MicroRNAs Related to TACE Treatment Response: A Review of the Literature from a Radiological Point of View.

Hepatocellular Carcinoma (HCC) is the sixth most common cancer in the world. Patients with intermediate stage (Barcelona Clinic Liver Cancer, B stage) hepatocellular carcinoma (HCC) have been able to benefit from TACE (transarterial chemoembolization) as a treatment option. MicroRNAs (miRNAs), i.e., a subclass of non-coding RNAs (ncRNAs), participate in post-transcriptional gene regulation processes and miRNA dysfunction has been associated with apoptosis resistance, cellular proliferation, tumor genesis, and progression. Only a few studies have investigated the role of miRNAs as biomarkers predicting TACE treatment response in HCC. Here, we review the studies' characteristics from a radiological point of view, also correlating data with radiological images chosen from the cases of our institution.

Endovascular Interventional Radiology of the Urogenital Tract.

Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial embolizations. At the kidney level, arterial embolizations are performed mainly for palliative treatment of parenchymal tumors, for renal traumas and, less frequently, for arteriovenous fistulas and renal aneurysms and pseudoaneurysms. These latter may often require emergency intervention as they can cause renal or peri-renal hematomas or significant hematuria. Transcatheter arterial embolization is also an effective therapy for intractable severe bladder hematuria secondary to a number of neoplastic and inflammatory conditions in the pelvis, including unresectable bladder cancer and radiation-induced or cyclophosphamide-induced hemorrhagic cystitis. Endovascular interventional procedures for the penis are indicated for the treatment of post-traumatic priapism. In this article, we review the main endovascular radiological interventions of the male urogenital system, describing the technical aspects, results, and complications of each procedure at the various anatomical districts.

Detection of intracranial aneurysms with 64 channel multidetector row computed tomography: comparison with digital subtraction angiography.

PURPOSE: To compare the contribution of 64 channel multidetector row computed tomography angiography (64MDCT-angiography) with digital subtraction angiography (DSA) in the detection of intracranial aneurysms. METHODS AND MATERIALS: Twenty-nine patients (10 males and 19 females, age: 40-84 years; average: 61.9 years) with clinical and imaging findings strongly suggesting the presence of subaracnoid hemorrhage underwent 64MDCT-angiography and DSA with a short interval between the two examinations (less than 12 h-5 days). CT parameters were: 64 mm x 0.5 mm collimation, pitch-0.828 and helical pitch-53. DSA were performed with standard technique (four vessel catheterization) and multiple projections. Axial CT scans as well as maximum intensity projection, volume rendering and multiplanar reformations and angiographic views were independently reviewed by four readers (two for 64MDCT-angiography and two for DSA). Consensus was reached for discordant cases. DSA was considered as the standard of reference. RESULTS: In 29 patients, 28 aneurysms were found (14 patients had 1 aneurysm, 4 patients had 2 aneurysms and 2 patients had 3 aneurysms; in 9 patients no aneurysm were found). 64MDCT-angiography detected 26/28 aneurysms. No false-positive sites were recognized. The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 92.8, 100, 100, 99.4 and 99.5%. CONCLUSIONS: 64MDCT-angiography is helpful in detecting intracranial aneurysms with results similar to those of DSA but with less discomfort and risks for the patients and can be considered for the first line imaging technique. Conventional angiography is still needed in doubtful cases or negative MDCT-angiography associated with a strong clinical suspect.

Virtual stenting of iliac arteries: a new technique for choosing stents and stent-grafts by means of 3D rotational angiography. Preliminary data.

PURPOSE: Virtual stenting (VS) is a new tool in the 3D processing work station of rotational angiography (RA) systems. This tool enables the 3D visualization of a stent or stent-graft in the site of a stenotic, obstructive or aneurysmatic lesion to be treated. We report the preliminary results obtained with this software in the treatment of segmental stenotic, obstructive or aneurysmal lesions of the iliac artery. MATERIALS AND METHODS: Seventeen patients under-went rotational angiography and 3D reformations for one or more stenoses (19 cases), obstructive lesions (2 cases) or aneurysms (2 cases) of the common and/or external iliac artery and were treated with stents in 22/23 of cases. In all cases, the VS tool was applied to the stenotic-obstructive lesion on the identified on the 3D angiogram obtained before the stenting procedure. RESULTS: The measurements of the stents/stents-grafts (length, proximal and distal diameter) provided by the tool were compared to those of the stent deployed. In 22/23 procedures, the measurements of virtual stenting and those of the deployed stent showed a good level of concordance. The system failed to provide correct measurements in only one long and tortuous iliac aneurysm. CONCLUSIONS: The ''virtual stenting'' tool proved to be reliable and fast, and enabled a more objective selection of the stent to be deployed on a stenotic-obstructive lesion in almost all cases. In cases of aneurysms of marked tortuosity, the system tends to suggest an inappropriate stent. The possibility of manually defining the optimal stent path within the aneurysmal sac might be useful.

