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To explore the application value of 320-row computed tomography (CT) 4D digital subtraction angiography (DSA) for hepatocellular carcinoma (HCC).A total of 40 HCC patients received 320-row CT contrast scans. The 4D DSA images were obtained on the basis of baseline data. The normal anatomy and anatomical variations of hepatic artery, tumor supplying arteries, tumor vessels, tumor staining were observed by comparing DSA (n = 20).320-row CT 4D DSA could show 6-7 levels of intrahepatic arterial branch. Normal hepatic artery anatomy was found in 35 cases (87.5%, Michels I type) and variations in 5 cases (12.5%). The diagnose accordance rate was 100% between 4D DSA and DSA in showing the anatomy and variation of hepatic artery. Among them, 320-row CT 4D DSA showed tumor staining (n = 40), tumor vessels (n = 28), tumor supplying arteries (n = 26) and two hepatic supplying arteries (n = 3). The number of tumor supplying arteries observed by 4D DSA (n = 20) was 18 versus 19 by DSA. Compared with DSA, the accurate rate of 4D DSA was 94.7% (18/19) in detecting tumor supplying arteries.As a noninvasive vascular examination modality, 320-row CT 4D DSA can accurately visualize normal anatomy and variation of hepatic artery, dynamically display tumor staining and reproducibly delineate the three-dimension relationship between tumor and blood vessels. In consistency with DSA in detection blood supply of HCC, 320-row CT 4D DSA provides a rapid, DSA-like and non-invasive alternative.

To explore the effect of orthotopic liver transplantation (OLT) on portal hypertension by observing the radiological changes of splenic volume and collaterals before and after OLT.In our hospital 56 patients performing OLT due to cirrhosis, portal hypertension and splenomegaly were classified into five groups according to their following-up time: A (≤3 months), B (3-6 months), C (6-12 months), D (12-24 months), and E (24 months). Twenty health people were chose as control group (F). The splenic width, thickness, length, volume, diameter of portal and splenic vein and collaterals were measured and observed in every patient of six groups before and after OLT respectively.After OLT, the splenic volume decreased by 25.4%, 27.8%, 21.9%, 25.2%, 27.7% in five groups respectively, which was still larger than the normal group (P0.05). Gastroesophageal varices in 31 cases (81.6%, 31/36) became normal after OLT. The opened umbilical vein disappeared and the retroperitoneal varices persisted in five cases after OLT.Splenomegaly and opened collaterals can be relieved by OLT effectively. The splenic volume didn't change obviously until it decreased by 25% in the three months after OLT. Gastroesophageal varices can be removed in most of patients after OLT. The splenomegaly could last paralled with the splenic vein and retroperitoneal varices after OLT. After OLT, correct disposal of splenic and collateral changes could improve the success rate and the long-term treatment effect of OLT.

To introduce an innovative procedure for portal hypertension with preliminary results and assess the technical feasibility and efficacy of portosystemic shunt creation through percutaneous transhepatic approach with its potential clinical significance.Between November 2009 and January 2011, 8 patients with complicated portal hypertension underwent percutaneous transhepatic intrahepatic portosystemic shunt (PTIPS). The severity of liver disease was Child's A (n = 2), Child's B (n = 3) and Child's C (n = 3). Under fluoroscopic guidance, portal vein (PV) was punctured with a 22-gauge Chiba needle. A 0.018-inch guidewire was advanced through the needle into PV lumen. The needle was exchanged and a 7-French sheath inserted over the wire. Then retrohepatic inferior vena cava (RIVC) or hepatic vein (HV) was punctured with a 20-gauge, 20-cm Chiba needle through sheath. Another 0.018-inch guidewire was advanced through the needle into right internal jugular vein and then snared out of body. A 0.035-inch, 260-cm-long stiff shaft wire was then introduced through the transjugular sheath and manipulated into main portal vein (MPV) and then into superior mesenteric vein (SMV). Afterward the PTIPS procedure was completed in the standard transjugular fashion.The procedure was technically successful in all patients. And effective portal decompression and free antegrade shunt flow were achieved. The mean portal pressure gradient decreased from 31.0 ± 4.3 to 18.9 ± 2.7 mm Hg before and after PTIPS creation respectively and the difference was significant statistically (P0.01). Among 8 patients, 1 developed hepatic coma and died after 5 days while the other 7 patients survived. The median follow-up period was 9 months (range: 2 - 20). Among 5 patients with PTIPS created for bleeding varices, no recurrent bleeding occurred during the follow-up period. For the patient with diffuse portal vein thrombosis, the clinical symptoms disappeared after PTIPS and computed tomography (CT) showed the shunt was occluded after 4 months. One patient with refractory ascites had a recurrence of abdominal distention after 2 months. There was a stenotic shunt on CT. Cure was achieved by replanting a stent in MPV.PTIPS is both safe and effective for the treatment of portal hypertension with exceptionally challenging anatomy. It is an available supplement for transjugular intrahepatic portosystemic shunt.

