大动脉瘤螺旋CT血管造影与DSA比较研究

目的:探讨大动脉瘤螺旋CT 血管造影(SCTA) 检查技术和应用价值,为合理选择SCTA 和DSA 检查方法提供依据。材料和方法:34 例大动脉瘤,均行SCTA 和DSA 检查,其中29 例经手术证实,术后7 例随访检查用SCTA。SCTA用最大强度投影( MIP) 和表面遮盖显示(SSD) 两种方法重建血管。结果:胸主动瘤10 例,腹主动脉瘤15 例,胸腹主动脉连续性动脉瘤2 例,髂动脉瘤7 例。SCTA 和DSA 均能较好地显示大动脉瘤的部位、形状、范围及夹层情况。MIP 重建图像能显示动脉壁钙化,SSD 重建图像能较好地显示动脉瘤的三维形态,SCTA 结合CT 横断面及多平面重建图像可更清楚显示动脉腔、动脉壁、附壁血栓及动脉周围组织结构。DSA 图像空间分辨力较SCTA 高,但不能清楚显示动脉壁、附壁血栓及动脉周围组织结构。结论:对大动脉瘤可首选SCTA 检查以替代DSA 检查。     

16层螺旋CT血管成像在颅内动脉瘤诊断中的价值

目的:探讨16层螺旋CT血管成像(CTA)在颅内动脉瘤诊断中的价值.方法:对临床疑诊为颅内动脉瘤16例患者行CTA检查,其中8例同期行数字减影血管造影(DSA)检查.原始图像重建采用最大密度投影(MIP)和容积再现技术(VR).结果:16例患者经CTA检出动脉瘤17个.1例患者为多发动脉瘤(2个),15例为单发动脉瘤.瘤体以圆形或卵圆形居多(13个),也可以显示为肾形(2个)、葫芦形(1个)和串蛛状(1个).瘤体最大直径18 mm,最小直径1.5 mm.8例行DSA检查的患者中,7例DSA所见与CTA结果一致,1例DSA漏诊1个动脉瘤.结论:16层CTA检出动脉瘤准确率高,快速、无创,可以作为诊断动脉瘤首选影像学方法,尤其适合于急诊情况下,并能补充DSA诊断信息.     

螺旋CT血管造影诊断颅内动脉瘤的研究

目的：评价螺旋CT脑血管造影的临床应用价值。方法：对24例脑血管病变行螺旋CT血管造影检查，三维重建采用表面遮盖法显示(surface shaded display，SSD)，最大密度投影(maximum intensity projection，MIP)。结果：螺旋CT血管造影能较好显示正常脑血管的形态和病变，在24例进行CTA造影的患者中，颅内动脉瘤17例。有7例SCTA未见异常。在11例进行DSA造影的患者中，有10例与SCTA结果相符，仅1例DSA诊断小脑上动脉动脉瘤，而SCTA显示阴性。结论：SCTA是诊断颅内动脉瘤的一种有效无创性检查方法，具有重要的诊断价值。     

Intranidal aneurysms in cerebral arteriovenous malformations: evaluation and endovascular treatment.

Patients with cerebral arteriovenous malformations (AVMs) have an increased risk of hemorrhage if an intranidal aneurysm is present. Angiograms from 125 patients with cerebral AVMs were evaluated, and 15 (12%) had intranidal aneurysms. All 15 patients had a history of bleeding. Five patients underwent particulate or liquid embolization before surgical excision of or radiation therapy for the AVM. All aneurysms were thrombosed at the time of embolization. Ten patients underwent radio-surgery alone. Eight of the 10 underwent angiographic follow-up (mean, 33 months); seven patients showed complete obliteration of the AVM without residual aneurysm. Histologic evaluation showed intranidal aneurysms to be thin-walled vascular structures, and they are the likely site for AVM hemorrhage. Embolization is an effective method for achieving thrombosis of the intranidal aneurysm and may be beneficial in patients undergoing radiation therapy because of a long latency period between treatment and thrombosis of the AVM.     

