Recurrent Bleeding After Arterial Embolization in Patients with Hemoptysis: Comparison of Angiographic Findings and Relapsing Period

PURPOSE: To describe the angiographic findings of patients with recurrent hemoptysis after bronchial artery embolization (BAE) according to the point at which relapse occurred. MATERIALS AND METHODS: From 125 patients who underwent BAE due to hemoptysis between 1996 and 2000, we selected 18 of 23 who underwent additional BAE due to recurrent bleeding after initial BAE . Depending on the point at which relapse occurred, they were divided into two groups (I and II, according to whether additional BAE was performed within two weeks of initial BAE or more than two weeks after this). We retrospectively compared the two groups in terms of angiographic findings, number of embolized arteries, and character of feeding arteries at initial and additional BAE. RESULTS: Nine patients in group I (additional BAE: n=10) and nine in group II (additional BAE: n=13) were admitted for recurrent hemoptysis within two weeks of initial BAE and more than two weeks after this, respectively. In group I(n=29) and II(n=31), angiography demonstrated two direct and 27 indirect, and two direct and 29 indirect signs of hemorrhage, respectively. No statistically significant differences were observed (x2=0.005, p=0.945). Among the embolized feeder ressels in group I (n=30) there were 20 bronchial artery and 10 non bronchial systemic collaterals, while for group II(n=35), the corresponding totals were 21 and 14. Again, no statistically significant differences were encountered(x2=0.308; p=0.579). In group I, feeders were newly developed in one case(10%), previously embolized in five(50%), and missed in four(40%), while in group two the corresponding figures were none, twelve(92.3%), and one(7.7%). No significant differences were noted, though the incidence of previously embolized feeders in Group II was very high (x2=5.383, p=0.068). CONCLUSION: Among patients in whom hemoptysis after BAE recurred at different times, the angiographic findings and number of embolized arteries were not significantly different, but differences in the nature of the feeder were noted. Patients in whom hemoptysis recurred more than two weeks after BAE showed more recanalization of previously embolized feeders than those in whom there was recurrence within two weeks.

MR Findings of Dural Arteriovenous Fistula in Cavernous Sinus

PURPOSE: To evaluate the MR findings of dural arteriovenous fistula(DAVF) in the cavernous sinus and to determine the most useful imaging method for the diagnosis of DAVF. MATERIALS AND METHODS: We evaluated the MR findings of 12 patients in whom DAVF was diagnosed in the cavernous sinus on the basis of angiographic findings. Axial T1- and T2-weighted, and axial and coronal Gd-enhanced T1-weighted images with 3-6mm slice thickness had been obtained, and the findings of DAVF on three pulse sequences were examined and compared. On the basis of the detection of DAVF on three pulse sequences, the MR findings were graded as excellent, fair or poor, and the location of DAVF in the cavernous sinus was analysed. We also classified DAVFs as group A or B on the basis of MR findings (group A: lesions in the cavernous sinus were as large as or larger than the cavernous internal carotid artery; group B: these were smaller than the cavernous internal carotid artery) and compared with cognard type on angiogram. RESULTS: Multiple tortuous signal voids were found in all DAVFs. The signal voids were located mainly in the middle and posterior one third of the cavernous sinus, as seen on axial images, and the middle and inferior one third, as seen on coronal images. Axial and coronal enhanced T1-weighted images showed an excellent grade in 11 of 12 cases and a fair grade in 1 of 12. Axial T2-weighted images showed an excellent grade in 6 of 12 cases and a fair grade in 4 of 12. T1-weighted images showed an excellent grade in 4 of 12 cases and a fair grade in 6 of 12. Six cases were group A, and 5 of the 6 were Cognard type IIa or IIb; The other 6 cases were group B, 5 of the 6 were Cognard type I. CONCLUSION: MR findings of multiple tortuous signal voids in the cavernous sinus, especially in the posterior or inferior portion, suggest DAVF, and enhanced T1-weighted imaging could be the most useful sequence for its diagnosis.

