Enhancing transjugular intrahepatic portosystemic shunt procedure efficiency with digital subtraction angiography image overlay technology in esophagogastric variceal bleeding

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)is a pivotal intervention for managing esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis.AIM To evaluate the efficacy of digital subtraction angiography image overlay tech-nology(DIT)in guiding the TIPS procedure.METHODS We conducted a retrospective analysis of patients who underwent TIPS at our hospital,comparing outcomes between an ultrasound-guided group and a DIT-guided group.Our analysis focused on the duration of the portosystemic shunt puncture,the number of punctures needed,the total surgical time,and various clinical indicators related to the surgery.RESULTS The study included 52 patients with esophagogastric varices due to chronic hepatic schistosomiasis.Results demonstrated that the DIT-guided group expe-rienced significantly shorter puncture times(P<0.001)and surgical durations(P=0.022)compared to the ultrasound-guided group.Additionally,postoperative assessments showed significant reductions in aspartate aminotransferase,B-type natriuretic peptide,and portal vein pressure in both groups.Notably,the DIT-guided group also showed significant reductions in total bilirubin(P=0.001)and alanine aminotransferase(P=0.023).CONCLUSION The use of DIT for guiding TIPS procedures highlights its potential to enhance procedural efficiency and reduce surgical times in the treatment of esophagogastric variceal bleeding in patients with chronic hepatic schistoso-miasis.

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.

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.

Left inferior phrenic arterial malformation mimicking gastric varices: A case report and review of literature

BACKGROUND Gastric submucosal arterial dilation resulting from splenic artery occlusion represents an exceedingly rare etiology of acute upper gastrointestinal bleeding(UGIB).Although endoscopy is a widely utilized diagnostic and therapeutic modality for gastrointestinal bleeding,it has limitations in detecting arterial abnormalities.CASE SUMMARY This report presents a rare case of massive UGIB in a 57-year-old male with a tortuous left inferior phrenic artery accompanied by splenic artery occlusion.“Gastric varices”was identified during the patient's endoscopy one year before hemorrhage.Despite initial hemostasis by endoscopic clipping,the patient experienced massive rebleeding after one month,requiring intervention with transcatheter arterial embolization(TAE)to achieve hemostasis.CONCLUSION This is the first case to report UGIB due to a tortuous left inferior phrenic artery.This case highlights the limitations of endoscopy in identifying arterial abnormalities and emphasizes the potential of TAE as a viable alternative for the management of arterial bleeding in the gastrointestinal tract.

Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy

Patients with peripheral arterial disease(PAD)and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow.Patients with PAD often have several comorbidities,including chronic kidney disease,diabetes mellitus,and hypertension.Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy(CIN).The use of carbon dioxide(CO2)as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN.However,CO2 angiography has been underutilized due to concerns regarding safety and image quality.Modern CO2 delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN.Awareness of the need for optimal imaging conditions,contraindications,and potential complications have improved the safety of CO2 angiography.This review aims to highlight current technological advances in the delivery of CO2 in vascular angiography for patients with PAD and critical limb ischemia,which result in limb preservation while preventing kidney damage.

An evaluation of the arterial occlusions in peripheral arterial disease by 64-detector multi-slice CT angiography: DSA correlation

Objective: Evaluation of peripheral arterial disease with 64-detector multi-slice CT angiography (MDCT- A) and comparison of the results with the results of digital subtraction angiography (DSA), a standard reference. Materials and Method: The written informed consent of the patients and ethics committee approval were obtained. The retrospective study group consisted of 28 patients with a diagnosis of peripheral arterial disease. Using 64-MDCT-A, the arterial tree of the lower extremity was evaluated for the presence of steno-occlusive lesions that might have led to luminal stenosis. The diagnostic reliability of 64-MDCT- A was calculated and compared with that of DSA. Findings: In the segment-based analysis, the sensitivity, specificity, and reliability rates of 64-MDCT angiography in determining significant stenoses were 97.7%, 97%, and 97.3%, respectively. The Kappa co-efficiency for compatibility between 64-MDCT-A and DSA methods in grading stenosis was calculated as 0.896

Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization

AIM: To assess the value of gemstone spectral imaging (GSI) in efficacy evaluation in hepatocellular cancer (HCC) after transcatheter arterial chemoembolization (TACE) treatment.METHODS: Thirty patients with HCC underwent GSI, including nonenhanced, arterial, portalvenous and delayed phase scans, after TACE treatment. Arterial phase images were acquired with GSI for reconstruction of virtual nonenhanced images and color overlay images. Digital subtraction angiography (DSA) was performed in all these patients. Two blinded and independent readers evaluated the data in two reading sessions; standard nonenhanced, arterial, portalvenous, and delayed phase images were read in session A, and the optimal monochromatic images, iodine/water based images and spectrum features were read in session B. Sensitivity and specificity were calculated with the DSA data as the reference standard. The sensitivity and specificity were compared using the χ2 test.RESULTS: DSA revealed 154 lesions in 30 patients, and 100 of them had blood supply. Overall sensitivity and specificity were 72% (72/100) and 77.8% (42/54) for session A, and 97% (97/100) and 94.4% (51/54) for session B, respectively. The sensitivity and specificity of the two reading sessions were significantly different (χ2 = 23.04, χ2 = 7.11, P < 0.05).CONCLUSION: Compared with conventional CT, GSI could significantly improve the detection of small and multiple lesions without increasing the radiation dose. Based on spectrum features, GSI could assess tumor homogeneity and more accurately identify residual tumors and recurrent or metastatic lesions during efficacy evaluation and follow-up in HCC after TACE treatment.

The Role of Color Doppler Ultrasound Arterial Mapping for Decision Making in the Treatment of Patients with Lower Extremity Peripheral Arterial Disease

Purpose: To assess the efficacy of color Doppler imaging for decision making in the treatment of patients with lower extremity peripheral arterial disease (PAD) compared to digital subtraction angiography (DSA). Materials and Methods: Color Doppler scan was done on patients suspected for lower limb PAD, a day prior to the DSA which was done by a vascular surgeon. Also, for the patients who were candidates for endovascular intervention based on the color Doppler arterial mapping results, endovascular interventions were performed at the same time if the DSA findings are correlated with the color Doppler map. The grading for evaluated segments was normal, insignificant stenosis (<50%), hemodynamically significant stenosis (≥50%) and occlusion. We yielded the diagnostic efficacy indices of Doppler for detecting arterial stenosis in each 18 different arterial segments below the renal arteries including, infrarenal aorta, common and external iliac, common femoral, superficial femoral (proximal, middle and distal segments), deep femoral, popliteal artery, tibioperoneal trunk, anterior and posterior tibial arteries (proximal, middle and distal segments) and peroneal artery (proximal and distal segments). Then, we yielded the kappa agreement between Doppler and DSA findings considering the grade of stenosis in 18 arterial segments separately. Results: Totally 115 lower extremities (2045 arterial segments) were evaluated in 90 patients [mean age: 60.8 ± 8.9 (range: 47 - 84 years old)] of which 68 (75.6%) were men. The sensitivity of color Doppler for all arterial segments was 90% or higher except for common iliac artery, distal segment of superficial femoral artery and proximal segments of anterior and posterior tibialis and peroneal arteries. However, the specificity was 89% or higher, in all arterial segments. Kappa agreement was 0.72 or higher in all segments (All P-Values 0.001). Conclusion: This study suggests that considering excellent capability of color Doppler sonography in the evaluation of lower extremity arterial disease, color Doppler arterial mapping is sufficient for decision making in the treatment of these patients and can reduce the rate of diagnostic angiography.

