Objective To evaluate the clinical value of three dimensional computerized tomography angiography in the diagnosis and treatment of spontaneous subarachnoid hemorrhage. Methods 616 cases were diagnosed as suspected in...Objective To evaluate the clinical value of three dimensional computerized tomography angiography in the diagnosis and treatment of spontaneous subarachnoid hemorrhage. Methods 616 cases were diagnosed as suspected intracranial aneurysms in 3D CTA system. Computed tomographic scans and CTA studies were展开更多
Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective eval...Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial AVMs展开更多
BACKGROUND ： Digital subtraction angiography （DSA） is always regarded as the golden standard for diagnosis of intracranial aneurysm; however, the procedure is complex, traumatic, expensive and easy to induce vascul...BACKGROUND ： Digital subtraction angiography （DSA） is always regarded as the golden standard for diagnosis of intracranial aneurysm; however, the procedure is complex, traumatic, expensive and easy to induce vascular complication. Three-dimensional computed tomography angiography （3D-CTA） can make up deficiencies of DSA; therefore, it is used in clinical therapy wider and wider. OBJECTIVE ： To evaluate the clinical effect of 3D-CTA on disruption and hemorrhage of intracranial aneurysm pre- and post-operation and compare with the effect of DSA. DESIGN ： Auto-control contrast observation SETTING ： Department of Neurosurgery, Shengjing Hospital of China Medical University PARTICIPANTS ： A number of 106 patients with disruption and hemorrhage of intracranial aneurysm were selected from the Department of Neurosurgery, Shengjing Hospital of China Medical University from January 2003 to April 2006. All patients were diagnosed with cranial operation and consent. There were 47 males and 59 females aged from 3-76 years with the mean age of （47±13） years. Among them, 82 patients had extensive subarachnoid hemorrhage （SAH）, 7 had hemorrhage at longitudinal fissure, and 17 had hemorrhage at ambiens cistema and lateral fissure. Moreover, intraventricular hematocele was accompanied on 13 patients and hematom on 9 patients. METHODS： （1） 3D-CTA examination： Siemens SOMATOM Sensation 64 CT was used in this study. The thickness was 1 mm and interval of reconstruction was 0.8 mm. Localizing section was plainly scanned as the standard of canthus line. Scan ranged from 30 mm below sella to 50 mm above sella. Non-ion contrast medium of Omnipaque 350 （concentration of iodine was 350 g/L） was inserted into anterior vein of elbow with 18G trochar retained with high-pressured injectoc pum. The speed was 4.5 mL/s and the total volume was 80-100 mL with the means of 90 mL. Scan started at 10-20 s after injection of contrast medium. Original image was dealt with Leonardo workstation and retreated with Syngo software. Volume rendering and maximum intensity projection were used to reconstructed images, （2） All 106 patients suffered from occlusion of aneurysm clamp. Before operation, 3D-CTA was undertaken and DSA was followed. After operation, patients were rechecked with 3D-CTA. MAIN OUTCOME MEASURES： Comparisons between 3D-CTA and DSA. RESULTS ： All 106 patients were involved in the final analysis. （1） Examination of 3D-CTA and DSA： Among 118 patients with aneurysm, 110 were checked with 3D-CTA and the detected rate was 93.2% （110/118）. Among other 8 cases, 3 were negative and checked again with DSA; 1 had pericallosal aneurysm, 1 ophthalmic aneurysm, and 1 anterior choroidal artery of aneurysm. 3D-CTA results of other 5 cases were suspicious, and then, they were regarded as having aneurysm with DSA. Before operation, correlation among site, body, neck of aneurysm and peripheral anatomic structure were shown sufficiently. After operation, 82 patients were rechecked with 3D-CTA, which was complete occlusion, precise, unobvious constriction, emphraxis or remains as compared with 3D-CTA those pre-operation. （2） Characteristics of 3D-CTA： With multiple vessels and angles, 3D-CTA observed the relationship between aneurysm neck and carried artery and showed thrombosis in cavity of aneurysm, calcification of aneurysm wall and peripheral structure of vessel at the same time. However, DSA could not detect the reactions mentioned above. It could delete image of cranium, simulate image of operative route, eliminate artifact induced by metal, but not distinguish blood stream direction. Meanwhile, posterior communicating artery was always poor during circle of Willis artery showing. CONCLUSION： （1） 3D-CTA is characterized by simple operation and non-invasive showing vascular stereo structure and correlation. Therefore, it is significant for diagnosis and designing plan of operative approach and focal location pre-operation and evaluating effect post-operation. （2） 3D-CTA does not completely replace DSA on the diagnosis of intracranial aneurysm.展开更多
BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentec...BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.展开更多
AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography(CCTA). METHODS: A total of 350 CCTA of Saudi pat...AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography(CCTA). METHODS: A total of 350 CCTA of Saudi patients were included in this study(236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications(typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association. RESULTS: Myocardial bridging was found in 89 of 350(22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending(LAD)(24.6%), followed by distal LAD(3.7%), diagonal branches(2%), ramus intermedius artery(1.4%) and obtuse marginal artery(0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females(P = 0.14). Coronary artery atherosclerosis was found in 51 of 89(57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35(94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries. CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.展开更多
Objective To investigate the feasibility of subtraction coronary computed tomographic(CT)angiography(SubCCTA)to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and a...Objective To investigate the feasibility of subtraction coronary computed tomographic(CT)angiography(SubCCTA)to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and analyze the factors that influence SubCCTA.Methods A total of 294 patients suspected of having coronary artery diseases underwent coronary computed tomographic angiography(CCTA)and SubCCTA.Coronary stenoses were blindly evaluated by two experienced radiologists,which were compared with invasive coronary angiography(ICA).Multiple statistical indexes were adopted to analyze the value of SubCCTA for the diagnosis of calcium stenoses.Results The diagnosable rate of SubCCTA was 67.2%(n=197),and the non-diagnosable rate was 32.8%(n=97).Using SubCCTA,the false positive rate decreased from 56.5%to 17.4%,and the corresponding diagnostic accuracy was increased from 83.6%to 92.9%.Univariate logistic regression analysis showed that height(OR=1.029,95%CI=1.001–1.058),weight(OR=1.025,95%CI=1.004–1.046),left ventricular size(OR=1.018,95%CI=1.007–1.030),cardiothoracic ratio(OR=39.917,95%CI=1.244–1281.098),the average heart rate(OR=0.866,95%CI=0.836–0.896)and heart rate range(OR=0.882,95%CI=0.853–0.912)might be the factors influencing SubCCTA.Conclusion This study suggested that SubCCTA could help improve diagnostic accuracy in the presence of calcium plaques.Moreover,several factors were discovered for the first time to possibly influence SubCCTA,which will be helpful in improving the subtracted image quality.展开更多
Introduction: The aim of our study was to assess the incremental value of Coronary Computed Tomography Angiography (CCTA) added to classical coronary angiography, for complex characterization of coronary lesions and p...Introduction: The aim of our study was to assess the incremental value of Coronary Computed Tomography Angiography (CCTA) added to classical coronary angiography, for complex characterization of coronary lesions and prediction of procedural complexity in patients with significant left main (LM) stenoses. Material and Methods: Thirty-six patients with LM disease were enrolled in the study, and each subject underwent CCTA followed by coronary angiography and percutaneous revascularization. Results: Logistic regression analysis indicated a good correlation between the angiographic-calculated and the CCTA-derived Syntax scores for the whole group (r = 0.87, p < 0.0001) and for the high risk subgroup (r = 0.86, p < 0.0001), but not for the low and intermediate risk (r = 0.38, p = 0.21 and r = 0.62, p = 0.07 respectively). In cases which required complex PCI procedures, both angiographic and CCTA Syntax score were significantly higher than those who did not require complex revascularization procedures (24.5 +/-11.5 vs 32.2 +/-14.6, p = 0.09 for Angio Syntax, 35.3 +/-11.5 vs 25.2 +/-11.3, p = 0.01 for CCTA). In the same time, Ca scoring was significantly higher and plaque volumes were significantly larger in cases requiring complex revascularization procedures (299.5 +/-359.6 vs 917.3 +/-495.4, p = 0.04 for calcium score, 79.7 +/-28.5 vs 108.7 +/-25.3 mm3, p = 0.002 for plaque volumes). Multivariate analysis identified the following CCTA parameters as significant predictors of increased risk for complex intervention in LM lesions: plaque volume (OR 8.00, p = 0.008), Ca scoring (OR 6.37, p = 0.02) and CCTA Syntax score (OR 6.87, p = 0.01). Conclusions: CCTA derived parameters provide incremental information to classical coronary angiography for preoperative assessment of lesion severity in complex left main stenosis. CCTA derived Syntax score significantly correlates with the classical Coronary Angiography Syntax score and identifies the subgroup of patients who will be more exposed to procedural complications during the revascularization interventions.展开更多
BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vess...BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.展开更多
AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing...AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.展开更多
Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furt...Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.展开更多
