The authors have no acknowledgements.

这项研究是在所有参与中心经当地机构审查委员会。在多中心临床试验的所有受试者提供书面知情同意参与eTRIS在各自的机构。 1.图像采集<ol><li>执行使用专门的相控阵线圈MRV 1.5 T或3个T全身扫描仪的磁共振成像诸如末梢血管线圈，体基质线圈或径流线圈。与其他身体矩阵线圈或脊柱线圈一起使用这些线圈。如果没有合适的专门的线圈可用，用身体代替线圈。 注：使用市售的扫描仪，如西门子交响乐，奏鸣曲等。 <ol><li>屏幕主题，扫描前审查MRI安全调查问卷。有变更将成为一个袍子。 </li></ol></li><li>放置在受试者的注射造影剂的肘前静脉的静脉内线路。按照标准安全PROCedures注射钆造影剂。 </li><li>仰卧，在MRI机器和位置适当的线圈区域上脚先地位的地方接受扫描。安全使用的线圈绑带魔术贴需要。 <ol><li>法尔胜主体的腿/脚，以防止运动伪影在MRI扫描。 </li><li>打开定心激光和移动台，直到激光横梁就位于被检者的膝盖（髌骨）所示。接受这个位置的扫描的等角点移动患者台到扫描器孔的中心位置。 </li></ol></li><li>测量肌酐清除率（CrCl），并确定要用于根据受试者体重的造影剂的剂量。如果肌酐清除率&lt;30毫升/分钟，但被排除在研究。用于与CRCL“30毫升/分钟但小于45毫升/分钟的个人，0.01毫摩尔/千克的造影剂的使用。为个人提供的CrCl&gt;45毫升/分钟但&lt;60毫升/分钟，0.02毫摩尔/千克gadofo的sveset被注入。对于具有正常肾功能（肌酐清除率“60毫升/分钟）的个体，0.03毫摩尔/公斤（0.12毫升/公斤）gadofosveset磷酸三钠的剂量使用。一种MRI兼容动力注射器被用来将造影剂注入。 </li><li>如表1所示和在MRI方案一节中所述进行双腿和下部骨盆在单个检查会话持续大约60分钟的双侧成像。 注：匿名图像传送到一个​​中心芯实验室进行分析前的患者数据。 </li></ol> 2. MRI协议<ol><li>通过选择从协议窗口每个协议步骤，并将其拖动到执行列表执行从扫描器控制台成像协议。一旦准备就绪，按扫描/执行或等效按钮运行序列。 </li><li>获得2D梯度回波中旬小牛使用表1中的序列参数，在三个正交轴来基于图像序列上述髂嵴和使用作为本地化/侦察兵。 </li><li>如表1中指定执行的每个段中飞行（TOF）的血管造影扫描时间 注意：这些扫描也用作定位器，以区分从静脉动脉作为长循环的造影剂是用在稳定状态在此协议。这种观点动脉树是相当有限的，只是为了帮助图像分析员从静脉血管区分动脉和不作为一个成熟的血管造影。 </li><li>为了避免在采集成像体积的劣势和优越的程度较差的图像质量，收购三家冠状40厘米段脚在3D T1加权梯度回波扫描头方向×10厘米的重叠。 注意：这些三个段包括：一）中小腿到膝盖以上b）中膝盖大腿/下部骨盆和c）大腿/骨盆腹图1示出了样本图像与三个采集位置。说明。 </li><li>急慢性静脉血栓形成区分，收购T1W直接血栓成像（DTHI），并在表1中使用参数3D梯度回波（GRE）序列。 注意：这些3次扫描也可以作为对MRV收购预增强扫描。这些收购的覆盖程度是相同的，在图中所示的三个位置中获取的初始定位器1。GRE序列也对各种扫描平台和跨成像的场强容易实施的。 </li></ol><img alt="图1" src="/files/ftp_upload/52761/52761fig1.jpg" /> 图1：表示用于成像的3站采集地点样本图像的视图在冠状方向和轴向方向上的场为40cm的每个床位置[采集：（中小腿到膝盖以上），（以上膝盖大腿/骨盆），（大腿/骨盆<html>以腹部），每个床位之间10厘米重叠。 （ 一 ）轴向图像; （二）矢状图像和（c）冠状图像。红色箭头表示DVT。 <a href="https://www.jove.com/files/ftp_upload/52761/52761fig1highres.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <ol start="6"><li>施用造影剂（gadofosveset磷酸三钠）以0.03毫摩尔/公斤（0.12毫升/千克）静脉内入受试者的剂量为2毫升/秒的速率，用20ml生理盐水冲洗。让造影剂循环5分钟，以确保在血池的稳定状态。 </li><li>获得MRV图像;在3个地点交造影3D梯度回波序列如前所述。 见表1和表2序列参数。使用这些图像，以确定所述血栓的位置和大小。 </li></ol>文件/ ftp_upload / 52761 / 52761table1.jpg“/&gt; 表1：用造影剂，gadofosveset磷酸三钠，包括直接血栓成像下肢磁共振造影协议。 <img alt="表2" src="/files/ftp_upload/52761/52761table2.jpg" /> 表2：在协议获取的每个序列的特定摄像参数。 <ol start="8"><li>扫描完成后，从核磁共振成像扫描仪主题，并采取了静脉线。要求如有更改了礼服和退出设施。 </li></ol> 3.图像分析<ol><li>执行图像分析的专用图像分析工作站运行FDA批准的开源图像处理软件如OsiriX MD 20上，由受过训练的2图像分析。确保分析师有一个最低的每次3年的工作经验。 </li><li>转移到图像之前短暂致盲所有图片分析师工作站进行分析。 </li><li>确保放射科医师评估为血栓的存在和位置的每个MRI扫描。提供放射科医师的评估到图像分析以用作整个分析的指导方针。 </li><li>通过选择“导入”加载从受试者到图像处理软件的两个MRI访问所有DICOM图像，并比较该两个成像的时间点的MRV系列的每个受试者，以确保整个时间点足够空间覆盖和注册。 <ol><li>选择浏览器的“3D MPR”工具提供图像数据的同时浏览的3正交视图（轴向，冠状，矢状和）。 