Percutaneous microwave ablation for control of massive portal venous bleeding.

We present a case of a 46 years old female with decompensated liver cirrhosis who developed severe intraperitoneal hemorrhage secondary to inadvertent liver puncture during a paracentesis which resulted in a combined hepatic arterial and portal venous injury. The arterial injury was managed with transarterial embolization. The portal venous injury was managed with percutaneous microwave ablation. This article also highlights the importance of evaluating both arterial injury as well as portal venous injury in the setting of hepatic bleeding, particularly in patients with portal hypertension.

Time-resolved lower extremity MRA with temporal interpolation and stochastic spiral trajectories: preliminary clinical experience.

PURPOSE: To assess added value of a new time-resolved technique with temporal interpolation and stochastic spiral trajectory through k-space and parallel imaging (TR-MRA) to conventional bolus chase MRA (BC-MRA) for infragenual peripheral artery evaluation. MATERIALS AND METHODS: An institutional review board-approved retrospective review of peripheral arterial disease patients was performed. Infragenual TR-MRA and BC-MRA were performed in 26 patients over four months. Two readers individually assessed image quality, diagnostic confidence, and stenosis severity and length in 13 defined below knee segments, first with BC-MRA alone, and then with a combined BC-MRA and TR-MRA reading (BC+TR-MRA). Perceived contribution of TR-MRA was rated by each reader. The reference standard was a consensus reading of both sequences. Catheter angiographic (CA) correlation was available in 6 patients. RESULTS: A total of 646 infragenual segments in 51 extremities were evaluated. Image quality and diagnostic confidence were superior for BC+TR-MRA compared with BC-MRA alone (P < 0.001). Adding TR-MRA improved sensitivity (85.7% versus 80.7%; P < 0.05) and diagnostic accuracy (88.1% versus 85.4%; P < 0.05) for hemodynamically significant stenosis. Venous contamination (0% versus 13.1% segments) and motion (0.9% versus 8.0%) were decreased for BC+TR-MRA versus BC-MRA alone, P < 0.01. For BC+TR-MRA, TR-MRA was rated more useful than BC-MRA in 30/51 legs (58.8%). TR-MRA identified retrograde flow in 5 segments. Where available, there was high concordance between CA and BC+TR-MRA (91.6%) for stenosis. CONCLUSION: Adding TR-MRA with temporal interpolation and stochastic spiral trajectories to bolus chase MRA improves image quality, diagnostic confidence and accuracy. It provides hemodynamic information and minimizes venous contamination and patient motion.