16层螺旋CT颈部血管成像的初步临床应用

目的:探讨颈部血管(颈动脉、椎动脉)16层螺旋CT血管造影成像技术及其临床应用价值。材料和方法:38例临床怀疑颈动脉及椎动脉狭窄者,经16层螺旋CT扫描后,用薄层横断面放大图像(MTI)及最大密度投影(MIP)、多平面重建(MPR)、曲面重建(CPR)等后处理方法,进行管腔及管壁斑块的形态学显示,并用高级血管分析软件测量狭窄段径线、狭窄段长度等作定量分析。结果:38例共计76支颈动脉、76支椎动脉CTA图像中,正常颈动脉血管40支,狭窄血管36支,其中1支颈总动脉中度狭窄者合并有动脉瘤;76支椎动脉中,6支椎动脉狭窄,受压于邻近椎体骨质;38例中有9例行颈动脉DSA检查,18例做了颈动脉多普勒超声(TCD),7例DSA和16例TCD对照结果一致,2例CTA轻度狭窄者TCD显示正常,11例颈动脉斑块均为混合密度斑块。结论:16层螺旋CT颈部血管成像图像质量满意,重建图像质量高,能较准确显示管腔狭窄及管壁斑块形态学改变,满足临床诊断需要,具有很好的临床筛查及实用价值。     

16排CT诊断颈动脉狭窄病变的应用价值

目的：探讨16排螺旋CT颈动脉成像（CTA）的临床应用价值。方法：对颈动脉支配区脑梗死的住院患者行16排螺旋CT颈动脉成像检查，采用VR、MIP、SSD和VE技术重建三维颈动脉图像。结果：正常4例，异常30例，共观察颈动脉68支，其中正常血管25支，狭窄血管43支。16排螺旋CT颈部血管成像能清楚显示颈部血管，对决大部分的颈部血管狭窄能迅速，准确的诊断。结论：螺旋CT、CTA检查是一种显示颈部血管狭窄病变有价值的检查方法，对怀疑颈动脉狭窄的进行筛查及临床治疗方案的制定有重要的指导作用。     

下肢动脉闭塞性病变的64层CT血管造影与DSA的对照研究

目的对照DSA,研究64层螺旋CT血管造影(CTA)对下肢动脉闭塞性病变诊断的临床应用价值。方法对31例下肢动脉闭塞性病变患者行64层螺旋CTA检查,检查后2周内行DSA。CT数据重建采用最大密度投影、容积重建及多平面重建技术。DSA采用步进跟踪造影技术或分段DSA进行下肢血管检查,将CTA与DSA结果比较。结果在216个动脉节段中,2种检查方法狭窄程度显示一致的有157个,被CTA高估13个,低估6个。CTA对下肢动脉狭窄程度≥50%诊断的灵敏度为98.21%,特异度96.15%,准确率97.22%,阳性预测值96.49%,阴性预测值98.04%。结论64层CT血管造影是下肢动脉闭塞性病变评估的可靠方法,可为制订介入治疗方案提供准确的参考依据。     

64排128层螺旋CT血管造影成像技术对颈内动脉粥样硬化狭窄性病变的诊断价值简

目的：探讨64排128层螺旋CT血管造影成像技术（MSCTA）在颈内动脉粥样硬化狭窄性病变诊断中的应用价值。方法回顾性分析行颅颈部CTA检查的31例缺血性脑血管病患者的临床资料,患者全部行颅颈部CTA检查,对其颈动脉成像质量进行评价。结果本组31例缺血性脑血管病患者检查共发现病变血管43支,轻度狭窄20支（46％）,中度狭窄14支（33％）,重度狭窄7支（16％）,闭塞2支（5％）。其中1级可评价血管显示率为87％,2级可评价血管显示率为11％,3级可评价血管显示率为2％。结论64排128层MSCTA可用于颈内动脉粥样硬化狭窄性病变的诊断。     

