共查询到20条相似文献，搜索用时 31 毫秒
1.
Can MR Measurement of Renal Artery Flow and Renal Volume Predict the Outcome of Percutaneous Transluminal Renal Angioplasty? 总被引：3，自引：0，他引：3
Christoph A. Binkert Jorg F. Debatin Ernst Schneider Juerg Hodler Stefan G. Ruehm Michaela Schmidt Ulrich Hoffmann 《Cardiovascular and interventional radiology》2001,24(4):233-239
Purpose: Predicting therapeutic benefit from percutaneous transluminal renal angioplasty (PTRA) in patients with renal artery stenosis
(RAS) remains difficult. This study investigates whether magnetic resonance (MR)-based renal artery flow measurements relative
to renal parenchymal volume can predict clinical outcome following PTRA.
Methods: The data on 23 patients (13 men, 10 women; age range 47–82 years, mean age 64 years) were analyzed. The indication for treatment
was hypertension (n = 18) or renal insufficiency (n = 5). Thirty-four cases of RAS were identified: bilateral disease was manifest in 11 and unilateral disease in 12 patients. The
MR imaging protocol included a breath-hold, cardiac-gated cine phase-contrast sequence for renal flow measurement and a fast
multiplanar spoiled gradient-echo sequence for renal volume measurement. MR measurements were performed on the day prior to
and the day following PTRA. Clinical success was defined as (a) a reduction in diastolic blood pressure > 15% or (b) a reduction
in serum creatinine > 20%. Kidneys were categorized as normal volume or low volume. A renal flow index (RFI) was calculated
by dividing the renal flow (ml/min) by the renal volume (cm3).
Results: Clinical success was observed in 11 patients. Twelve patients did not benefit from angioplasty. Normal kidney volume was
seen in 10 of 11 responders and in 8 of 12 nonresponders, resulting in a sensitivity of 91%, specificity of 33%, a positive
predictive value (PPV) of 56% and a negative predictive value (NPV) of 80%. A RFI below a threshold of 1.5 ml/min/cm3 predicted successful outcome with 100% sensitivity, 33% specificity, 58% PPV, and 100% NPV. The combination of normal renal
volume and a RFI below 1.5 ml/min/cm3 identified PTRA responders with a sensitivity of 91%, a specificity of 67%, a PPV of 71%, and a NPV of 89%. PTRA resulted
in a greater increase in renal flow in responders compared with nonresponders (p < 0.001).
Conclusion: A combination of cine phase-contrast MR renal flow and parenchymal volume measurements enables identification of patients
benefiting from PTRA with a high sensitivity and NPV, but only moderate specificity and PPV. 相似文献
2.
Derek W. Cool John R. Kachura 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1658-1663
Purpose
To evaluate oncologic outcomes and graft viability after percutaneous radiofrequency (RF) ablation of renal cell carcinoma (RCC) developing within renal transplant allografts.Materials and Methods
A single-institution, retrospective study reviewed all patients treated with RF ablation for RCC between February 2004 and May 2016. Ten patients were identified (age 49.6 y ± 12.6; 9 men, 1 woman) with 12 biopsy-confirmed RCC tumors within the allograft (all T1a, mean diameter 2.0 cm ± 0.7). Mean time from transplant to RCC diagnosis was 13.2 years ± 6.3. RF ablation was performed on an outpatient basis using conscious sedation. Procedural efficacy, complications, oncologic outcomes, and allograft function were evaluated. Statistical analysis with t tests and Pearson correlation compared allograft function before and after RF ablation and impact of proportional ablation size to allograft volume on function after ablation.Results
Technical success rate and primary technique efficacy were 100% (12/12). No local or distant RCC progression was seen at mean follow-up of 54.3 months ± 38.7 (range, 9–136 months). Graft failure requiring hemodialysis or repeat transplantation occurred in 3 patients (26, 354, and 750 d after RF ablation), all of whom had glomerular filtration rate (GFR) < 30 mL/min/1.73 m2 before ablation. For all patients, mean GFR 6 months after RF ablation (35.8 mL/min/1.73 m2 ± 17.7) was not significantly different (P = .8) from preprocedure GFR (36.2 mL/min/1.73 m2 ± 14.3). Proportional volume of allograft that was ablated did not correlate with immediate or long-term GFR changes. One patient died of unrelated comorbidities 52 months after ablation. No major complications occurred.Conclusions
RF ablation of renal allograft RCC provided effective oncologic control without adverse impact on graft viability. 相似文献3.
