multi-modality imaging

多模态成像
  • 文章类型: Journal Article
    二尖瓣返流(MR)是一种广泛的弥漫性瓣膜性心脏病(VHD),对医疗保健系统和患者预后有重大影响。经导管二尖瓣介入治疗(TMVI)现已成为治疗性器械中用于管理二尖瓣反流患者的成熟技术。主要或功能MR。即使指南给出了正确管理VHD的指示,患者临床背景和瓣膜和心脏解剖结构的广泛异质性使每个患者都成为一个独特的病例,其中选择合适的设备需要多模态成像评估和多学科讨论。正确的程序前评估对于判断TMVI的可行性起着举足轻重的作用,而成像者和干预主义者之间的合作对于程序上的成功也至关重要。本手稿旨在提供需要评估的主要参数的详尽概述,以进行适当的设备选择,程序前规划,TMVI设置中的术中指导和术后评估。此外,它试图为结构性心血管成像的未来前景提供一些见解。
    Mitral regurgitation (MR) is a broadly diffuse valvular heart disease (VHD) with a significant impact on the healthcare system and patient prognosis. Transcatheter mitral valve interventions (TMVI) are now well-established techniques included in the therapeutic armamentarium for managing patients with mitral regurgitation, either primary or functional MR. Even if the guidelines give indications regarding the correct management of this VHD, the wide heterogeneity of patients\' clinical backgrounds and valvular and heart anatomies make each patient a unique case, in which the appropriate device\'s selection requires a multimodal imaging evaluation and a multidisciplinary discussion. Proper pre-procedural evaluation plays a pivotal role in judging the feasibility of TMVI, while a cooperative work between imagers and interventionalist is also crucial for procedural success. This manuscript aims to provide an exhaustive overview of the main parameters that need to be evaluated for appropriate device selection, pre-procedural planning, intra-procedural guidance and post-operative assessment in the setting of TMVI. In addition, it tries to give some insights about future perspectives for structural cardiovascular imaging.
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  • 文章类型: Case Reports
    输尿管囊肿是一种先天性异常,其中输尿管远端扩张异常,当它进入膀胱时。尿路感染频繁的患者,尿潴留,周期性腹痛,未能茁壮成长,还有血尿.输尿管囊肿通常在产前超声检查中诊断,有时在产后在尿路感染的情况下进行超声检查。该病例描述了一名51岁的女性,她反复出现尿路感染。随后用超声波成像,静脉尿路造影,计算机断层扫描显示了双侧输尿管囊肿的典型特征。
    A ureterocele is a congenital abnormality in which there is abnormal dilatation of the distalmost portion of the ureter, as it enters the urinary bladder. Patients present with frequent urinary tract infections, urinary retention, cyclical abdominal pains, failure to thrive, and hematuria. Ureteroceles are often diagnosed on antenatal ultrasound and sometimes postnatally on ultrasounds done in the setting of a urinary tract infection. This case describes a 51-year-old female who presented with recurrent urinary tract infections. Subsequent imaging with ultrasound, intravenous urogram, and computed tomography demonstrated features typical for bilateral ureteroceles.
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  • 文章类型: Case Reports
    原发性心脏内膜肉瘤极为罕见,预后不佳。他们的管理代表了一个复杂的临床挑战,因为完全手术切除是唯一可靠的治愈可能性,但仅在50%的患者中可能。在不可切除的疾病中,蒽环类药物是最有效的治疗方法,但帕唑帕尼可用于不适合接受蒽环类药物治疗的患者。
    一名38岁男子因原发性心脏内膜肉瘤而出现急性右心衰竭症状。心脏手术后明确诊断。多模式心脏成像显示二尖瓣和肺静脉侵犯的疾病早期复发,患者被认为无法手术。由于慢性肾脏疾病和以前的心力衰竭症状,他开始接受一线帕唑帕尼姑息治疗。化疗11个月后,有良好的临床耐受性,没有疾病进展的证据,发生在13个月后。
    此案例突出了多模态成像方法对心脏肿块的价值。最重要的是,它报道了一名年轻的原发性心脏内膜肉瘤患者的成功治疗,该患者开始接受姑息帕唑帕尼治疗,无进展生存期明显高于文献报道。当蒽环类化疗有禁忌症时,这一发现可能支持帕唑帕尼作为一线治疗的良好选择。
    UNASSIGNED: Primary intimal sarcomas of the heart are extremely rare and have a dismal prognosis. Their management represents a complex clinical challenge since complete surgical resection is the only reliable possibility of cure but is only possible in 50% of patients. In non-resectable disease, anthracycline-based therapy is the most effective treatment, but pazopanib may be used in patients unfit to receive anthracyclines.
