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OBJECTIVES: Visualization of the bone distribution is an important prerequisite for MRI-guided high-intensity focused ultrasound (MRI-HIFU) treatment planning of bone metastases. In this context, we evaluated MRI-based synthetic CT (sCT) imaging for the visualization of cortical bone. METHODS: MR and CT images of nine patients with pelvic and femoral metastases were retrospectively analyzed in this study. The metastatic lesions were osteolytic, osteoblastic or mixed. sCT were generated from pre-treatment or treatment MR images using a UNet-like neural network. sCT was qualitatively and quantitatively compared to CT in the bone (pelvis or femur) containing the metastasis and in a region of interest placed on the metastasis itself, through mean absolute difference (MAD), mean difference (MD), Dice similarity coefficient (DSC), and root mean square surface distance (RMSD). RESULTS: The dataset consisted of 3 osteolytic, 4 osteoblastic and 2 mixed metastases. For most patients, the general morphology of the bone was well represented in the sCT images and osteolytic, osteoblastic and mixed lesions could be discriminated. Despite an average timespan between MR and CT acquisitions of 61 days, in bone, the average (± standard deviation) MAD was 116 ± 26 HU, MD - 14 ± 66 HU, DSC 0.85 ± 0.05, and RMSD 2.05 ± 0.48 mm and, in the lesion, MAD was 132 ± 62 HU, MD - 31 ± 106 HU, DSC 0.75 ± 0.2, and RMSD 2.73 ± 2.28 mm. CONCLUSIONS: Synthetic CT images adequately depicted the cancellous and cortical bone distribution in the different lesion types, which shows its potential for MRI-HIFU treatment planning. KEY POINTS: ⢠Synthetic computed tomography was able to depict bone distribution in metastatic lesions. ⢠Synthetic computed tomography images intrinsically aligned with treatment MR images may have the potential to facilitate MR-HIFU treatment planning of bone metastases, by combining visualization of soft tissues and cancellous and cortical bone.
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Neoplasias Ósseas , Imageamento por Ressonância Magnética , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Estudos de Viabilidade , Fêmur/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Pelve , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: Endovascular procedures are conventionally conducted using two dimensional fluoroscopy. A new technology platform, Fiber Optic RealShape (FORS), has recently been introduced allowing real time, three dimensional visualisation of endovascular devices using fiberoptic technology. It functions as an add on to conventional fluoroscopy and may facilitate endovascular procedures. This first in human study assessed the feasibility of FORS in clinical practice. METHODS: A prospective cohort feasibility study was performed between July and December 2018. Patients undergoing (regular or complex) endovascular aortic repair (EVAR) or endovascular peripheral lesion repair (EVPLR) were recruited. FORS guidance was used exclusively during navigational tasks such as target vessel catheterisation or crossing of stenotic lesions. Three types of FORS enabled devices were available: a flexible guidewire, a Cobra-2 catheter, and a Berenstein catheter. Devices were chosen at the physician's discretion and could comprise any combination of FORS and non-FORS devices. The primary study endpoint was technical success of the navigational tasks using FORS enabled devices. Secondary study endpoints were user experience and fluoroscopy time. RESULTS: The study enrolled 22 patients: 14 EVAR and eight EVPLR patients. Owing to a technical issue during start up, the FORS system could not be used in one EVAR. The remaining 21 procedures proceeded without device or technology related complications and involved 66 navigational tasks. In 60 tasks (90.9%), technical success was achieved using at least one FORS enabled device. Users rated FORS based image guidance "better than standard guidance" in 16 of 21 and "equal to standard guidance" in five of 21 procedures. Fluoroscopy time ranged from 0.0 to 52.2 min. Several tasks were completed without or with only minimal X-ray use. CONCLUSION: Real time navigation using FORS technology is safe and feasible in abdominal and peripheral endovascular procedures. FORS has the potential to improve intra-operative image guidance. Comparative studies are needed to assess these benefits and potential radiation reduction.
