In vivo dosimetry during DSA of the carotid and renal arteries. Deriviation of local DRLs

The Euratom directive 97/43 recommends the use of patient dose surveys in diagnostic radiology and the establishment of diagnostic reference dose levels (DRLs). The aims of this study are to perform measurements of the entrance surface dose (ESD) during diagnostic digital subtraction angiography (DSA) of the renal and carotid arteries using thermoluminescence dosemeters (TLDs), extraction of local DRLs, and calculation of the effective dose. Dose measurement for the staff was also performed. Dose measurements were performed on 48 participating patients. The mean effective dose was calculated to be 15.9 mSv and 8.9 mSv, for the renal and carotid DSA, respectively. The effective dose of the radiologist was calculated to be 0.022 mSv and 0.023 mSv per procedure for renal and carotid DSA respectively, when wearing a protective apron and using a movable ceiling mounted shield. Radiation dose variation depends on the physical characteristics of the patient, on the procedure preferences by radiologists and on the difficulties in conducting the procedures. The lack of DRLs for the specific examinations lead the research team to choose the DRL for DSA of the renal arteries to be 169 mGy for ESD at the pelvic region and for DSA of the carotid arteries to be 313 mGy for ESD at the region of the aortic arc.     

盆腔疾病髂内动脉栓塞术的研究进展

髂内动脉栓塞是盆腔出血性疾病和肿瘤治疗的重要治疗方法,常规采用Seldinger技术,从一侧股动脉径路两侧髂内动脉选择性与超选择性插管。髂内动脉是盆腔脏器主要供血来源,根据数字减影动脉造影术（Digital subtraction arteriography,DSA）功能可分为：常规DSA,旋转DSA,平板数字减影旋转血管造影与三维血管重建和路图技术。栓塞剂可分为颗粒型和液态型栓塞剂。本文综述了盆腔疾病髂内动脉栓塞术近年来的研究进展。     

Estimation of the functional role of arterial pathways to the buttock circulation during treadmill walking in patients with claudication.

The aim of the study was to estimate the functional contribution of the arterial inflow pathways to the pelvic circulation during walking in patients with stage 2 lower extremity arterial disease. Transcutaneous oxygen pressure (Ptc(O(2))) changes during exercise can be used to estimate the severity of regional blood flow impairment while walking. Seventy patients with stable lower limb claudication were studied using a multivariate linear regression model. The relationship between exercise-induced buttock Ptc(O(2)) changes, the ipsilateral calf Ptc(O(2)) changes, and the arterial diameters of the pelvic arteriographic pathways were analyzed. The ipsilateral hypogastric and lumbar pathway, as well as the ipsilateral calf Ptc(O(2)) changes, were the only variables significantly related to buttock Ptc(O(2)) changes (r = 0.47; P < 0.001). Their normalized respective contribution to the regressive model was 39%, 19%, and 18%. None of the contralateral hypogastric, mesenteric, and sacral pathways or pathways stemming from the external iliac artery showed significant correlation to buttock Ptc(O(2)) changes. The ipsilateral hypogastric and ipsilateral lumbar pathways are the major pathways responsible for the functional buttock blood flow supply during walking. The role of contralateral hypogastric, inferior mesenteric, and median sacral pathways and arteries distal to the internal iliac trunk is negligible in the normal or compensatory blood flow supply. Distal Ptc(O(2)) decrease at exercise aggravates proximal Ptc(O(2)) decrease, possibly through the occurrence of a "steal phenomenon" of distal over proximal circulation during walking.     

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。     

Digital subtraction angiography of patent ductus arteriosus

Digital subtraction angiography (DSA) was performed in 31 patients with the open arterial duct (OAD), of them 15 were outpatients. Diagnosis was made in all primary patients using DSA, indications and contraindications for endovascular occlusion of the OAD were defined. Of 17 patients examined at varying time after endovascular occlusion of the duct, valid signs of reliable occlusion of the duct were obtained in 16. In one patient a contrast medium got from the aorta to the pulmonary artery via the arterial duct indicating OAD incomplete closure. DSA can be used under outpatient conditions to define indications and contraindications for endovascular occlusion of the OAD and to assess its long-term effectiveness.     