注：该图像处理软件的3D MPR模式使感兴趣的血管的观看。 </li></ol></li><li>分析以下的船只，如果DVT存在：髂外，股总，股浅，股深，腘动脉​​，胫前，胫后I＆二，腓肠肌I＆II，和腓I＆II脉。所有分析仅限于存在于从两个时间点的图像的血管的区域。 </li><li>评估每个静脉与已知的DVT的图像的质量作为一个0-5级表示由放射科医生的评估，有0-2个是无法分析和3-5是可分析的同时为DTHI和MRV序列。对于评分系统的崩溃见图2。 </li></ol><img alt="图2" src="/files/ftp_upload/52761/52761fig2.jpg" /> 图2：用于评估图像的质量与已知的DVT每个感兴趣的静脉评分系统的崩溃。 <ol start="7"><li>对于MRV分析，逐一分析每个容器。经过三维曲面多平面重建，使用下面的每一个静脉，通过跟踪分析师的中心线轮廓，产生弯曲的路径，每个静脉并保存到文件。 <ol><li>建立在三维空间中的血栓的位置。从弯曲的MPR平面，3D贝塞尔路径将被显示出来。 </li><li>通过选择“创模”的“轮廓路径”工具划定静脉的中心线。 </li><li>地方点上反复任何正交的MPR视图拉直感兴趣的整个容器中。 </li><li>进行调整，必要时，以确保船舶完全伸直在“编辑模式” </li><li>当轮廓路径准确圈定在血管中心线，节省通过选择“曲线路径”图标导出文件</li><li>产生1毫米轴向切片垂直于弯曲路径并保存为DICOM文件（ 图3）。观察该曲线路径，拉直容器，以及相应的轴位图像从MRV图像量化DVT。 注：在3D曲面MPR阅读器渲染这些图像必须被我出口Ñ​​DICOM格式并添加到数据库中作为一个新的一系列图像。 </li></ol></li></ol><img alt="图3" src="/files/ftp_upload/52761/52761fig3.jpg" /> 图3：对MRV序列所示样品的DVT（ⅰ，左图）曲线路径（黄线）示出了轮廓随后静脉被分析。 （ 二 ，中间面板）整了整船只沿中心线船只被分析（红色虚线）（ 三 ，右图）显示轴位片垂直静脉用黄线（A，B，C）上的纵向部分指示的位置被分析。 <a href="https://www.jove.com/files/ftp_upload/52761/52761fig3highres.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <ol start="7"><li><ol start="7"><li>对这些轴向DICOM图像，手动分段区域息，通过使用“封闭多边形的ROI工具”涵盖了血栓（ 见图4）。保存利益的地区，通过选择“保存此系列的所有ROI”位于“投资回报率”，以文件下拉菜单，节省投资回报率指标通过导航到“插件”菜单中，选择“工具的投资回报率”，其次是“出口的ROI “。这应该被保存在一个CSV格式。 </li></ol></li></ol><img alt="图4" src="/files/ftp_upload/52761/52761fig4.jpg" /> 图4：利息（绿色）手动分割区域显示包含在轴向格式化DICOM图像血栓 <a href="https://www.jove.com/files/ftp_upload/52761/52761fig4highres.jpg" target="_blank">请点击此处查看该图的放大版本。</a> <ol start="7"><li><ol start="8"><li>乘以芳计算血栓体积<html> EA通过使用内置MATLAB脚本定制的切片厚度（1毫米）每个切片分析上。通过在每个容器中加入血栓体积计算每个科目的总体积血栓。 </li></ol></li><li>对于DTHI分析，找出新鲜血栓明亮区域由MRV分割的DVT区域内造影前的T1W 3D梯度回波扫描13。 <ol><li>上轴向预对比度的图像，通过绘制的感兴趣区（ROI）手动如图5区域计算的新鲜血栓的体 ​​积。在图6中，表示DVT通过DTHI与MRV图像一起测量样本图像被描绘。 </li><li>打开彼此并排的造影前的和后的对比序列。选择“轴”的观点，并划定明亮区域的沿采用“封闭的多边形ROI工具”的船只。 </li></ol></li></ol>ES / ftp_upload / 52761 / 52761fig5.jpg“/&gt; 图5：对DTHI成像序列所示样品DVT（一 ）冠状图像，（B）轴向图像，和（c）的轴向图象，显示的兴趣（绿色）区域追踪预对比度图像周围新鲜血栓（蓝色箭头）。的DTHI图像获取的注入造影剂之前，依靠血栓的气象 - 血红蛋白含量，以产生亮信号。 <img alt="图6" src="/files/ftp_upload/52761/52761fig6.jpg" /> 图6：关于DTHI成像序列中所示样品的DVT左侧图板显示的MRV图像与表示总DVT（绿色箭头）信号空隙。相应DTHI图像明亮信号指示的新鲜血栓（蓝色箭头）存在右侧面板显示。 <a href="https://www.jove.com/files/ftp_upload/52761/52761fig6highres.jpg" target="_blank">请点击此处查看</a>更大的版本这个数字。 重现性4.评估<ol><li>评估十受试者的一个子集用于该分析的再现性。 </li><li>如上所述，通过两个独立的图像分析（伯和仲读者）评估观察者间变异性进行分析， </li><li>确保第一分析来评估结果的内观察员变异后三个月初级读者还执行第二图像分析。 </li><li>计算内部类相关系数（ICC）和执行奥特曼分析来评估国米和内部观察员可重复性。开展了一个样本t检验来寻找偏见奥特曼分析。 ICC&gt; 0.9和奥特曼分析没有偏差，被认为是可以接受的。 </li></ol>