Abath C Andrade G Cavalcanti D Brito N Marques R 《Techniques in Vascular and Interventional Radiology》2007,10(4):299-307
Although renal aneurysms are considered uncommon lesions, they are being disclosed more often with the increasing use of noninvasive imaging diagnostic methods. As the natural history is poorly defined, criteria for treatment are still controversial. Because it is less invasive, the endovascular treatment of renal artery aneurysms has become preferable to surgery, over recent years. The development of microcatheter-guidewire systems and new embolic materials, primarily used in interventional neuroradiolgy, enables a superselective embolization, even in complex lesions. We describe our experience in 11 complex renal artery aneurysms, using platinum detachable coils, liquid embolic agents (glue and Onyx), and remodeling technique, according to the lesion architecture and topographic classification. Complete durable occlusion was obtained in all cases, with only two minor complications. If an appropriated strategy is done and the tools are available, the endovascular approach currently is the first treatment option for renal artery aneurysms. 相似文献
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Mitsuko Yodoya Takao Hiraki Toshihiro Iguchi Hiroyasu Fujiwara Yusuke Matsui Yoshihisa Masaoka Jun Sakurai Toshiharu Mitsuhashi Hideo Gobara Susumu Kanazawa 《Journal of vascular and interventional radiology : JVIR》2017,28(6):869-876
Purpose
To retrospectively evaluate the effect of cryoablation of renal-cell carcinoma on nearby renal cysts with the goal to investigate the potential for an alternative therapy to treat symptomatic renal cysts.Materials and Methods
The study population comprised 46 cysts (mean size, 12 mm; range, 5–43 mm) that were within or near the ice ball during cryoablation in 22 patients. Size change of each cyst was evaluated via enhanced CT or MR imaging before and 1, 3, 6, and 12 months after cryoablation. Forty-one cysts were also followed after 12 months. Variables including positional relationship between the cyst and the ice ball were evaluated via linear regression analysis using generalized estimating equation models to determine which factors affected cyst shrinkage rate at 12 months.Results
Fifteen, 12, and 19 cysts were completely included in, partially included in, or excluded from the ice ball, respectively. The overall shrinkage rate was 62%, and 57% of cysts (26 of 46) had disappeared at 12 months. Only the relationship between the cyst and the ice ball was significantly (P < .001) associated with cyst shrinkage rate. Cyst disappearance rates at 12 months were 100% (15 of 15), 67% (8 of 12), and 16% (3 of 19) for cysts completely included, partially included, and excluded from the ice ball, respectively. Among the 22 cysts that disappeared at 12 months and continued to be followed, none recurred after 12 months.Conclusions
All renal cysts that were completely included in the ice ball disappeared after cryoablation, demonstrating the potential utility of cryoablation as an alternative therapy for symptomatic renal cysts. 相似文献5.
Alberto V. Mansilla Eugene E. Bivins Francisco Contreras Manuel A. Hernandez Nathan Kohler Julie W. Pepe 《Journal of vascular and interventional radiology : JVIR》2017,28(2):222-229
Purpose
To develop a scoring system that stratifies complexity of percutaneous ablation of renal tumors.Materials and Methods
Analysis was performed of 36 consecutive patients (mean age, 64 y; range, 30–89 y) who underwent CT-guided microwave (MW) ablation of 45 renal tumors (mean tumor diameter, 2.4 cm; range, 1.2–4.0 cm). Technical success and effectiveness were determined based on intraprocedural and follow-up imaging studies. The RENAL score and the proposed percutaneous renal ablation complexity (P-RAC) score were calculated for each tumor.Results
Technical success was 93.3% (n = 42). Biopsy of 38 of 45 renal tumors revealed 23 renal cell carcinomas. Median follow-up period was 9.7 months (range, 2.9–46.8 months). There were no tumor recurrences. One major complication, ureteropelvic junction stricture, occurred (2.6%). The P-RAC score was found to differ statistically from the RENAL score (t = 3.754, df = 44, P = .001). A positive correlation was found between the P-RAC score and number of antenna insertions (r = .378, n = 45, P = .011) and procedure duration (r = .328, n = 45, P = .028). No correlation was found between the RENAL score and number of MW antenna insertions (r = .110, n = 45, P = .472) or procedure duration (r = .263, n = 45, P = .081). Hydrodissection was significantly more common in the P-RAC high-complexity category than in low-complexity category (χ2 = 12.073, df = 2, P = .002).Conclusions
The P-RAC score may be useful in stratifying percutaneous renal ablation complexity. Further studies with larger sample sizes are necessary to validate the P-RAC score and to determine if it can predict risk of complications. 相似文献6.
