腘血管陷迫综合征的MR诊断(附5例报告)

目的：探讨MRI在胭血管陷迫综合征诊断（PVES）中的应用价值。方法：回顾性分析5例经手术病理证实的PVES患者的删资料，其中3例行DSA检查。结果：5例MRI图像均可清晰显示胭血管与周围组织之间的关系，均可见异常走行的肌肉、肌腱或纤维组织束压迫胭动脉，明确病因诊断。结论：MRI能很好的反映胭动脉的狭窄闭塞的部位、范围、程度及侧枝循环形成的情况，并且能清晰显示胭血管与周围组织间的关系，明确病因诊断明显优于DSA。     

MRI结合MRA在腘血管陷迫综合征诊治中的应用

目的探讨MRI结合MRA在腘血管陷迫综合征(PVES)诊断及治疗中的应用价值。方法回顾性分析9例经手术证实的PVES患者的MRI及MRA检查资料,以手术结果为标准,分析MRI合并MRA检查在PVES诊断中的准确性。结果 9例MRI平扫图像均可清晰显示腘血管与周围肌束、肌腱之间的异常关系,明确诊断及分型。MRA能很好地显示腘动脉的移位、管腔狭窄闭塞情况、腘动脉瘤的形成及周围侧枝循环的情况,与手术结果一致。结论 MRI结合MRA检查能很好地显示腘血管病变及其与周围组织间的关系,在PVES诊治中有重要价值。     

CT血管成像术在腘血管陷迫综合征诊治中的应用价值

目的探讨CT血管成像术(CT angiography,CTA)在腘血管陷迫综合征(Popliteal vascular entrapment syn-drome,PVES)诊断及治疗中的应用价值。方法回顾性分析12例经手术证实的PVES患者的CTA资料,其中10例行DSA检查。以手术结果为标准,评价CTA检查在PVES诊断中的准确性。以DSA检查为标准,评价CTA在显示腘动脉走行及狭窄闭塞程度的准确性。结果 12例CTA图像均可清晰显示腘血管与周围组织之间的关系,明确分型,与手术结果一致。CTA横断面图像及三维重建图像能直观显示腘血管狭窄闭塞的位置、范围、程度,与DSA中立位检查一致。结论 CTA不但能够显示腘血管的形态,而且能清晰显示腘窝内腘血管与周围肌肉组织间的关系,在PVES的诊治中有重要的价值。     

颈动脉体瘤的影像学诊断

目的:探讨比较颈动脉体瘤的超声、CT、MRI、DSA的影像学表现,提高术前诊断水平。方法:回顾性分析手术病理证实的14例颈动脉体瘤的各种影像学表现及特征。结果:各种检查均可显示肿瘤部位、大小及形态,颈动脉体瘤的彩色多普勒特点为中等偏低实质回声,境界清楚,大于3.0cm的肿瘤可见管道结构,但肿瘤上缘观察欠清,14例行彩色多普勒超声其中9例可显示瘤内网状血管,有1例神经鞘瘤误诊为颈动脉体瘤,诊断符合率为93%(14/15)。14例均行CT平扫加增强,CT增强显示为富血管肿瘤,其中12例肿瘤均匀强化,2例呈明显不均匀强化,CT值150～180HU,颈内、外动脉密度与瘤体等同难以分辨,术前CT诊断符合率为100%(14/14)。11例患者行MRI及MRA检查,MRI平扫特点为瘤内见流空的血管影像,明确显示颈内、外动脉分离和紧贴或镶嵌在肿瘤后外缘及前外缘,MRA能良好显示肿瘤与颈总动脉及其分叉的关系,术前MRI诊断符合率为100%(11/11)。其中8例同时行DSA血管造影,除能明确诊断和显示供血动脉外,DSA能清晰显示其血供及与颈内、外动脉的关系,术前DSA诊断符合率为100%(8/8)。结论:彩色多普勒超声、CT和MRI对颈动脉体瘤均有很高的诊断价值,差异无显著性意义。     

旋转数字减影血管造影及三维重建在颅内动脉瘤诊治中的应用

目的 探讨脑血管旋转数字减影血管造影(DSA)和三维重建对颅内动脉瘤的诊断和治疗价值.方法 使用荷兰PHILIPS公司数字减影机,对35例疑有动脉瘤破裂的蛛网膜下隙出血患者行普通二维DSA及旋转DSA检查,并行血管三维重建,获得关于动脉瘤的定位、方向、瘤颈、动脉瘤清晰度、载瘤动脉和周嗣血管分支的立体解剖图像,将旋转DSA及三维影像与普通二维DSA结果比较.结果 常规DSA检查发现动脉瘤36个(30例),其中7例动脉瘤的方向及载瘤动脉和周围血管解剖关系显示不清,3例动脉瘤的颈部显示不清;5例未见明显动脉瘤染色.加摄旋转DSA并行三维重建后,又发现3例微小动脉瘤,明确诊断颅内动脉瘤39个(33例),2例仍未见动脉瘤.动脉瘤的全貌,瘤颈的位置、宽窄,载瘤动脉及周围血管分支的解剖关系清晰显示,避免了因血管重叠而产生的对动脉瘤的遮挡.结论 旋转DSA可从270°旋转视角更清晰地连续显示动脉瘤、瘤颈及周围的血管解剖结构,加三维重建后,动脉瘤的大小、方向、载瘤动脉及周围血管的关系呈立体解剖影像,既提高了动脉瘤血管造影诊断的灵敏度,降低了漏诊率,又为手术和介入治疗提供了更为全面、准确的影像资料.     

