Computer-assisted 3D reconstruction of the terminal branches of the cerebral arteries

We present a three-dimensional anatomical computer model of the terminal branches of the anterior cerebral artery, acquired from equidistant serial anatomical slices of three brains. The reconstructions provide a clear picture from all angles of the complicated course of the terminal branches of the cerebral arteries, which can help to identify them on conventional and magnetic resonance angiography. Our rendition of the cerebral arteries can also be matched with CT, MR or PET images to indicate the areas of extension of individual branches, allowing neuromorphological and functional correlations.     

Accessory hepatic arteries and their nomenclatoric problems in radiology (author's transl)]

The numerous anatomical and radiological nomenclatures of hepatic arteries are compared and discussed. Our own material for the assessment of accessory hepatic arteries consisted of 220 anatomically prepared individuals and 74 angiograms. The individual branches in the normal case as well as all variations and their frequency are discussed. The present, often confusing nomenclature is critically reviewed and an attempt is made to establish a simple and clinically acceptable nomenclature. We propose to name the additional branches supplying the liver as 'arteria hepatica accessoria' with reference to the vessel from which they originate. Additional branches in the terminal branching (ramus accessorius) and vessels of the liver capsula should not be referred to as accessory hepatic arteries.     

Identification of the ascending middle cerebral artery branches on digital subtraction angiography

We aimed to establish a method for identifying the ascending convexity branches of the middle cerebral artery on digital subtraction arteriography. We reviewed 100 randomly chosen lateral internal carotid arteriograms of patients with aneurysms. After identifying the Sylvian triangle, the posterior internal frontal, paracentral, superior internal parietal and pericallosal arteries, we formulated templates in order to assess the position of the angular, posterior parietal, central, precentral and prefrontal arteries. Using the Sylvian triangle as a template, we identified the angular and posterior parietal arteries in 91% and 96% of cases, respectively. Using a combination of the posterior internal frontal, paracentral, superior internal frontal and pericallosal arteries a template could be formulated in 87% of cases. This was successfully used to identify the central arteries. A template derived from the pericallosal artery and Sylvian triangle was used to identify the prefrontal arteries in 83% of cases. Templates can be formulated on the basis of the Sylvian triangle and anterior cerebral artery branches for consistent identification of branches of the ascending complex of the middle cerebral artery on digital subtraction angiography.     

Catheterization and superselective angiography of the cerebral vessels

Summary The technique of catheterization and superselective angiography of the cerebral arteries is described. The balloon can be introduced safely into any of the cerebral arteries including the anterior communicating artery and the peripheral branches of the middle cerebral artery. The superselective angiography seems to be suitable for the study of the regional venous circulation of the brain.     

远节手指动脉走行解剖与断指再植

目的　了解远节指动脉及分支走行位置及供血区域,探讨末节指再植方法。方法　利用36例病人54个新鲜废弃指的指体动脉内加压灌注墨水染色后在放大镜下解剖和总结临床141例病人189指再植结果。结果　在远侧掌横弓以远动脉血供中,根据动脉走行特点,分为A,B,C三型,其中52指A型血供,即指掌侧固有动脉优势侧在末端动脉血供中占支配地位,主要由优势侧动脉发出3-5条分支,其中指端支最为粗大,其它分支均细小。1指为B型血供,即双侧指掌侧固有动脉发出交通支形成远侧掌横弓后继续向指端走行,形成双指端支,均较粗大。1指为C型血供,双侧指掌侧固有动脉直接吻合成远侧掌横弓后,弓上发出3条分支,均较细小。再植141例189指Ⅰ,Ⅱ区断指,成功率98％。结论　绝大多数指掌侧固有动脉存在着优势动脉现象,优势侧动脉在指端血供中占主要地位,断指再植手术中重点修复优势侧动脉。在远侧掌横弓以远的断指再植术中,修复指端支是恢复远端血供的唯一选择。     

Clinical investigation of the branching formation of the bronchial arteries in the Japanese