<ol>
	<li>Goldhaber, S. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Venous+thromboembolism:+epidemiology+and+magnitude+of+the+problem.">Venous thromboembolism: epidemiology and magnitude of the problem.</a> Best Pract Res Clin Haematol. 25, 235-242 (2012).</li><li>Huisman, M. V., Klok, F. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+management+of+acute+deep+vein+thrombosis+and+pulmonary+embolism.">Diagnostic management of acute deep vein thrombosis and pulmonary embolism.</a> J Thromb Haemost. 11, 412-422 (2013).</li><li>Ramzi, D. W., Leeper, K. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=DVT+and+pulmonary+embolism.">DVT and pulmonary embolism.</a> Part I. Diagnosis. Am Fam Physician. 69, 2829-2836 (2004).</li><li>Wilbur, J., Shian, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+of+deep+venous+thrombosis+and+pulmonary+embolism.">Diagnosis of deep venous thrombosis and pulmonary embolism.</a> Am Fam Physician. 86, 913-919 (2012).</li><li>Goodacre, S., Sampson, F., Thomas, S., van Beek, E., Sutton, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+and+meta-analysis+of+the+diagnostic+accuracy+of+ultrasonography+for+deep+vein+thrombosis.">Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis.</a> BMC Med Imaging. 5, 6 (2005).</li><li>Elias, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+single+complete+ultrasound+investigation+of+the+venous+network+for+the+diagnostic+management+of+patients+with+a+clinically+suspected+first+episode+of+deep+venous+thrombosis+of+the+lower+limbs.">A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs.</a> Thromb Haemost. 89, 221-227 (2003).</li><li>Farahmand, S., Farnia, M., Shahriaran, S., Khashayar, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+accuracy+of+limited+B-mode+compression+technique+in+diagnosing+deep+venous+thrombosis+in+lower+extremities.">The accuracy of limited B-mode compression technique in diagnosing deep venous thrombosis in lower extremities.</a> Am J Emerg Med. 29, 687-690 (2011).</li><li>Sampson, F. C., Goodacre, S. W., Thomas, S. M., van Beek, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+accuracy+of+MRI+in+diagnosis+of+suspected+deep+vein+thrombosis:+systematic+review+and+meta-analysis.">The accuracy of MRI in diagnosis of suspected deep vein thrombosis: systematic review and meta-analysis.</a> Eur Radiol. 17, 175-181 (2007).</li><li>Moody, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Direct+imaging+of+deep-vein+thrombosis+with+magnetic+resonance+imaging.">Direct imaging of deep-vein thrombosis with magnetic resonance imaging.</a> Lancet. 350, 1073 (1997).</li><li>Phinikaridou, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+vivo+magnetization+transfer+and+diffusion-weighted+magnetic+resonance+imaging+detects+thrombus+composition+in+a+mouse+model+of+deep+vein+thrombosis.">In vivo magnetization transfer and diffusion-weighted magnetic resonance imaging detects thrombus composition in a mouse model of deep vein thrombosis.</a> Circ Cardiovasc Imaging. 6, 433-440 (2013).</li><li>Phinikaridou, A., Qiao, Y., Giordano, N., Hamilton, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+thrombus+size+and+protein+content+by+ex+vivo+magnetization+transfer+and+diffusion+weighted+MRI.">Detection of thrombus size and protein content by ex vivo magnetization transfer and diffusion weighted MRI.</a> J Cardiovasc Magn Reson. 14, 45 (2012).</li><li>Carpenter, J. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+venography+for+the+detection+of+deep+venous+thrombosis:+comparison+with+contrast+venography+and+duplex+Doppler+ultrasonography.">Magnetic resonance venography for the detection of deep venous thrombosis: comparison with contrast venography and duplex Doppler ultrasonography.</a> J Vasc Surg. 18, 734-741 (1993).</li><li>Westerbeek, R. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+direct+thrombus+imaging+of+the+evolution+of+acute+deep+vein+thrombosis+of+the+leg.">Magnetic resonance direct thrombus imaging of the evolution of acute deep vein thrombosis of the leg.</a> J Thromb Haemost. 6, 1087-1092 (2008).</li><li>Koizumi, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+venography+of+the+lower+limb.">Magnetic resonance venography of the lower limb.</a> Int Angiol. 26, 171-182 (2007).</li><li>Goyen, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gadofosveset:+the+first+intravascular+contrast+agent+EU-approved+for+use+with+magnetic+resonance+angiography.">Gadofosveset: the first intravascular contrast agent EU-approved for use with magnetic resonance angiography.</a> Future Cardiol. 3, 19-26 (2007).</li><li>Aime, S., Caravan, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Biodistribution+of+gadolinium-based+contrast+agents,+including+gadolinium+deposition.">Biodistribution of gadolinium-based contrast agents, including gadolinium deposition.</a> J Magn Reson Imaging. 30, 1259-1267 (2009).</li><li>Shamsi, K., Yucel, E. K., Chamberlin, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+summary+of+safety+of+gadofosveset+(MS-325)+at+0.03+mmol/kg+body+weight+dose:+Phase+II+and+Phase+III+clinical+trials+data.">A summary of safety of gadofosveset (MS-325) at 0.03 mmol/kg body weight dose: Phase II and Phase III clinical trials data.</a> Invest Radiol. 41, 822-830 (2006).</li><li>Zhang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trisodium-[(2-(R)-[(4,4-diphenylcyclohexyl)phosphono-oxymethyl]-diethylenetriamin+epentaacetato)(aquo)gadolinium(III).">Trisodium-[(2-(R)-[(4,4-diphenylcyclohexyl)phosphono-oxymethyl]-diethylenetriamin epentaacetato)(aquo)gadolinium(III).</a> Gadofosveset. , (2004).</li><li>Pfeil, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+VIBE+venography+using+the+blood+pool+contrast+agent+gadofosveset+trisodium--an+interrater+reliability+study.">Magnetic resonance VIBE venography using the blood pool contrast agent gadofosveset trisodium--an interrater reliability study.</a> Eur J Radiol. 81, 547-552 (2012).</li><li>Rosset, A., Spadola, L., Ratib, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=OsiriX:+an+open-source+software+for+navigating+in+multidimensional+DICOM+images.">OsiriX: an open-source software for navigating in multidimensional DICOM images.</a> J Digit Imaging. 17, 205-216 (2004).</li><li>Ouriel, K., Greenberg, R. K., Green, R. M., Massullo, J. M., Goines, D. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+volumetric+index+for+the+quantification+of+deep+venous+thrombosis.">A volumetric index for the quantification of deep venous thrombosis.</a> J Vasc Surg. 30, 1060-1066 (1999).</li><li>Elias, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+single+complete+ultrasound+investigation+of+the+venous+network+for+the+diagnostic+management+of+patients+with+a+clinically+suspected+first+episode+of+deep+venous+thrombosis+of+the+lower+limbs.">A single complete ultrasound investigation of the venous network for the diagnostic management of patients with a clinically suspected first episode of deep venous thrombosis of the lower limbs.</a> Thromb Haemost. 89, 221-227 (2003).</li><li>Farahmand, S., Farnia, M., Shahriaran, S., Khashayar, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+accuracy+of+limited+B-mode+compression+technique+in+diagnosing+deep+venous+thrombosis+in+lower+extremities.">The accuracy of limited B-mode compression technique in diagnosing deep venous thrombosis in lower extremities.</a> Am J Emerg Med. 29, 687-690 (2011).</li><li>Thomas, S. M., Goodacre, S. W., Sampson, F. C., van Beek, E. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+value+of+CT+for+deep+vein+thrombosis:+results+of+a+systematic+review+and+meta-analysis.">Diagnostic value of CT for deep vein thrombosis: results of a systematic review and meta-analysis.</a> Clin Radiol. 63, 299-304 (2008).</li><li>Heverhagen, J. T., Krombach, G. A., Gizewski, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+of+Extracellular+Gadolinium-based+MRI+Contrast+Agents+and+the+Risk+of+Nephrogenic+Systemic+Fibrosis.">Application of Extracellular Gadolinium-based MRI Contrast Agents and the Risk of Nephrogenic Systemic Fibrosis.</a> Rofo. , (2014).</li><li>Alhadad, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+aspects+of+gadofosveset+in+clinical+practice+-+analysis+of+acute+and+long-term+complications.">Safety aspects of gadofosveset in clinical practice - analysis of acute and long-term complications.</a> Magn Reson Imaging. , (2014).</li></ol>

