Cheng-Yen Chang

National Yang Ming University, T’ai-pei, Taipei, Taiwan

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Publications (209)267.28 Total impact

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    ABSTRACT: Lipoblastoma is a rare, benign, lipomatous soft tissue tumor that occurs in infants and very young children. We report the application of sonography in detection of a pathologically proven submandibular lipoblastoma in an 8-month-old boy. The sonographic feature of the tumor was described and correlated with the pathological findings.
    Full-text · Article · Oct 2015 · Journal of Medical Ultrasound
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    ABSTRACT: To examine the correlation between the severity of venous calcifications and the clinical symptoms of phlebosclerotic colitis. This was a retrospective study. The data, including the numbers of episodes of active disease, were collected from the medical records at Taipei Veterans General Hospital and Wei Gong Memorial Hospital in Taiwan between January 2005 and December 2014. All computed tomography images with or without contrast enhancement were obtained using a multiple detector computed tomography scanner. The scanning range reached from the dome of the diaphragm to the pelvis. The severity of calcification at the tributaries of the portal vein was measured using a four-grade scoring system of the calcification of phlebosclerotic colitis. The episodes of active disease were defined as symptoms of fever, abdominal pain, severe constipation, bowel obstruction, vomiting or diarrhea based on a review of the medical records. Spearman's correlation analysis was used to examine the correlation between the numbers of episodes of active disease and the severity of the calcification of the mesenteric veins. More than 3000 cases were reviewed from 2005 to 2014, and a total of 12 patients from Taipei Veterans General Hospital and Wei Gong Memorial Hospital were enrolled according to our inclusion criteria. Among these 12 patients, the mean age of the six males and the six females was 61.8 ± 11.5 years. All patients exhibited typical imaging characteristics, consisting of threadlike calcifications and colonic wall thickening in the standard radiographs and calcifications along the colonic and mesenteric vessels or associated with colonic wall thickening and adjacent fat stranding in the computed tomography images. The median score of the severity of the venous calcifications was 18 ± 13, and the median number of active disease episodes was 1 ± 1.75. Spearman's correlation analysis revealed that the number of episodes of active phlebosclerotic colitis disease significantly positively correlated with the severity of the calcification of the mesenteric veins (r = 0.619, P < 0.05). The extent of mesenteric venous calcification is strongly associated with the number of episodes of active disease among patients with phlebosclerotic colitis.
    No preview · Article · Jul 2015
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    ABSTRACT: Ultrasound (US) elastography can provide information about the hardness of calcification and might help decide treatment strategy. The purpose of this study was to evaluate the hardness of the calcific area within rotator cuffs by US elastography as an aid for the selection of aspiration or fine-needle repeated puncture for the treatment of rotator cuff calcific tendinosis. This prospective study included 39 patients (32 males, 7 females; mean age, 52.9 years) who received US elastography and gray-scale ultrasonography before US-guided treatment for rotator cuff calcific tendinosis. The morphology of the calcifications was classified as arc, fragmented, nodular, and cystic types. US elastography using virtual touch imaging (acoustic radiation force impulse) technique was performed to examine the calcified region to obtain an elastogram that was graded dark, intermediate, or bright. The hardness of the calcifications were recorded, and graded as hard, sand-like, or fluid-like tactile patterns during the US-guided treatment, and the tactile patterns were compared with the results of US elastography and gray-scale ultrasonography. Though the morphologies of the calcifications were significantly related to the tactile pattern of the needle punctures (p < 0.001), gray-scale US could not accurately demonstrate the hardness of the calcifications. With the aid of elastography, the fluid-like tactile pattern could be predicted well as a nondark pattern by elastography (p < 0.001). Ultrasound elastography is a useful modality for evaluation of rotator cuff calcific tendinosis, and as an aid to guide management. If elastography shows the calcified area as a non-dark pattern, then fine-needle aspiration should be performed. Copyright © 2015. Published by Elsevier Taiwan.
