螺旋CT血管造影在主动脉病变中的应用

目的评价螺旋ＣＴ血管造影在主动脉病变中的作用。方法４２例主动脉病变患者进行了螺旋ＣＴ增强扫描,其中包括主动脉夹层、主动脉瘤、假性动脉瘤、主动脉缩窄和离断、大动脉炎。应用５ｍｍ床进速度和３或５ｍｍ层厚（螺距＝１．６７或１）进行扫描,在工作站进行各种重建。结果１４例主动脉夹层,多平面重组（ＭＰＲ）较好地显示夹层和血栓范围以及弓部血管受累情况;表面覆盖显示（ＳＳＤ）见内膜片呈螺旋状剥离,不能区分真假腔;最大密度投影（ＭａｘＩＰ）不能提供更多的信息。２２例腹主动脉瘤（ＡＡＡ）,ＳＳＤ清晰显示动脉瘤的范围和与周围血管的关系;ＭＰＲ显示壁内血栓的范围;ＭａｘＩＰ则显示了血管壁的钙化和血管内支架的位置及支架周围情况。ＭＰＲ较好显示了假性动脉瘤与管腔的关系及动脉破口。３例先天性主动脉病变,ＳＳＤ能清晰显示血管的连接关系,而ＭａｘＩＰ和ＭＰＲ不能提供更多的信息。结论螺旋ＣＴ血管造影是评价主动脉病变较好的影像方法,可为临床治疗提供更多的信息     

颈胸部螺旋CT血管成像的临床应用评价

目的：探讨颈胸部螺旋ＣＴ血管成像（ＳＣＴＡ） 的合理检查技术及临床应用价值。方法：５６ 例颈、胸部ＳＣＴＡ病例，其中，２１例为血管性疾病，３５ 例为正常血管结构。均采用ＳＣＴ容积增强扫描，传输到工作站后处理成像，获得血管的三维（３Ｄ） 、四维（４Ｄ）及多平面重组（ＭＰＲ） 图像。结果：２１ 例血管病变３Ｄ、４Ｄ及ＭＰＲ图像，可直观、立体、多角度观察管腔及管壁形态，并显示感兴趣血管的立体结构及与周围组织的关系。结论：ＳＣＴＡ是有效的无创伤性血管成像技术，能准确地诊断颈、胸部血管病变，对指导手术有重要意义。     

CT仿真结肠镜与其他后处理方法检查结直肠息肉的比较研究

目的 比较研究多平面重建（ＭＰＲ）、ＣＴ仿真结肠镜检查（ＣＴＶＣ）,表面遮盖显示（ＳＳＤ）和透明显示（Ｒａｙｓｕｍ）检查结直肠息肉的临床价值。材料与方法 用螺旋ＣＴ机对２３例结直肠息肉病例进行容积扫描,在工作站应用４种后处理方法获取ＭＰＲ、ＣＴＶＣ、ＳＳＤ和Ｒａｙｓｕｍ图像。按息肉大小分３组及总结果进行统计分析。病变均经常规结肠镜检查（ＣＣ）活检和／或手术病理证实。结果 ２３例共５６枚息肉。ＭＰＲ     

螺旋CT表面遮盖法及多平面重组对骨病变的诊断价值

目的: 探讨螺旋CT三维(3-D)表面遮盖法(SSD)和多平面重组(MPR)立体和多方位显示骨病变,比较与常规CT的优缺点.材料与方法: 选择30例典型病例,均经临床或手术病理证实.全部数据输入工作站进行图像处理.结果: SSD很好地立体展现了骨病变,MPR可从任意平面观察并能进行位置调整.结论: SSD和MPR在影像显示上有独特的优势,可立体或任意平面观察病变,改变了影像思维方式,有助于影像与实际解剖相结合.     

