Synergy in IR–Hybrid CT/C-arm in the setting of critical trauma

Emergency Radiology - Access to multi-detector computed tomography (MDCT) scanning for interventional procedures can prove to be logistically challenging as resources are often in different areas...     

Percutaneous embolization of post traumatic splenic pseudoaneurysm

Management of splenic pseudoaneurysms in hemodynamically stable patients has shifted toward nonoperative management, including watchful waiting and endovascular embolization. Standard of treatment does not include percutaneous embolization for splenic pseudoaneurysm repair. In this case report, we document a successful percutaneous embolization of a post traumatic splenic pseudoaneurysm with thrombin. Percutaneous embolization of splenic pseudoaneurysms can be considered a viable technique in patients who fail endovascular embolization or have lesions inaccessible to endovascular repair.     

Periprocedural complications by Child-Pugh class in patients undergoing transcatheter arterial embolization or chemoembolization to treat unresectable hepatocellular carcinoma at a VA medical center

Background

For patients with compensated cirrhosis, transcatheter arterial embolization with and without additive chemotherapy has been shown to improve survival. The aim of this study was to compare periprocedural complications in a population with hepatitis C virus-related hepatocellular carcinoma to evaluate for differences in complications by severity of liver disease.

Methods

Patients with unresectable hepatocellular carcinoma treated by transcatheter arterial embolization with or without additive chemotherapy procedures from 2003 to 2006 were retrospectively reviewed and compared by Child-Pugh (CP) class. A total of 141 embolizations were done in 76 patients.

Results

Complication rates were seen in 27% of CP class A and 17% of CP class B patients. There was no significant difference in the grade of complications between the 2 groups or between procedure types. Survival rate was dependent on the degree of liver dysfunction (3-year CP class A, 49%; CP class B, 13%; P = .0048).

Conclusion

Embolization procedures to treat hepatitis C virus-related hepatocellular carcinoma can be performed safely with low morbidity and mortality rates, even in patients with a compromised hepatic reserve.     

Quantification of emphysema: a composite physiologic index derived from CT estimation of disease extent

The combination of functional indices best reflecting the extent of emphysema is not known. High-resolution computed tomography (HRCT) studies of 106 patients with emphysema [men=71; median age=61 (range=26–86 years)] were reviewed and the extent of emphysema was quantified: (a) visually (emphysema_vis) and (b) by automated estimation (emphysema_auto). Functional-morphologic relationships were compared for the two scoring systems, and a composite physiologic index (CPI) (providing the best fit of functional indices against emphysema extent) was derived. Emphysema_vis and emphysema_auto were strongly correlated (r=0.90; p<0.0005), but the extent of emphysema_vis was consistently greater (p<0.00005). Emphysema_vis correlated most strongly with indices of gas transfer [percent predicted single-breath carbon monoxide diffusing capacity (Dl_co) and alveolar volume (K_co); r=−0.70, both p<0.0005]. The combination of physiologic indices most representative of emphysema extent on CT (using visual or automated methods) consisted of K_co and forced expiratory volume in 1 s (FEV₁) levels. The equation explanatory power was higher for visual scoring [emphysema_vis=96.8-(0.67×% predicted K_co)-(0.41×% predicted FEV₁); equation r ²=0.57] than automated estimation (equation r ²=0.48). Weighted combinations of K_co and FEV₁ levels provide a CPI best reflecting morphologic emphysema extent. CPI has the potential to refine the stratification of patients in epidemiological and therapeutic studies.