Asthma COPD Overlap Syndrome on CT Densitometry: A Distinct Phenotype from COPD.

Patients with asthma COPD overlap syndrome (ACOS) are an important but poorly characterized group. This study sought to explore the distinct characteristics of ACOS on CT densitometry. The study population was randomly selected from communities via questionnaires. All participants underwent low-dose volumetric chest CT both before and after bronchodilator administration. Each CT scan was performed at full-inspiration and full-expiration for CT densitometry. Emphysema index (EI), air trapping (AT), mean lung density (MLD) and total lung volume (TLV) were measured and compared between the ACOS and COPD groups. The distributions of both EI and AT were compared between patients with ACOS and COPD. The variations between the pre- and post-BD measurements observed in patients with ACOS were compared with those in patients with COPD. A total of 71 patients completed the study, including 32 patients with COPD and 39 patients with ACOS. The patients with ACOS exhibited lower EI and more upper-zone-predominant EI distributions, compared with the patients with COPD. No significant differences were exhibited in AT and its distribution. Following bronchodilator administration, the variations in AT and expiratory MLD were greater in patients with ACOS than in patients with COPD. No differences were observed in the variations of EI and inspiratory MLD. Our results indicate that patients with ACOS have lower extent of emphysema and different emphysema distribution, as well as greater post-BD variations in air trapping, compared with patients with COPD. These findings suggest that CT densitometry characterizes ACOS as a distinct phenotype from COPD.

Computed Tomography Number Measurement Consistency Under Different Beam Hardening Conditions: Comparison Between Dual-Energy Spectral Computed Tomography and Conventional Computed Tomography Imaging in Phantom Experiment.

PURPOSE: To compare computed tomography (CT) number measurement consistency under different beam hardening conditions in phantom experiment between dual-energy spectral CT and conventional CT imaging. MATERIALS AND METHODS: A phantom with 8 cells in periphery region and 1 cell in central region were used. The 8 conditioning tubes in the periphery region were filled with 1 of the 3 iodine solutions to simulate different beam hardening conditions: 0 for no beam hardening (NBH), 20 mg/mL for weak beam hardening (WBH) and 50 mg/mL for severe beam hardening (SBH) condition. Test tube filled with 0, 0.1, 0.5, 1, 2, 5, 10, 20, and 50 mg/mL iodine solution was placed in the central cell alternately. The phantom was scanned with conventional CT mode with 80, 100, 120, and 140 kVp and dual energy spectral CT mode. For spectral CT, 11 monochromatic image sets from 40 to 140 keV with interval of 10 keV were reconstructed. The CT number shift caused by beam hardening was evaluated by measuring the CT number difference (ΔCT) with and without beam hardening, with the following formulas: ΔCTWBH = |CTWBH - CTNBH| and ΔCTSBH = |CTSBH - CTNBH|. Data were compared with 1-way analysis of variance. RESULTS: Under both WBH and SBH conditions, the CT number shifts in all monochromatic image sets were less than those for polychromatic images (all P < 0.001). Under WBH condition, the maximum CT number shift was less than 6 Hounsfield units for monochromatic spectral CT images of all energy levels; under SBH condition, only monochromatic images at 70 keV and 80 keV had CT number shift less than 6 HU. CONCLUSION: Dual energy spectral CT imaging provided more accurate CT number measurement than conventional CT under various beam hardening conditions. The optimal keV level for monochromatic spectral CT images with the most accurate CT number measurement depends on the severities of beam hardening condition.

Anomalous origin of the left coronary artery from the pulmonary artery in infants: imaging findings and clinical implications of cardiac computed tomography.

