Feeding Vessels Research Articles

Orbital and Ocular Venous Congestion: A Rare Manifestation of Hypervascular Paget Disease of the Bone.

A 73-year-old male with a history of incidentally diagnosed Paget disease of bone affecting the skull and left orbit 2 years prior presented with 3 months of vision loss, proptosis, and periorbital swelling of the OS. Examination showed best-corrected Snellen visual acuity of 20/150 in the affected eye, intact motility, 7 mm of relative proptosis, significant dilated and tortuous "corkscrew" conjunctival vessels, serous choroidal and retinal detachments, optic nerve hyperemia, and venous tortuosity and dilation. Although the bony lesions in the left orbit were stable from 1 year prior on imaging, the diagnostic angiogram demonstrated osseous blush and hypervascularity of the lesion. It was thus determined that the abnormal bone of the left orbit with enhanced blood flow was adversely affecting the blood flow in the orbit and eye. The patient underwent coil embolization of the feeding vessels and external blood supply to the lateral orbital wall and hyperostotic Paget lesion via coil embolization of the left internal maxillary artery and left middle meningeal artery with improvement of the choroidal effusions and subretinal fluid, followed by bony orbital decompression with improvement in the proptosis. This is a novel case of orbital and ocular vascular congestion due to Paget disease.

Congenital Pulmonary Hybrid Lesions: Clinical Presentation, Surgical Management, and Outcomes.

Congenital pulmonary airway malformation (CPAM) lesion with an aberrant systemic blood supply is considered a "hybrid" lesion (HL). The aim of the study was to report authors' experience in the presentation, surgical management, and outcomes of HL. A retrospective cohort study of HL patients followed from 2000 to 2022 in a single institution was done. Clinical and radiographic data were collected from the medical records. Over the study period, 39 patients with HL were identified. HL with CPAM type 2 was more common than type 1 (74% vs. 26%), and intralobar sequestrations were more prevalent than extralobar sequestrations (ELS) (79.5% vs. 20.5%). HL with CPAM type 2 had higher rates of co-morbidities and higher likelihood to present with respiratory symptoms after birth. HL with ELS had smaller feeding vessels (all < 4mm) which resulted in lower rates of open thoracotomy approach for resection. The variability in HL patient presentation and outcomes is correlated with the size and the hybrid composition.

Technical Considerations for Oncologic Colectomy

AbstractColectomy for malignant tumors or unresectable benign tumors requires preoperative planning based on cross-sectional imaging, consideration of neoadjuvant therapy, a decision on the extent of lymphadenectomy, and comprehensive knowledge of the relevant anatomy. Imaging review is critical for determining resectability and noting any aberrant anatomy. Based on the imaging, neoadjuvant therapy should be considered for bulky or locally advanced disease. The anatomical resection of the colon, mesentery, and lymph node basins is performed in accordance with the concept of complete mesocolic excision (CME), entailing the resection of the mesentery with visceral peritoneum intact, appropriate proximal and distal margins taken en bloc, and high ligation of the primary feeding vessels along which the lymph nodes are positioned. High ligation of the colic arteries is part of a standard lymphadenectomy and is intended to address possible micrometastatic nodal disease and proper staging for adjuvant therapy. Extended lymphadenectomy in the form of CME with central vascular ligation is indicated for patients with advanced T stage or clinical lymphadenopathy. Whether extended lymphadenectomy should be performed routinely is subject to debate. In this article, we review the indications and operative strategies for management of colon cancer in various locations in the colon, as well as key considerations for minimally invasive colectomy and advanced techniques such as CME with central vascular ligation.

Imaging of unicentric hyaline-vascular variant of Castleman disease: Emphasis on perilesional fat stranding and fatty proliferation.

