Incidence and clinical impact of bile ducts changes after multibipolar radiofrequency ablation for hepatocellular carcinoma.

OBJECTIVES: This study aimed to evaluate the incidence and clinical implications of bile duct changes following multibipolar radiofrequency ablation (mbpRFA) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Radiological, clinical, and biological data from consecutive cirrhotic patients who underwent first-line mbpRFA between 2007 and 2014 for uninodular HCC ≤ 5 cm were retrospectively collected. Follow-up imaging was reviewed to identify bile duct changes and factors associated with biliary changes were assessed using multivariable analysis. Baseline and 6-month liver function tests were compared in patients with and without bile duct changes. Complications, cirrhosis decompensation, and survival rates were compared in both groups. RESULTS: A total of 231 patients (mean age 68 years [39-85], 187 men) underwent 266 mbpRFA sessions for uninodular HCC (mean size 26 mm). Of these, 76 (33%) developed bile duct changes (upstream bile duct dilatations and/or bilomas) with a mean onset time of 3 months. Identified risk factors for these changes were the infiltrative aspect of the tumor (p = 0.035) and its location in segment VIII (p < 0.01). The average increase in bilirubin at 6 months was higher in the group with biliary changes (+2.9 vs. +0.4 µg/mL; p = 0.03). There were no significant differences in terms of complications, cirrhosis decompensation at 1 year (p = 0.95), local and distant tumor progression (p = 0.91 and 0.14 respectively), and overall survival (p = 0.4) between the two groups. CONCLUSION: Bile duct changes are common after mbpRFA for HCC, especially in tumors with an infiltrative aspect or those located in segment VIII. These changes do not appear to negatively impact the course of cirrhosis at 1 year or overall survival. CLINICAL RELEVANCE STATEMENT: Bile duct changes following mbpRFA for HCC are relatively common. Nevertheless, they do not raise clinical concerns in terms of complications, deterioration in liver function, or survival rates. Consequently, specific monitoring or interventions for these bile duct changes are not warranted. KEY POINTS: • Bile duct changes are frequently observed after multibipolar radiofrequency ablation for hepatocellular carcinoma, occurring in 33% of cases in our study. • Patients with bile duct changes exhibited a higher increase in bilirubin levels at 6 months but no more cirrhosis decompensation or liver abscesses. • Biliary changes following multibipolar radiofrequency ablation for hepatocellular carcinoma are not alarming and do not necessitate any specific monitoring or intervention.

Technical Feasibility of Electromagnetic US/CT Fusion Imaging and Virtual Navigation in the Guidance of Spine Biopsies.

PURPOSE: To test the technical feasibility of electromagnetic computed tomography (CT) + ultrasound fusion (US)-guided bone biopsy of spinal lesions. MATERIALS AND METHODS: This retrospective study included 14 patients referred for biopsy of spinal bone lesions without cortical disruption or intervertebral disc infection. Lesions were located in the sacrum (n = 4), lumbar vertebral body (n = 7) or intervertebral disc (n = 3). Fusion technology matched a pre-procedure CT scan with real-time ultrasound. The first six procedures were performed under both standard CT and CT + US fusion guidance (group 1). In the last eight procedures, the needle was positioned under fusion imaging guidance alone, and CT was only used at the end of needle placement to confirm correct positioning (group 2). Additionally, we retrieved 8 patients (controls) with location-matched lesions as group 2, which were biopsied in the past with the standard CT-guided technique. The procedure duration and number of CT passes were recorded. RESULTS: Mean procedure duration and median CT pass number were significantly higher in group 1 vs. group 2 (45 ±â€Š5 vs. 26 ±â€Š3 minutes, p = 0.002 and 7; 5.25-8.75 vs. 3; 3-3.25, p = 0.001). In controls, the mean procedure duration was 47 ±â€Š4 minutes (p = 0.001 vs. group 2; p = 0.696 vs. group 1) and the number of CT passes was 6.5 (5-8) (p = 0.001 vs. group 2; p = 0.427 vs. group 1). No complications occurred and all specimens were adequate overall. In one case in group 2, the needle position was modified according to CT assessment before specimen withdrawal. CONCLUSION: Electromagnetic CT+US fusion-guided bone biopsy of spinal lesions is feasible and safe. Compared to conventional CT guidance, it may reduce procedural time and the number of CT passes.

