Nepalese Journal of Radiology

Bronchial Artery Embolization: IS NBCA/LIPIODOL Better Than PVA?

2023-11-17T11:33:41+00:00

Introduction: Bronchial artery embolization (BAE) is a minimally invasive interventional procedure, which is now considered the first-line management strategy and an alternative to surgery for massive and recurrent haemoptysis. The advances in embolic agents have led to a significant improvement in the success rates of the procedure, however, there has been no significant change in the recurrence rate of haemoptysis.

Methods: This retrospective study was conducted at a tertiary care center from January 2012 to December 2020. The final analysis was performed on 123 patients [NBCA(n= 37) and PVA(n= 86)]. Technical and clinical success rates, complications and recurrence rates were compared between the two groups.

Results: A total of 248 arteries were embolized. In the PVA group, clinical success was achieved in 84 out of 86 cases (97.6%) and with NBCA in 36 out of 37 patients (97.3%) (p >0.05). Of the 120 patients in whom BAE was clinically successful, recurrence was observed in 43 patients within the 12-month follow-up period. The study showed a statistically significant association between the embolizing agent used for BAE and the recurrence of hemoptysis (χ2 = 4.80, df = 1, p = 0.028). The use of PVA particles for BAE was found to have
2.62 times higher odds (95% CI 1.10 - 6.81) of recurrence of hemoptysis as compared to the use of NBCA glue.

Conclusions: BAE with NBCA provided higher hemoptysis-free survival rates compared with PVA particles without increasing complication rates.

Early Experience of Transarterial Therapy in Ruptured Hepatocellular Carcinoma

2023-11-17T11:38:22+00:00

Introduction: Hepatocellular carcinoma (HCC) is the 3rd leading cause of cancer-related mortality. Ruptured HCC carries a high mortality if untreated. Peripherally located HCC has a higher risk of rupture. However, most of the ruptured HCCs on presentation are in an advanced stage and, hence are unresectable. Henceforth treatment options available are conservative and transcatheter embolization.

Methods: Retrospectively, 8 patients with ruptured HCC who underwent trans arterial embolization were studied for hemostasis and 30-day mortality. Clinical history and laboratory data were obtained from the medical records of the patients, and radiological images were extracted from picture archiving and communication systems and studied.

Results: The age ranged between 31 to 78 years and 7 were male. In patients presenting with sudden onset pain abdomen, ruptured HCC was suspected if there was a hemoperitoneum with or without extravasation of contrast adjacent to peripherally located HCC on CT angiography. Angiography revealed tumour blush with sentinel vessels in all. Two showed active contrast extravasation. Seven patients with relatively preserved liver function (Child A and B) attained both radiological and clinical hemostasis. One patient with Child C status died due to MODS on day 3 of embolisation. Three patients survived more than a year with additional liver-directed therapies. Two patients were lost to follow-up after discharge and two after six months.

Conclusions: Transarterial embolization for ruptured HCC is an effective method of hemostasis and helps in achieving better survival by the additional benefit of tumor control and poor functional status of the liver predicts lower survival.

Percutaneous Sclerotherapy as Therapeutic Option in Benign Vascular Lesions: A Retrospective Study

2023-11-17T11:43:45+00:00

Introduction:Sclerotherapy, a minimally invasive approach, has gained prominence as a therapeutic modality for the treatment of these lesions. The objective of this article is to assess clinical success, complications and periprocedural pain score of sclerotherapy and their variation with the nature of the lesion and choice of sclerosants.

Methods: This was a hospital record-based retrospective study in a tertiary care centre in Kathmandu. Sclerotherapy done in the institute from January 2019 to December 2022 was evaluated for the nature of the lesion, clinical success, number of sessions, periprocedural pain score and complications. All sclerotherapy was performed under combined USG and fluoroscopic guidance by an interventional radiologist. Data was entered in predesigned proforma and data analysis was done using SPSS 25.0.

Results: A total of 33 patients underwent 61 sessions of sclerotherapy during the study period. Venous malformation (72.2%) was the most common vascular lesion followed by hemangioma. There was significant resolution of symptoms post sclerotherapy pain relief in 95% complete resolution of swelling in 65.38 % and partial resolution with acceptable cosmetic results in 26.92% of cases. Only minor complications were seen in 6.5% of cases. The median periprocedural pain score was 5 with an interquartile range of 2. Periprocedural pain was significantly less with sodium tetradecyl sulphate than with alcohol(P-0.002). The resolution of swelling was less in hemangiomas than in other lesions, while pain relief was similar for all lesions. Complications were seen only in the alcohol group.

