Diagnostic and Interventional Radiology最新文献

PURPOSE We aimed to develop models for predicting overall survival (OS) and progression-free survival (PFS) of patients with primary hepatocellular carcinoma (HCC). METHODS Clinicopathological characteristics and laboratory information of patients were collected. We retrospectively analyzed presurgical data of 216 patients with primary HCC. The random forest and least absolute shrinkage and selection operator regression models were used to select features. We established prognostic models for predicting OS and PFS of primary liver cancer using ultrasonic imaging as well as clinical and pathological features. Accuracy of the models was evaluated using area under the curve, C index, and calibration curves, whereas their clinical application value was assessed using decision curve analysis. RESULTS Models for predicting OS and PFS were established based on ultrasonic imaging accessible features. The models showed excellent accuracy and prognosis prediction of OS and PFS in patients with primary HCC. CONCLUSION The established models based on factors such as aspartate aminotransferase platelet ratio index, Child-Turcotte-Pugh grade, tumor grade, hepatitis B virus-DNA, the intensity of ultrasound enhancement at the portal stage, lymphocyte/monocyte ratio, portal hypertension, gender, stage, the beginning time of ultrasonic contrast, and the total grade of ultrasonic enhancement can effectively predict OS and PFS of primary HCC.

This study aimed to report on complication management in a 58-year-old woman referred for transjugular biopsy for the evaluation of unknown liver disease. After an initial uneventful biopsy procedure, the patient complained of severe upper abdominal pain. Laboratory tests revealed increasing liver enzymes. Imaging studies depicted an iatrogenic pseudoaneurysm associated with an arterio-biliary fistula originating from the right peripheral hepatic artery. Angiography and percutaneous transarterial superselective embolotherapy was performed by means of a microcatheter and microvascular plug. Precise device positioning allowed for successful closure of the bleeding site without compromising the hepatic vasculature.

PURPOSE We aimed to evaluate the spectrum of magnetic resonance cholangiopancreatography (MRCP) findings in patients with ectopic opening of the common bile duct (CBD) into the duodenal bulb and to determine the effectiveness of the MRCP technique in diagnosis. METHODS Morphologic and morphometric MRCP/MRI features in 16 patients and 36 controls were retrospectively analyzed by 2 radiologists. The frequency of MRCP findings was determined. The significance of the difference between the MRCP observations in patients and controls was evaluated statistically and the diagnostic effectiveness of MRCP was investigated. RESULTS Hook-shaped ending of CBD and bulbar deformity were the most frequent morphologic findings seen on MRCP in the ectopic bulbar opening. Mean pylorus-papilla distance and mean CBD length were significantly shorter and the median diameter of CBD was significantly larger than the control group (patients: 28.6 ± 15.3 mm, 33.7 ± 12.8 mm, 8.6 (2-16) mm; controls: 66.7 ± 11.7 mm, 50.3 ± 14.4 mm, 3.2 (1.5-10) mm, P < .001, respectively). Receiver operating curve analysis showed sensitivity and specificity of MRCP in the diagnosis to be 87.5% and 100%, respectively, if any 3 of the 4 signs (hook-shaped ending of CBD, bulbar deformity, large, and short CBD) were present in a patient whose pylorus-papilla distance was <50 mm. CONCLUSION At MRCP, the presence of short and large CBD with a hook-shaped ending in the deformed duodenal bulb may support the diagnosis of ectopic biliary drainage.

PURPOSE This study aimed to assess the agreement between liver stiffness (LS) values obtained by the gradient-recalled echo (GRE) magnetic resonance elastography (MRE) and spin-echo echo-planar imaging (SE-EPI) MRE with those of transient elastography (TE), respectively. METHODS We retrospectively included 48 participants who underwent liver MRE with both GRE and SE-EPI sequences in the same session and also TE within 1 year. We obtained LS values for MRE by drawing free-hand region of interest, and TE was performed using a FibroScan device. We assessed the relationship between the mean LS values obtained by each MRE sequence and TE using the correlation coefficients and Bland-Altman plots, respectively. We also compared LS values and technical failure rates of measured values from MRE between SE-EPI and GRE sequences using the paired t-test and McNemar's test. The MRE failure was defined as the absence of pixel value with a confidence index above 95%. RESULTS The LS values from SE-EPI and GRE sequences strongly correlated with those from TE (GRE; r = 0.73, P < .001 vs. SE-EPI; r = 0.79, P < .001). In addition, the LS values from the 2 MRE sequences showed excellent relationship (intraclass correlation coefficient, 0.94 [0.89-0.97], P < .001). The LS values from SE-EPI and GRE MRE were not significantly different (4.14 kPa vs. 3.88 kPa, P = .19). Furthermore, the technical success rate of SE-EPI MRE was superior to that of GRE (100% vs. 83.8%, P = .031). CONCLUSION The measured LS values obtained using TE correlated strongly with those obtained using GRE and SE-EPI MRE techniques, even though SE-EPI-MRE resulted a higher technical success rate than GRE-MRE. Therefore, we believe that TE, GRE, and SE-EPI MR elastography techniques may complement each other according to the appropriate individual situation.

