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Abstract No. 255: Fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses
S104 䡲 Wednesday
Scientific Session 䡲 JVIR
Conclusion: INL is a feasible technique to visualize the TD for TDE to treat chylothorax. INL allows for faster visualization and catheterization of the TD. INL may help overcome barriers of traditional PL and broaden the usage of TDE as the first line intervention in treating chylous effusions; however, continued investigation of INL is needed given the small sample size of the present study.
11:10 AM
Abstract No. 253
Initial experience of lipiodol marking for video-assisted thoracic surgery (VATS): does the lipiodol accumulation pattern on CT appearance affect the identification of lipiodol on fluoroscopic image?
WEDNESDAY: Scientific Sessions
M. Inoue1, S. Nakatsuka1, S. NIshimura1, N. Ito1, S. Oguro1, S. Hashimoto1, S. Kuribayashi1, Y. Yamauchi2, Y. Izumi2, K. Hashimoto2, H. Nomori2; 1Diagnostic Radiology, Keio University, School of Medicine, Tokyo, Japan; 2Thoracic surgery, Keio University, School of Medicine, Tokyo, Japan Purpose: Small pulmonary nodules have frequently been detected with high-resolution CT. The number of VATS for such nodules is increasing; however, it is difficult to target the nodules because of impossibility of manual palpation or the lack of visualization. Although several studies about lipiodol marking for VATS have been reported, to our knowledge, there has been no report about the effect of the lipiodol accumulation pattern on fluoroscopic visualization of lipiodol. The purpose of this study is to evaluate that whether the lipiodol accumulation pattern on CT affect the visualization of lipiodol on fluoroscopic image or not. Materials and Methods: Institutional review board approval was obtained. This study included 98 lung tumors in 70 consecutive patients (33 men and 37 women; mean age, 60.0 years). Lipiodol (0.4-0.5 mL) was injected near the targeted tumors under CT guidance using 21-gauge Chiba needle. The lipiodol accumulation pattern of CT was classified into 3 types (Type 1, spheroidal; Type 2, gourd, clubbed, or separated; Type 3, aggregated). The visualization of lipiodol on chest radiograph was classified into 3 grade (Grade 1, clear; Grade 2, obscure; Grade 3, unclear). Univariate analysis was performed using SPSS to assess the effect of the lipiodol accumulation pattern on the visualization grade. Results: Lipiodol marking was succeeded in 97 tumors. The relationship between the Type and the Grade was as follows: Type1, 71 (Grade1, 70; Grade2, 1; Grade3, 0); Type2, 20 (Grade1, 18; Grade2, 2; Grade3, 0); Type3, 6 (Grade1, 0; Grade2, 5; Grade3, 1). The accumulation pattern of Type 1 could be better visualized on chest radiograph than that of Type 2 and Type 3 (p⬍0.001). Conclusion: The lipiodol accumulation pattern on CT affects the identification of lipiodol on fluoroscopic image during thoracoscopic surgery. The pattern of Type 1 (spheroidal) is desirable. The Relationship between the Pipiodol Accumulation Pattern and the Visualization Grade Grade1 Type1 Type2 Type3 Total
11:18 AM
70 18 0 88
Grade2
Grade3
Total
2 5 8
0 0 1 1
71 20 6 97
Abstract No. 254
Video-assisted thoracoscopic resection of
ground-glass pulmonary nodules after computed tomography-guided localization with a hook-wire system S. Wang; 1Radiology, hospital, Shanghai, China; 2 Radiology, Cancer Center Fudan University, Shanghai, China Purpose: The purpose of this study was to assess the safety and effectiveness of CT-guided placement of a hook-wire system used to guide video-assisted thoracoscopic surgical (VATS) excision of impalpable GGNs, with successful excision as the primary outcome and successful CT-guided hook-wire placement and procedural complications as secondary outcomes. Materials and Methods: The institutional review board approved the study protocol. Informed consent was obtained from all 50 enrolled patients (13 men, 37 women; mean age, 55.0 years ⫾ 8.9 [standard deviation]) with 53 nodules. Under local anesthesia and CT control, 50 patients underwent the positioning of a hookwire system into the lung, with the hook located close to or inside the nodule to be resected. Then the patients underwent videoassisted thoracoscopic surgery resection of the nodules, and the hook-wire was performed with fluoroscopic guidance. Results: Fifty-two (98.1%) 5.1-34.2-mm nodules were successfully removed at fluoroscopically guided VATS excision; one nodules (1.9%) could not be removed. CT-guided hook-wire placement was successful in all cases; however, one (1.9%) of 53 hook-wires were displaced at VATS excision. Pneumothorax requiring chest tube placement and asymptomatic hemothorax not occurred in all patients. The hook-wire did not impede intraoperative frozen-section histopathologic analysis, which facilitated accurate clinical management in all patients. Conclusion: Hook-wire localization of GGNs enabled fluoroscopically guided VATS resection of 98% of the nodules, without intervention for procedural complications.
