640层容积CT4D-DSA技术评价肝动脉解剖变异及肝癌供血血管类型的初步应用

目的探讨640层容积CT4D．DSA技术评价肝动脉解剖变异及肝癌供血动脉类型的应用价值。方法回顾分析经640层容积CT4D-DSA技术处理的31例拟诊或确诊肝癌患者4D血管图像,并结合横轴位容积图像观察分析。结果除2例图像质量不符合诊断要求外,29例中肝动脉解剖变异MichelsⅠ型21例（79．31％）,Ⅸ型6例（20．67％）,Michels未描述分型2例（22．22％）;规则性肝动脉供血肝癌18例（75％）,其中存在寄生动脉供血3例,变异型肝动脉供血肝癌5例（25％）。动门静脉双供血4例（17.39％）;结论640层容积CT4D-DSA技术有助于全面评价肝动脉解剖变异及肝癌供血动脉类型。     

High resolution MR anatomy of the subthalamic nucleus: imaging at 9.4 T with histological validation

Using conventional MRI the subthalamic nucleus (STN) is not clearly defined. Our objective was to define the anatomy of the STN using 9.4 T MRI of post mortem tissue with histological validation. Spin-echo (SE) and 3D gradient-echo (GE) images were obtained at 9.4 T in 8 post mortem tissue blocks and compared directly with corresponding histological slides prepared with Luxol Fast Blue/Cresyl Violet (LFB/CV) in 4 cases and Perl stain in 3. The variability of the STN anatomy was studied using internal reference points. The anatomy of the STN and surrounding structures was demonstrated in all three anatomical planes using 9.4 T MR images in concordance with LFB/CV stained histological sections. Signal hypointensity was seen in 6/8 cases in the anterior and medial STN that corresponded with regions of more intense Perl staining. There was significant variability in the volume, shape and location of the borders of the STN. Using 9.4 T MRI, the internal signal characteristics and borders of the STN are clearly defined and significant anatomical variability is apparent. Direct visualisation of the STN is possible using high field MRI and this is particularly relevant, given its anatomical variability, for planning deep brain stimulation.     

旋转数字减影血管造影及三维重建技术对脑血管疾病的评估作用

背景常规数字减影血管造影(digital subtraction angiography,DSA)存在病变血管与周围血管重叠问题,应用旋转DSA(rotational digital subtrac-tion angiography,RDSA)及三维重建(three-dimensional reconstructed im-ages by use of rotational digital subtraction angiography,3D-DSA)是否能解决这一问题?目的评价RDSA及3D-DSA技术对脑血管疾病诊断的应用意义.设计以诊断为依据的非随机对照研究.地点和对象2002-05/2002-07解放军北京军区总医院收治的蛛网膜下腔出血患者8例,男6例,女2例,年龄28～70岁,平均43岁.干预所有患者均应用传统DSA,RDSA及3D-DSA技术进行检查.血管造影机使用GE公司Adventx LCV数字减影血管造影系统及Mark VProvis高压注射器.用于图像后处理的计算机为采用Sun Spare UNIX系统的AW4.0三维处理工作站.图像的采集和处理通过图像存储和传输系统(picture archive and communication system,PACS)连接.主要观察指标不同技术方法获得的血管造影图像质量、颅内病变血管位置及病变结构显示情况.结果所有患者均确诊为颅内动脉瘤.常规正侧位DSA能显示存在动脉瘤病变或可疑存在动脉瘤,仅极少数病例能明确显示瘤颈形态(2/8)和载瘤动脉与瘤体的关系(1/8).RDSA显示病变复杂结构的能力较常规DSA明显提高.8例3D-DSA图像都清晰显示了脑动脉瘤瘤体、瘤颈形态及载瘤动脉关系.结论RDSA结合3D-DSA技术对颅内动脉瘤病变结构显示极佳,有助于对脑血管病变的诊断和治疗及康复介入提供理论依据.     