螺旋CT三维和多平面重建在髋臼骨折中的应用

目的 探讨螺旋ＣＴ（ＳＣＴ）三维和多平面重建在髋臼骨折中的临床价值。材料与方法 分析１６例髋臼骨折的轴位、多平面ＣＴ及三维ＣＴ表现。结果 表面重建（ＳＳＤ）对１４例超过２ｍｍ的骨折均很好显示,但对于２ｍｍ以下移位显示较差,多平面重建（ＭＰＲ）良好显示髋臼负重区的损伤及稳定性。结论 ＳＣＴ三维重建和ＭＰＲ对复杂的髋臼骨折的术前分类、指示手术入路及估计预后均有重要的临床意义。     

螺旋CT门静脉血管造影对肝炎后肝硬化门静脉高压的诊断和评价

目的：探讨螺旋ＣＴ门静脉血管造影（ＳＣＴＰ）及三维重建对肝炎后肝硬化门静脉高压的诊断和临床应用价值。方法：５７例肝炎后肝硬化患者行ＳＣＴＰ及三维重建。三维重建方法包括最大强度投影（ＭＩＰ）,表面阴影成像（ＳＳＤ）和多平面重建（ＭＰＲ）。结果：ＭＩＰ和ＳＳＤ显示５１例门静脉１～２级分支增粗,肝内门静脉２组以下分支细小、扭曲,３５例呈枯枝或残根状。６例仅见门静脉１～２级分支增粗,肝内门静脉２级以下分支     

螺旋CT三维成像在诊断气管、支气管疾病中作用的评价

目的 评价综合运用三维成像技术在诊断气管、支气管疾病中的作用。材料与方法 选择５３直支气管以上气道疾病患者行高档螺旋ＣＴ扫描,将容积扫描数据预处理后传至计算机工作站,分别用ＣＴ仿真支气管内镜（ＣＴＶＢ）,表面遮盖显示法（ＳＳＤ）,最大强度投影（ＭＩＰ）,最小强度投影（Ｍｉｎ ＩＰ）,多平面重构（ＭＰＲ）进行重建,分析影像学表现,４例与手术标本进行对照。结果 在轴位图像基础上,气管肿瘤在ＭＰＲ、ＣＴ     

骨关节创伤的螺旋CT三维影像应用研究

目的：探讨螺旋ＣＴ三维影像（ＳＳＤ和ＭＰＲ）在骨关节创伤中的应用价值及相关的技术要点。方法：研究经Ｘ线和螺旋ＣＴ证实的骨关节创伤病例８５例。扫描参数：（１）３ｍｍ层百,４．５ｍｍ床速和１￣２ｍｍ重建间距;（２）５ｍｍ层厚、５￣７．５ｍｍ床速和２ｍｍ重建间距;作ＳＳＤ时阈值范围之低值为１２０￣１８０,观察ＳＳＤ和ＭＰＲ的窗宽和窗位分别为３０００￣３２００、１０００￣１２００和８００￣１０００、２５０     

颅内病变三维CT成像技术的临床应用

目的：探讨三维ＣＴ成像在颅内病变中的临床应用价值。材料与方法：对７１例颅内病变患者行螺旋ＣＴ增强扫描,然后对颅内血管和／或病变进行三维重建。其中２３例进行ＣＴ血管造影（ＣＴＡ）扫描,４８例非ＣＴＡ扫描。结果：（１）２３例ＣＴＡ扫描者,血管表面遮盖法（ＳＳＤ）与最大强度投影法（ＭＩＰ）重建都能显示颅内动脉的第３组分支。ＳＳＤ对显示血管的立体空间关系比较直观;ＭＩＰ图像类似ＤＳＡ图像。（２）３３例颅内     

正常听骨链的CT仿真内镜和三维重建

探讨正常听骨链ＣＴ仿真内镜（ＣＴＶＥ）和三维（３Ｄ）重建方法及其应用价值。材料和方法：２０例无中耳疾病者采用层厚１．０ｍｍ、螺距１．０轴位薄层扫描,骨算法、０．１ｍｍ～０．２ｍｍ间隔重建,分别做ＣＴＶＥ成像、表面（ＳＳＤ）和骨最大密度投影（ＭＩＰ）３Ｄ重建,观察和比较ＣＴＶＥ和３Ｄ显示正常听骨链的能力。结果：ＣＴＶＥ上,锤、砧骨及锤砧关节显示率都是１００％,镫骨底板显示率为３５％,仅２５％能分辨镫     

A simplified method for continuous hepatic arterial port-catheter system placement not requiring catheter end-hole occlusion

Purpose: To evaluate the efficacy of hepatic port-catheter system placement without distal catheter tip occlusion or gastroduodenal artery embolization distal to the catheter tip.