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Aneurisma da Aorta Abdominal/cirurgia , Procedimentos Endovasculares/instrumentação , Tecnologia de Fibra Óptica , Aneurisma Ilíaco/cirurgia , Imageamento Tridimensional/instrumentação , Doenças Vasculares Periféricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Estudos de Viabilidade , Feminino , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/diagnóstico por imagem , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: Catheter directed thrombolysis (CDT) for acute arterial occlusions of the lower extremities is associated with a risk of major bleeding complications. Strict monitoring of vital functions is advised for timely adjustment or discontinuation of thrombolytic treatment. Nevertheless, current evidence on the optimal application of CDT and use of monitoring during CDT is limited. In this study the different standard operating procedures (SOPs) for CDT in Dutch hospitals were compared against a national guideline in a nationwide analysis. METHODS: SOPs, landmark studies, and national and international guidelines for CDT for acute lower extremity arterial occlusions were compared. The protocols of 34 Dutch medical centres where CDT is performed were assessed. Parameters included contraindications to CDT, co-administration of heparin, thrombolytic agent administration, angiographic control, and patient monitoring. RESULTS: Thirty-four SOPs were included, covering 94% of medical centres performing CDT in the Netherlands. None of the SOPs had identical contraindications and a strong divergence in relative and absolute grading was found. Heparin and urokinase dosages differed by a factor of five. In 18% of the SOPs heparin co-administration was not mentioned. Angiographic control varied between once every 6 h to once every 24 h. In 76% of the SOPs plasma fibrinogen levels were used for CDT dose adjustments. However, plasma fibrinogen level threshold values for treatment adjustments varied between 2.0 g/L and 0.5 g/L. CONCLUSION: The SOPs for CDT for acute arterial occlusions of the lower extremities differ greatly on five major operating aspects among medical centres in the Netherlands. None of the SOPs exactly conforms to current national or international guidelines. This study provides direction on how to increase homogeneity in guideline recommendations and to improve guideline adherence in CDT.
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Cateterismo Periférico/tendências , Disparidades em Assistência à Saúde/tendências , Hospitais/tendências , Doença Arterial Periférica/tratamento farmacológico , Padrões de Prática Médica/tendências , Terapia Trombolítica/tendências , Cateterismo Periférico/efeitos adversos , Tomada de Decisão Clínica , Fidelidade a Diretrizes/tendências , Humanos , Países Baixos/epidemiologia , Seleção de Pacientes , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Guias de Prática Clínica como Assunto , Medição de Risco , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do TratamentoAssuntos
Fístula Biliar , Fístula Brônquica , Embucrilato , Humanos , Embucrilato/uso terapêutico , Colangiografia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/terapia , Endoscopia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/terapia , Colangiopancreatografia Retrógrada EndoscópicaAssuntos
Fístula Biliar , Fístula Brônquica , Embucrilato , Humanos , Embucrilato/uso terapêutico , Colangiografia , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/etiologia , Fístula Biliar/terapia , Endoscopia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/etiologia , Fístula Brônquica/terapia , Colangiopancreatografia Retrógrada EndoscópicaRESUMO
Vascular Ehlers-Danlos Syndrome (vEDS) is caused by heterozygous mutations in COL3A1 and is characterized by fragile vasculature and hollow organs, with a high risk of catastrophic events at a young age. During pregnancy and delivery, maternal mortality rates up until 25% have been reported. However, recent pedigree analysis reported a substantial lower pregnancy-related mortality rate of 4.9%. Here, we describe an extended vEDS family with multiple uneventful pregnancy outcomes. In the proband, a 37-year-old woman, DNA-analysis because of an asymptomatic iliac artery dissection revealed a pathogenic mutation in COL3A1 (c.980G>A; p. Gly327Asp). She had had three uneventful vaginal deliveries. At the time of diagnosis, her 33-year-old niece was 25 weeks pregnant. She had had one uneventful vaginal delivery. Targeted DNA-analysis revealed that she was carrier of the COL3A1 mutation. Ultrasound detected an aneurysm in the abdominal aorta with likely a dissection. An uneventful elective cesarean section was performed at a gestational age of 37 weeks. The 40-year-old sister of our proband had had one uneventful vaginal delivery and an active pregnancy wish. Cascade DNA-screening showed her to carry the COL3A1 mutation. Computed Tomography Angiography (CTA) of her aorta revealed a type B dissection with the most proximal entry tear just below the superior mesenteric artery. Pregnancy was therefore discouraged. This familial case illustrates the complexity and challenges of reproductive decision-making in a potentially lethal condition as vEDS, and highlights the importance of a multidisciplinary approach. Moreover, it suggests that previous pregnancy-related risks of vEDS may be overestimated. © 2016 Wiley Periodicals, Inc.
