Background:It is crucially important to understand the risk factors for rectal bleeding after volumetric-modulated arc radiotherapy (VMAT) for prostate cancer to prevent subsequent rectal bleeding. We assayed clinical and dosimetric data to investigate the risk factors for rectal bleeding after VMAT of prostate cancer. Materials and methods:This study included 149 patients with prostate cancer who received VMAT from February, 2012 to June, 2020. Irradiated total doses were 78 Gy/39 fractions in 33 patients (22.1%), 76 Gy/38 fractions in 89 (59.7%), 74 Gy/37 fractions in 4 (2.7%), and 72 Gy/36 fractions in 23 (15.4%). We investigated multiple clinical and dosimetric factors with reference to rectal bleeding. Results:The median observation period was 38 months. Fourteen patients (9.4%) experienced rectal bleeding: five (3.4%) were classified as Grade 2, and nine (6.0%) as Grade 1. There were significant differences between Grade ≥ 1 and Grade 0 patients in the overlap region of the planning target volume (PTV) and the rectum, the rectal V30-75, and the mean rectal dose (p < 0.05). There were significant differences between Grade 2 and Grade 0-1 patients in rectal V30-65 and mean rectal dose (p < 0.05). Conclusions:Rectal bleeding occurred, but its grades and rate of occurrence were permissible. Higher rectal doses were shown to be related to rectal bleeding, and reduction of low/intermediate and mean rectal doses will be important for preventing rectal bleeding.

A direct carotid cavernous fistula (CCF) is an abnormal shunt between the internal carotid artery (ICA) and the cavernous sinus (CS). Traumatic CCF is the most common type, accounting for up to 75% of all CCFs. For the management of direct CCF, endovascular therapy has become the standard. For successful endovascular therapy, evaluation of the size and location of orifice of the CCF, venous drainage, and tolerance for ICA occlusion on cerebral angiography is necessary. Multi-planner reformatted images of 3D rotation angiography are useful to visualize the fistula and compartments of the CS precisely. Due to the limited commercial availability of detachable balloons, detachable coils have become a widely employed endovascular tool for the treatment of direct CCFs. The advantageous aspects of coil application are their easy retrievability and better control. In the case of large/multiple fistulas, adjunctive techniques, including balloon- and stent-assisted techniques, are often needed to occlude the CCF while preserving the ICA. To avoid cranial nerve palsy related to over-packing of the CS with detachable coils or a detachable balloon, selective embolization of the fistula portion is required. Use of liquid embolic materials and covered stents was recently reported as another adjunctive technique. In cases in which it is impossible to occlude the CCF while preserving the ICA, parent artery occlusion (PAO) is considered. The selection of additional/alternative techniques and devices depends on the anatomy and hemodynamics of each CCF, and the skill and experience of individual operators.

Objective: We report a patient in whom encephalopathy developed after coil embolization of an unruptured basilar artery aneurysm and stent placement for vertebral artery stenosis.

The aim of this study was to investigate the multidetector computed tomography (MDCT) features of strangulated ileus caused by epiploic appendix of the sigmoid colon.

Purpose: Transvenous sinus packing with coils has been widely accepted as a curative treatment method for dural arteriovenous fistulas (DAVFs) with sinus occlusion. Some technical reports have described using luminal angioplasty or stent placement to reconstruct antegrade venous drainage. In addition, recent anatomical considerations of the parasinuses have enabled us to achieve selective embolization of the shunted venous pouch. Here, we report the technical results from five cases of DAVF with sinus occlusion treated by selective transvenous embolization combined with balloon sinoplasty (STVEBS).

Purpose Transcatheter angiography is the gold standard for evaluating the condition and anatomy of the dural sinuses in patients with arteriovenous fistulas (AVFs); however, the patency and intraluminal condition of the dural sinuses can also be evaluated on magnetic resonance imaging (MRI). The purpose of this study was to evaluate the usefulness of MRI for the diagnosis of sinus occlusion. Materials and Methods Thirty-one patients (19 males, 12 females; age range, 52-81 years) were diagnosed with dural arteriovenous fistulas (DAVFs) and surrounding dural sinus occlusion on transcatheter angiography. Twenty-three patients with transverse-sigmoid DAVFs showed ipsilateral transverse and/or sigmoid sinus occlusion, and eight patients with cavernous sinus DAVFs showed ipsilateral inferior petrosal sinus occlusion. The MR images were retrospectively evaluated, focusing on the signal intensity and contrast enhancement of the occluded sinuses. The accessibility of transvenous embolization through the occluded sinuses was also assessed. Results The occluded sinuses showed isointensity in 24 patients and hypointensity in six on T1-weighted imaging (T1WI); furthermore, they showed isointensity in seven patients, hyperintensity in 17, and heterogeneous hypoand hyperintensity in seven on T2-weighted imaging (T2WI). All occluded sinuses showed marked enhancement in the 14 patients in whom contrast-enhanced three-dimensional (3D)-T1WI was performed. Transvenous embolization was performed in 27 patients. An approach through the occluded sinuses was successful in 18 of these 20 patients. Conclusion The occluded sinuses showed various signal intensities on T1WI and T2WI, while all of the occluded sinuses showed homogeneous enhancement on contrast-enhanced T1WI.