To evaluate the feasibility and efficacy of endovascular treatment for different types of carotid cavernous fistula (CCF) via the approach of internal carotid artery (ICA) or inferior petrosal sinus (IPS).From April 2005 to June 2010, 28 CCF patients underwent endovascular treatment at our institution. There were 13 males and 15 females with a mean age of 39 years (range: 21 - 71). According to the Barrow's classification, they were classified into type A (n = 21), type B (n = 2) and type D (n = 5). Patients of type A underwent detachable balloon embolization of ipsilateral cavernous sinus or stent-graft placement via the ICA approach. Patients of types B and D received detachable coil plus n-BCA (n-butyl-2-cyanoacrylate) embolization of ipsilateral cavernous sinus via the IPS approach. The technical results, complications and therapeutic outcomes were reviewed.Detachable balloons (number: 1 - 4) were used in 16 patients of type A. Angiography at immediate postembolization showed a complete occlusion of fistula in 15 patients and a small residual fistula (20%) in 1 patient. Five patients of type A received stent-graft placement. One stent was placed in 4 patients and 2 stents in 1 patient. Complete fistula closures with preserved ICA were documented on immediate angiogram in 3 patients whereas a large residual flow (50%) persisted in 1. The fistula was completely occluded after 3 detachable balloons were deployed in affected cavernous sinus through a gap between stent and vascular wall. Both fistula and ICA were occluded in 1 patient after stenting. No cerebral infarction was observed due to the adequate collateral blood flow from contralateral ICA. Complete closures of affected cavernous sinus were achieved in 6 patients of types B and D while residual flow (50%) persisted in 1. The number of detachable coils for each embolization ranged from 3 to 8 (mean: 6.0). The volume of n-BCA mixture varied from 1.0 to 2.1 ml (mean: 1.3). The mean duration of n-BCA injection was 65 s (range: 45 - 90). Clinical symptoms were completely relieved in 26 patients. During the mean follow-up period of 30 months (range: 12 - 60), no recurrence of clinical symptoms was observed. No thrombosis or stenosis was found in the lumina of stents.Detachable balloon embolization is the preferential treatment for direct CCF. Detachable coil plus n-BCA embolization of cavernous sinus via the IPS approach is an efficient and safe treatment for indirect CCF.

To discuss the application values of DWI (diffusion-weighted imaging) and ADC (apparent diffusion coefficient) on ischemic-type biliary lesions (ITBL) after orthotopic liver transplantation.According to whether there was ITBL after liver transplantation or not, 46 cases of liver transplantation were selected and divided into 2 groups on the basis of PTC (percutaneous transhepatic cholangiography) or ERCP (endoscopic retrograde cholangiopancreatography) examination, pathology or clinical follow-up data: ITBL group (n = 29) and no ITBL group (C group, n = 17). The ADC value was measured for right lobe of graft liver parenchyma (b value = 600 s/mm(2)). And the signal of biliary system of graft on DWI and biliary tract on MRCP were analyzed.(1) The ADC values of liver graft were (1.456 ± 0.286) × 10(-3) mm(2)/s and (1.716 ± 0.391) × 10(-3) mm(2)/s in ITBL and C groups respectively. The difference in ADC value was significant between two groups (P = 0.015); (2) the incidence of increased signal of bile duct on DWI was 82.8% (24/29) and 5.9% (1/17) for ITBL and C groups respectively. The lesion was located in porta hepatis and intrahepatic small bile duct was seen in 17 of 24 patients (70.8%) in ITBL group. The difference was significant in signal of bile ducts between ITBL and C groups (P0.001). Twenty-one cases with sludge on DWI in ITBL group had hyperintensity, isointensity or hypointensity. There was no abnormal signal in the lumen of bile duct in C group.The major sign of ITBL is a hyperintensity of porta hepatis and small bile ducts on DWI. And the ADC value of graft liver parenchyma decreases. These reflect the pathological changes to an extent and may be an effective and sensitive monitoring tool of early ITBL. DWI is a novel, non-invasive, simple and practical method in the diagnosis and differential diagnosis of ITBL after liver transplantation.

