Bronchial and non-bronchial systemic arteries: value of multidetector CT angiography in diagnosis and angiographic embolisation feasibility analysis.

INTRODUCTION: The aim of this study is to evaluate the diagnostic performance of multidetector CT angiography (CTA) in depicting bronchial and non-bronchial systemic arteries in patients with haemoptysis and to assess whether this modality helps determine the feasibility of angiographic embolisation. MATERIALS AND METHODS: Fifty-two patients with haemoptysis between January 2010 and July 2011 underwent both preoperative multidetector CTA and digital subtraction angiography (DSA) imaging. Diagnostic performance of CTA in depicting arteries causing haemoptysis was assessed on a per-patient and a per-artery basis. The feasibility of the endovascular treatment evaluated by CTA was analysed. Sensitivity, specificity, and positive and negative predictive values for those analyses were determined. RESULTS: Fifty patients were included in the artery-presence-number analysis. In the per-patient analysis, neither CTA (P = 0.25) nor DSA (P = 1.00) showed statistical difference in the detection of arteries causing haemoptysis. The sensitivity, specificity, and positive and negative predictive values were 94%, 100%, 100%, and 40%, respectively, for the presence of pathologic arteries evaluated by CTA, and 98%, 100%, 100%, and 67%, respectively, for DSA. On the per-artery basis, CTA correctly identified 97% (107/110). Fifty-two patients were included in the feasibility analysis. The performance of CTA in predicting the feasibility of angiographic embolisation was not statistically different from the treatment performed (P = 1.00). The sensitivity, specificity, and positive and negative predictive values were 96%, 80%, 98% and 67%, respectively, for CTA. CONCLUSIONS: Multidetector CTA is an accurate imaging method in depicting the presence and number of arteries causing haemoptysis. This modality is also useful for determining the feasibility of angiographic embolisation for haemoptysis.

Demonstration of the dorsal pancreatic artery by CTA to facilitate superselective arterial infusion of stem cells into the pancreas.

PURPOSE: To investigate the diagnostic performance of 64-section CTA in the detection of dorsal pancreatic artery before interventional therapy for patients with diabetes. MATERIALS AND METHODS: The study was approved by the institutional ethics committee; written informed consent was obtained. Forty-two consecutive patients with diabetes received an experimental treatment of autologous bone marrow-derived stem cell transplantation by means of infusion into the dorsal pancreatic artery. All cases underwent abdominal CTA before angiography of pancreatic arteries in order to locate the origin and course of dorsal pancreatic artery. Angiography of coeliac artery, splenic artery, common hepatic artery and superior mesenteric artery were performed both in CTA and DSA. Superselective catheterization of dorsal pancreatic artery was carried out for the infusion of stem cell. Sensitivity, specificity and accuracy for the detection of dorsal pancreatic artery with CTA were calculated using DSA images as the reference standard. RESULTS: Thirty-five and thirty-six dorsal pancreatic arteries were detected by CTA and DSA respectively. Dorsal pancreatic artery was not visualized in either CTA or DSA in 5 patients. The sensitivity, specificity and accuracy for CTA were 94.4%, 83.3% and 92.9%. CONCLUSION: 64-section CTA is accurate for the detection of dorsal pancreatic artery. It may be useful for the facilitation of superselective arterial infusion of stem cells to pancreas.

Digital subtraction angiography and computed tomography angiography of predominant artery feeding pancreatic body and tail.

