CT血管成像对胰十二指肠切除术前肝动脉变异的检出价值

目的 评价多层螺旋CT血管成像(MSCTA)对胰十二指肠切除术前肝动脉的检出价值.方法 胰腺癌和壶腹周围肿瘤患者术前均行腹部CT血管成像(CTA),以数字减影血管造影(DSA)和术中所见的肝动脉解剖为金标准进行比较.结果 81例患者纳入本研究,其中29例行DSA评估肿瘤可切除性和动脉灌注化疗,66接受了手术治疗.CTA检测到17例(21％)患者有变异的肝动脉,13例(16.0％)为一根动脉变异,4例(4.9％)为两根动脉变异.按Michels分型,Ⅳ型、Ⅶ和Ⅷ型各1例,MichelsⅢ型和Ⅴ型各2例,5例为MichelsⅥ型,4例为MichelsⅪ型,1例为罕见变异,未包括在Michels分型里.MSCTA的准确率、灵敏度和特异度均为100％.对于每根肝动脉的清晰度评分,MSCTA与DSA的差异无统计学意义.结论 MSCTA可有效评估胰头周围动脉的解剖变异,为胰十二指肠切除术前了解胰周血管结构提供有价值的信息.     

多层螺旋CT血管造影术在肝动脉解剖变异分析中的应用

目的探讨16层螺旋CTA在分析肝动脉的解剖变异中的应用价值。方法分析240例肝动脉的CTA,并与DSA(26例)或手术(19例)结果进行对照。所有病例均在Toshiba Aquilion 16层螺旋CT机上进行。动脉期层厚为1mm,重建层厚为0.8 mm,螺距15,延迟时间25 s,对比剂用量为1.5 ml/kg。依据Michels分型对240例CTA进行分类,并记录CTA对不同管径动脉分支的显示率。结果正常肝动脉解剖占74.6%,变异占25.4%。45例有DSA或手术结果者,CTA的诊断符合率为95.6%。结论16层CT容积重建在显示肝动脉解剖及变异方面有较高的符合率,可应用于介入、手术以及肝移植术前的评价。     

肝移植受者肝动脉CT血管造影量化分型

有关肝动脉的起源及分布，早在20世纪50年代Michels就有报道。研究者主要基于肝脏供血动脉数量、起源及分布情况，从不同角度提出了诸多分型方法，虽有文献心别报道过肝动脉直径的统计结果，但均未将其与肝动脉解剖分型研究联系起来，而动脉内径与术式的选择及动脉并发症关系密切，现有分型已不能满足临床需要。常规CT血管造影（computed tomography angiography，CTA）检查，可在术前为术者提供肝动脉数量、起源、走行、分布及动脉内径等丰富信息。     

MSCTA观察腹腔干与肠系膜上动脉的解剖学变异

目的采用MSCTA评价腹腔干与肠系膜上动脉及其主要分支的解剖变异。方法收集1000例患者的MSCTA,进行VR、MIP和MPR,观察腹腔干与肠系膜上动脉及其主要分支的起源和走行。结果1000例患者中,880例（88．00％）属于正常解剖学类型（Michels I型）,120例（12．00％）存在不同类型的解剖变异,其中72例（7．20％）属于Mi-chelsⅡ～X型;48例（4．80％）不属于Michels分型,包括腹腔干-肠系膜上动脉共干31例（3．10％）,脾动脉起源于肠系膜上动脉5例（O．50％）,胃十二指肠动脉起源于肠系膜上动脉和脾动脉各3例（O．30％）、肝左动脉1例（O．10％）,腹腔干缺如2例（O．20％）,胃左动脉起源于腹主动脉、脾动脉和肝固有动脉各1例（O．10％）。结论腹腔干与肠系膜上动脉存在广泛的解剖学变异;MSCTA有助于了解变异情况,对腹部血管外科手术具有指导意义。     

