Qualitative and quantitative analysis of contrast-enhanced ultrasound images for assessing the correlation between the stability of newly formed vessels in the carotid plaque and the occurrence of ischemic stroke / 中国基层医药

Objective:To evaluate the stability of newly formed blood vessels in the carotid plaque using qualitative and quantitative analysis of contrast-enhanced ultrasound images and to investigate its correction with the occurrence of ischemic stroke.Methods:A total of 100 patients with carotid artery plaques diagnosed by routine ultrasound who received treatment between August 2017 and December 2019 in Haiyan People's Hospital, China were included in this study. They were divided into an ischemic stroke group ( n = 60) and a non-ischemic stroke group ( n = 40) according to the occurrence of stroke. Two groups of patients underwent contrast-enhanced ultrasound examination of the carotid artery. The correlation between the stability of the newly formed vessels in the carotid plaque and the occurrence of ischemic stroke was quantitatively analyzed. Results:Contrast-enhanced ultrasound results revealed low or medium intensity of echoes. The proportion of patients exhibiting grade 3-4 intensity of echoes in the ischemic stroke group was significantly higher than that in the non-ischemic stroke group ( P < 0.05). Time to peak in the ischemic stroke group was significantly shorter than that in the non-ischemic stroke group [(25.46 ± 3.25) seconds vs. (32.77 ± 4.28) seconds, t = 3.783, P = 0.000]. In the ischemic stroke group, peak intensity [(59.62 ± 10.18) dB vs. (47.53 ± 14.36) dB, t = 3.263, P = 0.000] and the area under the receiver operating characteristic curve [(2 365.37 ± 346.03) cm 2vs. (1 695.42 ± 525.44) cm 2, t = 4.981, P = 0.000] were significantly higher than those in the non-ischemic stroke group (both P < 0.05). Conclusion:Contrast-enhanced ultrasound visual scoring combined with quantitative ultrasonography technology can be used to assess the stability and possible development process of carotid plaques, which provide practical and reliable evidence for selecting a rational opportunity for clinical treatment of ischemic cerebrovascular disease and developing a reasonable treatment plan.

Radiofrequency obliteration of varicose veins of lower extremity guided by combined venography and ultrasonography / 北京大学学报(医学版)

OBJECTIVE@#To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound.@*METHODS@#Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed.@*RESULTS@#After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found.@*CONCLUSION@#The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.

Sampling of the petrosal sinuses. Indications, results and usefulness / Muestreo de senos petrosos. Indicaciones, resultados y utilidad

Abstract Objectives: to analyze, evaluate and describe the usefulness of petrosal sinus sampling for diagnosing central Cushing's syndrome. Materials and methods: the technical aspects and results of bilateral venous sampling of the petrosal sinuses at the Hospital Universitario San Vicente de Paul in Medellín, Colombia, from January 1, 2012 to December 31, 2018, were analyzed. Results: the average age was 43.3 years, with a range from 19 to 69 years. Laterality could be shown in 68.2% of cases, with a tendency to be located on the left in 53.3%. The central source of ACTH production could be shown in 95.4% of cases, with a basal average central/peripheral ratio of 21.7, and 70.8 after stimulation. All samples at 3, 5 and 10 minutes were confirmatory following stimulation. Conclusion: in our retrospective study, petrosal sinus catheterization provided laboratory confirmation of the central source of ACTH production in a high percentage of patients, with no immediate complications.

Resumen Objetivos: analizar, evaluar y describir la utilidad del muestreo de senos petrosos para diagnóstico del síndrome de Cushing de origen central. Material y métodos: se analizaron los aspectos técnicos y resultados del muestreo bilateral venoso de senos petrosos, desde el 1° de enero de 2012 a 31 de diciembre de 2018 en el Hospital Universitario San Vicente de Paúl en Medellín, Colombia. Resultados: el promedio de edad fue 43.3 años con un rango de edad desde los 19 hasta los 69 años. La lateralidad pudo ser demostrada en 68.2% de los casos con una tendencia a la localización en el lado izquierdo en 53.3%. El origen central de producción de ACTH logró ser demostrado en 95.4% de los casos, con una relación central/periferia basal promedio de 21.7 y postestimulación de 70.8. Todas las muestras a los 3, 5 y 10 minutos fueron confirmatorias tras la estimulación. Conclusión: en nuestro estudio retrospectivo el cateterismo de senos petrosos confirmó la fuente central de producción de ACTH por laboratorio en un alto porcentaje de pacientes sin ninguna complicación inmediata.

