Diagnostic and Interventional Radiology最新文献

Purpose: We aimed to determine the safety and effectiveness of percutaneous endobiliary radiofrequency ablation of malignant biliary obstructions with a temperature-controlled radiofrequency ablation device.

Methods: In this single center retrospective study, a total of 62 consecutive patients with malignant biliary obstruction were evaluated. Thirty patients who underwent endobiliary radiofrequency ablation with metallic stent placement were in the study group and 32 patients who underwent only metallic stenting were in the control group. Outcomes of this study were technical success, complications related to the procedure, stent patency, and overall survival.

Results: All procedures were technically successful in both groups. There was no procedure-related mortality in either group. Procedural complication rates were similar between the groups. Although statistically not significant, the only two major complications (hemobilia requiring endovascular treatment) were in the control group. Median primary stent patency was significantly longer in the study group than in the control group (223 days vs. 158 days; P = 0.016). Median survival rates were also longer in the study group (246 days vs. 198 days; P = 0.004).

Conclusion: Percutaneous endobiliary radiofrequency ablation is safe and feasible with this novel radiofrequency ablation device in patients with malignant biliary obstruction. Percutaneous endobiliary radiofrequency ablation has a potential to improve both stent patency and survival.

Purpose: We aimed to evaluate the safety and diagnostic accuracy of computed tomography (CT)-guided transthoracic biopsy of small lung nodules (≤20 mm) adjacent to the pericardium or great vessels.

Methods: This retrospective study examined the safety and diagnostic accuracy of percutaneous CT-guided biopsy for small lung nodules (≤20 mm) located within 10 mm of the pericardium or great vessels. Technical aspects and factors influencing complications were assessed, and diagnostic accuracy was calculated.

Results: A total of 168 biopsies were performed in 168 patients. The complications were mainly pneumothorax (34.5%; 58 of 168 patients), chest tube insertion (5.3%; 9 of 168 patients), and pulmonary hemorrhage (61.3%; 103 of 168 procedures), with no patient mortality. One patient (0.6%) was admitted because of hemorrhage complications. Significant independent risk factors for pneumothorax were nodules resided in upper or middle lobes and lateral patient position, and for hemorrhage, longer distance from structures and longer needle trajectory through the lung parenchyma. Overall, the sensitivity, accuracy, and specificity were 91.0%, 92.2%, and 100%, respectively.

Conclusion: Percutaneous CT-guided transthoracic biopsy was highly accurate in small lung nodules (≤20 mm) adjacent to the pericardium or great vessels. Complications are common, but most were minor and self-limited.

Purpose: Silicosis is an incurable occupational disease that sometimes rapidly progresses with fatal outcomes. We aimed to evaluate the association between disease severity and the change in the pectoralis major muscle volume (PMV), subcutaneous fat volume (SFV), and the pulmonary artery/aorta (P/Ao) ratio in patients with silicosis using computed tomography (CT).

Methods: The study included 41 male silicosis patients and 41 control group subjects with available chest CT images. Using dedicated software, we measured PMV and SFV from the axial CT images. We calculated the P/Ao ratio and obtained body mass index (BMI) and forced expiratory volume/forced vital capacity (FEV1/FVC) results from hospital records. We used the chest X-ray profusion score according to the International Labor Organization (ILO) classification to evaluate the severity of the silicosis.

Results: The mean age was 33.5±4.4 and 34.7±4.7 years in the silicotic and control groups, respectively. The mean BMI, PMV, SFV, and P/Ao values significantly differed between the study and control groups (P = 0.0009, P < 0.0001, P < 0.0001, and P = 0.0029, respectively). According to the ILO classification, there were 12 silicosis patients in category 1, 13 in category 2, and 16 in category 3. A significant difference was found between disease categories in terms of PMV, SFV, P/Ao, BMI, and FEV1/FVC values (P = 0.0425, P = 0.0341, P = 0.0002, P = 0.0492, and P = 0.0004, respectively).

Conclusion: Disease severity had a stronger association with decreased PMV and SFV and increased P/Ao ratios than BMI in patients with silicosis caused by denim sandblasting. Thus, CT evaluation might be a useful indicator of disease severity.

Immediate intervention is needed for aortoesophageal fistulas (AEF), a rare but highly lethal cause of massive gastrointestinal hemorrhage. Emergent thoracic endovascular aortic repair (TEVAR) is considered first-line treatment for massive bleeding from AEFs. We describe an unusual and challenging case of TEVAR coverage of an AEF involving the central aortic arch immediately followed by in vivo endograft fenestration to regain arch vessel perfusion. In vivo fenestration, currently a procedure for emergency or investigational purposes only, was shown to be life saving in our case. The main complications associated with the procedure included stroke and infection, requiring esophagectomy and cervical diversion as well as ongoing antibiotic treatment.

Purpose: We aimed to compare duration of uterine artery embolization, radiation exposure, safety and quality of life associated with the procedure in patients undergoing uterine artery embolization using transradial and transfemoral access.

