Are survival outcomes dependent on the tumour dose threshold of 139 Gy in patients with chemorefractory metastatic colorectal cancer treated with yttrium-90 radioembolization using glass particles? A real-world single-centre study.

OBJECTIVES: To compare the survival and objective response rate (ORR) of the patients receiving estimated tumour absorbed dose (ETAD) <140 Gy versus ETAD ≥140 Gy in patients with advanced chemorefractory colorectal carcinoma liver metastases (CRCLM) treated with yttrium-90 transarterial radioembolization (90Y TARE). METHODS: Between August 2016 and August 2023 adult patients with unresectable, chemorefractory CRCLM treated with 90Y TARE using glass particles, were retrospectively enrolled. Primary outcomes were overall survival (OS) and hepatic progression free survival (hPFS). Secondary outcome was ORR. RESULTS: A total of 40 patients with a mean age of 66.2 ± 7.8 years met the inclusion criteria. Mean ETAD for group 1 (ETAD <140 Gy) and group 2 (ETAD ≥140) were 131.2 ± 17.4 Gy versus 195 ± 45.6 Gy, respectively. The mean OS and hPFS for group 1 versus group 2 were 12 ± 10.3 months and 8.1 ± 9.3 months versus 9.3 ± 3 months and 7.1 ± 8.4 months, respectively and there were no significant differences (P = .181 and P = .366, respectively). ORR did not show significant difference between the groups (P = .432). CONCLUSION: In real-world practice, no significant difference was found in OS, hPFS, and ORR between patients who received ETAD <140 Gy versus ETAD ≥140 Gy in patients with CRCLM, in this series. ADVANCES IN KNOWLEDGE: This study demonstrated that increased tumour absorbed doses in radioembolization may not provide additional significant advantage for OS and hPFS for patients with CRCLM.

Mechanical thrombectomy for middle cerebral artery M2 occlusions.

BACKGROUND: The safety and efficacy of mechanical thrombectomy (MT) for proximal large vessel occlusion after acute ischemic stroke (AIS) have been demonstrated. Clinical investigations of endovascular approaches for treating AIS due to M2 occlusions have been ongoing. PURPOSE: To assess the outcomes of M2 occlusions according to treatment modality and anatomical division. METHODS: A total of 113 consecutive M2 occlusions treated with endovascular treatment (EVT) at our tertiary stroke center between January 2019 and December 2022 were retrospectively analyzed. Patients were divided into three groups: mechanical thrombectomy (MT); intravenous thrombolysis plus MT (IVT + MT); and IVT alone. The primary outcomes were good prognosis (mRS = 0-2) and mortality (mRS = 6) on day 90. The secondary outcome was to determine the differences in outcomes between lesions in the superior and inferior branches of M2. RESULTS: In total, 55 (48.7%) patients underwent MT. In 42 (37.2%) patients, bridging IVT was performed with MT, and IVT alone was applied in 16 (14.2%) patients. Neither the prognosis at 90 days nor the mortality rate significantly differed among the groups. The outcomes did not significantly differ between occlusions in the superior and inferior branches of M2. CONCLUSION: MT was found to be safe and effective for treating M2 occlusions in this series.

Percutaneous nephrostomy in infants: a 20-year single-center experience.

PURPOSE: To investigate the safety and efficacy of the imaging-guided percutaneous nephrostomy (PCN) procedure in infants. METHODS: A total of 75 (50 boys; 66.7%) patients with a mean age of 121 days (range, 1-351 days) who underwent PCN over a period of 20 years were included in this retrospective study. For each patient, PCN indications, catheter size, the mean duration of catheterization, complications, and the procedure performed following nephrostomy were recorded. Technical success was determined based on the successful placement of the nephrostomy catheter within the pelvicalyceal system. Clinical success was defined as the complete resolution of hydronephrosis and improvement in renal function tests during follow-up. In patients with urinary leakage, technical and clinical success was determined based on the resolution of leakage. RESULTS: The technical success rate was 100%, and no procedure-related mortality was observed. In 11 patients (14.7%), bilateral PCN was performed. The most frequent indication of PCN was ureteropelvic junction obstruction (n = 41, 54.7%). Procedure-related major complications were encountered in two patients (methemoglobinemia and respiratory arrest caused by the local anesthetic agent in one patient and the development of urinoma caused by urinary leakage from the puncture site in the other). Mild urinary leakage was the only minor complication that occurred and only in one patient. Catheter-related complications were managed through replacement or revision surgery in 16 patients (21.3%). CONCLUSION: Imaging-guided PCN is a feasible and effective procedure with high technical success and low major complication rates, and it is useful for protecting kidney function in infants.

