低剂量CT扫描技术在右肾上腺静脉成像中的应用

目的 研究低剂量CT技术在右肾上腺静脉成像中的应用价值。方法 前瞻性收集天津医科大学第二医院2017年9月-2018年6月临床怀疑原发性醛固酮增多症需行肾上腺Ⅲ期增强CT检查的124例受检者,依排除标准排除4例,共计120例。按照随机数表法将受检者分为A、B、C 3组,每组40例。A组为常规剂量对照组,采用120 kV,自动毫安,按动脉期、静脉期、实质期又分为A₁、A₂、A₃组;B组为常规剂量试验组,采用120 kV,自动毫安,按动脉期、动脉晚期、静脉期分为B₁、B₂、B₃组;C组为低剂量试验组,第2期采用100 kV、150 mA,其余扫描参数及方法同B组,按动脉期、动脉晚期、静脉期分为C₁、C₂、C₃组。两名影像诊断医师分别对3组图像质量进行主观评分,测量不同扫描时期的右肾上腺静脉（RAV）、同层面临近右肾上腺（RAG）及前腹壁脂肪的CT值,记录剂量长度乘积（DLP）,计算和比较图像信号噪声比（SNR）、对比噪声比（CNR）及有效剂量（E）。结果 两观察者图像质量主观评分一致性好（Kappa值=0.63）;A₂、B₂、C₂ 3组图像中B₂组图像的主观评分差异有统计学意义（H=7.18,P<0.05）,组内比较仅B₂与A₂组主观评分差异有统计学意义（t=-18.03,P<0.05）;客观评价B₂组RAV的CT值、SNR、CNR均高于A₂组,差异有统计学意义（t=36.99、6.92、9.02,P<0.05）;C₁与C₂相比,E减少了45.52%,差异有统计学意义（t=12.19,P<0.05）。结论 使用100 kV 150 mA低管电压低管电流的对比增强多排螺旋CT（MDCT）扫描技术,在动脉晚期右肾上腺静脉检出率可达95%,并可在保证图像质量的基础上,降低约45.52%的有效剂量。     

Visualization of right adrenal vein: Comparison with three phase dynamic contrast-enhanced CT

PurposeTo evaluate the visualization of the right adrenal vein (RAV) on dynamic contrast-enhanced computed tomography (CT) images in patients with primary aldosteronism.Materials and methodsWe evaluated 27 consecutive patients with primary aldosteronism who underwent contrast-enhanced dynamic CT and subsequent adrenal venous sampling. Scan delays were 10-, 20- and 60-s after a bolus-tracking program detected that the threshold of a 100 Hounsfield units (HU) increase in the abdominal aorta had been achieved. RAV visualization for each phase was evaluated by two readers using a four-point scale. The Friedman and McNemar tests were employed to compare the confidence ratings and the RAV visualization rates between the three phase images.ResultsThe RAV visualization rates were 20.4%, 83.3%, and 63.0%, for the first, second, and third phase, respectively. The RAV visualization rates were 92.6%, 83.3%, 63.0%, and 92.6% for all three phases combined, the first and second phase image combined, the first and third phase image combined, and second and third phase image combined. The combined second and third phase images had the highest RAV visualization rates compared with all other image combinations (P < 0.0001).ConclusionRAV visualization was significantly improved by combining the second and third phase images.     

CT appearance of right gonadal vein

The CT appearance of the right gonadal vein was studied. It is usually first seen 1 cm below the bifurcation of the inferior vena cava (IVC) and empties into the IVC laterally or anterolaterally 4 cm below the union of the right renal vein and IVC. Occasionally, it empties into an accessory right renal vein rather than the IVC. The right gonadal vein was visualized partially or completely in 80% of patients, and generally measured less than or equal to 4 mm in maximum diameter. It was enlarged in a patient with portal hypertension and in a post-partum woman. Knowledge of its typical CT appearance should prevent confusion with abdominopelvic lymph nodes.     

