Patient with Leriche's syndrome and concomitant superior mesenteric aneurysm: evaluation with contrast-enhanced three-dimensional magnetic resonance angiography, computed tomography angiography and digital subtraction angiography

Conventional angiography is regarded as the gold standard in vascular imaging but it is invasive, and difficulty may be encountered in the evaluation of aortic occlusion disease. Superior mesenteric artery aneurysm is an uncommon disease, which can result in life-threatening haemorrhage after rupture. With the rapid development of computed tomography angiography (CTA) and magnetic resonance angiography (MRA), high-quality images of the vascular system can be obtained in a non-invasive manner. We report a case of Leriche's syndrome with concomitant superior mesenteric aneurysm using contrast-enhanced 3-D CTA and MRA, with digital subtraction angiography correlation.     

Value of CT angiography in the evaluation of a peripheral anterior inferior cerebellar artery aneurysm: case report.

We report a case of a peripheral anterior inferior cerebellar artery (AICA) aneurysm in a 66-year-old woman. Computed tomography angiography (CTA) demonstrated a saccular aneurysm in the left AICA. A subsequent vertebral digital subtraction angiography using our standard injection technique failed to demonstrate the aneurysm. However, the aneurysm was visualized on a follow-up injection performed with an increased contrast dose and injection rate. CTA proved to be critical in the detection of this aneurysm which could have been easily overlooked on a conventional angiogram.     

颈动脉瘤的手术及介入治疗体会

目的：探讨颈动脉瘤的诊断及治疗方法。方法：通过典型病例分析病因、症状、影像学改变及手术和介入等不同治疗方法。结果：4例分别行动脉造影、DSA、CTA确诊。手术治疗3例，血管内支架治疗1例均获得成功。随访2月～6年，效果满意。结论：①选择性颈动脉造影是诊断颈动脉瘤最有效的手段；②术前尽可能行颈动脉压迫训练，切忌做诊断性穿刺；③动脉瘤内缝合及外包裹术和介入治疗是选择的主要术式；④本组1例是先天性左颈总动脉闭锁、右颈外动脉瘤；1例术后顽固性高血压，均较罕见，值得探讨。     

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。     

Primary pulmonary malignant fibrous histiocytoma mimics pulmonary artery aneurysm with partial thrombosis: various radiologic evaluations

Primary pulmonary malignant fibrous histiocytoma (MFH) is very rare, so only a few imaging features have been reported. We report one case of rapidly growing primary pulmonary MFH mimicking a partially thrombosed pulmonary artery aneurysm and its radiologic findings, including multidetector row computed tomography (MDCT), conventional angiography, and fluorodeoxyglucose-positron emission tomography CT ([18F] FDG-PET/CT). On multi-phasic MDCT, this mass mimicked a pulmonary artery aneurysm with partial thrombosis. However, pulmonary artery aneurysm was excluded and suggested as a hypervascular parenchymal mass by subsequent conventional angiography. On [18F] FDG-PET/CT, it was a highly metabolic mass, showing a maximal standard uptake value (SUV) 12.1. Although primary pulmonary MFH is very rare and has no specific imaging findings, our experience might be helpful to differentiate a hypervascular pulmonary mass.     

Angiography-assisted computed tomography for the detection and intervention of a subtle aneurysm of the omentum

Intra-abdominal hemorrhage caused by omental artery rupture is a rare condition traditionally diagnosed via exploratory laparotomy in hemodynamically unstable patients. We experienced a case in which contrast-enhanced multidetector computed tomography (MDCT) and digital subtraction angiography did not identify the rupture site, whereas CT during left omental arteriography depicted a small 4-mm aneurysm. The lesion was then embolized with microcoils and N-butyl cyanoacrylate lipiodol glue. We consider that performing a CT during selective arteriography could be useful in cases in which the rupture site is unclear with other imaging techniques such as contrast-enhanced MDCT and digital subtraction angiography.     

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.     

CT血管造影在颅内动脉瘤及动静脉畸形诊断的价值

目的探讨CT血管造影(CTA)在颅内动脉瘤及动静脉畸形(AVM)的诊断价值。方法对100例行CTA检查发现有颅内动脉瘤及动静脉畸形的患者的临床资料回顾性分析。CTA采用容积再现(VR)、最大密度投影(MIP)和曲面重建(CPR)等方法进行图像重建。100例中有11例与数字减影血管造影对照,89例与介入治疗、手术对比。结果100例中CTA发现116个动脉瘤,包括前交通动脉瘤29个、后交通动脉瘤16个、大脑前动脉9个、大脑中动脉35个、大脑后动脉3个、颈内动脉瘤16个、椎动脉4个、小脑后下动脉2个,小脑前下动脉1个,基底动脉1个。2例AVM,4例动脉瘤合并AVM,2例AVM合并静脉瘤,诊断准确率达94.91%。结论 CTA诊断颅内动脉瘤及AVM是一种安全可靠的方法,具有很好的临床应用价值。     