Transjugular Intrahepatic Portosystemic Shunt with PTFE-Covered Spiral Z-stent: An Experimental Study in Swine

PURPOSE: To improve TIPS patency by inserting polytetrafluoroethylene(PTFE)-covered spiralZ-stents in swine. MATERIALS AND METHODS: Using PTFE covered spiral Z-stents lined with TIPS tract from theportal vein wall to the inferior vena caval orifice of the right hepatic ve i n , TIPS were created in seven youngswine. The animals were followed up by portal ve n o g r a p hy and venous pressure was measured at two - weekintervals for 12 weeks or until shunt occlusion. After sacrifice, resected liver was examined grossly andpre-pared for histology. RESULTS: The fifty percent patency rate using lifetime analysis was 83 % at 4 weeks, 33%at 6 weeks, 17 % at 8 weeks and 0% at 10 weeks. Venography demonstrated that the predominant sites of stenosiswere the portal vein wall(2/6), the TIPS tract(2/6) and the IVC orifice of the right hepatic vein(2/6). One swinedied 11 days after TIPS due to illness, and bile leaks were discovered in two of the seven animals. Histologicstudy demonstrated intimal hyperplasia in either the portal vein wall or the end of the stent at which the IVCorifice was located, as well as thrombus and pseudointimal hyper-plasia in the TIPS tract. CONCLUSION: P T F E -c overed spiral Z-stents were easily placed and significantly im-proved TIPS patency.

Quantitative CT of Lung in Healthy Koreans :Evaluation with PULMO-CT

PURPOSE: Spirometric gating quantitative CT, PULMO-CT, is an objective method for the measurement of pulmonary parenchymal attenuation at a constant level of inspiration. In order to obtain a normal value for quantitative CT of the lung, the authors therefore used PULMO-CT to evalvate the lung density of healthy koreans with different respiratiory status. MATERIALS AND METHODS: Twenty healthy Korean volunteers, 18 men and 2 women, ranging in age from 24 to 27 years and with normal chest radiography, were evaluated using the PULMO-CT option of Somatom Plus(Siemens, Erlangen, Germany). Spirometric gating HRCT images, at levels of 50% and 20% of vital capacity, were obtained at the level of the tracheal carina and at 5cm above and below this point. The images were analyzed by semiautomatic programs and the results were evaluated using the Student t-test. RESULTS: The mean attenuation value of lung parenchyma at 50% of vital capacity was -791HU27.1 and at 20% was -700HU+/-42.9. The difference in lung attenuation was 91HU and was statistically significant(p<0.001). The for 58% of participants, the highest reading for of lung attenuation at 50% of vital capacity was between -899HU and -800HU, and for 20.3% of participants, this reading was between -799HU and -700HU. At 20% of vital capacity, the largest proportion of participants(43.8%) had a reading of between -799HU and -700HU; the reading of 35.2% was higher than -699HU. CONCLUSION: Respiratory status significantly affects the quantitative accessment of pulmonary parenchyma; in order to determine, during quantitative HRCT, the parameters of a pathologic condition, lung parenchyma of differing respiratory status must be evaluated.

PTBD Spiral CT Cholangiography: Utility in Patients with Extrahepatic Biliary Obstruction

