创伤性颈内动脉假性动脉瘤的血管内治疗

目的 探讨载瘤动脉闭塞、弹簧圈栓塞以及支架技术治疗颅内创伤性颈内动脉假性动脉瘤(pseudoaneurysm,PSA)的适应证及其疗效.方法 本组6例患者,3例海绵窦段PSA合并颈内动脉海绵窦痿(carotid-cavernous fistula,CCF),2例单纯颈内动脉PSA,1例CCF球囊栓塞后复查显示PSA.球囊闭塞CCF及创伤性颈内动脉PSA 1例,弹簧圈栓塞3例,颈内动脉球囊闭塞2例.根据6例患者的临床表现、影像学资料、治疗方法选择、临床疗效、随访资料以及文献,分析三种治疗方式的适应证.结果 本组患者无手术相关并发症发生,无脑缺血并发症.术后无鼻出血发生,3例眼球突出回复,1例随访半年视力改善,3例颅内杂音消失,3例瞳孔缩小,复查数字减影血管造影(DSA)未见PSA复发.结论 血管内治疗是治疗颈内动脉PSA的首选,合并CCF时可行球囊闭塞或载瘤动脉闭塞.对单纯窄颈者予以弹簧圈栓塞,对宽颈的采用支架技术结合弹簧圈栓塞,而位于颈内动脉岩段可选择带膜支架.

Abstract：

Objective To investigate the indication and result of parental artery occlusion, embolization with coils, stents in treatment of the traumatic carotid artery pseudoaneurysm. Methods There were six patients with traumatic carotid artery pseudoaneurysm including three patients of cavernous pseudoaneurysm combined with carotid-cavernous fistula (CCF), two with simple traumatic carotid artery pseudoaneurysm and one with traumatic carotid artery pseudoaneurysm that was found after CCF embolization with detachable balloon. The treatment included balloon occlusion for CCF and traumatic carotid pseudoaneurysm in one patient, coil embolization in three and intenal carotid artery balloon occlusion in two. The Clinical manifestations, imaging data, choice of treatment, clinical efficacy, follow-up data and literatures were analyzed to discuss the indications for three treatments. Results There was no cerebral ischemia or surgically-related complication. No epistaxis occurred. The eyeball protrusion restoration was found in three patients and intracranial bruit vanishing in three. Vision was improved one patient after half a year follow-up. The pupils shrank in three patients during follow - up. Digital subtraction angiography (DSA) showed no recurrence of pseudoaneurysm. Conclusions Endovascular treatment is the preferred choice of treatment for traumatic carotid artery pseudoaneurysm. The occlusion or parent artery balloon occlusion can be used when the pseudoaneurysm is combined with CCF. Coil embolization can be used for shoes with narrow neck, stent technology combined with coil embolization for those with wide neck and the covered stent for the rock section of the internal carotid artery.     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

SPECT肺灌注与CT异机融合图像评价非小细胞肺癌肺功能的价值

objective The aim of this study was to assess the value of fusion SPECT perfusion and CT images acquired separately at 2 time-points in evaluating regional lung function of patients with stage Ⅲ non-small cell lung cancer(NSCLC).Methods Thirty-two patients with untreated stage Ⅲ NSCLC underwent pulmonary function test(PFT),CT and SPECT imaging.Two series of images were registered by software fusion based on external markers by Philips Pinnacle3 planning treatment system.The SPECT/CT fu sion images were graded by comparing lung perfusion defect with the area of radiological abnormality.Grade O:no lung perfusion defect in the area of radiological abnormality.Grade 1:the area of lung perfusion defect was similar to the size of radiological abnormality.Grade 2:the area of lung perfusion defect was bigger than that of radiological abnormality.and extended to 1 pulmonary lobe.Grade 3:the area of lung perfusion defect exceeded 1 pulmonary lobe.Statistically significant difference was evaluated by Pearson X2-test using SPSS 13.0 software.Results In 32 patients with stage Ⅲ NSCLC,31 patients had lung perfusion defects.There were 13 patients with grade 1,8 with grade 2,10 with grade 3.There was statistically significant difference between central lung cancer and peripheral lung cancer(X2=10.495,P＜0.05);8 patients had PFT abnormality.There was also statistically significant difference between the positive rate of SPECT/CT fusion images and PFT[96.9%(31/32)vs 25.0%(8/32),X2=34.724,P＜0.05].Conclusion The fusion of SPECT lung perfusion and CT images acquired separately at 2 different time-points is a feasible technique for assessing the regional lung function of patients with stageⅢNSCLC,thereby offering more information for surgical planning,prediction of postoperative lung function and optimization of radiation treatment plans.     

