Kawanisi Y, Kimura K, Lee K S, Koizumi T, Nakatsuji H, Kojima K, Yamamoto A, Numata A
Department of Urology, Takamatsu Red Cross Hospital.
Nihon Hinyokika Gakkai Zasshi. 2001 Nov;92(7):674-81. doi: 10.5980/jpnjurol1989.92.674.
CT angiography reconstructed by a multidetector-row helical CT scanner is a newly developed form of imaging. We compared CT angiography and ultrasonic Doppler examination with digital subtraction angiography (DSA) in the diagnosis of arterial lesion.
Eighteen patients with arteriogenic erectile dysfunction (ED) underwent color Doppler study, DSA, and CT angiography after providing informed consent. The CT angiography images were obtained by a multidetector-row helical CT scanner, Asteion TSX021A (TOSHIBA). We injected prostaglandin E1 into the penile cavernous body, and then rapidly infused nonionic contrast medium into the antecubital vein. DSA and CT angiography images of the bilateral internal pudendal arteries and cavernous arteries were examined for stenotic lesions or occlusion. We also compared the peak systolic blood flow velocity in the cavernous artery measured by color Doppler ultrasound with CT angiography and DSA.
The CT angiography and color Doppler studies were performed on an outpatient basis, but DSA required hospitalization. In the 36 internal pudendal arteries, DSA represented 22 normal arteries and 14 stenosis or occlusions. CT angiography showed 15 normal arteries and 21 occlusions. For the diagnosis of stenosis or occlusion in the internal pudendal artery, the CT angiography image had a good agreement, with a sensitivity of 1.00, specificity of 0.68, and accuracy of 0.81. For diagnosis in the cavernous artery, CT angiography image also showed a good agreement with DSA; however, the quality of the images of fine arteries was better in the DSA images. The inferior view and internal view of the pelvis in CT angiography were helpful for visualizing the internal pudendal artery, especially at the pubic bone. There was insufficient correlation between peak systolic blood flow velocity and DSA findings. There were no serious complications involved in either examination.
CT angiography has not yet reached the same level as DSA in the evaluation of fine arteries. However, CT angiography can produced images sufficient for the diagnosis of arteriogenic ED with some advantages. We believe that with improvement, CT angiography will become an adequate replacement for DSA in the diagnosis of penile arterisl lesion.
多层螺旋CT扫描仪重建的CT血管造影是一种新开发的成像形式。我们比较了CT血管造影、超声多普勒检查和数字减影血管造影（DSA）在诊断动脉病变中的应用。
18例动脉性勃起功能障碍（ED）患者在签署知情同意书后接受了彩色多普勒检查、DSA和CT血管造影。CT血管造影图像由多层螺旋CT扫描仪Asteion TSX021A（东芝）获取。我们将前列腺素E1注入阴茎海绵体，然后将非离子型造影剂快速注入肘前静脉。检查双侧阴部内动脉和海绵体动脉的DSA和CT血管造影图像，以查找狭窄病变或闭塞情况。我们还比较了彩色多普勒超声测量的海绵体动脉收缩期峰值血流速度与CT血管造影和DSA的结果。
CT血管造影和彩色多普勒检查可在门诊进行，但DSA需要住院。在36条阴部内动脉中，DSA显示22条动脉正常，14条有狭窄或闭塞。CT血管造影显示15条动脉正常，21条有闭塞。对于阴部内动脉狭窄或闭塞的诊断，CT血管造影图像具有良好的一致性，敏感性为1.00，特异性为0.68，准确性为0.81。对于海绵体动脉的诊断，CT血管造影图像与DSA也显示出良好的一致性；然而，DSA图像中细小动脉的图像质量更好。CT血管造影中骨盆的下视图和内视图有助于观察阴部内动脉，尤其是在耻骨处。收缩期峰值血流速度与DSA结果之间的相关性不足。两种检查均未出现严重并发症。
在细小动脉评估方面，CT血管造影尚未达到DSA的水平。然而，CT血管造影能够生成足以诊断动脉性ED的图像，且具有一些优势。我们相信，随着技术的改进，CT血管造影将成为诊断阴茎动脉病变时DSA的合适替代方法。
