Microwave ablation followed by cTACE in 5-cm HCC lesions: does a single-session approach affect liver function?

PURPOSE: Microwave ablation (MWA) and conventional transarterial chemoembolization (cTACE) are locoregional treatments commonly performed in very early, early and intermediate stages of hepatocellular carcinoma (HCC). Despite combined locoregional approaches have shown encouraging results in obtaining complete tumor necrosis, their application in a single session is poorly described. Our aim was to evaluate the safety and efficacy of single-session MWA and cTACE treatment in 5-cm HCCs and its influence on liver function. MATERIALS AND METHODS: All 5-cm HCCs treated by MWA and cTACE performed in a single-session in our Interventional Radiology unit between January 2020 and December 2022 were retrospectively recorded and analyzed. Patients with poor or missing pre- and post-treatment imaging were excluded. Technical success, clinical success, and complications rate were examined as primary endpoints. Pre- and post-treatment liver function laboratory parameters were also evaluated. RESULTS: A total of 15 lesions (mean lesion diameter, 5.0 ± 1.4 cm) in 15 patients (11 men; mean age, 67.1 ± 8.9 years) were retrospectively evaluated. Technical and clinical success were 100% and 73%, respectively. Four (27%) cases of partial response and no cases of progressive or stable disease were recorded. AST and ALT values have found to be significantly higher in post-treatment laboratory tests. No other significant differences between pre- and post-treatment laboratory values were registered. AST and ALT pre- and post-treatment higher differences (ΔAST and ΔALT) were significantly associated with a lower clinical success rate. CONCLUSION: MWA and cTACE single-session approach is safe and effective for 5-cm HCCs, without significant liver function impairment. A post-treatment increase in AST and ALT values may be a predictor for clinical failure.

A Novel Use of Autologous Fibrin by Intracatheter Injection in Persistent Postoperative Biliary Defects: Technical Note on a Preliminary Experience.

PURPOSE: To introduce percutaneous selective injection of autologous platelet-rich fibrin as a novel technique for persistent bile leakage repair and sharing the results of our preliminary experience. MATERIALS AND METHODS: Seven patients (57.1% females; mean age 69.6 ± 8 years) with the evidence of persistent bile leak secondary to hepatobiliary surgery and ineffective treatment with percutaneous transhepatic biliary drainage were submitted to fibrin injection. Platelet-rich fibrin, a dense fibrin clot promoting tissue regeneration, was obtained from centrifuged patient's venous blood. Repeated percutaneous injections through a catheter tip placed in close proximity to the biliary defect were performed until complete obliteration at fistulography. Technical and clinical success were evaluated. RESULTS: Bile leaks followed pancreaticoduodenectomy in five and major hepatectomy in two patients. Technical success defined as fibrin injection at BD site was achieved in all seven patients, and clinical success defined as a complete healing of the BD at fistulography was achieved in six patients. The median time to BD closure was 76.7 ± 40.5 days and the average procedure number was 3 ± 1 per patient. In one patient, defect persistance after four treatments required gelatin sponge injection. No major complications occurred. One case of post-procedural transitory hyperpirexia was registered. CONCLUSION: In persistent biliary defects, despite prolonged biliary drainage stay, percutaneous injection of autologous platelet-rich fibrin appears as a readily available and feasible emergent technique in promoting fistulous tracts obliteration still mantaining main ducts patency.

Artificial Intelligence in Lung Cancer Screening: The Future Is Now.

