磁共振TRICKS技术在下肢血管成像的临床应用价值

目的：探讨3．0T磁共振的时间分辨对比剂动态显像技术（TRICKS）在下肢血管成像中的应用价值。方法：对21例下肢血管疾病患者（肿瘤病变10例,血管性病变11例）行常规MRI平扫,注入对比剂后应用TRICKS技术行动态血管造影,最后行常规增强扫描,分析全部病例的图像质量和病变显示情况并与手术病理或DSA对照。结果：所有病例均顺利完成TRICKS检查,TRICKS图像动态显示了动静脉的充盈情况和动脉结构,肿瘤性病变可以清晰显示肿瘤的供血血管,血管性病变可以直观显示出畸形或迂曲的血管,所有诊断与DSA和病理诊断相符。结论：TRICKS技术是一种新的、有效的腹部至下肢血管成像方法,能够在不影响常规增强扫描的情况下动态观察血管情况,对下肢血管病变的诊断具有重要价值。     

数字减影血管造影诊断小儿大动脉炎

目的：用数字减影血管造影（DSA）显示小儿大动脉炎。方法：用DSA对12例小儿多发性大动脉炎进行检查。结果：胸主动脉及弓部狭窄2例（17％），均同时合并左颈总及左锁骨下动脉狭窄。腹主动脉狭窄10例（83％）其中合并肾动脉狭窄9例。髂总动脉狭窄1例，骼内动脉狭窄1例，常外动脉狭窄1例，馆外动脉完全闭塞1例。结论；与常规血管造影术比较。DSA具有造影剂用量少，病变显示忧的特点。     

三维高时间分辨率动态增强MR血管成像在临床的初步应用

目的评价三维高时间分辨率动态增强MR血管成像（contrast-enhanced MR angiography using 3D time-resolved imaging of contrast kinetics，CE-MRA 3D-TRICKS）在临床中的应用价值。方法TRICKS应用超短Tn（2．8～4．0ms）、TE（0．9～1．3ms）、中心K空间3倍于外周K空间采集的方法获得高时间分辨率（2～6s）的MRA技术。TRICKS于增强前首先扫描3D模片，团注对比剂后连续扫描15～20个序列的3D图像。结果30例患者行TRICKS检查并获得满意的CE-MRA图像。12例椎动脉显示良好（7例正常，1例双侧椎动脉狭窄，4例单侧椎动脉狭窄，其中1例伴同侧颈总动脉分叉部狭窄）。4例双侧肾动脉显示正常，1例移植肾动脉正常，1例移植肾动脉狭窄。2例脑动脉显示正常，1例显示矢状窦血栓，1例显示颅内动静脉畸形。3例肺动脉显示正常，1例显示双侧肺动脉血栓，1例清晰显示左下肺肺段隔离症的供血动脉及引流静脉。1例左下肢纤维脂肪瘤可见动脉分支供血增多。1例显示左侧尺桡动脉人工造瘘口的狭窄。1例显示左前臂海绵状血管瘤。结论TRICKS能清晰显示全身各部位的血管系统，并能清晰显示各种血管异常。TRICKS具有方便、高成功率的特点，使其有望成为显示血管异常首选的影像学检查手段。     

脑动脉狭窄的CTA和MRA及DSA对照分析

目的：探讨CT血管成像（CTA）和磁共振血管成像（MRA）对脑动脉狭窄的诊断价值。方法：52例临床拟诊为脑动脉硬化的患者均行颅脑CTA和31〉TOF-MRA检查,其中23例同时行DSA检查。分析不同影像方法对血管狭窄的显示情况及部位分布。结果：52例患者MRA共显示脑血管狭窄73处,其中Ⅰ～Ⅱ级17处,3处CTA显示相应部位无。狭窄;Ⅲ～Ⅳ级56处,6处CTA显示相应部位无狭窄,13处CTA显示相应部位为Ⅰ～Ⅱ级狭窄;4处MRA显示无狭窄而CTA显示狭窄。23例行DSA检查的患者,MRA诊断脑动脉狭窄42处,DSA诊断相应部位血管狭窄36处,MRA假阳性率为14．3％、过度诊断率为57．1％;CTA显示动脉狭窄37处,CTA假阳性率为2．7％,过度诊断率为29．7％。结论：CTA对脑动脉狭窄具有较高的检出率及诊断符合率,能较真实地反映脑动脉狭窄情况;3D-TOF—MRA简便、无创,可作为筛选脑动脉狭窄的重要手段。     

