Bronchial arteries: CT demonstration with arteriographic correlation

Dynamic computed tomography (CT) was performed in nine patients with enlarged bronchial arteries documented by arteriography. Plain and contrast-material-enhanced CT scans of two more patients with prominent bronchial arteries were retrospectively reviewed. The study was conducted to determine visibility of the bronchial artery with CT and to depict the anatomic relationship of its mediastinal portion to surrounding structures. The mediastinal portion of the bronchial artery was successfully outlined as nodular or linear densities on all dynamic CT scans. The right bronchial artery was confirmed to arise from the medial wall of the thoracic aorta, whereas the left arises from the anterior wall. Because of its retroesophageal location, the enlarged right bronchial artery can compress the posterior wall of the esophagus. It is postulated that the left bronchial artery occasionally traverses the aorticopulmonary window, recognized as nodular or linear densities below the aortic arch on CT scans.     

CT demonstration of extracranial carotid artery aneurysms

Aneurysms arising from the extracranial carotid arteries are uncommon lesions. Clinically, they may present as lateral masses in the superior cervical area, as medial masses in the tonsillar fossa or parapharyngeal region, or as a mass palpable in both areas. Tenderness or pain may or may not be present. Pulsation is usually detectable. Embolic neurological episodes are a common event leading to discovery of these lesions. Etiologies include trauma, atherosclerosis, fibromuscular dysplasia, infection, and congenital predisposing factors. We report the CT appearance of this condition in three patients. In all three patients (four aneurysms) the CT findings were characteristic. Thus far, we have discovered only one account in the English literature that included the CT demonstration of an extracranial carotid aneurysm.     

CT of intrasellar colloid cyst

Colloid cysts are congenital lesions considered to be derived from the primitive neuroepithelium and are most frequently located in the anterior third ventricle. In this paper a case of colloid cyst with a intra/suprasellar location is presented. Computed tomographic characteristics of this lesion were strongly consistent with the classic features of colloid cysts, particularly when interpreted retrospectively after surgical and histopathological data became available. The unusual occurrence of a colloid cyst in this location supports the theory that epithelial cysts related to sella turcica are derived not solely from Rathke cleft but also from neuroepithelium.     

Multidetector-row CT angiography in the study of atherosclerotic carotid arteries

Pathologies of the carotid arteries, and in particular atherosclerosis, are now an important medical problem. Stroke is the third leading cause of severe disability in the Western World leading to millions of deaths every year. Extracranial carotid atherosclerotic disease is the major risk factor for stroke. In years, with the advent of multidetector-row CT (MDCT) scanners and the use of specific angiographic protocols (MDCTA), CT imaging of the carotid arteries has become increasingly effective. In addition, the volume data obtained can be further rendered to generate high-quality two-dimensional and three-dimensional images. The purpose of this study was to review the atherosclerotic carotid arteries, their complications and how MDCTA depicts them, underlining the benefits and pitfalls of this diagnostic technique.     

Cutis verticis gyrata: its computed tomographic demonstration in acromegaly

A retrospective review of the 17 cases of acromegaly, recorded in the hospital and with available CT scans was undertaken in order to determine the presence and of cutis verticis gyrata (CVG) frequency, and the spectrum of other associated radiographic appearances of CVG. The hormone levels were analysed, and the histopathology of the surgical specimens reviewed. Five cases were uncovered. In these, the scalp in CVG was markedly thickened with convoluted, gyriform or cog-wheel appearances. There was no correlation in the age, sex, duration of symptoms or the hormone levels in these two groups of acromegalics: with or without CVG. All cases were histologically pituitary adenoma. It is concluded that CVG is not uncommon in acromegaly. Its presence on a CT scan should caution the radiologist to the presence of pituitary adenoma or any of the other neurological causes of CVG.     