16层螺旋CT在血管病变诊断中的临床应用

目的评价16层螺旋CT血管造影(16SCTA)及重建技术在血管病变诊断中的临床应用价值。方法100例血管病变行16SCTA,采用准直0.75 mm,层厚1 mm,间隔0.5 mm。重建应用多平面重建(MPR),最大密度投影(M IP)及容积显示技术(VRT)。结果100例血管病变中65例经手术病理或DSA证实。100例病变中,8例脑动脉瘤,2例脑动静脉畸形,6例肺动静脉畸形,9例肺动脉栓塞伴下肢深静脉血栓,4例肺隔离症,20例冠状动脉软斑块和/或钙化,12例主动脉瘤,3例肾动脉狭窄,2例肠系膜上动脉血栓,1例股动脉狭窄,33例软组织血管瘤。这3种重建技术均能显示病变的大小、形态及范围,对病变可进行任意角度重建和观察,VRT可立体地显示病变。MPR和M IP可显示血栓,M IP和VRT显示钙化。结论综合应用16层螺旋CT的各种重建技术,能够全面而清晰地显示血管病变,可取代DSA,为患者提供一种安全可靠的诊断手段,对临床治疗具有重要指导意义。     

Contrast-enhanced MRI in spinal arteriovenous malformations and fistulae before and after embolisation therapy

MRI was performed in six cases of spinal arteriovenous malformation (AVM) and arteriovenous fistula (AVF) before and after embolisation. Intramedullary and perimedullary AVMs showed marked vascular enhancement after embolisation. This was thought to reflect feeding vessel occlusion and correlated well with a favourable clinical outcome. In dural AVFs, contrast-enhanced studies were essential for the diagnosis, unenhanced images being nonspecific. After embolisation, enhancement of the spinal cord was reduced, although one case with a poor outcome showed persistent enhancement. Received: 20 June 1995 Accepted: 23 August 1995     

64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:与DSA相对照,探讨64层螺旋CT脑血管造影在颅内动脉瘤中的诊断价值。方法:对29例临床怀疑颅内动脉瘤的患者行64层螺旋CT脑血管造影(CTA)和DSA检查,使用GE64层Lightspeed VCT获得原始图像,所有病例均采用多层面重建(multiplanar reconstruction,MPR)、容积再现(volume rendering,VR)、薄层块最大密度投影(thin-slab maximumintensity projectjon,TS MIP)。后处理图像及DSA图像由2位放射科医生共同评估。结果:29例患者中,DSA证实25例共27个动脉瘤,其中2例为2个动脉瘤。与DSA结果相对照,CTA共检出25例26个动脉瘤,漏诊了1个颈出动脉瘤。CTA清晰显示了动脉瘤的形态、大小及载瘤动脉,3例动脉瘤瘤颈DSA未显示,CTA显示了全部动脉瘤的瘤颈。结论:64层CTA在颅内动脉瘤的诊断中具有极高价值,特别在显示动脉瘤瘤颈方面具有独特的优势,对临床治疗具有指导意义。     

64层螺旋CT分别减影脑动脉混合脑动静脉和脑静脉血管成像在颅内自发性出血术前评估的价值

目的：探讨64层螺旋CT分别减影脑动脉、混合脑动静脉、脑静脉血管成像在自发性颅内出血术前评估价值。方法回顾分析同时行CT血管造影（CTA）和数字减影血管造影（DSA）检查的自发性颅内出血患者共215例。 CTA检查全部行64层螺旋CT平扫、增强动脉早期和静脉早期扫描,将动、静脉早期数据减去平扫数据分别重建动脉及混合动静脉,静脉早期数据减去动脉早期数据重建静脉。结果减影脑动脉、脑静脉血管图像去除了颅骨并且动脉、静脉无相互干扰,分别清晰显示动脉或静脉病变,混合脑动静脉则去除颅骨干扰且同时显示脑动静脉病变。215例颅内出血患者中14例CTA和DSA检查颅内均未见畸形血管,2例动脉瘤DSA发现而CTA未显示,3例动脉瘤CTA发现而DSA未显示。 CTA和DSA共同显示畸形血管196例,敏感性为99．9％,特异性为82．4％,其中动脉瘤179例,动静脉畸形9例,静脉瘤3例,烟雾病5例。结论64层螺旋CT分别减影脑动脉、混合脑动静脉、脑静脉血管成像在颅内出血检查,病变及周围结构显示清楚,对临床术前评估有较大意义,值得推广应用。     

动脉数字减影血管造影对脑动静脉畸形出血的预测分析

报告８３例经ＤＳＡ和手术证实的脑动静脉畸形。其中ＣＴ示出血者５８例，占６９．９％。笔者探讨脑动静脉畸形血管造影形态与出血的关系，结果表明下列因素与出血有关：（１）小的脑动静脉畸形；（２）仅有１支引流静脉的；（３）向深部静脉引流的及引流静脉狭窄和并发动脉瘤者。而供血动脉的数目和有颈外动脉参与供血者未见明显关系，笔者还分析了脑动静脉畸形的ＣＴ表现，认为ＣＴ与脑血管造影并用，可为临床提供更详细的资料。     

