Spontaneous retroperitoneal hematoma treated with transarterial embolization: a systematic review and metanalysis

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the safety, technical, and clinical effectiveness of percutaneous Transarterial Embolization (TAE) in treating spontaneous retroperitoneal hematomas as well as assess treatment outcomes in patients who underwent target or empirical embolization.

MATERIALS AND METHODS

Through the PubMed, Embase, and Google Scholar databases, an extensive search was performed in the fields of spontaneous retroperitoneal hematomas treated with transcatheter arterial embolization. We collected pooled data on 141 patients from 6 separate articles selected according to the inclusion and exclusion criteria.

RESULTS

Technical success rate was 100% in all six studies, for both targeted and empirical embolization. The clinical success rate varied from 56.3 to 89.5%. The total number of complications related to the embolization procedure was 10 events out of 116 procedures analyzed. Empirical or empirical embolization was performed in three studies, where the source of active bleeding was not evident during DSA. A meta-analysis compared the rebleeding rates between targeted and empirical embolization groups. The odds ratio from pooled data from the three assessed studies (72 patients) showed no significant difference in rebleeding rates after empirical TAE compared with targeted TAE.

CONCLUSIONS

TAE is a safe, effective, and potentially life-saving procedure for the treatment of life-threatening spontaneous retroperitoneal hematomas. Empirical and targeted TAE procedures demonstrate a relatively low risk of complications, compared to the high technical and relatively high clinical success rates.

Radiographic predictive factors for 10-year survival of removable partial denture abutment teeth: Alveolar bone level and density

PURPOSE

To determine postoperative periodontal and radiographic factors that predict the survival rates of abutments of removable partial dentures (RPDs).

METHODS

Patients who wore RPDs for > 10 years and received supportive periodontal therapy were included. Periodontal examinations and radiographic assessments were conducted on 83 abutment teeth in 35 patients at baseline, and five years after RPD insertion. In addition to conventional factors, such as tooth mobility at 5 years, radiographic factors, such as the crown-root ratio (ΔCR ratio) and gray-level changes reflecting changes in alveolar bone density (ΔABD), were evaluated. The impact of the covariables on the 10-year survival of abutment teeth was estimated using a multivariate Cox regression model, considering multicollinearity.

RESULTS

Patients were classified as having A2-B2 (45.7%) and B3-C2 (54.3%) tooth loss, according to the Eichner classification. A probing depth ≥ 4 mm, tooth mobility ≥ grade 1, and CR ratio ≥ 1 were found in 30.1%, 33.7%, and 51.8% of abutment teeth, respectively. The 10-year survival rate of abutment teeth was 86.7%. Multivariate analysis showed that the 10-year survival of abutment teeth was significantly associated with root canal treatment (P = 0.045, hazard ratio [HR] = 1.23), the 5-year ΔCR ratio (P = 0.022, HR = 3.20), and ΔABD on the edentulous side of the abutment teeth (P = 0.047, HR = 1.08).

CONCLUSIONS

In addition to root canal treatment, changes in the CR ratio and radiographic alveolar bone density at five years predicted the long-term survival rate of RPD abutments.

Novel simultaneous determination of alliin and allicin in Allium sp. using digital subtraction HPTLC

Allicin is a major thiosulfinate found in garlic and other Allium sp. and it is responsible for their pungent aroma. It is formed during the tissue lysis of garlic, by the initial action of alliinase upon alliin, the major cysteine sulfoxide. Simultaneous detection of these two analytes is usually performed using HPLC. Contrary to the most important phytoconstituents in other samples, allicin is scarcely detected using the simple HPTLC technique, due to challenges caused by its unique structure, despite its simplicity and high needs in the analytical monitoring of the Allium sp. In this work, a cost-effective, simple, sensitive and accurate method was developed for the determination of allicin together with alliin, using HPTLC. Allicin is quickly pre-derivatised with cysteine in excess to the stable S-allylmercaptocysteine that is then simultaneously detected with alliin, using ninhydrin reagent. The method was validated in terms of accuracy (recoveries of 90-120 %), precision (RSD% of 4-12 %), selectivity, robustness, peak purity and limit of detection (LOD = 0.05 μg/band for allicin and LOD = 0.10 μg/band for alliin). The method was successfully applied using real Allium sp. samples and the results were in good agreement with HPLC data.

