多层螺旋CT脑血管成像在颅脑血管病变的临床应用

目的探讨多层螺旋CT（MSCT）脑血管成像的临床应用价值。方法回顾性分析40例颅内血管性病变患者的16层螺旋CT脑血管成像（CTA）资料,其中动脉狭窄14例,动脉闭塞2例,动脉瘤9例,动静脉畸形12例,静脉畸形1例,烟雾病1例,颈动脉海绵窦瘘1例。结果多层螺旋CT脑血管成像（CTA）对脑血管主干及其主要分支均可显示,其中大脑前、中动脉清晰显示5级分支。动脉狭窄14例,CTA均清晰显示狭窄部位及动脉粥样硬化斑块。动脉闭塞2例,CTA清楚显示中断部位、形态、范围。脑动脉瘤9例,CTA均清晰显示动脉瘤位置、大小、形态、瘤颈与其及载瘤动脉关系。动静脉畸形12例,CTA均清晰显示畸形血管团、供血动脉和引流静脉。静脉畸形1例可显示左顶叶静脉畸形。烟雾病1例,CTA显示各动脉的闭塞部位及侧支血管团形态。40例患者中,5例动静脉畸形及1例烟雾病经数字减影血管成像证实,6例动脉瘤及4例动静脉畸形经手术证实。结论CTA是一种快速、无创、有效的脑血管病变诊断手段,对临床治疗有指导作用。     

时间分辨对比剂动态显像技术在脑动脉畸形诊断中的应用

目的探讨时间分辨对比剂动态显像技术(TRICKS)对于脑动静脉畸形的诊断价值。方法收集笔者所在医院25例脑动脉畸形(AVM)患者资料,使用GE公司超导Signa HD 1.5T MR扫描仪,应用椭圆中心TRICKS,对病灶区进行连续不间断扫描,利用多平面重建及最大强度投影技术对原始图像进行血管重建。结果 TRICKS清楚显示大小不等的畸形血管巢及供血动脉和引流静脉。畸形血管巢位于颞叶7例,顶叶6例,额叶5例、枕叶6例和小脑半球1例。发现供血动脉37支,其中单支供血动脉15例,多支供血动脉10例;引流静脉33支,单只引流10例,多支引流15例。结论 TRICKS显示AVM的供血动脉、畸形血管巢和引流静脉,为临床治疗方案的制定提供可靠的依据,值得在临床上推广使用。     

巨大子宫肌瘤供血动脉的MSCTA表现及临床应用价值

目的探讨巨大子宫肌瘤供血动脉在多层螺旋CT血管造影（MSCTA）中的表现特点及临床应用价值。方法搜集术前经多层螺旋CT检查并术后病理证实的巨大子宫肌瘤患者32例,采用容积再现（vR）血管生长技术（AV）进行肿瘤供血动脉重建,研究其血供特点。结果32例子宫肌瘤均可显示其供血动脉,显影率100％,表现为双侧子宫动脉供血为主型或一侧子宫动脉供血为主型;4例显示双侧卵巢动脉参与供血,2例显示一侧卵巢动脉参与供血。结论MSCTA能清楚显示巨大子宫肌瘤供血动脉及侧支循环,能作为判断肿瘤起源的依据及为制定手术切除方案或栓塞介入治疗方案提供依据。     

16层螺旋CT脑血管成像的临床应用价值

目的探讨16层螺旋CT脑血管成像的临床应用价值。方法选择我院2009年10月～2012年10月收治的脑血管病变患者70例,采用16层螺旋CT进行诊断,就临床资料进行回顾性分析。结果肝血管主干及其主要分支采用MSCTA均可显示,大脑前、中动脉及其5级分支可清晰显示。29例动脉狭窄的患者,动脉粥样硬化斑块及狭窄部位CTA可清晰显示。4例动脉闭塞患者中断部位、范围、形态CTA或清楚显示。脑动脉瘤18例患者其形态、大小、位置、载瘤动脉及瘤颈关系CTA均可清晰显示。23例动静脉畸形的患者引流静脉、供血动脉、畸形血管团CTA可清晰显示。静脉畸形CTA显示静脉呈海蛇头样畸形。颈动脉海绵窦患者CTA显示患侧眼上静脉扩张,海绵窦扩大。动静脉畸形及动脉瘤后均经手术证实,无其他异常情况发生。结论临床颅内血管性病变检查中,多层螺旋CT脑血管造影成像技术具有无创、定位明确、定性、快速、方便的特点,明显提高了确诊率,为临床治疗提供了强有力的保障。     

