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Photobiomodulation (PBM) occurs when a cell is exposed to low energy intensities. A novel central venous port (CVP) with light-emitting diodes (LEDs) that emits red light with a wavelength of 680 nm via wireless energy transmission technology has been established. This comparative in vitro study examined whether PBM can reduce the growth of methicillin-resistant Staphylococcus aureus (MRSA), a common cause of central venous (CV) infections, in vitro. In this comparative in vitro study, the red light with a wavelength of 680 nm was used to irradiate an MRSA suspension in phosphate-buffered saline for 7.5, 15, 30, or 60 min in a 3.5 cm Petri dish with an area of 8.5 cm2. The total energy was 85 J at 7.5 min, 170 J at 15 min, 340 J at 30 min, and 680 J at 60 min. Six dishes for each time and 6 temperature-controlled samples were prepared. Each sample was incubated overnight at 37℃. The Shapiro-wilk test was used to determine whether the data were normally distributed. The numbers of colonies were counted and compared using one-factor ANOVA and Bonferroni's post-hoc test. The mean numbers of colonies in the control group were 60.3, where the numbers of colonies in the irradiated group were 51.4 at 7.5 min, 53.5 at 15 min, 44.6 at 30 min, 34.3 at 60 min. The mean number of colonies in the 60 min irradiated group differed significantly from that in the control, 7.5 min, and 15 min groups. The Bonferroni's post-hoc test showed significant difference in the number of colonies between control vs. 30 min control vs. 60 min, 7.5 min vs. 60 min, 15 min vs. 60 min. PBM with 680 nm LEDs on MRSA for 340 J at 30 min and 680 J at 60 min inhibited the growth of cell colonies. These findings support the use of photobiomodulation in Central venous port to prevent CV access port-Blood stream infection. [ABSTRACT FROM AUTHOR]

Implantable central venous (CV) ports are widely used for chemotherapy and parenteral nutrition. Generally, CV ports are used safely; however, some patients suffer from drug leakage around the port septum due to mispuncture. Therefore, we developed a CV port that is visible under the skin. We created a prototype of a CV port using a 3D printer. Three red light-emitting diodes (LEDs) were attached around the septum that made the puncture site visible by applying wireless energy transmission technology using electromagnetic resonance. The CV port was implanted under the skin of pork rose meat. The thickness of the skin of pork loin was measured. Fifteen medical doctors participated in the study to visually confirm the lighted CV port. The visibility of the center of the septum with and without lights was scored 0 as non-diagnostic; 1, slightly visible; 2, well visible; and 3, obviously visible. The visibility with or without lights was assessed. The relationship between the years of experience and the visibility score was assessed. The Wilcoxon test was used for statistical analysis. LEDs were easily transmitted through the skin of pork rose meat. The median visibility scores with or without lights were 2 (range, 1–3) and 3 (range, 1–3), respectively (p = 0.005). No significant relationship was found between experience and visibility score (p = 0.289). CV ports with LEDs can be easily recognized compared with those without LEDs. This technique may contribute to medical safety by improving its visibility to avoid mispuncture. [ABSTRACT FROM AUTHOR]

Background. Whole-body computed tomography (WBCT) is commonly employed for primary screening in pediatric patients experiencing out-of-hospital cardiac arrest (OHCA) without prehospital return of spontaneous circulation (ROSC). This study aimed to evaluate the cause of OHCA on WBCT and compare WBCT findings between ROSC and non-ROSC groups in non-traumatic pediatric OHCA cases in an emergency department setting. Methods. A retrospective analysis was conducted on 27 pediatric patients (mean age: 32.4 months; median age: 10 months) who experienced non-traumatic OHCA without prehospital ROSC and were transported to our tertiary care hospital between January 2013 and December 2023. WBCT scans were performed to investigate the cause of OHCA, with recorded findings in the head, chest, abdomen, and subcutaneous tissues. Results. In all cases, the direct causes of OHCA were undetermined, and WBCT identified no fatal findings. Statistical comparisons of CT findings between the ROSC and non-ROSC groups revealed significant differences. The non-ROSC group had a higher incidence of brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic walls, narrowed aorta, gas in the mediastinum, and hepatomegaly compared to the ROSC group. Conclusions. Although WBCT did not reveal the direct cause of OHCA, several CT findings were significantly more frequent in the non-ROSC group, including brain swelling, loss of cerebral gray-white matter differentiation, symmetrical lung consolidation/ground-glass opacity, cardiomegaly, hyperdense aortic wall, narrowed aorta, gas in the mediastinum, and hepatomegaly. These findings, resembling postmortem changes, may aid in clinical decision making regarding the continuation or cessation of resuscitation efforts in pediatric OHCA cases.

