Quantitative Assessment of Thyroid Nodules Using Dual-Energy Computed Tomography: Iodine Concentration Measurement and Multiparametric Texture Analysis for Differentiating between Malignant and Benign Lesions.

RESULTS: The 34 nodules comprised 14 benign nodules and 20 malignant nodules. Iodine content and Hounsfield unit curve slopes did not differ significantly between benign and malignant thyroid nodules (P = 0.480-0.670). However, significant differences in the texture features of monochromatic images were observed between benign and malignant nodules: histogram mean and median, co-occurrence matrix contrast, gray-level gradient matrix (GLGM) skewness, and mean gradients and variance of gradients for GLGM at 80 keV (P = 0.014-0.044). The highest AUC was 0.77, for the histogram mean and median of images acquired at 80 keV. CONCLUSIONS: Texture features extracted from monochromatic images using DECT, specifically acquired at high keV, may be a promising diagnostic approach for thyroid nodules. A further large study for incidental thyroid nodules using DECT texture analysis is required to validate our results.

Cost-Effectiveness Analysis of Percutaneous Sclerotherapy for Venous Malformations.

PURPOSE: To assess cost-effectiveness of sclerotherapy for venous malformations (VMs) to improve patient quality of life (QOL). MATERIALS AND METHODS: This prospective study enrolled 28 patients with symptomatic VMs who underwent sclerotherapy. EuroQol-5 Dimension (EQ-5D) and Short-Form 36 (SF-36) Health Survey were used to measure health-related QOL. Questionnaires were collected before and 1, 3, 6, and 12 months after sclerotherapy. Quality-adjusted life years (QALYs) were calculated using EQ-5D score as a measure of health utility. Medical costs obtained from the hospital accounting system and other costs of staff, drugs, materials, and angiographic equipment were calculated for each procedure. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER) as the medical cost/gain of QALYs. RESULTS: Median EQ-5D scores improved from 0.768 (range, 0.705-1) to 1 (range, 0.768-1) after 6 months (P = .023) and 1 (range, 0.768-1) after 12 months (P = .063). The gain of QALYs at 12 months was 0.043. The mean medical cost was ¥281,228 ($2,337). The pain group (baseline bodily pain scale of SF-36 score < 70) showed greater improvement in median EQ-5D score, from 0.705 (range, 0.661-0.768) to 0.768 (range, 0.705-1) after 6 months (P = .041) and 0.768 (range, 0.768-1) after 12 months (P = .049). ICER at 12 months was ¥6,600,483 ($54,840) in the overall group and decreased to ¥3,998,113 ($33,218) in the pain group, < ¥6,000,000 ($49,850), threshold for acceptance of a public health benefit in Japan, even accounting for 50% increase in costs. CONCLUSIONS: Sclerotherapy was cost-effective for improving QOL for symptomatic VMs, especially for patients with moderate to severe pain.

A case of renal transcatheter arterial embolization with ethanol in autosomal dominant polycystic kidney disease for volume reduction.

We report herein the case of a 76-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) and chronic renal failure resulting in intractable abdominal distension and anorexia. Computed tomography (CT) showed enlarged and cystic kidneys. We performed transcatheter arterial embolization (TAE) for renal arteries with ethanol. Absolute ethanol with iodinated contrast medium or Lipiodol was delivered into both renal arteries. The patient's low-grade fever subsided in 5 days, and no other complication occurred. The sensation of abdominal distension diminished approximately 1 month after embolization. A progressive decrease in kidney size was observed soon after embolization. The percentage of the decrement of kidney size was approximately 50% after 17 months. These results indicate that renal TAE with ethanol is a safe, cost-effective, and minimally invasive technique to reduce kidney size in symptomatic ADPKD patients.

Percutaneous computed tomography-guided lung biopsy and pleural dissemination: an assessment by intraoperative pleural lavage cytology.

