Successful arterial embolization of a giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis with literature review

We report a case of an uncommon giant pseudoaneurysm of the gastroduodenal artery secondary to chronic pancreatitis. It presented with a perfused volume of 17.3 cm3 close to the branch-off of the right hepatic artery. Superselective transcatheter embolization including interlocking detachable coils and a mixture of Ethibloc and Lipiodol was our technique of choice. Following the procedure, the patient was in hemodynamically stable condition. At that time, he was free of any clinical symptoms and showed no further signs of bleeding or ischaemia. Additionally, we present an overview of the relevant literature

Value of three-dimensional reconstructions in pancreaticcarcinoma using multidetector CT: Initial results

AIM: To evaluate the use of three-dimensional imaging of pancreatic carcinoma using multidetector computed tomography (CT) in a prospective study. METHODS: Ten patients with suspected pancreatic tumors were examined prospectively using multidetector CT (Somatom Sensation 16, Siemens, Erlangen, Germany). The images were evaluated for the presence of a pancreatic carcinoma and invasion of the peripancreatic vessels and surrounding organs. Using the isotropic CT data sets, a three-dimensional image was created with automatic vascular analysis and semi-automatic segmentation of the organs and pancreatic tumor by a radiologist. The CT examinations and the three-dimensional images were presented to the surgeon directly before and during the patient’s operation using the Medical Imaging Interaction Toolkit-based software “ReLiver”. Immediately after surgery, the value of the two images was judged by the surgeon. The operation and the histological results served as the gold standard. RESULTS: Nine patients had a pancreatic carcinoma (all pT3), and one patient had a serous cystadenoma. One tumor infiltrated the superior mesenteric vein. The infiltration was correctly evaluated. All carcinomas were resectable. In comparison to the CT image with axial and coronal reconstructions, the three-dimensional image was judged by the surgeons as better for operation planning and consistently described as useful. CONCLUSION: A 3D-image of the pancreas represents an invaluable aid to the surgeon. However, the 3D-software must be further developed in order to be integrated into daily clinical routine

Accuracy of estimation of graft size for living-related liver transplantation: first results of a semi-automated interactive software for CT-volumetry.

ObjectivesTo evaluate accuracy of estimated graft size for living-related liver transplantation using a semi-automated interactive software for CT-volumetry.Materials and methodsSixteen donors for living-related liver transplantation (11 male; mean age: 38.2±9.6 years) underwent contrast-enhanced CT prior to graft removal. CT-volumetry was performed using a semi-automated interactive software (P), and compared with a manual commercial software (TR). For P, liver volumes were provided either with or without vessels. For TR, liver volumes were provided always with vessels. Intraoperative weight served as reference standard. Major study goals included analyses of volumes using absolute numbers, linear regression analyses and inter-observer agreements. Minor study goals included the description of the software workflow: degree of manual correction, speed for completion, and overall intuitiveness using five-point Likert scales: 1--markedly lower/faster/higher for P compared with TR, 2--slightly lower/faster/higher for P compared with TR, 3--identical for P and TR, 4--slightly lower/faster/higher for TR compared with P, and 5--markedly lower/faster/higher for TR compared with P.ResultsLiver segments II/III, II-IV and V-VIII served in 6, 3, and 7 donors as transplanted liver segments. Volumes were 642.9±368.8 ml for TR with vessels, 623.8±349.1 ml for P with vessels, and 605.2±345.8 ml for P without vessels (PConclusionsCT-volumetry performed with P can predict accurately graft size for living-related liver transplantation while improving workflow compared with TR

Assessment of tissue perfusion of pancreatic cancer as potential imaging biomarker by means of Intravoxel incoherent motion MRI and CT perfusion: correlation with histological microvessel density as ground truth

