[en] Objective: To explore the feasibility, safety, and effect of interventional technology for inserting ¹²⁵I seeds into tumor focus and to study the advantage or shortcome of different image equipment used in seed implantation. Methods: Fifteen cases of advanced stage tumor with metastasis and another 15 cases of advanced unresectable esophageal cancer were enrolled. Method of seed implantation was carried out by inserting ¹²⁵I seeds into tumor foci through percutaneous puncture under ultrasound or CT guidance, and placed the esophageal stent binding with ¹²⁵I seed to the diseased esophageal segment under DSA. Results: All ¹²⁵I seeds were successfully released to the target places under ultrasound, CT and DSA guidance, except one seed was found to be lost from one esophageal ¹²⁵I seed irradiated stent due to misoperation. A follow-up showed obvious improvement of clinical symptom, no significant changes of hemogram, immunity markers, and no complications including esophageal perforation, hemorrhage, and skin necrosis. No radiation seeds shedded during the releasing processes by ECT. One month follow-up by CT showed the target places were thinned in 13 cases, thickened in 2 cases. 3 cases had been followed-up for 13 months, CT revealed the obvious thinning of the foci. Three-month follow up with gastroendoscopy and biopsy demonstrated that the foci within the ¹²⁵I seede binding stent placement segment resolved markedly, with no tumor cells found in biopsy for 3 of 5 cases. 15 cases by percutaneous puncture implantation had been followed-up for two months, showed the foci becoming obviously small under diagnostic imaging. Conclusions: It is feasible and safe to insert ¹²⁵I seeds into tumor foci by interventional technology and the confirmed effect is favorable. (authors)

[en] Objective: To evaluate percutaneous vertebroplasty (PVP) treatment for benign and malignant vertebral lesions from a technique view. Methods: PVP was performed in 29 consecutive patients with 41 vertebrae involvement, including 23 vertebral metastatic neoplasms in 16 patients, osteoporotic fractures within 10 vertebrae in 7 patient, hemangiomas in 3 patients, and other lesions in 3 patients. PVP procedures were performed under the guidance of CT plus C-arm fluoroscopy or fluoroscopy only. Two to 8 ml of PMMA was injected per vertebra. Results: A techniques success of PVP was obtained in 97.56% (40/41). CR and PR were reached in 65.52% and 31.03% respectively in a follow-up of 2-10 months. No further or new vertebral compression occurred in all patients at the last follow-up. No major complications occurred in this series, except asymptomatic PMMA leak around vertebrae demonstrated by CT in 3 cases. Conclusions: PVP provides significant pain relief in both benign and malignant lesions. Procedure of PVP is safe and uncomplicated when performed under monitoring by C-arm X-ray machine in most cases. It is stressed that a proper use of PMMA is a key factor for PVP procedure

[en] Objective: To evaluate the efficacy of percutaneous vertebroplasty (PVP) and endovascular chemotherapy and embolization for the treatment of vertebrae malignant tumors. Methods: Twenty nine patients (male 16, female 13) had 40 vertebrae malignant tumors, including 28 patients with 37 vertebrae metastases and 1 patient with multiple myeloma involving 3 vertebrae. The primary foci were esophageal cancer, lung cancer, colon carcinoma, hepatic cancer, stomach cancer, breast cancer, kidney cancer and 2 of unknown. All the patients showed moderate or severe thoracic and lumbar pain with 2 patients of spinal cord dysfunction. Eighteen cases with 26 vertebrae were performed PVP only, 11 cases with 16 vertebrae were undergone endovascular chemotherapy and/or embolization. Results: After treatment among 29 patients, 16 had CR (55.1%), 12 had PR(41.4%), 1 was unsuccessful with PVP but pain was relieved by endovascular therapy. No complication occurred. Conclusions: PVP and PVP combined with endovascular therapy may have an excellent efficacy for vertebral malignant tumors, with relief of pain obviously and prolong the patient's life

