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Background CT-derived fractional flow reserve (CT-FFR) and dynamic CT myocardial perfusion imaging enhance the specificity of coronary CT angiography (CCTA) for ruling out coronary artery disease (CAD). However, evidence on comparative diagnostic value remains scarce. Purpose To compare the diagnostic accuracy of CCTA plus CT-FFR, CCTA plus CT perfusion, and sequential CCTA plus CT-FFR and CT perfusion for detecting hemodynamically relevant CAD with that of invasive angiography. Materials and Methods This secondary analysis of a prospective study included patients with chest pain referred for invasive coronary angiography at nine centers from July 2016 to September 2019. CCTA and CT perfusion were performed with third-generation dual-source CT scanners. CT-FFR was assessed on-site. Independent core laboratories analyzed CCTA alone, CCTA plus CT perfusion, CCTA plus CT-FFR, and a sequential approach involving CCTA plus CT-FFR and CT perfusion for the presence of hemodynamically relevant stenosis. Invasive coronary angiography with invasive fractional flow reserve was the reference standard. Diagnostic accuracy metrics and the area under the receiver operating characteristic curve (AUC) were compared with the Sign test and DeLong test. Results Of the 105 participants (mean age, 64 years ± 8 [SD]; 68 male), 49 (47%) had hemodynamically relevant stenoses at invasive coronary angiography. CCTA plus CT-FFR and CCTA plus CT perfusion showed no evidence of a difference for participant-based sensitivities (90% vs 90%, P > .99), specificities (77% vs 79%, P > .99) and vessel-based AUCs (0.84 [95% CI: 0.77, 0.91] vs 0.83 [95% CI: 0.75, 0.91], P = .90). Both had higher participant-based specificity than CCTA alone (54%, both P < .001) without evidence of a difference in sensitivity between CCTA (94%) and CCTA plus CT perfusion (P = .50) or CCTA plus CT-FFR (P = .63). The sequential approach combining CCTA plus CT-FFR with CT perfusion achieved higher participant-based specificity than CCTA plus CT-FFR (88% vs 77%, P = .03) without evidence of a difference in participant-based sensitivity (88% vs 90%, P > .99) and vessel-based AUC (0.85 [95% CI: 0.77, 0.93], P = .78). Compared with CCTA plus CT perfusion, the sequential approach showed no evidence of a difference in participant-based sensitivity (P > .99), specificity (P = .06), or vessel-based AUC (P = .54). Conclusion There was no evidence of a difference in diagnostic accuracy between CCTA plus CT-FFR and CCTA plus CT perfusion for detecting hemodynamically relevant CAD. A sequential approach combining CCTA plus CT-FFR with CT perfusion led to improved participant-based specificity with no evidence of a difference in sensitivity compared with CCTA plus CT-FFR. ClinicalTrials.gov registration no.: NCT02810795 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Sinitsyn in this issue.
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Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Humanos , Masculino , Feminino , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Idoso , Imagem de Perfusão do Miocárdio/métodos , Hemodinâmica/fisiologia , Sensibilidade e EspecificidadeRESUMO
PURPOSE: The objective of this study was to compare the outcomes of patients treated with tube grafts and AFX stent-graft in the narrow infrarenal aortic anatomy. MATERIALS AND METHODS: Patients with penetrating aortic ulcers (PAUs) or sacciform aneurysms of the infrarenal aorta and an aortic bifurcation diameter ≤20 mm who underwent endovascular aneurysm repair (EVAR) with bifurcated AFX or tube stent-grafts (TUBE) between 2012 and 2020 were included. Demographic data and the outcome of the AFX group were compared with the TUBE group. All morphological measurements in the preoperative and postoperative computed tomography scans were performed in the aortic centerline. RESULTS: Fifty-one patients (female: 12/51; 29%; median age: 72 years [63, 77]) with a median follow-up of 10 (3, 39) months, were included, of whom 35/51 (69%) had PAUs and 11/51 were symptomatic (22%). The aortic bifurcation diameter was 17 mm (15, 18) with severe calcifications in 25/51 (49%). The distal aortic landing zone was longer in the TUBE group (9 mm vs 24 mm; p<0.001). The technical success was 96% with a median aneurysm shrinkage of 8% (3, 13), which was comparable between the groups (p=0.264). Periprocedural mortality, conversion to open surgery, myocardial infarction, and stroke were not observed. Two type Ia endoleaks (EL) and 2 type Ib EL occurred, all in the TUBE group (Type 1 EL; 19 vs 0%; p=0.013). The limb patency in the AFX group was 100%. One patient with a tube graft developed an infrarenal aortic thrombosis 40 months after the intervention. The reintervention rate in the TUBE group was higher (14 vs 0%; p=0.032) and included 3 aortic cuff implantations and 1 covered endovascular aortic reconstruction of aortic bifurcation (CERAB). CONCLUSION: AFX stent-graft showed a lower rate of type I endoleaks and reinterventions in sacciform infrarenal aortic pathologies during the early and midterm follow-up.