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Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/genética , Fenótipo , Complicações na Gravidez , Resultado da Gravidez , Adulto , Idoso , Tomada de Decisão Clínica , Colágeno Tipo III/genética , Gerenciamento Clínico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mutação , Linhagem , GravidezRESUMO
BACKGROUND: The clinical dilemma in suspected aortic graft infection (AGI) is how to noninvasively obtain a reliable proof of infection. In addition to confirming the presence of infection, obtaining information regarding the extent of infection to select a proper strategy for reoperation is also necessary. Therefore, developing a more reliable noninvasive physiologic approach to detect infected prostheses is required. (18)F-fluorodeoxyglucose positron emission tomography scanning ((18)F-FDG PET) has been suggested to have a pivotal role in the detection of AGI. In this study, we assessed the contribution of two (semi) quantitative parameters-maximal standardized uptake value (SUVmax) and tissue-to-background ratio (TBR)-and of two visual parameters-fluorodeoxyglucose (FDG) distribution patterns and visual grading scale-in the final confirmation of the diagnosis of AGI. METHODS: Patients with a central aortic prosthetic graft and symptoms clinically suggestive of AGI were gathered from a prospectively maintained database. Included were those who underwent (18)F-FDG PET scanning combined with computed tomography angiography and in whom periprosthetic samples were taken at some stage in the diagnostic process. AGI was considered proven in case of a positive culture and compared with a group with negative cultures. Positive predictive values (PPVs) and negative predictive values (NPVs) were calculated. Receiver operating characteristics curves were used to assess the ability of SUVmax and TBR to identify the presence and absence of AGI (ie, accuracy). RESULTS: In 37 of 77 patients with suspected AGI, (18)FDG-PET and perigraft material for culturing was obtained. The tissue culture was positive in 21 of these 37 patients (56.7%). Mean ± standard deviation SUVmax for proven infection was 8.1 ± 3.7 (range, 3.6-18.5) and TBR was 5.9 ± 2.7 (range, 1.7-13.0). The area under the curve for SUVmax was 0.78 (95% confidence interval, 0.63-0.93). A cutoff value of 8 yielded a PPV of 80% and a NPV of 54%. The area under the curve for TBR was 0.70 (95% confidence interval, 0.52-0.87). A cutoff value of 6 yielded a PPV of 73% and NPV of 52%. The PPVs for the visual grading scale and (18)F-FDG distribution patterns were 75% and 61%, respectively; the NPVs were 77% and 67%, respectively. CONCLUSIONS: Our study, performed in a small sample of patients suspected of AGI, showed that the diagnostic abilities of quantitative and visual (18)F-FDG PET parameters are modest.
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Aorta/diagnóstico por imagem , Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Idoso , Idoso de 80 Anos ou mais , Aorta/microbiologia , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Bases de Dados Factuais , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/microbiologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To analyze the movement of the aorta in the craniocaudal direction (through-plane movement) during the cardiac cycle at several levels to determine any potential impact on endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS: For this study, 30 patients (median age 73.0 years; 27 men) with an infrarenal AAA were randomly selected from a prospectively maintained EVAR database. All patients had undergone preoperative electrocardiogram-gated computed tomography angiography consisting of 8 phases. After semiautomatic segmentation, a 3-dimensional location probe was placed in the center of the aorta (center point) on the orthogonal slices at 12 different levels along the aorta and iliac arteries for all 8 phases. Movement of the center point during the cardiac cycle was analyzed for each level. Values are given as the median and interquartile range (IQR). RESULTS: The median through-plane movement of all levels was 3.0 mm (IQR 2.8-3.2) and appeared to be lower in the region of the celiac and renal arteries: 2.6 mm (IQR 1.7-3.1) at 3 cm proximal to the most distal renal artery and 2.4 mm (IQR 1.9-2.9) at 1 cm distal to the most distal renal artery, respectively. The thoracic part of the aorta showed the largest through-plane motion: 4.1 mm (IQR 2.7-4.6). CONCLUSION: This study quantifies aortic through-plane motion in the craniocaudal direction. Since through-plane movement appears to be limited, findings of previous studies investigating pulsatile in-plane distension seem to be representative for aortic distension.
