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This study aimed to evaluate the radiation doses (peak skin dose (PSD) and bilateral lens dose) for each interventional neuroradiology procedure. A direct measurement system consisting of small radiophotoluminescence glass dosimeter chips and a dosimetry cap made of thin stretchable polyester was used for radiation dosimetry. The mean PSDs for each procedure were 1565 ± 590 mGy (simple technique coil embolization (STCE) cases), 1851 ± 825 mGy (balloon-assisted coil embolization (BACE) cases), 2583 ± 967 mGy (stent-assisted coil embolization (SACE) cases), 1690 ± 597 mGy (simple flow-diverter stenting (FDS) cases), and 2214 ± 726 mGy (FDS + coiling cases). The mean PSD was higher in SACE cases than in STCE, BACE, and simple FDS cases. Moreover, the PSD exceeded 2000 mGy and 3000 mGy in 46 (67.6%) and 19 (27.9%) SACE cases, respectively. The left lens doses for each procedure were 126 ± 111 mGy (STCE cases), 163 ± 152 mGy (BACE cases), 184 ± 148 mGy (SACE cases), 144 ± 60 mGy (simple FDS cases), and 242 ± 178 mGy (FDS + coiling cases). The left lens dose in SACE cases was higher than that in STCE cases and exceeded 500 mGy in 3 (4.4%) patients. In FDS + coiling cases, the mean PSD and left lens dose were 2214 ± 726 mGy and 242 ± 178 mGy, respectively. The left lens dose was higher than that in the STCE and BACE cases, with two (15.4%) patients receiving doses >500 mGy in FDS + coiling cases. The detailed data obtained in this study are expected to contribute to the promotion of radiation dose optimization.
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Aneurisma Intracraneal , Dosis de Radiación , Radiografía Intervencional , Humanos , Aneurisma Intracraneal/terapia , Masculino , Femenino , Persona de Mediana Edad , Embolización Terapéutica , Anciano , Radiometría , Adulto , Cristalino/efectos de la radiación , NeurorradiografíaRESUMEN
INTRODUCTION: During Interventional Cardiology (IC) and Interventional Radiology (IR) procedures operators' gloves, guide wires and catheters may stick together due to the inherent stickiness of Iodine Containing Contrast Media (ICCM). This may result in displacement of materials, compromising technical success. In this study we compare the stickiness of seven frequently used types of ICCM. MATERIAL AND METHODS: Xenetix 300, Hexabrix 320 (Guerbet, Villepinte, France), Ultravist 300 (Bayer, Leverkusen, Germany), Visipaque 270, Omnipaque 300, Visipaque 320 (GE, Wauwatosa, WI) and Iomeron300 (Bracco, Milano, Italy) are compared using a probe-tack test. Pieces of surgical gloves are put together with 0.1 ml of of ICCM in between, and subsequently pulled apart under computer control. Stickiness is measured as the work needed to separate the probes. RESULTS: From least to most sticky results were: Hexabrix 320 (mean Work (mJ); range: 0.70; 0.16-1.23), Visipaque 270 (1.18; 0.47-1.89), Visipaque 320 (1.70; 0.59-2.81), Iomeron 300 (3.01; 1.82-4.20), Xenetix 300 (5.83; 3.96-7.69), Ultravist 300 (5.83; 2.83-8.84), Omnipaque 300 (8.14; 6.95-9.33). The four least sticky ICCM differ statistically significantly (p = 0.000-0.004) from the remaining. In this research Omnipaque 300, Ultravist 300 and Xenetix 300 are the stickiest and may hence pose the greatest practical problems during procedures; in contrast, Hexabrix 320, Visipaque 270 and Visipaque 320 are the least sticky in this research and may therefore aid in constraining complications caused by stickiness. CONCLUSION: A significant and reproducible difference in stickiness exists between commercially available ICCM, Hexabrix 320, Visipaque 270, Visipaque 320 and Iomeron 300, being least sticky.
