Transjugular Intrahepatic Portosystemic Shunt Creation in a Polycystic Liver Facilitated by Hybrid Cross-sectional/Angiographic Imaging
Department of Radiology, Stanford University Medical Center, H-3646, Stanford, California 94305-5642, USA.Journal of Vascular and Interventional Radiology (Impact Factor: 2.41). 05/2006; 17(4):711-5. DOI: 10.1097/01.RVI.0000208984.17697.58
Polycystic liver disease (PCLD) has long been considered to represent a contraindication to transjugular intrahepatic portosystemic shunt (TIPS) creation, primarily because of the risk of hemorrhage. Three-dimensional (3D) navigation within the enlarged and potentially disorienting parenchyma can now be performed during the procedure with the development of C-arm cone-beam computed tomography, which relies on the same equipment already used for angiography. Such a hybrid 3D reconstruction-enabled angiography system was used for safe image guidance of a TIPS procedure in a patient with PCLD. This technology has the potential to expedite any image-guided procedure that requires 3D navigation.
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ABSTRACT: To evaluate C-arm computed tomography (CT) and assess its potential impact on hepatic arterial interventions. Between May 2005 and March 2006, all hepatic arterial interventions for hepatic malignancies were retrospectively reviewed. C-arm CT acquisitions were performed as an adjunct to conventional digital subtraction angiography (DSA). The number of procedures with C-arm CT, the acquisitions per intervention, and the procedure time for all interventions were recorded. The added information provided by C-arm CT was scored as category 1 (no additional information); category 2 (added information without impact on procedure management); or category 3 (added information with impact on procedure management). Intervention types included infusions, radioembolization, embolization, and chemoembolization. A two-sided, two-sample t test was used to compare interventions with and without C-arm CT, and P values less than .05 were considered significant. C-arm CT was used in 86 of 240 interventions (36%) in 135 patients. The mean number of acquisitions per study was 1.9 (range, 1-4). Thirty-five interventions (40.7%) were scored as category 2 and 16 interventions (18.6%) were scored as category 3. Chemoembolization was associated with the highest percentage of C-arm CT investigations classified as category 2 and 3 assessed per intervention. The mean procedure time was significantly longer (18 minutes) when C-arm CT was used (P<.001). C-arm CT provides additional imaging information beyond DSA during hepatic arterial interventions (approximately 60%), and this information impacted procedure management in 19% of cases. C-arm CT offers the greatest opportunity for additional information during chemoembolization procedures and is responsible for a significant but acceptable increase in procedure time for this type of hepatic intervention.
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ABSTRACT: To compare angiographic computed tomographic (CT) imaging with standard spiral CT imaging for the depiction of extraosseous cement after vertebral augmentation. Retrospective analysis of 28 consecutive patients treated with vertebral augmentation for compression fracture was conducted. Intraprocedural angiographic CT and postprocedural spiral CT images were acquired in all patients. Angiographic CT and spiral CT images were evaluated independently by two experienced radiologists. All vertebral augmentation procedures were performed successfully. All observed cement leaks were small, and no patient underwent additional treatment for cement leak. One level was excluded as a result of severe motion artifacts that rendered angiographic CT nondiagnostic. Further analysis was performed in the remaining 27 patients (12 men; mean age, 62 years; age range, 31-87 y) corresponding to 48 vertebral levels. Seventeen patients were treated under general anesthesia (33 levels) and 11 were treated under conscious sedation (15 levels). To detect the presence of extraosseous cement, angiographic CT achieved sensitivity of 0.70 and 0.57 for reader 1 and reader 2, respectively, and specificity of 0.93 and 0.92, respectively. Stratified analyses by anesthesia type showed sensitivity of 0.73 and 0.50, respectively, for conscious sedation versus 0.67 and 0.62, respectively, for general anesthesia. Specificity was 1.00 and 1.00, respectively, versus 0.92 and 0.90, respectively. Cement leaks were detected with a high specificity and a moderate sensitivity with angiographic CT. No difference was found between treatments with general anesthesia versus intravenous conscious sedation.
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