三种心血管造影组合对肺动脉闭锁肺动脉发育情况的评价分析

目的评价分析三种心血管造影组合显示肺动脉闭锁合并室间隔缺损的肺动脉发育情况。资料与方法回顾性分析22例肺动脉闭锁合并室间隔缺损患者的临床资料,包括X线平片、心电图、超声心动图和心血管造影。重点分析三种造影组合对显示肺动脉发育情况的优缺点。结果（1）右心室造影＋楔入肺静脉造影共3例,均显示左右肺动脉融合,一侧肺动脉发育细小。（2）右心室造影＋弓降部主动脉和／或升主动脉造影共15例,其中11例主要由未闭动脉导管供血,均见左右肺动脉融合,融合部狭窄3例,一侧或双侧肺动脉发育不良或变细8例,2例可见主肺动脉及盲端;另4例左右不融合。（3）右心室造影＋弓降部主动脉或升主动脉造影＋体肺侧支血管造影共4例,其中1例由细小动脉导管供血,左右肺动脉融合并发育较好;3例均由小体肺侧支和网状细小血管供血,肺动脉发育细小。结论三种心血管造影组合均能有效显示肺动脉发育情况,主动脉造影能全面了解体肺侧支血管分布,选择性侧支血管造影是术前栓塞所必要的;楔入肺静脉造影可极好地显示纵隔内肺动脉的情况。     

对比剂智能跟踪与预试验肺动脉MSCT成像的对比研究

目的:探讨对比剂智能跟踪技术(BT)和预实验时间-密度曲线(PTDC)技术在CT肺动脉成像中的应用价值。方法:疑诊为肺动脉栓塞而行CT肺动脉成像(CTPA)的患者中,筛选出CTPA结果阴性的患者38例,其中采用BT法者20例、PTDC法者18例。BT法的兴趣区选在取主动脉弓上1cm水平的头臂静脉内,阈值设为100HU,触发后延迟3.2s开始增强扫描;PTDC法的兴趣区选在支气管隆突水平肺动脉主干内。采用双盲法对两种技术所得CTPA影像质量进行评分,并测量双上肺动脉与肺静脉、下肺动脉与肺静脉的密度差,进行统计学分析。结果:BT组图像质量评分优于PTDC组,但差异无显著性意义;右上肺前叶和右肺下叶的肺动、静脉密度差在两组间的差异没有统计学意义;左上肺前叶和左下肺下叶肺动、静脉密度差在两组间的差异有统计学意义(P值分别为0.008和0.019)。结论:选择头臂静脉BT法CTPA检查较PTDC扫描减少了对比剂剂量和患者受照剂量,而且图像质量好于PTDC法。     

Variation of the size of pulmonary venous ostia during the cardiac cycle: optimal reconstruction window at ECG-gated multi-detector row CT

The aim of this study was to investigate the variation of the size of pulmonary vein ostia during cardiac cycle using ECG-gated multi-detector row CT (MDCT). Nineteen patients were included in this study. Transaxial images at the level of right inferior pulmonary vein (RIPV) were reconstructed in increments of 5%. The ostial diameter of RIPV was measured, the reconstruction windows showing maximal and minimal diameters were selected. The ostial areas of four pulmonary veins were measured at axial image sets of two selected reconstruction windows. The measurement of RIPV revealed that the maximal diameter (1.50±0.32 cm) was generally 35% and the minimal diameter (1.28±0.28 cm) was usually at 85%. The measurement of ostial areas showed that the ostia enlarged at the end of ventricular systole when compared with those at the end of ventricular diastole, by the factors of 1.44±0.55 for the right superior, 1.25±0.23 for the right inferior, 1.45±0.81 for the left superior, and 1.31±0.26 for the left inferior pulmonary vein (P<0.05). The size of the pulmonary vein ostia is variable during the cardiac cycle and the measurement of the pulmonary veins should always be in the same phase of the cardiac cycle during the follow-up of patients.     

Angiographic demonstration of complications resulting from the Waterston procedure.