    UNASSIGNED: A 38-year-old man presented with acute right heart failure symptoms due to a primary intimal sarcoma of the heart. A definite diagnosis was made after cardiac surgery. Multi-modality cardiac imaging showed early recurrence of disease with mitral valve and pulmonary veins\' invasion, and the patient was deemed inoperable. Due to chronic kidney disease and previous heart failure symptoms, he was started on first-line pazopanib palliative treatment. After 11 months of chemotherapy, there was good clinical tolerance and no evidence of disease progression, which occurred after 13 months.
    UNASSIGNED: This case highlights the value of a multi-modality imaging approach for cardiac masses. Most importantly, it reports the successful treatment of a young patient with a primary intimal sarcoma of the heart who was started on palliative pazopanib, with a significantly higher progression-free survival than is reported in the literature. This finding may support pazopanib as a good alternative as first-line treatment when there is contraindication for anthracycline-based chemotherapy.
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  • 文章类型: Journal Article
    肥厚型心肌病(HCM)的特征是心肌异常生长,肌丝紊乱和心肌收缩过度,导致左心室肥厚和纤维化。在找出罪魁祸首基因的地方,它们通常与心肌细胞肌节的结构和功能有关。多模态成像在诊断中起着至关重要的作用,监测,和HCM的风险分层,以及筛查那些有风险的人。继最近出版的第一个欧洲心脏病学会(ESC)心肌病指南,我们在以前的综述的基础上,探索心电图的作用,超声心动图,心脏磁共振(CMR),心脏计算机断层扫描(CT),和核成像。我们依次检查每种模态的优势及其局限性,并讨论如何单独使用它们,或组合,为了促进个性化的病人护理方法,以及在新的研究领域提供关键信息和可靠的安全性和有效性证据。
    Hypertrophic cardiomyopathy (HCM) is characterized by abnormal growth of the myocardium with myofilament disarray and myocardial hyper-contractility, leading to left ventricular hypertrophy and fibrosis. Where culprit genes are identified, they typically relate to cardiomyocyte sarcomere structure and function. Multi-modality imaging plays a crucial role in the diagnosis, monitoring, and risk stratification of HCM, as well as in screening those at risk. Following the recent publication of the first European Society of Cardiology (ESC) cardiomyopathy guidelines, we build on previous reviews and explore the roles of electrocardiography, echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography (CT), and nuclear imaging. We examine each modality\'s strengths along with their limitations in turn, and discuss how they can be used in isolation, or in combination, to facilitate a personalized approach to patient care, as well as providing key information and robust safety and efficacy evidence within new areas of research.
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    心脏假性动脉瘤是一种可能危及生命的病理,具有多种非特异性临床表现。这个病例系列独特地分享了一系列罕见的病理,这些病理具有不同的先前风险因素和表现,强调多模态成像在诊断和管理中的实用性。
    我们介绍了3例心脏假性动脉瘤。病例1是一名27岁的女性,延迟出现创伤性左心室假性动脉瘤(LVP)。病例2是一名73岁的男性,患有心肌梗死后LVP。病例3是一名38岁的男性,主动脉瓣置换术后患有左心室流出道假性动脉瘤。
    心脏假性动脉瘤很少见,需要及时诊断。非侵入性成像模式的进步提高了我们区分假性动脉瘤与其他病理的能力,导致更及时的管理。
    UNASSIGNED: Cardiac pseudoaneurysms are a potentially life-threatening pathology with a variety of non-specific clinical manifestations. This case series uniquely shares a collection of rare pathologies with differing preceding risk factors and presentations, with an emphasis on the utility of multi-modality imaging in diagnosis and management.
    UNASSIGNED: We present three cases of cardiac pseudoaneurysms. Case 1 is a 27-year-old woman with delayed presentation of a traumatic left ventricular pseudoaneurysm (LVP). Case 2 is a 73-year-old man with post-myocardial infarction LVP. Case 3 is a 38-year-old man with left ventricular outflow tract pseudoaneurysm after aortic valve replacement.
    UNASSIGNED: Cardiac pseudoaneurysms are rare and important to diagnose in a timely manner. Advances in non-invasive imaging modalities have improved our ability to distinguish pseudoaneurysms from other pathologies, leading to more timely management.