双探头符合线路SPECT正电子显像衰减校正实验研究

Objective The photons from the body would be attenuated in their intensity by the soft tissue before they reach the detectors. Some of them lost more intensity than others when coming from the deeper body. Attenuation of the photons would distort the image, affect the image quality, and may lead to misdiagnosis. In this research the X-ray and γ-ray were used as transmission resources for accurate assess-ment of attenuation in each part of the body. The transmission data was used to correct the emission data from the body. Iteration algorithm was used for the reconstruction of attenuation corrected tomography ima-ges. Evaluate the efficacy of attenuation correction in duel head hybrid SPECT/coincidence PET systems (SPECT/PET) and SPECT using both the Jaszczak and the myocardial phantoms. Methods For PET phantom study, the Jaszczak phantom was filled with the aqueous solution of 18F-fluorodeoxyglucose (FDG) and was scanned with two hybrid SPECT/coincidence PET systems respectively (Vertex Plus, Netherlands Philips ADAC Company and Hawkeye, USA GE Company). The PET images were acquired and reconstruc-ted. Results The "cold" lesion, which the diameter was less than 12 mm of uncorrected image, could not be identified. But it, after correction, diameter 9 mm, would be recognized clearly, less than 7 mm would not be distinguished. Noncorrected image could only identify "hot" lesions which the diameter were 9, 12, 14, 18, 22 and 38 mm, while in the corrected image, not only it was much better, but also the "hot" le-sion of 6 mm was distinguished. In Hawkeye, the same situation, the corrected image of was improved obvi-ously; the disparity of counts between surrounding and deep center less, and the counts in deep center were compensated. There were only 3 round " cold" lesions could be recognized, the diameter: 14, 18 and 20 mm; all of them which diameter were less than 12 mm could not be distinguished. One in the center was al-most as background, and could not be identified. The radioactive accounts of surrounding and center were quite different. The corrected image 5 "cold" lesions could be found, 9, 12, 14, 18 and 20 mm, but7 mm could not be found. The noncorrected image, only 12, 14, 18, 22 and 38 mm " hot" lesions could be found, and by the surrounding, there was an arc shape "hot" lesion. But it could distinguish 9, 12, 14, 18, 22 and 38 mm "hot" lesions on the corrected image, and the image was much better than noncorrected one. Conclusions The corrected image of Vertex Plus was improved obviously with the disparity of counts between surrounding and deep center less, and the counts in deep center was compensated. The result of at-tenuation with phantom showed that 137Cs was better than CT in both image quality and spatial resolution.     

