Upper extremity digital subtraction venography with gadoterate meglumine before fistula creation for hemodialysis.

BACKGROUND: The purpose of this study was to evaluate the feasibility, safety, and potential role of gadoterate meglumine (Gd-DOTA) as a contrast agent for upper extremity venography before the creation of an arteriovenous fistula (AVF) for nondialyzed renal insufficiency patients. METHODS: Over a 16-month period, 50 venographies were performed on end-stage renal insufficiency patients, using Gd-DOTA as a contrast agent on a high-resolution digital subtraction angiography system. Three sequences were performed on forearm, arm, and chest at 3 mL/sec for a total of 35 mL of Gd-DOTA. Examinations were reviewed by two radiologists for diagnostic and opacification quality. Tolerance was evaluated on the evolution of serum creatinine levels and occurrence of pain during injection. RESULTS: Good interobserver correlation was obtained in evaluating the feasibility of AVF creation by vein segment (0.64 < kappa < 0.88) and in relationship to opacification quality (0.62 to 0.87). No deterioration in renal function (creatinine level before and after) or pain was observed. Twenty-six patients underwent surgical creation of brachiobasilic (N = 8), brachiocephalic (N = 8), radiocephalic (N = 8), and cubitocephalic (N = 1) fistulas or insertion of a polytetrafluoroethylene (PTFE) graft (N = 1). Seventeen were awaiting AVF or were on peritoneal dialysis. Two died before surgery for reasons unconnected with the venography. CONCLUSIONS: Venography with Gd-DOTA is an effective and safe technique in planning AVFs for renal insufficiency patients.

Assessment of Fallopian tube patency by HyCoSy: comparison of a positive contrast agent with saline solution.

OBJECTIVE: To compare the efficiency of air-filled albumin microspheres (Infoson) with saline solution in determining Fallopian tube patency during hysterosalpingo contrast sonography (HyCoSy). METHODS: This was a prospective randomized multicenter study with a sequential design. Over a 10-month period, 23 patients (mean age, 33 years) referred for infertility were examined by HyCoSy (saline or Infoson) before conventional hysterosalpingography (Iopamiron 370), performed during the same session. Contrast agents were administered through a 5-F Ackrad balloon catheter inserted transcervically into the uterine cavity. HyCoSy was performed with a 7-MHz transvaginal probe using both B-mode and color Doppler, and tubal patency was demonstrated by the appearance of contrast agent in the peritoneal cavity near the ovaries. Data were registered for each patient during the examination and the results were monitored by sequential analysis. RESULTS: Mean volumes of contrast injections were 35.3 mL of saline, 14.4 mL of Infoson, and 13.8 mL of Iopamiron 370. Infoson-enhanced HyCoSy provided a significantly larger (P = 0.006) number of correct diagnoses (20/22 Fallopian tubes) than did saline HyCoSy (12/24 Fallopian tubes), and the same number as that achieved by hysterosalpingography. CONCLUSION: A positive ultrasound contrast agent appears to be more efficient than saline solution at determining Fallopian tube patency in infertile women by means of HyCoSy, and as efficient as an iodinated contrast agent in the same population explored by HSG. HyCoSy could be used to screen infertile women, thereby avoiding the use of iodinated contrast medium and exposure to ionizing radiation during conventional HSG in patients with patent Fallopian tubes.

Subungual glomus tumor: combined use of MRI and three-dimensional contrast MR angiography.

We describe a case of digital glomus tumor diagnosed by MRI and three-dimensional contrast MR angiography (MRA). Images provided the formal definitive diagnosis and the precise localization of the tumor, guiding the necessary surgical resection. It is possible that noninvasive MRA could replace conventional arteriography for the evaluation of patients with clinical suspicion of glomus tumor.

Abdominal aortic aneurysms in sheep: prevention of rupture with endoluminal stent-grafts.

PURPOSE: The authors evaluated the ability of an aortic balloon-expandable endovascular stent-graft to prevent rupture in a model of spontaneously rupturing abdominal aortic aneurysms in sheep. MATERIALS AND METHODS: Aneurysms were created in 16 sheep by inserting a 60 x 18-mm segment of the left internal jugular vein, end-to-end anastomosed, to the sectioned infrarenal abdominal aorta. The sheep were randomly assigned into two groups; eight animals underwent endovascular implantation of an 80 x 12-mm balloon expandable stent-graft (group A), and eight were only followed up (group B). RESULTS: In group B, seven of eight animals had died of aneurysmal rupture by 3 months. In group A, six of the eight aortic aneurysms were immediately excluded, and six animals were alive at 3 months without rupture. The 3-month survival rate was 100% in group A and 12% in group B (P = .0023). Macro- and microscopic analysis of the section of the aorta in which the stent-graft had been placed revealed rapid retraction of the aneurysmal sac. CONCLUSION: Placement of an endovascular stent-graft induced regression of a branchless aneurysm and prevented rupture.

Anastomoses between the spermatic and visceral veins: a retrospective study of 500 consecutive patients.

