Diagnostic and interventional radiology最新文献

{"title":"Nomogram based on clinical characteristics and radiological features for the preoperative prediction of spread through air spaces in patients with clinical stage IA non-small cell lung cancer: a multicenter study.","authors":"Yun Wang, Deng Lyu, Di Zhang, Lei Hu, Junhong Wu, Wenting Tu, Yi Xiao, Li Fan, Shiyuan Liu","doi":"10.4274/dir.2023.232404","DOIUrl":"10.4274/dir.2023.232404","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the value of clinical characteristics and radiological features for predicting spread through air spaces (STAS) in patients with clinical stage IA non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>A total of 336 patients with NSCLC from our hospital were randomly divided into two groups, i.e., the training cohort (n = 236) and the internal validation cohort (n = 100) (7:3 ratio). Furthermore, 69 patients from two other hospitals were collected as the external validation cohort. Eight clinical patient characteristics were recorded, and 20 tumor radiological features were quantitatively measured and qualitatively analyzed. In the training cohort, the differences in clinical characteristics and radiological features were compared using univariate and multivariate analysis. A nomogram was created, and the predictive efficacy of the model was evaluated in the validation cohorts. The receiver operating characteristic curve and area under the curve (AUC) value were used to evaluate the discriminative ability of the model. In addition, the Hosmer-Lemeshow test and calibration curve were used to evaluate the goodness-of-fit of the model, and the decision curve was used to analyze the model's clinical application value.</p><p><strong>Results: </strong>The best predictors included gender, the carcinoembryonic antigen (CEA), consolidation-to-tumor ratio (CTR), density type, and distal ribbon sign. Among these, the tumor density type [odds ratio (OR): 6.738] and distal ribbon sign (OR: 5.141) were independent risk factors for predicting the STAS status. Moreover, three different STAS prediction models were constructed, i.e., a clinical, radiological, and combined model. The clinical model comprised gender and the CEA, the radiological model included the CTR, density type, and distal ribbon sign, and the combined model comprised the above two models. A DeLong test results revealed that the combined model was superior to the clinical model in all three cohorts and superior to the radiological model in the external validation cohort; the cohort AUC values were 0.874, 0.822, and 0.810, respectively. The results also showed that the combined model had the highest diagnostic efficacy among the models. The Hosmer-Lemeshow test showed that the combined model showed a good fit in all three cohorts, and the calibration curve showed that the predicted probability value of the combined model was in good agreement with the actual STAS status. Finally, the decision curve showed that the combined model had a better clinical application value than the clinical and radiological models.</p><p><strong>Conclusion: </strong>The nomogram created in this study, based on clinical characteristics and radiological features, has a high diagnostic efficiency for predicting the STAS status in patients with clinical stage IA NSCLC and may support the creation of personalized treatment strategies before surgery.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41126915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate zones and tumor morphological parameters on magnetic resonance imaging for predicting the tumor-stage diagnosis of prostate cancer.","authors":"Shanshan Xu, Xiaobing Liu, Xiaoqin Zhang, Huihui Ji, Runyuan Wang, Huilin Cui, Jinfeng Ma, Yongjian Nian, Yi Wu, Ximei Cao","doi":"10.4274/dir.2023.232284","DOIUrl":"10.4274/dir.2023.232284","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether the morphological parameters of prostate zones and tumors on magnetic resonance imaging (MRI) can predict the tumor-stage (T-stage) of prostate cancer (PCa) and establish an optimal T-stage diagnosis protocol based on three-dimensional reconstruction and quantization after image segmentation.