Search

Abstract This report is of a systematic review and meta-analysis evaluating the efficacy and safety of transcatheter arterial embolization (TAE) for nonvariceal gastrointestinal bleeding (GIB) with n-butyl cyanoacrylate (NBCA) or coils as the primary embolic agent. The primary outcome was the clinical success rate. The secondary outcomes were technical success rates, 30-day rebleeding rates, major complication rates, and 30-day overall mortality rates. A systematic search was performed in PubMed, Embase, and Cochrane Library. Articles included had been published in English from January 2000 to August 2023 and assessed patients with nonvariceal upper and lower GIB (UGIB and LGIB) who received TAE with NBCA or coils. Single-arm meta-analyses were performed for these outcomes. Subgroup analyses comparing NBCA and coils were conducted if there were more than 10 articles selected for each outcome. Thirty-seven articles were selected for analysis. The pooled rates of TAE for UGIB and LGIB were clinical success 73.0% and 76.5%, technical success 94.9% and 91.4%, 30-day rebleeding 25.0% and 17.1%, major complications 3.5% and 10.0%, and 30-day overall mortality 20.7% and 11.4%, respectively. The subgroup analysis showed a significant difference only for the technical success rates of LGIB between NBCA and the coils (p

We present a case of pulmonary metastasis originating from renal angiomyolipoma (AML), as evidenced by whole-exome sequencing (WES) analysis. Although AML predominantly arises in the kidneys, it can emerge in various body parts, making it important to distinguish between multicentric development and metastasis. However, previous studies have not distinguished between these conditions. Our case features an 82-year-old woman with a history of renal AML who presented with multiple, randomly distributed, bilateral pulmonary nodules of varying size and pure fat densities. The patient's condition followed a benign course over 10 years. Through WES, we discovered shared mutations in pulmonary lesions that were absent in the patient's blood, including a pathological mutation in TSC2, suggesting a metastatic origin from renal AML. Knowledge of the pulmonary manifestations of AML and their distinctive imaging findings can help radiologists and clinicians diagnose and manage patients with similar presentations.

We herein report a case of acute subdural hematoma caused by hemorrhagic falx meningioma. The patient was a 64-year-old woman with no significant medical history or prior history of trauma. She experienced a sudden onset of headache and weakness in her extremities. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a mass lesion with intratumoral hemorrhage or faint calcification along the left side of the fronto-parietal cerebral falx. There was also a linear lesion at the left side of the falx, suggesting acute subdural hematoma. MRI was performed again on the eleventh day. On precontrast T1-weighted images, intratumoral hemorrhage and widespread left subdural hematoma were shown as high intensity. On postcontrast T1-weighted images, the tumor showed heterogeneous enhancement with a dural tail sign on the falx, indicative of a falx meningioma. She underwent surgical resection, and the histological subtype was transitional meningioma. Nine cases of hemorrhagic falx meningioma associated with acute subdural hematoma have been reported. If not limited to the site of occurrence, there have been 59 reported cases overall. In our investigation, the incidence of hemorrhage is higher in the convexity and lower in the skull base. It is higher for fibrous, angiomatous, and metaplastic subtypes and lower for meningothelial subtype. The location and histological subtype might be risk factors for meningioma associated with subdural hematoma. Further accumulation of cases will be necessary to establish the cause of bleeding.

A developmental venous anomaly (DVA) is a venous drainage of the associated parenchyma that is normally asymptomatic. However, a DVA located adjacent to the aqueduct can cause obstructive hydrocephalus by blocking the flow of cerebrospinal fluid. We describe a rare case of obstructive hydrocephalus due to aqueductal stenosis secondary to a DVA. A 43-year-old man presented with sudden bilateral temporal pain during weight training. Using a 3-Tesla scanner, cranial magnetic resonance imaging (MRI) was performed, and hydrocephalus was found with mild enlargement of the lateral and third ventricles. Susceptibility-weighted imaging and postcontrast MRI revealed that the DVA from the bilateral thalami narrowed the orifice of the aqueduct on its drainage route towards the vein of Galen. We assumed that force exerted during weight training may have caused dilation of the anomalous veins, leading to his symptom. A review of the relevant English-language literature yielded only 19 cases of aqueductal stenosis due to DVA. In comparison to these cases, the duration of symptom in our case was extremely short because the patient had a history of ventriculomegaly detected on plain computed tomography and was diagnosed quickly based on the characteristic finding of DVA: the caput medusae appearance.

We report a rare patient with portal hypertension who presented with esophageal- and gastric varices and refractory ascites due to hepatic arterioportal fistulas. Treatment by transportal scleroembolization using ethanolamine oleate and coils were successful. Pretreatment hepatofugal flow subsequently changed to hepatopetal flow and the symptoms of portal hypertension improved. We describe our endovascular treatment option for addressing hepatic arterioportal fistulas.