3D DSA在颅内动脉瘤诊疗中的应用价值

目的 探讨3D DSA在颅内动脉瘤诊断和血管内介入治疗中的临床应用价值.方法 11例蛛网膜下腔出血患者（经CT证实）,分别进行常规DSA与3D DSA造影,9例进行血管内介入治疗.结果 常规DSA一般能显示存在动脉瘤病变,极少数能明确显示瘤颈和载瘤动脉的关系.3D DSA能清晰显示颅内动脉瘤瘤体,瘤颈及其与载瘤动脉的关系,显示动脉瘤结构的能力比常规DSA明显提高,提示血管内介入治疗的可行性,并指导制定治疗方案.结论 3D DSA对颅内动脉瘤的诊断和血管内介入治疗具有较高的临床应用价值.     

旋转DSA诊断颅内动脉瘤的价值

目的 研究旋转DSA对颅内动脉瘤的诊断价值。方法 使用荷兰PHILIPS－INTEGRIS V－3000型DSA系统,对20例疑有颅内动脉瘤的蛛网膜下腔出血患者作旋转DSA检查,并与常规DSA检查比较,得到一系列关于动脉瘤的定位,动脉瘤颈的清晰度及血管分支解剖的图象。结果 旋转DSA诊断颅内动脉瘤的20例患者,常规DSA检查发现18例动脉瘤,其中6例（6／18）动脉瘤的载瘤动脉及周围血管解剖关系显示不清,7例（7／18）动脉瘤的颈部显示不清。加摄旋转DSA检查后,动脉瘤的全貌,瘤颈的位置与结构及周围血管分支的解剖关系清晰显示。结论 旋转SA可更好、更清晰的显示动脉瘤的颈部及其周围的血管解剖结构,从而提高了动脉瘤的血管造影诊断价值,为手术提供更为准确的参考价值。     

烟雾病的影像学诊断(附20例分析)

目的 :通过对 2 0例烟雾病患者的影像学分析 ,阐述CT、MRI与DSA在诊断本病中的价值。方法 :本组烟雾病患者共 2 0例 ,均经CT与DSA检查 ,其中 13例行MRI及MRA检查。结果 :有 7例颈内动脉狭窄或合并大脑前、中动脉狭窄或闭塞患者在MRA图像得以显示 ,而在脑血管造影时 ,2 0例患者均清晰显示出动脉的狭窄与闭塞。CT图像上仅可见蛛网膜下腔出血 ,脑梗塞等继发改变。结论 :DSA在烟雾病诊断中 ,在显示细节方面如烟雾血管、侧枝循环血管等仍优于MRA。     

硬脊膜动静脉瘘MRI与DSA诊断的对比研究

目的　总结硬脊膜动静脉瘘 (SDAVF)的MRI和DSA特点 ,评价其诊断价值。方法　回顾性分析 2 5例SDAVF患者的脊髓MRI和DSA表现。结果　MRIT2 权重像矢状面与冠状面最好显示脊髓髓外的异常血管及其并发病变 ,脊髓血管DSA检查能清楚显示瘘口部位、供血动脉的组成和引流静脉的类型范围。结论　SDAVF诊断主要依据脊髓血管DSA检查 ,MRI虽不能确诊SDAVF ,但能很好显示脊髓髓外的异常血管及继发病变 ,从而为本病的诊断提供参考     

旋转DSA及三维重建技术在颅内动脉瘤诊断中的应用价值

目的 评价旋转DSA及血管三维重建技术在颅内动脉瘤诊断中的价值.方法 40例蛛网膜下腔出血患者应用传统DSA,旋转DSA 及血管三维重建进行检查,对比不同方法对动脉瘤病变的显示情况.结果 40例患者均确诊为颅内动脉瘤,共45个动脉瘤.常规正侧位DSA能显示存在动脉瘤病变,但仅极少数病例能明确显示瘤颈和载瘤动脉的关系.旋转DSA显示动脉瘤结构的能力较常规DSA明显提高.所有血管三维重建的图像都清晰显示了颅内动脉瘤瘤体、瘤颈形态及载瘤动脉关系.结论 旋转DSA及血管三维重建技术对颅内动脉瘤病变结构显示极佳,尤其是三维重建技术,明显有助于提高对颅内动脉瘤的诊断和介入治疗.     

