Fluoroscopic CBCT guidance for percutaneous osteoid osteoma ablation yields similar technical and clinical success, reduced radiation dose, and increased total room utilization time compared to conventional CT guidance.

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Purpose: To assess the diagnostic performance of contrastenhanced C-Arm CT (CACT) in comparison to multi-detector CT (MDCT) of the pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Materials and Methods: 21 patients (16m, 5w; mean age 64.2Ϯ15.6y) suffering from CTEPH underwent CACT (resolution 0.4mm 3 , total injected volume 70mL, 210 mgI/mL, flow 8mL/s, delay 2s) using a 5F pigtail catheter placed in the pulmonary trunk and 16(4)/64(17)-row MDCT (slice thickness 1.2/0.625mm, total injected volume 100mL, 350 mgI/mL, flow 5mL/s) using a peripheral venous access. Both studies were acquired during a single breath-hold and within 1Ϯ3 days. Contrast-enhancement was measured in the pulmonary trunk (TP), the right and left pulmonary artery (RPA; LPA) and the left atrium in both modalities. The most distal branch of the pulmonary artery where the lumen could be clearly delineated from the vessel wall was determined (four locations) and the distance to the pleura (dVP) was measured. Additionally, two readers (R1; R2) independently evaluated the pulmonary arteries on a segmental basis including the subsegmental branches in CACT and MDCT for pathologic findings. Results: A total of 378 pulmonary artery segments (PAS) and their peripheral branches were evaluated. Contrast-density was significantly higher in the TP, RPA and LPA (po0.001) and significantly lower in the left atrium (p¼0.0002) with CACT compared to MDCT. dVP was significantly lower in CACT images compared to MDCT (11.4Ϯ3.6mm vs. 15.2Ϯ4.2mm po0.0001). Inter-observer agreement was good for both CACT (κ¼0.77) and MDCT (κ¼0.77), while inter-modality agreement was moderate for both readers (R1: κ¼0.59, R2: κ¼0.59). In MDCT both readers found no pathologic findings in 173 (46%) PAS compared to 131 (35%) in CACT. Overall, both readers found more web stenoses with CACT (75; 20%) compared to MDCT (24; 6%). Conclusion: CACT of the pulmonary arteries enables acquisition of a pure arterial phase. Combined with high spatial resolution this enables excellent delineation of small (peripheral) pulmonary arteries. Compared to MDCT more pathologic findings were detected. Diagnostic work-up of CTEPH patients is substantially improved with CACT.

further bowel infarction, all had improvement of abdominal symptoms, and five patients were able to discontinue anticoagulation at 6 months. Two patients experienced encephalopathy after TIPS, two required stent revision for thrombosis, one required stent downsizing for encephalopathy and one underwent stent downsize to maintain anterograde hepatic flow in an asymptomatic patient. Conclusions: PMVT is a potentially life-threatening complication of bariatric surgery that may lead to bowel ischemia and infarction. TIPS, thrombolysis and thrombectomy are valuable treatment options in the setting of acute thrombotic disease with positive patient outcomes. Further comparison with patients who underwent conservative management for symptomatic PMVT after bariatric surgery will be performed.

further bowel infarction, all had improvement of abdominal symptoms, and five patients were able to discontinue anticoagulation at 6 months. Two patients experienced encephalopathy after TIPS, two required stent revision for thrombosis, one required stent downsizing for encephalopathy and one underwent stent downsize to maintain anterograde hepatic flow in an asymptomatic patient. Conclusions: PMVT is a potentially life-threatening complication of bariatric surgery that may lead to bowel ischemia and infarction. TIPS, thrombolysis and thrombectomy are valuable treatment options in the setting of acute thrombotic disease with positive patient outcomes. Further comparison with patients who underwent conservative management for symptomatic PMVT after bariatric surgery will be performed.