回顾性探讨冠状动脉造影的质量控制

目的:探讨冠状动脉造影的质量控制,就其对比剂的选择及注射、摄影体位的选择、曝光参数设定及其它操作因素的分析提出质量控制措施。方法:常规Seldinger导管法,选择好造影技术参数,常规呼吸训练及心电监护,分别进行左右冠状动脉造影、多体位摄影,并对其图像质量进行综合分析评价。结果:检查155例病例(PTCA19例,CAG136例),获取930个曝光采集序列(Sequences),洗印1220幅图像,其中图像质量优秀的776个序列,占83.4%;图像质量良好的121个序列,占13%;图像质量差的33个序列,占3.6%。结论:不同病例、不同部位的图像采集应用不同的摄影体位;使用非离子型对比剂有利于提高检查图像质量;绝大多数病例造影要利用密度补偿;手推对比剂要注意总量、压力、流率控制及血管充盈情况;术中监护与呼吸训练必不可少。     

流入翻转恢复非对比剂增强磁共振血管成像序列评估移植肾动脉狭窄的研究

目的与数字减影血管造影(DSA)相比较,探讨流入翻转恢复序列磁共振血管成像(IFIR-MRA)技术对移植肾动脉狭窄的临床应用价值。方法对超声怀疑血管狭窄的32例肾移植术患者行DSA检查和流入翻转恢复非对比剂增强磁共振血管成像检查,获取移植肾动脉血管的解剖图像;由2位放射医师对磁共振血管的图像进行技术评分,以DSA为金标准,并将IFIR的结果与DSA结果进行对照分析。结果 32例肾移植患者行磁共振IFIR序列扫描,图像质量评分为优秀占88%(28/32),中等的占3%(1/32),一般的占3%(1/32),差的6%(2/32)。经DSA证实移植肾动脉狭窄的30例(2例患者磁共振检查配合欠佳图像较差无法进行临床评价)中:轻度狭窄10例,中度狭窄14例,重度狭窄6例;但IFIR序列扫描有1例轻度狭窄被过高评估为中度,有1例中度狭窄被过高评估为重度。两种成像方法相比较磁共振有时会过高估计狭窄程度,但差异没有统计学意义(P 0. 05),在评估移植肾动脉狭窄程度方面与DSA具有很好的一致性。结论 IFIR成像技术无创伤、没有电离辐射,无需使用对比剂,可以为临床怀疑移植肾动脉血管狭窄的患者做出可靠诊断,为临床治疗方案提供重要依据。     

3D-SPACE序列在儿童MRCP检查中的参数优化研究

目的探讨参数优化后的三维快速自旋回波序列(3D sampling perfection with application optimized contrasts using different flip angle evolutions,3D-SPACE)在儿童磁共振胰胆管造影(magnetic resonance cholangiopancreatogaphy,MRCP)检查中提升图像质量的应用价值。方法对30例患儿采用经优化参数3D-SPACE序列及常规参数3D-SPACE序列进行MRCP扫描,对两种扫描序列得到的图像进行对比分析,比较两种扫描的质量差异。结果经优化后的3DSPACE序列扫描时间是(50±7) s,常规3D-SPACE序列扫描时间是(210±33) s,2种序列间差异有统计学意义(t=15.95,P=0.000)。优化参数3D-SPACE序列得4分图像的24例,占80%(24/30); 3分图像3例,占10%(6/30); 2分图像2例,占7%(2/30); 1分图像1例,占3%(1/30);常规3D-SPACE序列得4分图像的15例,占50%(15/30); 3分图像9例,占30%(9/30); 2分图像5例,占17%(5/30); 1分图像1例,占3%(1/30),2种序列间差异有统计学意义(Z=2.254,P=0.024),优化3D-SPACE序列在呼吸运动伪影、胆总管、胆囊管、肝总管、肝内胆管显示,病灶清晰度和图像质量方面均优于常规3D-SPACE序列。结论优化参数3D-SPACE能减少扫描时间,明显减少儿童MRCP的运动伪影,改善图像质量。在儿童磁共振胆道系统疾病检查中具有较高的应用价值。     