Methods: This randomized controlled trial was conducted from February 2013 to March 2017 in three hospitals. Transradial access was used in 78 patients and transfemoral access in 75 patients. Clinical characteristics of the patients were comparable between the two groups. Patients were evaluated for the success and duration of the procedure, radiation exposure, major and minor complications. Quality of life associated with the procedure was assessed among patients with uterine fibroids.

Results: Embolization procedures were successfully performed in all patients in both groups. The duration of uterine artery embolization (32.27±7.99 vs. 39.24±9.72 minutes, P < 0.001), uterine artery catheterization time (12.36±5.73 vs. 19.08±6.06 minutes, P < 0.001) and radiation exposure (0.28±0.14 vs. 0.5±0.21 mZv, P < 0.001) were significantly lower in the transradial access group. The rate of major (0% vs. 2.7%, P = 0.37) and minor (11.53% vs. 17.3%, P = 0.42) complications was comparable between the two groups. Transradial access was associated with a statistically significant improvement in the quality of life associated with the procedure among patients with uterine fibroids.

Conclusion: Transradial access in uterine artery embolization has the same efficacy and safety compared to transfemoral access. This access reduces radiation exposure and duration of the procedure.

Purpose: According to the Barcelona Clinic Liver Cancer (BCLC) staging classification, transarterial chemoembolization (TACE) is the treatment of choice for intermediate hepatocellular carcinoma (HCC). Thereby, the use of drug-eluting beads (DEB) as embolic agents has been recently established in clinical practice. The aim of this study was to evaluate tumor response after DEB-TACE.

Methods: This retrospective study was approved by the institutional ethics committee. Overall, 89 patients with HCC (Child Pugh A or B) receiving DEB-TACE as palliative treatment option or as bridging before liver transplantation were included in the study. Tumor response was assessed by modified response evaluation criteria in solid tumors (mRECIST) and a tumor growth rate. Survival analysis was performed using Kaplan-Meier estimator with log-rank testing and Cox proportional hazards.

Results: A total of 188 TACE procedures were performed between 2006 and 2010. After the last intervention, 18% achieved complete response, 45% achieved partial response, 28% had stable disease and 9% had progressive disease. Using the tumor growth rate, 90% of all patients showed a tumor reduction between first and final response evaluation. The 6-month, 1-, 2- and 3-year overall survival rates were 86.5%, 67.4%, 47.2%, and 33.7%, with a median survival of 45, 24, 15, and 14 months for complete response, partial response, stable disease, and progressive disease, respectively. Tumor reduction showed a positive effect on survival.

Conclusion: DEB-TACE offers conclusive response results with mRECIST and proves a strong tendency of tumor reduction on survival benefits. Therefore, tumor growth rate represents a possible parameter to predict survival.

Purpose: We aimed to demonstrate the safety and feasibility of revascularization of chronic total occlusion of the superficial femoral artery (SFA) using the transpedal approach and describe a new technique called "re-route".

Methods: The study included all consecutive patients who had chronic total occlusions at the level of SFA and underwent retrograde treatment through a pedal artery intervention between September 2017 and October 2019. Balloon angioplasty was applied as the first treatment option. After angioplasty, bailout stenting was performed when necessary in patients with indications. If the common femoral artery lumen could not be reached from the SFA ostium, the re-route technique was used. Technical success was defined as revascularization with residual stenosis of less than 30%.

Results: Twenty-five SFAs were revascularized in 23 patients (17 males; mean age, 66±7.3 years) by angioplasty in 5 SFAs and angioplasty and stents in 20 SFAs. While the transpedal approach was applied after the failure of antegrade recanalization in three patients, it was used as the first treatment route in the remaining cases. The re-route technique was applied in 7 patients, with a 100% technical success rate. The mean follow-up was 15.3 months (range, 12-18 months). The primary patency rate was 78% at one year.

Conclusion: The retrograde transpedal approach is a safe and successful technique for chronic total occlusion recanalization and carries a low risk of complications. In order to increase technical success, the re-route technique can be used as an alternative re-entry method.

Purpose: We aimed to assess the effectiveness of percutaneous radiofrequency ablation (PRFA) combined with iodine-125 (125I) seed strand brachytherapy (125I-BT) for treatment of occluded biliary stents.

Methods: From November 2015 to September 2017, 13 consecutive patients with occluded biliary metal stents, implanted for malignant obstruction, underwent PRFA combined with 125I-BT to reopen the bile duct. Data included clinical and technical success, stent patency, complications, and overall survival.

Results: The clinical and technical success rates were both 100%. One month after treatment, the total serum bilirubin level had decreased significantly (P < 0.001). Early complications of cholangitis or hemobilia were experienced by one patient each. Three patients (23.1%) had late complications, including two cases of cholangitis and one case of cholecystitis. During the mean follow-up of 233±82.9 days (range, 88-365 days), the stent patency time was 239±26.5 days (95% CI, 187-291 days), and the 6-month stent patency rate was 68.4%. Five patents died; the mean survival time was 298±30.1 days (95% CI, 239-358 days). The 6-month survival rate was 83%.

Conclusion: PRFA therapy combined with 125I-BT is feasible and safe for patients with occluded metal stents placed for malignant biliary obstruction. Nevertheless, randomized controlled trails are needed to confirm the effectiveness of this new approach.