烟雾病20例脑血管造影分析

目的；对２０例烟雾病造影征象进行分析，总结其血管造影表现。材料与方法；２０例经造发现的烟雾病患者，均接受了双侧颈内动脉、颈外动主椎动脉造影，其中１８例有完整的ＣＴ资料对比分析，结果：病变发生于双侧者占，且多同时累及多在管；颈内动脉主干上的病变主要表现为管壁毛糙、不规则及管腔狭窄，基分支大脑前中、后动脉上的病变多表现为管腔闭塞；在基底节区均可见异常血管网；大脑后动脉、颈外动主脑底的常血管形成广泛的侧     

脑血管DSA对出血性烟雾病的诊断价值

目的 探讨烟雾病的病因及诊断方法.方法 对20例经CT检查为蛛网膜下腔出血和脑室出血的患者做DSA脑血管造影.结果 20例患者被确诊为烟雾病,累及单侧或双侧的颈内动脉分支和椎动脉分支.结论 DSA脑血管造影是未能明确病因的脑出血患者的常规检查方法,对出血性烟雾病的诊断具有重要价值.     

烟雾病的DSA分析研究

目的:提高对烟雾病的理解和认识。方法:对19例证实为烟雾病病人的脑血管造影片(包括双侧颈动脉造影及单侧椎动脉造影)按狭窄及闭塞部位,脑底异常血管网,和脑内、外侧支循环进行分析。结果:38 例次颈动脉造影,除4 例显示正常外,均发现不同程度颈内动脉系统病变,此外,脑膜中动脉病变见14 例次,颞浅动脉病变见7例次。19 例单侧椎动脉造影见大脑后动脉病变12例(19侧),伴基底动脉病变5例,同时伴椎动脉病变3 例。所有病例均可见各种形式侧支循环的形成。结论:烟雾病为脑底动脉进行性狭窄或闭塞伴广泛侧支循环形成的疾病,它的血管病变不仅累及颈内动脉系统,椎- 基底动脉系统及颈外动脉系统亦可累及     

36例烟雾病血管造影的影像分析

目的：探讨烟雾病ＤＳＡ表现特征。方法：３６例中，男２１例，女１５例，年龄４～３２岁。均经股动脉插管行全脑血管造影。结果：３６例脑血管ＤＳＡ均为烟雾病表现。结论：１．先天性因素在烟雾病发病病因中不可忽视。２．烟雾病脑血管造影有以下主要特征：（１）双侧颈内动脉末端和／或基底动脉末端狭窄、闭塞；（２）颅底异常血管网形成；（３）颅内与颅内、颅内与颅外广泛侧支循环建立；（４）脑循环时间的改变。３．脑血管改变与临床表现关系密切。４．本病需与脑动脉硬化、动脉炎及动－静脉畸形鉴别     

成人烟雾病血管影像演变特征及治疗对策

目的 探讨烟雾病（Ｍｏｙａｍｏｙａ ｄｉｓｅａｓｅ，ＭＭＩ）血管影像演变及治疗对策。方法 对１例成人型ＭＭＤ病人６年内临床表现、影像改变、内外科治疗对比、各项化检验查指标进行分析。结论 ＭＭＤ的影像特征是首先为供血动脉主干狭窄，继而闭塞，随后出现烟雾血管生成。内科药物治疗无效，颅内外血管间接或直接吻合手术有效。     

烟雾病数字减影血管造影的诊断价值

目的评价数字减影血管造影(DSA)对烟雾病的诊断价值。材料与方法对13例烟雾病患者行DSA检查及回顾性分析。结果13例烟雾病DSA表现为不同程度颈内动脉分叉处血管狭窄或闭塞,侧支循环形成呈烟雾状。结论DSA可清晰地显示烟雾病血管狭窄程度或闭塞的部位及侧支循环情况,为临床治疗提供直接的影像学资料。     

烟雾病并发颅内出血的DSA影像分析

目的　探讨烟雾病并发颅内出血的DSA表现特征。方法　 19例患者均经CT诊断为颅内出血 ,经股动脉穿刺插管行全脑血管造影。结果　 19例脑血管造影均为烟雾病表现 ,具有下列特征 :1受累动脉狭窄或闭塞 ;2颅底部烟雾状毛细血管网 ;3大量的侧支循环形成。结论　CT检查一般只能提示颅内出血的部位 ,而DSA检查是诊断烟雾病的主要手段 ,具有明显优势     

出血性脑血管病全脑血管造影结果分析

目的评价DSA在出血性脑血管病中的应用及价值。资料与方法回顾性分析216例出血性脑血管病患者的全脑血管造影结果。结果112例蛛网膜下腔出血(SAH)患者中发现颅内动脉瘤45例(40．2％),动静脉畸形(AVM)4例(3．57％),未见异常者63例(56．2％)。自发性脑出血104例,发现AVM50例(48．1％),动静脉瘘2例(1．92％),动脉瘤3例(2．88％),烟雾病2例(1．92％),未见异常者47例(45．2％)。结论脑血管造影在出血性脑血管病的病因诊断中是一项必不可少的检查,对明确诊断,制定合理的治疗方案有明确的指导意义。     

Cerebral angiography with iohexol a comparison with metrizamide in man

Summary The new non-ionic contrast medium iohexol was compared with Amipaque in selective cerebral angiography in a double blind study in 60 patients. There were no adverse reactions or reports of discomfort during the examinations or in the 24 h follow-up period. No differences were observed with regard to image quality or cerebral circulation time.     