Right ventricle outflow tract dilatation and pulmonary artery aneurysm,rare cardiac conditions

We describe a rare case of simultaneous idiopathic right ventricular outflow tract dilatation and idiopathic main pulmonary artery aneurysm. A 59-year-old male presented with complaints of exertional shortness of breath and a cardiac murmur since childhood. CT pulmonary angiogram showed main pulmonary artery dilatation with a diameter of 5.8 cm. Cardiac MRI revealed right ventricular outflow tract dilatation with a diameter of 5.4 cm and a main pulmonary artery aneurysm with a 5.6 cm diameter. Cardiothoracic surgery was consulted for surgical repair. Definitive management of right ventricular outflow tract dilatation and pulmonary artery aneurysms is challenging due to their infrequent diagnosis and lack of established guidelines. The treatment for central aneurysms is surgery which includes aneurysmectomy and right ventricular outflow tract repair or replacement.     

CT angiography for the diagnosis of aneurysm in the bifurcation of the middle cerebral artery

This study reports 10 aneurysms found in the bifurcation of the middle cerebral arteries (MCA) of seven patients, diagnosed by computed tomography angiography (CTA) and confirmed by digital subtraction angiography and surgery. Six of the 10 aneurysms bled and caused subarachnoid hemorrhage (SAH): the SAH was predominant in the Sylvian fissure where the aneurysms located. Eight aneurysms had a saccular pattern, while two had a fusiform pattern. Nine aneurysms were larger than 8 mm and were easily detected by CTA, while one aneurysm was 6 mm in diameter and was missed initially. It was found, however, after the direction of the CTA was readjusted. In conclusion, the hemorrhages of aneurysm in the bifurcation of the MCA predominated in the Sylvian fissure, and the size of the aneurysm is often big, and thus easily detected by CTA.     

数字减影和常规CTA在颅内动脉瘤诊断中的对照研究

目的:探讨多层螺旋CT(MSCT)数字减影和常规血管造影术在颅内动脉瘤诊断中的临床应用价值。方法:回顾分析本院56例可疑颅内动脉瘤患者,应用MSCT数字减影和常规血管造影术(简称减影和常规CTA)进行颅内动脉成像检查,全部患者均进行了手术确诊或DSA检查,并将两种检查结果进行比较。结果:全部患者中手术及DSA造影共检出动脉瘤65个,采用数字减影CTA共检出61个,敏感性为93.8%。常规CTA检出动脉瘤54个,敏感性为83.1%。结论:MSCT数字减影血管造影术是一种安全、无创的新型检查方法,具有较高的特异性及敏感性,明显优于常规CTA检查。     

Subclavian aneurysm producing the subclavian steal syndrome

An atherosclerotic aneurysm of the right subclavian artery causing subclavian steal syndrome is described. Complementary information obtained from digital subtraction angiography and computed tomography helped to establish a correct preoperative diagnosis.     

Noninvasive detection of a ruptured aneurysm at a basilar artery fenestration with submillimeter multisection CT angiography

The criterion standard for the detection of intracranial aneurysms is digital subtraction angiography. MR imaging and CT provide good accuracy in the evaluation of brain arteries and aneurysms. We herein report a case of a ruptured aneurysm at a basilar artery fenestration. The diagnosis was assessed with 16-row multisection CT angiography and was confirmed by using digital subtraction angiography. The patient was successfully treated with coil placement.     

Digital angiography in pulmonary embolism

Pulmonary digital subtraction angiography was diagnostic in 98.3 per cent of patients with possible acute pulmonary embolism. The procedure was well tolerated even in severely ill patients. A large image intensifier made simultaneous imaging of both lungs possible, reducing the number of contrast injections necessary. Small volumes of low iso-osmolar concentration of modern contrast media were used. There was no need for catheterization of the pulmonary artery. Theoretical considerations and our limited experience indicate that this will reduce the number of complications compared with conventional pulmonary angiography. The procedure is rapidly performed and the diagnostic accuracy high. This makes digital subtraction angiography cost effective. Digital pulmonary angiography can be recommended as the primary diagnostic method in most patients with possible pulmonary embolism.     

Giant mediastinal bronchial artery aneurysm mimicking mediastinal mass: A case report and brief review of the literature

Bronchial artery aneurysm and pseudoaneurysm is a rare but life-threatening diagnosis due to catastrophic complications from rupture. Prompt detection and management is key to prevent complications. CT angiogram and digital subtraction angiography are preferred diagnostic imaging modalities. Being very uncommon, these entities can be misdiagnosed as a nonspecific mediastinal soft tissue mass, which can lead to delay in diagnosis and inappropriate or delayed management. We present a case of 72-year-old woman with incidentally detected large bronchial artery pseudoaneurysm, incorrectly classified as mediastinal malignancy at outside facility, receiving follow-up exams for 2 years, before correct diagnosis and management.     