Lung cancer has one of the worst morbidity and fatality rates of any malignant tumour. Most lung cancers are discovered in the middle and late stages of the disease, when treatment choices are limited, and patients' survival rate is low. The aim of lung cancer screening is the identification of lung malignancies in the early stage of the disease, when more options for effective treatments are available, to improve the patients' outcomes. The desire to improve the efficacy and efficiency of clinical care continues to drive multiple innovations into practice for better patient management, and in this context, artificial intelligence (AI) plays a key role. AI may have a role in each process of the lung cancer screening workflow. First, in the acquisition of low-dose computed tomography for screening programs, AI-based reconstruction allows a further dose reduction, while still maintaining an optimal image quality. AI can help the personalization of screening programs through risk stratification based on the collection and analysis of a huge amount of imaging and clinical data. A computer-aided detection (CAD) system provides automatic detection of potential lung nodules with high sensitivity, working as a concurrent or second reader and reducing the time needed for image interpretation. Once a nodule has been detected, it should be characterized as benign or malignant. Two AI-based approaches are available to perform this task: the first one is represented by automatic segmentation with a consequent assessment of the lesion size, volume, and densitometric features; the second consists of segmentation first, followed by radiomic features extraction to characterize the whole abnormalities providing the so-called "virtual biopsy". This narrative review aims to provide an overview of all possible AI applications in lung cancer screening.

Virtual Treatment Zone From Cone Beam CT Commonly Alters Treatment Plan and Identifies Tumor at Risk for Under-Treatment in US or US Fusion-Guided Microwave Ablation of Liver Tumors.

Tumor ablation is included in several major cancer therapy guidelines. One technical challenge of percutaneous ablation is targeting and verification of complete treatment, which is prone to operator variabilities and human imperfections and are directly related to successful outcomes, risk for residual unablated tumor and local progression. The use of "Prediction Ablation Volume Software" may help the operating Interventional Radiologist to better plan, deliver, and verify before the ablation, via virtual treatment zones fused to target tumor. Fused and superimposed images provide 3-dimensional information from different timepoints, just when that information is most useful. The aim of this study is to evaluate the technical success and efficacy of an ablation treatment flowchart provided by a cone beam computed tomography (CBCT) "Prediction Ablation Volume Software." This is a single-center retrospective study. From April 2021 to January 2022, 29 nonconsecutive evaluable patients with 32 lesions underwent liver ablation with Prediction Ablation Volume Software. Each patient was discussed in a multidisciplinary tumor board and underwent an enhanced computed tomography or magnetic resonance imaging approximately 1 month before the procedure, as well as ∼1 month after. Technical success was defined as treatment of the tumor according to the protocol, covered completely by the Prediction Ablation Volume. Technical efficacy was defined as assessment of complete ablation of the target tumor at imaging follow up (∼1 month). Technical success, technical efficacy, and procedural factors were studied. Technical success was achieved in 30 of 32 liver lesions (94%), measuring 20 mm mean maximum diameter. The antenna was repositioned in 16 of 30 (53%) evaluable target lesions. Residual tumor was detected at 1 month imaging follow up in only 4 of 30 (13%) of the treated lesion. Technical efficacy was of 87% in this retrospective description of our process. The implementation of a CBCT Prediction Ablation Volume Software and flowchart for the treatment of liver malignancies altered the procedure, and demonstrated high technical success and efficacy. Such tools are potentially useful for procedural prediction and verification of ablation.

Computed Tomography Urography: State of the Art and Beyond.

Computed Tomography Urography (CTU) is a multiphase CT examination optimized for imaging kidneys, ureters, and bladder, complemented by post-contrast excretory phase imaging. Different protocols are available for contrast administration and image acquisition and timing, with different strengths and limits, mainly related to kidney enhancement, ureters distension and opacification, and radiation exposure. The availability of new reconstruction algorithms, such as iterative and deep-learning-based reconstruction has dramatically improved the image quality and reducing radiation exposure at the same time. Dual-Energy Computed Tomography also has an important role in this type of examination, with the possibility of renal stone characterization, the availability of synthetic unenhanced phases to reduce radiation dose, and the availability of iodine maps for a better interpretation of renal masses. We also describe the new artificial intelligence applications for CTU, focusing on radiomics to predict tumor grading and patients' outcome for a personalized therapeutic approach. In this narrative review, we provide a comprehensive overview of CTU from the traditional to the newest acquisition techniques and reconstruction algorithms, and the possibility of advanced imaging interpretation to provide an up-to-date guide for radiologists who want to better comprehend this technique.

