Value of cerebral small vessel disease burden in predicting prognosis after endovascular therapy for acute ischemic stroke / 中华放射学杂志

Objective:To assess the value of cerebral small vessel disease (CSVD) burden in predicting prognosis in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO) after endovascular therapy (EVT).Methods:The study was a cross-sectional study. A total of 242 patients with AIS due to anterior circulation LVO received EVT in the First Affiliated Hospital of Nanjing Medical University from February 2018 to September 2022. The clinical and imaging data of all patients were analyzed retrospectively. On follow-up MRI within 7 days after EVT, CSVD features [white matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed, cerebral atrophy] and CSVD burden score (0-5) was evaluated. Modified Rankin scale (mRS) score at 90 days after EVT was assessed. Patients were categorized into a mild burden group (0-1 points) and a moderate-severe burden group (2-5 points) based on CSVD burden score. Meanwhile, patients were categorized into a good prognosis group (0-2 points) and a bad prognosis group (3-6 points) based on mRS score at 90 days after EVT. Mann-Whitney U test and χ2 test were used to compare the difference of clinical and imaging indexes between the 2 groups, and variables with P<0.1 in the univariate analysis were included in the multifactorial logistic regression to screen for independent factors to predict the prognosis. Results:There were 169 patients in the good prognosis group and 73 patients in the bad prognosis group out of 242 patients. Compared with the good prognosis group, age, incidence of hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) scores, incidence of hemorrhagic conversion, CSVD burden scores, incidence of periventricular WMH scores of 3 and/or deep WMH scores≥2, and incidence of moderate-severe cerebral atrophy of patients in the bad prognosis group were higher, and the incidence of complete recanalization was lower (all P<0.05). Multivariate analysis showed hyperlipemia ( OR=8.438, 95% CI 1.691-42.119, P=0.009), baseline NIHSS score ( OR=1.103, 95% CI 1.047-1.162, P<0.001), complete recanalization ( OR=0.131, 95% CI 0.038-0.454, P=0.001) and hemorrhage transformation ( OR=1.952, 95% CI 1.031-3.697, P=0.040) were independent factors for the prognosis of EVT in patients with LVO AIS. There were 157 cases in the mild burden group and 85 cases in the moderate-severe burden group. The 90-day mRS score was higher in the moderate-severe burden group compared with the mild burden group ( Z=-2.24, P=0.025). Conclusion:CSVD burden has some clinical implications in predicting the prognosis of EVT in patients with anterior circulation LVO AIS.

Incidence rates of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting and related risk factors / 临床肝胆病杂志

ObjectiveTo investigate the clinical characteristics and risk factors of hyperamylasemia and acute pancreatitis after percutaneous transhepatic biliary stenting (PTBS). MethodsA retrospective analysis was performed for the clinical data of 249 patients with malignant biliary obstruction who were admitted to Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, and underwent PTBS from March 2016 to February 2020, and according to the presence or absence of postoperative hyperamylasemia or acute pancreatitis, the patients were divided into two groups to analyze incidence rate, severity, and related risk factors. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A multivariate logistic regression analysis was performed for the factors with P＜0.1 in the univariate analysis to investigate independent risk factors for hyperamylasemia and acute pancreatitis after PTBS. ResultsAfter PTBS, 55 patients (221%) patients had abnormally elevated serum amylase, among whom 26 (10.4%) were diagnosed with hyperamylasemia and 29 (11.7%) were diagnosed with acute pancreatitis. All patients with acute pancreatitis had mild manifestations. The multivariate logistic regression analysis showed that age ≤60 years (odds ratio ［OR］=2.2, 95% confidence interval ［CI］: 1.07-4.52, P=0033), iodine-125 seed strand implantation (OR=2.8, 95%CI: 1.21-6.45, P=0.016), biliary stent placement across the papilla (OR=6.3, 95%CI: 2.85-1405, P＜0.001), and visualization of the pancreatic duct during surgery (OR=13.9, 95%CI: 5.64-3403, P＜0.001) were risk factors for hyperamylasemia and acute pancreatitis after PTBS. ConclusionHyperamylasemia and acute pancreatitis are relatively common complications after PTBS. Age ≤60 years, iodine-125 seed strand implantation, biliary stent placement across the papilla, and visualization of the pancreatic duct during surgery are independence risk factors for hyperamylasemia and acute pancreatitis after PTBS.