Background: Metallic and hyperdense artifacts and T1-shortening substances in the abdominal aortic aneurysm (AAA) sac generated by embolic materials and lipiodol pose challenges in the identification of endoleaks on follow-up computed tomography (CT) or magnetic resonance imaging (MRI)., Purpose: To evaluate the usefulness of contrast-enhanced subtraction MRI (CES-MRI) for detecting endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) with intraoperative AAA sac embolization compared with CE-CT, this study was conducted., Material and Methods: In this study, 28 consecutive patients who underwent EVAR with prophylactic AAA sac embolization were included. All patients underwent CES-MRI and CE-CT to detect endoleaks. The definitive diagnosis of endoleaks was a consensus reading of CE-CT and CES-MRI by two certified radiologists, in addition to angiography or reproducible radiological findings in the observational examination. Analysis was performed to evaluate which examination was better for detecting endoleaks., Results: The sensitivity, specificity, and area under the curve of CE-CT and CES-MRI according to observer 1 were 50%, 100%, and 0.813 (95% confidence interval [CI] = 0.625-1.00) and 100%, 95%, and 0.997 (95% CI = 0.984-1.00), respectively, and those according to observer 2 were 50%, 100%, and 0.750 (95% CI = 0.514-0.986) and 100%, 95%, and 0.969 (95% CI = 0.903-1.00), respectively. Intolerable artifacts were significantly observed on CE-CT. The severity of the artifacts did not depend on the stent graft on CT and MRI., Conclusion: Although no significant difference was observed, CES-MRI tended to have better accuracy for endoleak detection in EVAR with intraoperative AAA sac embolization than CE-CT., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: This study evaluates the diagnostic performance of the latest large language models (LLMs), GPT-4o (OpenAI, San Francisco, CA, USA) and Claude 3 Opus (Anthropic, San Francisco, CA, USA), in determining causes of death from medical histories and postmortem CT findings., Methods: We included 100 adult cases whose postmortem CT scans were diagnosable for the causes of death using the gold standard of autopsy results. Their medical histories and postmortem CT findings were compiled, and clinical and imaging diagnoses of both the underlying and immediate causes of death, as well as their personal information, were carefully separated from the database to be shown to the LLMs. Both GPT-4o and Claude 3 Opus generated the top three differential diagnoses for each of the underlying or immediate causes of death based on the following three prompts: 1) medical history only; 2) postmortem CT findings only; and 3) both medical history and postmortem CT findings. The diagnostic performance of the LLMs was compared using McNemar's test., Results: For the underlying cause of death, GPT-4o achieved primary diagnostic accuracy rates of 78%, 72%, and 78%, while Claude 3 Opus achieved 72%, 56%, and 75% for prompts 1, 2, and 3, respectively. Including any of the top three differential diagnoses, GPT-4o's accuracy rates were 92%, 90%, and 92%, while Claude 3 Opus's rates were 93%, 69%, and 93% for prompts 1, 2, and 3, respectively. For the immediate cause of death, GPT-4o's primary diagnostic accuracy rates were 55%, 58%, and 62%, while Claude 3 Opus's rates were 60%, 62%, and 63% for prompts 1,2, and 3, respectively. For any of the top three differential diagnoses, GPT-4o's accuracy rates were 88% for prompt 1 and 91% for prompts 2 and 3, whereas Claude 3 Opus's rates were 92% for all three prompts. Significant differences between the models were observed for prompt two in diagnosing the underlying cause of death (p = 0.03 and <0.01 for the primary and top three differential diagnoses, respectively)., Conclusion: Both GPT-4o and Claude 3 Opus demonstrated relatively high performance in diagnosing both the underlying and immediate causes of death using medical histories and postmortem CT findings., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board, The University of Tokyo Hospital issued approval 2076. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: This work was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant No. 23K07202, gained by Masanori Ishida, and No. 20K07989, gained by Wataru Gonoi. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ishida et al.)

