1,721,113 research outputs found
Low-dose CT angiography: which contrast medium?
No full textThe purpose of this study was to simulate pulmonary emboli (PE) and image quality at low tube energy and reduced contrast material volume in normal-dose pulmonary CT angiography (CTA) images and to analyze the diagnostic accuracy with normal- and low-dose pulmonary CTA
Cardiovascular and interventional radiological society of europe guidelines on endovascular treatment in aortoiliac arterial disease
No full textThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.
METHODS:
Any recommendation contained in the text comes from the highest level and extension of literature review available to date.
RESULTS:
The success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques.
CONCLUSION:
The design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction
Endovascular treatment of thoracic aortic diseases: Follow-up and complications with multi-detector computed tomography angiography.
No full textEndovascular procedures with placement of stent-graft has become an accepted alternative to traditional open surgery for treatment of descending
thoracic aortic aneurysms, ulcers, post-traumatic rupture, or complications of type-B dissection, due to significant reduction in perioperative mortality, rate of complications and length of hospitalization. Moreover, increasing operator experience and continuous advances in stent-graft technology are making treatment of a wider range of cases possible with redefinition of guidelines for endovascular stent-graft. The feasibility of
endovascular stent-graft is mainly dependent on anatomic factors which represent the important predictors of the success of this procedure as well
as on strictly follow-up in order to obtain early detection and treatment of eventual complications. Multi-detector CT-angiography is a fast, safe, and minimally invasive imaging technique that represents the standard of reference in the follow-up of patients who have undergone endovascular stent-graft, as it is effective and specific in the detection of procedure-correlated complications. The purpose of this article is to give a brief review of those techniques most commonly used for endovascular treatment of thoracic aortic diseases
together with a more detailed description of post-procedural complications and their appearance on multi-detector CT-angiography
How to combine CTA, 99mTc-WBC SPECT/CT, and [18F]FDG PET/CT in patients with suspected abdominal vascular endograft infections?
Full text linkPurpose: We aimed at comparing 99mTc-HMPAO white blood cells (99mTc-WBC) scintigraphy, 18fluorine-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) and CT angiography (CTA) in patients with suspected abdominal vascular graft or endograft infection (VGEI). Moreover, we attempted to define a new visual score for interpreting [18F]FDG PET/CT scans aiming at increasing its specificity. Methods: We prospectively compared 99mTc-WBC SPECT/CT, [18F]FDG PET/CT, and CTA in 26 patients with suspected abdominal VGEI. WBC scans were performed and interpreted according to EANM recommendations. [18F]FDG PET/CT studies were assessed with both qualitative (Sah’s scale and new visual score) and semi-quantitative analyses. CTA images were interpreted according to MAGIC criteria. Microbiology, histopathology or a clinical follow-up of at least 24 months were used to achieve final diagnosis. Results: Eleven out of 26 patients were infected. [18F]FDG PET/CT showed 100% sensitivity and NPV, with both scoring systems, thus representing an efficient tool to rule out the infection. The use of a more detailed scoring system provided statistically higher specificity compared to the previous Sah’s scale (p = 0.049). 99mTc-WBC SPECT/CT provided statistically higher specificity and PPV than [18F]FDG PET/CT, regardless the interpretation criteria used and it can be, therefore, used in early post-surgical phases or to confirm or rule out a PET/CT finding. Conclusions: After CTA, patients with suspected late VGEI should perform a [18F]FDG PET/CT given its high sensitivity and NPV. However, given its lower specificity, positive results should be confirmed with 99mTc-WBC scintigraphy. The use of a more detailed scoring system reduces the number of 99mTc-WBC scans needed after [18F]FDG PET/CT. Nevertheless, in suspected infections within 4 months from surgery, 99mTc-WBC SPECT/CT should be performed as second exam, due to its high accuracy in differentiating sterile inflammation from infection
ENDOLEAKS AFTER ENDOVASCULAR REPAIR OF ABDOMINAL AORTIC ANEURYSM: VALUE OF CEUS.
