Right internal iliac vein joining the left common iliac vein: case report demonstrated by CT angiography

An unusual variation of the iliac veins was detected by computed tomography (CT) angiography in a 35-year-old man. In coronal CT reconstructions, it was shown that the right internal iliac vein of this patient crossed to the left side and drained to the left common iliac vein. This variation is important in retroperitoneal, laparoscopic and orthopedic surgery. We present the CT findings and discuss the embryological origin of this unusual congenital anomaly.

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Veine iliaque interne droite tributaire de la veine iliaque commune gauche. Un cas découvert par angio-scanner

Résumé Une variation inhabituelle des veines iliaques a été découverte par tomodensitométrie chez un malade de 35 ans. Les reconstructions coronales ont montré que la veine iliaque interne droite du patient croisait la ligne médiane vers la gauche pour se drainer dans la veine iliaque commune gauche. Cette variation est importante à connaître en chirurgie rétro-péritonéale, laparoscopique et orthopédique. Nous présentons les documents obtenus par tomodensitométrie et discutons l'origine embryologique de cette anomalie congénitale rare.

     

异位嗜铬细胞瘤的CT诊断价值

目的探讨异位嗜铬细胞瘤的CT诊断价值,指导临床手术,降低手术风险。方法回顾性分析10例异位嗜铬细胞瘤的临床资料及CT表现,并复习文献。结果10例异位嗜铬细胞瘤术前均进行CT平扫及增强检查,8例位于腹主动脉旁,1例位于膀胱,1例位于后纵隔。平扫肿瘤呈类圆形或椭圆形,伴有囊变、坏死及钙化密度常不均匀;动脉期明显强化,病灶内或周围见增粗迂曲血管影;实质期病灶强化程度稍下降或持续强化。结论 CT检查对异位嗜铬细胞瘤的定位、定性有重要价值,并对手术方案制定及术后的随访有重要意义。     

Renal vasculature of the trout demonstrated by scanning electron microscopy,compared with canine glomerular vessels

In order to gain additional information regarding renal circulatory patterns, we have used both ink and resin injections to study the arterial supply to the mesonephric kidney of trout. Arterial injections through the dorsal aorta with ink were made for histological preparations in which the length, termination and relationship of glomerular vessels were examined. Similar injections with methyl methacrylate were made in preparation of corrosion casts to provide us with gross replicas of the aortic branches to the kidney as well as casts of glomerular structure for scanning electron microscopy. The sequence of vessels through which arterial blood passed to the renal corpuscle and ultimately to the uriniferous tubules was traced. Each afferent arteriole was found to terminate in three to six brancehs which formed anastomosing circuits of capillaries; these vessels reunited at the hilum to form a single efferent arteriole. The efferent arterioles in turn traveled a short distance to peritubular capillary beds and sinusoids. Morphological evidence was found for preglomerular sphincter-like action only. The glomerular vessels were found to be similar to, although less complex than, those of the outer and mid-cortical regions of the dog kidney.     

Angiomyolipoma of the kidney: expanding disease spectrum demonstrated by 3 cases.

We report 3 recent cases of angiomyolipoma of the kidney. Although generally regarded as a benign neoplasm, angiomyolipoma rarely behaves in an aggressive manner, producing complicated clinical courses leading to metastasis and death. The presence of epithelioid elements within the tumor can result in difficulty differentiating benign from malignant angiomyolipoma and differentiating this tumor from renal adenocarcinoma. The presence of lymph node involvement can cause difficulty in differentiating multicentric disease in lymph nodes from metastasis to lymph nodes. The presence of cytologic abnormalities in the primary tumor can result in difficulty in differentiating atypia in benign angiomyolipoma from malignant sarcomatous transformation of a benign lesion. The 3 cases reported show many of these problems. Criteria for predicting malignancy in epithelioid tumors and sarcomatous transformation are not well recognized because of the rarity of this entity. The typical immunophenotype of all types of angiomyolipoma (cytokeratin-negative and melanomarkers-positive) is very useful in diagnosis but does not help in the differentiation from renal adenocarcinoma at frozen section. We report the empiric use of Ki67 and p53 in these cases as adjuncts to clinical and histologic assessment in predicting behavior. High Ki67 expression was a feature of malignant epithelioid angiomyolipoma. Low levels of p53 expression were seen in the angiomyolipoma with sarcomatous transformation. Benign angiomyolipomas were consistently negative for both Ki67 and p53.     

