颈动脉16层螺旋CT成像和应用

随着多层螺旋CT的不断发展,多层螺旋CT成像及血管造影已成为颈动脉疾病的主要检查方法,研究证明CTA在评价颈动脉的狭窄和闭塞上与DSA有高度的一致性,可常规用来评价颈动脉狭窄等病变.同时CTA还可用来评价颈部血管外伤,可以发现颈部血管部分或完全闭塞、假性动脉瘤、夹层、动静脉瘘等,以及颈部软组织、气道、颈髓椎管等部位的病变,可作为怀疑颈部血管外伤但暂无手术指征的无创性检查方法.     

Multi-slice CT (MSCT) angiography for assessment of traumatic lesions of lower limbs peripheral arteries

Aim The aim of this study was to evaluate the feasibility and effectiveness of multi-slice computed tomography (MSCT) angiography for the assessment of traumatic lesions involving the arteries of the lower limbs. Materials and methods Forty-seven patients with suspected arterial post-traumatic lesions of lower limbs underwent MSCT angiography (4 × 2.5-mm collimation, 3-mm slice width). The standards of reference were: digital subtraction angiography (DSA; patients with inconclusive/doubtful or positive MSCT angiography indicating a need for intravascular treatment), surgical findings (patients with positive MSCT angiography indicating a need for surgery), or clinical/investigational follow-up (patients with negative MSCT angiography and no need for further diagnostic procedures or surgery). Results All CT exams were technically adequate. Sensitivity, specificity, and overall diagnostic accuracy of MSCT angiography were 96.3, 90, and 93.6%, respectively, relative to the reference of standard findings. In 44 out of 47 patients, MSCT angiography allowed a correct continuation of the diagnostic work-up. Conclusion MSCT angiography is a reliable fast tool for diagnosing traumatic vascular lesions, providing results comparable to DSA.     

Diagnostic accuracy of computed tomography angiography in detection of post traumatic renal vascular injury

Objectives

To evaluate accuracy of computed tomography angiography (CTA) in evaluation of post traumatic renal vascular injury.

Vascular trauma to the extremities and lower neck: initial assessment with intravenous digital subtraction angiography

Rapid assessment of a patient with possible major peripheral vascular injury is essential to preserve limb function. Intravenous digital subtraction angiography (IV DSA) allows rapid evaluation of these patients without the need for intraarterial examination. We report our experience in 295 vessels studied by IV DSA for the evaluation of possible traumatic arterial injury to the extremities or neck. Of our study population requiring angiography (469 patients), 63.4% were appropriate candidates for IV DSA. Of the vessels studied by IV DSA, 93.6% required no further radiologic evaluation. A normal appearance on IV DSA study indicates no major vascular injury; patients with positive studies may proceed to surgery without further interventional assessment.     

3D angiography in the evaluation of intracranial aneurysms before and after treatment. Initial experience

PURPOSE: The aim of the study is to evaluate the advantages of 3D angiography as compared to 2D angiography in assessing intracranial aneurysms before and after treatment and, in particular, in selecting and planning the correct treatment. MATERIALS AND METHODS: Thirty intracranial aneurysms were retrospectively reviewed before and after treatment. The study population consisted of 12 men and 18 women (age range: 35-77 years; mean age: 58 years). Eighteen aneurysms were treated surgically, 10 endovascularly and 2 with combined treatment. The 2D and 3D findings before and after treatment were compared, and the pre-treatment angiographic images were compared with surgical findings. The following parameters were assessed and compared: aneurysmal sac and neck size, vascular involvement and evaluation of post-treatment residual mass. RESULTS: On the 2D DSA images, visualisation of the sac and neck was optimal in 45% and 15% of cases, adequate in 10% and 35% of cases and inadequate in 5% and 50% of cases, respectively. On the 3D DSA images, visualisation of the sac and neck was optimal in 100% of cases. Three-dimensional DSA was able to detect 8 aneurysms with vessel involvement in all cases (100%). Of these, four (50%) went undetected on 2D DSA; in two cases, two-dimensional DSA erroneously detected the presence of vascular involvement (false positive). Three-dimensional angiography proved superior to 2D angiography in the evaluation of the residual aneurysms treated with clipping. Finally, 3D DSA was able to reduce the number of radiographic projections, the quantity of contrast medium, the time and associated risks necessary for a precise evaluation of the aneurysm. CONCLUSIONS: In our first experience, 3D DSA proved useful in reducing the risks and diagnostic time as well as in selecting and planning the treatment. Moreover, it improved the operating conditions of both surgical and endovascular treatment. Technological advances in this field will enable the optimisation of the technique in terms of anatomical detail and reconstruction time.     

