Transcatheter Coil Embolization of an Arc of Buhler Aneurysm

We report the findings of a patient with an asymptomatic Arc of Buhler (AOB) aneurysm, which was successfully treated by transcatheter coil embolization. An abdominal CT and angiography revealed an intact pancreaticoduodenal artery arcade (PDAA) and an anomalous communication between the SMA and celiac axis, termed an AOB. An aneurysm was observed at the origin of the AOB and treated with a transcatheter embolization using coils. A follow-up CT imaging confirmed the total occlusion of the aneurysm with a patent PDAA. The successful results of this treatment suggest that the endovascular therapy of an AOB aneurysm with a celiac axis occlusion and an intact PDAA is feasible and safe.

Assessment of Mesenteric Vascular Steno-occlusive Lesion in Acute Mesenteric Ischemia: Comparison between CT Angiography and Digital Subtraction Angiography

PURPOSE: Acute mesenteric ischemia (AMI) is one of the most dramatic abdominal emergencies. The most common cause of AMI is a thrombo-embolism of the mesenteric artery or vein. The aim of this study was to evaluate the feasibility of CT angiography for evaluating mesenteric vascular steno-occlusive lesion in AMI. MATERIALS AND METHODS: Fifteen patients with clinically and angiographically proven AMI underwent a two-phase CT. The CT angiographic images were reconstructed using a 3D rendering algorithm, such as the maximum intensity projection and volume-rendering. All the CT angiographic images were reviewed with respect to stenosis or occlusion of mesenteric vessel by the consensus of two radiologists, and were correlated with the findings of digital subtraction angiography. RESULTS:Digital subtraction angiography (DSA) visualized 60 mesenteric vessels including the superior mesenteric artery (n=15) and vein (n=15), and the inferior mesenteric artery (n=15) and vein (n=15). DSA showed steno-occlusive lesions in 16 mesenteric vessels (13 superior mesenteric arteries, two superior mesenteric veins, and one inferior mesenteric artery). CT angiography detected steno-occlusive lesions in 16 mesenteric vessels (12 superior mesenteric arteries, one superior mesenteric vein, and three inferior mesenteric arteries). The sensitivity, specificity, and accuracy of CT angiography for evaluating mesenteric vascular steno-occlusive lesion were 87.5%, 95.4%, and 93.3%, respectively. CONCLUSION: CT angiography is an useful adjunct to abdominal CT in an AMI setting on account of its ability to detect the causes of AMI such as a steno-occlusive lesion of the mesenteric vessel.

The Usefulness of Enhanced 3D-TOF MR Angiography in the Patients with Cerebral Infarction: Comparison with Conventional Angiography

PURPOSE: The aim of this study was to compare the usefulness of enhanced 3D-TOF MR angiography with that of the conventional kind in patients with cerebral ischemic symptoms and to determine the difference between radiologists who have interpreted MR angiograms for less than one year and for more than five years. MATERIALS AND METHODS: Seventy-three patients with clinical symptoms of cerebral ischemic infarction who had undergone conventional angiography MR imaging and MR angiography were involved in this study. On the basis of divisions of the internal carotid artery, three groups were designated: Group I, from the bifurcation of the common carotid artery to the bifurcation of the internal carotid; Group II, from the bifurcation of the internal carotid to the bifurcation of the anterior and middle cerebral artery; Group III, the anterior and middle cerebral artery segments distal to their branching. Two radiologists, one who had interpreted MR angiographic findings for less than one year, and the other for more than 5 years, retrospectively reviewed the findings and graded them according to the degree of vascular stenosis. k statistics were used to measure agreement between the two readers and to compare their techniques. Sensitivity and specificity were calculated only if there were abnormal vascular findings. RESULTS: A total of 438 arteries, 146 in each group, were available. In Group I, agreement between CA and MRA was high; k was 0.538 in reader A and 0.687 in reader B and there was close agreement between the readers(K=0.621). For reader A, sensitivity was 82.4% and specificity was 77.7%, while for reader B, the figures were 88.2% and 87.2%, respectively. In Group II, agreement between CA and MRA was high; k was 0.508 for reader A and 0.566 for reader B and again there was close agreement between the two readers(k=0.622). Reader A showed a sensitivity of 88.2% and a specificity of 73.7%, while for reader B, the corresponding figures were 68.2% and 81.8%. In Group III, agreement between CA and MRA was high; k was 0.508 in reader A and 0.566 in reader B and there was close agreement between (k=0.622). For reader A, sensitivity was 50.0% and specificity was 77.6%, while for reader B, the corresponding figures were 40% and 89.7%. Overall, in total of 438 ar-teries, there was good agreement between each reader (k=0.662). Reader A showed a sensitivity of 81.1% and a specificity of 76.4%, and for reader B, the figures were 83.2% and 86.4%, respectively. CONCLUSIONS: For the evaluation of intracranial vascular disease, e3D-TOF MRA is faster and less invasive than conventional angiography. Regardless of the reader's experience, it shows high sensitivity and there is close agreement between the readers involved. It is thus a useful method for the evaluation of steno-occlusive lesions in patients with cerebral infarction.

Superselective Embolization with Microcoil in Acute Gastrointestinal Hemorrhage

PURPOSE: To evaluate the efficacy and safety of superselective arterial embolization using the microcoil in acute gastrointestinal hemorrhage. MATERIALS AND METHODS: We evaluated 11 of 42 patients who had undergone diagnostic angiography and tran-scatheter arterial embolization due to acute gastrointestinal hemorrhage and subsequently underwent superselective arterial embolization using the microcoil. Nine were males and two were females, and their age ranged from 33 to 70 (mean, 51) years. The etiologies were bleeding ulcer (n=5), pseudoaneurysm from pancreatitis (n=3), and postoperative bleeding (n=3). The symptoms were melena, hematemesis, and hematochezia, and the critical signs were decreased hemoglobin and worsening of vital signs. All patients underwent superselective embolization using the microcatheter and microcoil. RESULTS: Bleeding occurred in the gastroduodenal artery (n=5), inferior pancreaticoduodenal artery (n=2), left gastric artery (n=2), right hepatic artery (n=1), and ileal branch of the superior mesenteric artery (n=1). All cases were treated succesfully, without complications. In one case in which there was bleeding in the right he-patic artery, reembolization with a microcoil was needed because of persistent melena. During follow up, three patients died from complications arising underlying diseases, namely disseminated intravascular coagulopathy, chronic renal failure, and adult respiratory distress syndrome. Procedural complications, such as ischemia or infarction were not noted. CONCLUSION: Superselective arterial embolization using the microcoil is a safe and effective method for the treatment of acute gastrointestinal bleeding, and does not lead to complications.

MR Imaging Finding of Xanthogranulomatous Cholecystitis: A Case Report

We describe a case of xanthogranulomatous cholecystitis in which there was close correlation between MR andhistopathological finding and review the previous literature. On both T1-and T2-weighted MR images, multiplegallstones and diffuse wall thickening of the gallbladder were seen, with multiple hyperintense intra-muralnodules. The nodules were pathologically confirmed as anthogranuloma.