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Preliminary observation of the effect of cystic cavity on visual function of macular area before and after operation in idiopathic macular hole

ObjectiveTo observe and analyze the effect of peripore cavity size on visual function of macular area before and after surgery for idiopathic macular hole (IMH). MethodsA retrospective clinical study. From July 2020 to February 2021, a total of 25 patients with 25 eyes with monocular IMH (operation group) diagnosed by ophthalmology examination in Department of ophthalmology, Fourth Hospital of Hebei Medical University were included in the study. The control group was contralateral healthy eyes. All subjects were examined by best corrected visual acuity (BCVA), microfield of vision, frequency domain optical coherence tomography (SD-OCT), and OCT angiography (OCTA). The diameter of macular hole was measured by SD-OCT. The cystic morphology of deep capillary plexus (DCP) was detected by en face OCT, and the cystic area was measured by Image J software. MP-3 microperimeter was used to measure central macular retinal light sensitivity (MS) and mean macular retinal light sensitivity (MMS). Central macular retinal light sensitivity (CMS), MMS and cystic cavity MS were measured in the operation group. MMS was measured in the control group. The microperimetry images were superimposed on the DCP layer of OCTA to identify and calculate the average MS within the lumen and compare it with the control group. Standard three incisions were performed in all affected eyes by vitrectomy of the flat part of the ciliary body + stripping of the inner boundary membrane + intraocular sterile air filling. Three months after the operation, the same equipment and methods were used to perform relevant examinations. Paired sample t test was used to compare MS between operation group and control group. Pearson correlation analysis was used to analyze the correlation between capsular area, macular hole diameter before and after operation and MS before and after operation. The correlation between BCVA and capsular area before and after surgery was analyzed by Spearman correlation analysis. ResultsIn the surgical group, the retinal MS was (4.24±3.07) dB. The MMS of control group was (19.08±6.11) dB. The MS in the surgical group was significantly lower than that in the control group, and the difference was statistically significant (t=10.832, P＜0.01). Before operation, the area of cyst was (1.04±0.55) mm2, and the diameter of macular hole was (564.80±166.59) μm. CMS and MMS were (2.27±2.29) dB and (9.08±3.65) dB, respectively. The diameter of macular hole (r=0.50, P=0.010) and BCVA before operation (r=0.57, P＜0.001) were positively correlated with peripore cavity area. Before operation, CMS and MMS were negatively correlated with peripore cavity area (r=－0.53, －0.47; P=0.010, 0.020). At 3 months after surgery, the capsular area was negatively correlated with CMS and MMS (r=－0.65,－0.76; P=0.020, 0.030). There was no correlation with BCVA (r=0.23, P=0.470). ConclusionsRetinal MS is decreased in the peri-capsular area of IMH pore. There is a positive correlation between capsule area, BCVA and macular hole diameter before operation. The capsular area is negatively correlated with CMS and MMS before operation.

Application value of gadobutrol in contrast-enhanced magnetic resonance angiography in abdominal artery angiography: a prospective multicenter study

ObjectiveTo explore the value of gadobutrol enhanced magnetic resonance angiography (MRA) in abdominal artery angiography.MethodsThe patients were prospectively included for gadobutrol enhanced MRA examination from December 2014 to December 2015. The image quality was assessed by two radiologists. The subjective score and signal intensity were measured for the large and medium arteries, and the subjective score for the small artery was recorded. The Kappa consistency analysis was used to assess the two radiologists’ subjective score.ResultsAll 112 patients were enrolled in this study, 96 of whom were included for the physical examination, 16 of whom were included for the liver tumors. No adverse reactions were found in these patients. The MRA images of 2 patients were affected by the severe respiratory artifact. The MRA images of the other 110 cases were clear and could well show the origins, shapes of large and medium arteries and small arteries. The subjective scores were 21.22±1.93 and 6.24±1.33 of the large and medium arteries and small arteries, respectively. The values of signal noise ratio and contrast signal noise ratio of the large and medium arteries were 1 093.27±331.71 and 897.27±333.29, respectively. The Kappa values of the two radiologists’ subjective score were 0.782 and 0.772 for the large and medium arteries and small arteries, respectively.ConclusionsGadobutrol enhanced MRA can clearly display large and medium arteries, and can also display some small arteries. It has a good application value in abdominal artery angiography.

