64层螺旋CT血管造影对癌性上腔静脉综合征的诊断

目的 探讨多层螺旋CT血管造影对上腔静脉综合征(SVCS)的诊断价值.方法 回顾性分析18例病理确诊为癌性SVCS的64层螺旋CT血管造影表现.结果 (1)原发病变:肺癌位于右上肺叶8例,右上纵隔型7例,淋巴瘤2例,侵袭性胸腺瘤1例.(2)上腔静脉梗阻征:单侧压迫(5例)、半环状包埋(8例)、环状包埋(4例)、夹心状包埋(1例).(3)继发侧枝循环:侧枝循环开放10例.结论 多层螺旋CT血管造影能全面、准确地诊断SVCS,为临床诊断与治疗提供更丰富的影像学信息.     

肺癌致上腔静脉综合征继发病变类型及介入治疗CT研究

目的探讨肺癌致上腔静脉综合征(SVCS)继发病变CT表现类型及介入治疗价值。方法病理确诊肺癌致SVCS51例,其中7例行上腔静脉(SVC)支架植入术,回顾分析上腔静脉梗阻程度、继发病变CT表现及支架植入术后CT表现的变化,并作统计分析。结果(1)继发病变CT表现:单纯侧枝循环建立与开放14例、单纯胸壁肿胀12例、二者均有16例、二者均无9例,肺癌致SVCS时上腔静脉梗阻程度不同,胸部侧枝循环和/或胸壁水肿CT显示率不同(P<0.05)。肺癌致SVCS时血栓形成(或癌栓)7例。(2)上腔静脉支架植入术后CT表现的变化:7例成功行此治疗后CT示上腔静脉通畅,侧枝循环和胸壁水肿减退。结论肺癌致SVCS继发病变包括侧枝循环建立与开放、胸壁肿胀、上腔静脉梗阻端血栓形成,前二者CT表现与梗阻程度有关,且有助于判断支架植入术近期疗效。     

肺癌致上腔静脉综合征CT特征及其病理学基础

目的探讨肺癌致上腔静脉综合征(SVCS)生物学行为、肺癌与上腔静脉梗阻段周围病变位置关系的CT特征及病理学基础.资料与方法病理确诊肺癌致SVCS共51例,回顾分析肺癌解剖部位、大体类型及其致SVCS生物学行为、与上腔静脉梗阻段周围病变间位置关系的CT表现,并作统计分析.结果肺癌致SVCS生物学行为CT表现:直接蔓延7例,淋巴结转移17例,二者并存27例.致SVCS肺癌与上腔静脉梗阻段周围病变间位置关系CT表现:直接相连32例,间接相连10例,不相连接9例.不同肺叶不同大体类型肺癌致SVCS生物学行为及其与上腔静脉梗阻段周围病变间位置关系均不同(P<0.05).结论肺癌致SVCS生物学行为、与上腔静脉梗阻段周围病变间位置关系均与肺癌解剖部位及大体类型有关.     

多层螺旋CT对布-加氏综合征的诊断价值

目的：探讨螺旋CT对布加氏综合征的诊断价值；方法：搜索经临床及其影像检查证实的布加氏综合征4例，回顾性分析其CT表现。结果：CT动态增强扫描及后处理重建显示肝水平上段下腔静脉狭窄3例；肝水平下腔静脉显示不清1例；肝下段下腔静脉扩张3例；脾大，脾静脉迂曲、扩张3例；奇静脉及半奇静脉扩张4例；食管胃底静脉曲张1例。均显示局部肝静脉和下腔静脉狭窄及范围。结论：多层螺旋CT可明确血管阻塞部位，程度，范围及侧支循环，对诊断具有重要参考价值并指导临床治疗。     

上腔静脉综合征继发改变的CT评价

目的:探讨肺癌致上腔静脉综合征(SVCS)继发改变的CT表现类型及CT价值。方法:经病理证实肺癌致SVCS51例,其中7例行上腔静脉支架植入术,回顾分析上腔静脉梗阻程度、继发改变CT表现,并作统计分析。结果:①上腔静脉梗阻程度:轻~中度18例,重度28例,完全闭塞5例;②继发改变CT表现:单纯侧枝循环建立与开放14例,单纯胸壁肿胀12例,侧支循环建立并胸壁水肿16例,两种表现均未发现9例。肺癌致SVCS时上腔静脉梗阻程度不同,胸部侧枝循环和/或胸壁水肿CT显示率不同(P<0.05)。肺癌致SVCS时血栓形成7例。结论:胸部CT增强扫描是显示肺癌致SVCS继发改变的一种很有价值的影像学方法。     

