Jo-Yu Chen

Risk profile of patients with poor-grade aneurysmal subarachnoid hemorrhage using early perfusion computed tomography.

OBJECTIVE To determine whether perfusion computed tomography (CT) is useful for identifying patients with poor-grade subarachnoid hemorrhage (SAH) with reversible etiologies and whether early obliteration in patients with poor-grade aneurysmal SAH leads to favorable outcomes. METHODS Patients with new-onset aneurysmal SAH in World Federation of Neurological Surgeons (WFNS) grade IV or V neurologic condition who had perfusion CT performed at admission were eligible for the study. The study retrospectively enrolled 38 patients seen between January 2007 and July 2009. The decision to perform an early obliteration was made by the family after a discussion with the neurosurgeons, neurointensivists, and interventional radiologists. The functional outcomes were correlated with the Glasgow Outcome Scale (GOS) at 6 months, and quantitative perfusion CT data were collected. RESULTS This study included 10 (26%) grade IV and 28 (74%) grade V patients. Favorable outcomes occurred in 19 (50%) patients, and 11 (29%) patients died. After a multivariate logistic regression analysis of the parameters, older age (odds ratio 1.104, P = 0.0317), bilateral prolonged mean transient time (MTT) at the thalami (odds ratio 4.155, P = 0.0362), and early obliteration (odds ratio 0.098, P = 0.003) were predictive of poor outcome. CONCLUSIONS Early bilateral prolonged MTT at the thalami and old age are associated with a poor outcome. Early obliteration benefits a significant portion of SAH patients.

Hyperacute cerebral aneurysm rerupture during CT angiography

OBJECT The object of this study was to identify the clinical features and outcomes of a subgroup of patients with aneurysmal subarachnoid hemorrhage (SAH) who had active contrast extravasation from a ruptured aneurysm during initial cerebral CT angiography (CTA). METHODS The authors performed a retrospective study of spontaneous SAH cases involving patients treated at their institute. They identified 9 cases in which active contrast extravasation was evident on the initial CT angiogram. Another 12 similar cases were also identified in a literature review and data was gathered from these cases to evaluate the outcomes. RESULTS Analysis of all 21 cases revealed that the overall outcomes in cases characterized by active aneurysmal bleeding during CTA were poor. Seventy-six percent of patients had unfavorable results. Patients who showed poor neurological status at presentation died no matter what kind of treatment they received. In contrast, patients who presented with good neurological status initially had a chance of favorable outcome. Among the patients with good initial neurological status, most demonstrated rapid deterioration of their condition during the CTA examination; only those who received immediate and effective decompressive surgery and aneurysm obliteration had good results. CONCLUSIONS Active aneurysmal rebleeding during CTA is an uncommon but devastating event. Though the mortality of this distinct group of patients remains high, a clinical subgroup may benefit from immediate surgery. Patients with good initial neurological status who show rapid neurological deterioration may still have a favorable outcome if they undergo timely and successful decompressive surgery and proper aneurysm obliteration. Patients who present with poor neurological status do badly, and there is no effective treatment for such patients.

Evaluation of the treatment response to neoadjuvant chemotherapy in locally advanced breast cancer using combined magnetic resonance vascular maps and apparent diffusion coefficient.

To evaluate the treatment response of locally advanced breast cancer (LABC) to neoadjuvant chemotherapy using magnetic resonance (MR) vascular maps and apparent diffusion coefficient (ADC) at 3T.

Quantitative computed tomography of pulmonary emphysema and ventricular function in chronic obstructive pulmonary disease patients with pulmonary hypertension.

