High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection:A case report

BACKGROUND Vertebral artery dissection(VAD)is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery,leading to stenosis,occlusion or rupture.The clinical presentation of VAD can be heterogeneous,with common symptoms including headache,dizziness and balance problems.Timely diagnosis and treatment are crucial for favorable outcomes;however,VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines.High-resolution magnetic resonance imaging(HRMRI)has emerged as a reliable diagnostic tool for VAD,providing detailed visualization of vessel wall abnormalities.CASE SUMMARY A young male patient presented with an acute onset of severe headache,vomiting,and seizures,followed by altered consciousness.Imaging studies revealed bilateral VAD,basilar artery thrombosis,multiple brainstem and cerebellar infarcts,and subarachnoid hemorrhage.Digital subtraction angiography(DSA)revealed vertebral artery stenosis but failed to detect the dissection,potentially because intramural thrombosis obscured the VAD.In contrast,HRMRI confirmed the diagnosis by revealing specific signs of dissection.The patient was managed conservatively with antiplatelet therapy and other supportive measures,such as blood pressure control and pain management.After 5 mo of rehabilitation,the patient showed significant improvement in swallowing and limb strength.CONCLUSION HR-MRI can provide precise evidence for the identification of VAD.

Nomogram prediction of vessels encapsulating tumor clusters in small hepatocellular carcinoma≤3 cm based on enhanced magnetic resonance imaging

BACKGROUND Vessels encapsulating tumor clusters(VETC)represent a recently discovered vascular pattern associated with novel metastasis mechanisms in hepatocellular carcinoma(HCC).However,it seems that no one have focused on predicting VETC status in small HCC(sHCC).This study aimed to develop a new nomogram for predicting VETC positivity using preoperative clinical data and image features in sHCC(≤3 cm)patients.AIM To construct a nomogram that combines preoperative clinical parameters and image features to predict patterns of VETC and evaluate the prognosis of sHCC patients.METHODS A total of 309 patients with sHCC,who underwent segmental resection and had their VETC status confirmed,were included in the study.These patients were recruited from three different hospitals:Hospital 1 contributed 177 patients for the training set,Hospital 2 provided 78 patients for the test set,and Hospital 3 provided 54 patients for the validation set.Independent predictors of VETC were identified through univariate and multivariate logistic analyses.These independent predictors were then used to construct a VETC prediction model for sHCC.The model’s performance was evaluated using the area under the curve(AUC),calibration curve,and clinical decision curve.Additionally,Kaplan-Meier survival analysis was performed to confirm whether the predicted VETC status by the model is associated with early recurrence,just as it is with the actual VETC status and early recurrence.RESULTS Alpha-fetoprotein_lg10,carbohydrate antigen 199,irregular shape,non-smooth margin,and arterial peritumoral enhancement were identified as independent predictors of VETC.The model incorporating these predictors demonstrated strong predictive performance.The AUC was 0.811 for the training set,0.800 for the test set,and 0.791 for the validation set.The calibration curve indicated that the predicted probability was consistent with the actual VETC status in all three sets.Furthermore,the decision curve analysis demonstrated the clinical benefits of our model for patients with sHCC.Finally,early recurrence was more likely to occur in the VETC-positive group compared to the VETC-negative group,regardless of whether considering the actual or predicted VETC status.CONCLUSION Our novel prediction model demonstrates strong performance in predicting VETC positivity in sHCC(≤3 cm)patients,and it holds potential for predicting early recurrence.This model equips clinicians with valuable information to make informed clinical treatment decisions.