Renal arteriovenous (AV) shunt, a rare pathologic condition, is divided into two categories, traumatic and nontraumatic, and can cause massive hematuria, retroperitoneal hemorrhage, pain, and high-output heart failure. Although transcatheter embolization is a less-invasive and effective treatment option, it has a potential risk of complications, including renal infarction and pulmonary embolism, and a potential risk of recanalization. The successful embolization of renal AV shunt requires a complete occlusion of the shunted vessel while preventing the migration of embolic materials and preserving normal renal arterial branches, which depends on the selection of adequate techniques and embolic materials for individual cases, based on the etiology and imaging angioarchitecture of the renal AV shunts. A classification of AV malformations in the extremities and body trunk could precisely correspond with the angioarchitecture of the nontraumatic renal AV shunts. The selection of techniques and choice of adequate embolic materials such as coils, vascular plugs, and liquid materials are determined on the basis of cause (eg, traumatic vs nontraumatic), the classification, and some other aspects of the angioarchitecture of renal AV shunts, including the flow and size of the fistulas, multiplicity of the feeders, and endovascular accessibility to the target lesions. Computed tomographic angiography and selective digital subtraction angiography can provide precise information about the angioarchitecture of renal AV shunts before treatment. Color Doppler ultrasonography and time-resolved three-dimensional contrast-enhanced magnetic resonance angiography represent useful tools for screening and follow-up examinations of renal AV shunts after embolization. In this article, the classifications, imaging features, and an endovascular treatment strategy based on the angioarchitecture of renal AV shunts are described.

Introduction The aim of the study was to investigate the variations in the uncal vein (UV) termination and its clinical implication in cavernous sinus dural arteriovenous fistulas (CSDAVFs). Methods Biplane cerebral angiography in 80 patients (160 sides) with normal cerebral venous return (normal group) was reviewed with special interest in the termination of the UV. Frequency and types of uncal venous drainage from CSDAVFs in consecutive 26 patients were also analyzed. Results In the normal group, the UV was identified in 118 sides (74 %). The UV terminated into cavernous sinus (CS) in 41 sides (34 %), the superficial middle cerebral vein (SMCV) in 58 sides (48 %), the laterocavernous sinus (LCS) in 15 sides (13 %), and the paracavernous sinus (PCS) in 4 sides (3 %). Cerebral venous blood via the UV draining into the CS directly ( n = 41) or through the SMCV and/or the LCS ( n = 45) was observed in 86 sides (54 %). Uncal venous drainage from CSDAVFs was found in 13 patients (50 %). The CSDAVFs drained directly into the UV in two patients, drained via LCS into the UV in two patients, and drained through the SMCV into the UV in the remaining nine patients. All cases were successfully treated by transvenous embolization with special attention given to uncal venous drainage. Conclusion There are several variations in UV termination according to the embryological development of the primitive tentorial sinus and the deep telencephalic vein. Careful attention should be paid to uncal venous drainage for the treatment of CSDAVFs.

Comprehensive reports concerning selective embolization for arterial bleeding from third molar removal have not been published. We analyzed cases of arterial bleeding from third molar extraction that required transarterial embolization, and we demonstrate representative cases.

The maxillary artery is a terminal branch of the external carotid artery. Although the main maxillary artery trunk and most of its branches course within the extracranial space and supply the organs and muscles of the head and neck, other surrounding soft tissues, and the oral and rhinosinusal cavities, other branches supply the dura mater and cranial nerve and can anastomose to the internal carotid artery (ICA). Various pathologic conditions of the intracranial, head, and neck regions can involve the branches of the maxillary artery. Many of these diseases can be treated with endovascular approaches; however, there is a potential risk of complications in the brain parenchyma and cranial nerves related to the meningoneuronal arterial supply and anastomoses to the ICA. Therefore, familiarity with the functional and imaging anatomy of the maxillary artery is essential. In the past, conventional angiography has been the standard imaging technique for depicting the maxillary artery anatomy and related pathologic findings. However, recent advances in computed tomographic, magnetic resonance, and rotational angiography have further elucidated the maxillary artery anatomy by means of three-dimensional representations. Understanding the functional and imaging anatomy of the maxillary artery allows safe and successful transcatheter treatment of pathologic conditions in the maxillary artery territories.

Poster: ECR 2013 / C-1939 / Borden type3 superior sagittal sinus dural arteriovenous fistula, angiographic features and endovascular treatment. by: T. Dotsu1, H. Kiyosue1, Y. Hori1, S. Tanoue1, J. Kashiwagi1, R. Shimada2, Y. Sagara1, M. Okahara1, H. Mori1; 1Oita/JP, 2Yufu city/JP

The pancreas has complex arterial supplies. Therefore, special attention should be paid in pancreatic arterial intervention for patients with acute pancreatitis and pancreatic carcinomas. Knowledge of pancreatic arterial anatomy and arterial territory is important not only to perform pancreatic arterial intervention, but to read the pancreatic angiography and cross-sectional image. We reviewed 226 selective abdominal angiography and CT scans during selective arteriography (CTA) of common hepatic artery, superior mesenteric artery, splenic artery, or peripancreatic arteries including posterior superior pancreaticoduodenal artery, anterior superior pancreaticoduodenal artery, inferior pancreaticoduodenal artery, and dorsal pancreatic artery. CTA images were evaluated to clarify the cross-sectional anatomy of the pancreatic arterial territory. Variations of the peripancreatic arteries were also investigated. In this exhibit, schemes and illustrative cases demonstrate pancreatic arterial territory and variations.

