Jacek Kurcz

Imaging results of multi-modal ultrasound computerized tomography system designed for breast diagnosis

Nowadays, in the era of common computerization, transmission and reflection methods are intensively developed in addition to improving classical ultrasound methods (US) for imaging of tissue structure, in particular ultrasound transmission tomography UTT (analogous to computed tomography CT which uses X-rays) and reflection tomography URT (based on the synthetic aperture method used in radar imaging techniques). This paper presents and analyses the results of ultrasound transmission tomography imaging of the internal structure of the female breast biopsy phantom CIRS Model 052A and the results of the ultrasound reflection tomography imaging of a wire sample. Imaging was performed using a multi-modal ultrasound computerized tomography system developed with the participation of a private investor. The results were compared with the results of imaging obtained using dual energy CT, MR mammography and conventional US method. The obtained results indicate that the developed UTT and URT methods, after the acceleration of the scanning process, thus enabling in vivo examination, may be successfully used for detection and detailed characterization of breast lesions in women.

Balloon angioplasty for disruption of tunneled dialysis catheter fibrin sheath

Purpose Management of failing tunneled hemodialysis catheters, sometimes the only vascular access for hemodialysis, presents a difficult problem. In spite of various techniques having been developed, no consensus has been reached about the preferred technique, associated with the longest catheter patency. Methods We report disruption of the fibrin sheath covering dysfunctional tunneled hemodialysis catheter by means of angioplasty, followed by over guidewire catheter exchange. Results Following the procedure, the catheter placed in the recovered lumen of the vessel presented correct function. Conclusions The described procedure allowed maintenance of vascular access in our patient. Additionally, dilatation of the concomitant central vein stenosis opens an option for another attempt for arteriovenous fistula creation.

Embolization of a True Giant Splenic Artery Aneurysm Using NBCA Glue - Case Report and Literature Review.

Summary Background Although splenic artery aneurysms (SAAs) are common, their giant forms (more than 10 cm in diameter) are rare. Because of the variety of forms and locations of these aneurysms, there are a lot of therapeutic methods to choose. In our case of a giant true aneurysm we performed an endovascular embolization with N-butyl-cyano-acrylate (NBCA) glue. To our knowledge it is the first reported case of this method of treatment of true giant SAA. Case Report A 74-year-old male patient with symptomatic giant SAA (13 cm) was urgently admitted to our hospital for the diagnostic and therapeutic procedures. Due to the general health condition, advanced age and the large size of the aneurysm we decided to perform an endovascular treatment with N-butyl-cyano-acrylate (NBCA) glue. Conclusions The preaneurysmal part of splenic artery was occluded completely with exclusion of the aneurysm. No splenectomy was needed. The patient was discharged in good general condition Embolization with NBCA can be an efficient method to treat the giant SAA.

Renal artery denervation due to refractory hypertension in a patient after kidney transplantation – 3 years of observation - Case Report

INTRODUCTION Hypertension is prevalent in most patients after renal transplantation, and it is the main factor contributing to cardiovascular diseases that cause death of a significant number of these patients. Up to 95% of patients after transplantation have hypertension, and among them are patients with refractory hypertension. Elevated blood pressure is one of the causes of deterioration of transplant function and may accelerate transplant loss. CASE REPORT We present the first case in the world of a patient (who was 61 years old) in whom denervation of native renal arteries was performed after renal transplantation (2004). The patient was suffering from uncontrolled refractory hypertension. Antihypertensive therapy was used but the effect was not satisfactory. The patient received amlodipine, bisoprolol, clonidine, furosemide, and doxazosin in high doses. Clinical assessments with ambulatory blood pressure monitoring revealed a predominant blood pressure 149/96 with incidents of hypertensive crises. High blood pressure is a cardiovascular risk factor and it also has a significant influence on transplant failure, which was the reason for performing the denervation. The procedure was carried out through the femoral artery with the use of a 6F guiding catheter. During a 3-year observation, significant decreases in ambulatory blood pressure monitoring systolic and diastolic blood pressures were observed after the procedure (149/96 mm Hg vs 134/91 mm Hg before and after the denervation, respectively). There was a significant regression of left ventricle mass (577 g before denervation vs 470 g after 3 years). The functioning of the renal transplant became stable after 3 years of observation (38 mL/min before denervation and 38 mL/min after 3 years). CONCLUSIONS The first case in the world of a renal transplant patient who had denervation of native renal arteries has demonstrated a positive effect in controlling blood pressure over a 3-year observation. Three years after denervation, a reduction of heart hypertrophy and stabilization of renal function were noted. The presented case shows that denervation of native renal arteries denervation may be successful and safe in kidney transplant recipients.

