320排CT联合纤支镜对小儿血管发育异常及气管-胆管瘘的诊断价值

目的:探讨320排CT对心肺血管畸形及纤支镜下碘油造影对先天气管-胆管瘘的诊断价值。方法:对5例先天性心肺发育异常患儿的病例资料进行回顾性分析,评估320排CT及纤支镜下X线碘油造影在儿科复杂心肺发育异常中的诊断价值。结果:5例患儿起病均表现为反复发作的肺炎、肺不张,伴有咳嗽、气促和咯血等症状。320排CT联合纤维支气管镜检查诊断动脉导管假性动脉瘤1例,双主动脉弓1例,左肺静脉缺如1例,右肺静脉缺如1例,320排CT未有阳性发现、经纤支镜下碘油造影确诊为先天性气管-胆管瘘1例。结论:320排CT结合纤支镜检查可以诊断先天性心肺血管畸形,对于高度怀疑为气管-胆管瘘的患儿采用纤支镜下X线碘油造影可明确诊断。

Bifunctional staining for ex vivo determination of area at risk in rabbits with reperfused myocardial infarction

AIM: To develop a method for studying myocardial area at risk(AAR) in ischemic heart disease in correlation with cardiac magnetic resonance imaging(c MRI). METHODS: Nine rabbits were anesthetized, intubated and subjected to occlusion and reperfusion of the left circumflex coronary artery(LCx) to induce myocardial infarction(MI). ECG-triggered c MRI with delayed en-hancement was performed at 3.0 T. After euthanasia, the heart was excised with the LCx re-ligated. Bifunctional staining was performed by perfusing the aorta with a homemade red-iodized-oil(RIO) dye. The heart was then agar-embedded for ex vivo magnetic resonance imaging and sliced into 3 mm-sections. The AAR was defined by RIO-staining and digital radiography(DR). The perfusion density rate(PDR) was derived from DR for the AAR and normal myocardium. The MI was measured by in vivo delayed enhancement(i DE) and ex vivo delayed enhancement(e DE) c MRI. The AAR and MI were compared to validate the bifunctional straining for cardiac imaging research. Linear regression with Bland-Altman agreement, one way-ANOVA with Bonferroni's multiple comparison, and paired t tests were applied for statistics.RESULTS: All rabbits tolerated well the surgical procedure and subsequent c MRI sessions. The openchest occlusion and close-chest reperfusion of the LCx, double suture method and bifunctional staining were successfully applied in all animals. The percentage MI volumes globally(n = 6) and by slice(n = 25) were 36.59% ± 13.68% and 32.88% ± 12.38% on i DE, and 35.41% ± 12.25% and 32.40% ± 12.34% on e DE. There were no significant differences for MI determination with excellent linear regression correspondence(r global = 0.89; r slice = 0.9) between i DE and e DE. The percentage AAR volumes globally(n = 6) and by slice(n = 25) were 44.82% ± 15.18% and 40.04% ± 13.64% with RIO-staining, and 44.74% ± 15.98% and 40.48% ± 13.26% by DR showing high correlation in linear regression analysis(r global = 0.99; r slice = 1.0). The mean differences of the two AAR measurements on BlandAltman were almost zero, indicating RIO-staining and DR were essentially equivalent or inter-replaceable. The AAR was significantly larger than MI both globally and slice-by-slice(P < 0.01). After correction with the background and the blank heart without bifunctional staining(n = 3), the PDR for the AAR and normal myocardium was 32% ± 15% and 35.5% ± 35%, respectively,which is significantly different(P < 0.001), suggesting that blood perfusion to the AAR probably by collateral circulation was only less than 10% of that in the normal myocardium.CONCLUSION: The myocardial area at risk in ischemic heart disease could be accurately determined postmortem by this novel bifunctional staining, which may substantially contribute to translational cardiac imaging research.

肝内胆管细胞癌磁共振扩散加权成像与TACE术后碘油沉积对照研究

目的:分析肝内周围型胆管细胞癌(PCC)MR扩散加权成像与经肝动脉化疗栓塞术TACE术后碘油沉积的关系。方法:收集经病理证实的接受MRI扩散加权成像检查及TACE治疗的周围型胆管细胞癌患者17例的影像学及临床资料。并收集肝细胞癌20例、肝转移瘤26例行TACE治疗的影像资料作为对比,对PCC术后碘油分布形态进行统计分析。并与术前DWI图像进行对照分析。结果:PCC与肝细胞癌、富血供转移瘤组比较有显著差异,PCC与少血供转移瘤组无明显差异;本组17例PCC中14例周边部于DWI图可见明显高信号,其中13例可见碘油沉积,表现为稀糙型和缺损型分布型态。余3例胆管细胞癌于DWI图表现为高低混杂信号者,肿瘤中心及周边部位均见少量碘油沉积。结论:PCC TACE术后碘化油沉积量少,DWI能从微观层面反映胆管细胞癌TACE术后碘油沉积的病理基础。

碘化油与碘海醇在子宫输卵管造影中的应用比较

目的 对比分析碘化油及碘海醇在子宫输卵管造影中的优缺点，探讨碘海醇（取头低足高位）造影的优点。方法 回顾性分析2010年10月到2012年10月来我院做子宫输卵管造影的患者，并随机抽选用碘化油和碘海醇行子宫输卵管造影各49例就其图像质量、副反应及逆流、造影方便程度等方面进行对比分析。结果在图像质量、造影诊断效果及在造影检查中、检查后副反应、方便程度方面碘海醇组优于碘化油组。结论 用碘海醇造影，取头低足高位，减慢造影剂的排出，子宫、输卵管显影清楚；图像对比度、清晰度更高；碘海醇副作用少、安全，患者所受痛苦小；造影到领取报告时间短，病人可以及时就医。所以笔者认为碘海醇造影更值得推广。