Microvasculature in the mouse ovarian follicle demonstrated by a lectin angiography method

A lectin angiography method was applied to identify ovarian vasculature in 32-34 days old mice treated with gonadotropins. Blood was washed out by perfusion until the inferior vena cava became translucent. Horseradish-peroxidase (HRP)-conjugated Concanavalin A (Con A) solution (10-15 ml) was perfused into the systemic circulation via the left ventricle at the rate of 2-3 ml/min. The animals were left for a 30 min reaction interval. The lumina of the blood vessels were flushed with 5-10 ml of phosphate buffered saline (pH 7.4). The ovaries were excised and fixed by immersion in 4% paraformaldehyde and sectioned serially at thickness of 100, 200 or 400 microm using a Microslicer. The binding of HRP-conjugated-Con A to endothelial cells was visualized by using 3,3'-diaminobenzidine-4 HCl (DAB-4 HCl) reaction. By examining various sections the three-dimensional architecture of the vascular networks of the preovulatory Graafian follicles and corpora lutea can be established. Capillary networks of preovulatory Graafian follicles were identified in sections of ovaries removed 11 h after hCG injection. Then, capillary networks of the Graafian follicles increased due to the hypertrophic growth of the theca interna and extension of capillary branches into the follicles. Well-developed capillary networks of corpora lutea were found in ovaries removed 24 h after hCG injection. For these observations the 200 microm-sections were the most useful. The present modified lectin angiography is a useful method for visualizing the microvasculature of mouse ovaries.     

An extremely rare bifurcation pattern of the caudal abdominal aorta: case report demonstrated by angiography

An extremely rare bifurcation pattern at the caudal abdominal aorta was encountered on the pelvic angiography and MR angiography of a male patient. Instead of dividing into two common iliac arteries, the caudal abdominal aorta first gave the right external iliac artery at the level of the last lumbar arteries, then bifurcated into a right internal iliac artery and a left common iliac artery. The median sacral artery originated at this anomalous bifurcation. This high origin of the right external iliac artery and separate branching of these right iliac vessels from the abdominal aorta are important during the interventions in the region. We present the angiography findings and discuss the embryological origin of this unusual and unreported congenital anomaly.     

Aortitis in giant cell arteritis: diagnosis with FDG PET/CT and agreement with CT angiography

Objectives

To assess the detection rate of aortitis in giant cell arteritis (GCA) with fluorodeoxyglucose positron emission tomography/computed tomography (PET) and to compare the findings with CT angiography (CTA).

Left main renal artery entrapment by diaphragmatic crura: spiral CT angiography

Entrapment of renal artery by the diaphragmatic crus is a rare cause of renal artery stenosis. Spiral computed tomography angiography provides a definitive diagnosis and shows the precise relationship of the artery to the diaphragmatic crus. The authors present a case of hypertension developing in a young 20-year-old female due to entrapment of the left renal artery by the diaphragmatic crus. This condition should be considered in young hypertensive patients with renal artery stenosis without cardiovascular risk factors.     

bBMP异位诱导成骨的Micro—CT评价

借助Micro—CT评价单纯牛骨形态发生蛋白（bovine bone morphogenetic protein,bBMP）异位诱导成骨的长期三维影像学及骨质变化。（20±2）g昆明小鼠21只,麻醉后于双侧股部肌肉中植入bBMP各2mg,分别于1、2、4、6、8、10、12周各处死3只,切取诱导分化组织,5％戊二醛固定,行Micro—CT扫描和三维重建,运用ABA专用骨骼分析软件测定组织矿含量（tissue mineral content,TMC）,组织骨密度（tissue mineral density,TUB）,骨体积分数（bone volume fraction,BVF）,结构模型指数（structure model index,SMI）,骨小梁厚度（trabecular thickness,Tb．Th）,骨小梁数量（trabecular number,Tb．N）及皮质骨骨密度（bone mineral density,BMD）等参数,运用SPSS10．0统计软件进行统计学分析。bBMP从植入2周开始逐渐形成一椭圆形骨组织块,2～4周,异位生成骨呈疏松的新生骨,4周时组织矿含量达第一个峰值,骨小梁数量最多;随着观察时间的延长（6-12周）,异位诱导生成的椭圆形骨组织内部骨小梁逐渐吸收,数量减少,12周时骨小梁数量最少;而外层骨组织逐渐塑形成为皮质骨,12周时骨矿含量值、骨小梁厚度、组织骨密度和皮质骨骨密度均达最大值。说明bBMP具有强大的异位骨诱导能力,血供不足时,骨质降解吸收;血供充足时,骨质逐渐成熟改建。     

Anomalous left main coronary artery detected by CT angiography

The growing improvements of computed tomography have made this technique more and more available for cardiac evaluation. Coronary artery anomalies (CAAs) are often incidental findings in subjects with suspected coronary artery disease (CAD) undergoing coronary angiography or computed tomography coronary angiography (CTCA). In some cases, CAAs can be clinically relevant so their identification could change radically patient management and treatment. We report the case of a 68-year-old male patient with known CAD and associated anomalous origination of the left coronary artery from the opposite sinus.     

