Tumor tissue characterization evaluating the luciferase activity under the control of a hsp70 promoter and MR imaging in three tumor cell lines

Severe stenosis/occlusion of the proximal celiac trunk due to median arcuate ligament compression (MALC), arteriosclerosis, pancreatitis, tumor invasion, and celiac axis agenesis has been reported. However, clinically significant ischemic bowel disease attributable to celiac axis stenosis/occlusion appears to be rare because the superior mesenteric artery (SMA) provides for rich collateral circulation. In patients with celiac axis stenosis/occlusion, the most important and frequently encountered collateral vessels from the SMA are the pancreaticoduodenal arcades. Patients with celiac artery stenosis/occlusion are treated by interventional radiology (IR) via dilation of the pancreaticoduodenal arcade. In patients with dilation of the pancreaticoduodenal arcade on SMA angiograms, IR through this artery may be successful. Here we provide several tips on surmounting these difficulties in IR including transcatheter arterial chemoembolization for hepatocellular carcinoma, an implantable port system for hepatic arterial infusion chemotherapy to treat metastatic liver tumors, coil embolization of pancreaticoduodenal artery aneurysms, and arterial stimulation test with venous sampling for insulinomas.     

Aneurysms of the pancreaticoduodenal arteries in association with celiac axis occlusion

Four patients with aneurysms of the inferior pancreaticoduodenal artery are described. All had occlusion of the celiac axis at its origin, with the inferior pancreaticoduodenal arcades serving as a collateral pathway. We propose that the association of the celiac axis occlusion and aneurysms in the collateral supply via the pancreatic arcades is more than coincidental. Awareness of this relationship may be of significance in planning therapeutic intervention     

Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation.

Although celiac axis stenosis is a frequently encountered occlusive vascular disease, clinically significant ischemic bowel disease caused by celiac axis stenosis is rarely reported due to rich collateral circulation from the superior mesenteric artery (SMA). The most important and frequently encountered collateral vessels from the SMA in patients with celiac axis stenosis are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Subtypes of collateral pathways via the dorsal pancreatic artery include a longitudinal pathway between the celiac branches and the SMA or its branches and a transverse pathway to either the splenic or gastroduodenal artery. A communicating channel between the right hepatic artery and the SMA can be a route for collateral circulation. Hepatic artery variants cause the development of unique collateral pathways that have different characteristics depending on the type of variant. These collateral pathways include intrahepatic interlobar collateral vessels, right gastric to left gastric arterial anastomoses, left hepatic to left gastric arterial anastomoses, and peribiliary arterial plexuses. Major collateral pathways in patients with celiac axis stenosis can be identified with spiral CT, and knowledge concerning this collateral circulation may be important for certain medical procedures such as interventional procedures for the management of hepatic tumors, pancreaticobiliary surgery, and liver transplantation.     

胰弓高流量灌注及其在肝癌介入治疗中的意义

目的探讨胰弓高流量灌注形成的原因、DSA表现及其在肝癌介入治疗中的意义。方法回顾性分析942例肝癌患者的腹腔动脉造影,发现33例患者存在肝癌胰弓高流量灌注现象,均经过胰弓对肝癌进行选择性肿瘤供血动脉栓塞治疗。结果33例胰弓高流量灌注患者中,肝总动脉闭塞25例(75.7%),腹腔干闭塞8例(24.3%)。引起胰弓高流量灌注的原因有:重复导管栓塞化疗23例(69.7%);肝动脉内置化疗药盒治疗7例(21.2%);腹腔干动脉硬化性闭塞症2例(6.1%);先天性肝动脉狭窄1例(3%)。胰弓供血的DSA表现类型为:单独前弓开放2例(6.1%),单独后弓开放7例(21.2%),前、后弓均开放24例(72.7%)。结论腹腔干闭塞和/或肝总动脉闭塞是引起胰弓高流量灌注的主要形成原因,胰弓供血在肝癌介入治疗中具有重要价值。     

Hepatic arterial embolization in cases of extensive celiac arterial stenosis.