PURPOSE: This study aimed to retrospectively analyze the imaging features of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in pediatric patients, with cardiac computed tomography (CT) and echocardiography. MATERIALS AND METHODS: To define the precise location of ostium of the left coronary artery, we examined 9 patients using chest film, electrocardiogram, echocardiography, and cardiac CT 4 modalities, 2 of them also using cardiac MR and 1 of them using catheter cardiac angiography. Cardiac CT scan was performed in all 9 patients using a body size adapted low-dose protocol after bolus injection of intravenous nonionic contrast medium. Multiplane reconstruction, maximum intensity projection, and 3-dimensional coronary tree images were obtained for each patient. Two radiologists in consensus analyzed the cardiac CT findings for the origin of the anomalous coronary artery, course, and collateral vessels. The ALCAPA in these 9 patients was confirmed retrospectively by surgery. RESULTS: Cardiac CT can distinguish the site of origin of the anomalous left coronary artery and variants: 2 patients with inner ostium of the pulmonary trunk, 3 patients with left-sided ostium, 2 patients with posterior ostium, and 2 patients with sinus of the pulmonary root ostium; 1 patient combined with the right coronary artery arising from the left coronary sinus. CONCLUSIONS: Cardiac CT can provide fast and accurate depiction of complex coronary arteries, particularly in unstable and fragile patients with ALCAPA, and according to cardiac CT, surgical strategies can be decided.

Comparison of gadolinium-enhanced magnetic resonance imaging with ultrasound in evaluation of cesarean scar pregnancy.

AIM: The aim of this study was to evaluate the validity of gadolinium-enhanced magnetic resonance imaging (MRI) in diagnosing cesarean scar pregnancy (CSP) and to compare this with ultrasound results. MATERIAL AND METHODS: Forty-two consecutive patients underwent both gadolinium-enhanced MRI and ultrasound to evaluate CSP before treatment from May 2010 to September 2013. The results of both MRI and ultrasound were reviewed and compared to each other with diagnosis of CSP confirmed by pathological findings and clinical outcome. RESULTS: MRI and ultrasound were performed in all 42 patients, with ultrasound performed more than twice in 29 cases. Pathological findings confirmed CSP in all 42 patients, 41 of whom were diagnosed correctly using MRI, with one misdiagnosed as uterine fibroid. Misdiagnosis occurred in seven cases in the first ultrasound, and report was inconclusive in one case. However, correct and definite diagnosis was achieved in repeated ultrasound in seven of the eight cases. The case misdiagnosed as uterine fibroid using MRI was also misdiagnosed as blood clot by ultrasound. The specificity of MRI in diagnosing CSP was 97.6% (41/42) versus 81% (34/42) of the initial ultrasound (P < 0.05). No contrast-agent-related complications occurred in our series. CONCLUSIONS: Gadolinium-enhanced MRI is highly specific in the diagnosis of CSP. Ultrasound is relatively less specific when initially performed, but it can be repeated conveniently, with specificity greatly improved. Repeated ultrasound is as specific as MRI in confirming diagnosis of CSP.

[Diagnosis and differential diagnosis of testicular epidermoid cyst with MRI].

OBJECTIVE: To investigate the MRI characteristics and differential diagnosis of testicular epidermoid cyst. METHODS: The MRI imaging features of 7 testicular epidermoid cyst cases were retrospectively analyzed and compared with that of testicular seminoma. All cases were examined by contrast-enhanced MRI scans. RESULTS: The group of 7 cases of testicular epidermoid cyst MRI showed characteristic: On T1-weighted MR images, some lesions showed low signal-based, center with spotty high signal ("target sign"). On T2-weighted MRI, some lesions had a laminated appearance, with alternating low and high signal intensity areas ("onion skin" sign). On contrast-enhanced images, all lesions were sharply demarcated low signal intensity masses, and contrast enhancement were not seen in any of the cases. CONCLUSION: MRI characteristics of testicular epidermoid cyst are distinctive in certain extent. It may express "target sign", "onion skin" sign, T2 low signal intensity complete rings, and without enhancement.

[The value of soft tissue neurogenic tumors in the extremities with 3.0 T magnetic resonance imaging].

