New Diagnostic Criteria for the Localization of Insulinomas with the Selective Arterial Calcium Injection Test: Decision Tree Analysis

Purpose

To explore optimal diagnostic criteria for localizing insulinomas with the selective arterial calcium injection (SACI) test using decision tree analysis.

Combined Therapy of Transcatheter Arterial Chemoembolization and Radiofrequency Ablation versus Surgical Resection for Single 2–3 cm Hepatocellular Carcinoma: A Propensity-Score Matching Analysis

Purpose

To compare therapeutic outcomes of radiofrequency (RF) ablation combined with transcatheter arterial chemoembolization vs surgical resection (SR) for single 2–3 cm hepatocellular carcinoma (HCC).

Laser-Assisted Transgraft Embolization: A Technique for the Treatment of Type II Endoleaks

A transgraft embolization (TGE) technique was performed in a patient to treat a type II endoleak. Using a transfemoral arterial approach, the endograft was punctured using a coronary laser catheter aimed toward the type II endoleak nidus, which was treated with Onyx (Medtronic, Minneapolis, Minnesota). TGE resulted in successful embolization, as demonstrated on 1-year follow-up CT angiography, which showed complete elimination of the type II endoleak and shrinkage of the aneurysmal sac. TGE is an alternative to transarterial embolization, translumbar embolization, and transcaval embolization.     

Optimized Angiographic CT Using Intravenous Contrast Injection: A Noninvasive Imaging Option for the Follow-Up of Coiled Aneurysms?

BACKGROUND AND PURPOSE:Because recanalization of coiled cerebral aneurysms is reported to occur, follow-up imaging is mandatory, ideally noninvasively. Our study aimed to evaluate the accuracy of an optimized angiographic CT by using intravenous contrast material injection in the assessment of coiled cerebral aneurysms, compared with MR angiography and digital subtraction angiography, the criterion standard.MATERIALS AND METHODS:We included 69 patients with 76 coiled cerebral aneurysms. In each patient, we performed an angiographic CT with intravenous contrast material injection with a dual rotational acquisition, a time-of-flight MR angiography, and a DSA. The angiographic CT with intravenous contrast material injection data was postprocessed by using newly implemented reconstructions modes and a dual-volume technique. An aneurysm occlusion rate was assessed in angiographic CT with intravenous contrast material injection and MRA; remnants were measured and correlated with DSA, respectively.RESULTS:Twenty-eight remnants were revealed by DSA with a mean size of 3.1 × 3.1 mm. Angiographic CT with intravenous contrast material injection demonstrated a sensitivity of 93% and a specificity of 96% in remnant detection. MRA showed almost identical accuracy (sensitivity of 93%, specificity of 100%). Assessment of remnant size by angiographic CT with intravenous contrast material injection and by MRA revealed a high significant correlation with DSA, respectively (P < .001).CONCLUSIONS:Optimized angiographic CT with intravenous contrast material injection and MRA demonstrated accuracy comparable with that of DSA in the follow-up of coiled aneurysms, respectively. The assessment of remnant size showed a high correlation with DSA for both techniques. Due to the lack of radiation exposure, MRA seems to be the preferred technique. However, angiographic CT with intravenous contrast material injection can be considered a reliable, noninvasive alternative in patients with MR imaging contraindications or in cases of compromising artifacts due to metal implants (ie, clips).

