[Ablation of liver tumors : From pre-interventional imaging to post-interventional assessment].

The aim of this article is to provide an overview on the most frequently applied image-guided, percutaneous, local ablative techniques for treatment of primary and secondary liver tumors. The technical procedures of microwave ablation (MWA) and radiofrequency ablation (RFA) are presented. The pre-interventional diagnostics, indications and feasibility are also discussed, taking the current national guidelines into consideration.

Image Quality and Radiation Exposure in Abdominal Angiography: A Head-to-Head Comparison of Conventional Detector-Dose-Driven Versus Contrast-to-Noise Ratio-Driven Exposure Control at Various Source-to-Image Receptor Distances and Collimations in a Pilot Phantom and Animal Study.

Objectives: This phantom and animal pilot study aimed to compare image quality and radiation exposure between detector-dose-driven exposure control (DEC) and contrast-to-noise ratio (CNR)-driven exposure control (CEC) as functions of source-to-image receptor distance (SID) and collimation.

Materials And Methods: First, an iron foil simulated a guide wire in a stack of polymethyl methacrylate and aluminum plates representing patient thicknesses of 15, 25, and 35 cm. Fluoroscopic images were acquired using 5 SIDs ranging from 100 to 130 cm and 2 collimations (full field of view, collimated field of view: 6 × 6 cm).

New perspectives in unresectable cholangiocarcinoma? Evaluation of chemosaturation with percutaneous hepatic perfusion as a palliative treatment option.

Cholangiocarcinoma (CCA) are the second most common primary liver tumors and carry a dismal prognosis. Chemosaturation with percutaneous hepatic perfusion (PHP) is a palliative, intra-arterial therapeutic approach that provides a high dose chemotherapy of the liver with reduced systemic exposure. Aim of this retrospective, monocentric study was to analyze PHP as a palliative treatment for unresectable CCA.

Tantalum-specific contrast-to-noise ratio or conventional detector dose-driven exposure control in angiography: radiation dose and image quality evaluation in a porcine model.

Background: The aim of this animal study was to compare the fluoroscopic image quality (IQ) and radiation dose between a tantalum (Ta)-specific contrast-to-noise ratio-driven exposure control (Ta-CEC) and a detector dose-driven exposure control (DEC) in abdominal angiography.

Methods: Nine angiography scenarios were created in seven anaesthetised pigs using Ta-based embolisation material during percutaneous liver and kidney intervention. Fluoroscopic images were acquired using three DEC protocols with different dose levels and Ta-CEC protocols with different IQ levels, sampled in small steps.

Percutaneous Transsplenic Balloon-Assisted Transjugular Intrahepatic Portosystemic Shunt Placement in Patients with Portal Vein Obliteration for Portal Vein Recanalization: Feasibility, Safety and Effectiveness.

Purpose: To assess the feasibility, safety and effectiveness of portal vein recanalization (PVR)-transjugular portosystemic shunt (TIPS) placement via splenic access using a balloon puncture technique.

Materials And Methods: In a single-center retrospective study from March 2017 to February 2021, 14 consecutive patients with portal hypertension, chronic liver disease and portal vein occlusion or near-complete (> 95%) occlusion were referred for PVR-TIPS placement. Feasibility, safety and effectiveness including procedural characteristics such as technical success, complication profile and splenic access time (SAT), balloon positioning time (BPT), conventional portal vein entry time (CPVET), overall procedure time (OPT), fluoroscopy time (FT), dose-area product (DAP) and air kerma (AK) were evaluated.

Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology.

Purpose: Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT).

Methods: In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT's level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded.

Comparison of a contrast-to-noise ratio-driven exposure control and a regular detector dose-driven exposure control in abdominal imaging in a clinical angiography system.

Purpose: The first purpose of this phantom study was to verify whether a contrast-to-noise ratio (CNR)-driven exposure control (CEC) can maintain target CNR in angiography more precisely compared to a conventional detector dose-driven exposure control (DEC). The second purpose was to estimate the difference between incident air kerma produced by CEC and DEC when both exposure controls reach the same CNR.

Methods: A standardized 3D-printed phantom with an iron foil and a cavity, filled with iodinated contrast material, was developed to measure CNR using different image acquisition settings.

Depiction of mosaic perfusion in chronic thromboembolic pulmonary hypertension (CTEPH) on C-arm computed tomography compared to computed tomography pulmonary angiogram (CTPA).

