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Stroke has become the leading cause of death in China, and carotid atherosclerosis is an important risk factor for ischemic stroke. In current carotid atherosclerosis diagnosis and treatment guidelines, patients are stratified based on the degree of vascular stenosis. However, the presence of carotid atherosclerotic vulnerable plaques can cause ischemic stroke at any time, regardless of the degree of carotid stenosis. The development of MRI technology, especially the advent of high-resolution MRI, enables non-invasive assessment of carotid plaque structure and properties, and provides optimized treatment strategies for high-risk stroke population in the early stage to achieve the goal of prevention and treatment of stroke.
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Stroke seriously endangers people's life and health because of its high prevalence, disability and recurrence rate. Among them, large vessel occlusive stroke (LVOS) has the worst outcome. Rapid recovery of cerebral perfusion is the key to improve the outcomes of patients with LVOS. As a new type of treatment, endovascular treatment can effectively recanalize the occluded blood vessels and extend the treatment time window. The level of collateral circulation determines the severity of symptoms, treatment choices, treatment effects and outcomes in patients with LVOS. This article summarizes the clinical factors related to collateral circulation compensation in patients with LVOS, and focuses on the application value of imaging technology in the evaluation of collateral circulation.
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Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.
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Objective To investigate the clinical application value of hippocampal volume (HV)measurement with MMSE score in varying different degrees cognitive impairment.Methods 30 Alzheimer’s disease(AD)patients,30 mild cognitive impairment (MCI)patients and 30 normal controls(NC)were recruited,HV was measured by Siemens Tim-avanto 3.0T super conductance magnetic resonance.Standardized HV and MMSE scores of three groups were comprehensive analyzed.Results The left and right sides and the total HV of AD group were lower than the MCI and the NC group,with significant differences by statistical analysis (P <0.05).The HV had no significant differences between the MCI and the NC group.The MMSE scores of AD group were lower than the MCI and the NC group,with significant differences by statistical analysis (P <0.05),the score had no significant differences between the MCI and the NC group.Conclusion HV measurement with MMSE score would be helpful to provide effective basis for the AD diagnosis,the sensitivity in the diagnosis of MCI is not high.
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Objective To observe the differences of metabolite ratios among mild cognitive impairment (MCI),Alzheimer’s disease (AD) and normal cognitive state (NC)patients in the hippocampus.Methods According to the clinical features,patients were divided into three groups:MCI group (n=30),AD group (n=28)and NC group (n=30).All the patients were examined by 1 H MRS and compared the ratios of NAA/Cr,Ins/Cr,NAA/Ins,Cho/Cr of both the left and right side of the hippocampus.Results The NAA/Cr in MCI group and AD group were much lower than that in NC group (P <0.05).The Ins/Cr and NAA/Ins in MCI group and AD group showed significant differences compared with NC group (P <0.05).On Ins/Cr and NAA/Ins of the left side,there were significant differences among three groups (P <0.05).Conclusion 1 H MRS as a non-invasive diagnostic technique has higher sensitivity in the early diagnosis and differential diagnosis between MCI and AD patients.
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Objectve To investigate the correlation between vertebral artery hypoplasia (VAH) and posterior circulation ischemic stroke (PCIS).Methods The patients who were diagnose as ischemic cerebral stroke and underwent brain magnetic resonance imaging and cervical three-dimensional contrast-enhanced magnetic resonance angiography from March 2012 to March 2014 were enrolled.VAH was defined as vertebral artery diameter ＜ 2 mm and thin or did not develop.They were divided into either an anterior circulation ischemic stroke (ACIS) group or a PCIS group according to the sites of disease.The clinical and imaging data were compared.Results A total of 137 patients were enrolled,including 96 patients (70.07％) with ACIS and 41 (29.93％) with PCIS.Thirty-seven patients were (27.01％) diagnosed as VAH,including 13 on the left and 24 on the right; 14 females and 23 males.The detection rate of females (29.17％) was higher than that of males (25.84％),but the difference was not statistically significant (x2 =0.175; P =0.676).There were significant differences in TOAST classificanon (x2 =6.710; P =0.035),combined with ischemic heart disease (14.6％ vs.61.5％ ; x2 =25.262,P ＜ 0.001) and VAH (58.5％ vs.13.5％ ; x2 =9.505,P ＜0.001) between the PCIS group and the ACIS group.Multivariable logistic regression analysis showed that VAH was independently correlated with PCIS (odds ratio 10.788,95％ confidence interval 3.863-30.131; P ＜ 0.001),and combined with ischemic heart disease was independently correlated with ACIS (odds ratio 0.082,95％ confidence interval 0.024-0.278; P ＜ 0.001).Conclusions VAH is not rare in patients with ischemic stroke.It may promote the occurrence of PCIS.