Ultrasound (US) imaging of the kidneys has greatly improved in recent years with introduction of wideband transducers and advances is beamformer technology. US is often the first imaging technique to be employed in patients with renal failure, haematuria or proteinuria, after clinical and laboratory evaluation. After conventional US evaluation, Doppler US (DUS) and resistive indices (RIs) analysis provide renal functional evaluation. Anyway, both sensitivity and specificity of conventional US and DUS in renal parenchymal disease evaluation remains low. In the initial or mild clinical stages of renal parenchymal diseases, kidneys may present normal US morphological appearance and normal RIs values, whereas different renal parenchymal diseases may reveal similar appearance on US and DUS evaluation. Besides, different renal parenchymal diseases may present some distinct features on conventional US and DUS with colour Doppler (CD) and power Doppler (PD) evaluation, even though percutaneous renal biopsy is often necessary to reach definite diagnosis. Renal vasculitides and tubular-interstitial nephropathies are more frequently identified by conventional US and DUS than glomerular nephropathies, since glomerular component accounts only for 8% of the renal parenchyma, whereas the highest percentage is occupied by vascular and tubulo-interstitial component. Follow-up of acute renal failure, during and after medical treatment, is the most useful field of employment of conventional US and DUS techniques, since a progressive lowering of RIs is correlated to a progressive recovery of renal function. 相似文献
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肾钙乳（ＭｉｌｋｏｆＣａｌｃｉｕｍＲｅｎａｌＳｔｏｎｅ）黎孝勇肾钙乳为一少见病，１９３７年由Ｆｒｅｓ－ｎａｓｓ［‘３首次报道，１９５９年Ｈｏｗｅｄ［‘ｊ依其Ｘ线表现而命名。近来文献报道渐多，一致认为其发病机制与梗阻和感染有关，Ｘ线检查即能确诊。为加强... 相似文献
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《Journal of vascular and interventional radiology : JVIR》2014,25(4):520-523
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PURPOSE: To determine if the attenuation values of simple renal cysts are artifactually increased on contrast material-enhanced, clinically acquired spiral computed tomographic (CT) images. MATERIALS AND METHODS: Dual-phase renal spiral CT studies (5-mm collimation; pitch, 1.0) were retrospectively analyzed in 24 consecutive patients who had ultrasonographic (US) documentation of simple renal cysts. Forty-eight cysts were identified. The attenuation values of each cyst were measured on nonenhanced, cortical phase, and nephrographic phase images. The size and the location of each cyst in relation to the renal parenchyma were also recorded. RESULTS: The cysts were 0.6-10.8 cm in diameter (mean, 2.6 cm; SD, 2.0). The mean attenuation change in the cysts from nonenhanced to contrast-enhanced images was statistically significant in a comparison of cortical phase and nephrographic phase images (P: <.01): +1.8 HU (SD, 3.8) for cortical phase and +3. 6 HU (SD, 5.6) for nephrographic phase images. Renal cysts 1.0 cm or smaller showed a higher attenuation increase (mean, +4.0 HU for cortical phase and +11.0 HU for nephrographic phase). None of the renal cysts larger than 1.0 cm demonstrated an increase greater than 10 HU (mean, +1.4 HU for cortical phase and +2.3 HU for nephrographic phase). Intraparenchymal cysts showed higher mean attenuation changes than the exophytic cysts. CONCLUSION: Attenuation values in the renal cysts increased artifactually on contrast-enhanced images, but this pseudoenhancement was not substantial and was less than 10 HU when the cyst was larger than 1. 0 cm in diameter. 相似文献
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Sapoval M Azizi M Bobrie G Cholley B Pagny JY Plouin PF 《Cardiovascular and interventional radiology》2012,35(3):463-471
Endovascular renal artery denervation (ERAD) is a new procedure to reduce renal and systemic sympathetic overactivity in hypertensive patients. The role of sympathetic overactivity is recognized since a long time as being one the contributor of human hypertension. In support of this view, several studies in experimental models of hypertension in animal as well as hypertensive human subjects have demonstrated that sympathetic overactivity plays a central role in hypertension catheter based renal denervation is now possible, and this procedure may provide a useful adjunct for the management of patients with drug-resistant primary hypertension. Following a cohort study, the results of an open label randomized control trial have been published showing very encouraging results. The purpose of this paper is to help interventionalists to better understand the medical and technical issues related to this new intervention. It is most likely that as underlined in a recent editorial several other technical approaches may appear in the future, however because this is the only technique that is available today, we will focus on radiofrequency based technique. 相似文献
13.