容积重建成像3D-CTA与3D-DSA在诊断急性破裂性颅内微小动脉瘤的研究

目的 对比研究容积重建成像三维CT血管造影与三维DSA(3D-DSA)在颅内微小动脉瘤诊疗中的临床应用价值.方法 对广东省人民医院2007年5月至2008年11月收治的174例蛛网膜下腔出血患者首先采用采用GE公司的Light Speed Plus 64排容积螺旋CT机获得原始图像,采用容积重建成像技术(VR)进行三维重建.并辅助运用多轴面重建(MPR),然后再行全脑血管造影术,并行3D-DSA成像.结果 本组174例蛛网膜下腔出血患者诊断为颅内微小动脉瘤11例,均经开颅手术证实;其中CTA诊断11例,3D-DSA诊断10例.容积重建成像CTA清晰显示颅内微小动脉瘤、载瘤动脉、动脉瘤的形状和大小及其与邻近结构的解剖关系,与3D-DSA差异无统计学意义.结论 容积重建成像CTA是一种可靠、无创的快速诊断颅内微小动脉瘤的方法,为急症手术提供了详实的影像学资料,可帮助制定治疗方案.     

二维超声及彩色多普勒能量图对低回声型肝小血管瘤的诊断价值

目的：探讨二维超声及彩色多普勒能量图（CDE）对直径小于3cm的低回声型肝小血管瘤（简称SHCH）的诊断价值。方法：应用二维超声和CDE对37例（43个病灶）SHCH进行检查。结果：SHCH的二维声像图主要表现为：边界清晰，边缘回声增强，内部呈均匀的网络状或管道要结构；CDE表现：SHCH周围显示环绕状48．8％（21／43）及爪形34．9％（15／43）的连续性静脉血流，“静脉血流延伸”征占60．5％（26／43），病灶内显示1－3个散点或短棒状彩色血流，脉冲多普勒检测为连续性静脉血液，动脉血流显示率仅2．3％（1／43）。本组诊断符合率为95．3％（41／43）。结论：二维超声结合CDE在SHCH诊断和鉴别诊断上有较大的应用价值。     

A digital anatomical study of the corona mortis in females

It was a different study from traditional anatomy to construct three-dimensional (3D) model of the corona mortis (CMOR) through contrasted enhanced computed tomography (CT) scanning. This will provide an aid for the understanding of the fine anatomy of CMOR, as well as surgical produces. A medical image processing system was used to process computed tomography scanning data collected from 330 cases of woman patients. Accurate digital 3D models of the CMOR were used to study the incidence, location, and the morphological patterns. These models have a rotation of 360° and allow displaying from different views. The incidence was 51.1% for the venous CMOR, 14.1% for the arterial CMOR in the 660 sides pelvic wall and vessel models. The mean distance from the symphysis pubis for the venous CMOR was 66.87?mm, and 59.60?mm for the arterial CMOR. The morphological patterns we identified were classified in three types (I-III). The model of CMOR serves as a useful tool for the learning and investigation of the CMOR. In the future, the digital anatomical data can be beneficial to illustrating the operation approach and decreasing the surgical complications.     

Two dimensional ultrasound scanning of excised brains—I. Normal anatomy

This study demonstrated techniques for visualization of detailed brain anatomy with two dimensional ultrasound. The use of large aperture focused ultrasound transceivers appears to be essential for displaying the outlines of thalamus, internal capsule and substantial nigra in addition to those of the ventricles. The ability to vary grey scale and edge enhancement using either linear or logarithmic amplification through a scan converter assisted in identification of anatomical structural detail. It was most clearly visualized when the images were displayed with accentuation of edge enhancement. Brain position during ultrasound scanning was also important for maximal visualization of structural detail.

Anatomical studies are useful in clinical application of two dimensional ultrasound brain visualization, to assure maximum diagnostic information with minimum scan time. The development of ultrasound diagnostic instruments and techniques is expected to add valuable information to computer assisted tomography, isotope brain scanning and cerebral angiography in the management of brain disorders, particularly in infants.     