旋转数宇减影血管造影技术应用于脑血管造影

目的探讨快速旋转造影在脑血管中应用。方法使用数字减影血管造影机,对疑有脑血管病变的61例患者首先进行常规正、侧位脑血管造影检查,其中41例进行旋转DSA检查。结果经过快速旋转血管造影检查的41例患者（颅内动脉瘤33例,颅内动静脉畸形6例,颈动脉海绵窦瘘2例）。病变血管的位置清晰可见,其中36例（87.9%）病变血管的供血和分支动脉能避开造影剂重叠。5例（12.1%）显示效果不好（颅内动脉瘤3例,颅内动静脉畸形2例,）。结论旋转DSA能够显示头颈部大多数病变血管的供血动脉和分支结构,是对常规DSA的重要补充,对头颈部血管病变的诊断和治疗有很大帮助。     

CT静脉成像和磁共振静脉成像及三维数字减影血管造影在神经外科手术中的应用

目的探讨CT静脉成像（CTV）、磁共振静脉成像（MRV）、三维数字减影血管造影（3D—DSA）显示脑肿瘤的供血动脉和引流静脉的情况,以及判断肿瘤与静脉（窦）关系的准确性,从而为神经外科手术方案的制定提供重要信息。方法回顾性分析31例脑肿瘤患者脑CTV、MRV、3D—DSA血管造影检查资料,其中松果体区肿瘤6例,脑膜瘤25例（镰幕脑膜瘤6例,窦镰旁脑膜瘤9例,其他部位10例）。肿瘤均为单发,术前判断对肿瘤的供血动脉和引流静脉（窦）的显示并与术中情况对照。结果CTV、MRV、3D—DSA获得三维冈像均能清晰显示肿瘤内部及表面结构、供血动脉及引流静脉,且显示的肿瘤一静脉（窦）关系与术中情况有很好的吻合率。CTV优于MRV、3D—DSA,可作为判定金标准。结论对脑肿瘤患者术前采用CTV、MRV、3D—DSA血管造影可准确显示肿瘤的供血动脉、引流静脉（窦）以及肿瘤与血管的空间关系,有助于完整切除肿瘤的同时避免损伤邻近静脉（窦）,为手术方案的制定提供至关重要的信息。     

脑动静脉畸形的MRI和MRA诊断价值

目的本文主要通过15例AVM临床试验研究MRA和MRI对脑动、静脉畸形诊断的应用价值。其中,15例采用3DTOFMRA与MRI检查,10例同时采用2DTOFMRA检查,结果为3DTOFMRA对脑动、静脉畸形的供血动脉、瘤巢显示良好,对引流静脉显示较差;2DTOFMRA对引流静脉显示好,对供血动脉及瘤巢显示差。3例AVM的MRA与DSA对照,MRA供血动脉显示率为85.7%,瘤巢与引流静脉显示率为100%。MRI对病灶部位定位准确。结论 AVM应同时做3DTOFMRA与2DTOFM-RA检查结并合MRI图像,为临床合理选择治疗方案提供依据。     

