Pulmonary perfusion is an important factor for gas exchange. Chest digital dynamic radiography (DDR) by the deep-breathing protocol can evaluate pulmonary perfusion in healthy subjects. However, respiratory artifacts may affect DDR in patients with respiratory diseases. We examined the feasibility of a breath-holding protocol and compared it with the deep-breathing protocol to reduce respiratory artifacts. Materials and methods: A total of 42 consecutive patients with respiratory diseases (32 males; age, 68.6 ± 12.3 yr), including 21 patients with chronic obstructive pulmonary disease, underwent chest DDR through the breath-holding protocol and the deep-breathing protocol. Imaging success rate and exposure to radiation were compared. The correlation rate of temporal changes in each pixel value between the lung fields and left cardiac ventricles was analyzed. Results: Imaging success rate was higher with the breath-holding protocol vs the deep-breathing protocol (97% vs 69%, respectively; P < 0.0001). The entrance surface dose was lower with the breath-holding protocol (1.09 ± 0.20 vs 1.81 ± 0.08 mGy, respectively; P < 0.0001). The correlation rate was higher with the breath-holding protocol (right lung field, 41.7 ± 9.3%; left lung field, 44.2 ± 8.9% vs right lung field, 33.4 ± 6.6%; left lung field, 36.0 ± 7.1%, respectively; both lung fields, P < 0.0001). In the lower lung fields, the correlation rate was markedly different (right, 15.3% difference; left, 14.1% difference; both lung fields, P < 0.0001). Conclusion: The breath-holding protocol resulted in high imaging success rate among patients with respiratory diseases, yielding vivid images of pulmonary perfusion.

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Background: To evaluate the efficacy and safety of transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter and a mixture of ethanol and Lipiodol. Methods: Seven consecutive patients with total of eight angiomyolipomas underwent this procedure between June 2014 and June 2017. A 1.8-French tip microballoon catheter was advanced to the feeding artery of the angiomyolipoma, and transcatheter arterial embolization was performed with a mixture of ethanol and Lipiodol under microballoon inflation. We retrospectively evaluated the characteristics of angiomyolipomas, technical success rate, clinical success rate, renal function, and adverse events. Technical success and clinical success were defined as complete embolization of all feeding arteries and reduction of tumor size, respectively. Results: The median size of the angiomyolipomas was 46 mm (range, 40-64 mm). Transcatheter arterial embolization was successful in all eight angiomyolipomas. The median volume of the mixture of ethanol and Lipiodol was 6.0 ml (range, 2.0-14 ml). The median ratio of ethanol to Lipiodol was 71% (range, 71-75%). All eight angiomyolipomas shrank with a median shrinkage rate of 34% in diameter (range, 9-63%) and 77% in volume (range, 48-94%). The median follow-up period was 13 months (range, 9-54 months). Clinical success was achieved in all cases. Serum creatinine concentrations and the pre-and post-procedural estimated glomerular filtration rates did not change notably, and there were no major complications. Conclusion: Transcatheter arterial embolization for renal angiomyolipoma using a 1.8-French tip microballoon catheter with a mixture of ethanol and Lipiodol is effective and safe.

Background and Purpose: During a percutaneous vertebroplasty (PVP) procedure, patients typically lie in the prone position. However, some elderly patients have difficulty in maintaining the prone position. Therefore, we aimed to investigate the safety and efficacy of PVP in a lateral decubitus position in patients experiencing difficulty in maintaining the prone position. Materials and Methods: A total of 123 PVP procedures performed consecutively on 117 patients for symptomatic vertebral fractures caused by bone tumors or osteoporosis were studied. The patients were divided into prone (n=113) and decubitus groups (n=10) according to their positions during the PVP procedures. The factors related to the patients' background, procedures, therapeutic effects, and adverse events were compared between the 2 groups. Univariate analysis was performed using Student's t-test, Mann-Whitney's U-test, chisquared test, or Wilcoxon signed-rank test. Results: In the decubitus group, the average age was 6.7 years older (p<0.05), the average setup time was 1.6 times longer (p<0.01), the average fluoroscopic exposure dose was 1.37 times greater (p<0.05), the average dose-length product of interventional computed tomography was 1.78 times greater (p<0.05), and mobility restoration on the 7 th day after the PVP was less (p<0.05) compared to the prone group. There were no significant differences in bone cement leakage, pulmonary embolism, recurrence of compression fractures, or pain relief. Conclusion: Although some disadvantages were observed, decubitus PVP seemed to be completed safely and successfully. Decubitus PVP can become a treatment option for patients with vertebral fractures and difficulty in maintaining the prone position.

Objective The aim of this study was to investigate the diagnostic performance of detecting systemic arterial pulmonary circulation shunts on multidetector row computed tomography arteriography (MDCTA). Methods Thirty-five consecutive bronchial artery embolization sessions with preprocedural MDCTA were performed for 32 patients and 35 sessions. The MDCTA studies with computed tomography value of pulmonary trunk visually lower than that of ascending aorta were defined as “diagnostic MDCTA.” Angiographic studies and “diagnostic MDCTA” were evaluated, respectively, for shunting into pulmonary artery. Based on the results of angiographic studies, diagnostic performance of “diagnostic MDCTA” was evaluated. Results The rate of diagnostic MDCTA was 63% (23 of 35). On “diagnostic MDCTA,” sensitivity, specificity, and positive and negative predictive values for detecting shunts were 83% 100%, 100%, 94%, respectively. Conclusions Systemic arterial pulmonary circulation shunts were detected on “diagnostic MDCTA” with high sensitivity and specificity.