大节段生物活性陶瓷多孔支架肌内血管化：3年期3D-数字减影血管造影观察

背景：人工骨材料生物体内的活化,与自体骨生物键合,完成自体骨组织爬行替代,核心是材料的血管化。如何判断血管化发生？目的：观察大节段生物活性陶瓷多孔支架骨骼肌内植入3年后血管化情况。方法：雄性中国自养犬10只,于骨骼肌内植入直径1.5cm、长4.0－4.5cm羟基磷灰石-聚乳酸多孔支架,饲养36个月后行3D数字减影血管造影检查。结果与结论：所有动物均顺利完成材料植入及数字减影血管造影成像,且所得结果相似：营养血管由股动脉、股深动脉发出并指向羟基磷灰石-聚乳酸支架,分支后进入材料。结果表明,3D数字减影血管造影技术是用于监测人工骨材料体内血管化的有效手段,羟基磷灰石-聚乳酸支架骨骼肌内植入3年后能够形成完整的动静脉血循环系统。     

Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation

BACKGROUND: To assess the impact of preliver transplant double helical computed tomography (DHCT) and three-dimensional computed tomography arteriography (3D-CTA) on surgical planning for hepatic transplantation. METHODS: Vascular findings detected on DHCT/3D-CTAs of 80 patients were shown to the transplant surgeon in a blinded fashion. These findings included hepatic arterial anatomy, diameters of the major vessels that supplied the liver, celiac axis stenosis, splenic artery (SA) aneurysms, and portal vein thrombosis (PVT). The surgeon was asked to state the "planned" surgical approach for each case based on scan findings. These results were subsequently compared with what "actually" occurred at transplantation by review of surgical records. RESULTS: Fifty-five patients had conventional and 25 patients had nonconventional hepatic arterial anatomy. Three patients had PVT, three patients had celiac axis stenosis, and three patients had SA aneurysms. Correlation between the "actual surgical technique" and the "planned surgical approach" was seen in 50/55 (91%) patients with conventional and in 23/25 (92%) patients with nonconventional anatomy. Five patients requiring aortohepatic interposition grafts for arterial anastomoses had either severe celiac axis stenoses or arterial inflow vessels that were 3 mm or smaller. Three patients with PVT underwent successful surgical resection of the thrombosed segment and standard PV anastomoses as planned. Patients with complete replacement of hepatic arterial supply to the superior mesenteric artery required alteration of the sequence of the vascular anastomoses. Patients with SA aneurysms had surgical ligation of the splenic artery. CONCLUSIONS: DHCT/3D-CTA provides noninvasive means to identify findings that have significant impact on surgical planning for hepatic transplantation including celiac axis stenosis, diameter of inflow arterial vessel 相似文献   

螺旋CT三维重建在诊断气管、支气管病变的应用

目的评价螺旋CT三维重建对气管、支气管疾病诊断的价值。方法85例患气管、支气管疾病患者,由纤维支气管镜活检或手术病理证实,回顾性对病灶的MPR、MinP、SSD和CTVB图像进行分析。结果MPR对气管、支气管内外组织的结构和位置显示清晰,且能显示病灶的细节,结合横轴位有助定性和定位。MinP对连续性气管、支气管显示最佳。SSD显示支气管树及病灶立体的外表形态,测量大小有误差。CTVB类似纤维支气管镜(FB)所见,对3级及3级以下支气管病灶诊断不可靠。结论螺旋CT三维重建对气管、支气管疾病诊断有较大辅助价值,且对病灶的显示各有其优劣,诊断疾病需综合运用。     

Anatomical basis for pancreas transplantation via isolated splenic artery perfusion: A literature review

The variability of vascular anatomy of the pancreas underlines the difficulty of its transplantation. Research regarding the consistency of anatomical variations shows splenic arterial dominance in most cases. This can significantly improve transplantation success. A systematic literature review was performed according to the quality standards described in the AMSTAR measurement tool and the PRISMA guidelines. We valuated existing literature regarding the vascularization and blood perfusion patterns of the pancreas in terms of dominance and variability. The collected data was independently analyzed by two researchers. Variance of vascular anatomy was seen to be underreported in literature, though significant findings have been included and discussed in this study, providing valuable insight into the dynamics of pancreatic perfusion and feasibility of transplantation on several different supplying arteries. The splenic artery (SA) has a high percentage of consistency in all found studies (over 90%). High frequency of anastomoses between arterial pools supplying the pancreas can mediate sufficient blood supply through a dominant vessel, such as the SA, which is present in most cases. Pancreatic transplantation with isolated SA blood supply can provide sufficient arterial perfusion of the pancreas for stable transplant viability due to high anatomical consistency of the SA and vast communications with other arterial systems.     

