Objective To assess the feasibility, safety, and efficacy of balloon disruption of thrombus by using a deflated balloon catheter combined with intraarterial thrombolysis for the treatment of acute middle cerebral artery(MCA) occlusion. Methods Five consecutive patients with acute MCA occlusion underwent balloon disruption combined with intra-arterial thrombolysis. The microballoon was inflated in the distal carotid artery and then deflated and advanced just distal to the occlusion site in the MCA. Thereafter, intra-arterial thrombolysis of the MCA was applied and the maximum dosage of urokinase was 500,000 U. Results Complete recanalization was achieved in 3 patients and partial recanalization in 2. All patients got favourable clinical outcome. There was no major intracerebral hemorrhage. Conclusion The penetration of the MCA with a deflated balloon catheter combined with an intra-arterial thrombolysis may be a safe and effective treatment for acute ischemic stroke.

Objective To assess the clinical value of dual-energy intracranial CT angiography (CTA).Methods Forty-one patients suspected of intracranial vascular diseases underwent dual-energy intracranial CT angiography, and 41 patients who underwent conventional subtraction CT were enrolled as the control group.Image quality of intracranial and skull base vessels and radiation dose between dual-energy CTA and conventional subtraction CTA were compared using two independent sample nonparametrie test and independent-samples t test, respectively.Prevalence and size of lesions detected by dual-energy CTA and digital subtraction CTA were compared using paired-samples t test and Spearman correlative analysis. Results The percentage of image quality scored 5 was 70.7% (29/41) for dual-energy CTA and 75.6% (31/41) for conventional subtraction CTA.There was no significant difference between the two groups(Z= -0.455, P=0.650).Image quality of vessels at the skull base in conventional subtraction CTA was superior to that in dual-energy CTA, especially for the petrosal and syphon segment (Z=-4.087, P= 0.000).Radiation exposure of dual energy CTA and conventional CTA were (396.54±17.43) and (1090.95±114.29) mGy · cm respectively.Radiation exposure was decreased by 64% (t=-38.52, P=0.000) by dual energy CTA compared with conventional subtraction CTA.Out of the 41 patients,19 patients were diagnosed as intracranial aneurysm, 2 patients as arteriovenous malformation (AVM), 3 patients with Moya-moya's disease, and the remaining 17 patients with negative results.Nine patients with intracranial aneurysm, 2 patients with AVM, 3 patients with Moya-moya's disease, and 2 patients with negative findings underwent DSA or operation, with concordant findings from both techniques.Diameter of aneurysm neck, long axis and minor axis by dual-energy CTA was (2.90±1.61), (5.23±1.68) and (3.83±1.69) nun, respectively; Diameter of aneurysm neck, long axis and minor axis by DSA was (2.95±1.71), (5.10±1.60) ,(3.83±1.65) nan,respectively.There was no significant difference for the diameters of aneurysm between dual energy CTA and DSA ((t=-0.734,1.936,0.12.5 respectively, P=0.482,0.085,0.903 respectively), and good correlation was found between diameter measurements using the two techniques(r=0.964,0.976,0.973, respectively, all P=0.000) Conclusions Compared with conventional subtraction CTA, dual energy CTA has good image quality for intracranial vessels; however, image quality of the skull base vessels is worse, especially for the petrosal and syphon segment.Dual energy CTA has decreased radiation dose and a high diagnostic accuracy, being a practical imaging madality for diagnosis of intracranial vascular lesions.

Objective To assess the value of dual-source computed tomography angiography (DSCTA)in detecting intracranial aneurysms by comparing with conventional and three-dimensional DSA.Methods In this study,95 patients with subarachnoid hemorrhage(SAH)underwent both DSCTA and DSA examination.The detection rate,size,and ratio of the neck to the dome(N/D ratio)of the aneurysrns were evaluated.Statistical analysis was performed using a paired sample Student's t-test for the comparisons of the value of N/D and 2 Related Samples test for long axis.Results A total of 67 aneurysms in 63 patients at DSA and 64 aneurysms in 60 patients at DSCTA were detected,respectively;whereas no aneurysm was detected in 32 patients at DSA.Compared with DSA,the overall sensitivity.specificity,positive predictive value,and negative predictive value of DSCTA on a per-aneurysm basis were 94.2%,100.0%,100.0%,and 91.4%,respectively.For the aneurysms larger than 3 mm,the sensitivity and specificity of DSCTA in detecting intracranial aneurysms were equal to those of DSA:For aneurysms smaller than 3 mm,however,the sensitivity and specificity of DSCTA is 80.0% and 100.0%.The N/D ratio for DSA and DSC:TA was 0.46±0.14 and 0.51±0.18.respectively,and the median of long axis was 4.9 mm and 4.8 mm.respectively.There was no significant difierence in the N/D ratio(t=3.20;P＞0.05)and the long axis(Z=-1.309;P＞0.05)between DSA and DSCT.Condusions Compared with conventional and three-dimensional digital subtraction angiography,DSCTA has high sensitivity and specificity in the detection of intracranial aneurysms,especially for detection of snlall aneurysnm(＜3 mm).It can be used as a routine screening technique.

