二氧化碳数字减影血管造影技术现状及临床应用

目的：评价二氧化碳数字减影血管造影技术（ＣＯ２－ＤＳＡ）在临床上的应用和效果。材料和方法：对８５例患者行ＣＯ２－ＤＳＡ，包括肝、肾、脾、肠系膜上动脉造造影７５例，腹主及四肢动脉造影３例直接门静脉造影６例，肝静脉造影１例。采用与气体造影相适应注射方法、投照条件及后处理方法以取得较好困难，同时行碘剂造影对照。结果：ＣＯ２－ＤＳＡ可较好显示靶血管的主干及１、２级分支，且可引导介入插管，尽管对细微结构对照     

下肢动脉的二氧化碳DSA造影

目的；探讨二氧化碳作下肢动脉造影的临床应用价值。材料与方法：３０例临床疑及下肢动脉病变者，经二氧化碳动脉数字减影血管造影（ＣＯ２－ＤＳＡ），再行泛影葡胺血管造影，将两者的诊断结果及影像质量进行对比。结果：下肢动脉ＣＯ２－ＤＳＡ的影像质量能达到诊断成碘剂结果一致，而影像质量以背景、血管边缘锐利度较碘剂差，结论：ＣＯ２作业上肢动脉造影的阴性造影剂是安全、有效、经济，对血管闭塞性病变有较大的潜力，但完全     

CO2与含碘液性造影剂行肝静脉楔入法造影显示门静脉的能力

目的回顾性分析应用二氧化碳气体（ＣＯ２）和含碘液性造影剂（ＩＣ）行肝静脉楔入法造影，探讨两种不同方法显示门静脉的能力。方法在４３例行经颈静脉肝内门体静脉分流术（ＴＩＰＳ）治疗的患者中，门静脉穿刺前行肝静脉楔入法造影，２３例应用ＣＯ２，２０例用ＩＣ。４２例门静脉穿刺后应用ＩＣ行直接法门静脉造影。分析应用两种造影剂行肝静脉楔入法造影显示门静脉的结果，并同直接法造影加以比较。结果在肝静脉楔入法造影中，应用ＣＯ２门静脉显示优良者为９１％（２１／２３），应用ＩＣ，则仅为１０％（２／２０）。ＣＯ２楔入法同直接法相比，结果基本一致以上者为８７％（２０／２３），而ＩＣ为１０％（２／２０）。３例ＴＩＰＳ失败者，２例行ＣＯ２楔入法造影显示了门静脉结构异常，１例未行ＣＯ２楔入法造影。结论应用ＣＯ２行肝静脉楔入法造影，可更容易和准确地显示门静脉的解剖结构。     

二氧化碳数字减影血管造影术的动物实验

二氧化碳数字减影血管造影术的动物实验任安姜卫剑张雪哲朱建钢黄振国刘瑞宏尤国庆任树勇章建伟马占超冉志民周万里谭必勇王春红１９８２年Ｈａｗｋｉｎｓ［１］首次报道２０例二氧化碳数字减影动脉造影（ＣＯ２－ＤＳＡ）。目前，ＣＯ２－ＤＳＡ技术在国外已广泛用于血管...     

烟雾病的磁共振成像诊断

目的：回顾分析８例烟雾病的磁共振成像表现，探讨磁共振成像对烟雾病的诊断价值。方法：８例烟雾病中男女各４例。年龄４～４９岁，平均２０．４岁。磁共振成像应用Ｓｉｅｍｅｎｓ１．０ＴＭＲ系统和头表面线圈。均有ＳＥ序列Ｔ１ＷＩ和Ｔ２ＷＩ，７例有三维时间飞跃法磁共振血管造影（３Ｄ－ＴＯＦＭＲＡ），１例有ＤＳＡ。结果：ＳＥ序列ＭＲＩ均见丘脑－基底节区（单侧２例，双侧６例）有扩张的烟雾血管，其中以Ｔ１ＷＩ显示更为清楚直观。７例３Ｄ－ＴＯＦＭＲＡ和１例ＤＳＡ均见ＩＣＡ上端、ＭＣＡ和ＡＣＡ近端闭塞以及丘脑－基底节区的烟雾血管。这些病理血管分布侧别与ＳＥ序列磁共振成像所见一致。结论：ＳＥ序列磁共振成像和３Ｄ－ＴＯＦＭＲＡ是诊断烟雾病的有效方法。Ｔ１ＷＩ显示丘脑－基底节区烟雾血管优于Ｔ２ＷＩ。３Ｄ－ＴＯＦＭＲＡ尚适用于烟雾病血管旁路术后随诊及其高危人群普查。     

