Nonvariceal Upper Gastrointestinal Bleeding: the Usefulness of Rotational Angiography after Endoscopic Marking with a Metallic Clip

송지수,곽효성,정경호 대한영상의학회 2011 Korean Journal of Radiology Vol.12 No.4

Objective: We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. Materials and Methods: In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Results: Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Conclusion: Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly. Objective: We wanted to assess the usefulness of rotational angiography after endoscopic marking with a metallic clip in upper gastrointestinal bleeding patients with no extravasation of contrast medium on conventional angiography. Materials and Methods: In 16 patients (mean age, 59.4 years) with acute bleeding ulcers (13 gastric ulcers, 2 duodenal ulcers, 1 malignant ulcer), a metallic clip was placed via gastroscopy and this had been preceded by routine endoscopic treatment. The metallic clip was placed in the fibrous edge of the ulcer adjacent to the bleeding point. All patients had negative results from their angiographic studies. To localize the bleeding focus, rotational angiography and high pressure angiography as close as possible to the clip were used. Results: Of the 16 patients, seven (44%) had positive results after high pressure angiography as close as possible to the clip and they underwent transcatheter arterial embolization (TAE) with microcoils. Nine patients without extravasation of contrast medium underwent TAE with microcoils as close as possible to the clip. The bleeding was stopped initially in all patients after treatment of the feeding artery. Two patients experienced a repeat episode of bleeding two days later. Of the two patients, one had subtle oozing from the ulcer margin and that patient underwent endoscopic treatment. One patient with malignant ulcer died due to disseminated intravascular coagulation one month after embolization. Complete clinical success was achieved in 14 of 16 (88%) patients. Delayed bleeding or major/minor complications were not noted. Conclusion: Rotational angiography after marking with a metallic clip helps to localize accurately the bleeding focus and thus to embolize the vessel correctly.

The Clinical Outcomes of Transcatheter Microcoil Embolization in Patients with Active Lower Gastrointestinal Bleeding in the Small Bowel

곽효성,한영민,이수택 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.4

Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. Materials and Methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography. Objective: To assess the clinical outcomes of the transcatheter microcoil embolization in patients with active lower gastrointestinal (LGI) bleeding in the small bowel, as well as to compare the mortality rates between the two groups based on the visualization or non-visualization of the bleeding focus determined by an angiography. Materials and Methods: We retrospectively evaluated all of the consecutive patients who underwent an angiography for treatment of acute LGI bleeding between January 2003 and October 2007. In total, the study included 36 patients who underwent a colonoscopy and were diagnosed to have an active bleeding in the LGI tracts. Based on the visualization or non-visualization of the bleeding focus, determined by an angiography, the patients were classified into two groups. The clinical outcomes included technical success, clinical success (no rebleeding within 30 days), delayed rebleeding (> 30 days), as well as the major and minor complication rates. Results: Of the 36 patients, 17 had angiography-proven bleeding that was distal to the marginal artery. The remaining 19 patients did not have a bleeding focus based on the angiography results. The technical and clinical success rates of performing transcatheter microcoil embolizations in patients with active bleeding were 100% and 88%, respectively (15 of 17). One patient died from continued LGI bleeding and one patient received surgery to treat the continued bleeding. There was no note made on the delayed bleeding or on the major or minor complications. Of the 19 patients without active bleeding, 16 (84%) did not have recurrent bleeding. One patient died due to continuous bleeding and multi-organ failure. Conclusion: The superselective microcoil embolization can help successfully treat patients with active LGI bleeding in the small bowel, identified by the results of an angiography. The mortality rate is not significantly different between the patients of the visualization and non-visualization groups on angiography.

