DXA测量用校准脊椎体模的研制及临床测试

目的研制一种性能可靠的DXA测量用校准(cross-calibeation)及质量控制脊椎体模,并进行体模临床测试。方法经过固体水、骨体模材料和整体组合3个研制阶段,制成羟磷灰石质量控制体模1个,并在LUNAR公司生产的4台不同型号DXA仪器上对该体模进行临床测试。结果4台DXA仪器中,以Expert扇束仪的骨密度(bonemineraldensity,BMD)、骨矿含量(bonemineralcontent,BMC)和面积(Area)的准确度误差较大,其他3台(窄扇束Prodigy和2台笔束仪)误差较小;所有仪器的3个指标中以BMD误差较小(-15.4%～11.5%),其中以Prodigy型的BMD误差最小;BMD测量值高端误差小偏正值,低端误差大偏负值,在校准中用同时照顾两端差异的回归方程校准为好。25d测量25次作精确度误差基线优于1d测量25次者,精确度误差以1d测量25次的变异系数(CV)最小(0.0043),12例成人测量的CV最大(0.0078)。结论该体模可用于不同DXA仪器的质量控制和校准。

前列腺影像报告和数据系统指南(PI-RADS)解读及典型病例分析

本文旨在让放射科医师熟悉欧洲泌尿生殖放射学会在2012年制定和批准的前列腺影像报告和数据系统(PI-RADS)。PI-RADS的目的在于规范前列腺癌MRI报告,指导临床医生对前列腺癌恶性度的分级,从而对前列腺癌的治疗做出正确决定。

SPM和ROI方法研究脑内^(99)Tc^m-ECD的稳定性

目的 用统计参数绘图 (SPM)及感兴趣区 (ROI)方法评价脑内双半胱乙酯 (ECD)的稳定性。方法 13名正常志愿者 ,年龄 (31.2± 11.8)岁 ,静脉注射99Tcm ECD后 1h ,用三探头SPECT仪进行 60min、12次断层显像。通过SPM方法 ,比较早 10min与末 10min图像中99Tcm ECD的分布情况。用ROI方法测定局部ECD在 60min内的清除率和了解灰白质比值的变化。结果 SPM法显示局部99Tcm ECD分布 ,包括大脑皮层、基底节和丘脑无明显变化 ;ROI法显示局部ECD清除率在 60min内差异无显著性 (P >0 .0 5 ) ,60min内灰白质比值的变化趋于 0。结论 在正常脑内局部ECD的分布是稳定的。

^(18)FDG-PET在诊断头颈部鳞状细胞癌复发中的价值

目的 :了解18FDG -PET在诊断头颈部鳞状细胞癌复发中的价值 ,确定标准吸收值 (SUV)来鉴别放疗后的炎症与肿瘤复发。材料和方法 :头颈部鳞状细胞癌患者 43例 ,在放疗后至少 4个月 (平均 11个月 )进行18FDG PET检查。计算感兴趣区的SUV值。肿瘤复发诊断依赖组织病理学检查或 6个月以上的临床随访。结果 :43例患者中 ,FDG PET阳性 2 3例 ,其中 3例为假阳性 ;2 0例为阴性 ,其中假阴性 2例。FDG PET的诊断准确性是 88% (38/ 43) ,而CT/MRI的诊断准确性则为 6 6 % (2 5 / 38)。肿瘤复发病灶和炎症病灶的SUV有部分重叠 ,无统计学上差异 (p =0 31)。结论 :18FDG PET检测头颈部鳞状细胞癌复发中肉眼分析更有价值 ;18FDG -PET较CT/MRI更为准确。

Hepatocellular carcinoma treated with interventional procedures:CT and MRI follow-up