基于多层螺旋CT的供肝动脉解剖变异与新解剖分型研究

背景与目的:供肝动脉解剖变异较多,目前肝动脉解剖分型以Michels和Hiatt分型为主,但不断有新发现的解剖变异情况。既往分型不能满足临床需要。本研究通过影像学观察统计供肝动脉解剖变异情况,提出精准分型,为临床工作提供科学准确的依据。方法:回顾性分析2019年1月—2019年3月行腹部多层螺旋CT双期增强扫描患者的影像资料,观察供肝动脉状态,记录相关数据,并进行分类统计。结果:总共纳入1520例患者的CT影像资料,男967例,女553例。符合Michels分型者1504例(98.95%),16例(10.53‰)不符合Michels分型。符合Hiatt分型者1507例(99.14%),13例(8.55‰)不符合Hiatt分型。从肝总动脉(CHA)起源、副左肝动脉(ALHA)起源、供肝动脉类型3个方面对供肝动脉解剖进行分析,笔者提出了供肝动脉解剖分型的七分法(根据CHA起源)与五分法(根据左右供肝动脉的解剖变异及不同变异的组合情况)。七分法中Ⅰ型1471例(96.78%)、Ⅱ型25例(1.64%)、Ⅲ型7例(0.46%)、Ⅳ型5例(0.33%)、Ⅴ型4例(0.26%)、Ⅵ型4例(0.26%)、Ⅶ型4例(0.26%)。五分法中Ⅰ型1381例(90.86%)、Ⅱ型87例(5.72%)、Ⅲ型38例(2.50%)、ⅣⅥ型10例(0.66%);Ⅴ型4例(0.26%)。结论:本研究提出的供肝动脉解剖新分型方法囊括了各种可能的解剖变异,简化了既往研究将CHA和供肝动脉同时纳入分型的复杂情况,分型思路清晰,符合解剖实际与临床认知,可为临床工作提供理论依据与指导。     

多层螺旋CTA对肝脏肿瘤介入化疗及栓塞治疗的指导意义

目的探讨多层螺旋CTA在肝脏肿瘤介入化疗及栓塞治疗中的应用价值。方法对32例肝脏肿瘤患者行MSCTA检查,再行肝脏动脉DSA造影并介入化疗及栓塞治疗。结果以DSA造影作为标准进行比较,MSCTA检出变异动脉10例,准确率为100%,肿瘤明确供血动脉30例,准确率为93.75%。显示肿瘤染色24例,异常肿瘤血管20例,门静脉癌栓7例,动静脉短路4例,与DSA造影所见具有高度的一致性,且对门静脉显影及癌栓的显示优于DSA。结论MSCTA能准确显示变异血管、肿瘤的肝外供血动脉,有无门静脉受累及受累程度,对肝脏肿瘤的介入化疗及栓塞治疗有重要的指导意义。     

肝动脉解剖变异在肝癌介入治疗中的临床意义

目的探讨肝动脉解剖变异的DSA表现及其在肝癌肝动脉栓塞化疗（TACE）中的临床意义。方法回顾分析223例肝癌患者的DSA资料，对存在解剖变异的肝动脉进一步分析其起源、走行、分布及对TACE的影响，统计每组变异肝动脉的发生率。结果223例中，32例存在肝动脉解剖变异，占14．34％，共40支变异肝动脉，其中变异肝总动脉2支（5％，2／40），变异肝固有动脉1支（2．5％，I／40），变异肝右动脉24支（60％，24／40），变异肝左动脉13支（32．5，13／40），有30支变异肝动脉直接参与肿瘤供血，其中24支行TACE治疗，6支行肝动脉化疗（TAI）。结论正确认识肝动脉的解剖变异特征对提高TACE的成功率、降低手术风险有极其重要的意义。     

多层螺旋CT血管造影在血管压迫所致肾盂输尿管连接部梗阻中的诊断价值

目的探讨多层螺旋CT血管造影（CTA）对血管压迫所致肾盂输尿管连接部梗阻（UPJO）中的诊断价值。方法分析手术证实的16例血管压迫所致UPJO患者的CT血管造影图像,观察有无肾脏血管变异,肾盂输尿管连接部周围有无骑跨血管、血管的起源、大小及其与UPJO间的关系。结果16例UPJO中,肾动脉解剖变异12例,肾静脉解剖变异3例。CTA16例见19支血管压迫,其中动脉血管15支,静脉血管4支。单支血管压迫13例,双支血管压迫3例,包括副。肾动脉12例,迷走动脉3例,性腺静脉2例,副肾静脉2例。均与手术病理相吻合。结论多层螺旋CTA不但能够了解肾脏血管解剖及变异,并且在血管压迫所致UPJO的诊断及手术治疗方面具有重要价值。     

