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The failure rate following prostate artery embolization (PAE) is around 20%, which may in part result from inadequate embolization. Prostate contrast retention (PCR) adequacy on immediate post-embolization cone-beam CT may provide better assessment of embolization completeness than arterial contrast stasis seen on fluoroscopy alone. The aim of this study was to evaluate outcomes of PAE using PCR adequacy as the procedural endpoint. A retrospective cohort study of all PAE cases using this technique at a single large volume center was conducted. Following initial embolization of the main prostatic arteries, if PCR was inadequate, additional embolization was performed. Technical success (adequate PCR) was defined as > 75% global prostate gland contrast staining. Clinical success was determined in accordance to CIRSE standards of practice. One hundred sixty-five patients (mean age 68 ± 8.4 years) underwent PAE from June 2017 to March 2019. Technical and clinical success rates were 98.8% and 96.4% respectively. Clinical success rate was significantly higher in patients with adequate PCR. International Prostate Symptom Scores (IPSS) and Quality of Life (QoL) scores significantly improved at 1-, 3-, 6-, and 12-month follow-up when compared to baseline. Prostate volume (PV) and post-voiding residual bladder volume were significantly reduced at 3, 6, and 12 months in comparison to baseline. Mild (Clavien-Dindo grade I/II) and moderate (grade III) complication rates were 12.1% and 3.6% respectively. By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates. • By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.

PURPOSE To evaluate the feasibility, efficacy, and tolerance of self-expanding metallic stent insertion under fluoroscopic guidance for palliation of symptoms related to malignant gastroduodenal obstruction. MATERIALS AND METHODS Seventy-two patients (38 men, 34 women) aged 25–98 years (mean, 62 years) with duodenal ( n = 43), antropyloric ( n = 13), surgical gastrojejunostomy ( n = 10), or pyloroduodenal ( n = 6) malignant obstruction were referred for insertion of self-expanding metallic stents over a 6-year period. Stent insertion was performed with use of a peroral or transgastric approach when necessary ( n = 11). RESULTS Stents were successfully inserted in 70 of the 72 patients (97%) and provided symptom relief in 65 patients (90%). Inserted stents were mainly uncovered vascular ( n = 55) or enteral ( n = 10) Wallstents. One hundred eight stents were initially inserted: one, two, three, or four stents were indicated in 43, 17, nine, and one patient, respectively. Mean follow-up was 119 days (range, 4–513 days). Mean stent patency was 113 days (range, 4–513 days). Mean survival of patients was 120 days. During follow-up, stent obstruction occurred in seven patients as a result of tumoral overgrowth ( n = 5) or ingrowth ( n = 2). Complications occurred in 12 of the 72 patients (17%), including stent migration ( n = 8), stent fracture ( n = 1), duodenal perforation ( n = 1), and death related to general anesthesia ( n = 1). CONCLUSION Despite a significant complication rate, self-expanding metallic stent insertion under fluoroscopic guidance appears to be a feasible and useful technique in the palliative management of malignant gastroduodenal obstruction.

Our objective was to describe the technical aspects and evaluate the feasibility, safety, and efficacy of endovascular management of mechanical complications related to implanted central venous devices.One hundred fifty-six patients with cancer, who ranged in age from 3 months to 75 years (mean +/- SD, 47 +/- 18 years), were referred 290 +/- 200 days (mean +/- SD; range, 0-1202 days) after central venous device placement for retrieval of a fractured and embolized central venous device catheter (n = 100), retrieval of a guidewire embolized during placement of a central venous device (n = 2), repositioning of the migrated tip of a central venous device catheter (n = 38), and fibrin-sheath stripping (n = 16). All procedures were performed with the patient under local anesthesia on an outpatient basis, except for the eight pediatric patients.Ninety-five of the 100 embolized catheters and both of the guidewires were successfully retrieved. Retrieval was preceded by repositioning the embolized catheter with a pigtail catheter in 48 of these cases. Most of the procedures were performed with standard vascular tools (loop snares and pigtail catheters); the use of more sophisticated devices (grasping forceps, baskets, or balloons) rarely overcame the failure of a loop snare. Repositioning a migrated catheter tip was achieved with a pigtail catheter in 32 of 38 attempts. Of the repositioned catheters, only 24 could be used. Most of the 11 repositioning and retrieval failures were encountered because the catheter lacked a free end. Fibrin-sheath stripping was always technically successful: all these catheters were patent at 3-month follow-up. No procedure-related complications occurred.The endovascular approach is highly feasible, safe, and effective for the management of mechanical complications of central venous devices. It is probably advisable to reserve endovascular repositioning for port catheters that are cumbersome to exchange and to replace simple catheters.

