Facilitated Retrograde Access via the Facial Vein for Transvenous Embolization of the Cavernous Sinus Dural Arteriovenous Fistula with Isolated Ophthalmic Venous Drainage.

Management of cavernous sinus dural arteriovenous fistula (CSDAVF) continues to present significant challenges, particularly when the inferior petrosal sinus is thrombosed, collapsed, or angiographically invisible. In this study, we introduce facilitated retrograde access via the facial vein, which is employed in the transvenous embolization of CSDAVF with isolated superior ophthalmic venous drainage. We also present illustrative cases and technical points.

Comparative Assessment of Crohn's Disease Activity Using Magnetic Resonance Enterography and Endoscopy.

Introduction Magnetic resonance enterography (MRE) has emerged as a promising technique for evaluating the extent and severity of Crohn's disease activity. To compare how we measure Crohn's disease activity with MRE and endoscopy. Material and methods We retrospectively reviewed MRE studies of 60 patients with suspicious Crohn's disease who underwent 1.5-T MRI examinations (T1-weighted images pre- and post-IV contrast medium administration and T2-weighted images) and endoscopy within one month, and they were evaluated by one radiology consultant with experience of 17 years. Endoscopy was used as the reference standard for diagnosing active Crohn's disease cases. Data analysis was performed using the websites (www.graphpad.com and www.medcalc.org) and Microsoft Excel (Microsoft® Corp., Redmond, USA). Results A total of 35 patients were included in the study. The remaining 25 patients were excluded either due to non-available data in the endoscopy report or cases of non-Crohn's disease. The MRI examinations were reviewed by one radiology consultant and revealed 27 active and eight non-active Crohn's disease cases compared to 30 active and five non-active Crohn's disease cases in endoscopy. The sensitivity of MRI in detecting active cases of Crohn's disease compared to endoscopy was 83.3% and the specificity of 60%. The strength of agreement between both methods was fair to good (Kappa = 0.347, p-value = 0.4497, Chi-squared = 0.571 with one degree of freedom). Conclusion MRE statistically has a good impact on the assessment of Crohn's disease as well as endoscopy with the parameters used in this study. Non-invasiveness and the changes of activity seen in the bowel proximal to the ileocecal junction undetectable by endoscopy make MRE more practically applicable in this aspect.

Preliminary report on embolization with quick-soluble gelatin sponge particles for angiographically negative acute gastrointestinal bleeding.

Prophylactic embolization is usually performed using gelatin sponge particles, which are absorbed within several weeks, for managing angiographically negative gastrointestinal bleeding. This study aimed to evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) with quick-soluble gelatin sponge particles (QS-GSP) that dissolve in less than 4 h for treating angiographically negative gastrointestinal bleeding. We included ten patients (M:F = 7:3; mean age, 64.3 years) who underwent prophylactic TAE with QS-GSP for angiographically negative acute gastrointestinal bleeding between 2021 and 2023. The technical success rate of TAE, clinical outcomes focusing on rebleeding, and procedure-related complications were evaluated. The embolized arteries were the gastroduodenal (n = 3), jejunal (n = 4), and ileal (n = 3) arteries. QS-GSP (150-350 µm or 350-560 µm) were used alone (n = 8) or in combination with a coil (n = 1). A 100% technical success rate was accomplished. In 1 patient (10%), rebleeding occurred 2 days after prophylactic TAE of the gastroduodenal artery, and this was managed by repeat TAE. There were no procedure-related complications. The use of QS-GSP for prophylactic TAE appears to be safe and effective for controlling bleeding among patients with angiographically negative gastrointestinal bleeding. There were no cases of related ischemic complications of the embolized bowels likely attributable to recanalization of the affected arteries following biodegradation of QS-GSP.

Awareness and Knowledge of Ionizing Radiation in Common Radiological Investigation and Associated Risks Among Medical and Applied Medical Sciences Students at Majmaah University.

AIM: This study aims to evaluate the awareness and knowledge of ionizing radiation in common radiological investigations, as well as the associated risks, among medical and applied medical sciences students at Majmaah University in Majmaah, Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study involved 209 participants who completed an anonymous electronic questionnaire consisting of 21 questions. Participants were categorized based on demographic characteristics and assessed for their awareness and knowledge of radiation and its associated risks. Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) software, version 24.0 (IBM Corp., Armonk, NY, USA). Qualitative data comparisons were performed using the Chi-square test, with a p-value of <0.05 considered statistically significant. RESULTS: A total of 209 participants completed the questionnaire, with a nearly equal distribution of males (49.8%) and females (50.2%). Most of the participants were medical students (59.3%). The overall knowledge score had a mean of 2 (SD=2) and a range of 0-7. The overall awareness score had a mean of 3 (SD=2) and a range of 0-6. Male gender and knowledge had a significant association (p=0.022). Applied medical sciences students had a significantly higher awareness level than medical students (p=0.004). There was a significant association between academic level and knowledge level (p=0.025), which was highest among third-year students. CONCLUSION:  Overall medical and applied medical sciences students' knowledge and awareness of ionizing radiation dose and the health risks associated with it was reported to be low. The results highlight the need to train medical and applied medical sciences students with sufficient radiological education that enable them to adhere to safe practices in the future.