Early spontaneous occlusion of a vertebral artery dissecting aneurysm caused by subarachnoid hemorrhage: A case report

We report a case of vertebral artery dissecting aneurysm (VADA) that developed with subarachnoid hemorrhage and was found to be occluded based on subsequent digital subtraction angiography. Few reports have been published on ruptured VADA in which ipsilateral vertebral arteries are occluded. The proper management of this type of aneurysm is controversial. A 44-year-old woman developed a sudden onset headache. Computed tomography and three-dimensional computed tomography were immediately performed and showed subarachnoid hemorrhage and VADA distal to the right posterior inferior cerebellar artery bifurcation. We decided to treat the VADA immediately and performed digital subtraction angiography but found the VADA had spontaneously occluded. We performed coil embolization, including the aneurysm and the parent artery, with reference to the findings of three-dimensional computed tomography. On Day 16, recurrence was considered due to the finding of dilation of the distal end where the coil was embolized. An additional embolization was performed via the posterior communicating artery. No cases of endovascular treatment have been reported in VADA cases in which the rupture site is spontaneously occluded. In such cases, the treatment may be incomplete, so strict follow-up is required.     

Ultrasound-guided computed tomography angiography for the diagnosis of rotational vertebral artery occlusion: 2 case reports and technical notes

Rotational vertebral artery occlusion is a rare cause of ischemic stroke in the vertebrobasilar arteries. While computed tomography angiography (CTA) is less invasive for the diagnosis of rational vertebral artery occlusion than digital subtraction angiography and more useful for elucidating the correlation between vertebrobasilar arteries and the surrounding structure, carotid ultrasound is noninvasive and more beneficial for the real-time evaluation of the hemodynamic change with neck rotation compared to CTA. Here, we reported 2 cases of rotational vertebral artery occlusion in patients aged 81 and 38 years and proposed a novel technique for its diagnosis using ultrasound-guided CTA. We suggest that the combination of ultrasound and CTA is useful for diagnosing rotational vertebral artery occlusion, which would compensate for the disadvantages of CTA alone.     

Infundibular dilation and aneurysm at the origin of the posterior communicating artery: differential diagnosis by CT angiography

Introduction

Infundibular dilation (ID) and aneurysm at the internal carotid artery (ICA)–posterior communicating artery (PComA) junction can be difficult to distinguish but may differ in clinical significance. The aim of this study was to evaluate the utility of CT angiography (CTA) in differentially diagnosing IDs and small unruptured aneurysms at the ICA–PComA junction.

Methods

This retrospective study comprised 88 patients diagnosed with 107 protrusions (70 IDs and 37 aneurysms <5 mm; 19 bilateral lesions) at the ICA–PComA junction who underwent both CTA and digital subtraction angiography (DSA). Two neuroradiologists independently reviewed CTA and DSA images according to these criteria: (a) size (maximum dimension <3 or ≥3 mm), (b) shape (triangular or round/oval/irregular), (c) aneurysmal neck (absent or present), (d) horizontal direction (posteriomedial or posteriolateral), and (e) PComA origin (apex, no PComA, or base). The intermodality (between CTA and DSA) and interobserver (between the two readers) agreement were determined for each finding. We also evaluated the sensitivity and specificity of CTA for distinguishing ID and aneurysm, using DSA as the reference standard.

Results

The mean κ values of intermodality agreement for the size, shape, aneurysmal neck, horizontal direction, and PComA origin were 0.88, 0.87, 0.84, 0.71, and 0.56, respectively. All interobserver agreements of CTA and DSA were excellent. The sensitivity, specificity, and accuracy of CTA for differentiating aneurysms from IDs were 94.6, 100, and 98.0 %, respectively.

Conclusion

CTA may be a useful noninvasive modality for differential diagnosis of ID and aneurysm at the ICA–PComA junction.     

CT血管造影对脑动脉瘤的临床应用价值

目的 评价ＣＴ血管造影（ＣＡＴ）对脑动脉瘤的诊断价值。方法 脑动脉瘤,１９例行ＤＳＡ检查,１８例手术。用最大强度投影（ＭＩＰ）法进行血管重建。结果 ２０例患者中ＤＳＡ及手术发现２１个动脉瘤,ＣＴＡ发现０个。１９例为单发,１９例为单发,１例为多发（２个）,ＤＳＡ示位于基底动脉和左后交通动脉,ＣＴＡ未能显示后者动脉径为３～３３ｍｍ。１例有血管。靶重建、ＣＴＡ像与原始图像后交通动脉,ＣＴＡ像与原有显始图