Left atrial appendage occluder detachment treated with transthoracic ultrasound combined with digital subtraction angiography guided catcher:A case report

BACKGROUND There are very few cases of cardiac occluder detachment,and it is rare to completely remove the occluder using interventional methods without undergoing thoracotomy surgery after detachment.This case innovatively used ultrasound guidance combined with digital subtraction angiography(DSA)to completely remove the occluder,accumulating some experience.CASE SUMMARY The patient underwent left atrial appendage occlusion surgery in our hospital due to atrial fibrillation.After the surgery,the occluder fell off and became free in the left ventricle,which is very dangerous.We innovatively used ultrasound guidance,combined with DSA,and interventional surgery to successfully capture the free occluder using a catcher,completely remove it,and then re implant a new left atrial appendage occluder.After the surgery,the patient recovered very well.CONCLUSION The size selection of the occluder is slightly conservative,and the shape of the left atrial appendage opening is irregular.

Modified magnetic resonance angiography of the liver using sensitivity encoding in comparison with digital subtraction angiography and CT arterial portography

BACKGROUND: Over 355 patients have received ortho- topic liver transplantation ( OLT) at this hospital since 1993. Preoperative imaging studies of both hepatic vessels and parenchyma in these recipients bettered surgical plan- ning or even precluded the necessity of surgery. Here we report our preliminary results of modified magnetic reso- nance angiography ( MRA ) using sensitivity encoding ( SENSE) through comparative study with conventional digital subtraction angiography (DSA) and CT arterial por- tography (CTAP). METHODS: Sixteen patients with suspected liver diseases were included in the study. All of them received both dy- namic MRI of the liver using SENSE and digital DSA with CTAP within a two-week interval. The four-phase MRA was reconstructed from source images of the coronal dy- namic study. The arterial phase of the modified MRA was compared with DSA in the evaluation of hepatic arteries and the portal phase compared with CT portography recon- structed from source images of CTAP. In dynamic study of the liver, a fixed dose (20 ml) of contrast medium and scan timing were used. RESULTS: The main branches and variations of the hepatic arterial system were well shown on the modified MRA, al- though the marginal branches of hepatic arteries were of poor quality. The figures of portal veins on MRA were as clear as or superior to those of CTAP. In addition, the su- prarenal inferior vena cava (IVC) was well demonstrated on MRA and/or non contrast-enhanced coronal balanced fast-field echo (b-FFE) scan sequence in most cases. MRI detected most parenchymal lesions of the liver and hemo- dynamics of these lesions could be evaluated on source ima- ges of the modified MRA. MRI/MRA also serendipitously revealed several extrahepatic disease entities or variations that were not found on DSA/CTAP. CONCLUSIONS: The modified MRA using SENSE is a cost-effective modality of examination for the demonstra- tion of the whole hepatic vascular system. Combined with MRI, it has the potential as a one-stop imaging modality in the preoperative evaluation in fields such as OLT.

Detection of hypervascular hepatocellular carcinoma: Comparison of multi-detector CT with digital subtraction angiography and Lipiodol CT

AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).METHODS: Twenty-eight patients with nodular HCC underwent biphasic MDCT examination: hepatic arterial phase (HAP) 25 s and portal venous phase (PVP) 70 s after injection of the contrast medium (1.5 mL/kg). They also underwent hepatic angiography and intra-arterial infusion of iodized oil. Lipiodol CT was performed 3-4 wk after infusion. MDCT images were compared with DSA and Lipiodol CT images for detection of hepatic nodules.RESULTS: The three imaging techniques had the same sensitivity in detecting nodules ＞20 mm in diameter. There was no significant difference in the sensitivity among HAP-MDCT, Lipiodol CT and DSA for nodules of 10-20 mm in diameter. For the nodules ＜10 mm in diameter, HAP-MDCT identified 47, Lipiodol CT detected 27 (X2= 11.3, P= 0.005＜0.01, HAP-MDCT vs Lipiodol CT) and DSA detected 16(X2= 9.09, P= 0.005＜0.01 vs Lipiodol CT and X2= 29.03,P = 0.005＜0.01 vs HAP-MDCT). However, six nodules ＜10 mm in diameter were detected only by Lipiodol CT.CONCLUSION: MDCT and Lipiodol CT are two complementary modalities. At present, MDCT does not obviate the need for DSA and subsequent Lipiodol CT as a preoperative examination for HCC.