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Medios de Contraste , Radiología Intervencionista , Medios de Contraste/efectos adversos , Humanos , Yodo , Radiografía Intervencional , CardiologíaRESUMEN
PURPOSE: Proton therapy is highly effective for liver malignancies, and to increase its accuracy, placement of fiducial markers in the liver is preferred. We retrospectively evaluated the safety and feasibility of CT-guided fiducial marker implantation using ultra-fine 25-gauge needles before proton therapy for liver malignancies. MATERIALS AND METHODS: Between May 2016 and April 2021, 334 cases were investigated. All of procedures were performed without anesthesia. Technical success was defined as the completion of implantation at the intended site. Tumor-marker distance and possibility of synchronization between tumors and markers were evaluated and compared with Mann-Whitney U test. Complications were evaluated using the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: Technical success rate was 97.3%. Tumor-marker distance was 19.1 mm (median, range 0-96) in the group in which the implanted marker was synchronized with tumor (n = 315), while it was 34.5 mm (median, range 6-94) in the group in which the implanted marker was not synchronized (n = 13) (p value = 0.011 < 0.05). The complication rate was 2.4%, 2 were classified as grade 4 and 5 as grade 1, and 1 as grade 2. There were no grade 3 or higher complications that seemed to be related to the procedure. CONCLUSION: CT-guided marker implantation using a 25-gauge needle achieved a satisfactory success rate with few complications and was useful for the image-guided and respiratory-synchronized proton therapy. LEVEL OF EVIDENCE 3: Local non-random sample.
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Marcadores Fiduciales , Neoplasias Hepáticas , Agujas , Terapia de Protones , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Humanos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/diagnóstico por imagen , Femenino , Terapia de Protones/métodos , Masculino , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Anciano de 80 o más Años , Radiografía Intervencional/métodos , Adulto , Estudios de FactibilidadRESUMEN
Fluoroscopy is an advanced medical imaging modality that utilizes x-rays to acquire real-time images throughout a medical examination. It is commonly used in various procedures such as in interventional radiology, cardiac catheterization, and gastrointestinal and genitourinary studies. While fluoroscopy is a valuable diagnostic and therapeutic tool, it exposes patients and medical staff to ionizing radiation, which carries health risks. A radiation dose summary page is a report generated by the fluoroscope that displays important information about the procedure. It provides an overview of the radiation doses administered during a fluoroscopic procedure, as well as certain technical parameters used during the irradiation events. The contents of a radiation dose summary page may vary depending on the make and model of the fluoroscope but some common elements include the cumulative reference air kerma, which serves as a surrogate of radiation dose delivered to the patient, and the dose-area product, which takes account of the x-ray beam area and is a measure of the total amount of energy imparted on the patient. Other imaging acquisition parameters may be also included in the dose summary page, including tube voltage, tube current, pulse width, pulse rate, spectral filters, primary and secondary angles, and source-to-image distance. The radiation dose summary page for fluoroscopy is a useful tool for physicians, technologists, and medical physicists, allowing them to comprehend the technical details of a fluoroscopically guided procedure. ©RSNA, 2024.
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Dosis de Radiación , Radiografía Intervencional , Fluoroscopía , Humanos , Radiografía Intervencional/métodos , Protección Radiológica/métodosRESUMEN
PURPOSE: To compare the indications, specimen quality, and cost of CT versus non-image guided bone marrow aspirate and biopsy (BMAB). METHODS: All CT and non-image guided BMAB performed from January 2013-July 2022 were studied. Body-mass-index (BMI), skin-to-bone distance, aspirate, and core specimen quality, and core sample length were documented. Indications for CT guided BMAB were recorded. Categorical variables were compared using chi-squared test and continuous variables using Mann-Whitney test. Analysis of per-biopsy factors used linear mixed-effect models to adjust for clustering. Cost of CT and non-image guided BMAB was taken from patient billing data. RESULTS: There were 301 CT and 6535 non-image guided BMABs studied. All CT guided BMAB were studied. A subset of 317 non-image guided BMAB was selected randomly from the top ten CT BMAB referrers. BMI (kg/m2) and skin-to-bone distance (cm) was higher in the CT versus the non-image guided group; 34.4 v 26.8, p < 0.0001; 4.8 v 2.5, p < 0.0001, respectively. Aspirate and core sample quality were not different between groups, p = 0.21 and p = 0.12, respectively. CT guided core marrow samples were longer, p < 0.0001. The most common CT BMAB referral indications were large body habitus (47.7 %), failed attempt (18.8 %) and not stated (17.4 %). Cost of a CT guided BMAB with conscious sedation was $3945 USD versus $310 USD for non-image guided. CONCLUSION: CT guided BMAB are commonly performed in patients with large body habitus and failed attempt. However, the cost is 12.7 fold higher with no increase in specimen quality. These findings can help referrers be cost conscious.
