Prostate shapes on pre-treatment MRI between prostate cancer patients who do and do not undergo biochemical recurrence are different: Preliminary Findings.

Early identification of PCa patients at risk for biochemical recurrence (BCR) post-therapy will potentially complement definitive therapy with either neo- or adjuvant therapy to improve prognosis. BCR post definitive therapy is often associated with disease progression that might cause a bulge in the prostate gland. In this work we explored if an atlas-based comparison approach reveals shape differences in the prostate capsule as observed on pre-treatment T2-weighted MRI between prostate cancer patients who do (BCR +) and do not (BCR -) have BCR following definitive therapy. A single center IRB approved study included 874 patients. Complete image datasets, clinically localized PCa, availability of Gleason score, data available for post-treatment PSA and follow-up for at least 3 years in patients without BCR were the inclusion criteria to select 77 patients out of the 874 patients. Further controlling for Gleason score, stage, age and to maintain equal number of cases for the BCR + and BCR - categories, the total number of cases was reduced to 50. Manually segmented prostate capsules were aligned to a BCR - template for statistical comparison between the BCR + and BCR - groups. Statistically significant shape difference between the two groups was observed towards the lateral and the posterior sides of prostate.

Added Value of Covered Stents in Transjugular Intrahepatic Portosystemic Shunt: A Large Single-Center Experience.

PURPOSE: Transjugular intrahepatic portosystemic shunts (TIPS) were historically placed using uncovered bare-metal stents. Current practice has now shifted toward the use of polytetrafluoroethylene (PTFE)-covered stents, given the improved primary patency seen with these stents. The aim of this study was to determine whether there is any added value, such as overall survival or stent patency, when using covered stents versus uncovered stents in TIPS placement in a large cohort. MATERIALS AND METHODS: From April 1995 to June 2012, a total of 744 consecutive adult patients underwent de novo TIPS placement (378 receiving uncovered stents, 366 receiving covered stents). Information was obtained on demographics, baseline clinical variables, and outcomes after TIPS placement. Data were collected, compared, and analyzed to assess outcomes including mortality, primary patency (determined via repeat intervention), and secondary patency (determined via ultrasound parameters). RESULTS: Covered stents were associated with significantly improved primary patency (P < 0.001) and secondary patency (P < 0.001) when compared with uncovered stents in TIPS procedures. Additionally, covered stents were associated with higher estimated overall survival rates and higher survival rates when TIPS was performed emergently and in patients with higher Model for End-Stage Liver Disease (MELD) scores. For example, in patients with MELD scores between 11 and 18, there was a predicted survival of 59.2% with covered stents versus 42.8% with uncovered stents at 1 year. CONCLUSION: This study demonstrated that covered stents offer the additional value of higher estimated overall survival and higher estimated survival in patients undergoing TIPS emergently and in those with higher MELD scores when compared to uncovered stents.

Evaluating the safety and effectiveness of percutaneous acetabuloplasty.

PURPOSE: To evaluate the safety and effectiveness of percutaneous acetabuloplasty in treating the pain and disability related to metastatic lesions of the acetabulum. MATERIALS AND METHODS: This institutional review board approved retrospective study examined 11 patients who underwent percutaneous acetabuloplasty in our hospital from April 2007 to June 2010. All patients gave informed consent prior to the procedure, and all records were HIPAA compliant. Chart review was performed to collect patient demographics and to assess pre- and post-treatment patient performance on the Visual Analog Scale, Functional Mobility Scale and Analgesic Scale. Paired testing comparing the pre- and post-treatment scores for each patient was performed using the Wilcoxon signed rank test. RESULTS: There were 11 procedures: 10 performed under CT guidance and one using fluoroscopic guidance. There was a statistically significant decrease in patient Visual Analog Scale score (p=0.001) and Functional Mobility Scale score (p=0.03) after treatment. There was no change in median Analgesic Scale scores pre- and post-treatment although paired testing revealed a trend towards reduced analgesic use postoperatively (p=0.06). There were no clinically significant complications in this series. CONCLUSION: Percutaneous acetabuloplasty appears to be safe and effective for improving the pain and decreased mobility secondary to metastatic lesions of the acetabulum.

Percutaneous sacroplasty.

The recognition of sacral insufficiency fractures continues to be poor, and diagnosis is often delayed resulting in significant morbidity. Percutaneous sacroplasty is an image guided procedure that is safe and potentially effective for treating the pain and disability related to these fractures. Several cohort studies reviewed here report successful outcomes using this procedure, with patients experiencing nearly full pain relief immediately and longitudinally. As with the well proven results from percutaneous vertebral augmentation within the thoracic and lumbar spine, sacroplasty reduces the cost associated with bed rest and physical therapy and allows patients to return to activities of daily living sooner than with conservative therapy.