Hypertension crises and management during radiofrequency ablation of adrenal pheochromocytoma: A case report.

This case report describes the radiofrequency (RF) ablation of a pheochromocytoma in a 35-year-old female with multiple endocrine neoplasia (MEN) II syndrome, who previously underwent a right adrenalectomy and thyroidectomy. The patient presented with a new tumor in the left adrenal gland, detected via imaging, without evidence of metastasis. Opting against surgical adrenalectomy due to previous surgeries, she underwent RF ablation after preparatory alpha and beta blockader. During RF ablation, a hypertensive crisis occurred, managed effectively with nitroprusside sodium and supportive measures. Postprocedure recovery was uneventful, with normal metanephrine levels and imaging indicating successful ablation. This report highlights the feasibility and challenges of using RF ablation for adrenal pheochromocytoma, suggesting a potential shift towards less invasive management for select cases.

An Evaluation of Ultrasound-Guided Percutaneous Microwave Ablation for the Treatment of Symptomatic Uterine Fibroids.

PURPOSE: To evaluate the feasibility and effectiveness of ultrasound-guided percutaneous microwave ablation (MWA) for the treatment of symptomatic uterine fibroids. MATERIALS AND METHODS: A single-center retrospective study was conducted on 17 patients, mean age 37.5 years (SD ± 7.3; range 19-47 years) with symptomatic uterine fibroid who underwent MWA between September 2018 and December 2022. Outcomes included volume reduction of uterine fibroids, hemoglobin levels, uterine fibroid symptoms, and health-related quality-of-life questionnaire scores before and 12 months after ablation. RESULTS: Preoperative fibroid diameter was a mean of 6.7 cm (SD ± 1.1; range 5-9 cm), and volume was a mean of 101.9 cm3 (SD ± 63.3; range 16.9-264.1 cm3). The mean ablation time was 12.2 minutes (SD ± 3.1; range, 8-20 minutes). The mean reduction of volume at 12 months after treatment was 70.9% (SD ± 23.8). The hemoglobin level increased significantly from 9.96 g/dL ± 2.33 before treatment to 12.14 g/dL ± 1.34 at 12 months after treatment (P = .002). The symptom severity score and health-related quality-of-life scores were significantly improved at follow-up (P < .001). CONCLUSIONS: The application of MWA as a standalone treatment method might provide an effective, minimally invasive option for Federation of Gynecology and Obstetrics Types 1-6 symptomatic uterine fibroids with the potential to enhance patients' quality of life.

CT-guided Transgluteal Prostate Fiducial Marker Insertion for Localized Radiation Therapy.

PURPOSE: To Evaluate the safety and technical success of transgluteal CT-guided fiducial marker implantation into the prostate as an alternative method to transperineal and transrectal approaches. MATERIAL AND METHODS: We retrospectively identified all patients who had undergone CT-guided transgluteal fiducial marker insertion between 2020 and 2022. Four patients with confirmed prostate cancer were identified. One radiologist performed all procedures via a bilateral transgluteal approach under the guidance of real-time CT-fluoroscopy. Twenty cm long pre-waxed 18G guiding needles, preloaded with smooth gold fiducial markers, were used to implant markers. Technical success was defined as the successful placement of the fiducial markers into the planned positions. RESULTS: The mean age of patients was 70 years. The mean procedure time was 19.25 (SD: 6.75) min, and the mean total dose length product (DLP) was 801.75 (SD: 291.17) mGycm, which is compatible with the 12 mSv estimated effective dose. All procedures were technically successful (100%). All patients tolerated the procedure and did not require any analgesia for pain, and there were no requests to stop or pause the procedure. Only one patient reported hematuria one day after the procedure, which required no treatment. CONCLUSION: Transgluteal CT-guided fiducial marker implantation into the prostate is an alternative method to transperineal and transrectal approaches. In this technique, the risk of septic complications is minor, and general anesthesia is not required. Thus, transgluteal CT-guided marker insertion is a feasible and well-tolerated method for image-guided radiation therapy (IGRT) in patients with prostate cancer.

Survival outcomes and quality of life after percutaneous cryoablation for liver metastasis: A systematic review and meta-analysis.