Diagnostic Value of 64 Slice Spiral Computed Tomography for Budd-Chiari Syndrome

Objective　To investigate the imaging features of Budd-Chiari syndrome (BCS) on 64 slice spiral computed tomography (64SCT) and the diagnostic value of 64SCT for BCS. Methods　Twenty-nine patients diagnosed as BCS by 64SCT were retrospectively included into this study and all the patients were researched by digital substraction angiography (DSA). Two abdominal radiologists analyzed the CT imaging features of BCS, paying attention to the vascular lesion, the morphology abnormality of the liver and the degree of portal hypertension, with review of DSA findings. Results　①The accuracy of 64SCT for BCS was 93.1% (27/29), and there were 2 false positive cases and no false negative case. The accuracy of 64SCT for those patients with thrombosis of inferior vena cava (IVC) and (or) hepatic vein (HV) was high as compared to those with stenosis of IVC and (or) HV. ②The morphology abnormality of the liver included hepatomegaly (24 cases), low attenuation (27 cases) and inhomogeneous pattern of parenchymal contrast enhancement (5 patients in arterial phase and 19 patients in portal vein phase). ③The images of all the patients showed the features of portal hypertension. Conclusion　The accuracy of 64SCT for BCS is satisfactory and the false negative is seldom. The 64SCT could accurately display the morphology abnormality of the liver and the compensatory circulation in BCS patients. For those patients with stenosis of IVC and (or) HV, however, the diagnostic power of 64SCT is limited.

Congenital Abdominal Aortic Aneurysm in Children: A Case Report and Literature Review

目的　提高對先天性腹主動脈瘤（AAA）的認識。 方法　報道2012年11月1日先天性AAA 1 例，回顧國內外報道的24 例先天性AAA的臨床資料。 結果　患兒男，2歲，以肉眼血尿起病，伴高血壓、蛋白尿和反復血小板降低；多層螺旋CT血管成像（MSCTA）見AAA伴左腎動脈狹窄；彩色多普勒超聲見AAA累及雙側髂總動脈伴動脈壁間血栓及鈣化，左腎萎縮；保守治療7個月后猝死，臨終前頭顱CT見腦梗死。回顧分析24例先天性AAA，包括腎下型AAA 15 例，腎上型AAA 5例，胸腹部AAA 2例，未具體指明類型2例；產前診斷6例，出生后診斷18例（其中包括新生兒5例和1個月～3歲嬰幼兒8例）；以腹部搏動性包塊起病8 例，嘔吐4 例，呼吸困難2例，腰部疼痛1例，因其他疾病就診3例；采用血管超聲21例，MSCTA 16例，磁共振血管造影9例；13例腎下型AAA接受手術治療；死于AAA破裂5例，死于心力衰竭2例。 結論　先天性AAA以腎下型為主，多為嬰幼兒，常表現為腹部腫塊，確診該病首選MSCTA，主張行早期個體化手術。

Advances in application of optical coherence tomography angiography for quantitative analysis in central serous chorioretinopathy

Central serous chorioretinopathy (CSC) is one of the representative pachychoroid spectrum disease. Although fundus fluorescein angiography and indocyanine green angiography can be used as the gold standard for the diagnosis of CSC, they are invasive examinations, which may bring certain risks in clinical application and cannot help us obtain quantitative parameters. Optical coherence tomography angiography (OCTA), as a non-invasive and quantitative examination, is an important imaging tool for understanding the pathogenesis, diagnosis and treatment of CSC. With the advancement of OCTA, the swept-source OCTA has a satisfying scanning depth, a wider scanning range and a higher resolution. The development of OCTA broadens the horizons of the pathogenesis of CSC, promotes the understanding of the pathophysiology of CSC, and sheds new light for its clinical diagnosis and treatment. Based on OCTA, the choroid and retina in eyes with CSC are presented with qualitative and quantitative changes in vascular system. OCTA-guided CSC treatment and the discovery of prognostic markers based on OCTA challenge the application of traditional imaging techniques in CSC. With the continuous improvement and progress of OCTA technology, traditional angiography combined with OCTA will bring great benefits to the diagnosis and treatment of CSC. This review summarizes the quantitative application of OCTA in the pathogenesis, diagnosis and treatment of CSC.

