数字化影像在血管造影和介入放射学中的应用

目的：结合数字化Ｘ线机Ｐｏｌｙｓｔａｒ的使用体会，讨论数字化成像技术的应用价值。材料与方法：８５例患者完成单纯造影３８例，造影及介入治疗５２例，由３位医师评价全部血管造影所见、介入治疗及影像质量。结果：血管造影１５４支，最远解剖段血管分支获满意显示，肝内显示的最小病灶０．８ｃｍ×１．０ｃｍ，影像质量优良片８２例（９６．５％）。结论：数字化成像技术功能多且操作简便，可为临床提供充分信息并减少操作时间     

平板式全数字心血管造影机在周围血管及非血管介入中的应用

目的 :评价平板式全数字心血管造影机在周围血管及非血管介入中的应用价值。方法 :对平板探测器(FPDD)X线成像与影像增强器 电视 (IITV)X线成像在动态范围、成像均匀性、对比度线性、对比分辨率等图像质量指标的检测及比较。随机选择上述两机型在周围血管及非血管介入诊疗病例图像资料各 6 0例 ,由三名高年资医师对其图像质量进行综合评价 ,记录评价结果 ,并进行比较。结果 :FPDD成像在动态范围、成像均匀性、对比度线性、对比分辨率等图像质量指标均优于IITV成像 ;在人体各部位周围血管及非血管介入诊疗中的图像综合评价结果也优于IITV成像。结论 :平板式全数字化心血管造影机不仅适用于心血管介入 ,同时能满足全身各部位周围血管及非血管介入诊疗的需要。     

三维重建结合手术体位改变在脑动脉瘤介入治疗中的应用价值

目的 评价旋转三维重建技术及术中体位在脑动脉瘤介入治疗中的应用价值.方法 采用GE INNOVA 3100数字减影血管造影系统对25例患者进行脑动脉正侧位和旋转DSA造影.结果 正侧位造影中16例患者动脉瘤阳性,其中9例动脉瘤和载瘤动脉与周围血管关系显示不清,使用三维重建能在介入手术中为术者提供清晰的工作体位,动脉瘤颈...     

国产血管内介入治疗导管的临床应用

目的：探讨国产导管在血管内介入治疗中的价值。方法：应用60条国产血管内介入治疗导管行脑血管造影17例、盆腔动脉造影及栓塞6例、肝动脉造影及栓塞37例。结果：所有血管造影及治疗均成功完成。结论：国产血管内介入治疗导管能够满足介入治疗的需要。     

国产数字胃肠机在介入治疗中的应用体会

目的探讨数字胃肠机在介入治疗过程中的体会及临床应用。方法回顾性总结我院使用该机进行血管造影和介入治疗临床资料，分析DSI图像质量和机器性能特点。结果全部病例均顺利完成，图像质量尚可，能显示脑血管及肿瘤血供的情况，能为介入手术提供影像资料，但仍有很多缺陷，如能熟练操作，是可以克服的。结论国产数字胃肠机可以满足一般介入治疗的需要，能提高二级甲等医院医疗技术水平，扩大对外影响具有重要意义。     

不明原因消化道出血的血管造影及介入治疗

目的：探讨不明原因消化道出血血管造影和介入治疗的方法及临床价值。方法：不明原因消化道出血血管造影23例，男16例，女7例。介入治疗7例，分别进行血管加压素灌注止血和明胶海绵、不锈钢圈栓塞治疗。结果：血管造影阳性病例16例，其中炎症出血3例（小肠2例、结肠1例），小肠憩室5例，小肠血管畸形4例，肿瘤4例（小肠3例、胃癌1例）；造影阴性7例。介入治疗7例，其中4例血管加压素灌注止血、明胶海绵栓塞2例、不锈钢圈栓塞1例。结论：血管造影时应尽可能将导管超选择插入相应的可疑异常血管分支，提高不明原因消化道出血的检出阳性率，并同时进行介入治疗。     

