Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Background: and Purpose Limited evidence exists on the effectiveness of endovascular treatment (EVT) for acute posterior circulation tandem lesion (PCTL). This study aimed to explore the role of extracranial vertebral artery (VA) stenting in patients with PCTL stroke undergoing EVT. Methods: Individual patient data were pooled from the BASILAR (EVT for Acute Basilar Artery Occlusion Study) and PERSIST (Posterior Circulation Ischemic Stroke) registries. Patients with PCTLs who underwent EVT were included in the present cohort and divided into the stenting and nonstenting groups based on the placement of extracranial VA stents. The primary efficacy outcome was the modified Rankin Scale (mRS) scores at 90 days and 1 year. Safety outcomes included 24-hour symptomatic intracranial hemorrhage (sICH) and all-cause mortality at 90 days and 1 year post-surgery. Results: A combined dataset of 1,320 patients with posterior circulation artery occlusion, including 263 (19.9%) with tandem lesions, of whom 217 (median age, 65 years; 82.9% male) met the inclusion criteria for the analysis. The stenting group had 84 (38.7%) patients, while the non-stenting group had 133 (61.3%). After adjustment for the potential confounders, extracranial VA stenting was associated with favorable shifts in mRS scores at both 90 days (adjusted common odds ratio [OR], 2.30; 95% confidence interval [CI], 1.23–4.28; P<0.01) and 1 year (adjusted OR [aOR], 2.04; 95% CI [1.05–3.97]; P=0.04), along with lower rate of mortality at both 90 days (aOR, 0.45; 95% CI [0.21–0.93]; P=0.01) and 1 year (aOR, 0.36; 95% CI [0.16–0.79]; P=0.01), with no significant difference in sICH incidence (aOR, 0.35; 95% CI [0.06–1.98]; P=0.24). Conclusion Extracranial VA stenting during EVT may improve functional outcomes and reduce mortality in patients with PCTL strokes.

Objective To explore the value of oblique coronal position-maximum intensity projection(OC-MIP)and volume rendering(VR)reconstructed CT portal vein angiography(CTPA)for diagnosing spleen/stomach-left kidney shunt(S/sLKS).Methods A total of 62 patients with decompensated liver cirrhosis who underwent TIPS were retrospectively collected.Based on pre-TIPS enhanced portal vein stage CT,CTPA was reconstructed with OC-MIP and VR technology to diagnose S/sLKS and judging the types.Taken digital subtraction angiography(DSA)findings during TIPS treatment as standards,the efficacy of OC-MIP or VR images for diagnosing S/sLKS were evaluated,and their consistency with DSA for diagnosing S/sLKS were evaluated.Results DSA showed S/sLKS in 14 cases(14/62,22.58%),while no S/sLKS in 48 cases(48/62,77.42%).The sensitivity,specificity and accuracy of OC-MIP and VR images for diagnosing S/sLKS were all consistent,which was 92.86%(13/14),95.83%(46/48)and 95.16%(59/62),respectively.OC-MIP and VR images diagnosed S/sLKS were both consistent with that of DSA(both Kappa=0.865).Among 14 cases of S/sLKS,DSA showed spleen-renal shunt(SRS)and gastro-renal shunt(GRS)each in 1 case(1/14,7.14%),spleen-stomach-renal shunt(SsRS)in 7 cases(7/14,50.00%),both SRS and GRS(SRS&GRS)in 4 cases(4/14,28.57%)and SRS&GRS+SRS dual shunt in 1 case(1/14,7.14%).OC-MIP and VR images did not show the shunt of GRS in 1 case.Among 4 cases of SRS&GRS,DSA showed 1 small branch of splenic vein(SPV)each in 2 cases,while OC-MIP and VR images did not show.The findings of OC-MIP and VR images for source veins were consistent with DSA in the other cases.Conclusion OC-MIP and VR reconstructed CTPA had high clinical value for diagnosing S/sLKS.

