64排螺旋CT诊断主动脉缩窄伴心脏畸形

目的 探讨64排螺旋CT在主动脉缩窄伴心脏畸形中的临床诊断价值. 方法 对15例主动脉缩窄患者进行64层螺旋CT扫描,采用容积再现(VR)、最大密度投影(MIP)、多平面重组(MRP)等三维重建. 结果 64排螺旋CT清晰显示15例主动脉缩窄,与手术结果一致;所有患者均为复杂畸形,其中合并动脉导管未闭6例、室间隔缺损6例(其中3例同时合并肺动脉高压)、主动脉瓣狭窄6例、继发心壁肥厚6例.VR明确显示主动脉缩窄的部位、长度和狭窄程度.64排螺旋CT在侧支循环及肺动脉显示方面明显优于心脏超声检查. 结论 64排螺旋CT可清晰显示主动脉缩窄的类型、范围、程度及合并的心脏畸形,可作为诊断主动脉缩窄首选.     

急性主动脉夹层患者肺部改变的多排CT研究

目的探讨多排CT（MDCT）上主动脉夹层患者的肺部改变特征及发生率。方法观察71例主动脉夹层首诊患者的MDCT上肺部改变,分析并比较Stanford A型和B型患者的肺部改变情况,随访主动脉腔内覆膜支架置入术治疗和保守治疗前后患者的肺部改变。结果肺间质病变（51例,71.8%）、心包积液/心脏增大（28例,39.4%）、胸腔积液（18例,25.4%）、肺不张（13例,18.3%）在主动脉夹层患者的MDCT上最为常见,发生率相对较高;在Stanford A型和B型患者肺部MDCT改变中,心包积液/心脏增大发生率的差异有统计学意义,A型多于B型〔51.2%（21/41例）比23.3%（7/30例）,P＝0.011〕;主动脉腔内覆膜支架置入术治疗和保守组治疗前后各种肺内改变均未见明显变化,差异均无统计学意义（均P＞0.05）。结论通过MDCT图像观察肺部改变,有助于制定正确的临床治疗计划,提高MDCT在主动脉夹层诊断和随访中的临床价值。     

Aortic valve bypass for aortic stenosis: imaging appearances on multidetector CT

Object Aortic valve bypass is a technique used in high-risk patients with critical aortic stenosis that consists of placement of a conduit from the left ventricular apex to descending aorta. We describe the imaging appearances of this apicoaortic conduit on multidetector CT (MDCT). Methods Each patient underwent retrospective ECG-gated MDCT using a 16-detector-row scanner several days after placement of an apicoaortic conduit. All images were assessed by two radiologists who reviewed the appearance of the apicoaortic conduit and any post-operative complications. Follow-up studies were available for several patients. Results Twelve patients (9 men, 3 women, mean age - 78 years) underwent evaluation and the conduit was visible in each. The valve within the conduit was visible in ten (91%) of the 11 patients who received intravenous contrast material. Common findings were periconduit outpouching and hypoperfusion involving the left ventricle. Complications included pericardial hemorrhage, hemothorax and ventricular pseudoaneurysm. Mild to moderate increase in wall thinning was identified in the three patients who underwent follow-up imaging. Conclusion Aortic valve bypass with an apicoaortic conduit appears to be a feasible alternative to aortic valve replacement in high-risk patients. MDCT is an excellent method to assess the imaging features of such conduits.     

Kawasaki disease: role of coronary CT angiography

Invasive coronary angiography is considered to be the gold standard for diagnosis and follow-up of coronary artery aneurysms, thrombosis and stenosis in patients with Kawasaki Disease. However, the availability of multi-detector CT coronary angiography provides a viable alternative as a non-invasive imaging modality for sequential follow-up of patients with Kawasaki disease. High quality multidetector CT angiography images of coronary arterial anatomy can be obtained after adequate heart rate control using beta blockers.     

Pancreatic metastasis of renal cell carcinoma: multidetector CT findings

Pancreatic metastasis of renal cell carcinoma is more prevalent than the rates reported in the literature before the development of multidetector computed tomography (MDCT). These lesions are usually asymptomatic and used to be an incidental finding detected on radiological follow-up of these patients. If they are not associated with extrapancreatic involvement, they show an excellent response to surgical treatment. Thus, radiologists should be aware of the radiological characteristics of this condition to allow detection at an early stage. In this article we review the MDCT features of four cases of pancreatic metastasis of renal cell carcinoma to familiarize radiologists with this entity and the most suitable study method for its detection. The main imaging findings observed were hypervascular lesions in arterial phase of biphasic studies, hence the detection of these lesions is performed better during the early phase scanning.     