</p><p><strong>Methods: </strong>A dataset of the prostate MRI scans and clinical data of 175 patients who underwent biopsy and had pathologically proven PCa from January 2018 to November 2020 was retrospectively analyzed. The authors manually segmented and measured the volume, major axis, and cross-sectional area of the peripheral zone (PZ), transition zone, central zone (CZ), anterior fibromuscular stroma, and tumor. The differences were evaluated by the One-Way analysis of variance, Pearson's chi-squared test, or independent samples t-test. Spearman's correlation coefficient and receiver operating characteristic curve analyses were also performed. The cut-off values of the T-stage diagnosis were generated using Youden's J index.</p><p><strong>Results: </strong>The prostate volume (PV), PZ volume (PZV), CZ volume, tumor's major axis (TA), tumor volume (TV), and volume ratio of the TV and PV were significantly different among stages T1 to T4. The cut-off values of the PV, PZV, CZV, TA, TV, and the ratio of TV/PV for the discrimination of the T1 and T2 stages were 53.63 cm³, 11.60 cm³, 1.97 cm³, 2.30 mm, 0.90 cm³, and 0.03 [area under the curves (AUCs): 0.628, 0.658, 0.610, 0.689, 0.724, and 0.764], respectively. The cut-off values of the TA, TV, and the ratio of TV/PV for the discrimination of the T2 and T3 stages were 2.80 mm, 8.29 cm³, and 0.12 (AUCs: 0.769, 0.702, and 0.688), respectively. The cut-off values of the TA, TV, and the ratio of TV/PV for the discrimination of the T3 and T4 stages were 4.17 mm, 18.71 cm³, and 0.22 (AUCs: 0.674, 0.709, and 0.729), respectively.</p><p><strong>Conclusion: </strong>The morphological parameters of the prostate zones and tumors on the MRIs are simple and valuable diagnostic factors for predicting the T-stage of patients with PCa, which can help make accurate diagnoses and lateral treatment decisions.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41108316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A model incorporating clinicopathologic and liver imaging reporting and data system-based magnetic resonance imaging features to identify hepatocellular carcinoma in LR-M observations.","authors":"Xin-Xing Hu, Dong Bai, Zhen-Lei Wang, Yi Zhang, Jue Zhao, Mei-Ling Li, Jia Yang, Lei Zhang","doi":"10.4274/dir.2023.232215","DOIUrl":"10.4274/dir.2023.232215","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the predictive value of a combination model of Liver Imaging Reporting and Data System (LI-RADS)-based magnetic resonance imaging (MRI) and clinicopathologic features to identify atypical hepatocellular carcinoma (HCC) in LI-RADS category M (LR-M) observations.</p><p><strong>Methods: </strong>A total of 105 patients with HCC based on surgery or biopsy who underwent preoperative MRI were retrospectively reviewed in the training group from hospital-1 between December 2016 and November 2020. The LI-RADS-based MRI features and clinicopathologic data were compared between LR-M HCC and non-HCC groups. Univariate and least absolute shrinkage and selection operator regression analyses were used to select the features. Binary logistic regression analysis was then conducted to estimate potential predictors of atypical HCC. A predictive nomogram was established based on the combination of MRI and clinicopathologic features and further validated using an independent external set of data from hospital-2.</p><p><strong>Results: </strong>Of 113 observations from 105 patients (mean age, 61 years; 77 men) in the training set, 47 (41.59%) were classified as LR-M HCC. Following multivariate analysis, aspartate aminotransferase >40 U/L [odds ratio (OR): 4.65], alpha-fetoprotein >20 ng/mL (OR: 13.04), surface retraction (OR: 0.16), enhancing capsule (OR: 5.24), blood products in mass (OR: 8.2), and iso/hypoenhancement on delayed phase (OR: 10.26) were found to be independently correlated with LR-M HCC. The corresponding area under the curve for a combined model-based nomogram was 0.95 in the training patients (n = 113) and 0.90 in the validation cohort (n = 53).</p><p><strong>Conclusion: </strong>The combined model incorporating clinicopathologic and MRI features demonstrated a satisfactory prediction result for LR-M HCC.