Angiography System Research Articles

Percutaneous Angiographically Assisted Cryoablation of Renal Cell Carcinoma under the Control of Flat-Detector Computed Tomography: Capabilities and Potential Advantages of the Technique

Purpose: Percutaneous cryoablation (PCA) of renal cell carcinoma (RCC) stage T1a (≤4 cm) generally performed using MDCT with intravenous contrast material administration. Most interventional radiology departments are not equipped MDCT scanners and this is holding back widespread adoption of this technique into practical medicine. Flat-detector computed tomography (FDCT) is included in the standard equipment of modern angiographic systems, which makes it possible to combine the technologies of computed tomography with various technologies of intra-arterial contrasting and endovascular treatment. The purpose of the study was to assess the possibilities and potential advantages of using intraarterial contrasting during FDCT-controlled PCA of RCC T1a.Material and methods: Since 2017 angiographically assisted PCA under the FDCT control performed in 14 patients with RCC T1a. The procedure was performed in the X-ray operating room on an Artis Zee Floor angiographic unit with FDCT function and iGuide Needle Guidance and 3D/3D Fusion technologies (Siemens, Germany) using the SeedNet Gold system and IceEDGE 13 G, IceRod 17 G or IceSphere 17 G cryoprobes (Galil Medical, USA). At all stages of the procedure, FDCT-arteriography of the kidney (FDCT-A) performed according to the original technique: injection into the renal artery 12 ml of non-ionic contrast materials at a rate of 1 ml/s and performing scanning 5 s after the start of contrast materials injection.Results: The primary technical efficiency of FDCT-controlled PCA of RCC T1a was 92.9 %, the secondary — 100 %. Complications of grade 3 according to the CIRSE classification were identified in three patients (21.4 %), complications of grade 4, 5 and 6 not observed. The use of arterial access and the FDCT-A execution at different stages of PCA had the following advantages: 1) high-quality visualization of the tumor with minimal consumption of contrast materials; 2) simple and accurate positioning of cryoprobes using the iGuide Needle Guidance program; 3) estimation of the future ablative margin by fusion FDCT data about tumor with FDCT data about ice ball; 4) reliable diagnosis of bleeding after removal of cryoprobes with the possibility of immediate performing of endovascular hemostasis.Conclusion: Percutaneous angiographically assisted cryoablation under the FDCT control is an affordable, safe and effective technology for the treatment of RCC T1a, which has a number of potential advantages compared to performing procedures using MDCT control. Further research is advisable to study of this PCA technique with its subsequent possible introduction into the routine practice in Interventional Radiology departments of multidisciplinary oncological hospitals.

Short-Vessel Occlusion Might Indicate Higher Possibility of Success in Reperfusion following Mechanical Thrombectomy in Acute Middle Cerebral Artery Occlusion

Background: The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy. Methods: This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared. Results: We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5–1.9] vs. 1.2 [1.2–1.5] mm, p = 0.007) and shorter length (7.1 [4.9–9.7] vs. 12.3 [7.2–15.8] mm, p = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90). Conclusion: In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.

Delphi Consensus Study Toward a Comprehensive Classification System forAngioplasty-Induced FemoropoplitealDissection: The DISFORM Study.

The aim of this study was to seek expert consensus regarding the features that predict adverse outcomes in order to develop a dedicated angiographic classification system for femoropopliteal artery dissection. Dissection of the femoral and popliteal arteries is common after percutaneous angioplasty. Its classification is important. However, all current classification systems have significant limitations. Delphi consensus methodology was performed over 3 rounds, using an expert panel of 17 interventionalists. Each was asked to rank dissection features with the potential to lead to acute technical failure and/or early restenosis and then which combination of features would require the placement of a metallic scaffold to avoid those outcomes. Results were used to develop a novel grading system and dissection treatment algorithm. Four main characteristics were identified from a comprehensive preliminary list. There was a good level of agreement between panelists from 773 responses (48 combinations). All panelists recommended scaffolding if a dissection produced a≥50% diameter reduction (100%). Most recommended scaffolding if the dissection had a spiral shape (73%-100%), was severely flow limiting (93%-100%), or had complex morphology defined by long and multiple dissections (65%-100%). Multiple combinations of those features were more likely to receive a recommendation to scaffold. Scaffolding of a postangioplasty dissection is recommended in the presence of significant diameter reduction, spiral shape, flow impairment, or adverse morphology (DISFORM). The DISFORM classification system has been developed as a tool to provide uniform language to standardize reporting and for discussion of dissection treatment and prognosis.

