Efficacy of a Drug-Eluting Stent Versus Bare Metal Stents for Symptomatic Femoropopliteal Peripheral Artery Disease: Primary Results of the EMINENT Randomized Trial.

BACKGROUND: A clear patency benefit of a drug-eluting stent (DES) over bare metal stents (BMSs) for treating peripheral artery disease of the femoropopliteal segment has not been definitively demonstrated. The EMINENT study (Trial Comparing Eluvia Versus Bare Metal Stent in Treatment of Superficial Femoral and/or Proximal Popliteal Artery) was designed to evaluate the patency of the Eluvia DES (Boston Scientific, Marlborough, MA), a polymer-coated paclitaxel-eluting stent, compared with BMSs for the treatment of femoropopliteal artery lesions. METHODS: EMINENT is a prospective, randomized, controlled, multicenter European study with blinded participants and outcome assessment. Patients with symptomatic peripheral artery disease (Rutherford category 2, 3, or 4) of the native superficial femoral artery or proximal popliteal artery with stenosis ≥70%, vessel diameter of 4 to 6 mm, and total lesion length of 30 to 210 mm were randomly assigned 2:1 to treatment with DES or BMS. The primary effectiveness outcome was primary patency at 12 months, defined as independent core laboratory-assessed duplex ultrasound peak systolic velocity ratio ≤2.4 in the absence of clinically driven target lesion revascularization or surgical bypass of the target lesion. Primary sustained clinical improvement was a secondary outcome defined as a decrease in Rutherford classification of ≥1 categories compared with baseline without a repeat target lesion revascularization. Health-related quality of life and walking function were assessed. RESULTS: A total of 775 patients were randomly assigned to treatment with DES (n=508) or commercially available BMSs (n=267). Baseline clinical, demographic, and lesion characteristics were similar between the study groups. Mean lesion length was 75.6±50.3 and 72.2±47.0 mm in the DES and BMS groups, respectively. The 12-month incidence of primary patency for DES treatment (83.2% [337 of 405]) was significantly greater than for BMS (74.3% [165 of 222]; P<0.01). Incidence of primary sustained clinical improvement was greater among patients treated with the DES than among those who received a BMS (83.0% versus 76.6%; P=0.045). The health-related quality of life dimensions of mobility and pain/discomfort improved for the majority of patients in both groups (for 66.4% and 53.6% of DES-treated and for 64.2% and 58.1% of BMS-treated patients, respectively) but did not differ significantly. At 12 months, no statistical difference was observed in all-cause mortality between patients treated with the DES or BMS (2.7% [13 of 474] versus 1.1% [3 of 263]; relative risk, 2.4 [95% CI, 0.69-8.36]; P=0.15). CONCLUSIONS: By demonstrating superior 1-year primary patency, the results of the EMINENT randomized study support the benefit of using a polymer-based paclitaxel-eluting stent as a first-line stent-based intervention for patients with symptomatic peripheral artery disease attributable to femoropopliteal lesions. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02921230.

Feasibility and potential value of flat-panel detector-based computed tomography in myelography after spinal surgery.

OBJECT: The purpose of this study was to assess the value of myelography using flat-panel detector-based computed tomography (fpCT) in 5 patients in whom the image quality of multislice CT (MSCT) or MR imaging was limited by metal artifacts. METHODS: The application of fpCT to myelographic imaging of the lumbar spine and cervicothoracic junction after surgery was feasible. Multiplanar, preferably sagittal, and 3D reconstructions adequately depicted disc space implants and provided high resolution images of osseous structures. RESULTS: The images obtained with fpCT allowed evaluation of anatomical details such as single nerve roots and proved especially valuable in a patient with impaired MR imaging results caused by metal artifacts from an intraoperative abrasion. In a case of recurrent disc herniation, imaging results of myelographic fpCT and MSCT scanning were in good agreement. CONCLUSIONS: The novel imaging technique the authors describe yielded adequate results in patients with a history of spinal surgery, may be superior to MSCT scanning in depicting osseous structures and metallic implants, and has the potential to provide multilevel spinal images. Myelographic fpCT scanning may be the preferred modality in patients with expected or known metal artifacts on myelographic MSCT scans and/or MR images.

FDG PET/CT in the detection of recurrent rectal cancer.

