Robotic versus freehand CT-guided radiofrequency ablation of pulmonary metastases: a comparative cohort study.

PURPOSE: Radiofrequency ablation (RFA) is a curative treatment option for small lung metastases, which conventionally involves multiple freehand manipulations until the treating electrode is satisfactorily positioned. Stereotactic and robotic guidance has been gaining popularity for liver ablation, although has not been established in lung ablation. The purpose of this study is to determine the feasibility, safety, and accuracy of robotic RFA for pulmonary metastases, and compare procedures with a conventional freehand cohort. METHODS: A single center study with prospective robotic cohort, and retrospective freehand cohort. RFA was performed under general anesthesia using high frequency jet ventilation and CT guidance. Main outcomes were (i) feasibility/technical success (ii) safety using Common Terminology Criteria for Adverse Events (iii) targeting accuracy (iv) number of needle manipulations for satisfactory ablation. Robotic and freehand cohorts were compared using Mann-Whitney U tests for continuous variables, and Fisher's exact for categorical variables. RESULTS: Thirty-nine patients (mean age 65 ± 13 years, 20 men) underwent ablation of 44 pulmonary metastases at single specialist cancer center between July 2019 and August 2022. 20 consecutive participants underwent robotic ablation, and 20 consecutive patients underwent freehand ablation. All 20/20 (100%) robotic procedures were technically successful, and none were converted to freehand procedures. There were 6/20 (30%) adverse events in the robotic cohort, and 15/20 (75%) in the freehand cohort (P = 0.01). Robotic placement was highly accurate with 6 mm tip-to-target distance (range 0-14 mm) despite out-of-plane approaches, with fewer manipulations than freehand placement (median 0 vs. 4.5 manipulations, P < 0.001 and 7/22, 32% vs. 22/22, 100%, P < 0.001). CONCLUSIONS: Robotic radiofrequency ablation of pulmonary metastases with general anesthesia and high frequency jet ventilation is feasible and safe. Targeting accuracy is high, and fewer needle/electrode manipulations are required to achieve a satisfactory position for ablation than freehand placement, with early indications of reduced complications.

Outcome of radiological interventions in pediatric gastrointestinal diseases: A large tertiary center experience.

BACKGROUND: Interventional radiology (IR) is an indispensable component of multidisciplinary care in various gastrointestinal (GI) diseases. The literature on safety and utility of IR is limited in children. OBJECTIVES: In this study, we aim to analyze the outcomes of IR in various pediatric GI diseases. METHODS: The data of children (≤18 years) who underwent radiological interventions for GI disorders (2009-2017) were analyzed, retrospectively. The indications for interventions included vascular (Budd Chiari syndrome [BCS], pseudoaneurysm) and nonvascular (pancreatic fluid collections [PFCs], cholangitis and anastomotic biliary strictures). The outcomes of radiological interventions, including success and adverse events, were assessed. RESULTS: A total of 93 children (mean age 13.45 ± 4.09 years) underwent radiological interventions for vascular (chronic BCS = 14, pseudoaneurysm = 28) or nonvascular (PFCs = 33, hepaticojejunostomy strictures or leaks = 12, cholangitis = 6) indications. Of 33 children who underwent drainage of PFCs, clinical success was noticed in 32 children during a mean follow-up of 32.4 ± 21.66 months; 11 children with persistent external pancreatic fistula were managed with endoscopic pancreatic ductal stenting (8 children) and internalization of transgastric drain (3 children). In children who underwent hepatic vein or inferior vena cava stenting for BCS, mean stent patency was 78.57% during a follow-up of 24.1 ± 13.78 months. In children with pseudoaneurysms, angioembolization was successfully performed in 92.8% patients. Re-bleeding was noticed in two children, one of whom required reintervention. In children who underwent percutaneous transhepatic biliary drainage, resolution of anastomotic strictures was noticed in all during a follow-up of 36.1 ± 13.73 months. CONCLUSION: Interventional radiology is safe and effective in the management of various pediatric GI diseases.

Assessment of MRI as a Modality for Evaluation of Soft Tissue Injuries of the Spine as Compared to Intraoperative Assessment.

