Intracranial physiological calcifications evaluated with cone beam CT

Objectives

The purpose of this study was to evaluate cone beam CT (CBCT) scans for the presence of physiological and pathological intracranial calcifications.

Methods

CBCT scans from male and female patients that met our ascertainment criteria were evaluated retrospectively (n = 500) for the presence of either physiological or pathological intracranial calcifications.

Results

Out of the 500 patients evaluated, 176 had evidence of intracranial physiological calcification (35.2% prevalence), and none had evidence of pathological calcification. There was a 3:2 male-to-female ratio and no ethnic predilection; the ages of affected patients ranged from 13 years to 82 years with a mean age of 52 years. The majority of calcifications appeared in the pineal/habenular region (80%), with some also appearing in the choroid plexus region bilaterally (12%), and a smaller subset appearing in the petroclinoid ligament region bilaterally (8%).

Conclusions

Intracranial physiological calcifications can be a common finding on CBCT scans, whereas pathological intracranial calcifications are rare.     

Agenesis of the internal carotid artery with a large hemangioma of the tongue

Summary A case of agenesis of the left internal carotid artery combined with a large cavernous hemangioma of the tongue is reported. The detailed angiographic findings are demonstrated together with the poly- or computed tomographic findings of the skull. A review of the pertinent literature is presented.     

Pseudoaneurysm of internal carotid artery secondary to tonsillectomy: Combined radiologic and surgical treatment

An unusual case of pseudoaneurysm of the internal carotid artery secondary to tonsillectomy is reported. The management consisted of combined intraoperative transcatheter embolization with surgical ligation of the internal cartoid artery.     

Artefacts in CBCT: a review

Artefacts are common in today's cone beam CT (CBCT). They are induced by discrepancies between the mathematical modelling and the actual physical imaging process. Since artefacts may interfere with the diagnostic process performed on CBCT data sets, every user should be aware of their presence. This article aims to discuss the most prominent artefacts identified in the scientific literature and review the existing knowledge on these artefacts. We also briefly review the basic three-dimensional (3D) reconstruction concept applied by today's CBCT scanners, as all artefacts are more or less directly related to it.     

颈内动脉颅内段硬化256层 CTA 表现

目的：研究颈内动脉颅内段硬化256层C T血管成像（CTA）表现。方法收集2013—2014年经256层C T A检查诊断头颈部动脉硬化402例,其中男274例,女128例,分析累及颈内动脉颅内段的发病率,分别观察动脉硬化斑块在不同性别、不同年龄组（≤60岁、＞60岁）、不同部位（左、右）特点及斑块长度、性质及血管狭窄率的差异。结果402例头颈动脉硬化累及颈内动脉颅内段164例（40．80％）,男38．32％,女46．09％（χ2＝2．182,P＝0．140）。两性别＞60岁组发病率均高于≤60岁组（χ2＜31．105, P＜0．001）,不同性别、年龄在部位发病率无显著差异（χ2＜0．035,P＞0．088）。斑块长度（按≤10 m m ,11～20 m m及＞20 m m分组）在男、女两性别不同年龄组间无显著性差异（χ2＜0．027,P＞0．091）。钙化斑块多见（79．81％）,混合斑块次之（15．46％）,脂质斑块、纤维斑块少见（1．58％,3．15％）。男性混合性斑块＞60岁年龄组较≤60岁年龄组多见（χ2＝12．204,P＝0．001）,其余不同性质斑块在不同性别、不同年龄组间未见显著差异。轻度狭窄多见（54．57％）,中度狭窄次之（39．75％）,重度狭窄少见（5．68％）,男女两性别在不同年龄组间血管狭窄率未见显著差异（χ2＜2．062,P＞0．151）。结论头颈部C T A对颈内动脉颅内段硬化诊断有重要作用。     

