RPS 2215 - Treatment planning and surveillance in vascular imaging

Author Block: F. De Geer¹, L. C. ter Beek¹, A. Te Boekhorst¹, B. Plakke¹, L. Karssemakers¹, R. Dirven¹, F. Siepel², M. Van Alphen¹, W. Schreuder¹; ¹Amsterdam/NL, ²Enschede/NL
Purpose: Large head and neck defects following oncological resection are often reconstructed using free vascularized tissue flaps such as the anterolateral thigh flap (ALT) and fibula free flap (FFF). These flaps depend on small perforator vessels for perfusion. Preoperative Magnetic Resonance Angiography (MRA) could offer detailed insights into perforator course, caliber, origin and main pedicle length and could aid in successful surgical flap design and elevation. This study presents an optimized MRA protocol for head and neck cancer patients scheduled for oncological resection with ALT or FFF reconstruction.
Methods or Background: Using a 3.0-T Philips MRI system (dStream Achieva), T1-weighted 3D gradient echo DIXON sequences are acquired: pre-contrast, arterial, and early venous phases after gadolinium-based contrast injection. Scans are fluoroscopically triggered with centra k-space acquisition initiated two seconds post-trigger. Post-contrast axial slices are analyzed for perforator identification. Vascular structures and surrounding anatomy are segmented and rendered into 3D models. Based on the MRA-based 3D models, a surgical plan is created and translated into the operating room with 3D printed perforator marking guides.
Results or Findings: Nineteen patients underwent surgery using this protocol. In all cases, intraoperative perforators matched those visualized on MRA. Seventeen surgeries followed the preoperative plan; two required intraoperative adjustments. The mean System Usability Score (SUS) for the 3D models as evaluated by the operating surgeons was 73.7 (SD 9.0), indicating the clinical utility of this method.
Conclusion: Preoperative MRA combined with 3D modeling enables accurate perforator mapping and enhances surgical planning for head and neck reconstruction using lower extremity perforator flaps.
Limitations: The current protocol requires gadolinium-based contrast agents, though MRI offers potential for non-contrast-enhanced vascular imaging. Research in our institute is ongoing to optimize such sequences and preliminary results will be presented at ECR.
Funding for this study: Not applicable.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved by Institutional Review Board from Netherlands Cancer Institute - Antoni van Leeuwenhoek with registration number IRBdm22-042

Author Block: N. Kerschbaumer¹, A. Fereydooni¹, D. Vigneault¹, K. Bäumler¹, G. Mistelbauer¹, D. Mastrodicasa², E. George¹, D. Fleischmann¹; ¹Stanford, CA/US, ²Seattle, WA/US
Purpose: To identify anatomic and device-related factors associated with aortic remodeling and complications following PETTICOAT(Provisional-Extension-To-Induce-Complete-Attachment).
Methods or Background: The concept of scaffolding the aortic true lumen (TL) with bare-stent distal to standard TEVAR has become valuable in dissection treatment. However, anatomical and technical factors associated with treatment outcomes have not been established.
In this observational, single-center study two cardiovascular radiologists reviewed a retrospective cohort of 64 patients with complicated type-B-dissection or residual descending dissection after type-A-repair, treated with distal bare-stent extension. Available pre-/postoperative and follow-up (median 15 months) CT-angiograms were assessed.
Results or Findings: We identified four distinct, PETTICOAT-specific phenomena:
First, small contrast jets into the false lumen (FL) through dissection flap fenestrations corresponding to intercostal arteries were observed at several bare-stent levels, typically thrombosing throughout follow-up.
Second, in contrast to covered endografts, the aortic TL can fully re-expand, even beyond the diameter of the bare-stent, with gradual complete absorption of the FL thrombus (n=1).
Third, we observed new focal contrast outpouchings in the dissection flap separating the TL from the thrombosed FL (proposed term: ‘junctional SINE’) at the junction between covered and uncovered stents (n=2). These can be explained as intimal erosions caused by protruding bare-stent wires, associated with abrupt caliber changes and ‘telescoping’ where the bare-stent exits the endograft.
Fourth, all cases of bare-stent migration (n=3), were associated with junctional SINEs. Predisposing factors for migration were short device overlaps within angulated aortic segments.
Conclusion: Temporary intercostal fenestrations and TL re-expansion beyond device diameter may be part of normal healing. The prognosis of ‘junctional SINEs’ and their association with aortic angulation and device migration may impact patient selection and device design.
Limitations: This study identified unique imaging features, but is underpowered to establish prognostic significance of these observations.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: IRB Stanford University, eProtocol #52791