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Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Feminino , Idoso , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Correção Endovascular de Aneurisma , Endoleak/diagnóstico por imagem , Endoleak/etiologia , Endoleak/cirurgia , Stents/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Resultado do Tratamento , Procedimentos Endovasculares/efeitos adversos , Estudos Retrospectivos , Prótese Vascular , Aorta Abdominal/cirurgia , Desenho de PróteseRESUMO
PURPOSE: To evaluate efficacy, safety, and outcomes of endovascular treatment of hepatic vein stenosis post major liver resection. METHODS: A retrospective data analysis was performed including all interventional treatments of hepatic vein stenosis post major liver resection since 2010. Post procedural course and clinical parameters including amount of ascites accumulation and relevant laboratory values were assessed during the follow-up period. Primary and primary assisted hepatic venous patency time were calculated. RESULTS: Twelve patients (median age 55.5, IQR 49.75 to 61.5 years) undergoing a total of 16 interventions were included. Interventions were primary stent placement (n = 3), primary balloon angioplasty (n = 8), three re-interventions and two aborted interventions (no significant pressure gradient). Technical success was 100% (16/16). Permanent reduction and / or complete resolution of ascites was achieved in 72% (8/11). Laboratory parameters related to liver function did not show significant improvement after intervention. Median follow-up period was 6 months (IQR: 1.5 to 18 months). The median primary patency time for patients with balloon angioplasty was 11 months (IQR: 1.375 to 22.25 months) and assisted patency time was 13.25 months (IQR: 4.5 to 22.25 months). The median primary patency time for patients with angioplasty and stent placement was 1 months (IQR: 1.0 to 1.5 months) and assisted patency time was 2.0 months (IQR: 1.5 to 2.5months). CONCLUSION: An endovascular approach for the treatment of hepatic venous stenosis post major liver resection is safe and efficient to reduce and / or resolve refractory ascites. However, liver function parameters seem not to be improved by the procedure. Stent placement can be a reasonable option in patients with significant residual stenotic disease post angioplasty.
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Angioplastia com Balão , Síndrome de Budd-Chiari , Procedimentos Endovasculares , Transplante de Fígado , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ascite/etiologia , Ascite/terapia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Resultado do Tratamento , Angioplastia com Balão/métodos , StentsRESUMO
PURPOSE: To evaluate the safety and efficacy of percutaneous interventional treatment of portal vein stenosis in children. MATERIAL AND METHODS: A retrospective analysis of all interventional treatments for portal vein stenosis in pediatric patients at a single institution from 2010 to 2021 was conducted. Platelet count, spleen size and portal vein flow velocity were assessed during the follow-up period. Primary and primary assisted patency time were determined. RESULTS: A total of ten children (median age 28.5 months, interquartile range (IQR): 2.75-52.5 months) with portal vein stenosis after Mesorex-Shunt (n = 4), liver transplantation (n = 3) and other etiologies (n = 3) underwent 15 interventional procedures. There were five reinterventions and one discontinued intervention. The technical success rate was 93.3% (14/15) and clinical success of treated patients was 100% (14/14). Median follow-up was 18 months (IQR: 13.5-81 months). The median primary patency time for stent placement was 70 months (IQR: 13.5-127.25 months). For balloon angioplasty, the median primary patency time was 9 months (IQR 7.25-11.5 months), while the median assisted primary patency time was 14 months (IQR: 12 to 15 months). Platelet count, spleen size and portal vein flow velocity reliably corresponded to recurrence of portal vein stenosis in asymptomatic patients during follow-up. CONCLUSION: Interventional treatment is a safe and efficient method to treat portal vein stenosis with long patency times, regardless of etiology. Primary stent placement shows a higher primary patency time than balloon angioplasty. Implementation of stent placement as the primary interventional method may improve patency times and reduce the need for repeat reinterventions in pediatric patients.