Value of contrast-enhanced ultrasound and intraluminal angiography in the differential diagnosis of benign and malignant endometrial lesions in postmenopausal women / 中国医师杂志

Objective To explore the value of contrast-enhanced ultrasound (CEUS) and intraluminal contrast in the differential diagnosis of postmenopausal endometrial benign and malignant lesions.Methods The ultrasound data of 90 patients with postmenopausal endometrial lesions diagnosed in our hospital between March 2016 and March 2018 were retrospectively analyzed.According to pathological findings,they were divided into benign group (55 cases) and malignant group (35 cases).The endometrial thickness of endovascular contrast,rise time (RT),time to peak (TTP),base intensity (BI),and peak intensity (PI) of CEUS in two groups were compared.Receiver operating characteristic curves (ROC) were used to compare the efficacy of different ultrasound parameters in benign and malignant endometrial by using pathology diagnosis as "gold standard".Results The endometrial thickness and PI were significantly higher in the malignant group than those in the benign group (P ＜ 0.05),while the RT and TTP were significantly lower than benign group (P ＜ 0.05),with no statistical difference in BI (P ＞ 0.05).The ROC curve showed that PI has the highest area under curve (AUC) in the differential diagnosis of benign and malignant endometrial lesions (AUC =0.983),followed by RT and TTP (AUC =0.889,0.872),and intimal thickness (AUC =0.766).AUC of PI was significantly higher than RT,TTP and intimal thickness (P ＜ 0.05),and the best cut-off point for PI ≥20.23 dB.The sensitivity of PI,RT,and TTP in differentiating benign and malignant endometrial lesions was significantly higher than that in intimal thickness (P ＜ 0.05),whereas the specificity and positive likelihood ratio (+ LR) of PI were significantly higher than those of RT,TTP,and intimal thickness (P ＜ 0.05).Conclusions Compared with intracavitary ultrasound,CEUS has better diagnostic value in differentiating benign and malignant endometrial tumors.Among them,the diagnostic sensitivity and specificity of PI≥20.23 dB are higher.

Clinical significance of antegrade lower limb venography in varicose veins of lower limbs / 中国医师杂志

Objective@#To investigate the clinical significance of antegrade lower limb venography in varicose veins of lower limbs.@*Methods@#The data of 230 cases of varicose veins of lower limb in Department of Vascular Surgery, Xiangyang Central Hospital from June 2018 to August 2019 were examined by antegrade lower limb venography. All patients were divided into simple varicose veins group (group A, 67 cases) and secondary varicose veins group (group B, 63 cases) according to the patency of deep veins. The data of sex, limb side, swelling and ulcer were analyzed respectively.@*Results@#There was no significant difference in the results of sex between the two groups (57.5% vs 63.5%, P>0.05). The incidence of left side in group A was lower than that in group B (59.3% vs 76.2%, P<0.05). And the incidence of swelling of lower extremities and ulcer in boot area in group A was lower than that in group B (31.1% vs 49.2%, P<0.05; 18.6% vs 31.7%, P<0.05 respectively).@*Conclusions@#Combined with swelling of lower extremities, ulcer in boot area or the varicose veins in left side had a higher incidence of secondary varicose veins. Anterograde venography of lower extremities can accurately distinguish the classification of varicose veins of lower extremities and improve the diagnostic coincidence rate, which has significant clinical significance.

Comparison of intravascular ultrasound and venography in the intraoperative evaluation of iliac vein compression syndrome / 中华普通外科杂志

Objective To compare intravascular ultrasound (IVUS) with venography in the intraoperative evaluation of iliac vein compression syndrome (IVCS).Methods From Sep 2017 to Mar 2018,consecutive patients with suspicious iliac vein compression,underwent both venography and IVUS.The results were compared between IVUS and venography.Results 40 patients with 48 limbs were enrolled.Venography underestimated both the diameter and area stenosis compared with IVUS (39.63％ ± 15.48％ vs.64.97％ ±16.42％,P＜0.001;51.83％ ±18.23％ vs.59.19％ ±14.17％,P=0.021,respectively).The eccentricity detected by venography was lower than IVUS (0.69 ±0.17 vs.0.93 ±0.17,P ＜0.001).Taking IVUS as gold standard,the sensitivity and the specificity of venography for detecting a ≥50％ stenosis was 18.92％ and 81.82％,and the intertechnique agreement was extremely low between venography and IVUS (κ =0.004).Conclusion Compared with IVUS,venography underestimated the degree of stenosis in IVCS.The sensitivity of venography in detecting a significant stenosis was very low.

