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1.
Federico Collettini Mascha Golenia Dirk Schnapauff Alexander Poellinger Timm Denecke Peter Wust Hanno Riess Bernd Hamm Bernhard Gebauer 《Journal of vascular and interventional radiology : JVIR》2012,23(5):618-626
PurposeTo analyze initial experience with computed tomography–guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM).Materials and MethodsBetween January 2008 and December 2010, 37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34–83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid–enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter.ResultsTwo patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3–32 mo). Mean tumor diameter was 25.5 mm (range 8–74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3–39 months (median 18 months).ConclusionsCT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM. 相似文献
2.
Percutaneous CT–Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis
Paula García-Barquín Jesús Dámaso Aquerreta Beola José María Bondía Gracía Agustín España Alonso Juan Pérez Cajaraville Pablo Bartolomé Leal Gorka Bastarrika 《Journal of vascular and interventional radiology : JVIR》2017,28(6):877-885
Purpose
To evaluate the benefits of computed tomography (CT)–guided percutaneous sympathicolysis with radiofrequency in patients with primary palmar hyperhidrosis (PPHH) in terms of safety, patient satisfaction, and short- and long-term efficacy.Materials and Methods
A total of 139 procedures in 108 patients (mean age, 29.89 y ± 10.94), including 50 men and 58 women, with PPHH and therapy-resistance of nonsurgical treatments were retrospectively analyzed. Treatment was performed bilaterally at T2, T3, and T4 levels, reaching 90°C during 8 minutes. Technical success, immediate efficacy, and presence of complications were analyzed. For follow-up, the Hyperhidrosis Disease Severity Scale was used to evaluate the hyperhidrosis before, at one month, and in the long-term through a survey of 42 patients. Patients' satisfaction and complications were also recorded.Results
The technical success rate was 98.56%. The increase in palmar skin temperature was 4.88°C ± 1.85. A total of 85.3% of participants had completely dry hands immediately after treatment. The mean follow-up time was 41.34 months (range, 6–62 mo). One month after treatment, the response rate was 77.38% (P < .001). At long-term follow-up, the response rate was 69.04% (P < .001). Two major complications were observed (1.8%), 52.38% of patients were satisfied, and 59.52% of patients presented compensatory hyperhidrosis at long-term follow-up.Conclusions
Percutaneous CT–guided sympathicolysis is a safe and effective technique for the treatment of PPHH and can be considered as a second choice in patients in whom other nonsurgical therapeutic options have failed, despite the compensatory hyperhidrosis rates. 相似文献3.
Yu-Kai Su Rosewell V. Mackey Ahsun Riaz Vanessa L. Gates Al B. Benson Frank H. Miller Vahid Yaghmai Ahmed Gabr Riad Salem Robert J. Lewandowski 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1520-1526
Purpose
To determine long-term hepatotoxicity of yttrium-90 (90Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms.Materials and Methods
Retrospective review from 2003 to 2016 was performed for patients with mNET treated with 90Y glass microspheres. Fifty-four patients with > 2 year follow-up were stratified into unilobar (n = 15) vs whole-liver (n = 39) treatment. The most common primary mNET sites were small bowel (19 of 54), pancreas (19 of 54), and unknown (8 of 54). Preradioembolization imaging and laboratory findings were compared with most recent follow-up for indications of worsening portal hypertension and decline in hepatic function.Results
Among patients who underwent unilobar radioembolization, imaging follow-up at a mean of 4.1 years (range, 2.0–15.2 y) revealed cirrhosis-like morphology in 26.7% (4 of 15), ascites in 13.3% (2 of 15), varices in 6.7% (1 of 15), and a 21.9% increase in splenic volume. The respective incidences in patients treated with whole-liver 90Y radioembolization were 56.4% (22 of 39), 41.0% (16 of 39), and 15.4% (6 of 39), with a 64.7% increase in splenic volume. Patients treated with whole-liver radioembolization exhibited significantly decreased platelet counts (P = .023) and lower albumin levels (P = .0002). Eight patients (20.5%) treated with whole-liver radioembolization who exhibited cirrhosis-like morphology showed clinical signs of hepatic decompensation; only 2 of 39 patients (5.1%) had no other causes of hepatotoxicity.Conclusions
Whole-liver 90Y radioembolization for patients with mNET results in long-term imaging findings of cirrhosis-like morphology and portal hypertension in > 50% of treated patients, but the majority remain clinically asymptomatic. Long-term hepatotoxicity solely attributable to 90Y develops in a small percentage of patients. 相似文献4.
