Objective To explore the diagnostic value of computed tomography angiography (angio-CT) in superior mesenteric artery-derived gastrointestinal hemorrhage, as well as the safety and efficacy of interventional embolization, and to compare its detection difference with digital subtraction angiography (DSA). Methods A retrospective analysis was performed on the clinical data of 25 patients with superior mesenteric artery-derived gastrointestinal hemorrhage admitted to our hospital from January 2023 to June 2025. All patients underwent DSA and angio-CT to confirm the bleeding site, followed by DSA-guided interventional embolization. The bleeding detection rates of the two examination methods, interventional embolization success rate, postoperative complication rate, and rebleeding rate during follow-up were compared, and the application value of angio-CT in preoperative evaluation was analyzed. Results Among the 25 patients, DSA identified 16 bleeding sites (detection rate 64.0%), while angio-CT accurately identified 25 bleeding sites (detection rate 100.0%), with a statistically significant difference (χ²=11.976, P < 0.05). The bleeding sites included 16 cases (64.0%) of main branches of the superior mesenteric artery, 5 cases (20.0%) of jejunal artery branches, and 4 cases (16.0%) of ileal artery branches. The technical success rate of interventional embolization was 100%, and the clinical hemostasis success rate was 92.0% (23/25). Postoperatively, 2 cases had mild abdominal pain and 1 case had fever, with no serious complications (such as intestinal necrosis or severe infection). During the 3 ~ 12 months of follow-up, 2 patients experienced rebleeding, which was successfully stopped by secondary embolization, resulting in a rebleeding rate of 8.0%. Conclusion Angio-CT can quickly and accurately locate the bleeding site of superior mesenteric artery-derived gastrointestinal hemorrhage, making up for the disadvantage of DSA in identifying low-flow or static-phase bleeding. It provides precise navigation for interventional embolization, improving the treatment success rate. Interventional embolization has the advantages of minimal invasiveness, high efficiency, and few complications, which is worthy of clinical promotion and application.

Objective:The long-term effects of transarterial chemoembolization (TACE) on liver function and their prognostic implications in hepatocellular carcinoma (HCC) have not been fully explored. The Albumin-Bilirubin (ALBI) score, an objective measure of liver function, is a validated prognostic tool in HCC. This study aims to characterize the longitudinal trajectories of ALBI-scores after TACE, evaluate their impact on clinical outcomes, and identify factors influencing these trajectories. Materials and Methods:This retrospective study included patients with BCLC stage B/C HCC who underwent TACE, with baseline and at least two post-TACE ALBI-score measurements. Group-Based Trajectory Modeling (GBTM) was used to identify distinct ALBI-score trajectories. Clinical outcomes and patient characteristics were compared across trajectory groups. A CatBoost-based clinical prediction model was developed to identify factors influencing ALBI-score trajectories, with Shapley Additive Explanations (SHAP) values providing feature importance interpretation. Results:Among 501 patients, three ALBI-score trajectories were identified: improve, stable, and decline. The improve group had better overall survival (OS) and progression-free survival (PFS) compared to the stable and decline groups. Multivariate analysis confirmed that ALBI-score trajectories were independent risk factors for OS. Subgroup analysis suggested that TACE plus systemic therapy reduced mortality risk in the stable and decline groups. The CatBoost model effectively distinguished distinct trajectory groups, with SHAP analysis highlighting ALBI-grade, Child-Pugh class, and tumor number as key predictors. Conclusion:Post-TACE ALBI-score trajectories are closely linked to clinical outcomes, with improved liver function associated with better prognosis. Monitoring these trajectories could guide personalized treatment strategies for HCC patients undergoing TACE.