Mid-term efficacy of prostatic artery embolization for benign prostatic hyperplasia / 中华放射学杂志

Objective:To investigate the mid-term efficacy of prostatic artery embolization (PAE) for the treatment of lower urinary tract symptoms (LUTS), urinary retention (UR) or hematuria secondary to benign prostatic hyperplasia (BPH).Methods:This was a retrospective study conducted from February 2014 to December 2018 in 140 patients who underwent PAE for LUTS, UR or hematuria secondary to BPH, including 85 patients with LUTS (60 patients with LUTS and 25 LUTS combined with hematuria), 52 patients with UR (50 patients with UR and 2 UR combined with hematuria) and 3 patients with hematuria. All patients were followed up for 24 months. Clinical success rates were evaluated. Friedman test was performed to compare the differences in International Prostate Symptom Score (IPSS), quality of life (QoL) score, and prostatic volume (PV) between baseline and follow-up time points (3, 6, 12 and 24 months). A post hoc test was performed by the Bonferroni method.Results:Significant differences in IPSS, QoL score and PV between baseline and follow-up time points were observed in 85 patients with LUTS ( P<0.001 for all), and clinical success rates at 3, 6, 12, 24 months after PAE were 95.3% (81/85), 91.8% (78/85), 87.1%(74/85), 83.5%(71/85). The success rate of extubation in patients with UR within 1 month after PAE was 98.1% (51/52). The average interval from PAE to catheter-independence was (6.8±3.7) days, and clinical success rates were 94.1% (48/51), 92.2% (47/51), 88.2% (45/51), 84.3% (43/51), respectively. The interval from PAE to the resolution of hematuria was (3.4±2.5) days, and clinical success rates were 90.0%(27/30), 90.0%(27/30), 83.3%(25/30), 80.0%(24/30), respectively. Conclusions:PAE was an effective treatment option for symptoms secondary to BPH in mid-term follow up.

Construction of human-computer dialogue teaching and examination system for medical imaging under the guidance of post competence / 中华医学教育探索杂志

With the rapid development of medical imaging technology, there are many corresponding kinds of medical images. The traditional teaching and examination mode based on typical images cannot meet the needs of medical imaging teaching. Therefore, we took the post competence of medical imaging students as the guidance, integrated multidisciplinary medical image resources, and established the human-computer dialogue teaching and examination system for medical images. The system was applied to medical imaging teaching and examination, achieving the standardization and clinical simulation of teaching and examination, and effectively improving the post competence of students.

The safety and efficacy of mechanical thrombectomy for anterior circulation small vessel occlusion / 中华神经科杂志

To evaluate the safety and efficacy of mechanical thrombectomy with stent-retriver for anterior circulation small vessel occlusion in patients with acute ischemic stroke (AIS).Methods:From a prospectively collected thrombectomy database of consecutive patients with AIS between January 2017 and November 2018, 311 angiographic images were analyzed to assess small vessel occlusions (A 2 and M 2 segments). Patients were categorized into alteplase with thrombectomy group and thrombectomy alone group. The primary outcome was a favorable outcome (modified Rankin Scale scores 0-2) at 90 days. Secondary outcomes were successful recanalization (modified thrombolysis in cerebral infarction 2b or 3), symptomatic intracranial hemorrhage, and 90-day mortality. Results:Small vessel occlusions were identified in 19 patients, including 14 M 2occlusions, two A 2occlusions, and three M 2+A 2 occlusions. Six patients were in the alteplase with thrombectomy group and 13 patients in the thrombectomy alone group. Favorable outcome was achieved in eight of 19 patients at 90 days. Successful recanalization was achieved in 18 patients (18/19), symptomatic intracranial hemorrhage was observed in one patient (1/19), and death was recorded in five patients (5/19). No statistically significant difference was detected between the two groups with regard to successful recanalization (6/6 in the alteplase with thrombectomy group vs 12/13 in the thrombectomy alone group), symptomatic intracranial hemorrhage (0/6 vs 1/13), favorable outcome (2/6 vs 6/13) and death (1/6 vs 4/13; all P>0.05). Conclusion:As to anterior circulation small vessel occlusions, the combination-therapy within 4.5 hours or mechanical thrombectomy alone in extended time window with perfusion evaluation may be both safe and effective.

