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Objective To compare the safety and efficacy of direct thrombectomy versus bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke under different collateral circulation statuses.Methods Totally 93 patients with acute anterior circulation ischemic stroke admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2020 to March 2023 were selected as the research subjects.Patients were divided into direct throm-bectomy group(n=47)and bridging thrombectomy group(n=46)based on the type of thrombectomy.Patients in the direct thrombectomy group received direct intravascular thrombectomy,while patients in the bridging thrombectomy group received intravenous thrombolysis with alteplase combined with mechanical thrombectomy.According computed tomography angiography,the collateral circulation Tan classification was applied to divide the patients into good collateral circulation sub-group and poor collateral circulation sub-group.The modified thrombolysis in cerebral infarction grading(mTICI)was used to evaluate vessel recanalization.Head computed tomography plain scan was performed at 24-48 hours postoperatively to assess if there was hemorrhagic transformation,and modified Rankin Scale score was performed at 90 days postoperatively.Information such as imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,prognosis and spontaneous non-traumatic symptomatic intracerebral hemorrhage(SICH)were collected.Results The age,gender,baseline Alberta stroke program early computed tomography score,baseline national institutes of health stroke scale score,proportions of hypertension,diabetes and atrial fibrillation,baseline systolic pressure,creatinine,baseline blood glucose,platelet count,occlusion site,stroke etiologies and collateral circulation status of patients in the two groups were not statistically significantly different(P>0.05).There were no significant differences in the post-admission imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,successful vascular reperfusion rate,good prognosis rate,mortality rate,and SICH incidence between the two groups(P>0.05).The hemorrhagic transformation rate of patients in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group(P<0.05).There were no significant differences in the post-admission imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,successful vascular reperfusion rate,good prognosis rate,mortality rate,and SICH incidence between patients with good collateral circulation and patients with poor collateral circulation in the two groups(P>0.05).The hemorrhagic transformation rate of patients with good and poor collateral circulation in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group(P<0.05).Conclusion Under different collateral circulation conditions,the safety and efficacy of direct thrombectomy and bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke are similar,but bridging thrombectomy is more likely to result in cerebral hemorrhage transformation compared with direct thrombectomy.
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Objective:To investigate the relationship between serum vascular endothelial growth factor (VEGF) levels and white matter high signal and non-dementia vascular cognitive dysfunction in patients with cerebral small vascular disease (CSVD).Methods:Total 106 patients with CSVD who were admitted to the Department of Neurology of the First Affiliated Hospital of Xinxiang Medical College from April 2019 to December 2020 were enrolled.They were divided into vascular cognitive impairment no dementia group (VCIND group, n=47) and no vascular cognitive impairment group (N-VCI group, n=59)according to mini-mental assessment scale (MMSE), Montreal cognitive assessment (MoCA) scale and activity of daily living scale (ADL). Serum VEGF levels were detected by enzyme-linked immunosorbent assay (ELISA). The baseline data, serum VEGF levels, MoCA score and Fazekas score were compared between the two groups.The correlation between serum VEGF level and white matter high signal and cognitive function was analyzed.SPSS 19.0 software was used for data processing.The statistical methods were t-test, Chi square test, nonparametric test, Logistic regression analysis, Pearson correlation analysis and Spearman correlation analysis. Results:There were significant differences in serum VEGF level((464.18±114.58)pg/mL, (414.17±45.80)pg/mL, F=22.880), MoCA score((13.07±6.48), (20.17±4.06), F=17.920) and Fazekas score (4(3, 5), 3(1, 3), Z=-4.189)between the two groups (all P<0.05). The level of VEGF( β=0.008, OR=1.008, 95% CI=1.001-1.015, P<0.05) was the influencing factor of cognitive function in patients with CSVD .The level of VEGF was negatively correlated with the total score of MoCA, attention and calculation power, and orientation ability ( r=-0.345, -0.373, -0.445, all P<0.05) and it was positively correlated with the total Fazekas score and the Fazekas score of paraventricular and deep white matter ( r=0.392, 0.495, 0.302, all P<0.05). There was a linear trend between the high signal grade of paraventricular and deep white matter and VCIND (both P<0.05). Conclusion:Serum VEGF level is correlated with cognitive function and white matter hyperintensity in patients with CSVD.The increase of VEGF level may be a factor reflecting cognitive dysfunction.In addition, with the increase of white matter hyperintensity level, the risk of VCIND in CSVD is increased.
