Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?

PURPOSEOur purpose is to clarify the optimal timing of surgery after transarterial embolization (TAE) for renal cell carcinoma (RCC) bone metastases.METHODSThis retrospective study included 41 patients with RCC bone metastases embolized between 2013 and 2019. Different-sized particulate and/or liquid embolic agents were used for TAE. Embolizations were categorized into groups 1–3 according to the interval between TAE and surgery (group 1: 3 days). Degree of embolization after TAE was graded visually based on angiographic images (90%). The relationship between the TAE–surgery interval and intraoperative blood loss (IBL) and the correlation between IBL and embolization grade were examined. Lesion sizes and the relationships among lesion localizations and contrast media usage, intervention time, and IBL were also analyzed.RESULTSForty-six pre-operative TAEs (single lesion at each session) were performed in this study (26 in group 1, 13 in group 2, 7 in group 3). Lesion sizes and distributions were similar between groups (p = 0.897); >75% devascularization was achieved in 40 (TAEs 86.96%), but the IBL showed no correlation with the embolization rate (r=0.032, p = 0.831). The TAE–surgery interval was 1–7 days. The median IBL in group 1 (750 mL; range, 150–3000 mL) was significantly lower than those in the other groups (p = 0.002). Contrast media usage (p = 0.482) and intervention times (p = 0.261) were similar for metastases at different localizations. IBL values after TAE were lower for extremity metastases (p = 0.003).CONCLUSIONBone metastases of RCC are well-vascularized, and to achieve lowest IBL values, surgery should preferably be performed <1 day after TAE

T2 Ağırlıklı Manyetik Rezonans Inceleme (Mrı) ve Manyetik Rezonans Anjiografi (Mra) ile Ölçülen Arteria Basilaris Çaplarının Karşılaştırılması- Retrospektif Bir Çalışma

Invasive angiography is regarded as the golden standard for basilar artery imaging and for defining pathological features with radiological methods. The dolichoectasia of basilar artery can be diagnosed with comparable confidence by both MRA and CTA. It is also known that both contrast enhanced CT and MRI studies provide important information in diagnosing basilar artery dolichoectasia; however, only a few studies about the compatibility of the diameters measured with MRI versus TOF MRA are present. In this study, we compared the diameters measured with MRI to the ones measured with TOF MRA. We found that the two measurements are correlated, though the measurement taken with T2 weighted images were not as statistically significant as the ones taken with TOF MRA. As a result, we reached the following conclusions that will assist physicians with patients that are diagnosed with basilar artery dolichoectasia: (1) when following up a with MRI, the results of above comparison should be taken into consideration, and (2) when studying the pathological and anatomical variation of basilar artery, reporting physician should ensure detailed analysis of data. Present study will help clinicians in diagnosis, treatment, and follow up of patients with basilar artery dolichoectasia.A. basilaris’ in radyolojik yöntemler ile gösterilmesi ve bu arteriyel yapıya ait patolojik görünümlerin tanımlanması açısından invazif anjiografi altın standart yöntemdir. A. basilaris dolikoektazisinin tanısıda MRA ve BTA ile invazif anjiografiye benzer ölçümler sağlanabilmektedir. A. basilaris dolikoektazisi tanısında kontrastlı BT ve MRG uygulamalarının değerli bilgiler sunduğu bilinmektedir; ancak literatürde, a. basilaris’ in MRG görüntülerde elde edilen çap ölçümleri ile TOF MRA’ daki ölçümlerde elde edilen değerlerinin uyumluluğuna yönelik yapılmış yeterli çalışma izlenmemektedir.Çalışmamız sayesinde T2 A serilerde ölçülen a. basilaris çaplarının TOF MRA’ da yapılan ölçümlerle karşılaştırılması sağlanmıştır. Bu karşılaştırmalar ışığında, elde edilen verilerin birbirleri ile korele olmakla beraber, T2A serilerde elde edilen verilerin TOF MRA’ da elde edilen verilerden istatistiksel olarak anlamlı oranda küçük ölçüldüğü sonucuna ulaşıldı. Bu sonuçlar ışığında,çeşitli tetkikler ile a. basilaris dolikoektazisi tanısını almış hastaların MRG takibinde bu bilgilerin akılda tutulması gerektiği, MRG’ de izlenen arteria basilaris değişikliklerinin patolojik/anatomik varyasyon olarak değerlendirilmesi sırasında, elde edilen verilerin daha detaylı irdelenmesi gerektiği akıldan çıkarılmamalıdır.Çalışmamız sonucunda elde edilen veriler, a. basilaris dolikoektazisinde, tanı/tedavi/takip sırasında, klinisyenlere yardımcı olacaktır