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Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aortografia/métodos , Tomografia Computadorizada Multidetectores , Idoso , Automação , Técnicas de Imagem de Sincronização Cardíaca , Meios de Contraste , Bases de Dados Factuais , Feminino , Humanos , Imageamento Tridimensional , Iohexol/análogos & derivados , Masculino , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por ComputadorRESUMO
PURPOSE: The purpose of this study was to compare multidetector-row computed tomography (MDCT) leaflet restriction measurements with fluoroscopy measurements in commonly used mechanical prosthetic heart valves (PHVs). METHODS: Four mechanical PHVs (ON-X, Carbomedics, St. Jude, and Medtronic Hall) were imaged in a pulsatile model using fluoroscopy and 64-detector-row computed tomography. Five image acquisitions of each PHV without (1) and with (4) restricted leaflet closure were made. Three observers measured closure angles on fluoroscopy and MDCT. Data were analyzed using intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: Interobserver agreement was high in restricted and non-restricted leaflets on both modalities (ICCs >0.995). MDCT and fluoroscopy showed high agreements (ICCs >0.989). Median MDCT closure angle measurements differed at most -2 to +2 degrees from fluoroscopy in the restricted and -1 to +2 degrees in the non-restricted leaflets. CONCLUSIONS: MDCT allows measurement of leaflet motion with a maximal median discrepancy of 2 degrees. Both MDCT and fluoroscopy detect restricted leaflet closure with great accuracy.
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Fluoroscopia/métodos , Próteses Valvulares Cardíacas , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/cirurgia , Tomografia Computadorizada Multidetectores/métodos , Imagens de Fantasmas , Análise de Falha de Equipamento/métodos , Fluoroscopia/instrumentação , Humanos , Tomografia Computadorizada Multidetectores/instrumentação , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Young healthy individuals have a large aortic pulsatile distension during the cardiac cycle. In patients with an abdominal aortic aneurysm (AAA), aortic distension during the cardiac cycle is associated with stent graft migration. However, whether the pulsatile distension is larger in relatively young patients with an AAA compared to older AAA patients is unknown. This study investigated whether preoperative pulsatile aneurysm neck distension is related to age. METHODS: From our database of endovascular aneurysm repair (EVAR), we selected 25 consecutive male patients ≤65 years of age (group 1) and 25 consecutive patients >65 years of age (group 2). All patients had a preoperative electrocardiogram-triggered computed tomography angiography scan consisting of 8 phases. Aortic area and diameter changes per heartbeat were measured at 2 levels: (A) 3 cm above and (B) 1 cm below the most distal renal artery. RESULTS: In group 1 compared to group 2, distension during the cardiac cycle at level A was 1.6 ± 0.4 versus 1.5 ± 0.4 mm (P = 0.62), and the aortic area increase was 45.4 ± 19.6 versus 41.7 ± 20.8 mm(2) (P = 0.52). Aortic distension at level B was 1.4 ± 0.3 versus 1.5 ± 0.4 mm (P = 0.79), and the area increase was 35.5 ± 12.0 versus 35.0 ± 15.5 mm(2) (P = 0.90). CONCLUSIONS: Preoperative pulsatile aneurysm neck distension did not differ between younger and older patients; therefore, we do not expect young patients to have more pulsatile distension-related complications after EVAR.