Atheromatous extracranial carotid arteries: CT evaluation correlated with arteriography and pathologic examination

Dynamic, rapid sequence, axial computed tomography (CT) was employed to evaluate the extracranial common and internal carotid arteries in 17 patients with clinical histories suggesting recent or remote ischemia in the territory supplied by the internal carotid artery. The CT findings were correlated with arteriographic observations and with gross and histologic evaluations of endarterectomy specimens. Areas of arterial wall thickening were evaluated on CT scans with regard to both degree of thickening and radiographic density (attenuation). The degree of vessel wall thickening secondary to atheromatous plaque demonstrated on CT scans corresponded closely to the severity of luminal compromise seen on arteriograms. Isodense or mildly hypodense focal mural thickening noted on CT scans of seven endarterectomy specimens proved to be primarily fibrotic (simple) atheromatous plaque on gross and histologic examination. Areas of markedly lucent focal mural thickening on CT scans of 11 specimens all demonstrated varying amounts of subintimal hemorrhage within loosely arranged and rather acellular (complex) atheromatous plaques on pathologic examination. While arteriography provides information regarding the status of the arterial lumen, CT offers the potential of accurate characterization of pathologic changes in the wall of the extracranial carotid arteries in patients with symptoms of cerebral ischemia.     

Helical CT demonstration of dilated right inferior phrenic arteries as extrahepatic collateral arteries of hepatocellular carcinomas

PURPOSE: The purpose of this work was to demonstrate the appearance of the right inferior phrenic artery (RIPA) on CT in patients with hepatocellular carcinoma (HCC). METHOD: We assessed the biphasic helical CT scans using 10 mm collimation in 16 patients with arteriographically proven HCCs supplied by the RIPAs. Size of the right and left inferior phrenic arteries and origin of the RIPA were evaluated and correlated with arteriographic images. RESULTS: Helical CT showed dilated RIPAs on the right diaphragmatic crus as foci of high attenuation on arterial-phase images in all patients. Diameter of the RIPA (average 3.3 mm) was larger than that of the left inferior phrenic artery (average 1.5 mm). The origin of the RIPAs was correctly predicted in 13 of 16 (celiac artery 6, abdominal aorta 5, right renal artery 2) patients. CONCLUSION: Asymmetric dilatation of the RIPA as an indicator of extrahepatic collateral of HCC can be demonstrated on the right diaphragmatic crus with arteriographic images of biphasic helical CT.     

Intraluminal thrombus of the internal carotid arteries: angiographic demonstration of resolution with anticoagulant therapy alone

Fourteen patients with angiographically demonstrated thrombus in the cerebral vessels were treated immediately with anticoagulant or antiplatelet medication. Follow-up angiograms, obtained in eight cases, showed resolution of the thrombus in seven. In no patient did the thrombus progress to occlude the vessel completely, and no new distal emboli were identified on the follow-up angiograms. There were no new permanent neurologic events in these 14 patients while they were undergoing medical therapy. Six patients subsequently underwent delayed endarterectomy to treat underlying stenoses. Our experience indicates that the presence of intraluminal thrombus may not be a surgical emergency.     

Clivus fracture: CT demonstration

A transverse fracture of the clivus through the region of the fused sphenooccipital synchondrosis involving the carotid canals was studied by CT. The patient also had bilateral temporal bone fractures with otorrhea and a carotid cavernous fistula. The literature related to clivus fractures is reviewed.     

Elastofibroma dorsi: CT demonstration

Elastofibroma dorsi is a pseudotumorous connective tissue mass that characteristically arises between the chest wall and the inferior angle of the scapula. Its long axis is typically craniocaudal. Two patients are illustrated, each presenting with a fixed subscapular mass. Computed tomography showed each mass as elongated, incompletely marginated, and of soft tissue density deep to the inferior angle of a scapula. The latissimus dorsi and an underlying layer of fat were posterolaterally elevated inferior to the tip of the scapula. After incisional biopsy excluded sarcoma, each mass was locally excised.     