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。

Fastunnel导管在颅内动脉狭窄介入治疗中的价值

目的探讨新型输送型球囊扩张导管(Fastunnel导管)在颅内动脉粥样硬化性狭窄介入治疗中的临床应用价值。方法回顾性分析2022-06—2024-02郑州大学第一附属医院采用Fastunnel导管治疗的18例颅内动脉粥样硬化性狭窄患者的临床资料,所有患者均接受球囊扩张联合支架成形术,分析患者的临床资料、治疗情况、手术成功率及术后并发症发生情况。结果18例患者均成功接受介入手术治疗,手术成功率100%。术前血管狭窄率(78.94±5.3)%,病变血管长度(7.14±2.14)mm。手术时长21~58(43.56±9.05)min,治疗期间射线暴露时间10~28(21.3±3.56)min,辐射剂量1526~5281(3436.50±626.39)mGy。术后血管狭窄率(13.50±4.94)%。所有患者围手术期及术后均未出现并发症。结论Fastunnel导管治疗颅内动脉粥样硬化性狭窄具有较好的疗效和安全性,可简化手术步骤,提高手术效率,具有良好的临床应用价值。

MSCTA在颈动脉血管支架植入术前后颈动脉狭窄程度评估中的应用

目的评价多层螺旋CT血管造影(MSCTA)在颈动脉血管支架植入术(CAS)前后颈动脉狭窄程度评估中的应用价值。方法回顾性分析2020年2月至2023年11月在我院行CAS治疗的82例患者临床资料,所有患者均在术前、术后进行MSCTA检查评估颈动脉狭窄程度,比较患者术前、术后颈动脉狭窄程度变化,以数字减影血管造影(DSA)为金标准评估MSCTA在不同颈动脉狭窄程度患者颈动脉狭窄程度评估中的诊断价值。结果82例颈动脉狭窄患者,其中左、右侧颈内动脉狭窄29例、41例,双侧颈内动脉狭窄12例,CAS治疗血管共94支,手术均成功;MSCTA结果显示,CAS术前94支血管以中、重度为主,占比82.98%,部分血管闭塞,占比13.83%,CAS术后以轻度狭窄为主,占比92.55%,部分患者为中度狭窄,占比7.45%,无重度狭窄和闭塞患者,82例患者CAS治疗前后颈动脉狭窄程度分布差异有统计学意义(P<0.05);CAS术前,MSCTA评估轻、中、重度颈动脉狭窄和颈动脉闭塞的灵敏度分别为0.00%、77.08%、90.62%、85.71%,特异度分别为96.80%、90.38%、88.701%、98.75%,准确率分别为96.80%、84.00%、89.36%、96.80%,与DAS结果比较,kappa值分别为0、0.678、0.770、0.870;CAS术后,MSCTA评估轻、中度颈动脉狭窄和颈动脉闭塞的灵敏度分别为92.55%、0.00%,特异度分别为0.00%、92.55%,准确率均为92.55%,与DAS结果比较,kappa值均为0,MSCTA评估重度颈动脉狭窄和颈动脉闭塞结果均与DAS结果一致。结论MSCTA在CAS术前后颈动脉狭窄程度的评估中具有较好的应用价值。

DSA联合3D ASL对优势侧椎动脉狭窄支架置入前后小脑半球血流动力学改变的评估

目的:探讨DSA联合3D动脉自旋标记技术(ASL)在椎动脉狭窄支架置入前后小脑半球血流动力学评估中的应用价值。方法:回顾性分析21例因优势侧椎动脉颅外段管腔狭窄行支架置入术患者的临床、DSA及ASL资料,评估不同标记后延迟时间(PLD)、椎动脉优势侧与非优势侧、支架置入术前后小脑半球不同供血区脑灌注的变化。结果:21例术前DSA显示优势侧椎动脉重度狭窄,支架置入部位均为优势侧椎动脉颅外段,术后狭窄均解除。PLD为2.5 s时,术前、术后,优势侧及非优势侧,小脑各供血区脑血流量(CBF)值均较PLD为1.5 s时高,差异均有统计学意义(均P<0.05)。术后在椎动脉优势侧,小脑上动脉供血区、小脑前下动脉供血区、小脑后下动脉供血区的CBF值均高于术前(包括PLD=1.5、2.5 s);椎动脉非优势侧,小脑上动脉供血区的CBF值高于术前(包括PLD=1.5、2.5 s)。结论:DSA联合ASL能定量评估小脑半球的血流动力学改变,优势侧椎动脉狭窄支架置入术能提高椎动脉优势侧小脑半球各区的脑血流灌注水平及椎动脉非优势侧的小脑半球小脑上动脉供血区的脑血流灌注水平。