It is imperative to be familiar with anatomical variation in the branching formation of the bronchial artery for radiologists attempting an interventional angiography to the pulmonary diseases such as hemoptysis or pulmonary carcinoma. The anatomy of the bronchial arteries reported by Cauldwell et al. is the most frequently quoted literature in the world as well as in Japan. However, we had noticed that some discrepancies exist between our clinical experience and those in Cauldwell's report regarding anatomical variation of the bronchial arteries. Then, we reviewed the bronchial arteriograms in 640 patients. We included 412 patients in investigation, in which it was possible to identify the branches supplying all pulmonary lobes. In 50 out of 640 patients, catheterization of the branches supplying the lesion was failed. Branching formation of the bronchial arteries is extremely variable and complicated by presence of the accessory bronchial arteries and anastomosing branches from the systemic arteries, which may be enlarged in various pathological conditions. Our results showed that the most common branching type was single artery on each side (50.0%), followed by common trunk (14.1%). The incidence of single on the right and dual on the left, most common in Cauldwell's series, was only 12.9%. Kasai and Chiba also pointed out these differences in their detail report investigating 100 cadavers. These discrepancies between the data may be due to differences of methodology or due to differences between the races. The authors feel that Cauldwell's data should not be referred to the anatomical variation of the bronchial artery in Japanese.     

Peripheral vascular gunshot bullet embolus migration to the cerebral circulation

Summary Bullet embolization to intracranial branches of the major cerebral arteries is a rare complication of gunshot wounds. A review of the literature on cerebral vascular bullet embolization from peripheral sources revealed a number of single case reports that included 12 cases involving the anterior cerebral circulation, and one which involved the posterior circulation. This communication details two additional subjects who were treated at our institution.     

Treatment of type D dural carotid-cavernous fistula by embolization followed by irradiation

Summary In a patient with dural carotid-cavernous fistula supplied by meningeal branches of both internal and external carotid arteries, particulate embolization of the meningeal branches of only the external carotid artery failed to cure the fistula. Subsequent radiation therapy achieved clinical and anatomical cure of the lesion.     

Cerebral angiographic changes on serial examination of a patient with migraine

Summary Curious cerebral angiographic changes are described in a 27-year-old female migraine patient. During the period of observation of this patient, both the intracranial carotid artery and the vertebrobasilar artery systems presented unusual and fascinating cerebral arteriographic pictures. In an attack of migraine, angiography showed that all the intracranial secondary and tertiary branches of the carotid arterial system were dilated without showing any changes in the extracranial arteries and when the migraine attack had subsided, all branches of the carotid arteries as well as the vertebrobasilar arteries demonstrated abnormal segmental narrowings or vasospasm. These sequential angiographic changes have not been hitherto reported in migraine.     

Selective intracranial magnification angiography of the rabbit: basic techniques and anatomy

Development of new therapies for stroke requires animal models with well-defined intracranial vasculature. The rabbit as a small animal model has many desirable traits; however, a modern atlas of rabbit angiographic anatomy is not readily available. Improved digital subtraction magnification angiography and superselective small-catheter techniques now allow excellent anatomical definition. Angiographic techniques include selection of the internal carotid artery and subselection with microcatheters that can progress to branches of the circle of Willis and provide high-resolution cerebral angiography. The authors present an overview of current techniques and illustrations of the angiography of cerebral vessels.     

低剂量对比剂在64排CT头颈部血管联合成像中的应用

目的 评价低剂量对比剂在头颈部CT血管联合成像中的动脉分级能力及图像质量效果.资料与方法 搜集1183例行64排CT头颈部血管联合成像患者的资料,按对比剂注射剂量不同将患者分为低剂量组(n=708)和常规剂量组(n=475).观察容积重建图像上患者颈总动脉、颈内动脉颈段、颈内动脉岩骨段至颅内段、大脑前动脉及其主要分支血管的显示情况,根据最大密度投影上血管质量评分判定图像质量.结果 两组头颈部动脉血管及脑内较大分支在容积重建图像上显示良好,且最大密度投影图像上多数血管显示清晰,边缘光滑锐利.低剂量组和常规剂量组各段血管的显示率及图像质量评分差异均无统计学意义(P＞0.05).结论 低剂量对比剂在CT头颈部联合成像上可以很好地显示颅内血管,且具有较高的图像质量.     

