摘要:目的:评价64层螺旋CT对冠心病的诊断价值。方法:对25例典型病例的CT图片进行分析、总结,观察64层螺旋CT对冠状动脉的管腔狭窄程度及冠脉内斑块性质的显示能力,并对桥血管和支架通畅性进行观察。结果:近端冠脉中度以上狭窄的敏感度、准确度、阳性预测值分别为93.5%,90.3%,88.5%,对左主干及前降支病变诊断价值较高;对冠状动脉内软斑块显示较佳;对桥血管及支架通畅和有无再狭窄显示良好。结论:MSCT冠状动脉成像在冠心病筛查及冠状动脉支架术后和搭桥术后的随访发挥重要作用。Abstract: Objective: To study the diagnose value of 64slice spiral CT for coronary heart disease. Methods:The CT pictures of 25 typical cases of coronary heart disease were analyzed so as to survey the displaying ability coronal arterial stenosis, its degree and the character plaques, the patency of bypass graft and stents by 64slice spiral CT. Results:The sensitivity, accuracy, positive predictive value for RCA1 narrow above moderate was 93.5%, 90.3%, 88.5% respectively. For LM and LAD, its diagnose value was high. The coronary soft or fibrous plaque, stent and bypass graft were displayed well. Conclusion:MSCT plays an important role in filtering coronary heart disease and reexamination after stents and bypass.
The abnormalities of retinal vessels such as retinal arteriolar narrowing, arteriovenous nicking, micro-aneurysms, retinal hemorrhages, and cotton wool spot are closely related to systemic diseases including hypertension, diabetes mellitus, cardiovascular disorders, stroke and renal diseases. The modern retinal vessels examination technology has features of quick noninvasive, quantitative standardized and intelligent analysis. Taking advantage of these to fully discover the retinal vascular abnormalities and get deeper understanding of the relationship between its' mechanism and systemic vascular diseases is not only helpful to better diagnose and treat retinal vascular diseases, but also contributes to predicting the risk and prognosis of systemic diseases. We suggest emphasizing on the study of correlation between retinal vascular abnormalities and systemic vascular diseases using modern retinal vessels examination technology. It will provide the preventive clue of diseases of circulatory system by finding out the retinopathy. Meanwhile, correctly treating systemic diseases would get a better prognosis of the retinopathy. They exist side by side and play a part together for providing a better prognosis, which would be a new direction for the doctors and scientists in the new era.
ObjectiveTo investigate the value of rectumaerated MSCT examination in diagnosis of mesorectal infiltration of rectal cancer and lymph node metastasis staging. MethodsFrom January 2010 to July 2010, the data of 68 patients with rectal cancer confirmed by pathology were analyzed in the First Affiliated Hospital of Liaoning Medical University. All the patients underwent rectumaerated MSCT preoperatively and postoperative pathology was taken as the gold standard for evaluation of the accuracy, sensitivity, specificity, positive or negative predictive values of MSCT in diagnosis of mesorectal infiltration and lymph node metastasis.ResultsIn rectum-aerated MSCT scanning, rectum and sigmoid colon was fully expanded, perirectal fat space was clear between perirectal fat space and relatively high density rectal wall and very low density enteric cavity. For mesorectal infiltration of degree Ⅰ, Ⅱ, and Ⅲ, the accuracies were 92.6%（63/68）, 91.1%(62/68), and 95.6%(65/68), respectively; sensitivities were 91.2%(31/34), 85.0%(17/20), and 92.9%(13/14), respectively; specificities were 94.1%(32/34), 93.8%(45/48), and 96.3%(52/54), respectively; positive predictive values were 93.9%(31/33), 85.0%(17/20), and 86.7%(13/15), respectively; negative predictive values were 91.4%(32/35), 93.8%(45/48), and 98.1%(52/53), respectively. For lymph node metastasis in N0, N1, and N2, the accuracies were 92.6%(63/68）,85.3%(58/68）, and 92.6%(63/68）, respectively; sensitivities were 86.2%(25/29), 90.0%(27/30), and 66.7%(6/9), respectively; specificities were 97.4%(38/39), 81.6%(31/38), and 96.6%(57/59), respectively; positive predictive values were 96.2%(25/26), 79.4%(27/34), and 75.0%(6/8), respectively; negative predictive values were 90.5%(38/42), 92.1%(35/38), and 95.0%(57/60), respectively. ConclusionsRectumaerated MSCT scaning can clearly show the depth of rectal carcinoma infiltration in the mesorectum, and N staging of mesorectal lymph node metastasis of MSCT has a higher consistency with that of pathological staging. Rectumaerated MSCT scanning is an important referenced method for clinical preoperative staging and individualized chemotherapy regimen.