Objective To explore the value of oblique coronal position-maximum intensity projection(OC-MIP)and volume rendering(VR)reconstructed CT portal vein angiography(CTPA)for diagnosing spleen/stomach-left kidney shunt(S/sLKS).Methods A total of 62 patients with decompensated liver cirrhosis who underwent TIPS were retrospectively collected.Based on pre-TIPS enhanced portal vein stage CT,CTPA was reconstructed with OC-MIP and VR technology to diagnose S/sLKS and judging the types.Taken digital subtraction angiography(DSA)findings during TIPS treatment as standards,the efficacy of OC-MIP or VR images for diagnosing S/sLKS were evaluated,and their consistency with DSA for diagnosing S/sLKS were evaluated.Results DSA showed S/sLKS in 14 cases(14/62,22.58%),while no S/sLKS in 48 cases(48/62,77.42%).The sensitivity,specificity and accuracy of OC-MIP and VR images for diagnosing S/sLKS were all consistent,which was 92.86%(13/14),95.83%(46/48)and 95.16%(59/62),respectively.OC-MIP and VR images diagnosed S/sLKS were both consistent with that of DSA(both Kappa=0.865).Among 14 cases of S/sLKS,DSA showed spleen-renal shunt(SRS)and gastro-renal shunt(GRS)each in 1 case(1/14,7.14%),spleen-stomach-renal shunt(SsRS)in 7 cases(7/14,50.00%),both SRS and GRS(SRS&GRS)in 4 cases(4/14,28.57%)and SRS&GRS+SRS dual shunt in 1 case(1/14,7.14%).OC-MIP and VR images did not show the shunt of GRS in 1 case.Among 4 cases of SRS&GRS,DSA showed 1 small branch of splenic vein(SPV)each in 2 cases,while OC-MIP and VR images did not show.The findings of OC-MIP and VR images for source veins were consistent with DSA in the other cases.Conclusion OC-MIP and VR reconstructed CTPA had high clinical value for diagnosing S/sLKS.

Objective To explore the application value of multidetector computed tomography(MDCT),computed tomography cholangiography(CTC)and computed tomography angiography(CTA)reconstruction technology in the diagnosis and classification and the evaluation of the efficacy of biliary drainage in advanced hilar cholangiocarcinoma(HCCA).Methods A total of 44 patients of inoperable advanced HCCA were collected.Conventional CT plain scan and enhanced multi-phase scan were performed before treat-ment.Minimum intensity projection(MinIP)combined with curve planar reformation(CPR)was used to perform CTC.CTA of the portal vein,hepatic artery and hepatic vein were performed by maximum intensity projection(MIP),volume rendering(VR)or CPR,respectively.CT was reexamined after biliary drainage treatment.The study included the comparison between reconstruction technology of CTC and CTA and conventional CT scanning technology,CTC in the classification and diagnosis of HCCA,CTA in the evaluation of vascular invasion,and the evaluation of the effect of jaundice drainage by biliary imaging before and after biliary drain-age treatment.Results All HCCA cases obtained clear location diagnosis,including 39 cases of Bismuth-Corlette type Ⅳ and 5 cases of type Ⅲ.There were 40 cases of hepatic vascular involvement,including 15 cases of bilateral portal vein invasion by tumor,12 cases of portal vein constriction,8 cases of portal vein tumor thrombosis,4 cases of bilateral hepatic arteries involvement,and 1 case of hepatic vein involvement.CTC and CTA could better display a full view of the bile duct and blood vessel than conventional CT scanning ima-ges,and provided more accurate analysis of tumor classification and degree of vascular invasion.Before treatment,CT showed severe dila-tion of bile duct in 21 cases and moderate dilation in 20 cases,severe dilation of the intrahepatic bile duct in the left lobe but mild dilation of the intrahepatic bile duct in the right lobe in 3 cases.After drainage treatment,the contraction rate of intrahepatic bile duct dilation was＜25％in 4 cases,25％to 49％in 13 cases,50％to 74％in 18 cases,and ≥75％in 9 cases.The bile duct contraction rate was positively correlated with the decrease in total bilirubin(TBIL).Conclusion MDCT,CTC and CT A reconstruction technology can well complete the diagnosis of advanced HCCA,Bismuth-Corlette typing,and vascular evaluation.Observing the contraction rate of the intrahepatic bile duct after biliary drainage treatment can evaluate the efficacy of jaundice drainage.

