125I粒子条联合门静脉支架及化疗栓塞治疗原发性肝癌合并门静脉癌栓

目的 评估125I粒子条联合金属支架门静脉内植入+动脉化疗栓塞治疗原发性肝癌合并门静脉主干癌栓的疗效.方法 选取17例原发性肝癌伴门静脉主干癌栓患者,行125I粒子条联合门静脉内支架+TACE.粒子植入数量17～23粒(6711型,0.7 mCi/粒),第1个半衰期组织内平均吸收剂量为73.51～76.22 Gy.疗效和不良反应评价指标包括:术后并发症,肝肾功能及血常规改变等.采用Kaplan-Meier生存曲线分析患者的生存时间、支架通畅时间、累积生存率和累积支架通畅率.结果 所有患者门静脉支架和125I粒子条均成功植入,未发生手术相关严重并发症.术后随访2～13个月,12例存活,5例死亡(肝功能衰竭4例,多发转移1例).60、180和360 d的累积支架通畅率为94%、94%和94%;累积生存率为87%、65%和53%.结论 125I粒子条联合金属支架门静脉内植入+动脉化疗栓塞治疗原发性肝癌合并门静脉主干癌栓可以提高支架通畅率,延长生存时间.但远期效果尚需进一步观察.     

125I粒子植入联合高强度聚焦超声治疗肝癌门静脉癌栓的临床价值

目的 探讨125I粒子植入联合高强度聚焦超声(HIFU)治疗肝癌门静脉癌栓(PVTT)的临床应用价值.方法 回顾性分析2011年3月至2013年10月19例125I粒子植入联合HIFU治疗的肝癌PVTF患者(男17例,女2例,平均年龄50岁;Ⅰ～Ⅲ级分别为8、7和4例)的临床特征及生存资料,125I剂量为90～ 120 Gy,单个粒子活度为18.5 MBq;HIFU参数:频率0.85 mHz,总治疗时间33～70 min,平均辐照功率300～ 400 W.随访评估疗效及不良反应(3～ 24个月),观察治疗前后癌栓大小的变化、术后并发症及患者生存率等;采用Kaplan-Meier生存曲线分析患者生存率.结果 19例患者均顺利完成治疗,未发生严重并发症.术后1个月复查,癌栓均有不同程度缩小.术后1个月随访,19例中PR 9例,SD 4例,PD 6例.随访3～24个月,平均生存期为(11.6±3.0)个月,Ⅰ、Ⅱ、Ⅲ级中位生存期分别为13.5、7.0和4.0个月;1年和2年生存率分别为47.4％与7.9％.结论 125I粒子植入联合HIFU治疗肝癌PVTT,局部疗效肯定,创伤小且并发症发生率低.     

经导管动脉化疗栓塞术联合经皮 125I粒子植入序贯治疗肝癌伴门静脉主干癌栓

目的评价经导管动脉化疗栓塞术（TACE）联合经皮125I放射性粒子植入序贯治疗肝癌伴门脉主干瘤栓的临床疗效及安全性。 方法2010年1月至2012年3月48例确诊为肝癌合并门静脉主干癌栓患者,TACE术后1周进行经皮门脉瘤栓125I放射性粒子植入序贯治疗。随访时间12-24月,对比序贯治疗前后各项临床指标、影像学的变化,以评价其疗效及安全性。 结果48例患者共接受215次TACE治疗,平均每例患者4.5次,每例患者平均植入粒子数16枚,技术成功率100%,全组未出现治疗相关性死亡,肝内病灶客现缓解率为37.3%（18/48）。瘤栓3个月后影像复查平均回缩3.9mm,完全缓解（CR）15例,部分缓解(PR)25例,稳定（SD）6例,进展（PD）2例,总有效率（CR+PR）为83.3%。门脉主干内径恢复大于80%共41例（85.4%）。1年生存率和2年生存率分别为47.9%,33.33%,中位生存时间为15.8月。48例患者术后3个月患者的肝功能、血常规与术时比较,P=0.028,差异均无统计学意义。 结论TACE联合经皮125I放射性粒子植入序贯治疗原发性肝癌伴门静脉主干癌栓是一种有效安全的方法。     

血管内近程放疗在肝癌合并门静脉一级分支癌栓中的应用

目的 评估碘-125(125I)粒子条联合动脉化疗栓塞(TACE)治疗肝细胞肝癌(HCC)合并门静脉一级分支癌栓的安全性及有效性.方法 回顾性分析2013年1月至2018年1月就诊的71例HCC合并门静脉一级分支癌栓患者的病历资料,24例接受门静脉一级分支125I粒子条植入术联合TACE术作为研究组,47例仅接受TAC...     