Role of Bronchial Artery Embolization as Early Treatment Option in Stable Cystic Fibrosis Patients with Sub-Massive Hemoptysis: Personal Experience and Literature Review.

(1) Background: We describe our experience with cystic fibrosis (CF) patients treated with bronchial artery embolization (BAE) for sub-massive hemoptysis to understand if early treatment of sub-massive hemoptysis can reduce the volume of any subsequent bleedings. (2) Materials: We performed a retrospective study including CF patients who underwent angiographic procedures for BAE following sub-massive hemoptysis, from March 2016 to December 2021. All patients underwent an initial chest angio-CT study. BAE was realized with microspheres or coils. (3) Results: Thirteen patients were included, subjected to at least one BAE after sub-massive hemoptysis, for a total of 19 procedures. Technical success was 94.7%; in a single case, the catheterization of the bronchial arterial feeder was not achievable and the procedure was repeated. Primary clinical success was 92.3%; secondary clinical success was 69.2%. Relative clinical success was 85%. A higher incidence of recurrent hemoptysis following treatment with coils was observed (100% of cases) compared to treatment with microspheres (54.5% of cases) χ2 = 5.43 (p < 0.05). (4) Conclusions: BAE is a safe and effective method for the treatment of hemoptysis in CF patients; it should be practiced not only after massive or recurrent hemoptysis but also in patients with sub-massive bleeding to improve their life expectancy and quality of life.

2D shear wave elastography in evaluation of prognostic factors in breast cancer.

PURPOSE: To evaluate the reproducibility of the 2D shear wave elastography (2D-SWE) method and to identify the prognostic factors of breast lesions. METHODS: In this prospective study, 44 female patients were consecutively included from January 2020 to September 2021. All patients showing visible masses at B-mode ultrasound underwent to clinical evaluation, followed by qualitative and quantitative 2D-SWE by two different operators with over 15-year and 2-year experience, respectively. Subsequently, patients underwent to surgical treatment after core needle biopsy. Reproducibility of qualitative and quantitative 2D-SWE was evaluated by Cohen's kappa and intraclass correlation coefficient (ICC). Clinical, imaging, and histopathological data and 2D-SWE evaluations were analysed with Spearman's rank correlation test. RESULTS: The mean age of the patients was 55 years ± 12. The mean histological and ultrasound tumour size of were 23.1 mm ± 13.2 and 17.2 mm ± 10.2, respectively. The interobserver agreement showed a good reproducibility limited to the qualitative evaluation colour maps (Cohen's kappa = 0.603) and to the quantitative evaluation E ratio (ICC = 0.771). Correlation analysis between the ultrasound and 2D-SWE values and the clinical-pathological parameters showed a significant relationship between E ratio and Elston-Ellis grading (P < 0.030) and between tumour size and Elston-Ellis grading (P < 0.041). CONCLUSION: The 2D-SWE has shown good reproducibility among operators with different experience. It could be a promising tool in the evaluation of some prognostic factors in ultrasound visible breast cancer.

Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures.

Interventional oncology (IO) procedures have become extremely popular in interventional radiology (IR) and play an essential role in the diagnosis, treatment, and supportive care of oncologic patients through new and safe procedures. IR procedures can be divided into two main groups: vascular and non-vascular. Vascular approaches are mainly based on embolization and concomitant injection of chemotherapeutics directly into the tumor-feeding vessels. Percutaneous approaches are a type of non-vascular procedures and include percutaneous image-guided biopsies and different ablation techniques with radiofrequency, microwaves, cryoablation, and focused ultrasound. The use of these techniques requires precise imaging pretreatment planning and guidance that can be provided through different imaging techniques: ultrasound, computed tomography, cone-beam computed tomography, and magnetic resonance. These imaging modalities can be used alone or in combination, thanks to fusion imaging, to further improve the confidence of the operators and the efficacy and safety of the procedures. This article aims is to provide an overview of the available IO procedures based on clinical imaging guidance to develop a targeted and optimal approach to cancer patients.

