Embolization in pelvic venous disorders using ethylene vinyl alcohol copolymer (Onyx®) and Aetoxysclerol: a prospective evaluation of safety and long-term efficacy.

OBJECTIVES: To prospectively evaluate the safety and efficacy of embolization using ethylene vinyl alcohol copolymer (Onyx®) and Aetoxysclerol for treatment of pelvic venous disorders (PeVD). METHODS: This prospective study was approved by the institutional ethics review board. Ten clinical parameters were retained for evaluation of PeVD (pelvic pain, dyspareunia, post-coital pain, menstruation pain, lower limbs pain, difficulty walking, aesthetic discomfort, impact on daily working life, psychological impact and impact on daily life), measured on a visual analogue scale (VAS) between 0 and 10, and a global score out of 100 was noted before embolization, after 3 months during the imaging follow-up, and at the end of follow-up by phone call. The main criterion was clinical efficacy of embolization defined by an impairment score < 40/100 and a 50% decrease in overall score. Complications were recorded. Visualization of Onyx® on MRI 3 months after embolization was noted. RESULTS: Between July 2017 and May 2019, 73 consecutive women (mean age ± SD [range]: 41 ± 11 years [25-77]) treated by embolization with Onyx® and Aetoxysclerol were included. The median follow-up was 28 months [Q1-Q3: 24.0-29.2] (range: 18.1-34.5). The median initial VAS impairment score was 39/100 [29.75-48.50] (12-58). Clinical efficacy was obtained for 70 patients (70/73, 95.9%), and the median VAS impairment score at the end of follow-up was significantly lower at 3 [0.00-7.25] (0-73) (p < 0.0001). Four minor complications occurred. Onyx® was visualized on DIXON sequence of MRI for all patients. CONCLUSION: Embolization using Onyx® and Aetoxysclerol for PeVD is safe and effective. KEY POINTS: • Embolization using Onyx® and Aetoxysclerol for pelvic venous disorders is safe and effective. • Imaging follow-up is facilitated by visualization of Onyx® on MRI DIXON sequences.

RNA profiling of human testicular cells identifies syntenic lncRNAs associated with spermatogenesis.

STUDY QUESTION: Is the noncoding transcriptional landscape during spermatogenesis conserved between human and rodents? SUMMARY ANSWER: We identified a core group of 113 long noncoding RNAs (lncRNAs) and 20 novel genes dynamically and syntenically transcribed during spermatogenesis. WHAT IS KNOWN ALREADY: Spermatogenesis is a complex differentiation process driven by a tightly regulated and highly specific gene expression program. Recently, several studies in various species have established that a large proportion of known lncRNAs are preferentially expressed during meiosis and spermiogenesis in a testis-specific manner. STUDY DESIGN, SIZE, DURATION: To further investigate lncRNA expression in human spermatogenesis, we carried out a cross-species RNA profiling study using isolated testicular cells. PARTICIPANTS/MATERIALS, SETTING, METHODS: Human testes were obtained from post-mortem donors (N = 8, 51 years old on average) or from prostate cancer patients with no hormonal treatment (N = 9, 80 years old on average) and only patients with full spermatogenesis were used to prepare enriched populations of spermatocytes, spermatids, Leydig cells, peritubular cells and Sertoli cells. To minimize potential biases linked to inter-patient variations, RNAs from two or three donors were pooled prior to RNA-sequencing (paired-end, strand-specific). Resulting reads were mapped to the human genome, allowing for assembly and quantification of corresponding transcripts. MAIN RESULTS AND THE ROLE OF CHANCE: Our RNA-sequencing analysis of pools of isolated human testicular cells enabled us to reconstruct over 25 000 transcripts. Among them we identified thousands of lncRNAs, as well as many previously unidentified genes (novel unannotated transcripts) that share many properties of lncRNAs. Of note is that although noncoding genes showed much lower synteny than protein-coding ones, a significant fraction of syntenic lncRNAs displayed conserved expression during spermatogenesis. LARGE SCALE DATA: Raw data files (fastq) and a searchable table (.xlss) containing information on genomic features and expression data for all refined transcripts have been submitted to the NCBI Gene Expression Omnibus under accession number GSE74896. LIMITATIONS, REASONS FOR CAUTION: Isolation procedures may alter the physiological state of testicular cells, especially for somatic cells, leading to substantial changes at the transcriptome level. We therefore cross-validated our findings with three previously published transcriptomic analyses of human spermatogenesis. Despite the use of stringent filtration criteria, i.e. expression cut-off of at least three fragments per kilobase of exon model per million reads mapped, fold-change of at least three and false discovery rate adjusted P-values of less than <1%, the possibility of assembly artifacts and false-positive transcripts cannot be fully ruled out. WIDER IMPLICATIONS OF THE FINDINGS: For the first time, this study has led to the identification of a large number of conserved germline-associated lncRNAs that are potentially important for spermatogenesis and sexual reproduction. In addition to further substantiating the basis of the human testicular physiology, our study provides new candidate genes for male infertility of genetic origin. This is likely to be relevant for identifying interesting diagnostic and prognostic biomarkers and also potential novel therapeutic targets for male contraception. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by l'Institut national de la santé et de la recherche médicale (Inserm); l'Université de Rennes 1; l'Ecole des hautes études en santé publique (EHESP); INERIS-STORM to B.J. [N 10028NN]; Rennes Métropole 'Défis scientifiques émergents' to F.C (2011) and A.D.R (2013). The authors have no competing financial interests.