Investigating the relationship between intracranial atherosclerotic plaque remodelling and diabetes using high-resolution vessel wall imaging

BACKGROUND Intracranial atherosclerosis,a leading cause of stroke,involves arterial plaque formation.This study explores the link between plaque remodelling patterns and diabetes using high-resolution vessel wall imaging(HR-VWI).AIM To investigate the factors of intracranial atherosclerotic remodelling patterns and the relationship between intracranial atherosclerotic remodelling and diabetes mellitus using HR-VWI.METHODS Ninety-four patients diagnosed with middle cerebral artery or basilar artery INTRODUCTION Intracranial atherosclerotic disease is one of the main causes of ischaemic stroke in the world,accounting for approx-imately 10%of transient ischaemic attacks and 30%-50%of ischaemic strokes[1].It is the most common factor among Asian people[2].The adaptive changes in the structure and function of blood vessels that can adapt to changes in the internal and external environment are called vascular remodelling,which is a common and important pathological mechanism in atherosclerotic diseases,and the remodelling mode of atherosclerotic plaques is closely related to the occurrence of stroke.Positive remodelling(PR)is an outwards compensatory remodelling where the arterial wall grows outwards in an attempt to maintain a constant lumen diameter.For a long time,it was believed that the degree of stenosis can accurately reflect the risk of ischaemic stroke[3-5].Previous studies have revealed that lesions without significant luminal stenosis can also lead to acute events[6,7],as summarized in a recent meta-analysis study in which approximately 50%of acute/subacute ischaemic events were due to this type of lesion[6].Research[8,9]has pointed out that the PR of plaques is more dangerous and more likely to cause acute ischaemic stroke.Previous studies[10-13]have found that there are specific vascular remodelling phenomena in the coronary and carotid arteries of diabetic patients.However,due to the deep location and small lumen of intracranial arteries and limitations of imaging techniques,the relationship between intracranial arterial remodelling and diabetes is still unclear.In recent years,with the development of magnetic resonance technology and the emergence of high-resolution(HR)vascular wall imaging,a clear and multidimensional display of the intracranial vascular wall has been achieved.Therefore,in this study,HR wall imaging(HR-VWI)was used to display the remodelling characteristics of bilateral middle cerebral arteries and basilar arteries and to explore the factors of intracranial vascular remodelling and its relationship with diabetes.

Secondary rectal linitis plastica caused by prostatic adenocarcinoma-magnetic resonance imaging findings and dissemination pathways:A case report

BACKGROUND Secondary rectal linitis plastica(RLP)from prostatic adenocarcinoma is a rare and poorly understood form of metastatic spread,characterized by a desmoplastic response and concentric rectal wall infiltration with mucosal preservation.This complicates endoscopic diagnosis and can mimic gastrointestinal malignancies.This case series underscores the critical role of magnetic resonance imaging(MRI)in identifying the distinct imaging features of RLP and highlights the importance of considering this condition in the differential diagnosis of patients with a history of prostate cancer.CASE SUMMARY Three patients with secondary RLP due to prostatic adenocarcinoma presented with varied clinical features.The first patient,a 76-year-old man with advanced prostate cancer,had rectal pain and incontinence.MRI showed diffuse prostatic invasion and significant rectal wall thickening with a characteristic"target sign"pattern.The second,a 57-year-old asymptomatic man with elevated prostatespecific antigen levels and a history of prostate cancer exhibited rectoprostatic angle involvement and rectal wall thickening on MRI,with positron emission tomography/computed tomography PSMA confirming the prostatic origin of the metastatic spread.The third patient,an 80-year-old post-radical prostatectomy,presented with refractory constipation.MRI revealed a neoplastic mass infiltrating the rectal wall.In all cases,MRI consistently showed stratified thickening,concentric signal changes,restricted diffusion,and contrast enhancement,which were essential for diagnosing secondary RLP.Biopsies confirmed the prostatic origin of the neoplastic involvement in the rectum.CONCLUSION Recognizing MRI findings of secondary RLP is essential for accurate diagnosis and management in prostate cancer patients.