Material and Methods: A port-catheter system was percutaneously implanted in 29 patients (16 men, 13 women; mean age 65.6 years) with unresectable liver cancer. Persistent blood flow through the end hole of the catheter was verified immediately and 1-10 days after catheter placement.

Results: In all cases, percutaneous port-catheter placement was successfully performed. In seven of 29 (24.1%) patients, flow through the end hole of the catheter was verified immediately after the procedure. However, no flow was seen 1-10 days after the procedure.

Conclusion: It is not necessary to occlude the end hole of the catheter tip and embolize the gastroduodenal artery beyond the catheter tip when placing a port-catheter system for repeated hepatic arterial infusion chemotherapy.     

Management of end hole in placement of port-catheter system for continuous hepatic arterial infusion chemotherapy using the fixed catheter tip method

OBJECTIVE: The purpose of our study was to compare persistent hepatofugal blood flow in the gastroduodenal artery after implanting a port-catheter system for repeated hepatic arterial infusion chemotherapy using either the original or the modified fixed catheter tip method. With the original method the lumen of the catheter tip is closed with a microcoil; with the modified method it is left open. Persistent hepatofugal blood flow can induce reactive gastric or duodenal mucosal lesions. MATERIALS AND METHODS: A port-catheter system with the catheter tip fixed to the gastroduodenal artery by embolic agents was percutaneously implanted in 156 patients (102 men, 54 women; mean age, 63.2 years) with unresectable liver cancer. In 98 patients the original method was used, and in 58 patients the modified method was used. Existence of persistent blood flow beyond the indwelling catheter tip as shown on arteriography via the port performed immediately and 2-10 days after port-catheter placement was compared between these two groups. RESULTS: In all cases, percutaneous port-catheter placement was successfully performed. In one (1.0%) of 98 procedures involving the original method, the gastroduodenal artery was detected on arteriography just after implantation, compared with 23 (39.7%) of 58 procedures using the modified method. However, arteriography performed 2-10 days (mean, 5.02 days) after implantation detected the gastroduodenal artery in only one case. CONCLUSION: This retrospective study indicates that closure of the end hole appears to occur spontaneously shortly after implantation. Thus, such closure is not always necessary to avoid persistent hepatofugal blood flow in the gastroduodenal artery.     

Percutaneous gastrostomy and gastrojejunostomy with gastropexy: experience in 701 procedures.

PURPOSE: To evaluate the safety and efficacy of fluoroscopically directed percutaneous gastrostomy and gastrojejunostomy catheter placement with gastropexy. MATERIALS AND METHODS: The authors retrospectively reviewed the charts from 643 patients referred for fluoroscopically directed percutaneous gastrostomy or gastrojejunostomy during a 9 1/2-year period. In 615 patients, placement was attempted with use of three T-fastener gastropexy devices followed by percutaneous gastric puncture. Placement of a 14-F gastrostomy or gastrojejunostomy catheter was then accomplished with the Seldinger technique. RESULTS: A catheter could not be placed in 28 patients (4.4%) owing to overlying viscera or prior gastric surgery. In the remaining patients, 701 procedures, including revisions, were performed, including 643 gastrojejunostomies (92%) and 58 gastrostomies (8.3%). The success rate for catheter placement was 100%. Revision was necessary in 83 instances in 64 patients (13.5%). Forty-six (55%) of these were attributed to tube dislodgment, but only two repeat gastric punctures were necessary secondary to tract disruption. There were three major complications (0.5%) and 29 minor complications (5.3%). No complications were attributed directly to gastropexy. Thirty-day follow-up data were available for 393 patients (64%), and 14-day follow-up data were available for 550 (89%). The 30-day mortality rate was 5.8% (23 of 393 patients); none of the deaths were related to the procedure. CONCLUSION: Fluoroscopically directed percutaneous placement of gastrostomy and gastrojejunostomy catheters with routine gastropexy is a safe procedure. Catheter revision was necessary in 13% of patients and was usually secondary to tube dislodgment, with tract disruption an unusual complication.     

