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PURPOSE: To examine short-term outcomes and complications in patients with a solitary kidney treated with irreversible electroporation (IRE) for a potentially malignant renal mass. MATERIALS AND METHODS: Five patients (2 female, 3 male; mean age, 66 y) with 7 lesions who underwent IRE for renal tumors in a solitary kidney between August 2014 and August 2015 were retrospectively reviewed. Changes in signal intensity (SI) of the treated lesion were evaluated on contrast-enhanced magnetic resonance imaging. To evaluate functional outcome, creatinine levels and estimated glomerular filtration rate (eGFR) were compared vs baseline after 1 day, 2-7 days, 3-6 weeks, and 6-12 weeks after the intervention. RESULTS: Mean tumor diameter was 24.4 mm (range, 15-38 mm), with an average score of 7.7 (range, 4-9) per R.E.N.A.L. criteria (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines). There was a progressive, significant decrease in treated tumor SI on follow-up imaging (mean, 70%-82%), suggesting a treatment response rate of 100% at a mean follow-up of 6.4 months (range, 3-11 mo). Two minor acute complications (Society of Interventional Radiology class A) occurred: transient gross hematuria and stage I acute kidney failure. Overall, there was no significant decrease in eGFR (-2.75 mL/min) over 3 months, even though 1 patient's eGFR decreased from > 60 mL/min/1.73m(2) to 44 mL/min/1.73m(2). CONCLUSIONS: The data suggest that percutaneous IRE for renal mass in patients with a solitary kidney is safe and feasible. It may help to preserve renal function and offers promising short-term oncologic results.
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Técnicas de Ablación , Electroporación , Neoplasias Renales/cirugía , Nefrectomía , Técnicas de Ablación/efectos adversos , Técnicas de Ablación/mortalidad , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Anciano , Biomarcadores/sangre , Creatinina/sangre , Estudios de Factibilidad , Femenino , Tasa de Filtración Glomerular , Hematuria/diagnóstico , Hematuria/etiología , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nefrectomía/efectos adversos , Nefrectomía/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Carga TumoralRESUMEN
PURPOSE: Gastrointestinal stromal tumors (GISTs) spread frequently to the peritoneum and the liver. If metastasectomy or tyrosine kinase inhibitors (TKIs) fail, interventional ablation techniques are considered. The purpose of this study is to assess the progression-free interval (PFI) of GIST liver metastases after radioembolization (RE). MATERIALS AND METHODS: Eleven patients with progressive GIST liver metastases undergoing TKI therapy were referred for RE; one was excluded because of a large hepatopulmonary shunt, and one was lost to follow-up. Depending on intrahepatic tumor distribution, one or both liver lobes were treated with RE. Contrast-enhanced magnetic resonance imaging, contrast-enhanced computed tomography (CT), and [(18)F]fluorodeoxyglucose positron-emission tomography/CT were used for follow-up. RESULTS: In all, 16 liver lobes were treated with a mean activity of 1.06 GBq ± 0.37 (range, 0.55-1.88) per lobe. Three patients showed complete response, five showed partial response, and one showed stable disease. No patient showed progressive disease after RE. Median PFI was 15.9 months (range, 4-29 mo). Median survival was 29.8 months (range, 10-72 mo). No radiation-induced liver disease developed; however, one patient required surgery for persistent stomach ulcer. CONCLUSIONS: RE offers a safe and effective treatment for patients with GIST liver metastases who do not show a response to TKIs. RE could be an option for earlier phases of therapy in patients with mutational status. The results might also challenge the notion that GISTs are resistant to radiation therapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioradioterapia/métodos , Tumores del Estroma Gastrointestinal/secundario , Tumores del Estroma Gastrointestinal/terapia , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Adulto , Anciano , Inhibidores de la Angiogénesis/administración & dosificación , Quimioembolización Terapéutica/métodos , Neoplasias Gastrointestinales/terapia , Tumores del Estroma Gastrointestinal/diagnóstico , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Persona de Mediana Edad , Proteínas Tirosina Quinasas/antagonistas & inhibidores , Radiofármacos/uso terapéutico , Resultado del Tratamiento , Radioisótopos de Itrio/uso terapéuticoRESUMEN