Transarterial hepatic embolization was attempted in 10 and succeeded in nine patients with hepatocellular carcinoma accompanied by extensive celiac arterial stenosis. All catheterization was done through the femoral artery. In six cases, the tip of the catheter (2.5-F ball-tip microcatheter in three cases, 4-F ball-tip supple catheter in three cases) was placed in the proper hepatic artery through the pancreaticoduodenal collaterals. In three cases, a ball-tip microcatheter was injected from the guiding catheter, which was placed in a pinhole of the celiac trunk. These techniques involving flow-guided ball-tip catheters are of great value for hepatic arterial catheterization in cases of extensive celiac arterial stenosis.     

胰腺动脉螺旋CT解剖的研究--正常表现及临床意义

目的研究正常胰腺供血动脉的CT表现及变异,探讨显示胰腺供血动脉的最佳扫描方法.方法对50例非胰腺病变行上腹部增强CT扫描的病人,采用薄层动态、大剂量团注对比剂扫描,观察胰腺直接供血动脉与间接供血动脉(腹腔干、肝总动脉、脾动脉、胃十二指肠动脉和肠系膜上动脉)的CT表现,统计显示率. 结果胰腺间接供血动脉全部显示,直接供血动脉显示例数分别为胰十二指肠上前动脉48例(96%),胰十二指肠上后动脉30例(60%),胰十二指肠下前动脉31例(62%),胰十二指肠下后动脉18例(36%),胰背动脉20例(40%),胰大动脉13例(26%),胰横动脉6例(12%),胰尾动脉8例(16%).结论采用螺旋CT薄层扫描与重建技术、大剂量快速团注对比剂及合理的扫描延迟时间可得到胰腺供血动脉的良好显示.     

Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the reconstructed inferior phrenic artery: anatomical and technical analysis

PURPOSE: To evaluate reconstructed patterns of occluded inferior phrenic artery (IPA) and determine the technical success rate and complications of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) fed by the occluded IPA through the anastomosing branch. MATERIALS AND METHODS: In 19 patients, 24 IPAs, including two that had been previously embolized, were demonstrated through collateral pathways. The incidence of each collateral circulation was evaluated. Thirteen IPAs in 12 patients fed the tumor and TACE was attempted. TACE was performed only if the catheter could be advanced into the anastomosing branch so that the nontarget branches were avoided. RESULTS: A reconstructed unilateral IPA was observed in 14 patients (11 right IPAs and three left IPAs) and two reconstructed IPAs were observed in five. The IPA was demonstrated through the dorsal pancreatic artery (n = 13), inferior or middle adrenal artery (n = 7), left gastric artery (n = 2), contralateral IPA (n = 2), lumbar artery (n = 1), and small branch derived from the celiac trunk (n = 1). Five IPAs (21%) were demonstrated through more than two separate arteries, including two demonstrated through both dorsal pancreatic arteries arising from the celiac and superior mesenteric artery. The IPA opacified through the lumbar artery had been previously embolized. TACE of the reconstructed IPA was possible in 10 of 13 IPAs (77%). Complications related to the procedure were a small amount of pleural effusion (n = 4) and basal atelectasis (n = 2). CONCLUSION: The IPA is reconstructed mainly through the retroperitoneal anastomosing branch in the upper abdomen. TACE of the reconstructed IPA can be performed with a high success rate without major complications.     

