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Objective:To evaluate the influence factors of the peak time in computed tomography (CT) portal venography.Methods:Twenty-eight patients who underwent CT perfusion (CTP) examination in Minhang Hospital Affiliated to Fudan University from October 2020 to December 2021 were retrospectively collected. The CT enhancement time-density curves of the main portal vein trunk and abdominal aorta were obtained at the cross section of the left and right branches of portal vein. The peak time of portal vein and abdominal aorta, the enhanced CT attenuation of the liver and spleen parenchyma enhancement at the peak value of portal vein were measured. Pearson correlation and regression analysis were performed.Results:The peak time of abdominal aorta was (16.39±2.68)s, and portal vein was (27.12±4.65)s. The enhanced CT attenuation of liver and spleen parenchyma were (84.64±20.21)HU and (142.28±25.15)HU, respectively. The peak time of portal vein was positively correlated with the peak time of abdominal aorta ( r=0.825, P<0.001), and there was no statistical correlation with the enhanced CT values of liver and spleen. Multiple linear regression analysis showed that the peak time of abdominal aorta was an independent factor affecting the peak time of portal vein ( b=1.326, t=5.874, P<0.001). The regression equation was the peak time of portal vein=4.185+ 1.451× the peak time of abdominal aorta. The peak time of portal vein in cirrhosis group was (27.78±4.48)s, and that in noncirrhosis group was (26.8±4.81)s, with no significant difference between the two groups ( P=0.614). Conclusions:There was a linear correlation between the peak time of portal vein and the abdominal aorta, and the results could be helpful to optimize the setting of delay time before CT portal venography.
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OBJECTIVE@#To assess the clinical application of preoperative retrograde portal venography for children with cavernous transformation of the portal vein (CTPV).@*METHODS@#The clinical data of 8 cases of CTPV admitted in the Children's Hospital of Zhejiang University from January 2018 to September 2019 were retrospectively analyzed. Preoperative retrograde portography was performed to determine the corresponding vascular morphology and size of portal vein system. If the retrograde portography showed that the left branch of the shadow portal vein was unobstructed and its diameter was greater than 3 mm, Rex shunt would be performed after anatomic exploration of Rex recess; if retrograde portography showed that the diameter of left portal vein was less than 3 mm, but the diameter of left renal vein dissected during shunt operation was greater than 5 mm, Warren operation was selected. The patients were followed up for 1, 3 and 6 months after discharge, and then were followed up every 6 months.@*RESULTS@#Retrograde portal venography was successfully performed in 8 child patients.The anatomical position and size of main portal vein and its left and right branches, left renal vein and other important vessels were determined. Among them, there was the well-developed left and right branches of portal vein in 4 child patients, in which the left and right branches of portal vein converged together, but did not communicate with the main portal vein. In addition, the left branch diameter of the portal vein was greater than 3 mm, and the anatomical exploration results during shunt were consistent with it, so Rex shunt was performed. In the other 4 cases, the left branch diameter of the portal vein was small (less than 3 mm) in 3 cases, and the right branch was not clearly developed. Moreover, the left branch of the portal vein was poorly developed and almost occluded in 1 case. However, the left renal vein in these 4 child patients was well developed, the blood flow was unobstructed and the diameter was greater than 5 mm, so Warren operation was performed. Seven patients recovered well after the operation, and the other one had digestive tract rudimentary one year after operation, and the condition was stable after conservative treatment.@*CONCLUSIONS@#The preoperative retrograde portal venography can be used to evaluate the portal vein system in children with CTPV, which provides important clinical basis for making appropriate treatment plan before surgery.
