64层螺旋CT对肺静脉异位引流的诊断价值

目的 探讨64层螺旋CT血管造影(MSCTA)及三维重组在诊断肺静脉异位引流(anomalous pulmonary venous drainage,APVD)中的临床应用价值.资料与方法 回顾性分析18例手术证实的APVD患儿的64层螺旋CT的影像资料.结果 18例中完全性APVD 15例,其中心上型6例,心内型6例,心下型2例,混合型1例,部分性APVD 3例.MSCTA诊断与手术结果一致.结论 MSCTA及三维重组对APVD诊断准确性高,是一种可靠的无创检查方法.     

16层螺旋CT血管成像诊断脾动脉瘤的价值

目的：探讨多层螺旋CT血管成像（MSCTA）诊断脾动脉瘤的价值。材料和方法：回顾性分析经多层螺旋CT腹部检查发现的7例脾动脉瘤的MSCTA表现，血管成像方法为容积再现（VR）、表面覆盖显示法（SSD）、最大密度投影（MIP）及多平面重组（MPR）和曲面重组法（CPR）。结果：7例均发现脾动脉瘤，其中单发5例，多发2例。VR、SSD、MIP、MPR、CPR均可明确显示脾动脉瘤，但以VR为最佳。结论：多层螺旋CT血管成像是一种有效的无创性检查手段，能准确显示脾动脉瘤，可作为诊断和随访脾动脉瘤首选检查方法。     

MSCTA对肺静脉异位引流的诊断价值

目的：比较多层螺旋CT血管成像（MSCTA）和经胸超声心动图（TTE）对肺静脉异位引流的诊断价值。方法：对2007年9月～2009年5月22例临床怀疑先天性肺静脉异位引流的患儿行MSCTA检查及TTE检查,并与手术结果相对照。结果：经手术证实22例病例中,完全性肺静脉异位引流13例,其中心上型6例,心内型5例,心下型2例;部分肺静脉异位引流9例,其中心上型8例,心内型1例。MSCTA和TTE的诊断符合率分别为96%和73%。结论：MSCTA是诊断先天性肺静脉异位引流的重要手段。     

脑发育性静脉异常的MRI诊断评价

目的分析脑发育性静脉异常（DVA）的MRI表现及诊断价值。方法对16例MR诊断为DVA的临床资料进行回顾性分析。结果16例平扫显示引流静脉,12例增强扫描均显示引流静脉及髓静脉,并呈特征性表现,5例磁共振血管造影（MRA）发现3例粗大引流静脉。结论MR平扫能显示引流静脉;MR增强扫描可以显示细小髓静脉,是诊断DVA准确、可靠的方法。     

外生性肝细胞肝癌的MSCTA诊断

目的：探讨多层螺旋CT血管成像（MSCTA）在诊断外生性肝细胞肝癌（EHCC）中的价值。方法：回顾性分析经手术病理证实的23例EHCC患者的病例资料,采用容积再现重组血管生长技术（AV）进行血管重组,显示肿瘤供血动脉,并与手术结果进行比较,评价其在肿瘤定位及周围器官侵犯诊断中的准确性。结果：23例25个EHCC最大径6.5～17.5cm,平均10.8cm。肿瘤与肝脏以蒂带连接2处,基底连接23处,起源于肝右叶及尾状叶者（12个）由肝右动脉分支供血,左叶者（11个）主要由肝左动脉供血,MSCTA定位诊断符合率100%（25/25）。肿瘤侵犯周围器官4例5处,MSCTA仅显示3处侧支供血动脉。结论：MSCTA通过显示EHCC供血动脉,能准确进行定位诊断,对判断周围器官的侵犯亦有较高的价值。     