Awareness of Interventional Radiology Among Medical Students at Majmaah University, Saudi Arabia.

INTRODUCTION: Interventional radiology (IR) is a medical specialty that employs imaging techniques such as X-rays, ultrasound, CT scans, and MRI to guide minimally invasive procedures for diagnosing and treating a variety of medical disorders. The purpose of this investigation was to determine the level of IR awareness among medical students at Majmaah University. METHODS: The cross-sectional investigation was carried out among the medical students at Majmaah University in Saudi Arabia. A self-administered questionnaire that had been pretested was used to gather the data. SPSS Statistics (IBM Corp. IBM SPSS Statistics for Windows. Armonk, NY: IBM Corp) was used to analyze the data. The chi-square test was used to compare qualitative data, and a p-value <0.05 was considered significant. RESULTS: There were 202 students who participated in this study, and among them, the majority were males, 126 (62.4%), and the majority of them were pre-clinical students, 105 (52.0%). Knowledge of routinely performed procedures by IR (only by a radiologist) was assessed; 116 (57.4%) of them responded with paracontinuous transluminal coronary angioplasty, 105 (52.0%) with central venous access, and 100 (49.5%) with lower arterial limp percutaneous transluminal angioplasty, which are routinely performed procedures by the radiologists. There was no significant difference in knowledge levels between genders. CONCLUSION: Increasing awareness of IR among medical students is essential to improving patient outcomes and addressing healthcare challenges. Efforts to educate and expand access to IR services must be prioritized to ensure that medical students receive a comprehensive education and that patients receive the highest quality care possible.

Comparison of transradial and transfemoral access for transcatheter arterial embolization of iatrogenic renal hemorrhage.

BACKGROUND: There are few reports of renal artery embolization (RAE) via transradial access (TRA) for renal hemorrhage, and none have compared outcomes of RAE via TRA and transfemoral access (TFA). The objective was to compare technical and clinical outcomes in patients undergoing RAE via TRA or TFA for iatrogenic renal hemorrhage. MATERIALS AND METHODS: This study included 45 RAE procedures (16 TRA and 29 TFA) for iatrogenic renal hemorrhage in 43 patients performed at a tertiary referral center between October 2018 and December 2020. Information regarding underlying diseases, coagulation status, angiographic and embolization procedure details, technical and clinical successes, and complications were retrospectively evaluated. RESULTS: There were no differences in demographics, underlying diseases, updated Charlson comorbidity scores, angiographic findings, and volume of contrast material between the TRA and TFA groups. By contrast, prothrombin time and international normalized ratio were significantly lower in the TRA than in the TFA group. Embolic materials differed significantly in the two groups. Procedure duration, fluoroscopy time, digital subtraction angiography number, and dose area product were slightly lower in the TRA than in the TFA group, but the differences were not statistically significant. Technical and clinical success rates in the TRA and TFA groups were 100% and 96.6%, and 100% and 96.6%, respectively. No patient in either group experienced procedure-related complications during a 4 week follow-up period. CONCLUSION: RAE via TRA in the management of iatrogenic renal hemorrhage was safe and feasible, with similar procedure duration and radiation exposure to RAE via TFA. TRA may be an acceptable alternative to TFA in these patients.

Sorafenib Combined with Chemoembolization for Locally Advanced Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score Analysis.

The purpose of this study was to compare the efficacy and safety of transarterial chemoembolization (TACE) plus sorafenib with those of TACE alone in patients with locally advanced hepatocellular carcinoma (HCC). Treatment-naïve patients with preserved hepatic reserve (Child-Pugh score ≤ 7) who received TACE plus sorafenib (n = 91) or TACE alone (n = 109) for locally advanced HCC with macrovascular invasion were retrospectively evaluated. Propensity score matching (PSM) was used to correct selection bias, and 63 pairs were created. In the entire study population, the median progression-free survival (PFS) and overall survival (OS) with TACE plus sorafenib were better than those with TACE alone. After PSM, the median PFS (7.0 vs. 4.3 months; p = 0.017) and OS (17.5 vs. 12.8 months; p = 0.049) were again significantly longer with TACE plus sorafenib than with TACE alone. Stratified Cox regression analysis and doubly robust estimation revealed that treatment type was significantly associated with both PFS and OS. In the subgroup analysis, TACE plus sorafenib did not show a significant survival benefit for patients with main portal vein or inferior vena cava invasion. Major complications were similar in both groups (p = 0.330). In conclusion, TACE plus sorafenib showed better survival outcomes than TACE alone in patients with locally advanced HCC.