对比剂追踪DSA技术临床应用探讨

目的 探讨对比剂追中农DSA技术在胸、腹主动脉、髂及四肢动脉造影中的应用。方法 25例患者进行40例次对比剂追踪DSA检查,使用系统的Mask Before程序,用控制手丙控制导管订的移动,获得与血流速度一致的实时对比剂追踪DSA图像。结果 40例产欠造影中,35例次造影图像质量优良,占87.5％,5例次造影质量欠佳,占12.5％,经非减影处理后仍能满足诊断需要。结论 对比剂追踪DSA能准确显示从胸至四肢的大范围血管解剖结构和血流情况,是一种能连续实时观察多段血管结构的新方法。     

MRI快速扫描技术在儿童先天性心脏病诊断中的应用

目的:探讨MRI半傅立叶采集单次激发快速SE(HASTE)序列、真稳态进动快速成像(TrueFISP)序列和并行采集技术在儿童先天性心脏病诊断中的应用价值.方法:对50例经超声心动图检查的先天性心脏病患儿进行心脏大血管MRI检查,其中26例行DSA检查,全部病例经手术证实.扫描序列包括HASTE、TrueFISP序列以及回顾性心电门控心血管电影成像,并加用并行采集技术.分析各序列MRI图像质量,并将MRI检查结果与超声心动图、DSA结果进行对照.结果:MRI共检出10种复杂先心共181处心血管畸形.26例行DSA检查共检出畸形120个并均与手术结果吻合,MRI显示畸形114个(95.00%),超声心动图检出畸形110个(92.67%).TrueFISP序列和HASTE序列利于显示血管畸形,电影序列有助于检出心内外分流.结论:HASTE黑血技术、TrueFISP亮血技术结合快速电影序列进行心脏MRI检查,可以获得高质量的图像以及较高的病变检出率,适用于儿童先天性心脏病的诊断.     

Dyna-CT在非血管介入诊疗中的应用

目的 探讨与数字平板DSA结合的旋转断层重组技术所获得的CT样图像(Dyna-CT)在非血管介入诊疗过程中的应用方法及价值.资料与方法 对53例非血管病变患者行84次Dyna-CT检查.根据检查部位不同分为:骨关节21例(脊柱14例,头颅4例,肩关节2例,髋关节1例),共32次重组;软组织23例(肝脏20例,肾脏2例,盆腔1例),共37次重组.腔道9例(气管6例,食管3例),共15次重组.图像后处理主要通过多平面重组(MPR)获得Dyna-CT图像.图像的评价由介入手术医师在术中或术后进行,分为优、良、差三类.结果 在84次重组中,39次图像质量优,占46%,34次图像质量良,占41%,11次差,占13%.导致图像质量差的原因为:碘油、导管及支架造成的高密度伪影(5次),病变与周围组织密度相差太小(4次),因患者屏气不良造成移动伪影(2次).其中骨关节图像质量优20次,良10次,差2次.腔道系统图像质量优7次,良6次,差2次.软组织图像质量优12次,良18次,差7次.经统计学处理3组间差异有统计学意义.结论 通过数字平板DSA获得的Dyna-CT图像可提供清晰、任意角度的断面图像,特别在骨关节和腔道系统能获得优质的图像,可满足临床非血管介入诊疗的需要.     

呼吸训练对儿童腹部MR图像质量的影响

目的 探讨呼吸训练对学龄期儿童腹部MR图像质量的影响。方法 选取80例行3.0T MRI全腹检查的学龄期儿童，其中实验组40例，扫描前对患儿行吸气-呼气-屏气训练，记录患儿可耐受的最长屏气时间；并以此设定为单次屏气扫描的最长时间。常规组40例，检查前行吸气-呼气-屏气训练，但不记录屏气时间，据扫描范围和年龄不同，设置屏气扫描时间经验值。对比两组患儿的配合率、一次检查成功率、MR图像优良率及检查时间。结果 实验组患儿配合率和一次检查成功率(97.5%,100%)均高于常规组(87.5%,87.5%)(P<0.05)。实验组图像质量优良率(95.0%)明显高于常规组(80.0%)(P<0.05),两组检查时间无差异(P>0.05)。结论 学龄期儿童腹部MRI检查过程中，通过呼吸训练，记录屏气最长时间，以此进行扫描参数设定，可提高检查的成功率，获得优质的图像质量并提高就诊满意度。     

