A woman in her 20s presented with an 8-year history of postprandial abdominal pain. Contrast-enhanced computed tomography revealed severe stenosis at the origin of the celiac artery, collateral circulation from the superior mesenteric artery, and an associated inferior pancreaticoduodenal artery aneurysm. Respiratory variation in celiac artery compression suggested median arcuate ligament syndrome. However, Doppler ultrasonography revealed an atypical hemodynamic pattern, with a lower peak systolic velocity during expiration than during inspiration. Two laparoscopic median arcuate ligament release procedures were performed, with additional perivascular neural tissue dissection during the second. Despite these interventions, residual celiac artery stenosis and elevated flow velocity persisted. Subsequent angiography and intravascular ultrasound confirmed focal residual stenosis. Percutaneous transluminal angioplasty was performed, which increased the minimal luminal diameter from 1.8 to 3.5 mm and improved flow dynamics. Prior to aneurysm treatment, a superior mesenteric artery occlusion test confirmed preserved antegrade flow from the celiac artery to the pancreaticoduodenal arcade. Following restoration of celiac artery inflow, coil embolization of the inferior pancreaticoduodenal artery aneurysm was successfully performed without ischemic complications, following which the patient’s abdominal symptoms resolved. This case highlights a stepwise treatment approach that combines laparoscopic median arcuate ligament release and endovascular angioplasty to restore celiac artery inflow before aneurysm embolization in patients with median arcuate ligament syndrome complicated by visceral artery aneurysm.

To quantitatively evaluate changes in portal venous hemodynamics after partial splenic embolization (PSE) and portosystemic shunt occlusion (PSO) using four-dimensional (4D) flow magnetic resonance imaging (MRI). This retrospective cohort study included 30 procedures (16 PSE and 14 PSO) performed between 2019 and 2025. Flow rates were measured in the main portal vein (MPV), splenic vein (SpV), superior mesenteric vein (SMV), and portosystemic shunts (PSS) using pre- and post-procedural 4D flow MRI. For PSE, correlations were assessed between changes in MPV and SpV flow, and between vessel-specific flow change ratios and the embolic volume ratio. For PSO, changes in MPV flow were compared based on whether all PSS were treated, and correlation was assessed between flow changes in MPV and PSS flow. After PSE, MPV flow decreased (median, 751.0 to 441.5 mL/min; p = 0.025) as did SpV flow (482.5 to 323.0 mL/min; p = 0.001), whereas SMV flow remained unchanged. Changes in MPV and SpV flow were strongly correlated (ρ = 0.726, p = 0.002). The embolic volume ratio showed a moderate correlation with the SpV flow change ratio (ρ = 0.563, p = 0.036), but not with the MPV flow change ratio. After PSO, MPV flow increased (544.5 to 692.5 mL/min; p < 0.001), along with SpV flow (63.0 to 231.5 mL/min; p = 0.001), while SMV flow did not change significantly. The increase in MPV flow was greater when all PSS were treated than when they were not (140.0 vs. 17.0 mL/min; p = 0.019), and was not correlated with PSS flow. 4D flow MRI demonstrates that PSE decreases portal and splenic venous flow, whereas PSO increases both. These findings provide quantitative insight into complex treatment-related hemodynamic changes in the portal venous system.