动态增强MRA的实验研究

目的：通过动物实验来评估动态增强ＭＲＡ（ＤＣＥ ＭＲＡ）潜在的临床价值。材料与方法：选择６条狗同时行２Ｄ ＴＯＦ ＭＲＡ和ＤＣＥ ＭＲＡ检查，以ＤＳＡ图像为黄金标准，比较两者对不同部位血管的显示满意率。结果：２Ｄ ＴＯＦ ＭＲＡ和ＤＣＥ ＭＲＡ的显示满意率，主动脉弓及弓上分支分别为２２．２％和１００％，颈、椎动脉分别为７０％和７５％，腹主动脉及肾动脉分别为６６．７％和２６．７％，髂、股动脉分别为８     

二氧化碳血管造影的成本和效果

用二氧化碳气体行数字减影血管造影称为ＣＯ2 ＤＳＡ。适用于碘剂过敏、甲亢、肾功能不全者、多发性骨髓瘤、心衰和严重高血压患者。目前主要用于横膈以下动脉 ,特别是脑血管以外的动脉造影以及四肢静脉、腔静脉和门静脉等血管造影。适合观察常规造影剂未能显示的动 静脉短路     

二氧化碳程控注射器的临床应用

二氧化碳数字减影血管造影（ＣＯ２ＤＳＡ）可取得准确、有用的血管造影图像。它在显示狭窄血管、动静（门）脉短路（瘘）、小剂量出血和逆行显示门脉等方面优于常规ＤＳＡ［１］。但ＣＯ２是无色、可被压缩的气体，手推注射和普通高压注射器注射很难使之被匀速线形注...     

动态增强MRA的临床研究

目的与常规ＭＲＡ比较，并以手术或ＤＳＡ作为金标准，评估动态增强磁共振血管成像（ＤＣＥＭＲＡ）的图像质量和应用价值。方法４０例共１３２条体部血管同时作了常规ＭＲＡ和ＤＣＥＭＲＡ检查，前者以二维时间飞跃法（２ＤＴＯＦ）ＭＲＡ为主，后者以三维（３Ｄ）ＤＣＥＭＲＡ为主，部分病例屏气扫描（２０～３０秒），快速注射ＧｄＤＴＰＡ２０ｍｌ（０．１５～０．２ｍｍｏｌ／ｋｇ），造影剂注射速度和扫描时间依据靶血管的性质、部位、范围而定。结果４０例中３５例发现有血管病变，与手术或其他影像学方法检查结果一致。３０例主动脉弓及弓上分支、腹主动脉、腔静脉及门静脉的显示满意率，２ＤＴＯＦＭＲＡ为４０％，ＤＣＥＭＲＡ为９６％，颈动脉及下肢血管则分别为９０％、７０％。利用配对计数资料χ２检验，前者两种方法有显著性差异（χ２＝１６．６５，Ｐ＜０．００１），后者无显著性差异（精确卡方检验：χ２＝０．５８，Ｐ＞０．０５）。结论ＤＣＥＭＲＡ为新的磁共振血管成像技术，克服了常规ＭＲＡ的许多缺点，尤其对胸腹部血管，两种方法血管显示满意率有极显著性差异。屏气薄层３ＤＤＣＥＭＲＡ技术，几乎达到与ＤＳＡ相仿的结果，其临床应用潜能极大。     

