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Botsford A, Tradi F, Loubet A, Tantawi S, Soulez G, Giroux MF, Faughnan ME, Gauthier A, Perreault P, Bouchard L, Holderbaum do Amaral R, Chartrand-Lefebvre C, Therasse E. Transarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs. J Vasc Interv Radiol 2024; 35:349-360. [PMID: 38013007 DOI: 10.1016/j.jvir.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/24/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE To compare the safety, effectiveness, and persistence rates of 0.018-inch coils with those of Amplatzer vascular plugs (AVPs; Abbott Vascular, Abbott Park, Illinois) for the treatment of pulmonary arteriovenous malformations (PAVMs) in response to a growing concern that 0.018-inch coil embolization would increase the long-term persistence rate. MATERIALS AND METHODS This is a retrospective, single-center study of a database (2002-2020) of 633 PAVM embolizations. Complex PAVMs and those not embolized with 0.018-inch coils or plugs were excluded. PAVM embolization material was classified into 4 groups: (a) 0.018-inch nonfibered coils (NFCs), (b) 0.018-inch fibered coils (FCs), (c) NFCs and FCs, or (d) plugs. Persistence was defined as flow through the PAVM on digital subtraction angiography (DSA) or as <30% diameter reduction of the aneurysmal sac on unenhanced computed tomography (CT). Kaplan-Meier analysis and Cox regression were used to assess PAVM's persistence-free survival. RESULTS A total of 312 PAVM embolizations with NFCs (43 PAVMs), FCs (127 PAVMs), NFCs and FCs (12 PAVMs), or plugs (130 PAVMs) in 109 patients (28% men; mean age = 49 years) were included. All PAVM embolizations were technically successful without any major adverse events. PAVM persistence-free survival rates at 10 years' follow-up were 40.8% versus 44.7% in the NFC and FC groups (P = .22) and 47.3% versus 81.0% in the 0.018-inch coil (NFC or FC) and plug groups (P < .0001), respectively. There were 0.43 (79/182) and 0.08 (10/130) re-embolization procedures per PAVM in the 0.018-inch coil and plug groups, respectively (P < .001). CONCLUSIONS PAVM embolization with 0.018-inch coils was safe, but persistence rate with PAVM embolization was significantly higher than that with plugs, with no significant differences between FCs and NFCs.
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Affiliation(s)
- Alexander Botsford
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Farouk Tradi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Assistance publique-hôpitaux de Marseille, Hôpital de la Timone, Service d'imagerie diagnostic et interventionnelle, Marseille, France; Laboratoire d'imagerie interventionnelle expérimentale (LIIE), Faculté de Médecine, CERIMED, Université Aix-Marseille Marseille, France
| | - Antoine Loubet
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Department of Radiology, Université de Montpellier, France
| | - Suhad Tantawi
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Marie E Faughnan
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada; Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital and Li Ka Shing Knowledge Institute Toronto, Ontario, Canada
| | - Andréanne Gauthier
- Montreal HHT Centre, Division of Pneumology, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, Quebec, Canada
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | | | - Carl Chartrand-Lefebvre
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada; Centre de recherche du CHUM (CRCHUM), Pavillon R, Montréal Quebec, Canada.
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Therasse E, Caty V, Gilbert P, Giroux MF, Perreault P, Bouchard L, Oliva VL, Lespérance J, Ethier J, Ouellet G, Francoeur M, Cournoyer S, Soulez G. Safety and Efficacy of Paclitaxel-Eluting Balloon Angioplasty for Dysfunctional Hemodialysis Access: A randomized trial Comparing with Angioplasty Alone. J Vasc Interv Radiol 2021; 32:350-359.e2. [PMID: 33483226 DOI: 10.1016/j.jvir.2020.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess whether angioplasty of hemodialysis access (HA) stenosis with a drug-coated balloon (DCB) would prevent restenosis in comparison with plain-balloon percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS This prospective randomized clinical trial enrolled 120 patients with dysfunctional arteriovenous fistulae (n = 109) and grafts (n = 11), due to a ≥50% stenosis between March 2014 and April 2018. All patients underwent high-pressure balloon angioplasty and were then randomized to either DCB (n = 60) or PTA (n = 60). Patients were followed-up for 1 year, and angiography was performed 6 months after angioplasty. The primary endpoint was the late lumen loss (LLL) at 6 months. Secondary endpoints included other angiographic parameters at 6 months and HA failures, adverse event, and mortality at 12 months. Continuous variables were compared with a Student t-test, and Kaplan-Meier curves were used for freedom from HA failure and for mortality. RESULTS LLL in the DCB and in the PTA group were 0.64 mm ± 1.20 and 1.13 mm ± 1.51, respectively (P = .082, adjusted P = .0498). DCB was associated with lower percentage stenosis (54.2% ± 19.3 vs 61.7% ± 18.2; P = .047) and binary restenosis ≥50% (56.5% vs 81.1%; P = .009) than PTA. The number of HA failures after 12 months was lower for DCB than for PTA (45% vs 66.7%; P = .017). Mortality at 12 months was 10% and 8.3% in the DCB and PTA groups, respectively (P = .75). CONCLUSIONS Despite LLL improvement that failed to reach statistical significance, this study demonstrated decreased incidence and severity of restenosis with DCB compared with PTA to treat dysfunctional HA.
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Affiliation(s)
- Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
| | | | - Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Vincent L Oliva
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Jean Ethier
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Martin Francoeur
- Department of Radiology, Charles Lemoyne Hospital, Greenfield Park, Canada
| | - Serge Cournoyer
- Department of Medicine, Charles Lemoyne Hospital, Greenfield Park, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
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Merrachi NA, Bouchard-Bellavance R, Perreault P, Gilbert P, Soulez G, Bouchard L, Oliva VL, Giroux MF, Normandeau L, Therasse E. Eye Lens Dosimetry in Interventional Radiology: Assessment With Dedicated Hp(3) Dosimeters. Can Assoc Radiol J 2020; 72:317-323. [PMID: 32216558 DOI: 10.1177/0846537120911755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To quantify eye lens dose in interventional radiology and assess whether neck dosimeter is a good surrogate to evaluate eye lens dosimetry. METHODS Radiation exposure was prospectively measured in 9 interventional radiologists between May and October 2017. Standard Hp(0,07) thermoluminescent dosimeters (TLDs) were worn at the neck outside the lead apron, and 2 dedicated eye lens Hp(3) TLDs were placed just above the eyes, one midline and another at the outer edge of the left eye. Correlations between eye lens and neck TLD doses were assessed with Pearson coefficient, and linear regression was used to predict eye lens dose from neck TLD values. RESULTS Eye lens dose without eye protection was 0.18 ± 0.11 (mean ± standard deviation; 0.08-0.41) mSv per workday and 35.3 ± 6.6 mSv (16.3-82.9) annually (200 workdays/year). Five (56%) radiologists exceeded the 20 mSv annual eye lens dose limit. Eye lens doses from left and central TLDs were 12.46 ± 3.02 and 9.29 ± 3.38 mSv, respectively (P = .027). Mean eye lens (left and central) and neck TLD doses were 10.87 ± 2.67 and 16.56 ± 5.67 mSv, respectively (P = .008). Pearson correlation coefficient between both eye lens TLD and between mean eye lens TLD and neck TLD doses were 0.91 and 0.92, respectively. Average of eye lens dose was 0.0179 + (0.5971 × neck dose). CONCLUSION Full-time interventional radiologists are likely to suffer from deterministic radiation effects to the eye lens, especially on the left side. Neck TLD significantly overestimates eye lens dose. However, eye lens doses are highly correlated with neck doses and may be predicted from the neck TLD values.