Long term evolution of magnetic resonance imaging characteristics in a case of atypical left lateral wall hypertrophic cardiomyopathy

We are reporting a long-time magnetic resonance imaging(MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy(HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance(CMR) imaging can be a valuable tool for assessment of detailed information on size,localization,and tissue characteristics of hypertrophied myocardium. However,there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently,our group reported a case of left lateral wall HCM as a rare variant of the more common forms,such as septal HCM,or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago,we are able to provide the thrilling experience of an ultra-long MRI followup presentation in this rare case of left lateral wall hypertrophy. Furthermore,this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging.

Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

Magnetic Resonance Imaging of Coronary Arteries:Latest Technical Innovations and Clinical Experiences

Cardiovascular disease(CVD)is the leading cause of death and a major health care challenge globally.Coronary artery disease(CAD)is a primary underlying pathological process in the majority of cardiovascular disease cases.Magnetic resonance imaging(MRI)can play a potentially important role in the management of CAD as a noninvasive imaging modality without ionizing radiation,although its early promise has not been delivered because of several crucial technical limitations.However,recent innovations in MRI have reopened the door,with tremendous opportunities for multiparametric assessment of CAD including luminal stenosis,plaque burden and composition,and disease activities such as infl ammation and hemorrhage.Novel MRI acquisition and reconstruction strategies now offer much increased spatial resolution and image quality and shortened examination times compared with conventional approaches.Recent clinical experiences of coronary MRI indicated the potential to improve the current management of coronary atherosclerosis,such as identifying the patients at the highest risk and evaluating therapeutic responses.In this review we discuss the latest technical advances and clinical insights in coronary MRI.

Non-invasive assessment of intracranial wall shear stress using high-resolution magnetic resonance imaging in combination with computational fluid dynamics technique

In vivo studies on association between wall shear stress(WSS)and intracranial plaque are deficient.Based on the three-dimensional T1-weighted high-resolution magnetic resonance imaging(3DT1 HR-MRI)data of patients with low-grade stenotic(<50%)atherosclerotic middle cerebral artery(MCA)and subjects with normal MCA,we built a three-dimensional reconstructed WSS model by computational fluid dynamics(CFD)technique.Three-dimensional registration of the CFD model to the HR-MRI was performed with projections based on the resolution and thickness of the images.The relationships between the Wss at each side of the vessel wall and plaque location were analyzed.A total of 94 MCA plaques from 43 patients and 50 normal MCAs were analyzed.In the normal MCAs,WSS was lower at the ventral-inferior wall than at the dorsal-superior wall(proximal segment,p<0.001;middle segment,p<0.001)and lower at the inner wall than at the outer wall of the MCA curve(p<0.001).In atherosclerotic MCAs,similar low Wss regions were observed where plaques developed.The WSS ratio of the ventral-inferior wall to the dorsal-superior wall in atherosclerotic MCAs was lower than that in normal MCAs(p=0.002).The WSS_(inmer-outer)ratio in atherosclerotic MCAs was lower than that in normal MCAs(p=0.002).Low WSS was associated with MCA atherosclerosis formation and occurred mainly at the ventral inferior wall,which was anatomically opposite the orifices of penetrating arteries,and at the inner wall of the MCA curve.Overall,the results were well consistent with the low WSS theory in atherosclerosis formation.The reconstructed WSS model is a promising novel method for assessing an individualized vascular profile once validated by further studies.

igh-resolution Magnetic Resonance Vessel Wall Imaging for Intracranial Arterial Stenosis