BACKGROUND: Liver metastasis is present in a wide range of malignancies, with colorectal cancer as the most common site. Several minimally invasive treatments have been suggested for managing hepatic metastases, and cryoablation is among them, yet not widely used. In this systematic review, we aimed to assess the effectiveness of percutaneous cryoablation in all types of liver metastases. METHODS: A systematic search was performed in international databases, including PubMed, Scopus, Embase, and Web of Science, to find relevant studies reporting outcomes for percutaneous cryoablation in liver metastasis patients. In addition to baseline features such as mean age, gender, metastasis origin, and procedure details, procedure outcomes, including overall survival, local recurrence, quality of life (QoL), and complications, were extracted from the studies. Random-effect meta-analysis was performed to calculate the mean difference (MD) and 95% confidence interval for comparison of QoL. RESULTS: We screened 2131 articles. Fifteen studies on 692 patients were included. Mean overall survival ranged from 14.5-29 months. The rate of local recurrence in the included studies ranged from 9.4% to 78%, and local control progression-free survival ranged from 1 to 31 months. The total QoL decreased one week after the cryoablation procedure (-3.08 [95% Confidence interval: -4.65, -1.50], p-value <0.01) but increased one month (5.69 [3.99, 7.39], p-value <0.01) and three months (3.75 [2.25, 5.24], p-value <0.01) after the procedure. CONCLUSION: Cryoablation is an effective procedure for the treatment of liver metastases, especially in cases that are poor candidates for liver resection. It could significantly improve QoL with favorable local recurrence.

The role of imaging techniques in understanding and evaluating the long-term pulmonary effects of COVID-19.

INTRODUCTION: Limited data exist regarding the long-term pulmonary sequelae of COVID-19. Identifying features utilizing multiple imaging modalities engenders a clearer picture of the illness's long-term consequences. AREAS COVERED: This review encompasses the common pulmonary findings associated with different imaging modalities during acute and late remission stages of COVID-19 pneumonia. EXPERT OPINION: Chest x-ray, a common preliminary diagnostic imaging technique, is not optimal for extended care due to limited tissue contrast resolution providing suboptimal assessment of pulmonary pathology and subtle interval changes. Ultrasound may be utilized on a case-by-case basis in certain patient populations, or in countries with limited resources. Chest CT's accessibility, high tissue contrast and spatial resolution make it the foremost modality for long-term COVID-19 follow-up. While MRI can viably monitor extrapulmonary disease due to its lack of radiation and high inherent soft-tissue contrast, it has limited pulmonary utility due to motion artifact and alveolar gas decreasing lung signal. Although 18F-FDG-PET/CT is costly and has limited specificity, it can provide molecular level data and inflammation quantification. Lung perfusion scintigraphy may also explain COVID-19 induced thromboembolic events and persistent dyspnea despite normal structural imaging and testing results. Correlating the long-term pulmonary findings of COVID-19 with each imaging modality is essential in elucidating the post-recovery course.

Magnetic resonance imaging features of coronavirus disease 2019 (COVID-19) pneumonia: The first preliminary case series.

RATIONALE AND OBJECTIVES: There is a rising onus on understanding the common features of COVID-19 pneumonia on different imaging modalities. In this study, we aimed to review and depict the common MRI features of COVID-19 pneumonia in our laboratory confirmed case series, the first comprehensive reported cohort in the literature. MATERIALS AND METHODS: Upon IRB approval, eight laboratory confirmed COVID-19 patients who presented to our outpatient imaging clinic underwent chest CT and, once various features of COVID-19 pneumonia were identified, a dedicated multisequence chest MRI was performed on the same day with an institutional protocol. Demographic data and the morphology, laterality and location of the lesions were recorded for each case. RESULTS: Five males and three females with the mean age of 40.63 ± 12.64 years old were present in this case series. Five cases had typical CT features with ground glass opacities and consolidations, readily visible on different MRI sequences. Three cases had indeterminate or atypical features which were also easily seen on MRI. The comprehensive review of MRI features for each case and representative images have been illustrated. CONCLUSION: Becoming familiar with typical findings of COVID-19 pneumonia in MRI is crucial for every radiologist. Although MRI is not the modality of choice for evaluation of pulmonary opacities, it has similar capabilities in detection of COVID-19 pneumonia when compared to chest CT.