The dissections of craniocervical arteries

Dissection of craniocervical arteries internal carotid artery (ICA), or vertebral artery (VA) is an increasingly recognized entity and infrequent cause of stroke. We investigated 8 patients (4 women and 4 men) with dissections of the craniocervical arteries. Diagnostic procedures for detection of craniocervical dissection included: extracranial ultrasound-color Doppler flow imaging (CDFI) of carotid and vertebral arteries, transcranial Doppler sonography (TCD) and radiological computed tomography (CT) and digital subtractive angiography (DSA) examinations. Ultrasound findings (CDFI of carotid and vertebral arteries) were positive for vessel dissection in seven patients (or 87.5 per cent) and negative in one patient. DSA was consistent with dissection in five patients (or 62.5 per cent), negative in one, while in two patients the examination was not performed due to known allergy to contrast media. Five patients (62.5 per cent) were treated with anticoagulants, one with suppressors of platelet aggregation, and two patients were operated. Six patients (75 per cent) after the treatment showed partial recovery of neurological defects, and an improvement of ultrasound finding of dissected arteries. In one patient, following operation, stroke developed with deterioration of motor deficit, and one patient was readmitted three months later due to a newly developed stroke and soon died. The diagnosis should be suspected in any young or middle-age patient with new onset of otherwise unexplained unremitting headache or neck ache, especially in association with transient or permanent focal neurological deficits.     

The blood supply to the abdominal and pelvic regions in talpids: character analysis and implications for specific relationships among Insectivora

The morphology of the abdominal and pelvic arterial system was analysed in two talpid species, the common mole (Talpa europaea) and the Pyrenean desman (Galemys pyrenaicus). Animals were studied by injection of coloured latex solution into the aorta by cannulation through the left ventricle of the heart, and subsequent dissection under a surgical microscope. In spite of the intra- and interspecific variation observed in the main abdominal and pelvic vessels examined, the general arrangements observed in talpids are consistent with the patterns described in other Insectivora, such as Soricinae and Crocidurinae. Interspecific morphological comparisons within the Insectivora and with representatives of other mammal orders revealed that the origin and arrangement of certain arteries, such as the renal, gonadal, caudal mesenteric, and median sacral arteries are clearly uncorrelated with function and phylogeny. Similar conclusions can be extended to the common or separate origin of the cœliac and the cranial mesenteric arteries. In contrast, other specific arterial traits can be interpreted from a functional and/or evolutionary standpoint. We discuss these implications for the following characteristics: the absence of gastroepiploic arteries; the presence of double lienal arteries and right gastric artery; the course of the cranial mesenteric artery; the presence of the ductus deferentis artery; and the origin of the cranial gluteal, deep iliac circumflex, and medial and lateral femoral circumflex arteries. Phenetic relationships among Soricomorpha were evaluated by cluster analysis. Congruence between the phenogram obtained and an accepted evolutionary hypothesis corroborates the phylogenetic significance of some arterial arrangements.     

DynaCT对肝转移瘤介入治疗具有指导意义

为了探讨锥形束CT (DynaCT)在肝癌患者实施经导管肝动脉化疗栓塞(TACE)手术治疗中的指导作用、栓塞效果评估中的价值,本研究选取了2012年3月至2015年5月在本院实施TACE手术治疗的102例原发性肝癌或转移性肝癌患者进行研究。通过对102例患者病灶进行手术前螺旋CT检测、术中数字减影血管造影(DSA)及DynaCT检测,并对比DSA与DynaCT对肝癌病灶、供血动脉、术后栓塞效果的检测结果。本研究发现术前普通螺旋CT共计检出病灶105个,术中DSA检出病灶数目176个,DynaCT术中检出肿瘤病灶285个;DynaCT和DSA的平均检出病灶数目均显著的高于普通螺旋CT (p<0.05),DynaCT平均检出病灶数目均显著的高于DSA (p<0.05);DynaCT的病灶供血动脉检出率为86.67%,显著地高于DSA (55.68%)(p<0.05);DynaCT检出的285个病灶对栓塞效果评估结果与实际栓塞效果一致的有271个病灶(95.09%),DSA评估结果与实际结果一致的有138个病灶(78.41%),DynaCT对于TACE术后效果评估的一致性高于DSA (p<0.05)。本研究表明,DynaCT在肝癌患者实施TACE手术治疗中能够更有效的发现病灶,指导栓塞操作。     

Development of arterial and lymphatic collaterals under the action of a UHF magnetic field]

The work performed in 48 experimental and 24 control rats dealt with the development of arterial and lymphatic collaterals of pelvic extremities under effects of magnetic field of ultra high frequency (15 and 30 vt) in terms from 2 up to 6 weeks after surgery and exposure to magnetic field. The methods of investigation were arterio- and lymphoroentgenography and dissection. It has been established that formation of arterial collaterals in experimental rats takes place in all zones during the second week after cutting femoral arteries. The rate of the development of arterial collaterals was accelerated as compared with control animals. The lymph outflow after exposure to the influence of magnetic field of UHF goes mainly along superficial collaterals to groin nodes. The influence of the magnetic field of UHF appears to be accompanied by stable dilatation of super ficial lymph vessels, and due to this the lymph outflows along these vessels.     