Background: Research on the relationship between neuron-specific enolase (NSE) levels and normal organs, particularly the central nervous system, in small cell lung cancer is limited. Therefore, this study aimed to investigate the relationship between positron emission tomography-computed tomography (PET-CT) accumulation at hypothalamic/pituitary regions, tumor activity, and NSE level in limited-stage small cell lung cancer. We retrospectively analyzed patients who were diagnosed with limited-stage small cell lung cancer at Tokyo Medical University Hospital between July 1, 2019, and May 31, 2023, and were treated with chemoradiotherapy or radiotherapy. Leukocytes, erythrocytes, hemoglobin, platelets, total protein, albumin, NSE, and carcinoembryonic antigen were measured in blood samples obtained before treatment initiation. The maximum standardized uptake value (SUVmax), volume, and total lesion glycolysis (TLG) of each hypothalamic /pituitary region, primary tumor, and lymph node metastases were extracted from PET-CT images. The total tumor volume (primary tumor volume plus lymph node metastases volume) and total TLG (primary tumor TLG plus lymph node metastases TLG) were calculated., Results: This study included 19 patients (mean age, 70.1 ± 8.8 years; 13 men and 6 women); the pathology in all patients was small cell lung cancer. Patients were classified into two groups according to the NSE reference value (16.3 ng/mL): six patients having NSE level below the reference value and 13 having NSE level above the reference value. The SUVmax in the hypothalamic/pituitary region was 2.95 in the NSE < 16.3 ng/mL group and 4.10 in the NSE > 16.3 ng/mL group, with a statistically significant difference (p = 0.03). The total tumor volume was 17.8 mL in the NSE < 16.3 ng/mL group and 98.9 mL in the NSE > 16.3 ng/mL group, with a statistically significant difference (p < 0.01). A correlation coefficient of r = 0.458 (p = 0.0486) was observed between SUVmax in the hypothalamus/pituitary and NSE level. A correlation coefficient of r = 0.647 (p < 0.01) was also observed between total tumor volume and NSE level. Finally, a correlation coefficient of r = 0.53 (p = 0.01) was observed between hypothalamic/pituitary TLG and primary tumor TLG., Conclusions: The findings demonstrated a correlation between hypothalamic/pituitary activity and tumor activity, suggesting the prognostic significance of NSE., (© 2024. The Author(s).)

Objective: This study aims to retrospectively evaluate the outcomes of uterine artery embolization (UAE) for uterine fibroids (UFs), specifically submucosal UFs, according to the International Federation of Gynecology and Obstetrics (FIGO) classification of UFs., Materials and Methods: Forty-two patients with symptomatic UFs underwent UAE with Embosphere ® between July 2016 and November 2021. MRI was performed before, at 3 and 6 months after the UAE. At each examination, the volume of UF was measured, and the percentage volume reduction rate (VRR) was calculated. The technical success rate (TSR), symptom improvement rate (SIR), regrowth rate (RR) after 6 months, and adverse events (AEs) were examined; VRR was compared between patients with submucosal UFs (FIGO types 0-2, group A), those with submucosal contacts (FIGO type 3, group B), and those without submucosal UFs (FIGO types 4-7, group C). Statistical analysis was performed on the difference in VRR between groups A, B, and C at 3 and 6 months after UAE. The relationship with hormone levels before UAE and VRR was evaluated., Results: Thirty-seven of the 42 patients were evaluated. Overall, VRR was 37.0% at 3 months and 52.1% at 6 months; TSR, SIR, and RR were 100%, 95.2%, and 5.4%, respectively; VRR at 6 months was 80.7% for group A (n = 7), 57.8% for group B (n = 13), and 37.1% for group C (n = 17). Significant differences were found between A and C (p < 0.001) and B and C (p = 0.023). Hormone levels before UAE had no effect on VRR. There was no significant AEs other than grade 3 pulmonary embolism in one patient., Conclusion: UAE was effective for submucosal FIGO types 0-3. UAE was especially useful as an option for FIGO type 3 with a low protrusion rate that is difficult to treat with transcervical resection., (© 2023. The Author(s) under exclusive licence to Japan Radiological Society.)