PURPOSE: To evaluate the efficacy of microwave ablation for osteoid osteomas by using dynamic contrast-enhanced magnetic resonance (MR) imaging in early treatment assessment. MATERIALS AND METHODS: Ten patients (two female, eight male; mean age, 28 y; range, 16-47 y) presenting with osteoid osteomas were treated between June 2010 and December 2012 with the use of computed tomography (CT)-guided microwave ablation. Osteoid osteomas were found at the femoral neck (n = 4), tibia (n = 3), calcaneus (n = 1), navicular bone (n = 1), and dorsal rib (n = 1). Dynamic contrast-enhanced MR imaging at 3.0 T was performed 1 day before microwave ablation and again after ablation. The procedure was considered successful if the signal intensity (SI) of the lesion on MR imaging decreased by at least 50% and the patient was pain-free within 1 week of intervention. RESULTS: All patients were pain-free within 1 week after microwave ablation and remained so during the 6 months of follow-up. No major or minor complications developed. On average, SI of the lesions decreased by 75% (range, 55.5%-89.1%) after treatment. The difference in lesion SI before versus after ablation was significant by t test (P < .0001; confidence interval, 120.26-174.96) and Wilcoxon test (P = .0020). CONCLUSIONS: Microwave ablation treatment of osteoid osteoma was highly successful, without any complications observed. Dynamic contrast-enhanced MR imaging is a useful tool for diagnosing osteoid osteoma and evaluating treatment.
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Técnicas de Ablación , Neoplasias Óseas/cirugía , Imagen por Resonancia Magnética , Microondas/uso terapéutico , Osteoma Osteoide/cirugía , Técnicas de Ablación/efectos adversos , Adolescente , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/patología , Medios de Contraste , Femenino , Humanos , Masculino , Microondas/efectos adversos , Persona de Mediana Edad , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/patología , Dolor Postoperatorio/etiología , Valor Predictivo de las Pruebas , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The etiology of acute pancreatitis can be manifold, beside the usual causes. We are reporting an unusual cause that triggered acute pancreatitis. PATIENT & RESULTS: A 50 year-old male experienced attacks of acute pancreatitis (abdominal pain and elevated amylase and lipase) during sexual arousal. Serial imaging showed a rapidly-progressing, partly-thrombosed splenic artery aneurysm, with local compression of the pancreas. After angiographic coiling, the attacks subsided. Further angiography revealed additional aneurysms consistent with segmental arterial mediolysis at other sites of the body. Molecular analysis regarding Ehlers-Danlos-syndrome and genetic factors for pancreatitis, autoantibodies and Syphilis serology was negative. CONCLUSIONS: Acute pancreatitis was triggered by a transient rise in blood pressure during sexual stimulation, which caused rapid progression of a splenic artery aneurysm as part of systemic segmental arterial mediolysis.
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Aneurisma/complicaciones , Pancreatitis/etiología , Arteria Esplénica , Dolor Abdominal/etiología , Aneurisma/diagnóstico por imagen , Aneurisma Roto/complicaciones , Presión Sanguínea , Humanos , Masculino , Radiografía , Radiología Intervencionista , Disfunciones Sexuales Psicológicas/complicacionesRESUMEN
OBJECTIVE: The purpose of this article is to evaluate the added diagnostic accuracy of time-resolved MR angiography (MRA) of the calves compared with continuous-table-movement MRA in patients with symptomatic lower extremity peripheral artery disease (PAD) using digital subtraction angiography (DSA) correlation. MATERIALS AND METHODS: Eighty-four consecutive patients with symptomatic PAD underwent a low-dose 3-T MRA protocol, consisting of continuous-table-movement MRA, acquired from the diaphragm to the calves, and an additional time-resolved MRA of the calves; 0.1 mmol/kg body weight (bw) of contrast material was used (0.07 mmol/kg bw for continuous-table-movement MRA and 0.03 mmol/kg bw for time-resolved MRA). Two radiologists rated image quality on a 4-point scale and stenosis degree on a 3-point scale. An additional assessment determined the degree of venous contamination and whether time-resolved MRA improved diagnostic confidence. The accuracy of stenosis gradation with continuous-table-movement and time-resolved MRA was compared with that of DSA as a correlation. Overall diagnostic accuracy was calculated for continuous-table-movement and time-resolved MRA. RESULTS: Median image quality was rated as good for 578 vessel segments with continuous-table-movement MRA and as excellent for 565 vessel segments with time-resolved MRA. Interreader agreement was excellent (κ = 0.80-0.84). Venous contamination interfered with diagnosis in more than 60% of continuous-table-movement MRA examinations. The degree of stenosis was assessed for 340 vessel segments. The diagnostic accuracies (continuous-table-movement MRA/time-resolved MRA) combined for the readers were obtained for the tibioperoneal trunk (84%/93%), anterior tibial (69%/87%), posterior tibial (85%/91%), and peroneal (67%/81%) arteries. The addition of time-resolved MRA improved diagnostic confidence in 69% of examinations. CONCLUSION: The addition of time-resolved MRA at the calf station improves diagnostic accuracy over continuous-table-movement MRA alone in symptomatic patients with PAD.
