Biodegradable Polydioxanone Microspheres for Transcatheter Arterial Embolization: Proof of Principle.

PURPOSE: To evaluate feasibility, embolization success, biodegradability, reperfusion, and biocompatibility of biodegradable microspheres (MS) made from polydioxanone (PDO) for transcatheter arterial embolization. MATERIALS AND METHODS: Unilateral selective renal embolization of a segmental artery was performed in 16 New Zealand White rabbits with PDO-MS (100-150 µm and 90-315 µm). Animals were randomly assigned to different observation periods and underwent control digital subtraction angiography (DSA) and MR imaging immediately (n = 3), 1 week (n = 2), 4 weeks (n = 2), 8 weeks (n = 2), 12 weeks (n = 5), and 16 weeks (n = 2) after embolization. Kidneys were harvested for macroscopic and histologic analysis of embolization success, biodegradability, and biocompatibility. RESULTS: Embolization was technically successful in 15 of 16 animals. One animal died of anesthesia-related circulatory failure. The 100-150 µm MS were injected easily through 3-F catheters; the 90-315 µm MS tended to clog with intermittent catheter obstruction. DSA and MR imaging showed successful target embolization in 13 of 15 animals. In 2 animals, the entire kidney was affected owing to catheter clogging, including a reflux of MS while flushing. Control DSA and MR imaging showed increasing vascular reperfusion with time. Macroscopic and histologic analysis revealed necrosis/infarction in areas in which embolization was achieved. MS were extensively degraded after 16 weeks, and overall inflammatory reaction was mild. CONCLUSIONS: Biodegradable PDO-MS induced effective embolization of target vessels while demonstrating good biocompatibility. MS increasingly dissolved at 16 weeks, partial reperfusion started at week 1, and complete reperfusion started at week 8, thus offering possible advantages as a temporary embolic agent.

Simultaneous dual-isotope SPECT/CT with (99m)Tc- and (111)In-labelled albumin microspheres in treatment planning for SIRT.

OBJECTIVES: To investigate simultaneous dual-isotope SPECT/CT with two differently radioisotope-labelled albumin-microsphere fractions for treatment planning of hepatic radioembolisation. METHODS: In addition to (99m)Technetium-labelled albumin microspheres (commercially available), we performed labelling with (111)Indium. Binding stability of (111)Indium-labelled microspheres was tested in vitro and in vivo in mice. Simultaneous dual-isotope SPECT/CT imaging was validated in an anthropomorphic torso phantom; subsequently, dual-isotope SPECT/CT was performed under in-vivo conditions in pigs (n = 3) that underwent transarterial injection of (99m)Technetium- and (111)Indium-labelled microspheres in the liver (right and left hepatic artery, respectively), in both kidneys and in the gluteal musculature. In total, n = 18 transarterial injections were performed. RESULTS: In-vitro testing and in-vivo studies in mice documented high binding stability for both (99m)Technetium-labelled and (111)Indium-labelled microsphere fractions. In phantom studies, simultaneous dual-isotope SPECT/CT enabled reliable separation of both isotopes. In pigs, the identified deposition of both isotopes could be accurately matched with intended injection targets (100 %, 18/18 intended injection sites). Furthermore, an incidental deposition of (99m)Technetium-labelled microspheres in the stomach could be correlated to the test injection into a right hepatic artery. CONCLUSION: Simultaneous dual-isotope SPECT/CT after transarterial injection with (99m)Technetium- and (111)Indium-labelled microspheres is feasible. Thus, it may offer additional, valuable information compared to single (99m)Technetium-labelled albumin examinations. KEY POINTS: • Simultaneous dual-isotope SPECT/CT with (111) In- and (99m) Tc-labelled albumin microspheres is feasible. • Differentiation of two microsphere fractions after transarterial injection is possible. • The origin of an extra-hepatic microsphere deposition can be correlated to the corresponding artery. • This technique could reduce the setup time for selective internal radiation treatment.

