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手的MRI血管成像

2014-01-19 三峡医院 医学影像

 

 

 

图1 显示了手的正常动脉解剖结构。掌浅弓发出3条指掌侧总动脉和1条小指尺掌侧动脉(灰色),掌深弓(黑色)发出拇主要动脉和3条掌心动脉。

Figure 1.  Drawing illustrates the normal arterial anatomy of the hand. The superficial palmar arch gives rise to the proper digital arteries (gray), and the deep palmar arch (black) supplies the thumb.

 

图2a  手的正常动脉解剖和变异。(a)磁共振血管造影显示无掌浅弓。掌深弓发出拇主要动脉(弯曲箭头)和示指总动脉(空心箭头)。尺动脉分支(大直实线箭头)吻合成弓,直接发出第三,第四和第五指掌侧总动脉(小直实线箭头)。

 

图2b  手的正常动脉解剖和变异。(b)不同的患者磁共振血管成像显示常见的指掌侧总动脉(箭头)从掌深弓发出,然后发出尺桡侧指掌侧固有动脉。

 

图2c  手的正常动脉解剖和变异。(c)第三个病人,磁共振血管成像显示无尺动脉。桡动脉(弯曲箭头)合成掌浅弓(直箭头),然后发出指掌侧总动脉。该患者被认为不适合动静脉造瘘术。

Figure 2.  Normal arterial anatomy and variants of the hand. (a) MR angiogram demonstrates absence of the superficial arch. The deep arch gives rise to the princeps pollicis artery (curved arrow) and the second common digital artery (open arrow). The ulnar artery gives off a branch (large straight solid arrow) to complete the arch and directly supplies the common digital arteries to the third, fourth, and fifth digits (small straight solid arrows).(b) MR angiogram obtained in a different patient demonstrates how the common digital arteries (arrows) arise from the deep arch and in turn give rise to the radial and ulnar proper digital arteries. (c) MR angiogram obtained in a third patient demonstrates absence of the ulnar artery. The radial artery (curved arrow) feeds the superficial arch (straight arrows), which in turn gives rise to the common digital arteries. The patient was not thought to be a suitable candidate for arteriovenous fistulization.

图3a

 

图3b

27岁,厨师,曾受手掌离断伤。(a)磁共振增强血管造影显示左尺动脉中断(箭头),桡动脉供应掌浅弓和掌深弓。(b)保守治疗后磁共振增强血管成像显示离断血管的侧支循环(箭头),提示早期再通和修复。

Figure 3.  Traumatic transection in a 27-year-old cook who had sustained a deep cut to the palm of the hand. (a)Contrast-enhanced MR angiogram demonstrates abrupt termination of the left ulnar artery (arrow), with the radial artery supplying both the superficial and deep arches. (b) Contrast-enhanced MR angiogram obtained following conservative treatment shows a collateral vessel bridging the transected segment of the artery (arrow), a finding that is consistent with early recanalization and repair.

图4a

 

图4b

34岁,木匠,3个月前食指撕裂伤。(a)未减影图片显示食指尺侧血管近侧指间关节水平充盈缺损,对应于裂伤部位。(b)磁共振增强减影血管成像显示裂伤远端血管充盈(箭头),大概是侧支血管未见显示。

Figure 4.  Traumatic transection in a 34-year-old carpenter who had sustained laceration of the second digit 3 months earlier. (a) Image from the unsubtracted data set shows nonfilling of a segment of the ulnar digital vessel at the level of the proximal interphalangeal joint of the second digit (arrow), a location that corresponds to the laceration site. (b) Subtracted contrast-enhanced MR angiogram demonstrates filling of the vessel distal to the laceration (arrow), presumably by collateral vessels that are not visualized.

 

图5a

 

图5b  动脉瘤

43岁,建筑工人,手腕尺侧搏动性肿块。(a)磁共振增强血管成像显示来自尺动脉囊状动脉瘤(箭头)邻近尺骨茎突。未减影,显示动脉瘤与骨的关系。(b)减影后清楚显示动脉瘤(箭头)。

Figure 5.  Aneurysm in a 43-year-old builder who presented with a pulsatile mass of the ulnar aspect of the wrist.(a) Contrast-enhanced MR angiogram demonstrates a saccular aneurysm (arrow) that arises from the ulnar artery adjacent to the ulnar styloid process. The precontrast data set has not been subtracted from the postcontrast data set, so that the relationship of the aneurysm to the bone structures could be appreciated. (b)Subtracted image clearly demonstrates the aneurysm (arrow).

