Multi-slice Spiral CT Angiography Research Articles

Effect of low density carotid plaque on the development of cerebral small vessel disease in patients with carotid stenosis

Objective: To investigate the correlation between cerebral small vessel disease (CSVD) and carotid low-density plaque on multi-slice spiral CT angiography (MSCTA) in patient with carotid stenosis. Methods: The clinical data of 221 patients with carotid stenosis who admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, from January 2016 to January 2021 were retrospectively analyzed. There were 195 males and 26 females, with the age of (70.0±8.4) years (range: 48 to 88 years). According to MRI, the patients were divided into carotid stenosis combined with CSVD group (the CSVD group) and carotid stenosis without CSVD group (the non-CSVD group). Lowest density in the carotid atherosclerotic plaque area (CAPALD) was analyzed by MSCTA. The t-test, Mann-Whitney U test and Chi-square test were used for comparison between the two groups. Univariate and multivariate Logistic regression analysis were performed on CAPALD and other clinical indicators with CSVD. Receiver operating characteristic (ROC) curves of CAPALD and CAPALD combined with the demographics (sex, age and body mass index) were plotted for predicting CSVD, and the area under the curve (AUC), sensitivity and specificity were calculated. Results: There were 169 patients in the CSVD group and 52 patients in the non-CSVD group. In the CSVD group, 88.8% (150/169) were males and 11.2% (19/169) were females, with the age of (70.5±8.2) years (range: 48 to 88 years). In the non-CSVD group, 86.5% (45/52) were males and 13.5% (7/52) were females, with the age of (68.4±9.1) years (range: 51 to 85 years). CAPALD and the score of Montreal cognitive assessment were lower in the CSVD group than those in the non-CSVD group (21.0 HU vs. 35.0 HU, Z=-3.760, P<0.01; 22.6±3.9 vs. 24.8±3.3, t=-2.064, P<0.05). Multivariate Logistic regression analysis showed that CAPALD was an independent factor for CSVD (OR=1.044, 95%CI:1.020 to 1.070, P<0.01). The AUC of the ROC curve for CAPALD predicting carotid stenosis with CSVD was 0.672 (P<0.01), with cut-off value of 34.5 HU, sensitivity of 82.8%, and specificity of 50.0%. The AUC of ROC curve for CAPALD combined with the demographics predicting CSVD was 0.733 (P<0.01), with sensitivity of 82.9% and specificity of 64.0%. Conclusions: The decreased CAPALD is a risk factor for CSVD in patients with carotid stenosis. The analysis of carotid plaque density by MSCTA may help to identify the patients at high risk of CSVD.

Clinical Applications of Multi-slice Spiral CT Angiography (CTA)

Clinical Applications of Multi-slice Spiral CT Angiography (CTA)

Diagnostic value of three-dimensional reconstruction with multislice spiral CT angiography in patients with cerebrovascular disease.

Diagnostic value of three-dimensional reconstruction with multislice spiral CT angiography in patients with cerebrovascular disease.

Clinical Value of Multi-Slice Spiral CT Angiography, Colon Imaging, and Image Fusion in the Preoperative Evaluation of Laparoscopic Complete Mesocolic Excision for Right Colon Cancer: a Prospective Randomized Trial

PurposeTo evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer. MethodsIn this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery. ResultsIn the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05). ConclusionsFor laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes.

Preoperative evaluation using multi-slice spiral CT angiography of right-side colon vascular in laparoscopic radical operation for right colon cancer

