The incidence of hilar cholangiocarcinoma is very rare worldwide. Radical resection is the only prognostic factor for long survival in patients with hilar cholangiocarcinoma. Postoperative radiation therapy can improve local control and survival rates for patients with palliative resection,but it remains controversial in patients with radical resection. Biliary drainage can effectively release bile duct obstruction for the majority of patients with locally advanced disease,and may even prolong survival when combined with radiation therapy. Radiation therapy includes extrernal beam therapy alone,external beam therapy with intraluminal brachytheapy and new radiation technique,such as three dimentional conformal therapy and intensity modulated radiation therapy. The propective randomized clinical study is needed for further investigation in the role of combined modality therapy especially for hilar cholangiocarcinoma.(J Intervent Radiol,2007,16: 705-709)

Intervetional therapy as an important therapeutic method for malignant biliary obstruction has been used extensively,but there still remain some problems worthy for our emphasis and research. We retrospectively reviewed more than 800 patients with malignant obstructive jaundice during 12 years. Indications,contraindications,complications and corresponding treatment methods were studied. Furthermore,discussion including methods of biliary drainage,proper time of stent implantation,methods of anesthesia,usage of antibiotics and haemostat were also carried out. Use of analgesics (pain-suppressal)pre-and post procedure,development of acute pancreatitis and its management,and peri-operative mortality were further investigated in detail. We hope our experiences and lessons would give interventional doctors some help in their career.(J Intervent Radiol,2007,16: 649-651)

Objective To discuss the correlative factors affecting the short-term prognosis in treating malignant obstructive jaundice with percutaneous transhepatie biliary drainage (PTBD) and/or percutaneous transhepatic biliary stenting (PTBS). Methods During the period of December 2008-June 2009, PTBD and/or PTBS were performed in 67 patients. The clinical date were reviewed and analyzed. According to the reduction degree of serum bilirubin and survival condition in 30 days, the patients were divided into effective group (54 cases) and ineffective group (13 cases). Single factor affecting the short-term prognosis was analyzed by using X~2 test and multi-factors were analyzed by using non-conditional logistic regression mode. Results Single variable analysis showed that time of obstruction, way of drainage, preoperative biliary infection, Child-Pugh grade, TBIL, HGB and Cr level were of statistical significance. The logistic regression analysis showed that there were obvious correlation among preoperative biliary infection, Child-grade ≥ 11 and Cr > 115 μmol/L. Conclusion The infection of the bile duct before operation, Child-grade ≥ 11 and Cr >115μmol/L carry a close relationship with the short-term prognosis of PTBD and PTBS. Therefore, an overall preoperative evaluation for malignant obstructive jaundice is of great importance.

Objective To determine the added clinical applications of MR virtual endoscopy (MRVE) plus MRCP in cholangiopancreatography. Methods In 14 month, 44 patients with obstructive jaundice and symptomatic bile trace were assessed by MRVE in biliary tract.The 2D data of heavily T 2 weighted images with FSE(non breath hold, respiratory trigger) and SSFSE(breath hold, multi slice single shot fast spin echo) sequence were transferred to the computer workstation. Navigator software (GEMS) was used to display intraluminal views of the pancreaticobiliary tract with a surface rendering technique. Results Patients suffered from neoplasm ( n =18), bile stone (17), postoperative complications of cholecystectomy( n =3), and other disease of biliary tract( n =6). MRVE could clearly demonstrate the anatomical structures in biliary tract, extended pancreas tract,biliary meatus narrowing and obstruction, bile duct stones, duct branches, and the inner wall of pathological obstruction.The main limitation of virtual endoscopy was inability to evaluate mucosa and lack of histological diagnosis. Sensitivity for detection of bile duct dilatation and site of obstruction was: 2D FSE 91 7%, and SSFSE 97 9%. Conclusion MRVE provided noninvasively endoscope like display of biliary tract.Its display ability was a supplement to image biliary trace. MRVE effect of multi slice SSFSE sequence was better than that of fast spin echo.

Objective To optimize the injection protocol of spiral CT portography(SCTP) and to evaluate its diagnostic value.Methods 48 normal individuals were randomly divided into three groups with different injection rates of contrast material:4 ml/s,3 ml/s and 2 ml/s.Single-level dynamic CT was performed through the trunk of portal vein.In each scan,time-attenuation curves of the portal vein,liver and P-L(the difference between portal vein and liver)were obtained.And SCTP was prospectively performed in 30 cases.The SCTP findings in a variety of disease were analyzed and the quality of SCTP images was assessed.Results ①The groups of 4 ml/s and 3 ml/s had greater peak enhancement of the portal vein and P-L than the group of 2 ml/s(?

