超声造影、CT、DSA对肝癌肝动脉栓塞术后残存血供及后续治疗方案的评估作用

目的：探讨超声造影、CT、X线数字减影血管造影（DSA）对肝癌肝动脉栓塞术（TAE）后残存血供及后续治疗方案的评估作用。方法：对30例接受TAE的肝癌患者行超声造影、CT、DSA检查,对照结果。并对25例有残存血供者再次TAE后的碘油沉积情况进行比较。结果：30例中,5例三项检查均提示病灶灭活完全,无残留血供。19例三项检查均显示病灶残存血供丰富,再次TAE碘油沉积良好。6例CT显示病灶灭活,无血供,超声造影显示病灶局部残存少量血供,DSA造影结果与超声造影相符,再次TAE碘油沉积不良。结论：超声造影对肝癌TAE后病灶残存血供的显示较CT更敏感、准确,与DSA相仿,且操作简便、无创。TAE后病灶的碘油沉积情况与血供相关,对于灭活不全但血供不丰富者,应选择更有效的治疗方法。     

AFP阳性、超声与MSCT阴性人群中应用DSA检出早期肝癌的研究

目的:探讨AFP显著或持续增高、超声与MSCT检查阴性或可疑人群中应用DSA检出早期肝癌的研究.方法:对肝癌高危人群中AFP显著或持续增高、超声或/和MSCT检查未发现明确病变或疑似肝癌的68例患者,行DSA造影.结果:68例患者中超声、MSCT检查阴性29例,疑似小肝癌者39例,DSA检出51例58个病灶.DSA表现为肝动脉早至中期供瘤血管增粗、走形迂曲或紊乱,边缘见较清楚的染色结节.17例DSA阴性或可疑病人在肝动脉内注射碘油约3-5ml,1月后复查CT,7例有碘油小灶沉积者手术治疗证实为肝癌,10例排除肝癌.结论:对高危人群中AFP显著增高和持续增高、超声与MSCT阴性或可疑人群应用DSA检出早期肝癌具有临床意义.     

超声造影评价微波凝固治疗肝细胞肝癌的应用

目的:探讨超声造影在评价微波凝固治疗肝细胞癌(HCC)的应用价值.方法:经静脉注射造影剂 SonoVue 后,对 30例(男20例、女10例)HCC患者(共 33 个病灶)在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至 2 周采用超声造影检查评价疗效,并与同期增强 CT 检查结果进行比较,12 个病灶治疗区取病理标本送检,21 个病灶治疗区接受随访观察.结果:微波治疗后超声造影显示 22 个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11 个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及 6 个月以上的随访,证实微波治疗联合肝动脉栓塞化疗(TACE),的 2 个 HCC 病灶,增强 CT 判断失误,增强 CT 诊断肿瘤灭活准确率为 94%(31/33);超声造影诊断肿瘤灭活准确率为 97%(32/33).统计结果显示,两者诊断肿瘤灭活差异无统计学意义(P>0.05).结论:超声造影不仅能评价 HCC 微波治疗的疗效,且能有效地评价 TAE 和微波凝固联合治疗 HCC 的疗效,因不受碘油干扰可优于增强 CT.     

腹部Xper CT双期扫描联合三维血管重建在TACE术中的应用与价值

目的 探讨TACE术中应用腹部Xper CT双期扫描(Xper CT Abdomen Dual Ph.Roll)技术并进行肝脏血管三维重建(以下简称Xper CT)在发现肝癌病灶和指导临床医生进行超选化疗和栓塞上的价值。方法 收集88例接受TACE治疗的原发性肝癌患者,术中分别行DSA常规造影和腹部Xper CT双期扫描,将术后的碘油CT作为金标准,观察两者发现的病灶数。将88例病例分为实验组和对照组,各44例。实验组进行双期扫描联合三维重建,对照组先行常规DSA造影下尝试超选插管,对比2组准确找到肿瘤供血动脉尝试超选插管所需的次数。结果 所有手术均顺利进行,并行术后碘油CT。碘油CT共显示133个病灶,Xper CT动静脉期发现的病灶高于DSA常规造影(98.4%vs 96.2%);其一次插管成功率高于DSA常规造影(90.9%vs 72.7%),但二次插管成功率较DSA常规造影低(9.1%vs 27.3%)。结论 Xper CT较DSA常规造影能发现更多的原发性肝癌病灶,并能提高一次超选插管的成功率,对指导临床医生进行超选插管进行化疗栓塞有一定价值。     