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Pierna/irrigación sanguínea , Angiografía por Resonancia Magnética/métodos , Enfermedad Arterial Periférica/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
The complex molecular alterations that underlie cancer pathophysiology are studied in depth with omics methods using bulk tissue extracts. For spatially resolved tissue diagnostics using needle biopsy cores, however, histopathological analysis using stained FFPE tissue and the immunohistochemistry (IHC) of a few marker proteins is currently the main clinical focus. Today, spatial omics imaging using MSI or IRI is an emerging diagnostic technology for the identification and classification of various cancer types. However, to conserve tissue-specific metabolomic states, fast, reliable, and precise methods for the preparation of fresh-frozen (FF) tissue sections are crucial. Such methods are often incompatible with clinical practice, since spatial metabolomics and the routine histopathology of needle biopsies currently require two biopsies for FF and FFPE sampling, respectively. Therefore, we developed a device and corresponding laboratory and computational workflows for the multimodal spatial omics analysis of fresh-frozen, longitudinally sectioned needle biopsies to accompany standard FFPE histopathology of the same biopsy core. As a proof-of-concept, we analyzed surgical human liver cancer specimens using IRI and MSI with precise co-registration and, following FFPE processing, by sequential clinical pathology analysis of the same biopsy core. This workflow allowed for a spatial comparison between different spectral profiles and alterations in tissue histology, as well as a direct comparison for histological diagnosis without the need for an extra biopsy.
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PURPOSE: To evaluate the clinical efficacy of EverFlex stents (length, 6-20 cm) for the treatment of peripheral artery disease (PAD) in the superficial femoral artery (SFA). MATERIAL AND METHODS: Over a period of 18 months, 56 SFA lesions in 53 patients were treated with an EverFlex stent. The following parameters were documented before the intervention, immediately afterward, and 12 months later: clinical stage, ankle-brachial index, and peak systolic velocity ratio (PSVR). The primary study endpoint was the primary patency rate after 12 months (defined as a PSVR < 2.5). RESULTS: In 18% of the 56 lesions, complete occlusions were present. Mean lesion length was 9.4 cm ± 5.3, and mean stent length was 12.6 cm ± 5.6. Of the 53 patients enrolled in the study, a 12-month follow-up was performed in 46. The primary patency rate after 12 months was 71.7%. In-stent restenosis or occlusion occurred in 13 patients. Compared with the total study group, the mean stent length in these 13 patients was greater (14.0 cm ± 7.3) and the incidence of de novo lesions was lower. In the patient group with stents less than 10 cm in length (n = 24), six patients (25%) required a repeat intervention, compared with seven patients (32%) in the group with stents longer than 12 cm. CONCLUSIONS: Although the primary patency rate associated with the EverFlex stent is comparable to those in published data, the present results demonstrate a higher percentage of in-stent stenoses in patients in whom longer SFA stents were implanted.