5.
Objective
To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program.Methods
The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings.Results
Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142).Conclusions
This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. 相似文献6.
Michael G. Holmes Erik Foss Gabby Joseph Adam Foye Brooke Beckett Daria Motamedi Jack Youngren George V. Thomas Jiaoti Huang Rahul Aggarwal Joshi J. Alumkal Tomasz M. Beer Eric J. Small Thomas M. Link 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1073-1081.e1
Purpose
To evaluate the success rate of CT–guided bone biopsies in metastatic castration-resistant prostate cancer (mCRPC) and to investigate associated technical, imaging, and clinical parameters affecting diagnostic yields.Materials and Methods
Eighty CT–guided bone biopsy specimens were obtained from 72 men (median age, 68 y; range, 49–89 y) enrolled in a multicenter trial to identify mechanisms of resistance in mCRPC. Successful biopsy was determined by histologic confirmation of tumor cells and successful isolation of RNA for molecular analysis.Results
The overall success rate of CT–guided bone biopsies was 69% (55/80) based on histology and 64% (35/55) based on isolation of molecular material for RNA sequencing. Biopsies performed in lesions with areas of radiolucency had significantly higher diagnostic yields compared with lesions of predominantly dense sclerosis (95% vs 33%; P = .002) and lesions of predominantly subtle sclerosis (95% vs 65%; P = .04). Success rates increased in lesions with density ≤ 475 HU (79% for ≤ 475 HU vs 33% for > 475 HU; P = .001) and in lesions with ill-defined margins (76% for ill-defined margins vs 36% for well-circumscribed margins; P = .005). Alkaline phosphatase was the only clinical parameter to correlate significantly with diagnostic yield (83% for > 110 U/L vs 50% for ≤ 110 U/L; P = .001).Conclusions
Image-guided bone tumor biopsies can be successfully used to acquire cellular and molecular material for analyses in patients with osteoblastic prostate cancer metastases. Diagnostic yields are significantly increased in lesions with areas of radiolucency, density ≤ 475 HU, ill-defined margins, and interval growth and in patients with alkaline phosphatase > 110 U/L. 相似文献7.
Tim J. van Oostenbrugge Johan F. Langenhuijsen Christiaan G. Overduin Sjoerd F. Jenniskens Peter F.A. Mulders Jurgen J. Fütterer 《Journal of vascular and interventional radiology : JVIR》2017,28(8):1098-1107.e1
Purpose
To assess the feasibility of percutaneous magnetic resonance (MR) imaging–guided cryoablation of small renal masses (SRMs) in a 3-T environment and to evaluate intraprocedural imaging, procedural safety, and initial outcomes.Materials and Methods
The analysis included 9 patients (4 men; median age, 72 y; range, 70-82 y) with 9 SRMs (diameter, 12–30 mm). Lesions underwent biopsy, and cryoneedles were inserted under ultrasound guidance. Verification of needle positions and ice-ball monitoring were performed by T1-weighted volumetric interpolated breath-hold examination and T2-weighted half-Fourier acquired single-shot turbo spin-echo sequences. On image analysis, needle positioning was considered appropriate if the target lesion border was visible, the needle tip was inside the target lesion, and the ice ball was expected to cover the target lesion with a 5-mm margin. If these criteria could not be assessed, imaging was considered inadequate. Technical success was defined as tumor coverage with a 5-mm margin and no residual disease on 1-mo follow-up MR imaging.Results
Median total procedure time was 170 min (range, 135–193 min). Intraoperative imaging allowed adequate needle visualization in 67% of acquired scans (4 of 7 T1-weighted and 6 of 8 T2-weighted). Appropriate positioning of two or three needles used for each procedure was confirmed in all cases on T1- or T2-weighted imaging. Ice-ball formation was adequately visualized in all patients. Technical success rate was 100%. No local recurrences were detected on follow-up imaging at a median of 12 mo (range, 3–22 mo).Conclusions
Percutaneous MR-guided cryoablation of SRMs in a 3-T MR imaging environment is safe and feasible, showing adequate intraoperative imaging capabilities with promising short-term clinical outcomes. 相似文献8.
