Combination Radiofrequency Ablation and Percutaneous Osteoplasty for Palliative Treatment of Painful Extraspinal Bone Metastasis: A Single-Center Experience

PurposeTo evaluate combined radiofrequency (RF) ablation and percutaneous osteoplasty (POP) in patients with painful extraspinal bone metastases.Materials and MethodsIn a retrospective study, 38 patients with 54 extraspinal bone metastases (ilium, n = 24; acetabulum, n = 21; femur, n = 7; ischium, n = 1; tibia, n = 1) were treated with RF ablation and POP. All patients had pain refractory to analgesic medication with intensity > 3 on a visual analog scale (VAS). Changes in quality of life were evaluated based on pain relief (VAS score), function on a Karnofsky performance scale, and analgesic dose before and immediately after the procedure and during follow-up. VAS score was the primary outcome, and the others were secondary outcomes.ResultsTechnical success was achieved in 37 patients (97.4%). Mean VAS score declined significantly from 7.1 ± 1.5 before treatment to 2.2 ± 2.0 at 24 hours after treatment (P < .05), 1.6 ± 1.8 at 3 months after treatment (P < .05), and 1.3 ± 1.8 at 6 months after treatment (P < .05). Pain relief immediately after the procedure was reported by 35 patients (92.1%); pain regressed completely in 7 (18.4%) patients. After 6 months, narcotic analgesia had been suspended in 32 of 33 patients (97.0%). Pain was controlled by nonsteroidal antiinflammatory drugs in 8 patients (24.2%), and no analgesia was necessary in 24 patients (72.7%). Mean Karnofsky performance scale score after treatment was higher than before treatment (P < .05). The major complication rate was 2.6% (1 of 38 patients), with one case of vasovagal shock. The minor complication rate was 23.7% (9 of 38 patients).ConclusionsRF ablation with POP is effective for pain relief and functional recovery in patients with painful extraspinal bone metastases and can significantly improve quality of life.     

Incidence and predictors of lesion-specific ischemia by FFRCT: Learnings from the international ADVANCE registry

BackgroundTo date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry.MethodsOne thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFRCT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFRCT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFR_CT.ResultsFFR_CT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFR_CT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFR_CT than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04–2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14–2.14, p = 0.005) were both predictive of abnormal FFR_CT. In addition, >70% stenosis was significantly associated with low FFR_CT (OR 31.16, 95%CI 12.25–79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30–49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52–9.17, p < 0.0001).ConclusionsIn this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFR_CT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.     

Early Results from a United States Trial of Prostatic Artery Embolization in the Treatment of Benign Prostatic Hyperplasia

PurposeTo report early findings from a prospective United States clinical trial to evaluate the efficacy and safety of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).Materials and MethodsFrom January 2012 to March 2013, 72 patients were screened and 20 patients underwent treatment. Patients were evaluated at baseline and selected intervals (1, 3, and 6 mo) for the following efficacy variables: American Urological Association (AUA) symptom score, quality of life (QOL)–related symptoms, International Index of Erectile Function score, peak urine flow rate, and prostate volume (on magnetic resonance imaging at 6 mo). Complications were monitored and reported per Society of Interventional Radiology guidelines.ResultsEmbolization was technically successful in 18 of 20 patients (90%); bilateral PAE was successful in 18 of 19 (95%). Unsuccessful embolizations were secondary to atherosclerotic occlusion of prostatic arteries. Clinical success was seen in 95% of patients (19 of 20) at 1 month, with average AUA symptom score improvements of 10.8 points at 1 month (P < .0001), 12.1 points at 3 months (P = .0003), and 9.8 points at 6 months (P = .06). QOL improved at 1 month (1.9 points; P = .0002), 3 months (1.9 points; P = .003), and 6 months (2.6 points; P = .007). Sexual function improved by 34% at 1 month (P = .11), 5% at 3 months (P = .72), and 16% at 6 months (P = .19). Prostate volume at 6 months had decreased 18% (n = 5; P = .05). No minor or major complications were reported.ConclusionsEarly results from this clinical trial indicate that PAE offers a safe and efficacious treatment option for men with BPH.     

CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris

BackgroundCoronary stenosis and plaque evaluation by coronary computed tomography angiography (CTA) may contribute to identify hemodynamically relevant lesions. We evaluated the most stenotic lesion including plaques proximal to it versus a total vessel analyses combined with stenosis for ischemia.MethodsPatients scheduled for clinically indicated invasive coronary angiography (ICA) for suspected coronary artery disease underwent coronary CTA and ICA including fractional flow reserve (FFR) as part of the NXT trial (clinicaltrials.gov NCT01757678). Stenoses were visually graded ≤50%, 51–70%, and >70% on coronary CTA. Semi-automated plaque analyses were performed using a proximal to the FFR pressure sensor location (including the most severe lesion to the coronary ostium) versus a total vessel (vessel diameter ≥2 mm) approach. Coronary stenosis and plaque parameters were evaluated for discrimination of ischemia by logistic regressions and combined models analyzed using receiver operating characteristics (ROC) with invasive FFR≤ 0.80 as reference standard.ResultsIn 254 patients, mean (±SD) age 64 (±10) years, 64% male, a coronary CTA stenosis >50% was present in 239 (49%) vessels. Invasive FFR was ≤0.80 in 100 (21%) vessels. Coronary stenosis severity and low-density non-calcified plaque (LD-NCP) volume were independent predictors of ischemia in the “proximal” and “total-vessel” analyses. Stenosis severity + total vessel LD-NCP assessment performed better than stenosis severity + proximal LD-NCP evaluation (Area under curve [AUC] (95%CI): 0.83 (0.78–0.87) vs 0.81 (0.76–0.86), p-value = 0.009), whereas stenosis severity + proximal LD-NCP performed better than stenosis alone (AUC (95%CI): 0.81 (0.76–0.86) vs 0.78 (0.73–0.83), p-value = 0.019).ConclusionAdding total vessel high-risk plaque volume to stenosis severity improves discrimination of ischemia in coronary CTA performed in patients with stable angina pectoris.     

The Effect of Uterine Artery Embolization on Premenstrual Symptoms in Patients with Symptomatic Fibroids or Adenomyosis

PurposeTo evaluate whether uterine artery embolization (UAE) can reduce the premenstrual symptoms in women undergoing UAE for fibroid tumors or adenomyosis.Materials and MethodsAmong 141 women who underwent UAE for symptomatic fibroid tumors or adenomyosis at a single institution between March 2011 and February 2013, 54 premenstrual symptoms in 39 patients were prospectively analyzed. Premenstrual symptoms were rated by the patient on a scale of 0 to 10, with 0 representing no symptom and 10 representing the baseline severity. The change in premenstrual symptom score was calculated by subtracting the baseline score from the post-UAE score. At 3–6 months after UAE, each woman also completed a symptom severity questionnaire to assess the severity of menstrual bleeding to compare the changes in premenstrual symptoms scores between women with and without menorrhagia.ResultsBack pain, headache, and gastrointestinal symptoms (eg, constipation, indigestion, lower abdominal pain) were significantly improved after UAE (P < .05). Muscle pain, fatigue, nervousness, breast tenderness, and systemic edema were also improved, but not significantly so. The mean premenstrual symptom score change in patients with menorrhagia was significantly greater than in those without menorrhagia (−6.4 vs −3.7; P = .044).There was no correlation between the degree of menorrhagia score change and the degree of premenstrual symptom score change (P = .186).ConclusionsUAE could be a method to alleviate some premenstrual symptoms in patients with uterine fibroid tumors or adenomyosis.     

Dual-source CT coronary angiography: Diagnostic accuracy without the use of B blockers