Identification of the iodine concentration that yields the highest intravascular enhancement in MDCT angiography.

OBJECTIVE: The objective of our study was to identify the iodine concentration that yields the highest intravascular contrast enhancement in MDCT angiography by intraindividual comparison in an animal model. MATERIALS AND METHODS: Six pigs underwent repeated chest MDCT examinations under standardized conditions using the same contrast medium (iopromide) with different iodine concentrations (150, 240, 300, and 370 mg I/mL). The contrast injection protocol was adapted to ensure an identical iodine delivery rate of 1.5 g I/s and the same total iodine dose of 300 mg/kg of body weight for all studies. Dynamic CT scans were acquired at the levels of the pulmonary artery and the ascending and descending aorta. Pulmonary and aortic peak enhancement values as well as time to peak (TTP) were calculated from time-enhancement curves. RESULTS: Pulmonary and aortic peak contrast enhancement values were significantly higher with the 240 and 300 mg I/mL contrast media than the 150 and 370 mg I/mL contrast media (e.g., ascending aorta: 240 vs 150, p = 0.0070; 300 vs 150, p = 0.0096; 240 vs 370, p = 0.0262; 300 vs 370, p = 0.0079). TTP values tended to be lower for the 150 mg I/mL contrast medium than for the contrast media with higher iodine concentrations. CONCLUSION: Comparison of contrast media with iodine concentrations ranging from 150 to 370 mg I/mL showed that contrast enhancement was significantly improved with the use of 240 and 300 mg I/mL contrast media given a fixed identical iodine delivery and normalized total iodine load in a porcine model. Contrast media with a moderate iodine concentration are most suitable for obtaining the highest intravascular contrast enhancement in CT angiography.

Transaneurysmal Occlusion of Complicated Common Femoral Artery Pseudoaneurysms Using the Angio-Seal Closure Device-A Promising Technique.

PURPOSE: Pseudoaneurysm (PSA) developing after catheter examinations is one of the most frequent vascular complications and a nonsurgical technique with utmost low risk of complications is warranted. Our aim was to investigate the technical feasibility, success, and safety of transaneurysmal occlusion of complicated post-interventional common femoral artery (CFA) PSA using the Angio-Seal Closure Device (ASCD) and a technique that we describe as the transaneurysmal (TA) maneuver. MATERIAL AND METHODS: We used the Angio-Seal (Terumo, Tokyo, Japan) Closure System to manage complicated PSAs in patients who would otherwise have needed surgery after failure of all conservative therapies. The TA maneuver was performed in 14 consecutive patients from July 2021 to July 2022. After ultrasound-guided puncture of the PSA close to its neck, the CFA was entered radiographically with micro-guidewires, and the neck of the PSA was closed with the ASCD after changing the sheaths and wires. All patient had to wear a pressure dressing until the next day, when successful closure was verified by sonography. RESULTS: All procedures were performed with technical success and without any complications. No patient had to undergo surgery. All sonographies on the next day confirmed complete absence of perfusion within the PSA and normal flow conditions of the CFA and vessels below. CONCLUSION: The TA maneuver a promising minimally invasive procedure for closing complicated PSA of the CFA after catheter examination.

Functional MR imaging of the eustachian tube in patients with clinically proven dysfunction: correlation with lesions detected on MR images.

