Diagnostic accuracy of CE-CT, MRI and FDG PET/CT for detecting colorectal cancer liver metastases in patients considered eligible for hepatic resection and/or local ablation.

PURPOSE: To compare the diagnostic performance of contrast-enhanced computed tomography (CE-CT), magnetic resonance imaging (MRI) and combined fluorodeoxyglucose/positron emission tomography/computed tomography (FDG-PET/CT) for detection of colorectal liver metastases (CRLM) in patients eligible for local treatment. MATERIALS AND METHODS: This health-research ethics-committee-approved prospective consecutive diagnostic accuracy study, with written informed consent, included 80 cases (76 patients, four participating twice) between 29 June 2015 and 7 February 2017. Prior chemotherapy or local treatment did not exclude participation. Combined FDG-PET/CT including CE-CT and MRI was performed within 0-3 days shortly before local treatment. CE-CT and MRI images were read independently by two readers for each modality. The combined FDG-PET/CT images were read independently by two pairs of readers. A composite reference standard was used. Sensitivities, specificities and area under the receiver operating characteristic curves (AUCROC) were calculated and compared. RESULTS: In total, 260 CRLMs were confirmed. The MRI readers had significantly higher per-lesion sensitivity (85.9% and 83.8%) than both CE-CT readers (69.1% and 62.3%) and both PET/CT reader pairs (72.0% and 72.1%) (p<0.001). There were no significant differences in per-lesion specificity. MRI readers had significantly higher AUCROC (0.92 and 0.88) than both CE-CT readers (0.80 and 0.82) (p≤0.001). AUCROC for MR reader 1 was higher than that of both PET/CT reader pairs (0.83 and 0.84) (p≤0.0001). CONCLUSION: MRI performed significantly better than both CE-CT and combined FDG-PET/CT for detection of CRLM in consecutive patients eligible for local treatment irrespective of prior chemotherapy or local treatment. KEY POINTS: • Patients eligible for local treatment of colorectal liver-metastases require optimal imaging. • In 80 consecutive patients, MRI had superior per lesion diagnostic performance. • Findings were independent of prior treatment and type of planned local treatment. • Equally, MRI had superior diagnostic performance on per segment basis.

Combination of radiofrequency ablation with transarterial chemoembolization for treatment of hepatocellular carcinoma: experience from a Danish tertiary liver center.

BACKGROUND: Recent studies have shown that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) for unresectable hepatocellular carcinoma (HCC) may offer a survival advantage compared to monotherapy. PURPOSE: To study the effectiveness of combination therapy with RFA and TACE compared to that of TACE alone in a Scandinavian tertiary liver cancer center. MATERIAL AND METHODS: A retrospective study of the patients treated with combination therapy vis-à-vis TACE alone from June 2007 to November 2012 was performed. Eighteen patients were treated with a combination of RFA and TACE with an interval of 1-4 days between the treatments. For comparison, a group of 18 patients treated with TACE as monotherapy in the same time period was matched with the combination group by demographic data, tumor characteristics, biochemical and clinical parameters, and performance status (PS). RESULTS: Each group consisted of 14 patients with cirrhosis and four without. There were no significant differences between the groups regarding age, gender, tumor characteristics, causes of cirrhosis, levels of bilirubin, creatinine, prothrombin time, Child Pugh score, or World Health Organization (WHO) performance status. The median survival of patients in the RFA + TACE combination group was 586 days compared to 296 days in the control group. The difference was not statistically significant (P = 0.26). However, when we stratified the data for cirrhosis and WHO performance status, patients in the combination group had significantly better survival (P = 0.024). CONCLUSION: Combination therapy with RFA and TACE for unresectable HCC, compared to TACE alone, may offer a survival benefit for a selected group of patients with HCC.

Renal Artery Stenting in Consecutive High-Risk Patients With Atherosclerotic Renovascular Disease: A Prospective 2-Center Cohort Study.

