胸廓出口综合征的CT血管成像评价

CT血管成像（CTA）是微创性显示胸廓出口综合征血管结构的有效方法。对胸廓出口解剖、CTA检查技术与方法及胸廓出口综合征的表现进行了回顾。     

胸廓出口综合征一例报道

胸廓出口综合征一般是指臂丛神经和锁骨下动脉、静脉在胸廓出口和斜角肌止点之间卡压而引起的一系列症状。临床上比较少见。作在工作上遇到1例,现将其影像学表现报道如下。     

胸廓出口综合征的CT血管成像评价

CT血管成像(CTA)是微创性显示胸廓出口综合征血管结构的有效方法.对胸廓出口解剖、CTA检查技术与方法及胸廓出口综合征的表现进行了回顾.     

选择性盆腔动脉造影诊断治疗妇科恶性肿瘤

目的：提出操作简便，省时，省材的一侧经皮股动脉穿刺采用ｃｏｏｋ公司研制的ＲＳ管或ＲＨ和双侧髂内动脉插管在妇科恶性肿瘤诊断与治疗方面的应用。     

主动脉弓综合征血管造影诊断研究－－53例大动脉炎头臂动脉病变的分析

主动脉弓综合征是各种病变所致的主动脉弓及头臂动脉狭窄，阻塞及其引起一系列缺血症状和体征的总称。在我国最常见的原因是大动脉炎，尤其是青少年女性，70年代以来，国内外对大动脉炎已做了深入的研究，但有关中国人大动脉炎所致的主动脉弓综合征的造影表现，尚少专题报导，本文分析了53例大动脉炎主动脉弓综合征的造影表现，并讨论了有关诊断及其与临床的联系，现将主要结果报导如下。     

下消化道出血的肠系膜动脉造影诊断

众所周知，选择性的肠系膜动脉造影在下消化道出血的诊断和治疗上起着重要作用，是下消化道出血诊断中的一个重要手段，其应用价值很大。本文收集了我院近5年来11例做过肠系膜动脉造影的下道化道出血病例，并讨论造影的诊断价值，定位诊断和定性诊断意义。     

导管动脉造影并发症的分析探讨

导管动脉造影已得到广泛应用，其并发症也受到极大的关注（1－3），目前国内尚缺乏有关并发症的研究资料，为了及时发现，正确处理并尽可能地防止其发生，系统地分析研究很有必要。     

Comparison of blood pool and extracellular gadolinium chelate for functional MR evaluation of vascular thoracic outlet syndrome

Objective

To compare performance of single-injection blood pool agent (gadofosveset trisodium, BPA) against dual-injection extracellular contrast (gadopentetate dimeglumine, ECA) for MRA/MRV in assessment of suspected vascular TOS.

Materials and methods

Thirty-one patients referred for vascular TOS evaluation were assessed with BPA (n = 18) or ECA (n = 13) MRA/MRV in arm abduction and adduction. Images were retrospectively assessed for: image quality (1 = non-diagnostic, 5 = excellent), vessel contrast (1 = same signal as muscle, 4 = much brighter than muscle) and vascular pathology by two independent readers, with a separate experienced reader providing reference assessment of vascular pathology.

Results

Median image quality was diagnostic or better (score ≥3) for ECA and BPA at all time points, with BPA image quality superior at abduction late (BPA 4.5, ECA 4, p = 0.042) and ECA image quality superior at adduction-early (BPA 4.5; ECA 4.0, p = 0.018). High qualitative vessel contrast (mean score ≥3) was observed at all time points with both BPA and ECA, with superior BPA vessel contrast at abduction-late (BPA 3.97 ± 0.12; ECA 3.73 ± 0.26, p = 0.007) and ECA at adduction-early (BPA 3.42 ± 0.52; ECA 3.96 ± 0.14, p < 0.001). Readers readily identified arterial and venous pathology with BPA, similar to ECA examinations.

Conclusion

Single-injection BPA MRA/MRV for TOS evaluation demonstrated diagnostic image quality and high vessel contrast, similar to dual-injection ECA imaging, enabling identification of fixed and functional arterial and venous pathology.     

Recurrent middle cerebral artery stroke caused by arterial thoracic outlet syndrome and coagulopathy

Thoracic outlet syndrome (TOS) is defined as compression of neurovascular components passing the thoracic outlet. While neurologic compression is the most common form, rare cases of arterial comprssion could result in concerning cerebral thromboembolic events. Here we present a 15-year-old female with repeated left hemiparesis and radiologic signs of cerebrovascular accident (CVA) in right middle cerebral artery. Further investigations revealed stenosis of the right subclavian artery, saccular aneurysm, and occlusion of the right brachial artery which suggested the diagnosis of arterial TOS. Based on this report, we present this diagnosis as a rare but important cause of CVA, especially in young patients.     

Dynamic CT angiography for the diagnosis of patients with thoracic outlet syndrome: Correlation with patient symptoms

IntroductionVasculo-nervous structures serving the upper limbs may be compressed as they pass through three areas: the inter-scalene triangle (IST), the costo-clavicular space (CCS) and the retropectoralis minor space (RMS). The diagnosis of thoracic outlet syndrome (TOS) is essentially clinical, but requires imaging to specify the site of compression, its grade and the existence of predisposing anatomical factors, in order to guide the treatment and eliminate the main differential diagnoses.Material and methodsImages from 141 patients who underwent dynamic CT angiography of the thoracic outlets from June 2008 to January 2015 were analyzed retrospectively. Patients had unilateral or bilateral vascular, neurological, mixed or atypical symptoms. We studied the degree of stenosis of the subclavian artery with the following grading system: 1 (0-<25%), 2 (25-<50%), 3 (50-<75%), 4 (75-100%). The site of stenosis and the presence of underlying anatomical predisposing factors were also taken in account.ResultsA total of 221 thoracic outlets were analyzed. Symptoms were neurological, mixed, vascular and atypical in 30%, 28%, 13% and 12%, respectively. Among patients with bilateral acquisitions, 38 outlets were asymptomatic; 40% of symptomatic outlets and only 5% of asymptomatic ones had grade 3 or 4 stenosis. 63% of the stenosis were in the CCS and 37% in the IST; 21% had a predisposing anatomical factor most often a costo-clavicular anomaly, associated with significant stenosis in 50% of cases.ConclusionVascular stenosis of more than 50% on dynamic CT angiography is strongly associated with TOS. Predisposing factors were present in 21% of cases, causing significant vascular stenosis in half, underscoring the need for functional evaluation.     

