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Background: Bypass grafting is the standard of care for chronic aorto-iliac occlusive disease (AIOD, aka Leriche Syndrome) but is associated with mortality rates of up to 25% if surgical re-intervention is necessary. Despite a recent shift towards an endovascular-first strategy for TransAtlantic InterSociety Consensus II ("TASC II") C and D lesions, reports from Leriche Syndrome are still limited.Patients and Methods: 15 high-risk patients (11 male, 4 female), mean age of 60.6 years, with chronic aorto-iliac occlusive disease were retrospectively reviewed. Retrograde approaches via the bilateral femoral arteries for aortic occlusion less than 4 cm in length and/or antegrade fashion from the brachial artery for juxtarenal type lesions were made. For the latter, thrombolysis prior to angioplasty was also performed. Intraluminal or if necessary, subintimal angioplasty was performed with deployment of either bare metal stents or stentgrafts in a kissing-stent fashion.Results: A total of 28 iliac arteries and 14 occluded abdominal aorta were treated with 100% technical success, of which 25% success were achieved by using subintimal technique. Two minor complications occurred, including vascular rupture and distal emboli in one patient apiece, which were successfully managed via endovascular fashion. There were no complications of renal artery emboli. Primary and secondary patency rates at 1, 3 and 5 years were 92.3% and 100%; 83.9% and 100%; and 83.9% and 100%, respectively.Conclusion: Endovascular therapy for chronic aorto-iliac occlusion has a high technical success rate, with good short- and mid-term primary and secondary patency rates and may provide a valid alternative to surgery for high-risk patients. [ABSTRACT FROM AUTHOR]

Background To determine if mammography combined with digital breast tomosynthesis (DBT), leads to superior performance in screening for breast cancer compared to digital mammography (DM) alone. Methods We retrospectively collected data from A) the results of population-based mammography-screening provided by the National Cancer Registry in Taiwan, and B) the results from all screening mammography performed with DBT from 2012 through 2015 at Kaohsiung Veterans General Hospital (VGHKS) since the institution of DBT at the end of 2011. This was compared data from 3 years with DM performed prior to DBT implementation. We calculated the results of medical audit of VGHKS and compared this with national data. Fisher's exact test is applied. Results VGHKS data demonstrated a higher cancer detection rate (CDR) and positive predictive value 1 (PPV 1) than the national average. Most prominently in the year 2014, our CDR was 120% better than that of the national average. CDR ranged from 6.3 to 8.1‰ prior to the introduction of DBT, and following DBT implementation this improved to 8.5–11.4‰, reflecting a mean increase of 32.2%. Early cancer detection was 50% higher and node negative rate was 25% higher than the national average of latest year. A 17.8% reduction in recall rate (RR) was achieved due to a decrease in unnecessary recall. Conclusion There was a 32.2% increase in CDR and a 17.8% decrease in RR when DBT was used as an adjunct to DM, as compared to DM alone. CDRs were approximately twofold better than national average data. DBT was more effective at detecting cancer in ductal carcinoma in situ and stage 1. [ABSTRACT FROM AUTHOR]

Background: Recurrence rate after curative surgical resection of Hepatocellular carcinoma (HCC) remains high. Postoperative hepatic arterial infusion chemotherapy (HAIC) has been suggested to improve survival. This study is to investigate the efficacy of HAIC in the patients with poor tumor factors such as vascular invasion or multiplicity.Methods: From 2006 to 2014, 221 patients with HCC undergoing hepatectomy and pathologically staged as ≧ T2 (American Joint Committee on Cancer TNM staging system, 7th edition) were included. 61 patients received adjuvant HAIC with 5-fluorouracil, cisplatin, and epirubicin. 160 patients received surgery alone. The overall survival time (OST) and disease free survival time (DFST) were compared between the two groups.Results: In all patients, the multivariate analysis of survival data showed that resection margin less than 10 mm was the independent poor prognostic factors. The median OST and DFST between the HAIC and surgery alone groups were 56.4 vs. 56.9 months (p = 0.76), and 50.6 vs. 54.5 months (p = 0.905), respectively. There was no significant difference. For patients with multiple tumors and concomitantly microvascular invasion, the OST was better in the HAIC group (69.7 vs. 54.6 months, p < 0.05). Based on the image and operative finding, we classified multiple HCC's into two types. Type A: multiple small nodules were close to each other or a huge tumor with several satellite nodules. Type B: two or more tumors scattering in separate segments. Our study showed that type A group benefits from adjuvant HAIC much more than type B. (the median OST in type A versus type B were 85.06 vs. 41.53 months, p = 0.0036).Conclusion: The surgical outcome for the patients with multiple HCC's and vascular invasion was poor. Our study showed adjuvant HAIC was beneficial in these patients and formed the basis for further randomized controlled trials. [ABSTRACT FROM AUTHOR]