PurposeTo evaluate the effect of heart rate, heart rate variability on dual-source computed tomography image quality performed without the use of B blockers and to assess diagnostic accuracy of dual-source CT (using adaptive electrocardiographic pulsing) for coronary artery stenosis, by using invasive coronary angiography as the reference standard.Materials and methodsPatients were studied without β-blocker pre-medication. Unenhanced CT and CT coronary angiography with adaptive ECG pulsing were performed using DSCT (DEFINITION, Siemens Medical Solutions, Forchheim, Germany). A contrast-enhanced volume dataset was acquired (two tubes, 120 kV, 400 mAs/rot, collimation 64 × 0.6 mm). Fifty-one patients (11 women, 40 men; mean age, 60.5 years ± 10 [standard deviation]) known to have or suspected of having coronary artery disease underwent dual-source CT and invasive coronary angiography. Accuracy of dual-source CT in depiction or exclusion of significant stenosis (?50%) was evaluated on a per-segment and per-patient basis. Effects of heart rate, heart rate variability were assessed. Patients were divided in three HRF groups: low, intermediate, and high (?65, 66–79, and ?80 beats/min, respectively), and four HRV groups given mean inter beat difference (IBD) during CT coronary angiography: normal, minor, moderate, and severe (IBDs of 0–1, 2–3, 4–10, and >10, respectively). The diagnostic performance was presented as sensitivity, specificity, positive predictive values, and negative predictive values validated against invasive coronary angiography (?50% lumen diameter reduction).ResultsGood image quality was achieved in 98% of patients without the use of B blockers and no significant differences in image quality were found among HRF and HRV groups. Twenty-three patients were examined having a heart rate ?65 beats/min, image quality was sufficient for diagnosis in 281 of 312 coronary segments (92%), whereas in 28 patients with a heart rate <65 beats/min, the image quality was sufficient for diagnosis in 387 of 388 coronary segments (100%). On a per-patient basis, 93% of patients (?65 beats/min) and 100% of patients (<65 beats/min) were considered evaluable. None of these differences were statistically significant. Similarly, no difference in diagnostic accuracy was found in per-vessel and -segment analyses.ConclusionIn 51 patients studied without β-blocker pre-medication, the overall image quality of dual-source CT coronary angiography is sufficient for diagnosis within a wide range of mean heart rates and variability of heart rates. Only heart rates that are both high and variable significantly deteriorate image quality, but the quality remains adequate for diagnosis.     

Cone-Beam CT Hepatic Arteriography in Chemoembolization for Hepatocellular Carcinoma: Angiographic Image Quality and Its Determining Factors

PurposeTo analyze image quality and the factors that determine it for cone-beam computed tomography (CT) hepatic arteriography in chemoembolization for hepatocellular carcinoma (HCC).Materials and MethodsFrom September 2009–December 2010, 399 consecutive patients referred for chemoembolization of HCC were scheduled for cone-beam CT scan. There were 12 patients (3%) excluded because of difficulty with breath-hold. Of the 387 patients who underwent cone-beam CT hepatic arteriography, 100 patients were ultimately included in the study according to inclusion criteria. Maximum intensity projection images were scored for image quality of each segmental hepatic artery. Potential determining factors for image quality were diaphragmatic motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio. The flow rate of contrast media, x-ray delay, and location of the catheter tip were also evaluated.ResultsIt was possible to trace at least subsegmental hepatic arteries in 625 of 700 segments (89.3%) on cone-beam CT hepatic arteriography. Diaphragmatic motion, prominent portal vein enhancement, and low hepatic artery-to-parenchyma enhancement ratio worsened image quality (P < .001, P = .022, and P = .017). Owing to cardiac motion artifacts, image quality of the left lateral segments (S2 and S3) was poorer compared with the remaining hepatic segments (S4–S8).ConclusionsIn most cases, the quality of cone-beam CT hepatic arteriography images was good enough to trace subsegmental hepatic arteries at a minimum. Respiratory and cardiac motion, portal vein enhancement, and hepatic artery-to-parenchyma enhancement ratio significantly affected the image quality of cone-beam CT hepatic arteriography.     

Coronary plaque characteristics in computed tomography and 2-year outcomes: The PREDICT study

