Liver transplantation is a method that allows treating of various liver pathological conditions. Interventional radiology (IR) focuses on oncology patients, primarily those with hepatocellular ...carcinoma. The importance of interventional radiology techniques is in preventing the progression of current liver disease in those patients awaiting liver transplantation and downstaging in patients with unresectable liver tumors to the stage where transplantation is possible. Chemoembolization (TACE), i.e., conventional transarterial chemoembolization (cTACE) or with drug particles (DEBTACE), radioembolization (SIRT), BLAND embolization, radiofrequency ablation (RFA), and microwave ablation (MWA) are the most widely used IR methods in the treatment of liver cancer. cTACE is a form of TACE in which a high dose of cytostatic is injected into the feeding vessel and the tumor’s microenvironment, and then the blood vessels that feed the tumor are embolized. DEB-TACE is a form of TACE in which a cytostatic bind to bead particles that gradually release the drug within the liver tumor itself after injection. BLAND embolization is an IR method of TACE based on ischemia of tumor tissue by IR procedure of embolization and occlusion of the feeding vessel that supplies the tumor, without the use of chemotherapeutics. Transarterial radioembolization is a method that uses endovascular techniques to bring radiospheres containing a radioactive substance near the tumor. Radiofrequency ablation (RFA) is an IR percutaneous method of treatment in which an RF needle inserted into a liver tumor releases heat that causes coagulation necrosis of tumor cells. MWA is an IR percutaneous method of treatment that uses molecules with an internal dipole moment, which move kinetic energy and then heat inside the tumor via a percutaneously inserted MWA needle into the tumor.
The KEYWORDS of this article on page 87 as listed are first-line treatment, metastatic urothelial bladder cancer,
maintenance immunotherapy. Keywords have been corrected to: transplantation, ...chemoembolization, radioembolization,
ablation.
The dose absorbed by sensitive breast glandular tissue in abdominal computed tomography examinations, even when the breasts are outside the primary imaging beam, is still significant. Several studies ...have explored using breast shielding with a protective lead sheet or a bra. Since the source of radiation in computed tomography rotates by 360° around the patient, we made a custom-tailored shielding device that wraps around the entire thorax. The hypothesis is that such a custom-tailored breast shielding device provides significantly better dose reduction. Study participants were female patients with no anatomic anomalies. Entrance surface doses were measured using thermoluminescence dosimeters placed on the skin of the breast in the control group without shielding and on the surface and below the shielding device in the group with anterior shielding and the group with the new device. As expected, according to literature data, doses measured at breast level were above the threshold that epidemiological studies determine as an increased risk of breast cancer development although they were not in the primary imaging plane. Preliminary results of our study showed that average dose reduction was 42% with conventional anterior shielding and 57% with wrapped shielding compared to the doses measured with no shielding.
Cilj: Kompjutorizirana tomografska angiografija (CTA) zlatni je standard za otkrivanje endoleaka nakon endovaskularnog liječenja aorte (EVAR). Cilj je ovog rada utvrditi može li kontrastni ultrazvuk ...(CEUS) zamijeniti CTA u dijagnostici endoleaka nakon EVAR-a. Materijali i metode: Pregled literature na engleskom jeziku proveden je u bazama podataka: PubMed/MEDLINE, ScienceDirect, Google Scholar. Ključne riječi bile su: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studije koje su odgovarale kriterijima uključivanja recenzirane su u cijelosti te je odabrano 39 studija. Rezultati: Pacijenti su u analiziranim studijama najvećim dijelom bili muškarci (86 %). Medijan dobi iznosio je 74 godine. Endoleak nakon EVAR-a promatran je u infrarenalnih (79 %), jukstarenalnih (17 %) i suprarenalnih aneurizama (4 %). Stopa endoleaka kretala se između 3 i 52 %. Najčešći endoleak bio je po tipu II te se u 15 % slučajeva javljao unutar prvih šest mjeseci, odnosno u manje od 10 % slučajeva unutar dvije godine nakon EVAR-a. Za sve tipove endoleaka CEUS je pokazao uravnoteženu osjetljivost, specifičnost i područje ispod krivulje od 94 %, 88 % i 96 %. U odnosu na CTA, CEUS ima veću osjetljivost (94/83 %), ali lošiju specifičnost (94,8/99 %). Specifično za tip II endoleaka, CEUS je imao veću stopu detekcije (36,88/20,88 %). Visoka osjetljivost (97 %) i specifičnost (100 %) obilježje su CEUS-a u prikazu endoleaka tipa I i III, bez prednosti u odnosu na CTA. Zaključci: CEUS je slikovna metoda ravnopravna CTA u probiru pacijenata za endoleak nakon EVAR-a. CEUS ne može u potpunosti nadomjestiti CTA, no sigurna je i efikasna alternativa za korištenje u pacijenata bez CTA komplikacija nakon jednogodišnjeg kontrolnog intervala.