双探头符合线路SPECT正电子显像衰减校正实验研究

Objective The photons from the body would be attenuated in their intensity by the soft tissue before they reach the detectors. Some of them lost more intensity than others when coming from the deeper body. Attenuation of the photons would distort the image, affect the image quality, and may lead to misdiagnosis. In this research the X-ray and γ-ray were used as transmission resources for accurate assess-ment of attenuation in each part of the body. The transmission data was used to correct the emission data from the body. Iteration algorithm was used for the reconstruction of attenuation corrected tomography ima-ges. Evaluate the efficacy of attenuation correction in duel head hybrid SPECT/coincidence PET systems (SPECT/PET) and SPECT using both the Jaszczak and the myocardial phantoms. Methods For PET phantom study, the Jaszczak phantom was filled with the aqueous solution of 18F-fluorodeoxyglucose (FDG) and was scanned with two hybrid SPECT/coincidence PET systems respectively (Vertex Plus, Netherlands Philips ADAC Company and Hawkeye, USA GE Company). The PET images were acquired and reconstruc-ted. Results The "cold" lesion, which the diameter was less than 12 mm of uncorrected image, could not be identified. But it, after correction, diameter 9 mm, would be recognized clearly, less than 7 mm would not be distinguished. Noncorrected image could only identify "hot" lesions which the diameter were 9, 12, 14, 18, 22 and 38 mm, while in the corrected image, not only it was much better, but also the "hot" le-sion of 6 mm was distinguished. In Hawkeye, the same situation, the corrected image of was improved obvi-ously; the disparity of counts between surrounding and deep center less, and the counts in deep center were compensated. There were only 3 round " cold" lesions could be recognized, the diameter: 14, 18 and 20 mm; all of them which diameter were less than 12 mm could not be distinguished. One in the center was al-most as background, and could not be identified. The radioactive accounts of surrounding and center were quite different. The corrected image 5 "cold" lesions could be found, 9, 12, 14, 18 and 20 mm, but7 mm could not be found. The noncorrected image, only 12, 14, 18, 22 and 38 mm " hot" lesions could be found, and by the surrounding, there was an arc shape "hot" lesion. But it could distinguish 9, 12, 14, 18, 22 and 38 mm "hot" lesions on the corrected image, and the image was much better than noncorrected one. Conclusions The corrected image of Vertex Plus was improved obviously with the disparity of counts between surrounding and deep center less, and the counts in deep center was compensated. The result of at-tenuation with phantom showed that 137Cs was better than CT in both image quality and spatial resolution.     

双探头符合线路SPECT正电子显像衰减校正实验研究

Objective The photons from the body would be attenuated in their intensity by the soft tissue before they reach the detectors. Some of them lost more intensity than others when coming from the deeper body. Attenuation of the photons would distort the image, affect the image quality, and may lead to misdiagnosis. In this research the X-ray and γ-ray were used as transmission resources for accurate assess-ment of attenuation in each part of the body. The transmission data was used to correct the emission data from the body. Iteration algorithm was used for the reconstruction of attenuation corrected tomography ima-ges. Evaluate the efficacy of attenuation correction in duel head hybrid SPECT/coincidence PET systems (SPECT/PET) and SPECT using both the Jaszczak and the myocardial phantoms. Methods For PET phantom study, the Jaszczak phantom was filled with the aqueous solution of 18F-fluorodeoxyglucose (FDG) and was scanned with two hybrid SPECT/coincidence PET systems respectively (Vertex Plus, Netherlands Philips ADAC Company and Hawkeye, USA GE Company). The PET images were acquired and reconstruc-ted. Results The "cold" lesion, which the diameter was less than 12 mm of uncorrected image, could not be identified. But it, after correction, diameter 9 mm, would be recognized clearly, less than 7 mm would not be distinguished. Noncorrected image could only identify "hot" lesions which the diameter were 9, 12, 14, 18, 22 and 38 mm, while in the corrected image, not only it was much better, but also the "hot" le-sion of 6 mm was distinguished. In Hawkeye, the same situation, the corrected image of was improved obvi-ously; the disparity of counts between surrounding and deep center less, and the counts in deep center were compensated. There were only 3 round " cold" lesions could be recognized, the diameter: 14, 18 and 20 mm; all of them which diameter were less than 12 mm could not be distinguished. One in the center was al-most as background, and could not be identified. The radioactive accounts of surrounding and center were quite different. The corrected image 5 "cold" lesions could be found, 9, 12, 14, 18 and 20 mm, but7 mm could not be found. The noncorrected image, only 12, 14, 18, 22 and 38 mm " hot" lesions could be found, and by the surrounding, there was an arc shape "hot" lesion. But it could distinguish 9, 12, 14, 18, 22 and 38 mm "hot" lesions on the corrected image, and the image was much better than noncorrected one. Conclusions The corrected image of Vertex Plus was improved obviously with the disparity of counts between surrounding and deep center less, and the counts in deep center was compensated. The result of at-tenuation with phantom showed that 137Cs was better than CT in both image quality and spatial resolution.     