In the past decade, a variety of interventional procedures have been employed for local control of hepatocellular carcinoma (HCC). These include transcather arterial chemoembolization (TACE) and several tumour ablation techniques, such as percutaneous ethanol injection (PEI),radio-frequency ablation (RFA), or percutaneous microwave coagulation therapy (PMC), laser-induced interstitial thermotherapy (LIFr), etc. For a definite assessment of the therapeutic efficacy of interventional procedures,histological examination using percutaneous needle biopsy may be the most definite assessment of the therapeutic efficacy of interventional therapy, however, it is invasive and the specimen retrieved does not always represent the entire lesion owing to sampling errors. Therefore, computed tomography (CT) and magnetic resonance imaging (MRI) play a crucial role in follow-up of HCC treated by interventional procedures, by which the local treatment efficacy, recurrent disease and some of therapy-induced complications are evaluated. Contrast enhanced axial imaging (CT or MR imaging) may be the most sensitive test for assessing the therapeutic efficacy. The goal of the review was to describe the value of CT and MRI in the evaluation of interventional treatments.

Combined interventional therapies of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most commonmalignancies in the world, responsible for an estimated one million deaths annually. It has a poor prognosis due to its rapid infiltrating growth and complicating liver cirrhosis.Surgical resection, liver transplantation and cryosurgery are considered the best curative options, achieving a high rate of complete response, especially in patients with small HCC and good residual liver function. In nonsurgery, regional interventional therapies have led to a major breakthrough in the management of unresectable HCC, which include transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave coagulation therapy (MCT), laser-induced thermotherapy (LITT), etc. As a result of the technical development of locoregional approaches for HCC during the recent decades,the range of combined interventional therapies has been continuously extended. Most combined multimodal interventional therapies reveal their enormous advantages as compared with any single therapeutic regimen alone,and play more important roles in treating unresectable HCC.

CT perfusion at early stage of hepatic diffuse disease

AIM: To determine the validity of the non-invasive method of CT perfusion (CTP) in rat model of hepatic diffuse disease. METHODS: Twenty-eight Wistar rats were divided into two groups. Liver diffuse lesions were induced by diethyln-itrosamine in 14 rats of test group. Rats in control group were bred with pure water. From the 1st to 12th wk after the test group was intervened, both groups were studied every week with CTP. CTP parameters of liver parenchyma in different periods and pathologic changes in two groups were compared and analyzed. RESULTS: The process of hepatic diffuse lesions in test groups was classified into three stages or periods according to the pathologic alterations, namely hepatitis, hepatic fibrosis, and cirrhosis. During this period, hepatic artery flow (HAF) of control group declined slightly, mean transit time (MTT), blood flow (BF) and volume (BV) increased, but there were no significant differences between different periods. In test group, HAF tended to increase gradually, MTT prolonged obviously, BV and BF decreased at the same time. The results of statistical analysis revealed that the difference in the HAF ratio of test group to control group was significant. The ratio of BV and BF in test group to control group in stage of hepatitis and hepatic cirrhosis, hepatic fibrosis and early stage of hepatic cirrhosis was significantly different, but there was no significant difference between hepatitis and hepatic fibrosis. The main pathological changes in stage of hepatitis were swelling of hepatic cells, while sinusoid capillarization and deposition of collagen aggravated gradually in the extravascular Disse's spaces in stage of fibrosis and early stage of cirrhosis. CONCLUSION: The technique could reflect some early changes of hepatic blood perfusion in rat with liver diffuse disease and is valuable for their early diagnosis.

