Locoregional options in the management of cholangiocarcinoma: single center experience.

BACKGROUND: The purpose of this case series is to assess the safety and efficacy, as well as the overall survival (OS) and progression free survival (PFS) of patients with intrahepatic cholangiocarcinoma (ICC) treated with percutaneous ablation, transarterial arterial chemoembolization (TACE) or a combination of both at our institution. METHODS: Ten patients with pathological diagnosis of adenocarcinoma treated at out institution between January 1st 2013 and January 1st 2019 were reviewed. Three patients received a combined TACE and ablation treatment, three patients received TACE without ablation and four patients were treated with ablation only. Ablation technical success was determined by absence of residual tumor in the ablation zone on follow-up imaging one-month post-ablation. TACE response was assessed using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST). Technical success was defined as injection of chemoembolic material in the involved liver lobes. PFS and OS were calculated from the date of diagnosis. RESULTS: In the TACE and radiofrequency ablation (RFA) group, OS was 12, 55 and 56 months; PFS was 5, 6 and 32 months, one patient died and two others remain alive. In the TACE group, OS was 29, 10 and 5 months; PFS was 15, 10 and 4 months. All three patients remain alive. In the ablation group, OS and PFS were 16, 31, 30 and 40 months. All patients remain alive. Overall, 9 of 10 patients are alive, with a Median OS and PFS of 29.5 and 15.5 months, respectively, with some patients remain alive over four years following initial presentation. CONCLUSIONS: Our study shows that ablation and TACE in combination with more traditional modalities such as chemoradiation and surgical resection can extend survival in patients with ICC significantly. Locoregional therapy is well tolerated with only minor adverse events. The use of stereotactic body radiation therapy (SBRT) with ablation demonstrated the synergistic nature of using multiple lines of interventions.

Lung density in the trajectory path is a strong indicator of patients sustaining a pneumothorax during CT-guided lung biopsy.

INTRODUCTION: The purpose is to evaluate the prognostic significance of lung parenchymal density during percutaneous coaxial cutting needle lung biopsy (PNLB). MATERIALS AND METHODS: Retrospective analysis of 179 consecutive patients (106 males, 73 females; mean age 59.16 ± 16.34 years) undergoing PNLB was included. Mean lobar parenchymal lung density, mean densities anterior to the lesion and posterior to the chest wall in the needle trajectory path were measured in HU. Lesion location and needle trajectory were also measured. Fisher's exact test and Chi-square test were conducted to analyze the categorical variables. ANOVA test was done to examine continuous and normally distributed variables. Statistical significance was considered when p < 0.05. RESULTS: Mean lobar parenchymal lung density (p < 0.05) and mean parenchymal lung density relative to the needle trajectory path were below -800 HU in patients who sustained a pneumothorax. Increase in the number of pleural passes was significantly associated with the risk of patients having pneumothorax (p < 0.05). The mean distance from the skin to the lesion and needle trajectory angle were not statistically different among patients with and without pneumothorax (p > 0.05). CONCLUSION: Lobar parenchymal density and lung parenchymal density anterior to the lesion and posterior to the chest wall in the needle trajectory path could be used as predicting parameters in patients undergoing PNLB who sustained a pneumothorax. These findings can help interventional radiologist further assess risk of pneumothorax when preforming such procedure.

Peristaltic Contrast Media Injection Improved Image Quality and Decreased Radiation and Contrast Dose When Compared With Direct Drive Injection During Liver Computed Tomography.

PURPOSE: The aim of this study was to compare hepatic vascular and parenchymal image quality between direct and peristaltic contrast injectors during hepatic computed tomography (HCT). METHODS: Patients (n = 171) who underwent enhanced HCT and had both contrast media protocols and injector systems were included; group A: direct-drive injector with fixed 100 mL contrast volume (CV), and group B: peristaltic injector with weight-based CV. Opacification, contrast-to-noise ratio, signal-to-noise ratio, radiation dose, and CV for liver parenchyma and vessels in both groups were compared by paired t test and Pearson correlation. Receiver operating characteristic curve, visual grading characteristics, and Cohen κ were used. RESULTS: Contrast-to-noise ratio: compared with hepatic vein for functional liver, contrast-to-noise ratio was higher in group B (2.17 ± 0.83) than group A (1.82 ± 0.63); portal vein: higher in group B (2.281 ± 0.96) than group A (2.00 ± 0.66). Signal-to-noise ratio for functional liver was higher in group B (5.79 ± 1.58 Hounsfield units) than group A (4.81 ± 1.53 Hounsfield units). Radiation dose and contrast media were lower in group B (1.98 ± 0.92 mSv) (89.51 ± 15.49 mL) compared with group A (2.77 ± 1.03 mSv) (100 ± 1.00 mL). Receiver operating characteristic curve demonstrated increased reader in group B (95% confidence interval, 0.524-1.0) than group A (95% confidence interval, 0.545-1.0). Group B had increased revenue up to 58% compared with group A. CONCLUSIONS: Image quality improvement is achieved with lower CV and radiation dose when using peristaltic injector with weight-based CV in HCT.