    No preview · Article · Jul 2015 · Journal of the Chinese Medical Association
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    ABSTRACT: To quantitatively measure the hemodynamic change of hepatic artery before and after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) by quantitative color-coding analysis (QCA). This prospective study registered 64 consecutive HCC patients who underwent segmental or subsegmental TACE with epirubicin and lipiodol at level 2 or 3 of the subjective angiographic chemoembolization endpoint. QCA was used to determine the maximal density time (T max) of selected intravascular region of interest (ROI). Relative T max (rT max) was defined as the T max at the selected ROI minus the time of contrast medium spurting from the catheter tip. The rT max of hepatic arteries was analyzed before and after embolization. The pre- and post-treatment rT max of the landmarks at the treated segmental artery were 1.96 ± 0.48 and 3.14 ± 1.77 s, p < 0.001. According to the treated lobe, 30 patients were treated for the right lobe alone, and 8 patients were treated for the left lobe alone. The pre- and post-rT max of treated segmental artery were 2.06 ± 0.54, 3.34 ± 1.63 s, p < 0.001 and 1.89 ± 0.45, 2.68 ± 1.46 s, p = 0.12, respectively. The rT max of the proximal lobar hepatic arteries or proper hepatic artery had no significant change before and after TACE. The QCA is feasible to quantify embolization endpoints by comparing the rT max in selected hepatic arteries before and after TACE. The rT max of treated segmental artery was significant prolonged after optimized procedures.
    No preview · Article · May 2015 · CardioVascular and Interventional Radiology
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    ABSTRACT: Background: Percutaneous cryoablation is a minimally invasive alternative for surgical resection of a renal tumor. We report our experience with applying computed tomography-guided cryoablation in renal tumors, focusing on the technique, safety, and treatment response. Methods: We retrospectively reviewed the medical records of patients who received cryoablation from October 2009 to August 2013 for renal tumor diagnosed by imaging studies performed at Taipei Veterans General Hospital, Taipei, Taiwan. Patient comorbidities and tumor morphology, technical success rate, tumor control rate, renal function change, and complications were recorded. Results: A total of 30 patients (32 tumors) were treated, comprising 30 renal cell carcinomas and two angiomyolipomas. The mean age of the patients was 73.7 years (range, 34-89 years). The patients were referred for percutaneous cryoablation arising from old age, medical comorbidities, or preexisting malignancy. The mean follow-up period was 15.2 months (range, from 32 days to 47.4 months). According to the Clavien-Dindo classification, surgical complications included one Grade III, four Grade II, and two Grade I complications. The mean decrease in hemoglobin was 0.77 g/dL (range, from +1.1 g/dL to -3 g/dL). The mean hospital stay after cryoablation was 2.2 days (range, 1-10 days). Incomplete ablation was noted in two patients and local tumor recurrence in two patients. One of them received repeated cryoablation and achieved successful local control. Of the 22 renal cell carcinoma patients with follow-up period > 6 months, 19 patients achieved successful local tumor control (86.4%). The percentage change of glomerular filtration rate before and 3-6 months after the procedure was +1.9%, which was statistically nonsignificant (p = 0.94). Conclusion: Computed tomography-guided percutaneous cryoablation is a safe and effective technique for treating renal tumors with excellent renal function preservation.
    No preview · Article · Feb 2015 · Journal of the Chinese Medical Association
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    ABSTRACT: Management of diseases of the descending thoracic aorta is trending from open surgery toward thoracic endovascular aortic repair (TEVAR), because TEVAR is reportedly associated with less perioperative mortality. However, comparisons between TEVAR and open surgery, adjusting for patient comorbidities, have not been well studied. In this nationwide population-based study, we compared the outcomes between TEVAR and open surgery in type B aortic dissection. From 2003 to 2009, data on patients with type B aortic dissection who underwent either open surgery or TEVAR were obtained from the National Health Insurance Research Database. Survival, length of stay, and complications were compared between TEVAR and open repair. To minimize possible bias, we performed an additional analysis after matching patients by age, sex, and propensity score. A total of 1661 patients were identified, of whom 1542 underwent open repair and 119 TEVAR. Patients in the TEVAR group were older (63.0 ± 15.4 years vs. 58.1 ± 13.1 years; p = 0.001), included more males, and had more preoperative comorbidities. Thirty-day mortality in the TEVAR group was significantly lower than that in the open repair group (4.2% vs. 17.8%; p < 0.001). The midterm survival rates in the unmatched cohort between the open surgery and TEVAR groups at 1 year, 2 years, 3 years, and 4 years were 76%, 73%, 71%, and 68% vs. 92%, 86%, 82%, and 79%, respectively. The length of stay in the TEVAR group was shorter than that in the open repair group (p = 0.001). The TEVAR group had less respiratory failure (p = 0.022) and fewer wound complications than the open repair group (p = 0.008). The matched cohort showed similar results. TEVAR for type B aortic dissection repair has less perioperative mortality, a shorter length of hospitalization, a higher midterm survival rate, less postoperative respiratory failure, and fewer wound complications than open surgery. Copyright © 2015. Published by Elsevier Taiwan.