Assessment of hepatocellular carcinoma vascularity before and after transcatheter arterial chemoembolization by using first pass perfusion weighted MR imaging

AIM:To assess the vascularity of hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE) with the quantitative parameters obtained by first pass perfusion weighted MR imaging (FP-MRI). METHODS:Seventeen consecutive patients with one to three lesions in liver underwent FP-MRI before treatment. FP-MRI was also performed one,three,six,nine months, and one year after TACE.The baseline signal intensity (SO) of pre-TACE and one month after TACE was analyzed,the vascularity of HCC assessed by steepest slope of the signal intensity versus time curves (SS) was blindly correlated with their DSA feature and clinical outcome. RESULT:No significant difference was found on baseline signal intensity (S0) between pre-TACE and one month after TACE (F=0.309,P=0.583),The SS (mean,32% per second) of lesion one month after TACE was lower than that of pre-TACE (mean,69% per second),but with no statistical significance (F=3.067,P=0.092).When local recurrence occurred,the time intensity curves became steeper.The vascularity of HCC before and after TACE graded by SS closely correlated with that by DSA (K=0.453,P<0.05). CONCLUSION:FP-MRI is a useful criterion for selecting effective interventional treatment for patients with HCC in their initial treatment and during follow up.

The value and limitation of transcatheter arterial chemoembolization in preventing recurrence of resected hepatocellular carcinoma

AIM: To evaluate the value and limitation of postoperative transcatheter arterial chemoembolization (TACE) in preventing recurrence of hepatocellular carcinoma (HCC). METHODS: In the first group, 987 postoperative patients with HCC, who did not have any evidence of recurrence in the first preventative TACE but were found to have recurrence at different times during the follow-up survey, were analyzed. In the second group, 643 postoperative patients with HCC had no TACE for compared study. To study the relationship between the recurrence time and the number of TACE treatments was analyzed. RESULTS: The 6-, 12-, and 18-mo recurrence rates in the first and second groups were 22.2% (210 cases) vs 61.6% (396 cases), 78.0% (770 cases) vs74.7% (480 cases) and 88.6% (874 cases) vs80.1% (515 cases). There were significant differences between the recurrence rates of the two groups at 6 mo (P＜0.0001).CONCLUSION: The principal role of TACE after HCC operation is to suppress, detect early and treat micrometastasis. It has a good effect of preventing recurrence of HCC in 6 mo, but such an effect is less satisfactory in a longer period. When it is uncertain whether HCC is singlecentral or multi-central and if there is cancer residue or metastasis after operation, TACE is valuable to prevent recurrence.

Changes of tumor microcirculation after transcatheter arterial chemoembolization:First pass perfusion MR imaging and Chinese ink casting in a rabbit model

AIM: To observe the change of tumor microcirculation after transcatheter arterial chemoembolization (TACE) with bletilla microspheres by using first pass perfusion MR imaging (FP) and Chinese ink casting.METHODS: VX2 carcinoma cells were surgically implanted into the left and right lobes of liver of 30 New Zealand white rabbits, which were divided into 3 groups at random. Emulsion of lipiodol mixed with mitomydn C, and 5-FU bletilla microspheres were injected into the hepatic artery respectively, and saline was used as control agent. MR imaging was performed with turbo-flash sequence 14 d after tumor implantation and 7 d after interventional therapy. The steepest slopes (SS) of the signal intensity versus time curves were created for quantitative analysis, 7.5% Chinese ink gelatin solution was injected through ascending artery (17 cases) or portal vein(2 cases) for lesion microvessel area (MVA) measurement after the last MRI examination.The correlation between perfusion imaging and MVA was studied blindly.RESULTS: The SS values at the rim of tumor in lipiodol group (mean, 49% per second) and bletilla group (mean,35% per second) were significantly decreased (P<0.05) as compared with control group (mean, 124% per second), no difference was found between lipiodol and bletilla groups(P>0.05). In lipiodol group, the MVAs (24 974±11 836μm^2) in the center of the tumor were significantly smaller than those of the control group (35 510±15 675 μm^2) (P<0.05),while the MVAs (80 031±22 745 μm^2) around the tumor were significantly increased because small and dense plexuses appeared around the tumor which correlated to intense reaction of granulation tissue. None of the vessels was seen in the tumor in bletilla group, the peripheral MVAs of the tumor were significantly smaller than those of the control group (P<0.05) and lipiodol group (P<0.05). There was a good correlation between SS and MVAs in control group (rsl, 0.985, P<0.0001) and bletilla group (rsl, 0.743,P<0.05), the correlation was not significant in lipiodol group(rsl, 0.527, P>0.05).CONCLUSION: TACE with bletilla microspheres may enhance its anti-tumor effect by inhibiting the angiogenesis,and FP-MRI provides useful information to assess the TACE effect by depicting tumor vascularization and perfusion,

Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma

AIM:To evaluate long-term effect of ethanol embolization for the treatment of hepatocellular carcinoma (HCC) with severe hepatic arterioportal shunt (APS), compared with Gelfoam embolization.METHODS:Sixty-four patients (ethanol group) and 33 patients (Gelfoam group) with HCC and APS were respectively treated with ethanol and Gelfoam for APS before the routine interventional treatment for the tumor. Frequency of recanalization of shunt, complete occlusion of the shunt,side effects, complications, and survival rates were analyzed between the two groups.RESULTS: The occlusion rate of APS after initial treatment in ethanol group was 70.3%(45/64), and recanalization rate of 1 month after embolization was 17.8%(8/45),and complete occlusion rate was 82.8%(53/64).Those in Gelfoam group were 63.6%(21/33), 85.7%(18/21), and 18.2%(6/33).There were significant differences in recanalization rate and complete occlusion rate between the two groups (P<0.05).The survival rates in ethanol group were 78% at 6 months,49% at 12 months, 25% at 24 months, whereas those in Gelfoam group were 58% at 6 months, 23% at 12 months,15% at 24 months.The ethanol group showed significantly better survival than Gelfoam group (P<0.05). In the ethanol group, there was a significant prolongation of survival in patients with monofocal HCC (P<0.05) and Child class A (P<0.05).There were no significant differences in survival rate in the Gelfoam group with regard to the number of tumor and Child class (P>0.05). The incidence rate of abdominal pain during procedure in ethanol group was 82.8%.There was no significant difference in postembolization syndromes between two groups. Procedure-related hepatic failure did not occur in ethanol group.CONCLUSION: Ethanol embolization for patients with HCC and severe APS is efficacious and safe, and may contribute to prolongation of the life span versus Gelfoam embolization.

Transjugular intrahepatic portosystemic shunt for palliative treatment of portal hypertension secondary to portal vein tumor thrombosis

AIM: To evaluate the palliative therapeutic effects of transjugular intrahepatic portosystemic shunt (TIPS) in portal vein tumor thrombosis (Pv-n-) complicated by portal hypertension.METHODS: We performed TIPS for 14 patients with PVTT due to hepatocellular carcinoma (HCC). Of the 14 patients,8 patients had complete occlusion of the main portal vein,6 patients had incomplete thrombosis, and 5 patients had portal vein cavernous transformation. Clinical characteristics and average survial time of 14 patients were analysed.Portal vein pressure, ascites, diarrohea, and variceal bleeding and circumference of abdomen were assessed before and after TIPS.PESULTS: TIPS was successful in 10 cases, and the successful rate was about 71%. The mean portal vein pressure was reduced from 37.2 mmHg to 18.2 mmHg. After TIPS, the ascites decreased, hemorrhage stopped and the clinical symptoms disappeared in the 10 cases. The average survial time was 132.3 d. The procedure failed in 4 cases because of cavernous transformation in portal vein and severecirrhosis.CONCLUSION: TIPS is an effective palliative treatment to control hemorrhage and ascites due to HCC complicated by PVTT.