A Comparison of Low-Dose and Normal-Dose Gadobutrol in MR Renography and Renal Angiography

Ilkay Koray Bayrak,Zafer Ozmen,Mehmet Selim Nural,Murat Danaci,Baris Diren 대한영상의학회 2008 Korean Journal of Radiology Vol.9 No.3

Objective: It has been advocated that a reduced injection volume with highly concentrated (1 M) contrast material can produce a sharper bolus peak and an increased intravascular first-pass gadolinium concentration when compared with the use of a lower concentration (0.5 M). A higher concentration would also cause a reduction in dose. The purpose of our study was to test the use of a low dose (0.05 mmol/kg) of gadobutrol in magnetic resonance renography and angiography and compare the findings with a dose of 0.1 mmol/kg. Materials and Methods: One-hundred-thirty-four patients referred for magnetic resonance angiography for suspected renovascular disease participated in the study. Contrast enhanced MR renography and angiography were performed after administration of a bolus of 0.1 mmol/kg or 0.05 mmol/kg gadobutrol in randomized patients. The relative signal intensity-time curves of the aorta, peripheral cortex and parenchyma, were obtained. Two radiologists evaluated the angiographic images and evaluated the quality of angiography. Results: The signal intensity with a low dose of gadobutrol was significantly lower in early phases, in the peripheral cortex (for 36, 54, 72 and 90 seconds), the parenchyma (for 36, 54, 72 seconds) and the aorta (for 18, 36, 54, 72 seconds). The decreases in the early phase obtained with a low dose of gadobutrol caused blunter time intensity curves. The difference in the quality scores of the readers for the angiographic images for the use of the two different doses was not statistically significant (p > 0.05). Conclusion: A lower dose of gadobutrol can be used for MR renal angiography, but for MR renography the normal dose should be used. Objective: It has been advocated that a reduced injection volume with highly concentrated (1 M) contrast material can produce a sharper bolus peak and an increased intravascular first-pass gadolinium concentration when compared with the use of a lower concentration (0.5 M). A higher concentration would also cause a reduction in dose. The purpose of our study was to test the use of a low dose (0.05 mmol/kg) of gadobutrol in magnetic resonance renography and angiography and compare the findings with a dose of 0.1 mmol/kg. Materials and Methods: One-hundred-thirty-four patients referred for magnetic resonance angiography for suspected renovascular disease participated in the study. Contrast enhanced MR renography and angiography were performed after administration of a bolus of 0.1 mmol/kg or 0.05 mmol/kg gadobutrol in randomized patients. The relative signal intensity-time curves of the aorta, peripheral cortex and parenchyma, were obtained. Two radiologists evaluated the angiographic images and evaluated the quality of angiography. Results: The signal intensity with a low dose of gadobutrol was significantly lower in early phases, in the peripheral cortex (for 36, 54, 72 and 90 seconds), the parenchyma (for 36, 54, 72 seconds) and the aorta (for 18, 36, 54, 72 seconds). The decreases in the early phase obtained with a low dose of gadobutrol caused blunter time intensity curves. The difference in the quality scores of the readers for the angiographic images for the use of the two different doses was not statistically significant (p > 0.05). Conclusion: A lower dose of gadobutrol can be used for MR renal angiography, but for MR renography the normal dose should be used.

족부 혈관의 평가: 3차원 Gadolinium조영 증강 자기공명 혈관조영술과 디지털 감산 혈관조영술의 비교

이정민,강성권,변주남,김영철,최정렬,김영숙,Lee, Jeong-Min,Gang, Seong-Gwon,Byeon, Ju-Nam,Kim, Yeong-Cheol,Choe, Jeong-Ryeol,Kim, Yeong-Suk 대한영상의학회 2002 대한영상의학회지 Vol.47 No.1