双探头符合线路SPECT正电子显像衰减校正实验研究

Objective The photons from the body would be attenuated in their intensity by the soft tissue before they reach the detectors. Some of them lost more intensity than others when coming from the deeper body. Attenuation of the photons would distort the image, affect the image quality, and may lead to misdiagnosis. In this research the X-ray and γ-ray were used as transmission resources for accurate assess-ment of attenuation in each part of the body. The transmission data was used to correct the emission data from the body. Iteration algorithm was used for the reconstruction of attenuation corrected tomography ima-ges. Evaluate the efficacy of attenuation correction in duel head hybrid SPECT/coincidence PET systems (SPECT/PET) and SPECT using both the Jaszczak and the myocardial phantoms. Methods For PET phantom study, the Jaszczak phantom was filled with the aqueous solution of 18F-fluorodeoxyglucose (FDG) and was scanned with two hybrid SPECT/coincidence PET systems respectively (Vertex Plus, Netherlands Philips ADAC Company and Hawkeye, USA GE Company). The PET images were acquired and reconstruc-ted. Results The "cold" lesion, which the diameter was less than 12 mm of uncorrected image, could not be identified. But it, after correction, diameter 9 mm, would be recognized clearly, less than 7 mm would not be distinguished. Noncorrected image could only identify "hot" lesions which the diameter were 9, 12, 14, 18, 22 and 38 mm, while in the corrected image, not only it was much better, but also the "hot" le-sion of 6 mm was distinguished. In Hawkeye, the same situation, the corrected image of was improved obvi-ously; the disparity of counts between surrounding and deep center less, and the counts in deep center were compensated. There were only 3 round " cold" lesions could be recognized, the diameter: 14, 18 and 20 mm; all of them which diameter were less than 12 mm could not be distinguished. One in the center was al-most as background, and could not be identified. The radioactive accounts of surrounding and center were quite different. The corrected image 5 "cold" lesions could be found, 9, 12, 14, 18 and 20 mm, but7 mm could not be found. The noncorrected image, only 12, 14, 18, 22 and 38 mm " hot" lesions could be found, and by the surrounding, there was an arc shape "hot" lesion. But it could distinguish 9, 12, 14, 18, 22 and 38 mm "hot" lesions on the corrected image, and the image was much better than noncorrected one. Conclusions The corrected image of Vertex Plus was improved obviously with the disparity of counts between surrounding and deep center less, and the counts in deep center was compensated. The result of at-tenuation with phantom showed that 137Cs was better than CT in both image quality and spatial resolution.     

双探头符合线路SPECT正电子显像衰减校正实验研究

Objective The photons from the body would be attenuated in their intensity by the soft tissue before they reach the detectors. Some of them lost more intensity than others when coming from the deeper body. Attenuation of the photons would distort the image, affect the image quality, and may lead to misdiagnosis. In this research the X-ray and γ-ray were used as transmission resources for accurate assess-ment of attenuation in each part of the body. The transmission data was used to correct the emission data from the body. Iteration algorithm was used for the reconstruction of attenuation corrected tomography ima-ges. Evaluate the efficacy of attenuation correction in duel head hybrid SPECT/coincidence PET systems (SPECT/PET) and SPECT using both the Jaszczak and the myocardial phantoms. Methods For PET phantom study, the Jaszczak phantom was filled with the aqueous solution of 18F-fluorodeoxyglucose (FDG) and was scanned with two hybrid SPECT/coincidence PET systems respectively (Vertex Plus, Netherlands Philips ADAC Company and Hawkeye, USA GE Company). The PET images were acquired and reconstruc-ted. Results The "cold" lesion, which the diameter was less than 12 mm of uncorrected image, could not be identified. But it, after correction, diameter 9 mm, would be recognized clearly, less than 7 mm would not be distinguished. Noncorrected image could only identify "hot" lesions which the diameter were 9, 12, 14, 18, 22 and 38 mm, while in the corrected image, not only it was much better, but also the "hot" le-sion of 6 mm was distinguished. In Hawkeye, the same situation, the corrected image of was improved obvi-ously; the disparity of counts between surrounding and deep center less, and the counts in deep center were compensated. There were only 3 round " cold" lesions could be recognized, the diameter: 14, 18 and 20 mm; all of them which diameter were less than 12 mm could not be distinguished. One in the center was al-most as background, and could not be identified. The radioactive accounts of surrounding and center were quite different. The corrected image 5 "cold" lesions could be found, 9, 12, 14, 18 and 20 mm, but7 mm could not be found. The noncorrected image, only 12, 14, 18, 22 and 38 mm " hot" lesions could be found, and by the surrounding, there was an arc shape "hot" lesion. But it could distinguish 9, 12, 14, 18, 22 and 38 mm "hot" lesions on the corrected image, and the image was much better than noncorrected one. Conclusions The corrected image of Vertex Plus was improved obviously with the disparity of counts between surrounding and deep center less, and the counts in deep center was compensated. The result of at-tenuation with phantom showed that 137Cs was better than CT in both image quality and spatial resolution.     