Percutaneous catheter placement for hepatic arterial infusion chemotherapy

Hepatic arterial infusion chemotherapy employs a hepatic artery catheter as a conduit to achieve a high concentration of antineoplastic agents to liver tumors. Historically, this catheter placement has been performed via laparotomy. However, it may now be performed using less-invasive percutaneous image guided procedures. There are many anatomical hepatic arterial variations and complicated blood flow patterns. Various techniques are required to ensure high concentration of antineoplastic agents in liver tumors. These techniques are composed of arterial redistribution by embolization, percutaneous catheter placement applying "tip-fixation method," and evaluation and management of flow patterns that reflect drug distribution. The role of interventional radiologists in hepatic arterial infusion chemotherapy is to create and manage the access to achieve these objectives.     

Percutaneous femoral catheter placement for long-term chemotherapy infusions: preliminary technical results

OBJECTIVE: The purpose of our study was to evaluate the feasibility and usefulness of using a port-catheter system equipped with a W-spiral catheter for hepatic chemotherapy; this novel catheter does not require fixation by pericatheter embolization and can be safely withdrawn when not needed. SUBJECTS AND METHODS: Sixty-one patients (40 men and 2l women; mean age, 59 years) with advanced liver cancers (primary hepatic or biliary cancer [n = 31] and metastatic liver cancer [n = 30]) underwent percutaneous port-catheter placement with the tip of W-spiral catheter inserted into the right gastroepiploic artery and the side-hole opened at the common hepatic artery after embolization of the right gastric artery, pancreaticoduodenal arteries, or aberrant hepatic arteries. Pericatheter embolization for preventing catheter dislodgement was not performed. The technical success of port-catheter placement, clinical patency of the port-catheter system, and technical success of port-catheter removal were evaluated. RESULTS: Percutaneous port-catheter placement using this method was successfully performed in 59 (97%) of 61 patients. Subsequently, chemotherapy was successfully performed through the port in 57 (93%) of 61 patients. Complications during and after the procedure were observed in two (3%) of 61 patients and 12 (20.7%) of 58 patients. Hepatic artery thrombosis occurred in two (3.4%) of 58 patients. The port-catheter removal and the catheter replacement were performed in eight and four patients, respectively, who wanted the procedure. It was completed successfully without any complications. CONCLUSION: This method of implantation of a port-catheter system appeared to offer clinical advantages of safe catheter removal, femoral artery access, and an acceptable complication rate.     

Hepatic arterial infusion chemotherapy using percutaneous catheter placement with an implantable port: assessment of factors affecting patency of the hepatic artery

OBJECTIVE: To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously. PATIENTS AND METHODS: Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed. RESULTS: Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method (P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE (P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE. CONCLUSION: We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.     

Using n-butyl cyanoacrylate and the fixed-catheter-tip technique in percutaneous implantation of a port-catheter system in patients undergoing repeated hepatic arterial chemotherapy