    No preview · Article · Feb 2015 · Journal of the Chinese Medical Association
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    ABSTRACT: To retrospectively analyze the efficacy and short- to mid-term survival rate of cryoablation for malignant lung tumors METHODS: Percutaneous CT-guided cryoablation for 45 malignant lung tumors in 26 patients during 41 sessions from 2009-2013 were performed. Follow up CT-scan were used to determine local tumor progression. Survival rate, local tumor control rate and associated risk factors were analyzed. The immediate during and short-term complications with CTCAE grade 2 or upper include pneumothorax (15%), pleural effusion (20%), pulmonary hemorrhage (24%), pneumonitis (15%), hemothorax (15%), hemoptysis (10%), pain (20%), bronchopleural fistula (n=1), and empyema (n=2). Life-threatening bleeding or hemodynamic instability was not observed. There was no procedural-related mortality. Overall survival rate of 1, 2, 3 years are 96%, 88%, 88%. For curative intent, local tumor control (LTC) rate of 1, 2, 3 years are 75%, 72%, 72%. Cryoablation for malignant lung tumors is effective and feasible in local control of tumor growth, with good short- to mid-term survival rate, as an alternative option for inoperable patients. Copyright © 2014. Published by Elsevier Inc.
    No preview · Article · Dec 2014 · Cryobiology
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    ABSTRACT: Spinocerebellar ataxia (SCA) and multiple system atrophy-cerebellar type (MSA-C) often present with similar clinical manifestations in the beginning. Magnetic resonance spectroscopy (MRS) has been proved to be a useful tool to help differentiate different types of SCA and MSA-C on cross-sectional studies. However, longitudinal changes of the MRS metabolites in these subjects have never been reported. The purpose of this study was to track the longitudinal evolution of the MRS metabolites in these patients and to ascertain the correlation between clinical severity measured by Scale of the Assessment and Rating of Ataxia (SARA) and MRS metabolites. Significant reductions of NAA/Cr and NAA/Cho in the cerebellar hemispheres in all patients and lower Cho/Cr in the cerebellar hemispheres in patients with SCA2 or MSA-C were found at all times. At initial assessments, patients with MSA-C or SCA2 tended to have lower NAA/Cr and Cho/Cr in the cerebellar hemispheres than those with SCA3 or SCA6. At follow-ups, patients with SCA2 or MSA-C had a lower NAA/Cr in cerebellar hemispheres than those with SCA3 or SCA6. Patients with MSA-C had a lower NAA/Cr in the vermis and Cho/Cr in the cerebellar hemispheres than those with SCA2 at the start, and had a lower NAA/Cr in cerebellar hemispheres than those with SCA2 at follow-ups. Characteristic patterns of neurodegenerative evolution were observed in patients with disparate SCAs and MSA-C using MRS and SARA. A continual impairment of neuronal integrity was observed in all groups of patients. The longitudinal changes of MRS metabolites and SARA scores were most striking in patients with SCA2 and MSA-C. Although the changes in the metabolites on MRS may still be used to help understand the pathophysiology of ataxia disorders, they are short of being a good biomarker.
