Comparison of diagnostic performance of a deep learning algorithm, emergency physicians, junior radiologists and senior radiologists in the detection of appendicular fractures in children.

BACKGROUND: Advances have been made in the use of artificial intelligence (AI) in the field of diagnostic imaging, particularly in the detection of fractures on conventional radiographs. Studies looking at the detection of fractures in the pediatric population are few. The anatomical variations and evolution according to the child's age require specific studies of this population. Failure to diagnose fractures early in children may lead to serious consequences for growth. OBJECTIVE: To evaluate the performance of an AI algorithm based on deep neural networks toward detecting traumatic appendicular fractures in a pediatric population. To compare sensitivity, specificity, positive predictive value and negative predictive value of different readers and the AI algorithm. MATERIALS AND METHODS: This retrospective study conducted on 878 patients younger than 18 years of age evaluated conventional radiographs obtained after recent non-life-threatening trauma. All radiographs of the shoulder, arm, elbow, forearm, wrist, hand, leg, knee, ankle and foot were evaluated. The diagnostic performance of a consensus of radiology experts in pediatric imaging (reference standard) was compared with those of pediatric radiologists, emergency physicians, senior residents and junior residents. The predictions made by the AI algorithm and the annotations made by the different physicians were compared. RESULTS: The algorithm predicted 174 fractures out of 182, corresponding to a sensitivity of 95.6%, a specificity of 91.64% and a negative predictive value of 98.76%. The AI predictions were close to that of pediatric radiologists (sensitivity 98.35%) and that of senior residents (95.05%) and were above those of emergency physicians (81.87%) and junior residents (90.1%). The algorithm identified 3 (1.6%) fractures not initially seen by pediatric radiologists. CONCLUSION: This study suggests that deep learning algorithms can be useful in improving the detection of fractures in children.

Abdominal adipose tissue quantification and distribution with CT: prognostic value for surgical and oncological outcome in patients with rectal cancer.

OBJECTIVES: Obesity is a known factor of poor surgical and oncological outcomes in patients who undergo surgery for colorectal cancer. There are physiological differences between abdominal visceral and subcutaneous adipose tissue. Evaluation of its quantity and distribution is possible with routine clinical imaging techniques, such as computed tomography. The goal of this study was to explore the associations and find correlations of fat measurements and distribution with surgical morbidity, long-term mortality and disease progression in patients who underwent surgery for rectal cancer. METHODS: Patients who underwent rectal cancer resection between 2006 and 2016 were included in this retrospective study. Computed tomography fat area measurements were assessed on preoperative computed tomography scans and were compared with postoperative outcomes (local and general complications), long-term survival and oncological response. RESULTS: Of 202 patients included, 50 (25%) died with a median survival time of 34 months, and 152 (75%) were still alive at the end of the study. Death and disease progression were significantly associated with a high intermuscular/subcutaneous fat ratio at the L4-L5 level, with a cut-off established at 0.12 (p < 0.05). Patients with a low (< 1.15) subcutaneous/visceral fat ratio at the L2-L3 level experienced significantly more local complications (p < 0.05). CONCLUSIONS: This study suggests that patients with a low subcutaneous fat area/visceral fat area ratio had more local postoperative complications and that a high intermuscular fat area/subcutaneous fat area ratio was associated with worse survival outcomes, as well as a high postoperative complication rate. KEY POINTS: • A low subcutaneous/visceral fat ratio seems to be associated with more local postsurgery complications in patients with rectal cancer, while a high intermuscular/subcutaneous fat ratio seems to be associated with worse survival and oncological outcomes. • A high intermuscular/subcutaneous fat ratio seems to be associated with worse survival outcomes or progressing disease, as well as a higher postoperative complication rate. • Computed tomography abdominal fat area measurements are correlated with one another on multiple anatomical levels.

Transhepatic forceps biopsy combined with biliary drainage in obstructive jaundice: safety and accuracy.