Diagnostic accuracy of DSA in carotid artery stenosis: a comparison between stenosis measured on carotid endarterectomy specimens and DSA in 644 cases

BACKGROUND AND PURPOSE

DSA (digital subtraction angiography) is the gold standard for measuring carotid artery stenosis (CS). Yet, the correlation between DSA and stenosis is not well documented.

MATERIAL AND METHODS

We compared CS as measured by DSA to carotid artery specimens obtained from carotid endarterectomy surgery. Patients were divided into three groups according to NASCET criteria (North American Symptomatic Carotid Endarterectomy Trial): stenosis of 30-49% (mild), stenosis of 50-69% (moderate), and stenosis of 70-99% (severe).

RESULTS

This prospective cohort study involved 644 patients. The mean stenosis in the mild stenosis group (n = 128 patients) was 54% ECST (European Carotid Surgery Trial), 40% NASCET, and 72% ESs (endarterectomy specimens). The mean absolute difference between ECST and NASCET was 14%. The mean stenosis in the moderate stenosis group (n = 347 patients) was 66% ECST, 60% NASCET, and 77% ES. The mean absolute difference between ECST and NASCET was 6%. The mean stenosis in the severe group (n = 169 patients) was 80% ECST, 76% NASCET, and 79% ES. No significant correlation coefficients were found between DSA and ES methods. In the mild group, the CC was 0.16 (ESCT) and 0.13 (NASCET); in the moderate group, the CC was 0.05 (ESCT) and 0.01 (NASCET); and in the severe group, the CC was 0.23 (ESCT) and 0.10 (NASCET). For all groups combined, CC was 0.22 for the ECST and 0.20 for the NASCET method.

CONCLUSION

The relationship between DSA and ES methods to measure CS is almost random. This lack of a relationship between the DSA and ES techniques questions the validity of current DSA-based guidelines.

Medium Term Outcomes of Deep Venous Stenting in the Management of Venous Thoracic Outlet Syndrome

OBJECTIVE

Venous thoracic outlet syndrome (vTOS) is a relatively rare condition associated with significant morbidity. Its management continues to evolve, with increasing use of endovascular adjuncts, such as percutaneous thrombectomy and angioplasty, in addition to first rib resection. The utility of stenting residual venous stenotic lesions is poorly defined within the literature. This study sought to review the medium term patency rates of upper limb deep venous stenting in the management of vTOS.

METHODS

A single centre, retrospective review of patients managed for vTOS with first rib resection followed by upper limb deep venous stenting between January 2012 and February 2021 was conducted. Post-procedural ultrasounds were reviewed to determine stent patency.

RESULTS

Twenty-six patients were included, with 33 stents placed. The median duration of follow up was 50 months. On venous duplex ultrasound at three years post-operatively, primary patency rates were 66%, primary assisted patency rates were 88%, secondary patency rates were 91%, and total occlusion rates were 9%. After stent placement, 80% of patients remained asymptomatic with regard to compression symptoms.

CONCLUSION

Upper limb deep venous stenting is an effective adjunct to surgical decompression in the management of vTOS. Stent medium term patency rates are promising; however, further studies with longer follow up and larger cohorts with multicentre results are required to confirm these early findings.

Long-term observation of periodontal condition following placement of removable partial dentures with rigid retainers and major connector in patients with/without diabetes: A retrospective study

PURPOSE

This retrospective study evaluated the periodontal tissues of the abutment teeth of removable partial dentures (RPDs) with rigid retainers and major connectors in patients with and without type 2 diabetes mellitus (T2D).

METHODS

A total of 313 patients who had been treated with RPDs, including rigid retainers and major connectors, were divided into two groups: T2D and non-T2D. The periodontal parameters and radiographic bone heights of the abutment teeth were evaluated at baseline and at a 5-year examination during supportive periodontal therapy (SPT). For patients with accessible standardized radiographs, bone density was analyzed based on the gray level (GL) using digital subtraction radiography (n = 83).