Relationships of compression degree, type and thrombosis of left common iliac vein in patients with left lower extremity venous insufficiency / 中国介入影像与治疗学

Objective: To investigate the relationships of compression degree, type and thrombosis of left common iliac vein in patients with left lower extremity venous insufficiency (LEVI). Methods: Totally 258 patients with left LEVI underwent lower extremity CTV. The compression degree, compression type and thrombosis of left common iliac vein were observed, and their relationships were analyzed. Results: Among 258 patients, 84 patients had left iliac vein thrombosis, and the compression degree of left common iliac vein was (54.12±32.73)%. About compression type, there were 5 cases of high-order type, 241 cases of borderline type and 12 cases of low-order type. The difference in compression type between patients with left common iliac vein compression degree <50% and those with compression degree ≥50% was significant (P<0.05). There was significant difference of compression degree between patients with or without left common iliac vein thrombosis (P<0.001). Conclusion: The borderline type is main compression type of left common iliac vein in patients with LEVI, and compression degree ≥50% promotes thrombosis.

Clinical significance of antegrade lower limb venography in varicose veins of lower limbs / 中国医师杂志

Objective To investigate the clinical significance of antegrade lower limb venography in varicose veins of lower limbs.Methods The data of 230 cases of varicose veins of lower limb in Department of Vascular Surgery,Xiangyang Central Hospital from June 2018 to August 2019 were examined by antegrade lower limb venography.All patients were divided into simple varicose veins group (group A,67 cases) and secondary varicose veins group (group B,63 cases) according to the patency of deep veins.The data of sex,limb side,swelling and ulcer were analyzed respectively.Results There was no significant difference in the results of sex between the two groups (57.5％ vs 63.5％,P ＞ 0.05).The incidence of left side in group A was lower than that in group B (59.3％ vs 76.2％,P ＜ 0.05).And the incidence of swelling of lower extremities and ulcer in boot area in group A was lower than that in group B (31.1％ vs 49.2％,P＜0.05;18.6％ vs31.7％,P＜0.05 respectively).Conclusions Combined with swelling of lower extremities,ulcer in boot area or the varicose veins in left side had a higher incidence of secondary varicose veins.Anterogrede venography of lower extremities can accurately distinguish the classification of varicose veins of lower extremities and improve the diagnostic coincidence rate,which has significant clinical significance.

Comparison of intravascular ultrasound and venography in the intraoperative evaluation of iliac vein compression syndrome / 中华普通外科杂志

Objective@#To compare intravascular ultrasound (IVUS) with venography in the intraoperative evaluation of iliac vein compression syndrome (IVCS).@*Methods@#From Sep 2017 to Mar 2018, consecutive patients with suspicious iliac vein compression, underwent both venography and IVUS. The results were compared between IVUS and venography.@*Results@#40 patients with 48 limbs were enrolled. Venography underestimated both the diameter and area stenosis compared with IVUS (39.63%±15.48% vs. 64.97%±16.42%, P<0.001; 51.83%±18.23% vs. 59.19%±14.17%, P=0.021, respectively). The eccentricity detected by venography was lower than IVUS (0.69±0.17 vs. 0.93±0.17, P<0.001). Taking IVUS as gold standard, the sensitivity and the specificity of venography for detecting a ≥50% stenosis was 18.92% and 81.82%, and the intertechnique agreement was extremely low between venography and IVUS (κ=0.004).@*Conclusion@#Compared with IVUS, venography underestimated the degree of stenosis in IVCS. The sensitivity of venography in detecting a significant stenosis was very low.

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures / Utilidade da Venografia Pré-Operatória em Procedimentos de Troca de Cabos-Eletrodos ou Mudança do Modo de Estimulação

Abstract Background: Venous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation. Objectives: We aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures. Methods: From April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level. Results: Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan. Conclusions: The prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.