[en] Objective: To evaluate the key technique, short term clinical efficacy and degree of changes in vertebral body height for percutaneous vertebroplasty in treating patients with osteoporotic vertebral compression fractures containing intraosseous cystic cavity phenomena. Methods: Thirty two vertebrae of painful compression fractures with intraosseous vacuum sign occurring in 27 patients were identified from 326 percutaneous vertebroplasties performed in 207 patients during 4 years. PVP was performed under C-arm fluoroscopy guidance only with local anesthesia. Intaosseous venography was performed on each vertebra by hand injection with non-ionic contrast agent, with CT monitoring after PMMA injection for the PMMA distribution in the vertebrae and looking for leakage. The heights of 32 vertebral bodies were measured before and after the vertebroplasty. The efficacy of PVP was evaluated during the follow-up. Results: The successful rate of PVP was 100%. Main appearance of vertebral venography showed cystic cavity-like, stasis of contrast medium within the marrow space of the fractured vertebra. 6.8 ml of PMMA in average was injected into each vertebra. CR, PR and NR were obtained respectively 66.7%, 18.5%, 14.8% mm centrally and 0.06 mm posteriorly. The heights restoration of vertebrae anteriorly and centrally were significantly different (P<0.05), but the heights restoration of vertebrae posteriorly showed no significant different (P>0.05). No serious complications related to the technique occurred, except 3 cases with asymptomatic PMMA leakage around vertebrae demonstrated by CT. Conclusions: Significant pain relief and vertebral height restoration by PVP in the treatment of patients with painful vertebral compression fractures accompanied by intraosseous cysticavitary change, are promising with low-rate of PMMA leakage. The basic successful mechanism lies on the proper complete PMMA filling predicting through venography. (authors)

[en] Objective: To assess the effectiveness and the safety of IDET for chronic discogenic low back pain. Methods: Standard intradiscal electrothermal treatment were performed in two adjacent disc levels (L3-4, L4-5) of two domestic pigs. MRI were available at pretreatment, posttreatment of 1,2 weeks, and then the two animals were killed respectively at 1,2 weeks after the procedure. The specimens were then undergone thin sectioned and subjected to humatoxylin and eosin staining for histological investigation. 23 patients (totally 29 discs, including L2-3 to L5-S1) with chronic symptoms underwent IDET for clinical study. VAS (Visual Analog Scale) pain scores were collected before the treatment, 1 week and 3 months after the procedure. One way ANOVA was used for statistical analysis. Results: 4 discs of standard IDET models have been set up in two pigs showing normal MRI T2W1 signal of nucleus pulposus immediately after the procedure, but the high signal extent of the central part of the nucleo pulposus shrinked with conspicuous peripheral low signal changes during the following 1-2 W. Degeneration and shrinkage of nucleo-pulposus with lecolized fibrous ring thickening were found pathologically but without damage to nurve roots and epidural sac. 29 discs in 23 patients were performed successfully, without complication. The follow-up evaluation of 1 week and 3 months after the treatment showing significant differences with those before the treatment on was scores 65.3% and 78.9% respectively (P<0.0001). Conclusions: IDET is safe and effective for chronic discogenic low back pain. (authors)

[en] Objective: To evaluate the feasibility, methods and clinical efficacy of re-vertebroplasty for un-relief pain or recurrence after previous treatment with vertebroplasty. Methods: Nine vertebrae of osteoporotic compression fractures in 9 patients with un-relief pain and 5 vertebrae of metastasis in 4 patients with pain recurrence after vertebroplasty were treated by re-vertebroplasty. CT was done after PMMA injection to observe PMMA distribution in vertebrae and whether having leakage or not. The efficacy of re-vertebroplasty was evaluated during follow-up. Results: The successful rate of technique of re-vertebroplasty was 100%. 4.8% ml of PMMA in average was injected in each vertebra. CR and PR were obtained respectively in 10 and 3 cases during 1-4 months of follow-up. No serious complications related to the technique occurred, except 2 cases with asymptotomatic PMMA leakage around vertebrae demonstrated by CT. Conclusions: Significant pain relief after re-vertebroplasty in the treatment of patients with pain un-relief or recurrence after previous vertebroplasty, with low rate of PMMA leakage. The important technique lies on the assurance of sufficient PMMA filling in the vertebral pain caused area preventing future motion. (authors)

