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Brendlin AS, Dehdab R, Stenzl B, Mueck J, Ghibes P, Groezinger G, Kim J, Afat S, Artzner C. Novel Deep Learning Denoising Enhances Image Quality and Lowers Radiation Exposure in Interventional Bronchial Artery Embolization Cone Beam CT. Acad Radiol 2024; 31:2144-2155. [PMID: 37989681 DOI: 10.1016/j.acra.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES In interventional bronchial artery embolization (BAE), periprocedural cone beam CT (CBCT) improves guiding and localization. However, a trade-off exists between 6-second runs (high radiation dose and motion artifacts, but low noise) and 3-second runs (vice versa). This study aimed to determine the efficacy of an advanced deep learning denoising (DLD) technique in mitigating the trade-offs related to radiation dose and image quality during interventional BAE CBCT. MATERIALS AND METHODS This study included BMI-matched patients undergoing 6-second and 3-second BAE CBCT scans. The dose-area product values (DAP) were obtained. All datasets were reconstructed using standard weighted filtered back projection (OR) and a novel DLD software. Objective image metrics were derived from place-consistent regions of interest, including CT numbers of the Aorta and lung, noise, and contrast-to-noise ratio. Three blinded radiologists performed subjective assessments regarding image quality, sharpness, contrast, and motion artifacts on all dataset combinations in a forced-choice setup (-1 = inferior, 0 = equal; 1 = superior). The points were averaged per item for a total score. Statistical analysis ensued using a properly corrected mixed-effects model with post hoc pairwise comparisons. RESULTS Sixty patients were assessed in 30 matched pairs (age 64 ± 15 years; 10 female). The mean DAP for the 6 s and 3 s runs was 2199 ± 185 µGym² and 1227 ± 90 µGym², respectively. Neither low-dose imaging nor the reconstruction method introduced a significant HU shift (p ≥ 0.127). The 3 s-DLD presented the least noise and superior contrast-to-noise ratio (CNR) (p < 0.001). While subjective evaluation revealed no noticeable distinction between 6 s-DLD and 3 s-DLD in terms of quality (p ≥ 0.996), both outperformed the OR variants (p < 0.001). The 3 s datasets exhibited fewer motion artifacts than the 6 s datasets (p < 0.001). CONCLUSIONS DLD effectively mitigates the trade-off between radiation dose, image noise, and motion artifact burden in regular reconstructed BAE CBCT by enabling diagnostic scans with low radiation exposure and inherently low motion artifact burden at short examination times.
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Affiliation(s)
- Andreas S Brendlin
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.).
| | - Reza Dehdab
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
| | - Benedikt Stenzl
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
| | - Jonas Mueck
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
| | - Patrick Ghibes
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
| | - Gerd Groezinger
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
| | - Jonghyo Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.K.); ClariPi Inc., 11 Ihwajang 1-gil, Jongno-gu, Seoul 03088, Republic of Korea (J.K.)
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany (A.S.B., R.D., B.S., J.M., P.G., G.G., S.A., C.A.)
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Dohna M, Kühl H, Sutharsan S, Bruns N, Vo Chieu VD, Hellms S, Kornemann N, Montag MJ. Morphological chest CT changes in cystic fibrosis and massive hemoptysis. RADIOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00117-024-01266-4. [PMID: 38326635 DOI: 10.1007/s00117-024-01266-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Massive hemoptysis (MH) is a rare but potentially life-threatening condition of patients with mainly advanced cystic fibrosis (CF). Morphological lung changes are aggravated with disease progression. The aim of this study was to determine whether morphological lung changes differ between patients with CF (pwCF) who have MH and pwCF without MH. METHODS Chest computed tomography (CT) scans of pwCF and MH acquired at a maximum of 4 months prior to MH (1/2008 to 2/2015) were evaluated for morphological changes and bronchial artery (BA) diameters. Lung lobes with MH were compared with lobes without MH and with matched control patients with end-stage CF and no hemoptysis using the Helbich scoring system. RESULTS The study included 26 patients with MH (PMH; 15 female, median age 29 years, interquartile range [IQR]: 25-33.75) and 17 matched control patients (11 male, median age 24 years, IQR: 19.5-30). No difference in Helbich score was detected between lobes with MH and matched control patients (p = 0.051). Higher scores were detected in lobes with MH compared to lobes without MH in PMH (p = 0.021), but no difference was detected in the subscores. The BA diameters were larger in PMH (p = 0.02); 85% of PMH had unilateral MH, with 65% of MH involving only one or two lobes. CONCLUSION Morphological changes are more severe in lobes with MH in the same patient, but there is no difference when compared with matched control patients. Besides abscess/sacculation, no specific changes for MH were identified. Other factors such as BA hypertrophy might play a pivotal role in the pathogenesis of MH in pwCF. Commonly used scores to evaluate chest CT in pwCF cannot be used to assess MH, and other factors, e.g., hypertrophied BA, not represented and not measured in these scores, might be more suitable for assessing the risk for MH.
