肺动静脉畸形影像学诊断

目的：评价各种成像技术（传统Ｘ线检查、核素显像、ＣＴ、血管造影）诊断ＰＡＶＭ的价值，提高对ＰＡＶＭ的认识。材料和方法：回顾性分析了１２例经手术／血管造影证实ＰＡＶＭ影像学资料。结果：胸部传统Ｘ线检查１２例，８例提示ＰＡＶＭ；肺灌注核素显像６例，均提示胸内右向左分流；ＣＴ检查５例，诊断ＰＡＶＭ３例；血管造影１２例，均确诊为ＰＡＶＭ。结论：临床上除外心脏疾患引起的缺氧症状，胸部Ｘ线检查显示单发或多发结节影，透视大小及形态能改变，存在异常引流血管影者应高度怀疑ＰＡＶＭ。肺灌注核素显像具有筛查作用，ＣＴ扫描对诊断有一定的帮助，血管造影具有确诊价值。     

蛛网膜下腔出血的CT与临床（附94例分析）

本文分析７４例经腰穿证实的自发性蛛网膜下腔出血（ＳＡＨ）及２０例经ＣＴ检查为外伤性ＳＡＨ的ＣＴ和临床表现。着重探讨了自发性ＳＡＨ的病因诊断，笔者认为常见原因是颅内动脉瘤、脑动静脉畸形（ＡＶＭ）、高血压动脉硬化。而动脉瘤、ＡＶＭ最常见，占查出原因的７４％，ＣＴ像上有ＳＡＨ表现的又以动脉瘤最常见，根据ＣＴ像上ＳＡＨ的分布及附近并发的脑内血肿可推断动脉瘤破裂的位置。本文还概括了ＳＡＨ典型的临床表现和常见     

动脉DSA对188例脑中风的病因诊断

对经ＣＴ证实的１８８例脑中风患者进行了ＤＳＡ检查，确定病因者１２４例，占全部病例的６６％，主要病因为动脉瘤，动静脉畸形（ＡＶＭ）和烟雾病（Ｍｏｙａｍｏｙａ）。笔者认为，ＤＳＡ对脑中风的病因确诊率与患者的年龄、有无高血压史及出血部位有关。对不能解释的脑叶出血和蛛网膜下腔出血（ＳＡＨ）应提倡作血管造影检查。对基底节－丘脑区高血压脑出血的高龄患者，以不做血管造影检查为宜，而对年轻患者无论有无高血压史，接受血管造影检查仍有诊断意义。     

脑动静脉畸形(AVMs)的NBCA栓塞治疗

评价ＮＢＣＡ栓塞治疗脑ＡＶＭｓ的临床效果。材料和方法：３６例脑ＡＶＭｓ患者（临床表现为脑出血１４例,癫痫１６例,其他６例）,均经完整的血管造影检查、畸形血管的血管构筑学研究和Ｓｐｅｔｚｌｅｒ分级,在供血动脉选择性血管造影后注入ＮＢＣＡ,术后即刻行血管造景,半年后行ＭＲＩ 评估栓塞的近、远期效果。结果：术后即刻血管造影显示闭塞范围大于９０％为１１例（３０．５％）,７０％￣９０％为８例（２２．２％）,     

脊髓血管畸形的影像学特点与介入治疗(附6例报告)

目的：分析６例脊髓ＡＶＭ的影像学表现和评价血管栓塞治疗的效果。方法：６例作了数字减影血管造影检查,并行血管内栓塞治疗,分析术前ＣＴ,脊髓造影和ＭＲ资料。结果：根据病变位置和血管形态,血流动力学改变,本组有３例符合硬膜动静脉瘘（ＳＤＡＶＦ）,１例为髓周的巨大ＡＶＦ,２例为髓内型。栓塞术后随访３￣２４个月,２例完全治愈,４例好转,结论：脊髓ＡＶＭ的影像学特点相对典型,ＤＳＡ为其金标准诊断方法。血管内栓     

颈髓动静脉畸形的临床和影像诊断

文中报道７例经选择性脊髓动脉造影或／和ＭＲＩ证实的颈髓动静脉畸形（ＣＳＡＶＭ），着重分析其临床和影像特点。其中２例行手术治疗，１例经血管内栓塞。４例突发起病，临床症状和体征以及脑脊液检查诊断蛛网膜下腔出血（ＳＡＨ），脑ＣＴ和颈动脉造影正常。４例病变位于髓内，３例以髓外为主，髓内也受累。５例行ＭＲＩ检查均明确显示病变的部位和范围，１例可见异常血管团内的慢性出血灶以及位于颈髓背侧呈锯齿状向头侧引流的静脉。ＭＲＩ检查可作为ＣＳＡＶＭ确诊的方法，但对拟行手术和血管栓塞治疗的患者行选择性脊髓动脉造影是必要的。上颈段动静脉畸形主要由颅内段椎动脉分支供血，血管栓塞和手术治疗较下颈段困难和危险。     