肺癌致上腔静脉综合征的CT诊断

目的:探讨肺癌致上腔静脉综合征(SVCS)的CT表现。材料和方法:病理确诊肺癌致SVCS51例,回顾性分析肺癌、上腔静脉梗阻及SVCS继发病变的CT特征,并作统计分析。结果:(1)原发疾病特征:致SVCS肺癌位于右上肺叶32例、右中肺叶3例、右下肺叶5例、左上肺叶2例、左下肺叶5例、右全肺4例;大体类型:中央型35例、右上纵隔型12例、周围型4例。(2)上腔静脉梗阻征:环状包埋11例、半环状包埋5例、夹心状包埋5例、推移10例、向左推压15例、完全闭塞5例。梗阻程度不同,前五者发生率有差异(P<0.05)。(3)继发病变征:单纯侧枝循环建立与开放14例、单纯胸壁肿胀12例、二者均有16例、二者均无9例,上腔静脉梗阻程度不同,侧枝循环和/或胸壁水肿CT显示率不同(P<0.05)。结论:CT增强扫描能全面诊断肺癌致SVCS。     

下腔静脉畸形的64层螺旋CT表现

目的 探讨64层螺旋CT下腔静脉畸形的影像表现.方法 回顾性分析6986例受检者的腹部64层螺旋CT增强扫描资料,共发现25例下腔静脉先天畸形.分析下腔静脉畸形的影像表现.结果 25例下腔静脉畸形中包括左下腔静脉6例,CT表现为肾下段腹主动脉左侧上行的下腔静脉.双下腔静脉10例,CT表现为肾下段腹主动脉两侧上行的下腔静脉.左肾静脉畸形5例,CT增强扫描横断面显示腹主动脉后和环主动脉走行的左肾静脉.肝下段下腔静脉中断伴奇静脉延续2例,胸腹部CT增强扫描显示肝段至肾上段下腔静脉缺如,肾段下腔静脉由奇静脉延续回流人上腔静脉,而肝静脉直接回流右心房.腔静脉血管造影见对比剂经增粗的奇静脉和半奇静脉通过上腔静脉回流右心房.肝下段下腔静脉中断伴门静脉延续1例,增强CT显示下腔静脉直接与门静脉在肝门部连接,肝门部门静脉呈瘤样扩张.左下腔静脉伴半奇静脉延续1例,增强CT可见左下腔静脉与半奇静脉连接,上行汇入奇静脉.结论 64层螺旋CT可清晰显示下腔静脉及其属支的畸形,可成为下腔静脉畸形的重要诊断方法.     

Multislice Spiral CT Diagnosis of Etiology in Sigmoid Colon Obstruction

目的 探讨64排螺旋CT的多平面重组(MPR)、最大密度投影(MIP)及容积再现(VR)后处理技术在鉴别乙状结肠梗阻病因中的价值.资料与方法 收集经手术及病理证实的乙状结肠癌、乙状结肠扭转及乙状结肠粘连所致肠梗阻各1例,分析乙状结肠梗阻的多排螺旋CT表现.结果 梗阻点肠壁增厚伴管腔狭窄是乙状结肠癌的特征性表现;梗阻点肠系膜血管漩窝状排列是乙状结肠扭转的特征性表现;乙状结肠牵拉、固定,梗阻点无明显肠壁增厚、无肠系膜血管扭转是乙状结肠粘连的特征性表现.结论 64排螺旋CT的MPR、MIP及VR后处理技术在鉴别诊断不同原因乙状结肠梗阻中有较高实用价值.     