Purpose For patients with advanced or unresectable hepatocellular carcinoma (HCC), safe and effective therapies are urgently needed to improve their long-term prognosis. Although the guidelines recommend first-line treatments such as sorafenib, lenvatinib, and atezolizumab in combination with bevacizumab (T+A) and second-line treatments such as regorafenib, the efficacy comparison between drugs is lacking, that is, a treatment is not recommended as the optimal or alternative choice for a specific patient population. Therefore, we will conduct a high-quality network meta-analysis based on Phase III randomized controlled trials (RCTs) to systematically evaluate and compare overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and serious adverse events (SAE) of different treatment protocols in the context of first-line and second-line therapies, which are critical for clinical decision making and prognostic improvement in advanced HCC patients. Methods The studies of interest were Phase III RCTs evaluating the efficacy or safety of first- or second-line therapies in patients with unresectable or advanced HCC. Literature published in English from the four databases of PubMed, Embase, Cochrane Library, and Web of Science was comprehensively searched from the inception to May 23, 2022. Outcomes of interest included OS, PFS, ORR, and SAE. A league table was developed to show the results of the comparison between different treatments. A histogram of cumulative probability was drawn to discuss the ranking probability of treatments based on different outcomes. The effectiveness and safety of various treatments were comprehensively considered and the two-dimensional diagram was plotted to guide clinical practice. The Gemtc package in R Studio was used for network meta-analysis in a Bayesian framework. Results The results showed that HAIC-FO was superior to T+A regimen, regardless of OS, PFS or ORR. TACE combined with lenvatinib performed better than T+A in PFS, and ORR. In addition to the T+A regimen, Sintilimab combined with IBI305 and camrelizumab combined with apatinib were also associated with longer OS, PFS, and ORR, and their SAE incidence was not higher than that of T+A, especially for camrelizumab combined with apatinib, its safety was better than that of T+A regimen. There were no new treatments or combinations that were more effective than regorafenib. It was important to note that for PFS, the efficacy of apatinib and cabozantinib was not statistically different from that of regorafenib, so these two treatments could be used as alternative treatment options in cases where regorafenib was not tolerated or treatment failed. Conclusions We conducted a network meta-analysis to evaluate the efficacy and safety of multiple treatment modalities by integrating the results of direct and indirect comparisons. This study included high-quality multicenter Phase III RCTs, collated and summarized all treatments involved in advanced or unresectable HCC in first-line and second-line settings, and compared with T+A and regorafenib, respectively, and ranked based on efficacy and safety to support clinical decision making.

Background:Transarterial chemoembolization (TACE) is a non-radical treatment. How to improve the local response rate of tumor is the direction we have been exploring. The purpose of this study is to compare the efficacy and safety of occlusion-TACE (O-TACE) versus conventional TACE (C-TACE) in the treatment of patients with early to mid-stage hepatocellular carcinoma (HCC) of lesions being confined to the same hepatic venous drainage area.Methods:In this study, 40 patients with HCC were prospectively enrolled and randomly assigned to the O-TACE and C-TACE groups, and the efficacy of all patients was assessed at 1, 2, and 3 months after the first treatment, and adverse events (AEs) occurring during the treatment period were also recorded.Results:At 1, 2 and 3 months after the first treatment, patients in the O-TACE group had significantly better complete response (CR) rates (35% vs. 5%, P=0.04; 50% vs. 15%, P=0.04; 70% vs. 30%, P=0.02) than those in the C-TACE group. The most common AE was abdominal pain, and the liver function indexes of patients in both groups returned to the baseline level at 1 month after the first treatment, and there was no statistically significant difference in the rate of AEs between the two groups.Conclusions:O-TACE has a better CR rate and a favorable safety profile in patients with early to mid-stage HCC of lesions being confined to the same hepatic venous drainage area.

Background: This study aimed to evaluate whether the lipiodol deposition pattern on intraprocedural Angio-CT could predict tumor treatment response in hepatocellular carcinoma (HCC) patients treated with conventional transarterial chemoembolization (c-TACE). Methods: This retrospective study enrolled intermediated and advanced HCC nodules treated with c-TACE and Angio-CT from June 2021 to June 2022. The therapeutic efficacy was evaluated according to the mRECIST standards. First, Angio-CT was used to determine lipiodol deposition at the end of c-TACE, redefined as complete, partial-complete, and incomplete groups. Second, the mean CT value of lipiodol deposition and its association with therapeutic efficacy were calculated in the complete model. Finally, the relationship between imaging biomarkers and efficacy was evaluated.Results: A total of 45 patients with 72 HCC nodules were enrolled with 28 nodules in the complete group, 31 nodules in the partial-complete group, and 13 nodules in the incomplete group. The complete response (CR) proportion was significantly higher in patients with good lipiodol deposition compared with patients with poor lipiodol deposition (P<0.0001). There was no significantly different CR rate between CT value >= 800 and <800 HU (P=0.119) in the complete group. Meanwhile, the non-CR rate in cases with hepatic vein development was significantly higher than that in cases with no hepatic vein development in the arterial phase (P<0.0001).Conclusions: Complete lipiodol deposition on Angio-CT during c-TACE was a predictive factor for therapeutic response to TACE. For HCC nodules with well-deposited lipiodol, hepatic vein development on Angio-CT in the arterial phase was strongly associated with poor efficacy of TACE.