We herein report a case of fenestration of the superior cerebellar artery (SCA), which was incidentally diagnosed by magnetic resonance (MR) angiography. A 65-year-old woman was referred to our hospital for unruptured cerebral aneurysms. MR angiography revealed 2 unruptured aneurysms. It also showed fenestration of the left SCA near its origin from the basilar artery, as well as several other vascular variations: a left common carotid artery arising from the brachiocephalic trunk, and a right vertebral artery terminating to the right posterior inferior cerebellar artery. Yearly observation was chosen as a treatment strategy due to the small size of the cerebral aneurysms. According to previous reports, SCA fenestration is an extremely rare variation. This is the second case of SCA fenestration diagnosed by MR angiography in the relevant English-language literature.

Abstract Objective To evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI)-based characteristics and a texture analysis (TA) for discriminating between ovarian thecoma-fibroma groups (OTFGs) and ovarian granulosa cell tumors (OGCTs). Methods This retrospective multicenter study enrolled 52 patients with 32 OGCTs and 21 OTFGs, which were dissected and pathologically diagnosed between January 2008 and December 2019. MRI-based features (MBFs) and texture features (TFs) were evaluated and compared between OTFGs and OGCTs. A least absolute shrinkage and selection operator (LASSO) regression analysis was performed to select features and construct the discriminating model. ROC analyses were conducted on MBFs, TFs, and their combination to discriminate between the two diseases. Results We selected 3 features with the highest absolute value of the LASSO regression coefficient for each model: the apparent diffusion coefficient (ADC), peripheral cystic area, and contrast enhancement in the venous phase (VCE) for the MRI-based model; the 10th percentile, difference variance, and maximal correlation coefficient for the TA-based model; and ADC, VCE, and the difference variance for the combination model. The areas under the curves of the constructed models were 0.938, 0.817, and 0.941, respectively. The diagnostic performance of the MRI-based and combination models was similar (p = 0.38), but significantly better than that of the TA-based model (p

OBJECTIVES:To compare remission status at completion of chemotherapy for multiple myeloma (MM) with changes in total diffusion volume (tDV) calculated from whole-body diffusion-weighted imaging (WB-DWI) and fat fraction (FF) of lumbar bone marrow (BM) by modified Dixon Quant (mDixon Quant) soon after induction of chemotherapy, and to assess the predictive value of MRI. METHODS:Fifty patients (mean age, 66.9 ± 10.5 years) with symptomatic myeloma were examined before and after two cycles of chemotherapy. From WB-DWI data, tDV was obtained with the threshold for positive BM involvement. Mean FF was calculated from lumbar BM using the mDixon Quant sequence. At the completion of chemotherapy, patients were categorized into a CR/very good PR (VGPR) group (n = 15; mean age, 67.6 ± 10.3 years) and a PR, SD or PD group (n = 35; mean age, 69.1 ± 8.6 years). ROC curves were plotted to assess performance in predicting achievement of CR/VGPR. RESULTS:At second examination, serum M protein, β2-microglobulin, and tDV were significantly decreased and hemoglobin, mean ADC, and FF were significantly increased in the CR/VGPR group and serum M protein was significantly increased in the PR/SD/PD group. The general linear model demonstrated that percentage changes in FF and M protein contributed significantly to achieving CR/VGPR (P = 0.02, P = 0.04, respectively). AUCs of ROC curves were 0.964 for FF and 0.847 for M protein. CONCLUSIONS:Early change in FF of lumbar BM and serum M protein soon after induction of chemotherapy contributed significantly to prediction of CR/VGPR.

This article describes a quantitative evaluation of visualizing small vessels using several image reconstruction methods in computed tomography. Simulated vessels with diameters of 1–6 mm made by 3D printer was scanned using 320-row detector computed tomography (CT). Hybrid iterative reconstruction (hybrid IR) and model-based iterative reconstruction (MBIR) were performed for the image reconstruction. Keywords: Computed tomography (CT), CT angiography, Image reconstruction, Hybrid iterative reconstruction, Model-based iterative reconstruction