Fibrin sealants in lumbar annuloplasty after endoscopic discectomy as a method to prevent recurrent lumbar disc herniation.

Fibrin sealant as a promising agent for providing scaffold and efficient hemostasis is widely accepted in several specialties. However, the outcome of Fibrin sealants in lumbar annuloplasty after endoscopic discectomy has not been evaluated in patients with disc herniation. The goal of this study was to evaluate the efficacy, response, and probability of future recurrence rates in herniated nucleus pulposus (HNP) with the use of fibrin sealant in conjunction with endoscopic disc surgery. A total of 35 patients (28 men, 7women) were evaluated, including 18 patients who underwent endoscopic discectomy alone and 17 patients that received fibrin sealant at the site of annulus tear and endoscopic discectomy. All patients were followed through both clinical and imaging methods for an average of 10.5 months. Primary outcome measure was defined as lumbar decompression approved by imaging and symptom alleviation after endoscopic spinal discectomy with Visual Analogue Scale (VAS) score ≤ 4 (cut-off point). Median size of annular tearing was significantly lower in the endoscopic discectomy group (median, 3) (minimum, 2; maximum, 5); however, the corresponding factor in the endoscopic discectomy plus fibrin sealant group was significantly larger (median, 6) (minimum, 5; maximum, 10), with P <0.001. Only one patient in the endoscopic discectomy group had an HNP recurrence during follow-up compared to two patients in the endoscopic discectomy plus fibrin sealant group. Due to the temporary effects of fibrin sealant in preventing disc herniation and the observed recurrence rate in both the case and control groups, the results of this study suggest a role of fibrin sealants combined with endoscopic discectomy to prevent early HNP recurrence rate.

New Policy and Regulations for a Radiology-Oncology Center During the COVID-19 Outbreak in Tehran, Iran.

On February 19, 2020, the first case of a patient infected with Coronavirus Disease-2019 (COVID-19) was announced in Iran. The number of infected patients increased rapidly, and all health care centers faced an extremely challenging situation in Iran. The centers had to adopt new regulations and approaches to keep their patients and staff safe while providing service to society. Patients diagnosed with a malignancy are at a higher risk for infection with COVID-19 with a poorer prognosis. The Pardis Noor Radiology-Oncology center is a private center in Tehran composed of different departments, including radiation therapy and chemotherapy. Soon after the outbreak, we changed our rules and regulations for patients and staff. This is a report from a private radiology-oncology center in Tehran during the COVID-19 outbreak.

Common CT Findings of Novel Coronavirus Disease 2019 (COVID-19): A Case Series.

Given the highly infectious nature of the coronavirus disease 2019 (COVID-19) virus and the lack of proven specific therapeutic drugs and licensed vaccines effective against it, early diagnosis of the disease is of paramount importance. The common chest CT imaging of confirmed COVID-19 cases is discussed here, which shows ground-glass opacity, crazy paving, and consolidation.

The Role of Emergency Radiology in COVID-19: From Preparedness to Diagnosis [Formula: see text].

Emergency trauma radiology, although a relatively new subspecialty of radiology, plays a critical role in both the diagnosis/triage of acutely ill patients, but even more important in providing leadership and taking the lead in the preparedness of imaging departments in dealing with novel highly infectious communicable diseases and mass casualties. This has become even more apparent in dealing with COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, first emerged in late 2019. We review the symptoms, epidemiology, and testing for this disease. We discuss characteristic imaging findings of COVID-19 in relation to other modern coronavirus diseases including SARS and MERS. We discuss roles that community radiology clinics, outpatient radiology departments, and emergency radiology departments can play in the diagnosis of this disease. We review practical methods to reduce spread of infections within radiology departments.

Transarterial Bleomycin-Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma.