肝癌合并腹腔动脉与肠系膜上动脉侧支循环通路假性闭塞(附12例报告)

目的：探讨肝癌合并腹腔动脉与肠系膜上动脉侧支循环通路假性闭塞的血管造影表现及其在介入治疗中的价值。方法：回顾性分析12例该类患者的肠系膜上动脉造影，腹腔动脉造影及介入治疗资料。结果：12例假性闭塞中，位于肝总动脉与腹腔动脉分叉处6例，肝总动脉分出胃十二指肠动脉支处5例，1例右肝动脉直接起源于腹腔动脉，并在其分叉处发生假性闭塞。在这12处假性闭塞中，于腹腔动脉造影时呈闭塞状态，而肠系膜上动脉造影却完全通畅，似静脉瓣样。并且导丝、导管能顺利通过该闭塞处。10例患者完成了肝动脉化疗栓塞术。结论：这一少见现象可能与其血液动力学改变和解剖学变异有关，了解此征象对于指导介入治疗有一定价值。     

Hepatic embolization through pancreaticoduodenal arcade: double catheter technique

Transcatheter arterial embolization through pancreaticoduodenal arcade was performed in a patient with hepatocellular carcinoma using double catheter technique. This method is very useful for hepatic embolization in patients with occlusion and stenosis of the celiac axis or common hepatic artery.     

螺旋CT对胰腺动脉解剖的初步研究

目的 探讨螺旋CT动脉期薄层扫描对胰腺动脉的显示情况。材料与方法 回顾性分析58例正常胰腺的螺旋CT动脉期薄层扫描（准直5mm,重建间距3mm）图像,由两位医师阅片并记录胰腺间接供血动脉（腹腔干、肝动脉、脾动脉、肠系膜上动脉、胃十二指肠动脉）和直接供血动脉（胰背、胰横、胰大、胰尾、胰十二指肠上前、上后、胰十二指肠下动脉）的显示率。结果 胰腺的间接供血动脉全部显示,直接供血动脉显示例数分别为胰背动脉36例（62％）,胰横动脉22例（38％）,胰大动脉6例（10％）,胰十二指肠上前动脉38例（66％）,胰十二指肠上后动脉15例（26％）,胰十二指肠下动脉26例（45％）。结论 螺旋CT动脉期薄层扫描能很好地显示胰腺间接供血动脉,但对胰腺直接供血动脉的显示率较低。     

A New Technique for Superselective Catheterization of Arteries: Preshaping of a Micro-Guide Wire into a Shepherd's Hook Form

Objective

We wanted to introduce a new technique for superselective catheterization of arteries with preshaping of a micro-guide wire into a shepherd''s hook form, and this is useful for superselection of small arteries branching at an acute angle from a large parent artery for the treatment of tumors and hemorrhages.

Materials and Methods

We developed a superselective catheterization technique by using preshaping of a micro-guide wire into a shepherd''s hook form. We encountered six patients in our practice for whom we failed to catheterize the small tumor-feeding arteries that branched at an acute angle from wide parent arteries during chemoembolization of hepatocellular carcinoma; the parent arteries were the right inferior phrenic artery (n = 4) and the left gastric artery (n = 1) from the celiac axis with celiac stenosis due to compression by the median arcuate ligament and the proper hepatic artery from the gastroduodenal artery (n = 1) in a patient who had celiac axis occlusion with collateral circulation via the pancreaticoduodenal arcade from the superior mesenteric artery. In these consecutive six patients, we tested the usefulness of this new technique with employing preshaping of a micro-guide wire into a shepherd''s hook form for superselective catheterization of targeted vessels.

Results

The target arteries were successfully catheterized and satisfactory transcatheter arterial chemoembolization was performed in all six patients. There were no significant complications such as arterial dissection.

Conclusion

We developed a technique that is effective for superselection of vessels with preshaping of micro-guide wire into a shepherd''s hook form, and we successfully applied it during chemoembolization of hepatocellular carcinoma. This technique can be useful for superselection of small arteries that branch from a large parent artery at acute angles for the treatment of tumors and hemorrhages.     