多层螺旋CT血管成像诊断脑动脉瘤临床价值

目的探讨多层螺旋CT血管成像对颅内动脉瘤的诊断价值。方法选取我院2014年1月～2016年1月收治入院的对62例疑患有颅内动脉瘤的患者进行多层螺旋CT血管造影技术检查,观察其原始数据和图像与经过容积再现、多平面重建和最大密度投影等方法处理后的头像和数据比较。结果本研究中62例血管病患者64排螺旋CTA技术对VR、MIP和MPR重建图像,其中脑血管主干及其主要分支情况显示率100%,而大中脉5分支示率95%。本研究62例脑血管病患者中,58例动脉瘤(其中左右大前动脉瘤14例,左右大脑中动脉瘤10例,前后交通动脉30例,基底动脉瘤4例),清晰可动脉瘤的位置、形状、大小以及瘤颈;4例脑动静脉畸形(AVM)(其中右左侧颞叶2例,右枕颞叶1例,侧额顶叶1例),清晰可见引流静脉、供血动脉以及血管畸形血管团,经手术所见与手术前多层螺旋CT血管造影检查的结果相符。结论多层螺旋CT血管成像对颅内动脉瘤有较高的诊断价值,为临床治疗和术后复诊提供可靠的依据。     

脑血管动静脉畸形MRI及MRA的影像学研究

目的 总结脑动静脉畸形的磁共报成像(MRI)及磁共振静脉血流成像(MRA)特征，评价不同的成像方法对脑动静脉畸形的诊断价值。方法 对15例巳证实脑动静脉畸形的患者分别行常规MR成像和MR血管成像。结果 “流空信号”是MRI诊断脑动静脉畸形的主要依据，MRI能很好的显示动静脉畸形的内部结构及既发改变；RMA则较准确的显示了畸形的血管团、供血动脉和引流静脉的解剖学关系。讨论 MRA能显示动静脉畸形的三维解剖结构，能完整的显示供血动脉及引流静脉与瘤巢的关系，MRA及MRI的联合应用有利于对血管的结构及周围软组织作出更准确的评价。     

脑血管造影在脑血管病变中的应用价值

目的:分析脑血管病变在脑血管造影中的影像学表现特点,讨论脑血管造影显示的脑血管形态学改变在探讨脑血管病变的发病机制、预测临床表现及选择治疗方式中的应用价值.方法:回顾性分析2005年1月-2007年10月行脑血管造影检查并明确诊断为脑血管病变的病例140例,观察各种脑血管病变的造影表现,探讨病变血管的形态学特点与脑血管病变的发生、临床过程、治疗方式等的关系.结果:前交通动脉瘤组中,A1优势征26例(占68.42%),随机选取293例非前交通动脉瘤脑血管造影病例作为对照组.A1优势征11例,两组比较差异具有显著性(P<0.05).脑动静脉畸形组中单支引流静脉的出血率比3支或以上引流静脉明显升高,两组间差异有显著性(P<0.05),不同数量供血动脉组中出血率差异未见显著性(P>0.05).颈内动脉狭窄或闭塞组中前交通动脉或后交通动脉代偿在单、双侧病变中出现率的比较差异有显著性.结论:A1优势征是前交通动脉瘤发生的高危因素.脑动静脉畸形单支引流静脉的出血率明显高于多支引流静脉,供血动脉的数目则不是脑动静脉畸形出血的相关因素.单侧颈内动脉狭窄或闭塞患者经过前交通动脉或后交通动脉的侧支血流代偿,而双侧颈内动脉狭窄或闭塞患者主要是通过后交通动脉的侧支血流代偿.     

Hereditary haemorrhagic teleangiectasia: diagnostic imaging of visceral involvement

Hereditary Haemorrhagic Telangiectasia (HHT), also known as Rendu-Osler-Weber disease, is an autosomal-dominant vascular disease characterised by mucocutaneous or visceral angiodysplastic lesions (telangiectases and arteriovenous malformations), which may be widely distributed throughout the cardiovascular system. Its diagnosis is based on clinical criteria. Liver, lungs and brain, in order of prevalence, are the most frequently involved visceral districts of the body other than skin and nasal mucosa. Liver involvement is frequent and characterised by the presence of intrahepatic shunts, disseminated intraparenchymal telangiectases and other vascular lesions. Although it is usually asymptomatic, congestive cardiac failure, portal hypertension, portosystemic encephalopathy, cholangitis or atypical cirrhosis are possible complications. Pulmonary arteriovenous malformations involve more than one third of HHT patients and can consist of diffuse telangiectases or high-flow low-pressure shunts between pulmonary arteries and veins. Pulmonary involvement can cause serious complications: hypoxaemia, pulmonary or pleural hemorrhage, paradoxical embolism into cerebral circulation. Various types of cerebrovascular malformations can affect HHT patients and the most common are arteriovenous malformations, consisting of one or more feeding arteries connected to one or more draining veins. Diagnostic imaging has a fundamental role in detecting the alterations involving these various districts in the body. The possibility to perform fast and complete studies and to provide high quality multiplanar and angiographic reconstructions, gives multi-detector row helical computed tomography and magnetic resonance the ability to detect and characterise the complex anatomo-pathological alterations typical of HHT. Ultrasonography seems to be the best screening modality for hepatic and pulmonary involvement.     