BackgroundCoronary computed tomography angiography (CCTA) not only provides information regarding luminal stenoses but also allows for visualization of mural atheromatous changes (coronary plaques).ObjectiveWe sought to elucidate whether plaques seen on CCTA enable prediction of 2-year outcomes in patients with suspected and known coronary artery disease (CAD).MethodsOf 3015 patients who underwent CCTA, the images and 2-year clinical courses of 2802 patients were independently analyzed. The primary endpoint was the composite of all-cause death and acute coronary syndrome.ResultsDuring the 2-year observation period, 49 (1.7%) patients developed the primary outcome. The 2-year rates of the primary outcome in the normal (n = 515, no mural lesions), calcium (n = 654, calcified lesion alone), and plaque groups (n = 1633, presence of noncalcified or partially calcified plaques) were 0.2%, 2.0%, and 2.1%, respectively (P = 0.0028). Adverse plaque features such as low attenuation, positive remodeling, spotty calcification, and the napkin-ring sign (low-attenuation core with a higher-attenuation rim) were assessed by an independent core laboratory. Stepwise multivariate Cox proportional hazard analysis showed that a plaque with two or more characteristics (adjusted hazard ratio, 1.98; 95% confidence interval, 1.09–3.60; P = 0.0254), age of ≥67 years (mean), statin treatment after CCTA, and obstructive stenosis remained independent predictors of the primary outcome.ConclusionsPlaque imaging in CCTA has predictive value for the 2-year outcome and is a useful identifier for high-risk patients among those with known and suspected CAD.     

Relationship of the Duke jeopardy score combined with minimal lumen diameter as assessed by computed tomography angiography to the hemodynamic relevance of coronary artery stenosis

ObjectivesTo study the diagnostic performance of the ratio between the Duke jeopardy score (DJS) and the minimal lumen diameter (MLD) (DJS/MLDCT ratio) as assessed by coronary computed tomographic angiography (CTA) for differentiating functionally significant from non-significant coronary artery stenoses, with reference to invasive fractional flow reserve (FFR).MethodsPatients who underwent both coronary CTA and FFR measurement during invasive coronary angiography (ICA) within 2 weeks were retrospectively included in the study. Invasive FFR measurement was performed in patients with intermediate to severe coronary stenoseis. DJS/MLDCT ratio and anatomical parameters were recorded. Lesions with FFR ≤0.80 were considered to be functionally significant.ResultsOne hundred and sixty-one patients with 175 lesions were included into the analysis. Diameter stenosis in CT, area stenosis, plaque burden, lesion length (LL), ICA-based stenosis degree, DJS, LL/MLD⁴ ratio, DJS/MLA ratio as well as DJS/MLD ratio were all significantly different between hemodynamically significant and non-significant lesions (p<0.05 for all). ROC curve analysis determined the optimal cut-off value for DJS/MLD_CT ratio to be 1.96 (area under curve = 0.863, 95 % confidence interval = 0.803–0.910), yielding a high diagnostic accuracy (86.9%, 152/175).ConclusionsIn coronary artery stenoses detected by coronary CTA, the DJS/MLD ratio is able to predict hemodynamic relevance.     

Downstaging Disease in Patients with Hepatocellular Carcinoma Outside of Milan Criteria: Strategies Using Drug-eluting Bead Chemoembolization

PurposeTo assess downstaging rates in patients with United Network for Organ Sharing stage T3N0M0 hepatocellular carcinoma (HCC) treated with doxorubicin-eluting bead transarterial chemoembolization to meet Milan criteria for transplantation.Materials and MethodsA single-center retrospective review of 239 patients treated with doxorubicin-eluting bead (DEB) chemoembolization between September 2008 and December 2011 was undertaken. Baseline and follow-up computed tomography or magnetic resonance imaging was assessed for response based on the longest enhancing axial dimension of each tumor (ie, modified Response Evaluation Criteria In Solid Tumors measurements), and medical records were reviewed. Fisher exact tests and exact logistic regression were used to test the association of patient and disease characteristics with downstaging.ResultsAfter exclusions, 22 patients remained in the analysis, 17 of whom (77%) had their HCC downstaged to meet Milan criteria. Among those whose disease was downstaged, seven underwent transplantation, one remained listed for transplantation, six had disease progression beyond Milan criteria, two underwent conventional transarterial chemoembolization, and one underwent radiofrequency ablation. The seven patients who received transplants were still living, but recurrent HCC developed in two. Baseline age (P = .25), Model for End-stage Liver Disease score (P = .77), and α-fetoprotein (AFP) level (P = 1.00) were similar between patients with and without downstaged HCC. No associations were observed between the odds of downstaging and sex (P = .21), Child–Pugh class (P = .14), Child–Pugh class controlling for baseline tumor multiplicity (P = .15), Eastern Cooperative Oncology Group performance status (P = 1.00), tumor burden (P = .31), multiple tumors (P = .31), or hepatitis C virus infection (P = 1.00). Fifteen patients who did not receive transplants were alive at 1 year, with two progression-free. Baseline AFP levels differed between those who survived 1 year and those who did not (P = .02), but did not differ by progression-free survival status (P = .62).ConclusionsT3N0M0 HCC treatment with DEB chemoembolization has a high likelihood (77%) of downstaging the disease to meet Milan criteria.     

