Stent graft treatment for coronary sinus hemorrhage associated with esophageal cancer.

Hemorrhage arising from the coronary sinus is very rare and can be lethal. It has historically been treated surgically. The present patient had coronary sinus rupture secondary to esophageal cancer and an abscess in the pericardium. Due to her poor general status, this patient was contraindicated for surgery and underwent endovascular therapy. The hemorrhage was treated by stent graft deployment and the patient was temporarily discharged. Two months later, CT showed that the stent graft was occluded by thrombosis. The patient died without hemorrhage 2.5 months thereafter.

Usefulness of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position: a new technique for cases unsuitable for conventional implantation.

PURPOSE: Totally implantable central venous access port implantation is typically performed in the supine position. However, some patients cannot adopt the supine position due to severe pain and/or dyspnea. The present study evaluated the technical feasibility of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position in such cases. MATERIALS AND METHODS: In the sitting position method, PICC-PORT implantation was performed with the patients seated on a videofluoroscopy chair positioned between the limbs of an angiographic C-arm and the operative upper arm positioned on an arm stand. From January 2019 to September 2021, eight patients underwent PICC-PORT implantations using this sitting method. We also evaluated 251 consecutive patients with conventional supine position PICC-PORT implantation as controls. Differences in technical success, procedure time and complications were retrospectively assessed between the two groups. RESULTS: Procedural success rates were 100% in both groups. Median procedure times in the sitting and conventional groups were 42 and 44 min, respectively. No complications were observed in the sitting group. There were no significant differences between the two groups in procedure time (p = 0.674) and complications (p = 1.000). CONCLUSION: Implantation of PICC-PORT in the sitting position is technically feasible and useful.

In Vitro Characterization of Drug-Loaded Superabsorbent Polymer Microspheres: Absorption and Release Capacity of Contrast Material, Antibiotics and Analgesics.

PURPOSE: To examine the characteristics of drug-loaded superabsorbent polymer microspheres (SAP-MS) such as drug absorption, drug release, diameter, and visibility. MATERIALS AND METHODS: SAP-MS (HepaSphere150-200 µm; Merit Medical, South Jordan, UT, USA) were suspended in drug solutions: (a) cefazolin, (b) lidocaine, (c) iopamidol and cefazolin, (d) iopamidol and lidocaine, and (e) iopamidol, cefazolin, and lidocaine. The concentrations of drugs were measured, and the amount of each drug absorbed was calculated. Filtered drug-loaded SAP-MS were mixed with saline, and the drug release rates were calculated. The diameter changes of SAP-MS during absorption were observed. Radiography of drug-loaded SAP-MS was evaluated as radiopacity by contrast-to-noise ratio (CNR). RESULTS: The drug concentration did not change during absorption. The release rates increased for 10 min and then came to an equilibrium. The mean amounts of drug absorbed at 180 min and mean release rates at 24 h were (a) cefazolin: 265.4 mg, 64.2%; (b) lidocaine: 19.6 mg, 75.6%; (c) iopamidol: 830.2 mg, 22.5%; cefazolin: 137.6 mg, 21.2%; (d) iopamidol: 1620.6 mg, 78.5%; lidocaine: 13.5 mg, 81.4%; and (e) iopamidol: 643.7 mg, 52.9%; cefazolin: 194.0 mg, 51.6%; lidocaine: 5.3 mg, 58.4%. The diameter of SAP-MS increased for approximately 15 min. Finally, the diameters of SAP-MS were (a) 3.9 times, (b) 5.0 times, (c) 2.2 times, (d) 5.5 times, and (e) 3.6 times larger than the original size. Drug-loaded SAP-MS containing iopamidol were visible under X-ray imaging, with CNRs of (c) 3.0, (d) 9.0, and (e) 4.5. CONCLUSION: SAP-MS can absorb and release iopamidol, cefazolin, and lidocaine.

Distribution of scatter radiation by C-arm cone-beam computed tomography in angiographic suite: measurement of doses and effectiveness of protection devices.

