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Medline ® Abstract for Reference 69

of 'Renal manifestations of tuberous sclerosis complex'

Prophylactic embolization of renal angiomyolipomas: evaluation of therapeutic response using CT 3D volume calculation and density histograms.
PlanchéO, Correas JM, Mader B, Joly D, Méjean A, Hélénon O
J Vasc Interv Radiol. 2011 Oct;22(10):1388-95. Epub 2011 Jul 14.
PURPOSE: To evaluate the efficacy and tolerance of prophylactic embolization of angiomyolipomas (AMLs) and to analyze the therapeutic response by using three-dimensional 3D volume calculation and 3D quantification of fatty and angiomyogenic components during computed tomography (CT) follow-up.
MATERIALS AND METHODS: Over a 51-month period, 30 patients with 34 AMLs (mean diameter, 82 mm±37; range, 30-173 mm) underwent 37 prophylactic embolization procedures. The protocol included supraselective arterial embolization with a combination of absolute alcohol, microparticles, and coils. Mean clinical and imaging follow-up were 20.5 and 14.5 months, respectively. The 3D volume calculation and density histograms were retrospectively analyzed for treatment evaluation.
RESULTS: Four technical failures were observed (11%), with one successful secondary reattempt, resulting in 31 AMLs (91.2%) being embolized. Thirty (88.2%) had CT follow-up and were included in the analysis. Embolization was complete after a single procedure for 25 AMLs (83%) and required two procedures in two cases. Three AMLs had incomplete embolization and were scheduled for a second procedure. Mean volume reductions were 43%±32 for AMLs followed for 1-6 months after embolization and 81%±19 for the 12 AMLs followed for more than 1 year. The volume reduction after embolization was significantly correlated with the AML initial composition, with fat-rich AMLs showing a much smaller reduction of size than predominantly angiomyomatous AMLs (P<.05).
CONCLUSIONS: Prophylactic embolization allows significant reduction of AML volume with a high success rate. Three-dimensional CT volume and density histogram calculations suggest that it is especially effective on angiomyogenic components and fat-poor AMLs.
Adult Radiology Service, Hôpital Necker Enfants Malades, 161 rue de Sèvres, 75743 Paris 15, France. op@cegetel.net