64层螺旋CT血管造影在诊断颅颈部血管病变中的应用

目的：探讨64层螺旋CT用于颅颈部血管成像的技术操作要点,分析影响成像质量的因素,评价64层螺旋CT无创性颅颈部血管造影在诊断颅颈部血管疾病中的临床应用价值。方法：对进行了CTA检查的50例怀疑颅颈部血管疾病患者的资料进行回顾性分析,以DSA及手术结果为金标准,评价CTA在颅颈部血管病变的诊断敏感性与准确性。结果：64层螺旋CT利用CTA显示动脉280节段,其中动脉狭窄235节段。与DSA或手术结果比较,符合的有260节段,不符合有20节段,不相符处主要表现在动脉狭窄的评估方面。CTA显示正常37节段,与DSA比较,符合31节段,不符合6节段。在所有检查结果中,以DSA或手术结果为金标准,经计算,其敏感性为97．4％。采用X^2检验统计学分析,CTA检查结果与DSA或手术结果之间差别无统计学意义。结论：64层螺旋CT颅颈部CTA成像无创、经济,简单易行,既能显示管腔又能显示管壁情况,弥补了DSA的不足。在颅颈部血管病变的诊断中具有较高的敏感性,可作为一种有效的无创性检测手段广泛用于颅颈部血管疾病的筛查、诊断和随访中。     

16层螺旋CT血管造影在颅内病变中的应用

目的:探讨16层螺旋CT血管造影(CTA)对颅内疾病的应用价值。方法:应用16层螺旋CT对43例脑血管病变和颅内肿瘤患者行CTA检查,全部病例均采用多平面重建(MPR)、曲面重建(CPR)、表面遮盖显示(SSD)、最大密度投影(MIP)、三维容积重建(3D-VR)等技术显示脑血管,对脑血管显示情况进行评价,并将结果与DSA和/或手术结果比较。结果:43例患者CTA脑血管主干及1~3级分支血管显示率为100%;CTA检查未见异常4例,动脉瘤20例,血管畸形8例,缺血性脑血管病7例,脑肿瘤4例,其中21例行DSA检查,13例行手术治疗;与DSA比较,CTA对动脉瘤的敏感性为92%(12/13),CTA清晰地显示了瘤体、瘤颈、载瘤动脉及其详细关系,CTA显示的瘤体小于手术所见;CTA显示的畸形血管团大小、部位、供血动脉和引流静脉与DSA及手术所见相符;CTA显示脑血管狭窄、中断部位、形态与DSA一致;CTA显示了肿瘤与周围血管和颅骨间的三维关系。结论:16层螺旋CT血管造影对颅内各种血管性病变的诊断及显示血管与其他颅内病变的三维空间关系具有重要价值,是诊断颅内病变的重要而有效的检查方法。     

螺旋CT血管造影及CT仿真内窥镜诊断颈动脉狭窄

目的评价CT血管造影(CTA)、CT仿真内窥镜(CTVE)诊断颈动脉狭窄的价值.材料与方法9例18支颈动脉行CTA、CTVE、MRA、DUS检查,3例颈动脉重度狭窄者行颈动脉内膜切除术.CTA螺旋CT扫描,层厚3mm,螺距1.0.最大密度投影(MIP)及遮盖表面显示法(SSD)3D血管重建.CIVE导航系统行颈动脉C1VE成像.结果颈动脉轻度狭窄6支,中度狭窄3支,重度狭窄4支,5支正常.显示斑块、附壁血栓13支.8支颈动脉与DSA对照7支相符.3例手术所见与CTA对比一致性较好,术后狭窄解除,斑块消失.结论CTA能准确评估血管狭窄程度,显示斑块.CIVE能观察狭窄管腔内部形态及斑块.     

多层螺旋CT颈动脉血管成像技术与临床应用初步探讨

目的分析颈血管疾病多层螺旋CT(multislicespiralCT,MSCT)影像学特征,并初步评价其临床应用价值。方法本组研究共搜集80例行颈动脉血管成像检查的患者,其中15例同时行DSA检查。分析MSCTA图像质量;比较同1例患者的CTA及DSA结果,评价SCTA诊断颈动脉狭窄的准确性。比较几种CTA后处理方法对管壁钙化显示情况并进行统计学分析。结果本组15例共计60支颈/椎动脉与同期DSA结果进行对照。MSCTA诊断颈/椎动脉狭窄的敏感度89.5%,特异度92.7%,阴性预测值95%,Kappa值0.81。同时,最大密度投影(MIP)、容积重建(VR)等技术能较好显示颈脉动脉管壁钙化情况,较易获得满意图像质量。结论多层螺旋CT血管成像技术作为一种无创性检查颈部血管疾病的方法,有望作为诊断此类疾病的首选检查手段。     