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Affiliation(s)
- Nassim-Albert Merrachi
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | | | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Patrick Gilbert
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche, 25443CHUM (CRCHUM), Montreal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Vincent L Oliva
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Lysanne Normandeau
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada.,Centre de recherche, 25443CHUM (CRCHUM), Montreal, Quebec, Canada
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Cournoyer-Rodrigue J, Bui TB, Gilbert P, Soulez G, Perreault P, Bouchard L, Oliva VL, Giroux MF, Therasse E. Percutaneous Thrombectomy with the JETi8 Peripheral Thrombectomy System for the Treatment of Deep Vein Thrombosis. J Vasc Interv Radiol 2020; 31:444-453.e2. [PMID: 31982312 DOI: 10.1016/j.jvir.2019.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE This study evaluated the safety and efficacy of the JETi8 peripheral thrombectomy system in treating acute deep vein thrombosis (DVT). MATERIALS AND METHODS A retrospective study was conducted in 18 consecutive patients (mean age, 41 years old [range, 15-74 years old]; 5 men and 13 women). There were 21 instances of DVTs (9 iliofemoral, 10 axillosubclavian, and 2 portal), which were treated using the JETi8 thrombectomy device between November 2016 and July 2018. Thrombus was laced with recombinant tissue plasminogen activator (r-TPA) (9.3 mg, on average; range, 2-12 mg) in 17 procedures (81%) prior to thrombectomy. Technical success was defined as restoration of antegrade flow using the JETi8 with or without additional treatment of an underlying obstructive lesion. Procedural success was defined as technical success with or without the addition of overnight catheter-directed thrombolysis (CDT) RESULTS: Mean procedure time was 83 minutes (range, 30-160 minutes), and mean thrombus reduction with the JETi8 alone was 92% (range, 60%-100%). Stent placement was required in 6 procedures (29%). Technical success using the JETi8 system alone was 76% (16 of 21 procedures), whereas 5 procedures (24%) required subsequent overnight CDT in the intensive care unit. Procedural success rate was 100% (20 of 20 procedures). Mean aspirated volume was 531 mL (range, 250-1,230 mL). The only adverse event was a subsegmental pulmonary embolism. Seven patients (33%) were discharged the same day. Recurrent thrombosis was observed in 5 patients (24%), of whom 3 were successfully treated with the JETi8 system. CONCLUSIONS The JETi8 system may be a safe and effective option for thrombectomy of acute DVT.
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Affiliation(s)
- Jean Cournoyer-Rodrigue
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - The-Bao Bui
- Department of Radiology, Centre Hospitalier de l'Université de Sherbrooke, Hôpital Fleurimont (CHUS), Sherbrooke, Québec, Canada
| | - Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Centre de recherche, CHUM, Pavillon R, 900 rue Saint-Denis, Montréal, Québec, Canada, H2X 0A9
| | - Pierre Perreault
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Louis Bouchard
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Vincent L Oliva
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Centre de recherche, CHUM, Pavillon R, 900 rue Saint-Denis, Montréal, Québec, Canada, H2X 0A9.
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Riahi A, Kauffmann C, Therasse E, Morin-Roy F, Elkouri S, Gilbert P, Giroux MF, Perreault P, Bouchard L, Oliva VL, Soulez G. Clinical Validation of a Semi-Automated Software for Maximal Diameter Measurements for Endovascular Repair Follow-up. J Vasc Interv Radiol 2019; 30:523-530. [PMID: 30910174 DOI: 10.1016/j.jvir.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/25/2018] [Accepted: 11/04/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare automated measurements of maximal diameter (Dmax) of abdominal aortic aneurysm (AAA) orthogonal to luminal or outer wall envelope centerline for endovascular repair (EVAR) follow-up. MATERIAL AND METHODS Eighty-three consecutive patients with AAA treated by EVAR who had at least 1 computed tomography (CT) scan before and 2 CT scans after EVAR with at least 5 months' interval were included. Three-dimensional reconstruction of the AAA was achieved with dedicated segmentation software. Performances of automated calculation algorithms of Dmax perpendicular to lumen or outer wall envelope centerlines were then compared to manual measurement of Dmax on double-oblique multiplanar reconstruction (gold standard). Accuracy of automated Dmax measurements at baseline, follow-up, and progression over time was evaluated by calculation of mean error, Bland-Altman plot, and regression models. RESULTS Disagreement in Dmax measurements between outer wall envelope algorithm and manual method was insignificant (mean error: baseline, -0.07 ± 1.66 mm, P = .7; first follow-up, 0.24 ± 1.69 mm, P = .2; last follow-up, -0.41 ± 2.74 mm, P = .17); whereas significant discrepancies were found between the luminal algorithm and the manual method (mean error: baseline, -1.24 ± 2.01 mm, P < .01; first follow-up, -1.49 ± 3.30 mm, P < .01; last follow-up, -1.78 ± 3.60 mm, P < .01). Dmax progression results were more accurate with AAA outer wall envelope algorithm compared to luminal method (P = .2). CONCLUSIONS AAA outer wall envelope segmentation is recommended to enable automated calculation of Dmax perpendicular to its centerline during EVAR follow-up.
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Affiliation(s)
- Amine Riahi
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4
| | - Claude Kauffmann
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Laboratoire Central du Traitement de l'Image, Research Imaging Platform, University of Montreal Hospital Research Center, Montreal, Canada
| | - Eric Therasse
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Florence Morin-Roy
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4
| | - Stephane Elkouri
- Department of Surgery, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Patrick Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Marie-France Giroux
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Pierre Perreault
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Louis Bouchard
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Vincent L Oliva
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada
| | - Gilles Soulez
- Department of Radiology, Radio-Oncology and Nuclear Medicine, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Institute of Biomedical Engineering, University of Montreal, 2900 Édouard-Montpetit, Montreal, Quebec, Canada H3T 1J4; Laboratoire Central du Traitement de l'Image, Research Imaging Platform, University of Montreal Hospital Research Center, Montreal, Canada; Department of Radiology, University of Montreal Hospital (CHUM), Montreal, Canada.
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Bourgouin P, Thomas-Chaussé F, Gilbert P, Giroux MF, Périgny S, Guertin L, Dubois J, Soulez G. Effectiveness and Safety of Sclerotherapy for Treatment of Low-Flow Vascular Malformations of the Oropharyngeal Region. J Vasc Interv Radiol 2018; 29:809-815. [PMID: 29628299 DOI: 10.1016/j.jvir.2017.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of sclerotherapy with sodium tetradecyl sulfate (STS) and bleomycin for treatment of venous malformations (VMs) of the oropharyngeal region. MATERIALS AND METHODS A retrospective study of 33 patients with 46 VMs of the buccal and pharyngolaryngeal cavity associated with impairment of eating, respiration, or elocution was performed. Individual lesions were divided based on their anterior or posterior location, using the base of the tongue as an anatomic landmark. Lesion size was estimated with the use of orthogonal measurements on magnetic resonance or ultrasound images before and after treatment to assess radiologic response. Sclerotherapy sessions were performed under ultrasound, fluoroscopic, and, if needed, endoscopic guidance. Clinical response was assessed with the use of the Manchester Orofacial Pain Disability Scale. Methods for airway management were also compiled. RESULTS Following sclerotherapy, average VM diameter was reduced by 31.4% (P < .0001) on a per-patient basis and by 30.8% (P < .0001) on a per-lesion basis. The Manchester score improved by an average of 37.0% (P = .013). Four patients reported a worsening of symptoms, and 11 patients experienced symptomatic recurrence. Complications include pneumonia (5 patients) and urgent placement of a post-procedure tracheostomy (4 patients). Patients with posterior malformations experienced more complications (emergency tracheostomies in 4 and pneumonias in 4). CONCLUSIONS Sclerotherapy using STS is an efficient treatment for venous malformations of the buccal and pharyngolaryngeal cavity but can lead to significant complication for posterior lesions. Careful assessment of the airway is needed before treatment, and prophylactic tracheotomy should be considered in patients with posterior lesions.
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Affiliation(s)
- Patrick Bourgouin
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada
| | - Frédéric Thomas-Chaussé
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada
| | - Patrick Gilbert
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada
| | - Marie-France Giroux
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada
| | - Sébastien Périgny
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada
| | - Louis Guertin
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada
| | - Josée Dubois
- Department of Medical Imaging, Sainte-Justine University Hospital, Montréal, Québec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal H2X0C1, Québec, Canada.
