大动脉炎综合征的影像表现特点

目的 讨论多发性大动脉影像表现特点。方法46例大动脉炎综合征病例，经普通血管造影7例，DSA造影23例，MR检查8例，DSA和MR检查4例，DSA和CT检查4例。结果大动脉炎综合征病变以狭窄-阻塞型最常见(73.9％)，按Lupi-Herrea分型以Ⅲ型多见(43．5％)，最常受累的血管为左锁骨下动脉(69．6％)及左颈总动脉(60．9%)。结论大动脉炎综合征多部位血管受累多见，以狭窄-阻塞型常见，MR及CT可观察血大动脉炎病变血管壁病理改变。     

Riolan动脉弓的MSCT血管成像表现

目的探讨MSCT血管成像（MSCTA）Riolan动脉弓的影像表现。方法收集6例Riolan动脉弓病变患者,3例男性患者为高血压动脉粥样硬化性疾病,3例女性患者均为多发性大动脉炎。采用16层（4例）、64层（2层）螺旋CT扫描行腹部CTA检查,对病变血管行VR、MIP和MPR重建。结果 6例Riolan动脉弓血管直径为3.5～10.0mm,平均（6.7±0.4）mm。3例腹主动脉粥样硬化性病变中,肠系膜上动脉（SMA）近端闭塞2例,远端与肠系膜下动脉（IMA）形成Riolan动脉弓,其中1例伴有腹主动脉瘤,同时SMA、IMA与腹腔动脉干形成动脉吻合弓;IMA近端闭塞1例,远端与SMA形成Riolan动脉弓。3例多发大动脉炎中,2例SMA狭窄,SMA与IMA间形成Riolan动脉弓,1例SMA、IMA同时与腹腔动脉干形成动脉吻合弓;1例IMA近端狭窄,IMA与SMA间形成Riolan动脉弓。结论 MSCTA可以显示SMA与IMA间Riolan动脉弓结构,其特征性影像表现是SMA与IMA间的纡曲扩张的血管弓。出现Riolan动脉弓提示SMA或IMA管腔闭塞或狭窄。     

多层螺旋CT血管造影对下肢动脉闭塞性疾病的诊断价值

目的：探讨多层螺旋ＣＴ血管成像对下肢动脉闭塞性疾病的诊断价值。方法：对２１例下肢动脉疾病病人采用多层螺旋ＣＴ血管造影技术（ＭＳＣＴＡ）显示下肢动脉粥样硬化狭窄、血栓闭塞性脉管炎和多发性大动脉炎等下肢动脉疾病的形态学改变,并结合部分病例的血管造影或手术结果评价多层螺旋ＣＴ血管造影的准确性。结果：与ＤＳＡ相比,ＭＳＣＴＡ显示下肢动脉主干狭窄和闭塞的符合率达１００％,对２级以上股动脉分支血管病变显示的阳性预测值为１００％,阴性预测值５０％,灵敏度９０％。结论：ＭＳＣＴＡ方法具安全、方便、准确、无创等特点,是下肢动脉疾病较理想的影像学检查手段。     

多层螺旋CT血管成像诊断脑动脉瘤:与DSA对比研究

目的 探讨16层螺旋CT容积再现脑血管成像技术对脑动脉瘤的诊断价值。方法 对23例临床怀疑脑动脉瘤患者（其中蛛网膜下腔出血者20例）的16层螺旋CT三维血管后处理图像、DsA图像进行回顾性对比研究。CT后重建技术分别采用小视野容积再现技术（shutter volume rendering）、最大密度投影法（M1P）和多曲面重建（MPR），所有CT图像及DSA脑血管造影图像均由两位放射科医生和两位脑外科医生进行双盲法分析评价。结果 16层螺旋CT脑血管成像共检出动脉瘤25个，其中3例为多发性，1例CT血管成像（CTA）结果为阴性，阳性率95．7％（22／23），与DSA比较符合率95．7％（22／23）；16层CTA发现动脉瘤的敏感性为100％（24／24），特异性为100％（1／1），准确性为96．2％（25／26）。CTA对显示瘤体、瘤颈、载瘤动脉与周围血管关系与DSA相比更清晰、确切，并能显示病灶与颅骨结构间的关系，立体感强。结论 16层螺旋CT脑血管成像对脑动脉瘤具有极高的诊断价值，相对无创是诊断脑动脉瘤的最佳影像检查方法，有望替代DSA。     