3D TRICKS MRA对颈动脉粥样硬化狭窄的诊断价值

目的：探讨3D TRICKS MRA对颈动脉粥样硬化狭窄的诊断价值。方法：对43例临床疑诊颈动脉粥样硬化狭窄的患者行2D TOF MRA和3D TRICKS MRA检查,其中31例同期行DSA检查,以颈总动脉法（CC法）计算狭窄率。结果：颈动脉闭塞2支,重度狭窄10支,中度狭窄31支,轻度狭窄25支,正常18支。2D TOF MRA、3D TRICKS MRA与DSA对照,显示狭窄部位均与DSA所示相符。2D TOF MRA高估狭窄程度6支,3D TRICKS MRA高估狭窄程度1支。以DSA为标准,2D TOF MRA诊断颈动脉狭窄的敏感度、特异度、诊断符合率分别为91.6%,85.7%,90.3%（K=0.737）;3D TRICKS MRA诊断颈动脉狭窄的敏感度、特异度、诊断符合率分别为97.9%,100%,98.4%（K=0.955）。两种方法对诊断颈动脉狭窄的敏感度、特异度和诊断符合率差异均具有统计学意义（P〈0.05）。结论：3D TRICKS MRA与DSA对评估颈动脉粥样硬化狭窄具有极好的一致性（K=0.955）,明显优于2D TOF MRA（K=0.737,P〈0.05）,是对颈动脉粥样硬化狭窄筛查、术前评估、术后随访的最佳检查方法,能基本替代DSA检查。     

肺癌16层螺旋CT支气管动脉血管成像与DSA对比分析

目的:探讨16层螺旋CT血管三维重组对诊断与评价肺癌支气管动脉供血血管和血供的临床应用价值.方法:10例肺癌同时行16层螺旋CT支气管动脉血管三维重组和DsA检查,并对16层螺旋cT支气管动脉血管三维重组和DSA资料进行对比分析.结果:10例肺癌16层螺旋CT血管成像显示11支支气管动脉,其中图像质量优5支、良好6支;DSA显示10支支气管动脉.10例肺癌16层螺旋CT血管成像显示肿瘤供血支气管动脉起源、形态及分支状况与DSA一致.10例肺癌16层螺旋CT血管VR彩色成像与DSA显示肿瘤染色及肿瘤内血供状况一致率为90%.结论:16层螺旋CT血管成像可克服DSA一次检查不能显示其全部供血血管的缺点;对诊断和评价肺癌供血血管和血供状况有较大临床价值.     

64排螺旋CT减影血管成像在头部烟雾病诊断中的应用

目的探讨64排螺旋CT减影血管成像技术在烟雾病诊断中的临床价值。方法回顾分析在我院行减影脑血管成像烟雾病患者,共18例。对整个头部平扫、增强动脉早期和静脉早期扫描获得未减影数据,将动脉早期数据减去平扫数据获得减影动脉期数据,静脉早期数据减去动脉早期数据获得减影静脉期数据。采用容积再现(VR)、最大密度投影(MIP)重建减影血管图像。结果减影图像去除了动脉、静脉相互的及颅骨的干扰,对脑动、静脉解剖结构显示清楚,特别是对烟雾病异常颈内动脉和脑底血管网显示。本组显示脑底异常血管网占100%;双侧颈内动脉狭窄占61%,左侧颈内动脉狭窄占17%,右侧颈内动脉狭窄占22%;双侧大脑中动脉狭窄占39%(其中1例左侧大脑中动脉闭塞),右侧大脑中动脉狭窄占17%;双侧大脑前动脉狭窄占39%(其中1例双侧大脑前动脉闭塞),无单侧大脑前动脉狭窄;合并脑动脉瘤占17%;全部脑静脉未见异常。结论 64排螺旋CT智能跟踪扫描减影技术能清楚分别显示脑动脉和脑静脉,在显示颅内动脉血管畸形时可排除脑静脉畸形,对颅内烟雾病分析评价有较大临床价值。     

256层螺旋CT对迷走右锁骨下动脉的诊断价值

目的探讨256螺旋CT血管造影术(CTA)诊断迷走右锁骨下动脉(ARSA)的诊断价值。方法对8例接受头颈部联合CTA检查的ARSA患者的影像学资料进行回顾分析,结合原始数据、最大密度投影、曲面重组及容积再现三维技术,观察ARSA及其伴发的其他主动脉弓分支变异。结果 8例ARSA均为左位主动脉弓起源,呈食管后型,其中单纯性5例;合并左侧椎动脉起源于主动脉弓2例;合并主动脉夹层1例。结论 256层螺旋CTA能够准确评价迷走右锁骨下动脉及其伴发的其他主动脉弓分支变异,对临床有重要意义。     