双探头符合线路SPECT正电子显像衰减校正实验研究

Objective The photons from the body would be attenuated in their intensity by the soft tissue before they reach the detectors. Some of them lost more intensity than others when coming from the deeper body. Attenuation of the photons would distort the image, affect the image quality, and may lead to misdiagnosis. In this research the X-ray and γ-ray were used as transmission resources for accurate assess-ment of attenuation in each part of the body. The transmission data was used to correct the emission data from the body. Iteration algorithm was used for the reconstruction of attenuation corrected tomography ima-ges. Evaluate the efficacy of attenuation correction in duel head hybrid SPECT/coincidence PET systems (SPECT/PET) and SPECT using both the Jaszczak and the myocardial phantoms. Methods For PET phantom study, the Jaszczak phantom was filled with the aqueous solution of 18F-fluorodeoxyglucose (FDG) and was scanned with two hybrid SPECT/coincidence PET systems respectively (Vertex Plus, Netherlands Philips ADAC Company and Hawkeye, USA GE Company). The PET images were acquired and reconstruc-ted. Results The "cold" lesion, which the diameter was less than 12 mm of uncorrected image, could not be identified. But it, after correction, diameter 9 mm, would be recognized clearly, less than 7 mm would not be distinguished. Noncorrected image could only identify "hot" lesions which the diameter were 9, 12, 14, 18, 22 and 38 mm, while in the corrected image, not only it was much better, but also the "hot" le-sion of 6 mm was distinguished. In Hawkeye, the same situation, the corrected image of was improved obvi-ously; the disparity of counts between surrounding and deep center less, and the counts in deep center were compensated. There were only 3 round " cold" lesions could be recognized, the diameter: 14, 18 and 20 mm; all of them which diameter were less than 12 mm could not be distinguished. One in the center was al-most as background, and could not be identified. The radioactive accounts of surrounding and center were quite different. The corrected image 5 "cold" lesions could be found, 9, 12, 14, 18 and 20 mm, but7 mm could not be found. The noncorrected image, only 12, 14, 18, 22 and 38 mm " hot" lesions could be found, and by the surrounding, there was an arc shape "hot" lesion. But it could distinguish 9, 12, 14, 18, 22 and 38 mm "hot" lesions on the corrected image, and the image was much better than noncorrected one. Conclusions The corrected image of Vertex Plus was improved obviously with the disparity of counts between surrounding and deep center less, and the counts in deep center was compensated. The result of at-tenuation with phantom showed that 137Cs was better than CT in both image quality and spatial resolution.     

双能量CT头颅血管成像的影像质量、辐射剂量及初步临床应用

Objective To assess the clinical value of dual-energy intracranial CT angiography (CTA).Methods Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group.Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametrie test and independent-samples t test, respectively.Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA.There was no significant difference between the two groups(Z= -0.455, P=0.650).Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P= 0.000).Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy · cm respectively.Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA.Out of the 41 patients,19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results.Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques.Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) nun, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1.71), (5.10±1.60) ,(3.83±1.65) nan,respectively.There was no significant difference for the diameters of aneurysm between dual energy CTA and DSA ((t=-0.734,1.936,0.12.5 respectively, P=0.482,0.085,0.903 respectively), and good correlation was found between diameter measurements using the two techniques(r=0.964,0.976,0.973, respectively, all P=0.000) Conclusions Compared with conventional subtraction CTA, dual energy CTA has good image quality for intracranial vessels; however, image quality of the skull base vessels is worse, especially for the petrosal and syphon segment.Dual energy CTA has decreased radiation dose and a high diagnostic accuracy, being a practical imaging madality for diagnosis of intracranial vascular lesions.     