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10500845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combination transarterial chemoembolization and microwave ablation vs. microwave ablation monotherapy for hepatocellular carcinomas greater than 3 cm: a comparative study.","authors":"Jason Chiang, Pradeep S Rajendran, Frank Hao, James Sayre, Steven S Raman, David S K Lu, Justin P McWilliams","doi":"10.4274/dir.2023.232159","DOIUrl":"10.4274/dir.2023.232159","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of combination therapy using transarterial chemoembolization with microwave ablation (MWA) therapy vs. MWA monotherapy for hepatocellular carcinomas (HCCs) >3 cm in size.</p><p><strong>Methods: </strong>This two-arm retrospective observational study included patients with HCCs >3 cm who underwent either combination therapy (29 patients) or MWA monotherapy (35 patients) between 2014 and 2020. The treatment outcomes related to primary treatment efficacy, local tumor progression (LTP), tumor control rate, and overall survival were compared between each cohort.</p><p><strong>Results: </strong>The technical success and primary efficacy were 96.56% and 100.00% in the combination therapy cohort, and 91.42% and 100.00% in the MWA cohort, respectively, over a mean follow-up period of 27.6 months. The 1- and 3-year rates of LTP-free survival were 78.57% and 69.56% in the combination therapy cohort, vs. 72.45% and 35.44% in the MWA cohort, respectively (<i>P</i> = 0.001). The overall progression-free survival was longer in the combination therapy cohort compared with the MWA cohort (median: 56.0 vs. 13.0 months; <i>P</i> = 0.017). With the incorporation of additional locoregional therapy, the overall survival rates were not significantly different, with 1- and 3-year overall survival rates of 100.00% and 88.71% in the combination therapy cohort and rates of 90.15% and 82.76% in the MWA cohort, respectively (<i>P</i> = 0.235).</p><p><strong>Conclusion: </strong>The combination therapy provided significantly longer upfront LTP-free survival in HCCs >3 cm when compared with the MWA treatment alone, albeit with similar local tumor control and overall survival rates when accounting for additional locoregional therapies.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10500846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of tumor perfusion on cone-beam CT after hepatic arterial infusion port implantation for evaluating tumor response to hepatic arterial infusion chemotherapy in hepatocellular carcinoma treatment.","authors":"Phan Nhan Hien, Ho Jong Chun, Jung Suk Oh, Su Ho Kim, Byung Gil Choi","doi":"10.4274/dir.2023.232311","DOIUrl":"10.4274/dir.2023.232311","url":null,"abstract":"<p><strong>Purpose: </strong>To compare tumor perfusion on cone-beam computed tomography (CBCT) after hepatic artery infusion port implantation with the tumor response to hepatic arterial infusion chemotherapy (HAIC) in patients with hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>This retrospective study was conducted in patients with advanced HCC treated with HAIC from 2015 to 2020. We performed CBCT with contrast injection via a port on the day following implantation. We classified tumor perfusion on CBCT into three groups: hyperperfusion, isoperfusion, and hypoperfusion. We also evaluated tumor response to HAIC on follow-up images using RECIST 1.1 and compared it with tumor perfusion on CBCT.</p><p><strong>Results: </strong>This study included 206 tumors in 193 patients (mean: 60.5 years) with HCC. There were 100 hyperperfusion tumors (48.5%), 92 isoperfusion tumors (44.7%), and 14 hypoperfusion tumors (6.8%). The tumor response to HAIC included 10 tumors with a complete response (CR) (4.9%), 66 tumors with a partial response (32%), 60 tumors with stable disease (29.1%), and 70 tumors with progressive disease (34%). Hyperperfusion tumors had a 65% objective response rate (ORR) and a 92% disease control rate (DCR). Isoperfusion tumors had a 12% ORR and a 46.8% DCR, while hypoperfusion tumors had a 0% ORR and a 7.1% DCR. A CR was shown only in hyperperfusion tumors. The ORR and DCR of the three groups were different, with statistical significance (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Hyperperfusion tumors on CBCT showed a better tumor response to HAIC, with a 65% ORR in patients with HCC. Tumor perfusion on CBCT after implantation of the hepatic arterial infusion port was associated with the tumor response to HAIC.