목적: 족부 혈관의 평가에 있어서 조영 증강 자기공명 혈관조영술의 유용성을 디지털 감산 혈관조영술과 비교하고자 하였다. 대상과 방법: 환자 11명을 대상으로 12개의 하지에 대해 디지털 감산 혈관조영술(DSA)과 조영 증강 자기공명 혈관조영술(CE-MR angiography)을 1주 이내에 시행하였다.환자 11명중동맥경화증이 4명,당뇨발이 3명,Buerger씨병이 1명,피부판 이식수술을 위해 혈관조영술을시행 받은 환자가 1명,calciphylactic 동맥병증이 1명,족부의 동정맥기형이 1명이었다.자기공명 혈관조영술은 1.5T의 자기공명영상장치에 사지코일 또는 두부코일을 이용하여 3차원 항정상태세차고속영상(FISP)기법으로 조영 전 영상을 얻은 후에 kg당 0.2 mmol의 gadolinium을 초당 3 ml의 속도로 수동 주입하고 이어 생리식염수 10 ml를 정주 하였으며,조영제 주입 후 10초 후부터 20초간의 스캔을 10초 간격을 두고 4차례 시행하였다.발목 및 족부의 혈관을 전경골동맥,원위부 비골동맥,후경골동맥,내측족저동맥,외측족저동맥,족배동맥 그리고 족궁의 7분절로 나누어 2명의 방사선과 의사가 분석하였고 한 개의 하지에서 보인 분절의 평균 수의 차이를 통계학적으로 분석하였다. 결과: 전체 84개의 동맥 분절 중에 16개는 두 검사 모두에서 전혀 볼 수 없었고 39개는 두 검사 모두에서 보였다.조영 증강 자기공명 혈관조영술에서만 보인 분절의 수는 26개였고 디지털 감산 혈관조영술 에서만 보인 분절의 수는 3개였다.한 개의 하지에서 보인 분절의 평균수는 조영 증강 자기공명 혈관조영술에서 5.42개,디지털 감산 혈관조영술에서는 3.50개로 조영증강 자기공명 혈관조영술에서 통계학적으로 유의하게 많이 보였다(T-test,p <0.000).각분절에 대해서는 모두 CE-MR angiography에서 더 많이 보였지만 족배동맥(T-test,p < 0.000)을 제외한 모든 분절에서 통계적으로 유의하지 않았다. 결론: 족부 혈관의 평가에서 3차원 조영 증강 자기공명 혈관조영술은 디지털 감산 혈관 조영술 보다 우수하며 족부의 다양한 혈관질환의 진단과 치료계획의 수립에 유용할 것으로 생각된다. Purpose: To compare the three-dimensional gadolinium-enhanced MR angiography with digital subtraction angiography (DSA) for evaluation of the pedal artery. Materials and Methods: In 12 extremities of 11 patients, both digital subtraction angiography (DSA) and contrast-enhanced MR angiography (CE-MR angiography) were performed during the same week. Among ten of the 11 patients, the following conditions were present: atherosclerosis (n=4), diabetic foot (n=3), Buerger's disease (n=1), calciphylactic arteriopathy (n=1) and arteriovenous malformation of the foot (n=1). The remaining patient underwent angiography prior to flap surgery. For MR angiography, a 1.5T system using an extremity or head coil was used. A three-dimensional FISP (fast imaging with steady state precession) sequence was obtained before enhancement, followed by four sequential acquisitions (scan time, 20 secs; scan interval time, 10 secs) 10 seconds after intravenous bolus injection of normal saline (total 10 cc), following intravenous adminstration of gadolinium (0.02 mmol/kg, 3 ml/sec). Arterial segments of the ankle and foot were classified as the anterior or posterior tibial artery, the distal peroneal artery, the medial or lateral plantar artery, the pedal arch, and the dorsalis pedis artery. Two radiologists independently analysed visualization of each arteraial segment and the mean of visible arterial segments in one extreminty using CE-MR angiography and DSA. Results: Among 84 arterial segments, 16 were invisible at both CE-MR angiography and DSA, while 39 were demonstrated by both modalities. Twenty-six segments were visible only at CE-MR angiography and three only at DSA. CE-MR angiography displayed a higher number of arterial segments than DSA (mean, 5.42 vs. mean 3.50, respectively), a difference which was statistically significant (p<0.000). The difference between each arterial segment was not statistically significant, except for the dorsalis pedis artery (t test, p<0.000). Conclusion: In that it provides additional information for the planning of treatment of lower-extremity arterial disease, three-dimensional CE-MR angiography is superior to DSA for evaluation of the pedal artery