Background: This study investigated the loadability and releasing profiles of vinorelbine and raltitrexed from CalliSpheres® Beads (CB) in vitro, and further explored the pharmacokinetic features of vinorelbine and raltitrexed eluting CB in vivo.Materials and Methods: Ten milligrams vinorelbine and 0.2 mg raltitrexed were mixed with 0.15 g CB at two sizes (100-300 and 300-500 μm) for 24 h, respectively, to measure the loadability. Then vinorelbine/raltitrexed loading CBs were placed in 20% phosphate-buffered saline for 24 h to measure the release profiles. Transcatheter arterial chemoembolization (TACE) with 1 mg vinorelbine eluting CBs (two sizes respectively) and transcatheter arterial hepatic infusion (TAI) with 1 mg vinorelbine were performed in 9 rabbits (3 rabbits in each group). The above experiments were repeated with 0.2 mg raltitrexed. Results: Vinorelbine loading efficiency quickly reached 90% within 10 min with maximum loadability >90% by CB with both two sizes, and vinorelbine release rate gradually increased to ∼100% within 1 h. Raltitrexed loading efficiency gradually increased to >40% within 15 min, then slowly increased to >60% within 24 h, with maximum loadability <70% by CB with both sizes, and raltitrexed release rate gradually increased to >90% within 1 h. Besides, vinorelbine/raltitrexed eluting CB showed greatly decreased maximum serum concentration (Cmax) of the drug compared with TAI in rabbits with similar area under the curve (0-t), mean residence time (0-t), and half-time (T1/2). Conclusion: CB exhibits good loadability and an acceptable releasing profile for eluting vinorelbine and raltitrexed, and shows lower Cmax and numerically stable concentration than TAI.

PURPOSE:The prognostic role of the tumor volume in patients with hepatocellular carcinoma (HCC) at the Barcelona Clinic Liver Cancer (BCLC) 0 and A stages remains unclear. This study aims to compare the volumetric measurement with linear measurement in early HCC burden profile and clarify the optimal cut-off value of the tumor volume.METHODS:The consecutive patients diagnosed with HCC who underwent initial and curative-intent radiofrequency ablation (RFA) were included retrospectively. The segmentation was performed semi-automatically, and enhanced tumor volume (ETV) as well as total tumor volume (TTV) were obtained. The patients were categorized into high- and low-tumor burden groups according to various cutoff values derived from commonly used diameter values, X-tile software, and decision-tree analysis. The inter- and intra-reviewer agreements were measured using the intra-class correlation coefficient. Univariate and multivariate time-to-event Cox regression analyses were performed to identify the prognostic factors of overall survival.RESULTS:A total of 73 patients with 81 lesions were analyzed in the whole cohort with a median follow-up of 31.0 (interquartile range: 16.0–36.3). In tumor segmentation, excellent consistency was observed in intra- and inter-reviewer assessments. There was a strong correlation between diameter-derived spherical volume and ETV as well as ETV and TTV. As opposed to all linear candidates and 4,188 mm3 (sphere equivalent to 2 cm in diameter), ETV >14,137 mm3 (sphere equivalent to 3 cm in diameter) or 23,000 mm3 (sphere equivalent to 3.5 cm in diameter) was identified as an independent risk factor of survival. Considering the value of hazard ratio and convenience to use, when ETV was at 23,000 mm3, it was regarded as the optimal volumetric cut-off value in differentiating survival risk.CONCLUSION:The volumetric measurement outperforms linear measurement on tumor burden evaluation for survival stratification in patients at BCLC 0 and A stages HCC after RFA.

