Transcatheter Embolization in Patients with Massive Upper Gastrointestinal Hemorrhage

Angiography and transcatheter embolization were performed in 12 patients with massive UGI bleeding from March 1990 to Feburuary 1996. These patients were all men of a mean age of 46 years (range, 33~76 years). Causes of bleeding were duodenal ulcer(5 cases), pseudoaneurysm(3 cases) due to chronic pancreatitis, hemobilia(2 cases) due to trauma, gastric mucosal injury(1 case) due to drug ingestion. Celiac arteriography and superior mesenteric arteriography were performed. Embolization was done in 12 patients. Embolic agents were steel coils. Eleven patients show an extravasaton of contrast media on angiography. In one patient who shows no extravasation, an pseudoaneurysm in gastroduodenal artery was found. Sources of bleeding were gastroduodenal artery(8), right hepatic artery(2), left hepatic artery(1), and left gastric artery(1). Bleeding was successfully controlled in all 12 patients. Two patients, however, rebled and an operation was performed. In one patient with pseudoaneurysm, bleeding recurred 13 days after embolization. This patient underwent second embolotherapy and operation 14 days later. There were no complication related to the procedure. Angiographic localization and transcatheter embolization can be an safe and effective treatment for massive UGI hemorrhage, especially in patients considered poor candidate for operation.

Evaluation of the Lesions of Synovial-lined Clefts in the infrapatellar Hoffa's Fat Pad with MR imaging

PURPOSE: Within Hoffa's infrapatellar fat pad there are two synovial clefts, horizontal and vertical, whichcommunicate with the intra-articular space. Intra-articular lesions can also occur in these clefts, and are oftendifficult to differentiate from extra-articular lesions. The purpose of this study is to evaluate, using MRimaging, the lesions occurring in these synovial lined clefts, as well as associated abnormalities. MATERIALS AND METHODS: Thirty-one knees of 31 patients with lesions in horizontal and vertical clefts in Hoffa's infrapatellarfat pad were retrospectively evaluated. Using a 1.5T MR imager, axial, sagittal, and coronal MR images of kneeswere obtained. Lesions in clefts, degree of joint effusion and associated knee abnormalities were analyzed. RESULTS: Horizontal cleft lesions were noted in 21 cases ; there were 17 cystic dilatations, two loose bodies,one synovial chondroma, and one case of pigmented villonodular synovitis(PVNS). Vertical cleft lesions were notedin 15 cases ; these comprised 11 cystic dilatations, two loose bodies, one synovial osteochondromatosis, and onePVNS. Among all cases, three cystic dilatations, one loose body, and one PVNS occurred in both horizontal andvertical clefts. Among 25 knees with cystic dilatations of clefts, five showed grade I joint effusion, ten gradeII, and ten grade III. Associated abnormalities were meniscal tear in 16 cases, osteoarthritis in 13, cruciateligament tear in five, osteochondritis dissecans in three, osteochondral fracture in two, osteonecrosis in one,loose body in one, and synovitis in one. CONCLUSION: Among synovial-lined clefts in Hoffa's fat pad, the mostcommon lesion was cystic dilatation ; there were various associated abnormalities and a close relationship tojoint effusion. An awareness of the types of lesions found in clefts is helpful for narrowing the differentialdiagnosis of lesions occurring in the area of Hoffa's fat pad.

Significance of Transcatheter Arterial Embolization in the Treatment of Pseudoaneurysm ComplicatingPancreatitis

PURPOSE: To evaluate the significance of transcatheter arterial embolization(TAE) of pseudoaneurysmcomplicating pancreatitis. MATERIALS AND METHODS: This study was based on a retrospective analysis of eightcases, in which TAE for the control of pseudoaneurysm complicating pancreatitis was attempted. All patients weremales, and were aged between 35 and 65(mean, 47) years. Seven had a history of episodes of chronic pancreatitisand one case was the result of acute pancreatitis. All patients underwent diagnostic angiography andsuperselective embolization. RESULTS: Arteries in which pseudoaneurysm had occurred were the gastroduodenal(n=5), inferior pancreaticoduodenal (n=1), superior mesenteric artery root (n=1), and the celiac axis (n=1). Sixcases were treated successfully without complications, but in two, embolization failed due to a wide aneurysmalneck arising from the superior mesenteric artery root and celiac axis. In four successful cases, pseudoaneurysmswere completely resolved within three to six months of embolization. One of the other two remained as apseudocyst, while in the other, also a pseudocyst, surgery was performed. CONCLUSION: Because TAE in patientswith pseudoaneurysm complicating pancreatitis has a high success rate, and also leads to absolute resorption of apseudocyst, TAE is the preferred pre-surgical treatment mode.

