The role of MR and endoscopy in postoperative management of skull base reconstruction by vascular pedicle septal flap / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the significance of MR and endoscopy in the postoperative management of skull base reconstruction with a vascular pedicle nasoseptal mucoperiosteal flap.@*METHOD@#The immediate, and delayed postoperative MR imaging scans and endoscopic data of 8 patients who underwent endonasal endoscopic reconstruction of skull base dural defects with a vascular pedicle nasoseptal mucoperiosteal flap were retrospectively studied. Among the 8 patients, 7 cases have integrated immediate, delayed postoperative MR and synchronous endoscopic data which were harvest at the first week and at a 3- to 7-month interval respectively. One case was followed up by CT and endoscopy. The intracranial parenchymal changes, local situation of skull base defect site, the septal flap, healing of flap donor site and the transition of naso sinus mucosa were fully evaluated to explore the healing process and to improve the success rate of the reconstruction.@*RESULT@#We can obtain the key postoperative information of intracranial and the skull base reconstruction site with MR and endoscopy. The MR can exclude the intracranial complications such as postoperative intracranial hematoma, cerebral edema, or pneumocephalus, and clearly show the location and extent of skull base defects, the position of the flap, the overlapping manner between the dural defect margin and the flap and the postoperative cerebrospinal fistula. In immediate and postoperative follow-up with MR, the septal flap had homogeneous enhanced image with a roughly "C" figure under the skull base, indicating stable blood supplement. The synchronous endoscopic examination also proved the survival of the septal flaps in 7 cases , the cerebrospinal fluid leakage in 1 case. One case flap necrosis. The septal flaps presented edema and congested in the immediate postoperative endoscopy, and returned to normal in the delayed examination. The non-vascular materials such as gelatin sponge and fat tissue had the different characteristics signal. Nasal mucosal edema and sinus ventilation continually recovered during the follow up and the exposed septal cartilage on the donor site resurfaced by mucosa in 2 months.@*CONCLUSION@#MR and endoscopy could provide the critical postoperative information about the vascular pedicle septal flap reconstruction. MR combined with endoscopy not only could rule out the complications, but also could gain the information such as the position, blood supply and healing of the flap, at the same time detected the cerebrospinal fluid leakage to provide accurate information for the secondary stage reconstruction. The information got from MR and endoscopy were important for the surgeon and the radiologist to recognize the flap and to evaluate for variations that may suggest potential flap failure.

MRI Features of Bone Marrow Edema in Avascular Necrosis of Femoral Head / 实用放射学杂志

Objective To discuss MRI features of bone marrow edema in avascular necrosis of femoral head(ANFH),and to evaluatethe relationship between bone marrow edema and the stage of ANFH.Methods MRI findings of 99 hips in 73 patients with ANFH wereretrospectively analyzed.Using SE T_1WI,T_2WI and STIR scaning,both coronal and axid were performed in all patients.The bone marrow edema in ANFH was graded into 0~3,which correlated with the stage of ANFH was concerned.Results Bone marrow edema of the femur was best demonstrated on T_2WI and STIR coronal images.Grade 1~3 bone marrow edema were seen in 61% diseased femoral heads.Bone marrow edema of the femur was increasing with progressing of the disease.Bone marrow edema was not commonly seen and localized in stageⅠof ANFH,but it was more commonly seen and extensive in stage Ⅱ,Ⅲ of ANFH.Conclusion Bone marrow edema is one sign that isaccompanied with ANFH.The probability and extent of bone marrow edema correlated well with the stage of ANFH.MRI is the mostsensitive and non-invasive means for demonstrating bone marrow edema.

Follow - up study and evaluation of benign stricture of upper gastrointestinal tract with interventional procedure / 中华放射学杂志

Objective To make follow-up s tudy and e valuation of benign stricture of upper gastrointestinal tract (UGIT) with interv entional procedure. Methods There were 85 cases of benign stric ture of UGIT with interventional procedu re. There were 35 cases with pneumatic dilation (group A), 25 cases with permane nt (group B) placement, and 25 cases with temporary (group C) placement of expan dable metallic stent, respectively. All cases were completed under fluoroscopy. 35 cases of group A had 67 times dilations (mean 1.9 times). Fifteen partial co vered and 10 uncovered expandable metallic stents were permanently placed in the 25 ca ses of group B. 25 partial covered expandable metallic stents were temporari ly p laced in the 25 cases of group C, and the stents were drawn out via gastroscopy 3-7 days later. All stents placement and drawing were technically successful. T he most strictured diameters of UGIT were 0.7-8.5 mm before dilations and 5.1- 200 mm after dilations. Dysphagia scores of all cases were from grade 2 to 4 b efo re dilations, and from grade 0 to 1 after dilations. Follow-up time of all case s was from 6 months to 36 months (mean 19.1 months). Results Complications in group A included chest pain (n=10), reflux (n=8), and bleeding (n =3). Seven (20%) in 35 cases of group A had dysphagia relapse during follow-up over 6 months; 32 (91%) in 35 cases of group A had dysphagia relapse during follow-up over 12 mon t hs; 19(95%) in 20 cases of group A had dysphagia relapse during follow-up over 36 months. Complications in group B included chest pain (n=10), reflux (n =15), bleeding (n=3), and stent migration (n=4). Five (20%) in 25 case s of group B had dysp hagia relapse during follow-up over 6 months; 3(25%) in 12 cases of group B had dysphagia relapse during follow-up over 12 months; 3(60%) in 5 cases of gro up B had dysphagia relapse during follow-up over 36 months. Complications in group C included chest pain (n=10), reflux (n=3), and bleeding (n=4). 3( 12%) in 25 cases of group C had dysphagia relapse during follow-up over 6 months, 2(13.3%) in 1 5 cases of group C had dysphagia relapse during follow-up over 12 months; 1(12.5 % ) in 8 cases of group C had dysphagia relapse during follow-up over 36 months. ConclusionThe effective treatment method of benign stricture of UGIT with inte rventional procedure in short-term therapeutic efficiency were graded pneumatic dilation and temporary placement of partial covered expandable metallic stent. T emporary placement of partial covered expandable metallic stent was the first me thod of choice in the treatment of benign stricture of UGIT in terms of mid and long-term therapeutic efficiency.

The Diagnosis of Subsegmental pulmonary Thromboembolism by Pulmonary Arteriography(Report of 10 Cases) / 介入放射学杂志

Pulmonary Arteriography in 11 patients with pulmonary filling defects found by TC-MAA pulmonary perfusicn were analysed The results of arteriography corresponded well with the results of lung imaging.The technique of pulmonary arteriography, radiologic manifestation of PTE together with the correlation of literatures were discussed.