Purpose: To describe the clinical manifestations of hepatic myelopathy (HM) after transjugular intrahepatic portosystemic stent shunts (TIPSS)in five patients. Materials and Methods: Four men and one woman, age ranging from 41 to 54 years, had history of hepatitis B and recurrent bleeding from gastroesophageal varices. Obvious liver atrophy was found in the five patients before TIPSS procedure and shunt patency was by color Doppler US after TIPSS. Spinal cord MRI was performed in 4, CT and myelography were performed in lcase. Lumbar puncture was done in 5 patients. Results: Spastic paralysis in the lower extremities occurred progressively during 4 weeks to 4 months after TIPSS in the five patients. Weakness of the upper extremities presented in one patient, and urinary incontinence was in another one. HE following TIPSS occurred more than once (1~6 times) in these patients. Physical ex- amination revealed that hyperreflexia of tendons and positive reaction of ankle clonus were seen in all patients. Superficial sensation was normal in 5, decreasing in deep sesation in 1. Muscular atrophy in the paralytic lower extremities was not obvious in all but one patient. No mass effect or other abnormalities were found in the suspected spinal cords on the imaging studies. Lumbar puncture and cerebrospinal fluid examination were normal. The abnormalities of laboratory tests included hyperammonemia and hypoal- buminemia. Conclusion: Spastic paralysis with intact of superficial sensation in the lower extremity fol- lowing TIPSS should be considered as HM. The potential risk factors of TIPSS related HM were obvious liver atrophy, refractory hyperammonemia and HE follwing TIPSS.

0.05);in treating gradeⅢto IV aGVHD,the effectiveness of FK506 with MP was significantly better than that of CsA with MP(P

Objective To analyze and evaluate the image quality and the impact factors of CT virtual endoscopy (CTVE) in the application of various body parts. Methods CTVE images from 143 patients were classified into 2 types according to the chosen threshold: low attenuation lumen (including natural air filled and artificially air filled lumina) and high attenuation lumen. A 4 point scale was used to evaluate the differences of diagnostic confidence, artifacts, and overall image quality rating between both kinds of lumina. Results There was no statistically significant differences in diagnostic confidence of CTVE images among 3 kinds of lumina, but the image quality of CTVE of natural air filled lumen was better than that of artificially air filled lumen ( P 0.05). There was a significant difference in artifact rating of CTVE images among three kinds of lumina with the most artifacts seen on images of high attenuation lumen. Common artifacts observed on the CTVE images were attributed to patient motion artifacts such as respiration, inappropriate choice of spiral CT scanning parameters, and improper modification of thresholds. Conclusion The threshold setting was one of the most important factors impacting the image quality of CTVE images, and most artifacts seen on the CTVE images were easily recognized on the basis of their characteristic appearance, and did not influence the diagnostic information heavily.

Objective To investigate the features of MR imaging of acute high voltage electric injury in forearm muscle. Methods Nine patients (17 forearms, 8 males and 1 female, 15～36 years of age) with clinically and pathological proved acute high voltage electric injury were studied on MRI retrospectively. MRI studies were obtained within 72 hours on Siemens 1 0 T MR scanner. 2 forearms were examined with body coil, and 15 with head coil. The severe area was placed as near as possible to the isocenter in the magnet and was used as the center of the MR imaging acquisition. Spin echo T 1 weighted images, spin echo and fast spin echo T 2 weighted images were acquired in all patients. 14 out of 17 were performed with Ⅳ administration of Gd DTPA. Results All 17 forearms had fascistomy after MRI. 11 had only debridement. The lesions were mainly observed in the flexor digitorum supericialis or profunduds muscle appearing as isointense on T 1 weighted images, hyperintense on T 2 weighted images, and strongly enhanced after Ⅳ administration of Gd DTPA in 8. The proximal aspect of the lesion appeared as sharp knife in 11. There was a weaker twitch response to electrocauterization in the injury muscle than in healthy muscle. It was variably necrotic in histopathology. Two transitional zones accompanied with the suffered forearm in 2, and one transitional zone in 6. Both of them had well defined margin. 6 forearms had amputation after debriding. There was Ⅰ,Ⅱ,and Ⅲ mixture signal all over the forearms. The proximal lesions showed type Ⅰ changes. Distal to the zone of forearm showed type Ⅱ and Ⅲ pattern appearing as isointense on T 1 weighted images, hyperintense and hypointense on T 2 weighted images. It was hardly enhanced after Ⅳ administration of Gd DTPA. There was no twitch response to electrocauterization in the injury muscle. It was almost completely necrotic in histopathology. ALL amputated forearms had two transitional zones and ill defined margin. The second transitional zone was enhanced something like flower border. Conclusion MR imaging of acute high voltage electric injury in forearm appeared as three kinds of signal mode, which was closely related with histopathology. MRI was useful in dealing with clinic problem and in judging the prognosis.