With the continuing global trend of population aging, the number of older patients who require hepatectomy for malignant or benign liver diseases is steadily increasing. Postoperative liver failure remains one of the major causes of mortality after major hepatic resection, particularly among patients with limited hepatic reserve. Preoperative portal vein embolization (PVE) has been established as a safe and effective method to increase the future remnant liver volume (RLV), thereby improving postoperative outcomes. However, the regenerative capacity of the aged liver and the clinical benefits of PVE in older patients have not been fully clarified. This study aimed to assess the safety and efficacy of PVE in older patients compared with younger counterparts. We analyzed 113 patients who underwent PVE at Hokkaido University Hospital between 2000 and 2020. Patients were classified into 2 groups: 30 older patients (≥75 years; older group) and 83 younger patients (<75 years; younger group). We compared the patients’ characteristics, PVE-related factors, period from PVE to surgery, increase in RLV after PVE, and perioperative complications. Right hepatectomy was the most common surgical procedure (76.1%). The increase in RLV 2 weeks after PVE was comparable between the older (131.9%) and younger (130.3%) groups, and the period from PVE to surgery was also comparable (29 vs 26 days. respectively). Additionally, planned surgeries were completed successfully in all older patients. PVE-related complications were comparable, with recanalization of the embolic portal branch in 2 cases (6.7%) in the older group and 11 cases (13.3%) in the younger group. The liver failure rate, as a postoperative complication, was similar in the groups. Despite concerns regarding the diminished hepatic regenerative potential associated with aging, preoperative PVE effectively induces hypertrophy of the future remnant liver and may enable safe major hepatectomy in older patients. Although our findings suggest comparable outcomes between older and younger patients, these results should be interpreted with caution. PVE may be a safe and useful strategy in appropriately selected older patients requiring major liver resection.

Purpose: To evaluate the efficacy and safety of the GOREⓇ VIABAHNⓇ Endoprosthesis (stent graft) for traumatic or iatrogenic vessel injury. Material and Methods: This prospective, multicenter, cohort study for post-marketing clinical surveillance was conducted in Japan. Efficacy and safety endpoints included successful device implantation, primary and secondary hemostasis of injury, 1-month and 1-year survival rate, and at 1-, 6-, 12-months post-procedure, primary and secondary patency rates, antiplatelet drug administration, and serious adverse events. Results: In 37 patients (mean age 73.3±12.5 years; 22 males; 59.5%), 38 vessel injuries were evaluated. Primary treated arteries were visceral, subclavian, and iliac arteries; 86.8% (33/38) were iatrogenic, and 13.2% (5/38) were traumatic vessel injury. Iatrogenic injury included pseudoaneurysm (63.6%), perforation (24.4%), rupture (15.2%), dissection (12.1%), or fistula (3.0%). Technical success in 36 patients (36/37; 97.3%) with 37 vessels (37/38; 97.4%), and primary and secondary hemostasis in all patients were achieved. Primary patency at 1-, 6-, and 12-months was 89.1%, 84.8%, and 80.6%, and secondary patency was 91.5%, 87.3%, and 82.4%, respectively. The Kaplan-Meier survival estimate was 94.4% through 1 month and 75.9% through 1 year. No device-related deaths occurred. Through 12 months, of the 19 serious adverse events (13 patients), three serious adverse events were judged by the investigator to be device-related (vascular stent graft stenosis) or procedure-related (device occlusion and cerebellar infarction). Conclusions: The use of the VIABAHN stent graft for vessel injury was safe and effective in this study. Successful hemostasis was achieved through 1 month. Through 1 year, no device-related deaths were reported.

This study aimed to determine the effect of simulation training using a 3-dimensionally (3D) printed patient-specific vascular model on the advanced vascular catheterization skills of experienced interventional radiologists. Two specific anatomical types of 3D-printed patient-specific models from 2 patients with challenging celiac axis arterial anatomy were constructed. The Global Rating Scale of Endovascular Performance (GRS-EP) was used to evaluate vascular insertion skills. The training sessions comprised pretraining and posttraining evaluations. Two blinded raters evaluated the effectiveness of the training. Improvements were observed in success rate, insertion time, and GRS-EP scores among all 5 experienced interventonial radiologists. The GRS-EP demonstrated high interrater reliability. Posttraining scores increased significantly in both video and self-evaluations. Although there is no proof that better performance on this type of model directly translates to improved performance in humans, simulation training using this model has the potential to help experienced interventional radiologists further refine their vascular catheterization skills.