供血动脉及引流静脉的MSCT研究对卵巢肿瘤的诊断价值

目的:通过对卵巢肿瘤供血动脉及引流静脉的MSCT研究,探讨卵巢血管对卵巢肿瘤的定位和定性诊断价值。方法:回顾性分析经病理确诊的48例56个卵巢肿瘤,单发40例,多发8例,其中囊性为主肿瘤9例9个,囊实混合性23例24个,实性为主的16例23个。采用MSCTA重组卵巢血管,通过子宫动脉卵巢支和/或卵巢动脉及卵巢静脉丛的显示,明确肿瘤起源,并通过观察肿瘤供血动脉的来源、数量、形态、起止、走行和分布等初步判断肿瘤的良恶性,并与病理结果进行对照分析。结果:MSCTA显示卵巢肿瘤的供血动脉43例,敏感度为89.6%(43/48),其中显示单侧子宫动脉卵巢支35支、双侧6对,单侧卵巢动脉10支、双侧3对,肠系膜上动脉分支1支,根据供血动脉判断卵巢来源肿瘤的符合率为97.7%(42/43)。CTA显示引流卵巢静脉丛45例,敏感度为93.8%(45/48),根据卵巢静脉丛显示并进入肿块来定位诊断卵巢肿瘤的符合率为97.8%(44/45)。术前根据重组血管特点定性诊断卵巢良性肿瘤20例22处、恶性肿瘤28例34处,诊断符合率达87.5%。结论:通过对卵巢肿瘤供血动脉及引流静脉丛的MSCT研究,能明显提高卵巢肿瘤定位和定性诊断准确性。     

Value of feeding artery and draining vein displayed on multi-slice CT angiography in the diagnosis of ovarian tumors

目的:通过对卵巢肿瘤供血动脉及引流静脉的MSCT研究,探讨卵巢血管对卵巢肿瘤的定位和定性诊断价值.方法:回顾性分析经病理确诊的48例56个卵巢肿瘤,单发40例,多发8例,其中囊性为主肿瘤9例9个,囊实混合性23例24个,实性为主的16例23个.采用MSCTA重组卵巢血管,通过子宫动脉卵巢支和/或卵巢动脉及卵巢静脉丛的显示,明确肿瘤起源,并通过观察肿瘤供血动脉的来源、数量、形态、起止、走行和分布等初步判断肿瘤的良恶性,并与病理结果进行对照分析.结果:MSCTA显示卵巢肿瘤的供血动脉43例,敏感度为89.6％(43/48),其中显示单侧子宫动脉卵巢支35支、双侧6对,单侧卵巢动脉10支、双侧3对,肠系膜上动脉分支1支,根据供血动脉判断卵巢来源肿瘤的符合率为97.7％(42/43).CTA显示引流卵巢静脉丛45例,敏感度为93.8％(45/48),根据卵巢静脉丛显示并进入肿块来定位诊断卵巢肿瘤的符合率为97.8％(44/45).术前根据重组血管特点定性诊断卵巢良性肿瘤20例22处、恶性肿瘤28例34处,诊断符合率达87.5％.结论:通过对卵巢肿瘤供血动脉及引流静脉丛的MSCT研究,能明显提高卵巢肿瘤定位和定性诊断准确性.     

多层螺旋CT血管成像诊断主动脉壁内血肿的临床应用

目的：探讨多层螺旋CT血管成像诊断主动脉壁内血肿的临床应用价值。方法：对30例拟诊主动脉壁内血肿患者行MSCT血管成像。采用容积再现（VR）、多平面重组（MPR）、曲面重组（CPR）及最大密度投影（MIP）重组图像。由两名经验丰富的心血管影像医师评估,明确血肿的部位和范围。结果：30例壁内血肿中Stanford A型1例,Stanford B型29例。合并穿透性动脉粥样硬化性溃疡（PAU）17例,占56.7%。合并胸腔积液8例,心包积液1例。结论：MSCTA能清晰显示病变特征和累及范围,是主动脉壁内血肿重要检查方法。     

MSCT后处理技术在脑血管成像中的应用

目的：探讨多排螺旋CT血管造影（MSCTA）及后处理技术在脑血管成像中的应用。方法：对临床疑似颅内血管性病变的93例患者行MSCTA检查,所得扫描数据传输到工作站,利用容积重建（VR）和最大密度投影（MIP）技术进行处理,表面遮盖法（SSD）和仿真内镜（CTVE）技术作为辅助手段,其中55例行DSA检查对照,38例与外科手术对照。结果：93例患者共检出脑动脉瘤63个（59例）,其中〈3 mm的动脉瘤6个,血管畸形15例,烟雾病19例。所有病例经VR、MPR、MIP及CTVE重组处理后能够全面直观地显示动脉瘤的大小、形态、位置,血管与动脉瘤的内部结构,能多方位观察瘤体与载瘤动脉及AVM的供血动脉与引流静脉的解剖关系。结论：多种重组技术联合运用能为脑动脉瘤及血管畸形的诊断提供更多信息,充分显示动脉瘤和血管畸形的解剖结构。     