Gero Wieners Maciej Pech Bert Hildebrandt Nils Peters Annett Nicolaou Konrad Mohnike Max Seidensticker Marcin Sawicki Peter Wust Jens Ricke 《Cardiovascular and interventional radiology》2009,32(5):937-945
The aim of this study was to evaluate the feasibility, safety, and efficacy of combined treatment with hepatic interstitial
brachytherapy (HIB) and hepatic arterial infusion (HAI) of chemotherapy after interventional implantation of port catheter
systems. Thirty-three patients with unresectable “liver-only” metastases of colorectal cancer were treated with both HIB and
HAI during the course of their disease. All 33 patients had recurrent disease and 27 had received previous chemotherapy. Of
these, 15 received HAI first and were then consolidated with HIB, 9 started with HIB and were continued with HAI, and 9 received
first HIB and subsequently HAI after hepatic disease progression. Patients were evaluated for treatment characteristics, side
effects, and efficacy. Comparisons between treatment groups were also performed. The median tumor diameter of metastases treated
with brachytherapy was 4.6 cm (range: 1–12 cm). The median minimal irradiation dose inside the tumor margin was 18 Gy administered
to a mean of two metastases in 69 interventions. Minor (n = 4) and major (n = 3) complications occurred in 10% of interventions. WHO grade III adverse events of the regional chemotherapy were observed
in seven patients; grade IV, in one patient. At a median follow-up of 28 months (range: 7–74 months), the median time to disease
progression after first treatment was 10.5 months (range: 1–35 months). Of 138 metastases treated by brachytherapy, 16 local
recurrences were seen (mean, 12.3 months; range, 3–45 months). No signs of hepatic failure were observed in any of our patients.
In conclusion, combinations of two minimally invasive therapeutic methods are feasible, with acceptable complication rates,
and provide promising results in colorectal cancer patients with unresectable hepatic metastases. 相似文献
9.
Is a Diagnostic CT of the Brain Indicated in Patients with Choroidal Metastases Before Radiotherapy?
BACKGROUND AND PURPOSE: There is no evidence in the literature about the incidence of synchronous brain metastases in patients with choroidal metastases. This is of major importance, because the radiation fields of choroidal metastases and, later on, brain metastases, if treated consecutively, are partly overlapping, thus potentially increasing the rate of late side effects such as brain necrosis. The goal of this study was to determine the frequency of synchronous brain metastases. PATIENTS AND METHODS: 50 patients with choroidal metastases were enrolled into a study of the "Arbeitsgemeinschaft Radiologische Onkologie" of the German Cancer Society (ARO 95-08) with standardized 40 Gy radiotherapy, 2 Gy single dose. All patients were staged before treatment with a computed tomography of the brain (CCT). No patient showed clinical signs of brain metastases. RESULTS: 13 out of 50 patients (26%) had brain metastases in the CCT leading to radiotherapy of the brain and choroidal metastases in one volume. CONCLUSION: A CCT is indicated at the diagnosis of choroidal metastases for screening of synchronous brain metastases. The incidence is about 25%, and the diagnosis of brain metastases results in a different target volume: the whole brain including the posterior parts of the eyes compared to the posterior parts of the eyes alone. Therefore, the risk of late side effects could be reduced compared with an additional later radiotherapy of the whole brain with partly overlapping fields. 相似文献
10.