Dynamic multidetector CT and non-contrast-enhanced MR for right adrenal vein imaging: comparison with catheter venography in adrenal venous sampling

Objectives

To evaluate visualization of the right adrenal vein (RAV) with multidetector CT and non-contrast-enhanced MR imaging in patients with primary aldosteronism.

Methods

A total of 125 patients (67 men) scheduled for adrenal venous sampling (AVS) were included. Dynamic 64-detector-row CT and balanced steady-state free precession-based non-contrast-enhanced 3-T MR imaging were performed. RAV visualization based on a four-point score was documented. Both anatomical location and variation on cross-sectional imaging were evaluated, and the findings were compared with catheter venography as the gold standard.

Results

The RAV was visualized in 93.2 % by CT and 84.8 % by MR imaging (p?=?0.02). Positive predictive values of RAV visualization were 100 % for CT and 95.2 % for MR imaging. Imaging score was significantly higher in CT than MR imaging (p?<?0.01). The RAV formed a common trunk with an accessory hepatic vein in 16 % of patients. The RAV orifice level on cross-sectional imaging was concordant with catheter venography within the range of 1/3 vertebral height in >70 % of subjects. Success rate of AVS was 99.2 %.

Conclusions

Dynamic CT is a reliable way to map the RAV prior to AVS. Non-contrast-enhanced MR imaging is an alternative when there is a risk of complication from contrast media or radiation exposure.

Key Points

? Dynamic CT and non-contrast-enhanced MR imaging detect the right adrenal vein (RAV). ? Dynamic CT can visualize the RAV more than non-contrast-enhanced MR imaging. ? Mapping the RAV helps to achieve successful adrenal venous sampling. ? Sixteen per cent of RAVs share the common trunk with accessory hepatic veins.

     

Ureteric obstruction by the right testicular vein: CT diagnosis

The close relationship of the ureter and gonadal blood vessels is often clearly demonstrated by computed tomography (CT). A case of ureteral obstruction in a man possibly caused by the crossing testicular vein is presented. Unlike the ovarian vein syndrome in women, which is often related to pregnancy and/or venous thrombosis, no predisposing factors were found.     

Ureteric obstruction by the right testicular vein: CT diagnosis.

The close relationship of the ureter and gonadal blood vessels is often clearly demonstrated by computed tomography (CT). A case of ureteral obstruction in a man possibly caused by the crossing testicular vein is presented. Unlike the ovarian vein syndrome in women, which is often related to pregnancy and/or venous thrombosis, no predisposing factors were found.     

CT象素矩阵图对鉴别肾上腺的腺瘤与恶性肿瘤的价值

目的：进一步探讨CT象素矩阵图对鉴别肾上腺腺瘤与恶性肿瘤的价值。方法：64例经临床、病理证实的肾上腺肿瘤共73个病灶,肿瘤的平扫平均CT值＞0HU。在CT平扫和增强图像上,分别应用CT象素矩阵图观察肿瘤内有无轻度负CT值区域。结果：在平扫和增强CT象素矩阵图上,分别有77％（24／31）和23％（6／26）的肾上腺腺瘤内见轻度负CT值区域,33例共42个恶性肿瘤病灶均未见此征象,特异性为100％。结论：分析CT象素矩阵图能发现病灶内最小CT值,对鉴别肾上腺的腺瘤与恶性肿瘤具有重要的价值。     

门静脉主干及右叶分支变异的CT诊断

目的:研究门静脉主干及右叶分支变异的发生率及类型.方法:本研究包括200例接受16层螺旋CT腹部增强检查的病例,两位医生观察其轴面图像,最大密度投影(MIP)和容积重建图像(VR),分析门静脉主干及右叶分支的类型.结果:64.5%患者门静脉主干解剖正常,9.5%患者门静脉主干分支成三叉,即门静脉左支、门静脉右前支、门静脉右后支,23.5%患者门静脉主干分成一个门静脉右后支和一个共干,后者发出门静脉左支和门静脉右前支.3例患者有多种变异.131例门静脉主干解剖正常患者中,22例患者(16.8%)右叶分支变异,最多变异是分成三叉,其次是第Ⅶ肝段门静脉起源于右侧主干近端.结论:门静脉主干变异很常见,门静脉右前支和门静脉左支共干较三分叉更常见,虽然少见,右叶分支变异也存在.     