Imaging diagnosis of 12 patients with hepatic tuberculosis

AIM: To assess CT, MR manifestations and their diagnostic value in hepatic tuberculosis. METHODS: CT findings in 12 cases and MR findings in 4 cases of hepatic tuberculosis proved by surgery or biopsywere retrospectively analyzed. RESULTS: (1) CT findings: One case of serohepatic type of hepatic tuberculosis had multiple-nodular lesions in the subcapsule of liver. Parenchymal type was found in 10 cases, including multiple, miliary, micronodular and low-density lesions with miliary calcifications in 2 cases; singular, low-density mass with multiple flecked calcifications in 3 cases; multiple cystic lesions in i case; multiple micronodular and low-density lesions fusing into multiloculated cystic mass or 'cluser' sign in 3 cases; and singular, macronodular and low-density lesion with multiple miliary calcifications in 1 case. One case of tuberculous cholangitis showed marked dilated intrahepatic ducts with multiple flecked calcifications in the porta hepatis. (2) MR findings in 4 cases were hypointense on both Tl-weighted imagings and T2-weighted imagings in one case, hypointense on Tl-weighted imagings and hyperintense on T2-weighted imagings in 3 cases. Enhanced MR in 3 cases was slightly shown peripheral enhancementor with multilocular enhancement. CONCLUSION: Various types of hepatic tuberculosis have different imaging findings, and typical CT and MR findingscan suggest the diagnosis.

Multidetector CT in evaluating blood supply of hepatocellular carcinoma after transcatheter arterial chemoembolization

AIM:To assess the value of multidetector-row computed tomography (MDCT) in choosing retreatment methods of hepatocellular carcinoma (HCC) through evaluating the blood supply of low-density area of HCC after transcatheter arterial chemoembolization (TACE).METHODS: Thirty-two patients with HCC after TACE treatment were examined by plain scanning and hepatic multidetector-row CT. The location of low-density area on plain scanning and the enhancement patterns on dynamic contrast-enhanced scanning were observed. At the same time, three-dimensional CT(3D CT) models of the volume rendering, curved multiplanar reformations, surface shaded display and maximum intensity projection reconstruction of the hepatic artery and portal vein were performed in 6 cases.RESULTS: In CT plain scanning data, low density areas of 32 cases of HCC after TACE treatment were divided into three types: peripheral, one-side-located and mixed types.In contrast-enhanced CT scans, the blood supply of low-density area was classified into four types: arterial blood supply (20 cases), portal blood supply (5 cases), arterial combined with portal blood supply (5 cases) and poor blood supply (2 cases). In 6 cases, the relationship between the low-density area and branches of hepatic artery as well asportal vein was shown by 3D CT.CONCLUSION: Hepatic MDCT is an effective method for evaluating the blood supply of low-density area and therapeutic effect of HCC after TACE treatment. Types of blood supply is helpful for the selection of retreatment.

CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes. METHODS: CT-cjuided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and styler, a disposable curved tip (25 G) and a fine styler. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors,multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curvedneedle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle.RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRi) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors,respectively. Among the 8 tumors sizing up to 3 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases.In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3 times of PEI, all the foci treated were completely necrotic and smaller demonstrated by dynamic contrast-enhanced CT or MRI 3 months later. CONCLUSION: CT-guided PEI using a disposable curved needle is effective, time-saving and convenient, providing an alternative therapy for the treatment of malignant liver tumors and their retroperitoneal lymph node metastases.

Spiral CT in gastric carcinoma:Comparison with barium study,fiberoptic gastroscopy and histopathology

