RESUMO
A 77-year-old woman with a 1 years history of Multiple Myeloma (MM) presented with headache, fatigue, and bone pain. She underwent whole body multi-detector computed tomographic (MD-CT) to evaluate possible lytic bone lesions. MD-CT showed small, multiple osteolytic lesions, particularly at the skull level (Figure 1, 2). MM is a plasma cell disorder. It is characterized by the monoclonal proliferation of malignant plasma cells (1,2). These cells, among their various characteristics, determine an infiltrate haemopoietic locations (1). Pathogenesis of MM related bone disease is the uncoupling of the bone remodelling process. There is an increased activity of osteoclastogenesis with the suppressed osteoblastic one, resulting in bone loss (1- 3). This process creates lytic lesions without reactive bone formation (2). Bone disease could be from single lytic lesion to multiple lytic lesions affecting any part of skeleton, preferably skull, spine and long bones (3). MD-CT, with dedicated low-dose protocols, is able to provide whole body skeletal volume information with a greater sensitivity than conventional X-ray studies in MM patients (3). Whole body CT with lowdose protocols can detect lesions with less than 5% trabecular bone destruction, and it is the first-line diagnostic imaging procedure for the diagnosis of lytic bone disease in patients affected by MM (4). When skull is involved, its most common MD-CT presentation is by numerous, well-circumscribed and punched-out lytic bone lesions, without reactive bone formation and diffuse osteopenia (1-5), as in the case presented.
Assuntos
Doenças Ósseas , Mieloma Múltiplo , Idoso , Feminino , Humanos , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Crânio/diagnóstico por imagemAssuntos
Tumor Glômico , Neoplasias Gástricas , Gastroscopia , Tumor Glômico/diagnóstico por imagem , Tumor Glômico/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Antro Pilórico/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/patologiaRESUMO
Artificial intelligence (AI) is revolutionizing healthcare and transforming the clinical practice of physicians across the world. Radiology has a strong affinity for machine learning and is at the forefront of the paradigm shift, as machines compete with humans for cognitive abilities. AI is a computer science simulation of the human mind that utilizes algorithms based on collective human knowledge and the best available evidence to process various forms of inputs and deliver desired outcomes, such as clinical diagnoses and optimal treatment options. Despite the overwhelmingly positive uptake of the technology, warnings have been published about the potential dangers of AI. Concerns have been expressed reflecting opinions that future medicine based on AI will render radiologists irrelevant. Thus, how much of this is based on reality? To answer these questions, it is important to examine the facts, clarify where AI really stands and why many of these speculations are untrue. We aim to debunk the 6 top myths regarding AI in the future of radiologists.
Assuntos
Inteligência Artificial , Radiologistas/tendências , Radiologia Intervencionista/tendências , Aprendizado Profundo , Previsões , Humanos , Aprendizado de Máquina , Papel do Médico , Padrões de Prática Médica/tendências , Radiografia/tendências , Radiologistas/educaçãoRESUMO
The aim of our study is a retrospective evaluation of effectiveness and safety of Computed Tomography (CT)-guided radiofrequency ablation (RFA) therapy of primary and metastatic lung lesions in patients that cannot be considered surgical candidates. From February 2007 to September 2017, we performed 264 CT-guided ablation sessions on 264 lesions in 174 patients (112 M and 62 F; mean age, 68 years; range 36-83 years) affected by primary and metastatic lung lesions. The 45% of patients was affected by primary lung cancer, with size range lesion of 10-50 mm, and the 55% by metastatic lung lesions with size range of 5-49 mm. All patients had no more than three metastases in the lung and pulmonary relapses were treated up to three times. Overall Survival (OS), Progression-Free Survival (PFS), Local Progression-Free Survival (LPFS) and Cancer-specific survival (CSS) at 1, 3 and 5 years were calculated both in primary lung tumors and in metastatic patients. Immediate and late RFA-related complications were reported. Pulmonary function tests were evaluated after the procedures. The effectiveness