16层螺旋CT颈脑动脉联合成像的技术评价

目的:探讨16层螺旋CT颈脑动脉联合成像技术的可行性,评价其图像质量。方法:134例缺血性脑血管病患者应用SiemensSensation16层螺旋CT行颈脑动脉联合CTA检查。扫描准直16×0.75mm,Pitch值0.8～1.0,球管旋转时间0.5s/r。采用对比剂自动跟踪技术,对比剂使用Ultravist(370mgI/ml)100ml和30～40ml无菌生理盐水,注射流率3.5ml/s。于Wizard工作站参考DSA造影的操作顺序和投照角度,行颈脑动脉多平面重组、最大密度投影、曲面图像重建及容积再现CTA图像。技术分析包括扫描延迟时间及数据采集时间,分析图像质量。结果:134例CTA扫描延迟时间最快17.1s,最迟37.2s,平均21.5s,<20s者26例,20-30s者87例,>30s者21例;数据采集时间最少者13.1s,最多者为17.5s,平均15.6s,<15s者30例,>15s者104例。134例脑动脉CTA图像质量优者113例,质量好者16例,质量中等者5例,质量差者0例,无局部伪影病例,所有病例图像均满足诊断需要;颈动脉CTA图像,除11例患者存在局部伪影外,余123例图像质量均满足诊断需要。结论:应用16层螺旋CT可以在20s内完成颈部与脑动脉的一次性扫描,此技术是可行的;其CTA图像质量能够满足诊断需要。     

18F-FDG accumulation in atherosclerosis: use of CT and MR co-registration of thoracic and carotid arteries

Purpose The purpose of this study was to depict ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) accumulation in atherosclerotic lesions of the thoracic and carotid arteries on CT and MR images by means of automatic co-registration software. Methods Fifteen hospitalised men suffering cerebral infarction or severe carotid stenosis requiring surgical treatment participated in this study. Automatic co-registration of neck MR images and FDG-PET images and of contrast-enhanced CT images and FDG-PET images was achieved with co-registration software. We calculated the count ratio, which was standardised to the blood pool count of the superior vena cava, for three arteries that branch from the aorta, i.e. the brachial artery, the left common carotid artery and the subclavian artery (n=15), for atherosclerotic plaques in the thoracic aorta (n=10) and for internal carotid arteries with and without plaque (n=13). Results FDG accumulated to a significantly higher level in the brachial artery, left common carotid artery and left subclavian artery at their sites of origin than in the superior vena cava (p=0.000, p=0.000 and p=0.002, respectively). Chest CT showed no atherosclerotic plaque at these sites. Furthermore, the average count ratio of thoracic aortic atherosclerotic plaques was not higher than that of the superior vena cava. The maximum count ratio of carotid atherosclerotic plaques was significantly higher than that of the superior vena cava but was not significantly different from that of the carotid artery without plaque. Conclusion The results of our study suggest that not all atherosclerotic plaques show high FDG accumulation. FDG-PET studies of plaques with the use of fused images can potentially provide detailed information about atherosclerosis.     

Esophageal fistula: demonstration by CT

While barium esophagography is useful in revealing fistulas between the esophagus and trachea or bronchus, it is not adequate to show those between esophagus and lung or mediastinum. In this study, a patient with esophago-pulmonary and esophago-mediastinal fistulas was evaluated by CT, which proved to be more effective in showing fistulas between the esophagus and lung or mediastinum.     

Temporomandibular joint chondrosarcoma: CT demonstration

Chondrosarcoma of the temporomandibular joint is a rare lesion. A 49-year-old woman presented with painless left preauricular swelling. Computed tomography demonstrated a soft tissue mass in the left temporomandibular joint with extraarticular extension along the mandibular ramus. Calcification was present in the extraarticular component.     

Frontal horn coarctation: CT demonstration

Summary The CT aspects of frontal horn coarctation by ependymal fusion in two cases are described with post-mortem verification. These ependymal fusions in the lateral ventricles are seen frequently on air ventriculograms, especially in the occipital horns. Ependymal fusions in the frontal horns are rare and not very well known. These fusions are clearly seen on CT and post-mortem examinations. The frontal horns appear asymmetrical on CT and this asymmetry evokes frontal horn compression (by an isodense tumour for instance), or contralateral frontal horn dilatation. Some CT details of ventricular coarctation make it easy to differentiate tumoural compression from controlateral subcortical atrophy.     

Lumbar artery pseudoaneurysm: CT demonstration

A psoas mass in a patient with a history of penetrating trauma to the area was demonstrated by computed tomography (CT) to represent a lumbar artery pseudoaneurysm surrounded by hematoma. This report emphasizes the importance of recognizing the anatomic position of the lumbar arteries on CT images and considering the possibility of pseudoaneurysm in the differential diagnosis of post-traumatic psoas masses.