PURPOSE: This study was conducted in order to investigate the safety and accuracy of percutaneous transluminal forceps biopsy (PTFB) during percutaneous biliary drainage (PTBD) in patients with a suspicion of malignant biliary stricture. MATERIAL AND METHODS: Fifty consecutive patients with obstructive jaundice underwent PTFB during PTBD. Biopsy specimens were obtained using 5.2-F flexible biopsy forceps and these specimens were independently analysed by two pathologists. Consensus was obtained in case of discrepancy. Biopsy was considered as a true positive when tumour cells were retrieved. In the absence of tumour cells, comparison with available surgical findings and/or endoscopic ultrasound fine-needle aspiration (EUS-FNA) and/or percutaneous liver biopsy and/or imaging or clinical follow-up was made to distinguish true and false negatives. Specificity, sensitivity, positive predictive value, negative predictive value and accuracy were calculated. Influence of tumour location and pre-operative imaging findings was evaluated. Adverse events were reported. RESULTS: Biliary drainage and tissue sampling were achieved in 100% of patients. Sensitivity and specificity were 70 and 100%, respectively, while overall accuracy was 72%. After excluding the first 25 patients, accuracy and sensitivity for tissue sampling reached 80 and 78%, respectively. Sensitivity was better (87%) if stenosis was located at the upper part of the biliary tree, compared to the lower part (55%). In case of cholangiocarcinoma or intraductal invasion suspected on imaging, biopsy was contributive in 84 and 81% of patients, respectively. Four complications occurred consisting of one bile leak, two haemobilia and one pneumoperitoneum. CONCLUSION: PTFB combined with PTBD is a safe and effective technique for both histopathological diagnosis and biliary decompression of biliary strictures. KEY POINTS: Implications for patient care: • Percutaneous transbiliary forceps biopsy is technically feasible (100% of tissue sampling in our study) and is a safe technique. • Radiological management combining PTFB plus PTBD may allow diagnosis and treatment of the biliary stricture at the same time. • Sensitivity and accuracy for PTFB reached 78 and 80%, respectively, with a 100% specificity.

Midterm Recanalization after Arterial Embolization Using Hydrogel-Coated Coils versus Fibered Coils in an Animal Model.

PURPOSE: To compare angiographic and pathologic effects (ie, occlusion, recanalization) after embolization with Hydrogel-coated coils (HydroCoils) and fibered coils in the renal and internal iliac arteries after 7 days and 1 and 4 months in an animal model. MATERIALS AND METHODS: Twelve sheep had 1 internal iliac and 1 renal artery randomly embolized with HydroCoils or fibered coils. Renal and internal iliac arteries were embolized with detachable 0.018-inch coils and pushable 0.035-inch coils, respectively. All animals had control angiography performed at 7 days, and 1 and 4 months to assess recanalization before euthanasia. Recanalization and inflammation were evaluated via pathologic examination. RESULTS: At 1 month, 100% of arteries embolized with HydroCoils were occluded vs 50% of those embolized with fibered coils (P = .004). At 4 months, 80% of arteries embolized with HydroCoils were occluded vs 25% of those embolized with fibered coils (P = .01). Surface of vessel occlusion was significantly greater for iliac arteries (96.7% ± 8.9) than for renal arteries (94.2% ± 5.3; P = .0076). Surface of occlusion of the renal arteries (92.2% ± 5.1) was lower for fibered coils than for HydroCoils (96.8% ± 4.7; P = .0287). Surface percentage of thrombus was significantly lower for HydroCoils than for fibered coils (P < .0001). Surface percentage of thrombus was correlated with surface percentage of recanalization (P = .0181). CONCLUSIONS: After 4 months, 75% of arteries embolized with fibered coils were recanalized vs 20% of those embolized with HydroCoils (P = .01). Reduced amount of thrombus after embolization with HydroCoils accounted for a reduced rate of arterial recanalization.

One-month apparent diffusion coefficient correlates with response to radiofrequency ablation of hepatocellular carcinoma.

PURPOSE: To assess whether apparent diffusion coefficient (ADC) values at 1 and 3 months after radiofrequency ablation (RFA) may be associated with a favorable response to therapy for hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS: Fifty-nine patients with HCC (n = 35) or liver metastases (n = 24) who underwent 1.5T diffusion-weighted magnetic resonance imaging (DWMRI) at 1 and 3 months post-RFA were included. ADC values of patients with local tumor recurrence were compared to those without local recurrence. A subgroup analysis was performed for HCC and metastases. RESULTS: Thirty-eight HCC and 27 metastases were evaluated. The ADC value of HCC at 1 month after RFA was lower in recurrent tumors (0.957 ± 0.229 [SD] × 10-3 mm2 ) compared to tumors with complete response (1.414 ± 0.322 [SD] × 10-3 mm2 /s, P = 0.006). At multivariate analysis, ADC at 1 month was the single independent variable associated with recurrence for HCC (area under the receiver operating characteristic curve = 0.860). No significant association was observed for liver metastases (P = 0.089). CONCLUSION: A low ADC value at 1 month after RFA is associated with an early local recurrence of HCC. This study does not confirm that such association exists for hepatic metastases. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1648-1658.

Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors.

OBJECTIVES: To evaluate the fertility of women eligible for surgical multiple myomectomy, but who carefully elected a fertility-sparing uterine artery embolization (UAE). METHODS: Non-comparative open-label trial, on women ≤40 years, presenting with multiple symptomatic fibroids (at least 3, ≥3 cm), immediate pregnancy wish, and no associated infertility factor. Women had a bilateral limited UAE using tris-acryl gelatin microspheres ≥500 µm. Fertility, ovarian reserve, uterus and fibroid sizes, and quality of life questionnaires (UFS-QoL) were prospectively followed. RESULTS: Fifteen patients, aged 34.8 years (95%CI 32.2-37.5, median 36.0, q1-q3 29.4-39.5) were included from November 2008 to May 2012. During the year following UAE, 9 women actively attempting to conceive experienced 5 live-births (intention-to-treat fertility rate 33.3%, 95%CI 11.8%-61.6%). Markers of ovarian reserve remained stable. The symptoms score was reduced by 66% (95%CI 48%-85%) and the quality of life score was improved by 112% (95%CI 21%-204%). Uterine volume was reduced by 38% (95%CI 24%-52%). Women were followed for 43.1 months (95%CI 32.4-53.9), 10 live-births occurred in 8 patients, and 5 patients required secondary surgeries for fibroids. CONCLUSION: Women without associated infertility factors demonstrated an encouraging capacity to deliver after UAE. Further randomized controlled trials comparing UAE and myomectomy are warranted. KEY POINTS: • Women without infertility factors showed an encouraging delivery rate after UAE. • For women choosing UAE over abdominal myomectomy, childbearing may not be impaired. • Data are insufficient to definitively recommend UAE as comparable to myomectomy. • Further randomized trials comparing fertility after UAE or myomectomy are warranted.

Value of Round Ligament Artery Embolization in the Management of Postpartum Hemorrhage.

PURPOSE: To evaluate the feasibility and efficacy of embolization of the round ligament arteries in the management of postpartum hemorrhage. MATERIALS AND METHODS: Eleven women (mean age, 31 y) underwent round ligament artery because of persistent or recurrent hemorrhage after initial uterine or internal iliac artery embolization. RESULTS: A total of 16 round ligament arteries were embolized. The round ligament artery arose from the inferior epigastric artery in 11 cases (69%) and directly from the external iliac artery in 5 (31%). Embolization was performed with calibrated microspheres in 7 women (63%) and gelatin sponge pledgets in 4 (37%). Coils were used in addition to gelatin sponge pledgets in 3 patients. Hemostasis was achieved in 10 patients (91%), and 1 required additional conservative surgery. The mean hemoglobin level before embolization was 7.2 g/dL ± 1 and increased significantly on day 1 after embolization (10.3 g/dL ± 1.0; P < .05). No procedure-related complication was reported. The mean hospital stay was 5.6 days ± 2. Two patients had further pregnancies 13 and 14 months after embolization. CONCLUSIONS: Selective embolization of the round ligament artery is a safe and effective treatment for obstetric hemorrhage. It should be considered in cases of persistent or recurrent bleeding after initial uterine or internal iliac artery embolization.

Anatomic basis of Le Fort 1 impaction osteotomy: a radiological study.