    Preview · Article · Dec 2014
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    ABSTRACT: The analgesic effect of xylocaine alone versus xylocaine with corticosteroid injection after ultrasonographically (US)-guided treatment of rotator cuff calcific tendonosis has not been described in English literature. The aim of this study was to compare the analgesic effect of xylocaine only with xylocaine and corticosteroid following US-guided percutaneous treatment of rotator cuff calcific tendonosis.Methods This prospective study enrolled 88 patients who were given different analgesic treatments [xylocaine only, n = 23; xylocaine with corticosteroid, n = 44; control (no xylocaine or corticosteroid), n = 21]. The assessment of a patient's painful symptoms was recorded prior to treatment, 1 day, 1 week, 1 month, and 3 months after treatment by the visual analogue scale (VAS) system.ResultsThere were no significant differences in age, gender, calcification size prior to and after treatment, and amount of calcification decrease after treatment, but there was a significant difference in calcification morphology among the groups (p = 0.010). General linear model analysis indicated that the three groups had no difference in pain prior to treatment. After treatment, the xylocaine only and the xylocaine with corticosteroid groups had less pain than the control group at 1 day, 1 week, and 1 month after treatment. At 3 months after treatment, the xylocaine only group had less pain than the control group (p = 0.039), and the xylocaine with corticosteroid and control groups had similar levels of pain.Conclusion Injection of xylocaine alone after US-guided treatment of rotator cuff calcific tendonosis provided a longer pain relief period than that of a mixture of xylocaine with corticosteroid.
    No preview · Article · Nov 2014 · Journal of the Chinese Medical Association
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    ABSTRACT: Microcalcifications are frequently associated with papillary thyroid cancers. Metastatic nodules from extrathyroid malignancies may mimic primary thyroid neoplasm on sonography, but do not present with microcalcifications. We report the case of a 45-year-old woman with a history of invasive ductal carcinomas of bilateral breasts, status post surgery and neoadjuvant chemotherapy. Four years after surgery, thyroid sonography revealed diffuse microcalcifications without nodular component. Core needle biopsy confirmed thyroid metastasis from primary breast cancer. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 2014;
    No preview · Article · Sep 2014 · Journal of Clinical Ultrasound
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    ABSTRACT: Background Moyamoya disease (MMD) is an uncommon cerebrovascular disorder characterized by idiopathic progressive stenosis or the occlusion of the intracranial arteries. Digital subtraction angiography (DSA) is the reference diagnostic imaging modality for MMD. Use of the conventional Suzuki grading remains the gold standard for evaluating the severity of MMD. In this study, we propose a quantitative method using color-coded parametric quantitative DSA (QDSA) to improve prediction of the severity of MMD. Methods Eighteen DSA examinations from 18 patients with MMD and 14 control participants were included. All patients with MMD underwent DSA and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI). QDSA was used to determine the delay time of maximal opacification (Td) between the internal carotid artery and the M2 segment of the middle cerebral artery. The time-to-peak (TTP) was measured in the medial frontal, lateral frontal, parietal, and occipital lobes from the DSC-PWI. The relative TTP (rTTP) values were then obtained by subtracting the TTP of the cerebellum. Results The Td was significantly longer in the patients with MMD presenting with infarction than in the control group. The Td significantly correlated with the angiographic Suzuki grading system and showed closer correlation with prolonged rTTP in the medial frontal, lateral frontal, and parietal regions compared with Suzuki grading. Conclusion The Td significantly correlated with conventional angiographic grading and with the status of hemodynamic impairment in patients with MMD. QDSA and Td measurements can provide a simple and quantitative angiographic grading system for patients with MMD.
    Full-text · Article · Aug 2014 · Journal of the Chinese Medical Association
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    ABSTRACT: We herein describe a patient with segmental pulmonary artery transection after blunt trauma, which was diagnosed preoperatively by computed tomography. Bolus tracking contrast-enhanced computed tomography clearly depicted both aortic and pulmonary vasculatures. A one-step examination quickly disclosed aortic damage and injury to significant visceral organs. To the best of our knowledge, our patient appeared to be a unique case of pulmonary segmental artery transection after blunt injury, which was preoperatively diagnosed by computed tomography. Ultimately, successful surgical repair of the pulmonary artery was performed.
