Prediction Role of Baseline Digital Substraction Angiography in GEP Neuroendocrine Liver Metastases Treated with TAE/ TACE

Aim Transarterial embolization (TAE) or transarterial chemoembolization (TACE) is an important treatment approach for unresectable liver metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). The prediction tool for therapeutic evaluation is still unclear. This study was performed to assess the prediction role of baseline digital substraction angiography (DSA) in synchronous liver metastatic GEP-NETs treated with TAE/ TACE. Methods Twenty-two patients with synchronous unresectable liver metastatic GEP-NETs (G1/2) and treated with TAE/ TACE were retrospectively enrolled. Clinical characteristics, baseline DSA and computed tomography (CT) information were collected. Results Totally, the overall response rate of TAE/ TACE on liver metastasis was 45.5%. The average baseline CT ratio (the density of the target lesion / the density of abdominal aorta during arterial phase) between responsive group and nonresponsive group were not statistically different (0.30±0.06 versus 0.36±0.11, P=0.149). Whereas, the average baseline DSA ratio (the density of target lesion / the density of liver background on DSA imaging before TAE/ TACE) of responsive group was significantly lower compared with that of nonresponsive group (0.57±0.13 versus 0.70±0.15, P=0.037). Patients with a DSA ratio ≤0.64 were more responsive to TAE/ TACE than those with a DSA ratio ༞0.64 (58.3% versus 30%). Univariate and multivariate analysis indicated that patients with lower hepatic tumor burden had longer PFS. Conclusions Baseline DSA ratio is a simple and potentially useful method to predict therapeutic effect of TAE/ TACE in liver metastases from GEP-NETs. And patients with lower hepatic tumor burden might indicate better prognosis. Prospective large-scale study is warranted.

A glomus caroticum paragangliomája és ellátása

Our goal was to report a 44-year-old woman with carotid body tumor, and to give a brief and comprehensive presentation about the disease and summarize its complex management. Carotid body tumor is a rare, mostly sporadic, benign head and neck mass originating from the glomus caroticum. It occurs mostly in middle-aged women as a slowly growing, semifix, painless neck mass. The diagnosis is based upon the physical examination (pulsatile mass, Fontaine-sign) and – as the gold standard – CT-angiography. It should be established that preoperative embolisation by digital substraction angiography plays a crucial role in the treatment of carotid body tumors that should be followed by surgical removal. In case of inoperable/irresecable and residual tumors, radiotherapy is the treatment option. The patient was treated in our department in April 2017. Orv Hetil. 2018; 159(36): 1487–1492.

FISTULA ARTERIOVENOSUS FASIALIS PADA KEHAMILAN

FACIAL ARTERIOVENOSUS FISTULA IN PREGNANCYABSTRACTArteriovenosus fistula (AVF) of superficial temporal artery is rarely found. We report a case of 34 years old women, with facial AVF during her third pregnancy. The patient was admitted to the hospital with complain of pulsating headache, tinnitus, and pulsating mass on the left preauricular region. Arteriovenosus fistula diagnosis was confirmed by Digital Substraction Angiography (DSA), showing the left superficial temporal artery as the feeding artery. The headache and tinnitus was diminished immidiately after embolization procedure followed by ligation surgery.Keywords: Arteriovenosus fistula, pregnancy, superficial temporal arteryABSTRAKFistula arteriovenosus (FAV) pada arteri temporalis superfisialis (ATS) jarang ditemukan. Dilaporkan kasus seorang perempuan berusia 34 tahun yang mengalami FAV fasial dalam kehamilan anak ketiganya. Pasien mengeluhkan nyeri kepala berdenyut, tinnitus, dan massa berdenyut pada area preaurikularis kiri. Pemerikasan digital substraksi angiografi (DSA) mengkonfirmasi adanya FAV, dengan feeding artery berasal dari ATS kiri. Setelah tindakan embolisasi dan operasi penutupan fistula, keluhan nyeri kepala dan tinnitus menghilang.Kata kunci: Arteri temporalis superfisialis, fistula arteriovenosus, kehamilan