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Médula Ósea , Tomografía Computarizada por Rayos X , Humanos , Tomografía Computarizada por Rayos X/economía , Masculino , Femenino , Persona de Mediana Edad , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Biopsia Guiada por Imagen/economía , Biopsia Guiada por Imagen/métodos , Adulto , Anciano , Estudios Retrospectivos , Biopsia con Aguja/economía , Radiografía Intervencional/economíaRESUMEN
Venous malformation (VM) stands as the most prevalent form of vascular malformation, characterized by its diverse morphology. These lesions can manifest in any part of the body, affecting different tissue planes and giving rise to symptoms such as pain, swelling, or physical dysfunction. In the realm of treatment, direct puncture VM sclerotherapy holds its place as the primary approach. This technique involves the administration of a sclerosing agent into the VM channels during contrast phlebography while simultaneously managing the outflow veins through different methods. The process of VM sclerotherapy induces endothelial damage, thrombosis, and fibrosis, resulting in symptom relief through lesion shrinkage. It is crucial to exercise caution techniques and sclerosing agents during VM sclerotherapy to minimize procedural complications, enhance clinical outcomes, and ultimately improve the patient's overall quality of life.
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Soluciones Esclerosantes , Escleroterapia , Malformaciones Vasculares , Humanos , Escleroterapia/efectos adversos , Soluciones Esclerosantes/efectos adversos , Soluciones Esclerosantes/administración & dosificación , Malformaciones Vasculares/terapia , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/fisiopatología , Resultado del Tratamiento , Venas/diagnóstico por imagen , Venas/anomalías , Venas/fisiopatología , Radiografía Intervencional/efectos adversos , Flebografía , Punciones , FemeninoRESUMEN
This review explores the clinical presentation of lower extremity DVT and pulmonary embolism (PE), treatment strategies, and outcomes for venous thromboembolism (VTE) in the pediatric population. Traditional therapy for pediatric VTE was anticoagulation alone with thrombolysis and surgery reserved only in life or limb-threatening cases. Catheter-directed thrombolysis (CDT), pharmacomechanical thrombectomy (PMT) and mechanical thrombectomy (MT) have emerged as effective and safe treatment options for VTE management. Although most data are from adult studies, early pediatric studies suggest that these interventional procedures can be effective in children. The significant clinical impact of post-thrombotic syndrome (PTS) is also discussed, as PTS can lead to lifelong physical symptoms and psychosocial damage.
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Trombectomía , Terapia Trombolítica , Tromboembolia Venosa , Humanos , Niño , Terapia Trombolítica/efectos adversos , Resultado del Tratamiento , Trombectomía/efectos adversos , Tromboembolia Venosa/terapia , Tromboembolia Venosa/diagnóstico por imagen , Adolescente , Preescolar , Factores de Riesgo , Lactante , Factores de Edad , Radiografía Intervencional , Embolia Pulmonar/terapia , Embolia Pulmonar/diagnóstico por imagen , Femenino , Síndrome Postrombótico/diagnóstico por imagen , Síndrome Postrombótico/terapia , Masculino , Recién Nacido , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Fibrinolíticos/administración & dosificación , Anticoagulantes/uso terapéuticoRESUMEN
Portal interventions in pediatric patients present unique difficulties when compared to adult procedures. In addition, children who need a portal intervention require a different workup and clinical management. Based on these elements, the clinical decisions for the study and treatment of these pathologies are different. This review is intended to present a summary of the interventional radiologist's role in treating pediatric portal venous diseases. Focus is placed on the technical elements, patient management and procedural indications while discussing different interventions involving the portal vein, providing some recommendations supported by recent research and the authors' experience.