408例小细胞肺癌伴或不伴上腔静脉综合征预后的分析

支气管癌约46％是小细胞肺癌(SCLC),伴上腔静脉综合征(SVCS)约75％,淋巴瘤伴SVCS为10％～15％。普遍认为SCLC伴SVCS的预后不良。作者旨在分析一组408例SCLC伴与不伴SVCS的预后。其中大多数体力状态≥70％,360例无SVCS,43例(11％)有SVCS,5例无足够临床资料诊断SVCS。SVCS组中女性较无SVCS组多(42％比24％)。经     

多脾综合征的CT、MRI表现(附5例报道及文献复习)

目的探讨多脾综合征(PS)的CT及MRI表现,提高对PS的认识及诊断准确率。方法回顾性分析5例PS的CT、MRI影像及临床资料,观察其并发内脏及心血管系统畸形的影像学表现。结果 5例多脾综合征患者,全内脏转位3例,部分内脏翻转1例,短胰腺4例,中位肝脏1例,中位胆囊2例,小肠旋转不良3例,下腔静脉肝内段缺如、肝静脉直接汇入右心房2例,奇静脉或半奇静脉扩张与上腔静脉异常连接3例,肝总动脉起自肠系膜上动脉1例。结论多脾综合征是一组多系统发育畸形,其影像学表现多样,熟悉多脾综合征伴有其他脏器异常的各种CT、MRI表现,有助于提高对多脾综合征的认识,减少漏误诊的发生。应用胸腹部CT增强扫描、腹部MRI增强扫描有助于多脾综合征的全面诊断。     

血管内支架置入术治疗肺癌引起的上腔静脉综合征

目的:观察血管内支架置入治疗肺癌引起的上腔静脉综合征的疗效。方法:对56例肺癌引起的上腔静脉综合征患者行经股静脉上腔静脉内支架置入治疗。结果:56例患者均成功置入支架,患者症状缓解。8例支架内继发血栓形成,其中1例支架内再次置入支架,7例经溶栓后症状缓解。结论:血管内支架置入术是一种治疗肺癌引起的上腔静脉综合征安全有效的方法。     

The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT

OBJECTIVE: The superior vena cava (SVC) obstruction by malignant diseases is either by direct invasion and compression or by tumour thrombus of the SVC. Whatever is its cause, obstruction of the SVC causes elevated pressure in the veins draining into the SVC and increased or reversed blood flow through collateral vessels. Severity of the syndrome depends on the collateral vascular system development. Therefore, imaging of the collateral veins with variable location and connection is important in determining the extension and management of the disease. Our aims are to describe collateral vessels of the superior vena cava syndrome (SVCS) related with the malignant diseases and to assess the ability of multi-detector row CT with multiplanar and 3D volume rendering techniques in determining and describing collateral circulations. MATERIALS AND METHODS: We present CT angiography findings of seven patients with small cell carcinoma of the lung (n = 2), squamous cell carcinoma of the lung (n = 3), Hodgkin disease of the thorax (n = 1), and squamous cell carcinoma of the oesophagus (n = 1). The patients received contrast-enhanced CT scans of the chest and abdomen on a multi-detector row CT during breath holding at suspended inspiration. RESULTS: CT images revealed the cause and level of the SVC obstruction in all patients with axial and multiplanar reconstructed images. The SVC showed total obstruction in five patients and partial obstruction in two patients. The most common experienced collateral vessels were azygos vein (6), intercostal veins (6), mediastinal veins (6), paravertebral veins (5), hemiazygos vein (5), thoracoepigastric vein (5), internal mammary vein (5), thoracoacromioclavicular venous plexus (5), and anterior chest wall veins (5). While one case showed the portal-systemic shunt, V. cordis media and sinus coronarius with phrenic veins were enlarged in two cases, and the left adrenal vein was enlarged in a patient. In one case, the azygos vein with reversed blood flow was drained into both inferior vena cava and hemiazygos vein with the left renal vein. CONCLUSION: Multi-detector row CT with multiplanar and 3D imaging is an effective tool in evaluation of the SVCS and has a greater advantage than the other imaging techniques. 3D volume rendering is a useful technique in determining and describing collateral circulations in addition to the primary disease process.     

Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality

PURPOSE: To retrospectively evaluate pulmonary artery (PA) clot load scores and computed tomographic (CT) cardiovascular parameters as predictors of mortality in patients with severe pulmonary embolism (PE). MATERIALS AND METHODS: Institutional review board approval was obtained with waiver of informed consent. A total of 82 consecutive patients (42 women, 40 men; mean age+/-standard deviation, 61 years+/-15) were admitted to the intensive care unit for PE-related conditions and were evaluated by using CT pulmonary angiography. Two independent readers who were blinded to clinical outcome quantified PA clot load by using four scoring systems. Cardiovascular measurements included right ventricular (RV) and left ventricular (LV) short-axis measurements; RV short axis to LV short axis (RV/LV) ratios; main PA, ascending aorta, azygos vein, and superior vena cava diameters; and main PA diameter to aorta diameter ratios. Reflux of contrast medium into the inferior vena cava, leftward bowing of the interventricular septum, pleural or pericardial effusion, pulmonary consolidation, infarct, platelike atelectasis, and mosaic ground-glass opacity were also recorded. Results were correlated with patient outcome during hospital stay by using the Wilcoxon rank sum and chi2 tests. RESULTS: Twelve patients died within 1-14 days. RV and LV short axis; RV/LV ratio; azygos vein, superior vena cava, and aorta diameters; and contrast medium reflux into the inferior vena cava were significantly different between survivors and nonsurvivors (P<.05). No significant relationship was found between PA clot load and mortality rate. RV/LV ratio and azygos vein diameter allowed correct prediction of survival in 89% of patients (P<.001). CONCLUSION: RV/LV ratio and azygos vein diameter are predictors of mortality in patients with severe PE.     

Radionuclide angiography of azygos continuation of inferior vena cava in left atrial isomerism (polysplenia syndrome)

Interruption of the inferior vena cava with azygos continuation is present in at least 65% of the patients suffering from left atrial isomerism (polysplenia syndrome). First-pass radionuclide angiography using a peripheral vein of the foot correctly diagnosed interruption of the inferior vena cava in seven patients. Four had azygos continuation to the right superior vena cava and in three it was to the left superior vena cava. In all the patients, cardiac catheterization confirmed the diagnosis. Four underwent surgical correction (or palliation), three are waiting for an operation. Radionuclide angiography is a simple outpatient procedure and useful in the clinical diagnosis of this syndrome.     

Alterations in CT mediastinal anatomy produced by an azygos lobe

Computed tomographic (CT) scans of 11 patients with an azygos lobe were compared with similar scans of age- and gender-matched normal controls. The reflections of the right lung against the superior mediastinum were evaluated, and particular attention was directed to five specific areas: the azygos vein and arch, the superior vena cava, the pretracheal and retrotracheal areas, and the esophagus. With an azygos lobe, the azygos arch is at a more cephalad position than normal. The axis of the superior vena cava is oriented toward the left. The azygos lobe intrudes into the pretracheal and retrotracheal mediastinum contacting the anterior wall of the trachea, the medial wall of the superior vena cava, and most of the posterior wall of the trachea in the majority of patients. The presence of an azygos lobe significantly alters the contour of the right mediastinum and changes the relation of lung to the superior vena cava and trachea.     

体静脉连接异常的心血管造影诊断

目的评价心血管造影对体静脉连接异常的诊断价值。方法回顾分析371例经手术证实的体静脉连接异常患儿的心血管造影。结果左上腔静脉残存共190例,其中左上腔静脉回流入冠状窦171例,左上腔静脉回流入左房9例,左上腔静脉经无顶冠状窦回流入左房10例;右上腔静脉缺如3例;下腔静脉异常连接42例,其中40例为下腔静脉中断伴奇静脉回流,1例为下腔静脉回流入左房,1例为双下腔静脉。无名静脉异常共136例。结论体静脉连接异常在先天性心脏病的患者中并不少见,先心病术前通过心血管造影了解体静脉的连接关系对手术有重要的指导意义。     

Superior vena cava obstruction: a venographic classification

Analysis of venacavograms in 27 patients with superior vena caval obstruction revealed the following four patterns of venous collateral return: type I, partial obstruction (up to 90% stenosis) of the superior vena cava with patency of the azygos vein; type II, near-complete to complete obstruction (90-100%) of the superior vena cava with patency and antegrade flow through the azygos vein and into the right atrium; type III, near-complete to complete obstruction (90-100%) of the superior vena cava with reversal of azygos blood flow; type IV, complete obstruction of the superior vena cava and one or more of the major caval tributaries, including the azygos system. These patterns correlate well with the patients' clinical courses and can be used to identify patients who are at risk of developing cerebral and airway compromise and therefore would benefit from superior vena cava bypass surgery.