Background: To assess the technical feasibility, success rate, puncture complications and procedural characteristics of transjugular intrahepatic portosystemic shunt (TIPS) placement using a three-dimensional vascular map (3D-VM) overlay based on image registration of pre-procedural contrast-enhanced (CE) multi-detector computed tomography (MDCT) for portal vein puncture guidance. Materials and methods: Overall, 27 consecutive patients (59 ± 9 years, 18male) with portal hypertension undergoing elective TIPS procedure were included. TIPS was guided by CE-MDCT overlay after image registration based on fluoroscopic images. A 3D-VM of the hepatic veins and the portal vein was created based on the pre-procedural CE-MDCT and superimposed on fluoroscopy in real-time. Procedural characteristics as well as hepatic vein catheterization time (HVCT), puncture time (PT), overall procedural time (OPT), fluoroscopy time (FT) and the dose area product (DAP) were evaluated. Thereafter, HVCT, PT, OPT and FT using 3D-VM (61 ± 9 years, 14male) were compared to a previous using classical fluoroscopic guidance (53 ± 9 years, 21male) for two interventional radiologist with less than 3 years of experience in TIPS placement. Results: All TIPS procedure using of 3D/2D image registered 3D-VM were successful with a significant reduction of the PSG (p < 0.0001). No clinical significant complication occurred. HVCT was 14 ± 11 min, PT was 14 ± 6 min, OPT was 64 ± 29 min, FT was 21 ± 12 min and DAP was 107.48 ± 93.84 Gy cm². HVCT, OPT and FT of the interventionalist with less TIPS experience using 3D/2D image registered 3D-VM were statistically different to an interventionalist with similar experience using fluoroscopic guidance (p_HVCT = 0.0022; p_OPT = 0.0097; p_FT = 0.0009). PT between these interventionalists was not significantly different (p_PT = 0.2905). Conclusion: TIPS placement applying registration-based CE-MDCT vessel information for puncture guidance is feasible and safe. It has the potential to improve hepatic vein catherization, portal vein puncture and radiation exposure.

Purpose: To assess the feasibility, safety and effectiveness of portal vein recanalization (PVR)–transjugular portosystemic shunt (TIPS) placement via splenic access using a balloon puncture technique. Materials and Methods: In a single-center retrospective study from March 2017 to February 2021, 14 consecutive patients with portal hypertension, chronic liver disease and portal vein occlusion or near-complete (> 95%) occlusion were referred for PVR–TIPS placement. Feasibility, safety and effectiveness including procedural characteristics such as technical success, complication profile and splenic access time (SAT), balloon positioning time (BPT), conventional portal vein entry time (CPVET), overall procedure time (OPT), fluoroscopy time (FT), dose–area product (DAP) and air kerma (AK) were evaluated. Results: Transsplenic PVR–TIPS using balloon puncture technique was technically feasible in 12 of 14 patients (8 men, 49 ± 13 years). In two patients without detectable intrahepatic portal vein branches, TIPS placement was not feasible and both patients were referred for further treatment with nonselective beta blockers and endoscopic variceal ligation. No complications grade > 3 of the Cardiovascular and Interventional Radiological Society of Europe classification system occurred. The SAT was 25 ± 21 min, CPVET was 33 ± 26 min, the OPT was 158 ± 54 min, the FT was 42 ± 22 min, the DAP was 167.84 ± 129.23 Gy*cm² and the AK was 1150.70 ± 910.73 mGy. Conclusions: Transsplenic PVR–TIPS using a balloon puncture technique is feasible and appears to be safe in our series of patients with obliteration of the portal vein. It expands the interventional options in patients with chronic PVT.

Purpose: To evaluate the feasibility of 2D-perfusion angiography (2D-PA) for the analysis of intra-procedural treatment response after intra-arterial prostaglandin E1 therapy in patients with non-occlusive mesenteric ischemia (NOMI). Methods: Overall, 20 procedures in 18 NOMI patients were included in this retrospective case–control study. To evaluate intra-procedural splanchnic circulation changes, post-processing of digital subtraction angiography (DSA) series was performed. Regions of interest (ROIs) were placed in the superior mesenteric artery (SMA; reference), the portal vein (PV; ROI_PV), as well as the aorta next to the origin of the SMA (ROI_Aorta). Peak density (PD), time to peak (TTP), and area under the curve (AUC) were assessed, and parametric ratios ‘target ROI_{PD, TTP, AUC}/reference ROI’ were computed and compared within treatment and control group. Additionally, a NOMI score was assessed pre- and post-treatment compared to 2D-PA. Results: Vasodilator therapy leads to a significant decrease of the 2D-PA-derived values PD_Aorta (p = 0.04) and AUC_Aorta (p = 0.03). These findings correlated with changes of the simplified NOMI score, both for overall (4 to 1, p < 0.0001) and for each category. Prostaglandin application caused a significant increase of the AUC_PV (p = 0.04) and TTP_PV was accelerated without reaching statistical significance (p = 0.13). When compared to a control group, all 2D-PA values in the NOMI group (pre- and post-intervention) differed significantly (p < 0.05) with longer TTP_Aorta/PV and lower AUC_Aorta/PV and PD _Aorta/PV. Conclusion: 2D-PA offers an objective approach to analyze immediate flow and perfusion changes following vasodilatory therapies of NOMI patients and may be a valuable tool for assessing treatment response.