PURPOSE The purpose of this study is to systematically evaluate the effect of tube voltage, current kernels, and monoenergetic post-processing on stent visualization. METHODS A 6 mm chrome-cobalt peripheral stent was placed in a dedicated phantom and scanned with the available tube voltage settings of a third-generation dual-source scanner in single-energy (SE) and dual-energy (DE) mode. Images were reconstructed using the latest convolution kernels and monoenergetic reconstructions (40-190 keV) for DE. The sharpness of stent struts (S), struts width (SW), contrast-to-noise-ratios (CNR), and pseudoenhancement (PE) between the vessel with and without stent were analyzed using an in-house built automatic analysis tool. Measurements were standardized through calculated z-scores. Z-scores were combined for stent (SQ), luminal (LQ), and overall depiction quality (OQ) by adding S and SW, CNR and SW and PE, and S and SW and CNR and PE. Two readers rated overall stent depiction on a 5-point Likert-scale. Agreement was calculated using linear-weighted kappa. Correlations were calculated using Spearman correlation coefficient. RESULTS Maximum values of S and CNR were 169.1 HU/pixel for [DE; 100/ Sn 150 kV; Qr59; 40 keV] and 50.0 for [SE; 70 kV; Bv36]. Minimum values of SW and PE were 2.615 mm for [DE; 80 to 90/ Sn 150 kV; Qr59; 140 to 190 keV] and 0.12 HU for [DE; 80/ Sn 150 kV; Qr36; 190 keV]. Best combined z-scores of SQ, LQ, and OQ were 4.53 for [DE; 100/ Sn 150 kV; Qr 59; 40 keV], 1.23 for [DE; 100/ Sn 150 kV; Qr59; 140 keV] and 2.95 for [DE; 90/ Sn 150 kV; Qr59; 50 keV]. Best OQ of SE was ranked third with 2.89 for [SE; 90 kV; Bv59]. Subjective agreement was excellent (kappa=0.86; P < .001) and correlated well with OQ (rs=0.94, P < .001). CONCLUSION Combining DE computed tomography (CT) acquisition with the latest kernels and monoenergetic post-processing allows for improved stent visualization as compared with SECT. The best overall results were obtained for monoenergetic reconstructions with 50 keV from DECT 90/Sn 150 kV acquisitions using kernel Qr59.

PURPOSE We aimed to determine the safety and feasibility of transradial access (TRA) in bronchial artery and non-bronchial systemic artery (NBSA) embolization in patients with non-massive hemoptysis. METHODS This retrospective study was approved by the Institutional Review Board. Among the 300 patients treated for hemoptysis with bronchial artery and NBSA embolization between April 2018 and July 2019, 19 procedures in 19 patients were conducted by TRA and were retrospectively analyzed. TRA was considered when the bronchial artery or NBSA originated from the arch vessel or its tributaries. The exclusion criteria of TRA included Barbeau C or D waveform and a radial artery diameter of less than 1.8 mm on ultrasound. TRA was also avoided in cases of the high-origin bronchial artery (i.e., T4 or higher level of the aorta). The hemoptysis-free time was estimated using the Kaplan-Meier method. RESULTS The technical success (i.e., embolization of all target artery with TRA) rate was 94.7% (18 out of 19 patients). In terms of the target arteries, embolization with TRA was technically successful in treating 47 out of 48 arteries (97.9%). The 1-month and 6-month hemoptysis-free rates were 89.5% (17/19) and 73.7% (14/19), respectively. The only adverse event was iatrogenic dissection of the bronchial artery with little clinical significance in 1 patient. No access site complications were identified on post-procedure day 1 ultrasonography. CONCLUSION With proper patient selection, TRA offers a safe and effective approach to embolize the bronchial arteries and NBSAs in patients with hemoptysis.