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Angioplastia com Balão , Veia Porta , Criança , Humanos , Pré-Escolar , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Resultado do Tratamento , Constrição Patológica/cirurgia , Estudos Retrospectivos , Angioplastia com Balão/efeitos adversos , Angioplastia com Balão/métodos , StentsRESUMO
BACKGROUND. Diagnosing liver lesions is challenging. CT is used for primary diagnosis, but its contrast resolution is limited. Investigating methods to improve detection of liver lesions is important. OBJECTIVE. The purpose of this study was to evaluate the effect of frequency-selective nonlinear blending on the detectability of liver lesions on CT. METHODS. A retrospective search yielded 109 patients with 356 malignant and benign liver lesions (191 principally diagnosed, 165 incidental findings) who underwent contrast-enhanced CT (CECT) in the portal venous phase and liver MRI between January 2012 and December 2017. Nonlinear blending was applied to CECT examinations, and three blinded readers independently rated the quality (5-point Likert scale) of randomly presented images. Focal lesions (n = 356) were evaluated for lesion identification and categorization to assess sensitivity. For 191 lesions (primary diagnosis), two readers evaluated CECT and nonlinear blending CT to compare lesion size and the accuracy of subjective measurements. A fourth reader performed ROI measurements for calculation of contrast-to-noise ratio (CNR), and a fifth reader reviewed MRI as the standard of reference. Statistics included interobserver agreement, quantitative comparisons of CNR, lesion size, and subjective image analyses of image quality and sensitivity for detecting liver lesions. RESULTS. Three readers rated the image quality of nonlinear blending CT (rating, 4; 10th-90th percentiles, 4-5) higher than that of CECT (rating, 2; 10th-90th percentiles, 1-3) (p < .001). CECT had good interreader agreement (interclass correlation coefficient [ICC], 0.81; 95% CI, 0.76-0.85), as did nonlinear blending CT (ICC, 0.75; 95% CI, 0.69-0.79). The median CNR of liver lesions increased with nonlinear blending (CECT, 4.18 [10th-90th percentiles, 1.67-9.06]; nonlinear blending CT, 12.49 [10th-90th percentiles, 6.18-23.39]; p < .001). Bland-Altman analysis of lesion size showed a reduction in underestimation from 2.5 (SD, 9.2) mm (95% CI, 1.2-3.9 mm) with CECT to 0.1 (SD, 3.9) mm (95% CI, -0.68 to 0.46 mm) for nonlinear blending CT (concordance correlation coefficient, 0.99). Sensitivity for detecting liver lesions increased to 86% for nonlinear blending CT. The sensitivity of CECT was 76%. CONCLUSION. Frequency-selective nonlinear blending in CECT increases image quality and CNR, increases the precision of size measurement, and increases sensitivity for detecting liver lesions. CLINICAL IMPACT. Use of nonlinear blending CT improves liver lesion detection and increases the accuracy of lesion size measurement, which is important when local ablation or liver transplant is being considered.
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Meios de Contraste , Neoplasias Hepáticas , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Padrões de Referência , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: Patients with hepatic metastatic uveal melanoma still have a poor outcome. PURPOSE: To evaluate overall survival (OS), progression-free survival (PFS), and response predictors in these patients treated with chemosaturation by percutaneous hepatic perfusion with melphalan (CS-PHP). MATERIAL AND METHODS: Between June 2015 and March 2020, a total of 29 patients (median age 69.7 years; age range 30-81 years; 60% women; median BMI 25.7 kg/m2; range 18.7-35.3kg/m2; 1-6 procedures per patient) were treated with 53 CS-PHPs. All patients received cross-sectional imaging for initial and follow-up examinations. Baseline tumor load, extrahepatic tumor load, tumor response, PFS, and OS were assessed. Non-parametric statistics were used. RESULTS: After the initial CS-PHP, a partial response was observed in 11 patients (41%), stable disease in 12 patients (44%) and progressive disease in 4 patients (15%); two patients died before the response was evaluated. After initial CS-PHP, median OS was 12.9 ± 7.4 months and median PFS was 7.1 ± 7.4 months. OS after one year was 50%. After the second CS-PHP, median PFS was 7.9 ± 5.7 months. Seven patients had a liver tumor burden >25%, associated with a significantly shorter OS (6.0 ± 2.4 vs. 14.1 ± 12.7 months; P = 0.008). At the time of first CS-PHP, 41% (12/29) of the patients had extrahepatic metastases that did not affect OS (11.1 ± 8.4 months vs. 12.9 ± 13.6 months; P = 0.66). CONCLUSION: CS-PHP is a safe and effective treatment for the hepatic metastatic uveal melanoma, especially for patients with a hepatic tumor burden <25%.
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Neoplasias Hepáticas , Segunda Neoplasia Primária , Neoplasias Uveais , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Alquilantes/efeitos adversos , Quimioterapia do Câncer por Perfusão Regional/efeitos adversos , Quimioterapia do Câncer por Perfusão Regional/métodos , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/tratamento farmacológico , Masculino , Melanoma , Melfalan/uso terapêutico , Pessoa de Meia-Idade , Neoplasias Uveais/diagnóstico por imagem , Neoplasias Uveais/tratamento farmacológicoRESUMO
OBJECTIVE: To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. MATERIAL AND METHODS: One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. RESULTS: OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. CONCLUSION: The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion's degree of calcification. KEY POINTS: ⢠Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. ⢠Target lesion's degree of calcification decreases technical success. ⢠Complications related to the distal vascular access were rare.