In vivo percutaneous microwave ablation in kidneys: Correlation with ex vivo data and ablation work.

PURPOSE: To compare diameters of in vivo microwave ablation (MWA) performed in swine kidneys with ex vivo diameters, and to correlate with ablation work (AW), a new metric reflecting total energy delivered. MATERIAL AND METHODS: Eighteen in vivo MWA were performed in 6 swine kidneys successively using one or two antennas (MicroThermX®). Ablation consisted in delivering power (45-120W) for 5-15minutes. Ex vivo diameters were provided by the vendors and obtained on bovine liver tissue. AW was defined as the sum of (power)*(time)*(number of antennas) for all phases of an ablation (in kJoules). Kidneys were removed laparoscopically immediately after ablation. After sacrifice, ablations zones were evaluated macroscopically, and maximum diameters of the zones were recorded. Wilcoxon sum rank test and Pearson's correlation were used for comparisons. RESULTS: For a single antenna (n=12), the in vivo diameters ranged from 12 to 35mm, and 15-49mm for 2 antennas (n=6). The in vivo diameters remained shorter than ex vivo diameters by 8.6%±30.1 on 1 antenna and 11.7%±26.5 on 2 antennas (P=0.31 and 0.44, respectively). AW ranged from 13.5 to 108kJ. Diameters increased linearly with AW both with 1 and 2 antennas, but only moderate correlations were observed (r=0.43 [95% confidence interval: -0.19; 0.81], P=0.16; and 0.57 [-0.44; 0.95], P=0.24, respectively). CONCLUSION: Although diameters after in vivo renal MWA increased linearly with AW, the moderate correlation and wide standard deviations observed may justify a careful imaging monitoring during treatment delivery and settings adaptation, if needed, for optimal ablation.

Percutaneous cryoablation of symptomatic venous malformations as a second-line therapeutic option: a five-year single institution experience.