To explore the effect of enhanced green fluorescence protein (EGFP) labeling mediated by lentivirus on the biophysical properties of mesenchymal stem cells (MSC), and whether the EGFP gene expression is permanent and stable.MSC were infected with EGFP lentivirus at different virus multiplicity of infection (MOI). EGFP positive rate was measured with fluorescent-activated cell scanning (FACS) analysis, and EGFP expression in MSC was investigated under a fluorescence microscope. Cell viability, proliferation, apoptosis and cell cycle were detected with trypan blue stain, MTT colorimetric assay, Hoechst stain and FACS analysis respectively. To evaluate the stability of EGFP expression, EGFP lentivirus infected MSC were harvested after cultured continuously in vitro for 2, 4, 8 or 16 weeks, and EGFP positive rate and fluorescence strength were detected with FACS analysis.After infected with EGFP lentivirus (MOI = 20) for 96 h, EGFP positive rate of MSC was 97.39% +/- 0.68%. Cell viability, proliferation, apoptosis and cell cycle of MSC infected with EGFP lentivirus were unaffected, as compared with control MSC (P0.05). When cultured in vitro continuously for 2, 4, 8 or 16 weeks, EGFP positive rates of EGFP-MSC were 97.50% +/- 0.54%, 97.32% +/- 0.51%, 97.39% +/- 0.11%, and 97.48% +/- 0.13% respectively, while EGFP fluorescence strength were 440 +/- 13, 445 +/- 12, 458 +/- 13 and 456 +/- 16 respectively. Both EGFP positive rate and fluorescence strength kept in a stable level.EGFP lentivirus can efficiently label MSC and has no significant effect on the biophysical properties of MSC. EGFP gene expression in MSC is permanent and stable. EGFP-MSC can be used for further cell tracing research.

To evaluate the value of low-dose contrast-enhanced 4D DSA acquired from 320-detector row CT on the diagnosis of the hepatic artery complications after liver transplantation.320-detector row CT were performed in fifth patients with liver dynamic enhanced using volume CT body-perfusion protocol, hepatic artery phase images obtained after intravenous injection of 50 ml of contrast at a rate of 6 ml/s were acquired based on 4D DSA. The time-density curve (TDC) of the hepatic artery was delineated. The time to peak, peak contrast enhancement were recorded. The data of artery phase were sent to workstation to reconstruct the hepatic artery with VR, MIP and MPR.The delay mean time and the peak CT value of hepatic artery was 20 (10.0 - 24.2) s and 373 (310 - 440) HU; 4D DSA revealed hepatic artery pseudo-aneurysm (n = 2), and hepatic artery mild stenosis (n = 3), moderate stenosis (n = 4), severe stenosis (n = 1) and occlusion (n = 1). Compensatory circulation was seen in 2 cases. 4 patients were appeared segmental stenosis and hepatoportal arteriovenous fistulas (HPAVF). Hepatic arterial branch are decreased and opened in 9 cases and 4 cases. 4D DSA also displayed other signs including hepatic hemangioma and the splenic artery aneurysms (SAA) and ectasi (n = 1), donor-recipient hepatic artery mismatch (n = 3).4D DSA provided a safe, noninvasive and accurate method for guiding the diagnosis of hepatic artery complication and play an effective role after liver transplantation.