多层螺旋CT对门静脉海绵样变的诊断价值

目的:分析门静脉海绵样变(CTPV)的多层螺旋CT(MSCT)表现和特征,探讨MSCT对该病的诊断价值.方法:使用16排MSCT对30例CTPV患者,行上腹部CT平扫、动态增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现 (VR)等图像后处理技术显示异常的门静脉及侧枝血管情况.结果:CTPV的MSCT平扫示门静脉结构不清,肝门区可见多发的结节状软组织影.增强扫描示动脉期10例有肝实质灌注异常;门静脉期18例患者门静脉主干和(或)左右分支增粗,内可见充盈缺损,4例门静脉显示不清;8例门静脉主干和(或)左右分支在正常范围内;1例门静脉主干变细.胆管周围静脉丛(100%)、胆囊静脉(60%)及胃左静脉(23.3%)呈点状、簇状扩张.MPR、MIP、VR可直观地显示各曲张血管的走行及曲张程度.结论:MSCT及图像后处理系统对CTPV诊断具有重要价值,门静脉栓塞及其周围纡曲扩张的侧枝静脉为其特征性表现.     

Carotid cavernous fistulae: indications for urgent treatment

Angiographic and clinical data from 155 patients with carotid cavernous fistulae were retrospectively reviewed to determine angiographic features associated with increased risk of morbidity and mortality. These features included presence of a pseudoaneurysm, large varix of the cavernous sinus, venous drainage to cortical veins, and thrombosis of venous outflow pathways distant from the fistula. Clinical signs and symptoms that characterized a hazardous carotid cavernous fistula included increased intracranial pressure, rapidly progressive proptosis, diminished visual acuity, hemorrhage, and transient ischemic attacks. Cortical venous drainage from the carotid cavernous fistula is secondary to occlusion or absence of the normal venous outflow pathways and is associated with signs and symptoms of increased intracranial pressure and an increased risk of intraparenchymal hemorrhage. Angiographic demonstration of a cavernous sinus varix, with extension of the sinus into the subarachnoid space, is associated with an increased risk of fatal subarachnoid hemorrhage. Identification of these high-risk features provides a basis for making decisions about treatment.     

彩色多普勒超声对颈动脉-海绵窦瘘的诊断价值

目的探讨彩色多普勒超声（CDUS）对颈动脉-海绵窦瘘（CCF）的诊断价值。方法本文应用CDUS对6例CCF患者进行了分析,并与脑血管造影比较。结果CDUS显示,引流静脉多以扩张的眼上静脉为主,脉冲多普勒可测到连续层流的静脉频谱中混叠有动脉搏动性频谱,患侧颈内动脉流速明显高于健侧;患侧大脑中动脉（MCA）、大脑前动脉（ACA）流速低于健侧。压迫患侧颈总动脉,患侧颈内动脉（瘘口以上）出现不同程度的倒灌血流。结论彩色多普勒超声对颈动脉-海绵窦瘘的诊断具有高度的特异性,是一项值得临床推广应用的无创、方便、快捷的诊断颈动脉-海绵窦瘘的辅助检查方法。     

双源CT前瞻性心电触发技术用于脑血管成像的初步研究

目的 探讨双源Flash Spiral CT前瞻性心电触发序列(step-and-shoot,SAS)模式脑血管成像的图像质量及辐射剂量.方法 将43例临床怀疑脑血管性病变的患者,行前瞻性心电触发序列模式的脑血管造影术( SAS-CTA)扫描,采集期相:应用60％ R-R间期的ECG演示模式,对SAS-CTA做图像后处理,分析评价图像质量评分、统计辐射剂量及优良率.结果 评价SAS-CTA,图像质量评分为4.72±0.50,优良率达97.7％ (42/43),平均有效剂量为(0.216±0.01) mSv,SAS-CTA有效辐射剂量与双能量CTA( DE-CTA)比较降幅达到76.31％.结论 前瞻性心电触发序列模式应用于脑血管成像,可在保证图像质量的同时显著降低辐射剂量.     

