AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in de...AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).METHODS: Twenty-eight patients with nodular HCC underwent biphasic MDCT examination: hepatic arterial phase (HAP) 25 s and portal venous phase (PVP) 70 s after injection of the contrast medium (1.5 mL/kg). They also underwent hepatic angiography and intra-arterial infusion of iodized oil. Lipiodol CT was performed 3-4 wk after infusion. MDCT images were compared with DSA and Lipiodol CT images for detection of hepatic nodules.RESULTS: The three imaging techniques had the same sensitivity in detecting nodules ＞20 mm in diameter. There was no significant difference in the sensitivity among HAP-MDCT, Lipiodol CT and DSA for nodules of 10-20 mm in diameter. For the nodules ＜10 mm in diameter, HAP-MDCT identified 47, Lipiodol CT detected 27 (X2= 11.3, P= 0.005＜0.01, HAP-MDCT vs Lipiodol CT) and DSA detected 16(X2= 9.09, P= 0.005＜0.01 vs Lipiodol CT and X2= 29.03,P = 0.005＜0.01 vs HAP-MDCT). However, six nodules ＜10 mm in diameter were detected only by Lipiodol CT.CONCLUSION: MDCT and Lipiodol CT are two complementary modalities. At present, MDCT does not obviate the need for DSA and subsequent Lipiodol CT as a preoperative examination for HCC.展开更多
AIM: To establish a prognostic formula that distinguishes non-hypervascular hepatic nodules(NHNs) with higher aggressiveness from less hazardous one. METHODS: Seventy-three NHNs were detected in gadolinium ethoxybenzy...AIM: To establish a prognostic formula that distinguishes non-hypervascular hepatic nodules(NHNs) with higher aggressiveness from less hazardous one. METHODS: Seventy-three NHNs were detected in gadolinium ethoxybenzyl diethylene-triamine-pentaaceticacid magnetic resonance imaging(Gd-EOB-DTPA-MRI) study and confirmed to change 2 mm or more in size and/or to gain hypervascularity. All images were interpreted independently by an experienced, board-certified abdominal radiologist and hepatologist; both knew thatthe patients were at risk for hepatocellular carcinoma development but were blinded to the clinical information. A formula predicting NHN destiny was developed using a generalized estimating equation model with thirteen explanatory variables: age, gender, background liver diseases, Child-Pugh class, NHN diameter, T1-weighted imaging/T2-weighted imaging detectability, fat deposition, lower signal intensity in arterial phase, lower signal intensity in equilibrium phase, α-fetoprotein, des-γ-carboxy prothrombin, α-fetoprotein-L3, and coexistence of classical hepatocellular carcinoma. The accuracy of the formula was validated in bootstrap samples that were created by resampling of 1000 iterations. RESULTS: During a median follow-up period of 504 d, 73 NHNs with a median diameter of 9 mm(interquartile range: 8-12 mm) grew or shrank by 68.5%(fifty nodules) or 20.5%(fifteen nodules), respectively, whereas hypervascularity developed in 38.4%(twenty eight nodules). In the fifteen shrank nodules, twelve nodules disappeared, while 11.0%(eight nodules) were stable in size but acquired vascularity. A generalized estimating equation analysis selected five explanatories from the thirteen variables as significant factors to predict NHN progression. The estimated regression coefficients were 0.36 for age, 6.51 for lower signal intensity in arterial phase, 8.70 or 6.03 for positivity of hepatitis B virus or hepatitis C virus, 9.37 for des-γ-carboxy prothrombin, and-4.05 for fat deposition. A formula incorporating the five coefficients revealed sensitivity, specificity, and accuracy of 88.0%, 86.7%, and 87.7% in the formulating cohort, whereas these of 87.2% ± 5.7%, 83.8% ± 13.6%, and 87.3% ± 4.5% in the bootstrap samples. CONCLUSION: These data suggest that the formula helps Gd-EOB-DTPA-MRI detect a trend toward hepatocyte transformation by predicting NHN destiny.展开更多
objective: To explore the surgical treatment of hypervascular acoustic tumor (HAT). Methods: In past ten years (1975–1985) there were 90 patients with unilateral acoustic tumors were treated by surgery. Among them (4...objective: To explore the surgical treatment of hypervascular acoustic tumor (HAT). Methods: In past ten years (1975–1985) there were 90 patients with unilateral acoustic tumors were treated by surgery. Among them (4 cases of HAT and 86 cases of nonhypervascular acoustic tumors, NHATs) were retrospectively reviewed and clinical characteristics, radiological and surgical finding were compared. Results: HATs presented at a younger age than NHATs (28±10 vs. 54±17 years old) (P<0.01). MRI showed that HATs was solid, without tumor cyst, and larger than NHATs significantly (P<0.05). The surface of HATs consistently showed multiple flow voids representing large draining veins. The characteristic angiographical findings of HATs were extensive tumor vessels, tumor stains and early filling of draining veins; Vertebrobasilar arteries supplied HATs. The authors preferred the control hypotension anaesthesia to remove HATs and got total resection of 4 cases of HATs successfully. No patients has needed transfusion or suffered any other complications after operation. Conclusion: HATs was a solid tumor presented at young. Angiographical findings may provide characteristic manifestation, and could be managed by control hyper- tension in one-stage surgical approach.展开更多