Accurate liver-volume measurements from CT scans are essential for treatment planning, particularly in liver resection cases, to avoid postoperative liver failure. However, manual segmentation is time-consuming and prone to variability. Advancements in artificial intelligence (AI), specifically convolutional neural networks, have enhanced liver segmentation accuracy. We aimed to identify optimal CT phases for AI-based liver volume estimation and apply the model to track liver volume changes over time. We also evaluated temporal changes in liver volume in participants without liver disease. In this retrospective, single-center study, we assessed the performance of an open-source AI-based liver segmentation model previously reported, using non-contrast and dynamic CT phases. The accuracy of the model was compared with that of expert radiologists. The Dice similarity coefficient (DSC) was calculated across various CT phases, including arterial, portal venous, and non-contrast, to validate the model. The model was then applied to a longitudinal study involving 39 patients without liver disease (527 CT scans) to examine age-related liver volume changes over 5 to 20 years. The model demonstrated high accuracy across all phases compared to manual segmentation. Among the CT phases, the highest DSC of 0.988 ± 0.010 was in the arterial phase. The intraclass correlation coefficients for liver volume were also high, exceeding 0.9 for contrast-enhanced phases and 0.8 for non-contrast CT. In the longitudinal study, the model indicated an annual decrease of 0.95

Introduction:Doege-Potter syndrome (DPS) is a rare paraneoplastic phenomenon of severe hypoglycemia associated with solitary fibrous tumors (SFT). We report a case of a giant pelvic SFT with DPS, which was managed with preoperative arterial embolization and complete excision. Case Presentation:This report describes the case of a 77-year-old patient with persistent hypoglycemia and a giant pelvic mass. He required continuous total parenteral nutrition (TPN) for severe hypoglycemia. CT showed a giant hypervascular mass (20 × 18 × 15 cm) in the pelvic space. Tumor biopsy showed SFT. To avoid intraoperative brisk bleeding, transcatheter arterial embolization (TAE) of the main feeders was performed 1 day before surgery. The tumor was completely resected via midline abdominal incision. Hypoglycemia resolved postoperatively. He was recurrence-free for 11 months after surgery. Conclusion:The combination of preoperative TAE and surgical resection appears to be an effective therapeutic strategy for DPS-associated SFT.

Patient-specific vascular models enhance preoperative planning in interventional radiology, particularly in complex and anatomically challenging cases. This report presents two cases of complex aneurysm coil embolization in which three-dimensional, printed, patient-specific vascular hollow models were key to selecting optimal catheters, leading to successful interventions. Preoperative simulations with these models facilitated preselection of the optimal catheter, minimizing the need for intraoperative catheter exchange and reducing the time required for catheter engagement and placement. This approach improves procedural efficiency and outcomes by ensuring a smoother workflow.

Bronchial artery aneurysm (BAA) is a rare but increasingly recognized condition due to advances in imaging. We report two cases of BAA in patients with long-standing pulmonary hypertension. Case 1 is a 30-year-old man with idiopathic peripheral pulmonary artery stenosis diagnosed at age 23. He developed a slightly dilated bronchial artery, which later enlarged, leading to bronchial artery embolization. Case 2 is a 30-year-old woman with pulmonary arterial hypertension diagnosed at age 3. Multiple BAAs were identified at age 24, and progressive enlargement was observed at age 28. Due to lesion complexity, she remains under careful observation.

Background Hypoglycemia can cause various neurological symptoms, including seizures and impaired consciousness; however, they are often non-specific and can easily be overlooked. In pediatric patients, recurrent hypoglycemia-related seizures are rare, and can frequently lead to a misdiagnosis of epilepsy. Case presentation An 8-year-old boy initially presented with clonic convulsions or myoclonic jerks, primarily affecting the right upper limb without impairment of awareness. He later developed generalized tonic-clonic convulsions or non-convulsive seizures with altered consciousness and urinary incontinence. He was diagnosed with symptomatic focal epilepsy, and levetiracetam and valproic acid were initiated. At the age of 13 years, blood test results revealed hyperinsulinemia and severe hypoglycemia. Abdominal CT and a selective arterial secretagogue injection test identified a functional pancreatic neuroendocrine tumor. Subsequent surgical procedures and histopathological analyses confirmed the diagnosis of an insulinoma. These findings clarified the cause of the patient's recurrent seizures, which were secondary to severe hypoglycemia. Genetic analysis identified a pathogenic variant of MEN1 gene (NM_001370259.2(MEN1): c.784-9G>A), leading to the diagnosis of insulinoma associated with multiple endocrine neoplasia type 1. Conclusion This patient underscores the diagnostic challenge of hypoglycemia-related neurological symptoms and highlights the importance of screening for hypoglycemia in pediatric patients presenting with atypical seizure features.