BACKGROUND: Large hepatic hemangiomas can cause symptoms such as pain and bleeding. No consensus currently exists on the optimal management of large and symptomatic hemangiomas. The purpose of this study was to evaluate the role of transarterial bleomycin-lipiodol embolization (B/LE) in the treatment of symptomatic large hepatic hemangioma. MATERIALS AND METHODS: We retrospectively reviewed 23 patients (29 hemangiomas) treated between July 2011 and August 2017. Transarterial B/LE was performed using 7-15 cc of Lipiodol mixed with 30-45 IU of bleomycin by standard three-way stopcocks. All patients were followed clinically and by imaging for an average of 7.5 months. Patterns of bleomycin-lipiodol distribution in the periphery of hemangiomas were categorized into four different grades. Technical success was defined as proper delivery of bleomycin-lipiodol into the hemangioma confirmed by post-embolization computed tomography. Clinical success was defined as more than 50% reduction of hemangioma volume and symptom improvement during follow-ups. RESULTS: Technical success and clinical success were 100 and 73.9% (17 patients), respectively. Six patients (26.08%) experienced transient post-embolization syndrome. Significant size reduction was seen in patients with grade 4 hemangioma border coverage (P = 0.042). CONCLUSION: Transarterial B/LE is a safe and efficient alternative for controlling symptoms related to large hemangiomas.

Repeated Intraportal Injection of Mesenchymal Stem Cells in Combination with Pioglitazone in Patients with Compensated Cirrhosis: A Clinical Report of Two Cases.

BACKGROUND: Transplantation of mesenchymal stem cells (MSCs) in combination with pioglitazone, an agonist of peroxisome proliferator-activated receptor-γ (PPAR-γ), can reduce liver fibrosis in models of liver injury. In this study, we conducted a pilot study of intraportal infusion of autologous MSCs in combination with pioglitazone to assess safety, feasibility, and effectiveness in patients with compensated cirrhosis. METHODS: Two patients with compensated cirrhosis were enrolled in this study. Intraportal autologous bone marrow-derived MSCs were transplanted twice (6 months interval) to the patients. Meanwhile, 30 mg/day pioglitazone was prescribed for 12 months.  Patients were assessed at baseline and months 1, 3, 6, and 12 post-infusion. RESULTS: Procedural complications or any major adverse effects did not occur in this pilot study.  The patients' clinical conditions remained stable with no evidence of deterioration during the course of the study. A transient improvement in the Model for End-Stage Liver Disease (MELD) score was observed at month 3 post-infusion in one patient, which eventually returned to baseline at month 12. CONCLUSION: The combination of pioglitazone with MSCs is safe and feasible. The data justify further study of the combination therapy in cirrhotic patients.

Intraportal Infusion of Bone Marrow Mononuclear or CD133+ Cells in Patients With Decompensated Cirrhosis: A Double-Blind Randomized Controlled Trial.

UNLABELLED: The present study assessed the effects of intraportal infusions of autologous bone marrow-derived mononuclear cells (MNCs) and/or CD133+ cells on liver function in patients with decompensated cirrhosis. We randomly assigned 27 eligible patients to a placebo, MNCs, and/or CD133+ cells. Cell infusions were performed at baseline and month 3. We considered the absolute changes in the Model for End-Stage Liver Disease (MELD) scores at months 3 and 6 after infusion as the primary outcome. The participants and those who assessed the outcomes were unaware of the treatment intervention assignments. After 6 months, 9 patients were excluded because of liver transplantation (n=3), hepatocellular carcinoma (n=1), loss to follow-up (n=3), and death (n=2). The final analysis included 4 patients from the CD133+ group, 8 from the MNC group, and 6 from the placebo group. No improvement was seen in the MELD score at month 6 using either CD133+ cells or MNC infusions compared with placebo. However, at month 3 after infusion, a trend was seen toward a higher mean absolute change in the MELD score in patients who had received CD133+ cells compared with placebo (-2.00±1.87 vs. -0.13±1.46; p=.08). No significant adverse events occurred in the present study. A transient improvement in the MELD score was observed in subjects treated with CD133+ cells but not in the MNC or placebo group. Although the study was not powered to make definitive conclusions, the data justify further study of CD133+ therapy in cirrhotic patients. SIGNIFICANCE: Cell therapy is a new approach in liver disease. Several clinical experiments have been reported on the safety of bone marrow-derived stem cells to treat liver disorders. However, the effectiveness of these approaches in the long-term follow-ups of patients initiated controversial discussions among the scientific community. A double-blind randomized controlled trial was designed to address this concern scientifically. A transient improvement in the patients' signs occurred; however, for a sustainable result, more work is needed. The results of multiple administrations of cells reported in the present study can be compared with the results from other single-injection studies.

