Objective To compare the efficacy and safety of cryoablation(CA)and microwave ablation(MWA)for treating rabbit VX2 paravertebral tumors.Methods Forty-eight New Zealand rabbits were selected to establish models of VX2 paravertebral tumor.The rabbits were then randomly divided into CA group(n=24)and MWA group(n=24).The complete ablation rates,survival rates,Bristol rabbit pain scale(BRPS)scores and incidence of complications were compared between groups.Results The complete ablation rate and 21-day survival rate of CA group was 91.67%(22/24)and 33.33%(8/24),both better than those of MWA group(66.67%[16/24]and 16.67%[4/24]),respectively(both P＜0.05).BRPS scores of 4 h,1 day,4 days,7 days and 14 days after treatment of CA group were all lower than those of MWA group(all P＜0.001),and BRPS scores of both groups at the above time points were all lower than that before treatments(all P＜0.05).The incidence of complications in CA group(3/24,12.50%)was lower than in MWA group(8/24,33.33%)(P＜0.05).Conclusion The efficacy and safety of CA were both better than those of MWA for treating rabbit VX2 paravertebral tumors.
目的 探讨基于深度学习(DL)重建列表模式提取低剂量图像用于儿童18 F-FDG PET/CT检查的可行性.方法 对93例患儿行全身18 F-FDG PET/CT,分别以120秒/床位行标准全剂量扫描、20秒/床位行快速扫描,之后以列表模式于120秒/床位图像中提取20秒/床位图像.将20秒/床位图像与以列表模式提取的20秒/床位图像传输至DL平台进行重建,分别获得相应全剂量图像(DL-f20s、DL-20s);对比标准全剂量120s、DL-f20s、DL-20s图像的靶本比(TBR)、对比噪声比(CNR)、变异系数(CV)、图像质量主观评分,以及肝血池、纵隔血池、肌肉血池及原发病灶最大标准摄取值(SUVmax)和平均标准摄取值(SUVmean),分析基于DL-f20s与DL-20s图像所获SUVmax及SUVmean的一致性.结果 120s、DL-f20s和DL-20s图像的主观质量Likert评分、TBR、CNR、CV及各血池、病灶的SUVmax、SUVmean差异均无统计学意义(P均>0.05).DL-f20s与DL-20s图像之间,5％以上肌肉血池SUVmax、SUVmean差值在95％一致性界限(LoA)以外,其余血池及病灶的SUVmax、SUVmean差值在95％LoA以外者均≤5％.结论 基于DL重建列表模式提取低剂量图像可用于儿童18 F-FDG PET/CT检查,且所获图像的质量及代谢参数与快速扫描相当.
Objective To observe the risk factors of recurrence after ultrasound-guided thermal ablation for treating uremia secondary hyperparathyroidism(SHPT).Methods Totally 59 patients with uremia SHPT who underwent ultrasound-guided thermal ablation were enrolled,including 23 cases with(relapse group)and 36 without SHPT recurrence(non relapsed group).Clinical data were compared between groups,univariate and multivariate logistic regression analysis were performed to screen independent risk factors of SHPT recurrence.Results There were significant differences of serum free thyroxine(FT4),urea,intact parathyroid hormone(iPTH)1 day after ablation,1 day decrease rate of iPTH,the maximum diameter of the largest nodule,ablation time,total ablation energy,energy to volume ratio and the proportion of 1 day decrease rate of iPTH≤90%between groups(all P＜0.05).Higher urea,lower energy to volume ratio and 1 day decrease rate of iPTH≤90%were all independent risk factors of SHPT recurrence(all P＜0.05).Conclusion Higher urea,lower energy to volume ratio and 1 day decrease rate of iPTH≤90%were independent risk factors of recurrence after ultrasound-guided thermal ablation for treating uremia SHPT.
希氏-浦肯野系统起搏为生理性心室起搏方式,包括希氏束起搏(His' bundle pacing, HBP)及左束支(left bundle branch, LBB)起 搏(left bundle branch pacing, LBBP),理论上可恢复心肌收缩同步性、改善心脏功能[1-2].相比HBP,LBBP具有起搏阈值低、可跳过希氏束及以下传导阻滞处和操作难度低等优势[3],其成功关键在于准确定位左束支;目前临床常以多导电生理仪定位左束支.本研究报道以临时起搏电极辅助定位19例患者LBB行LBBP的效果.