Objectives: To examine the value of multi-slice spiral CT angiography (MSCTA) in the analysis of anatomical variation and structural classification of right colon vessels. Methods: From August 2015 to August 2017, 198 patients (96 of whom underwent laparoscopic radical resection of right colon cancer) at Department of General surgery of Peking University First Hospital were retrospectively collected, and the results of abdominal enhanced CT scan were collected and three-dimensional reconstruction of blood vessels was performed. There were 104 males and 94 females. The age was 64(27) years (M(Q(R)), range: 19 to 87 years). Right gastroepiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein (RCV), superior right colonic vein, ileocolon artery or vein (ICA or ICV), middle colon artery or vein (MCA or MCV) and Henle trunk were observed and recorded respectively. The anatomical relationship between the positions of blood vessels, the length of Henle trunk and surgical trunk were measured. Results: ICV and ICA were the most constant anatomic structures. The ICV/ICA of all patients came directly from SMV/SMA, 36.9% (73/198) ICV going in front of SMV and 63.1% (125/198) behind SMV. 72.2% (143/198) of the patients had RCV imported into Henle trunk and the rest into SMV. Middle colonic vein (MCV) could be observed in 81.3% (161/198) of the cases. 81.4% (131/161) of MCV were imported into SMV, 16.8% (27/161) into Henle trunk, 1.2% (2/161) into the first jejunal vein and 0.6% (1/161) into the splenic vein. Henle trunk was divided into 4 types, among which the occurrence probability of gastric node and pancreatic trunk was the highest. The dry length of Henle trunk was (0.82±0.39) cm (range: 0.37 to 1.68 cm). The length of surgical trunk was (2.54±0.83) cm (range: 1.57 to 3.95 cm). Accuracy of MSCTA results was 96.9%(93/96). Conclusions: Anatomical variation of blood vessels in the right colon is common. Abdominal CT angiography can accurately determine the anatomical structure of the blood vessels in the right colon.

Clinical value of multi-slice spiral CT angiography in the diagnosis of abdominal tumors

Objective To study the clinical value of multi-slice spiral CT angiography in the diagnosis of abdominal tumors. Methods From January 2015 to December 2017, 90 patients with abdominal neoplasms in the First People's Hospital of Yongkang were divided into two groups according to double-blind randomized method, with 45 patients in each group.The patients with conventional CT scan were included in the control group, and the patients with multislice spiral CT angiography were selected as the observation group.The scan results, invasion range and location of abdominal tumor, vascular display and perfusion parameters were compared between the two groups. Results The diagnostic accuracy of abdominal tumor and invasion range in the observation group(93.33%, 80.00%) was higher than those of the control group(χ2=5.414, 5.086, all P<0.05). The proportions of abnormal thickening of one supply artery(27 cases) and two blood supply arteries(8 cases) in patients with malignant and borderline venereal lesions with normal diameter were higher than those of patients with benign lesions(χ2=31.765, 8.372, all P<0.05). The contrast medium through time, blood flow, blood volume and capillary surface permeability in patients with benign lesions and normal average diameter were (10.55±3.02)s, (21.54±5.58)mL·min-1·100 g-1, (4.04±0.76) mL/100 g, (10.16±2.73)mL·min-1·100 g-1, respectively, which were lower than those of patients with malignant and border venereal focal lesions (t=3.016, 5.005, 4.982, 6.989, all P<0.05). Conclusion Application of multislice spiral CT angiography in the clinical diagnosis of abdominal tumors has high accuracy and can better display the abnormal condition of blood vessels. Key words: Abdominal tumor; Tomography, spiral computed; Cineangiography; Single slice spiral CT; Invasive range; Benign lesion; Supply artery; Normal diameter; Perfusion parameters; Application value

Clinical value of multi-slice spiral CT angiography in the diagnosis of intracranial aneurysms