125I粒子条联合血管支架植入治疗原发性肝癌合并门脉癌栓17例

【摘要】 目的 探讨125I粒子条联合门静脉血管支架植入治疗原发性肝癌合并门脉癌栓的安全性及疗效。方法 回顾性分析2015年2月至2020年1月在新疆医科大学第一附属医院诊疗的17例原发性肝癌合并门脉癌栓患者的临床资料,17例均行经皮穿刺门静脉内125I粒子条联合血管支架植入术。每例患者植入粒子数量10～45粒,粒子活度0.8 mCi/粒,处方剂量100～120 Gy。植入血管支架数量1～2枚。评价指标包括手术成功率、术后并发症、门脉压力改善情况、累计生存率和支架通畅性。结果 17例患者手术均获成功。1例术后并发穿刺道出血,1例支架未开通（门脉开通率94.1%）。门脉支架植入前患者平均门脉压力为（35.0±3.0） cmH2O（1 cmH2O=0.098 kPa）,支架植入后平均门脉压力为（27.2±5.4） cmH2O,平均下降（7.8±4.3） cmH2O,两组比较差异有统计学意义（P＜0.05）。术后15例患者获得随访（2～16个月）,4例患者目前生存,其中2例生存时间已超过1年。11例死亡（肝功能衰竭7例,多发转移1例,肝癌结节破裂出血1例,食管胃底静脉破裂出血2例）,其中1例最长生存14个月。患者平均生存时间为（209.23±38.38） d（95%CI, 134.00～284.46）,中位生存时间为（145±19.1） d（95%CI, 107.42～182.58）。术后3个月、6个月和1年的累计生存率分别为93.3%、26.7%和20.0%。支架平均通畅时间为（246.87±59.52） d（95%CI, 130.21～363.53）。随访期内有9例患者行TACE治疗（共行19例次）。结论 125I粒子条联合血管支架植入治疗原发性肝癌合并门脉癌栓安全可行,能降低门脉压力,恢复部分肝脏血流灌注,扩大肝动脉化疗栓塞适应证,有效延长患者生存期。     

CT引导经皮穿刺植入放射性125I粒子治疗HCC合并肝静脉、下腔静脉癌栓

目的 探讨CT引导经皮穿刺植入放射性125I粒子治疗原发性肝细胞肝癌(HCC)并肝静脉、下腔静脉癌栓的可行性.方法 回顾分析本科10例行CT引导经皮穿刺植入放射性125I粒子治疗HCC合并肝右静脉、下腔静脉癌栓临床资料,术后2月行CT增强、肝功能、AFP检查.以后每2月复查.结果 所有患者均手术成功,无相关手术并发症出现.每位患者平均植入125I粒子10.2粒.术后2月,5例患者肝右静脉、下腔静脉内癌栓较前不同程度缩小,3例患者癌栓较前无明显变化,2例患者癌栓较前增大.结论 放射性125I粒子组织间植入治疗HCC合并肝静脉、下腔静脉癌栓是一安全有效的方法.     

