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In this report, we present a case of a radiotherapy-induced tracheoesophageal fistula treated with the fluoroscopy-guided insertion of a covered stent through the gastrostomy route using both the antegrade and retrograde approaches. The initial antegrade endoscopic and fluoroscopic stent insertion procedure failed due to severe esophageal stricture. Compared to the endoscopic approaches, fluoroscopy-guided radiologic procedures are generally less invasive and more successful because they allow for a better understanding of the anatomy outside the lumen during the procedure and enable the use of devices with smaller diameters.
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ABSTRACT: If the cause of the bile leakage after hepaticojejunostomy is accidental non-anastomosis of one bile duct, it is unlikely that the leakage will resolve spontaneously, and reoperation may be necessary. However, if the patient has contraindications to surgery, other treatments should be considered. In this case report, we describe a new percutaneous tract creation between the isolated right bile duct and Roux-en-Y afferent jejunal loop in a patient who underwent hepaticojejunostomy, and the right bile duct was accidentally not anastomosed with the jejunal loop.
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BACKGROUND: Transvenous access for endovascular treatment of dysfunctional hemodialysis (HD) access can be technically difficult in the retrograde selection of the HD access. This study aims to evaluate the efficacy of primary antegrade wire guidance in assisting transvenous access. METHODS: A total of 41 transvenous access procedures (17 with and 24 without antegrade wire guidance), performed between March 2019 and February 2023, were included. Electronic medical records and procedural images were retrospectively reviewed. RESULTS: Of the 41 procedures, 17 performed primary antegrade wire guidance (group A) and 24 did not (group B). The technical success rate was 100% in group A and 95.8% (23/24) in group B. The mean retrograde selection time was 16.7 min in group A, whereas it was 30.9 min in group B (p = 0.014). Additional intraprocedural fistulography was not performed in group A, while it was performed at an average of 1.5 times (range: 0-4) in group B (p = 0.001). One patient in group B experienced venous dissection as a minor complication; however, no major complications were observed in either of the groups. CONCLUSIONS: Using primary antegrade wire guidance in endovascular treatment of dysfunctional HD access via alternative transvenous access is safe and time-saving.
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Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%-54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%-20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques.
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This study aimed to develop a convolutional neural network (CNN) using the EfficientNet algorithm for the automated classification of acute appendicitis, acute diverticulitis, and normal appendix and to evaluate its diagnostic performance. We retrospectively enrolled 715 patients who underwent contrast-enhanced abdominopelvic computed tomography (CT). Of these, 246 patients had acute appendicitis, 254 had acute diverticulitis, and 215 had normal appendix. Training, validation, and test data were obtained from 4,078 CT images (1,959 acute appendicitis, 823 acute diverticulitis, and 1,296 normal appendix cases) using both single and serial (RGB [red, green, blue]) image methods. We augmented the training dataset to avoid training disturbances caused by unbalanced CT datasets. For classification of the normal appendix, the RGB serial image method showed a slightly higher sensitivity (89.66 vs. 87.89%; p = 0.244), accuracy (93.62% vs. 92.35%), and specificity (95.47% vs. 94.43%) than did the single image method. For the classification of acute diverticulitis, the RGB serial image method also yielded a slightly higher sensitivity (83.35 vs. 80.44%; p = 0.019), accuracy (93.48% vs. 92.15%), and specificity (96.04% vs. 95.12%) than the single image method. Moreover, the mean areas under the receiver operating characteristic curve (AUCs) were significantly higher for acute appendicitis (0.951 vs. 0.937; p < 0.0001), acute diverticulitis (0.972 vs. 0.963; p = 0.0025), and normal appendix (0.979 vs. 0.972; p = 0.0101) with the RGB serial image method than those obtained by the single method for each condition. Thus, acute appendicitis, acute diverticulitis, and normal appendix could be accurately distinguished on CT images by our model, particularly when using the RGB serial image method.
