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Introduction Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical). Methods We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms. Results RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group. Conclusion Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.

Purpose To report current practices of transarterial chemoembolization (TACE) by interventional radiologists (IR) for hepatocellular carcinoma (HCC) through a French national survey. Materials and methods An electronic survey was sent by e-mail to 232 IRs performing TACE in 32 private or public centers. The survey included 66 items including indications for TACE, technical aspects of TACE, other locally available treatments for HCC, follow-up imaging and general aspects of interventional radiology practices. Results A total of 64 IRs (64/232; 27%) answered the survey. Each IR performed a mean of 49 ± 45 (SD) TACE procedures per year. Marked variations in indications for TACE in HCC were observed. Six percent of IRs (4/64) treated only patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC. Antibioprophylaxis was not used by 43/64 of IRs (67%). The number of HCC nodules was considered to select conventional TACE versus drug-eluting beadsTACE (DEB-TACE) by 17/49 IRs (35%) followed by patient performance status and Child–Pugh score by 6/49 IRs (12%). Seventy-three percent of IRs (45/62) treated nodules selectively in patients with unilobar disease with cTACE. Thirty-three percent of IRs (21/64) planned systematically a second TACE session. Doxorubicin was the most frequently used drug (52/64; 81%) and 15/64 IRs (23%) used gelatine sponge as the only embolic agent. For DEB-TACE, 100–300 μm beads were used by 26/49 IRs (53%) and no additional embolization was performed by 19/48 IRs (39%). Monopolar radiofrequency technique was widely available (59/63; 94%) compared to selective internal radiation therapy (37/64; 58%). Magnetic resonance imaging was used for follow-up by 13/63 IRs (20%). Conclusion Current practices of TACE for HCC varied widely among IRs suggesting a need for more standardized practices.

Introduction Abdominal Aortic Aneurysm (AAA) is a common pathology which treatment decision is mostly made upon measurement of maximal diameter, despite known limitations. Thanks to the collaboration between Medical Physicist and Radiologist, this study aimed to identify new biomarkers based on computational fluid dynamics (CFD) analysis to predict AAAs rapid growth risk. Methods In our multi-centric and prospective study, we included 78 patients with an AAA from September 2012 to June 2014. Patients underwent two CT examinations separated by a one-year interval to assess aneurysms growth. Fifty patients underwent CFD analysis thanks to the Medical Physicist expertise. Based on a 10 ml threshold of total volume growth, we classified patients into slow and rapid growth groups. Aneurysms initial morphological and functional parameters were analyzed including: maximal diameter and surface, thrombus and lumen volumes, maximal wall pressure and wall shear stress (WSS). Results There was a significant difference between the two groups regarding aneurysm lumen volume (P = 0.0051) and mean WSS variation (P = 0.0240) unlike maximal diameter (P = 0.71). We found significant correlation of aneurysm volume growth with lumen volume and reduction of the mean WSS variation value (respectively R = 0.47, P = 0.0015 and R = −0.42, P = 0.0062) and total aneurysm volume growth. Combining these parameters, we computed an AAAs growth-predicting model, which featured better area under ROC than the only measurement of maximal diameter (0.78 vs 0.52, P = 0.0031). Depending on the threshold, our model yields either excellent sensitivity (95.00% [IC95% 75.1, 99.9]) or specificity (90.00% [IC95% 73.5, 97.9]). Conclusions Tight collaboration between Medical Physicist and Radiologists allowed to find a promising biomarker based on CFD which provides better information than maximal diameter to assess rapid AAAs volume growth risk.

Background: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure–lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report the influence of adherence to antihypertensive treatment on blood pressure control. Methods: One hundred six patients with hypertension resistant to 4 weeks of treatment with indapamide 1.5 mg/d, ramipril 10 mg/d (or irbesartan 300 mg/d), and amlodipine 10 mg/d were randomly assigned to renal denervation plus standardized stepped-care antihypertensive treatment, or the same antihypertensive treatment alone. For standardized stepped-care antihypertensive treatment, spironolactone 25 mg/d, bisoprolol 10 mg/d, prazosin 5 mg/d, and rilmenidine 1 mg/d were sequentially added at monthly visits if home blood pressure was ≥135/85 mm Hg after randomization. We assessed adherence to antihypertensive treatment at 6 months by drug screening in urine/plasma samples from 85 patients. Results: The numbers of fully adherent (20/40 versus 21/45), partially nonadherent (13/40 versus 20/45), or completely nonadherent patients (7/40 versus 4/45) to antihypertensive treatment were not different in the renal denervation and the control groups, respectively ( P =0.3605). The difference in the change in daytime ambulatory systolic blood pressure from baseline to 6 months between the 2 groups was –6.7 mm Hg ( P =0.0461) in fully adherent and –7.8 mm Hg ( P =0.0996) in nonadherent (partially nonadherent plus completely nonadherent) patients. The between-patient variability of daytime ambulatory systolic blood pressure was greater for nonadherent than for fully adherent patients. Conclusions: In the DENERHTN trial, the prevalence of nonadherence to antihypertensive drugs at 6 months was high (≈50%) but not different in the renal denervation and control groups. Regardless of adherence to treatment, renal denervation plus standardized stepped-care antihypertensive treatment resulted in a greater decrease in blood pressure than standardized stepped-care antihypertensive treatment alone. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01570777.