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Affiliation(s)
- Martha Dohna
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Clinic for diagnostic and interventional Radiology, University Hospital Bonn, Bonn, Germany, Venusberg-Campus 1, 53127.
| | - Hilmar Kühl
- St. Bernhard-Hospital Kamp-Lintfort, Bürgermeister-Schmelzing-Str. 90, 47475, Kamp-Lintfort, Germany
| | - Sivagurunathan Sutharsan
- Division of Cystic Fibrosis, Department of Pulmonary Medicine, University Medicine Essen -Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department of Pediatrics I, University Medicine Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Van Dai Vo Chieu
- St. Vicenz-Hospital Paderborn, Am Busdorf 2, 33098, Paderborn, Germany
| | - Susanne Hellms
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Norman Kornemann
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael J Montag
- Clinic for Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Herrera DG, Ostad BJ, Wilkins LR, Sheeran DP, Park AW, Goode AR, Patrie JT, Angle JF. Effect of computed tomography angiography prior to bronchial embolization on radiation dose and recurrent hemoptysis. Clin Imaging 2023; 100:48-53. [PMID: 37207442 DOI: 10.1016/j.clinimag.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023]
Abstract
PURPOSE To investigate whether pre-procedure Computed Tomography Angiography (CTA) improves radiation exposure, procedure complexity, and symptom recurrence after bronchial embolization for massive hemoptysis. MATERIAL AND METHODS A single-center retrospective review of bronchial artery embolization (BAE) for massive hemoptysis was performed for procedures between 2008 and 2019. Multi-variate analysis was performed to determine the significance of pre-procedure CTA and etiology of hemoptysis on patient radiation exposure (reference point air kerma, RPAK) and rate of recurrent hemoptysis. RESULTS There were 61 patients (mean age 52.5 years; SD = 19.2 years, and 57.3% male) and CTA was obtained for 42.6% (26/61). Number of vessels selected was a mean of 7.2 (SD = 3.4) in those without CTA and 7.4 (SD = 3.4) in those with CTA (p = 0.923). Mean procedure duration was 1.8 h (SD = 1.6 h) in those without CTA and 1.3 h (SD = 1.0 h) in those with CTA (p = 0.466). Mean fluoroscopy time and RPAK per procedure were 34.9 min (SD = 21.5 min) and 1091.7 mGy (SD = 1316.6 mGy) for those without a CTA and 30.7 min (SD = 30.7 min) and 771.5 mGy (SD = 590.0 mGy) for those with a CTA (p = 0.523, and p = 0.879, respectively). Mean total iodine given was 49.2 g (SD = 31.9 g) for those without a CTA and 70.6 g (SD = 24.9 g) for those with a CTA (p = 0.001). Ongoing hemoptysis at last clinical follow up was 13/35 (37.1%) in those without CTA and 9/26 (34.6%) in those with CTA (p = 0.794). CONCLUSIONS Pre-procedure CTA did not improve radiation effective dose and symptom recurrence after BAE and is associated with significant increases in total iodine dose.
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Affiliation(s)
- Daniel Giraldo Herrera
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America.