Microwave Thermal Ablation of Spinal Metastatic Bone Tumors

PurposeTo assess feasibility, safety, and efficacy of microwave ablation of spinal metastatic bone tumors.Materials and MethodsRetrospective study of 17 patients with 20 spinal metastatic tumors treated with microwave ablation under computed tomographic guidance between March 2011 and August 2013 was performed. Ablations were performed under local anesthesia and nitrous oxide ventilation. Lesions were lumbar (n = 10), sacral (n = 7), and thoracic (n = 3) in location. Primary neoplastic sites were lung (n = 9), prostate (n = 4), kidney (n = 6), and uterus (n = 1). Adjunct cementoplasty was performed in nine cases, and a temperature-monitoring device was used in four cases. Procedure effectiveness was evaluated by visual analog scale (VAS) during a 6-month follow-up. Patient medical records were reviewed, and demographic and clinical data, tumor characteristics, and information on pain were assessed.ResultsMean ablation time was 4.4 minutes ± 2.7 (range, 1–8 min), with an average of 3.8 cycles per ablation at 60 W (range, 30–70 W). The preprocedure mean VAS score was 7.4 ± 1.2 (range, 6–9). Pain relief was achieved in all but one patient. Follow-up VAS scores were as follows: day 0, 1.3 ± 1.8 (P < .001); day 7, 1.6 ± 1.7 (P < .001); month 1, 1.9 ± 1.6 (P < .001); month 3, 2.2 ± 1.5 (P < .001); and month 6, 2.3 ± 1.4 (P < .01). No complications were noted.ConclusionsMicrowave ablation appears to be feasible, safe, and an effective treatment of painful refractory spinal metastases and may be considered as a potential alternative percutaneous technique in the management of spinal metastases.     

Dynamic Volumetric CT Angiography for the Detection and Classification of Endoleaks: Application of Cine Imaging Using a 320-Row CT Scanner with 16-cm Detectors

PurposeTo assess the feasibility and diagnostic performance of dynamic volumetric computed tomography (CT) angiography with large-area detectors in the detection and classification of endoleaks after endovascular aneurysm repair (EVAR).Materials and MethodsLow-dose dynamic volumetric CT angiography performed with the patient in Fowler position was used to scan the entire stent graft with a 16-cm-area detector during the first follow-up examination after EVAR. There were 39 consecutive patients (36 men and 3 women; mean age, 74 y ± 8.7) examined with approximately 14–20 intermittent scans (temporal resolution, 2 s; scan range, 160 mm). The effective radiation dose, image quality, interobserver and intraobserver agreement for endoleak detection, and time delay between peak enhancement of the aorta and endoleaks were evaluated.ResultsAll examinations with the patient in Fowler position enabled the entire stent graft to be scanned and were rated as diagnostic. The mean effective radiation dose was 13.1 mSv. Endoleaks were detected in eight patients (type Ia, n = 1; type II, n = 6; type III, n = 1). Interobserver agreement (κ = 0.794) and intraobserver agreement (κ = 1.00) for detection of endoleaks were excellent. The mean time delay between peak enhancement of the aorta and the endoleaks was significantly less for type I/III endoleaks (2.0 s ± 0) compared with type II endoleaks (5.3 s ± 1.0; P < .001).ConclusionsLow-dose dynamic volumetric CT angiography performed with the patient in Fowler position is feasible after EVAR. Dynamic information, including cine imaging, the timing of peak enhancement, and the Hounsfield units index, is useful in detecting and classifying endoleaks.     

