Multislice computed tomography angiography of the abdominal arteries: Comparison between computed tomography angiography and digital subtraction angiography findings in 52 cases

Since the introduction of multislice CT scanners, CT angiography (CTA) has become a powerful tool for imaging the vascular system. We compare conventional angiography to CTA in the diagnosis of morphological changes in the abdominal aorta and its branches. A retrospective analysis of 52 patients who underwent both multislice CT angiography (MSCTA) and digital subtraction angiography before surgical treatment is presented. All CT examinations were performed after administration of 100 mL contrast medium with a collimation of 4 × 1 mm and a pitch of 7. A standardized evaluation of the axial, multiplanar and 3D reconstructions was performed by two experienced radiologists. Stenoses were classified as high‐grade and low‐grade, and aneurysms, occlusions and arteriosclerosis were evaluated. The CTA findings were compared with conventional angiography. All aneurysms, occlusions, stenoses and calcifications were diagnosed correctly by CTA in axial and multiplanar projections (sensitivity 1.0; specificity 1.0). The degree of stenosis was overestimated in three cases when using axial projections. Three‐dimensional volume‐rendered CTA showed a sensitivity of 0.91 for aneurysms, 0.82 for stenoses, 0.75 for occlusions and 0.77 for calcifications. The specificity was 1.0 in all cases. Multislice CT angiography seems to be similar to conventional digital subtraction angiography for abdominal vessels if multiplanar projections are used.     

The inter‐sonographer reliability of carotid duplex ultrasound

Carotid duplex ultrasound (CDUS) is a non‐invasive technique used to assess the severity of carotid artery stenosis. It has been shown to have good correlation with digital subtraction angiography (DSA) but has been criticised for its variability. One source of this is the variation in results between studies responsible for re‐validating velocity criteria to match the established treatment thresholds of internal carotid artery (ICA) stenosis. The aim of this study was to develop velocity criteria and determine the presence of inter‐sonographer variation of CDUS when grading ICA stenosis in our department. Five sonographers measured the degree of ICA stenosis with CDUS in 33 patients who also underwent DSA. Receiver operator characteristic curve analysis was used to develop optimal velocity criteria for the 50%, 70% and 90% ICA stenosis thresholds as a group and for each individual sonographer. A peak systolic velocity ratio of ≥ 3.25 was shown to have the highest accuracy (91.5%) for predicting a 70% stenosis. A moderate value of κ (0.53 ± 0.027) was calculated if the optimum velocity criterion was employed for each sonographer. There was no significant variation between the ability of sonographers to grade ICA stenosis (P > 0.05) and an excellent ICC of 0.911 was calculated. This study provides evidence to suggest that CDUS in our department is not an operator‐dependant test for the investigation of ICA stenosis.     

Digital subtraction angiography demonstration of bone hypervascularity in Paget’s disease

Bone hypervascularity is a well-known component of Paget’s disease, but has not been previously reported on digital subtraction angiography. The features shown in the present case include sustained bone enhancement and early venous filling.     

DSA导向经皮椎体成形术治疗椎体转移瘤87例疗效分析

目的探讨数字减影血管造影机(digital subtraction angiography,DSA)引导经皮穿刺椎体成形术(percutaneous vertebroplasty,PVP)治疗椎体转移瘤的技术方法及临床疗效。方法收集2010-10-01-2012-10-01右江民族医学院附属医院收治胸腰椎溶骨性转移瘤患者87例,DSA导向经椎弓根途径穿刺行椎体成形术。病变累及胸椎36例,腰椎51例。术后观察患者视觉模拟疼痛评分(visualana logue pain scale,VAS)变化,行CT扫描观察患者椎体骨水泥填充情况,并经X射线片测量病变椎体前缘高度的变化。结果87例患者96节病变椎体手术均获得成功,手术成功率为100%。骨水泥注射量在腰椎为3~5mL,胸椎2~3mL。出现椎旁骨水泥渗漏3例,椎外静脉渗漏2例,皮下血肿2例,并发症发生率为8.0%(7/87)。术后腰背部疼痛均有不同程度缓解,手术前后疼痛VAS分别为6.5±1.5和2.5±1.5,差异有统计学意义,t=6.23,P<0.01。手术前后摄正侧位片测量椎体前缘高度分别为(15.53±2.23)和(16.37±2.36)mm,差异有统计学意义,P<0.05。所有患者术后1周、1个月和3个月得到随访,脊柱生理曲度正常,无椎体压缩塌陷及脊髓受压、瘫痪等神经系统症状,局部疼痛控制及功能恢复好。结论 DSA引导下PVP治疗胸、腰椎溶骨性恶性肿瘤定位准确,成功率高,并发症少,可有效缓解患者腰背部疼痛,改善了椎体转移瘤患者的生存质量,值得临床推广应用。     