Objective： To discuss the feasibility and clinical value of high-resolution magnetic resonance vessel wall imaging （HRMR VWI） for intracranial arterial stenosis. Date Sources： We retrieved information from PubMed database up to December 2015, using various search terms including vessel wall imaging （VWI）, high-resolution magnetic resonance imaging, intracranial arterial stenosis, black blood, and intracranial atherosclerosis. Study Selection： We reviewed peer-reviewed articles printed in English on imaging technique of VWI and characteristic findings of various intracranial vasculopathies on VWI. We organized this data to explain the value of VWI in clinical application. Results： VWI with black blood technique could provide high-quality images with submillimeter voxel size, and display both the vessel wall and lumen of intracranial artery simultaneously. Various intracranial vasculopathies （atherosclerotic or nonatherosclerotic） had differentiating features including pattern of wall thickening, enhancement, and vessel remodeling on VWI. This technique could be used for determining causes of stenosis, identification of stroke mechanism, risk-stratifying patients, and directing therapeutic management in clinical practice. In addition, a new morphological classification based on VWI could be established for predicting the efficacy of endovascular therapy. Conclusions： This review highlights the value of HRMR VWI for discrimination of different intracranial vasculopathies and directing therapeutic management.

High-resolution Magnetic Resonance Imaging of Moyamoya Disease

Objective： To introduce the imaging characteristics of moyamoya disease （MMD） using high-resolution magnetic resonance imaging （HR-MRI） and to discuss the role of HR-MRI in differentiating MMD from other intracranial artery diseases, especially intracranial atherosclerotic disease （ICAD）. Data Sources： This review was based on the data in articles published between 2005 and 2015, which were obtained from PubMed. The keywords included HR-MRI, MMD, ICAD, and intracranial artery diseases. Study Selection： Articles related to HR-MRI for MMD or other intracranial artery diseases were selected for review. Results： There are differences between the characteristic patterns of HR-MRI in MMD and ICAD. MMD is associated with inward remodeling, smaller outer diameters, concentric occlusive lesions and homogeneous signal intensity, while ICAD is more likely to be associated with outward remodeling, normal outer diameters, eccentric occlusive lesions, and heterogeneous signal intensity. Other intracranial artery diseases, such as dissection and vasculitis, also have distinctive characteristics in HR-MRI. HR-MRI may become a useful tool for the differential diagnosis of MMD in the future. Conclusions： HR-MRI of MMD provides a more in-depth understanding of MMD, and it is helpful in evaluating pathological changes in the vessel wall and in differentiating MMD from other intracranial artery steno-occlusive diseases, particularly ICAD.以

Distribution of wall shear stress in carotid plaques using magnetic resonance imaging and computational fluid dynamics analysis： a preliminary study

Background Wall shear stress is an important factor in the destabilization of atherosclerotic plaques. The purpose of this study was to assess the distribution of wall shear stress in advanced carotid plaques using high resolution magnetic resonance imaging and computational fluid dynamics.Methods Eight diseased internal carotid arteries in seven patients were evaluated. High resolution magnetic resonance imaging was used to visualize the plaque structures, and the mechanic stress in the plaque was obtained by combining vascular imaging post-processing with computational fluid dynamics.Results Wall shear stresses in the plaques in all cases were higher than those in control group. Maximal shear stresses in the plaques were observed at the top of plaque hills, as well as the shoulders of the plaques. Among them,the maximal shear stress in the ruptured plaque was observed in the rupture location in three cases and at the shoulder of fibrous cap in two cases. The maximal shear stress was also seen at the region of calcification, in thrombus region and in the thickest region of plaque in the other three cases, respectively.Conclusion Determination of maximal shear stress at the plaque may be useful for predicting the rupture location of the plaque and may play an important role in assessing plaque vulnerability.

Blood-brain barrier pathology in cerebral small vessel disease

Cerebral small vessel disease is a neurological disease that affects the brain microvasculature and which is commonly observed among the elderly.Although at first it was considered innocuous,small vessel disease is nowadays regarded as one of the major vascular causes of dementia.Radiological signs of small vessel disease include small subcortical infarcts,white matter magnetic resonance imaging hyperintensities,lacunes,enlarged perivascular spaces,cerebral microbleeds,and brain atrophy;however,great heterogeneity in clinical symptoms is observed in small vessel disease patients.The pathophysiology of these lesions has been linked to multiple processes,such as hypoperfusion,defective cerebrovascular reactivity,and blood-brain barrier dysfunction.Notably,studies on small vessel disease suggest that blood-brain barrier dysfunction is among the earliest mechanisms in small vessel disease and might contribute to the development of the hallmarks of small vessel disease.Therefore,the purpose of this review is to provide a new foundation in the study of small vessel disease pathology.First,we discuss the main structural domains and functions of the blood-brain barrier.Secondly,we review the most recent evidence on blood-brain barrier dysfunction linked to small vessel disease.Finally,we conclude with a discussion on future perspectives and propose potential treatment targets and interventions.

