Detection of Hemorrhagic Transformation in Patients with Acute Cerebral Infarction: Comparison of CT with T1WI, FLAIR, and Gradient-Echo MR Imaging

PURPOSE: To determine the diagnostic accuracy of T1-weighted, FLAIR, and GRE MR imagings in the detection of hemorrhagic transformation in patients with acute cerebral infarction and to compare it with CT. MATERAILS AND METHODS: Fifty-three patients with acute territorial cerebral infarction were studied prospectively. All patients underwent nonenhanced CT and MRI including the T1-weighted, FLAIR, and GRE. Lesion conspicuity of hemorrhage was scored as follows: 0-none; 1-suspicious; 2-sure. CT and MR imagings were reviewed two radiologists respectively. The mean value of the lesion conspicuity in each CT and MR sequences was compared by means of a Wilcoxon signed ranks test. The time intervals between CT and MR imagings ranged from 3 to 14 hours (mean; 7.6 hours). RESULTS: Hemorrhagic transformation was detected on nonenhanced CT in 26 of 53 patients. In the detection of hemorrhage in patients with acute cerebral infarction, T1-weighted and FLAIR MR imagings were inferior to NECT (p<0.05). By contrast, lesion conspicuity of GRE MR imaging was not different from that of CT (p=0.5). In addition, lesion conspicuity of GRE MR imaging was greater than that of CT in five patients on reader A and two patients on reader B. CONCLUSION: GRE MR imaging was superior to T1-weighted and FLAIR MR imagings, equal to nonenhanced CT in the detection of hemorrhagic transformation in patients with acute cerebral infarction.

Bronchial Artery and Non-bronchial Systemic Artery Embolization for the Treatment in Patients with Hemoptysis: Analysis of Efficacy of Gelfoam Single Use

PURPOSE: To investigate the efficacy of Gelfoam single use for the management of hemoptysis by analyzing patients with recurrence in embolized artery and other artery, respectively. MATERIALS AND METHODS: Between 1992 and 2000, 131 patients (104 men and 27 women, mean age: 54.4 years) with hemoptysis underwent BAE using gelatin sponge only. After puncturing the femoral artery using the Seldinger method, angiographies of the thoracic aorta, the bronchial arteries, the intercostal arteries, and the systemic collaterals which were suspected of bleeding focus and embolization were performed. Gelfoam was used 1x3 mm and 2x3 mm or 2x5 mm by the diameter of feeding arteries. The cumulative hemoptysis control rate and recurrence rate were analyzed from the previously embolized vessels. RESULTS: Hemoptysis were recurred among 34 of 131 patients. Twenty-two patients had a recurrence from the same vessels and 12 from the different ones. Using the Kaplan-Meier method, the cumulative hemoptysis control rate was obtained in the patients with a recurrence from the same vessels: 88.8% in 1 month, 79.9% in 1 year, and 77.3% in 2 year. The reasons for recurrences of the same lesions are as follows; due to the tortuosity of the vessel (n=3); partial embolization through the common trunk formation between bronchial and anterior spinal artery (n=3); by vessel spasms or autogenous thrombus (n=2); due to the contrast media hypersensitivity (n=1). These 9 patients were not treated successfully. In the remaining 13 cases, hemoptysis were recurred due to recanalization of embolized vessels. Among 161 procedure, complications consisted of fever (n=8), dyspnea (n=8), mild chest discomfort (n=7), lower back pain (n=1), and transient lower leg paralysis (n=1), which were improved within several days. There was no serious complication in this study. CONCLUSION: Bronchial artery embolization using Gelfoam alone maybe effective and safe to control hemoptysis.

Metallic Stent Implantation in Patients with Iliac Artery Occlusion: Long-term Patency Rate and Factors Related to Recurrence

PURPOSE: To determine the long-term patency rate in 68 patients with iliac artery occlusion who underwent metallic stent implantation, and to analyze the factors related to recurrence. MATERIALS AND METHODS: Sixty-eight patients with occlusive disease of the iliac artery underwent implantation of a self-expandable metallic stent. The clinical symptoms were intermittent claudication (n=48), resting pain (n=11), and gangrene (n=9). Stent patency was determined by follow-up angiography and color Doppler imaging, and the cumulative patency rate using the Kaplan-Meier method. Cox's proportional hazard model was used to analyse recurrence-related factors involving clinical symptoms (Fontaine stage), risk factors, and anatomical factors such as lesion location, length, and the development of collaterals. The duration of followup varied from 1 day to 73 months (mean, 23.8 months). RESULTS: Arterial occlusion recurred in 16 of 68 patients (23.5%), and the cumulative patency rate was as follows: 95.4% at one month, 93.2% at six months, 80.1% at one year, 73.2% at two years, 68.9% at three years, and 62% at five years. According to a statistical analysis of risk factors, the recurrence p=0.04) than in those without it, but in patients who smoked, hypertension, DM, and previous cerebrovascular disease were not statistically significant. With regard to anatomical factors, the recurrent rate for lesions involving the external iliac artery was 6.5 times higher (p=0.02) than for those involving the common iliac artery. Variations in the Fontaine stage were not statistically significant indicators of recurrence. CONCLUSION: The recurrence rate after implantation of an iliac artery stent is higher in patients with heart disease than in those without it, and higher for occlusive lesions involving the external iliac artery than for those of the common iliac artery.