Introduction:Liver function deterioration after transarterial chemoembolization (TACE) may preclude systemic therapy. The JIVROSG-1302 PRESIDENT study, a prospective, randomized controlled trial, showed a significantly higher local complete response rate with selective conventional TACE (cTACE) than with selective TACE using drug-eluting beads (DEB-TACE). However, this study did not assess the changes in liver function after selective TACE. The purpose of this study, JIVROSG-2001 PRESIDENT-ALBI, was to evaluate the change in liver function after selective TACE for unresectable hepatocellular carcinoma (HCC) using the same patient cohort. Methods:The primary endpoint was ALBI grade deterioration rate after 3 months of TACE compared to DEB-TACE and cTACE. Secondary endpoints included the ALBI grade and score change and the identification of risk factors associated with liver function deterioration. Results:A total of 197 patients with unresectable HCC were enrolled in this study. The ALBI grade deterioration rate at 3 months was 11% for the DEB-TACE group and 6% for the cTACE group, with no significant difference (p = 0.203). The mean ALBI score deterioration at 1 and 3 months was 0.06 and 0.02, respectively, and no notable deterioration in liver function was observed. The risk factors for ALBI score deterioration 1 month after selective TACE included large tumor diameter, high number of treated tumors, and treated vessels. Conclusions:Selective TACE, whether DEB-TACE or cTACE, did not significantly impair the liver function. Even with selective TACE, larger tumors, multiple tumors, and a large number of treated blood vessels were associated with worsening liver function 1 month after TACE.

Pancreatic neuroendocrine tumors (pNETs) are rare and heterogeneous neoplasms occasionally presenting as giant, hypervascular, and anatomically complex tumors. In such cases, curative resection is often challenging, and multidisciplinary treatment is required. However, the clinical utility and optimal sequencing for these approaches remain unclear. We report a 39-year-old woman with a 130 mm hypervascular pNET occupying nearly the entire pancreas, complicated by portal vein tumor thrombus (PVTT) and extensive collateral circulation. The tumor was initially deemed unresectable by a multidisciplinary team. Streptozotocin (STZ)-based chemotherapy led to tumor regression and PVTT resolution. Preoperative transcatheter arterial embolization (TAE) was subsequently performed to reduce arterial inflow and facilitate surgical manipulation. Total pancreatectomy with segmental portal vein resection was successfully performed without transfusions. Histopathological examination confirmed a grade 2 pNET with a multifocal histological response which was consistent with radiological findings. The patient remained recurrence-free for 12 months postoperatively without adjuvant therapy. This case highlights the clinical utility of integrating STZ-based chemotherapy and selective TAE to achieve curative surgery for locally advanced giant pNETs. The unique clinical course and radiologic–pathologic correlation of this rare disease further contribute to the understanding of the treatment response.