    No preview · Article · Jun 2014 · Journal of the Chinese Medical Association
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    ABSTRACT: Background Transarterial embolization of intracranial dural arteriovenous fistulas (DAVFs) is usually associated with inadequate embolization. The purpose of this study was to report our experience of transarterial Onyx embolization of intracranial DAVFs with an emphasis on treatment outcome with this new embolic agent in different types of DAVFs. Methods In the past 3 years, a total of 14 intracranial DAVFs have been treated by transarterial Onyx embolization. Among these, there were nine males and five females, aged from 30 years to 82 years (mean = 62 years). We retrospectively analyzed the injection volume and time of Onyx embolization as well as outcomes in different types of DAVFs. Results The locations of the DAVFs were sigmoid sinus (n = 6), tentorium (n = 3), sinus confluence (n = 2), transverse–sigmoid sinus (n = 1), sigmoid sinus–jugular bulb (n = 1) and the superior petrous sinus (n = 1). The mean volume and time of Onyx injection were 3.4 mL and 28 minutes, respectively (Cognard type I: 4.9 mL, 40 minutes; type II: 4.5 mL, 34 minutes; type III: 2.2 mL, 21 minutes; type IV: 2 mL, 22 minutes). Total fistula occlusion was achieved in six out of seven patients of type III and type IV DAVFs, and in four out of seven patients of type I and type II DAVFs. Nine patients had total resolution of their symptoms, whereas partial regression occurred in five patients. No significant periprocedural complication was found. Mean clinical follow-up period was 16 months. Conclusion Transarterial Onyx embolization of intracranial DAVFs is safe and effective. This technique is particularly useful in type III and type IV DAVFs with a high cure rate, and lower volume of Onyx as well as a short injection time.
    No preview · Article · Apr 2014 · Journal of the Chinese Medical Association
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    ABSTRACT: With growing ketamine abuse, ketamine-induced uropathy (KIU) has become more prevalent in recent years. This research evaluates the presence, distribution and extent of KIU in the upper and lower urinary tracts by retrospectively reviewing CT urography (CTU) images. Patients diagnosed with KIU who underwent CT scanning from 1 January 2006 to 31 December 2011 were recruited. The CT protocols included three-phase CTU in six patients, split-bolus CTU in 17, two-phase CT in one and unenhanced CT in three. The CT images were retrospectively reviewed by two radiologists. A total of 27 patients participated in this study. The common CT findings included diffuse bladder wall thickening (88.9%), small bladder volume (66.7%) and perivesical inflammation (44.4%). Twelve patients (44.4%) were diagnosed with hydronephrosis, including three patients with unilateral hydronephrosis and nine with bilateral hydronephrosis. Of these patients, nine had ureteral wall thickening (33.3%) and two (7.4%) had ureterovesical junction involvement (ie, they had hydronephrosis but no ureteral wall thickening). One patient had a ureteral obstruction because of a ureter stone. The correlation between upper urinary tract involvement and grading of the interstitial cystitis was statistically non-significant (p=0.33). Four patients (14.8%) had a vesicovaginal fistula which could be detected in the excretory phase only. Upper urinary tract involvement is common in patients with KIU. CTU might aid evaluation of the extent of KIU and prompt adequate management.
    Preview · Article · Jan 2014 · Postgraduate medical journal
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    ABSTRACT: Since the introduction of pancreas transplantation more than 40 years ago, surgical techniques and immunosuppressive regiments have improved and both have contributed to increase the number and success rate of this procedure. However, graft survival corresponds to early diagnosis of organ-related complications. Thus, knowledge of the transplantation procedure and postoperative image anatomy are basic requirements for radiologists. In this article, we demonstrate the imaging spectrum of pancreas transplantation with enteric exocrine drainage.
    Preview · Article · Jan 2014 · Korean journal of radiology: official journal of the Korean Radiological Society
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    ABSTRACT: We herein describe a patient with segmental pulmonary artery transection after blunt trauma, which was diagnosed preoperatively by computed tomography. Bolus tracking contrast-enhanced computed tomography clearly depicted both aortic and pulmonary vasculatures. A one-step examination quickly disclosed aortic damage and injury to significant visceral organs. To the best of our knowledge, our patient appeared to be a unique case of pulmonary segmental artery transection after blunt injury, which was preoperatively diagnosed by computed tomography. Ultimately, successful surgical repair of the pulmonary artery was performed.
