Hepatic falciform artery

The hepatic falciform artery is an occasional terminal branch of the left or middle hepatic artery, and may provide an uncommon but important collateral route when the principal visceral arteries are occluded.     

Reexamination of hepatic falciform artery: angiographic study]

Supraumbilical skin complication during hepatic artery infusion chemotherapy or transcatheter arterial chemoembolization (TACE) for liver tumor has been reported by some authors. This complication is thought to be caused by the flow of chemotherapeutic, agent and embolus into the hepatic falciform artery (HFA). It is important for angiographers to be aware of the presence of HFA to prevent possible supraumbilical skin complication. The rate of visualization of the HFA on angiography has been considered to be only about 2%. In a retrospective study of celiac angiograms performed in 200 patients, we found an incidence of 32/200 (16%). The proximal side of this artery may be tortuous. In all cases, the flow of the HFA is slower than that of the hepatic artery. The paraumbilical vein was visualized with the HFA in 18 cases. Chemotherapy or transcatheter arterial chemoembolization was performed in 10 patients, and there was no postprocedure supraumbilical skin complication.     

子宫动脉造影解剖分析及对栓塞治疗子宫肌瘤的指导意义

目的研究子宫肌瘤血管造影表现特点及其临床价值。方法75例患者,经临床症状,彩超和(或)CT检查确诊子宫肌瘤,其中黏膜下肌瘤9例,肌壁间肌瘤50例,浆膜下肌瘤16例;单发肌瘤21例,多发肌瘤54例。经右侧股动脉穿刺插管,导管分别插入双侧子宫动脉造影,观察内容包括：子宫动脉的起源及其分支、不同类型子宫肌瘤的血管造影表现,然后进行栓塞治疗。结果①大多数患者子宫动脉大部分发自髂内动脉的臀下动脉阴部干,其次为髂内动脉主干和臀上动脉。②子宫肌瘤供血情况分为：a、一侧子宫动脉供血为主型。b、双侧子宫动脉均衡供血型。c、单纯一侧子宫动脉供血型。③卵巢支的栓塞几乎不可避免,其临床后果仍存在争议。结论子宫动脉栓塞是治疗子宫肌瘤的一种安全有效的方法,熟悉子宫肌瘤的血管解剖对提高技术成功率、合理选用栓塞方法有重要意义。     

Hepatic falciform artery. Angiographic findings in 25 patients

Purpose: To determine the frequency of hepatic falciform artery (HFA) occurrence on celiac or hepatic angiograms and elucidate the anatomy and clinical importance.Material and Methods: Among 1,250 patients who underwent celiac or hepatic arteriography, we encountered 25 patients (2%) with a HFA. Prospectively, CT hepatic falciform arteriography (CTHA) was performed in 4 patients. Indigocarmine dye was injected into the HFA in 6 patients to evaluate whether the abdominal skin was stained. Embolization of the HFA before chemoembolization for hepatocellular carcinoma was performed in 4 patients to prevent abdominal wall injury.Results: Among 25 patients, the HFA arose as a terminal branch of the middle hepatic artery in 14 patients (56%) and of the left hepatic artery in 11 patients (44%). The vessel was single in 18 patients (72%) and double in 7 patients (28%). Two vessels ran side by side along the hepatic falciform ligament. On CTHA, the HFA ran within the hepatic falciform ligament and the branches were connected with the liver around the hepatic falciform ligament. After indigocarmine dye injection, the stain of abdominal skin was recognized in all 6 patients. No abdominal wall injury occurred in any of the 4 patients who were subjected to hepatic chemoembolization.Conclusion: HFA is an extrahepatic pathway which runs to the abdominal wall. Before chemoembolization of the middle or left hepatic artery for hepatic malignancy, the HFA should be recognized.     

Persistent sciatic artery: clinical, embryologic, and angiographic features

The persistent sciatic artery is a rare but interesting and clinically pertinent vascular anomaly that may present as a buttock aneurysm or as ischemic or embolic disease. Its correct angiographic diagnosis depends on recognition of an abnormally large internal iliac artery, appropriate injection and adequate timing to fill and follow flow into the large vessel, and recognition and differentiation of the tapering superficial femoral artery from routine occlusive disease so that an accurate picture of lower leg runoff is provided.     

肝脏肿瘤射频消融术后螺旋CT表现及临床意义

目的：研究肝肿瘤经皮射频消融治疗后的典型和不典型CT表现并分析其临床意义。方法：52冽原发和肝转移瘤患者经皮射频消融术后或术后1月,如果效果显著3月后应用CT三期增强扫描。结果：根据肿瘤灶毁损的程度及时间的变化,消融区影像表现差异大。结论：肝脏肿瘤消融术后螺旋CT扫描,尤其是三期增强扫描对治疗后的疗效及并发症可作出精确的影像诊断,对确定肿瘤残存及复发与否有着重要的作用。     

Single coronary artery from the right sinus of Valsalva: angiography, anatomy, and clinical significance.

A case of single coronary artery from the right sinus of Valsalva with a connecting branch passing between the aorta and right ventricular infundibulum is described. The anomaly was demonstrated at coronary arteriography and verified at surgery. This type of single coronary artery has been associated with sudden exertional death in young persons. The case prompted a review of the classification of single coronary artery with emphasis on clinical significance of the various subtypes and angiographic findings.     

