Safety margin of embolized area can reduce local recurrence of hepatocellular carcinoma after superselective transarterial chemoembolization

BACKGROUND/AIMS: We aimed to determine the relationship between the safety margin of an embolized area and local tumor recurrence (LTR) of patients with hepatocellular carcinoma (HCC) who underwent superselective transarterial chemoembolization (TACE). METHODS: The medical records of 77 HCC patients with 109 HCC nodules who underwent superselective TACE were retrospectively analyzed for LTR. Univariate and multivariate analyses were performed for 16 potential factors using Cox proportional hazard regression. Iodized oil deposition on cone-beam computed tomography (CBCT) imaging was divided into three grades: A=complete tumor staining and complete circumferential safety margin, B=complete tumor staining but incomplete safety margin, C=incomplete tumor staining. The effect of a safety margin on LTR was evaluated by comparison between grade A and B group. RESULTS: Univariate and multivariate analyses revealed that grade A iodized oil deposition and portal vein visualization were the only two independent significant factors of LTR (P<0.001 and P=0.029, respectively). The 12- and 24-month LTR rates of tumors for grade A (n=62), grade B (n=30), and grade C (n=17) were 16% vs. 41% vs. 100% and 16% vs. 61% vs. 100%, respectively (P<0.001). The tumors in the grade A group had a 75% risk reduction in LTR (odds ratio, 0.25; 95% confidence interval, 0.10 to 0.64; P=0.004) compared to the grade B group. CONCLUSIONS: LTR was significantly lower when a greater degree of iodized oil deposition occurred with a complete circumferential safety margin. In superselective TACE, the safety margin of the embolized areas using intraprocedural CBCT affected LTR in HCC patients.

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

OBJECTIVE: To report the results of angioplasty with paclitaxel-coated balloons for the treatment of early restenosis of central veins in hemodialysis patients. MATERIALS AND METHODS: Sixteen patients (9 men and 7 women; mean age 65.8 ± 14.4 years; range, 40–82 years) with 16 episodes of early restenoses of central veins within 3 months (median patency duration 2.5 months) were enrolled from January 2014 to June 2015. Ten native central veins and 6 intra-stent central veins were treated with double paclitaxel-coated balloons (diameter 6–7 mm) plus a high pressure balloon (diameter 12–14 mm). The study outcomes included procedural success (< 30% residual stenosis) and primary patency of the treated lesion (< 50% angiographic stenosis without re-intervention). RESULTS: Procedural success was achieved in all 16 cases of central vein stenoses. The mean diameter of the central vein was 3.7 ± 2.4 mm before the procedure vs. 11.4 ± 1.8 mm after the initial procedure. There were no procedure-related complications. The mean diameters of the central veins at 6 months and 12 months were 7.8 ± 1.3 mm and 6.9 ± 2.7 mm, respectively. The primary patency rates at 6 months and 12 months were 93.8% and 31.2%, respectively. One patient had significant restenosis of the central vein at 3 months. The median primary patency period was 9 months for paclitaxel-coated balloons and 2.5 months for the last previous procedure with conventional balloons (p < 0.001). CONCLUSION: In our limited study, paclitaxel-coated balloons seem to improve the patency rate in cases of early restenosis of central veins. However, a further randomized control trial is necessary.

Anatomic variants and anomalies of coronary arteries detected by computed tomography angiography in southern Thailand

anatomic variants and anomalies detected by computedtomography angiography (CTA)Materials and methods: A retrospective study wasconducted on all patients undergoing coronary CTA using a64-detector row CT in the Radiology Department,Songklanagarind Hospital, from January 2010 to January2013. Data were recorded and analyzed.Results: The imaging results of 279 patients were reviewed.One hundred and twenty-two females (43.7%) and 157 males(56.3%) [age range, 26-82 years] were reviewed for coronaryartery variants and anomalies with post-processing images.The right coronary dominance was the most commondominant type (91.4%). The prevalence of ramus intermediuswas 68.8%; those of the absence of the left main coronaryartery and left circumflex artery were 0.4%, respectively; andof the high takeoff of the coronary artery was 3.6%.Anomalies of origin and course were detected as the rightcoronary artery originating from the left coronary sinus in1.1% of the patients. Myocardial bridging and coronaryfistulas were demonstrated in 55.6% and 0.7% of oursubjects, respectively.Conclusion: A coronary CTA can effectively represent thecomplex anatomy of the coronaries as well as their anatomicvariations and anomalies. The prevalence of most coronaryvariations were in concordance with the data of previousreports.