MR imaging and MR angiography in popliteal artery entrapment syndrome

Popliteal artery entrapment (PAE) syndrome is an uncommon congenital anomaly seen in young adults causing ischemic symptoms in the lower extremities. It is the result of various types of anomalous relationships between the popliteal artery and the neighboring muscular structures. The purpose of this study was to define the role of MR imaging combined with MR angiography in the diagnosis of PAE cases. Four cases with segmental occlusion and medial displacement of popliteal artery in digital subtraction angiography (DSA) examinations were diagnosed as PAE syndrome by MR imaging and MR angiography. The DSA and MRA images are compared. All of the cases showed various degrees of abnormal intercondylar insertion of the medial head of the gastrocnemius muscle. The MR images showed detailed anatomy of the region revealing the cause of the arterial entrapment. Subclassification of the cases were done and fat tissue filling the normal localization of the muscle was evaluated. The DSA and MRA images demonstrated the length and localization of the occluded segment and collateral vascular developments equally. It is concluded that angiographic evaluation alone in PAE syndrome might result in overlooking the underlying cause of the arterial occlusion, which in turn leads to unsuccessful therapy procedures such as balloon angioplasty. Magnetic resonance imaging combined with MR angiography demonstrates both the vascular anatomy and the variations in the muscular structures in the popliteal fossa successfully, and this combination seems to be the most effective way of evaluating young adults with ischemic symptoms suggesting PAE syndrome. Received 7 April 1997; Revision received 15 July 1997; Accepted 13 November 1997     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

The value of MRI in popliteal entrapment syndrome

The popliteal artery entrapment syndrome (PAES) is a frequent disease of especially young patients, often following a muscular exertion. To avoid the complications, the diagnosis must rapidly be done. According to this report of a 12 year old child, we think that magnetic resonance imaging (MRI) is very accurate to diagnose the abnormalities of the popliteal artery course, the muscular hypertrophies and can relieve of more invasive procedures such as the arteriography associated with known morbidity in young patients.     

Role of CT angiography in the diagnosis and treatment of popliteal vascular entrapment syndrome

OBJECTIVE: Popliteal vascular entrapment syndrome is an uncommon congenital abnormality of the anatomic relations between the popliteal vessels and the neighboring musculotendinous structures. The purpose of this essay is to describe the CT angiographic findings in the diagnosis and treatment of this syndrome. CONCLUSION: Digital subtraction angiography is of limited value in the evaluation of popliteal vascular entrapment syndrome and has been replaced by noninvasive imaging techniques, such as Doppler sonography, CT angiography, MRI, and MR angiography.     

Popliteal artery entrapment: findings at MR imaging.

Magnetic resonance (MR) imaging can noninvasively demonstrate the anatomic relationships between the popliteal artery and the muscles within the popliteal fossa, making it an ideal screening test for popliteal artery entrapment prior to angiography or surgery. The authors describe a patient with bilateral type II popliteal artery entrapment in whom the anomaly was diagnosed in the asymptomatic extremity with MR imaging.     

Popliteal artery entrapment syndrome: morphological classification utilizing MR imaging

Objective To retrospectively analyze magnetic resonance (MR) findings in patients with popliteal arterial entrapment syndrome.Materials and methods This study was a retrospective MRI and CT scan review of 12 patients with 23 limbs with popliteal artery entrapment syndrome (PAES) treated over a 10-yr period. All 12 patients (23 limbs) were evaluated with MR and CT scan (11 patients—bilateral sides; one patient—unilateral side). All cases were classified as to various types of anomalous relationships between the popliteal artery and the neighboring muscles. The PAES was classified to gastrocnemius medial head and lateral head anomaly. Gastrocnemius medial head anomaly was classified according to the classification made by Whelan and Rich, from type 1 to type 6 [12, 13]. Gastrocnemius lateral head anomaly was defined as popliteal artery entrapment due to medially inserted gastrocnemius lateral head or aberrant accessory head of gastrocnemius lateral head.Results The gastrocnemius medial head anomaly was found in 14 limbs (14/23). The classic type 1 was found in none, type 2 in five patients (six limbs), type 3 in four patients (five limbs), type 4 in none, type 5 in one patient (one limb) and type 6 in one patient (two limbs). The uncommon type, i.e. lateral head of gastrocnemius anomaly, was found in five patients (eight limbs).Conclusion The gastrocnemius medial head anomaly was the cause of PAES, and PAES was classified by medial head anomaly. However the gastrocnemius lateral head anomaly was also the cause of PAES, and most cases of gastrocnemius lateral head anomaliy showed aberrant accessory slip which entrapped the popliteal artery and vein.     