Comparison of magnetic resonance imaging and computed tomography to measure preoperative parameters of children with pectus excavatum

Importance:Pectus excavatum (PE) is the most common thoracic wall deformity in children,we need a method which could be used to evaluate pulmonary functions and effects on development.Objective:To evaluate the use of 3D T 1-weighted (3 DT 1) and mDIXON magnetic resonance imaging (MRI) sequences for measuring the thoracic parameters and morphology of children with PE,comparing the measurements with those made on computed tomography (CT).Methods:This is a retrospective study of children with thoracic deformities who were hospitalized at the Department of Thoracic Surgery of the Heart Center,Beijing Children's Hospital,between June 2014 and June 2015.Chest CT was performed first,with the MRI scanning then being performed 0-3 days later.The mDIXON sequences were obtained in inspiratory and expiratory phases and the 3DT1 sequences were obtained during free breathing.Thoracic volume was measured using the acquired images.Results:The lung volumes measured on mDIXON MRI and CT were highly correlated,with the Haller index not being significantly different between the two methods.Bland-Altman analyses showed that lung,cardiac,and retrosternal parameters were similar between the two methods.Pulmonary parameters were higher with the end-inspiratory phase mDIXON images than with the end-expiratory phase images,as expected,while cardiac parameters were unaffected by the respiratory phase.Interpretation:Thoracic volumes measured on mDIXON MRI in combination with held respiration could reflect lung volume functions and help in observing the movement functions of the lungs and heart.The method could be used instead of CT,avoiding subjecting the patient to potentially harmful radiation.

Predictive value of a constructed artificial neural network model for microvascular invasion in hepatocellular carcinoma:A retrospective study

BACKGROUND Microvascular invasion(MVI)is a significant risk factor for recurrence and metastasis following hepatocellular carcinoma(HCC)surgery.Currently,there is a paucity of preoperative evaluation approaches for MVI.AIM To investigate the predictive value of texture features and radiological signs based on multiparametric magnetic resonance imaging in the non-invasive preoperative prediction of MVI in HCC.METHODS Clinical data from 97 HCC patients were retrospectively collected from January 2019 to July 2022 at our hospital.Patients were classified into two groups:MVI-positive(n=57)and MVI-negative(n=40),based on postoperative pathological results.The correlation between relevant radiological signs and MVI status was analyzed.MaZda4.6 software and the mutual information method were employed to identify the top 10 dominant texture features,which were combined with radiological signs to construct artificial neural network(ANN)models for MVI prediction.The predictive performance of the ANN models was evaluated using area under the curve,sensitivity,and specificity.ANN models with relatively high predictive performance were screened using the DeLong test,and the regression model of multilayer feedforward ANN with backpropagation and error backpropagation learning method was used to evaluate the models’stability.RESULTS The absence of a pseudocapsule,an incomplete pseudocapsule,and the presence of tumor blood vessels were identified as independent predictors of HCC MVI.The ANN model constructed using the dominant features of the combined group(pseudocapsule status+tumor blood vessels+arterial phase+venous phase)demonstrated the best predictive performance for MVI status and was found to be automated,highly operable,and very stable.CONCLUSION The ANN model constructed using the dominant features of the combined group can be recommended as a noninvasive method for preoperative prediction of HCC MVI status.

Pancreatic fluid collections: What is the ideal imaging technique?