肝动脉螺旋CT血管成像和三维重建的临床应用

目的：评价肝动脉螺旋ＣＴ血管成像（ＳＣＴＡ）和三维重建（３Ｄ）的临床价值,并比较ＳＣＴＡ两种３Ｄ成像方法（表面阴影显示和最大强度投影,简称ＳＳＤ和ＭＩＰ）对肝动脉的显示的差别。方法：对２２例患者的肝动脉进行了ＳＣＴＡ成像,８例与常规血管造影对照。结果：（１）ＳＣＴＡ三维重建可显示肝脏主要的和变异的供血动脉及副肝动脉,在良好地显示肝内病变动脉期血供特点的同时,还能显示病变的供血动脉和化疗栓塞后的肝动脉的变化。（２）ＳＳＤ可以良好地显示肝动脉分支和腹主动脉大分支处的复杂的解剖关系及变异。ＭＩＰ则对肝动脉肝段分支和病变的肝脏供血动脉等细小分支显示相对较好,更接近常规血管造影表现。ＭＩＰ对肝总动脉或肝固有动脉、第一、第二、第三级肝动脉分支的显示率分别为１００％、９５．５％、５０％和１８．２％,优于ＳＳＤ。３Ｄ对肝段以下细小动脉分支显示差。结论：ＳＣＴＡ可以较好地显示腹主动脉大分支和肝动脉较大分支处的复杂的解剖关系及变异,与常规血管造影相吻合,具有较高的临床价值。     

Digital subtraction angiography in the preoperative evaluation of patients with a renal tumor

Inguinal intravenous digital subtraction angiography (DSA) was performed in 14 patients referred for preoperative evaluation of a renal tumor previously diagnosed by CT and ultrasound. Conventional cavography and aortography were used as reference methods for comparison. Both DSA and conventional angiography were carried out following selective arterial injection to the abnormal kidney. The diagnostic value of DSA in examination of the inferior vena cava was generally comparable to that of conventional cavography. Intravenous aortography was unsuccessful in 2 patients due to motion artifacts. In all other patients, the information provided by DSA regarding the aorta, renal arteries and renal veins was similar to that of conventional aortography. Intrarenal vascular detail, however, was far superior on conventional films and was only useful with DSA when intra-arterial injection was implemented. In one of the 12 diagnostic examinations, localization of the renal mass could not be established by intravenous DSA, but was possible in all others. The inguinal approach advocated permits simultaneous inferior vena cavography and intravenous aortography with one single injection of contrast medium; the method is less traumatic than aortography , and does not require hospitalization of the patient. DSA may also be of value in those cases still requiring selective catheterization of the renal arteries, i.e. for angiotherapy . Intra-arterial DSA then allows reduction of the amount of contrast medium and a rapid processing of the images without detriment to the quality of the examination.     

Revealing hepatic metastases from colorectal cancer: value of combined helical CT during arterial portography and CT hepatic arteriography with a unified CT and angiography system

OBJECTIVE: The purpose of our study was to evaluate the use of combined helical CT during arterial portography and CT hepatic arteriography in the preoperative assessment of hepatic metastases from colorectal cancer using a unified CT and angiography system. MATERIALS AND METHODS: Fifty-four patients with hepatic metastases from colorectal cancer preoperatively underwent combined CT during arterial portography and CT hepatic arteriography using the unified CT and angiography system. Three radiologists independently and retrospectively reviewed the images of CT during arterial portography alone, CT hepatic arteriography alone, and combined CT during arterial portography and CT hepatic arteriography. Image review was conducted on a segment-by-segment basis; a total of 432 hepatic segments with (n = 103) 118 metastatic tumors ranging in size from 2 to 160 mm (mean, 25.8 mm) and without (n = 329) tumor were reviewed. RESULTS: Relative sensitivity of combined CT during arterial portography and CT hepatic arteriography (87%) was higher than that of CT during arterial portography alone (80%, p < 0.0005) and CT hepatic arteriography alone (83%, p < 0.005). Relative specificity of CT hepatic arteriography alone (95%, p < 0.0005) and combined CT during arterial portography and CT hepatic arteriography (96%, p < 0.0001) was higher than that of CT during arterial portography alone (91%). Diagnostic accuracy, determined by a receiver operating characteristic curve analysis, was greater with combined CT during arterial portography and CT hepatic arteriography than with CT during arterial portography alone (p < 0.05) or CT hepatic arteriography alone (p < 0.01). CONCLUSION: Using a unified CT and angiography system, we found that combined CT during arterial portography and CT hepatic arteriography significantly raised the detectability of hepatic metastases from colorectal cancer.     