RESULTS

Overall, 739 abutment teeth (86 in the T2D group) of 235 patients (25 in the T2D group) were analyzed, and 95.0% (94.2% in the T2D group, and 95.2% in the non-T2D group) were maintained. The mean probing pocket depth significantly increased in both groups ( p < 0.001). There were significant changes in the radiographic bone height (p = 0.038) and GL on the side of the denture base area (p = 0.048) in the T2D group compared to those in the non-T2D group.

CONCLUSIONS

Regardless of T2D, RPDs with rigid retainers and major connectors could prevent the progression of periodontal disease and successfully maintain most of the abutment teeth during 5-years of SPT. However, T2D may be significantly associated with loss of bone height reduction and density on the side of the denture base area.

The role of imaging in the management of non-traumatic subarachnoid hemorrhage: a practical review

The purpose of this review is to understand the role of imaging in the diagnosis and management of non-traumatic subarachnoid hemorrhage (SAH). SAH is a life-threatening emergency and a relatively common entity, the most common etiology being ruptured aneurysms. Multiple conundrums exist in literature at various steps of its imaging workup: diagnosis, management, and follow-up. We target our review to highlight the most effective practice and suggest efficient workup plans based on literature search, and describe in detail the clinical diagnostic and prognostic scales, role of CT scan, lumbar puncture, and MR, including angiography in the diagnosis and workup of SAH and its complications, and try to simplify the conundrums. Practical knowledge of imaging workup of SAH can help guide correct management of these patients, so as to reduce morbidity and mortality without resource overutilization.

The clinical value of ceMRA versus DSA for follow-up of intracranial aneurysms treated by coil embolization: an assessment of occlusion classifications and impact on treatment decisions

OBJECTIVE

The aim of this study was a detailed analysis of the value of contrast-enhanced magnetic resonance angiography (ceMRA) compared to digital subtraction angiography (DSA) for follow-up imaging of intracranial aneurysms treated by coil embolization.

METHODS

Patients with coiled aneurysms and follow-up exams including both DSA and 3 T ceMRA were retrospectively identified. In blinded readings, both modalities were graded according to the modified Raymond-Roy classification (MRRC) and the Meyers scale. Additionally, readers were asked to make a decision regarding retreatment/follow-up based on the respective imaging findings.

RESULTS

The study comprised 92 patients harboring 102 coiled aneurysms. There was good intermethod agreement of DSA and ceMRA concerning both the MRRC (κ = 0.64) and the Meyers scale (κ = 0.74). Agreement regarding occlusion of < 90% of the aneurysm (Meyers grade ≥ 2) was very good (κ = 0.87). Regarding the detection of a remnant with contrast between the coil mass and the aneurysm wall (MRRC IIIb), there were 12 discrepant findings and agreement was good (κ = 0.70). Comparing treatment/follow-up decisions, the two methods agreed very well (κ = 0.92). In seven patients with discrepant treatment decisions, the authors concurred with DSA in four cases and with ceMRA in three cases when evaluating both modalities together. Interval aneurysm growth was found in more cases with ceMRA (n = 19) than with DSA (n = 16).

CONCLUSIONS

CeMRA is very unlikely to miss a relevant aneurysm remnant and thus could be suitable as the primary follow-up method. In case of remnant growth or recurrence, however, additional DSA might be required to guide treatment decisions.

KEY POINTS

• There is high accordance between ceMRA and DSA regarding the evaluation of intracranial aneurysms treated by endovascular coil embolization, but closer analysis also revealed relevant differences. • CeMRA could be suitable as the primary follow-up imaging modality, potentially eliminating the need for routine DSA. • DSA will still be required in case of aneurysm remnant growth or recurrence as detected by ceMRA.