多层CT血管成像诊断肠系膜上动脉病变

目的回顾性分析45例肠系膜上动脉（SMA）病变的多层CT血管影像,探讨肠系膜上动脉多层CT血管成像的临床应用和价值。方法怀疑SMA病变的45例患者,男30例,女15例,平均年龄50岁。使用GE16层CT机,探测器1.25mm×8,重建间隔1.0mm,重建层厚1.3mm。增强用对比剂优维显（300mgI/L）80～90ml,流速3.5ml/s。对SMA进行MPR、MIP、VR图像重组,最佳角度显示SMA的病变。结果SMA病变的类型：SMA动脉粥样硬化斑块形成、管腔狭窄16例;SMA近段管腔血栓性栓塞5例,3例有Riolan动脉弓形成,IMA近段管腔血栓性栓塞1例;＂胡桃夹＂征7例;SMA和腹腔动脉干共干2例;主动脉夹层动脉瘤累及SMA近中段管腔4例;多发性大动脉炎5例;SMA近段内支架术后1例;SMA管壁及管腔未见明显异常4例。多层CT图像后处理图像情况：MPR、MIP均清楚显示SMA管腔壁的增厚、斑块情况、管腔狭窄程度;MIP对SMA的显示范围较MPR大,随着MIP显示厚度及角度的变化,可以对SMA的部分管腔或整体管腔情况进行最佳角度显示;VR对SMA与周围血管结构的关系显示较MPR及MIP佳。结论16层CT肠系膜上动脉血管成像检查,可以明确观察SMA各类病变情况和周围血管结构的情况,有广泛的临床应用价值。     

128层螺旋CT血管成像对头颈部血管病变的临床诊断价值探析

目的：探讨128层螺旋 CT 血管成像（MSCTA）对头颈部血管病变的临床诊断价值。方法选取我院接收的30例临床怀疑或确诊为头颈部血管病变患者作为本次的研究对象,30例患者均行128层螺旋 CT 血管造影检查,并采用多平面重建（MPR）、曲面重建（CPR）、容积重建（VR）、最大密度投影（MIP）显示血管,对128层螺旋 CT 血管成像在头颈部血管性病变中的应用价值进行评价。结果本组30例患者中8例患者行头颅 CTA 检查,其中6例患者为先天性血管发育异常,22例患者行头颈部 CTA 检查,其中14例患者发育异常,17例患者显示颈动脉系统粥样硬化。结论128层螺旋 CT 血管成像具有无创、准确性高、快速、安全性高等多种优点,在头颈部血管性病变的诊断中有较高的应用价值,可推广应用。     

多层螺旋CT重建技术诊断支气管病变

目的评价多层螺旋CT重建成像技术对支气管病变的临床应用价值。方法对56例患者进行螺旋CT扫描,扫描条件为120kV/110mA,层厚/间隔分别为7.5mm/7.5mm,扫描方式为连续容积扫描（CVS）螺距0.85∶1,每周0.8s。重组层厚2.5mm,间隔2.5mm,后处理方式为容积遮盖重建（SVR）、多平面重组（MPR）、仿真内镜（VE）、最小密度投影（Min-IP）和最大密度投影（MIP）。结果在56例患者的75处支气管病变中,MPR能观察支气管的形态、确定病变位置、范围、邻近组织侵犯程度;SVR显示支气管树的整体形态以及管腔外部特征;VE显示腔内肿块、局限性隆起、管腔狭窄;Min-IP显示一般。结论螺旋CT三维重组能立体直观地显示支气管的形态（畸形）、病变的部位、范围和程度,可加深对病变的全面和整体理解。     

MSCTA在自发性蛛网膜下腔出血超急性期诊疗中的应用

目的探讨多排螺旋CT三维血管成像（MSCTA）在自发性蛛网膜下腔出血（SAH）超急性期诊疗中的作用、评价MSCTA在SAH患者病因诊断学中的价值。方法回顾分析经CT平扫及腰穿明确诊断的自发性蛛网膜下腔出血48例患者，在超急性期（24h内）行多排螺旋CT血管造影检查，并与DSA全脑动脉造影检查比较。结果48例患者中MSCTA发现动脉瘤34例，显示瘤体、瘤颈、载瘤动脉和与周围血管及颅骨的关系清晰、确切；动静脉畸型（AVM）7例，显示畸形血管团的部位、大小、供血动脉来源，引流静脉的分支情况，空间立体结构清晰。颈内动脉海绵窦瘘（ICCF）1例，显示扩张的海绵窦大小、形态、范围及纡曲的引流静脉，可显示ICCF的瘘口；静脉性血管畸形（CVM）3例；不明原因3例。对脑血管病的检出敏感性为95％，特异性为100％。结论MSCTA是简单、快速、无创、安全、可靠的脑血管成像技术，在一定程度上可替代DSA检查，可作为sAH超急性期患者病因诊断的首选检查方法。     