Comparison of spiral CT angiography with conventional digital subtraction angiography in the evaluation of renal transplant donors: A pilot study

Conventional digital subtraction renal arteriography (IA‐DSA) has been traditionally used as the preoperative imaging modality for assessment of renal vascular anatomy for renal transplant donors. This study evaluates the potential use of spiral CT angiography in replacing IA‐DSA in the preoperative assessment of this group of patients. Seven patients underwent both spiral CT angiography and IA‐DSA between October 1997 and April 1998. It is concluded that spiral CT angiography can demonstrate the number, length and location of renal arteries and it is suggested that spiral CT angiography can potentially replace IA‐DSA in the preoperative assessment of renal donors.     

Analysis of the tumor staining obtained by preoperative IV-DSA for breast cancer patients: Density and metastasis correlation

We examined the density of tumor enhancement onintravenous digital subtraction angiography (IV-DSA) in patients withbreast cancer in relation to disease-free survival. Thesubjects of the present study consisted of 103patients with invasive ductal carcinoma measuring 5 cmor less treated from July 1988 to September1993. In the 103 patients, 15 had distantmetastasis. The region of interest was set inthe areas enhanced by IV-DSA of the breast.The maximum density (MAX) was calculated by thetime-density curve. When the patients were divided accordingto three classes of MAX, i.e., 0–5.0 pixels(group A, n=23), 5.1–9.0 pixels (groupB, n=50), 9.1 pixels or more(group C, n=30), disease-free survival washighest in group A followed by group Band C, respectively. The disease-free survival rate ingroup C was significantly lower than that ofgroup A or B (p < 0.05). Thus,high values of MAX were associated with lowrates of disease-free survival. Since the value ofMAX was found to be independent from otherprognostic factors by multivariate analysis, these results indicatethat MAX has a close correlation with metastasisor recurrence of breast cancer, making IV-DSA apromising prognostic factor.     

肝癌术后复发的MSCT和DSA影像诊断对照

Objective： To evaluate the value of MSCT and DSA in diagnosing the postoperative recurrence of hepatocellular carcinoma by analyzing the results of these two image examinations. Methods： Seventytwo patients with postoperative recurrence of hepatocellular carcinoma were subjected to MSCT and DSA of their livers. The interval of two examinations was 2 to 14 days. Results： In 51 cases （70.83%）, the recurrent lesions were multiple small nodules （type Ⅰ）, 9 cases （12.36%） were single nodule （type Ⅱ）, and the remaining 12 cases （16.81%） were unequal nodules （type Ⅲ）. The results of two examinations were discrepancy in 10 patients. In 7 cases having positive results in DSA, the number of small nodules in 5 cases displayed by DSA was more than that by MSCT, and 2 cases had negative results in MSCT. In 3 patients having positive results in MSCT, number of small nodules in 2 cases displayed by MSCT was more than that by DSA and 1 case had negative results in DSA. Conclusion： MSCT and DSA had difference in displaying the postoperative recurrent lesions of hepatocellular carcinoma. The combined application of MSCT and DSA would be beneficial to improve the diagnosis of recurrent lesions.     

Helical computed tomography in the assessment of abdominal aortic pathology

A pilot study was undertaken to evaluate the role of helical computed tomography in the assessment of abdominal aortic pathology. A total of 17 patients underwent intra-arterial digital subtraction angiography (IADSA) and helical computed tomography, with eight patients undergoing subsequent operative intervention. A comparison of radiological findings between IADSA and helical computed tomography (CT) was made and, where applicable, a comparison was made with operative findings. Pathology included abdominal aortic aneurysm (AAA) (n=12), thoracoabdominal aneurysm (n=2) and dissection (n=1), graft distension following AAA repair (n=1) and plaque haemorrhage in the distal aorta following percutaneous transluminal angioplasty (PTA) of the iliac artery (n=1). Planned operative management as based on pre-operative helical CT imaging findings, in particular with reference to the type of graft used (straight or bifurcated) was not changed at operation. Our findings on helical CT in regards to AAA, thoroco-abdominal aneurysm and dissection correlated well with angiography and surgery findings.     