CT仿真内窥镜技术诊断脑血管病变的临床价值

目的探讨CT仿真内窥镜技术诊断脑血管病变的临床价值.材料和方法选择经DSA证实的6例颅内动脉瘤,2例脑血管狭窄性病变,颈内动脉夹层和AVM各1例,行螺旋CT血管造影检查,应用Navigator软件三维重建血管图像模拟内窥镜观察血管腔内结构.结果CT仿真内窥镜能精确显示动脉瘤颈部的解剖关系,帮助了解狭窄处血管的内壁情况和病变程度.结论CT仿真内窥镜是一种无创的血管内腔检查技术,可直观地显示脑血管病变的内腔形态及其三维解剖关系,是DSA和其它三维CT重建方法的重要信息补充.     

Multislice CT angiography in the assessment of peripheral aneurysms

PURPOSE: Peripheral aneurysms are usually located in the femoro-popliteal district; these lesions may present some complications such as distal embolisation and thrombosis; rupture is quite rare, but may be life-threatening. The aim of this study is to test the accuracy of CT multislice angiography in the assessment of this pathology and to compare it with DSA, until now considered the gold standard in vascular imaging. MATERIALS AND METHODS: From January 2001 to May 2002 we studied 10 patients (8 males and 2 females) aged between 48 and 74 years with 14 lesions. All patients were affected by femoro-popliteal aneurysms. Eight patients underwent US as a first examination, 2 patients directly underwent DSA because of acute ischaemic symptoms; then, a CT angiography was performed. The first eight patients underwent CT and DSA after US. Hence, all patients underwent both DSA and CT. All CT examinations were performed with a multislice spiral CT scanner using the following parameters: 2 mm slice thickness, pitch 6, 2mm slice thickness, 1mm reconstruction interval, 120 mAs, 120 kVp. A nonionic contrast medium was infused intravenously at a biphasic rate. Angiography was performed by humeral artery catheterisation with a 4F device, the distal tip of the catheter was placed in the infra-renal abdominal aorta. RESULTS: In 7/10 patients the diagnosis was correctly formulated after DSA; in two patients, only the obstruction of the popliteal artery was detected, but not the dilatation and the thrombus. In one patient the parietal annular thrombus simulated a normal artery. CT was diagnostic in all cases and all the complications were detected as well. DISCUSSION AND CONCLUSIONS: Multislice spiral CT angiography allows depiction of aneurysms, and of the precise site, dimensions, quantity and quality of parietal thrombus; multislice CT is to be considered, in our opinion, essential in the assessment of diagnosis and in the planning of therapy. Moreover, CT provides exact measurements of the vessels before and after the aneurysm, which is essential to plan stent-graft implantation. A very interesting feature comes from the execution of a complete 3D angiography of the entire lower extremity circulation with high spatial resolution. DSA cannot provide direct information about the wall of the vessel and about the thrombus; therefore, in some cases it is unable to provide the correct diagnosis. Today DSA remains the best examination to evaluate the quality of run-off in lower extremity, especially under the knee.     

多层螺旋CT血管造影在急性自发性颅内出血中的应用价值

目的探讨多层螺旋CT血管造影(MSCTA)在急性自发性颅内出血中的应用价值。方法CT诊断急性自发性颅内出血41例,其中蛛网膜下腔出血29例、脑内血肿12例,采用容积重建(VR)和最大密度投影(MIP)方法进行MSCTA检查,并对7例颅内动脉瘤钛夹夹闭术病例和2例脑动静脉畸形、1例脑动静脉畸形伴巢内动脉瘤手术切除病例进行术后MSCTA评价。结果41例急性自发性颅内出血中,MSCTA检查出颅内动脉瘤11例、脑动静脉畸形4例、脑动静脉畸形伴巢内动脉瘤1例;MSCTA对动脉瘤的瘤体大小、瘤颈、载瘤动脉和脑动静脉畸形的部位、大小、瘤巢的形态、供血动脉和引流静脉的显示均较清楚。7例动脉瘤行钛夹夹闭术和2例脑动静脉畸形、1例脑动静脉畸形伴巢内动脉瘤行手术切除,手术所见与术前MSCTA表现相符;术后行MSCTA复查,显示夹闭动脉瘤之钛夹位置正常,载瘤动脉、颅内大血管通畅,脑动静脉畸形之瘤巢已切除。结论MSCTA是急性自发性颅内出血病因诊断的一种无创伤、快捷有效的影像学方法,并且在颅内动脉瘤、脑动静脉畸形术后评价方面也具有临床应用价值。     