INTRODUCTION: Traumatic injuries of the spine and spinal cord are potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that directly compare MR imaging findings to surgical findings. AIM: Hence, this study was undertaken to assess the sensitivity of MRI in identifying injuries to the soft tissue structures of the spine. MATERIALS AND METHODS: MRI scans were performed on 31 cases of acute spinal injuries that presented within 72 hours of the trauma and underwent surgical fixation by either an anterior or posterior approach. The non-osseous structures namely; Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament (ISP) and the Spinal Cord were evaluated. They were classified as 'True Positive' if an injury was found to correlate with intraoperative findings and as 'False Negative' when diagnosed falsely as normal. The statistical sensitivity of MRI in diagnosing injuries to the non-osseous structures of the spine were thus calculated. RESULTS: Of the 31 patients, in 51.6% of patients the site of injury was to the cervical spine (n=16), thoracic spine was the next highest in occurrence of 39% (n=12) and lumbar spine accounted for the least. In correlating the imaging findings to the intraoperative findings, MRI was highly sensitive in detecting injuries to the Posterior Longitudinal Ligament (94.4%) and the Spinal cord (93%) and fairly high in detecting injuries to the Intervertebral disc. However coming to the ligamentum flavum and interspinous ligaments, the sensitivity of the MRI dropped to 62.5% and 63.6% respectively. CONCLUSION: MRI was found to be highly sensitive in detecting injuries to the spinal cord and the posterior longitudinal ligament and moderately sensitive for detection of disc injuries. Though concerning the Anterior Longitudinal Ligament, Ligamentum Flavum and the Interspinous Ligaments MRI performed ineffectively with higher number of false negative interpretations.

A Comparative Study of Sonographic Grading of Renal Parenchymal Changes and Estimated Glomerular Filtration Rate (eGFR) using Modified Diet in Renal Disease Formula.

INTRODUCTION: The sonographic findings are of help in evaluating the nephrological diseases. Glomerular filtration rate is another parameter for assessing the reserved renal function and an indicator of prognosis. In clinical practice GFR estimation (eGFR) is done by using a mathematical formula. In our study, we compared the sonographic grading of renal parenchymal changes with eGFR calculated using Modified Diet in Renal Diseases formula based on serum creatinine, age, gender and ethnicity. AIM: To evaluate the relevance of sonographic grading of renal parenchymal changes in assessing the severity of the renal disease and comparing it to the eGFR calculated using MDRD formula based on the age, gender and serum creatinine value of the patient. MATERIALS AND METHODS: The adult patients with suspected kidney disease referred for sonography of abdomen were our study participants. As per our study design following strict inclusion and exclusion criteria, patients were selected as study participants and for each of the patient's renal parenchymal status, serum creatinine, age, gender and ethnicity were documented. RESULTS: A total of 70 patients were our study participants, out of which 67.1% were males and 32.9% were females. Our study showed a linear correlation between sonographic grading of renal parenchymal changes with eGFR. CONCLUSION: We conclude that by evaluating the kidneys with sonography and calculating eGFR using MDRD formula the renal status will be more accurately interpreted.

Diagnostic accuracy of high resolution ultrasound to differentiate neoplastic and non neoplastic causes of cervical lymphadenopathy.

INTRODUCTION: Lymph nodes are normal structures distributed throughout the human body and are enlarged in various disease entities. Identifying the relevant lymph nodes is important in treating these patients. High resolution sonography (HRSG) and fine needle aspiration cytology (FNAC) play crucial role in planning the treatment. OBJECTIVE: To assess the diagnostic accuracy of HRSG differentiate neoplastic and non neoplastic causes of enlarged cervical lymph nodes. MATERIALS AND METHODS: HRSG evaluation of enlarged cervical lymph nodes were performed to differentiate neoplastic from non neoplastic lymph nodes followed by FNAC correlation and the accuracy of HRSG was studied. RESULTS: One hundred and fourteen lymph nodes of 106 patients were analysed to accomplish the study objective. In our study, HRSG had 96% sensitivity and 90.6% specificity for differentiating between neoplatic and non-neoplastic cervical lymphadenopathy. Similarly positive and negative predictive values were 88.9% and 96.7% respectively. Overall accuracy of HRSG was 93%. CONCLUSION: Owing to high sensitivity and negative predictive value, HRSG with Doppler is an excellent first line investigating tool for enlarged lymph nodes and avoids invasive procedures like FNAC in cases of reactive/ inflammatory (non-neoplastic) lymph nodes. However, neoplastic diagnosis of HRSG needs further confirmation by FNAC.