CTA、MRA诊断脑动静脉畸形:与DSA比较

目的比较CTA、MRA与DSA对脑动静脉畸形（AVM）的诊断价值。方法回顾性分析经DSA确诊为脑AVM的48例患者的脑CTA及MRA图像,并统计其诊断效率。结果27例患者接受颅脑CTA检查,7例大型脑AVM（直径〉6cm）与DSA结果一致,12例中型脑AVM（直径3-6cm）中1例CTA未检出,8例小型脑AVM（直径〈3cm）中CTA漏诊3例,CTA与DSA检查结果的差异有统计学意义（P〈0．05）。对21例患者行MRA检查,其中14例大、中型脑AVM（直径≥3cm）MRA诊断结果与DSA一致,7例小型脑AVM（直径〈3cm）中MRA漏诊4例,与DSA检查结果的差异有统计学意义（P〈0．05）。结论CTA、MRA诊断大、中型脑AVM与DSA基本相符,而对于小型脑AVM的诊断效率较低。     

容积CT数字减影血管造影与同步匹配蒙片去骨法对颅内动脉瘤的诊断价值比较

目的探讨容积CT数字减影血管造影(VCTDSA)与同步匹配蒙片去骨(MMBE)法对颅内动脉瘤的诊断价值。方法分析临床怀疑颅内动脉瘤、并接受VCTDSA检查的57例患者资料,其中47例经3DDSA和/或手术证实,比较VCTDSA与MMBE的减影图像质量、对动脉瘤的检出率以及二者图像后处理时间。结果57例患者分别采用VCTDSA与同步MMBE的图像质量差异有统计学意义(P0.05)。经手术和/或3DDSA结果证实,47例患者共检出53个动脉瘤;VCTDSA对于IA的检出率为96.23%(51/53),高于MMBE(46/53,86.79%);VCTDSA对于颈内动脉瘤的检出率为94.12%(32/34),高于MMBE(27/34,79.41%)。VCTDSA对于3mm的动脉瘤的检出率为86.67%(13/15),高于MMBE(10/15,66.67%)。VCTDSA的平均后处理时间为(3.87±0.73)min,同步MMBE的平均后处理时间为(4.05±0.79)min,二者差异有统计学意义(P0.05)。结论 VCTDSA是一种方便、快速的检查方法,图像真实、可靠,对颅内动脉瘤的检出与诊断优于同步MMBE。     

The value and limitations of the CT scan in the diagnosis of giant intracranial aneurysms (two cases)

Summary Two cases of giant cerebral aneurysms, the diagnosis of which was made by angiography after a dubious CT scan, are reported.     

三维增强核磁共振血管造影在内脏动脉瘤诊治中的应用

目的 探讨三维增强核磁共振血管造影在内脏动脉瘤诊治中的临床价值.方法 对43例内脏动脉瘤患者行三维增强MR血管造影检查,19例同期行数字减影血管造影(digital subtraction angiography,DSA).三维增强MR血管造影用屏气超快速三维梯度回波序列,图像减影后进行三维重建.结果 43例共50个内脏动脉瘤,涉及脾动脉32个(其中5例脾动脉异位起源于肠系膜上动脉),占64%;肠系膜上动脉7个(14%),腹腔动脉干5个(1例为腹腔系膜干),肾动脉4个,肝动脉2个.三维增强MR血管造影能清楚显示动脉瘤部位、大小、形态,并在立体直观显示动脉瘤及其与周围血管脏器关系方面优于DSA.43例中,行栓塞治疗15例,手术9例,保守观察19例.结论 三维增强MR血管造影能尤创、准确诊断内脏动脉瘤,所提供的三维解剖细节有助于临床治疗方案的制定,可作为内脏动脉瘤的首选检查方法.     

对MRA诊断主动脉夹层动脉瘤的评价(附136例报告)