Conclusions: Sclerotherapy is a safe and effective procedure for benign vascular lesions. Complications and periprocedural pain are less with sodium tetradecyl sulphate as compared to alcohol.

Spectrum of Radiological Findings in Hysterosalpingography for Female Subfertility: A Retrospective Cross-Sectional Study in a Tertiary Care Center of Nepal

2023-11-17T11:47:21+00:00

Introduction: Hysterosalpingography (HSG) is a commonly used diagnostic procedure to investigate the causes of female subfertility. This study aimed to evaluate the range of findings observed in HSG examinations conducted for this purpose.

Methods: A prospective cross-sectional study was conducted at the Department of Radiology and Imaging, Tribhuvan University Teaching Hospital, from December 2022 to April 2023. The study included 196 female participants who underwent HSG and met the inclusion criteria.

Results: Out of the 196 participants, 127 (64.8%) were categorized as having primary subfertility, while 69 (35.2%) had secondary subfertility. The mean age of the participants was 30.61±5.623 years, with an age range of 20 to 45 years. Among the participants, 142 (72.4%) exhibited a normal uterus, 23 (11.7%) displayed left tubal occlusion, 17 (8.7%) showed right tubal occlusion, 13 (6.6%) had other findings, and 1 (0.5%) was diagnosed with uterine fibroids.

Conclusions: This study demonstrated that approximately one out of every five HSG examinations performed to evaluate subfertility revealed tubal occlusion. Consequently, the high detection rate of uterine and tubal pathologies using HSG underscores its critical role as a diagnostic tool for assessing women with subfertility.

Pioneering the Future by Respecting the Past: A Glimpse into the History of Interventional Radiology in Nepal

2023-11-17T11:18:31+00:00

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Intracardiac KCl Injection in Cesarean Scar Pregnancy: A Review Article

2023-11-17T11:28:41+00:00

Embryo implantation in a previous caesarean scar (CS) resulting in a caesarean scar pregnancy (CSP) is another rare but potentially catastrophic complication of a previous caesarean birth. CSP can be detected between days 33 and 94 of pregnancy. Methotrexate and potassium chloride (KCl) are the most common feticidal agents used. intracardiac KCl causes feticide and reduces the uteroplacental blood flow, thereby decreasing the rate of hemorrhage due to placenta previa, caesarian scar pregnancy and in cases of fibroids; it is easy to evacuate the macerated fetus. Intracardiac KCl causes feticide and reduces the uteroplacental blood flow, thereby decreasing the rate of hemorrhage and abortion time before termination of pregnancy (TOP) leading to an easy evacuation of the macerated fetus. In conclusion, feticide with intracardiac KCl is a safe procedure.

High Output External Biliary Drainage Leading to Acute Kidney Injury in a Patient with Malignant Obstructive Jaundice: A Rare Case Report

2023-11-17T11:51:15+00:00

Most patients with malignant obstructive jaundice present to the hospital in an advanced unresectable stage. Percutaneous transhepatic biliary drainage (PTBD) and stenting are the established , safe and effective way of palliative treatment aiming prolongation and improving the quality of the life. We report a rare case of high output external biliary drainage leading to AKI and electrolyte imbalance following insertion of PTB drain. Patient was managed with hemodialysis and subsequent self- expandable metallic stent (SEMS) placement. We highlight the importance of awareness of this complication and need of further studies regarding role of biliary interventions, associated complications and management.

Improved Health-Related Quality of Life with Superficial Femoral Artery Stenting in Intermittent Claudication Done Prior to Medical Treatment: A Case Report

2023-11-17T11:54:57+00:00

In cases involving TASC A lesions of the superficial femoral artery (SFA), the conventional approach typically starts with medical therapy and supervised exercise. When these measures fail to yield the desired results, endovascular procedures may be contemplated. However, in the distinctive case of a 68-year-old male, endovascular therapy was employed to reestablish blood flow through the obstructed SFA segment. This intervention substantially improved the patient’s ability to walk. Subsequently, the patient continued with optimal medical therapy. This integrated approach, beginning with SFA stenting followed by conservative care, promptly alleviated claudication-related symptoms, ultimately resulting in an enhanced quality of life