To evaluate mosaic perfusion patterns and vascular lesions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using C-Arm computed tomography (CACT) compared to computed tomography pulmonary angiography (CTPA). We included 41 patients (18 female; mean age 59.9 ± 18.

Comparison of the Uptake of Hepatocellular Carcinoma on Pre-Therapeutic MDCT, CACT, and SPECT/CT, and the Correlation with Post-Therapeutic PET/CT in Patients Undergoing Selective Internal Radiation Therapy.

(1) Background: To comparatively analyze the uptake of hepatocellular carcinoma (HCC) on pre-therapeutic imaging modalities, the arterial phase multi-detector computed tomography (MDCT), the parenchymal phase C-arm computed tomography (CACT), the Technetiumm-macroaggregates of human serum albumin single-photon emission computed tomography/computed tomography (SPECT/CT), and the correlation to the post-therapeutic Yttrium positron emission tomography/computed tomography (PET/CT) in patients with selective internal radiation therapy (SIRT). (2) Methods: Between September 2013 and December 2016, 104 SIRT procedures were performed at our institution in 74 patients with HCC not suitable for curative surgery or ablation. Twenty-two patients underwent an identical sequence of pre-therapeutic MDCT, CACT, SPECT/CT, and post-therapeutic PET/CT with a standardized diagnostic and therapeutic protocol.

Impact of a contrast-to-noise ratio driven and material specific exposure control on image quality and radiation exposure in angiography.

Conventional detector-dose driven exposure controls (DEC) do not consider the contrasting material of interest in angiography. Considering the latter when choosing the acquisition parameters should allow for optimization of x-ray quality and consecutively lead to a substantial reduction of radiation exposure. Therefore, the impact of a material-specific, contrast-to-noise ratio (CNR) driven exposure control (CEC) compared to DEC on radiation exposure was investigated.

Evaluation of perfusion changes using a 2D Parametric Parenchymal Blood Flow technique with automated vessel suppression following partial spleen embolization in patients with hypersplenism and portal hypertension.

To evaluate the feasibility and potential value of 2D Parametric Parenchymal Blood Flow (2D-PPBF) for the assessment of perfusion changes following partial spleen embolization (PSE) in a retrospective observational study design.Overall, 12 PSE procedures in 12 patients were included in this study. The outcome of the study was the platelet response (PR), calculated as the percentage increase of platelet count (PLT), following PSE.

Chemosaturation with Percutaneous Hepatic Perfusion: Outcome and Safety in Patients with Metastasized Uveal Melanoma.

Purpose:  Chemosaturation percutaneous hepatic perfusion (CS-PHP) allows selective intrahepatic delivery of high dose cytotoxic melphalan in patients with curatively untreatable liver tumors while limiting systemic toxicity through hemofiltration of the hepatic venous blood. Aim of this study was to investigate the response to therapy, survival and safety of the CS-PHP procedure in patients with liver-dominant metastatic uveal melanoma (UM).

Materials And Methods:  Overall response rate (ORR) and disease control rate (DCR) were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST1.

2D-Perfusion Angiography Using Carbon Dioxide (CO2): A Feasible Tool to Monitor Immediate Treatment Response to Endovascular Therapy of Peripheral Arterial Disease?

Purpose: Patients with peripheral arterial disease (PAD) or critical limb ischemia (CLI) require revascularization. Traditionally, endovascular therapy (EVT) is performed with iodinated contrast agent (ICM), which can provoke potential deterioration in renal function. CO2 is a safe negative contrast agent to guide vascular procedures, but interpretation of CO2 angiography is challenging.

Percutaneous isolated hepatic perfusion (chemosaturation) with melphalan following right hemihepatectomy in patients with cholangiocarcinoma and metastatic uveal melanoma: peri- and post-interventional adverse events and therapy response compared to a matched group without prior liver surgery.

To evaluate feasibility, frequency and severity of peri-procedural complications and post-procedural adverse events (AEs) in patients with advanced cholangiocarcinoma or liver metastasis of uveal melanoma and prior hemihepatectomy undergoing chemosaturation percutaneous hepatic perfusion (CS-PHP) and to analyze therapy response and overall survival compared to a matched group without prior surgery. CS-PHP performed between 10/2014 and 02/2018 were retrospectively assessed. To determine peri-procedural safety and post-procedural adverse events, hospital records and hematological, hepatic and biliary function were categorized using Common Terminology Criteria for Adverse Events (CTCAE) v5.

Two-dimensional parametric parenchymal blood flow in transarterial chemoembolisation for hepatocellular carcinoma: perfusion change quantification and tumour response prediction at 3 months post-intervention.