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Procedimientos Endovasculares/instrumentación , Arteria Femoral , Enfermedad Arterial Periférica/terapia , Stents , Anciano , Aleaciones , Índice Tobillo Braquial , Velocidad del Flujo Sanguíneo , Constricción Patológica , Procedimientos Endovasculares/efectos adversos , Femenino , Arteria Femoral/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Diseño de Prótesis , Recurrencia , Flujo Sanguíneo Regional , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción VascularRESUMEN
Cystic adventitial degeneration (CAD) of the popliteal artery is a rare, but well-recognized, disorder leading to claudication. Usually, surgical treatment is indicated. So far, <400 patients have been described. We report on a series of three patients with CAD. Because we observed local recurrence of CAD after local resection, we conclude that 360° resection and venous interposition is preferable for a favorable outcome. Furthermore, we review etiology, pathology, and different surgical treatment approaches.
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Adventicia , Arteriopatías Oclusivas/diagnóstico , Quistes/diagnóstico , Arteria Poplítea , Adventicia/diagnóstico por imagen , Adventicia/patología , Adventicia/cirugía , Anciano , Anticoagulantes/uso terapéutico , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/cirugía , Quistes/complicaciones , Quistes/cirugía , Femenino , Humanos , Claudicación Intermitente/etiología , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/patología , Arteria Poplítea/cirugía , Recurrencia , Vena Safena/trasplante , Resultado del Tratamiento , Ultrasonografía Doppler en ColorRESUMEN
BACKGROUND: Radiologic imaging is important for the detection, staging and follow-up of urological tumors. Basic therapy decisions for both oncological (surgical vs. systemic therapy, e.g. in testicular cancer) and non-oncological pathologies (interventional vs. conservative therapy, e.g. for ureteral stones) depend largely on the tomographic imaging performed. Due to its almost ubiquitous availability, speed and cost-effectiveness, computed tomography (CT) plays an important role not only in the clarification of abdominal trauma and non-traumatic emergencies, but also in staging and follow-up of oncological patients. However, the level of radiation exposure, impaired renal function and allergies to iodinated contrast media limit the use of CT. Magnetic resonance imaging (MRI) can be a good alternative for many areas of application in oncological and non-oncological imaging due to its high soft tissue differentiation and functional-specific protocols but without the use of ionizing radiation. AIM: In the following, the main indications of abdominal and pelvic CT and MRI in urology and their limitations are summarized. RESULTS: The areas of application between CT and MRI are increasingly overlapping, since the latest developments in CT continue to further reduce radiation exposure and increase contrast information, while the speed and robustness of MRI are significantly improving at the same time.
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Neoplasias Testiculares , Enfermedades Urológicas , Medios de Contraste , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Tomografía Computarizada por Rayos X/métodos , Enfermedades Urológicas/diagnóstico por imagenRESUMEN
PURPOSE: The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP). METHODS: The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature. A decision tree-based Markov model was created, analyzing long-term cost-effectiveness for TURP and PAE from a US health care sector perspective. Cost-effectiveness over a time frame of 5 years was estimated while assuming a willingness to pay of $50,000 per quality-adjusted life-year (QALY). The primary outcome was incremental cost-effectiveness ratio. RESULTS: PAE resulted in overall cost of $6,464.92 and an expected outcome of 4.566 QALYs. In comparison, TURP cost $9,221.09 and resulted in expected outcome of 4.577 QALYs per treatment. The incremental cost-effectiveness ratio for TURP was $247,732.65 per QALY. On the basis of the willingness-to-pay threshold, PAE is cost effective compared with TURP. CONCLUSIONS: On the basis of our model, PAE in comparison with TURP can be regarded as a cost-effective treatment option for patients with lower urinary tract symptoms within the US health care system.
