First experience of combined cardiac PET/64-detector CT angiography with invasive angiographic validation.

PURPOSE: Despite modern CT systems and expert evaluators, the diagnostic performance of coronary CT angiography is limited by overestimation of vessel stenosis which reduces the positive predictive value (PPV) of the test. The aim of this study was to evaluate the performance of combined cardiac PET/64-detector CT angiography. METHODS: Included in this retrospective study were 33 consecutive patients (5 women, 28 men; mean age 61.6 years, range 47-87 years, mean BMI 27.3+/-5.2 kg/m(2)) with clinically suspected flow-limiting coronary artery disease who underwent combined cardiac PET/64-detector CT angiography and invasive angiography. Combined PET/CT images were reported by an experienced dual-accredited radiologist/nuclear physician. An experienced cardiac CT radiologist re-read the CT images without PET. Stenotic disease was defined as >50% vessel narrowing. Invasive coronary angiography was used as a reference standard. Local ethics committee approval and patient consent were obtained. RESULTS: CT angiography (without PET data) was concordant with invasive angiography in 31/33 patients and at a patient level, the sensitivity in detecting significant coronary artery lesions was 100%, the specificity was 82%, the PPV was 92% and the negative predictive value (NPV) was 100%. Using combined PET/CT angiography the findings were concordant with invasive angiography in 32/33 patients and at a patient level, the sensitivity was 96%, the specificity was 100%, the PPV was 100% and the NPV was 91%. CONCLUSION: The use of integrated cardiac PET/64-detector CT angiography is feasible and appears to improve some aspects of the diagnostic performance of 64-detector coronary artery angiography in detecting coronary artery disease.

Trans-arterial embolisation (TAE) in haemorrhagic pelvic injury: review of management and mid-term outcome of a major trauma centre.

BACKGROUND: Management of pelvic fracture associated haemorrhage is often complex with high morbidity and mortality rates. Different treatment options are used to control bleeding with an on-going discussion in the trauma community regarding the best management algorithm. MAIN BODY: Recent studies have shown trans-arterial embolisation (TAE) to be a safe and effective technique to control pelvic fracture associated haemorrhage. Computed tomography (CT) evidence of active bleeding, haemodynamic instability, and pelvic fracture patterns are amongst important indicators for TAE. CONCLUSION: Herein, we aim to provide a comprehensive literature review of the effectiveness of TAE in controlling haemorrhage secondary to pelvic fracture according to the indications, technique and embolic agents, and outcomes, whilst incorporating our Level 1 major trauma centre's (MTC) results between 2014-2017.

Early results with the use of heparin-bonded stent graft to rescue failed angioplasty of chronic femoropopliteal occlusive lesions: TASC D lesions have a poor outcome.

PURPOSE: To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome. METHODS: Heparin-bonded Viabahn stent grafts were placed in 33 limbs in 33 patients during 2009-2010. The stents were deployed to rescue failed conventional balloon angioplasty. Mean age was 69 (range 44-88) years, and 67 % (22 of 33) were men. Most procedures (21 of 33, 64 %) were performed for critical limb ischemia (33 % for rest pain, 30 % tissue loss). Kaplan-Meier plots and Cox regression analysis were used to identify significant risk factors. RESULTS: The average length of lesions treated was 25 ± 10 cm, and they were predominantly TASC (Transatlantic Intersociety Consensus) D (n = 13) and C (n = 17) lesions. The median primary patency was 5.0 months (95 % confidence interval 1.22-8.77). The mean secondary patency was 8.6 months (95 % confidence interval 6.82-10.42). Subsequently, 4 patients underwent bypass surgery and 5 patients underwent major amputation. One patient died. There were 5 in-stent or edge-stent stenoses. Cox multivariate regression analysis identified TASC D lesions to be a significant risk factor for early occlusion (p = 0.035). CONCLUSION: TASC D lesions of femoropopliteal occlusions have poor patency rates with the use of heparin-bonded stent grafts after failed conventional angioplasty. Alternative options should be considered for these patients.

How do patients perceive the benefits and risks of peripheral angioplasty? Implications for informed consent.

PURPOSE: To explore perceptions of benefits and risks of patients undergoing peripheral angioplasty and to investigate factors that modify them. MATERIALS AND METHODS: Two hundred patients undergoing peripheral angioplasty during a 12-month period (134 men and 66 women; mean age, 68.8 years; age range, 37-94 years) were interviewed by one interventional radiologist who asked 18 questions with regard to the risks and benefits of this procedure. The patients were randomly assigned into two groups of 100 patients. The first group answered questions with use of a recognized risk assessment chart. The other group answered without the aid. Depending on the referral pathway, patients received the institution's patient information sheet. RESULTS: Of the 200 patients, 178 (89%) thought that they would have at least a 75% (three in four) chance of benefiting from angioplasty. Eighty patients (40%) thought they would definitely benefit from angioplasty. One hundred one patients (50%) thought the test would be painful. Fifty-four patients (27%) thought there would be no radiation exposure. Forty-one patients (21%) realized there was a chance of needing emergency surgery. Sixty-seven patients (34%) thought the test was easier than anticipated. Previous peripheral angioplasty altered perceptions of benefit (P = .012), but not risk. The use of a risk assessment chart altered perceptions of benefit (P = .049). The use of a patient information sheet predicted (made more realistic) the patients' perceptions of risks (P = .012) and benefits (P = .001). CONCLUSIONS: Patients who undergo peripheral angiography tend to underestimate the risks and overestimate the benefits of peripheral angioplasty. The patient information sheet and risk assessment tool used in this study altered patient perceptions of risks and benefits of the procedure and, therefore, aid informed consent.

CT coronary angiography: quantitative assessment of myocardial perfusion using test bolus data-initial experience.

The aim of this study is to quantify myocardial perfusion during coronary CT angiography using data from a modified timing test-bolus acquisition. Institutional review board approval and informed consent were obtained. Nineteen patients with suspected coronary artery disease underwent combined coronary CT angiography and cardiac (82)Rubidium-PET perfusion. Prior to the CT angiogram a retrospectively ECG-gated dynamic test bolus was obtained following 25 mls of IV contrast medium injected at 5 ml/s. Images were acquired every 1.5 s for 30 s using 4 x 1.25-mm slices at 120 kV, 35 mAs. Regions of interest were drawn to delineate the myocardium and aorta on the resulting transaxial images. Time density curves were created and perfusion calculated using two simple approaches: maximum-slope method and peak method. In patients with normal PET myocardial perfusion, the mean (SD) resting myocardial perfusion estimated by CT using the maximum-slope method was 0.89 (+/-0.27) ml/min/g and 0.93 (+/-0.21) ml/min/g at end-systole and end-diastole, respectively, and 0.69 (+/-0.11) ml/min/g and 0.79 (+/-0.19) at end-systole and end-diastole, respectively, for the peak method. Thus quantification of myocardial perfusion from a routine coronary CT angiography test bolus is possible. CT-derived myocardial perfusion values are consistent with published values derived from other techniques.