Amar Karalli Ramin Ghaffarpour Rimma Axelsson Lars Lundell Bela Bozoki Torkel Brismar Ove Gustafsson 《Journal of vascular and interventional radiology : JVIR》2017,28(12):1664-1672
Purpose
To prospectively assess feasibility, safety, and cytoreductive effect of transarterial chemoembolization on renal cell carcinoma (RCC) using drug-eluting embolic agent (DEE) saturated with doxorubicin compared with transarterial embolization (TAE).Materials and Methods
Between 2012 and 2015, 12 patients (male/female = 5/7, age 66 y ± 9.8) with biopsy-verified RCC eligible for nephron-sparing surgery or radical nephrectomy were recruited. Mean tumor size was 3.2 cm ± 0.62. Patients were randomized at 1:1 ratio to receive either DEE transarterial chemoembolization or TAE before planned surgery. A microcatheter was used to inject particles selectively into arteries feeding the tumors. Response was evaluated by CT according to modified Response Evaluation Criteria In Solid Tumors and by microscopy of excised tumors. Complications were scored according to the Society of Interventional Radiology classification.Results
DEE transarterial chemoembolization (n = 6) resulted in a significantly (P = .018) higher degree of necrosis with an average of 88.3% (range, 70%–100%) compared with TAE (n = 5), which resulted in an average of 29.4% (range, 0–77%), as evaluated by CT. Histopathologic evaluation showed similar results (P = .016) with an average necrosis of 87.5% (range, 80%–95%) for DEE transarterial chemoembolization (n = 4) versus 26% (range, 0–70%) for TAE (n = 5). Percentage of necrosis seen on microscopy correlated significantly (P = .0005) with radiologic findings, as 4 tumors in each arm were evaluated by both CT and microscopy. No major complications were observed in either group.Conclusions
DEE transarterial chemoembolization is safe for treating localized RCC and has a significantly superior cytoreductive effect compared with TAE. 相似文献14.
Francis I. Baffour LaTonya J. Hickson Mark D. Stegall Patrick G. Dean Tina M. Gunderson Thomas D. Atwell A. Nicholas Kurup John J. Schmitz Walter D. Park Grant D. Schmit 《Journal of vascular and interventional radiology : JVIR》2017,28(2):188-194
Purpose
To determine if patient aspirin exposure and timing affect bleeding risk after renal allograft biopsy.Materials and Methods
Review of 6,700 renal allograft biopsies (in 2,362 unique patients) was performed. Median patient age was 53.0 years [interquartile range 43.0, 62.0]; 56.2% of patients were male. Of biopsies, 4,706 (70.2%) were performed in patients with no aspirin exposure within 10 days of biopsy; 664 (9.9%), were performed within 8–10 days of aspirin exposure; 855 (12.8%), within 4–7 days; and 475 (7.1%), within 0–3 days. Follow-up to 3 months after the procedure was completed in all patients. Biopsies were categorized as protocol or indication; 19.7% were indication biopsies. Bleeding complications were graded based on SIR criteria. Logistic regression models examined the association between aspirin use and bleeding events.Results
Rate [95% confidence interval] of major bleeding complications was 0.24% [0.14, 0.39], and rate of any bleeding complication was 0.66% [0.46, 0.90]. Bleeding events were significantly associated with patients undergoing indication biopsies compared with protocol biopsies (odds ratio [OR] 2.27, P = .012). Patient factors associated with major bleeding complications in multivariate models included estimated glomerular filtration rate (OR 0.61, P = .016) and platelet count (OR 0.64, P = .033). Aspirin use was not significantly associated with increased risk of bleeding complication except for use of 325 mg of aspirin within 3 days of biopsy (any complication OR 3.87 [1.12, 13.4], P = .032; major complication OR 6.30 [1.27, 31.3], P = .024).Conclusions
Renal allograft biopsy bleeding complications are very rare, particularly for protocol biopsies. Use of 325 mg of aspirin within 3 days of renal allograft biopsy was associated with increased bleeding complications. 相似文献15.
