含钆造影剂在DSA中的应用

含碘造影剂是目前常规Ｘ线血管造影和数字减影血管造影 (ＤＳＡ)最常用的造影剂 ,ＣＴ增强扫描和绝大多数介入治疗操作也都需要使用含碘造影剂。一般认为 ,含碘造影剂的安全系数较高 ,毒副反应发生率低 ,特别是在新型非离子型造影剂在临床应用以后 ,有关碘剂毒副反应的报道大大减少。尽管如此 ,使用含碘造影剂仍然存在一定风险 ,如最近报道 ,一般患者对离子型含碘造影剂过敏的发生率为 0 1%～ 0 2 % ,对非离子型含碘造影剂过敏的发生率为 0 16‰ ,其它毒副反应的发生率约 0 5‰～ 2‰ ;当患者存在肾功能不全的情况下 ,使用含碘造影剂做…     

二氧化碳在血管造影和介入治疗中的应用

已经证明二氧化碳数字减影血管造影是准确，安全适于临床应用的血管造影方法，并具有无肾中毒和过敏，对病人痛苦小的优点，本文回顾它的历史，理化技术和应用ＣＯ２－ＤＳＡ的病理重学改变及一些临床实验，还讨论了ＣＯ２在血管性介入治疗和其它成像中的应用，以及ＣＯ２－ＤＳＡ的优点与限度。     

髂总动脉造影在股骨头坏死介入治疗中的应用价值

目的探讨髂总动脉造影对股骨头缺血性坏死介入治疗的指导意义和应用价值。方法收集182例(216髋)患者,行选择性髂总动脉造影,根据影像确定股骨头供血动脉,行超选择性插管并经导管进行局部药物治疗,记录相关资料。结果全部髂总动脉造影显示清晰,股骨头以旋股内、臀下动脉、旋股外和闭孔动脉为优势供血动脉的分别为192髋、13髋、8髋、3髋,各占88.9%、6.0%、3.7%、1.4%。旋股内动脉发自股深动脉186髋,占86.1%;直接发自股动脉23髋,占10.6%;其他异位起源5髋,占2.3%;缺如2髋,占1.0%。旋股外动脉发自股深动脉211髋,占97.7%;起源于股动脉5髋,占2.3%。介入治疗总曝光时间一般不超过2 m in。结论髂总动脉造影有利于提高股骨头坏死介入治疗的效率、减轻血管损伤和辐射危害。     

血管跟踪摄影在下肢动脉造影中的应用

下肢动脉病变的术前诊断常需进行下肢动脉血管的DSA成像，影像诊断上也必须有完整的下肢动脉图像。由于照射野及影像增强器尺寸的限制，通常造影时只能对下肢进行分段逐次造影，造影图象质量虽然很好，但是病人接受的X线剂量和使用造影剂量明显增大，同时也增加了病人的痛苦，延长了造影时间。自我院PHILIPS V-5000数字减影机于1999年投入使用以来，我们应用其几种血管跟踪（Bolus Chase）模式进行6l例下肢动脉造影，效果非常好，下面就对此功能的实际应用进行探讨。     

经上肢动脉入路全脑血管造影及介入治疗的临床分析

目的 探讨经上肢动脉全脑血管造影的安全性及可行性.方法 经上肢动脉脑血管造影156例与同期经股动脉穿刺脑血管造影278例在手术成功率、并发症以及操作曝光时间比较,同时分析经肱动脉穿刺颅内支架成形术2例.结果 经上肢动脉穿刺成功率100%.经上肢动脉全脑血管造影成功率96.8%(151/156),低于经股动脉成功率99.2%(276/278),但两者比较无统计学差异(P>0.05).经上肢动脉造影术后并发症5.8%(9/156)低于经股动脉入路11.1%(31/278),两者比较无统计学差异(P>0.05);经上肢动脉造影平均曝光时间明显高于经股动脉造影曝光时间,两者有统计学意义(P<0.05),但在患者及操作医师可承受范围之内.经股动脉途径失败的2例颅内支架成形术经肱动脉途径成功.结论 经上肢动脉全脑血管造影及介入治疗安全、可行.     

