X-ray of blood vessels (arteries)

Radiation angiology and radiation vascular surgery have grown into a broad discipline that is developing at the intersection of medical radiology and surgery. The success of this discipline is associated with four factors:

1. all arteries, all veins and venous sinuses, all lymphatic pathways are accessible to radiological examination;
2. all radiation methods can be used to study the vascular system: X-ray, radionuclide, magnetic resonance, ultrasound, and this creates the possibility of comparing their data, in which they complement each other;
3. radiation methods provide a combined study of the morphology of blood vessels and blood flow in them;
4. Various therapeutic manipulations on vessels (X-ray endovascular interventions) can be performed under the control of radiation methods. They represent an alternative to surgical operations for a number of pathological conditions of the vessels.

Thoracic aorta

The shadow of the ascending aorta, its arches and the beginning of the descending part are quite clearly visible on radiographs. In the supravalvular section, its caliber reaches 4 cm, and then gradually decreases, averaging 2.5 cm in the descending part. The length of the ascending part varies from 8 to 11 cm, and the length of the aortic arch - from 5 to 6 cm. The upper point of the arch on the radiograph is 2 - 3 cm below the jugular notch of the sternum. The shadow of the aorta is intense, uniform, its contours are smooth.

Ultrasound examination allows to evaluate the thickness of the aortic wall (normally 0.2-0.3 cm), the speed and nature of blood movement in it. CT allows to see not only the aorta, but also the brachiocephalic trunk, the left common carotid artery and the left subclavian artery, as well as the right common carotid and subclavian arteries, both brachiocephalic veins, both vena cava, and the internal jugular veins. The capabilities of CT in visualizing the aorta have significantly expanded with the introduction of spiral computed tomographs into medical practice. Three-dimensional reconstruction of the image of the aorta and its large branches has become available on these devices. The capabilities of MRI are especially noteworthy.

In routine clinical practice, atherosclerotic lesions of the aorta can be assumed based on the results of a general X-ray examination. Atherosclerosis of the aorta is indicated by its expansion and elongation, clearly visible on a chest X-ray. The upper pole of the aortic arch is located at the level of the jugular notch, and the aorta itself is strongly curved to the left. The elongated aorta forms bends, which are also clearly visible on X-rays. The bends of the descending aorta can compress and displace the esophagus, which is determined by its artificial contrast. Calcium deposits are often detected in the walls of the aorta.

Radiography is a reliable means of detecting an aneurysm of the ascending aorta. An aneurysm has the appearance of a round, oval or irregular formation, inseparable from the aorta. Sonography is of great importance in diagnosing an aneurysm of the aorta. CT and MRI can clarify its relationship with surrounding organs, the condition of the aneurysm wall, including the possibility of a dissecting aneurysm, and establish thrombosis of the aneurysmal sac. All these signs are determined with even greater detail under conditions of artificial contrast of the aorta - aortography.

However, aortography is especially necessary for studying the brachiocephalic trunk and brachiocephalic branches of the aorta in order to diagnose vascular anomalies that are generally not uncommon in this area, as well as occlusive lesions, i.e. narrowing of the vessels due to arteritis or atherosclerosis.

Abdominal aorta and arteries of the extremities

On conventional radiographs, the abdominal aorta and arteries of the extremities do not produce an image. They can be seen only when calcification occurs in their walls, so sonography and Doppler mapping are of primary importance in examining this part of the vascular system. Important diagnostic information is obtained from CT and MRI. In some cases, preference is given to an invasive method - aortography.

Sonograms provide a direct image of the abdominal aorta and large arteries. They allow one to judge the position, shape and contours of the aorta, the thickness of its walls, the size of the lumen, the presence of atheromatous plaques and thrombi, and intimal detachment. Local narrowing and widening of the vessel are clearly visible. Sonography is of great importance in examining patients with abdominal aortic aneurysm. This method makes it easy to determine the diameter of the aneurysm, which has a decisive prognostic value. Thus, aneurysms with a diameter of more than 4 cm are an indication for surgical treatment, since with such aneurysm sizes the probability of its rupture increases. Similar morphological data can be obtained using other non-invasive techniques - CT and MRI.

In recent years, MRI has taken a firm place in the examination of patients with peripheral vascular diseases. Modern mid-field and especially high-field tomographs allow non-invasive imaging of the vascular bed of all areas of the body, down to medium-caliber vessels, and the use of contrast agents has opened the way for MRI to visualize fairly small arteries - up to 5-6 caliber and volumetric reconstruction of the vascular bed (MR angiography).

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ]

Angioscintigraphy

Radionuclide visualization of arterial vessels - angioscintigraphy - has a certain significance in the diagnosis of lesions of arterial vessels.

The method is non-invasive, can be used in outpatient settings, and involves low radiation exposure. In general, this method can be used as a screening method when selecting patients for invasive studies, such as X-ray angiography.

[ 6 ], [ 7 ]

Aortography

Aortography plays a decisive role in assessing the condition of the abdominal aorta and iliofemoral segments, especially when planning surgical or X-ray endovascular intervention.

The study is performed by translumbar puncture of the aorta or its retrograde catheterization from a peripheral artery (most often the femoral artery). In any case, it is necessary to obtain an image of the entire abdominal aorta, pelvic arteries and both lower extremities, since the classic sites of atherosclerotic lesions are the aortic bifurcation area, iliac vessels, femoral arteries, and the area of the adductor (Hunter's) canal (middle and distal parts of the thigh).

The shadow of the normal aorta looks like a strip gradually tapering downwards, located in front of the spine and slightly to the left of the midline of the body. At the level of the origin of the renal arteries, there is a physiological decrease in the lumen of the aorta. The distal diameter of the aorta in an adult is on average 1.7 cm. A number of branches extend from the aorta to the abdominal organs. At the level of the lower edge of the body, the LV aorta divides into the common iliac arteries. They in turn divide into the external and internal iliac arteries. The former directly pass into the femoral arteries.

Both the abdominal aorta itself and its large branches in a healthy person have clear and even contours. Their caliber gradually decreases in the distal direction. Atherosclerosis initially causes straightening of the vessel and its moderate expansion, but as sclerosis increases, tortuosity of the affected vessel, unevenness, waviness of its outlines, unevenness of the lumen, contour defects in places of atherosclerotic plaques occur. In case of aortoarteritis, narrowing of the vessel with relatively smooth contours prevails. Expansion of the vessel is noted in front of the narrowed area. Due to impaired blood flow in occlusive lesions, the development of a collateral network of vessels is detected, which is also clearly visible on arteriograms and magnetic resonance angiography. Blood flow disorders in the arteries are demonstratively determined by Dopplerography with color mapping. If a thrombus is detected in an artery, the issue of thrombectomy using a hydrodynamic catheter and subsequent placement of a stent coated with polytetrafluoroethylene is considered.

[ 8 ], [ 9 ], [ 10 ]