hemorrhage (616 cases report)

Objective To evaluate the clinical value of three dimensional computerized tomography angiography in the diagnosis and treatment of spontaneous subarachnoid hemorrhage. Methods 616 cases were diagnosed as suspected intracranial aneurysms in 3D CTA system. Computed tomographic scans and CTA studies were

Splanchnic vein thrombosis in necrotizing acute pancreatitis: Detection by computed tomographic venography

AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.

Preoperative diagnosis and operative effect of intracranial aneurysm with three-dimensional computed tomography angiography

BACKGROUND ： Digital subtraction angiography （DSA） is always regarded as the golden standard for diagnosis of intracranial aneurysm; however, the procedure is complex, traumatic, expensive and easy to induce vascular complication. Three-dimensional computed tomography angiography （3D-CTA） can make up deficiencies of DSA; therefore, it is used in clinical therapy wider and wider. OBJECTIVE ： To evaluate the clinical effect of 3D-CTA on disruption and hemorrhage of intracranial aneurysm pre- and post-operation and compare with the effect of DSA. DESIGN ： Auto-control contrast observation SETTING ： Department of Neurosurgery, Shengjing Hospital of China Medical University PARTICIPANTS ： A number of 106 patients with disruption and hemorrhage of intracranial aneurysm were selected from the Department of Neurosurgery, Shengjing Hospital of China Medical University from January 2003 to April 2006. All patients were diagnosed with cranial operation and consent. There were 47 males and 59 females aged from 3-76 years with the mean age of （47±13） years. Among them, 82 patients had extensive subarachnoid hemorrhage （SAH）, 7 had hemorrhage at longitudinal fissure, and 17 had hemorrhage at ambiens cistema and lateral fissure. Moreover, intraventricular hematocele was accompanied on 13 patients and hematom on 9 patients. METHODS： （1） 3D-CTA examination： Siemens SOMATOM Sensation 64 CT was used in this study. The thickness was 1 mm and interval of reconstruction was 0.8 mm. Localizing section was plainly scanned as the standard of canthus line. Scan ranged from 30 mm below sella to 50 mm above sella. Non-ion contrast medium of Omnipaque 350 （concentration of iodine was 350 g/L） was inserted into anterior vein of elbow with 18G trochar retained with high-pressured injectoc pum. The speed was 4.5 mL/s and the total volume was 80-100 mL with the means of 90 mL. Scan started at 10-20 s after injection of contrast medium. Original image was dealt with Leonardo workstation and retreated with Syngo software. Volume rendering and maximum intensity projection were used to reconstructed images, （2） All 106 patients suffered from occlusion of aneurysm clamp. Before operation, 3D-CTA was undertaken and DSA was followed. After operation, patients were rechecked with 3D-CTA. MAIN OUTCOME MEASURES： Comparisons between 3D-CTA and DSA. RESULTS ： All 106 patients were involved in the final analysis. （1） Examination of 3D-CTA and DSA： Among 118 patients with aneurysm, 110 were checked with 3D-CTA and the detected rate was 93.2% （110/118）. Among other 8 cases, 3 were negative and checked again with DSA; 1 had pericallosal aneurysm, 1 ophthalmic aneurysm, and 1 anterior choroidal artery of aneurysm. 3D-CTA results of other 5 cases were suspicious, and then, they were regarded as having aneurysm with DSA. Before operation, correlation among site, body, neck of aneurysm and peripheral anatomic structure were shown sufficiently. After operation, 82 patients were rechecked with 3D-CTA, which was complete occlusion, precise, unobvious constriction, emphraxis or remains as compared with 3D-CTA those pre-operation. （2） Characteristics of 3D-CTA： With multiple vessels and angles, 3D-CTA observed the relationship between aneurysm neck and carried artery and showed thrombosis in cavity of aneurysm, calcification of aneurysm wall and peripheral structure of vessel at the same time. However, DSA could not detect the reactions mentioned above. It could delete image of cranium, simulate image of operative route, eliminate artifact induced by metal, but not distinguish blood stream direction. Meanwhile, posterior communicating artery was always poor during circle of Willis artery showing. CONCLUSION： （1） 3D-CTA is characterized by simple operation and non-invasive showing vascular stereo structure and correlation. Therefore, it is significant for diagnosis and designing plan of operative approach and focal location pre-operation and evaluating effect post-operation. （2） 3D-CTA does not completely replace DSA on the diagnosis of intracranial aneurysm.