The hyaline-vascular variant of Castleman disease (HVCD) is relatively uncommon and demonstrates no specific clinical or laboratory findings; therefore, its preoperative diagnosis warrants a radiological evaluation. This study aimed to review imaging findings of HVCD, focusing on perilesional fat stranding and fatty proliferation. Patients with a pathologically confirmed HVCD diagnosis who had undergone CT were recruited from five hospitals from January 2000 to March 2023. Three experienced radiologists assessed CT findings, including lesion location, lesion size, calcification, enhanced pattern, feeding vessel visualization, and arterial enhancement. Perilesional fat stranding, fatty proliferation, neighboring fascial thickening, and surrounding lymphadenopathy were the primary targets of analysis. Moreover, the intensities and apparent diffusion coefficient (ADC) values on MRI and the maximum standardized uptake value (SUVmax) on 18F-fluorodeoxyglucose positron emission tomography (PET) were evaluated. This study enrolled 43 patients (mean age 41.3 years ± 14.6 [standard deviation], 23 women). All lesions were well-defined round masses. Calcification and feeding vessels were detected in 21% (9/43) and 86% (36/43) of the patients, respectively. Perilesional fat stranding and fatty proliferation were observed in 44% (19/43) and 19% (8/43), respectively, with fatty proliferation detected only in retroperitoneal HVCD. Neighboring fascial thickening and surrounding lymphadenopathy were identified in 21% and 60%, respectively. The mean ADC value and SUVmax were 0.884 × 10-3 mm2/s and 5.0, respectively. Retroperitoneal HVCD cases with perilesional fatty proliferation demonstrated a higher visceral fat ratio than those without (p = 0.046). Perilesional fat stranding and fatty proliferation were new characteristics of HVCD, especially in retroperitoneal cases.

Temporary Flow Diversion in Oncological Embolization Procedures Using Degradable Starch Microspheres.

This study aims to report on the application of degradable starch microspheres to provide flow diversion by means of temporary embolization of healthy tissues in oncological endovascular procedures when tumor feeding vessels are not selectively accessible. This is a multicenter retrospective analysis of patients undergoing visceral embolization procedures of malignancies. The inclusion criteria were as follows: flow diversion performed by injection of degradable starch microspheres, visceral embolization procedures with unfeasible superselective catheterism of the target, and a malignant pathology. Technical success was defined as complete flow diversion with temporary exclusion of the non-target district from arterial flow, associated with successful embolization of the target. Clinical success was intended as procedural achievement with patient clinical improvement. Sixteen patients were included in this analysis. Peripheral embolization procedures were performed in the coeliac visceral district all in oncologic patients, including 4 transarterial radioembolization work-up procedures in patients with hepatocarcinoma, 10 chemioembolization procedures in patients with hepatocarcinoma (8) or cholangiocarcinoma (2), and 2 palliative transarterial embolizations in patients with gastric cancer. Technical success was obtained in 100% of the cases, while clinical success was reached in 87.5%: in two chemioembolization procedures, despite technical success, the procedural clinical benefits were partial, with an incomplete target lesion response. Minor complications occurred in five patients (31.2%). In this study, temporary flow diversion with degradable starch microspheres during oncological embolization procedures was safe and effective; this approach is suitable to protect healthy surrounding tissues when vessels feeding the target cannot be selected with the microcatheter.

Deep learning model combined with computed tomography features to preoperatively predicting the risk stratification of gastrointestinal stromal tumors

BACKGROUND Gastrointestinal stromal tumors (GIST) are prevalent neoplasm originating from the gastrointestinal mesenchyme. Approximately 50% of GIST patients experience tumor recurrence within 5 years. Thus, there is a pressing need to accurately evaluate risk stratification preoperatively. AIM To assess the application of a deep learning model (DLM) combined with computed tomography features for predicting risk stratification of GISTs. METHODS Preoperative contrast-enhanced computed tomography (CECT) images of 551 GIST patients were retrospectively analyzed. All image features were independently analyzed by two radiologists. Quantitative parameters were statistically analyzed to identify significant predictors of high-risk malignancy. Patients were randomly assigned to the training (n = 386) and validation cohorts (n = 165). A DLM and a combined DLM were established for predicting the GIST risk stratification using convolutional neural network and subsequently evaluated in the validation cohort. RESULTS Among the analyzed CECT image features, tumor size, ulceration, and enlarged feeding vessels were identified as significant risk predictors (P &lt; 0.05). In DLM, the overall area under the receiver operating characteristic curve (AUROC) was 0.88, with the accuracy (ACC) and AUROCs for each stratification being 87% and 0.96 for low-risk, 79% and 0.74 for intermediate-risk, and 84% and 0.90 for high-risk, respectively. The overall ACC and AUROC were 84% and 0.94 in the combined model. The ACC and AUROCs for each risk stratification were 92% and 0.97 for low-risk, 87% and 0.83 for intermediate-risk, and 90% and 0.96 for high-risk, respectively. Differences in AUROCs for each risk stratification between the two models were significant (P &lt; 0.05). CONCLUSION A combined DLM with satisfactory performance for preoperatively predicting GIST stratifications was developed using routine computed tomography data, demonstrating superiority compared to DLM.