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10204398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of percutaneous core biopsy before cryoablation for small-sized renal cell carcinoma.","authors":"Yasuhiro Ushijima, Akihiro Nishie, Nobuhiro Fujita, Yuichiro Kubo, Keisuke Ishimatsu, Kousei Ishigami","doi":"10.4274/dir.2022.221152","DOIUrl":"10.4274/dir.2022.221152","url":null,"abstract":"<p><strong>Purpose: </strong>To retrospectively determine the diagnostic accuracy of a percutaneous core biopsy performed before cryoablation for small-sized renal cell carcinoma.</p><p><strong>Methods: </strong>In this study, 216 patients underwent a percutaneous core biopsy for 242 renal lesions suspected to be renal cell carcinoma on image findings before cryoablation at Kyushu University Hospital. We calculated the success rate of the histological diagnosis and investigated factors that may have contributed to the diagnostic success. Complications caused by the biopsy procedure were also evaluated.</p><p><strong>Results: </strong>The histological diagnosis was successful in 203 lesions (82.8%). The success rate of the histological diagnosis was 65.4% (34/52 cases) for tumors with a diameter of ≤15 mm and 88.9% (169/190 cases) for those >15 mm. Therefore, tumor diameter was a factor contributing to the histological diagnosis success rate in both univariate and multivariable analyses (<i>P</i> < 0.001). For lesions with a tumor diameter ≤15 mm, the histological diagnosis success rates increased from 50.0% to 76.2% in the presence of pre-lipiodol marking and to 85.7% when the biopsy procedure was performed separately from cryoablation; the latter was statistically significant (<i>P</i> = 0.039). Major complications that may have been caused by the biopsy procedure were grade 3 bleeding and tract seeding (one case each).</p><p><strong>Conclusion: </strong>Percutaneous core biopsy in cryoablation for small-sized renal cell carcinoma had a high diagnostic rate and was safely performed. For lesions with a tumor diameter ≤15 mm, a separate biopsy procedure and pre-lipiodol marking may improve the diagnostic accuracy.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual non-enhanced dual-energy computed tomography reconstruction: a candidate to replace true non-enhanced computed tomography scans in the setting of suspected liver alveolar echinococcosis.","authors":"Mecit Kantarcı, Sonay Aydın, Ayşegül Kahraman, Hayri Oğul, Barış İrgül, Akın Levent","doi":"10.4274/dir.2023.221806","DOIUrl":"10.4274/dir.2023.221806","url":null,"abstract":"<p><strong>Purpose: </strong>When a suspected hepatic alveolar echinococcosis (AE) lesion is detected on a contrast enhanced computed tomography (CT) scan, an additional triphasic or non-enhanced CT scan is required to determine the presence of calcification and enhancement. As a result, imaging costs and exposure to ionizing radiation will increase. We can create a non-enhanced series from routine contrast-enhanced images using dual-energy CT (DECT) and virtual non-enhanced (VNE) images. This study's objective is to assess virtual non-enhanced DECT reconstruction as a potential diagnostic tool for hepatic AE.</p><p><strong>Methods: </strong>Triphasic CT scans and a routine dual energy venous phase were acquired using a third-generation DECT system. A commercially available software package was used to generate VNE images. Individual evaluations were conducted by two radiologists.</p><p><strong>Results: </strong>The study population consisted of 100 patients (30 AE, 70 other solid liver masses). All AE cases were diagnosed [no false positives/negatives, 95% confidence interval (CI) sensitivity: 91.3%-100%; 95% CI specificity: 95.3%-100%]. Interrater agreement was k: 0.79. In total, 33 (33.00%) of the patients had AE, which was detected using both true non-enhanced (TNE) and VNE images. The mean dose-length product of a standard triphasic CT was significantly higher than biphasic dual-energy VNE images.