Venkatesh Mani has received research grants from Novartis. Nadia Alie, Sarayu Ramachandran, Cecilia Besa, Philip Robson and Bachir Taouli have nothing to disclose. Michele Mercuri and Michael Grosso are employees of Daiichi Sankyo. Greg Piazza has received research grants from Daiichi Sankyo, BMS, EKOS, and the Thrombosis Research Institute. Samuel Goldhaber has received grants from BMS, Daiichi Sankyo, EKOS, NHLBI and the Thrombosis Research Institute. He is a consultant for Ariad, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Genentech, Janssen, Merck, Pfizer and Portola. Zahi Fayad has received research grants from Daiichi Sankyo, Roche, GlaxoSmithKline, Merck, VBL Therapeutics, Novartis, Bristol-Myers Squibb, and Via Pharmaceuticals.

使用gadofosveset磷酸三钠作为造影剂，用分析的定量血栓的体积在多中心良好的重现性，本研究证实深静脉血栓形成的定量的可行性磁共振造影。要计算总成交量血栓的主要方法使用后对比MRV扫描来测量体积血栓。所使用的二次方法是直接血栓成像方法（DTHI），它利用会见血红蛋白的存在内的新鲜血栓产生一个明亮的信号在T1W MR图像13,14。在MRV音量措施高度重复性。该DTHI方法有较少的重现?...