Kristen A. Lee Andrew Taylor Brittany Bartolome Nicholas Fidelman K. Pallav Kolli Maureen Kohi Ryan Kohlbrenner Jeanne Laberge Evan Lehrman Robert Kerlan 《Journal of vascular and interventional radiology : JVIR》2019,30(7):1043-1047
PurposeTo evaluate efficacy and safety of transjugular liver biopsy (TJLB) via the left hepatic vein in patients with left lobe–only liver transplants (LLOTs).Materials and MethodsRetrospective review revealed 43 TJLBs performed in 26 patients with LLOTs (mean age 51.3 y; range, 18–73 y) between January 2009 and June 2016 at a single institution. A comparison group of 44 randomly selected TJLBs performed in 37 orthotopic whole liver transplant (OWLT) recipients (mean age 57.6 y; range, 35–74 y) during the same time period was evaluated. Patient demographics, type and age of transplant, technical success, adequacy of samples, number of portal tracts obtained, pathologic diagnosis, and complication rate were reviewed.ResultsTechnical success was achieved in 98% (42/43) of LLOT procedures. TJLB failed in 1 patient with LLOT, in whom no patent hepatic veins were identified. Technical success was achieved in 100% (44/44) in the OWLT group. Mean (SD) number of needle passes was 4.12 (1.25) in the LLOT group vs 3.95 (1.28) in the OWLT group (P = .54). Mean (SD) specimen length was 1.16 (0.75) cm in the LLOT group vs 1.19 (0.58) cm in the OWLT group (P = .78). Mean (SD) number of portal tracts obtained in the LLOT group was 10.7 (5.26) vs 12.3 (4.68) in the OWLT group (P = .17). No major complications were observed in either group.ConclusionsTJLB in adult patients with LLOTs appears safe and feasible, with favorable rates of technical success and adequacy of sampling. 相似文献
11.
Waleed Shady Elena N. Petre Kinh Gian Do Mithat Gonen Hooman Yarmohammadi Karen T. Brown Nancy E. Kemeny Michael DAngelica Peter T. Kingham Stephen B. Solomon Constantinos T. Sofocleous 《Journal of vascular and interventional radiology : JVIR》2018,29(2):268-275.e1
Purpose
To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs).Materials and Methods
This is a retrospective review of CLMs ablated from November 2009 to April 2015 (110 patients). Margins were measured on contrast-enhanced computed tomography (CT) 6 weeks after ablation. Clinical and technical predictors of LTPFS were assessed using a competing risk model adjusted for clustering.Results
Technique effectiveness (complete ablation) was 93% (79/85) for RF ablation and 97% (58/60) for MW ablation (P = .47). The median follow-up period was significantly longer for RF ablation than for MW ablation (56 months vs. 29 months) (P < .001). There was no difference in the local tumor progression (LTP) rates between RF ablation and MW ablation (P = 0.84). Significant predictors of shorter LTPFS for RF ablation on univariate analysis were ablation margins 5 mm or smaller (P < .001) (hazard ratio [HR]: 14.6; 95% confidence interval [CI]: 5.2–40.9) and perivascular tumors (P = .021) (HR: 2.2; 95% CI: 1.1–4.3); both retained significance on multivariate analysis. Significant predictors of shorter LTPFS on univariate analysis for MW ablation were ablation margins 5 mm or smaller (P < .001) (subhazard ratio: 11.6; 95% CI: 3.1–42.7) and no history of prior liver resection (P < .013) (HR: 3.2; 95%: 1.3–7.8); both retained significance on multivariate analysis. There was no LTP for tumors ablated with margins over 10 mm (median LTPFS: not reached). Perivascular tumors were not predictive for MW ablation (P = .43).Conclusions
Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors. 相似文献12.