Endovascular treatment of aneurysms on the feeding arteries of intracranial arteriovenous malformations

The association between intracranial aneurysms and arteriovenous malformations (AVMs) is well documented. Recent advances in the understanding of the haemodynamics of this association encourage an aggressive approach to these aneurysms. However, the pathophysiology of these aneurysms is not fully understood and a strategy for their management has not been established. We describe seven patients, with eight aneurysms, on the feeding arteries of AVMs. The aneurysms could be divided into those located 1. proximally on the superficial feeding artery (type I; 4 aneurysms); 2. distally on the superficial feeding artery (type II; 3 aneurysms); and 3. on the deep feeding artery (type III; 1 aneurysm). All aneurysms were treated by the endovascular procedure prior to, or simultaneously with, treatment of the AVM, using detachable coils or liquid embolic material. All aneurysms were obliterated successfully, with no adverse events. Each patient further received treatment of the AVM. None of the patients suffered intracranial haemorrhage after treatment for the aneurysms. Based on our experiences, we discuss the indications for this approach for each type of aneurysm. We believe endovascular treatment could be an important alternative for treatment of aneurysms associated with AVMs, thus reducing the risk of haemorrhage. Received: 6 October 1997 Accepted: 5 June 1998     

64层3D-CTA与3D-DSA对颅内动脉瘤评价的对比研究

目的 对比评价64层螺旋CT三维血管造影(3D-CTA)与三维数字减影血管造影(3D-DSA)对颅内动脉瘤的诊断价值.方法 28例临床怀疑颅内动脉瘤的患者均行64层螺旋CT血管造影和DSA,CT三维后处理主要包括容积重建(VR)及最大密度投影(MIP).常规二维DSA检查后,对可疑病变血管行旋转DSA检查,应用三维工作软件行3D后处理,比较3D-CTA与3D-DSA对动脉瘤显示的价值.结果 28例病例中22例CTA和DSA均显示动脉瘤并经手术或栓塞证实,其中1例CTA和DSA显示单个动脉瘤,手术证实为2个动脉瘤,1例CTA显示假阳性.3D-CTA与3D-DSA均能清楚显示动脉瘤形状、瘤径指向、瘤体直径、瘤颈、载瘤动脉、瘤体穿动脉情况,两者无明显差异.结论 64层3D-CTA在颅内动脉瘤诊断及细节显示上与3D-DSA无明显差异,一定程度上应能替代血管造影,指导临床治疗.     

Cerebral arteriovenous malformations: morphologic evaluation by ultrashort 3D gadolinium-enhanced MR angiography

The purpose of this study was to evaluate the usefulness of a new ultrashort contrast-enhanced (CE) MR angiography (MRA) for the morphologic evaluation of cerebral arteriovenous malformations (AVMs). The method was compared with conventional X-ray digital subtraction angiography (DSA) and time-of-flight (TOF) MRA in 22 patients to assess the angioarchitecture of the malformations which is essential for treatment planning and follow-up. Two experienced MR readers independently evaluated both techniques with regard to the assessment of feeding arteries, AVM nidus, and venous drainage patterns. Contrast-enhanced MRA was able to detect all AVMs seen on DSA, whereas the TOF MRA failed in 1 patient with a very small AVM. In the assessment of the different vessel components of the AVM there was no difference for the detection and delineation of feeding arteries and the AVM. The venous drainage patterns could always be clearly delineated in the CE MRA, whereas TOF MRA could demonstrate the exact venous drainage in only 9 patients. Contrast-enhanced MRA was found to be superior to conventional TOF MRA in the assessment of the angioarchitecture of cerebral AVMs especially regarding the assessment of the venous drainage patterns. The superiority is supported by the improved vessel-to-background contrast and contrast-to-noise ratios. The major limitations of this new technique consist of a low spatial resolution at the used time resolution which can be improved by further sequence modifications. Contrast-enhanced MRA is thus an important additional imaging technique for treatment planning and follow-up of AVMs. Electronic Publication     