血管内治疗颈内动脉颅外段伴同侧颅内动脉急性串联闭塞

目的探讨颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者血管内治疗方法 ,评估其疗效和安全性。方法回顾性分析2015年1月至2019年12月在南阳市中心医院接受血管内治疗的63例颈内动脉颅外段伴同侧颅内动脉急性串联闭塞患者临床资料。根据治疗方式不同,分为顺行再通组(n=41)和逆行再通组(n=22)。采用改良溶栓治疗脑梗死(mTICI)血流分级判断术后血管再通程度,改良Rankin量表(mRS)评分评估术后90 d临床预后。结果两组患者年龄、性别、伴高血压病、伴糖尿病、伴心房颤动、吸烟史、术前美国国立卫生研究院卒中量表(NIHSS)评分、术前Alberta卒中项目早期CT评分(ASPECTS)、脑卒中病因等差异均无统计学意义(均P>0.05)。顺行再通组、逆行再通组分别有16例(39.0%)、15例(68.2%)接受急诊颈内动脉起始段支架植入(P=0.027),穿刺至再通时间分别为(138+55) min、(120+47) min(P<0.01),90 d恢复良好(mRS评分≤2分)分别有17例(41.5%)、15例(68.2%)(P=0.043),差异均有统计学意义。结论血管...     

Influence of exposure factors on the variability of CBCT voxel values: a phantom study

Objectives:

To assess the influence of milliamperage and kilovolt peak (kVp) on the variability of cone beam CT (CBCT) voxel values.

Methods:

CBCT scans were obtained from radiographic phantoms in varying concentrations of dipotassium hydrogen phosphate solutions (200–1200 mg ml⁻¹) under different protocols of milliamperage and kVp. In addition, scans were performed with and without a dental implant and exo-mass. The variability of CBCT voxel values was measured on each scan, and factorial analysis of variance and the post hoc Tukey test were performed (α = 0.05). Linear regression was performed to assess the relationship between voxel value variability and dipotassium hydrogen phosphate concentration.

Results:

milliamperage and the presence of a dental implant did not produce significant interference (p = 0.28 and 0.87, respectively) in voxel value variability. Scans at the highest kVp value presented a significant reduction (p ≤ 0.0001) in voxel value variability when only exo-mass was not present. Voxel value variability was not influenced by exo-mass in scans at the highest levels of milliamperage and kVp. The presence of exo-mass produced a significant reduction (p ≤ 0.0001) in voxel value variability in most of the scans. Higher concentrations yielded greater variations in voxel values in all scans, except for those operating at the highest levels of mAs and kVp.

Conclusions:

mAs did not influence the variability of CBCT voxel values; higher kVp reduced such variability when only the object was smaller than the field of view.     

Congenital absence and aberrant course of the internal carotid artery

We retrospectively reviewed the imaging features of an aberrant course of the internal carotid artery (ICA) in one patient and its unilateral absence in four. Absence of the ICA was initially detected by MRI and MR angiography in both patients who underwent these examinations. CT revealed an abnormal or absent carotid canal in all cases. Radiological diagnosis by MRI and MR angiography could play an important role in the diagnosis. Correspondence to: S. Takahashi     

牙周骨质丢失与颈动脉钙化相关性的无创性MSCT评价

目的：通过多层螺旋 CT(MSCT)容积成像技术探讨牙周骨质丢失(PBL)与颈动脉钙化的相关性及临床意义。方法回顾性分析270例可疑动脉粥样硬化患者颈部的 MSCT 检查,将原始数据进行薄层重建后进行颅外颈部动脉全程钙化积分的测量,根据平均积分情况将患者分为3组：颈动脉钙化积分<100分者为轻度钙化组;颈动脉钙化积分≥100分者为重度钙化组;颈部动脉无钙化者为对照组。应用 EBW4.5工作站对原始图像进行容积重现(VR)、多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)等多种后处理方法,观察记录各组口内存牙数及牙周骨质丢失情况。结果MSCT 容积成像技术可以在定量测量颈部动脉钙化程度的同时准确显示牙齿数目及牙周骨质丢失情况;颈动脉钙化者牙周骨质丢失牙位数高于对照组,存在统计学差异(P <0.01),且牙周骨质丢失牙位数与颈动脉钙化程度呈正相关。结论牙周骨质丢失与颈动脉钙化密切相关。MSCT 容积成像是定量评估颈动脉硬化与牙周炎严重程度的无创检查方法。     

Unilateral agenesis and hypoplasia of the internal carotid artery: a report of three cases

We report one patient with agenesis and two with hypoplasia of the internal carotid artery (ICA) from an angiographic series of 1275 consecutive patients. In all three patients, MRI and MR angiography were used to establish the anatomical situation; however, they may not clearly distinguish between hypoplasia and agenesis or acquired stenosis or occlusion of the ICA. In such cases, CT of the skull base may be obtained to clarify matters. In all patients, retrograde flow via a large posterior communicating artery was demonstrated. Single-photon emission computed tomography confirmed both the adequacy of cerebral perfusion and the preservation of vasomotor reactivity.     