多層螺旋CT血管成像在顱內動脈瘤診斷中的臨床應用

目的 探討多層螺旋CT血管成像在顱內動脈瘤診斷中的臨床價值。 方法 對2005年1月-2009年1月收治的50例顱內動脈瘤患者的臨床影像資料，進行回顧性分析。 結果 多層螺旋CT血管造影（MSCTA）的容積重建（VR）和最大密度投影（MIP）兩種方法在顯示血管形態時與數字減影血管造影術（DSA）圖像質量無統計學意義（Pgt;0.05）。但對于瘤壁血栓伴鈣化導致的血管狹窄，MIP與DSA結果有統計學意義（Plt;0.05），兩種診斷結果的陽性率差異無統計學意義（Pgt;0.05）。 結論 MSCTA是一種安全、可靠、無創、準確診斷顱內動脈瘤的影像學診斷方法。

THREE DIMENSIONAL VISUAL RESEARCH OF THORACIC DORSAL ARTERY BASED ON CT ANGIOGRAPHY

ObjectiveTo study the digital anatomy and application value of the thoracic dorsal artery based on CT angiography (CTA). MethodsBetween September 2012 and June 2014, aorta CTA images were chosen from 10 cases (20 sides) undergoing aorta CTA. By using Mimics 17.0 software for three dimensional (3D) reconstruction of image post-processing, the digital vascular anatomical information were obtained after observing and measuring the origin of the thoracic dorsal artery, the number of perforators, type, inner diameter, and pedicle length; and the body surface location of perforator vessel was determined, and then the thoracic dorsal artery perforators tissue flap harvesting was simulated. Results3D reconstruction images showed that the thoracic dorsal artery originated from subscapular artery, 76 perforator vessels were found, including 32 perforators (42.1%) from the medial branch of the thoracic dorsal artery and 44 perforators (57.9%) from the lateral branch of the thoracic dorsal artery, of which 69 were intramuscular perforators (90.8%) and 7 were direct skin artery (9.2%). The inner diameter of the thoracic dorsal artery was (1.69±0.23) mm, and its pedicle length was (2.12±0.64) cm. The first lateral perforator of the thoracic dorsal artery located at (1.65±0.42) cm above the horizontal line of the inferior angle of scapula and at (1.68±0.31) cm lateral to vertical line of the inferior angle of scapula. The first medial perforator located at (1.43 ±0.28) cm above the horizontal line of the inferior angle of scapula and at (1.41±0.28) cm lateral to vertical line of the inferior angle of scapula. The thoracic dorsal artery perforators flap harvesting was successfully simulated. ConclusionCTA is a more intuitive method to study the thoracic dorsal artery in vivo, it can clearly display 3D information of the main blood supply artery course and distribution after flap reconstruction, so it can effectively and accurately guide the design of the flap.

左、右冠狀動脈瘤合并冠狀動脈-肺動脈瘺一例

MultiSlice Spiral CT Angiography in Diagnosis of 31 Patients with Arteriosclerosis Obliterans Disease of Lower Extremities

目的 探討多層螺旋CT血管成像(MSCTA)技術對下肢閉塞性動脈硬化癥(ASD)的應用價值。 方法 對2007年1月-2009年12月收治的31例ASD患者進行檢查，將數據在ADW4.1工作站行容積再現(VR)、最大密度投影(MIP)、多平面重組(MPR)、曲面重組(CPR)等后處理技術并結合原始圖像進行綜合分析。 結果 血管重建圖像31例顯示良好，存在不同程度的阻塞，閉塞動脈周圍有代償側支血管。 結論 MSCTA可清楚地觀察下肢動脈的血管形態及管壁的鈣化斑塊，狹窄程度及閉塞情況。

Clinical Application of 1.5T Magnetic Resonance Arterial Spin Labeling, Diffusion Weighted Imaging and Magnetic Resonance Aangiography in the Diagnosis of Ischemic Cerebrovascular Disease

目的　探討磁共振擴散加權成像（DWI）、動脈自旋標記技術（ASL）、磁共振血管成像（MRA）聯合應用在缺血性腦血管病診斷中的價值。 方法　對2010年3月－2012年5月經臨床和影像學診斷的104例缺血性腦血管病患者，行常規MRI、液體衰減反轉恢復序列、DWI及ASL、MRA序列檢查，分析DWI、ASL、MRA多種技術顯示病變的信號特征、面積大小及與血管關系。 結果　DWI對急性及亞急性腦梗死的檢出率為100%，對大、小面積梗死病灶檢出率無明顯差異；ASL對大、小面積的急性及亞急性腦梗死的檢出率有差異，對大面積梗死檢出率為100%，對小面積梗死的檢出率為70%；DWI和ASL對短暫性腦缺血發作的檢出率分別為0%、70%，液體衰減反轉恢復序列對短暫性腦缺血發作患者大腦皮層下斑狀缺血灶檢出最敏感。 結論　DWI和ASL均可用于急性腦梗死的早期診斷，ASL對大、小面積的急性及亞急性腦梗死的檢出率有差異，DWI、ASL及MRA聯合應用可準確評估缺血半暗區及側支血管情況，在缺血性腦血管病診斷中有重要價值。