1.MR Diagnosis and Clinical Analysis of Moyamoya Disease
Journal of Practical Radiology 2000;0(02):-
Objective To probe MRI diagnostic characteristics of moyamoya disease(MMD). Methods Both MRI and MRA findings in 17 cases, aged 10~49 years, with MMD were analyzed retrospectively. Axial T_1WI and T_2WI were performed for MRI, while 3D TOF was used for MRA.Gd-DTPA enhanced MRA and T_1WI were carried out in 2 and 4 patients respectively.FLAIR was performed in 5 cases.Results ( 1 ) Multiple focal infarction was noted in 5 cases , old hemorrhage in 4 cases, dilatation of unilateral ventricle with history of ventricle hemorrhage was displayed in 2 cases;(2)MRI showed signal void of the following vessels as well as other lesions:① internal carotid artery (ICA) bifurcation, anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) (17/17);②collateral circulation from the skull base, PCA and ECA were demonstrated well in combination with MRA,T_1WI and T_2WI (17/17);③“Ivy sign” or leptomeningeal high signal intensity could be demonstrated on contrast-enhanced T_1WI or FLAIR images(2/17). Conclusion MRI findings can suggest the diagnosis of the MMD, and definite diagnosis can be usually made if combined with MRA.
2.CT,MRI and DSA Appearances of Giant Cell Tumors of Bone in Unusual Sites
Wanyin SHI ; Xindao YIN ; Liping WANG ; Jianping GU
Journal of Practical Radiology 2010;26(1):74-76
Objective To investigate retrospectively CT,MRI and DSA appearances of giant cell tumors(GCT) of bone in unusual sites,in order to improve the diagnosis of it.Methods CT,MRI and DSA features of GCT in 11 cases proved by surgery and pathology,were retrospectively analyzed.GCTs located in iliac bone in 4,sacral vertebrae in 3,ischial bone in 2, calcaneus and temporal bone in one respectively.Results (1) At CT,the tumors were mainly showed as expanding growth and osteolytic destruction,without periosteal reaction and calcification.(2)At MRI,the tumors were hypo-,isointensity on T_1WI and heterogeneously iso, hyperintensity on T_2WI.Low intensity curvilinear strips inside the tumor on T_1WI and T_2WI were found in 5 patients,and "bright patches sign" on T_2WI were also displayed in 2 cases.(3)At DSA,abundant blood supply to the tumors was demonstrated,the thickened and twisted feeding artery and,"tumor's stain sign" were also found.Conclusion To analyse imaging data synthetically,including CT,MR imaging and DSA,can improve the knowledge of GCT of bone in unusual sites.
3.Endovascular treatment of recurrent intracranial aneurysms with re-coiling or covered stents
Wanyin SHI ; Yongdong LI ; Minghua LI ; Bulang GAO ; Chun FANG ; Yingsheng CHENG ; Wu WANG ; Wenbin LI ; Jungong ZHAO ; Peilei ZHANG ; Jue WANG ; Min LI
Journal of Interventional Radiology 2010;19(4):269-274
Objective To report our experiences in the treatment of recurrent intracranial aneurysms with re-coiling or covered stents.Methods A total of 291 patients with 305 intracranial aneurysms were treated with detachable coils.and 41(28.9%)of 142 patients with aneurysms in the intemal carotid artery had a recurrent aneurysm during the follow-up period.For this study,31 recurrent aneurysms in 31 patients who had angiograms within 6 months following retreatment with detachable coils(group A,n=20)or covered stents(group B.n=11)were analysed.Aneurysms were categorised as complete or incomplete occlusion via angiographic assessment and graded as full recovery,improvement,no change or deterioration via clinical assessment.Data regarding technical success,initial and final angiographic results,final clinical outcome were collected and analysed postoperatively.Results Coil embolisation and covered stent placement.were technically successful in all recurrent aneurysms.The initial angiographic results showed complete occlusion in 11 patients(55%)in group A and in eight(72.7%)in group B(P=0.452),and the final angiographic results exhibited complete occlusion in 10 patients(50%)in group A and in 11(100%)in group B(P=0.005).There were no significant differences in technique success or final clinical outcome between the two groups.Conclusions Recurrent aneurysms after coiling can be successfully treated and occluded with re-coiling or covered stent placement.However,covered stents seem to be more effective than re-coiling with regard to complete occlusion of recurrent aneurysms.