Technical Considerations of Phosphorous-32 Bremsstrahlung SPECT Imaging after Radioembolization of Hepatic Tumors: A Clinical Assessment with a Review of Imaging Parameters.

Background. Bremsstrahlung (BS) imaging during radioembolization (RE) confirms the deposition of radiotracer in hepatic/extrahepatic tumors. The aim of this study is to demonstrate (32)P images and to optimize the imaging parameters. Materials and Methods. Thirty-nine patients with variable types of hepatic tumors, treated with the intra-arterial injection of (32)P, were included. All patients underwent BS SPECT imaging 24-72 h after tracer administration, using low energy high resolution (LEHR) (18 patients) or medium energy general purpose (MEGP) (21 patients) collimators. A grading scale from 1 to 4 was used to express the compatibility of the (32)P images with those obtained from CT/MRI. Results. Although the image quality obtained with the MEGP collimator was visually and quantitatively better than with the LEHR (76% concordance score versus 71%, resp.), there was no statistically significant difference between them. Conclusion. The MEGP collimator is the first choice for BS SPECT imaging. However, if the collimator change is time consuming (as in a busy center) or an MEGP collimator is not available, the LEHR collimator could be practical with acceptable images, especially in a SPECT study. In addition, BS imaging is a useful method to confirm the proper distribution of radiotherapeutic agents and has good correlation with anatomical findings.

Classification of normal and diseased liver shapes based on Spherical Harmonics coefficients.

Liver-shape analysis and quantification is still an open research subject. Quantitative assessment of the liver is of clinical importance in various procedures such as diagnosis, treatment planning, and monitoring. Liver-shape classification is of clinical importance for corresponding intra-subject and inter-subject studies. In this research, we propose a novel technique for the liver-shape classification based on Spherical Harmonics (SH) coefficients. The proposed liver-shape classification algorithm consists of the following steps: (a) Preprocessing, including mesh generation and simplification, point-set matching, and surface to template alignment; (b) Liver-shape parameterization, including surface normalization, SH expansion followed by parameter space registration; (c) Feature selection and classification, including frequency based feature selection, feature space reduction by Principal Component Analysis (PCA), and classification. The above multi-step approach is novel in the sense that registration and feature selection for liver-shape classification is proposed and implemented and validated for the normal and diseases liver in the SH domain. Various groups of SH features after applying conventional PCA and/or ordered by p-value PCA are employed in two classifiers including Support Vector Machine (SVM) and k-Nearest Neighbor (k-NN) in the presence of 101 liver data sets. Results show that the proposed specific features combined with classifiers outperform existing liver-shape classification techniques that employ liver surface information in the spatial domain. In the available data sets, the proposed method can successful classify normal and diseased livers with a correct classification rate of above 90 %. The performed result in average is higher than conventional liver-shape classification method. Several standard metrics such as Leave-one-out cross-validation and Receiver Operating Characteristic (ROC) analysis are employed in the experiments and confirm the effectiveness of the proposed liver-shape classification with respect to conventional techniques.

Management of Intravenous Contrast Extravasations with Ultrasonography: A Case Report.

Extravasation of ionic and nonionic contrast materials is a well-recognized complication of contrast-enhanced imaging studies. Complications vary from minimal swelling to severe skin and subcutaneous ulceration, necrosis, and compartment syndrome. We report a case of Omnipaque (iohexol) extravasation in a 50-year-old man with erythema, blistering, and compartment syndrome who was treated medically but was not cured. Using gray scale ultrasonography, we determined the characteristics of the lesion, its distance from the skin, and its proximity to the vessels. We then determined the depth of the lesion, and then inserted the tip of the needle into the lesion. We also used ultrasonography in locations where extravasation was near an artery. After aspiration, the diameter of the lesion decreased significantly. The patient was cured by ultrasonography-guided aspiration from the extravasated site.

Randomized placebo-controlled trial of mesenchymal stem cell transplantation in decompensated cirrhosis.