静脉血栓栓塞（VTE）每年影响1在美国300,000-600,000人。深静脉血栓（DVT）是静脉血栓栓塞的最常见的表现，且最常见的影响小腿，大腿或盆腔静脉。诊断，管理和后续的科目DVT不能仅仅根据临床检查，因为这种疾病的症状和体征非特异性2,3。而验血（如D-二聚体）可以帮助排除DVT的诊断，成像要求建立DVT 4的存在。压缩超声（CUS）是目前在疑似急性DVT诊断中最常用的成像试验。 CUS价格低廉，具有较高的敏感性和特异性检测急性深静脉血栓形成5。然而，CUS不能可靠地评估深静脉肾盂6。此外，CUS不能直接量化血栓数量和组成，区分betw时非常重要EEN急性深静脉血栓形成和慢性DVT（不太可能栓塞）和治疗功效7的评价（肺栓塞（PE）的潜在来源）。 不像计算机断层扫描（CT），磁共振成像（MRI）不提供电离辐射，并且因此适合于串行检查以评价血栓进化或消退。与CUS相比，MRI可检测盆腔DVT和能够更精确地定义近端（腘静脉及以上）和远端腿（下面腘静脉）的DVT 8，以更好地评估PE的风险。 MRI可表征血栓的年龄和组织，并可能有助于慢性DVT 9-11（参更新）区分严重。血栓的体积，以评估治疗的疾病演变和响应的一个重要指标，定量与磁共振成像是可行的。当前的磁共振造影协议注射钆（Gd）造影剂12之后执行。这些小分子量分子迅速外渗注射后，并且需要仔细定时拍摄需要正确的形象化13,14血栓静脉强化阶段。 概念验证的研究，edoxaban减少血栓影像学研究（eTRIS），采用开放式标签设计，调查的疗效和每天10天edoxaban 90毫克，一次安全，其次是edoxaban 60毫克，每天一次治疗急性，症状性DVT（ClinicalTrials.gov标识符：NCT01662908）。 eTRIS地址是否edoxaban单一治疗，而没有伴随的低分子量肝素（LMW肝素）在开始治疗的时间，比用低分子量肝素/华法林治疗的受试者与DVT标准治疗更有效的评估，从百分比（％）变化在基线量血栓/尺寸（通过MRI测量）在14-21天。 eTRIS的另一个目标是开发和验证一个简单的MR在DVT血栓体积的量化静脉造影（MRV）的图像采集和分析的协议。为了克服所面临的多中心设置当前MRV协议的一些挑战，我们利用最近FDA批准的，长循环，钆血池造影剂（gadofosveset三钠）。相比，使用细胞外基于Gd的螯合物（ 例如，钆DTPA）为MRV，gadofosveset具有显著较长的循环时间，这允许使用更简单的MR采集方案，而不采集的任何定时。 Gadofosveset磷酸三钠是静脉注射后15,16循环2-3小时的血池MRI造影剂。它的安全性是类似于那些传统的血管外胞外MRI造影剂17。它使血管历时1小时的稳态成像。因此，图像采集不依赖于操作时序对比剂注射后是必需的。另外的优点使用这种造影剂的是，它是一个小分子（分子量857道尔顿）18，并可以渗透甚至完全闭塞血栓的两侧，从而提供了DVT的优异对比度从周围区域上的MRV和启用DVT的定量计算卷。以前的研究已经建立了使用使用gadofosveset磷酸三钠19卷MR插值屏气检查（VIBE）静脉造影可视化脉间信度。在这里，我们使用类似的方法在一个多中心临床试验的设置来评价深静脉血栓形成和使用的DVT通过MRI作为终点测量的音量。 eTRIS提供了理想的平台来评估这里提出的MRV成像方法的分析的可行性和再现性，使用长循环基于Gd的血池造影剂，用于评估DVT卷。我们还评估使用的直接血栓成像（DTHI）的方法来量化的新鲜DVT之前的程度在注射造影剂。 随机分组后在36小时首次进入edoxaban单药治疗组或肝素/华法林组，随机分组后14〜21天之间的第二：在研究过程中进行的两个MRI检查。所有图像的分析由集中式核心实验室进行。新鲜血栓体积是从一个直接血栓成像（DTHI）在腿部和下部骨盆注射任何造影剂之前进行计算。总血栓体积（新鲜和旧）由交对比度磁共振造影（MRV）的腿部和下部骨盆静脉的图像来计算。

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Ablavar (gadofosveset trisodium)</td>
			<td>Lantheus</td>
			<td></td>
			<td>Contrast Agent</td>
		</tr>
		<tr>
			<td>1.5T or 3T Scanners</td>
			<td>GE, Siemens, or Phillips</td>
			<td></td>
			<td>GE(Horizon, Signa, Hdx, 750), Siemens (Symphony, Avanto, Sonata, Trio, Aera) or Philips (Intera, Achieva)</td>
		</tr>
	</tbody>
</table>

a multicenter mri protocol for the evaluation and quantification of deep vein thrombosis

我们评估了磁共振造影（MRV）与gadofosveset量化总血栓量的变化作为一个多中心随机对照研究治疗效果的主要标准有肝素/华法林治疗方案为急性，症状性下肢深静脉血栓形成比较单一edoxaban（DVT方法）治疗。我们还用一个直接的血栓成像方法（DTHI，不使用造影剂），以量化新鲜血栓。然后，我们试图评估的分析方法，并采用3D磁共振造影和直接血栓成像的深静脉血栓形成的多中心试验设定的定量应用的可重复性。从参加edoxaban血栓减少影像学研究（eTRIS）中随机选择10个受试者，在整个下肢深静脉系统总血栓体积双侧定量。受试者采用3D-T1W梯度回波序列之前（直接成像牛逼hrombus成像，DTHI）和注射的0.03毫摩尔/千克gadofosveset磷酸三钠（磁共振造影，MRV）的后5分钟。在DVT对相应的轴向，弯曲的多平面重组图像的边缘由两名观察员手动划定获得静脉血栓的体积测量。 MRV被用于计算总的DVT体积，而DTHI用于计算新鲜血栓的体积。组内相关（ICC）和布兰德Altman分析进行对比国米和内部观察员变异分析。国际刑事法院间内和观察员变异性优（0.99和0.98，P &lt;0.001），与对MRV影像奥特曼分析没有偏向。对于DTHI图像，结果略低（ICC = 0.88和0.95，P &lt;0.001），与偏见对奥特曼地块国际观察员的结果。这项研究表明血栓量估计在使用MRV与gadofosveset磷酸三钠DVT的可行性，具有良好的区域内和在之三观察员重复性的多中心。

对于重复性的评估，基准的目的和后续扫描，汇集和分析不同的案件。从10个随机选择的科目（各2浏览次数），有59艘DVT使用MRV的方法确定29艘，确定了DTHI新鲜血栓。在对重复性指标分析这10个随机选择的科目的子集，没有船只DVT被认为是未分析的质量（定义为主观评分0-2为MRV和DTHI图像）。由MRV对比度测定的平均总血栓体积（与血栓识别每个单独的容器的体积的总和）为3.13±6.23厘米3为初?...