Okan Akhan Adalet Elcin Yildiz Devrim Akinci Baris Dogu Yildiz Turkmen Ciftci 《Cardiovascular and interventional radiology》2014,37(6):1568-1574
Objective
The purpose of this study was to determine the safety and efficacy of adjuvant albendazole medication in percutaneous liver hydatid cyst treatment with puncture, aspiration, injection, and reaspiration (PAIR) method.Methods
Between November 2007 and May 2011, total of 39 patients with newly diagnosed liver hydatid cyst (total of 77 cysts) were prospectively randomized and enrolled in 3 groups. In the first group, cysts (n = 14) were treated with PAIR without albendazole. In the second (n = 16) and third groups (n = 47), cysts were treated with PAIR with albendazole 1 week before and 1 month after the procedure, with albendazole 1 week before and 3 months after the procedure respectively.Results
Technical and clinical success rates were 100 and 96.1 % respectively. In 3 of 77 cysts (3.9 %), findings of recurrence were detected on US imaging. All recurrent cysts were in group 1 and recurrence rates in this group were statistically different from cysts of second and third groups (p = 0.005). Side effects of albendazole were detected in 7 of 29 patients (24.1 %), and no statistically significant difference was observed between the second (15.3 %) and third (38.4 %) groups (p = 0.378).Conclusions
Use of albendazole medication as an adjuvant to percutaneous treatment of liver hydatid cyst decreases the recurrence rate. Although there is no statistically significant difference between groups 2 and 3 in terms of efficacy and recurrence rate, patients in group 3 had a higher rate of side effect. Therefore, we conclude that albendazole treatment 1 week before and 1 month after PAIR treatment is sufficient to reduce/prevent recurrences. 相似文献13.
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15.
Marirosa Cristallo Lacalamita Marco Moschetta Maria Elisabetta Mancini Arnaldo Scardapane Giuseppe Angelelli 《La Radiologia medica》2014,119(9):651-657
Purpose
The purpose of this study was to evaluate the computed tomography (CT) signs of free and covered small-bowel perforations and the potential of CT in recognising the aetiology.Materials and methods
Thirty-five patients with surgically proven small-bowel perforation were retrospectively evaluated. Fundamental signs (extraluminal air, solution of continuity) and secondary signs (thickening of the mesentery, free or perilesional fluid, wall thickening) were considered.Results
CT alterations were found in 31/35 (88.6 %) patients: extraluminal air (30/35, 85.7 %), solution of continuity (11/35, 31.4 %), intra-abdominal fluid (27/35, 77.1 %), thickening of the mesentery (20/35, 57.1 %), and wall thickening (14/35, 40 %). In 25/35 cases (71.4 %) pneumoperitoneum was detected, associated with secondary signs (23/25, 82 %), confirmed as free perforations at surgery. In 5/35 patients (14.2 %), peri-intestinal air bubbles and secondary signs were evident, while in 1/35 cases (2.8 %) only secondary signs were seen, namely covered perforations. In 4/35 patients (11.4 %) with a covered perforation, the CT scan was negative. The nature of the perforations was completely recognisable in 26/31 cases (83.9 %), partially identifiable in 4/31 (12.9 %), not evident in 1/31 (3.2 %).Conclusion
CT investigation is essential in the recognition of a small-bowel perforation and in the definition of its nature. 相似文献16.
Sebastian Keil Philipp Bruners Katharina Schiffl Martin Sedlmair Georg Mühlenbruch Rolf W. Günther Marco Das Andreas H. Mahnken 《Cardiovascular and interventional radiology》2010,33(2):297-306
The purpose of this study was to investigate differences in change of size and CT value between local recurrences and tumor-free
areas after CT-guided radiofrequency ablation (RFA) of hepatic metastases during follow-up by means of dedicated software
for automatic evaluation of hepatic lesions. Thirty-two patients with 54 liver metastases from breast or colorectal cancer
underwent triphasic contrast-enhanced multidetector-row computed tomography (MDCT) to evaluate hepatic metastatic spread and
localization before CT-guided RFA and for follow-up after intervention. Sixteen of these patients (65.1 ± 10.3 years) with
30 metastases stayed tumor-free (group 1), while the other group (n = 16 with 24 metastases; 62.0 ± 13.8 years) suffered from local recurrent disease (group 2). Applying an automated software
tool (SyngoCT Oncology; Siemens Healthcare, Forchheim, Germany), size parameters (volume, RECIST, WHO) and attenuation were
measured within the lesions before, 1 day after, and 28 days after RFA treatment. The natural logarithm (ln) of the quotient
of the volume 1 day versus 28 days after RFA treament was computed: lnQ1//28/0volume. Analogously, ln ratios of RECIST, WHO, and attenuation were computed and statistically evaluated by repeated-measures ANOVA.