3.0T高分辨率CE-MRA对颈部血管狭窄的诊断价值

目的探讨三维对比增强磁共振血管成像(3D CE-MRA)在颈部动脉血管狭窄诊断中的临床应用价值。方法对23例临床拟诊颈部动脉血管狭窄行数字减影血管造影(DSA)的患者行颈部3D CE-MRA。将两种方法检查结果进行相关性比较。结果 23例患者共230个节段血管,3D CE-MRA显示了227个节段,共诊断出74处(32.6%)狭窄,其中28处轻度狭窄,22处中度狭窄,20处重度狭窄,4处闭塞;DSA共显示了230个节段的血管,共诊断出69处(30.4%)血管狭窄,其中24处轻度狭窄,23处中度狭窄,19处重度狭窄,3处闭塞。与DSA相比,3DCE-MRA对颈部动脉轻度、中度、重度狭窄及动脉闭塞的显示敏感性均为100%,特异性分别为85.71%、90.91%、90%和75%,两种检查方法对颈部动脉狭窄程度的判断有良好的一致性(κ=0.921,P=0.000)。结论 3.0T 3DCE-MRA能够可靠的评价颈部动脉狭窄性病变,基本可以替代DSA检查。     

MR-TRICKS技术在足踝软组织病变诊断中的应用

目的:探讨1.5TMR-TRICKS技术在足踝血管成像的可行性及在足踝疾病诊断中的临床应用价值。方法:回顾性分析进行MR常规序列及TRICKS序列扫描的31例疑似或确诊的足踝部病变患者的临床及影像学资料。两位有经验的放射科医生利用MIP重建图像来评价足踝血管成像质量,评价动脉与足踝部病变的关系,并观察足踝部动脉动态血流及病变染色情况。TRICKS减影后图像使用功能软件SER计算出相应病变的时间信号曲线,得出时间信号曲线的峰值。结果:31例中有28例血管成像质量得分≥3,TRICKS影像能清晰显示足踝部动脉及分支;8例经临床及影像学证实无足踝部病变;TRICKS影像可显示足踝动脉与病变的关系(23例)及肿瘤染色(5例);时间信号曲线反映了软组织病变的动态强化程度。结论:TRICKS技术在足踝软组织病变的诊断中是可行性的,它为临床诊断提供更多有价值的信息,并为临床治疗提供参考。     

Angioplasty in stenosis of the innominate artery

We describe a successful percutaneous transluminal dilatation (PTD) of an innominate artery stenosis in a 40-year-old patient with aortic arch syndrome. Five years earlier both a left central carotid artery occlusion and an innominate and left subclavian artery stenosis were treated by grafting from the aorta to the distal vessels. At recurrence of the neurological symptoms, reocclusion of the graft to the innominate artery and subtotal stenosis of the left carotid anastomosis were noted. To prevent the hazards of a reoperation, the innominate artery stenosis was dilated by means of PTD via the right brachial artery. Success of the procedure was demonstrated by Doppler sonography and angiography. It appears that PTD serves as an excellent method of treating stenoses of the aortic arch branches in aortic arch syndrome.     

Subclavian steal syndrome: diagnosis with perfusion metrics from contrast-enhanced MR angiographic bolus-timing examination--initial experience