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Artéria Femoral , Doença Arterial Periférica , Doença Crônica , Estudos de Coortes , Artéria Femoral/diagnóstico por imagem , Humanos , Doença Arterial Periférica/diagnóstico por imagem , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: We investigated the mid-term results of carotid-axillary bypass (CAB) in the setting of zone II thoracic endovascular aortic repair as an alternative method for the left subclavian artery (LSA) revascularization. METHODS: Our retrospective, single cohort study included all 69 patients from March 2015 to December 2018 with zone II thoracic endovascular aortic repair and CAB for the revascularization of the LSA. Demographics and clinical data were collected. We assessed several clinical outcomes: local complications (hematoma, injury of the brachial plexus, vagus and sympathetic chain nerve palsies, chyle leakage), subclavian steal, arm ischemia, paraplegia, mortality, and stroke. Follow-up computed tomography scans were analyzed for CAB and vertebral artery (VA) patency and the extent of thrombus formation in the LSA. RESULTS: The in-hospital mortality was 3% and the perioperative stroke rate was 4%. Permanent paraplegia occurred in 3%. Perioperative morbidity included irritation of the brachial plexus (1%), sympathetic chain nerve palsy (1%), and wound hematoma in 3% of the cases. Phrenic and vagus nerve lesions and chyle leakage were not observed. Bypass patency was 97% at mean follow-up of 333 ± 39 days. VA occlusion was found in 6% of all cases. Strokes did not occur during the follow-up. Morbidity at follow-up included arm claudication (3%) in two patients with bypass thrombosis. Subclavian steal was observed in 3%. The LSA ostium was ligated (44%), plugged (22%), or left open (35%) in patients without a type II endoleak. Subgroup analysis of LSA thrombosis to the level of the VA was more prevalent after surgical ligature (P = .02), but had no negative effects on CAB or VA patency or stroke. CONCLUSIONS: CAB is a safe alternative to classic debranching procedures, with distinctive advantages regarding local complication rates described in the literature.
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Doenças da Aorta/cirurgia , Artéria Axilar/cirurgia , Artéria Carótida Primitiva/cirurgia , Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Artéria Axilar/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Stents , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/epidemiologia , Síndrome do Roubo Subclávio/etiologia , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
OBJECTIVES: To evaluate the predictive performance of the modified hepatoma arterial embolisation prognostic II (mHAP-II) score in a real-life western hepatocellular carcinoma (HCC) cohort treated with drug-eluting bead-TACE and compare the mHAP-II with other scores in this cohort. METHODS: One hundred seventy-nine HCC patients (mean age 77 (± 9) years, 87% male) with one or more drug-eluting bead (DEB)-TACE sessions using 100-300 µm microspheres were retrospectively analysed. Performance analysis of the mHAP-II score was based on Mann-Whitney U tests, the Kaplan-Meier method, log-rank tests, receiver operating characteristics, Akaike's information criterion and Cox regression models. RESULTS: In this population, HCC risk factors were mainly alcohol abuse (31%) and hepatitis C (28%). The median survival of the entire cohort was 29.4 months. mHAP-II classification of the cohort was mHAP-II B (30%), C (41%) and D (23%) respectively. Survival of all subgroups differed significantly from each other (each p < 0.05). Area under the curve for receiver operating characteristic was 0.60 and Akaike's information criterion was 21.8 (p = 0.03), indicating a superior performance of mHAP-II score compared with HAP score and BCLC. Tumour number ≥ two (HR 1.54), alpha-fetoprotein > 400 µg/l (HR 1.14), serum albumin < 3.6 g/dl (HR 1.63) and total bilirubin > 0.9 mg/dl (HR 1.58) contributed significantly in Cox proportional hazards regression (each p < 0.05). CONCLUSION: The mHAP-II score can predict survival outcomes of western HCC patients undergoing DEB-TACE and further subdivide this heterogeneous group; however, certain limitations concerning the predictive power of mHAP-II score must be taken into account. KEY POINTS: ⢠This retrospective study evaluated the predictive performance of the modified hepatoma arterial embolisation prognostic II (mHAP-II) score in a real-life western HCC cohort treated with drug-eluting bead-TACE. ⢠Survival of all mHAP-II subgroups differed significantly, area under the curve for mHAP-II was 0.60 and Akaike's information criterion was 21.8. ⢠The mHAP-II score can predict survival outcomes of western HCC patients undergoing DEB-TACE and further subdivide this heterogeneous group. However, because the study is underpowered, true survival prediction may be more difficult to infer.