Para-cavernous sinus venous structures: anatomic variations and pathologic conditions evaluated on fat-suppressed 3D fast gradient-echo MR images

BACKGROUND: The cavernous sinus communicates with several para-cavernous sinus venous structures, receiving blood flow from the superficial middle cerebral vein (SMCV), the sphenoparietal sinus (SPS), and the superior ophthalmic vein, and draining into the superior and inferior petrosal sinuses and pterygoid and basilar plexuses. Anatomic variations of these veins have been previously reported; however, some details, such as the relationship between the SPS and the SMCV, are incompletely characterized. The anatomic variations of para-cavernous sinus veins, especially drainage patterns of the SMCV, were evaluated on MR imaging. MATERIALS AND METHODS: Thirty-seven patients, including those without any lesions affecting the cavernous sinus or para-cavernous veins and patients with carotid cavernous fistulas, were examined by using fat-suppressed contrast-enhanced 3D fast gradient-echo MR imaging. Two neuroradiologists evaluated the images on a viewer, regarding the normal anatomy and the pathologic findings of the para-cavernous sinus veins. RESULTS: The fat-suppressed 3D fast gradient-echo MR images clearly depicted the para-cavernous sinus venous structures in all patients. SMCVs had 4 variations in the drainage patterns. The most frequent pattern was drainage into the SPS (39%), and other types were draining into cavernous sinus, pterygoid plexus, and tentorial sinus. The SPS had 3 variations. The most frequent pattern was drainage into cavernous sinus (72%), and others were the hypoplastic type or those draining into pterygoid plexus. CONCLUSION: The fat-suppressed 3D fast gradient-echo MR image is useful for evaluating the venous structures in the skull base. Knowledge of the variations is important for diagnosis and endovascular treatment of the cavernous sinus lesions.     

Test-Bolus部位选择对MSCT双期脑血管成像质量的影响

目的对比不同部位Test-Bolus测试对MSCT脑动静脉双期成像图像质量的影响。方法75例随机分配到脑动脉环窦汇（A）组、颈内动静脉（B）组、颈总动静脉（C）组（每组25例）,以相同参数行Test-Bolus测试及MSCT双期脑血管成像,用Kruskal-Wallis H检验比较3组测试成功病例CTA、CTV图像质量差异。结果A,B,C3组Test-Bolus测试成功显示动静脉强化峰值率分别为76％,92％,96％;3组测试动静脉峰值时间差有差别（P〈0．005）;3组测试动脉峰值时间没有统计学差异（p=0．744）。3组CTA图像脑动脉各级分支清晰显示,静脉干扰轻微,两者评分及脑动静脉最大强化CT差值均无显著差异（P=0．192;P=0．347;P=0．327）。3组CTV图像深浅静脉、静脉窦显示清晰,其评分没有差别（p=0．839）;脑动脉仍强化明显,动脉干扰评分及动静脉最大强化CT差值没有差别（p=0．347;P=0．327）。结论颅内、颈内、颈总动静脉行Test—Bolus测试成功后,确定MSCT双期脑血管成像延时扫描时间对CTA及CTV图像质量影响无显著差异,颈内动静脉可作为MSCT脑动静脉双期成像推荐测试部位。     

Traumatic carotid-rosenthal fistula treated with Jostent Graftmaster

Traumatic injuries of the carotid artery may result in severe morbidity and mortality. The most common location of carotid artery injury is the cavernous segment, which may result in fistulous connection to the cavernous sinus and ophthalmic veins, which in turn lead to pressure symptoms in the ipsilateral orbit. Unlike the commonly reported direct traumatic carotid-cavernous fistula, we describe an unusual case of a 38-year-old man presented with a traumatic brain injury led to a fistula connection between the cavernous carotid artery and the ipsilateral basal vein of Rosenthal, with eventual drainage to the straight and transverse sinuses. The basal vein of Rosenthal is usually formed from confluence of anterior and middle cerebral veins deep in the Sylvian fissure and drain the insular cortex and the cerebral peduncles to the vein of Galen. Immediate endovascular deployment of a covered stent in the cavernous carotid artery allowed sealing the laceration site. Three months follow up showed a non-focal neurological examination and healed carotid laceration over the covered stent.     

