超声心动图评价室间隔缺损封堵术前后心功能

目的:探讨经胸超声心动图(Transthoracic echocardiography,TTE)在评估室间隔缺损(Ventricular septal defect,VSD)封堵术前、后心脏负荷、功能变化的应用价值。方法:回顾性研究2007年1月至2012年8月广西医科大学一附院62例成功实施经皮穿刺VSD封堵术的患者资料。术前经超声筛查,术后3天、术后3个月、术后6个月及术后1年分别行TTE复查,常规测量左房收缩末期前后径(Left atrium end-systolic diameter,LAESD)、左室舒张末期前后径(Left ventricular end-diastolic diameter,LVEDD)、左室收缩末期前后径(Left ventricular end-systolic diameter,LVESD)、左室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)、左室每博输出量(Left ventricular stroke volume,LVSV)、右室舒张末期前后径(Right ventricular end-diastolic diameter,RVEDD)、主肺动脉中段内径(Main pulmonary artery,MPA)、左室射血分数(Left ventricular ejection fraction,LVEF)、左室短轴缩短率(Left ventricular fraction shortening,LVFS)、三尖瓣反流压差(Pressure gradient of tricuspid regurgitation,PGTR)。结果:术后3个月、术后6个月、术后1年LAESD、LVEDD、LVESD、LVEDV、LVSV、MPA均较术前降低(P0.05),且术后3天LVEDD、LVEDV、LVSV、MPA均较术前降低(P0.05),术后3天LAESD、LVESD较术前差异无统计学意义(P0.05);术后3天PGTR较术前降低(P0.05),术后3个月、术后6个月、术后1年较术后3天无统计学差异(P0.05);术前、术后RVEDD、LVEF、LVFS差异无统计学意义(P0.05)。结论:TTE对VSD封堵术后心脏功能变化的评估有重要临床指导意义。     

幼猪室间隔缺损动物模型研究

目的　探讨幼猪室间隔缺损的实验动物模型的建立方法。方法　 16只幼猪在全麻下经右心耳行室间隔穿刺造口置环 ,建立室间隔缺损。术后 3天行超声心动图、术后 1月行心导管检查。结果　 11只猪手术成功。经超声心动图、心导管检查确认有 10只建模成功。超声心动图示最大分流流速Vmax为 1 7～ 4 4m/sec (2 6 3± 0 92 )。血流动力学指标测定结果示肺动脉压无显著升高 ,Qp/Qs 1 6 8～ 2 12 (1 84± 0 2 4 )。结论　采用改良的Synhorst方法在国内首次成功建立了幼龄室间隔缺损动物模型 ,对深入了解左向右分流先心病病理生理改变具有重要意义。     

Comparison of Aortic Annulus Diameter Measurement between Multi-Detector Computed Tomography and Echocardiography: A Meta-Analysis

Background and Purpose

Accurate measurement of aortic annulus diameter is crucial for choosing suitable prosthetic size for transcatheter aortic valve implantation (TAVI). Several imaging methods are available for the measurement, but significant variability between different modalities has been observed. The purpose of this study was to systematically compare the measurements of aortic annulus diameter between multi-detector computed tomography (MDCT), transthoracic echocardiography (TTE), and transesophegeal echocardiography (TEE).

Methods

PubMed and EMBASE databases between January 2000 and January 2012 were searched. We extracted data from eligible studies evaluating the aortic annulus diameter by MDCT and echocardiography (TTE, TEE, or both). We performed a random-effects meta-analysis to calculate the weighted mean differences of aortic annulus diameter measurement between MDCT, TTE, and TEE.

Results

A total of 10 eligible studies involving 581 subjects with aortic valve stenosis were included. Aortic annulus diameter measured on coronal view by MDCT (25.3±0.52 mm) was respectively larger than that measured on sagittal view by MDCT (22.7±0.37 mm), TTE (22.6±0.28 mm), and TEE (23.1±0.32 mm). The weighted mean difference of aortic annulus diameter between coronal view by MDCT and TTE these two methods was 2.97 mm, followed by the weighted mean difference of 2.53 mm between coronal view and sagittal view by MDCT, and the mean difference of 1.74 mm between coronal view on MDCT and TEE (P<0.0001 for all). The weighted mean difference of aortic annulus diameter measurement between TEE and TTE was significant but somewhat small (0.45 mm, P = 0.007).

Conclusion

Aortic annulus diameter measured on coronal view by MDCT was robustly and significantly larger than that obtained on sagittal view by MDCT, TTE, or TEE. Such variability of aortic annulus diameter measurement by different imaging modalities cannot be ignored when developing optimal strategies for selection of prosthetic valve size in TAVI.     