Distribution of radiation by C-arm cone-beam computed tomography (CBCT) in the angiographic suite and effectiveness of protection devices were assessed. CBCT image of a human phantom was obtained by a rotation of 220 degrees during 8 seconds of exposure. One hundred and twelve dosimeters were placed at different positions around the beam entry site, and color maps of dose distributions were drawn for horizontal and vertical planes. The measurements showed the highest radiation dose over 600 µGy by a single CBCT image acquisition at a distance of 60 cm from the beam entry site and a height of 90 cm from the floor. The color maps demonstrated the dose distribution to be more intense at the bilateral directions of the phantom. With the use of a ceiling-mounted transparent lead-acryl screen and a table-suspended lead curtain, the doses were reduced by 45-92 % at a direction of 210 degrees and a distance of 120 cm.

Stenosis of the third portion of the duodenum due to bleeding from the anterior pancreaticoduodenal artery: assessment by multiphase contrast-enhanced examination with multislice CT.

BACKGROUND: This study was undertaken to analyze the CT findings for the rare pathological process that stenosis of the third portion of the duodenum was presumed to be caused by bleeding from the anterior pancreaticoduodenal artery. METHODS: Four consecutive patients presenting with frequent vomiting, who did not have well-known underlying disorders causing duodenal stenosis, were retrospectively recruited. Multiphase contrast-enhanced CT examinations were performed with 0.5- or 1-mm collimation. Two radiologists evaluated 2-mm axial and multiplanar reformatted images. RESULTS: In all patients, endoscopy demonstrated severe edematous stenosis of the third portion of the duodenum not associated with ulcer, bleeding, or neoplasm. The following CT findings were observed in all patients: homogenous swelling of the third portion of the duodenum associated with luminal stenosis in un-enhanced images, a band-like area of lower contrast-enhancement surrounding the walls of the third portion of the duodenum in pancreatic-phase images, and stenosis of the celiac axis. In three patients, aneurysms of the anterior pancreaticoduodenal artery in arterial-phase images were depicted. In the remaining patient, the diameter of the artery was irregular. CONCLUSIONS: Multiphase contrast-enhanced CT examination using a multislice CT scanner helps to establish the diagnosis of this pathological process.

Percutaneous Retrieval of a Misinserted Pigtail Catheter Straightener during Infra-Renal Abdominal Aortic Stenting: A Case Report.

Percutaneous retrieval of an intravascular foreign body is a minimally invasive technique. Using cone-beam computed tomography and the lateral grasp technique, we successfully retrieved a pigtail catheter straightener that had been misinserted into the right common iliac artery. Some examples of catheter straightener retrieval have been reported; however, it is important to take care not to accidentally insert a catheter straightener into a vessel via an angiographic sheath.

Endometrial cancer arising from adenomyosis: Case report and literature review of MRI findings.

Endometrial cancer arising from adenomyosis (EC-AIA) is extremely rare, and the typical magnetic resonance imaging (MRI) findings of EC-AIA have not been established. We report a case of EC-AIA that was detected preoperatively on MRI and conduct a literature review of the MRI findings of EC-AIA.

Arteriovenous malformation of the pancreas: assessment of clinical and multislice CT features.

BACKGROUND: This study was undertaken to analyze the clinical and CT features of arteriovenous malformation (AVM) of the pancreas. METHODS: Seven lesions in six consecutive patients (one woman and five men, mean age 51 years) with AVM of the pancreas who underwent multiphase contrast-enhanced CT with 0.5 or 1-mm collimation were retrospectively studied. CT images were evaluated and correlated with angiographic findings by two radiologists. RESULTS: In four patients, the lesions were incidental findings. Two patients presented with abdominal pain and gastrointestinal bleeding, respectively. Serum amylase levels were within normal limits in all patients. The mean size of the lesions was 32.1 mm (3.0-97.3 mm). Conglomeration of strong nodular stains and early enhancement of the portal venous system were observed for all the lesions. The diagnosis of AVM of the pancreas was retrospectively established for all lesions, but was prospectively established for four lesions. The feeding arteries of all lesions were depicted, showing agreement with those observed by angiography performed for four lesions. One lesion showed pseudocyst formation, haziness around the lesion, and strong enhancement of the duodenal wall. CONCLUSION: Multiphase CT examination using multislice CT is useful for diagnosis of AVM of the pancreas, including identification of the feeding arteries.

