Initiation of Chemosaturation With Percutaneous Hepatic Perfusion Program in Interventional Radiology Department.

Objectives Chemosaturation with percutaneous hepatic perfusion (PHP) is a relatively new minimally-invasive liver-directed therapy, which aims to deliver high-dose chemotherapy into the liver with low systemic side effects. Initial studies showed promising results, especially in the treatment of metastatic uveal melanoma. But unfamiliarity of the interventional radiologists prevents its widespread implantation in clinical routine. This study aimed to outline how to initiate a PHP program and report initial results. Methods We retrospectively reviewed all patients who underwent chemosaturation with PHP in our institution between March 2016 and February 2017 and their follow-up results till October 2018. Patient demographics, procedural characteristics, clinical and imaging results, and complications were evaluated. Additionally, modifications regarding infrastructure and procedure techniques were described. Results A total of three patients (two females and one male) with a mean age of 59 underwent six PHP procedures. The primary disease was colorectal carcinoma in one patient and uveal melanoma in two patients. The technical success rate was 100% and the mean melphalan dose was 190.8 mg. No procedural death was observed. Patients were hospitalized for a mean of 3.3 days after procedures. Grade 3 and 4 complications were seen after 50% and 33.3% of procedures, respectively. Two patients showed partial response and the other patient showed stable disease after procedures. Mean hepatic progression-free survival was 10.8 months. Overall survival from the first procedure was 14.8 months in our cohort. Conclusion Our results show that chemosaturation with PHP offers a promising minimally invasive treatment option in patients with unresectable liver metastases. The technical challenges of PHP can be easily handled by an experienced interventional radiology (IR) team. It is a relatively safe procedure and its toxicities are usually hematological and can be manageable with close surveillance and appropriate medical therapies.

Outcomes of Radioembolization in Patients with Chemorefractory Colorectal Cancer Liver Metastasis: a Single-Center Experience.

PURPOSE: We aimed to evaluate the efficacy and outcomes of radioembolization with Yttrium-90 (Y-90) microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastasis (CRCLM). METHODS: This single-center study included 43 patients (34 male, 9 female) who underwent radioembolization with Y-90 for unresectable, chemorefractory CRCLM between September 2008 and July 2014. Overall survival (OS), liver progression-free survival (LPFS), overall response rate (ORR), local disease control rate (LDCR), and relations of these parameters with patient disease characteristics were evaluated. OS and LPFS rates were compared according to microspheres. Survival rates were calculated with Kaplan-Meier method, and potential prognostic variables were evaluated on univariate analyses. RESULTS: Post-procedural median OS was 12.8 months. LPFS was 5.6 months. ORR was 33%, LDCR was 67% on 3rd month follow-up. Low tumor burden (< 25%) was associated with higher median OS after radioembolization (< 25 vs > 25-50% p < 0.0001 and < 25 vs > 50% p = 0.005). Patients with left colon tumors exhibited significantly longer median OS after metastasis than right colon tumors (p = 0.046). Extrahepatic disease and synchronicity showed poorer survival parameters; however, the difference was not significant (p = 0.1 and p = 0.3, respectively). In subgroup analyses, the distribution of patient number and characteristics showed heterogeneity as number of patients with low tumor burden was higher in resin Y-90 group. Resin Y-90 group exhibited significantly higher median OS and LPFS compared to glass Y-90 group (16.5 vs. 7 months, p = 0.001; 6.73 vs. 3.38 months, p = 0.023, respectively). CONCLUSION: Radioembolization is a safe local-regional treatment option in chemorefractory, inoperable CRCLM. Radioembolization at earlier stages may lead to more favorable results especially with lower tumor burden patients.

Endovascular treatment of true renal artery aneurysms: a single center experience.