ObjectiveTo analyze the subfoveal choroidal thickness in retinitis pigmentosa (RP) patients and to evaluate the correlation between the subfoveal choroidal thickness (SCT) and visual function. MethodsTotally 42 RP patients (84 eyes) and 49 age and diopter-matched normal controls (98 eyes) were enrolled in this study. All the patients were taken the enhanced depth imaging technique of optical coherence tomography (EDI-OCT) examination for the measurement of the SCT. The covariate analysis was used to analyze the interaction effect between age and group. Then the SCT was amended. The RP patients were examined by 30°visual field test (T32 or LVC program) and electroretinogram (ERG) test. 32 eyes examined by T32 program, 52 eyes examined by LVC program. The waveform of ERG, mean sensitivity (MS) and mean defect (MD) were recorded. The relationship of SCT, MS and MD were analyzed by Pearson correlation analysis. ResultsThe SCT of RP patients and controls were (223.12±69.59), (288.29±52.36) μm. The covariate analysis of covariance with different age group interaction was not statistically significant (F=1.619, P=0.205), as amended SCT of RP patients and controls were (217.34±6.60), (293.20±6.00) μm, respectively. The SCT was decreased in RP patients (t=7.042, P < 0.001). Among 84 eyes, bright cone response weaken in 35 eyes, scotopic rod response weaken in 31 eyes. The difference of SCT in different ERG waveform was not significant (t=-0.976, -1.584; P=0.332, 0.117). The MS and MD of 32 eyes using T32 program were (9.05±6.42), (18.84±6.30) dB, the SCT was (209.83±71.48) μm; the MS and SCT of 52 eyes using LVC program were (7.14±5.03) dB and (228.32±66.32) μm. The SCT was related to MS (r=0.494, P=0.003) and MD (r=-0.448, P=0.009) in eyes using T32 program. There was no correlation between SCT and MD in eyes using LVC program (r=-0.232, P=0.095). ConclusionsThe SCT of RP patients is thinner than that of normal controls. The SCT of RP patients is related to MS and MD of T32 program, but not correlated to ERG waveform and MS of LVC program.
Objective To observe the choroidal thickness and its relationship with age and refraction status in Chinese population. Methods 180 healthy volunteers (360 eyes) were enrolled in this study. Based on the age, the volunteers were divided into A (20-29 years old), B (30-39 year old), C (40-49 years old), D (50-59 year old), E (60-69 year old), and F (70-85 year old) group, with 33, 31, 29, 30, 31, 26 volunteers respectively. And the volunteers were divided into ＜60 years old group with 123 volunteers and ge; 60 years old group with 57 volunteers. Enhanced depth imaging (EDI) choroidal scans were obtained in all eyes by using spectraldomain optical coherence tomography. Subfoveal choroidal thickness (CT) and CT at 1 mm/3 mm temporal, nasal, superior, inferior to the fovea (S 1 mm, I1 mm, T1 mm, N 1 mm, S, I3 mm, T3 mm, N3 mm) were measured. The differences of CT between different quadrants, genders, eyes and ages were comparatively analyzed. The correlations between age, refraction status and CT in the volunteers of ＜60 years old and ge; 60 years old group were analyzed. Results The subfoveal CT was (262.78plusmn;84.38) mu;m. The differences were significant between subfoveal CT and all the quadrants CT (P＜0.05) except for S1 mm and T1 mm (P＞0.05 ). There was no difference between genders or eyes in subfoveal CT (P＞0.05 ). There was no difference between A, B, C, D group in subfoveal CT (P＞0.05 ). The subfoveal CT of E and F group were thinner than A, B, C, D group (P＜0.05). In the ＜60 years old group, there was a positive correlation between refraction status and CT (r=0.147,P＜0.05); but no correlation between age and CT (r=－0.055, P＞0.05 ). In the ge; 60 years old group, there was a significant negative correlation between CT and age (r=－0.543, P＜0.05), but no correlation between refraction status and CT (r=-0.008, P＞0.05). Conclusions The average subfoveal CT in Chinese population was (262.78plusmn;84.38) mu;m. The refraction status is the main influence factors in subjects ＜60 years old, while the age is the main influence factors in subjects ge;60 years old.
ObjectiveTo observe the OCT image characteristics of the posterior cortical anterior vitreous capsular bag (PPVP) in human eyes.MethodsA retrospective clinical study. From May 2012 to February 2017, 107 PPVP patients (173 eyes) diagnosed by OCT in Ophthalmology Department of The Third People's Hospital of Chengdu were included in the study. One hundred and three eyes underwent examination of frequency-domain OCT (SD-OCT) and 70 eyes underwent examination of frequency-scanning light source OCT (SS-OCT), respectively. SD-OCT the German Heidelberg Spectralis OCT instrument. SS-OCT was performed by the vitreous enhancement scan mode of Japan's Topcon DRI OCT instrument. The differences of different types of PPVP OCT imaging and image characteristics were observed.ResultsSD-OCT and SS-OCT showed that the PPVP structure was clear and manifested as macular weakly reflective in the shape of a boat-shaped cavity, the front boundary was vitreous collagen, and the rear boundary was vitreous cortex. There was a weakly reflective Martegiani area on the nasal side of PPVP, and there was a connection channels between them. The two examinations showed a similar pattern, but SS-OCT with the clearer imaging of PPVP.ConclusionsThe OCT image of PPVP in the human eye is characterized by an anterior weakly reflecting boat-shaped cavity in the macula, with anterior border of vitreous collagen and posterior border of vitreous cortex. Martegiani area is located on the nasal side.