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Apendicite , Apêndice , Diverticulite , Humanos , Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Estudos Retrospectivos , Doença Aguda , Diverticulite/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To investigate the image quality of lower extremity computed tomography angiography (LE-CTA) using a reconstruction algorithm for monoenergetic images (MEIs) to evaluate peripheral arterial disease (PAD) at different kiloelectron volt (keV) levels. METHODS: A total of 146 consecutive patients who underwent LE-CTA on a dual-energy scanner to obtain MEIs at 40, 50, 60, 70, and 80 keV were included. The overall image quality, segmental image quality of the arteries and PAD segments, venous contamination, and metal artifacts from prostheses, which may compromise quality, were analyzed. RESULTS: The mean overall image quality of each MEI was 2.9 ± 0.7, 3.6 ± 0.6, 3.9 ± 0.3, 4.0 ± 0.2, and 4.0 ± 0.2 from 40 to 80 keV, respectively. The segmental image quality gradually increased from 40 to 70-80 keV until reaching its highest value. Among 295 PAD segments in 68 patients, 40 (13.6%) were scored at 1-2 at 40 keV and 13 (4.4%) were scored at 2 at 50 keV, indicating unsatisfactory image quality due to the indistinguishability between high-contrast areas and arterial calcifications. The segments exhibiting metal artifacts and venous contamination were reduced at 70-80 keV (2.6 ± 1.2, 2.7 ± 0.5) compared with at 40 keV (2.4 ± 1.1, 2.5 ± 0.7). CONCLUSION: The LE-CTA method using a reconstruction algorithm for MEIs at 70-80 keV can enhance the image quality for PAD evaluation and improve mitigate venous contamination and metal artifacts.
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Doença Arterial Periférica , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Humanos , Angiografia por Tomografia Computadorizada/métodos , Artefatos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Algoritmos , Doença Arterial Periférica/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Razão Sinal-Ruído , Estudos RetrospectivosRESUMO
Early diagnosis of deep venous thrombosis is essential for reducing complications, such as recurrent pulmonary embolism and venous thromboembolism. There are numerous studies on enhancing efficiency of computer-aided diagnosis, but clinical diagnostic approaches have never been considered. In this study, we evaluated the performance of an artificial intelligence (AI) algorithm in the detection of iliofemoral deep venous thrombosis on computed tomography angiography of the lower extremities to investigate the effectiveness of using the clinical approach during the feature extraction process of the AI algorithm. To investigate the effectiveness of the proposed method, we created synthesized images to consider practical diagnostic procedures and applied them to the convolutional neural network-based RetinaNet model. We compared and analyzed the performances based on the model's backbone and data. The performance of the model was as follows: ResNet50: sensitivity = 0.843 (± 0.037), false positives per image = 0.608 (± 0.139); ResNet152 backbone: sensitivity = 0.839 (± 0.031), false positives per image = 0.503 (± 0.079). The results demonstrated the effectiveness of the suggested method in using computed tomography angiography of the lower extremities, and improving the reporting efficiency of the critical iliofemoral deep venous thrombosis cases.
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Embolia Pulmonar , Trombose Venosa , Humanos , Inteligência Artificial , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/complicações , Embolia Pulmonar/etiologia , Angiografia/efeitos adversos , Extremidade InferiorRESUMO
Peripheral arterial disease (PAD) is common in elderly patients. Lower-extremity CT angiography (LE-CTA) can be useful for detecting PAD and planning its treatment. PAD can also be accurately evaluated on reconstructed monoenergetic images (MEIs) from low kiloelectron volt (keV) to high keV images using dual-energy CT. Low keV images generally provide higher contrast than high keV images but also feature more severe image noise. The noise-reduced virtual MEI reconstruction algorithm, called the Mono+ technique, was recently introduced to overcome such image noise. Therefore, this pictorial review aimed to present the imaging findings of PAD on LE-CTA and compare low and high keV images with those subjected to the Mono+ technique. We found that, in many cases, the overall and segmental image qualities were better and metal artifacts and venous contamination were decreased in the high keV images.
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[This corrects the article DOI: 10.1016/j.radcr.2020.10.027.].
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Percutaneous sclerotherapy is a safe and effective treatment for renal parapelvic cysts. However, if the cyst is in communication with the adjacent renal pelvocalyceal system, sclerotherapy is contraindicated and alternative treatment should be considered. Here, we report a case of a patient with a symptomatic renal parapelvic cyst that was treated using a novel technique involving percutaneous new tract formation between the cyst and renal pelvis.
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Cistos , Doenças Renais Císticas , Cistos/terapia , Drenagem/métodos , Humanos , Doenças Renais Císticas/complicações , Doenças Renais Císticas/terapia , Pelve Renal , Escleroterapia/métodos , Resultado do TratamentoRESUMO
In this study, we aimed to investigate quantitative differences in performance in terms of comparing the automated classification of deep vein thrombosis (DVT) using two categories of artificial intelligence algorithms: deep learning based on convolutional neural networks (CNNs) and conventional machine learning. We retrospectively enrolled 659 participants (DVT patients, 282; normal controls, 377) who were evaluated using contrast-enhanced lower extremity computed tomography (CT) venography. Conventional machine learning consists of logistic regression (LR), support vector machines (SVM), random forests (RF), and extreme gradient boosts (XGB). Deep learning based on CNN included the VGG16, VGG19, Resnet50, and Resnet152 models. According to the mean generated AUC values, we found that the CNN-based VGG16 model showed a 0.007 higher performance (0.982 ± 0.014) as compared with the XGB model (0.975 ± 0.010), which showed the highest performance among the conventional machine learning models. In the conventional machine learning-based classifications, we found that the radiomic features presenting a statistically significant effect were median values and skewness. We found that the VGG16 model within the deep learning algorithm distinguished deep vein thrombosis on CT images most accurately, with slightly higher AUC values as compared with the other AI algorithms used in this study. Our results guide research directions and medical practice.