OBJECTIVES: To visualise the function of the Eustachian tube by MRI and assess the effect of surrounding lesions. METHODS: Using 1.5 T MRI, 32 Eustachian tubes of 16 patients with clinically proven dysfunction (clinical symptoms, such as autophonia and fullness and non-opening at tympanometry) were investigated. For depiction of the anatomy and associated abnormalities, coronal and axial T2-weighted turbo spin echo sequences and a T1-weighted-2D-gradient echo sequences were acquired. Eustachian tube opening was analysed with real time turbo-gradient echo sequences during a Valsalva manoeuvre. RESULTS: Dysfunction, that is, failure of opening of the Eustachian tube as shown by MRI, correlated in all patients with tympanometry. Lesions detected included nasopharyngeal carcinoma in 4 patients. Mucosal swelling in the paranasal sinus was present in 9 patients. One patient had postoperative defects. In two patients both pharyngotympanic tubes did not open although no structural abnormalities could be depicted. CONCLUSIONS: The opening of the Eustachian tubes during the Valsalva manoeuvre is assessable on MRI. Failure of opening may be due to swelling of the mucosa and may be also associated with tumours. MRI assessment may be helpful in patients with chronic otitis media, where the information about tubal function is important in preoperative planning. KEY POINTS: •Eustachian tube opening during Valsalva manoeuvre can be visualised with MRI •Lesions hampering tubal opening can be delineated at the same MRI examination •Functional MRI of the Eustachian tubes might determine the cause of dysfunction.

Bile aspiration and hydrodissection to prevent complications in hepatic RFA close to the gallbladder.

BACKGROUND: Radiofrequency ablation (RFA) of liver tumors is a mainstay of interventional oncology. Its application, however, is limited by tumor size and location with lesions located within 1 cm to the gallbladder being at increased risk for complications. PURPOSE: To evaluate the safety of hepatic RFA after bile aspiration with or without additional hydrodissection for lesions adjacent to the gallbladder. MATERIAL AND METHODS: Six patients undergoing RFA of tumors with a distance of less than 1 cm to the gallbladder were retrospectively identified from a computer database. All patients underwent RFA combined with percutaneous bile aspiration from the gallbladder. In four patients additional hydrodissection was performed. Technical success and post-interventional complications were assessed by reviewing images and patient charts. RESULTS: Ablations were successfully completed in 5/6 patients. In one patient with incomplete ablation re-ablation was performed 2 months after the initial procedure. Minor complications occurred in three patients, including right-sided pleural effusion, hematoma in the gallbladder fossa, and intralesional hemorrhage in one patient each. There were no cases with cholecystitis or damage to the gallbladder during follow-up. CONCLUSION: Bile aspiration with or without additional hydrodissection permits safe RFA of tumors located close to the gallbladder.

Splenic artery steal syndrome in patients with orthotopic liver transplant: Where to embolize the splenic artery?

PURPOSE: This study compared proximal and distal embolization of the splenic artery (SA) in patients with splenic artery steal syndrome (SAS) after orthotopic liver transplantation (OLT) regarding post interventional changes of liver function to identify an ideal location of embolization. METHODS AND MATERIALS: 85 patients with SAS after OLT treated with embolization of the SA between 2007 and 2017 were retrospectively reviewed. Periinterventional DSA was used to assess treatment success and to stratify patients according to the site of embolization. Liver function was assessed using following laboratory values: bilirubin, albumin, gamma-glutamyl transferase, glutamat-pyruvat-transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), Alkaline Phosphatase (ALP), aPTT, prothrombin time and thrombocyte count. Descriptive statistics were used to summarize the data. Median laboratory values of pre, 1- and 3-days, as well as 1-week and 1-month post-embolization were compared between the respective embolization sites using linear mixed model regression analysis. RESULTS: All procedures were technically successful and showed an improved blood flow in the hepatic artery post-embolization. Ten Patients were excluded due to re -intervention or inconsistent image documentation. Pairwise comparison using linear mixed model regression analysis showed a significant difference between proximal and distal embolization for GPT (57.0 (IQR 107.5) vs. 118.0 (IQR 254.0) U/l, p = 0.002) and GOT (48.0 (IQR 48.0) vs. 81.0 (IQR 115.0) U/l, p = 0.008) 3-days after embolization as well as median thrombocyte counts 7-days after embolization (122 (IQR 108) vs. 83 (IQR 74) in thousands, p = 0.014). For all other laboratory values, no statistically significant difference could be shown with respect to the embolization site. CONCLUSION: We conclude that long-term outcomes after embolization of the SA in the scenario of SAS after OLT are irrespective of the site of embolization of the SA, whereas a proximal embolization potentially facilitates earlier normalization of liver function. Choice of technique should therefore be informed by anatomical conditions, safety considerations and preferences of the interventionalist.