Angioplasty and stent therapy for stenoses of the renal artery have long been part of the everyday life of interventional radiologists. Newer studies, however, challenge the clinical significance of the method. A decisive advantage of endovascular techniques for the treatment of arterial hypertension as opposed to therapy with modern antihypertensives could not be proven in individual randomized studies, even though blood pressure control was observed to be facilitated by PTA (percutaneous transluminal angioplasty). Renal function often did not show any sustainable improvement following elimination of the renal artery stenosis. However, progression of kidney insufficiency could be slowed down. There is still no general justification from the existing data for the treatment of incidental stenoses. Many questions remain open regarding the technique. Whereas fibromuscular dysplasia can be treated by balloon angioplasty as a general rule, a metallic endoprosthesis must often be used for atherosclerotic stenoses. The outstanding morphologic results of stent therapy in the short and medium term course are often simply used to justify primary stent implantation in ostial stenoses. 相似文献
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Michelle S. Tsang Mui Chung Aaron W. Maxwell Li-Juan Wang William W. Mayo-Smith Damian E. Dupuy 《Journal of vascular and interventional radiology : JVIR》2018,29(9):1240-1244
Purpose
To determine diagnostic yield of renal biopsies performed in patients referred for image-guided tumor ablation (IGTA) and the frequency with which biopsy results would have obviated the need for subsequent ablation.Materials and Methods
Retrospective review of an internal ablation database of a single institution revealed 401 consecutive percutaneous renal mass IGTAs performed from April 2000 to April 2015. Of 401 ablations, 32 were excluded, yielding 369 ablation events in 342 patients, which represented the study cohort. Patients were subdivided into groups according to whether or not biopsy was performed. Lesions were categorized according to size, malignancy/benignity, and pathology.Results
IGTA was performed with biopsy for 317/369 (85.9%) and without biopsy for 52/369 (14.1%) lesions. Overall diagnostic yield for percutaneous biopsy was 94.3% (299/317). Based on biopsy results, 82.6% (262/317) were classified as malignant or suspicious, 9.5% (30/317) were classified as likely benign, and 2.2% (7/317) were classified as definitively benign. Only definitively benign lesions were designated as obviating the need for IGTA. IGTA was supported by biopsy results in the remaining 97.8% (310/317), including renal cell carcinomas, oncocytic neoplasms, metastases, and nondiagnostic biopsy results.Conclusions
Biopsy of renal masses with suspicious imaging features rarely (2.2%) obviated the need for IGTA. For patients who have undergone counseling and have elected to forgo active surveillance and surgical options, biopsy can safely be performed concomitantly with ablation. 相似文献18.
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Paragangliomas are extra-adrenal pheochromocytomas that derive from chromaffin cells and arise along the sympathetic paraganglia in the body. In the majority of cases, they are secretory tumors and most commonly present with palpitations. Plasma metanephrines are the standard screening tests for making the diagnosis which is confirmed by pathology. Imaging plays a very important role in establishing the diagnosis. However, there is no specific feature on imaging for paragangliomas; the vascularity of the tumor should show as hyper-enhancing lesions but this is not always the case. The diagnostic value of PET is yet a matter of debate. We present a very rare case of a paraganglioma arising at the renal hilum, splaying the renal artery and vein and causing vascular compromise to the left kidney. The patient presented with an atypical presentation of unrelenting fever that was followed by acute colicky pain. Based on imaging and blood metanephrine levels, the diagnosis of paraganglioma was made. Resection of the tumor was achieved and the patient is now asymptomatic. 相似文献
20.
Hussein D. Aoun Peter J. Littrup Mohamed Jaber Fatima Memon Barbara Adam Mark Krycia Matthew Prus Elisabeth Heath Edson Pontes 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1363-1370