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Objective:To investigate the relationship between serum matrix metalloproteinase-9 (MMP-9) level and the location and severity of bleeding in patients with cerebral microbleeds(CMBs).Methods:A total of 60 CMBs patients admitted to the Department of Neurology of the First Affiliated Hospital of the Xinxiang Medical University from January 2019 to August 2020 were selected as subjects as the CMBs group, and 60 healthy controls without nervous system diseases in outpatient physical examination during the same period were selected as the control group. The clinical data and biochemical indicators of the two groups were collected. Serum MMP-9 levels were measured by enzyme linked immunosorbent assay (ELISA). According to susceptibility weighted imaging (SWI), CMBs patients were divided into grade 1 group ( n=24), grade 2 group ( n=19) and grade 3 group ( n=17), and according to the micro analytical rating scale (MARS), the CMBs patients were divided into the lobar group ( n=19), the deep or infratentorial group ( n=17) and the mixed group ( n=24).The relationship between serum MMP-9 level and the location and severity of CMBs was analyzed. SPSS 19.0 software was used for data statistical analysis.One-way ANOVA, t-test and rank sum test were used for comparison. Logistic regression analysis was used to analyze the influencing factors. Pearson correlation analysis and Spearman correlation analysis were used for correlation analysis. Results:The level of MMP-9 in CMBs group was significantly higher than that in control group (208.13(142.25, 285.88) μg/L, 149.50(93.40, 186.51)μg/L), and the difference was statistically significant ( P<0.05). Serum MMP-9 level was a risk factor of CMBs ( β=1.322, OR=3.750, 95% CI=2.038-7.997, P=0.002). The difference of level of MMP-9 in different severity of CMBs was statistically significant (147.55(109.25, 266.47)μg/L, 242.12(147.55, 288.80)μg/L, 270.42(203.43, 364.27)μg/L, P=0.017). Serum MMP-9 level was positively correlated with the number of CMBs ( r=0.371, P=0.003). The difference of MMP-9 level of CMBs in different locations were statistically significant (249.77(158.43, 338.46)μg/L, 188.83(138.52, 243.15)μg/L, 210.65(144.25, 255.78)μg/L, P=0.013). The increased serum MMP-9 level was a risk factor for CMBs( β=0.401, OR=1.122, 95% CI=1.004-1.204, P=0.036). Conclusion:The increased level of serum MMP-9 may be a risk factor of CMBs, especially for CMBs in cerebral lobesand, and the level of MMP-9 is positively correlated with the severity of CMBs.
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Objective To investigate the correlation between tumor perfusion parameters and tumor volume and Child-Pugh classification in CT of hepatocellular carcinoma (HCC).Methods Fifty-six patients with hepatocellular carcinoma were selected to perform CT perfusion imaging.The parameters of the total tumor perfusion such as hepatic artery perfusion (HAP),portal vein perfusion (PVP)and hepatic perfusion index (HAPI)were calculated according to the degree of hepatic encephalopathy,albumin,bilirubin, clotting time,ascites for liver Child-Pugh classification.The relationship between the tumor or peritumoral perfusion parameters with tumor volume and Child-Pugh classification were analyzed.Results (1)There was no correlation between tumor or peritumoral perfusion with the tumor volume.(2)The difference of HAP,PVP and HAPI between the different Child-Pugh classification groups was statistically significant (P<0.000 1).(3)With the reduction of Child-Pugh classification,the tumor body HAP and HAPI values gradually decreased, while the PVP value increased gradually.Conclusion There is no correlation between the tumor volume of hepatocellular carcinoma with total tumor perfusion parameters.The differences in perfusion measurements between different Child-Pugh classification can intuitively and quantitatively reflect the reserve function of the liver.