Prediction of Bleeding by the PRECISE-DAPT Score in Patients with Carotid Artery Stenting.

PURPOSE: The predicting bleeding complications in patients undergoing stent implantation and the subsequent dual antiplatelet therapy (PRECISE-DAPT) score predicts the risk of bleeding in patients with dual antiplatelet therapy (DAPT) after percutaneous coronary interventions (PCIs). Patients with carotid artery stenting (CAS) are also treated with DAPT. In this study, we aimed to investigate the performance of the PRECISE-DAPT score in predicting bleeding in patients with CAS. METHODS: Patients who had CAS between January 2018 and December 2020 were retrospectively enrolled. The PRECISE-DAPT score was calculated for each patient. The patients were divided into two groups based on their PRECISE-DAPT score: low < 25 and high ≥ 25. Bleeding and ischemia complications and laboratory data among the two groups were compared. RESULTS: A total of 120 patients with a mean age of 67.3 ± 9.7 years were included. Forty-three patients had high PRECISE-DAPT scores, and 77 patients had low PRECISE-DAPT scores. Six patients developed bleeding events during the six-month follow-up, and five of them were in the PRECISE DAPT score ≥ 25 group. The difference between the two groups regarding bleeding events at six months was significant (P = 0.022). CONCLUSION: The PRECISE-DAPT score might be used for predicting the bleeding risk in patients with CAS, and the bleeding rate was significantly higher in patients with a PRECISE-DAPT score ≥ 25.

Identifying overall survival in 98 glioblastomas using VASARI features at 3T.

PURPOSE: This study aims to evaluate qualitative and quantitative imaging metrics along with clinical features affecting overall survival in glioblastomas and to classify them into high survival and low survival groups based on 12, 19, and 24 months thresholds using machine learning. METHODS: The cohort consisted of 98 adult glioblastomas. A standard brain tumor magnetic resonance (MR) imaging protocol, was performed on a 3T MR scanner. Visually Accessible REMBRANDT Images (VASARI) features were assessed. A Kaplan-Meier survival analysis followed by a log-rank test and multivariate Cox regression analysis were used to investigate the effects of VASARI features along with the age, gender, the extent of resection, pre- and post-KPS, ki67 and P53 mutation status on overall survival. Supervised machine learning algorithms were employed to predict the survival of glioblastoma patients based on 12, 19, and 24 months thresholds. RESULTS: Tumor location (p<0.001), the proportion of non-enhancing component (p=0.0482), and proportion of necrosis (p=0.02) were significantly associated with overall survival based on Kaplan-Meier analysis. Multivariate Cox regression analysis revealed that increases in proportion of non-enhancing component (p=0.040) and proportion of necrosis (p=0.039) were significantly associated with overall survival. Machine-learning models were successful in differentiating patients living longer than 12 months with 96.40% accuracy (sensitivity=97.22%, specificity=95.55%). The classification accuracies based on 19 and 24 months survival thresholds were 70.87% (sensitivity=83.02%, specificity=60.11%) and 74.66% (sensitivity=67.58%, specificity=82.08%), respectively. CONCLUSION: Employing clinical and VASARI features together resulted in a successful classification of glioblastomas that would have a longer overall survival.

Limited positive predictive value of diffusion tensor tractography in determining clinically relevant white matter damage in brain stem cavernous malformations: A retrospective study in a single center surgical cohort.