11:26 AM
Abstract No. 255
Fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses W. Lee, J. Kim; Asan Hospital, Seoul, Republic of Korea Purpose: To evaluate the clinical safety and efficacy of fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses. Materials and Methods: From February 2000 to November 2010, 14 patients underwent fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses, causing dyspnea or respiratory dysfunction. Technical and clinical success, complications and symptomatic improvement period were evaluated. Technical success was defined as successful full dilatation of balloons with passage of the bronchoscope through the stenosis. Clinical success was defined as an improvement of more than one grade on the Hugh-Jones classification scale. The symptomatic improvement period was defined as period between times of initial procedure and recurrence of symptoms and was calculated according to the Kaplan-Meier method. Results: In all patients, fluoroscopically-guided balloon dilation was technically and clinically successful (100%) with no complications. During the mean 74-months follow-up period, there was recurrence in five patients, and they underwent additional sessions of fluoroscopically guided balloon dilation (n ⫽ 4) or other
JVIR 䡲 Scientific Session
Wednesday 䡲 S105
procedures (n ⫽ 1). The mean symptomatic improvement period was 56 days (95% CI, 25-87 days). The symptomatic improvement rates were at 1 year, 3 years and 5 years were 36%, 36% and 43%, respectively. Conclusion: Fluoroscopically-guided balloon dilation seems to be effective and safe for patients with post-intubation tracheal stenoses.
11:34 AM
Abstract No. 256
Outcomes of tracheobronchial temporary partial covered stent placement for benign disease X. Han, J. Ma, G. Wu; Zhengzhou university, Zhengzhou, China
11:42 AM
Purpose: To present our 7 years of experience in the treatment of benign and malignant tracheobronchial stenosis using metallic stents. Materials and Methods: 123 stents were deployed in 86 patients (74 benign and 12 malignant stenosis): 97 in the trachea, 17 in the main left bronchus,7 in the main right bronchus and 1 in the intermediate bronchus. The procedures were performed under general anaesthesia and laryngeal mask, with fluoroscopic and flexible broncoscopic guidance. In case of severe stenotic lesions or obstruction, laser resection was performed preprocedure. Patients were followed-up clinically and by thorax imaging at 48 hours and at 1,3,6 and 12 months and by functional tests at 3 months. Results: Technical success was of 100%. Clinical improvement was observed in all patients: dyspnea disappearance and pulmonary functional data improvement (see Table). Complications were detected in 23 patients (26.7%). The follow-up mean time was of 6.3⫾1.2 months in malignant lesions and 76.2⫾2.3 months in benign lesions. At the end of the study, 100% of the patients with malignancy and 6.7% of the rest were deceased. Functional Pulmonary Data
Parameter
Pre-treatment (Mean ⫾ SD)
Post-treatment (Mean ⫾ SD)
p*
FEV1 (mL) FVC (mL) PEF (L/min) FEF50 (L/min) PIF (L/min) FIF50 (L/min) TOTAL RAW (cmH20/L/s) TLC (mL) RV (mL)
1751.5 ⫾ 829.7 3157.8 ⫾ 1044.6 262.49 ⫾ 190.93 150.98 ⫾ 116.76 201.03 ⫾ 133.82 173.85 ⫾ 135.57 1.75 ⫾ 2.18 575.24 ⫾ 202.68 284.04 ⫾ 202.46
2694.7 ⫾ 953.8 3488.9 ⫾ 107.21 578.63 ⫾ 261.28 295.84 ⫾ 165.43 388.65 ⫾ 180.01 370.00 ⫾ 196.70 0.63 ⫾ 1.19 568.17 ⫾ 147.66 216.77 ⫾ 119.47
⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 0.704 0.001
* Significance according to T-student Test for paired samples FEV1 Forced expiratory volume in first second FVC Forced vital capacity PEF Peak expiratory flow FEF50 Forced expiratory volumen at 50% PIF peak inspiratory flow FIF forced inspiratory flow at 50% TOTAL RAW Total resistances of the airway TLC total lung capacity RV residual volume.