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  • 文章类型: Journal Article
    背景:阿尔茨海默病(AD)中基于tau的神经原纤维缠结(T)和神经变性(N)关系的变异性源于N的非特异性性质,由非AD共病调制,与年龄相关的变化,和弹性因素。
    方法:我们使用区域T-N残差模式将阿尔茨海默病连续体中的184名患者分为数据驱动组。将这些与159名非AD(淀粉样蛋白“阴性”)患者的皮质厚度进行比较,98例患者进行验尸前MRI和验尸后组织测量N和T,分别。我们应用初始T-N残差模型将独立队列中的71名患者分为预定义的组。
    结果:AD组显示空间T-N不匹配模式,类似于非AD组的神经变性模式,与非AD因素和不同的认知结果相似。在尸检队列中,边缘T-N错配与TDP-43共病相关。
    结论:T-N错配可能为确定与AD中的弹性/脆弱性相关的非AD因素提供了一种个性化的方法。
    Variability in relationship of tau-based neurofibrillary tangles (T) and neurodegeneration (N) in Alzheimer\'s disease (AD) arises from non-specific nature of N, modulated by non-AD co-pathologies, age-related changes, and resilience factors.
    We used regional T-N residual patterns to partition 184 patients within the Alzheimer\'s continuum into data-driven groups. These were compared with groups from 159 non-AD (amyloid \"negative\") patients partitioned using cortical thickness, and groups in 98 patients with ante mortem MRI and post mortem tissue for measuring N and T, respectively. We applied the initial T-N residual model to classify 71 patients in an independent cohort into predefined groups.
    AD groups displayed spatial T-N mismatch patterns resembling neurodegeneration patterns in non-AD groups, similarly associated with non-AD factors and diverging cognitive outcomes. In the autopsy cohort, limbic T-N mismatch correlated with TDP-43 co-pathology.
    T-N mismatch may provide a personalized approach for determining non-AD factors associated with resilience/vulnerability in AD.
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  • 文章类型: Journal Article
    每年在欧洲心脏病学会国家中植入超过500,000个心血管可植入电子设备(CIED)。心血管成像在被认为是CIED的患者中的作用与在CIED受者中的成像明显不同。在前一组中,成像可以帮助识别心脏传导阻滞的特定或潜在可逆原因,与恶性心律失常相关的潜在组织特征,传导延迟的机械后果,也可以帮助具有挑战性的铅放置。另一方面,对于标准适应症,CIED接受者都需要进行心血管成像,并评估对植入装置的反应,诊断植入后的即时和延迟并发症,并指导设备优化。本临床共识声明(第1部分)来自欧洲心血管成像协会,与欧洲心律协会合作,提供全面的,对心脏病学家的最新和循证指导,心脏成像仪和起搏专家关于在植入常规起搏器的患者中使用成像,心脏复律除颤器和再同步治疗装置。该文件总结了有关在患者选择和植入过程中使用成像的现有证据,并强调了该领域证据的差距。在第二篇文献(第2部分)中讨论了CIED植入后成像的作用。
    More than 500 000 cardiovascular implantable electronic devices (CIEDs) are implanted in the European Society of Cardiology countries each year. The role of cardiovascular imaging in patients being considered for CIED is distinctly different from imaging in CIED recipients. In the former group, imaging can help identify specific or potentially reversible causes of heart block, the underlying tissue characteristics associated with malignant arrhythmias, and the mechanical consequences of conduction delays and can also aid challenging lead placements. On the other hand, cardiovascular imaging is required in CIED recipients for standard indications and to assess the response to device implantation, to diagnose immediate and delayed complications after implantation, and to guide device optimization. The present clinical consensus statement (Part 1) from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists, cardiac imagers, and pacing specialists regarding the use of imaging in patients undergoing implantation of conventional pacemakers, cardioverter defibrillators, and resynchronization therapy devices. The document summarizes the existing evidence regarding the use of imaging in patient selection and during the implantation procedure and also underlines gaps in evidence in the field. The role of imaging after CIED implantation is discussed in the second document (Part 2).
