Uterine Artery Embolization in Patients With Autoimmune Disease: A Matched Case-Control Study.

OBJECTIVE. The purpose of this study is to investigate the safety of uterine artery embolization (UAE) for symptomatic leiomyomas in patients with autoimmune disease. MATERIALS AND METHODS. Of 1183 patients who underwent UAE for symptomatic leiomyomas, nine patients (mean age, 42.6 years; range, 34-49 years) with autoimmune disease were included in this study. An age- and disease-matched control group (n = 8) was randomly generated from our patient registry to compare the effectiveness and safety of UAE in patients with autoimmune disease. Volume reduction rates of the uterus and dominant leiomyoma and the change in C-reactive protein (CRP) levels before and after UAE were compared. RESULTS. Except for one patient who had Takayasu arteritis and indiscernible uterine arteries on angiogram, UAE was technically successful in both groups. All of the patients who underwent technically successful UAE experienced improvement or resolution of symptoms (16/16; 100%). Complete necrosis of dominant fibroids was achieved in all patients (16/16; 100%). Although there was no significant difference in the mean initial CRP level before UAE (0.4 ± 0.14 mg/L vs 1.06 ± 1.26 mg/L; p = 0.067), it was significantly higher in the autoimmune group 1 day after UAE (1.23 ± 0.6 mg/L vs 9.54 ± 6.63 mg/L; p = 0.001). There was no significant difference in the volume reduction rates of uterus and dominant leiomyoma. In the autoimmune group, there was one major adverse event that was not related to underlying disease. CONCLUSION. In patients with autoimmune disease, UAE could be considered for symptomatic leiomyomas, as long as the underlying disease is well controlled.

Cryoablation of Hepatocellular Carcinoma with High-Risk for Percutaneous Ablation: Safety and Efficacy.

PURPOSE: The aim of this study was to evaluate the safety and effectiveness of cryoablation in the treatment of subcapsular hepatocellular carcinoma (HCC) adjacent to various organs. MATERIALS AND METHODS: Twenty-eight patients with subcapsular HCC were treated with cryoablation in our institution. The degree of peri-procedural pain was measured using the visual analog scale (VAS). Technical success, local tumor progression, and overall disease progression rates were calculated. Procedure-related complications were identified by reviewing electronic medical records. Biochemical data, including serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin levels before and after the procedure were collected. RESULTS: Subcapsular HCC tumors were located near the gallbladder, colon, stomach, kidney, diaphragm, or abdominal wall. The technical success rate of cryoablation was 96.4 % (27/28). Local recurrence- and progression-free survival rates were 96 and 84 % at 6 months, and 82 and 43 % at 1 year, respectively. All patients survived during the follow-up period. The VAS pain score ranged from 0 to 3 (mean, 1.57). A major complication occurred in one patient (3.6 %) and minor complications occurred at a rate of 17.9 %. Transient elevations of serum AST, ALT, and bilirubin levels were observed. CONCLUSION: Cryoablation is a safe and an effective procedure for the treatment of subcapsular HCC adjacent to various major organs.

Transarterial Chemoembolization Using Sorafenib in a Rabbit VX2 Liver Tumor Model: Pharmacokinetics and Antitumor Effect.

PURPOSE: To investigate feasibility, safety, and effect of transarterial chemoembolization using sorafenib on degree of tumor necrosis in a rabbit VX2 liver tumor model. MATERIALS AND METHODS: New Zealand White rabbits (n = 20) with a VX2 tumor were divided into two groups; one group was treated with hepatic arterial administration of 0.5 mL ethiodized oil alone (Lipiodol; Guerbet, Aulnay-sous-Bois, France) (transarterial embolization with Lipiodol [TAE-L] group), and one group was treated with 0.5 mL ethiodized oil plus 10 mg sorafenib (transarterial embolization with sorafenib [TAE-S] group). Liquid chromatography tandem mass spectrometry was used to measure sorafenib concentration in peripheral blood and tissue. Hepatic enzymes, vascular endothelial growth factor (VEGF), and hypoxia-inducible factor 1α (HIF-1α) were measured at 0, 24, and 72 hours after treatment. Histopathologic examination was performed to evaluate extent of tumor necrosis and normal parenchymal damage. RESULTS: Serum sorafenib concentration peaked at 2 hours after treatment. The mean tissue concentration was 406.8 times greater than the serum concentration. Aspartate aminotransferase and alanine aminotransferase levels were significantly elevated in the TAE-S group at 24 hours after treatment. Serum VEGF and HIF-1α concentrations were not significantly different between the TAE-L and TAE-S groups. Hepatic parenchymal damage was more severe in the TAE-S group. Mean fraction of tumor necrosis after treatment was significantly greater in the TAE-S group. CONCLUSIONS: Transarterial chemoembolization using sorafenib resulted in a high intrahepatic concentration of sorafenib. The degree of tumor necrosis was significantly greater in the TAE-S group compared with the TAE-L group, but more severe toxicity of normal liver tissue also occurred.