Unusual Manifestation of Retained Product of Conception in the Cervix: A Case Study

Retained products of conception (RPOC) occur when fragments of the placenta or decidual tissue remain in the uterus, often leading to postpartum hemorrhage. Early and accurate diagnosis, aided by ultrasonography, is essential for appropriate management and prevention of complications. We report a case of a 22-year-old woman admitted to our tertiary medical department with irregular vaginal bleeding and abdominal pain. She had no significant past medical history. Abdominal ultrasonography revealed a normal-sized uterus with homogeneous myometrial echogenicity. However, a heterogeneous echogenic mass, exhibiting considerable vascularity and feeding vessels from the endometrial cavity, was observed in the cervix. Additionally, the patient’s beta human chorionic gonadotropin (Beta-HCG) concentration was positive, with a titer of 201 μ/l, despite her claim of being a virgin. Subsequently, the patient underwent hysteroscopy, during which an infected and malodorous lesion was removed from the uterus, confirming the diagnosis of RPOC. In follow-up assessments, she experienced no complications. To the best of our knowledge, no cases of RPOC located in the cervix have been reported previously, as RPOC is typically expected to be found in the endometrial cavity. This study aims to share our experience in considering the differential diagnosis of RPOC as cervical lesions and highlights the importance of ultrasonography in early pregnancy management

Primary Retroperitoneal Approach to the Superior Mesenteric Vessels in Minimally Invasive Surgical Treatment of Right Colon Cancer with D3 Lymph Node Dissection. Technique and First Short-Term Outcomes

Aim: to develop and describe the technique of primary retroperitoneal approach to the superior mesenteric vessels for D3 lymph node dissection in minimally invasive surgical treatment of the right colon cancer; to evaluate the shortterm results of the first series of patients operated by this technique.Materials and methods. Patients with adenocarcinoma of the right colon were included in the study. The technique of primary retroperitoneal approach consisted in mobilization of the right mesocolon along the posterior surface in the direction of the superior mesenteric vessels, D3 lymph node dissection with crossing of the feeding vessels from the retroperitoneal side using a single-port access system and consisted of five consecutive steps. At the last step of the procedure the peritoneum and the remaining part of the mesentery were crossed laparoscopically to the intended borders of the colon resection. The specimen was extracted through the incision for the single port, followed by the formation of an anastomosis extracorporeally. The endpoints of the study were the short-term results of surgical treatment.Results. The study presents data of the first 5 patients with adenocarcinoma of the right colon who underwent surgical treatment with D3 lymph node dissection using primary retroperitoneal approach to the superior mesenteric vessels. The duration of the retroperitoneal step averaged 110 (90–140) min. The average blood loss was 62 (10–100) mL. The first two patients underwent a three-stage retroperitoneal portion of the surgery. The other three patients were successfully operated by primary retroperitoneal approach with performing of all five steps of the operation. The number of removed regional lymph nodes was on average 36 (18–57), apical lymph nodes — 6 (4–5), metastatic regional lymph nodes — 3 (2–4). One patient developed a Class 1 Clavien — Dindo complication, which did not require a change in treatment tactics. The average postoperative hospital stay was 8 (5–12) days.Conclusion. The technique of primary retroperitoneal approach to the superior mesenteric vessels to perform D3 lymph node dissection was described for the first time. The obtained results demonstrated the possibility of using this method for minimally invasive radical treatment of right colon cancer.

Computed tomographic features of pulmonary and extrapulmonary lesions can be useful in prioritizing the diagnosis of hemangiosarcoma metastases in dogs.