OBJECTIVE: To explore the diagnostic value of 3.0T MRI in neurogenic tumor of soft tissue in the extremities. METHODS: The MRI appearance of 17 neurogenic tumors with pathological confirmation was retrospectively analyzed. Various imaging characteristics of tumors were evaluated and different imaging findings were compared. The diagnosis value of each MRI features was evaluated with receiver-operating-characteristics (ROC) analysis. RESULTS: In the benign tumors significant differences between neurilemmoma and neurofibromas were noted for the position (P = 0.044). Heterogenicity on T(2)-weighted fat suppression images was also significant in differentiating between neurilemmoma and neurofibromas ( P = 0.020) . The shape of tumors, maximum length of tumor short diameter, edem around masses, relationship with adjoining fascia had the best discriminatory ability. The ROC analysis yield the area under curve (AUC) of them was 0.967 (P = 0.037), 0.923 (P = 0.048) , 0.981 (P = 0.034) , 0.981 (P = 0.034), respectively. CONCLUSION: If the neurogenic tumors of soft tissue in the extremities had one or several features of these characteristics (irregular margin, big volume, edem around masses, aggressive behavior with adjoining fascia) on 3.0T MRI, they had more possibility to be malignant. T(2)-weighted fat suppression series on 3.0TMRI was very important for discrimination of tumor histological characteristics.

Embolization of symptomatic renal angiomyolipoma with a mixture of lipiodol and PVA, a mid-term result.

OBJECTIVE: To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol (PVA) particles on symptomatic renal angiomyolipoma and to present the mid-term results from our single-center site. METHODS: We performed a retrospective review of the seven patients who underwent embolization with a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma in our center between February 2011 and December 2013. Medical records and follow-up results were reviewed and analyzed. RESULTS: Seven patients underwent eight episodes of embolization using a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma. One patient required a subsequent embolization of the right kidney 9 months after the initial embolization of the left kidney. No nephrectomy was required in any of these cases during follow-up. None had recurrence of tumor bleeding or rupture during follow-up. Decreased tumor size was achieved in six patients (85.7%) during the mid-term follow-up. CONCLUSIONS: Embolization with a mixture of lipiodol and PVA particles is an effective and safe treatment for symptomatic renal angiomyolipoma. Based on the durable mid-term results of the present study, a mixture of lipiodol and PVA particles is recommended for embolization.

"Dynamic spot sign" on CT perfusion source images predicts haematoma expansion in acute intracerebral haemorrhage.

OBJECTIVES: To evaluate the association between dynamic progressive enhancing foci ("dynamic spot sign") in acute haematoma on CT perfusion source images (CTP-SI) and haematoma expansion. METHODS: One hundred twelve consecutive patients with spontaneous intracerebral haemorrhage according to unenhanced CT, CTP and CT angiography within 6 h of symptom onset were prospectively evaluated. Patients were dichotomised according to the presence/absence of the dynamic spot sign on CTP-SI in haematoma. The predictive value of haematoma expansion was analysed. RESULTS: Haematoma expansion was detected in 28 patients (25.0 %) on follow-up unenhanced CT images. Thirty patients (26.8 %) demonstrated the dynamic spot sign on CTP-SI, about 83.3 % of patients with haematoma expansion (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value and kappa value for expansion were 89.3 %, 94.0 %, 96.3 %, 83.3 % and 0.814, respectively. In multiple regression, the presence of the CTP dynamic spot sign within acute haematomas independently predicted haematoma expansion; the univariate analysis OR value was 131.667 (29.386-590.289), P < 0.0001. Moreover, the multivariate analysis CTP dynamic spot sign OR value was 203.996 (32.123-1295.488), P < 0.0001. CONCLUSIONS: The CTP-SI dynamic spot sign is associated with acute haematoma expansion, is more direct in showing active ongoing bleeding and has a higher predictive value than the CTA spot sign. KEY POINTS: • It is important to identify potential progression of spontaneous intracerebral haemorrhage. • Dynamic enhancement within CT perfusion source images is associated with haemorrhage expansion. • The CTP dynamic spot sign may be present throughout arterial to venous phase imaging. • The CTP dynamic spot sign carries a higher predive value for haematoma expansion than CTA.

[Magnetic resonance imaging evaluation of early rheumatoid arthritis of hand and wrist].