| | - Bahrom J Ostad
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Luke R Wilkins
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Daniel P Sheeran
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Auh Whan Park
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
| | - Allen R Goode
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Diagnostic Medical Physics, United States of America
| | - James T Patrie
- University of Virginia School of Medicine, Department of Public Health Sciences, United States of America
| | - John F Angle
- University of Virginia Health System, Department of Radiology and Medical Imaging, Division of Interventional Radiology, United States of America
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An J, Dong Y, Niu H. Application of the 5F JL4 Catheter in Bronchial Artery Embolization With the Opening in the Inferior Wall of the Aortic Arch. Vasc Endovascular Surg 2023; 57:379-385. [PMID: 36597616 DOI: 10.1177/15385744221149910] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We investigated the efficacy and safety of bronchial artery embolization (BAE) using a 5F JL4 catheter in patients with hemoptysis and a bronchial artery opening in the inferior wall of the aortic arch. METHODS This was a single-center retrospective study. Seventeen patients underwent BAE using 5F JL4. We then evaluated technical success (TS), clinical success (CS), incidence of complications, and hemoptysis recurrence rate (RR). RESULTS The TS rate of microcatheter superselective catheterization and CS rate after surgery were 100%, and the incidence of severe complications and postoperative RR were 17.6%. CONCLUSIONS Bronchial artery embolization for hemoptysis with a BA opening in the inferior wall of the aortic arch using the 5F JL4 catheter could be a safe method. The short- and medium-term results were excellent.
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Affiliation(s)
- Jianli An
- Department of Interventional Treatment, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, PR China
| | - Yanchao Dong
- Department of Interventional Treatment, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, PR China
| | - Hongtao Niu
- Department of Interventional Treatment, Qinhuangdao Municipal No. 1 Hospital, Qinhuangdao, PR China
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Zhang CJ, Jiang FM, Zuo ZJ, Li SS, Zhao YA, Li PJ, Ye DF, Zhang LL, Tong LH, Chen SL, Li HM, Luo FM, Wang Y. Clinical characteristics and postoperative outcomes of systemic artery-to-pulmonary vessel fistula in hemoptysis patients. Eur Radiol 2022; 32:4304-4313. [PMID: 35029731 DOI: 10.1007/s00330-021-08484-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/12/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics and outcomes on the success of bronchial arterial embolization (BAE) in patients with and without systemic artery-to-pulmonary vessel fistula (SA-PF) and to evaluate the feasibility of CTA in the assessment of SA-PF. METHODS We retrospectively enrolled 420 consecutive patients that underwent BAE for hemoptysis control in our hospital from September 2011 to May 2019. The clinical characteristics, preprocedural CTA findings, BAE procedural findings, and follow-up outcomes were collected. Patients were divided into two groups according to DSA findings: patients with SA-PF and those without. RESULTS A total of 184 (43.7%) patients presented with SA-PF. Pneumonia was less likely to be the concomitant condition in patients with SA-PF (p < 0.001). The mean number of culprit arteries per patient was significantly higher in patients with SA-PF compared to that in patients without SA-PF (p = 0.017). The SA-PF patients saw a greater probability of recurrence (HR: 2.782, 95% CI: 1.617-4.784, p < 0.001). SA-pulmonary venous fistula (SA-PVF) favored lower hemoptysis recurrence rate (HR: 0.199, 95%CI: 0.052-0.765, p = 0.019). SA-pulmonary artery fistula (SA-PAF) can be detected by optimized CTA protocol with a detection rate of 65.3% (49/75). CONCLUSIONS The presence of SA-PF is an independent risk factor predicting early recurrence of hemoptysis after BAE. SA-PVF seems to be a protective factor for longer hemoptysis control compared to SA-PAF. Optimized preprocedural CTA is a reliable examination to identify SA-PAF. KEY POINTS • The appearance of SA-PF is associated with a greater probability of early recurrent hemoptysis after bronchial artery embolization. • The presence of SA-PVF seems to be a protective factor for longer hemoptysis control after BAE compared to SA-PAF. • Optimized CTA protocol seems to be a promising auxiliary examination to detect SA-PAF.
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Affiliation(s)
- Chu-Jie Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China
| | - Fa-Ming Jiang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China.,Center of Interventional Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ze-Jin Zuo
- Institutional Review Board, West China Hospital, Sichuan University, Chengdu, China
| | - Shan-Shan Li
- Department of Intensive Care Unit, Karamay Municipal People's Hospital, Karamay, China
| | - Yue-An Zhao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China
| | - Pei-Jun Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China
| | - Dong-Fan Ye
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China
| | - Lan-Lan Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China
| | - Li-Hong Tong
- Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Song-Lin Chen
- Department of Respiratory and Critical Care Medicine, Pangang Group General Hospital, Panzhihua, China
| | - Hai-Ming Li
- Department of Intensive Care Unit, Karamay Municipal People's Hospital, Karamay, China
| | - Feng-Ming Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Ye Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan Province, #37 Guo Xue Xiang, Chengdu, 610041, China. .,Center of Interventional Radiology, West China Hospital, Sichuan University, Chengdu, China. .,Department of Intensive Care Unit, Karamay Municipal People's Hospital, Karamay, China.