Computed tomography angiography-negative aortic dissection in a patient using Phencyclidine

Although the average age of diagnosis for aorticdissection is 63,[1] this case demonstrates the need toconsider AD in younger patients, particularly in thepresence of risk factors or in the absence of anotherreasonable diagnosis. This case suggests PCP use as aprecipitant for hypertension and sympathomimetic stresson the aorta. Despite high sensitivity, false negativeCTA imaging for AD can occur. If pretest probabilityremains high, further imaging must be obtained. Duringresuscitation in the ED, focused point-of-care ultrasoundcan also assist with medical decision making.

Numerical Simulation of Flow Behavior in Basilar Bifurcation Aneurysms Based on 4-Dimensional Computed Tomography Angiography

Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.

腹主动脉联合常规一站式胸痛三联CTA检查在急性胸痛患者诊疗中的价值

目的 探讨腹主动脉联合常规胸痛三联CT血管成像(triple rule-out computed tomography angiography, TRO-CTA)检查在急性胸痛患者检查中的价值。方法 回顾性纳入1 482例急性非创伤性胸痛患者,414例患者接受传统的TRO-CTA扫描,1 068例患者在临床医师的要求下接受包括腹主动脉的TRO-CTA扫描(TRO-CTAwAA)。两组患者主动脉期的扫描范围不同:常规TRO-CTA只扫描胸主动脉,TRO-CTAwAA扫描整个主动脉,其余所有的扫描参数均相同。采用卡方检验对两组主动脉主要血管异常(主动脉夹层、动脉瘤、穿透性溃疡、壁内血肿、血管闭塞和血栓形成)的检出率进行比较。采用方差分析(ANOVA)对两组辐射剂量(CTDIvol和DLP)和扫描时间进行比较。结果 TRO-CTAwAA组的主动脉异常检出率明显高于TRO-CTA组(35.1%vs. 4.8%,P<0.001)。在TRO-CTAwAA组中,有26.5%的血管异常在胸主动脉和腹主动脉上均可检出,另外8.6%只发生在腹主动脉上。两组间辐射剂量相比,TRO-CTAwAA组的总DLP明显高于常规TRO-CTA(P<0.001)。两组扫描时间对比差别无统计学意义(P=0.410)。结论 腹主动脉联合常规TRO-CTA检查,可显著提高急性胸痛患者主动脉血管异常的检出率,不增加检查流程。

3D-Slicer重建CTA在颅内动脉瘤夹闭术后随访中的应用

目的 探究基于3D-Slicer后处理CT血管造影(CTA)在颅内动脉瘤夹闭术后复查中的应用价值。方法 回顾性收集57例动脉瘤夹闭术患者的术后CTA影像资料,图像后处理方法包括多平面重组(MPR)、容积再现(VR)及最大密度投影重组(MIP),并与放射科工作站处理结果进行定性、定量对比,评价其临床应用价值。结果 57例患者69个动脉瘤共夹闭63个,术后CTA除5例图像质量不佳,余均可轻清晰显示瘤夹位置、残余瘤体、载瘤动脉瘤通畅性;术后CTA见2例夹闭不全,2例新发动脉瘤,9例血管广泛痉挛显影浅淡;脑出血3例,脑积水5例,脑梗死1例,以上结果与放射科工作站一致。两种方法重建3D-CTA对于夹闭后载瘤动脉瘤管径大小呈现无统计学差异,且一致性高。结论 3D-Slicer软件对于夹闭术后CTA的图像后处理结果令人满意,可作为一种备选的工具服务于临床。