Objective To compare the predicted efficiency of macular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery. Methods This is a prospective exploratory clinical study. A total of 63 patients (63 eyes) with idiopathic MH, who received vitrectomy, inner limiting membrane peeling and gas tamponade, were enrolled in this study. All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI=（M+N）/BASE, M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole, respectively. BASE is the length of MH base. MHCI1 was measured by built-in caliper of OCT software, MHCI2 was measured by ImageJ software. The minimum macular diameter (MHD) was measured by built-in caliper of OCT software. Based on the OCT images, the anatomical outcomes were classified grade A (bridge-like shape closure), grade B (complete closure) and grade C (poor closure). Grade A and B are considered as good closure, grade C as poor closure. Patients were followed up at 3, 6 and 12 months after surgery. The closure grades at last visit were the final outcome. The relationship between MHCI1, MHCI2 and closure grades was analyzed. And the predicted efficiency of MHD, MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied. Results The mean MHCI1 was 0.68±0.21 (0.30-1.35), MHCI2 was 0.95±0.26 (0.41-1.55), and MHD was (476.24±210.18) μm (127-956 μm). MHCI1 and MHCI2 were both negative correlated with the closure grades (r=−0.665, −0.691; P＜0.001). The receiver operating characteristic (ROC) curve analysis of MHCI1, MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928, 0.957 and 0.916 respectively, and 0.505, 0.67 and 559 μm were set as the lower cut-off value. The sensitivity was 96.2%, 92.3% and 90.9% respectively, and specificity was 81.8%, 72.7% and 76.9% respectively. Accordingly, the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840, 0.847 and 0.653 respectively, and 0.705, 0.965 and 364 μm were set as the upper cut-off value. The sensitivity was 80.0%, 82.9%, 63.4% respectively and specificity was 75.0%, 85.7%, 65.9%. Conclusion MHCI1 and MHCI2, measured by built-in caliper of OCT software or ImageJ software, both have good predictive efficiency for the anatomical outcomes of MH surgery.
ObjectiveTo quantitatively analyze the changes of choroidal capillaries in chronic central serous chorioretinopathy (CCSC) before and after half-dose photodynamic therapy (PDT).MethodsA retrospective cohort study. Nineteen patients (21 eyes) with CCSC were enrolled in this study from November 2017 to September 2018 in People’s Hospital of Wuhan University. Among them, there were 14 males (15 eyes) and 5 females (6 eyes), with diseases course over than 6 months. All patients underwent half-dose PDT. Twenty normal subjects (40 eyes) matched with age and sex in CCSC group were taken as controls. The subfoveal choroidal thickness (SFCT) was measured by Heidelberg depth enhanced imaging-OCT before and after PDT treatment in CCSC patients and in normal subjects. Spectral-domain OCT (Retina map) and Angio-OCT angiography (3 mm×3 mm) were arranged for all subjects at the same time. Macular fovea retinal thickness (CMT) was recorded under OCT-Retina map mode, and Angio-OCT 3 mm×3 mm choroidal capillary images were binarized using Image J software, and calculating the area ratio of low pixel area as flow signal void (FSV). BCVA, spectral-domain OCT and Angio-OCT were performed 1 week and 1, 3 months after PDT with the same equipment and methods before PDT. The changes of CMT, SFCT, FSV and BCVA in CCSC patients before and after PDT treatment were compared. Pearson correlation analysis was used to analyze the correlation between FSV and SFCT, age.ResultsThe average CMT, SFCT and FSV in CCSC patients increased significantly compared with the controls (P＜0.05). The average SFCT and FSV in CCSC patients 3 months after treatment were higher and the average CMT decreased compared with the controls (P=0.000, 0.000, 0.000). Comparison before and after PDT in CCSC patients: there were significant differences in average CMT, SFCT and FSV before and after PDT (P=0.000, 0.000, 0.000). Post Hoc multiple comparisons showed that the average CMT (P=0.000, 0.000, 0.000, 0.000, 0.000) and FSV (P=0.010, 0.000, 0.000, 0.001, 0.000) decreased significantly in all time points except for 1 month and 3 months after treatment, so as the average FSV (P=0.788, 0.702). The average SFCT decreased 1 month and 3 months after treatment compared with the baseline (P=0.024, 0.008), and there was no significant difference between before treatment and 1 week after treatment (P=0.162), and between 1 month and 3 months after treatment (P=0.687). The correlation analysis showed that there was no correlation between FSV and age in CCSC patients (r=0.052, P=0.822), but there was a correlation between FSV and age in controls (r=0.716, P=0.000).ConclusionQuantitative analysis of OCTA showes the degree of choriocapillary ischemia in the form of FSV in CCSC patients decreased after PDT treatment, however, which is still higher than normal controls.