4.The application of percutaneous mechanical thrombectomy with AngioJet system in management of acute lower limb arterial ischemia
Maofeng GONG ; Jianping GU ; Guoping CHEN ; Xu HE ; Wensheng LOU ; Liang CHEN ; Haobo SU ; Jinhua SONG ; Wanyin SHI ; Tao WANG ; Boxiang ZHAO ; Hao HUANG ; Yinghao LI
Journal of Interventional Radiology 2017;26(6):509-513
Objective To discuss the clinical application of mechanical thrombectomy with AngioJet system for acute lower limb arterial ischemia (ALI).Methods A total of 12 ALI patients,who underwent percutaneous mechanical thrombectomy with AngioJet systemn during the period from January 2015 to November 2016,were enrolled in this study.The clinical data were retrospectively analyzed.The blood flow classification score after thrombolysis in myocardial infarction (TIMI) was used to evaluate the blood perfusion condition,and Cooley standard of efficacy score was used to assess the clinical curative effect.Results The technical success rate of mechanical thrombectomy with AngioJet system was 91.7% (11/12).The average restored perfusion time was (1.5±0.6) hours.The clinical success rate and limb salvage rate were 83.3% (10/ 12) and 91.7% (11/12),respectively.The TIMI flow scores were improved from preoperative grade 0 (n=8) and Ⅰ (n=4) to postoperative grade 0 (n=1),Ⅰ (n=3) and Ⅱ (n=8).In 11 patients (91.7%) the symptoms of lower limb arterial ischemia were strikingly improved after mechanical thrombectomy.In one patient,the postoperative TIMI flow score remained 0 as preoperative state and the symptoms of lower limb arterial ischemia were not improved although catheter directed thrombolysis therapy was employed for 24 hours,and above-knee surgical amputation had to be carried out.Cooley efficacy score showed that complete cure was seen in 4 patients (33.3%),good response in 6 patients (50.0%),general improvement in one patient (8.3%) and pool response in one patient (8.3%).No severe bleeding complications occurred.Conclusion Percutaneous mechanical thrombectomy with AngioJet can rapidly recover the blood perfusion in patients with ALI,thus,further deterioration of the disease can be prevented and the limb salvage rate can be improved.Therefore,this technique has good clinical application value.
5.Early and long-term outcomes for postpartum deep vein thrombosis:the role of endovascular treatment
Lanyue HU ; Wensheng LOU ; Jianping GU ; Xu HE ; Liang CHEN ; Guoping CHEN ; Haobo SU ; Jinhua SONG ; Wanyin SHI ; Tao WANG ; Boxiang ZHAO
Chinese Journal of Radiology 2015;(5):386-390
Objective To investigate the effect of endovascular treatment to initial and long-term outcomes of postpartum deep venous thrombosis (DVT) . Methods The clinical data, venography and 3-yaer follow up data of 30 female patients with acute or subacute deep vein thrombosis in the postpartum period who received endovascular therapy consisting of catheter-directed thrombolysis with angioplasty (stenting for some patients with iliac vein compression syndrome (IVCS)) were retrospectively evaluated. Clot removal was graded as grade Ⅲ(>95%), grade Ⅱ(50% to 95%), and grade Ⅰ(<50%). Grade Ⅱ, Ⅲconsidered effective. Data from onset time, vaginal delivery or by elective, patients ages, IVCS or not and stenting or not were included in this analysis. And the χ2 test and survival analysis was used for statistical analysis of initial and long-term patency respectively. Results In 30 cases, the initial result included 14 cases(46.7%) of gradeⅢ, 12 cases(40.0%) of gradeⅡand 4 cases(13.3%) of gradeⅠ. Patients' onset time, vaginal delivery or by elective, patients ages and IVCS or not have no significant statistical difference to initial patency(χ2=0.88, 1.28, 1.15, 3.08,P>0.05).For 18 patients with IVCS, there was significant statistical difference between patients implanting stents(initial patency was 100.0%(7/7) and whom not
implanting stents(initial patency was 63.6%,7/11) (χ2=5.14, P<0.05). 1, 3, 6 months and 1, 2, 3 years follow-up showed: The primary patency of postoperative 1, 3, 6 months respectively were 86.7%, 70%(21/30),66.7%(20/30), and postoperative 1, 2, 3 years were all 66.7%. There was significant statistical difference between patients with IVCS implanting stents and whom not implanting stents (χ2=6.562, P<0.05), patients with IVCS not implanting stents and whom without IVCS (χ2=3.377, P<0.05). There was no significant statistical difference among patients with IVCS implanting stents and whom without IVCS(χ2=1.932, P>0.05). Conclusions Endovascular therapy consisting of catheter-directed thrombolysis with angioplasty could be considered as a primary therapeutic procedure in patients with acute or subacute postpartum DVT. Stenting for treatment of iliac compression which contributed to postpartum DVT is very valuable to ensuring higher long-term patency rate.