Purpose: To determine frequency of and assess risk factors for hepatic artery (HA) injury during percutaneous transhepatic biliary drainage (PTBD) and to discuss the technique and report the clinical outcome of embolization for HA injury.Materials and Methods: Over a 14-year period (2002-2016), 1,304 PTBD procedures in 920 patients were recorded. The incidence of HA injury was determined, and possible associated risk factors were analyzed. When injury occurred, HA embolization was performed at the site as close to the bleeding point as possible. Clinical outcomes of these patients after embolization were reported.Results: Of 1,304 PTBD procedures, a left-sided approach was used in 722 procedures (55.4%), and intrahepatic duct (IHD) puncture under ultrasound guidance was used in 1,161 procedures (90.1%). The IHD was nondilated in 124 (9.5%) patients. The punctured ductal entry site was peripheral in 1,181 (90.6%) patients. In this series, 8 procedures (0.61%) were complicated by HA injury. IHD dilatation status was the only risk factor (P = .017) for HA injury. Embolization was performed with technical and clinical success in all 8 patients. No recurrent hemobilia, intraabdominal bleeding, or other sequelae of HA injury after embolization was noted during 1 week to 84 months of follow-up.Conclusions: HA injury is a relatively rare complication of PTBD. IHD dilatation status was the only risk factor for HA injury in this study. When HA injury occurred, embolization therapy was effective in managing this complication. [ABSTRACT FROM AUTHOR]

Background To report the technique and clinical outcome of subintimal re-entry in chronic iliac artery occlusion by using a Colapinto transjugular intrahepatic portosystemic shunt (TIPS) needle under rotational angiography (cone-beam computed tomography; CT) imaging guidance. Methods Patients with chronic iliac artery occlusion with earlier failed attempts at conventional percutaneous recanalization during the past 5 years were enrolled in our study. In these patients, an ipsilateral femoral access route was routinely utilized in a retrograde fashion. A Colapinto TIPS Needle was used to aid the true lumen re-entry after failed conventional intraluminal or subintimal guidewire and catheter-based techniques. The puncture was directed under rotational angiography cone-beam CT guidance to re-enter the abdominal aorta. Bare metallic stents 8–10 mm in diameter were deployed in the common iliac artery, and followed by balloon dilation. Results Ten patients (9 male; median age, 75 years) were included in our investigation. The average occlusion length was 10.2 cm (range, 4–15 cm). According to the Trans-Atlantic Inter-Society Consensus (TASC) II classification, there were five patients each with Class B and D lesions. Successful re-entry was achieved in all patients without procedure-related complications. The ankle–brachial index (ABI) values increased from 0.38–0.79 to 0.75–1.28 after the procedure. Imaging follow-up (> 6 months) was available in six patients with patency of all stented iliac artery. Thereafter, no complaints of recurrent clinical symptoms occurred during the follow-up period. Conclusion The use of Colapinto TIPS needle, especially under cone-beam CT image guidance, appears to be safe and effective to re-enter the true lumen in a subintimal angioplasty for a difficult chronic total iliac occlusion. [ABSTRACT FROM AUTHOR]

