The role of multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress. Technical note.

Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this paper is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward.

Advantages and limits of percutaneous breast core biopsy with Mammotome and stereotactic equipment in upright seated patient.

PURPOSE: To confirm the diagnostic accuracy of percutaneous core breast biopsy with Mammotome and stereotactic equipment in upright seated patients, and to compare results from this method with those obtained using the dedicated unit with prone table. MATERIALS AND METHODS: We analysed 72 microbioptic samples from 69 upright seated patients. These samples were obtained in the course of mammographies assisted by digital stereotactic equipment (Diamond Delta32 General Electric Medical System/Instrumen-tarium), and further equipped with a lateral arm to support the Mammotone probe. We studied the following lesions: 57 cases of isolated microcalcification clusters, 12 masses with microcalcification and three cases of plain masses. We describe in detail the various phases of our 30-minute long microbiopsy procedure. All 72 samples were extracted without problems. Only in one case a large haematoma emerged, but quickly disappeared. RESULTS: We were able to characterise the histology of the lesions in all our samples: in 39/72 cases they were identified as benign, 28 were classified as malignant, and the remaining 5 as atypia. In the 39 lesions identified as benign, the microbiopsy procedure could be carried out without surgical biopsy - consequently, these patients were available for routine follow-up exams, which confirmed the benign nature of their lesions. Our identification of the 28 malignant lesions was confirmed by surgical biopsy. The microbiopsy finding and the histological result did not agree in only two cases. The 5 cases with atypical ductal hyperplasia showed no neoplastic alteration following surgical biopsy. In our personal experience, core biopsy with Mammotome achieved a high diagnostic accuracy. CONCLUSIONS: After careful analysis of the results obtained using Mammotome in upright seated patients with stereotactic equipment, we can confirm the diagnostic accuracy of this procedure in mammography alterations not visible in sonography. In agreement with previous studies, we also confirm that the diagnostic accuracy of this approach, as well as possible complications deriving from it, do not depend on the position of the patient.