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.

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 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 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 explore the optimal low-dose protocol of volumetric high-resolution CT (VHRCT) of the lung and evaluate its diagnostic value.Methods Catphan phantom were scanned using GE Lightspeed VCT with different parmeters from 120 kV,10 mAs to 120 kV,250 mAs in 10 mAs increments.Other parameters included 0.969 pitch,20 mm scan coverage,0.625 mm collimation and 30 cm display field of view and bone recon kernel.The spatial and density resolution,noise and radiation dose of each scanning were measured to determine the low-dose VHRCT protocol.In clinical study,105 patients with diffuse lung diseases underwent standard-dose VHRCT with 120 kV,250 mA according to the clinical needs.Low-dose VHRCT was performed with 120 kV,120 mAs in follow-up.Two radiologists who were unaware of the CT technique reviewed randomized images for the detail of diffuse lung diseases,including linear or reticular opacities,micro-nodules or tree-in-bud patterns,bronchiolectasis,ground-glass opacities and emphysema using a 4-point scale.Results In phantom study,the spatial-resolution maintained at 9 LP/cm from 250 mAs to 120 mAs.Below 120 mAs,the spatial-resolution and density-resolution decreased and noise increased with the decrease of tube-current.In clinical study,there were no statistical differences between standard-dose and low-dose VHRCT in demonstrating the detail of diffuse lung diseases(P ＞0.05).The CTDIvol was 23.44 mGy at 250 mAs and 11.25 mGy at 120 mAs,with 52％dose reduction by low-dose VHRCT.Conclusions Low-dose VHRCT at 120 kV,120 mAs offers maximum dose reduction without compromising spatial resolution and diagnostic value.

Objective This research is one of the sub-researches of"The comparative study of the standards of interventional therapies and the evaluation of the long-term and middle-term effects for common malignant tumors",which is one of the National Key Technologies R&D Program in the eleventh five-year plan. Based on the project,the authors need to establish an international standard in order to set up the national tumor interventional therapy database and registration system.Methods By using the computing programs of downloading software,self-management and automatic integration,the program was written by the JAVA words.Results The database and registration system for the national tumor interventional therapy Wag successfully set up,and it could complete both the simple and complex inquiries.The software worked well through the initial debugging.Conclusion The national tumor interventional therapy database and registration system can not only precisely teU the popularizing rate of the interventional therapy nationwide,compare the results of different methods,provide the latest news concerning the interventional therapy,subsequently promote the academic exchanges between hospitals,but also help as get the information about the distribution of the interventional physicians,the consuming quantity and variety of the interventional materials,so the medical costs can be reduced.

Objective To introduce our experience in embolizing cerebral ruptured-aneurysms of elderly patients in our hospital. Methods Totally 76 elderly patients were referred to our hospital due to ruptured-aneurysms.81 aneurysms were confirmed by DSA,all of them were sac aneurysms,among which 75 cases (body/neck≥ 1) were treated with balloon-assisted coiling,29 narrow-necked (body/neck≥2) aneurysms and 30 wide-necked (1 ≤ body/neck＜ 2) aneurysms were treated with balloon-assisted coiling successfully,but 6 narrow-necked (body/neck≥2) were treated with balloonassisted coiling in emergency,followed by a stent-assisted coiling in secondary embolization,4 cases with body/neck＜1 were treated with stent-assisted coiling technique in emergency,2 non ruptured aneurysms could not be treated.The times of balloon dilation were (2.1 ± 1.3),single expansion of filling was (33.4±14.1)s. Results The arterial thrombosis happened in two patients (2.7 ％),two aneurysms ruptured (5.3％) during the procedure. No stent-related thrombosis happened. 86were elevated as good,8 as serious according to the Glasgow outcome scale,neither died after operation or delayed thrombosis or infarction lesion during following up. Conclusions Balloonassisted coiling is a safe and effective method in elderly patients during acute stage of rupturedaneurysms.