Objective: To explore the value of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA) enhanced MRI T₁ mapping in diagnosing and distinguishing dysplastic nodule (DN) and hepatocellular carcinoma (HCC) with different degrees of differentiation. Methods: A retrospective study in the first affiliated Hospital of Guangxi Medical University from September 2015 to December 2017 was conducted. Seventy-one patients with HCC or DN (a total of 79 lesions) that confirmed by biopsy or surgical pathology findings. Seventy-nine lesions were divided into DN (n=10), well differentiated HCC (n=15), moderately differentiated HCC (n=36) and poorly differentiated HCC (n=18) according to histopathology. All the patients underwent plain MRI scan and Gd-EOB-DTPA-MRI T₁ mapping before surgery or needle biopsy. The T₁ values of each lesion and non-tumorous liver parenchyma were measured on 20 min hepatobiliary phase (HBP) T₁ mapping after Gd-EOB-DTPA administration, respectively. The increment rate of T₁ value in lesions relative to non-tumorous liver parenchyma were calculated. One-way ANOVA was used to compare the differences of T₁ value and the increment rate of T₁ value of DN and 3 groups of HCC with different degrees of differentiation. Spearman correlation was used to evaluate the correlation between T₁ mapping parameters and the malignancy degree of DN and HCC. Area under the receiver operating characteristic (ROC) curves were used to evaluate the efficacy of T₁ mapping parameters in the differential diagnosis of DN and HCC with different degree of differentiation. Results: Significant differences were found in T₁ value and increase rate of T₁ value of DN and HCC with different degrees of differentiation (P< 0.05). The T₁ value and increase rate of T₁ value showed an increasing trend from DN to poorly differentiated HCC after enhancement. The T₁ value and increase rate of T₁ value were positively correlated with the malignancy of DN and HCC (r=0.418 and 0.634, P<0.01). There were significant differences in the increase rate of T₁ value between well-differentiated HCC and moderately-differentiated, well-differentiated HCC and poorly-differentiated HCC, respectively (P<0.05). The area under ROC curve of T₁ value and the increase rate of T₁ value for differentiating DN from well-differentiated, moderately differentiated and poorly differentiated HCC was 0.933, 0.928, 0.939 and 0.867, 0.961, 0.961, respectively. The area under ROC curve of the increase rate of T₁ value for differentiating well-differentiated HCC from moderately-differentiated, well-differentiated HCC from poorly-differentiated HCC was 0.770 and 0.844, respectively. Conclusions Gd-EOB-DTPA enhanced MRI combined with T₁ mapping can provide valuable diagnostic information for identifying DN and HCC with different degrees of differentiation.

Objective To identify the 2- year recurrence- related factors in patients with myasthenia gravis (MG) after treatment of low-dose tacrolimus. Methods The clinical data of 100 MG patients treated with low- dose tacrolimus from February 2011 to February 2016 were retrospectively analyzed. All patients were followed up at least 2 years, and the risk factors affecting the recurrence of MG patients were analyzed. Results At the end of follow-up, there were 49 cases who had recurrence, and the recurrence rate was 44.5％ (49 / 110). Logistic regression analysis result showed that reducing dosage or withdrawal, MG crisis and diabetes mellitus were the independent risk factors for recurrence of MG patients (OR = 134.113, 8.850 and 6.652; P < 0.01 or <0.05). Conclusions The rate of recurrence with low- dose tacrolimus treatment in patients with MG during 2 years is higher. Reducing dosage or withdrawal should be avoided, especially in patients with a history of MG crisis. Patients with diabetics mellitus need to control blood glucose stability to avoid recurrence.

Objective To investigate the diagnostic value of some measured values of CT for nutcracker syndrome(NCS).Methods 28 patients with NCS confirmed by clinical diagnosis and other 81 normal controls were enrolled in the study.The angle between the superior mesenteric artery and the abdominal aorta,and the diameter and the area of left renal vein before/within this angle were measured on enhanced CT and MPR reconstruction images.The ratios of the diameter and the area before the angle to those within the angle were calculated.ROC curve was established to calculate the cut-off value and to evaluate the sensitivity,specificity,positive predictive value and negative predictive value of these parameters.Results In patient group,the mean aortomesenteric angle was 22.4°± 7.16°,mean diameter ratio was 5.10 ± 1.76 and the mean area ratio was 4.07 ± 2.10.In control group,the mean aortomesenteric angle was 61.32°± 22.82°,mean diameter ratio was 1.38 ± 0.40 and mean area ratio was 1.29 ± 0.49.The area under the ROC of the aortomesenteric angle,and the diameter ratio and area ratio were 0.979,1.000 and 0.989 respectively with corresponding cut-off values of 32.5°,2.63 and 2.06,sensitivity of 92.8%,100% and 96.4%,specificity of 95.1%,100% and 92.6%,positive predictive value of 86.7%, 100% and 81.8%,and negative predictive value of 97.5%,100% and 98.7%,respectively.Conclusion The aortomesenteric angle, the diameter and area ratios of left renal vein before/within the aortomesenteric angle have significant diagnostic value in the patients with NCS,and the value of diameter ratio is the highest.

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, and in the process of HCC development, early identification and timely treatment can significantly improve patient survival rate. Imaging techniques play an important role in the monitoring of chronic liver diseases, evolution of cirrhotic nodules, and early diagnosis of HCC. Multi-phase or dynamic contrast-enhanced computed tomography and magnetic resonance imaging (MRI) reflect the changes in blood supply during the evolution of liver cirrhotic nodules. Functional MRI can reflect the structure and function of living organisms at the molecular level. The application of liver-specific contrast agents can improve the detection rate and identification of early-stage HCC. With the development of MRI techniques and the accumulation of clinical experience in functional imaging will further improve the diagnostic rate of early-stage HCC.