Patient Radiation Dose in Neurointerventional Radiologic Procedure: A Tertiary Care Experience / 신경중재치료의학

PURPOSE: Neurointerventional radiology procedures often require a long time to perform. Patient radiation dose is an important issue due to the hazards of ionizing radiation. The objective of this study was to measure the peak skin dose (PSD) and effective dose to estimate the deterministic and stochastic effects of a therapeutic interventional neuroradiologic procedure. MATERIALS AND METHODS: The cumulative dose (CD) and dose area product (DAP) were automatically recorded by a fluoroscopic machine and collected prospectively between April and November 2015. The study included 54 patients who underwent therapeutic neurointerventional radiology procedures. The CD of each patient was used to estimate the peak skin dose and the DAP was also calculated to estimate the effective dose. RESULTS: The average estimated peak skin dose was 1,009.68 mGy. Two patients received radiation doses of more than 2 Gy, which is the threshold that may cause skin complications and radiation-induced cataract. The average effective dose was 35.32 mSv. The majority of patients in this study (85.2%) who underwent therapeutic neurointerventional radiologic procedures received effective doses greater than 20 mSv. CONCLUSION: Not all therapeutic neurointerventional radiology procedures are safe from deterministic complications. A small number of patients received doses above the threshold for skin complications and radiation induced cataract. In terms of stochastic complications, most neurointerventional radiology procedures in this study were quite safe in terms of radiation-induced cancer.

Pharmacomechanical Thrombolysis versus Surgical Thrombectomy for the Treatment of Thrombosed Haemodialysis Grafts

<p><b>INTRODUCTION</b>The key to treatment of a thrombosed dialysis graft is restoration and maintenance of function as long as possible. The objective of this study was to compare the outcomes of pharmacomechanical thrombolysis and surgical thrombectomy in the treatment of thrombosed haemodialysis grafts.</p><p><b>MATERIALS AND METHODS</b>During a 3-year period, 108 patients with 114 thrombosed dialysis grafts were referred to our institute for treatment. Fifty thrombosed dialysis grafts underwent pulse-spray catheter thrombolysis using recombinant tissue plasminogen activator (rt-PA) with angioplasty, and 64 thrombosed dialysis grafts underwent surgical thrombectomy. The procedural success rates, complications and average patency times and patency rates were compared between the 2 procedures. P values less than 0.05 were considered to be statistically significant.</p><p><b>RESULTS</b>There were no statistically significant differences between the pharmacomechanical thrombolysis group and the thrombectomy group in the procedural success rates (94% and 93.8%, P = 0.15) or average patency times (6.24 months and 6.30 months, P = 0.17). The primary and secondary patency rates at 12 months were 28.0% ± 8.4% and 54.3% ± 7.8% for the thrombolysis with angioplasty group, and 30.0% ± 6.3% and 57.0% ± 4.8% for the thrombectomy group, respectively (P = 0.65 and P = 0.49, respectively). There were no procedural-related major complications.</p><p><b>CONCLUSION</b>Our study found no differences in outcomes between patients treated with pharmacomechanical thrombolysis and surgical thrombectomy for thrombosed haemodialysis grafts. Pharmacomechanical thrombolysis can be considered as an alternative treatment for dialysis graft thrombosis.</p>

Spontaneous Massive Hemothorax in a Patient with Neurofibromatosis Type 1 with Successful Transarterial Embolization

Vascular involvement in neurofibromatosis type 1 is rare but has the potential to be fatal. We report a case of a patient with spontaneous rupture of a left intercostal artery aneurysm, which presented as a massive left hemothorax and was successfully treated by transarterial coil embolization.

A rare case of primary muscular non-Hodgkin's lymphoma and a review of how imaging can assist in its diagnosis

Primary malignant non-Hodgkin's lymphoma of the muscle is rare. Currently, imaging tools are necessary to enable its diagnosis. Herein, we report the case of a patient who presented with swelling and pain in the right thigh and pelvis. Computed tomography findings revealed isodense masses in the patient's right thigh and left iliacus muscle, leading to the initial diagnosis of either primary muscular lymphoma or soft tissue sarcoma. Further investigation with magnetic resonance imaging was done, and a biopsy was performed. The ensuing histological diagnosis was that of diffuse large B-cell lymphoma.