PURPOSE: To report the mid-term outcomes of percutaneous cryoablation (PCA) performed as second-line therapeutic option of venous malformations (VM). MATERIAL AND METHODS: From 2011 to 2015, PCA was offered in 24 patients (mean age: 31 years, range: 12-64) as second-line treatment for recurrence of symptoms after sclerotherapy and when resection was not possible (due to lesion location or previous failure) or refused by the patient. Adverse effects were recorded, disease-free survival (DFS) and local tissue control (LTC) rates were calculated based on symptoms and volume evolution. RESULTS: Mean follow-up was 18.7 months (6-48). Nine (37.5%, 9/24) adverse effects occurred and three (12.5%, 3/24) were severe. Mean pain assessed by visual analog scale (VAS) was 41.7 mm (0-80) before treatment and 20.3 mm (0-80) (p=0.01) after. Mean volume decreased significantly after treatment from 22.4 cm3 (0.9-146) to 8.35 cm3 (0-81.3) (p<0.001). Pain recurred in nine patients and size of one lesion increased. The DFS and LTC rates were 54% [95%CI: 22.94-77.27] and 93.33% [61.26-99.03] at 24 months, respectively. Only VM volume >10 cm3 was associated with a higher risk of local recurrence (p=0.05). CONCLUSION: PCA as second-line treatment appears to be safe and effective for local control of VM according to mid-term results. KEY POINTS: • Percutaneous cryoablation of venous malformations appeared well tolerated. • Size of venous malformations decreased significantly after percutaneous cryoablation (p<0.001). • Pain decreased significantly after percutaneous cryoablation of venous malformations (p=0.01).

Percutaneous Image-Guided Cryoablation as Second-Line Therapy of Soft-Tissue Venous Vascular Malformations of Extremities: A Prospective Study of Safety and 6-Month Efficacy.

PURPOSE: To report the safety and short-term efficacy of percutaneous image-guided cryoablation performed as second-line therapy of venous vascular malformations (VVM) of extremities. MATERIALS AND METHODS: In this non-blinded, no-randomized trial, cryoablation was proposed in 14 patients presenting with symptomatic VVM for recurrences after treatment. Eligibility criteria were: cryoablation feasible, localization at least 5 mm from skin and nerves, absence of contra-indication for anesthesia. Safety was evaluated by the common terminology criteria for adverse events (AE). Clinical response was assessed by evaluating pain at day 7, month 2 and 6 using visual analog scale; quality of life before cryoablation and at 2 and 6 months after using questionnaire. Evolution of volume was evaluated by MRI at 6 months. Comparison was performed using the Wilcoxon test. RESULTS: A technical success was observed in all cases. While 11 patients (78.6%) presented AE (13 grade 1-2 and 3 grade 3), only two severe AE (grade 3) related to cryoablation occurred in two patients (14.3%) during the 6-month follow-up: one immediate sciatic paralysis and one delayed paresthesia. A clinical response was observed in 12 patients (85.7%) at 6 months. Pain decreased significantly from 42.5 ± 14.2 mm before the intervention to 11.8 ± 17.9 mm at 6 months (P = 0.002). A significant decrease in the mean volume from 12.8 ± 14.3 to 3 ± 2.7 cm3 was observed at 6 months (P = 0.002). CONCLUSION: Percutaneous cryoablation is a promising alternative treatment for sclerotherapy-resistant venous malformations. However, to improve safety, careful patient selection and treatment planning will be mandatory.

Imaging of non-traumatic abdominal emergencies in adults.

Non-traumatic abdominal pathology is one of the most common reasons for consultation in emergency care services. Abdominal pain is the presenting symptom for many diseases, which often requires urgent care. Clinical history and physical examination are rarely sufficient to establish a definite diagnosis and imaging is usually necessary. The choice of imaging modality is oriented by the clinical context and guided by the institutional capabilities, safety and cost-effectiveness of the available tests. Plain radiographs have little or no place in the evaluation of the acute abdomen. Magnetic resonance imaging (MRI) still has limited availability in many hospitals, thus narrowing the imaging choice to ultrasound (US) and computerized tomography (CT). No scientific evidence exists to allow the imposition of one single strategy. At the present time, the clinician may choose either routine US evaluation complemented by CT in case the US is inconclusive or first-line CT (except for the evaluation of right lower quadrant [RLQ] pain, right upper quadrant [RUQ] pain and in pregnant women where ultrasound is the first-line study).

Multiparametric magnetic resonance imaging for the differentiation of low and high grade clear cell renal carcinoma.