Interventionaltreatmentofdelayedhemorrhageafterabdominalsurgery / 实用放射学杂志

Objective Toevaluatetheclinicaleffectofinterventionaltreatmentfordelayedhemorrhageinpatientsafterabdominal surgery.Methods Dataof76patients,undergoingangiographyduetodelayedpostoperativehemorrhage,wereanalyzedretrospectively. Theexclusioncriteriaincludedpositiveangiographywithoutembolizationorhaemorrhagecausedbyothercauses(urologicaland reproductivesystemdiseases).Basedonendovascularprocedures,thepatientsweredividedintoembolizedgroup (positiveangiography withembolization)andnon-embolizedgroup(negativeangiographywithoutembolization).Theoutcomesoftreatmentwerecompared betweentwogroupsandfactorsassociatedwithrebleedingwerealsoanalyzed.Results Angiogramswerepositivein70% (53/76)of patients,andintravascularembolizationswereperformed.Intheembolizationgroup,technicalsuccessrateandclinicalsuccessrate were98.1%(52/53)and71.7%(38/53),respectively.Noseverecomplications,suchasgastrointestinalorhepaticischemicnecrosis wereobservedinallpatients.Therebleedingrateswere28.3%and52.2%intheembolizationgroupandthenon-embolizationgroup, respectively(P＝0.046).Multivariateanalysisshowedthatuseofvasopressoragentsbeforesurgerywasanindependentriskfactor forrebleeding (P＝0.022).Conclusion Intravascularinterventionaltherapyisasafeandeffectivemethodfordelayedhemorrhageafter abdominalsurgery.Useofvasopressoragentsbeforesurgerymayincreasetheriskofpostoperativerebleeding.

Differential value of CT quantitative analysis for different subtypes of invasive lung adenocarcinoma presenting as subsolid nodule / 实用放射学杂志

Objective To explore the value of CT quantitative analysis in differentiating lepidicGpredominant adenocarcinoma (LPA)from invasive nonGlepidicGpredominant adenocarcinoma (INV)manifested as subsolid nodules (SSN).Methods A total of patients with lung adenocarcinoma manifested as SSNs on CT images were divided into LPA group and INV group according to their pathological results.Total volume,solid volume,solid volume percentage,total mass,solid mass,solid mass percentage and threeGdimensional mean CT value of the nodules were calculated after segmenting pulmonary nodules by a 3DGCT segmentation software,meanwhile the oneGdimensional mean CT value and maximal diameter were manually measured.SPSS 22.0 software was used for statistical analysis. Results Solid volume (0.1 6 ±0.3 6 cm3 vs 1.2 6 ±2.1 7 cm3 ,P＜0.00 1),solid volume percentage (4.7 9 ±5.40% vs 2 6.3 3 ± 1 5.6 3%, P＜0.001),total mass (1 180.64±1 751.46 mg vs 2 386.59±3 224.54 mg,P＝0.010),solid mass (151.64±337.53 mg vs 1 257.34± 2 220.9 2 mg,P＜0.00 1 ),solid mass percentage (7.9 8 ± 8.5 8% vs 3 7.2 3 ± 1 8.83%,P＜0.00 1 ),threeGdimensional mean CT value (－492.26±71.21 HU vs －350.73±94.52 HU,P＜0.001 )and oneGdimensional mean CT value (－472.29 ± 1 12.46 HU vs －282.02 ± 1 5 9.13 HU,P＜0.001)in LPA group were found significantly lower than those in INV group.There were no significant differences in the maximal diameter and total volume between LPA group and INV group.Solid volume percentage and solid mass percentage were selected according to stepwise discriminant analysis.The accuracy of Bayes modes by using substitution method and cross validation method were 84.2% and 83.3%,respectively.Conclusion Solid volume percentage and solid mass percentage were important parameters for differentiating LPA from INV.Quantitative analysis of SSN was very helpful to preoperatively evaluate the subtypes and prognosis of lung adenocarcinoma by using 3DGCT segmentation technique.