The aim of this study was to evaluate the CT features of pulmonary metastases in dogs with hemangiosarcoma (HSA) at various sites. Additionally, the CT characteristics of extrapulmonary metastases in the same population were assessed. Retrospective, observational, and descriptive study conducted from April 2013 to January 2024. Dogs with histologically confirmed HSA and suspected or cytologically/histologically confirmed lung metastases were included. Dogs were excluded if they had a second primary tumor or only 1 unsampled pulmonary nodule. 33 dogs were included, with 26/33 [78.8%] having more than 10 metastatic pulmonary nodules. Most nodules were generalized (24/33 [72.7%]), miliary (29/33 [87.9%]) to subcentimetric (32/33 [97%]) in size, well-defined margins (29/33 [87.9%]), or a perilesional halo sign (24/33 [72.7%]). When more than 10 nodules were present, a generalized distribution was prevalent, while a peripheral location was more common when 2 to 10 nodules were present (P < .0001). In 32/33 (97%) cases, a pulmonary vessel was directly connected to the nodule (feeding vessel). After contrast administration, most lung metastases appeared homogenous (26/33 [78.8%]), although some showed areas of intense enhancement (5/33 [15.1%]) a feature also observed in extrapulmonary metastases with varying frequency (0% to 85.7%). Pulmonary HSA metastases were characterized by generalized, small (miliary/subcentimetric), well-defined nodules, commonly associated with a halo sign and feeding vessel. Intralesional areas of spotty postcontrast linear or amorphous strong hyperdensity were frequently observed especially in extrapulmonary metastases. These features may help radiologists and clinicians orient their diagnosis toward metastatic HSA.

Percutaneous coil embolization of a large right gluteal arterio-venous malformation with multiple feeding vessels

Percutaneous coil embolization of a large right gluteal arterio-venous malformation with multiple feeding vessels

Clinical and pathologic characteristics of inflamed juvenile conjunctival nevus and its treatment with immunosuppressant eye drops.

To clarify the clinical and pathologic findings of 7 patients with inflamed juvenile conjunctival nevus (IJCN) treated with tacrolimus. Retrospective study. The medical records of 7 male patients diagnosed with IJCN between February 2007 and October 2022 at the Kansai Medical University Hospital and Ideta Eye Hospital were retrospectively reviewed. The patients' mean age was 11.3 (8-20) years, and the average follow-up period was 18 months. The patients underwent anterior segment optical coherence tomography (AS-OCT) and anterior segment optical coherence tomography angiography (AS-OCTA). All the patients were treated with steroids or immunosuppressant eye drops, or both. Histopathologic examinations were performed on specimens resected from 2 patients. The clinical characteristics of IJCN were as follows: (1) presence of cysts within a pigmented conjunctival mass, (2) tumor accompanied by feeder vessels, and (3) predominantly found in boys with allergic diseases. AS-OCT and AS-OCTA revealed the presence of a cystic structure with poor vascular signals within it and numerous vessels distributed on the sclera underlying the lesion. Immunosuppressant eye drops relieved the congestion, diminished the inflow vessels, and induced shrinkage of the cysts in all the patients. Histopathologic examinations revealed infiltration of inflammatory cells such as lymphocytes and macrophages and low proliferative activity of melanocytes with no division pattern. This study clarified the clinical and histologic characteristics of IJCN. Noninvasive AS-OCT and AS-OCTA might be useful for diagnosing IJCN. The histopathologic findings of this study indicate that immunosuppressive and antiallergic agents can effectively bring about disease remission.

Clinical Profiles of Retinal Vasoproliferative Tumors.

Purpose: To describe the clinical features and treatment outcomes of patients with retinal vasoproliferative tumors. Methods: This retrospective case series comprised patients diagnosed with a retinal vasoproliferative tumor. Electronic medical records were reviewed, and patients' demographic details, clinical presentation, and treatment outcomes were analyzed. Results: Nineteen eyes of 19 patients with vasoproliferative tumors were included. The mean age (±SD) at presentation was 37.0 ± 16.95 years. No eye had bilateral tumors, and 1 eye had multiple tumors. Three eyes (15%) had primary tumors, while 16 (84%) had secondary tumors. Primary tumors mainly affected the inferotemporal quadrant (n = 3). Secondary tumors involved the inferior quadrant (n = 4), inferotemporal quadrant (n = 5), and inferonasal quadrant (n = 5). Secondary tumors were associated with Coats disease (n = 6), intermediate uveitis (n = 3), traumatic chorioretinopathy (n = 2), familial exudative vitreoretinopathy (n = 2), retinal vasculitis (n = 2), and retinal vascular occlusion (n = 1). Retinochoroidal features included intraretinal and subretinal exudates, subretinal fluid, intraretinal hemorrhaging, vitreous hemorrhaging, cystoid macular edema, vitritis, preretinal fibrosis, dilated feeding vessel, epiretinal membranes, and tractional retinal detachment. Treatment modalities included cryotherapy, laser photocoagulation, and local steroids. The mean follow-up was 25.3 months, during which 18 eyes had tumor regression and 1 had a worsening condition. Conclusions: Secondary vasoproliferative tumors were more frequently observed than primary tumors, often presenting as unilateral, unifocal tumors situated posterior to the equator in the inferior fundus. Conventional treatment approaches, such as cryotherapy and laser photocoagulation, were effective at tumor regression and often required multiple sessions.

