Multisection CT angiography compared with catheter angiography in diagnosing vertebral artery dissection

BACKGROUND AND PURPOSE: Multisection CT angiography is a minimally invasive technique that can provide high-resolution and high-contrast images of the arterial lumen and wall. To our knowledge, the ability of multisection CT angiography in detecting vertebral artery (VA) dissection has never been evaluated. We assessed the sensitivity and specificity of a routine, standardized, multisection CT angiographic protocol for the detection of VA dissection. METHODS: We retrospectively reviewed multisection CT angiograms of 17 patients with VA dissection and 17 control subjects. The acquisition protocol for multisection CT angiography was 1.25-mm nominal section thickness, a table speed of 7.5 mm per rotation (9.4 mm/s), and a 0.8-second gantry rotation period. Two radiologists assessed the maximum intensity projection and axial source images. The sensitivity and specificity of this technique in depicting VA dissection were determined. RESULTS: Conventional angiography depicted 15 normal and 19 dissected VAs (including five stenotic, seven occlusive, and seven aneurysmal dissections) in the patient group and 28 normal and six atherosclerotic VAs in the control group. Multisection CT angiography enabled successful diagnosis of all 19 dissected VAs and 48 (98%) of 49 nondissected VAs but misidentified a severe atherosclerotic lesion as an aneurysmal-type dissection. The sensitivity, specificity, accuracy, and positive and negative predictive values of multisection CT angiography in diagnosing VA dissection were 100%, 98%, 98.5%, 95%, and 100%, respectively. CONCLUSION: Multisection CT angiography was a sensitive and accurate technique for the diagnosis of VA dissection.     

肠系膜上动脉夹层一例

患者男,60岁.因右上腹部持续性疼痛,阵发性加剧3 d入院.实验室检查:白细胞12.8 × 109/L,血、尿淀粉酶正常,肝、肾功能正常.心电图未见异常.血压:135/80 mm Hg(1 nun Hg=0.133 kPa).体检无明显异常.     

Multidetector CT angiography in spontaneous popliteal artery dissection

Primary dissection of the femoropopliteal or popliteal arteries is rare in the absence of involvement of the aorta or aneurysmal arterial changes. In this report, we present multidetector CT angiography findings of a case of a spontaneous nonaneurysmal dissection limited to the left popliteal artery in an otherwise healthy 40-year-old woman.     

Postoperative bilateral vertebral artery dissection: a case report

With the improvement of medical imaging and surgical techniques, surgery on cervical vertebral is more frequent. Some cases of complications of this type of surgery have been described. We report a case of postoperative bilateral vertebral artery dissection. It concerns a 58 year-old woman who suffered from a left cervico-brachial C6 neuralgia with paresthesiae of the thumb. She underwent discectomy at C5-C6 and C6-C7 followed by setting up intersomatic cages. In subsequent days, an irreversible coma developed. Supra-aortic echographic study revealed bilateral vertebral artery thrombosis. CT scan revealed ischemic lesions of the brain stem and cerebellum. Cerebral death was declared five days after the operation. Autopsy was performed to determine whether death was the consequence of the intervention. The cause of death was determined to be ischemic brain injury of the brain stem and cerebellum resulting from bilateral traumatic occlusion of the vertebral arteries caused by the surgery.     

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,     

Isolated intrapetrous carotid canal atraumatic internal carotid artery dissection: MRI and digital subtraction angiography findings

A case of spontaneous internal carotid artery (ICA) dissection confined to the intrapetrous carotid canal that was confirmed by angiography and magnetic resonance imaging is presented. Isolated dissection involving the intrapetrous ICA is rare; however, whenever arterial dissection is a consideration, specific review of imaging in this region is warranted.     

Spontaneous renal artery dissection revealed by helical CT angiography

Spontaneous renal artery dissection is rare and may be misdiagnosed because its clinical presentation is confusing. Diagnosis is usually made by intra-arterial angiography. We report a case where a spontaneous renal artery dissection was initially misdiagnosed as a renal abscess. Diagnosis was made later with helical CT for suspicion of renal artery stenosis in a patient with recent onset of hypertension. This unusual case shows that helical CT can be useful for non-invasive diagnosis of renal artery dissection. Received: 20 May 1999; Revised: 2 September 1999; Accepted: 3 September 1999     

CT angiography in the assessment of carotid artery atherosclerosis

Objective: The aim of the study was to evaluate the ability of CT angiography (CTA) to detect atherosclerosis of the carotid arteries in comparison with 3D time-of-flight MR angiography (3D TOF MRA), using contrast angiography and intravascular ultrasound (IVUS) as a reference.Material and Methods: Contrast angiography and CTA were performed in 31 patients (mean age 65 years, range 45-79). The image quality was evaluated, atherosclerotic lesions were registered, and diameter stenosis degree was visually estimated from axial source images of CTA and 3D TOF MRA (21 patients), and results of interpretations were compared. The comparison of quantitative measurements was performed using IVUS as a reference.Results: Contrast angiography detected 51 lesions (mean diameter stenosis 50%, range 10-100%), and CTA detected all same lesions. CTA provided better image quality and consistency of image interpretation than 3D TOF MRA. IVUS verified 29 atherosclerotic lesions with a mean diameter stenosis of 35%, (range 4-40%). CTA yielded a sensitivity of 96% to 100% (≤10% or ≤20% diameter stenosis regarded as normal) for the detection of lesions with reference to IVUS.Conclusion: CTA seems feasible and accurate for the detection of atherosclerosis in carotid arteries.     

