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1.
CO2—DSA的临床应用研究 总被引:5,自引:2,他引:3
目的:探索二氧化碳气体作为血管造影剂的临床应用效果。材料方法:对16例患者行二氧化碳数字减影血管造影(CO2-DSA)。其中肝动脉造影8例,腹主动脉造影1例,股动脉造影2例,直接门静脉造影3例,肾静脉造影2例,并与同一患者碘剂造影比较。结果:在8例肝肿瘤中,CO2-DSA显示肝动脉-门静脉瘘(APF)6例(6/8),而碘剂显示1例(1/8)。CO2-DSA显示肝内小动脉分支及肿瘤染色不如碘造影剂。但腹主动脉造影、股动脉造影和直接门静脉造影图像较满意,且副作用小。结论:CO2是一种安全的血管造影剂。CO2-DSA可得到准确、有价值的血管图像,且危险性小。它是显示肝APF的可靠方法 相似文献
2.
二氧化碳数字减影血管造影技术现状及临床应用 总被引:1,自引:0,他引:1
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 相似文献
3.
TIPS术前门静脉MRA评价初探 总被引:2,自引:0,他引:2
目的:探讨门静脉MRA对TIPS病例术前评价的价值。材料和方法:7例门脉高压患者在TIPS术前经2D TOF及2D PC评价门脉的开放性、血流方向以及门脉主干及其分支与肝静脉的空间关系,以及静脉曲张情况。结果:本组7例TIPS术前门脉MRA均满意显示门脉、分叉部以及肝静脉各支,所得结果与造影相符。食管静脉、胃冠状静脉、脾门静脉曲张分别为7、4、3例。脐静脉开放2例。结论:门脉MRA是一种有价值的无损伤性检查技术,对TIPS术前门静脉评价将起重要作用。 相似文献
4.
应用屏气法连续多角度斜位二维TOF对冠状动脉磁共振血管造影临床应用的可行性进行评价。共23例,20例为健康者,2例冠脉造影证实有病变,1例超快速CT显示冠脉有钙化。结果:左冠脉主干、左前降支、左旋支及右冠脉近段在23例均完全显示,冠脉显示长度超过7cm者本组病例中左前降支有9例(39%),左旋支4例(17%),右冠脉13例(57%),2例冠脉造影显示冠脉狭窄≥50%者磁共振检查均较好显示。 相似文献
5.
目的:评价螺旋CT作肝脏肿瘤早期增强扫描的作用。材料和方法:用螺旋CT和造影剂快速滴注法对36例肝脏肿瘤患者作全肝早期增强扫描。以2ml/s左右的速度经时前静脉注入浓度为300mgI/ml的非离子型造影剂100ml,在开始滴注造影剂75秒内扫完全肝。结果:所有图像主动脉密度均高于或等于门静脉密度。与邻近肝组织相比,15例(20灶)肝细胞性肝癌(HCC)呈高密度。11例HCC呈等或较低密度:2例为弥漫型HCC;9例有严重肝动脉-门静脉瘘,其中2例门静脉呈逆向增强。7例肝转移瘤呈低密度。3例(5灶)海绵状血管瘤呈向心性增强。结论:螺旋CT作肝脏早期增强扫描可如实显示肿瘤血供和血管受侵的情况,有利于病灶性质的鉴别和多血供多发病灶及小病灶的发现。 相似文献
6.