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Vena Porta , Radiografía Intervencional , Humanos , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Niño , Resultado del Tratamiento , Flebografía , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/terapia , Enfermedades Vasculares/fisiopatología , Adolescente , Preescolar , Lactante , Portografía , Factores de Edad , Masculino , Femenino , Recién NacidoRESUMEN
Fibro-Adipose Vascular Anomaly (FAVA) is a recently identified type of vascular malformation predominantly affecting adolescent females. Comprising abnormal adipose and vascular components, FAVA is frequently misdiagnosed as other vascular anomalies. It primarily manifests with pain, functional impairment, and musculoskeletal symptoms, particularly in the lower extremities. Accurate diagnosis requires a combination of clinical, radiologic, and histopathologic evaluation, with MRI and ultrasound being the primary imaging tools. Management of FAVA is multidisciplinary and tailored to individual patients. Interventional radiology procedures, such as percutaneous cryoablation, sclerotherapy, and embolization, are effective in long term control of symptoms. Cryoablation is particularly successful in alleviating pain and improving function. Surgical resection is reserved for specific cases with extensive lesions involving joints or when there is severe muscle or joint dysfunction. Additionally, sirolimus, an mTOR inhibitor, has shown promise in symptom relief, although further research is needed to confirm its long-term efficacy. Early diagnosis and treatment are essential for improving the quality of life in FAVA patients. Advances in imaging and treatment strategies have enhanced the ability to manage this complex and rare condition effectively.
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Valor Predictivo de las Pruebas , Malformaciones Vasculares , Humanos , Malformaciones Vasculares/terapia , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/fisiopatología , Femenino , Resultado del Tratamiento , Escleroterapia , Tejido Adiposo/diagnóstico por imagen , Embolización Terapéutica , Adolescente , Criocirugía/efectos adversos , Radiografía IntervencionalRESUMEN
Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.
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Radiografía Intervencional , Trombosis de la Vena , Humanos , Niño , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/terapia , Trombosis de la Vena/fisiopatología , Resultado del Tratamiento , Preescolar , Adolescente , Lactante , Flebografía , Grado de Desobstrucción Vascular , Factores de Edad , Factores de Riesgo , Recién Nacido , Masculino , Femenino , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Cateterismo Periférico/efectos adversos , Valor Predictivo de las PruebasRESUMEN
OBJECTIVE: This study aimed to evaluate the diagnostic performance and procedural characteristics of fluoroscopy-guided percutaneous transthoracic pleural forceps biopsy (PTPFB) in patients with exudative pleural effusion. MATERIALS AND METHODS: Patients with exudative pleural effusion who underwent PTPFB between May 1, 2014, and February 28, 2023, were included in this retrospective study. The interval between percutaneous catheter drainage (PCD) and PTPFB, number of biopsies, procedural time, and procedure-related complications were evaluated. The sensitivity, specificity, and accuracy of diagnosing malignancy were computed for pleural cytology using PCD drainage, PTPFB, and combined PTPFB and pleural cytology. RESULTS: Seventy-one patients, comprising 50 male and 21 female (mean age, 69.5 ± 15.3 years), were included in this study. The final diagnoses were benign lesions in 48 patients (67.6%) and malignant in 23 patients (32.4%). The overall interval between PCD and biopsy was 2.4 ± 3.7 days. The interval between PCD and biopsy in the group that underwent delayed PTPFB was 5.2 ± 3.9 days. The mean number of biopsies was 4.5 ± 1.3. The mean procedural time was 4.4 ± 2.1 minutes. Minor bleeding complications were reported in one patient (1.4%). The sensitivity, specificity, and accuracy for pleural cytology, PTPFB, and combined PTPFB and pleural cytology were 47.8% (11/23), 100% (48/48), and 83.1% (59/71), respectively; 65.2% (15/23), 100% (48/48), and 88.7% (63/71), respectively; and 78.3% (18/23), 100% (48/48), and 93.0% (66/71), respectively. The sensitivity and accuracy of cytology combined with PTPFB were significantly higher than those of cytological testing alone (P = 0.008 and 0.001, respectively). CONCLUSION: Fluoroscopy-guided PTPFB is an accurate and safe diagnostic technique for patients with exudative pleural effusion, with acceptable diagnostic performance, low complication rates, and reasonable procedural times.