Coronary artery fistula in a patient with coronary artery disease: evaluation by coronary angiography and multidetector computed tomography

A 54-year-old man with acute miyocardial infarction was successfully treated with coronary artery stenting. Coronary angiography is the preferred diagnostic method for imaging the coronary arteries, but coronary artery fistulas origin and course may not be apparent. New tomographic cardiovascular imaging tests such as, multidetector computed tomography (MDCT) can be used to precise delineation of coronary fistulas. An erratum to this article can be found at     

Evaluation of bowel and mesenteric injury: role of multidetector CT

The development of thin-section multidetector computed tomography has improved the accuracy of computed tomography in the evaluation of abdominal trauma. Multidetector computed tomography is more sensitive and specific than diagnostic peritoneal lavages, abdominal sonography, and clinical examination for the detection of bowel and mesenteric injury. Computed tomographic findings include pneumoperitoneum, visualization of direct tears in the bowel wall, intraperitoneal fluid, bowel wall thickening, abnormal bowel wall enhancement, and mesenteric infiltration or hematoma.     

3D-DSA与MSCTA在肾动脉狭窄检查中价值

目的比较三维数字减影血管造影（3-dimensional digital subtraction angiography,3D-DSA）与多层螺旋CT血管造影（multi-slice CT angiography,MSCTA）在肾动脉狭窄检查中的应用价值,评价MSCTA在肾动脉狭窄诊断中的优势。方法 50例拟诊肾动脉狭窄患者,分别行肾动脉MSCTA及3D-DSA检查,比较2种方法在肾动脉狭窄程度诊断上的差异。结果 MSCTA诊断肾动脉狭窄〈50%者9例,≥50%~75%者21例,〉75%~99%者19例,完全闭塞1例;3D-DSA分别诊断11、20、18、1例;以3D-DSA检查结果为＂金标准＂,MSCTA评价肾动脉狭窄程度的符合率为92%。结论 MSCTA诊断肾动脉狭窄可在一定程度上替代有创的3D-DSA检查。     

多层螺旋CT肾动脉成像的图像后处理技术及临床应用

目的探讨多层螺旋CT肾动脉成像的各种图像后处理技术对肾动脉变异和不同病变显示的优缺点及临床应用价值。方法分析使用多层螺旋CTA检查肾动脉的51例患者的血管重建图像,比较各种图像后处理技术对肾动脉变异及不同病变的显示效果。29例与同期数字减影动脉造影(DSA)检查结果进行比较。51例患者中包括肾动脉变异12例、肾动脉狭窄27例、肾动脉瘤3例、肾动脉栓塞3例、肾动脉夹层6例。3例经手术证实,29例经DSA检查证实,19例经MRA等其他相关检查和随访证实。结果51例患者都能清晰显示变异的肾动脉、副肾动脉及肾动脉病变,特异度100%,灵敏度100%。29例患者与同期DSA图像对比,肾动脉的变异情况、病灶的部位、范围完全一致。各种常用图像后处理技术中,MPR难以完整显示血管的解剖学全貌,但能清晰显示肾动脉钙化、狭窄、栓塞、夹层、动脉瘤及肾内梗塞灶。MIP既能清晰显示肾动脉的解剖学形态,又能清晰显示不同病灶。VR能完整显示肾动脉的解剖学形态,在发现副肾动脉和对重叠血管、动脉瘤的显示方面优于MIP,但不能显示血管腔内情况。SSD可显示复杂的血管解剖学形态,但受阈值选择的影响较大。CPR可将迂曲的肾动脉伸展,显示较直观,并可应用来测量肾动脉狭窄处的截面积。结论MSCTA可直观地、准确地显示肾动脉变异及病变。肾动脉成像的各种后处理技术中,MIP和VR两者联合应用对肾动脉变异及病变显示最佳;MPR及SSD亦有很好的辅助作用。     

Extravascular incidental findings at multislice CT angiography of the abdominal aorta and lower extremity arteries: a retrospective review study

Purpose To assess the frequency and clinical impact of extravascular incidental findings on routine CT angiography of abdominal aorta or lower extremity arteries. Materials and methods From January 2002 to July 2004, a total of 692 patients underwent CT angiography of abdominal aorta and lower extremity arteries. Two radiologists retrospectively reviewed by consensus cross-sectional images for the presence and clinical impact definition of extravascular findings. The revision of hospital charts, medical records, and all procedures’ reports performed before and after CT angiography represented the standard of reference (SOR). Results Only 373 out of 605 patients in whom extravascular findings were found had a SOR; in these patients CT angiography obtained a true-positive incidental rate of 98.9% (369/373). For the clinical impact definition of CT-angiography incidental findings, a concordance with SOR was obtained in 56.3% of patients, whereas a subsequent investigation was required in 183 patients (183/369, 49.6%). Among clinically relevant incidental findings, a total of 35 malignancies (35/894, 3.9%) were detected in 20 patients (20/423, 4.7%); in 15 patients (15/423, 3.5%) malignancy was unknown before CT-angiography exam. Conclusions A careful observation of cross-sectional images, even if “time consuming”, is mandatory not only to assess vascular findings but also to avoid a misdiagnosis of clinical relevant extravascular findings.     