AIM: To evaluate spiral computed tomography (CT) including virtual gastroscopy for diagnosis of gastric carcinoma in comparison with upper gastrointestinal series (UGI),fiberoptic gastroscopy (FG) and histopathology.METHODS: Sixty patients with histologically proven gastric carcinoma (54 advanced and 6 early) were included in this study. The results of spiral CT were compared with those of UGI and FG. Two observers blindly evaluated images of spiral CT and UGI and video recording of FG with consensus in terms of diagnostic confidence with a five-point scale.Sensitivities of lesion detection, Borrmann′s classification of spiral CT, UGI and FG, as well as the accuracy of TNM staging of spiral CT were determined by comparing them to surgical and histological findings.RESULTS: The lesion detection rate was 98 % (59/60),95 % (57/60) and 98 % (59/60) for spiral CT, UGI and FG,respectively. There were no statistical differences in the detection sensitivity among the three techniques (P＞0.05).For the sensitivity in Borrmann′s classification, spiral CT was higher than that of UGI (P=0.025) and similar to that of FG (P＞0.05). The accuracy of spiral CT in staging the gastric carcinoma was 76.7 %. Six cases of early gastric carcinoma were all detected by spiral CT as well as FG.CONCLUSION: Spiral CT is equivalent to UGI and FG in the detection of gastric carcinoma, and superior to UGI but similar to FG in the Borrmann′s classification of advanced gastric carcinoma. Spiral CT is more valuable than FG in the staging of gastric carcinoma.

Functional brain imaging in irritable bowel syndrome with rectal balloon-distention by using fMRI

AIM: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity is a key factor in the pathophysiology of IBS. The aim of this study was to examine the effect of rectal balloon-distention stimulus by blood oxygenation leveldependent functional magnetic resonance imaging (BOLDfMRI) in visceral pain center and to compare the distribution,extent, and intensity of activated areas between IBS patients and normal controls. METHODS: Twenty-six patients with IBS and eleven normal controls were tested for rectal sensation, and the subjective pain intensity at 90 ml and 120 ml rectal balloon-distention was reported by using Visual Analogue Scale. Then, BOLDfMRI was performed at 30 ml, 60 ml, 90 ml, and 120 ml rectal balloon-distention in all subjects. RESULTS: Rectal distention stimulation increased the activity of anterior cingulate cortex (35/37), insular cortex (37/37),prefrontal cortex (37/37), and thalamus (35/37) in most cases.At 120 ml of rectal balloon-distention, the activation area and percentage change in MR signal intensity of the regions of interest (ROI) at IC, PFC, and THAL were significantly greater in patients with IBS than that in controls. Score of pain sensation at 90 ml and 120 ml rectal balloon-distention was significantly higher in patients with IBS than that in controls. CONCLUSION: Using fMRI, some patients with IBS can be detected having visceral hypersensitivity in response to painful rectal balloon-distention. fMRI is an objective brain imaging technique to measure the change in regional cerebral activation more precisely. In this study, IC and PFC of the IBS patients were the major loci of the CNS processing of visceral perception.

Effects of p53 on apoptosis and proliferation of hepatocellular cardnoma cells heated with transcatheter arterial chemoembolization

AIM:To evaluate the effects of p53 on apoptosis and proliferation of hepatocellular carcinoma (HCC) cells treated with transcatheter arterial chemoernbolization (TACE).METHODS: A total of 136 patients with HCC received TACE and other management before surgery were divided into TACE group and non-TACE group.TACE group included 79 patients who had 1-5 courses of TACE before surgery,of them,11 patients had 1-4 courses of chemotherapy (group A),33 patients had 1-5 courses of chemotherapy combined with iodized oil (group B), 23 patients had 1-3 courses of chemotherapy,iodized oil and gelatin sponge (group C),12 patients had 1-3 courses of chemotherapy combined with iodized oil,ethanol and gelatin sponge (group D).Non-TACE group included the remaining 57 patients who had surgery only.The extent of apoptosis was analyzed by transferase mediated dUTP nick end labeling (TUNEL) staining.The expressions of p53, Bcl-2,Bax,Ki-67 and PCNA protein were detected by immunohistochemical method.RESULTS: P53 protein expressions in trabecular and clear cells in HCC specimens were significantly lower than that in pseudoglandar, solid, poorly differentiated or undifferentiated and sclerosis HCC (P<0.05) Expression of p53 protein in HCC cells increased with the increase of pathological grades(P<0.05),and correlated positively with expressions of Ki-67 and PCNA protein,and negatively with Bcl-2 to Bax protein expression rate and AI (P<0.05).Expression of p53 protein was significantly higher in group A than in groups B, C, D and the non-TACE group, and was higher in group B than in groups C and D,and lower in group D than in the non-TACE group (P<0.05).CONCLUSION:Expression of p53 protein can enhance proliferation of HCC cells and suppress apoptosis of HCC cells after TACE.

Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up

AIM: To determine the best method out of the three types of interventional procedure for achalasia based on a longterm follow-up.METHODS: The study cohort was comprised of 133 patients of achalasia. Among them, 60 patients were treated under fluoroscopy with pneumatic dilation (group A), 8 patients with permanent uncovered or antireflux covered metal stent dilation (group B), and 65 patients with temporary partially covered metal stent dilation (group C).RESULTS: One hundred and thirty dilations were performed on the 60 patients of group A (mean 2.2 times per case).The mean diameter of the strictured cardia was 3.3±2.1 mm before dilation and 10.6±3.8 mm after dilation. The mean dysphagia score was 2.7±1.4 before dilation and 0.9±0.3after dilation. Complications in group A were chest pain (n=30), reflux (n=16), and bleeding (n=6). Thirty-six patients (60 %) in group A exhibited dysphagia relapse during a 12-month follow-up, and 45 patients (90 %) out of 50 exhibited dysphagia relapse during a 36-month followup. Five uncovered and 3 antireflux covered expandable metal stents were permanently placed in the 8 patients of group B. The mean diameter of the strictured cardia was 3.4±1.9 mm before dilation and 19.5±1.1 mm after dilation.The mean dysphagia score was 2.6±1.3 before dilation and 0.4±0.1 after dilation. Complications in group B were chest pain (n=6), reflux (n＝5), bleeding (n=3), and hyperplasia of granulation tissue (n=3). Four patients (50 %) in group B exhibited dysphagia relapse during a 12-month followup, and 2 case (66.7 %) out of 3 patients exhibited dysphagia relapse during a 36-month follow-up. Sixty-five partially covered expandable metal stents were temporarily placed in the 65 patients of group C and withdrawn after 3-7 days via gastroscopy. The mean diameter of the strictured cardia was 3.3±2.3 mm before dilation and 18.9±3.5 mm after dilation. The mean dysphagia score was 2.4±1.3 before dilation and 0.5±0.2 after dilation. Complications in group C were chest pain (n=26), reflux (n=13), and bleeding (n=8).6 patients (9.2 %) out of 65 exhibited dysphagia relapse during a 12-month follow-up, and 8 patients (14.5 %) out of 55 exhibited dysphagia relapse during a 36-month followup. All the stents were inserted and withdrawn successfully.The follow-up in groups A-C lasted 12-96 months.CONCLUSION: Temporary partially covered metal stent dilation is one of the best methods with interventional procedure for achalasia in terms of long-term follow-up.

Adjustment of lipiodol dose according to tumor blood supply during transcatheter arterial chemoembolization for large hepatocellular carcinoma by multidetector helical CT

AIM: To work out an indMdualized lipiodol dose in transcabheter arterial chemoembolization (TACE) for large hepatocellular carcinoma (HCC) according to its blood supply evaluated by CT.METHODS: One hundred patients with large HCC (more than 8 cm in diameter) were studied by multidetector helical CT. Patterns of blood supply of HCC were divided into sufficient blood supply, poor blood supply, mixed blood supply and arteriovenous (A-V) shunt. The dose of ultrafluid lipiodol was determined by diameter and blood supply type of HCC. Patients were divided into two groups (50 cases each): lipiodol perfusion group and iodized oil perfusion group according to tumor diameter and the blood supply type of tumor.RESULTS: The confirmation and effective rates were 82%,84% in the first group and 36%, 46% in the second group (P<0.01).CONCLUSION: A relatively individualized lipiodol dose may be determined according to the blood supply pattern and the tumor diameter by CT imaging.