BACKGROUND: Percutaneous computed tomography (CT)-guided needle biopsy remains one of the most important diagnostic tools in the management of lung nodules; however, it carries a risk of intrapleural dissemination of cancer cells. METHODS: CT-guided lung biopsy was performed before surgery in 171 (34.8%) of 491 patients. A coaxial biopsy system was used that comprised a 19-gauge introducer needle and a 20-gauge core biopsy needle. A total of 412 (83.9%) of the 491 patients underwent intraoperative pleural lavage cytology just after thoracotomy. Intraoperative pleural lavage cytology was performed immediately after opening the thorax, after the pleural cavity was gently washed with 50 mL of saline. RESULTS: No patients had implantation of cancer cells in the chest wall after a median follow-up of 20.2 months. Intraoperative pleural lavage cytology results were positive for 5 (2.9%) of the 171 patients who underwent CT-guided biopsy before surgery, in contrast to 13 (5.4%) of the 241 patients who did not undergo biopsy before surgery. The difference between the biopsy and nonbiopsy groups was not statistically significant. When the analysis was limited to patients with stage IA disease, intraoperative pleural lavage cytology results were positive for 1 (0.8%) of the 128 patients who underwent CT-guided biopsy, in contrast to 3 (2.7%) of the 110 patients who did not undergo biopsy. This difference was also not statistically significant. CONCLUSIONS: No significant association was observed between percutaneous CT-guided lung biopsy and intraoperative pleural lavage cytology results, even in patients with stage IA disease. Percutaneous CT-guided lung biopsy with a coaxial needle does not seem to cause pleural dissemination.

Effects of radiofrequency ablation on individual renal function: assessment by technetium-99m mercaptoacetyltriglycine renal scintigraphy.

We quantitatively evaluated total and individual renal function by technetium-99m mercaptoacetyltriglycine (Tc-99m MAG3) renal scintigraphy before and after radiofrequency ablation (RFA) of renal tumors. Eleven patients who underwent Tc-99m MAG3 renal scintigraphy 1 week before and after RFA were evaluated (7 men and 4 women; age range: 23-83 years; mean age: 60.6 years). Five patients had solitary kidneys, and five had normally or minimally functioning contralateral kidneys. One patient had a renal cell carcinoma in the contralateral kidney. One patient with a solitary kidney underwent RFA a second time for a residual tumor. In patients with a solitary kidney, MAG3 clearance decreased after 5 of 6 RFAs, and in patients with a normally functioning contralateral kidney, MAG3 clearance decreased after 4 of 5 RFAs, but no significant differences were observed between before and after treatments. In addition to the total MAG3 clearance, the split MAG3 clearance was evaluated in patients with a normally functioning contralateral kidney. MAG3 clearance decreased in 4 of 5 treated kidneys, while it adversely increased in the contralateral kidneys after 4 of 5 RFAs. No significant differences, however, were observed between before and after treatments. The results of our study revealed no significant differences in sCr, BUN, CCr, or MAG3 clearance between pre- and post-RFA values. These results support data regarding the functional impact and safety of renal RFA in published reports. We evaluated total and individual renal function quantitatively using Tc-99m MAG3 renal scintigraphy before and after treatment. This scintigraphy was very useful in assessing the effects of RFA on renal function.

[Percutaneous vertebroplasty combined with radiofrequency ablation for a patient with a spinal metastatic tumor: case report].

Recent technological development has allowed expanding applications of radiofrequency ablation (RFA) for malignant tumor therapy. We report a case with a spinal metastatic tumor treated with combination of percutaneous vertebroplasty (PVP) that provides pain relief and spinal stabilization and RFA. A 68-year-old male who had undergone resection of left ureteric carcinoma was referred to our hospital with lower back pain due to the fifth lumbar (L5) vertebral metastatic tumor. Conventional radiation therapy was discontinued because of pneumonia. One year later, the patient was admitted again with weakness of the right knee and foot and severe pain of the back and the right lower extremity. Radiographs demonstrated a compressive fracture of the L5 vertebra predominantly on the right side. CT and MRI showed a tumor of the L5 body invading the right pedicle, the intervertebral foramen, and the retroperitoneal space. RFA was performed in the ventral part of the L5 body, and then around the right L5/the first sacral intervertebral foramen. Temperature and time for ablation ranged from 74 degrees C to 95 degrees C and from 11 min. to 30 min., respectively. Next, PVP was performed by the right transpedicular approach. Bone cement was injected into the L5 body and the pedicle by an amount of 3.0 ml in total without technical complications. Postoperatively, visual analogue scale demonstrated decreased pain degree from 10 cm to 5.4 cm. Combined treatment with RFA and PVP is a feasible and promising procedure for spinal metastatic tumors. Further evaluation is necessary to confirm its long-term efficacy.