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Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/tratamento farmacológico , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/tratamento farmacológico , Idoso , Carcinoma Hepatocelular/diagnóstico , Estudos de Coortes , Feminino , Humanos , Injeções Intra-Arteriais/métodos , Neoplasias Hepáticas/diagnóstico , Masculino , Microesferas , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos RetrospectivosRESUMO
PURPOSE: To provide an overview of endovascular treatment of renal artery stenosis (RAS) using the data of the Deutsche Gesellschaft für interventionelle Radiologie (DeGIR) quality management system. MATERIALS AND METHODS: A retrospective analysis was performed. Pre-, peri- and postprocedural data, technical success rates, complication rates, and clinical success rates at dismissal were examined. RESULTS: Between 2018 and 2021, 2134 angiography examinations of the renal arteries were performed: diagnostic angiography in 70 patients (3â%), balloon angioplasty in 795 (37â%), stent implantation in 1166 (55â%) and miscellaneous procedures in 103 (5â%). The lesion length was less than or equal to 5âmm in 1837 patients (87â%), between 5 and 10âmm in 197 (9â%), and between 10 and 20âmm in 62 (3â%). The degree of stenosis was less than 50â% in 156 patients (7â%), greater than 50â% in 239 (11â%), and greater than 70â% in 1472 (70â%). Occlusion was treated in 235 patients (11â%). Symptoms at discharge resolved in 600 patients (29â%), improved in 1012 (49â%), were unchanged in 77 (4â%), and worsened in 5 (0.2â%). Complications were reported in 51 patients (2.5â%) and the mortality rate was 0.15â%. CONCLUSION: A substantial number of patients with RAS and occlusions were treated by radiologists in Germany, with high technical success rates and low complication rates. The indication should be determined carefully as the current European guidelines for the treatment of RAS suggest that only carefully selected groups of patients will benefit from recanalizing treatment. KEY POINTS: · Carefully selected patient groups may benefit from endovascular treatment of renal artery stenosis.. · Analysis of the DEGIR quality management database shows that treatment of renal artery stenosis was performed by radiologists in Germany with high technical success rates and low complication rates.. · Recanalization even led to symptom improvement in a large proportion of patients with occlusions..
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Angioplastia com Balão , Procedimentos Endovasculares , Obstrução da Artéria Renal , Humanos , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/epidemiologia , Obstrução da Artéria Renal/terapia , Resultado do Tratamento , Estudos Retrospectivos , Angiografia , StentsRESUMO
This study investigated the efficacy of single-phase dual-energy CT (DECT) in differentiating pulmonary hamartomas from malignant lung lesions using virtual non-contrast (VNC), iodine, and fat quantification. Forty-six patients with 47 pulmonary lesions (mean age: 65.2 ± 12.1 years; hamartomas-to-malignant lesions = 22:25; male: 67%) underwent portal venous DECT using histology, PET-CT and follow-up CTs as a reference. Quantitative parameters such as VNC, fat fraction, iodine density and CT mixed values were statistically analyzed. Significant differences were found in fat fractions (hamartomas: 48.9%; malignancies: 22.9%; p ≤ 0.0001) and VNC HU values (hamartomas: -20.5 HU; malignancies: 17.8 HU; p ≤ 0.0001), with hamartomas having higher fat content and lower VNC HU values than malignancies. CT mixed values also differed significantly (p ≤ 0.0001), but iodine density showed no significant differences. ROC analysis favored the fat fraction (AUC = 96.4%; sensitivity: 100%) over the VNC, CT mixed value and iodine density for differentiation. The study concludes that the DECT-based fat fraction is superior to the single-energy CT in differentiating between incidental pulmonary hamartomas and malignant lesions, while post-contrast iodine density is ineffective for differentiation.
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Hamartoma , Iodo , Neoplasias Pulmonares , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Hamartoma/diagnóstico por imagemRESUMO
BACKGROUND: The Viabahn endoprosthesis has become a vital option for endovascular therapy, yet there is limited long-term data on its effectiveness for peripheral aneurysm repair. This study aimed to evaluate the safety, technical and clinical success, and long-term patency of the Viabahn endoprosthesis for treating femoropopliteal aneurysms. METHODS: This retrospective tertiary single-center study analyzed patients who underwent a Viabahn endoprosthesis procedure for femoropopliteal aneurysm repair from 2010 to 2020. Intraoperative complications, technical and clinical success rates, and major adverse events (MAE, including acute thrombotic occlusion, major amputation, myocardial infarction, and device- or procedure-related death) at 30 days were assessed. Incidence of clinically-driven target lesion revascularisation (cdTLR) was noted. Patency rates were evaluated by Kaplan-Meier analysis. RESULTS: Among 19 patients (mean age, 72 ± 12 years; 18 male, 1 female) who underwent aneurysm repair using the Viabahn endoprosthesis, there were no intraoperative adverse events, with 100% technical and clinical success rates. At the 30-day mark, all patients (19/19, 100%) were free of MAE. The median follow-up duration was 1,009 days [IQR, 462-1,466]. Popliteal stent graft occlusion occurred in 2/19 patients (10.5%) after 27 and 45 months, respectively. Consequently, the primary patency rates were 100%, 90%, 74% at 12, 24, and 36-72 months, respectively. Endovascular cdTLR was successful in both cases, resulting in sustained secondary patency at 100%. CONCLUSION: The use of Viabahn endoprostheses for femoropopliteal aneurysm repair demonstrated technical and clinical success rates of 100%, a 0% 30-day MAE rate, and excellent long-term patency.
