Radiologic resectability assessment in pancreatic cancer.

Complete tumor resection is still the only potentially curative therapy option for patients with ductal adenocarcinoma of the pancreas. Surgical exploration is the gold standard for the determination of tumor resectability. Radiological resectability assessment is of great importance because many clearly unresectable cases can be identified preoperatively and it became essential for surgical planning. The evolving surgical and radiological techniques demand a continuous reappraisal of radiological criteria in resectability assessment. In the following, the criteria for resection planning are described along with surgical management and the role of radiology in some innovative surgical concepts is explained.

Cost comparison of nerve root infiltration of the lumbar spine under MRI and CT guidance.

OBJECTIVES: To compare the costs of CT- and MR-guided lumbosacral nerve root infiltration for minimally invasive treatment of low back pain and radicular pain. METHODS: Ninety patients (54 men, 36 women; mean age, 45.5 ± 12.8 years) underwent MR-guided single-site periradicular lumbosacral nerve root infiltration with 40 mg of triamcinolone acetonide. A further 91 patients (48 men, 43 women; mean age, 59.1 ± 13.8 years) were treated under CT fluoroscopy guidance. Prorated costs of equipment use (purchase, depreciation and maintenance), staff costs based on involvement times and expenditure for disposables were identified for MR- and CT-guided procedures. RESULTS: Mean intervention time was 20.6 min (14-30 min) for MR-guided and 14.3 min (7-32 min) for CT-guided treatment. The average total costs per patient were €177 for MR-guided and €88 for CT-guided interventions. These consisted of (MR/CT guidance) €93/29 for equipment use, €43/35 for staff and €41/24 for disposables. CONCLUSIONS: Lumbosacral nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. Given the advantages of no radiation exposure and possible future decrease in prices for MRI devices and MR-compatible injection needles, MR-guided nerve root infiltration may become a promising alternative to the CT-guided procedure. KEY POINTS: • MR-guided nerve root infiltration therapy is now technically and clinically established. • Costs using MRI guidance are still about double those for CT guidance. • MR guidance involves no radiation exposure to patients and personnel. • MR-guided nerve root infiltration may become a promising alternative to CT.

Living related liver transplantation: preoperative magnetic resonance imaging for assessment of hepatic vasculature of donor candidates.

PURPOSE: To evaluate the accuracy of magnetic resonance angiography (MRA) for preoperative assessment of hepatic vascular anatomy in liver donors before living related liver transplantation. MATERIAL AND METHODS: A total of 55 consecutive living liver donors (mean age 42 years, range 18-68 years) underwent multiphase contrast-enhanced MRA of the hepatic vessels. Two readers categorized vessel visualization on a five-point scale and recorded vascular anatomy or variations thereof for the arterial, portal venous and venous systems. All 55 living liver donors subsequently underwent right hemihepatectomy for hemiliver donation, and preoperative MRA results were correlated with surgical findings. RESULTS: Overall vessel visualization assessment demonstrated good or very good ratings for the majority of patients. For hepatic arteries, the mean score was 4.4+/-0.8 (mean+/-standard deviation), and for the portal venous and venous systems it was 4.6+/-0.7 and 4.3+/-0.8, respectively. Among all 55 donors, 16 (29%) demonstrated accessory or replaced hepatic arteries, and seven (13%) and 20 (36%) donors had surgically relevant portal vein (trifurcation or early right posterolateral branching types) and hepatic vein variations, respectively. Correlation coefficients between MRA and surgery were 0.94, 1.00 and 0.91 for hepatic arteries, portal veins and hepatic veins, respectively. CONCLUSION: In the preoperative evaluation before living related liver donation, contrast-enhanced MR angiography was a highly accurate, noninvasive tool for visualizing the hepatic vasculature and variations thereof in liver donor candidates.