Actuellement, la plupart des equipes de radiologie interventionnelle utilisent de fagon systematique une antibioprophylaxie au cours des procedures les plus agressives. Meme si de nombreux auteurs ont rapporte ce type de pratique, il n»y pas dans la litterature de serie controlee randomisee permettant d’analyser scientifiquement l’efficacite de l’antibioprophylaxie en radiologie interventionnelle (1–3).

Objectifs Savoir bien etudier la morphologie du rehaussement. Connaitre les quelques criteres qui permettent d’orienter vers une lesion de haut grade. Connaitre les limites de l’IRM mammaire pour l’approche histologique. Points cles Un carcinome colloide est souvent en net hypersignal T2. Les criteres cinetiques sont peu predictifs d’une lesion de haut grade ou de bas grade. Un rehaussement suspect avec des contours bien nets est evocateur d’une lesion de haut grade. Un CCIS decouvert en IRM, sans traduction mammographique, serait plutot de haut grade. Resume Le type histologique est difficile a approcher en IRM. Les criteres morphologiques ou cinetiques sont peu specifiques pour faire la difference entre un cancer infiltrant lobulaire ou canalaire. Le cancer mucineux pur apparait souvent en net hypersignal T2. L’intensite de la prise de contraste et la morphologie du rehaussement ne sont pas des facteurs predictifs discriminatifs d’un type histologique. L’etude morphologique de la prise de contraste peut orienter vers une lesion infiltrante, ou in situ, mais elle est peu fiable. Les lesions infiltrantes qui presentent un rehaussement annulaire et un centre fibreux, ou des contours bien definis seraient plutot de haut grade. Les contours spicules seraient plutot en faveur d’une lesion infltrante de bas grade ou de grade intermediaire. Dans les CCIS (carcinomes canalaires in situ) purs, l’etude cinetique de rehaussement ne permet pas de determiner le grade. Les CCIS purs detectes en IRM, mais non vus sur la mammographie seraient plutot en faveur d’une lesion de haut grade. L’IRM fonctionnelle n’est actuellement pas assez performante pour l’etude discriminative du grade histologique.

Objectifs Reconnaitre une formation liquidienne pelvienne et determiner qu’elle n’est pas ovarienne. Savoir faire le diagnostic etiologique d’un kyste extra ovarien pelvien afin d’en optimiser la prise en charge. Resume Le kyste pelvien non ovarien peut etre d’origine tres diverse. La connaissance du dossier clinique est importante. L’echographie, pelvienne et endocavitaire, est souvent suffisante pour determiner l’origine extra ovarienne du kyste. Elle permet dans la majorite des cas de faire le diagnostic des anomalies kystiques uterines, tubaires, vaginales, urinaires, et parfois digestives. Elle peut etre insuffisante pour l’exploration des kystes volumineux ou posterieurs. L’IRM, permet par son approche multiplanaire de faire le diagnostic des kystes d’origine neurologique, articulaire et peritoneale. La nature liquidienne pure, hemorragique ou riche en proteine du contenu kystique est connue en etudiant le signal de la lesion. Conclusion L’etude topographique et morphologique du kyste doit permettre de detenniner son origine. L’analyse du signal en IRM permet d’en connaitre son contenu. Le diagnostic radiologique d’un kyste pelvien extra ovarien est necessaire pour eviter une prise en charge inadaptee.

Objective to show how differences in anatomical and physiological risk factors can affect the outcome of endovascular repair of AAA by describing the experience of two centres with different selection policies. Methods one hundred and thirty-five patients (group I) were treated at Queen's Medical Centre (Nottingham, U.K.) using 101 in-house made and 34 manufactured stent-grafts. Median diameter, length and angulation of the proximal aneurysm neck were 26 mm, 27 mm, 40°, respectively. Seventy-six patients had ischaemic heart disease, 47 had left ventricular failure, median forced expiratory volume in one second (FEV1) was 83%, median creatinine was 100 μmol/l and median age was 72 years. Fifty patients (group II) were treated at Timone Hospital (Marseilles, France) using seven in-house made and 43 manufactured stent-grafts. Median diameter, length and angulation of the proximal aneurysm neck were 25 mm, 34 mm, 33°, respectively. Thirteen patients had ischaemic heart disease, two had left ventricular failure, median forced expiratory volume in one second was 101%, median creatinine was 108 μmol/l and mean age was 72 years. Results anatomical characteristics of the proximal neck were significantly worse in group I (p=0.02 for the three variables). Cardiac comorbidities were more frequent and mean FEV1 was lower in group I (p