Bilateral popliteal artery entrapment syndrome: reemphasis on reading axial tomograms

A 33-year-old man with bilateral popliteal artery entrapment syndrome (PAES) presented with right calf claudication. He underwent radiological studies including conventional arteriography, multidetector row CT (MDCT), and magnetic resonance imaging (MRI) of the lower extremities. He had been fine since birth and athletic in his school days. Axial tomographic images by MDCT and MRI at the popliteal fossa bilaterally showed an anomalous medial head of the gastrocnemius muscle between the popliteal artery and vein, resulting in right popliteal artery occlusion and leading to the diagnosis of bilateral PAES type II. MDCT or MR facilitates noninvasive computer-aided arteriography and is often utilized for screening patients with claudication for peripheral arterial diseases. However, axial tomograms are more essential for confirming PAES than arteriography, and radiologists should continue to look for possible abnormalities on popliteal fossa tomograms because early diagnosis of PAES allows better choices and outcomes of treatment.     

Popliteal artery entrapment syndrome: arteriographic findings and thrombolytic therapy.

PURPOSE: To review the arteriographic appearance of popliteal artery entrapment syndrome (PAES) and functional popliteal artery entrapment, and determine the role of thrombolysis in the treatment of these disorders. MATERIALS AND METHODS: Retrospective review of hospital records from 1991 to 1998. RESULTS: Seven patients with PAES and one with functional entrapment were identified. The popliteal artery was occluded in two limbs and compressed in 13. Active plantar flexion was necessary to demonstrate impingement in nine limbs. Medial deviation of the popliteal artery was evident in six of 14 patent popliteal arteries, and lateral deviation was observed in one limb. "Classic" abrupt medial angulation of the popliteal artery was observed in one limb. Both limbs were involved in all six patients who underwent bilateral popliteal exploration. Thrombolytic therapy was performed in three limbs. In two instances, it permitted a less extensive surgical procedure than would otherwise have been required. CONCLUSIONS: There is considerable variability in the arteriographic appearance of PAES, which is arteriographically indistinguishable from functional entrapment. It is frequently bilateral. Thrombolytic therapy does not obviate surgery but may permit a less extensive procedure to be performed.     

飞行员腘动脉压迫综合征一例并文献回顾

目的 探讨腘动脉压迫综合征的临床特征及飞行人员的健康鉴定原则. 方法 分析1例飞行员腘动脉压迫综合征的临床资料,并复习国内外相关文献16篇. 结果 患者以间歇性跛行为首发症状,下肢血管多普勒彩色超声及动脉造影检查发现右侧腘动脉闭塞,下肢血管及腘窝核磁检查提示右侧腓肠肌内侧头起始位置升高,使腘动脉位于股骨内上髁与腓肠肌内侧头之间的狭窄缝隙内. 结论 腘动脉压迫综合征是一种罕见的血管外科疾病,动脉造影、血管超声、CT及MRI对诊断及鉴别诊断具有重要价值,及早诊断有利于指导手术治疗方案和改善患者预后.飞行人员患腘动脉压迫综合征,应个别评定飞行结论 .     

Popliteal artery entrapment syndrome evaluation with multislice CT angiography

Purpose

The purpose of this study is to evaluate the use of multislice computed tomography (MCT), Doppler US, and angiography in the diagnosis of popliteal artery entrapment syndrome.

Patients and methods

In a prospective study of 26 patients referred to Doppler ultrasound examination with suspected popliteal artery entrapment syndrome, we have made Doppler study of the popliteal artery of the diseased limb using 7–10 MHz probe. Additional multislice CT angiography after bolus injection of non-ionic contrast medium (Ultravist), axial transverse sections and multiplanar reformation reconstruction images were analyzed. Conventional angiography of the diseased limb was performed with the use of pigtail catheter and injection of 60 cc Ultravist.

Results

On 22 of 26 patients, the Doppler study revealed damped flow, biphasic waves and a dramatic decrease in peak velocity. All these signs appeared in the Doppler study of popliteal artery while retaining normal flow and waves in distal tibial vessels.When 26 patients were examined, the conventional angiography revealed sudden attenuated and decreased caliber of popliteal artery with retained average caliber of the distal run-off vessels without showing the surrounding structures.When 26 patients were examined, the CT angiography revealed decreased caliber of popliteal artery, verified the exact diameter of popliteal artery and gave an accurate idea about the wall of the vessels and the surrounding soft tissue structures. These last benefits enable us to differentiate between organic and functional causes of popliteal artery entrapment syndrome.

Conclusion

In conclusion, popliteal artery entrapment syndrome can be diagnosed with the use of multislice CT which is as efficient as conventional angiography. However, multislice CT provides detailed information on the wall, diameter of the artery and relation of the artery to adjacent structures by a non-invasive technique.