目的探讨MRA诊断主动脉夹层动脉瘤的价值。方法2000年10月至2002年12月,136例患主动脉疾病的病人术前经trueFISP3DCEMRA影像学检查,并与术中主动脉病理改变进行对比研究。病人男116例,女20例;平均年龄(45.5±12.2)岁。分为主动脉夹层动脉瘤组108例,急诊发病(发病时间小于2周)76例,包括I型夹层动脉瘤41例,II型夹层动脉瘤9例,IIIA夹层动脉瘤1例,IIIB夹层动脉瘤57例;非夹层动脉瘤组28例,包括升主动脉瘤9例,马方根部瘤6例,降主动脉脉假性动脉瘤5例,降主动脉瘤4例,升主动脉假动脉瘤、降主动脉缩窄、弓部瘤、弓部假性动脉瘤各1例。结果术前MRA诊断与术中所见对比显示,MRA对主动脉夹层动脉瘤及其累及范围诊断的敏感性及特异性均为100%;撕裂位置诊断的敏感性为85.2%,特异性100%;头臂干受累情况诊断的敏感性为90.3%,特异性为100%;心包及胸腔积液诊断的敏感性及特异性均为100%;假腔内血流情况诊断的敏感性为98.1%,特异性为100%。结论trueFISP3DCEMRA技术对主动脉夹层动脉瘤的诊断安全、可靠,基本可取代常规血管造影,被视为主动脉夹层动脉瘤和其他主动脉疾病诊断的“金标准”。     

增强磁共振门静脉造影在肝硬化门静脉高压症的应用价值

目的探讨三维动态对比增强磁共振门脉血管造影（3D DCE MRP）在肝硬化门脉高压症门静脉系统及门体侧支循环显像中的应用价值.方法对19例肝硬化门脉高压症组病人及51例非肝硬化对照组行3DDCEMRP检查,测量门脉系统各主要干支的径线并比较两者差异;于3DDCEMRP检查前后10 d内,对所有肝硬化症组病人行门脉间接造影,以其结果为标准,分析侧支循环发生的部位和分布范围,评价两者的符合情况.结果肝硬化门脉高压症组MPV、SPV及SMV直径明显大于对照组（P＜0.05）,门脉分支级数明显减少;但Child A、B级病人间MPV直径及门脉分支级数的减少无明显差别（P＞0.05）.同时,3D DCE MRP显示2例门脉主干海绵样变并检出48条肝外侧支血管,与DSA结果相对照,除1例脐静脉开放及1例自发性脾肾分流未见显示外,其余侧支循环在3D DCE MRP上均清楚显影,总符合率为96.0%（48/50）.结论3D DCE MRP能较好显示门脉系统的解剖影像,并对曲张静脉、侧支循环显影良好,也是诊断门脉海绵样变的有效方法,对于门脉高压症的诊断及手术治疗有重要指导意义.     

Intraoperative angiography and embolization in intracranial AVM's and aneurysms

Intraoperative angiography allows for control procedures for exstirpation of arteriovenous malformations and clipping of problematic aneurysms during the entire operation. During intraoperativ embolizations, it is especially helpful to see whether the occlusion of the nidus of an arteriovenous malformation is complete. The method is easy to perform; there were no complications in 19 cases.     

双源Flash扫描模式CTA结合迭代重建诊断脑血管病变

目的探讨第二代双源Flash扫描模式CTA结合迭代重建诊断脑血管病变的临床应用价值。方法回顾性分析105例接受双源Flash扫描模式结合迭代重建脑血管CTA的疑诊脑血管病变患者的资料。以3D-DSA为金标准,计算Flash扫描模式CTA诊断脑血管病变的敏感度、特异度、阳性预测值、阴性预测值及准确率。比较3D-DSA与Flash扫描模式CTA诊断脑血管病变的差异,计算双源Flash扫描模式CTA的辐射剂量及对比剂用量。结果 105例中,Flash扫描模式CTA诊断60例共73个脑动脉瘤,其中微小动脉瘤24个;诊断13例脉动静脉畸形(AVM);检出颈内动脉海绵窦瘘5例、静脉畸形2例,脑动脉狭窄9例,烟雾病6例。以3D-DSA为金标准,CTA误诊微小动脉瘤2例,漏诊1例位于大脑中动脉远端区域的AVM。Flash扫描模式CTA诊断脑血管病变的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为98.94%(93/94)、81.82%(9/11)、97.89%(93/95)、90.00%(9/10)和97.14%(102/105),辐射剂量为(231.9±13.2)mGy·cm,对比剂用量为(49.32±2.54)ml。结论脑部Flash扫描模式CTA结合迭代重建可快速、准确诊断脑血管病变,同时辐射剂量低、对比剂用量少。     

2D DSA、3D DSA与CTA对颅内动脉瘤诊断的比较研究

目的比较评价2D DSA、3D DSA(MIP、SSD、VR)及CTA(SVR)几种方法对颅内动脉瘤诊断的价值。方法对34例蛛网膜下腔出血的患者经常规DSA、3D DSA及CTA检查诊断颅内动脉瘤28例,检出动脉瘤33个。回顾性分析对比2D DSA、3D DSA及CTA几种方法对33个动脉瘤的显示情况,分别对动脉瘤的检出率和动脉瘤颈的可见度及与载瘤血管位置关系进行评价。结果就动脉瘤检出情况,2D DSA与CTA间无明显统计学差异,3D DSA的SSD、VR与CTA间有明显统计学差异。对于瘤颈及与载瘤血管的关系的显示,2D DSA与CTA间存在显著性差异。3D DSA的SSD、VR与CTA间存在显著性差异。结论2D DSA与CTA在动脉瘤的检出率方面无显著差异,但在瘤形态、瘤颈及与载瘤血管的关系方面,CTA优于2D DSA。3D DSA在瘤的检出率、瘤颈及与载瘤血管的显示方面均较CTA有明显优势。     

Unruptured intracranial aneurysms in haemodialysis patients

SUMMARY:   While the mortality rate of subarachnoid haemorrhage is very high in haemodialysis (HD) patients, the prevalence of unruptured intracranial aneurysms in HD patients has not yet been elucidated. We performed cerebral magnetic resonance angiography (MRA) on 123 HD patients who did not have symptomatic cerebrovascular disease, and on 52 control subjects. On the basis of these images, the prevalence of unruptured intracranial aneurysms was evaluated. Unruptured aneurysms were found in three HD patients (2.4%). There were no aneurysms found in the healthy control group. There was no significant difference in the prevalence of unruptured aneurysms between HD patients and healthy controls. Therefore, the incidence of intracranial aneurysms is not associated with chronic renal failure.     

颅内动脉瘤夹闭术后影像学随访研究进展

颅内动脉瘤是一种发生率、致死率及致残率高的脑血管疾病。其主要治疗方式是动脉瘤夹闭术,但动脉瘤夹闭术后并发症较多,主要有动脉瘤夹闭不全、瘤夹脱落、脑梗死、载瘤动脉及周围血管狭窄或闭塞、脑血管痉挛以及动脉瘤再出血、再生、新生、硬膜外血肿等,需进行长期随访。颅内动脉瘤夹闭术后随访的影像学检查主要有DSA、MRA、CTA,本文对颅内动脉瘤夹闭术后随访的影像学进展进行综述。     

超选择性动脉栓塞对外伤性肝破裂假性动脉瘤的应用价值

目的探讨超选择性动脉栓塞对外伤性肝破裂假性动脉瘤的临床应用价值。方法对20例经MSCT扫描确诊为外伤性肝破裂假性动脉瘤的患者行介入栓塞治疗,栓塞材料采用COOK弹簧圈。术后第3天、第1个月及第3个月复查MSCT及肝功能。结果 20例MSCT检查发现肝破裂假性动脉瘤,DSA检查表现为肝内动脉瘤样扩张并见对比剂外溢征象。20例栓塞治疗后出血均立即停止,瘤样扩张的血管消失。随访3个月,无复发出血,未见严重并发症。肝功能介入治疗前与术后第3天对比无明显改变,且经保肝治疗后肝功能于术后第1个月均恢复正常。结论超选择插管介入治疗外伤性肝破裂假性动脉瘤安全、迅速、有效,并能最大限度保护肝脏功能。     

肾脏淋巴瘤CT检查的影像学特点

目的 总结CT检查诊断肾脏淋巴瘤的影像学特点. 方法回顾性分析14例经穿刺或手术病理证实为肾脏淋巴瘤的CT影像表现.男8例,女6例.平均年龄53(9~68)岁.临床表现腹部不适9例、腹泻3例、腹痛2例,伴血尿2例、发热2例.采用Somatom Plus4型螺旋CT机和Presto多层螺旋CT机,平扫加增强扫描12例,动脉期加实质期扫描2例.总结分析肾脏淋巴瘤CT检查的直接征象和间接征象. 结果 14例患者CT检查的直接征象:单发结节型1例,病灶密度均匀,增强后较明显均质强化,边缘清楚;多发结节型6例,增强后结节边缘清楚,呈轻度均质强化或强化不明显,肾外形无明显外凸;弥漫浸润型7例,肾脏肿大,病灶轻度强化,境界不清楚.间接征象:腹主动脉、肾门旁多发淋巴结肿大13例,其中淋巴结肿大成串或成堆4例,淋巴结广泛肿大融合,包绕血管,显示"腹主动脉淹没"征3例.13例淋巴结肿人密度均匀,轻度强化,其中边缘清楚、光整9例.伴骶椎、骶管淋巴瘤1例、肾周筋膜浸润2例.右肾手术切除1例,穿刺活检证实13例,病理报告均为B细胞型非霍奇金淋巴瘤. 结论肾脏淋巴瘤的CT诊断及鉴别诊断除直接征象外,典型间接征象有重要意义.     

三维对比增强磁共振血管成像诊断胡桃夹综合征

目的探讨3D-CE MRA对胡桃夹综合征（NCS）的诊断价值。方法对4例NCS患者及对照组（30名3D-CEMRA表现正常者）的3D-CE MRA原始图像进行重建,测量数据并对照分析。结果所有研究对象左肾静脉（LKV）均跨过腹主动脉前方;对照组肠系膜上动脉（SMA）与腹主动脉间夹角为（84.50±13.60）°,SMA前行（13.40±5.10）mm转而下行,经过LKV层面SMA与腹主动脉间距离为（16.40±5.10）mm,LKV肾门前段与SMA、腹主动脉夹角段前后径比值为1.4。4例NCS患者的夹角明显变小（〈30°）,且SMA以较小角度发出后前行较短距离后即转向下行,SMA与腹主动脉间距离变小,SMA与腹主动脉夹角内LKV明显受压,LKV扩张段与狭窄段前后径平均比值为4.5,与对照组有明显差异。结论3D-CE MRA能显示腹主动脉、SMA与LKV三者之间关系,准确诊断NCS。     

CTA术前评估颅内窦旁脑膜瘤

目的探讨320层CTA术前评估颅内窦旁脑膜瘤的价值。方法回顾性分析经手术病理证实的36例颅内窦旁脑膜瘤患者的CT资料,所有患者术前均接受320层CTA,扫描后数据后处理方法为MPR、VR、MIP,观察及评估肿瘤与周围血管及静脉窦的关系,并与术中所见比较,分析CTA术前诊断与术中所见是否一致。结果 36例中,肿瘤位于上矢状窦旁25例,下矢状窦旁2例,横窦旁4例,直窦旁5例;CT静脉成像(CTV)示13例静脉窦正常,未受肿瘤侵犯,与术中所见一致;CTV示23例静脉窦不同程度受肿瘤侵犯,其中Ⅰ型6例,Ⅱ型10例,Ⅲ型7例,而术中示22例静脉窦受侵,1例未受侵,CTV与术前诊断符合率为97.22%(35/36)。36例中CTA均可以清楚显示脑膜瘤的供血血管,其中颈外动脉供血26例(脑膜中动脉、颞浅动脉、枕后动脉),颈外、颈内动脉共同供血6例,颈内动脉供血4例,CTA结果与术中所见一致。结论 320层CTA能清楚显示颅内窦旁脑膜瘤与供血动脉及静脉窦的关系,对临床选择最佳手术入路、确定肿瘤切除范围和处理周围血管有重要的意义。     

Risk factors for the association of intracranial and aortic aneurysms

Summary This study investigated the association of intracranial aneurysms and abdominal aortic aneurysms to elucidate the incidence and independent risk factors for this association. Ultrasonography of the abdominal aorta was performed in 181 patients with 224 intracranial aneurysms. Six patients had suffered subarachnoid haemorrhage and the others had chronic disease or no symptoms. Magnetic resonance angiography was performed for confirmation if abdominal aortic aneurysm was identified by ultrasonography. Thirteen patients (7.2%) with 23 intracranial aneurysms had abdominal aortic aneurysms. Univariate analysis demonstrated that age (p < 0.01), size of intracranial aneurysms (p < 0.001), male sex (p < 0.01), multiplicity of intracranial aneurysms (p < 0.001), history of cerebrovascular diseases (p < 0.05), and current smoking (p < 0.0001) were significantly different between patients with and without this association. Multiple logistic analysis indicated that age (odds ratio [OR] 1.27, 95% confidence interval 1.08–1.48, p < 0.01), multiplicity (OR 22.1, 95% confidence interval 1.83–266.3, p = 0.01), size of intracranial aneurysms (OR 1.30, 95% confidence interval 1.10–0.54, p < 0.01), and current smoking (OR 33.3, 95% confidence interval 2.43–456.7, p = 0.01) were independent risk factors for the association. Patients with intracranial aneurysms who are older males with multiple or large intracranial aneurysms, and current smokers should be examined for abdominal aortic aneurysms using ultrasonography.     

Prediction of traumatic avascular necrosis of the femoral head by single photon emission computerized tomography and computerized tomography: an experimental study in dogs

Objective: To evaluate the femoral head perfusion and to predict the traumatic avascular necrosis (AVN) of the femoral head by single photon emission computerized tomography and computerized tomography (SPECT/CT). Methods: Totally 18 adult beagle dogs were divided randomly into three equal-sized (n=6) groups. Subsequently different degrees of ischemia model were developed by destroying blood vessels of the femoral head. The left hip received sham operation as normal control and the right hip underwent blood interruption. In Group A, the ligamentum teres was cut off. In Group B, the marrow cavity of the right femoral neck was destroyed while in Group C, the soft tissues at the base of the femoral neck were stripped in addition to the resection of the ligamentum teres and destruction of the marrow cavity. Three hours after surgery, SPECT/ CT was performed. Laser Doppler Flowmetry (LDF) measurements were also obtained at three different time points (before operation, immediately and three hours after operation) in order to assess the change process of blood supply to the femoral head. Results: SPECT/CT showed no significant difference in the radionuclide uptake between the right and left femoral heads in Group A (t=-0.09, P=0.94) and Group B (t= 0.52, P=0.62). However, in Group C, it was 261 ±62 for the right femoral head, only 12% of that in the left femoral head. LDF measurements indicated that the femoral head perfusion was decreased from (45.0±3.3) PU to (39.1±3.7) PU in Group A, from (44.0±2.7) PU to (34.3±2.6) PU in Group B, and from (47.3 ±2.1) PU to (4.96±0.6) PU in Group C immediately after operation. However, the perfusion was restored and returned to normal values three hours after operation except in Group C. Conclusion: SPECT/CT could assess the perfusion of the femoral head semiquantitatively, which might be useful in predicting the development of traumatic AVN.     

颈部动脉增强磁共振血管成像51例分析

目的分析测试团块时间-信号曲线颈部动、静脉峰值差和不同的成像扫描方法对颈部动脉增强磁共振血管成像（CE-MRA）图像的影响。方法 51例患者接受颈部CE-MRA。对36例应用3D-FLASH序列（3D组）,15例加用并行采集成像技术（iPAT,iPAT组）。对受检者均行2D-PC定位,在双侧颈动脉中心层面冠状位行3 ml/s小剂量（1~2 ml）Gd-DTPA测试团块。应用平均曲线对头臂静脉、上腔静脉、主动脉弓、颈总动脉、颈内静脉ROI绘制时间-信号强度曲线,测其峰值时间。分别评估图像动脉显影均匀度及静脉窦、颈内静脉、头臂静脉对观察动脉的影响。结果 51例受检者颈动脉测试峰值时间为（14.17±2.90）s,42例颈动、静脉峰值差为（7.95±2.12）s,36例上腔静脉（两次体循环）两次峰值时间间隔为（17.06±3.21）s。两组动脉显影均匀度差异无统计学意义,静脉窦显影对观察颈内动脉的影响两组差异有统计学意义（χ2=7.465,P〈0.05）。结论颈部动脉CE-MRA中,应用测试团注,可获得动、静脉峰值时间和二次循环间隔时间,应用合适的成像序列和延迟时间可获得高质量的动脉血管图像。     

MRA 、IPVG及DUS在门静脉高压症血流动力学研究中的应用价值

目的 探讨磁共振血管造影（MRA）、间接门静脉造影（IPVG）、多普勒超声（DUS）在门静脉高压症血流动力学研究中的应用价值。方法 对38例肝硬变门静脉高压症患者进行MRA检查，检测门静脉系统解剖显像和血流量，分别与IPVG和DUS的结果进行比较。结果 MRA成像结果优于IPVG，能很好显示门静脉及其属支；对流速、流量的测定结果与DUS所测结果有正相关性。结论 MRA能较好显示门静脉系统解剖影像，并可测得流速、流量，应成为门静脉高压症血流动力学研究的首选方法。     

磁共振血管造影诊断永存三叉动脉

目的探讨永存三叉动脉（PTA）及变异型永存三叉动脉（PTAV）的MRA表现及临床意义。方法回顾性分析11例PTA和3例PTAV患者的MRA资料。结果本组PTA和PTAV的发生率分别为0．18％（11／6153）和0．05％（3／6153）。根据PTA走行及与外展神经的关系,II例PTA分为外侧型PTA10例,中央型PTAI例;其中基底动脉发育正常I例,中度发育不良4例,重度发育不良6例。3例PTAV患者基底动脉发育均正常。结论MRA能明确诊断PTA及PTAV,清楚显示其走行及与相邻神经、血管的关系,对神经外科手术具有一定指导意义。