Carbon dioxide contrast agent for CT arteriography: results in a porcine model

PURPOSE: To test the feasibility of carbon dioxide (CO(2))-enhanced computed tomographic (CT)-arteriography in an animal model. MATERIALS AND METHODS: Five domestic swine underwent digital subtraction angiography (DSA), conventional CT angiography with iodinated contrast material, and CO(2)-enhanced CT arteriography. For each CO(2)-enhanced DSA image series, 100 mL of pressurized CO(2) was injected at 1.3 bar. CT imaging was performed according to a standardized scan protocol (2 x 32 x 0.6 mm; 120 kV, 210 mAs(eff), 330 msec gantry rotation time). Iodinated contrast material was administered intravenously according to a biphasic injection protocol. For CO(2)-enhanced CT arteriography, CO(2) was administered intraarterially via a catheter placed in the juxtarenal aorta. An injection pressure of 0.65 bar (volume flow rate, 7.5 mL/sec) was applied. Images were assessed visually by two observers on a four-point grading scale. Absolute intraarterial attenuation values were measured. RESULTS: Image quality was rated to be the best for standard DSA. CO(2)-enhanced DSA was rated slightly superior to CO(2)-enhanced CT arteriography. No examination was considered to be nondiagnostic. The average multislice spiral CT (MSCT) scan duration was 7.9 sec +/- 0.6. The average amount of gas required for CO(2)-enhanced CT arteriography was 104 mL +/- 4, compared with 400 mL for CO(2)-enhanced DSA. Absolute attenuation values were significantly higher with CO(2)-enhanced CT arteriography (aorta, -928 HU +/- 39) than with standard CT angiography (490 HU +/- 40; P < .0001). CONCLUSIONS: CO(2)-enhanced CT arteriography is feasible. In a porcine model, this technique is capable of depicting the aortoperipheral vessels down to the lower limb. These results warrant further studies of the diagnostic value of CO(2)-enhanced MSCT arteriography for the detection of arterial pathologic processes.     

Carbon dioxide angiography. A new injection system

PURPOSE: To evaluate the usefulness of a new carbon dioxide (CO2) intravascular injection system in digital subtraction angiography. MATERIAL AND METHODS: March 1998 to May 1999, thirty-nine patients were submitted to digital subtraction angiography with CO2 injection by a new delivery system, CO2-Angioset, OptiMed, Ettingen, Germany. The patients were 29 men and 10 women, whose age ranged 32 to 76 (mean: 47), eighteen of them with absolute or relative contraindications to iodinated contrast media and 6 with poor diagnostic findings at previous conventional angiography. CO2 was used for comparison with iodinated contrast agents in 4 patients. We studied the following vascular districts: renal arteries in 9 patients, portal vein in 18, lower limb arteries in 7, upper limb veins in 4. In 1 patient CO2 angiography was carried out for the diagnosis and interventional treatment, by transcatheter embolization, of a postbioptic arteriovenous renal fistula. During the procedure, arterial blood pressure, EKG status and oxygen stauration were monitored, and subjective sensations recorded in all patients. RESULTS: CO2 angiography provided adequate visualization of vascular districts and of abnormal findings in 32 cases (82%), while its results were considered insufficient for correct and complete assessment in 7 cases (18%). In detail, renal arteries studies were adequate in 9/9 cases, providing good depiction of the arterial trunk and main branches but poor demonstration of interlobar and arcuate arteries. The portal trunk was well depicted in 12/18 cases, but CO2 angiography results were insufficient in 3 cases because of poor catheter wedging in the hepatic vein and in 2 cases because of CO2 drainage by an accessory hepatic vein. Peripheral circulation was clearly depicted in 5/7 cases, while there was incomplete filling of the abdominal aorta and of iliac and femoral arteries in 2 cases. We had only one transient complication (2.57%) due to mesenteric ischemia during an aortic injection, with mild abdominal pain and diarrhea which subsided spontaneously in few minutes. CONCLUSIONS: In our experience the CO2-Angioset delivery system has proved to be a simple and safe tool, particularly suitable for use in patients at risk for allergic reactions to iodinated contrast agents and in those with renal function impairment. Also, the system can help carry out some interventional procedures such as arteriovenous fistula embolization and transjugular portosystemic shunting.     