动脉闭塞性疾患的血管造影表现及介入治疗

目的观察动脉闭塞性疾患介入治疗的疗效。方法本组17例患，男9例，女8例，年龄32～72岁。造影证实为动脉闭塞后，对其中的10例进行动脉溶栓治疗和／或PTA、置人支架。结果治疗有效8例，总有效率80％，对急性缺血有效率为83．3％，对慢性缺血有效率为75％。结论介入治疗动脉闭塞性疾患疗效好，安全可靠，损伤小。     

数字化影像在血管造影和介入放射学中的应用

目的：结合数字化Ｘ线机Ｐｏｌｙｓｔａｒ的使用体会，讨论数字化成像技术的应用价值。材料与方法：８５例患者完成单纯造影３８例，造影及介入治疗５２例，由３位医师评价全部血管造影所见、介入治疗及影像质量。结果：血管造影１５４支，最远解剖段血管分支获满意显示，肝内显示的最小病灶０．８ｃｍ×１．０ｃｍ，影像质量优良片８２例（９６．５％）。结论：数字化成像技术功能多且操作简便，可为临床提供充分信息并减少操作时间     

互动式造影剂追踪技术在下肢动脉造影中的应用

目的探讨互动式造影剂追踪技术在下肢动脉造影中的应用价值。方法对27例患者进行双侧或单侧互动式造影剂追踪下肢动脉造影,远端血管显示不佳的行超选择造影。结果27名患者共进行造影35例次,清晰显示病变29例次,良1例次,差5例次。结论互动式造影剂追踪技术能一次大范围显示下肢动脉形态、结构,缩短检查与治疗时间,降低患者辐射剂量。     

中国人膈下动脉血管造影解剖研究

目的 :观察国人膈下动脉 (IPA)的血管造影解剖。材料和方法 :对 168例患者进行了选择性IPA造影 ,其中男性116例、女 5 2例 ,年龄平均 5 2 .7岁。用手推或高压注射器注入非离子型造影剂 ,注入速度 2～ 3ml/s、总量 8～ 12ml。投照位置以正位为主 ,少数病例辅以斜位、侧位取像。结果 :做右侧IPA造影 162支 ,左侧 99支。左、右IPA以共干发自同一血管者占 42 .9% ;右侧IPA单独起源者占 5 9.3 % :发自腹主动脉占 3 7.0 % ,右肾动脉开口占 17.9% ;左侧IPA单独起源者占 18.2 % :发自腹腔动脉占 12 .1%、腹主动脉占 6.1%。 96.7%IPA开口位于胸 -12 ～腰 -1椎体水平。结论 :IPA起源、开口位置及分支走行等 ,对介入治疗医师具有重要参考价值。     

Gadopentetate dimeglumine as a contrast agent in common carotid arteriography

BACKGROUND AND PURPOSE: Despite improvements in noninvasive imaging, some patients with contraindications to iodine-based contrast material still require angiography for the evaluation of carotid stenosis. Our aim was to assess the utility of gadopentetate dimeglumine as an intraarterial contrast agent in common carotid angiography. METHODS: Twelve patients with suspected carotid artery stenosis were enrolled in the study. In addition to the standard injection sequences with iohexol, common carotid arteriograms were obtained after administration of gadopentetate dimeglumine. Neurologic status and vital signs were monitored during and for 6 hours after the examination. For each injection, five independent observers, blinded to the contrast agent used, measured the percentage of carotid stenosis and assessed their confidence in grading the stenosis, the overall quality of the examination, and, in cases of decreased quality, the reason(s) for it. Statistical analysis was done with paired and unpaired t-tests with equal variances. RESULTS: No patient had an adverse clinical outcome, and measurements of carotid artery stenosis showed no statistically significant differences between the gadopentetate dimeglumine and iohexol examinations. Overall image quality and observer confidence in measurements of stenosis on the gadolinium-based studies were slightly but significantly lower than those of identical iodine-based studies. CONCLUSION: Gadopentetate dimeglumine may be an alternative to iodine in selected patients undergoing carotid angiography. Although overall image quality of the gadolinium studies is slightly inferior to that of the iohexol studies, measurements of carotid artery stenosis are similar for the two examinations.     

Gadopentetate dimeglumine as a bowel contrast agent: safety and efficacy

To determine the safety and efficacy of gadopentetate dimeglumine as a bowel contrast agent, magnetic resonance (MR) imaging (0.5 T) was performed with a formulation of gadopentetate dimeglumine (1.0 mmol/L of gadopentetate dimeglumine, 15 g/L of mannitol, 6-17 mL/kg) in 133 patients with intraabdominal mass lesions. Mostly short-lived gastrointestinal side effects were noted in 32% of patients. Gadopentetate dimeglumine provided uniform hyperintense marking of the bowel and contrast enhancement in the region of interest in 81% of patients. Among 78 patients with images obtained both before and after administration of contrast material, post-contrast improvement of lesion delineation was found in 62%. Among 55 patients with only postcontrast images, gadopentetate dimeglumine proved useful in 65%. Intravenous injection of scopolamine or glucagon effectively eliminated "ghost" images of the opacified bowel in 105 of 109 cases. The authors conclude that gadopentetate dimeglumine is a safe and effective bowel contrast agent for MR imaging.     

