螺旋CT血管造影在主动脉病变中的临床应用

目的评价螺旋CT血管造影(SCTA)在主动脉病变中的临床应用和价值。方法87例临床疑为主动脉病变的患者做了SCTA检查,54例经手术证实,49例同时做了MRA及超声检查,18例行血管造影(XRA),包括DSA 8例。全部病例均在VQ工作站进行各种重建。结果87例中主动脉夹层48例,主动脉瘤23例,外伤后假性动脉瘤2例,先天性主动脉缩窄3例,大动脉炎3例,右位主动脉2例,动脉粥样硬化3例,3例正常。结论SCTA作为一种微创性影像诊断方法,能可靠显示主动脉病变,对主动脉瘤及主动脉夹层等大动脉病变的诊断已基本替代传统血管造影,并在术前提供精确的解剖信息和术后随访评估等方面具有重要的临床应用价值。     

主动脉夹层的超声心动图诊断与磁共振影像诊断的比较

 目的探讨经胸超声心动图(TTE)、经食管超声心动图(TEE)对主动脉夹层诊断价值,并与磁共振影像(MRI)进行比较.方法对21例经手术证实的主动脉夹层患者影像资料进行分析,对照手术结果,评价超声心动图(CDE)诊断主动脉夹层及其并发症的准确性,并同磁共振影像(MRI)诊断结果进行比较.结果CDE、MRI对主动脉夹层的诊断率分别为95.2%、90.5%.CDE对诊断主动脉瓣损害,显示心腔扩大、心功能降低、心包腔积液等心脏整体情况优于MRI.MRI对内膜破口及主动脉分支受累的诊断优于CDE.结论CDE对主动脉夹层的诊断具有较高的临床应用价值,对主动脉夹层的诊断敏感性与MRI相似,联合应用TTE、TEE、MRI检查有利于全面估计疾病情况,从而为临床医生提供准确而全面的信息.     

螺旋CT血管造影及三维重建在主动脉夹层诊断中的应用

目的:评价螺旋CT血管造影(SCTA)及三维重建在主动脉夹层诊断中的临床应用。方法:对21例主动脉夹层患者进行了SCTA成像及三维重建,并与手术及血管造影对照。结果:SCTA能清楚显示主动脉夹层病变及其复杂的解剖关系,如双腔、内膜片及累及的范围等。与血管造影及手术对照,SCTA的诊断符合率达100％。结论:SCTA二维与三维重建的联合应用,有助于主动脉夹层的诊断并可指导手术,且有望取代传统血管造影。     

主动脉夹层螺旋CT与电子束CT血管造影价值比较

目的：比较螺旋CT血管造影（SCTA）与电子束CT血管造影（EBCTA）诊断主动脉夹层（AD）的价值。方法：对经手术证实的AD14例的影像学资料进行分析，对SCTA、EBCTA在显示AD的内膜瓣、破裂口、真假腔、附壁血栓、钙化及并发症，以及对判断AD分型的准确性进行比较，并与手术结果进行对比。结果：SCTA、EBCTA对AD的诊断与分型准确率均为100％。SCTA在AD的诊断、分型和术后随访等方面有较高价值；EBCTA显示升主动脉根部、主动脉瓣膜及冠状动脉等病变更具优越性。结论：SCTA和EBCTA对AD的诊断和治疗均有较高的临床价值。     

16层CT血管造影对主动脉夹层的诊断价值

目的 探讨16层CT血管造影(16SCTA)对主动脉夹层的诊断价值和技术优势.方法 对39例主动脉夹层进行16-SCTA检查,采用多平面重建(MPR),曲面重建(CPR),容积再现(VR),最大密度投影(MIP)和仿真内镜(VE)多种图像后处理技术,并结合原始横断面增强图像进行综合分析.结果 根据DeBakey分型,本组39例主动脉夹层患者中,16SCTA显示Ⅰ型5例、Ⅱ型1例和Ⅲ型33例.显示真假腔39例(100%)、内膜片39例(100%)、内膜破口25例(64.1%)、假腔内血栓17例(43.6%).结论 16SCTA可作为主动脉夹层治疗前首选的影像学检查方法,价值可以肯定.     