PURPOSE This study aimed to compare the radiation dose received by the operator among different patients' positions via transradial access (TRA) or transfemoral access (TFA) during transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). METHODS A total of 120 patients with HCC undergoing TACE for the first time between January and November 2019 were randomized into 4 groups with 30 patients in each group. In group A, patients were placed in the foot-first position with the left upper arm abducted, and TACE was performed via the left radial artery. In group B, patients were placed in the conventional headfirst position with the left hand placed at the left groin, and TACE was performed via the left radial artery. In group C, patients were placed in the conventional head-first position, and TACE was performed via the right radial artery. In group D, patients were placed in the conventional head-first position, and TACE was performed via the right femoral artery. Before each procedure, thermoluminescent dosimeters were taped at 7 different body parts of the operator and the radiation dose was measured and collected after the procedure. The normalized radiation dose was also calculated. Procedural parameters included radiation dose, fluoroscopy time (FT), dose-area product (DAP), and air kerma (AK) were recorded. Patients' demographics, tumor baseline characteristics, radiation dose, and procedural parameters were compared between groups. RESULTS No significant differences were found in patients' demographics, tumor baseline characteristics, as well as in total FT, DAP, and AK. However, significant differences were found in the total radiation dose received by the operator and the doses on the pelvic cavity and the right wrist (P < .05). In group C, the radiation doses received on the pelvic cavity, the right wrist, and the total radiation doses were relatively higher. Significant differences were also found in the normalized radiation doses received by the operator on the thyroid, chest, left wrist, right wrist, and pelvic cavity, and the total normalized doses (all P < .05). Similarly, the radiation doses received by the operator at the aforementioned parts in group C were higher, while those in group A were lower. CONCLUSION No statistically significant differences were observed in the FT, DAP, and AK in TACE via TRA when patients were placed in different positions. However, TACE via the left TRA, with patients in the feet-first position, reduced the radiation dose received by the operator, thereby reducing the radiation risk.

PURPOSE Systemic to pulmonary vasculature shunting (SPS) is an important finding to identify the probable site of bleeding, especially in multicentric parenchymal lung disease. The purpose of this study was to evaluate the value of imaging findings, which can locate SPS on dual-energy computed tomography angiography (DECTA), and correlate with digital subtraction angiography (DSA), which was considered as a gold standard. METHODS Retrospective analysis of 187 patients (148 males, 39 females, mean age: 43.7 ± 15.1 years) between October 2014 and November 2018 who underwent both DECTA and DSA. Computed tomography angiography was performed using dual-source (80 and 140kV), 2 × 128 slice equipment, using 50-80mL iodinated contrast (400mg iodine/mL). These patients were divided into shunting (group A) and non-shunting groups (group B), based on the presence or absence of signs of shunting on DECTA. Group A had 98 and group B had 89 patients. We analyzed the following imaging signs for identifying SPS: (1) non-tapering pulmonary artery sign, (2) clustering of vessels sign, and (3) significant differential attenuation sign (>25 HU difference in attenuation between segmental pulmonary arteries of shunting side and normal non-shunting side was considered significant). The correlation was done with DSA to identify the presence of SPS. RESULTS In 187 patients, 281 lobes were evaluated to look for the signs of shunting from systemic artery to pulmonary vessels on DECTA. A total of 98 patients who showed signs of shunting on DECTA presented 135 lobes with parenchymal, with or without pleural, abnormalities. Of these, 84 patients had one or more aspergilloma in the lobe where shunting was seen. In one patient, a specific artery could not be cannulated due to a tortuous course; hence, all arteries which were seen on CTA causing shunting were also seen on DSA. Non-tapering pulmonary artery segmental branches were seen in 97 (99%) patients, clustering of systemic vessels was seen in 90 (91.8%) patients, and significant attenuation difference was seen in 74 (75.5%) patients. In the rest of the 89 patients, 146 lobes were assessed but no signs of shunting were seen on DECTA. Nine arteries in 8 patients showed shunting on DSA, while the rest did not show any shunting. Digital subtraction angiography correlation showed 96.4%, 100%, 100%, and 93.8% of sensitivity, specificity, positive predictive value, and negative predictive value, respectively, for DECTA in detecting SPS on a per artery basis. CONCLUSION The proposed signs on DECTA help in identifying the systemic vessels that cause shunting, and hence, the most likely bleeding site, which aids in planning the endovascular management by targeting specific arteries in case of multicentric disease. Being the gold standard, DSA is an ideal modality for detecting very small SPSs and in classifying the latter.

PURPOSE Fontan procedure and its modifications are the preferred approach to definitive palliation in uni- ventricular hearts though often with short-term or long-term complications. It is believed that a dysfunction in lymphatic circulation is responsible for part of the complications. Occasionally, abnormal supraclavicular lymphatic vessel convolutes can be observed in contrast-enhanced magnetic resonance angiography (ceMRA). This study aims to determine the frequency of this phenomenon as well as a possible correlation with the functional status after Fontan procedure. METHODS CeMRA of 37 patients after Fontan surgery was retrospectively screened and grouped for the presence or absence of abnormal lymphatic convolute. An attempt was made to identify differ- ences in the level of dysfunction of the Fontan circulation between the 2 groups. RESULTS In 6 of 37 patients (16%), an abnormal cervical lymphatic convolute was found in the cervical venous angle. The surrogate parameters for a malfunction of the Fontan circulation did not sig- nificantly differ between both groups. CONCLUSION This is the first description of cervical lymphatic vessels in Fontan patients enhancing incidentally in ceMRA, probably due to venous-to-lymphatic reflux. As the likelihood of various complica- tions of Fontan circulation increases with the severity of lymphatic dysfunction, this observation could help to select patients who require closer monitoring or advanced lymphatic imaging.