6.Retrospective study on clinical features and interventional therapy of acute deep venous thrombosis of lower extremity combined with type Ⅱ heparin-induced thrombocytopenia
Haobo SU ; Wensheng LOU ; Jianping GU ; Xu HE ; Liang CHEN ; Guoping CHEN ; Jinhua SONG ; Wanyin SHI ; Tao WANG ; Boxiang ZHAO ; Hao HUANG
Chinese Journal of Radiology 2015;(5):380-385
Objective To explore the clinical features, diagnosis and interventional management of acute deep venous thrombosis of lower extremity (LEDVT)combined with type Ⅱ heparin-induced thrombocytopenia (HITⅡ) and to improve the knowledge of this disease. Methods A retrospective review and analysis of the clinical data of the patients with acute LEDVT combined with HIT Ⅱ enrolled from January 2010 to June 2014. All of them underwent anticoagulation with low molecular weight heparin (LMWH) and the comprehensive interventional therapy at the beginning of treatment.When HIT Ⅱ was
identified, all forms of heparin and LMWH were avoided . Alternative anticoagulation was commenced with argatrobam. Adjustments in interventional therapy were taken while the short-term low-dose glucocorticoid treatment were used.The clinical manifestations, changes of PLT, 4Ts score (Warkentin 4T scoring system, 4Ts) , HIT antibody assay (ELISA) and response to therapy of the patients were analyzed and the treatment effect was observed . The efficacy of interventional therapy was evaluated according to the improvement clinical symptoms and venography. Results The incidence of acute LEDVT combined with HIT Ⅱ was 1.9%(8/416). There were 4 males and 4 females with a median age of 24 years in this study. The median time between their initiation exposure to heparin and onset of thrombocytopenia was 5 days (range,3 to 8 days). The median platelet counts prior to HIT Ⅱ was 218 × 109/L( range,122 × 109/L to 254 × 109/L ). Platelet counts decreased to the lowest level range from 20 × 109/L to 51 × 109/L(median 32 × 109/L). After alternative anticoagulation, the interval period which PLT recovered to the basic level was range from 3 to 7 days (median 3.5 days) . According to the score of 4Ts , there were 2 cases score 6 and 6 cases score 8. HIT antibody assay (ELISA) was detected in 6 patients which the results were positive. During heparin anticoagulation treatment, the LEDVT condition of all patients continued to deteriorate. Vein thrombosis extended in 7 patients. Among them, 5 patients occurred new thrombosis in the inferior vena cava and(or) at the vessel of catheter insertion. Another 2 patients complicated with pulmonary embolism. After underwent anticoagulation with argatrobam , with the increased of PLT the treatment efficacy of thrombolysis therapy was ameliorated. At the endpoint of interventional therapy, the curative effect evaluation was excellent in 3 cases, good in 3 cases and medium in 2 cases respectively. All patients were followed up for 12 to 20 months (median 15.5 months) with no evidence of recurrence .Conclusions The study showed that acute LEDVT combined with HITⅡdisplayed the following features:(1)an absolute drop in platelet count below the normal range (PLT ≤100 × 109/L) or as a relative decrease of 30% to 50% from baseline counts. (2) refractory venous thrombosis,during the interventional treatment of acute LEDVT, platelets counts should be monitored regularly in patients who receiving heparin anticoagulation. For patients with strongly suspected HIT Ⅱ, withdrawal of all forms of heparin and early introduction of alternative anticoagulant therapy can improve the effect of interventional therapy.
7.Clinical value of magnetic resonance venography in diagnosing Cockett syndrome
Hailin XUE ; Liwei WANG ; Shaojuan WANG ; Wanyin SHI ; Jianping GU ; Xindao YIN
Journal of Interventional Radiology 2017;26(9):783-786
Objective To evaluate non-enhancement magnetic resonance venography (MRV) of iliac vein in diagnosing Cockett syndrome.Methods Magnetic resonance iliac venography was performed with Ingenia 3.0 T superconducting type MRI system.Abdominal surface coil was employed.The scanning sequences included M2DIPEAR (TR/TE=45/5.8 ms,flip angle=60°),THRIVE (TR/TE=6.8/3.5 ms,flip angle=10°),BTFESPAIR (TR/TE=3.4/1.7 ms,flip angle=80°) and FLAIR (TR/TE=9 000/120 ms,flip angle 90°).The layer thickness of 3 mm was used in all scanning,and the average number of acquisition was 3 times.Results On MRV imaging,Cockett syndrome was characterized by narrowed anteroposterior diameter and broadened transverse diameter of the compressed iliac vein,and curved impression could be seen on its anterior border,and collateral vessel formation could be observed.The mean diameters of the left iliac veins in the light,mnedium and severe patients with Cockett syndrome were 7.52,4.83 and 2.76 mm respectively,with the average compression ratios being 37%,69% and 83% respectively.Conclusion Non-enhanced MRV is a feasible method for the diagnosis of iliac vein stenosis,this examination is especially suitable for the checking needs of specific population.