认知功能障碍与脑卒中部位的相关性分析

目的探讨脑卒中部位与认知功能障碍之间的关系,观察不同部位脑卒中所致认知功能障碍的特点。方法采用中文版蒙特利尔认知评估量表（MOCA）对100例脑卒中患者进行测试,将脑卒中患者的CT／MRI定位与MOCA的7个分项目（定向力ORT、视空间与执行功能EF、命名NAM、记忆MEM、注意ATT、语言功能包括复述与流畅性LANG、抽象概括ABS）的测试结果进行相关分析。结果（1）100例患者中脑梗死63例,脑出血37例,其中额叶卒中15例,顶叶15例,颞叶12例,枕叶8例,丘脑14例,基底节20例,小脑8例,脑桥8例。额叶、顶叶、颞叶、枕叶、丘脑、基底节卒中与认知功能障碍发生相关（P〈0.05）。枕叶、脑桥卒中与认知功能障碍无关（P〉0.05）。（2）额叶卒中患者认知功能的EF、ORT、MEM、ATT、ABS损害明显;顶叶卒中与认知功能的NAM、MEM、ATT、EF损害有关;颞叶卒中与LANG和EF损害有关,枕叶卒中患者视空间及执行功能（EF）损害明显;丘脑损害语言功能（LANG）受损明显;基底节卒中患者MOCA各分测验均有损害。结论脑卒中患者认知功能障碍的发生与卒中部位有关,不同部位卒中损害认知功能不同。     

Endovascular treatment of pulmonary and cerebral arteriovenous malformations in patients affected by hereditary haemorrhagic teleangiectasia

Hereditary Haemorrhagic Teleangiectasia (HHT) is a vascular disorder of angiogenesis transmitted in an autosomal dominant pattern, characterised by heterogeneity in clinical manifestations. One of the most important organ involved is lung, including pulmonary arteriovenous malformations (PAVM). PAVM occur in 20 to 30% of the HHT population and recently are considered a marker of disease. PAVM are direct artery-to-vein connections with low pressure and without an interveining capillary bed. PAVM are classified as simple (supplied by one feeding artery) or complex (receiving blood supply from two or more feeding artery). According to the international reports, treatment it's recommendable for all PAVM with feeding vessels 3mm or larger, in order to reduce the risk of cerebral ischaemia and neurologic manifestations frequently attributed to paradoxical embolisation. Transcatheter embolotherapy of PAVM is a form of treatment based on occlusion of the feeding artery to a PAVM by using platinum coils or detachable balloons. The technique of coil embolisation involves the exact localisation of PAVM by pulmonary angiography followed by superselective percutaneous caheterisation of feeding artery obtained by using a dedicated 7F guiding catheter, which coaxially allocates a 5F hydrophilic catheter advanced in order to perform both superselective angiography of feeding artery and embolisation itself. Inside the 5F catheter the platinum coils are advanced using a .035' guide-wire and released until an optimal occlusion of feeding artery is achieved. At the end of the procedure angiographic control is performed in order to verify the occlusion of feeding artery. The use of platinum coils is preferable over detachable balloons when feeding artery are greater than 7 mm in diameter and have irregular anatomical configuration. On the other hand, the principal advantage of using detachable balloons is that the balloon itself can be deflated and repositioned if necessary. Transcatheter embolotherapy is technically safe and clinically effective and may represent the primary choice of treatment in HHT patients. On the other hand the most common complications of this treatment (pleurisy and air embolism) can be prevented by using some tips during the embolisation procedure like "anchor technique," "scaffold technique" and "balloon assisted technique." Cerebral arteriovenous malformations (CAVM) are present in 10-20% of patients with HHT and multiple in 50% of cases. Cortical surface is the most frequent localisation. Angiography is needed to diagnose all CAVM and to clarify the angioarchitecture of the lesion. In HHT CAVM are usually either micro-AVM, with a nidus not bigger than 1 cm, or small AVM, with a nidus between 1 and 3 cm. Quite frequently there are lesions characterised by arteriovenous fistulas. In the three patterns of CAVM usually found in HHT, small AVM are the most risky for bleeding although the risk is lower than that associated with sporadic ones. It is estimated from 0.38 to 0.69% per year in spite of the general incidence of bleeding in sporadic CAVM that ranges from 2 to 4% per year. In HHT patients, at present, the precise indications and timing of treatment are not established. Trend is to treat small AVM and AVF and to follow-up micro-AVM with MRI and angiography. As for sporadic CAVM, treatment of small AVM is usually referred to stereotactic radiosurgery. Endovascular embolisation is proposable if the lesion is easily reachable by microcatheterism and the position of the microcatheter is safe. Glue is used for embolisation and the technique is briefly discussed.     