Background To evaluate the prognostic value of skeletal muscle index (SMI) and its change in patients with hepatocellular carcinoma (HCC) experiencing curative hepatectomy plus adjuvant transarterial chemoembolization (TACE). Materials and methods A total of 62 patients with HCC who underwent adjuvant TACE after curative hepatectomy were analysed retrospectively. Skeletal muscle area at the third lumbar level was quantitated using computed tomography images and was normalized for height squared to obtain skeletal muscle index (SMI). Skeletal muscle loss (SML) over 6 months was computed with two SMIs before and after hepatectomy plus adjuvant TACE. Correlation analyses were preformed to investigate factors associated with SML. The curves of cause-specific survival (CSS) were analysed using the Kaplan-Meier method. A Cox proportional hazards model was used to assess prognostic factors. Results Low SMI was diagnosed in 23(37.1%) patients preoperatively. The median SML standardized by 6 months was - 1.6% in the entire cohort. Liver cirrhosis and microvascular invasion correlated negatively with SML, respectively (r = - 0.320, P = 0.002; r = - 0.243, P = 0.021). Higher SML (< - 2.42%) predicted a significant reduction in CSS (P = 0.001), whereas low SMI did not(P = 0.687). Following the multivariate analysis for CSS, AFP > 400 ng/ml (HR, 5.643; 95%CI, 3.608-17.833; P < 0.001) and SML < - 2.42%(HR, 6.586; 95%CI, 3.610-22.210; P < 0.001) were independent predictors for poor CSS. Conclusions Skeletal muscle loss during hepatectomy plus adjuvant TACE was remarkable. Higher SML was an independent risk factor for CSS in patients with HCC, especially those with liver cirrhosis.

Background:Targeted drug therapy and transcatheter arterial chemoembolization (TACE) is the most effective control method for middle and late-stage hepatocellular carcinoma (HCC). Regorafenib as the second-line treatment of patients with advanced HCC, combined with TACE treatment still achieved good results in clinic. However, there is no relevant research at present. However, there is no relevant research at present. This study was to investigate the efficacy and safety of regorafenib combined with TACE in the treatment of patients with advanced HCC after the failure of first-line targeted treatment.Methods:Fifty-nine patients with advanced HCC received second-line regorafenib treatment between October 2019 and September 2021 were enrolled in the study. Patients were treated with routine TACE. Oral administration of regorafenib was started 1 week after the operation for 3 weeks and then stopped for 1 week. Objective response rate (ORR), disease control rate (DCR), median progression-free survival (m-PFS), and safety were evaluated according to the modified Response Evaluation Criteria in Solid Tumors (m-RECIST). In our study, most of the analyses are descriptive.Results:One patient achieved complete response (CR), and 24 patients achieved partial response (PR). stable disease (SD) was observed in 14 patients, while progression disease (PD) was observed in 20 patients. The ORR was 42.3% (25/59), and the DCR was 66.1% (39/59). The longest follow-up was 23 months, and the shortest was 1 month. Disease progression was found in 45 patients during follow-up. Among these patients, the longest interval before the detection of disease progression was 16 months, and the shortest was 1 month. Among patients who had disease progression, the median PFS was 8 months. Adverse events (AEs) were observed in 59 patients. These included hand-foot reaction (n=50, 84.7%), weight decrease (n=18, 30.5%), hypertension (n=8, 13.6%), proteinuria (n=1, 1.7%), weakness (n=12, 20.3%), diarrhea (n=1, 1.7%), and hoarseness (n=9, 15.3%). No treatment-related death occurred.Conclusions:Regorafenib combined with TACE achieved a good ORR and DCR among patients with advanced HCC receiving second-line targeted therapy, with only 9 patients experiencing grade 3 or 4 adverse reactions. Therefore, regorafenib combined with TACE is effective and safe in the treatment of advanced HCC.