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Background/Objectives: To evaluate radiation exposure in standard interventional radiology procedures using a twin robotic X-ray system compared to a state-of-the-art conventional angiography system. Methods: Standard interventional radiology procedures (port implantation, SIRT, and pelvic angiography) were simulated using an anthropomorphic Alderson RANDO phantom (Alderson Research Laboratories Inc. Stamford, CT, USA) on an above-the-table twin robotic X-ray scanner (Multitom Rax, Siemens Healthineers, Forchheim, Germany) and a conventional below-the-table angiography system (Artis Zeego, Siemens Healthineers, Forchheim, Germany). The phantom's radiation exposure (representing the potential patient on the procedure table) was measured with thermoluminescent dosimeters. Height-dependent dose curves were generated for examiners and radiation technologists in representative positions using a RaySafe X2 system (RaySafe, Billdal, Sweden). Results: For all scenarios, the device-specific dose distribution differs depending on the imaging chain, with specific advantages and disadvantages. Radiation exposure for the patient is significantly increased when using the Multitom Rax for pelvic angiography compared to the Artis Zeego, which is evident in the dose progression through the phantom's body as well as in the organ-related radiation exposure. In line with these findings, there is an increased radiation exposure for the performing proceduralist, especially at eye level, which can be significantly minimized by using protective equipment (p < 0.001). Conclusions: In this study, the state-of-the-art conventional below-the-table angiography system is associated with lower radiation dose exposures for both the patient and the interventional radiology physician compared to an above-the-table twin robotic X-ray system for pelvic angiographies. However, in other clinical scenarios (port implantation or SIRT), both devices are suitable options with acceptable radiation exposure.
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Background/Objectives: To assess free-breathing, dynamic radial magnetic resonance angiography (MRA) for detecting endoleaks post-endovascular aortic repair (EVAR) in cases with inconclusive computed tomography angiography (CTA). Methods: This prospective single-center study included 17 participants (mean age, 70 ± 9 years; 13 males) who underwent dynamic radial MRI (Golden-angle RAdial Sparse Parallel-Volumetric Interpolated BrEath-hold, GRASP-VIBE) after inconclusive multiphasic CT for the presence of endoleaks during the follow-up of EVAR-treated abdominal aortic aneurysms. CT and MRI datasets were independently assessed by two radiologists for image quality, diagnostic confidence, and the presence/type of endoleak. Statistical analyses included interrater and intermethod agreement, and diagnostic performance (sensitivity, specificity, area under the curve (AUC)). Results: Subjective image analysis demonstrated good image quality and interrater agreement (k ≥ 0.6) for both modalities, while diagnostic confidence was significantly higher in MRA (p = 0.03). There was significantly improved accuracy for detecting type II endoleaks on MRA (AUC 0.97 [95% CI: 0.87, 1.0]) compared to CTA (AUC 0.66 [95% CI: 0.41, 0.91]; p = 0.03). Although MRA demonstrated higher values for sensitivity, specificity, AUC, and interrater agreement, none of the other types nor the overall detection rate for endoleaks showed differences in the diagnostic performance over CT (p ≥ 0.12). CTA and MRA revealed slight to moderate intermethod concordance in endoleak detection (k = 0.3-0.64). Conclusions: The GRASP-VIBE MRA characterized by high spatial and temporal resolution demonstrates clinical feasibility with good image quality and superior diagnostic confidence. It notably enhances diagnostic performance in detecting and classifying endoleaks, particularly type II, compared to traditional multiphase CTA with inconclusive findings.
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BACKGROUND: The Viabahn stent graft has emerged as an integral tool for managing vascular diseases, but there is limited long-term data on its performance in emergency endovascular treatment. This study aimed to assess safety, technical success, and long-term efficacy of the Viabahn stent graft in emergency treatment of arterial injury. METHODS: We conducted a retrospective single tertiary centre analysis of patients who underwent Viabahn emergency arterial injury treatment between 2015 and 2020. Indication, intraoperative complications, technical and clinical success, and major adverse events at 30 days were evaluated. Secondary efficacy endpoints were the primary and secondary patency rates assessed by Kaplan-Meier analysis. RESULTS: Forty patients (71 ± 13 years, 19 women) were analyzed. Indications for Viabahn emergency treatment were extravasation (65.0%), arterio-venous fistula (22.5%), pseudoaneurysm (10.0%), and arterio-ureteral fistula (2.5%). No intraoperative adverse events occurred, technical and clinical success rates were 100%. One acute stent graft occlusion occurred in the popliteal artery on day 9, resulting in a 30-day device-related major-adverse-event rate of 2.5%. Median follow-up was 402 days [IQR, 43-1093]. Primary patency rate was 97% (95% CI: 94-100) in year 1, and 92% (95% CI: 86-98) from years 2 to 6. One stent graft occlusion occurred in the external iliac artery at 18 months; successful revascularization resulted in secondary patency rates of 97% (95% CI: 94-100) from years 1 to 6. CONCLUSION: Using Viabahn stent graft in emergency arterial injury treatment had 100% technical and clinical success rates, a low 30-day major-adverse-event rate of 2.5%, and excellent long-term patency rates.