Efficacy of targeted CT angiography in evaluation of intracranial internal carotid artery disease

RATIONALE AND OBJECTIVES: This study evaluated the efficacy of targeted computed tomographic (CT) angiography in the diagnosis of intracranial internal carotid artery (ICA) disease and compared the results of routine and targeted CT angiography. MATERIALS AND METHODS: Fifty-four patients (24 male and 30 female patients aged 2 months to 87 years) were examined with CT angiography. Digital subtraction angiography (DSA) was performed in 42. CT angiograms were reconstructed with the maximum-intensity projection (MIP) algorithm. Targeted CT angiography was performed by individually reconstructing a single ICA territory. Each ICA was divided into four segments, and findings of routine MIP CT angiography, routine MIP plus targeted CT angiography, and DSA were reviewed independently by two neuroradiologists for vascular lesions involving each segment. Routine and targeted CT angiograms were also evaluated to determine how well both ICAs were visualized. RESULTS: Routine CT angiography was rated good or excellent for ICA visualization in 64% of cases, compared with 81% for targeted CT angiography (P = .0005). The overall agreement between routine CT angiography and DSA and between routine plus targeted CT angiography and DSA was 92% and 94%, respectively. There was no statistically significant difference between the percentages of vascular lesions detected with routine CT angiography alone and with routine plus targeted CT angiography. Both methods tended to show false-positive findings of steno-occlusive disease, but targeted CT angiography showed details of aneurysms and stenotic lesions that were easily overlooked with routine CT angiography alone. CONCLUSION: Routine plus targeted CT angiography, while providing superior image quality, did not have much clinical effect; further assessment may be needed.     

64层螺旋CT血管成像诊断脊髓血管畸形的价值

目的 探讨64层螺旋CT 血管成像(CTA)对脊髓血管畸形的诊断价值.方法 经临床和MR检查拟诊为脊髓血管畸形的15例患者进行了CTA.所有患者均在1周内进行了DSA检查.其中4例行于术治疗.将CTA图像与DSA和手术所见进行对照,从判定畸形的类型、显示病变累及的范围、供血动脉、引流静脉和可能存在的瘘口等方面,对CTA图像进行评价.结果 15例脊髓血管畸形经DSA和手术确诊,分别为6例髓内动静脉畸彤、2例髓周动静脉瘘、3例硬脊膜动静脉瘘和4例Cobb综合征.CTA对15例患者的分类和对病变累及范围的判断与DSA结果一致.CTA清晰显示了病变的主要供血动脉和引流静脉.5例动静脉瘘中4例CTA判断的瘘口位置与DSA所见一敛,另1例为复杂血管畸形,瘘口难以辨别.CTA还清晰显示了4例Cobb综合征位于椎旁和皮下的畸形血管团.结论 64层螺旋CTA可以判定脊髓血管畸形的类型,快速、无创地显示其主要病变特征,可作为该病的筛查手段.     