PURPOSE: Diffusion tensor tractography (DTT) might reflect the postoperative clinical outcome of the patients with brain stem (BS) tumors correlating well with the neurological symptoms, but cavernous malformation (CM) is a hemorrhagic tumor prone to artifacts that may limit DTT. We set out to determine the correlation of DTT findings with the neurological examination before and after surgical resection in patients with BSCMs. MATERIALS AND METHODS: DTT findings were evaluated bilaterally for fiber tract displacement or deviation, deformation and interruption in every patient before and after the surgery. Neurological examination was performed at admission, discharge and outpatient follow-up visit. The sensitivity, specificity, positive and negative predictive values of DTT were calculated both pre- and post-operatively. RESULTS: There were 25 patients (9 men 16 women) with a mean age of 39.5±13.9 years. The mean size of the CMs was 6909±8374mm3 (range: 180-38,220mm3) The mean follow-up time was 42.7±23.2 months (range: 8 to 112 months). Preoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for corticospinal tracts (CST) and medial lemnisci (ML) were 100%, 60%, 38.4%, 100% and 87.5%, 11.7%, 31.8%, 66.6%, respectively. Postoperatively, the sensitivity, specificity, positive and negative predictive values of DTT for CSTs and ML were 100%, 64.7%, 40%, 100% and 100%, 0%, 33.3%, 66.6%, respectively. CONCLUSION: Positive findings on DTT such as fiber tract deviation, deformation, disruption or interruption should be taken cautiously before drawing conclusions of a clinically relevant damage of white matter tracts.

Predictors of long-term outcomes after polytetrafluoroethylene-covered stent-graft repair of peripheral arterial aneurysms, pseudo-aneurysms, and arterio-venous fistulas.

OBJECTIVES: To evaluate the primary patency rate at three years for the infra-aortic peripheral arterial pathologies treated with polytetrafluoroethylene-covered stent-grafts. METHODS: Patients treated with self-expandable polytetrafluoroethylene-covered stent-grafts for infra-aortic peripheral arterial aneurysms, pseudo-aneurysms, and arterio-venous fistulas were evaluated retrospectively. A total of 48 patients (35 male, 13 female; mean age: 53.8 ± 13.5) were included with 29.0 ± 16.5 months (median 27, range 4-70) mean follow-up period. The primary objective was to determine the primary patency rate at three years. The secondary objectives were to compare type and localization of pathology, and length and diameter of the stent-grafts with primary patency rate. Kaplan-Meier test was used as the main statistical method. RESULTS: Overall mean primary patency rate at three years was 77.10%. Polytetrafluoroethylene-covered stent-graft implantation in aneurysms had worse primary patency rate than pseudo-aneurysms and arterio-venous fistulas (66.6%, P = 0.03; 76.9%, P = 0.03; 88.2%, P = 0.01, respectively). Stent-graft location, length, and diameter are not associated with primary patency rate (P > 0.05) but stent diameter is associated with better primary assisted and secondary patency rates (P < 0.05). CONCLUSIONS: Pathology of the lesion is associated with the long-term primary patency rate of polytetrafluoroethylene-covered stent-grafts but not the stent-graft location, length, or diameter. Stent diameter is associated with primary assisted and secondary patency rates.

Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case-Control Study.

