Concordance Assessment of Pathology Results with Imaging Findings after Image-Guided Biopsy.

PURPOSE: To assess the impact of radiology review for discordance between pathology results from computed tomography (CT)-guided biopsies versus imaging findings performed before a biopsy. MATERIALS AND METHODS: In this retrospective review, which is compliant with the Health Insurance Portability and Accountability Act and approved by the institutional review board, 926 consecutive CT-guided biopsies performed between January 2015 and December 2017 were included. In total, 453 patients were presented in radiology review meetings (prospective group), and the results were classified as concordant or discordant. Results from the remaining 473 patients not presented at the radiology review meetings were retrospectively classified. Times to reintervention and to definitive diagnosis were obtained for discordant cases; of these, 49 (11%) of the 453 patients were in the prospective group and 55 (12%) of the 473 patients in the retrospective group. RESULTS: Pathology results from CT-guided biopsies were discordant with imaging in 11% (104/926) of the cases, with 57% (59/104) of these cases proving to be malignant. In discordant cases, reintervention with biopsy and surgery yielded a shorter time to definitive diagnosis (28 and 14 days, respectively) than an imaging follow-up (78 days) (P < .001). The median time to diagnosis was 41 days in the prospective group and 56 days in the retrospective group (P = .46). When radiologists evaluated the concordance between pathology and imaging findings and recommended a repeat biopsy for the discordant cases, more biopsies were performed (50% [11/22] vs 13% [4/31]; P = .005). CONCLUSIONS: Eleven percent of CT-guided biopsies yielded pathology results that were discordant with imaging findings, with 57% of these proving to be malignant on further workup.

Pancreatic atrophy in patients with chronic graft-versus-host disease.

PURPOSE: To determine if patients with chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (HSCT) develop greater loss of pancreatic tissue than patients without cGVHD. MATERIALS AND METHODS: This is an IRB-approved, HIPAA-compliant retrospective study of patients receiving allogeneic HSCT at our institution from 01/2006 to 01/2010 with abdominal CT performed within 3 months prior to HSCT and CT performed at least 3 months after HSCT. Measurement of glandular tissue thickness of the head, body, and tail of the pancreas was performed independently by two radiologists blinded to clinical data. Statistical analysis was performed using the Student t-test, and interobserver agreement was evaluated with linear-weighted kappa. RESULTS: 117 patients underwent HSCT during study period, with 36 patients meeting inclusion criteria. 22 subjects (61%) had clinical features of cGVHD, and 14 patients (39%) did not have evidence of cGVHD. Following HSCT, there was a significant decrease in mean total thickness (10.9%, p = 0.002) of the pancreas in the group of patients with cGVHD. The change from pretreatment to the nadir in pancreatic thickness was significantly greater in patient with cGVHD (13.9 ± 12.1 mm), but not in non-cGVHD patients (5.4 ± 4.7 mm) (p = 0.02), with head of the pancreas atrophy accounting for the difference (decrease of 4.8 ± 4.6 mm in cGVHD patients vs. 1.6 ± 2.1 mm in non-cGVHD patients (p = 0.02)). CONCLUSION: Patients with cGVHD develop significantly greater loss of pancreatic glandular tissue than patients without cGVHD following HSCT, with atrophy of pancreatic head being a major contributor.

Embolization therapy for benign prostatic hyperplasia: influence of embolization particle size on gland perfusion.

PURPOSE: To assess the influence of embolic size on the therapy response of prostatic arterial embolization (PAE) based on perfusional changes seen on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). MATERIALS AND METHODS: Twelve beagles underwent PAE, four dogs with each particle size: A: 100-300 µm; B: 300-500 µm; and C: 500-700 µm. Prior to and 1 month after the embolization all dogs underwent prostate DCE MRI. RESULTS: After embolization, time to maximal perfusion intensity for prostate parenchyma increased in B (188 vs. 135 sec, P = 0.023) and C (200 vs. 120 sec, P = 0.001), while it did not change for A (139 vs. 124 sec, P = 0.39). The maximal relative intensity increased after embolization in C (3.84 vs. 2.38, P < 0.001), while it did not change for A (2.50 vs. 2.44, P = 0.36) and B (3.23 vs. 2.9, P = 0.21). The extent of visualized intraprostatic urethral wall increased after embolization in B compared with A and C, 239.5 ± 138.1% vs. 56.1 ± 34.3, P = 0.04. Enhancement changes correlated with prostate volume changes: prostate volumes in A decreased less as compared with B and C (77 ± 34% vs. 56 ± 14%), P = 0.02. CONCLUSION: The enhancement and morphological data are useful to monitor response to therapy after embolization. Embolization with 300-500 and 500-700 µm particle may provide better results than with 100-300 µm particles in a canine model.

Quality initiatives: strategies for anticipating and reducing complications and treatment failures in hepatic radiofrequency ablation.

Radiofrequency (RF) ablation is one of several local treatment strategies that can be used for the destruction of a variety of primary and secondary liver tumors. As experience with RF ablation grows, it becomes increasingly evident that successful ablation requires meticulous technique. In addition, knowledge of potential complications is critical for both the interventionalist and the radiologist, whose postablation interpretation can facilitate identification of complications and treatment failures. Hepatic RF ablation offers significant advantages in that it is less invasive than surgery and carries a low risk of major complications. Successful prevention of complications and treatment failures begins at initial consultation and continues with preablation evaluation of specific patient factors such as coagulation profiles, use of medications, and risk factors for infection. Other predisposing factors include background liver cirrhosis, prior hepatectomy, and portal hypertension. During ablation, careful attention must be given to tumor size, number, and location. For large or multiple ablations, separate ablation sessions can help reduce the prevalence of postablation syndrome, and clustered electrodes and multiple overlapping treatment zones may be used to reduce the risk of treatment failure. It is critical to reevaluate tumors during ablation to determine the best approach and to compensate for changes in size and relative location due to patient positioning. With use of these strategies, hepatic RF ablation can be performed with greater safety, better patient tolerance, and a reduced risk of complications and treatment failures.