The role of combined assessment of defense against oxidative stress and inflammation in the evaluation of peripheral arterial disease

Atherosclerosis in symptomatic peripheral arterial disease affects wide portions of numerous arteries in lower extremities. The resulting active inflammation in a considerable amount of arterial tissue facilitates systemic detection via measurement of inflammation-related variables. We reasoned that the combined assessment of defense against oxidative stress, in the form of paraoxonase-1 (PON1), and monocyte migration measured as circulating (C-C motif) ligand 2 (CCL2), may play a role in the evaluation of these patients. Plasma CCL2 and serum PON1-related variables, assessed by their interaction with functional genetic variants, were measured in a cross-sectional study in patients with symptomatic PAD. We found that PON1 activity and concentration were significantly lower and CCL2 concentration higher in PAD patients compared to controls, that the combination of plasma CCL2 and PON1- related values, especially PON1 concentration differentiated, almost perfectly, controls from patients and that the expression of CCL2 and PON1 generally co-localized in the atherosclerotic lesion. Since no association with genetic variants was found, such a relationship is probably the result of the disease. Our data suggest a coordinated role between CCL2 and PON1 that may be detected in blood with simple measurements and may represent an indicator of the extent of atherosclerosis.     

Transposition of the great arteries: logical anatomical arterial correction.

In a 20-month-old child with classic transposition of the great arteries the pulmonary artery, coronary arteries, and aorta were successfully retransposed at arterial level. It was difficult to reimplant the coronary arteries in the dilated pulmonary artery root without damaging the attachments of the valve cusps, and it may be better to divide the pulmonary artery first to avoid this hazard. Retransposition at arterial level will not be suitable for all patients with transposition of the great arteries, and many questions about long-term outcome remain to be answered.     

Non-Contrast Enhanced MR Angiography (NCE-MRA) of the Calf: A Direct Comparison between Flow-Sensitive Dephasing (FSD) Prepared Steady-State Free Precession (SSFP) and Quiescent-Interval Single-Shot (QISS) in Patients with Diabetes

Objectives

To compare the image quality and diagnostic performance of two non-contrast enhanced MR angiography (NCE-MRA) techniques using flow-sensitive dephasing (FSD) prepared steady-state free precession (SSFP) and quiescent-interval single-shot (QISS) for the calf arteries in patients with diabetes.

Materials and Methods

Twenty six patients underwent the two NCE-MRA techniques followed by contrast-enhanced MRA (CE-MRA) of lower extremity on a 1.5T MR system. Image quality scores, arterial stenosis scores, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel sharpness, and diagnostic accuracy for detecting more than 50% arterial stenosis were evaluated and statistically compared using CE-MRA as the reference standard.

Results

All examinations were performed successfully. Of the total 153 calf arterial segments obtained in the 26 patients, FSD and QISS showed no significant difference in the number of diagnostic arterial segments (151 [98%] vs. 147 [96%], respectively, P>0.05). The image quality of FSD was higher than that of QISS in the peroneal artery and posterior tibial artery (P<0.05), but no significant difference in the anterior tibial artery (P>0.05). SNR and CNR of FSD were higher than those of QISS (P<0.01), while FSD showed comparable vessel sharpness compared with QISS (P>0.05). The time efficiency of SNR and CNR between FSD and QISS showed no significant difference when taking into account the times for FSD-related scout scans. There was no difference in sensitivity (95% vs. 93%, P>0.05) and negative predictive value (98% vs. 97%, P>0.05) between FSD and QISS for detecting stenosis greater than 50%. However, FSD showed higher specificities (99% vs. 92%, P<0.05) and diagnostic accuracy (98% vs. 92%, P<0.05) compared to QISS.

Conclusion

Both FSD and QISS had similar high sensitivity and negative predictive value for detecting calf arteries with over 50% stenosis, but FSD showed slightly higher diagnostic specificity and better depiction of arterial lesions due to its isotropic submillimeter spatial resolution. QISS, being an easier to use and less time-consuming technique, could be a method of choice for rapid screening of arterial disease of the lower extremity.     

