上矢状窦栓塞大脑髓静脉改变的SWI研究

目的:利用磁敏感加权成像(SWI)技术探讨上矢状窦栓塞后大脑髓静脉的改变。方法:对10例上矢状窦栓塞患者和年龄、性别相匹配的10例健康志愿者行常规MRI、MRV和SWI,应用计算机后处理软件对SWI图像进行处理,得到校正后的磁矩图和相位图,将大脑髓静脉增多扩张脑白质区作为病变组、其对侧镜像正常脑白质区为对照组1,健康志愿者与病变组相同位置脑白质区为对照组2,分别测量相位值,进行比较,统计学分析采用单因素方差分析。结果:病变组选择髓静脉增多扩张脑白质区37处测得相位值为-0.571～0.104,平均-0.051;对照组1相位值为-0.047～0.079,平均0.010;对照组2相位值为-0.045～0.056,平均0.014;病变组相位值低于对照组1和对照组2,差异有统计学意义(P<0.001);对照组1和对照组2相比,二者无显著差异(P=0.790)。结论:磁敏感加权成像(SWI)能明显显示上矢状窦栓塞患者大脑髓静脉的增多、扩张,并可利用相位信息为其提供量化依据。     

小脑上动脉解剖变异的DSA研究

目的：研究数字减影血管造影（DSA）下小脑上动脉的解剖变异。方法：回顾分析我院从2007年8月~2008年12月的137份,常规脑血管造影的DSA片。结果：本组病例SCA重复变异发生率右侧为4.4%,左侧为5.8%,双侧重复变异为0.7%。小脑上动脉起源于大脑后动脉发生率右侧为2.2%,左侧为1.5%,双侧为0.7%。小脑上动脉提前分岔发生率右侧为1.5%,双侧为0.7%。结论：DSA了解小脑上动脉的解剖变异对指导脑血管疾病的介入治疗以及神经外科临床具有重要的意义。     

三维数字减影血管造影技术诊断脑血管疾病的应用价值

目的评价三维数字减影血管造影(3D—DSA)技术诊断脑血管疾病的应用价值。方法对临床怀疑和确诊为脑血管疾病的71例患者行常规脑血管数字减影造影(DSA)和3D—DSA。结果本组共检查71例,经3D—DSA技术共检出动脉瘤44例64枚、颅内动静脉畸形(AVM)19例、血管狭窄致脑缺血8例(6例颈内动脉狭窄、大脑前动脉闭塞)。结论3D—DSA诊断脑血管疾病具有极大的临床应用价值。尤其对颅内动脉瘤、AVM、血管狭窄的诊断最为准确、快速、安全。     

Intra-venous digital subtraction angiography: an alternative method to intra-arterial digital subtraction angiography for experimental aneurysm imaging

Conventional intra-arterial digital subtraction angiography (IADSA), which necessitates surgical exposure and ligation of the femoral artery, is an invasive and expensive method of evaluation for experimental elastase-induced aneurysms in rabbits. The purpose of this study was to examine and validate intra-venous digital subtraction angiography (IVDSA) as an alternative to IADSA by comparing their diagnostic accuracies. We performed both IVDSA and IADSA for 24 elastase-induced saccular aneurysms in a rabbit model, 1 month following creation. Aneurysm sizes (neck, width and height) from both the IVDSA and IADSA procedures were evaluated and measured. Comparison of the aneurysm sizes between IVDSA and IADSA were performed with the Wilcoxon paired signed-rank test. All the aneurysms were seen clearly in both the IVDSA and IADSA techniques. Mean sizes of the IVDSA aneurysm neck, width and height were 3.41±0.80 mm, 3.61±0.93 mm and 8.07±2.11 mm, respectively. Mean sizes of the IADSA aneurysm neck, width and height were 3.43±0.80 mm, 3.66±0.92 mm and 8.16±2.25 mm, respectively. No significant difference was found in the sizes of the aneurysm neck, width and height between the two groups (P=0.311, P=0.086 and P=0.258, respectively). IVDSA appears to be an alternative method for evaluating elastase-induced aneurysms in rabbits.     

Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage

Objective

Subarachnoid hemorrhage (SAH), which can cause mortality and severe morbidity, is a serious condition whose underlying cause must be determined. We aimed to compare 2D digital subtraction angiography (2DDSA), rotational angiography (RA) and 3D volume rendering digital subtraction angiography (3DVRDSA) for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage.