Objective To investigate the clinical value of multi-slice spiral CT angiography(CTA) in the diagnosis of intracranial cerebral aneurysms. Methods From January 2014 to December 2016, the clinical data of 60 patients with suspected intracranial aneurysms in Yiwu Central Hospital were retrospectively analyzed.The patients received CTA, digital subtraction angiography(DSA) examination.Based on the postoperative pathological results, the specificity, accuracy, consistency of CTA and DSA in the diagnosis of intracranial aneurysm were calculated.CTA, DSA diagnosis results and cerebral aneurysm surgery results were analyzed.The intracranial aneurysm diameter, the maximum diameter of the aneurysm neck of CTA, DSA inspection were compared. Results Based on the postoperative pathological results, the diagnostic sensitivity, specificity and accuracy of CTA for intracranial aneurysms were 97.06%, 92.31%, 95.00%, respectively, which of DSA were 94.12%, 96.15%, 95.00%, respectively, there were no statistically significant differences between the two groups(all P>0.05). The consistency coefficient of CTA was 0.719, and DSA coefficient of agreement with the findings in operation was 0.736, the consistency was good.The intracranial artery tumor maximum diameter, maximum diameter of aneurysm neck by CTA, DSA examination had no statistically significant differences(all P>0.05). Conclusion CTA in the diagnosis of intracranial aneurysm has high sensitivity and accuracy, the diagnostic value is close to DSA and can be used as auxiliary means of DSA. Key words: Intracranial aneurysm; Cerebral angiography; Tomography, spiral computed; Angiography, digital subtraction; Diagnosis

Value of the multi-slice spiral CT angiography, CT colonography and image fusion technology in preoperative evaluation of laparoscopic right colon cancer

Objective To observe the distribution and variation of right colonic vessels, and investigate the clinical value of computed tomography angiography (CTA), computed tomography colonography (CTC) and image fusion technology in preoperative evaluation of laparoscopic right colonic cancer (RCC). Methods The retrospective and descriptive study was conducted. The clinicopathological data of 38 patients who underwent laparoscopic extended radical resection of RCC + D3 lymphadenectomy in the Affiliated Wuxi Second People′s Hospital of Nanjing Medical University between January 2015 and July 2017 were collected. Patients received preoperative plain and enhanced scans of abdominal and pelvic CT. The original images were reconstructed and fused by CTA and CTC, and then coming out with three-dimensional images of blood vessels and gut. Observation indicators: (1) branches of superior mesenteric artery (SMA); (2) positional relationship between SMA and superior mesenteric vein (SMV); (3) composition of gastrocolic venous trunk. Results Scan images of 38 patients had fused with scan images of vessels and primary tumors and reached the diagnostic standard, with a good imaging performance. Distribution of blood vessels of virtual reality (VR) images and were compared with that of naked blood vessels under intraoperative laparoscopy, showing a coincidence rate of 100.0%(38/38). (1) Branches of SMA: results of CTA and intraoperative anatomy showed that the occurrence rate of the right colonic artery, middle colonic artery and ileocolic artery were respectively 94.7%(36/38), 92.1%(35/38) and 100.0%(38/38). A right colonic artery was found in 28 patients. Ten patients had structure variation of right colonic artery, including 3 with 2 right colonic arteries and 2 without right colonic artery. The right colonic artery and middle colonic artery merged into the same trunk and then flowed into SMA were detected in 2 patients; the right colonic artery and ileocolic artery merged into the same trunk and then flowed into SMA were detected in 3 patients. (2) Positional relationship between SMA and SMV: results of CTA and intraoperative anatomy showed that the occurrence rate of both SMA and SMV was 100.0%(38/38). The SMA in 20 patients was located in the ventral side of SMV; SMA in 18 patients was located in the dorsal side of SMV. (3) Composition of gastrocolic venous trunk: results of CTA and intraoperative anatomy showed that 29 of 38 patients had gastrocolic venous trunks, which belonged to four sources, including right colonic vein, middle colonic vein, right gastric epiploic vein and anterior superior pancreaticoduodenal vein. Among 29 patients, 18 had 2- or 3-branch type of gastrocolic trunk that consisted of the right gastric epiploic vein, middle colonic vein and right colonic vein; 3 had 2-branch type of gastric pancreatic trunk that consisted of the right gastric epiploic vein and anterior superior pancreaticoduodenal vein; 8 had 3- or 4-branch type of stomach-pancreas-colon trunk that consisted of right gastric epiploic vein, anterior superior pancreaticoduodenal vein, right colonic vein and middle colonic vein. Conclusion CTA, CTC and image fusion technology can intuitively show the anatomy and variation of right colonic vessels, with a high clinical value. Key words: Colonic neoplasms; Preoperative evaluation; Vascular reconstruction; Computed tomography angiography; Computed tomography colonography; Extend right hemicolectomy; Laparoscopy