Conclusion: Minimally invasive treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients which are not good candidates for surgery. A correct assessment of the patient is essential to choose the best treatment.
Scientific Session 20 Embolization III Wednesday, March 28, 2012 10:30 AM – 12:00 PM Room: 122
Abstract No. 257
Metallic stents for tracheobronchial pathology treatment A. Laborda1, J.M. Lozano2, H. Caballero2, C. Serrano1, A. Sebastian3, J. Lopera4, M.A. de Gregorio1; 1GITMIUniversidad de Zaragoza, Zaragoza, Spain; 2 Department of Radiology, Marly Clinic, Bogota, Colombia; 3Department of Pulmonology, Hospital
10:30 AM
Abstract No. 258
Efficacy and safety of selective arterial embolization with fibrin glue in the treatment of
WEDNESDAY: Scientific Sessions
Purpose: To retrospectively determine mid-term outcomes in patients who have undergone temporary partial covered tracheobronchial stent placement for benign diseases. Materials and Methods: This is a retrospective analysis of consecutives 34 patients (23 women , 11 men; mean age, 35 years; range, 18-54 years) who received the stent placement between January 2009 and March 2011.Causes of airway stenosis included tracheal tube injury (n⫽5), tracheobronchomalacia (n ⫽4), tracheal amyloid (n ⫽6), endobronchial tuberculosis (n⫽19). 15 patients were treated with temporary partial covered stent and 19 with temporary partial covered branched stent. All of the stent were removed after approximately 85 to 95 days of placement. Respiratory function test was prospectively performed before and 1 day after stent placement. Respiratory function was assessed in terms of visual analog scale (VAS) and Karnofsky Performance Status (KPS). All cases were scheduled for clinical and imaging follow up using CT at before stent placement, 1 month, six months after removal of the stent. To measure the diameter of the stenosis on CT. Results: 34 stent placement performed on 34 patients were retrospectively reviewed. The procedure was completed in all patients without complications. VAS and KPS significantly improved (p⬍0.05) from average of 6.291⫾0.495 to 1.493⫾0.504 and 25.352⫾10.533 to 60.140⫾16.344 respectively. Mean diameter of the stenosis in trachea and main bronchus were 7.876⫾2.351mm and 2.143⫾0.770mm before stent placement, 17.235⫾3.457mm and 8.993⫾0.961mm at 1 month after removal of the stent, 16.353⫾4.132mm and 8.357⫾1.082mm at 6 months after removal of the stent. Statistically significant difference between diameter of the stenosis before stent placement and that at 1 month after removal of the stent was indentified (p⬍0.05), statistically significant difference between diameter of the stenosis before stent placement and that at 6 months after removal of the stent was indentified (p⬍0.05), although no significant deference between 1 month after removal of the stent and 6 months after removal of the stent was noted. Conclusion: Temporary partial covered stent is feasible and effective to manage with benign tracheobronchial stenosis.