AIMS: The hepatic venous pressure gradient is a major prognostic factor in portal hypertension but its measurement is complex and requires invasive angiography. This study investigated the relationship between the hepatic venous pressure gradient and a number of Doppler measurements, including the arterial acceleration index. METHOD: We measured the hepatic venous pressure gradient in 50 fasting patients at hepatic venography. Immediately afterwards, a duplex sonographic examination of the liver was performed at which multiple measurements and indices of the venous and arterial hepatic vasculature were made. RESULTS: Hepatic arterial acceleration was correlated directly with the hepatic venous pressure gradient ( r = 0.83, P 0.0001) and with the Child–Pugh score ( r = 0.63, P 0.0001). An acceleration index cut-off value of 1m.s −2 provided a positive predictive value of 95%, a sensitivity of 65% and a specificity of 95% for detecting patients with severe portal hypertension (hepatic venous pressure gradient>12mmHg). A correlation between the hepatic venous pressure gradient and the congestion index of the portal vein velocity ( r = 0.45,P = 0.01) and portal vein velocity ( r = 0.40, P = 0.044), was also noted. CONCLUSION: Measuring the hepatic arterial acceleration index may help in the non-invasive evaluation of portal hypertension . Tasu, J-P. etal . (2002). Clinical Radiology 57 , 746–752.

We assess the feasibility, safety and efficacy of radio frequency ablation of small peripheral renal cell carcinomas.Five patients with a histologically proven renal cell carcinoma 30 to 40 mm. in diameter were treated with radio frequency ablation. A triple needle electrode was percutaneously advanced into each tumor under sonographic (4 cases) or computerized tomography (CT) (1) guidance. The radio frequency generator was activated for 15 minutes in each location where the electrode had been placed. Patients were then followed with CT and blood tests every 2 months for 6 months and every 3 months thereafter.Four tumors required 1 radio frequency delivery and 1 required 2 applications during the same session. No complications were encountered except for a subcapsular hematoma in 1 patient, which resolved spontaneously. Two patients experienced transient hematuria. Of the patients 4 were discharged from the hospital after 2 days and 1 after 1 day. After 6 to 18 months (median 9) all patients were tumor-free on CT without suppress additional treatment.In this small preliminary study radio frequency ablation of small peripheral renal cell carcinomas appears to be a feasible, safe and promising technique.

We evaluate the efficacy of transcatheter ethanol renal ablation for destruction of a unilateral, poorly functioning kidney with persistent urinary leaks from fistulas or a nephrostomy tube.From January 1992 to January 1999, 19 females and 1 male with a history of pelvic neoplasms, which were responsible for ureteral leaks through the nephrostomy tube in 13 cases or fistulas in 7, were treated with transcatheter ethanol renal ablation. Serum creatinine ranged from 60 to 140 micromol./l. (mean 90), and function of the involved kidney determined by diethylenetetraminepentaacetic acid scintigraphy in 16 patients or by morphological imaging in 4 was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After epidural anesthesia or intravenous sedation renal ablation was performed by catheterization of the renal artery and injection of 1. 5 to 12 ml. (mean 4.6) absolute ethanol, and completed by proximal occlusion with coils and absorbable gelatin sponge.Arterial flow was interrupted in all cases. Urinary flow ceased in 2 days in 18 of 20 patients, and drains were removed. Two patients had residual urine that was successfully treated with additional embolization. No complications occurred.Transcatheter ethanol renal ablation is safe and effective, and permits an in situ nephrectomy that can replace surgical nephrectomy for treatment of urinary leaks.