Objective: To investigate the positron emission tomography/computed tomography (PET/CT) findings of T1/T2N0M0 glottic cancer (hereafter referred to as T1/T2) and dose distribution in radiotherapy., Subjects and Methods: We retrospectively collected data from patients diagnosed with T1/T2N0M0 glottic cancer who received radiotherapy. The extent of fluorine-18-fluorodeoxyglucose ( 18 F-FDG) accumulation in primary tumors, maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), tumor volume of primary tumors on PET/CT were compared. Furthermore, the tumor identified on PET/CT was incorporated into the radiotherapy plans. A dummy plan (radiation field 6x6cm, prescription point facing the vertebral body, maximum dose ≤107%, T1/T2 66Gy/33 fractions) was developed for three-dimensional conformal radiotherapy, and the dose distribution of primary tumors was calculated., Results: Twenty-nine patients (27 men and two women) were included; their mean age was 67.2±15.0 years. Increased 18 F-FDG accumulation in primary tumors was observed on PET/CT in 22/29 (78.5%; T1: 14/21 [67%], T2: 8/8 [100%]) patients. The median SUVmax, TLG, and primary tumor volume were significantly different between T1 and T2 (SUVmax, T1: 4.56 vs. T2: 8.43, P=0.035; TLG, T1: 1.01 vs. T2: 3.71 SUVxmL, P<0.01; primary tumor volume, T1: 0.38mL vs. T2: 0.80mL, P=0.01). At a TLG cut-off value of 3.470, the area under the curve was 0.875, sensitivity was 0.875, and specificity was 0.929 for T1-T2 differentiation. In 20 patients with 18 F-FDG accumulation, the minimum radiation dose was significantly different between T1 and T2 (66Gy vs. 64Gy, P<0.01) at the same 66Gy prescription. The minimum radiation dose and primary tumor volume show the correlation value (r=-0.516, P=0.02)., Conclusion: In glottic cancer, T1 and T2 can be differentiated by the extent of 18 F-FDG accumulation in primary tumors on PET/CT. The minimum radiation dose rate decreases as volume increases.