Materials and methods

After an initial diagnosis of SAH with computed tomography, 122 patients (52 males and 70 females with a mean age of 47.77 ± 12.81 ranging between 20 and 83 years) underwent 2DDSA imaging, RA and 3DVRDSA imaging for detection of aneurysms. The location of the aneurysm, the best working angles, the dome/neck ratios, the largest diameter of the aneurysm, the shape of the aneurysm, the presence of spasms or pseudostenoses, and the relationship to the neighboring arteries were recorded.

Results

2DDSA missed 15.6% of the aneurysms that had a mean size of 2.79 ± 0.74 mm. RA was superior to 2DDSA for detecting aneurysm neck, and 3DVRDSA was superior to RA for detecting aneurysm neck. 3DVRDSA conclusively depicted the shape of the aneurysms in all patients. 3DVRDSA imaging was superior to 2DDSA and RA in the detection of the aneurysm relationship to neighboring arteries. The sensitivity and specificity of 3DVRDSA imaging for the detection of vasospasms were 100 and 84%, respectively.

Conclusions

3DVRDSA imaging is superior to 2DDSA and RA for detecting intracranial aneurysms and their morphological properties, especially those of small, ruptured aneurysms. However, 2DDSA should not be neglected in cases of vasospasm.     

Dural arteriovenous fistula involving the transverse sigmoid sinus after treatment: assessment with magnetic resonance digital subtraction angiography

Introduction The purpose of this study was to evaluate the utility of magnetic resonance digital subtraction angiography (MRDSA) in showing the presence or absence of retrograde venous drainage (RVD) in patients with intracranial dural arteriovenous fistula (DAVF) involving the transverse sigmoid sinus (TSS) after treatment. Methods Of 16 patients with DAVF involving the TSS, 13 underwent digital subtraction angiography (DSA) and MRDSA before and after treatment, and 3 underwent DSA before treatment and DSA and MRDSA after treatment. Five patients underwent these procedures twice after treatment. A total of 21 examinations after treatment were evaluated retrospectively. The presence or absence of DAVF and RVD was decided on the basis of the DSA findings. Two neuroradiologists reviewed the MRDSA findings concerning the presence or absence of DAVF and RVD. Results DSA showed residual DAVF in 9 and residual RVD in 5 of 21 examinations. MRDSA revealed residual DAVF in 8 of 21 examinations. MRDSA did not show residual DAVF in one examination because of a very small (low-flow) residual DAVF without RVD. MRDSA identified residual RVD in 5 of 21 examinations. MRDSA was completely consistent with DSA concerning the presence or absence of residual RVD. Conclusion MRDSA could evaluate the presence or absence of RVD in patients with DAVF involving TSS after treatment. MRDSA may give reliable information as to whether patients with DAVF involving the TSS should undergo additional DSA after treatment.     

64层螺旋CT低能量同步减影脑血管成像研究

目的:探讨64层螺旋CT低能量同步减影(CT low-energy synchronous digital subtraction angiography,CTLESDSA)脑血管成像方法及价值。方法:对拟诊脑血管疾病患者共89例,按能量随机分为A组(高能量)31例,B组(低能量)58例,全部行64层螺旋CT平扫、增强动脉期和静脉期扫描获得未减影数据,测量颈内动脉和颈内静脉密度。将动、静脉期数据减去平扫数据获得减影动脉期及减影混合动静脉期数据,静脉期数据减去动脉期数据获得减影静脉期数据。采用容积再现(VR)、薄层最大密度投影(TSMIP)重组动脉、混合动静脉及静脉图像。根据血管图像质量从好、一般到差分为Ⅰ、Ⅱ、Ⅲ级。结果:①A、B组动脉期或静脉期血管密度比较,B组动、静脉密度均较A组明显高(P0.05);组内比较,动脉期动脉较静脉密度明显高(P0.05),静脉期动、静脉密度均高且相似(P0.05);②A、B组间比较,B组血管图像质量较A组好,差异有统计学意义(P0.05)。减影图像与未减影图像相比去除了动脉、静脉相互的及颅骨的干扰,对脑血管解剖结构及病变显示清楚、直观。结论:64层螺旋CT同步减影脑血管成像是一种安全、可靠的技术,以低能量组脑血管密度更高,图像质量更好、更稳定,值得临床推广应用。     