CT引导下125I放射性粒子植入治疗肝癌门静脉癌栓的疗效评价

目的探讨CT引导下^125I放射性粒子植入联合肝动脉化疗栓塞术（TACE）治疗肝癌合并门静脉癌栓（PVTT）的疗效。方法回顾性分析原发性肝癌合并PVTT患者58例,A组（26例）行TACE结合CT引导下^125I放射性粒子植入局部放射治疗;B组（32例）单纯行TACE。对比两组疗效。结果 A组1、2年生存率分别为42.3%、23.0%,平均生存期15.5个月,完全缓解（CR）3例,部分缓解（PR）9例,总有效率（CR＋PR）为46.2%（12/26）。B组1、2年生存率分别为21.9%、6.3%,平均生存期7.5个月CR2例,PR6例,CR＋PR为25.0%（8/32）。A组的生存率及总有效率显著高于B组（P〈0.05）。结论 TACE联合CT引导下^125I放射性粒子植入治疗肝癌门脉癌栓能明显提高其疗效,并具有创伤少,并发症少等优点。     

125I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的近期疗效

目的探讨¹²⁵I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的安全性及近期疗效。 方法15例原发性肝癌伴门静脉主干癌栓患者行门静脉¹²⁵I粒子条植入术,手术操作在超声及DSA引导下进行。术后对肝功能、血常规及凝血功能的变化、癌栓的改变、不良反应进行评价。 结果所有患者均成功植入放射性¹²⁵I粒子条,门静脉主干癌栓的有效率为40.00%(6/15),疾病控制率为86.67%(13/15)。术后2个月复查所有患者的肝功能、血常规、凝血功能与术前比较差异无统计学意义。未出现与粒子条植入相关的严重并发症。 结论植入¹²⁵I粒子条治疗肝癌伴门静脉主干癌栓是安全、可行、有效的。     

原发性肝癌合并下腔静脉及右心房癌栓的动脉内化疗栓塞治疗

目的 评价肝动脉化疗栓塞(TACE)治疗原发性肝癌合并下腔静脉及右心房癌栓的可行性.方法 回顾性分析经肝动脉化疗栓塞治疗16例原发性肝癌合并下腔静脉及右心房癌栓的患者.在行氟尿嘧啶、丝裂霉素、吡柔比星动脉灌注化疗后用与吡柔比星、碘油和PVA颗粒(直径300 μm)混合物进行肿瘤供血动脉栓塞治疗.结果 癌栓治疗有效患者11例(占68.7％,11/16),其中位生存期为13.5个月(7.5～26个月).整组的中位生存期为12个月(范围2.6 ～ 26个月).5例癌栓无反应组(癌栓对治疗无反应)的中生存期为3.3个月(2.6～ 12.5个月)(P＜0.01).所有患者无严重栓塞后并发症发生.结论 肝动脉化疗栓塞治疗原发性肝癌合并下腔静脉及右心房癌栓是安全,有效的方法.     

门脉粒子支架联合载药微球栓塞治疗肝癌7例

目的 探讨门静脉放射性粒子支架植入联合载药微球经肝动脉化学栓塞术(DEB-TACE)治疗肝细胞肝癌(HCC)伴门静脉主干癌栓(MPVTT)的可行性和安全性.方法 前瞻性单臂研究,7例确诊患者顺序入组接受治疗,比较门静脉支架植入前后门静脉压力变化,术前和术后1～3 d、4d和5～7 d肝功能变化的差异,总结并发症发生情况.结果 7例患者均为BCLC-C期,Child-Pugh A～B级.均为巨块型肝癌,左肝1例,右肝6例,门静脉左支癌栓1例,右支癌栓6例,均伴有MPVTT.所有患者均顺利进行放射性粒子支架门静脉内植入联合DEB-TACE治疗.支架植入前后门静脉平均压力分别为15.3和10.2 cmH20,压力下降明显.血清总胆红素(TB)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)术后一过性增高,3～4 d后逐渐下降,TB恢复较ALT、AST慢.2例患者伴心肌损害,2～3 d后逐渐恢复.结论 联合应用放射性粒子支架门静脉内植入和DEB-TACE治疗HCC合并MPVTT是安全可行的,远期疗效需进一步研究.     