颈动脉海绵窦瘘的临床及MSCT表现特征

目的:分析颈动脉海绵窦瘘(CCF)的临床及MSCT表现特征,提高对CCF的诊断准确率。材料和方法:采用16层螺旋CT对13例CCF病人进行扫描,图像后处理分别行MPR、MIP及VR成像,其中10例外伤性CCF还采用骨窗重建。结果:CCF的主要临床表现为眼球突出、视力减退、结膜充血、血管杂音等,MSCT的直接征象为海绵窦扩大13例(100%),眼上静脉扩张13例(100%),瘘口显示6例(46.2%),大脑中、浅静脉早显8例(61.5%)。间接征象为眼突、眼肌肥厚、眶内软组织肿胀、颅面部骨折等。MSCT检查结合临床病史可以对外伤性CCF作出准确的诊断,自发性CCF临床表现不典型,需与炎性假瘤、眼眶肿瘤、Craves眼病、血管畸形等眼部疾病进行鉴别诊断,本组采用MSCT对CCF的诊断准确率为100%。结论:MSCT具有安全、快速、准确的检查优势,多种成像技术结合使用,能清楚显示CCF的直接征象和间接征象,为临床及介入治疗提供可靠的诊断依据。     

Cerebral venous angiomas

Summary Sixteen cases of cerebral venous angiomas, seven cerebellar and nine supratentorial were imaged by magnetic resonance, using a T1 sequence and a motion compensated T2 sequence. The transcerebral draining vein of the lesion could be identified in thirteen out of sixteen patients. On T1-weighted images all the lesions were hypointense. On T2-weighted images, five lesions were hypointense, and eleven were hyperintense consistent with slow flow. In three cases the lesion was hemorrhagic. Three lesions with hypointense aspect on T1 and hyperintense aspect on T2-weighted images were only seen in retrospect, due to partial volume averaging in two and concomitant chronic hemorrhage in one. Before contrast, the peripheral dilated medullary veins could only be identified in five cases. On T2-weighted images, in three of these lesions the signal was higher than in the draining veins, pointing to a slower flow. After intravenous administration of Gadolinium, performed in twelve patients, the main transcerebral draining vein as well as the peripheral medullary veins could be well identified in all patients.     

Long-term clinical outcome of spontaneous carotid cavernous sinus fistulae supplied by dural branches of the internal carotid artery

We report the long-term clinical outcome of spontaneous carotid cavernous sinus fistulae (CCF) originally supplied by branches arising from the internal carotid artery (Barrow's type B), or type-D lesion that became type B after particulate embolization. A total of 55 patients was included in this study. Their angiography revealed that cortical drainage was absent, and that the arteries supplying the fistulae originated in the dural branches of the internal carotid artery. Thirty-two patients had type-D lesions, which became type-B lesions after obliteration of the external carotid supply by endovascular treatment. The other 23 patients had type-B lesions documented by angiography, and had no embolization. The follow-up period ranged from 8 to 144.5 months. Clinical cure was achieved in 39 patients (70.9%), improvement in eight patients (14.5%), the lesion remained stable in four patients (7.3%), and was aggravated in four patients (7.3%). The number of drainage veins is the only radiographic factor that could predict the outcome. Those patients with single draining veins had a better chance of complete remission. The outcome between the group with original type D lesions after embolization and the group with original type B revealed no statistically significant difference. The time-course to complete cure was significantly shorter in the group with embolization of the external carotid supply. In the four patients whose symptoms were aggravated, embolization was performed, and the result was excellent. The clinical outcome of type-B CCF, or type D converted to type B, is good. Previous external carotid artery embolization can significantly shorten the time to complete cure. Aggressive treatment should be reserved for those who have aggravated symptoms.