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Keshmiri MS, Shafaghi S, Sharif-Kashani B, Sadoughi A, Ghorbani F, Naghashzadeh F, Abedini A. Preemptive non-selective bronchial artery angioembolization to reduce recurrence rate of hemoptysis. Multidiscip Respir Med 2020; 15:723. [PMID: 33456774 PMCID: PMC7802011 DOI: 10.4081/mrm.2020.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter. Methods In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow up. Results 153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (p<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography. Conclusion BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding.
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Affiliation(s)
- Mohammad Sadegh Keshmiri
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Sadoughi
- Divisions of Pulmonary and Critical Care, Albert Einstein College of Medicine, New York, USA
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Unilateral temporary diaphragmatic paralysis secondary to bronchial artery embolization in a girl with cystic fibrosis and massive hemoptysis: a case report. BMC Pulm Med 2020; 20:38. [PMID: 32046694 PMCID: PMC7014762 DOI: 10.1186/s12890-020-1076-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Massive hemoptysis is a serious complication in Cystic Fibrosis (CF), occurring commonly in older patients. Bronchial artery embolization (BAE) can be performed to stop the bleeding. BAE is generally safe and effective, but can sometimes lead to serious complications. We report the first case of temporary unilateral diaphragmatic paralysis associated to lung consolidation following BAE in a pediatric CF female patient. This complication worsened the lung function of the patient who underwent lung transplantation after 9 months. Case presentation A 14 years old female CF patient followed by the CF center of Florence presented low-grade fever, cough increase and recurrent episodes of major hemorrhages such as to carry out a BAE. Within 24 h the patient started to complain of severe thoracic pain in the right hemithorax, increased dyspnea and fever. A computed tomographic angiography and a dynamic fluoroscopic evaluation revealed the right diaphragmatic paralysis, not present before the procedure. After 4 days the clinical condition and radiological imaging had improved with restored mobility of the right hemidiaphragm. Nine months later, she required mechanical ventilation, and subsequently the initiation of extracorporeal membrane oxygenation (ECMO) for a pulmonary exacerbation with septic shock. Lung transplantation in ECMO was performed with success. Conclusion Clinicians should be aware of the possibility of phrenic nerve injury with BAE in pediatric CF patients.
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Sarioglu O, Capar AE, Yavuz MY, Belet U. Angiographic Findings and Outcomes of Bronchial Artery Embolization in Patients with Pulmonary Tuberculosis. Eurasian J Med 2020; 52:126-131. [PMID: 32612418 DOI: 10.5152/eurasianjmed.2020.19221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/24/2019] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate the angiographic findings and outcomes of bronchial artery embolization in tuberculosis patients and to compare them with those of non-tuberculosis patients. Materials and Methods Patients who underwent bronchial artery embolization in a single interventional radiology department with hemoptysis were reviewed. A total of 89 patients (66 males and 23 females; mean age 52.71±15.37) were incorporated in the study. The patients were divided into two groups: tuberculosis group (n=36) and non-tuberculosis group (16 malignancy, 22 bronchiectasis, 6 pulmonary infection, 5 chronic obstructive pulmonary disease, 4 idiopathic; n=53). Angiography and embolization procedure were performed by interventional radiologists with 5, 10, and 20 years of experience. Angiographic findings were classified as tortuosity, hypertrophy, hypervascularity, aneurysm, bronchopulmonary shunt, extravasation, and normal bronchial artery. Chi-square test was used to compare angiographic findings between tuberculosis and non-tuberculosis patient groups. Results Bronchopulmonary shunt was found to be significantly higher in the tuberculosis group as compared to that in the non-tuberculosis group (p=0.002). Neither of the groups showed a statistically significant difference with respect to recurrence (p=0.436). Conclusion Bronchial artery embolization is a useful and effective treatment method of hemoptysis in tuberculosis. Evaluation of bronchopulmonary shunts in patients with tuberculosis is critical for the reduction of catastrophic complications.