Cone-Beam Computed Tomography Correlates with Conventional Helical Computed Tomography in Evaluation of Lipiodol Accumulation in HCC after Chemoembolization

Background & Aims

The amount of drug-loaded lipiodol in an HCC tumor post-transarterial chemoembolization (TACE) correlates with the risk of local tumor recurrence. Lipiodol enhancement of a tumor on conventional CT, measured in Hounsfield units (HU), can predict tumor response. Here we investigate whether cone-beam CT (CBCT) can also be used to predict tumor response, providing the benefit of being able to optimize the patient’s treatment plan intra-procedurally.

Methods

A total of 82 HCC nodules (82 patients), ≤5 cm in diameter, were treated with balloon-occluded TACE using miriplatin between December 2013 and November 2014. For each patient, both CBCT and conventional CT images were obtained post-TACE. The degree of correlation between CBCT and conventional CT was determined by comparing identical regions of interest for each imaging modality using pixel values.

Results

The pixel values from conventional CT and CBCT were highly correlated, with a Pearson correlation coefficient of 0.912 (p<0.001). The location of the nodules within the liver did not affect the results; the correlation coefficient was 0.891 (p<0.001) for the left lobe and 0.926 (p<0.001) for the right lobe. The mean pixel value for conventional CT was 439 ± 279 HU, and the mean pixel value for CBCT was 416 ± 311 HU.

Conclusions

CBCT may be used as a substitute for conventional CT to quantitatively evaluate the amount of drug-loaded lipiodol within an HCC nodule and, hence, the efficacy of TACE treatment. The major benefit of using CBCT is the ability to predict the likelihood of local recurrence intra-procedurally, enabling subsequent treatment optimization.     

多层螺旋CT对胃癌术前分期的准确性评价

目的:评价多层螺旋CT对胃癌术前分期的准确性.方法:对78例经胃镜活捡证实为胃癌的患者进行MSCT增强扫描,其中67例经历了手术治疗,并获得术后病理结果.由两位资深放射科医师对影像学资料进行分析,轴位和MPR影像用于术前TNM分期,N分期分别采用UICCTNM分期和日本分期,两种分期的准确性比较采用McNemar检验进行统计学分析.结果:轴位和轴位结合MPR影像的总体T分期准确率分别为67%(45/67)和78%(52/67)(P＜0.05),总体N分期的准确率分别是61%(41/67)和67%(45/67)(P＞0.05,日本分期),54%(36/67)和60%(40/67)(P＞0.05,UICC TNM分期),总体M分期准确率为93%(73/78).结论:服水低张动态增强MSCT对胃癌术前TNM分期具有很高的准确性,MPR能提高胃癌T分期的准确率,但不能提高N分期的准确率.     

Visual versus Automated Evaluation of Chest Computed Tomography for the Presence of Chronic Obstructive Pulmonary Disease

Background

Incidental CT findings may provide an opportunity for early detection of chronic obstructive pulmonary disease (COPD), which may prove important in CT-based lung cancer screening setting. We aimed to determine the diagnostic performance of human observers to visually evaluate COPD presence on CT images, in comparison to automated evaluation using quantitative CT measures.

Methods

This study was approved by the Dutch Ministry of Health and the institutional review board. All participants provided written informed consent. We studied 266 heavy smokers enrolled in a lung cancer screening trial. All subjects underwent volumetric inspiratory and expiratory chest computed tomography (CT). Pulmonary function testing was used as the reference standard for COPD. We evaluated the diagnostic performance of eight observers and one automated model based on quantitative CT measures.

Results

The prevalence of COPD in the study population was 44% (118/266), of whom 62% (73/118) had mild disease. The diagnostic accuracy was 74.1% in the automated evaluation, and ranged between 58.3% and 74.3% for the visual evaluation of CT images. The positive predictive value was 74.3% in the automated evaluation, and ranged between 52.9% and 74.7% for the visual evaluation. Interobserver variation was substantial, even within the subgroup of experienced observers. Agreement within observers yielded kappa values between 0.28 and 0.68, regardless of the level of expertise. The agreement between the observers and the automated CT model showed kappa values of 0.12–0.35.

Conclusions

Visual evaluation of COPD presence on chest CT images provides at best modest accuracy and is associated with substantial interobserver variation. Automated evaluation of COPD subjects using quantitative CT measures appears superior to visual evaluation by human observers.     