CTA技术判断胃癌周围血管受累情况对胃癌根治术的临床应用价值

目的观察64层螺旋CT血管成像技术(CTA)对术前胃癌血管受累情况的诊断敏感性及特异性。方法选取2013-01—2015-12间术前行CT检查筛查出胃癌手术适应证的26例患者。将每例患者的19支血管(包括10条静脉和9条动脉)作为研究对象(共494支)。通过CTA对上述血管进行探查,判断胃周血管的受累情况和受侵表现。同时与术中探查结果进行对比。结果 CTA判断胃静脉侵犯情况的灵敏度为92.00%,特异度为99.53%。CTA判断胃动脉侵犯情况的灵敏度为96.15%,特异度为98.74%。CTA检测与手术探查在判断血管管腔狭窄或扩大表现时差异有统计学意义(χ~2=4.44,P=0.035)。结论 64层螺旋CT血管成像技术是术前判断胃癌血管受累情况的有效方法。     

螺旋CT对动脉性勃起功能障碍诊断的应用分析

目的探讨初步运用螺旋CT对动脉性勃起功能障碍（ED）诊断的价值。方法对9例临床拟诊为动脉性ED的患者行螺旋CT增强扫描，运用螺旋CT原始图像，结合CT三维软件后处理进行观察诊断。结果观察组9例中，2例阴茎背动脉中断，6例有不同程度阴茎深动脉狭窄和充盈欠佳，1例表现为单侧阴部内动脉充盈缺损。结论运用螺旋CT对动脉性ED可以进行初步筛查性诊断。     

Patterns of aortic involvement in Takayasu arteritis and its clinical implications: evaluation with spiral computed tomography angiography

OBJECTIVE: Although the luminal changes of Takayasu arteritis are well depicted with conventional angiography, its mural changes can be best evaluated with spiral computed tomography (CT) angiography. Here, the authors investigated the patterns of aortic involvement in Takayasu arteritis by using CT angiography. METHODS: CT angiography was performed from the carotid bifurcation to the iliac bifurcation in a consecutive 85 patients (M:F = 10:75, mean age: 37 years) with Takayasu arteritis. Two radiologists interpreted axial images and three-dimensional reconstructed images by consensus with respect to disease extent, lesion continuity, and disease activity based on mural and luminal changes on CT angiography. RESULTS: Eighty-one (95%) patients had aortic involvement with or without aortic branch involvement, and the other four (5%) patients had only aortic branch involvement. In terms of aortic branches, the left common carotid artery (77%) and the left subclavian artery (76%) were most commonly involved. Extent of disease involvement assessed by mural change was wider than that assessed by luminal change in 52 (61%) patients. Although arterial involvement was contiguous in 69 (81%) patients, skipped lesions were identified in 16 (19%) patients. An analysis of mural findings revealed the coexistence of active and inactive lesions in nine (11%) patients. CONCLUSIONS: Aortic involvement in Takayasu arteritis can occur from the aortic root to below the iliac bifurcation, and isolated branch vessel involvement is also possible. In most patients, aortic involvement occurs in a contiguous, synchronous fashion. However, skipped involvement and the coexistence of active and inactive lesions also occur.     

Stenting for the occlusive carotid and subclavian arteries in Takayasu arteritis]

The authors report the initial results of stenting in four patients of Takayasu arteritis for 11 occlusive carotid and subclavian arteries between January 1999 and December 2000. The lesions included stenoses of two right subclavian, three right common carotid, two left common carotid, and two left subclavian arteries, and total occlusion of two subclavian arteries. A total of 14 stents were implanted in 10 arterial lesions, resulting in a 91% procedural success rate. One failure was due to inability to cross the total occlusion of the subclavian artery. Procedural complications and problems were pain during balloon angioplasty in three patients, vaso-vagal reflex in two, carotid artery perforation associated with transient horseness in one, and stent migration in one. There was no permanent morbidity. Follow-up over a mean duration of 12 months revealed one symptomatic recurrence of left subclavian stenosis, followed by a successful re-dilatation. The results of the current study indicated that primary stenting is an excellent therapeutic option for the occlusive carotid and subclavian arteries in Takayasu arteritis. A long-term follow-up is required to determine the response or behavior of stented segments of the affected arteries.     