PURPOSE: To retrospectively evaluate the ability of magnetic resonance (MR) imaging to differentiate low from high Fuhrman grade renal cell carcinoma (RCC). MATERIALS AND METHODS: MR images from 80 consecutive pathologically proven RCC (57 clear cell, 16 papillary and 7 chromophobe) were evaluated. Double-echo chemical shift, dynamic contrast-enhanced T1- and T2-weighted images and apparent diffusion coefficient (ADC) maps were reviewed independently. Signal intensity index (SII), tumour-to-spleen SI ratio (TSR), ADC ratio, wash-in (WiI) and wash-out indices (WoI) between different phases were calculated and compared to pathological grade and size. The Fuhrman scoring system was used. Low grade (score ≤ 2) and high grade (score ≥ 3) tumours were compared using univariate and multivariate analyses. RESULTS: No associations between grade and imaging factors were found for papillary and chromophobe RCCs. For clear cell RCCs, there was a significant association between the grade and parenchymal WiI (WiI2) (P = 0.02) or ADCr (P = 0.03). A significant association between tumour grade and size (P = 0.01), WiI2 (P = 0.02) and ADCr (P = 0.05) remained in multivariate analysis. CONCLUSIONS: Multiparametric MRI can be used to accurately differentiate low Fuhrman grade clear cell RCC from high grade. High Fuhrman grade (≥ 3) RCCs were larger, had lower parenchymal wash-in indices and lower ADC ratios than low grade. KEY POINTS: • Fuhrman grade of clear cell RCC can be differentiated with multiparametric MR imaging. • Fuhrman grade significantly differed for size, parenchymal wash-in index and ADC ratio. • No significant associations were found for papillary and chromophobe renal cell carcinoma.

Long-term results of preventive embolization of renal angiomyolipomas: evaluation of predictive factors of volume decrease.

OBJECTIVES: To evaluate the efficacy of selective arterial embolization (SAE) of angiomyolipomas based on the percentage volume reduction after embolization and to identify predictive factors of volume decrease. METHODS: Patients receiving prophylactic SAE of renal angiomyolipomas were included retrospectively over 3 years. The volume change after SAE and haemorrhagic or surgical events were recorded. Initial tumour volume, percentage tumour fat content, mean tumour density, embolic agent used, number of angiomyolipomas and tuberous sclerosis disease were evaluated as predictive factors of volume decrease. RESULTS: A total of 19 patients with 39 angiomyolipomas were included with median follow-up of 28 months (interquartile range 21-37 months). All treatments were technically successful (92% primary and 8% secondary). No distal bleeding or any increase in size or surgical nephrectomy after SAE was recorded. Mean volume reduction was 72% (±24%). Volumes before SAE (R(2) = 0.276; p = 0.001), percentage fat content (R(2) = 0.612; p < 0.0001) and mean angiomyolipoma density (R(2) = 0.536; p < 0.0001) were identified as predictive factors of volume decrease. In multivariate regression, only percentage fat content influenced volume decreases. CONCLUSIONS: SAE is an efficient treatment for angiomyolipoma devascularisation and volume reduction. A significant reduction of volume is modulated by the initial volume and tissue composition of the tumour. KEY POINTS: • Selective arterial embolization is effective for angiomyolipoma devascularisation and volume reduction • Volume reduction depends of initial volume and tissue composition of the tumour • Selective arterial embolization is a low radiation treatment.

Routinely performed multiparametric magnetic resonance imaging helps to differentiate common subtypes of renal tumours.