BACKGROUND: Accumulation of macrocyclic gadolinium agents in children's brains remain to be determined. PURPOSE: To demonstrate whether there is an intracranial macrocyclic gadolinium deposition after multiple contrast-enhanced MRI with gadoterate meglumine in a pediatric population. STUDY TYPE: Retrospective case-control. POPULATION: In all, 45 children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the study group and 45 healthy children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the control group. FIELD STRENGTH/SEQUENCE: T1 - and T2 -weighted axial images on a 1.5T scanner. ASSESSMENT: Children with at least three enhanced brain MRIs and an age- and sex-matched control group with an unenhanced brain MRIs were compared in terms of T1 signal intensity (SI). All patients in the study group received gadoterate meglumine intravenously (0.1 mmol/kg). SI measurements were made by drawing six regions of interest (ROIs): dentate nuclei (DN), pons, globus pallidi (GP), frontal white matter (FWM), thalamus (T), clivus, and cerebrospinal fluid (CSF) for both groups on unenhanced T1 -weighted images. STATISTICAL TESTS: Student's t-test was used for comparison of SI. The Pearson correlation was calculated for the correlation between the SI and the number of gadolinium administrations. RESULTS: A significant difference was detected between two groups for DN/CSF, pons/CSF, GP/CSF, thalamus/CSF, and FWM/CSF (P < 0.001, P < 0.001, P = 0.002, P = 0.002, P = 0.024, respectively). There was no significant difference between the two groups for clivus/CSF (P = 0.15). A good correlation between the number of gadoterate meglumine administrations and the SI for DN/CSF, pons/CSF, GP/CSF, and T/CSF (r = 0.80, r = 0.73, r = 0.91, and r = 0.90, respectively) was found. DATA CONCLUSION: A significant T1 SI increase reflecting gadolinium retention in the brain was detected for children with at least three gadoterate meglumine administrations in this series. The number of administrations correlated well with the increased SI. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:1471-1477.

Fast kilovoltage-switching dual-energy CT offering lower x-ray dose than single-energy CT for the chest: a quantitative and qualitative comparison study of the two methods of acquisition.

PURPOSE: We aimed to compare the size-specific dose estimates (SSDE), computed tomography (CT) dose indices and image quality parameters of the chest CTs obtained with fast kilovoltage-switching (FKS) dual-energy (DE) CT versus those with single-energy (SE) CT. METHODS: Patients who had chest SECT within the last 6 months were prospectively scanned with chest FKS-DECT. Quantitative comparison was made by calculating the mean SSDE, CTDIvol, contrast, noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) for both acquisitions. Two radiologists evaluated the chest SECT and DECT images qualitatively blinded to the technique used. The paired Student's t test was utilized for comparing the quantitative and qualitative data. Inter- and intraobserver agreement were also assessed. RESULTS: A total of 42 patients were included. The mean SSDE, CTDIvol, contrast, noise, CNR, and SNR for SECT versus DECT were 12.7±2.2 mGy vs. 9.3±1.2 mGy (P = 0.001), 10.9±2.4 mGy vs. 8±1.2 mGy (P < 0.001), 211.9±44.7 vs. 216.3±59 (P = 0.350), 12.9±2.4 vs. 13.9±3.7 (P = 0.086), 13.5±5.2 vs. 13.3±8.4 (P = 0.548) and 12±3.5 vs. 11.5±3.4 (P = 0.774), respectively. Interobserver reproducibility was high for contrast, noise, CNR, and SNR (ICC = 0.89, 0.85, 0.93, and 0.82, respectively; all P < 0.05). Intraobserver reproducibility was high for contrast, noise, CNR, and SNR (ICC = 0.80, 0.77, 0.85, and 0.88, respectively; all P < 0.05). CONCLUSION: The mean SSDE of the chest CTs obtained with FKS-DECT were 26.8% lower than those with SECT with significant difference for the objective assessment and there was no significant difference for the subjective assessment of the image qualities, in this series.

Safety of transarterial radioembolization with Yttrium-90 glass microspheres without cystic artery occlusion.

PURPOSE: To assess radiation-induced cholecystitis in cases of cystic artery origin nearby the treatment zone for transarterial radioembolization (TARE) treatment. MATERIALS AND METHODS: Patients with primary or secondary malignant liver tumors treated with TARE, in whom cystic artery was located in the surrounding area of the treatment zone on 99m-technetium-MAA angiograms, were included in this study. Whole liver dose, tumor dose and healthy injected liver dose, lung dose and if applicable the gallbladder dose were all calculated by using the Medical Internal Radiation Dose (MIRD) formula from SPECT-CT images. Qualitative and quantitative assessment of the gallbladder was performed on SPECT-CT. The observed adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v5.0). RESULTS: A total of 34 TARE procedures from 29 patients (18 men and 11 women), with a mean age of 65 ± 13.3 years meeting the inclusion criteria, were involved in the current study. The mean tumor dose, healthy injected liver dose, healthy whole liver dose and gallbladder dose were 204.9 ± 66.8 Gy, 70.5 ± 15.7 Gy, 31.1 ± 12.7 Gy and 96.4 ± 53.4 Gy, respectively. The mean follow-up period was 14 ± 5.2 months. Qualitative assessment revealed gallbladder radioactivity on SPECT-CT in 11 (32.3%) patients with six mild and five moderate-severe radioactivities. There were no detected grade 2 or 3 adverse events. CONCLUSION: TARE is safely performed without cystic artery embolization when its origin is close to the treatment area.