PURPOSE: We aimed to report a single center's experience on endovascular treatment of true renal artery aneurysms (TRAAs), including treatment techniques and outcomes. METHODS: This retrospective study was designed to evaluate the treatment and follow-up of TRAAs treated by a variety of endovascular interventional techniques over a period of 6 years. Six patients with nine TRAAs were identified; seven of the TRAAs were treated using different combinations of coil embolization and flow diverter stents. The clinical findings, aneurysm characteristics, endovascular methods and treatment outcomes were reported. RESULTS: Seven TRAAs of six patients were treated, with a median aneurysm size of 20 mm. Three TRAAs were treated with primary sac occlusion (one with primary coil embolization, one with balloon and stent assisted coil and glue embolization, and one with amplatzer vascular occlusion device and coil embolization). The remaining four TRAAs of three patients were treated with flow diverter stents (Cardiatis, Silk, Pipeline, and Surpass). Immediate clinical success was achieved in patients treated with primary sac embolization (95% CI, 29.2%-100%). Among patients treated with flow diverter stents, one patient required an additional flow diverter at 6-month follow-up. The occlusion time in flow diverters ranged from 1 month to 12 months (median, 3.5 months) taking the repeat procedure into account. In patients treated with flow diverters, the clinical success rate was 100% (95% CI, 29.2%-100%) at one-year follow-up. Long-term follow-up ranged from 3 to 52 months. One intraprocedural complication was encountered with a flow diverter during deployment, which required additional stenting and tirofiban infusion. No other major complication was seen. CONCLUSION: Endovascular treatment is an effective and safe method offering high success rates and low morbidity in the treatment of TRAAs and may supplant surgery as the primary therapy. Current experience in the use of flow diverter stents in TRAAs is limited to individual case reports with one brand of flow diverter device. Our small numbered series of four TRAAs shows our experience regarding endovascular treatment with different flow diverter brands.

Trapezius Port Placement in Patients with Breast Cancer: Long-Term Follow-up and Quality-of-Life Assessment.

PURPOSE: To evaluate the long-term results of and patient satisfaction with trapezius ports in breast cancer patients, as an alternative to chest ports. PATIENTS AND METHODS: This retrospective study included all patients who underwent trapezius port placement from December 2007 to January 2017. Seventy female patients with breast cancer, with a mean age of 54 ± 9.9 years (range, 29-76 years), were included. Indications for trapezius implantation were bilateral breast surgery or unilateral breast surgery and contralateral breast involvement. Sixty-eight of 70 patients had long-term follow-up. A retrospective, questionnaire-based survey was conducted to assess satisfaction and the trapezius port's effect on the daily life of the patient. RESULTS: All implantations were technically successful. Total catheter service time for 68 patients was 65,952 days (2 patients were lost to follow-up). Mean catheter service time was 969.8 days (range 7-3,458 days; median 570 days; 95% confidence interval, 739-1199; standard deviation, 947.7). No immediate procedural complications occurred. Port complications developed in 4 patients (5.9%); port infection developed in 2 patients (0.03/1,000 days); skin dehiscence developed in 1 patient (0.02/1,000 days); and port malfunction developed in 1 patient (0.02/1,000 days). The overall infection rate was 2.9% (2/68). All patients (n = 44) or a close relative (n = 17) who were interviewed with a phone call reported satisfaction regarding their ports. CONCLUSIONS: Trapezius ports offer a safe and feasible option to patients with breast cancer who need an alternative site to chest ports. It is also associated with high overall patient satisfaction.

Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension.

AIM: To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH). METHODS: In this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes. RESULTS: A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. CONCLUSION: Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

Quantitative liver tumor blood volume measurements by a C-arm CT post-processing software before and after hepatic arterial embolization therapy: comparison with MDCT perfusion.