To evaluate a devascularization technique for hypervascular tumors of the head and neck by direct intratumoral puncture Methods Six cases of hypervascular tumor of the head and neck were reviewed, focusing on find...To evaluate a devascularization technique for hypervascular tumors of the head and neck by direct intratumoral puncture Methods Six cases of hypervascular tumor of the head and neck were reviewed, focusing on findings from digital subtraction angiography and preoperative direct intratumoral embolization and their effects after the operation Results Total devascularization by complete embolization was achieved in 2 cases: 1 nasopharyngeal angiofibroma and 1 spongiform tumor, both of which were completely excised endoscopically with blood loss of 60 ml Incomplete devascularization through 80%-90% embolization was achieved in the other 4 cases: 1 paraganglioma was totally removed with 800 ml of blood loss, 1 hemangioblastoma was not completely excised with 400 ml of blood loss and 2 nasopharyngeal angiofibromas involving the intracranial region were partially eliminated with a total blood loss of 1600 ml Conclusion The new technique of preoperative embolization of hypervascular tumors of the head and neck by direct intratumoral puncture, which can decrease blood loss during the accompanying tumor resection and increase the possibility of complete tumor removal, is feasible, convenient, safe, and effective展开更多
Importance Pediatric hypervascular primary airway tumors are progressive,fatal lesions with a low incidence,and the disease is often more serious than that in adults.Objective To evaluate the clinical efficacy and saf...Importance Pediatric hypervascular primary airway tumors are progressive,fatal lesions with a low incidence,and the disease is often more serious than that in adults.Objective To evaluate the clinical efficacy and safety of interventional therapeutic bronchoscopy combined with conservative treatment and bronchial arterial embolization in children with primary airway tumors.Methods We retrospectively analyzed the clinical data of four pediatric patients with hypervascular primary airway tumor between 2017 and 2019 at Beijing Children’s Hospital.Results Two patients were low-grade bronchial mucoepidermoid carcinoma,one patient was pleomorphic adenoma,and one was bronchial leiomyoma.Interventional therapeutic bronchoscopy combined with bronchial arterial embolization was used for treatment(all four patients received general anesthesia).The tumors were safely resected in all patients via interventional bronchoscopy.There were no severe complications related to the procedures.All patients were followed up for 5–12 months,and one low-grade bronchial mucoepidermoid carcinoma recurred.Interpretation Interventional therapeutic bronchoscopy combined with bronchial arterial embolization appears to be a safe and efficient therapeutic method associated with less trauma and fewer complications,including no serious adverse events,in children with hypervascular primary airway tumors without bronchus wall infiltration.展开更多
基金Supported by the Medical Science Research Fund of Sichuan Province,No. 200054
文摘AIM: The purpose of this study was to compare the diagnostic accuracy of biphasic multi-detector row helical computed tomography (MDCT), digital subtraction angiography (DSA)and Lipiodol computed tomography (CT) in detection of hypervascular hepatocellular carcinoma (HCC).METHODS: Twenty-eight patients with nodular HCC underwent biphasic MDCT examination: hepatic arterial phase (HAP) 25 s and portal venous phase (PVP) 70 s after injection of the contrast medium (1.5 mL/kg). They also underwent hepatic angiography and intra-arterial infusion of iodized oil. Lipiodol CT was performed 3-4 wk after infusion. MDCT images were compared with DSA and Lipiodol CT images for detection of hepatic nodules.RESULTS: The three imaging techniques had the same sensitivity in detecting nodules ＞20 mm in diameter. There was no significant difference in the sensitivity among HAP-MDCT, Lipiodol CT and DSA for nodules of 10-20 mm in diameter. For the nodules ＜10 mm in diameter, HAP-MDCT identified 47, Lipiodol CT detected 27 (X2= 11.3, P= 0.005＜0.01, HAP-MDCT vs Lipiodol CT) and DSA detected 16(X2= 9.09, P= 0.005＜0.01 vs Lipiodol CT and X2= 29.03,P = 0.005＜0.01 vs HAP-MDCT). However, six nodules ＜10 mm in diameter were detected only by Lipiodol CT.CONCLUSION: MDCT and Lipiodol CT are two complementary modalities. At present, MDCT does not obviate the need for DSA and subsequent Lipiodol CT as a preoperative examination for HCC.
