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Diagnosis and treatment of spontaneous carotid artery dissection

Fan ZHANG ; Lihui GAO ; Guijun GUO ; Guodong XU ; Qingxi MENG

Chinese Journal of Interventional Imaging and Therapy.2011;08(5):416-419.

ObjectiveTo discuss the diagnosis and treatment of spontaneous carotid artery dissection (SCAD).Methods Clinical diagnosis and treatment data of 9 patients with SCAD were analyzed retrospectively.ResultsVascular ultrasound showed stenoses or occlusions of carotid artery.Angiography showed “flame-shaped ” sign in totally occluded proximal section and free intimal flap in stenoses section.One patient with total occlusion of bilateral internal carotid artery and 6 patients with total occlusion of unilateral internal carotid artery were treated with antiplatelet therapy.Two patients with incomplete occlusion of the carotid were operated with stent implantation in carotid arteries,and the clinical effect of both operations was satisfactory.ConclusionAngiography remains the gold standard in diagnosing SCAD,and stent implantation is an effective treatment of this disease.

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Transcatheter uterine artery intervention for placenta increta

Zhibin ZENG ; Jianzhong MING ; Bixian SHEN ; Jing HUANG ; Wenxin ZHONG ; Erwei CHU ; Qiqin SONG

Chinese Journal of Interventional Imaging and Therapy.2010;7(2):101-103.

Objective To investigate the method and clinical effect of interventional treatment on placenta increta.Methods Fifteen patients with placenta increta were treated interventionally through uterine artery.and Methotrexate 50-100 mg were superselectively infused.Then gel foam particulate or stripes were used for embolization of uterine artery.The therapeutic effect,prognosis and side effects were observed and analyzed.Results All patients underwent uterine artery embolization (UAE) .One week after UAE,curettage was successfully performed.No heavily hemorrhage nor hysterectomy occurred.Conclusion Transcatheter uterine artery intervention is simple,safe and effective with highly successful rate and has little side effects for the treatment of placenta increta.

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"Value of ""rigid wall"" and ""outer coarse"" signs in 64-slice CT for pre-operation staging of colorectal carcinoma"

Jun JIANG ; Ying LI ; Liming JIANG ; Chunwu ZHOU

Chinese Journal of Interventional Imaging and Therapy.2010;7(1):5-9.

Objective To assess the value of rigid wall and outer coarse signs in 64-slice CT for pre-operation stages of colorectal carcinoma. Methods One hundred and twenty-three colorectal carcinoma patients underwent 64-slice CT;then rigid wall and out coarse signs were evaluated respectively. The tumors were grouped according to the postoperative pathologic infiltrative depth. Two signs of the neighboring infiltrative depth groups were compared and analyzed, so as the relativity between two signs and tumor infiltrative depth. Results Among all 123 patients, 7 were Tis, 6 were T1, 14 were T2a, 16 were T2b, 75 were T3 (including 22 infiltrate to chorion and 53 infiltrate through chorion) and 5 were T4. According to the pathologic infiltrative depth, the patients were grouped into GroupⅠ: Tis+T1;GroupⅡ: T2a;Group Ⅲ: T2b;Group Ⅳ: T3a;Group Ⅴ: T3b+T4. Significant difference of the incidence of rigid wall was found between GroupⅠand Ⅱ (P=0.013), while of outer coarse between Group Ⅱ and Ⅲ (P=0.004). Coefficient correlation of rigid wall, outer coarse and the infiltrative depth of the tumor were detected (r=0.673, r=0.528, respectively, both P＜0.001), also between the two signs (r=0.725, P＜0.001). To predict the tumor of and above T1 with rigid wall and tumor of and above T3a with outer coarse, the sensitivity, specificity and accuracy was 92.30% and 79.31%, 89.09% and 69.44%, 89.43% and 76.42%, respectively. Conclusion The sign of rigid wall is valuable to distinguish the pathological changes in the tumor of and above T1, while outer coarse is better to distinguish the pathological changes of and above T2a, but not good at distinguishing tumors of T2b and T3 or above. Rigid wall and outer coarse are both in positive correlation with the infiltrative depth of the tumor, and each has different values. Combination of the two signs may be helpful to raise the accuracy for pre-operation staging of colorectal carcinoma.