Stress MR imaging for evaluation of popliteal artery entrapment

The popliteal artery entrapment (PAE) syndrome has been recognized as a cause of arterial occlusion in young people. It is the result of an anomaly of the relationship between the popliteal artery and the gastrocnemius muscle. Eight young healthy volunteers (16 legs) and six patients (10 legs) with suspected PAE underwent magnetic resonance (MR) imaging. Gradient-echo images were obtained in axial planes with the leg at rest and during active plantar flexion against resistance. Imaging at rest allowed identification of PAE signs in only one leg, which had an anomalous medial course of the popliteal artery. In the other cases, only the stress technique was able to show signal loss in the popliteal artery due to muscular compression (two legs) or the presence of accessory muscle slip around the vessel (two legs), as confirmed at surgery. MR imaging is therefore a useful technique for the diagnosis of PAE because of its capability of combining information obtainable with other modalities.     

MR imaging of muscle and tender points in fibromyalgia

Fibromyalgia is a syndrome manifested by chronic, diffuse muscu-loskeletal aching and soreness, palpable muscle tender points, and other symptoms. Standardized clinical diagnostic criteria have recently been developed. Skeletal muscle has been postulated as the end organ in this disease. Biochemical, histologic, electromyographic, and conventional radiographic studies have demonstrated no definitive abnormality. This study sought to establish whether magnetic resonance (MR) imaging could demonstrate any abnormality in these patients. Eighteen patients were entered in the study, 14 of whom were able to complete their examinations. T1 -weighted, T2-weighted, gradient-echo, and STIR (short-tau inversion-recovery) sequences were performed in all patients, with selected patients examined with T1weighted, gadopentetate dimeglu-mine-enhanced sequences. The trapezius and suboccipital regions were imaged in patients who, clinically, had active fibro-myalgia. No abnormalities could be detected. The authors conclude that the conventional MR imaging used in this study was unable to depict any primary skeletal muscle abnormality in fibromyalgia.     

Controversies in cervical spine imaging in trauma patients

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury. The second part will discuss the merits of radiography and computed tomography as the main screening diagnostic examination. In addition to the roles of each modality in the evaluation process, such factors as efficacy of diagnosis, time (duration) of study, and cost will be discussed. Finally, the third part will explore the methods currently employed to clear the cervical spine in comatose patients.Presented at the Annual Meeting of the American Society of Emergency Radiology, Las Vegas, Nevada, 22–25 October, 2003     

Uterine contractions: Possible diagnostic pitfall at MR imaging

A total of 206 nongravid patients with various gynecologic problems underwent pelvic magnetic resonance (MR) examinations that included both sagittal T2-weighted and contrast agent–enhanced T1-weighted images. MR images were retrospectively reviewed to identify changes in endometrial configuration on serial images obtained during the same MR examination. In 20 MR examinations (all in women of reproductive age), endometrial distortion due to myometrial bulging was noted on T2-weighted or contrast-enhanced T1-weighted images. It was absent on other MR images obtained at different times. Myometrial bulging exhibited low signal intensity in 18 examinations. The finding resembled adenomyosis or leiomyoma on T2-weighted or contrast-enhanced T1-weighted images. These results evidence the presence of transient myometrial bulging and transient low-intensity myometrium in the nongravid uterus. This phenomenon is thought to represent uterine contraction. Clinicians should be aware of the potential presence of transient low-signal-intensity myometrial bulging that could present diagnostic problems in the normal uterus.     

Brodie Abscess: MR imaging appearance in 10 patients

The magnetic resonance (MR) imaging features of Brodie abscess have not yet been fully evaluated. Ten patients with Brodie abscess, eight of long bone and two of vertebra, were studied with MR imaging. Long bone abscess had a characteristic “target” appearance with four layers: (a) a center with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR (short-inversion-time inversion recovery) images, (b) an inner ring isointense to muscle on T1-weighted images and with high signal intensity on T2-weighted and STIR images, (c) an outer ring hypoin-tense on all images, and (d) a peripheral halo hypointense on T1-weighted images. In six of eight cases, a soft-tissue mass was found. The two vertebral abscesses had a less specific appearance, with low signal intensity on T1-weighted images and high signal intensity on T2-weighted and STIR images. Only the peripheral halo was clearly identified in both cases.     