磁敏感加权成像在脑静脉畸形诊断中的应用

目的：探讨磁敏感加权成像（SWI）在脑静脉畸形诊断中的价值。方法：回顾性分析19例脑静脉畸形的常规MRI及SWI表现。结果：19例常规MRI均可显示引流静脉,其中9例可显示髓静脉汇入引流静脉;19例磁敏感加权成像均可清晰显示引流静脉及髓静脉,呈现特征性的＂海蛇头＂或＂蜈蚣＂征。结论：SWI较常规MRI更能清晰和精确地显示脑静脉畸形的影像特征,可作为脑静脉畸形诊断常规序列的重要补充。     

Reliability of MDCT in characterizing pulmonary venous drainage, diameter and distance to first bifurcation: an interobserver study

RATIONALE AND OBJECTIVES: To evaluate the interobserver agreement of readers in evaluating pulmonary venous anatomy and in measuring pulmonary vein ostial diameters and distance to first bifurcation. MATERIALS AND METHODS: This study was approved by our institutional review board. Thin-section contrast material-enhanced multidetector computed tomography examinations of the thorax were retrospectively reviewed in 200 consecutive patients (38 females and 162 males), age 24-79 years (mean, 52.8) referred for imaging before radiofrequency ablation therapy for atrial fibrillation. For each patient, pulmonary venous anatomy and drainage patterns including the number of venous ostia was assessed independently by experienced cardiothoracic radiologists. Pulmonary vein ostial diameter and distance to the first bifurcation of the four major pulmonary veins (right inferior and superior, left inferior and superior), the middle lobe pulmonary vein, and any anomalous pulmonary veins (common trunks and accessory veins) were measured independently at a workstation. Interreader assessment of pulmonary venous anatomy was evaluated using the Kappa statistic. Interreader variation in measurements of venous diameter and distant to first bifurcation were estimated by Bland-Altman plots and Pitman's test of difference in variance. RESULTS: Very good to excellent interreader agreement in detection of anomalous pulmonary venous anatomy, middle lobe pulmonary venous drainage, and other thoracic venous anomalies. No significant variation between readers in pulmonary vein ostial diameter measurements for the four major and middle lobe pulmonary veins, or the anomalous pulmonary veins. Significant interreader variability was noted in measurements of the pulmonary vein distance to first bifurcation for the right inferior (P = .017), middle lobe (P = .005), and left inferior (P = .015) pulmonary veins. CONCLUSIONS: There is excellent interobserver agreement when evaluating normal and anomalous pulmonary venous drainage patterns, and when measuring normal or anomalous pulmonary vein diameters. However, measurements of distances to first bifurcation were less reliable across readers.     

64层螺旋CT对肺静脉异位引流的诊断价值

目的 探讨肺静脉异位引流的64层螺旋CT及后处理图像征象,以提高对该病的诊断价值.资料与方法 回顾性分析16例先天性肺静脉异位引流患者的64层螺旋CT图像在工作站进行多半面重组(MPR)、最大密度投影(MIP)和容积再现(VR)等后处理资料,观察异位引流肺静脉的位置、形态、其异位连接(心腔或静脉)以及合并的心脏畸形,并对8例行手术治疗病例的CT诊断、超声心动图检查与手术结果进行比较.结果 64层螺旋CT诊断完全性肺静脉异位引流8例,其中心上型5例,心内型3例;部分性肺静脉异位引流8例,其中心上型4例,心内型4例.8例手术病例CT诊断与手术结果完全相符.结论 64层螺旋CT在诊断肺静脉异位引流中具有重要作用,是肺静脉异位引流的有效、无创检查方法.     

