Comparison of lower extremity atherosclerosis in diabetic and non-diabetic patients using multidetector computed tomography.

BACKGROUND: Lower extremity atherosclerosis (LEA) is among the most serious diabetic complications and leads to non-traumatic amputations. The recently developed dual-source CT (DSCT) and 320- multidetector computed tomography (MDCT) may help to detect plaques more precisely. The aim of our study was to evaluate the differences in LEA between diabetic and non-diabetic patients using MDCT angiography. METHODS: DSCT and 320-MDCT angiographies of the lower extremities were performed in 161 patients (60 diabetic and 101 non-diabetic). The plaque type, distribution, shape and obstructive natures were compared. RESULTS: Compared with non-diabetic patients, diabetic patients had higher peripheral neuropathy, history of cerebrovascular infarction and hypertension rates. A total of 2898 vascular segments were included in the analysis. Plaque and stenosis were detected in 681 segments in 60 diabetic patients (63.1%) and 854 segments in 101 non-diabetic patients (46.9%; p <0.05). Regarding these plaques, diabetic patients had a higher incidence of mixed plaques (34.2% vs. 27.1% for non-diabetic patients). An increased moderate stenosis rate and decreased occlusion rate were observed in diabetic patients relative to non-diabetic patients (35.8% vs. 28.3%; and 6.6% vs. 11.4%; respectively). In diabetic patients, 362 (53.2%) plaques were detected in the distal lower leg segments, whereas in non-diabetic patients, 551 (64.5%) plaques were found in the proximal upper leg segments. The type IV plaque shape, in which the full lumen was involved, was detected more frequently in diabetic patients than in non-diabetic patients (13.1% vs. 8.2%). CONCLUSION: Diabetes is associated with a higher incidence of plaque, increased incidence of mixed plaques, moderate stenosis and localisation primarily in the distal lower leg segments. The advanced and non-invasive MDCT could be used for routine preoperative evaluations of LEA.

High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report.

BACKGROUND: High flow priapism (HFP) is a rare type of priapism. Perineal trauma is the most common cause of HFP. Trauma-induced penile artery injury may lead to an arterial-cavernosal fistula, whereas persistent irregular arterial blood flow entering the corpora cavernosum can cause a persistent penile erection. The routine treatment of HFP focuses on addressing the abnormal penile erectile status and avoiding post-treatment erectile dysfunction. Interventional embolization is an important therapeutic modality for HFP, and bilateral embolization therapy is currently the most commonly used technique for patients with bilateral cavernous artery fistulas; however, unilateral embolization therapy has yet to be reported. CASE SUMMARY: Herein, we report of the case of a 26-year-old Chinese male who presented with a persistent abnormal erection for 12 h after perineal impact injury. Medical history, cavernous arterial blood gas analysis and radiological examinations led to a diagnosis of HFP caused by bilateral cavernous artery fistulas. We performed routine conservative treatment (compression therapy and ice application) for the patient after admission; however, 10 d later, his symptoms had not been relieved. After completion of the preoperative workup, right (severe side) selective perineal artery embolization was performed; the left cavernous artery fistula was left untreated. After postoperative continuation of conservative treatment for 72 h, the patient experienced complete penile thinning. The patient had no symptoms of erectile dysfunction over a follow-up period of 12 mo. CONCLUSION: Compared with bilateral cavernous artery fistula embolization, we believe that unilateral cavernous artery fistula embolization can achieve positive clinical efficacy and reduce the risk of postoperative erectile dysfunction secondary to penile ischemia.

Computed tomography-guided interstitial implantation of I (125) radioactive seeds in the treatment of hilar airway stenosis caused by non-small cell lung cancer.