OBJECTIVE: To explore the value of Magnetic resonance imaging (MRI) in the early rheumatoid arthritis (RA). METHODS: 56 patients (24 men and 32 women) fulfilling the 2010 ACR/EULAR for RA, 34 with early RA, and 22 with established RA, (disease duration < 12 months, and >12 months, respectively) were enrolled in the study. MRI of the dominant hand and wrist was performed by using short time inversion recovery (STIR), plain and contrast-enhanced T1-weighted sequences. Evaluation of bone marrow edema, bone erosions and synovitis was performed with the OMERACT RA MRI scoring system. RESULTS: Edema, erosions, and synovitis were present in early RA and established RA, and the prevalence was 88.2% (30/34), 91.1% (31/34), 100% (34/34) and 90.9% (20/22) , 95.4% (21/22), 100% (22/22) , respectively. But no significant difference was found in two group (P > 0.05). Significant differences in edema and erosions were found between earlier RA and established RA (P < 0.05). No significant difference was found in synovitis (P > 0.05). CONCLUSIONS: Bone marrow edema, bone erosions and synovitis are important sign of early RA. But bone edema and erosions in MRI may play an important role in the diagnosis of early RA.

EBP50 inhibits EGF-induced breast cancer cell proliferation by blocking EGFR phosphorylation.

Ezrin-radixin-moesin-binding phosphoprotein-50 (EBP50) suppresses breast cancer cell proliferation, potentially through its regulatory effect on epidermal growth factor receptor (EGFR) signaling, although the mechanism by which this occurs remains unknown. Thus in our studies, we aimed to determine the effect of EBP50 expression on EGF-induced cell proliferation and activation of EGFR signaling in the breast cancer cell lines, MDA-MB-231 and MCF-7. In MDA-MB-231 cells, which express low levels of EBP50, EBP50 overexpression inhibited EGF-induced cell proliferation, ERK1/2 and AKT phosphorylation. In MCF-7 cells, which express high levels of EBP50, EBP50 knockdown promoted EGF-induced cell proliferation, ERK1/2 and AKT phosphorylation. Knockdown of EBP50 in EBP50-overexpressed MDA-MB-231 cells abrogated the inhibitory effect of EBP50 on EGF-stimulated ERK1/2 phosphorylation and restoration of EBP50 expression in EBP50-knockdown MCF-7 cells rescued the inhibition of EBP50 on EGF-stimulated ERK1/2 phosphorylation, further confirming that the activation of EGF-induced downstream molecules could be specifically inhibited by EBP50 expression. Since EGFR signaling was triggered by EGF ligands via EGFR phosphorylation, we further detected the phosphorylation status of EGFR in the presence or absence of EBP50 expression. Overexpression of EBP50 in MDA-MB-231 cells inhibited EGF-stimulated EGFR phosphorylation, whereas knockdown of EBP50 in MCF-7 cells enhanced EGF-stimulated EGFR phosphorylation. Meanwhile, total expression levels of EGFR were unaffected during EGF stimulation. Taken together, our data shows that EBP50 can suppress EGF-induced proliferation of breast cancer cells by inhibiting EGFR phosphorylation and blocking EGFR downstream signaling in breast cancer cells. These results provide further insight into the molecular mechanism by which EBP50 regulates the development and progression of breast cancer.

Association between cerebral microbleeds and the first onset of intracerebral hemorrhage - a 3.0 T MR study.

BACKGROUND: Cerebral microbleeds (CMBs) detected by gradient-echo MRI have been proven to be a potential risk factor for further bleeding, while the association between CMBs and the first onset of intracerebral hemorrhage has not been well investigated. PURPOSE: To analyze the association between CMBs and the first onset of primary intracerebral hemorrhage (pICH). MATERIAL AND METHODS: Two hundred and two consecutive inpatients with ICH and 234 consecutive outpatients without ICH as control group were enrolled in this study. MR imaging including T2*-GRE, T(1)W, T(2)W and fluid attenuated inversion recovery (FLAIR) sequences were performed to detect CMBs and other abnormalities. Prevalence, distribution, and grades of CMBs, as well as the location and size of the intracerebral hematoma were analyzed, respectively. Comparison was made between pICH and control group. Logistic analysis was performed to evaluate the association between CMBs and ICH. The correlation between hematoma size and CMBs grade/numbers was analyzed. RESULTS: CMBs were detected in 140 patients in pICH (69.3%) group and 62 patients in control group (26.5%). The incidence of CMBs in pICH group was significantly higher than that in control group (P < 0.0001). As the logistic regression analysis results, CMBs was the risk factor associated with ICH, with modulation OR value of 8.363 (95% CI 5.210-13.421). The volume of ICH with CMBs was 12.57 ± 17.23 mL, and the volume of ICH without CMBs was 17.77 ± 26.97 mL. Negative correlation was demonstrated between CMBs number and ICH volume (r(s) = -0.1769, P = 0.0118), as well as between CMBs grade and hematoma volume (r(s) = -0.1185, P = 0.1557). CONCLUSION: CMBs may be an independent risk factor for the first onset of intracerebral hemorrhage.

