Comparison between Onyx and coil embolization for persistent type 2 endoleaks after endovascular aneurysm repair.

Purpose: Type 2 endoleaks (T2EL) are the most common form of endoleaks after endovascular aneurysm repair (EVAR). Several studies on the feasibility of embolization using ethylene vinyl alcohol copolymer (Onyx, Medtronic) for T2EL have been reported. The purpose of this study was to compare coil and Onyx embolization for T2EL treatment after EVAR. Methods: Between August 2005 and July 2022, 46 patients underwent endovascular embolization for treatment of T2EL (15 Onyx and 31 coils). The primary endpoint was endoleaks resolution or significant aneurysm sac growth of >5 mm in maximal diameter after T2EL embolization. In addition, periprocedural factors, reintervention, sac rupture, and survival analysis were assessed. Results: The follow-up period after embolization was significantly shorter in the Onyx group (11.6 months vs. 34.7 months, P = 0.016), and there was no difference in aneurysm sac growth rate between both groups (20.0% vs. 51.6%; P = 0.472, log-rank test). However, cases with multiple endoleak origins tended to be treated with Onyx (P = 0.002). When applying Onyx, there was no significant difference in results between the transarterial and translumbar approaches. Conclusion: There appears to be no significant difference in the results of Onyx and coil embolization for T2EL treatment, although it is difficult to evaluate effectiveness due to the small number of cases and short follow-up period. However, in cases of multiple origin endoleaks or when the transarterial approach is not feasible, the Onyx by translumbar approach may be a more effective method.

CT evaluation of systemic artery to pulmonary artery fistula: an underdiagnosed disease in patients with hemoptysis.

Background: Systemic artery to pulmonary artery fistula (SA-PAF) is an uncommon disease which is often incidentally diagnosed during evaluation of hemoptysis patients. The aim of our study was to describe the cases of SA-PAF in our institution and to report the correlating clinical and radiological findings. Methods: We reviewed 231 chest computed tomography (CT) scans performed in our institution due to hemoptysis from January 2020 to February 2023. In patients diagnosed with SA-PAF had their electronic medical records and CT images analyzed. Results: In 231 patients, 19 (8.2%) of them had SA-PAF findings which was characterized by a peripheral nodular soft tissue opacity in the subpleural lung and traceable vascular structure in continuity with one or more peripheral pulmonary artery branches in CT. Etiology of each patient was categorized as either congenital (7, 36.8%), and acquired (12, 63.2%). The origins of SA-PAFs were 16 intercostal, two anterior mediastinal, and one costocervical artery. Eight of 19 patients did not show any associated intralobar imaging abnormalities, while bronchiectasis, cellular bronchiolitis, centrilobular emphysema, and pleura effusion were observed in 11 patients. Conclusions: SA-PAF is a benign vascular anomaly which is frequently overlooked when evaluating hemoptysis by either clinician or radiologists but is an important factor in the differential diagnosis of patients with hemoptysis.

Arteriovenous Malformation Associated with Intravenous Leiomyomatosis of the Uterus: Characteristic CT Findings and Treatment by Embolization and Surgery.

Seven consecutive female patients with pathologically confirmed arteriovenous malformation (AVM) with intravenous leiomyomatosis (IVL) of the uterus (age range, 32-61 years; mean age, 43 years) treated between 2005 and 2021 from a single institution were reviewed. Computed tomography (CT) findings of congenital pelvic AVM of 10 female patients were compared with those of AVM with IVL. Characteristic CT findings of AVM with IVL revealed a focal soft tissue mass inside a dilated venous structure of the AVM. Multiple sessions of transvenous coil embolization of the AVM with or without the injection of ethanol were performed. After complete (6/7, 86%) or partial (1/7, 14%) embolization of the AVM, complete surgical resection of the IVL and embolized AVM mass was performed in 4 patients. Patients with lung metastasis or residual embolized AVM masses are under follow-up with antiestrogen hormonal therapy.

Repeated Pseudoaneurysm after Endovascular Repair of Popliteal Aneurysm due to Graft Disintegration and Fabric Tear.

Endovascular repair of popliteal artery aneurysms (PAA) using a stent graft is suitable for patients with favorable anatomy. In the domestic situation where Gore Medical withdrew, we report two cases of unusual complications of pseudoaneurysm after endovascular repair of PAA. A 44-year-old male with a history of bypass surgery for a PAA presented with recurrent vein graft pseudoaneurysm. Endovascular treatment using a domestic stent graft was performed. However, pseudoaneurysm developed due to the graft fabric tear 1 month later, requiring surgical removal. In another case, an 84-year-old female presented with acute limb ischemia related to PAA. Endovascular aneurysm repair with the same domestic stent graft was performed. However, stent graft failure occurred 2 years later and the patient underwent open surgical repair. There was a graft fabric disintegration. When proper endovascular device is not available, open surgical treatment is the best option for treating PAA.

