The feasibility and efficacy of endovascular treatment for very small or tiny ruptured paraclinoid aneurysms.

INTRODUCTION: The aim of this study was to evaluate the feasibility of endovascular treatment (EVT) for ruptured very small (≤5 mm) or tiny (≤3 mm) paraclinoid aneurysms of the internal carotid artery (ICA). METHODS: From November 2009 to April 2012, 32 ruptured paraclinoid aneurysms (very small, 23; tiny, 9) in 31 patients received EVT. Angiographic follow-up determined occlusion rates which were classified as total/near-total (95-100 %), subtotal (80-95 %), and partial (<80 %) occlusions. Follow-up data were retrospectively analyzed and categorized using the Modified Rankin Scale (mRS). RESULTS: Based on our paraclinoid aneurysm classification, 25 % (8) were classified as type I, 46.9 % (15) as type II, and 28.1 % (9) as type III. EVT was technically successful in 96.8 % (31), with coiling only in 12.5 % (4), balloon remolding coiling in 6.3 % (2), and stent-assisted coiling in 78.1 % (25). Total/near-total occlusion was immediately achieved in 34.4 % (11), subtotal occlusion in 37.5 % (12), and partial occlusion in 28.1 % (9). Follow-up angiography (mean, 9.9 ± 6.4 months) revealed total/near-total occlusion in 50 % (16) aneurysms, subtotal in 31.3 % (10), and partial occlusion in 18.8 % (6). At the end of clinical follow-up (mean, 14.8 ± 9.5 months), it revealed an mRS grade 0 in 38.7 % (12) of patients, grade 1 in 25.8 % (8), grade 2 in 22.6 % (7), grade 3 in 6.5 % (2), grade 4 in 3.2 % (1), and grade 5 in 3.2 % (1). CONCLUSION: EVT is feasible and effective for ruptured very small or tiny paraclinoid aneurysms of the ICA.

[Early management of intracranial ruptured vertebral dissecting aneurysms].

OBJECTIVE: To evaluate the early management of intracranial ruptured vertebral dissecting aneurysms. METHODS: Twenty-two patients with ruptured vertebral dissecting aneurysms were managed by various treatment modalities according to their conditions. One aneurysm was treated by proximal vertebral artery coiling, 15 aneurysms by aneurysm and parent artery coiling, and 5 aneurysms by stent-assisted coiling (4 of 5 by stent-within-a-stent technique), one by single double-stent. Bloody cerebrospinal fluid was drained by postoperative lumbar subarachnoid drainage in order to prevent cerebral vasospasm. RESULTS: All 22 cases were successful without bleeding complication during the operation.There was 1 case of early postoperative non-aneurysmal hemorrhage, 2 cases of posterial group cranial nerves palsies, 1 case harbored Hunt & Hess IV who gave up treatment. After follow-up for 3-18 months, there was no rebleeding and infarction. Twenty patients recovered well, except 1 having posterial group cranial nerves palsies. Fourteen cases were followed up by angiography. In 3 patients treated by stent-assisted coiling, DSA showed that aneurysms disappeared and loading vessel passed freely.DSA of 11 cases with aneurysm and parent artery coiling demonstrated complete obliteration of the dissection without aneurysm imaging. CONCLUSION: Early endovascular treatment of ruptured vertebral dissecting aneurysms is essential. The selective method of endovascular management according to the characteristics of aneurysm is safe and effective. Double stent-assisted coiling should be the first choice.

Contrast-enhanced multiple-phase imaging features in hepatic epithelioid hemangioendothelioma.

AIM: To investigate and review the contrast-enhanced multiple-phase computed tomography (CEMP CT) and magnetic resonance imaging (MRI) findings in patients with pathologically confirmed hepatic epithelioid hemangioendothelioma (HEHE). METHODS: Findings from imaging examinations in 8 patients (5 women and 3 men) with pathologically confirmed HEHE were retrospectively reviewed (CT images obtained from 7 patients and MR images obtained from 6 patients). The age of presentation varied from 27 years to 60 years (average age 39.8 years). RESULTS: There were two types of HEHE: multifocal type (n = 7) and diffuse type (n = 1). In the multifocal-type cases, there were 74 lesions on CT and 28 lesions on MRI with 7 lesions found with diffusion weighted imaging; 18 (24.3%) of 74 lesions on plain CT and 26 (92.9%) of 28 lesions on pre-contrast MRI showed the target sign. On CEMP CT, 28 (37.8%) of 74 lesions appeared with the target sign and a progressive-enhancement rim and 9 (12.2%) of 74 lesions displayed progressive enhancement, maintaining a state of persistent enhancement. On CEMP MRI, 27 (96.4%) of 28 lesions appeared with the target sign with a progressive-enhancement rim and 28 (100%) of 28 lesions displayed progressive-enhancement, maintaining a state of persistent enhancement. In the diffuse-type cases, an enlarged liver was observed with a large nodule appearing with persistent enhancement on CEMP CT and MRI. CONCLUSION: The most important imaging features of HEHE are the target sign and/or progressive enhancement with persistent enhancement on CEMP CT and MRI. MRI is advantageous over CT in displaying these imaging features.

A large functional somatostatinoma in the pancreatic tail: atypical CT appearances.

Somatostatinomas are extremely rare endocrine tumors, and those with diameters above 2 cm are reported to increase the risk of metastasis significantly. We report a case of a large functional somatostatinoma in the pancreatic tail without metastases. A 46-year-old woman with a history of recurrent mild upper abdominal pain and diarrhea for 10 months was admitted to our hospital. Multiple-phase spiral computed tomography revealed a 10 cm x 8 cm, ill-defined, elliptic mass in the body and tail of the pancreas. There was a slightly heterogeneous enhancement on hepatic arterial phase and isodensity to the pancreatic parenchyma with small dotted necrosis within the middle region of the mass on hepatic portal venous and parenchymal phase, with patent splenic vein, dilated collaterals at the splenic hilum and no dilated pancreatic duct, resembling a diffuse infiltration tumor. To the best of our knowledge, this is the first description of multiple-phase spiral computed tomography findings of a functional somatostatinoma in the pancreatic tail and the largest thus far on reported computed tomography, with some differences compared with the previous reports.

[Three-dimensional CT angiography with volume rendering for the detection of intracranial aneurysms].

OBJECTIVE: To evaluate the value of three-dimensional CT angiography (3D-CTA) with volume rendering (VR) for the detection of intracranial aneurysm. METHODS: Axial CT images were obtained by helical CT scanning on 45 patients with intracranial aneurysms, 15 males and 30 females, aged 63.9 (33-79 years). The primitive data were entered into the Silicon Graphics O2 board to be treated. VR technique was adopted to reconstruct 3D-CTA imaging, aided by multiplanar reformation to obtain the total volume of aneurysm. Among the 45 patients 25 underwent DSA simultaneously, 21 underwent clamping of aneurysm, and 3 underwent GDC thrombosis. RESULTS: Fifty-nine intracranial aneurysms were detected in 45 patients by 3D-CTA, including 32 small aneurysms (< or = 5 mm). 3D-CTA with VR well demonstrated aneurysms and provided useful information including the site, shape, size and spatial relationship to the surrounding vessels and bony structures. CONCLUSION: A quick, reliable, and relatively noninvasive diagnostic tool for intracranial aneurysms, 3D-CTA with VR delineates the aneurysmal morphology in detail, and provides useful information for choosing and planning microsurgical or endovascular treatment.