Arterial angiography in high-kilovoltage technique with gadolinium as the contrast agent: first clinical experience

Iodine-containing contrast agents are currently used for angiography. However, due to the relatively low atomic number of iodine, imaging must be performed with a relatively low tube voltage. Gadolinium has been used for several years as a contrast agent in MRI with low adverse side effects. This substance has a higher atomic number as compared with iodine. We investigated whether the use of a gadolinium-containing contrast agent with a higher tube voltage reduces the radiation exposure in angiography, and how the image quality compares with the previous technique. A total of 15 patients were examined with either a survey angiography or a selective angiography. In all patients angiography was performed with an iodine-containing contrast agent with a tube voltage of 75 kV. Then gadolinium-containing contrast agent was administered immediately with a tube voltage of 110 kV. Radiation exposure and image quality were compared. On average, a dose reduction factor of 3.57 times was achieved by using 110 instead of 75 kV. However, the image quality was poorer in the majority of cases as compared with the images taken with iodine as a contrast agent and a tube voltage of 75 kV. The poorer image quality is caused by the relative low concentration (0.5) m of the used gadolinium solution. A 1 m solution is currently tested for market approval and would probably solve this problem. Correspondence to: F. Fobbe     

Gadopentetate dimeglumine: a possible alternative contrast agent for CT angiography of the aorta

We report the use of a gadolinium chelate for limited CT angiography of the aorta in a patient in whom iodinated contrast agent was contraindicated and who had undergone nondiagnostic MRI.     

Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography

The aim of this study was to evaluate gadolinium diethylenetriaminepenta-acetic acid (Gd-DTPA) as an alternative contrast agent for digital subtraction angiography (DSA) in patients with renal insufficiency or previous anaphylactic reaction to iodinated contrast agents. We performed 34 DSAs in 31 patients by use of the commercially available 0.5-M Gd-DTPA solution (Magnevist, Schering, Berlin, Germany). The contrast material was power- or hand-injected at the same rate as iodinated contrast material, without exceeding a total amount of 0.4 mmol/kg body weight. In 18 studies Gd-DTPA was the sole contrast agent. In 9 cases gadolinium injections were combined with carbon dioxide. Restricted non-ionic contrast medium injections were administered to complete the examinations in 7 cases and for comparative purposes in 1 case. Cerebral and carotid arteries, one superior limb, abdominal aorta, renal arteries, renal transplants, iliac arteries and inferior limbs were imaged, and ten endovascular interventional procedures, including three transjugular intrahepatic percutaneous stent shunts, were performed. No side effects were observed. Diagnostic angiographic images were obtained in all cases except in 5 of the 8 distal run-off studies. Gadolinium-based contrast can produce clinically useful angiograms in patients with a contra-indication to iodine who must undergo angiography. Received: 15 April 1998; Revision received: 2 July 1998; Accepted: 25 July 1998     

肾癌伴腔静脉癌栓的双途径血管造影诊断与介入治疗

目的评价经肾动脉和下腔静脉双途径对肾癌伴下腔静脉癌栓的诊断与介入治疗的价值。方法在２８例肾癌血管造影与介入治疗材料中，分成以介入治疗为主组１６例，和以介入性术前化疗栓塞为辅组１２例两组，重点对以介入治疗为主的１６例中６例提示伴腔静脉癌栓的患者进行分析。结果经肾动脉途径对肾癌伴腔静脉癌栓的显示率在２８例中仅检出１例，占４％，腔静脉造影对其癌栓的显示则明显提高。１６例介入治疗组的１年和２年生存率分别为８１％与３１％。结论经肾动脉和腔静脉双途径血管造影对肾癌特别是伴腔静脉癌栓的术前诊断具有重要意义。腔静脉内的溶栓化疗是此类病例重要的姑息治疗手段     