Diagnosis and treatment of pelvic congestion syndrome: Single-centre experiences

BACKGROUND One of the underestimated causes of chronic pelvic pain (CPP) in women may be pelvic congestion syndrome (PCS) that is defined as the presence of varicose of ovarian and pelvic veins associated with chronic pain in the region of the pelvis. This pain is present longer than 6 months and intensifies with prolonged standing, coitus and menstruation. The disease constitutes a diagnostic as well as therapeutic problem, thus posing a challenge for the clinician. Transcatheter ovarian vein embolization might be a safe and effective option for PCS treatment. OBJECTIVES The objective of this study was to evaluate the efficacy of ovarian vein embolization ovarian as a method of the PCS treatment. MATERIAL AND METHODS Between 2002-2012, 11 embolization procedures were performed in 10 women (age range: 34-43; median age 39) with the diagnosis of PCS. One patient underwent embolization procedure twice. In 1 case the combined therapy of endovascular embolization and surgical phlebectomy of vulvar varices was performed. RESULTS There were no major intrainterventional complications. In all the patients (100%) a significant improvement in the clinical status was noted. The procedure improved the quality of life in the patients. Three women (30%) had a mild recurrence of the symptoms at mid-term follow-up. Among 8 women who had complained of dyspareunia prior to embolization 6 patients reported complete pain relief, in other 2 cases the pain subsided partially. There was a significant decrease in the severity of symptoms associated with hemorrhoids. CONCLUSIONS We consider embolization of insufficient ovarian veins an effective and safe way of treatment in a well-selected group of patients with PCS.

Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast – Own Experiences

Summary Background High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages. Material/Methods Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1–2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6–8 mL of Iodixanol (320 mg/mL) diluted with saline to 18–24 mL was administered at a speed of 4–5 mL/s. Results Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. Conclusions 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site.

Endovascular Reparation of Central Vein Injury with Balloon-Protected Embolization.

Iatrogenic central venous injury is a potentially lifethreatening complication following central vein catheterization. The incidence of catheter misplacement is 3–4 % [1]. Mortality associated with superior vena cava rupture is reported to be 44 % [2]. Data on the methods of treatment of these serious events are scarce. The postulated approaches depend on the individual clinical conditions of the patient. Vein injury can be treated either with open surgery, videothoracoscopy, or with endovascular methods, which include mainly stent-graft implantation [2–5]. One report of direct intrapericardial thrombin administration after the perforation of pericardium by the insertion of tunneled haemodialysis catheter was noted [6]. We present a novel endovascular approach to iatrogenic central vein perforation by the use of metal coils and Histoacryl glue. The subject was an 83-year-old female patient with endstage renal disease, with significant comorbidities: generalized atherosclerosis, chronic cardiovascular insufficiency, history of myocardial infarction, required tunneled dialysis catheter placement due to dysfunction of the fistula. Because of the oedema of the right upper extremity with the fistula, the left internal jugular vein was chosen for catheterization. Dual-lumen, radiopaque, 14.5 F, 23-cm tip to cuff length tunneled hemodialysis catheter (Bard HemoStar) was inserted using Seldinger technique under the ultrasound guidance. After catheter insertion, the patient’s condition remained unchanged with stable blood pressure. The attempt to draw blood from both catheter lines appeared unsuccessful. In the next step, chest x-ray was performed, which showed unusual catheter position, suggesting that the catheter tip left intravascular space and entered mediastinum. Bilaterally, the fluid in pleural cavities was noted, as observed before the procedure. Contrast administration through the catheter confirmed left innominate vein perforation. As far as the vast comorbidities of our patient are concerned, we refrained from thoracotomy. The vessel injury repair with stent-graft insertion also was abandoned due to the high risk of thrombosis. Therefore, we decided to repair the vessel injury with balloon-protected Histoacryl embolization with the additional use of metal coils. Diagnostic catheter Vertebral 5F (Boston Scientific) was introduced via the right femoral vein into the left J. Garcarek J. Kurcz Department of Radiology, Wroclaw Medical University Borowska, 213 50-556 Wroclaw, Poland e-mail: jgarcarek@interia.pl

Breast Phantom Imaging Results from an Ultrasound Computer Tomography Research System

Today, in the age of computerization, experts not only strive to perfect methods of ultrasonographic (US) imaging of tissue structure, but also intensively develop transmission methods, focusing especially on ultrasound transmission tomography (UTT) (analogous to X-ray computed tomography - CT) and ultrasound reflection tomography (URT) based on synthetic aperture method used in radar imaging. The following paper presents and analyses the results of ultrasound transmission tomography of the internal structure of a biopsy CIRS Model 052A breast phantom. The imaging was performed with an internally designed ultrasound computer tomography research system. The obtained results were compared to the imaging results from dual energy CT, MR mammography and traditional US.

Successful embolization of the peripheral branches of the superior mesenteric artery performed because of tuberculosis-associated acute bleeding in a patient after a renal transplant.

We report a renal transplant recipient infected with Mycobacterium tuberculosis who presented with severe intestinal bleeding. The bleeding was the result of an injured vessel of mesenteric artery distal branches diagnosed by traditional arteriography and computed tomography angiography. As the patients condition was serious, the only considered rescue therapy was endovascular treatment. The endovascular procedure was successful because the bleeding stopped. Embolization of a small intestinal artery may be a successful rescue treatment of intestinal bleeding in a patient after renal transplant.