Pulmonary benign metastasizing leiomyoma: a study of six cases / 中国医师进修杂志

Objective To investigate the clinical, radiological and pathological characteristics, treatment and prognosis of pulmonary benign metastasizing leiomyoma (PBML). Methods The clinical and image data of 6 patients with PBML confirmed by pathology from October 2012 to December 2016 were retrospectively analyzed, and the related literature was reviewed. Results Six cases were female, age was from 32 to 55 (43.80 ± 7.17) years. Two cases were found by physical examination, 2 cases had chest distress and asthma, 1 case had chest pain, and 1 case had hemoptysis. Pulmonary abnormalities were detected between 1 month and 15 years after uterine myomectomy. Chest CT showed that multiple lung nodules or masses were observed in 5 patients, among which random distribution was in 3 cases, diffuse military nodule pattern was in 2 cases, and single mass combined with primary lung adenocarcinoma was in 1 case. Fluorine-18-fluorodeoxyglucose positron emission tomography/CT (18F- FDG PET/CT) of one patient showed no obvious uptake of the maximum standardized uptake value. All patients were confirmed histologically with CT guided lung biopsy (2 cases), thoracoscopic lung biopsy (2 cases), and thoracoscopic lobectomy with wedge resection (2 cases). Tumor cells revealed the characteristics of smooth muscle cell differentiation. Immunohistochemistry showed strong positive express of Desmin, SMA smooth muscle specific markers, estrogen receptor and progesterone receptor. Three patients were treated with oral tamoxifen anti estrogen therapy with follow-up from 5 months to 5 years. Four cases had a good prognosis, and 2 cases were lost in follow-up. Conclusions PBML is a rare disease that is prone to occur in women of childbearing age. The clinical symptoms are atypical. Imaging examination and pathology are necessary for diagnosis. Surgery combined with endocrine therapy is effective.

Quantitative analysis of dynamic contrast-enhanced MRI in conjunction with diffusion weighted imaging for differentiating benign and malignant orbital lymphoproliferative disorder / 中华放射学杂志

Objective To evaluate the value of quantitative analysis of dynamic contrast-enhanced MRI (DCE-MRI) and diffusion weighted imaging (DWI) for differentiating malignant from benign orbital lymphoproliferative disorder(OLPD). Methods Forty-three patients with OLPDs(20 patients with benign OLPDs and 23 patients with orbital lymphoma) confirmed by histopathology or clinical follow-up were enrolled in this retrospective study.Quantitative parameters of DCE-MRI including volume transfer constant (Ktrans), flux rate constant (Kep), and extravascular extracellular volume fraction (Ve) and mean apparent diffusion coefficient(ADC)values were obtained. χ2test and t test were used to compare the differences of qualitative and quantitative parameters between two groups. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic ability of each parameter and its combination. Results Malignant group showed significantly lower mean ADC values and higher Kepvalues than benign group [ADC:(0.674±0.126)×10-3mm2/s vs(1.030±0.304)×10-3mm2/s,P<0.001;Kep:(1.299±0.566)/min vs(0.787± 0.311)/min, P= 0.001], while no significant differences was found on Ktrans(P= 0.637) and Ve(P= 0.023). ROC analyses results indicated that,a sensitivity of 95.7%,specificity of 80.0% and area under curve(AUC) of 0.896 could be obtained,when using ADC=0.809×10-3mm2/s as the cut-off value.Setting the Kepvalue of 0.863/min as the cut-off value, a sensitivity of 91.3%, specificity of 75.0% and AUC of 0.848 could be obtained. When combination of mean ADC and Kepwas used, optimal diagnostic performance could be obtained (AUC, 0.926;sensitivity, 91.3%;specificity, 90.0%). Conclusion Mean ADC values and Kepare significant variables in predicting malignant OLPDs. Combination of DWI and DCE-MRI can further improve the diagnostic capability in differentiating malignant from benign OLPDs.

