肠血管发育不良的血管造影诊断及标记定位（附36例报告）

肠血管发育不良是引发消化道出血的原因之一。应用血管造影诊断并同时放置标记物为外科手术定位以减少手术中的盲目性。选择性血管造影是目的诊断该病的最好办法，同时放置定位标记能帮助外科医师顺利寻找并切除病灶，且无并发症。该法是一全新定位方法，值得推广应用。     

肺动脉栓塞的螺旋CT血管造影的诊断研究(附七例报告)

目的评价螺旋ＣＴ血管造影（ＳＣＴＡ）诊断肺动脉栓塞（ＰＥ）的可信性。方法对７例临床怀疑ＰＥ的患者行螺旋ＣＴ血管造影,其中６例在溶栓治疗２０天后进行了复查。结果７例患者累及２０处肺动脉及其分支。栓子表现为肺动脉腔内柱状、丘状及不规则形充盈缺损。７例均有肺动脉高压,其中６例中心肺动脉扩张呈“残根征”改变。６例经溶栓治疗后,４例栓子完全消失,１例明显缩小,１例略有缩小。结论螺旋ＣＴ血管造影是诊断中心性肺动脉栓塞可靠而直观的检查方法,并可较准确地判断溶栓疗效。     

颅外颈动脉螺旋CT血管造影的临床意义(附45例报告)

目的 报告颅外颈动脉ＣＴ血管造影（ＣＴＡ）的初步经验,探讨该技术对各种颅外颈动脉病变的诊断意义,并在可能范围内与数字减影血管造影（ＤＳＡ）作小样本的对照。方法 ４５例颈动脉ＣＴＡ,经最大密度投影（ＭａｘＩＰ）及表面灰度成像法（ＳＳＤ）行三维重建,其中５例在１周内作了ＤＳＡ检查。结果 ４５例颈动脉ＣＴＡ检查,共得到９０支血管图像。其中正常血管５５支,狭窄血管３１支,闭塞血管２支,颈内动脉动脉瘤１支,     

布-卡氏(Budd—Chiari)综合征的血管造影诊断(附12例报告)

本文报导了12例布—卡氏综合征的临床资料及血管造影结果,并结合文献对该12例下腔静脉型布—卡氏综合征予以分型、讨论。12例布—卡氏综合征可分为膈膜狭窄型、膈膜闭锁型、节段狭窄或闭锁型及血栓形成闭塞型4种类型,这种分型对于手术或PTA有着重要意义,作者认为血管造影对于布—卡氏综合征是必不可少的,尤以数字减影血管造影(DSA)为佳。在造影时可根据需要行右心房、下腔静脉双向同时造影,亦可补充右前斜位投照,以便使梗阻形态显示更清楚。     

单发右室发育不良的影像学诊断(附6例报告)

目的　报道6例单发右室发育不良并评价其影像学诊断方法。方法　6例单发右室发育不良患者均行X线平片、心电图、超声心动图、心导管及心血管造影检查,2例经外科手术证实。结果　6例中,5例小梁部发育不全,1例右房室瓣、流入道及小梁部皆发育不良。6例患者均伴有II孔型房间隔缺损。结论　单发右室发育不良是一种少见的紫绀属先天性心脏病,确诊需行心血管造影检查     

椎动脉发育不良的螺旋CT血管造影诊断

目的探讨椎动脉发育不良的螺旋CT血管造影(spiralCTangiography,SCTA)表现和临床意义。方法180例临床诊断为椎-基动脉供血不足患者行SCTA检查。造影剂为浓度350mg/100ml的Omnipaque80～100ml,足背静脉注射。流率3ml/s,延迟时间由预扫描确定。层厚、间隔分别为3mm和4.5mm。重建间隔1.5mm。采用多平面容积重建(MPVR)和表面遮盖法重建(SSD),用原始横断面图像测量椎动脉直径。CT显示有椎动脉狭窄者于1周内行DSA检查。结果360根椎动脉中共发现78根(21.7%)有全程狭窄,平均直径1.3mm(1.0～1.5mm)。其中左侧24根,右侧54根。其中有20根同时伴有局限性进一步狭窄。对侧椎动脉合并局部管壁钙化13根(16.7%),合并V1段扭曲20根(25.6%),合并钩椎关节增生压迫11根(14.1%)。DSA检查结果与SCTA完全一致。结论椎动脉发育不良是椎-基动脉供血不足的常见原因之一,SCTA可以确诊并能取代诊断性DSA检查。     