脑动静脉畸形电子束CT三维血管造影的临床应用

目的：探讨电子束ＣＴ血管造影（ＥＢＣＴＡ）在诊断脑动静脉畸形中的价值与限度。材料与方法：选择１７例不同部位、不同类型的脑动静脉畸形进行了ＥＢＣＴＡ和ＤＳＡ对照研究,采用最大信号强度投景（ＭＩＰ）和表面遮盖法（ＳＳＤ）进行重建。结果：ＥＢＣＴＡ能１００％显示瘤巢,ＭＩＰ法供血动脉显示率为９３．９％,ＳＳＤ法供血动脉显示率为８７．８％,引渡以静脉两者显示率均为８５．７％,对于颈外动脉供血和小型ＡＶＭ的     

Alzheimer病与血管性痴呆的SPECT

目的：研究脑ＳＰＥＣＴ在诊断及鉴别Ａｌｚｈｅｉｍｅｒ病（ＡＤ）和血管性痴呆（ＶＤ）方面的作用。材料和方法：分别选择符合《精神障碍诊断和统计手册》第４版（ＤＳＭ—ＩＶ）中ＡＤ或ＶＤ诊断标准的患者各１７例和１２例，进行ＳＰＥＣＴ检查，兼作ＣＴ（或ＭＲＩ），并作神经心理测定及其它相关量表评分。将ＡＤ、ＶＤ和ＳＰＥＣＴ结果，以及ＳＰＥＣＴ和ＣＴ（或ＭＲＩ）的结果进行比较。结果：ＡＤ的ＳＰＥＣＴ以颞、顶叶低灌注为典型表现，ＶＤ以局灶性低灌注为主。在右颞下回和右枕叶，ＡＤ组ＳＰＥＣＴ放射性计数比值显著低于ＶＤ组（Ｐ＜０．０５，Ｐ＜０．０１），而在左顶叶显著高于ＶＤ组（Ｐ＜０．０５）。两组左半球的放射性计数比值普遍低于右半球，但ＶＤ的左右不对称性明显重于ＡＤ，以左顶叶最为突出（Ｐ＜０．０１）。ＭＲＩ结果与ＳＰＥＣＴ有较多的一致性。各量表评分除Ｈａｃｈｉｎｓｋｉ缺血指数外，均无显著差异。结论：ＳＰＥＣＴ在诊断和鉴别ＡＤ与ＶＤ方面有一定实用价值     

脑静脉血管瘤的MRI及MRA

目的：探讨颅内静脉血管瘤的ＭＲＩ和ＭＲＡ影像学表现及诊断和鉴别诊断。材料和方法：应用ＳｉｅｍｅｎｓＭｅｇｎｅｔｉｏｎＶｉｓｉｏｎ１．５Ｔ超导系统对诊断静脉血管瘤（ＶＡ）２０例进行分析。ＭＲＩ扫描用ＳＥＴ１和ＴｕｒｂｏＳＥＴ２加权序列。ＭＲＡ采用ｔｏｆ－ｔｉ３Ｄ－ｍｕｌｔｉ－ｓｌａｂ－ｔｒａ－ｔｕｎ序列。１６例作增强Ｔ１加权及ＭＲＡ检查。血管重建采用ＭＩＰ技术。有１１例曾行ＣＴ检查，１例行手术治疗。结果：所有病例均由ＭＲ检查作出首诊。Ｔ１加权１８例显示扩张引流静脉呈点条状低信号影，有２例未显示，经增强后显示，并有部分髓静脉显示。Ｔ２加权引流静脉多呈高信号，个别呈低信号。较大的ＶＡ亦可显示髓质静脉。ＭＲＡ１５例显示异常血管，典型的表现为脑实质内见为数不等的髓质静脉呈伞状汇入一根异常扩张的引流静脉，整个形态似“水母头”。１例ＭＲＡ未显示病灶。结论：ＭＲ是诊断ＶＡ最好的影像方法，ＭＲＡ有助于确诊本病。增强ＭＲＩ及ＭＲＡ可提高ＶＡ的检出率     