OBJECTIVES: To retrospectively evaluate the ability of multiparametric magnetic resonance (MR) imaging to differentiate renal tumours. METHODS: MR images from 100 consecutive pathologically proven solid renal tumours without macroscopic fat [57 clear cell, 16 papillary and 7 chromophobe renal cell carcinomas (RCCs), 16 oncocytomas and 4 minimal fat angiomyolipomas (AMLs)] between 2009 and 2012 were evaluated. Two radiologists blinded to pathology results independently reviewed double-echo chemical shift, dynamic contrast-enhanced T1- and T2-weighted images and apparent diffusion coefficient (ADC) maps. Signal intensity index (SII), tumour-to-spleen SI ratio (TSR), ADC ratio, wash-in (WiI) and wash-out indices (WoI) between different phases were calculated. RESULTS: There were significant differences between papillary RCCs and other renal tumours for arterial WiI (P < 0.001), initial WoI (P = 0.006) and ADC ratio (P < 0.001); between chromophobe RCCs and oncocytomas for TSR (P = 0.02), parenchymal WiI (P = 0.03), late WiI (P = 0.02), initial WoI (P = 0.03) and late WoI (P = 0.04); and between clear cell RCCs and oncocytomas for SII (P = 0.01) and parenchymal WiI (P = 0.01). Papillary RCCs were distinguished from other tumours (sensitivity 37.5 %, specificity 100 %) and oncocytomas from chromophobe RCCs (sensitivity 25 %, specificity 100 %) and clear cell RCCs (sensitivity 100 %, specificity 94.2 %). CONCLUSION: MR imaging provides criteria able to accurately distinguish papillary RCCs from other tumours and oncocytomas from chromophobe and clear cell RCCs. KEY POINTS: • Multiparametric MR parameters accurately distinguish papillary RCCs with high specificity (100 %). • Oncocytomas can be distinguished from chromophobe RCCs with high specificity (100 %). • Oncocytomas can be distinguished from clear cell RCCs with high specificity (94.2 %). • In oncocytomatosis, imaging follow-up with such parameters analysis could be promoted.

Percutaneous cryoablation of symptomatic abdominal scar endometrioma: initial reports.

PURPOSE: The purpose of this preliminary study was to report the short-term local control of percutaneous image-guided cryoablation of localized symptomatic abdominal scar endometrioma. METHODS: Four consecutive patients (mean age 34.5 years) with a total of ten lesions were included, with mean preoperative pain of 7 (range 5-9) on the visual analog scale. Cryoablation was performed in a single session under general anesthesia. RESULTS: Postoperative superficial edema disappeared within 2 weeks for all patients. No severe complications (>grade 2 according to the CTCAE classification) were reported. Mean postoperative pain was 1.7 at 6 months (range 0-5) and magnetic resonance imaging demonstrated a significant volume decrease for all patients (range 72.2-100%; p = 0.028). CONCLUSIONS: Percutaneous cryoablation shows promising local control in patients with symptomatic abdominal wall endometriosis.

Perfusion imaging in renal diseases.

Functional imaging of the kidney using radiological techniques has a great potential of development because the functional parameters, which can be approached non-invasively, are multiple. CT can provide measurement of perfusion and glomerular filtration but has the inconvenient to deliver irradiation and potentially nephrotoxicity due to iodine agents in this context. Sonography is able to evaluate perfusion only but quantification remains problematic. Therefore, MR imaging shows the greatest flexibility measuring blood volume and perfusion as well as split renal function. The main applications of perfusion imaging of the kidney are vascular diseases, as renal artery stenosis, renal obstruction and follow-up of renal tumors under antiangiogenic therapy. However, full clinical validation of these methods and the evaluation of their clinical impact are still often worthwhile.

Renal ultrasound elastography.

Chronic kidney disease (CKD) incidence and prevalence are increasing in Western countries, due particularly to diabetes mellitus and hypertension-related nephropathies. CKD may lead to end-stage renal failure, with extensive morbidity, mortality and increasing health costs. Primary and secondary prevention requires a better knowledge of mechanisms underlying renal scarring, the development of specific therapies to slow down the progression of the disease and the development of non-invasive diagnostic tools to characterize the process. Ultrasound elastography is a new imaging technique under development that provides information about renal stiffness. Kidney elasticity measurements with ultrasound should be performed with a quantitative technique, such as Shearwave techniques. However kidney stiffness is not only related to fibrosis, as it also sensitive to mechanical and functional parameters such as anisotropy, vascularization, hydronephrosis and external pressure. This paper reviews the existing ultrasound elastography techniques. Elastography is a new tool under development for renal tissue characterization and needs further validation in clinical practice.

Ten-year experience of percutaneous image-guided radiofrequency ablation of malignant renal tumours in high-risk patients.