旋转DSA及三维重建技术在脑血管造影中的应用

目的 评价旋转DSA及血管三维重建技术在颅内动脉瘤血管造影诊断中的应用意义。方法 8例蛛网膜下腔出血患者应用传统DSA、旋转DSA及血管三维重建进行检查，对比不同方法对动脉瘤病变的显示情况。结果 所有患者均确诊为颅内动脉瘤。常规正侧位DSA能显示存在动脉瘤病变或可疑存在动脉瘤，仅极少数病例能明确显示瘤颈形态(2／8)和载瘤动脉与瘤体的关系(1／8)。旋转DSA显示病变复杂结构的能力较常规DSA明显提高。8例血管三维重建处理的图像都清晰显示了脑动脉瘤瘤体、瘤颈形态及载瘤动脉关系。结论 旋转DSA及血管三维重建技术对颅内动脉瘤病变结构显示极佳，明显有助于提高对脑血管病变的诊断和治疗水平。     

Virtual endoscopy of the cerebral ventricles based on 3-D ultrasonography

Virtual endoscopy enables preoperative surgical planning based on "surgeons' view" information in the individual patient. In neurosurgery, magnetic resonance (MR) images are mainly used for planning of virtual neuroendoscopy (VNE). We studied the feasibility of three-dimensional (3-D) ultrasonography as the imaging modality for VNE in pediatric patients with hydrocephalus. 3-D ultrasonography data sets were obtained through the open anterior fontanelle and analyzed using perspective volume rendering, with delineation of the ventricular system for anatomical details in relation to standard ultrasonography and intraoperative anatomy, during endoscopy in two infants with hydrocephalus. VNE clarified anatomical variants seen on standard ultrasonography images, anticipated ventricular dysmorphia seen during neuroendosopy and enabled a realistic impression of an endoscopic inspection into the ventricular system of the two infants studied. Based on 3-D ultrasonography, VE enables detailed information on ventricular anatomy in pediatric patients for planning of endoscopic interventions.     

Cerebrovascular segmentation and planning of depth electrode insertion for epilepsy surgery

Purpose

Depth electrodes are inserted in the brain to locate the epileptogenic zone without craniotomy, but there is risk of surgical hemorrhage. Preoperative planning is required to mitigate this risk. A preoperative imaging, segmentation and three dimensional (3D) visualization procedure was developed to provide neurosurgeons with cortical and vascular anatomy information for surgical planning and neuronavigation.

Methods

Cerebral vascular imaging was performed with phase-contrast magnetic resonance angiography (PC-MRA). Fuzzy c-means was performed to extract brain parenchyma from the PC-MRA images. A multi-scale vessel enhancement filter and thresholding process were combined to segment the vasculature and suppress background noise in the PC-MRA images. Finally, 3D visualization of the vasculature and cortical structures was implemented using volume rendering.

Results

Quantitative and qualitative validation of the vascular segmentation method were done. Using manual vascular segmentation as the gold standard, our method produced a satisfactory result: sensitivity was as high as 90 % at a specificity level of 95 %. Moreover, comparing the 3D visualizations of the vasculature and cortical structure for 4 patients with their respective intraoperative craniotomy photographs showed high levels of similarity.

Conclusion

A new automated segmentation and visualization procedure provides sufficient and accurate cortical and vascular anatomy information compared to intraoperative photographs. This method has potential to assist neurosurgeons with planning and neuronavigation for depth electrode insertion with avoidance of cerebral hemorrhage.     

