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 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 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 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 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 summarize the clinical nursing experience for patients with malignant obstructive jaundice after receiving percutaneous biliary radiofrequency ablation (RFA) and stent implantation. Methods The postoperative nursing experience in 9 patients with malignant obstructive jaundice who received percutaneous biliary RFA together with stent implantation were retrospectively analyzed. The postoperative complications and the nursing intervention measures were analyzed and evaluated. Results Biliary RFA and subsequent stent implantation were successfully carried out in all 9 patients. After the procedure, biliary fistula occurred in one patient, biliary hemorrhage in 2 patients and biliary infection in 2 patients. The patient, who developed biliary fistula, died one week later, and the clinical conditions in the remaining 4 patients were improved after symptomatic treatment. During the follow-up period of one month, the patients were in good condition. Conclusion The main purpose of postoperative nursing for patients after receiving percutaneous biliary RFA is to prevent the occurrence of bile duct perforation, hemorrhage, infection, etc. It is very important to keep the patients under close observation and comprehensive nursing so as to make an early detection and timely treatment of such complications, thus to reduce the incidence of complications causing serious consequences as well as to promote an early recovery.

Objective To study the value of CT virtual endoscopy(CTVE) and multiplanar reconstruction(MPR) in the diagnosis of small intestinal diseases.Methods The small intestines in 13 cases with small intestinal lesions were filled with enough air by means of gastro-duodenal tube,after CT volume scans of the small intestine with multi-detector row CT scanner,VE and MPR were reconstructed and analyzed retrospectively.Results 91%(10/11) of the space-occupying lesions of small intestine were found by VE,among them,100%(8/8) of tumors inside the lumen and 66.7%(2/3) of tumors outside the lumen were diagnosed.82%(9/11) of the space-occupying lesions of small intestine were found by MPR.100%(11/11) of the space-occupying lesions of small intestine were found by VE combined with MPR.2 cases with small intestinal inflammatory lesions were also well showed by CTVE and MPR.Conclusion CTVE and MPR are of significant clinical applied value in diagnosing the small intestinal diseases.

Objective To compare the values of helical CT Ray sum projection(RSP)with shaded surface display (SSD)in diagnosing pelvic lesion.Methods Ray sum images in 18 cases of ankylosing spondylitis,5 cases of bone tumor,15 cases of pelvic fracture were analyzed and compared with shaded surface display(SSD),plain films and CT scans.Results The positive rate of 18 cases ankylosing spondylitis was 93.5% for RSP,38.7% for SSD and 83.9% for plain films.In 12 cases of 1～2 stages articular sacroiliaca arthritis,RSP can detect sacroiliac joints sclerosis and vesicula osteonecrosis as well as the axial view,it had higher positive rate than plain film or SSD(?