基于CTA数据后处理对颈内动脉狭窄处血流动力学特点的研究

目的 基于头颈部CTA影像数据建立计算流体力学(CF)仿真模型,研究颈内动脉狭窄处的血流动力学特点。方法 回顾性分析蚌埠医学院第二附属医院2021-05—2023-03符合纳入标准的30例患者,运用脑血管三维重建技术对颈动脉及颈内动脉进行3D模型重建,并进行血流动力学参数分析测量及统计,测得颈内动脉狭窄处的壁面剪切应力(WSS)、时间平均壁面剪切应力(TAWSS)、震荡剪切指数(OSI)、相对滞留时间(RRT)并分析各项参数之间的相关性及差异性。结果 颈内动脉狭窄区域的WSS、TAWSS、OSI、RRT分别为58.669 3(43.882 0,65.979 2)、18.695 8(14.973 8,25.534 6)、0.074 6(0.063 3,0.085 4)、0.092 3(0.082 2,0.109 6),正常侧WSS、TAWSS、OSI、RRT分别为15.215 3(9.039 7,25.117 2)、5.138 2(3.373 4,6.139 9)、0.122 7(0.099 7,0.151 2)、0.712 3(0.519 0,0.821 7)。颈内动脉狭窄处的血流速度及血流量分别为1.925 9±0.125 5、4.374 1±0.277 9,正常侧的血流速度及血流量分别为0.992 6±0.074 7、6.190 7±0.260 9。狭窄区域的WSS、TAWSS明显增大,OSI和RRT相对较小,血流速度明显增大,同时伴随较小的血流量,差异均有统计学意义(P<0.05)。结论 颈内动脉狭窄处的血流动力学因素较正常侧发生明显变化,可通过CFD仿真模拟分析方法评估血流动力学因素变化程度,帮助分析颈内动脉狭窄患者的危险程度,辅助临床诊断、治疗及预后评估。

头颈部3D-CTA与DSA影像融合技术在神经介入手术中的初步应用价值

目的分析探究头颈部三维CT血管造影(3D-CTA)与数字减影血管造影(DSA)影像融合技术在神经介入手术中的初步应用价值。方法选取2019年3月至2021年3月许昌中医院期间收治的70例神经介入治疗患者为本次研究对象。根据随机数表法将所有患者分为对照组与观察组,各35例。对照组患者进行术中DSA辅助检查及治疗,观察组患者进行术中3D-CTA联合DSA辅助检查及治疗,对两组手术治疗效果进行对比。结果对比两组图像融合情况,发现观察组融合成功率高于对照组(P<0.05);观察组所用照射剂量及造影剂剂量均低于对照组(P<0.05)。结论为神经介入治疗患者应用头颈部3D-CTA联合DSA影像融合诊断技术更能有效减少放射量,可控制造影剂的剂量,可为临床治疗提供科学全面的诊断依据,降低手术治疗风险,值得在实际工作中进行应用与推广。

CTA、冠状动脉造影、血管内超声联合诊断前降支异常起源1例

1临床资料患者男,59岁,因“劳力性胸痛1年”入院,既往2型糖尿病6年。体格检查未见异常;常规心电图示窦性心律,未见明显异常;动态心电图示部分时间ST段压低;心脏彩色超声示左心室顺应性降低。冠状动脉CTA示左前降支异常起源于右冠状窦并走行于主动脉根部和右心室流出道之间(图1)。CT血流储备分数(FFR):右冠状动脉(RCA)0.88,左前降支(LAD)0.81,左回旋支(LCX)0.96,对角支(D)0.77。

冠状动脉CTA延迟扫描对心房颤动患者左心耳封堵术前血栓评估的临床价值研究

目的 探讨冠状动脉计算机断层扫描血管成像(CCTA)增强扫描联合延迟扫描,对心房颤动(房颤,AF)患者左心耳封堵术(LAAO)前左心耳(LAA)内血栓的诊断效能和有效放射剂量。方法 回顾性纳入2018年1月至2020年12月,于中国人民解放军总医院心血管内科住院拟行LAAO的非瓣膜性AF患者109例(其中阵发性AF患者48例,持续性AF患者61例)。所有患者在术前48 h接受CCTA回顾性心电门控增强扫描联合FLASH舒张期单期延迟扫描,并在术前24 h进行经食道超声心动图(TEE)检查。以TEE作为诊断“金标准”,分析CCTA的诊断效能和有效放射剂量。结果 阵发性AF与持续性AF患者一般临床资料的组间差异均无统计学意义(P>0.05)。CCTA联合扫描相较TEE表现出良好的诊断效能,具有较高的灵敏度(88.89%)、特异度(93.90%)和准确度(92.66%)。CCTA联合扫描相比增强扫描可显著提高特异度(75.61%vs. 93.90%,P=0.003),尤其在持续性AF患者中特异度改善明显(61.36%vs. 93.18%,P=0.001),而在阵发性AF患者中特异度改善不明显(92.11%vs. 94.74%,P>0.05)。此外,CCTA联合扫描并未显著增加有效放射剂量[(10.65±3.17)mSv vs.(9.87±3.12)mSv,P=0.167]。结论 AF患者在LAAO术前行CCTA增强扫描联合延迟扫描,对LAA内血栓具有较佳的诊断效能且不带来显著的有效放射剂量增加。