The ascending aorta--right pulmonary artery anastomosis, originally introduced by Waterston as a palliative shunt to increase pulmonary blood flow in certain cyanotic congenital heart diseases, has been found to be associated with late complications in a significant number of cases. These complications include preferential distribution of most or all shunt flow to the right lung, narrowing or obstruction of the right pulmonary artery at the anastomotic site, increasing stenosis or atresia of the right ventricular outflow tract, hypoplasia of the left pulmonary artery, and obstruction of the shunt itself. A properly planned angiocardiographic study is the principal method of detection of these complications.     

Echocardiogram-gated multislice spiral CT in functionally univentricular heart following long-lasting Waterston-Cooley anastomosis

Waterston-Cooley anastomosis may be carried out in patients with tricuspid atresia to provide pulmonary perfusion. It is associated with several complications, including preferential blood flow to the right lung, hypoplasia of the left pulmonary artery, obstruction of the anatomosis or rupture of pulmonary aneurysms. We study a patient with thrombosis in the pulmonary arteries following surgical construction of a Waterston shunt in childhood. Imaging findings and clinical symptoms are discussed with emphasis on echocardiogram-gated multislice spiral CT.     

Radionuclide pulmonary arteriography

Radionuclide pulmonary arteriography offers a unique method for visualizing the main pulmonary artery and its major branches. Since the radioactive particles that are injected intravenously become lodged in the pulmonary capillaries and pre-capillary arterioles, there is no interference from the systemic circulation. Normally, the main pulmonary artery is visualized for no longer than 4 or 6 seconds; prolongation of the duration of visualization may be indicative of, for example, pulmonary hypertension and pulmonary embolism. The patency of the left and right pulmonary arteries may be determined and sites of occlusion identified.     

肺动脉吊带的彩色多普勒超声心动图诊断

目的:探讨彩色多普勒超声心动图对肺动脉吊带的诊断价值。方法:经心导管及手术证实为肺动脉吊带的6例患者为研究对象,回顾性分析其超声心动图表现。结果:6例肺动脉吊带患者中,超声诊断3例,诊断正确率50%;漏诊3例,漏诊率50%。6例肺动脉吊带患者中,2例合并四联症,2例合并房间隔缺损,1例合并室间隔缺损,1例合并左心发育不育综合症。结论:肺动脉吊带是极为少见的先天性心脏病,常规超声心动图检查时,在正常左肺动脉起源处若未发现左肺动脉,提示可能存在肺动脉吊带。     

The vascular converging points of the right pulmonary hilus and their diagnostic significance

The shadows of the right descending pulmonary artery, the superior pulmonary vein crossing it, the middle lobe artery, and branches of the artery supplying the superior segment of the lower lobe converge distinctly at the right hilus. Because the right pulmonary artery bifurcates within the mediastinum, the arteries of the right upper lobe form a second though less obvious converging point above this level. In contrast, the left pulmonary artery does not bifurcate until it reaches the left hilus, providing only a single converging point on that side. A survey of 100 chest radiographs showed that the two converging points on the right could be distinguished in 95 cases, with the upper one being situated somewhat above the single point on the left in 83. In the absence of lobar resection, finding only one converging point on the right is suggestive of collapse of either the upper or lower lobe, whereas visualization of both points excludes major atelectasis.     

Bronchial arteries to right pulmonary artery anastomoses in right pulmonary vein atresia

A case of right sided pulmonary vein atresia with blood return exclusively through the right pulmonary artery is presented. Plain films revealed no evidence of venous obstruction. Our case emphasizes the potential association of pulmonary hypoplasia with radiographically occult pulmonary vein atresia.     

Aneurysms of proximal pulmonary arteries: CT diagnosis and preoperative assessment

We reviewed our experience with proximal pulmonary artery aneurysm (PPAA) to determine whether accurate preoperative evaluation (crucial to differential diagnosis and surgical planning) had been obtained on the basis of CT study alone. Three patients with PPAA were studied with contrast-enhanced CT. We evaluated the size and shape of PPAAs, their proximal and distal extent, eventual presence of intraluminal thrombi, dissection, perianeurysmal fibrosis, and rupture. The results were compared with surgical findings. In two patients the aneurysm involved the pulmonary trunk and both the right and left arteries origin. In one patient the aneurysm extended from the left artery origin to the hilum of the left lung. Contrast-enhanced CT alone allows detection of aneurysm in the pulmonary trunk, in right or left pulmonary arteries with precise preoperative evaluation of the extent, size, shape, and complications. The CT imaging was unable to establish the etiologic origin and presence of small intimal tears in PPAA. Correspondence to: G. Iula     

