Yousif, Paul

Aberrant internal carotid artery (ICA) is a vascular anomaly in which a segment of the ICA courses through the middle ear. The association of aberrant ICAs and pseudoaneurysm formation is not well known and can be an important finding to recognize on imaging. In this series, we present three cases of aberrant ICAs having asymmetric contour deformities consistent with pseudoaneurysms diagnosed utilizing CT of the temporal bone.

Percutaneous gastrostomy tube insertion in post Roux-en-Y patients can be challenging due to decompression of the excluded stomach and its discontinuity with the proximal enteric tract. Presented here is a 65-year-old woman status post Roux-en-Y gastric bypass who required gastrostomy tube placement for enteral feeding. The remnant stomach collapsed, and direct percutaneous gastric access was not possible for insufflation. To facilitate insufflation, computed tomography (CT) was used to access the duodenal bulb. This duodenal access was used to insufflate the stomach in a retrograde fashion which created a safe percutaneous window for gastrostomy tube placement into the remnant stomach. The technique described in this study can be a useful tool in patients with difficult to access remnant stomachs. Utilizing either direct or transhepatic access to the duodenum with ultrasound or CT guidance for remnant stomach insufflation can facilitate gastrostomy tube placement in challenging cases.

Abstract Background: Prostate artery embolization (PAE) requires a careful understanding of pelvic arterial anatomy and identifying prostatic artery variants. Pre-procedure CTA and intra-procedural cone beam CT are traditional means of planning and performing PAE, with the latter providing guidance for embolization. Photon counting detector (PCD) CT is a novel technology enabling ultra-high spatial resolution (UHR) whole-body imaging, with reconstructed slices as thin as 200 um. For PAE, we obtain a single UHR PCD CT acquisition, which provides both detailed pre-procedure pelvic arterial anatomy information and a registration reference for intra-procedural embolization guidance. Case Presentation: In five patients who underwent technically successful PAE via a left transradial approach, the pre-procedure diagnostic UHR PCD prostate CTA delineated bilateral prostatic artery origins and course in all cases, as confirmed with conventional angiograms. Further, registration of the UHR PCD CT for embolization guidance was successful in all cases, augmenting vessel selection. No complication occurred. Conclusion: UHR PCD CT is a novel acquisition option that is well suited to PAE due to its ability to delineate small vessels. Further, our experience has shown that a single pre-procedure scan can also be utilized for intra-procedural embolization guidance, obviating the need for a traditional cone beam CT angiogram. Further research is needed to assess reductions in radiation dose, contrast use, and intra-procedural time with these techniques.