PURPOSE:To assess and compare the feasibility and safety of transarterial and percutaneous fiducial marker placements for gated radiotherapy using real-time tumor-tracking (RTRT) in patients with pancreatic cancer. MATERIALS AND METHODS:This retrospective cohort study included 61 patients with inoperable pancreatic cancer who underwent transarterial (n = 34) or percutaneous (n = 27) fiducial marker placement between 2015 and 2023. Technical and clinical success, adverse events (AEs), procedure time, number of markers, tumor-to-marker distance, migration, per-marker availability for RTRT, and reasons for marker unavailability were assessed. RESULTS:Both approaches achieved high technical and clinical success rates (transarterial approach, 91.4% and 97.1%; percutaneous approach, 96.3% and 96.3%; P = .626 and P = 1.000) without moderate or severe AEs. Mild AEs occurred in 2.9% and 7.4% of patients in the transarterial and percutaneous groups (P = .575). The median procedure time was shorter in the percutaneous group (35 vs 50 minutes, P = .006). The percutaneous group used more markers (3 vs 1 [median], P < .001). The median tumor-to-marker distance was comparable between groups (transarterial approach, 21 mm; percutaneous approach, 26 mm; P = .317). Migration occurred in only 1 percutaneous case (1.4%). On a per-marker basis, the transarterial group had higher marker availability for RTRT (97.1%) than the percutaneous group (70.8%, P = .001). Marker unavailability was due to untraceable shape (transarterial approach, 1; percutaneous approach, 12), lack of synchronization with tumor motion (percutaneous approach, 6), or others (percutaneous approach, 3). CONCLUSIONS:Transarterial and percutaneous fiducial marker placements are safe and feasible for administering RTRT in patients with pancreatic cancer.

Purpose: To investigate the change in serum albumin (Alb) levels and hepatic reserve scores before and after portal vein stent placement (PVS) for postsurgical portal vein (PV) stenosis. Materials and Methods: A retrospective cohort of patients who underwent PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by PV patency at final portography) were evaluated. Alb, prothrombin time-international ratio (PT-INR), total bilirubin (Tbili), platelet (Plt) counts, Child-Pugh scores (CPS), and Alb-bilirubin (ALBI) scores/grades before and 1 month after PVS were compared. Normally distributed variables were summarized as mean +/- standard deviation (SD) and compared with paired t-tests. Skewed variables were summarized as median (interquartile range) and compared with the signed-rank tests. Results: Twenty-five patients (mean age, 61 years [SD +/- 10]; female, 44%) were included. Technical success of PVS was achieved in all. Comparison was conducted for 28 PVS sessions: the Alb levels increased from 3.1 g/dL (SD +/- 0.6) to 3.5 g/ dL (SD +/- 0.5) (P = .006), with greatest change in patients with pre-PVS Alb levels of <= 2.9 g/dL (2.6 g/dL +/- 0.3 to 3.3 g/dL +/- 0.4, P < .001). Improvements in CPS (P = .026), ALBI score (P = .002), and ALBI grades (P = .026) were observed. PT-INR elongated (1.2 [1.1-1.3] to 1.3 [1.2-1.6], P = .002), mainly because of patients receiving post-PVS warfarin (P = .005 and P = .20 for with and without warfarin, respectively). No significant changes were observed for Tbili (P = .40) and Plt counts (P = .25). Conclusions: Improvements of liver synthetic function represented by serum Alb levels and in hepatic reserve scores were observed after PVS, particularly in patients with pre-PVS hypoalbuminemia.

The SyncTraX series enables real-time tumor-tracking radiotherapy through the real-time recognition of a fiducial marker using fluoroscopic images. In this system, the isocenter should be located within approximately 5-7.5 cm from the marker, depending on the version, owing to the limited field of view. If the marker is placed away from the tumor, the isocenter should be shifted toward the marker. This study aimed to investigate stereotactic body radiotherapy (SBRT) outcomes of primary liver tumors treated with SyncTraX in cases where the isocenter was shifted marginally or outside the planning target volume (PTV). Twelve patients with 13 liver tumors were included in the analysis. Their isocenter was shifted toward the marker and was placed marginally or outside the PTV. The prescribed doses were generally 40 Gy in four fractions or 48 Gy in eight fractions. The overall survival (OS) and local control (LC) rates were calculated using the Kaplan-Meier method. All patients completed the scheduled SBRT. The median distance between the fiducial marker and PTV centroid was 56.0 (interquartile range [IQR]: 52.7-66.7) mm. By shifting the isocenter toward the marker, the median distance between the marker and isocenter decreased to 34.0 (IQR: 33.4-39.7) mm. With a median follow-up period of 25.3 (range: 6.9-70.0) months, the 2-year OS and LC rates were 100.0% (95% confidence interval: 100-100). An isocenter shift makes SBRT with SyncTraX feasible in cases where the fiducial marker is distant from the tumor.