Functional cardiac MR imaging with true fast imaging with steady-state free precession before and after intravenous injection of contrast medium: comparison of image quality and accuracy.

OBJECTIVE: To compare image quality and accuracy of left ventricular function of cine SSFP (steady-state free precession) images before and after injection of Gd-DTPA. METHODS: In 30 patients T1 times of LV blood and myocardium were measured before and after injection of 0.2 mmol/kg body weight Gd-DTPA. Signal intensity of myocardium and left ventricular blood were measured on SSFP images and the contrast calculated. In 20 additional patients short axis images completely covering the left ventricle were acquired before and after injection of Gd-DTPA and parameters of left ventricular function compared. Image quality and regional function were assessed using the 17-segment model. RESULTS: Image quality after injection of contrast medium did not significantly change compared with unenhanced images. Contrast between myocardium and LV blood decreased from 0.6 ± 0.01 to 0.4 ± 0.03 after injection while the T1 value of myocardium decreased from 1121 ± 21 ms to 389 ± 14 ms (blood 1413 ± 48 ms to 222 ± 8 ms). Assessment of regional and global left ventricular function revealed similar results before and after the injection of contrast medium. CONCLUSION: Cine SSFP can be obtained after injection of contrast medium without loss of accuracy for regional and global LV ventricular function. This protocol can be used to decrease imaging time for thorough cardiac examination.

Volumetric arterial enhancement fraction predicts tumor recurrence after hepatic radiofrequency ablation of liver metastases: initial results.

OBJECTIVE: The objective of our study was to investigate the diagnostic value of the volumetric arterial enhancement fraction of the liver with color mapping for the early detection of tumor relapse after hepatic radiofrequency ablation (RFA). MATERIALS AND METHODS: Fifty-three patients (24 men, 29 women; mean age ± SD, 65 ± 10 years) with a total of 215 liver metastases treated by RFA and a mean postinterventional follow-up period of 20 ± 15 (SD) months were included in this retrospective study. Quantitative arterial enhancement fraction color maps of the whole liver were computed from triple-phase contrast-enhanced MDCT images. Follow-up examinations served as the standard of reference. The diagnostic performance of the arterial enhancement fraction color maps to predict subsequent tumor occurrence before tumor was visible on routine multiphase CT images was evaluated. RESULTS: The mean arterial enhancement fraction of segments that developed metastases (62% ± 23%) was significantly higher than the mean of segments that did not develop metastases (39% ± 20%) (p < 0.0001). Receiver operating characteristic curve analysis revealed a probability of 77% for arterial enhancement fraction values to be higher in case of subsequent metastases as compared with liver parenchyma without tumor recurrence. CONCLUSION: The arterial enhancement fraction provides incremental value in the imaging surveillance for liver metastases after RFA. Arterial enhancement fraction color maps may be suited to predict tumor recurrence earlier than routine assessment using contrast-enhanced MDCT.

Towards case-based medical learning in radiological decision making using content-based image retrieval.