Modified Surgical Drain-Guided Percutaneous Catheter Drainage of Postoperative Fluid Collection in Inaccessible Locations.

PURPOSE: To investigate the feasibility and safety of a modified surgical drain-guided percutaneous catheter drainage technique for postoperative fluid collection in inaccessible locations. MATERIALS AND METHODS: The modified technique was used in 24 patients (age, 58.6 years ± 11.3; men, 58.3%) from September 2015 to March 2021. All fluid collections had no safe access route on preprocedural computed tomography (CT) images. Every patient had a long (>20 cm) and tortuous surgical drain, which prevented the use of conventional surgical drain exchange. A favorable midpoint of the surgical drain tract was punctured under either ultrasound or fluoroscopic guidance, and a guide wire was advanced into the fluid collection. Technical success was defined as the successful placement of a drainage catheter, and clinical success was defined as the complete evacuation of fluid collection without recurrence. Follow-up was performed using CT images and a chart review. Adverse events within 30 days of the procedure were evaluated. RESULTS: Target fluid collections in the pelvic cavity (n = 9); subphrenic (n = 7), peripancreatic (n = 4), and subhepatic spaces (n = 3); and abdominal cavity (n = 1) were drained using catheters measuring 7-10.2 F in diameter and 25-30 cm in length. The technical success rate was 91.7% (22/24), and the clinical success rate was 90.9% (20/22). No procedure-related or catheter-related adverse events were observed. The median follow-up period was 8.2 months (range, 10-1,721 days). CONCLUSIONS: The modified surgical drain-guided percutaneous catheter drainage technique is a useful alternative when conventional exchange techniques cannot be used because of long and tortuous surgical drain paths.

Combined transarterial chemoembolization and radiofrequency ablation for subphrenic versus nonsubphrenic hepatocellular carcinoma: a propensity score matched study.

PURPOSE: To compare therapeutic outcomes of combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) treatment for small hepatocellular carcinoma (HCC) in subphrenic versus nonsubphrenic locations by propensity score matching. METHODS: This retrospective study included 293 patients with single HCC (≤ 3 cm) ineligible for ultrasound-guided RFA who received iodized oil TACE and subsequent RFA between June 2010 and January 2017. The patients were divided into two groups according to the tumor location: subphrenic (n = 99) and nonsubphrenic (n = 194). Subphrenic HCC was defined as a tumor abutting the diaphragm. Local tumor progression (LTP) and overall survival (OS) rates were compared by propensity score matching. Procedure-related complications were also assessed. RESULTS: Matching yielded 93 matched pairs of patients. In the matched cohorts, cumulative 1-, 3-, and 5-year LTP rates were 5.4%, 12.1%, and 12.1% in the subphrenic group and 1.1%, 7.5%, and 8.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.278). Corresponding OS rates were 100%, 80.2%, and 71.3% in the subphrenic group and 97.9%, 88.1%, and 75.6% in the nonsubphrenic group, respectively, with no significant differences (p = 0.308). The subphrenic location was not a significant risk factor for LTP and OS in multivariate analysis. There were no significant differences in complication rates between the two groups (p > 0.05). CONCLUSION: The therapeutic outcomes of combined TACE and RFA for small subphrenic HCC were similar to those for nonsubphrenic HCC. The combination therapy seems to be an effective and safe method in treating small subphrenic HCC.

Indistinguishable T2/T3-N0 rectal cancer on rectal magnetic resonance imaging: comparison of surgery-first and neoadjuvant chemoradiation therapy-first strategies.