Interventional Radiology's Osteoid Osteoma Management: Percutaneous Thermal Ablation.

Osteoid osteoma (OO) is one of the most common benign bone tumors with specific clinical and radiological characteristics. Analgesic therapy and surgical treatment have been considered the only therapy for a long time. Recently, safe and effective new therapeutic options have been introduced, among which percutaneous thermal ablation techniques. This review aims to describe the recent updates in the field of percutaneous thermal ablation techniques in the treatment of OO, assessing the outcomes in terms of efficacy, complications, and recurrence rate.

Anatomical Variations of Anterior Ethmoidal Foramen and Cribriform Plate: Relations With Sex.

ABSTRACT: Position of anterior ethmoidal artery and height of lateral lamella of cribriform plate (LLCP) represent critical variants in endoscopy.In 200 maxillofacial computed tomography scans of patients the position of anterior ethmoidal foramen (AEF) in relation to ethmoid roof was recorded. The height of LLCP was measured and classified according to Keros classification.Differences in AEF position and distribution of Keros types, and LLCP height according to sex were assessed through chi-square test (P < 0.05) and 1-way analysis of covariance (ANCOVA) test, respectively (P < 0.05). Differences in LLCP height according to different AEF position were assessed through Mann-Whitney test (P < 0.05).No differences were observed in prevalence of AEF exposure according to sex (P > 0.05); LLCP height was higher in males than in females, with a higher frequency of Keros type 3 (P < 0.05). Moreover, subjects with AEF exposure had a significantly higher LLCP height (P < 0.01).Results highlighted innovative data useful for improving the knowledge of these sensitive variants.

Temporal Bone Pneumatization: Relationship With Sex and Variants of the Ethmoid and Sphenoid Bone.

ABSTRACT: Pneumatization variants of the temporal bone have a crucial importance in several surgical interventions. However, very few data are known about possible correlation with other pneumatization variants.Pneumatization of glenoid fossa, petrous apex, and infralabyrinthine portion of temporal bone was assessed in 200 computed tomography scans, equally divided between males and females (18-92 years). Pneumatization variants of the ethmoid (concha bullosa, agger nasi, pneumatized crista galli) and the sphenoid sinuses (pneumatized pterygoid processes, anterior clinoid processes, dorsum sellae, volume) were recorded as well.Differences in prevalence of each pneumatization type according to sex and side, among different portions of the temporal bone, and between temporal bone and the pneumatized variants of the ethmoid bone and sphenoid sinuses, were assessed through chi-square test (P < 0.05). Differences in sphenoid volume among different pneumatization degrees of the temporal bone were assessed through 1-way analysis of covariance test (P < 0.05).Pneumatization of the petrous apex and the infralabyrinthine portion was significantly more frequent in males than in females, whereas pneumatization of the glenoid fossa was more often observed on the right side (P < 0.05). Variants of the temporal bone are all related one with each other in males, whereas in females only the relationship between pneumatized petrous apex and infralabyrinthine portion was found. Moreover, in females the pneumatized petrous apex was related with pneumatized anterior clinoid process, and the pneumatized infralabyrinthine portion was related with the sphenoid sinus volume.Results may be useful for predicting these important variants in planning surgical interventions of the cranial base.

Comparison Between CBCT and Fusion PET/CT-CBCT Guidance for Lung Biopsies.