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Biopsia Guiada por Imagen , Sensibilidad y Especificidad , Humanos , Masculino , Femenino , Anciano , Fluoroscopía , Estudios Retrospectivos , Biopsia Guiada por Imagen/métodos , Derrame Pleural/patología , Derrame Pleural/diagnóstico por imagen , Persona de Mediana Edad , Anciano de 80 o más Años , Pleura/patología , Pleura/diagnóstico por imagen , Radiografía Intervencional/métodos , Derrame Pleural Maligno/patología , Derrame Pleural Maligno/diagnóstico por imagenAsunto(s)
Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Humanos , Neoplasias Nasofaríngeas/radioterapia , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/diagnóstico por imagen , Fluoroscopía , Constricción Patológica , Carcinoma Nasofaríngeo/radioterapia , Carcinoma Nasofaríngeo/terapia , Carcinoma Nasofaríngeo/diagnóstico por imagen , Masculino , Radiografía Intervencional , Persona de Mediana Edad , Carcinoma/radioterapia , Carcinoma/terapia , Dilatación/métodos , Traumatismos por Radiación/terapia , Traumatismos por Radiación/etiología , Traumatismos por Radiación/diagnóstico por imagenRESUMEN
Ectopic varices are rare but potentially life-threatening conditions usually resulting from a combination of global portal hypertension and local occlusive components. As imaging, innovative devices, and interventional radiologic techniques evolve and are more widely adopted, interventional radiology is becoming essential in the management of ectopic varices. The interventional radiologist starts by diagnosing the underlying causes of portal hypertension and evaluating the afferent and efferent veins of ectopic varices with CT. If decompensated portal hypertension is causing ectopic varices, placement of a transjugular intrahepatic portosystemic shunt is considered the first-line treatment, although this treatment alone may not be effective in managing ectopic variceal bleeding because it may not sufficiently resolve focal mesenteric venous obstruction causing ectopic varices. Therefore, additional variceal embolization should be considered after placement of a transjugular intrahepatic portosystemic shunt. Retrograde transvenous obliteration can serve as a definitive treatment when the efferent vein connected to the systemic vein is accessible. Antegrade transvenous obliteration is a vital component of interventional radiologic management of ectopic varices because ectopic varices often exhibit complex anatomy and commonly lack catheterizable portosystemic shunts. Superficial veins of the portal venous system such as recanalized umbilical veins may provide safe access for antegrade transvenous obliteration. Given the absence of consensus and guidelines, a multidisciplinary team approach is essential for the individualized management of ectopic varices. Interventional radiologists must be knowledgeable about the anatomy and hemodynamic characteristics of ectopic varices based on CT images and be prepared to consider appropriate options for each specific situation. ©RSNA, 2024 Supplemental material is available for this article.
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Hemorragia Gastrointestinal , Derivación Portosistémica Intrahepática Transyugular , Humanos , Derivación Portosistémica Intrahepática Transyugular/métodos , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/etiología , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/terapia , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/complicaciones , Várices/diagnóstico por imagen , Várices/terapia , Radiografía Intervencional/métodos , Radiología Intervencionista/métodos , Embolización Terapéutica/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Left atrial appendage closure (LAAC) represents an alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation (AF). While transoesophageal echocardiography is the current standard for guiding LAAC procedures, several centers have employed fluoroscopic guidance alone. However, data on long-term outcomes are lacking. METHODS: A total of 536 patients with AF undergoing LAAC and with available data on long-term follow-up were included in the retrospective, single-center analysis. Outcomes of patients undergoing fluoroscopy-guided LAAC were compared with those undergoing echocardiography guided LAAC. Time-dependent analysis was performed with the Kaplan-Meier method. RESULTS: A total of 234 (44%) and 302 (56%) patients were treated with echocardiography and fluoroscopy guidance, respectively. Baseline characteristics did not differ between the two groups. Procedural success rates were high in both groups (97% of fluoroscopy vs. 98% of echocardiography guided procedures; p = 0.92) and rates of relevant peri-device leaks (p = 0.50) and device-related thrombus formation (p = 0.22) did not differ between groups. Median clinical follow-up time was 48 (IQR 19-73) months. Rates of all-cause mortality (p = 0.15, HR 0.83, CI 0.64-1.07) and stroke (p = 0.076, HR 2.23, CI 0.90-5.54) were comparable among groups. CONCLUSION: LAAC with fluoroscopy guidance alone is equally safe and leads to similar clinical outcome compared to LAAC with additional echocardiography guidance.