당뇨망막병증 환자에서 플루레신 형광안저조영술이 신기능에 미치는 영향

김정태(Jung Tae Kim),진선영(Sun Young Jin),장영석(Young Suk Chang),황원민(Won Min Hwang),이영훈(Young Hoon Lee) 대한안과학회 2016 대한안과학회지 Vol.57 No.10

목적: 당뇨망막병증 환자에서 플루레신을 이용한 형광안저조영술 시행 전후의 신기능의 변화에 대하여 알아보고자 한다. 대상과 방법: 2004년 4월부터 2014년 12월까지 당뇨망막병증을 진단 받은 비투석 환자 80명을 대상으로 플루레신 형광안저조영술 시행 전후 1주일 이내의 혈액검사를 후향적으로 분석하여, blood urea nitrogen (BUN)/serum creatinine (Scr)및 estimated glomerular filtration rate (eGFR)의 변화를 측정하고, chronic kidney disease (CKD) stage에 따라 플루레신이 신기능에 미치는 영향을 평가하였다. 결과: 형광안저조영술 시행 전후 측정한 BUN, Scr의 평균값은 변화가 없었고, 추정 사구체여과율(eGFR)은 형광안저조영술 시행 전과 비교하여 후에 감소는 없었으며, 4 mL/min per 1.73 m2의 증가를 보였다(p=0.006). CKD stage로 구분한 환자군에서는 CKD stage 5, 4, 2 & 1에서 형광안저조영술 시행 전후 신기능에 변화는 없었고, CKD stage 3에서는 형광안저조영술 시행 후에 eGFR이 증가되었다(p=0.042). 결론: 당뇨망막병증 환자에서 플루레신을 이용한 형광안저조영술 시행 전후의 신장 기능은 유의한 변화를 보이지 않았으며, 만성신부전 정도에 따른 분류에서도 시술 전후의 신기능의 감소는 관찰되지 않았다. 이에 투석을 시행하지 않는 당뇨망막병증 환자에서 플루레신을 이용한 형광안저조영술은 신기능 저하의 위험성이 크지 않은 비교적 안전한 진단법이라 할 수 있다. <대한안과학회지 2016;57(10):1598-1603> Purpose: This study was designed to compare the change of renal function before and after fluorescein angiography in patients with diabetic retinopathy. Methods: This study included 80 patients diagnosed with diabetic retinopathy who did not receive dialysis from April 2004 to December 2014. Based on retrospective analysis of a blood test performed within one week before and after fluorescein angiography, the changes of blood urea nitrogen (BUN), serum creatinine (Scr), and estimated glomerular filtration rate (eGFR) were measured. Additionally, the effect of fluorescein angiography on renal function was estimated according to chronic kidney disease (CKD) stage. Results: The average BUN/SCr before and after fluorescein angiography was not statistically significantly different before and after fluorescein angiography. The average eGFR before and after fluorescein angiography increased from 62.62 ± 31.59 to 66.46 ± 31.22 (p = 0.006). Regarding changes in renal functions according to CKD stage, based on the average eGFR in CKD stages 5, 4, 2, and 1, no significant differences were observed in renal functions before and after fluorescein angiography, whereas eGFR was significantly increased after fluorescein angiography at CKD stage 3 (p = 0.042). Conclusions: In patients with diabetic retinopathy, BUN/Scr and eGFR were not significantly different before or after fluorescein angiography. Moreover, the deterioration of renal function was not observed at any CKD stage. Therefore, fluorescein angiography is a relatively safe diagnostic examination in patients with diabetic retinopathy who did not receive dialysis due to the low-risk of renal function deterioration. J Korean Ophthalmol Soc 2016;57(10):1598-1603

뇌동맥류의 진단에 대한 전산화단층촬영 뇌혈관조영술과 고식적 뇌혈관조영술의 비교

송상현,윤수한,안영환,안영민,조기홍,조경기,김선용,서정호 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.10