Comparison of the effect of different contrast media concentrations on multi slice spiral CT angiography of abdominal artery

Objective To investigate the effect of different contrast media concentrations on abdominal aortic angiography with multi-slice spiral CT. Methods 85 patients underwent abdominal multi slice spiral CT angiography were selected, and they were randomly divided into high concentration group(45 cases) and low concentration group(40 cases) according to random number table method.The high concentration group used 370mgI/mL contrast agent 60mL, and the low concentration group used 300mgI/mL contrast agent 100mL.The abdominal aorta to enhance value, image quality and the incidence of adverse reactions were compared between the two groups. Results The scores of renal artery and abdominal aorta in the high concentration group were significantly higher than those in the low concentration group[(3.76±0.85)points vs.(3.27±0.69)points, (2.57±0.53)points vs.(2.11±0.50)points], the differences were statistically significant(t=2.895, 4.101, all P<0.05). The levels of celiac trunk, renal artery and iliac artery in the high concentration group were significantly higher than those in the low concentration group[(346.37±27.85)Hu vs.(305.74±22.69)Hu, (310.77±28.39)Hu vs.(289.50±19.85)Hu, (301.42±24.87)Hu vs.(276.59±23.10)Hu], the differences were statistically significant(t=7.316, 3.955, 4.750, all P<0.05). No adverse reactions occurred in the two groups. Conclusion High concentration of contrast agent can improve the multi-slice spiral CT angiography in patients with abdominal aorta to enhance value, so as to improve the image quality, and can reduce the dose of contrast agent, and it has high safety and is worthy of promotion. Key words: Tomography, spiral computed; Contrast media; Angiography; Abdomen

Evaluation of the relationship between meningiomas and adjacent large cerebral arteries by multi-slice spiral CTA

Objective To evaluate the relationship between meningiomas and adjacent large cerebral arteries by multi-slice spiral CT angiography (MSCTA) and its clinical significance in preoperative planning of tumor resection. Methods A retrospective analysis was conducted on 32 patients with meningiomas who were admitted to the Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University and underwent surgical operations from January 2004 to January 2016. MSCTA was conducted for all patients to evaluate the relationship between the tumors and adjacent (≤ 3 cm) cerebral large arteries. The relationship was categorized into 4 types according to the degree of compression, embedding or erosion, based on which the operational plan for tumor resection was made. Results All 32 patients included 3 (9.4%) cases in type Ⅰ, 10 (31.3%) in type Ⅱ, 9 (28.1%) in type Ⅲ and 10 (31.3%) in type Ⅳ (3 in type Ⅳa, 5 in type Ⅳb, and 2 in type Ⅳc). The coincidence rate of MSCTA classification with intraoperative findings was 96.9% (31/32). The tumor resection plan preoperatively made according to the classification was proved to be reasonable during surgery. The Simpson grade Ⅰ resection was performed in 10 (31.3%) cases, Simpson Ⅱ resection in 5 (15.6%) cases, and Simpson Ⅳ resection in 17 (51.1%) cases. The follow-up 6 months post operation did not report any complications related to damages of cerebral large arteries. Conclusion MSCTA could be used to accurately assess the relationship between meningiomas and adjacent large cerebral arteries and help with proper treatment of the nearby arteries during tumor resection. Key words: Meningioma; Cerebral arteries; Cerebral angiography; Multidetector computed tomography; Clinical protocols

Diagnosis of lower gastrointestinal bleeding by multi-slice CT angiography: A meta-analysis