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Almarzooqi MK, Chagnon M, Soulez G, Giroux MF, Gilbert P, Oliva VL, Perreault P, Bouchard L, Bourdeau I, Lacroix A, Therasse E. Adrenal vein sampling in primary aldosteronism: concordance of simultaneous vs sequential sampling. Eur J Endocrinol 2017; 176:159-167. [PMID: 27836950 DOI: 10.1530/eje-16-0701] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/21/2016] [Accepted: 11/11/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Many investigators believe that basal adrenal venous sampling (AVS) should be done simultaneously, whereas others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate the concordance of sequential and simultaneous AVS methods. DESIGN AND METHODS Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 min, in 188 consecutive patients (59 women and 129 men; mean age: 53.4 years). Selectivity was defined by adrenal-to-peripheral cortisol ratio ≥2, and lateralization was defined as an adrenal aldosterone-to-cortisol ratio ≥2, the contralateral side. Sequential AVS was simulated using right sampling at -5 min (t = -5) and left sampling at 0 min (t = 0). RESULTS There was no significant difference in mean selectivity ratio (P = 0.12 and P = 0.42 for the right and left sides respectively) and in mean lateralization ratio (P = 0.93) between t = -5 and t = 0. Kappa for selectivity between 2 simultaneous AVS was 0.71 (95% CI: 0.60-0.82), whereas it was 0.84 (95% CI: 0.76-0.92) and 0.85 (95% CI: 0.77-0.93) between sequential and simultaneous AVS at respectively -5 min and at 0 min. Kappa for lateralization between 2 simultaneous AVS was 0.84 (95% CI: 0.75-0.93), whereas it was 0.86 (95% CI: 0.78-0.94) and 0.80 (95% CI: 0.71-0.90) between sequential AVS and simultaneous AVS at respectively -5 min at 0 min. CONCLUSIONS Concordance between simultaneous and sequential AVS was not different than that between 2 repeated simultaneous AVS in the same patient. Therefore, a better diagnostic performance is not a good argument to select the AVS method.
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Affiliation(s)
- Mohamed-Karji Almarzooqi
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Miguel Chagnon
- Department of Mathematics and StatisticsUniversity of Montreal, Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
- Centre de RechercheCHUM (CRCHUM), Montréal, Quebec, Canada
| | - Marie-France Giroux
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Patrick Gilbert
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Vincent L Oliva
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Pierre Perreault
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Louis Bouchard
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Isabelle Bourdeau
- Department of MedicineDivision of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - André Lacroix
- Department of MedicineDivision of Endocrinology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Eric Therasse
- Department of RadiologyCentre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
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Bélanger C, Chartrand-Lefebvre C, Soulez G, Faughnan ME, Tahir MR, Giroux MF, Gilbert P, Perreault P, Bouchard L, Oliva VL, Therasse E. Pulmonary arteriovenous malformation (PAVM) reperfusion after percutaneous embolization: Sensitivity and specificity of non-enhanced CT. Eur J Radiol 2016; 85:150-157. [DOI: 10.1016/j.ejrad.2015.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 02/03/2023]
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Mailhot JP, Traistaru M, Soulez G, Ladouceur M, Giroux MF, Gilbert P, Zhu PS, Bourdeau I, Oliva VL, Lacroix A, Therasse E. Adrenal Vein Sampling in Primary Aldosteronism: Sensitivity and Specificity of Basal Adrenal Vein to Peripheral Vein Cortisol and Aldosterone Ratios to Confirm Catheterization of the Adrenal Vein. Radiology 2015; 277:887-94. [DOI: 10.1148/radiol.2015142413] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Efanov JI, Odobescu A, Giroux MF, Harris PG, Danino MA. Intra-arterial Thrombolysis for Postoperative Digital Ischemia: A Case Report. Eplasty 2014; 14:e26. [PMID: 25165495 PMCID: PMC4102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Surgical repair of digital flexion deformities can result in vascular injuries threatening the viability of the affected digit. While uncommon, these injuries are reported to have a rate as high as 0.8% following palmo-digital fasciectomy for Dupuytren's disease. Late presentation of such vascular events pose a challenge, since taking the patient to the operating room does not guarantee success. METHODS We report a case of subacute digital ischemia that presented 10 days following correction of a boutonniere deformity treated with intra-arterial thrombolysis. There were no particular intraoperative complications. The thrombolytic regimen consisted of Alteplase (Roche, Mississauga, Canada) 2 mg bolus and 1 mg per hour (total 30 mg received over 28 hours) and intravenous heparin with a subtherapeutic target partial thromboplastin time of 40 to 50 seconds. RESULTS Thirty hours after the initiation of thrombolysis, an angiography confirmed complete reperfusion of the digital arteries at the distal interphalangeal joint that correlated with the clinical appearance of the digit. Thrombolysis was interrupted and therapeutic intravenous heparin was maintained. Bridging to warfarin was started 6 days postthrombolysis with a target international normalized ratio of 2 to 3. Unfortunately, she was weaned from the heparin while her international normalized ratio was not yet in the therapeutic range and the vessels rethrombosed. This was confirmed by angiography, and intra-arterial thrombolysis was performed with successful revascularization. The patient was restarted on therapeutic dose of heparin and carefully bridged to Coumadin. CONCLUSIONS For traction injuries, thrombolytic therapy can be a viable option although we should keep in mind that it could provoke severe adverse events.
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Affiliation(s)
- Johnny I. Efanov
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Andrei Odobescu
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Marie-France Giroux
- bDivision of Interventional Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Patrick G. Harris
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Michel A. Danino
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada,Correspondence:
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Vu KN, Kaitoukov Y, Morin-Roy F, Kauffmann C, Giroux MF, Thérasse E, Soulez G, Tang A. Rupture signs on computed tomography, treatment, and outcome of abdominal aortic aneurysms. Insights Imaging 2014; 5:281-93. [PMID: 24789068 PMCID: PMC4035490 DOI: 10.1007/s13244-014-0327-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) rupture has a high mortality rate. Although the diagnosis of a ruptured AAA is usually straightforward, detection of impending rupture signs can be more challenging. Early diagnosis of impending AAA rupture can be lifesaving. Furthermore, differentiating between impending and complete rupture has important repercussions on patient management and prognosis. The purpose of this article is to classify and illustrate the entire spectrum of AAA rupture signs and to review current treatment options for ruptured AAAs. METHODS Using medical illustrations supplemented with computed tomography (CT), this essay showcases the various signs of impending rupture and ruptured AAAs. Endovascular aneurysm repair (EVAR) and open surgical repair are also discussed as treatment options for ruptured AAAs. RESULTS CT imaging findings of ruptured AAAs can be categorised according to location: intramural, luminal, and extraluminal. Intramural signs generally indicate impending AAA rupture, whereas luminal and extraluminal signs imply complete rupture. EVAR has emerged as an alternative and possibly less morbid method to treat ruptured AAAs. CONCLUSIONS AAA rupture occurs at the end of a continuum of growth and wall weakening. This review describes the CT imaging findings that may help identify impending rupture prior to complete rupture. TEACHING POINTS • AAA rupture occurs at the end of a continuum of growth and wall weakening. • Intramural imaging findings indicate impending AAA rupture. • Luminal and extraluminal imaging findings imply complete AAA rupture. • Some imaging findings are not specific to AAA ruptures and can be seen in other pathologies. • EVAR has emerged as an alternative and possibly less morbid method of treating ruptured AAAs.
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Affiliation(s)
- Kim-Nhien Vu
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Saint-Luc, 1058 Saint-Denis, Montréal, Québec, Canada, H2X 3J4
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Naim C, Douziech M, Therasse E, Robillard P, Giroux MF, Arsenault F, Cloutier G, Soulez G. Vulnerable atherosclerotic carotid plaque evaluation by ultrasound, computed tomography angiography, and magnetic resonance imaging: an overview. Can Assoc Radiol J 2013; 65:275-86. [PMID: 24360724 DOI: 10.1016/j.carj.2013.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/31/2013] [Indexed: 01/23/2023] Open
Abstract
Ischemic syndromes associated with carotid atherosclerotic disease are often related to plaque rupture. The benefit of endarterectomy for high-grade carotid stenosis in symptomatic patients has been established. However, in asymptomatic patients, the benefit of endarterectomy remains equivocal. Current research seeks to risk stratify asymptomatic patients by characterizing vulnerable, rupture-prone atherosclerotic plaques. Plaque composition, biology, and biomechanics are studied by noninvasive imaging techniques such as magnetic resonance imaging, computed tomography, ultrasound, and ultrasound elastography. These techniques are at a developmental stage and have yet to be used in clinical practice. This review will describe noninvasive techniques in ultrasound, magnetic resonance imaging, and computed tomography imaging modalities used to characterize atherosclerotic plaque, and will discuss their potential clinical applications, benefits, and drawbacks.