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Embolización Terapéutica , Síntomas del Sistema Urinario Inferior , Hiperplasia Prostática , Resección Transuretral de la Próstata , Arterias , Análisis Costo-Beneficio , Humanos , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/terapia , Masculino , Próstata/irrigación sanguínea , Próstata/cirugía , Hiperplasia Prostática/complicaciones , Hiperplasia Prostática/terapia , Resección Transuretral de la Próstata/efectos adversos , Resección Transuretral de la Próstata/métodos , Resultado del TratamientoRESUMEN
PURPOSE: The study aimed to evaluate a new robotic assistance system (RAS) for needle placement in combination with a multi-axis C-arm angiography system for cone-beam computed tomography (CBCT) in a phantom setting. MATERIALS AND METHODS: The RAS consisted of a tool holder, dedicated planning software, and a mobile platform with a lightweight robotic arm to enable image-guided needle placement in conjunction with CBCT imaging. A CBCT scan of the phantom was performed to calibrate the robotic arm in the scan volume and to plan the different needle trajectories. The trajectory data were sent to the robot, which then positioned the tool holder along the trajectory. A 19G needle was then manually inserted into the phantom. During the control CBCT scan, the exact needle position was evaluated and any possible deviation from the target lesion measured. RESULTS: In total, 16 needle insertions targeting eight in- and out-of-plane sites were performed. Mean angular deviation from planned trajectory to actual needle trajectory was 1.12°. Mean deviation from target point and actual needle tip position was 2.74 mm, and mean deviation depth from the target lesion to the actual needle tip position was 2.14 mm. Mean time for needle placement was 361 s. Only differences in time required for needle placement between in- and out-of-plane trajectories (337 s vs. 380 s) were statistically significant (p = 0.0214). CONCLUSION: Using this RAS for image-guided percutaneous needle placement with CBCT was precise and efficient in the phantom setting.
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Procedimientos Quirúrgicos Robotizados , Tomografía Computarizada de Haz Cónico , Humanos , Agujas , Fantasmas de Imagen , PuncionesRESUMEN
PURPOSE: Thoracic surgeons are currently asked to resect smaller and deeper lesions which are difficult to detect thoracoscopically. The growing number of those lesions arises both from lung cancer screening programs and from follow-up of extrathoracic malignancies. This study analyzed the routine use of a CT-aided thoracoscopic approach to small pulmonary nodules in the hybrid theatre and the resulting changes in the treatment pathway. METHODS: 50 patients were retrospectively included. The clinical indication for histological diagnosis was suspected metastasis in 46 patients. Technically, the radiological distance between the periphery of the lesion and the visceral pleura had to exceed the maximum diameter of the lesion for the patient to be included. A spiral wire was placed using intraoperative CT-based laser navigation to guide the thoracoscopic resection. RESULTS: The mean diameter of the lesions was 8.4 mm (SD 4.27 mm). 29.4 minutes (SD 28.5) were required on average for the wire placement and 42.3 minutes (SD 20.1) for the resection of the lesion. Histopathology confirmed the expected diagnosis in 30 of 52 lesions. In the remaining 22 lesions, 9 cases of primary lung cancer were detected while 12 patients showed a benign disease. CONCLUSION: Computer tomography assisted thoracoscopic surgery (CATS) enabled successful resection in all cases with minimal morbidity. The histological diagnosis led to a treatment change in 42% of the patients. The hybrid-CATS technique provides good access to deeply located small pulmonary nodules and could be particularly valuable in the emerging setting of lung cancer screening.
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Nódulos Pulmonares Múltiples/cirugía , Nódulo Pulmonar Solitario/cirugía , Cirugía Asistida por Computador , Cirugía Torácica Asistida por Video , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/cirugía , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Metástasis de la Neoplasia , Nódulo Pulmonar Solitario/diagnóstico por imagen , Nódulo Pulmonar Solitario/patología , Tomografía Computarizada por Rayos XRESUMEN
Abdominal aortic aneurysms (AAA) may remain clinically silent until they enlarge and patients present with a potentially lethal rupture. This necessitates early detection and elective treatment. The goal of this study was to develop an easy-to-train algorithm which is capable of automated AAA screening in CT scans and can be applied to an intra-hospital environment. Three deep convolutional neural networks (ResNet, VGG-16 and AlexNet) were adapted for 3D classification and applied to a dataset consisting of 187 heterogenous CT scans. The 3D ResNet outperformed both other networks. Across the five folds of the first training dataset it achieved an accuracy of 0.856 and an area under the curve (AUC) of 0.926. Subsequently, the algorithms performance was verified on a second data set containing 106 scans, where it ran fully automated and resulted in an accuracy of 0.953 and an AUC of 0.971. A layer-wise relevance propagation (LRP) made the decision process interpretable and showed that the network correctly focused on the aortic lumen. In conclusion, the deep learning-based screening proved to be robust and showed high performance even on a heterogeneous multi-center data set. Integration into hospital workflow and its effect on aneurysm management would be an exciting topic of future research.