Purpose: We have developed a new microcatheter (designated "NSX") with an outer layer of polytetrafluoroethylene (PTFE) at its tip. We compared the adhesion of the new NSX microcatheter and a conventional microcatheter with n -butyl-2-cyanoacrylate (NBCA) in vitro and in swine blood vessels., Materials and Methods: The 3 cm tip of the NSX microcatheter is composed of PTFE, which can be identified by double platinum markers. The tips of the NSX and conventional microcatheters were inserted into a vascular model filled with porcine blood with no flow, and NBCA mixed with lipiodol (1:2) was injected from the microcatheters. Two minutes after the injection of NBCA, the microcatheter was withdrawn and the degree of its adhesion to NBCA was evaluated by measuring the resistance value (N) during catheter removal with a digital force gauge. These measurements were repeated with 20 catheters of each type. Similarly, 5 injections were performed with both the NSX and conventional microcatheters in swine vessels. The degree of adhesion of the catheter and blood vessel was evaluated by 2 radiologists under X-ray fluoroscopy on a 3-point scale: 1, no adhesion; 2, mild adhesion; 3, strong adhesion., Results: The mean resistance values (N) for the NSX and conventional microcatheters were 0.503±0.186 and 1.051±0.367 (N), respectively (p<0.001). The NSX adhered negligibly to the NBCA and was easily removed, whereas the conventional microcatheter adhered strongly to the NBCA in the blood vessels and was difficult to remove from the swine vessels (p=0.008)., Conclusions: The new NSX microcatheter with a PTFE tip exhibits poorer adhesion to NBCA than do conventional microcatheters and allows for safer injection of NBCA than conventional microcatheters, without requiring immediate catheter retrieval., Clinical Impact: The NSX microcatheter with a PTFE tip adheres less strongly to NBCA than do conventional microcatheters and allows the safe injection of NBCA. The NSX microcatheter has double platinum markers on its tip, which make it easy to distinguish the PTFE-covered region. As the NSX does not adhere firmly to the arterial wall, it is less likely to cause vascular injury during removal of the catheter compared with conventional microcatheters, so there is no need to remove the NSX immediately after injecting NBCA. Even operators unfamiliar with NBCA can use NBCA safely with this new NSX microcatheter without requiring special training or skill., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To determine the usefulness of CT-guided percutaneous drainage for the causative microorganism detection in patients with spondylodiscitis., Materials and Methods: Data of patients who underwent CT-guided percutaneous drainage for spondylodiscitis from January 2014 to April 2022 were extracted from the radiological database of our hospital and investigated. The administration rate of antibiotics prior to blood culture and CT-guided percutaneous drainage (CTPD) were analyzed. The detection rate of microorganisms via blood culture and CT-guided percutaneous drainage were compared using the Mann-Whitney's U test with the SPSS software., Results: In this study, a total of 30 (20 male and 10 female) patients were analyzed. A total of 13 patients (43%) were administered antibiotics prior to blood culture. Of them, microorganisms were detected via blood culture in only one patient (7%). A total of 25 patients (83%) were administered antibiotics prior to CTPD. Of them, the causative microorganisms in 19 patients (76%) were detected. Overall, the causative microorganism could be detected in 24 out of 26 patients (92%) via CT-guided percutaneous drainage. There was a statistical significance in the detection rate of microorganisms between blood culture and CTPD (P = 0.004) in favor of CTPD., Conclusion: CT-guided percutaneous drainage showed a high positive rate of microorganism detection in patients with spondylodiscitis regardless of antibiotic administration prior to the procedure. CT-guided percutaneous drainage can be a solution for the detection of the causative microorganism in spondylodiscitis patients who received antibiotics before obtaining any culture., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Purpose: To investigate the relationships between indications for thoracic endovascular aortic repair for acute/subacute complicated Stanford type B aortic dissection and clinical outcomes, and complications specific to thoracic endovascular aortic repair., Material and Methods: The J-predictive study retrospectively collected data of patients treated with thoracic endovascular aortic repair for complicated Stanford type B aortic dissection at 20 institutions from January 2012 to March 2017. From the database, those treated for acute/subacute complicated Stanford type B aortic dissection were extracted (n = 118; 96 men; average age, 66.1 years; standard deviation, ± 13) and classified into groups 1, 2, and 3 according to thoracic endovascular aortic repair indications (rupture, superior mesenteric artery malperfusion, and renal or lower extremity malperfusion, respectively). Primary and secondary measures were mortality (overall and aortic-related) and complications related to thoracic endovascular aortic repair, respectively. For each outcome, the risks of being in groups 1 and 2 were statistically compared with that of being in group 3 as a control using Fisher's exact test., Results: Mortality rate (odds ratio, 5.22; 95% confidence interval [CI], 1.33-20.53) and prevalence of paraparesis/paraplegia (odds ratio, 30.46; confidence interval, 1.71-541.77) were higher in group 1 than in group 3. Compared to group 3, group 2 showed no statistically significant differences in mortality or complications related to thoracic endovascular aortic repair., Conclusions: Rupture as an indication for thoracic endovascular aortic repair for type B aortic dissection was more likely to result in worse mortality and high prevalence of spinal cord ischemia., Level of Evidence: Level 4, Case series., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).)

Purpose: To determine the optimal ratio of n-butyl cyanoacrylate (NBCA)-Lipiodol-ethanol (NLE) mixture for balloon-assisted embolization of wide-neck aneurysms., Materials and Methods: We created 32 wide-neck aneurysms on both the common carotid arteries and external iliac arteries in eight female swine. Eight aneurysms were randomly assigned to four groups. Under balloon occlusion, the aneurysms were packed using NLE at one of four ratios of NLE: 2:2:1 (NLE221; 40%NBCA); 3:6:1 (NLE361; 30%NBCA); 2:7:1 (NLE271; 20%NBCA); and 1:5:1 (NLE151; 14.3%NBCA). We performed angiography before and after embolization to assess the aneurysms, and we compared adhesion between NLE and the balloon and assessed NLE migration. Three days after embolization, the aneurysms were removed for histopathologic evaluation., Results: Embolization was performed in 27 aneurysms. Adhesion between NLE and the balloon was not observed in any group. NLE migration was found in 0/7 aneurysms in the NLE221 group, 0/6 in the NLE361 group, 5/6 in the NLE271 group, and 7/8 in the NLE151 group. NLE migration was significantly lower in the NLE221 group than in the NLE271 and NLE151 groups (P = 0.0047 and 0.0014, respectively) and was significantly lower in the NLE361 group than in the NLE271 and NLE151 groups (P = 0.0152 and 0.0047, respectively). Media necrosis of the arterial wall close to the aneurysms was observed in all groups., Conclusion: NLE with an NBCA concentration of ≥ 30% is a safe and feasible embolic material for balloon-assisted embolization of wide-neck aneurysms in swine in the short term up to 3 days after embolization.