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Affiliation(s)
- Cyrille Naim
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada
| | - Maxime Douziech
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Eric Therasse
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Pierre Robillard
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Marie-France Giroux
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Frederic Arsenault
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada
| | - Guy Cloutier
- Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada
| | - Gilles Soulez
- Département de Radiologie, Radio-Oncologie et Médecine Nucléaire, Université de Montréal, Montreal, Québec, Canada; Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montreal, Québec, Canada.
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Naim C, Cloutier G, Mercure E, Destrempes F, Qin Z, El-Abyad W, Lanthier S, Giroux MF, Soulez G. Characterisation of carotid plaques with ultrasound elastography: feasibility and correlation with high-resolution magnetic resonance imaging. Eur Radiol 2013; 23:2030-41. [PMID: 23417249 DOI: 10.1007/s00330-013-2772-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/19/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the ability of ultrasound non-invasive vascular elastography (NIVE) strain analysis to characterise carotid plaque composition and vulnerability as determined by high-resolution magnetic resonance imaging (MRI). METHODS Thirty-one subjects with 50 % or greater carotid stenosis underwent NIVE and high-resolution MRI of internal carotid arteries. Time-varying strain images (elastograms) of segmented plaques were generated from ultrasonic raw radiofrequency sequences. On MRI, corresponding plaques and components were segmented and quantified. Associations between strain parameters, plaque composition and symptomatology were estimated with curve-fitting regressions and Mann-Whitney tests. RESULTS Mean stenosis and age were 72.7 % and 69.3 years, respectively. Of 31 plaques, 9 were symptomatic, 17 contained lipid and 7 were vulnerable on MRI. Strains were significantly lower in plaques containing a lipid core compared with those without lipid, with 77-100 % sensitivity and 57-79 % specificity (P < 0.032). A statistically significant quadratic fit was found between strain and lipid content (P < 0.03). Strains did not discriminate symptomatic patients or vulnerable plaques. CONCLUSIONS Ultrasound NIVE is feasible in patients with significant carotid stenosis and can detect the presence of a lipid core with high sensitivity and moderate specificity. Studies of plaque progression with NIVE are required to identify vulnerable plaques. KEY POINTS • Non-invasive vascular elastography (NIVE) provides additional information in vascular ultrasound • Ultrasound NIVE is feasible in patients with significant carotid stenosis • Ultrasound NIVE detects a lipid core with high sensitivity and moderate specificity • Studies on plaque progression with NIVE are required to identify vulnerable plaques.
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Affiliation(s)
- Cyrille Naim
- Department of Radiology, University of Montreal Hospital Center (CHUM), Montréal, Québec, Canada.
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Dugas A, Therasse É, Kauffmann C, Tang A, Elkouri S, Nozza A, Giroux MF, Oliva VL, Soulez G. Reproducibility of Abdominal Aortic Aneurysm Diameter Measurement and Growth Evaluation on Axial and Multiplanar Computed Tomography Reformations. Cardiovasc Intervent Radiol 2011; 35:779-87. [DOI: 10.1007/s00270-011-0259-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022]
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Sam K, Gahide G, Soulez G, Giroux MF, Oliva VL, Perreault P, Bouchard L, Gilbert P, Therasse E. Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 2011; 22:1563-8. [PMID: 21840226 DOI: 10.1016/j.jvir.2011.06.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 06/21/2011] [Accepted: 06/30/2011] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of percutaneous renal artery embolization (RAE) of iatrogenic vascular kidney injuries and the effects of RAE on renal function and arterial blood pressure (BP). MATERIALS AND METHODS Over a 12-year period, 50 consecutive patients with severe hemorrhage after iatrogenic arterial kidney injuries underwent RAE. Technical success was defined as occlusion of the bleeding site, and clinical success was defined as complete bleeding cessation. The effects on renal function and arterial BP were assessed by comparing the estimated glomerular filtration rate (eGFR), renal function stage (National Kidney Foundation scale), systolic BP, and BP stage (European Society of Hypertension classification) before and after RAE. RESULTS RAE was technically successful in 49 patients (98%). Two patients were lost to follow-up after RAE. Clinical success was obtained in 40 (83%), 45 (94%), and 47 patients (98%), respectively, at 24, 48, and 96 hours after RAE. Three patients (6%) had minor complications, and one patient (2%) died within 30 days after RAE. Follow-up renal function data (mean, 4 mo) were available for 33 patients (66%). No statistically significant differences in eGFR (P = .186) or renal function stage (P = .183) were apparent after RAE. Follow-up BP data (mean, 3 mo) were available for 28 patients (56%). There were no significant differences in systolic BP (P = .233) or BP stage (P = .745) after RAE. CONCLUSIONS Embolization of iatrogenic renal artery injuries is safe and associated with high technical and clinical success rates. It is not associated with a significant worsening of renal function or increase in BP.
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Affiliation(s)
- Karl Sam
- Department of Radiology, Centre de Recherche, Centre Hospitalier de l'Université de Montréal, Hôtel-Dieu, 3840 St. Urbain St., Montreal, QC, Canada H2W 1T8
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Kauffmann C, Tang A, Therasse E, Giroux MF, Elkouri S, Melanson P, Melanson B, Oliva VL, Soulez G. Measurements and detection of abdominal aortic aneurysm growth: Accuracy and reproducibility of a segmentation software. Eur J Radiol 2011; 81:1688-94. [PMID: 21601403 DOI: 10.1016/j.ejrad.2011.04.044] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 04/07/2011] [Accepted: 04/13/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE To validate the reproducibility and accuracy of a software dedicated to measure abdominal aortic aneurysm (AAA) diameter, volume and growth over time. MATERIALS AND METHODS A software enabling AAA segmentation, diameter and volume measurement on computed tomography angiography (CTA) was tested. Validation was conducted in 28 patients with an AAA having 2 consecutive CTA examinations. The segmentation was performed twice by a senior radiologist and once by 3 medical students on all 56 CTAs. Intra and inter-observer reproducibility of D-max and volumes values were calculated by intraclass correlation coefficient (ICC). Systematic errors were evaluated by Bland-Altman analysis. Differences in D-max and volume growth were compared with paired Student's t-tests. RESULTS Mean D-max and volume were 49.6±6.2mm and 117.2±36.2ml for baseline and 53.6±7.9mm and 139.6±56.3ml for follow-up studies. Volume growth (17.3%) was higher than D-max progression (8.0%) between baseline and follow-up examinations (p<.0001). For the senior radiologist, intra-observer ICC of D-max and volume measurements were respectively estimated at 0.997 (≥0.991) and 1.000 (≥0.999). Overall inter-observer ICC of D-max and volume measurements were respectively estimated at 0.995 (0.990-0.997) and 0.999 (>0.999). Bland-Altman analysis showed excellent inter-reader agreement with a repeatability coefficient <3mm for D-max, <7% for relative D-max growth, <6ml for volume and <6% for relative volume growth. CONCLUSION Software AAA volume measurements were more sensitive than AAA D-max to detect AAA growth while providing an equivalent and high reproducibility.
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Affiliation(s)
- Claude Kauffmann
- Department of Radiology, Centre Hospitalier Universitaire de Montréal and CHUM Research Center, University of Montreal, 1560 Sherbrooke Est, H2L 4M1 Montréal, Québec, Canada.