Carbon dioxide-angiography for patients with peripheral arterial disease at risk of contrast-induced nephropathy

Patients with peripheral arterial disease (PAD) and critical limb ischemia are at risk for limb amputation and require urgent management to restore blood flow. Patients with PAD often have several comorbidities, including chronic kidney disease, diabetes mellitus, and hypertension. Diagnostic and interventional angiography using iodinated contrast agents provides excellent image resolution but can be associated with contrast-induced nephropathy (CIN). The use of carbon dioxide (CO₂) as a contrast agent reduces the volume of iodine contrast required for angiography and reduces the incidence of CIN. However, CO₂ angiography has been underutilized due to concerns regarding safety and image quality. Modern CO₂ delivery systems with advanced digital subtraction angiography techniques and hybrid angiography have improved imaging accuracy and reduced the incidence of CIN. Awareness of the need for optimal imaging conditions, contraindications, and potential complications have improved the safety of CO₂ angiography. This review aims to highlight current technological advances in the delivery of CO₂ in vascular angiography for patients with PAD and critical limb ischemia, which result in limb preservation while preventing kidney damage.

A systematic review of automated feeder detection software for locoregional treatment of hepatic tumors

PURPOSE

The purpose of this study was to perform a systematic review of current literature describing the efficacy and technical outcomes of transarterial liver therapies using automated feeder detection (AFD) software.

MATERIALS AND METHODS

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A structured search was performed in the PubMed, SCOPUS, and Embase databases of patients undergoing locoregional therapy of liver tumors utilizing AFD software. Demographic data, procedure data (including radiometrics) and tumor response rate were recorded. Where available, performance of AFD was compared to conventional digital subtraction angiography (DSA) and cone-beam CT (CBCT) without AFD.

RESULTS

A total of 14 full-text manuscripts met inclusion criteria, comprising 1042 tumors in 604 patients (305 men, 156 women; mean age, 68.6±6.0 [SD] years), including 537 patients with hepatocellular carcinoma, 8 with metastases from neuroendocrine tumors, and 59 patients without reported etiology. Reported sensitivity of AFD ranged between 86% and 98.5%, compared to DSA alone (38% - 64%) or DSA in combination with CBCT (69% - 81%). Three studies reported tumor response by modified response evaluation criteria in solid tumors (mRECIST) guidelines, with complete response in the range of 60% - 69%.

CONCLUSION

AFD is a promising new technology for the identification of intrahepatic and extrahepatic tumor-feeding arteries and should be considered a useful adjunct to conventional DSA and CBCT in the treatment of liver tumors.

Effects of Remote Ischaemic Preconditioning on Arterial Stiffness in Patients Undergoing Lower Limb Angiographic Procedures: A Randomised Clinical Trial

OBJECTIVES

Remote ischaemic preconditioning (RIPC) is a phenomenon that promotes protection of tissues and organs against ischaemia reperfusion injury. RIPC has been shown to reduce myocardial and renal injury but its effect on arterial stiffness in patients undergoing lower limb digital subtraction angiography (DSA) is unknown. The aim of this study was to evaluate the effect of RIPC on arterial stiffness in patients with peripheral arterial disease (PAD) undergoing lower limb DSA.

METHODS

In the RIPC intervention, the blood pressure cuff on the arm was inflated to 200 mmHg or to 20 mmHg above systolic pressure, and in the sham intervention to 20 mmHg. For both, the procedure was repeated for four five minute cycles at five minute intervals between the cycles. Changes in heart rate corrected augmentation index (AIx@75), augmentation index (AIx), carotid femoral pulse wave velocity (PWV), and haemodynamic parameters were measured before and 24 h after DSA.

RESULTS

111 (RIPC 54, sham 57) patients with symptomatic lower limb PAD scheduled for DSA were randomised. 102 patients (RIPC 47, sham 55) were included in final analysis. RIPC significantly improved AIx (-5.46% in RIPC and -1.45% in sham group; p = .05), but not AIx@75 (-4.88% in RIPC and -1.38% in sham group; p = .07) or PWV (-0.41 m/s in RIPC and -0.27 m/s in sham group; p = .74). In the RIPC group a significant reduction in AIx (p = .002) and AIx@75 (p = .003) was noted after stenting when compared with the sham intervention. AIx (p = .001), AIx@75 (p = .002), mean arterial (p = .01), peripheral (p = .02), and central systolic blood pressure (p = .006) were significantly reduced only in the RIPC group 24 h after DSA.

CONCLUSION

This study evaluates for the first time the effects of RIPC on arterial stiffness parameters in patients with symptomatic PAD following DSA. RIPC may modulate arterial stiffness following a DSA procedure and is more pronounced in patients after stent placement.

