64层MSCT血管成像对下肢动脉粥样硬化的评价

目的:探讨多层螺旋CT血管成像对下肢动脉粥样硬化的诊断价值.方法:选择临床可疑下肢动脉粥样硬化性疾病患者21例作为研究对象,采用GE LightSpeed 64层螺旋CT对全下肢动脉进行CTA扫描,将获得的原始数据传入AW4.2P后处理工作站,血管重建技术包括VR、MIP、MPR及CPR,血管狭窄程度的评估采用智能血管分析与目测法相结合.结果:21例患者共显示血管336段,均获得了清晰的血管重建图像,全部满足诊断要求.除5例患者下肢动脉CTA表现正常外,其余16例均发现不同程度的粥样硬化斑块.336段血管中,7段有脂质纤维性斑块,27段有钙化斑块,222段显示广泛的混合性斑块;其中完全闭塞占4.46%;重度狭窄7.14%;中度狭窄31.8%;轻度狭窄32.7%;无明显狭窄者23.8%.结论:64层MSCT血管成像对下肢动脉粥样硬化的诊断具有很高雄确性,各种血管重建技术的联合应用能够提供更多的诊断信息,有助于临床治疗方案的选择.     

64层MSCT血管成像对婴幼儿主动脉缩窄及离断的评价

目的:评价64层螺旋CT血管成像在婴幼儿主动脉缩窄及离断诊断中的应用价值及其准确性.方法:对临床和超声怀疑主动脉缩窄的21例患儿行胸片、心脏大血管彩超及CT主动脉成像,其中5例行DSA检查,16例进行了手术治疗.CT血管重建技术包括VR、MIP、MPR及CPR等,对主动脉缩窄程度、长度、侧枝血管显示情况进行评价,并比较原始数据、VR、MPR、MIP及CPR几种后处理方式对主动脉缩窄诊断的准确性和敏感性.结果:21例患者中,19例为主动脉缩窄,2例为主动脉离断.病变部位于左锁骨下动脉远端、动脉导管开口附近20例(95.2%),正对左锁骨下动脉1例(4.8%).病变部位位于动脉导管近段2例,动脉导管附着处3例,动脉导管远段16例.多层螺旋CTA对主动脉狭窄诊断的总体准确率和敏感性均为100%,对主动脉缩窄的显示以靶血管VR最好,其次是CPR和MPR;对侧枝血管的显示以整体VR和CPR最好,其次是MIP和MPR;而整体VR和原始轴位图像对主动脉缩窄显示较差.结论:64层MSCT血管成像各种后处理技术相结合能为主动脉缩窄及离断患者提供了更多有价值的诊断信息,有助于临床术前评估和制定恰当的治疗方案.     

对比剂注射方式对下肢动脉血管成像质量的影响

目的:探讨对比剂不同注射方式对下肢动脉血管成像(CTA)质量的影响。方法:选择2013年6月到2015年10月在我院怀疑下肢动脉栓塞或狭窄而行CTA检查的患者80例,按随机数字表法分为A、B两组,各40例。A组患者先以5 mL/s的速率注射100 mL优维显,后以5 mL/s的速率注射50 mL生理盐水。B组患者先以5 mL/s的速率注射50 mL优维显,后以2.5 mL/s的速率注射50 mL优维显,最后以5 mL/s的速率注射50 mL生理盐水。比较两组患者的下肢动脉CTA图像质量。结果:B组患者不同横断面CT值相比于A组较平稳(P0.05)。B组患者小腿动脉和足部动脉的边缘分级、血管分支等级评价及显示的节段数均明显高于A组(P0.05)。结论:对比剂以不同速率相结合的注射方式能够使下肢动脉血管中对比剂浓度维持在平稳且较高的水平,可以提高下肢动脉CTA图像质量,值得在临床上推广应用。     