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Fibrilación Atrial , Ecocardiografía Transesofágica , Cierre del Apéndice Auricular Izquierdo , Radiografía Intervencional , Accidente Cerebrovascular , Ultrasonografía Intervencional , Humanos , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/fisiopatología , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/mortalidad , Fibrilación Atrial/terapia , Fluoroscopía , Cierre del Apéndice Auricular Izquierdo/efectos adversos , Cierre del Apéndice Auricular Izquierdo/instrumentación , Valor Predictivo de las Pruebas , Radiografía Intervencional/efectos adversos , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/etiología , Factores de Tiempo , Resultado del Tratamiento , Ultrasonografía Intervencional/efectos adversosRESUMEN
The current state of the literature for a bullet embolization to the heart and/or pulmonary vasculature indicates the occurrence is rare but could increase due to the rise in civilian low-kinetic-energy firearm acquisition and use. We present the case of an older teenage male who sustained a gunshot wound to the left flank. The bullet entered the iliac vein, travelled through the heart and lodged in the pulmonary artery. Successful relocation of the bullet to the internal iliac vein was performed by the interventional radiologist. This article highlights the advancement of interventional radiology as a successful non-invasive endovascular technique for bullet embolus removal.
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Procedimientos Endovasculares , Migración de Cuerpo Extraño , Arteria Pulmonar , Heridas por Arma de Fuego , Humanos , Heridas por Arma de Fuego/complicaciones , Heridas por Arma de Fuego/diagnóstico por imagen , Heridas por Arma de Fuego/cirugía , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/lesiones , Arteria Pulmonar/cirugía , Resultado del Tratamiento , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/terapia , Procedimientos Endovasculares/instrumentación , Adolescente , Radiografía Intervencional , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/lesiones , Vena Ilíaca/cirugía , Angiografía por Tomografía Computarizada , Embolia Pulmonar/etiología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/cirugía , Embolia Pulmonar/terapiaRESUMEN
The present standard of care for unresectable liver cancer is transarterial chemoembolization (TACE), which involves using chemotherapeutic particles to selectively embolize the arteries supplying hepatic tumors. Accurate volumetric identification of intricate fine vascularity is crucial for selective embolization. Three-dimensional imaging, particularly cone-beam CT (CBCT), aids in visualization and targeting of small vessels in such highly variable anatomy, but long image acquisition time results in intra-scan patient motion, which distorts vascular structures and tissue boundaries. To improve clarity of vascular anatomy and intra-procedural utility, this work proposes a targeted motion estimation and compensation framework that removes the need for any prior information or external tracking and for user interaction. Motion estimation is performed in two stages: (i) a target identification stage that segments arteries and catheters in the projection domain using a multi-view convolutional neural network to construct a coarse 3D vascular mask; and (ii) a targeted motion estimation stage that iteratively solves for the time-varying motion field via optimization of a vessel-enhancing objective function computed over the target vascular mask. The vessel-enhancing objective is derived through eigenvalues of the local image Hessian to emphasize bright tubular structures. Motion compensation is achieved via spatial transformer operators that apply time-dependent deformations to partial angle reconstructions, allowing efficient minimization via gradient backpropagation. The framework was trained and evaluated in anatomically realistic simulated motion-corrupted CBCTs mimicking TACE of hepatic tumors, at intermediate (3.0 mm) and large (6.0 mm) motion magnitudes. Motion compensation substantially improved median vascular DICE score (from 0.30 to 0.59 for large motion), image SSIM (from 0.77 to 0.93 for large motion), and vessel sharpness (0.189 mm-1 to 0.233 mm-1 for large motion) in simulated cases. Motion compensation also demonstrated increased vessel sharpness (0.188 mm-1 before to 0.205 mm-1 after) and reconstructed vessel length (median increased from 37.37 to 41.00 mm) on a clinical interventional CBCT. The proposed anatomy-aware motion compensation framework presented a promising approach for improving the utility of CBCT for intra-procedural vascular imaging, facilitating selective embolization procedures.