探讨影响冠状动脉造影的设备技术因素

目的　探讨影响冠状动脉造影成像质量的技术因素。方法　随机抽取 35 0例冠状动脉造影检查 ,其中男 2 75例、女 75例 ,年龄 38～ 80岁 ,临床诊断 :不稳定型心绞痛 2 2 5例 ,急性心肌梗死 6 3例 ,陈旧性心肌梗死 4 2例 ,高血压、高脂血症 2 0例。 35 0例中有 2 80例既往有抽烟、饮酒史。多数病例有心前区疼痛病史和心电图缺血性改变。结果　　相关技术因素分析情况表技术因素图像质量Ⅱ级 (例 )Ⅲ级 (例 )导管位置 5 3投照体位 9 1移动摄影技术 15 1缩光器和滤过板技术 9造影剂注射流率 10 2合计 487结论　本组 3 5 0例图像质量评定结果 ,Ⅰ级 2 95例 ,占 83 % ;Ⅱ级 48例 ,占 15 % ;Ⅲ级 7例 ,占 2 %。操作技术因素 ,对冠状动脉造影成像质量有很大影响 ,它可能导致图像质量降级 ,并影响诊断。①合理使用对比剂的注射流率。常规采用注射延迟 ,这种注射对比剂的方法 ,可以充分显示冠状动脉充盈显影的全部过程。推注对比剂的压力及流速要适度 ,用力不够、流速不稳 ,图像显示不清晰 ,用力过度导管会反弹出冠脉口。本组有 10例Ⅱ级图像 ,就是由于对比剂注射流率不恰当和注射对比剂与采集图像配合不当 ,而导致图像质量降级。②灵活运用移动摄影。移动摄影是根据对比剂注入的剂量、血流状态和摄影范围来决定摄     

平板探测器DSA冠状动脉造影的临床应用及评价

目的 通过对平板探测器DSA系统与传统DSA系统冠状动脉造影图像质量进行比较和分析，评价平板DSA系统成像质量和临床应用。方法 回顾性分析与比较平板DSA和传统DSA冠状动脉造影检查软拷贝图像各50例。结果 平板探测器DSA系统优于传统DSA系统的图像质量，但会受到几个相关技术因素的影响。结论 平板探测器DSA系统在冠状动脉造影中的合理应用，能充分发挥它的优越性，保证图像质量的稳定和提高。     

颈动脉三维增强磁共振血管成像技术初步探讨

目的　探讨颈动脉三维增强磁共振血管成像 (3DCEMRA)方法和影响图像质量的因素。方法　使用 1.5T超导型MR扫描机 ,头部、颈部以及部分腰椎相控阵线圈。对 48例病人进行颈动脉 3DCEMRA增强扫描。检查时 ,嘱患者屏气 ,于静脉内团注钆双胺 (Gd -DTPA -BMA)对比剂后进行颈动脉期扫描 ,用 3DFLASH序列采集图像。结果　检查的病例 96%获得了满意的图像 ,经MIP和MPR重建后 ,能够清楚显示颈动脉正常解剖结构和病变的部位、大小及其狭窄程度。 2 3例经数字减影血管造影(DSA)或 /和超声以及手术证实的病例中 ,3DCEMRA显示颈动脉的特异性和敏感性均为 10 0 %。结论　高质量的颈动脉MRA图像依赖于注药后扫描时机的准确性 ,注药流速与总量的合理性 ,合适的扫描序列 ,以及操作者的技巧和熟练程度     

A technique for determining pump injector settings for an on-table CT or 3D DSA in interventional radiology

IntroductionOn-Table computed tomography (CT) or 3D digital subtraction angiography (DSA) in interventional radiology (IR) has become a valuable diagnostic tool.MethodsA review of the literature found a poor evidential base supporting the technical parameters for iodinated contrast delivery during these acquisition sequences.Results and conclusionThis technical note presents an easy method of estimating the parameters needed to reliably obtain diagnostic on-table CT or 3D DSA images, whilst attempting minimising contrast dose.Implications for practiceA systematic approach to estimating contrast delivery regimes during on-table CT and 3D DSA can help ensure diagnostic quality images are obtained. Further clinical studies are now required to rigorously evaluate this protocol.     