PURPOSE: We aimed to determine whether the C-arm computed tomography (CT) blood volume (BV) imaging of hepatic tumors performed with a new prototype software is capable of measuring the BV changes in response to hepatic arterial treatments and to validate these quantitative measurements with commercially available multidetector computed tomography (MDCT) perfusion software. METHODS: A total of 34 patients with hepatic tumors who underwent either radioembolization (RE, n=21) or transarterial chemoembolization (TACE, n=13) were included in the study. Using a prototype software by Siemens Healthcare, 74 C-arm CT BV measurements were obtained in both pre- and postembolization settings (three patients had additional BV measurements before and after work-up angiography for RE). Ten of 34 patients underwent MDCT perfusion study before embolization, enabling comparison of BV measurements using C-arm CT versus MDCT methods. RESULTS: The mean BV of 14 tumor lesions in 10 patients on MDCT perfusion was highly correlated with the BV values on C-arm CT (r=0.97, P < 0.01). The BV values obtained by C-arm CT decreased from 140.6±28.3 mL/1000 mL to 45.9±23.5 mL/1000 mL after TACE (66.37% reduction) and from 175.6±29.4 mL/1000 mL to 84.1±22.5 mL/1000 mL after RE (53.75% reduction). DISCUSSION: Quantitative BV measurement with C-arm CT is well-correlated with MDCT BV measurements, and it is a promising tool to monitor perfusion changes during hepatic arterial embolization.

Transarterial chemoembolization for treatment of hepatocellular carcinoma: A single center experience.

BACKGROUND/AIMS: We aimed to determine the effect of transarterial chemoembolization treatment on survival in patients with hepatocellular carcinoma and to investigate the efficacy and tolerability of two different transarterial chemoembolization procedures, conventional transarterial chemoembolization and drug-eluting beads, in these patients. MATERIALS AND METHODS: A total of 40 patients with hepatocellular carcinoma treated with transarterial chemoembolization between January 2007 and March 2011 were included. Thirty-seven patients had Child-Pugh class A and the remaining 3 had class B. Intra-arterial administration of doxorubicin with lipiodol-based conventional transarterial chemoembolization or drug-eluting beads-transarterial chemoembolization was performed. Eighty sessions were performed with a median of 2 sessions. Sixteen patients were treated with conventional transarterial chemoembolization and 11 with drug-eluting beads-based transarterial chemoembolization, and 13 were treated with both treatment procedures in separate sessions. Primary outcome was defined as patient survival after treatment. RESULTS: The median follow-up was 19 months. The median overall survival of patients was 23.2 months. The survival of patients with Child-Pugh class A was significantly better than that of patients with class B (24 vs 6 months, p=0.004). No statistically significant difference in survival was observed between conventional transarterial chemoembolization and drug-eluting beads-based transarterial chemoembolization treatments (p>0.05). Baseline low serum albumin level (p=0.003) and the presence of portal vein thrombosis (p=0.011) negatively affected patient survival. Side effects of conventional transarterial chemoembolization and drug-eluting beads-based transarterial chemoembolization were similar. CONCLUSIONS: Based on the results of this study and in comparison with the findings in the literature, transarterial chemoembolization treatment was seen to improve overall survival and provide better outcome in selected patients with hepatocellular carcinoma. No differences in survival or side effects were observed between the two transarterial chemoembolization treatment modalities.

Portal vein embolization with different embolic agents for right hepatectomy.

BACKGROUND/AIMS: We aimed to retrospectively evaluate our experience in portal vein embolization that induces hypertrophy of the future liver remnant before right hepatectomy and to determine the differences in outcome with respect to the embolic agents used. METHODS: Twenty right portal vein embolization procedures performed in our institution between 2004 and 2009 were reviewed in this study. The average patient age was 59 years (range: 45-72 years). Embolization was performed through a right portal vein percutaneous access with use of the combination of several agents. Computed tomography volumetry was performed before and 4-6 weeks after the procedure to measure total liver volume and future liver remnant. RESULTS: There was no major complication related to the embolization procedures. After embolization, future liver remnant/total liver volume ratio increased to 12.7%, which was statistically significant. No significant difference was noted in hypertrophic outcomes between alcohol and the other embolic agents. Although five patients had sufficient future liver remnant, they did not undergo subsequent hepatectomy for a variety of reasons. CONCLUSIONS: According to our results, the mean increase in the size of the future liver remnant was greater than reported in previous studies of portal vein embolization. Despite the limited patient number of our study, we believe that portal vein embolization is helpful especially in gray-zone patients who may be a good candidate for surgical resection and thus possible cure. However, randomized, controlled studies with hypertrophy- inducing agents are needed.