MSCTA对基底动脉变异的初步研究及其临床意义

目的:研究MSCT血管成像对基底动脉变异的诊断价值,并探讨其临床意义.方法:回顾性分析MSCT血管成像诊断基底动脉变异120例.所有患者均采用GELightSpeed64层螺旋CT对其头颈部动脉进行CT血管成像扫描,将获得的原始数据传入AW4.2P后处理工作站,血管重建技术包括容积再现(VR)、最大密度投影(MIP)、多平面重建(MPR)及曲面重建(CPR),影像分析采用智能血管分析与目测法相结合.结果:基底动脉走行弯曲50例(42%),包括左侧凸30例(25%)、右侧凸例15例(占12.5%)、S型凸5例(3.5%);基底动脉起止点变异47例(39.3%),其中起点变异35例(29.3%)、终点变异12例(10%);基底动脉形态变异14例(11.7%),其中开窗型lO例(8.3%)、管径粗大2例(占1.7%)、管径细小2例(1.7%);基底动脉主要分支变异9例(7.5%).结论:MSCT血管成像是一种无创性诊断基底动脉变异的有效方法,能够解释临床上部分不明原因的基底动脉供血不足,具有重要的临床意义.     

多层螺旋CT 血管造影在脑动脉瘤中应用

目的:观察多层螺旋CT血管造影对脑动脉瘤的诊断价值.方法:对16例脑动脉瘤患者的多层螺旋CT血管造影结果进行总结分析.结果:多层螺旋CT血管造影的诊断准确性与DSA无明显差异;多层螺旋CT血管造影显示动脉瘤的部位、大小、动脉瘤颈结构及其与周围血管的关系等与手术结果基本符合.结论:多层螺旋CT血管造影对脑动脉瘤的诊断准确率高,具备十分重要的临床应用价值.     

16层螺旋CT血管成像诊断颅内动脉瘤的价值

目的:探讨16层螺旋CT血管成像(16SCTA)诊断颅内动脉瘤的价值.方法:对33例16SCTA诊断的颅内动脉瘤进行回顾性分析.其中4例经手术证实,13例经数字减影血管造影(DSA)证实.结果:16SCTA在33例患者中,共发现40个动脉瘤.其中3例为两个动脉瘤,2例为三个动脉瘤.40个动脉瘤中大脑中动脉瘤9个,大脑前动脉瘤8个,大脑后动脉瘤2个,后交通动脉瘤4个,颈内动脉瘤12个,基底动脉瘤3个,胼周动脉瘤1个,小脑上动脉瘤1个.16SCTA均清晰显示瘤体的大小、位置、形态及瘤颈宽度、瘤轴指向、载瘤动脉、动脉瘤与周围重要解剖结构的关系.有DSA资料对照的13例中,16SCTA发现16个动脉瘤中DSA只发现13个,另外DSA发现1个动脉瘤而16SCTA漏诊.16SCTA诊断颅内动脉瘤的敏感度、特异度、阳性预测值、阴性预测值分别为92.9%、97.1%、81.3%、99%.结论:16SCTA在颅内动脉瘤临床诊断和术后随访中有较高的应用价值.     