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PURPOSE: To evaluate a peripheral magnetic resonance (MR) angiographic protocol combining continuous table movement (CTM) MR angiography of the entire runoff vasculature with time-resolved (TWIST) 3-T MR angiography of the calves with a total gadolinium dose of 0.1 mmol per kilogram of body weight. MATERIALS AND METHODS: In this retrospective institutional review board-approved study, 31 consecutive patients (22 men, nine women; mean age, 65 years ± 14 [standard deviation]) with peripheral arterial occlusive disease who had undergone a low-dose MR angiographic protocol that consisted of CTM MR angiography (repetition time msec/echo time msec, 2.4/1.0; 21° flip angle; voxel size, 1.2 mm(3); gadolinium dose, 0.07 mmol per kilogram of body weight) and TWIST MR angiography (2.8/1.1; 20° flip angle; voxel size, 1.1 mm(3); temporal resolution, 4.8-5.5 sec, gadolinium dose, 0.03 mmol/kg), as well as digital subtraction angiography (DSA), were included. Two radiologists rated image quality and stenosis degree on four-point scales. The accuracy of stenosis gradation and, specifically, the detection of high-grade stenoses (stenosis of 70%-99%) with CTM MR angiography alone and with the combined protocol were compared with accuracy of stenosis gradation and detection of high-grade stenoses with DSA. Means and standard deviations were calculated for all data. Interobserver agreement was determined with κ statistics. Positive and negative predictive values, sensitivity, specificity, and overall diagnostic accuracy were calculated for CTM MR angiography alone and for the combined protocol. RESULTS: For CTM MR angiography, image quality was good or excellent in 95.9% of vessel segments; for TWIST MR angiography, image quality was good or excellent in 94.3% and 97.8% of vessel segments for readers 1 and 2, respectively. The combined protocol resulted in high overall diagnostic accuracy of more than 80% for detection of stenosis and diagnostic accuracy of 93.5% for detection of high-grade vessel stenosis. Inclusion of TWIST MR angiography increased diagnostic value over that achieved with CTM MR angiography alone. CONCLUSION: A combined MR angiographic approach in which a low total gadolinium dose (0.1 mmol/kg) is used yields excellent image quality and is accurate in the diagnosis of peripheral arterial stenosis.
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Arteriopatías Oclusivas/diagnóstico , Angiografía por Resonancia Magnética/métodos , Enfermedades Vasculares Periféricas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Angiografía de Substracción Digital , Medios de Contraste/administración & dosificación , Femenino , Humanos , Masculino , Meglumina/administración & dosificación , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
AIM: Application of a drug delivery device for transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Clinical and radiological treatment assessment. PATIENTS AND METHODS: 24 patients with liver cirrhosis and uni- or multifocal HCC underwent TACE with doxorubicin beads (DC Bead). The underly-ing cause of liver cirrhosis was hepatitis (A: n = 7; B: n = 10) or alcohol consumption (n = 7). Patients presented with Child Pugh stage A (n = 15) and B (n = 9). The mean intrahepatic tumor size, considering the sum of diameters of all lesions treated, was 3.83 cm (+/-2.4). Liver function and hematological parameters were documented before and after each TACE. Magnetic resonance imaging (MRI) was performed before and 4 weeks after TACE. The T1-w 3D volume-interpolated breathhold exam (VIBE) sequence was applied for evaluation of the therapy response. RESULTS: 24 patients received a total number of 69 TACE treatments with DC beads (mean dose 160 mg). The elevation of liver function parameters after treatment did not affect the patients' clinical condition. The T1-w VIBE sequence proved very valuable for assessment of the intrahepatic tumor spread. Post-contrast images enabled delineation of the viable HCC lesions, hence facilitating the selective transcatheter approach. The tumor marker a-fetoprotein (AFP), available in 19/24 patients, dropped from 347.5 to 299.5 ng/ml, without being a reliable predictor of treatment response. A decrease of tumor size after TACE from 3.83 (+/-2.40) to 3.01 cm (+/-2.67; p < 0.0001) was evident on the T1w-VIBE sequences. The mean follow-up period was 30 months. At the time of data analysis, 10 (42%) out of 14 patients were alive. CONCLUSION: TACE with DC beads in HCC offers a safe and efficient treatment resulting in tumor response within a very short time.