Superiority of Digital Subtraction for Analysis of Simultaneously-Acquired Dual-Radiopharmaceutical Parathyroid Scintigraphy

With dual-radiopharmaceutical (DR) parathyroid scintigraphy, imaging with 99mTcO4-or 123I-NaI is combined with 99mTc-sestamibi scintigraphy for localization of parathyroid adenomas. The set images are then either visually compared or digitally subtracted to aid in interpretation. While both EANM and SNMMI guidelines recommend use of digital subtraction over visual interpretation alone, to date, the few formal comparisons performed have not demonstrated superiority. The purpose of this investigation is to rigorously assess the added value of digital subtraction over visual interpretation alone using simultaneously-acquired 123I-NaI and 99mTc-sestamibi images. Materials: 90 consecutive patients with DR parathyroid scintigraphy for primary hyperparathyroidism who underwent successful parathyroidectomy were included. DR planar acquisition was performed 15 minutes post injection using 10% dual energy windows. Digital subtraction was subsequently performed using commercially available software. Images were independently reviewed by 3 nuclear medicine trainees and 2 experienced nuclear medicine physicians with and without digital subtraction. Results were compared with surgical and histopathologic findings, which served as ground truth. Results: 90 patients had a total of 91 confirmed parathyroid lesions. All 5 readers had significantly greater sensitivity with digital subtraction compared with visual interpretation alone while specificity was not significantly diminished. Area under the ROC curve was significantly greater with digital subtraction in 3 of 5 readers. Agreement was greater among trainees and experienced physicians when using digital subtraction. Conclusion: Using an optimized DR planar co-imaging technique, digital subtraction significantly improved inter-observer agreement and confidence of interpretation and increased sensitivity, without diminishing specificity.

Interventional digital subtraction angiography for small bowel gastrointestinal stromal tumors with bleeding

AIM:To retrospectively evaluate the diagnostic efficacy of interventional digital subtraction angiography(DSA)for bleeding small bowel gastrointestinal stromal tumors(GISTs).METHODS:Between January 2006 and December2013,small bowel tumors in 25 consecutive patients undergoing emergency interventional DSA were histopathologically confirmed as GIST after surgical resection.The medical records of these patients and the effects of interventional DSA and the presentation and management of the condition were retrospectively reviewed.RESULTS:Of the 25 patients with an age range from34-to 70-year-old(mean:54±12 years),8 were male and 17 were female.Obscure gastrointestinal bleeding,including tarry or bloody stool and intermittent melena,was observed in all cases,and one case also involved hematemesis.Nineteen patients required acute blood transfusion.There were a total of 28 small bowel tumors detected by DSA.Among these,20 were located in the jejunum and 8 were located in the ileum.The DSA characteristics of the GISTs included a hypervascular mass of well-defined,homogeneous enhancement and early developed draining veins.One case involved a complication of intussusception of the small intestine that was discovered during surgery.No pseudoaneurysms,arteriovenous malformations or fistulae,or arterial rupture were observed.The completely excised size was approximately 1.20 to 5.50 cm(mean:3.05±1.25 cm)in maximum diameter based on measurements after the resection.There were ulcerations(n=8),erosions(n=10),hyperemia and edema(n=10)on the intra-luminal side of the tumors.Eight tumors in patients with a large amount of blood loss were treated with transcatheter arterial embolization with gelfoam particles during interventional DSA.CONCLUSION:Emergency interventional DSA is a useful imaging option for locating and diagnosing small bowel GISTs in patients with bleeding,and is an effective treatment modality.