三维增强核磁共振血管造影在内脏动脉瘤诊治中的应用

目的 探讨三维增强核磁共振血管造影在内脏动脉瘤诊治中的临床价值.方法 对43例内脏动脉瘤患者行三维增强MR血管造影检查,19例同期行数字减影血管造影(digital subtraction angiography,DSA).三维增强MR血管造影用屏气超快速三维梯度回波序列,图像减影后进行三维重建.结果 43例共50个内脏动脉瘤,涉及脾动脉32个(其中5例脾动脉异位起源于肠系膜上动脉),占64%;肠系膜上动脉7个(14%),腹腔动脉干5个(1例为腹腔系膜干),肾动脉4个,肝动脉2个.三维增强MR血管造影能清楚显示动脉瘤部位、大小、形态,并在立体直观显示动脉瘤及其与周围血管脏器关系方面优于DSA.43例中,行栓塞治疗15例,手术9例,保守观察19例.结论 三维增强MR血管造影能尤创、准确诊断内脏动脉瘤,所提供的三维解剖细节有助于临床治疗方案的制定,可作为内脏动脉瘤的首选检查方法.     

副肝动脉瘤破裂出血的诊断与治疗

副肝动脉瘤破裂出血临床罕见,通过CT血管造影检查（CTA）或多层面重建可为临床诊断提供可靠依据,介入手术是其主要治疗手段。本研究采用介入栓塞成功治疗1例副肝动脉瘤破裂出血病例。该病人副肝动脉变异属于Michels 4型,通过CTA与数字减影血管造影检查明确变异血管出血部位,经介入栓塞治疗后随访,其治疗效果良好。     

Preoperative evaluation of living kidney donors using multirow detector computed tomography: comparison with digital subtraction angiography and intraoperative findings

To assess the accuracy of multirow detector computed tomography (MDCT) for the evaluation of renal anatomy for preoperative donor assessment in living related kidney transplantation. MDCT-scans (4- and 16-slice-CT) of 51 consecutive living kidney donors (age, 51.6 +/- 9.7 years; range, 28-68 years) were analysed by three blinded observers and compared with digital subtraction angiography (DSA) and surgery. Contrast-enhanced MDCT was performed with 1 mm slice thickness reconstruction interval during arterial and venous phases. Supernumerary renal arteries, veins, early branching of vessels and abnormalities of the ureters were documented. The overall accuracy of computed tomography angiography (CTA) for detection and classification of surgically relevant arterial variants was 97% (99/102). The interpretation of 16-channel MDCT images was correct in all cases (accuracy, 100%), while the four-channel CTA had three incorrect results regarding the differentiation of early branching vessels from double renal arteries (accuracy, 93%). The overall accuracy of DSA was 91%. Renal vein abnormalities were correctly diagnosed with MDCT in 100% compared with 89% correct findings with DSA. There were three kidneys with incomplete ureter duplication, detected both with MDCT and DSA. MDCT demonstrated superior accuracy compared with non-selective DSA for the preoperative assessment of renal anatomy in living kidney donors; and for the distinction of supernumerary arteries versus early branching patterns, 16-channel CTA data were better than those of the four-channel system.     