To evaluate the efficacy and safety of intraarterial hepatic iodine 131 iodized oil for treatment of hepatocellular carcinoma in patients with impeded portal venous flow.Twenty-four patients (mean age, 61 years) with hepatocellular carcinoma underwent 38 courses of 131I iodized oil (one to three per patient), with a mean dose of 2,146 MBq injected into the proper hepatic artery. Hepatocellular carcinoma manifested as single nodules (n = 8; mean, 7.75 cm), multiple nodules (n = 13; mean, 5.46 cm), or a mass (n = 3) occupying more than two hepatic segments. Portal venous thrombosis was complete (n = 10), right (n = 9), left (n = 2), or multisegmental (n = 1). Two patients had hepatofugal portal flow.Among the 23 patients with evaluable results, response to treatment was partial in three, and disease was stable in 12 and progressive in eight. Estimated actuarial survival rates were 70%, 33%, 12%, and 6% at 3, 6, 9, and 12 months, respectively, with two patients alive at 9 and 11 months. The median survival time was 147 days. Adverse events were the early death of one patient owing to hepatic failure and transient symptomatic hepatic failure after 12 courses in nine patients.In this preliminary experience, intraarterial hepatic 131I iodized oil did not demonstrate high efficacy in the treatment of hepatocellular carcinoma in patients with portal venous thrombosis, as side effects were not rare.

OBJECTIVE: Our objective was to evaluate the efficacy of self-expanding metallic stents as palliative treatment in 10 patients with malignant stenosis of the stomach (n = 2) or the duodenum (n = 8). CONCLUSION: Metallic stents appeared valuable for the treatment of malignant gastroduodenal stenosis in this preliminary study because they provided durable relief of symptoms in eight of 10 patients for a mean of 93 days, until death. Particular attention should be paid to evaluating the digestive tract meticulously downstream because this zone was the cause of failure in two patients. Further studies are needed using a larger series.

We report a case of a spontaneous rupture of a normal stomach after therapeutic oxygen administration. In this case, early treatment precluded the need for a laparotomy. This rare complication highlights the importance of the right positioning of a nasal catheter and leads us to question its role compared to other means of oxygen delivery (nasal cannulae, Hudson mask, Venturi mask).

BACKGROUND AND PURPOSE: Lack of cerebral circulation is an important confirmatory test for brain death (BD). Conventional angiography remains the standard imaging method, but CT angiography (CTA) is emerging as an alternative. France accepts BD diagnoses relying on a score based on lack of opacification of 7 intracerebral vessels in CTA images. The purpose of this study was to validate the efficiency of this score and to evaluate the sensitivity of a novel 4-point CTA score in confirming BD. MATERIALS AND METHODS: A prospective multicentric study was conducted during 12 months with 105 patients referred for CTA to confirm a clinical diagnosis of BD. Clinical data were recorded. CTA images were interpreted first by local radiologists at the referent center, resulting in a 7-point score based on lack of opacification of the pericallosal and cortical segments of the middle cerebral arteries (MCAs), internal cerebral veins (ICVs), and 1 great cerebral vein per patient and, second, by a consensus panel of 3 expert radiologists, blinded to the initial scores, resulting in novel 4-point scores based on the lack of opacification of the cortical segments of the MCAs and ICVs. RESULTS: Injection of contrast medium did not alter renal function. With the initial 7-point score, sensitivity was 62.8%. With the simplified 4-point score, sensitivity was 85.7% and specificity was 100%. Opacification of ICVs was absent in 98.1% of patients. CONCLUSIONS: Lack of opacification in the cortical segments of the MCAs and internal veins in CTA is efficient and reliable for confirming BD.

Summary Objectives To investigate radiological response and findings after Intra Arterial Chemotherapy (IAC) for patients with Squamous Cell Carcinoma (SCC) of the oral cavity. Materials and methods Patients received 1-2 cycles of IAC. Radiological assessment was performed on day 7 and day 21 after each cycle using CT scan and MRI. Results Six patients (median age: 52, ranging 46-60; male/female: 5/1) received 10 cycles (4 patients received 2 cycles). Primary tumors were floor of the mouth (4 patients) and oral tongue (2 patients). TNM classification was T2N0-2b in 3 patients and T4N0-1 in 3 patients. All patients had good locoregional/systemic tolerance and 3 showed clinical objective response (OR). Four patients were evaluable on both CT and MRI, 1 patient on MRI only and 1 patient did not tolerate imaging. Three patients showed OR both on CT and MRI, 1 patient showed stable disease (SD) on CT and OR on MRI and 1 patient showed SD on MRI. Contrast-enhancement of hemiperfused tongue was reported in all evaluable patients. Two patients presented intratumoral necrosis and 5 patients displayed local edema (MRI). One patient had modification of the sternocleidomastoid muscle after IAC. Conclusion Radiological modifications were observed in the infused area and correlated well with clinical response. This study is ongoing.

