Dual time-point 18F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases / Imágenes en 2 tiempos con 18F-FDG PET/TC para evaluar la ablación por radiofrecuencia de las metástasis pulmonares

Aim. To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. Materials and methods. This prospective study included 18 cases (3 female, 15 male, mean age 71 ± 15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1 h after injection of 4.07 MBq/kg of 18F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2 h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI = (SUVmax delayed image − SUVmax standard image/SUVmax standard image) * 100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. Results. Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. Conclusions. Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA (AU)

Objetivo. Establecer la utilidad de las imágenes PET/TC en 2 tiempos en la determinación de la respuesta a la ablación por radiofrecuencia (RFA) de las metástasis pulmonares de tumores digestivos. Material y métodos. Estudio prospectivo con 18 casos (3 mujeres, 15 varones) y edad media de 71 ± 15 años con metástasis pulmonar única de cáncer digestivo candidato a tratamiento mediante RFA. Se realizaron imágenes PET/CT 1 h tras inyección de 4,07 MBq/Kg de 18F-FDG (imagen estándar) basal, un mes y 3 meses después de la RFA y una imagen tardía 2 h tras la inyección centrada en tórax un mes después de la RFA. Se calculó el índice de retención (RI): RI = (SUVmáx imagen tardía − SUVmáx imagen estándar/SUVmáx imagen estándar) * 100. La recurrencia local se confirmó con estudio histológico de la lesión tratada con RFA. Un resultado negativo en las pruebas de imagen durante el seguimiento se consideró como respuesta completa. Resultados. Se diagnosticó recidiva local en 6/18 lesiones y respuesta completa en 12/18. El cambio porcentual medio de SUVmáx al mes y a los 3 meses mostró una sensibilidad y especificidad para evaluar la respuesta a la RFA de 50% y 33% y 67% y 92%, respectivamente. El RI un mes posradiofrecuencia mostró una sensibilidad y especificidad del 83% y 92%. Conclusiones. Las imágenes en 2 tiempos con PET/TC un mes posradiofrecuencia pueden predecir el resultado de la RFA de las metástasis pulmonares de origen digestivo. El RI se puede utilizar para indicar la necesidad de otros procedimientos para descartar recurrencia tumoral debido a una RFA incompleta (AU)

Dual time-point (18)F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases.

AIM: To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. MATERIALS AND METHODS: This prospective study included 18 cases (3 female, 15 male, mean age 71±15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1h after injection of 4.07MBq/kg of (18)F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI=(SUVmax delayed image-SUVmax standard image/SUVmax standard image)*100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. RESULTS: Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. CONCLUSIONS: Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA.

Loco-regional control after postoperative radiotherapy for patients with regional nodal metastases from melanoma

INTRODUCTION: The role of adjuvant radiation therapy (RT) following nodal surgery in malignant melanoma remains controversial. There are no published randomised trials comparing surgery alone to surgery with postoperative RT. AIM AND METHODS: The purpose of the present retrospective study was to review the results of loco-regional control after postoperative RT in patients with nodal metastases of melanoma. Seventy-seven patients with high-risk disease (lymph nodes > or =3 cm, more than three lymph nodes involved, extracapsular extension and recurrent disease) were treated with adjuvant RT. Hypofractionation was used in 65 patients and conventional fractionation in 12 patients. RESULTS: Seventy-seven patients with nodal metastases from melanoma were managed with lymphadenectomy and radiation, with or without systemic therapy. The median age was 56 years old (range: 21-83). There were 47 males (61%) and 30 females (39%). Loco-regional control was observed in 95% of patients (73/77). The actuarial 5-year in-field loco-regional control rate was 90% (mean: 105 months; CI95%: 96-115 months). Median metastasis disease- free survival (MDFS) was 16 months (CI95%: 13-18 months). Median survival time (MST) for the entire group was 26 months (CI95%: 18-34 months). MST according to the localisation of node metastases (groin, axilla and cervical) was also analysed, without statistically significant differences (p=0.08). Concerning the number of risk factors score, analysis of survival did not show statistically significant differences (p=0.055). CONCLUSIONS: Despite the high incidence of distant metastases, loco-regional control remains an important goal in the management of melanoma. Surgery and adjuvant RT provides excellent loco-regional control, although distant metastases remain the major cause of mortality (AU)

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Percutaneous repair of an iatrogenic laceration of the left bile duct with a covered stent.

The presence of biliary leaks after liver resections is not an unusual problem, especially after extended hepatectomies. The usual treatment of choice for biliary duct injuries is to decompress the biliary system with draining catheters. Persistent biliary fistulas are nevertheless a challenging problem when endoscopic or percutaneous approaches fail to achieve occlusion of the bile leakage. The authors report a bile duct injury after a right lobe hepatectomy treated percutaneously with placement of a covered stent. After 6 months, the patient was tube-free and without any episode of cholangitis or bile duct dilation. Longer follow-up will clarify the future role of this kind of device in biliary system lacerations.

Early detection of hepatic artery thrombosis after liver transplantation by Doppler ultrasonography: prognostic implications.

We assessed the usefulness of routine Doppler ultrasonography for early detection of hepatic artery thrombosis after orthotopic liver transplantation and repercussions in patient prognosis. Seventeen confirmed cases of early hepatic artery thrombosis initially diagnosed by Doppler ultrasonography (10 of them before clinical indication) were reviewed. All patients underwent Doppler ultrasonographic studies in the first 3 days after orthotopic liver transplantation. Twelve cases of hepatic artery thrombosis (70.6%) were detected by this early Doppler ultrasonography. All 10 unsuspected cases of hepatic artery thrombosis and 5 of the 7 cases diagnosed after clinical indication were treated by revascularization. Grafts were salvaged in 80% of asymptomatic patients and in 42.8% of symptomatic patients. Furthermore, biliary complications were less serious in the first group. In conclusion, Doppler ultrasonography performed routinely in the first 3 days after orthotopic liver transplantation may permit early detection of hepatic artery thrombosis, even before clinical indications. This allows hepatic artery repermeabilization before liver function damage, improving graft rescue and patient prognosis.

Sonographic appearance of a retained surgical sponge in the neck.

We report the sonographic appearance and clinical course of a retained surgical sponge in the neck beginning 6 months after a partial thyroidectomy. Sonograms showed a subcutaneous curvilinear hyperechoic interface with marked acoustic shadowing obscuring the left side of the neck. Three months later, a fistulous tract could be seen. Surgical exploration revealed a florid foreign tissue reaction due to a retained surgical sponge. Early diagnosis of retained sponges is important to enable expeditious removal before complications develop.