FDG PET-CT findings of extra-thoracic sarcoid are associated with cardiac sarcoid: A rationale for using FGD PET-CT for cardiac sarcoid evaluation.

PURPOSE: This retrospective study investigates the relationship between cardiac and extra-thoracic sarcoid findings on FDG PET-CT using a 72-hour pretest high-fat, high-protein, and very low-carbohydrate (HFHPVLC) diet. PATIENTS AND METHODS: A total of 196 consecutive FDG PET-CT scans with 72-hour HFHPVLC diet preparation were performed between December 2014 and December 2015 in known sarcoid patients. Of these scans, 5 were excluded for non-adherence to diet preparation or underlying cancer. Cardiac and extra-thoracic sarcoid lesions were categorized and measured for radiotracer uptake. RESULTS: A total of 188 patients had 191 eligible FDG PET/CT scans (3 follow-up scans), of which there were 20 (10%) positive, 6 indeterminate (3%), and 165 (86%) negative for CS. Among the 20 scans positive for CS, 8 (40%) had findings of both cardiac and extra-thoracic sarcoid. CONCLUSION: Our study shows that 40% of CS patients also have FDG PET-CT findings of extra-thoracic sarcoid. This makes an intriguing case for FDG PET-CT use with pretest diet prep over cardiac MRI (CMR) for cardiac sarcoid evaluation, given that CMR is likely to overlook these extra-thoracic sites of disease.

Anatomic Variations of the Right Portal Vein: Prevalence, Imaging Features, and Implications for Successful Transjugular Intrahepatic Portosystemic Shunt Creation.

Given the widespread use of transjugular intrahepatic portosystemic shunt (TIPS) creation for the treatment of portal hypertensive complications, a working knowledge of portal venous anatomy is critical for interventional radiologists. The right portal vein - which is most commonly accessed during TIPS - is subject to various anatomic variants that may potentially impact procedure success. This pictorial essay characterizes the anatomic patterns of the right portal vein branching in terms of type and frequency based on case series review. The work also explains the potential procedural implications of the right portal vein anatomic variations as they pertain to TIPS technical success.

Does advanced chronic kidney disease impact transjugular intrahepatic portosystemic shunt efficacy and safety?

BACKGROUND AND STUDY AIMS: There are currently limited data available summarizing the clinical outcomes and safety of transjugular intrahepatic portosystemic shunts (TIPS) in cases of advanced chronic kidney disease (CKD). The study aimed to assess efficacy and safety of TIPS in patients with advanced CKD. PATIENTS AND METHODS: Seventeen patients (M :F 8 :9, age 55 years, MELD 24) with grade 4-5 CKD who underwent TIPS for ascites (n = 7) or varices (n = 10) were analyzed. The primary outcome was TIPS efficacy - assessed by comparing paracentesis frequency and diuretic regimen pre- and post-TIPS among ascites patients - and through bleeding cessation in variceal bleeding patients. Other outcomes included hepatic encephalopathy (HE), GFR increase, and mortality. RESULTS:   Median baseline GFR was 19.9 mL/min. No patients were hemodialysis dependent. Median post-TIPS pressure gradient was 8 mm Hg. Among ascites patients, 5/6 (83%) were TIPS responsive, with reduced or stable diuretics in 4/5 (80%). Among variceal hemorrhage cases, bleeding cessation rate was 90% (9/10). New or worsening HE incidence was 47% (8/17), and one patient required shunt reduction. Of 8 patients with lab follow-up, 6 (75%) demonstrated significant GFR increase (42.2 versus 20.0 mL/min, P = 0.028). The 90-day mortality incidence was 29% (5/17). CONCLUSIONS: In conclusion, TIPS can potentially address ascites and variceal bleeding in advanced CKD patients, though HE incidence may be increased. Further investigation in larger cohorts may corroborate these results.

Regression of Hepatocellular Carcinoma Lung Metastases after Guyabano Fruit Extract Consumption.

Hepatocellular carcinoma (HCC) is a leading cause of worldwide cancer-related mortality, and even with established treatment paradigms, its global burden demands greater research into therapeutic options. In the following case report, a patient suffering from HCC with lung metastasis demonstrated regression of metastatic disease while consuming guyabano fruit extract in the absence of conventional chemotherapy. While the antineoplastic effects of the guyabano fruit is well documented, there is sparse clinical documentation of HCC regression associated with it, and a better understanding of guyabano and its antineoplastic activity may trigger discovery of novel therapeutic options for this deadly disease.