16层螺旋CT在肝癌动门脉分流中的诊断价值探讨

目的 研究肝癌APS的16层螺旋CT和DSA表现,探讨16层螺旋CT对肝癌APS的诊断价值。方法 分析175例肝癌患者的16层螺旋CT扫描和DSA影像表现,比较两种检查方法在检出和显示肝癌APS影像学征象方面的差别并分析16层螺旋CT诊断肝癌APS的准确性、敏感性和特异性。结果 16层螺旋CT在显示肝癌APS的密度差异和解剖位置上优于DSA。以DSA作为金标准,16层螺旋CT诊断肝癌APS的准确性、敏感性、特异性分别为98．8％、98．4％、99．1％。结论 16层螺旋CT对肝癌APS的密度差异和解剖位置显示优于DSA。16层螺旋CT诊断肝癌APS有较高的准确性、敏感性和特异性。     

Comparison of intra‐arterial digital subtraction angiography using carbon dioxide by ‘home made’ delivery system and conventional iodinated contrast media in the evaluation of peripheral arterial occlusive disease of the lower limbs

To prospectively compare the feasibility, safety and diagnostic role of carbon dioxide (CO₂) digital subtraction angiography (DSA) using a ‘home made’ delivery system with iodinated contrast medium (ICM) DSA in the evaluation of peripheral arterial occlusive diseases (PAOD) of lower limbs. Twenty‐one patients (27 limbs; all men; mean age, 47.6 years) who presented with PAOD of lower limbs underwent DSA using both intra‐arterial CO₂ and ICM. Conventional ICM DSA was performed first and used as gold standard. Carbon dioxide was then injected by hand using a locally improvised home made plastic bag delivery system. Patient tolerance was assessed subjectively. Arteries from aortic bifurcation to the ankle were independently evaluated by two radiologists and graded for stenosis using a five‐point scale. For each patient, the quality of CO₂ DSA images were compared with the corresponding images of ICM DSA and an overall grade of ‘good’, ‘acceptable’ or ‘poor’ was assigned. Cohen’s kappa coefficient was used to determine inter‐observer agreement. Carbon dioxide opacified 86.2% (188/195) of major arteries and depicted stenosis adequately in 84.5% (191/226) of arterial segments. A good or acceptable image quality of CO₂ DSA was obtained in over 95% of patients. Infrapopliteal arteries were inadequately visualized. Mild pain was seen in six (28.6%) patients with both contrast agents; one patient developed severe pain during CO₂ DSA. Inter‐observer agreement was good (k > 0.75) at 70% of the segments. Administration of CO₂ into lower limb arteries is well tolerated. Carbon dioxide DSA using the locally improvised home made delivery system is a feasible and safe alternative to ICM DSA in the evaluation of PAOD. It provides adequate imaging of arteries of lower extremities except infrapopliteal segments.     

Correlation of the Appearances of DSA with VEGF Expression and Its Clinical Significance in Patients with Primary Hepatocellular Carcinoma

目的探讨原发性肝癌患者的数字减影血管造影(DSA)表现和血管内皮细胞生长因子(VEGF)水平之间的关系。方法对24例原发性肝癌患者30次进行DSA的同时选用酶联免疫吸附定量法检测血清的VEGF水平。结果24例HCC血管造影中,18例有肝动脉肿瘤染色,瘤区肝动脉染色15例为多血供,3例为少血供;4例仅表现为门静脉供血; 1例为肠系膜上动脉供血,且合并大量门静脉瘘;另1例肿瘤无血供,HCC组血清VEGF表达水平(194．5±14．2)ng/L与对照组(132．4±47．9)比较,有显著性差异(P<0．01)。结论肝癌病灶血供丰富或伴有动静脉瘘形成者,血循环中VEGF浓度明显增高,且和肝内播散、肝癌复发及转移呈正相关。     

CT灌注成像对原发性肝癌介入术后疗效

目的探讨CT灌注成像(CT perfusion imaging,CTPI)在评价原发性肝癌(Primary hepatic carcinoma,PHC)行经导管动脉化疗栓塞术(Transcatheter arterial chemoembolization,TACE)后的疗效方面的价值。方法 收集患有PHC并行TACE术的患者33例,病灶均为单发,所有病例于TACE术前1周及术后1个月行64排CTPI、CT增强和血管造影(Digital subtraction angiography,DSA)检查。以DSA为“金标准”,对生成血流灌注伪彩图和各项灌注参数进行分析比较,评价CTPI在判断肝细胞癌介入术后的疗效方面的价值。结果 术后肿瘤组织肝动脉灌注值(Hepatic arterial perfusion,HAP)、肝动脉灌注指数值(Hepatic perfusion index,HPI)和全肝总灌注量(Total hepatic blood flow,THBF)与术前相比明显减少(P＜0.01),门静脉灌注值(Portal vein perfusion,PVP)与治疗前相比无明显变化(P＞0.05),碘油沉积区及坏死区无血流灌注,时间密度曲线呈直线;周围正常肝组织的各项CTPI值与术前相比无统计学差异(P＞0.05)。CTPI对PHC 行经TACE后局部残留或复发灶的诊断准确性为87.88%,灵敏度为95.83%,特异度为66.67%,与DSA相比,两者的一致性较好(kappa≥0.75)。结论 CTPI能够很好地反映PHC TACE术后局部病灶和周围正常组织的血供情况,可部分代替DSA评价PHC经 TACE术后的疗效。     