数字化多用途X线透视系统临床应用价值

本文评价了一种可倾斜诊床和Ｃ型臂一体化、能进行多种方向透视检查的数字化影像系统在全身普通Ｘ线检查和介入放射学中的应用价值。所记录的３６２次数字化影像检查中胃肠道造影检查１３０次，脊髓造影８５次，数字化血管造影５６次，ＤＳＡ４９次，介入操作３６次和其他６次。３６２次２１种不同检查方法由８名医生完成。根据１至５级标准图像质量评价，３６２次检查中３５０次图像满意的，仅１２次不满意。研究表明，多用途数字化影像系统能承担和代替专用Ｘ线机为透视检查、血管造影和介入操作。图像质量与同标准Ｘ线机在同样条件下获得的图像相同甚至更好。     

心血管造影及介入治疗的放射技术管理

心血管造影及介入治疗的放射技术管理重庆第三军医大学附属新桥医院放射科谢俊文为配合我院重点科室——心血管内外科进行各种心血管疾病的检查与治疗，我科于１９８６年引进日本大型心血管造影系统。到１９８９年，由于介入放射学的开展，此系统又担负起介入治疗的任务。...     

小儿双腔右心室的影像检查

目的：探讨X线胸片、超声、心导管、心血管造影对双腔右心室诊断价值。材料与方法：选择13例经手术证实为双胜右心室的病例，并均有X线胸片、超声、心导管及心血管造影资料，对这四种影像检查进行分析对照。结果：X线胸片无特征性改变，超声正确率仍较低，心导管、心血管造影正确率高于超声。结论：双腔右心室术前确诊应选择心导管及心血管造影检查。     

提高数字化成像和照相的技术附加值在消化道造影检查与治疗中的临床应用价值

目的：探讨数字化成像和照相的技术附加值在消化道造影检查与治疗中的临床应用价值。材料和方法：我院利用数字化成像系统和激光照相技术开展了1221例消化道气钡造影，所有患者影像资料经过计算机后处理，将图像质量分为3级，并随机抽取普通气钡造影摄片1063份按上述标准进行评价对比分析。结果：数字化成像在影像对比上能更好地显示细微改变，并减少患者肠道蠕动对图像质量的影响加上消化道低张气钡造影等精细检查方法的推广应用，因此使得消化道造影图像质量又向前迈进了一步。结论：数字化成像系统由于曝光时间短．操作方便，其连续采集装置对胃肠道功能异常的发现和研究特别有帮助，加上合理的视野选择及图像后处理技术的应用，为诊断提供高质量的图像资料。因此数字化成像消化道造影适用范围广，临床应用价值大。     

Patient absorbed dose in coronary angiography determined by the flat panel digital detector X-ray system

The INNOVA 2000, an all-digital cardiovascular X-ray system with flat panel detector, is equipped with a monitoring function that makes it possible to track a patient's absorbed dose by displaying the real-time presumed absorbed dose. We verified this dose monitoring system and evaluated how it is affected by various parameters. We also compared the INNOVA 2000 to a conventional machine, the Advantx LC. The average absorbed dose of the INNOVA 2000 was 1,066 mGy, while that of the Advantx LC was calculated to be 2,028 mGy. Dose reduction with the INNOVA 2000 was 76% at Low mode and 52% even at Normal mode. The INNOVA provides an advantage in lowering absorbed dose, even considering that it has a rectangular image intensifier (I.I.) versus the Advantx LC's round I.I. This comparison was made by cine and digital angiography.     

The multifunctional therapy room of the future: image guidance, interdisciplinarity, integration and impact on patient pathways

With few exceptions the interventional rooms of the present are either imaging suites or sterile operating rooms. Their users are restricted to either percutaneous procedures or to two-staged image-guided surgery without intra-operative imaging control. Since interventional therapy of the future will be minimally invasive and since minimally invasive therapy is essentially image-guided therapy, a new physical place for these activities has to be devised: the multifunctional therapy room of the future integrates sophisticated imaging and image guidance modalities together with advanced surgical and life-support equipment in a sterile environment [1, 2, 3]. Even given a high degree of integration, this will be a complex and costly piece of medical technology. These two factors – complexity and cost – require interdisciplinary technological and medical collaboration to bring it into existence, distribute its cost and maximize usage and medical benefit. Yet another dimension of multifunctionality will be introduced and a significant impact on the care of vitally threatened patients will be exerted by using this room not only for elective image-guided therapy but also for emergent one-stop diagnosis and treatment. Motivation, technology, implementation strategies and funding of this image-guided, integrated and interdisciplinary therapy room, as well as a comprehensive approach combining emergency care and elective computer-assisted therapy (CAT), are discussed in this paper. Received: 28 October 1999; Revised: 18 February 2000; Accepted: 6 April 2000     