Background： Coronary computed tomographic angiography （CCTA） has been widely used in patients who are at intemaediate risk for having stable coronary artery disease （SCAD）, and 2013 European Society of Cardiology...Background： Coronary computed tomographic angiography （CCTA） has been widely used in patients who are at intemaediate risk for having stable coronary artery disease （SCAD）, and 2013 European Society of Cardiology Guidelines on the Management of SCAD （2013G） recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice. Methods： A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model （UDFM）. Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA. Results： Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time （P = 0.8701）. The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before （22.29%） or after （19.98%） the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G （odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678）. Conclusions： These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.展开更多
Coronary computed tomographic angiography （CCTA） as a noninvasive diagnostic technique for the evaluation of coronary anatomy is widely used clinically. Its advantages include high sensitivity and specificity for th...Coronary computed tomographic angiography （CCTA） as a noninvasive diagnostic technique for the evaluation of coronary anatomy is widely used clinically. Its advantages include high sensitivity and specificity for the diagnosis of present of coronary artery lesions and lesion characteristics,展开更多
Risk assessment in coronary artery disease plays an essential role in the early identification of high-risk patients.However,conventional invasive imaging procedures all require long intraprocedural times and high cos...Risk assessment in coronary artery disease plays an essential role in the early identification of high-risk patients.However,conventional invasive imaging procedures all require long intraprocedural times and high costs.The rapid development of coronary computed tomographic angiography(CCTA)and related image processing technology has facilitated the formulation of noninvasive approaches to perform comprehensive evaluations.Evidence has shown that CCTA has outstanding performance in identifying the degree of stenosis,plaque features,and functional reserve.Moreover,advancements in radiomics and machine learning allowmore comprehensive interpretations of CCTA images.This paper reviews conventional as well as novel diagnostic and risk assessment tools based on CCTA.展开更多
The aim of this study is to examine morphology of intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography and discuss whether such aneurysms can be treated by interve...The aim of this study is to examine morphology of intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography and discuss whether such aneurysms can be treated by interventional embolization. 6 patients who had not been treated by embolization due to irregular wide-necked aneurysms indistinguishable from surrounding artery branches by cerebral angiography received craniotomy for aneurysm clipping. The operations succeeded. Morphologically, neck width and location of the aneurysms were carefully observed and photographed from different directions and multi-angles during operation. The intraoperative findings were compared with the preoperative CTA and DSA images. Walls of the 6 patients’ aneurysms tightly clung to or adhered to surrounding branches and oppressed the branches into arcs, similar to the aneurysm walls in shape, and arterial branches and aneurysm walls suffered from segmental adhesion. In addition, abnormalities of communicating arteries to vary degrees were observed in 4 patients. However, after successful surgical clipping, it was revealed that the aneurysms would have been better treated by embolization since they are basically saccular aneurysms with regular sizes. Deformations in preoperative angiography may be due to anatomical variations of surrounding vessels near the aneurysms, aneurysm wall oppression or incomplete adhesion of surrounding arterial branches. Such deformations can be recognized by careful observation in preoperative angiography from different directions and multi-angles.展开更多
BACKGROUND:Orthotopic liver transplantation has be-come the treatment of choice for patients with end-stage liver disease.This study was designed to study whether multislice spiral CT angiography(MSCTA)could be used f...BACKGROUND:Orthotopic liver transplantation has be-come the treatment of choice for patients with end-stage liver disease.This study was designed to study whether multislice spiral CT angiography(MSCTA)could be used for preoperative evaluation for orthotopic liver transplanta-tion candidates.METHODS:Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di-mensional CT angiography(3DCTA).The arterial-phase was used to create vascular maps of the celiac axis(inclu-ding the origin of the hepatic common artery,left gastric artery and splenic artery)and origin of the superior mesen-teric artery.The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein.Statistical analyses were made using the chi-square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients.Appearance of MSCTA and operative results of 16 patients were analyzed.RESULTS;Sixty-two patients(77.5%)showed conven-tional and 18(22.5%)nonconventional hepatic arterial anatomy.A significant difference was found between the two groups in anatomy of the hepatic artery(P<0.05).Celiac axis stenosis was observed in 6 patients,SA aneu-rysm in 2,small-caliber hepatic arterial vessels in 2,and portal vein thrombosis in 15.Vascular structures of 16 ope-rative patients were well defined.CONCLUSION:As a noninvasive examination,MSCTA can provide a comprehensive preoperative vascular evalua-tion for liver transplantation candidates.展开更多
OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-four patients suspected of intracranial aneurysms underwent routi...OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA). RESULTS: A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P展开更多
文摘Objective To evaluate the clinical value of three dimensional computerized tomography angiography in the diagnosis and treatment of spontaneous subarachnoid hemorrhage. Methods 616 cases were diagnosed as suspected intracranial aneurysms in 3D CTA system. Computed tomographic scans and CTA studies were
文摘Obejctive To assess the value of noninvasive three dimensional computed tomographic angiography (3D CTA) in preoperative detection of intracranial arteriovenous malformations (AVMs) Methods A prospective evaluation at a single institute over a 2 year period included 23 patients suspected of intracranial AVMs All patients underwent 3D CTA and digital subtraction angiography (DSA) Results from both procedures were compared Results 3D CTA imaging provided excellent visualization of intracranial AVMs The false positive error and false negative error were zero in our sample The details of arterial supply (numerical measure, orientation, caliber and routing) and vascular nidus (size, morphosis and location) provided by 3D CTA images were the same as DSA and the details of venous drainage were an approximate match Additionally, 3D CTA can depict tridimensional anatomical information for AVMs and their relationship to adjacent structures, a function not possible with DSA This assisted the surgeons in making better surgical planning and reduced trauma As a non invasive course, there were no related complications in the course of 3D CTA processing Conclusions DSA is still regarded as the gold standard for intracranial AVMs detection The modality of 3D CTA is accurate, noninvasive, nearly risk free and low price; we could routinely use it instead of or as a supplement to DSA, in the preoperative detection of suspected intracranial AVMs and postoperative radiological follow up 3D CTA adds tridimensional aspect and assists the surgeon in a the more accurate therapeutic scheme Preliminary data suggest that 3D CTA is playing a favorable role in the assessment of patients with intracranial AVMs
文摘BACKGROUND ： Digital subtraction angiography （DSA） is always regarded as the golden standard for diagnosis of intracranial aneurysm; however, the procedure is complex, traumatic, expensive and easy to induce vascular complication. Three-dimensional computed tomography angiography （3D-CTA） can make up deficiencies of DSA; therefore, it is used in clinical therapy wider and wider. OBJECTIVE ： To evaluate the clinical effect of 3D-CTA on disruption and hemorrhage of intracranial aneurysm pre- and post-operation and compare with the effect of DSA. DESIGN ： Auto-control contrast observation SETTING ： Department of Neurosurgery, Shengjing Hospital of China Medical University PARTICIPANTS ： A number of 106 patients with disruption and hemorrhage of intracranial aneurysm were selected from the Department of Neurosurgery, Shengjing Hospital of China Medical University from January 2003 to April 2006. All patients were diagnosed with cranial operation and consent. There were 47 males and 59 females aged from 3-76 years with the mean age of （47±13） years. Among them, 82 patients had extensive subarachnoid hemorrhage （SAH）, 7 had hemorrhage at longitudinal fissure, and 17 had hemorrhage at ambiens cistema and lateral fissure. Moreover, intraventricular hematocele was accompanied on 13 patients and hematom on 9 patients. METHODS： （1） 3D-CTA examination： Siemens SOMATOM Sensation 64 CT was used in this study. The thickness was 1 mm and interval of reconstruction was 0.8 mm. Localizing section was plainly scanned as the standard of canthus line. Scan ranged from 30 mm below sella to 50 mm above sella. Non-ion contrast medium of Omnipaque 350 （concentration of iodine was 350 g/L） was inserted into anterior vein of elbow with 18G trochar retained with high-pressured injectoc pum. The speed was 4.5 mL/s and the total volume was 80-100 mL with the means of 90 mL. Scan started at 10-20 s after injection of contrast medium. Original image was dealt with Leonardo workstation and retreated with Syngo software. Volume rendering and maximum intensity projection were used to reconstructed images, （2） All 106 patients suffered from occlusion of aneurysm clamp. Before operation, 3D-CTA was undertaken and DSA was followed. After operation, patients were rechecked with 3D-CTA. MAIN OUTCOME MEASURES： Comparisons between 3D-CTA and DSA. RESULTS ： All 106 patients were involved in the final analysis. （1） Examination of 3D-CTA and DSA： Among 118 patients with aneurysm, 110 were checked with 3D-CTA and the detected rate was 93.2% （110/118）. Among other 8 cases, 3 were negative and checked again with DSA; 1 had pericallosal aneurysm, 1 ophthalmic aneurysm, and 1 anterior choroidal artery of aneurysm. 