Poster: RANZCR ASM 2010 / R-0009 / Intrasinusal septation: frequency and clinical significance in dural arteriovenous fistulas by: H. Kiyosue , Y. Sagara, S. Tanoue, M. Okahara, Y. Hori, H. Mori; JP

Vertebrobasilar artery occlusion (VBO) produces high mortality and morbidity due to low recanalization rate utilization in endovascular therapy. The use of percutaneous transluminal angioplasty (PTA) to improve recanalization rate additional to local intra-arterial fibrinolysis (LIF) was investigated in this study. Results obtained following recanalization therapy in acute intracranial VBO are reported.

OBJECTIVE:The purpose of this article is to retrospectively compare radiation dose, noise, and image quality of abdominal low-dose CT reconstructed with adaptive statistical iterative reconstruction (ASIR) and routine-dose CT reconstructed with filtered back projection (FBP).MATERIALS AND METHODS:Fifty-three patients (37 men and 16 women; mean age, 60.8 years) underwent contrast-enhanced abdominal low-dose CT with 40% ASIR. All 53 patients had previously undergone contrast-enhanced routine-dose CT with FBP. With the scanning techniques masked, two radiologists independently graded images for sharpness, image noise, diagnostic acceptability, and artifacts. Quantitative measures of radiation dose and image noise were also obtained. All results were compared on the basis of body mass index (BMI).RESULTS:The volume CT dose index (CTDI(vol)), dose-length product, and radiation dose for low-dose CT with ASIR were 17 mGy, 860 mGy, and 13 mSv, respectively, compared with 25 mGy, 1,193 mGy, and 18 mSv for routine-dose CT with FBP, representing an approximate overall dose reduction of 33%. Low-dose CT with ASIR had significantly reduced (p < 0.001) quantitative and qualitative assessment of image noise. Image sharpness, however, was significantly reduced for low-dose CT with ASIR (p < 0.001), although diagnostic acceptability and artifact scores were nearly identical to those for routine-dose CT with FBP. The average CTDI(vol) dose reduction was 66% for patients with a BMI of less than 20 and 23% for patients with a BMI of 25 or greater.CONCLUSION:Compared with routine-dose CT with FBP, abdominal low-dose CT with ASIR significantly reduces noise, thereby permitting diagnostic abdominal examinations with lower (by 23-66%) radiation doses. Despite reduced image sharpness in average and small patients, low-dose CT with ASIR had diagnostic acceptability comparable to that of routine-dose CT with FBP.

Poster: ECR 2010 / C-2671 / Normal variations of cervical-petrosal Internal Carotid Artery; Imaging and Embryologic consideration by: R. Shimada1, H. Kiyosue1, Y. Sagara1, S. Tanoue1, Y. Kondo2, J. Kashiwagi3, Y. Hori2, M. Okahara3, H. Mori1; 1Yufu/JP, 2Oita/JP, 3Beppu/JP

Poster: ECR 2009 / C-678 / Dural arteriovenous fistula (DAVF) associated with unusual anatomical variation of dural sinuses by: Sagara1, H. Kiyosue1, H. Mori1, S. Tanoue1, R. Shimada1, Y. Hori2, M. Okahara1, J. Kashiwagi1; 1Yufu/JP, 2Oita/JP

This study aimed to define the patterns of basal cerebral venous drainage (BCVD) from cavernous sinus dural arteriovenous fistulas (CSDAVFs).Forty sets of selective angiographic data from 36 patients with spontaneous CSDAVFs (age range, 53-79 years) were retrospectively analyzed for their drainage patterns. Three types of BCVD were observed, i.e., superolateral type, BCVD via the deep middle cerebral vein or uncal vein; posterolateral type, BCVD via the superior petrosal sinus and petrosal vein; and posteromedial type, BCVD via the bridging vein and the anterior pontomesencephalic vein. MR images and/or 3D-DSA images were also reviewed when available.BCVD from CSDAVF was found in 12 patients (30%), and the other drainage routes included the superior ophthalmic vein in 25 (63%), the inferior petrosal sinus in 17 (43%), the superficial middle cerebral vein in 17 (43%), intercavernous sinus in 15 (38%), the superior petrosal sinus in seven (18%), and pterygoid plexus in two (5%), respectively. In 12 patients with BCVD, superolateral type was found in four (33%), posterolateral type in five (42%), and posteromedial type in seven (58%). Four cases of posteromedial type were associated with other types of BCVD.CSDAVFs are often associated with BCVD via three different pathways. The posteromedial type via the bridging vein is the most frequent type of BCVD.