Background The aim of this study was to prospectively evaluate the effects of renal artery stenting in consecutive patients with severe atherosclerotic renal artery stenosis and high-risk clinical presentations as defined in a national protocol developed in 2015. Methods and Results Since the protocol was initiated, 102 patients have been referred for revascularization according to the following high-risk criteria: severe renal artery stenosis (≥70%) with true resistant hypertension, rapidly declining kidney function, or recurrent heart failure/sudden pulmonary edema. At baseline, the mean 24-hour ambulatory systolic blood pressure was 166.2 mm Hg (95% CI, 162.0-170.4), the defined daily dose of antihypertensive medication was 6.5 (95% CI, 5.8-7.3), and the estimated glomerular filtration rate was 41.1 mL/min per 1.73m2 (95% CI, 36.6-45.6). In 96 patients with available 3-month follow-up data, mean 24-hour ambulatory systolic blood pressure decreased by 19.6 mm Hg (95% CI, 15.4-23.8; P<0.001), the defined daily dose of antihypertensive medication was reduced by 52% (95% CI, 41%-62%; P<0.001), and estimated glomerular filtration rate increased by 7.8 mL/min per 1.73m2 (95% CI, 4.5-11.1; P<0.001). All changes persisted after 24 month follow-up. Among 17 patients with a history of hospitalization for acute decompensated heart failure, 14 patients had no new episodes after successful revascularization. Conclusions In this prospective cohort study, we observed a reduction in blood pressure and antihypertensive medication, an increase in estimated glomerular filtration rate, and a decrease in new hospital admissions attributable to heart failure/sudden pulmonary edema after renal artery stenting. Registration URL: https://clinicaltrials.gov. Identifier: NCT02770066.

Morphological patterns and distributions in portable chest radiographs of COVID-19-positive cases admitted to a tertiary care hospital: An early experience from Scandinavia.

INTRODUCTION: Chest radiographic (CXR) features, particularly portable CXR findings, of COVID-19 have not yet been systematically described, either as a baseline tool or as a follow-up method, despite the continuing global pandemic. There is a marked paucity of articles detailing the CXR findings vis-à-vis a multitude of articles dedicated to the CT features of COVID-19. The purpose of this article is to describe the morphological and distributional patterns of the lung opacities in CXR and to classify the spectrum of essential features on portable AP chest radiographs of PCR-positive COVID-19 patients admitted in a tertiary care hospital in Scandinavia. To our knowledge, this is the first article to describe the morphological and topographical features of CXRs in COVID-19-positive cases. METHODS: A retrospective analysis of twenty (20) RT-PCR-positive COVID-19 patients admitted to the hospital between 12.03.2020 to 10.04.2020 was done in this study. Morphology and distribution of the opacities were reviewed by two senior consultants and analysed for patterns. RESULTS: Most patients had ground-glass opacities (80-85%) and interspersed interstitial opacities (70-75%), often with a characteristic appearance. The opacities were mostly bilateral (80%) and distributed in the lower zones (and to some extent mid zones) and in the middle and peripheral regions, with a tendency to merge towards the hilar areas. There were high interobserver agreements among various parameters and no significant statistical difference between observer 1 and 2. CONCLUSION: Chest radiographics show characteristic patterns and distributions, which can be used as an adjunct in the diagnosis and follow-up of COVID-19 patients in specific clinical contexts.

CIRSE Standards of Practice on Conducting Meetings on Morbidity and Mortality.

This CIRSE Standards of Practice document is developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It aims to assist Interventional Radiologists in their daily practice by providing best practices for conducting meetings on morbidity and mortality.

[Interventional radiology in minimally invasive treatments].