Mesenteric angiography of patients with gastrointestinal tract hemorrhages: a single center study.

PURPOSE: This retrospective study was designed to investigate the transcatheter mesenteric angiography of patients with gastrointestinal (GI) bleeding and to determine the most important variables that should be monitored in patients with GI bleeding prior to transcatheter arteriography. MATERIALS AND METHODS: In this study, we evaluated the transcatheter mesenteric angiography results of patients with massive GI bleeding (defined as hypotension, tachycardia, and a greater than 4-unit blood transfusion requirement in 24 h) seen between 2005 and 2009. Detailed clinical follow-up and accessible hospital data from 45 procedures were examined from 42 patients (two procedures were performed in three patients) between 24 and 85 years old (mean age, 57.6 years). The present study included 33 males and 9 females. Angiography was performed for lower GI bleeding in 22 patients, upper GI bleeding in 15 patients, and upper/lower (multiple origins) GI bleeding in five patients. Imaging work-ups, including endoscopic interventions, and follow-ups with patients after the procedure were evaluated in detail. Several variables recorded prior to the procedure, including the clinical status, etiological cause of the bleeding, bleeding parameters (e.g., international normalized ratio, platelets), imaging workup, gender, season, and angiography time, were examined. RESULTS: Embolization was performed in 24 (53%) of the 45 procedures. Overall, the technical success rate of the diagnostic arteriograms was 100%, and no major complications occurred. For the embolizations, coils were used in 17 patients (70%), polyvinyl alcohol particles were used in six patients (25%), and n-butyl cyano-acrylate was used in one patient (4%). The detection rate of mesenteric arteriographies to examine GI bleeding performed outside of normal working hours was significantly greater than the detection rate of the arteriographies performed during normal working hours (P = 0.050). Low platelet levels or a prolonged prothrombin time were not associated with the mesenteric arteriography results (P = 1.00). Interestingly, the intermittent nature of GI bleeding was the most challenging part of detection, which made management of the bleeding difficult. Blind embolization of the left gastric artery was only helpful in preventing massive bleeding in three out of eight patients with upper GI bleeding. CONCLUSION: Endoscopy for upper gastrointestinal bleeding and scintigraphy for lower gastrointestinal bleeding are important steps in the management and outcome of transcatheter angiography. Computerized tomography angiography is a promising tool for the treatment of both upper and lower GI bleeding, and this procedure has become part of the imaging toolset. In addition, angiography performed outside of working hours had a higher rate of clinical success than the angiographies performed in working hours, most likely secondary to much appropriate timing of arteriogram in terms of critical bleeding intervals.

Percutaneous management of peripheral vascular malformations: a single center experience.

PURPOSE: To review the therapeutic results of the combination of embolization and sclerotherapy, with or without surgery, in patients with peripheral vascular malformations (PVMs). MATERIALS AND METHODS: A total of 40 patients (24 males and 16 females) with PVMs, who were treated via percutaneous embolization (transarterial [TA] versus direct puncture [DP]) and sclerotheraphy between March 2003 and September 2009, were included in this retrospective study. The mean age was 28 years (range, 6-66 years), and 9 patients (7 boys, 2 girls) were ≤18 years of age (range, 6-18 years). The 40 patients experienced 40 PVMs, of which 15 were localized to an upper extremity, 13 to a lower extremity, 7 to the axial body, and 5 to the pelvis. A total of 22 PVMs were high-flow, whereas 18 were low-flow. Indications for treatment included pain, swelling, extremity function loss, and cosmetic concerns. RESULTS: A total of 85 embolization/sclerotheraphy sessions were performed (2.1 sessions per patient). For the 22 high-flow PVMs, 53 treatment sessions were completed (2.4 sessions per lesion). Of the high-flow PVMs, 10 were treated via embolization only (7 DP, 2 TA, 1 DP and TA), 5 via alcohol sclerotheraphy only (2 DP, 2 TA, 1 DP and TA) and 7 via a combination of embolization and sclerotheraphy (3 TA, 4 DP and TA). The agents of embolization and sclerotherapy were n-butyl cyanoacrylate (n=22 patients), Onyx® (n=12 patients), and alcohol (n=19 patients). A total of 18 low-flow PVMs were treated in 32 sessions (1.8 sessions per lesion), all via the direct puncture approach. Of the low-flow PVMs, 11 were treated with embolization only, 6 with sclerotheraphy only, and 1 with a combined approach. In 16 patients (6 high-flow versus 10 low-flow), after a mean of 2.1 sessions (range, 1-9 sessions), the percutaneously treated lesions were excised by surgery without any major complications. In the 24 patients who did not have surgery, the lesions significantly decreased in size and the complaints from these patients improved. In four patients, skin ulcerations were identified, two of these patients needed surgical grafting; whereas in one patient, sciatic nerve paralysis developed after trans-arterial embolization and recovery was achieved in six months. CONCLUSION: Percutaneous treatment of PVMs by embolization and sclerotheraphy is a safe and effective method, provided that appropriate lesion classification and treatment agent selection are performed.