MSCT评价兔VX2乳腺种植瘤抗血管生成治疗的研究

探讨多层螺旋CT（multi—slice spiral computed tomography,MSCT）灌注成像与肿瘤血管内皮生长因子（vascular endothelial growth factor,VEGF）表达的相关性以评估兔VX2乳腺种植瘤抗血管生成治疗的疗效。将69R乳腺VX：瘤兔于肿瘤生长2周后随机分为对照组（生理盐水1、恩度组（Endostar）、cEF组[环磷酰胺（Cyclophosphamide C）、表阿霉素（EpirubicinE）和5-氟尿嘧啶（5．FluorouracilF）]、联合治疗CR（Endostar和CEF）。治疗2周后对瘤兔进行MSCT灌注扫描,获得血流量（bloodflow,BF）、血容量（bloodvolume,BV）、平均通过时间（meantransittime,MTT）及表面通透性（permeabilitysurface,PS）等灌注参数均值：随后取瘤组织进行免疫组化及Westernblot检测 VEGF蛋白表达情况。结果显示,对照组、CEF组、恩度组、联合治疗组BF、BV和Ps均与VEGF表达结果呈正相关（R对照组=0．896、0．680、0．765,RCEF组=0．877、0．876、0．852,R恩度组=0．804、0．924、0．888,R联合治疗组=0．780、0．735、0．744;P〈0．05）,MTT均与VEGF表达结果呈负相关（R对照组＝-0．591,RCEF组=0．678,R恩度组=0．793,R联合治疗组=-0．687;P〈0．05）。MSCT灌注参数与VEGF蛋白表达具有相关性,MSCT灌注参数可以反映肿瘤治疗后免疫组化与分子水平VEGF表达的变化,MSCT可以在体无创评价兔VX2乳腺种植瘤抗血管生成治疗的疗效。     

64排螺旋CT下肢血管成像技术与DSA评估动脉狭窄的效果对比研究

目的探讨64排螺旋CTA评估下肢动脉狭窄闭塞性疾病的效果。方法对43例下肢动脉闭塞性疾病患者行64排螺旋CTA扫描,18例一周后行双下肢DSA检查,将每侧下肢血管分成8段,动脉狭窄程度分为：正常、轻度狭窄、中度狭窄、重度狭窄、闭塞5个级别。并以DSA为标准来评估。结果对18例患者双侧下肢共288段血管进行研究,CTA与DSA对血管狭窄程度显示一致的有275段,被CTA高估有ll段血管,低估有2段血管。结论64排螺旋CTA是下肢动脉狭窄硬化性疾病可靠的评估方法。     

MSCT评价兔VX_2乳腺种植瘤抗血管生成治疗的研究

探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)灌注成像与肿瘤血管内皮生长因子(vascular endothelial growth factor,VEGF)表达的相关性以评估兔VX2乳腺种植瘤抗血管生成治疗的疗效。将69只乳腺VX2瘤兔于肿瘤生长2周后随机分为对照组(生理盐水)、恩度组(Endostar)、CEF组[环磷酰胺(Cyclophosphamide C)、表阿霉素(Epirubicin E)和5-氟尿嘧啶(5-Fluorouracil F)]、联合治疗组(Endostar和CEF)。治疗2周后对瘤兔进行MSCT灌注扫描,获得血流量(blood fl ow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)及表面通透性(permeability surface,PS)等灌注参数均值;随后取瘤组织进行免疫组化及Western blot检测VEGF蛋白表达情况。结果显示,对照组、CEF组、恩度组、联合治疗组BF、BV和PS均与VEGF表达结果呈正相关(R对照组=0.896、0.680、0.765,RCEF组=0.877、0.876、0.852,R恩度组=0.804、0.924、0.888,R联合治疗组=0.780、0.735、0.744;P0.05),MTT均与VEGF表达结果呈负相关(R对照组=–0.591,RCEF组=–0.678,R恩度组=–0.793,R联合治疗组=–0.687;P0.05)。MSCT灌注参数与VEGF蛋白表达具有相关性,MSCT灌注参数可以反映肿瘤治疗后免疫组化与分子水平VEGF表达的变化,MSCT可以在体无创评价兔VX2乳腺种植瘤抗血管生成治疗的疗效。     