BACKGROUND: Radiologists' training is based on intensive practice and can be improved with the use of diagnostic training systems. However, existing systems typically require laboriously prepared training cases and lack integration into the clinical environment with a proper learning scenario. Consequently, diagnostic training systems advancing decision-making skills are not well established in radiological education. METHODS: We investigated didactic concepts and appraised methods appropriate to the radiology domain, as follows: (i) Adult learning theories stress the importance of work-related practice gained in a team of problem-solvers; (ii) Case-based reasoning (CBR) parallels the human problem-solving process; (iii) Content-based image retrieval (CBIR) can be useful for computer-aided diagnosis (CAD). To overcome the known drawbacks of existing learning systems, we developed the concept of image-based case retrieval for radiological education (IBCR-RE). The IBCR-RE diagnostic training is embedded into a didactic framework based on the Seven Jump approach, which is well established in problem-based learning (PBL). In order to provide a learning environment that is as similar as possible to radiological practice, we have analysed the radiological workflow and environment. RESULTS: We mapped the IBCR-RE diagnostic training approach into the Image Retrieval in Medical Applications (IRMA) framework, resulting in the proposed concept of the IRMAdiag training application. IRMAdiag makes use of the modular structure of IRMA and comprises (i) the IRMA core, i.e., the IRMA CBIR engine; and (ii) the IRMAcon viewer. We propose embedding IRMAdiag into hospital information technology (IT) infrastructure using the standard protocols Digital Imaging and Communications in Medicine (DICOM) and Health Level Seven (HL7). Furthermore, we present a case description and a scheme of planned evaluations to comprehensively assess the system. CONCLUSIONS: The IBCR-RE paradigm incorporates a novel combination of essential aspects of diagnostic learning in radiology: (i) Provision of work-relevant experiences in a training environment integrated into the radiologist's working context; (ii) Up-to-date training cases that do not require cumbersome preparation because they are provided by routinely generated electronic medical records; (iii) Support of the way adults learn while remaining suitable for the patient- and problem-oriented nature of medicine. Future work will address unanswered questions to complete the implementation of the IRMAdiag trainer.

Free-hand CT-based electromagnetically guided interventions: accuracy, efficiency and dose usage.

The purpose of this paper was to evaluate computed tomography (CT) based electromagnetically tip-tracked (EMT) interventions in various clinical applications. An EMT system was utilized to perform percutaneous interventions based on CT datasets. Procedure times and spatial accuracy of needle placement were analyzed using logging data in combination with periprocedurally acquired CT control scans. Dose estimations in comparison to a set of standard CT-guided interventions were carried out. Reasons for non-completion of planned interventions were analyzed. Twenty-five procedures scheduled for EMT were analyzed, 23 of which were successfully completed using EMT. The average time for performing the procedure was 23.7 ± 17.2 min. Time for preparation was 5.8 ± 7.3 min while the interventional (skin-to-target) time was 2.7 ± 2.4 min. The average puncture length was 7.2 ± 2.5 cm. Spatial accuracy was 3.1 ± 2.1 mm. Non-completed procedures were due to patient movement and reference fixation problems. Radiation doses (dosis-length-product) were significantly lower (p = 0.012) for EMT-based interventions (732 ± 481 mGy x cm) in comparison to the control group of standard CT-guided interventions (1343 ± 1054 mGy x cm). Electromagnetic navigation can accurately guide percutaneous interventions in a variety of indications. Accuracy and time usage permit the routine use of the utilized system. Lower radiation exposure for EMT-based punctures provides a relevant potential for dose saving.

Molecular magnetic resonance imaging of myocardial perfusion with EP-3600, a collagen-specific contrast agent: initial feasibility study in a swine model.

BACKGROUND: Cardiac magnetic resonance (MR) perfusion imaging during the first pass after intravenous administration of extracellular contrast agents is hampered by the spatial and temporal resolution achievable and by the artifacts seen in ultrafast MR imaging. Furthermore, time-consuming quantitative data analysis is often added. The use of molecular MR imaging with a target-specific contrast agent with perfusion-dependent binding to myocardium may enable prolonged visualization of perfusion defects and thus may help to overcome limitations of currently used first-pass extracellular MR imaging. EP-3600 is a new gadolinium-containing molecular contrast agent that binds reversibly to myocardial collagen. METHODS AND RESULTS: A significant but nonocclusive coronary artery stenosis was modeled in 7 domestic swine with an undersized MR-compatible balloon positioned in the left anterior descending artery as verified by x-ray angiography. Two animals died before contrast injection as a result of arrhythmias. In 5 swine, high-spatial-resolution gradient echo imaging (approximately 1 x 1 mm(2) in-plane resolution) was performed before and 5, 20, 40, and 60 minutes after intravenous administration of 12.3 micromol/kg EP-3600. Contrast was administered during stress induced by an infusion of 250 mumol x kg(-1) x min(-1) adenosine. Yb-DTPA was administered simultaneously for comparison of myocardium-to-plasma ratios. Images were assessed subjectively by 2 investigators, and signal-to-noise and contrast-to-noise ratios over time were calculated. Normal myocardium showed a significant signal-to-noise ratio increase during the entire examination time. In all animals (n=5), the perfusion defect in the left anterior descending artery territory could be visualized with a high contrast-to-noise ratio for at least 20 minutes after contrast injection. A significantly higher myocardium-to-plasma ratio was found for EP-3600 compared with the control agent Yb-DTPA (0.85+/-0.26 versus 0.22+/-0.08, respectively; P<0.01). CONCLUSIONS: EP-3600 is a new molecular MR imaging contrast agent that binds to the myocardium and enables prolonged, high-contrast, high-spatial-resolution visualization of myocardial perfusion defects.