Comparison of Characteristics and Transarterial Chemoembolization Outcomes in Patients with Unresectable Hepatocellular Carcinoma and Different Viral Etiologies

PurposeTo determine any differences in patient characteristics and outcomes after transarterial chemoembolization between different viral etiologies of hepatocellular carcinoma (HCC).MethodsThis retrospective study consisted of 201 patients undergoing first-time transarterial chemoembolization for unresectable HCC from January to December 2009. The patients were divided into four groups: hepatitis B virus (HBV) only (n = 104), hepatitis C virus (HCV) only (n = 63), HBV and HCV (n = 10), and no viral hepatitis (n = 24). The clinical and laboratory data were obtained from electronic medical records, and imaging findings obtained before transarterial chemoembolization were analyzed. Kaplan-Meier analyses were used to assess the impact of HBV or HCV status, clinical characteristics, and imaging results on overall survival.ResultsAfter a median follow-up of 28.3 months ± 16.2, the 1-, 2-, and 3-year overall survival rates were 74.1%, 59.7%, and 53.2%. Patients with HBV had a significant association with younger age (P = .001), higher male-to-female ratio (P = .003), lower alanine aminotransferase levels (P = .018), higher albumin levels (P = .009), and multifocal tumors at diagnosis (P = .04) compared with patients with HCV. Patients with both HBV and HCV had significantly higher serum bilirubin levels compared with the other groups (P = .002). No significant difference was found in overall survival among the different hepatitis groups (P = .943). Multivariate analysis showed that statistically significant determinants for overall survival were Child-Pugh class (P = .002), Barcelona Clinic Liver Cancer stage (P < .001), tumor size (P < .001), and distribution (P < .001).ConclusionsViral etiology has no correlation with the outcome of patients with HCC undergoing transarterial chemoembolization.     

Endovascular Procedures versus Intravenous Thrombolysis in Stroke with Tandem Occlusion of the Anterior Circulation

PurposeStroke with tandem occlusion within the anterior circulation presents a lower probability of recanalization and good clinical outcome after intravenous (IV) thrombolysis than stroke with single occlusion. The present study describes the impact of endovascular procedures (EPs) compared with IV thrombolysis alone on recanalization and clinical outcome.Materials and MethodsThirty patients with symptom onset less than 4.5 hours and tandem occlusion within the anterior circulation were analyzed retrospectively. Recanalization was assessed per Thrombolysis In Cerebral Infarction (TICI) classification on computed tomography, magnetic resonance imaging, or digital subtraction angiography within 24 hours. Infarct size was detected on follow-up imaging as a dichotomized variable, ie, more than one third of the territory of the middle cerebral artery. Clinical outcomes were major neurologic improvement, independent outcome (90-d modified Rankin Scale [mRS] score), symptomatic intracerebral hemorrhage (sICH; per European Cooperative Acute Stroke Study criteria), and death within 7 days.ResultsPatients treated with EPs (n = 14) were significantly younger and had a history of arterial hypertension more frequently than patients treated with IV thrombolysis alone (n = 16). Recanalization (ie, TICI score 2b/3; EP, 64%; IV, 19%; P = .01), major neurologic improvement (EP, 64%; IV, 19%; P = .01), and independent outcome (mRS score ≤ 2; EP, 54% IV, 13%; P = .02) occurred more often in the EP group, whereas infarct sizes greater than one third of the MCA territory (EP, 43%; IV, 81%; P = .03) were observed less often. Rates of sICH (P = .12) and death within 7 days (P = .74) did not differ significantly.ConclusionsHigher recanalization rate, smaller infarct volume, and better clinical outcome in the EP group should encourage researchers to include this subgroup of patients in prospective randomized trials comparing IV thrombolysis versus EP in stroke.     

Relationship of Thrombus Length to Number of Stent Retrievals,Revascularization, and Outcomes in Acute Ischemic Stroke

PurposeTo study the relationship between intracranial thrombus length and number of stent retrievals, revascularization rates, and functional outcomes in stroke.Materials and MethodsRetrospective data were collected from consecutive cases of stroke treated with endovascular procedures at a single institution from April 2012–September 2013. Thrombus length was measured in the anterior cerebral circulation. Demographic and clinical details; involved vessels; and procedural details, including the number of devices used and number of retrievals used for each device, were recorded. Revascularization rates and 90-day functional outcomes were recorded.ResultsData regarding the length of thrombus in the anterior cerebral circulation were available for 28 patients. There was no significant association between thrombus length and number of stent retrievals (P = .3780), final thrombolysis in cerebral infarction (TICI) score (P = .4835), or 90-day modified Rankin Scale score (P = .4146). There was a significant difference (P = .0280) between number of retrievals and final TICI score, with lower number of retrieval passes corresponding to higher final TICI scores.ConclusionsThe data suggest no relationship between thrombus length and number of stent retrievals, final TICI score, or functional neurologic outcomes at 90 days in stent retrieval thrombectomy for acute ischemic stroke. These results do not support a predictive value for thrombus length quantification in the evaluation of stroke.     