An 80-year-old female underwent EVAR 4 years ago. She presented type II endoleak with sac expansion from 68 to 80 mm during 3-year follow-up after EVAR. Although she underwent translumbar percutaneous sac embolization, the AAA sac continued to enlarge, suggesting mixed-type endoleak including type I, II, and III. Transgraft direct sac angiography revealed endoleak cavity without demonstrable feeding vessel. Transgraft sac embolization using n-butyl cyanoacrylate and graft reinforcement was performed concurrently, without complications. The graft reinforcement consisted of graft extension for eliminating occult type I endoleak, and relining for eliminating occult type III endoleak. Six months after the procedure, CT showed no signs of sac expansion. Transgraft sac embolization combined with graft reinforcement is one of the available options for persistent and refractory mixed-type endoleak.

Background: Femoral pseudoaneurysm (PA) is a frequent complication of arterial access for endovascular procedures. Surgery has traditionally been considered as the gold standard of therapy. We aimed to report our experience of percutaneous ultrasound (US)-guided balloon-assisted embolization with cyanoacrylate glue for the treatment of iatrogenic femoral PAs., Methods: Retrospective two-center study of patients with femoral iatrogenic PAs treated by N-butyl cyanoacrylate-methacryloxy sulfolane (NBCA-MS) Glubran ® 2 glue embolization between July 2013 and November 2017. All patients underwent contralateral arterial access with balloon placement of an appropriate size in front of the PA neck before glue/lipiodol embolization in a 1:1 ratio by percutaneous US-guided puncture of the aneurysmal sac under fluoroscopy control., Results: Twenty-three patients (12 females, 11 males; median age, 79 years; range, 18-93 years) were included. Median PA size was 34 mm (range, 17-60 mm). The median time to treatment was 5 days (range, 1-30 days). Twenty patients (86.9%) were successfully treated by glue injection alone. The three remaining patients (13.1%) with persistent PA or associated arterial-venous fistula were immediately treated during the same procedure by additional stent-graft. Then, overall immediate and 1-month clinical success rates were 100%. No surgical conversion was necessary. No recurrence was reported during the median follow-up of 11 months (range, 2-73 months). Two (8.7%) puncture-related complications occurred at the contralateral arterial access site, which spontaneously resolved. No non-target glue embolization occurred., Conclusions: US-guided balloon-assisted glue embolization is safe and effective to treat iatrogenic femoral PAs in most cases, offering complete exclusion of the PA and avoiding the morbidity of open surgery., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Purpose: To determine the feasibility of prophylactic intraoperative abdominal aortic aneurysm (AAA) sac embolization using a mixture of N-butyl cyanoacrylate/Lipiodol/ethanol (NLE) with proximal neck aortic balloon occlusion during endovascular aneurysm repair (EVAR) to prevent the occurrence of endoleak and aneurysm sac expansion., Materials and Methods: Prophylactic intraoperative AAA sac embolization was performed in 24 patients with an infrarenal neck angulation > 60° (n = 16) or AAA sac diameter > 60 mm (n = 17). AAA sac pressure was continuously measured with a 3-F catheter inserted into the AAA sac. The systolic sac pressure index (SPI) was calculated as the ratio of systolic AAA sac pressure to the simultaneously measured systolic aortic pressure, and was measured with and without proximal neck aortic balloon occlusion. The aneurysm sac was embolized with NLE during proximal neck aortic balloon occlusion immediately after EVAR. Endoleak and AAA sac diameter were evaluated by enhanced computed tomography and subtraction magnetic resonance imaging at 6 months and yearly after EVAR., Results: Mean SPIs after EVAR with and without proximal neck aortic balloon occlusion were 0.36 and 0.57, respectively. There were no adverse events related to intraoperative sac embolization. Follow-up imaging (mean, 12.1 mo) revealed three minor endoleaks (12.5%) and no aneurysm sac expansion., Conclusions: Prophylactic intraoperative sac embolization with NLE during proximal neck aortic balloon occlusion was safe and feasible and may reduce endoleaks and prevent sac expansion after EVAR in patients with unfavorable anatomic factors., (Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR)., Materials and Methods: We performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks., Results: Data were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greater in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was -4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002)., Conclusion: Patients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.