Pancreatic fluid collections(PFCs) are seen in up to 50% of cases of acute pancreatitis. The Revised Atlanta classification categorized these collections on the basis of duration of disease and contents, whether liquid alone or a mixture of fluid and necrotic debris. Management of these different types of collections differs because of the variable quantity of debris; while patients with pseudocysts can be drained by straight-forward stent placement, walledoff necrosis requires multi-disciplinary approach. Differentiating these collections on the basis of clinical severity alone is not reliable, so imaging is primarily performed. Contrast-enhanced computed tomography is the commonly used modality for the diagnosis and assessment of proportion of solid contents in PFCs; however with certain limitations such as use of iodinated contrast material especially in renal failure patients and radiation exposure. Magnetic resonance imaging(MRI) performs better than computed tomography(CT) in characterization of pancreatic/peripancreatic fluid collections especially for quantification of solid debris and fat necrosis(seen as fat density globules), and is an alternative in those situations where CT is contraindicated. Also magnetic resonance cholangiopancreatography is highly sensitive for detecting pancreatic duct disruption and choledocholithiasis. Endoscopic ultrasound is an evolving technique with higher reproducibility for fluid-to-debris component estimation with the added advantage of being a single stage procedure for both diagnosis(solid debris delineation) and management(drainage of collection) in the same sitting. Recently role of diffusion weighted MRI and positron emission tomography/CT with ^(18)F-FDG labeled autologous leukocytes is also emerging for detection of infection noninvasively. Comparative studies between these imaging modalities are still limited. However we look forward to a time when this gap in literature will be fulfilled.

Segmentation of carotid arterial walls using neural networks

BACKGROUND Automated,accurate,objective,and quantitative medical image segmentation has remained a challenging goal in computer science since its inception.This study applies the technique of convolutional neural networks(CNNs)to the task of segmenting carotid arteries to aid in the assessment of pathology.AIM To investigate CNN’s utility as an ancillary tool for researchers who require accurate segmentation of carotid vessels.METHODS An expert reader delineated vessel wall boundaries on 4422 axial T2-weighted magnetic resonance images of bilateral carotid arteries from 189 subjects with clinically evident atherosclerotic disease.A portion of this dataset was used to train two CNNs(one to segment the vessel lumen and the other to segment the vessel wall)with the remaining portion used to test the algorithm’s efficacy by comparing CNN segmented images with those of an expert reader.Overall quantitative assessment between automated and manual segmentations was determined by computing the DICE coefficient for each pair of segmented images in the test dataset for each CNN applied.The average DICE coefficient for the test dataset(CNN segmentations compared to expert’s segmentations)was 0.96 for the lumen and 0.87 for the vessel wall.Pearson correlation values and the intra-class correlation coefficient(ICC)were computed for the lumen(Pearson=0.98,ICC=0.98)and vessel wall(Pearson=0.88,ICC=0.86)segmentations.Bland-Altman plots of area measurements for the CNN and expert readers indicate good agreement with a mean bias of 1%-8%.CONCLUSION Although the technique produces reasonable results that are on par with expert human assessments,our application requires human supervision and monitoring to ensure consistent results.We intend to deploy this algorithm as part of a software platform to lessen researchers’workload to more quickly obtain reliable results.

Infiltrating angiolipoma of the thoracic wall: A case report

We describe a case of infiltrating angiolipoma of the thoracic wall, which is an extremely unusual site for this tumor. Infiltrative angiolipoma is a rare benign soft tissue tumor that commonly affects the extremities and the trunk. This is the first report of infiltrative angiolipoma that affects this site. Magnetic resonance imaging (MRI) revealed a high intensity signal on T2-weighted images and contrast enhanced images showed moderate enhancement effect that mimicked tumors of neurogenic or vascular origin. Angiolipoma should be included in a differential diagnosis of the thoracic wall tumor with T2 high intensity signal and contrast enhancement that is not typical shape and signal for neurogenic tumor or hemangioma.