    No preview · Article · Jan 2014 · Journal of the Chinese Medical Association
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    ABSTRACT: PURPOSE Conventional digital subtraction angiography (DSA) helps to evaluate the severity of vascular spasm after subarachnoid hemorrhage (SAH). Being equipped with flat detector (FD), DSA is able to provide in-room assessment of peri-therapeutic cerebral hemodynamics and help tailoring endovascular treatments. The aim of current study is to compare the cerebral circulation time (CCT) that derived color-coded quantitative FD-DSA and CT perfusion (CTP) in SAH patients. METHOD AND MATERIALS Nineteen SAH patients entered our neurovascular service in 8 months interval and with available CCT derived from diagnostic FD-DSA and MDCT, were retrospectively recruited. The mean time interval between two examinations was 19 (4-36) hours. The CCT derived from FD-DSA was defined as the difference of Tmax (Time of maximum intensity) between the region-of-interest (ROI) of selected arteries and superior sagittal sinus (SSS). Four CCT were defined accordingly, namely, RA-CCT and LA-CCT (arterial ROI placed on the second portion of right and left anterior cerebral arteries), RM-CCT and LM-CCT (arterial ROI placed on the second portion of right and left middle cerebral artery). The CCT from MDCT was defined as the difference of time-to-peak between corresponding arterial (RM, LM) and SSS ROI. For CCT of anterior cerebral artery, only the dominant was defined due to limited spatial resolution. RESULTS The mean of RA-CCT, LA-CCT, RM-CCT and LM-CCT defined by FD-DSA were 5.6±1.5, 6.0±1.8, 5.9±1.9, 6.0±2.3 seconds respectively. The mean of RA-CCT, LA-CCT, RM-CCT and LM-CCT defined by MDCT were 6.0±2.3, 5.9±2.3, 6.0±2.3 seconds respectively. The intraclass classification of CCT merited from FD-DSA between two observers ranged from 0.86-0.99, and those from MDCT between two observers ranged from 0.72-0.98. The correlations of RA-CCT, LA-CCT, RM-CCT, and LM-CCT between two modalities were 0.70, 0.76, 0.70, 0.80, respectively. The correlation got worse when the CCT became longer. CONCLUSION With no extra radiation dose, FD-DSA provides CCT of SAH patients with comparable results as CTP. It facilitates the feasibility of both in-room peri-therapeutic hemodynamic monitoring and tailoring endovascular treatments. CLINICAL RELEVANCE/APPLICATION The CCT measured by QDSA provides additional hemodynamic information in SAH patients in addition to vascular morphology. It confirms the reproducibility of intra-arterial hemodynamic models.
    No preview · Conference Paper · Dec 2013
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    ABSTRACT: PURPOSE To quantitatively measure the hemodynamic change of hepatic artery before and after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) by quantitative color-coding analysis (QCA). METHOD AND MATERIALS This prospective study was performed from December 2012 to February 2013. 64 patients (mean 67.5 year old; male 50, female 14) who were diagnosed with HCC and underwent TACE with doxorubicin and lipiodol emulsion or with microspheres were enrolled if superselective segmental TACE was technically feasible. The endpoint of TACE was sluggish of antegrade arterial flow. QCA (syngo iFlow; Siemens) was used to determine the maximal density time (Tmax) of selected intravascular region of interest (ROI). Relative Tmax (rTmax) was defined as the Tmax at the selected ROI minus the time of contrast medium spurting from the catheter tip. The catheter tip was placed in common hepatic artery, proper hepatic artery or lobar hepatic arteries before and after TACE with the same acquisition and injection protocols. The rTmax of treated and proximal hepatic arteries were analyzed before and after embolization. RESULTS The pre- and post-treatment rTmax of the landmarks at the treated segmental artery and proximal right hepatic artery were1.84~2.08s, 2.7~3.59s (p < 0.001) and 1.4~1.64s, 1.55~1.89s (p<0.05), respectively. However, in subgroup analysis of one lobe treatment including 30 patients of right lobe only and 8 patient of left lobe only, the pre- and post-rTmax of treated right and left segmental arteries were 1.86~2.26s, 2.73~3.95s (p < 0.001) and 1.55~2.24s, 1.56~3.8s (p = 0.12), respectively. The rTmax of the proximal lobar hepatic arteries or proper hepatic artery had no significant change before and after TACE. CONCLUSION QCA is feasible to quantify embolization endpoint by comparing the rTmax in selected hepatic arteries before and after TACE. The rTmax of treated segmental artery was significant prolonged after optimized procedures. CLINICAL RELEVANCE/APPLICATION QCA is able to quantitatively determine the adequate embolization endpoint in HCC patients.