Role of C-Arm CT in Identifying Caudate Arteries Supplying Hepatocellular Carcinoma

PurposeTo evaluate the role of C-arm computed tomography (CT) performed at the proper hepatic artery or equivalent in patients with caudate-lobe hepatocellular carcinoma (HCC) for the detection of tumor-feeding arteries during chemoembolization.Materials and MethodsFrom July 2009 to June 2012, 1,785 patients received initial chemoembolization at a single institution. Among them, 52 patients with caudate HCC underwent initial chemoembolization with the use of C-arm CT. C-arm CT images were obtained at the proper hepatic artery or equivalent. Two radiologists reviewed the C-arm CT scans and angiograms in consensus. The cumulative local recurrence rate was calculated by the Kaplan–Meier method.ResultsTumor-feeding arteries were single (n = 31), double (n = 12), triple (n = 6), and quadruple (n = 3). Seventy-nine tumor-feeding arteries and their origins in 48 patients were demonstrated on C-arm CT. In four patients (7.7%), five tumor-feeding arteries were not clearly indicated on C-arm CT because of poor image quality caused by failure of the patients to hold their breath. Selective chemoembolization via tumor-feeding arteries was successful in 45 patients (87%). The cumulative local recurrence rates at 6 months, 1 year, and 3 years were 19.4%, 32.8%, and 35.8%, respectively. Nonselective chemoembolization of tumor-feeding arteries of caudate-lobe HCC was a significantly important factor in higher cumulative local recurrence rates (hazard ratio, 3.916; 95% confidence interval, 1.367–11.216; P = .011).ConclusionC-arm CT obtained at the proper hepatic artery or equivalent level can demonstrate most tumor-feeding arteries supplying HCCs in the caudate lobe.     

Embolization of Angiographically Visible Type I and II Utero-ovarian Anastomoses during Uterine Artery Embolization for Fibroid Tumors: Impact on Symptom Recurrence and Permanent Amenorrhea

PurposeTo compare the incidences of symptom recurrence and permanent amenorrhea following uterine artery embolization (UAE) for symptomatic fibroid tumors in patients with type I and II utero-ovarian anastomoses (UOAs) with versus without ovarian artery embolization (OAE).Materials and MethodsA retrospective, institutional review board–approved study of 99 women who underwent UAE for symptomatic fibroid tumors from April 2005 to October 2010 was conducted to identify patients who had type I or II UOAs at the time of UAE. Based on the embolization technique, patients were categorized into standard (ie, UAE only), combined (ie, UAE and OAE), and control (patients without UOAs who underwent UAE) groups. Data collected included patient characteristics, procedural technique and findings, symptom recurrence, secondary interventions, and permanent amenorrhea. Statistical analysis was performed with the Fisher exact test, with significance reached at P < .05.ResultsTwenty patients (20.2%; mean age, 46.9 y ± 6.3) had type I (n = 3) or II (n = 17) UOAs. Thirteen (65%) underwent UAE only (standard group) and seven (35%) underwent UAE and OAE (combined group). There were no significant differences between groups in demographics or in the incidence of permanent amenorrhea after procedures (follow-up, 561 d ± 490). There was a significantly higher incidence of symptom recurrence in the standard group compared with the control group (P = .01), with no differences between combined and control groups (P = 1).ConclusionsThere were no statistical differences in permanent amenorrhea rates in the groups studied, with significantly higher symptom recurrence rates observed when OAE was not performed in the setting of UOA.     