Fetal choroid plexus cysts: prevalence, clinical significance, and sonographic appearance

To determine the prevalence, sonographic appearance, and clinical significance of fetal choroid plexus cysts, we analyzed the sonograms and clinical records of 17 fetuses with cysts. Fetal and maternal age, sonographic indication, cyst size and multiplicity, and evolution on serial studies were recorded. Fetal outcome was available in 16 cases by genetic amniocentesis (n = 5) or neonatal clinical records (n = 11). The prevalence of fetal choroid plexus cysts was 0.8% (17/2084) during a 40-month period. All cysts were initially identified on sonograms performed between 14 and 21 weeks. Cysts ranged from 3 to 11 mm in size and were bilateral in four (36%) of 11 cases in which both lateral ventricles were visualized. In nine of 10 cases with serial sonograms 2-21 weeks after the initial study, the cysts were no longer present. One fetus had a small cyst persisting at term. All five cases with genetic amniocentesis had normal chromosomes. The only phenotypic abnormality in the 11 cases with clinical follow-up was a small hemangioma of the chest wall. We conclude that most fetuses with isolated choroid plexus cysts have a normal outcome and that serial sonography for cyst evaluation is not useful in determining fetal prognosis.     

Posterior cerebral artery occlusion: clinical, computed tomographic, and angiographic correlation.

The distribution of low-density areas on computed tomography (CT) suggested occlusions in the proximal half of the circummesencephalic portion in 38 patients with posterior cerebral artery (PCA) occlusion. Correlation between clinical, CT, and angiographic findings in 24 cases showed that occlusion was most common in the crural segment. Clinical manifestations and infarction extension varied widely among proximal occlusions. In cases with good collateral filling, the infarction was restricted to the thalamus; in those with poor filling, it involved most of the PCA's territory, and hemorrhagic transformation occasionally ensued. Discrepancies between findings were ascribed to dislodging of emboli or thrombi, recanalization, and transient obscuration of the infarction on CT.     

Carotid and vertebral artery trauma: clinical and angiographic features.

Injury to the carotid or vertebral artery is an important clinical entity that requires angiography for definitive diagnosis and evaluation. The common carotid artery may be injured by penetrating trauma while the internal carotid artery is usually damaged by either trivial or blunt trauma. With trivial trauma extracranial internal carotid artery dissection should be considered if there is unilateral headache, Horner's syndrome or delayed transient ischaemic attack, and intracranial dissection if a profound neurological defect occurs immediately following trauma. Injury to the internal carotid artery following blunt trauma includes dissection of the extracranial internal carotid artery, carotid-cavernous fistula and pseudoaneurysm formation. These should be considered in a patient with delayed neurological deficit, mandibular or skull fracture, a constellation of orbital signs or diffuse subarachnoid haemorrhage, respectively. Vertebral artery injury is less frequent. Dissection typically follows abrupt cervical rotation and occurs at C1-2, whereas penetrating trauma may involve either the proximal or distal vertebral artery and occlusion, arteriovenous fistula or pseudoaneurysm may be found. Endovascular techniques may be used in either the carotid or vertebral artery to close fistulae or occlude an extensively damaged vessel.     

Mesenteric Castleman's disease: ultrasound, computed tomography and angiographic appearance

The localized form of Castleman's disease is rare, and a mesenteric location is particularly unusual. A case of an asymptomatic young woman having the hyaline vascular type is presented and the ultrasound, CT and angiographic features of the condition are demonstrated.     

The ascending pharyngeal artery: branches,anastomoses, and clinical significance

Neuroradiologists generally do not fully appreciate the importance of the territory of the ascending pharyngeal artery. The ascending pharyngeal artery is a small but important artery that supplies multiple cranial nerves and anastomotic channels to the anterior and posterior cerebral circulations. Several disease processes in the head and neck involve the ascending pharyngeal artery. To evaluate and treat such diseases, it is necessary for neuroradiologists not only to know selective angiography and embolization techniques, but also the territory of the ascending pharyngeal artery, anastomoses, and vascular supply to the vasa nervorum of lower cranial nerves. Herein, the normal angiographic anatomy of the ascending pharyngeal artery, its relationship with neighboring territories, its importance in clinical situations, and research models are reviewed.     

Topographic anatomy of paraclinoid carotid artery aneurysms: usefulness of MR angiographic source images

We evaluated the usefulness of magnetic resonance angiography (MRA) for showing the topography of paraclinoid carotid artery aneurysms in 27 patients with 30 paraclinoid aneurysms undergoing conventional angiography, three-dimensional time-of-flight MRA and surgery. The anatomy shown on the axial MRA source images was consistent with that found at surgery. The neck of the aneurysm could always be identified on the source images, while it could not be analysed exactly on conventional angiography in 3 cases (10 %). The optic nerves, including those displaced by the aneurysm, were recognised in all patients. The anterior clinoid process was shown as a low-intensity rim or area contiguous with the cortical bone. The source images were of great value in understanding the topography of paraclinoid carotid artery aneurysms. Received: 11 April 1996 Accepted: 12 August 1996     

Occlusion of internal carotid artery. Further clinical angiographic,and therapeutic considerations

Summary Patients with occlusion of ICA have been reviewed. Further ischemic attacks have been observed in 25–30%. The cause of the ischemia was generally embolization by way of collateral circulation through the ECA. Treatment of these patients is considered.     

Aortocaval fistula: CT appearance with angiographic correlation

As CT is often the initial imaging method in the evaluation of suspected complications of abdominal aortic aneurysm, especially rupture of the aneurysm, it is important to be aware of other less common complications that can be detected by CT. A patient with an aortocaval fistula and renal venous hypertension is discussed. The constellation of CT findings that suggest this diagnosis is described as is the angiographic correlation. Awareness of these CT findings, including early equivalent enhancement of the inferior vena cava and aorta; enlarged, poorly functioning kidney; and perirenal "cobwebs," will lead to the appropriate confirmatory angiographic studies.