"Virtual stent" - clinical evaluation and user experience of on-the-fly stent simulation in treatment of cerebral aneurysms.

Predicting final stent position can be challenging when treating cerebral aneurysms. Third-Party software proved helpful in selecting proper stents in treatment planning. Recent angiographic systems provide basic stent simulation capabilities integrated in the post-processing software to simulate stent position. Goal of this analysis was to evaluate the simulation process and correlation with definite stent position. Thirty-three datasets with fusiform (n = 10) and saccular (n = 23) aneurysms, treated with stent or flow-diverter, were processed. A "virtual stent" of the same (nominal) size was simulated and its position was compared to the treatment result. Simulated length was rated in five grades (too short, shorter, equal, longer, too long), with regard to side-branches, anchoring zone etc. Simulation quality (centerline recognition/adherence to vessel margins) was rated in three grades (no, minor or major corrections required). Simulation was successful in 32/33 cases (97%), with one abortive attempt (3%). In 27/33 simulations (82%), there was no need for centerline refinement. Minor corrections were necessary in four and major corrections in two cases. Simulated nominal length was rated "equal" in 14/33 (42%) cases and "shorter" or "longer" - but within acceptable range - in each 9/33 (27%) cases. Basic stent simulation tools available with genuine angiographic workplace software can provide good simulation capabilities without need for third-party equipment. They can facilitate treatment planning and help to avoid shortage of devices. Yet, lack of calculation of foreshortening in large vessel diameters leaves the user to rely on their experience to account for device-specific properties.

Comparison of a contrast-to-noise ratio-driven exposure control and a regular detector dose-driven exposure control in abdominal imaging in a clinical angiography system.

The first purpose of this phantom study was to verify whether a contrast-to-noise ratio (CNR)-driven exposure control (CEC) can maintain target CNR in angiography more precisely compared to a conventional detector dose-driven exposure control (DEC). The second purpose was to estimate the difference between incident air kerma produced by CEC and DEC when both exposure controls reach the same CNR. A standardized 3D-printed phantom with an iron foil and a cavity, filled with iodinated contrast material, was developed to measure CNR using different image acquisition settings. This phantom was placed into a stack of polymethylmethacrylate and aluminum plates, simulating a patient equivalent thickness (PET) of 2.5-40cm. Images were acquired using fluoroscopy and digital radiography modes with CEC using one image quality level and four image quality gradients and DEC having three different detector dose levels. The spatial frequency weighted CNR and incident air kerma were determined. The differences in incident air kerma between DEC and CEC were estimated. When using DEC, CNR decreased continuously with increasing attenuation, while CEC within physical limits maintained a predefined CNR level. Furthermore, CEC could be parameterized to deliver the CNR as a predefined function of PET. To provide a given CNR level, CEC used equal or lower air kerma than DEC. The mean estimated incident air kerma of CEC compared to DEC was between 3% (PET 20cm) and 40% (PET 27.5cm) lower in fluoroscopy and between 1% (PET 20cm) and 55% (PET 2.5cm) lower in digital radiography while maintaining CNR. Within physical and legislative limits, the CEC allows for a flexible adjustment of the CNR as a function of PET. Thus, the CEC enables task-dependent examination protocols with predefined image quality in order to easier achieve the as low as reasonably achievable principle. CEC required equal or lower incident air kerma than DEC to provide similar CNR, which allows for a substantial reduction of skin radiation dose in these situations.

Determination of geometric information and radiation field overlaps on the skin in percutaneous coronary interventions with computer-aided design-based X-ray beam modeling.