BACKGROUND: Recently a considerable number of promising clinical trials have been designed to perform infusion of stem cells by pancreatic arterial intervention to improve the endocrine function of the pancreas for better diabetes control. It is necessary to investigate the pancreatic body and tail (PBT) arterial system for human islets located mostly in the PBT and identify the predominant artery or arteries. However, the arterial system in the PBT is complicated and variable. In this study we comprehensively investigated the anatomical characteristics of arteries feeding the PBT. RESEARCH DESIGN AND METHODS: One hundred two patients with diabetes underwent 64-slice computed tomography angiography (CTA) and digital subtraction angiography (DSA). The target artery was catheterized, and DSA was performed to show the PBT. All images were documented for later analysis. RESULTS: DSA demonstrated that the feeding arteries for the PBT included the dorsal pancreatic artery (DPA) alone (n = 51 [50%]), combined DPA and great pancreatic artery (GPA) (n = 22 [21.6%]), GPA alone (n = 16 [15.7%]), and transverse pancreatic artery (TPA) (n = 11 [10.8%]). DPA was observed to originate from the initial segment of the splenic artery (n = 34 [46.6%]), common hepatic artery (n = 17 [23.3%]), or superior mesenteric artery (n = 14 [19.2%]). The GPA was mostly from the middle (n = 36 [94.7%]), and only two were found to originate from the initial segment of the splenic artery. The TPA (n = 11) was from either the pancreatoduodenal artery (n = 5 [54.5%]) or the gastroduodenal artery (n = 4 [36.4%]). In most case, the predominant artery of the PBT (95.1%, 97 of 102) could be revealed by 64-slice CTA. CONCLUSIONS: The origins and identities of the predominant artery in the PBT are variable. DSA is superior to CTA for preoperative imaging in arterial intervention therapy.

Visual pathway lesion and its development during hyperbaric oxygen treatment: a bold- fMRI and DTI study.

PURPOSE: To characterize and evaluate functional and anatomic changes of visual pathway lesions during hyperbaric oxygen (HBO) treatment with blood-oxygenation-level-dependent functional MRI (BOLD-fMRI) and diffusion tensor imaging (DTI). MATERIALS AND METHODS: Sixteen patients with visual pathway lesions received HBO treatment. Both BOLD-fMRI and DTI were performed before and after the treatment, while 12 healthy subjects were also studied with 2 examinations as control. The t-tests were used for the comparison of number of activated voxels (AVs) and fractional anisotropy (FA) between the two groups, and within the patient group before and after HBO treatment. Visual acuity of the patient group before and after the treatment was compared using Wilcoxon signed-rank test. RESULTS: Before the treatment, both AVs (P < 0.01) and FA (P < 0.05) in the bilateral cortexes of occipital lobes were significantly less in the patient group than in the control group. After the treatment, both AVs (P < 0.05) and FA (P < 0.05) were significantly increased. Moreover, The FA of 6 patients with lesions in the optical nerve was greater than the FA of the other 10 patients with lesions in the optic radiation (P < 0.05). CONCLUSION: BOLD-fMRI combined with DTI was useful for the characterization and evaluation of anatomic and functional changes of visual pathway lesions and their development during HBO treatment.

Evaluating ischemic stroke with diffusion tensor imaging.

INTRODUCTION: In recent years, diffusion tensor imaging (DTI) has emerged as a promising tool to study ischemic stroke. The aim of this study is to evaluate the anisotropic changes of cerebral white matter tracks in patients with ischemic stroke using DTI, and investigate the correlation between corticospinal tract damage and muscle strength in such patients during acute ischemia. METHODS: Nine patients with acute ischemic stroke and nine healthy subjects were examined with T1 weighted magnetic resonance imaging (MRI), T2 weighted MRI and DTI. Fractional anisotropy (FA) was measured and the three-dimensional fibrous band images of bilateral corticospinal tracts were reconstructed. The muscle strength of the affected hand was assessed by Brunnstorm standard. RESULTS: In the control group, there was no significant difference in FA between the bilateral corticospinal tracts, but FA in different white matter structures of the same side was significantly different (t=3.12, p<0.05); while in the patient group, FA of the infarcted sites was significantly lower than the contralateral ones (t=5.570, p<0.01). The ipsilateral corticospinal tract demonstrated continuous interruption and the loss of consistent anatomic structure. The involved severity of corticospinal tract had significant correlation with that of muscle strength of the ipsilateral hand (r=1.30, p<0.01). CONCLUSION: This study shows that DTI can be used to investigate ischemic stroke and assess ischemic stroke-induced damage. The damaged severity of corticospinal tracts is correlated with that of muscle strength.