One lesion in group 2 was excluded from further evaluation due to automated missegmentation. Statistically significant differences
between the two groups were observed with respect to initial volume, RECIST, and WHO (p < 0.05). Furthermore, ln ratios corresponding to volume, RECIST, and WHO differed significantly between the two groups. Attenuation
evaluations showed no significant differences, but there was a trend toward attenuation assessment for the parameter lnQ28/0attenuation (p = 0.0527), showing higher values for group 1 (–0.4 ± 0.3) compared to group 2 (–0.2 ± 0.2). In conclusion, hepatic metastases
and their zone of coagulation necrosis after RFA differed significantly between tumor-free and local-recurrent ablation zones
with respect to the corresponding size parameters. A new parameter (lnQ1//28/0volume/RECIST/WHO/attenuation) was introduced, which appears to be of prognostic value at early follow-up CT. 相似文献
17.
Richard R. Saxon James F. Benenati Corey Teigen George L. Adams Luke E. Sewall 《Journal of vascular and interventional radiology : JVIR》2018,29(1):92-100
Purpose
To investigate the safety and initial efficacy of XTRACT, a power aspiration–based extraction technique for treatment of peripheral arterial thromboembolism with the use of the Penumbra/Indigo system.Materials and Methods
A total of 79 patients were enrolled: 39 (49.4%) underwent XTRACT as the initial therapy and 40 (50.6%) underwent XTRACT after failed catheter-directed thrombolysis or other mechanical intervention or for removal of distal emboli that occurred during an intervention. Occlusion locations were as follows: 36.7% (n = 29) in the profunda, common, or superficial femoral artery; 35.4% (n = 28) in the popliteal artery; 15.2% (n = 12) in the tibial artery; 7.6% (n = 6) in the peroneal artery; and the remainder in the common iliac (n = 1), external iliac (n = 1), sciatic (n = 1), and brachial (n = 1) arteries.Results
Complete or near-complete revascularization (Thrombolysis In Myocardial Infarction [TIMI] grade 2/3 flow) was achieved in 87.2% of patients (68 of 78) immediately after the XTRACT procedure and before any other intervention. Successful revascularization was achieved in 79.5% of patients (31 of 39) as an initial treatment and in 92.5% (37 of 40) as salvage or secondary therapy. After additional adjunctive endovascular interventions, TIMI grade 2/3 flow was achieved in 96.2% of patients (76 of 79). Complete thrombus removal and restoration of normal flow (TIMI grade 3) was achieved in 77.2% of patients (61 of 79) after all endovascular treatment was completed. No patients required surgical revascularization. No device-related adverse events occurred.Conclusions
XTRACT was safe and effective for revascularization of acute or subacute peripheral arterial occlusions as a primary therapy or as a secondary therapy after other endovascular techniques had failed. 相似文献18.