The Challenge in Diagnosis and Management of Secondary Conjunctival Cysts

Introduction: Conjunctival cysts can be categorized as primary or secondary. This report emphasizes difficulties in diagnosing secondary conjunctival cysts and distinguishing them from other conjunctival lesions like conjunctival benign reactive lymphoid hyperplasia (BRLH). Case Presentation: A 43-year-old male had a painless progressive conjunctival mass for four months. He took anti-aging and muscle-enhancing injections for a year and changed the product brand four months ago. Our examination revealed a conjunctival translucent mass with distinct margins and surface-feeding vessels without visual disturbance. We provisionally diagnosed it as a conjunctival cyst with a differential diagnosis of BRLH. We treated the patient with oral methylprednisolone and dexamethasone eye drops and discontinuation of anti-aging injections. The mass completely disappeared after one month of treatment. Conclusions: This case presented a diagnostic challenge due to the presence of a feeding vessel, which indicated inflammation. This made differentiating from inflamed conjunctival masses, such as BRLH, difficult. The patient had a history of suspected inflammation from changing the brand of injectable drug. Initially, we used steroids to reduce inflammation and prevent mass growth, but surprisingly, the lesion completely disappeared. If it recurs, a biopsy may be needed to identify the exact cause, as we have not ruled out BRLH. Secondary conjunctival cysts can result from toxins, trauma, or allergies. A thorough history taking, eye examination, and biopsy may be necessary to rule out other causes of inflamed conjunctival masses.

Ultrasound and magnetic resonance imaging (MRI) features of angioleiomyoma.

Vascular leiomyoma or angioleiomyoma is a rare benign tumor which belongs to the group of benign smooth muscle tumors. They are commonly located at the extremities, usually presented as a painful solitary lesion in the subcutaneous tissue. To date, very few reports describe its characteristics from an imaging point of view, especially their ultrasound characteristics, making it difficult to do a pre-surgical diagnosis. Our purpose is to describe the clinical, pathologic and imaging features of angioleiomyoma [ultrasound, Doppler ultrasound and magnetic resonance imaging (MRI) findings]. We retrospectively reviewed from the pathology database from Hospital Universitario Fundación Alcorcón, Madrid, Spain, the clinical histories of 139 patients who had surgical excision and histologic diagnosis of angioleiomyoma during the last 17 years, from May 31st 2006 to April 17th 2023. Of those patients, we focused on 50 who had soft tissue angioleiomyoma with imaging study [ultrasonography (US) and/or MRI] performed in our institution, making a descriptive cross-sectional study. In our series, a very characteristic ultrasonographic and US Doppler pattern was found. It consists in the presence of a well defined, homogeneous and highly vascularized soft tissue tumor, sometimes with the presence of a feeding vessel. When the described US features appear in a mobile and elastic subcutaneous slow growing tumor on an extremity, the diagnosis of angioleiomyoma should be considered as highly probable.

Abstract 348: Optimizing carotid body tumor embolization: The role of flow arrest using EMBOGUARD ™ Balloon Guide Catheter