Resumo Fundamento: Obstruções venosas são frequentes em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) endocárdicos, mas raramente causam problemas clínicos imediatos. A principal consequência destas lesões é a dificuldade para obtenção de via de acesso para o implante de novos cabos-eletrodos. Objetivos: Determinar a prevalência de lesões venosas em candidatos a reoperações envolvendo o manuseio de cabos-eletrodos, e definir o papel da venografia pré-operatória no planejamento desses procedimentos. Métodos: De abril de 2013 a julho de 2016, 100 pacientes com indicação de troca de cabos-eletrodos, ou mudança no modo de estimulação, realizaram venografia com subtração digital no período pré-operatório. As lesões venosas foram classificadas em: não significativas (< 50%), moderadas (51-70%), graves (71-99%) ou oclusivas (100%), e a circulação colateral, em ausente, discreta, moderada ou acentuada. A estratégia cirúrgica foi definida a partir do resultado deste exame. Empregou-se análise univariada para a pesquisa de fatores de risco relacionados à ocorrência dessas lesões, com nível de significância de 5%. Resultados: Obstruções venosas moderadas foram observadas em 23%, graves em 13% e oclusões em 11% dos pacientes estudados, não sendo identificadas diferenças significativas em sua distribuição em relação ao lado do implante, ou do segmento venoso. A utilidade do exame para definição da tática operatória foi comprovada, sendo que em 99% dos casos, a estratégia cirúrgica estabelecida pode ser executada. Conclusões: A prevalência de obstruções venosas é elevada em portadores de DCEI que serão submetidos a reoperações. A venografia é altamente indicada como exame pré-operatório para o adequado planejamento cirúrgico de procedimentos envolvendo cabos-eletrodos transvenosos previamente implantados.

Application values of double contrast enhanced ultrasonography in the diagnosis of micro vessel formation on gastric cancer / 中国医师杂志

Objective To discuss the application of double contrast enhanced ultrasonography in the diagnosis of micro vessel formation on gastric cancer.Methods 52 cases of patients with gastric cancer who scheduled for elective tumor resection on our hospital from August 2015 to October 2017 were enrolled in the study.Oral ultrasonic contrast agent,and intravenous contrast agent were used to assess the preoperative condition.The image feature of gastric ultrasound imaging was observed,and the time-intensity curve (TIC) parameters of gastric lesions and normal gastric were recorded,the relationship of gastric carcinoma TIC parameters and the expression of micro vessel density (MVD),vascular endothelial growth factor (VEGF) expression were analyzed.Results Comparison of gastric lesions and normal gastric tissue,there were statistically significant difference on the basic strength (BI),enhanced intensity (EI),peak intensity (PI),perfusion time (WIT) (P ＜ 0.05);Correlation analysis showed that EI,PI were positively correlated with MVD,BI,WIT was negatively correlated with MVD (P ＜ 0.05);EI,PI were positively correlated with VEGF,BI was negatively correlated with VEGF (P ＜ 0.05).Conclusions Gastric ultrasound imaging technology can accurately assess the blood perfusion characteristics of gastric carcinoma,with a certain value on the gastric cancer angiogenesis evaluation.

Influencing factors of quality in contrast-enhanced ultrasound quantitative perfusion analysis for hepatocellular carcinoma and a reproducibility study / 中国医师杂志