Feasibility of multi-slice computed tomography in the diagnosis of arteriogenic erectile dysfunction

OBJECTIVE: To compare computed tomography (CT) angiography (CTA) obtained by multi-slice CT (a new minimally invasive method) with the current standard of arterial imaging, digital subtraction angiography (DSA), in diagnosing arteriogenic erectile dysfunction (ED). PATIENTS AND METHODS: Twenty-one patients with suspected arteriogenic ED underwent DSA and CTA after providing informed consent. Prostaglandin E1 was injected into the penile cavernosal body and then non-ionic contrast medium was rapidly infused into the antecubital vein. The DSA and CTA images were diagnosed as showing a normal or abnormal status by three reviewers independently. CTA was undertaken on an outpatient basis but DSA required hospitalization. RESULTS: In the 42 internal pudendal arteries, DSA showed 28 normal and 14 impaired arteries; CTA showed 21 normal arteries and 21 occlusions. The CTA image correlated closely with the diagnosis of stenosis or occlusion in internal pudendal arteries, with a sensitivity of 93%, a specificity of 71% and an accuracy of 79%. In the cavernosal arteries, DSA depicted 14 normal and 28 impaired arteries; CTA showed seven normal arteries and 35 occlusions. The CTA image agreed closely with the diagnosis of stenosis or occlusion in cavernosal arteries, with a sensitivity of 96%, a specificity of 43% and an accuracy of 79%. Of the 42 inferior epigastric arteries, DSA could not depict 11 arteries but CTA showed all 42 inferior epigastric arteries. CONCLUSIONS: CTA images correlated with DSA images; at present DSA is better than CTA in visualizing stenosis in fine arteries. However, CTA is less invasive and relatively inexpensive, and in future will probably provide even greater improvements in graphic quality. CTA would be an adequate replacement for DSA in evaluating internal pudendal arterial stenosis.     

计算机断层扫描血管造影和数字减影血管造影在主动脉夹层诊断及术前评估中的应用比较

目的探讨计算机断层扫描血管造影(CTA)和数字减影血管造影(DSA)在主动脉夹层(AD)的诊断及术前评估的作用及一致性。方法回顾性分析60例AD患者的临床资料,比较CTA及DSA两种检查方法显示的AD破口近侧锚定区的距离、左锁骨下动脉左侧平面胸主动脉直径、主动脉夹层累及的范围及主动脉主要分支血管的累及情况。结果 60例患者均同期行CTA、DSA检查,CTA、DSA检查破口近端锚定区的距离大于或等于15mm者分别为44例(44/51,86.2%)、46例(46/56,82.1%);小于15mm者分别为7例(7/51,13.7%)、10例(10/56,17.8%),两种方法比较差异无统计学意义。CTA发现夹层累及左髂动脉(LIA)36例(36/60,60.0%)、累及右髂动脉(RIA)28例(28/60,46.7%),DSA仅发现夹层累及LIA14例(14/60,23.0%)、累及RIA13例(13/60,21.7%),两种方法比较差异有统计学意义(P=0.012,P=0.022);CTA、DSA在显示左锁骨下动脉左侧胸主动脉直径及内脏动脉受累情况比较差异无统计学意义。结论 CTA、DSA两种检查方法有较好的一致性,CTA因其无创性在EVAR术前评估中有重要价值。     

Prospective study comparing three-dimensional computed tomography and magnetic resonance imaging for evaluating the renal vascular anatomy in potential living renal donors

OBJECTIVE: To prospectively compare the accuracy of multislice spiral computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) in evaluating the renal vascular anatomy in potential living renal donors. SUBJECTS AND METHODS: Thirty-one donors underwent multislice spiral CTA and gadolinium-enhanced MRA. In addition to axial images, multiplanar reconstruction and maximum intensity projections were used to display the renal vascular anatomy. Twenty-four donors had a left laparoscopic donor nephrectomy (LDN), whereas seven had right open donor nephrectomy (ODN); LDN was only considered if the renal vascular anatomy was favourable on the left. CTA and MRA images were analysed by two radiologists independently. The radiological and surgical findings were correlated after the surgery. RESULTS: CTA showed 33 arteries and 32 veins (100% sensitivity) whereas MRA showed 32 arteries and 31 veins (97% sensitivity). CTA detected all five accessory renal arteries whereas MRA only detected one. CTA also identified all three accessory renal veins whereas MRA identified two. CTA had a sensitivity of 97% and 47% for left lumbar and left gonadal veins, whereas MRA had a sensitivity of 74% and 46%, respectively. CONCLUSION: Multislice spiral CTA with three-dimensional reconstruction was more accurate than MRA for both renal arterial and venous anatomy.     

