Retrospectively to acknowledge the 15 years achievement on diagnostic imaging and interventional therapy for Budd-Chiari syndrome and the current status with existing problems of the interventional therapy, more strength and emphasis should be laid on the fundamental research for the etiology and pathogenesis. (J Intervent Radiol, 2006, 15: 513-514)

Objective To investigate whether the injured vascular endothelial plays an important role in the membranous formation of the inferior vena cava (IVC). Methods There were 40 cases of membranous obstruction of inferior vena cava (MOVC) in the experimental group and 40 arrhythmic inpatients in the control group from affiliated hospital .There were 23 males and 17 females in experimental group while 21 males and 19 females in control group, and the age were (41.8±8.1) yrs and (43.2±7.6) yrs respectively. All of them had no anti-coagulation (clotting) drug history and smoking history, no hypertension, no pulmonary artery hypertension, no coronary heart disease, no valvular disease, no myocardial disease, no blood disease, no diabetes, no connective tissue disease and malignancy, and liver and renal function must be normal. And then the serum concentrations of von Willebrand factor(vWF), endothelin-1(ET-1), vascular endothelial growth factor(VEGF) were defined by enzyme-linked immunosorbent assay (ELISA). The results were analyzed with independent sample t-test. Results In MOVC patients, the serum concentrations of vWF, ET-1 and VEGF[ (37.8±6.6) μg/L, (31.9±6.0) ng/L, (20.84±5.78) μg/L] were higher than those in the control group[ (3.3±1.3) μg/L, (5.3±1.8) ng/L, (4.2±1.2) μg/L. t=32.65,26.70,17.85,P＜0.01, respectively]. ConclusionsThe injury of vascular endothelium is related to the formation of membrane in the IVC.

Objective To evaluate the value of removing intracranial lipiodol by fat emulsion injection.Methods Twelve rabbits were randomly divided into two groups,control group(n=6) and experimental group(n=6).All rabbits were injected lipiodolvia the internal carotid artery(0.06 ml/kg).When lipiodol was found intracranially by CT scan,the model was considered to be successful.The rabbits were then injected with fat emulsions intravenously immediatedly following the CT and at intervals of 24 hours,for a total of 6 times(20 ml/kg).Subsequently,the experimental group of rabbits underwent head CT scan at that time and 144 hours later.The control group without treatment underwent head CT scan at the same time interval.The highest density of 0.01 cm2 was selected as region of interest and the CT value was measured.Comparison between the two groups at different times used repeated measurements of ANOVA.Same time points between the two groups were compared using the two independent-samplesttest.Changes of clinical symptoms were observed in rabbits.Results At 24,48,72,96,120 hours,144 hours post-treatment,the CT values of the ROI in the control group and the experimentalgroupwere(103.8 ±7.1),(91.0±4.2),(79.5 ±5.5),(67.8±6.6),(53.9±5.1),(39.9±3.1)HU respectively and(90.7-±5.4),(74.1±4.6),(62.9±4.5),(48.1±3.1),(39.1±1.3),(38.8± 1.2)HU respectively.The results of the repeated measurementsof ANOVA showed that the CT values difference of the two groups at different time was statistically significant(F=201.30,P＜0.01).The results of the two independent-samples t test showed that the CT values difference of 24 to 120 hours posttreatment of the two groups also was statistically significant(t=3.60,6.64,5.72,6.62,6.89,P＜0.05).After the intra-arterial injection of lipiodol,all animals had different degrees of stroke symptoms.Clinical symptoms disappeared earlier in the experimental group than the control group by 24 hours.Conclusion Fat emulsions can accelerate the intracranial lipiodolclearence.This study provides some theoretical basis for clinical treatment of cerebrallipiodol embolism.

Objective To assess the therapeutic effect of microwave radiation combined with Adriamycin liposome on liver VX2 tumor in rabbits. Methods VX2 tumor pieces were successfully implanted into liver lobes of rabbits with liver tumors formation. All rabbits were divided randomly into 4 groups (each n=8). Group A underwent transcatheter arterial chemoembolization (TACE) with Adriamycin, group B were treated with Adriamycin liposome, group C were treated with microwave radiation combinate with Adriamycin, and group D were treated with microwave radiation combinate with Adriamycin liposome. Spiral CT scans was performed to measure size of liver tumors at 1 day before operation and 14 days after operation, and liver function was tested at 1 day before operation, 1 day and 7 days after operation. Breathing frequency, heart rate and body temperture were measured before microwave radiation processing of microwave radiation, at 30 min after microwave radiation and 1 h after microwave radiation. All experimental animals were scarficed on the 15th day after operation and followed by pathologic and histologic examination of the tumor and after the operation with correlative comparisons. Results There was no significant difference in volumes and liver function among 4 groups at 1 day before operation. At 14 days after operation, the average tumor volume was (6.02±1.21) cm3 in group A, (5.74±1.43) cm3 in group B, (3.26±0.37) cm3 in group C and (1.89±0.14) cm3 in group D. There was no significant difference of liver function among 4 groups. After microwave radiation the rabbit's vital signs were stable. The intratumoral necrosis was more significant in group D than in the others (P<0.05). Conclusion Adriamycin liposome treatment for liver tumor via vascular interventional method combined with microwave radiation can significantly inhibit the growth of liver VX2 tumor in rabbits. Adriamycin liposome is a kind of effective pracputium in interventional chemoembelization, and the united therapy is safe and acceptable.