Carbon-dioxide-guided vascular interventions: technique and pitfalls

Purpose: To evaluate the usefulness of carbon dioxide (CO2) angiography to guide vascular interventions. Methods: A prospective study was carried out of 50 procedures (angioplasty, stenting, stent-grafting and embolization) using CO2 angiography. Indications for using CO2 were renal impairment, cardiac failure, previous reaction to conventional iodinated contrast, or likelihood of needing high doses of conventional contrast. CO2 was intended to be the sole contrast agent. The use of additional conventional contrast or gadolinium was recorded, as were procedural complications. Radiation dose was compared with similar procedures using conventional contrast. Results: Angiographic quality was satisfactory in 44 (88%) procedures and CO2 guidance was all that was required; in 6 (12%) cases adjunctive use of conventional contrast or gadolinium was necessary. Contrast doses were significantly reduced and there was a trend toward decreased radiation doses with CO2. There were two significant complications but only one related to the use of CO2. Conclusion: CO2 angiography is well tolerated and can be successfully used to guide even complex vascular interventions. High-risk patients can be spared the risks of conventional contrast agents.     

肝海绵状血管瘤CO2—DSA与常规DSA的比较研究

目的：评价二氧化碳数字减影血管造影（CO2－DSA）在肝海绵状血管瘤（CHL）中的诊断价值。材料和方法：对7例CHL患者行CO2－DSA，其影像表现与常规DSA相比较。结果：7例CHL患者均获得有明显诊断价值的CO2－DSA图像，与常规DSA相比仅1个近右隔顶的小病灶未被显示。CO2－DSA显示瘤体大小、形态及边缘情况较碘剂DSA好，同样可显示出“早出晚归”这一特征性表现。7例CHL－CO2－DSA均在瘤体附近出现门脉分支的显影（7／7），而常规DSA仅有1例显示（1／7）。结论：CO2－DSA可对CHL作出准确诊断，CHL患者CO2－DSA中显示门脉，提示门脉为CHL的主要引流静脉。     

Evaluation of vascular rings with digital subtraction angiography

Seven patients with vascular rings were evaluated over a 2-year period with intravenous digital subtraction angiography (DSA), which was compared with screen-film aortography or cineangiography. The seven patients were also evaluated with barium esophagography. Six of the seven DSA images were totally diagnostic and one study was only partly diagnostic. Six of the seven vascular anomalies were confirmed surgically. DSA is suggested as an alternative to arteriography in evaluating patients with suspected vascular rings.     

CT引导下经皮肝穿刺微波治疗原发性肝癌后肝动脉造影表现

目的:探讨原发性肝癌微波治疗后的DSA表现及临床意义。方法:本组共12例原发性肝癌,均为单发病灶,肿瘤直径3.0～6.5cm(平均4.4cm),经皮肝穿刺微波治疗术后1～3个月内行肝总动脉及可疑区域供血动脉超选择性血管造影,同时对残留及复发灶进行栓塞治疗。结果:术后造影表现为微波治疗的肿瘤区多为无血管区,呈圆形或类圆形无染色或低密度染色区;治疗边缘区可见以下几种征象:肉芽形成(7例)、出血(3例)、边缘残留或复发(7例)和无异常造影征象(2例)。肝内异位复发灶(7例)造影表现同其原发肿瘤常见造影表现。本组12例造影发现原位边缘复发和/或肝内异位复发灶8例并全部完成栓塞治疗。结论:微波治疗区域的边缘征象的发现和鉴别是判断局部残留及复发的关键,DSA在疗效的观察及进一步综合治疗中有较高的临床价值。