64层螺旋CT血管造影及融合技术对胃周动脉的评价

目的探讨64层螺旋CT血管成像（64-MSCTA）及融合技术对胃周动脉的显示能力和临床应用价值。方法对2011年4—8月间收治的53例患者行腹部64层螺旋CT扫描．其中26例胃癌患者行手术治疗。采用容积再现（VR）技术分别重建胃周动脉和胃,并使之相融合,观察腹腔干分型和10条胃周动脉的起源和走行及其与胃的空间关系：将手术患者的术前MSCTA资料与术中所见对比,评价64-MSCTA的准确性、敏感性和特异性。结果53例MSCTA均清晰显示腹腔干,其中MichelsI型（肝脾胃干型）46例（86．8％）。通过融合技术可任意角度清晰显示胃周动脉和胃的空间解剖关系,胃左动脉和胃网膜右动脉显示率均为100％（53／53）,胃网膜左动脉94_3％（50／53）．胃右动脉83．0％（44／53）,胃短动脉58．5％（31／53）,胃后动脉49．1％（26／53）,替代肝左动脉15．1％（8／53）。副肝左动脉、副胃左动脉及替代肝右动脉显示率均为7．5％（4／53）。CTA术前预测各动脉的准确性为84．6％。100％．敏感性为82．6％～100％．特异性均为100％。结论64．MSCTA可清晰显示胃周动脉．采用融合技术使胃周动脉和胃相融合．可真实显示活体胃及胃周血管解剖,指导手术安全进行。     

Three-dimensional multislice helical computed tomography with the volume rendering technique in the detection of vascular complications after liver transplantation

BACKGROUND: Hepatic artery stenosis and thrombosis are common complications in liver transplant patients. Digital subtraction angiography (DSA) has served as the gold standard to make this diagnosis. More recently, three-dimensional helical computed tomographic arteriography (3D CTA) with maximum intensity projection and shaded surface display techniques has been compared with DSA. The purpose of this study was to determine whether 3D CTA with the volume rendering technique is a useful and accurate tool in the detection of vascular complications after liver transplantation. METHODS: Thirty-five consecutive liver transplant patients underwent 3D CTA with volume rendering technique. The standard of reference was DSA for 20 patients and imaging and clinical follow-up for 15 patients. Two blinded reviewers evaluated the axial and 3D CTA images in consensus. RESULTS: 3D CTA with volume rendering technique detected 10 hepatic artery stenoses, six hepatic artery thromboses, two hepatic artery pseudoaneurysms, two splenic artery aneurysms, two portal vein stenoses, and four redundant hepatic arteries. In one case computed tomography (CT) detected a moderate hepatic artery stenosis, while conventional angiography showed a normal artery. The sensitivity of CT for detecting vascular lesions was 100%, specificity was 89% (8 of 9), accuracy was 95% (19 of 20), positive predictive value was 92% (11 of 12), and negative predictive value was 100% (8 of 8). CONCLUSIONS: 3D CTA is a useful and accurate noninvasive technique for detection of vascular complications in liver transplant patients.     

Evaluation of vasospasm after subarachnoid hemorrhage by use of multislice computed tomographic angiography