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Antibióticos Antineoplásicos/administración & dosificación , Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/instrumentación , Doxorrubicina/administración & dosificación , Neoplasias Hepáticas/terapia , Neoplasias Primarias Múltiples/terapia , Anciano , Anciano de 80 o más Años , Antibióticos Antineoplásicos/efectos adversos , Biomarcadores de Tumor/sangre , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/patología , Preparaciones de Acción Retardada , Doxorrubicina/efectos adversos , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Pruebas de Función Hepática , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/patología , Imagen por Resonancia Magnética , Masculino , Microesferas , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Primarias Múltiples/mortalidad , Neoplasias Primarias Múltiples/patología , Estudios Retrospectivos , Tasa de Supervivencia , alfa-Fetoproteínas/análisisRESUMEN
Radioembolization with 90Y-microspheres has been reported to induce contralateral liver hypertrophy with simultaneous ipsilateral control of tumor growth. The aim of the present systematic review was to summarize the evidence of contralateral liver hypertrophy and oncological outcome following unilateral treatment with radioembolization. A systematic literature search using the MEDLINE, EMBASE, and Cochrane libraries for studies published between 2008 and 2020 was performed. A total of 16 studies, comprising 602 patients, were included. The median kinetic growth rate per week of the contralateral liver lobe was 0.7% and declined slightly over time. The local tumor control was 84%. Surgical resection after radioembolization was carried out in 109 out of 362 patients (30%). Although the available data suggest that radioembolization prior to major hepatectomy is safe with a promising oncological outcome, the definitive role of radioembolization requires assessment within controlled clinical trials.
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AIM: Evaluation of osteoid osteoma (OO) perfusion characteristics pre and post microwave ablation (MWA) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with clinical follow-up. MATERIALS AND METHODS: Patients with OO underwent T1-weighted 3D DCE-MRI at 3.0T pre and post MWA. Signal intensity (SI) and perfusion of lesions was measured. Patients answered a questionnaire for clinical follow-up. RESULTS: A total of 24 patients were included (mean age of 28 years; nine females); 21 DCE-MRI datasets were of sufficient quality for analysis. The mean SI of lesions, plasma flow, volume of distribution and pain level all decreased statistically significantly after ablation. CONCLUSION: Quantitative MRI-perfusion analysis allows for objective treatment evaluation after MWA of OO, plasma flow and volume of distribution seem to be reliable indicators for successful thermoablation. MWA is an effective treatment option for OO with a low risk profile and significant pain reduction after treatment.
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Técnicas de Ablación , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Angiografía por Resonancia Magnética , Microondas/uso terapéutico , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Imagen de Perfusión/métodos , Técnicas de Ablación/efectos adversos , Adolescente , Adulto , Neoplasias Óseas/irrigación sanguínea , Neoplasias Óseas/patología , Niño , Angiografía por Tomografía Computarizada , Femenino , Humanos , Masculino , Microondas/efectos adversos , Persona de Mediana Edad , Osteoma Osteoide/irrigación sanguínea , Osteoma Osteoide/patología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: The aim of this study was to compare transrectal ultra-sound (TRUS), hydro-computed tomography (hydro-CT), and endorectal magnetic resonance imaging (MRI) in the preoperative staging of rectal cancer. PATIENTS AND METHODS: 23 patients with rectal adenocarcinoma underwent TRUS, hydro-CT, and MRI (1 Tesla) with endorectal coil. The results were correlated with the histopathological findings based on the TNM classification. RESULTS: T staging with TRUS, hydro-CT, and endorectal MRI correlated with the histopa-thological findings in 83% of patients (19/23). Tumors were overestimated by TRUS in 2/23 patients, by CT in 3/23, and by MRI in 3/23 patients. Tumor size was underestimated by TRUS in 2 patients, by CT and MRI in 1 case each. Local lymphatic node involvement was correctly diagnosed with CT and MRI in 87% and 83%, respectively. Using TRUS, false-negative results in the staging of lymph node involvement were seen in 3/23 patients, whereas 1 patient was over-staged. Using hydro-CT as well as endorectal MRI, overstaging of the local lymph nodes took place in 2/23 patients. CONCLUSION: All methods are limited because peritumoral inflammation cannot be precisely distinguished from infiltration by the tumor. Correct lymph node staging is hampered in advanced disease using TRUS. In these patients, further cross-sectional imaging may be required.