下肢动脉阻塞性病变多层螺旋CT 低剂量扫描成像初探

目的:探讨低剂量CT扫描在下肢动脉脉阻塞性病变诊断中的应用价值.方法:选择127段经DSA确诊的不同部位下肢动脉阻塞性病变行低剂量CT扫描,并采用MPR,VR,MIP等重建方法获得各下肢动脉CTA图像,将CTA图像与DSA图像的诊断结果利用统计学软件SAS8.1行加权Kappa一致性检验,检验水准为:Kaapa.系数大于0.75.结果:所得CTA图像与DSA图像诊断结果的一致性检验的kappa系数为0.8058,两种诊断结果的一致性为优.结论:采用低剂量扫描条件获得高质量的CTA图像在下肢动脉阻塞性病变的诊断上有肯定的价值.     

Blood vessel size of circulus arteriosus cerebri (circle of Willis): a statistical research on 100 human subjects

The brain weight of 100 fresh cadavers of Italian subjects (60 males and 40 females), aged between 17 and 84 years, was obtained and the corrected circumference of the following blood vessels was measured: basilar artery, internal carotid arteries, anterior and posterior cerebral arteries, and anterior and posterior communicating arteries. The cerebral 'potential flow' was expressed in each case by adding the circumference of the basilar artery to that of the internal carotid arteries. Moreover, the sides and the perimeter of the circle of Willis as well as the length of the basilar artery were calculated. The statistical analysis of the obtained data yielded the following main results: (1) the brain weight decreases with aging, is lower in females than in males and and is statistically correlated neither with the circumferences of the considered arteries and the 'potential flow' nor with the perimeter of the arterial polygon (circle of Willis); (2) the arteries of the left side appear to be larger than those of the right one; (3) no significant difference exists in the circumference and length of the arteries between males and females; (4) the increase of the perimeter of the arterial polygon is achieved by means of a harmonious increase of all its sides; (5) the anterior and posterior communicating arteries have an anarchic pattern, because of the relatively frequent anomalies and the lack of a correlation between their circumference and that of the vessel of origin or of outlet.     

下肢动脉阻塞性病变多层螺旋CT低剂量扫描成像初探

目的：探讨低剂量CT扫描在下肢动脉脉阻塞性病变诊断中的应用价值。方法：选择127段经DSA确诊的不同部位下肢动脉阻塞性病变行低剂量CT扫描,并采用MPR,VR,MIP等重建方法获得各下肢动脉CTA图像,将CTA图像与DSA图像的诊断结果利用统计学软件SAS8.1行加权Kappa一致性检验,检验水准为：Kaapa.系数大于0.75。结果：所得CTA图像与DSA图像诊断结果的一致性检验的kappa系数为0.8058,两种诊断结果的一致性为优。结论：采用低剂量扫描条件获得高质量的CTA图像在下肢动脉阻塞性病变的诊断上有肯定的价值。     

下肢动脉硬化闭塞症的诊断方法

近些年下肢动脉硬化闭塞症(LEASD)在国内外发病率均明显上升。其诊断方法很多,包括动脉造影、彩色超声多普勒、核磁共振血管造影、计算机断层血管造影和多功能周围血管检查等。动脉造影做为诊断动脉病变的金标准,因其价格相对昂贵,技术复杂,在临床应用上有一定的局限性;彩色多普勒超声操作简便,无创伤、可重复,临床应用较多,但不能直观的提供病变血管的形态;新近发展的核磁共振血管造影和计算机断层血管造影无创伤、可重复、分辨率高,且可直观的提供病变血管的形态,发展前景广阔;PVL作为一种无损伤血管检查,可进行多普勒血流图形描记和节段性测压,在判断下肢动脉狭窄闭塞性病变方面与彩色超声相关性好,准确性高,可在LEASD病人的门诊初步筛选、病情估计和随访等方面推广应用。     

Increased resistance in postobstructive pulmonary vasculopathy: structure-function relationships

Postobstructive pulmonary vasculopathy (POPV) was produced by chronic ligation (120 days) of the left main pulmonary artery of seven dogs. To explain the abnormal physiological changes found using arterial and venous occlusion (AVO) in POPV (J. Appl. Physiol. 69: 1022-1032, 1990), the light-microscopic morphology, morphometry (n = 5), and ultrastructure (n = 6) of ligated left lower lobes were compared with contralateral control right lower lobes. First, there was a proliferation of bronchial vessels around pulmonary vessels and airways to explain bronchial blood flow rates of 330 ml/min in left lower lobes. The walls of the bronchial vessels contained smooth muscle with minimal elastic tissue and prominent myoendothelial junctions. Second, focal bronchopulmonary anastomoses were seen in pulmonary arteries approximately equal to 100 microns diam, which is consistent with our conclusion that the major site of communication is at the precapillary level and suggests that the limit between arterial and middle segments defined by AVO may lie in arteries of approximately equal to 100 microns. Third, to explain the increased arterial resistance in POPV, the pulmonary arteries had an increased percent medial muscle thickness, peripheral muscularization, and focal intimal thickening but had no plexiform lesions. The ultrastructure of the arteries revealed new intimal cells and numerous myoendothelial junctions rarely found in controls. Capillaries and veins were only subtly altered. Fourth, the hyperreactivity of arteries to serotonin and of veins to histamine found using AVO was partially explained by the increased medial thickness and decreased diameter but may also be due to increased receptor concentration or related to the myoendothelial junctions. We conclude that most of the hemodynamic alterations in POPV are related to morphological abnormalities and that this model has clinical and experimental relevance in the study of bronchopulmonary vascular interactions.     

