3-dimensional Computed Tomography Angiography Research Articles

Comparison of 2 Contrast Materials With Different Iodine Concentrations in 3-Dimensional Computed Tomography Angiography of the Hepatic Artery at Multi-Detector-Row Computed Tomography

To investigate differences in visual evaluation of the hepatic arteries and contrast enhancement of the vessels and liver at 3-dimensional (3D) computed tomography (CT) angiography by 2 different concentrations of contrast materials. Eighty patients were randomly assigned into groups A and B receiving contrast materials with iodine concentrations of 300 and 370 mg/mL, respectively. The total iodine load (600 mg/kg), iodine injection time (25 seconds), and saline flush time (10 seconds) were identical. Seventy-two patients were evaluable. There were no differences between the 2 groups in visual evaluation of the hepatic arteries at 3D CT angiography. Contrast enhancement of the aorta at the late arterial phase and the liver at the portal phase was significantly higher in group B than in group A, but otherwise, there were no differences. Enhancement of the aorta and portal vein was higher in women than in men at some phases. With the same iodine dose and injection time, the concentration of contrast materials did not seem to be important in obtaining optimal images at 3D CT angiography of the hepatic artery.

Three Dimensional Computed Tomography Angiography in Imaging Jugular Foramen Lesions

Three Dimensional Computed Tomography Angiography in Imaging Jugular Foramen Lesions

Three Dimensional Computed Tomography Angiography in Imaging Jugular Foramen Lesions

Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.

Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report

Background Tentorial dural arteriovenous fistula (AVF) presented symptoms due to mass effect on the dilated draining vein. We report a patient presenting left hemisensory disturbance because of compression of the midbrain by a dilated draining vein of the AVF. The AVF has disappeared completely by drainer clipping after feeder embolization. Case Description A 66-year-old woman presented with left hemisensory disturbance due to compression of the midbrain by a dilated draining vein with tentorial dural AVF. On admission, she complained of left hemisensory disturbance. Enhanced computed tomography (CT), magnetic resonance imaging, and magnetic resonance angiogram revealed the midbrain compressed by a mass lesion, which was a draining vein with AVF fed by numerous feeding arteries neighboring the right tentorial edge. The single-photon emission CT (SPECT) did not depict any laterality. Conclusion This is a rare case of a tentorial dural AVF which caused left hemisensory disturbance not by venous congestion, but by a compression of the midbrain by the dilated draining vein, because SPECT showed no laterality. In this case, magnetic resonance angiogram, 3-dimensional CT angiography, and SPECT were useful in the diagnosis and planning the strategy for treatment.

Commentary

Background: Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). The origin of the DMCA lies between the anterior choroidal artery and the distal end of the ICA. The association of cerebral aneurysm and DMCA is rare. Case Description: In this 63-year-old woman, preoperative angiography and 3-dimensional computed tomography angiography revealed an aneurysm at the origin of the DMCA. The aneurysm was clipped and superficial temporal artery-DMCA anastomosis was performed. She was discharged with no neurologic deficits. Duplication of the middle cerebral artery can be divided into 2 types based on whether the site of separation from the ICA is at the top of the ICA (type A) or between the ICA top and the anterior choroidal artery (type B). The diameter of type A DMCA is comparable with that of the main middle cerebral artery trunk; in type B, it is smaller. In all 18 previously reported cases, the aneurysm was associated with type B DMCA. Conclusion: For appropriate treatment planning, it is necessary to determine the DMCA type and the anatomic relationship between the aneurysm and the DMCA. In patients with type B DMCA, the possibility of aneurysm formation should be considered.

Treatment of unruptured duplicated middle cerebral artery aneurysm: case report

Background Duplication of the middle cerebral artery (DMCA) is an anomalous vessel arising from the internal carotid artery (ICA). The origin of the DMCA lies between the anterior choroidal artery and the distal end of the ICA. The association of cerebral aneurysm and DMCA is rare. Case Description In this 63-year-old woman, preoperative angiography and 3-dimensional computed tomography angiography revealed an aneurysm at the origin of the DMCA. The aneurysm was clipped and superficial temporal artery–DMCA anastomosis was performed. She was discharged with no neurologic deficits. Duplication of the middle cerebral artery can be divided into 2 types based on whether the site of separation from the ICA is at the top of the ICA (type A) or between the ICA top and the anterior choroidal artery (type B). The diameter of type A DMCA is comparable with that of the main middle cerebral artery trunk; in type B, it is smaller. In all 18 previously reported cases, the aneurysm was associated with type B DMCA. Conclusion For appropriate treatment planning, it is necessary to determine the DMCA type and the anatomic relationship between the aneurysm and the DMCA. In patients with type B DMCA, the possibility of aneurysm formation should be considered.