No full textEndovascular repair (EVAR) is playing an increasingly role in the treatment of abdominal aortic aneurysm. A successful procedure depends on the complete sealing of the aneurysm sac from blood flow to achieve general pressure relief and avoid aneurysm rupture, with a shrinkage of the aneurysm sac. The most common complication of EVAR is endoleak that is the persistence of perigraft flow within the aneurysm sac, which has to be considered the major cause of enlargement and rupture of the aneurysm, and the main indication for surgical late conversion. For this reason, strict surveillance of these patients is mandatory for the early detection of endoleaks and the preferred method of follow-up is represented by CT angiography. However, CTA has limitations. The investigation is repeated several times, making radiation exposure a necessary concern. Therefore, it would be useful to have another reliable diagnostic examination during follow-up. Color duplex ultrasound is non-invasive, does not use radiation or contrast medium, is less expensive, easy to perform and widely available. However, this technique obtained poor results in terms of sensitivity in the detection of endoleaks. In the last years, the introduction of ultrasound contrast agents and contrast-specific imaging has, however, rekindled interest in this modality and its potential for replacing of CTA in routine surveillance. The purpose of this review is to highlight the diagnostic value of CEUS in the post-EVAR endoleaks detection
Cutting-balloon angioplasty of resistant ureteral stenosis as bridge to stent insertion
No full textUreteral stenting is a routine, minimally invasive procedure performed for relief of benign or malignant obstruction. In case of ureteral stenosis, to allow a correct insertion of the stent, a predilatation of the ureter stenosis with a conventional balloon catheter can be necessary. In exceptional cases, it can be difficult to advance an 7-8 Fr JJ-catheter over a tight resistant ureter stenosis following unsuccessful high-pressure balloon dilatation. In the present report, we describe two cases of resistant ureter stenosis successfully dilated by a cutting-balloon following the failure of high-pressure balloon dilatation, allowing a correct and uncomplicated antegrade stent insertion
Safety, Feasibility and Technical Considerations from a Prospective, Observational Study-CIREL: Irinotecan-TACE for CRLM in 152 Patients
Full text linkCIREL, a prospective, Europe-wide, observational study aimed to assess the real-world feasibility and tolerability of irinotecan-based transarterial chemoembolization (LP-irinotecan TACE) for unresectable colorectal cancer liver metastases with regard to the treatment plan and adverse events (AEs). CIREL enrolled 152 eligible patients (>= 18 years) with liver-only or dominant metastases treated with LP-irinotecan TACE following a multidisciplinary tumor board decision. Data were prospectively collected for baseline, the number of planned and performed sessions, and technical information and safety according to CTCAE 4.03/5.0. Results from 351 analyzed treatment sessions showed technical success for 99% of sessions, and 121 patients (79%) completed all planned sessions. Further, 60% of sessions were performed using opioids, 4% intra-arterial anesthetics, and 25% both. Additionally, 60% of patients experienced at least one peri-interventional AE of any grade; 8% of grade 3-4. Occurrence of AEs was related to larger liver-involvement (p < 0.001), bi-lobar disease (p = 0.002), and larger beads (p < 0.001). Using corticosteroids together with antiemetics showed reduced and lower grade vomiting (p = 0.01). LP-irinotecan TACE was tolerated well and had a high proportion of completed treatment plans. This minimally invasive locoregional treatment can be used together with concomitant systemic therapy or ablation
Evidence-based guideline of the European Association of Nuclear Medicine (EANM) on imaging infection in vascular grafts
Full text linkPurpose: Consensus on optimal imaging procedure for vascular graft/endograft infection (VGEI) is still lacking and the choice of a diagnostic test is often based on the experience of single centres. This document provides evidence-based recommendations aiming at defining which imaging modality may be preferred in different clinical settings and post-surgical time window. Methods: This working group includes 6 nuclear medicine physicians appointed by the European Association of Nuclear Medicine, 4 vascular surgeons, and 2 radiologists. Vascular surgeons formulated 5 clinical questions that were converted into 10 statements and addressed through a systematic analysis of available literature by using PICOs (Population/problem–Intervention/Indicator–Comparator–Outcome) strategy. Each consensus statement was scored for level of evidence and for recommendation grade, according to the Oxford Centre for Evidence-based Medicine criteria. Results: Sixty-six articles, published from January 2000 up to December 2021, were analysed and used for evidence-based recommendations. Conclusion: Computed tomography angiography (CTA) is the first-line imaging modality in suspected VGEI but nuclear medicine modalities are often needed to confirm or exclude the infection. Positron emission tomography/computed tomography (PET/CT) with 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) has very high negative predictive value but it should be performed preferably at least 4 months after surgery to avoid false positive results. Radiolabelled white blood cell (WBC) scintigraphy, given its high diagnostic accuracy, can be performed at any time after surgery. Preamble: The European Association of Nuclear Medicine (EANM) is a professional no-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the EANM, has undergone a thorough consensus process in which it has been subjected to extensive review. The EANM recognizes that the safe and effective use of diagnostic nuclear medicine imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the EANM suggests caution against the use of the current consensus document in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgement regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in the light of all the circumstances presented. Thus, there is no implication that an approach differing from the consensus document, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the consensus document when, in the reasonable judgement of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the consensus document. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to this consensus document will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient, to deliver effective and safe medical care. The sole purpose of this consensus document is to assist practitioners in achieving this objective
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