Background Ductal carcinoma in situ (DCIS) is a malignant proliferation of ductal epithelium confined by the basement membrane of the involved breast ducts. The aim of this study was to categorize positive findings of DCIS of the breast on sonography. Methods From 2007 to 2011, 100 pathologically proven DCIS lesions were evaluated. Four sonographic patterns used to identify DCIS have been characterized as cumulus-type, coral-type, pipe-type, and miscellaneous lesions. Results The lesion numbers of nonhigh-grade and high-grade DCIS were 44 and 56, respectively. The coral type (42%) was the most commonly found lesion, followed by cumulus-type (38%), pipe-type (17%), and miscellaneous (3%) lesions. There was no significant difference between the sonographic pattern and nuclear grades. However, the coral-type group was composed of significantly more high-grade DCIS cases than the other three types ( p < 0.05). Conclusion Coral-, cumulus-, and pipe-type lesions are three easily recognizable sonographic findings of DCIS. Improving the breast ultrasound technique to better demonstrate the sonographic pattern is necessary to facilitate breast lesion interpretation. [ABSTRACT FROM AUTHOR]

Background A greater policy of emphasis on the early detection and treatment of breast cancer is prevalent among developed countries. To raise the screening performance with a potentially decreased mortality rate, it is crucial to evaluate and analyze the screening outcome after implementation. We report the clinical outcome of an 8-year nationwide mammography screening in Taiwan to help share our statistical information on breast screening worldwide, especially in Asia. Methods Taiwan has provided nationwide, free, biennial mammographic screening since 2004. A total of 2,392,789 consecutive screening mammography examinations were performed during this study period for women aged 50–69 years (2006–2009) and 45–69 years (from December 2009 onwards). The screening covers 33.2% of the target population in the most recent 2 years. The workload of every screening radiologist, the overall recall rate, positive predictive value (PPV1), cancer detection rate (CDR), cancer incidence rate (CIR) from the screening, 1-year interval cancer, sensitivity, and specificity of the screening mammography are calculated, and compared with the American College of Radiology (ACR) recommendation level and/or those of other screening mammographic series. Results The CDRs (%) and CIRs (%) increased from 3.94–4.08 and 4.80–5.04 to 4.71–5.04 and 5.71 after 2009, implying a high occurrence of breast cancer in the younger age group of 45–49 years. The recall rates (9.3–10.0%) in this review are within the ACR recommendation range (<10%) and the PPV1 has also reached the ACR recommended level (>5%) in the most recent 2 years. The improvement of the screening performance may be attributed to our peer auditing review and education program. The sensitivity of our screening mammography is slightly lower than that of the ACR recommended level (>85%), which is still comparable to the results of the Vermont area in the USA. Although the workload (screenees/screeners) for every radiologist each year has increased from 150 in 2004 to 1360 in 2012, it does not seem to worsen the quality outcome of this screening program. Conclusion From the outcome review of this national mammography screening, there is still room to ameliorate our performance through comprehensive and continued education, to improve the competence of cancer detection and decrease false negative (FN) cases. [ABSTRACT FROM AUTHOR]

Balloon-occluded retrograde transvenous obliteration (BRTO) is an interventional radiologic technique that obliterates gastric varices (GV) from draining veins under balloon occlusion. A 54-year-old man presented with Stage IV hepatocellular carcinoma and tumor thrombi in main portal vein. Intractable GV bleeding had no response to repeated endoscopic sclerotherapy and pharmacotherapy well. Additionally, his medical condition could not allow transjugular intrahepatic portosystemic shunt or surgical portal decompression. Due to spontaneous gastrorenal shunt proved with abdominal computed tomography, we conducted BRTO to prevent further bleeding. The immediate postprocedural venogram showed total occlusion of the gastrorenal shunt and no visualization of the GV. Follow-up endoscopy was performed at 1 month, 2 months, and 4 months after BRTO. It revealed shrinkage of gastric varices and no worsening of esophageal varices after 4 months of BRTO. The patient was free from repeated GV bleeding for 4 months. Our experience proved BRTO could be the other effective treatment for intractable GV bleeding. [ABSTRACT FROM AUTHOR]