Aim: Computed tomography angiography (CTA) is the mainstay in endoleak detection after endovascular aneurysm repair (EVAR). The objective of this review is to determine if contrast enhanced ultrasound (CEUS) is able to replace CTA in monitoring endoleaks in patients after EVAR. Materials and methods: The literature search of Englishlanguage articles was conducted in PubMed/MEDLINE, ScienceDirect, Google Scholar. The used keywords included: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studies appearing to meet inclusion criteria were reviewed in full and 39 studies were included. Results: In analysed studies, patients were predominantly men (86%) and median age was 74 years. Endoleak after EVAR was followed in infrarenal (79%), juxtarenal (17%) and suprarenal aneurysms (4%). Endoleak detection rate was 3-52%. Type II endoleaks were the most frequently encountered – in 15% of cases during the first six months and in less than 10% of cases during the first two years after EVAR. In diagnosing all endoleaks, CEUS demonstrated sensitivity, specificity, and AUC of 94%, 88%, 96%, respectively. Compared to CTA, CEUS possesses higher sensitivity (94/83%), but lesser specificity (94.8/99%). Particularly in type II endoleak evaluation, CEUS provided higher detection rates (36.88/20.88%). Regarding type I and type III endoleaks, CEUS demonstrated high sensitivity (97%) and specificity (100%), but without superiority over CTA. Conclusions: CEUS is an imaging technique equivalent to CTA in screening for post-EVAR endoleaks. CTA cannot be entirely replaced by CEUS; however, it is safe and effective alternative method to use after one year of negative CTA exams.
Transplantacija jetre je metoda koja omogućuje liječenje brojnih jetrenih patoloških stanja. Intervencijska radiologija (IR) najveći značaj pruža liječenju onkoloških pacijenata, najčešće onima s ...hepatocelularnim karcinomom. Odlike interventnih radioloških tehnika ogledaju se ponajprije u prevenciji progresije trenutne jetrene bolesti te smanjenju stupnja proširenosti tumorske bolesti. U najčešće korištene IR metode u liječenju jetrenih tumora svrstavaju se transarterijska kemoembolizacija (TACE), tj. konvencionalna transarterijska kemoembolizacija (cTACE) ili TACE česticama koje sadržavaju citostatik (DEB-TACE), radioembolizacija, BLAND embolizacija, radiofrekvencijska ablacija (RFA) te mikrovalna ablacija (MWA). cTACE metoda konvencionalni je oblik TACE metode temeljen na lokalnoj aplikaciji citostatika u mikrookoliš tumora te embolizaciji krvnih žila koje opskrbljuju tumor. DEB-TACE metoda zasniva se na lokalnoj aplikaciji čestica ispunjenih citostatikom koje omogućavaju konstantno otpuštanje lijeka u tumorski mikrookoliš.
BLAND embolizacijom emboliziraju se krvne žile koje opskrbljuju tumor što rezultira tumorskom ishemijom. Transarterijska radioembolizacija metoda je kojom se radiosferama apliciraju radioaktivne supstance u tumorski mikrookoliš. RFA tehnika zasnovana je na aplikaciji toplinske energije kroz radiofrekvencijsku iglu uvedenu u jetreni tumor što rezultira koagulacijskom nekrozom tumora.
