Clinical Outcomes following Percutaneous Radiofrequency Ablation of Unilateral Aldosterone-Producing Adenoma: Comparison with Adrenalectomy.

PURPOSE: To compare adrenal radiofrequency (RF) ablation with adrenalectomy in treating unilateral aldosterone-producing adenoma (APA). MATERIALS AND METHODS: Between April 2008 and September 2013, 44 patients with adrenal venous sampling-confirmed (lateralization index ≥ 4) unilateral APA underwent adrenal RF ablation (12/44 [27%]) or adrenalectomy (32/44 [73%]). Outcomes of adrenal RF ablation (patient age, 51 y ± 11; 4/12 men) were compared with adrenalectomy (patient age, 50 y ± 11; 19/32 men). Blood pressure (145/94 mm Hg ± 19/13 vs 144/89 mm Hg ± 10/8, P = .92), number of antihypertensives (3.0 ± 1.3 vs 2.7 ± 0.89, P = .38), and serum potassium (3.2 mEq/L ± 0.6 vs 3.5 mEq/L ± 0.6, P = .65) of patients were similar before treatment. RESULTS: RF ablation and adrenalectomy resulted in normokalemia (RF ablation, 4.2 mEq/L ± 0.1, P = .0004; adrenalectomy, 4.3 mEq/L ± 0.6, P < .0001) and normotension (RF ablation, 129/81 mm Hg ± 11/11, P = .02/P = .001; adrenalectomy, 128/85 mm Hg ± 13/12, P < .0001/P = .07) in all patients. Proportions of RF ablation and adrenalectomy patients cured of hypertension (2/12 [17%] vs 12/32 [38%], P = .28) or requiring fewer antihypertensives (7/12 [58%] vs 13/32 [40%], P = .29) were similar. RF ablation patients had a shorter length of stay (0.6 d ± 0.8 [range, 0-2 d] vs 1.7 d ± 1.4 [range, 0-7 d]; P = .01) and less intraoperative blood loss (1.2 mL ± 3 vs 40 mL ±85; P = .01). Procedural complications occurred in 5/32 (15%) adrenalectomy patients (2 major, 3 minor) and in 0/12 RF ablation patients. CONCLUSIONS: RF ablation to treat APA can achieve similar clinical outcomes as adrenalectomy and results in shorter hospital stays. Larger, prospective trials are needed to validate these results.

Traumatic shoulder injuries: a force mechanism analysis of complex injuries to the shoulder girdle and proximal humerus.

OBJECTIVE: Acute shoulder trauma can result in complex injuries to the bone and soft-tissue structures of the shoulder girdle with the associated risk of development of shoulder girdle instability. Destabilizing injuries to the shoulder girdle and fractures of the proximal humerus can occur in predictable patterns based on the injury mechanism. The objectives of this article are to illustrate the relevant anatomy of the shoulder, use 3D modeling and animation to aid in a mechanistic understanding of some of the most common injury patterns, discuss the most relevant radiologic findings that determine the ultimate treatment approach, and discuss an approach to imaging diagnosis with attention to the common treatment strategies. CONCLUSION: Understanding the force mechanisms responsible for the most common patterns of traumatic shoulder girdle injuries and proximal humeral fractures can improve detection of associated clinically significant secondary injuries, increase the effectiveness of injury classification, and ultimately direct appropriate and timely intervention.

Traumatic shoulder injuries: a force mechanism analysis-glenohumeral dislocation and instability.

OBJECTIVE: Acute traumatic glenohumeral dislocation is one of the most commonly encountered shoulder injuries and can produce a complex combination of associated bony and soft-tissue injuries, the full extent of which is often initially underappreciated. The objectives of this article are to illustrate the relevant anatomy of the shoulder and provide a more intuitive understanding of the complex biomechanics of traumatic glenohumeral instability through the use of 3D modeling and animation to improve the radiologist's awareness of some of the most common injury patterns, and potentially improve the detection of associated injuries. Emphasis is placed on the most critical injuries to determine the ultimate treatment modality, and imaging recommendations are provided. CONCLUSION: Understanding the force mechanisms responsible for traumatic glenohumeral dislocation can potentially improve detection of associated secondary injuries, which can guide more effective injury classification and ultimately direct more appropriate and timely intervention.

Value of PET/CT in the management of liver metastases, part 1.

OBJECTIVE: Metastasis is the most common (95%) of liver lesions. Early diagnosis and staging are the keys to treatment planning and prognosis. There is a consistent benefit to the use of PET/CT for detecting hepatic, local, and distant metastases from a variety of primary malignancies, which can contribute to staging and ultimately helps to establish the best course of treatment and to determine prognosis. CONCLUSION: For colorectal cancer, FDG PET and FDG PET/CT are particularly effective for identification of additional hepatic and extrahepatic metastases, frequently upstaging the tumor stage and affecting management. In addition, PET/CT is very useful in local ablative and systemic therapy assessment and surveillance for liver metastases.

Value of PET/CT in the management of primary hepatobiliary tumors, part 2.

OBJECTIVE: Primary hepatobiliary malignancies consist of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder cancer. Benign hepatic lesions include hepatic cysts, hemagiomas, adenomas, and focal nodular hyperplasias. The utility of PET/CT in imaging primary hepatobiliary lesions varies according to the type and location of the lesion. CONCLUSION: There is a consistent benefit to the use of PET/CT for detection and staging, and it ultimately helps to establish the best course of treatment and to determine prognosis. In addition, PET/CT is very useful in local ablative and systemic therapy assessment and surveillance for hepatobiliary malignancies.

Radiofrequency ablation treatment for aldosterone-producing adenomas.

PURPOSE OF REVIEW: To review the current status of radiofrequency ablation as a primary treatment for hyperfunctioning adrenal nodules, predominantly aldosterone-producing adenomas (APAs). RECENT FINDINGS: Radiofrequency ablation is an established treatment for focal benign and malignant lesions, including metastatic disease to the adrenal gland. Hyperaldosteronism is the leading cause of secondary hypertension with up to 80% due to APA, statistically the most common functioning adrenal nodule. Although surgery remains the recommended treatment of choice for confirmed unilateral functioning adrenal nodules, radiofrequency ablation offers a less-invasive approach, with results comparable with surgery. SUMMARY: Radiofrequency ablation of functioning adrenal nodules is a newer application of a technology in use for almost 2 decades. Although limited, reports to date suggest that results are comparable with those of laparoscopic adrenalectomy, but with advantages including being a less-invasive outpatient procedure with lower morbidity, faster recovery, and lower cost. However, the current data are all retrospective, the number of patients treated is small, and reported long-term results are limited.

Neurocandidiasis: a case report and consideration of the causes of restricted diffusion.

Diffusion weighted magnetic resonance imaging has risen to the forefront of imaging for acute stroke. However, the differential diagnosis of restricted diffusion is wide and includes ischemia, metabolic derangements, infections, and highly-cellular masses. We present a case of central nervous system (CNS) candidiasis presenting radiographically as bilateral punctate areas of restricted magnetic resonance (MR) diffusion in the basal ganglia. This case illustrates the value of carefully considering the causes of restricted diffusion in the brain, notably to be broader than acute stroke and to include invasive fungal infections.