Three-Dimensional Reconstruction of the Semicircular Canals with a Two-Hands Model.

OBJECTIVE: To help understand the anatomy and the diseases of the semicircular canals (SCCs) by defining the three-dimensional reconstruction of the SCCs in a model reconstructed using the two hands (two-hands model) and to determine the three-dimensional configuration of the two hands by measuring the angle between the SCCs and the sagittal plane. METHODS: Patients older than 18 years of age with computed tomography (CT) scans of the temporal bones taken between 2017 and 2018 at the Yeditepe University Hospital were included in the study. CT images were evaluated by a radiologist. The angles between every SCC and the sagittal plane were measured with the MIMICS 12.1 program. Mean angles between the SCCs and the sagittal plane were measured. These angles were demonstrated on the two-hands model of the SCCs by means of a goniometer and photographed. RESULTS: Thirty patients and 60 temporal bones were included in the study. Mean angles between the superior, the posterior, and the horizontal SCCs and the sagittal plane were found as 37.1±3.3°, 50.4±4.1°, and 89.5±4.7°, respectively. CONCLUSION: This is the first study to define the three-dimensional representation of the SCCs with a two-hands model. This may allow for a better understanding and the better teaching of the anatomy and diseases of SCCs.

Anterior inferior iliac spine morphology: quantitative and qualitative assessment in an asymptomatic population.

PURPOSE: To assess the prevalence of anterior inferior iliac spine (AIIS) types, and to investigate the quantitative measurements that characterize AIIS morphology in an asymptomatic adult population. METHODS: In this prospective study, 358 hips from 179 consecutive subjects (age range, 19-82 years; 91 males, 88 females), who underwent CT examination for reasons other than hip problems and were negative for hip impingement test, were analyzed. AIIS types were determined (1, flat wall of the ilium between distal end of AIIS and acetebular rim; 2, bony eminence between distal end of AIIS and acetebular rim; and 3, extension of AIIS to the anterior superior acetebular rim) and AIIS tip angle (TA), direct distance (DD) of the anterior acetabular rim to AIIS as well as projectional distances in vertical (VD) and horizontal (HD) planes were measured. Age- and gender-related factors were searched using two-way ANOVA test under three age groups (18-39, 40-59, and ≥ 60 years). RESULTS: There were 238 (66.5%) type 1, 118 (33.0%) type 2, and two (0.5%) type 3 AIISs, with significant difference between AIIS types among age groups and genders (P < 0.001). VD and DD showed age- and gender-related (P < 0.001, P < 0.001), and TA demonstrated gender-related differences (P < 0.001). Inter-observer agreement was good for TA and moderate to poor for other measurements. CONCLUSIONS: Type 1 AIIS is the most common shape across all age groups in adult females and in young and middle-aged adult males. TA, DD, and VD might be reliably used for the evaluation of AIIS morphology.

Intermediate catheter placement distal to the cerebral aneurysm during flow diversion embolization with the Surpass device.