Diseases of the aerodigestive tract and of the soft tissues of the neck. Comparison of MRI and CT

CT and MRT are compared with each other in examinations of the aerodigestive tract in 250 patients. MRT was found to be the method of highest sensitivity and specificity after intravenous administration of the contrast medium Gd-DTPA. Magnetic resonance tomography was found to be clearly superior to computed tomography on account of the 3-dimensional imaging possibilities, improved contrasting of soft parts, and freedom from artifacts. In space-occupying growths of the nasopharynx, oropharynx and hypopharynx, the primary use of MRT must be considered mandatory in diagnostic strategy planning. CT occupies the second rank and can be used for optimised visualisation of small osseous lesions and for digital subtraction angiography (DSA). The latter plays an important role in the analysis of selective vascular supply and in diagnosis before intraarterial chemotherapy. In respect of processed in the soft tissues of the neck, pathological lesions of the lymph nodes, vessels, soft parts and cervical processes are differentiated (n = 139). For the diagnosis of the entire neck region, magnetic resonance tomography with the additional use of the contrast medium Gd-DTPA proves to be the method with the highest rate of accuracy. In processes of the soft tissues, sonography can also be employed as a primary diagnostic tool. However, in certain localisations and lesions this method can only be used with certain restrictions. According to the present state of the art, computed tomography must be considered as a secondary procedure in the diagnosis of the neck region.     

3D rotational digital subtraction angiography may underestimate intracranial aneurysms: findings from two basilar aneurysms

3D digital subtraction angiography (DSA) allows clinicians to review intracranial aneurysms and other vascular lesions. We report 2 basilar aneurysms that were imaged by both 3D DSA and DynaCT. These 2 techniques produced very different aneurysm appearances. Anterior portions of the aneurysms were invisible on 3D DSA but were revealed by DynaCT. These aneurysms appeared to have been flattened by image artifacts in 3D DSA. Pulsation and gravity are 2 possible causes of aneurysm underestimation.     

Digital subtraction angiography of the aortic arch

We evaluated the utility of intravenous digital subtraction angiography (IV DSA) for diagnosing lesions of the aortic arch and great vessels in 25 patients. Digital subtraction angiography (DSA) was found useful in evaluating congenital and acquired lesions of the arch and great vessel origins, and it proved adequate for follow-up of patients who had graft replacement. Cases examined included: right aortic arch, double arch, aortic coarctation, aberrant vascular origins, aortic aneurysm and pseudoaneurysm, changes in atherosclerotic great vessels, and revascularization procedures for patients with pulmonary atresia and aortic interruption. In our experience, DSA is a useful tool for screening and following patients with aortic arch or great vessel lesions; it is often the only diagnostic imaging examination necessary.     

Three-dimensional digital angiography: new tool for simultaneous three-dimensional rendering of vascular and osseous information during rotational angiography

Three-dimensional (3D) digital subtraction angiography (DSA) is the latest development in the neurovascular imaging armamentarium. 3D-DSA combines the anatomic resolution of DSA with 3D visualization abilities previously offered by only CT or MR angiography. 3D-DSA provides more detailed information than does DSA alone in the evaluation of neurovascular lesions, such as cerebral aneurysms. However, the inability of 3D-DSA to simultaneously image osseous and vascular structures is noted as a weakness of this technique compared with CT angiography. We describe a new 3D digital angiography reconstruction algorithm that allows the concurrent display of the cerebral vasculature and the osseous landmarks.     

旋转DSA技术及COMPAS功能在血管造影中的应用

目的探讨旋转DSA及COMPAS技术在血管造影中的应用。方法使用GE数字减影机对疑有血管病变的30例进行常规正侧位检查,而后选择合适的技术参数,对18例进行旋转DSA检查。结果18例患者病变血管位置清晰可见。12例脑血管造影中,11例避开了对比剂血管影的重叠,1例显示不佳;6例肝、肾动脉造影均清晰显示狭窄位置。结论旋转DSA技术及COMPAS功能能显示大多数特殊复杂病变血管并能辅助定位,是常规DSA的重要补充,对病变的诊断及治疗有很大价值。     