Interventional radiology (IR) is a fast expanding field which includes vascular (arterial and venous) as well as non-vascular topics. IR is minimally invasive methods, which are performed under guidance of radiological modalities. The methods are in general patient-friendly and organ-sparing procedures and can often be performed on out-patient basis or with short admission to the hospital and with short reconvalescence and economic advantages compared with corresponding surgical treatments. IR has in some cases substituted former surgical procedures. Technological development has facilitated increasing IR treatment offers and indications, and there is a high level of evidence for many of the offers.

Superior Mesenteric Artery Syndrome: A Rare Mimic of Common Causes of Upper Gastrointestinal Obstruction.

Rare causes of common symptoms often pose a diagnostic dilemma which can lead to unwanted loss of precious time in proper diagnosis and management. Superior mesenteric artery (SMA) syndrome is such a rare disorder. It typically presents with signs and symptoms of upper gastrointestinal (GI) obstruction which can be mimicked by a variety of clinical conditions, such as peptic ulcer, chronic pancreatitis, mesenteric ischemia and systemic lupus erythematosus (SLE). A high degree of clinical suspicion is required to direct proper investigations to narrow down to the correct diagnosis. Multi-detector CT (MDCT) proves to be invaluable not only in ruling out more common conditions mimicking SMA syndrome but also in arriving at the correct diagnosis quickly and effectively with great clinical accuracy and thereby removing confusion and delay in proper management. ABBREVIATIONS: SMA: Superior mesenteric artery; GI: Gastrointestinal; MDCT: Multidetector computed tomography; MPR: Multiplanar reconstruction; AMA: Aortomesenteric Angle; AMD: Aortomesenteric distance.How to cite this article: Madhab G, Madsen J, Dalgaard EB, Bharadwaz A. Superior Mesenteric Artery Syndrome: A Rare Mimic of Common Causes of Upper Gastrointestinal Obstruction. Euroasian J Hepato-Gastroenterol 2014;4(1):58-60.

Chemoembolization of intermediate stage hepatocellular carcinomas: results from a Nordic tertiary liver cancer center.

BACKGROUND: Transarterial chemoembolization (TACE) is used as palliative treatment of hepatocellular carcinoma (HCC). Most publications are from HCC patient populations where viral hepatitis is the primary cause of liver disease. In the Nordic countries, most patients have either alcohol-induced cirrhosis or are noncirrhotic. The aim of this single-center study was to evaluate patient characteristics, survival, and side effects of TACE in a Danish referral center for HCC treatment. METHODS: Fifty-nine consecutive patients with HCC, treated with TACE, either chemoembolization with drug-eluting beads or conventional-TACE with Lipiodol, were included in the study. Their medical records were retrospectively reviewed, computed tomography images analyzed, and biochemical markers recorded. The primary endpoint was overall survival. Analyses were by intention to treat. RESULTS: Thirty-five patients (59 %) had HCC on a background of liver cirrhosis most often caused by alcohol (60 % of cirrhotics or 35 % overall). Before the first chemoembolization, the patients had a median Child-Pugh score of 6 (5-7) and a median MELD score of 10 (6-21). Median survival after chemoembolization was 18.9 months (13.1-24.7). TACE patients were hospitalized for an average of 3 days (2-30). Prolonged stay was most often due to side effects-eg. pain (31 %), fever (14 %), nausea (10 %), and infection (10 %). Thirty-three patients (56 %) did not have any side effects. CONCLUSIONS: In this cohort, we observed an acceptable survival following TACE without significant side effects.

Liquid Embolization with Onyx in a Technically Challenging Case of Acute Upper GI Bleeding.

Conventional embolization such as coiling of acute upper gastrointestinal bleeding may be rendered impossible or unsuitable due to anatomical and technical factors. Liquid (Onyx) embolization in such situations may prove valuable and life saving, though literature on the subject, particularly of acute upper gastrointestinal bleeding due to duodenal ulcer, is sparse. We present a technically challenging case of acutely rebleeding duodenal ulcer embolized successfully using ethylene polyvinyl alcohol polymer (Onyx).