BACKGROUND: Airway stenosis secondary to non-small cell lung cancer (NSCLC) is one of the severe complications that can lead to life-threatening outcomes. OBJECTIVE: To investigate the clinical utility of computed tomography (CT)-guided interstitial implantation of radioactive I-125 seeds in the treatment of hilar airway stenosis caused by NSCLC. METHODS: The cases of hilar airway stenosis caused by NSCLC in our hospital from 2017 to 2022 were collected and divided into observation and control groups. Both groups underwent conventional lung cancer treatment, and the observation group was treated with CT-guided interstitial implantation of radioactive I-125 seeds. The mean tumor diameter, hilar airway stenosis, and obstructive pneumonia scores at 3 months after treatment were compared between the two groups. RESULTS: After 3 months of treatment, the mean tumor diameter (28.8 ±â€…9.3 mm vs 49.33 ±â€…16.75 mm, P  < 0.001), hilar airway stenosis (20.55 ±â€…30.36% vs 84.85 ±â€…26.19%, P  < 0.001), and obstructive pneumonia score (2.19 ±â€…1.41 vs 3.48 ±â€…1.12, P  < 0.001) of the observation group were significantly lower than those of the control group. CONCLUSION: CT-guided interstitial implantation of I (125) radioactive seeds in the treatment of hilar airway stenosis caused by NSCLC can effectively reduce the tumor volume, relieve airway stenosis, and alleviate the associated obstructive pneumonia and has a certain value of application in the clinic.

Chemotherapy, transarterial chemoembolization, and nephrectomy combined treated one giant renal cell carcinoma (T3aN1M1) associated with Xp11.2/TFE3: A case report.

BACKGROUND: Renal cell carcinoma (RCC) with Xp11.2 translocation/TFE3 gene fusion is a rare and distinct subtype of RCC that is classified under tumors with translocation of the microphthalmia-associated transcriptional factor. CASE SUMMARY: We report an adult case of Xp11.2 translocation advanced RCC with metastasis (T3aN1M1), after targeted treatment, alcohol ablation, and transarterial chemoembolization, who eventually underwent successful surgical excision. No recurrence or transfer was seen within one year, and the survival period was more than 3 years. A review of the relevant literature was conducted to improve our understanding of the pathogenesis, epidemiology, clinical manifestations, diagnosis, differential diagnosis, treatment, and other aspects of the disease. CONCLUSION: Transarterial chemoembolization and ablation did not achieve the desired tumor reduction in this patient, but had a significant effect on reducing intraoperative bleeding and inhibiting tumor activity.

320-slice CT angiography of an interrupted aortic arch patient relying on collaterals: An addition to classification criteria.

A 13-year-old female patient presented with chest pain had no history of heart disease or trauma. She was finally diagnosed with the interrupted aortic arch by 320-slice CT angiography, without intracardial malformations or patent ductus arteriosus. Her descending aortic blood was supplied by plentiful collateral circulation on the chest. According to literature reports, patients with complete interruption of the aortic arch rarely live 10 years without surgical intervention. More particularly, this case does not fit the current classification systems.

Application of Dual-Source CT Coronary Angiography in Type 2 Diabetic Patients with Symptomatic Coronary Heart Disease.

OBJECTIVE: To evaluate the epidemiological and morphological characteristics of coronary plaque in diabetic patients with symptomatic coronary heart disease (CHD) by dual-source computed tomography (DSCT). MATERIALS AND METHODS: From June 2013 to December 2014, 267 consecutive patients with type 2 diabetes mellitus were examined by DSCT. Plaque type, distribution, as well as extent and obstructive characteristics were determined for each segment. RESULTS: A total of 225 patients were included in the final study. Among the 225 cases, patients with calcium score >10 accounted for 76.9%. With the increase in calcium score, the number of obstructive stenoses increased from 17 (22.7%) to 150 (66.4%) segments, and non-obstructive stenosis decreased from 58 (77.3%) to 76 (33.6%) segments. A total of 862 (3.8±3.0 per patient) plaques were detected, of which 448 (52%) were calcified plaque, 272 (32%) mixed plaques and 142 (16%) soft plaques. Regarding the stenosis type, there were significantly more mild (54%), followed by moderate (26%) and severe stenosis (20%); 152 (67.6%) patients had .2 vascular lesions, while 73 (32.4%) patients with single diseased vessel. 190 (84.40%) patients with atherosclerotic plaque were located in left anterior descending (LAD) coronary artery, 146 (64.9%) patients in right coronary artery (RCA), 114 (50.7%) patients in left circumflex (LCX) coronary artery. The most common site of all detected plaques was the proximal segment of the LAD (18.7%). CONCLUSION: DSCT showed that coronary arteries of diabetic patients with symptomatic CHD were more prone to calcification. There was more non-obstructive than obstructive lumen narrowing; obstructive stenosis and calcification score was positively correlated; coronary plaques were widely distributed, and mainly located in multiple diseased vessels.

