Changes in Liver Congestion in Patients with Budd–Chiari Syndrome following Endovascular Interventions: Assessment with Transient Elastography

Purpose

Transient elastography (TE) is routinely used for noninvasive staging of hepatic fibrosis. The objective of the present study was to investigate the role of TE (FibroScan) in determining changes in liver congestion in patients with Budd–Chiari syndrome (BCS) treated by endovascular interventions and determine the effects of pretreatment Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) fibrosis score on posttreatment liver stiffness (LS).

Percutaneous Endovascular Creation of an Inferior Vena Cava in a Patient with Caval Agenesis,Budd–Chiari Syndrome,and Iliofemorocaval Thrombosis

A 29-year-old woman with acute iliofemorocaval thrombosis was discovered to have suprarenal caval agenesis with azygous continuation, hepatic congestion, and fibrosis as a result of chronic Budd–Chiari syndrome. Three staged procedures were performed: pharmacomechanical thrombolysis of acute thromboses, transfemoral liver biopsy and hemodynamic assessment, and percutaneous endovascular creation of a “neocava” lined with endografts. Symptomatic improvement and patency were maintained at 12-week follow-up.     

Classification and Endovascular treatment of the Spinal arteriovenous shunts:

ClassificationofspinalvascularlesionsLocations :ParachordalarteriovenousfistulaeSpinalextraduralandparaspinalarteriovenousfistulasIsolated(VVFandotherlocations)Associated(systematizeddysplasia ,e .g .vonRecklinghausen’s)diseaseSpinalduralarteriovenousfistulas　Isolated　MultipleSpinalcordvascularmalformation :perimedullary superficial deeplocation　Isolated(arteriovenousmalformation ,arteriovenousfistula)　Multiple　　Metameric(Cobbandothersyndromes SAMS andassociations)　　Nonmetamer…     

Evaluations of non-contrast enhanced MR venography with inflow inversion recovery sequence in diagnosing Budd–Chiari syndrome

Non-contrast-enhanced (NCE) inflow inversion recovery magnetic resonance venography (MRV)and digital subtraction angiography (DSA) examination were carried out in 35 patients who were suspected of having Budd–Chiari syndrome (BCS). With DSA as the reference, NCE MRV got 100% in the diagnostic sensitivity, 67.8% in the specificity, 97.1% in the accuracy, 100% in the negative predictive value, and 96.9% in the positive predictive value. The consistency between NCE MRV and DSA in the depiction of IVC was excellent. NCE MRV is regarded as an alternative method in the diagnosis of BCS.     

Coronary–subclavian steal syndrome: treatment with percutaneous transluminal angioplasty and stent placement

The aim of this study was to assess the efficacy of percutaneous transluminal angioplasty (PTA) and stenting in the management of the coronary-subclavian steal syndrome (CSSS). A 56-year-old man presented with CSSS due to occlusion of the left subclavian artery. He was treated with PTA and placement of two stents in the left subclavian artery. Systolic blood pressure became equal in both arms and dizziness disappeared. There were no complications. Percutaneous transluminal angioplasty and stenting can effectively and safely manage CSSS. Received: 6 May 1998; Revision received: 22 July 1998; Accepted: 12 August 1998     

Budd–Chiari Syndrome in Young Chinese: Clinical Characteristics,Etiology and Outcome of Recanalization from a Single Center

Purpose

We aimed to characterize the clinical profile, etiology, and outcomes of young Chinese patients with Budd–Chiari syndrome treated with recanalization.

Methods

A total of 35 consecutive young patients (≤25 years of age) with primary Budd–Chiari syndrome treated with recanalization at our center were enrolled in this study between March 2011 and December 2014. Data on baseline information, etiology tests, therapeutic recanalization strategies, and follow-up were collected.

Results

The most common clinical feature was ascites, present in 33 cases (94 %). Hepatic vein obstruction was present in 60 % (21/35) of patients, inferior vena cava obstruction in 3 % (1/35), and combined obstruction in 37 % (13/35). The most common risk factor for thrombosis was hyperhomocysteinemia (14/35, 40 %). Recanalization was technically successful in 32 of 35 patients (91 %), and clinically successful in 28 of these 32 patients (88 %). The cumulative 1- and 3-year primary patency rates were 75.2 and 54.3 %, respectively. The cumulative 1- and 3-year secondary patency rates were 89.3 and 89.3 %, respectively. The cumulative 1- and 3-year survival rates were 96.9 and 93.8 %, respectively.

Conclusion

In this study, the most common type of lesion was hepatic vein obstruction, the most common thrombotic risk factor was hyperhomocysteinemia, and recanalization resulted in good mid-term outcomes in young Chinese patients with Budd–Chiari syndrome.

     

Mueller–Weiss syndrome: imaging and implications

Mueller–Weiss syndrome (MWS), or spontaneous osteonecrosis of the tarsal navicular in adults, is a rare cause of chronic medial midfoot pain. MWS has been described in orthopedic, podiatric, and radiologic literature without consensus agreement on its pathophysiology and treatment. We present the radiographic and magnetic resonance imaging of a case of MWS with reference to navicular biomechanical stressors and potential pathogenesis.     

Percutaneous transluminal angioplasty for treatment of subclavian and coronary artery steal syndrome

Percutaneous transluminal angioplasty is a well described technique for revas-cularization which has gained increasing acceptance for use in the aorta and branch vessels.We present a case in which a patient with a left internal mammary artery(LIMA)graft andproximal left subclavian artery stenosis,experiencing both coronary and subclavian arterysteal,was successfully treated with balloon angioplasy.     