</p><p><strong>Conclusion: </strong>In terms of diagnostic confidence, VNE images are comparable with actual non-enhanced imaging when evaluating hepatic AE. Further, VNE images could replace TNE images with a substantial radiation dose reduction. Advances in knowledge: hepatic cystic echinococcosis and AE are serious and severe diseases with high fatality rates and a poor prognosis if managed incorrectly, especially AE. Moreover, VNE images produce equal diagnostic confidence to TNE images for assessing liver AE, with a significant reduction in radiation dose.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9277239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous radiologic gastrostomy with single gastropexy using balloon-assisted tract dilatation: comparison with peel-away sheath.","authors":"Ji Su Lim, Gyoo Sik Jung, Kyung Seung Oh, Kyung Won Seo, Kyoungwon Jung, Jong Hyouk Yun","doi":"10.4274/dir.2023.232342","DOIUrl":"10.4274/dir.2023.232342","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of percutaneous radiologic gastrostomy (PRG) with balloon-assisted tract dilatation (BATD) using a single gastropexy.</p><p><strong>Methods: </strong>This retrospective study was approved by the institutional review board. From August 2018 to October 2022, 61 patients (53 male and 8 female, mean age 67 years, age range 27-90 years) underwent PRG with balloon-retained tubes for enteral nutrition. Single gastropexy was performed in all cases. Patients were divided into two groups based on the tract dilatation technique used. In the first group, BATD (n = 48) was performed. In the second group, a 24-Fr peel-away sheath (PAS) was used for tract dilatation (n = 13). Patient demographics, technical success rate, clinical success rate, fluoroscopy time, cumulative radiation dose, and complications were retrospectively evaluated. The Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables were performed to compare the two groups.</p><p><strong>Results: </strong>All procedures were successfully performed with 100% technical and clinical success rates in both groups. The mean fluoroscopy time for the BATD group vs. the PAS group (1.68 ± 0.93 min vs. 3.56 ± 2.41 min, <i>P</i> < 0.001) and mean cumulative radiation dose (12.98 ± 9.28 mGy vs. 33.01 ± 15.14 mGy, <i>P</i> < 0.001) were significantly lower in the BATD group compared with the PAS group. There was one major complication of peritonitis that led to death in the PAS group (1/13, 7.7%) and no major complications in the BATD group. Minor complications such as pneumoperitoneum, abdominal pain, leakage, and balloon deflation occurred in 16 patients: 12 (12/48, 25.0%) patients in the BATD group and 4 (4/13, 38.5%) patients in the PAS group. The overall rate of major and minor complications was higher in the PAS group but did not show statistically significant differences (odds ratio: 1.875, 95%; confidence interval: 0.514-6.841, <i>P</i> = 0.486).</p><p><strong>Conclusion: </strong>BATD using a single gastropexy is a safe and effective technique for PRG.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical thrombectomy is associated with shorter length of hospital stay and lower readmission rates compared with conservative therapy for acute submassive pulmonary embolism: a propensity-matched analysis.","authors":"Zain M Khazi, Justin Pierce, Shahrzad Azizaddini, Ryan Davis, Ambarish P Bhat","doi":"10.4274/dir.2022.221622","DOIUrl":"10.4274/dir.2022.221622","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if mechanical thrombectomy (MT) for submassive pulmonary embolism (PE) positively impacts length of hospital stay (LOS), intensive care unit stay (ICU LOS), readmission rate, and in-hospital mortality compared with conservative therapy.</p><p><strong>Methods: </strong>This was a retrospective review of all patients with submassive PE who either underwent MT or conservative therapy (systemic anticoagulation and/or inferior vena cava filter) between November 2019 and October 2021. Pediatric patients (age <18) and those with low-risk and massive PEs were excluded from the study. Patient characteristics, comorbidities, vitals, laboratory values (cardiac biomarkers, hospital course, readmission rates, and in-hospital mortality) were recorded. A 2:1 propensity score match was performed on the conservative and MT cohorts based on age and the PE severity index (PESI) classification. Fischer's exact test, Pearson's χ2 test, and Student's t-tests were used to compare patient demographics, comorbidities, LOS, ICU LOS, readmission rates, and mortality rates, with statistical significance defined as <i>P</i> < 0.05. Additionally, a subgroup analysis based on PESI scores was assessed.