PurposeTo estimate the diagnostic value of multi-slice spiral CT angiography (CTA) in lower gastrointestinal bleeding by a meta-analysis. MethodsThe relevant clinical studies on the diagnostic value of CTA were searched on PubMed, Embase and other electronic documents databases with the deadline of 2016 September. Language was limited to English. A diagnostic meta-analysis was performed by using Meta-DiSc software. The effect sizes included sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) and 95% confidence interval (CI). The Cochran-Q test and I2 statistic based on χ2 test were used for estimation of the heterogeneity. Meta-regression was performed to explore the source of heterogeneity. SROC curve was established. ResultsA total of 14 articles including 549 patients with lower gastrointestinal bleeding were enrolled in the meta-analysis. The combined PLR, NLR and DOR were respectively 8.149, 0.158 and 56.213. There were significant heterogeneities in all estimations but we could not find the sources by meta-regression based on study design, study location, CT slices and sample size. The AUC and Q index under the fixed effect model was respectively 0.9463 and 0.8856. ConclusionsThe multi-slice CTA has high diagnostic value for lower gastrointestinal bleeding.

Relationship between multi-slice spiral CT angiography imaging features and in-hospital death of patients with aortic dissection

Objective: To explore the imaging manifestations of multi-slice spiral CT angiography (CTA) and relationship with in-hospital death in patients with aortic dissection (AD). Methods: The clinical data of 429 patients with AD who underwent CTA in Zhongshan Hospital of Fudan University between January 2009 and January 2016 were retrospectively analyzed. AD patients were divided into 2 groups, including operation group who underwent surgery or interventional therapy (370 cases) and non-operation group who underwent medical conservative treatment(59 cases). The multi-slice spiral CTA imaging features of AD were analyzed, and multivariate logistic regression analysis was used to investigate the relationship between imaging manifestations and in-hospital death in AD patients. Results: There were 12 cases (3.24%) of in-hospital death in operation group, and 28 cases (47.46%) of in-hospital death in non-operation group(P<0.001). AD involved different vascular branches. Multi-slice spiral CTA can clearly show the dissection of true and false lumen, and intimal tear was detected in 363 (84.62%) cases, outer wall calcification was revealed in 63 (14.69%) cases, and thrombus formation was present in 227 (52.91%) cases. The multivariate logistic regression analysis showed that the number of branch vessels involved (OR=1.374, 95%CI 1.081-1.745, P=0.009) and tearing false lumen range(OR=2.059, 95%CI 1.252-3.385, P=0.004) were independent risk factors of in-hospital death in AD patients, and the number of branch vessels involved (OR=1.600, 95%CI 1.062-2.411, P=0.025) was independent risk factor of in-hospital death in the operation group, while the tearing false lumen range (OR=2.315, 95%CI 1.019-5.262, P=0.045) was independent risk factor of in-hospital death of non-operation group. Conclusions: Multi-slice spiral CTA can clearly show the entire AD, true and false lumen, intimal tear, wall calcification and thrombosis of AD patients. The number of branch vessels involved and tearing false lumen range are the independent risk factors of in-hospital death in AD patients.

Correlation between ponticulus of atlas and abnormal morphology of V3 segment of vertebral artery using multi-slice spiral CT angiography