Increased incidence of spondyloarthropathies in patients with Takayasu arteritis: a systematic clinical survey

ObjectivesTakayasu arteritis and Spondyloarthritis are two distinct inflammatory diseases that affect the same age periods. Increasing number of reports on co-incident Takayasu arteritis-spondyloarthritis cases in literature raised the hypotheses about their association. The purpose of this study is to evaluate the incidence of spondyloarthropathy spectrum diseases in Takayasu arteritis patients.MethodsDetailed clinical and demographic features of Takayasu arteritis patients were recorded and all were screened meticulously for the presence of spondyloarthropathy features following recommendations of Assessment of SpondyloArthritis international Society. Patients were questioned for inflammatory back pain, enthesitis, uveitis, inflammatory bowel disease, peripheral arthritis, and investigated accordingly with HLA-B27, plain X-rays and sacroiliac magnetic resonance imaging.ResultsA total of 69 Takayasu arteritis patients (65 female, 94.2%) were enrolled. After detailed investigation, 14 (20.3%) Takayasu arteritis patients fulfilled the Assessment of SpondyloArthritis international Society criteria for Spondyloarthropathy. Two of 14 (14.2%) spondyloarthropathy patients were positive for HLA-B27. Type 1 and type 2 Takayasu arteritis were more common in patients with diagnosis of both Takayasu arteritis and spondyloarthropathy than those without spondyloarthropathy. Most of patients with diagnosis of both these diseases required biologic therapies than patients with diagnosis of Takayasu arteritis alone (64.3% vs 29.1%, P = 0.014) due to refractory Takayasu arteritis.ConclusionOur results suggest a significant association between Takayasu arteritis and spondyloarthropathy. Possible shared genetic or immunopathogenic processes may explain this association, which merits further investigations.     

Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis: Part 1

This is a review article describing some new and interesting aspects in the diagnosis and treatment in systemic vaseulitis and demonstrating several cases that we have encountered. Particular emphasis will be put on Takayasu arteritis(also known as aortitis syndrome) most commonly observed in Japan and other oriental countries. CT and MRI better demonstrate the vessel wall abnormality of Takayasu arteritis than angiography. Importance of plain chest radiograph should also be kept in mind;it could provide a clue in the diagnosis of Takayasu arteritis in its early stage.     

27例多发性大动脉炎血管介入治疗

目的探讨血管介入治疗多发性大动脉炎(Takayasu arteritis,TA)所致血管狭窄或闭塞性病变的临床疗效。方法 2003年6月～2011年6月对27例TA经股动脉穿刺选择性血管造影,确定病变部位,明确诊断,并对因大动脉炎引起的锁骨下动脉、颈动脉、肾动脉、腹主动脉病变进行了选择性球囊扩张或支架植入手术。结果 27例施行血管腔内扩张成形术或支架植入术,其中颈总动脉扩张10例,支架2例;锁骨下动脉扩张6例;腹主动脉扩张4例;肾动脉扩张10例,支架4例;无名动脉扩张1例,支架1例;共置入支架7枚。2例颈动脉扩张时因并发症而终止治疗,其余病例病变血管均获得满意的治疗。27例随访5个月～7年,平均4年,其中<12个月6例,1～3年12例,3～5年6例,>5年3例:11例头晕、视觉异常等脑缺血症状改善;12例肾动脉狭窄所致高血压经球囊扩张及支架植入后血压控制正常;2例肾动脉狭窄在球囊扩张后14、18个月再次发生血压增高,造影显示扩张后肾动脉再次狭窄,再次行肾动脉球囊扩张成形术,扩张后高血压恢复正常。结论介入性血管内成形术治疗TA所致血管狭窄或闭塞性病变疗效满意。     

Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis

BACKGROUND: Takayasu arteritis is associated with a low incidence of coronary artery involvement, such as stenosis, obstruction, aneurysm, and coronary steal syndrome, but coronary ischemia can be fatal. METHODS: Between 1972 and April 2001, 81 of 130 patients given a diagnosis of Takayasu arteritis underwent selective coronary angiography, and among them, 31 patients (4 male and 27 female patients; mean age, 41.1 +/- 13.2 years) had abnormal coronary angiographic findings and were recruited for this study. RESULTS: Abnormal coronary findings consisted of 24 coronary artery stenoses of greater than 75%, 3 coronary artery-bronchial artery anastomoses, 3 aneurysmal coronary ectasias, and 1 combined coronary ectasia and anastomosis. Among 24 patients with coronary stenosis, the ostium was most frequently involved (87.5%). Twenty-three of 24 patients with coronary artery stenoses were treated surgically. The mean follow-up duration was 9.65 +/- 6.9 years, with a 100% follow-up rate. Four fistulas and 4 aneurysms in 7 patients were not treated surgically. Coronary steal phenomenon was always associated with occluded pulmonary arteries and pulmonary hypertension. Aneurysmal coronary ectasia was related to severe aortic hypertension with or without aortic regurgitation and atypical coarctation. There were 2 (8.7%) in-hospital deaths and 3 (13%) late deaths. The actuarial survival rate, including in-hospital deaths, was 86.5% +/- 7.3% at 5 years and 81.4% +/- 8.4% at 10 years. CONCLUSION: The incidence of coronary abnormalities is relatively low in patients with Takayasu arteritis; however, surgical treatment is recommended for patients with coronary ostial stenoses because coronary ischemia can be one of the major causes of death.     