Objective To observe the therapeutic effect of endovascular embolization for perimedullary arteriovenous fistula(PMAVF).Methods Data of 8 PMAVF patients who underwent endovascular embolization were retrospectively analyzed.Findings of digital subtraction angiography(DSA)immediately and 6 months after treatment were reviewed,and the modified Aminoff-Logue score(mALS)was compared before and 6 months after treatment.Results Among 8 cases of PMAVF,there were 2 cases of type Ⅰ,5 cases of type Ⅱand 1 case of type Ⅲ,among them 3 were treated with Onyx glue while 5 with Glubrane glue.The immediate DSA results after treatment showed complete embolization of the fistula in all 8 cases,while those 6 months after treatment showed no recurrence.One case recovered and the other 7 cases improved,and mALS(2.25±2.12)6 months after treatment was lower than that(5.50±2.39)before treatment(P＜0.05).Conclusion Endovascular embolization could safely and effectively treat PMAVF.
Objective To observe the feasibility of low tube voltage scanning technology in CT-guided cryoablation therapy of liver cancer.Methods Twenty-one patients who underwent routine CT(tube voltage 120 kV)-guided cryoablation of liver cancer(group A)were retrospectively enrolled,while low tube voltage(100 kV)CT-guided cryoablation of liver cancer was prospectively performed in 23 patients(group B).CT scanning were performed before and after ablation with automatic tube current mode(50-450 mA),and adaptive statistical iterative reconstruction(ASIR)algorithm was used for image reconstruction(reconstruction percentages of 40%)of both groups.The subjective scores and objective evaluations of CT image quality before and after treatment were compared between groups,so as the treatment effect and patient's radiation dose(volume CT dose index[CTDIvol]).Results No significant difference of subjective scores,objective evaluations of CT image quality nor treatment effect was detected between groups(all P＞0.05).Before and after treatment,CTDIvol of patients in group A was significantly higher than that in group B(btoh P＜0.001).Conclusion Low tube voltage scanning technology could be used for CT-guided cryoablation of liver cancer,which might ensure image quality without affecting evaluation on cryoablation effect and reduce radiation dose combined with ASIR algorithm.
Objective To explore the feasibility of low-dose CT-guided Hookwire localization of lung nodules in patients with body mass index(BMI)≤22 kg/m2.Methods Totally 53 BMI≤22 kg/m2 patients with 66 lung nodules were prospectively enrolled,CT-guided Hookwire localization of lung nodules were performed.According to the dose of CT scanning,the patients were divided into conventional dose group(group A,25 patients with 32 lung nodules)or low dose group(group B,28 patients with 34 lung nodules),while previous conventional dose CT scanning data of patients in group B were taken as control(group C).The image quality of group A and group B were scored using a 5-point scale,and the displaying of lung nodules in group B and group C were scored using a 3-point scale.The basic information of patients,lung nodules location,type,CT value,the maximum diameter,image quality score,puncture times,complications,as well as volume CT dose index(CTDIvol),dose-length product(DLP)and effective dose(ED)were compared between group A and B,so were score of lung nodules display,the maximum diameter and CT value of nodules between group B and C.Results No significant difference of basic information,the location,type,CT value,the maximum diameter,puncture times of lung nodules nor complications was found between group A and B(all P＞0.05).The quality score of group B(4[3,4])was lower than that of group A(5[4,5])(P＜0.05)but all greater than 3 and met the needs of puncturing.CTDIvol,DLP and ED of group B were lower than those of group A(all P＜0.05).There was no significant difference of the maximum diameter,CT value nor score of lung nodules display between group B and C(all P＞0.05).Conclusion Low-dose CT-guided Hookwire localization of lung nodules was feasible in patients with BMI≤22 kg/m2.
患者女,40岁,10年前体检发现颈部 1.2 cm×1.3 cm无痛性结节,近3年增大至3.0 cm×1.8 cm×1.9 cm,伴颈部异物感,无声音嘶哑、饮水呛咳及吞咽困难;既往体健.查体:于颈前正中触及3.0 cm×2.0 cm×2.0 cm质硬肿物,表面光滑,活动度尚可,无压痛.实验室检查未见明显异常.