Non-anastomotic biliary strictures following orthotopic liver transplantation: treatment with percutaneous transhepatic biliary drainage.

BACKGROUND/AIMS: To report our experiences with percutaneous transhepatic biliary drainage to treat non-anastomotic biliary strictures following orthotopic liver transplantation in an effort to evaluate the efficacy and safety of this procedure. METHODOLOGY: From January 2002 to December 2011, forty-two consecutive patients (37 male and 5 female; aged 17-67 years, mean age 45.8 years) underwent percutaneous trans hepaticbiliary drainage for non-anastomotic biliary strictures.Twenty-six of them underwent percutaneous trans hepatic biliary drainage through right bile duct, 15 under-went bilateral (right bile duct and left bile duct) percutaneous transhepatic biliary drainage with 12 patients through left bile duct in the second procedure, the remaining one underwent percutaneous transhepatic biliary drainage through the left bile duct alone. RESULTS: Percutaneous transhepatic biliary drainage was successfully completed in all 42 patients, 23 of whom gained treatment success after first procedure. The other 19 patients underwent percutaneous transhepatic biliary drainage for the second time and 15 of them were successfully treated, the total success rate was 90.5% (38 in 42 cases). Procedure related complications were observed in 4 patients including cholangitis, sepsis, bleeding and acute pancreatitis. CONCLUSIONS: Percutaneous transhepatic biliary drainage ap-pears to be an effective and safe treatment with high technical success rate and few major complications for non-anastomotic biliary strictures following orthotopic liver transplantation.

[Impact of breast density on computer-aided detection (CAD) of breast cancer].

OBJECTIVE: To evaluate the impact of breast density on computer-aided detection (CAD) for breast cancer and the CAD false-positive rate of normal controls. METHODS: Two hundred and seventy-one histologically proven breast malignant lesions (from Feb. 2008 to Dec. 2009) and 238 randomly selected normal cases were classified by mammographic density according to the American College of Radiology breast imaging reporting and data system (BI-RADS). Mammograms of BI-RADS 1 or BI-RADS 2 density were categorized as non-dense breasts, and those of BI-RADS 3 or BI-RADS 4 density were categorized as dense breasts. Full-field digital mammography (GEMS Senographe) were performed in all patients and controls with craniocaudal (CC) and mediolateral oblique (MLO) views. Then the image data were transferred to review workstation (SenoAdvantage), and the lesions were marked by Second Look Digital CAD system (version 7.2, iCAD). The differences of sensitivity and false-positive rate between dense and non-dense breasts were compared. RESULTS: Overall, the sensitivity of CAD in detection of cancers was 84.1% (228/271), there was a statistically significant difference in CAD of cancers in dense versus non-dense breasts (P = 0.015). The sensitivity of CAD in detection of mass cancers was 76.5% (186/243), in detection of calcification cancers was 79.1% (125/158), there was no statistically significant difference in CAD performance for the detection of mass cancers versus calcification cancers (P = 0.547). There was a significant difference in the CAD performance for the detection of mass cancer cases in non-dense versus dense breasts (P = 0.001), but no significant difference in the CAD for the detection of calcification cancers in non-dense versus dense breasts (P = 0.216). In the controls, the distribution of mass false-positive marks did not differ significantly between non-dense and dense breast tissue cases (P = 0.207), but the distribution of calcification false-positive marks differed significantly between non-dense and dense breast tissue cases (P = 0.001). There was a statistically significant difference of false-positive marks in non-dense versus dense breasts (P = 0.043). CONCLUSIONS: The sensitivity of CAD in the detection of breast cancers is impacted by breast density. There is a statistically significant difference in the CAD performance for the detection of cancer cases in non-dense versus dense breasts. The false-positive rate of CAD is lower in dense versus non-dense breasts. It appears difficult for CAD in the early detection of breast cancer in the absence of microcalcifications, particularly in dense breasts.

