Vascular compression syndromes for the interventional radiologist

No. 373 Detection of small hepatocellular carcinoma less than three centimeters by dual phase cone beam computed tomography hepatic arterial angiography (CBCTHA) during conventional transcatheter arterial chemoembolization X. Wang, G. Cao, X. Zhu, P. Liu, R. Yang, S.B. Solomon; Peking University Cancer Hospital, Beijing Cancer Hospital & Institute, Beijing, China; Sloan-Kettering Cancer Center, New York, NY Purpose: The objective of this study was to compare the sensitivity of identify small hepatocellular carcinoma tumor less than 30 millimeters in diameter by dual phase cone beam computed tomography hepatic arterial angiography (CBCTHA) during conventional transcatheter arterial chemoembolization with non-selective hepatic arterial digital substraction angiogram (DSA) and pre-TACE conventional contrast enhanced tri-phase CT or MR. Materials and Methods: Thirty five consecutive patients with newly diagnosed unresectable hepatocellular carcinoma were referred to receive TACE. Pre CE-CT or CE-MR were performed within 1 months. Dual phase CBCTHA were performed following conventional hepatic arterial angiography (DSA-HA) before TACE. Lipiodol CBCT were performed just after TACE procedure. The detectability of small hepatocellular carcinoma tumor less than 30 millimeters in diameter by dual phase CBCTHA were compared with that by DSA common hepatic angiograms and pre-TACE tri-phase CECT or MR. Results: Sixty-six small hepatic carcinoma tumors were detected in twenty patients. Dual phase CBCTHA can depict all small tumors either on arterial or venous phase, with sensitivity of 100%, compared with 46/66(69.7%) and 43/66 (65.2%) on pre-TACE CT or MR and DSA-HA. Sensitivity of single arterial phase (97%) of CBCTHA is higher than that of venous phase (71.2%). Of these 66 small tumors, only two were detected just on venous phase rather than on arterial phase. On the venous phase, the corona enhancement were shown in 46 (68.2%) of all 66 lesions, and 46 (95.7%) of 47 venous phase visualized tumors. 8 wedge shape or irregular stained nodules depicted on arterial phase which were not shown on venous phase and on lipiodol CBCT were deemed as portal venous fistula. For sensitivity of these 33 tiny tumors less than 10mm, pre-TACE CT or MR and DSA-HA were more limited, only depicted 18 (54.5%) and 16 (48.5%) tumors. Conclusion: Dual phase CBCTHA is superior than CE-CT or MR and DSA-HA for detection the small lesion less than 30 mm, especially of that less than 10mm, and is helpful in making accurate planning of TACE. Educational Exhibit Abstract No. 374 Vascular compression syndromes for the interventional radiologist S. Cornejo, S.G. Naidu, E. Huettl, S. Money, W. Stone, R. Fowl; Radiology, Mayo Clinic Arizona, Scottsdale, AZ; Vascular Surgery, Mayo Clinic Arizona, Scottsdale, AZ Learning Objectives: Review the vascular compression syndromes and their clinical presentation, imaging findings and percutaneous treatment strategies via a case based approach. Background: Anatomic variants can result in compression of vascular structures with resultant intimal damage, ischemia, thrombosis and/or embolic disease. Aortosternal venous compression, Paget-Schroetter syndrome, Nutcracker compression, May-Thurner, quadrilateral space syndrome, median arcuate ligament compression, and popliteal artery entrapment comprise the majority of vascular compression syndromes. Distinguishing normal from variant anatomy is an important first step when one is entertaining such a diagnosis. As many asymptomatic patients may have imaging findings of a compression syndrome, correlation with clinical presentation and in some cases, reproducibility of symptoms triggered by maneuvers to induce compression is often a key piece of information in the diagnostic algorithm. The interventional radiologist provides useful diagnostic information and in some cases, potential treatment options. Clinical Findings/Procedure Details: In compliance with the IRB, the radiology database was retrospectively searched to identify cases of vascular compression syndromes. The clinical course, cross sectional and angiographic images are presented highlighting normal and variant anatomy resulting in these pathological states as well as percutaneous treatment strategies. Conclusion and/or Teaching Points: 1. Understand the most common presenting clinical symptoms with each vascular compression disorder. 2. The union of imaging findings with clinical symptoms is often the most reliable method for diagnosis. 3. The interventional radiologist is well suited to play a diagnostic role in these patients, but when appropriate, provide initial management.