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Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/fisiopatologia , Fluxo Pulsátil , Fatores Etários , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aortografia/métodos , Implante de Prótese Vascular , Técnicas de Imagem de Sincronização Cardíaca , Eletrocardiografia , Procedimentos Endovasculares , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Valor Preditivo dos TestesRESUMO
INTRODUCTION: The risk of major bleeding complications in catheter directed thrombolysis (CDT) for acute limb ischemia (ALI) remains high, with reported major bleeding complication rates in up to 1 in every 10 treated patients. Fibrinogen was the only predictive marker used for bleeding complications in CDT, despite the lack of high quality evidence to support this. Therefore, recent international guidelines recommend against the use of fibrinogen during CDT. However, no alternative biomarkers exist to effectively predict CDT-related bleeding complications. The aim of the POCHET biobank is to prospectively assess the rate and etiology of bleeding complications during CDT and to provide a biobank of blood samples to investigate potential novel biomarkers to predict bleeding complications during CDT. METHODS: The POCHET biobank is a multicentre prospective biobank. After informed consent, all consecutive patients with lower extremity ALI eligible for CDT are included. All patients are treated according to a predefined standard operating procedure which is aligned in all participating centres. Baseline and follow-up data are collected. Prior to CDT and subsequently every six hours, venous blood samples are obtained and stored in the biobank for future analyses. The primary outcome is the occurrence of non-access related major bleeding complications, which is assessed by an independent adjudication committee. Secondary outcomes are non-major bleeding complications and other CDT related complications. Proposed biomarkers to be investigated include fibrinogen, to end the debate on its usefulness, anti-plasmin and D-Dimer. DISCUSSION AND CONCLUSION: The POCHET biobank provides contemporary data and outcomes of patients during CDT for ALI, coupled with their blood samples taken prior and during CDT. Thereby, the POCHET biobank is a real world monitor on biomarkers during CDT, supporting a broad spectrum of future research for the identification of patients at high risk for bleeding complications during CDT and to identify new biomarkers to enhance safety in CDT treatment.
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Hemorragia , Terapia Trombolítica , Humanos , Hemorragia/etiologia , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Estudos Prospectivos , Biomarcadores/sangue , Masculino , Feminino , Fibrinogênio/metabolismo , Fibrinogênio/análise , Doença Arterial Periférica/tratamento farmacológico , Doença Arterial Periférica/sangue , Idoso , Arteriopatias Oclusivas/tratamento farmacológico , Arteriopatias Oclusivas/sangue , Pessoa de Meia-IdadeRESUMO
PURPOSE: Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic-arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. MATERIALS AND METHODS: In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. RESULTS: 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p < 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). CONCLUSIONS: In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications.
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PURPOSE: To compare different techniques for positive contrast imaging of susceptibility markers with MRI for three-dimensional visualization. As several different techniques have been reported, the choice of the suitable method depends on its properties with regard to the amount of positive contrast and the desired background suppression, as well as other imaging constraints needed for a specific application. MATERIALS AND METHODS: Six different positive contrast techniques are investigated for their ability to image at 3 Tesla a single susceptibility marker in vitro. The white marker method (WM), susceptibility gradient mapping (SGM), inversion recovery with on-resonant water suppression (IRON), frequency selective excitation (FSX), fast low flip-angle positive contrast SSFP (FLAPS), and iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) were implemented and investigated. RESULTS: The different methods were compared with respect to the volume of positive contrast, the product of volume and signal intensity, imaging time, and the level of background suppression. Quantitative results are provided, and strengths and weaknesses of the different approaches are discussed. CONCLUSION: The appropriate choice of positive contrast imaging technique depends on the desired level of background suppression, acquisition speed, and robustness against artifacts, for which in vitro comparative data are now available.
