scholarly journals Integrated prognostication of intrahepatic cholangiocarcinoma by contrast-enhanced computed tomography: the adjunct yield of radiomics

2021 ◽  
Author(s):  
Mario Silva ◽  
Michele Maddalo ◽  
Eleonora Leoni ◽  
Sara Giuliotti ◽  
Gianluca Milanese ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Risk Model ◽  
Full Range ◽  
Univariate Analysis ◽  
Distant Metastases ◽  
Risk Models ◽  
Contrast Enhanced ◽  
Venous Phase ◽  
Enhanced Computed Tomography

Abstract Purpose To test radiomics for prognostication of intrahepatic mass-forming cholangiocarcinoma (IMCC) and to develop a comprehensive risk model. Methods Histologically proven IMCC (representing the full range of stages) were retrospectively analyzed by volume segmentation on baseline hepatic venous phase computed tomography (CT), by two readers with different experience (R1 and R2). Morphological CT features included: tumor size, hepatic satellite lesions, lymph node and distant metastases. Radiomic features (RF) were compared across CT protocols and readers. Univariate analysis against overall survival (OS) warranted ranking and selection of RF into radiomic signature (RSign), which was dichotomized into high and low-risk strata (RSign*). Models without and with RSign* (Model 1 and 2, respectively) were compared. Results Among 78 patients (median follow-up 262 days, IQR 73–957), 62/78 (79%) died during the study period, 46/78 (59%) died within 1 year. Up to 10% RF showed variability across CT protocols; 37/108 (34%) RF showed variability due to manual segmentation. RSign stratified OS (univariate: HR 1.37 for R1, HR 1.28 for R2), RSign* was different between readers (R1 0.39; R2 0.57). Model 1 showed AUC 0.71, which increased in Model 2: AUC 0.81 (p < 0.001) and AIC 89 for R1, AUC 0.81 (p = 0.001) and AIC 90.2 for R2. Conclusion The use of RF into a unified RSign score stratified OS in patients with IMCC. Dichotomized RSign* classified survival strata, its inclusion in risk models showed adjunct yield. The cut-off value of RSign* was different between readers, suggesting that the use of reference values is hampered by interobserver variability.

Successful Embolization of Persistent Endoleak from a Patent Inferior Mesenteric Artery

1997 ◽  
Vol 4 (3) ◽  
pp. 312-315 ◽  
Author(s):  
Greg van Schie ◽  
Kishore Sieunarine ◽  
Mike Holt ◽  
Michael Lawrence-Brown ◽  
David Hartley ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Aortic Aneurysm ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Abdominal Aortic ◽  
Contrast Enhanced ◽  
Retrograde Filling ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Purpose: To report the successful endovascular occlusion of a persistent endoleak owing to collateral perfusion in a 1-year-old bifurcated aortic endograft. Methods and Results: An 81-year-old man underwent endovascular repair of a 5.5-cm abdominal aortic aneurysm (AAA) with a bifurcated stent-graft in 1995; collateral perfusion of the excluded aneurysm by retrograde filling of the patent inferior mesenteric artery (IMA) was noted postoperatively. At his 1-year follow-up, the mid-sac endoleak persisted on contrast-enhanced computed tomography. Using the superior mesenteric artery for access, the stump of the IMA was successfully embolized with glue. Conclusions: This case, which highlights the importance of documenting a patent IMA prior to AAA endografting, illustrates one option for the management of persistent collateral perfusion of endovascularly excluded aneurysms.

scholarly journals Complex Arteriovenous Malformation in a Kidney with Multiple Renal Arteries: A Case Report

2020 ◽  
Author(s):  
J Sanjay Prakash ◽  
T Mathisekaran ◽  
Nitesh Jain ◽  
Pritam Chatterjee ◽  
Sandeep Bafna
Keyword(s):  
Computed Tomography ◽  
Arteriovenous Malformation ◽  
Renal Artery ◽  
Renal Vein ◽  
Renal Arteries ◽  
Contrast Enhanced ◽  
Complete Obliteration ◽  
Ct Brain ◽  
Enhanced Computed Tomography

The abnormal communications between arteries and veins outside the capillary level are called Arteriovenous Malformation (AVM). A 25-year-old known hypertensive on irregular medications, presented with acute stroke (Computed Tomography (CT) brain revealed left putamen haemorrhage). On evaluation, all routine investigations were normal except for microscopic haematuria. Ultrasound (USG) KUB showed right AVM and on further evaluation with 320 slice Contrast Enhanced Computed Tomography (CECT) abdomen with angiogram and 3D reconstruction revealed right kidney supplied by three renal arteries. The second renal artery was dilated (1.1 cm diameter) and communicates directly with aneurysmally dilated right renal vein (2.9 cm diameter). Digital Subtraction Angiography (DSA) with angioembolisation was done four days’ postadmission. Large second renal artery with a direct Arteriovenous Fistula (AVF) draining into the renal vein with aneurysmal venous sacs was occluded with 16 mm, 12 mm and 10 mm coils. Complete obliteration of fistula was confirmed. Then the inferior most third renal artery was accessed and angiogram revealed RAVM with multiple feeders shunting into the venous sacs and it was occluded with 40% glue. Postoperative day one USG showed thrombosed venous aneurysmal sacs and occlusion of the arterial fistulae. He was discharged at four weeks with antihypertensive and antiseizure medications. During the follow-up there was no loss in the function of the kidney and micro or macroscopic haematuria was not detected.