The purpose of this study was to assess the additional value of combined fluorine 18 (18F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in the follow-up of rectal cancer after surgery. Forty-eight examinations in 30 patients were evaluated retrospectively. CT and PET components were interpreted separately, and this was followed by a consensus reading. Sites of increased FDG uptake as well as PET/CT findings were categorized as benign (1), equivocal (2), or malignant (3). The standard of reference was histology or clinical and imaging follow-up for at least 6 months. Sensitivity, specificity, positive and negative predictive values, and accuracy for differentiating benign (14/31) from malignant (17/31) uptake sites in the small pelvis were 100%, 64%, 77%, 100%, and 84% for PET/CT, and 100%, 29%, 63%, 100%, and 68% for PET, respectively. Regarding extrapelvic abnormalities, PET/CT was able to distinguish benign (31/88) from malignant (57/88) with a sensitivity, specificity, positive and negative predictive values, and accuracy of 100%, 87%, 93%, 100%, and 95%, compared with 96%, 68%, 85%, 91%, and 86% for PET. The rare case of an FDG uptake of adrenal adenoma is documented. PET/CT is valuable in the staging of rectal cancer, particularly for excluding recurrent disease suspected by PET interpretation alone in a considerable number of patients.

Sonography of dermatofibrosarcoma protuberans of the groin.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon tumor that arises from the dermis of adults. Its malignant potential is considered to be intermediate. Because the diagnosis of DFSP can frequently be suspected on the basis of physical examination reports on its sonographic appearance are rare. We report a case that highlights the value of sonography in assessing the subcutaneous extent of DFSP.

Impact of PVCs noted during coronary calcium scan on image quality and accuracy in subsequent coronary dual-source CT angiography.

The purpose of this study was to investigate the impact of the presence of one or more premature ventricular contractions (PVCs) during coronary calcium score scan (CS) on image quality and accuracy of subsequent dual-source coronary CT angiography (DS CCTA). Fifty-three out of 502 patients showed one or more PVCs during CS and built the study group. Sixty consecutively registered patients with sinus rhythm formed the control group. Two independent, blinded readers classified 1,723 coronary artery segments as being of diagnostic or non-diagnostic image quality. All segments with diagnostic image quality were assessed for the presence for significant coronary artery stenosis. Accuracy was calculated using conventional angiography as standard of reference. The percentage of DS CCTA data sets with diagnostic image quality was significantly lower in the study group (79.2%) compared to the control group (90.6%, P < 0.05). The rate of coronary segment with diagnostic image quality was highly significant lower in the study group (89.5%; n = 723/808) compared to the control group (99.4%; n = 908/915; P < 0.001). However, accuracy did not differ in both groups. Significant correlation between non-diagnostic image quality and mean HR was only found in the study group (P = 0.019). The presence of one or more PVCs during CS does not affect accuracy but impairs image quality of subsequent DS CCTA. Mean HR is a predictor of non-diagnostic data sets only in the study group, suggesting more aggressive HR control could be beneficial.

Aortic development and anomalies.

Development of the aorta takes place during the third week of gestation. It is a complex process that can lead to a variety of congenital variants and pathological anomalies. In diagnostic and interventional radiology, knowledge of aortic abnormalities and variant branching sequence is crucially important. This article gives a systematic overview of anatomical variability of the aorta.

Percutaneous nephrostomy and antegrade ureteral stenting: technique-indications-complications.

In this review the technique, indication for and complications of percutaneous nephrostomy (PCN) and antegrade ureter stent insertion are described. In the majority of the cases PCN is performed to relieve urinary obstruction, which can be of benign or malignant nature. Another indication for PCN is for treatment of urinary fistulas. PCN can be performed under ultrasound and/or fluoroscopic guidance, with a success rate of more than 90%. The complication rate is approximately 10% for major and minor complications together and 4-5% for major complications only. Percutaneous antegrade double-J stent insertion usually is performed if retrograde ureter stenting has not been successful. However, especially in malignant obstructions, the success rate for antegrade stenting is higher than for retrograde transvesical double-J stent insertion. In the case of severe infection and bleeding after PCN JJ-stent insertion may be contraindicated so long as there is no sufficient concomitant drainage via a PCN . Lower urinary tract dysfunction should be excluded before stent placement. The complication rate is 2-4%. Consequent stent surveillance with regular stent exchange is mandatory.