Introduction Preoperative embolization is a known and acceptable adjunct to surgical resection of carotid body tumors (CBTs). Current literature depicts devascularization primarily through the transarterial route with superselective catheterization and embolization of feeding vessels by use of liquid or particle embolic agents. Less commonly used practices include percutaneous direct tumor puncture, coil embolization, a combined percutaneous and transarterial approach, and covered stent placement. Few studies have reported on embolization techniques that utilize balloon occlusion for assistance. We present our initial experience in pre‐treatment of CBTs using a combined approach of established embolization techniques and balloon occlusion of the external carotid artery (ECA) via the EMBOGUARD ™ Balloon Guide Catheter. Methods We performed a retrospective review of medical records from March 2023 to February 2024. The study included patients over 18 years old diagnosed with a carotid body tumor who had pre‐operative embolization using the the EMBOGUARD ™ Balloon Guide Catheter. The primary outcome measure was the degree of angiographic devascularization achieved, categorized as either near‐total or total occlusion of the tumor's feeding arteries. Safety outcomes included procedural complications, such as non‐target embolization into previously uninvolved territories and cranial nerve deficits affecting the glossopharyngeal, vagus, hypoglossal, or sympathetic chain. Results Three patients were included in this retrospective study, all of whom were female (100.0%, n=3/3). The median (standard deviation [SD]) age was 29.0 (±17.4) years. Two patients underwent transarterial embolization using a combination of Onyx, n‐butylcyanoacrylate, and coils. One patient had percutaneous direct tumor puncture embolization. In all cases, the external carotid artery (ECA) trunk was completely occluded using a balloon catheter during embolization. Near‐total angiographic devascularization of the tumor was achieved in all three patients (100.0%). There were no immediate complications or neurological deficits related to the embolization procedures. However, one patient experienced vocal cord paresis that persisted for six months following surgical resection of the tumor. Conclusions Using the EMBOGUARD ™ Balloon Guide Catheter to temporarily occlude the ECA during embolization of CBTs offers several advantages: prevents retrograde reflux of embolic particles into the internal carotid artery and intracranial circulation, reducing the risk of stroke; blocks anterograde flow in the ECA minimizing the chances of embolic material migrating into the ECA branches and causing complications like cranial nerve palsies; and stagnates blood flow to allow for more controlled and precise delivery of embolic agents into the tumor vasculature, which can improve the degree of angiographic devascularization achieved.

The polar vessel sign: insights from CT imaging analysis in Asian Indian primary hyperparathyroidism.

Data on the polar vessel sign (enlarged feeding vessel terminating in parathyroid lesions) on four-dimensional computed tomography (4D-CT) is limited. We performed a retrospective analysis to determine the prevalence, predictors, and adjunctive utility of polar vessel sign in pre-operative 4D-CT of patients with primary hyperparathyroidism (PHPT). One radiologist blinded to the patients' details reported the 4D-CT of eighty-four operated patients with histopathology-proven single-gland PHPT. Two protocols were used to obtain arterial-phase images: timed via bolus tracking (n = 41) or fixed at 20 s after contrast injection (n = 43). Seventy-one patients were symptomatic for PHPT, with median serum calcium 12.1 mg/dL. On the arterial phase of 4D-CT, 88.1% of lesions had the polar vessel sign, including 7/9 asymptomatic patients, 6/6 parathyroid carcinomas, and 3/4 ectopic(1:mediastinum, 2:thyro-thymic ligament). Predictors of polar vessel sign were maximum lesion dimension (2.2 vs. 1.4 cm; P = 0.03), solid-cystic CT morphology (47.3% vs. none; P = 0.004), and bolus tracking-timed arterial phase (55.4% vs. none; P = 0.001). Of these, bolus tracking improved the polar vessel's visualization (100% vs. 76.7%; P = 0.001) independent of lesion dimension and solid-cystic morphology. The latter two predicted polar vessel sign in images obtained at a fixed interval (20 s). A significantly lower proportion of bolus tracking-timed scans had lesion percentage arterial enhancement (PAE) < 128.9% (2/41 vs. 9/43; P = 0.04). Even with suboptimal PAE, the polar vessel helped identify 9/11 lesions. The polar vessel sign demonstrated an additive role to PAE during CT reporting. Bolus tracking is valuable in optimizing vessel and tumor arterial enhancement and is easily incorporated into parathyroid 4D-CT protocol.

Anaerobic bacterial metabolism responsive microspheres for bacterial embolization cancer therapy

Anaerobic bacteriolytic cancer therapy, whether delivered locally or systemically, frequently encounters challenges related to limited colonization within hypoxic pockets of central tumors and activation of innate immunity. Herein we have developed trans-arterial bacteria embolization therapy using bacterial embolic microspheres. C. novyi-NT spores loaded calcium alginate embolic microspheres demonstrated C. novyi-NT metabolites-mediated microsphere degradation, releasing vegetative C. novyi-NT bacterial in hypoxic condition. Transcatheter directed bacterial microsphere embolization therapy occludes tumor feeding vessels with infused bacterial embolic microspheres and enhances tumoral hypoxia. Notably, anaerobic bacterial metabolism responsive microsphere-bacterial embolization therapy achieved a complete tumor response with enhanced tumor-specific bacterial delivery and colonization, resulting in cancer cell killing across the entire tumor. In vivo tumor response and immunological profiling revealed that bacterial embolization uniquely enhances anti-cancer response, effectively engaging direct anaerobic bacterial oncolysis and adaptive and innate immune responses in a cooperative manner.