TIPSS治疗肝硬化门脉高压的应用研究 总被引:13,自引:4,他引:9
笔者报告了自1992年6月以来,应用TIPSS治疗62例肝硬化门脉高压(CPH)的研究结果。62例中,肝炎后CPH33例;酒精性CPH3例;Budd-Chiari综合征(BCS)4例,其余为原因不明者。在TIPSS获得成功的60例(97%)中,应用国产Z-stent者46例。其中,并用食管胃底静脉硬化栓塞术(8EEV)者31例。TIPSS后,门脉压平均下降1.32±0.51kPa(1kPa=10.20cmH_2O)。病人的主要症状、体征得到有效控制或/和明显改善。未发生与技术操作有关的严重并发症。但出现肝性脑病者8例(14%),术后经1~25个月(平均9个月)的随访观察,肝内分流道发生阻塞者9例(15%),7例获得再通。术后1~20个月内死亡10例。其中,30天内死亡4例。笔者认为:(1)TIPSS作为CPH治疗的一个安全有效的新方法,既可作为应急性抢救措施,也可作为预防性治疗手段;其治疗对象既可以是酒精性CPH,也可以是肝炎后CPH及BCS所致的瘀血性CPH;(2)在实施限制性TIPSS时,应把SEEV作为一个重要步骤。(3)与一般Z-stent相比,螺旋式Z-stent更适于在TIPSS中应用。 相似文献
7.
SEEV在TIPSS治疗中的应用及意义 总被引:3,自引:1,他引:2
笔者报告了在限制性TIPSS中并用食管胃底静脉硬化栓塞术(SEEV)对28例肝硬化门脉高压(CPH)患者进行治疗的初步结果。28例TIPSS均选择10mm直径的肝内分流道,并实施了SEEV治疗。术后,平均门脉压由术前的4.38±0.76kPa(1kPa=10.20cmH_2O)降为3.11±0.75kPa。TIPSS后即刻行脾、门静脉造影观察,食管胃底静脉血流均完全消失。术后经1~14个月(平均5个月)的随访观察,除1例于TIPSS8个月后因分流道狭窄而再发少量出血外,其余27例均获得良好的治疗效果。笔者认为限制性TIPSS并用SEEV治疗不仅具有方法合理、操作简便、疗效确切等特点,而且可明显提高TIPSS的临床效果。因此,应把SEEV作为TIPSS的一项重要步骤加以实施。 相似文献
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10.
TIPSS术前影像学检查方法选择及意义:兼论最佳穿佳途径的选择 总被引:3,自引:0,他引:3
作者分析了90例肝脏MRI,CT,超声及血管造影这四种影像检查资料,其中50例于影像检查后行TIPSS,旨在评价如何选择行TIPSS前的影像检查。结果表明:在显示肝静脉,门静脉方法,MRI具有优越性,超声在显示门静脉血流方面具有优越性,我们认为,MRI和超声为常规TIPSS前的首选影像检查方法,急诊TIPSS前则以血管造影为主。 相似文献
11.
RATIONALE AND OBJECTIVES: The purpose of this study was to evaluate the utility of CO2 versus iodinated contrast medium for wedge hepatic venography in identifying portal vein anatomy during transjugular intrahepatic portosystemic shunt (TIPS) procedures. MATERIALS AND METHODS: Wedge hepatic venograms obtained with CO2 or iodinated contrast medium and direct portograms of 43 patients undergoing TIPS procedures were analyzed retrospectively. Wedge venography was performed in 23 patients with CO2 and in 21 with iodinated contrast medium; direct portography was subsequently performed in 42 of 44 patients with iodinated contrast medium and in one with CO2. All cases were reviewed systematically to compare portal vein anatomy and completeness of anatomic identification between direct portography and wedge venography, and the results with CO2 were compared to those with iodinated contrast material. RESULTS: On the basis of opacification of the main portal trunk, branches, or both, the portal vein appearance (definition of the portal bifurcation) was good to excellent in 21 of 23 patients imaged with CO2 but in only two of 20 patients imaged with iodinated contrast medium. Wedge venograms agreed with direct portograms in 91% (21 of 23) of the CO2 cases and in 10% (two of 20) of the iodinated contrast medium cases. The two patients with poor opacification using CO2 had poor delineation of the main portal trunk, branches, and varices. TIPS could not be created in three patients, In two, abnormal morphology was identified at CO2 venography; in the third, wedge venography was not performed. CONCLUSION: Wedge hepatic venography with CO2 compared with iodinated contrast medium has a substantially higher likelihood of correctly and completely identifying the location and anatomy of the portal vein. 相似文献
12.
