Transcript Slide 1

Arteriograms and Lower Limb Venograms
Numbers next to items refer to plates in Netter’s Atlas of Atlas of Human Anatomy
Numbers in parenthesis are from the 3rd edition.
Numbers not in parenthesis are frrom the 4th edition.
1.
2.
3.
4.
5.
6.
Abdominal Aorta
4th lt lumbar artery (256) 264
Stent in the rt common iliac artery
Lt common iliac artery
Lt internal iliac artery (383) 402
Posterior division of the lt iliac
artery (382) 403
7. Lt external iliac artery
8 Anterior division of the lt iliac
artery
Iliacs
#1
Inflated balloon in the right common
iliac artery, deploying a stent.
Radiographs vs. DSA
This is the raw image seen in the
previous slide (#1) before it was
subtracted. This process, known as
digital subtraction angiography
(DSA) attempts to remove all
densities except those in the range
of the iodine contrast in the arteries.
Notice the bones of the pelvis and
spine seen on this image are not
seen on image 1. Bowel gas is seen
due to motion. The success of this
process is dependant on there being
no motion between an image taken
before contrast injection, (the mask
image) and the contrast film. Several
seconds may pass between them, and
areas of motion create subtraction
artifacts.
#2
#2a
Abdominal arteriogram
These images are identical. Image 2 is the original, 2a is subtracted and the densities have
been reversed.
1. Rt renal artery
2. Pigtail catheter in the abdominal aorta
3. 1st through 4th lumbar arteries
1. Rt. common iliac artery
2. Perirenal branch of rt renal artery
3. Rt low accessory renal artery (324) 333
Bilateral renal
arteriogram
1. Superior messenteric artery (328)
341
2. Middle suprarenal arteries 332 *
3. Abdominal aorta
* Compare the origin of this vessel,
from the abdominal aorta, to the
variation labeled “B” on plate
(324) 333
#3
This injection of the abdominal
aorta is unusual. Typically the
aorta fills instantly, and the renals
and SMA fill momentarily, or
sometimes not well at all (notice
the lack of filling of the SMA on
image 2). In this case the position
of the catheter and the sideholes
were such that everything but a
small portion of the aorta were filled
at the moment the image was made.
Selected renal arteriogram
and angioplasty
1.
2.
3.
4.
5.
#3
#3a
Catheter*
Rt renal artery**
Segmental arteries (323) 335
Interlobar arteries
Rt ureter
1. Tip of the angioplasty catheter
2. Opaque markers***
3. Capsular branches of the renal artery (323) 335
* The tip is in a proximal subdivision of the
renal artery, which is a variation of the typical
appearance
** Just beyond the arrow is a stenosed segment
of the vessel. This is the major area of
atherosclerotic disease that is being treated in
image 3a.
*** Between the markers is where the angioplasty
balloon will deploy
Selective Hepatic
Plates (290-293) 300-302
1.
2.
3.
4.
5.
Common hepatic artery
Gastroduodenal artery
Hepatic artery proper
Rt hepatic artery
Lt hepatic artery
On this injection the catheter
tip was advanced to the
common hepatic artery. On
Netter’s plate (293) 303, the
catheter tip is in the celiac
trunk. Notice the filling
of the splenic and Lt gastric
artery as well. Due to its
small size and position at
the proximal part of the trunk
the Lt gastric does not always
fill on a celiac injection.
#5
Selected SMA
Plates (296-297) 306-307
1.
2.
3.
4.
5.
Catheter*
Middle colic artery**
Rt colic artery
Ileocolic artery
Jejunal & ileal (intestinal)
arteries
6. Anastomotic loops (arcades)
* In the abdominal aorta. The
tip is in the proximal SMA.
** Due to the numerous normal
variants of the SMA (note
a few of the more common
presentations on plate 298)
308 the exact identification
of items 2-4 are difficult.
These will not be included
on the test.
#6
Arch of the Aorta
Plate (131) 138
1.
2.
3.
4.
5.
6.
7.
8.
Descending aorta*
Rt. common carotic artery**
Rt subclavian artery
Rt vertebral artery
Lt common carotid artery
Lt vertebral artery
Lt subclavian artery
Lt thyrocervical artery
* Note the end of the pigtail catheter in
the ascending aorta, just beyond the
aortic valve.
** This arch is anomalous. There is
no brachiocephalic trunk. The Rt
CCA and subclavian originate from
the arch.
To lay the arch out in profile the patient
is in an RPO position. (Supine, rolled to
the right side at approximately 30 degrees.)
Clavicle
Head of the
humerus
Subclavian
arteriogram
Plate (420) 427
Glenoid process
Lung
#7
1.
2.
3.
4.
5.
Rt subclavian artery
Rt axillary artery*
Rt internal thoracic (mammary) artery**
Rt thyrocervical trunk***
Rt dorsal scapular artery
* The subclavian becomes the axillary
on passing under the clavicle. #2 is
close to the boundary of the 1st &
2nd segment of the axillary artery
** Sometimes used in coronary bypass
*** The trunk is lower than the arrow
indicates (prior to the bifurcation)
Axillary arteriogram
#8
Plate (417) 434
1. Lt axillary artery
2. Lt brachial artery
3. Anterior & Posterior circumflex
arteries
4. Lt circumflex subscapular artery
5. Lt thoracoacromial artery
6. Lt subscapular artery
7. Head of the lt humerus
Projection is anterior to posterior with the arm raised
Carotid injection
Plate (130) 136
1.