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Destrempes F, Meunier J, Giroux MF, Soulez G, Cloutier G. Segmentation of plaques in sequences of ultrasonic B-mode images of carotid arteries based on motion estimation and a Bayesian model. IEEE Trans Biomed Eng 2011; 58. [PMID: 21411400 DOI: 10.1109/tbme.2011.2127476] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of this work is to perform a segmentation of atherosclerotic plaques in view of evaluating their burden and to provide boundaries for computing properties such as the plaque deformation and elasticity distribution (elastogram and modulogram). The echogenicity of a region of interest comprising the plaque, the vessel lumen, and the adventitia of the artery wall in an ultrasonic B-mode image was modeled by mixtures of three Nakagami distributions, which yielded the likelihood of a Bayesian segmentation model. The main contribution of this paper is the estimation of the motion field and its integration into the prior of the Bayesian model that included a local geometrical smoothness constraint, as well as an original spatiotemporal cohesion constraint. The Maximum A Posteriori (MAP) of the proposed model was computed with a variant of the Exploration/Selection (ES) algorithm. The starting point is a manual segmentation of the first frame. The proposed method was quantitatively compared with manual segmentations of all frames by an expert technician. Various measures were used for this evaluation, including the mean point-to-point distance and the Hausdorff distance. Results were evaluated on 94 sequences of 33 patients (for a total of 8988 images). We report a mean point-to- point distance of 0.24 ± 0.08 mm and a Hausdorff distance of 1.24 ± 0.40 mm. Our tests showed that the algorithm was not sensitive to the degree of stenosis or calcification.
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Letourneau-Guillon L, Faughnan ME, Soulez G, Giroux MF, Oliva VL, Boucher LM, Dubois J, Prabhudesai V, Therasse E. Embolization of pulmonary arteriovenous malformations with amplatzer vascular plugs: safety and midterm effectiveness. J Vasc Interv Radiol 2010; 21:649-56. [PMID: 20346701 DOI: 10.1016/j.jvir.2010.01.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 11/14/2009] [Accepted: 01/19/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of Amplatzer vascular plugs (AVPs) for percutaneous closure of arteries feeding pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS Over a 45-month period, 24 consecutive patients with at least one PAVM treated with an AVP were selected from a database on patients with a PAVM who received embolotherapy. Immediate technical success was defined as the complete absence of flow through the PAVM after embolization without the need for additional embolization material. Success on follow-up imaging was defined as a reduction in size of at least 70% of the aneurysm or draining vein on follow-up computed tomography or the absence of flow through the PAVM on a subsequent pulmonary angiogram. RESULTS Thirty-seven AVPs were used to close 36 feeding arteries in 35 PAVMs in seven male and 17 female patients aged 11-86 years (mean age, 50 y). Technical success was achieved in 35 feeding arteries (97%). One feeding artery required two AVPs for closure. There were no immediate procedure-related complications. At a mean clinical follow-up of 322 days (range, 1-1,126 d), all patients were alive without new PAVM-related complications. Imaging follow-up was available for 29 embolized vessels (81%) with a mean follow-up of 418 days (range, 40-937 d), and recanalization occurred in two treated vessels (7%). CONCLUSIONS AVPs are safe and effective for closure of PAVMs feeding vessels that can be reached with a guiding catheter, with an acceptable rate of recanalization.
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Affiliation(s)
- Laurent Letourneau-Guillon
- Department of Radiology and Centre de Recherche, Centre Hospitalier de l'Université de Montréal-Hôtel-Dieu, Montreal, QC, Canada
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Destrempes F, Meunier J, Giroux MF, Soulez G, Cloutier G. Segmentation in ultrasonic B-mode images of healthy carotid arteries using mixtures of Nakagami distributions and stochastic optimization. IEEE Trans Med Imaging 2009; 28:215-229. [PMID: 19068423 DOI: 10.1109/tmi.2008.929098] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The goal of this work is to perform a segmentation of the intimamedia thickness (IMT) of carotid arteries in view of computing various dynamical properties of that tissue, such as the elasticity distribution (elastogram). The echogenicity of a region of interest comprising the intima-media layers, the lumen, and the adventitia in an ultrasonic B-mode image is modeled by a mixture of three Nakagami distributions. In a first step, we compute the maximum a posteriori estimator of the proposed model, using the expectation maximization (EM) algorithm. We then compute the optimal segmentation based on the estimated distributions as well as a statistical prior for disease-free IMT using a variant of the exploration/selection (ES) algorithm. Convergence of the ES algorithm to the optimal solution is assured asymptotically and is independent of the initial solution. In particular, our method is well suited to a semi-automatic context that requires minimal manual initialization. Tests of the proposed method on 30 sequences of ultrasonic B-mode images of presumably disease-free control subjects are reported. They suggest that the semi-automatic segmentations obtained by the proposed method are within the variability of the manual segmentations of two experts.
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Affiliation(s)
- François Destrempes
- Laboratoire de Biorhéologie et d'Ultrasonographie Médicale (LBUM), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, H2L 2W5 Canada
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Maurice RL, Soulez G, Giroux MF, Cloutier G. Noninvasive vascular elastography for carotid artery characterization on subjects without previous history of atherosclerosis. Med Phys 2008; 35:3436-43. [DOI: 10.1118/1.2948320] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Oliva VL, Perreault P, Giroux MF, Bouchard L, Therasse E, Soulez G. Recovery G2 Inferior Vena Cava Filter: Technical Success and Safety of Retrieval. J Vasc Interv Radiol 2008; 19:884-9. [DOI: 10.1016/j.jvir.2008.02.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 02/26/2008] [Accepted: 02/29/2008] [Indexed: 11/16/2022] Open
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Woolfson JP, Baerlocher MO, Giroux MF, Simons M, Millward SF. Why should the Royal College of Physicians and Surgeons of Canada recognize interventional radiology as a subspecialty within radiology? A summary of the application for subspecialty recognition. Can Assoc Radiol J 2008; 59:55-60. [PMID: 18533393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Baerlocher MO, Owen R, Poole A, Giroux MF. Interventional Radiology Deserves Formal Recognition as a Distinct Medical Subspecialty: A Statement from the Canadian Interventional Radiology Association. J Vasc Interv Radiol 2008; 19:9-12. [DOI: 10.1016/j.jvir.2007.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Schmitt C, Soulez G, Maurice RL, Giroux MF, Cloutier G. Noninvasive vascular elastography: toward a complementary characterization tool of atherosclerosis in carotid arteries. Ultrasound Med Biol 2007; 33:1841-58. [PMID: 17698283 DOI: 10.1016/j.ultrasmedbio.2007.05.020] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 05/25/2007] [Accepted: 05/30/2007] [Indexed: 05/06/2023]
Abstract
Only a minority of patients with carotid arterial disease have warning symptoms, because the majority of strokes are caused by previously asymptomatic lesions. Because morbidity and mortality after acute stroke are high, patients should be diagnosed and treated before symptoms develop. The hypothesis of this study is that vascular elasticity maps (or elastograms) of carotids are of predictive value for plaque characterization. The strain tensor from either cross-sectional or longitudinal ultrasound radiofrequency data were assessed by a new implementation of the Lagrangian speckle model estimator (LSME), which considers local echogenicity variations. A 26-year-old healthy male (HS1), a 40-year-old (HS2) normal female subject and two 75-year-old asymptomatic patients with severe carotid stenoses were scanned. Reproducible elastograms were obtained as a function of time over five to seven cardiac cycles. Stress-strain modulus elastograms were computed for normal subjects. Stiffening of healthy carotid walls was estimated to be 148 +/- 7 kPa and 163 +/- 30 kPa at peak-systole for HS1 and HS2, respectively. For patients with heterogeneous plaques, strain and shear elastograms revealed interesting information about plaque size, tissue composition and mechanical interaction between structures. In conclusion, the LSME provides a promising approach for strain and shear estimates to characterize vulnerable plaque.