Carbon dioxide digital subtraction angiography manifestations of hepa-tocellular carcinoma

Objective: To investigate the imaging features and clinical significance of carbon dioxide digital subtraction angiography (CO2-DSA) in the diagnosis and treatment of hepatocellular carcinoma (HCC). Methods: Both CO2-DSA and conventional DSA were performed in all 47 patients with HCC, and the angio-graphic manifestations of CO2-DSA were compared with those of conventional DSA in the same patients. Results: Peripheral arterial and capillary imaging by CO2-DSA was inferior to that by conventional DSA, although blood pools were well visualized with CO2. Improved visualization of arterioportal shunting (APS) was obtained with CO2-DSA compared with that by conventional angiography. APS was observed in 33 cases by CO2-DSA and in 12 cases by conventional angiography (P<0. 001). Retrograde visualization of the portal vein (PV) trunk and its large branches was demonstrated in 16 cases by CO2-DSA and in 1 case by conventional DSA (P<0. 001). The manifestation of lipiodol retention in the tumors was consistent

Value of digital subtraction angiography in endovascular graft exclusion for abdominal aortic aneurysms

Objective: To evaluate the value of digital subtraction angiography (DSA) in management of endovascular graft exclusion (EVGE) for abdominal aortic aneurysms. Methods: Monitored by DSA and fluoroscopy, stent-graft complex were introduced into the aneurysm sac via femoral arteries and were deployed at the proximal and distal necks to exclude the sac from circulation. Results: The success rate of deployment was 94. 74% (36/38). Endoleaks occurred in 4 cases. One converted to open surgery because of sac rupture 4 days after deployment. Thrombosis and stenosis occurred in 2 cases. Three patients died shortly after the operation (< 3 months). Conclusion: DSA can monitor EVCE on real-time throughout the whole procedure. It can meet the needs of measurement, location, evaluating, detecting, and also can be much helpful in correcting complications. Moreover, it provides large visual field and operating space, and is a very important monitoring method for EVGE.

Evaluation of Diagnostic Efficacy of Digital Subtraction Radiography in the Diagnosis of Simulated External Root Resorption: An <i>in Vitro</i>Study

External root resorption can induce the degeneration of dental cementum and dentine and may extend towards the pulp reductive. Digital subtraction radiography can function as a useful tool in diagnosing degenerative carious lesions. This study investigated the diagnostic value of digital subtraction radiography in detecting external root resorption. This was a descriptive study conducted using the lab trial method. Artificially-induced external root resorption was created in different sizes at the coronal and apical aspects of 20 premolar teeth. Digital radiographs were obtained of each tooth under standard conditions and these radiographs were subtracted by imaging devices. The subtracted images and the digital radiographs were observed by three radiologists. Chi-square, Kappa test, and Z-test were used to analyze the data. The mean of general sensitivity of digital subtraction radiography and direct digital radiography was low in diagnosing 0.05 mm lesions (Sen = 35%), yet, the accuracy index was good for all lesions (Acc ≥ 65%). Other diagnostic parameters were also acceptable. Both types of radiography worked better in diagnosing coronal than apical lesions (P > 0.05). The interpreters (observers) showed a better performance in diagnosing external root resorption using digital subtraction radiography compared to digital radiography. Both modalities were exact and accurate in detecting 0.05 mm lesions as well as other lesions. However, the results of digital subtraction radiography were not significantly different from those of direct digital radiography.

Duodenal ulcer caused by coil wiggle after digital subtraction angiography-guided embolization: A case report

BACKGROUND Acute gastrointestinal bleeding(GIB)is a life-threatening medical emergency with high morbidity and mortality.Transcatheter embolization with endovascular coils under digital subtraction angiography guidance is a common and effective method for the treatment of GIB with high technical success rates.Duodenal ulcers caused by coils wiggled from the branch of the gastroduodenal artery,which is a rare complication,have not previously been reported in a patient with right intrathoracic stomach.CASE SUMMARY A 62-year-old man had undergone thoracoscopy-assisted radical resection of esophageal cancer and gastroesophageal anastomosis 3 years ago,resulting in right intrathoracic stomach.He was admitted to the hospital 15 mo ago for dizziness and suffered acute GIB during his stay.Interventional surgery was urgently performed to embolize the branch of the gastroduodenal artery with endovascular coils.After 15 mo,the patient was re-admitted with a chief complaint of melena for 2 d,esophagogastroduodenoscopy and abdominal computed tomography revealed that some endovascular coils had migrated into the duodenal bulb,leading to a deep ulcer.Bleeding was controlled after conservative treatment.Seven months later,duodenal balloon dilatation was performed to relieve the stenosis after the removal of a few coils,and the patient was safely discharged with only one coil retained in the duodenum due to difficulties in complete removal and risk of bleeding.Mild melena recurred once during the long-term follow-up.CONCLUSION Although rare,coil wiggle after interventional therapy requires careful attention,effective precautionary measures,and more secure alternative treatment methods.

