多排螺旋 CT 血管成像对颈部动脉粥样硬化性狭窄的初步评估

动脉粥样硬化颈动脉狭窄是缺血性脑血管疾病的常见原因[1],椎动脉起始部狭窄是后循环缺血最常见的原因[2],支架置入术是颈部动脉粥样硬化重度狭窄患者的主要治疗手段。多排螺旋 CT 血管成像(computed tomographic angiography, CTA)作为一种快捷、无创的检查方法,对颈部动脉粥样硬化性狭窄的诊断具有优势。本研究以数字减影血管造影(digital subtraction angiography,DSA)为金标准,比较 CTA 检查对颈内动脉起始部及椎动脉起始部粥样硬化性狭窄的诊断价值,及其在支架置入术前初步评估的准确性。     

时间分辨磁共振动态增强血管成像技术和临床应用

对于全身各部位的血管性疾病,数字减影血管造影(digital subtraction angiography,DSA)是传统诊断手段,常作为诊断的金标准,但导管技术具有侵入性,可能引起各类并发症.多层螺旋CT的广泛应用,使CT血管成像(computed tomography angiography,CTA)成为重要的无创性诊断方法,但是它存在电离辐射,且可能发生对比剂过敏和引起对比剂肾病等严重并发症.     

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。     

肺癌16层螺旋CT支气管动脉血管成像与DSA对比分析

目的:探讨16层螺旋CT血管三维重组对诊断与评价肺癌支气管动脉供血血管和血供的临床应用价值.方法:10例肺癌同时行16层螺旋CT支气管动脉血管三维重组和DsA检查,并对16层螺旋cT支气管动脉血管三维重组和DSA资料进行对比分析.结果:10例肺癌16层螺旋CT血管成像显示11支支气管动脉,其中图像质量优5支、良好6支;DSA显示10支支气管动脉.10例肺癌16层螺旋CT血管成像显示肿瘤供血支气管动脉起源、形态及分支状况与DSA一致.10例肺癌16层螺旋CT血管VR彩色成像与DSA显示肿瘤染色及肿瘤内血供状况一致率为90%.结论:16层螺旋CT血管成像可克服DSA一次检查不能显示其全部供血血管的缺点;对诊断和评价肺癌供血血管和血供状况有较大临床价值.     

64层螺旋CT头颈动脉联合成像诊断颅内动脉瘤的应用价值

 目的 评价64层螺旋CT诊断颅内动脉瘤的临床应用价值。方法 选取我院176例颅内动脉瘤患者的头颈CTA(computed tomographic angiography,CTA)检查资料,评价颅内动脉瘤的大小、形态、位置及术后情况。结果 176例均行数字减影血管造影(digital subtraction angiography,DSA)存在动脉瘤(157经手术治疗),共计 201个动脉瘤,其中19例为多发动脉瘤。首次CTA明确诊断动脉瘤171例(196个),漏诊5例,阳性诊断率97.5%(196/201)。171例(196个)中颈内动脉瘤112例,后交通动脉瘤10例,前交通动脉瘤26例,基底动脉瘤5例,大脑中动脉瘤13例,大脑前动脉瘤5例,对照DSA再次重组首次漏诊的5例CTA图像,又发现动脉瘤2例,阳性诊断率提高至98.5%。结论 应用多层螺旋CT头颈血管联合成像选择合理的后处理方法,有助于提高图像质量与诊断的准确性,对临床术前评估与术后评价有重要意义。     

16排螺旋CT减影后血管成像在颈动脉闭塞性疾病的应用

目的:探讨16排螺旋CT减影后血管成像在颈动脉闭塞性疾病的应用价值。方法:36例患者先后进行平扫及增强扫描,原始数据传入工作站,以平扫图像为蒙片进行减影,最后进行三维血管成像处理,评价图像质量及病变的影像表现,其中8例进行了DSA检查。结果:血管重建后总体可评价率为91·5%,共发现病变血管28支,其中轻度狭窄10支,中度狭窄6支,重度狭窄8支,闭塞4支。8例DSA检查结果与DS-CTA一致。结论:16排螺旋CT减影后血管成像可以提供高质量的重建图像,在诊断颈动脉闭塞性疾病方面有很高的应用价值,可以为临床治疗提供指导。     

原发性肝癌动脉化疗栓塞术后影像学评价

目前,经导管动脉化疗栓塞( transcatheter arterial chemoembolization, TACE)术治疗肝癌已广泛应用于临床, 并且成为那些失去手术切除机会肝癌的首选治疗方法.介入治疗后的疗效问题一直为临床所关注,影像学评价是最为常用的手段.随着影像学诊断和技术的不断发展,B 超和彩色多普勒超声显像(color Doppler flow imaging , CDFI),数字减影血管造影术( digital subtraction angiography ,DSA),计算机体层摄影术(computed tomography ,CT ),磁共振成像(magnetic resonance imaging ,MRI),正电子发射体层摄影术(position emission tomography ,PET)在肝癌TACE 术后随访中发挥着越来越重要的作用,成为不可缺少的随访手段.本文着重就TACE后影像学评价作一简要综述.     