OBJECTIVES: To evaluate survival and outcomes after percutaneous radiofrequency ablation (RFA) of malignant renal tumours in high-risk patients with long-term follow-up. METHODS: Between 2002 and 2009, 62 patients (71 tumours), with a median age of 73.5 years (20-87), consecutively treated with RFA under ultrasound or computed tomography guidance for malignant renal tumours were retrospectively selected and prospectively followed until 2012, including 25 patients (40.3 %) with solitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 and 46 mm (median: 23 mm). RESULTS: Radiofrequency ablation was technically possible for all patients. Mean follow-up was 38.8 months (range: 18-78 months). Primary and secondary technique effectiveness was 95.2 % and 98.4 % per patient respectively. The rates of local tumour progression and metastatic evolution were 3.2 % and 9.7 % per patient and were associated with tumour size >4 cm (P = 0.005). The disease-free survival rates were 88.3 % and 61.9 % at 3 and 5 years. No significant difference in glomerular filtration rates before and after the procedure was observed (P = 0.107). The major complications rate was 5.9 % per session with an increased risk in the case of central locations (P = 0.006). CONCLUSIONS: Percutaneous renal RFA appears to be safe and effective with useful nephron-sparing results. KEY POINTS: • Radiofrequency ablation (RFA) is a well-tolerated technique according to mid-term results. • RFA for malignant renal tumours preserved renal function in high-risk patients. • Mid-term efficacy of RFA was close to that of formal conservative surgery. • Tumour size and central location limit the efficacy and safety of RFA.

Radiologically-guided thermal ablation of renal tumours.

Thermal ablation techniques for renal tumours have become the norm in surgically at-risk patients. These percutaneous treatments are locally effective, particularly for tumours measuring less than 4cm. Larger tumours may be treated by adapting the technique and strategy. Multidisciplinary discussion is essential before any decision, in order to decide on the most appropriate technique. Radiofrequency is simple, effective and inexpensive. Cryotherapy is more complex and should be preferred when the tumour is large or there is vascular or urinary tract contact. Microwaves can be used to treat larger tumours. Morbidity is low, but good knowledge of these techniques and of dissection is required to avoid injury to neighbouring digestive or urinary structures.

Embolization of polycystic kidneys as an alternative to nephrectomy before renal transplantation: a pilot study.

In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation.

Small pelvic lymph node metastases: evaluation with MR imaging.

The purpose of this study was to determine if lymph node asymmetry in small (< 1.0 cm) pelvic lymph nodes was a significant prognostic feature in determining metastatic disease. Two hundred and sixteen patients who presented with pelvic carcinoma underwent magnetic resonance imaging (MRI). They were correlated with pathological findings obtained at surgery. We considered the maximum diameter (MAD) of both round- or oval-shaped suspicious masses seen in the axial plane. Two different cut-off values were determined: lymph node diameter greater than 1.0 cm (criterion 1) and lymph node diameter greater than 0.5 cm with asymmetry relative to the opposite side for lymph nodes ranging from 0.5 cm to 1.0 cm (criterion 2). With criterion 1, MRI had an accuracy of 88%, a sensitivity of 65%, a specificity of 96%, a positive predictive value (PPV) of 88% and a negative predictive value (NPV) of 88% in the detection of pelvic lymph node metastasis. By considering criterion 2, MRI had an accuracy of 85%, a sensitivity of 75%, a specificity of 91%, a PPV of 71% and a NPV of 91%. Normal small asymmetric lymph nodes were present in 5.6% of cases. Normal asymmetry of pelvic lymph nodes is not uncommon. It cannot be relied on to diagnose metastatic involvement in cases of small suspicious lymph nodes.

Benign hyperplasia in ectopic prostatic tissue: a rare cause of pelvic mass.

Four cases of a pelvic mass due to the development of benign hyperplasia within ectopic prostatic tissue are reported. They presented a hypoechoic homogeneous or heterogeneous pattern on transrectal ultrasonography and a high signal intensity on T2-weighted spin-echo sequences on MR. On CT the density was similar to that of prostatic tissue. No recent imaging findings of this rare entity have been described in the literature. Possible aetiologies are discussed. Even if it is a rare event, the correct diagnosis can be reached. It is important for radiologists to consider the presence of this lesion because of its benign nature.