PURPOSE: In Le Fort 1 osteotomy when a maxillary impaction is necessary, surgeons have to face different anatomical problems. (1) To determine the best bone resection route, they have to consider the situation of dental roots, infraorbital foramen and maxillary artery. (2) In case of Le Fort 1 osteotomy combined with a mandibular sagittal split osteotomy, the palate has to be replaced in horizontal position although there is no anatomical landmark. (3) In case of Gummy smiles, it can be due to either long face or short upper lip. The main objective was to identify safe bony landmarks to perform a Le Fort I osteotomy and to find a reliable way for repositioning the palate horizontally; the secondary objective was to determine the upper lip normal length. METHODS: The study was based on 178 facial CT examinations. The following parameters have been used: the vertical length of the upper lip, the vertical heights of the anterior nasal spine, the canine and molar roots, the inferior limit of the pterygomaxillary fossa and the vertical height of the infraorbital foramen on both sides. RESULTS: The vertical length from the subnasal point to the upper vermilion was 15.06 ± 3.09 mm, and to the junction of the upper and lower lips was 23.94 ± 3.79 mm. The vertical length from the anterior nasal spine to the incisor alveolar border was 19.70 ± 3.17 mm. The height of the canine root was 17.11 ± 2.60 mm. The height of the highest lateral root of first or second maxillary molars was 11.71 ± 1.83 mm. The vertical length from the inferior limit of the pterygomaxillary fossa (pti point) to the alveolar border of the pterygomaxillary suture was 19.86 ± 3.45 mm. The height from the center of the infraorbital foramen to the alveolar border of the maxilla on a vertical line was not statistically different on right and left sides. CONCLUSIONS: According to our results, in impaction Le Fort 1 osteotomy, the bone resection must pass 20 mm above the alveolar border in canine area, and 15 mm above the alveolar border in molar area. The resection has to end less than 20 mm above the inferior border of the pterygomaxillary suture. The vertical height of the infraorbital foramen is a consistent landmark for repositioning of the palate in a horizontal plane.

Diagnosis of pediatric gastric, small-bowel and colonic volvulus.

Digestive volvulus affects the stomach, small bowel and mobile segments of the colon and often has a developmental cause. Reference radiologic examinations include upper gastrointestinal contrast series for gastric volvulus, possibly with ultrasonography for small-bowel volvulus, and contrast enema for colonic volvulus. Treatment is usually surgical. This pictorial essay describes the embryological development and discusses the clinical and radiologic presentation of volvulus, depending on location, and details the appropriate radiologic examinations.

Neurological involvement in hereditary hemorrhagic telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by epistaxis, telangiectases, and multi-organ vascular dysplasia. Head and neck localizations of HHT are recurrent, frequent associated with serious complications. The aim of this study was to describe the clinical and imaging patterns of neurological involvement in HHT and to discuss the role of interventional radiology in the management of HHT patients. Based on a multidisciplinary experience of twenty years at our center, we report here the different aspects of neurological involvement of HHT. Depending on the genetic type of the disease, vascular abnormalities may affect different organs. The knowledge of neurological involvement according to specific localization of HHT makes detection easier. As cerebral or spinal arteriovenous fistula may be present in patients with epistaxis or pulmonary arteriovenous malformations (PAVMs), radiologists should be able to detect high-risk lesions and prevent related complications. Finally, we review indications and techniques of embolization for hemorrhagic lesions and emphasize that endovascular therapies are very effective and safe in experienced hands. Head and neck imaging is commonly used for the diagnosis of HHT. Imaging plays also a key role for patient evaluation before treatment as pluridisciplinary management is needed.

A novel resorbable embolization microsphere for transient uterine artery occlusion: a comparative study with trisacryl-gelatin microspheres in the sheep model.

PURPOSE: To evaluate angiographic recanalization, inflammatory reaction, and uterine damage after sheep uterine artery embolization (UAE) with a novel calibrated resorbable embolization microsphere (REM) and compare the results with control nonresorbable microspheres. MATERIALS AND METHODS: Six hormonally artificially cycled sheep underwent bilateral UAE until stasis with either REM or trisacryl-gelatin microspheres (TGMS). At 7 days, control angiograms were obtained to assess the residual vascularization at arterial and parenchymal phases. The animals were then sacrificed for analysis of the presence of microspheres, inflammatory foreign body reaction, and surface areas of uterine damage. RESULTS: Mean volume of microspheres injected per uterine artery (UA) or per animal did not differ between groups. At day 7, the flow was normal for six of six UAs that received embolization with REM versus only three of six UAs with TGMS (P = .0455, χ(2) test). Uterine parenchymography showed no defects in six UAs in the REM group versus five defects in six UAs in the TGMS group (P = .0060, χ(2) test). No REM or residual fragments of microspheres were observed on histologic analysis. TGMS were observed in tissues and accompanied by a mild inflammatory response. Necrosis rates were not significantly different between the two products, either in endometrium (REM 23.5% ± 28.8% [median 8.1%] vs TGMS 21.8% ± 23.7% [median 14.6%]) or in myometrium (REM 8.2% ± 22.7% [median 0.0%] vs TGMS 8.8% ± 20.8% [median 0.9%]). Endometrium alteration rate was lower with REM than with TGMS (39.7% ± 25.7% [median 34%] vs 60.6% ± 27.1% [median 71%]; P = .0060, Mann-Whitney test). Myometrium alteration rates were not significantly different between REM (45.7% ± 37.1% [median 63.0%]) and TGMS (37.8% ± 34.0% [median 19.1%]). CONCLUSIONS: At 1 week after sheep UAE with REM, the recanalization was complete, the microspheres were completely degraded, and there was no remnant inflammatory response.