Krajina A Lojik M Chovanec V Raupach J Hulek P 《Cardiovascular and interventional radiology》2002,25(3):171-175
Purpose: Carbon dioxide
(CO2) can traverse the hepatic sinusoids better than
iodinated contrast medium and has been used by many interventionalists
for wedged hepatic venography during transjugular intrahepatic
portosystemic shunt (TIPS) procedures. Our study was designed to
compare the extent of the portal vein opacification using either
CO2 or iodinated contrast medium.
Methods:
Wedged hepatic venography for portal vein opacification during TIPS was
performed using hand injection through a 6.5 Fr diagnostic catheter.
Portograms of 36 patients performed with 10 ml of iodinated contrast
medium were retrospectively compared with portograms of 45 patients
performed with 30-40 ml of CO2. Opacification of the right
portal vein branch including the portal vein bifurcation was defined as
a successful study.
Results: Using CO2 the
right portal vein branch and the portal vein bifurcation were opacified
in 87% of patients (39 of 45); only a part of the right portal vein
branch was opacified in 6% of patients and no opacification of any
portal vein branch was seen in 7% of patients. Using iodinated
contrast medium, there was opacification of the portal vein bifurcation
in 25% of patients (9 of 36), of a part of the portal vein branch in
36% and no opacification of any branch in 39%. There was one case of
hepatic laceration from CO2 wedged venography which was
treated with microcoil embolization.
Conclusions: Using
CO2 as a contrast medium, opacification of the portal vein
bifurcation by wedged hepatic venography was seen in 87% of patients,
in comparison with only 25% when iodinated contrast medium was used
(p < 0.001). CO2 is superior to
iodinated contrast medium for wedged hepatic venography during TIPS. 相似文献
13.
Jin Shan Zhang M.D. Yan Ping Wang Mao Qiang Wang Li Yang Chong Chong Xing Miao Yu Zhipeng Cui 《Cardiovascular and interventional radiology》1996,19(4):239-241
Purpose To present a peculiar anatomic portal veins variant and evaluate its clinical implications.
Methods Among 118 consecutive patients undergoing transjugular intrahepatic portosystemic shunting (TIPS), six male patients were
found to have an accessory portal vein, which was seen during direct portography.
Results In all six patients, portograms showed an accessory small-caliber vein parallel to the trunk of the main portal vein ending
in the right lobe of the liver. Two of the six accessory portal veins drained blood from coronary veins, precluding access
to coronary vein embolization during TIPS.
Conclusion An accessory portal vein is a rare anatomical variation with clinical significance for both surgical shunt placement and TIPS,
as well as for transportal embolization of coronary veins. 相似文献
14.
Objectives
The blind portal vein puncture remains the most challenging step during transjugular intrahepatic portosystemic shunt (TIPS) creation. We performed a prospective randomised clinical trial to compare three-dimensional (3D) roadmap with CO2 wedged hepatic vein portography for portal vein puncture guidance.Methods
Between March 2017 and May 2017, 30 patients were enrolled and randomly allocated to the study group (3D roadmap) or the control group (CO2 wedged hepatic vein portography).Results
Technical success of TIPS procedures was achieved in all 30 patients. The mean number of needle passes was significantly lower in the study group (2.0 ± 1.0) compared to the control group (3.7 ± 2.5; p = 0.021). A total of six (40%) patients in the study group and three (20%) in the control group required only one puncture for the establishment of TIPS. There were no significant differences in total fluoroscopy time (p = 0.905), total procedure time (p = 0.199) and dose-area product (p = 0.870) between the two groups.Conclusions
3D roadmap is a safe and technically feasible means for portal vein puncture guidance during TIPS creation, equivalent in efficacy to CO2 wedged hepatic vein portography. This technique could reduce the number of needle passes, thereby simplifying the TIPS procedure.Key Points
? 3D roadmap can be used to guide portal vein puncture. ? Compared with CO 2 venography, 3D roadmap reduced the number of needle passes. ? 3D roadmap has a potential to simplify the TIPS procedure.15.