Objective To observe the effect of transcatheter arterial embolization(TAE)with Glubran-2 glue for treating hemorrhage after percutaneous transhepatic cholangial drainage(PTCD).Methods Data of 17 patients with hemorrhage after PTCD who underwent TAE with Glubran-2 glue were retrospectively analyzed.The technical success rate,clinical success rate and complications were observed.The red blood cell(RBC)and hemoglobin(Hb)on the day of TAE and the next day of TAE were compared,also the glutamic-pyruvic transaminase(GPT)level before TAE,on the next day of TAE,on the second and the fourth day after TAE,respectively.Results The offending vessel of bleeding was successfully embolized in all 17 cases,both technical success rate of TAE and clinical success rate of hemostasis were 100%.There was no serious complication such as liver abscess,septicemia nor pulmonary embolism.No significant difference of RBC nor Hb was found between the day of TAE and the next day of TAE(both P＞0.05).GPT before TAE was lower than the next day of TAE and the second day after TAE(P＜0.05),while no significant difference of GPT was found before TAE and 4 days after TAE(P＞0.05).Conclusion TAE with Glubran-2 glue for treating hemorrhage after PTCD was safe and effective.
Objective To observe the value of multimodal imaging for diagnosis of cardiac space-occupying lesions.Methods Data of 70 patients with cardiac space-occupying lesions who underwent echocardiography and cardiac CT(CCT)were retrospectively analyzed,among them 35 also underwent cardiac MRI(CMRI).The value of multimodal imaging for diagnosis of cardiac space-occupying lesions were explored according to the results of surgical pathology or clinical diagnosis.Results Among 70 cases,benign tumors were confirmed by surgical pathology in 43 cases,while malignant tumors were confirmed by surgical pathology in 3 cases and clinically diagnosed in 1 case.Meanwhile,non-tumor-occupying lesions were clinically diagnosed in 23 cases,all obviously shrunken after treatments.Among 70 cases,echocardiography correctly diagnosed 57 cases,misdiagnosed 8 cases and unclearly diagnosed 5 cases,with diagnostic accuracy rate of 81.43%(57/70).CCT correctly diagnosed 63 cases,misdiagnosed 4 cases but missed 3 cases,with diagnostic accuracy rate of 90.00%(63/70).CMRI outcomes in all 35 cases were consistent with surgical pathologic results,with diagnostic accuracy rate of 100%(35/35).Conclusion Multimodal imaging might provide objective evidences for diagnosis and treatment of cardiac space-occupying lesions.
Endovascular stent implantation had become a major therapeutic option for heart,brain and peripheral vascular diseases.After stent implantation,CT angiography(CTA)and MR angiography(MRA)were often performed during follow-up to diagnose or predict relative complications as early as possible.The research progresses of different material endovascular stent and imaging follow-up after stent implantation were reviewed in this article.
Objective To observe the value of zero echo time(ZTE)3.0T MRI for detecting lung cancer nodules.Methods Totally 126 lung cancer patients(176 lung nodules)were prospectively enrolled and underwent 3.0T MR axial lung scanning,including T1-volumetric interpolated breath-hold examination(VIBE),T2-BLADE,T2-half-Fourier acquisition single-shot turbo spin-echo(HASTE)and ZTE sequences.The consistency between ZTE MRI and previous CT for displaying characteristics of pulmonary nodules was analyzed,and the sensitivity of different MR sequences for detecting pulmonary nodules were observed.Results Among 176 pulmonary nodules showed on CT,ZTE MRI detected 140 and missed 36 ones.The consistency between ZTE MRI and CT for displaying the maximum diameter and actual maximum diameter of pulmonary nodules were both good(ICC=0.954,0.943,both P＜0.001),and the difference between ZTE MRI and CT was small.The consistency between ZTE MRI and CT for displaying tracheal vascular bundles,pleural indentation and internal bronchial inflation signs were all good(Kappa=0.894,0.912,0.917),while for displaying the type and shape of nodules were both moderate(Kappa=0.661,0.501).The sensitivity of ZTE MRI for detecting pulmonary nodules was higher than that of other individual MR sequences(all P＜0.05),of combination of ZTE and T2 BLADE was higher than that of other sequence combinations(all P＜0.05).Conclusion ZTE 3.0T MRI could be used to detect lung cancer nodules,which was superior to conventional MRI.Combination of ZTE 3.0T MRI with T2-BLADE could improve the sensitivity for detecting pulmonary nodules.
