Osteoid osteomas in common and in technically challenging locations treated with computed tomography-guided percutaneous radiofrequency ablation.

OBJECTIVE: To evaluate the efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation for the treatment of osteoid osteomas in common and in technically challenging locations. MATERIALS AND METHODS: Twenty-three patients with osteoid osteomas in common (nine cases) and technically challenging [14 cases: intra-articular (n = 7), spinal (n = 5), metaphyseal (n = 2)] positions were treated with CT-guided RF ablation. Therapy was performed under conscious sedation with a seven-array expandable RF electrode for 8-10 min at 80-110 degrees C and power of 90-110 W. The patients went home under instruction. A brief pain inventory (BPI) score was calculated before and after (1 day, 4 weeks, 6 months and 1 year) treatment. RESULTS: All procedures were technically successful. Primary clinical success was 91.3% (21 of total 23 patients), despite the lesions' locations. BPI score was dramatically reduced after the procedure, and the decrease in BPI score was significant (P < 0.001, paired t-test; n-1 = 22) for all periods during follow up. Two patients had persistent pain after 1 month and were treated successfully with a second procedure (secondary success rate 100%). No immediate or delayed complications were observed. CONCLUSION: CT-guided RF ablation is safe and highly effective for treatment of osteoid osteomas, even in technically difficult positions.

Overcoming the heat-sink phenomenon: successful radiofrequency thermal ablation of liver tumors in contact with blood vessels.

PURPOSE: To evaluate the efficacy and safety of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) of liver tumors (hepatocellular carcinoma and liver metastases) > 3 mm in diameter that were in contact with blood vessels. MATERIALS AND METHODS: During a 3-year period RFA was performed in 28 patients (age range, 36-83 years; male/female ratio, 17:11) with liver tumors (primary and metastatic) that were in contact with blood vessels > 3 mm in diameter. Tumor diameter ranged from 1.7 to 5.1 cm. To evaluate the immediate response, dual-phase dynamic CT images were obtained after intravenous contrast material administration. Imaging follow-up was at 1, 3, 6, and 12 months post-RFA, and every year thereafter. RESULTS: All of 28 patients were treated with a total of 36 sessions. In 22 (79%) of the patients, complete ablation of the tumor was achieved. The remaining 6 (21%) patients showed irregular peripheral enhancement and underwent a second session. At 1-year follow-up 2 of the tumors showed a recurrent lesion and a new ablation was performed. The local tumor progression rate at 1-year follow-up was 8.7% and disease-free survival was achieved in 82.1% of the patients. Complications occurred in 4 patients (14.3%); 2 patients presented with a small sub-capsular hematoma, and 2 patients had a partial liver infarction. CONCLUSION: RFA is a safe and effective method, even with high-risk tumors adjacent to large blood vessels, which can lead to good results with minimal complications and a low rate of tumor progression.

Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience).

Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

Palliative treatment of rectal carcinoma recurrence using radiofrequency ablation.

PURPOSE: To evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation for the palliative treatment of recurrent unresectable rectal tumors. MATERIALS AND METHODS: Twenty-seven patients with locally recurrent rectal cancer were treated with computed tomography (CT)-guided RF ablation. Therapy was performed with the patient under conscious sedation with a seven- or a nine-array expandable RF electrode for 8-10 min at 80-110°C and a power of 90-110 W. All patients went home under instructions the next day of the procedure. Brief Pain Inventory score was calculated before and after (1 day, 1 week, 1 month, 3 months, and 6 months) treatment. RESULTS: Complete tumor necrosis rate was 77.8% (21 of a total 27 procedures) despite lesion location. BPI score was dramatically decreased after the procedure. The mean preprocedure BPI score was 6.59, which decreased to 3.15, 1.15, and 0.11 at postprocedure day 1, week 1, and month 1, respectively, after the procedure. This decrease was significant (p < 0.01 for the first day and p < 0.001 for the rest of the follow-up intervals (paired Student t test; n - 1 = 26) for all periods during follow-up. Six patients had partial tumor necrosis, and we were attempted to them with a second procedure. Although the necrosis area showed a radiographic increase, no complete necrosis was achieved (secondary success rate 65.6%). No immediate or delayed complications were observed. CONCLUSION: CT-guided RF ablation is a minimally invasive, safe, and highly effective technique for treatment of malignant rectal recurrence. The method is well tolerated by patients, and pain relief is quickly achieved.