双源CT血管成像在冠状动脉-肺动脉瘘诊断中的应用

目的探讨双源CT血管成像在冠状动脉-肺动脉瘘诊断中的应用价值。方法回顾性分析本院2010年1月-2014年1月行双源CT冠状动脉CT血管造影的患者资料,观察有无冠状动脉瘘及其起源及行径。结果16683例冠状动脉CTA的患者中共检测出冠状动脉-肺动脉瘘34例,检出率为0.20%,其中右冠状动脉分支瘘入肺动脉9例（26.47%）,左冠状动脉分支瘘入肺动脉11例（32.35%）,两侧冠状动脉分支共同瘘入肺动脉14例（41.18%）。结论双源CT冠状动脉造影可清晰显示冠状动脉-肺动脉瘘的起源及行径,可作为诊断冠状动脉ˉ肺动脉瘘的常规检查方法。     

Primary sarcoma of the distal abdominal aorta: CT angiography findings

Primary aortic angiosarcomas are extremely rare. Clinically and radiographically, they mimic atherosclerosis and atheroembolic disease. For a definitive diagnosis, histologic evaluation of the tumor or of peripheral emboli is required. The imaging findings are frequently nonspecific and in most published cases did not allow a definitive preoperative diagnosis. This is the first report of the computed tomographic angiographic findings of a primary intimal abdominal aortic sarcoma and a review of previously described imaging findings in these tumors.     

Revolution CT行冠状动脉联合胸腹主动脉成像

目的 观察Revolution CT用于冠状动脉联合胸腹主动脉CT血管造影(CTA)的价值.方法 采用Revolution CT分别对A组、B组、C组各40例疑诊冠状动脉和/或主动脉病变患者行冠状动脉联合胸腹主动脉CTA、常规冠状动脉CTA及常规胸腹主动脉CTA.记录患者有效辐射剂量(ED),比较A组与B组、A组与C组...     

Multidetector spiral CT renal angiography in the diagnosis of giant renal artery aneurysms

A case of giant renal artery aneurysm in a 63-year-old man is presented. Renal artery aneurysms are rare (incidence of <1%) and this case is one of the largest giant renal artery aneurysms recorded in the literature. This case also demonstrates the value of multidetector spiral CT renal angiography (CTA) in the diagnosis, planning and treatment of renal aneurysms.     

Multidetector spiral CT renal angiography in the diagnosis of giant renal artery aneurysms

A case of giant renal artery aneurysm in a 63-year-old man is presented. Renal artery aneurysms are rare (incidence < 1%) and this case is one of the largest giant renal artery aneurysms recorded in the literature. This case also demonstrates the value of multidetector spiral computed tomographic renal angiography in the diagnosis, planning, and treatment of renal aneurysms.     

无对比增强MR血管成像与CT血管成像对肾动脉狭窄评价的对照研究

目的探讨结合时间-空间双重标记反翻转恢复脉冲（Time-SLIP）序列的无对比增强（non-contrast-enhanced）MR血管造影（MRA）技术在评价肾动脉狭窄（RAS）中的应用,并与CT血管造影（CTA）比较。材料与方法对22例怀疑RAS的患者同期进行MRA和CTA检查。在1.5 T MR扫描仪上,运用结合Time-SLIP技术的冠状面和轴面采集真实稳态自由进动序列（true SSFP）进行肾动脉MRA成像。评价肾动脉MRA图像质量和狭窄程度,并与CTA进行比较。结果共46支肾动脉列入统计,MRA图像质量优秀29例（63%）,良好13例（28%）,一般4例（9%）。无对比增强MRA与CTA对诊断肾动脉狭窄程度分级结果具有相关性（r=0.991,（P〈0.01）。以CTA为参照标准,MRA诊断明显RAS（狭窄程度≥50%）的敏感度为100%,特异度为97.1%。结论结合Time-SLIP的无对比增强MRA技术可有效用于评价肾动脉狭窄。     

