前列腺供血动脉的来源及临床意义

目的观察DSA下前列腺供血动脉的来源,为动脉栓塞治疗前列腺增生提供参考。方法对72例选择性及超选择性插管成功病例,进行前列腺供血动脉造影,观察并记录前列腺供血动脉的来源、个数、优势供血动脉。结果前列腺供血动脉复杂(72例,共237支供血动脉),常有数支动脉同时参与供血,主要的起源动脉和个数为:膀胱下动脉69支、髂内动脉63支、阴部内动脉52支、直肠下动脉29支、膀胱上动脉14支。优势供血动脉63支,主要来源为:髂内动脉3支、膀胱下动脉20支、阴部内动脉6支和直肠下动脉2支。结论动脉造影检查可对前列腺供血动脉的来源和优势供血动脉作出正确判断,对指导介入栓塞治疗具有重要的临床意义。     

血管内介入治疗下消化道出血的初步经验

临床上对下消化道出血的原因及部位的判断常常较困难,以往常规检查方法很容易漏诊.数字减影血管造影及栓塞治疗可以及时发现出血部位并行栓塞治疗.我科2000-02～2004-08对18例下消化道出血患者施行了选择性数字减影血管造影,对6例施行栓塞治疗,均取得了满意的效果.     

咯血患者肺外体循环动脉供血的CT血管造影

目的探讨咯血患者肺外体循环动脉(ESCA)供血的CT血管成像(CTA)表现及其与胸膜增厚的关系。资料与方法回顾性分析233例咯血患者的影像学资料,通过数字减影血管成像(DSA)明确咯血责任血管的来源和数量,分析ESCA的CTA表现及其与胸膜增厚的关系。结果 233例咯血患者中,84例(36.1%)存在ESCA供血,共318支,包括肋间后动脉171支,锁骨下动脉分支56支,胸廓内动脉分支47支,腋动脉分支23支,腹主动脉分支21支;CTA表现为管径增粗、走行纡曲,发出分支至病灶区域参与供血,部分与肺动脉或供血支气管动脉相互吻合形成血管网。84例有ESCA供血患者中,82例(97.62%)伴有靶胸膜增厚;149例无ESCA供血患者,90例(60.40%)伴有靶胸膜增厚;有ESCA供血患者伴靶胸膜增厚率高于无ESCA患者(χ2=36.60,P<0.01),且ESCA来源与靶胸膜增厚部位之间存在对应关系。结论 ESCA是重要的咯血责任血管,其数目、来源与病灶部位及胸膜增厚密切相关。     

血管内介入治疗肝癌中C臂CT的应用

目的探讨C臂CT技术在肝癌介入治疗中的应用。方法 77例选择性肝动脉化疗栓塞患者治疗后作C臂CT。其中13例化疗栓塞前后均作C臂CT并利用其Integris3D-RA工作站行三维重建,然后对栓塞程度进行分析评价。结果 77例患者均能清晰显示肿瘤外周边缘及肿瘤实质的栓塞情况。13例化疗栓塞前作C臂CT检查者,除显示与CT所见相同外,尚有3例显示出肝内微小瘤灶。结论 C臂CT技术是继常规CT之后,因血管内介入检查中需要观察层面图像,评价治疗效果、制订手术方案而采用的一种高新技术。C臂CT服务于DSA诊疗现场,便于制订手术方案。相比于常规CT平扫能提供更直观、更丰富、更准确的信息。可用于多系统介入治疗。     

数字减影血管造影临床应用的初步体会

本文介绍了51例数字减影血管造影的应用情况。介绍静脉法及动脉法数字减影血管造影方法,并提出静脉法数字减影血管造影创伤小、检查快速、适合于老年及幼年患者,动脉法数字减影血管造影则使图像质量明显提高,优于普通血管造影,并可同时进行介入性治疗。对于可能出现的并发症本文亦一一作了介绍。     

支气管扩张大咯血DSA特点及栓塞治疗

目的探讨支气管扩张(支扩)大咯血病变动脉DSA表现特点及栓塞治疗疗效。方法35例支扩大咯血患者,参考胸片、CT等影像资料行选择性支气管动脉及其他目标血管DSA检查,根据造影表现行病变动脉栓塞治疗,栓塞材料为PVA和(或)明胶海绵颗粒(条),术后随访疗效。结果①DSA表现:病变血管单独为支气管动脉占74.3%,合并非支气管体循环动脉22.9%,单独为非支气管动脉2.9%,异常动脉数量为1～5(平均1.8)支/例。显示出血直接征象25.7%,间接征象100%。②栓塞情况及疗效:栓塞34例共61支病变血管;应用微导管16例。1例3d内栓塞2次无效,3个月内复发4例,3个月后复发2例,栓塞治疗总有效率为85.3%,复发率为20.6%,无脊髓损伤等严重并发症。结论支扩大咯血DSA检查阳性率高,参考造影特点行选择性病变动脉栓塞治疗安全性好,疗效确切。     