Effectiveness of the conservative therapy for spontaneous isolated iliac artery dissection: Preliminary results

Vascular ◽  
2017 ◽  
Vol 25 (6) ◽  
pp. 649-656 ◽  
Author(s):  
Zhuhong Liang ◽  
Weiwei Guo ◽  
Chunhua Du ◽  
Yingdi Xie
Keyword(s):  
Computed Tomography ◽  
Conservative Therapy ◽  
False Lumen ◽  
Artery Dissection ◽  
True Lumen ◽  
Contrast Enhanced ◽  
Entry Points ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Purpose To investigate the effectiveness of conservative therapy for spontaneous isolated iliac artery dissection (SIIAD). Methods From February 2006 to May 2016, all patients with SIIAD were included and analyzed. The diagnosis of SIIAD was made based on contrast-enhanced computed tomography. The imaging morphologic characteristics, treatments, and outcomes for each patient were analyzed. Results A total of 11 patients (10 male and 1 female, age 71.1 ± 7.8 years) were included in this study. Of the 11 patients, 8 patients were asymptomatic and the SIIADs were discovered during the course of computed tomography for other diseases, and 3 patients were symptomatic. Initial computed tomography findings: iliac arterial calcification ( n = 7); compression of the true lumen ( n = 6), with stenosis of the true lumen from 25% to 50% ( n = 3) and ≥ 50% ( n = 3); thrombosed false lumen partially ( n = 4), and no thrombosis in false lumen ( n = 7); dissecting aneurysm ( n = 11); entry points ( n = 11); re-entry points ( n = 1); no dissection extended to the internal iliac or common femoral artery. Conservative treatment was performed in six patients, and the remaining five patients need no treatment. During 23.3 ± 14.2 months follow-up, none recurred symptoms and signs of symptomatic SIIAD; partial remodeling of SIIAD was achieved in four patients, and the remaining seven patients with no change of SIIAD. There was no presence of new false lumen enhancement on contrast-enhanced computed tomography during follow-up. Conclusions SIIAD without arterial rupture or lower limb necrosis can be safely treated with conservative therapy.

Differentiation between non-hypervascular pancreatic neuroendocrine tumors and mass-forming pancreatitis using contrast-enhanced computed tomography

2020 ◽  
pp. 028418512092150
Author(s):  
Yajie Wang ◽  
Xin Chen ◽  
Jianhua Wang ◽  
Wenjing Cui ◽  
Cheng Wang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Neuroendocrine Tumors ◽  
Ct Imaging ◽  
Pancreatic Neuroendocrine Tumors ◽  
Imaging Findings ◽  
Tumor Margin ◽  
Contrast Enhanced ◽  
Venous Phase ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background Non-hypervascular pancreatic neuroendocrine tumors (PNETs) showed slight or iso-enhancement in contrast-enhanced computed tomography (CE-CT), which shared similar imaging findings with mass-forming pancreatitis (MFPs). Purpose To explore the value of CT imaging features in differentiating the two diseases. Material and Methods Fifty-one patients with histologically proved MFPs (n = 27) or non-hypervascular PNETs (n = 24) were included. Two radiologists reviewed CT imaging findings and clinical features. Logistic regression analysis was performed to identify relevant features in differentiating non-hypervascular PNETs and MFPs. Receiver operating characteristic (ROC) curve analysis was used to show the performance of the optimal parameters in differentiating non-hypervascular PNETs and MFPs. Results A well-defined margin was more common in non-hypervascular PNETs ( P < 0.05) than that in MFPs. MFPs often occurred in older people ( P < 0.01) and the head–neck of the pancreas compared with non-hypervascular PNETs ( P < 0.05). Metastases only presented in non-hypervascular PNETs ( P < 0.05). CT values at venous phase and delay phase of MFPs were higher ( P = 0.010 and P = 0.029) than those in non-hypervascular PNETs. Logistic analysis showed gender, tumor margin, CT values at venous phase, and tumor components were independent predictors in differentiating the two lesions. The area under the curve (AUC) was 0.938 with a sensitivity of 87.5% and specificity of 92.6% for combined predicators. Conclusion Gender, tumor margin, CT values at venous phase, and tumor components were useful predicators in differentiating non-hypervascular PNETs and MFPs.

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