Clinico Lozano Blesa, Zaragoza, Spain; 4Interventional Radiology Department, Health Science Center, San Antonio, TX
Scientific Session 䡲 JVIR
Conclusion: INL is a feasible technique to visualize the TD for TDE to treat chylothorax. INL allows for faster visualization and catheterization of the TD. INL may help overcome barriers of traditional PL and broaden the usage of TDE as the first line intervention in treating chylous effusions; however, continued investigation of INL is needed given the small sample size of the present study.
11:10 AM
Abstract No. 253
Initial experience of lipiodol marking for video-assisted thoracic surgery (VATS): does the lipiodol accumulation pattern on CT appearance affect the identification of lipiodol on fluoroscopic image?
WEDNESDAY: Scientific Sessions
M. Inoue1, S. Nakatsuka1, S. NIshimura1, N. Ito1, S. Oguro1, S. Hashimoto1, S. Kuribayashi1, Y. Yamauchi2, Y. Izumi2, K. Hashimoto2, H. Nomori2; 1Diagnostic Radiology, Keio University, School of Medicine, Tokyo, Japan; 2Thoracic surgery, Keio University, School of Medicine, Tokyo, Japan Purpose: Small pulmonary nodules have frequently been detected with high-resolution CT. The number of VATS for such nodules is increasing; however, it is difficult to target the nodules because of impossibility of manual palpation or the lack of visualization. Although several studies about lipiodol marking for VATS have been reported, to our knowledge, there has been no report about the effect of the lipiodol accumulation pattern on fluoroscopic visualization of lipiodol. The purpose of this study is to evaluate that whether the lipiodol accumulation pattern on CT affect the visualization of lipiodol on fluoroscopic image or not. Materials and Methods: Institutional review board approval was obtained. This study included 98 lung tumors in 70 consecutive patients (33 men and 37 women; mean age, 60.0 years). Lipiodol (0.4-0.5 mL) was injected near the targeted tumors under CT guidance using 21-gauge Chiba needle. The lipiodol accumulation pattern of CT was classified into 3 types (Type 1, spheroidal; Type 2, gourd, clubbed, or separated; Type 3, aggregated). The visualization of lipiodol on chest radiograph was classified into 3 grade (Grade 1, clear; Grade 2, obscure; Grade 3, unclear). Univariate analysis was performed using SPSS to assess the effect of the lipiodol accumulation pattern on the visualization grade. Results: Lipiodol marking was succeeded in 97 tumors. The relationship between the Type and the Grade was as follows: Type1, 71 (Grade1, 70; Grade2, 1; Grade3, 0); Type2, 20 (Grade1, 18; Grade2, 2; Grade3, 0); Type3, 6 (Grade1, 0; Grade2, 5; Grade3, 1). The accumulation pattern of Type 1 could be better visualized on chest radiograph than that of Type 2 and Type 3 (p⬍0.001). Conclusion: The lipiodol accumulation pattern on CT affects the identification of lipiodol on fluoroscopic image during thoracoscopic surgery. The pattern of Type 1 (spheroidal) is desirable. The Relationship between the Pipiodol Accumulation Pattern and the Visualization Grade Grade1 Type1 Type2 Type3 Total
11:18 AM
70 18 0 88
Grade2
Grade3
Total
2 5 8
0 0 1 1
71 20 6 97
Abstract No. 254
Video-assisted thoracoscopic resection of
ground-glass pulmonary nodules after computed tomography-guided localization with a hook-wire system S. Wang; 1Radiology, hospital, Shanghai, China; 2 Radiology, Cancer Center Fudan University, Shanghai, China Purpose: The purpose of this study was to assess the safety and effectiveness of CT-guided placement of a hook-wire system used to guide video-assisted thoracoscopic surgical (VATS) excision of impalpable GGNs, with successful excision as the primary outcome and successful CT-guided hook-wire placement and procedural complications as secondary outcomes. Materials and Methods: The institutional review board approved the study protocol. Informed consent was obtained from all 50 enrolled patients (13 men, 37 women; mean age, 55.0 years ⫾ 8.9 [standard deviation]) with 53 nodules. Under local anesthesia and CT control, 50 patients underwent the positioning of a hookwire system into the lung, with the hook located close to or inside the nodule to be resected. Then the patients underwent videoassisted thoracoscopic surgery resection of the nodules, and the hook-wire was performed with fluoroscopic guidance. Results: Fifty-two (98.1%) 5.1-34.2-mm nodules were successfully removed at fluoroscopically guided VATS excision; one nodules (1.9%) could not be removed. CT-guided hook-wire placement was successful in all cases; however, one (1.9%) of 53 hook-wires were displaced at VATS excision. Pneumothorax requiring chest tube placement and asymptomatic hemothorax not occurred in all patients. The hook-wire did not impede intraoperative frozen-section histopathologic analysis, which facilitated accurate clinical management in all patients. Conclusion: Hook-wire localization of GGNs enabled fluoroscopically guided VATS resection of 98% of the nodules, without intervention for procedural complications.