Hepatic Artery Injection of 131I-Metuximab Combined with Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Prospective Nonrandomized, Multicenter Clinical Trial.

This prospective nonrandomized, multicenter clinical trial was performed to investigate the efficacy and safety of 131I-labeled metuximab in adjuvant treatment of unresectable hepatocellular carcinoma. Methods: Patients were assigned to treatment with transcatheter arterial chemoembolization (TACE) combined with 131I-metuximab or TACE alone. The primary outcome was overall tumor recurrence. The secondary outcomes were safety and overall survival. Results: The median time to tumor recurrence was 6 mo in the TACE + 131I-metuximab group (n = 160) and 3 mo in the TACE group (n = 160) (hazard ratio, 0.55; 95% CI, 0.43-0.70; P < 0.001). The median overall survival was 28 mo in the TACE + 131I-metuximab group and 19 mo in the TACE group (hazard ratio, 0.62; 95% CI, 0.47-0.82; P = 0.001). Conclusion: TACE + 131I-metuximab showed a greater antirecurrence benefit, significantly improved the 5-y survival of patients with advanced hepatocellular carcinoma, and was well tolerated by patients.

[Quantitative comparison of idiopathic interstitial pneumonias on high-resolution computed tomographic findings].

OBJECTIVE: To analyze the high-resolution computed tomographic (HRCT) findings of IPF (interstitial pulmonary fibrosis), NSIP (nonspecific interstitial pneumonia) and COP (cryptogenic organizing pneumonia) retrospectively through quantification methods and to explore their distinguishing features. METHODS: Observers with no prior knowledge of the diagnosis evaluated the frequency, extent and distribution of various thin-section CT findings in 29 males and 17 females. The mean age was 50 ± 10 years old (range: 25 - 76). They had a histological diagnosis of IPF (n = 19), nonspecific interstitial pneumonia (NSIP) (n = 14) and cryptogenic organizing pneumonia (COP) (n = 13). RESULTS: Ground-glass opacity, thickening of bronchovascular bundles and interlobular septal thickening were frequent features of IPF and NSIP. The frequency and extent of honeycombing and bronchiolectasis were more found in IPF than in NSIP and COP (P < 0.05). The frequency and extent of air space consolidation were more found in COP than IPF (P < 0.05). There were more number of segments with traction bronchiectasis and less extent of air space consolidation in IPF than NSIP and COP. The number of segments with traction bronchiectasis was less in NSIP than that of IPF and COP. CONCLUSION: The various subtypes of idiopathic interstitial pneumonias often have the distinguishing characteristics easily identified on HRCT. Bronchiolectasis and honeycombing are valuable features for IPF; air space consolidation is a valuable feature for COP. The features of NSIP are also found in both IPF and COP so that additional features are required for both.

[Quantitative study of therapeutic efficacy on early intervention of hyperbaric oxygen to model of steroid-induced avascular osteonecrosis of femoral head by multi-slice perfusion imaging].