PHACES syndrome with ectopia cordis and hemihypertrophy.

PHACES is the acronym describing the phenotypic association of posterior fossa anomalies, facial hemangioma, cardiac and eye anomalies, and sternal defects. To date, more than 300 cases of PHACE(S) have been reported. We present the case of a newborn girl who was born with a variant of the PHACES syndrome. Although the sternal cleft and the small facial hemangioma were evident clinically at birth, magnetic resonance imaging of the brain provided additional information to establish the diagnosis. In addition, the patient manifested later with hemihypertrophy, an association that has not been described previously.

Case report of epithelioid osteoblastoma of the mandible: findings on positron emission tomography/computed tomography and review of the literature.

Epithelioid osteoblastoma is a clinically aggressive subtype of osteoblastoma that favors the mandible and the maxilla. Its histologic features lie on a spectrum between conventional osteoblastoma and low-grade osteosarcoma, thus making it difficult at times to confirm the diagnosis. It is known to have a high risk of recurrence after surgical resection, but it is a benign entity and does not have the propensity to metastasize. To our knowledge, there are no published reports on findings of epithelioid osteoblastoma on positron emission tomography/computed tomography (PET/CT). We report a case of a 25-year-old male patient with a diagnosis of epithelioid osteoblastoma of the mandible. The lesion exhibited significantly increased fluorodeoxyglucose uptake on PET/CT with a maximum standardized uptake value of 5.5. PET/CT is not specific in differentiating between malignant and benign bone lesions but may be necessary to rule out distant lesions when a confirmed diagnosis of epithelioid osteoblastoma cannot be obtained through histologic examination.

High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for intertrochanteric fractures in elderly patients.

AIM: The aim of our study is to investigate the results of constrained total hip arthroplasty as a primary treatment of intertrochanteric fractures (ITF) in elderly patients with high comorbidities. MATERIALS AND METHODS: Total hip replacement (THR) with a retentive cup was performed on 73 patients with ITF over the age of 54 years who had high comorbidities and a Charlson score above five. Short- and long-term complications were determined by follow-up. Bivariate analysis was conducted in order to determine the possible determinants of mortality and factors associated with comorbidity as measured by the Charlson comorbidities index. RESULTS: Patient demographics that consisted of females (58.9%) (p < 0.04) with the mean age of both males and females demonstrated no statistical significance. The mean hospitalization time and weight bearing time were 11 and 2.67 days, respectively. Only 4.1% needed re-intervention due to re-fracture and none due to prosthesis failure. There was a statistical significance between the comorbidity index and the mortality rate. However, no statistical significance was identified between the comorbidity index and the functional status after constrained THR. CONCLUSION: High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for ITF in elderly patients.

New era of PET/CT in breast cancer: high-resolution PET/dfCT.

OBJECTIVE: To determine whether breast cancer staging differs between high-resolution (HR) and standard-resolution (SR) PET/computed tomography acquisition. PATIENTS AND METHODS: This retrospective study included 39 women with breast cancer referred for staging. Images were assessed for the number of primary breast lesions with the corresponding size and the average maximum standardized uptake value (SUVmax), the anatomical site of fluorine-18-fluorodeoxyglucose-avid lymph nodes (LNs) with their SUVmax, and the number and type (lytic/blastic) of metastatic bone lesions. RESULTS: On HR, 42 breast tumor lesions with a size range of 0.30 cm up to 12.00 cm were detected versus 34 breast tumor lesions on SR. One hundred and forty-one versus 90 axillary LNs were detected on HR versus SR, respectively. Pathology reports were available for 60 axillary LNs out of the total 141 identified on HR. Rates for HR versus SR sensitivity, true positivity, false positivity, and false negativity are as follows: 92 versus 75%, 92 versus 75%, 2 versus 0%, and 7 versus 25%. The higher detection rate of axillary LN on HR was significant (P<0.001), but not the number of nodes detected (P=0.091). SUVmax for breast tumor lesions (P=0.225) and axillary LNs (P=0.134) were not significant. Three (8%) patients had a change in staging and management. CONCLUSION: HR detected primary breast lesions and metastatic LNs missed on SR, which led to change in staging and management. In addition, HR images provided higher SUVmax, which enabled a more comfortable localization, especially when SR presented borderline values. Finally, HR images decreased the number of gray zone lesions, especially in axillary LN detection.