CT and MRI radiomics of bone and soft-tissue sarcomas: a systematic review of reproducibility and validation strategies.

BACKGROUND: Feature reproducibility and model validation are two main challenges of radiomics. This study aims to systematically review radiomic feature reproducibility and predictive model validation strategies in studies dealing with CT and MRI radiomics of bone and soft-tissue sarcomas. The ultimate goal is to promote achieving a consensus on these aspects in radiomic workflows and facilitate clinical transferability. RESULTS: Out of 278 identified papers, forty-nine papers published between 2008 and 2020 were included. They dealt with radiomics of bone (n = 12) or soft-tissue (n = 37) tumors. Eighteen (37%) studies included a feature reproducibility analysis. Inter-/intra-reader segmentation variability was the theme of reproducibility analysis in 16 (33%) investigations, outnumbering the analyses focused on image acquisition or post-processing (n = 2, 4%). The intraclass correlation coefficient was the most commonly used statistical method to assess reproducibility, which ranged from 0.6 and 0.9. At least one machine learning validation technique was used for model development in 25 (51%) papers, and K-fold cross-validation was the most commonly employed. A clinical validation of the model was reported in 19 (39%) papers. It was performed using a separate dataset from the primary institution (i.e., internal validation) in 14 (29%) studies and an independent dataset related to different scanners or from another institution (i.e., independent validation) in 5 (10%) studies. CONCLUSIONS: The issues of radiomic feature reproducibility and model validation varied largely among the studies dealing with musculoskeletal sarcomas and should be addressed in future investigations to bring the field of radiomics from a preclinical research area to the clinical stage.

Endovascular management of the deep venous thrombosis: A new challenging role for the endovascular specialist in 2020.

Over the last years, the endovascular approach to the management of the acute and chronic deep vein thrombosis (DVT) has gained more and more attention from the scientific community. DVT is the third most common cardiovascular disease after coronary heart disease and stroke, with classic treatment based on anticoagulation. Recent evidences have highlighted the risk of postthrombotic syndrome as high as 30%-50% in proximal ilio-femoral lesions, with irreversible clinical symptoms and impact on the quality of life of the population. Since 2000s, the new concept of thrombus removal in the acute phase has been supported by the introduction of different techniques based on the endovascular ablation of the clot by in-situ fibrinolysis and, more recently, fragmentation and aspiration. In the chronic phase, recanalization of the thrombosed segment is recommended by stent placement to remove the obstruction and eventually reduce the congestion. Immediate technical success of these procedures is widely satisfying, whereas the long-term clinical benefits are still debated. This paper presents an overview of the modern management of the DVT by endovascular approach with regard to the clinical contexts, interventional strategies and clinical outcomes. Endovascular specialist needs to be aware of this incoming challenge, as local expertise is demanded for the modern management of these patients in multidisciplinary theaters.

Transhepatic endovascular repair for portal vein haemorrhage.