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PTAS treatment for lower extremity atherosclerotic occlusive diseases

Xiquan ZHANG ; Baocun LING ; Wei ZHU ; Xiaolin PAN ; Ge DONG ; Feng GUO ; Lei YUAN

Chinese Journal of Interventional Imaging and Therapy.2009;6(4):334-337.

Objective To estimate the clinical effect and application value of percutaneous transluminal angioplasty and stenting (PTAS) on patients with lower extremity atherosclerotic occlusive disease (LEAOD). Methods Percutaneous transluminal angioplasty (PAT) and PATS were performed on 127 patients with diabetic lower limb arteriosclerosis. Results Total achievement ratio was 97.64% (124/127). PTAS was failed in 3 patients, clinical symptoms disappeared or improved in 124 patients. The average ankle brachial index (ABI) before and after operation was 0.35 (0.11-0.58) and 0.87 (0.67-1.06), respectively. The difference in ABI before and after operation was significant (P<0.05). During 3-60 months following-up, arteria iliaca remained open in 53 patients, and no recurrence of clinical symptom was found. At 6, 12, 36 and 60 months after operation, the encumbered superficial femoral artery kept smooth bloodstream with a proportion of 97.78%, 91.11%, 84.44%, 75.56% in 45 patients in upper 2/3 segment and 89.66%, 79.31%, 72.41%, 65.52% in 29 patients in infer 1/3 segment, respectively. Conclusion Long-term vessel recanalization can be obtained effectively and haemodynamics index be remarkably improved with PTA and PTAS in LEAOD patients.

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Contrast-enhanced ultrasonic diagnosis of benign and malignant solid thyroid lesions

Jing WANG ; Jing SUN ; Hong YANG ; Jin TANG ; Xin CHEN

Chinese Journal of Interventional Imaging and Therapy.2011;08(5):420-423.

ObjectiveTo investigate the value of CEUS in differential diagnosis of benign and malignant thyroid solid lesions.MethodsTotally 45 patients with thyroid solid lesions underwent CEUS examination.The enhancement mode and blood perfusion characteristics of malignant and benign lesions were analyzed,and the results were compared with pathology.ResultsCEUS diagnosed 31 benign lesions and 14 malignant masses.The diagnostic accordance rate of CEUS was 93.75％ (30/32) and 92.31％ (12/13) for benign and malignant lesions respectively.In 31 benign lesions,27 (27/31,87.10 ％) showed entire homogeneous enhancement,4 (4/31,12.90％) presented inhomogeneous enhancement.In 14 malignant masses,1 (1/14,7.14 ％) showed homogeneous hypoechoic enhancement,12 (12/14,85.71％) presented inhomogeneous hyperechoic enhancement and 1 (1/14,7.14％) presented non-enhancement.ConclusionCombined with two-dimensional grey scale ultrasound and CDFI,CEUS enables dynamic observation of the microvascular perfusion of thyroid lesions,therefore helps to differentiate benign and malignant thyroid lesions.

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Whole-body diffusion-weighted imaging: technical improvement and clinical application

Xu WU ; Changying MA ; Xia ZHAO

Chinese Journal of Interventional Imaging and Therapy.2009;6(4):382-385.

Diffusion weighted imaging of entire body is a new promising technique which is feasible to evaluate multi-focal disease. Whole-Body diffusion weighted imaging (WB-DWI) has revealed great potential in the evaluation of both quantitative and qualitative information of the whole body. The technique should be used combined with the other standard sequences such as STIR images. A complete scanning sequence and diffusion weighted imaging (DWI) can be performed in less than 40 min. The feasibility, limitations and the clinical effect of WB-DWI are reviewed.

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Application of ventricular septal defect occluders in infants and young children with large patent ductus arteriosus

Silin PAN ; Quansheng XING ; Huiwen SUN ; Kefeng HOU ; Kuiliang WANG ; Yueyi REN ; Bei ZHANG

Chinese Journal of Interventional Imaging and Therapy.2010;7(2):137-139.