永存动脉干影像学诊断(附11例报告)

目的：探讨永存动脉干的病理分型及影像学表现,提高对本病的认识。方法：搜集11例经DSA证实的永存动脉干,复习相关文献并与普通X线、多普勒超声结果对比分析。结果：本组11例中普通X线诊断永存动脉干3例,误诊8例;多普勒超声诊断永存动脉干7例,误诊4例;DSA确诊11例。按照Colett分类法：Ⅰ型2例,Ⅱ型4例,Ⅲ型3例,Ⅳ型2例。结论：X线表现虽没有特异性,但某些征象有助于诊断;多普勒超声能为临床提供较可靠的诊断;DSA能够进一步明确病理类型。     

医原性肝动脉假性动脉瘤的血管造影诊断与栓塞治疗（附24例报告）

笔者报告了经选择性肝动脉造影证实的２４例医原性肝动脉假性动脉瘤，３例源于胆囊切除术后并破裂与胆道相通发生消化道大出血，其余２１例发生于经导管肝动脉灌注化疗与栓塞术后，由血管内膜损伤引起。所有病例均施行了肝动脉栓塞治疗并取得良好治疗结果。笔者描述了肝动脉假性动脉瘤的血管造影表现并讨论了诊断与治疗问题。     

Multidetector spiral CT renal angiography in the diagnosis of renal artery fibromuscular dysplasia

OBJECTIVE: The aim of this study was to evaluate the role and detection rate of multidetector spiral CT renal angiography (CTA) as compared with conventional angiography (CA), the commonly accepted gold standard, in the diagnosis of renal artery fibromuscular dysplasia (FMD). In addition, the role of CTA reconstructions (multiplanar reformatted images (MPR), maximum intensity projections (MIP) and shaded-surface display (SSD)) in the detection of FMD was also evaluated. MATERIALS AND METHODS: CTA results were retrospectively reviewed in 21 hypertensive patients with CA-proven FMD. Clinical indications for referral included resistant hypertension (requiring greater than three antihypertensive medications), labile hypertension, hypertension in combination with renal impairment and the presence of abdominal bruits in the context of systemic hypertension. In some cases, these clinical indications were supplemented by positive results in other tests, including plasma renin assay, captopril scintigraphy and/or Doppler ultrasound. The findings of CA in these 21 patients were compared to CTA. RESULTS: Mean patient age was 62.33+14.32 years (range 24-85 years). CTA identified all 42 main renal arteries (100%) and all 10 accessory renal arteries (100%) visualized on CA. In the diagnosis of FMD, CTA detected all 40 (100%) lesions detected by CA. No single CTA reconstruction technique was able to detect all lesions noted on corresponding CA, however, upon review of all CTA reconstructions (MPR, MIP and SSD) in each case, every lesion was correctly identified by CTA. CONCLUSION: Our experience suggests that CTA is a non-invasive, reliable and accurate method for the diagnosis of renal artery fibromuscular dysplasia. Moreover, in our experience CTA has many advantages as a diagnostic screening tool over CA, including accessibility, speed, lower complication profile, versatility and cost-effectiveness. CTA shows great potential as a guiding tool for directing subsequent procedures such as CA+balloon angioplasty.     

Percutaneous transluminal angioplasty of fibromuscular dysplasia of the internal carotid artery

Percutaneous transluminal angioplasty via the common femoral artery was performed in a 32-year-old woman with neurologic symptoms secondary to stenosis of the left internal carotid artery due to fibromuscular dysplasia. Good anatomic results after dilatation and gradual normalization of the neurologic symptoms show that this technique can be used for the treatment of nonarteriosclerotic stenosis of the internal carotid artery.     