BACKGROUND: Post-surgical bleeding of the main portal vein (PV) is a rare event but difficult to manage surgically. Among the different options of treatment, endovascular stenting of the PV can be considered. We reported two cases of stent-graft placement in PV with subsequent closure of the portal vein access with two percutaneous closure devices deployed simultaneously. CASES PRESENTATION: The first patient was a 43 years-old woman affected with a pseudoaneurysm of the extrahepatic PV, occurred after a duodenocephalopancreasectomy performed for a neuroendocrine tumour of the pancreatic isthmus. The second patient was a 54 years-old man suffering from multiple episodes of bleeding after liver transplantation, due to a PV fissure. In both cases, a stent graft was placed into the portal system, between the PV and the superior mesenteric vein through a right trans-hepatic access to the portal system. In both cases, a final control showed patency of the mesenteric vein and PV and no endoleak detection. At the end of the procedure, two percutaneous closure devices were loaded, to close the transhepatic portal access. In one case, one of the devices did not work and the entry point was managed with a single device, without further complications. No bleeding was seen though the entry point nor at the US examination performed right after the procedure. After procedure, patients were prescribed with low-molecular weight heparin (LMWH) and kept under surveillance. For both patients, CT scan performed within 24h after the procedure, showed a patent stent-graft and no evidence of any venous portal ischemia. The first patient was then transferred to another hospital, to continue observation and medical management. The second one underwent 2 months of hospitalization, during which he developed a pancreatic fistula and mild renal insufficiency. Then, he left the hospital to its native Country to continue his medical. CONCLUSION: PV stent-graft placement seems a feasible option to manage portal bleeding. Trans-hepatic access is an easy and fast approach. The trans-hepatic portal accesses may be successfully managed with the deployment of percutaneous closure devices.

Efficacy of thermal ablation in benign non-functioning solid thyroid nodule: A systematic review and meta-analysis.

BACKGROUND: Image-guided thermal ablations are commonly used in the treatment of thyroid nodules. Radiofrequency ablation (RFA) and laser ablation are the most commonly used. Here we aimed to obtain solid evidence of the long-term efficacy of RFA and laser ablation in benign non-functioning solid thyroid nodules (BNFSTN). METHODS: PubMed, CENTRAL, Scopus, and Web of Science were searched until March 2019. Studies reporting the effectiveness of RFA or laser ablation in patients with BNFSTN in terms of volume reduction rate (VRR), compressive symptoms and cosmetic concerns were included. Complications were also assessed. RESULTS: Out of 963 papers, 12 studies on RFA and 12 on laser ablation were included, assessing 1186 and 2009 BNFSTNs, respectively. Overall, VRR at 6, 12, 24, and 36 months was 60%, 66%, 62%, and 53%. VRR of RFA was 68%, 75%, and 87%, respectively. VRR of laser ablation was 48%, 52%, 45%, and 44%, respectively. Baseline volume of nodules undergone RFA was significantly smaller compared to laser ablation (20.1 ± 22.4 versus 24.6 ± 23.6 ml; p < 0.01). Nodules smaller than 30 ml obtained better outcomes than larger ones. A significant reduction in compressive symptoms and cosmetic concerns was found after RFA. CONCLUSIONS: This meta-analysis showed that both RFA and laser ablation are able to obtain a significant volume reduction in BNFSTNs. A significant volume reduction is already evident at 6 months after thermal ablation and results are stable over the time.

The ENETS TNM staging and grading system accurately predict prognosis in patients with rectal NENs.

BACKGROUND: Factors associated with rectal NENs prognosis are poorly investigated. AIM: To evaluate the prognostic role of the ENETs staging and grading systems in rectal NENs. METHODS: Tertiary referral, multicenter, retrospective study. Factors associated with OS and PFS were investigated by Cox-regression analysis, with best size cut-offs calculated by ROC analysis. RESULTS: Of 100 patients (mean age 55, 45% male, mean size 16.2 mm) 62, 5, 10 and 23 were TNM stage 1 to 4, and 63, 15 and 22 were G1, G2 and G3. Primary treatment was endoscopic snare resection in 62%, endoscopic mucosal resection/endoscopic submucosal dissection in 10%, surgery in 20% and medical treatment in 8%. The best size cut-offs to predict OS and PFS were 10 and 12 mm. During a mean follow-up of 40.7 months 12% died and 26% progressed. The 5-year OS and PFS were 79.5% and 65.2%. Stage IV and G3 were associated with worse OS (HR 8.16; p = 0.002; HR 15.57; p = 0.0004) and PFS (HR 14.26 p < 0.0001; HR 6.42; p = 0.0007). CONCLUSION: Both staging and grading accurately predict rectal NENs prognosis. Size alone has limited accuracy as 26% of patients with stage IV and 16% with G3 have a primary tumour≤10 mm.