旋转肾动脉DSA的临床应用

目的　探讨旋转肾动脉DSA临床应用的可行性。方法　回顾性分析 48例肾肿瘤患者腹主动脉DSA检查中肾动脉的解剖情况。测量 5 0例腹部CT增强扫描肾动脉开口的位置、方向。观察 16例旋转肾动脉DSA的效果。结果　 48例常规腹主动脉DSA中 ,右肾动脉开口、主干及分支显示不清分别为 12例、5例及 10例。左肾动脉开口、主干及分支显示不清分别为 8例、4例及 6例。 5 0例腹部CT增强扫描显示 :右肾动脉开口位于腹主动脉侧壁、侧前壁以及侧后壁分别为 4例、2 4例及 3例。左肾动脉开口位于腹主动脉侧壁、侧前壁以及侧后壁分别为 13例、2例及 13例。两肾动脉开口位于腹主动脉同一水平面 11例。 16例旋转肾动脉DSA中 ,两侧肾动脉旋转 6例 ,单侧肾动脉旋转 10例。肾动脉开口狭窄 3例 ,主干狭窄 2例 ,肾肿瘤供血动脉 7例 ,排除肾动脉狭窄 4例。结论　旋转肾动脉DSA有助于详细显示肾动脉的解剖细节。     

Computed tomography of cerebral infarction along the distribution of the basal perforating arteries. Part I: Striate arterial group

Computed tomographic (CT) manifestations of cerebral infarction along the distribution of the basal perforating arteries were reviewed in correlation with cerebral angiography. Infarcts in the territories of perforators were demonstrated individually based on knowledge of their three-dimensional distribution as demonstrated by microangiography of cadavers. In Part I of the study, the areas supplied by the medial (MSA) and lateral striate arteries (LSA) were examined. Infarction along the branches of the MSA usually involved the antero-inferior portion of the corpus striatum, immediately posterolateral to the most inferior part of the frontal horn of the lateral ventricle. Infarcts along the branches of the LSA abutted the territory of the MSA posteriorly and superiorly and involved the posterolateral region of the corpus striatum. Clinical and neuroradiological correlations are discussed.     

Preoperative embolization of lower-falx meningiomas with ethylene vinyl alcohol copolymer: technical and anatomical aspects

PURPOSE: To report the feasibility of using ethylene vinyl alcohol copolymer (EVAC) for embolization of lower-falx meningiomas. MATERIAL AND METHODS: Three patients were treated. The procedures were done under general anesthesia. A terminal branch of the middle cerebral artery in the proximity of the tumor was catheterized as near as possible or into the pre-falcine arterial anastomotic network around the superior sagittal sinus, and embolization with EVAC was performed with a standard injection technique. RESULTS: This technique resulted in filling of the tumor-supplying dural arteries including all collaterals from both sides, filling of the dural territory of the tumor circulation, and some obliteration of the tumor's pial supply. On later operation, the tumors could be removed from the inside out with minimal brain retraction. CONCLUSION: Effective preoperative embolization of lower-falx meningiomas using EVAC is feasible. This technique has a sound anatomical basis, and it can be used with benefit even in falx meningiomas with predominantly pial vascular supply.     

Anatomy of the thalamoperforating arteries with special emphasis on arteriography of the third ventricle: Part I.

The thalamoperforating arteries are divided into 2 distinct groups, an anterior and a posterior. The PTPAS are retromammillary branches of the precommunicating segments of the posterior cerebral arteries. The PTPAS may be divided into interpeduncular, mesencephalic and thalamic segments and are not directly related to the third ventricle. They are primarily midbrain and thalamic arteries. The main trunk of the PTPA (mesencephalic segment) normally does not undulate, but assumes a characteristically straight configuration. The ATPAS arise from the posterior communicating arteries anterior and lateral to the mamillary bodies. The ATPAS are primarily diencephalic vessels. Interpeduncular, paraventricular (hypothalamic) and thalamic segments may be identified. The major segment of the ATPAS is para third ventricular in location at the level of the massa intermedia.     

Perforating arteries originating from the posterior communicating artery: a 7.0-Tesla MRI study

The aim of this study was to investigate the ability of time-of-flight (TOF) magnetic resonance (MR) angiography at 7.0 Tesla to show the perforating branches of the posterior communicating artery (PCoA), and to investigate the presence of such visible perforating branches in relation to the size of the feeding PCoA. The secondary aim was to visualise and describe the anterior choroidal artery and the perforating branches of the P1-segment of posterior cerebral artery (P1). Forty-six healthy volunteers underwent TOF MR angiography at 7.0 Tesla. With 7.0-Tesla imaging, we visualised for the first time perforating arteries originating from the PCoA in vivo without the use of contrast agents. A perforating artery from the PCoA was found in a large proportion of the PCoAs (64%). The presence was associated with a larger diameter of the underlying PCoA (1.23 versus 1.06 mm, P = 0.03). The anterior choroidal artery was visible bilaterally in all participants. In 83% of all P1s, one or two perforating branches were visible. Non-invasive assessment of the perforating arteries of the PCoA together with the anterior choroidal artery and the perforating arteries of the P1 may increase our understanding of infarcts in the deep brain structures supplied by these arteries.     