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Background and Objective: Vascular calcification (VC) and resulting vascular disease is one of the major causes of cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD). CKD itself is increasingly recognized as a risk factor for cardiac and peripheral arterial disease (PAD). This paper examines the atherosclerotic plaque composition and specific endovascular considerations in the end stage renal disease (ESRD) patients. The literature was reviewed regarding the current status of medical and interventional management arteriosclerotic disease in patients with CKD. Lastly, three representative cases displaying typical endovascular treatment options are provided. Methods: A literature search was performed in PubMed covering publications up to September 2021 as well as discussion with experts in the field. Key Content and Findings: The high prevalence of atherosclerotic lesions in patients with chronic renal failure and high (re-)stenosis cause problems in the medium and long term as vascular calcium load represents one of the most widely encountered predictors of failure of endovascular treatment of PAD and future cardiovascular events (e.g., coronary calcium score). Patients with CKD also suffer from a greater risk for major vascular adverse events in general and worse revascularization outcomes following peripheral vascular intervention. A correlation between calcium burden and drug-coated balloon (DCB) performance has been established for PAD necessitating the need for different tools to cope with vascular calcium such as endoprosthesis or braided stents. Patients with CKD are at a higher risk of developing contrast-induced nephropathy (CIN). In addition to recommendations such as the administration of intravenous fluids, carbon dioxide (CO2) angiography is one option to potentially provide an effective and safe alternative both to iodine-based contrast media allergy and to the use of iodine-based contrast media in patients with CKD. Conclusions: Management and endovascular procedures of patients with ESRD are complex. In the course of time, new endovascular therapy methods have been developed such as directional atherectomy (DA) and the so-called "pave-and-crack" technique to deal with high vascular calcium burden. Besides interventional therapy, vascular patients with CKD benefit from aggressive medical management.
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PURPOSE: To evaluate the safety and efficacy of rotational thrombectomy (RT) in a large single-center real-world cohort for total vascular occlusions of the lower extremity. MATERIALS AND METHODS: The clinical records and images of all patients between 2010 and 2020 treated via RT (Rotarex, BD) were assessed. Patient demographics, clinical data, procedural characteristics, and outcome parameters were documented. In total, 397 procedures in 293 patients were included (mean age 69.8â±â12.0 years; 64.8â% male). Occlusions were acute (47.5â%), subacute and acute-on-chronic (22.2â%), and chronic (30.3â%). The target lesions were the iliac artery (7.1â%), iliac/femoropopliteal (5.0â%), femoropopliteal (59.4â%), femoropopliteal/below-the-knee (27.0â%), below-the-knee (1.5â%), and after bypass surgery (14.9â%). Lesion length was >â20âcm in 61.5â% of cases. RESULTS: Clinically successful revascularization was achieved in 90.4â% of cases. Additional thrombolysis was necessary for 32.0â% of procedures. The arithmetic mean ankle-brachial index increased from 0.33â±â0.29 to 0.81â±â0.25 (pâ<â0.0001). Bypass grafts were less likely to be fully treatable and required additional lysis (pâ<â0.001). The overall primary patency (no clinically driven target lesion revascularization) was 93.2â%, 88.8â%, 79.1â%, and 72.4â% at 1, 3, 6, and 12 months, respectively. Adverse events occurred in 46.1â% of cases, of which peripheral embolization (22.4â%) was most frequent, requiring interventional treatment in 67.4â% of cases. RT was directly associated with 7.1â% (nâ=â28) of complications, which consisted of perforations 2.8â%, arteriovenous fistula 1.3â%, and dissections 2.0â%. CONCLUSION: Rotational thrombectomy is a safe and efficient method for the treatment of occlusions of the arterial circulation of the lower extremity with bypass occlusions having a higher propensity for residual thrombi requiring further lysis therapy. KEY POINTS: · Rotational thrombectomy was safe and efficacious for treating occlusions of the lower extremities.. · Rotational thrombectomy was associated with 7.1â% of complications.. · Distal embolization occurred in 22.4â% of cases with 67.4â% requiring interventional treatment.. · Primary patency was 93.2â%, 88.8â%, 79.1â%, 72.4â% after 1, 3, 6, and 12 months, respectively.. CITATION FORMAT: · Artzner C, Martin I, Hefferman G etâal. Safety and Efficacy of Rotational Thrombectomy for Treatment of Arterial Occlusions of the Lower Extremities: A Large Single-Center Retrospective Study. Fortschr Röntgenstr 2023; 195: 406â-â415.