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.

肾移植术后血管并发症的诊疗策略

随着肾移植供受者评估标准、器官获取保存方案、手术技术等不断进步,肾移植术后血管并发症的发生率有所下降,但仍是肾移植较为严重的手术并发症之一,可导致移植物丢失及受者死亡,严重影响肾移植效果。因此,本文就肾移植术后常见血管并发症,包括血管狭窄、动脉夹层、假性动脉瘤、血管破裂、血栓等的发生概况、临床表现、诊断和治疗策略进行综述,并结合西安交通大学第一附属医院肾移植术后血管并发症发生和诊治情况,总结肾移植术后常见血管并发症的诊疗策略,以期为肾移植术后血管并发症的临床诊断和治疗提供参考,降低血管并发症的发生率,提高肾移植疗效和受者生存率。

数字减影血管造影引导下经鞘管内钳夹活检辅助诊断肺动脉梗阻性疾病

目的 观察数字减影血管造影(DSA)引导下经鞘管内钳夹活检辅助诊断肺动脉梗阻性疾病的有效性及其安全性。方法 回顾性分析16例因肺动脉梗阻性疾病而接受经股静脉途径钳夹活检患者资料,记录其临床表现,以取材满足病理学诊断所需为技术成功;根据病理学结果诊断恶性病变,将活检病理为良性且其后半年及以上病情无明显变化,或手术病理良性者归为良性病变,二者均不符合为“未确诊”。记录钳夹活检操作时间、技术成功率、诊断效能、并发症及活检前、后肺动脉压改变。结果 16例中,9例表现为间断胸闷、4例胸痛伴胸闷、2例胸痛、1例无明显症状;10例病灶位于左肺、6例位于右肺,增强CT显示病变肺动脉内存在充盈缺损。对16例共行16次钳夹活检,平均操作时间(31.02±6.02)min,技术成功率100%。10例恶性肿瘤中,1例肺癌钳夹活检结果呈假阴性;6例良性病变中,钳夹活检均正确诊断。活检后2例出现一过性胸痛伴胸闷加重,均经对症治疗后缓解。活检前[(53.38±14.28)mmHg]、后[(53.69±14.15)mmHg]肺动脉压差异无统计学意义(P>0.05)。结论 DSA引导下经鞘管内钳夹活检能安全、有效地辅助诊断肺动脉梗阻性疾病。

多层螺旋CT仿真内窥镜在颈动脉狭窄中的诊断价值

目的:探讨多层螺旋CT仿真内窥镜技术(computed tomography virtual endoscopy,CTVE)在颈动脉狭窄中的诊断价值。方法:回顾性分析2021年1月—2023年3月期间汕头大学医学院第一附属医院收治的60例颈动脉狭窄患者的临床资料,其中男性49例,女性11例,年龄46~85(66±8)岁。所有患者均行颈部CT血管造影(computed tomography angiography,CTA)检查、颈部血管超声(cervical vascular ultrasound,CVUS)检查及数字减影血管造影(digital subtraction angiography,DSA)检查,其中CTA检查后进行CTVE成像处理。以DSA诊断结果为金标准,分析CTA联合CTVE及CVUS诊断颈动脉狭窄程度的一致性。结果:以DSA诊断结果为金标准,CTA联合CTVE及CVUS诊断颈动脉狭窄的Kappa值分别为0.764和0.756,均具有较好的一致性。CTA联合CTVE诊断不同程度颈动脉狭窄的Kappa值分别为0.702(轻度狭窄)、0.648(中度狭窄)、0.905(重度狭窄)、0.959(闭塞)。结论:CTVE在颈动脉狭窄中具有较好的诊断价值,尤其在对于颈动脉重度狭窄或闭塞的诊断中,其优势更加突出。