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Child , Humans , Portal Vein/surgery , Portography , Retrospective StudiesABSTRACT
Purpose To discuss the value of phase III CT angiography (CTA) and ultrasound in evaluating the preoperative vascular anatomical variation and the lumen patency of the patients with liver transplantation. Materials and Methods The clinical and imaging data of 126 patients with liver transplantation in the First Affiliated Hospital of Zhengzhou University were collected. CT scan in arterial phase, portal venous phase, venous phase and CTAreconstruction and ultrasound examination were performed before surgery. CTA images included volume rendering (VR), maximum intensity projection (MIP), curve plane reformation (CPR), and multi-plane reformation (MPR). The anatomical variations and lumen patency of the hepatic artery, the portal vein system, the hepatic vein and the inferior vena cava were observed. The accuracy of CTA and ultrasound of the evaluation of blood vessels in patients with liver transplantation was compared with the criteria of intraoperative exploration and postoperative pathological results. Results Among 126 patients with liver transplantation, all the hepatic artery lumen was unobstructed, with 98 cases of normal anatomical structure and 28 cases (22.2％) of anatomical variation, including Michel type II 7.1％ (9/126), type III 6.3％ (8/126), type IV 3.2％ (4/126), type V 2.4％ (3/126), type VI 0.8％ (1/126); 2.4％(3/126) of Michel classification was not included. The diagnostic accuracy of CTA for arterial anatomical variations was 100.0％, and the patency diagnosis of the lumen was consistent with the operation, and the anatomical variation cannot be evaluated. In 126 patients, there were 94 cases of portal vein patency, and 32 cases of portal vein embolus, including 21 cases with thrombus and 11 cases with tumor embolus. The diagnostic accuracy of CTA and ultrasound for portal vein embolus was 93.7％ and 96.0％, respectively; and there was no statistical significance (P>0.05). The diagnostic accuracy of them for thrombosis was 96.0％ and 91.3％, respectively; and there was statistical significance (P<0.05). The diagnostic accuracy of them for the tumor thrombus was 97.6％ and 92.1％, respectively; and there was statistical significance (P<0.05), CTA could show the collateral circulation around the portal vein. The diagnostic accuracy of CTA and ultrasound for venous patency was both 99.3％. The diagnostic accuracy of CTA and ultrasound for the anatomy of hepatic venous trunk was 99.2％ and 95.2％, respectively; and there was no statistical significance (P>0.05). Conclusion CTA can accurately evaluate the hepatic artery variation of liver transplantation. It has a high accuracy rate for the qualitative diagnosis of portal vein emboli, and can display collateral circulation. Its overall preoperative diagnostic value is better than that of ultrasound.
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Objective To explore the feasibility of fusion image of Xper-CT and CT portal venography (CTPV) as DSA 3D-roadmap in operation of transjugular intrahepatic portosystemic stent shunt (TIPS).Methods Thirty-seven patients with portal hypertension were enrolled in this study,among them 21 underwent conventional TIPS retrospectively,16 underwent Xper-CT and CTPV imaging to obtain fusion image in the workstation with the software of Multi-Modality Matching for hepatic portal vein without contrast medium administration.Then the fusion image was used as the 3D-roadmap in the process of real-time fluoroscopy.Results In the fusion process of Xper-CT and CTPV,osseous registration error was ＜ 2.00 mm,while error of the portal vein fusion image and the real-time X-ray image displacement were ＞2.00 mm between up and down in 15 patients,＞5.00 mm between left and right in 1 patient.Conclusion Xper-CT with CTPV fusion image can be used as 3D-roadmap of TIPS to observe the relationship between puncture needle and the portal vein without administration of contrast medium,improving the accuracy and safety of puncture and reducing operation time.
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Objective To investigate the efficacy and safety of CT portograph combined with endoscopic ultrasonography for the pricision treatment of esophagogastric varices in patients with cirrhosis. Methods A total of 130 inpatients with cirrhosis complicated with esophagogastric variceal bleeding who received endoscopic treatment from January 2013 to January 2015 were selected. Using prospective randomized controlled design, the patients were divided into two groups, the experimental group and the control group, with 65 cases in each group. The number and degree of esophagogastric varices were assessed by CT portography in the experimental group. Then endoscopic ultrasonography was used to assess the paraesophageal vein and perforator vein before endoscopic treatment. The range and degree of esophagogastric varices were observed and the lesions were treated by endoscopy in the control group. Results A total of 62 patients completed the study in the experimental group, and 63 in the control group. The number of treatment was significantly lower in the experimental group than that in the control group(3. 00±0. 76 VS 5. 63±0. 92, P=0. 000) . The disappearance time of varices was significantly shorter in the experimental group than that in the control group(7. 25±1. 16 months VS 8. 88±1. 64 months, P=0. 039). The variceal recurrence rate of the experimental group was significantly lower than that of the control group [ 1. 6％ ( 1/62 ) VS 12. 7％( 8/63) , P=0. 040] . The incidence of pleural effusion was significantly lower in the experimental group than that in the control group [ 0 ( 0/62 ) VS 9. 5％ ( 6/63 ) , P= 0. 040 ] . The total complication rate was significantly lower in the experimental group than that in the control group [ 27. 4％ ( 17/62 ) VS 58. 7％(37/63), P=0. 003]. Conclusion CT portography combined with endoscopic ultrasonography is safe and effective for esophageal gastric varices in patients with cirrhosis.