Median arcuate ligament syndrome with multivessel involvement: diagnosis with spiral CT angiography

Intestinal angina may be caused by compression of the celiac artery by the median arcuate ligament of the diaphragm. Aortography can suggest the diagnosis, but the diaphragm cannot be visualized by this examination. We report a symptomatic woman in whom spiral computed tomography-guided angiography demonstrated stenosis of the celiac artery, superior mesenteric artery, and both renal arteries due to diaphragmatic compression. Surgery was beneficial. Received: 15 August 1995/Accepted: 26 September 1995     

双源CT冠状动脉成像与常规冠状动脉造影诊断冠状动脉病变的对比分析

目的探讨双源CT冠状动脉成像(DSCTCA)对冠状动脉狭窄程度及复杂性冠状动脉病变的诊断价值。方法选择71例接受DSCTCA检查,提示至少有1支冠状动脉病变(CAL)患者,并于3周内行常规冠状动脉造影(CCA)。对比分析DSCTCA与CCA显示的冠状动脉狭窄程度及复杂性冠状动脉病变,包括分叉病变、慢性完全闭塞病变(choronic total occlusion,CTO)、开口病变、弥漫性长病变结果。结果 DSCTCA对每支冠状动脉及每例患者的冠状动脉病变程度的评价,与CCA比较相似,差异均无统计学意义(P均(0.05);DSCTCA检出95支冠状动脉有钙化,CCA仅发现12支冠状动脉有钙化,差异有统计学意义(χ2=79.327,P0.01);DSCTCA检出53支血管有弥漫性长病变,CCA仅检出32支,差异有统计学意义(χ2=6.101,P=0.014);DSCTCA检出61处分叉病变,按照Lefevre分型,Ⅰ型20处、Ⅱ型25处、Ⅲ型7处、Ⅳ型3处、Ⅳa型4处和Ⅳb型2处,与CCA对比,DSCTCA诊断分叉病变敏感度、特异度、阳性预测值、阴性预测值,以患者计算均为100.0%,以血管计算分别是100.0%、99.3%、90.2%、100.0%;DSCTCA检查11处慢性完全闭塞性病变、5处开口病变,与CCA比较,DSCTCA诊断CTO及开口病变的敏感度、特异度、阳性预测值、阴性预测值,以患者和血管计算均为100%。结论 DSCTCA能评价冠状动脉病变狭窄程度,对钙化病变、弥漫性长病变DSCTCA的诊断价值优于CCA,对分叉病变、CTO、开口病变的诊断与CCA有极好的一致性。     

64排螺旋CT脑灌注和CT血管成像在大脑中动脉狭窄或闭塞的应用

目的评价64排螺旋CT脑灌注(CTP)联合头颈部CT血管成像(CTA)检查对大脑中动脉(MCA)狭窄或闭塞所致脑缺血的临床应用价值。方法对37例经DSA诊断为单、双侧MCA狭窄或闭塞患者及10名正常成年志愿者分别进行螺旋CT头颅平扫、CTP和CTA检查。脑CTP检查获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TP)等参数值,判断脑缺血。结果按照脑CTP的MTT和TP图将脑灌注延迟表现分为三型:Ⅰ型病变仅累及MCA区,Ⅱ型病变仅累及分水岭区,Ⅲ型病变同时累及MCA和分水岭区。①在25例单侧MCA狭窄/闭塞患者中,4例CTP正常,17例脑CTP灌注延迟区为Ⅰ型,4例为Ⅲ型。②与正常对照组相比,12例双侧大脑中动脉重度狭窄患者的双侧MCA支配区均有MTT和TP延迟,CBF下降和症状侧CBV升高的异常改变,提示为双侧脑缺血。侧支循环能明显减少单侧MCA狭窄患者的症状侧的脑灌注损伤,但对双侧MCA重度狭窄和闭塞患者,无论有无侧支循环,双侧脑组织灌注损伤都很严重。结论脑CTP检查的MTT和TP图能敏感显示MCA重度狭窄或闭塞所致的脑灌注损伤,为脑缺血的诊断、治疗及预防脑梗死均具有重要价值。     

活体肾动脉及其变异的CT血管成像研究

全面了解正常与变异肾动脉解剖对外科手术及介入治疗的术式选择、手术方案制定等术前决策有重要作用。本研究观察150例患者的正常及变异肾动脉图像,旨在为外科手术及介入治疗提供有价值的影像学信息。1资料与方法1.1一般资料回顾性分析2009年1月—2010年1月于我院接受64层肾动脉CTA的150例患者,其中男78例,女72例,