Peter Graffy Scott B. Loomis Perry J. Pickhardt Meghan G. Lubner Douglas R. Kitchin Fred T. Lee J. Louis Hinshaw 《Journal of vascular and interventional radiology : JVIR》2017,28(4):608-613.e1
Purpose
To investigate whether an autologous intraparenchymal blood patch (IPB) reduces the rate of pneumothorax-related complications associated with computed tomography (CT)–guided lung biopsies.Materials and Methods
This study included 834 patients: 482 who received an IPB and 352 who did not. Retrospective review was performed of all CT–guided lung biopsies performed at a single institution between August 2006 and September 2013. Patients were excluded if no aerated lung was crossed. The rate of pneumothorax, any associated intervention (eg, catheter placement, aspiration), chest tube placement, and chest tube replacement requiring hospital admission were compared by linear and multiple regression analysis.Results
Patients who received an IPB had a significantly lower rate of pneumothorax (145 of 482 [30%] vs 154 of 352 [44%]; P < .0001), pneumothorax-related intervention (eg, catheter aspiration, pleural blood patch, chest tube placement; 43 of 482 [8.9%] vs 85 of 352 [24.1%]; P < .0001), and chest tube placement along with other determinants requiring hospital admission (18 of 482 [3.7%] vs 27 of 352 [7.7%]; P < .0001). No complications related to the IPB were noted in the study group.Conclusions
Autologous IPB placement is associated with a decreased rate of pneumothorax and associated interventions, including chest tube placement and hospital admission, after CT–guided lung biopsies, with no evidence of any adverse effects. These results suggest that an IPB is safe and effective and should be considered when aerated lung is traversed while performing a CT–guided lung biopsy. 相似文献19.
Liang Zhang Na Wang Jingsong Mao Xiaofei Liu Zhichun Gao Xu Dai Bo Feng 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1455-1461
Purpose
To evaluate whether changes in volumetric iodine concentration (VIC) could serve as a suitable predictor of therapeutic response to microwave (MW) ablation in a rabbit intrahepatic VX2 tumor model.Materials and Methods
Sixteen intrahepatic VX2 tumors were transplanted in 8 New Zealand White rabbits treated with MW ablation. Contrast-enhanced dual-energy CT scans were obtained at baseline and follow-up. Therapeutic response assessment by modified Response Evaluation Criteria In Solid Tumors (mRECIST), Choi criteria, and VIC changes was performed. An intraclass correlation coefficient (ICC) was used to characterize consistency of assessment results among the criteria used. Technical success was evaluated with explant pathologic findings as a reference. Correlations between technical success and variations in diameter, CT density, and VIC were analyzed.Results
Disease control was observed in 4, 8, and 10 of the 16 tumors per mRECIST, Choi criteria, and VIC changes, respectively. VIC exhibited strong consistency (ICC = 0.807, P < .0001) with Choi criteria. According to explant pathology, technical success was achieved in 10 of the 16 tumors. There was a moderate correlation between VIC changes and technical success (r = 0.532, P = .034), and no correlation was found between technical success and variations in diameter or CT density.Conclusions
Compared with mRECIST and Choi criteria, dual-energy CT–derived VIC allowed for better prediction of therapeutic response after MW ablation and could provide a potential imaging biomarker of tumor response to MW ablation in patients with hepatocellular carcinoma. 相似文献20.
《Journal of vascular and interventional radiology : JVIR》2014,25(6):839-846
PurposeTo evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene–vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, California) as the primary treatment for acute and massive lower gastrointestinal bleeding (LGIB).Materials and MethodsBetween January 2008 and October 2013, all patients with focal massive LGIB who were treated by embolization were retrospectively analyzed. The study was approved by the hospital’s ethics committee; informed consent was obtained in all cases. Onyx was chosen as the embolic agent in all cases in an intention-to-treat fashion. Embolization was indicated in 31 consecutive patients (mean age, 80 y ± 11.1). Multidetector computed tomography and digital subtraction angiography were performed in all patients.ResultsActive bleeding was detected in all cases. A colonoscopy was performed in 11 patients. The correlation between multidetector computed tomography and angiography findings was 96.7%. The causes of bleeding were diverticula in 15 patients, iatrogenic in 7 patients, neoplasia in 3 patients, hemorrhoids in 2 patients, angiodysplasia in 2 patients, and unknown in 2 patients. Embolization was not possible in one patient, who required urgent left hemicolectomy. The technical success rate was 93.5%. The embolic material refluxed in one patient, causing an undesired embolization, without any clinical consequences. In the 30 patients who received embolization, the immediate bleeding control rate was 100%. Rebleeding at 30 days occurred in three patients (10%). There were no major complications, intestinal ischemia, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 23.7 months (range, 1–71 mo).ConclusionsControl of massive LGIB using superselective embolization with Onyx is feasible and safe. 相似文献