Treatment of adenomyosis, abdominal wall endometriosis and uterine leiomyoma with interventional radiology: A review of current evidences.

Interventional radiology shows promises in the field of women's health, particularly in pelvic interventions. This review article discusses the latest advancements in interventional radiology techniques for pelvic conditions affecting women including adenomyosis, abdominal wall endometriosis and uterine leiomyoma. Extraperitoneal endometriosis involving the abdominal wall may be treated by percutaneous thermal ablation, such as cryoablation, whereas uterine leiomyoma and adenomyosis can be managed either using percutaneous thermal ablation or using uterine artery embolization. Continued research and development in interventional radiology will further enhance the minimally-invasive interventions available for women's health, improving outcomes and quality of life for this large patient population of women.

Conventional Transarterial Chemo embolization Using Streptozocin in Patients with Unresectable Neuroendocrine Liver Metastases.

BACKGROUND: The purpose of this study was to evaluate the clinical, biological and radiological responses to, and tolerability of, conventional transarterial chemoembolization (cTACE) using streptozocin for unresectable neuroendocrine liver metastases. PATIENTS AND METHODS: A total of 52 patients with predominant liver disease were treated with cTACE using an emulsion of streptozocin, Lipiodol and embolization particles. A sequential approach was favored in patients with high liver tumor burden. Clinical, biological and radiological responses were evaluated using carcinoid symptoms, biomarkers and mRecist criteria, respectively. RESULTS: A total of 127 procedures were performed with a sequential approach in 65% of patients. All patients received streptozocin and Lipiodol. Carcinoid syndrome was improved in 69% of patients after treatment (p = 0.01). Post-embolization syndrome was reported in 78% of patients. At the end of all cTACE, objective response and non-progressive disease were 32% and 70%, respectively. Progression-free survival was 18.3 ± 13.3 months (median 14.9) and median overall survival (OS) from start of treatment was 74 months. The OS at 1 year, 2 years, 3 years and 5 years was 91% (IC = 84-99%), 84% (CI = 72-95%), 69% (CI = 53-84%) and 63% (C = 46-81%), respectively. CONCLUSIONS: cTACE using streptozocin is an effective and well-tolerated palliative option for patients with neuroendocrine liver metastases, associated with prolonged survival and delayed time to progression.

Pulmonary Artery Embolization in the Management of Hemoptysis Related to Lung Tumors.

(1) Background: Bronchial artery embolization has been shown to be effective in the management of neoplastic hemoptysis. However, knowledge of pulmonary artery embolization is lacking. The aim of this study was to evaluate the safety and efficacy of pulmonary artery embolization in patients presenting with hemoptysis related to lung tumors. (2) Methods: This retrospective study reviewed all consecutive patients with cancer and at least one episode of hemoptysis that required pulmonary artery embolization from December 2008 to December 2020. The endpoints of the study were technical success, clinical success, recurrence of hemoptysis and complications. (3) Results: A total of 92 patients were treated with pulmonary artery embolization (63.1 years ± 9.9; 70 men). Most patients had stage III or IV advanced disease. Pulmonary artery embolization was technically successful in 82 (89%) patients and clinically successful in 77 (84%) patients. Recurrence occurred in 49% of patients. Infectious complications occurred in 15 patients (16%). The 30-day mortality rate was 31%. At 3 years, the survival rate was 3.6%. Tumor size, tumor cavitation and necrosis and pulmonary artery pseudoaneurysm were significantly associated with recurrence and higher mortality. (4) Conclusions: Pulmonary artery embolization is an effective treatment to initially control hemoptysis in patients with lung carcinoma, but the recurrence rate remains high and overall survival remains poor.