Objective To evaluate the inhibitory effect on the VX2 tumor of rabbit with CT-guided percutaneous high-temperature pingyangmycin lipiodol injecting. Methods New Zealand white rabbits were performed to plant rabbit VX2 tumor in the left liver leaf. After two weeks, all the rabbits were scanned with CT and divided into 5 groups randomly, and every group was injected different temperature pingyangmycin combined with lipiodol, then the effect was evaluated after 2 weeks. Results Compared with control group, the volume of VX2 tumor in every group injected high-temperature lipiodol reduced obviously (P<0.05), and the necrosis rate of hepatic transplant tumor increased significantly (P<0.05) as the temperature increased. MVD value of the tumor and VEGF expression obviously reduced (P<0.05), there was a positive relationship between MVD value and VEGF expression with the temperature. Conclusion CT-guided percutaneous high-temperature pingyangmycin lipiodol injecting can inhibit the VX2 tumor growth and tumor angiogenesis formation obviously, and the higher temperature, the better the therapeutic effect.

Purpose: Introduce the way of the treatment of deep veinous thrombosis of leg. Meerials and Methods: 26 patients (27 legs) refred for phlebothrombosis of leg, were prove by lower limb Phlebography or ECT. 100～200 thousand unit UK was infused through dorsal veins of sick leg, once or twice per day with 7 days a coure of treatment. Results: 17of 27 legs with phlebothromb0sis, were cured the successful rate 63%, 8 were improved, 30%; 2 were noneffective, 7%. No bleeding occurred 1 case of pulmonary segment embolism. Conclusion The way of the treatment of lower limb deep vein thrombosis by infusion of UK from dorsal veins of sick foot is safe and reliable.

Objective To study the interventional therapeutic methods in Budd Chiari syndrome (BCS) complicated with thrombosis. Methods Eighteen patients of BCS complicated with thrombosis, including 2 cases of hepatic vein (HV) occlusion and 16 cases of inferior vena cava (IVC) occlusion, were treated. Therapeutic methods were anti coagulation with Co Danshen and aspirin in 10 cases or the anti coagulation and thrombolysis with urokinase in 8 cases before operation, treatment with PTA and stent during operation,and thrombolysis with urokinase and the anti coagulation after operation. Results Technical success was achieved in all patients without serious complications. The mean blood pressure in IVC dropped from (31 82?0 52)cm H 2O(1 cm H 2O= 0 098 kPa) to (18 17?0 38)cm H 2O immediately after the procedure. The blood pressure in HV dropped from 42 cm H 2O and 41 cm H 2O to 15 cm H 2O and 16 cm H 2O, respectively. All 18 cases were followed up for an average of 38 months (range 6-72 months). The main symptoms and signs completely disappeared in 12 cases and partially alleviated in 6 cases. Conclusion The interventional treatment of BCS complicated with thrombosis was a safe and effective method.

A prospective study was performed to evaluate the diagnostic value of B- mode ultrasonography and inferior vena cavograme and the value of PTA in Budd-Chiari syndrome.One hundred sixty-eight cases including ninety-two men and seventy-six women, age ranged 11～63(mean,34.8 years).Among them 65 were treated with PTA or stent placement.The authors gave a minute and detail description of clinical feature,ultrasono- graphy,inferior vena cava or hepatic venogram,CT and other radiologic demonstration of Budd-Chiari syndrome retrospectively.Four types of Budd-Chiari syndrome were demon- strated based on anatomy,B-mode ultrasonography,inferior vena cavogram and hepa- tovenograme.(1)IVC membranous webs(76 subjects,45.2%),(2)IVC segmental stenosis or occlusion(65 subjects,38.7%),(3)hepatic vein occlusion(10 subjects,6. 1%),(4)mixed type(17 subjects,10%).The treatment of the Budd-Chiari syndrome with percutaneous transluminal balloon dilatation and stent placememnt of inferior vena cava or hepatic vein was safe and satisfied.Its long-term effectiveness(follow up 3-5 years)is al- so satisfactory.

Two patients of Budd-Chiari syndrome,suffering from the anemalons drainage of inferior vena cava into left atrium were reported including one male of 41 years old and female of 42. togectll with labial cyanosis,fingers and toes symptoms of portal hypertension and IVC hypertension. The obstruction of IVC wastreated with balloon catheter hypertension and IVC hypertension the disrotreaed also after PTA.The echo wasn't discovered with Dopple ultrasound after PTA.

Objective To explore the value of the application of vascular enhancement technology (VET) in the diagnosis of Budd-Chiari syndrome (BCS) and the evaluation of the therapeutic efficacy of interventional therapy.Methods B-mode ultrasound,color Doppler and VET were performed on 93 patients with BCS for the systematic detection of intrahepatic vessels and the inferior vena cava (IVC),with the static and dynamic images of these vessels stored prior to interventional therapy.Subsequent to the operation,the same procedures were repeated on the vessels concerned and the images were recorded.The definitions of B-mode and VET images of the detected vessels were compared by two sonography experts.Regarding DSA as standard,the diagnostic accordance rate of VET and B-mode imaging of the diseased vessels was compared.Results Of the 613 vessels detected prior to intervention therapy,440 vessels images were distinct by B-mode and 533 by VET(P<0.05).VET demonstrated 37 intrahepatic collaterals which were invisible by B-mode.Regarding DSA as the gold standard,the diagnostic accordance rate of affected vessels of B-mode and VET was 69.2% and 92.5%,respectively(P<0.05).In total 103 therapeutic vessels,B-mode sonography and VET revealed 81 and 95 distinct vessels,respectively(P<0.05).Conclusions VET can improve the definition of veins and venous stents.The combination of VET and color Doppler can improve the clinical value of ultrasound in the diagnosis of BCS and evaluation of the therapeutic efficacy of interventional therapy.