PURPOSE: To retrospectively determine whether differential temporal changes in signal intensity of the vertebral arteries, measured at a bolus-timing examination with a test dose of a gadolinium-based contrast agent, are present in patients with subclavian steal syndrome. MATERIALS AND METHODS: Institutional review board exemption was obtained, and informed consent was not required for this retrospective study. The study complied with the Health Insurance Portability and Accountability Act. Twenty-five patients with known or clinically suspected atherosclerotic disease of the aortic arch and branch vessels underwent breath-hold contrast material-enhanced magnetic resonance (MR) angiography with circulation time derived from a timing examination by using a test bolus of a gadolinium-based contrast agent. Eight patients (three men and five women aged 54-80 years; mean, 70 years) had subclavian stenosis or occlusion with retrograde vertebral artery flow confirmed with time-of-flight MR angiography, nine patients (eight men and one woman aged 31-91 years; mean, 70 years) had mild to severe ostial stenosis of a single vertebral artery, and eight patients (including four men and four women aged 53-86 years; mean, 73 years) had normal vertebral arteries. The difference in time to peak signal intensity between the right and left vertebral arteries was compared among the three groups by using Fisher exact and Cochran-Mantel-Haenszel tests. RESULTS: The delay in peak enhancement in the ipsilateral vertebral artery ranged from 2 to 4 seconds (mean, 2.5 seconds) in all eight patients with subclavian steal syndrome. In eight of nine patients with ostial vertebral artery stenosis and eight controls, both vertebral arteries filled simultaneously. The presence of unilateral delayed vertebral artery enhancement was significantly associated with retrograde flow in patients with subclavian steal syndrome, compared with patients with normal flow (P < .01) and those with ostial vertebral artery stenosis (P < .01). CONCLUSION: A bolus-timing examination performed with a test bolus of the gadolinium-based contrast agent via the neck vessels that demonstrates at least a 2-second delay in peak contrast enhancement in the right or left vertebral arteries may, in the appropriate clinical setting, indicate subclavian steal syndrome.     

MSCTA对先天性血管环的诊断价值

目的：探讨儿童先天性血管环的MSCTA表现,提高临床对本病的认识水平。方法：搜集2011年1月-2012年2月经手术确诊30例先天性血管环患者的病例资料,年龄1个月～9岁。主要临床表现为反复呼吸道感染者19例,反复呕吐、进食困难等消化道症状4例,6例合并心内畸形,1例为偶然发现。MSCTA原始图像以0．6mm层厚重建,使用多平面重组（MPR）、最大密度投影（MIP）、容积再现（VR）等技术对图像进行后处理。结果：30例中双主动脉弓4例,右位主动脉弓伴迷走左锁骨下动脉9例,左位主动脉弓伴迷走右锁骨下动脉7例,肺动脉吊带9例,右位主动脉弓伴迷走左头臂动脉1例。合并气管病变26例,主要为先天性气道发育畸形（4例）和气管狭窄（22例）。结论：MSCTA能清楚显示心外大血管情况,对先天性血管环明确诊断的同时,可了解气管受压程度及狭窄范围,有助于临床明确诊断及选择治疗方法。     

主动脉弓分支相关变异的多层螺旋CT研究

目的分析多层螺旋CT血管成像(CT angiography,CTA)对主动脉弓凸侧分支血管的显示,观察主动脉弓分支的相关变异。方法搜集颈胸结合部CTA患者237例,采用容积再现(VR)和多平面重组(MPR)等多种图像后处理技术,获得主动脉弓部重组图像。多角度、多平面、多方位立体观察主动脉弓及其主要分支的解剖结构,分析主动脉弓分支的相关变异情况。结果主动脉弓分为两种类型,即:标准型和变异型,以标准型最常见,占总病例数的89.03%;变异型占总病例数的10.97%,其中可见4种不同类型的变异。左侧椎动脉自主动脉弓发出并位于左颈总动脉(left common carotid artery,LCCA)和左锁骨下动脉(left subclavian artery,LSA)之间者占变异型患者的50%,为总病例数的5.49%;LCCA自头臂干(brachiocephalic trunk,BT)发出者占变异型的38.46%,为总病例数的4.22%;LCCA发自于BT并存左椎动脉发自主动脉弓并位于LCCA和LSA之间者占变异型的7.69%,为总病例数的0.84%;右位主动脉弓伴迷走左锁骨下者占变异型的3.85%,为总病例数的0.42%。结论多层螺旋CTA能为临床提供主动脉弓变异的解剖信息。     

Contrast-enhanced MR angiography of the supra-aortic vessels in 24 seconds: a feasibility study

A contrast-enhanced, gradient-echo 3D pulse sequence providing angiographic information in 24 s was tested in five healthy subjects and used prospectively in 21 patients for the investigation of the cervical arteries. Indications included suspected stenosis of the carotid (in 13), or vertebral arteries (in 1), carotid dissection (3), variants of the branches of the aortic arch (2) and extracranial carotid aneurysms (2). The results in all patients were compared with those of intra-arterial digital subtraction angiography (DSA). In patients with carotid stenosis, they were also compared with high-resolution 3D time-of-flight (TOF) MR angiography (MRA). Good quality MR angiograms of the neck vessels were obtained with the fast 3D sequence in 20 of the 21 patients. One claustrophobic patient was unable to co-operate. The degree of internal carotid artery (ICA) stenosis was graded correctly (compared to DSA) in 21 of 24 cases (87.5 %). Two mild stenoses were overestimated as moderate using the fast MR sequence and one high-grade stenosis was misdiagnosed as a complete occlusion. Carotid dissection was confirmed in one case and correctly excluded in two. Four extracranial ICA aneurysms in two patients, arterial variants and stenosis of the origin of the vertebral artery were correctly diagnosed using the contrast-enhanced MR angiogram. Three-dimensional TOF MRA was unsuccessful due to motion artefacts in half of the cases of ICA stenosis. Received: 6 August 1998 Accepted: 21 December 1998     