头颈部DSA与CT、MRI临床应用的回顾性研究

目的：在目前广泛应用ＣＴ、ＭＲＩ甚至ＣＴＡ、ＭＲＡ的情况下，探讨ＤＳＡ在头颈部疾病中的应用价值、限度及相关问题。方法：回顾性复习２８０例头颈部ＤＳＡ检查的临床、影像学及部分手术病理资料，其中１９０例造影或手术前后曾行ＣＴ和或／ＭＲＩ。共行５０６例次ＤＳＡ，包括ＩＶＤＳＡ４６例次，ＩＡＤＳＡ４６０例次。并作密度时间曲线分析。分别选用离子型（ＩＣＭ）或非离子型（ＮＩＣＭ）造影剂。结果：２８０例ＤＳＡ明确诊断２６６例（９４．６４％），包括肿瘤２９例，血管性病变１９８例，其它４例及未见异常３５例，其中ＣＴ、ＭＲＩ未见异常，ＤＳＡ显示明确病变１４例。未明确诊断１４例（５．３６％），包括造影剂重度反应３例，临床ＳＡＨ或ＣＴ、ＭＲＩ显示病变，ＤＳＡ未见异常１１例。本组发生造影剂不良反应２９例（１０．３６％），其中ＩＣＭ２５例（１５．１５％），ＮＩＣＭ４例（３．４８％），两者差别有显著性（Ｐ＜０．０１）。结论：ＩＡＤＳＡ对头颈部疾病，尤其小动脉病变仍然有确诊价值，且便于介入治疗     

Transluminal imaging of three-dimensional CT and MR angiograms for transluminal observation of angioarchitecture of cerebral aneurysms

To investigate the angioarchitecture of cerebral aneurysms, we studied various opacity curves to select specific volume data of CT and MR angiograms from the opacity charts of CT density or MR signal intensity distribution. We developed the method of transluminal imaging of CT and MR angiograms; the vessels and aneurysms were depicted transluminally through spaces between the rings of the vessel walls. Two cases of unruptured cerebral aneurysms were studied by transluminal imaging of three-dimensional CT and MR angiograms. The technical aspects of transluminal imaging and characteristics of volume data, obtained by CT and MR angiograms, were discussed.     

破裂与未破裂大脑中动脉瘤容积CT数字减影血管成像对照研究

目的探讨破裂与未破裂大脑中动脉动脉瘤(middle cerebral artery aneurysm,MCAA)在容积CT数字减影血管成像(volume CTdigital subtraction angiograhy,VCTDSA)上的形态学差异。资料与方法回顾性分析2007年9月至2010年1月54例55个MCAA VCTDSA表现,根据颅内有无出血分为破裂组和未破裂组,由两名神经放射学医师采用双盲法评价二者形状、大小、瘤颈、载瘤动脉分叉角度、瘤体纵横比(aspect ratio,AP值),比较二者在形态学上的差异。结果破裂组动脉瘤36个(65.45%),其中椎状或半球状15个(41.6%),囊状12个(33.33%),梭状3个(8.33%),球状1个(2.77%),不规则5个(13.88%);未破裂动脉瘤19个(34.55%),其中锥状或半球状11个(57.89%),囊状4个(21.05%),球状4个(21.05%),二者形状分类上有统计学差异(P<0.05)。破裂组动脉瘤瘤壁伴尖角征12个(33.33%):顶壁8个,侧壁4个;瘤样突起6个(16.67%):顶壁4个,侧壁2个;瘤体上小动脉2个(5.56...     

Angiographic follow-up of large cerebral AVMs incompletely embolized with isobutyl-2-cyanoacrylate

This study evaluated the long-term angiographic results in large cerebral arteriovenous malformations (AVMs) partially embolized with isobutyl-2-cyanoacrylate. Preembolization, immediate postembolization, and long-term follow-up angiograms were performed in 30 large, partially embolized brain AVMs. Particular attention was paid to the relative size of the residual AVM nidus and the embolized arterial feeders, to recruitment of new feeders, to the size of residual draining veins, and to the speed of arteriovenous shunt. Nine cases with less than 50% AVM nidus obliteration showed no significant morphologic changes. In 18 cases with 50-75% obliteration of the AVM nidus, 11 (61.1%) showed no significant changes, six (33.3%) showed enlargement of the AVM nidus, and one (5.5%) evolved to complete angiographic obliteration. In three cases with 75-99% AVM nidus obliteration, one remained unchanged, one showed an increase in the size of the AVM nidus, and one evolved to complete obliteration. Evaluation by plain film, CT, and cerebral angiography of the isobutyl-2-cyanoacrylate deposits showed that when the polymer was positioned predominantly in arterial feeders there was invariably reconstitution of the AVM nidus through leptomeningeal, deep medullary, and/or dural collaterals. This phenomenon did not occur when the isobutyl-2-cyanoacrylate was deposited mainly in the AVM nidus.     

Complications of endovascular treatment of cerebral aneurysms

The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms.     