PURPOSE: We present the preliminary angiographic and clinical results of the combined utilization of an AXS Catalyst 5 (Cat5) distal access catheter and a Surpass flow diverter (SFD) for the endovascular treatment of intracranial aneurysms. MATERIALS AND METHODS: Interventional neuroradiology case records were evaluated retrospectively to identify patients treated with an SFD in combination with Cat5. Demographic data, technical success, location of the catheter tip, aneurysm occlusion rate, and procedure-related morbidity and mortality were noted. RESULTS: The analysis yielded 24 patients with 25 aneurysms with a mean age of 52.3±19.7 years. The mean aneurysm diameter was 15.7±8.8 mm. Twenty-one were anterior circulation (seven supraclinoid, one middle cerebral, one anterior choroidal and 12 petrocavernous) and four were posterior circulation (three basilar tip, one posterior inferior cerebellar) aneurysms. Only two of these aneurysms were re-treatments for recurrences. For SFD deployment, the distal tip of Cat5 was placed intradurally and at, or distal to, M1 segment in 88% and 48% of patients, respectively. Aneurysms were bypassed with Cat5 in 80% of the procedures. In one patient, flow diversion was abandoned totally due to arterial tortuosity. With the exclusion of this patient, the technical success rate was 91.7%. There was no permanent procedure-related morbidity or mortality. Of the 22 aneurysms treated successfully with the Surpass device, 20 had imaging follow-up at 6.3±3.8 months and 95% were totally occluded. CONCLUSION: The Cat5 catheter, which was manufactured for the navigation of large-bore stent-like devices, is a useful adjunct to the Surpass device and allowed us to deploy the device safely.

Bronchial Artery Embolization with Large Sized (700-900 µm) Tris-acryl Microspheres (Embosphere) for Massive Hemoptysis: Long-Term Results (Clinical Research).

PURPOSE: To investigate the safety, efficacy and long-term results of bronchial artery embolization with microsphere particles (Embosphere® Microspheres, BioSphere Medical, Rockland, MA) 700-900 µm in size for massive hemoptysis. METHODS: One hundred and seventy-four patients (94 female, 80 male; mean age 39.4 ± 5.7) who had bronchial artery embolization for massive hemoptysis between January 2010 and October 2015 were incorporated in the study. Patients had hemoptysis with a mean volume of 525 ± 150 mL (median 500 mL, range 300-1200 mL) over a 24-h period. Underlying pathologies included bronchial artery hypertrophy due to bronchiectasis (56.3% [98/174]), lung cancer (29.9% [52/174]), tuberculosis (10.3% [18/174]) and the rest remained idiopathic (3.4% [6/174]). Mean bronchial artery diameter before the intervention was 3.8 ± 1.5 mm (median 4 mm, range 3.1-7.5 mm). Median follow-up period was 56 months (range 10-82 months). Primary objectives were the technical and clinical success. RESULTS: Technical success was 100%. Clinical success for preventing massive hemoptysis was 91.9% (160/174). There was no procedure-related mortality or morbidities. Minor complications such as chest pain were observed in nine patients (5.0%). Recurrent hemoptysis (8.1%) was observed within 6 months in 14 patients, ten of whom were treated with a second embolization session and the remaining four with a total of three embolization sessions. CONCLUSION: Bronchial artery embolization for massive hemoptysis with Embosphere particles 700-900 µm in size is a safe and effective method with high technical and clinical success rates. Long-term results are excellent.

Imaging pearls of pediatric Behçet's disease.

OBJECTIVE: To emphasize the diverse diagnostic imaging findings of pediatric Behçet's disease and to define the fundamental imaging clues for pulmonary, vascular, gastrointestinal and central nervous system involvements of Behçet's disease in pediatric age group. We also aim to list the major imaging differences of Behçet's disease in childhood and adulthood. CONCLUSION: The diagnosis of pediatric Behçet's disease is challenging. Imaging can narrow the differential diagnosis by using some substantial clues and prevent diagnostic delays.

Atrium Advanta V12 Large Diameter Stent-Graft Applications for Infrarenal Abdominal Aortic Pseudoaneurysms (due to Behcet Disease): Safety and Efficacy.