Purpose: To evaluate the feasibility of balloon-assisted packing with a mixture of n-butyl cyanoacrylate (NBCA), Lipiodol, and ethanol for wide-neck aneurysms., Materials and Methods: Of 10 carotid aneurysms with wide necks created in a swine model, 3 aneurysms (long and short diameters 10.9 × 9.8 mm; neck width 8.3 ± 1.2 mm (mean ± SD)) and 7 aneurysms (11.2 × 9.5 mm; neck width 8.3 ± 1.4 mm) were packed with a mixture of NBCA, Lipiodol, and ethanol in the ratios 1:1:0 (NL11) and 1:1:2 (NLE112), respectively. A microcatheter was advanced into the aneurysm and a balloon catheter was inflated at the aneurysm neck. Ten minutes after injection, the balloon catheter was deflated and its removal was attempted., Results: For all three aneurysms in the NL11 group, the balloon catheter and the microcatheter adhered strongly to the vessel and could not be adjusted. For all seven aneurysms in the NLE112 group, both the balloon catheter and the microcatheter could be easily removed, which enabled successful full packing of the aneurysm by re-advancing the microcatheter and re-injecting NLE112 after re-inflation of the balloon catheter., Conclusion: Although at a preliminary stage, balloon-assisted NLE injection is feasible for packing a wide-neck aneurysm.

We report the case of a 69-year-old woman with reactive lymphoid hyperplasia (RLH) of the liver. She underwent partial hepatectomy under a preoperative diagnosis of hepatocellular carcinoma; however, histopathological analysis revealed RLH. The liver nodule showed the imaging feature of perinodular enhancement in the arterial dominant phase on contrast-enhanced computed tomography and magnetic resonance imaging, which could be a useful clue for identifying RLH in the liver. Histologically, the perinodular enhancement was compatible with prominent sinusoidal dilatation surrounding the liver nodule.

Objective: The purpose of this study was to assess the utility of (99m)Tc-human serum albumin diethylenetriamine pentaacetic acid ((99m)Tc-HSAD) SPECT in the detection of endoleaks after endovascular abdominal aortic aneurysm repair., Subjects and Methods: Fifteen patients (11 men, four women) with aneurysm sac expansion of 5 mm or greater after endovascular abdominal aortic aneurysm repair underwent three-phase CT, (99m)Tc-HSAD SPECT, and CT during aortography. Sensitivity calculations for three-phase CT and (99m)Tc-HSAD SPECT were performed with CT during aortography as the reference standard. The volume of each endoleak was measured with CT during aortography. Seven subjects underwent embolization with N-butyl cyanoacrylate (NBCA)-Lipiodol (ethiodized oil, Guerbet and metallic coils. Three-phase CT and (99m)Tc-HSAD SPECT were repeated after embolization to assess their efficacy., Results: Endoleaks were interpreted as perigraft radioisotope accumulation in 12 patients (80.0%) on (99m)Tc-HSAD SPECT images, in 13 patients (86.7%) on three-phase CT images, and in 15 patients (100%) on CT during aortography. The mean endoleak volume visualized with (99m)Tc-HSAD SPECT was 8.37 cm(3) (range, 5.2-15.1 cm(3)), and the volume not visualized was 3.47 cm(3) (2.5-4.6 cm(3)), a statistically significant difference (p = 0.019). In two patients, (99m)Tc-HSAD SPECT depicted endoleaks evident at delayed phase CT during aortography but not at three-phase CT, suggesting they were slow-filling endoleaks. Accumulation of (99m)Tc-HSAD corresponding to endoleaks disappeared after embolization, but CT evaluation of embolization was impeded by artifacts of NBCA-Lipiodol and metallic coils., Conclusion: Technetium-99m-labeled HSAD SPECT proved less sensitive than three-phase CT but depicted endoleaks with volumes 5.2 cm(3) or greater as perigraft radioisotope accumulation. Slow-filling endoleaks can be visualized with (99m)Tc-HSAD SPECT, which can be used to evaluate the efficacy of embolization.