Purpose: To investigate whether deep cervical lymph node (DCLN) ligation alters intracranial cerebrospinal fluid (CSF) tracer dynamics and outflow using a rat model with intrathecal dynamic contrastMethods: Six bilateral DCLN-ligated and six sham-operated rats were subjected to DCE MRI with GdBTDO3A, and dynamic T1-weighted images were acquired. ROIs were collected from the CSF at the C1 level (CSF_C1), CSF between the olfactory bulbs (CSF_OB), CSF at the pituitary recess (CSF_PitR), and CSF at the pineal recess (CSF_PinR), upper nasal turbinate (UNT), olfactory bulbs, cerebrum, and the jugular region. Time-intensity curves were evaluated, and the maximum slope, peak timing, peak signal ratio, and elimination half-life for the four CSF ROIs and UNT were calculated and compared. Results: Delayed tracer arrival in the rostral CSF space and the nasal cavity with tracer retention in the ventral CSF space were observed in the ligation group. The maximum slopes were smaller in the ligation group at UNT (sham: 0.075 +/- 0.0061, ligation: 0.044 +/- 0.0086/min, P = 0.011). A significant difference was not detected in peak timings. The peak signal ratio values were lower in the ligation group at UNT (sham: 2.12 +/- 0.19, ligation: 1.72 +/- 0.11, P = 0.011). The elimination half-life was delayed in the ligation group at CSF_C1 (sham: 30.5 +/- 2.70, ligation: 44.4 +/- 12.6 min, P = 0.043), CSF_OB (sham: 30.2 +/- 2.67, ligation: 44.8 +/- 7.47 min, P = 0.021), and CSF_PitR (sham: 30.2 +/- 2.49, ligation: 41.3 +/- 7.57 min, P = 0.021). Conclusion: The DCLN ligation in rats blocked CSF outflow into the nasal cavity and caused CSF retention.

Purpose To investigate the change in serum albumin levels and hepatic reserve scores before and after portal vein stent placement (PVS) for post-surgical portal vein stenosis. Material and Methods A retrospective cohort of patients undergoing PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by portal vein patency at final portography) were evaluated. Serum albumin (Alb), prothrombin international ratio (PT-INR), total bilirubin (Tbili), platelet counts (Plt), Child-Pugh scores (CPS), and albumin-bilirubin (ALBI) scores/grades before and one month after PVS were compared. Normally distributed variables were summarized as mean ± standard deviation and compared with paired t-tests. Skewed variables were summarized as median [interquartile range] and compared with signed-rank tests. Results Twenty-five patients (age 61±10 years; 44% female) were included. Technical success of PVS was achieved in all. Comparison was conducted for 28 PVS sessions: Alb elevated from 3.1±0.6 to 3.5±0.5 g/dL (P=0.006), with greatest change in patients with pre-PVS Alb ≤2.9 g/dL (2.6±0.3 to 3.3±0.4 g/dL, P<0.001). Improvements in CPS (P=0.026), ALBI score (P=0.002), and ALBI grades (P=0.026) were observed. PT-INR elongated (1.2 [1.1–1.3] to 1.3 [1.2–1.6]; P=0.002), mainly because of patients receiving post-PVS warfarin (P=0.005 and P=0.20 for with and without warfarin). No significant changes were observed for Tbili (P=0.40) and Plt (P=0.25). Conclusion Improvement of liver synthetic function represented by serum albumin levels and in hepatic reserve scores were observed after PVS, particularly in patients with pre-PVS hypoalbuminemia.