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Arteriopatias Oclusivas , Artéria Poplítea , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Estudos Retrospectivos , Artéria Poplítea/cirurgia , Trombectomia/métodos , Artéria Femoral/cirurgia , Arteriopatias Oclusivas/terapia , Arteriopatias Oclusivas/cirurgia , Extremidade Inferior , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
To evaluate Quiescent Interval Slice Selective (QISS) balanced steady-state free precession (bSSFP) and QISS fast low-angle shot (FLASH) sequences for non-contrast Magnetic Resonance Angiography (MRA) of iliac arteries regarding image quality and diagnostic confidence in order to establish these sequences in daily clinical practice. A prospective study of healthy subjects (n = 10) was performed. All subjects underwent the QISS MRI protocol with bSSFP und FLASH sequences. Vessel contrast-to-background ratio (VCBR) were measured in pre-defined vessel segments. Image quality and diagnostic confidence was assessed using a Likert scale (five-point scale). Inter-reader agreement was determined using Cohen's kappa coefficient (κ). Ten healthy subjects (median age 29 years, IQR: 26.25 to 30 years) were included in this prospective study. Median MR examination time was 2:05 min (IQR 1:58 to 2:16) for QISS bSSFP and 4:11 min (IQR 3:57 to 4:32) for QISS FLASH. Both sequences revealed good VCBR in all examined vessel segments. VCBR (muscle tissue) were marginally higher for FLASH sequences (e.g., 0.82 vs. 0.78 in the right femoral artery, p = 0.035*), while bSSFP sequence showed significantly higher VCBR (fat tissue) in the majority of examined arterials vessels (e.g., 0.78 vs. 0.62 in right femoral artery, p = 0.001*). The image quality and diagnostic confidence of both sequences were rated as good to excellent. Moderate to good inter-reader agreement was found. QISS MRA using bSSFP and FLASH sequences are diagnostic for visualization of iliac arterial vasculature. The QISS bSSFP sequence might offer advantages due to the markedly shorter exam time and superior visualization of smaller vessels. The QISS FLASH sequence seems to be a robust alternative for non-contrast MRA since it is less sensitive to magnetic field inhomogeneities.
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Artérias , Angiografia por Ressonância Magnética , Humanos , Adulto , Estudos Prospectivos , Valor Preditivo dos Testes , Angiografia por Ressonância Magnética/métodos , Reprodutibilidade dos Testes , Meios de ContrasteRESUMO
Even with liver-targeted therapies, uveal melanoma with hepatic metastasis remains a challenge. The aim of this study was to compare the outcome of patients treated with either SIRT or CS-PHP. We included 62 patients with hepatic metastasized uveal melanoma (n = 34 with SIRT, receiving 41 cycles; n = 28 with CS-PHP, receiving 56 cycles) that received their treatments between 12/2013 and 02/2020 at a single center. We evaluated their response according to the RECIST 1.1, as well as progression-free survival (PFS) and overall survival (OS), after the initiation of the first cycle of the liver-directed treatment using Cox regression, adjusted via propensity score analysis for confounders, including the amount of hepatic involvement. The disease control rate was 18% for SIRT and 30% for CS-PHP. The median (range) of PFS was 127.5 (19-1912) days for SIRT and 408.5 (3-1809) days for CS-PHP; adjusted Cox regression showed no significant difference (p = 0.090). The median (range) of OS was 300.5 (19-1912) days for SIRT and 516 (5-1836) days for CS-PHP; adjusted Cox regression showed a significant difference (p = 0.006). In our patient cohort, patients treated with CS-PHP showed a significantly longer OS than patients treated with SIRT. CS-PHP might therefore be preferable for patients with liver-dominant metastatic uveal melanoma.
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OBJECTIVES: In interventional bronchial artery embolization (BAE), periprocedural cone beam CT (CBCT) improves guiding and localization. However, a trade-off exists between 6-second runs (high radiation dose and motion artifacts, but low noise) and 3-second runs (vice versa). This study aimed to determine the efficacy of an advanced deep learning denoising (DLD) technique in mitigating the trade-offs related to radiation dose and image quality during interventional BAE CBCT. MATERIALS AND METHODS: This study included BMI-matched patients undergoing 6-second and 3-second BAE CBCT scans. The dose-area product values (DAP) were obtained. All datasets were reconstructed using standard weighted filtered back projection (OR) and a novel DLD software. Objective image metrics were derived from place-consistent regions of interest, including CT numbers of the Aorta and lung, noise, and contrast-to-noise ratio. Three blinded radiologists performed subjective assessments regarding image quality, sharpness, contrast, and motion artifacts on all dataset combinations in a forced-choice setup (-1 = inferior, 0 = equal; 1 = superior). The points were averaged per item for a total score. Statistical analysis ensued using a properly corrected mixed-effects model with post hoc pairwise comparisons. RESULTS: Sixty patients were assessed in 30 matched pairs (age 64 ± 15 years; 10 female). The mean DAP for the 6 s and 3 s runs was 2199 ± 185 µGym² and 1227 ± 90 µGym², respectively. Neither low-dose imaging nor the reconstruction method introduced a significant HU shift (p ≥ 0.127). The 3 s-DLD presented the least noise and superior contrast-to-noise ratio (CNR) (p < 0.001). While subjective evaluation revealed no noticeable distinction between 6 s-DLD and 3 s-DLD in terms of quality (p ≥ 0.996), both outperformed the OR variants (p < 0.001). The 3 s datasets exhibited fewer motion artifacts than the 6 s datasets (p < 0.001). CONCLUSIONS: DLD effectively mitigates the trade-off between radiation dose, image noise, and motion artifact burden in regular reconstructed BAE CBCT by enabling diagnostic scans with low radiation exposure and inherently low motion artifact burden at short examination times.