64层CT颅内血管减影成像的应用研究

目的 评估64层CT减影血管成像(subtraction CT angiography,SCTA)的图像质量和在诊断颅内动脉瘤中的临床价值.资料与方法 两名影像医师对32例行SCTA和数字减影血管造影(DSA)的颅内动脉瘤患者资料进行回顾性分析,对SCTA和CT血管成像(CT angiography,CTA)图像质量进行比较,以DSA为金标准对SCTA和CTA诊断颅内动脉瘤的准确性进行评估.结果 SCTA的后处理时间明显少于CTA(P<0.01),SCTA中图像质量优秀占25%(8/32),图像质量好占44%(14/32),图像质量一般占28%(9/32),图像质量较差占3%(1/32).SCTA在颅内动脉瘤整体诊断准确性和颈内动脉(internal carotid artery,ICA)段诊断准确性与CTA相比仅轻度提高(P>0.05),但在脑前动脉(前交通动脉和大脑前动脉交通后段)、大脑中动脉(middle cerebral artery,MCA)和后循环动脉的诊断准确性完全相同.结论 SCTA是一种减影去除邻近血管骨的有效方法,具有好的图像质量并且明显缩短了后处理时间,但诊断准确性无明显改善.     

数字减影CT血管成像诊断小脑后下动脉动脉瘤:与DSA比较

正摘要目的以DSA为参考标准,评估数字减影CT血管成像(DS-CTA)检测小脑后下动脉(PICA)动脉瘤的诊断准确性。方法回顾性分析115例病人,包括56例经CTA或DSA     

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。     

Flat-detector computed tomography in the assessment of intracranial stents: comparison with multi detector CT and conventional angiography in a new animal model

Objective  

Careful follow up is necessary after intracranial stenting because in-stent restenosis (ISR) or residual stenosis (RS) is not rare. A minimally invasive follow-up imaging technique is desirable. The objective was to compare the visualisation of stents in Flat Detector-CT Angiography (FD-CTA) after intravenous contrast medium injection (i.v.) with Multi Detector Computed Tomography Angiography (MD-CTA) and Digital Subtracted Angiography (DSA) in an animal model.     

烟雾病双源CT与三维全脑灌注血容量成像的初步应用

目的：评价双源CT血管成像（CTA）联合三维全脑灌注血容量成像（PBV）在烟雾病患者中的应用价值。方法：13例可疑烟雾病病例在3天内行双源CT和DSA检查。在双源CTA上对颅底血管狭窄、烟雾病血管的严重程度进行判定,并与DSA进行对照。在三维全脑PBV上,测量双侧额叶大脑前动脉供血区和大脑中动脉供血区皮层、颞叶皮层、枕叶皮层、基底节区的血容量;并按照DSA评价标准进行比较。结果：在诊断颅底血管狭窄程度上CTA与DSA有9例完全符合,在烟雾病血管严重程度的判断上CTA与DSA有8例判断一致。三维全脑PBV能够显示不均质性的脑血容量降低,侧别和部位上血容量的差异无统计学意义（P〉0．05）。结论：双源CTA联合三维全脑PBV技术可用于评价烟雾病患者脑部血管形态和血容量改变。     

Digital video angiography

Digital Video Angiography is a new radiologic technique utilizing digital electronics to enhance subliminal information in the fluoroscopic image. Angiography performed via intravenous technique is safer, faster, and can be done on an outpatient basis reducing cost and patient inconvenience. Initial investigations indicate Digital Video Angiography is a useful diagnostic procedure that can, in certain instances, be used in place of angiography.     

新一代放射诊断设备数字X线机

目的:对新一代放射诊断设备——数字X线机中的数字透视;数字摄影、数字点片、数字血管减影术及计算机摄影的原理进行介绍,便于了解X线新技术、新设备的基本知识。     

Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in inflammatory pancreatic disease

PURPOSE: Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease. MATERIALS AND METHODS: A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram. RESULTS: Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively. CONCLUSION: Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients.     