To describe the technique, efficacy, and safety of multimodality interventional treatments for biliary complications after orthotopic liver transplantation (OLT). The core of multimodality interventional treatments is percutaneous transhepatic biliary drainage (PTBD).From January 2006 to May 2008, seventy-two patients with biliary complications afte OLT were closed in our study. On the basis of the cholangiographic appearance, patients were classified into 4 groups: anastomotic biliary strictures (n = 19), hilar biliary strictures (n = 16), multifocal/diffuse biliary strictures (n = 31), and anastomotic biliary fistulae (n = 6). All patients were treated in our hospital, including PTBD only in 6 patients, PTBD combined with balloon dilation in 50 patients, balloon dilation and plastic stent implantation in 10 patients, balloon dilation and metallic stent implantation in 6 patients. Their data were analyzed retrospectively, including serum hemobilirubin, cholangiographic appearance and complications.PTBD were successful in all cases. The clinical symptoms improved or eliminated were observed in 66 cases, the effective rate was 91.7% (66/72). Among 72 patients, 26 patients were free of drainage tube, 8 patients underwent second PTBD for the obstruction of biliary stents, and 38 patients maintained drainage tube for long-term. In 66 patients with biliary obstruction, the direct bilirubin was (145 +/- 106) micromol/L before treatments and 76 micromol/L +/- 59 micromol/L one month after PTBD (t = 3.78, P0.001). The rate of biliary tract infection was 14.3% and 43.8% respectively with the tip of drainage tube placed in biliary duct and in duodenum. There was a significantly statistical difference between these two items (chi(2) = 4.886, P = 0.027).PTBD combined with balloon dilation and biliary stent implantation is a effective therapeutic modality for biliary complications after OLT, which can improve patients' clinical symptoms, elevate patients' quality of life. The tip of drainage tube being placed in biliary duct can decrease the rate of biliary tract infection significantly.

To explore the influence of early hepatic artery ischemia on the occurrence and prognosis of biliary complications after orthotopic liver transplantation (OLT), and the value of early hepatic arterial interventional therapy.In the 720 recipients who received OLT in our hospital from October 2003 to June 2007, 32 cases were detected hepatic artery stenosis (HAS, 30 cases) or hepatic artery thrombosis (HAT, 2 cases) by color Doppler Ultrasound from 4 to 65 days (mean, 25 +/- 15) after OLT. All of them were confirmed by DSA and/or CT angiography. Of the 32 patients, 20 were treated by hepatic arterial interventional therapy. The end-point of follow-up was the time of patient's death and retransplantation.In this study, 20 cases developed biliary complications, including the common bile duct stenosis in 2 cases, intra- and extra hepatic bile duct stenosis in 13 cases and multiple intrahepatic bile duct stenosis in 5 cases. Among them, 2 patients complicated with bile leakage, 4 with biloma and 3 with liver abscess. Of the 20 patients, 8 with HAS received successful hepatic arterial interventional therapy which was performed two weeks after HAS detected; 10 with HAS didn't receive hepatic arterial interventional therapy; 1 with HAT received successful thrombolysis; 1 with HAS received failed hepatic artery stent implantation. During a median follow-up of 262 days (range, 22 -517 days), 10 patients died, 6 underwent retransplantation, and the other 4 survived; cumulated survival rates at 6, 12 and 24 months were 60.0%, 34.9% and 0, respectively. 12 cases didn't develop biliary complications. Nine of them received successful hepatic arterial interventional therapy within 2 weeks HAS detected, 2 with acute rejection received flushing anti-rejection therapy, 1 with HAT received retransplantation because of unsuccessful thrombolysis. During a median follow-up of 952 days (range, 14 - 1398 days), 3 patients died, 1 underwent retransplantation, and the other 8 survived; cumulated survival rates at 6, 12 and 24 months were 75%, 66.7% and 66.7%, respectively.Early hepatic artery ischemia after OLT is an important agent for biliary complications. Early and successful hepatic arterial interventional therapy helped to reduce the incidence of biliary complications and improve the patients' prognosis.

To evaluate the long-term clinical outcomes and complications of coronary stent placement for hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) retrospectively.Eighteen of the 26 patients with HAS or hepatic artery thrombosis confirmed by digital subtraction angiography underwent hepatic artery stenting with coaxial catheter technique and then followed up for 21.7 months (2.3 - 37.2 months). Liver function tests, color Doppler ultrasonography and CT angiography were conducted.Three patients died and 1 patient underwent re-transplantation within 2 months after stenting procedure. Seven patients' hepatic arteries looked normal after stenting. Restenosis was seen in 4 patients (28.5%). Two of them needed re-transplantation 20.5 and 5.1 months after stenting respectively. Three patients died of septic multiple-organ failure, liver abscess, and biliary infection respectively though their hepatic arteries were patent. Kaplan-Meier curve showed that the 1-, 2-, and 3-year survival rates were 76%, 76%, and 76% respectively, and the 1-, 2-, and 3-year graft survival rates after stenting were 69.5%, 69.5%, and 48.0% respectively, and the primary hepatic artery patency rates were 63%, 63%, and 63% respectively.HAS after OLT can be successfully treated with stent placement with an acceptable 1-, 2- and 3-year patient, graft survival and primary stent patency rates.