PURPOSE: The purpose of this study is to assess the utility of PTBD spiral CT cholangiography, after infusion of contrast media through a PTBD tube, for evaluation of a biliary lesion after emergency PTBD due to severe jaundice. MATERIALS AND METHODS: Forty patients with emergency PTBD due to extrahepatic biliary obstruction were transferred to our clinic and prospectively studied. The causes of obstruction were 17 extrahepatic cholangiocarcinomas (including three Klatskin's tumors), seven pancreatic head carcinomas, six calculous diseases of the common bile duct, six periampullary lesions, two ampulla of Vater carcinomas, one gall bladder carcinoma with invasion of the common hepatic duct, and one cholangitis. Diagnosis was on the basis of pathologic, radiologic, and clinical findings. Pre-contrast CT scanning was performed. After the infusion of contrast media (iothalamate : normal saline=1:10) through a PTBD tube, spiral CT scans were obtained. After IV infusion of contrast media (Ultravist, 100cc), early- and delayed-phase spiral CT scans were obtained at 45 and 210 seconds, respectively, with an interscan interval of 5mm. 3-D CT cholangiograms were then reconstituted. Spiral CT without infusion of contrast media through a PTBD tube and PTBD spiral CT cholangiography were performed in 14 cases. The level of extrahepatic biliary obstruction was categorized as either upper, middle, or lower third. In 21 surgically confirmed cases, we evaluated the accuracy with which the level and cause of obstruction was determined; levels and causes during surgery and by as seen on PTBD cholaniography were compared. RESULTS: The levels of obstruction diagnosed on PTBD spiral CT cholangiography and on 3-D CT cholangiography corresponded in all cases to the levels during surgery and on PTBD cholangiography [upper third (n=7), middle third (n=12), lower third (n=21)], and the level diagnosed on spiral CT without infusion of contrast media through a PTBD tube corresponded to the level during surgery in ten of 14 cases. The cause of obstruction diagnosed on PTBD spiral CT cholangiography corresponded to pathologic findings in 19 of 21 cases. In 15 cases, 3-D CT cholangiography was diagnostically helpful. CONCLUSION: PTBD spiral CT cholangiography is a useful diagnostic method for determining the level and cause of biliary obstruction.

Bronchiectasis in Diffuse Panbronchiolitis: High Resolution CT Assessment

PURPOSE: To evaluate the characteristics of the bronchiectasis in diffuse panbronchiolitis using HRCT. MATERIALS AND METHODS: We retrospectively studied 12 HRCT scans and two bronchography of 12 patients with diffuse panbronchiolitis(DPB). According to Akira et al., DPB was classified into four types: small nodules around the end of bronchovascular branchings(CT type I), small nodules in the centrilobular area connected with small branching linear opacities(CT type II), nodules accompanied by ring-shaped or small ductal opacities connected to proximal bronchovascular bundles(CT type III), large cystic opacities accompanied by dilated proximal bronchi(CT type IV). We compared the type and the extent of bronchiectasis, CTtypes of DPB, and pulmonary function test. RESULTS: Bronchiectasis was defined in 12 cases with the tubular type predominantly involving small and medium-sized bronchi. These bronchiectasis involved the proximal bronchi of the centrilobular lesions of DPB. Among eight cases of advanced DPB(CT type III & IV) which extended to both upper lobes, seven showed tubular bronchiectasis at the same area. Cystic bronchiectasis was shown in eight cases predominantly involving right middle lobe(n=7). There was no linear correlation between the values of pulmonary function test and CTtypes of DPB. CONCLUSION: Characteristic feature of the bronchiectasis in DPB is the tubular ectasis predominantly involving the small and medium-sized bronchi. DPB with associated tubular bronchiectasis can involve whole lung field in advanced cases. HRCT is useful not only to depict the findings of DPB but also to demonstrate the extent of lesion.

Destructive lesions of vertebral body:CT findings and differential diagnosis of inflammation and malignancy

The CT findings and their differential points were evaluated by reviewing the CT scans of 47 patients with destructive lesions of vertebral bodies which included tuberculous spondylitis(23), pyogenic infection(9), syphilitic spondylitis(1) and malignant lesions(14). Twenty-one(91.3%) of 23 patients with tuberculous spondylitis showed mixed osteolytic and osteosclerotic patterns of bony destruction. Six(66.7%) of 9 patients with pyogenic infection and 10(71.4%) of 14 malignant lesions showed osteolytic pattern of bony destruction. Thirty(90.9%) of 33 infections lesions including pyogenic infection and tuberculous spondylitis involved intervertebral disc, while the involvement of intervertebral disc was not found in malignant lesions. The Swisscheese appearance of bony destruction was commonly seen in tuberculous spondylitis, but pyogenic infections and malignant lesions more commonly revealed geographic or moth-eaten appearance. The sequestral pattern and sclerotic rims in and around bony destruction were mainly seen in tuberculous spondylitis, and they were thought to be specific findings in tuberculous spondylitis. CT of the spine appears to offer the detailed findings of vertebral body destruction and may be a useful adjunct in differentiation between tuberculous spondylitis, pyogenic infections and malignant lesions of the spine.