副胃左动脉在肝癌介入治疗中的意义

目的探讨副胃左动脉在肝细胞癌介入治疗中的临床意义。方法对387例确诊原发性肝细胞癌患者行64层螺旋CT检查,动脉期采用容积再现(VR)及最大密度投影(MIP)技术重建肠系膜上动脉及腹腔动脉分支起源及走行,并与血管造影对比。结果 387例均清楚显示腹腔动脉、脾动脉、胃左动脉、肝总动脉、肝固有动脉、肝左动脉、肝右动脉及胃十二指肠动脉;282例清楚显示胃右动脉起源。共发现副胃左动脉50例,其中46例发自肝左动脉远端,1例发自副肝左动脉远端,1例发自肝右动脉近端,2例发自肝固有动脉。三维重建结果与血管造影一致。结论副胃左动脉多起源于肝左动脉远端,正确认识副胃左动脉可以避免肝细胞癌介入治疗过程中异位栓塞的发生,减少并发症具有实用意义。     

肝癌的肝外动脉供血及其介入治疗

目的　探讨肝癌肝外动脉供血规律、插管技术及介入治疗。方法　总结７６ 例肝癌肝外动脉供血特征。７６ 例肝癌动脉栓塞术前常规腹腔动脉、肝总动脉、肠系膜上动脉造影,对位于膈顶部肿瘤还作膈动脉造影,发现肝外供血支进一步超选插管,并同时进行肝动脉、肝外动脉双动脉内化疗栓塞术。结果　７６ 例肝外供血支,由肝动脉闭塞引起侧支动脉供血达２１ 例,其余５５ 例为肝脏本身固有的寄生性供血。肝外供血与肿块部位、大小密切相关。Ｃｏｂｒａ、Ｙａｓｈｉｒｏ 导管配合ＳＰ 导管肝外动脉插管成功率为７２ ．４％ ,随访３６ 例,１、２ 年生存率分别为５２ ％ 和２１％ 。结论　１ ． 依据肿块部位积极寻找肝外供血支;２． 在介入治疗中,预防肝动脉闭塞,减少侧支供血形成至关重要;３． 对具有肝外动脉供血的肝癌采取双动脉内化疗栓塞是必要的、有效的     

Arterial blood supply to the posterior aspect of segment IV of the liver from the caudate branch: demonstration at CT after iodized oil injection

PURPOSE: To retrospectively evaluate the arterial blood supply to the posterior aspect of segment IV of the liver with computed tomography (CT) after transcatheter arterial chemoembolization (TACE) with iodized oil through the caudate arterial branch of the liver for treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Institutional review board approval and patient informed consent were not required for this retrospective study. Twenty-four patients (11 men and 13 women; mean age, 68 years) with HCC originating in the caudate lobe (n = 23) or posterior aspect of segment IV (n = 1) were selected. TACE of the caudate arterial branch was performed in all patients, including one patient with HCC in the posterior aspect of segment IV who underwent TACE of the caudate arterial branch after CT helped confirm that iodized oil was not distributed in the tumor after TACE of the medial segmental artery. The distribution of iodized oil in the posterior aspect of segment IV was analyzed with CT 1 week after TACE. The number and origin of all arteries supplying the caudate lobe and the number of arteries embolized were determined. RESULTS: Thirty-three caudate arterial branches were embolized. Twenty-nine branches were derived from the right hepatic artery and four were derived from the left hepatic artery. A single branch was seen in 17 patients, two branches were seen in five, and three branches were seen in two. Eight patients simultaneously underwent additional TACE of branches of the right hepatic artery (n = 6) or right inferior phrenic artery (n = 2). At CT, iodized oil was seen to be distributed entirely (n = 19) or partially (n = 5) in the caudate lobe. Distribution of iodized oil at the posterior aspect of segment IV was observed in 16 patients (67%), including 13 (54%) whose caudate arterial branches were derived entirely from the right hepatic artery. CONCLUSION: The results of this study suggest that the caudate arterial branch, which is mainly derived from the right hepatic artery, frequently supplies the posterior aspect of segment IV. This knowledge is important for managing HCC in the posterior aspect of segment IV by means of TACE.     