Watch this Scientific Journal Video about A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis at JoVE.com

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

The goal of this study is to use magnetic resonance venography with long-circulating gadolinium-based contrast agent and direct thrombus imaging for quantitative evaluation of DVT volume in a multicenter, clinical trial setting. Inter- and intra-observer variability assessments were conducted, and reproducibility of the protocol was determined.

深静脉血栓形成的评价和定量的多中心MRI协议

We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for ...

a-multicenter-mri-protocol-for-evaluation-quantification-deep-vein

Research

JoVE Journal

Medicine

16.9K 次观看.  Icahn School of Medicine at Mount Sinai. The goal of this study is to use magnetic resonance venography with long-circulating gadolinium-based contrast agent and direct thrombus imaging for quantitative evaluation of DVT volume in a multicenter, clinical trial setting. Inter- and intra-observer variability assessments were conducted, and reproducibility of the protocol was determined.

视频: A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

The calcineurin inhibitor tacrolimus is the cornerstone of most immunosuppressive treatment protocols after solid organ transplantation in the United States. Tacrolimus is a narrow therapeutic index drug and as such requires therapeutic drug monitoring and dose adjustment based on its whole blood trough concentrations. To facilitate home therapeutic drug and adherence monitoring, the collection of dried blood spots is an attractive concept. After a finger stick, the patient collects a blood drop on filter paper at home. After the blood is dried, it is mailed to the analytical laboratory where tacrolimus is quantified using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) in combination with a simple manual protein precipitation step and online column extraction.
For tacrolimus analysis, a 6-mm disc is punched from the saturated center of the blood spot. The blood spot is homogenized using a bullet blender and then proteins are precipitated with methanol/0.2 M ZnSO4 containing the internal standard D2,13C-tacrolimus. After vortexing and centrifugation, 100 &#181;l of supernatant is injected into an online extraction column and washed with 5 ml/min of 0.1 formic acid/acetonitrile (7:3, v:v) for 1 min. Hereafter, the switching valve is activated and the analytes are back-flushed onto the analytical column (and separated using a 0.1% formic acid/acetonitrile gradient). Tacrolimus is quantified in the positive multi reaction mode (MRM) using a tandem mass spectrometer.
The assay is linear from 1 to 50 ng/ml. Inter-assay variability (3.6%-6.1%) and accuracy (91.7%-101.6%) as assessed over 20 days meet acceptance criteria. Average extraction recovery is 95.5%. There are no relevant carry-over, matrix interferences and matrix effects. Tacrolimus is stable in dried blood spots at RT and at +4 &#176;C for 1 week. Extracted samples in the autosampler are stable at +4 &#176;C for at least 72 hr.

Here we describe a high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) assay to quantify the immunosuppressant tacrolimus in dried blood spots using a simple manual protein precipitation step and online column extraction.

在免疫抑制剂他克莫司对干血斑使用LC-MS / MS定量

The calcineurin inhibitor tacrolimus is the cornerstone of most immunosuppressive treatment protocols after solid organ transplantation in the United ...

科研

医学

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

使用Saccadometry与深部脑刺激来研究正常和病理脑功能

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

In Vivo Evaluation of Fracture Callus Development During Bone Healing in Mice Using an MRI-compatible Osteosynthesis Device for the Mouse Femur

Endochondral fracture healing is a complex process involving the development of fibrous, cartilaginous, and osseous tissue in the fracture callus. The amount of the different tissues in the callus provides important information on the fracture healing progress. Available in vivo techniques to longitudinally monitor the callus tissue development in preclinical fracture-healing studies using small animals include digital radiography and &#181;CT imaging. However, both techniques are only able to distinguish between mineralized and non-mineralized tissue. Consequently, it is impossible to discriminate cartilage from fibrous tissue. In contrast, magnetic resonance imaging (MRI) visualizes anatomical structures based on their water content and might therefore be able to noninvasively identify soft tissue and cartilage in the fracture callus. Here, we report the use of an MRI-compatible external fixator for the mouse femur to allow MRI scans during bone regeneration in mice. The experiments demonstrated that the fixator and a custom-made mounting device allow repetitive MRI scans, thus enabling longitudinal analysis of fracture-callus tissue development.

In Vivo Evaluation of Fracture Callus Development During Bone Healing in Mice Using an MRI-compatible Osteosynthesis Device for the Mouse Femur

The evaluation of tissue development in the fracture callus during endochondral bone healing is essential to monitor the healing process. Here, we report the use of a magnetic resonance imaging (MRI)-compatible external fixator for the mouse femur to allow MRI scans during bone regeneration in mice.

在体内MRI 对小鼠股骨骨愈合过程中骨折愈伤组织发育的评价

Endochondral fracture healing is a complex process involving the development of fibrous, cartilaginous, and osseous tissue in the fracture callus. The ...