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PURPOSE: To evaluate the safety, efficacy, and long-term outcome of bronchial artery embolization (BAE) in the treatment of non-massive hemoptysis and the prognostic factors associated with recurrent bleeding. MATERIALS AND METHODS: From March 2005 to September 2014, BAE was performed in 233 patients with non-massive hemoptysis. All patients had a history of persistent or recurrent hemoptysis despite conservative medical treatment. We assessed the technical and clinical success, recurrence, prognostic factors related to recurrent bleeding, recurrence-free survival rate, additional treatment, and major complications in all the patients. RESULTS: Technical success was achieved in 224 patients (96.1%), and clinical success was obtained in 219 (94.0%) of the 233 patients. In addition, 64 patients (27.5%) presented hemoptysis recurrence with median time of 197 days after embolization. Tuberculosis sequelae and presence of aberrant bronchial artery or non-bronchial systemic collaterals were significantly related to recurrent bleeding (p < 0.05). The use of Histoacryl-based embolic materials significantly reduced the recurrent bleeding rate (p < 0.05). Patient who had a tuberculosis sequelae showed a significantly lower recurrence-free survival rate (p = 0.013). Presence of aberrant bronchial artery or non-bronchial systemic collaterals showed a statistically significant correlation with recurrence-free survival rate (p = 0.021). No patients had major complications during follow-up. CONCLUSIONS: BAE is a safe and effective treatment to manage non-massive hemoptysis. The procedure may offer a better long-term control of recurrent hemoptysis and quality of life than conservative therapy alone.
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Artérias Brônquicas/diagnóstico por imagem , Embolização Terapêutica/métodos , Hemoptise/diagnóstico por imagem , Hemoptise/terapia , Adulto , Idoso , Cateterismo/métodos , Estudos de Coortes , Estudos de Viabilidade , Feminino , Seguimentos , Esponja de Gelatina Absorvível/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: We compared the image quality according to the radiation dose on computed tomography (CT) venography at 80 kVp using advanced modeled iterative reconstruction for deep vein thrombus and other specific clinical conditions considering standard-, low-, and ultralow-dose CT. METHODS: In this retrospective study, 105 consecutive CT venography examinations were included using a third-generation dual-source scanner in the dual-source mode in tubes A (reference mAs, 210 mAs at 70%) and B (reference mAs, 90 mAs at 30%) at a fixed 80 kVp. Two radiologists independently reviewed each observation of standard- (100% radiation dose), low- (70%), and ultralow-dose (30%) CT. The objective quality of large veins and subjective image quality regarding lower-extremity veins and deep vein thrombus were compared between images according to the dose. In addition, the CT dose index volumes were displayed from the images. RESULTS: From the patients, 24 presented deep vein thrombus in 69 venous segments of CT examinations. Standard-dose CT provided the lowest image noise at the inferior vena cava and femoral vein compared with low- and ultralow-dose CT (p < 0.001). There were no differences regarding subjective image quality between the images of popliteal and calf veins at the three doses (e.g., 3.8 ± 0.7, right popliteal vein, p = 0.977). The image quality of the 69 deep vein thrombus segments showed equally slightly higher scores in standard- and low-dose CT (4.0 ± 0.2) than in ultralow-dose CT (3.9 ± 0.4). The CT dose index volumes were 4.4 ± 0.6, 3.1 ± 0.4, and 1.3 ± 0.2 mGy for standard-, low-, and ultralow-dose CT, respectively. CONCLUSIONS: Low- and ultralow-dose CT venography at 80 kVp using an advanced model based iterative reconstruction algorithm allows to evaluate deep vein thrombus and perform follow-up examinations while showing an acceptable image quality and reducing the radiation dose.