The effect of body posture change on the catheter tip position of totally implantable venous access port / 介入放射学杂志

Objective To discuss the effect of body posture change on the catheter tip position of totally implantable venous access port (TIVAP).Methods Under ultrasound guidance,implantation of TIVAP was carried out through bedside puncturing of internal jugular vein or subclavian vein.After the implantation of TIVAP,X-ray chest films of both erect position and supine position were taken to check the catheter tip position.The distance from the upper edge of the first thoracic vertebra to the catheter tip was separately measured on the erect position and supine position chest films.The shift of the catheter tip position was judged by the difference in the distance measured on chest films as well as by the comparison with the bony anatomic marks.Results Successful implantation of TIVAP was accomplished in 86 patients.When the patients changed from erect position to supine position,the catheter tip of TIVAP moved caudally in 71 patients,with the mean displace distance being (12.29±7.48) mm;the catheter tip of TIVAP moved cephalad in 31 patients,with the mean displace distance being (5.00±3.79) mm;and the catheter tip of TIVAP remained in the same position in 2 patients.When the patients changed from erect position to supine position,the catheter tip of TIVAP had a tendency to move toward the foot side,the average displace distance was (-9.32±9.36) mm,the difference in catheter tip location between two photographic positions was statistically significant (P＜0.000 1).No statistically significant correlation existed between the changes of catheter tip position and the sex,age,height,weight as well as body mass index (P＞0.05).Conclusion After the implantation of TIVAP,the position of catheter tip will change with patient's body posture.When patient's posture changes from erect position to supine position the tip of the catheter tends to shift towards the atrium.

Percutaneous transampulla stent implantation for the treatment of lower malignant obstructive jaundice: an analysis of related factors influencing the stent patency / 介入放射学杂志

Objective To evaluate percutaneous transampulla stent implantation in treating lower malignant obstructive jaundice, and to discuss the related factors that may influence the stent patency time. Methods The clinical data of a total of 104 patients with lower malignant obstructive jaundice, who received percutaneous transampulla stent implantation during the period from January 2010 to March 2016, were retrospectively analyzed. The parameters, including gender, age, primary tumor type, preoperative external drainage, total bilirubin (TBIL), albumin (ALB), glutamic-pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), white blood cell (WBC) count, platelet (PLT) count, hemoglobin (HGB) and length of biliary stricture, were used to evaluate the risk factors related to postoperative patency time. Results Single Cox regression analysis showed that primary tumor type, ALB, WBC count, length of biliary stricture were the related factors that significantly affected the stent patency time. The Cox regression analysis further indicated that primary tumor type and length of biliary stricture were the important related factors that significantly affected the stent patency time. Conclusion In treating lower malignant obstructive jaundice with percutaneous transampulla stent implantation, primary tumor type and length of biliary stricture may be the important related factors that affect the stent patency time. These parameters are of great value in estimating the stent patency time.

Multivariate analysis of short-term prognostic factors in recanalization therapy for acute cerebral ischemia / 中华急诊医学杂志

Objective To analyze the clinical characteristics and short-term prognostic factors in acute cerebral infarction patients who underwent recanalization. Methods This retrospective study enrolled 94 cases of acute cerebral ischemic patients in the First Affiliated Hospital of Nanjing Medical University between October 2014 and August 2016. Based on the clinical characteristics of the enrolled patients, a multivariate Logistic regression model was established to analyze the risk factors of unfavorable prognosis. Besides, patients were further divided into good collateral circulation group (1-2) and poor collateral circulation group (3-5) according to the Pial Collateral score, and the prognosis improvement rates between patients recanalized within 4 h and over 4 h were analyzed in each group. Chi-square test or Fisher's exact test was used to analyze statistical difference as indicated. Results By multivariate Logistic regression analysis, age older than 70 years old (OR=2.651, 95％CI: 1.013-6.937)and poor collateral circulation (OR=3.160, 95％CI: 1.113-8.977) were independent risk factors of short-term poor prognosis. In the poor collateral circulation subgroup, patients recanalized within 4 h exerted a relatively better prognosis than patients recanalized over 4 h (42.9％ vs.10.5％, P=0.047). However, the effect of recanalization duration on the prognosis in the good collateral circulation subgroups was not statistically significant (42.9％ vs. 10.5％, P=0.047), however, the effect of recanalization duration on prognosis in patients with good collateral circulation was not statistically significant (58.3％ vs. 37.8％, P=0.117). Conclusions For patients with acute cerebral infarction, age and collateral circulation status may influence the prognosis of recanalization therapy. The treatment time had a significant influence on the prognosis in patients with poor collateral, while it had minimal significance on patients with good collateral.