Sensitivitas Dan Spesifisitas Mdct Angiografi Dalam Mendiagnosis Aneurisma Intrakranial

Latar belakang: Deteksi yang cepat untuk menemukan ruptur aneurisma intrakranial (AI) sangat penting karena ruptur AI menyebabkan perdarahan subarahnoid (PSA) spontan yang merupakan kegawatan medis dan menyebabkan kematian atau kecacatan berat. Multidetector computed tomography angiography (MDCTA), sebagai alat diagnostik non invasif, telah digunakan secara luas dalam imaging pembuluh darah otak. Tujuan: mengetahui kemampuan sensitivitas dan spesifisitas MDCTA untuk mendeteksi lokasi dan ukuran aneurisma intrakranial. Metode: Studi cross-sectional pada pasien dengan dugaan aneurisma intrakranial yang telah dilakukan pemeriksaan MDCTA dan Digital Substraction Angiography (DSA) dari data rekam medik di RSUP Dr. Kariadi Semarang mulai Oktober 2012 – November 2015. Pengambilan sampel dilakukan dengan consecutive sampling. Dua orang dokter spesialis radiologi yang independen mengevaluasi hasil MDCTA dan DSA untuk menentukan lokasi dan ukuran aneurisma. Analisis statistik menggunakan sensitivitas dan spesifisitas. Hasil: Penderita aneurisma intrakranial terbanyak berusia 40-60 tahun 73,7%, perempuan 78,9% dan 52,6% berukuran 3-7 mm serta 80,5% berlokasi di sirkulasi anterior. Sensitivitas MDCTA dalam mendeteksi aneurisma baik yang berukuran kurang dari 3 mm, 3-7 mm dan lebih dari 7 mm pada penelitian ini adalah 100, 100, 100 %, sedangkan nilai spesifisitas adalah 100, 100 dan 93,3%. Kesimpulan: Penggunaan MDCTA untuk mendiagnosis aneurisma intrakranial mempunyai sensitivitas dan spesifisitas tinggi sehingga dapat menjadi pilihan pertama dalam tehnik imaging. Kata kunci: Aneurisma intrakranial, MDCTA, sensitivitas, spesifisitas

Aneurysm Characteristics of Patients Presented with Sub-Arachnoid Haemorrhage in Combined Military Hospital Dhaka and Detected at Digital Substraction Angiography

Introduction: Digital Substraction Angiography (DSA) is the gold standard for proper diagnosis and further evaluation of intra cranial aneurysm. Intracranial aneurysm rupture leading to Subarachnoid hemorrhage (SAH) may be associated with serious neurological sequelae or even mortality. According to international literature, only aneurysm >7 mm or aneurysm in the posterior circulation require treatment. Retrospective single center studies have however, disputed that the average size of ruptured aneurysms are <7 mm. Objective: To assess the aneurysm characteristics and demographics of patients who reported to CMH, Dhaka with SAH secondary to an aneurysm detected at Digital Subtraction Angiography (DSA). Materials and Methods: This retrospective study was conducted among the patients who presented with SAH more than 3 year period, from November 2013 to April 2017. All patients had undergone CT scan of brain in the department of Radiology & Imaging and DSA in the Cath Lab of Combined Military Hospital (CMH), Dhaka. Data about aneurysm characteristics, size and patient demographics were obtained from patients files. Results: A total of 74 patients underwent DSA and amongst them 32 patients had ruptured aneurysms. Ages ranging from 20 to 75 years (mean 45 years), little more male patients. The mean size of aneurysms was 5.8mm (range 1.2 mm to 20 mm) with 74.5% of aneurysms having size <7 mm. Most aneurysms were noted involving anterior circulation (72%) with the majority arising from the anterior communicating (ACom) artery (36.7%). Conclusion: An aneurysm is an abnormal dilatation of an artery. It can be found in almost any age and can rupture at size <7 mm. Those are commonly located in the anterior circulation. Findings of this study emphasize the importance of conducting the institutional reviews, to consider adapting the international treatment guidelines. Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 107-110