OBJECTIVE: To quantitatively evaluate the hemodynamic status in animal models of steroid-induced avascular osteonecrosis of femoral head (SANFH) by multislice CT (MSCT) perfusion imaging, and estimate the therapeutic efficacy on early intervention of hyperbaric oxygen (HBO) to improve the region blood flow (rBF) of ischemic femoral head. METHODS: Forty-eight New Zealand male rabbits were injected with Escherichia coli endotoxin and methyl-prednisolone to establish SANFH models and then divided into 3 subgroups to undergo MSCT to measure the rBF, regional blood volume (rBV), and mean transit time (MTT) to obtain perfusion maps at the femoral head epiphysis, metaphysic, and neck of femur, and then were killed to undergo histological examination of the bilateral femoral heads 2, 4, and 6 weeks later respectively (Groups M(2), M(4), and M(6)). Twenty-four rabbits underwent HOB treatment after the second injection of E. c. endotoxin for 1-3 courses respectively (Groups H(1), H(2), and H(3)), and then underwent MSCT and pathological examination as described above. Eight rabbits were used as controls (Group N). RESULTS: (1) The rBF values of Groups M(2), M(4), and M(6) were all significantly lower than that of Group N (P < 0.001, < 0.001, and < 0.002). The rBF value of femoral head epiphysis of Group M(2) was remarkably lower than that of Group N, decreased to the lowest in Group M(4), and re-increased in Group M(6). The rBV value demonstrated similar change pattern in femoral head epiphysis. The MTT values of Groups M(2) and M(4) were longer than that of Group N, and then re-decreased in Group M(6). (2) It did differ significantly between the perfusion data of different femoral head anatomic regions in Groups M(2), M(4), M(6) and N (rBF: F = 52.190, P < 0.001; rBV: F = 42.677, P < 0.001; MTT: F = 3.09, P = 0.048). The changes of the perfusion data in femoral head epiphysis were more significant than those in other anatomic regions. (3) There were no statistically significant differences in the rBF value of the femoral head epiphysis and metaphysis (F = 2.081, P = 0.115; F = 1.142, P = 0.341), in the rBV value of the femoral metaphysis and neck of femur (F = 2.642, P = 0.059; F = 1.568, P = 0.209), and the MTT value of all the anatomic regions (F = 1.111, P = 0.347) among Groups H(1), H(2), H(3), and N. The rBF values of Groups H(1), H(2), and H(3) were statistically higher than those of the corresponding phase model groups (all P < 0.05). CONCLUSIONS: Able to detect hemodynamic status of femoral head, MSCT perfusion imaging technique may be used in the early detection of SANFH. Early intervention of HBO therapy can improve the blood perfusion of femoral head.

Treatment of gastric outlet and duodenal obstructions with uncovered expandable metal stents.

AIM: To investigate and evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided peroral uncovered expandable metal stent placement to treat gastric outlet and duodenal obstructions. METHODS: Fifteen consecutive patients underwent peroral placement of Wallstent(TM) Enteral Endoprosthesis to treat gastric outlet and duodenal obstructions (14 malignant, 1 benign). All procedures were completed under fluoroscopic guidance without endoscopic assistance. Follow-up was completed until the patients died or were lost, and the clinical outcomes were analyzed. RESULTS: The technique success rate was 100%, and the oral intake was maintained in 12 of 14 patients varying from 7 d to 270 d. Two patients remained unable to resume oral intake, although their stents were proven to be patent with the barium study. One patient with acute necrotizing pancreatitis underwent enteral stenting to treat intestinal obstruction, and nausea and vomiting disappeared. Ten patients died during the follow-up period, and their mean oral intake time was 50 d. No procedure-related complications occurred. Stent migration to the gastric antrum occurred in one patient 1 year after the procedure, a tumor grew at the proximal end of the stent in another patient 38 d post-stent insertion. CONCLUSION: Fluoroscopically guided peroral metal stent implantation is a safe and effective method to treat malignant gastrointestinal obstructions, and complications can be ignored based on our short-term study. Indications for this procedure should be discreetly considered because a few patients may not benefit from gastrointestinal insertion, but some benign gastrointestinal obstructions can be treated using this procedure.

Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment.

AIM: To evaluate the utility of local tumor therapy combined with percutaneous transhepatic biliary drainage (PTBD) for malignant obstructive biliary disease. METHODS: A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stents and/or plastic tubes. After PTBD, 49 patients accepted brachytherapy or extra-radiation therapy or arterial infusion chemotherapy. The patients were followed up with clinical and radiographic evaluation. The survival and stent patency rate were calculated by Kaplan-Meier survival analysis. RESULTS: Twenty-two patients underwent chemotherapy (11 cases of hepatic carcinoma, 7 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy), and 14 patients received radiotherapy (10 cases of cholangiocarcinoma, 4 cases of pancreatic carcinoma), and 13 patients accepted brachytherapy (7 cases of cholangiocarcinoma, 3 cases of pancreatic carcinoma, 4 cases of metastatic lymphadenopathy). The survival rate of the local tumor treatment group at 1, 3, 6, and 12 months was 97.96%, 95.92%, 89.80%, and 32.59% respectively, longer than that of the non treatment group. The patency rate at 1, 3, 6, and 12 months was 97.96%, 93.86%, 80.93%, and 56.52% respectively. The difference of patency rate was not significant between treatment group and non treatment group. CONCLUSION: Our results suggest that local tumor therapy could prolong the survival time of patients with malignant biliary obstruction, and may improve stent patency.