Background:At present, there is no standard for the posterior treatment of hepatocellular carcinoma (HCC). This study isTo evaluate and compare the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with regorafenib and anti-PD-1 antibody with continued TACE combined with regorafenib in patients with HCC after the failure of second-line treatment with regorafenib.Methods:We enrolled patients with advanced HCC who were treated with sorafenib and sequential regorafenib. All patients were treated with TACE and found to have tumor progression in 2021. After tumor progression, patients were treated with TACE combined with regorafenib and PD-1 antibody or with continued TACE combined with regorafenib according to the wishes of the patient. Efficacy was evaluated after 1 month of treatment. The objective response rate (ORR), disease-control rate (DCR), and safety were evaluated according to adverse reactions of patients.Results:Nine patients were treated with TACE combined with regorafenib and PD-1 antibody, and the 9 patients continued to receive TACE combined with regorafenib. There was no significant difference in baseline data between the 2 groups. In the PD-1 group five patients achieved a partial response (PR), three achieved stable disease (SD), and one patient had progressive disease (PD) after 1 month of treatment. The ORR was 55.6% and the DCR was 88.9%. In the continued TACE-regorafenib group, four patients achieved PR, one achieved SD, and four patients achieved PD after 1 month of treatment, while the ORR was 44.4% and the DCR was 55.6%. There was a significant difference in the DCR between the two groups (P=0.012), while adverse events were similar in both.Conclusions:TACE combined with regorafenib and PD-1 antibody had a higher DCR and was more effective than continued TACE combined with regorafenib in patients with HCC who failed second-line treatment with regorafenib. However, PD-1 antibody therapy might increase the risk of death by causing an uncontrollable immune response. Given the risk of an immune response, patients may choose to continue TACE combined with regorafenib, given the similar ORR of the two treatments.

OBJECTIVE:To investigate the effect of different types of transverse sinus stenosis on blood flow patterns in the ipsilateral superior curve of the sigmoid sinus.METHODS:According to the morphology of transverse and sigmoid sinus sections in pulsatile tinnitus patients, ten idealized models with different degrees and positions of transverse sinus stenosis were constructed. Computational fluid dynamics simulations were performed to compare the hemodynamic characteristics among these models. Follow-up images of previous cases were included, which preliminarily confirmed the hypothesis that bone plate erosion of the sigmoid sinus sulcus is related to blood flow impingement.RESULTS:Blood flow impingement on the superior curve of the sigmoid sinus wall intensified with increasing degree of stenosis and decreased with increasing distance between the stenosis and the sigmoid sinus. The impact zone was generally confined to the anterior and lateral walls of the superior curve of the sigmoid sinus. When the stenosis was located far from the middle of the transverse sinus, the blood flow impingement on the sigmoid sinus wall was very weak.CONCLUSIONS:When stenosis is located far from the sigmoid sinus, the causes of tinnitus should be comprehensively considered instead of assuming that stenosis is the main cause. Bone plate erosion of the sigmoid sinus sulcus was promoted by blood flow impingement.KEY POINTS:• Ten idealized models with different degrees and positions of stenosis were constructed. • The causes of pulsatile tinnitus should be comprehensively considered. • Sigmoid sinus plate dehiscence was promoted by blood flow impingement.

目的 观察高危溃疡致胃肠道出血血管造影表现及动脉栓塞治疗效果.方法 对49例经胃镜证实高危溃疡致胃肠道出血患者行血管造影及栓塞治疗,观察造影表现、栓塞前后溃疡变化,评价栓塞疗效.结果 造影总阳性率51.02％(25/49),栓塞成功率100％,止血总有效率83.67％(41/49),再出血率10.20％(5/49),无严重并发症发生.术后复查胃镜提示溃疡Forrest分级均下降,无活动性出血表现,高危溃疡由急性期向愈合期转变.结论 高危溃疡致急性胃肠道出血动脉造影总阳性率高,栓塞治疗安全有效.