Cerebral angiography in ischemic strokes

Summary Angiography remains a very important means of evaluation of ischemic strokes: it confirms the diagnosis showing the occluded artery. It eventually shows the anastomotic pathways for cerebral circulation and it often finds the causes of stroke, among which the most frequent are atherosclerosis (70%) and fibromuscular hyperplasia (10%). The safer way to perform angiography is the retrograde route. Indications for angiography must be discussed according to the type of stroke, its onset, and the arterial territory involved.     

Cerebral angiography with the non-ionic water-soluble contrast medium Iohexol and Meglumine-Ca-Metrizoate

Summary A double blind study was carried out to evaluate safety, tolerability and visualization quality of the non-ionic contrast medium Iohexol compared to Meglumine-Ca-Metrizoate (Isopaque Cerebral) for cerebral angiography. The two contrast media were found equal in most respects. A slight increase in systolic blood pressure following Meglumine-Ca-Metrizoate injections and a slight decrease in diastolic blood pressure following Iohexol were statistically significant. Tachycardia following injections of Meglumine-Ca-Metrizoate in the aortic arch was also significant and may indicate more discomfort from this medium, although no difference was found in patient interviews. The changes in blood pressure and heart rate were small and of no clinical importance.     

Complications of cerebral angiography. Comparing metrizamide (Amipaque) and meglumine metrizoate (Isopaque Cerebral)

Summary The complications of cerebral angiography have been carefully recorded in 308 patients referred for cerebral angiography during one year, 1977–1978. The patients were randomly sampled for metrizamide or meglumine metrizoate as contrast medium according to a code list, and the two contrast media were compared using a double blind technique. The frequency of complications was the same for metrizamide and meglumine metrizoate. Metrizamide had the advantage that it caused no discomfort in selective external carotid angiography, while this was a problem with meglumine metrizoate. The study seemed to indicate that factors other than toxicity of the contrast medium are of major importance to explain the complications of cerebral angiography.Presented at VIII Congress of the European Society of Neuroradiology, Strasbourg, 8 September 1979     

Complications of cerebral angiography

Summary All types of complications, both minor and major, are tabulated and analyzed in 5531 consecutive cerebral angiographies performed on 3730 patients during a period of 5 years.     

Cerebral proliferative angiopathy depicted by four-dimensional computed tomographic angiography: A case report

Cerebral proliferative angiopathy is a rare cerebrovascular disorder characterized by diffuse abnormal vessels with intermingled brain parenchyma fed by many arteries and draining into many veins without high-flow arteriovenous shunts, which is usually confirmed by conventional digital subtraction angiography. However, dilution of the contrast medium due to the markedly increased blood flow and volume in cerebral proliferative angiopathy leads to low-contrast angiography. We report a 53-year-old man with cerebral proliferative angiopathy who underwent CT, MR imaging, MR angiography, digital subtraction angiography and 4D-CTA. The 4D-CTA exhibited abnormal vessels without early venous filling between the atrophic brain parenchyma in higher contrast than the angiography due to high spatial and time resolution, whereas the left external carotid angiography visualized the characteristic transdural supply more clearly than the 4D-CTA due to high vascular selectivity. Therefore, novel 4D-CTA and conventional angiography plays a complementary role in the accurate diagnosis of cerebral proliferative angiopathy. Taking invasiveness into account, 4D-CTA may be advantageous for the diagnosis of cerebral proliferative angiopathy based on the characteristic imaging findings.     

Conventional digital subtraction x-ray angiography versus magnetic resonance angiography in the evaluation of carotid disease: patient satisfaction and preferences

AIM: To compare conventional digital subtraction x-ray angiography (DSA) and contrast-enhanced magnetic resonance angiography (MRA) of the carotid arteries in terms of patient satisfaction and preferences. METHODS: One hundred and sixty-seven patients with symptomatic carotid artery disease, who underwent both DSA and MRA, were prospectively recruited in this study. Patients' perceptions of each method were assessed by the use of a questionnaire after each procedure. Main outcome measures were anxiety, pain, satisfaction rate and patient preferences. RESULTS: DSA generated more anxiety and pain during the procedure, but the severity of these ill-effects was mild. Satisfaction rates for each method were similar. More patients were, however, willing to have a repeat MRA compared with DSA (67 versus 41%). The majority of patients (62%) preferred MRA over DSA (31%). The shorter MRA imaging time was found to be a significant factor in patients' acceptance of the technique. The main reasons cited by patients for their dislike of a particular procedure was noise and claustrophobia for MRA and invasiveness, pain and post-procedural bed rest for DSA. CONCLUSIONS: MRA is the method that is preferred by the majority of patients, although the actual disutility of DSA may be small. Assuming equal diagnostic accuracy, our data supports replacement of DSA by MRA for routine carotid imaging.     