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Objective To investigate the change regulation of the serum ferritin level and its correlation with the clinical outcomes.Methods The patients with spontaneous intracerebral hemorrhage were enrolled.Their clinical data were collected.The serum ferritin levels were detected within 24 h after admission and on day 3,7,and 14,respectively.The modified Rankin Scale (mRS) were used to evaluate the clinical outcomes at day 90 after onset.mRS 0 to 2 was defined as good outcome and ＞ 2 was defined as poor outcome.Results A total of 32 patients with spontaneous intracerebral hemorrhage were enrolled,including 18 in the good outcome group and 14 in the poor outcome group.There were significant differences in age (66.33 ±12.57 years vs.76.50 ±6.55 years;t =-2.908,P =0.007),baseline National Institutes of Health Stroke Scale (NIHSS) scores (median [interquartile range];9.50 [4.75-11.25] vs.15.00 [11-20];Z=-3.499;P=0.001),diastolic blood pressure (82.16± 13.79 mmHg vs.94.76± 12.17mmHg,1 mmHg=0.133 kPa);t=-1.145,P=0.045),amount of bleeding (4.50 [2.75-9.00] mlvs.11.00 [7.50-15.00] ml;Z=-2.613,P=0.008],blood glucose (5.82±0.87 mmoFL vs.7.09±1.72 mmoFL;t =-2.548,P =0.020),and white blood cell count ([7.26 ± 2.36] × 109/L vs.[10.94 ±5.83] × 109/L;t =-2.440,P =0.021) between the good outcome group and the poor outcome group.The serum ferritin levels of the good outcome group were 139.81 ± 98.50 μg/L,181.77 ± 97.29 μg/L,198.17 ±96.63 μg/L,and 159.59 ±72.43 μg/L,respectively,within 24 h on admission and at day 3,7,and 14.There were no significant differences at each time point (F=1.397,P =0.251),and those of the poor outcome group were 226.07 ± 119.22 μg/L,297.36 ± 81.48 μg/L,305.45 ± 97.05 μg/L,and 307.74 ± 82.54 μg/L,respectively,and they increased progressively over time (F =4.245,P =0.044);at each time point,the good outcome group was significantly lower than the poor outcome group (within 24 hon admission:t =-2.242,P=0.033;at 3 days after onset:t =-3.234,P =0.003;at 7 days after onset:t =-3.149,P =0.004;at 14 days after onset:t =-3.628,P =0.001).Multivariate logistic regression analysis showed that the serum ferritin level within 24 h on admission (odds ratio 1.048,95％ confilence interval 1.004-1.095;P=0.034)and baseline NIHSS score (odds ratio 1.021,95％ confidence interval 1.004-1.039;P =0.016) were the independent risk factors for affecting the outcomes in patients with acute intracerebral hemorrhage.Conclusions The serum ferritin level increases in the poor-outcome patients with acute intracerebral hemorrhage.The increased serum ferritin level is an independent risk factor for poor outcome in patients with acute intracerebral hemorrhage.
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Objective To investigate the application of proton magnetic resonance spectroscopy (1H-MRS) in patients with white matter lesions (WMLs).Methods Patients with WML were enrolled.According to imaging and clinical symptoms,they were divided into either a subcortical atherosclerotic encephalopathy (SAE) group or a simple leukoaraiosis (LA) group.All patients completed the examinations of MRI,1H-MRS,and auditory event-related potential P300.Multi-voxel 1H-MRS acquisition range was lateral periventricular white matter region.N-acetyl aspartic acid (N-acetylaspartate,NAA),creatinine (Cr),choline (Cho),NAA/Cr,and P300 latency and amplitude were documented.Results A total of 50 patients with WML were enrolled,including 30 patients with SAE and 20 with simple LA.NAA (median,quartile interval; M,IQR) (0.732 [0.680-0.804] vs.0.915 [0.866-0.963] ; Z =5.634,P ＜ 0.001) and NAA/Cr(M,IQR)(1.533 [1.317-1.817] vs.2.003 [1.794-2.387];Z=-3.921,P＜0.001) intheSAE group were significantly lower than those in the simple LA group.The htency of P300 (M,IQR) in the SAE group was significantly bnger than that in the LA group (370.50 [363.50-385.25] msvs.351.50 [342.75-359.00] ms; Z =-4.382,P ＜ 0.001),and the amplitude (M,IQR) was significantly lower than that in the simple LA group (4.35 [2.90-7.20] mVvs.6.95 [5.93-9.10] mV; Z=-2.942,P=0.003).Conclusions 1H-MRS can be used to identify the patients with SAE and simple LA,and provide an objective basis for the prevention of progress from LA to SAE.
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Primary breast lymphoma (PBL) is a kind of rare primary extranodal lymphoma, which is of relatively poor prognosis and so far there is no unified treatment. In the case diagnosed by Our hospital where one patient recurring breast diffuse large B cell lymphoma (DLBCL) many times, has been treated with good therapeutic effect through surgery, chemotherapy, targeted drug therapy and radiotherapy. A multidisciplinary discussion is made concerning the treatment of the patient in this article for the purpose of further discussing the standard treatment procedure for PBL and promoting multi-disciplinary team.
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Objective Compare the value of multislice CT perfusion imaging (MSCTPI)?color brain atlas (CBA)?visual evoked potential mapping (VEP-M) in the diagnosis of acute cerebral infarction.Methods After routine CT was performed,the 27 cases of acute cerebral infarction underwent MSCTPI?CBA?and VEP-M respectively.Results The examination of MSCTPI showed that abnormal perfusion changes were in accordance with clinical symptoms;the examination of CBA showed that in 32 scale local high power shadow presented on the power of ??? of lesion;the examination of VEP-M showed the prolongation of latency of P100?degrade of amplitude on the lesion of the chart,the power of the lesion degraded obviously on the map of distribution of power,and distribution asymmetry.Conclusion Combined use of MSCTPI?CBA?VEP-M in the diagnosis of acute cerebral infarction can remedy the defects and improve diagnostic rate of acute cerebral infarction further.