超声造影评价微波凝固治疗肝细胞肝癌的应用

目的：探讨超声造影在评价微波凝固治疗肝细胞癌（HCC）的应用价值。方法：经静脉注射造影剂SonoVue后,对30例（男20例、女10例）HCC患者（共33个病灶）在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至2周采用超声造影检查评价疗效,并与同期增强CT检查结果进行比较,12个病灶治疗区取病理标本送检,21个病灶治疗区接受随访观察。结果：微波治疗后超声造影显示22个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及6个月以上的随访,证实微波治疗联合肝动脉栓塞化疗（TACE）,的2个HCC病灶,增强CT判断失误,增强CT诊断肿瘤灭活准确率为94%（31/33）;超声造影诊断肿瘤灭活准确率为97%（32/33）。统计结果显示,两者诊断肿瘤灭活差异无统计学意义（P〉0.05）。结论：超声造影不仅能评价HCC微波治疗的疗效,且能有效地评价TAE和微波凝固联合治疗HCC的疗效,因不受碘油干扰可优于增强CT。     

影响原发性肝癌LP—TAE疗效的因素分析

1988年4月至1990年12月,以碘油—抗癌剂混悬液及明胶海绵碎粒栓塞肝癌的供血动脉(Lp—TAE)治疗原发性肝癌178例,累积生存率(Cumulative Survival Rate)分别是一年67.97％和二年43.51％。认为LP—TAE是肝癌的最好姑息手段。如何进一步提高疗效使姑息变成治愈?作者对178例患者的肝动脉造影,CT扫描片,手术病理标本等资料进行了对比分析,认为碘油抗癌药物混悬液沉积不充分是病灶未能完全被消灭的关键。影响药物充分沉积的主要因素是:①肝癌乏病理血管;②药量不足;③癌灶内严重的动静脉分流;④没有用明胶海绵栓塞或栓塞不充分;⑤肝动脉外供血;⑥混悬液制作不良等。强调了首次LP—TAE的重要性。     

原发性肝癌肝外侧支动脉供血的诊断及介入治疗

目的:探讨肝癌侧支供血的影像学类型和介入治疗方法。方法:分析165例肝癌患者的数字减影血管造影(DSA)表现,并与多层螺旋CT对照。分析侧支供血类型,并相应行栓塞治疗。结果:165例肝癌侧支供血的患者DSA检查共发现侧支206条,其中右膈下动脉107条,左膈下动脉31条,右肋间动脉19条,胃十二指肠动脉13条,胃左动脉7条,右肾上腺动脉18条,胸廓内动脉11条。术前多层螺旋CT检查发现157条肝外侧支供血动脉,阳性率为76%(157/206)。栓塞侧支动脉后,行CT复查可见肿瘤病灶内碘油沉积较前密实、均匀,其边缘与肿瘤边缘相吻合。结论:肝癌的肝外侧支供血发生率较高,及时发现并进行栓塞治疗,可明显提高对肝癌的治疗效果。     

MRI、DSA和碘油CT联合应用对肝硬化结节癌变的诊断价值

背景与目的:肝硬化结节癌变是肝硬化转变成为肝癌的必经阶段,早期发现和早期干预对提高患者的生存率具有重要意义。本研究探讨联合应用MRI、DSA和碘油CT对肝硬化结节癌变诊断价值,旨在早期发现肝硬化结节癌变。方法:收集经病理证实的肝硬化癌变病例18例,所有患者均行MRI、DSA和和碘油CT检查,分析MRI、DSA和碘油CT对肝硬化结节恶变的诊断价值。结果:18例患者中共有31个病灶,其中MRI发现病灶29个,肿瘤病灶T1WI呈低信号12个,高信号9个,等信号8个;T2WI呈稍高信号20个,等信号9个;DWI呈高信号23个;三期动态增强扫描呈"快进快出"共18个,"快进慢出"3个,持续强化3个;另有5个病灶因T1WI呈高信号,强化表现观察不满意。DSA发现27个病灶,表现为肿瘤血管生成、血管扭曲、血供增多、肿瘤染色;2周后复查碘油CT,31个病灶均有碘油沉积。结论:MRI、DSA和碘油CT联合应用能提高肝硬化结节癌变的诊断准确性,从而早期发现肝硬化结节癌变。     

超声造影与增强CT在评价肝癌行TACE后疗效的对照研究

目的:通过超声造影与增强CT在肝癌行肝动脉化疗栓塞术（TACE）后的影像对照研究,探讨超声造影在肝癌TACE后评估中临床价值。方法:对42例行TACE后的原发性肝癌患者,术后一个月分别行超声造影、增强CT检查,之后行DSA检查,有未栓塞完全病灶再次行TACE,之后将二者的检查结果与术中DSA结果进行对照研究,分析超声造影的特征。结果:行DSA造影后,41名患者行TACE,1名患者未行TACE。而增强CT示36例患者的病灶栓塞不完全,有强化表现,需要再次行TACE,敏感度为87.8%,特异度为100%,阳性预测值为100%,阴性预测值为16.7%,准确度为88.1%。超声造影示40例患者病灶栓塞不完全,有强化表现,需要再次进行TACE,敏感度为97.6%,特异度为100%,阳性预测值为100%,阴性预测值为50%,准确度为97.6%。两组检查结果无统计学差异(P＞0.05)。结论:超声造影检查结果的准确度高于增强CT检查结果,接近DSA检查结果,可以应用于肝癌行TACE后的评价。     