Objective To explore the correlation between ponticulus of atlas and abnormal morphology of V3 segment of vertebral artery. Methods All patients included in this study were underwent CTA and 3D reconstruction examination of intracranial ponticulus and cervical in our workstation, as well as the site, shape of petals and its relationship with vertebral artery was observed. The diameter, shape and trail of vertebral V3 segment were measured and analyzed. The results were analyzed by χ2 test. Results A total of 195 sides (157 cases) ponticulus were detected in 613 cases (1 226 sides), the abnormal morphology of V3 segment of vertebral artery were 103 sides and combined with ponticulus 69 sides among them, including (according to side): the collectivity was 8.4% (103/1 226), combination ponticulus was 35.4% (69/195), uncombination ponticulus was 3.3% (34/1 031), and the risk with ponticulus was increased compared with no ponticulus, and showed statistical significance by Chi-square test (χ2=215.679, P=0.001). The difference of abnormality of vertebral artery was performanced in number, site and shape of ponticulus, we found that the ponticulus composite was 57.1% (12/21) and higher than ponticulus simple 32.8%(57/174) (χ2=4.873, P= 0.027), the ponticulus borderl was 68.8% (11/16) which was also higher than ponticulus posticus (27.2%) and ponticulus lateralis (36.4%) in the ponticulus simple (χ2=11.357, P=0.030), the sharp ones (64.2%) were higher than the blunt (14.6%)in the tip of bony processes of the incomplete type ponticulus (χ2=26.813, P=0.001 ),the smaller ones were higher than the larger in the distance of the gap between the two tips of bony processes in the incomplete type ponticulus (χ2=9.212, P=0.010), and the smallerones (87.5%) were also higher than the larger (28.6%)in the diameter of the hole of complete type ponticulus (χ2=18.193, P=0.001), all of the above ones showed statistical significance among all groups by Chi-square test (P<0.05). Conclusions Ponticulus of atlas can significantly increase the risk of abnormal morphology of V3 segment of vertebral artery, and the differences of abnormality of vertebral artery were performed in number, site and shape of ponticulus, which included the ponticulus composite, ponticulus borderland, the shape tip of bony processes, the moderate distance between the two lip of bony processes, and the smaller diameter of complete type Ponticulus. Key words: Atlanto-occipital joint; Vertebral artery; Angiography; Tomography, spiral computed

The value of CT angiography in diagnosis of intracranial aneurysms

Objective To study the application value of multislice spiral CT angiography(MSCTA)in diag-nosis of intracranial aneurysms. Methods MSCTA was used to diagnose intracranial aneurysms in 40 patients with subarachnoid hemorrhage. Subtraction angiography digital（DSA）was used as the gold standard to evaluate the sensi-tivity，specificity and accuracy of MSCTA for diagnosis of intracranial aneurysms. Results In 40 patients,34 aneu-rysms were detected in 32 patients and they were all confirmed by incarceration of aneurysm. The aneurysms were detected in 33 cases by MSCTA, and the aneurysms were 34.Most of them were single(31 cases),1 case was multiple and 1 case was false positive. DSA was detected in 32 patients with 34 aneurysms, but single in 30 cases and multiple in 2 cases. DSA as the gold standard, the sensitivity, specificity and accuracy of MSCTA in diagnosis of intracranial aneurysms were 100%,87.50% and 97.50% respectively. MSCTA detected aneurysm neck width 1.85-4.33mm, average aneurysm neck width was(3.65±1.85)mm.DSA detected aneurysm neck width 1.52-4.48mm, average aneurysm neck width was(3.41±1.96)mm. The average tumor neck width detected by the two methods had no sta-tistically significant difference(t＝0.78,P＞0.05). But from the minimum of the detection, DSA still had certain advantages. Conclusion The sensitivity of MSCTA for intracranial aneurysmswas high. It can be used as a method for surgical treatment of intracranial aneurysms, but it still can not completely replace the DSA. Key words: CT angiography angiography; Digital subtraction angiography; Intracranial aneurysms

Efficacy comparison of mid-term patency rates between sequential and individual saphenous vein grafts after off-pump coronary artery bypass grafting