Objective To investigate the influencing factors of quality in contrast-enhanced ultrasound (CEUS) perfusion analysis for hepatocellular carcinoma (HCC) and the reproducibility of using CEUS perfusion analysis on HCC.Methods A total of 136 HCC lesions were undergone CEUS perfusion analysis.Maximum intensity (Imax),rise time (RT),time to peak (TTP),mean transit time (mTF) and quality of fit (QOF) of HCC lesion,top-enhanced region inside HCC lesion and adjacent liver parenchyma were measured.The quality of perfusion analysis was classified into three grades " Good" (QOF ＞ 75％),"Common" [QOF (50％-75％)],and " Poor" (QOF ＜ 75％).Ultrasound machine,patients' age,tumor depth,tumor size and tumor location were recorded and compared among the three groups.20 consecutive patients with 20 HCC lesions were received CEUS perfusion analysis by two operators and another 20 consecutive HCC lesions were received CEUS perfusion analysis by one operator at different time.Intra-class correlation coefficient (ICC) was used to evaluate the reproducibility of inter-and intra-observer.Results Fifty-six HCC lesions were classified as " Good",39 as " Common" and 39 as " Poor",respectively.Tumor size (P =0.015) and tumor location (P =0.041) were significantly different among the three groups.Tumor size ＞ 3.0 cm and tumor located in S3,S4b,S5,S6 were apt to gain a better QOF.No significant difference was found for the different ultrasound machine,tumor depth and patients' age.For all CEUS perfusion analysis parameters of both lesion and adjacent parenchyma,intra-class correlation coefficient of inter-and intra-observer were higher than 0.90,the reproducibility of CEUS perfusion analysis was good.For Imax,RT and TTP in top-enhanced region inside HCC lesion,ICC of inter-and intra-observer was all higher than 0.90 (good).For mITT in highest enhanced area inside HCC lesion,ICC of inter-and intra-observer were 0.459 (poor),0.609 (common),respectively.Conclusions The parameters of HCC quantitative perfusion analysis were reproducible in peripheral liver parenchyma and tumor,but the mTT repeatability was poor in the highest enhancement area of the tumor.The size and location of the lesion were the factors affecting quantitative analysis.The quantitative analysis of ＞ 3.0 cm and the tumor located in S3,S4b,S5,S6 in the liver were satisfactory.

Clinical value of contrast-enhanced ultrasonic contrast in the diagnosis of thyroid microcarcinoma / 中国基层医药

Objective To investigate the clinical value of contrast-enhanced ultrasonic contrast in the diagnosis of thyroid microcarcinoma .Methods A total of 115 patients with thyroid nodules diagnosed surgically and pathologically were selected .Chose a series of contrast pulse contrast imaging ( CPS ) features of Acuson sequoia 512 color Doppler ultrasound diagnostic apparatus and Italy Bracco company production of ultrasound contrast agent SonoVue, the patients received routine ultrasonography firstly , then received ultrasonic contrast.Results Of 115 nodules,49 malignant nodules,including 49 cases of papillary thyroid carcinoma ,1 case of papillary carcinoma with metastasis;66 benign nodules,including 54 cases of nodular goiter(3 cases with calcification),7 cases of adeno-mas(1 case with calcification ),left thyroid sub acute thyroiditis in 1 case,4 cases with benign nodules .Benign nodules were more common than malignant nodules , the boundary was clearly more than the malignant nodules , low echo in less malignant nodules ,the blood flow signal was less than that of malignant nodules (χ2 =9.356,9.144, 9.832,6.581,all P <0.05).Benign nodules enhanced significantly more than the uniform malignant nodules, malignant nodules enhanced significantly less than the low , enhanced significantly more than the malignant clear boundary nodules(χ2 =6.130,5.791,23.206,all P<0.05).The specificity,sensitivity and accuracy of contrast-enhanced ultrasound were higher than conventional ultrasound (χ2 =6.971, 7.462, 7.152, all P<0.05 ). Conclusion Ultrasonic contrast has high clinical value in the diagnosis of thyroid microcarcinoma , and the sensitivity , specificity and accuracy are high , and can significantly improve the detection rate of thyroid microcarcinoma .

The characteristics of proximal deep vein thrombosis after total knee and hip arthroplasty / 中华骨科杂志

