Interventional management of gastroduodenal lesions complicating intra-arterial hepatic chemotherapy

Herein we report the efficacy of embolization of small patent gastric or duodenal vessels for treating gastroduodenal complications after hepatic arterial infusion therapy (HAIC). Catheter ports were implanted percutaneously from a femoral approach in three cases or surgically in the gastroduodenal artery in two cases. Acute abdominal pain developed on average after four HAIC courses of 5FU-oxaliplatin, mytomycin, oxaliplatin or fotemustine. Esophagogastroduodenoscopy showed gastroduodenal lesions (gastroduodenitis with or without ulcerations) in all cases. Despite the interruption of the HAIC, symptoms persisted and led to selective hepatic arteriography showing a patent right gastric artery (n = 4) or a recanalized gastroduodenal artery (n = 1) responsible for gastroduodenal misperfusion. Successful embolizations of the arteries responsible for gastroduodenal misperfusion (right gastric artery in four cases and gastroduodenal artery in one case) using 0.018 platinium coils relieved the patients' symptoms and allowed the HAIC to continue. In gastroduodenal complications of HAIC, a selective hepatic arteriography should be performed to search any artery responsible for the misperfusion of the toxic agent in the gastroduodenal area. Embolization of these arteries allowed the HAIC to be restore

Interventional radiology in the management of complications after liver transplantation

The arrival of new surgical transplantation techniques, such as split living donor or auxiliary liver transplantation, have increased the incidence of vascular and biliary complications. The causes, symptoms, and diagnostic modalities of arterial, portal caval, and biliary complications are detailed. Interventional techniques, such as balloon angioplasty and stent placement in the arterial and portal tree, as well as biliary interventional techniques, are discusse

Multidetector CT enteroclysis: comparison of the reading performance for axial and coronal views

The purpose of this study was to compare the diagnostic performance of axial and coronal views in multidetector CT enteroclysis (MDCTE). We retrospectively evaluated 48 patients with pathological correlation investigated by MDCTE for small bowel disorders. After nasojejunal administration of 2l of 5% methylcellulose axial arterial and venous acquisition of MDCTE was followed by coronal reconstructions using equal slice thicknesses of 2.5mm with 2mm increments. Spatial resolution of both planes was evaluated by phantom. Three radiologists independently read axial and coronal images concerning 12 pathological features. The interobserver agreement and time of reading was calculated. Sensitivity and specificity resulted from comparison with histopathology (n=39) or follow-up (n=9). Phantom study revealed higher spatial resolution for axial than coronal views, whatever reconstruction interval was used. However, spatial frequency always remained high. Most pathological signs, such as bowel wall thickening (BWT), bowel wall enhancement (BWE) and intraperitoneal fluid (IPF), showed better interobserver agreement on axial than coronal views (BWT: 0.61 vs. 0.44; BWE: 0.56 vs. 0.5; IPF:0.53 vs. 0.43). The Wilcoxon signed-rank test revealed significantly higher sensitivity for axial than coronal views (P=0.0453); the time of reading was significantly shorter for the latter (P=0.0146). The diagnostic value of axial slices is superior to coronal reconstructions despite the reduced data volume and display of the physiological course of bowel loops on the coronal plan

Pose de stents métalliques auto-expansifs sous guidage fluoroscopique pour le traitement des obstruations gastro-duodénales malignes

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Evaluation of antiangiogenic treatment effects on tumors' microcirculation by Bayesian physiological pharmacokinetic modeling and magnetic resonance imaging.

International audienceA physiological pharmacokinetic (PBPK) model was used to estimate tumor microcirculation in nude mice with a grafted tumor. The kinetics of a rapid clearance blood pool agent, Vistarem, were investigated by dynamic MRI after bolus administration. Signal enhancements were recorded in arterial blood and in tumor tissue. To analyze these data, we developed a whole-body mathematical model of the agent's biodistribution using physiological parameters. The model included six compartments: arterial and venous plasma, tumor (split into capillaries and interstitium), and the rest of the body (also split into capillaries and interstitium). As an application, changes in tumor microcirculation parameters were evaluated in mice receiving either an antiangiogenic treatment (ZD4190) or a placebo. The analysis was performed in a Bayesian framework, and the model was fitted to experimental data using Markov Chain Monte Carlo techniques. Results showed a significant difference in tumor microcirculation between the two groups of mice when the microcirculation parameters are considered together. This whole-body physiological model enables to analyze jointly data in tumor tissue and in arterial blood. This leads to accurate estimates of microcirculation parameters and the evaluation of their uncertainty

Nouveaux critères pour l'estimation de qualité d'ajustement en imagerie dynamique T1 avec injection d'agent de contraste pour l'imagerie de perfusion et de perméabilité

International audienceContrast-enhanced (CE) MRI provides in vivo physiological information that cannot be obtained by conventional imaging methods. This information is generally extracted by using models to represent the circulation of contrast agent in the body. However, the results depend on the quality of the fit obtained with the chosen model. Therefore, one must check the fit quality to avoid working on physiologically irrelevant parameters. In this study two dimensionless criteria-the fraction of modeling information (FMI) and the fraction of residual information (FRI)-are proposed to identify errors caused by poor fit. These are compared with more conventional criteria, namely the quadratic error and the correlation coefficient, both theoretically and with the use of simulated and real CE-MRI data. The results indicate the superiority of the new criteria. It is also shown that these new criteria can be used to detect oversimplified models. Magn Reson Med 54:868-877, 2005