PurposeThis study aimed to develop a method for the determination of the source‐to‐surface distance (SSD), the X‐ray beam area in a plane perpendicular to the beam axis at the entrance skin surface (Ap ), and the X‐ray beam area on the actual skin surface (As ) during percutaneous coronary intervention (PCI).Materials and MethodsMale and female anthropomorphic phantoms were scanned on a computed tomography scanner, and the data were transferred to a commercially available computer‐aided design (CAD) software. A cardiovascular angiography system with a 200 × 200 mm flat‐panel detector with a field‐of‐view of 175 × 175 mm was modeled with the CAD software. Both phantoms were independently placed on 40 mm thick pads, and the examination tabletop at the patient entrance reference point. Upon panning, the heart center was aligned to the central beam axis. The SSD, Ap , and As were determined with the measurement tool and Boolean intersection operations at 10 gantry angulations.ResultsThe means and standard deviations of the SSD, Ap , and As for the male and female phantoms were 573 ± 15 and 580 ± 15 mm, 8799 ± 1009 and 9661 ± 1152 mm2, 10495 ± 602 and 11913 ± 600 mm2, respectively. The number of As overlaps for the male and female phantoms were 15/45 and 21/45 view combinations, respectively.ConclusionsCAD‐based X‐ray beam modeling is useful for the determination of the SSD, Ap , and As . Furthermore, the knowledge of the As distribution helps to reduce the As overlap in PCI.

CatLet score and Clinical CatLet score as predictors of long-term outcomes for patients with acute myocardial infarction undergoing delayed percutaneous coronary intervention

Abstract Background We have recently developed a Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system based on the 17 myocardial segment model, law of competitive blood supply, and law of flow conservation. This novel angiographic scoring system can be utilized to account for the variable coronary anatomy, the severity and complexity of coronary artery lesions, and to standardize the collection of angiographic data. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score for patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). The current study aimed at assessing whether the CatLet score (CS) and the Clinical CatLet score (CCS) predicted clinical outcomes for AMI patients undergoing delayed PCI. Methods The CS was calculated in 1018 consecutively prospectively enrolled AMI patients. Primary end point was major adverse cardiac events (MACEs), a composite of myocardial infarction, cardiac death, and ischemia-driven revascularization. CCS was calculated multiplying the CS by the ACEF score constructed using age, creatinine, and LVEF. Tertile partitioning of CS and CCS were as follows: CSlow ≤12, CSmid 13–18, and CStop ≥19; CCSlow ≤13, CCSmid 14–24, and CCStop ≥25, respectively. Cox regression analysis was employed to identify the associations between predictors and clinical outcomes. Results Four-year MACE rates were significantly higher with CStop compared with CSlow [4.82 (3.39–6.85), P<0.001], which was also the case for all-cause death, cardiac death, myocardial infarction, and ischemia-driven revascularization; for all these endpoints, there were a significant trend (P<0.001) for higher event rates with the increasing CS tertiles as shown in Figure 1. Stratifying outcomes across CCS tertiles resulted in similar results for the comparisons between CCStop and CCSlow. For MACEs, CCS had a significantly increased C-index [(C-index (95% CI), 0.725 (0.692–0.759) vs. 0.693 (0.659–0.727), P=0.001] compared with CS, which was also the case for all-cause death, cardiac death, and myocardial infarction. However, for ischemia-driven revascularization, CCS had a slightly decreased C-index [0.655 (0.609–0.701) vs. 0.670 (0.625–0.716), P=0.235] compared with CS, without a significant difference. In terms of calibration, CCS was comparable to CS for MACEs, all-cause death, cardiac death, and myocardial infarction. However, calibration for ischemia-driven revascularization worsened for CCS compared with CS (χ2=22.07, P=0.004 vs. χ2=7.79, P=0.454). Both scores remained to be independent predictors of clinical outcomes (in separate models) after adjustment for a broad spectrum of risk factors. Conclusions CS and to a greater extent CCS were able to risk-stratify long-term outcomes in AMI patients undergoing delayed PCI. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): 2020YFC2004705 & SYS2019040 Figure 1. Kaplan-Meier curves for endpoints

Effect of equalization filters on measurements with kerma-area product meter in a cardiovascular angiography system.