Functional imaging of the thoracic outlet syndrome in an open MR scanner

Symptoms due to thoracic outlet syndrome may present only in abduction, a position that cannot be investigated in conventional MR scanners. Therefore, this study was initiated to test MRI in an open magnet as a method for diagnosis of thoracic outlet syndrome. Ten volunteers and 7 patients with a clinical suspicion of thoracic outlet syndrome were investigated at 0.5 T in an open MR scanner. Sagittal 3D SPGR acquisitions were made in 0 and 90 ° abduction. In the patients, a similar data set was also obtained in maximal abduction. To assess compression, the minimum distance between the first rib and the clavicle, measured in a sagittal plane, was determined. In the neutral position, no significant difference was found between patients and controls. In 90 ° abduction, the patients had significantly smaller distance between rib and clavicle than the controls (14 vs 29 mm; p < 0.01). On coronal reformatted images, the compression of the brachial plexus could often be visualised in abduction. Functional MR examination seems to be a useful diagnostic tool in thoracic outlet syndrome. Examination in abduction, which is feasible in an open scanner, is essential for the diagnosis. Received: 22 February 1999; Revised: 15 June 1999; Accepted: 30 June 1999     

MR angiography of thoracic outlet syndrome.

Thoracic outlet syndrome is a disorder caused by neurovascular compression of the brachial nerve plexus and the subclavian artery or vein by bones and muscles. We report the MR angiographic findings of a patient with thoracic outlet syndrome.     

胸廓上口大血管损伤的分类和救治

目的 探讨胸廓上口大血管损伤病因分类和救治经验。方法 分析经手术治疗的64例胸廓上口大血管损伤的临床资料，其中男44例，女20例；年龄18～68岁。致伤原因分别为创伤性（锐器伤、钝性或减速伤）、病理性及医源性损伤。损伤部位归为颈根部和胸顶部两类，损伤血管为颈总动脉、无名动脉、锁骨下动脉及伴行的静脉。手术方式：（1）按损伤原因及部位的分类选择切口；（2）依血管具体损伤选用不同修复方法（或体外循环下）。结果 治愈56例（88％），死亡7例（11％），致残1例（2％）。结论 对颈根部血管损伤宜间断压迫止血并扩创施术；胸顶部血管损伤需开胸控制血管近端后施术，特殊病例需在体外循环支持下实施血管分流和重建。     

Dose reduction in spiral CT angiography of thoracic outlet syndrome by anatomically adapted tube current modulation

The aim of this study was to evaluate dose reduction in spiral CT angiography of the thoracic outlet by on-line tube-current control. Prospectively, 114 patients undergoing spiral CT angiography of the subclavian artery for thoracic outlet arterial syndromes were evaluated with and without tube-current modulation at the same session (scanning parameters for the two successive angiograms, one in the neutral position and one after the postural maneuver): 140 kV; 206 mA; scan time 0.75 s; collimation 3 mm; pitch = 1). The dose reduction system was applied in the neutral position in the first 92 consecutive patients and after postural maneuver in the remaining 22 consecutive patients. Dose reduction and image quality were analyzed in the overall study group (group 1; n = 114). The influence of the arm position was assessed in 44 of the 114 patients (group 2), matched by the transverse diameter of the upper thorax. The mean dose reduction was 33 % in group 1 (range 22–40 %) and 34 % in group 2 (range 26–40 %). In group 2 the only difference in image quality was a significantly higher frequency of graininess on low-dose scans compared with reference scans whatever the patient's arm position, graded as minimal in 38 of the 44 patients (86 %). When the low-dose technique was applied after postural maneuver in group 2: (a) the mean dose reduction was significantly higher (35 vs 32 % in the neutral position; p = 0.006); (b) graininess was less frequent (82 vs 91 % in the neutral position); and (c) the percentage of graininess graded as minimal was significantly higher (83 vs 70 % in the neutral position; p = 0.2027). On-line tube-current modulation enables dose reduction on high-quality, diagnostic spiral CT angiograms of the thoracic outlet and should be applied during data acquisition in the neutral position and after postural maneuver for optimal use. Received: 31 July 2000 Revised: 6 October 2000 Accepted: 6 October 2000     

Klippel-Trenaunay综合征血管内硬化治疗的临床探讨

目的探讨Klippel-Trenaunay(KT)综合征血管内硬化治疗的疗效及安全性。方法6例KT综合征患者行顺行静脉造影、多普勒超声后行患肢动脉造影,并经动脉主干注入碘油平阳霉素乳剂,随访观察疗效及术后并发症。结果顺行静脉造影和多普勒超声显示单纯异常扩张浅静脉6例,深静脉无异常;动脉造影显示动脉二、三级分支增多,软组织内见染色影。术后并发症主要有肢体肿胀和感觉异常。随访8～40个月,5例肢体症状明显好转,1例症状反复。结论碘油平阳霉素乳剂血管内硬化治疗KT综合征能有效改善患肢症状。