MR elastography is a good response parameter for microwave ablation liver tumors.

OBJECTIVES: To determine the response of hepatic tissue to percutaneous microwave ablation (MWA) of liver tumors via MR elastography in a clinical setting using MRI and MR elastography. METHODS: 51 Patients (28 m, 23f) underwent MWA of liver tumors (HCC: 20, metastasis: 31) and received MRI and MR elastography immediately before and 24 h after MWA. Retrospective analysis included pre- and post-ablative tumor extent, T1/T2 mapping and stiffness values as well as the duration and energy dose of the MWA session. RESULTS: Total liver stiffness increased by 4.3% from 3.31 kPa to 3.45 kPa (p = 0.036). Total liver stiffness post-MWA significantly correlated with the duration of the MWA session (r = 0.369, p = 0.008). The higher the baseline tumor stiffness was, the more energy had to be applied in MWA (r = 0.391, p < 0.001) and the longer the duration of the session (r = 0.391, p = 0.007). Healthy parenchyma stiffness increased by 3.5% from 3.55 kPa to 3.68 kPa (p = 0.142) and was strongly influenced by the cumulative energy (r = 0.436, p < 0.001), the duration (r = 0.458, p < 0.001) and the energy intensity (r = 0.458, p < 0.001) of MWA. 43 patients had a technically successful ablation result (margin ≥ 5 mm). Those with successful ablation had increased ablation margin stiffness (5.3 kPa vs. 4.6 kPa, p = 0.26) and had received higher ablation intensity than those with unsuccessful ablation (5.73 kJ/min vs. 5.03 kJ/min, p = 0.002). CONCLUSION: Additional MRE may be used before and after MWA to assess treatment response and collateral tissue damage after MWA. Baseline tumor stiffness helps finding the appropriate MWA parameters.

Therapeutic Anticoagulation Impacts MR Morphologic Recurrence Patterns in Glioblastoma-A Matched-Pair Analysis.

BACKGROUND: Glioblastoma (GBM) patients are at particularly high risk for thrombotic complications. In the event of a postoperative pulmonary embolism, therapeutic anticoagulation (tAC) is indispensable. The impact of therapeutic anticoagulation on recurrence pattern in GBM is currently unknown. METHODS: We conducted a matched-pair cohort analysis of 57 GBM patients with or without tAC that were matched for age, sex, gross total resection and MGMT methylation status in a ratio of 1:2. Patients' characteristics and clinical course were evaluated using medical charts. MRI characteristics were evaluated by two independent authors blinded to the AC status. RESULTS: The morphologic MRI appearance in first GBM recurrence showed a significantly higher presence of multifocal, midline crossing and sharp demarcated GBM recurrence patterns in patients with therapeutic tAC compared to the matched control group. Although statistically non-significant, the therapeutic tAC cohort showed increased survival. CONCLUSION: Therapeutic anticoagulation induced significant morphologic changes in GBM recurrences. The underlying pathophysiology is discussed in this article but remains to be further elucidated.

Incidence, risk factors and clinical course of pyogenic spondylodiscitis patients with pulmonary embolism.

PURPOSE: In patients with pyogenic spondylodiscitis, surgery is considered the treatment of choice to conduct proper debridement, stabilise the spine and avoid extended bed rest, which in turn is a risk factor for complications such as deep vein thrombosis and pulmonary embolism. METHODS: We conducted a retrospective clinical study with analysis of a group of 99 patients who had undergone treatment for pyogenic discitis at our institution between June 2012 and August 2017. Included parameters were age, sex, disease pattern, the presence of deep vein thrombosis, resuscitation, in-hospital mortality, present anticoagulation, preexisting comorbidities, tobacco abuse, body mass index, microbiological germ detection and laboratory results. RESULTS: Among the analysed cohort, 12% of the treated patients for pyogenic spondylodiscitis suffered from a radiologically confirmed pulmonary embolism. Coronary heart disease (p < 0.01), female sex (p < 0.01), anticoagulation at admission (p < 0.01) and non-O blood type (p < 0.001) were associated with development of pulmonary embolism. Pulmonary embolism was significantly associated with resuscitation (p < 0.005) and deep vein thrombosis (p < 0.001). Neurosurgery was not associated with increased risk for pulmonary embolism compared to conservative-treated patients (p > 0.05). CONCLUSION: Surgery for pyogenic spondylodiscitis was not associated with an elevated risk of pulmonary embolism in our analysis. However, we describe several risk factors for pulmonary embolism in this vulnerable cohort. Prospective studies are necessary to improve prevention and postoperative management in patients with pyogenic spondylodiscitis.

Direct oral anticoagulants vs. low-molecular-weight heparin for pulmonary embolism in patients with glioblastoma.

Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date, only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the sporadic use of DOACs remains off-label. A retrospective cohort analysis of patients with GBM and postoperative, thoracic CT scan confirmed PE was performed. Clinical course, follow-up at 6 and 12 months and the overall survival (OS) were evaluated using medical charts and neuroradiological data. Out of 584 GBM patients, 8% suffered from postoperative PE. Out of these, 30% received direct oral anticoagulants (DOACs) and 70% low-molecular-weight heparin (LMWH) for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis, or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6 and 12 months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS. In our analysis, DOACs showed a satisfactory safety profile in terms of major ICH, re-thrombosis, and re-embolism compared to LMWH in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.