11:26 AM
Abstract No. 255
Fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses W. Lee, J. Kim; Asan Hospital, Seoul, Republic of Korea Purpose: To evaluate the clinical safety and efficacy of fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses. Materials and Methods: From February 2000 to November 2010, 14 patients underwent fluoroscopically-guided balloon dilation for post-intubation tracheal stenoses, causing dyspnea or respiratory dysfunction. Technical and clinical success, complications and symptomatic improvement period were evaluated. Technical success was defined as successful full dilatation of balloons with passage of the bronchoscope through the stenosis. Clinical success was defined as an improvement of more than one grade on the Hugh-Jones classification scale. The symptomatic improvement period was defined as period between times of initial procedure and recurrence of symptoms and was calculated according to the Kaplan-Meier method. Results: In all patients, fluoroscopically-guided balloon dilation was technically and clinically successful (100%) with no complications. During the mean 74-months follow-up period, there was recurrence in five patients, and they underwent additional sessions of fluoroscopically guided balloon dilation (n ⫽ 4) or other
JVIR 䡲 Scientific Session
Wednesday 䡲 S105
procedures (n ⫽ 1). The mean symptomatic improvement period was 56 days (95% CI, 25-87 days). The symptomatic improvement rates were at 1 year, 3 years and 5 years were 36%, 36% and 43%, respectively. Conclusion: Fluoroscopically-guided balloon dilation seems to be effective and safe for patients with post-intubation tracheal stenoses.
11:34 AM
Abstract No. 256
Outcomes of tracheobronchial temporary partial covered stent placement for benign disease X. Han, J. Ma, G. Wu; Zhengzhou university, Zhengzhou, China
11:42 AM
Purpose: To present our 7 years of experience in the treatment of benign and malignant tracheobronchial stenosis using metallic stents. Materials and Methods: 123 stents were deployed in 86 patients (74 benign and 12 malignant stenosis): 97 in the trachea, 17 in the main left bronchus,7 in the main right bronchus and 1 in the intermediate bronchus. The procedures were performed under general anaesthesia and laryngeal mask, with fluoroscopic and flexible broncoscopic guidance. In case of severe stenotic lesions or obstruction, laser resection was performed preprocedure. Patients were followed-up clinically and by thorax imaging at 48 hours and at 1,3,6 and 12 months and by functional tests at 3 months. Results: Technical success was of 100%. Clinical improvement was observed in all patients: dyspnea disappearance and pulmonary functional data improvement (see Table). Complications were detected in 23 patients (26.7%). The follow-up mean time was of 6.3⫾1.2 months in malignant lesions and 76.2⫾2.3 months in benign lesions. At the end of the study, 100% of the patients with malignancy and 6.7% of the rest were deceased. Functional Pulmonary Data
Parameter
Pre-treatment (Mean ⫾ SD)
Post-treatment (Mean ⫾ SD)
p*
FEV1 (mL) FVC (mL) PEF (L/min) FEF50 (L/min) PIF (L/min) FIF50 (L/min) TOTAL RAW (cmH20/L/s) TLC (mL) RV (mL)
1751.5 ⫾ 829.7 3157.8 ⫾ 1044.6 262.49 ⫾ 190.93 150.98 ⫾ 116.76 201.03 ⫾ 133.82 173.85 ⫾ 135.57 1.75 ⫾ 2.18 575.24 ⫾ 202.68 284.04 ⫾ 202.46
2694.7 ⫾ 953.8 3488.9 ⫾ 107.21 578.63 ⫾ 261.28 295.84 ⫾ 165.43 388.65 ⫾ 180.01 370.00 ⫾ 196.70 0.63 ⫾ 1.19 568.17 ⫾ 147.66 216.77 ⫾ 119.47
⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 ⬍0.001 0.704 0.001
* Significance according to T-student Test for paired samples FEV1 Forced expiratory volume in first second FVC Forced vital capacity PEF Peak expiratory flow FEF50 Forced expiratory volumen at 50% PIF peak inspiratory flow FIF forced inspiratory flow at 50% TOTAL RAW Total resistances of the airway TLC total lung capacity RV residual volume.