Purpose: To compare therapeutic effect, adverse events, and embolized hepatic artery impairment in transcatheter arterial chemoembolization between Lipiodol plus insoluble gelatin sponge particles (Gelpart) and Lipiodol plus 2-day-soluble gelatin sponge particles (2DS-GSPs)., Materials and Methods: In a single-center, prospective, randomized controlled trial, patients with hepatocellular carcinoma were assigned to the 2DS-GSP group or the Gelpart group. Radiographic response at 3 months per modified Response Evaluation Criteria In Solid Tumors was evaluated as the primary endpoint; secondary endpoints were safety (per Common Terminology Criteria for Adverse Events, version 4.0) within 3 months and hepatic branch artery impairment at the time of repeat chemoembolization (grade 0, no damage; grade I, mild vessel wall irregularity; grade II, overt stenosis; grade III, occlusion of more peripheral branch artery than subsegmental artery; grade IV, occlusion of subsegmental artery). Grade II, III, or IV indicated significant hepatic artery impairment., Results: Thirty-seven patients with 143 nodules were randomized to the 2DS-GSP group and 36 patients with 137 nodules were randomized to the Gelpart group. No significant differences in patient background existed between groups. Target lesion response and overall tumor response in the 2DS-GSP and Gelpart groups were 77.7% versus 76.9% and 78.3% versus 77.8%, respectively, with no significant differences. No significant difference in adverse events existed between groups. Hepatic artery impairment was observed in 5% of patients in the 2DS-GSP group (n = 32) and in 16% in the Gelpart group (n = 33; P< .001)., Conclusions: Transcatheter arterial chemoembolization with 2DS-GSPs resulted in the same therapeutic and adverse effects as chemoembolization with Gelpart while causing significantly less hepatic artery impairment., (Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the effectiveness and safety of emergency balloon-occluded retrograde transvenous obliteration (BRTO) for ruptured gastric varices., Methods: Emergency BRTO was performed in 17 patients with gastric varices and gastrorenal or gastrocaval shunts within 24 h of hematemesis and/or tarry stool. The gastric varices were confirmed by endoscopy, and the gastrorenal or gastrocaval shunts were identified by contrast-enhanced computed tomography (CE-CT). A 6-Fr balloon catheter (Cobra type) was inserted into the gastrorenal shunt via the right internal jugular vein, or into the gastrocaval shunt via the right femoral vein, depending on the varices drainage route. The sclerosant, 5% ethanolamine oleate iopamidol, was injected into the gastric varices through the catheter during balloon occlusion. In patients with incomplete thrombosis of the varices after the first BRTO, a second BRTO was performed the following day. Patients were followed up by endoscopy and CE-CT at 1 d, 1 wk, and 1, 3 and 6 mo after the procedure, and every 6 mo thereafter., Results: Complete thrombosis of the gastric varices was not achieved with the first BRTO in 7/17 patients because of large gastric varices. These patients underwent a second BRTO on the next day, and additional sclerosant was injected through the catheter. Complete thrombosis which led to disappearance of the varices was achieved in 16/17 patients, while the remaining patient had incomplete thrombosis of the varices. None of the patients experienced rebleeding or recurrence of the gastric varices after a median follow-up of 1130 d (range 8-2739 d). No major complications occurred after the procedure. However, esophageal varices worsened in 5/17 patients after a mean follow-up of 8.6 mo., Conclusion: Emergency BRTO is an effective and safe treatment for ruptured gastric varices.

We quantified to clarify the optimum factors for CT image reconstruction of an enhanced hepatocellular carcinoma (HCC) model in a liver phantom obtained by multi-level dynamic computed tomography (M-LDCT) with 64 detector rows. After M-LDCT scanning of a water phantom and an enhanced HCC model, we compared the standard deviation (SD, 1 ± SD), noise power spectrum (NPS) values, contrast-noise ratios (CNR), and the M-LDCT image among the reconstruction parameters, including the convolution kernel (FC11, FC13, and FC15), post-processing quantum filters (2D-Q00, 2D-Q01, and 2D-Q02) and slice thicknesses/slice intervals. The SD and NPS values were lowest with FC11 and 2D-Q02. The CNR values were highest with 2D-Q02. The M-LDCT image quality was highest with FC11 and 2D-Q02, and with slice thicknesses/slice intervals of 0.5 mm/0.5 mm and 0.5 mm/0.25 mm. The optimum factors were the FC11 convolution kernel, 2D-Q02 quantum filter, and 0.5 mm slice thickness/0.5 mm slice interval or less.