Abstract：Objective To explore anatomical variations of the internal mammary arteries (IMA) and measure its distances with the sternum from chest CT imaging, and to provide imaging data for route design of parasternal transthoracic or pericardial interventions.Methods CT data from 224 patients [Male 129, female 95, average age (63.2±10.4) years, range 27-90 years] who underwent enhanced chest multi-slice computed tomography were retrospectively analyzed. The modified Schwabegger classification was used to define the anatomical type of bilateral internal vessels and the distance between IMA and sternum edge from the 1st to the 5th intercostal space (ICS) were also determined on reconstructed coronal thin slab curved multiple planar paralleled with sternum combined with maximum intensity projection images.Results One artery accompanied with one vein was mostly encountered IMA anatomical type (type Ⅱ and type Ⅳ, 73.7% and 19.6% in the left, 61.2% and 15.6% in the right, respectively), followed by type Ⅰ, Ⅲ and Ⅴ (left: 2.2%, 2.7% and 1.8%; right 12.5%, 7.1% and 3.6%, respectively). No significant distance difference was observed between left and right IMA (all P values>0.05). The distance between IMA and sternal margin increasing sequentially from the 1st, 3rd, 2nd, 4th and 5th ICS, the differences were all statistically significant (all P values＜0.05). Male-to-female differences were significant at left of the 2nd, 3rd, 5th ICS and right 2nd ICS, with female significantly lower than male(all P values<0.05). No statistically distance differences were observed within different IMA anatomical types (all P values >0.05).Conclusions Multi-slice computed tomography allows a detailed anatomical evaluation of IMAs and provides precise distances of IMA and sternum which is helpful for route design of parasternal thoracic or pericardial interventions.
倪建明, 唐平, 张雷, 刘君. 胸骨旁入路胸腔及心包腔穿刺相关的内乳血管CT影像学研究[J]. 中华解剖与临床杂志, 2017, 22(6): 452-456.
Ni Jianming,Tang Ping,Zhang Lei,Liu Jun. Parasternal transthoracic and pericaridal puncture related anatomy of internal mammary arteries by multi-slice computed tomography. Chinese Journal of Anatomy and Clinics, 2017, 22(6): 452-456.
Heerink WJ, de Bock GH, de Jonge GJ, et al. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis[J]. Eur Radiol, 2017, 27(1): 138-148. DOI:10.1007/s00330-016-4357-8
[2]
Mehra S, Buch A, Truong CN, et al. Post-traumatic internal mammary artery pseudoaneurysm: a rare complication of pericardiocentesis[J]. Radiol Case Rep, 2014, 9(1): e00031. DOI:10.2484/rcr.v9i1.931
[3]
Azpurua FE, Dougherty KG, Massumi A, et al. Fistula from right internal mammary artery to superior vena cava after use of a laser sheath to extract a pacemaker lead[J]. Tex Heart Inst J, 2012, 39(5): 727-730
[4]
Kang K, Maholic R, Kang G. Successful coil embolization of a bleeding internal thoracic artery that caused severe hypotension immediately after permanent pacemaker placement[J]. Indian Heart J, 2015, 67(5): 493-494. DOI:10.1016/j.ihj.2015.06.016
[5]
Dursun M, Yekeler E, Yilmaz S, et al. Mapping of internal mammary vessels by multidetector computed tomography for parasternal transthoracic intervention guidance[J]. J Comput Assist Tomogr, 2005, 29(5): 617-620. DOI:10.1097/01.rct.0000172673.17188.69
[6]
Tuinder S, Dikmans R, Schipper RJ, et al. Anatomical evaluation of the internal mammary vessels based on magnetic resonance imaging (MRI)[J]. J Plast Reconstr Aesthet Surg, 2012, 65(10): 1363-1367. DOI:10.1016/j.bjps.2012.04.035
[7]
Ninkovic＇ MM, Schwabegger AH, Anderl H. Internal mammary vessels as a recipient site[J]. Clin Plast Surg, 1998, 25(2): 213-221
[8]
Han S, Yoon SY, Park JM. The anatomical evaluation of internal mammary vessels using sonography and 2-dimensional computed tomography in Asians[J]. Br J Plast Surg, 2003, 56(7): 684-688. DOI:10.1016/s0007-1226(03)00360-6
[9]
Tashima H, Fujikawa M, Izumi K, et al. Anatomic evaluation of the internal mammary vessels using multidetector CT angiography images in 100 Asian patients[J]. Eplasty, 2014, 14: e9
[10]
Glassberg RM, Sussman SK, Glickstein MF. CT anatomy of the internal mammary vessels: importance in planning percutaneous transthoracic procedures[J]. AJR Am J Roentgenol, 1990, 155(2): 397-400. DOI:10.2214/ajr.155.2.2115273
Haubenreisser H, Bigdeli A, Meyer M, et al. From 3D to 4D: Integration of temporal information into CT angiography studies[J]. Eur J Radiol, 2015, 84(12): 2421-2424. DOI:10.1016/j.ejrad.2015.06.014
2017, Vol. 22 