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Background:CT portography(CTP)permits comprehensive evaluation of portal vein and its collateral pathways. It is widely used for assessment of portal hypertension in clinical practice. Aims:To assess the value of CTP in esophagogastric varices in cirrhotic patients. Methods:A retrospective cohort study was performed in 143 cirrhotic patients admitted from Jan. 2013 to Sep. 2015 at the Affiliated Hospital of Qingdao University. All patients fulfilled the inclusion criteria and underwent CTP and gastroscopy within 7 days after admission. According to the occurrence of gastrointestinal bleeding at admission,patients were allocated into two groups:bleeding group( n = 70 ) and non-bleeding group( n = 73 ). Consistency of the results of CTP and gastroscopy was analyzed by kappa coefficient;the accuracy of CTP parameters, including diameters of main portal vein(MPV),splenic vein(SPV)and left gastric vein(LGV)for prediction of variceal bleeding was evaluated by ROC curve. Results:CTP and gastroscopy had a good consistency in typing and grading of esophagogastric varices,with the kappa value of 0. 793 and 0. 775,respectively. The diameters of MPV,SPV and LGV were significantly higher in bleeding group than in non-bleeding group(P < 0. 01),and their area under the ROC curve (AUC)in predicting variceal bleeding was 0. 741,0. 627 and 0. 816,respectively. The accuracy of diameter of LGV was superior to that of MPV and SPV. With the cutoff value of 6. 1 mm,the sensitivity and specificity of diameter of LGV were 65. 71% and 84. 93% ,respectively. With the cutoff value of 16. 3 mm,the sensitivity of diameter of MPV was 75. 71% , which was higher than that of LGV and SPV. Conclusions:CTP can be used in clinical diagnosis of esophagogastric varices in cirrhotic patients,and two CTP parameters,the diameters of LGV and MPV,might be helpful for prediction of variceal bleeding.
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Objective To evaluate the clinical application of preoperative multi-slice computed tomography (MSCT) and multi-slice computed tomography portography (MSCTP) in performing transjugular intrahepatic portosystemic stent shunt (TIPSS) combined with gastric coronary vein embolization (GCVE). Methods A total of 126 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The patients were arranged to receive TIPSS together with GCVE. Before the treatment, MSCT and MSCTP were performed in all patients. By using post-processing techniques, including maximum intensity projection (MIP), multiplanar reformation (MPR), volume rendering (VR) and surface shade display (SSD), the anatomy of liver was comprehensively evaluated. Results Both MSCT and MSCTP could clearly display morphologic changes of liver , the spatial relationship of the portal and hepatic veins , the degree and extent of portal collateral circulation , and the severity of ascites, which provided important anatomical information for preoperative evaluation of TIPSS and GCVE. Conclusion MSCT and MSCTP are non-invasive and reliable examinations for the diagnosis of cirrhosis with portal hypertension, it can further clarify the diagnosis and guide the performance of TIPSS and GCVE.
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Objective To evaluate the clinical application of preoperative multi-slice computed tomography (MSCT) and multi-slice computed tomography portography (MSCTP) in performing transjugular intrahepatic portosystemic stent shunt (TIPSS) combined with gastric coronary vein embolization (GCVE). Methods A total of 126 patients with cirrhosis complicated by upper gastrointestinal bleeding or massive ascites due to portal hypertension were enrolled in this study. The patients were arranged to receive TIPSS together with GCVE. Before the treatment, MSCT and MSCTP were performed in all patients. By using post-processing techniques, including maximum intensity projection (MIP), multiplanar reformation (MPR), volume rendering (VR) and surface shade display (SSD), the anatomy of liver was comprehensively evaluated. Results Both MSCT and MSCTP could clearly display morphologic changes of liver , the spatial relationship of the portal and hepatic veins , the degree and extent of portal collateral circulation , and the severity of ascites, which provided important anatomical information for preoperative evaluation of TIPSS and GCVE. Conclusion MSCT and MSCTP are non-invasive and reliable examinations for the diagnosis of cirrhosis with portal hypertension, it can further clarify the diagnosis and guide the performance of TIPSS and GCVE.