3D-CTA results of other 5 cases were suspicious, and then, they were regarded as having aneurysm with DSA. Before operation, correlation among site, body, neck of aneurysm and peripheral anatomic structure were shown sufficiently. After operation, 82 patients were rechecked with 3D-CTA, which was complete occlusion, precise, unobvious constriction, emphraxis or remains as compared with 3D-CTA those pre-operation. （2） Characteristics of 3D-CTA： With multiple vessels and angles, 3D-CTA observed the relationship between aneurysm neck and carried artery and showed thrombosis in cavity of aneurysm, calcification of aneurysm wall and peripheral structure of vessel at the same time. However, DSA could not detect the reactions mentioned above. It could delete image of cranium, simulate image of operative route, eliminate artifact induced by metal, but not distinguish blood stream direction. Meanwhile, posterior communicating artery was always poor during circle of Willis artery showing. CONCLUSION： （1） 3D-CTA is characterized by simple operation and non-invasive showing vascular stereo structure and correlation. Therefore, it is significant for diagnosis and designing plan of operative approach and focal location pre-operation and evaluating effect post-operation. （2） 3D-CTA does not completely replace DSA on the diagnosis of intracranial aneurysm.
基金Supported by The National Natural Science Foundation of China,No.81800050Natural Science Fund of Yangzhou City,No.YZ2017119Science and Technology Innovation Cultivation Program of Yangzhou University,No.2017CXJ122
文摘BACKGROUND Situs inversus totalis(SIT)is a rare congenital condition that is characterized by a complete mirror image of the typical arrangement of the thoracic and abdominal viscera.Performing thoracoscopic segmentectomy for a patient with lung cancer and SIT is an extremely skilled and challenging surgical procedure.CASE SUMMARY A 41-year old woman with a medical history of dextrocardia since childhood was admitted to our hospital with a mixed ground-glass opacity(mGGO)in her left lung field,discovered by computed tomography during her health checkup.In order to facilitate surgical orientation,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was preoperatively carried out.The result of 3D-CTBA was consistent with the diagnosis of SIT and an mGGO in the posterior segment of the left upper lobe(LS2).Surgery was conducted in accordance with preoperative 3D-CTBA and designed surgical procedure,combined with intraoperative navigation.Final pathological examination revealed in situ adenocarcinoma.The patient’s postoperative condition was uneventful and no complications were observed.CONCLUSION We present the first case of lung cancer in a patient with SIT who successfully underwent thoracoscopic segmentectomy assisted by 3D-CTBA.This is a new technique that covers precise confirmation and dissection of targeted structures and intersegmental demarcation,and can help achieve a meticulous anatomical segmentectomy.
文摘AIM: To assess the incidence, location, morphology and clinical association of myocardial bridging in a Saudi population using coronary computed tomographic angiography(CCTA). METHODS: A total of 350 CCTA of Saudi patients were included in this study(236 men, 114 women) with a mean age of 56.3 years. All patients were examined for appropriateness criteria of CCTA indications(typical chest pain, recent onset cardiomyopathy, left bundle branch block, etc.). The scans were retrospectively reviewed for the presence of myocardial bridging and any other pathological association. RESULTS: Myocardial bridging was found in 89 of 350(22.5%) patients. Most of the intramuscular segments were of the superficial type and found in the mid left anterior descending(LAD)(24.6%), followed by distal LAD(3.7%), diagonal branches(2%), ramus intermedius artery(1.4%) and obtuse marginal artery(0.8%). No myocardial bridging was detected in the right coronary or circumflex arteries. No significant differences were found between males and females(P = 0.14). Coronary artery atherosclerosis was found in 51 of 89(57.3%) patients with MB. Atherosclerotic plaques were not detected in the intramuscular or distal segment of bridging arteries. Dynamic compression was observed in 35(94.5%) patients with full encasement. No evidence of myocardial hypoperfusion was found in the territories supplied by the bridging arteries. CONCLUSION: CCTA is excellent in analyzing myocardial bridging in a Saudi population and the results are comparable to other populations. However, finding the real incidence may need a large multicenter study.