OBJECTIVE: The purpose of our study was to evaluate the usefulness of adding n-butyl cyanoacrylate to microcoils to fix the catheter tip in percutaneous implantation of a port-catheter system for hepatic arterial-infusion chemotherapy. SUBJECTS AND METHODS: Ninety-three patients (64 men and 29 women; age range, 38-83 years; mean age, 62.2 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system with the catheter tip fixed at the gastroduodenal artery with microcoils and a mixture of n-butyl cyanoacrylate and iodized oil. The rates of successful implantation and complications closely associated with this technique and management of the complications were reviewed. RESULTS: Percutaneous port-catheter placement was successfully performed in all patients. However, in eight patients, complications occurred: hepatic arterial obstruction (n = 5, 5.4%); catheter dislocation (n = 2, 2.2%); recanalization of the gastroduodenal artery (n = 1, 1.1%); or movement of n-butyl cyanoacrylate (n = 1, 1.1%). In five of the eight patients with complications, hepatic arterial-infusion chemotherapy was continued either after observation of the patient to ensure that stability had been established or after treatment using comparatively easy interventional techniques. In three (3.2%) of the 93 patients, planned hepatic arterial-infusion chemotherapy could not be performed because of complications associated with the technique. CONCLUSION: Fixation of the catheter tip in the gastroduodenal artery using a combination of microcoils and a mixture of n-butyl cyanoacrylate and iodized oil is a useful and safe technique in percutaneous port-catheter placement for repeated hepatic arterial infusion chemotherapy.     

Value of Micronester coils in port-catheter implantation for continuous hepatic arterial infusion chemotherapy with fixed catheter tip method

To retrospectively evaluate the use of Micronester coils in port-catheter implantation with the fixed catheter tip method in comparison with other previously used coils. The cohort of this study was 143 consecutive patients with unresectable advanced liver cancer for whom a port-catheter system was percutaneously implanted. In the most recent 32 patients, Micronester coils were used for catheter tip fixation. Details of embolic agents for fixation, persistent blood flow beyond the distal end of the indwelling catheter, and complications were compared between cases without and with Micronester coils. In all, percutaneous port-catheter placement was successful. Mean number of coils used for fixation was 4.2 without Micronester coils vs. 2.5 with Micronester coils. N-butyl cyanoacrylate (NBCA)-Lipiodol was additionally used for catheter tip fixation in 85.6% of 111 procedures without Micronester coils and in 50% of 32 using Micronester coils. The gastroduodenal artery beyond the distal end was not detected at the final examination after any procedure. Catheter dislocation occurred in five and hepatic arterial obstruction or severe stenosis in eight. The number of coils used and necessity of NBCA-Lipiodol could be decreased with usage of Micronester coils without decreasing fixation ability compared to other coils.     

Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy

The purpose of this paper is to present our experience with real-time computed tomography (CT) fluoroscopy guided percutaneous nephrostomy (PNT) and to describe this technique involving puncture under laser guidance. We attempted 30 placements in 25 patients: puncture was directed by laser guidance and placement of the tube was made under real time CT fluoroscopy. 25 procedures were performed in prone position and 5 procedures in the supine position. The time necessary for the procedure ranged from 10 to 45 min (mean 25 min). The average duration of CT fluoroscopy per placement was 49 seconds (range 7–110 s). The PNT placement was successful as a sole procedure including puncture and catheter placement in 24 of 30 cases; in the remainder of cases, puncture was performed under CT guidance but the catheter was definitively positioned in conventional fluoroscopy. The CT fluoroscopy technique allows routine, efficient and safe PNT placement, especially when encountering difficult access to the pelvicaliceal system. Received: 9 June 1999; Revised: 12 November 1999; Accepted: 12 November 1999     

Catheter placement in the right gastroepiploic artery without fixation using a W spiral catheter for implantable reservoir therapy of malignant liver tumors

Intra-arterial infusion chemotherapy using a percutaneously implanted port-catheter system was performed in 21 patients with liver tumors. We developed a new procedure, the gastroepiploic method, using a W Spiral Catheter without embolization around/within the catheter and embolization for the right gastroepiploic artery distal to the catheter tip. After embolizing the gastroduodenal arterial branches, right gastric artery, or aberrant hepatic arteries, we mainly inserted the catheter tip into the right gastroepiploic artery. There were no complications such as peptic ulcer, hepatic artery obstruction, or catheter dislocation (observation time, 5.3 months). This method seemed to be feasible for implantable reservoir therapy of patients with malignant liver tumors.