Efficacy and safety of particle embolization in bronchial arteries of hemoptysis patients with shunts.

AIM: This study assesses the safety and efficacy of particle embolization during bronchial artery embolization (BAE) in patients with shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. METHODS: In this retrospective, single-center study, we analyzed 312 BAE procedures performed from June 2020 to April 2023. The patient cohort had shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery. We meticulously collected and examined comprehensive data, including clinical characteristics, computed tomography (CT) imaging, and embolization procedural details. RESULTS: Vascular shunts were identified in 49 patients. The etiologies of hemoptysis included post-TB sequelae (42.8%), bronchiectasis (26.5%), active TB (12.2%), aspergilloma (8.1%), bacterial pneumonia (4.1%), lung cancer (4.1%), and non-tuberculous mycobacterial infection (2%). The technical success rate of the procedures was 98%, with 149 out of 152 identified vessels successfully embolized. All patients experienced cessation or significant reduction of hemoptysis within 24 hours following the procedure. The clinical success rates were 97.9% at one month, 93.9% at six months, and 89.8% at one year. No shunt-related complications were detected. CONCLUSION: BAE with particle embolization is a safe and effective treatment for hemoptysis, particularly in cases with complex shunts between bronchial and non-bronchial systemic arteries and the pulmonary artery.

Correlation of quantitative MR imaging findings with symptoms in patients with incidentally detected inflammatory sinonasal disease.

PURPOSE: To assess the relationships between mucosal thickness, T1-weighted, T2-weighted signals and restricted diffusion on magnetic resonance imaging (MRI) with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease. MATERIALS AND METHODS: Conventional and diffusion-weighted MRI of 100 patients with incidental sinonasal mucosal thickening were prospectively evaluated. There were 53 men and 47 women, with a mean age of 44.6 years±15.17 (SD) (range: 18-81 years). Correlations between quantitative values (T1-signal, T2-signal and apparent diffusion coefficient [ADC]) and three different quality of life questionnaires (chronic sinusitis survey, sinonasal outcomes test-22 and nasal obstruction and septoplasty effectiveness scale [NOSE]) were searched using the Spearman correlation test. RESULTS: The mean SNOT-22 score was 35.81±20.36 (SD) (range: 0-83), CSS score was 4.64±3.42 (SD) (range: 0-14), and NOSE score was 5.91±4.84 (range: 0-18). All patients (100%) had maxillary sinus involvement. Ethmoidal sinus involvement was present in 57% of patients, frontal sinus involvement in 33% and sphenoidal sinus involvement in 27%. Morphologically, 40 patients (40%) had septal deviation, 41 (41%) had maxillary sinus retention cyst and 78 (78%) had hypertrophy of the conchae. No correlations were found between morphological abnormalities, quantitative values and patient scores in none of the questionnaires. CONCLUSION: Incidental morphological abnormalities or restricted diffusion of the paranasal sinuses on MRI do not correlate with the degree of symptoms in patients with incidentally detected inflammatory sinonasal disease.

Preoperative grading of supratentorial gliomas using high or standard b-value diffusion-weighted MR imaging at 3T.

PURPOSE: The goal of this study was to compare diffusion-weighted magnetic resonance imaging (DW-MRI) using high b-value (b=3000s/mm2) to DW-MRI using standard b-value (b=1000s/mm2) in the preoperative grading of supratentorial gliomas. MATERIALS AND METHODS: Fifty-three patients with glioma had brain DW-MRI at 3T using two different b-values (b=1000s/mm2 and b=3000s/mm2). There were 35 men and 18 women with a mean age of 40.5±17.1 years (range: 18-79 years). Mean, minimum, maximum, and range of apparent diffusion coefficient (ADC) values for solid tumor ROIs (ADCmean, ADCmin, ADCmax, and ADCdiff), and the normalized ADC (ADCratio) were calculated. A Kruskal-Wallis statistic with Bonferroni correction for multiple comparisons was applied to detect significant ADC parameter differences between tumor grades by including or excluding 19 patients with an oligodendroglioma. Receiver operating characteristic curve analysis was conducted to define appropriate cutoff values for grading gliomas. RESULTS: No differences in ADC derived parameters were found between grade II and grade III gliomas. Mean ADC values using standard b-value were 1.17±0.27×10-3mm2/s [range: 0.63-1.61], 1.05±0.22×10-3mm2/s [range: 0.73-1.33], and 0.86±0.23×10-3mm2/s [range: 0.52-1.46] for grades II, III and IV gliomas, respectively. Using high b-value, mean ADC values were 0.89±0.24×10-3mm2/s [range: 0.42-1.25], 0.82±0.20×10-3mm2/s [range: 0.56-1.10], and 0.59±0.17×10-3mm2/s [range: 0.40-1.01] for grades II, III and IV gliomas, respectively. ADCmean, ADCratio, ADCmax, and ADCmin were different between grade II and grade IV gliomas at both standard and high b-values. Differences in ADCmean, ADCmax, and ADCdiff were found between grade III and grade IV only using high b-value. CONCLUSION: ADC parameters derived from DW-MRI using a high b-value allows a better differential diagnosis of gliomas, especially for differentiating grades III and IV, than those derived from DW-MRI using a standard b-value.