Background/objectives!#!The aim of this study was to compare intravoxel incoherent motion (IVIM) diffusion weighted (DW) MRI and CT perfusion to assess tumor perfusion of pancreatic ductal adenocarcinoma (PDAC).!##!Methods!#!In this prospective study, DW-MRI and CT perfusion were conducted in nineteen patients with PDAC on the day before surgery. IVIM analysis of DW-MRI was performed and the parameters perfusion fraction f, pseudodiffusion coefficient D*, and diffusion coefficient D were extracted for tumors, upstream, and downstream parenchyma. With a deconvolution-based analysis, the CT perfusion parameters blood flow (BF) and blood volume (BV) were estimated for tumors, upstream, and downstream parenchyma. In ten patients, intratumoral microvessel density (MVD!##!Results!#!f!##!Conclusions!#!The study shows that IVIM derived f!##!Trial registration!#!DRKS, DRKS00022227, Registered 26 June 2020, retrospectively registered. https://www.drks.de/drks_web/navigate.do?navigationId=trial . HTML&TRIAL_ID=DRKS00022227

Semi-automated Interactive Software (P) – Image Example.

<p>A Transverse image of the portal-venous phase – automated outline of the entire liver after manual correction of false-positive and false-negative extractions. B Manual positioning of the anatomical landmark “first bifurcation of the right portal vein” (blue circle) according to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0110201#pone-0110201-g001" target="_blank">Fig. 1A</a>. C Automated definition of segments of Couinaud for right liver - transverse image. D Automated definition of segments of Couinaud for left liver - sagittal image. E Volume rendering (coronal view) with automated definition of segments of Couinaud of the entire liver. F List of volumes for the different segments of Couinaud. G Transverse image of the portal-venous phase – automated outline of the entire liver after manual correction of false-positive and false-negative extractions. H Volume rendering (coronal view) with automated definition of vessels (liver veins in light blue and portal veins in dark blue). Note: in each live liver donor, CT-volumetry of the entire liver was performed to ensure that the postoperative liver volume, calculated on the basis of Fig. 5F, is adequate.</p

Manual Commercial Software (TR) – Image Example.

<p>A Transverse image of the portal-venous phase – manual outline of the entire liver (yellow). B Transverse image of the portal-venous phase – manual outline of liver segments II/III (yellow). C Volume rendering (coronal view) resulting after manual outline of the entire liver. D Volume rendering (coronal view) resulting after manual outline of liver segments II/III. Note: in each live liver donor, CT-volumetry of the entire liver as well as of the future liver graft (transplanted liver segments) were performed to ensure that the postoperative liver volume is adequate.</p

Linear Regression Analysis between Intraoperative Weights and Volumes of Transplanted Liver Segments.

<p>A For the manual commercial software (TR) with vessels, the regression equation was y = 0.94x+30.1 (R² = 0.92; P<0.001). B For the semi-automated interactive software (P) with vessels, the regression equation was y = 1.00x+12.0 (R² = 0.92; P<0.001). C For semi-automated interactive software (P) without vessels, the regression equation was y = 1.01x+28.0 (R² = 0.92; P<0.001). Note: dotted curves mark the 95% confidence bands; linear regression analysis demonstrated a strong linear relationship between intraoperative weights and volumes with comparable results between the 3 different techniques.</p

Intraoperative Weights and Volumes of Transplanted Liver Segments.

<p>Note: *statistically significant differences between the 3 different techniques were evaluated applying ANOVA for repeated measures; mean of 4 reads (Read 1 and Read 2 for Observer 1 as well as Read 1 and Read 2 for Observer 2); given numbers are mean±SD (range).</p><p>Intraoperative Weights and Volumes of Transplanted Liver Segments.</p

Patient Demographics.

<p>Note: given numbers are mean±SD (range).</p><p>Patient Demographics.</p

Semi-automated Interactive Software for CT-volumetry (P) – Manual Positioning of 9 Anatomical Landmarks to Define the Segments of Couinaud (Schematic Illustration; Courtesy of Philips Healthcare Germany, Hamburg, Germany).

<p>A first bifurcation of the right portal vein (black circle). B inferior caval vein (black circle). C right hepatic vein (black circle). D middle hepatic vein (black circle). E left hepatic vein (black circle). F superficial ligamentum venosum (black circle). G deep ligamentum venosum (black circle). H end of left portal vein (black circle). I left liver tip (black circle) Note: after automated outline of the entire liver with correction of false-positive and false-negative extractions, and then after manual positioning of the 9 anatomical landmarks, volumes of transplanted liver segments are obtained.</p