Influence of inferior petrosal sinus drainage symmetry on detection of adenomas in Cushing's syndrome

BACKGROUND

Asymmetric inferior petrosal sinuses (IPS) are not infrequently encountered during bilateral IPS sampling. There is little data on whether IPS symmetry influences success in predicting the adenoma side in patients with ACTH-dependent Cushing's syndrome (CS).

OBJECTIVE

To assess the influence of IPS drainage patterns on detection of an adenoma in CS.

METHODS

Retrospective single-center cohort analysis reviewing records of patients with CS and negative MRI findings who subsequently underwent BIPSS.

RESULTS

BIPSS was performed in 38 patients with a mean age of 45±15 years. The overall technical success rate was 97% for bilateral cannulation. Asymmetric IPS were observed in 11 (39%) patients with Cushing's disease (CD). A side-to-side ACTH ratio was not significantly different between patients with symmetric outflow and those with asymmetric outflow at baseline (8.6±2.7 versus 16.4±6.0; P=0.45), but ratios were significantly different after ovine corticotropin-releasing hormone (oCRH) stimulation (6.0±2.5 versus 35.7±22.5; P=0.03). BIPSS correctly predicted the side of the adenoma in 25 (96%) patients with CD. Prediction was better when the venous outflow was symmetric (100%) rather than asymmetric (93%), although the difference was not significant (P=0.42). Remission from CS was achieved in 32 patients (87%), independent of the symmetry of IPS.

CONCLUSIONS

Bearing in mind the sample size of this audit, asymmetric IPS at least do not seem to diminish the accuracy of diagnosis of ACTH-dependent CS, nor do they influence the clinical outcome.

Intraoperative contrast-enhanced ultrasound for early diagnosis of endoleaks during endovascular abdominal aortic aneurysm repair

BACKGROUND

The aim of this study was to evaluate the feasibility and utility of intraoperative contrast-enhanced ultrasound (CEUS) for early detection of endoleaks (ELs) during endovascular abdominal aortic aneurysm repair (EVAR) compared with completion digital subtraction angiography.

METHODS

Patients undergoing elective EVAR from January 2017 to April 2018 were consecutively enrolled in this prospective study. After endograft deployment, two-digital subtraction angiography (2DSA) with orthogonal C-arm angulations (anteroposterior and sagittal view) were routinely performed. After the endovascular treatment of clear, high-flow type I/III ELs detected by 2DSA, intraoperative CEUS was carried out in sterile conditions on the surgical field before guidewire removal. Presence and type of EL were evaluated with 2DSA and CEUS. CEUS was performed with the vascular surgeon blinded to the 2DSA findings. The primary end point was the level of agreement between 2DSA and CEUS to detect any type of EL and type II EL. Agreement between two diagnostic methods was calculated using Cohen's kappa. The secondary end point was utility of CEUS for intraoperative adjunctive procedure guidance.

RESULTS

Sixty patients were enrolled (mean age, 78 ± 6 years; 90% male). 2DSA revealed 11 ELs (18%; 1 type IA, 10 type II), and CEUS 25 ELs (42%; 2 type IA, 23 type II). 2DSA and CEUS were in agreement in 39 cases (65%; 32 no ELs, 7 type II ELs). CEUS detected 17 ELs not identified by 2DSA (28%; 2 type IA, 15 type II); 2DSA detected three ELs not identified by CEUS (5%; 3 type II). In one case, 2DSA and CEUS detected type II and type IA ELs, respectively. For EL and type II EL detection, Cohen's kappa was 0.255 and 0.250, respectively (both "fair agreement"). Intraoperative adjunctive sac embolization was performed under CEUS control in 4 cases and technical success was 100%.

CONCLUSIONS

Intraoperative CEUS during EVAR is feasible and can detect a greater number of ELs than 2DSA, in particular type II ELs. Further studies are necessary to assess the reliability of this intraoperative diagnostic examination. In type II ELs, CEUS may represent an additional, useful tool for intraoperative sac embolization guidance.