双源64排螺旋CT血管成像对下肢动脉狭窄及闭塞性病变的诊断价值

目的：通过双源64排螺旋CT血管成像（CTA）与数字减影血管造影（DSA）进行比较,探讨双源64排螺旋CTA对下肢动脉狭窄及闭塞性病变的诊断价值。方法采用德国西门子公司生产的双源64排螺旋CT对30例临床怀疑下肢动脉狭窄及闭塞性病变的患者进行双下肢动脉血管成像检查,扫描范围自腹主动脉下段至足底,扫描层厚0．75 mm,管电压120 kV,管电流250 mAs,将原始图像送入工作站进行图像后处理,主要包括容积再现（VR）、最大密度摄影（MIP）、多平面重建（MPR）、曲面重建（CPR）,并结合原始图像进行分析,所有患者1周后行DSA检查,以DSA作为参考标准,对诊断一致性、敏感性、特异性和狭窄部位的检出准确率进行计算。结果在720个动脉节段中,700个节段在CTA和DSA均可以显示,以DSA作为诊断标准,双源64排螺旋CTA诊断下肢动脉闭塞的敏感性、特异性、准确性分别为99.3％、97．8％、97．8％;对于显示中度以上的狭窄,双源64排螺旋CTA的敏感性、特异性、准确性分别为99．7％、97．6％、95．6％;双源64排螺旋CTA在诊断下肢动脉狭窄及闭塞性病变与DSA结果一致性好（kappa值＝0．937）。结论双源64排螺旋CTA可以作为下肢动脉狭窄及闭塞性病变的首选检查手段,对临床具有重要的指导价值。     

多层螺旋CT血管造影诊断髂及下肢动脉闭塞性病变的价值

目的:评价多层螺旋CT诊断髂及下肢血管闭塞性病变的价值。材料和方法:185例怀疑髂总动脉及下肢动脉闭塞性病变的患者行16层螺旋CT血管造影检查。其中大动脉炎6例,外伤4例和动脉粥样硬化175例。采用16层螺旋CT,层厚1.25mm,重建间隔1mm。100mL非离子造影剂(300mgI/mL)以4mL/s的速度经手背静脉或肘静脉注入,注射开始后25~30S进行扫描。在工作站获得多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)和容积重建(VR)图像,并应用血管分析软件测量血管狭窄程度。结果:128例CTA可显示髂及下肢动脉狭窄/闭塞。有7例患者行血管内支架治疗;26例行人工血管架桥或大隐静脉植入手术,31例患者同时进行了MSCTA和DSA检查。MSCTA对腘动脉以上和腘动脉以下狭窄和闭塞显示与DSA一致性好。结论:多层面螺旋CT是下肢血管病变的术前评价和术后复查非常有用的影像手段,可以替代有创的诊断性血管造影检查。     

CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography

BACKGROUND AND PURPOSE: To compare multisection CT angiography (CTA) analyzed with source/maximum intensity projection (MIP) images as well as semiautomated vessel analysis software with intra-arterial digital subtraction angiography (DSA) in detection and grading of carotid artery bifurcation stenosis. METHODS: Consecutive patients with sonography evidence of a marked internal carotid artery stenosis underwent both carotid CTA and DSA (37 patients, 73 vessels). In CTA, the grade of stenosis was determined using axial source and MIP images as well as vessel analysis. The scans were blind-analyzed by 2 neuroradiologists using the NASCET criteria. RESULTS: Correlation of CTA source/MIP images versus DSA estimates of stenosis (R = 0.95) was higher than for the vessel analysis method versus DSA (R = 0.89). Compared with DSA, CTA source/MIP images underestimated high (78.2% versus 86.4%, P < .05) and moderate grades of stenosis (57.3% versus 63.1%, P < .05) to a lesser extent than the vessel analysis method (68.5% versus 83.5% and 51.8% versus 63.1%, P < .05). For a high-grade stenosis, sensitivity and specificity of source/MIP image CTA were 75% and 96%, respectively, whereas for the vessel analysis method, they were 47% and 96%, respectively. For moderate stenosis, the source/MIP image CTA sensitivity and specificity were 88% and 82%, respectively, and for vessel analysis method, 62% and 82%, respectively. CTA detected all 4 occlusions. CONCLUSION: In evaluation of carotid stenosis, CTA provides an adequate, less invasive alternative with a high correlation to conventional DSA, though it tends to underestimate clinically relevant grades of stenosis. Its accuracy is not improved by semiautomated analysis. The data support the use of CTA in confirming carotid occlusion.     

Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography

Dual-energy CT can be applied for bone elimination in cerebral CT angiography (CTA). The aim of this study was to compare the results of dual-energy direct bone removal CTA (DE-BR-CTA) with those of digital subtraction angiography (DSA). Twelve patients with intracranial aneurysms and/or ICA stenosis underwent a dual-source CT in dual-energy mode. Post-processing software selectively removed bone structures using the two energy data sets. Three-dimensional images with and without bone removal were reviewed and compared to DSA. Dual-energy bone removal was successful in all patients. For 10 patients, bone removal was good and CTA maximum-intensity projection (MIP) images could be used for vessel evaluation. For two patients, bone removal was moderate with some bone remnants, but this did not inhibit the three-dimensional visualization. Three aneurysms adjacent to the skull base were only partially visible in conventional CTA but were fully visible in DE-BR-CTA. In five patients with ICA stenosis, DE-BR-CTA revealed the stenotic lesions on the MIP images. The correlation between DSA and DE-BR-CTA was good (R ²=0.822), but DE-BR-CTA led to an overestimation of stenosis. DE-BR-CTA was able to eliminate bone structure using only a single CT data acquisition and is useful to evaluate intracranial aneurysms and stenosis.     

64层螺旋CT血管成像对下肢动脉系统疾病的应用价值

目的:探讨64层螺旋CT血管成像术在下肢动脉疾病中的应用价值及技术优势。方法:对21例疑有下肢动脉疾病患者行64层螺旋CT增强扫描,扫描范围从肾动脉水平达足底。薄层重建横断面图像传入Wizard工作站,进行血管三维重建。其中21例结合常规血管造影评价64层螺旋CT血管成像术(CTA)的准确性。结果:在441个动脉节段中,435个节段在CTA与DSA均可以显示,在DSA图像上,狭窄闭塞的节段共130个(轻度狭窄16段,中度狭窄12段,重度狭窄22段,闭塞80段),最大密度投影(MIP)显示中度以上狭窄的敏感性、特异性及准确性分别为:99.1%、99.7%、99.5%。结论:64层CT血管成像是一种高度准确、非侵袭性的成像技术,在评估下肢动脉疾病方面与常规血管造影结果无明显差别,是下肢动脉疾病较好的影像学检查手段。     

40层螺旋CT血管成像在下肢闭塞性动脉硬化症诊断中的应用价值

目的探讨40层螺旋CT血管成像(40-slice computedtomographic angiography,CTA)在下肢闭塞性动脉硬化症(arterioscleroticocclusive disease,ASO)诊断中的价值。方法对临床可疑下肢ASO的27例患者行CT血管成像检查,将数据在Lenonado工作站行容积再现(volume rendering,VR)、最大密度投影(maximum intensity projection,MIP)、曲面重建(curved planar reformation,CPR)及多平面重建(Multiplanar reformation,MPR)等多种后处理并结合原始图像进行综合分析。结果 27例432支血管中均存在以下不同程度的狭窄或闭塞,0级55支,Ⅰ级103支,Ⅱ级104支,Ⅲ级96支,Ⅳ级74支,下肢Ⅲ级以上狭窄最多发生在胫前动脉。9例患者术中所见与CTA一致。结论 40层螺旋CT血管成像可以清晰显示ASO的下肢动脉病变,了解下肢动脉狭窄程度及闭塞情况,对下肢动脉硬化性闭塞性病变的术前明确诊断和筛选治疗方案有很大的帮助。     

64层螺旋CT数字减影术对头颈部动脉成像应用研究

目的:探讨64层螺旋CT数字减影技术对头颈部动脉成像的优势。方法:对25例怀疑头颈部血管病变患者行64层螺旋CT血管减影成像检查,用特殊头部固定装置固定头颅,先行平扫,然后以相同的扫描参数行增强扫描,将增强前后图像送至工作站进行减影,利用inspace从减影的图像中提取动脉,进行血管重组,其中15例同时行常规CTA检查,8例行DSA检查,比较减影CTA与常规CTA的成像速度、图像质量,并与DSA成像比较。结果:25例均能显示颈总动脉、颈内动脉、椎动脉及主要分支,其中17例颈椎及颅底骨质完全减去,血管显示良好,8例因检查时头部轻微动或做吞咽动作而造成部分颈椎骨及颅底骨未完全减去,但动脉仍能显示,减影CTA平均成像时间4.3min,常规CTA平均成像时间24.3min,2种成像技术比较,颈部动脉图像质量无明显差别,减影CTA对颅内动脉主干及更多分支的显示优于常规CTA,减影CTA与8例DSA比较图像完全相同。结论:64层螺旋CT血管减影技术省时省力、便捷灵活、图像质量好,值得在临床推广。     

