2014-01-19 三峡医院 医学影像
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.
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.
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.
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.
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).
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.
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).
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.