三维对比增强磁共振血管成像在脑血管疾病诊断中的应用研究

目的 探讨三维对比增强磁共振血管成像(3D CE-MRA)对常见脑血管病的诊断价值及其影响因素.方法 收集行颅脑3D CE-MRA检查患者450例,其中135例在1周内行数字减影血管造影(DSA)检查.常规MRI包括T1、T2WI轴位扫描和冠状面T1WI扫描及T2WI FLAIR轴位扫描;3D CE-MRA采用三维快速场回波序列,Gd-DTPA剂量30ml,注射速率2.5 mL/s,行增强前、增强后动脉期及静脉期4次扫描,图像减影后至工作站上三维重建.结果 ①3D CE-MRA疑脑动脉狭窄或闭塞者75例,其中65例行DSA进行对照,3D CE-MRA与DSA在轻度、中度、重度狭窄和闭塞的一致率分别为75.6%(31/41)、83.3%(30/36)、88.9%(16/18).3D CE-MRA比DSA更易把正常血管评估为轻度狭窄.②3D CE-MRA疑脑动脉瘤者71例,其中55例行DSA进行对照,3D CE-MRA与DSA在小型、中型、大型和巨大型动脉瘤的一致率分别为78.9%(30/38)、86.5%(32/37)、90.0%(18/20)、100%(4/4).3D CE-MRA比DSA更易把正常血管评估为小型动脉瘤.③3D CE-MRA疑是脑动静脉畸形23例,其中15例行DSA进行对照,3D CE-MRA对供血动脉、引流静脉的显示率分别为90.7%(39/43)、91.4%(32/35),3D CE-MRA联合MRI对异常血管团的定位优于DSA,但在细节显示上不如DSA.④3D CE-MRA质量的影响因素有采集时间、延迟时间、扫描参数、K空间填充技术、造影剂团注参数等.结论 3D CE-MRA能无创、快速、有效诊断常见脑血管病,可作为脑血 管病患者的首选诊断方法.

Abstract：

Objective To explore the diagnosis value and influence factors of three dimensional contrast enhanced MR angiography(3D CE-MRA)in common cerebrovascular diseases.Methods Totally 450 patients underwent cerebral CE-MRA,among then,150 patients were received DSA in a week.Conventional MRI includes transverse T2WI and T1WI,transverse T2WI FLAIR,and coronal T1WI.3D fast field sequence(FFE)was used for CEMRA with Gd-DTPA(30 ml,2.5 ml/s).includes front-line,enhanced arterial phase and venous phase scan.The sion was detected by MRA,in which,65 patients were received DSA,the consistency of MRA and DSA in mild,moderate,severe stenosis and occlusion was 75.6%,83.3%,88.9%,100%,respectively.MRA is easy to assess tients were received DSA,the consistency of MRA and DSA in small.medium.large and giant aneurysms was Twenty-three patients with cerebral arteriovenous malformations was detected by MRA,in which,15 patients were underwent DSA.The sensitivity of MRA in depicting feeding arteries,draining veins was 90.7%,91.4%,respectors of MRA have acquisition time,delay time,scan parameters,K space-filled technique,contrast agent parameters.Conclusions CE-MRA is a fast,noninvasive and effective technique of diagnosing common cerebrovascular diseases.It can be the first diagnosis metllod of detecting cerebrovascular diseases.     