胰头和十二指肠供血动脉及吻合支MSCT血管成像

目的：探讨胰十二指肠上前动脉（ASPDA）、上后动脉（PSPDA）和胰十二指肠下前动脉（AIPDA）、下后动脉（PIPDA）及其侧支吻合在多层螺旋CT血管成像（MSCTA）中的显示情况。方法：搜集无腹腔动脉（CA）、肠系膜上动脉（SMA）、肠系膜下动脉（IMA）狭窄闭塞且行腹部MSCTA检查的病例230例,采用容积再现（VR）和血管生长技术（AV）对胰头、十二指肠区域供血动脉及吻合支进行血管重建,分析其表现。结果：230例检查者中,ASPDA、PSPDA、AIPDA、PIPDA直径分别为（1.50±0.15）mm、（1.60±0.16）mm、（1.50±0.10）mm、（1.70±0.11）mm,显示率分别为90.4%（208/230）、95.7%（220/230）、87.8%（202/230）、90.0%（207/230）。前、后动脉弓直径分别为（2.90±0.15）mm、（3.00±0.17）mm,显示率为53.0%（122/230）。胰背动脉直径（0.80±0.15）mm,显示率为74.8%（172/230）。PSP-DA、PIPDA起源变异发生率为3.0%（7/230）,其他侧支吻合发生率为5.2%（12/230）。结论：MSCTA能清楚显示胰头、十二指肠区域供血动脉的起源、变异及吻合支。     

肠系膜上动脉供血型肝癌的血管造影分析及介入治疗

目的：研究肠系膜上动脉供血型(即变异肝动脉起源于肠系膜上动脉)肝癌的血管造影表现及插管技术。方法：回顾分析41例肠系膜上动脉供血型肝癌的DSA及介入治疗资料，统计血管解剖变异的发生率，对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。结果：350例肝癌中肠系膜上动脉供血型41例(11．9％)，其中副肝右动脉15例(36．5％)，替代肝右动脉16例(39．0％)，肝总动脉8例(19．5％)，腹腔动脉干起源于肠系膜上动脉2例(5％)。31例肠系膜上动脉发出替代或副肝右动脉者，29例(94．0％)腹腔动脉造影表现为肝右动脉细小或缺如，肝右叶出现无血管区。RH导管超选择性插管成功25例(61％)，未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。结论：肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血，熟忿其血管变异的特点对肝动脉化疗栓塞术具有重要的意义。     

Natural history of true pancreaticoduodenal artery aneurysms

Advances in non-invasive diagnostic techniques, such as CT and ultrasonography, have improved our ability to detect unruptured pancreaticoduodenal artery aneurysms. No definitive study evaluating the natural history of these lesions or their preferred method of treatment has been published. In this report, we describe five patients with eight unruptured true pancreaticoduodenal artery aneurysms followed without treatment. Of these patients, four had coeliac axis stenosis (n = 1) or occlusion (n = 3) and one had occlusion of the superior mesenteric artery. The mean diameter of the aneurysms was 12.0 mm (range 7–17 mm). The mean duration of follow-up was 29.4 months (range 6–57 months). There was no aneurysm rupture during a total of 147 patient-months (243 aneurysm-months) of follow-up. Of the eight aneurysms, three increased in size over the follow-up period. We conclude that the risk of rupture of true pancreaticoduodenal artery aneurysms might be lower than expected from the data on ruptured aneurysms; however, careful follow-up of untreated aneurysms is necessary.True pancreaticoduodenal artery aneurysms are rare, accounting for 2% of all visceral aneurysms. More than half of true pancreaticoduodenal artery aneurysms are associated with coeliac axis stenosis or occlusion [1]. The development of pancreaticoduodenal artery aneurysms might be related to increased retrograde blood flow through the pancreaticoduodenal arcades when there is stenosis or occlusion in the coeliac axis [2]. Aneurysm formation is generally preceded by enlargement of the arcades to accommodate the increased blood flow.Although 60% of reported cases of true pancreaticoduodenal artery aneurysms presented with rupture [1], advances in non-invasive diagnostic techniques, such as CT and ultrasonography, have improved our ability to detect unruptured pancreaticoduodenal artery aneurysms. These are now found as incidental findings, usually by CT or ultrasonography. No definitive study evaluating the natural history of these lesions or their preferred method of treatment has been published. In this report, we retrospectively reviewed unruptured true pancreaticoduodenal artery aneurysms followed without treatment to assess the natural history of these lesions.     