Fenestration of Vertebral Artery at the Craniovertebral Junction in Down Syndrome: A Case Report

Case report of a Down syndrome patient with right vertebral artery fenestration and abnormalities of the craniovertebral junction. Describe the utility of 3-dimensional computed tomography angiography for evaluating vertebral artery anomalies before surgery. Previous reviews evaluating catheter angiograms identified various anomalies of vertebral artery at the craniovertebral junction. The frequency of vertebral artery anomalies is increased in patients having osseous anomalies at the craniovertebral junction. Down syndrome is associated with a high incidence of bone abnormalities at the craniovertebral junction, but there have been no published reports of vertebral artery anomalies per se at the craniovertebral junction. A 16-year-old woman with trisomy 21 presented with gait abnormalities and myelopathy in association with bone abnormalities at the craniovertebral junction, including hypoplastic odontoid and ossiculum terminale. Computed tomography angiography showed that right vertebral artery bifurcated after exiting the C2 transverse foramen with one branch passing through the C1 transverse foramen, whereas the other turned posteromedially and entered the spinal canal between C1 and C2. Occipito-C2 posterior fusion was performed with a rod and screw system. Intraoperatively, the course of the anomalous right vertebral artery was identified by Doppler angiography, and the surgical approach was modified to allow safe pedicle screw insertion while avoiding vertebral artery injury. After surgery, myelopathy resolved within 3 months. Before corrective surgery of craniovertebral junction anomalies in patients with Down syndrome, the possibility of vertebral artery anomalies associated with abnormal craniovertebral junction anatomy should be considered. With preoperative 3-dimensional computed tomography angiography, we can precisely identify the anomalous vertebral artery and modify the surgical approach to reduce the possible risk of intraoperative vertebral artery injury in advance.

Selective intra-arterial 3-dimensional computed tomography angiography for preoperative evaluation of nephron-sparing surgery.

To evaluate selective intra-arterial 3-dimensional computed tomography (3D-CT) angiography as a tool for the preoperative evaluation of nephron-sparing surgery (NSS). Twenty-three patients with renal cell carcinoma indicating NSS underwent selective intrarenal 3D-CT angiography. The time-lapse dual-phase technique was used for simultaneous vascular and urographic visualization. The 3D images were created by the shaded volume-rendering method. The CT attenuation of target structures was measured for quantitative evaluation. The 3D images were visually evaluated for the renal artery, vein, and collecting system using a grading system. Results were statistically analyzed. The 3D-CT angiography depicted the intrarenal branches of the renal artery and vein and the whole collecting system in most patients. Visualization of the renal artery was significantly correlated to its CT attenuation. Visualization of the renal vein was correlated to its CT attenuation adjusted by the surrounding renal parenchyma. Selective intra-arterial 3D-CT angiography allows the detailed visualization of intrarenal structures.

Renal computed tomography with 3-dimensional angiography and simultaneous measurement of plasma contrast clearance reduce the invasiveness and cost of evaluating living renal donor candidates.

Renal computed tomography (CT), 3-dimensional CT angiography (3D-CTA), and simultaneous measurement of glomerular filtration rate (GFR) by x-ray fluorescence determination of plasma contrast clearance (PCC) are alternatives to intravenous urography (IVU), renal arteriography (RA), and 24-hr urine creatinine clearance (CrCl) for evaluation of renal structure and function in living renal donor (LRD) candidates. To determine if CT, 3D-CTA, and PCC provide data comparable to IVU, RA, and CrCl, both methods were used to evaluate 23 LRD candidates. Costs were also compared. Conventional RA identified 19 accessory arteries and one case of medial fibroplasia. Each of these anomalous vessels was recognized on 3D-CTA. Venous anatomy was more clearly delineated on 3D-CTA than the venous phase of conventional RA. CT demonstrated 3 benign cysts and a single, small intraparenchymal calcification in 3 renal units. GFRs measured by PCC and CrCl were 91 +/- 4 and 132 +/- 7 ml/min/1.73m2, respectively (r = 0.64, P < 0.05). Total cost for CT/3D-CTA/PCC was 46% less than that of IVU/RA/CrCl and 40% less than RA/CrCl. CT/3D-CTA/PCC provided reliable structural and functional data at substantially less cost, discomfort, and inconvenience to the living renal donor candidate. As such, CT/3D-CTA/PCC is superior to conventional methods for evaluation of the living renal donor candidate.