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Objective To explore the features of multi-slice spiral computed tomography (MSCT) examination of indirect,direct and femoral inguinal hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 106 patients with indirect,direct and femoral inguinal hernia who were admitted to the First Affiliated Hospital of Xinxiang Medical University between December 2014 and August 2017 were collected.All the patients were diagnosed as inguinal hernia by MSCT examination and multi-planar reconstruction.Observation indicators:(1) sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT;(2) inguinal anatomic presentation in MSCT examination;(3) relationship between hernial sac and surrounding structures in MSCT examination;(4) hernia contents and quadrants of hernial sac in the quadrant partition with " cross intersect" method and complications.Count data were described as absolute number or percentage.Comparison of count data was done using the chi-square test with row multiplied by column.Results (1) Sensitivity,specificity,positive and negative predictive values and diagnostic accordance rate of indirect,direct and femoral inguinal hernia by MSCT:of 106 patients,66,22 and 18 were diagnosed as indirect hernia,direct hernia and femoral hernia with 70,27 and 20 hernial sacs respectively.Sensitivity,specificity,positive and negative predictive values of inguinal hernia by MSCT were respectively 95.7%,96.3%,98.5%,89.7% in indirect hernia patients and 96.3%,95.7%,89.7%,98.5% in direct hernia patients and 100.0%,100.0%,100.0%,100.0% in femoral hernia patients,and diagnostic accordance rate of femoral hernia was also 100.0%.Diagnostic accordance rate of inguinal hernia was 95.9%,and correct index was 0.920.(2) Inguinal anatomic presentation in MSCT examination:transverse,coronal and sagittal imagings of inferior epigastric artery,inguinal ligament,musculus rectus abdominis,femoral vein and other anatomic structures can be identified,and internal ring of inguinal canal of 6 patients cannot be observed clearly.For relationship between internal ring of inguinal canal and inferior epigastric artery,coronal view was the best,transverse view was the next,and sagittal view was rarely observed.For relationship between inguinal ligament and hernial sac,sagittal view was the best,coronal view was also observed clearly by continuous planes,and transverse view was poor.The oblique coronal view was the best for the direct hernial triangle and internal ring of inguinal canal,and coronal view of femoral triangle was the best.The lateral crescent sign and quadrant partition of "ross intersect" method needed to be observed in transverse plane.(3) Relationship between hernial sac and surrounding structures in MSCT examination:indirect hernia entered into the inguinal canal through internal ring of inguinal canal,and hernial sac was located at the outside of inferior epigastric artery;direct hernia was out through triangle hernia,and hernial sac was located at the inside of inferior epigastric artery,92.6% (25/27) patients were accompanied by lateral crescent sign.The indirect hernia and direct hernia went along the upper front of inguinal ligament;femoral hernia was out through femoral triangle hernia,and hernial sac was located at the lower back of inguinal ligament and the outside of the pubic tubercle.(4) The hernia contents and quadrants of hernial sac in the quadrant partition with "cross intersect" method and complications:the most common hernia content was small intestine,including partial patients with hernia content composed of various substances;indirect hernia contents included small intestine (35),mesentery (29),effusion (25),intraabdominal fat (9),colon (8) and ovary (1) in turn;direct hernia contents included small intestine (14),intraabdominal fat (11),effusion (6),mesentery (6),colon (3) and bladder (2) in turn;femoral hernia contents included small intestine (12),intraabdominal fat (8),effusion (3) and mesentery (2) in turn.There was a statistically significant difference in the hernia contents among indirect hernia,direct hernia and femoral hernia (x2=28.389,P<0.05).The main hernial sac located at antero-external quadrant was respectively occurred in 70 hernial sacs of indirect hernia and 27 hernial sacs of direct hernia and 15 hernial sacs of femoral hernia,and 5 hernial sacs of femoral hernia were located at postero-external quadrant.There was a statistically significant difference in comparison of the quadrant partition with "cross intersect" method (x2 =78.904,P < 0.05).The intestinal obstruction was respectively occurred in 8 patients with indirect hernia and 14 patients with direct hernia and 12 patients with femoral hernia,with a statistically significant difference (x2=26.674,P<0.05).Conclusions Indirect hernia,direct hernia and femoral hernia have characteristic signs of imaging.MSCT can display precisely the anatomical details of inguinal region,which plays an important role in diagnosis and differential diagnosis of indirect hernia,direct hernia and femoral hernia,especially in display of hernia contents and diagnosis of complications,thus it can provide important information for evaluating risk and making operation plan.