基金supported by Hubei Health Committee of China(No.WJ2019M119).
文摘Objective To investigate the feasibility of subtraction coronary computed tomographic(CT)angiography(SubCCTA)to decline calcium artifacts and improve diagnostic accuracy in the presence of coronary calcification and analyze the factors that influence SubCCTA.Methods A total of 294 patients suspected of having coronary artery diseases underwent coronary computed tomographic angiography(CCTA)and SubCCTA.Coronary stenoses were blindly evaluated by two experienced radiologists,which were compared with invasive coronary angiography(ICA).Multiple statistical indexes were adopted to analyze the value of SubCCTA for the diagnosis of calcium stenoses.Results The diagnosable rate of SubCCTA was 67.2%(n=197),and the non-diagnosable rate was 32.8%(n=97).Using SubCCTA,the false positive rate decreased from 56.5%to 17.4%,and the corresponding diagnostic accuracy was increased from 83.6%to 92.9%.Univariate logistic regression analysis showed that height(OR=1.029,95%CI=1.001–1.058),weight(OR=1.025,95%CI=1.004–1.046),left ventricular size(OR=1.018,95%CI=1.007–1.030),cardiothoracic ratio(OR=39.917,95%CI=1.244–1281.098),the average heart rate(OR=0.866,95%CI=0.836–0.896)and heart rate range(OR=0.882,95%CI=0.853–0.912)might be the factors influencing SubCCTA.Conclusion This study suggested that SubCCTA could help improve diagnostic accuracy in the presence of calcium plaques.Moreover,several factors were discovered for the first time to possibly influence SubCCTA,which will be helpful in improving the subtracted image quality.
文摘Introduction: The aim of our study was to assess the incremental value of Coronary Computed Tomography Angiography (CCTA) added to classical coronary angiography, for complex characterization of coronary lesions and prediction of procedural complexity in patients with significant left main (LM) stenoses. Material and Methods: Thirty-six patients with LM disease were enrolled in the study, and each subject underwent CCTA followed by coronary angiography and percutaneous revascularization. Results: Logistic regression analysis indicated a good correlation between the angiographic-calculated and the CCTA-derived Syntax scores for the whole group (r = 0.87, p < 0.0001) and for the high risk subgroup (r = 0.86, p < 0.0001), but not for the low and intermediate risk (r = 0.38, p = 0.21 and r = 0.62, p = 0.07 respectively). In cases which required complex PCI procedures, both angiographic and CCTA Syntax score were significantly higher than those who did not require complex revascularization procedures (24.5 +/-11.5 vs 32.2 +/-14.6, p = 0.09 for Angio Syntax, 35.3 +/-11.5 vs 25.2 +/-11.3, p = 0.01 for CCTA). In the same time, Ca scoring was significantly higher and plaque volumes were significantly larger in cases requiring complex revascularization procedures (299.5 +/-359.6 vs 917.3 +/-495.4, p = 0.04 for calcium score, 79.7 +/-28.5 vs 108.7 +/-25.3 mm3, p = 0.002 for plaque volumes). Multivariate analysis identified the following CCTA parameters as significant predictors of increased risk for complex intervention in LM lesions: plaque volume (OR 8.00, p = 0.008), Ca scoring (OR 6.37, p = 0.02) and CCTA Syntax score (OR 6.87, p = 0.01). Conclusions: CCTA derived parameters provide incremental information to classical coronary angiography for preoperative assessment of lesion severity in complex left main stenosis. CCTA derived Syntax score significantly correlates with the classical Coronary Angiography Syntax score and identifies the subgroup of patients who will be more exposed to procedural complications during the revascularization interventions.
基金National Natural Science Foundation of China,No.81800050Natural Science Fund of Yangzhou City,No.YZ2017119Science and Technology Innovation Cultivation Program of Yangzhou University,No.2017CXJ122.