Author Block: S. Santra, L. K. B P, E. Joseph, A. IRODI, L. Robinson Vimala ; Vellore/IN
Purpose: To highlight the significance of radiological imaging in evaluating disease progression and guiding immunomodulation in pediatric patients with Takayasu arteritis.
To develop an optimal workflow of radiological techniques to minimise radiation exposure in this vulnerable age group.
Methods or Background: A retrospective analysis of fifteen pediatric patients diagnosed with Takayasu arteritis at our institute between 2014 and 2024 was conducted.
The study evaluated the role of Computed Tomography (CT) angiography, Magnetic Resonance angiography (MRA), and Positron Emission Tomography-Computed Tomography (PET-CT) in diagnosis and follow-up in pediatric patients with Takayasu arteritis.
Radiological findings were compared with clinical presentation and lab parameters- ESR & CRP.
Results or Findings: Wall thickening, stenosis, dilation, aneurysm, signs of organ damage, such as a contracted kidney in renal artery stenosis, and collateral vessel formation were the observed imaging features.
The majority of patients underwent CT angiography for diagnosis. Dose-limiting techniques such as high pitch, iterative reconstructions, body-adapted protocols, and shielding for thyroid and gonads should be included in the workflow of evaluation of pediatric patients with Takayasu arteritis.

The CARDS score can be used to assess the disease severity. On comparing the CARDS score with laboratory parameters –CRP & ESR in follow-up patients, no definitive pattern was found, thus making imaging crucial for disease assessment.
Conclusion: Radiological investigations are crucial for evaluating disease activity and progression, as the accuracy of lab parameters for Takayasu arteritis is limited in diagnosis and disease progression. However, due to significant concerns regarding radiation exposure to this age group requiring repeated follow-up examinations, judicious use of radiation and non-radiation-emitting techniques is highly recommended in managing these patients.
Limitations: No limitations
Funding for this study: No funding
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: G. Francavilla, L. M. Cacioppa, M. Rosati, P. Boscarato, N. Rossini, S. Ielpo, R. Candelari, C. Floridi, A. Giovagnoni; Ancona/IT
Purpose: Follow-up of visceral aneurysms treated with metallic coils remains challenging for conventional CT due to metal artifacts that limit evaluation of the aneurysm sac and adjacent vessels. Dual-Energy CT (DECT), through virtual monoenergetic images (VMI) and iodine maps, may improve diagnostic accuracy and reduce the need for confirmatory angiography.
Methods or Background: Seventeen patients with true visceral aneurysms (splenic, hepatic, renal, and mesenteric) treated by coil embolization were retrospectively analyzed. All underwent DECT follow-up between 1 and 6 months. High-keV VMI (100–140 keV) were evaluated for artifact reduction and morphological assessment of the aneurysm sac and surrounding tissues, while low-keV VMI (40–60 keV) and iodine maps were used for detection of in/out arterial feeders and residual perfusion.
The analysis was performed both qualitatively and quantitatively: qualitative assessment was conducted using a 5-point Likert scale for image quality and diagnostic confidence, while quantitative evaluation included placement of circular regions of interest (ROIs) to measure attenuation values and image noise.
Findings were compared with conventional CT reconstructed at 120 kVp and, when available, with angiography as the reference standard.
Results or Findings: High-keV VMI significantly reduced coil-related artifacts, improving diagnostic readability (p < 0.05). Low-keV VMI increased sensitivity for intravascular contrast, allowing identification of feeders and residual perfusion not visible on conventional CT. Iodine maps confirmed these findings, helping to differentiate true enhancement from artifacts.
Conclusion: DECT provides clear advantages over conventional CT in the follow-up of coil-embolized visceral aneurysms. High-keV VMI reduce metallic artifacts, while low-keV VMI and iodine maps enhance detection of feeders and residual flow. DECT may become the reference imaging tool for post-procedural monitoring, improving patient management and reducing the need for angiographic confirmation.
Limitations: The limited number of cases
Funding for this study: This study received no external funding
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Ethical review and approval were waived for this study since all data were anonymized and collected as part of routine clinical follow-up.