Objective To evaluate the value of dual energy CT with Lung Vessels application in diagnosing pulmonary embolism (PE) of children.Methods Forty-seven patients with nephrotic syndrome and aged ≤ 18 years old (32 male,15 female,mean age 15 years) underwent dual-energy CT pulmonary angiography (CTPA).Two radiologists recorded the presence or absence of emboli and counted the clots on a per-patient and per-lobe basis with Lung Vessels,respectively.With conventional CTPA as reference standard,sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) of Lung Vessels application to detect PE were computed for two readers.Inter-reader agreement was also calculated.Results Conventional CTPA detected 51 clots in 35 lung lobes in 13 patients,giving PE incidence was 27.6％ (13/47) for this cohort.On a per-patient basis,readers 1 and 2 detected 25 and 21 patients with PE with Lung Vessels,corresponding to sensitivities,specificities,PPVs,and NPVs of 100.0％ (13/13),58.6％ (17/29),43.3％ (13/30),100.0％ (17/17) and 100.0％ (13/13),76.5％ (21/29),50.0％ (13/26),100.0％ (21/21),respectively.On a per-lung lobe basis,readers 1 and 2 detected 74 and 63 clots with Lung Vessels,respectively,corresponding to sensitivities,specificities,PPVs,and NPVs of 94.3％ (33/35),79.5％ (159/200),44.6％ (33/74),98.7％ (159/161) and 97.1％ (34/36),85.5％ (171/200),54.0％ (34/63),98.8％ (171/173),respectively.On a per-clot basis,134 and 105 clots were detected with Lung Vessels application,corresponding to sensitivities,specificities,PPVs,and NPVs for DECT of 96.1％ (49/51),64.9％ (159/245),36.3％ (49/135),98.7％ (159/161) and94.1％ (48/51),75.0％ (171/228),45.7％ (48/105),98.3％ (171/174)for readers 1 and 2,respectively.Excellent or good inter-reader agreement was observed on a per-patient,per-lobe and per-clot basis (Kappa =0.828,0.859,0.695 ; all P ＜ 0.01).Conclusions Dual-energyCT with Lung Vessels application has a high sensitivity and negative predictive value for PE detection in children.More clots are detected with Lung Vessels application than conventional CTPA,which deserve further investigation.

Objective To study the potential of functional MRI (fMRI) during passive finger extension (FE) for predicting the motor function recovery of hemiplegic stroke survivors.Methods Nineteen survivors of a 1st cerebral infarction in the non-M1 cortex with complete paralysis on one side were selected for study.Within 1 week after the stroke,fMRI was performed while one of the patient's paralyzed fingers was passively flexed and extended.fMRI signals were acquired from the sensorimotor cortex (SMC),the supplementary motor area (SMA) and the premotor area (PM).Fugl-Meyer (FM) scores of arm motor function were recorded one week,one month and three months after the stroke.Results The early fMRI results were used to classify cortex activation performances as type Ⅰ (activation mainly on the affected side,but SMC and SMA activated bilaterally),type Ⅱ (activation of the SMC and SMA only on the affected side) or type Ⅲ (only activation of the SMC on the affected side).At one week after stroke the average FM scores of the three groups were not significantly different.At one month the three average FM scores were 47.1 ± 5.5 points,36 ±6.7 points and 11.2 ± 3.1 points,for groups Ⅰ,Ⅱ and Ⅲ respectively,each significantly different from the others.At three months the average FM ratings of groups Ⅰ (61.1 ± 3.8 points) and Ⅱ (59 ± 5.2 points) were not significantly different,but both were significantly higher than the average score of group Ⅲ (10.8 ± 5.6 points).Conclusion The early stage fMRI characteristics of hemiplegic patients can be used for predicting motor outcomes.

Objective To investigate the significance of change of fluid-attenuated inversion recovery(FLAIR) hyperintense vessel sign(HVS) after endovascular recanalization in acute ischemic stroke. Methods The clinical and imaging data of the patients with acute middle cerebral artery(MCA) occlusion treated by mechanical thrombectomy with Solitaire AB from January 2013 to october 2014 were analyzed retrospectively. The inclusion criteria: (1) The preoperative MRI included conventional non-enhanced MR, diffusion-weighted imaging (DWI), magnetic resonance angiography(MRA) and perfusion-weighted imaging (PWI), and HVS was observed on preoperative FLAIR images; (2) acute MCA occlusion verified by conventional angiography;(3) postoperative similar MR images examination was performed within 48 hours. The relationships among postoperative changes in the HVS, DWI and Thrombolysis In Cerebral Ischemia (TICI) scale (1—3) were assessed. Results After endovascular therapy, HVS of the 11 cases were showed to be disappeared(n = 9) and decreased (n = 2). All the 9 patients with disappeared HVS achieved high grade flow (TICI 3), and minor decrease of ischemic area on DWI in 1 case, minor progression in 6, and significant progression in 2. However, of the 2 patients with decreased HVS, one achieved relatively low grade flow (TICI 2a) and the other was found to be relatively high grade flow (TICI 2b), but severe MCA stenosis. DWI demonstrated significant progression in both two cases. Conclusion Our data indicate that endovascular recanalization of acute MCA occlusion was effective for decreasing HVS. Postoperative decrease and disappear in HVS can be considered as a marker for hemodynamic improvement.