Is there an alternative to TIPS? Ultrasound-guided direct intrahepatic portosystemic shunt placement in Budd-Chiari syndrome.

Budd-Chiari syndrome is a spectrum of manifestations which develops as a result of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive vascular and interventional radiological procedure indicated in the management of refractory ascites in such patients. Conventional TIPS requires the presence of a patent hepatic vein and reasonable accessibility to the portal vein, and in patients with totally occluded hepatic veins, this procedure is technically challenging. Direct intrahepatic portosystemic shunt (DIPS) or so called "percutaneous TIPS" involves ultrasound-guided percutaneous simultaneous puncture of the portal vein and inferior vena cava followed by introduction of a guidewire through the portal vein into the inferior vena cava, as a deviation from conventional TIPS. Described here is our experience with DIPS. Three patients with BCS who had refractory ascites but were unsuitable for conventional TIPS due to occlusion of the hepatic veins were chosen to undergo the DIPS procedure. Our technical success was 100%. The shunts placed in two patients remain patent to date, while the shunt in a third patient with underlying antiphospholipid syndrome was occluded a month after the procedure. The percutaneous TIPS procedure seems to be technically feasible and effective in the management of refractory ascites as a result of BCS, particularly in the setting of occluded hepatic veins.

Unilobar tapering cirrhosis in a patient with Caroli syndrome associated with an abnormal common bile duct.

Caroli syndrome is a rare condition and is composed of congenital cystic dilatation of the biliary system and congenital hepatic fibrosis. Although many associated conditions are defined and hypothesized to occur concomitantly, due to the rarity of this syndrome, none has proven to be an essential component of this syndrome. In order to investigate a patient presenting with a cholestatic clinical picture, ultrasound, endoscopic retrograde cholangiopancreatography, abdominal computed tomography, liver biopsy, splenoportal venous angiography, and all available liver tests were performed. Upon typical findings, a diagnosis of Caroli syndrome was made and an orthotopic liver transplantation was performed. Investigation of the patient demonstrated multiple intracystic stones mimicking hemangiomatosis in the ultrasound; severe irregularity and narrowing in the main bile duct mimicking sclerosing cholangitis in the endoscopic retrograde cholangiopancreatography; partial portal vein thrombosis with irregularity in the portography; and a unilobar cirrhosis of the left liver lobe while the right lobe demonstrated only congenital hepatic fibrosis in the explanted liver. Caroli syndrome may be associated with main bile duct and portal vein abnormalities. Although the syndrome can be monolobar in nature, a cirrhotic left lobe sparing the right lobe, partially affected by the cirrhotic process, has never been defined. Here, we report a case of Caroli syndrome who had liver transplantation, with very rare and interesting findings of the explanted liver, such as tapering cirrhosis from the left lobe to the right lobe and countless stones in biliary cysts mimicking hemangiomas.

Radioembolization for the treatment of unresectable liver cancer: initial experience at a single center.