Objective This study strived to evaluate the relationship between degree of pulmonary emphysema and cardiac ventricular function in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension (PH) using electrocardiographic-gated multidetector computed tomography (CT). Materials and Methods Lung transplantation candidates with the diagnosis of COPD and PH were chosen for the study population, and a total of 15 patients were included. The extent of emphysema is defined as the percentage of voxels below -910 Hounsfield units in the lung windows in whole lung CT without intravenous contrast. Heart function parameters were measured by electrocardiographic-gated CT angiography. Linear regression analysis was conducted to examine the associations between percent emphysema and heart function indicators. Results Significant correlations were found between percent emphysema and right ventricular (RV) measurements, including RV end-diastolic volume (R2 = 0.340, p = 0.023), RV stroke volume (R2 = 0.406, p = 0.011), and RV cardiac output (R2 = 0.382, p = 0.014); the correlations between percent emphysema and left ventricular function indicators were not observed. Conclusion The study revealed that percent emphysema is correlated with RV dysfunction among COPD patients with PH. Based on our findings, percent emphysema can be considered for use as an indicator to predict the severity of right ventricular dysfunction among COPD patients.

Occipitocervical malformation with atlas duplication

A 55-year-old man presented to our institution with tetraparesis after a ground-level fall. The presence of hyper-reflexia in four limbs led to suspicion of cervical myelopathy. Initial cervical spine plain x-ray films showed spinal canal stenosis at C1/C2, os odontoideum and two atlas-like vertebrae. Duplication of the atlas in humans …

Preoperative computed tomography-guided dye injection to localize multiple lung nodules for video-assisted thoracoscopic surgery

BACKGROUND Preoperative computed tomography (CT)-guided localization of small lung nodules is important for accurate and efficient video-assisted thoracoscopic surgery (VATS). Resection of multiple small pulmonary nodules in one VATS procedure can aid in patient management. The aim of this study was to evaluate the usefulness of CT-guided Patent Blue V (PBV) dye localization in patients with multiple pulmonary nodules who underwent VATS. METHODS This retrospective study was conducted from January 2013 to December 2015. One hundred consecutive patients (59.9±10.5 years of age) with 217 nodules who underwent preoperative CT-guided PBV dye localization for multiple (2 to 4) nodules before VATS were enrolled. RESULTS The mean nodule size was 0.8±0.4 cm, with a mean depth from the pleura or fissure of 0.7±0.7 cm. The mean procedure duration was 50±20 minutes. The mean amount of injected PBV dye was 0.2±0.1 mL per nodule. The overall success rate was 99% by nodule. Failed localization of two nodules in two patients was due to poor dye visualization (n=1) and significant pneumothorax (n=1). Cases of hemorrhage (24%) were mild and asymptomatic, and none of the patients had hemoptysis. None of the cases of pneumothorax (40%) required chest tube placement before VATS. One (1%) patient developed anaphylaxis. The mean post-operative hospital stay was 6.4±4.4 days. CONCLUSIONS CT-guided PBV dye localization for multiple small pulmonary nodules before VATS is a safe, feasible, and accurate method with high success rate. This approach makes it easy to perform multiple nodule resections during one VATS operation.

Do we need to wait longer for cardiac arrest survivor to wake up in hypothermia era

Before the era of therapeutic hypothermia, a practice parameter including absent or extensor motor response at day 3 and the presence of myoclonus status epilepticus within 24 hours was used to assist prognostication of poor neurologic outcomes. There are conflicting results concerning whether hypothermia influences the reliability of the predictors and the accurate predictors and optimal timing for assessing neurologic recovery are largely unknown. Several prognostic indicators other than guidelines are also applied to help determining prognosis, including electroencephalogram, cerebral computed tomographic scan, and cerebral perfusion scintigraphy single-photon emission computed tomographic scan. Here, we present a cardiac arrest survivor treated with therapeutic hypothermia waked up finally on the 13th day, although clinical and laboratory examinations after return of spontaneous circulation all indicated poor neurologic prognosis. However, life support was reported to be withdrawn within 3 to 5 days in 25% to 50% cardiac arrest survivors treated with hypothermia when grave prognosis was predicted. The clinical course of the patient raises some important questions concerning the accuracy of current predictors, the optimal observation period for neurologic recovery, and the appropriate timing to determine withdrawal of life support in cardiac arrest victims receiving therapeutic hypothermia.

Giant serpentine aneurysm mimics cerebral arteriovenous malformation on angiography

A serpentine aneurysm is defined as a thrombosed giant aneurysm with internal channel, which mimics a giant arteriovenous malformation on angiography. We report a case of serpentine aneurysm and its radiological characters.