A. Alfidja

Reduced Radiation Dose with Model-based Iterative Reconstruction versus Standard Dose with Adaptive Statistical Iterative Reconstruction in Abdominal CT for Diagnosis of Acute Renal Colic.

PURPOSE To evaluate the accuracy of reduced-dose abdominal computed tomographic (CT) imaging by using a new generation model-based iterative reconstruction (MBIR) to diagnose acute renal colic compared with a standard-dose abdominal CT with 50% adaptive statistical iterative reconstruction (ASIR). MATERIALS AND METHODS This institutional review board-approved prospective study included 118 patients with symptoms of acute renal colic who underwent the following two successive CT examinations: standard-dose ASIR 50% and reduced-dose MBIR. Two radiologists independently reviewed both CT examinations for presence or absence of renal calculi, differential diagnoses, and associated abnormalities. The imaging findings, radiation dose estimates, and image quality of the two CT reconstruction methods were compared. Concordance was evaluated by κ coefficient, and descriptive statistics and t test were used for statistical analysis. RESULTS Intraobserver correlation was 100% for the diagnosis of renal calculi (κ = 1). Renal calculus (τ = 98.7%; κ = 0.97) and obstructive upper urinary tract disease (τ = 98.16%; κ = 0.95) were detected, and differential or alternative diagnosis was performed (τ = 98.87% κ = 0.95). MBIR allowed a dose reduction of 84% versus standard-dose ASIR 50% (mean volume CT dose index, 1.7 mGy ± 0.8 [standard deviation] vs 10.9 mGy ± 4.6; mean size-specific dose estimate, 2.2 mGy ± 0.7 vs 13.7 mGy ± 3.9; P < .001) without a conspicuous deterioration in image quality (reduced-dose MBIR vs ASIR 50% mean scores, 3.83 ± 0.49 vs 3.92 ± 0.27, respectively; P = .32) or increase in noise (reduced-dose MBIR vs ASIR 50% mean, respectively, 18.36 HU ± 2.53 vs 17.40 HU ± 3.42). Its main drawback remains the long time required for reconstruction (mean, 40 minutes). CONCLUSION A reduced-dose protocol with MBIR allowed a dose reduction of 84% without increasing noise and without an conspicuous deterioration in image quality in patients suspected of having renal colic.

Endovascular treatment of eight renal artery aneurysms

Background Renal artery aneurysms (RAA) are a relatively rare vascular entity. Treatment could be either surgical or via an endovascular route. The main aim of therapy is to prevent lethal rupture. Purpose To evaluate the angiographic and clinical results after endovascular treatment (EVT) of eight renal artery aneurysms. Material and Methods From January 2000 to June 2011, 18 patients presented with 18 renal artery aneurysms. One was classified as Rundback type I, 15 were type II, and two aneurysms were type III. Endovascular treatment was considered unsafe in 10 cases (all were Rundback type II), and were referred to surgery. The remaining eight aneurysms were treated endovascularly during altogether nine sessions. Among these, four patients were asymptomatic, three were hypertensive, and one presented with ipsilateral flank pains. Aneurysmal sac diameter varied between 12 and 50 mm. EVT included selective coil embolization in five cases, covered stents in two cases, and parent artery occlusion in one. Results Follow-up with CT angiography was obtained in all endovascularly treated aneurysms (range 6–54 months, mean 15 months). Complete durable occlusion was achieved in all aneurysms except one, which showed re-expansion after 20 months and was retreated with covered stent implantation. Clinically silent, branch occlusion occurred after four procedures with subsequent limited (less than 25%) ischemic parenchymal loss. All patients were discharged with preserved renal function. Clinical improvement was noted in all symptomatic patients. Conclusion Endovascular treatment of renal artery aneurysms is an adequate treatment and can be proposed, if feasible, as first step.

Cardiac tamponade after malignant superior vena cava stenting: Two case reports and brief review of the literature

Percutaneous stenting of the superior vena cava (SVC) is usually recommended as a palliative procedure for malignant SVC obstruction with low reported morbidity. Complications are uncommon and usually of minor consequence. We report two unusual cases of cardiac tamponade following SVC stenting in patients with malignant SVC syndrome. Echocardiography allows rapid diagnosis and guides pericardial drainage in the interventional radiology suite.

Revascularization of traumatic renal artery dissection by endoluminal stenting: Three cases:

Traumatic injury of renal arteries is rare and can induce renal dysfunction and hypertension. Management options include observation, nephrectomy, surgical repair, and, more recently, percutaneous angioplasty. We report three cases of renal artery thrombosis occurring in young multitrauma patients (mean age 28.7 years) treated with stenting. Immediate satisfactory results were obtained in all cases. Postprocedure anticoagulant and antiplatelet treatment were given according to associated contraindicating lesions. During follow-up, in-stent restenosis occurred in one patient and was treated successfully with a second stenting procedure. No renal dysfunction or hypertension was observed after 28.6 months follow-up. Percutaneous angioplasty is a valuable alternative to surgical treatment in selected patients.