膈下动脉参与供血的大咯血的急诊介入治疗

目的探讨膈下动脉（IPA）参与供血的大咯血患者的动脉造影表现及急诊栓塞治疗的疗效。方法回顾性分析15例IPA参与供血的大咯血患者的临床资料。选用明胶海绵条、聚乙烯醇（poly vinylal cohol,PVA）颗粒及弹簧圈选择性栓塞供血的IPA,对动脉造影的表现及治疗结果进行总结及评价。结果选择性IPA造影显示为IPA增粗,分支增多、紊乱及新生血管形成。IPA供血区对比剂外溢10例,肿瘤血管及肿瘤染色3例,IPA与肺动脉分流2例。本组患者均行供血的IPA栓塞术,同时栓塞支气管动脉5支、肋问动脉4支,胸廓内动脉4支,栓塞术后咯血停止。术后随访1～2年,所有患者无再次咯血。结论IPA可参与大咯血的供血,漏栓IPA是栓塞治疗大咯血失败或复发大咯血的原因之一,行急诊IPA栓塞是一种安全、有效的治疗手段。     

三维数字减影血管造影影像在颈动脉狭窄血管内治疗中的价值

目的 评价三维数字减影血管造影(3D DSA)在颈动脉狭窄血管内治疗中的价值。方法 对138例缺血性脑血管病颈动脉的3D DSA与二维(2D)DSA图像进行比较，分析颈动脉的形状、狭窄的显示、血管内治疗的必要性、血管内治疗的工作角度及支架的选择。结果 与2D DSA相比，3D DSA能更清晰显示颈动脉狭窄的形状及程度，能提供最佳血管内治疗的工作角度，使用3D DSA能正确决策支架的选择。结论 3D DSA在颈动脉狭窄血管内治疗中具有重要的价值，能提供许多2D DSA不能提供的有价值信息，对常规DSA是一种有益的补充。     

支气管动脉CTA对介入栓塞治疗咯血的指导及应用价值

目的探讨支气管动脉CT血管成像（CTA）对咯血介入治疗的指导作用及效果。 方法将34例咯血患者按介入栓塞治疗前是否行支气管动脉CTA检查分为单纯DSA组及术前CTA组,每组17例。比较两组检出可疑出血动脉情况、手术时间及术后一年复发率,分析术前CTA组的CTA血管检出率。 结果术前CTA组共检出可疑出血动脉28支,单纯DSA组检出31支,并全部予以栓塞。术前CTA组的手术时间为（28.33±7.68）min,低于单纯DSA组的（40.55±10.01）min,差异有统计学意义（t=4.03,P<0.05）。 结论支气管动脉CTA可以客观评价咯血相关血管的起源、数目及走形,可为术中寻找出血动脉提供准确的定位。并且能减少手术时间及医患人员的辐射剂量,避免漏栓,降低复发几率,对指导咯血的介入治疗有重要的临床应用价值。     

C臂类CT血管成像技术在前列腺动脉栓塞术中的应用价值

目的:探讨C臂类CT血管成像技术在前列腺动脉介入栓塞术中的应用价值.方法:2017年9月-2020年1月32例患者(前列腺增生23例,前列腺癌9例)在本院行前列腺动脉栓塞治疗,所有患者在术中行髂内动脉DSA检查,31例行双侧、1例行单侧前列腺动脉超选择性DSA及C臂类CT血管成像检查.由一位影像诊断医师及一位介入手术医...     

Bronchial arteriography and embolotherapy for hemoptysis in patients with cystic fibrosis

Bronchial arteriography and embolotherapy were performed to control hemoptysis in 11 patients with advanced stages of cystic fibrosis. Two patients suffered massive, 1 moderate, and 8 mild but recurrent hemoptysis. The embolization procedures were performed with Gelfoam, Ivalon, and coils in one to four separate procedures. Altogether, 19 of 20 procedures were successful, with follow-up periods ranging from 9 months to 8 years. No serious complications were encountered except for one femoral artery pseudoaneurysm which required surgical repair. Rapid digital subtraction angiography and “roadmapping” were considered helpful in avoiding the complication of reflux embolization and expediting the procedures. Bronchial embolization is a life-saving procedure for severe hemoptysis in patients with cystic fibrosis and is considered safe enough to include the indications of moderate and mild/recurrent hemoptysis to improve the quality of life in these patients.     

Multidetector CT chest with bronchial and pulmonary angiography determining causes,site and vascular origin of bleeding in patients with hemoptysis

Objective

To assess the role of MDCT chest with bronchial and pulmonary angiography in determining the cause, site of bleeding, and its vascular origin in patients presenting with hemoptysis.

Materials and methods

Fifty patients suffering from hemoptysis were evaluated by MDCT with bronchial and pulmonary angiographic techniques.

Results

MDCT chest with angiography revealed the cause in 84% of cases, the site and vascular origin in 76% of cases presenting with hemoptysis.