CT对原发性肝癌碘油栓塞后的随访价值

目的 探讨肝癌介入治疗后CT平扫、双期增强及3DCT对肝癌肝动脉插管化疗及碘油栓寨治疗(LP-TACE)术后的随访价值.方法 43例肝癌LP-TACE治疗后行CT平扫及双期增强扫描,10例同时行MIP、曲面重建.结果 43例肝癌LP-TACE治疗后碘油沉积形态分4个类型:完全型、缺损型、簇集型和稀少型.35例LP-TACE治疗后肿瘤内见非坏死低密度区,增强后18例动脉门静脉双重供血型,10例动脉供血型.4例门静脉供血型,3例少血供型.10例肝动脉及门静脉血管MIP、曲面重建可显示肝动脉及门静脉与非坏死低密度区的关系.结论 CT三期扫描及三维重建是显示肝癌LP-TACE治疗后残留病灶、反映其血供变化的有效方法,对制订新的治疗方案有指导意义.     

Multislice computed tomography angiography of the abdominal arteries: Comparison between computed tomography angiography and digital subtraction angiography findings in 52 cases

Since the introduction of multislice CT scanners, CT angiography (CTA) has become a powerful tool for imaging the vascular system. We compare conventional angiography to CTA in the diagnosis of morphological changes in the abdominal aorta and its branches. A retrospective analysis of 52 patients who underwent both multislice CT angiography (MSCTA) and digital subtraction angiography before surgical treatment is presented. All CT examinations were performed after administration of 100 mL contrast medium with a collimation of 4 × 1 mm and a pitch of 7. A standardized evaluation of the axial, multiplanar and 3D reconstructions was performed by two experienced radiologists. Stenoses were classified as high‐grade and low‐grade, and aneurysms, occlusions and arteriosclerosis were evaluated. The CTA findings were compared with conventional angiography. All aneurysms, occlusions, stenoses and calcifications were diagnosed correctly by CTA in axial and multiplanar projections (sensitivity 1.0; specificity 1.0). The degree of stenosis was overestimated in three cases when using axial projections. Three‐dimensional volume‐rendered CTA showed a sensitivity of 0.91 for aneurysms, 0.82 for stenoses, 0.75 for occlusions and 0.77 for calcifications. The specificity was 1.0 in all cases. Multislice CT angiography seems to be similar to conventional digital subtraction angiography for abdominal vessels if multiplanar projections are used.     

Total body MR angiography and atherosclerosis

The early detection of atherosclerotic vascular lesions is very important for diagnostic and interventional purposes. Traditionally, Digital Subtraction Angiography (DSA) is considered the reference diagnostic technique, but recently several new non-invasive procedures have been developed, like Doppler US, CT-angiography and MR-Angiography (MRA). MRA has progressively gained acceptance as a valid alternative. At present, the use of fast sequence and contrast injection allows to acquire segmental volumes within a few seconds (10-20s), with high diagnostic quality and accuracy. The systemic distribution of atherosclerosis requires the use of techniques which can assess the arterial system as exhaustively as possible. A MRA scanning protocol including all arteries from the epiaortic branches to the calf has recently been proposed with encouraging preliminary results. In this article, the relevant technical concepts in MRA and the present most important clinical findings are reported and discussed, including the proposed technique for a whole-body MR angiographic assessment of the atherosclerotic patient.     

CT血管成像与数字减影血管造影对颅内动脉瘤的临床应用价值

目的探讨CT血管成像(CTA)与数字减影血管造影(DSA)对颅内动脉瘤的临床应用价值。方法选取2013年5月至2016年5月间沈阳市第二中医医院收治的118例颅内动脉瘤患者,均先行CTA检查,后行DSA检查。比较CTA和DSA对颅内动脉瘤的检出率、灵敏度、准确度及空间关系显示的差异。结果 CTA检查共发现动脉瘤123个,多发11例,假阳性3例。DSA检查共发现动脉瘤122个,多发10例,假阳性2例,两种方法检出的动脉瘤数目比较,差异无统计学意义(P>0.05)。两者所测瘤体直径及瘤颈宽度比较,差异均无统计学意义(均P>0.05)。两者造影图像比较,CTA可通过最大密度投影和三维技术,显示颅内动脉血管瘤大小及形态,瘤颈与载瘤动脉的关系较DSA更清晰,DSA显示细小动静脉及血流方向优于CTA。结论 CTA与DSA诊断颅内动脉瘤,效果相近,CTA易操作且无创,可成为原发性蛛网膜下腔出血的首要诊断根据。     