An overview of smas; anatomic and radiologic approach

Superficial Musculo-Aponeurotic System (SMAS) is a network of collagen fibers, elastic fibers and fat interconnecting facial muscles and dermis. Subcutaneous morphology of face is more organized than subcutaneous layer of any part of body. SMAS has distinctive features in forehead, parotid region, zygomatic region, temporal region, cheek, infraorbital region, nasolabial fold, and lower lip. Because SMAS is a key feature for either percutaneous and surgical aesthetic interventions, neurovascular structure embedded in this tissue must be well known. Radiologic views were enrolled from the archive system of radiology department. Images of 50 patients were randomly selected. (29 ale, 21 female). Age width of the participants was in between 18 and 78 years (mean age 40.34± 15.32). Thickness of SMAS for each region is measured. Continuity of the tissue was followed between the junctions of the regions in a proper sequence with MR images. Thickness of SMAS in the zygomatic region was measured in 50 patients and mean value was 0.12 mm. Left and right side measures were compared between genders and no statistical difference between gender groups was found. Correlation between measures and age was analyzed statistically and no correlation was found. A radiologically and clinically neglected tissue: SMAS deserves more attention because of its continuous course interconnecting distinct regions of face and acting as a functional unit for the expressions. Age and gender related changes in SMAS morphology studied in healthy individuals by means of radiology provides an important contribution to the literature

Prostatic Artery Originating from Inferior Mesenteric Artery: A Very Rare Variation Observed in Computed Tomography Angiography

The knowledge of detailed anatomy of the pelvic arterial system is essential to prevent the postoperative morbidity of prostate surgery. Prostatic artery embolization has an increasing importance in treatment of benign prostatic hyperplasia. Studies concerned with prostatic arterial supply are predominantly based on cadaveric studies and there are a few radiologic studies. Various variations and presence of collateral shunts causing complications in prostatic artery embolization were reported in the literature. However; to our knowledge, the prostatic arteries originating from the branches of abdominal arteries have not been described. In the present study, we described a 36 year-old male patient with three prostatic arteries via computed tomography angiography (CTA). From these three arteries; the dominant vessel was originating from inferior mesenteric artery. Arterial variations of the region may be well defined due to the increasing popularity of minimally invasive nonsurgical treatments and widespread use of CTA as a diagnostic method

Primer ve metastatik karaciğer tümörlü hastalarda transarteriyel radyoembolizasyon ve kemoembolizasyona erken yanıtı değerlendirmede18F-FLT PET/BT’nin rolü

Objectives: Metastases and primary malignancies are common in the liver. Local ablative applications such as transarterial chemoembolization (TACE), and transarterial radioembolization (TARE) provide minimally invasive and safe treatment in unresectable liver tumors. Early detection of response to treatment prevents unnecessary toxicity and cost in non-responder patients and provides an earlier use of other options that may be effective. This study aimed to identify the role of18F-fluorothymidine (FLT) positron emission tomography/computed tomography (PET/CT) in the assessment of early response to TACE and TARE treatments in patients with unresectable primary and metastatic liver tumors. Methods: This single-center study included 63 patients who underwent18F-FLT PET/CT for response evaluation after TACE and TARE. After excluding 20 patients whose data were missing 43 TARE-receiving patients were analyzed. The compatibility of change in semi-quantitative values obtained from the18F-FLT PET/CT images with the treatment responses detected in18F-fluorodeoxyglucose PET/CT, CT, and MR images and survival was evaluated. Results: There was no correlation between early metabolic, morphological response, and18F-FLT uptake pattern, and change in standardized uptake values (SUV) which were ΔSUVmax, ΔSUVmean, ΔSUVpeak., ΔSUVmean, ΔSUVpeak values. There was no significant correlation between18F-FLT uptake pattern, ΔSUVmax, ΔSUVmean, ΔSUVpeak, and overall survival, progression-free survival (PFS) for the target lobe PFS for the whole-body. The survival distributions for the patients with >30% change in ΔSUVmax and ΔSUVpeak values were statistically significantly longer than the patients with <30% change (p<0.009 and p<0.024, respectively). Conclusion: There was significant longer PFS for target liver lobe in patients with more than 30% decrease in18F-FLT SUVmax and SUVpeak of the liver lesion in primary and metastatic unresectable liver tumors undergoing TARE