BACKGROUND: The aim of the study was to determine the safety and effectiveness of Atrium Advanta V12 large diameter stent-graft applications for infrarenal abdominal aortic pseudoaneurysms (due to Behcet disease [BD]). METHODS: Data of Advanta V12™ (Atrium Europe B.V, Mijdrecht, the Netherlands) applied 12 female patients (mean age 30.5 ± 6.3, range 26-44) with infrarenal abdominal aortic pseudoaneurysms were analyzed retrospectively. All Advanta V12 large diameter stent grafts were implemented from right or left sided 12F femoral sheaths. Stent grafts with 12-16 mm in size and 29-61 mm in length were utilized. Technical success rate, procedure-related mortality and morbidity, and primary patency rate at 4 years were evaluated. RESULTS: Technical success rate was 100%. Neither procedure-related mortality nor morbidity was determined. The mean aortic diameter was 14.0 ± 0.8 mm for pseudoaneurysmatic abdominal aortas. The mean follow-up period was 46.5 ± 40.3 months (range 18-75). During follow-ups, only one recurrent aneurysm has evolved at the stenting site due to patients' withdrawal of immunosuppressive treatment. The advent of a new aneurysm proximal or distal to the stent-graft region or at the femoral access localization was not observed. There were no stent occlusions. Primary patency rate at 4 years was 100%. Complete aneurysm exclusion was achieved 100% at 48 months. CONCLUSIONS: The use of Advanta V12 large diameter stent grafts for infrarenal abdominal aortic pseudoaneurysms (due to BD), especially in female patients with small aortic diameter, is safe and efficient. Primary patency rate of the stent grafts at 4 years is excellent.

Misdiagnosed epigastric mass: Ectopic liver.

We discuss an ectopic liver misdiagnosed as an abdominal mass and the importance of magnetic resonance imaging (MRI) in liver positional anomalies. A solid midline mass midline adjacent to the liver was found in a 45-year-old female at an external center during an ultrasound investigation conducted for occasional abdominal pain of many years. The patient was referred to us for MRI. MRI revealed a solid epigastric lesion adjacent to the liver but unrelated to the liver parenchyma. The mass was of similar intensity as the liver in all sequences and in postcontrast dynamic phases following hepatospecific contrast material administration. We also observed contrast material excretion into the solid lesion from the biliary ducts in the hepatobiliary phase. The lesion was diagnosed as ectopic liver tissue with these findings. LEVEL OF EVIDENCE: 5 J. Magn. Reson. Imaging 2017;45:761-763.

Reproducibility and variability of very low dose hepatic perfusion CT in metastatic liver disease.

PURPOSE: We aimed to determine the intra- and interobserver agreement on the software analysis of very low dose hepatic perfusion CT (pCT). METHODS: A total of 53 pCT examinations were obtained from 21 patients (16 men, 5 women; mean age, 60.4 years) with proven liver metastasis from various primary cancers. The pCT examinations were analyzed by two readers independently and perfusion parameters were noted for whole liver, whole metastasis, metastasis wall, and normal-looking liver (liver tissue without metastasis) in regions of interest (ROIs). Readers repeated the analysis after an interval of one month. Intra- and interobserver agreements were assessed with intraclass correlation coefficients (ICC) and Bland-Altman statistics. RESULTS: The mean ICCs of all ROIs between readers were 0.91, 0.93, 0.86, 0.45, 0.53, and 0.66 for blood flow (BF), blood volume (BV), permeability, arterial liver perfusion (ALP), portal venous perfusion (PVP) and hepatic perfusion index (HPI), respectively. The mean ICCs of all ROIs between readings were 0.86, 0.91, 0.81, 0.53, 0.56, and 0.71 for BF, BV, permeability, ALP, PVP, and HPI, respectively. There was greater agreement on the parameters measured for the whole metastasis than on the parameters measured for the metastasis wall. The effective dose of all perfusion CT studies was 2.9 mSv. CONCLUSION: There is greater intra- and interobserver agreement for BF and BV than for permeability, ALP, PVP, and HPI at very low dose hepatic pCT. Permeability, ALP, PVP, and HPI parameters cannot be used in clinical practice for hepatic pCT with an effective dose of 2.9 mSv.