Three-dimensional display of cortical anatomy and vasculature: Magnetic resonance angiography versus multimodality integration

We present two methods for acquiring and viewing integrated three-dimensional (3D) images of cerebral vasculature and cortical anatomy. The aim of each technique is to provide the neurosurgeon or radiologist with a 3D image containing information which cannot ordinarily be obtained from a single imaging modality. The first approach employs recent developments in MR which is now capable of imaging flowing blood as well as static tissue. Here, true 3D data are acquired and displayed using volume or surface rendering techniques. The second approach is based on the integration of x-ray projection angiograms and tomographic image data, allowing a composite image of anatomy and vasculature to be viewed in 3D. This is accomplished by superimposing an angiographic stereo-pair onto volume rendered images of either CT or MR data created with matched viewing geometries. The two approaches are outlined and compared. Results are presented for each technique and potential clinical applications discussed.     

多层螺旋CT图像后处理诊断移植肾动脉狭窄

背景：对肾移植后并发移植肾动脉狭窄患者的诊断及随访是否可采用一种无创伤、特异性高、安全的检查方法。 目的：评估多层螺旋CT图像后处理技术对移植肾动脉狭窄的诊断价值。 方法：对11例临床怀疑为移植肾动脉狭窄的患者进行移植肾动脉期的增强扫描,扫描后所得到的数据经容积重建、最大密度投影、曲面重建、多平面重建处理成像。 结果与结论：11例患者均诊断为移植肾动脉狭窄,10例多层螺旋CT图像后处理技术显示移植肾动脉狭窄程度54%~75%,1例移植肾动脉狭窄程度< 50%。吻合口狭窄10例,其中合并移植肾动脉主干狭窄2例;移植肾动脉分支狭窄1例。经数字减影血管造影检查9例,狭窄程度75%~95%,8例置入支架,1例球囊扩张;1例给予药物治疗随访,于2年后出现肾功能进一步恶化及难治性高血压,置入支架。1例无临床症状,经多层螺旋CT移植肾动脉狭窄程度< 50%,随访4年肾功能、血压正常。支架置入治疗的患者中1例行球囊扩张者2年后彩色多普勒提示移植肾吻合口狭窄,行多层螺旋CT检查移植肾动脉狭窄程度< 50%,随访4年3个月,肾功能、血压正常。提示多层螺旋CT后成像技术可作为移植肾动脉狭窄的诊断依据,对区分临床疑似病例,制定支架置入治疗方案,以及术后随访观察有一定的临床参考价值。     

CT血管造影结合三维重建技术对Corona Mortis动脉的解剖学研究

目的:探讨Corona Mortis(CMOR)动脉的发生率、起源、走行及位置,为骨盆前入路手术提供依据。方法:回顾性研究。收集2018年6月—2020年6月行CT血管造影检查的112例患者(224侧半骨盆)的影像资料,其中男68例、女44例,年龄28～92岁。将患者的CT血管造影影像资料进行三维重建,观察CMOR动脉...     

256层螺旋CT对脊髓前大根动脉解剖位置的显示研究

目的探讨256层螺旋CT对脊髓前大根动脉(the Adamkiewicz artery,AKA)解剖位置的显示情况。方法本院72例行脊髓动脉CTA造影患者,通过多平面重组(MPR)、曲面重组(CPR)、容积显示(VR)、最大密度投影(MIP)等后处理方法寻找前大根动脉,并根据在解剖上的连续性和图像质量对其显示情况进行分级。结果前大根动脉作为脊髓的主要供血动脉,走行在左侧椎间孔者占74.0%,右侧椎间孔者占26.0%,位于T9-L1水平者占79.5%。全部病例图像质量为优秀的显示率为63.9%,一般者显示率为23.6%,而且非血管畸形组AKA显示率高达98.1%。结论 256层螺旋CT可以很好的显示AKA的解剖位置,可作为无创性血管成像的首选检查方法。