We describe the rates and potential risk factors of complications of radiofrequency ablation of hepatic tumors. SUBJECTS AND METHODS. Over a 5-year period, 312 patients underwent 350 sessions of radiofrequency ablation (124 intraoperative and 226 percutaneous) for treatment of 582 liver tumors including 115 hepatocellular carcinomas and 467 metastatic tumors. The chi-square test was used for a group-to-group comparison of the occurrence of adverse events.Thirty-seven (10.6%) adverse events and five (1.4%) deaths were related to radiofrequency treatment. The deaths were caused by liver insufficiency (n = 1), colon perforation (n = 1), and portal vein thrombosis (n = 3). Portal vein thrombosis was significantly (p0.00001) more frequent in cirrhotic livers (2/5) than in noncirrhotic livers (0/54) after intraoperative radiofrequency ablation performed during a Pringle maneuver. Liver abscess (n = 7) was the most common complication. Abscess occurred significantly (p0.00001) more frequently in patients bearing a bilioenteric anastomosis (3/3) than in other patients (4/223). We encountered five pleural effusions, five skin burns, four hypoxemias, three pneumothoraces, two small subcapsular hematomas, one acute renal insufficiency, one hemoperitoneum, and one needle-tract seeding. The 6.3% of minor complications did not require specific treatment or a prolonged hospital stay. Among the 5.7% major complications, 3.7% required less than 5 days of hospitalization for treatment or surveillance and 2% required more than 5 days for treatment.Radiofrequency ablation of liver tumors is a well-tolerated technique, but caution should be exercised when treating patients with a bilioenteric anastomosis, and radiofrequency ablation during vascular occlusion in cirrhotic livers should be avoided.

We report a case of a spontaneous rupture of a normal stomach after therapeutic oxygen administration. In this case, early treatment precluded the need for a laparotomy. This rare complication highlights the importance of the right positioning of a nasal catheter and leads us to question its role compared to other means of oxygen delivery (nasal cannulae, Hudson mask, Venturi mask).

To describe the appearance of hepatic tumors treated with radio-frequency (RF) ablation on computed tomographic (CT) and magnetic resonance (MR) images and the pattern of residual tumor at the site of RF ablation and to assess prospectively the sensitivity, specificity, and positive and negative predictive CT and MR imaging values in the evaluation of RF treatment.Thirty-one patients with 50 tumors (nine hepatocellular carcinomas and 41 metastases) treated with RF ablation underwent CT and MR imaging on the same day at 2, 4, and 6 months; CT was performed every 3 months thereafter. CT and MR findings were interpreted separately and prospectively by two reviewers with consensus. For both imaging techniques, appearance of the treated area, treatment efficacy, and complications were assessed at each time. Sensitivity and specificity were determined by using the McNemar test.After a mean follow-up of 19 months, nine tumors showed local regrowth. At 2 months, MR imaging depicted more local regrowths (eight of nine; sensitivity, 89%) than did CT (four of nine; sensitivity, 44%) but without significant differences (P =.12). In two cases, only T2-weighted imaging depicted local regrowth. All nine lesions became conspicuous at 4-month follow-up with both techniques. At 2 months, thin peripheral rim enhancement and arterioportal shunting were found in 24% and 12%, respectively, of the treated tumors. These findings disappeared thereafter and are not linked to tumor regrowth.Despite the small number of patients, CT and MR imaging may depicted all local regrowth at 4 months or sooner. MR imaging may have an edge over CT in the early detection of local regrowth.