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Algoritmos , Encéfalo/anatomia & histologia , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Humanos , Imageamento por Ressonância Magnética/instrumentação , Imagens de Fantasmas , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: We present a technique that combines Hepatic Arteriography with C-arm CT-Guided Ablation (HepACAGA) to improve tumor visualization, navigation and margin confirmation for percutaneous ablation of liver tumors. MATERIALS AND METHODS: All consecutive patients scheduled for HepACAGA between April 20th, 2021, and November 2nd, 2021, were included in this retrospective, cohort study. HepACAGA was performed in an angiography-suite under general anesthesia. The hepatic artery was catheterized for selective contrast injection. C-arm CT and guidance software were then used to visualize the tumor and the microwave antenna was inserted during apnea. Pre- and post-ablation C-arm CTs were performed and ablation margins assessed. Technical success, antenna placement deviation, number of repositions, tumor recurrence, and safety were evaluated. Technical success was defined as a tumor that was ablated according to the HepACAGA technique. RESULTS: A total of 21 patients (28 tumors) were included. The main tumor type was colorectal cancer liver metastases (11/21, 52%), followed by hepatocellular carcinoma (7/21, 33%), neuroendocrine tumor metastases (1/21, 5%), and other tumor types (2/21, 10%). The technical success rate was 93% (26/28 tumors) with two small hypovascular lesions unable to be identified. A single microwave antenna was used in all patients. The median antenna placement deviation was 1 mm (range 0-6 mm). At a median follow-up time of 16 months (range 5-22 months), there was no tumor recurrence in any patient. Safety analysis showed a complication rate of 5% grade 2 and 5% grade 3. CONCLUSION: HepACAGA was demonstrated to be a safe and effective percutaneous ablation technique, without any local tumor recurrence in this study.
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OBJECTIVE: During endovascular abdominal aortic aneurysm repair (EVAR), blood is trapped in the aneurysm sac at the moment the endograft is deployed. It is generally assumed that this blood will coagulate and evolve into an organized thrombus. It is unknown whether this process always occurs, what its time span is, and how it influences aneurysm shrinkage. With magnetic resonance imaging (MRI), quantitative analysis of the aneurysm sac is possible in terms of endoleak volume as well as unorganized thrombus volume and organized thrombus volume. We investigated the presence of unorganized thrombus in nonshrinking aneurysms years after EVAR. METHODS: Fourteen patients with a nonshrinking aneurysm without endoleak on computed tomography/computed tomography angiography underwent MRI with a blood pool agent (gadofosveset trisodium). Precontrast T1-, precontrast T2-, and postcontrast T1-weighted images (3 and 30 minutes after injection) were acquired and evaluated for the presence of endoleak. The aneurysm sac was segmented into endoleak, unorganized thrombus, and organized thrombus by interactively thresholding the differently weighted images. The classification was visualized in real-time as a color overlay on the MR images. The volumes of endoleak, unorganized thrombus, and organized thrombus were calculated. RESULTS: Median time after EVAR was 2 years (range, 1-8.2 years). The average aneurysm sac volume of the patients was 167 ± 107 mL (mean ± standard deviation). Nine patients had an endoleak on the postcontrast T1-w images 30 minutes after injection. On average, the aneurysm sac contained 78 ± 61 mL unorganized thrombus, which corresponded to 51 ± 21 volume-percentage, irrespective of the presence of an endoleak on the blood pool agent enhanced MRI images (independent t-test, P = .8). CONCLUSIONS: In our study group, half of the nonshrinking aneurysm sac contents consisted of unorganized thrombus years after EVAR.