超声造影、CT、DSA对肝癌肝动脉栓塞术后残存血供及后续治疗方案的评估作用

目的：探讨超声造影、CT、X线数字减影血管造影（DSA）对肝癌肝动脉栓塞术（TAE）后残存血供及后续治疗方案的评估作用。方法：对30例接受TAE的肝癌患者行超声造影、CT、DSA检查,对照结果。并对25例有残存血供者再次TAE后的碘油沉积情况进行比较。结果：30例中,5例三项检查均提示病灶灭活完全,无残留血供。19例三项检查均显示病灶残存血供丰富,再次TAE碘油沉积良好。6例CT显示病灶灭活,无血供,超声造影显示病灶局部残存少量血供,DSA造影结果与超声造影相符,再次TAE碘油沉积不良。结论：超声造影对肝癌TAE后病灶残存血供的显示较CT更敏感、准确,与DSA相仿,且操作简便、无创。TAE后病灶的碘油沉积情况与血供相关,对于灭活不全但血供不丰富者,应选择更有效的治疗方法。     

Self-expandable stents for tracheal stenosis: Experience in two patients

Two patients with cervical tracheal stenosis, following prolonged ventilatory support, underwent balloon dilatation and expandable stainless steel stent placement across the stenoses. Following the successful release of the stent, there was gradual widening of the stenosed trachea in one patient, while in the other re-stenosis occurred due to columns of tracheal tissue projecting between the limbs of the stent. In the chronically ill and debilitated, use of expandable stents provides a good alternative to complex reconstructive surgery.     

复合手术室在脑脊髓血管病与富血供肿瘤治疗中的应用

目的:分析复合手术室在脑脊髓血管类疾病及富血供肿瘤治疗中应用情况及价值体现。方法:运用回顾性分析方式对2018年3月至2019年4月在郑州大学附属第一医院收治的193例病人进行分析,男性病人为101例,女性为92例,平均年龄为49.69岁;对复合手术的死亡率、致残率、感染率、住院时间及住院费用实施数据分析。结果:复合手术闭塞率、死亡率、致残率与传统肿瘤手术比较,数值差异不具有统计学意义（P>0.05）。19例富血供肿瘤中,彻底切除为89.47%（17/19）,死亡率为5.26%（1/19）,术后出现新发神经功能障碍发生率为21.05%（4/19）。复合手术术后感染率为15.54%（30/193）,中枢系统感染率为11.40%（22/193）,与传统手术比较,数值差异不具有统计学意义（P>0.05）。平均住院总天数和平均术后住院天数数值与传统手术数值比较,差异不具有统计学意义（P>0.05）;复合手术住院费用与传统手术数值比较,差异具有统计学意义（P<0.05）。结论:复合手术能够在脑脊髓血管类疾病及富血供肿瘤的手术过程中顺利开展实施,有效保证手术治疗预后效果及简化治疗流程,具有推广价值。     

Clinical Studies of Postoperative Arterial Infusion Chemotherapy in Patients with Pathologic T3 Esophageal Squamous Carcinoma

Multi-sample and multi-center studies have provided no evidence to indicate that preoperative chemo-radiation therapy can in- crease the 5 year survival rate of patients with esophageal squamous carcinoma, although some clinical studies have indicated tha…     

Experience of intravenous digital subtraction angiography (IV-DSA) in evaluation of neoadjuvant chemotherapy for advanced breast cancer

 Intravenous digital subtraction angiography (IV-DSA) was performed before and after neoadjuvant chemotherapy (NACT) in five patients with locally advanced breast cancer, and the efficacy of NACT was evaluated on the basis of the results of IV-DSA and histopathological examination. Following NACT, the maximum density of tumor enhancement (MAX) in the IV-DSA image decreased by 61.6% in case 1, 50% in case 2, 58.1% in case 3, 90.8% in case 4, and 97.2% in case 5. In all five patients, the efficacy of chemotherapy was rated as a partial response in terms of tumor size, while histological efficacy was rated as slightly effective in cases 1–4 and moderately effective in case 5. The pathological efficacy of NACT was highest in case 5, which showed the greatest decrease in MAX. These results indicate that variations in MAX reflect clinical efficacy, and, to some extent, also permit prediction of pathological efficacy. Received: March 4, 2002 / Accepted: June 10, 2002 Correspondence to:O. Watanabe     