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El presente trabajo describe la arborización del sistema venoso portal intrahepático desde los enfoques anatómico, radiológico y ecográfico. Se realizaron 5 preparados anatómicos mediante inyección de resinas plásticas y posterior corrosión. Por radiología se contrastó el árbol portal en una pieza anatómica. Se realizaron estudios ecográficos bidimensionales y Doppler en 13 caninos de raza Beagle. Estos procedimientos permitieron a los autores comparar la tridimensionalidad de los preparados anatómicos con la bidimensionalidad de los estudios por imágenes.
This article describes the distribution of the intra-hepatic portal vein system by means of anatomy, radiology and ultrasound echo-scan approach. Five anatomical resin-embedded vein preparations with posterior corrosion have been done. The portal tree was depicted by radiology. Ultrasound B-mode and Doppler Scans were performed on 13 beagle dogs. These procedures allowed the authors to compare the three-dimensional preparations with the two-dimensional imaging methods.
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Portal Vein/diagnostic imaging , Dogs/anatomy & histology , Hepatic Veins/diagnostic imaging , Liver/diagnostic imaging , Portal Vein/diagnostic imaging , Cadaver , Portography , Corrosion Casting , Ultrasonography, Doppler , Hepatic Veins/anatomy & histology , Liver/blood supplyABSTRACT
Objective To investigate the safety and clinical effect of endovascular radiofrequency ablation (RFA) catheter, the HabibTM VesOpen, in treating portal vein tumor thrombus. Methods Fifteen patients of hepatocellular carcinoma associated with portal vein thrombus causing obstruction of blood flow were enrolled in this study. Guided by ultrasound percutaneous portal catheter implantation was performed, then, under DSA guidance RFA catheter was placed at portal vein tumor thrombus. RF generator (RITA) was connected to the electrodes, the power was set at 10 W for 2 - 10 minutes. The technical success rate, the postoperative complications, the hepatic and renal functions as well as routine blood tests, portal vein blood flow and the ablation extent of portal vein tumor thrombus were evaluated, and the results were analyzed. Results The procedure was successfully accomplished in all patients. No technique-related complications, such as hemorrhage, vessel perforation, bile leak complicated by infection, liver abscess, abdominal bleeding occurred. Direct portography performed immediately after RFA showed that the portal vein was re-opened. Laboratory examinations performed 4 weeks after RFA showed that no obvious changes in hepatic functions and routine blood tests were observed. Doppler ultrasound examinations revealed that flowing blood was obviously displayed within previously obstructed portal vein. CT scanning was carried out in some patients with portal vein thrombus, and it indicated that the portal vein tumor thrombus was reduced in size or even disappeared. Conclusion For the treatment of portal vein tumor thrombus in patients with hepatocellular carcinoma, endovascular radiofrequency ablation is technically feasible, and the initial results indicate that this technique is an effective treatment.
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Objective To renovate angiography in identifying portal vein anatomy during transjugular intrahepatic portosystemic shunt (TIPS) procedures,saving the time of TIPS procedures,decreasing the risk of the complications of the post-procedure.MethodsThe difference between the Wedge hepatic venography with Carbon Dioxide in 6 cases and Inferior Mesenteric artery angiography in 7 cases during TIPS procedures were compared in the identification of portal vein anatomy.The quality of images,their effects on the procedures,the complications and the recovery post-procedure were evaluated.Results Using CO2,the portal veins were opacified in all 6 cases.TIPS procedures succeeded in all cases except 1 case because of poor coagulation function.Using Inferior Mesenteric artery angiography,the portal veins were opacified in al1 7 cases.TIPS procedure succeeded in all cases except 1 case because of chronic portal occlusion.Puncture-site hematoma occurred in 1 case after TIPS procedure.ConclusionWedge hepatic venography with Carbon Dioxide is superior,safer and more convenient than Inferior Mesenteric Artery angiography in identifying portal vein anatomy during TIPS.
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Objective To investigate the effect of different injection rate of contrast medium on the quality of multislice spiral CT portography(SCTP). Methods Thirty patients with no prominent difference in the age and weight randomly divided into 3 groups (10 cases each group) underwent contrast-enhanced CT scan of abdomen. Non-ionic contrast medium (300 mgⅠ/ml, 1.5 ml/kg) was injected through antebrachium veins with power injector at the rates of 2.0 ml/s,3.0 ml/s and 4.0ml/s. Arterial phase acquisi-tion was made using the software of automated bolus triggering with a ROI placed on abdominal aorta when 100 HU was reached, and 7 seconds and 20 seconds later, portal phases were done respectively. The attenuations of portal vein(PV) and hepatic parenchy-ma of 3 groups were measured on source images. Then the oblique axial and coronal maximum intensity projection(MIP) maps were reconstructed at workstation and PVs were observed. Statistics analysis was made with software of SPSS 11.5. Results The attenu-ations of PV in 2.0ml/s, 3.0 ml/s and 4.0 ml/s groups were (150.80±21.16)HU, (170.90±17.26)HU and [181.90±22.88) HU respectively. There was obvious difference between 2.0ml/s and 4.0ml/s groups for atteuation of PV(P=0.017). The differences of CT attenuation of PV-hepatic parenchyma in three groups were (50.20±17.40) HU, (67.10±23.08) HU and (76.20±22.75) HU respectively. Prominent difference was also found between 2.0 ml/s and 4.0 ml/s groups(P=0.039). The grades of segment of PV displayed on SCTP maps were 4.20±1.14,4.90±0.99 and 5.50±0.53 in 2.0 ml/s,3.0 ml/s and 4.0 ml/s groups respectively, which were of obvious differences between them (P=0.013). Conclusion Injection rate of contrast medium dose influence the quality of SCTP of PV,SCTP quality is best with velocity of flow at 4.0 ml/s.
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Objective To study the application of multi-slice spiral CT(MSCT) portography in diagnonsis of pancreatic portal hypertension. Methods Forty-seven patients with lesion in body or tail of pancrease,47 normal subjects and 126 patients with portal hypertension underwent MSCT portography with LightSpeed 16 CT scanner. The inner diameter of portal system and the main collateral veins were measured in maximun intensity projection (MIP) image. The volume of liver and spleen were also measured in volume rendering (VR) image. The liver parenchyma and main portal vein enhancement in portal vein phase were also taken. The endoscopy examination was made in 57 patiens with portal hypertension. Results In 47 patiens with lesion in body or tail of pancreas , stenosis or occlusion of spleen vein were found in 38 patients(pancreatic portal hypertension in 27 patients, chronic and acute pancreatitis in 11 patients). In 38 patients with pancreatic portal hypertension, esophageal varices was found in 5 patients(13.2%), gastric fundus varix in 25 patients (65.8%), gastric body variees in 22 patients (57.9%), short-gastric vein/post-gastric vein(SGV/PGV) in 26 patients (68.4%), coronal gastric vein in 26 patients (68.4%),dilated gasto-omenta vein in 24 patients(63.2%), mesenterica varicesin 1 patient, splenic vein occlusion in 14 patients (36.8%), splenic vein stenosis in 23 patinets(63.2%). Conclusions The patients with pancreatic portal hypertension were demonstrate characteristic changes in MSCT portography. The MSCT portography is helpful in etiological diagnosis of pancreatic portal hypertension by supplying images in vessel morphology.
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PURPOSE: To assess the usefulness of three-dimensional CT portography using a standardized maximum intensity projection (MIP) technique for the evaluation of portosystemic collaterals in cirrhotic patients. MATERIALS AND METHODS: In 25 cirrhotic patients with portosystemic collaterals, three-phase CT using a multidetector-row helical CT scanner was performed to evaluate liver disease. Late arterial-phase images were transferred to an Advantage Windows 3.1 workstation (Gener Electric). Axial images were reconstructed by means of three-dimensional CT portography, using both a standardized and a non-standardized MIP technique, and the respective reconstruction times were determined. Three-dimensional CT portography with the standardized technique involved eight planes, namely the spleno-portal confluence axis (coronal, lordotic coronal, lordotic coronal RAO 30 degree, and lordotic coronal LAO 30 degree), the left renal vein axis (lordotic coronal), and axial MIP images (lower esophagus level, gastric fundus level and splenic hilum). The eight MIP images obtained in each case were interpreted by two radiologists, who reached a consensus in their evaluation. The portosystemic collaterals evaluated were as follows: left gastric vein dilatation; esophageal, paraesophageal, gastric, and splenic varix; paraumbilical vein dilatation; gastro-renal, spleno-renal, and gastrospleno-renal shunt; mesenteric, retroperitoneal, and omental collaterals. RESULTS: The average reconstruction time using the non-standardized MIP technique was 11 minutes 23 seconds, and with the standardized technique, the time was 6 minutes 5 seconds. Three-dimensional CT portography with the standardized technique demonstrated left gastric vein dilatation (n=25), esophageal varix (n=18), paraesophageal varix (n=13), gastric varix (n=4), splenic varix (n=4), paraumbilical vein dilatation (n=4), gastro-renal shunt (n=3), spleno-renal shunt (n=3), and gastro-spleno-renal shunt (n=1). Using three-dimensional CT portography and the non-standardized MIP technique, the portosystemic collaterals demonstrated were similar to those demonstrated using the standardized technique. Additionally, howerer, the former revealed features not revealed by the latter, namely splenic varix (n=1), mesenteric collaterals (n=4), retroperitoneal collaterals (n=3), and omental collaterals (n=2). CONCLUSION: In patients with liver desease, three-dimensional CT portography using a standardized of MIP technique helps evaluate portosystemic collaterals, reduces interobserver bias, and saves reconstruction time.
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Humans , Axis, Cervical Vertebra , Bias , Consensus , Dilatation , Esophageal and Gastric Varices , Esophagus , Gastric Fundus , Liver , Liver Diseases , Portasystemic Shunt, Surgical , Portography , Renal Veins , Tomography, Spiral Computed , Varicose Veins , VeinsABSTRACT
Objective To discuss the value of spiral CT portography(SCTP) in diagnosis of liver diseases.Methods SCTP was performed in 81 cases suspected with liver diseases,SCTP of hepatic lesions and collateral pathways of portal vein were observed.On reconstruction axial images,the minor calibers of portal vein and splenic vein were measured.Results SCTP could exactly locate and diagnose the hepatic lesions, the portal venous system could be distinctly displayed by SCTP; in cirrhotic cases, main portal vein and splenic vein were dilated(?
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Objective To assess the role of dynamic-enhanced MR angiography (MRA) by comparing with DSA and CT arterial portography (CTAP).Methods Sixteen patients with liver diseases (mainly HCC) were included in the study. All patients underwent dynamic MRI of the liver using SENSE, digital subtraction angiography (DSA) and CTAP within two-week. MRA was reconstructed from raw data. The arterial phase of the modified MRA was compared with DSA for the evaluation of hepatic arteries and the portal phase compared with CTAP. In dynamic MRI, a fixed dosage (20 ml) of contrast medium and scan timing were used. Results The main branches and variations of the hepatic arterial system were well displayed on the dynamic-enhanced MRA, although the distant intrahepatic branches were showed poorly. Portal veins on MRV were showed as well as or even superiorly to CTAP. In addition, the inferior vena cava (IVC) was well demonstrated on MRV in most cases. MRV revealed 1 vascular variation which was not found on DSA and CTAP.Conclusion The dynamic-enhanced MRA using SENSE was a effective modality in demonstrating the hepatic vascular system. It may be a first choice modality in preoperative evaluation of orthotopic liver transplantation.
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Objective To evaluate the clinical efficacy of percutaneous ultra-fine needle CO_2 splenoportography (CO_2-SP).Methods CO_2-SP and 3D-CE-MRA were performed in 36 patients.The imaging quality of the methods was compared by a scoring criterion setup based on the visualization of the trunk,intrahepatic branches of the portal vein and collateral vessels.Results Transient mild abdominal discomfort was presented in 19 patients(52.8% )receiving CO_2-SP.One patient developed snbcapsular splenic hematoma and was discharged with clinical stability several days later after conservative treatment. The imaging quality of the intrahepatic branches of the portal vein with CO_2-SP was much more superior to 3D-CE-MRA (the score was 232 and 198 respectively,t=4.52,P0.05 ).Conclusion Ultrafine needle CO_2-SP is a minimally invasive and safe procedure,able to provide dynamic and clearer imaging of the intrahepatic branches of the portal vein.
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Objective The application of CTHA/CTAP in examination of liver cancer relapse after interventional therapy were retrospectively analyzed.Methods The CTHA/CTAP and DSA were performed on 19 patients with primary hepatic cancer after receiving TACE procedure followed by obvious rising of AFP.Results CTHA/CTAP discovered 14 recurrent lesions in the peripheral region of the embolized tumors,and 15 new lesions.In comparison,DSA only discovered 6 recurrent lesions and 8 new lesions.Conclusion Comparing with DSA,CTHA/CTAP is a more sensitive and reliable method in detection of liver cancer relapse after interventional therapy.
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Objective To investigate the diagnosis and treatment of portal hypertension caused by cavernous transformation of the portal vein (CTPV) in adults Methods A retrospective study was made on clinical data of 31 adult upper GI bleeding patients with CTPV The diagnosis of CTPV in all cases were confirmed by B ultrasonography or ultrasonic Doppler and by percutaneous splenoportography or selective arteriography Splenic artery and coronary vein ligation plus C graft mesocaval shunt was performed in 12 cases Splenorenal graft shunt was performed in 1 In 8 post splenectomy rebleeding, cases 6 underwent C graft mesocaval shunt, one inferior meso caval shunt and one jejunectomy due to ictopic variceal hemorrhage Six cases received splenocaval shunt 2 splenopneumopexy 1 splenorenal shunt 1 portocaval shunt 1 pericardial devascularization ResultsPostoperativelly varices disappeared or ameliorated in all patients There was no rebleeding and hepatoencephalopathy occurred in follow up of 6 months to 4 years Conclusion Ultrasonic Doppler and percutaneous splenoportography are diagnostic for CTPV in adults Portasystemic shunt plus porta azygous devascularization is the choice of treatment
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Objective To evaluate the optimization of perfusing artery and contrast agent dose, and to determine the effect of precontrast injection of papaverine into the perfusing artery or not on the degree of contrast enhancement of the hepatic parenchyma during MRAP in dog models. Methods Sixteen dogs were included in this study and distributed to three study groups (perfusing artery, dose of Gd-DTPA and use of papaverine or not). Animals were anesthetized with Thiopental Sodium. After placement of a 5F end hole angiography catheter with no metal parts into the perfusing artery, the dogs were transferred immediately to the MR imaging unit. Unenhanced GRE MR and MRAP images were performed with a 2.0 T superconducting magnet. Signal intensity of liver parenchyma was measured with 6 different regions of interest. Relative value (%) of liver parenchymal enhancement was measured and compared. Time-enhancement curves were created and compared. Results MRAP images with good quality were obtained in all 16 dogs. The peak relative value of liver parenchymal enhancement and the time to the peak enhancement was similar in the superior mesenteric artery (SMA) group and in the splenic artery (SA) group. The peak relative value of liver parenchymal enhancement was the lowest in the 0.025 mmol/kg group among all groups. There was no statistical difference in the time to relative peak liver enhancement across the four groups. The time to relative peak liver enhancement in the group with papaverine injection was statistically earlier than that in the group without papaverine injection. Conclusion MRAP is a new and feasible imaging technique to detect hepatic masses before operation. When a 20 ml mixed solution of Gd-DTPA(0.050 -0.100 mmol/kg)was injected into perfusing artery at the rate of 1 ml/s, MRAP image of best liver parenchymal enhancement in dogs could be obtained at 21-28 s after the start of injection of Gd-DTPA. We can place catheters in SMA or SA and there was no statistical difference on MRAP images and time-enhancement curves. The dose of 0.050-0.100 mmol/kg Gd-DTPA was sufficient for MRAP. Application of papaverine precontrast advanced the time to peak liver enhancement, but the peak value of liver enhancement was not affected.