Conclusion: Minimally invasive treatment of tracheobronchial stenosis with metallic stents is a therapeutic alternative in patients which are not good candidates for surgery. A correct assessment of the patient is essential to choose the best treatment.
Scientific Session 20 Embolization III Wednesday, March 28, 2012 10:30 AM – 12:00 PM Room: 122
Abstract No. 257
Metallic stents for tracheobronchial pathology treatment A. Laborda1, J.M. Lozano2, H. Caballero2, C. Serrano1, A. Sebastian3, J. Lopera4, M.A. de Gregorio1; 1GITMIUniversidad de Zaragoza, Zaragoza, Spain; 2 Department of Radiology, Marly Clinic, Bogota, Colombia; 3Department of Pulmonology, Hospital
10:30 AM
Abstract No. 258
Efficacy and safety of selective arterial embolization with fibrin glue in the treatment of
WEDNESDAY: Scientific Sessions
Purpose: To retrospectively determine mid-term outcomes in patients who have undergone temporary partial covered tracheobronchial stent placement for benign diseases. Materials and Methods: This is a retrospective analysis of consecutives 34 patients (23 women , 11 men; mean age, 35 years; range, 18-54 years) who received the stent placement between January 2009 and March 2011.Causes of airway stenosis included tracheal tube injury (n⫽5), tracheobronchomalacia (n ⫽4), tracheal amyloid (n ⫽6), endobronchial tuberculosis (n⫽19). 15 patients were treated with temporary partial covered stent and 19 with temporary partial covered branched stent. All of the stent were removed after approximately 85 to 95 days of placement. Respiratory function test was prospectively performed before and 1 day after stent placement. Respiratory function was assessed in terms of visual analog scale (VAS) and Karnofsky Performance Status (KPS). All cases were scheduled for clinical and imaging follow up using CT at before stent placement, 1 month, six months after removal of the stent. To measure the diameter of the stenosis on CT. Results: 34 stent placement performed on 34 patients were retrospectively reviewed. The procedure was completed in all patients without complications. VAS and KPS significantly improved (p⬍0.05) from average of 6.291⫾0.495 to 1.493⫾0.504 and 25.352⫾10.533 to 60.140⫾16.344 respectively. Mean diameter of the stenosis in trachea and main bronchus were 7.876⫾2.351mm and 2.143⫾0.770mm before stent placement, 17.235⫾3.457mm and 8.993⫾0.961mm at 1 month after removal of the stent, 16.353⫾4.132mm and 8.357⫾1.082mm at 6 months after removal of the stent. Statistically significant difference between diameter of the stenosis before stent placement and that at 1 month after removal of the stent was indentified (p⬍0.05), statistically significant difference between diameter of the stenosis before stent placement and that at 6 months after removal of the stent was indentified (p⬍0.05), although no significant deference between 1 month after removal of the stent and 6 months after removal of the stent was noted. Conclusion: Temporary partial covered stent is feasible and effective to manage with benign tracheobronchial stenosis.
Clinico Lozano Blesa, Zaragoza, Spain; 4Interventional Radiology Department, Health Science Center, San Antonio, TX