8. Clinical study of comprehensive endovascular treatment for acute deep vein thrombosis in elderly patients
Maofeng GONG ; Guoping CHEN ; Jianping GU ; Xu HE ; Wensheng LOU ; Liang CHEN ; Haobo SU ; Jinhua SONG ; Wanyin SHI ; Boxiang ZHAO
Chinese Journal of Geriatrics 2019;38(10):1137-1141
Objective:
To investigate the safety and clinical efficacy of comprehensive endovascular treatment for acute deep vein thrombosis(DVT)in elderly patients.
Methods:
Clinical data of 94 elderly patients who underwent endovascular treatment from June 2013 to June 2016 were retrospectively analyzed.All patients underwent inferior vena cava filter implantation(IVCF). Of them, 57 patients initially underwent thrombectomy and subsequently received the adjunctive catheter-directed thrombolysis(CDT)(Group A)and 37 cases underwent CDT(Group B). Clinical efficacy and safety of treatments in the two groups were examined.
Results:
Among the 94 patients, 88 cases had retrievable IVCF, and the retrieval rate was 94.3%(83/88). There were significant differences in total infusion time(73.92±31.68 h
9. The safety and effectiveness of celect inferior vena cava filter evaluated by CT
Boxiang ZHAO ; Jianping GU ; Xu HE ; Jinhua SONG ; Wensheng LOU ; Liang CHEN ; Guoping CHEN ; Haobo SU ; Wanyin SHI ; Tao WANG
Chinese Journal of Radiology 2018;52(8):619-623
Objective:
To investigate the safety and effectiveness of the Celect inferior vena cava filter (IVCF) in the treatment of deep venous thrombosis (DVT).
Methods:
CT follow-up examinations were performed in 72 patients who underwent Celect inferior vena cava filter placement between August 2015 and September 2017. Forty-five patients (62.5%) presented with DVT alone, 27(37.5%) with DVT and pulmonary embolism (PE). With filters in place, each patient was followed up with CT at least once, to visualize new pulmonary embolism, inferior vena cava occlusion, filter tilting, fracture of struts, migration and penetration of struts through the inferior vena cava. Caval penetration was graded on a five-point scale.
Results:
All Celect filters were successfully deployed. The interval between the filter placement and the CT was 5.0 to 695.0 days, mean (42.4±84.6)days. No new pulmonary embolism, cava occlusion, filter fracture and migration were found. Forty-two (58.3%) filters tilted, including tilt
10.Interventional treatment of acute thrombo-embolism of artificial arteriovenous fistula
Yadong SHI ; Jianping GU ; Liang CHEN ; Wanyin SHI ; Xu HE ; Wensheng LOU ; Guoping CHEN ; Haobo SU ; Tao WANG
Journal of Interventional Radiology 2018;27(1):63-67
Objective To assess the safety and efficacy of catheter-directed thrombolysis combined with percutaneous transluminal angioplasty (PTA) in treating acute thrombo-embolism of artificial arteriovenous fistula.Methods The clinical data of 64 patients with acute thrombo-embolism of artificial arteriovenous fistula (84 events in total),who were admitted to single medical center during the period from January 2012 to September 2016,were retrospectively analyzed.The diagnosis of acute thrombo-embolism of artificial arteriovenous fistula was confirmed by angiography via femoral approach in all patients.Mechanical thrombectomy of the thrombotic occlusion segment by using common guide wire was carried out first,which was followed by bolus injection of urokinase (125,000-375,000 units);if the thrombus was not completely dissolved the catheter would be retained and the urokinase would be continuously infused with a micro-pump until the thrombus was completely dissolved.Conventional balloon dilatation would be employed when the stenosis of artificial arteriovenous fistula lumen was >50% or the stenosis impeded the performance of dialysis.Kaplan-Meier survival curve was used to estimate the primary and secondary cumulative patency rates after the first intervention.Results Of the 84 interventional procedures,technical success was achieved in 69 procedures (82.1%).A total of 14 conventional balloon dilatation procedures had to be conducted as the fistula was seriously narrowed,and up to 12 procedures (85.7%) were succeeded.The overall clinical success rate was 78.5% (66/84).During the therapeutic course,bleeding event occurred in 7 procedures (8.3%),including major bleeding (n=3) and minor bleeding (n=4).After the treatment,the 3-,6-,12-,24-month primary and secondary patency rates were 76.1%,63.6%,40.8%,12.5% and 81.3%,70.8%,47.0%,32.5%respectively.Conclusion For the treatment of acute thrombo-embolism of artificial arteriovenous fistula,catheter-directed thrombolysis is safe and effective,it can assist conventional balloon dilatation therapy to obtain satisfactory therapeutic result for internal fistula stenosis.