The objective of our study was to evaluate the efficacy and safety of radiofrequency ablation of hepatic metastases performed either percutaneously for treatment of hepatic metastases in patients deemed ineligible for surgery or intraoperatively during partial hepatectomy to destroy unresectable metastases.Sixty-eight patients with 121 hepatic metastases (5 metastases per patient) that were mainly colorectal in origin underwent 76 sessions of radiofrequency ablation with cooled-needle electrodes under sonographic guidance. Twenty-one patients with 33 metastases of 5-20 mm in diameter (mean +/- SD,13 +/- 7 mm) underwent intraoperative radiofrequency ablation. Forty-seven patients with 88 metastases of 10 to 42 mm in diameter (mean +/- SD, 26 +/- 9 mm) were treated with percutaneous radiofrequency ablation. Procedure efficacy was evaluated with dynamic enhanced CT and MR imaging performed 2, 4, and 6 months after treatment and then every 3 months.Radiofrequency ablation allowed eradication of 91% of the 100 treated metastases that were followed up for 4-23 months (mean, 13.7 months). Tumor control was equivalent for percutaneous radiofrequency ablation (90%) and for intraoperative radiofrequency ablation (94%). Failure to achieve tumor control occurred mostly with the largest tumor nodules. One bilioperitoneum and two abscesses were the major complications encountered after treatment of 121 metastases with a follow-up of more than 2 months.Radiofrequency ablation appears to be a promising therapeutic modality capable of extending the possibilities of partial hepatectomy and of efficiently treating small metastases percutaneously.

To evaluate the feasibility, complications, adequacy of feeding support, and tolerability of fluoroscopically guided gastrostomy in cancer patients.Five hundred cancer patients were referred for fluoroscopically guided gastrostomy, among whom percutaneous endoscopic gastrostomy was contraindicated or had been unsuccessful in approximately one-fourth. Five hundred eight fluoroscopically guided gastrostomies with T-fastener gastropexy were performed in 496 patients. The procedure was unsuccessful in four patients, and 12 patients needed a second gastrostomy.Fluoroscopically guided gastrostomy was feasible in 99% of patients. During the first 30 postprocedure days, there were seven major complications (1.4%): cardiac failure (n = 1), hemorrhage (n = 1), and peritonitis (n = 5); one patient died of peritonitis. No major complications occurred after the 30th postprocedure day. There were 27 minor complications (5.4%) during the first 30 postprocedure days and 88 (17.6%) thereafter. Long-term minor complications mainly involved the disturbances and nearly always resolved once the tube was exchanged. Such exchanges were easily performed under fluoroscopic guidance except in two patients, who required repeat fluoroscopically guided gastrostomy.Fluoroscopically guided gastrostomy is highly feasible and safe and provides adequate feeding support, even when percutaneous endoscopic gastrostomy is impossible. Long-term complications, which are mainly tube disturbances, are easily treated.

To evaluate the efficacy of metallic stents for palliation of malignant gastro-duodenal stenosis.Twenty-three patients aged from 36 to 88 years old presented with nausea, vomiting and weight loss due to duodenal (n = 16) or antro-pyloric (n = 7) malignant stenosis and underwent placement of 37 Wallstents (1 to 3 per patient) under fluoroscopic guidance.After initial stent placement 17 patients had normal food intake. One patient was able to eat fractionated meals. Five patients did not experience any improvement due to the presence of a jejunal stenosis downstream in 2, or insufficient stenosis coverage in 2 and stent migration in 1. Nine of the 18 patients with improvement died without symptoms within 101 +/- 56 days after stent placement and 6 were alive and symptom-free after a mean follow up of 176 +/- 83 days. Three asymptomatic patients were lost to follow up after 3 days, 1 and 2 months, respectively.Metallic stents appear to be a valuable option for the treatment of malignant gastro-duodenal stenoses.

Objectifs pedagogiques Connaitre les complications classiques et specifiques de la radiofrequence des tumeurs hepatiques. Reconnaitre l’imagerie des complications de la radiofrequence hepatique. Reconnaitre les signes d’echec ou de recidive locale. Savoir prevenir et eviter les complications de la radiofrequence hepatique. Messages a retenir Entre janvier 2004 et mars 2007,200 radiofrequences ont ete realisees. Un scanner et une IRM a 1 et 3 mois puis tous les 6 mois ont ete realises de facon systematique. En cas de localization dangereuse, un scanner dans les 24 heures etait realise. L’imagerie a permis de faire le diagnostic d’epanchement pleural, d’hemothorax, de plaie diaphragmatique, de dissemination tumorale sur le trajet de l’aiguille, de stenose biliaire, de thrombus porte, d’abces hepatique, de fistule, d’infarctus hepatique et de perforation colique.