缺血性脑血管病DSA分析

目的探讨缺血性脑血管病患者脑动脉狭窄或闭塞的分布特征及危险因素。方法回顾性分析2006年6月至2010年12月收治的495例缺血性脑血管病患者的DSA资料.按年龄大小分为青中年组(28～59岁)和老年组(≥60岁)。所有患者均经CTA或MRA检查证实为脑动脉狭窄或闭塞,最后经DSA检查验证。结果 495例缺血性脑血管病患者中,452例经DSA检查确诊为动脉粥样硬化性狭窄或闭塞,其中35.2%(159例)为颅内动脉病变,31.8%(144例)为颅外动脉病变,33.0%(149例)为颅内、外病变并存;颅内动脉病变的发生率为68.1%(308例),稍高于颅外动脉的64.8%(293例)。青中年组单纯颅内动脉病变的比例明显高于老年组(95比64,P<0.01);老年组颅外动脉病变的发生率明显高于青中年组(80比64,P<0.01),后循环病变的发生率亦高于青中年组(155比112,P<0.05)。高血压、高龄、糖尿病是颅外动脉病变的独立危险因素,高血压、糖尿病是颅内动脉病变的独立危险因素。颅外病变组高龄患者的比例高于颅内病变组(P<0.05)。结论在缺血性脑血管病患者中,颅内动脉粥样硬化性病变的发生率高于颅外段,随着年龄的增长,单纯颅内动脉病变逐渐减少,颅外病变及后循环病变增多。颅外病变组高龄者多于颅内病变组。     

应用多层螺旋CT评价脑缺血症状与颈动脉狭窄关系的研究

目的探讨基于多层螺旋CT血管造影(MDCTA)测量的颈动脉直径和脑血管症状之间的关系,寻找与症状相关的颈动脉狭窄的阈值。方法以接受MDCTA检查的230例可疑颈动脉狭窄患者为研究对象,记录患者有无大脑前循环障碍症状。所有患者均行MDCTA检查测量狭窄颈动脉直径,同时观测动脉粥样硬化斑块类型。利用ROC曲线对症状和狭窄颈动脉直径进行分析确定诊断阈值,利用Logistic多元回归探讨症状与狭窄颈动脉直径、粥样硬化斑块类型和其他变量之间的关系。结果症状组颈动脉直径明显较无症状组小,ROC曲线分析发现曲线下面积为0.720,出现脑缺血症状的最佳预测值为1.6mm,灵敏度为0.734,特异度为0.638。Logistic回归分析证实颈动脉狭窄和软斑块是脑血管症状的独立危险因素。结论利用MDCTA测量颈动脉直径能够较为可靠地预测脑缺血症状,脑缺血症状与颈动脉狭窄和软斑块密切相关,这对于MDCTA在脑卒中防治领域进一步应用具有重要意义。     

脑CT灌注成像与CT血管成像诊断颈内动脉狭窄及闭塞的临床研究

目的　评价CT灌注成像与CT血管成像 (CTA)在颈内动脉狭窄及闭塞疾病中的临床应用价值。方法　 2 7例颈内动脉狭窄及闭塞的患者 ,14例行单层CT灌注成像 ,对比剂总量为 50ml ,注射流率为 4.5ml s。 13例行 2次CT灌注成像 ,每次对比剂剂量为 3 5ml。随后使用螺旋CT扫描对颈内动脉颅外段和 (或 )颅内段行CTA。由 2名神经影像医生阅片比较 2种CT灌注成像的最大峰值时间 (timetopeak ,PT) ,以及平均通过时间 (meantransittime ,MTT)和相对血流量 (relativeflow ,RF)图像。观察CT血管成像的螺旋横轴面图像以评价管壁斑块。应用Xtension软件实现最大密度投影(maximumintensityprojection ,MIP)和表面阴影成像 (thresholdshadedsurfacedisplay ,SSD)以观察血管整体形态 ;使用FlyThrough软件生成CT仿真血管内窥镜图像以观察血管内部形态。结果　 2 7例患者常规CT图像检出 2 9个病灶。CT灌注图像共检出 43个病灶 ,其中 8个病灶RF与对侧相比无明显降低 ;其MTT略延长 ,PT明显延长。注射 3 5ml对比剂与注射 50ml对比剂的CT灌注图像的质量差异无显著性意义 (χ2 =0 .487,P >0 .0 5)。 13例患者 2 6支颈动脉中 2 1支颈动脉可以观察到动脉管壁钙化斑块 ,15支颈动脉可以观察到密度值为 -12～ 15HU的软斑块。SSD、MIP和内窥