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Affiliation(s)
- Cédric Schmitt
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Quebec, Canada
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Baerlocher MO, McLaren K, Collingwood P, Giroux MF, Owen R, Poole A, Pugash R, Asch MR. Conclusions and recommendations from the position paper on interventional radiology in Canada. Can Assoc Radiol J 2007; 58:11-4. [PMID: 17408157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
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Tang A, Cloutier G, Therasse E, Beaudoin G, Qanadli SD, Giroux MF, Boussion N, de Guise JA, Oliva VL, Soulez G. Optimization of spatial resolution for peripheral magnetic resonance angiography. Acad Radiol 2007; 14:54-61. [PMID: 17178366 DOI: 10.1016/j.acra.2006.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 10/12/2006] [Accepted: 10/13/2006] [Indexed: 01/30/2023]
Abstract
RATIONALE AND OBJECTIVES To determine optimum spatial resolution when imaging peripheral arteries with magnetic resonance angiography (MRA). MATERIALS AND METHODS Eight vessel diameters ranging from 1.0 to 8.0 mm were simulated in a vascular phantom. A total of 40 three-dimensional flash MRA sequences were acquired with incremental variations of fields of view, matrix size, and slice thickness. The accurately known eight diameters were combined pairwise to generate 22 "exact" degrees of stenosis ranging from 42% to 87%. Then, the diameters were measured in the MRA images by three independent observers and with quantitative angiography (QA) software and used to compute the degrees of stenosis corresponding to the 22 "exact" ones. The accuracy and reproducibility of vessel diameter measurements and stenosis calculations were assessed for vessel size ranging from 6 to 8 mm (iliac artery), 4 to 5 mm (femoro-popliteal arteries), and 1 to 3 mm (infrapopliteal arteries). Maximum pixel dimension and slice thickness to obtain a mean error in stenosis evaluation of less than 10% were determined by linear regression analysis. RESULTS Mean errors on stenosis quantification were 8.8% +/- 6.3% for 6- to 8-mm vessels, 15.5% +/- 8.2% for 4- to 5-mm vessels, and 18.9% +/- 7.5% for 1- to 3-mm vessels. Mean errors on stenosis calculation were 12.3% +/- 8.2% for observers and 11.4% +/- 15.1% for QA software (P = .0342). To evaluate stenosis with a mean error of less than 10%, maximum pixel surface, the pixel size in the phase direction, and the slice thickness should be less than 1.56 mm2, 1.34 mm, 1.70 mm, respectively (voxel size 2.65 mm3) for 6- to 8-mm vessels; 1.31 mm2, 1.10 mm, 1.34 mm (voxel size 1.76 mm3), for 4- to 5-mm vessels; and 1.17 mm2, 0.90 mm, 0.9 mm (voxel size 1.05 mm3) for 1- to 3-mm vessels. CONCLUSION Higher spatial resolution than currently used should be selected for imaging peripheral vessels.
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Affiliation(s)
- An Tang
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM)-Hôpital Notre-Dame, Montreal, Quebec, Canada
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Vidal V, Therasse E, Berthiaume Y, Bommart S, Giroux MF, Oliva VL, Abrahamowicz M, du Berger R, Jeanneret A, Soulez G. Bronchial Artery Embolization in Adults with Cystic Fibrosis: Impact on the Clinical Course and Survival. J Vasc Interv Radiol 2006; 17:953-8. [PMID: 16778227 DOI: 10.1097/01.rvi.0000222822.82659.50] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Although bronchial artery embolization (BAE) is effective in the acute control of recurrent or major hemoptysis in adults with cystic fibrosis, outcomes after embolization are not well known. The objective of this retrospective study was to evaluate respiratory function, survival, and hemoptysis-free survival in adult patients with cystic fibrosis treated for hemoptysis with BAE. MATERIALS AND METHODS Of 297 patients with cystic fibrosis hospitalized from 1990 to 2004, 30 patients (mean age, 26.7+/-9.2 years) presented with major or persistent hemoptysis that required 42 BAE sessions. These patients were compared with a control group of 27 patients without hemoptysis requiring embolization who were matched for age, sex, and forced expiratory volume in 1 second (FEV1). RESULTS Hemoptysis stopped within 24 hours after BAE in 96.6% of patients (n=29), and there were no major complications. The change in the slope of FEV1 after the BAE or matching date was significantly worse in the embolization group (P=.0007). At last follow-up, nine and one patients, respectively, had undergone lung transplantation in the BAE and control groups (P=.002). The 5-year survival rates without lung transplantation were 31% and 84%, respectively, in the BAE and control groups (hazard ratio, 5.95; P=.002). Sixty-two percent of patients were free of hemoptysis 5 years after BAE. The number of collateral arteries was the only factor associated with the risk of death or recurrent hemoptysis (P=.001). CONCLUSIONS Despite the effectiveness of embolization in controlling recurrent or major hemoptysis, adults with cystic fibrosis who have undergone BAE for hemoptysis are at much higher risk of respiratory function aggravation, death, and the need for lung transplantation than those who have not undergone BAE for hemoptysis. They are more likely to die or to undergo lung transplantation than to present with recurrent major hemoptysis.
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Affiliation(s)
- Vincent Vidal
- Department of Radiology, Hôpital Timone, Marseille, France, and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada
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Vidal V, Therasse E, Jacquier A, Giroux MF, Bommart S, Bartoli JM, Oliva VL, Cohen F, Blair JF, Moulin G, Philie M, Soulez G. Endovascular Embolization of Symptomatic Arteriovenous Fistulas Secondary to Lower-limb In Situ Venous Bypass Grafts. J Vasc Interv Radiol 2006; 17:481-6. [PMID: 16567672 DOI: 10.1097/01.rvi.0000202610.73314.3c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of endovascular treatment of symptomatic arteriovenous (AV) fistulas associated with femoropopliteal in situ venous bypass grafts. MATERIALS AND METHODS Twenty-one patients underwent embolization of symptomatic AV fistulas associated with lower-limb bypass with use of the saphenous vein (n = 16) or femoral vein (n = 5). The procedures were performed with microcatheters and metallic coils. Indications for embolization were venous congestion (n = 15) and arterial insufficiency (n = 6). Eight patients had persistent lower-limb edema, seven had painful inflammatory skin thickening, three had intermittent claudication, and three had nonhealing ulcers. RESULTS Forty-four AV fistulas were embolized. Symptoms of venous congestion regressed completely in 12 of 15 patients (80%). Partial symptom improvement was achieved in three other patients (20%), two of whom had persistent lower-limb edema and bypass with use of the femoral vein. Five of six patients with ischemic symptoms (83%) had complete symptom relief. One patient (17%) whose ischemic ulcer did not recover despite successful embolization of AV fistulas required an amputation 4 months later. Overall, 17 of 21 patients (81%) showed complete recovery of clinical symptoms. There was no bypass occlusion during follow-up (mean, 17.5 months; range, 1-45 months). CONCLUSIONS Embolization of symptomatic AV fistulas secondary to lower-limb in situ venous bypass is a safe and efficient alternative to surgical ligature. Complete regression of clinical symptoms is less likely when the bypass is performed with use of the femoral vein.
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Affiliation(s)
- Vincent Vidal
- Department of Radiology, Hôpital Timone, Marseille, France
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Oliva VL, Szatmari F, Giroux MF, Flemming BK, Cohen SA, Soulez G. The Jonas Study: Evaluation of the Retrievability of the Cordis OptEase Inferior Vena Cava Filter. J Vasc Interv Radiol 2005; 16:1439-45; quiz 1445. [PMID: 16319149 DOI: 10.1097/01.rvi.0000171699.57957.c7] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the success, safety, and efficacy of the retrieval of the OptEase Permanent/Retrievable Vena Cava Filter (Cordis, Warren, NJ), when implanted for temporary protection against venous thromboembolism. MATERIALS AND METHODS This prospective, multicenter, non-randomized study enrolled 27 patients who needed temporary protection against pulmonary embolism in whom the intent at the time of filter insertion was retrieval of the OptEase filter. Patients presented with deep venous thrombosis (n = 17), pulmonary embolism (PE) (n = 6), and high risk for PE without thromboembolic disease (n = 4). Assessments included duplex sonography of the access site performed within 24 hours of device implantation and retrieval. All patients underwent cavography before and after filter placement and filter retrieval. Contrast-enhanced computed tomography (CT) of the abdomen and clinical follow-up was performed at 1 month after device retrieval. RESULTS Of the 27 enrolled patients, 21 patients (77.8%) met the criteria for retrieval and all 21 patients (100%) had filters successfully retrieved with no associated adverse events. Retrieval was not attempted in six patients as a result of ongoing contraindication to anticoagulation (n = 3), large trapped thrombi within the filter (n = 2), and poor patient prognosis (n = 1). Time to retrieval ranged from 5 to 14 days with a mean implantation time of 11.1 days +/- 1.82. No symptomatic pulmonary embolism, vena cava wall injury, vena cava stenosis, significant bleeding, filter fracture, or filter migration was observed. Nineteen of the 21 patients (90.5%) were followed for 1-month post-retrieval with no device-related adverse events or symptomatic PE. Caval patency was documented in 18 of these 19 patients with CT. Two patients were lost to follow-up, and one patient refused to undergo CT examination. CONCLUSION The OptEase permanent/retrievable vena cava filter can be safely and successfully retrieved up to 14 days in patients who no longer require inferior vena cava filter protection against pulmonary embolism.