Relationship of TN-C, MMP-9 and TGF-β1 with aorta atherosclerotic plaues in mice / 中华老年心脑血管病杂志

Objective To study the relationship of TN-C,MMP-9 and TGF-β1 expression with aorta atherosclerotic plaue stability in mice on long-term high fat diet.Methods Fifty male apo E/ mice on high fat diet served as an experimental group and 50 male C57BL/6 mice on basic diet served as a control group.The morphology of plaques was observed with HE staining and the expression of TN-C,MMP-9 and TGF-β1 was detected with immunohistochemical staining.Results The serum TC and LDL-C levels were significantly higher in experimental group than in control group at weeks 16,24,32 and 40 (P＜0.05).The serum TG level was significantly higher in experimental group than in control group at week 16 (P＜0.05) and was significantly lower in experimental group than in control group at week 40 (P＜0.05).With the lengthening of the feeding time,the plaque area,the ratio of plaque to lumen area,and the expression of TN-C and MMP-9 increased gradually,but the expression of TGF-β1 decreased gradually (P＜0.05).Conclusion The expression of TN-C,MMP-9 and TGF-β1 can show the stability of atherosclerotic plaques.

Effects of deep and moderate neuromuscular blockade on surgical conditions during minor laparoscopic gynecologic surgery / 中华麻醉学杂志

Objective To evaluate the effect of deep and moderate neuromuscular blockade on surgical conditions during minor laparoscopic gynecologic surgery.Methods Sixty-five patients,with expected surgery time ＜ 3 h,aged 18-60 yr,with body mass index＜30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ orⅡ,scheduled for elective laparoscopic gynecological surgery,were allocated into deep neuromuscular blockade group (group D,n =33) and moderate neuromuscular blockade group (group M,n=32) using a random number table.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated.Cisatracurium was continuously infused to maintain the degree of neuromuscular blockade in both groups to achieve the target degree post-tetanic count of 1 or 2 in group D and train-of-four (TOF) count of 1 or 2 in group M.Surgical conditions were assessed and scored after surgery.The recovery index,time for TOF ratio returning to 0.7 and 0.9,surgery time,mean intra-abdominal pressure,extubation time and TOF ratio at extubation were recorded.Results Compared with group M,the mean intra-abdominal pressure was significantly decreased,and the extubation time and time for TOF ratio returning to 0.7 and 0.9 were prolonged in group D (P＜0.05).There was no significant difference in the other parameters between the two groups (P＞0.05).Conclusion Moderate neuromuscular blockade can provide better surgical conditions for minor laparoscopic gynecological surgery with shorter recovery time.

TACE combined with MWA versus simple TACE for the treatment of large hepatic cancers: a meta-analysis of curative effect / 介入放射学杂志

Objective To compare the curative effect of transcatheter arterial chemoembolization (TACE) combined with microwave ablation (MWA) with that of simple TACE in treating large liver cancers.Methods A computer-based search assisted by manual searching for TACE+MWA vs simple TACE clinical control trials for large liver cancers was conducted.The patient survival,tumor response and complications were enrolled in the scope of analysis.Results A total of 16 papers met the inclusion criteria,which included 1199 patients in total.Meta-analysis indicated that one-,2-and 3-year survival rates of TACE+MWA group were better than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).The complete response (CR) rate and partial response (PR) rate of TACE+MWA group were higher than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).The stable disease (SD) rate and progressive disease (PD) rate of TACE+MWA group were lower than those of simple TACE group,and the differences between the two groups were statistically significant (P＜0.01).Conclusion For the treatment of large liver cancers,TACE +MWA is superior to simple TACE.(J Intervent Radiol,2017,26:225-231)