CT demonstration of intrapulmonary right brachiocephalic vein associated with an azygos lobe

We describe a rare anomaly demonstrated by CT in which the right brachiocephalic vein follows an extramediastinal course in the anterior portion of the azygos fissure.     

Non invasive cardiac vein mapping: Role of multislice CT coronary angiography

Purpose

Coronary venous anatomy is of primary importance when implanting a cardiac resynchronization therapy device, besides, the coronary sinus can be differently enlarged depending on chronic heart failure. The aim of this study is to evaluate the usefulness of Coronary CTA in describing the coronary venous tree and in particular the coronary sinus and detecting main venous system variants.

Materials and methods

301 consecutive patients (196 ♂, mean age 63.74 years) studied for coronary artery disease with 64 slice Coronary CTA were retrospectively examined. The acquisition protocol was the standard acquisition one used for coronary artery evaluation but the cardiac venous system were visualized. The cardiac venous system was depicted using 3D, MPR, cMPR and MIP post-processing reconstructions on an off-line workstation. For each patient image quality, presence and caliber of the coronary sinus (CS), great cardiac vein (GCV), middle vein (MV), anterior interventricular vein (AIV), lateral cardiac vein (LCV), posterior cardiac vein (PCV), small cardiac vein (SCV) and presence of variant of the normal anatomy were examined and recorded.

Results

CS, GCV, MV and AIV were visualized in 100% of the cases. The LCV was visualized in 255/301 (84%) patients, the PCV in 248/301 (83%) patients and the SCV in 69/301 (23%) patients. Mean diameter of the CS was 8.7 mm in 276/301 (91.7%) patients without chronic heart failure and 9.93 mm in 25/301 (8.3%) patients with chronic heart failure.

Conclusions

Coronary CTA allows non invasive mapping of the cardiac venous system and may represent a useful presurgical tool for biventricular pacemaker devices implantation.     

Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling

PURPOSE: To examine whether the use of C-arm computed tomography (CT) during adrenal vein sampling improves the technical success rate of the procedure. MATERIALS AND METHODS: Nine consecutive patients with suspected primary hyperaldosteronism underwent standard adrenal vein sampling that included cortisol stimulation. The procedure was augmented with multiplanar C-arm CT images reconstructed from data acquired during a 180 degrees C-arm rotation. Whenever C-arm CT images showed the sampling catheter to be in the wrong position, the catheter was repositioned. Cortisol response was correlated to C-arm CT findings. RESULTS: All patients had successful and diagnostic adrenal vein sampling. C-arm CT showed sampling catheter malposition in two patients (22%). Repeat C-arm CT after repositioning showed proper catheter location. Cortisol stimulation results and C-arm CT findings were concordant in 100% of cases. CONCLUSIONS: C-arm CT is reliable in confirming the location of sampling catheters during adrenal vein sampling. If the 100% concordance between cortisol stimulation and C-arm CT findings is found in larger groups, the technical success rate may approach 100%. Cortisol stimulation may become obsolete and repeat procedures unnecessary, with significant time and cost savings.     