Wide variety of bioserotypes of enteropathogenic Yersinia in tonsils of English pigs at slaughter.

The tonsils of 630 pigs from 45 English farms using three different rearing methods (Assured British Pigs, Open Management and Organic) were examined between 2003 and 2005 in order to investigate if the low incidence of human yersiniosis could be attributed to a low prevalence of enteropathogenic Yersinia among English pigs. In addition, different isolation methods were compared, possible differences in prevalence among pigs were studied, as well as the prevalence of different bioserotypes of enteropathogenic Yersinia. A high prevalence and a wide diversity of bioserotypes of enteropathogenic Yersinia compared to other European countries were observed. The prevalence of pathogenic Yersinia enterocolitica was 44% and of Yersinia pseudotuberculosis 18%. Overall, 60% of pigs carried enteropathogenic Yersinia. Y. pseudotuberculosis was detected on 78% of farms and Y. enterocolitica on 69%. The most common bioserotypes of Y. enterocolitica were 2/O:9 (33%) and 2/O:5 (26%), and of Y. pseudotuberculosis 2/O:3 (34%), 1/O:1 (26%) and 1/O:4 (24%). Cold enrichment gave the highest isolation rate for both species. Y. enterocolitica was more prevalent (P<0.001) and Y. pseudotuberculosis less prevalent (P<0.05) in winter than in summer in Eastern England. Y. enterocolitica was more common in Eastern England and in assured British pigs, whereas Y. pseudotuberculosis was more common in Western England and in organic pigs. Y. pseudotuberculosis 1/O:1 was predominant (P<0.05) in Western England. Types 1/O:4 (P<0.05) and 2/O:3 (P<0.001) predominated in Eastern England. The high prevalence of Y. enterocolitica bioserotypes 2/O:9 and 2/O:5 found in this study suggests that English pigs are an important reservoir of these bioserotypes whereas in other European countries bioserotype 4/O:3 predominates.

Percutaneous radiofrequency ablation of renal cell carcinomas in patients with solitary kidney: 6 years experience.

OBJECTIVE: In this study we attempt to present our clinical experience in RFA under CT-guidance, in patients with renal cell carcinoma in a solitary kidney. MATERIAL AND METHOD: Between October 2000 and June 2005, 18 patients with solitary kidney and renal cell carcinoma underwent percutaneous CT-guided radiofrequency ablation in our institution. Tumors diameter ranged from 1 to 7 cm and there was no evidence of spread beyond the kidney. The RFA-system used was with expandable needle electrode (7 or 9 arrays). Technical success, recurrence and survival rate and complications were accessed. Patients were available for clinical and laboratory evaluation at a mean follow-up time of 31.2 months (range: 12-72 months). RESULTS: In all cases the electrode was successfully placed at the lesion. The 18 tumors were treated with totally 24 RFA sessions. In small (1-3 cm) exophytic tumors technical success was 85.7%. Residual disease was totally seen in 6/18 tumors which required a 2nd RFA session. The recurrence rate was 11.1% but no recurrence was noticed in tumors less than 3 cm in diameter. No major complications were observed. Serum creatinine values were normal in 17/18 patients till the 3rd-month follow-up. Survival ranged from 12 to 72 months. CONCLUSION: RFA is an acceptable alternative for patients with small RCCs in a solitary kidney, which are not ideal candidates for surgical resection as their renal function must be preserved. They have an immediate solution to their clinical problem, under a minimally invasive therapy with no serious complications.

Radiofrequency ablation of liver metastases from cancer of unknown primary site.