Coronary artery bypass grafting for Takayasu arteritis with severe coronary, carotid, subclavian, and renal artery involvement and subsequent pregnancy

Takayasu arteritis is a rare idiopathic large-vessel vasculitis that involves the aorta and its major branches. It affects young women in their child-bearing period. We present a case of a 32-year-old lady with a history of remittent fever. Magnetic resonance angiography and arch aortogram showed aortic involvement with critical stenosis of both carotid and subclavian arteries. She also had critical ostial left main and right coronary artery stenosis as well as severe renal arteries involvement. The patient underwent coronary artery bypass grafting. She did well and after 12 months she got pregnant. She had an uneventful pregnancy and delivery without flaring of symptoms.     

The Asia Pacific meeting on vasculitis and ANCA 2012 workshop on Takayasu arteritis: advances in diagnosis and medical treatment

Takayasu arteritis is a rare disease affecting especially young females. Nonspecific symptoms make the diagnosis difficult; cases in which a diagnosis has not been made for a long period are not rare. However, recent progress in imaging modalities including magnetic resonance angiography, computed tomography angiography, and positron emission tomography have allowed making specific diagnoses in the early stage. Although specific serological markers of this disease are not known, many biomarkers specific to arterial inflammation are being developed and applied for diagnosing this disease. Also, advances in immunosuppressive treatment including new biological agents could alter the clinical outcome of the disease. According to these changes in diagnosis and treatment, the prognosis of Takayasu arteritis has been improving.     

Report of a case with surprising etiology of renovascular hypertension

Takayasu arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large vessels, such as the aorta and its main branches. Epidemiologically, it is found mostly in female patients and is more prevalent in Asian and Latin American countries. Disease may be heterogeneous in presentation. In this report, we present a different clinical expression of Takayasu arteritis in a young man who had hypertension as the sole manifestation of multiple critical arterial involvement with elevated inflammation markers but no other symptoms. A 28-year-old man was admitted with hypertension. There was no evidence for systemic vasculitis by history, serologic studies or other laboratory data. The acute-phase reactants were elevated with an erythrocyte sedimentation rate of 55 mm/h, and a C-reactive protein value of 22 mg/dl. Digital subtraction angiography showed multiple severe stenoses or occlusions of the branches of the abdominal aorta and arcus aortae together with bilateral renal artery involvement. The etiology of renovascular hypertension was found to be Takayasu arteritis with the presence of at least three criteria, as outlined by the American College of Rheumatology in 1990. Patients with Takayasu arteritis may have atypical clinical expression of the disease, and a diagnosis of Takayasu arteritis should be kept in mind in the differential diagnosis of renovascular hypertension in young subjects, even if they do not have associated symptoms of multiple arterial involvement.     

Subklaviastenose – endovaskuläre oder chirurgische Therapie?

The most common cause of subclavian artery stenosis is atherosclerosis, but in rare cases it may be induced by Takayasu’s disease, fibromuscular dysplasia or non-specific arteritis. In the JOINT study of 6,534 patients, 1,114 (17%) showed evidence of subclavian artery (SA) stenosis of 30% or more. In the majority of cases the stenosis is proximal to the origin of the vertebral artery. Further, more distally lying stenoses can be secondary to persistent compression due to thoracic outlet syndrome (TOS). In the JOINT study, 168 (15%) out of 1,114 patients showed evidence of subclavian steal, indicating retrograde blood flow in the ipsilateral vertebral artery (VA). The retrograde flow could be proven angiographically or by means of ultrasound examination. Vascular reconstruction of stenosed subclavian or innominate arteries can be performed by means of intrathoracic or extrathoracic surgery or by endovascular techniques. All three options have been described as giving excellent results, but unfortunately comparative studies are lacking, not allowing scientifically based recommendations. This article gives an overview of etiology, symptoms, diagnostics and therapeutic options for subclavian artery stenosis.