    No preview · Conference Paper · Dec 2013
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    ABSTRACT: The angioarchitecture of arteriovenous fistulas (AVFs) of cerebral arteriovenous malformation (CAVM) after stereotactic radiosurgery (SRS) remain unclear. The purpose of this study is to report the angiographic change of AVF components of CAVMs after SRS and outcomes of endovascular embolisation. From 2002 to 2012, a total of 523 CAVMs had been treated primarily by SRS with more than 3-year latency. Among these databases, there were 19 patients with 21 AVFs undergoing embolization after SRS. We retrospectively analyzed the angioarchitecture of the CAVM to identify AVFs, morphologic change and outcomes of AVFs after SRS and embolisation. Eight AVFs were in the periphery of CAVMs, the other 13 were in a central location. Eighteen of 21 AVFs remained constant in morphology after SRS, while three feeders of AVFs were associated with radiation arteritis. The causes of failure to identify AVFs before SRS were overlooked (n = 7) or there was superimposition with feeders, nidus and/or venous drains of CAVMs (n = 14). Total fistula occlusion was achieved in all 21 AVFs; residual CAVMs was totally obliterated by embolisation and/or additional SRS in 12 patients. One patient had a small procedure-related intracerebral hemorrhage. Mean follow-up period was 26 months. Early detection of AVF components of CAVMs prior to SRS may be difficult, particularly those in a central location. However, most AVFs became evident and showed consistency in angiographic morphology after obliteration of the majority nidus parts of CAVMs. Endovascular embolisation is effective in managing these AVF components.
    Full-text · Article · Nov 2013 · Acta Neurochirurgica
  • Chih-Chun Wu · Rheun-Chuan Lee · Cheng-Yen Chang
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    ABSTRACT: Objective: The purpose of this study was to investigate whether the diameter of superior hemorrhoidal vein on preoperative CT can predict the presence of lymphovascular invasion (LVI). Subjects and methods: This study recruited 102 patients with treatment-naive rectal cancers. The diameters of superior hemorrhoidal vein and inferior mesenteric vein (IMV) on pretreatment CT and postoperative pathologic reports were reviewed. Univariate analysis and receiver operating characteristic curve analysis were applied to determine the correlation between clinical factors and pathologic features and the diameters of superior hemorrhoidal vein and IMV. Results: The diameter of superior hemorrhoidal vein was significantly higher in patients with LVI than in those without (mean diameter, 44 vs 30 mm, respectively; p < 0.001) and was significantly higher in patients with distant metastases than in those without (p = 0.044). There was no significant difference between IMV diameter in LVI and that in distant metastasis (p = 0.521). Conclusion: Patients having rectal cancers with LVI showed a significantly increased mean superior hemorrhoidal vein diameter at presentation, which could be identified with pretreatment CT and help to direct the application of neoadjuvant treatment strategies.
    No preview · Article · Nov 2013 · American Journal of Roentgenology

Publication Stats

2k Citations
267.28 Total Impact Points

Institutions

  • 2001-2015
    • National Yang Ming University
      • • Faculty of Medicine
      • • School of Medicine
      T’ai-pei, Taipei, Taiwan
    • Taipei Medical University
      • Department of Radiology
      T’ai-pei, Taipei, Taiwan
  • 2001-2014
    • Taipei Veterans General Hospital
      • Division of Radiology
      T’ai-pei, Taipei, Taiwan
  • 2003
    • National Defense Medical Center
      T’ai-pei, Taipei, Taiwan