Cerebral angiography has been essential for the diagnosis of the intracranial aneurysms but. is sometimes accompanied by serious complications. Resolution of CT angiography was up-graded greatly to represent the three-demensional structure of vesseles since helical CT had been introduced. We have compared 26 cases of CT angiography and 28 cases of conventional angiography in terms of specificity and sensitivity for the diagnosis detectable aneurysm diameter. configurational diagnosis and diagnostic confidency. All results showed no statistical difference between CT angiography and conventional angiography. These should suggest that CT angiography could be replaced with conventional angiography for the diagnosis of ruptured aneurysms and even of unruptured aneurysms. resulting in the introduction of first screening modality of unruptured aneurysms.

간동맥 Multidetector-row CT 혈관조영술: 고식적 혈관조영술과 비교

정용연,윤웅,김재규,박진균,서정진,강형근,Jeong, Yong-Yeon,Yun, Ung,Kim, Jae-Gyu,Park, Jin-Gyun,Seo, Jeong-Jin,Gang, Hyeong-Geun 대한영상의학회 2003 대한영상의학회지 Vol.48 No.3

목적: 간동맥의 해부학을 평가하는데 있어서 Multidetector now CT(MDCT)를 이요한 삼차원 CT 혈관조영술의 유용성을 알아보고자 하였다. 대상과 방법: 간동맥화학색전술을 받기 위하여 고식적 혈관조영술과 MDCT를 같이 시행한 45 예를 대상으로 하였다. 사용된 CT기기는 MDCT(Lightspeed Qx/I, GE Medical systems, Milwaukee)로, 촬영조건은 초기동맥기를 절편두께(slice thickness) 2.5 mm, 테이블 이동속도 7.5 mm/rotation, pitch 3으로 하여 얻었다. 초기동맥기 영상은 한명의 방사선과 의사에 의해서 최대투시강도 기법을 이용하여 삼차원 CT 혈관조영술을 얻었다. 고식적 혈관조영술 소견을 모르는 두 명의 방사선과 전문의가 각각 독립적으로 간동맥의 형태와 영상의 질을 분석하였다. 결과: 삼차원 CT 혈관조영술에서 간동맥의 해부학적 평가는 방사선과의사 A는 총 45예중 38예(84%)에서, 방사선과의사 B는 40예(89%)에서 일치하게 평가하였다. 두 방사선과의사간 상호일치도(interobserver agreement)는 Kappa value가 0.73으로 우수하였다. 영상의 질은 두 방사선과의사 모두 우수하게 평가하였다. 결론: MDCT를 이용한 삼차원 CT 혈관조영술은 간동맥의 해부학적 구조를 정확히 진단할 수 있으며, 두 명의 방사선과의사간에 상호일치도가 우수하여 고식적 혈관조영술의 시술전의 환자에서 간동맥의 해부학적 변이에 관한 정보를 제공하리라 생각한다. Purpose: To determine the usefulness of three-dimensional CT angiography using multidetector-row CT (MDCT) for delineating the arterial anatomy of the liver. Materials and Methods: Hepatic arterial three-dimensional CT angiography was performed using MDCT (Lightspeed Qx/I; GE Medical Systems, Milwaukee, Wis., U.S.A.) in 45 patients with HCC undergoing conventional angiography for transcatheter hepatic arterial chemoembolization. The scanning parameters during the early arterial phase were 2.5 mm slice thickness, 7.5 mm rotation of table speed, and a pitch of 3. Images were obtained by one radiologist using maximum intensity projection from axial CT images obtained during the early arterial phase. Two radiologists blinded to the findings of conventional angiography independently evaluated the hepatic arterial anatomy and the quality of the images obtained. Results: Compared with conventional angiography, reader A correctly evaluated the hepatic arterial anatomy depicted at three-dimensional CT angiography. Reader B's evaluation was correct in 40 of 45 patients. Interobserver agreement was good (kappa value, 0.73), and both readers assessed the quality of three-dimensional CT angiography as excellent. Conclusion: Three-dimensional CT angiography using MDCT was accurate for delineating the arterial anatomy of the liver, and interobserver agreement was good. The modality may provide, prior to conventional angiography, valuable information regarding a patient's hepatic arterial anatomy.

