Giant coronary aneurysm in a toddler with Kawasaki disease: technical challenges in CT coronary angiography.

Kawasaki disease is the most common vasculitis causing acquired coronary artery aneurysm (CAA) and affects mostly children. Computed tomography coronary angiography (CTCA) has unique diagnostic and prognostic values in cases of giant CAA. Here, we report technical challenges encountered when performed CTCA for a case of Kawasaki disease complicated with giant CAA. In particular, there was significant flow alteration caused by the giant CAA(s) causing suboptimal enhancement when the standard protocol was applied. We share our experience in optimizing the scan and propose the use of either manual bolus tracking or test bolus technique in similar scenarios, as well as multidisciplinary approach to optimize patient preparation.

An update on irreversible electroporation of liver tumours.

OBJECTIVE. To investigate the clinical efficacy and safety of irreversible electroporation for ablation of liver tumour in humans. DATA SOURCES. The PubMed and MEDLINE databases were systematically searched. STUDY SELECTION. Clinical research published in English in the last 10 years until October 2013 that address clinical issues related to irreversible electroporation of human liver tumours were selected. "Liver tumor", "local ablative therapy", and "irreversible electroporation" were used as the search terms. DATA EXTRACTION AND SYNTHESIS. The data extracted for this review was analysed by the authors, with a focus on the clinical efficacy and the safety of irreversible electroporation. The complete response rates look promising, ranging from 72% to 100%, except in one study in a subgroup of liver tumours in which the complete response rate was only 50% that was likely due to the inclusion of larger-size tumours. In one study, the local recurrence rate at 12 months was approximately 40%. As for the safety of irreversible electroporation, there were only a few reported complications (cardiac arrhythmia, pneumothorax, and electrolyte disturbance) that were mostly transient and not serious. There was no reported mortality related to the use of irreversible electroporation. CONCLUSION. Irreversible electroporation is a potentially effective liver tumour ablative therapy that gives rise to only mild and transient side-effects. Further studies with better patient selection criteria and longer follow-up are needed to clarify its role as a first-line liver tumour treatment modality.