OBJECTIVE: Multislice computed tomographic angiography (CTA) can provide clearer vascular images, even of the peripheral arteries, than conventional CTA. Multislice CTA was compared with digital subtraction angiography (DSA) for the detection of cerebral vasospasm in patients with acute aneurysmal subarachnoid hemorrhage (SAH) to analyze whether multislice CTA can replace DSA in the detection of vasospasm after SAH. METHODS: Within 72 hours after the onset of symptoms, multislice CTA and DSA were performed in 20 patients with SAH. Multislice CTA and DSA were repeated on Day 7 to assess cerebral vasospasm. Regions of interest were established in the proximal and distal segments of the anterior and middle cerebral arteries on both multislice CTA and DSA images, and the agreement between the severity of vasospasm on multislice CTA and DSA images was statistically compared. The multislice Aquilon computed tomography system (Toshiba, Inc., Tokyo, Japan) used the following parameters: 1 mm collimation and 3.5 mm per rotation table increment (pitch, 3.5). RESULTS: The degree of vasospasm as revealed by multislice CTA correlated significantly with the degree of vasospasm revealed by DSA (P < 0.0001). The agreement between the severity of vasospasm on multislice images obtained via CTA and DSA in the overall, proximal, and distal segments of the cerebral arteries was 91.6, 90.8, and 92.3%, respectively. CONCLUSION: Multislice CTA can detect angiographic vasospasm after SAH with accuracy equal to that of DSA.     

The role of 3D-computed tomography angiography (3D-CTA) in investigation of spontaneous subarachnoid haemorrhage: comparison with digital subtraction angiography (DSA) and surgical findings

Spontaneous subarachnoid haemorrhage is a clinical condition that may be attributed to various underlying causes, such as rupture of intracranial aneurysms and arteriovenous malformations (AVMs). Suspected cerebrovascular abnormalities can be detected either with digital subtraction angiography (DSA) or with computed tomography angiography (CTA) combined with postprocessing tools, namely multiplanar reformation, maximum intensity projection, shaded surface display, virtual endoscopy and direct volume rendering. We prospectively studied a group of 205 patients with spontaneous subarachnoid haemorrhage. One-hundred-ninety-eight patients underwent both DSA and CTA, and formed our study group. Patients with intracranial aneurysms underwent surgical or endovascualar treatment. DSA was negative for 35 patients, detected 178/179 aneurysms and 15 AVMs. CTA correctly detected 176/179 aneurysms and all 15 cases of AVMs, whereas it was negative in 35 cases. After 3D reconstruction the size, location and the relationship to the parent vessel of the aneurysms, the extent of the AVMs with the main feeding vessel(s), nidus and draining veins were reliably shown by CTA, although DSA provided more anatomic details related to the anatomy of the adjacent vessels. The accuracy, sensitivity, positive predictive accuracy and negative predictive accuracy for CTA was 98, 97.9, 100 and 94.3% and for DSA was 99, 99.3, 100 and 98%, respectively. It is suggested that CTA is a reliable alternative to DSA in detecting intracranial aneurysms. The role of CTA in demonstrating AVMs can be considered complementary to that of DSA.     

Multidetector computed tomography angiography in the evaluation of potential living donors for liver transplantation: single-center experience in China

Objective

To evaluate relevant arterial, hepatic, and portal venous anatomy using multidetector computed tomography (CT) angiography in potential living liver donors at a single liver transplantation center in China.

Methods

One hundred two consecutive potential liver donors underwent CT angiography in the arterial, portal, and hepatic venous phases with a 16-row CT scanner. All source and reconstructed images were evaluated for hepatic vasculature anatomy by an experienced radiologist and a surgeon in consensus. The anatomic variants of arterial system, portal venous system, and hepatic veins were characterized according to the classification system of Michels, Akgul, and Nakamura respectively. In 42 donors of right hepatic lobectomy, CT findings were compared with the results of surgery.

Results

Of 102 candidates, 63 had type I, 8 type II, 12 type III, 3 type IV, 11 type V, 2 type VI, 2 type VIII, and 1 type IX hepatic arterial anatomy. According to the classification of the portal venous system created by Akgul, type A was seen in 81 subjects. Type B, type C, and type E were revealed in 15, 4, and 2 subjects, respectively. According to the classification of the right hepatic drainage pattern by Nakamura, type 1 drainage was seen in 71 subjects (69.6%), type 2 in 22 candidates (21.6%), and type 3 in 9 subjects (8.8%). Forty five right inferior hepatic veins were identified in 41 potential donors, and 68.9% of these veins were larger than 5 mm in diameter. CT angiography findings were confirmed in all donors who underwent operations.

Conclusions

Multidetector CT angiography can successfully show the relevant hepatic vascular anatomy in potential liver donors.