Observation on 108 Normal Ophthalmic Arteries in 80 Patients by Digital Subtraction Angiography

By digital subtraction angiography(DSA), the authors made observations on 108 normal ophthalmic arteries in 80 patients with regard to the origins, courses, branching, morphology and anastomoses of the vessels. The merits and demerits of DSA in observing the ophthalmic artery were discussed. Eye Science 1994; 10: 157- 162.

Head dual energy-computed tomography angiography versus neuro-digital subtraction angiography

Dual-energy X-ray absorptiometry provides two modes of head computed tomography （CT） angiography scanning： neuro-digital subtraction angiography and dual-energy CT angiography （DE-CTA）. Previous studies have compared image quality, radiation exposure, and bone removal between neuro-digital subtraction angiography and DE-CTA. However, the number of cases was relatively small. The present study examined 300 suspected cases of cerebrovascular disease and observed the methods and duration of post-processing, examination time, and data volume. Results demonstrated similar image quality between the two methods, but lower radiation doses and shorter examination time in DE-CTA. DE-CTA allowed for faster and more stable scanning performance and post-processing methods, facilitating accurate and direct diagnosis of cerebrovascular disease.

Digital subtraction angiography for the analysis of supraaortic vessels: What is its role nowadays?

For about 50 years, angiography represented the only imaging method for studying carotid arteries in order to detect the presence of pathological stenosis due to atherosclerotic plaque. Recently, thanks to the use of non-invasive methods, physicians are able to study and quantify the presence of carotid atherosclerosis in vivo These procedures have enabled the introduction of new concepts: (1) the degree of carotid stenosis is approxi- mate to the volume and extension of carotid plaque; and (2) a set of parameters, easily identifiable by com- puted tomography angiography, magnetic resonance angiogram and ultra-sound echo-color Doppler, are closely linked to the development of ischemic symptoms and can significantly increase the risk of stroke regard- less of the degree of stenosis. In light of these findings vulnerable plaques should be identified early, and the role of Digital Subtraction Angiography which is a purely technical luminal technique should be determined.

Use of digital subtraction angiography for assessment of digital replantation

Objective: To assess the blood flow of the proper digital artery using digital subtraction angiography (DSA) in the early stage after replantation. Methods: From January 2006 to October 2010, 27 anastomosed arteries in 27 replanted digits were included in the study. The patients included nine males and four females. The patients received DSA at 48 to 96 h after digital replantation. Based on DSA image, the blood flow was classified into normal, slow-running, and flow-stopping types. The patients with normal digital blood flow were given continuous routine treatments; the patients with slow-running flow were given the conservative treatments, such as release of the tight dressings, removal of stitches, keeping warm, the use of massage, and the use of anticoagulants and anti-inflammatory drugs; the patients with flow-stopping received immediate surgical re-exploration. Results: In this series, 23 digits in 11 patients showed a normal blood flow, and these digits all survived. In one of 13 patients, two digits which displayed slow-running flow also survived after conservative treatments. In two of 13 patients, two digits showed flow stopping, with one surviving and one failing after re-exploration and arterial revision. Conclusions: The DSA can be used to assess the blood flow of the proper digital artery in the early stage after replantation. It provides essential information for salvaging the replanted finger.

Classification and digital subtraction angiography evaluation of carotidcavernous fistulas

Objective To investigate the role of digital subtraction angiography (DSA) in evaluation of carotid cavernous fistulas, and to initiate a new classification for carotid cavernous fistula Methods Cerebral angiography and selective external and internal carotid angiography were carried out in 56 patients who were classified into 5 types according to their hemodynamic features Results The types were A (38 patients), B (4), C (10), D (2), and E (2) One of the 38 direct fistulas was located at C1 of the cavernous segment Fistulas at C2 were observed in 10 patients, at C3 in 4, at C4 in 10 and at C5 in 5 The anterior communicating arteries were patent and well compensated in 33 of the 56 patients The posterior communicating arteries were patent and well compensated in 39 patients Both communicating arteries were well compensated in 31 patients Fifty of the 56 patients were drained by ophthalmic veins, 47 by inferior petrous sinuses, 18 by cortical veins, and 8 to the posterior fossa region Conclusions Digital subtraction angiography was helpful in localization of the rents in carotid cavernous fistulas, in evaluation of function of Willis circles and provided valuable information for treatment of carotid cavernous fistulas Carotid cavernous fistulas were divided into 5 categories: type A, B, C, D and E, among which type E was not previously described elsewhere