24例镰刀综合征心血管造影征象分析

笔者分析了２４例镰刀综合征心肺血管病变的造影征象及其病理生理意义，并与手术（１４例）和尸解（４例）资料对照。２４例心血管造影示全部或部分右肺静脉异常引流，分别为１７例和７例。异常引流静脉近端局限性狭窄９例，其中２例异常和正常引流静脉间有侧支吻合，右下肺异常体动脉侧支供血１８例。并存各种心脏病变者１８例，马蹄肺６例，右下肺肺隔离症３例，下腔静脉闭锁和狭窄分别为２和１例。右下肺异常体动脉侧支和心脏病变是患者严重症状和肺动脉高压的主要因素。除肺隔离症外，经导管栓塞异常体动脉侧支可使用者明显受益。异常引流静脉狭窄具有限制血液分流的作用。     

多层螺旋CTA联合CTV在肺栓塞及下肢静脉血栓诊断中的应用

目的 评价多层螺旋CT肺动脉造影(MSCTA)及多种重建技术联合双下肢静脉扫描(CTV)在肺栓塞(PE)及下肢静脉血栓诊断中的应用价值.方法 47例经临床确诊的PE患者经MSCTA检查,扫描条件包括电压120 kV,电流210 mA,准直器宽度0.75 mm,对比剂注射速率为3～4 ml/s,延时时间的设定采用自动团注触发技术,MSCTA完成后延迟170 s行盆腔及CTV.结果 47例PE患者MsCTA及MPR、MIP、VRT等重建处理后均可显示两侧肺动脉主干、叶动脉、段及亚段肺动脉.受累动脉共363支,PE伴下肢深静脉血栓(DVT)31例,占65.9%.结论 MSCTA联合CTV诊断肺动脉栓塞及下肢静脉血栓具有重要价值.     

先天性肺静脉异位连接的电子束CT诊断

目的 探讨电子束ＣＴ对肺静脉异位连接的诊断价值。方法 对１４例ＥＢＣＴ诊断的肺静脉异位连接进行回顾性分析。ＥＢＣＴ检查采用增强单层容积扫描,层厚为３ｍｍ,扫描时间为１００毫秒,所用对比剂为非离子型碘对比剂。所有患者均行表面阴影显示法进行三维重建。所有病例均行超声心动图检查。其中８例行心血管造影检查,有２例尚有手术病理对照。结果ＥＢＣＴ诊断完全型肺静脉异位连接１０例,其中心上型６例,心脏型４例;心血     

Anomalous systemic venous drainage occurring in association with the hypogenetic lung syndrome

A case in which anomalous systemic venous drainage occurred in association with the hypogenetic lung syndrome (scimitar syndrome) is described. The chest radiograph appearances of the anomalous systemic vein mimicked an anomalous pulmonary or scimitar vein. Angiography demonstrated that the patient also had a small anomalous pulmonary vein draining and a systemic artery supplying, the right lung. As the right lung was hypoplastic, all three features of the hypogenetic lung syndrome were present, in addition to partial anomalous systemic venous drainage.     

3D multidetector CT angiographic evaluation of extralobar pulmonary sequestration with anomalous venous drainage into the left internal mammary vein in a paediatric patient

Pulmonary sequestration is a congenital lung malformation, defined by dysplastic and non-functioning lung tissue lacking normal tracheobronchial connections and accompanied by an anomalous systemic blood supply. Recognition of anomalous arteries and veins in pulmonary sequestration is paramount to making the correct diagnosis. In contrast to intralobar pulmonary sequestration, where anomalous venous drainage is usually into the pulmonary venous system, the pattern of anomalous venous drainage is more varied in extralobar pulmonary sequestration. To the best of our knowledge, anomalous venous drainage to the internal mammary vein in extralobar sequestrations has not been reported. We report an anomalous venous drainage into the internal mammary vein in an extralobar sequestration which was evaluated with 3D multidetector CT angiography.     

多普勒超声心动图诊断部分性肺静脉异位引流

目的:评价多普勒超声心动图诊断部分性肺静脉异位引流(PAPVC)的价值。方法:回顾分析132例经心外科手术确诊为PAPVC患者的超声心动图诊断情况。结果:根据Brody分型,132例患者中A型14例,超声诊断11例,诊断正确率78.6%;B型103例,超声诊断57例,正确率55.3%;C型4例,超声诊断3例,诊断正确率75%;D型3例,混合型8例,术前超声均未能做出正确诊断。132例患者中右侧肺静脉异位引流90.1%;左侧肺静脉异位引流7.4%,双侧占2.5%。合并房间隔缺损(ASD)121例(91.7%),其中静脉窦型ASD 40例(33.1%),功能性单心房(大型ASD)或单心房18例(14.9%),继发孔型ASD 63例(52%);9例房间隔完整(6.8%),2例冠状静脉窦隔缺损(1.5%)。结论:彩色多普勒超声心动图可以清晰显示肺静脉的回流情况,准确诊断PAPVC。     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.