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Affiliation(s)
- Vincent L Oliva
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Quebec, Canada.
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Soulez G, Thérasse E, Monfared AAT, Blair JF, Choiniére M, Elkouri S, Stéphane E, Beaudoin N, Giroux MF, Cliche A, Lelorier J, Oliva VL. Pain and Quality of Life Assessment after Endovascular Versus Open Repair of Abdominal Aortic Aneurysms in Patients at Low Risk. J Vasc Interv Radiol 2005; 16:1093-100. [PMID: 16105921 DOI: 10.1097/01.rvi.0000167858.16223.d5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare functional autonomy, quality of life (QOL), and pain control after endovascular and open repair (OR) of abdominal aortic aneurysms. MATERIALS AND METHODS Forty patients with a low surgical risk profile and anatomic compatibility for stent-graft therapy were randomized to receive OR or endovascular aneurysm repair (EVAR). Technical and clinical success as well as mortality were assessed in both groups and compared by Kaplan-Meier analysis. Functional autonomy and QOL were assessed by Karnofsky score and Short Form 36 (SF-36) questionnaire. Pain control was assessed by a numeric rating scale and Brief Pain Inventory questionnaire. QOL outcomes by means of the SF-36 and pain questionnaires were compared with use of mixed-effects models for repeated-measures analysis. RESULTS All procedures were technically successful in both groups. Three late clinical failures requiring surgical conversion or repeated intervention were observed in the EVAR group and one was observed in the OR group. There was no significant difference between groups in terms of functional autonomy or QOL. No difference in pain level was evident during the early postoperative period, whereas the pain level was lower in the OR group after 1 month. Opioid analgesic drug consumption was significantly greater in the OR group during the postoperative period. Mean hospitalization duration was shorter in the EVAR group than in the OR group (4.5 days +/- 2.4 vs 11.5 days +/- 8.1; P= .001). CONCLUSION EVAR has no advantage over OR in patients at low risk in terms of functional autonomy, QOL, and pain control. However, EVAR was associated with shorter hospitalization durations compared with OR.
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Affiliation(s)
- Gilles Soulez
- Department of Radiology, Université de Montréal, Montreal, Québec, Canada
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Bolduc JP, Oliva VL, Therasse E, Giroux MF, Bouchard L, Perreault P, Cliché A, Soulez G. Diagnosis and treatment of renovascular hypertension: a cost-benefit analysis. AJR Am J Roentgenol 2005; 184:931-7. [PMID: 15728620 DOI: 10.2214/ajr.184.3.01840931] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to evaluate and compare the relative cost-benefit of Doppler sonography, MR angiography, and captopril-enhanced renal scintigraphy as techniques for predicting a patient's clinical response to renal angioplasty. MATERIALS AND METHODS Estimations of positive and negative predictive values of baseline and captopril-enhanced renal scintigraphy and Doppler sonography examinations for predicting a favorable outcome after renal angioplasty were based on a previously published prospective study involving 74 patients who underwent this treatment. For gadolinium-enhanced MR angiography, predictive values were calculated from a subpopulation of 57 of these 74 subjects. The value of different combined strategies with these techniques for predicting clinical success after angioplasty was evaluated in this population. The costs of investigation and treatment per improved patient were calculated for each imaging technique and for combined strategies in a hypothetic 1,000-patient population with a 30% prevalence of renal artery stenosis, relying on the diagnostic performance reported in the literature for each technique in detecting renal artery stenosis. RESULTS The costs for each improved patient were $12,579 for patients selected on the basis of a positive finding on Doppler sonography (false-negative results = 12/1,000) and $10,149 for patients selected with criteria combining a positive finding on Doppler sonography with a bilateral resistive index of less than 0.75 (false-negative results = 32/1,000). Patient selection based on a positive finding on MR angiography cost $18,119 (false-negative results = 0), whereas the cost of patient selection based on a positive finding on renal scintigraphy was $12,939 (false-negative results = 29/1,000). CONCLUSION Doppler sonography is more cost-efficient but less sensitive than MR angiography for identifying patients with renovascular hypertension. MR angiography should be favored in hypertensive patients who are resistant to medical therapy to avoid false-negative examinations.
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Affiliation(s)
- Jean Philippe Bolduc
- Department of Radiology, CHUM-Notre-Dame Hospital, 1560 Sherbrooke East, Montreal, Quebec, Canada
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Therasse E, Soulez G, Giroux MF, Perreault P, Bouchard L, Blair JF, Beaudoin N, Benko A, Oliva VL. Stent-Graft Placement for the Treatment of Thoracic Aortic Diseases. Radiographics 2005; 25:157-73. [PMID: 15653593 DOI: 10.1148/rg.251045046] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The recent development of aortic stent-grafts has brought the management of thoracic aortic diseases into the realm of interventional radiology. Stent-graft placement is now an alternative to surgery for the treatment of descending thoracic aortic aneurysms, ulcers, and fistulas and is sometimes indicated in cases of mycotic aneurysm, posttraumatic aortic rupture, or thoracic descending aortic dissection. Pretreatment imaging is crucial for evaluating patient eligibility, selecting the appropriate stent-graft, and planning the intervention. Stent-graft treatment of long atherosclerotic aneurysms, lesions close to aortic branch vessels, and aortic dissections is subject to technical pitfalls, and adverse events such as endoleaks, stent migration or misplacement, aortic perforation, and vascular trauma will require specific interventions, although they occur in only a minority of patients. Thoracic stent-graft placement in good surgical candidates remains controversial because long-term results are unknown. However, short-term morbidity and mortality rates from endovascular treatment compare favorably with those from surgery, and stent-graft placement is proving to be a safe, minimally invasive, and effective treatment for thoracic aortic diseases and is already the best option in many affected patients who are poor surgical candidates.
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Affiliation(s)
- Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal-Hôtel-Dieu, 3840 St-Urbain St, Montreal, Quebec, Canada H2W 1T8.
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Abstract
Chemoembolization was performed in eight patients with liver metastasis from breast carcinoma. Five of eight patients had some radiographic regression of the liver tumors, one had stable liver disease, and two had disease progression. Two of four patients with pain showed clinical improvement of their symptoms. Only one patient with radiographic response or disease stabilization subsequently had intrahepatic progression (at 3 months). Five patients developed other metastasis, particularly brain metastasis, at a mean of 4.6 months after first chemoembolization (range, 2-12 months). All patients died within 13 months of treatment, with a mean survival of 49 months from primary diagnosis, 20 months from liver metastasis diagnosis, and 6 months from first chemoembolization.
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Affiliation(s)
- Marie-France Giroux
- Department of Radiology, Hospital of the University of Pennsylvania, 1 Silverstein, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA
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Létourneau-Guillon L, Soulez G, Beaudoin G, Oliva VL, Giroux MF, Qin Z, Boussion N, Therasse E, De Guise J, Cloutier G. CT and MR Imaging of Nitinol Stents with Radiopaque Distal Markers. J Vasc Interv Radiol 2004; 15:615-24. [PMID: 15178723 DOI: 10.1097/01.rvi.00000127898.23424.01] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate imaging characteristics and artifacts of a nitinol stent with distal tantalum markers with computed tomography (CT) angiography and magnetic resonance (MR) angiography. MATERIALS AND METHODS A vascular phantom was built to simulate in-stent restenosis. A nitinol stent with tantalum markers (Luminexx stent) was evaluated with CT angiography in different orientations relative to the z-axis and with MR angiography in different positions relative to both B0 and the readout gradient. Stenosis measurements were compared with conventional digital subtraction angiography for both modalities. In-stent signal intensity obtained with different flip angles was assessed in two nitinol stents with distal markers (Luminexx stent and SMART stent) and one without markers (Memotherm-FLEXX stent). RESULTS Stenosis detection was not possible with CT angiography when the stent was perpendicular to the z-axis because of streak-like artifacts induced by tantalum markers. Stenosis evaluation with multiplanar reformation was accurate when the stent was in parallel and oblique orientations relative to the table axis. With MR angiography, metallic artifacts were mostly related to the stent orientation with B0, whereas orientation of the readout gradient had little influence. The mean error (overestimation) for stenosis measurements varied between 0.1% and 7.4% for CT imaging in parallel and oblique positions and 3.6% and 9.5% for MR imaging. Higher flip angles did not improve signal intensity inside the three stents tested. CONCLUSION CT and MR angiography can be used for evaluating the patency of stents with distal markers that are parallel or oblique relative to the table axis (iliac, carotid, or femoral stents). MR angiography is preferred if the stent is perpendicular to the table axis (renal stent).