临床危险因素下慢性完全闭塞病变斑块成分及病变特点分析:基于冠脉CTA成像及冠脉造影的回顾性研究

目的本研究分别基于冠状动脉(冠脉)计算机断层血管成像(CTA)成像及冠脉造影对慢性完全闭塞病变(CTO)的斑块成分及病变特点分析,分析临床危险因素(高血压,糖尿病,肾功能不全,吸烟)与斑块成分及病理特点的关系。方法回顾性收集2015年9月至2019年9月于北京安贞医院及北京友谊医院住院行冠脉造影证实存在单支CTO病变,且在住院前2个月内完成冠脉CTA的195例患者。应用冠脉CTA对CTO病变进行斑块成分分析,应用冠脉造影分析CTO病变特点。结果基于冠脉CTA分析,糖尿病与非糖尿病患者相比,坏死脂核容积[55.88(26.40~98.96)vs.62.41(31.62~117.91)]、纤维脂肪斑块容积[25.08(9.93~50.18)vs.29.57(13.62~56.31)]、纤维斑块容积[17.39(3.31~45.52)vs.12.53(3.34-33.83)]、钙化斑块容积[0.85(0.00~6.44)vs.0.11(0.00~7.84)]、纤维钙化斑块容积[18.96(3.31~52.83)vs.15.42(3.34-44.34)]等方面差异无统计学意义(P>0.05)。高血压与非高血压患者相比,坏死脂核容积[58.47(26.71-101.49)vs.64.18(33.81-113.93)]、纤维脂肪斑块容积[27.07(12.61~54.45)vs.26.92(13.30~55.72)]、纤维斑块容积[12.58(3.23~42.53)vs.13.10(4.17~33.54)]、钙化斑块容积[0.12(0.00~5.94)vs.0.32(0.00~12.46)]、纤维钙化斑块容积[15.42(3.23~45.45)vs.16.85(4.17~48.35)]差异无统计学意义(P>0.05)。肾功能不全与非肾功能不全患者相比,坏死脂核容积[44.94(28.80~63.80)vs.62.38(30.69~110.81)]、纤维脂肪斑块容积[20.30(6.10~35.95)vs.27.76(13.04~55.28)]、纤维斑块容积[9.83(3.03~42.72)vs.13.10(3.43~39.81)]、钙化斑块容积[1.38(0.00~12.67)vs.0.19(0~7.40)]、纤维钙化斑块容积[12.49(3.03~45.45)vs.15.56(3.44~47.37)]差异无统计学意义(P>0.05)。吸烟与不吸烟患者相比,坏死脂核容积[67.73(35.70~124.49)vs.51.77(22.77~90.36)]、纤维脂肪斑块容积[28.53(15.10~57.89)vs.25.23(9.86~53.01)]、纤维斑块容积[13.10(3.26~34.81)vs.12.58(4.14~44.66)]、钙化斑块容积[0.19(0.00~8.80)vs.0.25(0.00~6.56)]、纤维钙化斑块容积[15.42(3.26~46.59)vs.16.44(4.14~48.36)]差异无统计学意义(P>0.05)。基于冠脉造影分析,糖尿病与非糖尿病相比,高血压与非高血压相比,肾功能不全与非肾功能不全相比,吸烟与非吸烟相比,钝头样闭塞残端、纤维帽模糊不全、闭塞段近端及远端是否存在严重病变、是否存在微通道、多节段闭塞、重度钙化、闭塞段长度>20 mm等方面,差异无统计学意义(P>0.05)。结论在本研究中,对于CTO患者,是否合并高血压、糖尿病、肾功能不全、吸烟等危险因素,斑块成分及病变特点无显著差异。对于术前CTO病变的斑块成分预测及病变特点预测不能完全依赖临床病史。对于CTO患者,术前冠脉CTA对于斑块成分及病变特点的评价更为重要。