Digital emboli from brachial artery fibromuscular dysplasia

A 64-year-old female presented with right digital artery emboli from biopsy-proven, angiographically typical, right brachial artery fibromuscular dysplasia (medial fibroplasia). Angiographic findings consistent with fibromuscular dysplasia were also found in the left brachial artery. The patient was treated with surgical excision of the abnormal right brachial artery segment and post-operative anticoagulation for 2 months. She remains asymptomatic at 22 months.     

Percutaneous transluminal angioplasty in fibromuscular dysplasia of the internal carotid artery: One year clinical and morphological follow-up

A case of fibromuscular dysplasia (FMD) of the internal carotid artery was treated by percutaneous transluminal angioplasty (PTA) using a Grüntzig balloon. A control angiographic study performed with intravenous digital subtraction angiography (IV DSA) showed a completely patent dilated vessel. This result, together with the total relief of clinical signs and symptoms, is evidence of the value of PTA in the treatment of FMD of the internal carotid artery.     

Intimal dissection following percutaneous transluminal carotid angioplasty for fibromuscular dysplasia

Summary Fibromuscular dysplasia (FMD) is an unusual form of segmental arteriopathy and may affect the internal carotid artery (ICA). We report a case of carotid FMD in which percutaneous transluminal angioplasty (PTA) was complicated by an intimal tear and required surgical exploration. PTA is a useful form of treatment, but there is a risk of intimal dissection. If this occurs, it may be necessary to excise the intimal flap surgically.     

Percutaneous transluminal angioplasty of renal artery fibromuscular dysplasia: mid-term results.

OBJECTIVE: To evaluate mid-term imaging, clinical follow-up, and restenosis rates from patients that had undergone percutaneous transluminal renal artery angioplasty (PTRA) for symptomatic renal artery fibromuscular dysplasia (FMD). MATERIALS AND METHODS: Between March 1999 and July 2006, 16 consecutive renal artery FMD patients underwent PTRA for poorly controlled hypertension. The patients were enrolled into this retrospective study after receiving 19 primary and four secondary PTRAs in 19 renal artery segments. Follow-up monitoring of blood pressure, use of antihypertensive medication, and the serum creatinine level after PTRA were assessed at 1, 3, 6, 9, 12 months, and each following year. The degree of restenosis was evaluated with computed tomographic angiography (CTA) after PTRA at 6, 12 months, and every year if possible. Technical and clinical success rates for the treatment of FMD, and restenosis rates for the renal artery were evaluated. RESULTS: The technical success rate for primary PTRA was 79% (15/19) and the complication rate was 16% (3/19). Hypertension improved in 80% (12/15) of the patients after four weeks follow-up, and was finally cured or improved in 93% (14/15) during the mean follow-up period of 23.6 months. There was a cumulative 22% (4/18) restenosis rate during the follow-up period. All of the patients were treated with a second PTRA without complications and all of the patients were cured of hypertension after the second PTRA. CONCLUSION: Percutaneous transluminal renal artery angioplasty for clinically symptomatic renal FMD is technically and clinically successful and safe to perform. For all patients with restenosis, there was a good response after undergoing a second PTRA.     

Post-traumatic aneurysmal rupture involving the circle of Willis affected by fibromuscular dysplasia. A case report and systematic review

The fatal rupture of a saccular aneurysm at the junction between the left anterior cerebral artery and anterior communicating artery affected by fibromuscular dysplasia (FMD) is a rare condition. Here is reported the case of a subject involved in a road traffic accident a few minutes before the death, which opened the debate on the real cause of death in a forensic setting.By autopsy, the examination of the brain revealed subarachnoid haemorrhage with flooding of the ventricles due to the breached saccular aneurysm of the junction between the left anterior cerebral artery and anterior communicating artery, in FMD mainly affecting the circle of Willis arteries. A spontaneous aneurysmal rupture was excluded on the basis of probabilistic analysis, in the presence of alternative hypotheses that could explain the facts. The passenger’s delayed loss of consciousness may be explained as much by a hypertension-linked rupture of the aneurysm triggered by the emotional stress experienced, as by the traumatic shaking/impact of the aneurysm against the bony skull structures, in a subject predisposed to aneurysm frailty due to FMD.Overall, the concausal role of both the road traffic accident, typified by high kinetic energy, and the presence of a pre-existing aneurysmatic weakness due to FMD is fully recognized.The identification of anatomical variants, jointly with uncommon diseases at the examination of the brain base arteries in any case of isolated basal subarachnoid haemorrhage, may avoid wrong legal consequences even when the cause of death seems to be obviously of simple traumatic origin.     

