Jean Francois Deux

Image Guidance for Endovascular Repair of Complex Aortic Aneurysms: Comparison of Two-dimensional and Three-dimensional Angiography and Image Fusion

PURPOSE To evaluate the feasibility of image fusion (IF) of preprocedural arterial-phase computed tomography with intraprocedural fluoroscopy for roadmapping in endovascular repair of complex aortic aneurysms, and to compare this approach versus current roadmapping methods (ie, two-dimensional [2D] and three-dimensional [3D] angiography). MATERIALS AND METHODS Thirty-seven consecutive patients with complex aortic aneurysms treated with endovascular techniques were retrospectively reviewed; these included aneurysms of digestive and/or renal arteries and pararenal and juxtarenal aortic aneurysms. All interventions were performed with the same angiographic system. According to the availability of different roadmapping software, patients were successively placed into three intraprocedural image guidance groups: (i) 2D angiography (n = 9), (ii) 3D rotational angiography (n = 14), and (iii) IF (n = 14). X-ray exposure (dose-area product [DAP]), injected contrast medium volume, and procedure time were recorded. RESULTS Patient characteristics were similar among groups, with no statistically significant differences (P ≥ .05). There was no statistical difference in endograft deployment success between groups (2D angiography, eight of nine patients [89%]; 3D angiography and IF, 14 of 14 patients each [100%]). The IF group showed significant reduction (P < .0001) in injected contrast medium volume versus other groups (2D, 235 mL ± 145; 3D, 225 mL ± 119; IF, 65 mL ± 28). Mean DAP values showed no significant difference between groups (2D, 1,188 Gy · cm(2) ± 1,067; 3D, 984 Gy · cm(2) ± 581; IF, 655 Gy · cm(2) ± 457; P = .18); nor did procedure times (2D, 233 min ± 123; 3D, 181 min ± 53; IF, 189 min ± 60; P = .59). CONCLUSIONS The use of IF-based roadmapping is a feasible technique for endovascular complex aneurysm repair associated with significant reduction of injected contrast agent volume and similar x-ray exposure and procedure time.

Gadolinium-enhanced MR Angiography as First-Line Preoperative Imaging in High-Risk Patients with Lower Limb Ischemia

PURPOSE To assess the clinical relevance of gadolinium-enhanced MR angiography (Gd-MRA) as the first-line angiographic examination for planning lower limb revascularization in patients at high risk of complications after contrast arteriography (CA). METHOD Forty-five consecutive patients at high risk of post-CA complications because of chronic renal insufficiency, diabetes mellitus, advanced age, or the need for brachial artery catheterization or graft puncture had Gd-MRA as first-line angiography before a surgical or endovascular procedure for lower limb ischemia. RESULTS After Gd-MRA, 59 procedures were performed, including 38 surgical reconstructions, 17 endovascular procedures, and four amputations. Complementary CA was only required in seven patients for whom a below-knee bypass was planned. Cumulative patency rates at 1 and 24 months were, respectively, 91% and 91% for suprainguinal bypasses, 100% and 92% for infrainguinal above-knee bypasses, 80% and 57% for below-knee bypasses, and 92% and 76% for iliofemoral angioplasties. After 24 months of follow-up, limb salvage, amputation, and mortality rates were, respectively, 86%, 3.5%, and 7% for stage II ischemia and 48%, 11%, and 30% for stages III and IV. CONCLUSION Gd-MRA can be proposed for first-line preoperative imaging in the management of lower limb ischemia for patients at high risk and permits the selective use of CA as a second-line examination if a below-knee bypass is required.

IRM cardiaque dans le dépistage des complications

RésuméL’IRM cardiaque peut mesurer des variations faibles de volume ou de FEVG au cours d’une chimiothérapie, permettant de détecter précocement l’apparition d’une cardiotoxicité infraclinique. Elle peut également calculer des paramètres reliés à la survenue d’événements cardiovasculaires péjoratifs tels que la masse myocardique indexée ou le rehaussement précoce (EGE) du myocarde. L’imagerie paramétrique dite de mapping fournit des valeurs quantitatives des temps de relaxation myocardique T1 et T2 (exprimés en millisecondes [ms]), valeurs prometteuses dans le dépistage d’une cardiotoxicité induite par la chimiothérapie (CIPC).AbstractCardiac magnetic resonance (CMR) imaging can detect subtle variations of cardiac volumes and left ventricular ejection fraction during chemotherapy and is therefore helpful to detect subclinical cardiotoxicity. CMR also provides parameters for predicting major adverse cardiovascular events such as indexed left ventricular mass and early global enhancement. Parametric imaging with mapping sequences allows to calculate T1 and T2 relaxation times of myocardium, which seems to be promising in detecting early cardiac toxicity.

Imagerie par résonance magnétique (IRM) corps entier en cancérologie

RésuméL’IRM est désormais une technique alternative aux autres outils d’imagerie corps entier — incluant scintigraphies, TEP-TDM et TDM. Alternative d’abord par la possibilité désormais offerte de couvrir l’ensemble du corps humain en IRM avec des temps d’imagerie limités; alternative aussi et surtout car des outils d’imagerie fonctionnelle — incluant imagerie de diffusion et de perfusion — peuvent naturellement se combiner à cette large couverture anatomique, alternative enfin de par l’absence d’irradiation induite par I’IRM comparativement aux autres techniques citées plus haut. Nous détaillerons ici les progrès de l’instrumentation IRM qui ont rendu possible cette émergence, avant de citer les premières applications cliniques de ce nouvel outil.AbstractMRI now offers an alternative imaging technique that combines functional tools with expanded anatomical coverage. Technical progress in magnetic resonance has reduced acquisition times, allowed perfusion and diffusion imaging to be combined with whole body scanning, and made it possible to perform whole body scanning without irradiation. Here we detail the technical advances in whole body MRI and the emerging clinical applications resulting from this new imaging tool.

Faux anévrysme chronique de l’aorte thoracique descendante proximale : traitement endovasculaire percutané

Resume Les faux anevrysmes chroniques de l’aorte thoracique sont generalement d’origine post-traumatique et peuvent evoluer spontanement vers la rupture. Nous rapportons le cas d’un patient de 70 ans presentant un faux anevrysme de l’aorte thoracique traite par endoprothese couverte posee par voie endovasculaire. Les axes arteriels supra-aortiques et abdomino-iliaques ont ete etudies par angio-IRM avant la procedure et l’aorte thoracique a ete etudiee par angio-scanner. Une prothese couverte a ete deployee sous controle scopique en regard du faux anevrysme couvrant egalement l’ostium de l’artere sous-claviere gauche. Aucun symptome ischemique n’est apparu dans les suites du geste et la transposition de l’artere sous-claviere n’a pas ete necessaire. Le suivi radiologique a 6 et a 30 mois a montre la persistance de l’exclusion et de la thrombose complete du faux anevrysme. Les faux anevrysmes chroniques de l’aorte thoracique peuvent beneficier d’un traitement endovasculaire, qui est bien adapte aux patients a risque chirurgical eleve. (J Mal Vasc 2006; 31: 38-42).