Background: To synthesize the results of various studies on the readability of ChatGPT and Bard in medical communication. Methods: Systemic literature research was conducted in PubMed, Ovid/Medline, CINAHL, Web-of-Science, Scopus and GoogleScholar to detect relevant publications (inclusion criteria: original research articles, English language, medical topic, ChatGPT-3.5/-4.0, Bard/Gemini, Flesch Reading Ease Score (FRE), Flesch Kincaid Grade Level (FKGL)). Study quality was analyzed using modified Downs-and-Black checklist (max. 8 points), adapted for studies on large language model. Analysis was performed on text simplification and/or text generation with ChatGPT-3.5/-4.0 versus Bard/Gemini. Meta-analysis was conducted, if outcome parameter was reported ≥ 3 studies. In addition, subgroup-analyses among different chatbot versions were performed. Publication bias was analyzed. Results: Overall, 59 studies with 2342 items were analyzed. Study quality was limited with a mean of 6 points for FRE and 7 points for FKGL. Meta-analysis of text simplification for FRE between ChatGPT-3.5/-4.0 and Bard/Gemini was not significant (mean difference (MD):5.03; 95%-confidence interval (CI):-20.05,30.11; p = 0.48). FKGL of simplified texts of ChatGPT-3.5/-4.0 and Bard/Gemini was borderline significant (MD:-1.59; CI:-3.15,-0.04; p = 0.05) and subgroup-analysis between ChatGPT-4.0 and Bard was not significant (MD:-1.68; CI:-3.53,0.17; p = 0.07). Focused on text acquisition, MD for FRE and FKGL of studies on ChatGPT-3.5/-4.0- and Bard/Gemini-generated texts were significant (MD:-10.36; CI:-13.08,-7.64; p < 0.01 / MD:1.62; CI:1.09,2.15; p < 0.01). Subgroup-analysis of FRE was significant for ChatGPT-3.5 vs. Bard (MD:-16.07, CI:-24.90,-7.25; p < 0.01), ChatGPT-3.5 vs. Gemini (MD:-4.51; CI:-8.73,-0.29: p = 0.04), ChatGPT-4.0 vs. Bard (MD:-12.01, CI:-16.22,-7.81; p < 0.01) and ChatGPT-4.0 vs. Gemini (MD:-7.91, CI:-11.68,-4.15; p < 0.01). Analysis of FKGL in the subgroups was significant for ChatGPT-3.5 vs. Bard (MD:2.85, CI:1.98,3.73; p < 0.01), ChatGPT-3.5 vs. Gemini (MD:1.21, CI:0.50,1.93; p < 0.01) and ChatGPT-4.0 vs. Gemini (MD:1.95, CI:1.05,2.86; p < 0.01), but it was not significant for ChatGPT-4.0 vs. Bard (MD:0.64, CI:-0.46,1.74; p = 0.24). Egger’s test was significant in text generation for FRE and FKGL (p < 0.01 / p < 0.01) and in subgroup ChatGPT-4.0 vs. Bard and ChatGPT-4.0 vs. Gemini (p < 0.01 / p = 0.02) for FRE as well as in subgroups ChatGPT-3.5 vs. Bard and ChatGPT-4.0 vs. Gemini for FKGL (p < 0.01 / p < 0.01). Conclusion: Readability of spontaneously generated texts by Bard/Gemini was slightly superior compared to ChatGPT-3.5/-4.0 and readability of simplified texts by ChatGPT-3.5/-4.0 tended to be improved compared to Bard. Results are limited due study quality and publication bias. Standardized reporting could improve study quality and chatbot development.

To evaluate feasibility, frequency and severity of peri-procedural complications and post-procedural adverse events (AEs) in patients with advanced cholangiocarcinoma or liver metastasis of uveal melanoma and prior hemihepatectomy undergoing chemosaturation percutaneous hepatic perfusion (CS-PHP) and to analyze therapy response and overall survival compared to a matched group without prior surgery. CS-PHP performed between 10/2014 and 02/2018 were retrospectively assessed. To determine peri-procedural safety and post-procedural adverse events, hospital records and hematological, hepatic and biliary function were categorized using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 (1–5; mild-death). Significance was tested using Wilcoxon signed-rank and Mann–Whitney U test. Kaplan–Meier estimation and log-rank test assessed survival. Overall 21 CS-PHP in seven patients (4/7 males; 52 ± 10 years) with hemihepatectomy (group^hemihep) and 22 CS-PHP in seven patients (3/7 males; 63 ± 12 years) without prior surgery (group^noresection) were included. No complications occurred during the CS-PHP procedures. Transient changes (CTCAE grade 1–2) of liver enzymes and blood cells followed all procedures. In comparison, group^hemihep presented slightly more AEs grade 3–4 (e.g. thrombocytopenia in 57% (12/21) vs. 41% (9/22; p = 0.37)) 5–7 days after CS-PHP. These AEs were self-limiting or responsive to treatment (insignificant difference of pre-interventional to 21–45 days post-interventional values (p > 0.05)). One patient in group^hemihep with high tumor burden died eight days following CS-PHP. No deaths occurred in group^noresection. In comparison, overall survival after first diagnosis was insignificantly shorter in group^noresection (44.7(32–56.1) months) than in group^hemihep (48.3(34.6–72.8) months; p = 0.48). The severity of adverse events following CS-PHP in patients after hemihepatectomy was comparable to a matched group without prior liver surgery. Thus, the performance of CS-PHP is not substantially compromised by a prior hemihepatectomy.