PurposeThis study aimed to evaluate the effect of equalization filters (EFs) on the kerma‐area product (KAPQKM) and incident air‐kerma (Ka,i,QKM) using a kerma‐area product (KAP) meter. In addition, potential underestimations of the Ka,i,QKM values by EFs were identified.Materials and methodsA portable flat‐panel detector (FPD) was placed to measure the X‐ray beam area (A) and EFs dimension at patient entrance reference point (PERP). Afterward, a 6‐cm3 external ionization chamber was placed to measure incident air‐kerma (Ka,i,Qext) at PERP instead of the portable FPD. KAP reading and Ka,i,Qext were simultaneously measured at several X‐ray beam qualities with and without EFs. The X‐ray beam quality correction factor by KAP meter (kQ,Q0KM) was calculated by A, Ka,i,Qext and KAP reading to acquire the KAPQKM and Ka,i,QKM. Upon completion of the measurements, KAPQKM, Ka,i,QKM, and Ka,i,Qext were plotted as functions of tube potential, spectral filter, and EFs dimension. Moreover, Ka,i,QKM/Ka,i,Qext values were calculated to evaluate the Ka,i,QKM underestimation.ResultsThe kQ,Q0KM values increased with an increase in the X‐ray tube potential and spectral filter, and the maximum kQ,Q0KM was 1.18. KAPQKM and Ka,i,QKM decreased as functions of EFs dimension, whereas Ka,i,Qext was almost constant. Ka,i,QKM/Ka,i,Qext decreased with an increase in EFs dimension but increased with an increase in tube potential and spectral filter, and the range was 0.55–1.01.Conclusions Ka,i,QKM value was up to approximately two times lower than the Ka,i,Qext values by EFs. When using the Ka,i,QKM value, the potential Ka,i,QKM underestimation with EFs should be considered.

Гібридні хірургічні втручання при оклюзійно-стенотичному ураженні дистальних артерій у хворих на цукровий діабет

Метою дослідження є оцінка ефективності застосування гібридних оперативних втручань у хворих з поєднаним ураженням артерій гомілкового сегмента з ураженням здухвинного та/або стегново-підколінного сегмента. Матеріали та методи. Дослідження проведено в Центрі судинної хірургії КЛ «Феофанія» ДУС, де протягом 2013–2014 рр. перебувало на лікуванні 54 хворих на цукровий діабет з оклюзією стегново-підколінного артеріального сегмента та ішемією нижньої кінцівки IV ст. за Фонтейном. Усім пацієнтам проводили вимірювання сегментарного тиску та визначення кісточково-плечового індексу, дуплексне сканування артерій нижньої кінцівки з вивченням характеру кровотоку на апараті Flex focus виробництва BK medical. Ангіо­графію виконали 42 хворим за допомогою ангіографічної системи EuroAmpli Alien виробництва Eurocolumbus S.r.l. Результати. В статті наведений досвід виконання 8 гібридних хірургічних втручань при оклюзійно-стенотичному ураженні дистальних артерій у хворих на цукровий діабет. Згідно з результатами передопераційних досліджень, майже 72 % хворих на цукровий діабет мають поєднання оклюзійно-стенотичного ураження артерій гомілкового сегмента з ураженням здухвинного та/або стегново-підколінного сегмента. Прохідність зони стегнової реконструкції за неадекватної ємності сприймаючого артеріального русла підколінно-гомілкового сегмента з застосуванням методів гібридної хірургії протягом періоду спостереження становила 87,5 % порівняно з ізольованою реконструкцією стегнового артеріального сегмента в таких самих умовах — 42,9 %. Прохідність зони стегнової реконструкції за адекватної ємності сприймаючого артеріального русла підколінно-гомілкового сегмента протягом періоду спостереження становила 90 %. Висновки. Отже, гібридні хірургічні втручання у даної групи хворих дозволяють збільшити ємність сприймаючого артеріального русла підколінно-гомілкового сегмента і, таким чином, покращити результати хірургічного лікування.

INVESTIGATING MICROANGIOPATHY USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN PATIENTS WITH SUSAC SYNDROME.