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. Bone is a dynamic tissue undergoing continuous remodeling with the competing activity of osteoblasts, which produce the new bone matrix, and osteoclasts, whose function is to eliminate mineralized bone. [18F]-NaF is a positron emission tomography (PET) radiotracer that enables visualization of bone metabolism. [18F]-NaF is chemically absorbed into hydroxyapatite in the bone matrix by osteoblasts and can thus noninvasively detect osteoblastic activity, which is occult to conventional imaging techniques. Kinetic modeling of dynamic [18F]-NaF-PET data provides detailed quantitative measures of bone metabolism. Conventional semi-quantitative PET data, which utilizes standardized uptake values (SUVs) as a measure of radiotracer activity, is referred to as a static technique due to its snapshot of tracer uptake in time.&#160; Kinetic modeling, however, utilizes dynamic image data where tracer levels are continuously acquired providing tracer uptake temporal resolution. From the kinetic modeling of dynamic data, quantitative values like blood flow and metabolic rate (i.e., potentially informative metrics of tracer dynamics) can be extracted, all with respect to the measured activity in the image data. When combined with dual modality PET-MRI, region-specific kinetic data can be correlated with anatomically registered high-resolution structural and pathologic information afforded by MRI. The goal of this methodological manuscript is to outline detailed techniques for performing and analyzing dynamic [18F]-NaF-PET-MRI data. The lumbar facet joint is a common site of degenerative arthritis disease and a common cause for axial low back pain.&#160; Recent studies suggest [18F]-NaF-PET may serve as a useful biomarker of painful facetogenic disease.&#160; The human lumbar facet joint will, therefore, be used as a prototypical region of interest for dynamic [18F]-NaF-PET-MRI analysis in this manuscript.

Quantitative [18F]-Naf-PET-MRI Analysis for the Evaluation of Dynamic Bone Turnover in a Patient with Facetogenic Low Back Pain

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. We present detailed methodologies for performing and analyzing dynamic [18F]-NaF-PET-MRI data in a patient with facetogenic low back pain using the lumbar facet joints as a prototypical region of interest.

定量 =18F_-Naf-PET-MRI 分析,用于评估面部腰痛患者的动态骨质周转率

Imaging techniques that reflect dynamic bone turnover may aid in characterizing a wide range of bone pathologies. Bone is a dynamic tissue undergoing ...

Quantification of Optic Nerve Cross Sectional Area on MRI: A Novel Protocol using Fiji Software

Optic nerve assessment is an important aspect of glaucoma diagnosis and follow-up. This project describes a protocol for a unified methodology of optic nerve cross-sectional assessment and quantification using 3 T MRI for image acquisition and ImageJ's Fiji software for image processing quantification. Image acquisition was performed using 3 T MRI, with proper instructions for the patient to ensure straight fixation during imaging. A T2-weighted fat suppressed sequence was used. A coronal cut taken 3 mm behind the globe and perpendicular to the optic nerve axis should be uploaded to the software. Using the threshold function, the white matter area of the optic nerve is selected and quantified, thus, eliminating inter-individual measurement bias. We also described the normal limits for the optic nerve cross-sectional area according to age, based on previously published literature. We used the described protocol to assess optic nerve of a suspected glaucoma patient. The optic nerve cross-sectional area was found to be within the normal limits, a finding further confirmed via optical coherence tomography of the optic nerve.

We provided a detailed protocol for a standardized method of optic nerve assessment and quantification using MRI, utilizing a widely available imaging sequence, and open access software for image analysis. Following this standardized protocol would provide meaningful data for comparison between different patients and different studies.

MRI 上光学神经横截面区域的量化：使用斐济软件的新协议

Optic nerve assessment is an important aspect of glaucoma diagnosis and follow-up. This project describes a protocol for a unified methodology of optic ...

Repetitive Blood Sampling from the Subclavian Vein of Conscious Rat

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to detect drug exposure. The rat blood sampling method determines the quality of the plasma and further affects the precision of the test results. The subclavian vein blood collection method described in this protocol collects blood samples repeatedly in the conscious state of animals to meet the needs of PK and TK tests. The skills of restraint handling and appropriate procedure of needle incision ensure the success rate of blood collection. It is easy to operate while ensuring the quality of plasma and at the same time catering to animal welfare. However, this method requires skilled operation, and an improper one may cause animal weakness, pain, lameness, and even mortality. The current method has been used in the testing facility for a 4-week oral toxicity study in Sprague Dawley (SD) rats with TK. The maximum amount of blood collected within 24 h did not exceed 20% of the animal's total blood. The animals' body weight was more than 200 g for males and females. The data showed that the animals' bodyweight increased steadily every week, and the clinical observation was normal after repetitive sample collection.

The present protocol describes a simple and efficient method for collecting blood from the subclavian vein in rats. It enables rapid, timely, and easily identifiable sampling without anesthesia and obtains high-quality blood through repetitive sample collection.

意识大鼠锁骨下静脉的重复血液采样

Rats are widely used in pharmacokinetics (PK) and toxicokinetic (TK) studies that need to collect a certain amount of blood at specific time points to ...