图6a

 

图6b

假性动脉瘤,23岁,板球运动员。摔倒时,手伸直。(a)手腕MR轴位图像显示钩骨钩(箭头)骨折。(b)磁共振增强血管成像显示尺动脉和掌深弓交界区边界模糊的病变(箭头),与血管损伤导致假性动脉瘤形成的表现一致。

Figure 6.  Pseudoaneurysm in a 23-year-old cricket player who had fallen on an outstretched hand. (a) Axial MR image of the wrist shows a fracture of the hook of the hamate bone (arrows). (b) Contrast-enhanced MR angiogram demonstrates a poorly defined lesion at the junction of the ulnar artery and the deep arch (arrow), a finding that is consistent with pseudoaneurysm formation resulting from vascular injury.

图7a

 

图7b

微栓子,53岁,男,左手无名指、小指突发缺血。(a)血管成像显示无名指、小指固有动脉血管突然闭塞(箭头),这一发现与周围血管栓子是一致的。其他图像(未显示)表明血栓部分闭塞左锁骨下动脉。(b)注射尿激酶后监测病人的反应,增强磁共振血管造影也显示出突然终止的无名指、小指固有血管(箭头)。

Figure 7.  Microemboli in a 53-year-old man with sudden onset of ischemia in the left fourth and fifth digits. (a)Angiogram demonstrates abrupt occlusion of the proper digital arteries to the fourth and fifth digits (arrows), a finding that is consistent with peripheral emboli. Other images (not shown) demonstrated thrombosis partially occluding the left subclavian artery. (b) Contrast-enhanced MR angiogram obtained to monitor patient response following urokinase injection also shows abrupt termination of the proper digital vessels of the fourth and fifth digits (arrows).

图8a

 

图8b

28岁,男,手的动静脉畸形。(a)断层图像显示梭形异常信号包绕屈肌腱(箭头)。(b)MIP图像显示动静脉畸形沿腕关节尺侧(弯箭头)和桡侧(直箭头)走行的大的引流静脉。

Figure 8.  Arteriovenous malformation in a 28-year-old man with vascular deformity of the hand. (a) Partition image demonstrates a fusiform abnormality encasing the flexor tendons (arrows). (b) MIP image produced by summing approximately 45 partition images demonstrates an arteriovenous malformation with large draining veins tracking along the ulnar (curved arrow) and radial (straight arrow) sides of the wrist.

图9a

 

图9b

血管瘤,15岁,男孩,中指近节掌侧搏动性肿块。(a)增强磁共振血管成像显示食指、中指、无名指指掌侧总动脉(粗箭头)和指掌侧固有动脉。还要注意中指基底部(细箭头)强化的分叶状病灶。(b)45秒后采集的图像显示了血管瘤和中指固有动脉(箭头)的关系。

Figure 9.  Hemangioma in a 15-year-old boy with a pulsatile mass on the volar side of the proximal third digit. (a)Contrast-enhanced MR angiogram shows the common and proper digital arteries to the second, third, and fourth digits (thick arrows). Note also the lobulated foci of enhancement around the base of the third digit (thin arrow). (b)Image from the second data set acquired 45 seconds later shows a hemangioma and its relationship to the proper digital vessels of the third digit (arrow).

图10

血管球瘤,37岁,女,右手食指指腹局部疼痛。增强磁共振血管成像显示由尺动脉发出的食指固有动脉(直箭头)朝着指尖小的强化病灶(弯箭头)。手术证实为血管球瘤。

Figure 10.  Glomus tumor in a 37-year-old woman with a painful focus in the pulp of the right second digit. Contrast-enhanced MR angiogram shows the proper digital vessels, with the ulnar artery to the second digit (straight arrow) coursing toward a small enhancing lesion in the fingertip (curved arrow). A glomus tumor was confirmed at surgery.

图11

滑膜肉瘤,47岁,男。左手拇指近端肿块。增强磁共振血管成像显示明显强化病灶(箭头)被血管网包绕。病灶切除,证实为滑膜肉瘤。

Figure 11.  Synovial sarcoma in a 47-year-old man with an enlarging mass in the proximal left thumb. Contrast-enhanced MR angiogram shows a vividly enhancing lesion (arrow) surrounded by a network of vessels. The lesion was resected and subsequently shown to be a synovial sarcoma.

图12

雷诺氏病,39岁,男,感冒引起的血管痉挛。增强磁共振血管成像显示拇指、小指血管逐渐变细,尖端毛细血管充血,与雷诺病相似。

Figure 12.  Raynaud disease in a 39-year-old man with cold-induced vasospasm. Contrast-enhanced MR angiogram demonstrates gradual tapering of the digital vessels with capillary congestion in the tips of the first and fifth digits, findings that are compatible with Raynaud disease.