64层螺旋CTA容积重建结合轴位图像对明确颈部包块与血管关系的价值

目的:探讨64层螺旋CT血管成像(CTA)对明确颈部包块与周围血管关系的价值。方法:采用GE LightSpeed6 4层螺旋CT对25例颈部包块患者行颈部平扫及增强扫描,将获得的原始数据传入ADW4.3后处理工作站,血管重建技术选择容积重建(VR),诊断采用VR与轴位图像相结合的方式。结果:淋巴性病变10例,包括淋巴结结核2例、淋巴结转移4例、淋巴瘤4例,非淋巴性病变15例,包括淋巴管瘤1例、腮腺混合瘤2例、甲状腺癌4例、甲状腺腺瘤3例、孤立性纤维瘤1例、蔓状血管瘤2例、表皮样囊肿1例、咽旁脓肿1例。包块位于气管两侧6例,左侧15例,右侧4例;位于甲状腺内7例,腮腺内2例,颈动脉间隙11例,1例位于咽旁,其余4例位于颈部表浅组织内;颈部包块致毗邻血管移位、变形9例,其中动脉7例、静脉2例;颈部包块侵袭及包绕血管3例,包括动脉1例、静脉2例,其中1例静脉内血栓形成;颈部包块与血管关系密切2例;颈动脉发出分支供应颈部包块1例;其余10例与颈部血管无明显关系。结论:64层螺旋CTA容积重建结合轴位图像,可较准确地明确颈部包块与血管之间的关系。     

Paravascular structures of the major arteries of the cerebral hemispheres (electron microscopy study)

The ultrastructure of the paravasal formations of the magistral arteries in the brain hemispheres has been studied: the paravasal nerve trunks (components of the external nerve plexus of the arteries, running outside the adventitia and surrounded with liquor) and the artery-stabilizing constructions--strings in the human being and in the dog. The human para-arterial nerve trunks possess the vasa nervorum system, presented by blood capillaries situating at the border of endo- and perineurium, by powerfully developed perineurium, which includes into its composition a system of basal membranes and perineural cells. In the canine para-arterial nerve trunks these formation are absent. In the string composition there are collagenous-fibrillar base represented by tightly packed fasciculi of collagenous fibers, oriented in parallel to the long axis of the string, and by stellate cells. Both the paravasal nerve trunks and the strings are surrounded with flattened cells of the endothelial sheath. They are very much alike with the arachnoidendothelial cells lining the subarachnoidal space.     

The microcirculation of cerebral arteries: a morphologic and morphometric examination of the major canine cerebral arteries

A morphologic and morphometric examination of the major cerebral blood vessels in the dog was carried out to determine whether there were vasa vasorum in these arteries and what features might be associated with them. True vasa vasorum confined to the media were not seen in any of the vessels examined. Microvessels confined to the adventitia, however, were found in the internal carotid and vertebral arteries but not in the basilar, middle cerebral, or anterior spinal arteries. Animal size, vessel size as determined by adventitial and medial area, and the number of smooth muscle cell lamellae were not associated with the presence of these adventitial vessels; they occurred only in arteries with both an intra- and extradural portion. It therefore appears that most canine cerebral arteries do not have vasa vasorum.     

Distribution of serotonin-like immunoreactive nerves in major cerebral arteries of rabbit: an immunohistochemical study

We studied the distribution pattern of serotonin-like immunoreactive nerve fibers in the major cerebral vessels of rabbit by an indirect immunofluorescence technique using whole-mount stretch preparations. The density of serotonin-like immunoreactive nerve fibers was greater in vessels of the posterior part of the circle of Willis compared with that in the anterior part. This is in contrast to most of the observations reported previously regarding adrenergic, cholinergic, and peptidergic innervation of the circle of Willis.     

MAO activity in serotonergic endings of rat major cerebral arteries

The present work studies the existence of monoamine oxidase (MAO) activity in serotonergic endings present in rat major cerebral arteries. Enzymatic activity was appraised in vivo by serotonin (5-HT) accumulation or 5-hydroxyindole acetic acid (5-HIAA) disappearance with time after systemic administration of MAO inhibitors. Pargyline (75 mg/Kg, ip) brought about significant 5-HT increase and 5-HIAA decrease in major cerebral arteries 30 and 60 min after its administration. Clorgyline (75 mg/Kg, ip) also induced 5-HT enhancement and 5-HIAA decline in these arteries 30 and 60 min after its injection. However, treatment with deprenyl (75 mg/Kg, ip) only evoked a significant 5-HT increase at 60 min. When either clorgyline (5 mg/Kg, ip) or deprenyl (5 mg/Kg, ip) were administered 5-HT and 5-HIAA levels remained unaffected. Two weeks after performing electrolytical lesion of dorsal raphe nucleus and 60 min after clorgyline (75 mg/Kg, ip) injection 5-HT and 5-HIAA levels appeared significantly reduced in cerebral arteries and striatum when compared to sham-lesioned controls. These results suggest that MAO-A isoform acting on endogenous 5-HT is present in rat major cerebral arteries and is located in nerve endings of fibers arising from dorsal raphe nucleus.     