Moyamoya disease: diagnosis with three-dimensional CT angiography

Our purpose was to assess the value of threedimensional (3D) CT angiography in the diagnosis of moyamoya disease. We studied seven patients with moyamoya disease proved by conventional angiography. Three-dimensional (3D) CT angiography was performed using rapid sequence or helical (spiral) scanning in conjunction with a bolus injection of intravenous contrast medium. All seven patients could be diagnosed as having moyamoya disease on the basis of the following 3D CT angiographic findings: poor visualisation of the main trunks and/or major branches of anterior and middle cerebral arteries (7 patients); dilated leptomeningeal anastomotic channels from the posterior cerebral arteries (4); and demonstration of moyamoya vessels in the basal ganglia (2). Although conventional angiography remains the principal imaging technique for demonstrating anatomical changes in detail, less invasive 3D CT angiography provides a solid means of diagnosing moyamoya disease when it is suspected on CT, MRI, or clinical grounds.     

Non-invasive assessment of the Circle of Willis using transcranial pulsed Doppler ultrasound with angiographic correlation.

The ability of transcranial pulsed Doppler ultrasound (TCD) to provide a dynamic assessment of the functional capability of the Circle of Willis was assessed using conventional cerebral angiography for anatomic correlation. Eleven patients had normal four-vessel cerebral angiography prior to being investigated with ultrasound. Angiography and ultrasound both demonstrated a functional anterior communicating artery in nine of the eleven patients, giving complete agreement between the two techniques. Posterior communicating arteries were visualized angiographically in all eleven patients. Ultrasound identified bilateral functional vessels in nine, the other two patients having non-functional vessels. In these latter two patients, angiography demonstrated three of the four posterior communicating arteries to be hypoplastic and it was uncertain whether these vessels carried significant blood flow. The fourth posterior communicating artery was shown to have an absent proximal segment of the ipsilateral posterior cerebral artery, with a persistent fetal posterior communicating artery. This anatomical variation is a potential limitation of ultrasound for assessing functional posterior communicating arteries. These preliminary results indicate that a combination of the anatomical (angiographic) and dynamic (ultrasonic) data may prove to be complementary for assessing the Circle of Willis.     

Empirical description of bronchial and nonbronchial arteries with MDCT

Purpose

We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders.

Materials and Methods

Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries.

Results

We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat.

Conclusions

The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.     

应用DSA诊断椎-基底动脉变异

目的探讨椎基底动脉变异的种类和发生率及DSA影像学特征,提高对椎基底动脉变异临床意义的认识。方法对6432例患者均进行全脑血管进行造影,对全脑血管造影的DSA图像资料进行回顾性分析,得出椎基底动脉变异的发生率及变异血管合并其他血管病变的情况。结果发生椎动脉起源变异272例患者278支椎动脉,检出率为4.3%,其中左椎动脉起源异常270支(4.2%),右椎动脉起源异常8支;左椎动脉起源异常中,258支直接起自主动脉弓,2例为双起源椎动脉,4支起自颈内动脉,6支起自左锁骨下动脉根部。8支右椎动脉起源异常中,2支直接起源于右颈总动脉,2支起自右颈内动脉动脉,2例为双起源椎动脉,2支直接起自头臂干动脉。141例椎基底动脉成窗(2.19%);61支小脑后下动脉起自颅外段位置较低部位。11例永久性原始三叉动脉。另外,有9例变异结构的远端或近端伴发动脉瘤、2例伴发动静脉畸形。7例出现与成窗结构供血区相一致的一过性脑缺血症状,其中2例出现经成窗结构远端供血部位的脑梗塞,1例出现经双起源椎动脉供血部位的脑梗塞。结论脑血管DSA可以清晰显示椎基底动脉变异的位置、形态、毗邻关系及有无伴发其他血管性病变;掌握椎基底动脉变异的DSA影像学表现及血流动力学特征,对脑血管病的明确诊断及手术和介入治疗方案的制定具有重要临床意义。