[Rotational angiography of the femoropopliteal arteries after percutaneous transluminal angioplasty: technical aspects and preliminary results].

PURPOSE: The angiographic evaluation of the results of femoropopliteal balloon angioplasty (PTA) is fundamental for monitoring long term success, but, often, the examination is performed only with one or two orthogonal projections. The aim of this study is to report our experience with a new digital angiography system able to perform "rotational" acquisitions to assess the results after femoro-popliteal PTA. MATERIALS AND METHODS: Twenty-eight patients underwent femoro-popliteal PTA due to steno-obstructive lesions varying in length between 1 and 10 cm. All examinations were performed on a Philips Integris Allura system able to perform "rotational angiography"(RA). The two frames showing the greatest degree of stenosis and the presence of subintimal "flaps" induced by PTA were compared with the frame obtained in the AP projection. RESULTS: RA after PTA was possible in all cases. In 12/28 (42.4%) cases there was no difference between the static AP projection and RA, whereas in 13/28 (46.5%) the static acquisition, compared with RA, underestimated the extent of residual stenosis by 10-30%. In 6 out of these 13 cases a discordance on the presence and extent of subintimal flap between static and rotational acquisition was identified. In three other cases (10.7%) there was substantial agreement on the residual stenosis but not on the PTA-induced dissection which was always better visible on RA. CONCLUSIONS: RA allowed optimal analyses of all cases improving the information of the conventional technique based on one projection only. It also proved very useful in demonstrating residual stenosis and PTA-induced dissections. In our experience this information modified our therapeutic approach leading to repeated balloon angioplasty or stenting in about 50% of cases.

Percutaneous revascularization of femoropopliteal artery disease: PTA and PTA plus stent. Results after six years' follow-up.

PURPOSE: To compare the long-term patency after the treatment of mild-to-moderate femoropopliteal artery disease by percutaneous transluminal angioplasty (PTA) alone (PTA group) and PTA plus stenting (STENT group) in a non-randomised retrospective study. MATERIALS AND METHODS: Eighty-six limbs in 64 patients (mean age 67+/-8 years, 47 males and 17 females) with femoropopliteal artery disease and symptomatic for mild-to-moderate intermittent claudication (Rutherford's category 1-2) were treated by percutaneous revascularization. None of the patients had critical lower limb ischaemia. Of the 86 lesions, 63 (40 stenoses and 23 occlusions) were treated by PTA alone and 23 (12 stenoses and 11 occlusions) by PTA plus stent implantation. The success was defined as a maximal = or < 30% residual stenosis of vessel lumen diameter, as defined by biplane angiography. The angiography findings were confirmed by colour-Doppler sonography of the treated segment. A peak systolic velocity = or < 150 cm/sec in the treated segment and an improvement of the ankle/brachial index by gs; 0.15 were considered indications of haemodynamic success. Restenosis at follow-up (mean 21 months, range 1-72 months) was defined by colour-Doppler sonography as a peak systolic velocity gs; 230 cm/sec or a peak systolic velocity ratio gs; 2.5 in the treated area and a gs; 0.15 decrease in ankle/brachial index compared with post-procedure measurements. RESULTS: Treatment by PTA plus stenting enabled correction of residual stenosis in 15/23 limbs, relief of PTA complications in 7/23 limbs and correction of restenosis after a PTA in 1/23. In the PTA group the treatment was successful in 59/86 limbs (68%) versus 21/23 (91%) in the STENT group (chi squared value= 0,04). As a whole, major complications occurred in 5.8% of cases (n=5), 3 in the PTA group and 2 in the STENT group. The primary patency rates at 6, 12, and 24 months were 70%, 66% and 58% in the PTA group versus 74%, 67% and 46% in the STENT group (Gehan p value=0.96). The secondary patency rates at 6, 12, 24 months were 75%, 73%, 65% in the PTA group versus 84%, 76%, 64% in the STENT group (Gehan p value=0,59). DISCUSSION AND CONCLUSIONS: In this study, stenting and PTA for the treatment of mild-to-moderate femoropopliteal peripheral artery disease improved the primary technical success of PTA by correcting residual stenosis, elastic recoil and occlusive intimal flaps. Moreover, stenting can prevent delayed constrictive remodelling. However, stenting did not improve long-term outcomes in comparison with PTA alone given that stent implantation increases the risk of restenosis due to myointimal hyperplasia. Our findings regarding the complication rates and long-term outcome agree with those published by other authors. Colour-Doppler US monitoring enabled early detection of restenosis in the treated area and its differentiation from the development of new lesions in other areas.