PURPOSE: To establish the feasibility of performing percutaneous biopsy of lung lesions guided by fusion PET/CT-CBCT and to evaluate whether the metabolic information provided by a prior PET/CT scan add incremental benefits for diagnosis. METHODS: We retrospectively reviewed data from 180 patients who underwent CBCT-guided lung biopsy (group 1-90 cases) or PET/CT-CBCT fusion-guided lung biopsy (group 2-90 cases). Technical and clinical success was calculated. We also evaluated the agreement between biopsy and definitive histology and the possibility to carrying out immunehistochemical and molecular biology analyses. RESULTS: Technical success was achieved in 84/90 (93.3%) cases for group 1 and 89/90 (98.9%) for group 2 cases (p 0.054). Clinical success was achieved in 80/94 (95.2%) cases for group 1 and 88/89 (98.9%) cases for group 2. Sensitivity, specificity, positive and negative predictive values and accuracy rate were, respectively, 94.5%, 100.0%, 100.0%, 73.3% and 95.2% for group 1 and 98.6%, 100.0%, 100.0%, 94.4% and 98.9% for group 2 (p 0.167). Agreement between biopsy and definitive histology was reached in 85.7% for group 1 and in 96.2% for group 2 (p 0.211). Immunohistochemical and molecular biology investigations were possible in 66.7% for group 1 and in 77.0% for group 2 (p 0.297). No major complication occurred. CONCLUSIONS: PET/CT-CBCT-guided lung biopsy is a feasible technique. In our retrospective case series, we found a higher clinical success rate, but no statistical difference was found.

The role of imaging in surgical planning for liver resection: what the radiologist need to know.

The management of patients undergoing surgical resection for liver malignancies requires a multidisciplinary team, including a dedicated radiologist. In the preoperative workup, the radiologist has to provide precise, relevant information to the surgeon. This requires the radiologist to know the basics of surgical techniques as well as liver surgical anatomy in order to help to avoid unexpected surgical scenarios and complications. Moreover, virtual resections and volumetries on radiological images will be discussed, and basic concepts of postoperative liver failure, regeneration, and methods for hypertrophy induction will be provided.

Hepatic tumors: pitfall in diagnostic imaging.

On computed tomography (CT) and magnetic resonance imaging (MRI), hepatocellular tumors are characterized based on typical imaging findings. However, hepatocellular adenoma, focal nodular hyperplasia, and hepatocellular carcinoma can show uncommon appearances at CT and MRI, which may lead to diagnostic challenges. When assessing focal hepatic lesions, radiologists need to be aware of these atypical imaging findings to avoid misdiagnoses that can alter the management plan. The purpose of this review is to illustrate a variety of pitfalls and atypical features of hepatocellular tumors that can lead to misinterpretations providing specific clues to the correct diagnoses.

MRI of perianal fistulas in Crohn's disease.

Perianal fistulas represent one of the most critical complications of Crohn's disease (CD). Management and treatment need a multidisciplinary approach with an accurate description of imaging findings. AIM: This study aspires to assess the significative role of Magnetic Resonance Imaging (MRI) in the study of perianal fistulas, secondary extensions, and abscess in patients with CD. Therefore it is essential to standardize an appropriate protocol of sequences that allow the correct evaluation of disease activity and complications. METHODS: We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about pelvic MRI imaging and features in CD. We excluded studies that weren't in the English language. CONCLUSIONS: MRI has a crucial role in the evaluation and detection of CD perianal fistulas because, thanks to its panoramic and multiplanar view, it gives excellent anatomic detail of the anal sphincters. Today MRI is the gold standard imaging technique for the evaluation of perianal fistulas, mainly because this technique shows higher concordance with surgical findings than does any other imaging evaluation. Surgical treatment is often required in the management of perianal fistula in patients with CD, which often have complex perineal findings.

Extranodal Lymphomas: a pictorial review for CT and MRI classification.

Extranodal lymphomas represent an extranodal location of both non-Hodgkin and Hodgkin lymphomas. This study aims to evaluate the role of CT and MRI in the assessment of relationships of extranodal lymphomas with surrounding tissues and in the characterization of the lesion. We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about CT and MRI imaging of extranodal lymphomas. Contrast-enhanced computed tomography (CT) is usually the first-line imaging modality in the evaluation of extranodal lymphomas, according to Lugano classification. However, MRI has a crucial role thanks to the superior soft-tissue contrast resolution, particularly in the anatomical region as head and neck.

Imaging guided percutaneous renal biopsy: do it or not?