中心型肺癌肺静脉浸润的CT评价

目的：ＣＴ评价中心型肺癌肺静脉浸润的价值。方法：回顾性分析经手术的１２５例中心型肺癌术前ＣＴ扫描图像。结果：２７例显示肺静脉浸润,并累及心包膜内,没有左心房内充盈缺损。１５例显示左右上肺静脉浸润,所有肿瘤都累及心包膜下（１００％）。１２例显示左右下肺静脉浸润,７例有心包膜受累（５８％）,两间统计学上有显差异（Ｐ〈０．０５）。结论：ＣＴ可应用于评价中心型肺癌肿瘤浸润范围。上肺静脉消失,高度提示肿     

Pre-operative evaluation with MR in tetralogy of fallot and pulmonary atresia with ventricular septal defect

Purpose: To assess whether MR imaging could replace angiography in pre-operative evaluation of patients with tetralogy of Fallot and pulmonary atresia with ventricular septal defect (VSD), especially since the surgical correction was done earlier than was previously the rule.Material and Methods: Fourteen patients with tetralogy of Fallot (n=10) or pulmonary atresia with VSD (n=4), mean age 7.5±4.4 months, were evaluated with angiocardiography and MR before definitive surgical correction.Results: There was good diagnostic agreement between the two modalities when evaluating right ventricular outflow obstruction; 86% for valvular and 93% for supravalvular stenosis, but the agreement was somewhat lower for the subvalvular obstruction (57%). Surgery findings, however, were in favour of MR in 5 patients concerning the subvalvular right ventricular outflow tract obstruction. MR images identified all stenoses in the right and left pulmonary arteries, but overlooked one stenosis in the main pulmonary artery. MR could evaluate patency in all palliative shunts.Conclusion: Even in this young age group, MR imaging offers a good alternative to angiocardiography for the pre-operative evaluation of the right ventricular outflow tract, the main pulmonary artery and the proximal right and left pulmonary arteries, before definitive surgical correction of tetralogy of Fallot and pulmonary atresia with VSD.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段：上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段 左肺8段：上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点：（1）横断面双肺由肺尖至肺底选取11个层面：胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面 （2）双肺由内向外分别选取6个层面,左肺：左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面 右肺：右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外 （3）冠状面双肺由前向后选取7个层面：胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

Catheter induced pseudostenosis of the right pulmonary artery: A technical note

A case of pseudostenosis of the right pulmonary artery caused by a catheter in the azygos vein is presented. The recognition of this pseudolesion occurred when a repeat catheterization prior to angioplasty, demonstrated a normal right pulmonary artery.     

Prediction of short term outcome of pulmonary embolism: Parameters at 16 multi-detector CT pulmonary angiography

Purpose

To evaluate the accuracy of computed tomography pulmonary angiography (CTPA) parameters, for predicting short-term mortality in patients with acute pulmonary embolism (PE).

Materials and methods

Thirty-two patients with proven PE had CT pulmonary angiography were included in the study. The clot burden using the Qanadli score (QS), and the right ventricular dysfunction (RVD) parameters were assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios, interventricular septum abnormality, inferior vena cava contrast reflux, azygous vein and superior vena cava measures. Contrast density in pulmonary artery and descending aorta was evaluated for all patients. Patients were followed up for 30 days and then classified as survivors or non survivors.

Results

Thirty-two patients were included in the study, 23 (71.8%) of them were classified as survivors, and the other nine (28.1%) patients died within the first month (non survivors). There was a positive, but weak correlation between the Qanadli score and the short term mortality (P value = 0.05). There was a statistically significant relationship between the RV/LV ratio and PE-related mortality, with a P value < 0.001. Also, there was a good correlation between degree of IVC reflux and PE outcome (P < 0.001). The PA/AO diameter ratio, SVC diameter and azygous vein diameter showed no statistically significant difference between survivors and non survivors.