Objective To analyze the characteristics of proximal deep vein thrombosis (DVT) after total joint arthroplasty.Methods 40 cases of proximal DVT were collected from May 2007 to October 2016 which were all diagnosed by lower limb venography or sonography.There were 9 males and 31 females aged from 38 to 86 years,average 67 years,and body mass index was from 16.94 to 31.25kg/m2,with an average of 24.3 kg/m2.29 cases of THA patients and 11 cases of TKA patients.The anatomical distribution,size,radiological performance,local physical findings were recorded and multivariable analysis was performed to evaluate the relationship between distribution of proximal DVT and related parameters including age,gender (male/female),side of leg(left/right),surgery type(knee and hip),preoperative diagnosis(femoral neck fracture/other disease),time of diagnosis with DVT (during hospitalization/after discharge).Results Among 40 proximal DVT cases,31 cases diagnosed by phlebography and 9 cases were diagnosed by ultrasound.2 cases were isolated proximal DVT while 38 cases connected with distal DVTs.9 cases of blood clots in the proximal and distal thrombosis connected discontinuously.There was no isolated proximal DVT in TKA group and 10 cases (90.9％) of blood clots in the proximal and distal thrombosis connected continuously while there were 2 cases (6.9％) isolated proximal DVTs in THA group and 21 (77.8％) of blood clots in the proximal and distal thrombosis connected discontinuously,and there was no statistic significant difference between the two groups.The average length of proximal was 8.85±9.3 1cm (range from 2-35cm) with 5.0±2.05 cm in TKA group and 10.31 ± 10.55 cmin THA group.A significant difference was found between the 2 groups (P=0.014).13 cases located in femoral veins and upper venous region which were all from THA group.There was a significant difference in the distribution between surgery type and preoperative diagnosis.However,there was no significant difference between other potential factors and distribution of proximal DVT.25 cases accepted the evaluation of symptom of DVT before scanning.However,no significant difference were found in edema,VAS score,Homans sign,Neuof sign between 9 TKA and 16 THA cases.Conclusion Proximal DVTs after knee and hip arthroplasty are more preferred to connect with distal DVT continuously.Surgery type and preoperative diagnosis have a significant effect on the distribution of proximal DVT.Proximal DVTs in THA and patients with preoperative femoral neck fracture could be more easily involving femoral veins and upper parts.

Low-dose 256-slice spiral CT Scanning for Superficial Varicosis of Lower Limbs / 中国医学影像学杂志

Purpose The patients with varicose veins of lower limbs need to undergo extensive CT or X-ray examinations with high doses of radiation before and after treatment.The aim of this study is to investigate the value of low-dose CT contrast-enhanced scan for the superficial varicosis of lower limbs.Materials and Methods Forty patients diagnosed as superficial varicosis of lower limbs were selected prospectively.According to the scanning parameters,40 patients were randomly divided into four groups:group Ⅰ (standard group) scanned by 120 kV and 250 mAs,group Ⅱ scanned by 120 kV and 100 mAs,group Ⅲ scanned by 100 kV and 200 mAs,group Ⅳ scanned by 80 kV and 300 mAs.The effective dose (ED),signal noise ratio (SNR),contrast noise ratio (CNR) and image quality were evaluated.Results (① There were no significant differences in age,body mass index and height between the four groups (P＞0.05).② The ED values of the four groups were statistically significant (P＜0.05).③ The differences of SNR and CNR had statistical significance between the four groups (F=3.7 and 3.6,P＜0.05).All images met the diagnostic requirements.Conclusion The lower tube voltage and the higher tube current (80 kV,300 mAs) can reduce the radiation dose and have less influence on the image quality,which can meet the clinical diagnostic requirements and can be used as routine scanning parameters for patients with superficial varicosis of lower limbs.

The application value of CT phlebography scan on communicating veins in treating varicose vein of the lower extremity / 实用放射学杂志

respectively)was significantly higher than that for digital anterograde venography (0.684 and 0.587,P =0.026,respectively).Conclusion Diagnostic accuracy and detection rate of residuaI or recurrent varicose veins with CT phlebography are found to be more superior than that with digital anterograde venography which has high guidance value in preoperation and assesses the efficacy of post-surgery treatment.

Contrast-enhanced ultrasound in pediatric population / 中国医师杂志

This article mainly summarized the safety and effectiveness of SonoVue (LUMASON) in pediatric intravenous application for contrast-enhanced ultrasound examination.

Iliac vein compression syndrome: literature review / Síndrome de compressão da veia ilíaca: revisão de literatura

Iliac vein compression syndrome is a clinical condition in which the right common iliac artery extrinsically compresses the left common iliac vein. The syndrome predominantly affects young women between their 2nd and 4th decades of life. In view of the syndrome's potential complications, it should be recognized/diagnosed and treated in symptomatic patients before it causes irreversible damage to patients' venous systems. Noninvasive methods, such as venous color Doppler US are reasonable screening methods, but angiotomography and magnetic resonance angiography are more reliable diagnostic tools and the method of choice for confirmation of diagnosis remains multi-plane phlebography with measurement of pressure gradients. Endovascular treatment (angioplasty with placement of self-expanding stents) is safe and effective and can replace open surgical reconstruction and/or anticoagulation alone...