A feeding vessel in the right paratracheal space: an insidious presence

A feeding vessel in the right paratracheal space: an insidious presence

Embolization of posterior fossa meningiomas supplied with meningohypophyseal trunk by using n-BCA and dual balloon protection.

Efficacy of tumor embolization for posterior fossa meningioma is controversial due to the lack of adequate embolization for dangerous feeders. Of these, a meningohypophyseal trunk (MHT) has high therapeutic value despite the high risks associated with embolization. To analyze the utility of preoperative MHT embolization for posterior fossa meningiomas using n-BCA with dual balloon protection, a single center retrospective record review was performed on eight consecutive patients who underwent preoperative tumor embolization via the MHT for posterior fossa meningiomas between 2020 and 2024. All patients successfully embolized the MHT using n-BCA. Complete obliteration was achieved in five cases, which is related to the tentorial artery alone as the feeding vessel. None of the patients had cerebral infarction associated with distal embolization. One patient experienced worsening of preoperatively observed abducens nerve palsy due to cranial nerve ischemia. Gross total resection was achieved in seven of eight cases. The mean estimated blood loss during surgical resection was 186 mL (range, 39-392 mL). The mean operative time was 431 min (range, 317-767 min). The MHT embolization of posterior fossa meningiomas by using n-BCA is technically feasible with a high success rate and an acceptable complication rate. MHT=meningohypophyseal trunk; ILT=inferolateral trunk; CPA=Cerebellopontine angle; BGC=balloon guide catheter; PVA=polyvinyl alcohol; GTR=Gross Total Resection; CN=Cranial nerve.

A Study of Fibroid Vascularization and Vascular Indices With Three-Dimensional Power Doppler and Superb Microvascular Imaging and the Correlation With Heavy Menstrual Bleeding.

Objective The objective of the study was to evaluate fibroid vascularization and vascular indices with three-dimensional (3D) power Doppler and superb microvascular imaging (SMI) and its correlation with heavy menstrual bleeding (HMB). Material and methods A total of 75 women with intramural uterine fibroid: 50 with HMB (Group A) and 25 without HMB (Group B)were recruited for the study. All participants were subjected to transabdominal and transvaginal color Doppler ultrasound. A 3D Power Doppler was used to measure Doppler Indices and flow rate in uterine arteries and the dominant vessel of fibroid. SMI was also used to determine vascularity in the dominant fibroid and to grade the vascularity. Results A significant association was observed between Doppler indices in the dominant feeding vessel of fibroid and HMB. Flow rates, namely peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly higher. Contrarily, resistance measured as Resistive Index (RI) and Pulsatility Index (PI) was lower in Group A than in Group B. The mean PSV of the dominant feeding vessel in group A was 26.42 ± 4.57and in group B was 14.56 ± 3.17, with p-value < 0.0001. For EDV, the median value (25th-75th percentile) in women with HMB was 6.76 (6.152-8.74) vs 3.99 (3.2-5.95)in womenwithout HMB (p < 0.0001). A significant association was observed between uterine artery Doppler indices (specifically, PSVand EDV) and HMB. However, no significant association was found between RI and PI of the uterine artery and HMB. In the study of the vascular pattern on SMI, the percentage of women exhibiting both central and peripheral vascularity in Group A and Group B were 72% and 4%, respectively (p< 0.0001). Women in Group A showed a significantly higher proportion of grade 2 and grade 3 vascularity (76% and 20%, respectively), whereas only 4% showed grade 1 vascularity. Conversely, in Group B, all the women showed grade 1 vascularity (p <0.001). Conclusion Doppler indices in the dominant feeding vessel of fibroid show a positive correlation with HMB. In the study of the vascular pattern on SMI, a significant proportion of women with HMB exhibited both peripheral and central vascularity and a higher grade. Most women with symptomatic fibroids are of childbearing age and fertility preservation is at times their prime concern. Fibroid vascularization assessed with 3D power Doppler ultrasound and the new advanced SMU tool may prove to be useful in the prediction of response to various non-surgical management options of uterine leiomyoma and thus aid in counseling and appropriate patient selection.