To determine whether optical coherence tomography angiography is of diagnostic utility for Susac syndrome (SuS) by quantifying microvascular retinal changes. We enrolled 18 eyes of 9 healthy controls and 18 eyes of 9 patients with chronic SuS (12 had previous branch retinal artery occlusions and 6 were clinically unaffected). Images of the fovea were taken using an optical coherence tomography angiography system. Analysis included vessel density, fractal dimension, vessel diameter, and measurements of the foveal avascular zone (area, eccentricity, acircularity index, and axis ratio) in deep and superficial retinal layers. Skeleton density and inner ring vessel density were significantly lower in patients with SuS (skeleton density: Susac 0.11 ± 0.01 vs. controls 0.12 ± 0.01, P = 0.027. VD: SuS 0.39 ± 0.04 vs. controls 0.42 ± 0.02, P = 0.041). Eccentricity and axis ratio were significantly higher in patients with SuS (EC: Susac 0.61 ± 0.11, controls 0.51 ± 0.10, P = 0.003; axis ratio: Susac 1.57 ± 0.28, controls 1.39 ± 0.11, P = 0.005). SuS eyes (affected and unaffected) had poorer outcomes of the remaining vascular parameters compared with controls (P > 0.05). Optical coherence tomography angiography identified chronic microvascular changes in the eyes of patients with chronic SuS. Even clinically unaffected SuS eyes showed poorer vascular parameters. Although further research is needed, this noninvasive imaging modality seems to have the potential to serve as a valuable additive diagnostic tool.

Institutional Diagnostic Reference Levels and Peak Skin Doses in selected diagnostic and therapeutic interventional radiology procedures.

Institutional (local) Diagnostic Reference Levels for Cerebral Angiography (CA), Percutaneous Transhepatic Cholangiography (PTC), Transarterial Chemoembolization (TACE) and Percutaneous Transhepatic Biliary Drainage (PTBD) are reported in this study. Data for air kerma-area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT) and number of images (NI) as well as estimates of Peak Skin Dose (PSD) were collected for 142 patients. Therapeutic procedure complexity was also evaluated, in an attempt to incorporate it into the DRL analysis. Local PKA DRL values were 70, 34, 189 and 54Gy.cm2 for CA, PTC, TACE and PTBD respectively. The corresponding DRL values for Ka,r were 494, 194, 1186 and 400mGy, for FT they were 9.2, 14.2, 27.5 and 22.9min, for the NI they were 844, 32, 602 and 13 and for PSD they were 254, 256, 1598 and 540mGy respectively. PKA for medium complexity PTBD procedures was 2.5 times higher than for simple procedures. For TACE, the corresponding ratio was 1.6. PSD was estimated to be roughly 50% of recorded Ka,r for procedures in the head/neck region and 10% higher than recorded Ka,r for procedures in the body region. In only 5 cases the 2Gy dose alarm threshold for skin deterministic effects was exceeded. Procedure complexity can differentiate DRLs in Interventional Radiology procedures. PSD could be deduced with reasonable accuracy from values of Ka,r that are reported in every angiography system.

Combined Angio-CT Systems: A Roadmap Tool for Precision Therapy in Interventional Oncology.

Combined angiography-CT (angio-CT) systems, which combine traditional angiographic imaging with cross-sectional imaging, are a valuable tool for interventional radiology. Although cone-beam CT (CBCT) technology from flat-panel angiography systems has been established as an adjunct cross-sectional imaging tool during interventional procedures, the intrinsic advantages of angio-CT systems concerning superior soft-tissue imaging and contrast resolution, along with operational ease, have sparked renewed interest in their use in interventional oncology procedures. Owing to increases in affordability and usability due to an improved workflow, angio-CT systems have become a viable alternative to stand-alone flat-panel angiographic systems equipped with CBCT. This review aims to provide a comprehensive technical and clinical guide for the use of angio-CT systems in interventional oncology. The basic concepts related to the use of angio-CT systems, including concepts related to workflow setup, imaging characteristics, and acquisition parameters, will be discussed. Additionally, an overview on the clinical applications and the benefits of angio-CT systems in routine therapeutic and palliative interventional oncology procedures will be reviewed. Keywords: Ablation Techniques, CT-Angiography, Interventional-Body, Interventional-MSK, Chemoembolization, Embolization, Radiation Therapy/Oncology, Abdomen/GI, Skeletal-Axial Supplemental material is available for this article. © RSNA, 2021.