ECG-synchronized DSA exposure control: improved cervicothoracic image quality

An electrocardiogram (ECG)-synchronized x-ray exposure sequence was used to acquire digital subtraction angiographic (DSA) images during 13 arterial injection studies of the aortic arch or carotid bifurcations. These "gated" images were compared with matched "ungated" DSA images acquired using the same technical factors, contrast material volume, and patient positioning. Subjective assessments by five experienced observers of edge definition, vessel conspicuousness, and overall diagnostic quality showed overall preference for one of the two acquisition methods in 69% of cases studied. Of these, the ECG-synchronized exposure series were rated superior in 76%. Linear intensity gradients across vessel margins generally showed improved or unchanged edge definition in the gated subtraction images as compared with their ungated pairs. These results, as well as the relatively simple and inexpensive modifications required, suggest that routine use of ECG exposure control can facilitate improved arterial DSA evaluations of suspected cervicothoracic vascular disease.     

Computer processed fluoroscopic images for digital intravenous renal angiography

We investigated intravenous digital angiography using computer processed fluoroscopic images. Computer processed fluoroscopy (CPF) was compared to conventional digital subtraction angiography (DSA) in 39 patients referred for renal vessel evaluation. For assessment of CPF the anterior-posterior images were compared with the corresponding digital subtraction angiograms. 79% percent of DSA and 71% of CPF studies were diagnostic. Peripheral injection of contrast medium caused deterioration of CPF images. Skin dose measurements were obtained in 24 patients. The median dose for DSA was 8.2 rad, compared to 1.1 rad for CPF. It is concluded that sophisticated algorithms should be investigated for digital angiography, so that high image quality can be achieved with a reduced radiation exposure.     

数字化摄影技术在非血管性介入术中的应用价值

目的　探讨数字化摄影技术在非血管性介入术中的应用价值及其特点。方法　搜集 2 0 4例次非血管性介入造影片 ,其中利用DSA组 12 6例次 ,数字化胃肠组 (CF) 78例次。根据其造影显影情况 ,图像质量 ,按两组进行观察、分析、评估、统计。结果　非血管性介入成像中 ,被检部位管腔充盈满意。管壁显示清楚者 ,DSA组有 10 4例次 ,占本组的 82 %。CF组有 6 6例次 ,占 85 %。对DSA组与CF组进行 χ2 检验 ,χ2 =7.32 6× 10 -4 (P >0 .0 5 )。结论　数字化摄影技术在非血管性介入术中与DSA有类似的图像清晰度。同时 ,在非血管性介入术中不需要快速的大量的连续摄影 ,利用数字化技术 ,用CF机作非血管造影 ,有一定的优越性     

Venous digital subtraction angiography in the diagnosis of arteriosclerotic diseases of the supra-aortic extracranial vessels

In addition to non-invasive sonographic examinations the slightly invasive transvenous DSA has been shown to be useful in outpatients to demonstrate acceptable images of the supraaortic extracranial vessels. In preselected patients (n = 140) different atherosclerotic lesions of the examined angiographic region could be diagnosed by DSA. Images of diagnostic quality including the carotid bifurcation could be found in 88% using three examination-sequences in different standardized projections; only 43% of cases could be diagnosed following two sequences. Compared with conventional angiography DSA showed an identical imaging of the carotid bifurcation in 22 of 25 cases. Using an additional o.m. projection of the skull base (n = 80) internal carotid arteries could be analyzed in all cases, vertebral arteries in 80% and the basilar artery in 82%.     

