Modified stent-assisted coil embolization technique to treat an internal iliac artery aneurysm.

Stent-assisted coil embolization is a well-described technique for the treatment of wide-necked intracranial aneurysms. We describe a modification of this technique used successfully to occlude a wide-necked internal iliac artery aneurysm.

Angioseal versus manual compression for haemostasis following peripheral vascular diagnostic and interventional procedures--a randomized controlled trial.

The aim of this study was to compare the angioseal device to manual compression for femoral artery puncture following peripheral vascular procedures, in the context of day case vascular procedures. One hundred patients were prospectively randomised to haemostasis using the angioseal device or manual compression following arterial puncture for peripheral vascular diagnostic or intervention procedures. Data were collected regarding time to haemostasis and complications immediately post-procedure, at 1h, 2h and at 1 week. There were 50 patients in each group. There were no significant differences in demographic variables, or in complication rates immediately, at 1h, 2h and at 1 week (Chi-squared). The only significant difference between the two groups was time to haemostasis. The mean time to haemostasis in the compression group was 10.6 min and 2.0 min in the angioseal group (t-test p<0.0001). In conclusion, no significant differences in complications were found between manual compression and angioseal. However, there was a significant difference in time to haemostasis.

Post-transplantation lymphoproliferative disorder: the spectrum of imaging appearances.

Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication of chronic immunosuppression following solid organ transplantation. Clinical presentation is non-specific and almost any organ can be affected. Early diagnosis is associated with a better prognosis but requires tissue sampling to ascertain the histopathological subtype of disease which cannot be predicted on imaging features alone. The radiologist has a key role in detecting the disorder, guiding biopsy and monitoring response to treatment which often only involves a reduction in immunosuppressive therapy. The aim of this paper is to illustrate the wide spectrum of imaging features in PTLD and emphasize the more specific findings which allow the diagnosis to be suggested at an early stage.

Differential diagnosis of intracranial lesions with high signal on T1 or low signal on T2-weighted MRI.

Magnetic resonance imaging (MRI) is the preferred technique for examining intracranial pathology in the non-acute setting in most cases. The aim of this review is to demonstrate the imaging appearances on unenhanced spin-echo MRI of lesions that show characteristic, unusual signal changes, which occur due to the presence of fat, cholesterol, paramagnetic substances, rapidly flowing fluids, air, cortical bone or calcification. The nature of the MRI signal, together with the anatomical location of the lesion should allow the provision of a narrow differential diagnosis, before the use of intravenous contrast medium or additional imaging sequences.

Embolisation of spinal dural arteriovenous fistulae with Onyx.

Surgery is currently the standard treatment for spinal dural arteriovenous fistulae (DAVF). Endovascular embolisation of these lesions using N-butyl cyanoacrylate (NBCA) has a high success rate. Onyx is a new liquid embolic agent whose viscosity makes it suitable for treatment of spinal DAVF where penetration into the proximal radicular vein is required. It is delivered with greater control than NBCA without the necessity for rapid withdrawal of the catheter and may therefore overcome some of the drawbacks of NBCA. We report two patients who underwent Onyx embolisation of spinal DAVF; to our knowledge this is the first such report.

A unique presentation of retroclival chordoma.

Chordomas are rare tumours which arise from remnants of the primitive notochord. They occur primarily in the sacrum, clivus and cervical regions. We report a case of retroclival chordoma which presented as an extradural haemorrhage following minor trauma. The underlying tumour was not apparent on imaging performed immediately following the event, and chordoma presenting in this manner has not previously been described in the literature. The tumour became apparent on subsequent imaging, and progressed despite surgical debulking and radiotherapy.