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Affiliation(s)
- Orkun Sarioglu
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Ahmet Ergin Capar
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
| | - Melike Yuksel Yavuz
- Department of Chest Diseases, Izmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Umit Belet
- Department of Radiology, Health Sciences University, Tepecik Educational and Research Hospital, Izmir, Turkey
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Efficacy and Safety of Bronchial Artery Embolization on Hemoptysis in Chronic Thromboembolic Pulmonary Hypertension: A Pilot Prospective Cohort Study. Crit Care Med 2020; 47:e182-e189. [PMID: 30531186 PMCID: PMC6407824 DOI: 10.1097/ccm.0000000000003578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: Managing hemoptysis in chronic thromboembolic pulmonary hypertension can be challenging due to the difficulties in maintaining coagulation homeostasis in affected patients. In this study, we evaluated the efficacy and safety of bronchial artery embolization in treating hemoptysis in chronic thromboembolic pulmonary hypertension patients. Design: Pilot, prospective cohort study. Setting: A large respiratory medical institute. Patients: From January 1, 2012, to December 31, 2017, hospitalized chronic thromboembolic pulmonary hypertension patients were eligible for inclusion. Patients with pulmonary hypertension caused by other conditions, or who failed to participate in the follow-up were excluded. Interventions: Hemoptysis in chronic thromboembolic pulmonary hypertension patients was treated with or without bronchial artery embolization based on whether the bleeding could be stopped with medication alone and patient willingness for bronchial artery embolization treatment. Measurements and Main Results: A total of 328 patients diagnosed with chronic thromboembolic pulmonary hypertension were consecutively collected, 317 patients were completed the follow-up. There were 15 chronic thromboembolic pulmonary hypertension patients with hemoptysis in total, and the occurrence rate of hemoptysis in chronic thromboembolic pulmonary hypertension patients was 4.7%. Among the hemoptysis chronic thromboembolic pulmonary hypertension patients, 10 (67%) underwent bronchial artery embolization, and five (33%) were treated with medication only. The median follow-up period for hemoptysis patients was 7.6 months. In patients underwent bronchial artery embolization treatment, oxygenation index and right heart function showed no significant difference between pre bronchial artery embolization and post bronchial artery embolization. Hemoptysis relapse (20% vs 80%; p = 0.025) and hemoptysis-related mortality (0% vs 40%; p = 0.032) were significantly lower, whereas the overall survival (90% vs 40%; p = 0.040) was higher in patients treated with bronchial artery embolization than in patients treated without bronchial artery embolization. Conclusions: Bronchial artery embolization procedure demonstrated effectiveness and safety to treat hemoptysis in chronic thromboembolic pulmonary hypertension patients at our center, but further controlled studies are needed before it can be considered as an effective therapy for these patients.
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Shah JH, Whitmore MJ. Interventional Radiology's Role in the Treatment of Pediatric Thoracic Disease. Semin Roentgenol 2019; 54:395-406. [PMID: 31706372 DOI: 10.1053/j.ro.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jay H Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA; Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
| | - Morgan J Whitmore
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
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Greenway C, Rozanski E, Johnson K, Cornejo L, Abelson A, Robinson N. Fatal hemoptysis after bronchoscopic biopsy in a dog. J Vet Intern Med 2019; 33:2718-2724. [PMID: 31663636 PMCID: PMC6872624 DOI: 10.1111/jvim.15640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 10/01/2019] [Indexed: 01/18/2023] Open
Abstract
An 8‐year‐old 24.6 kg mixed breed dog underwent bronchoscopy for evaluation of a persistent progressive cough. Bronchoscopy documented a markedly thick and irregular, cobblestone appearance of the mucosa. A bronchoscopic biopsy was obtained; immediately after the biopsy, a large amount of hemorrhage poured from the endotracheal tube. Multiple efforts to control the hemorrhage were unsuccessful and the dog suffered a cardiopulmonary arrest and could not be revived. A necropsy was performed, which was significant for pallor, evidence of prior heartworm disease, prominent bronchial arteries, and erosion of the submucosal vessels at the site of the biopsy. The cause of death was hemorrhage associated with transbronchial biopsy of an enlarged bronchial artery associated with heartworm disease. This report describes a rare complication of a routine diagnostic procedure.
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Affiliation(s)
- Clayton Greenway
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Elizabeth Rozanski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Kelsey Johnson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Lilian Cornejo
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Amanda Abelson
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Nicholas Robinson
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
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Embolisation d’hémostase du thorax, de l’abdomen et du pelvis. Presse Med 2019; 48:398-410. [DOI: 10.1016/j.lpm.2019.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/22/2019] [Indexed: 11/21/2022] Open
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