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Affiliation(s)
- Laurent Létourneau-Guillon
- Department of Radiology, CHUM-Notre-Dame Hospital, 1560 Sherbrooke East, Montreal, Quebec, Canada, H2L 4M1.
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Soulez G, Therasse E, Qanadli SD, Froment D, Léveillé M, Nicolet V, Turpin S, Giroux MF, Guertin MC, Oliva VL. Prediction of clinical response after renal angioplasty: respective value of renal Doppler sonography and scintigraphy. AJR Am J Roentgenol 2003; 181:1029-35. [PMID: 14500224 DOI: 10.2214/ajr.181.4.1811029] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The goal of our study was to compare Doppler sonography and renal scintigraphy as tools for predicting the therapeutic response in patients after undergoing renal angioplasty. SUBJECTS AND METHODS. Seventy-four hypertensive patients underwent clinical examination, Doppler sonography, and renal scintigraphy before and after receiving captopril in preparation for renal revascularization. The patients were evaluated for the status of hypertension 3 months after the procedure. The predictive values of the findings of clinical examination, Doppler sonography, renal scintigraphy, and angiography were assessed. RESULTS For prediction of a favorable therapeutic outcome, abnormal results from renal scintigraphy before and after captopril administration had a sensitivity of 58% and specificity of 57%. Findings of Doppler sonography had a sensitivity of 68% and specificity of 50% before captopril administration and a sensitivity of 81% and specificity of 32% after captopril administration. Significant predictors of a cure or reduction of hypertension after revascularization were low unilateral (p = 0.014) and bilateral resistive (p = 0.016) indexes on Doppler sonography before (p = 0.009) and after (p = 0.028) captopril administration. On multivariate analysis, the best predictors were a unilateral resistive index of less than 0.65 (odds ratio [OR] = 3.7) after captopril administration and a kidney longer than 93 mm (OR = 7.8). The two best combined criteria to predict the favorable therapeutic outcome were a bilateral resistive index of less than 0.75 before captopril administration combined with a unilateral resistive index of less than 0.70 after captopril administration (sensitivity, 76%; specificity, 58%) or a bilateral resistive index of less than 0.75 before captopril administration and a kidney measuring longer than 90 mm (sensitivity, 81%; specificity, 50%). CONCLUSION Measurements of kidney length and unilateral and bilateral resistive indexes before and after captopril administration were useful in predicting the outcome after renal angioplasty. Renal scintigraphy had no significant predictive value.
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Affiliation(s)
- Gilles Soulez
- Department of Radiology, CHUM-Notre-Dame Hospital, 1560 Sherbrooke Street E., Montreal, Quebec H2L 4M1, Canada.
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Therasse E, Oliva VL, Lafontaine E, Perreault P, Giroux MF, Soulez G. Balloon dilation and stent placement for esophageal lesions: indications, methods, and results. Radiographics 2003; 23:89-105. [PMID: 12533645 DOI: 10.1148/rg.231025051] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Esophageal balloon dilation and expandable stent placement are safe, minimally invasive, effective treatments for esophageal strictures and fistulas. These procedures have brought the management of dysphagia due to esophageal strictures into the field of interventional radiology. Esophageal dilation is usually indicated for benign stenoses and is technically successful in more than 90% of cases. Most patients with esophageal carcinoma are not candidates for resection; thus, the main focus of treatment is palliation of malignant dysphagia and esophagorespiratory fistulas. Esophageal stent placement, which is approved only for malignant strictures, is one of the main therapeutic options in affected patients and relieves dysphagia in approximately 90% of cases. Dedicated commercially available devices continue to evolve, each with its own advantages and limitations. Stent placement is subject to technical pitfalls, and adverse events occur following esophageal procedures in a minority of cases. Although chest pain is common and self-limited, reflux esophagitis, stent migration, tracheal compression, and esophageal perforation and obstruction require specific interventions. In many cases, these complications can be recognized and treated by the interventional radiologist with minimally invasive techniques.
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Affiliation(s)
- Eric Therasse
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, 3840 St Urbain St, Montreal, Quebec, Canada H2W 1T8.
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Giroux MF, Soulez G, Thérasse E, Nicolet V, Froment D, Courteau M, Oliva VL. Percutaneous revascularization of the renal arteries: predictors of outcome. J Vasc Interv Radiol 2000; 11:713-20. [PMID: 10877415 DOI: 10.1016/s1051-0443(07)61629-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To identify predictors of clinical outcome after percutaneous revascularization of the renal arteries. MATERIALS AND METHODS In 63 patients, the therapeutic response was retrospectively assessed after percutaneous revascularization of the renal arteries indicated for hypertension (41.3%), renal failure (4.8%), or both (53.9%). All patients underwent percutaneous transluminal renal angioplasty, complemented by stent insertion in 30 patients. The authors analyzed the role of clinical and imaging factors, including scintigraphy, Doppler sonography, and angiography for predicting clinical success. RESULTS In the hypertensive population, there were three cures (5.6%), 26 improvements (48.1%), and 25 failures (46.3%). Among patients with renal insufficiency, 12 were improved (37.5%), 11 were stabilized (34.4%), and nine deteriorated (28.1%). Predictors of favorable outcome for hypertension were shorter duration of hypertension, higher diastolic blood pressure, fibromuscular dysplasia, abnormal Doppler study, higher percentage of angiographic stenosis, and lower grade of aortic atheromatous disease. Predictors of favorable outcome for renal failure were nondiabetic status, abnormal Doppler study, and higher percentage of angiographic stenosis. Abnormal Doppler and scintigraphic examinations predicted successful treatment of hypertension in 60% and 53.8% of cases, respectively, and renal insufficiency in 85% and 60% of cases, respectively. CONCLUSION Clinical and angiographic variables were the best predictors of therapeutic success for hypertension. Doppler sonography was useful in patients with renal failure.
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Affiliation(s)
- M F Giroux
- Department of Radiology, CHUM-Notre-Dame Hospital, Montreal, Quebec, Canada
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Oliva VL, Denbow N, Thérasse E, Common AA, Harel C, Giroux MF, Soulez G. Digital subtraction angiography of the abdominal aorta and lower extremities: carbon dioxide versus iodinated contrast material. J Vasc Interv Radiol 1999; 10:723-31. [PMID: 10392939 DOI: 10.1016/s1051-0443(99)70106-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To compare the diagnostic value of carbon dioxide to that of iodinated contrast material for digital subtraction angiography of the abdominal aorta and lower extremities. MATERIALS AND METHODS Thirty-five patients underwent comparative CO2 and iodinated contrast material arteriography of the abdominal aorta and lower extremities. For each contrast study, three independent observers evaluated the degree of opacification and percentage of stenosis of each vessel, the degree of certainty of their observations, and the overall quality of the study. Data of CO2 and iodinated studies were compared using analysis of variance for repeated measures. Interobserver and intertechnique agreements were estimated with Cohen's kappa and intraclass correlation coefficient. RESULTS Iodine-based vascular opacification was superior to that with CO2 in the central and distal arteries (P = .02). The degree of certainty and overall quality score were higher for iodine than for CO2-based contrast studies (P = .00001). The interobserver agreement for categorizing stenoses was higher for iodine as compared to CO2-based angiography. No significant difference was observed between the mean stenosis values obtained with CO2 and iodine-based angiography in any segment. Intraclass correlation coefficient demonstrated a high degree of convergence of the two techniques for assessing the percentage of stenosis. CONCLUSION CO2 can be used as an alternative to iodinated contrast material for obtaining arteriograms of the abdominal aorta and lower extremities for investigating atherosclerotic disease.
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Affiliation(s)
- V L Oliva
- Department of Radiology, CHUM, Montreal, Canada
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