[Effects of different durations of thromboembolism on blood gases, hemodynamics, pulmonary arteriography and thrombo-pathology in a canine model with selective embolization of pulmonary lobar arteries].

OBJECTIVE: To investigate the effects of different durations of thromboembolism on blood gases, hemodynamic parameters, pulmonary arteriography and thrombo-pathology in an animal model mimicking chronic pulmonary thromboembolism (PTE). METHODS: Sixteen dogs were embolized with five thrombi developed by autologous blood into the left lower pulmonary artery (n = 15) and the right lower pulmonary artery (n = 1, used to confirm the available method of selective embolization). The 15 dogs were divided into three groups: sham group (n = 5), one-week group (n = 5) and two-week group (n = 5) according to the different durations of embolization. Swan-Ganz catheter was used to guide a plastic duct, through which the thrombi were injected selectively into the left or right lower pulmonary artery by X-ray fluoroscopy. Local pulmonary arteriography of lower pulmonary arteries was taken. Blood pressure (BP), and blood gases were measured. Central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arteriole wedge pressure (PAWP), and cardiac output (CO) were recorded, and pulmonary vascular resistance (PVR) was calculated. Each dog underwent muscular injection with tranexamic acid for one or two weeks to prevent thrombolysis. The lower lung lobe was dissected to confirm the thromboembolism after one or two weeks. The lung sections were stained with phosphotungstic acid hematoxylin (PTAH) to observe thromboemboli with optical microscopy. RESULTS: In the PTE group, PaO(2)/FiO(2), MPAP and PVR changed significantly as compared to baseline values (P < 0.05) after one hour of embolization, with MPAP increasing from (15 +/- 3) mm Hg to (21 +/- 4) mm Hg, PVR increasing from (178 +/- 114) mm Hg.s/L to (404 +/- 260) mm Hg.s/L, and PaO(2)/FiO(2) decreasing from (508 +/- 58) mm Hg to (395 +/- 100) mm Hg; these parameters returned to the baseline values one or two weeks later. After embolization, pulmonary arteriography demonstrated lower lobar artery cut-off perfusion defects. One week later, pulmonary arteriography demonstrated irregularities and stiffness of the arterial wall, enlarged proximal part of lower pulmonary artery and cut-off perfusion defects. Poor filling at embolus site was evident after embolization for two weeks. In the 1-week PTE group, organized tissue covered with the blue-purple fibrin nest was observed in the thrombus with PTAH stain. In the two-week group, the well organized thrombi were partially recanalized and surrounded and invaded by hyperplastic tissues from pulmonary artery wall. CONCLUSIONS: A canine model mimicking chronic PTE can be established by the use of fibrinolytic inhibitor tranexamic acid. Different manifestations on pulmonary arteriography and varied degree of organization of thrombi are evident at different times after embolization.

Biliary tract perforation following percutaneous endobiliary radiofrequency ablation: A report of two cases.

Endobiliary radiofrequency ablation (RFA) has recently been recognized as a beneficial treatment option for malignant biliary obstruction using percutaneous or endoscopic approaches. The feasibility and safety of this method has been demonstrated in clinical studies, with pain, cholangitis and asymptomatic biochemical pancreatitis reported as relatively common complications. By contrast, hepatic coma, newly diagnosed left bundle branch block and partial liver infarction have been reported as uncommon complications. Biliary tract perforation is a serious potential complication of percutaneous intraductal RFA, which may result in severe infection, peritonitis or even mortality, and which has not been previously reported in clinical research. The current study presents the first reports of biliary tract perforation in two patients with unresectable malignant biliary obstruction following percutaneous intraductal RFA. Although the patient in case 1 succumbed 12 days after RFA, the minor biliary tract perforation in case 2 was successfully treated by the deployment of a self-expanding metal stent. This study demonstrates that biliary tract perforation should be recognized as a serious potential complication of endobiliary RFA, and that metal stent deployment should be considered as a treatment option for minor biliary tract perforation.