Acute nonvariceal upper gastrointestinal (UGI) hemorrhage is a frequent complication associated with significant morbidity and mortality. The most common cause of UGI bleeding is peptic ulcer disease, but the differential diagnosis is diverse and includes tumors; ischemia; gastritis; arteriovenous malformations, such as Dieulafoy lesions; Mallory-Weiss tears; trauma; and iatrogenic causes. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, severe bleeding despite conservative medical treatment or endoscopic intervention occurs in 5-10% of patients, requiring surgery or transcatheter arterial embolization. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. Endovascular management using superselective catheterization of the culprit vessel, «sandwich» occlusion, or blind embolization has emerged as an alternative to emergent operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic treatment. Indeed, many published studies have confirmed the feasibility of this approach and its high technical and clinical success rates, which range from 69 to 100% and from 63 to 97%, respectively, even if the choice of the best embolic agent among coils, cyanaocrylate glue, gelatin sponge, or calibrated particles remains a matter of debate. However, factors influencing clinical outcome, especially predictors of early rebleeding, are poorly understood, and few studies have addressed this issue. This review of the literature will attempt to define the role of embolotherapy for acute nonvariceal UGI hemorrhage that fails to respond to endoscopic hemostasis and to summarize data on factors predicting angiographic and embolization failure.
Purpose
To demonstrate that hepatic tumor volume and enhancement pattern measurements can be obtained in a time efficient and reproducible manner on a voxel-by-voxel basis to provide a true 3D volumetric assessment.
Materials and Methods
Retrospective evaluation of MRI data obtained from 20 patients recruited for a single-institution prospective study. All patients carried a diagnosis of hepatocellular carcinoma (HCC) and underwent drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) for the first time. All patients had undergone contrast-enhanced MRI before and after DEB-TACE although poor image quality excluded 3 resulting in a final count of 17 patients. vRECIST and qEASL were measured and segmentation and processing times were recorded.
Results
Thirty-four scans were analyzed. The time for semi-automatic segmentation was 65±33 seconds with a range of 40–200 seconds. vRECIST and qEASL of each tumor were then computed less than one minute for each.
Conclusion
Semi-automatic quantitative tumor enhancement (qEASL) and volume (vRECIST) assessment is feasible in a workflow efficient time frame. Clinical correlation is necessary, but vRECIST and qEASL could become part of the assessment of intra-arterial therapy for interventional radiologists.
Hypertrophy after PVE is inversely correlated to initial FRL volume. Hypertrophy of the liver might be influenced by the systemic chemotherapeutic received before PVE.
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