Application of magnetic resonance imaging in transgenic and chemical mouse models of hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. The molecular mechanisms underlying hepatocarcinogenesis are still poorly understood. Genetically modified mice are powerful tools to further investigate the mechanisms of HCC development. However, this approach is limited due to the lack of non-invasive detection methods in small rodents. The aim of this study was to establish a protocol for the non-invasive analysis of hepatocarcinogenesis in transgenic mice using a clinical 1.5 Tesla Magnetic Resonance Imaging scanner. RESULTS: As a model system we used hepatocyte-specific c-myc transgenic mice developing hepatocellular carcinoma at the age of 12-15 months. The scans of the murine livers included axial T2-weighted turbo-spin echo (TSE) images, axial T1-weighted and contrast enhanced T1-weighted gradient echo (fast field echo, FFE) and sagittal true Fast Imaging with Steady state Precession (true-FISP) images. Application of contrast agent was performed via tail vein-catheter and confirmed by evaluation of the altered longitudinal relaxation T1 time before and after application. Through technical adaptation and optimization we could detect murine liver lesions with a minimum diameter of approximately 2 mm and provided histopathological evidence that these MR findings correspond to hepatocellular carcinoma. Tumor growth was repeatedly measured using sequential MRI with intervals of 5 weeks and subsequent volumetric analysis facilitating direct comparison of tumor progression between individual animals. We finally demonstrated that our protocol is also applicable in the widely- used chemical model of N-nitrosodiethylamine-induced hepatocarcinogenesis. CONCLUSION: Our protocol allows the non-invasive, early detection of HCC and the subsequent continuous monitoring of liver tumorgenesis in transgenic mice thereby facilitating future investigations of transgenic tumor mouse models of the liver.

Rapid right ventricular pacing with MR-compatible pacemaker lead for MR-guided aortic balloon valvuloplasty in swine.

PURPOSE: To assess the feasibility and effectiveness of rapid right ventricular pacing with a magnetic resonance (MR)-compatible pacemaker lead during MR-guided aortic valvuloplasty. MATERIALS AND METHODS: This study was approved by the institutional animal research committee. Seven pigs were investigated. All experiments were performed with an interventional 1.5-T MR system. Interventions were monitored with a steady-state free precession real-time imaging sequence. An MR-compatible pacemaker lead was placed in the right ventricular apex with MR guidance before valvuloplasty. After positioning the balloon in valve position, valvuloplasty was performed with rapid right ventricular rapid pacing at a heart rate of 180 beats per minute to minimize cardiac output. RESULTS: Positioning of the pacemaker lead with MR guidance was feasible in all swine (sensing, 6 mV +/- 1; threshold, 1 V +/- 0.5). The lead could be seen on steady-state free precession images without inducing any artifacts. Rapid right ventricular pacing was feasible in all swine, and balloon stability at the time of inflation was achieved with no balloon movement. Aortic valvuloplasty was successfully accomplished in all experiments. CONCLUSION: Rapid right ventricular pacing with an MR-compatible pacemaker lead is feasible and effective.