Abstract: Background: Femoral artery pseudoaneurysm is a rare complication but with increasing frequency nowadays due to the advances of endovascular intervention. Rare cases of brachial orpopliteal artery pseudoaneurysms had ever been reported and the predictive factors of failed ultrasound-guided compression repair (UGCR) are controversial. Methods: During the past 8 years, 21 patients (12 males and nine females; median age, 64 years) with peripheral pseudoaneurysms (femoral artery, n = 17; brachial artery, n = 3; popliteal artery, n = 1) were enrolled. A high frequency of 10–12 MHz color ultrasound was used to evaluate the presence of a pseudoaneurysm. The area of the pseudoaneurysm sac and the width and length of the pseudoaneurysm neck were recorded. Under real-time ultrasound guiding, gradual pressure was applied with the probe to obliterate flow in the pseudoaneurysm neck while still allowing flow through the supplying artery for approximately 10–15 minutes with at most three times (45 minutes’ compression). Follow-up color sonography was obtained at 24 hours to detect any recurrence. Results: The mean area and the largest dimension of the 21 pseudoaneurysms were 7.3 ± 6.5 cm2 and 3.6 ± 1.8 cm, respectively. The mean width and the mean length of the pseudoaneurysm neck were 2.1 ± 0.9 and 3.3 ± 2.0 mm, respectively. Successful thrombosis of the pseudoaneurysm was achieved in 19(90.5%) patients. The mean compression time of the 19 successful UGCR was 21.2 ± 11.0 minutes. Two patients failed the UGCR procedure after a 45-minute compression. Both of the two pseudoaneurysms were located in the femoral artery with a large width of the pseudoaneurysm neck (4 and 5 mm, respectively). Conclusion: UGCR is a safe and cost-effective therapy for treating peripheral pseudoaneurysms of not only femoral artery, but also brachial artery and popliteal artery. We considered the width of the pseudoaneurysm neck to be the predictive factor of technical success. [Copyright &y& Elsevier]

Abstract: Background: This study was conducted to investigate whether detectable missed breast cancers could be distinguished from truly false negative images in a mammographic screening by a regular peer auditing. Methods: Between 2004 and 2007, a total of 311,193 free nationwide biennial mammographic screenings were performed for 50- to 69-year-old women in Taiwan. Retrospectively comparing the records in Taiwan''s Cancer registry, 1283 cancers were detected (4.1 per 1000). Of the total, 176 (0.6 per 1000) initial mammographic negative assessments were reported to have cancers (128 traditional films and 48 laser-printed digital images). We selected 186 true negative films (138 traditional films and 48 laser-printed ones) as control group. These were seeded into 4815 films of 2008 images to be audited in 2009. Thirty-four auditors interpreted all the films in a single-blind, randomized, pair-control study. The performance of 34 auditors was analyzed by chi-square test. A p value of <0.05 was considered significant. Results: Eight (6 traditional and 2 digital films) of the 176 false negative films were not reported by the auditors (missing rate of 4.5%). Of this total, 87 false negatives were reassessed as positive, while 29 of the 186 true negatives were reassessed as positive, making the overall performance of the 34 auditors in interpreting the false negatives and true negatives a specificity of 84.4% and sensitivity of 51.8%. The specificity and sensitivity in traditional films and laser-printed films were 98.6% versus 43.8% and 41.8% versus 78.3%, respectively. Almost 42% of the traditional false negative films had positive reassessment by the auditors, showing a significant difference from the initial screeners (p < 0.001). The specificity of their reinterpretation of laser-printed films was obviously low. Conclusion: Almost 42% of the false negative traditional films were judged as missed cancers in this study. A peer auditing should reduce the probability of missed cancers. [Copyright &y& Elsevier]

Abstract: We report a rare case, in which, an interrupted inferior vena cava with anomalous transhepatic continuations is noticed in a variant of scimitar syndrome. The scimitar variant consisting of dextrocardia, hypoplastic right lung and a non-systemically drained meandering right pulmonary vein, which presents the “scimitar sign” on chest radiograph. To our knowledge, such a combination of cardiac and venous anomalies has not been described before. [Copyright &y& Elsevier]

Technical success rates for percutaneous restoration of thrombosed arteriovenous grafts are high. However, in thrombosed grafts without restorable original outflow veins, percutaneous salvage is usually not possible. In this situation, patients are referred for bypass grafting or recreation of their vascular access sites. This report describes a patient in whom the original outflow vein at the venous anastomosis was completely obliterated and in whom vascular access was successfully salvaged by percutaneously reanastomosing the venous stump of the thrombosed graft with an adjacent patent vein. This procedure is technically feasible for the salvage of a thrombosed graft. [Copyright &y& Elsevier]