BACKGROUND & AIMS: There has been great interest in recent years to take advantage of bone marrow stem cells to treat cirrhosis. Our uncontrolled trial showed promising results for bone marrow mesenchymal stem cell (MSC) transplantation in cirrhosis. Therefore, we conducted a randomized, placebo-controlled trial to evaluate the efficacy of autologous MSC transplantation in cirrhosis. METHODS: The enrolled patients with decompensated cirrhosis were randomly assigned to receive MSC or placebo infusions. A median of 195 million (range: 120-295 million) cultured MSCs were infused through a peripheral vein. The primary outcome was absolute changes in MELD score. Secondary outcomes were absolute changes in Child score, liver function tests and liver volumes between the MSC and placebo group 12 months after infusion. RESULTS: A total of 27 patients were enrolled. Of these, 15 patients received MSC and 12 patients received placebo. One patient in the MSC group and one patient in the placebo group were lost to follow-up. Three patients in the MSC group died of liver failure 3 months (one patient), or 5 months (two patients) after cellular infusion. The baseline MELD scores of the deceased patients were significantly higher than those who remained alive in either group (20.0 vs. 15.1; P = 0.02). The absolute changes in Child scores, MELD scores, serum albumin, INR, serum transaminases and liver volumes did not differ significantly between the MSC and placebo groups at 12 months of follow-up. CONCLUSION: Based on this randomized controlled trial, autologous bone marrow MSC transplantation through peripheral vein probably has no beneficial effect in cirrhotic patients. Further studies with higher number of patients are warranted to better clarify the impact of MSC infusion through peripheral vein or portal vein in cirrhosis.

Three cuts method for identification of COPD.

Two main forms of COPD (Chronic Obstructive Pulmonary Disease) refer to a group of lung diseases that block airflow and cause a huge degree of human suffering. A new method for identifying and estimating the severity of COPD from three-dimensional (3-D) pulmonary X-ray CT images would be helpful for evaluation of treatment effects and early diagnosing is presented in this paper. This method has five main steps. Firstly, corresponding positions of lungs in inspiration and expiration are found based on anatomical structures. Secondly, lung regions are segmented from the CT images by active contours. Next, the left and right lungs are separated using a sequence of morphological operations. Then, parenchyma variations of three main cuts which selected by a feed-forward neural network are found based on the inspiratory and expiratory states. Finally, a pattern classifier is used to decide about the disease and its severity. Twenty patients with air-trapping problems and twelve normal adults were enrolled in this study. Based on the results, a mathematical model was developed to relate variations of lung volumes to severity of disease. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the accuracy of our method for right regions were %81.6, %80.5, %87.5, %72.5 and %81.3 respectively. And these parameters for left regions were %90, %83.3, %90, %83.3 and %87.5 respectively. The proposed method may assist radiologists in detection of Asthma and COPD as a computer aided diagnosis (CAD) system.

Complementary effect of H MRS in diagnosis of suprasellar tumors.

OBJECTIVE: Suprasellar tumors are considered exceptionally important in neurosurgical practice due to their proximity to vital portions of the brain. Predicting histology of these tumors is of prime importance in determining the surgical approach, prognosis, and probable postoperative complications. There are numerous cases where computed tomography and magnetic resonance imaging (MRI) fail to predict histology. We have studied the role of magnetic resonance spectroscopy (MRS) in the diagnosis of suprasellar tumors. METHODS: Twenty-three patients with primary nonfunctional suprasellar tumors and high-quality magnetic resonance spectra were studied. The most probable diagnosis (adenoma, meningioma, craniopharyngioma, or astrocytoma) was made by a neuroradiologist based on the MRI findings and then based on MRI plus MRS findings. Finally, the results were compared with the pathology report. RESULTS: The information provided by MRS led the radiologist to alter his prior diagnosis that was based on the MRI in four patients, and the final diagnoses were in accordance with the histopathology. Wrong diagnosis was made by MRI plus MRS in three patients. Test efficiency of MRI was 69.6%, and it was 87% for MRI plus MRS. However, the difference was not statistically significant (P value=.152). CONCLUSION: MRS may be useful in providing a more improved preoperative diagnosis of suprasellar tumors.