Objective To observe the availability and safety of ventricular septal defect (VSD) occluder in infants and young children with large patent ductus arteriosus (PDA) associated with severe pulmonary hypertension.Methods Five patients (1 male and 4 fomale) of large PDA aged 5 months to 3 years,weighted from 5.1 to 15 kg,body surface area (BSA) 0.37-0.58 m2 underwent transcathter intervention with concentric VSD occluders from June 2008 to May 2009.Arterial ducta were tube-like and their diameters were 5.7 to 8.5 mm,with ulmonary vascular resistance from 4.8 to 5.7 Wood Unit,Qp/Qs 3.4-4.6.Three patients were given Bosentan after intervention.Results The large PDAs were successfully closed with VSD occluders,including 1 concentric perimembranous VSD occluder and 4 muscular VSD occluders.They all discharged 4 to 5 days with hidrosis and weight improved.Echocardiogram indicated VSD occluder was stable,no residue shunt and no stricture of left pulmonary artery and descending aorta were found.According to tricuspid and pulmonary regurgitation,pulmonary arterial pressure decreased differently and returned to normal after 6 months follow-up.Conclusion VSD occluder is available and effective to close large PDA associated with severe pulmonary hypertension in inrants and young children,but more cases and long-term follow-up are necessary.

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iFlow in the auxiliary diagnosis of cerebral vascular disease

Yuanliang HUANG ; Yuming ZHOU ; Suijun TONG ; Jianxin FU ; Xiangdong WANG ; Yuan JIANG

Chinese Journal of Interventional Imaging and Therapy.2011;08(5):401-404.

ObjectiveTo evaluate the impact of iFlow in the auxiliary diagnosis of cerebral vascular diseases.Methods Totally 65 patients with cerebral vascular diseases underwent whole brain 2D DSA.Then the data were converted to color coded images with iFlow.The vascular anatomy,the shape and size of lesions,the blood dynamics on 2D DSA and iFlow images were evaluated by junior and senior physicians,who then reported whether iFlow images had supplementary diagnosis value.ResultsiFlow images displayed whole information of lesions more clearly than those of 2D DSA in brain vascular dynamic sequence,including vascular anatomy,hemodynamic changes and tissues perfusions.The evaluation of 2D DSA and iFlow images with junior and senior physicians had statistical difference (x2 =6.032,P=0.014).ConclusionCompared to single DSA,iFlow can facilitate the diagnosis and evaluation of cerebral vascular diseases,especially for junior physicians.

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Clinical value and pathological basis of peritumoral hyperenhanced rim of renal cell carcinomas on contrast-enhanced ultrasound

Long LIU ; Lianfang DU ; Xiao JIA

Chinese Journal of Interventional Imaging and Therapy.2011;08(5):384-389.

ObjectiveTo investigate the clinical value and pathological basis of peritumoral hyperenhanced rim (PHR) of renal cell carcinomas (RCCs) on CEUS.MethodsCEUS images of 53 patients with 54 renal tumors (27 RCCs,27 renal angiomyolipomas) were analyzed,and the detection and distribution of PHR were evaluated.HE staining and immunohistochemistry of CD34 were performed in tissue surrounding RCCs (TSR) to observe distribution of psuedocapsule,large vessels,and microvasculars among TSR with different modes of PHR.ResultsPHR was found only in RCCs.PHR distribution between RCCs and angiomyolipomas was statistically different (P＜0.05).Using PHR to diagnose RCC,the sensitivity,specificity,positive predictive value,negative predictive value,false positive and false negative was 44.44％ (12/27),100％ (27/27),100％ (12/12),64.29％ (27/42),0 (0/27) and 35.71％ (15/42),respectively.Pseudocapsule distribution between RCCs with PHR and RCCs without PHR was not statistically different (P＞ 0.05).There were rich large blood vessels in TSR with PHR in washin and both phases,and few or thimbleful large vessels were found in TSR without PHR in washout phase.Cancer tissue near the boundary (CTNB) of TSR had the highest microvessel density (MVD).MVD differences in different TSR with PHR were statistically different between washin and washout phases,washin and both phases,both phases with PHR and without PHR (P＜0.05),but no statistical difference was found between washout and both phases (P＞0.05).ConclusionPHR is a highly specific complementary indicator in diagnosing RCC,and it is correlated with rich blood vessels in TSR and (or) a higher MVD value in CTNB.

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Clinical value of PET and PET/CT in diagnosis and treatment ofmalignant lymphoma

Haihui SUN ; Zhihong QIAO ; Shujun QIU ; Jiaqiang WANG

Chinese Journal of Interventional Imaging and Therapy.2009;6(4):378-381.

PET and PET/CT are the methods of displaying the functional and metabolic changes in tissues. With its high sensitivity and specificity, it can be used as a noninvasive systemic functional examination. There are significant values in its diagnosing, staging, treatment directing and prognosis assessing in the malignant lymphoma.

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