旋转式三维数字减影血管造影在脑动脉瘤临床诊断和治疗中的应用价值

目的：探讨旋转式三维数字减影血管造影在脑动脉瘤诊断和治疗中的应用价值，提高诊断水平，增强治疗效果。方法：回顾性分析了213例脑动脉瘤患者的二维、三维数字减影脑血管造影的影像学资料，并对其结果进行了对比分析。结果：213例患者中共检出222枚脑动脉瘤，其中囊性动脉瘤197枚，梭形动脉瘤16枚，夹层动脉瘤9枚；在222枚脑动脉瘤中，小型动脉瘤105枚，中型动脉瘤89枚，大型动脉瘤22枚，巨大型动脉瘤6枚。常规DSA清楚显示的有205枚，17枚显示可疑由三维数字减影脑血管造影进一步证实；对138例脑动脉瘤患者进行手术开颅银夹夹闭治疗，19例进行介入性金属微弹簧圈栓塞治疗。结论：旋转式三维脑血管造影可有效提高脑动脉瘤的诊断准确性和多种治疗方法的安全十牛及疗效。     

Evaluation of the carotid artery bifurcation: comparison of magnetic resonance angiography and digital subtraction arch aortography

Summary Thirty-four carotid artery bifurcations were examined using both magnetic resonance angiography (MRA) and digital subtraction arch aortography to determine their accuracy when compared to selective carotid angiography. The sensitivity of MRA was 73% and its specificity was 91% when compared with selective carotid angiography. The sensitivity of arch aortography was 27% and its specificity was 100%.     

磁敏感加权成像和三维对比增强MR静脉成像对上矢状窦旁桥静脉的显示及比较

目的 比较磁敏感加权成像( SWI)和三维对比增强MR静脉成像(3D-CE MRV)技术 对上矢状窦旁桥静脉的显示能力,为神经外科手术的术前影像学检查提供依据.方法 20例(40侧)健康成人受检者分别行矢状面3D-CE MRV和横轴面SWI检查.3D-CE MRV的原始图像行MIP,SWI原始图像行MinIP及MPR处...     

Postpartum superior sagittal,left transverse sinus and right internal jugular vein thrombosis with left parietal infarct: A case report

Cerebral venous sinus thrombosis is a rarely occurring condition. Pregnancy and postpartum are both known risk factors for cerebral venous sinus thrombosis. Early detection and treatment are critical, as CVST can be potentially life-threatening. Here, we present a case of a patient who developed left transverse and superior sagittal sinus thrombosis 15 days after normal vaginal delivery. The patient presented to the emergency department with complaints of irritability and an altered state of consciousness for two days. The patient also developed seizures extending from the lower limb to the upper body. Laboratory investigations revealed abnormalities in the complete blood count report and urine complete examination. The patient''s coagulation profile was totally abnormal, indicating a presence of a thrombus. All the other diagnostic techniques, including Electrocardiogram, Carotid Doppler Scan, and Ultrasound abdomen, revealed no findings. However, Magnetic resonance venography + Magnetic resonance imaging showed partial superior sagittal sinus thrombosis in the anterior and upper parietal regions, right internal jugular vein thrombosis, and left transverse thrombosis with associated left parietal infarcts. The presence of thrombosis in sinuses and jugular vein resulted in seizures, altered state of consciousness, and other associated symptoms. The patient was treated with sodium valproate, heparin, and other medications accordingly. The above-mentioned case was unique due to the involvement of unusual sinuses (transverse sinus) as previous studies have only reported cases of thrombus presence in the superior sagittal sinus. This case study will discuss patient diagnosis and management with Heparin and Diazepam to stop altered state of consciousness and seizures in females.     

侧位脑血管数字图像反向转动配准减影的初步研究

目的 探讨将侧位脑血管数字图像进行反向转动后配准减影的可行性及其价值.方法 (1)实验研究:在笔者用Visual Basic编写的旋转配准减影软件中对试验靶片直接进行减影处理和将靶片旋转角度后再进行减影处理.观察软件的自动旋转角度探测功能是否探测出直线旋转的角度以及减影功能是否正常.(2)患者图像回顾性研究:将15例在侧位脑血管成像过程中靶血管围绕冠状轴发生了转动的图像读入软件.对同一组蒙靶片分别进行传统的配准减影和先反转一定角度后再进行传统配准减影处理.(3)评价:由4名相关专业的高级职称医师一起对这两组图像进行对比读片.结果 (1)软件配备的自动旋转角度探测功能提示靶片应逆时针方向旋转1.3..软件减影结果正确.(2)在回顾性研究中,用传统减影方法获得较清晰图像3例,在经反转配准减影处理后,伪影明显减少,图像更加清晰;经传统配准减影后有明显伪影的图像10例,在经反转配准减影处理后,获得清晰图像,末梢的血管影像也得以显示;经传统配准减影后无法辨认的图像2例,经过反转配准减影后达到诊断要求.(3)评价结果:反转配准减影的噪声控制和血管细节显示能力都优于传统配准方法;图像没有变形失真;图像清晰度稍有下降.结论 反向转动配准减影技术能明显提高侧位脑血管数字减影图像的质量.     

Prevalence of venous sinus stenosis in Pseudotumor cerebri (PTC) using digital subtraction angiography (DSA)

Objectives

To study the prevalence of intracranial venous stenosis in Pseudotumor cerebri patients.

Patients and methods

Thirty patients were diagnosed having PTC according to Dandy criteria. All underwent general and neurological assessment. Radiological assessment included CT scan brain ±MRI brain without contrast, MRV. All underwent digital subtraction angiography (DSA) (venous phase) to confirm the validity of filling gaps seen at the level of MRV.

Results

MRV brain showed that 24 patients (80%) showed filling gaps. Digital subtraction cerebral angiography (venous phase) showed 9 patients (30%) had stenosis in their dural sinuses. MRV showed to be a good screening tool since it had 100% sensitivity and negative predictive value. However, since it has a moderate specificity (62%) with a positive predictive value (PPV) of only 35%, then lesions detected should be confirmed with digital subtraction cerebral angiography (venous phase) particularly those involving the transverse and sigmoid sinus.

Conclusion

Studying the intracranial venous system in patients with PTC is an important step in understanding the pathophysiology of the disease. Detection of venous sinus stenosis opens the way to a novel therapeutic option for refractory patients like venous sinus stenting.     

64层螺旋CT与数字减影血管造影对颅内动脉瘤诊断的比较

目的 通过64层螺旋CT的CT血管造影(CTA)及CT数字减影血管造影(CTDSA)技术与数字减影血管造影(DSA)的比较研究,评价64层螺旋CT在颅内动脉瘤诊断中的临床应用价值。方法 26例临床怀疑颅内动脉瘤的患者实施64层CT和DSA检查,对64层CT图像进行了CTA和DSCTA两种方式的后处理。CTA后处理技术包括容积再现(VR),最大密度投影(MIP)和多平面重建(MPR),在CTA图像基础上用增强数据逐层减去平扫数据,自动去除骨与脑组织,获得CTDSA影像。比较3种技术(DSA、CTA和CTDSA)的特征。结果 26例可疑患者中,DSA和CTDSA发现31个动脉瘤,CTA发现29个动脉瘤。CTA漏掉的2个动脉瘤,直径小于3mm。结论 CTDSA是检查颅内动脉瘤的高度敏感的影像学方法,具有与DSA相当的价值。     

脑血管造影和介入治疗过程中脑动脉痉挛的发生和治疗

目的探索脑血管造影和介入治疗过程中脑血管痉挛(CVS)的发生、表现和治疗效果。方法400例患者经股动脉穿刺对双侧颈内动脉、椎动脉等行数字减影血管造影检查共470例次,其中,52例在造影后接受了介入治疗。造影剂为含碘300mg/mL的非离子型造影剂。对造影和治疗过程中出现重度CVS者经导管注入0.3%罂粟碱10mL解痉。结果造影和介入治疗过程中CVS的发生率为17.7%(83/470),其表现为颈动脉管壁不光整,呈波浪状14例(16.9%),颈动脉管腔轻度变窄36例(43.4%),中度25例(30.1%),重度6例(7.2%),颈内动脉不显影2例(2.4%)。轻至中度CVS未作特殊治疗,无不良反应或后遗症发生;8例重度痉挛者经导管注入罂粟碱后6例明显缓解,1例遗留后遗症,1例病死。结论脑血管造影和介入治疗过程中CVS的发生率不容忽视,造影剂的高渗刺激、导管导丝机械性刺激和血管内压力改变是CVS的高危因素,动脉内注入罂粟碱有良好的解痉作用。     

肝动脉解剖及变异的DSA分析(附300例报告)

目的:进一步探讨肝动脉解剖及变异的种类和发生率.方法:回顾分析300例肝癌患者的肝动脉DSA表现.观察肝总动脉、肝固有动脉、肝右动脉、肝中动脉、肝左动脉的起源走行、分布情况.并分别统计其发生率.结果:300例肝动脉造影中,正常型(Michels Ⅰ型)207例,占 69.0%.变异的肝动脉 93例,占 31.0%,其中肝动脉分支变异26例,占8.7%,起源变异67例,占22.3%. 93例变异的肝动脉中属于Michels已有分型的44例,占14.7%;属于Michels未分类的49例,占16.3%,其中多种变异共存10例,占3.3%.结论:肝动脉总的变异率与国外学者报道的基本一致,但变异的种类具有多样性、复杂性.全面了解这些特点对肝脏血管内介入、肝脏外科手术和肝脏疾病的CTA 和 MRA检查有重要临床意义.     