基于3D Slicer的多模态影像融合技术及神经电生理监测在面肌痉挛微血管减压术中的应用

目的探讨基于3D Slicer的多模态影像融合技术及神经电生理监测在面肌痉挛微血管减压术中的应用价值。方法采用回顾性分析法,选取41例行血管减压术的面肌痉挛患者为研究对象。术前通过3D Slicer软件对责任血管进行多模态影像融合分析,确定手术方案,术中进行神经电生理监测以判断减压。观察手术效果并追踪术后复发情况。结果术前建模图像发现40例存在微血管压迫,1例未见微血管压迫。未见微血管压迫的1例经术中证实为岩静脉压迫,1例小脑前下动脉经术中证实为小脑上动脉,其余责任血管判定均与术中所见一致。术前建模图像的责任血管判定正确39例,正确率为95%。41例患者经手术治疗后症状均完全缓解,完全缓解率为100%。术后住院期间1例发生面瘫,1例发生听力下降,经对症处理后很快缓解,术后随访3~36个月无复发。结论在面肌痉挛微血管减压术中联合应用多模态影像融合技术可直观了解责任血管及周围重要结构解剖情况,配合神经电生理监测可避免术中减压过度或不充分的情况,两项技术的联合应用可有效提高手术疗效。

Imaging related to underlying immunological and pathological processes in COVID-19

The introduction of coronavirus disease-2019(COVID-19)as a global pandemic has contributed to overall morbidity and mortality.With a focus on understanding the immunology and pathophysiology of the disease,these features can be linked with the respective findings of imaging studies.Thus,the constellation between clinical presentation,histological,laboratory,immunological,and imaging results is crucial for the proper management of patients.The purpose of this article is to examine the role of imaging during the particular stages of severe acute respiratory syndrome coronavirus 2 infection–asymptomatic stage,typical and atypical COVID-19 pneumonia,acute respiratory distress syndrome,multiorgan failure,and thrombosis.The use of imaging methods to assess the severity and duration of changes is crucial in patients with COVID-19.Radiography and computed tomography are among the methods that allow accurate characterization of changes.

FLAIR与SWI对急性缺血性脑卒中患者侧支循环及临床疗效的评估价值

目的探索液体衰减反转恢复序列(FLAIR)与磁敏感加权成像(SWI)在急性缺血性脑卒中(AIS)患者临床疗效评估中的价值。方法本研究为回顾性研究。按照纳入与排除标准,搜集2017年3月—2022年12月于南通市第一人民医院收治的131例AIS患者。根据SWI上多发低信号血管征(MHVs)和FLAIR序列上血管高信号征(FVHs)的显示程度进行分级。按照患者入院时、入院后3 d美国国立卫生研究院卒中量表(NIHSS)评分,把患者分为早期神经功能减退(END)组(NIHSS增加≥2分)71例、非END组(NIHSS增加<2分)60例;按照90 d改良Rankin量表评分(mRS),把患者分为预后良好组(mRS 0~2分)76例、预后不良组(mRS>2分)55例。采用Mann-Whitney U检验比较组间患者的MHVs、FVHs分级差异;Spearman相关系数用于分析MHVs分级与FVHs分级的相关性。结果131例患者中,FVHs分级(0~2级依次为12、72、47例)与MHVs分级(0~3级依次为63、18、28、22例)呈轻度正相关(r=0.390,P<0.001);END组中FVHs、MHVs分级均明显高于非END组,差异均有统计学意义(Z值分别为-3.499、-4.663,P均<0.001);预后不良组MHVs分级明显高于预后良好组,差异有统计学意义(Z=-3.993,P<0.001),两组FVHs分级差异无统计学意义(Z=-1.472,P=0.141)。结论MHVs、FVHs能间接反映AIS患者脑血流动力改变,对缺乏再灌注治疗的超窗AIS患者END发生和90 d预后具有较好的预测价值。