Age, Serum Creatinine, and Left Ventricular Ejection Fraction Improved the Performance of the CatLet Angiographic Scoring System in Terms of Outcome Predictions for Patients with Acute Myocardial Infarction: A Median 4.3-Year Follow-Up Study

Background: We recently developed the Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system. Our preliminary study demonstrated that the CatLet score better predicted clinical outcomes than the SYNTAX score. The current study aimed at assessing whether 3 clinical variables (CVs) – age, serum creatinine, and left ventricular ejection fraction (LVEF) – improved the performance of the CatLet score in outcome predictions in patients with acute myocardial infarction (AMI). Methods: This study was a post hoc study of the CatLet score validation trial. Primary endpoint was major adverse cardiac or cerebrovascular events (MACCEs), and secondary endpoints were all-cause deaths and cardiac deaths. Results: Over 1,185 person-years (median [interquartile range], 4.3 [3.8–4.9] years), there were 64 MACCEs (20.8%), 56 all-cause deaths (18.2%), and 47 cardiac deaths (15.2%). The addition of the 3 CVs to the stand-alone CatLet score significantly increased the Harrell’s C-index by 0.0967 (p = 0.002) in MACCEs, by 0.1354 (p < 0.001) in all-cause deaths, and by 0.1187 (p = 0.001) in cardiac deaths. When compared with the stand-alone CatLet score, improved discrimination and better calibration led to a significantly refined risk stratification, particularly at the intermediate-risk category. Conclusions: CatLet score had a predicting value for clinical outcome in AMI patients. This predicting value can be improved through a combination with age, serum creatinine, and LVEF (http://www.chictr.org.cn; unique identifier: ChiCTR-POC-17013536).

Robotic Assistance System for Cone-Beam Computed Tomography-Guided Percutaneous Needle Placement

PurposeThe study aimed to evaluate a new robotic assistance system (RAS) for needle placement in combination with a multi-axis C-arm angiography system for cone-beam computed tomography (CBCT) in a phantom setting.Materials and MethodsThe RAS consisted of a tool holder, dedicated planning software, and a mobile platform with a lightweight robotic arm to enable image-guided needle placement in conjunction with CBCT imaging. A CBCT scan of the phantom was performed to calibrate the robotic arm in the scan volume and to plan the different needle trajectories. The trajectory data were sent to the robot, which then positioned the tool holder along the trajectory. A 19G needle was then manually inserted into the phantom. During the control CBCT scan, the exact needle position was evaluated and any possible deviation from the target lesion measured.ResultsIn total, 16 needle insertions targeting eight in- and out-of-plane sites were performed. Mean angular deviation from planned trajectory to actual needle trajectory was 1.12°. Mean deviation from target point and actual needle tip position was 2.74 mm, and mean deviation depth from the target lesion to the actual needle tip position was 2.14 mm. Mean time for needle placement was 361 s. Only differences in time required for needle placement between in- and out-of-plane trajectories (337 s vs. 380 s) were statistically significant (p = 0.0214).ConclusionUsing this RAS for image-guided percutaneous needle placement with CBCT was precise and efficient in the phantom setting.

Spatial positional relationship between macular superficial vessel density and ganglion cell-inner plexiform layer thickness in primary angle closure glaucoma