图13a

 

图13b

结节性多动脉炎(PAN),47岁,金属工人,食指、中指缺血。(a)传统的血管造影显示,食指、中指、无名指固有动脉血管闭塞(箭头),这一发现提示栓子的存在。该患者增强磁共振血管成像进一步检查。(b) MIP图像显示固有动脉节段性狭窄,多发小动脉瘤(短箭头)。还可以看出食指、中指固有动脉血管闭塞(长箭头)。随后的血清学检查和活检结果表明,结节性多动脉炎(PAN)。

Figure 13.  Polyarteritis nodosa (PAN) in a 47-year-old metal worker with ischemia of the second and third digits. (a) Conventional angiogram demonstrates occlusion of the proper digital vessels of the second, third, and fourth digits (arrows), a finding that suggests the presence of emboli. The patient was further evaluated with contrast-enhanced MR angiography. (b) MIP image demonstrates segmental narrowing of the proper digital vessels with numerous small aneurysms (short arrows). Occlusion of the proper digital vessels of the second and third digits is also seen (long arrows). Subsequent serologic testing and biopsy showed that the patient had PAN.

图14

系统性硬皮病,42岁,女。右手小指切除。磁共振血管成像尺动脉未见显示。桡动脉发出掌深弓,再发出掌侧总动脉(实心箭头)和拇主要动脉(空心箭头)。注意:指掌侧固有动脉未见显示。

Figure 14.  Systemic scleroderma in a 42-year-old woman who had undergone resection of the right fifth digit. MR angiogram demonstrates absence of the ulnar artery. The radial artery supplies the deep arch, which in turn gives rise to the common digital arteries (solid arrows) and princeps pollicis artery (open arrow). Note the absence of the proper digital vessels.

图15a

 

图15b

血管翳,49岁,女。长期的类风湿关节炎。(a)静脉注射钆喷酸葡胺获得断层图像显示环绕腕关节,掌指及近端指间关节的滑膜强化。(b) MIP图像清楚显示广泛分布的滑膜增生和强化,这一发现表明活动血管翳疾病的存在。

Figure 15.  Pannus disease in a 49-year-old woman with long-standing rheumatoid arthritis. (a) Partition image obtained following intravenous injection of gadopentetate dimeglumine shows vivid enhancement of the synovium around the carpal, metacarpophalangeal, and proximal interphalangeal joints. (b) MIP image clearly demonstrates widely distributed synovial proliferation and enhancement, a finding that suggests the presence of active pannus disease.

图16

银屑病性关节炎,42岁,女,手腕疼痛和肿胀。增强磁共振血管成像显示正常的血管弓,腕骨的滑膜明显增厚和强化,与滑膜疾病一致。

Figure 16.  Psoriatic arthropathy in a 42-year-old woman who presented with wrist pain and swelling. Contrast-enhanced MR angiogram demonstrates a normal vascular arch but marked synovial thickening and enhancement of the carpal bones, findings that are compatible with synovial disease.

图17  滑膜炎,51岁,女。6周前摔倒时伸手。磁共振血管成像显示桡腕关节周围滑膜增厚、强化,掌骨或指间关节周围未见明显滑膜增厚、强化。影像表现与创伤性滑膜炎一致。

Figure 17.  Synovitis in a 51-year-old woman who had fallen on an outstretched hand 6 weeks earlier. MR angiogram shows vivid synovial enhancement around the radiocarpal joint but absence of synovial disease around the metacarpal or interphalangeal joints, findings that are compatible with posttraumatic synovitis.

图18a

图18b

图18c

图18  新生血管,22岁,男。右侧舟状骨骨折,骨不连,植骨术后。(a)冠状位图像显示新生血管起源于桡动脉(箭头),朝向植入舟状骨远端走行。(b) MIP图像血管从桡动脉发出,包绕植入骨周围(箭头)。(c)静脉期MIP图像显示植入骨周围强化(箭头),表现与滑膜炎和近端造影剂渗漏一致。影像学随访显示植入骨愈合。

Figure 18.  Neovascularization in a 22-year-old man with a history of nonunion of a right scaphoid bone fracture treated with bone grafting. (a) Partition image demonstrates neovascularization with blood vessels that arise from the radial artery (arrow) and course toward the distal pole of the grafted scaphoid bone. (b) MIP image also demonstrates the vessels as they arise from the radial artery and neovascularization around the site of the bone graft (arrow). (c) Venous-phase MIP image shows contrast enhancement around the area of the bone graft (arrow), a finding that is compatible with synovitis and proximal leakage of contrast material. Follow-up imaging showed healing of the graft.

图19  折叠伪影,47岁,男,可疑血管炎。MIP图像,无名指、小指投影到桡侧,覆盖在拇指上。当FOV未将整个扫描区的人体结构包括在内时便会产生折叠伪影,位于FOV之外而被RF脉冲激发的解剖结构会投影到图像的另一边。

Figure 19.  Wraparound artifact in a 47-year-old man with suspected vasculitis. On an MIP image, the fourth and fifth digits have wrapped to the opposite side of the image and overlie the thumb.

http://pubs.rsna.org/doi/full/10.1148/radiographics.22.3.g02ma16583


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