Dual-Energy Subtraction X-Ray Digital Tomosynthesis: Basic Physical Evaluation

The present study was performed to determine the potential of applying dual-energy subtraction (DES) digital tomo-synthesis to basic physical evaluations. Volumetric X-ray DES digital tomosysnthesis was used to obtain an image of a detectability phantom (an artificial lesion). The image quality of DES digital tomosynthesis was compared to that of DES radiography. The purpose of this study was to determine enhanced visibility quantified in terms of the contrast- to-noise ratio, figure-of-merit, and root-mean-square error. In the in-focus plane, the image quality is better by DES digital tomosynthesis than by DES radiography. The potential usefulness of DES digital tomosynthesis for evaluating a detectability phantom was demonstrated. Further studies are required to determine the ability of DES digital tomosyn-thesis to quantify the spatial relationships between the artificial lesion components of these devices, as well as to iden- tify lesions with diagnostic consequences.

Manifestations of hepatic cavernous hemangioma in carbon dioxidedigi-tal subtraction angiography

Objective: To describe the characteristic appearance of cavernous hemangioma of the liver (CHL) presented in carbon dioxide digital subtraction angiography (CO2-DSA) and to evaluate the significance of CO2-DSA in the diagnosis of CHL. Methods: Both CO2-DSA and iodinated contrast DSA (IC-DSA) were performed in all 16 patients with CHL, and the angiographic manifestations in the same patients were compared. The image quality was rated by three experienced angiographers, and the complications were also assessed. Results: There was good correlation between angiographers on image quality (R = 0. 73). Diagnostic images were obtained with both CO2-DSA and IC-DSA in all CHL patients. No difference was noted between IC-DSA and CO2-DSA in visualizing the proper hepatic arteries and its branches (P>0. 05). CO2-DSA produced better images that clearly described the tumor size, shape and margination than those by IC-DSA (P< 0. 05), but both demonstrated characteristic appearances of early opacification and

脑血管数字减影血管造影高分辨率分割网络设计

针对现存卷积神经网络对脑血管数字减影血管造影分割精度不高的问题,本文提出了一种基于U-Net的改进网络(IC-Net)。通过融合使用Inception和CAM通道注意力模块,以多种感受域提取更丰富的血管特征信息,并对特征信息进行筛选。增加7×7卷积层,通过压缩特征层分辨率的方式减少训练过程中产生的数据量。本文所提模型与U-Net、R2U-Net、Attention U-Net相比,IOU、Accuracy、F1-Score和ROC曲线下面积4项指标平均提升了1.82%、0.014%、1.19%和0.73%。结果验证了IC-Net模型明显提升了脑血管数字减影血管造影虚弱血管和血管末端的检测能力,提升了分辨伪影噪声的能力,为医生识别脑血管中产生的病变提供有力参考。

基于深度学习的图像重建算法在下肢动脉病变CTA诊断中的研究

目的 探讨基于深度学习的图像重建算法对下肢动脉病变CT血管成像(Computed Tomography Angiography,CTA)的诊断价值。方法 回顾性收集2021年6月至2022年2月于我院就诊的51例下肢动脉狭窄或闭塞患者的CTA检查资料(65条下肢动脉)。分别基于深度学习的图像重建(Deep Learning Image Reconstruction,DLIR)算法和混合迭代重建(Hybrid Iterative Reconstruction,HIR)算法对CTA图像进行重建,以HIR法为参照进行质量评估;两位医师在不同重建算法下对血管狭窄的部位和程度进行评估,并采用Kappa检验观察者间一致性;以数字减影血管造影作为“金标准”比较HIR法和DLIR法诊断下肢动脉中度和重度狭窄的效能。结果与HIR法相比,DLIR法图像质量的噪声显著降低(Z膝上动脉=8.36,Z膝下动脉=9.46,Z足背动脉=7.19,均P<0.001),信噪比(Z膝上动脉=-7.32,Z膝下动脉=-7.91,Z足背动脉=-8.45,P<0.001)及对比噪声比(Z膝上动脉=-8.66,Z膝下动脉=-9.21,Z足背动脉=-8.52,均P<0.001)显著提高。DLIR法对动脉狭窄或闭塞程度的识别和评估均显示出更高的观察者间一致性(Kappa=0.86)。与HIR法相比,DLIR法的图像对膝下动脉重度狭窄的敏感度(72.2%vs.94.4%)、特异性(78.7%vs.95.7%),足背动脉中度狭窄的特异性(86.0%vs.97.7%)及重度狭窄的敏感度(50.0%vs.87.5%)均显著提高(P<0.05)。结论 DLIR算法可有效改善下肢动脉的CTA图像质量,并获得更优的诊断效能。

超声引导外周置入中心静脉导管失败的5年回顾性研究

目的探讨超声引导外周置入中心静脉导管(PICC)失败的原因及对策,提高PICC置管成功率。方法法选择2015年1月至2019年12月在青岛市市立医院接受超声引导PICC中置管失败患者32例,其中男性16例,女性16例;年龄43~85岁,平均年龄60.12岁;身体质量指数(BMI)16.55~31.26 kg/m^(2),平均BMI 22.56 kg/m^(2);恶性肿瘤32例,消化系统疾病12例,血管疾病8例,高血压5例,心脏病4例,糖尿病2例;置管原因,化学治疗19例(59.4%),静脉营养15例(46.9%);病变位置,颈胸部18例(56.3%),其他部位14例(43.7%);既往相关治疗,肿瘤切除21例(65.6%),放化疗19例(59.4%)。置管失败后移至介入手术室接受数字减影血管造影(DSA)辅助PICC复位/重置者。统计PICC相关指标。评估超声引导PICC失败原因,并分析失败原因与其他指标[年龄、性别、身体质量指数、血管病史、病变位置(颈胸部)、既往相关治疗、侧别和穿刺靶静脉]的相关性。结果左臂置入失败占56.3%(18/32)。穿刺贵要静脉者占65.6%(21/32),多于头静脉和肱静脉(P<0.001)。并发损伤仅为轻度痉挛或少量血栓占12.5%(4/32)。导管异位是置管失败主要原因占84.4%(27/32)。腋静脉最易发生异位(46.9%),贵要静脉(12.5%)、颈内静脉(9.38%)亦较常见。在DSA辅助下全部病例均复位/重置成功。导管异位与年龄、性别、BMI、血管病史、病变位置(颈胸部)、既往相关治疗、侧别和穿刺靶静脉指标均无显著相关性(P>0.05)。结论导管异位是超声引导PICC失败的首要原因,主要为血管变异所致。DSA辅助复位技术是解决超声引导PICC失败的有效方法,可显著提高置管成功率。

DSA机引导下经皮胃造瘘术治疗吞咽困难患者

回顾性分析莆田学院附属医院2018年5月—2022年5月利用数字减影血管造影(DSA)机引导行经皮胃造瘘术治疗41例吞咽困难患者的情况,统计分析手术成功率、并发症发生率及术前3 d、术后30 d、术后90 d患者的白蛋白(ALB)、总蛋白(TP)、前白蛋白(PA)、体重等指标,探讨DSA机引导下经皮胃造瘘术(Introducer法)治疗吞咽困难患者的安全性和有效性。结果表明,对41例患者实施DSA机引导下经皮胃造瘘术(Introducer法)均获得成功;3例患者出现并发症,并发症发生率为7.32%;术前3 d与术后30 d比较,患者的ALB、TP、PA、体重差异显著(P<0.05);术后30 d与术后90 d比较,各指标差异无统计学意义(P>0.05)。说明DSA机引导下经皮胃造瘘术(Introducer法)成功率高,并发症发生率低,可以提高吞咽困难患者术后的营养指标,有较高的临床应用价值。