螺旋CT血管造影在腹主动脉瘤诊断中的应用

目的 :评价螺旋 CT血管造影 (SCTA)在腹主动脉瘤诊断中的价值。方法 :13例腹主动脉瘤病人行螺旋 CT增强扫描 ,后进行各种重建 :表面阴影显示 (SSD)、多平面重建 (MPR)、最大密度投影 (MIP)。结果 :SSD明确显示动脉瘤的范围和周围血管的关系 ;MPR对瘤体内附壁血栓范围的显示较佳 ;而 MIP对瘤壁的钙化及对管腔各段的精确测量颇有价值。结论 :螺旋 CT血管造影操作简单、安全、诊断明确 ,能帮助和指导手术 ,可取代 DSA对腹主动脉瘤的诊断     

三维CT血管造影诊断脑血管病变的临床应用

目的：研究螺旋CT血管造影诊断脑血管病变的临床应用价值。材料和方法：选择临床上经DSA证实的12例（共15个病灶）脑血管病变的患者行三维CTA检查。采用表面遮盖显示法（SSD）、最大密度投影法（MIP）和伪彩技术观察脑血管病变的立体形态和空间毗邻关系；采用仿真内镜技术和透明化技术相结合观察病变血管的内部情况；并应用电影功能快速回放以动态观察。结果：三维CTA对15个病灶中除1个动脉狭窄未能显示外，其余病变能清晰辨认，包括6个动脉瘤，6个动静脉畸形，1个动脉狭窄，1个颈内动脉海绵窦瘘。结论：三维CT血管造影作为一种血管病变的诊断，并有其临床应用价值。     

16层螺旋CT血管造影诊断颅内动脉瘤

目的:探讨16层螺旋CT血管造影(MSCTA)诊断颅内动脉瘤的准确性。材料和方法:30例临床怀疑颅内动脉瘤的患者分别进行16层螺旋CT脑血管三维成像(3D-MSCTA)和数字减影血管造影(DSA),所有病例均完成多层面重建(MPR)、三维表面遮盖显示(SSD)、容积显示(VR)和薄层块最大密度投影(MIP),并对照手术或介入栓塞结果评估其诊断价值。结果:MSCTA共发现24例28个动脉瘤,其中22例为单个动脉瘤,2例为两个动脉瘤。动脉瘤直径最小2.7mm,最大35mm。MSCTA能清晰显示动脉瘤的瘤体大小、瘤颈、瘤轴指向、载瘤动脉及其动脉瘤与临近血管分支和骨性组织间的空间关系。23例与手术/DSA结果一致。结论:MSCTA诊断颅内动脉瘤有较高准确性,可部分取代DSA造影检查。     

64层螺旋CT脑血管成像对颅内动脉瘤的临床诊断价值

目的:探讨64层螺旋CT脑血管成像(CTA)对颅内动脉瘤的临床诊断价值。方法:对55例临床怀疑颅内动脉瘤的蛛网膜下腔出血患者行64层螺旋CT脑血管成像检查,观察其原始图像及采用VR、MIP、MPR技术重建三维脑血管成像,部分病例同DSA或手术所见对照。结果:55名自发性蛛网膜下腔出血患者中,共检出动脉瘤患者47例,动脉硬化、狭窄3例,正常5例。CTA表现与手术结果、DSA基本一致。结论:64层螺旋CT脑血管成像能清晰的显示颅内动脉瘤的部位、大小、形态、瘤颈、与载瘤动脉及邻近血管及骨结构的关系,对颅内动脉瘤诊断敏感性及特异性较高,对绝大部分动脉瘤能迅速、准确地诊断,对临床治疗方案的制定有重要指导作用,并可作为术后复诊和随诊的重要手段。     

16层螺旋CT血管造影在颅内动脉瘤中的应用价值

目的探讨16层螺旋CT血管造影(CTA)对颅内动脉瘤的诊断价值。方法28例疑有颅内动脉瘤患者均行16层CTA和DSA检查,对CTA的表现结合DSA和手术结果进行回顾性分析。结果本组28例经CTA共检出动脉瘤27个,其中25个经手术和DSA证实。1例CTA显示动脉瘤2个,DSA只显示1个,另1例CTA显示可疑动脉瘤2个,DSA显示正常。16层CTA诊断颅内动脉瘤的敏感性为89.2%,特异性为100%,准确性为96.4%。结论16层CTA在显示颅内动脉瘤方面可与DSA媲美,有重要临床应用价值。