Clinical practice guidelines on ultrasound-guided fine needle aspiration biopsy of thyroid nodules: a critical appraisal using AGREE II.

PURPOSE: To appraise the quality of current guidelines on fine needle aspiration biopsy (FNAB) of thyroid nodules for adults using the AGREE II quality assessment tool. METHODS: We conducted an online search for guidelines on FNAB of thyroid nodules published between 2013 and October 2018. They were evaluated by four independent reviewers previously trained to apply the AGREE II instrument, which is organized into items and domains. A fifth independent reviewer calculated scores for each domain and guideline as well as inter-appraiser agreement. RESULTS: Six sets of guidelines were included, respectively, provided by the American Thyroid Association (ATA), the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), the Korean Society of Thyroid Radiology (KSThR), the European Thyroid Association (ETA), the American College of Radiology (ACR) and the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency (KSR/NECA). Five out of the six guidelines (ATA, AACE/ACE/AME, ETA, ACR and KSR/NECA) reached a high level of overall quality, having at least five domain scores >60%. An average level of overall quality was achieved in one case (KSThR recommendations). Inter-appraiser agreement ranged from moderate to excellent. CONCLUSIONS: Overall, the quality of guidelines on FNAB of thyroid nodules is satisfactory when evaluated using the AGREE II instrument.

Quantification of visceral adipose tissue by computed tomography and magnetic resonance imaging: reproducibility and accuracy.

OBJECTIVE: To evaluate the feasibility of quantifying visceral adipose tissue (VAT) on computed tomography (CT) and magnetic resonance imaging (MRI) scans, using freeware, as well as calculating intraobserver and interobserver reproducibility. MATERIALS AND METHODS: We quantified VAT in patients who underwent abdominal CT and MRI at our institution between 2010 and 2015, with a maximum of three months between the two examinations. A slice acquired at the level of the umbilicus was selected. Segmentation was performed with the region growing algorithm of the freeware employed. Intraobserver and interobserver reproducibility were evaluated, as was the accuracy of MRI in relation to that of CT. RESULTS: Thirty-one patients (14 males and 17 females; mean age of 57 ± 15 years) underwent CT and MRI (mean interval between the examinations, 28 ± 12 days). The interobserver reproducibility was 82% for CT (bias = 1.52 cm2; p = 0.488), 86% for T1-weighted MRI (bias = -4.36 cm2; p = 0.006), and 88% for T2-weighted MRI (bias = -0.52 cm2; p = 0.735). The intraobserver reproducibility was 90% for CT (bias = 0.14 cm2; p = 0.912), 92% for T1-weighted MRI (bias = -3,4 cm2; p = 0.035), and 90% for T2-weighted MRI (bias = -0.30 cm2; p = 0.887). The reproducibility between T1-weighted MRI and T2-weighted MRI was 87% (bias = -0.11 cm2; p = 0.957). In comparison with the accuracy of CT, that of T1-weighted and T2-weighted MRI was 89% and 91%, respectively. CONCLUSION: The program employed can be used in order to quantify VAT on CT, T1-weighted MRI, and T2-weighted MRI scans. Overall, the accuracy of MRI (in comparison with that of CT) appears to be high, as do intraobserver and interobserver reproducibility. However, the quantification of VAT seems to be less reproducible in T1-weighted sequences.