Purpose: To evaluate the efficacy and safety of placement of a modified microcoil for precise preoperative localization of solitary pulmonary nodules (SPNs) before video-assisted thoracoscopic surgery (VATS). Materials and Methods: This prospective, single-arm, multicenter study included patients who underwent computed tomography (CT)-guided modified microcoil insertion prior to SPN resection by VATS between January 2018 and June 2018. The patient demographics, nodule characteristics, and histopathologic findings were recorded. The primary endpoints included efficacy and safety. Results: A total of 96 patients (41 men and 55 women; mean age, 59.3 years +/- 8.9) with 96 SPNs were eligible for enrolment in the study. The mean maximal transverse diameter of the nodules was 10.3 mm +/- 5.2 (range, 8-20 mm). The mean time between CT-guided microcoil insertion and the start of the surgical procedure was 14.6 hours (range, 12-24 hours). The duration of the preoperative CT-guided microcoil localization procedure was 29 minutes +/- 9 (range, 10-35 minutes), and the intraoperative fluoroscopy time was 0.7 minutes +/- 0.7 (range, 0.5-3 minutes). The clinical success rate was 96.9% (93/96), and all nodules were successfully resected using VATS. One patient experienced asymptomatic pneumothorax, but there were no cases of pulmonary hemorrhage. Conclusions: SPN localization with the modified microcoil is feasible and safe. The modified microcoil can facilitate the thoracoscopic resection of SPNs.

BACKGROUND & AIMS:Proton pump inhibitors (PPIs) have been reported to be associated with cholangitis and might possibly be carcinogenic. However, few studies have been conducted to investigate the association of PPIs with cholangiocarcinoma (CCA). Thus, a hospital-based case-control study was carried out in China to explore the association between PPIs and CCA.METHODS:In this study, 1468 CCA cases (826 intrahepatic cholangiocarcinoma (ICC) and 642 extrahepatic cholangiocarcinoma (ECC)) were included, which were observed at Beijing Friendship Hospital, from February 2002 to October 2018. We retrospectively extracted PPI use and other possible risk factors from clinical records, followed by an investigation of the relationship with CCA via calculation of odds ratios (ORs), adjusted odds ratios (AORs), and 95% confidence intervals (CIs) using logistic regression analysis.RESULTS:PPIs were used by 135 (9.2%) CCA cases and 173 (5.9%) controls. We found that PPI use was associated with a 1.61-fold elevated CCA odds (P < .001) (AOR = 1.61, 95% CI = 1.28-2.05; P < .001). After stratification by CCA subtypes, the AORs of PPIs were consistent for both CCA subtypes, with ORs of 1.36 (AOR = 1.36, 95% CI = 1.02-1.83; P = .003) and 1.95 (AOR = 1.95, 95% CI = 1.46-2.62; P < .001) for ICC and ECC respectively. Our results also showed that PPI use was slightly linked to the odds of CCA in a dose-dependent manner.CONCLUSION:PPI use was correlated with a significant 61% increased odds of CCA, particularly in the ECC. However, the retrospective design and observational nature cannot establish causation. Larger scale, multi-centre prospective studies are required for further validation.

Background Acute limb ischemia (ALI) can lead to death and amputation. Evaluating the severity of ischemia is important but difficult, through current methods of examination. The purpose of this research was to demonstrate the feasibility of magnetic resonance imaging (MRI) susceptibility-based imaging techniques for use in assessing muscle oxygenation alterations in ALI. Methods ALI animal models were established in 11 rabbits. Their left iliac arteries were embolized by microspheres. MRI scans were conducted 24 hours before (Pre) and 1 hour (Post 1) and 3 hours (Post 2) after the procedure. A susceptibility model was used to calculate skeletal muscle oxygenation extraction fraction (SMOEF) and relaxation rate (R2’). T2 weighted (T2w) imaging and diffusion-weighted (DW) imaging were performed. Results The average calf muscle SMOEF in the embolized hindlimbs increased from 0.43±0.02 (Pre) to 0.48±0.02 (Post 1) and 0.50±0.02 (Post 2), both P<0.05. The R2’ value increased from 13.01±2.31 s−1 (Pre) to 16.78±2.28 s−1 (Post 1) and 17.90±3.29 s−1 (Post 2), both P<0.05. No significant changes of SMOEF and R2’ were found after embolization in the contralateral hindlimbs. Apparent diffusion coefficient (ADC) values derived from DW imaging remained unchanged at different stages compared to before the procedures (all P>0.05). No abnormal signals were observed in the anatomical T2w images at Post 1 and Post 2. Conclusions This study demonstrates the feasibility of using SMOEF for the assessment of oxygenation alterations in ALI models. SMOEF is more sensitive than T2w and DW imaging in detecting acute muscle ischemia at an early stage.