of RFA treatment was evaluated by contrast-enhanced CT. In patients affected by primary lung lesions, the OS rates were 66.73% at 1 year, 23.13% at 3 years and 16.19% at 5 years. In patients affected by metastatic lung lesions, the OS rates were 85.11%, 48.86% and 43.33%, respectively, at 1, 3 and 5 years. PFS at 1, 3 and 5 years were 79.8%, 60.42%, 15.4% in primary lung tumors and 78.59%, 51.8% and 6.07% in metastatic patients. LPFS at 1, 3 and 5 years were 79.8%, 64.69%, 18.87% in primary lung tumors and 86.29%, 69.15% and 44.45% in metastatic patients. CSS at 1, 3 and 5 years was 95.56%, 71.84%, 56.72% in primary lung tumors and 94.07%, 71% and 71% in metastatic patients. Immediate RFA-related complications (pneumothorax, pleural effusion and subcutaneous emphysema) were observed, respectively, in 42, 53 and 13 of 264 procedures (15.9%, 20% and 5%). There also occurred one major complication (lung abscess, 0.36%). No significant worsening of pulmonary function was noted. Our retrospective evaluation showed long-term effectiveness, safety and imaging features of CT-guided RFA in patients affected by primary and metastatic lung cancer as an alternative therapy in non-surgical candidates.
Assuntos
Neoplasias Pulmonares/cirurgia , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Assistida por Computador , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Renal cell carcinoma (RCC) local recurrence after radical nephrectomy is uncommon. When feasible, surgical removal remains the primary treatment strategy; nevertheless, local RCC relapse management is controversial, and less invasive procedures may represent an attractive option to achieve oncologic control. The aim of our study was to assess the feasibility, safety, and clinical outcomes of image-guided percutaneous microwave ablation (MWA) for RCC local recurrence in patients initially treated with nephrectomy with curative intent. 10 consecutive patients underwent CT-guided percutaneous MWA of a total of 10 retroperitoneal nodules. Inclusion criteria were: histologically verified retroperitoneal metastases, previous radical nephrectomy, lesion no larger than 3 cm, no other metastatic site elsewhere. All the procedures were performed under moderate sedation choosing the most favorable patient decubitus. If deemed necessary, pneumodissection was induced before ablation. After the antenna placement inside the target lesion, thermal ablation was achieved by maintenance of a power of 100 W for a total time between 2 and 4 min. All patients were observed overnight and discharged the following day if clinically stable. Technical success was obtained in 100% of patients. One patient was re-treated to complete oncologic response with repeat MWA. No major complications were observed. No patients demonstrated local recurrence at a mean follow-up of 26 months. MWA is a safe and effective treatment strategy for loco-regional relapse of RCC following radical nephrectomy. This technique may represent a valuable approach for patients who are not eligible for surgery.
Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Recidiva Local de Neoplasia , Nefrectomia , Neoplasias Retroperitoneais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Estudos Prospectivos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Tumor de Klatskin/diagnóstico por imagem , Idoso , Ductos Biliares Intra-Hepáticos/patologia , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: To evaluate role of interventional radiology (IR) in post-surgical haemorrhagic complications of prostatectomy. METHODS: A retrospective study was performed. From April 2015 to January 2018, 10 patients referred to IR Department for haemorrhagic complications post radical prostatectomy (RP). All patients (mean age: 68.5 years; range, 58-85 years) were successfully treated with superselective trans-arterial embolization. We evaluated technical and clinical success and post procedural complications. RESULTS: Technical and clinical success was 100% (10/10) and no major complications were identified. No complications related to the endovascular procedures occurred. No recurrences during follow-up (8-20 months) were observed. Among minor complications, only 20% (2/10) developed mild post embolization syndrome. CONCLUSIONS: The endovascular management of significant haemorrhage after prostatectomy is safe and long-term effective, with no major ischaemic events associated to embolization.