Author Block: B. Zheng; Beijing/CN
Purpose: The study aims to elucidate the related factors of short-term efficacy of Ovarian Vein Embolization (OVE) in the treatment of pelvic venous insufficiency (PVI), constructs a predictive model for short-term efficacy of OVE, and evaluates its predictive efficacy.
Methods or Background: Clinical and ultrasound data were retrospectively collected from female patients with PVI who underwent OVE at Shijitan Hospital. This study was the first to apply the Minimal Clinically Important Difference to define symptomatic improvement in the Pelvic Venous Clinical Severity Score. Symptomatic improvement was the evaluation standard, and factors affecting short-term efficacy were analyzed. The ROC curve assessed predictive efficacy. Internal validation used k-fold cross-validation to evaluate discrimination, calibration, and clinical utility.
Results or Findings: (1) The study included 82 patients: 43 in the remission group and 39 in the non-remission group. (2)There were significant differences between the two groups in the duration of abdominal discomfort, the diameters of the left ovarian and parametrial veins, and the presence of internal iliac vein reflux..(3) Logistic regression revealed that longer abdominal discomfort, smaller left ovarian vein diameter, and internal iliac vein reflux were independent risk factors for poor short-term efficacy of OVE. The ROC curve AUC was 0.807, with a best cut-off value of 0.453. Sensitivity and specificity for predicting efficacy were 82.1% and 74.4%. Internal validation showed discrimination (AUC=0.779), a Brier score of 0.176 indicating accuracy, reasonable calibration, and positive net clinical benefit in decision curve analysis.
Conclusion: (1) The duration of lower abdominal discomfort, ovarian vein diameter and internal iliac vein reflux are independent predictors of the short-term efficacy of OVE for PVI. (2) The prediction model of short-term efficacy of OVE for PVI in this study has satisfactory validity.
Limitations: No external validation
Funding for this study: China State Railway Group Co. Ltd (J2023Z604) and Capital’s Funds for Health Improvement and Research (2024-2-2085).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Beijing Shijitan Hospital, Capital Medical University (protocol No. IIT2024-016-003)

Author Block: A-E. Iacobut¹, P. J. Kettnaker², R. W. Huegli¹, D. Bilecen²; ¹Bruderholz/CH, ²Liestal/CH
Purpose: To introduce PAD-RADS, a novel, comprehensive Peripheral Artery Disease Reporting and Data System for standardizing computed tomography angiography (CTA) reporting in patients with known peripheral artery disease (PAD).
Methods or Background: Despite advances in CTA technology and increasing use for PAD assessment, there is currently no standardized reporting system equivalent to CAD-RADS for coronary CTA. The lack of structured reporting hinders effective communication between interpreting and referring physicians, limits multicenter research, and creates inconsistencies in patient management recommendations. PAD-RADS was developed to address these gaps by categorizing lesion severity, quantifying overall atherosclerotic burden, and incorporating key modifiers relevant for clinical decision making.
Results or Findings: PAD-RADS assigns a grade (0–5) based on the most severe arterial lesion per limb, with 0 indicating no stenosis and 5 representing total occlusion. The system is complemented by a plaque burden score (P0–P4) and a set of clinical modifiers (e.g., non-diagnostic segments, stents, grafts, collateralization, uncalcified plaques etc.). Case-based application demonstrates enhanced reproducibility, clarity in identifying culprit and incidental lesions, and improved reporting quality in both outpatient and acute care settings. The proposed system serves as a framework for quality assurance and education.
Conclusion: PAD-RADS offers a structured, reproducible method for reporting peripheral artery imaging that has the potential to improve communication, research, and clinical care in PAD. Prospective studies are needed to validate its utility and impact on patient outcomes.
Limitations: PAD-RADS may oversimplify complex clinical scenarios and requires careful integration with clinical context. Its applicability in diverse populations, interobserver reliability, and effectiveness across different healthcare settings require further investigation. Adoption will necessitate prospective validation, multidisciplinary education and consensus building.
Funding for this study: No funding was received for the present study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: R. Y. Gasiea¹, A. T. Rogers², R. Lakshminarayan³, M. Hamady⁴, B. Huasen⁵; ¹Blackburn/UK, ²Nottingham/UK, ³Hull/UK, ⁴London/UK, ⁵Manchester/UK
Purpose: Minimally invasive procedures using X-rays have been taken over many traditional surgical techniques, less focus has been placed on the complications faced by primary operators compared to achieving better success rates and outcomes for procedures. The major focus has always been on patient safety and patient dose, which is important. However, there is no doubt that radiation exposure also poses risks to staff working in Interventional Radiology (IR). Over the years, protection for staff has improved, although this progress has unfortunately been driven by first-hand complications observed in healthcare providers.
Methods or Background: Together with the British Society of Interventional Radiology (BSIR), a survey was conducted to better understand current practice and availability to operators who use ionising radiation for their vascular and non-vascular practice. This was sent out to members over the 2023-2024 period.
Results or Findings: 112 respondents received across 22 vascular centres in the UK, including pregnant female members, helped gauge an understanding of current practice. We review and discuss the results obtained from the 30 questions asked.
Conclusion: The survey demonstrates some concern and also positive findings in terms of awareness. Clinicians are innovators and problem solvers. With the increased use of ionising radiation in clinical practice, radiation from scatter and strain from garments.
Limitations: N/A
Funding for this study: N/A
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: