ABSTRACT
Objective:To investigate the onset of hepatic artery-portal vein shunts (HAPVS) in primary liver cancer (PLC) pa-tients through digital subtraction angiography (DSA) and to devise a suitable strategy for treating both lesions and shunt tracts. In the process, the therapeutic effect on such patients can be enhanced. Methods:A total of 769 PLC patients who accepted transarterial che-moembolization (TACE) were analyzed retrospectively. We examined the image characteristics of 112 cases with HAPVS based on shunt type. For patients with middle or severe fistula, we initially attempted to overpass the fistula. Then, we either embolized the tumor lesions or merely provided chemotherapy to the patients. For patients with mild peripheral fistula, we embolized the tumor and fistula si-multaneously. Then, the accompanying arterial-vein shunt and portal vein tumor thrombus (PVTT) were handled at the same time. Re-sults: DSA findings showed that portal veins were observed in the early stage of angiography. A total of 52 of the 112 cases with HAPVS involved mild shunts, 34 exhibited moderate shunts, and 26 reported severe shunts. Among these cases, 31 involved central-and central peripheral-type artery-portal vein fistula, whereas 81 involved peripheral-type artery-portal vein fistula. Seven cases were examined in combination with hepatic artery-liver vein shunts, and 50 cases were investigated in conjunction with PVTT. Tumor embo-lization was successful in 101 cases (90.1%). Moreover, catheters successfully overpassed shunt tracts and embolized the tumors in 48 cases (42.9%). Shunt tracts were successfully closed in 74 cases (66.1%), and no serious complication was observed. Conclusion:Pe-ripheral-type artery-portal vein fistula and mild-to-moderate shunts were easier to close than central-type artery-portal vein fistula and severe shunts were. Tumor embolization and shunt closure were successful in most patients. Therefore, TACE is a safe and reliable method for treating HAPVS in PLC.
ABSTRACT
[Objective]To investigate imaginological evidences of hyperxtensive injury of cervical spine and to evaluate its use in clinics.[Method]Seventy-eight patients with hyperextension injury at cervical spine by different cause were estimated by radiograph、CT and MRI.Fifty-seven cases(73.1%) appeared with widen of soft tissue of anteriorspine,including focal type(17.5%) and diffused type(82.5%). Thirty-six cases showed avulsion fracture of anterior edge in the cervical spine. Sixty-three cases showed degeneration and developmental spinal stenosis,twenty-one cases appeared integral vertebral canal. No contrast CT scan showed osteophyte of thirty-seven cases and intervertebral discs degeneration and protrusion of twenty-one cases.Sixty-one cases(78.2%) with both disc and anterior-longitudinal-ligament injury showed by MRI,fifty-seven cases showed haematoma and oedema at the anterior of the vertebral body. Sixty-four cases accompanied with different spinal cord injury.[Result]Obvious imaging feature for hyperextension injury of cervical spine,including anterior longitudinal ligament,intervertebral disc and spinal cord were found.There exists good relationship between spinal cord injury and imaging appearance. Clinically it showed typical central syndrome,but mostly showed us neuron-functional disturbance of different degree.[Conclusion]Combining of imaginological apperarance including radiograph,CT,MRI can provide evidences for diagnosis of hyperextension and help to treat acute hyperextension cervical injury.