Pulmonary digital subtraction angiography

Intravenous digital subtraction pulmonary angiography was performed in 220 patients. Of these, 206 had suspected pulmonary embolism. Our intravenous studies yielded images of diagnostic quality in 98% of cases. Compared to conventional pulmonary angiography, intravenous digital subtraction angiography (IV DSA) is safer, faster, and easier to perform. This technique is an acceptable substitute for routine pulmonary angiography in all patients with pulmonary embolism. Intravenous DSA is currently the procedure of choice for the evaluation of patients with suspected pulmonary embolism.     

In vivo evaluation of patency and in-stent stenoses after implantation of nitinol stents in iliac arteries using MR angiography

OBJECTIVE: Our study was a prospective in vivo study to evaluate whether MR angiography is suitable for assessing stent patency and grading in-stent stenoses and to examine whether the accuracy of MR angiography changes with time after stent implantation. SUBJECTS AND METHODS: In a prospective study, 34 iliac stenoses in 27 patients were treated by implantation of 35 nitinol stents. MR angiography was performed immediately after stent placement for 32 stents, and both digital subtraction angiography (DSA) and MR angiography were repeated at the 6-month follow-up for 23 stents. Three blinded observers assessed stent patency and the degree of in-stent stenoses on MR angiography and DSA (the standard of reference) images. The difference between the observers' grading of stenoses on DSA and on MR angiography was determined. Statistical analysis was performed using the Student's t test for paired samples. RESULTS: Stent patency was assessed correctly for all stents and both sets of MR angiography images. Evaluation of DSA 1 images (obtained at end of implantation procedure) revealed that 96.9% of in-stent stenoses were less than 50%. On DSA 2 images (obtained at follow-up), 95.7% of in-stent stenoses were graded as less than 50%. The difference between grading of stenoses on DSA and MR angiography images was 15.0% +/- 16.0% (minimum, 0.0%; maximum, 63.3%) for DSA 1 versus MR angiography 1 (statistically significant, p = 0.037) and 9.8% +/- 13.5% (minimum, 0.0%; maximum, 63.3%) for MR angiography 2 versus DSA 2 (not statistically significant, p = 0.355). CONCLUSION: Patency was correctly assessed for all stents on MR angiography. The quality of MR angiography regarding characterization of in-stent stenoses improved with time after stent placement. However, discrepancies of more than 60% between grading of lumen narrowing on DSA and MR angiography images occurred even at the 6-month follow-up. Thus, MR angiography is not yet a reliable technique for characterization of in-stent stenoses.     

平板DSA低剂量模式在冠状动脉造影术中的应用价值

目的探讨平板探测器数字减影血管造影系统(DSA)低剂量模式在冠状动脉造影术中的应用价值。方法选取住院拟行冠状动脉造影术患者60例,均为体重50~70 kg正常体型,随机分为低剂量模式组30例与常规对照组30例。术后由2位心内科介入治疗医师采用双盲法对所有图像进行评分。分别对两组患者的辐射剂量面积(DAP)、累积剂量(CD)和图像质量评分进行统计学分析。结果图像质量评分差异无统计学意义;低剂量模式组的辐射剂量面积(DAP)和累积剂量(CD)均小于常规对照组,差异有统计学意义(P<0.05)。结论平板探测器数字减影血管造影系统(DSA)选择低剂量模式进行冠状动脉造影具有较高的临床应用价值,值得推广。     

Intravenous digital subtraction angiography of arteriosclerotic vertebrobasilar disease

Intravenous digital subtraction angiography (DSA) was performed in 111 patients with vertebrobasilar ischemia. Ninety percent of the vertebral images were of diagnostic quality; 23% of the basilar images were good quality and 53% fair quality; and 58% of the posterior cerebral images were poor. Compared with selective film arteriography in 23 patients, DSA tended to underestimate the degree of atheromatous disease. Segments of the basilar artery were often poorly seen, which could result in false-negative errors. DSA can provide a general assessment of atheromatous disease of the brachiocephalic vessels, including the vertebral and carotid arteries, and in many cases can exclude occlusion or critical stenosis of the vertebrobasilar system. However, it does not adequately image the posterior cerebral or cerebellar artery.