Palliative transarterial embolization of renal tumors in 20 patients

ObjectivesThe aim of this study is to evaluate immediate technical and clinical results of palliative transarterial renal embolization in patients with symptomatic renal tumors.MethodsParenchymal embolization of 20 renal tumors was performed in 20 symptomatic patients with hematuria and/or lumbar pain and/or para-neoplastic syndrome. Seven patients were inoperable because of poor general condition, and 15 patients had metastatic lesions.ResultsImmediate technical success was observed, with post-infarction pain in all patients requiring analgesia in 12 cases (which was successful in 90%); 8 patients had transitory fever. With a median follow up of 8.1 (range 4–27) months, recurrent hematuria was noted in two patients for which partial embolization was initially chosen; pain did not recur in any patients.ConclusionsPalliative embolization of advanced symptomatic renal tumors is easy to␣accomplish with low morbidity. It helps to alleviate invalidating symptoms in a multidisciplinary management of advanced renal tumors.

Management of isolated non-traumatic renal artery dissection: report of four cases

Background Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. Purpose To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. Material and Methods From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34–48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. Results Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. Conclusion Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.

Portal vein stenosis and occlusion stenting after liver transplantation in two adults

We report two cases of percutaneous transhepatic stenting of the portal vein to treat stenosis and occlusion disclosed 5 and 18 months, respectively, after orthotopic liver transplantation in two adult patients. If long-term patency is satisfactory, this technique should allow long-term management of portal vein stenosis and occlusion without the use of thrombolysis.

Fibrose périportale chez les enfants en zone d'endémie à Schistosoma mansoni: évaluation échographique

Purpose To assess with ultrasound periportal fibrosis due to chronic Schistosoma mansoni infection in children living in an endemic region.Resume Objectif Evaluer au moyen de l’echographie hepatique, la fibrose periportale induite par l’infection chronique a Schistosoma mansoni chez des enfants vivant en zone d’endemie. Materiel et methodes Quatre cent quarante et un enfants vivant en zone d’endemie ont beneficie d’une echographie abdominale et de deux examens parasitologiques des selles. L’echostructure hepatique etait comparee par deux examinateurs a des images standard dites « patterns » et un score de fibrose a ete attribue. Les resultats echographiques ont ete correles a l’âge, au sexe ainsi qu’aux donnees parasitologiques. Resultats La prevalence de l’infestation a Schistosoma mansoni etait de 63 %. Il est note 2 cas de fibrose severe (pattern E ou score de fibrose = 6). Il existe une correlation entre le degre de fibrose et l’âge des enfants. Il n’est pas note de relation statistiquement significative entre la severite de la fibrose et la charge parasitaire. Une concordance entre les deux examinateurs est notee pour 84 % des examens avec un coefficient kappa de 0,7. Conclusion Il est retrouve peu de cas de fibrose periportale severe du fait du caractere recent du foyer d’endemie. Un suivi echographique s’impose neanmoins, cet examen etant la seule technique non invasive et fiable dans le depistage de la morbidite hepatique liee a S. mansoni.

Severe non-traumatic bleeding events detected by computed tomography: do anticoagulants and antiplatelet agents have a role?

PurposeBleeding is the most common and most serious complication of anticoagulant (AC) and antiplatelet agents (APA) which are increasingly used in every day practice. The aim of this study was to enlist and analyze the most severe bleeding events revealed during computed tomography scanner (CT scan) examinations over a 1-year period at our University Hospital and to evaluate the role of ACs and APAs in their occurrence.MethodsThis descriptive monocentric retrospective study included all patients who benefited from an emergency CT scan with a diagnosis of severe non-traumatic bleeding. Patients were divided into two groups: those treated with ACs and/or APAs, and those not treated with ACs or APAs.ResultsAfter applying the inclusion criteria, 93 patients were enrolled. Sixty-one patients received an anticoagulant or antiplatelet treatment, and 32 did not receive any AC or APA therapy. Seventy nine percent presented with an intracranial hemorrhage, 17% with a rectus sheath or iliopsoas bleeding or hematoma, and 4% with a quadriceps hematoma. Only patients who received ACs or APAs suffered a muscular hematoma (p <0.0001). Among patients treated with vitamin K antagonists, 6/43 (14%), had an international normalized ratio (INR) higher than the therapeutic range (INR >3).ConclusionsIn our series, intracranial hemorrhage was preponderant and muscular hematomas occurred exclusively in patients treated with ACs and/or APAs. This study needs to be extended to evaluate the impact of new anticoagulant and antiplatelet agents.

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