A Síndrome de Compressão da Veia Ilíaca (SCVI) é uma situação clínica na qual a artéria ilíaca comum direita comprime extrinsecamente a veia ilíaca comum esquerda. Há uma predominância em mulheres jovens, entre a segunda e a quarta décadas de vida. Levando-se em consideração as complicações potenciais da síndrome, esta deve ser reconhecida/diagnosticada e tratada, em pacientes sintomáticos, antes que cause alterações irreversíveis no sistema venoso do paciente. Métodos não invasivos, como o US-Doppler colorido, quando realizados por examinadores experientes, são métodos de triagem razoáveis; porém, a angiotomografia e a angiorressonância são mais fidedignas. O método de escolha para a confirmação diagnóstica consiste na flebografia, em múltiplas incidências, com aferição de gradientes pressóricos. O tratamento endovascular (angioplastia com colocação de stent autoexpansível) é seguro e efetivo, podendo substituir a reconstrução cirúrgica aberta e/ou a anticoagulação isolada...

Retrograde venous bullet embolism after thoracic gunshot / Embolia balistica venosa retrograda apos ferimento toracico por arma de fogo

Bullet embolism is a rare complication of penetrating gunshots. We present a case of a 24-year-old man with a gunshot wound in the left scapular area, with no exit wound. Abdominal X-rays and a computed tomography (CT) scan suggested that the bullet was located within the intra-abdominal topography (intrahepatic), but laparotomy revealed no intra-abdominal injuries. After surgery, a sequential CT scan showed that the bullet had migrated to the right internal iliac vein (IIV). Venography confirmed the diagnosis of right IIV embolism and the decision was taken to attempt snare retrieval of the bullet, which was unsuccessful. It was therefore decided to leave the missile impacted inside the right IIV and the patient was put on oral anticoagulation. The patient recovered and was event free at 6 months' follow up.

Embolia balística é uma complicação rara de ferimentos por arma de fogo. Apresentamos um caso de um homem de 24 anos, vítima de um ferimento por arma de fogo em hemitórax posterior esquerdo (região escapular), sem orifício de saída. Radiografias e tomografia computadorizada do abdome evidenciaram um projétil em topografia intra-abdominal (intra-hepática); no entanto, a laparotomia exploradora demonstrou ausência de lesões intra-abdominais. Após a cirurgia, novo exame tomográfico revelou a migração da bala para a região da veia ilíaca interna (VII) direita. Realizada uma flebografia, esta confirmou a migração do projétil para a VII direita; tentou-se retirar o projétil durante o procedimento, sem sucesso. Optou-se, então, por deixá-la impactada na VII direita e manter o paciente em anticoagulação oral. O paciente evoluiu sem intercorrências até o sexto mês de seguimento.

The clinical application of combined dual-energy CT pulmonary angiography and indirect venography / 中华放射学杂志

Objective To assess the usefulness of combined dual-energy CT pulmonary angiography (DE-CTPA) and indirect CT venography (CTV) in the diagnosis of venous thromboembolism (VTE).Methods Forty-nine patients with leg swelling suspected of pulmonary embolism (PE) underwent both DE-CTPA combined with CTV and lower extremity venous ultrasound (US) in 1-2 days prior to CT.Image quality of CTPA and dual energy lung perfusion image (DEPI) was rated using a 5-point scale and the coherence between CTPA and DEPI was analyzed by Kappa statistics.The ability of CTV and US in the diagnosis of deep venous thrombosis (DVT) was compared by Chi-square test.Results Twenty-nine of 49 patients were identified with PE by DE-CTPA,including 28 patients identified by CTPA and one more by DEPI,and 21 patients were found to have both PE and DVT.Both DE-CTPA and DEPI had positive findings for pulmonary embolism in 19 patients and both had negative findings in 18 patients.There was a moderate agreement between DEPI and DE-CTPA in the assessment of PE (Kappa value =0.7534).Thirty-eight patients with DVT were identified by US,while 35 patients were identified by CTV.Among the 35 patients with DVT identified by CTV,pelvic veins were involved in 25 patients,while the inferior vena cava was involved in 3 patients.There was no significant difference between CTV and US in the diagnosis of DVT(P =0.625).The detection rate of VTE with DE-CTPA combining CTV was 30.6％ higher than that with CTPA alone.Conclusions The combined DE-CTPA and CTV achievesone-stop examination.It not only provides evaluation of PE and DVT and increases detection of VTE,but also depicts perfusion defect of pulmonary parenchyma that corresponds to PE.