Asunto(s)
Adenocarcinoma/diagnóstico , Aumento de la Imagen/métodos , Imagen por Resonancia Magnética/métodos , Estadificación de Neoplasias/métodos , Neoplasias del Recto/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Adenocarcinoma/clasificación , Adenocarcinoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Neoplasias del Recto/clasificación , Neoplasias del Recto/cirugía , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To evaluate a commercially available robotic assistance device for computed tomography-guided diagnostic and therapeutic interventions, compared to regular, manually performed CT scan-guided interventions in terms of precision, exposure to radiation to the patient and intervention time. MATERIALS AND METHODS: Over a period of 6 months, 55 consecutive patients were recruited and treated using robotic assistance and compared to a control group of 101 patients previously treated with a regular CT scan-guided, manual approach. Evaluated parameters were precision (deviation from planned target and number of needle replacements), radiation exposure to the patient and intervention time. Evaluations were performed with regard to complexity (in-plane vs out-of-plane interventions) and type of anesthesia (general vs local). RESULTS: Parameters related to precision were in general significantly better in the robotic assistance group (p < 0.01) with a mean deviation of 1.2 mm (± 1.6 mm) compared to 2.6 mm (± 1.1 mm) in the comparison group. Compared to manual procedure, the mean intervention time was reduced by 15 min (± 5.4 min) on average for an out-of-plane needle placement in the robotic group. There was no increase of exposure to radiation to the patient while radiation exposure for the physician was reduced to zero when the navigation system was used. CONCLUSION: Compared to manual placement, the use of a robotic assistance device in out-of-plane CT-guided interventions under general anesthesia allows for probe placement with high precision. Intervention time is reduced with no increase of exposure to radiation to the patient.
Asunto(s)
Radiografía Intervencional/métodos , Robótica/métodos , Tomografía Computarizada por Rayos X/métodos , Anciano , Femenino , Humanos , Masculino , Estudios Prospectivos , Dosis de Radiación , Factores de TiempoRESUMEN
BACKGROUND: Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. Whether these electric pulses of high field strength can cause cardiac damage and/or ablation-induced arrhythmias is unclear. OBJECTIVE: The purpose of this study was to systematically evaluate the safety of electrocardiogram (ECG)-gated IRE with regard to cardiac side effects. METHODS: In all patients, 12-lead ECG and signal-averaged ECG (SAECG) recordings were performed before and after IRE and 24-hour Holter recording on the day of the IRE procedure. Venous blood samples (N-terminal pro-brain-type natriuretic peptide [NT-proBNP], high-sensitive troponin I [hsTnI]) were obtained before and 4 and 16 hours after the procedure. Patients with abnormal findings were reevaluated after 3 months. RESULTS: In total, 26 patients with an oncologic indication for IRE (11 females, mean age 62.9 years) were prospectively enrolled. Nine patients (34.6%) showed an increase in hsTnI and 21 patients (80.8%) an increase in NT-proBNP after ablation. Fifteen patients (57%) developed arrhythmias related to the procedure. One patient, in whom hsTnI and NT-proBNP had increased, developed multiple, nonsustained ventricular tachycardia events. In another patient, atrial fibrillation was triggered twice in 2 separate procedures. Twelve patients had clinically benign arrhythmias. SAECG was negative in all patients. CONCLUSION: Subclinical myocardial injury and nonfatal cardiac arrhythmias can occur in the context of IRE treatment. Although no sustained cardiac injuries could be found at 3-month follow-up, we propose implementation of a cardiac safety algorithm consisting of cardiac biomarkers and ECG monitoring when IRE is conducted.