三维对比剂增强MR门静脉成像与直接门静脉造影术对照 总被引:4,自引:0,他引:4
目的通过与直接门静脉造影术的比较,评价三维对比剂增强MR门静脉成像(3D CE MRP)的准确性。方法26例患者行3D CE MRP和直接门静脉造影检查。分析3D CE MRP上门静脉主干、肝内左右分支的开放性和侧支循环发生情况,其结果与直接门静脉造影对照,评价两者符合情况,并分析两者不符的原因。结果3D CE MRP和直接门静脉造影显示门静脉主干的结果完全一致。对肝内门静脉分支,有21例2种检查结果符合,但有5例不符。1例肝右叶巨大肿瘤,3D CE MRP显示门静脉右后支闭塞,但直接门静脉造影显示明显狭窄。3例左叶肝癌患者,3D CE MRP显示门静脉左支闭塞,但直接门静脉造影显示其近段狭窄和远端闭塞。另有1例肝癌患者,3D CE MRP显示门静脉左支矢状段小癌栓,而直接门静脉造影却未能显示。除1例脐静脉重开由于扫描范围较小未显示之外,3D CE MRP显示侧支循环的结果和直接门静脉造影相符。结论多数病例,3D CE MRP的显示结果与直接门静脉造影符合。3D CE MRP在鉴别肝内门静脉分支狭窄或闭塞时有一定限度,而在显示门静脉小栓子方面却有优势。 相似文献
16.
动态增强磁共振门静脉造影在门脉高压症诊断中的价值 总被引:1,自引:1,他引:0
目的:探讨动态增强磁共振门静脉造影(DCE MRP)在门脉高压症诊断中的价值。方法:对门脉高压症组23例和正常对照组15例行DCE MRP检查。观察23例门静脉高压症在DCE MRP上的表现。结果:对照组15例均清楚显示门静脉。门脉高压症表现为门静脉增粗(21例)、脾静脉迂曲扩张(23例);门静脉分支级数减少(18例);门静脉延迟显影(7例);显示侧枝循环静脉(6例);门静脉血栓形成(3例)。结论:DCE MRP是评价门静脉的一项快速无创的技术,可准确显示门静脉高压症门静脉系统的病理改变。 相似文献
17.
Assessment of portal vein patency: comparison of arterial portography and ultrasound scanning 总被引:1,自引:0,他引:1
The accuracy of ultrasound assessment of portal vein patency has been defined by comparing it with the results of arterial portography in 115 cases. The accuracy of arterial portography was confirmed in 21 cases where orthotopic liver transplantation was performed and used as a 'bench-mark' against which to assess the ultrasound findings. Ultrasound correctly assessed portal vein patency in 87.5% of patients. It was more accurate in assessing patency (90%) than occlusion (68%). Ultrasound correctly assessed portal vein patency in 90% of cases of cirrhosis and hepatic malignancy. Difficulties occurred in children with biliary atresia particularly following the Kasai operation (37.5% accuracy). In the absence of previous surgery to the portal vein or biliary system, ultrasound is comparable to arterial portography and can be used as the sole means of assessment. 相似文献
18.
Covey AM Brody LA Getrajdman GI Sofocleous CT Brown KT 《AJR. American journal of roentgenology》2004,183(4):1055-1064
OBJECTIVE: The purpose of this study was to determine the incidence of variant intrahepatic portal vein anatomy detected on CT portography and to discuss surgical implications. CONCLUSION: Variant portal vein anatomy is nearly as common as variant hepatic artery anatomy. The complexity of hepatic interventions now performed by interventional radiologists and surgeons, including portal vein embolization, anatomic resection, and transplantation, make recognition and understanding of normal and variant portal vein anatomy increasingly important. 相似文献