Complications of peripherally inserted central catheters in adult hospitalized patients and outpatients in the KTFIXPICC study: A randomized controlled trial evaluating a fixation device KT FIX Plussystem.

BACKGROUND: Poor securement potentiates Peripherally inserted central catheters (PICC) complications. A dressing device (KT FIX Plus) offers stronger skin attachment, which may reduce the risk of dressing disruption. We aimed to evaluate this device. METHODS: We conducted a single-center parallel-group open-label randomized controlled trial. Hospitalized and outpatient consecutive adults requiring PICCs were randomized to KT FIX Plus or standard of care (SOC). The primary endpoint was the composite of PICC-associated complications until removal, including occlusion, migration, accidental withdrawal, infection, thrombosis, and hematoma. RESULTS: No statistically significant difference was observed in terms of complications: 67 (35%) in the KT FIX Plus group vs 36 (37%) in the SOC group (log-rank P = 0.76). In multivariate Cox analysis, independent risk factors for PICC-associated complications were obesity (adjusted hazard ratio (aHR), 1.08, P < .001) and diabetes (aHR, 1.85, P = .039), adjusting for chronic renal failure, number of lumens, catheter/vein diameter ratio and duration of home-based care. Multiple lumen catheters increased the risk of accidental withdrawal and migration (HR, 2.4, P = .008). CONCLUSIONS: In our study, the use of KT FIX Plus did not reduce the risk of complications adjusting for other risk factors such as obesity and diabetes. The number of catheter lumens is one of the modifiable factors to reduce complications. Further studies are required to find the best securement and dressing system.

Rabbit VX2 Liver Tumor Model: A Review of Clinical, Biology, Histology, and Tumor Microenvironment Characteristics.

The rabbit VX2 is a large animal model of cancer used for decades by interventional radiologists to demonstrate the efficacy of various locoregional treatments against liver tumors. What do we know about this tumor in the new era of targeted therapy and immune-oncology? The present paper describes the current knowledge on the clinics, biology, histopathology, and tumor microenvironment of VX2 based on a literature review of 741 publications in the liver and in other organs. It reveals the resemblance with human cancer (anatomy, vascularity, angiogenic profile, drug sensitivity, immune microenvironment), the differences (etiology, growth rate, histology), and the questions still poorly explored (serum and tissue biomarkers, genomic alterations, immune checkpoint inhibitors efficacy).

The arterial distribution of Embozene and Embosphere microspheres in sheep kidney and uterus embolization models.

PURPOSE: To compare the in vivo distribution of the new embolic Embozene versus Embosphere as a control in the sheep renal and uterine vasculature. MATERIALS AND METHODS: Twelve sheep (three per group of product and size) were selectively embolized with Embozene 700 µm, Embozene 900 µm, Embosphere 500-700 µm, or Embosphere 700-900 µm, in one renal artery (0.5 mL microspheres) and in the two uterine arteries (0.25 mL each) and sacrificed 72 hours later for pathologic examination of kidney and uterus. Partition of microspheres in the vasculature was determined according to a classification of the renal and the uterine vasculatures into several zones. Vascular diameters and microsphere deformation were measured. RESULTS: Embozene 700 µm and Embozene 900 µm occluded significantly more distally than Embosphere 500-700 µm and Embosphere 700-900 µm in renal and uterine vasculature. For Embozene, the vessel diameter was not significantly different between the two sizes, for each organ, whereas it was significantly larger for Embosphere 700-900 µm than for Embosphere 500-700 µm in each organ. Embozene deformation was significantly higher than that of Embosphere in renal and uterine vasculature, increased from proximal to distal in location for both organs and correlated negatively with vessel diameter (Rho = -0.623; P < .0001). Embosphere deformation did not vary according to the zone. CONCLUSIONS: Embozene microspheres have a higher in vivo deformation, which results in a more distal occlusion within the vascular network compared with reference Embosphere microspheres. The diameter of occluded vessels varied for the tested size range for Embosphere but was independent of the tested microsphere size range used for Embozene. The deformation of Embozene appears to determine the size of the vessels occluded as opposed to the granulometric particle size, which makes level of occlusion unpredictable.

Short-term Safety and Quality of Life Outcomes Following Radioembolization in Primary and Secondary Liver Tumours: a Multi-centre Analysis of 200 Patients in France.

