Objective To study the diagnosis and treatment of adrenocorticotrophic hormone (ACTH) independent Cushing syndrome. Methods A retrospective review was done on 89 patients with ACTH independent Cushing syndrome, including 85 cases of adrenal tumors with hypercorticism, 2 cases of adrenocortical adenocarcinoma and 2 cases with ACTH independent macronodular adrenal hyperplasia. Results Favorable results were observed from the surgery for 85 cases of adrenal tumors combined with hypercorticism.Two cases with ACTH independent macronodular adrenal hyperplasia were cured by bilateral adrenolectomy. Adrenal cortical adenocarcinoma was unresectable for both the patients who survived 7 and 9 months respectively. Plasma ACTH,dexamethasone suppression test,B ultrasonography and CT scan were useful for the diagnosis and differentiated diagnosis of ACTH independent Cushing syndrome. Conclusions Prognosis of adrenal tumors with hypercorticism and ACTH independent macronodular adrenal hyperplasia is favorable after surgery,whereas the prognosis of adrenal cortical adenocarcinoma is poor.

l 1H-MRS was good for clinical purpose.

Objective To evaluate the diagnostic value of in vivo 1H-MRS in the hyper acute reaction stage of radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy. Methods Eighteen patients with nasopharyngeal carcinoma accepted radiotherapy for the first time. Bilateral temporal lobes in all cases were examined by conventional MRI and 1H-MRS before and after radiotherapy with radiation dose of 20 Gy, 40 Gy, and 60 Gy, respectively. MR image was performed with T_1-weighted gradient- and spin-echo, T_2-weighted spin-echo, fluid-attenuated inversion-recovery, and point resolution spectroscopy. The change of the spectroscopic morphology and the ratios of the metabolites were observed. Results There were no changes of signal in the temporal lobes with conventional MRI, but the peak height of NAA and Cho decreased obviously in the anterior half of the temporal lobes with 1H-MRS after radiotherapy. The post-radiotherapy changes of different metabolic peak in the anterior temporal lobes presented as two types: one type was that Cho and NAA peak were of the same height simultaneously. There were 20 locations (56%) of the 36 reaching the peak when accepting 20 Gy, 22 (61%) when accepting 40 Gy, and 13 (36%) when accepting 60 Gy, respectively. The other type was that Cho peak became the highest, whereas NAA peak was obviously lower and decreased to be the second highest. There were 4 locations(11%) of the 36 reaching the peak when accepting 20 Gy, 10 (28%) when accepting 40 Gy, and 23 (64%) when accepting 60 Gy, respectively. The ratio of Cho/Cr, NAA/Cr, and NAA/Cho decreased in the same position too. In addition, there was positive correlation between the ratios of the metabolites and the dose of radiotherapy.Conclusion 1H-MRS can be used to diagnose the radiation-induced injury of the brain in early acute reaction stage after nasopharyngeal carcinoma radiotherapy through reflecting histiocytic metabolism, and provide objective basis for pathology development and cellular metabolism study, also it can provide feasible projects for the clinic.

The value of combined application of both ECG-gated cine MRA and 3D-CEMRA in the detection of large intracranial aneurysms was evaluated and the findings were compared with those of conventional MRA and DSA. Twenty-four patients with 26 large intracranial aneurysms underwent MRI and DSA. All these aneurysms, diameter from 15 to 39 mm, were located at internal cerebral artery (n=12), vertebral artery (n=3), basilar artery (n=4), anterior cerebral artery (n=2), middle cerebral artery (n=2), anterior communicate artery (n=2) and posterior communicate artery (n=1). Thirteen cases of hematoma or cavernoma were studied as control group. All patients were examined on GE 1.5T MR system. ECG-gated cine MRA was performed with 2D multi-phase fast gradient-recalled echo sequence in a single section. All the images were analyzed with signal intensity VS time curve for differentiating intraaneurysmal blood flow from static tissue. The results were analyzed by statistic "t" test. 3D-CEMRA was performed with spoiled gradient-recalled echo and one dose of Gd-DTPA. All data was processed with multi-plannar reformat (MPR) and tomography for the demonstration of aneurysms in detail. All 26 aneurysms were demonstrated successfully by combined application of both cine MRA and 3D-CEMRA. Compared to DSA and conventional 3D-MOTSA, its sensitivity and specificity figures were both 100%. Cine MRA could differentiate the blood flow from the static tissue. The intensity VS time curves of intraaneurysmal blood flow offered fluctuating form and average signal change between systole and diastole period was about 89.8 +/- 37.4; However, under the control group, intraaneurysmal thrombus or cerebral hemorrhage or cavernomas had no significant signal change and the curves offered steady form with the average signal change being about 8.2 +/- 6.3. There was statistically significant difference between the intraaneurysmal blood flow and static tissue (P=0.025, <0.05). 3D-CEMRA was very useful in demonstrating the aneurysmal size, intraaneurysmal thrombus formation, neck and the detailed relationship of the aneurysm to the surrounding structures. It was concluded that the combined application of both cine MRA and 3D-CEMRA might be a valuable clinical tool for the detection of large intracranial aneurysms.
Angiography, Digital Subtraction ; Contrast Media ; Evaluation Studies ; Image Enhancement ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional/methods ; Intracranial Aneurysm/*diagnosis ; Magnetic Resonance Angiography/*methods ; *Magnetic Resonance Imaging, Cine