OBJETIVO: Avaliar a viabilidade da quantificação do tecido adiposo visceral (TAV) pela tomografia computadorizada (TC) e ressonância magnética (RM) usando um software freeware, e também calcular a reprodutibilidade intraobservador e interobservador. MATERIAIS E MÉTODOS: Foi quantificado o TAV em pacientes submetidos a TC e RM de abdome em nossa instituição, entre 2010 e 2015, com um intervalo máximo de três meses entre os dois exames. Selecionou-se um corte adquirido ao nível da cicatriz umbilical. A segmentação foi realizada com o algoritmo de crescimento de região do freeware utilizado. As reprodutibilidades intraobservador e interobservador foram avaliadas, assim como a acurácia da RM em relação à TC. RESULTADOS: Trinta e um pacientes (14 homens e 17 mulheres; média de idade: 57 ± 15 anos) realizaram TC e RM (intervalo médio entre os exames: 28 ± 12 dias). A reprodutibilidade interobservador foi 82% para TC (viés = 1,52 cm2; p = 0,488), 86% para RM ponderada em T1 (viés = −4,36 cm2; p = 0,006) e 88% para RM ponderada em T2 (viés = −0,52 cm2; p = 0,735). A reprodutibilidade intraobservador foi 90% para TC (viés = 0,14 cm2; p = 0,912), 92% para RM ponderada em T1 (viés = −3,4 cm2; p = 0,035) e 90% para RM ponderada em T2 (viés = −0,30 cm2, p = 0,887). A reprodutibilidade entre a RM ponderada em T1 e a RM ponderada em T2 foi 87% (viés = −0,11 cm2; p = 0,957). Em comparação com a TC, a acurácia da RM ponderada em T1 e T2 foi 89% e 91%, respectivamente. CONCLUSÃO: O programa utilizado pode ser usado para quantificar o TAV na TC, na RM ponderada em T1 e na RM ponderada em T2. No geral, a acurácia da RM (em comparação com a TC) parece ser alta, assim como a reprodutibilidade intraobservador e interobservador. No entanto, a quantificação do TAV parece ser menos reprodutível nas sequências ponderadas em T1.

C1-C2 fractures in asymptomatic elderly patients with minor head trauma: evaluation with a dedicated head CT protocol.

OBJECTIVE: To evaluate the frequency and types of upper cervical spine injuries in asymptomatic elderly patients undergoing computed tomography (CT) for the investigation of minor head trauma. MATERIALS AND METHODS: This was a prospective study of 2613 asymptomatic elderly patients with minor head trauma seen between January 2015 and December 2016. We adopted a dedicated head CT protocol that included the C1-C2 region. RESULTS: Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries, corresponding to 8.37% of the 394 patients with trauma-related findings. Of those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of 16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%, respectively. CONCLUSION: Inclusion of the C1-C2 region in head CT scans allowed us to identify upper cervical spine injuries in 1.26% of asymptomatic elderly patients with minor head trauma. The protocol evaluated helps detect potentially life-threatening injuries and could be adopted for routine use in elderly individuals with minor head trauma.

OBJETIVO: Avaliar a frequência e os tipos de lesões da coluna cervical superior em pacientes idosos assintomáticos submetidos a tomografia computadorizada (TC) para investigação de trauma leve na cabeça. MATERIAIS E MÉTODOS: De janeiro de 2015 a dezembro de 2016, analisamos prospectivamente 2613 pacientes idosos assintomáticos com pequeno traumatismo na cabeça. com protocolo de TC dedicado incluindo a região de C1-C2. RESULTADOS: Trinta e três dos 2613 pacientes apresentaram lesões na coluna cervical superior, com frequência de 1,26% em toda a população e de 8,37% (33/394) em pacientes com achados relacionados ao trauma. Seis dos 33 pacientes apresentaram fratura de C1 e 27/33 pacientes apresentaram fratura de C2. A dose de TC aumentou 25% e 23,68% com scanner de 16 e 128 fileiras, respectivamente. CONCLUSÃO: A inclusão de C1-C2 na TC de cabeça revelou uma taxa de lesões da coluna cervical superior de 1,26% em pacientes idosos assintomáticos com lesão pequena na cabeça. O protocolo ajuda a detectar potencialmente lesões fatais e pode ser adotado para pessoas idosas com trauma leve na cabeça.