PURPOSE: Radioembolization has emerged as a treatment modality for patients with primary and secondary liver tumours. This observational study CIRT-FR (CIRSE Registry for SIR-Spheres Therapy in France) aims to evaluate real-life clinical practice on all patients treated with transarterial radioembolization (TARE) using SIR-Spheres yttrium-90 resin microspheres in France. In this interim analysis, safety and quality of life data are presented. Final results of the study, including secondary effectiveness outcomes, will be published later. Overall, CIRT-FR is aiming to support French authorities in the decision making on reimbursement considerations for this treatment. METHODS: Data on patients enrolled in CIRT-FR from August 2017 to October 2019 were analysed. The interim analysis describes clinical practice, baseline characteristics, safety (adverse events according to CTCTAE 4.03) and quality of life (according to EORTC QLQ C30 and HCC module) aspects after TARE. RESULTS: This cohort included 200 patients with hepatocellular carcinoma (114), metastatic colorectal cancer (mCRC; 38) and intrahepatic cholangiocarcinoma (33) amongst others (15). TARE was predominantly assigned as a palliative treatment (79%). 12% of patients experienced at least one adverse event in the 30 days following treatment; 30-day mortality was 1%. Overall, global health score remained stable between baseline (66.7%), treatment (62.5%) and the first follow-up (66.7%). CONCLUSION: This interim analysis demonstrates that data regarding safety and quality of life generated by randomised-controlled trials is reflected when assessing the real-world application of TARE. TRIAL REGISTRATION: Clinical Trials.gov NCT03256994.

Pancreatic involvement in hereditary hemorrhagic telangiectasia: assessment with multidetector helical CT.

PURPOSE: To evaluate and describe pancreatic involvement by using multidetector computed tomography (CT) in patients with a diagnosis of hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS: Institutional review board approval was obtained, and all patients provided informed consent. Across 12 months, all consecutive adult patients with a confirmed diagnosis of HHT referred to our pluridisciplinary HHT center for evaluation were enrolled prospectively in the study and underwent contrast material-enhanced multidetector CT of the abdomen. Pancreatic telangiectases and arteriovenous fistulas were noted, and their characteristics were described. Genetic mutation was also investigated. RESULTS: Thirty-five patients (19 women, 16 men; mean age, 48.4 years) were included. All patients were asymptomatic. A genetic mutation was identified in 28 (80%) patients, including endoglin in 16 (57%), activin type-II-like receptor kinase 1 (ALK1) in 11 (39%), and SMAD4 in one (4%). Eleven (31%) patients exhibited pancreatic involvement. Fifty-four percent of patients with ALK1 mutation had pancreatic involvement. Twenty-three pancreatic telangiectases were identified during the arterial phase in nine patients. Seven pancreatic arteriovenous malformations (AVMs) were identified in four patients. CONCLUSION: Pancreatic involvement commonly is found in patients with HHT (31% in our study), mainly in patients with ALK1 mutation; pancreatic telangiectases or AVMs are only diagnosed duringthe arterial phase at multidetector CT.

Do microspheres with narrow or standard size distributions localize differently in vasculature? An experimental study in sheep kidney and uterus.

PURPOSE: To compare standard embolization microspheres (SMS) with microspheres of very narrow size distribution in terms of physical properties and relative distribution within sheep kidney and uterine artery models of embolization. MATERIALS AND METHODS: Standard microspheres (SMS; 500-700 mum and 700-900 mum) were compared with narrow microspheres (NMS) of the same material made with a microfluidic method that produced a much narrower size distribution (600 mum and 800 mum). Characterization of both microspheres was performed in vitro (ie, bead size, water content, and compressive modulus). In the sheep model of kidney and uterus embolization, histopathologic analysis was performed to determine the average vessel size occluded, the number of microspheres per vessel, and the deformation in vivo, with a focus on the localization of the products within the different vascular zones of the organ tissues. RESULTS: In vitro testing showed the physical properties of NMS to be similar to those of SMS. SMS and NMS also possessed the same degree of deformation in vivo. In both embolization models, there were no major differences in the localization of SMS compared with NMS of equivalent mean bead diameters. CONCLUSIONS: Compared with SMS with a normal distribution in size range, NMS with a narrow size distribution did not exhibit a very different distribution within the vasculature of the sheep kidney or uterus.