A Real-World High-Intensity Interval Training Protocol for Cardiorespiratory Fitness Improvement

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, few studies have tested the efficiency of HIIT protocols in a &#34;real world&#34; setting, e.g., HIIT protocols designed for outdoor spaces without specialized equipment. This study presents a &#34;real world&#34; training protocol, named &#34;beep training&#34;, and compares the efficiency of a HIIT regiment versus a traditional long-duration Moderate-Intensity Continuous Training (MICT) regiment using this beep training protocol on VO2 max of overweight untrained men. Twenty-two subjects performed outdoor running with MICT (n = 11) or HIIT (n = 11). Cardiorespiratory fitness was assessed before and after training protocols using a metabolic analyzer. Both training protocols were performed 3 days a week for 8 weeks using the Beep Test results. The MICT group performed the exercise program at 60%-75% of the maximum speed of the 20 m shuttle test (Vmax) and with a progression of the distance of 3,500-5,000 m. The HIIT group performed the interval exercise with 7-10 bouts of 200 m at 85%-100% of the maximum speed of the 20 m shuttle test (Vmax), interspersed with 1 min of passive recovery. Although the HIIT group presented a significantly lower training volume than the MICT group (p &#60; 0.05) after 8 weeks of beep training, HIIT was superior to MICT in improving VO2 max (MICT: ~4.1%; HIIT: ~7.3%; p &#60; 0.05). The &#34;real world&#34; HIIT regiment based on beep training protocol is a time-efficient, low-cost, and easy-to-implement protocol for overweight untrained men.

This study presents a low-cost and easy-to-implement "real world" high-intensity interval training (HIIT) protocol for scientific research and discusses its efficiency for cardiorespiratory fitness.

一种用于改善心肺健康的真实世界高强度间歇训练方案

High-Intensity Interval Training (HIIT) has emerged as an interesting time-efficient approach to increase exercise adherence and improve health. However, ...

Establishment and Evaluation of a Porcine Vein Graft Disease Model

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the investigation of disease mechanisms and the development of therapeutic strategies. 
To perform the surgery, we enter the cardiac chamber through the third intercostal space and carefully dissect the internal mammary vein and immerse it in normal saline. The right main coronary artery is then treated for ischemia. The target vessel is incised, a shunt plug is placed, and the distal end of the graft vein is anastomosed. The ascending aorta is partially blocked, and the proximal end of the graft vein is anastomosed after perforation. The graft vein is checked for patency, and the proximal right coronary artery is ligated. 
CABG surgery is performed in minipigs to harvest the left internal mammary vein for its use as a vascular graft. Serum biochemical tests are used to evaluate the physiological status of the animals after surgery. Ultrasound examination shows that the proximal, middle, and distal end of the graft vessel are unobstructed. In the surgical model, turbulent blood flow in the graft is observed upon histological examination after the CABG surgery, and venous graft stenosis associated with intimal hyperplasia is observed in the graft. The study here provides detailed surgical procedures for the establishment of a repeatable CABG-induced VGD model.

In this protocol, novel pig vein bypass grafting was performed through a small incision in the left chest wall without cardiopulmonary bypass. A postoperative pathology study was done, which showed intimal thickening.

猪静脉移植病模型的建立与评价

Venous graft disease (VGD) is the leading cause of coronary artery bypass graft (CABG) failure. Large animal models of CABG-VGD are needed for the ...

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening sequelae. While whole leg compression ultrasound with color and spectral Doppler is commonly performed in radiology and vascular labs, point-of-care ultrasound (POCUS) is becoming more common in the acute care setting. Providers appropriately trained in focused POCUS can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. This paper describes a simplified yet validated approach to POCUS by describing a three-zone protocol for lower extremity DVT POCUS image acquisition. The protocol explains the steps in obtaining vascular images at six compression points in the lower extremity. Beginning at the level of the proximal thigh and moving distally to the popliteal space, the protocol guides the user through each of the compression points in a stepwise manner: from the common femoral vein to the femoral and deep femoral vein bifurcation, and, finally, to the popliteal vein. Further, a visual aid is provided that may assist providers during real-time image acquisition. The goal in presenting this protocol is to help make proximal lower extremity DVT exams more accessible and efficient for POCUS users at the patient&#39;s bedside.

Traditionally, lower extremity deep venous thrombosis (DVT) is diagnosed by radiology-performed venous duplex ultrasound. Providers appropriately trained in focused point-of-care ultrasound (POCUS) can perform a rapid bedside examination with high sensitivity and specificity in critically ill patients. We describe the scanning technique for focused POCUS DVT lower extremity examination.

下肢近端深静脉血栓形成的即时超声筛查

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

大鼠采血技术的比较研究

Modified Tail Vein and Penile Vein Puncture for Blood Sampling in the Rat Model

Blood samples are required in most experimental animal designs to assess various hematological parameters. This paper presents two procedures for blood collection in rats: the lateral tail vein puncture and the dorsal penile vein puncture, which offer significant advantages over other previously described techniques. This study shows that these two procedures allow for fast sampling (under 10 min) and yield sufficient blood volumes for most assays (202 &#956;L &#177; 67.7 &#956;L). The dorsal penile vein puncture must be done under anesthesia, whereas the lateral tail vein puncture can be done on a conscious, restrained animal.
Alternating these two techniques, therefore, enables blood draw in any situation. While it is always recommended for an operator to be assisted during a procedure to ensure animal welfare, these techniques require only a single operator, unlike most blood sampling methods that require two. Moreover, whereas these previously described methods (e.g., jugular stick, subclavian vein blood draw) require extensive prior training to avoid harm to or death of the animal, tail vein and dorsal penile vein puncture are rarely fatal. For all these reasons, and according to the context (e.g., for studies including male rats, during the perioperative or immediate postoperative period, for animals with thin tail veins), both techniques can be used alternately to enable repeated blood draws.

作者聚焦：大鼠的上下文依赖性采血方法 

Here, we present a protocol to offer rapid, easy, and reliable blood collection alternatives for the rat model. We describe three different blood sampling methods according to the context: tail vein puncture under anesthesia or on a conscious animal, and dorsal penile vein puncture under anesthesia.

改良尾静脉和静脉穿刺用于大鼠模型中的血液采样

Blood samples are required in most experimental animal designs to assess various hematological parameters. This paper presents two procedures for blood ...