Diagnostic and interventional radiology最新文献

Purpose: To evaluate coronary microvascular function using 13N-ammonia positron emission tomography/ computed tomography in individuals with pathogenic transthyretin (TTR) gene mutations, with and without cardiac involvement. This study is the first to assess coronary flow reserve (CFR) in this population before overt cardiac amyloidosis (CA) is detectable by conventional imaging.

Methods: We evaluated microvascular impairment by measuring CFR in 20 patients with and 20 patients without cardiac involvement due to TTR amyloidosis (ATTR), all presumed to be free from epicardial coronary artery disease and carrying TTR gene mutations.

Results: The study revealed a significantly reduced mean global CFR in the cardiac involvement group (1.849 ± 0.379 vs. 2.952 ± 0.7, P < 0.001). Global CFR inversely correlated with age, functional class, troponin, and B-type natriuretic peptide while positively correlating with the 6-minute walk test distance, mean blood pressure, and global longitudinal strain. Receiver operating characteristic curve analysis identified an optimal cutoff value of global CFR < 2.58, yielding a sensitivity of 100% and a specificity of 75% for detecting cardiac involvement.

Conclusion: In patients with ATTR CA, coronary microvascular dysfunction emerges as a clinically relevant marker of cardiac involvement, even in the absence of structural abnormalities or obstructive coronary disease.

Clinical significance: CFR assessment may aid in diagnostic suspicion, risk stratification, and understanding of angina symptoms in this population.

Purpose: To evaluate the feasibility and early postprocedural hemorrhage outcomes of absorbable gelatin sponge (AGS) torpedo tract closure and to briefly describe the tract-closure method used following portal vein recanalization in pediatric native-liver extrahepatic portal vein obstruction.

Methods: We retrospectively reviewed the cases of 18 consecutive children [11 boys, 7 girls; median age, 7 years (range, 5-12)] treated between 2020 and 2025 who underwent transsplenic and/or trans-hepatic portal vein recanalization with planned tract embolization using AGS torpedoes. The access sheath sizes were 5F and 6F, and unfractionated heparin was administered intraprocedurally in all cases. Procedures with inadvertent sheath dislodgment before embolization or intraprocedural wire perforation were excluded. The primary outcome was clinically significant access-tract hemorrhage within 24 hours, defined as a hemoglobin decrease > 2 g/dL together with an interval increase in intraperitoneal free fluid on ultrasound. Descriptive statistics were used; technical outcomes were summarized per tract and safety outcomes per patient.

Results: Eighteen patients underwent embolization of 28 access tracts (13 transsplenic and 15 trans-hepatic). The median number of torpedoes used per tract was three (range, 2-4). All access tracts were successfully embolized with AGS torpedoes (28/28, 100%). No clinically significant access-tract hemorrhage occurred at either the patient (0/18) or tract level (0/28) within 24 hours after AGS embolization. Small perisplenic or perihepatic fluid collections were observed in 16 (88.9%) patients immediately after the procedure without an interval increase on follow-up ultrasound within 24 hours following the intervention.

Conclusion: AGS torpedo tract closure appears feasible and effective in preventing clinically significant access- tract hemorrhage after pediatric portal vein recanalization, including cases requiring dual access with introducer sheaths of up to 6F and intraprocedural anticoagulation. Prospective, large, multicenter studies using standardized hemostasis endpoints are needed to validate these preliminary findings.

Clinical significance: A readily available, absorbable material deployed as torpedoes can achieve controlled, layered parenchymal sealing in pediatric portal venous interventions.

Ultrasound (US)-guided microwave ablation (MWA) has emerged as a promising minimally invasive therapy for both benign and malignant breast tumors. This review comprehensively examines the current clinical status, technical principles, and therapeutic outcomes of US-guided MWA in breast tumor management. We discuss the biophysical mechanisms of MWA, its advantages over other ablation techniques-such as rapid temperature elevation, the ability to create more extensive coagulation areas, and diminished impact from heat sink phenomena-and the critical role of real-time US guidance in enhancing procedural precision and safety. Clinical evidence supports the efficacy of US-guided MWA in achieving high rates of complete ablation and significant volume reduction for benign tumors, such as fibroadenomas, with minimal complications and excellent cosmetic results. For early-stage breast cancers, initial studies indicate that US-guided MWA provides local tumor control comparable with surgical resection in the short- to mid-term, while also offering the benefits of shorter operation times, reduced hospitalization, and stimulation of systemic antitumor immune responses. However, challenges remain, including technical limitations in treating tumors near critical structures, the lack of long-term oncological data, and operator dependence. Future directions involve technological refinements, integration with artificial intelligence and advanced imaging, combination with immunotherapy, and standardization of protocols. US-guided MWA represents an important advancement toward personalized, organ-preserving breast tumor therapy, with ongoing innovations poised to expand its clinical applicability.

Purpose: To evaluate whether baseline multiparametric magnetic resonance imaging (mpMRI)-defined prostate morphological phenotypes are associated with changes in the International Prostate Symptom Score (ΔIPSS) and maximum urinary flow rate (ΔQmax) following prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).

Methods: This retrospective single-center study included patients who underwent technically successful PAE with preprocedural mpMRI performed within 8 weeks of intervention. Prostate morphology was classified as glandular-dominant, stromal-dominant, or mixed phenotype based on the predominant nodule signal characteristics on T2-weighted imaging (T2WI), with supplemental assessment using diffusion-weighted and contrast-enhanced sequences when available. Symptomatic and functional outcomes-ΔIPSS and ΔQmax-were assessed at 3, 6, 12, and 24 months post-procedure. Associations between morphology and outcomes were evaluated using multivariable regression and subgroup analysis.

Results: A total of 152 patients (mean age, 70.0 ± 9.9 years) who underwent technically successful PAE were included in the study, all of whom had preprocedural MRI performed within 8 weeks prior to the intervention. All MRI-defined morphological phenotypes demonstrated improvements in the Qmax and IPSS after PAE. The glandular-dominant phenotype exhibited the most pronounced and earliest response, with peak improvements at 6 months (ΔQmax: 10.45 mL/s; ΔIPSS: 14.11 points) and sustained benefits through 24 months (ΔQmax: 8.78 mL/s; ΔIPSS: 13.04 points). Stromal-dominant and mixed phenotypes showed smaller, delayed improvements, typically peaking at 12 months. Morphology-related phenotype differences remained statistically significant at 24 months in unadjusted comparisons, particularly between glandular and stromal phenotypes, although ΔIPSS differences were attenuated in multivariable models (24-month β: 0.104, P = 0.547). Glandular morphology was consistently associated with a greater ΔQmax across all timepoints (e.g., 24-month β: 0.450, P < 0.001) and significantly interacted with baseline symptom severity (IPSS ≥ 20) to predict enhanced 24-month ΔIPSS (interaction β: 0.349, P = 0.045). Subgroup analyses stratified by prostate volume (< 80 vs. ≥ 80 mL) corroborated these findings, with glandular morphology consistently outperforming that of stromal and mixed phenotypes.

Conclusion: Baseline MRI-defined prostate morphology, assessed primarily on T2WIs, was significantly associated with clinical outcomes after PAE; glandular-dominant morphology was linked to larger and more sustained improvements in both the Qmax and IPSS. Therefore, MRI-based phenotypes offer a practical imaging biomarker for patient stratification, warranting prospective validation.