穿膜肽标记异硫氰酸荧光素及钆喷替酸葡甲胺行MR分子显像的探讨

目的选择穿膜肽的基本序列之一，构建目的多肽序列标记异硫氰酸荧光素（FITC）及钆喷替酸葡甲胺（Gd-DTPA），探讨穿膜肽携带FITC及Gd-DTPA跨膜转运性能及MR分子显像的价值。方法在穿膜肽9聚精氨酸[arginine]基础上，构建新目的多肽序列CPP13：LAGRRRRRRRRRK，固相合成多肽后标记FITC（记为CPP13-FITC）和Gd-DTPA（记为CPP13-DTPA-Gd）；分别取CPP13-FITC和FITC溶于无血清Dulbecco最低必须培养液（DMEM）培养基中，待HEPG2细胞及鼠骨髓干细胞爬片上生长至80％-90％汇合时，取2只30mm^2皿，弃去培养皿中培养液，一皿中加入CPP13-FITC／DMEM溶液，另一皿中加入FITC／DMEM溶液，37℃CO2孵箱中抚育10、30、60min时依次取出1片，磷酸平衡盐溶液（PBS）冲洗爬片后置于倒置荧光显微镜上观察细胞内出现荧光素分布的时间和部位。CPP13-DTPA-Gd作用肝癌细胞株HEPG2后，MRI研究CPP13-DTPA-Gd在细胞内转运性能及MRI的特点，将CPP13-DTPA-Gd溶于无血清DMEM培养基中，浓度为3mg／ml。待HEPG，细胞在100mm。培养皿中长至80％-90％汇合时，取3只皿分别加入CPP13-DTPA-Gd的DMEM溶液、DTPA-Gd／DMEM溶液和DMEM溶液，孵育30min后弃去培养液，以0．1MPBS反复冲洗，胰酶消化，加入2m 1l％琼脂糖／PBS溶液混匀，装入2ml离心管中，将3管固定于装有150ml 1％琼脂糖／PBS溶液的微量加样枪头盒中，待凝固后测定MR信号。结果固相合成多肽成功，测定分子量为1792．78，与理论值接近。纯度达到95％以上；标记荧光素后，倒置荧光显微镜观察细胞摄取显示10min时肝癌细胞株HEPG2和鼠骨髓干细胞胞质与细胞核内均出现荧光分布；CPP13标记的Gd-DTPA，作用细胞30min后MRI显示CPP13-DTPA-Gd作用HEPG2细胞组呈短TI、短T2信号。3层面内3组细胞感兴趣区T1信号强度（Ii）与琼脂糖T1信号强度（Io）的比值及统计学分析如下：（1）号管3层面内Iil／Io（为CPP—DTPA-Gd作用cell组管内信号值与管外烧杯内琼脂糖背景信号值的比值）分别为：2．84、2．60、2．48；（2）号管3层面内Ii2／Io（为Gd-DTPA作用cell组管内信号值与管外烧杯内琼脂糖背景信号值的比值）分别为1．15、1．11、1．12；（3）号管3层面内Ii3／Io（为空白cell对照组管内信号值与管外烧杯内琼脂糖背景信号值的比值）分别为1．13、1．11、1．11。两两组间F检验：（1）与（2）：F（I．2）=201．88（P〈0．001）；（1）与（3）：F（1．3）=206．37（P〈0．001）；（2）与（3）：F（2．3）=0．529（P=0．507）。说明T1WI信号强度与Gd-DTPA作用组及与单纯细胞组信号强度比较差异有统计学意义；HEPG2细胞不摄取Gd-DTPA，30min时信号强度与单纯细胞组信号强度间差异无统计学意义。结论在穿膜肽基本序列基础上成功地重新构建的多肽能够携带荧光素和MR对比剂，并有效地跨膜转运进入细胞，为MR分子显像提供了1种新的重要手段。     

双重介入治疗小肝癌的临床研究

目的 :评价综合应用化疗栓塞和瘤内无水酒精注射术治疗小肝癌的临床效果。方法 :2 4例患者 ,其中原发性肝癌 2 3例 (包括外科手术后复发性肝癌 3例 ) ,转移性肝癌 1例 ,瘤体平均大小为 4.1cm× 3 .7cm。先行超选择性肝动脉内化疗栓塞 ,术后 1周内再于瘤体内注射无水酒精。间隔 3～ 4周重复上述治疗 ,每例行综合介入治疗 2～ 3次。结果 :2 4例患者中 2 0例病变区有明显碘油沉积 ,综合介入治疗后无严重并发症发生。随访 8～ 2 6个月无死亡病例 ,瘤体明显缩小者 2 1例 (占 87.0 % ) ,16/17例患者AFP降低明显 ,14例经 2～ 3次介入治疗后病灶稳定。 3例介入治疗后手术病理切片示肿瘤组织基本坏死 ,瘤体周围包膜形成。结论 :综合应用化疗栓塞术和瘤内无水酒精注射术是治疗小肝癌安全有效的方法