Objective To investigate the clinicopathological features of patients with serous cystadenomas of the pancreas (SCAP).Methods The clinical and pathological features of 21 cases of SCAP were retrospectively analyzed.Results The mean age of the 21 cases was 61 years old,male:female ratio was 1∶ 1.33,18 (85.7％) patients presented with abdominal pain,bloating,abdominal mass,weight loss,and 3 (14.3％) patients were found during check-up.The tumors were located in pancreatic head in 9 patients,in pancreatic body and tail in 12 patients.The clinical manifestations were pancreatic cystic lesions.All patients underwent surgery.Histologically,the cyst wall was complete and lined with flat or cuboidal epithelium,cytoplasm was translucent,nucleus were round or oval with similar size,no significant nuclear atypia and mitotic activity was found.The pathologic diagnosis was micro-cyst type in 15 cases,single-cyst type in 6 cases.Immunohistochemistry method showed EMA,CK7,CK19 positive and PAS staining positive.The positive expression rate of Ki 67 was between 1％ and 3％.After follow-up of 19 cases ranging from 3 months to 7 years,no recurrence and metastasis was detected.Conclusions SCAP is seen predominantly in elderly female patients with significant symptoms.A majority of tumors are located in the pancreatic body and tail.SCAP presents with characteristics of pancreatic ductal epithelial,and the prognosis is excellent.

Objective:Rudimental contrast media in the subclavian vein often influence the display of carotid on dual-source computer tomography angiography.This article aimed to investigate this influence,and find a best solution.Methods:One hundred patients were randomly divided into Groups A(n=52) and B(n=48).The former received traditional imaging,with 65 ml contrast media,4.0 ml/s injection flow and caudocranial scanning direction,while the latter kept all the parameters unchanged except the scanning direction,from caudocranial to craniocaudal.Each group was graded by original axial images,maximum intensity projection(MIP),silhouette images and VR images for vascular delineation of the carotid.Results: The carotid artery was clearly displayed in Group B,while the subclavian vein was unsatisfactorily revealed in Group A,with statistically significant differences in extent scores between the two groups(P

Objective To evaluate the safety and efficacy of the endovascular treatment of anterior circulation multiple occlusions (AMO) in acute ischemic stroke.Methods The clinical data of 10 patients with AMO treated by endovascular method from January 2011 to August 2013 were retrospectively analyzed.The proximal internal carotid artery (ICA) occlusion was treated using angioplasty in order to achieve ideal location of the guiding catheter.When necessary,stenting was performed after the reconstitution of the intracranial vessel.Recanalization was assessed according to the thrombolysis in cerebral ischemia (TICI) grade.Clinical prognosis was assessed using mRS at 3 months.The National Institutes of Health Stroke Scale (NIHSS) on admission and at discharge was compared using t test.Results The intracranial vessel was recanalized successfully (TICI ≥ 2b) in 9 cases and cervical carotid was stented in 8 cases.Adverse events were recorded in 3 patients,including one case of asymptomatic subarachnoid hemorrhage and two cases of symptomatic intra-cerebral hemorrhage.Mortality rate was 10 ％ (n=1).At the three-month follow up,mRS ≤ 2 was observed in five patients.The mean NIHSS scores was 15.7±2.2 on admission and 9.6±4.7at discharge,and the difference was statistic significant(t=2.86,P=0.02).Conclusion Endovascular therapy of AMO is technically feasible,and relatively safe and effective.

Objective A comparative proteomic method was utilized to analyze serum proteins among pancreatic cancer patients,pancreatic benign tumor group,chronic pancreatitis group and normal control group to discover a new potential specific early diagnostic marker.Methods Comparative analysis on the pancreatic peripheral blood protein profiling from 40 pancreatic cancer patients,10 benign tumor patients,10 chronic pancreatitis patients and 40 cancer-free controls from May 2009 to April 2011 was carried out by 2D differential gel electrophoresis (2D-DIGE) and differentially expressed proteins were identified by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS).Results Three differentially expressed proteins,Hemopexin (Hpx),Ficolin 3 (FCN3) and Serum amyloid P-component (SAP) was identified.Those proteins were higher expression in pancreatic cancer group compared with benign tumor group,chronic pancreatitis group and normal control group.Each point in pancreatic cancer expression were 1.57,1.99,1.63 times than normal control expression,respectively (P ＜0.05).Conclusions In this study,the identified proteins,Hpx,FCN3 and SAP may be as potential specific early diagnostic markers of pancreatic carcinoma.2D-DIGE and MALDI-TOF-MS technology in screening specific serum tumor markers of pancreatic cancer has a well repeatability and stability.