Real-time tumor-tracking volumetric modulated arc therapy (RT-VMAT) enabling beam-gating based on continuous X-ray tracking of the three-dimensional position of internal markers is relevant for moving tumors. Dose-volume characteristics and treatment time were evaluated in ten consecutive patients who underwent liver stereotactic body radiation therapy with RT-VMAT. Target dose conformity and sparing of the stomach and the intestine were improved comparing RT-VMAT with RT-3D conformal radiotherapy. The mean treatment time for each fraction was less than 10 min. RT-VMAT could be effective, especially for targets located adjacent to organs at risk.

Purpose: To develop a vascular intervention simulation model that replicates the characteristics of a human patient and to compare the mechanical properties of a 3-dimensional (3D)-printed transparent flexible resin with those of porcine arteries using the elastic modulus (E) and kinetic friction coefficient (mu k).Materials and Methods: Resin plates were created from a transparent flexible resin using a 3D printer. Porcine artery plates were prepared by excising the aorta. E values and the adhesive strengths of the resin and arterial surfaces toward a polyethylene plate, were measured with a tensile-compressive mechanical tester. Resin transparency was measured using an ultraviolet-visible light spectrometer. The mu k value of the resin plate surface after applying silicone spray for 1-5 seconds and that of the artery were measured using a translational friction tester.Results: E values differed significantly between the arteries and resin plates at each curing time (0.20 MPa +/- 0.04 vs 8.53 MPa +/- 2.37 for a curing time of 1 minute; P < .05). The resin was stiffer than the arteries, regardless of the curing times. The visible light transmittance and adhesive strength of the resin decreased as the curing time increased. The adhesive strength of the artery was the lowest. The mu k value of the silicone-coated resin surface created by applying silicone for 2-3 seconds (thickness of the silicone layer, 1.6-2.0 mu m) was comparable with that of the artery, indicating that the coating imparted a similar slippage to the resin as to the living artery.Conclusions: A transparent flexible resin is useful for creating a transparent and slippery vascular model for vascular intervention simulation.

PURPOSE:To investigate whether deep cervical lymph node (DCLN) ligation alters intracranial cerebrospinal fluid (CSF) tracer dynamics and outflow using a rat model with intrathecal dynamic contrast-enhanced (DCE) MRI. METHODS:Six bilateral DCLN-ligated and six sham-operated rats were subjected to DCE MRI with Gd-BTDO3A, and dynamic T1-weighted images were acquired. ROIs were collected from the CSF at the C1 level (CSF_C1), CSF between the olfactory bulbs (CSF_OB), CSF at the pituitary recess (CSF_PitR), and CSF at the pineal recess (CSF_PinR), upper nasal turbinate (UNT), olfactory bulbs, cerebrum, and the jugular region. Time-intensity curves were evaluated, and the maximum slope, peak timing, peak signal ratio, and elimination half-life for the four CSF ROIs and UNT were calculated and compared. RESULTS:Delayed tracer arrival in the rostral CSF space and the nasal cavity with tracer retention in the ventral CSF space were observed in the ligation group. The maximum slopes were smaller in the ligation group at UNT (sham: 0.075 ± 0.0061, ligation: 0.044 ± 0.0086/min, P = 0.011). A significant difference was not detected in peak timings. The peak signal ratio values were lower in the ligation group at UNT (sham: 2.12 ± 0.19, ligation: 1.72 ± 0.11, P = 0.011). The elimination half-life was delayed in the ligation group at CSF_C1 (sham: 30.5 ± 2.70, ligation: 44.4 ± 12.6 min, P = 0.043), CSF_OB (sham: 30.2 ± 2.67, ligation: 44.8 ± 7.47 min, P = 0.021), and CSF_PitR (sham: 30.2 ± 2.49, ligation: 41.3 ± 7.57 min, P = 0.021). CONCLUSION:The DCLN ligation in rats blocked CSF outflow into the nasal cavity and caused CSF retention.