Value of blood flow velocity on color Doppler ultrasonography for optimization of delay in scanning time on computed tomography venography in patients with Budd–Chiari syndrome and inferior vena cava obstruction

Purpose

To prospectively determine the value of blood flow velocity in the inferior vena cava (IVC) on color Doppler ultrasonography for the optimization of the delay in scanning time after contrast injection during computed tomography (CT) venography in patients with Budd–Chiari syndrome (BCS) with IVC obstruction.

Methods

We enrolled 122 consecutive BCS patients with IVC obstruction. All patients underwent color Doppler ultrasonography, CT venography, and digital subtraction angiography (DSA) in that order prior to treatment. The delay in scanning time during CT venography was set at 120, 180, 240, and 300 s after contrast injection. The correlation between delay in CT scanning and IVC blood flow velocity on color Doppler ultrasonography was explored. Image quality was classified as good, moderate, or poor. Patients with good CT image quality were considered to have an optimal delay in scanning time.

Results

Delays in scanning time of 120, 180, 240, and 300 s yielded good-quality images in 2, 7, 49, and 64 patients, respectively. The corresponding IVC blood flow velocities in these patients were 16.10 ± 0.42 cm/s (range 15.8–16.4 cm/s), 12.90 ± 1.58 cm/s (range, 11–15 cm/s), 7.53 ± 1.35 cm/s (range 5–10 cm/s), and 1.95 ± 1.75 cm/s (range 0–5.5 cm/s).

Conclusion

IVC blood flow velocity on color Doppler ultrasonography could serve as a useful tool for the optimization of the delay in scanning time during CT venography to ensure good-quality images for the diagnosis of BCS with IVC obstruction.

     

Transjugular intrahepatic portocaval shunt placed through the strut of an inferior vena cava stent in a patient with Budd–Chiari syndrome: a technical modification

Transjugular intrahepatic portocaval shunt (TIPS) is performed in patients with symptomatic Budd–Chiari syndrome (BCS) who do not have repairable hepatic veins. We report the case of a patient who had an inferior vena cava (IVC) stent placed previously as part of the management for BCS, and who subsequently required TIPS. The TIPS tract was created through the strut of the previously placed IVC stent; the TIPS stent was placed after dilatation of the liver parenchyma as well as the strut of the IVC stent. This novel technique of “strutplasty” of a previously placed stent as part of TIPS has not been reported in the literature.The transjugular intrahepatic portocaval shunt (TIPS) procedure, as well as stent technology, is continually being improved [1–5]. Direct intrahepatic portocaval shunt (DIPS) – a modification of the TIPS procedure – is especially useful when there are occluded hepatic veins or an unfavourable angle between the inferior vena cava (IVC) and the hepatic vein resulting from hydrothorax and hypertrophy of the caudate lobe of the liver [1]. Herein, we report a technical modification of the TIPS procedure in Budd–Chiari syndrome (BCS).     

Fibrous dysplasia and McCune–Albright syndrome: Imaging for positive and differential diagnoses,prognosis, and follow-up guidelines

Purpose

The radiologist plays a critical role at all steps of the management of patients with fibrous dysplasia (FD) and McCune–Albright syndrome (MAS). The development of a standardized approach to the management of FD/MAS is crucial given the low incidence and multiple clinical presentations of these conditions. Our aim was to develop recommendations for bone imaging in FD/MAS management.

Materials and methods

The establishment of National Reference Centers in France as part of a Health Ministry program for orphan diseases has triggered the development of recommendations for the clinical management of FD/MAS. We used a well-established robust methodological approach involving an extensive literature review by a multidisciplinary working group (20 healthcare professionals) and scoring by a peer-review group (20 healthcare professionals different from the 20 previous ones). There were four phases: a systematic literature review, drafting of initial recommendations, peer-review of this initial draft, and drafting of the final recommendations.

Results

Fifty-seven specific recommendations are provided as key points for the diagnosis, prognosis, and follow-up of patients with FD/MAS. Issues of special interest are highlighted in the discussion, and areas in which future research is needed are identified.

Conclusion

We believe the dissemination of these recommendations within the radiology community may facilitate communication between radiologists and other healthcare providers, thereby substantially improving the management of patients with these rare but potentially disabling conditions.     

Real-time electromagnetic tracking–based treatment platform for high-dose-rate prostate brachytherapy: Clinical workflows and end-to-end validation

PurposeNew technologies were integrated into a novel treatment platform combining electromagnetically (EM) tracked catheters, a 3D ultrasound (3DUS) imaging device, and a new treatment planning system to provide a real-time prostate high-dose-rate (HDR) brachytherapy treatment system. This work defines workflows for offline CT and online 3DUS planning scenarios and preclinical end-to-end validation of the platform.Methods and MaterialsThe platform is composed of an EM-tracked stylet, a EM-tracked 3DUS probe, and an EM-tracked template guide, all used with the NDI Aurora field generator (NDI, Ontario, Canada). The treatment planning system performs continuous position and angular readings from all three EM sensors into a streamlined environment that allows for (1) contouring; (2) planning; (3) catheter insertion guidance and reconstruction; (4) QA of catheter path and tip position; and (5) exporting to an afterloader. Data were gathered on the times required for the various key steps of the 3DUS-based workflow.ResultsThe complete 3DUS-based workflow on 16-catheter implant phantoms took approximately 15 min. This time is expected to increase for actual patients. Plan generation is fast (7.6 ± 2.5s) and the initial catheter reconstruction with updated dose distribution is obtained at no (time) cost as part of the insertion process. Subsequent catheter reconstruction takes on average 10.5 ± 3.1s per catheter, representing less than 3 min for a 16-catheter implant.ConclusionsThis preclinical study suggests that EM technology could help to significantly streamline real-time US-based high-dose-rate prostate brachytherapy.