PurposeTo evaluate the spatial relationship between macular superficial vessel density (SVD) and macular ganglion cell-inner plexiform layer (GCIPL) thickness in primary angle closure glaucoma (PACG), and to investigate diagnostic abilities of macular SVD and foveal avascular zone (FAZ) parameters.MethodsThis was a cross-sectional study on 38 PACG patients (38 eyes) and 25 healthy subjects (25 eyes). Macular region was imaged using a 1050-nm-wavelength swept-source optical coherence tomography (OCT) angiography (OCTA) system (DRI OCT Triton, TOPCON). Vessel density of the macular region was quantified by ImageJ software. The peripapillary retinal nerve fiber layer (pRNFL) thicknesses and macular GCIPL thickness were obtained by swept-source OCT. Pearson correlation analysis was used to evaluate the spatial positional relationship between macular SVD and macular GCIPL thickness. At the same time, the correlation between macular SVD and pRNFL thickness was evaluated. Areas under the receiver operating characteristics curves (AUCs) of OCT, OCTA and FAZ measurement metrics were calculated to assess the diagnostic ability for glaucoma.ResultsMacular GCIPL thickness had a moderate correlation with the macular SVD in the inferonasal sector (r = 0.426, P = 0.008). In addition, there was a strong correlation between inferonasal sector of macular vessel density and 5,6,7,8 clock-hour regions of the pRNFL thicknesses (all r > 0.5). Inferoinferior sector of macular SVD and 6,7 clock-hour regions of pRNFL thicknesses also had strong correlation (all r > 0.5). The AUCs of macular SVD ranged between 0.61 (superonasal sector) and 0.76 (inferoinferior sector). The FAZ circularity index showed the highest diagnostic power (AUC = 0.94;95% CI, 0.85–0.99), followed by superotemporal sector of macular GCIPL thicknesses (0.93;95% CI,0.83–0.98).ConclusionsSector of macular SVD not only had a spatial positional correlation with corresponding macular GCIPL thickness, but also with clock-hour regional pRNFL thicknesses in PACG eyes. FAZ circulation index might be a useful diagnostic parameter.

Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

To assess and compare all current computed tomography angiography (CTA) scoring systems for the diagnostic workup of brain death (BD) to digital subtraction angiography (DSA) and clinical tests. Fifty-two patients with a clinical suspicion of BD underwent CTA and subsequently DSA. The diagnostic performance of all current CTA scoring systems was compared to that of DSA, in all patients with a suspicion of BD. A comparison to clinical tests was made only in DSA-positive for BD patients (n = 49), since in DSA-negative BD patients (n = 3) clinical tests were not performed. Further subgroup analysis was performed in relation to skull defects (SDs) stratification. Statistical analysis was conducted by applying statistics-contingency tables, Cochran’s-Q test and McNemar’s test. The CTA -10, and -7- and all 4-point scoring systems, showed overall sensitivities of 81,6%, 87.8% and 95.9% respectively and 100% specificity, when compared to DSA. In patients with a clinical verification of BD, the CTA -10 and -7-point scoring systems were significantly inferior to clinical tests (p = 0.004 and p = 0.031), while the 4-point scoring systems showed no such difference (p = 0.5). All 4-point scoring systems showed 100% sensitivity in patients with a minor SD or no SD. In patients with a major SD, all CTA scoring systems (− 10, − 7- and all 4-point) were less sensitive (62.5%, 62.5% and 75% respectively). The presence of a major SD was associated with an 8 × relative risk for false negative results in all 4-point scoring systems. CTA showed excellent diagnostic performance in patients with a suspicion of BD. The 4-point CTA scoring systems are the most sensitive for the diagnosis of BD, although in patients with a major SD patient, the role of CTA is ambiguous.

Gene polymorphism and serum levels of interleukin-18 in patients with coronary artery disease and type 2 diabetes mellitus

Background Circulating concentrations of interleukin-18 (IL-18) were shown to be correlated with the vascular events in patients with coronary artery disease (CAD). Objectives To assess the serum levels of IL-18 and its gene polymorphism in CAD and diabetic patients and correlate these findings with clinical, echocardiographic, laboratory, and coronary angiographic findings. Patients and methods This cross-sectional observational study included 180 patients, who were divided according to presence or absence of CAD and type 2 diabetes mellitus into four groups: group I (41 patients), nondiabetic patients without CAD; group II (51 patients), nondiabetic patients with CAD; group III (40 patients), diabetic patients without CAD; and group IV (48 patients), diabetic patients with CAD. Serum levels of IL-18 and its genotyping distributions were measured in all groups and correlated with the angiographic coronary scoring systems. Results Serum IL-18 level was higher significantly in patients with CAD (groups II and IV) than in patients without CAD (groups I and III) (P Conclusion IL-18 is a novel and independent risk factor for CAD, and it is associated with its extent and severity. IL-18 gene polymorphism at 137 G/C site could be a risk factor for development of CAD, presumably by increasing serum IL-18 levels. Individuals carrying the G allele and the G/G genotype of IL-18 have an increased risk to develop CAD.