Objective This study aimed to determine if superselective renal artery embolization is a safe and effective method of treating bleeding complications after percutaneous renal biopsy. Methods From January 2006 to December 2017, 43 patients (22 men and 21 women, mean age: 44.5 ± 14.0 years) underwent angiography for post-biopsy bleeding complications following percutaneous biopsy. Patients underwent angiography and superselective artery embolization. We recorded serum creatinine and hemoglobin values to assess the effect of embolization. Results Successful embolization was achieved in all patients. There was a pseudoaneurysm in 10 cases, arteriovenous fistula in eight, contrast media extravasation in 16, arteriovenous fistula combined with contrast media extravasation in five, and pseudoaneurysm combined with arteriovenous fistula in four. The embolic substance was a microcoil only or combined with a gelatin sponge. The mean creatinine value was not different at 1 day and 1 week after embolization compared with before embolization. Mean hemoglobin values were significantly higher at 1 day and 1 week after embolization than before embolization. Conclusions Superselective renal artery embolization is a safe and effective treatment for post-biopsy bleeding complications after percutaneous renal biopsy. Lumbar or iliolumbar artery angiography is necessary if renal arteriography shows no signs of hemorrhage.

PURPOSE:To investigate the feasibility of using MRI based oxygenation imaging for early assessment of ischemic acute kidney injury (AKI) in an embolization model.METHODS:Ischemic AKI model was induced in 40 rabbits by injection of microspheres into the right renal arteries. Animals were grouped according to the dose of microspheres: Severe AKI group, 2.0 mg (N = 10); Moderate AKI group, 1.0 mg (N = 10); Mild AKI group, 0.5 mg (N = 10); Control group, saline without microspheres (N = 10). A serial MRI examination was performed at intervals of 1 h, 1 day, 1 week and 4 weeks to evaluate the deterioration of renal function. A multi-echo ASE sequence was implemented for renal oxygenation measurement 1 h after surgery. Pathological examinations were performed 4 weeks after the surgery.RESULTS:In renal cortex, renal oxygen extraction fraction (OEF) raised significantly after embolization procedures in all experimental groups (severe AKI: 0.39 ± 0.05, P < 0.05; moderate AKI: 0.36 ± 0.03, P < 0.05; mild AKI: 0.34 ± 0.02, P < 0.05) compared to the control group (0.29 ± 0.02). In outer medulla, significant difference was observed between control group (0.29 ± 0.03) and severe AKI group (0.35 ± 0.03, P < 0.05), and between control group and moderate AKI group (0.34 ± 0.04, P < 0.05). Corresponding lesions were found in pathological examinations 4 weeks after the procedure.CONCLUSION:This study demonstrates the feasibility of using oxygenation imaging to assess the embolization induced ischemic AKI at an early stage.

PURPOSE:To demonstrate the feasibility of using a susceptibility-based MRI technique with multi-echo gradient and spin echo (MEGSE) sequence to achieve simultaneous R2, R2' and R2* measurement and assess skeletal muscle oxygenation alternations in a rabbit model of unilateral artery embolization. MATERIALS AND METHODS:Approved by the local institutional review board for experimental animal studies, nine New Zealand White rabbits were included in this study. The MEGSE sequence consists of embedding a set of gradient echoes around the echo of a single spin-echo sequence using several gradient echoes to collect the magnetization intensity during the formation and attenuation of spin-echo simultaneously after 180° radio frequency pulse. Within-session and between-day tests were conducted to evaluate the reproducibility of this skeletal muscle oxygenation alternations measurement. Furthermore, all the MEGSE scans of skeletal muscle were conducted using a 3-T clinical MRI scanner during resting state (before unilateral artery embolization operation, pre), 1 h after unilateral artery embolization operation (post1) and 2 h after unilateral artery embolization operation (post2) model to verify the feasibility and sensitivity of this method. RESULTS:The within-session coefficient of variations (CVs) of R2, R2' and R2* measurements were 1.57%, 3.33% and 2.57%, while the between-day CVs of were 1.42%, 5.85% and 2.85%. In all rabbits, the mean R2 decreased significantly from 36.46 ± 1.03 s-1 (pre) to 30.58 ± 2.11 s-1 (post1,**P < 0.01, relative to pre) and 28.62 ± 1.53 s-1 (post2, **P < 0.01, relative to post1), and the mean R2' went up markedly from 9.88 ± 2.14 s-1 (pre) to 16.10 ± 2.74 s-1 (post1, **P < 0.01) and 17.33 ± 2.25 s-1 (post2, **P < 0.05). The mean R2* increased from 43.27 ± 3.75 s-1 (pre) to 47.90 ± 5.08 s-1 (post1, *P < 0.05) and to 48.04 ± 4.42 s-1 (post2, NS, P > 0.05). CONCLUSION:This study demonstrates the feasibility of simultaneous R2, R2' and R2* measurement method for the evaluation of skeletal muscle ischemia. Besides, this study indicates the sensitivity of the R2 and R2' compared with R2* and especially the necessity of R2 and R2' measurement for the further evaluation of skeletal muscle ischemia which always causes both edema and hypoxia in a rabbit model of unilateral artery embolization.