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Aneurisma da Aorta Abdominal/patologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Trombose/patologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/complicações , Prótese Vascular , Estudos de Coortes , Meios de Contraste , Endoleak/etiologia , Endoleak/patologia , Feminino , Gadolínio , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos , Trombose/etiologia , Fatores de TempoRESUMO
BACKGROUND: We sought to investigate the relationship between infarct and dyssynchrony post- myocardial infarct (MI), in a porcine model. Mechanical dyssynchrony post-MI is associated with left ventricular (LV) remodeling and increased mortality. METHODS: Cine, gadolinium-contrast, and tagged cardiovascular magnetic resonance (CMR) were performed pre-MI, 9 ± 2 days (early post-MI), and 33 ± 10 days (late post-MI) post-MI in 6 pigs to characterize cardiac morphology, location and extent of MI, and regional mechanics. LV mechanics were assessed by circumferential strain (eC). Electro-anatomic mapping (EAM) was performed within 24 hrs of CMR and prior to sacrifice. RESULTS: Mean infarct size was 21 ± 4% of LV volume with evidence of post-MI remodeling. Global eC significantly decreased post MI (-27 ± 1.6% vs. -18 ± 2.5% (early) and -17 ± 2.7% (late), p < 0.0001) with no significant change in peri-MI and MI segments between early and late time-points. Time to peak strain (TTP) was significantly longer in MI, compared to normal and peri-MI segments, both early (440 ± 40 ms vs. 329 ± 40 ms and 332 ± 36 ms, respectively; p = 0.0002) and late post-MI (442 ± 63 ms vs. 321 ± 40 ms and 355 ± 61 ms, respectively; p = 0.012). The standard deviation of TTP in 16 segments (SD16) significantly increased post-MI: 28 ± 7 ms to 50 ± 10 ms (early, p = 0.012) to 54 ± 19 ms (late, p = 0.004), with no change between early and late post-MI time-points (p = 0.56). TTP was not related to reduction of segmental contractility. EAM revealed late electrical activation and greatly diminished conduction velocity in the infarct (5.7 ± 2.4 cm/s), when compared to peri-infarct (18.7 ± 10.3 cm/s) and remote myocardium (39 ± 20.5 cm/s). CONCLUSIONS: Mechanical dyssynchrony occurs early after MI and is the result of delayed electrical and mechanical activation in the infarct.
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Imagem Cinética por Ressonância Magnética , Contração Miocárdica , Infarto do Miocárdio/complicações , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda , Remodelação Ventricular , Animais , Fenômenos Biomecânicos , Meios de Contraste , Modelos Animais de Doenças , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Miocárdio/patologia , Suínos , Fatores de Tempo , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia , Imagens com Corantes Sensíveis à VoltagemRESUMO
Intravenous 177Lu-high-affinity (HA)-DOTATATE has shown promising results for the treatment of surgery- and radiotherapy-refractory meningiomas. We aimed to investigate the added value of intraarterial administration. Methods: Patients underwent at least 1 intravenous 177Lu-HA-DOTATATE treatment first and subsequent intraarterial cycles. Inpatient and intrapatient comparison was based on posttreatment 177Lu-HA-DOTATATE imaging 24 h after injection. The technical success rate and adverse events were recorded. Results: Four patients provided informed consent. The technical success rate was 100%, and no angiography-related or unexpected adverse events occurred. Intrapatient comparison showed an increased target lesion accumulation on both planar imaging (mean, +220%) and SPECT/CT (mean, +398%) after intraarterial administration, compared with intravenous administration. No unexpected adverse events occurred during follow-up. Conclusion: Intraarterial peptide receptor radionuclide therapy significantly increases tracer accumulation and is a safe and promising improvement for salvage meningioma patients. Future prospective studies on intraarterial peptide receptor radionuclide therapy are needed to determine the gain in efficacy and survival.
Assuntos
Neoplasias Meníngeas , Meningioma , Tumores Neuroendócrinos , Compostos Organometálicos , Radioisótopos de Gálio , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/radioterapia , Meningioma/diagnóstico por imagem , Meningioma/radioterapia , Tumores Neuroendócrinos/patologia , Octreotida/efeitos adversos , Compostos Organometálicos/uso terapêutico , Tomografia por Emissão de Pósitrons , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Receptores de PeptídeosRESUMO
Background: It remains unclear whether revascularization of moyamoya vasculopathy (MMV) has a positive effect on cognitive function. In this prospective, single-center study, we investigated the effect of revascularization on cognitive function in patients with MMV. We report clinical and radiological outcome parameters and the associations between clinical determinants and change in neurocognitive functioning. Methods: We consecutively included all MMV patients at a Dutch tertiary referral hospital who underwent pre- and postoperative standardized neuropsychological evaluation, [15O]H2O-PET (including cerebrovascular reactivity (CVR)), MRI, cerebral angiography, and completed standardized questionnaires on clinical outcome and quality of life (QOL). To explore the association between patient characteristics, imaging findings, and change in the z-scores of the cognitive domains, we used multivariable linear- and Bayesian regression analysis. Results: We included 40 patients of whom 35 (27 females, 21 children) were treated surgically. One patient died after surgery, and two withdrew from the study. TIA- and headache frequency and modified Rankin scale (mRS) improved (resp. p = 0.001, 0.019, 0.039). Eleven patients (seven children) developed a new infarct during follow-up (31%), five of which were symptomatic. CVR-scores improved significantly (p < 0.0005). The language domain improved (p = 0.029); other domains remained stable. In adults, there was an improvement in QOL. We could not find an association between change in imaging and cognitive scores. Conclusion: In this cohort of Western MMV patients, TIA frequency, headache, CVR, and mRS improved significantly after revascularization. The language domain significantly improved, while others remained stable. We could not find an association between changes in CVR and cognitive scores.