Morphofunctional changes in the adrenergic innervation of the major cerebral arteries during bilateral electrostimulation of the locus coeruleus

The intramural adrenergic nervous apparatus of cerebral arteries was studied in adult rabbits after 3-10 sessions of electrical stimulation of locus coeruleus. The activity of nerve structures was determined by estimating the density of adrenergic perivascular plexuses and by semi-quantitative cytophotometry of changes in the catecholamine content of nerve varicosities. The stimulation was followed by a 28.2 +/- 1.5% increase in adrenergic innervation density. while catecholamine content in perivascular nerve structures displayed a tendency to decrease. The problem of central effects on cerebral blood flow autoregulation is discussed.     

Pathway of nerves with vasoactive intestinal polypeptide-like immunoreactivity to the major cerebral arteries of the rat

Summary The pathway of nerves with vasoactive intestinal polypeptide(VIP)-like immunoreactivity to the major cerebral arteries was studied in rats by means of the indirect immunofluorescent method. The fibers are densely distributed in the ethmoidal nerves and in the adventitia of both the external and internal ethmoidal arteries. Section of both ethmoidal nerves and external ethmoidal arteries before they enter the cranial cavity induced a marked reduction of VIP-like immunoreactive fibers in the walls of the vessels of the circle of Willis and its major branches. However, section of the external ethmoidal artery alone did not result in visible changes of the nerves around major cerebral arteries. The present study suggests that VIP-like immunoreactive fibers surrounding major cerebral arteries of the rat arise from fibers in the ethmoidal nerve showing immunoreactivity to VIP.     

Trifurcations of the middle cerebral arteries

The furcation types of 100 human middle cerebral arteries (MCA) were investigated. Considering the physiological flow characteristics in furcations, a distinct definition for a bifurcation and a trifurcation was found. The common ramification type of the human MCA is the bifurcation. Trifurcations are very rare and we found them only in the proximal parts of the MCA. In 7 of the 100 cases, a trifurcation was found at the main division of the MCA, in 3 cases a secondary trunk trifurcated. Quadro- and pentafurcations according to the hydrodynamic definitions were not observed at all. Only in 1 case did the internal carotid artery trifurcate into the anterior cerebral artery, a superior trunk and an inferior trunk of the MCA.     

A scanning electron microscope study of human cerebral arteries.

Human cerebral arteries were obtained from autopsy, fixed under pressure, cut open, and tacked onto pieces of cork. For one artery the intima was partly teased away, exposing the media, and treated with a silver nitrate process. For another artery the adventitia was exposed. Both arteries were processed through graded ethanols and coated with gold paladium for the scanning electron microscope. The collagen fibers of the adventitia were approximately 5 mum in diameter and consisted of a bundle of microfilaments, each of which had a diameter of 800-1000 A (1 A = 10(-10) m). The collagen fibers were oriented parallel to the long axis of the artery. The muscle cells of the media had a diameter of 2-5 mum and were arranged circumferentially with a pitch of approximately 20 degrees. The collagen fibers of the media travel perpendicular to the muscle cells, and parallel to the long axis of the artery. The fibrillar components of the elastin in the intima had a diameter of approximately 700-1000 A and were arranged parallel to the long axis of the artery. It was postulated that the fibrillar part of the elastin was the elastic component of the elastin.