旋转数字减影血管造影与磁共振血管造影在动脉瘤诊断中的应用对比

目的:探析旋转数字减影血管造影（rotational digital subtraction angiography,R-DSA）与磁共振血管造影（magnetic resonance angiography,MRA）在动脉瘤诊断中的应用。方法:临床收集我院2010年至2015年收治的可疑颅内动脉瘤待查患者110例,所有患者均进行R-DSA与MRA检查,所有患者均签署知情同意书。诊断结果以介入或手术结果为“金标准”,比较MRA、R-DSA检查方法用于不同直径颅内动脉瘤的诊断率和准确度。结果:本组110例患者病灶情况均为单发,3D R-DSA、3D MRA两种检查方法的诊断符合率差异对比无统计学意义（P>0.05）;3D R-DSA法检测动脉瘤瘤体颈宽、纵径等指标显著高于3D MRA,差异有统计学意义（P<0.05）;3D MRA、3D R-DSA检测瘤颈>2.8 mm组动脉瘤差异有统计学意义（P<0.05）,检测瘤颈≤2.8 mm组动脉瘤与总体检出结果之间差异显著（P<0.05）。结论:颅内动脉瘤应用MRA检查具有快速、无创、准确率高等优越性,对颅内动脉瘤的诊断具有重要的应用价值。     

Combining stereotactic angiography and 3D time-of-flight magnetic resonance angiography in treatment planning for arteriovenous malformation radiosurgery

Purpose: This study was initiated to evaluate the advantages of using three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA), as an adjuvant to conventional stereotactic angiography, in obtaining three-dimensional information about an arteriovenous malformation (AVM) nidus and in optimizing radiosurgical treatment plans.

Methods and Materials: Following angiography, contrast-enhanced MRI and MRA studies were obtained in 22 consecutive patients undergoing Gamma Knife radiosurgery for AVM. A treatment plan was designed, based on the angiograms and modified as necessary, using the information provided by MRA. The quantitative analysis involved calculation of the ratio of the treated volume to the MRA nidus volume (the tissue volume ratio [TVR]) for the initial and final treatment plans.

Results: In 12 cases (55%), the initial treatment plans were modified after including the MRA information in the treatment planning process. The mean TVR for the angiogram-based plans was 1.63 (range 1.17–2.17). The mean coverage of the MRA nidus by the angiogram-based plans was 93% (range 73–99%). The mean MRA nidus volume was 2.4 cc (range 0.6–5.3 cc). The MRA-based modifications resulted in increased conformity with the mean TVR of 1.46 (range 1.20–1.74). These modifications were caused by MRA revealing irregular nidi and/or vascular components superimposed on the angiographic projections of the nidi. In a number of cases, the information from MRA was essential in defining the nidus when the projections of the angiographic outlines showed different superior and/or inferior extent of the nidus. In two cases, MRA revealed irregular nidi, correlating well with the angiograms and showed that the angiographically acceptable plans undertreated 27% of the MRA nidus in one case and 18% of the nidus in the other case. In the remaining 10 cases (45%), both MRI and MRA failed to detect the nidus due to surgical clip artifacts and the presence of embolizing glue.

Conclusions: The 3D TOF MRA provided information on irregular AVM shape, which was not visualized by angiography alone, and it was superior to MRI for defining the AVM nidus. However, when imaging artifacts obscured the AVM nidus on MRI and MRA, angiography permitted detection of AVM. Utilizing MRA as a complementary imaging modality to angiography increased accuracy of the AVM radiosurgery and allowed for optimal dose planning.     

Patient with Leriche's syndrome and concomitant superior mesenteric aneurysm: Evaluation with contrast‐enhanced three‐dimensional magnetic resonance angiography,computed tomography angiography and digital subtraction angiography

Conventional angiography is regarded as the gold standard in vascular imaging but it is invasive, and difficulty may be encountered in the evaluation of aortic occlusion disease. Superior mesenteric artery aneurysm is an uncommon disease, which can result in life‐threatening haemorrhage after rupture. With the rapid development of computed tomography angiography (CTA) and magnetic resonance angiography (MRA), high‐quality images of the vascular system can be obtained in a non‐invasive manner. We report a case of Leriche's syndrome with concomitant superior mesenteric aneurysm using contrast‐enhanced 3‐D CTA and MRA, with digital subtraction angiography correlation.