Spontaneous regression of two supraophthalmic internal cerebral artery aneurysms following flow pattern alteration

We report on a patient with fibromuscular dysplasia who presented with a right-sided giant calcified cavernous internal carotid artery (ICA) aneurysm and two additional supraophthalmic ICA aneurysms. Endovascular closure of the right ICA using detachable balloons was performed with collateralisation of the right hemisphere via the right-sided posterior communicating and the anterior communicating arteries. Repeat angiography after 6 months demonstrated spontaneous complete regression of the two supraophthalmic aneurysms, although the parent vessel was still perfused. In comparison to the former angiography, the flow within the parent vessel was reversed due to the proximal ICA balloon occlusion. MRI demonstrated that the aneurysms were not obliterated by thrombosis alone, but showed a real regression in size. This case report demonstrates that changes in cerebral hemodynamics potentially lead to plastic changes in the vessel architecture in adults and that aneurysms can be flow-related, even if not associated with high flow fistulas or arteriovenous malformations, especially in cases with an arterial wall disease.     

CT血管成像诊断破入蝶窦的颈内动脉创伤性假性动脉瘤

目的 评价颅脑CTA在海绵窦段颈内动脉创伤性假性动脉瘤中的诊断价值.方法 对7例经DSA证实的颈内动脉海绵窦段创伤性假性动脉瘤患者的CTA联合应用VR、MIP、MPR、CPR后处理技术及临床资料进行回顾性分析.结果 7例CTA均表现为蝶窦内不规则软组织影与海绵窦段颈内动脉同步均匀强化并与其沟通,边界清晰,边缘不规则,病变大小自3 mm×2 mm×1 mm～33 mm×30 mm×27 mm.周边为动脉期不强化的软组织影,邻近蝶窦壁骨折、缺损.6例病变位于海绵窦段颈内动脉前突段,1例位于游离段.7例破口均位于颈内动脉内壁或前内壁.多种后处理技术联合应用可明确显示病变与蝶窦腔、蝶窦骨质及邻近血管的空间关系.结论 颅脑CTA检查对破入蝶窦的海绵窦段颈内动脉创伤性假性动脉瘤可明确诊断;VR、MIP、MPR、CPR后处理技术联合应用可明确蝶窦壁骨折和颈内动脉破口的位置、范围及其二者的关系.

Abstract：

Objective To investigate diagnostic value of CTA for traumatic pseudoaneurysms (TPA) in the cavernous segment of the internal carotid artery (ICA) when they rupture into the sphenoid sinus. Methods CTA of 7 patients with TPA in the cavernous segments of ICA verified by DSA were retrospectively analyzed. All the patients were performed CTA scanning. The post-processing techniques included VR,MIP,MPR, and CPR. Results All the CTA images of 7 patients showed irregular mass in the sphenoid sinus with obviously enhancement in the same phase to ICA, which communicating with ICA in wide base. The peripheral area of the mass showed no enhancement. The size varied from 3 mm × 2 mm × 1 mm to 33 mm × 30 mm × 27 mm. The adjacent lateral wall of sphenoid sinus showed fractures in all cases. TPA located at anterior-knee segments of cavernous ICA in 6 cases, and cavernous free segment in 1 case. All the disruptions were found at medial or anterior medial wall of ICA. Conclusions Cranial CTA is the effective non-invasive method for diagnosing TPA in the cavernous segment of ICA when they rupture into sphenoid sinus. Combined using of VR, MIP, MPR, and CPR can delineate the location and size of the sphenoid wall fracture and the ICA rupture, which help to clarify the anatomical relationship between them.