Conclusions

CTPA findings that may predict short term mortality are the high grades of inferior vena cava reflux, RV/LV diameter ratio more than 1.2, and clot burden >18 according to the Qanadli score and to a lesser degree the interventricular septum abnormality.     

CT肺动脉成像评价慢性血栓栓塞性肺动脉高压栓塞指数及右心功能

目的：以选择性肺动脉造影及右心导管为标准,探讨多层螺旋计算机断层肺动脉成像（CTPA）评价慢性血栓栓塞性肺动脉高压（CTEPH）及右心功能的价值。方法：回顾性收集确诊CTEPH的患者24例,均行右心导管及肺动脉造影、CTPA及超声心动图检查。结果：CT Qanadli栓塞指数为（37.16±8.77）%,CT Mastora栓塞指数为（38.14±21.56）%,Qanadli栓塞指数高于Mastora栓塞指数（Z=-4.107,P=0.000）,且二者正相关（r=0.734,P=0.000）。CTPA测得主肺动脉/升主动脉直径比与右心导管测定肺动脉平均压（mean pulmonary arterial pressure,mPAP）正相关（r=0.461,P=0.036）。CTPA测定右心室前壁厚度与mPAP成正相关（r=0.515,P=0.018）。CTPA测得肺动脉直径大于超声测肺动脉内径（t=3.485,P=0.002）,且正相关（r=0.588,P=0.002）。CTPA测得右心室最大短轴直径大于超声测右室横径（t=2.647,P=0.016）,且正相关（r=0.429,P=0.031）。CTPA测定右室前壁厚度小于超声测值（t=3.768,P=0.001）,且成正相关（r=0.551,P=0.004）。CTPA测室间隔厚度略低于超声测室间隔厚度（t=2.941,P=0.007）,两组资料正相关（r=0.751,P=0.000）。Qanadli栓塞指数和Mastora栓塞指数与肺动脉压、主肺动脉直径、肺动脉/主动脉直径比、右室横径、右室前壁厚度等参数均无相关性（P〉0.05）。结论：CT肺动脉造影不仅能够明确诊断慢性血栓性肺栓塞,而且能够提供肺动脉树的阻塞程度、右心功能改变信息,为临床决策和治疗提供更多的信息,但慢性血栓性肺动脉高压肺栓塞程度与右心功能无关。     

CT肺血管成像对急性大面积肺栓塞患者的动态分析价值

目的 探讨CT肺血管成像(CTPA)对大面积肺栓塞患者的动脉栓塞程度及右心功能的动态分析价值.方法 回顾性分析23例大面积肺栓塞患者的CTPA资料,分析治疗前、治疗后24 h及14 d时的CTPA肺动脉栓塞指数及右心功能参数,采用单因素方差分析、LSD检验和X2检验分析治疗前后的变化,并采用Pearson法分析肺动脉栓寨指数与右心功能参数之间的相关性.结果 CTPA肺动脉栓塞指数在溶栓治疗后逐渐减小,Qanadli和Mastora评分在治疗前(分别为50.0、46.5分)与治疗后24 h(分别为42.5、12.1分)比较差异有统计学意义(t值分别为2.830、6.493,P值均<0.01);治疗后24 h与治疗后14 d(分别为25.0、8.4分)比较差异有统计学意义(t值分别为4.640、4.299,P值均<0.01).治疗后24 h,右心室最大短轴直径(4.58 cm)及横截面积(23.10 cm2)明显减小,左心室最大短轴直径(4.41 cm)及横截面积(26.37 cm2)明显增大,双侧心室最大直径比(1.07)和面积比(0.94)明显减小,与上述各指标治疗前相比(分别为5.07 cm、25.42 cm2、3.57 cm、20.17 cm2、1.59,1.38)差异有统计学意义(t=2.081～4.959,P值均<0.05);治疗后24 h,肺动脉收缩压(40.92 mm Hg)明显变小,与治疗前(58.61 mm Hg)相比差异有统计学意义(t=2.824,P<0.01);治疗前与治疗后24 h,CTPA肺动脉栓塞指数与右心功能参数间均有不同程度的相关性(r=0.034～0.598,P值均<0.01).结论 CTPA可以动态观察急性肺栓塞的肺动脉阻塞程度及右心功能的变化,为临床治疗提供重要的信息.