Day 2 :
University of Quebec at Trois-Rivières, Canada
Keynote: Feasibility of shear wave elasticity imaging to detect endoleak and evaluate thrombus organization after endovascular repair of an abdominal aortic aneurysm
Time : 10:00-10:40
Antony Bertrand-Grenier has completed his Ph.D. at the age of 30 years from Universite de Montreal in medical physics. Since 2016, he has been a Medical Physicist, a Researcher at Centre Integre Universitaire de sante et de services sociaux de la Mauricie-et-du-Centre-du-Quebec and an Associate Professor at Universite du Quebec a Trois-Rivieres. During his graduate studies, he published more than 12 papers and acquired expertise in medical imaging and radio-oncology, including elastography and radiotherapy. His research interests include introducing elastography (safely assess mechanical properties [rigidity] of tissues with ultrasounds) to diagnosis disease and treatment monitoring, image processing and optimize radiotherapy, spasticity and chemotherapy treatments.
Purpose: To investigate the feasibility of shear wave elasticity imaging (SWI) for detection of endoleaks and characterization of abdominal aortic aneurysms (AAAs) healing after endovascular aneurysm repair (EVAR), using a combination of duplex ultrasound (DUS) and CT-scan as the reference standard.
Methods: Endoleaks areas were detected on SWI by 2 readers and compared with DUS and CT in 30 patients. Elasticity values of endoleaks and thrombus were calculated and compared. The analysis included: a) Correlation between thrombus elasticity and AAA diameter and volume and their variation over time and b) Correlation between endoleak and fresh thrombus areas and aneurysm diameter and volume.
Results: Endoleaks were present in 6 patients. SWI, DUS, and CT respectively detected 6(100%), 3(50%) and 5(83%) of these endoleaks. SWI detected 3 endoleaks not seen on DUS and one not seen on CT. SWI reported from 6 to 8 false positives (specificity of 62% to 71%). Elasticity moduli in endoleaks and thrombi regions were estimated at 0.06kilopascal (kPa) and 22.3kPa, respectively (P<0.001). Thrombus elasticity of AAA with and without endoleaks were not significantly different (P=0.792). No significant correlations were found between thrombus elasticity moduli and AAA diameter and volume and their variation over time. No significant correlation was found between the proportion of fresh thrombus (less rigid and non-organized thrombi; 3-19kPa) and growth of AAA in diameter and volume.
Conclusion: This clinical study evaluated SWI as a biomarker of endoleak and thrombus stiffness in 30 patients with AAA after EVAR. AAAs were evaluated and correlated with SWI, DUS, and CT-scan. SWI provides real-time mechanical information on AAA sac content that is complementary to B-mode and DUS assessments. Our results suggest that not only SWI may help to detect endoleak but it may also detect aneurysm likely to grow by identifying the amount of fresh thrombus that is likely to be associated with post-EVAR aneurysm enlargement.
Clinical Relevance: SWI has the potential to identify endoleaks and to detect aneurysms that are likely to grow after EVAR. As both techniques are implemented on the same imaging modality, SWI may be combined with DUS in post-EVAR surveillance of endoleak. SWI could reduce costs, exposure to ionizing radiation and nephrotoxic contrast agents associated with CT-scan follow-up.
SUNY Upstate Medical University, USA
Keynote: The radiologist role in breast cancer detection and management what clinicians need to know
Time : 10:55-11:35
Abdel Mohsen Hussien is an American board certified radiologist. He has graduated from Cairo University Medical School. He also had his radiology residency in Egypt. He finished a four years of radiology fellowships in the University of Rochester in Neuroradiology, body imaging and women’s imaging. He practiced women’s imaging for about 5years, four of them at the University of Rochester. During which he was able to successfully make a great change in breast cancer detection rate in one of the affiliated locations in the town of Canandaigua. He then moved to SUNY Upstate Medical University for a wider scope of neuroradiology practice and research.
There are many factors that may increase the risk of breast cancer, some of them may need to be communicated with the patient by the referring physician; These factors include breast density, genetic mutation, family history of breast cancer, previous treatment using radiation, patient’s age, and the reproductive history. The role of the radiologist in breast cancer detection is pivotal. Early breast cancer is asymptomatic and the role of the radiologist is to find the early radiological signs of breast cancer. Now the radiologist role in breast cancer detection and management does not end at detecting cancer from screening mammogram. The radiologist role extends far beyond that, including calling the patient back for additional imaging, performing biopsies, evaluating the patient’s overall risk for developing breast cancer and risk calculation. The radiologist is also an important team member of the tumor board and their input in the management plan prior to treatment is critical. Some clinicians and patients are not aware of the whole scope of the radiologist role in dealing with breast cancer as clearing up the patient’s expectations would facilitate the radiologist job and improve patient’s cooperation with the radiologists.
Shanghai Tongji hospital, Tong ji University, China
Keynote: Endovascular treatment of carotid siphon aneurysms using Willis covered stent: A single-center experience
Time : 11:35-12:05
Chun Fang a Professor, Vice-chairman of the department of radiology and Director of a section of interventional radiology, Shanghai Tongji Hospital, Tong Ji University, China. His academic participation: Standing committee of Stroke Screening PreventionProject Committee of Experts, China; Standing committee of hybrid neurovascular surgery branch and neuro-interventional branch of Chinese Stroke Association; Deputy Chief of interventional radiology branch of Shanghai Medical Association, China; Deputy Chief of interventional radiology branch of Shanghai Association of Integrative Medicine, China
Objective: To report the clinical results and the initial clinical experience of endovascular isolation with Willis covered stent for carotid siphon aneurysms in 57 patients.
Methods: Between November 2013 and December 2016, a total of 57 patients who presented with carotid siphon aneurysms were treated with Willis covered stent. Results of procedures, technical events and complications were recorded. Clinical and imaging follow-ups were performed at 3 months after endovascular procedures.
Results: Placement of the Willis covered stent was successful in all patients. Immediate angiography revealed complete exclusion of aneurysms in 48 patients (84%), while endoleak happened in 9 patients (16%). Procedure-related complications occurred in 3 cases, including displacement of the covered stent in 1 patient, acute in-stent thrombosis in 1 patient and microwire-related intracranial hemorrhage in 1 patient. The angiographic follow-ups were done in 49 patients. Complete exclusion of aneurysms was shown in 47 patients. Endoleak was present only in 2 patients. No aneurysm recurrence was observed. 44 patients showed good parent artery patency, while the other 5 patients showed mild to moderate asymptomatic in-stent stenosis. During the follow-up period, no ischemic or hemorrhagic event was found. The mRS scores at follow-ups were 0 to 2 in 56 patients and over 2 in 1 patient.
Conclusions: The treatment of siphon aneurysms with Willis covered stent implantation resulted in satisfactory clinical outcomes. Willis covered stent seems safe and feasible for siphon aneurysms treatment, which still needs to be confirmed by longer follow-ups and controlled studies with larger samples.