Several recent studies have elucidated that the use of covered stents may improve patency rates compared with bare-metal stents (BMSs) in TransAtlantic Inter-Society Consensus (TASC) C and D aortoiliac occlusive disease patients. However, the evidence for endovascular treatment of Leriche syndrome, a unique category of TASC D lesions, is limited, and the effectiveness of both covered stents and BMSs has not been identified adequately. This study was undertaken to evaluate the acute and long-term results of endovascular treatment of Leriche syndrome with BMSs (Fig 1). Patients with Leriche syndrome treated with BMSs from August 2008 to May 2017 were included and followed up. The primary end point was primary patency rate at 1 year, 2 years, and 3 years. The secondary end points were 1-year, 2-year, and 3-year secondary patency rate, technical success rate, complication rate, procedure-related mortality rate, and clinical status improvement. Twenty patients were included, and the follow-up duration was 34.7 ± 18.7 months (0-72 months). The 1-year, 2-year, and 3-year primary patency rates were 100%, 93.3%, and 85.6%, and secondary patency rates were 100%, 91.7%, and 91.7%, respectively (Fig 2). The 1-year, 2-year, and 3-year freedom from target lesion revascularization rates were 100%, 93.3%, and 93.3%, respectively. The aortoiliac lesions were successfully treated with BMS bilaterally in 17 patients (85.0%) and unilaterally in another 3 patients (15.0%). The complication rate was 10.0% (one for acute kidney injury and the other for groin hematoma), and the procedure-related mortality rate was 0%. Mean ankle-brachial index increased significantly from 0.43 ± 0.20 before the procedure to 0.95 ± 0.21 after the procedure (P < .001) and to 1.00 ± 0.19 at the end of the follow-up (P < .001). Improvement in symptoms by at least one Rutherford category occurred in most patients both after the endovascular procedure (95.0%) and at the end of the follow-up period (88.2%). Endovascular treatment with BMSs is effective and safe for patients with Leriche syndrome according to the results of 3-year follow-up.Fig 2Primary patency, secondary patency, and freedom from target lesion revascularization (ffTLR) rates of endovascular treatment of Leriche syndrome with bare-metal stent (BMS).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Objective This study was performed to determine the relationship between the minimum distance from the radiofrequency ablation (RFA) needle tip to the tumor and local tumor progression (LTP) of hepatocellular carcinoma (HCC) nodules and identify prognostic factors for LTP. Methods We reviewed 197 patients (197 nodules) who underwent RFA after transcatheter arterial chemoembolization for HCC from January 2010 to January 2015. Three-dimensional registration of images was used to calculate the minimum distance from the tip to the tumor. We then divided the minimum distance into two groups: <2 and ≥2 mm. Contrast-enhanced computed tomography was performed after treatment. The LTP rate was calculated 1 and 3 years after RFA. We performed multivariate analysis to identify independent prognostic factors for LTP. Results The cumulative 1-year LTP rates in the <2- and ≥2-mm groups were 82.7% and 4.3%, respectively, and the cumulative 3-year LTP rates in the two groups were 94.8% and 10.8%, respectively. The minimum distance from the needle tip to the tumor was an independent prognostic factor for LTP. Conclusions A minimum distance of 2 mm from the needle tip to the tumor should be completely ablated along with the tumor.