颈动脉支架内再狭窄1例

患者 男性,69岁.2003年11月27日因左侧肢体无力6天入院.查体左侧肢体肌力Ⅳ级.CT:右侧基底节区及双侧半卵圆中心腔隙性梗塞.DSA检查左侧颈内动脉窦部动脉粥样硬化伴狭窄60%,行左侧颈内动脉血管内支架植入术.     

Acute massive subdural hematoma caused by rupture of internal carotid artery aneurysm during angiography: a case report

We present a case of acute, massive subdural hemorrhage caused by rupture of an internal carotid artery aneurysm during the procedure of cerebral angiography. To our knowledge, a case like the present one has been reported only once in the English-language literature. The incidence, mechanisms, treatment, and prognosis of (1) subdural hematoma, caused by rupture of cerebral aneurysm, and (2) re-rupture of aneurysm during the angiography procedure are discussed. Electronic Publication     

肠系膜上动脉夹层的MSCT血管成像

目的:探讨多层螺旋CT血管成像(MSCTA)在诊断肠系膜上动脉夹层(SMAD)中的价值.方法:回顾性分析我院临床漏诊、经CTA诊断为SMAD后经手术或DSA证实的16例患者的临床及CT影像资料.所有患者均行MSC-TA检查,并采用MPR、CPR、MIP和VR技术进行图像后处理.总结SMAD的CTA特征表现,分析临床漏诊的原因.结果:SMAD主要CT表现:16例患者均可见SMA为双腔结构,可见内膜片,其中7例患者假腔内可见新月形充盈缺损.CT横轴面和三维重组图像能清楚显示11例患者肠系膜上动脉夹层的范围和程度.SMAD患者的主要临床表现是急性或慢性腹痛、以中上腹为主,无特异性,临床医师未认识到MSCTA诊断SMAD的价值是导致漏诊或误诊的原因.结论:MSCTA能提供评估肠系膜上动脉夹层的可靠信息,临床医师和影像医师应该认识其价值,重视对肠系膜上动脉夹层的观察.     

Technical factors of CT angiography studied with a carotid artery phantom.

PURPOSETo evaluate scanning parameters (conventional versus spiral CT, section thickness, and pitch) and vessel orientation in the performance of CT angiography.METHODSConventional CT and 1.0-, 1.5-, and 2.0-pitch spiral CT acquisitions of a carotid phantom designed with vessels oriented parallel to the z-axis, 45 degrees oblique, and perpendicular to the z-axis were obtained with section thicknesses of 2, 4, and 8 mm. The phantom contained 32 vessels with 0% to 100% stenoses. Normal and stenotic luminal diameters were measured and the number of artifacts was assessed.RESULTSNo overall difference was observed among conventional and spiral CT acquisitions obtained with pitches of 1.0, 1.5, and 2.0. With thicker sections, CT angiographic accuracy decreased and artifacts increased. The three-vessel orientations were relatively comparable in accuracy in terms of the percentage of stenosis measured. Vessels parallel to the z-axis suffered less artifactual degradation. Unique artifacts, such as luminal distortion and beam hardening, were observed in vessels oriented at 45 degrees and perpendicular to the z-axis.CONCLUSIONUse of thinner sections with vessels oriented parallel to the z-axis optimizes CT angiographic quality. There is no apparent degradation with the use of spiral CT, and a pitch of 1.5 or 2.0 provides results equivalent to 1.0-pitch spiral studies.     

颈内动脉纤维肌肉发育不良的MSCT血管造影诊断(附9例报告)

目的:探讨颈内动脉纤维肌肉发育不良的多层螺旋CT血管造影(MSCTA)表现及诊断。方法:收集本院2003年~2005年6月经多层螺旋CT血管造影检查确诊的纤维肌肉发育不良9例。结果:9例中发生在颈内动脉颅内段5例,其中3例同时合并前、中动脉病变;岩骨段1例;单一中动脉3例。合并颈内动脉颅外整段狭窄、闭锁者2例,椎动脉整段性狭窄者2例,累计病灶17处。血管改变有:血管对称性狭窄,局限性偏心性狭窄,串珠样扭结状改变,狭窄伴动脉瘤。脑实质表现有:脑实质正常,脑梗塞,蛛网膜下腔出血。结论:本病无特异性临床症状,诊断依靠对本病的警惕,影像学特点是节段性血管腔狭窄及串珠样改变,使用MSCTA是生前诊断本病的简便有效方法。