[en] Objective: To evaluate the safety and efficacy of percutaneous vertebroplasty for the treatment of vertebral malignant tumors. The related factors with efficacy were analysed for improving the therapeutic technique. Methods: PVP was performed in 173 consecutive patients with 239 vertebral malignant tumors verified by the history, imaging and pathology. Among them, 39 cases had minor back pain, 84 with moderate and 50 with severe pain before the procedure. The efficacy was estimated during 1 week to 1 month after the procedure. Results: The success rate of technique reached 99.6%(238/239 levels). Contrast material injection after the needle placement within the vertebral body was undertaken in 197 vertebras. As a result, 57 paravertebral leakages and 6 cases with intervertebral leakage were seen before injecting PMMA cement. The amount of cement injected into cervical, thoracic and lumber vertebrae were 1.5-2.5 ml, 2-4 ml (mean 3.3 ml) and 2-6 ml (mean 4.5 ml) respectively, with CR and PR of 54.9% and 39.9% respectively. There were 63 paravertebral leaks, including 9 draining vein leaks, 4 epidural and 3 intervertebral leaks detected by CT scan. Only one patient went worse with paralysis before the procedure. Conclusions: PVP may provide significant pain relief in vertebral malignant lesions for a short term. Evaluation of the lesions in vertebrae with the vertebral venography before hand is the key factor for the proper using of PMMA to improve efficacy and avoid severe complications. (authors)

[en] Objective: To discuss the efficacy of percutaneous transsplenic CO₂ splenoportography with fine-needle and evaluate the invasion of portal vein by hepatic tumors. Methods: Twenty one patients (male 16, female 5) underwent transsplenic CO₂ digital substraction splenoportography with 26 G ultrafine-needle under ultrasound or fluoroscopic guidance. among them, 15 patients with primary hepatic carcinoma, 6 with hepatic metastatic cancer. Results: Nineteen cases presented excellent images with demonstration up to four-order branches of portal system clearly. Nine cases showed branches of portal vein compressed and displaced, 2 cases with portal vein occlusion, 2 cases with the left main branch of portal vein occlusion and 1 with severe stenosis, 3 cases demonstrated coronary and gastroesophageal varices, but there was 1 case failed. Eight patients did not have any discomfort, 10 patients had mild abdominal discomfort, and 2 complained of nausea during injection of CO₂, 1 patient with abdominal pain caused by splenic subpeplos hematoma after procedure was revealed by ultrasound. Conclusion: Percutaneous transspleinc CO₂ splenoportography with ultrafine needle presents optimal portography, which may clearly show compression of the portal branches by tumor or the presence of tumor emboli, and furthermore it is less time-consuming, minimally invasive and easy to perform. (authors)

[en] Objective: To evaluate the clinical efficacy of percutaneous ultra-fine needle CO2 splenoportography (CO₂-SP). Methods: CO₂-SP and 3D-CE-MRA were performed in 36 patients. The imaging quality of the methods was compared by a scoring criterion setup based on the visualization of the trunk, intrahepatic branches of the portal vein and collateral vessels. Results: Transient mild abdominal discomfort was presented in 19 patients (52.8%) receiving CO₂-SP. One patient developed subcapsular splenic hematoma and was discharged with clinical stability several days later after conservative treatment. The imaging quality of the intrahepatic branches of the portal vein with CO₂-SP was much more superior to 3D-CE-MRA (the score was 232 and 198 respectively, t=4.52, P<0.01). The visualization of the collateral vessels of the portal vein between the two techniques was not statistically significant (the score was 14 and 16 respectively, t=0.62, P>0.05). Conclusion: Ultrafine needle CO₂-SP is a minimally invasive and safe procedure, able to provide dynamic and clearer imaging of the intrahepatic branches of the portal vein. (authors)

[en] Objective: To study the clinical value of 64-slices spiral CTA with DSA comparatively in diagnosis of lower extremity arterial occlusive diseases. Methods: 31 patients with lower extremity arterial occlusive diseases underwent 64-slice spiral CT angiography of lower extremity arteries and they also underwent digital subtraction angiography (DSA)two weeks later. Reconstruction by maximum intensity projection (MIP), volume render (VR)and multiplanar reformatting (MPR)in working-station was undertaken comparing with the bolus chase DSA and traditional DSA for diagnostic accuracy. Results: The 216 arterial segments of lower extremity were selected, including 157 segments with consistent results in demonstrating degree of stenosis by both examinations. On CT angiography, 5 segmental stenosis were overestimated and 9 were underestimated. When stenosis of detected segments is more than 50%, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CTA were 98.21%, 96.15%, 97.22%, 96.49%, and 98.04%, respectively. Conclusion: 64-slices spiral CT angiography is an effective and reliable method for evaluating the lower extremity arterial occlusive diseases and may provide precious information for planning interventional therapy. (authors)