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Algoritmos , Flebografia , Doses de Radiação , Intensificação de Imagem Radiográfica , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Stents , Trombose Venosa/diagnóstico por imagemRESUMO
Coronary artery fistula is an abnormal communication between the coronary artery and either the cardiac chamber or the great vessel. In particular, the coronary-to-pulmonary artery fistula can be supplied by either one or both coronary arteries and drains to the pulmonary trunk. We report a unique case of fistula originating from both coronary arteries and draining into both sinuses of the main pulmonary artery in a 57-year-old female who experienced chronic chest pain and palpitation. Dilated and tortuous fistulas were found in coronary angiography and coronary computed tomography angiography examinations. To aid early diagnosis and clinical management, radiologists should be aware of the characteristic radiologic findings.
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OBJECTIVES: Transcatheter arterial embolisation (TAE) is widely used to treat gastrointestinal bleeding. This paper reports the safety and efficacy of TAE for bleeding following endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection. METHODS: Fifteen consecutive patients (13 males, two females; mean age 62.2 years) from two tertiary medical centres who underwent TAE for gastroduodenal bleeding after endoscopic resection from November 2001 to December 2020 were included. Patient demographics, clinical presentations, angiographic findings, and TAE details were retrospectively reviewed. RESULTS: Immediate bleeding during endoscopic resection was noted in four patients. Delayed bleeding 1-30 days after endoscopic resection in nine patients presented with haematochezia (n = 4), haematemesis (n = 6) and melaena (n = 1). Endoscopic haemostasis was attempted in 11 patients (73.3%) but failed due to continued bleeding despite haemostasis (n = 6), failure to secure endoscopic field (n = 3) and unstable vital signs (n = 2). Eleven patients had positive angiographic findings for bleeding, and all bleeding arteries were embolised except one owing to failed superselection of the bleeder. In the other four patients with negative angiographic findings, the left gastric artery with/without the right gastric artery or the accessory left gastric artery was empirically embolised using gelatin sponge particles. Both technical and clinical success rates were 93.3% (14/15). No procedure-related complications occurred during follow-up. CONCLUSIONS: TAE is safe and effective in the treatment of immediate and delayed bleeding after endoscopic resection procedures. ADVANCES IN KNOWLEDGE: This is the first and largest 20-year bicentric study published in English on this topic. Empirical TAE for angiographically negative bleeding sites was also effective without significant complications.
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Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Complicações Pós-Operatórias/terapia , Neoplasias Gástricas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia , Feminino , Gastroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To report a case of delayed splenic rupture after percutaneous transsplenic portal vein stent deployment. CASE REPORT: A 72-year-old male patient presented at a medical center with abdominal pain and reduced liver function according to laboratory tests. Due to a history of right hemihepatectomy and left portal vein occlusion, the percutaneous transhepatic approach was considered inappropriate. Instead, percutaneous transsplenic access was selected as a suitable procedure for portal vein catheterization. Eight days following the procedure, the patient developed abdominal pain, and a computed tomography scan showed a small splenic pseudoaneurysm that was underappreciated at the time. Patient suffered acute splenic rupture 32 days post-procedure. Subsequent embolization was performed, achieving complete hemostasis. CONCLUSION: The transsplenic approach should be considered when the transhepatic or transjugular approach is unfeasible or difficult to implement. A careful plugging of the puncture tract is necessary to prevent or minimize hemorrhage from the splenic access tract. In addition, careful serial follow-up computed tomography should be used to evaluate the splenic puncture tract.
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Procedimentos Endovasculares/efeitos adversos , Veia Porta , Ruptura Esplênica/etiologia , Doenças Vasculares/terapia , Idoso , Angiografia por Tomografia Computadorizada , Constrição Patológica , Embolização Terapêutica , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Flebografia , Veia Porta/diagnóstico por imagem , Veia Porta/fisiopatologia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/terapia , Stents , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologiaRESUMO
Liver injury is a common consequence of blunt abdominopelvic trauma. Contrast-enhanced CT allows for the rapid detection and evaluation of liver injury. The treatment strategy for blunt liver injury has shifted from surgical to nonoperative management, which has been widely complemented by interventional management to treat both liver injury and its complications. In this article, we review the major imaging features of liver injury and the role of interventional management for the treatment of liver injury.
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Spontaneous renal artery thrombosis is a rare cause of flank pain and can have fatal consequences. We report a case of acute renal artery thrombosis in a 61-year-old man who experienced flank pain and had no medical history. A contrast-enhanced computed tomography scan revealed total thrombotic occlusion of the left renal artery. The patient was taken to interventional radiology, and an urgent catheter-directed thrombolysis of the renal artery was performed. The procedure was successful, with the subsequent arteriogram demonstrating a substantial decrease of the thrombus extent and the recanalization of the left renal artery. This case highlights that emergency renal artery thrombolysis is an effective and safe treatment for acute occlusion of the renal artery.