Non-invasive assessment of epiaortic vessels. Comparison of magnetic resonance angiography with gadolinium, spiral computerized tomography angiography, and digital angiography

PURPOSE: The aim of the study was to compare gadolinium-enhanced MRA (Gd-MRA), Computed Tomography angiography (CTA) and digital subtraction angiography (DSA) in the evaluation of carotid stenosis. MATERIAL AND METHODS: Thirty patients with US-proven internal carotid artery stenosis over 50%, underwent Gd-MRA, CTA and DSA. Gd-MRA was acquired using the keyhole technique. RESULTS: The overall agreement was 90% for Gd-MRA and 93% for CTA. Gd-MRA and CTA overestimated 5 and 4 cases of mild stenosis and 1 case each of moderate stenosis, respectively. Gd-MRA better delineated ulcerated plaques, tandem lesions and pseudo-occlusions. DISCUSSION AND CONCLUSIONS: Because of the high speed acquisition breath-hold is no longer necessary for Gd-MRA and more delayed phases were analysed when necessary. The main limitation of Gd-MRA was represented by insufficient volume coverage that allowed the visualisation of supraaortic vessels from the arch only in 57% of the cases. Calcified plaques were very well detected by CTA and not by Gd-MRA. In our experience Gd-MRA represents the second step non invasive tool in patients with US-proven carotid stenosis. This leads to avoid conventional angiography in most cases.     

Peripheral vascular occlusive disease: evaluation with contrast-enhanced moving-bed MR angiography versus digital subtraction angiography in 106 patients

OBJECTIVE: The purpose of our study was to compare contrast-enhanced moving-bed MR angiography and digital subtraction angiography in the evaluation of peripheral vascular occlusive disease. MATERIALS AND METHODS: This retrospective report includes 106 patients (45 women, 61 men) with known or suspected peripheral vascular occlusive disease who underwent MR angiography and intraarterial digital subtraction angiography of the peripheral arteries. MR angiography was performed on a 1.0-T unit using a moving-bed technique. Every leg was divided into 14 vascular segments, and severity of disease was scored in four categories. Digital subtraction angiography was the standard of reference. RESULTS: In the 106 patients, 2378 vessel segments were evaluated with both imaging modalities. In 2156 segments, MR angiography and digital subtraction angiography were concordant for stenosis classification, in 188 segments the two modalities differed in one category, and in 24 segments they differed in two categories. MR angiography achieved sensitivity and specificity of 96.7% and 95.8%, respectively, for differentiating nonsignificant from hemodynamically significant stenosis (kappa = 0.91). CONCLUSION: This study indicates that MR angiography is an accurate imaging modality in clinical practice. Our data support the concept that MR angiography can modify the diagnosis of suspected peripheral vascular occlusive disease.     

Fibromuscular dysplasia, a pitfall in intravenous digital subtraction angiography

Intravenous Digital Subtraction Angiography (DSA) is described in a patient with severe fibromuscular renal artery dysplasia. DSA identified only a mild renovascular stenosis, while intraarterial angiography demonstrated multiple severe stenoses alternating with aneurysmatic segments. This case confirms the limitations of intravenous subtraction angiography. Higher spatial resolution is required if small stenoses are to be ruled out.     

Digital subtraction cerebral angiography by intraarterial injection: comparison with conventional angiography

For 4 months, a prototype digital subtraction system was used to obtain images of the cerebral vasculature after intraarterial contrast injections. In 12 instances, the intraarterial injections were recorded with both a digital subtraction unit and conventional direct magnification film-screen system. The digital subtraction and conventional film subtraction images were compared and graded for quality and information content by three skilled observers. In addition, quantitative measurements of contrast-detail performance and spatial resolution were obtained on both the digital system and the screen-film imaging chain. In a clinical setting, both the digital subtraction and conventional film-screen systems provided similar quality images and angiographic information. Contrast-detail curves demonstrated that digital subtraction angiography outperformed conventional film technique for low-contrast objects. Digital subtraction angiography also reduced the time required to obtain the angiogram, markedly reduced film cost, and lowered the contrast agent burden.     

Evaluation of prototype equipment for digital subtraction angiography in diagnosing intracranial lesions

Two prototype units for digital subtraction angiography have been developed by Japanese manufacturers. Their performance in demonstrating various intracranial lesions in 121 patients was evaluated. Comparison with conventional selective catheter angiography was possible in 77 patients. Digital subtraction angiography proved useful in preoperative evaluation of pituitary tumors when transsphenoidal surgery was being considered; demonstration of faint tumor stains which might be missed on conventional angiography; demonstration of larger aneurysms, arteriovenous malformations, and tumors as a screening technique; demonstration of abnormalities involving the dural sinuses; and follow-up of patients after surgery or embolization.