C1-C2 fractures in asymptomatic elderly patients with minor head trauma: evaluation with a dedicated head CT protocol / Fraturas de C1-C2 em pacientes idosos assintomáticos com trauma leve de cabeça: avaliação com protocolo de TC de cabeça dedicado

Abstract Objective: To evaluate the frequency and types of upper cervical spine injuries in asymptomatic elderly patients undergoing computed tomography (CT) for the investigation of minor head trauma. Materials and Methods: This was a prospective study of 2613 asymptomatic elderly patients with minor head trauma seen between January 2015 and December 2016. We adopted a dedicated head CT protocol that included the C1-C2 region. Results: Of the 2613 patients analyzed, 33 (1.26%) had upper cervical spine injuries, corresponding to 8.37% of the 394 patients with trauma-related findings. Of those 33 patients, 6 had C1 fractures and 27 had C2 fractures. The use of 16- and 128-slice scanners increased the CT dose by 25.0% and 23.7%, respectively. Conclusion: Inclusion of the C1-C2 region in head CT scans allowed us to identify upper cervical spine injuries in 1.26% of asymptomatic elderly patients with minor head trauma. The protocol evaluated helps detect potentially life-threatening injuries and could be adopted for routine use in elderly individuals with minor head trauma.

Resumo Objetivo: Avaliar a frequência e os tipos de lesões da coluna cervical superior em pacientes idosos assintomáticos submetidos a tomografia computadorizada (TC) para investigação de trauma leve na cabeça. Materiais e Métodos: De janeiro de 2015 a dezembro de 2016, analisamos prospectivamente 2613 pacientes idosos assintomáticos com pequeno traumatismo na cabeça. com protocolo de TC dedicado incluindo a região de C1-C2. Resultados: Trinta e três dos 2613 pacientes apresentaram lesões na coluna cervical superior, com frequência de 1,26% em toda a população e de 8,37% (33/394) em pacientes com achados relacionados ao trauma. Seis dos 33 pacientes apresentaram fratura de C1 e 27/33 pacientes apresentaram fratura de C2. A dose de TC aumentou 25% e 23,68% com scanner de 16 e 128 fileiras, respectivamente. Conclusão: A inclusão de C1-C2 na TC de cabeça revelou uma taxa de lesões da coluna cervical superior de 1,26% em pacientes idosos assintomáticos com lesão pequena na cabeça. O protocolo ajuda a detectar potencialmente lesões fatais e pode ser adotado para pessoas idosas com trauma leve na cabeça.

Quantification of visceral adipose tissue by computed tomography and magnetic resonance imaging: reproducibility and accuracy / Quantificação do tecido adiposo visceral por tomografia computadorizada e ressonância magnética: reprodutibilidade e acurácia

Abstract Objective: To evaluate the feasibility of quantifying visceral adipose tissue (VAT) on computed tomography (CT) and magnetic resonance imaging (MRI) scans, using freeware, as well as calculating intraobserver and interobserver reproducibility. Materials and Methods: We quantified VAT in patients who underwent abdominal CT and MRI at our institution between 2010 and 2015, with a maximum of three months between the two examinations. A slice acquired at the level of the umbilicus was selected. Segmentation was performed with the region growing algorithm of the freeware employed. Intraobserver and interobserver reproducibility were evaluated, as was the accuracy of MRI in relation to that of CT. Results: Thirty-one patients (14 males and 17 females; mean age of 57 ± 15 years) underwent CT and MRI (mean interval between the examinations, 28 ± 12 days). The interobserver reproducibility was 82% for CT (bias = 1.52 cm2; p = 0.488), 86% for T1-weighted MRI (bias = −4.36 cm2; p = 0.006), and 88% for T2-weighted MRI (bias = −0.52 cm2; p = 0.735). The intraobserver reproducibility was 90% for CT (bias = 0.14 cm2; p = 0.912), 92% for T1-weighted MRI (bias = −3,4 cm2; p = 0.035), and 90% for T2-weighted MRI (bias = −0.30 cm2; p = 0.887). The reproducibility between T1-weighted MRI and T2-weighted MRI was 87% (bias = −0.11 cm2; p = 0.957). In comparison with the accuracy of CT, that of T1-weighted and T2-weighted MRI was 89% and 91%, respectively. Conclusion: The program employed can be used in order to quantify VAT on CT, T1-weighted MRI, and T2-weighted MRI scans. Overall, the accuracy of MRI (in comparison with that of CT) appears to be high, as do intraobserver and interobserver reproducibility. However, the quantification of VAT seems to be less reproducible in T1-weighted sequences.