Objective To investigate the change of diffusion tensor imaging (DTI) parameters on extracorticospinal tract and some domain in Parkinson disease (PD), and to explore the relationship between DTI parameters and PD. Methods Ten PD patients with unilateral symptoms and 20 with bilateral symptoms were enrolled in PD group 1 and PD group 2, respectively. Control group included 30 volunteers whose age and sex matched with those of PD group. PD patients and the subjects in control group underwent routine MR plain scan and DTI scan. FA and ADC maps were obtained after postprocessing. FA values and ADC values of ROI (region of interest) were measured. ROI included substantia nigra (SN), red nucleus (NR), globus pallidus (GP), putamen (PUT), caudate nucleus (CN), thalamus, genu of corpus callosum, splenium of corpus callosum, callosal gyrus, white matter of frontal lobe and anterior centra gyrus. All data were analyzed statistically. Results FA value of SN, CN, thalamus and splenium of corpus callosum of PD group degraded obviously compared with that of control group (P<0.05). FA value of PD group 1 was lower than control group and PD group 2 at anterior central gyrus and callosal gyrus (P<0.05). There was no significant difference of FA value among PD groups and control group at other ROI's. There was negative correlation between the changes of FA value at SN and PD grade. No significant difference was found in ADC value among PD group 1, PD group 2 and control group, but there was an increasing tendency of ADC value along with the progress of PD. Conclusion FA values of SN, CN, thalamus and splenium of corpus callosum can offer some important information for the early diagnosis of PD. DTI is useful for the study about PD's pathomechanism and clinical manifestation in vivo.

The value of combined application of both ECG-gated cine MRA and 3D-CEMRA in the detection of large intracranial aneurysms was evaluated and the findings were compared with those of conventional MRA and DSA. Twenty-four patients with 26 large intracranial aneurysms underwent MRI and DSA. All these aneurysms, diameter from 15 to 39 mm, were located at internal cerebral artery (n=12), vertebral artery (n=3), basilar artery (n=4), anterior cerebral artery (n=2), middle cerebral artery (n=2), anterior communicate artery (n=2) and posterior communicate artery (n=1). Thirteen cases of hematoma or cavernoma were studied as control group. All patients were examined on GE 1.5T MR system. ECG-gated cine MRA was performed with 2D multi-phase fast gradient-recalled echo sequence in a single section. All the images were analyzed with signal intensity VS time curve for differentiating intraaneurysmal blood flow from static tissue. The results were analyzed by statistic "t" test. 3D-CEMRA was performed with spoiled gradient-recalled echo and one dose of Gd-DTPA. All data was processed with multi-plannar reformat (MPR) and tomography for the demonstration of aneurysms in detail. All 26 aneurysms were demonstrated successfully by combined application of both cine MRA and 3D-CEMRA. Compared to DSA and conventional 3D-MOTSA, its sensitivity and specificity figures were both 100%. Cine MRA could differentiate the blood flow from the static tissue. The intensity VS time curves of intraaneurysmal blood flow offered fluctuating form and average signal change between systole and diastole period was about 89.8 +/- 37.4; However, under the control group, intraaneurysmal thrombus or cerebral hemorrhage or cavernomas had no significant signal change and the curves offered steady form with the average signal change being about 8.2 +/- 6.3. There was statistically significant difference between the intraaneurysmal blood flow and static tissue (P=0.025, <0.05). 3D-CEMRA was very useful in demonstrating the aneurysmal size, intraaneurysmal thrombus formation, neck and the detailed relationship of the aneurysm to the surrounding structures. It was concluded that the combined application of both cine MRA and 3D-CEMRA might be a valuable clinical tool for the detection of large intracranial aneurysms.
Adult ; Aged ; Angiography, Digital Subtraction ; Contrast Media ; Evaluation Studies as Topic ; Female ; Humans ; Image Enhancement ; Image Processing, Computer-Assisted ; Imaging, Three-Dimensional ; methods ; Intracranial Aneurysm ; diagnosis ; Magnetic Resonance Angiography ; methods ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged

OBJECTIVETo evaluate the value of magnetic resonance imaging (MRI) and three dimensional (3D) contrast magnetic resonance angiography (MRA) in the diagnosis of complications of simultaneous pancreas-kidney transplantation (SPKT), as confirmed by biopsy and digital subtraction angiography (DSA).

METHODSFive MR examinations of five patients were performed within 28 days to 2 years after surgery on GE 1.5T MR system. Imaging techniques included axial and sagittal chemical fat-suppressed T1-weighted image (T1WI) and T2-weighted image (T2WI), additional contrast axial or saggital chemical fat-suppressed T1WI were obtained after 3D contrast MRA for calculating the mean percentage of the parenchymal enhancement (MPPE) of the pancreas and kidney. 3D contrast MRA was performed with Smartprep technique. MRA data were analyzed with maximum intensity projection (MIP) and multi-planner reformat (MPR).

RESULTSIn five cases of transplant pancreases, MRI found two normal pancreas grafts, one case of acute rejection, one case of chronic rejection with 70% fibrosis and one case of late pancreatitis. In five transplant kidneys, MRI detected four normal kidney grafts and one case of acute rejection with infarction. MPPE could distinguish infarction from other complications. 3D contrast MRA could display vascular complications of SPKT, such as stenosis or occlusion, aneurysm formation of transplanted vessels and narrowing at the site of anastomosis, as confirmed by DSA.

CONCLUSIONWith combined application of MRI and 3D contrast MRA, complications of SPKT can be clearly identified.

Adult ; Female ; Humans ; Image Enhancement ; Imaging, Three-Dimensional ; Kidney Transplantation ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pancreas Transplantation

Humans ; Critical Illness ; Critical Care ; Intensive Care Units ; Surveys and Questionnaires

The clinical practice guidelines of traditional Chinese medicine （TCM） have problems such as limited clinical application and unclear implementation effects， which may be related to the lack of clinical practice evidence. To provide reliable and precise evidence for clinical practice， this article proposes a model of combining TCM guidelines with real-world study， which includes 4 steps. Firstly， during the implementation process of the guidelines， a high-quality research database is established. Secondly， the recommendations in the guidelines are evaluated based on the established database in multiple dimensions， including applicability， effectiveness， safety， and cost-effectiveness， and thus their effectiveness in practical applications can be determined. Thirdly， based on the established database， core prescriptions are identified， and the targeted populations and medication plans are determined. That is， the best treatment regimen is established based on the analysis of abundant clinical data regarding the effects of different medication frequencies， dosages， and duration on efficacy. Fourthly， the guidelines are updated according to the real-world evidence. The research based on this model can provide real-world evidence for ancient and empirical prescriptions， improving their application in clinical practice. Moreover， this model can reduce research costs and improve research efficiency. When applying this model， researchers need to pay attention to the quality of real-world evidence， ensuring that it can truly reflect the situation in clinical practice. In addition， importance should be attached to the clinical application of guideline recommendations， ensuring that doctors can conduct standardized diagnosis and treatment according to the guidelines. Finally， full-process participation of multidisciplinary experts is encouraged to ensure the comprehensiveness and scientificity of the study. In conclusion， the application of this model will contribute to the development of TCM guidelines responsive to the needs of clinical practice and achieve the goal of promoting the homogenization of TCM clinical diagnosis and treatment.