运用容积重现和三维重建分析左肾动脉IIC类变异:1例报告

本文报告1例左肾动脉IIC类变异。患者术前行腹部增强CT扫描,发现其左肾动脉走行存在变异。肾动脉变异在临床上较为少见,然而在肾脏疾病的外科治疗中,解剖变异的发生却易引起较为严重的影响。因此,在术前对肾动脉走形及变异进行充分的了解,能减少泌尿外科手术的术中损伤、并能提高手术成功率、加快患者术后恢复。      

三维超声成像在肝胆疾病中的应用

本文利用不同的三维超声重建模式重建部分肝胆疾病的三维图像，旨在探讨三维超声的重建方法及其在肝胆疾病中的临床应用价值，同时描述了部分肝胆疾病的三维超声图像特征。所用仪器为Ｖｏｌｕ－ｓｏｎ５３０Ｄ三维超声成像系统，探头为三维容积探头，频率３．５／５ＭＨｚ，重建模式选用表面成像模式及透明成像模式。结果表明：（１）用表面成像模式，可清晰反映病变组织的外观形态、轮廓大小及表面细微结构特征，如肝硬化、肝癌、胆囊结石、胆囊息肉等。（２）用透明成像最小回声模式重建的肝内血管及扩张的胆管的三维图像，其血管树或胆管树连续性好，管道间空间关系明确，可显示末端细小的分支或属支，并可显示肝内血管或胆管的异常走行及异常通道。该模式与Ｘ线模式组合，能显示肝内血管或扩张胆管与病变组织的空间位置关系，并可显示引起胆管扩张病理因素的位置及其与远端胆管的空间关系。因此，三维超声重建可为肝胆疾病提供较二维超声更为丰富的信息，对全面了解病情、明确诊断及制定治疗方案有极大的临床意义     

多层螺旋CT与三维DSA重建成像对颈内动脉瘤构型分析的比较研究

目的探讨多层螺旋CT(multiple-slice spiral computed tomography angiography,MSCTA)和三维DSA(three-dimensional digital subtraction angiography,3D-DSA)重建成像在颈内动脉瘤构型分析中的意义,对比其在颈内动脉瘤诊断与治疗中的价值。方法回顾性分析91例可疑颅内动脉瘤患者的临床和影像资料,全部行MSCTA和3D-DSA检查,其重建成像显示颈内动脉瘤的三维空间构型,比较研究颈内动脉瘤的位置、形态、颈内动脉瘤瘤颈开口与载瘤动脉的连接方式、动脉瘤与颈内动脉及其分支血管开口的相互空间结构关系。并以3D-DSA重建成像结果为标准,计算MSCTA重建成像对诊断颈内动脉瘤的敏感性、特异性及准确度;采用Kappa分析评价MSCTA重建成像与3D-DSA重建成像两种诊断方法显示颈内动脉瘤的一致性;采用卡方检验分析检验MSCTA重建成像与3D-DSA重建成像两种诊断方法显示双泡及多泡型颈内动脉瘤的阳性率。结果 3D-DSA重建成像证实为颈内动脉瘤78例,其中单发59例,多发19例,共发现108枚动脉瘤;所有颈内动脉瘤可分型为三类:(1)单泡型动脉瘤74枚(68.52%)。(2)双泡及多泡型动脉瘤33枚(30.56%)。(3)梭型动脉瘤1枚(0.93%)。MSCTA重建成像检出颈内动脉瘤77例,单发58例,多发19例,共发现106枚动脉瘤;其中单泡型86枚(81.13%),双泡及多泡型19枚(17.92%),梭形动脉瘤1枚(0.94%);两者检查均为阴性13例。从另一个角度分析,所有颈内动脉瘤根据3D-DSA重建成像还可分型为:颈内动脉分支开口无关型动脉瘤、颈内动脉分支开口相关型动脉瘤和分支泡上发出型动脉瘤,分别有52枚、37枚和19枚;MSCTA重建成像显示的以上各型颈内动脉瘤分别是51枚、36枚和19枚;以3D-DSA重建成像为标准,MSCTA重建成像诊断颈内动脉瘤的敏感性、特异性、准确度分别为98.14%、92.86%、97.54%,两种检查方法有较强的一致性(Kappa=0.883,P<0.05)。3D-DSA重建成像显示双泡及多泡型颈内动脉瘤的阳性率为30.56%(33/108),高于MSCTA重建成像显示的阳性率17.92%(19/106),差异具有统计学意义(χ2=7.25,P<0.01)。结论 MSCTA重建成像为诊断颈内动脉瘤提供一个可靠的筛选、早期诊断的手段;而3D-DSA重建成像则清晰显示颈内动脉瘤的结构形态、动脉瘤与颈内动脉及其分支开口的空间结构关系,为制定合理的治疗方案提供了必要的可靠依据。     