In vitro evaluation of radiopacity of contrast-loaded superabsorbent polymer microspheres (SAP-MS) with static imaging and flow model.

PURPOSE: To evaluate the radiopacity of contrast-loaded superabsorbent polymer microspheres (SAP-MS) under X-ray imaging. MATERIALS AND METHODS: SAP-MS were suspended in contrast material (iodixanol) and the diameter change was assessed. The diameter of contrast-loaded SAP-MS in saline was measured sequentially. Radiography of the contrast-loaded SAP-MS was evaluated as radiopacity by contrast-to-noise ratio and visibility by multiple reader scoring. Under digital subtraction angiography, contrast-loaded SAP-MS were injected into a flow model. The flow speed was 1-10 cm/s, and images were acquired at 1-7.5 frames per second using a pulse width of 10-85 ms. Images were assessed by multiple reader scoring. RESULTS: The diameter of SAP-MS increased to 4.0-5.0 times its original size for approximately 15 min. The diameter of contrast-loaded SAP-MS in saline further increased by 10-30% within several minutes and returned to the previous size. Radiopacity and visibility of contrast-loaded SAP-MS decreased in 30 min after mixing with saline. Visibility was better with slow flow speed and narrow pulse width. CONCLUSION: For effective observation, contrast-loaded SAP-MS should be kept in non-diluted contrast material until use. The conditions of slower flow and use of a narrow pulse width are recommended.

Polidocanol Sclerotherapy Combined with Transarterial Embolization Using n-Butyl Cyanoacrylate for Extracranial Arteriovenous Malformations.

PURPOSE: To assess the safety and effectiveness of polidocanol sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). MATERIALS AND METHODS: Twenty-three patients with symptomatic AVMs in the head and neck (6), upper (7) and lower extremity (10) with a mean age of 42 years (range 4-74) treated with polidocanol sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 2 type I, 6 type II, 6 type IIIa and 9 type IIIb. Arterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. Polidocanol mixed with contrast material or carbon dioxide was delivered by percutaneous direct puncture. RESULTS: Treatment was successfully performed in all patients. In the mean follow-up period of 38 months, symptoms resolved or improved in 20/23 patients (87.0%). AVMs were devascularized 100% in 2 patients, 76-99% in 13, 50-75% in 7 and < 50% in 1. More than 50% devascularization was seen in 22 patients (95.6%). Two (8%) patients had complete remission, 17 (74%) had partial remission and 3 (13%) had no remission. There was no aggravation. Treatment was considered effective (complete and partial remission) in 20 patients (87.0%). Minor complications including localized arterial thrombosis (2) and spontaneously healing skin ulcer (1) were seen in 2 patients (8.7%). There were no major procedure-related complications. CONCLUSION: Polidocanol sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.

Renal dysfunction after abdominal or thoracic endovascular aortic aneurysm repair: incidence and risk factors.

PURPOSE: To determine the incidence and risk factors of renal dysfunction after abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). MATERIALS AND METHODS: The study consisted of 227 patients treated with EVAR and 90 with TEVAR for aortic aneurysms. Parameters, including patients' background factors, preoperative renal function, contrast dose and aortic wall irregularity on CT images were assessed in relation to postoperative renal dysfunction. RESULTS: Deterioration of renal function was observed in 33 of 218 patients (15.1%) after EVAR and in 7 of 79 (8.9%) patients after TEVAR. Hemodialysis was required in one patient after EVAR. In EVAR, renal dysfunction correlated with age (p = 0.034) and occlusion of accessory renal artery (p = 0.0001). In TEVAR, renal dysfunction correlated with age (p = 0.021), contrast dose (p = 0.042) and irregularity of the descending aortic wall (p = 0.023). In a multiple regression analysis, postoperative renal dysfunction was correlated with occlusion of accessory renal artery (p = 0.0003) after EVAR, and age (p = 0.02), contrast dose (p = 0.026) and irregularity of the descending aortic wall (p = 0.042) after TEVAR. CONCLUSION: Occlusion of accessory renal artery in EVAR, and age, contrast dose and irregularity of the descending aortic wall in TEVAR were considered to be predictors of postoperative renal dysfunction.

