Future of IR: Emerging Techniques, Looking to the Future…and Learning from the Past

Innovation has been the cornerstone of interventional radiology since the early years of the founders, with a multitude of new therapeutic approaches developed over the last 50 years. What is the future holding for us? This article presents an overview of the in-coming developments that are catching on at this moment, particularly focusing on three items: the new applications of existing techniques, particularly embolotherapy and interventional oncology; the cutting-edge devices; the imaging technologies at the forefront of the image-guidance. Besides this, clinical vision and patient relation remain crucial for the future of the discipline

French Roadmap for complex Systems 2008-2009

This second issue of the French Complex Systems Roadmap is the outcome of the Entretiens de Cargese 2008, an interdisciplinary brainstorming session organized over one week in 2008, jointly by RNSC, ISC-PIF and IXXI. It capitalizes on the first roadmap and gathers contributions of more than 70 scientists from major French institutions. The aim of this roadmap is to foster the coordination of the complex systems community on focused topics and questions, as well as to present contributions and challenges in the complex systems sciences and complexity science to the public, political and industrial spheres

The Maunakea Spectroscopic Explorer Book 2018

(Abridged) This is the Maunakea Spectroscopic Explorer 2018 book. It is intended as a concise reference guide to all aspects of the scientific and technical design of MSE, for the international astronomy and engineering communities, and related agencies. The current version is a status report of MSE's science goals and their practical implementation, following the System Conceptual Design Review, held in January 2018. MSE is a planned 10-m class, wide-field, optical and near-infrared facility, designed to enable transformative science, while filling a critical missing gap in the emerging international network of large-scale astronomical facilities. MSE is completely dedicated to multi-object spectroscopy of samples of between thousands and millions of astrophysical objects. It will lead the world in this arena, due to its unique design capabilities: it will boast a large (11.25 m) aperture and wide (1.52 sq. degree) field of view; it will have the capabilities to observe at a wide range of spectral resolutions, from R2500 to R40,000, with massive multiplexing (4332 spectra per exposure, with all spectral resolutions available at all times), and an on-target observing efficiency of more than 80%. MSE will unveil the composition and dynamics of the faint Universe and is designed to excel at precision studies of faint astrophysical phenomena. It will also provide critical follow-up for multi-wavelength imaging surveys, such as those of the Large Synoptic Survey Telescope, Gaia, Euclid, the Wide Field Infrared Survey Telescope, the Square Kilometre Array, and the Next Generation Very Large Array.Comment: 5 chapters, 160 pages, 107 figure

Transcatheter embolization of a large aberrant systemic artery to an intralobar pulmonary sequestration using an Amplatzer vascular plug in an adolescent

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Atypical use of ALN inferior vena cava filters as protection devices prior to embolization of a large portosystemic shunt with Amplatzer Vascular Plugs and Glubran 2 cyanoacrylate glue

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DIAGNOSTIC VALUE OF ULTRASOUND AND DUAL ENERGY COMPUTED TOMOGRAPHYTO ACHIEVE ACR-EULAR GOUT CLASSIFICATION CRITERIA IN REAL LIFE CLINICAL PRACTICE

