Selective internal radiation therapy of hepatic tumours: is coiling of the gastroduodenal artery always beneficial?

AIM: To assess the effect of gastroduodenal artery (GDA) occlusion prior to selective internal radiation therapy (SIRT) with regards to arterial hepato-intestinal collateralization (HIC). MATERIALS AND METHODS: Six hundred and six patients were scheduled for SIRT between 2006 and 2012 at University Hospital Essen, Germany. Digital subtraction angiography (DSA) followed by administration of 99m-technetium labelled human serum albumin microspheres ((99m)Tc-HSAM) and single-photon emission computed tomography combined with computed tomography (SPECT/CT) was initially performed. Depending on vascular anatomy and hepatic tumour load, GDA coil embolization was considered. In subsequent (99m)Tc-HSAM rescans or therapeutic DSA, HIC and its consequences for SIRT were analysed. RESULTS: The GDA was occluded in 86 of 606 patients (14%). Twenty-two of these 86 patients did not undergo SIRT due to the patients' clinical status or SIRT contraindications. In 28 of the remaining 64 patients, newly apparent or reopened HIC were seen either at the site of the proximal GDA (n = 21) or in the periphery of the hepatic arteries (n = 7). In 25 of these 28 patients, the HIC could be occluded or the catheter position could be changed achieving a safe (90)Y application. However, due to the newly visible HIC in three of 28 patients, SIRT was regarded as unsafe and was abandoned. CONCLUSION: Coil embolization of the GDA may induce arterial hepato-intestinal collaterals. Although most of these collaterals do not impede (90)Y administration, SIRT may become unfeasible in specific occasions. Hence, segmental or lobar SIRT instead of a whole-liver approach with coiling of the GDA is recommended.

Application of classification trees for the qualitative differentiation of focal liver lesions suspicious for metastasis in gadolinium-EOB-DTPA-enhanced liver MR imaging.

PURPOSE: To evaluate the diagnostic accuracy of qualitative descriptors alone and in combination for the classification of focal liver lesions (FLLs) suspicious for metastasis in gadolinium-EOB-DTPA-enhanced liver MR imaging. MATERIALS AND METHODS: Consecutive patients with clinically suspected liver metastases were eligible for this retrospective investigation. 50 patients met the inclusion criteria. All underwent Gd-EOB-DTPA-enhanced liver MRI (T2w, chemical shift T1w, dynamic T1w). Primary liver malignancies or treated lesions were excluded. All investigations were read by two blinded observers (O1, O2). Both independently identified the presence of lesions and evaluated predefined qualitative lesion descriptors (signal intensities, enhancement pattern and morphology). A reference standard was determined under consideration of all clinical and follow-up information. Statistical analysis besides contingency tables (chi square, kappa statistics) included descriptor combinations using classification trees (CHAID methodology) as well as ROC analysis. RESULTS: In 38 patients, 120 FLLs (52 benign, 68 malignant) were present. 115 (48 benign, 67 malignant) were identified by the observers. The enhancement pattern, relative SI upon T2w and late enhanced T1w images contributed significantly to the differentiation of FLLs. The overall classification accuracy was 91.3 % (O1) and 88.7 % (O2), kappa = 0.902. CONCLUSION: The combination of qualitative lesion descriptors proposed in this work revealed high diagnostic accuracy and interobserver agreement in the differentiation of focal liver lesions suspicious for metastases using Gd-EOB-DTPA-enhanced liver MRI.

[Resuscitation of a patient in the computed tomography unit]. / Der reanimationspflichtige Patient auf dem CT-Patiententisch.

An 80-year-old male patient presented with acute chest pain. Clinically an aortic dissection or pulmonary embolism was suspected therefore non-ECG-gated multislice computed tomography was performed and despite the lacking ECG gating the causative high grade coronary stenosis could be identified.

[Drug-induced eosinophilic pneumonia]. / Eosinophile Pneumonie als unerwünschte Arzneimittelwirkung.

Eosinophilic pneumonia is a lung disorder characterized by eosinophilic pulmonary infiltration and blood eosinophilia. It can be caused by a variety of drugs. Especially in mild forms and in chronically neurologically ill patients, it can be difficult to spot. We report the case of a 46-year-old woman suffering from multiple sclerosis who developed nitrofurantoin-induced eosinophilic pneumonia.

[Differential diagnosis of solitary neurosarcoidosis]. / Differenzialdiagnose der isolierten Neurosarkoidose.

Sarcoidosis is an inflammatory multisystemic disease characterised by noncaseating epithelioid granulomas. The lung is affected in over 90% of patients. According to clinical criteria, the nervous system is involved in 5-9%. However, in autopsy series this number increases to 25%. Solitary involvement of the nervous system without signs of systemic disease is rare and diagnostically cryptic. Due to the wide variety of neurologic symptoms, definite diagnosis of sarcoidosis is possible only by histopathological proof of noncaseating epithelioid granulomas. We report a 51-year-old woman who presented with chronic basal meningitis and involvement of the peripheral and central nervous system due to solitary neurosarcoidosis. Diagnostic procedures and differential diagnosis are discussed.

Device for rapid quantification of human carotid baroreceptor-cardiac reflex responses.

We designed, constructed, and evaluated a new device to characterize the human carotid baroreceptor-cardiac reflex response relation rapidly. We designed this system for study of reflex responses of astronauts before, during, and after space travel. The system comprises a new tightly sealing silicone rubber neck chamber, a stepping motor-driven electro-deposited nickel bellows pressure system, capable of delivering sequential R-wave-triggered neck chamber pressure changes between +40 and -65 mmHg, and a microprocessor-based electronics system for control of pressure steps and analysis and display of responses. This new system provokes classic sigmoid baroreceptor-cardiac reflex responses with threshold, linear, and saturation ranges in most human volunteers during one held expiration.