Objective To evaluate the application value of 64-row spiral CT coronary angiography(CAG)in myocardial bridge (MB)and mural coronary artery(MCA) .Methods Imaging data of 436 consecutive subjects underwent coronary CT angiography in Hospital of Beijing Puren were enrolled in this study .The prevalence ,clinical effects of patients ,precise location and incidence of each branch were evaluated .In addition ,the length and depth of MB ,as well as their relationship with MCA in stenosis were evalua-ted .Moreover ,the group of subjects with MB was compared with the control group(subjects without MB)in the probability of ath-erosclerosis .Results Among the total of 436 subjects ,76 subjects(17 .4% ,76/436)were found to have MB .The left anterior de-scending artery(LAD)was the most common coronary artery involved(68 .4% ,52/76) .The pressure level of MCA associated with the length and depth of MB .A significant difference was found between the LAD-MB-MCA group and the control group in the presence of coronary artery plaques(P<0 .05) .Conclusion The anatomic relation between MB and MCA can be precisely displayed on 64-row spiral CT coronary angiography ,which is considered to be an excellent diagnostic method to screen MB-MCA initially . There is a relationship between stenosis of MCA and the length and depth of MB .The present and stenosis of MB-MCA are meant to form coronary artery plaques in LAD segment more easily .

Objective To report our experience of interventional procedure for arterial complications in post renal transplantation and to evaluate its clinical value.Methods In a retrospective analysis of renal transplantations in our center,52 cases of renal allograft artery abnormalities had taken angiography.Interventional procedure included transluminal angioplasty of arterial stenoses,treatment of arterial occlusion,and embolization of pseudoaneurysm.Results Renal allograft artery abnormalities included artery stenosis (n=21),artery thrombosis (n=13) and embolision (n=1),renal artery pseudoaneurysms (n=2),and decrease of renal artery flow (n=3).Of the 21 artery stenosis,2 grafts with artery stenosis were lost because the stenosis could not be corrected,and 3 with mild stenosis received no treatment.Another 16 accepted renal artery angioplasty (balloon dilation,n=12,and stent implantation,n=4).14 achieved long-term allograft function.1 graft was lost because renal function failed to recover.Restenosis occurred in one stent implantation,and lost the allograft function after secondary dilation.13 cases received thrombolytic therapy through artery catheter for thrombosis and 9 achieved long-term allograft function.Thrombolyses failed in 3 cases,and renal function failed to recover in 1 case.One pseudoaneurysm received stent implantation after embolization,and got a short-term allograft function.The other one received allograft excision.Conclusion Intravascular interventional therapy will be the first-line therapy for any indications of complication in post renal transplantation,and it can surely save the kidney in a majority of instances.

Objective To analyze the occurrence of infections relative to percutanous biliary drainage(PTBD)or stenting for malignant obstructive jaundice and explore the therapy and prevention. Methods 181 patients(130 male and 51 female; median age 64.5 years old)with malignant biliary obstructive jaundice were investigated including 81 hepatobiliary cancers,42 pancreatico-ampullae tumors,58 gestro-intestinal portal lymphatic metastasis. All cases accepted PTBD or placement of metallic stents and the perioperative complications were recorded and analysed including the occurance and treatment. Results All cases accepted PTBD or stenting successfully. The perioperative biliary infection was the major complication including 50 out of 62 preoperative infected cases(34.25%). 18 cases(15.13%)suffered from biliary infection after operation with 13 under control,5 without control,4 complicated with pulmonary infection and 17(9.39%)died of serious biliary infections. Gram-negative bacilli and endotoxin were the main cause of the severe biliary infection. Postoperative mild pancreatitis occurred in 65 cases(35.91%)without severe necrotic changes and were cured after anti-inflammatory treatment. Hepatic abscess due to biliary leak occurred in 1 case(0.55%),and was cured by CT-guided drainage. Conclusion Biliary infection is the most common complication after interventional therapy and should be promptly under control for preventing mortality and prolonging survival. Simultaneously,acute pancreatitis should also be on alert but good prognosis would be obtained with apt therapy.(J Intervent Radiol,2007,16: 693-695)

Objective (1)To observe the imaging features of the normal anatomic structures of middle ear using CT virtual endoscopy.(2)To study morphologic changes of ear ossicles and auditory ossicular chain of patients with conductive deafness.Methods CTVE of the auditory ossicular chain was performed on GE Hispeed CT/I with 1.0 mm slice thickness at pitch 1, bone algorithm, voltage 140 kV, electric current 170～220 mA, 9.6 cm field of view.Results CTVE could clearly demonstrate the normal auditory ossicular chain and its anatomic details. The demonstration rate of CTVE images in detecting the malleus-incus joint was 100%(162/162), in detecting "L"type incus-stapes joint was 80%(130/162), in detecting the anterior and posterior stapes footplate was 73%(121/162); CTVE could well display the destruction of auditory ossicular chain in otitis media and cholesteatoma and could acurately show the malformation of the auditory ossicular chain.Conclusion CTVE can quickly, non-invasively, three-dimensionally display the middle ear auditory ossicular chain, can provide direct and reliable imaging information for discovering the cause of a disease of conductive deafness.

Objective To differentiate benign from malignant breast lesions by analyzing qualitative and quantitative MR characteristics.Methods The dynamic contrast-enhanced MR imaging of the breast was performed using a double breast coil at 1.5T.The correlation between qualitative and quantitative characteristics of lesions on MRI,the data system(BI-RADS) category scores and histology was comparatively analysed.Results Some qualitative characteristics (shape, margin type, relative T 2-weighted signal intensity, rim enhancement, the later heterogeneous enhancement, and time-signal intensity curve type) were statistically significantly correlated with malignancy, P