International audienceBackground: 2015 ACR/EULAR gout classification criteria (1) include ultrasound with double contour (DC) sign as key ultrasound features and dual energy computed tomography (DECT) with evidence of urate deposition. The positivity of either DECT or ultrasound allows 4 points in addition to others clinical and biological criteria to classify as gout is ≥8/23. However, in routine care, the imaging modality that should be promoted remains unclear between ultrasound or DECT.Objectives: To validate a possible diagnostic algorithm for the clinical use of DECT and ultrasound in suspected gouty arthritis.Methods: We conducted a single-center prospective study in the Rheumatology Department of Dijon University Hospital from july 2016 to december 2018, including all patients hospitalized for suspected gouty arthritis. Each patient received joint aspiration if possible, an ultrasound assessment (DC sign and/or tophus) and DECT scanning of symptomatic joints. All these examinations were performed blind of the clinical data and results of joint aspiration. The gold standard used for this study was the 2015 ACR/EULAR gout classification criteria. We have established two scenarios derived from the algorithm proposed by Nötzel et al (2): in scenario A, the DECT was performed first followed by ultrasound; in scenario B, ultrasound was performed first followed by DECT. Test performance such as sensitivity, specificity, positive and negative predictive value (PPV, NPV)) were calculated for each imaging techniques. Statistical analysis was performed by SAS/STAT software and Macnemar test was used to compare the two scenarios.Results: 40 consecutive patients were included. 3 patients had a score ≥8 from clinical data alone and classified as gout. The remaining 37 patients were included according to the two scenarios. In scenario A, 9/37 patients had a DECT positive with urate deposition leading to the diagnostic of gout with an ACR/EULAR score ≥ 8. 7/37 patients had a positive DECT without reaching ACR/EULAR treshold (< 8). 21/37 patients had a negative DECT. The ultrasound study of these 28 patients did not find any sign of gout (DC sign). In scenario B, 6/37 patients had a DC sign and an ACR/EULAR score ≥ 8. 1/37 patient had a DC sign but an ACR/EULAR score < 8. 30/37 patients had no ultrasound DC sign. DECT in these 31 patients revealed sodium urate deposits in 3/31 patients, leading to a score ≥8. DECT was positive in 7/31 patients with an ACR/EULAR score < 8. The comparison between the 2 scenarios did not find a significant difference (p = 0.250). For the DC sign, sensitivity = 66%, specificity = 96%, PPV = 89% and NPV = 87%. For the presence of DC sign and/or tophus, the values were 91%, 96%, 91%, 96% respectively. For DECT, sensitivity =100%, specificity = 75%, PPV = 63%, NPV = 100%.Conclusion: Our results confirm that ultrasound (DC sign alone) and DECT have similar diagnostic performance in gouty arthritis in routine care. It seems clinically relevant to propose the ultrasound as first imaging modality considering both the presence of the DC sign and/or ultrasound tophus (not included in ACR-EULAR criteria). It significantly improves the sensitivity of ultrasound while maintaining its PPV, with less false positive patients compared to DECT.References: [1] Neogi T, Jansen TLTA, Dalbeth N, et al. 2015Gout Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis & Rheumatology. 2015; 67:2557–68.[2] Nötzel A, Hermann K-G, Feist E, et al. Diagnostic accuracy of dual-energy computed tomography and joint aspiration: a prospective study in patients with suspected gouty arthritis. Clin Exp Rheumatol. 2018; 36 :1061–7.Disclosure of Interests: None declare

Embolization with ethylene vinyl alcohol copolymer (Onyx®) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study

International audienceBackground: Onyx® is a liquid embolic agent, which is approved for the treatment of cerebral vascular lesions but still rarely used in peripheral interventional radiology. The goal of this study is to report the feasibility and safety of embolization with Onyx® for peripheral hemostatic and non-hemostatic endovascular procedures.Methods: Retrospective study of all consecutive patients who underwent visceral or peripheral embolization with Onyx® for hemostatic or non-hemostatic purpose in our department between May 2014 and November 2016. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular procedure, pain during embolization, outcomes, and follow-up data were collected.Results: Fifty patients (males, 34; females, 16; mean age, 56±18 years; range, 15–89 years) were included. Twenty-nine (58%) of patients underwent hemostatic embolization for arterial (n=22, 44%) or venous (n=7, 14%) bleeding lesions, whereas 21 (42%) of patients underwent non-hemostatic embolization for arterial aneurysms (n=8, 16%), preoperative portal vein deprivation (n=6, 12%) or other indications (n=7, 14%). Onyx-18 was used in 37 (74%) patients, Onyx-34 in 9 (18%) patients, and a combination of both in 4 (8%) patients. Onyx was used alone in 25 (50%) patients and in combination with other agent in 25 (50%) patients. Mean number of Onyx® vials used was 3.7 (range, 1–17). Immediate technical success rate was 100%. Primary clinical success was achieved in all patients. Recurrent bleeding occurred in two patients. Significant pain (pain score ≥3) was noted during injection in 10 (20%) patients. No major complication or side effects were noted within 1 month.Conclusions: Transcatheter embolization with Onyx® is feasible and safe in the peripheral arterial or venous vasculature for both bleeding and non-bleeding patients whatever the anatomic site

Future of Interventional Radiology: Emerging Techniques

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