Objective To observe the impact factors of the diagnostic accuracy of fine needle aspiration biopsy(FNAB)for papillary thyroid carcinoma(PTC).Methods Totally 468 patients with single PTC confirmed by postoperative pathology who underwent FNAB before surgery were enrolled.The impact of clinica,l ultrasonic and pathological features on the accuracy of FNAB diagnosis were analyzed.Results The accuracy of FNAB for diagnosing PTC was 71.37%(334/468).The maximum diameter and location of PTC were both impact factors of the diagnostic accuracy of FNAB.The maximum diameter of 0.7 cm was the optimal cutoff value of FNAB for diagnosing PTC,and the diagnostic accuracy of FNAB for PTC with the maximum diameter＜0.7 cm and those≥0.7 cm was 62.96%(119/189)and 77.06%(215/279),respectively.The diagnostic accuracy of FNAB for PTC located in the difficult and easy area of puncture was 52.53%(52/99)and 76.42%(282/369),respectively.The diagnostic accuracy of FNAB for PTC with the maximum diameter≥0.7 cm and located in the easy area,≥0.7 cm and located in the difficult area,＜0.7 cm and located in the easy area,＜0.7 cm and located in the difficult area was 80.43%(185/230),61.22%(30/49),69.78%(97/139)and 44.00%(22/50),respectively.Conclusion The maximum diameter and location of PTC were both impact factors of the diagnostic accuracy of FNAB.
Objective To observe the impact factors of the total sonication dose of high-intensity focused ultrasound(HIFU)ablation in patients with cesarean scar pregnancy(CSP)using optimal scale regression analysis.Methods A total of 131 patients with CSP who underwent HIFU ablation combined with ultrasound-guided suction curettage were enrolled.The correlations of clinical and ultrasonic data with the total sonication dose were evaluated.The optimal scale regression analysis was used to explore the impact factors of the total sonication dose,also to establish a prediction model of the latter.Results The total success rate of HIFU treatment of CSP was 96.95%(127/131).The total sonication dose was significantly correlated with patient's body mass index(BMI,X1),menopause time(X2),serum β-human chorionic gonadotropin level(X3),myometrium thickness between gestational sac and bladder(X4),as well as the maximum meridian of the gestational sac(X5)(all P＜0.05),and the model was as follow:Total sonication dose=0.273×X1+0.044×X2+0.113×X3-0.033×X4+0.327×X5.The Optimal scale regression analysis showed that BMI and the maximum meridian of the gestational sac were both important impact factors of the total sonication dose(r=0.295,0.448,both P＜0.05),with an importance of 0.294 and 0.535,respectively.Conclusion BMI(17.9-29.3 kg/m2)and the maximum meridian of gestational sac were both the most important impact factors of the total sonication dose in HIFU ablation of CSP.
Objective To observe the value of abdominal contrast-enhanced CT for diagnosis of spontaneous retroperitoneal hematoma(SRH)and transcatheter arterial embolization for treating SRH.Methods Data of 7 SRH patients were retrospectively analyzed,including 4 cases diagnosed with abdominal contrast-enhanced CT,1 case diagnosed with plain CT and 2 cases diagnosed with abdominal ultrasound.Transcatheter angiography was performed to explore the offending artery of SRH which were then treated with trancatheter arterial embolization.The total angiographic time,i.e.the time span between the first and the last angiography was recorded and the treatment effect was observed.Results Among 7 patients,the offending artery of SRH was identified and embolized,and 30 days follow-up showed stable condition in 6 cases.The offending artery of SRH was not found in 1 case who then received conservative medical treatment,and the condition remained stable.The total angiographic time in 4 cases diagnosed with abdominal contrast-enhanced CT were 32-60 min,with a median time of 47.5 min,while in the rest 3 were 36-80 min,with a median time of 63.0 min.Conclusion Abdominal contrast-enhanced CT was helpful to diagnosis and displaying the offending artery of SRH.Transcatheter arterial embolization was effective for treating SRH.
Objective To comparatively observe the efficacy and safety of TACE combined with 125I seeds implantation or lenvatinib for treating hepatocellular carcinoma(HCC)complicated with portal vein tumor thrombosis(PVTT).Methods Totally 52 HCC patients complicated with type Ⅱ or type Ⅲ PVTT were enrolled and divided into TACE combined with 125I seeds group(group A,n=27)and TACE combined with lenvatinib group(group B,n=25).Objective response rate(ORR),overall survival(OS)and incidence rate of adverse reaction were compared between groups.Results ORR,the median OS,median OS of type Ⅱ PVTT and median OS of type Ⅲ PVTT was 70.37%(19/27),13.6 months,14.1 months and 13.2 months in group A,and 32.00%(8/25),11.3 months,12.3 months and 10.4 months in group B,respectively.The above indexes in group A were all better than those in group B(all P＜0.05).In group A,the incidence rate of adverse reaction was 48.15%(13/27),and no serious complication occurred.In group B,the incidence rate of adverse reaction was 88.00%(22/25),and severe drug toxicity was noticed in 5 cases(5/25,20.00%).Conclusion The efficacy and safety of TACE combined with 125I seeds were both better than those of TACE combined with lenvatinib for treating HCC complicated with PVTT.
