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2574 ISAKA Y et al. administered and whether measures to prevent CIN are necessary. Any use of contrast media that is not consistent with the revised guideline reflects the decisions made by the attending physicians on the basis of conditions specific to their patients, and their decisions should be prioritized. The present guideline does not provide any legal basis for prosecuting physicians who do not use contrast media according to the guideline. ▋ 1.3 Selection of Literature, Levels of Evidence, and Grades of Recommendations The revised guideline was prepared according to the procedures proposed by Minds. The guideline writing committee discussed and revised CQs on 9 themes regarding CIN. The working groups addressed the CQs by critically reviewing literature published from September 1, 2011 to March 31, 2017 in major literature databases (e.g., PubMed, MEDLINE, the Cochrane Library, and the Japan Centra Revuo Medicina [Ichushi]), in addition to the literature referenced in the CIN guideline 2012. Literature published since April 2017 was also included as deemed necessary by the guideline committee. Since the CIN guideline 2012 was prepared according to the Minds guideline 2007, CQs included in 2012 were revised according to the Minds guideline 2007. New CQs added in this revised guideline, CQ3-12, CQ5-6, CQ5-7, and CQ6-4, were prepared according to "Minds Guidebook for Guideline Development 2014" and "Minds Manual for Guideline Development 2017". Thus, in this revised guideline, 2 kinds of evidence and recommendation evaluation methods were adopted. A level of evidence and grade of recommendation were assigned to the answers to the CQs.

To identify factors predicting the presence of extrarenal feeders to renal angiomyolipomas (AMLs). MethodsThis is a retrospective study of 44 patients with 58 renal AMLs embolized in our department. Arteriography obtained during embolization and CTA obtained before and after embolization were reviewed to characterize AMLs with and without extrarenal feeders. Tumor characteristics were compared between the two groups.Simple logistic regression and ROC curve analysis were performed. P < 0.05 was considered to be statistically significant. ResultsOf the 58 AMLs reviewed, 29% had extrarenal arteries and 71% did not. AMLs with extrarenal feeders were significantly larger than those without, in terms of volume (median, 368 mL versus 109 mL, p < 0.0002) and largest diameter (mean, 12.0 cm versus 7.7 cm, p < 0.0001). Patient age, presence of tuberous sclerosis complex or sporadic lymphangioleiomyomatosis, and tumor location did not differ between the groups. Largest diameter and volume had similar predictive values for the presence of extrarenal feeders (AUC, 0.83 versus 0.82, p = 0.673). Extrarenal feeders were present in 0%, 21%, and 79% of the AMLs ≤6.5 cm, AMLs 6.6-10.5 cm, and AMLs >10.5 cm, respectively. ConclusionsAML size correlates with the presence of extrarenal feeders, with largest diameter and volume being significant predictors. AMLs >10.5 cm had a high chance of extrarenal feeders, making it mandatory to search for feeders to them in order to avoid incomplete embolization; AMLs ≤6.5 cm did not have extrarenal feeders, making a search for them unnecessary in these cases.

Objective Pregnant patients with lymphangioleiomyomatosis (LAM) and renal angiomyolipomas (AMLs) require care for both renal AMLs and pulmonary dysfunction because AMLs can grow and rupture during pregnancy, potentially causing hemorrhagic shock and fetal death. This study examined whether prophylactic transcatheter arterial embolization (TAE) could prevent the pregnancy-associated growth and rupture of renal AMLs in patients with LAM. Methods This retrospective study included five women with 14 renal AMLs (initial diameter, ≥2 cm) first encountered between September 2010 and August 2015 who subsequently became pregnant. Seven tumors in five patients were embolized, and seven tumors in two patients were not treated. Changes in the volume of each tumor were evaluated. Results Untreated tumors were much more likely to grow than embolized tumors both during pregnancy (100% vs. 0%) and at the first follow-up visit after delivery (100% vs. 14%). One untreated hypervascular tumor grew rapidly during pregnancy to 409% of the pretreatment volume. No tumor ruptured. Conclusions Prophylactic pre-pregnancy TAE decreased the growth and bleeding of renal AMLs during pregnancy in patients with LAM. TAE can be recommended for hypervascular tumors before pregnancy regardless of the size of the aneurysm.