Agenesis of an internal carotid artery: Angiographic,tomographic and computed tomographic correlation

Summary Congenital absence of one internal carotid artery was found by angiography in a woman of 52 years who had subarachnoid hemorrhage. The absence of the bony carotid canal on the affected side substantiated the congenital nature of this rare vascular anomaly. We believe this to be the first report of absence of the bony carotid canal and the intracavernous portion of the internal carotid artery confirmed by computed tomography and cavernous sinography.     

颅外颈内动脉损伤诊治方法的探讨

目的　探讨颅外颈内动脉损伤的早期诊断和治疗方法。方法　 1982～ 2 0 0 2年共收治颅外颈内动脉损伤 8例 ,其中颈内动脉破裂并休克 3例 ,并发栓塞 4例 ,假性动脉瘤 2例。行颈内动脉修补 2例 ,颈内动脉 -颈外动脉端端吻合 1例 ,颅内 -外动脉搭桥 2例 ,手术取栓 1例 ,瘤体切除加动脉修补 2例。结果无死亡 ,4例出现偏瘫失语等神经系统并发症 ,1例经颅内 -外动脉搭桥后完全康复 ,1例经取栓术后改善 ,2例经保守治疗症状轻度改善。余 4例除 1例遗有颈内动脉假性动脉瘤外 ,均痊愈。结论　早期诊断及颈内动脉修复重建是降低死亡率 ,减少神经系统并发症的关键     

Willis覆膜支架治疗颅段颈内动脉动脉瘤的前瞻性研究

目的评价Willis覆膜支架治疗颅段颈内动脉(ICA)动脉瘤的柔顺性和疗效。方法31例患者33枚颅段ICA(CICA)动脉瘤患者接受Willis覆膜支架治疗。根据血管造影表现,分为完全栓塞和不完全栓塞。术后第1,3,6,12个月及之后每年1次随访复查并收集最初及最终造影结果、死亡率、致残率及最终临床结果等数据。结果42枚覆膜支架中41枚顺利通过ICA并成功释放,成功率97.6%(95%CI:93%～102%)。术后即刻造影显示,23例患者中25枚为完全栓塞,占78.1%(95%CI:63%～93%);7例患者7枚动脉瘤为不完全栓塞(21.9%)。随访血管造影示27例患者共31枚动脉瘤,其中29枚完全栓塞,占93.5%(95%CI:84%～103%);2例为不完全栓塞(6.5%),其中2例患者出现轻度支架内狭窄。临床随访显示15例患者痊愈,14例症状改善。结论初步结果显示,Willis覆膜支架治疗CICA动脉瘤有效且具有良好的柔顺性,但仍需长期随访及大样本临床研究。     

介入分期开通症状性颈内动脉闭塞可行性临床研究

目的 探讨介入分期开通症状性颈内动脉闭塞(ICAO)的可行性和安全性,以及影响开通成功的因素.方法 回顾性分析43例接受介入分期开通支架成形术治疗的症状性ICAO患者,系统分析手术成功率、围术期并发症发生率及影响血管开通的因素.结果 43例患者中36例完成介入分期开通支架成形术,手术成功率为83.7％(36/43).1个月内新发脑梗死患者手术成功率高于半年内短暂性脑缺血发作患者(P＜0.05),ICAO侧眼动脉逆向血流在颈内动脉有反流患者手术成功率高于无眼动脉逆向血流反流患者(P＜0.05).1例患者二期术后3d出现同侧脑组织少量出血,1例二期术后出现脑过度灌注综合征,另1例一期术后出现同侧脑卒中新发梗死,围术期并发症发生率为6.9％ (3/43).结论 介入分期开通症状性ICAO技术上可行,有着较高的安全性.1个月内新发脑梗死、ICAO侧眼动脉逆向血流反流为开通成功的有利因素.     