Real-time ultrasonic imaging of the peripheral arteries: Technique, normal anatomy, and pathology

Real-time ultrasonic echo imaging of peripheral arteries promises to facilitate the management of selected patients with peripheral and extracranial arterial disease. This report outlines the technique of imaging the carotid system and portions of the arteries that supply the lower extremities. It also discusses the normal and pathologic anatomy of these arteries.     

Prolonged Cerebral Circulation Time Is the Best Parameter for Predicting Vasospasm during Initial CT Perfusion in Subarachnoid Hemorrhagic Patients

Purpose

We sought to imitate angiographic cerebral circulation time (CCT) and create a similar index from baseline CT perfusion (CTP) to better predict vasospasm in patients with subarachnoid hemorrhage (SAH).

Methods

Forty-one SAH patients with available DSA and CTP were retrospectively included. The vasospasm group was comprised of patients with deterioration in conscious functioning and newly developed luminal narrowing; remaining cases were classified as the control group. The angiography CCT (XA-CCT) was defined as the difference in TTP (time to peak) between the selected arterial ROIs and the superior sagittal sinus (SSS). Four arterial ROIs were selected to generate four corresponding XA-CCTs: the right and left anterior cerebral arteries (XA-CCT_RA2 and XA-CCT_LA2) and right- and left-middle cerebral arteries (XA-CCT_RM2 and XA-CCT_LM2). The CCTs from CTP (CT-CCT) were defined as the differences in TTP from the corresponding arterial ROIs and the SSS. Correlations of the different CCTs were calculated and diagnostic accuracy in predicting vasospasm was evaluated.

Results

Intra-class correlations ranged from 0.96 to 0.98. The correlations of XA-CCT_RA2, XA-CCT_RM2, XA-CCT_LA2, and XA-CCT_LM2 with the corresponding CT-CCTs were 0.64, 0.65, 0.53, and 0.68, respectively. All CCTs were significantly prolonged in the vasospasm group (5.8–6.4 s) except for XA-CCT_LA2. CT-CCT_A2 of 5.62 was the optimal cut-off value for detecting vasospasm with a sensitivity of 84.2% and specificity 82.4%

Conclusion

CT-CCTs can be used to interpret cerebral flow without deconvolution algorithms, and outperform both MTT and TTP in predicting vasospasm risk. This finding may help facilitate management of patients with SAH.     

Changes in the phospholipid composition of the arterial cell can result in severe atherosclerotic lesions

The oxysterol concentration in the plasma and the phospholipid composition of vascular tissue obtained by coronary artery bypass grafting (CABG) were compared with plasma and vascular tissue from age and sex matched controls. The plasma from CABG patients had a higher concentration of oxysterols than was present in the controls. Human endothelial cells were cultured for 72 hours in a medium containing plasma obtained from CABG patients, from controls or from the same controls to which 5 oxysterols were added to make the total oxysterol level equivalent to that in the CABG plasma and then pulsed with calcium (45Ca(2+)) for one hr. A significantly higher influx of 45Ca(2+) was noted in the endothelial cells cultured in the plasma obtained from CABG patients and from the controls with 5 added oxysterols, but not in those cultured without added oxysterols indicating that oxysterols increased calcium influx into endothelial cells. A phospholipid analysis indicated that the arterial tissue from CABG patients had 48.2% sphingomyelin in its phospholipid fraction compared to 10% in arterial tissue from umbilical cords. The saphenous vein obtained during CABG surgery from the same patient had only 24% sphingomyelin in its phospholipid fraction and unlike the coronary arteries had no atherosclerotic lesions. The higher level of oxysterol in the plasma of patients suffering from severe atherosclerosis could increase the concentration of sphingomyelin in the arterial cell membrane and thereby increase calcium influx required for producing the calcific type VII lesions in the coronary arteries.