Objective To observe the value of Neuroform Atlas stent-assisted coil embolization for treating wide-necked basilar artery tip aneurysm(BTA).Methods A total of 21 patients with single wide-necked BTA who underwent Neuroform Atlas stent-assisted coil embolization were enrolled,including 14 cases of ruptured BTA complicated with subarachnoid hemorrhage(SAH).Clinical and imaging data after treatment were observed,and serious adverse event(SAE)was recorded.Prognosis was evaluated with modified Rankin scale(mRS),while the status of arterial occlusion was assessed with Raymond grade.The value of Neuroform Atlas stent-assisted coil embolization for treating wide-necked BTA was analyzed.Results Totally 29 Neuroform Atlas stents were successfully implanted in 21 cases.Four patients with ruptured BTA complicated with SAH developed SAE during hospitalization,among them,1 patient died of ruptured BTA and bleeding again,1 died of cerebral hernia,while shunt dependent hydrocephalus and ischemic event occurred each in 1 case.The rest 19 cases were followed up for 6(6,12)months,and the last follow-up mRS score of 12 cases were 0,of 3 cases were 1,of 2 cases were 2 and of the other 2 cases were 3.Fifteen patients underwent reexamination of digital subtraction angiography during follow-up,and 11 BTA were classified as grade Ⅰ,3 as grade Ⅱ and 1 as grade Ⅲ.No stent stenosis nor occlusion was observed.Conclusion Neuroform Atlas stent-assisted coil embolization was safe and effective for treating wide-necked BTA.
目的 观察甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移(CLNM)的影响因素.方法 回顾性分析230例接受手术治疗的PTMC患者,根据术后病理显示有无颈部CLNM分为CLNM组(n=75)和非CLNM组(n= 155);以单因素及多因素分析对比 2组患者一般资料、超声及手术所见,筛选PTMC颈部CLNM的相关影响因素,并构建logistic回归模型;绘制受试者工作特征(ROC)曲线评估模型预测PTMC 患者存在颈部CLNM的效能.结果 组间患者性别、年龄、肿瘤最大径、肿瘤与被膜位置关系及BRAF V600E基因差异均有统计学意义(P均＜0.05).PTMC患者年龄、肿瘤最大径、肿瘤与被膜位置关系及BRAF V600E基因均为PTMC发生颈部CLNM的独立影响因素(P均＜0.05);以之构建的模型预测PTMC发生颈部CLNM的曲线下面积(AUC)、敏感度、特异度及准确率分别为0.802、73.33%、77.42%及 76.09%.结论 患者年龄、肿瘤最大径、肿瘤与被膜位置关系及BRAF V600E基因均为PTMC发生颈部CLNM的独立影响因素.
目的 观察超声引导下国产纳秒刀消融治疗甲状腺微小乳头状癌(PTMC)的效果及安全性.方法 前瞻性纳入 12例PTMC患者行超声引导下国产纳秒刀消融治疗,计算术后第 1、3、6个月病灶体积缩小率(VRR 病灶)以及消融灶体积缩小率(VRR 消融灶);观察围手术期并发症及随访期间复发、转移情况.结果 12例PTMC均一次完全消融成功.术后第1、3、6个月,VRR 病灶分别为-14.43%、81.79%及100%,VRR 消融灶分别为92.46%、98.56%及100%.1例术后颈部疼痛,3天后自行缓解.未见出血、喉返神经损伤、心律失常等严重并发症.随访期间无复发、转移.结论 超声引导下国产纳秒刀消融治疗PTMC有效且安全.
患者男,17岁,右乳进行性增大10个月伴胀痛半年、加重3天;既往体健,无服用激素类药物史及特殊家族病史.查体:右乳巨大肿物直径约 30 cm,质硬、压痛(+),边界不清,活动度差.实验室检查:泌乳素766.40 mIU/L,孕酮1.61 nmol/L.乳腺超声:双侧乳头深面见腺体样组织,右乳探及囊实性团块.胸部轴位CT/MRI:右乳腺体后缘 11 cm×8.6 cm卵圆形不均匀高密度/信号团块状病灶,累及胸壁及胸膜,边缘见少许钙化;增强后肿块明显不均匀强化,内见多发纡曲血管影(图1A～ 1D).影像学诊断:右乳肿瘤,肉瘤可能.