The establishment of esophageal re-stenosis model by using esophageal stent implantation: observation in experimental rats / 介入放射学杂志

Objective To evaluate the feasibility and safety of establishing benign proliferative esophageal stenosis model by using stent implantation in experimental rats.Methods A customized self-expanding,metallic and straight tubular stent was used in this experiment (5 mm in diameter and 15 mm in length),on both sides at the stent's middle part there was a protruding barb that was used as a fixation device.Twelve healthy Sprague Dawley (SD) rats were randomized divided into group A (blank control group) and group B (stent implantation group),with 6 rats in each group.Esophageal stent implantation was employed in the rats of group B,and esophageal radiography was separately performed immediately,one and 4 weeks after stent implantation.All the experimental rats were sacrificed 4 weeks after stent implantation.The normal esophageal tissue of the rats in group A and the esophageal tissue at stent site of the rats in group B were collected and sent for pathological examinations,including gross morphology,light microscopy,etc.Results Successful stent implantation was achieved in all rats of group B,and the esophageal radiography performed immediately,one and 4 weeks after stent implantation showed no esophageal stent displacement;no severe complications occurred during the operation or follow-up period.Compared with group A,esophageal radiography reexamination performed 4 weeks after stent implantation in group B revealed that esophageal stricture at stent segment,caused by benign tissue hyperplasia,could be observed.The esophageal stent segment was taken out,its lumen was obviously narrowed under gross observation,and typical benign hyperplasia could be seen under optical microscope examination.Conclusion Using esophageal stent implantation to establish esophageal stenosis model is safe and feasible in experimental rats.The use of esophageal stent with barbs can significantly reduce the incidence of stent displacement.

Chemoembolization by using ethanol-soaked gelatin sponge combined with chemotherapeutic drugs and/or iodized oil for HCC complicated by moderate-to-severe hepatic arterio-portal shunts: analysis of curative effect / 介入放射学杂志

Objective To evaluate the safety and efficacy of peripheral chemoembolization by using ethanol-soaked gelatin sponge (ESG) combined with chemotherapeutic drugs and/or iodized oil in treating patients with hepatocellular carcinoma (HCC) complicated by moderate-to-severe hepatic arterio-portal shunts (APS).Methods The clinical data of 106 HCC patients associated with moderate-to-severe APS,who were treated with ESG chemoembolization during the period from June 2008 to December 2015,were retrospectively analyzed.The postoperative improvement of APS,the procedure-related complications,the tumor response,the survival time,the prognostic factors,etc.were statistically analyzed.Results In the 106 HCC patients associated with moderate-to-severe APS,the median survival time was 278 days,and the 6-,12-and 18-month cumulative survival rates were 70.8％,36.1％ and 16％,respectively.Univariate analysis showed that sex,total bilirubin level,maximal tumor diameter,history of previous treatment,tumor response and postoperative improvement of APS were closely correlated with the patient's prognosis.Multivariate regression analysis indicated that tumor response and postoperative improvement of APS were the independent protection factors,while the female sex and the maximal tumor size ≥5 cm were the independent risk factors.Conclusion For the treatment of HCC complicated by moderate-to-severe hepatic APS,transarterial chemoembolization by using ESG combined with chemotherapeutic drugs and/or iodized oil is safe and effective.The presence of tumor response to treatment and the postoperative improvement of APS indicate a better prognosis.The female sex and the maximal tumor size ≥5 cm are the independent prognostic risk factors.

The value of MRI in diagnosis of chordoid meningioma and differenciation with other meningiomas / 实用放射学杂志