急性胰腺炎累及右侧肾上腺CT表现及其与胰腺外炎症评分的相关性

目的 :探讨急性胰腺炎(acute pancreatitis,AP)累及右侧肾上腺(right adrenal gland,RAG)的CT表现及其与胰腺外炎症(extrapancreatic inflammation on abdominal computed tomography,EPIC)评分的相关性。方法:回顾性分析95例行全腹CT扫描AP患者的资料,着重观察RAG改变,并计算出EPIC评分。结果:1EPIC评分0~3分36例,4~7分59例;2RAG受累16例,表现为局部边缘与胰周积液分界不清,可合并RAG密度降低、形态异常等;3AP累及RAG的CT表现与其EPIC评分有相关性(r=0.3587,P0.05)。结论:CT可充分显示AP累及RAG的情况;RAG的受累情况与AP的严重程度呈正相关。     

Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein

A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.     

单根4 F多功能导管经右上肢静脉行双侧肾上腺静脉采血

【摘要】 目的 探讨应用单根4 F多功能导管经右上肢静脉行双侧肾上腺静脉采血（AVS）的可行性。 方法 对63例确诊为原发性醛固酮增多症且需分型、定侧患者,经右上肢静脉插入4 F MPA1导管行右侧AVS和第1次下腔静脉（IVC）采血,然后拔出导管;接着在体外将导管头塑形呈直径6～7 cm类圆形,行左侧AVS和第2次IVC采血。每例患者右侧有1个采血点（共63个）,左侧有2个采血点（共126个）。在图像上标记对应采血序号,便于与检验值对比。采集完成后立即送检。结果 根据肾上腺静脉皮质醇和下腔皮质醇比值＞2为标准,左侧123个采血点比值达标,达标率为98%（123/126）。63例左侧2组数据中至少有1组数据有效,成功率达到100%;63例右侧数据中有2例不达标,成功率为97%（61/63）。双侧AVS成功率为97%（61/63）。手术过程顺利,术中无明显严重并发症发生。结论 单根4 F多功能导管经右上肢静脉行双侧AVS是简便、安全有效的采血方法。     

Overview of adrenal imaging/adrenal CT

CT is the imaging procedure of choice for the detection of most suspected adrenal masses. But except for some patients with acute adrenal hemorrhage or fat-containing myelolipoma, the precise histologic nature of an adrenal mass is not apparent from the CT image. MIBG radionuclide scanning is useful in some patients with pheochromocytoma, whereas bilateral adrenal venous sampling for hormone assay is necessary for correct lateralization in some patients with a small aldosterone-producing adenoma. The potential value of MR imaging in the characterization of adrenal masses, especially to distinguish benign adrenal cortical adenomas from metastatic disease, is now under investigation. Currently percutaneous aspiration biopsy is still necessary to make this distinction in patients with an adrenal mass and a known extraadrenal primary neoplasm.     

Overview of adrenal imaging/adrenal CT

CT is the imaging procedure of choice for the detection of most suspected adrenal masses. But except for some patients with acute adrenal hemorrhage or fat-containing myelolipoma, the precise histologic nature of an adrenal mass is not apparent from the CT image. MIBG radionuclide scanning is useful in some patients with pheochromocytoma, whereas bilateral adrenal venous sampling for hormone assay is necessary for correct lateralization in some patients with a small aldosterone-producing adenoma. The potential value of MR imaging in the characterization of adrenal masses, especially to distinguish benign adrenal cortical adenomas from metastatic disease, is now under investigation. Currently percutaneous aspiration biopsy is still necessary to make this distinction in patients with an adrenal mass and a known extra-adrenal primary neoplasm.     

CT导引下椎体穿刺活检

目的：评价ＣＴ导引下椎体穿刺活检对诊断的意义和价值。材料与方法：３６例椎体活检，包括颈椎２例、胸椎１１例、腰椎２１例和骶椎２例。活检时病人体位为俯卧位，穿刺针为Ａｃｋｅｒｍａｎｎ针，有时辅以抽吸针。结果：刺中率为１００％，正确率为８８．６％，假阴性为１１．４％。本组未出现并发症。结论：ＣＴ导引下椎体穿刺活检是一种简便、正确率高的诊断和鉴别诊断的有效方法。