文摘AIM: To establish a prognostic formula that distinguishes non-hypervascular hepatic nodules(NHNs) with higher aggressiveness from less hazardous one. METHODS: Seventy-three NHNs were detected in gadolinium ethoxybenzyl diethylene-triamine-pentaaceticacid magnetic resonance imaging(Gd-EOB-DTPA-MRI) study and confirmed to change 2 mm or more in size and/or to gain hypervascularity. All images were interpreted independently by an experienced, board-certified abdominal radiologist and hepatologist; both knew thatthe patients were at risk for hepatocellular carcinoma development but were blinded to the clinical information. A formula predicting NHN destiny was developed using a generalized estimating equation model with thirteen explanatory variables: age, gender, background liver diseases, Child-Pugh class, NHN diameter, T1-weighted imaging/T2-weighted imaging detectability, fat deposition, lower signal intensity in arterial phase, lower signal intensity in equilibrium phase, α-fetoprotein, des-γ-carboxy prothrombin, α-fetoprotein-L3, and coexistence of classical hepatocellular carcinoma. The accuracy of the formula was validated in bootstrap samples that were created by resampling of 1000 iterations. RESULTS: During a median follow-up period of 504 d, 73 NHNs with a median diameter of 9 mm(interquartile range: 8-12 mm) grew or shrank by 68.5%(fifty nodules) or 20.5%(fifteen nodules), respectively, whereas hypervascularity developed in 38.4%(twenty eight nodules). In the fifteen shrank nodules, twelve nodules disappeared, while 11.0%(eight nodules) were stable in size but acquired vascularity. A generalized estimating equation analysis selected five explanatories from the thirteen variables as significant factors to predict NHN progression. The estimated regression coefficients were 0.36 for age, 6.51 for lower signal intensity in arterial phase, 8.70 or 6.03 for positivity of hepatitis B virus or hepatitis C virus, 9.37 for des-γ-carboxy prothrombin, and-4.05 for fat deposition. A formula incorporating the five coefficients revealed sensitivity, specificity, and accuracy of 88.0%, 86.7%, and 87.7% in the formulating cohort, whereas these of 87.2% ± 5.7%, 83.8% ± 13.6%, and 87.3% ± 4.5% in the bootstrap samples. CONCLUSION: These data suggest that the formula helps Gd-EOB-DTPA-MRI detect a trend toward hepatocyte transformation by predicting NHN destiny.
文摘objective: To explore the surgical treatment of hypervascular acoustic tumor (HAT). Methods: In past ten years (1975–1985) there were 90 patients with unilateral acoustic tumors were treated by surgery. Among them (4 cases of HAT and 86 cases of nonhypervascular acoustic tumors, NHATs) were retrospectively reviewed and clinical characteristics, radiological and surgical finding were compared. Results: HATs presented at a younger age than NHATs (28±10 vs. 54±17 years old) (P<0.01). MRI showed that HATs was solid, without tumor cyst, and larger than NHATs significantly (P<0.05). The surface of HATs consistently showed multiple flow voids representing large draining veins. The characteristic angiographical findings of HATs were extensive tumor vessels, tumor stains and early filling of draining veins; Vertebrobasilar arteries supplied HATs. The authors preferred the control hypotension anaesthesia to remove HATs and got total resection of 4 cases of HATs successfully. No patients has needed transfusion or suffered any other complications after operation. Conclusion: HATs was a solid tumor presented at young. Angiographical findings may provide characteristic manifestation, and could be managed by control hyper- tension in one-stage surgical approach.
文摘To evaluate a devascularization technique for hypervascular tumors of the head and neck by direct intratumoral puncture Methods Six cases of hypervascular tumor of the head and neck were reviewed, focusing on findings from digital subtraction angiography and preoperative direct intratumoral embolization and their effects after the operation Results Total devascularization by complete embolization was achieved in 2 cases: 1 nasopharyngeal angiofibroma and 1 spongiform tumor, both of which were completely excised endoscopically with blood loss of 60 ml Incomplete devascularization through 80%-90% embolization was achieved in the other 4 cases: 1 paraganglioma was totally removed with 800 ml of blood loss, 1 hemangioblastoma was not completely excised with 400 ml of blood loss and 2 nasopharyngeal angiofibromas involving the intracranial region were partially eliminated with a total blood loss of 1600 ml Conclusion The new technique of preoperative embolization of hypervascular tumors of the head and neck by direct intratumoral puncture, which can decrease blood loss during the accompanying tumor resection and increase the possibility of complete tumor removal, is feasible, convenient, safe, and effective
文摘Importance Pediatric hypervascular primary airway tumors are progressive,fatal lesions with a low incidence,and the disease is often more serious than that in adults.Objective To evaluate the clinical efficacy and safety of interventional therapeutic bronchoscopy combined with conservative treatment and bronchial arterial embolization in children with primary airway tumors.Methods We retrospectively analyzed the clinical data of four pediatric patients with hypervascular primary airway tumor between 2017 and 2019 at Beijing Children’s Hospital.Results Two patients were low-grade bronchial mucoepidermoid carcinoma,one patient was pleomorphic adenoma,and one was bronchial leiomyoma.Interventional therapeutic bronchoscopy combined with bronchial arterial embolization was used for treatment(all four patients received general anesthesia).The tumors were safely resected in all patients via interventional bronchoscopy.There were no severe complications related to the procedures.All patients were followed up for 5–12 months,and one low-grade bronchial mucoepidermoid carcinoma recurred.Interpretation Interventional therapeutic bronchoscopy combined with bronchial arterial embolization appears to be a safe and efficient therapeutic method associated with less trauma and fewer complications,including no serious adverse events,in children with hypervascular primary airway tumors without bronchus wall infiltration.