Digital subtraction angiography and dynamic computed tomography in the evaluation of arteriovenous malformations and hemangioblastomas of the spinal cord

Digital subtraction angiography (DSA) and dynamic computed tomography (DCT) were used in the evaluation of five patients with surgically approachable vascular lesions of the spinal cord, including three arteriovenous malformations (AVM), one hemangioblastoma, and one lesion with a questionable radiographic-surgical diagnosis (AVM? hemangioblastoma?). Digital subtraction angiography was positive in three of the five cases and was particularly informative in the patient with hemangioblastoma, even vis a vis arteriography, which is considered the definitive diagnostic test for these lesions. Dynamic computed tomography was positive in four of the five cases. From this preliminary study, DSA and DCT appear to be useful screening and follow-up procedures which, in a number of aspects, complement each other.     

脑动脉瘤的MR血管造影与IA—DSA的对照研究

对经手术证实的２０例脑动脉瘤的ＭＲＡ和ＩＡ－ＤＳＡ的影像进行了对照分析研究，经ＭＲＡ检出１９例（９５％）动脉瘤，１０ｍｍ以下的动脉瘤９例，最小的为４ｍｍ，与ＤＳＡ检出率（１９／２０）相仿。ＭＲＡ的定位符合率为８４％，低于ＤＳＡ（９５％）。１３／１９例（６８％）在ＭＲＡ图象上能显示动脉瘤的瘤颈。作者认为ＭＲＡ是一种新的非侵入性的血管影像方法，可作为脑动脉瘤高危病例的筛选检查，随着ＭＲＡ技术的进一步完善，ＭＲＡ有望在神经外科领域替代部分侵入性血管造影检查。     

Possibility of using the spot camera in the documentation of the arterial phase in urography

32 patients have been examined with sequential angiourography (AUS) and image subtraction, utilizing a spot-camera instead of a rapid seriograph, for the visualization of the vascular phase of the renal artery. Satisfactory results have been obtained since in 96.9% of the cases (31/32) it has been possible to obtain representation of those structures sufficient for a clinical evaluation. This technique for its low cost and simplicity of execution can therefore be proposed as a routine examination in the suspect of vascular renal pathology. This method and the more diffuse AUS with rapid seriograph offer, with respect to digital subtraction angiography (DSA), the advantage of a better nephrographic and urographic phase due to the higher quantity of contrast medium injected.     

容积重建法CT脑血管造影的临床应用

目的：探讨CT三维容积重建（volume rendering,VR)脑血管造影的成像方法，评价其临床价值。方法：分析62例CT三维容积重建法脑血管造影的图像，三维观察正常血管及血管病变显示情况，同时与表面遮盖法（surface shade display,SSD)，最大强度投影法（maximum intensity project,MIP)图像比较，并对照DSA和（或）手术结果。结果：VR法脑血管造影显示及脑血管分支清楚，走行自然，能透过骨结构显示血管管腔，血管之间，血管与周围器官的相互关系，显示脑血管病变50例，显示率80．6％，与DSA或手术结果对照，48例诊断正确，2例假阳性，诊断正确率为96．0％，VR图像脑血管的显示与SSD，MIP比较差异无显著性意义（P＞0．25）。结论：VR法脑血管造影是最新的快速而有效的无创伤性三维血管成像术，能部分替代并弥补DSA，VR 旬具有显示血管管腔，重叠血管及避免去骨处理等优点。     

Intravenous digital subtraction angiography in diagnosis of vascular graft occlusion

Differentiation is often difficult between vascular graft occlusion and progression of underlying disease in patients after vascular surgery. We have studied 57 patients after surgery for traumatic and atherosclerotic arterial occlusion and other vascular anomalies using a commercial digital subtraction angiography (DSA) unit; no complications occurred. Indications for examination included pain, diminished pulse, and failure of catheter angiography. Graft patency was established if proximal and distal anastomoses were visualized; occlusion was diagnosed if no graft was imaged or vascular stump found—noted in 31 grafts. Our diagnosis was proved surgically in 24 patients (two refused operation); three others were confirmed angiographically and one by Doppler ultrasonic examination. In our experience DSA is a safe, specific means of following postoperative grafts and diagnosing their occlusion. This work was supported in part by U.S. Public Health Service Grant No. HL07334     