PURPOSE: This retrospective study was performed to review the efficacy of local radiofrequency ablation (RFA) in all the management of liver cancer of unknown primary site (CUP), and to identify possible prognostic features and complications that affect the efficacy of this treatment on survival. MATERIALS AND METHODS: From April 2003 to December 2007, 22 patients (15 men, 7 women) with a total of 36 liver metastasis of CUP and poor response to prior systemic chemotherapy were treated with computed tomography-guided RFA. The median age of patients was 66 years. All patients (22/22) had 1-, 3-, and 6- month follow-up and 8/22 of them had a 12-month followup. RESULTS: The overall median survival of all 22 patients was 10.9 months. Survival was better in patients with lesions 3 cm or smaller. No severe complications, including local seeding, were occured. CONCLUSION: Our study revealed that RFA appears to be an effective, safe and relatively simple alternative procedure for the local ablation of these lesions. These results are more encouraging for lesions 3 cm or smaller, all of which were successfully treated, as proved by the imaging criteria and the statistical analysis. Further prospective trials are needed to determine whether RFA should be proposed for standard protocols.

Computed tomography-guided radiofrequency ablation of hepatocellular carcinoma: treatment efficacy and complications.

AIM: To evaluate the efficacy and complications of computed tomography (CT)-guided radiofrequency ablation (RFA) of unresectable hepatocellular carcinoma (HCC). METHODS: A retrospective study of 282 patients (231 males, 51 females, age range: 44-76 years, mean age: 62 years) with HCC (322 lesions) who had been treated by CT-guided RFA over a period of 5 years, was performed. The diameter of the tumors ranged from 1.5 to 5 cm. The tumors were considered as ablated completely, if no viability was found on dual-phase dynamic contrast enhanced CT at 1 month after RFA. The follow-up period ranged from 6 to 68 months (mean 29 months) and included a dual-phase dynamic contrast enhanced CT at 1, 3 and 6 months post-RFA and every 6 months afterwards. Patient outcome was evaluated and the survival and recurrence rates were assessed. Each case was reviewed for short-term and long-term complications. RESULTS: The ablation success rate was 87.3% (281/322 HCC nodules), while 41 (12.7%) lesions were managed with repeated RFA because of tumor residue. The survival rates at 1, 2, 3, 4 and 5 years were 94.8%, 86.6%, 73.1%, 64.2% and 51.1%, respectively. A total number of 9 (2.8% per procedure) minor complications occurred. No major complications were observed. During the follow-up period, the local tumour progression rate was 22%, while the recurrence rate of new intrahepatic nodules was 48%. CONCLUSION: The results of this study support that RFA is an effective and safe technique for the treatment of unresectable HCC.

Aorto-enteric fistula: CT findings.

The objective of this pictorial essay is to present the different CT findings encountered in patients with aorto-enteric fistulas (AEFs). An AEF is a rare and sometimes disastrous occurrence, responsible for intermittent or massive gastrointestinal hemorrhage and hematemesis. CT provides fast and effective evaluation in hemodynamically stable patients suspected of having an AEF.

Nonoperable recurrent renal cell carcinoma: management with embolization and CT-guided RF ablation.

We report the case of a 59-year-old male who underwent embolization and computed-tomography-guided radiofrequency ablation of a recurrent renal cell carcinoma that developed after radical nephrectomy in contiguity to the inferior vena cava. The alternative of a new operation was rejected because of the proximity of the tumor to the vessel and percutaneous approach seemed to be the better solution.

Multifocal skeletal tuberculosis with Rhodotorula minuta co-infection.

Multifocal skeletal tuberculosis comprises lesions occurring at 2 or more locations of the skeleton. We present an atypical case of multifocal skeletal tuberculosis coexisting with Rhodotorula minuta infection in a non-immunocompromized host. The advantages of computed tomography-guided biopsy in establishing the diagnosis and thus influencing treatment are also discussed.

Percutaneous CT-guided core needle biopsy versus fine needle aspiration in diagnosing pneumonia and mimics of pneumonia.

The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure.