Dynamic CT diagnosis of primary dissecting aneurysm of the renal artery

Incremental dynamic CT clearly demonstrated primary dissecting aneurysm of the renal artery in a 36-year-old man presenting with loin pain. A sustained dense bolus in abdominal dynamic CT is vital if branch artery abnormalities are to be diagnosed.     

Proximal interruption of a main pulmonary artery with transpleural collateral vessels: CT and MR appearances

The plain chest radiographic, CT, and MR findings in a 31-year-old woman with proximal interruption of the right main pulmonary artery and transpleural collaterals are presented. The diagnosis can be established by both dynamic CT and MR. Intercostal collaterals and their transpleural connections are best demonstrated with dynamic CT.     

Vertebral artery dissection diagnosed with CT.

Vertebral artery dissection after neck manipulation has been well described. A case of bilateral vertebral artery dissection diagnosed with dynamic CT scanning of the neck is reported. The CT appearances and correlative angiographic and MR findings are presented.     

Anomalous origin of right coronary artery: diagnosis and dynamic evaluation with multidetector computed tomography

16 slice multidetector CT findings of an anomalous right coronary artery originating from the left sinus of Valsalva are presented. Multidetector CT depicted the malignant coronary anomaly in great anatomic detail as well as enabled dynamic evaluation through the cardiac cycle, documenting a substantial reduction in arterial diameter during peak systole. This case illustrates the full capabilities of multidetector cardiac CT in the evaluation of coronary artery pathology.     

Multiplanar computerized angiotomography in the evaluation of aneurysms of the posterior inferior cerebellar artery

Two cases of posterior inferior cerebellar artery aneurysms are reported. The diagnosis was made by dynamic multiplanar computerized tomography and afterwards confirmed by angiography and surgery. The role of CT in the diagnosis and follow-up of subarachnoid hemorrhage is discussed. Intracranial posterior fossa aneurysms are nicely demonstrated and localized by dynamic multiplanar CT.     

Dynamic CT of the laterosellar extradural venous spaces

We evaluated the ability of dynamic CT scanning to accurately demonstrate the laterosellar extradural venous spaces. Careful examination of 680 consecutive patients with this technique has permitted us to describe four main venous groups: the veins of the lateral wall (present in 98% of cases), the vein of the inferolateral group located beneath cranial nerve VI (present in 92% of cases), the medial vein located between the internal carotid artery and the pituitary gland (present in 20-30% of cases), and the vein of the carotid sulcus located between the intracavernous internal carotid artery and the lateral wall of the sphenoid bone (present in 65% of cases). The vein of the carotid sulcus is absent only when the internal carotid artery lies close to the sphenoid bone. In 12 patients with suspected cavernous sinus invasion, dynamic CT scanning demonstrated obliteration of the vein of the carotid sulcus. In five patients with huge tumors of the temporal region, dynamic CT scanning of the cavernous sinus permitted demonstration of normal laterosellar extradural venous spaces, thus permitting exclusion of intracavernous sinus invasion. We believe dynamic CT is the imaging technique best suited for studying the laterosellar extradural venous spaces. Its spatial resolution and dynamic capacity make it superior to MR, and it should be the first procedure when invasion of the cavernous sinus by a pituitary tumor is suspected.     

胃右动脉起源变异在肝癌介入治疗中的意义

目的探讨胃右动脉起源变异在肝细胞癌介入治疗中的指导意义。方法对72例原发性肝细胞癌患者行64层螺旋CT肝脏动态增强扫描,动脉期采用容积再现（VR）及最大密度投影（MIP）重建技术,追踪重建显示胃右动脉的起源与肝动脉的关系,并与血管造影结果对比。结果在72例原发性肝细胞癌患者中,VR及MIP清楚显示胃右动脉起源者43例,显示率为59.8%。胃右动脉起源于肝固有动脉19例,肝左动脉17例,胃十二指肠动脉4例,肝右动脉2例,肝总动脉1例。三维重建结果显示与血管造影一致。结论胃右动脉起源变异多发自肝左动脉,64层螺旋CT三维重建可提供胃右动脉血管影像资料,对介入治疗具有实用意义。     

Dynamic CT perfusion imaging with acetazolamide challenge for the preprocedural evaluation of a patient with symptomatic middle cerebral artery occlusive disease

We describe the use of a CT-based method of cerebral perfusion imaging, dynamic CT perfusion imaging, for the pre- and postprocedural assessment of cerebral blood flow in a patient with symptomatic middle cerebral artery occlusive disease who underwent balloon angioplasty with stent placement in the affected artery. Dynamic CT perfusion imaging represents a widely available and minimally invasive alternative to other available methods of cerebral perfusion imaging.     

Renal trauma: radiological studies. Comparison of urography, computed tomography, angiography, and radionuclide studies

Excretory urography, computed radionuclide urography, angiography, and both conventional and dynamic computed tomography (CT) were compared with regard to accuracy, sensitivity, and specificity in 388 patients with renal trauma. Used as the triage examination, urography established the absence of significant renal injury with an accuracy of 87%, obviating further evaluation. Dynamic CT proved to be the best method of assessing parenchymal injuries, establishing the correct diagnosis in 129 out of 130 cases compared to 116/130 for conventional CT. Angiography was the procedure of choice for diagnosis and categorization of renal artery injuries, which were diagnosed correctly in all 43 cases. The choice between dynamic CT and angiography as the second examination rests upon careful evaluation of clinical and urographic findings for signs of renal artery injury which would mandate angiographic assessment.     

Bronchial arteries: CT demonstration with arteriographic correlation

Dynamic computed tomography (CT) was performed in nine patients with enlarged bronchial arteries documented by arteriography. Plain and contrast-material-enhanced CT scans of two more patients with prominent bronchial arteries were retrospectively reviewed. The study was conducted to determine visibility of the bronchial artery with CT and to depict the anatomic relationship of its mediastinal portion to surrounding structures. The mediastinal portion of the bronchial artery was successfully outlined as nodular or linear densities on all dynamic CT scans. The right bronchial artery was confirmed to arise from the medial wall of the thoracic aorta, whereas the left arises from the anterior wall. Because of its retroesophageal location, the enlarged right bronchial artery can compress the posterior wall of the esophagus. It is postulated that the left bronchial artery occasionally traverses the aorticopulmonary window, recognized as nodular or linear densities below the aortic arch on CT scans.     

16排螺旋CT在高危胸痛诊断中的应用

目的:通过一次CT扫描同时完成冠状动脉、主动脉和肺动脉CTA检查,鉴别上述高危胸痛,探讨16排螺旋CT在高危胸痛诊断中应用价值。方法:2005年12月~2008年6月住院及急诊胸痛患者46人。应用两种方法行行一次性胸痛三联检查。结果:46例患者一次检查均可清晰显示肺动脉段以上分支、胸主动脉及冠状动脉左右主干及主要分支。共发现冠状动脉狭窄42例,肺动脉栓塞5例,主动脉夹层2例。结论:16排螺旋CT一次动脉期增强扫描显示肺动脉、胸主动脉及冠状动脉,对胸痛病因的诊断及鉴别诊断具有重要意义。     

CT扫描对肺隔离症的诊断价值

目的 :探讨CT扫描对肺隔离症的诊断价值。方法 :搜集经手术病理、主动脉造影证实的 2 1例肺隔离症。所有病例均行CT平扫及增强扫描 ,其中 5例行螺旋CT动态增强扫描。结果 :16例CT表现为含气体或液体的囊肿和 /或软组织肿块 ,5例肿块周围可见肺气肿。 16例非含气囊肿平扫密度均匀 ,增强扫描 7例无明显强化、5例为薄壁环形强化、4例为厚壁周围性强化。无强化区的病理成分为粘液、脓液或胶样液体。CT显示出 14支异常供血血管 ( 14 / 2 1) ,螺旋CT显示率 ( 4 / 5 )高于普通CT( 10 / 16)。结论 :肺隔离症的主要CT表现是囊肿、结节或肿块 ,增强CT扫描、螺旋CT动态增强扫描能发现平扫所不易显示的结节和肿块内部的囊性成分 ,有助于隔离肺异常供血血管的显示 ,后者对发现细小的异常供血血管有较大价值     

大脑中动脉高密度征的动态CT表现与临床

目的探讨大脑中动脉高密度征(HMCAS)在大脑中动脉(MCA)供血区超急性期梗死的诊断价值。方法对46例MCA供血区超急性期脑梗死(发病6h内)的CT征象及临床表现进行分析,并定期复查CT观察其动态变化。结果MCA供血区超急性期脑梗死46例中表现为HMCAS者32例(71.1%),临床均为完全前循环梗死(TACI),25例死亡(78.1%),其中HMCAS进展且合并MCA点状征的14例中12例(85.7%)死亡,其余均遗留严重神经功能缺损;而无HMCAS的14例中8例为部分前循环梗死(PACI),6例为TACI,仅2例(14.3%)死亡,两者差异具有统计学意义(P<0.01)。3例HMCAS在复查随访时消失,病人病情好转且均转化为出血性脑梗死。结论大脑中动脉高密度征的动态CT变化有助于MCA供血区超急性期脑梗死的诊断及预后判断。     

64层螺旋CT对急性肠系膜血管栓塞的诊断价值分析

目的 探讨64层螺旋CT血管造影对急性肠系膜血管栓塞(AMI)的诊断价值.方法 回顾性分析经64层螺旋CT全腹平扫加多期动态增强扫描诊断的15例AMI.其中,肠系膜上动脉栓塞3例(完全栓塞1例,不完全栓塞2例),肠系膜上静脉栓塞12例.结果 15例AMI直接征象:动脉期显示肠系膜上动脉完全或部分充盈缺损,可诊断为肠系膜上动脉完全或部分栓塞(3例).静脉期显示肠系膜上静脉完全或部分充盈缺损,可诊断为肠系膜上静脉完全或部分栓塞(12例);间接征象“缆绳征”12例,肠系膜水肿10例,肠管壁增厚12例,肠管扩张、积液8例,肠壁强化减弱7例,其中2例可见节段性未强化区,腹水6例,肾前筋膜增厚4例,肠壁积气2例.平扫肠系膜上动脉或上静脉高密度征7例(静脉栓塞6例,动脉栓塞1例),肠系膜上静脉栓塞累及门静脉、脾静脉6例,其中4例在增强扫描时,可见肝脏异常低灌注区.结论 64层螺旋CT平扫加多期动态增强扫描对急性肠系膜血管栓塞的诊断及时准确,应作为临床怀疑肠系膜血管疾病首选检查方法,值得推广应用.     

The computed tomographic appearances in pulmonary artery atresia

Isolated pulmonary artery atresia is an uncommon congenital abnormality. Plain radiography and ventilation/perfusion lung scintigraphy may suggest the diagnosis but pulmonary angiography has traditionally been recommended for confirmation. The computed tomographic (CT) appearances of four patients with isolated atresia of a pulmonary artery are described. In each case the atretic segment of the abnormal vessel could be identified. Other CT findings included reduction of volume of the involved hemithorax, increased density of the affected lung, a small hilum, and an abnormal pulmonary vascular pattern thought to be due to the collateral systemic arterial supply to the intrapulmonary branches of the atretic pulmonary artery. The diagnosis of isolated pulmonary artery atresia can be made using dynamic, contrast enhanced CT without recourse to more invasive procedures.     

Dynamic incremental computed tomography in evaluation of the pulmonary hila

Contrast-enhanced dynamic computed tomography (CT) with table incrementation between scans was used to evaluate the hila in 100 patients without hilar abnormality and 15 patients with hilar pathology. This method of hilar evaluation was found to be superior to conventional CT because hilar vascular structures could be clearly opacified. Opacification of normal hilar vessels permitted accurate detection of hypovascular hilar masses, some of which were very small, nonlobular, and invisible using conventional CT. The technique was also found to be useful in evaluating the hila in patients with pulmonary artery dilatation or pulmonary opacification contiguous with hilar borders. We recommend that contrast-enhanced dynamic incremental CT be used for hilar investigation in patients referred for hilar CT examination unless there is a specific contraindication to contrast medium administration.     

320层动态容积CT血管成像在肺动脉栓塞中的诊断价值

目的探讨320层动态容积CT血管成像在诊断肺动脉栓塞中的价值。方法回顾性分析30例临床确诊为肺动脉栓塞的320层动态容积CT肺动脉成像资料,并用最大密度投影(MIP)、多平面重组(MPR)、容积再现(VR)等方法显示肺动脉。结果 30例患者中,其中左右肺动脉栓塞有15支,叶肺动脉栓塞30支,段及亚段肺动脉栓塞60支。偏心型45支,闭塞型40支,中央型12支,附壁环形型5支。结论 320层动态容积CT肺动脉成像可作为肺动脉栓塞诊断的首选方法。     

CT assessment of cerebral perfusion: experimental validation and initial clinical experience.

PURPOSE: To validate a dynamic single-section computed tomographic (CT) method to measure cerebral blood volume (CBV) and cerebral blood flow (CBF) by using a noncarotid artery as the input and to demonstrate the feasibility of this method in a pilot series of patients. MATERIALS AND METHODS: Twelve dynamic contrast material-enhanced CT studies were performed in beagles. CBV, CBF, and mean transit time (MTT) values were calculated by using an internal carotid artery (ICA) and a noncarotid artery as the input artery to the brain. Patient studies with use of the radial artery as the input were performed (a) repetitively in two patients after subarachnoid hemorrhage, (b) in a patient with a symptomatic ICA occlusion before and after the intravenous injection of 1 g of acetazolamide, and (c) in a patient with a malignant brain tumor. RESULTS: Linear regression analyses revealed highly significant correlations (P < .001) between CBV (r, 0.98; slope, 0.96), CBF (r, 0.89; slope, 0.87), and MTT (r, 0.80; slope, 0.76) values calculated with the ICA and the noncarotid inputs. The CT-derived patient data correlated well with ancillary clinical and neuroradiologic findings. CONCLUSION: Dynamic single-section CT scanning to measure CBV and CBF on the basis of a noncarotid input is a highly accessible and cost-effective blood flow measurement technique.     

Unilateral renal artery stenosis: perfusion patterns with electron-beam dynamic CT--preliminary experience

Renal dynamic computed tomographic (CT) data for 16 patients with unilateral renal artery stenosis were compared with those for 12 control subjects. Three patterns of perfusion were distinguished in stenotic kidneys: pattern A, symmetric time-attenuation curves; pattern B, asymmetric time-attenuation curve with similar perfusion; and pattern C, asymmetric time-attenuation curve with impaired perfusion. Additional functional data can be obtained from the initial timing scan in a CT study of unilateral renal artery stenosis.     

Common tumors of the parapharyngeal space: refined imaging diagnosis

Computed tomographic (CT) scans and magnetic resonance (MR) images in 103 patients with either a deep-lobe parotid tumor extending into the parapharyngeal space, a minor salivary gland tumor, a neuroma, or a paraganglioma were reviewed. The parotid or extraparotid nature of these masses was established by identifying a fat plane between the mass and the parotid gland. This was more reliably accomplished with MR imaging than with CT. Although dynamic CT allowed identification of the glomus tumors, MR imaging also permitted diagnosis of these lesions. The inherent CT and MR imaging characteristics of most of the neuromas and minor salivary gland tumors were indistinguishable. However, the neuromas tended to displace the internal carotid artery anteriorly, whereas the salivary lesions displaced this vessel posteriorly. This artery was better identified on MR images than on CT scans. Thus, these lesions, which are the four most common primary parapharyngeal space tumors, can be distinguished on MR images by evaluating not only their inherent signal characteristics but also the surrounding fat planes and any displacement of the internal carotid artery.