Adipopenia in body composition analysis: a promising imaging biomarker and potential predictive factor for patients undergoing transjugular intrahepatic portosystemic shunt placement.

OBJECTIVE: Body tissue composition plays a crucial role in the multisystemic processes of advanced liver disease and has been shown to be influenced by transjugular intrahepatic portosystemic shunt (TIPS). A differentiated analysis of the various tissue compartments has not been performed until now. The purpose of this study was to evaluate the value of imaging biomarkers derived from automated body composition analysis (BCA) to predict clinical and functional outcome. METHODS: A retrospective analysis of 56 patients undergoing TIPS procedure between 2013 and 2021 was performed. BCA on the base of pre-interventional CT examination was used to determine quantitative data as well as ratios of bone, muscle and fat masses. Furthermore, a BCA-derived sarcopenia marker was investigated. Regarding potential correlations between BCA imaging biomarkers and the occurrence of hepatic encephalopathy (HE) as well as 1-year survival, an exploratory analysis was conducted. RESULTS: No BCA imaging biomarker was associated with the occurrence of HE after TIPS placement. However, there were significant differences in alive and deceased patients regarding the BCA-derived sarcopenia marker (alive: 1.60, deceased: 1.83, p = 0.046), ratios of intra- and intermuscular fat/skeletal volume (alive: 0.53, deceased: 0.31, p = 0.015) and intra- and intermuscular fat/muscle volume (alive: 0.21, deceased: 0.14, p = 0.031). CONCLUSION: A lower amount of intra- and intermuscular adipose tissue might have protective effects regarding liver derived complications and survival. ADVANCES IN KNOWLEDGE: Precise characterization of body tissue components with automated BCA might provide prognostic information in patients with advanced liver disease undergoing TIPS procedure.

Management of carotid cavernous fistulas: A single center experience.

Purpose: Multimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes. Materials and methods: From 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences. Results: Etiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality. Conclusion: Endovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.