Prediction, pattern recognition and modelling of complications post-endovascular infra renal aneurysm repair by artificial intelligence.

OBJECTIVES: The study evaluates the plausibility and applicability of prediction, pattern recognition and modelling of complications post-endovascular aneurysm repair (EVAR) by artificial intelligence for more accurate surveillance in practice. METHODS: A single-centre prospective data collection on (n = 250) EVAR cases with n = 26 preoperative attributes (factors) on endpoint of endoleak (types I-VI), occlusion, migration and mortality over a 13-year period was conducted. In addition to the traditional statistical analysis, data was subjected to machine learning algorithm through artificial neural network. The predictive accuracy (specificity and -1 sensitivity) on each endpoint is presented with percentage and receiver operative curve. The pattern recognition and model classification were conducted using discriminate analysis, decision tree, logistic regression, naive Bayes and support vector machines, and the best fit model was deployed for pattern recognition and modelling. RESULTS: The accuracy of the training, validation and predictive ability of artificial neural network in detection of endoleak type I was 95, 96 and 94%, type II (94, 83, 90 and 82%) and type III was 96, 94 and 96%, respectively. Endpoints are associated with increase in weights through predictive modeling that were not detected through statistical analytics. The overall accuracy of the model was >86%. CONCLUSION: The study highlights the applicability, accuracy and reliability of artificial intelligence in the detection of adverse outcomes post-EVAR for an accurate surveillance stratification.

Cross-sectional study of the provision of interventional oncology services in the UK.

OBJECTIVE: To map out the current provision of interventional oncology (IO) services in the UK. DESIGN: Cross-sectional multicentre study. SETTING: All National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards. PARTICIPANTS: Interventional radiology (IR) departments in all NHS trusts/health boards in the UK. RESULTS: A total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures. CONCLUSION: The provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services.

Evaluation of a noise reduction imaging technology in iliac digital subtraction angiography: noninferior clinical image quality with lower patient and scatter dose.

PURPOSE: To determine whether equivalent-quality images can be obtained from digital subtraction angiography (DSA) of the iliac artery after implementation of a novel imaging technology that reduces patient and scatter x-ray dose. MATERIALS AND METHODS: Imaging using two randomly ordered DSA runs was performed in 51 adults scheduled for iliac artery angiography or intervention or both. One DSA run used standard acquisition chain and image processing algorithms (referred to as " reference DSA"), and the other DSA run used dose-reduction and real-time advanced image noise reduction technology (referred to as "study DSA"). The quality of each pair of runs, consecutively performed without changes in working projection or injection parameters, was independently rated by five radiologists blinded to the imaging technology used. Patient radiation dose was evaluated using air kerma and dose area product, and scatter dose was evaluated using three dosimeters (DoseAware, Philips Healthcare, Best, The Netherlands), located at fixed positions. RESULTS: Comparable image pairs were available in 48 patients. There were 44 patients undergoing treatment involving the common (n = 33) or external (n = 29) iliac arteries. Study DSA images were rated as equal to or better than reference DSA images for 96% of comparisons, with an average overall agreement among raters of 0.93 (95% confidence interval, 0.65-0.96). Mean patient radiation dose (n = 48) and scatter dose rate for the three dosimeters (n = 50) was 83% ± 5 and 69% ± 10 lower, respectively, using the study technology (P < .001). CONCLUSIONS: Iliac artery DSA performed using a dose-reduction and real-time advanced image noise reduction technology results in image quality that is noninferior to conventional DSA but with significantly lower patient and scatter radiation exposure (P < .001).

A mystifying mass.

A 57-year-old male was referred by his general practitioner (GP) to hospital with right upper quadrant pain and a palpable mass (10 × 9 cm). He had been assessed by his GP several weeks earlier and represented as initial treatment failed. On his second presentation a mass was evident and thought to represent cholecystitis by the referring GP. However, the correct and prompt use of appropriate radiological imaging enabled swift diagnosis and management of atypical acute appendicitis through microbial specific therapy. Atypical appendicitis delays diagnosis and treatment which represents greater levels of appendiceal ischaemia and heightened perforation risk. This case study highlights the non-surgical management of acute atypical appendicitis and also reinforces the use of appropriate imaging modalities.

Aneurysmal degeneration and type Ib endoleak with proximal aneurysm rupture: A case report, review of literature and technical suggestions.

INTRODUCTION: Despite the reduction in mortality incidences of AAA in proportion to increased use of EVAR, the natural history of aneurysms with the presence of an endoleak post EVAR remains unclear. With a cumulative AAA rupture incidence of 2% at six years post EVAR, the lack of an immediate endoleak is not an indicator of success. CASE REPORT: We present a case of an 80-year-old man who presented to the emergency department with generalised abdominal pain and hypotension. Four years earlier he had underwent an EVAR for a 6 cm infra-renal AAA. The computed tomography angiogram (CTA) illustrated aneurysmal dilatation of the left common iliac artery with extensive retroperitoneal haemorrhage. The patient was transferred to the operating room for an endovascular repair but due to significant episodes of haemodynamic instability, an emergency exploratory laparotomy was performed. To our surprise, there was a left-sided infra-renal anterolateral rupture of the aneurysm sac. The stent was explanted with difficulty from its fixed proximal aortic section down to left-sided common iliac artery. The fixed bare portion of the stent in the proximal aorta and in the right common iliac artery was left in-situ and the rest was integrated to a trouser graft with an end-to-end technique. DISCUSSION: On detection of an endoleak, the aim should focus on their endovascular management, as open conversions are associated with high mortality and morbidity. CONCLUSION: If open conversion is indicated, all technical aspects of the repair including partial stent extraction should be considered for best outcome.

Rare immune-mediated pneumonitis in association with post-streptococcal glomerulonephritis.

We describe the case of a 48-year-old man with an acute nephritis and respiratory failure. Clinical history, streptococcal antibody titres and renal biopsy led to a diagnosis of post-streptococcal glomerulonephritis. Respiratory investigations excluded pulmonary oedema and infection. We hypothesize that this man had a co-existing post-streptococcal glomerulonephritis and an immune-mediated pneumonitis. This is a very rare association, which was last described in 1982.

Minimally invasive treatment of small renal tumors: trends in renal cancer diagnosis and management.

Renal cell carcinoma is a common malignancy causing significant mortality. In recent years abdominal imaging, often for alternate symptomatology, has led the trend toward the detection and confirmation of smaller renal tumors. This has permitted the greater use of localized and nephron-sparing techniques including partial nephrectomy and image-guided ablation. This article aims to review the current role of image-guided biopsy and ablation in the management of small renal tumors. The natural history of renal cell carcinoma, the role of renal biopsy, the principles and procedural considerations of thermal energy ablation, and the oncological outcomes of these minimally invasive treatments are discussed and illustrated with cases from the authors' institution. Image-guided ablation, in particular, has changed the treatment paradigm and, by virtue of its increasingly evident efficacy and low morbidity, now favors the treatment of smaller tumors in patients previously unfit for surgery.