RESUMO
Hepatic haemangioma is a congenital vascular malformation, considered the most common benign mesenchymal hepatic tumour. Spontaneous or traumatic rupture is the most severe complication. In case of rupture, surgical resection and enucleation, as a single therapy or after trans-arterial embolization are considered the treatments of choice. We report a case of spontaneous rupture of a hepatic haemangioma with massive hemoperitoneum successfully treated by percutaneous hepatic trans-arterial embolization and pelvic drainage alone.
RESUMO
Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). Several patients present contraindication for standard approach, individuals older than 60 years with urinary tract infection, strictures, post-operative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are not good candidates for surgery. Prostatic artery embolization (PAE) is emerging as a viable method for patients unsuitable for surgery. In this article, we report results about technical and clinical success and safety of the procedure to define the current status.
Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Artéria Hepática , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/terapia , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Angiografia por Tomografia Computadorizada , Artéria Hepática/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Tomografia Computadorizada Multidetectores , Radiografia Intervencionista , Resultado do TratamentoRESUMO
Congenital anomalies of superior vena cava (SVC) are generally discovered incidentally during central venous catheter (CVC) insertion, pacemaker electrode placement, and cardiopulmonary bypass surgery. Persistent left SVC (PLSVC) is a rare (0.3%) anomaly in healthy subjects, usually asymptomatic, but when present and undiagnosed, it may be associated with difficulties and complications of CVC placement. In individuals with congenital heart anomalies, its prevalence may be up to 10 times higher than in the general population.In this perspective, awareness of the importance of the incidental finding of PLSV during CVC placement is crucial. To improve knowledge of this rare but potentially dangerous condition, we describe the embryological origin of SVC, its normal anatomy, and possible congenital anomalies of the venous system and of the heart, including the presence of a right to left cardiac shunt. Diagnosis of PLSVC as well as the clinical complications and technical impact of SVC congenital anomalies for CVC placement are emphasized.
Assuntos
Cateterismo Venoso Central , Malformações Vasculares , Veia Cava Superior/anormalidades , Cateterismo Venoso Central/efeitos adversos , Humanos , Incidência , Achados Incidentais , Flebografia/métodos , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção , Malformações Vasculares/diagnóstico , Malformações Vasculares/embriologia , Malformações Vasculares/epidemiologia , Veia Cava Superior/diagnóstico por imagemAssuntos
Idoso , Feminino , Humanos , Bócio Nodular , Veia Cava Superior/patologia , Dilatação Patológica/diagnósticoRESUMO
Resection of giant sacrococcygeal teratoma with high-vasculature in newborns can be a fatal procedure due to massive bleeding of the tumor. Endovascular embolization of the arteries that supply the tumor may lead to minimal blood loss. We present a case of giant high-vascular sacrococcygeal teratoma type-1 that was embolized in an infant born at 35 weeks gestation. This procedure lead to a safe, surgical resection with minimal bleeding: 12 ml.
RESUMO
Percutaneous transhepatic removal techniques for malfunctioning plastic biliary endoprosthesis are considered safe and efficient second-line strategies, when endoscopic procedures are not feasible. We describe the percutaneous transhepatic balloon pulling technique in a patient with an unresectable malignant hilar cholangiocarcinoma.
RESUMO
Chronic mesenteric ischemia (CMI) is a rare disorder that is commonly caused by progressive atherosclerotic stenosis or occlusion of one or more mesenteric arteries. Endovascular treatment for symptomatic CMI represents a viable option, especially in high-operative risk patients. We report a case of acute symptomatic CMI with chronic totally occlusion of the superior mesenteric artery (SMA) associated with significant stenosis of celiac trunk (CT) and inferior mesenteric artery (IMA) that underwent endovascular treatment of all the three mesenteric arteries: stenting of CT and IMA stenosis, and recanalization of the SMA occlusion by retrograde crossing via the Villemin arcade.