To evaluate the value of multi-detector row CT (MDCT) in the diagnosis and hemodynamic studies of gastric varices (GV) in portal hypertension by comparison with endoscopy and DSA direct portography.Thirty-six consecutive cirrhotic patients with GV confirmed by endoscopy underwent tri-phase contrast-enhanced CT scans and CT portography (CTP) within 2 weeks after endoscopy examination. Three independent experienced radiologists, who were blinded to the patients' clinical data, analyzed the CT images, including the size and location of GV as well as afferent and efferent veins of GV, separately. Interobserver agreement among the 3 radiologists with regard to the diagnosis of submucosal and perigastric GV was determined by Kappa (k) values. The findings of endoscopy were used as standards.Sub mucosal GV was diagnosed in 34 of the 36 patients (94.4%) and perigastric GV in all 36 patients (100%) by the observation of the 3 radiologists. MDCT showed an excellent interobserver reliability with regard to the diagnosis of submucosal GV (kappa = 0.85) and perigastric GV (kappa = 1.0). Agreement between MDCT and endoscopy with regard to the opacification of variceal size and location were 86.1% and 88.9% respectively. The sensitivity, specificity, accuracy, and positive predictive value of CTP in the opacification of afferent and efferent veins of GV were all more than 80%. The frequencies of participation of posterior gastric vein and short gastric vein in blood supply to gastric fundal varices in the isolated gastric varices and gastroesophageal varices type 2 (GEV2) were 94.1% and 70.6% respectively, both significantly higher than those in the gastroesophageal varices type 1 (GEV1, 52.6% and 31.6%, respectively, both P0.05). The main blood drainage route of GEV1 was via azygous system into the super vena cava (100%), whereas in the gastric fundal varices the main blood drainage route was via the gastrorenal shunts into the inferior vena cava (82.4%).MDCT can be used as an important tool for detecting submucosal and perigastric GV, and can clearly reveal the size, location, and hemodynamics of GV.

To evaluate the multi-slice spiral CT dynamic enhancement features and the diagnostic value of CT angiography in Budd-Chiari syndrome with occlusion of hepatic vein (HVBCS), and to assess the CT clinical significance in the treatment of HVBCS.Twenty-one patients with HVBCS confirmed by digital subtraction angiography (DSA) were retrospectively analyzed. All patients received multi-slice spiral dynamic enhancement scans within 2 weeks before DSA. The relevant vein vessels were reconstructed respectively with Maximum Intensity Projection (MIP), Volume Rendering (VR) and Oblique Reformat techniques. The course of disease was less than three months in four patients, more than three months in seventeen patients.In the four patients with the course of disease of less than three months, CT showed global liver enlargement with diffuse hypodensity on plain scans and patchy enhancement in caudate lobe and perihilar areas on post-contrast CT scans, and the enhancement field spread to larger area as the time of scans delayed. In the seventeen patients with the course of disease of more than three months, plain CT scans showed abnormalities of liver morphology and hypodensity either in atrophic areas or in the periphery of the liver. On post-contrast CT scans, the hypodensity areas showed poor and heterogeneous enhancement, and hepatic drainage veins in these areas obstructed, whereas in hepatic veins drainage normal areas hepatic parenchymal showed homogeneous enhancement, their drainage veins had at least one patent hepatic vein or a dilated accessory hepatic vein that can provide adequate collaterals. Hepatic CT enhancement features were closely related to the occlusion location of hepatic vein and collateral drainage veins. In twenty-one patients, a total of 42 hepatic veins were occluded. Among them, 9 left hepatic veins, 12 middle hepatic veins, 16 right hepatic veins, and 6 accessory hepatic veins were occluded. The accuracy rate of hepatic veins occlusion showed on transverse scans and CT angiography were 61.9% and 100% respectively.Multi-slice spiral dynamic enhancement scans can accurately reflect the changes of intrahepatic hymodynamics. Transverse scans combined with CT angiography can explicitly show the location of hepatic veins occlusion and collateral circulation in HVBCS, which is of important clinical significance in the treatment of HVBCS.