Clinical effect and standardization of indocyanine green angiography in the laparoscopic colorectal surgery

손경모,안홍민,이인영,이선민,박상호,백광렬 대한내시경로봇외과학회 2021 Journal of Minimally Invasive Surgery Vol.24 No.3

Anastomotic complications occur after 5% to 20% of operations for rectosigmoid colon cancer. The intestinal perfusion status at the anastomotic site is an important modifiable risk factor, and surgeons should carefully evaluate and optimize the perfusion at the intended site of anastomosis. Indocyanine green (ICG) angiography is a simple noninvasive perfusion assessment modality. The use of ICG angiography is rapidly spreading in the field of colorectal surgery. However, there is debate on its contribution to reducing anastomotic complications. In this review, we discuss the clinical utility and the standardization of ICG angiography. ICG angiography can unequivocally reveal unfavorable perfusion zones and provide quantitative parameters to predict the risk of hypoperfusion-related anastomotic complications. Many studies have demonstrated the clinical utility of ICG angiography for reducing anastomotic complications. Recently, two multicenter randomized clinical trials reported that ICG angiography did not significantly reduce the incidence of anastomotic leakage. Most previous studies have been small-scale single-center studies, and there is no standardized ICG angiography protocol to date. Additionally, ICG angiography evaluations have mostly relied on surgeons’ subjective judgment. For these reasons, it is necessary to establish a standardized ICG angiography protocol and develop a quantitative analysis protocol for the objective assessment. In conclusion, ICG angiography could be useful for detecting poorly perfused colorectal segments to prevent anastomotic leakage after colorectal surgery. An optimized and standardized ICG angiography protocol should be established to improve the reliability of perfusion assessments. In the future, artificial intelligence-based quantitative analyses could be used to easily assess colonic perfusion status.

The Incidence and Anatomy of Accessory Pudendal Arteries as Depicted on Multidetector-Row CT Angiography: Clinical Implications of Preoperative Evaluation for Laparoscopic and Robot-Assisted Radical Prostatectomy

박범진,성득제,김민주,조성범,김윤환,정규병,강석호,천준 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.6

Objective: To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. Materials and Methods: The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64- channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. Conclusion: APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy. Objective: To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. Materials and Methods: The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64- channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. Conclusion: APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy.

자발성 뇌지주막하출혈에서 뇌전산화단층촬영 뇌혈관 조영술의 임상적 유용성

김병욱,심홍보,정영균,이선일,정용태,김수천,심재홍 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.2

Objective : The purpose of this study was to compare computed tomographic angiography (CT angiography) with conventional angiography and to assess usefulness of computed tomographic angiography in detection of ruptured intracranial aneurysms. Methods : From May 2000 to June 2001, eighty consecutive patients with spontaneous subarachnoid hemorrhage underwent computed tomographic angiography. With the images obtained from the three dimensional computed tomography, we performed preoperative assessments for the intracranial aneurysms and compared conventional angiography in sizes, shapes, sites and surrounding structures. Results : Computed tomography(CT) angiography revealed 59 aneurysms in 72 aneurysm patients and the detection rate of the CT angiograpy was 81.9%. The small aneurysms (〈3㎜ in diameter) were not visualized by CT angiography. Main undetected sites were posterior communication artery and vertebrobasilar artery. In fourteen cases, only CT angiography was performed and 6 cases were operated. Conclusions : CT angiography is a simple and safe method for the detection of intracranial aneurysms and an excellent adjunctive method in planning the surgery of the intracranial aneurysm. It can be also used to detect incidental aneurysms and familial aneurysms.