For treatment of cerebral aneurysms, coil embolization has been established as a widely accepted technique.^1,2 Follow-up evaluation is recommended because recanalization is reported in up to 20% of aneurysms,^3–5 with approximately 10% requiring retreatment. In this instance, DSA is still considered the criterion standard, but it has the disadvantage of being an invasive technique with the risk of procedural complications.⁶ Therefore, ideally, a noninvasive imaging technique is desirable as an alternative to DSA. TOF-MRA and contrast-enhanced MRA have demonstrated moderate-to-high diagnostic performance.^7–9 TOF-MRA was superior to contrast-enhanced MRA in terms of coil visibility and is the recommended MR imaging technique.¹⁰ On the other hand, MR imaging may be impossible due to contraindications or lack of availability.Here, angiographic CT by using intravenous contrast material injection could be an alternative, noninvasive imaging option. Angiographic CT allows the acquisition of high-resolution data from a rotational run of a C-arm-mounted flat panel detector that differs from conventional CT in the material composing it. Angiographic CT with intravenous contrast material injection (ivACT) has recently demonstrated comparable image quality to DSA in visualizing cerebral artery vasculature¹¹and has been helpful in aneurysm diagnostics¹² and in the follow-up of clipped aneurysms.¹³ Until now, only angiographic CT with intra-arterial contrast material injection has been investigated in the follow-up of coiled aneurysms, providing promising results.¹⁴ With the implementation of new reconstruction modes and enhanced postprocessing algorithms, the image quality of ivACT could be improved and artifacts could be reduced. Our study aimed to evaluate the accuracy of an optimized, noninvasive ivACT in the follow-up of coiled aneurysms compared with MRA and DSA, the criterion standard.     

Outcomes of Endovascular Treatment and Open Repair for Renal Artery Aneurysms: A Single-Center Retrospective Comparative Analysis

Purpose

To compare outcomes of endovascular repair and open repair in treatment of renal artery aneurysms (RAAs).

Does Polyvinyl Alcohol Particle Size Change the Outcome of Prostatic Arterial Embolization for Benign Prostatic Hyperplasia? Results from a Single-Center Randomized Prospective Study

PurposeTo evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH).Materials and MethodsA randomized prospective study was undertaken in 80 patients (mean age, 63.9 y; range, 48–81 y) with symptomatic BPH undergoing PAE between May and December 2011. Forty patients underwent PAE with 100-µm (group A) and 200-µm PVA particles (group B). Visual analog scales were used to measure pain, and rates of adverse events were recorded. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires, prostate volume (PV), prostate-specific antigen (PSA) levels, and peak flow rate measurements at baseline and 6 months.ResultsNo differences between groups regarding baseline data, procedural details, or adverse events were noted. Mean pain scores were as follows: during embolization, 3.2 ± 2.97 (group A) versus 2.93 ± 3.28 (group B); after embolization, 0.10 ± 0.50 (group A) versus 0 (group B; P = .20); and the week after PAE, 0.85 ± 1.65 (group A) versus 0.87 ± 1.35 (group B; P = .96). Patients in group B had greater decreases in IPSS (3.64 points; P = .052) and QoL (0.57 points; P = .07). Patients in group A had a greater decrease in PV (8.75 cm³; P = .13) and PSA level (2.09 ng/mL; P < .001).ConclusionsNo significant differences were found in pain scores and adverse events between groups. Whereas PSA level and PV showed greater reductions after PAE with 100-µm PVA particles, clinical outcome was better with 200-µm particles.     

Balloon-Occluded Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma: A Single-Center US Preliminary Experience

This report describes a single-center experience with balloon-occluded transarterial chemoembolization for liver-directed therapy. A total of 26 patients (11 male, 4 female; mean age, 65 y ± 7) with 28 tumors (mean diameter, 2.7 cm; range, 1.1–5.9 cm) were treated. Technical success rate was 100% (28 of 28 cases), with 1 minor complication of left portal vein thrombosis and small liver infarct. Of the 15 tumors analyzed for response, 60% (9 of 15) exhibited complete response, 33.3% (5 of 15) exhibited partial response, and 6.6% (1 of 15) had stable disease on follow-up. Eight patients exhibited overall progression with a new hepatic lesion and a median time to progression of 7.9 months (range, 5–11 mo).     

Combined Effects of Yttrium-90 Transarterial Radioembolization around Immunotherapy for Hepatic Metastases from Uveal Melanoma: A Preliminary Retrospective Case Series

Purpose

To evaluate the safety and efficacy of yttrium-90 (⁹⁰Y) transarterial radioembolization (TARE) around immunotherapy in patients with unresectable hepatic metastases from uveal melanoma (UM).