Multishot Echoplanar MR Imaging of the Female Pelvis: Comparison with T2 weighted Fast Spin Echo Imaging

PURPOSE: To compare the usefulness of multishot echoplanar imaging (EPI) with T2-weighted fast spin-echoimaging (FSE) for the evaluation of female pelvic organs and pathologic conditions. MATERIALS AND METHODS:Twenty-nine patients with pelvic lesion underwent MR imaging (GE Medical Systems) using a pelvic array coil (GEMedical Systems). Axial EPI (TR/TE=2,000/80, 6mm slice thickness, 2.5mm gap, multishot 16) and T2-weighted FSE(TR/TE=3,400/117, 5mm slice thickness, 1.5mm gap, ETL=12) were obtained. Overall image quality, the parametrialvenous plexus, anatomy of the uterine zone and outer margin, identification of the ovaries, pelvic pathologiccondition, and frequency of artifact, as seen on EPI and FSE imaging were reviewed separately by two radiologists. RESULTS: For overall imaging quality, EPI was superior to FSE in 14% of patients(4/29), equal in 24%(7/29), andinferior in 62%(18/29). For delineation of the parametrial venous plexus, EPI was superior to FSE in 79%(23/29).For uterine zonal anatomy and the outer margin, EPI was inferior to FSE in 55%(16/29) and in 45%(13/29),respectively. On EPI, visualization of the ovary was rated superior to FSE in 0%(0/9), equal in 52%(15/29), andinferior in 48%(14/29). Conspicuity of pelvic pathologic lesions was superior in 14%(4/29), equal in 52%(15/29),and inferior in 48%(14/29). Image distortion and susceptibility artifacts were seen on EPI in six cases, while onFSE motion artifacts were seen in two cases. CONCLUSIONS: As EPI is inferior to FSE in overall image quality,delineation of the normal anatomy of pelvic organs and conspicuity of pelvic lesions, it cannot replace FSE forimaging the female pelvis. However, because EPI reduces imaging time, further technical progress in this area maystimulate the use of ultrafast imaging of the femal pelvis.

Usefulness of MR Urography in the Diagnosis of Hydroureteronephrosis

PURPOSE: To evaluate the clinical usefulness of the MR urography (MRU) in the diagnosis of hydroureteronephrosis. MATERIALS AND METHODS: Twenty-five patients with hydronephrosis (26 cases) underwent MR urography, using a 1.5T MR scanner (Signa Horizon, GE Medical Systems, Milwaukee, U.S.A). The causes of hydronephrosis included benign ureteral stricture (12), ureteral stones (8) and malignant strictures (6), and were confirmed by operation, biopsy, conventional urography or clinical follow up. For MRU, a fat suppressed, respiratory-triggered, heavily T2-weighted fast spin echo (FSE) pulse sequence was used, and the 3-dimensional MR images were subsequently processed by a maximum-intensity-projection algorithm. We evaluated the success rate of MRU and its accuracy in determining the level and cause of obstruction, and compared the degree of hydroureteronephrosis seen on MRU with that seen on conventional urography. RESULTS: In all cases, a urogram was successfully obtained. In determining the degree of hydroureteronephrosis and the level of obstruction (in the upper ureter in 11 cases, in the mid-ureter in four, and in the lower ureter in 11), MRU findings matched those of conventional urography. In 24/26 cases (92%), MRU accurately determined the cause of urinary tract obstruction ; the two exceptions were in cases involving ureteral stones. CONCLUSION: MRU is a promising, noninvasive diagnostic method for evaluating hydroureteronephrosis, especially in children, pregnant women and patients with an allergic reaction to iodinated contrast material.

Dysphagia Following Stroke: Evaluation with Digital Radiography

PURPOSE: To evaluate the usefulness of digital radiography in the assessment of dysphagia following stroke. MATERIALS AND METHODS: Eighteen stroke patients (8 men, 10 women) referred for dysphagia and ten controls without known pharyngeal swallowing difficulty underwent digital radiography using a 1:1 mixture of barium and water. We evaluated oropharyngeal transit time and the location and severity of dysphagia; transit time was defined as the time from the first movement of the bolus to the return of the epiglottis to its original position. We sought to observe specific patterns of oropharyngeal dysfunction; dysphagia was classified as mild, moderate, or severe. RESULTS: In the control group, oropharyngeal transit time was 1.25sec (1.0-1.5sec), and for dysphagia patients, this was 4.32sec (1.75-6.5sec). Eleven patients (61%) had oral dysfunction, and 12 (67%), pharyngeal dysfunction; eight (44%) showed both oral and pharyngeal dysfunction. Mild swallowing difficulties occurred in six patients (33%), moderate dysfunction in six (33%), and severe dysfunction in three (17%). CONCLUSION: The dynamic image of the pharynx, as seen on a digital radiograph, may be diagnostically useful for defining the location and severity of dysphagia; in order to make feeding recommendations, this information is essential.