经远端桡动脉入路与常规桡动脉入路行数字减影血管造影的可行性及安全性研究

目的对比远端桡动脉入路(distal transradial artery access,dTRA)与常规桡动脉入路(transradial approach,TRA)行DSA的可行性和安全性,优化神经介入治疗的穿刺入路策略。方法前瞻性连续纳入2022年7月—2023年1月北京市大兴区人民医院神经内科拟行DSA的患者,按计算机产生随机数字的方法,将患者分为dTRA组和TRA组。将按照预定入路成功完成穿刺的患者纳入分析,收集两组患者的人口学信息、既往病史等基线资料,比较两组患者穿刺血管内径、穿刺时间、穿刺次数等手术过程指标,以及手臂疼痛、麻木、肿胀、桡动脉闭塞、动静脉瘘等术后并发症情况。利用多因素logistic回归模型分析影响dTRA首次穿刺成功率的影响因素。结果本研究共纳入320例拟行DSA的患者,其中306例患者纳入分析,dTRA组和TRA组各153例患者。两组患者的基线资料差异无统计学意义。dTRA组的穿刺血管内径较TRA组更小[(1.97±0.42)mm vs.(2.23±0.44)mm,P<0.001]。两组患者首次穿刺成功率差异无统计学意义,但与TRA组相比,dTRA组的穿刺时间更长(P=0.008)、穿刺次数更多(P=0.022)、总手术时间更长(P=0.003)、射线剂量更大(P=0.027)。与TRA组相比,dTRA组术后手臂疼痛评分更低(P<0.001),麻木、肿胀发生率更低(P<0.001),桡动脉闭塞发生率更低(P=0.002);TRA组患者术后均未发生动静脉瘘,dTRA组有2例患者发生动静脉瘘,差异无统计学意义。多因素logistic回归模型分析显示,远端桡动脉内径(OR 3.860,95%CI 1.364~10.924,P=0.011)及心房颤动病史(OR 0.121,95%CI 0.018~0.831,P=0.032)是影响dTRA首次穿刺成功率的危险因素。结论与TRA相比,dTRA可降低患者桡动脉闭塞、麻木、肿胀以及疼痛等并发症的发生率,提高患者舒适度。

经颅彩色多普勒超声对颈动脉支架成形术前颅内侧支循环的评价

目的:应用经颅彩色多普勒超声(transcranial color Doppler ultrasound,TCCD)对颈动脉支架成形术(carotid artery stenting,CAS)术前检查,评估颅内侧支血管循环的情况,评估其准确性及相关影响因素。方法:对63例行CAS手术的患者行TCCD检查,评估前交通动脉(anterior communicating artery,ACoA)、后交通动脉(posterior communicating artery,PCoA)、眼动脉(ophthalmic artery,OA)开放的情况,并与数字减影血管造影(digital subtraction angiography,DSA)结果对比,分析导致TCCD侧支开放误诊的因素。结果:颈动脉超声提示:单侧颈动脉重度狭窄或闭塞52例,双侧颈动脉均为重度狭窄或闭塞5例,一侧颈动脉重度狭窄(或闭塞)合并另一侧颈动脉中度及以上狭窄6例。ACoA开放组诊断符合率为79.4%、灵敏度为73.9%、特异度为94.1%、误诊率为5.9%、漏诊率为26.1%、阳性预测值为97.1%、阴性预测值为57.1%;PCoA开放组分别为84.1%、92.7%、68.2%、31.8%、7.3%、84.4%、83.3%;OA开放组分别为88.9%、100%、78.8%、21.2%、0%、81.1%、100%。三组与DSA一致性的Kappa数值分别为0.565、0.635、0.780。采用二元Logistic回归分析,得出相关影响因素,如前交通动脉压力差小,后交通动脉或眼动脉血管走行变异(详细说明)对TCCD误诊颅内血管侧支开放均有意义,为危险因素。结论:TCCD检查在术前较准确评估颅内侧支循环情况,能够为CAS手术提供可靠依据,且对术后定期随访颅内侧支循环变化情况,是更为有效安全简捷的诊断工具。

基于CTA和DSA评价膈下动脉解剖学变异和临床相关性:一项系统评价和Meta分析

目的:评价基于CT血管成像(CTA)和数字减影血管造影(DSA)的膈下动脉(IPA)解剖学变异的发生率与临床相关性。方法:系统检索PubMed、Web of Science、Scopus、Embase、Google Scholar、CBM、CNKI、WanFang、VIP和Baidu Scholar等数据库,纳入与左、右膈下动脉(LIPA和RIPA)相关的文献,并采用Stata 17.0软件进行Meta分析。结果:共纳入19篇文献,包括6754例患者。IPA共干和单独起源的汇总发生率分别为29.4%(95%CI:24.8%~34.2%)和70.6%(95%CI:65.8%~75.2%);IPA共干以起源于腹主动脉和腹腔干最为常见,汇总发生率分别为48.2%(95%CI:42.4%~54.1%)和49.0%(95%CI:43.3%~54.7%);RIPA单独起源以腹主动脉和腹腔干最为常见,汇总发生率分别为40.9%(95%CI:36.7%~45.3%)和34.8%(95%CI:30.7%~38.9%);LIPA单独起源以腹腔干和腹主动脉最为常见,汇总发生率分别为58.5%(95%CI:53.2%~63.7%)和32.6%(95%CI:27.3%~38.1%)。结论:IPA的起源变异十分丰富,熟悉IPA的起源变异对介入放射学、胃肠病学、外科学和创伤学医师具有十分重要的临床意义。

DSA联合动态增强CT定量分析肝癌HAIC的疗效

目的:探讨DSA联合动态增强CT定量分析和评估肝癌经肝动脉灌注化疗(HAIC)的疗效。方法:临床诊断为原发性肝癌患者50例,均行3次以上HAIC治疗。根据第1次及第3次HAIC治疗前1周内的增强CT,按照改良实体瘤疗效评价标准分为疗效良好组(CR+PR)和疗效不佳组(SD+PD),比较两组治疗前和2次HAIC治疗后DSA造影肝癌的血流动力学参数[染色达峰时间(TP)、峰值密度(PV)、时间-密度曲线上升支斜率(SU)]及CT增强扫描肝癌各期CT值的变化,并进行敏感性分析。对有统计学差异的指标进行Logistic回归分析和ROC曲线分析,以评估判断肝癌HAIC疗效的效能。结果:治疗前,两组间CT值及DSA指标无显著差异(P>0.05)。所有患者均成功完成2次HAIC治疗。第3次HAIC治疗前1周的增强CT,疗效良好组的动脉期和静脉期CT值相比于治疗前显著降低(P<0.05),延时期CT值无显著差异(P>0.05)。第3次HAIC时DSA造影肝癌的血流动力学参数PV与SU显著降低,TP显著延长(P<0.05)。疗效不佳组各项指标差异不显著。回归分析显示,动脉期CT值和DSA造影SU值与疗效显著相关。ROC曲线结果显示,动脉期CT值和SU值是判断疗效的有效指标。结论:DSA造影的SU值和动态增强CT的CT值能够客观地反映HAIC后肝癌的血供变化,且与HAIC疗效相关,可作为评估HAIC疗效的影像学依据。