螺旋CT上腔静脉造影的临床应用研究

目的探讨上腔静脉病变的螺旋CT上腔静脉造影(HCTP)的成像质量,并分析该技术在上腔静脉病变中的临床应用价值.资料与方法对22例上腔静脉异常患者应用HCTP检查,对比剂注射方案为经双侧肘前静脉以2 ml/s流率同时注射浓度为75 mgI/ml的非离子型对比剂,延迟25 s开始扫描.分析螺旋CT图像的上腔静脉强化程度、条状伪影、血流相关伪影及总体成像质量,评价HCTP的成像质量及对上腔静脉病变的显示能力和临床应用价值.结果所有22例患者成功完成了HCTP检查,所有病例的上腔静脉显示满意,仅2例出现头臂静脉的轻微的条状伪影,1例双上腔静脉畸形者出现奇静脉入口处假充盈缺损,2例MPR、MIP及SSD图像出现不同程度阶梯状伪影,但不足以影响诊断,19例二维与三维重建图像优质.22例患者中双上腔静脉畸形1例,上腔静脉阻塞21例,其中肺癌15例,淋巴瘤2例,右上肺癌术后复查1例,恶性胸腺瘤1例,静脉血栓1例,巨大升主动脉瘤压迫上腔静脉1例.HCTP准确显示了双上腔静脉畸形患者双侧上腔静脉的形态与流向,对上腔静脉阻塞的部位、程度、侧支循环及其病因显示清楚,所有病例诊断明确,临床符合率为100%,有效地指导了临床诊断和治疗.结论应用经双侧肘前静脉注射低浓度(75 mgI/ml)对比剂,并延迟25 s进行HCTP可获得优良的上腔静脉图像,可准确诊断各种上腔静脉异常,发现上腔静脉阻塞部位及其程度,显示侧支静脉,并可作出病因诊断,为临床诊断和治疗上腔静脉病变提供所需要的足够信息,有助于手术方案、介入治疗如支架放置、放疗方案的制定和疗效的评估,是目前上腔静脉最理想的无创性影像学检查方法之一.

Clinical Application of Helical CT Phlebography of the Superior Vena Cava in the Superior Vena Cava Abnormalities

Objective To analyze the image quality and to evaluate clinical application of HCTP of the SVC in SVC abnormalities.Materials and Methods HCTP were performed in 22 patients with SVC abnormalities. The best injection program with simultaneous bilateral anterior elbow veins injection of 75 mgI/ml contrast medium at 2 ml/s and a delay time of 25 s was used, the degree of opacification, stripes artifacts, flow artifacts of the SVC and total quality of images were analyzed. The images quality and its capabilities of display and diagnosis of SVC abnormalities were evaluated.Results HCTP was performed successfully in all 22 patients. The degree of opacification was good in all cases. Slight stripes artifacts showed in two cases. Flow artifacts of the SVC beside the entry of azygosv were found in one case with double SVC malformation. The quality of two and three-dimension reconstruction images was optimal in 19 cases. In all these patients, HCTP showed the double SVC malformation(1 case) and SVC obstructive (21 cases), including lung cancer 15 cases, lymphoma 2 cases, follow-up after operation with upper right lung cancer 1 case, malignant thymoma 1 case, vein thrombosis 1 case and compressed by giant aorta aneurysm 1 case. The site, extent, cause and collateral pathway of SVCO were displayed clearly. The diagnosis of HCTP was conformed in all cases (100%).Conclusion HCTP can provide all the information necessary to diagnosis and treatment of SVC abnormalities, it is a useful non-invasion technique for imaging the SVC.