Conclusion

MDCT of the chest with bronchial and pulmonary angiography is considered a primary noninvasive imaging modality in the evaluation of patients with hemoptysis. It also serves as a guide for other diagnostic or therapeutic procedures.     

股骨头缺血性坏死介入治疗前后的DSA对照研究

目的:通过对股骨头供血动脉行超选择性DSA,探讨股骨头缺血性坏死(ANFH)的血流动力学改变、介入治疗前后的变化及其意义.方法:对153例(194髋)ANFH行股骨头供血动脉超选择性血管造影.骨循环研究协会(ARCO)分期Ⅰ期22髋,Ⅱ期98髋,Ⅲ期74髋.根据血管造影表现,在其供血动脉内注罂粟碱30 mg、尿激酶50...     

介入治疗大咯血的价值

目的：探讨介入治疗在大咯血治疗中的价值。方法自2010年1月～2012年12月,我科共对34例大咯血患者进行了支气管动脉栓塞术,其中男23例,女11例,年龄27～81岁,平均56岁,出血原因包括支气管扩张、肺结核、肺癌、不明原因等。术后观察患者咯血情况是否消失。结果所有34例患者中,31例咯血停止,3例再次出现咯血,有效率91．2％（31/34）,术后部分患者出现低热、肋间疼痛等症状,无严重并发症发生。结论介入治疗对内科保守治疗无效的咯血患者是一种安全、有效的方法。     

DSA技术在顽固性鼻出血介入治疗中的应用

目的探讨顽固性鼻出血的数字减影(DSA)成像技术,评价其在顽固性鼻出血介入治疗中的价值。资料与方法搜集顽固性鼻出血患者20例,经颈外动脉DSA充分显示动脉走行并行栓塞治疗,术后复查DSA评价栓塞效果。对介入治疗前后图像作回顾性分析。结果20例患者造影均清晰显示鼻区出血血管及供血动脉,其中单侧供血18例,双侧供血2例;单纯由颌内动脉供血16例,由颌内动脉和面动脉同时供血4例。20例患者在供血血管栓塞后均成功止血,无严重并发症发生。结论合理的注射参数、合适体位、恰当的后处理技术和延长采像时间等方法可提高出血动脉的显示率。     

Computed tomography versus digital subtraction angiography for the diagnosis of obscure gastrointestinal bleeding

PurposeThe diagnostic yield of computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) for major obscure gastrointestinal bleeding (OGIB) is not known. Aim of the study was to prospectively evaluate the diagnostic yield of CTA versus DSA for the diagnosis of major OGIB.Material and methodsThe institutional review board approved the study and informed consent was obtained from each patient. Patients with major OGIB were prospectively enrolled to undergo both CTA and DSA. Two blinded radiologists each reviewed the CTA and DSA images retrospectively and independently. Contrast material extravasation into the gastrointestinal lumen was considered diagnostic for active bleeding. Primary end point of the study was the diagnostic yield, defined as the frequency a technique identified an active bleeding or a potential bleeding lesion. The diagnostic yield of CTA and DSA were compared by McNemar's test.Results24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%–99%) and 29% (7 of 24 patients; 95% CI 12%–49%) of patients, respectively (p < 0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%–63%) and 21% (5 of 24; 95% CI 7%–42%) of patients, respectively (p = 0.06).ConclusionDue to the lower invasiveness and higher diagnostic yield CTA should be favored over DSA for the diagnosis of major OGIB.     

Is digital substraction angiography still needed for the follow-up of intracranial aneurysms treated by embolisation with detachable coils?

Introduction  Follow-up of intracranial aneurysms treated by embolisation with detachable coils is mandatory to detect a possible recanalisation. The aim of this study was to compare contrast-enhanced magnetic resonance angiography (CE-MRA) with digital substraction angiography (DSA) used to detect aneurysm recanalisation to determine if DSA is still needed during follow-up. Materials and methods  From May 2006 to May 2007, 55 patients with 67 aneurysms were treated by endosaccular coiling with (n = 9) or without (n = 58) an adjunctive stent. Follow-up imaging protocol included MRA at 6 and 12 months and a DSA at 12 months or earlier if a major recanalisation was identified on the 6-month MRA. Two neuroradiologists independently reviewed MRA images (readers 1 and 2) and two other reviewed DSA images. Results  Follow-up DSA showed stability of the aneurysm occlusion in 52 cases, recanalisation in 14 cases, and further thrombosis in one. On CE-MRA, both readers identified all recanalisations but one (sensitivity of 93%) as they missed a major recanalisation in a 2-mm ruptured aneurysm. There were two false-positive evaluations by reader 1 and three for reader 2. Mean specificity of CE-MRA to detect aneurysm recanalisation was 95.5%. Conclusion  CE-MRA is accurate to detect aneurysm recanalisation after embolisation with detachable coils. CE-MRA may be proposed as first-intention imaging technique for their follow-up. However, its sensitivity and specificity remain inferior to that of DSA and major recurrences may be missed in very small aneurysms. Therefore, a single DSA remains mandatory during the imaging follow-up.