ABSTRACT
Objective To compare the diagnostic efficiency in showing the responsible blood vessels for neurovascular compression in patients with trigeminal neuralgia by 3D‐FIESTA‐C and 3D‐TOF‐MRA sequences .Methods The imaging data of 60 patients with primary trigeminal neuralgia were analyzed retrospectively .After MRI examination ,all of the patients underwent micro‐vascular de‐compression (MVD) .3D‐TOF‐MRA and 3D‐FIESTA‐C sequences were performed to evaluate the three‐dimensional relationship be‐tween trigeminal nerve and blood vessels through the original and reconstructed image .The intraoperative endoscopic findings were set as the gold standard comparing to the manifestations of 3D‐TOF‐MRA and 3D‐FIESTA‐C .Results The sensitivities of 3D‐TOF‐MRA and 3D‐FIESTA‐C for the diagnosis of the existence of responsible vessels were 85 .7% ,89 .3% ,the specificities were 75 .0% , 100% ,and the accuracies were 85 .0% ,90 .0% ,respectively (P=1 .000) .Furthermore ,the sensitivities of 3D‐TOF‐MRA and 3D‐FIESTA‐C for the diagnosis of the existence of responsible arteries were 94 .1% ,88 .2% (P=0 .244) ,while the sensitivities of the responsible veins were 0 .00% and 88 .2% (P=0 .009) .Conclusion Both the 3D‐FIESTA‐C and 3D‐TOF‐MRA sequences can accurately deter‐mine the existence of responsible vessels in trigeminal neuralgia before surgery .3D‐FIESTA‐C sequence is superior to 3D‐TOF‐MRA for presenting the responsible veins ,which can be used as a supplemental diagnostic tool before operation .
ABSTRACT
Objective To investigate the feasibility, safety and effectiveness of stent-assisted coil embolization for the treatment of intracranial wide-necked aneurysms. Methods The clinical and imaging data of the patients with intracranial wide-necked aneurysm treated with stent-assisted coil embolization were analyzed retrospectively. Results A total of 200 patients with 205 aneurysms were enrolled. The mortality was 1. 5% and the disability rate was 1. 0% at discharge. One hundred seventy-seven patients were followed up for 16-51 months. The modified Rankin Scale scores: 0 in 174 cases, 2 in 2 cases, 4 in 1 case. Eleven patients (5. 5% ) had perioperative complications, including intraoperative bleeding in 3 cases, postoperative bleeding in 3 cases, postoperative cerebral infarction in 2 cases, coil protrusion in 2 cases, and postoperative epileptic seizure in 1 case. Univariate analysis showed that there were significant differences in the proportions of male patients (9. 1% vs. 5. 3% ; χ2 = 4. 42, P = 0. 026), hypertension (54. 5% vs. 23. 3% ; χ2 = 5. 42, P = 0. 03) and stent prior to coil implantation (54. 5% vs. 85. 1% ; χ2 = 3. 54, P =0. 021) between the complication group and the noncomplication group. Multivariate logistic regression analysis showed that the pre-stenting was an independent protective factor for surgery-related complications (odds ratio [OR] 0. 208, 95% confidence interval [CI] 0. 055-0. 791; P = 0. 021), and hypertension was an independent risk factor for surgery-related complications (OR 4. 380, 95% CI 1. 170-16. 399; P = 0. 028). The imaging follow-up of 167 aneurysms was obtained, including 26 recurrent aneurysms (15. 6% ). Univariate analysis showed that there was significant difference in the aneurysm site (anterior circulation aneurysms: 73. 1% vs. 89. 1% ; posterior circulation aneurysms: 26. 9% vs. 10. 6% ; χ2 = 5. 09, P = 0. 033) and size (giant aneurysms: 7. 7% vs. 0. 7% ; large artery aneurysm: 65. 4% vs. 29. 1% ; small aneurysms:26. 9% vs. 70. 2% ; χ2 = 20. 77, P < 0. 001) between the recurrence group and the nonrecurrence group. Multivariate logistic regression analysis showed that large aneurysms (OR 6. 057, 95% CI 2. 296-5. 983; P <0. 001), giant aneurysms (OR 25. 260, 95% CI 1. 903- 335. 267; P = 0. 014 ), and posterior circulation aneurysms ( OR 3. 184, 95% CI 1. 028- 9. 857; P = 0. 045 ) were the independent risk factors of postoperative recurrence. Conclusions Stent-assisted coil embolization is one of the effective methods for the treatment of complex wide-neck aneurysms. Hypertension and coils prior to stenting are the independent risk factors for perioperative complications, and larger aneurysm size and aneurysms in the posterior circulation are the independent risk factors for postoperative recurrence.
ABSTRACT
Objective To investigate the value of MRCP in conjunction with CT or MRI contrast-enhanced scan in locating and qualitative diagnosis of biliary obstruction.Methods 954 patients with biliary obstruction confirmed by surgical pathology and clini-cal follow up underwent MRCP scans in our hospital.Contrast-enhanced CT scans in 87 patients,contrast-enhanced MRI scans in 52 and both CT and MRI enhancement in 37 were performed.Results The accuracy of location of biliary obstruction with MRCP was 100%,the accuracy of quality of biliary obstruction with MRCP combined with CT or MRI dynamic contrast-enhanced scan was 96%.Conclusion MRCP combined with CT or MRI dynamic contrast-enhanced scans has an important clinical value for the locali-zation and qualitative diagnosis of biliary obstruction.