文摘BACKGROUND Anatomical segmentectomy has been proposed as a substitution for lobectomy for early-stage lung cancer.However,it requires technical meticulousness due to the complex anatomical variations of segmental vessels and bronchi.AIM To assess the safety and feasibility of three-dimensional computed-tomography bronchography and angiography(3D-CTBA)in performing video-assisted thoracoscopic surgery(VATS)for lung cancers.METHODS In this study,we enrolled 123 patients who consented to undergo thoracoscopic segmentectomy and lobectomy assisted by 3D-CTBA between May 2017 and June 2019.The image data of enhanced computed tomography(CT)scans was reconstructed three-dimensionally by the Mimics software.The results of preoperative 3D-CTBA,in combination with intraoperative navigation,guided the surgery.RESULTS A total of 59 women and 64 men were enrolled,of whom 57(46.3%)underwent segmentectomy and 66(53.7%)underwent lobectomy.The majority of tumor appearance on CT was part-solid ground-glass nodule(pGGN;55.3%).The mean duration of chest tube placement was 3.5±1.6 d,and the average length of postoperative hospital stay was 6.8±1.8 d.Surgical complications included one case of pneumonia and four cases of prolonged air leak lasting>5 d.Notably,there was no intraoperative massive hemorrhage,postoperative intensive-care unit stay,or 30-d mortality.Preoperative 3D-CTBA images can display clearly and vividly the targeted structure and the variations of vessels and bronchi.To reduce the risk of locoregional recurrence,the application of 3D-CTBA with a virtual 3D surgical margin help the VATS surgeon determine accurate distances and positional relations among the tumor,bronchial trees,and the intersegmental vessels.Three-dimensional navigation was performed to confirm the segmental structure,precisely cut off the targeted segment,and avoid intersegmental veins injury.CONCLUSION VATS and 3D-CTBA worked in harmony in our study.This combination also provided a new pattern of transition from lesion-directed location of tumors to computer-aided surgery for the management of early lung cancer.
文摘AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) patients.METHODS:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative study.All CTV procedures were performed with a dual-source CT scanner.The presence and location of SVT were determined via blinded imaging data analyses.RESULTS:According to the DSA results,17(39.5%)of the total 43 patients had SVT.The sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),respectively.CONCLUSION:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.
文摘Initiation, growth, and rupture of cerebral aneurysms are caused by hemodynamic factors. It is extensively accepted that the cerebral aneurysm wall is assumed to be rigid using computational fluid dynamics (CFD). Furthermore, fluid-structure interactions have been recently applied for simulation of an elastic cerebral aneurysm model. Herein, we examined cerebral aneurysm hemodynamics in a realistic moving boundary deformation model based on 4-dimensional computed tomographic angiography (4D-CTA) obtained by high time-resolution using numerical simulation. The aneurysm of the realistic moving deformation model based on 4D-CTA at each phase was constructed. The effect of small wall deformation on hemodynamic characteristics might be interested. So, four hemodynamic factors (wall shear stress, wall shear stress divergence, oscillatory shear index and residual residence time) were determined from the numerical simulation, and their behaviors were assessed in the basilar bifurcation aneurysm.
基金grants from the National Natural Science Foundation of China，Capital Special Clinical Application Grants
文摘Background： Coronary computed tomographic angiography （CCTA） has been widely used in patients who are at intemaediate risk for having stable coronary artery disease （SCAD）, and 2013 European Society of Cardiology Guidelines on the Management of SCAD （2013G） recommended the appropriate application of CCTA. However, 2013G has not been subjected to systematic analyses for subsequent impact on clinical practice. Methods： A total of 5320 patients suspected with SCAD were enrolled and scheduled for CCTA from March 2013 to September 2014. For each patient, pretest probability of SCAD was calculated according to updated Diamond-Forrester model （UDFM）. Appropriate CCTA or appropriate stress test was determined as described in the 2013G. A generalized estimating equation model was used to determine the trends in the half-monthly rate of appropriate CCTA. Results： Overall, only 61.37% of patients received appropriate CCTA, and there was insignificant change over time （P = 0.8701）. The application of CCTA in patients who should have had a stress test accounted for most of the inappropriate CCTA before （22.29%） or after （19.98%） the publication of the 2013G. In all patients or any subgroup, no significant change in the adjusted half-monthly rate of appropriate CCTA was found after the publication of the 2013G （odds ratio, 1.002; 95% confidence interval, 0.982-1.021; P = 0.8678）. Conclusions： These findings suggest that the 2013G have not, to date, been fully incorporated into clinical practice, and the clinical utilization of CCTA remains unreasonable to some extent.
文摘Coronary computed tomographic angiography （CCTA） as a noninvasive diagnostic technique for the evaluation of coronary anatomy is widely used clinically. Its advantages include high sensitivity and specificity for the diagnosis of present of coronary artery lesions and lesion characteristics,
基金This study was supported by the National Natural Science Foundation of China(Grant No.81400267)Postdoctoral fellow support fund from Sichuan University(Grant No.20826041E4070)Sichuan Science and Technology Program(Grant No.2021YFS0330).