RESUMO
With increasing interest in home dialysis, there is a need for a translational uremic large animal model to evaluate technical innovations in peritoneal dialysis (PD). To this end, we developed a porcine model with kidney failure. Stable chronic kidney injury was induced by bilateral subtotal renal artery embolization. Before applying PD, temporary aggravation of uremia was induced by administration of gentamicin (10 mg/kg i.v. twice daily for 7 days), to obtain uremic solute levels within the range of those of dialysis patients. Peritoneal transport was assessed using a standard peritoneal permeability assessment (SPA). After embolization, urea and creatinine concentrations transiently increased from 1.6 ± 0.3 to 7.5 ± 1.2 mM and from 103 ± 14 to 338 ± 67 µM, respectively, followed by stabilization within 1-2 weeks to 2.5 ± 1.1 mM and 174 ± 28 µM, respectively. Gentamicin induced temporary acute-on-chronic kidney injury with peak urea and creatinine concentrations of 16.7 ± 5.3 mM and 932 ± 470 µM respectively. PD was successfully applied, although frequently complicated by peritonitis. SPA showed a low transport status (D/P creatinine at 4 h of 0.41 (0.36-0.53)) with a mass transfer area coefficient of 9.6 ± 3.1, 4.6 ± 2.6, 3.4 ± 2.3 mL/min for urea, creatinine, and phosphate respectively. In conclusion, this porcine model with on-demand aggravation of uremia is suitable for PD albeit with peritoneal transport characterized by a low transport status.
Assuntos
Diálise Peritoneal , Uremia , Animais , Creatinina , Soluções para Diálise , Gentamicinas , Diálise Peritoneal/efeitos adversos , Fosfatos , Suínos , Ureia , Uremia/terapiaRESUMO
PURPOSE: To evaluate the pulsatility of the iliac arteries and compare their distension at several levels that might influence preoperative stent-graft sizing and the long-term durability of stent-graft sealing and fixation. METHODS: Preoperative dynamic computed tomographic angiography (CTA) scans of 30 patients (24 men; median age 75 years, range 60-85) with an abdominal aortic aneurysm and patent iliac arteries were included. The CTAs consisted of 8 images per heartbeat. Bilateral diameter and area changes per heartbeat were measured semi-automatically in the common iliac artery (CIA) at 3 levels: (A) 0.5 cm after the aortic bifurcation, (B) in the middle of the CIA, and (C) 0.5 cm proximal to the iliac bifurcation. Pulsatility was defined as the largest difference in area and average diameter change over 180 axes per heartbeat. Pulsatility at the 3 levels was compared, and the intraobserver variability of the method was calculated according to Bland and Altman. RESULTS: The mean area increases in the CIAs at levels A, B, and C were 12.5% (16.3 mm²), 11.2% (13.6 mm²), and 9.6% (12.6 mm²), respectively, and the mean iliac diameter increases were 9.2% (1.1 mm), 8.5% (1.0 mm), and 8.1% (1.0 mm). The iliac distension was statistically significant at all levels. The iliac distension at level A was statistically significantly larger than the distension at level C. The intraobserver variability was 13.3 mm² for area and 0.6 mm for diameter measurements. CONCLUSION: The pulsatility in the iliac arteries is statistically significant at several levels relevant to endovascular aneurysm repair. The distension of the iliac artery possibly decreases more distally, which might encourage the extension of stent-grafts to the internal iliac artery.