The effect of patient age on contrast enhancement during CT of the pancreatobiliary region.

OBJECTIVE: The objective of our study was to assess whether it is possible to reduce the dose and rate of contrast material injection in elderly patients in triple-phase contrast-enhanced CT of the pancreatobiliary region with an MDCT scanner. SUBJECTS AND METHODS: One hundred twelve patients were divided into three groups: contrast injection at 0.08 mL/kg body weight/s (an upper limit of 5 mL/s) over 30 seconds in patients 60 years old or younger (group 1, n = 49), the same contrast injection as group 1 in patients more than 60 years old (group 2, n = 32), and contrast injection at 0.07 mL/kg body weight/s (an upper limit of 4.5 mL/s) over 30 seconds in patients more than 60 years old (group 3, n = 31). Contrast enhancement in the aorta, portal venous system, pancreas, and liver was assessed quantitatively. Two radiologists blinded to the patients' clinical information and the injection protocol used to acquire the CT images graded the degree of contrast enhancement using a 5-point scoring system. The results for the different groups were statistically compared. RESULTS: Contrast enhancement in the main phases for all organs was significantly more intense in group 2 than in groups 1 and 3. Cases in which pancreatic enhancement in the pancreatic phase was graded as excessive were more frequently observed in group 2. No statistically significant differences were observed between groups 1 and 3 in either quantitative or visual assessment for enhancement of any organ in any phase. CONCLUSION: We recommend reducing the dose and rate of contrast material injection by at least 10% for elderly patients undergoing MDCT examination of the pancreatobiliary region.

Application of subsecond rotation scan to helical CT for lung cancer screening.

PURPOSE: To clarify whether the benefit of a reduced effective scan width obtained using a smaller pitch outweighs the disadvantage of increased noise in the application of a subsecond helical CT to mass screenings for lung cancer. MATERIALS AND METHODS: Twenty-two helical CT scans of the lung were obtained in 11 healthy subjects using the following parameters: 1) scan 1 was performed at 120 kVp, 50 mA, 10-mm collimation, 1-second/rotation, helical pitch of 2.0; and 2) scan 2 was performed at 120 kVp, 50 mA, 10-mm collimation, 0.75-second/rotation, helical pitch of 1.5. Computer-generated nodules measuring 10 mm and 6 mm in diameter showing ground-glass opacity were superimposed on these images. The detectability of each nodule was evaluated by six blinded readers using ROC analysis. RESULTS: Detectability of the 6-mm nodules was significantly higher in scan 2 than in scan 1. Detectability of the 10-mm nodules was not significantly different between scans 1 and 2. CONCLUSION: The use of a smaller pitch by employing a subsecond rotation scan in a helical CT for lung cancer screenings improves the detection of small lesions without increasing either the scanning time or radiation dose.

Transhepatic portal venous angioplasty with stenting for bleeding jejunal varices.

A 54-year-old woman, who had undergone pancreatoduodenectomy with resection of the portal vein and intraoperative radiation therapy for cancer of the lower bile duct 16 months before, visited our institution complaining of melena. To identify the cause of bleeding and severe anemia, we performed gastrointestinal endoscopy but could detect no obvious source. The portal phase of the superior mesenteric arteriography and percutaneous transhepatic portography revealed severe stenosis of the extrahepatic portal vein, which corresponded to the end-to-end anastomosis of the portal vein, and hepatofugal collaterals. Extravasations into the afferent loop of the jejunum were detected only with portography. These findings suggested that portal hypertension due to extrahepatic portal obstruction led to bleeding varices. Subsequent to percutaneous transhepatic portography, we dilated the stenosis of the extrahepatic portal vein using a balloon catheter and placed an expandable metallic stent there. Portography after the treatment revealed the disappearance of the hepatofugal flow to collaterals and extravasations, and the patient has had no further episodes of gastrointestinal bleeding since. In conclusion, for patients with bleeding varices due to extrahepatic portal obstruction, especially after abdominal surgery, percutaneous transhepatic angioplasty is considered to be the treatment of choice because of its efficiency and minimal invasiveness.

