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目的通过与DSA对比研究64层CTA行子宫动脉造影的价值。方法选择经彩超诊断单发肌壁间子宫肌瘤患者35例,子宫动脉栓塞前进行先行64层CTA检查,应用容积再现(VR)、血管探针技术以及原始薄层图像进行图像后处理。重建显示子宫动脉的解剖,重点观察子宫动脉的开口位置。DSA血管造影时参照CTA结果,选择相应角度行子宫动脉造影,比较分析靶血管的逐级分支的能力,血管的走行及子宫动脉弓状吻合情况。结果子宫动脉起源于臀下阴部干33支(47%),脐动脉12支(17%),阴部内动脉11支(16%),臀下动脉8支(11%),髂内动脉6支(9%),其中7例左右子宫动脉起源不对称。子宫动脉与起源血管成角小于30°者46支(68%),介于30～60°之间者20支(29%),大于60°者2支(3%)。33例双侧子宫动脉粗细不对称,占94%。55支子宫动脉增粗(80%)。CTA对子宫动脉主干显示率为75%,对终末分支显示率41%,均能显示肿瘤供血动脉。DSA常规正位对子宫动脉起源开口及角度显示率分别为24%及27%,参照基于CTA数据旋转角度后都能更好显示子宫动脉。结论 64层CTA能较好地显示子宫动脉走行及开口解剖细节,子宫动脉栓塞前行CTA能更好地指导介入治疗。
Objective To compare the value of 64-slice CTA uterine arteriography with DSA. Methods Thirty - five patients with uterine myoma of single muscular wall were diagnosed by color Doppler ultrasonography. CTA was performed before embolization of uterine artery. Image reconstruction was performed by volume rendering (VR), vascular probe technique and original thin layer images. Reconstruction shows the uterine artery anatomy, focusing on the uterine artery opening position. DSA angiography with reference to CTA results, select the corresponding line of uterine artery angiography, the ability to compare the level of the target vessel, the blood vessels and uterine artery arch anastomosis. Results The uterine artery originated from 33 cases (47%) of the inferior genitals, 12 cases (17%) of the umbilical artery, 11 cases of internal genital artery (16%), 8 cases of inferior gluteal artery (11%), 6 cases of internal iliac artery (9%), of which about 7 cases of uterine artery asymmetry in origin. There were 46 (68%) uterine arteries and vessels of origin with angulation of less than 30 °, 20 (29%) between 30 and 60 ° and 2 (3%) over 60 °. 33 cases of bilateral uterine artery thickness asymmetry, accounting for 94%. 55 uterine artery thickening (80%). CTA on the uterine artery trunk showed a 75% rate of terminal branch showed that 41%, can show the tumor feeding artery. DSA conventional anteroposterior uterine artery opening angle and the rate of 24% and 27%, respectively, with reference to the rotation angle based on CTA data can better show the uterine artery. Conclusion 64-slice CTA can better show the uterine artery walking and the anatomic details of the opening. CTA before uterine artery embolization can better guide the interventional treatment.