64层螺旋CT脑血管造影在颅内动脉瘤诊断中的应用

目的:与DSA相对照,探讨64层螺旋CT脑血管造影在颅内动脉瘤中的诊断价值。方法:对29例临床怀疑颅内动脉瘤的患者行64层螺旋CT脑血管造影(CTA)和DSA检查,使用GE64层Lightspeed VCT获得原始图像,所有病例均采用多层面重建(multiplanar reconstruction,MPR)、容积再现(volume rendering,VR)、薄层块最大密度投影(thin-slab maximumintensity projectjon,TS MIP)。后处理图像及DSA图像由2位放射科医生共同评估。结果:29例患者中,DSA证实25例共27个动脉瘤,其中2例为2个动脉瘤。与DSA结果相对照,CTA共检出25例26个动脉瘤,漏诊了1个颈出动脉瘤。CTA清晰显示了动脉瘤的形态、大小及载瘤动脉,3例动脉瘤瘤颈DSA未显示,CTA显示了全部动脉瘤的瘤颈。结论:64层CTA在颅内动脉瘤的诊断中具有极高价值,特别在显示动脉瘤瘤颈方面具有独特的优势,对临床治疗具有指导意义。     

螺旋CT肾动脉成像与数字减影血管造影的对比分析

目的:客观评价螺旋CT肾动脉成像的临床应用价值.材料和方法:从本院螺旋CT肾动脉成像(CTRA)资料中选取31例曾做过DSA肾动脉造影(含动脉成形和支架放置术)者,CTRA和DSA图像分别先由两位医师独立观察.分析内容包括解剖变异、有无狭窄及进行狭窄程度分级.最后将结果进行对比分析.结果:CTRA发现狭窄血管33支,其中31支经DSA证实(2支假阳性).符合率为94%.清楚显示5支副肾动脉(经DSA证实).结论:CTRA是肾性高血压筛选的可靠方法并可取代DSA作为首选检查方法.     

Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler

OBJECTIVE: assessment of the degree of stenosis is the central point in the treatment of carotid stenosis. The purpose of our study was to assess whether invasive CT angiography (CTA) is a feasible alternative to the current invasive gold standard carotid digital subtraction angiography (DSA) and the current non-invasive gold standard color flow doppler. SUBJECTS AND METHODS: about 178 patients with cerebrovascular disease underwent digital subtraction angiography (DSA), CFD and CTA. CTA was performed on a Somatom plus 4 (Siemens, Erlangen Germany). CT was performed with 2/3/2 (collimation/table feed/reconstruction interval) or 2/3/1 mm, start delay 15-20 s, flow 2.5-3.0 ml/s, using 120 ml non-ionic contrast medium (300 mg J/ml). Quantification of degree of stenosis was based on the perfused area in the axial slices. Plaque morphology (soft and hard) and ulceration were evaluated. RESULTS: CTA detected nine cases of significant stenosis, which had been underestimated by DSA. CTA failed in two cases of a membraneous stenosis, which were underestimated, and in two cases with teeth artifacts. Calcifications were more readily appreciated by CTA than in CFD. In this respect, both methods were superior to DSA. CFD, DSA and CTA had a sensitivity of 100% for occlusions, respectively. CONCLUSION: CT angiography is useful in case of inconclusive CFD in the pre- and postoperative phase, and as a third modality in case of disagreement between DSA and CFD.     

Spiral CT angiography of renal arteries: comparison with angiography

A prospective study was carried out to determine the accuracy of spiral CT angiography (CTA) in the detection of renal artery stenosis (RAS). Eighty-two patients with arterial hypertension underwent CTA and digital subtraction angiography (DSA) to exclude RAS. For CTA a contrast medium bolus of 100–150 ml (flow rate 3 ml/s) was injected. A 24 or 40 s CTA was started at the origin of the superior mesenteric artery after a delay time determined by test bolus injection (collimation = 2 mm, pitch = 1/1.5). For stenosis detection transverse images supported by maximum intensity projections (MIP) or multiplanar reconstruction projections were used. Of 197 renal arteries examined (including 33 accessory arteries), 34 RAS were visualized using DSA. With CTA, one hemodynamic RAS was missed and one additional hemodynamic RAS was found. Sensitivity/specificity was calculated to be 94 %/98 %. For hemodynamically relevant RAS (> 50 %) the sensitivity/specificity was 96 %/99 %. CTA additionally depicted five adrenal masses. The high accuracy rate of RAS detection thus allows the use of CTA as a screening method in patients with arterial hypertension to exclude a renovascular cause. Received: 23 June 1997; Revision received: 6 January 1998; Accepted: 29 April 1998