Multiphase contrast-enhanced CT of the liver with a multislice CT scanner: effects of iodine concentration and delivery rate.

PURPOSE: To determine whether or not high-concentration contrast material is useful in multiphase contrast-enhanced CT of the liver with a multislice CT scanner. MATERIALS AND METHODS: One hundred twenty-four examinations, in which first- and second-pass acquisitions (double arterial phase imaging) were performed during a single breath-hold followed by third-pass acquisition, were randomized into three protocols: contrast injection at 0.07 mL/kg body weight/sec over 30 sec at an iodine concentration of 300 mgI/mL in group 1, contrast injection at 0.06 mL/kg body weight/sec over 30 sec at an iodine concentration of 350 mgI/mL in group 2, and contrast injection at 0.07 mL/kg body weight/sec over 25.7 sec at an iodine concentration of 350 mgI/mL in group 3. Each group received an equivalent iodine dose per kg body weight (2.1 mL/kg of contrast material of 300 mgI/mL). Contrast enhancement in each acquisition was measured in the aorta, portal vein, and liver. RESULTS: No statistically significant differences were seen between groups 1 and 2 in any enhancement in any acquisition. In group 3, aortic enhancement in the first-pass acquisition was significantly more intense than in groups 1 and 2, while portal venous enhancement and hepatic enhancement were equivalent. CONCLUSION: Shortening the injection duration for a given iodine dose with high-concentration contrast material (group 3) can achieve improved arterial enhancement on arterial phase images.

Three-phase CT examination of the pancreatobiliary region using multislice CT with 1-mm collimation.

PURPOSE: To evaluate the degree of contrast enhancement and accuracy of imaging of the circulatory phase in the first-pass, second-pass, and third-pass acquisitions in the pancreato-biliary region with 1-mm collimation obtained by multislice computed tomography (CT). MATERIALS AND METHODS: In 53 patients, two sequential acquisitions from the porta hepatis to the pancreas were performed during a single breath-hold, followed by a third-pass acquisition including the liver beginning 15 sec after the second-pass acquisition. Contrast enhancement in each acquisition was measured in the aorta, portal vein and its branches, and pancreas. Four experienced radiologists graded using four-point scoring whether or not each acquisition was appropriate for imaging of the arterial phase, pancreatic phase, and portal venous phase. RESULTS: Aortic enhancement was highest at the beginning of the second-pass acquisition. The portal and splenic veins and pancreas showed maximum enhancement in the second-pass acquisition, while the superior mesenteric vein showed maximum enhancement in the third-pass acquisition. In the visual assessment, significantly higher grades were achieved in the first-pass, second-pass, and third-pass acquisitions with regard to imaging of the arterial phase, pancreatic phase, and portal venous phase, respectively. CONCLUSION: Multislice CT permits the acquisition of three distinct circulatory phases (arterial, pancreatic, and portal venous phases) in the pancreatobiliary region with 1-mm collimation.

Uterine artery embolization by use of porous gelatin particles for symptomatic uterine leiomyomas: comparison with hand-cut gelatin sponge particles.

PURPOSE: To evaluate the results of uterine artery embolization (UAE) for symptomatic uterine leiomyoma by use of porous gelatin particles (PGP) in comparison with conventional hand-cut gelatin sponge particles. MATERIALS AND METHODS: One hundred and fifteen consecutive patients who had undergone UAE were retrospectively assessed. The first 64 patients were treated with hand-cut gelatin sponge and the last 51 with PGP. Extent of infarction, volume reduction of the dominant leiomyoma on magnetic resonance (MR) imaging, and change in symptoms were assessed. RESULTS: UAE was successfully performed for all patients. No major complications were observed. MR images one month after UAE showed that the mean extent of infarction of the dominant leiomyoma was 97 % for patients treated with PGP and 96 % for those treated with hand-cut gelatin sponge. Volume reductions of the dominant leiomyoma after 3, 6, 12, and 24 months were, respectively, 45, 56, 62, and 66 % for use of PGP and 45, 57, 63, and 68 % for use of hand-cut gelatin sponge. Symptoms including heavy menstrual bleeding, heavy menstrual pain, and abdominal heaviness had improved by 95-100 % at 12 months. There was no difference between the two groups. CONCLUSION: UAE with PGP is safe, and as effective as conventional gelatin sponge particles.