Objective To analyze the MRI features of chordoid meningioma (CM),and to compare with other meningiomas. Methods Clinical and MRI features of 7 patients with CM confirmed by pathology were analyzed retrospectively.Featrues of every MRI sequence were investigated qualitatively.Meanwhile normalized signal ratios of each sequence were analyzed furtherly,including normalized T1 weighted image intensity ratios (NT1 ),normalized T2 weighted image intensity ratios(NT2 ),normalized ADC ratios (NADC)and normalized T1 WI contast enhancement intensity ratios (NCE).Fisher ’s exact test and Dunnett T 3 test were employed to analyze the difference of CM and nonchordoid meningiomas (34 cases of WHO grade Ⅰ meningioma,1 6 cases of nonchordoid WHO grade Ⅱ meningioma,and 5 case of WHO grade Ⅲ meningioma).Results The CM showed hyperintensity on T2 WI and meanwhile other nonchordoid meningiomas demonstrated isointensity,hypointensity or slight hyperintensity on T2 WI.Evaluations of DWI revealed variable signal intensities of CM.But all 7 cases had no obvious restricted diffusion,and increased signal was seen on the ADC map in each patient.The solid parts of CM enhanced markedly after contrast agent injection.Quantitative indicators NT2 , NADC and NCE of CM were higher than other meningiomas(P <0.01),but NT1 showed no statistic difference between CM and other meningiomas (P =0.889).Whether there was cyst,necrosis,orflow void sign on T2 WI,and no matter with or without perifocal edema,dural tail sign and a broader base among meningiomas had no significance in differentiating CM and other meningiomas.Conclusion CM has typical MRI features.The tumors show hyperintensity on T2 WI,especially have no obvious restricted diffusion and enhance markedly after contrast.The measurement of NT2 ,NADC and NCE enables reliable preoperative prediction of the atypical histopathologic diagnosis.

Selective arterial embolization for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma: analysis of curative effect and prognosis / 介入放射学杂志

Objective To investigate the curative effect of transarterial embolization (TAE) for the treatment of spontaneous rupture with bleeding of hepatocellular carcinoma (HCC),and to discuss the factors influencing prognosis.Methods A total of 57 patients with HCC complicated by spontaneous rupture and bleeding,who received initial TAE during the period from June 2012 and June 2016,were enrolled in this study.The last follow-up visit was in October 2016.Kaplan-Meier method was used to calculate the cumulative survival rate,and Cox regression model was adopted to analyze prognostic factors.Results In this series of 57 patients,the median survival time was 208 days.The 6-month,1-year and 2-year cumulative survival rates were 50.3％,35.9％ and 14.7％,respectively.Multivariate Cox regression analysis indicated that tumor size,Child-Pugh classification,history of shock,and the used embolization materials were the independent prognostic factors.Conclusion The use of selective TAE,as an initial therapy,for HCC complicated by spontaneous rupture and bleeding is safe and effective.This study reveals that larger diameter of the tumor,poor Child-Pugh classification,the presence of shock history indicate a poor prognosis.TACE using lipiodol combined with gelatin sponge particles can expect a better prognosis than TACE using PVA particles alone.

TACE combined with microwave ablation versus pure TACE for hepatocellular carcinomas larger than five cm in diameter: a propensity matching analysis / 介入放射学杂志

Objective To compare the curative effect of transarterial chemoembolization (TACE)plus microwave ablation (MWA) with that of pure TACE in treating hepatocellular carcinoma (HCC) larger than 5 cm in diameter.Methods The clinical data of 208 patients with HCC,who were admitted to authors' hospital to receive treatment during the period from June 2014 to December 2015,were retrospectively analyzed.The patients were divided into combination group (n=40,treated with TACE+MWA) and TACE group (n=168,treated with TACE only).By using 1 ∶ 1 pairing,the curative results of the two groups were analyzed.The survival of patient was taken as the primary observation index,and both the one-month solidtumor response value determined with modified Response Evaluation Criteria in Solid Tumors (mRECIST)and the reduction in AFP level were the secondary observation indexes.Results A total of 31 pairings were accomplished.The baseline data of the paired groups were comparable.The results indicated that half-,one-,1.5-,2-and 2.5-year survival rates in the combination group were 96.8％,90.3％,86.8％,82.5％ and 70.7％ respectively,which were significantly better than those of 77.4％,61.3％,53.6％,48.2％ and 24.1％ respectively in the TACE group (P=0.011).The one-month tumor-control rate and the reduction degree in AFP level of the combination group were better than those of the TACE group.No severe complications occurred in both groups.Conclusion For the treatment of HCC that is larger than 5 cm in diameter,TACE combined with MWA is superior to pure TACE in increasing survival rate as well as in improving tumor-control rate.