Since its first reported application, renal biopsy became an important part of the diagnostic algorithm, considered advantages and risks, to better manage therapeutic options. The biopsy can be performed with different techniques (open, laparoscopic, transjugular, transurethral and percutaneous). Currently, the percutaneous approach is the modality of choice. Percutaneous biopsy can be performed under CT or US guidance, but critical benefits and disadvantages have to be considered. Core needle biopsy is usually preferred to fine-needle aspiration because of the sample quality, usually obtaining multiple cores, especially in heterogeneous tumors. Principal complications are hematuria (1-10%), perinephric hematoma (10-90%), pneumothorax (0,6%), clinically significant pain (1,2%).

Sphenoid sinuses: pneumatisation and anatomical variants-what the radiologist needs to know and report to avoid intraoperative complications.

PURPOSE: Sphenoid sinuses are pneumatised structures, placed in the body of the sphenoid bone, with highly variable morphology. The strict relationships with vascular and nervous structures determine the importance of their anatomical variants in otorhinolaryngology and neurosurgery; a precise understanding of the complex anatomy and anatomic variations of these structures is pivotal for radiological diagnosis of paranasal sinuses pathology and for surgical planning, to avoid potential complications. Our aim is to describe the anatomical variants of sphenoid sinuses, and to help general radiologists and specialists in endoscopic surgery in becoming familiar with these sensitive anatomical structures. METHODS: A literature search of PubMed and Embase (Elsevier) databases was performed using the keywords "sphenoid sinus" and "anatomy, "sphenoid sinus" and "anatomic variants", "sphenoid sinus", and "anatomic variations". RESULTS: We described the anatomical variants of the sphenoid sinuses anatomy, according to their size, shape, degree of pneumatisation, protrusion of anatomical structures into their lumen, superimposition of ethmoid cells (Onodi cells), and presence of accessory septations CONCLUSION: The information provided by this study may help in the identification and description of the anatomical variations of the sphenoid sinuses and their relationship to neurovascular structures.

New advances in CT imaging of pancreas diseases: a narrative review.

Computed tomography (CT) plays a pivotal role as a diagnostic tool in many diagnostic and diffuse pancreatic diseases. One of the major limits of CT is related to the radiation exposure of young patients undergoing repeated examinations. Besides the standard CT protocol, the most recent technological advances, such as low-voltage acquisitions with high performance X-ray tubes and iterative reconstructions, allow for significant optimization of the protocol with dose reduction. The variety of CT tools are further expanded by the introduction of dual energy: the production of energy-selective images (i.e., virtual monochromatic images) improves the image contrast and lesion detection while the material-selective images (e.g., iodine maps or virtual unenhanced images) are valuable for lesion detection and dose reduction. The perfusion techniques provide diagnostic and prognostic information lesion and parenchymal vascularization and interstitium. Both dual energy and perfusion CT have the potential for pushing the limits of conventional CT from morphological evaluation to quantitative imaging applied to inflammatory and oncological diseases. Advances in post-processing of CT images, such as pancreatic volumetry, texture analysis and radiomics provide relevant information for pancreatic function but also for the diagnosis, management and prognosis of pancreatic neoplasms. Artificial intelligence is promising for optimization of the workflow in qualitative and quantitative analyses. Finally, basic concepts on the role of imaging on screening of pancreatic diseases will be provided.

Ultrasound imaging classifications of thyroid nodules for malignancy risk stratification and clinical management: state of the art.

Assessing the risk of malignancy in the thyroid with ultrasound (US) is crucial in patients with nodules, as it can aid in selecting those who should have a fine-needle aspiration (FNA) biopsy performed. Many studies have examined whether the US characteristics of thyroid nodules are useful indicators of histological malignancy. Overall, these investigations have identified a few US features that are significantly more frequent in malignant thyroid nodules which can be coalesced into a defining set to be used as an indicator of a higher risk of malignancy. Despite these efforts, none of these classifications have been widely adopted worldwide, and there are still conflicting recommendations from different institutions. Understanding the role and appropriate utilization of these systems could facilitate the effective interpretation and communication of thyroid US findings among referring physicians and radiologists. In this comprehensive review, we outline the major US classification systems of thyroid nodules published in the last few years.