Aim: To evaluate the feasibility and potential value of two-dimensional (2D) parametric parenchymal blood flow (2D-PPBF) for the assessment of perfusion changes during transarterial chemoembolisation with drug-eluting beads (DEB-TACE) and to analyse correlations of 2D-PPBF parameters and tumour response.

Materials And Methods: Thirty-two patients (six women, 26 men, mean age: 67±8.9 years) with unresectable hepatocellular carcinoma (HCC) who underwent their first DEB-TACE were included in this study.

The Value of C-Arm Computed Tomography in Addition to Conventional Digital Subtraction Angiography in the Diagnostic Work-up of Patients with Suspected Chronic Thromboembolic Pulmonary Hypertension: An Update of 300 Patients.

Rationale And Objectives: To assess the value and possible benefit of combined C-arm computed tomography (CACT) and conventional digital subtraction angiography (DSA) of the pulmonary arteries in the diagnostic work-up of patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH).

Materials And Methods: We evaluated 308 pulmonary artery angiographies of 308 consecutive patients with suspected CTEPH. Seven patients were excluded because of incomplete imaging.

Safety and feasibility of transjugular intrahepatic portosystemic shunt in elderly patients with liver cirrhosis and refractory ascites.

Background & Aims: The management of patients with refractory ascites (RA) is challenging, particularly at higher age. Transjugular intrahepatic portosystemic shunt (TIPS) is an established treatment for RA, but safety data in elderly patients are rare. Our aim was to evaluate the safety and feasibility of TIPS in elderly patients with RA.

Transjugular intrahepatic portosystemic shunt placement: portal vein puncture guided by 3D/2D image registration of contrast-enhanced multi-detector computed tomography and fluoroscopy.

Background: To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance.

Materials And Methods: Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images.

Non-occlusive mesenteric ischemia (NOMI): evaluation of 2D-perfusion angiography (2D-PA) for early treatment response assessment.

Purpose: To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI).

Methods: Overall, 20 procedures in 18 NOMI patients were included in this retrospective case-control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed.

Transarterial chemoembolization for hepatocellular carcinoma: quality of life, tumour response, safety and survival comparing two types of drug-eluting beads.

Purpose: To compare two different types of drug-eluting microspheres with regard to impact on HRQoL after first TACE, tumour response, peri-procedural complications, adverse events and 1-year survival in patients suffering from unresectable hepatocellular carcinoma (HCC).

Methods: HRQoL was prospectively assessed with validated questionnaires (EORTC QLQ-C30 and -HCC18) before and 2 weeks after treatment with their first drug-eluting beads (DEB-)TACE with either acrylamido-polyvinylalcohol-AMPS hydrogel microspheres (group; 20 patients) or polyvinyl alcohol-co-acrylic acid microspheres (group; 16 patients). Baseline characteristics, peri-procedural complications, treatment-related adverse events and 1-year survival were compared between both types of microspheres.

Chemosaturation Percutaneous Hepatic Perfusion (CS-PHP) with Melphalan: Evaluation of 2D-Perfusion Angiography (2D-PA) for Leakage Detection of the Venous Double-Balloon Catheter.

Purpose: To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for detecting leakage of the double-balloon catheter used for chemosaturation percutaneous hepatic perfusion (CS-PHP).

Materials And Methods: Overall, 112 CS-PHP (09/2015-09/2018) in 52 patients were retrospectively screened for leakage alongside the double-balloon catheter on standard venograms. Finally, 18 procedures with visually detected leakage were included.

Evaluation of a newly developed 2D parametric parenchymal blood flow technique with an automated vessel suppression algorithm in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty.

Aim: To evaluate the feasibility of two-dimensional parametric parenchymal blood flow (2D-PPBF) to quantify perfusion changes in the lung parenchyma following balloon pulmonary angioplasty (BPA) for treatment of chronic thromboembolic pulmonary hypertension.

Materials And Methods: Overall, 35 consecutive interventions in 18 patients with 98 treated pulmonary arteries were included. To quantify changes in pulmonary blood flow using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed using dedicated software.

Detection of myocardial damage in patients with sarcoidosis.

Background: In patients with sarcoidosis, sudden death is a leading cause of mortality, which may represent unrecognized cardiac involvement. Delayed-enhancement cardiovascular magnetic resonance (DE-CMR) can detect minute amounts of myocardial damage. We sought to compare DE-CMR with standard clinical evaluation for the identification of cardiac involvement.