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage.

OBJECTIVE: To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. MATERIALS AND METHODS: From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. RESULTS: Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. CONCLUSION: PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension.

Dual-energy CT perfusion during pharmacologic stress for the assessment of myocardial perfusion defects using a second-generation dual-source CT: a comparison with cardiac magnetic resonance imaging.

OBJECTIVES: This study aimed to assess the diagnostic performance of adenosine-stress dual-energy myocardial computed tomography perfusion (DECTP) imaging using 128-slice dual-source computed tomography (CT) for the detection of myocardial perfusion defects in comparison with stress-perfusion magnetic resonance imaging (MRI). METHODS: This prospective study included 50 patients (mean age, 66 [9] years; 64% men) with suspected coronary artery disease who underwent adenosine-stress DECTP using 128-slice dual-source CT as well as adenosine-stress cardiac MRI using a 1.5-T scanner. Estimates of diagnostic accuracy in detecting myocardial perfusion defects were calculatedand compared with those of cardiac MRI. RESULTS: The estimates of diagnostic accuracy in detecting myocardial perfusion defects using DECTP were as follows: sensitivity, 77% (95% confidence interval [CI], 67%-87%); specificity, 94% (95% CI, 92%-95%); positive predictive value, 53% (95% CI, 44%-63%); and negative predictive value, 98% (95% CI, 97%-99%). The results of DECTP imaging were positively correlated with those of cardiac MRI (r = 0.602, P < 0.001). Mean effective radiation doses for stress DECTP imaging and rest coronary CTA were 6.5 (2.2) and 4.9 (1.7) mSv, respectively. CONCLUSIONS: Adenosine-stress DECTP imaging enables detection of myocardial ischemia. However, further technical developments are necessary to reduce artifacts and improve the sensitivity of DECTP.

Detection of cardiac myxomas with non-contrast chest CT.

BACKGROUND: Cardiac myxomas are sources of systemic embolism. Currently a large volume of chest CT and calcium-scoring CT scans are performed without contrast injection. PURPOSE: To evaluate the diagnostic capability of non-contrast CT covering heart in detecting cardiac myxomas. MATERIAL AND METHODS: This retrospective study included 36 non-contrast CT scans of 36 consecutive patients (16 men, 20 women) who underwent CT scan before surgery for left atrial myxomas and 20 patients without myxoma as a control group. Two independent readers who were blinded to medical information reviewed non-contrast CT scans of 36 patients with cardiac myxomas and 20 scans in the control group patients. They determined the presence of lesions suspicious of myxomas using a five-point scale. The other reader measured attenuation number in the non-calcific areas of the tumors and sizes of the masses on the non-contrast CT images. RESULTS: The average attenuation of cardiac myxoma (22.5 Hounsfield units [HU]; range, 8.9-32.9 HU) and adjacent unopacified blood (44.6 HU; range, 31.5-57 HU) were significantly different (P < 0.001). Twelve cardiac myxomas (31.6%) had internal calcification and all of them were detected by both of readers. Cardiac myxomas were measured smaller on non-contrast CT (mean, 3.5 cm; range, 1.1-9.7 cm) than on pathologic specimens (mean, 4.1 cm, 1.4-10.0 cm) (P < 0.001). Considering grade 3-5 on a five-grade scale as the detectability, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of non-contrast CT in detecting cardiac myxomas were 88.8%/86.1%, 95.0%/100%, 96.9%/100%, 82.6%/80.0%, and 91.1%/91.1%, by reader 1 and reader 2, respectively and there was good inter-observer reliability (kappa value = 0.92, P = 0.157). CONCLUSION: Non-contrast CT scan is useful for detecting cardiac myxomas. Therefore, radiologists should be familiar with imaging findings of cardiac myxomas on non-contrast CT.