PURPOSE: We compared the treatment outcome between surgery-first and neoadjuvant chemoradiation therapy (nCRT)-first strategies in patients with indistinguishable T2/T3-N0 rectal cancer on rectal magnetic resonance imaging (MRI). METHODS: Our institutional review board approved this retrospective study, and informed consent was waived. Among 1910 patients who underwent rectal MRI between 2008 and 2012, 79 patients (mean age, 59.4 years, 49 men and 30 women) who had indistinguishable T2/T3-N0 rectal cancer on rectal MRI were included. Local recurrence-free survival (LRFS), recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS) were compared between the two groups. Treatment-related complications were evaluated. RESULTS: Among 79 patients, 51 were treated by surgery first and 28 were treated by nCRT first. In comparison of survival of the surgery- and nCRT-first groups at 5 years, the LRFS rate was 95.6 and 96.3%, RFS rate was 91.0 and 92.4%, OS rate was 93.7 and 92.6%, and DSS rate was 98.0 and 92.6%, respectively. LRFS, RFS, OS, and DSS showed no significant difference between the two groups (p = 0.862, 0.677, 0.953, and 0.479). The complication rate was not significantly different between the groups (20.0% for surgery-first group vs. 10.7% for nCRT-first group, p = 0.357). CONCLUSION: Treatment outcomes were not significantly different between surgery-first and nCRT-first strategies for indistinguishable T2/T3-N0 rectal cancer on rectal MRI.

Prebiopsy Multiparametric MRI With Cancer-Negative Findings in Men With Suspected Prostate Cancer: Evaluation Using Prostate Imaging Reporting and Data System Version 2.

OBJECTIVE: The purpose of this study is to investigate the rates and characteristics of missed cancers at prebiopsy multiparametric MRI with cancer-negative findings according to the Prostate Imaging Reporting and Data System (PI-RADS) version 2 in men with suspected prostate cancer (PCa). MATERIALS AND METHODS: A total of 584 consecutive men (biopsy naive, n = 392; repeated biopsy, n = 192) with suspected PCa who underwent prebiopsy 3-T multipara-metric MRI, followed by subsequent biopsies, were enrolled. Cancer-positive findings were confirmed at systemic biopsies and cognitive MRI-targeted biopsies, whereas cancer-negative findings were confirmed at systemic biopsies performed during subsequent follow-up. Missing and detection rates of all PCa and clinically significant cancer according to five biopsy-based definitions were determined. The likelihood of PCa at multiparametric MRI was evaluated according to PI-RADS version 2, and the results were compared. RESULTS: Pathologically confirmed cancers were found in 25% of patients. Cancer-positive MRI findings were seen in 99 men (17%) and, of these, 85.9% had PCa. Of 485 men with cancer-negative MRI findings, a total of 61 (12.6%) had PCa, including 46 men in the biopsy-naive group and 15 men in the repeated-biopsy group. For clinically significant cancers, the rate of missed cancers at MRI was 0.1-6.0%, and the detection rate was 21.2-83.5%. For detecting PCa, multiparametric MRI had 96.8% specificity, 87.2% accuracy, and 87.4% negative predictive value. CONCLUSION: Prebiopsy 3-T multiparametric MRI with cancer-negative findings missed approximately 12.6% of cases of PCa, including 0.1-6.0% of clinically significant cancers in a cohort of biopsy-naive men and those who had undergone repeated biopsy.

Diagnostic performance of MRI for prediction of candidates for local excision of rectal cancer (ypT0-1N0) after neoadjuvant chemoradiation therapy.

PURPOSE: To evaluate the diagnostic performance of rectal MRI in predicting candidates for local excision (LE; ypT0-1N0) after neoadjuvant chemoradiation therapy (CRT) in patients with rectal cancer. MATERIALS AND METHODS: The institutional review board approved our retrospective study and waived informed consent. Inclusion criteria were as follows: patients with pathologically confirmed mid to lower rectal cancer (cT3NxM0 before neoadjuvant CRT) who underwent neoadjuvant CRT and had MRI performed at 3T before and after neoadjuvant CRT. A total of 168 patients met the study criteria between 2011 and 2012. Two observers independently assessed tumor and nodal stages on MR images obtained after neoadjuvant CRT. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for identifying a candidate for LE (ypT0-1N0) were calculated. Interobserver agreement was assessed with kappa value. Predictive factors for ypT0-1N0 were evaluated by logistic regression models. RESULTS: MRI had relatively high accuracy, specificity, and NPV (85.9%, 93.8%, and 88.9% for observer 1 and 85.3%, 96.1%, and 86.6% for observer 2), moderate PPV (71.4% and 76.2%), and relatively low sensitivity (57.1% and 45.7%) for predicting ypT0-1N0. The interobserver agreement was fair (kappa value = 0.593). Carcinoembryonic antigen levels after neoadjuvant CRT and the maximal extramural depth of tumor spread were significant predictors of ypT0-1N0 (P = 0.037 and 0.017, respectively). CONCLUSION: MRI after neoadjuvant CRT can predict a candidate for LE (ypT0-1N0) after neoadjuvant CRT with moderate PPV and relatively high NPV. J. Magn. Reson. Imaging 2016;44:471-477.