This study investigated which sizes of double-J stents are more effective in achieving an acceptable urine flow through stenotic and stented ureters. Sixty four computational fluid dynamics models of the combinations of two different gauge ureters (4.57 mm and 5.39 mm in diameter) with four different levels of ureteral and four different sizes of double-J stents were developed for the numerical analysis of urine flow in the ureter. Luminal, extraluminal, and total flow rates along the ureter were measured, and the flow patterns around the ports and side holes were investigated. For the 4.57-mm ureter, the total flow rate for each gauge of stent was 23–63 mL/h (5 Fr), 20–47 mL/h (6 Fr), 17–35 mL/h (7 Fr), and 16–26 mL/h (8 Fr) and for the 5.39-mm ureter, the total flow rate for each gauge of stent was 43–147 mL/h (5 Fr), 36–116 mL/h (6 Fr), 29–92 mL/h (7 Fr), and 26–71 mL/h (8 Fr). With a 74% stenosis, all stents allowed a low flow rate, and the differences in flow rates between the stents were small. At the other levels of stenosis, 5 Fr stents allowed greater flow rates than the 8 Fr stents. The luminal flow rate increased just before the area of stenosis and decreased after the stenosis because of the increase and decrease in the luminal flow through the side holes before and after the stenosis. Therefore, a larger double-J stent is not favorable in achieving an acceptable urine flow through the stenotic and stented ureters. The results in this study could not be necessarily correlated with clinical situation because peristalsis, viscosity of the urine and real format of the ureter were not considered in our model. In vivo experiments are necessary for confirmation of our findings. Double J stents are commonly used in the ureteral stenosis or occlusion, especially due to ureter stones which obstruct the flow of urine. Clinicians choose the size of double J stent on the basis of their clinical experience. Here, we tried to know which sizes of double J stents are better for sufficient urine flow. According to various documents that try to determine the optimal shape of double J stents to increase the urine flow through the ureter, mostly bigger stent is recommended to occur maximum urine flow. However, in case of ureter with stenosis or occlusion, the right size of the double J stent may vary depending on the degree of stenosis in the ureter. To find appropriate stent size for the ureter with stenosis, computational fluid dynamics was conducted. This study shows that smaller diameter stents are more appropriate than larger diameter stents depending on the situation.

Arterial peak enhancement on contrast-enhanced CT (CECT) images is thought to be higher in patients with low cardiac function. Using computer simulations, we tested the hypothesis that the relationship between the cardiac index and the aortic peak CT number (PCTN) is affected by the contrast material (CM) injection duration. We created computer simulation software for the contrast enhancement of various organs and vessels based on the Bae pharmacokinetics model and implemented models for CM transmission within organs and CM diffusion in blood plasma based on the osmotic pressure. Aortic contrast enhancement at coronary- and abdominal CT angiographs (CTA) was simulated for a representative 60-year-old Japanese male 166 cm in height and 65.0 kg in weight. The injection protocol for coronary CTA was: CM dose 45.5 ml, iodine dose, 245 mg/kg body weight (BW); injection duration 8-20 sec in 2-sec increments. For abdominal CTA it was CM dose 74.3 ml; iodine dose 400 mg/kg BW; injection duration 10-40 sec in 5-sec increments. In both protocols the iodine concentration was 350 mgI/ml, osmotic pressure was 590 mOsm/kgH2O, and the cardiac index ranged from 0.1-6.0 l/min/m2. Under all protocols, the aortic PCTN increased as the injection duration decreased and as the cardiac index rose to the cardiac index value. It then decreased as it exceeded the cardiac index value. At coronary CTA, at an injection duration of 8 or 10 sec, the PCTN exceeded 350 Hounsfield units (HU) at a cardiac index from 0.9-5.6 l/min/m2. At an HU value greater than 350, the range of the cardiac index narrowed when the injection duration was 12 sec or longer. On abdominal CTA scans performed with an injection duration of 10-, 15-, or 20 sec, the PCTN exceeded 350 HU at a cardiac index ranging from 0.4-5.3 l/min/m2. When the injection duration ranged from 25-40 sec, there was narrowing of the range of the cardiac index at which the PCTN exceeded 350 HU. For coronary and abdominal CTA, contrast enhancement protocols with shorter injection durations yield a diagnostically adequate aortic PCTN at a wide range of cardiac indices.

Purpose: We aimed to investigate the potentiality of atelocollagen, a new embolic agent which is collagen type I in a porcine experimental model., Materials and Methods: Three pigs underwent transcatheter embolization of lower interlobular arteries of the renal artery (n=6) and one branch of the hepatic artery (n=3) with collagen type I. Angiography was performed prearterial, during, and postarterial embolization. After the procedure, samples from the embolized organs were evaluated by histological analysis., Results: Six lower interlobular renal arteries and three hepatic arteries were successfully embolized by administration of 0.8±0.3 mL and 2.9±1.2 mL, respectively, of the collagen type I. Histological findings of the embolized kidney specimens showed that the collagenous materials filled the arterial lumen, whose size ranged from 2.02 to 839.82 μm and reached the level of afferent arteries of glomerular tufts. Although the area of occluded arteries of the liver was smaller than the kidney, histological findings of the liver specimens showed that the collagenous materials filled small arterial lumens from 2.81 to 187.86 μm in diameter., Conclusion: Atelocollagen, a collagen type I, has the potential to be used to embolize the distal vessels of both renal and hepatic arteries.