A simple method for the correction of distorted digital angiographic images for stereotactic target localization

The most commonly used imaging modality for the diagnosis and localization of arteriovenous malformations (AVMs) treated with stereotactic radiotherapy is traditional angiography, but it would be desirable to also use digital subtraction angiography (DSA). However, DSA images are distorted due to the electron-optical characteristics of the X-ray image intensifier. For that reason, we have developed a method for the correction of the image distortion. The ISIS II Treatment Planning System (ISIS II TPS), developed at the Curie Institute, has been used for image acquisition and stereotactic localization. A grid phantom has been constructed for determining the distortion of the DSA images. The software developed for the correction has been implemented into the TPS and is based on a correction vector produced by matching the distorted and corrected grid points. The method has been tested for its ability to correct the position of all grid points as well as its effectiveness in real cases as compared to traditional angiography. The maximum displacement of the corrected grid points compared with their original position is measured to be 0.1 mm. The accuracy of the target localization using the corrected DSA images is comparable with traditional angiography localization and falls inside acceptable accuracy limits. In conclusion, this method offers the possibility of using DSA images for stereotactic localization without limiting the requested accuracy.     

Predication of axillary lymph node metastasis by intravenous digital subtraction angiography in breast cancer, its correlation with microvascular density

Accurate predication of axillary node status by non-invasive diagnostic method would be of great value in cases of breast cancer. There have been few reports advocating digital subtraction angiography (DSA) as specifically advantageous for the detection of lymph node metastasis. IV (intravenous)-DSA was carried out on 42 patients with breast carcinoma using a DSA system with a matrix of 1024×1024×pixels. When a mass became stained in the axilla, it was considered to be metastatic. An immunohistochemical technique with JC70 antibody to platelet/endothelial cell adhesion molecules was used to evaluate the microvascular density (MVD) of the axillary lymph nodes. IV-DSA achieved a 76.2% sensitivity, 85.7% specificity, and 81.0% accuracy. The average MVD with JC70 antibody was 97.7±44.4 in metastatic and 62.9±23.6 in nonmetastatic nodes. MVD was significantly higher in the cancerous than in the noncancerous regions within lymph nodes. The MVD was 105±38.4 in DSA-N(+) cases and was 57.8±21.9 in DSA-N(–) cases, and the difference was statistically significant. In conclusion, IV-DSA is a useful diagnostic modality for detection of axillary lymph node metastasis. This new modality predicts lymph node status by assessing the neovascularization of the lymph node.     

A retrospective cost analysis of angioplasty compared to bypass surgery for lower limb arterial disease in an Australian tertiary health service

Introduction

Percutaneous transluminal angioplasty (PTA) and surgical bypass (BYP) are treatment options for symptomatic peripheral arterial disease (PAD). PTA and BYP have different clinical outcomes and cost implications. This paper aims to compare hospital‐related costs of PTA and BYP for PAD of the lower limbs in an Australian health service.

Methods

A retrospective cost analysis using clinical and financial data from an urban, tertiary hospital was performed. Patient cohorts were matched to existing published studies and 3‐year findings were calculated. Outcomes measured were mean initial admission cost; mean bed stay; mean complication rate; mean cost of re‐intervention at 12 months and extrapolated mean cost at 3 years.

Results

The mean total admission costs for PTA compared to BYP were $8758 vs. $27,849 (P < 0.001). Patients undergoing BYP were admitted for 10.25 vs. 3.77 nights (P < 0.001). The complication rate was greater in the BYP group for infection only. Re‐intervention was required by 13% of the PTA group and 16% of the BYP group, at a mean cost of $11,798 and $14,728, respectively (P = 0.453). The extrapolated total mean cost at 3 years was higher in the BYP group for patients with both intermittent claudication ($26,764 vs. $11,402) and critical limb ischaemia ($27,719 vs. $12,655).

Conclusions

In this cohort, PTA is a favourable alternative to BYP for PAD of the lower limbs as it is less costly, does not result in a greater re‐intervention rate at 1 year and has been previously demonstrated to have comparable clinical outcomes. Given the limitations of this retrospective analysis, a prospective cost‐effectiveness analysis is recommended.