Follow-up of intracranial aneurysms treated with detachable coils: comparison of plain radiographs, 3D time-of-flight MRA and digital subtraction angiography

All patients with aneurysms treated with Guglielmi detachable coils (GDC) are undergo angiography to assess long-term stability of aneurysm exclusion or to show recurrence of the aneurysm sac, which may require further treatment. We prospectively compared the plain-film appearance of the coil-mass, 3D time-of-flight MR angiography (TOF MRA) and digital subtraction angiography (DSA) for the detection of aneurysm recanalisation during follow-up. We studied 60 patients with 74 intracranial aneurysms treated with Guglielmi detachable coils. We used the unsubtracted image of the angiograms performed at the completion of any embolisation procedure and at follow-up as the plain radiographs. Recanalisation was considered if loosening, compaction or reorientation of the coil mass was apparent. TOF MRA was performed to assess the presence and size of a neck remnant. DSA was regarded as the definitive investigation. Comparison of the techniques showed good agreement as regards aneurysm recanalisation. MRA was more accurate than plain radiography and could replace DSA for long term follow- up. The initial follow-up examination should, however, include both modalities. In cases of contraindications or limitations to MRA, the interval between follow-up angiographic examinations could be increased if there is no change in the plain-film coil-mass appearances.     

Intravenous digital subtraction angiography of the thoracic and abdominal aorta

Intravenous digital subtraction angiography (IV DSA) is a new imaging modality that utilizes techniques of video image acquisition and computer image manipulation to provide anatomic information about blood vessels and organs. In many ways, it represents an electronic version of classic intravenous and film-subtraction angiography. As a means of imaging the thoracic and abdominal aorta, IV DSA has demonstrated great potential, particularly in vessels originally imaged by the former techniques. We have imaged the aorta in over 300 cases at Brigham and Women's Hospital, either alone, or in combination with other vessels in the course of work-up for vascular disease. Although experience has been limited, intravenous imaging of the aorta can be routinely performed, providing reliable and clinically significant information. Supported in part by CV Training Grant 201-HL20895-06     

Carbon dioxide (CO2) digital subtraction angiography: 26-year experience at the University of Florida

Although the vascular system is presently being imaged by multiple high technology modalities, contrast angiography continues to be the gold standard; however, severe complications rarely occur. During the last 25 years (in over 1400 patients), CO₂ has proven to be extremely safe (no allergy or renal failure). However, it is imperative to understand CO₂'s physical properties and potential dangers. Recently, CO₂ is being routinely utilized not only because of safety, but for detection of minute amounts of bleeding, better collateral filling, and for most interventional procedures since unlimited volumes of CO₂ can be injected between the catheter and guidewire. Presently, safe, reliable and “user-friendly” delivery systems are now commercially available. CO₂ DSA images are now nearly comparable to iodinated contrast, and improvement in DSA images are evolving, including “stacking” software. Received 10 July 1997; Revision received 9 September 1997; Accepted 15 September 1997     

Multidetector row CT angiography of the lower limb arteries: a prospective comparison of volume-rendered techniques and intra-arterial digital subtraction angiography

AIM: To assess whether multi-detector CT angiograms (MDCTA) of the lower limb arteries, compared with conventional digital subtraction angiograms (DSA), could replace invasive arteriography in patients with symptomatic peripheral arterial disease. MATERIALS AND METHODS: In a prospective comparative analysis of MDCTA and DSA in 44 patients, MDCTA was analyzed using volume-rendered images acquired at a workstation and viewed in tandem with the original axial data. Designated arterial segments were graded according to their degree of stenosis. RESULTS: We found agreement for the degree of stenosis in 88.8% and 85.4% of 1024 segments analysed for two observers. The sensitivity for treatable lesions (>50% stenosis) was 79.1% and 72% with a specificity of 93.3% and 92.6%. DSA failed to visualize 7.3% of segments that were visible with MDCTA. These segments were exclusively downstream to long segment occlusions. CONCLUSION: MDCTA using 4-slice machines is insensitive to detecting significant arterial stenoses in the lower limb arteries. MDCTA is superior to DSA in its visualization of arterial territories downstream to significant occlusive disease.