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Objective To explore the CT and MRI manifestations and diagnosis of elastofibroma dorsi(EFD).Methods CT or MRI findings of 20 cases (36 lesions)of EFD confirmed by surgical pathology were analyzed retrospectively.12 patients underwent plain chest CT,4 patients plain chest MRI,4 patients plain unilateral shoulder MRI.Results ① All of cases were located in the infrascapular region,between the thorax wall and serratus anterior,mainly shaped flat mound-like or semi-circular.CT densities and MRI signal intensities of the masses were similar to those of muscle with some interlaced fat-like areas within the lesions.The masses had irregular edges, with no clear boundary between the thorax wall and serratus anterior,with disappeared fat gaps.② Statistical difference were found in patients’incidence between men and women,incidence between unilateral and bilateral and lesion volume between the left and right (P <0.05),and the incidence in female was significantly higher than that in male,the incidence in bilateral was significantly higher than that in unilateral,the lesion volume in the right was bigger than that in the left.Conclusion ① EFD has its characteristic location and imaging findings,so a definite diagnosis can be made with CT and MRI.② The mechanical friction between the scapula and chest wall may be related to tumor growth.
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Objective To evaluate the outcomes of small (5 ~ 10mm),arterially enhancing nodules (SAENs)shown exclusively at the hepatic arterial phase of CT in a hepatocellular carcinoma(HCC) surveillance population and to determine risk factors for developing HCC.Methods The study population included 112 patients (maleifemale =100 ∶ 12 ; aged 36 ~ 92 years) with 1 7 5 SAENs who were at risk of HCC.We evaluated serial changes during follow-up(1.4 ~41.8 months,mean 35.7 months) and analysed the initial CT findings of SAENs and the accompanying lesions to elucidate the risk factors for HCC development.Results Of 175 SAENs,101 (57.7%) disappeared and 34(19.4%) persisted.Forty SAENs(22.9%) became HCC in 33 patients(29.5%).Presence of HCC treatment history(P =0.005,risk ratio =7.429),a larger size of SAEN(P =0.003,risk ratio =1.630),presence of coexistent HCC(P =0.021,risk ratio =3.777) and absence of coexistent typical arterioportal shunts (P =0.003,risk ratio =4.459) turned out to be independently significant risk factors for future development of HCC.Conclusion SAENs are frequently seen in an HCC surveillance population and have a 22.9% probability of becoming HCC on a per-lesion basis.Risk increased particularly when the lesion is associated with a previous or concurrent HCC,a large size or found without a coexistent typical arterioportal shunt.
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Objective To describe the interpositional omentum and demonstrate its clinical significance.MethodsCT and clinical data of the cases whose suprahepatic gaps widen were reviewed and the contrast of CT was adjusted to observe further.ResultsIn 1 916 cases with upper abdominal CT data,suprahepatic gap was widen in all 152 cases,and 119 cases showed fat density(6.21% ).There were 3 cases of trauma and 3 cases of acute abdomen in the 119 cases CT in the 119 cases displayed free gas under diaphragma,but displayed fat density after contrast adjusted.There were 11 cases undergoing operations,1 for sigmoid rupture 4 liver cirrhosis and portal hypertension,3 gastric cancer,and 1 acute cholecystitis,1 bile duct carcinoma and Ⅰ case congenital cystic dilatation of common bile duct.The other 108 cases did not undergo surgical operation.ConclusionsInterpositional omentum is a clinical phenomenon that the omentum was shift in suprahepatic gap covering the liver surface.It is not rarely,the incidence rate being 6.21% ( 119/1 916) in our study.The occurrence mechanism may be similar to that of Chilaiditi syndrome.It is difficult to differentiate interpositional omentum from free gas under diaphragms on CT plain scan picture,but it is easy after contrast adjusted of CT.Free gas under diaphragma should not be identify incorrecdied and patients should not undergo unnecessary surgical procedure.
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Objective To improve the cognition of abnormal changes of the medial soft tissue of styloid process (MSTSP) in nasopharyngeal carcinoma after radiotherapy. Methods CT scans of nasopharynx in 39 cases with NPC that had change at the MSTSP in NPC after radiotherapy were performed.CT findings of recurrence and non-recurrence at MSTSP were studied and compared carefully.Results In the recurrence cases, the MSTSP was thickening and compactness in all cases, in the non-recurrence cases ,only 37.04% (10/27) were thickening and compactness at MSTSP. In all the cases which had thickening and compactness of the MSTSP, the borders were slightly protruding in 9 cases and the borders were straight in 3 cases in the recurrence cases, while the borders were straight in 7 cases and the borders were slightly hollow in 3 cases,and there wasn't any case appeared as protruding of borders in the non-recurrence cases. All the cases were dealt with statistic methods and had remarkable difference between them(P