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  • 文章类型: Journal Article
    NIR-II荧光区域(1000-1700nm)中的聚集诱导发射发光体(AIEgens)由于其可编程的光学,已显示出作为肿瘤多模态诊断成像和联合治疗的治疗探针的巨大潜力,结构和功能特性。在这里,我们提出了放射性核素177Lu标记的AIEgen,177Lu-2TT-oC6B点,用于NIR-II荧光和SPECT/CT成像引导的肿瘤光热和放射性药物治疗。有趣的是,177Lu-2TT-oC6B自组装成10nm点,表现出较高的NIR-II荧光量子产率(QY,1.34%)和前所未有的光热转换效率(PCE,70.3%)体外。极长的血液循环(T1/2=52.4h),通过体内静脉给药获得肿瘤中持续的肿瘤积累和保留(NIR-IISNR=5.56;SPECTSNR=36.59).此外,在NIR光激活和177Lu照射下,177Lu-2TT-oC6B在协同光热/放射性药物肿瘤治疗中显示出巨大的应用潜力。
    Aggregation-induced emission luminogens (AIEgens) in the second near-infrared region (NIR-II,1000-1700 nm) have shown tremendous potential as theragnostic probe for tumor multimodal diagnostic imaging and combined treatment owing to their programmable optical, structural and functional properties. Herein, we presented a radionuclide 177 Lu-labeled AIEgen, 177 Lu-2TT-oC6B dots, for NIR-II fluorescence and SPECT/CT imaging-guided tumor photothermal and radiopharmaceutical therapy. Intriguingly, 177 Lu-2TT-oC6B self-assembled into 10 nm dots, exhibited high NIR-II fluorescence quantum yield (QY, 1.34 %) and unprecedented photothermal conversion efficiency (PCE, 70.3 %) in vitro, furtherly performed extremely long blood circulation (T1/2 =52.4 h), persistent tumor accumulation and retention in tumor (NIR-II SNR=5.56; SPECT SNR=36.59) via intravenous administration in vivo. Furthermore, upon NIR light activation and 177 Lu irradiation, 177 Lu-2TT-oC6B demonstrated great application potential in synergistic photothermal/radiopharmaceutical tumor therapy.
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  • 文章类型: Journal Article
    动态静息状态功能连通性(RRFC)表征功能性脑网络活动的时变波动。虽然许多研究已经调查了静态功能连通性,目前尚不清楚动态功能连接的特征是否与神经退行性疾病相关.用于提取动态RSFC的流行的滑动窗口和聚类方法具有各种限制,这些限制阻止提取可靠的特征来解决此问题。这里,我们使用一种新颖且稳健的时变动态网络(TVDN)方法,从阿尔茨海默病(AD)参与者和匹配对照的高分辨率脑磁图(MEG)数据中提取动态RSFC特征.TVDN算法自动和自适应地学习动态RSFC的低维时空流形,并检测数据中的动态状态转换。我们表明,在我们研究的所有功能特征中,动态流形特征对AD的预测能力最强。这些包括:大脑网络的时间复杂性,由状态转换的数量和它们的停留时间给出,以及大脑网络的空间复杂性,由本征模式的数量给出。这些动态特征在区分AD与健康受试者方面具有高灵敏度和特异性。有趣的是,我们发现,与健康对照组相比,AD患者通常具有较高的空间复杂度,但时间复杂度较低.我们还表明,TVDN动态成分的图论指标在AD与对照中存在显着差异,而静态图形度量在统计上没有差异。这些结果表明,动态RSFC特征在神经退行性疾病如阿尔茨海默病中受到影响,并且可能对理解这些疾病的病理生理轨迹至关重要。
    Dynamic resting state functional connectivity (RSFC) characterizes time-varying fluctuations of functional brain network activity. While many studies have investigated static functional connectivity, it has been unclear whether features of dynamic functional connectivity are associated with neurodegenerative diseases. Popular sliding-window and clustering methods for extracting dynamic RSFC have various limitations that prevent extracting reliable features to address this question. Here, we use a novel and robust time-varying dynamic network (TVDN) approach to extract the dynamic RSFC features from high resolution magnetoencephalography (MEG) data of participants with Alzheimer\'s disease (AD) and matched controls. The TVDN algorithm automatically and adaptively learns the low-dimensional spatiotemporal manifold of dynamic RSFC and detects dynamic state transitions in data. We show that amongst all the functional features we investigated, the dynamic manifold features are the most predictive of AD. These include: the temporal complexity of the brain network, given by the number of state transitions and their dwell times, and the spatial complexity of the brain network, given by the number of eigenmodes. These dynamic features have higher sensitivity and specificity in distinguishing AD from healthy subjects than the existing benchmarks do. Intriguingly, we found that AD patients generally have higher spatial complexity but lower temporal complexity compared with healthy controls. We also show that graph theoretic metrics of dynamic component of TVDN are significantly different in AD versus controls, while static graph metrics are not statistically different. These results indicate that dynamic RSFC features are impacted in neurodegenerative disease like Alzheimer\'s disease, and may be crucial to understanding the pathophysiological trajectory of these diseases.
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