经食管超声心动图检查与经胸超声心动图诊断心源性脑梗死患者卵圆孔未闭对比研究

目的 研究经食管超声心动图检查（TEE）与经胸超声心动图（TTE）诊断心源性脑梗死患者卵圆孔未闭（PFO）的应用价值。方法 挑选2017年1月至2021年12月我院疑似心源性脑梗死84例,所有患者均采用TEE与TTE检查,以食管超声心动图（c TEE）结果为“金标准”,结合小梗死灶、皮层下病灶、多发性病灶、双侧病灶,统计TEE、TTE诊断PFO的诊断结果、诊断效能、不同卵圆孔分离直径检出率变化。结果 本研究84例疑似患者中,经TEE联合右心声造影确诊PFO阳性37例、阴性47例,经TEE检查阳性35例、阴性49例,经TTE检查阳性17例、阴性67例;TEE诊断灵敏度94.6%(35/37)、准确度97.62%(82/84)较TTE诊断40.5%(15/37)、71.4%(60/84)高,且漏诊率5.4%(2/37)较TTE诊断59.5%(22/37)低（P<0.05）;经TEE联合右心声造影检查阳性37例,其中卵圆孔分离直径<2 mm为6例,2～4 mm为21例,>4 mm为10例;脑梗死病灶以小梗死病灶为主,约占41%(15/37)。结论 与TTE比较,TEE诊断心...     

螺旋CT在主动脉夹层诊断中的临床应用

急性主动脉夹层属危重急症,发病急,预后差,尽管外科手术及药物治疗有长足进步,但围手术期病死率仍很高.应用螺旋CT扫描、螺旋CT血管造影(spiral CT angiography)及影像后处理功能,使图像分辨率明显提高,能够明确主动脉夹层的类型并了解其形态变化,为临床内科及外科制定手术计划提供精确的影像信息,从而减少病死率.本文对22例螺旋CT诊断的主动脉夹层作了回顾性分析,并探讨螺旋CT扫描及SCTA的诊断价值.     

主动脉夹层的影像学诊断

主动脉夹层的影像学诊断和分型对其治疗方案的制定具有重要意义.本文叙述了主动脉夹层的病因、发病机理和病理学表现,重点介绍了血管造影、CT、经食管超声和MRI在本病诊断中的价值及限度.     

螺旋CT血管造影在脑动脉瘤诊断及治疗中的应用—兼与MR血管造影比较

目的探讨无创性的螺旋CT血管造影(SCTA)与MR血管造影(MRA)对脑动脉瘤的诊断价值以及对治疗的指导价值,并对两者作比较.材料和方法28例患者同时行SCTA、MRA、DSA,以DSA作为金标准,对SCTA与MRA作比较.结果(1)23例行SCTA及时间飞跃法(TOF)MRA者,SCTA诊断脑动脉瘤的准确性高于TOFMRA,但差异无显著统计学意义(p＞0.05).(2)SCTA较TOFMRA测量脑动脉瘤的最大径准确性高(p＜0.01),TOFMRA测量值常偏小.(3)SCTA测量的栓塞治疗最佳投照角度与DSA符合率94.7%.(4)动态增强(DCE)MRA的图像清晰度及价值与SCTA相似.结论SCTA对体积小、破裂出血的脑动脉瘤的检出率以及对动脉瘤测量的精确性高于TOFMRA,SCTA可较准确地测量动脉瘤栓塞治疗的最佳投照角度,MRA是脑动脉瘤电解可脱弹簧圈(GDC)栓塞术后随访的较好方法,DCEMRA的实用价值与SCTA相似.     

肾动脉狭窄螺旋CT血管造影及临床应用

目的　探讨螺旋CT血管造影 (SCTA)对诊断肾动脉狭窄的临床应用价值。方法　对 2 5例临床疑为肾动脉狭窄的患者行SCTA ,其中 12例经X线血管造影 (XRA) (包括DSA)对照。层厚 2～ 3mm ,重建间隔 1.0mm ,螺距 1.0～ 1.2 5 ,管电流 12 0～ 15 0mA ,管电压均为 12 0kV。造影剂使用欧乃派克 3 0 0mgI ml 75～ 10 0ml ,采用高压注射器方式经肘静脉给药 ,注射流速 3ml s ,延迟 2 2～ 2 7s扫描 ,扫描结束后行MPR和 3D重建。结果　 2 5例中SCTA显示肾动脉正常 3 9条 ,肾动脉狭窄 13条 ,共 5 2条。 12例有XRA对照者 ,显示肾动脉正常 11条 ,肾动脉狭窄 13条 ,SCTA显示的情况与之完全符合。结论　SCTA合理的成像技术和综合的图像分析 ,能清楚显示肾动脉并对肾动脉的狭窄部位和程度作出可靠诊断 ,具有重要的临床价值。     

螺旋CT血管造影在诊断脑动静脉畸形中的应用

目的探讨脑动静脉畸形(AVM)CT血管造影(CTA)的价值.材料与方法19例脑AVM病例行CTA检查,其中MRA、DSA检查各5例、8例.12例手术证实,7例保守治疗.CTA、MRA经工作站处理,获得三维血管图像;DSA通过股动脉插管技术,获得减影后血管图像.结果CTA能显示AVM的病变形态及准确部位,有效显示供养动脉、引流静脉及血管巢.但供养动脉显示不及MRA,引流静脉的显示较MRA为佳.结论CTA诊断脑AVM的图像质量、病变显示接近MRA、DSA,对制定治疗方案、指导手术和预后有重要意义.     

Carotid stenosis: a comparison between MR and spiral CT angiography

We performed a preliminary study comparing three-dimensional time-of-flight (3 D TOF) magnetic resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and assessment of internal carotid artery stenosis. Digital subtraction angiography (DSA) was the reference examination. We examined 20 patients with signs of cerebrovascular insufficiency, who underwent MRA, SCTA and DSA within a 3 day period. Both internal carotid arteries were assessed by three blinded readers for degree of stenosis at two different levels (bulb and remaining section) giving a total of 80 assessments. Interobserver variability, sensitivity, specificity, diagnostic accuracy, concordance, overestimation and underestimation were assessed. Interobserver variability was not statistically significant. MRA showed higher sensitivity, specificity, diagnostic accuracy and concordance than SCTA (92.0 % vs 80.8 %, 98.2 % vs 96.4 %, 96.3 % vs 91.3 % and 96.0 % vs 88.0 %, respectively). MRA gave rise to a 5.0 % overestimation rate, whereas SCTA occasioned a 7.5 % underestimation rate. These differences are not statistically significant. These results suggest that MRA is a more useful, noninvasive modality for assessment of the internal carotid artery with a more than 70 % stenosis. Received: 8 August 1997 Accepted: 10 October 1997     

Breath-hold 3D steady-state free precession coronary MRA compared with conventional X-ray coronary angiography

PURPOSE: To evaluate the use of breath-hold three-dimensional (3D) steady-state free precession (SSFP) coronary magnetic resonance angiography (MRA) in patients with coronary artery disease (CAD) in comparison with conventional coronary x-ray angiography (XRA). MATERIALS AND METHODS: Twenty-eight patients with suspected CAD were examined with the use of a breath-hold 3D-SSFP-MRA sequence and conventional XRA. To assess the accuracy of MRA, two clinicians who were blinded to patient information independently reviewed the MRA and XRA data, which were presented in a randomized order. To identify discrepancies between MRA and XRA, and assess features of coronary lesions on MRA, two additional clinicians examined MRA and XRA data that were presented side by side, divided into proximal, mid, and distal segments, and compared them segment by segment. RESULTS: The sensitivity and specificity for diagnosing significant coronary stenoses (> 50% diameter narrowing) were 64% and 94%, respectively. At sites of coronary lesions identified on XRA, bright signals and enlarged vessel profiles, in addition to the characteristic narrow lumen, were frequently observed on MRA. CONCLUSION: Breath-hold SSFP coronary MRA has good specificity but inconclusive sensitivity in diagnosing significant coronary stenoses, and provides important image features for depicting coronary lesions.     

Coronary magnetic resonance angiography using magnetization-prepared contrast-enhanced breath-hold volume-targeted imaging (MPCE-VCATS)

OBJECTIVES: Coronary artery x-ray angiography (XRA) is currently the gold standard for the assessment of coronary artery disease. A substantial minority of patients referred for coronary angiography have no significant coronary artery disease. The purpose of this study is to evaluate magnetization-prepared contrast-enhanced breath-hold volume-targeted imaging (MPCE-VCATS), a new 3-dimensional breath-hold coronary magnetic resonance angiography (MRA) technique, in detecting hemodynamically significant coronary artery stenoses in a patient population, with XRA correlation. MATERIALS AND METHODS: A total of 19 subjects who were referred for conventional coronary angiography were enrolled in the study. ECG-triggered MPCE-VCATS coronary artery scans were acquired for the left main coronary artery (LCA), left anterior descending (LAD), and right coronary artery (RCA). Coronary MRA and XRA results were compared. RESULTS: The overall sensitivity, accuracy, and negative predictive value for diagnosing any hemodynamically significant coronary artery disease (> or =50% diameter reduction) was 91%, 80%, and 90%, respectively. The sensitivity of the technique in the LCA, LAD, and RCA was 100%, 100% and 78%, respectively. The negative predictive value of the technique was 100%, 100%, and 71%, respectively. DISCUSSION: MPCE-VCATS is a promising technique for coronary artery imaging. It has a relatively high sensitivity as well as a high NPV. The results of the study may indicate a future role for the technique in obviating the need for some patients to undergo XRA.     