钆贝葡胺三维动态增强磁共振血管成像对活体肝移植供体术前血管系统的评价

目的 钆贝葡胺增强三维动态增强磁共振血管成像(3D DCE MRA)对活体肝移植供体肝动脉、门静脉、肝静脉血管解剖的显示情况.方法 32例肝移植供体,术前常规MR扫描.首先经静脉注入1 ml钆贝葡胺注射液,行testbolus测出循环至肝动脉时间,然后行冠状位三维T1加权快速扰相小角度梯度回波(3D-FLASH)序列扫描,自动脉期开始连续扫描4期,每期间隔10 s,获得肝动脉、门静脉、肝静脉等各期图像,观察原始图像及MIP重建后图像中肝动脉、门静脉、肝静脉及其分支的显示情况,确定血管的走形及有无变异.以肝移植术中观察的血管情况作为金标准,分析MRA所见.结果 MRA对于肝动脉、门静脉、肝静脉系统的显示质量均较好.MRA发现肝动脉变异5例,门静脉变异4例,肝静脉变异8例,均经过手术证实.术中发现副肝动脉1例,MRA未发现.结论 钆贝葡胺3D DCE MRA安全、无创,对肝动脉、门静脉、肝静脉显示清楚,诊断变异准确度高,有可能成为术前肝移植供体血管评价的首选影像学检查手段.     

Virtual 2D angiography from four-dimensional digital subtraction angiography (4D-DSA): A feasibility study

BackgroundDigital subtraction angiography (DSA) remains the gold standard for angiographic evaluation of cerebrovascular pathology, however, multiple acquisitions requiring additional time and radiation are often needed. In contrast, 3D-DSA provides volumetric information from a single injection but neglects temporal information. Four-dimensional-DSA (4D-DSA) combines temporal information of 2D-DSA with volumetric information of 3D-DSA to provide time-resolved tomographic 3D reconstructions, potentially reducing procedure time and radiation. This work evaluates the diagnostic quality of virtual single-frame 4D-DSA relative to 2D-DSA images by assessing clinicians’ ability to evaluate cerebrovascular pathology.MethodsSingle-frame images of four projections from 4D-DSA and their corresponding 2D-DSA images (n = 15) were rated by two neurointerventional radiologists. Images were graded based on diagnostic quality (0 = non-diagnostic, 1 = poor, 2 = acceptable, 3 = good). Dose area product (DAP) for each case was recorded for all 2D-DSA, 4D-DSA acquisitions, and the overall procedure.ResultsThe mean diagnostic quality of all four 4D-DSA projections from both raters was 1.75 while the mean of 2D-DSA projections was 2.8. Student’s t-test revealed significant difference in diagnostic quality between 4D-DSA and 2D-DSA at all four projections (p < 0.001). On average 4D-DSA acquisitions accounted for 30% dose compared to the overall average aggregated dose per procedure.ConclusionsThe difference in image quality between virtual single-frame 4D-DSA and their respective 2D-DSA images is statistically significant. Furthermore, 4D-DSA acquisitions require less radiation dose than conventional procedures with 2D-DSA acquisitions.     

自动移床式3DCE—MRA在下肢血管疾病中的应用研究

目的探讨三维对比增强MRA在下肢动脉病变血管成像中的临床应用价值。方法对95例临床疑是下肢动脉疾病的患者行三维对比增强MRA检查,其中20例行DSA检查,以DSA为标准,评估CE-MRA检出下肢动脉狭窄的准确性。结果双下肢主干动脉有1762节显示满意,满意显示率为97．62％（1762／1805）。在所显示的动脉血管节段中,CE—MRA与DSA分别检出轻度狭窄30／28节、严重狭窄24／22节、闭塞12／11节。二者在轻度狭窄、重度狭窄、闭塞的一致率分别为93．33％、91．67％、91．67％。结论下肢动脉三维对比增强MRA具有定位准确、无医源性损伤、安全迅速及可重复性等优点,是外科治疗下肢动脉疾病的重要依据,具有广阔的临床应用前景。