Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms: A Markov Model-Based Cost-Effectiveness Analysis.

PURPOSE: The aim of this study was to investigate whether prostatic artery embolization (PAE) can be considered a long-term cost-effective treatment option in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia in comparison to transurethral resection of the prostate (TURP). METHODS: The in-hospital costs of PAE and TURP in the United States were obtained from a recent cost analysis. Clinical outcomes including nature and rate of adverse events for TURP and PAE along with rates of retreatment because of complications or clinical failure were obtained from peer-reviewed literature. A decision tree-based Markov model was created, analyzing long-term cost-effectiveness for TURP and PAE from a US health care sector perspective. Cost-effectiveness over a time frame of 5 years was estimated while assuming a willingness to pay of $50,000 per quality-adjusted life-year (QALY). The primary outcome was incremental cost-effectiveness ratio. RESULTS: PAE resulted in overall cost of $6,464.92 and an expected outcome of 4.566 QALYs. In comparison, TURP cost $9,221.09 and resulted in expected outcome of 4.577 QALYs per treatment. The incremental cost-effectiveness ratio for TURP was $247,732.65 per QALY. On the basis of the willingness-to-pay threshold, PAE is cost effective compared with TURP. CONCLUSIONS: On the basis of our model, PAE in comparison with TURP can be regarded as a cost-effective treatment option for patients with lower urinary tract symptoms within the US health care system.

Semiautomatic Whole-lesion Apparent Diffusion Coefficient Assessment for Early Prediction of Liver Tumor Response to Radioembolization.

AIM: To evaluate volume-based apparent diffusion coefficient (ADCVOL) values for early prediction of therapy response after radioembolization (RE) of primary and secondary liver malignancies using a semiautomatic, image analysis software prototype. PATIENTS AND METHODS: In a retrospective analysis, 74 target lesions were assessed in terms of therapy response 1 month after RE using magnetic resonance imaging. Changes of the diameter of the target lesions, the mean ADC value in a representative single-slice region of interest (ADCROI) and mean ADCVOL were correlated. RESULTS: The median progression-free interval (PFI) of patients overall was 3.5±5.9 months. PFI in patients with an ADCVOL increase was statistically significantly longer than in patients with an ADCVOL decrease (mean PFI=6.5 vs. 2.5 months; p=0.0374). No correlation between PFI and early changes in lesion diameter or ADCROI was found. CONCLUSION: Semiautomatic, software-based ADC volume measurements seem to offer a clinically valuable parameter for early prediction of therapy response in patients after RE.

Microwave ablation of osteoid osteomas using dynamic MR imaging for early treatment assessment: preliminary experience.

PURPOSE: To evaluate the efficacy of microwave ablation for osteoid osteomas by using dynamic contrast-enhanced magnetic resonance (MR) imaging in early treatment assessment. MATERIALS AND METHODS: Ten patients (two female, eight male; mean age, 28 y; range, 16-47 y) presenting with osteoid osteomas were treated between June 2010 and December 2012 with the use of computed tomography (CT)-guided microwave ablation. Osteoid osteomas were found at the femoral neck (n = 4), tibia (n = 3), calcaneus (n = 1), navicular bone (n = 1), and dorsal rib (n = 1). Dynamic contrast-enhanced MR imaging at 3.0 T was performed 1 day before microwave ablation and again after ablation. The procedure was considered successful if the signal intensity (SI) of the lesion on MR imaging decreased by at least 50% and the patient was pain-free within 1 week of intervention. RESULTS: All patients were pain-free within 1 week after microwave ablation and remained so during the 6 months of follow-up. No major or minor complications developed. On average, SI of the lesions decreased by 75% (range, 55.5%-89.1%) after treatment. The difference in lesion SI before versus after ablation was significant by t test (P < .0001; confidence interval, 120.26-174.96) and Wilcoxon test (P = .0020). CONCLUSIONS: Microwave ablation treatment of osteoid osteoma was highly successful, without any complications observed. Dynamic contrast-enhanced MR imaging is a useful tool for diagnosing osteoid osteoma and evaluating treatment.

Cross-sectional imaging combined with 3D-MR angiography (3D-MRA): diagnostic tool for preoperative vascular assessment of head and neck tumors.

BACKGROUND: Head and neck cancer accounts for 5% of all malignancies worldwide. The presence of lymph node metastases and vascular infiltration influence patient outcome. This prospective study describes the preoperative morphologic assessment of the vascular status of patients with head and neck tumors by means of high spatial resolution and extended coverage of the arterial and venous system reaching from the supra-aortic region to the skull base. PATIENTS AND METHODS: Cross-sectional imaging combined with contrast-enhanced 3D-maximum intensity projection MR angiography (3D-MRA) was applied using a dedicated head and neck coil with a 4-channel panorama array system interface to assess vascular involvement in patients with suspected head and neck cancer. 32 patients underwent preoperative assessment by magnetic resonance imaging (MRI). The results were then correlated with surgical and histological findings. RESULTS: 3 of the 32 patients (9%) demonstrated involvement of the arterial system. In 2 of these 3 cases, MRA correctly predicted the arterial status, while in 1 case it gave a false negative result. 11 of the 32 patients (34%) presented with involvement of the venous system. 10 cases showed complete concordance between the findings of the MR venography and the intraoperative status, while in 1 case a false negative result was produced. CONCLUSION: In patients with suspected head and neck tumors, 3D-MRA in combination with cross sectional imaging is a valuable diagnostic tool for the detection of vascular involvement.