Value of apparent diffusion coefficient measurement for discrimination of focal benign and malignant hepatic masses.

The purpose of our study was to investigate the value of diffusion-weighted magnetic resonance imaging (DW-MRI) to discriminate benign and malignant focal lesions of the liver using parallel imaging technique. A total of 77 patients and 65 healthy controls were enrolled in the study. DW-MRI was performed with b-factors of 0, 500 and 1000 s/mm(2), and the apparent diffusion coefficients (ADC) values of the normal liver and the lesions were calculated. The mean ADC value of the focal liver lesions were as follows: simple cysts (3.16 +/- 0.18 x 10(-3) mm(2)/s), hydatid cysts (2.58 +/- 0.53 x 10(-3) mm(2)/s), hemangiomas (1.97 +/- 0.49 x 10(-3) mm(2)/s), metastases (1.14 +/- 0.41 x 10(-3) mm(2)/s) and hepatocellular carcinomas (HCC) (1.15 +/- 0.36 x 10(-3) mm(2)/s). The mean ADC values of all the disease groups were statistically significant when compared with the mean ADC value of the normal liver (1.56 +/- 0.14 x 10(-3) mm(2)/s), (P < 0.01). There were also statistically significant differences among the ADC values of hemangiomas and HCC metastases (P < 0.01), and simple and hydatid cysts (P < 0.008). However, there was no statistically significant difference between HCC and metastases. The present study showed that ADC measurement has the potential to differentiate benign and malignant focal hepatic lesions. We propose to add DW sequence in the MR protocol for the detection and quantitative discrimination of hepatic pathologies.

Quantitative diffusion-weighted magnetic resonance imaging of normal and diseased uterine zones.

BACKGROUND: Magnetic resonance (MR) imaging has been established as the best imaging modality for the detection, localization, and staging of uterine cancers. Recently, the usefulness of diffusion-weighted imaging (DWI) in the diagnosis of cancers has been reported in several studies. PURPOSE: To calculate the apparent diffusion coefficient (ADC) values of normal uterine zones as well as benign and malignant uterine diseases, and to determine a cut-off ADC value for the quantitative detection of uterine malignancies with DWI. MATERIAL AND METHODS: Eighty-seven patients (mean age 53 years) with 107 benign and malignant uterine pathologies and 50 healthy controls (mean age 38 years) were enrolled in the study. DWI was performed with b factors of 0, 500, and 1000 s/mm(2). RESULTS: The ADC values of benign and malignant lesions were compared using Student's t test. The mean and the standard deviation of the ADC values of the control group were as follows: myometrium 1.76+/-0.19 x 10(-3) mm(2)/s, junctional zone 0.99+/-0.18 x 10(-3) mm(2)/s, endometrium 1.65+/-0.33 x 10(-3) mm(2)/s, and cervix 1.71+/-0.17 x 10(-3) mm(2)/s. There was a statistically significant difference among the ADC values of normal myometrium and leiomyomas (1.47+/-0.36 x 10(-3) mm(2)/s; P<0.009), endometrium and endometrial carcinomas (0.86+/-0.13 x 10(-3) mm(2)/s; P<0.001), myometrium-junctional zone and adenomyosis (1.24+/-0.20 x 10(-3) mm(2)/s; P<0.001), and cervix and cervical carcinomas (0.91+/-0.14 x 10(-3) mm(2)/s; P<0.001). The ADC values differed significantly between malignant (0.88+/-0.11) and benign lesions (1.55+/-0.33; P<0.01). A cut-off value for malignant lesions of 1.05 x 10(-3) mm(2)/s yielded a sensitivity, specificity, and accuracy of 95.83%, 94.55%, and 94.94%, respectively. CONCLUSION: The present study shows that ADC measurements have the potential to quantitatively differentiate between normal and cancerous tissues of the uterine zones. We propose adding DWI as an adjunct sequence in the MR protocol for the assessment of uterine lesions.

Complete familial Currarino triad in association with Hirschsprung's disease: magnetic resonance imaging features and the spectrum of anorectal malformations.

Currarino syndrome, a rare hereditary condition, is defined as a partial sacral agenesis associated with a presacral mass and anorectal malformation. The authors present two siblings with complete Currarino triad and their mother with incomplete triad. The complete Currarino triad in the older sibling was associated with Hirschsprung's disease as the second reported case in the literature. Anorectal malformations, whether suspected of Currarino syndrome or not, should be examined with lumbosacral magnetic resonance imaging.