Dose evaluation of a flat-panel detector system

We compared the INNOVA2000 (INNOVA), which has a flat panel detector system, and the Advantx LCLP (LCLP), which has a conventional I. I. system, in terms of the dependence of phantom thickness on patient surface dose (surface dose) and receptor entrance dose (entrance dose). We examined the reduction in surface dose and entrance dose by using an additional filter and shortening the patient detector distance (PDD). The surface dose rate for fluoroscopy with INNOVA was 73.8-63.5%, and the reduction rate was high at a phantom thickness of less than 20 cm compared with LCLP, but such a reduction could not be expected at a phantom thickness of more than 30 cm, depending on maximum dose rate. The rate of reduction in surface dose in the case of exposure was considerably low at a phantom thickness of about 20 cm, while the other's (5, 10, 15, 25, 30 cm) reduction rates were about 40%. The length of PDD with INNOVA was shortened by 5 cm compared with LCLP. As a result, we obtained a reduction rate of surface dose of 11-15%, while the entrance dose was 10% lower. The reduction rate achieved with an additional filter was 43-60% in surface dose rate in fluoroscopy, whereas that of surface dose for exposure was about 50% at phantom thicknesses up to 20 cm, but remained just 25% thereafter. The results indicated that the reduction of surface dose with INNOVA could be changed by means of the phantom thickness, and we consider the effect achieved by the addition of a filter to be the main factor.     

Intravascular ultrasound in interventional radiology

Intravascular ultrasound (IVUS) imaging provides useful additional information to X-ray angiography in selected cases of balloon angioplasty and stent placement with complex vascular anatomy and unclear findings at angiography. It facilitates accurate measurements of the vessel dimensions and reveals the extent of the disease for the selection of proper angioplasty balloon size, as well as confirms full expansion and attachment of the stent or stent graft to the arterial wall. Intravascular US imaging contributes useful information for the basis of planning surgical or endovascular therapy of aortic dissection and is valuable for guiding percutaneous fenestration of the dissection flap. This imaging modality facilitates placement of vena cava filter without cavography and/or fluoroscopy in patients with contraindication for iodine contrast media and/or X-ray fluoroscopy. Technical development may further increase utility of IVUS imaging in interventional radiology. Received: 22 May 2000; Accepted: 7 June 2000     

Interventional cardiovascular procedures guided by real-time MR imaging: an interactive interface using multiple slices, adaptive projection modes and live 3D renderings

PURPOSE: To develop and test a novel interactive real-time MRI environment that facilitates image-guided cardiovascular interventions. MATERIALS AND METHODS: Color highlighting of device-mounted receiver coils, accelerated imaging of multiple slices, adaptive projection modes, live three-dimensional (3D) renderings and other interactive features were utilized to enhance navigation of devices and targeting of tissue. RESULTS: Images are shown from several catheter-based interventional procedures performed in swine that benefit from this custom interventional MRI interface. These include endograft repair of aortic aneurysm, balloon septostomy of the cardiac interatrial septum, angioplasty and stenting, and endomyocardial cell injection, all using active catheters containing MRI receiver coils. CONCLUSION: Interactive features not available on standard clinical scanners enhance real-time MRI for guiding cardiovascular interventional procedures.     