脑动静脉畸形的CT诊断(附69例分析)

本文收集经手术、脑血管造影等证实的脑动静脉畸形69例,CT诊断与手术病理、脑血管造影等符合率为92.7％。脑内隐匿性AVM诊断较为困难,讨论了隐匿性AVMCT表现的病理基础及鉴别诊断要点。有82.6％的病例临床诊断为其它疾病,l3％的病例CT平扫阴性,应引起重视。提出了双剂量增强在脑内AVMCT诊断中的应用。     

Visualization of intraaneurysmal flow patterns with transluminal flow images of 3D MR angiograms in conjunction with aneurysmal configurations

BACKGROUND AND PURPOSE: How the complex flow phenomena generated within unruptured cerebral aneurysms relate to the corresponding aneurysmal geometry is unknown. To estimate the interaction between flow patterns and morphologic features of unruptured cerebral aneurysms, we developed a method to visualize intraanuerysmal flow patterns with transluminal flow imaging of 3D MR angiograms in conjunction with aneurysmal configurations. METHODS: Transluminal images of the vessel lumen were reconstructed with use of a parallel volume-rendering algorithm by selecting information on the margin of lumina from the volume data sets of 3D time-of-flight MR angiograms. Transluminal flow images were then created by superimposing flow-related intraluminal information onto transluminal images. Intraaneurysmal flow patterns were evaluated in three cases of unruptured cerebral aneurysms, based on the animated display of transluminal flow images with stepwise extracted intraluminal volume data of signal intensity, in conjunction with the corresponding aneurysmal configurations depicted on 3D MR angiograms. RESULTS: Transluminal flow images showed 3D visualization of flow-related signal intensity distribution obtained from volume data of MR angiograms, so that qualitative information regarding intraaneurysmal flow patterns could be estimated with respect to morphologic features of cerebral aneurysms. CONCLUSION: Transluminal flow images of 3D MR angiograms allowed feasible visualization of intraaneurysmal flow patterns that were studied. More work is required to validate the technique and clarify the significance of being able to visualize intraaneurysmal flow patterns.     

动脉数字减影血管造影对脑动静脉畸形出血的预测分析

报告８３例经ＤＳＡ和手术证实的脑动静脉畸形。其中ＣＴ示出血者５８例，占６９．９％。笔者探讨脑动静脉畸形血管造影形态与出血的关系，结果表明下列因素与出血有关：（１）小的脑动静脉畸形；（２）仅有１支引流静脉的；（３）向深部静脉引流的及引流静脉狭窄和并发动脉瘤者。而供血动脉的数目和有颈外动脉参与供血者未见明显关系，笔者还分析了脑动静脉畸形的ＣＴ表现，认为ＣＴ与脑血管造影并用，可为临床提供更详细的资料。     

128例脑血管畸形X线分析：着重脑血管造影诊断

128 cases of AVM studied by cerebroangiography were analysed. All were confirmed by operation and pathology. Based on the feeding arteries, draining veins and malformed vessels, the authors analysed the hemodynamics of AVM and divided them into six types. This classification will be of benefit to the surgeon. In this article the associated cerebral aneurysm and blood supply from meningeal arteries were also discussed. The CT findings of AVM as well as various diagnostic imaging methods used were described.     

Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms

BACKGROUND AND PURPOSE: Despite experience and technological improvements, endovascular treatment of intracranial aneurysms still has inherent risks. We evaluated cerebral complications associated with this treatment. METHODS: From October 1998 to October 2002, 180 consecutive patients underwent 131 procedures for 118 ruptured aneurysms and 79 procedures for 72 unruptured aneurysms. We retrospectively reviewed their records and images to evaluate their morbidity and mortality. RESULTS: Thirty-seven (17.6%) procedure-related complications occurred: 27 and six with initial embolization of ruptured and unruptured aneurysms, respectively, and four with re-treatment. Complications included 22 cerebral thromboembolisms, nine intraprocedural aneurysm perforations, two coil migrations, two parent vessel injuries, one postprocedural aneurysm rupture, and one cranial nerve palsy. Fourteen complications had no neurologic consequence. Three caused transient neurologic morbidity; 10, persistent neurologic morbidity; and 10, death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 4.8% and 4.8%; ruptured aneurysms, 5.9% and 7.6%; unruptured aneurysms, 1.4% and 1.4%; and re-treated aneurysms, 10% and 0%. Combined procedure-related morbidity and mortality rates for ruptured, unruptured, and re-treated aneurysms were 13.5%, 2.8%, and 10%, respectively. Nonprocedural complications attributable to subarachnoid hemorrhage in 118 patients with ruptured aneurysm were early rebleeding before coil placement (0.9%), symptomatic vasospasm (5.9%), and shunt-dependent hydrocephalus (5.9%); mortality from complications of subarachnoid hemorrhage itself was 11.9%. CONCLUSION: Procedural morbidity and mortality rates were highest in ruptured aneurysms and lowest in unruptured aneurysms. Morbidity rates were highest in re-treated aneurysms and lowest in unruptured aneurysms. No procedural mortality occurred with re-treated aneurysms. The main cause of morbidity and mortality was thromboembolism.