Aberrant subclavian arteries: cross-sectional imaging findings in infants and children referred for evaluation of extrinsic airway compression

OBJECTIVE: The purpose of our study was to describe patterns of airway compression identified on cross-sectional imaging in infants and children with either right aortic arch and aberrant left subclavian artery or left aortic arch with aberrant right subclavian artery. MATERIALS AND METHODS: Data from MR imaging and CT performed to evaluate pediatric patients for extrinsic airway compression were reviewed for cases that revealed an aberrant right or left subclavian artery. Clinical, endoscopic, and imaging findings in identified cases were reviewed. Recurrent patterns of extrinsic compression were reviewed among cases. RESULTS: Twelve patients with right aortic arch with aberrant left subclavian artery and nine patients with left aortic arch and aberrant right subclavian artery were identified. All 12 with right aortic arch with aberrant left subclavian artery had airway compression shown, with multiple sites or diffuse compression in six. Of these 12 patients, nine had compression at the level of the arch and aberrant subclavian artery (10 had Kommerell's diverticulum), and nine had compression of the distal airway in association with a midline descending aorta. Five of the nine patients with left aortic arch and aberrant right subclavian artery had airway compression shown, all at the level of the arch and aberrant subclavian artery. None of these compressions was associated with either Kommerell's diverticulum or midline descending aorta. CONCLUSION: Both right and left aberrant subclavian arteries can be associated with symptomatic airway compression, but the patterns of compression are different. The airway compression in right aortic arch with aberrant left subclavian artery is often associated with either Kommerell's diverticulum or midline descending aorta, whereas compression associated with left aortic arch and aberrant right subclavian artery is not.     

Duplicate origin of left vertebral artery

Summary A verified case of duplicate origin of the left vertebral artery in association with a large aneurysm arising from the aortic arch immediately distal to the left subclavian artery is presented. An anomalous left vertebral artery arises directly from the aortic arch between the left common carotid and subclavian arteries, and joins with the normal left vertebral artery in the transverse foramen of the fifth cervical vertebra.     

MR imaging of congenital anomalies of the aortic arch

Eighteen patients with congenital aortic arch anomalies were evaluated by ECG-gated MR imaging. Transverse images encompassing the heart and thoracic aorta were available in all patients; sagittal or coronal studies were available in 12 patients. Visualization of the aortic arch, its orientation, and the origin and course of the arch vessels was assessed. Associated intracardiac abnormalities were noted, and the effect of aberrant vessels on the trachea or esophagus was determined. Thirteen patients had a right aortic arch. Mirror-image branching was found in 10 cases, and an aberrant left subclavian artery was found in three of these. Three patients had a left aortic arch with aberrant right subclavian artery, and two patients had a double arch. Tracheal compression caused by vascular rings was found in two patients with respiratory symptoms. Corroborating studies (angiography, surgery, CT, and autopsy) in 16 patients confirmed the MR diagnoses in all but one. We conclude that MR could substitute for other techniques as an effective, noninvasive method for the evaluation of congenital aortic arch anomalies.     

When Arteria lusoria meets Truncus bicaroticus: one of the rarest combinations of aortic arch anomalies

The Arteria lusoria or aberrant right subclavian artery (ARSA) constitutes one of the rarest malformations of the aortic arch, it can be associated with other congenital anomalies of the heart and large vessels, in particular the bi-carotid trunk or common origin of the carotid arteries (COCA) which is the presence of a single branch from the aorta giving off both right and left common carotid arteries. We report the case of a patient followed for severe mitral stenosis, and hospitalized for an ischemic cerebral vascular accident, a chest CT scan was performed in front of her clinical and biological degradation, which allowed the fortuitous discovery of an Arteria lusoria (aberrant retro-esophagealartery) associated with a Truncus bicaroticus.