MWA je metoda zasnovana na perkutanoj aplikaciji molekula sa unutarnjim dipolom koje u kombinaciji sa vanjskim promjenjivim poljem uzrokuju produkciju topline što rezultira nekrozom tumora.
Imaging the pregnant patient presents a unique challenge to radiologist due to the risk of radiation to the conceptus (embryo/fetus). A rare case of a successfully recognized and treated ...pseudoaneurysm (PA) of the abdominal aorta is to be presented. The pseudoaneurysm occurred in the third trimester and had a favorable outcome for the mother and the baby. Emergent abdominal ultrasound (US) is the first modality in diagnostic algorithm for the rupture of aortic aneurysm in a pregnant woman. It provides the most rapid diagnostic information, although intestinal gas and abdominal tenderness may limit its accuracy. To confirm the findings, magnetic resonance angiography (MRA) or CT angiography (CTA) can be used. In our case, the diagnosis was established using a color Doppler ultrasonography of the abdomen and was later confirmed by a low dose CT scan of the abdominal aorta. MRA in such cases have some disadvantages. At many health centers, the monitoring of patients with acute ruptures is more difficult in the MR suite than at the CT scanner. MRA angiographic images are also subject to degradation by multiple artifacts and the visualization of the distal vasculature is suboptimal and inferior to the one done by CTA. Due to fetal movements, a small quantity of fresh blood can be overlooked by MR. MRA is often not available on a 24-hours basis, and the time required for making a diagnosis can preclude the use of MRA in an unstable patient. For this reason, we used a low dose CTA protocol to confirm the diagnosis. Low dose scanning protocols in CT can obtain sufficient diagnostic information while reducing the risk of radiation. A particular focus is put on the outline of new concepts for dose management and optimization. We used new approaches based on tube current modulation. The birth was induced by an urgent Caesarean section followed by a resection of a pseudoaneurysm and a reconstruction of the aorta with an end-to-end vascular prosthesis.
To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution.
Hepatic artery stenosis ...was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter.
During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure.
Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery.
Imaging the pregnant patient presents a unique challenge to radiologist due to the risk of radiation to the conceptus (embryo/fetus). A rare case of a successfully recognized and treated ...pseudoaneurysm (PA) of the abdominal aorta is to be presented. The pseudoaneurysm occurred in the third trimester and had a favorable outcome for the mother and the baby. Emergent abdominal ultrasound (US) is the first modality in diagnostic algorithm for the rupture of aortic aneurysm in a pregnant woman. It provides the most rapid diagnostic information, although intestinal gas and abdominal tenderness may limit its accuracy. To confirm the findings, magnetic resonance angiography (MRA) or CT angiography (CTA) can be used. In our case, the diagnosis was established using a color Doppler ultrasonography of the abdomen and was later confirmed by a low dose CT scan of the abdominal aorta. MRA in such cases have some disadvantages. At many health centers, the monitoring of patients with acute ruptures is more difficult in the MR suite than at the CT scanner. MRA angiographic images are also subject to degradation by multiple artifacts, and the visualization of the distal vasculature is suboptimal and inferior to the one done by CTA. Due to fetal movements, a small quantity of fresh blood can be overlooked by MR. MRA is often not available on a 24-hours basis, and the time required for making a diagnosis can preclude the use of MRA in an unstable patient. For this reason, we used a low dose CTA protocol to confirm the diagnosis. Low dose scanning protocols in CT can obtain sufficient diagnostic information while reducing the risk of radiation. A particular focus is put on the outline of new concepts for dose management and optimization. We used new approaches based on tube current modulation. The birth was induced by an urgent Caesarean section followed by a resection of a pseudoaneurysm and a reconstruction of the aorta with an end-to- end vascular prosthesis
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