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Tomografía Computarizada de Haz Cónico , Imagenología Tridimensional , Neoplasias Hepáticas , Tomografía Computarizada de Haz Cónico/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/irrigación sanguínea , Imagenología Tridimensional/métodos , Movimiento (Física) , Quimioembolización Terapéutica/métodos , Radiografía Intervencional/métodos , Algoritmos , Movimiento , Redes Neurales de la ComputaciónRESUMEN
BACKGROUND: The incidence of pneumothorax is higher in patients with emphysema who undergo percutaneous lung biopsy. Needle embolization has been shown to reduce the incidence of pneumothorax in patients with emphysema. Existing studies have reported small sample sizes of patients with emphysema, or the degree of emphysema has not been graded. Therefore, the efficacy of biopsy embolization in the prevention of pneumothorax induced by percutaneous pulmonary biopsy in patients with emphysema remains to be determined. METHODS: In this retrospective, controlled study, patients with emphysema who underwent CT-guided PTLB were divided into two groups: group A (n = 523), without tract embolization, and Group B (n = 504), with tract embolization. Clinical and imaging features were collected from electronic medical records and Picture Archiving and Communication Systems. Univariate and multivariate analyses were performed to identify risk factors for pneumothorax and chest tube placement. RESULTS: The two groups did not differ significantly in terms of demographic characteristics and complications other than pneumothorax. The incidence of pneumothorax and chest tube placement in group B was significantly lower than in group A (20.36% vs. 46.12%, p < 0.001; 3.95% vs. 9.18%, p < 0.001, respectively). In logistic regression analyses, variables affecting the incidence of pneumothorax and chest tube placement were the length of puncture of the lung parenchyma (odds ratio [OR] = 1.18, 95% confidence interval [CI]: 1.07-1.30, p = 0.001; OR = 1.55, 95% CI: 1.30-1.85, p < 0.001, respectively), tract embolization (OR = 0.31, 95% CI: 0.24-0.41, p < 0.001; OR = 0.39, 95% CI: 0.22-0.69, p = 0.001, respectively), and grade of emphysema. CONCLUSIONS: Tract embolization with gelatin sponge particles after CT-guided PTLB significantly reduced the incidence of pneumothorax and chest tube placement in patients with emphysema. Tract embolization, length of puncture of the lung parenchyma, and grade of emphysema were independent risk factors for pneumothorax and chest tube placement. TRIAL REGISTRATION: Retrospectively registered.
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Embolización Terapéutica , Biopsia Guiada por Imagen , Pulmón , Neumotórax , Enfisema Pulmonar , Tomografía Computarizada por Rayos X , Humanos , Neumotórax/etiología , Neumotórax/prevención & control , Neumotórax/epidemiología , Femenino , Masculino , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Biopsia Guiada por Imagen/efectos adversos , Biopsia Guiada por Imagen/métodos , Embolización Terapéutica/métodos , Pulmón/patología , Pulmón/diagnóstico por imagen , Factores de Riesgo , Modelos Logísticos , Tubos Torácicos , Esponja de Gelatina Absorbible/administración & dosificación , Incidencia , Análisis Multivariante , Anciano de 80 o más Años , Radiografía Intervencional/métodosRESUMEN
Uterine artery embolization has an over 25-year track record of safety and efficacy. It has been evident for quite some time that this procedure can performed in an office-based lab. In this article, some of the prerequisites to performing uterine artery embolization in an office-based lab are reviewed.