2.
3.
4.
5.
Rt internal carotid artery
Rt external carotid artery
Rt common carotid artery
Tip of catheter
Swallowing artifact*
Digital subtraction angiography
(DSA) requires the patient to
be still or motion artifacts appear.
A swallowing artifact is common
to a carotid study.
#9
#9
Cerebral arteriogram
Plates (132-134) 139-141
1.
2.
3.
4.
5.
6.
Rt internal carotid artery
Rt external carotid artery
Rt middle cerebral artery
Rt anterior cerebral artery
Anterior communicating artery
Rt anterior cerebral artery
#10
#10
Cerebral arteriogram, venous phase
Plates (96- 98) 103-104
1.
2.
3.
4.
5.
6.
Rt superior sagittal sinus
Rt cerebral veins
Rt transverse sinus
Confluence of sinuses*
Rt sigmoid sinus
Rt internal jugular vein
* The confluence of sinuses appears to be shifted
to the right. This is due to the patient’s head
being slightly rotated to the left.
#11
#11
Magnetic Resonance Angiography
Plate (133) 140
MRA:axial
1.
2.
3.
4.
5.
6.
Rt middle cerebral artery
Lt anterior cerebral artery
Anterior cerebral artery
Rt posterior cerebral artery
Basilar artery
Internal carotid artery
There is a trace of the right posterior communicating
artery, but the left is not seen.
#12
This magnetic resonance angiography (MRA) image is a
3D reconstruction of the circle of willis, view in the axial
plane. The two triangular shapes on the top are the superior
surface of the orbital part of the frontal bone (roof of orbit).
#12
#13
1. Rt internal carotid artery
2. Rt internal carotid artery in the
carotid canal (130)
3. Rt middle cerebral artery
4. Rt anterior cerebral artery
5. Anterior communicating artery
MRA: Coronal
This 3D reconstruction is the result
of extracting the vasculature in the
volume of the MR scan, and displaying
a selected portion in the coronal plane.
Orientation marker indicates right, superior,
and anterior
#13
Hand
arteriorgram
#14
Plate (449) 466
1.
2.
3.
4.
5.
Radial artery
Ulnar artery
Common palmar digital arteries
Proper palmar digital arteries
Superficial palmar arch
Femoral arteriogram
Plate (494) 512
1.
2.
3a.
3b.
4.
5.
6.
a.
b.
#15
Joint space of Rt knee
Lt popliteal artery
Lt tibioperoneal trunk*
Lt posterior tibial artery
Lt anterior tibial artery
Lt peroneal (fibular) artery
Adipose tissue**
* Netter labels 3a and 3b only as the
posterior tibial artery. Identifying
3a as the tibioperoneal trunk helps
differentiate that section of the
vessel. This area (3-5) is also
known as a trifurcation.
** When doing a bilateral study of
the femoral arteries the legs must
be close together, causing an
overlap of soft tissue.
Rt leg
venogram
#16
Iliac crest
Plates (257, 283) 265, 403
Lumbar
spine
1.
2.
3.
4.
5.
6.
Inferior vena cava
Rt common iliac vein
Lt common iliac vein
Rt external iliac vein
Rt internal iliac vein
Posterior branch of Rt internal iliac vein
Plates (257, 283) 265, 403
Rt leg venogram
#17
Femoral
head
1.
2.
3.
4.
5.
6.
7.
Rt ilium of the pelvis
Rt common iliac vein
Rt femoral vein
Rt great saphenous vein
Pubic symphysis
Rt external iliac vein
Rt internal iliac vein
Rt leg venogram
#18
Femoral
head
1.
2.
3.
4.
Rt femoral vein
Rt deep (femoral) vein (487) 505
Rt femoral vein*
Rt obturator foramen
* The inverted V shape is a valve. Another is seen in
the deep vein.
The previous image showed the veins as black. This
is the typical fluoroscopic presentation. The gray
scale can be reversed electronically, but in this case
was filmed in the fluoroscopic mode. When contrast
filled vessels are white, that is the radiographic
presentation.
Rt leg
venogram
#19
Plates (498, 526-528) 502, 516-517
1. Rt femoral vein
2. Rt popliteal vein
The proliferation of veins below the head of the
fibula are superficial. They disappear so dramatically
due to a tourniquet at that level. Prior to vascular
ultrasound venograms were the “gold standard” for
visualizing deep vein thrombosis (DVT). The injection
was made through a superficial vein in the dorsum of
the foot, and tourniquets at the ankle, below the knee,
and on the distal thigh helped drive the iodine contrast
into the deep system.
Finding a vein in edematous tissue was a challenge,
and filling the deep venous system was a tricky and
exacting process, and most uncomfortable for the
patient. There are undoubtedly few, if any, radiologic
technologists who are not thankful that vascular
ultrasound has supplanted there need to perform this
exam.
Plates (498, 526–528) 502, 516-517
1. Rt. Popliteal vein
2. Rt short saphenous vein (498)
3. Rt great saphenous vein
Rt leg venogram
#20