High-pitch versus sequential mode for coronary calcium in individuals with a high heart rate: Potential for dose reduction

BackgroundTo determine the impact of high-pitch spiral acquisition on radiation dose and cardiovascular disease (CVD) risk stratification by coronary artery calcium (CAC) assessment with computed tomography in individuals with a high heart rate.MethodsOf the ROBINSCA trial, 1990 participants with regular rhythm and heart rates >65 beats per minute (bpm) were included. As reference, 390 participants with regular heart rates ≤65 bpm were used. All participants underwent prospectively electrocardiographically(ECG)-triggered imaging of the coronary arteries using dual source CT at 120 kVp, 80 ref mAs using both high-pitch spiral mode and sequential mode. Radiation dose, Agatston score, number of positive scores, as well as median absolute difference of the Agatston score were determined and participants were stratified into CVD risk categories.ResultsA similar percentage of participants with low heart rates and high heart rates had a positive CAC score in data sets acquired in high-pitch spiral (low heart rate: 57.7%, high heart rate: 55.8%) and sequential mode (58.0%, 54.7%, p = n.s.). The median absolute difference in Agatston scores between acquisition modes was 14.2% and 9.2%, for the high and low heart rate groups, respectively. Excellent agreement for risk categorization between the two data acquisition modes was found for the high (κ = 0.927) and low (κ = 0.946) heart rate groups. Radiation dose was 48% lower for high-pitch spiral versus sequential acquisitions.ConclusionRadiation dose for the quantification of coronary calcium can be reduced by 48% when using the high-pitch spiral acquisition mode compared to the sequential mode in participants with a regular high heart rate. CVD risk stratification agreement between the two modes of data acquisition is excellent.     

Radiography of the knee joint: A comparative study of the standing partial flexion PA projection and the standing fully extended AP projection using visual grading characteristics (VGC)

ObjectivesTo compare the diagnostic information in detection and assessment of knee pathology from knee radiographs using either the PA standing with partial flexion projection or AP fully extended standing projection.MethodA set of 32 knee radiographs was retrospectively compiled from 16 adult patients imaged using both projections over a 2-year period (PA: n = 16 and AP: n = 16). Repeat radiographs (n = 6) were added to the image set facilitating inter and intra observer reliability. Image evaluation was performed by 5 orthopaedic surgeons performing Absolute Visual Grading Analysis assessing image quality based on 6 anatomical image quality criteria specifically developed to evaluate and compare the two projections. The resulting image quality scores were analysed using Visual Grading Characteristics.ResultsImage quality scores were higher for the PA projection but variation between the two projections was not significant (p > 0.05). The PA projection was significantly (p < 0.05) better in the visualization of 2 anatomical image quality criteria involving the joint space width and tibial spines.ConclusionBoth projections can be used for general evaluation of the knee joint, however the PA partial flexion projection is preferred for the investigation of specific knee pathology. Recommendations for minimizing variations in radiographic positioning technique are also highlighted.     

Prospective Evaluation of Optical Coherence Tomography in Lower Limb Arteries Compared with Intravascular Ultrasound

PurposeTo compare in a prospective noninferiority study optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in popliteal and infrapopliteal vessels.Materials and MethodsOCT and IVUS images of 112 popliteal and infrapopliteal arterial segments were prospectively obtained from 16 patients with peripheral arterial occlusive disease. Three observers evaluated the corresponding OCT and IVUS images for image quality, artifact frequency, discriminability of vessel wall layers, and plaque composition. Measurements of the lumen, vessel, and plaque areas were compared for both modalities.ResultsThe intrareader and interreader reproducibility of plaque tissue discrimination (0.88 vs 0.75), overall image quality, and vessel wall layer discriminability were significantly higher for OCT (all P < .001). Artifact frequency was higher in OCT, constraining the imaging of the tibioperoneal trunk. The results of measurements of the lumen and vessel area were comparable for both modalities (correlation > 0.9, P < .001). Plaque area measurements differed (correlation 0.8, P < .01) because OCT underestimated it. The OCT procedure caused vessel spasms in two patients.ConclusionsOCT imaging of infrapopliteal arteries is feasible and safe and provides high image quality. It enables an accurate assessment of vessel lumen, wall, and plaque. Compared with IVUS, OCT images provide excellent image quality and superior visualization of vessel wall layers and different plaque components. The penetration depth of OCT restricts its use to suitable vessel regions.