</p><p><strong>Results: </strong>After matching, 123 patients were analyzed in the study, 41 in the MT cohort and 82 in the conservative therapy cohort. There was no significant difference in patient demographics, comorbidities, or PESI classification between the cohorts, except for increased incidence of obesity in the MT cohort (<i>P</i> = 0.013). Patients in the MT cohort had a significantly shorter LOS compared with the conservative therapy cohort (5.37 ± 3.93 vs. 7.76 ± 9.53 days, <i>P</i> = 0.028). However, ICU LOS was not significantly different between the cohorts (2.34 ± 2.25 vs. 3.33 ± 4.49, <i>P</i> = 0.059). There was no significant difference for in-hospital mortality (7.31% vs. 12.2%, <i>P</i> = 0.411). Of those that were discharged from the hospital, there was significantly lower incidence of 30-day readmission in the MT cohort (5.26% vs. 26.4%, <i>P</i> < 0.001). A subgroup analysis did not demonstrate that the PESI score had a significant impact on LOS, ICU LOS, readmission, or in-hospital mortality rates.</p><p><strong>Conclusion: </strong>MT for submassive PE can reduce the total LOS and 30-day readmission rates compared with conservative therapy. However, in-hospital mortality and ICU LOS were not significantly different between the two groups.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of transcatheter arterial embolization for hemodynamically unstable bleeding after percutaneous transthoracic needle biopsy.","authors":"Su Kyeong Yeon, Yura Ahn, Ji Hoon Shin, Sang Young Oh, Gun Ha Kim","doi":"10.4274/dir.2023.232253","DOIUrl":"10.4274/dir.2023.232253","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in controlling hemodynamically unstable bleeding following a percutaneous transthoracic needle biopsy (PTNB).</p><p><strong>Methods: </strong>A total of seven patients (four men and three women; mean age, 62 ± 12 years) who received TAE for post-PTNB bleeding between May 2007 and March 2022 were included. The observed types of bleeding were hemothorax (n = 3), hemoptysis (n = 2), and a combination of both (n = 2). In patients with active bleeding, the technical success of TAE was defined as superselective embolization of the target artery with no active bleeding visible on post-TAE angiography. Clinical success was defined as sustained cessation of bleeding without hemodynamic instability, requirement of repeat TAE, or the need for post-TAE hemostatic surgery during the initial admission. The metrics analyzed included technical and clinical success rates, complications, and 30-day mortality.</p><p><strong>Results: </strong>All seven patients achieved technical success, with a clinical success rate of 86% (6/7). Six patients were discharged alive, while one patient died of respiratory failure accompanied by hemothorax 19 days post-biopsy. The angiographic findings associated with bleeding were contrast media extravasation or pseudoaneurysm (n = 3) and vascular hypertrophy with tortuosity (n = 2). The implicated bleeding arteries included the intercostal artery (n = 2), bronchial artery (n = 2), and internal thoracic artery (n = 1). In two cases, no clear bleeding foci were identified; nonetheless, prophylactic embolization was performed on the right intercostal artery (n = 1) and right intercostobronchial trunk (n = 1). The embolic agents utilized included microcoils (n = 1), gelatin sponge particles (n = 2), polyvinyl alcohol (PVA) with gelatin sponge particles (n = 1), PVA with microcoils (n = 1), microcoils with gelatin sponge particles (n = 1), and microcoils with n-butyl-2-cyanoacrylate and gelatin sponge particles (n = 1). The 30-day mortality rate was 14% (1/7). No ischemic complications related to TAE were observed.</p><p><strong>Conclusion: </strong>The study suggests that TAE is safe and effective for controlling hemodynamically unstable bleeding following a PTNB.</p>","PeriodicalId":11341,"journal":{"name":"Diagnostic and interventional radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}