Objective To compare the mid-term patency rates between individual and sequential saphenous vein grafts after off-pump coronary artery bypass grafting (OPCAB) and evaluate the effect of sequential anastomosis technique on the graft patency after OPCAB. Methods Clinical data of 200 patients receiving OPCAB with individual and sequential saphenous vein grafts from June 2011 to June 2013 were retrospectively analyzed. The multislice spiral CT angiography (MSCTA) was performed at an average of (20.0±21.5) months after OPCAB. The patency rate of individual and sequential grafts and anastomoses were compared, and the effect of different locations on the patency rate of the anastomoses was analyzed. Results There was no significant difference in the patency rate between individual and sequential grafts (χ2=1.886, P=0.170). The anastomosis patency rates in different locations had no significant differences between individual and sequential grafts (χ2=4.567, P=0.102). There was no significant difference in the distal anastomosis patency rate between sequential and individual grafts (P>0.05). The anastomosis patency rate in sequential graft had no significant difference in the side-to-side anastomose versus end-to-side anastomose (P>0.05). The patency rate of side-to-side anastomose in the sequential graft was higher than that of distal anastomose in individual graft (χ2=4.653, P=0.031). There were no significant differences in the patency rate in sequential grafts among different coronary systems (including the anterior descending branch, the right coronary artery and the circumflex branch) and individual grafts among different coronary systems respectively (all P>0.05). The anastomosis patency rates had no difference between sequential and individual grafts in the anterior descending branch. There were significant difference in end-to-side anastomosis patency rates between sequential and individual grafts in different coronary systems (χ2=6.184, P=0.045), but the distal anastomosis patency rate had no difference (χ2=1.807, P=0.431). No significant difference in the patency rates between sequential and individual grafts in side-to-side versus end-to-side (all P>0.05). Conclusions There is no significant difference in the mid-term patency rate between individual and sequential saphenous vein grafts after off-pump coronary artery bypass grafting (OPCAB). The patency rate is related with the anastomotic mode, the location of anastomotic, and the quality of the target vessel, diameter, number of grafts and other factors. The mid-term patency rate can be improved by choosing the target vessel with better conditions as the most distal sequential bridge, when conducting sequential anastomosis technique. Key words: Coronary artery bypass grafting, off-pump; Saphenous vein; Surgical stomas

Diagnosis of multi-slice spiral CT angiography in penetrating atherosclerotic ulcer

Objective To discuss and evaluate the value of multi slice spiral CT angiography in the diagno -sis of penetrating atherosclerotic ulcer materials .Methods 17 patients of PAU were collected and examined with MSCT,the location,radiological diagnosis and complications of PAU on axial ,CTA and 2D/3D images were analyzed. Results Ulcer-like aortic projections were observed of 17 patients,and connected with aortic cavity ,where ＆quot;narrow neck sign ＆quot;was showed .The indirect signs included localized or extensive IMH ,calcification of aortic wall and dilata-tion of aorta .Conclusion Multi slice spiral CT angiography is an effective method for the diagnosis of PAU by provi -ding valuable information for the diagnosis and treatment . Key words: Atherosclerosis; Ulcer; Tomography,spiral computed; Diagnostic imaging

The imaging study of internal mammary artery and its branches

To investigate the distribution of the internal mammary artery and its branches by the multi-slice spiral CT angiography, and to explore the feasibility of transferring pedicled transverse rectus abdomials myocataneous (TRAM) flap for breast reconstruction through resection of inferior costicartilages. 30 female patients received abdominal CT angiography. (1) The distance between internal mammary artery and the sternum midline were recorded; (2) The position and the numbers of branches from bilateral internal mammary arteries at the level of 5th, 6th, 7th rib was observed; (3) The points where the superior epigastric artery gets through the rectus abdominis muscle were located. ( The average distance between left internal mammary artery to the sternum midline is from 1. 66 cm (0. 62-2. 39 cm ) to 2.34 cm (0.69-3.36 cm) at the level from 4th to 6th intercostal space. The average distance between right internal mammary artery to the sternum midline is from 1.55 cm(0. 66-2. 29 cm) to 2.29 cm(0. 73-3. 67 cm) at the level from 4th to 6th intercostal space; ) The number of branches is the most at the level of 6th intercostal space; (3) There are 235 branches in the superior epigastric artery. This imaging study of internal mammary artery explores the feasibility of transferring pedicled transverse rectus abdominals myocataneous flap for breast reconstruction. It has important significance in the breast reconstruction using TRAM flap with lengthened pedicle.