脑血管病变三维PC法MRA与动脉DSA的对照研究

目的 :通过与动脉 DSA结果的对照 ,研究三维 PC法 MRA对于检测各类脑血管病变的可信性。方法 :对临床或 MRI表现疑为或需排除脑血管病变的 5 9例兼作 MRA和 DSA检查 ,评价三维 PC法 MRA检测颅内各种血管病变的灵敏度、特异度、假阳性和假阴性率。结果 :MRA检出大于 5 mm的动脉瘤的灵敏度和特异度均达 10 0 %。但小于 5 mm者难以检出 ,使检出总灵敏度下降为 81.8%。 MRA检出 AVM的灵敏度为 92 .3%、特异度为 10 0 % ,畸形血管团及其主要供血动脉和引流静脉均可被 MRA显示。MRA检出颈内动脉 -海绵窦瘘的灵敏度和特异度均为 10 0 % ,表现十分典型。 MRA检出脑血管主干闭塞的灵敏度为 10 0 % ,特异度为 86 .70 % ,高度狭窄者可能过诊为闭塞。 MRA对于颅内占位病变引起的血管移位能全部显示 ,对于细小的肿瘤血管和肿瘤血供无法显示。结论 :MRA在脑血管病变的诊断上显示出很大的应用价值 ,对动静脉畸形、动静脉瘘、血管闭塞和血管移位的检测已有较高的灵敏度和特异度 ,对于较大动脉瘤的显示较好 ,对于小动脉瘤的检出率仍低 ,MRA对于肿瘤血管的检测基本无效。     

Retrospective registration of X-ray angiograms with MR images by using vessels as intrinsic landmarks

Conventional x-ray angiography (XRA) images are projections of the vasculature with high spatial and temporal resolution, while magnetic resonance (MR) angiography (MRA) and MR imaging data show the three-dimensional locations of vessels relative to brain parenchyma. The authors have developed a retrospective method of registering these studies, which makes it practical to produce multimodality displays of this complementary information. Registration was performed by matching vessels seen on both XRA and MRA images. First, the authors determined the coordinates of the center lines of a few “landmark” vessels on the XRA image and the three-dimensional locations of the corresponding intraluminal voxels in the MRA volume. Registration was performed by rotating and translating the MRA–MR imaging volume until the perspective projection of the MRA landmark vessels matched the corresponding vessel center lines on the XRA image. Experiments with phantoms and patients indicated that the two studies were registered with an average error of less than 2 mm. A linked-cursor display was developed to show correspondence between points on the registered XRA and MRA-MR images.     

A multi-center, comparative, phase 3 study to determine the efficacy of gadofosveset-enhanced magnetic resonance angiography for evaluation of renal artery disease

PURPOSE: To determine prospectively the safety and efficacy of the blood-pool contrast agent gadofosveset trisodium in renal artery magnetic resonance angiography (MRA). MATERIALS AND METHODS: Gadofosveset (0.03 mmol/kg) was administered to adult patients with known or suspected renal arterial disease in a multi-center phase 3 single dose study. The drug binds reversibly to albumin, prolonging the blood residence time, and allowing collection of images in the first-pass and steady-state phases. The combination of these images was compared to non-contrast MRA, using catheter X-ray angiography (XRA) as the standard of reference (SOR). All MRA images were collected at 1.5 T in one imaging session for direct comparison, and XRA within 30 days. Sensitivity, specificity, and accuracy for diagnosing significant disease (stenosis > or =50%) were calculated for MRA using three independent blinded readers. Patient safety was monitored for 72-96 h. RESULTS: A total of 145 patients at 18 centers were enrolled and received gadofosveset; the 127 with complete efficacy data entered the primary efficacy analysis. Gadofosveset-enhanced MRA led to significant improvement (p<0.01) in sensitivity (+25%, +26%, +42%), specificity (+23%, +25%, +29%), and accuracy (+23%, +28%, +29%) over non-enhanced MRA for the three readers. The rate of uninterpretable examinations decreased from 30% to less than 2%. There were no serious adverse events, and the most common adverse events were nausea, pruritis, and headache (8% each). No significant trends in clinical chemistry parameters, nor significant changes in serum creatinine, were found following administration of gadofosveset. CONCLUSION: In patients with known or suspected renal arterial disease, multi-phase gadofosveset-enhanced MRA significantly improves sensitivity, specificity, and accuracy versus non-enhanced MRA. Gadofosveset was safe and well tolerated in this patient population.