The accuracy of spot sign in predicting hematoma expansion after intracerebral hemorrhage: a systematic review and meta-analysis.

PURPOSE: The role of spot sign on computed tomography angiography (CTA) for predicting hematoma expansion (HE) after primary intracerebral hemorrhage (ICH) has been the focus of many studies. Our study sought to evaluate the predictive accuracy of spot signs for HE in a meta-analytic approach. MATERIALS AND METHODS: The database of Pubmed, Embase, and the Cochrane Library were searched for eligible studies. Researches were included if they reported data on HE in primary ICH patients, assessed by spot sign on first-pass CTA. Studies with additional data of second-pass CTA, post-contrast CT (PCCT) and CT perfusion (CTP) were also included. RESULTS: 18 studies were pooled into the meta-analysis, including 14 studies of first-pass CTA, and 7 studies of combined CT modalities. In evaluating the accuracy of spot sign for predicting HE, studies of first-pass CTA showed that the sensitivity was 53% (95% CI, 49%-57%) with a specificity of 88% (95% CI, 86%-89%). The pooled positive likelihood ratio (PLR) was 4.70 (95% CI, 3.28-6.74) and the negative likelihood ratio (NLR) was 0.44 (95% CI, 0.34-0.58). For studies of combined CT modalities, the sensitivity was 73% (95% CI, 67%-79%) with a specificity of 88% (95% CI, 86%-90%). The aggregated PLR was 6.76 (95% CI, 3.70-12.34) and the overall NLR was 0.17 (95% CI 0.06-0.48). CONCLUSIONS: Spot signs appeared to be a reliable imaging biomarker for HE. The additional detection of delayed spot sign was helpful in improving the predictive accuracy of early spot signs. Awareness of our results may impact the primary ICH care by providing supportive evidence for the use of combined CT modalities in detecting spot signs.

The value of diffusion tensor imaging in differentiating high-grade gliomas from brain metastases: a systematic review and meta-analysis.

PURPOSE: Differentiation of high-grade gliomas and solitary brain metastases is an important clinical issue because the treatment strategies differ greatly. Our study aimed to investigate the potential value of diffusion tensor imaging (DTI) in differentiating high-grade gliomas from brain metastases using a meta-analytic approach. MATERIALS AND METHODS: We searched Pubmed, Embase and the Cochrane Library for relevant articles published in English. Studies that both investigated high-grade gliomas and brain metastases using DTI were included. Random effect model was used to compare fractional anisotropy (FA) and mean diffusivity (MD) values in the two tumor entities. RESULTS: Nine studies were included into the meta-analysis. In the peritumoral region, compared with brain metastases, high-grade gliomas had a significant increase of FA (SMD  = 0.47; 95% CI, 0.22-0.71; P<0.01) and a significant decrease of MD (SMD  = -1.49; 95% CI, -1.91 to -1.06; P<0.01). However, in the intratumoral area, no significant change in FA (SMD  = 0.16; 95% CI, -0.49 to 0.82; P = 0.73) or MD (SMD  = 0.34; 95% CI, -0.91 to 1.60; P = 0.59) was detected between gliomas and metastases. CONCLUSIONS: High-grade gliomas may be distinguished from brain metastases by comparing the peritumoral FA and MD values. DTI appears to be a promising tool in diagnosing solitary intracranial lesions.