A trucut biopsy needle for bipolar radiofrequency ablation of needle tract: a proof-of-concept experiment.

OBJECTIVE: To develop a trucut biopsy needle featuring two electrodes that allow for bipolar radiofrequency (RF) coagulation of the puncture tract. METHODS: We modified a 14-G trucut biopsy needle to contain two insulated electrodes and connected the device to an RF generator. Biopsies in ex vivo porcine liver and kidney were performed. The puncture tract was coagulated by using different RF energy settings (5 W, 10 W, 20 W). Tissue specimens were dissected along the puncture tract and the coagulation area was macroscopically evaluated. CT-guided in vivo liver and kidney biopsies were performed in two domestic pigs. Lengths of specimens were measured. Post-biopsy contrast-enhanced CT examinations were performed to rule out biopsy-related bleeding. Animals were euthanised and coagulation areas macroscopically explored. RESULTS: The mean diameters of the coagulated area around the ex vivo biopsy tract were 4.2 +/- 1.1 mm (5 W), 6.0 +/- 2.0 mm (10 W) and 5.2 +/- 0.51 mm (20 W) in liver and 5.0 +/- 0.7 mm (5 W), 6.6 +/- 0.9 (10 W) and 6.0 +/- 2.0 mm (20 W) in kidney. After biopsies CT revealed no bleeding. Mean maximum coagulation diameters were 10.1 +/- 4.6 mm (10 W) in liver and 6.0 +/- 2.5 mm (10 W) in kidney. Mean length of the specimens was 12.2 +/- 4.4 mm in kidney and 11.1 +/- 3.6 mm in liver tissue. CONCLUSION: Bipolar RF biopsy is a promising tool for tract coagulation after percutaneous biopsy.

Comparison of dual-source CT angiography and MR angiography in preoperative evaluation of intra- and extracranial vessels: a pilot study.

Besides the assessment of carotid artery stenosis, evaluation of the vascular anatomy and lesions within both the extra- and intracranial arteries is crucial for proper clinical evaluation, treatment choice and planning. The purpose of our study was to evaluate the potential of dual-source CTA and 3T-MRA. In 16 symptomatic CAS patients, contrast-enhanced DSCT and 3T-MRA examinations were performed. For DSCT a dual-energy protocol with a 64 x 0.6-mm collimation was applied. In 3T-MRA intracranial high-resolution unenhanced TOF and extracranial contrast-enhanced MRA were performed. All examinations were analyzed for relevant morphologic and pathologic features or anomalies, and a total of 624 vessel segments were scored. All examinations were of diagnostic image quality with good to excellent vessel visibility. Almost all intracranial arteries were significantly better visualized by MRA compared to CTA (five of six vessels, p < 0.05). DSCT however allowed for further morphological carotid stenosis description, especially with respect to calcification. Although MRA proved to be superior in visualization of smaller intracranial arteries, all pre-interventionally relevant information could be perceived from DSCT. DSCT and MRA may both be regarded as a reliable, fast, pre-interventional imaging investigation in patients with carotid artery stenosis.

Robot arm based flat panel CT-guided electromagnetic tracked spine interventions: phantom and animal model experiments.