文摘Risk assessment in coronary artery disease plays an essential role in the early identification of high-risk patients.However,conventional invasive imaging procedures all require long intraprocedural times and high costs.The rapid development of coronary computed tomographic angiography(CCTA)and related image processing technology has facilitated the formulation of noninvasive approaches to perform comprehensive evaluations.Evidence has shown that CCTA has outstanding performance in identifying the degree of stenosis,plaque features,and functional reserve.Moreover,advancements in radiomics and machine learning allowmore comprehensive interpretations of CCTA images.This paper reviews conventional as well as novel diagnostic and risk assessment tools based on CCTA.
文摘The aim of this study is to examine morphology of intracranial aneurysm with neck indistinguishable from surrounding artery branches by cerebral angiography and discuss whether such aneurysms can be treated by interventional embolization. 6 patients who had not been treated by embolization due to irregular wide-necked aneurysms indistinguishable from surrounding artery branches by cerebral angiography received craniotomy for aneurysm clipping. The operations succeeded. Morphologically, neck width and location of the aneurysms were carefully observed and photographed from different directions and multi-angles during operation. The intraoperative findings were compared with the preoperative CTA and DSA images. Walls of the 6 patients’ aneurysms tightly clung to or adhered to surrounding branches and oppressed the branches into arcs, similar to the aneurysm walls in shape, and arterial branches and aneurysm walls suffered from segmental adhesion. In addition, abnormalities of communicating arteries to vary degrees were observed in 4 patients. However, after successful surgical clipping, it was revealed that the aneurysms would have been better treated by embolization since they are basically saccular aneurysms with regular sizes. Deformations in preoperative angiography may be due to anatomical variations of surrounding vessels near the aneurysms, aneurysm wall oppression or incomplete adhesion of surrounding arterial branches. Such deformations can be recognized by careful observation in preoperative angiography from different directions and multi-angles.
文摘BACKGROUND:Orthotopic liver transplantation has be-come the treatment of choice for patients with end-stage liver disease.This study was designed to study whether multislice spiral CT angiography(MSCTA)could be used for preoperative evaluation for orthotopic liver transplanta-tion candidates.METHODS:Eighty consecutive potential candidates for liver transplantation were evaluated with dual-phase three-di-mensional CT angiography(3DCTA).The arterial-phase was used to create vascular maps of the celiac axis(inclu-ding the origin of the hepatic common artery,left gastric artery and splenic artery)and origin of the superior mesen-teric artery.The portal venous-phase was used to analyze portal vein thrombosis and collateral vascularization of the portal vein.Statistical analyses were made using the chi-square test for differences between hepatic arterial anatomy of 80 patients and Michel's anatomy of 200 patients.Appearance of MSCTA and operative results of 16 patients were analyzed.RESULTS;Sixty-two patients(77.5%)showed conven-tional and 18(22.5%)nonconventional hepatic arterial anatomy.A significant difference was found between the two groups in anatomy of the hepatic artery(P<0.05).Celiac axis stenosis was observed in 6 patients,SA aneu-rysm in 2,small-caliber hepatic arterial vessels in 2,and portal vein thrombosis in 15.Vascular structures of 16 ope-rative patients were well defined.CONCLUSION:As a noninvasive examination,MSCTA can provide a comprehensive preoperative vascular evalua-tion for liver transplantation candidates.
文摘OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional CT angiography in the surgical treatment of intracranial aneurysms. METHODS: Twenty-four patients suspected of intracranial aneurysms underwent routine catheter four-vessel angiography, three dimensional CT angiography (3D-CTA), magnetic resonance angiography (MRA) or conventional digital subtraction angiography (DSA). RESULTS: A total of 28 aneurysms were detected by CT angiography in this study. Twenty-one patients each had a single aneurysm, two patients each had two aneurysms, and one had three aneurysms. The shapes of aneurysms revealed by 3D-CTA were round in 20 lesions, elliptical in 5, and 1 obulated in 3. Of the 24 lesions which were completely disclosed during surgery, the shapes correlated well with the 3D-CT angiograms. The mean diameter of the aneurysmal neck was 5.9 mm in 3D-CTA images, with the smallest being 1.6 mm and the largest 13.7 mm. The size was very close to the actual size measured at surgery (P