头颈部CTA联合人工智能对缺血性脑卒中患者的图像质量研究

目的探讨头颈部计算机体层扫描血管成像(CTA)应用人工智能(AI)对脑卒中患者的图像质量研究。方法选择2021年6月至2022年6月在乐山市人民医院接受治疗的脑卒中患者60例,其中男性38例,女性22例;年龄46~92岁,平均年龄68.26岁(标准差5.25岁);单侧肢体无力19例,口角歪斜14例,语言不清13例,昏迷8例,肢体运动不协调6例。所有患者头颈部CTA原始图像均上传星云工作站,并由两名主治医师对图像进行手动后处理及上传AI工作站,分别重建容积再现(VR)、最大密度投影(MIP)、曲面重建(CPR)。对比AI重建与手动重建的图像质量及时效性。结果头颈部CTA对脑卒中患者诊断中,AI重建的VR图像3分为75%,2分为23.3%,1分为1.7%;MIP图像3分为76.7%,2分为23.3%;CPR图像3分为85%;2分为15%;手动重建VR图像3分为80%;2分为20%;MIP图像3分为81.7%,2分为18.3%;CPR图像3分为95%,2分为5%。手动后处理与AI重建方法VR、MIP、CPR图像比较,差异均无统计学意义(P>0.05)。AI处理图像所需时间为(2.33±0.15)min,手动处理图像的时间为(12.33±2.30)min,AI的处理时间明显少于手动处理时间(P<0.05),AI较手动时间增益率为83.3%。结论AI后处理图像质量与手动后处理图像质量相近,但AI后处理图像时效性更好,有利于为脑卒中患者治疗赢得更多时间,值得临床推广。

CTA与MRA显示大脑动脉环正常解剖结构的对照研究

目的比较颅底大脑动脉环(Willis环)经磁共振血管成像(MRA)和CT血管成像(CTA)检查的显像情况。方法收集398例患者的完整颅脑血管检查图像,分为CTA组和MRA组进行回顾性分析,统计颅底Willis环形态和分型,与数字减影血管造影(DSA)结果比对,比较4种分型在CTA和MRA图像上的检出率。结果398例患者中,CTA组与MRA组均以Willis环I型为主,占比分别为56.0%、78.0%;前交通动脉检出率MRA组较高(P<0.05),完整后交通动脉检出率CTA组较高(P<0.05),2组单支后交通动脉检出率比较无统计学差异(P>0.05),CTA组单支或完整后交通动脉显著高于MRA组(P<0.05)。结论MRA对颅脑大脑动脉环的显像比CTA更具临床优势。

Noninvasive three-dimensional computed tomographic angiography in preoperative detection of intracranial arteriovenous malformations

Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial AVMs

Impact of Clinical Guideline Recommendations on the Application of Coronary Computed Tomographic Angiography in Patients with Suspected Stable Coronary Artery Disease

Background： Coronary computed tomographic angiography （CCTA） has been widely used in patients who are at intemaediate risk for having stable coronary artery disease （SCAD）, and 2013 European Society of Cardiology Guidelines on the Management of SCAD （2013G） recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice. Methods： A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model （UDFM）. Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA. Results： Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time （P = 0.8701）. The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before （22.29%） or after （19.98%） the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G （odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678）. Conclusions： These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.

Coronary Computed Tomographic Angiography for Suspected Stable Coronary Artery Disease： Gap Between the 2013 European Society of Cardiology Guideline Recommendations and Clinical Practice

Coronary computed tomographic angiography （CCTA） as a noninvasive diagnostic technique for the evaluation of coronary anatomy is widely used clinically. Its advantages include high sensitivity and specificity for the diagnosis of present of coronary artery lesions and lesion characteristics,