Variability and Reproducibility of the SYNTAX Score for Triple-Vessel Disease

BackgroundThe SYNTAX score (SX) is an angiographic grading system to determine the burden and complexity of coronary artery disease (CAD) and to guide operators as to the appropriateness of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG). However, variability of the SX may exist since the assessment relies on individual clinicians to visually interpret lesion severity and characteristics. We therefore aimed to assess SX variability and reproducibility among interpreting physicians. MethodsFifty patient angiograms were randomly selected from a registry of patients with multi-vessel CAD (treated with PCI or CABG) completed at our institution during the years 2011–2018. Each angiogram was evaluated by 6 clinicians on 2 separate occasions (minimum 8 weeks between occasions) for a total of 600 SX. Our goal was to evaluate both inter- and intra- observer reliability of SX scores. Variation in both raw score as well as risk classification (low, intermediate or high SX) was observed. Inter- and intra-observer reliability were assessed using the intra-class correlation coefficient (ICC), Cohen's weighted Kappa, and Fleiss' Kappa. ResultsSYNTAX scores on both assessments and across all 6 cardiologists had a mean score of 25.3. On the first assessment, the ICC for the inter-observer reliability of SX scores was 0.61 (95% CI: 0.50, 0.73). Across the 6 observers, only 16% of angiograms were classified in the same risk classification by all observers. 34% of angiograms had less than a majority agreement (3 or less observers) on risk classification. The weighted Kappa for intra-observer reliability of risk classification scores ranged from 0.30 to 0.81. Across the 6 observers, the proportion of angiograms classified as the same risk classification between each observer's 1st and 2nd assessment ranged from 46% to 84%. ConclusionThis study shows a wide inter- and intra- user variability in calculating SX. Our data indicates a significant limitation in using the SX to guide revascularization strategies. Further studies are needed to determine more reliable ways to quantitate burden of CAD.

Optical Coherence Tomography Angiography Microvascular Variations in Pre- and Posttreatment of Retinoblastoma Tumors

Introduction: The purpose of this study is to describe variations in microvasculature before and after treatment of treatment-naive lesions and during consolidation therapy of retinoblastoma lesions using an investigational portable optical coherence tomography angiography (OCTA) system. Methods: This study is a single-center, prospective, observational case series. Recruited subjects were either undergoing surveillance for retinoblastoma or had newly detected retinoblastoma. Nine tumors from 7 eyes in 6 patients were included. During exams under anesthesia, the tumors were imaged with an investigational portable OCTA system. OCTA images were analyzed to assess vascular changes before and after treatment. Results: In all 6 presented cases, OCTA imaging revealed distinctive vascular patterns, such as dilated feeder arteries and draining veins, disorganized and complex branching patterns, irregular vessel calibers, and dilation and tortuosity of vessels. After treatment, OCTA imaging revealed decreased intrinsic tumor vascularity and reduced dilation of draining and feeder vessels. Tumor relapse demonstrated prominent vascularity (n = 1) that resolved on repeat OCTA after transpupillary thermotherapy treatment. Type 2 (n = 1), 3 (n = 6), and 4 (n = 1) tumor regression patterns were seen in our patients after treatment, and OCTA findings were consistent with a previously published report. Interestingly, in one of the presented cases, OCTA demonstrated clear feeder, draining, and intrinsic tumor vessels that were not as evident on fluorescein angiography. Conclusions: OCTA may offer a noninvasive and sensitive technique to evaluate the vasculature of both the tumor and the surrounding retina in retinoblastoma. With additional research and development into its use in patients with retinoblastoma, OCTA may one day be useful in assessing treatment response and residual tumor activity.

Canon Interventional Angiography System

Canon Interventional Angiography System