PURPOSE: Radioembolization with yttrium-90 microsphere (Y-90) therapy with SIR-Spheres (Sirtex Medical, Lane Cove, Australia) was approved by the Turkish Ministry of Health in April 2008. In this study, we present the preliminary experience at a tertiary care center with early follow-up results of Y-90 therapy, as well as a review of the related literature. MATERIALS AND METHODS: Complete evaluation for radioembolization was performed in 10 patients (8 males, 2 females; mean age, 52.3 years) during an 8-month period at a single center, of which 9 were actually treated with SIR-Spheres(R). All patients underwent meticulous pre- and post-procedural imaging studies to document the therapy response. RESULTS; In order to isolate the target hepatic arterial circulation, following branches were embolized as they were considered as potential gastrointestinal shunts: the gastroduodenal artery (n = 5), right gastric artery (n = 1), and supraduodenal artery (n = 1). Radioembolization therapy could not be performed only in one patient because of a hepatogastric shunt of unknown origin. No significant hepatopulmonary shunting was identified (maximum, 9% shunting). The body surface area method was used to calculate the Y-90 dose in all patients (mean dose, 1.24 GBq). All patients had at least partial response of the targeted liver lesions, according to RECIST (Response Evaluation Criteria in Solid Tumors). CONCLUSION: In comparison to chemoembolization, radioembolization has less systemic toxicity and can be performed as an outpatient procedure, which makes it more attractive to both patients and physicians. From our limited experience, the radioembolization procedure is a promising first-line treatment in unresectable liver cancer; randomized controlled multi-center studies, however, are needed.

The impact of warmed intravenous contrast material on the bolus geometry of coronary CT angiography applications.

OBJECTIVE: This study was designed to investigate the effect of administration of warmed contrast material (CM) on the bolus geometry and enhancement as depicted on coronary CT angiography. MATERIALS AND METHODS: A total of 64 patients (42 men, 22 women; mean age, 56 years) were randomly divided into two groups. Group 1 included 32 patients administered CM (Omnipaque [Iohexol] 350 mg I/ mL; Nycomed, Princeton, NJ) saline solutions kept in an incubator at a constant temperature (37 degrees C). Group 2 included 32 patients administered the CM saline solutions kept at constant room temperature (24 degrees C). Cardiac CT scans were performed with a dual source computed tomography (DSCT) scanner. For each group, region of interest curves were plotted inside the ascending aorta, main pulmonary artery and descending aorta on test bolus images. Using enhancement values, time/enhancement diagrams were produced for each vessel. On diagrams, basal Hounsfield unit (HU) values were subtracted from sequentially obtained values. A value of 100 HU was accepted as a cut-off value for the beginning of opacification. The time to peak, the time required to reach 100 HU opacification, maximum enhancement and duration of enhancement above 100 HU were noted. DSCT angiography studies were evaluated for coronary vessel enhancement. RESULTS: Maximum enhancement values in the ascending aorta, descending aorta and main pulmonary artery were significantly higher in group 1 subjects. In the ascending aorta, the median time required to reach 100 HU opacification during the test bolus analysis was significantly shorter for group 2 subjects than for group 1 subjects. In the ascending aorta, the descending aorta and main pulmonary artery, for group 1 subjects, the bolus geometry curve shifted to the left and upwards as compared with the bolus geometry curve for group 2 subjects. CONCLUSION: The use of warmed CM yields higher enhancement values and a shorter time to reach maximum enhancement duration, resulting in a shift of the bolus geometry curve to the left that may provide optimized image quality.

Myocardial bridging as evaluated by 16 row MDCT.