BACKGROUND: Do visceral-spermatic vein shunts have any clinical impact on sclerotherapy of varicoceles? METHODS: The spermatic venograms of 500 consecutive patients were retrospectively reviewed to classify visceral-spermatic communications. Men with an average age of 27.8 years (range 11-65 years old) underwent sclerotherapy of a varicocele. Of the 500 men, 445 were referred for oligoasthenospermia (89%), 45 for pain (9%), and 10 for prevention of infertility (2%). After bilateral catheterization, percutaneous sclerosis was performed below the upper third of the sacroiliac joint. RESULTS: Three hundred forty patients (68%) had left-sided, 10 (2%) had right-sided, and 150 (30%) had bilateral varicoceles. Left side: Of 46 (9.4%) anastomoses, one (0.2%) communicated with the splenic vein and 45 (9.2%) with the inferior mesenteric vein of which 25 (5.1%) were a colic trunk with a competent valve, 15 (3.1%) were venules, and five (1%) were a single or double anastomosis. Right side: Of 48 (29.6%) anastomoses to the superior mesenteric vein, 34 (21%) were venules, 12 (7.4%) were a colic trunk with a competent valve, and two (1.2%) were a single or double vein. Our varicocele recurrence rate was only 1.2%. CONCLUSION: Visceral-spermatic vein communications are classified by number, morphology, and site. Percutaneous sclerotherapy could be optimized when performed caudally to these communications.

Oral magnetic particles (ferristene) as a contrast medium in abdominal magnetic resonance imaging.

RATIONALE AND OBJECTIVES: In this phase III study, we evaluated the efficacy and safety of a negative contrast medium, ferristene (oral magnetic particles), among 277 patients undergoing magnetic resonance (MR) imaging of the abdomen. METHODS: Enhanced (800 ml ferristene) MR images were compared with unenhanced MR images in an intraindividual-patient control design. Adverse events were recorded. The examinations were performed on 1.5-T MR systems (T1- and T2-weighted sequences). RESULTS: Ferristene increased the diagnostic information in 50.9% of the patients, particularly in those with abdominal masses, lymphoma, or pancreatic disease. Distribution of ferristene in the stomach, duodenum, jejunum, and ileum was complete or sufficient in 70.5-85% of the studies. In 64% of the patients, we were confident in the MR findings after the use of ferristene, and ferristene disclosed additional findings in 22% of the patients. The incidence of adverse events was 9.0%, but only 3.6% of all patients experienced ferristene-related adverse events (e.g., nausea, vomiting). Most events were mild or moderate in intensity. CONCLUSION: Ferristene was well tolerated, and for 50% of the patients it added useful diagnostic information.

US and CT imaging features of intrapancreatic metastases.

OBJECTIVE: Twenty-four patients with intrapancreatic metastases were retrospectively studied to identify diagnostic criteria on cross-sectional imaging. MATERIALS AND METHODS: Ultrasound and CT of the pancreas were reexamined by two radiologists who specified morphologic patterns. RESULTS: Metastases of the pancreas were found more often solitary (14 cases) than multiple (10 cases) and as homogeneous nodules hypoechoic on US (15 cases), hypodense on CT (11 cases), sometimes hypervascular (6 cases) or pseudocystic (4 cases). Dynamic contrast-enhanced CT demonstrated small lesions 10 mm in diameter (three cases), not seen on US, and was highly suggestive when it showed several nodules in the gland. We identified some other criteria of intrapancreatic metastatic disease: two or more locations in the pancreas, nonobliteration of the retropancreatic fat regardless of the size of the lesion, nondilated biliary tree in the case of a large tumor of the pancreatic head, and a hypervascular mass without endocrine syndrome. Percutaneous puncture assessed the diagnosis (10 cases) and differentiated metastases from a primary ductal adenocarcinoma of the pancreas. CONCLUSION: Detection and identification of suggestive features of pancreatic metastases may be obtained by examination of the pancreas with dynamic CT.

Contribution of oral magnetic particles in MR imaging of the abdomen with spin-echo and gradient-echo sequences.

An open phase III clinical trial of the oral contrast agent OMP (oral magnetic particles) was performed in 35 patients undergoing abdominal magnetic resonance (MR) imaging at 1.5 T with axial spin-echo and gradient-echo sequences. The diagnostic efficacy of OMP was examined by comparing pre-and postcontrast images. Bowel loops and abdominal organs were more easily recognizable after OMP ingestion, and the general quality of the images was improved because of fewer bowel-related artifacts. The diagnostic value of the postcontrast abdominal MR examination was superior or equal to that of the precontrast study, and additional information was obtained in 44% of the cases. Postcontrast gradient-echo sequences increased confidence in the MR examination in 18% of cases. OMP was well tolerated and increased the quality and amount of diagnostic information acquired during the examination. Gradient-echo imaging was found to be a useful complement, but the need for a reduction in susceptibility artifacts was apparent and indicates that a decrease in TE or the use of rapid spin-echo sequences might be advantageous.