Objectifs Valider les sequences d’angiographie sans produit de contraste dans le bilan pretherapeutique des arteriopathies symptomatiques. Materiels et methodes Etude de 10 patients presentant une arteriopathie obliterante stade> 2 de Leriche et Fontaine adresses pour cartographie pre-angioplastie ou chirurgie. Des sequences preparatoires couplees a l’ECG utilisant un gradient de dephasage permettent de definir les conditions optimales d’acquisition afin de s’adapter aux vitesses circulatoires. Une acquisition est realisee simultanement en 3D FASE en phase diastolique et systolique des membres inferieurs en 4 paliers (Toshiba-Vantage-champs de 1,5T) a l’aide d’une antenne TORSO multi-elements en sequence FBI (Fresh Blood Imaging). Reconstruction MIP apres soustraction des sequences diastoliques aux sequences systoliques. Resultats Les resultats sont compares a une angiographie conventionnelle par 2 lecteurs sur 5 criteres: qualite du reseau principal, du reseau secondaire, lesions atheromateuses identifiables (longueur, % de stenose, collateralite). Conclusion Cette etude montre la faisabilite de la methode et une qualite d’image en distalite compatible avec une decision therapeutique. Elle permet l’exploration sans reserve des patients diabetiques atteints d’importantes lesions de media-calcose et a fonction renale limite.

Objectifs Analyser les facteurs predictifs d’hypertrophie du futur foie restant (FFR) apres embolisation portai pre-operatoire (EPP) avant hepatectomie droite elargie. Materiels et methodes Parmi 142 EPP, 113 etaient realises avant hepatectomie droite (n = 75) ou droite elargie (n = 38) pour tumeur primitive (n = 12) ou metastatique (n = 101). Le cyanoacrylate etait l’embol le plus souvent utilise, sauf debut de notre experience (gelatine hemostatique) ou cas techniquement difficiles (coils+particules). Le degre d’hypertrophie du foie non embolise etait analyse retrospectivement en fonction de la pathologie initiale, de l’etendue de l’embolisation, du type d’embole utilise, le pourcentage initial futur foie restant/foie total (FFR/FT). Resultats L’hypertrophie etait respectivement de 101 %, 61 %, et 45 % pour un FFR/FT de 30 % (P Conclusion L’hypertrophie du foie non embolise etant d’autant plus importante que le volume FFR est petit nous amene a penser qu’il serait eventuellement possible de realiser une hepatectomie etendue ne laissant en place qu’un seul segment hepatique.

Objectifs Cette etude evalue l’apport d’une methode d’imagerie non invasive dans le suivi des patients porteurs de pontages coronariens. Materiels et methodes De septembre 2005 a fevrier 2006, 53 patients consecutifs ont beneficie d’un scanner cardiaque. Au total, 121 greffons ont ete evalues (2,28+/-0,86) et 147 anastomoses (2,77+/-1,18) par patient. Il s’agissait de greffons mammaires (72,5%), saphenes (25,8 %), gastro-epiploiques (1,7 %). Un controle coronarographique etait realise chez 11 patients (26 greffons) en cas d’anomalie. L’examen etait effectue avec un scanner 64 coupes avec synchronisation ECG (Aquilion 64™, Toshiba), apres injection de 90 a 120 ml de Iopamiron 370™, (4,5 ml/s), puise par du serum glucose (4, 0 ml/s). Resultats Les greffons etaient mal visualises (1,7 %), normaux (81,7 %), involues (3,3 %), occlus (8,3 %), autres (5,0 %). Les anastomoses n’etaient pas analysables dans 9,3 %, mal visualisees dans 9,2 %, stenosees dans 1,7 %, et occluses dans 5,8 % des cas. Sur les 26 greffons controles, la sensibilite etait de 91 % pour les greffons et 88 % pour les anastomoses, la specificite de 93 % et 84 %, la valeur predictive positive de 91 % et 80 % et negative de 93 % et 92 %. Conclusion Le scanner est une technique efficace dans le suivi des patients porteurs de pontages.