Value of multi-slice spiral CT angiography in diagnosis and treatment of cerebral arteriovenous malformations

Objective To evaluate the manifestation of cerebral arteriovenous malformations (CAVM) on multi-slice spiral CT (MSCT) angiography and the clinical value of this examinaion.Methods The data on 36 patients with CAVM undergoing MSCT angiography were collected.Vascular reconstruction were performed by volume rendering and AV.The manifestations of feeding arteries and draining veins were then analyzed.Results Among these 36 patients with cerebral arteriovenous malformations,ten patients had the lesion in occipital lobe,nine in temporal lobe,two in frontal lobe,three in parietal lobe,seven in occipital lobe and cerebellar hemisphere,three in occipital and temporal lobe,and two in frontal and parietal lobe,with a clear display of masses of deformed vessels,feeding arteries and draining veins; 4 patients were complicated by intra-aneurysm of CAVM,2 were complicated by extra-aneurysm of CAVM,3 concurred with subarachnoid hemorrhage,and 6 concurred with cerebral hemorrhage.Conclusions Multi-slice spiral angiography can clearly detect masses of deformed vessels,feeding arteries,draining veins,and coexisting aneurysms. Key words: Cerebral arteriovenous malformations; CT angiography

The clinical application value of multi-slice spiral CT angiography

Objective To explore the clinical application value of multi-slice spiral CT angiography.Methods 28 patients who were suspected cerebrovascular disease were taken cerebrovascular enhanced scan by 16-slice spiral CT,and VR,MIP and MPR post -processing were uset to reconstmct the cerebrovascular image.Results In 28 patients,11 cases were normal,17 cases were abnormal,and among these patients there were 8 cases of abnormal blood vessels,4 cases of aneurysms,1 case of cerebral arteriovenous malformation,4 cases of cerebral artery stenosis.Conclusion The multi-slice CT compared with ordinary spiral CT had the advantage of faster and more secure.It had an important role in guiding the screening and clinical treatment programs in cerebral infarction patients with suspected cerebral artery stenosis.It had a lot of advantages in diagnosis vascular disease and clinical observation after treatment. Key words: Tomography technique,X-ray computed; Cerebral angiography

Bedside noninvasive scoring system in diagnosis of coronary heart disease

Objectives To evaluate the effectiveness of bedside noninvasive scoring system in diagnosis of coronary heart disease (CAD).Methods Six hundred and twelve patients with suspected CAD in our hospital were enrolled (343 males and 269 females) from September 2008 to October 2010,with an average age of 55 ± 7 y.The detailed history was taken; physical examination,resting electrocardiogram,blood biochemistry,treadmill exercise test and/or 12 lead Holter monitoring,64 or 256 rows CT coronary artery imaging and coronary artery angiography were performed in all patients.The risk factors for CAD were screened by multiple questionnaire surveys with Delphi method.The risk factors were stratified according to the results of expert survey: heavy smoking,diabetes mellitus,typical angina,positive treadmill exercise test and positive Holter monitoring electrocardiogram were included in the highest risk factors with an integrated scores of 8 ; dyslipidemia of 3 items,hypertension complicated with left ventricular hypertrophy were high risk factors with an integrated scores of 6; males≥40 y,medium smoking,dyslipidemia of 2 items,pathoglycemia,heavy drinking,positive ECG and post-menopause females were moderate risk factors with integrated scores of 4; Low risk factors contain moderate drinking and dyslipidemia of item,were classified as low risk factors with an integrated scores of 2. The bedside noninvasive scoring system was evaluated in all patients and the results were compared with those from multi-slice spiral CT or coronary angiography.Results When integrated score ≥ 24 was set as the cut-off level for diagnosis of CAD,thesensitivity,specificity,positive predictive value and accuracy were 89.95％,85.63％,94.03％ and 88.73％ respectively.When integrated score≤ 14 was set as the exclusion criteria of CAD,the sensitivity,specificity,positive predictive value and accuracy were of 93.10％,82.86％,98.09％ and 84.80％ respectively.The accuracy was lower than that of multi-slice spiral CT or coronary angiography( P ＜0.05 ).Conclusions The bedside noninvasive scoring system is effective for preliminary diagnose of CAD,but need to be further improved. Key words: Coronary disease; Diagnostic techniques, cardiovascular; Research design