Evaluation of the Accuracy in Maximum Intensity Projection Images of Cerebral Computed Tomographic Angiography for the Diagnosis of Cerebral Vasospasm Following Subarachnoid Hemorrhage, in Comparison to Digital Subtraction Angiography

Objective

The purpose of this retrospective study is to determine the accuracy of maximum intensity projection (MIP) images of computed tomographic angiography (CTA) for diagnosis of cerebral vasospasm (CV) following subarachnoid hemorrhage (SAH) compared with that of digital subtraction angiography (DSA).

Materials and Methods

For patients admitted to our hospital for SAH, MIP images of CTA and DSA were checked at admission, and images were taken again 1 week later. This protocol was used in 39 cases. MIP images of CTA and DSA examinations were reviewed by two independent readers.

Results

Accuracy of MIP images of CTA in various arterial segments, using DSA as the gold standard: the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for different segments varied from 84 to 97, 33–100, 84–100%, 25–85, and 79–97%, respectively, for readers. Accuracy of CTA in various vasospasm severity, using DSA as the gold standard: the sensitivity, specificity, PPV, NPV, and accuracy for different vasospasm severity varied from 44 to 100, 69–100, 36–100%, 61–100, and 88–100%, respectively, for readers. Accuracy of CTA in central segments versus peripheral segments, using DSA as the gold standard: the sensitivity, specificity, PPV, NPV, and accuracy for central segments and peripheral segments varied from 90 to 94, 68–83, 93–97%, 56–69, and 87–93%, respectively, for readers.

Conclusion

MIP imaging of CTA is a useful modality when diagnosing CV after SAH.

Morphological and Hemodynamic Parameters for Middle Cerebral Artery Bifurcation Aneurysm Rupture Risk Assessment

OBJECTIVE

To investigate the morphological and hemodynamic parameters associated with middle cerebral artery (MCA)bifurcation aneurysm rupture.

METHODS

A retrospective study of 67 consecutive patients was carried out based on 3D digital subtraction angiography data. Morphological and hemodynamic parameters including aneurysm size parameters (dome width, height, and perpendicular height), longest dimension from the aneurysm neck to the dome tip, neck width, aneurysm area, aspect ratio, Longest dimension from the aneurysm neck to the dome tip (Dmax) to dome width, and height-width, Bottleneck factor, as well as wall shear stress (WSS), low WSS area (LSA), percentage of LSA (LSA%) and energy loss (EL) were estimated. Parameters between ruptured and un-ruptured groups were analyzed. Receiver operating characteristics were generated to check prediction performance of all significant variables.

RESULTS

Sixty-seven patients with MCA bifurcation aneurysm were included (31 unruptured, 36 ruptured). Dmax (p=0.008) was greater in ruptured group than that in un-ruptured group. D/W (p<0.001) and the percentage of the low WSS area (0.09±0.13 vs. 0.01±0.03, p<0.001) were also greater in the ruptured group. Moreover, the EL in ruptured group was higher than that in un-ruptured group (6.39±5.04 vs. 1.53±0.86, p<0.001). Multivariate regression analysis suggested D/W and EL were significant predictors of rupture of MCA bifurcation aneurysms. Correlation analyses revealed the D/W value was positively associated with the EL (R=0.442, p<0.01).

CONCLUSION

D/W and EL might be the most two favorable factors to predict rupture risk of MCA bifurcation aneurysms.

Chronological grey scale changes in supporting alveolar bone by removable partial denture placement on patients with periodontal disease: A 6-month follow-up study using digital subtraction analysis

OBJECTIVES

The purpose was to assess the early effects of removable partial denture (RPD) placement on abutment teeth in patients with periodontal disease.

METHODS

Fifteen distal-extension RPDs and 19 abutment teeth were evaluated in 13 patients with moderate-to-severe periodontal diseases. Clinical periodontal records and grey level (GL) score based on digital subtraction radiography were measured on the day of denture placement (baseline) and at 1day, 1 week, 1 month, 3 months, and 6 months after the placement. Occlusal force on total dentition (Ft) and abutment tooth (Fa) were recorded with (baseline) and without denture on the day of the placement, and with denture in the follow-up examinations.

RESULTS

No statistically significant difference between a follow-up period and the baseline was found in the clinical periodontal and occlusal force records, except for Ft with denture on the day of the placement, which was significantly lower than the baseline (p<0.05). The GL at distal crestal of the abutment was significantly higher at 1 week after the placement than at the baseline (p<0.05), while the scores of following examinations returned to the baseline level.