Dynamic contrast-enhanced MR imaging assessment of vascularized free fibular grafts

Magnetic resonance (MR) imaging may be a noninvasive method for assessing perfusion of vascularized bone grafts placed for treatment of avascular necrosis. One proximal femur of seven beagles was devascularized, with insertion of a vascularized fibular graft. MR imaging at 1 week (seven dogs) and 6 weeks (five dogs) after surgery included pre- and postcontrast spin-echo sequences, unenhanced twodimensional time-of-flight (TOF) vascular imaging, and dynamic gradient-echo imaging during infusion of gadolinium. Relative signal intensity values of selected regions obtained from the dynamic gradientecho images were plotted as percent enhancement versus time. In the operated hip, MR imaging did not show enhancement in six of seven femoral heads and greater trochanters at 1 week after surgery, with similar results after 6 weeks. MR imaging of fibular grafts 6 weeks after surgery showed an initial rapid increase in enhancement and a subsequent slower increase in five of five dogs, although no enhancement was seen in six of seven dogs at 1 week. These findings contrasted with a rapid initial increase in enhancement followed by slow decline in non-operated hips. Two-dimensional TOP imaging did not show the vascular pedicle of the graft in any dog. Findings of radionuclide bone scanning performed 1 week after surgery were consistent with devascularization of the operated femur and fibular graft. However, tetracycline distribution and histologic findings confirmed the viability of five of five grafts within the devascularized femurs 6 weeks after surgery. Thus, dynamic contrast-enhanced MR imaging at 6 weeks after surgery is valuable for assessing vascular bone graft perfusion, while similar imaging at 1 week may suggest otherwise.     

Right-side aortic arch with aneurysm of aberrant left subclavian artery: MR imaging appearance.

Reports of aneurysms of the subclavian artery in both normal and anomalous aortic arches have been rare. The authors describe a patient with a right-side aortic arch and an aneurysm of the aberrant left subclavian artery, which, to the authors' knowledge, is a previously unreported association. At presentation, the aneurysm appeared as a calcified left superior mediastinal mass. Magnetic resonance imaging enabled preoperative diagnosis and guided surgical planning.     

Adrenal tissue characterization with 0.5-T MR imaging: Value of T2*-weighted images

The authors investigated the value of magnetic resonance (MR) imaging at 0.5 T for distinguishing adrenal adenomas from adrenal metastases. The series included 23 adrenal adenomas (18 nonhyperfunctioning, five hyperfunctioning) and 23 adrenal metastases from various organs. Adrenal tumor–liver signal intensity ratios on T1-, T2-, and T2*-weighted images were calculated for adrenal tissue characterization. Adrenal adenomas were more precisely distinguished from adrenal metastases on T2*-weighted images (21 of 23, 91%) than on T2-weighted images (15 of 23, 65%). T1-weighted images were not useful for this distinction. In conclusion, T2*-weighted images were better than routine T2-weighted images for distinguishing adrenal adenomas from adrenal metastases. It can be postulated that the total signal intensity of adrenal adenomas, which contain some fat components, decreased on T2*-weighted images because of an out-of-phase effect.     

MR angiography of congenital heart disease: Value of segmented two-dimensional inflow technique and maximum-intensity-projection display

Magnetic resonance (MR) angiography of the cardiovascular system was evaluated in 41 patients with congenital heart disease by using a two-dimensional (2D) inflow technique based on a magnetization-prepared gradient-echo pulse sequence with segmented k-space data acquisition and electrocardiographic gating at 0.5 T. Inversion and saturation prepulses were used to suppress stationary tissue and enhance intravascular signal. Presaturation slabs were applied where certain vascular structures had to be suppressed. Sequence parameters were optimized by evaluating signal intensity and contrast characteristics for various flip angles and inversion and saturation delay times. The heart and intrathoracic vasculature were encompassed with 40–50 overlapping sections. Both 2D angiograms and maximum-intensity-projection images were evaluated. Combining data sets acquired in the sagittal and transverse orientations provided the most satisfactory information about the pulmonary arteries. The highest signal-to-noise ratios were obtained with a flip angle of 65° and short prepulse delay times. Two-dimensional MR angiography can provide useful diagnostic information but requires a thorough understanding of in-plane and hemodynamically induced signal intensity changes.