房间隔缺损闭合器组织相容性研究

目的:采用GB/T16175-1997和ISO10993-6:2007标准中植入后局部反应试验的结果判定方法,评价房间隔缺损闭合器植入体内后的组织相容性,探讨两种方法在组织相容性评价中的作用.方法:采用试验动物家兔皮下植入试验,将试验样品植入家兔背部皮下组织,分别于植入后1周、4周和12周后处死动物,取材,常规制片,HE染色,组织学观察采用炎症和纤维囊腔分级法及半定量记分法.结果:样品皮下植入后随着时间的延长,其周围组织的反应程度呈加重趋势.植入后12周,组织学反应未达到稳态.两种方法的组织学观察结果是一致的.结论:两种方法在组织学评价中均有其局限性,实际中可将两种方法结合来评价医疗器械的组织相容性,建议继续观察该样品植入后26周的局部反应,以减少临床使用的风险.     

The Effects of Computed Tomography with Iterative Reconstruction on Solid Pulmonary Nodule Volume Quantification

Background

The objectives of this study were to evaluate the influence of iterative reconstruction (IR) on pulmonary nodule volumetry with chest computed tomography (CT).

Methods

Twenty patients (12 women and 8 men, mean age 61.9, range 32–87) underwent evaluation of pulmonary nodules with a 64-slice CT-scanner. Data were reconstructed using filtered back projection (FBP) and IR (Philips Healthcare, iDose⁴-levels 2, 4 and 6) at similar radiation dose. Volumetric nodule measurements were performed with semi-automatic software on thin slice reconstructions. Only solid pulmonary nodules were measured, no additional selection criteria were used for the nature of nodules. For intra-observer and inter-observer variability, measurements were performed once by one observer and twice by another observer. Algorithms were compared using the concordance correlation-coefficient (p_c) and Friedman-test, and post-hoc analysis with the Wilcoxon-signed ranks-test with Bonferroni-correction (significance-level p<0.017).

Results

Seventy-eight nodules were present including 56 small nodules (volume<200 mm³, diameter<8 mm) and 22 large nodules (volume≥200 mm³, diameter≥8 mm). No significant differences in measured pulmonary nodule volumes between FBP, iDose⁴-levels 2, 4 and 6 were found in both small nodules and large nodules. FBP and iDose⁴-levels 2, 4 and 6 were correlated with p_c-values of 0.98 or higher for both small and large nodules. P_c-values of intra-observer and inter-observer variability were 0.98 or higher.

Conclusions

Measurements of solid pulmonary nodule volume measured with standard-FBP were comparable with IR, regardless of the IR-level and no significant differences between measured volumes of both small and large solid nodules were found.     

Circulating Matrix Metalloproteinase-2 and -9 Enzyme Activities in the Children with Ventricular Septal Defect

Ventricular septal defect (VSD) is the most common form of congenital heart diseases. Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases involved in causal cardiac tissue remodeling. We studied the changes of circulating MMP-2 and MMP-9 activities in the patients with VSD severity and closure. There were 96 children with perimembranous VSD enrolled in this study. We assigned the patients into three groups according to the ratio of VSD diameter/diameter of aortic root (Ao). They were classified as below: Trivial (VSD/Ao ratio ≤ 0.2), Small (0.2 < VSD/Ao ≤ 0.3) and Median (0.3 < VSD/Ao) group. Plasma MMP-2 and MMP-9 activities were assayed by gelatin zymography.There was a significant higher MMP-2 activity in the VSD (Trivial, Small and Median) groups compared with that in Control group. The plasma MMP-9 activity showed a similar trend as the findings in MMP-2 activity. After one year follow-up, a significant difference in the MMP-9 activity was found between VSD spontaneous closure and non-closure groups. In conclusion, a positive trend between the severity of VSD and activities of MMP-2 and MMP-9 was found. Our data imply that MMP-2 and MMP-9 activities may play a role in the pathogenesis of VSD.     

The Prevalence of Ventricular Septal Defect in Elementary School Children in the City of Toronto

A knowledge of the prevalence of ventricular septal defect in different age groups is basic to the estimation of all complications of this disease. The Cardiac Registry in the City of Toronto has provided this information for elementary school children. Clinical diagnosis of ventricular septal defect was made if the child had a pansystolic murmur in the 3rd or 4th left intercostal space with a palpable thrill and/or electrocardiographic evidence of ventricular hypertrophy and/or radiologic evidence of pulmonary plethora at one or more examinations. When possible, the diagnosis was confirmed by cardiac catheterization. Children with the same murmur, no thrill and normal electrocardiogram and radiograph were labelled “probable” and presumed to have a minute or disappearing defect.The prevalence rate of ventricular septal defect in elementary school children varied betwen 0.44 and 0.48 per 1000 in four successive years of study. The rate of “probable” ventricular septal defect varied between 0.27 and 0.37 per 1000 children.