CONCLUSIONS

The distal crestal bone of the abutment tooth transitorily reacts to mechanical stress due to the denture placement, while this does not suggest a detrimental effect within the limitation of the study design with a short-term observation period.

CLINICAL SIGNIFICANCE

The RPDs can be safely used for patients with periodontal diseases for at least 6 months if they are properly placed and maintained by professional care.

Clinical Utility of Angiographic CT with a Flat-detector Angiographic System during Endovascular Procedure

OBJECTIVE

We evaluated the feasibility of angiographic computed tomography (ACT) for visualizing stent material in patients who underwent intracranial or extracranial stent placement to treat atherosclerotic lesions or stent assisted coil embolization.

MATERIALS AND METHODS

We performed intrarterial and intravenous ACT on biplane angiography system equipped with flat panel detectors (Axiom Arits dBA; Siemens Medical Solutions, Forchheim, Germany). Vistipaque 320 was injected for contrast medium, total 150 mL at flow rate of 5 mL/s through artery and 77 mL at flow rate of 3.5 mL/s through vein.

RESULTS

ACT is a new imaging modality that provides a clear visualization of stent strut.

CONCLUSION

Therefore this new application has potential to become the noninvasive option for follow-up after endovascular surgery using stents.

Quantitative Digital Subtraction Angiography in Pediatric Moyamoya Disease

Moyamoya disease is a unique cerebrovascular disorder characterized by idiopathic progressive stenosis at the terminal portion of the internal carotid artery (ICA) and fine vascular network. The aim of this review is to present the clinical application of quantitative digital subtraction angiography (QDSA) in pediatric moyamoya disease. Using conventional angiographic data and postprocessing software, QDSA provides time-contrast intensity curves and then displays the peak time (T_max) and area under the curve (AUC). These parameters of QDSA can be used as surrogate markers for the hemodynamic evaluation of disease severity and quantification of postoperative neovascularization in moyamoya disease.

C-arm Lipiodol CT in transcatheter arterial chemoembolization for small hepatocellular carcinoma

AIM: To investigate the value of C-arm Lipiodol computed tomography (CT) for intra-procedural hepatocellular carcinoma (HCC) lesion detection during transcatheter arterial chemoembolization (TACE).

METHODS: Forty patients (37 male, 3 female; mean age, 52.6 ± 12.5 years, age range: 25-82 years) diagnosed with HCC were enrolled in this study. All patients underwent 64-slice CT 1-2 wk before TACE. During the procedure, hepatic angiography was performed first. Following diagnostic embolization with Lipiodol injected into the hepatic artery, a C-arm CT scan was immediately conducted (C-arm Lipiodol CT). If new HCC lesions were confirmed, gelfoam particles were super-selectively injected into the tumor-nourishing blood vessel. A Lipiodol CT scan was performed 7-14 d after TACE. All images acquired from 64-slice CT, digital subtraction angiography (DSA), C-arm Lipiodol CT and Lipiodol CT were retrospectively reviewed by four radiologists and the number of detected lesions in each examination was counted, respectively. The results of Lipiodol CT were taken as the diagnostic reference. Alpha-fetoprotein values were examined both before and after TACE. This study only takes into account the lesions that were not found or were considered suspicious on 64-slice CT before TACE.

RESULTS: Preprocedural 64-slice CT detected a total of 13 suspicious lesions in the 40 patients. DSA detected ten definite and four suspicious lesions. C-arm Lipiodol CT detected 71 lesions in total and Lipiodol CT confirmed 67 lesions with a diameter range of 3-12 mm. Four false-positive lesions, which were detected by C-arm Lipiodol CT, were considered to be hepatic artery-portal vein fistulas. The average alpha-fetoprotein values before and after TACE were significantly different (452.3 ± 192.6 ng/mL vs 223.8 ± 93.2 ng/mL; P = 0.039).

CONCLUSION: C-arm Lipiodol CT has a higher diagnostic sensitivity for small HCC lesions. This technique may help physicians make intraprocedural decisions to provide patients with earlier treatment.