Digital subtraction angiography in the preoperative evaluation of patients with a renal tumor

Inguinal intravenous digital subtraction angiography (DSA) was performed in 14 patients referred for preoperative evaluation of a renal tumor previously diagnosed by CT and ultrasound. Conventional cavography and aortography were used as reference methods for comparison. Both DSA and conventional angiography were carried out following selective arterial injection to the abnormal kidney. The diagnostic value of DSA in examination of the inferior vena cava was generally comparable to that of conventional cavography. Intravenous aortography was unsuccessful in 2 patients due to motion artifacts. In all other patients, the information provided by DSA regarding the aorta, renal arteries and renal veins was similar to that of conventional aortography. Intrarenal vascular detail, however, was far superior on conventional films and was only useful with DSA when intra-arterial injection was implemented. In one of the 12 diagnostic examinations, localization of the renal mass could not be established by intravenous DSA, but was possible in all others. The inguinal approach advocated permits simultaneous inferior vena cavography and intravenous aortography with one single injection of contrast medium; the method is less traumatic than aortography , and does not require hospitalization of the patient. DSA may also be of value in those cases still requiring selective catheterization of the renal arteries, i.e. for angiotherapy . Intra-arterial DSA then allows reduction of the amount of contrast medium and a rapid processing of the images without detriment to the quality of the examination.     

Comparison of magnetic resonance angiography and digital angiography of the epiaortic vessels

Atheromasic lesions and other pathologic conditions of the arterial vessels of the neck are the most frequent causes of cerebrovascular disease. Diagnostic imaging currently employs digital subtraction angiography (DSA), Doppler, and color-Doppler US to study these conditions. Digital subtraction intraarterial angiography (DSAA) can provide both an early diagnosis and an accurate preoperative depiction of neck vessels; however, in spite of its effective value, it still remains an invasive technique. Magnetic Resonance angiography (angio-MR) is the latest technique allowing the depiction of neck vessels morphology. It shares with digital angiography the capability of supplying spatial depiction of all the examined vascular structures, and with US its noninvasiveness. The authors investigated angio-MR capabilities in providing accurate and detailed images of neck arteries; the images were then compared with DSA ones. Thirty patients with cerebrovascular diseases were studied. MR imaging was performed with a 1.5 T unit with a dedicated coil, and gradient-echo sequences were employed. Refocused sequences for flow were acquired on both the coronal and the sagittal planes, with the following parameters: TR 40, TE 10, flip angle 25 degrees, acquisition volumes 80-35 mm, 64-15 frames. Digital angiography demonstrated 101 vascular lesions: 27 slight stenoses (less than 30%), 19 mild stenoses (31-70%), 12 severe stenoses (71-99%), 7 occlusions, 14 coilings, 7 kinkings, and 15 hypoplasias of vertebral artery. In slight stenoses, angio-MR underestimated the condition in 11/27 patients. In mild and severe stenoses, as well as in occlusive diseases, angio-MR tended to overestimate the condition. In coiling, kinking, and hypoplasia, angio-MR yielded the same results as DSA.     

Traumatic inferior gluteal artery pseudoaneurysm and arteriovenous fistula managed with emergency transcatheter embolization

We present a case of blunt trauma to the buttock resulting in an inferior gluteal artery pseudoaneurysm and arteriovenous fistula. The characteristic diagnostic features on CT angiography and digital subtraction angiography (DSA), along with the emergency percutaneous management of this traumatic vascular injury, are described. A review of the literature demonstrates inferior gluteal artery pseudoaneurysm is a rare condition, while successful treatment with glue embolization is previously unreported.