多层螺旋CT血管成像对大根髓动脉及其起源的应用研究

目的探讨多层螺旋CT血管成像(MSCTA)显示大根髓动脉(AKA)及其起源的扫描方案和临床价值。资料与方法回顾性分析我院2011年1月—2012年10月间行胸部MSCTA检查的50例病人资料,采用适当的扫描方案及多平面重组、曲面重组、容积再现等多种图像后处理技术多角度显示AKA及其起源,并确定其于主动脉开口的位置。结果 50例病例中39例可见AKA显影,显示率为78%(39/50例),其中32例可见1支显影,7例可见2支同时显影,其显示率为14%(7/50例)。显影的46支AKA中有35支能够连续、清晰地显示其走行和起源,其显示率为76%(35/46支)。其起源血管于主动脉壁开口位于脊柱左侧的有21支(21/35支,60%),位于脊柱右侧的有14支(14/35支,40%),开口对应脊柱水平的范围为T7~L1水平,最常见的为左侧T11水平的肋间动脉。结论采用较高浓度对比剂、较快的注射速率、适当的CT阈值及延迟时间进行扫描,并应用多种重组方式,有利于提高AKA的显示率并对其起源精确定位,这对指导临床手术具有重要价值。

Evaluating Adamkiewicz artery and its origin with multislice computed tomography angiography

Objective To investigate the optimized scan and reconstruction methods of multislice computed tomography angiography (MSCTA) in identifying the Adamkiewicz arteries (AKA) and its origin, and to evaluate the clinical value of this technique. Materials and Methods We retrospectively studied clinical data from 50 patients, who underwent chest MSCTA in Tianjin Haihe Hospital between January, 2011 and October, 2012. Optimized scan protocol and multiple reconstruction methods like multiple planar reformation (MPR), curved planar reformation (CPR), volume rendering (VR) were used to detect the AKA. The visualization of the AKA, level and side of origin of AKA was investigated. Results The Adamkiewicz arteries were visualized in 39 of the 50 patients (78%). One AKA was found in 32 patients and two Adamkiewicz arteries were found in 7 patients (14%). 35 of 46 （76%）delineated arteries showed continuity from their origins to the AKA. The vessel origin of 21/35（60%）AKA was on the left side of spine，and 14/35（40%）was on the right side. The corresponding spine level of its origin was between T₇-L₁, mostly was from the left intercostal artery at T₁₁ level. Conclusion By using optimized scan and reconstruction methods the visualization rate of AKA could be improved, the AKA and its origin could be clearly and directly displayed by MSCTA, that could provide significant support to clinical work.