CardioVascular and Interventional Radiology最新文献

Purpose: To evaluate the visualization of the ice ball during cryoablation of vertebral bodies and the bony pelvis in an in vivo swine model using virtual non-calcium imaging (VNCa) derived from photon-counting detector computed tomography (PCD-CT).

Materials and methods: Cryoablation was performed at six locations in the spine and pelvis of three live swine. Spectral ultra-high resolution image acquisition using PCD-CT was conducted before ablation and at 2, 4, 6 and 8 min after initiation of the cryoablation cycle. Artifacts were suppressed using iterative metal artifacts reduction. Ice ball visualization within bone and soft tissue was assessed on both, conventional and VNCa images. At each time point the presence and size of the ice ball visualization was evaluated.

Results: A total of 12 needle placements was analyzed. In conventional images the ice ball could not be seen within bone at any time. In contrast, in VNCa images the ice ball became visible after 2 min in all cases. However, the ice ball was less clearly visualized in the soft tissue on VNCa images. Mean ice ball volume at 2, 4, 6, 8 min was 1.6 ± 0.9, 2.8 ± 1.7, 5.5 ± 2.9 and 8.3 ± 3.2 ml in the vertebral bodies and 0.8 ± 0.3, 2.0 ± 0.4, 4.4 ± 0.6, 6.2 ± 1.1 ml in the bony pelvis, respectively.

Conclusion: PCD-CT enables early visualization of the ice ball within vertebral bodies and the bony pelvis in a swine model using VNCa images.

Purpose: This meta-analysis aims to evaluate thermal ablation for giant hepatic hemangiomas (GHHs) and compare the clinical outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA).

Methods: A systematic review and meta-analysis followed the Cochrane Collaboration Handbook and PRISMA 2020 guidelines. Eligible studies reporting on patients with GHHs (≥ 4 cm) treated with MWA or RFA were identified through Medline, Scopus, and Web of Science databases. Primary outcomes included technical success (complete and accurate execution of the intended MWA or RFA procedure as per the study protocol), safety outcomes, clinical success, and radiological success. Statistical analyses were performed using a random-effects model, with heterogeneity assessed via the I² statistic.

Results: Fourteen studies (925 patients; 33.6% men; mean age: 46.6 years) with 1,010 GHHs were included. The overall technical success rate for thermal ablation was 99.95%, with a major complication rate of 2.21%. Clinical success, defined as symptom resolution or significant improvement, was achieved in 99.85% of patients, while radiological success, defined as at least a 50% reduction in lesion size, was observed in 89.81%. Minor complications were reported in 48.88%, and total complications in 52.43%, while procedure-related morbidity was low at 0.34%. In the subgroup analysis, radiological success was 95.6% in the MWA group and 86.3% in the RFA group (p = 0.073). Major complication rates were 1.99% for MWA and 2.08% for RFA (p = 0.93), while total complication rates were 46.0% and 58.1%, respectively (p = 0.43).

Conclusion: MWA and RFA are highly effective and safe options for treating GHHs, with excellent technical and clinical success rates. MWA may offer advantages in radiological success and lower complication rates.

Purpose: To investigate whether post-prostate artery embolization (PAE) magnetic resonance imaging (MRI) can predict clinical outcomes at 1 year.

Materials and methods: Retrospective study of 63 consecutive patients undergoing microsphere PAE for benign prostatic enlargement. Clinical assessments were performed with the International Prostate Symptom Score (IPSS), quality of life (QoL) scores, and non-invasive urodynamics. MRI was performed at baseline and 3-month post-PAE: intravesical protrusion, prostate volume (PV), and infarction volumes were measured with semi-automated volumetry. Clinical success was defined as (1) a reduction of IPSS to < 9 and QoL score to < 3 or (2) freedom from urinary catheter in catheter-dependent patients. Statistical modeling was performed with multivariate logistic regression.

Results: Sixty-three patients were included. Median PV 116 ml (IQR 85-153); median PV reduction 26% (IQR 19-45) at 3 months. Presence of infarction on 3-month MRI was associated with clinical success at 12 months (OR = 1.15, 95% CI: 1.04-1.36, p = 0.025). A receiver operator curve analysis of infarct volume returned an area under the curve of 0.77 (CI 0.66-0.89) and indicated that an infarct volume ≥ 5% had a sensitivity of 72% and specificity of 80% to predict clinical success. PV reduction did not show statistically significant correlation with clinical success (p = 0.348, 95% CI: 0.98-1.08). A lower baseline IPSS was correlated with better clinical outcomes (OR 0.78; 95% CI 0.64-0.91; p = 0.003). Other clinical and anatomical variables including intravesical protrusion were not correlated with clinical outcomes.

Conclusion: Lower baseline IPSS and presence of infarction of > 5% on 3-month post-PAE MRI were associated with better clinical outcomes at 12 months.

Purpose: To assess the efficacy of conservative management for haematomas that demonstrate arterial bleeding, in anatomical regions of the body that are compressible against a firm bony landmark.

Methods: Single-centre retrospective cohort study of patients presenting with arterial bleeding managed conservatively or with either endovascular embolisation or surgical intervention. Patients who were identified to have a CT confirmed haematoma with arterial bleeding, in an anatomical location deemed compressible were included. Conservative management included compression, ice, anticoagulation reversal, and fluid resuscitation. Conservative management was deemed successful if no further intervention was required. Clinical outcomes measured included success of conservative management, length of hospital stay, and 30-day all-cause mortality.

Results: 256 patients were included with a mean age of 60 years (SD 21.2). The most common location of bleeding was gluteal (37%) and the most common cause for bleeding was motor vehicle accidents (42%). 67% of cases were managed conservatively as the primary management. Overall, 92.2% of patients were successfully treated with the primary management of choice, with no significant difference between patients managed conservatively or with intervention (92.4% vs. 91.8%, p = 0.43). Subgroup analysis of patients presenting in acute shock also demonstrated no significant difference between the conservatively managed group and the group managed with intervention (88% vs. 95% success, p = 0.26). The intervention group were more clinically unwell at presentation and had a higher 30-day all-cause mortality (p =  < 0.001). There was no significant difference in hospital length of stay.

Conclusion: Conservative management for arterial bleeding in anatomically compressible sites has a high success rate.