Evaluation of abdominal aortic aneurysm for endovascular stent-grafting with volume-rendered CT images of vessel lumen and thrombus.

PURPOSE: To evaluate the accuracy of CT images of abdominal aortic aneurysm (AAA) with volume-rendered (VR) display of vessel lumen and thrombus and to evaluate its usefulness in the planning of stent-grafting. MATERIALS AND METHODS: Helical CT was performed in 11 patients with AAA. Volume data of the vessel lumen and thrombus were separately extracted, and the VR images were reconstructed. Vessel measurements were made by five radiologists and compared with the axial and multiplanar reconstruction (MPR) images. Angiography and intravascular ultrasonography were used as standard references. The relations of aneurysmal sac to the major arterial branches and the subjective overall diagnostic value were evaluated by using a continuous rating scale. RESULTS: Accuracy of measurements was higher on VR images than on axial/MPR in 7 of 13 regions. Interobserver variance of VR images was smaller in 7 of 14 regions. Detection of renal and internal iliac artery involvements was better on VR images (p<0.05). Overall diagnostic value was also higher on VR images (p<0.05). CONCLUSION: VR CT images of vessel lumen and thrombus are supportive of and supplementary to conventional axial/MPR images in planning stent-grafting for AAA.

[Chemoradiation using 5-fluorouracil (5-FU) and nedaplatin (NDP) for gynecological malignancy--the relation between hemotoxicity and sequence of 5-FU and NDP].

We compared sequence-dependent schedules of 5-fluorouracil (5-FU) and nedaplatin (NDP) for hemotoxicity in genecological malignancy (GM). The safety of schedules using 5-FU before/after NDP combined radiotherapy in 8 patients with GM was evaluated. They received either 5-FU 700 mg/m2 i.v. continuous infusion on days (D) 1-4 + NDP 100 mg/m2 i.v. bolus on D1 (group A: 5 pts), or NDP on D4, 5-FU on D1-4 (group B: pts). In group A, 4 patients received a reduced dose of NDP because of less than 60 ml/min of creatinine clearance. In group A, WBC (2 pts), hemoglobin (3 pts), and platelet (1 pts) were grade 3 or higher. In group B, grade 3 or higher in hemotoxicity was not seen. A higher percentage of hemotoxicity was seen in group A compared with group B.

Ethanolamine oleate sclerotherapy combined with transarterial embolization using n-butyl cyanoacrylate for extracranial arteriovenous malformations.

PURPOSE: This study was designed to assess the safety and effectiveness of ethanolamine oleate (EO) sclerotherapy combined with transarterial embolization using a liquid adhesive agent (n-butyl cyanoacrylate, NBCA) for treatment of extracranial arteriovenous malformations (AVMs). METHODS: Twenty-four patients with symptomatic AVMs in the head and neck (n = 15), extremity (n = 5), and trunk (n = 4) with a mean age of 44 years (range, 18-78) treated with EO sclerotherapy were retrospectively assessed. AVMs were classified according to the angiographic morphology of the nidus. There were 7 type II (arteriolovenous fistulae), 6 type IIIa (arteriolovenulous fistulae with nondilated fistula), and 11 type IIIb (arteriolovenulous fistulae with dilated fistula). Transarterial embolization using NBCA was performed to reduce arterial flow before sclerotherapy. EO mixed with contrast material was delivered by percutaneous direct puncture or by catheterization into the draining vein under balloon occlusion. RESULTS: Three (13%) of 24 patients were cured, 17 (71%) had partial remission, and 4 (16%) no remission. Treatment was considered effective (cure and partial remission) in 20 patients (83%). Four patients (16%) experienced transient minor complications, including self-healing skin ulcer (n = 3) and localized deep venous thrombosis (n = 1). There were no major complications. CONCLUSIONS: EO sclerotherapy combined with transarterial embolization using NBCA is safe and effective for treating extracranial AVMs with an acceptable risk of minor complications.