Radiological evaluation of the intracranial arteriovenous nalformat- ion

No abstract available.

Radiologic consideration of intra-arterial digital subtraction angiography

Intra-Arterial Digital Subtraction Angiography(IADSA) was performed in 128 patients during 13-month period. Weexperienced the same advantages of IADSA over conventional film-screen angiography:(1) significant reduction incontrast material dose: 1/3 of the dose of conventional angiography, (2) reduced film cost: 18% of the cost ofconventional technique, (3) decreased need for selective catherization,(4) shortened examination time, and (5)more ready detection of cnntrast material.

Percutaneous hepatic arterial catheterization for infusion chemotherapy in treatment of primary hepatoma

Chemotherapy offers palliative treatment to patient with advanced nonresectable hepatoma. The usefulness of systemic chemotherapy is limited becaused of serious side reaction and low concentration of drug at tumor. Butthis problem may be overcome by intraarterial infusion. Nonsurgical percutaneous hepatic arteiral catheterizationwas done in 21 patients with primary hepatoma, and infusion chemotherapy was done in 19 patients who were successful in catherization. The results were as follows; 1. Selective catheterization of hepatic artery proper,common hepatic artery, and celiac artery were seccessful in 4, 9 and 4 patients, respectively. The success rate ofselective catheterization is 80.9% including celiac artery among 21 patients with hepatoma. 2. Simple catherization method was applied in 14 patients, and catheter exchange and Loop methods were applied in 2 and 1patient respectively. 3. Complications related to catheterization, such as infection and bleeding on punctured site, intimal injury and dislodgement of catheter were not serious. 4. Drugs were well tolerated without serioustoxicity or complication. 5. 3 patients showed objective response and median survival time of treated patients is 2.5 months.

The radiological study of optic canal in Korean

Various methods of taking of optic foramen view and avalubilities have been studied by many foreigninvistigators, but those in Korea have not been reported yet. The authors have measured and examined the size andshapes of optic foramina of optic foramen views in 111 Korean checked at Inje Medical College Hospital duringabout 3 years form June 1979 to March 1982. The cases were divided into gwo groups, A and B, for the convenienceof study. Group A consisted of 50 normal Korean 5 to 55 years of age with no visual symptoms and signs. Group Bincluded 69 patients 3 to 75 yrs of age with visual symptoms and signs. The results were as follows; 1. Mean valueof actual diameter of optic foramen meassured by Goalwin's method in Group A; Right; A diameter; 4.21mm, Bdiameter; 4.32mm, Left; A diameter; 4.29mm, B diameter; 4.30mm. 2. Absolute symmetry of the greatest diameters ofboth optic foramina in Group A; 36%, difference of 0.5 or lessl 28%, from 0.5 to 1.0mm; 18%, from 1.0 to 1.5mm;8%, uncomparable cases; 10%. The greatest difference was 1.4mm. 3. The shapes of optic foramen in Group A; ovalshape; 65%, circular ; 29%, keyhole or double foramen; 6%. 4. In Goup B, the peak age group was second decade(31%), the most comon clinical cause of examiniation of optic foramen view was optic nerve atrophy(30%), and thepathologic findings were only 4 cases(7%). 5. The technique of optic foramen view by modified Pfeiffer's methoddelineated the outline of optic foramen more clearly than ordinary Rhese's method in our experience.