PURPOSE: The purpose of this study is to find out the prevalence, appearance and clinical symptoms of myocardial bridging (MB) by MDCT coronary angiography (CTA). MATERIALS AND METHODS: A total of 280 (50 females) consecutive patients followed with coronary artery disease or postoperative stent and bypass control, underwent CTA performed by 16-MDCT scanner between January 2006 and April 2006. Short axis multiplanar reformatted images were evaluated. MBs were classified as complete and incomplete bridges with respect to continuity of the myocardium over the tunneled segment of left anterior descending artery (LAD) in interventricular groove and the cut-off value is 1.3mm. Patients diagnosed with MB on CTA who had prior catheter angiography studies were re-evaluated for the presence of MB. RESULTS: One hundred and twenty MBs [98 (81.6%) on LAD, 2 (1.6%) on diagonal branch, 11 (9.1%) on obtuse marginal, 4 (3.3%) on right coronary artery, 5 (4.1%) on ramus intermedius artery] were detected in 108 (38.5%) patients. Eighty-five (70.8%) of bridged segments in 79 (28.2%) patients were complete and the rest [35 (29.2%) in 34 (12.1%) patients] were incomplete. In 12 patients two MBs (either on different arteries or on the same artery) were detected. The length of bridged segments in patients with complete and incomplete MBs varied between 4-50.9mm (mean 18mm) and 4-37.3mm (mean 13.6mm), respectively, and the depth of myocardium over the artery ranged between 1-6.4mm (mean 2.3mm) and 1-1.2mm (mean 1mm), respectively. Thirty (27.7%) out of 108 patients, in whom MB was detected on CTA, were found to have correlative catheter angiography studies, retrospectively and MB was detected only in 4 (13.3%) out of 30 patients. CONCLUSION: MDCT coronary angiography is a non-invasive, efficient method in the diagnosis of MB avoiding the procedural risks that catheter angiography carries. MDCT coronary angiography allows direct visualization of the bridge itself and may thus give the opportunity to differentiate between complete and incomplete myocardial bridges.

"Portal double ductopathy sign" in patients with portal vein cavernous transformation.

BACKGROUND/AIMS: The aim of this study was to determine to what extent portal vein cavernous transformation affects the biliary tract and pancreatic duct system concurrently. METHODOLOGY: Patients who had liver cirrhosis, liver malignancy, history of chronic alcohol use, chronic pancreatitis, pancreatic cancer, or surgery of upper abdomen were excluded. Endoscopic retrograde cholangiopancreatography was performed on all patients. The radiographic images from the biliary and pancreatic systems obtained at the same session were evaluated. RESULTS: In 36 patients, both systems were evaluated. In 2 out of 36 patients, the biliary system was normal, while in 5 patients (13.9%) the pancreatic duct was found to be normal. Thus, 31 patients (12 men, 19 women) had successful visualization. Additionally, 31 out of 36 patients had luminal narrowing throughout the pancreatic duct, local atrophy at head of the pancreas with moderate dilatation behind the narrowed segment. These findings were not found in control patients. In 4 patients who underwent splenectomy for severe hypersplenism, radiological findings were consistent with surgical findings. CONCLUSIONS: The above mentioned morphological findings which are demonstrated in biliary and pancreatic duct are novel findings which the authors propose to call "portal double ductopathy sign" when both ducts are affected concurrently.

Endovascular management of life-threatening retroperitoneal bleeding.

BACKGROUND: The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings. METHODS: A total of 16 patients with retroperitoneal bleeding who underwent angiography followed by transcatheter embolization within a 4-year period in a single centre were reviewed retrospectively. Electronic charts as well as procedural reports were reviewed to assess immediate angiographic findings and results of embolization. RESULTS: Computed tomography was carried out in eight patients. All computed tomography scans showed retroperitoneal haematoma. In addition, contrast material extravasation consistent with active bleeding was seen in two patients and pseudoaneurysm in one. In the remaining eight patients, diagnosis of retroperitoneal bleeding was established based on combined ultrasound and clinical findings. The technical success rate for selective embolotherapy was 100%. Five of these 16 patients (three women and 13 men) had lumbar artery injury; 10 patients were associated with renal artery injury and one had bilateral internal iliac artery injury. Angiography showed active extravasation, pseudoaneurysm and arteriovenous fistula. For embolization, coils were used in six patients and N-butyl-2-cyanoacrylate in the remaining 10 patients. Four patients died within 1 month of embolotherapy. CONCLUSION: Transcatheter embolotherapy appears to be a life-saving, safe and effective treatment for retroperitoneal bleedings that may be carried out in emergency situations in haemodynamically unstable patients.