PURPOSE: To evaluate accuracy and procedure times of electromagnetic tracking (EMT) in a robotic arm mounted flat panel setting using phantom and animal cadaveric models. METHODS AND MATERIALS: A robotic arm mounted flat panel (RMFP) was used in combination with EMT to perform anthropomorphic phantom (n = 90) and ex vivo pig based punctures (n = 120) of lumbar facet joints (FJ, n = 120) and intervertebral discs (IVD, n = 90). Procedure accuracies and times were assessed and evaluated. RESULTS: FJ punctures were carried out with a spatial accuracy of 0.8 ± 0.9 mm (phantom) and 0.6 ± 0.8 mm (ex vivo) respectively. While IVD punctures showed puncture deviations of 0.6 ± 1.2 mm (phantom) and 0.5 ± 0.6 mm (ex vivo), direct and angulated phantom based punctures had accuracies of 0.8 ± 0.9 mm and 1.0 ± 1.3 mm. Planning took longer for ex vivo IVD punctures compared to phantom model interventions (39.3 ± 17.3 s vs. 20.8 ± 5.0 s, p = 0.001) and for angulated vs. direct phantom FJ punctures (19.7 ± 5.1 s vs. 28.6 ± 7.8 s, p < 0.001). Puncture times were longer for ex vivo procedures when compared to phantom model procedures in both FJ (37.9 ± 9.0 s vs. 23.6 ± 7.2 s, p = 0.001) and IVD punctures (43.9 ± 16.1 s vs. 31.1 ± 6.4 s, p = 0.026). CONCLUSION: The combination of RMFP with EMT provides an accurate method of navigation for spinal interventions such as facet joint punctures and intervertebral disc punctures.

Intra-individual comparison of different contrast media concentrations (300 mg, 370 mg and 400 mg iodine) in MDCT.

OBJECTIVE: To compare intra-individual contrast enhancement in multi-detector-row computed tomography (MDCT) using contrast media (CM) containing 300, 370 and 400 mg iodine per ml (mgI/ml). METHODS: Six pigs underwent repeated chest MDCT using three different CM (iopromide 300, iopromide 370, iomeprol 400). An identical iodine delivery (IDR) rate of 1.5 gI/s and a constant total iodine dose of 300 mg/kg body weight were used. Dynamic CT were acquired at the level of the pulmonary artery, and the ascending and descending aorta. After the time enhancement curves were computed, the pulmonary and aortic peak enhancement, time to peak and plateau time above 300 HU were calculated. RESULTS: Intra-individual peak contrast enhancement was significantly higher for the 300 mgI/ml contrast medium compared with the 370 and 400 mgI/ml media: pulmonary trunk 595 HU vs 516 HU (p = 0.0093) vs 472 HU (p = 0.0005), and aorta 505 HU vs 454 HU (p = 0.0008) vs 439 HU (p = 0.0001), respectively. Comparison of time to peaks showed no significant difference. Plateau times were significantly longer for the 300 mgI/ml than for the 370 and 400 mgI/ml CM at all anatomical sites. CONCLUSION: Given normalised IDR and total iodine burden, the use of CM with a standard concentration with 300 mg iodine/ml provides improved contrast enhancement compared with highly concentrated CM in the chest.

Semiautomated versus manual evaluation of liver metastases treated by radiofrequency ablation.

PURPOSE: To determine the accuracy of semiautomated volume and density measurements of liver metastases from colorectal and breast cancer before and after radiofrequency (RF) ablation compared with manual evaluation. MATERIALS AND METHODS: Twenty-five patients (mean age, 63.2 years +/- 10.7) with 50 known liver metastases from underlying primary breast (n = 15) or colorectal cancer (n = 35) underwent triphasic contrast-enhanced multidetector computed tomography (CT) to evaluate hepatic tumor load and localization before RF ablation and for postinterventional follow-up. Each lesion was quantified in terms of volume and CT value (in HU) with a semiautomated software tool and manually by an experienced radiologist before and 4 months after RF ablation. RESULTS: Before RF ablation, all 50 liver metastases, and after ablation, 49 of 50 ablation zones (98%), were correctly evaluated by the software. Mean lesion volumes before and after the intervention were 5.5 cm(3) and 22.4 cm(3), respectively. Corresponding concordance correlation coefficients between measurement techniques were 0.98 and 0.99, respectively, for volume; and 0.90 and 0.76, respectively, for CT value. CONCLUSIONS: Compared with manual measurements, semiautomated volumetric assessment of liver metastases before and after RF ablation demonstrated a high degree of correlation. Agreement of attenuation was slightly worse, particularly when assessing the postinterventional multidetector CT examination, probably because of the different regions of interest used for manual and semiautomated assessment of CT values.