Willis覆膜支架治疗颅内段颈内动脉病变临床应用

目的 评价Willis覆膜支架治疗颅内段颈内动脉病变的效果.方法 回顾性分析2013年4月至2015年4月采用Willis覆膜支架治疗的201例颅内段颈内动脉病变患者.术后3～6个月随访复查DSA和临床观察结果.结果 Willis覆膜支架成功治疗198例颅内段颈内动脉病变,其中囊性动脉瘤88例,外伤性动脉瘤19例,假性动脉瘤35例,外伤性颈动脉海绵窦瘘56例,技术成功率达到98.5％.Willis覆膜支架释放部位依次为颈内动脉C7段9例,C6段28例,C5段32例,C4段110例,C3段19例;支架释放后即刻DSA显示病变完全不显影163例,内漏35例,经球囊后扩或再植入支架治疗后病变完全不显影33例(其中2例闭塞载瘤动脉),2例仍存在内漏.术中发生支架源性血管破裂出血5例,术中成功止血4例;术后再出血1例,死亡2例.术后3～6个月随访复查DSA显示载瘤动脉通畅189例,轻度狭窄5例;病变完全不显影196例.临床随访3～20个月,存活患者无新发神经系统体征.结论 Willis覆膜支架能够安全有效地治疗颅内段颈内动脉病变,但需要更远期随访.     

Intracranial carotid anastomosis and partial aplasia of an internal carotid artery

Summary A rare arterial anastomosis between the right and left internal carotid arteries at the base at the skull, with aplasia of the cervical part of the left internal carotid artery is reported. The case is unusual because, in addition to the vascular anomaly of the carotid artery, there is an aneurysm of the anterior communicating artery and bilateral renal cysts. The condition is a complex malformation syndrome caused by defective regression of the third branchial artery. Because of the characteristic angiographic aspects such a case should be called transverse carotid anastomosis.Dedicated to Professor Dr. Friedrich Loew on his 60th birthday     

Duplication of the internal carotid artery

Summary The angiographic appearance of a duplicated internal carotid artery is described.     

Absence of the supraclinoid internal carotid artery in association with intracranial aneurysms

We report a case of absence of the supraclinoid segment of the left internal carotid artery associated with hypoplasia of the ipsilateral internal carotid artery and anterior communicating artery aneurysm formation. We discuss the embryology probably responsible for this anatomical variant and show the imaging findings. Received: 12 May 1997 Accepted: 12 June 1997     

快速原型技术建立人颅段颈内动脉弯曲的动物模型及Willis覆膜支架的柔顺性测试

目的 在犬体内建立人颅段颈内动脉系列弯曲形态的动物模型,并测试Willis覆膜支架柔顺性.方法 3T磁共振3D-TOF MRA序列采集头颅横断面DICOM格式图像,导入MATERIALISEMIMICS和Pro-E软件,做出管状三维数字模型.根据该文件利用快速原型技术制作出TangoPlus材料的实体模型并硅胶涂层.将犬两侧颈内动脉切断,一端结扎,一端穿过模型做端端吻合,得到人颅段颈内动脉弯曲形态的动物模型.1周后在DSA下置入Willis覆膜支架8枚(3.5 mm×16 mm 2枚,3.5 mm×13 mm 2枚,3.5 mm×10 mm 2枚,3.5 mm×7 mm 2枚)通过模型段血管释放到远端,设对照2枚.结果 在犬体内成功复制了人颅段颈内动脉弯曲形态的动物模型10例.Pro-E软件中进行图像融合比较,模型血管与志愿者颈内动脉高度相似.Willis覆膜支架分组测试时,无血管痉挛和急性血栓形成,测试后病理检查3.5 mm×16 mm组可见血管内膜及中膜不同程度损伤,3.5 mm×13 mm组可见内皮损伤及肿胀,3.5 mm×10 mm组仅见内皮肿胀,3.5 mm×7 mm组内皮肿胀更少见.结论 本实验模型具有高度可控性,可重复性和真实性,手术操作简单,可用于神经介入材料的研究和测试,为神经介入医师培训提供了可靠的工具.Willis覆膜支架具有较好的柔顺性,在弯曲血管中长度越小对血管内膜损伤越小.