Diffusion- and perfusion-weighted MRI in therapeutic neurointerventional procedures

We describe three patients in whom we used MRI, including diffusion- and perfusion-weighted imaging (DWI, PWI) in conjunction with endovascular therapy. Two had intracranial aneurysms and one an arteriovenous malformation (AVM). The aneurysms were treated by coil embolisation or detachable balloons for proximal artery occlusion; the AVM was obliterated by intranidal glue injection. All patients had transient or permanent neurological deficits after treatment. The MRI techniques and interventional procedures are described and the DWI and PWI patterns found are correlated with the clinical features. We discuss how the information gained from MRI may increase our understanding of procedure-related complications and its potential impact on our therapeutic interventions, in order to prevent or limit the clinical consequences of such events. Received: 7 April 2000 Accepted: 19 December 2000     

深入开展布-加综合征的基础研究

回顾我国15年来在布-加综合征的影像诊断和介入治疗研究方面所取得的成绩,分析了我国布-加综合征介入治疗研究的现状和存在的问题,强调今后在布-加综合征研究的重点是开展病因和发病机制的基础研究。     

Evaluation of Effective Dose During Abdominal Three-Dimensional Imaging for Three Flat-Panel-Detector Angiography Systems

The purpose of this study was to evaluate the effective dose during abdominal three-dimensional (3D) imaging on phantoms and estimate the dose-area product (DAP) for effective dose conversion factors for three types of angiographic units. Three-dimensional imaging was performed for three sizes (small, medium, large) of human-shaped phantoms using three types of angiographic units (Allura Xper FD20/10, INNOVA 4100, AXIOM Artis dTA). We calculated 25 organ doses and effective doses using Monte Carlo technique for the three phantoms with a program for a personal computer. As benchmark studies to back up the results by Monte Carlo technique, we measured the organ doses directly on the small phantom using radiophotoluminescent glass dosimeters. The DAP value increased as the phantom size increased. The organ doses and the effective doses during the 3D imaging increased as the phantom size increased. The effective doses for the small phantom by Monte Carlo technique were 1.9, 2.2, and 2.1 mSv for the Allura Xper FD20/10, INNOVA 4100, and AXIOM Artis dTA, respectively, while those by direct measurement were 1.6, 2.0, and 2.6 mSv. The effective doses to DAP ratios by Monte Carlo technique were 0.37–0.45, 0.26–0.32, and 0.13–0.15 (mSv Gy⁻¹ cm⁻²) for the Allura Xper FD20/10, INNOVA 4100, and AXIOM Artis dTA, respectively. In conclusion, the effective doses during 3D imaging and the dose-to-DAP ratios differ among angiographic units, and the effective dose can be estimated using a proper conversion factor for each angiographic unit.     

恶性肿瘤经动脉介入治疗致脊髓损伤的临床研究

目的:探讨恶性肿瘤经动脉介入治疗致脊髓损伤的发生率、影像及临床表现、处理原则及预防措施。方法:284例肺恶性肿瘤患者行420例次选择性支气管动脉介入治疗,63例肾癌患者行96例次经肾动脉介入治疗(部分例次经腰动脉介入治疗),肺恶性肿瘤和肾癌患者的介入治疗之和占同期恶性肿瘤经动脉介入治疗的2.0%。恶性肿瘤经动脉介入治疗后出现8例次脊髓损伤,对其临床资料进行回顾性分析。结果:肺恶性肿瘤经支气管动脉介入治疗,肾癌经肾动脉、腰动脉介入治疗,脊髓损伤发生率分别为1.2%、2.1%,1例次具有右膈动脉侧支供血的肝癌对右膈动脉行TACE术时出现脊髓损伤。同期的其他介入治疗(如腹腔动脉、肝动脉、脾动脉、肠系膜上动脉等)无脊髓损伤。血管造影仅1例次(1/8)显示脊髓根动脉及脊髓前动脉,造影即刻至数小时出现脊髓损伤症状。使用大剂量激素、血管扩张剂、脱水剂、神经营养剂等治疗,尽早进行康复训练,脊髓功能在0.5～3.5个月左右基本恢复。结论:恶性肿瘤经动脉介入治疗可导致脊髓损伤发生,血管造影脊髓根动脉及脊髓前动脉显示率低,术前及术中应以多种预防措施减少其发生率,术后积极治疗、尽早进行康复训练,脊髓功能可基本恢复。