Objectifs Montrer l’interet du guidage fluoroscanographique en terme de temps et de controle des actes interventionnels. Materiels et methodes L’arrivee des scanners multibarrettes et l’acceleration des calculs informatiques permettent aujourd’hui un affichage multicoupe simultane (3 coupes de 3 a 12 mm d’epaisseur) a une cadence de 8 images/secondes. Nous presenterons chronometre en main des procedures comparatives a l’ancienne et fluoroscanoguidees (entre autres, une radiofrequence hepatique et une infiltration foraminale rachidienne. Resultats La vision des coupes adjacentes pallie le manque de vision frontale. Il en resulte un controle des gestes et un suivi des complications en temps reel, d’ou une precision accrue des positionnements des drains, aiguilles de biopsies ou de radiofrequence. Le temps de procedure decroit de maniere vertigineuse. Conclusion La seule ombre peut venir de la dosimetrie lors de ces procedures (en cours d’evaluation dans notre unite). L’exposition etait quasi-nulle avant l’avenement du fluoroscanner mais le guidage etait sequentiel, lent donc hasardeux. Vitesse et precision ont toujours ete nos protecteurs lors des procedures conventionnels, gageons qu’elles le resteront pour ce nouvel outil… Fin chronometre.

Objectifs Faisabilite de l’angioscanner de perfusion et recherche de criteres cinetiques pour determiner la Mort Encephalique (ME). Materiels et methodes Etude prospective comparant 10 patients temoins (T) a 10 patients en etat de mort encephalique clinique selon les criteres suivants : delai entre l’ opacification arterielle et veineuse (D), temps de transit moyen (TTM), debit sanguin cerebral (DSC), volume sanguin cerebral (VSC), score de Benoit Dupas (sur 7 points). Ces parametres de perfusion tissulaire sont calcules a partir de graphiques densite vasculaire-temps apres acquisition multiphasique centree sur le polygone de Willis (algorithme « box-MTT » scanner multi-barrette Toshiba Aquilion 16). Resultats Les criteres susmentionnes ne sont pas mesurables pour les patients presentant une hemorragie meningee severe, ou lors d’une absence complete de visualisation des vaisseaux intracrâniens. Le D et le TTM sont allonges de maniere significative lorsque les scores de Dupas sont superieurs a 3 points tandis que le DSC diminue de maniere bilaterale. Le VSC diminue avec le score de Dupas. Conclusion Les criteres de perfusion sont mesurables et pourraient conforter le diagnostic clinique et morphologique de mort encephalique et notamment ceux qui posent des problemes decisionnels (Dupas

The purpose of this study was to evaluate computed analysis of three-dimensional (3D) cone-beam computed tomography angiography (CTA) of the liver for determination of subsegmental tumor-feeding vessels (FVs). Eighteen consecutive patients underwent transarterial chemoembolization (TACE) from January to October 2008 for 25 liver tumors (15 hepatocellular carcinomas [HCCs] and 10 neuroendocrine metastases). Anteroposterior projection angiogram (two-dimensional [2D]) and 3D cone-beam CTA images were acquired by injection of the common hepatic artery. Retrospectively, FVs were independently identified by three radiology technologists using a software package (S) that automatically determines FVs by analysis of 3D images. Subsequently, three interventional radiologists (IRs) independently identified FVs by reviewing the 2D images followed by examination of the 3D images. Finally, the “ground truth” for the number and location of FVs was obtained by consensus among the IRs, who were allowed to use any imaging―including 2D, 3D, and all oblique or selective angiograms―for such determination. Sensitivities, durations, and degrees of agreement for review of 2D, 3D, and S results were evaluated. Sensitivity of 3D (73%) was higher than 2D (64%) images for identification of FVs (P = 0.036). The sensitivity of S (93%) was higher than 2D (P = 0.02) and 3D (P = 0.005) imaging. The duration for review of 3D imaging was longer than that for 2D imaging (187 vs. 94 s, P = 0.0001) or for S (135 s, P = 0.0001). The degree of agreement between the IRs using 2D and 3D imaging were 54% and 62%, respectively, whereas it was 82% between the three radiology technologists using S. These preliminary data show that computed determination of FVs is both accurate and sensitive.

OBJECTIVE: We evaluated arteriographic findings and endovascular treatments of eight patients who had bleeding iliac artery pseudoaneurysms and who had undergone radiation therapy (3000-6500 rad [30-65 Gy]) and surgery for pelvic malignancies. CONCLUSION: Angiography revealed contrast media extravasation in 75% of patients who had bleeding iliac artery pseudoaneurysms and failed to show the source of bleeding in 25%. The patients who had positive findings at angiography were all successfully treated percutaneously, although two patients required additional bypass surgery. Among embolic materials, coils and balloons were safe and efficient, whereas cyanoacrylate was unsafe and led to complications in two of three patients. A covered stent, which was not available for most of our patients, was used in one patient and may be an effective means of treating pseudoaneurysms.