Pitfalls in diagnosis of aortic dissection by angiography: Algorithmic approach utilizing CT and MRI

Dissection of the thoracic aorta is a life-threatening event requiring imaging studies to define the level of the tear and the intinmal flap. The “gold standard” has been angiography. This method may fail to demonstrate the dissection, however, due to overlap of the true and false lumens or a very thin flap that is imaged en face rather than tangentially. Computed tomography has a diagnostic accuracy of 95%, but can fail to image the dissection due to technical factors or a thrombosed false hunen. Magnetic resonance imaging requires a hemodynamically stable and cooperative patient. A diagnostic algorithm is proposed for diagnosis of aortic dissection based on renal function and the surgeon's imaging modality preference.     

The anterior choroidal artery syndrome

We reviewed 12 cases of infarcts in the territory of the anterior choroidal artery (AChA) on CT and/or MRI. In each case vascular occlusion in the region was verified angiographically. Although the extent of the lesion on CT/MR images was variable, all were located on the axial images within an arcuate zone between the striatium anterolaterally and the thalamus posteromedially. The distribution of the lesions on mutiplanar MRI conformed well to the territory of the AChA demonstrated microangiographically. The variability of the extent of the infarcts may be explained by variations in the degree of occlusive changes in the AChA or the development of collateral circulation through anastomoses between the AChA and the posterior communicating and posterior cerebral arteries. The extent of the lesion appeared to be closely related to the degree of neurological deficit.     

Steno-Occlusive Changes in the External Carotid System in Moyamoya Disease

To evaluate the steno-occlusive changes in the external carotid system in moyamoya disease, cerebral angiograms of 39 moyamoya patients were retrospectively reviewed. There were 26 females and 13 males, age ranged from 4 to 62 years with a mean of 26 years. Initial symptoms were ischaemia in 27 patients, haemorrhage in 9, and none in 3. Stenosis, occlusion, and dilatation in the external carotid system were analysed angiographically. No stenosis or occlusion of the superficial temporal artery, middle meningeal artery, or occipital artery was observed in either preoperative or postoperative follow-up angiograms in any patients. Steno-occlusive changes do not occur in the external carotid system, but are confined in the internal carotid system in moyamoya disease.     

Material differentiation by dual energy CT: initial experience

The aim of this study was to assess the feasibility of a differentiation of iodine from other materials and of different body tissues using dual energy CT. Ten patients were scanned on a SOMATOM Definition Dual Source CT (DSCT; Siemens, Forchheim, Germany) system in dual energy mode at tube voltages of 140 and 80 kVp and a ratio of 1:3 between tube currents. Weighted CT Dose Index ranged between 7 and 8 mGy, remaining markedly below reference dose values for the respective body regions. Image post-processing with three-material decomposition was applied to differentiate iodine or collagen from other tissue. The results showed that a differentiation and depiction of contrast material distribution is possible in the brain, the lung, the liver and the kidneys with or without the underlying tissue of the organ. In angiographies, bone structures can be removed from the dataset to ease the evaluation of the vessels. The differentiation of collagen makes it possible to depict tendons and ligaments. Dual energy CT offers a more specific tissue characterization in CT and can improve the assessment of vascular disease. Further studies are required to draw conclusions on the diagnostic value of the individual applications.     

肠道血管畸形的诊断和治疗

目的：探讨肠道血管畸形的诊断和治疗方法。方法：对29例肠道血管畸形的临床资料进行回顾性分析。结果：本组以反复性，间歇性血便为主要临床表现，17例患经19例次选择性肠系膜血管造影，7次经纤维结肠镜、2例经单光子发射电子计算机断层扫描（ECT），3例行剖腹探查得以确诊。5例非手术治疗，24例行手术治疗。手术患无死亡，亦未发生术后并发症，随访20例（69．0％），再出血4例，其中非手术组3例，手术组1例，结论：（1）选择性肠系膜血管造影是诊断本病的最佳方法；（2）外科手术是治疗肠道血管畸形出血的最有效方法；（3）术前和术中的准确定位是手术成功的关键。     

螺旋CT冠脉成像在冠心病中的诊断意义

目的：分析螺旋CT冠脉造影对冠心病确诊和动脉狭窄程度的判断准确性。方法整群选择于2013年4月—2015年3月该院首次就诊的疑似冠心病患者53例。所有患者均进行螺旋CT冠脉成像,并在10 d后行经皮选择性冠状动脉造影术。以经皮选择性冠脉造影术为参照,50%狭窄为阳性,评估螺旋CT冠脉造影的准确性。结果螺旋CT冠脉成像对冠心病诊断的灵敏度为94.31%,特异度为100%,准确度98.38%,k值为0.9611,具有高度一致性。结论螺旋CT冠脉成像诊断准确度接近经皮选择性冠状动脉造影术,是一种无创的、可靠的冠心病筛查手段。     

三维螺旋CT血管造影检查在连头婴显微分离手术中的应用

目的 探讨三维螺旋CT血管造影在连头婴显微分离术术前影像检查中的作用。方法 采用表面遮盖显示法进行三维重建图像处理。结果 螺旋CT血管造影结果显示连头婴双头颅骨相互连续，连续部部分骨质，硬脑膜缺如；双侧脑组织相连，部分相融，双婴上矢状窦后1/3融合并汇入同一窦汇，两婴一侧横窦相融。结论 螺旋CT血管造影可以较清晰显示连头显颅脑，脑组织及颅内血管的变异尤其是颅内血管与颅骨的立体关系，有助于在手术中准确设计骨的立体关系，有助于在手术中准确设计骨瓣及手术入路，制定合理的手术计划。     

Two cases of spontaneous middle cerebral arterial dissection causing ischemic stroke

Spontaneous middle cerebral arterial dissection (MCAD) is a rare cause of ischemic stroke. We report two cases of isolated spontaneous MCAD causing ischemic stroke. MCAD should be considered when a young patient has a middle cerebral artery territory infarct with stenosis at the origin of the middle cerebral artery. We discuss noninvasive radiological techniques for the diagnosis of MCAD.     

消化道肿瘤肝转移61例超声造影分析

目的用定量的方法探讨消化道肿瘤肝转移的超声造影特点。方法对61例消化道肿瘤肝转移病人进行超声造影检查,并对超声检查过程进行定量分析,同时与原发性肝癌病人的相应参数进行比较。结果4组消化道肿瘤病人共5个定量参数指标差异无统计学意义（P〉0．05）。原发性肝癌组的峰值增强强度高于肝转移组（P〈0.01）,原发性肝癌组的50％清除斜率低于肝转移组（P〈0．01）。结论消化道来源的肝脏转移病灶在超声造影上有相近的表现,可以利用超声造影检查对消化道肿瘤的肝脏转移病灶进行定量诊断,并与原发性肝癌进行鉴别诊断,有一定的临床应用价值。