Pancreaticoduodenal arcades and dorsal pancreatic artery: comparison of CT angiography with three-dimensional volume rendering, maximum intensity projection, and shaded-surface display

OBJECTIVE: The objective of this study was to compare the ability of CT angiography to depict the pancreaticoduodenal arcades and the dorsal pancreatic artery using the techniques of three-dimensional (3D) volume rendering, maximum intensity projection (MIP), and shaded-surface display (SSD). SUBJECTS AND METHODS: Twenty-seven patients were selected at random from a group of 42 patients undergoing arterial-phase helical CT angiography before liver transplantation. CT angiograms were constructed from identical data sets using 3D volume rendering, MIP, and SSD. RESULTS: Seventy-two vessels were evaluated in 27 patients. Three-dimensional volume rendering depicted 24 anterior and 22 posterior arcades and 26 dorsal pancreatic arteries; combined MIP and SSD depicted 14 anterior and 13 posterior arcades and 19 dorsal pancreatic arteries. Thirty vessels with diameters of between 2 and 3 mm were well seen with 3D volume rendering but were incompletely depicted with MIP and SSD. Sixteen vessels with diameters of greater than 3 mm were well seen using all three techniques. Twenty-six vessels with diameters of less than 2 mm were faintly seen with 3D volume rendering but were unidentifiable with MIP and SSD. CONCLUSION: Three-dimensional volume rendering is superior to MIP and SSD in the depiction of pancreaticoduodenal arcades and dorsal pancreatic arteries. Unlike the other rendering techniques, 3D volume rendering can also show relationships between these vessels and pancreatic parenchyma and adjacent structures.     

内乳动脉参与肝癌供血的介入治疗

目的探讨内乳动脉(IMA)对肝癌的供血及其介入栓塞在肝癌治疗中的价值。评价经导管作IMA栓塞化疗的安全性和效果。方法对86例经血管造影确认有IMA参与肝癌供血患者进行TACE。全部病例均曾行TACE治疗,16例曾行经皮微波固化治疗,4例有外科手术史。术前行CT或MRI平扫及增强扫描,术中行IMA造影,在确认供血范围后将导管超选择至供血支,先用碘油-抗癌乳剂栓塞肿瘤末梢血管,然后注入明胶海绵碎粒或PVA颗粒,并摄肝区平片,观察肝区碘油分布及术后临床经过、相关实验室检查和影像学表现,并与血管造影进行对照分析。结果本组病例病灶均为巨块型,均位于肝脏前部接近膈肌或(和)肝包膜。57例累及S4、S5、S8段,29例累及S5、S7、S8。80例为右侧IMA参与供血,5例为左侧IMA参与供血,1例为双侧IMA参与供血。86例参与供血的IMA栓塞全部成功。未出现皮肤损伤并发症。结论IMA参与肿瘤供血一般多见于过去曾多次行TACE的巨块型肝癌患者,且肿块位于肝前部。IMA TACE方法安全,技术可行,但应警惕皮肤损伤并发症。     

经膈下动脉介入化疗栓塞术治疗原发性肝癌

目的观察膈下动脉形成肝癌侧枝血供的因素和几率。方法在对137例患者介入治疗中,造影寻找膈下动脉,并超选形成肿瘤血供的膈下动脉,进行化疗栓塞。结果137例患者中有21例经膈下动脉介入治疗(占15.3%),其中原发性肝癌手术切除后复发2例(9.5%),首次介入治疗出现膈下动脉供血3例(14.3%),2次或多次介入治疗后出现膈下动脉供血16例(76.2%)。结论膈下动脉是原发性肝癌的最重要侧枝供血动脉,经膈下动脉介入化疗栓塞原发性肝癌成功率高而且并发症少。