16层CTA在脑血管疾病中的临床应用研究

目的通过与DSA和手术对照,评价16层螺旋CT血管造影(CTA)在脑血管病诊断中的价值。方法应用16层螺旋CT增强扫描获得原始横断面图像,采用容积显示(volume rendering VR)及最大密度投影(maximum intensity projection MIP)技术进行扫描范围内脑血管三维成像,回顾性分析31例脑血管病患者CTA检查。结果CTA检出脑血管异常30例,CTA检出颅内动脉瘤22例(共25个),动静脉畸形6例,硬脑膜动脉静脉瘘1例,静脉血管畸形1例。对动脉瘤检出的敏感性为92.3%,对脑血管病总符合率96.8%。CTA能够清晰显示动脉瘤瘤体(形态、指向、轮廓)、瘤颈的宽度、载瘤动脉及与颅骨之间的关系,显示脑血管畸形的部位、范围、供血动脉及引流静脉的情况。结论16层螺旋CT血管成像图像质量高,能快速、安全、无创有效地诊断脑血管疾病,尤其适用于颅内动脉瘤破裂及脑血管畸形出血等急症病人的筛选。     

肾脏肿瘤多层螺旋CT血管造影的临床价值

目的评价多层螺旋CT血管造影对肾肿瘤的临床价值。方法对30例经超声和CT平扫。发现肾脏肿瘤的患者行多层螺旋CT血管造影检查,将获得的轴位扫描图像行3D后处理,包括MIP、MPVR、VR及MPR。结果30例患者均获得了满意的肾动脉和肾静脉CTA图像,能清晰地显示肿瘤供血动脉、肿瘤血管和引流静脉。结论多层螺旋CT血管造影可作为常规肾脏肿瘤检查方法,为临床制定治疗方案提供可靠依据。     

汕尾地区开展脑血管造影在出血性脑血管病中的临床应用

目的探讨汕尾地区开展全脑血管造影术（DSA）对出血性脑血管疾病的诊断价值。方法选择有造影指征的出血性脑血管疾病的患者60例,进行DSA全脑血管造影,并对治疗结果进行分析。结果自发性蛛网膜下腔出血42例：发现异常（出血性颅内动脉瘤）32例;颅内动静脉畸形（AVM）10例;出血性烟雾病2例;硬脑膜动静脉瘘（DAVF）3例;海绵状血管畸形（CA）2例;脑动静脉畸形合并动脉瘤1例。结论汕尾地区开展脑血管造影术．有助于该地区出血性脑血管疾病患者尽早明确病因,有助于病情判断和评估,并作为进一步治疗的依据。     

螺旋CT对区域性门静脉高压的诊断及临床价值

目的:探讨多层螺旋CT(MSCT)对区域性门静脉高压(RPH)的诊断及临床指导价值。方法:对21例区域性门静脉高压患者使用6排多层螺旋CT机行上下腹部CT增强扫描,分析脾静脉闭塞后侧支循环开放及曲张情况。结果:脾静脉局部突然中断、明显狭窄或不显影12例,主要的两个侧支循环通道有胃短静脉-胃底静脉丛-胃冠状静脉和胃网膜静脉-胃结肠干-肠系膜上静脉,在螺旋CT上表现出特征性的分布和走行。结论:MSCT增强多排螺旋CT能清晰显示RPH患者脾静脉闭塞后侧支循环开放及曲张情况,对于RPH的诊断和指导临床治疗具有重要的价值。