Resumo Objetivo: Avaliar a viabilidade da quantificação do tecido adiposo visceral (TAV) pela tomografia computadorizada (TC) e ressonância magnética (RM) usando um software freeware, e também calcular a reprodutibilidade intraobservador e interobservador. Materiais e Métodos: Foi quantificado o TAV em pacientes submetidos a TC e RM de abdome em nossa instituição, entre 2010 e 2015, com um intervalo máximo de três meses entre os dois exames. Selecionou-se um corte adquirido ao nível da cicatriz umbilical. A segmentação foi realizada com o algoritmo de crescimento de região do freeware utilizado. As reprodutibilidades intraobservador e interobservador foram avaliadas, assim como a acurácia da RM em relação à TC. Resultados: Trinta e um pacientes (14 homens e 17 mulheres; média de idade: 57 ± 15 anos) realizaram TC e RM (intervalo médio entre os exames: 28 ± 12 dias). A reprodutibilidade interobservador foi 82% para TC (viés = 1,52 cm2; p = 0,488), 86% para RM ponderada em T1 (viés = −4,36 cm2; p = 0,006) e 88% para RM ponderada em T2 (viés = −0,52 cm2; p = 0,735). A reprodutibilidade intraobservador foi 90% para TC (viés = 0,14 cm2; p = 0,912), 92% para RM ponderada em T1 (viés = −3,4 cm2; p = 0,035) e 90% para RM ponderada em T2 (viés = −0,30 cm2, p = 0,887). A reprodutibilidade entre a RM ponderada em T1 e a RM ponderada em T2 foi 87% (viés = −0,11 cm2; p = 0,957). Em comparação com a TC, a acurácia da RM ponderada em T1 e T2 foi 89% e 91%, respectivamente. Conclusão: O programa utilizado pode ser usado para quantificar o TAV na TC, na RM ponderada em T1 e na RM ponderada em T2. No geral, a acurácia da RM (em comparação com a TC) parece ser alta, assim como a reprodutibilidade intraobservador e interobservador. No entanto, a quantificação do TAV parece ser menos reprodutível nas sequências ponderadas em T1.

Materials and techniques for percutaneous retrieval of intravascular foreign bodies.

The presence of an intravascular foreign body represents a well-known risk of serious complications. While in the past surgical removal of intravascular foreign body was the most common intervention, nowadays a percutaneous approach in the retrieval of an intravascular foreign body is widely accepted as the first-line technique. In the literature, many case reports describe different techniques and materials. This article summarizes and illustrates the main materials and techniques currently applied for percutaneous retrieval of intravascular foreign body, providing a simplified tool with different interventional possibilities, adaptable to different clinical situations.

Endovascular Embolization of Spontaneous Iliopsoas Hematoma: First Experience with Squidperi.

A 79-year-old man, suffering from atrial fibrillation and on anticoagulation therapy, was admitted at the emergency department of our institution because of a worsening respiratory insufficiency. After a diagnostic work-up, he was found to suffer from pneumonia, and antibiotic therapy was settled. He was kept under observation for his pulmonary conditions but, within a week, he developed a spontaneous iliopsoas hematoma, due to a sudden dysregulation of anticoagulation therapy subsequent to new in-hospital treatments. An endovascular approach was attempted and the bleeding vessels were embolized with a new liquid agent, named Squidperi (Emboflu, Switzerland). Complete exclusion of the diseased vessels was obtained and no complications occurred after the procedure. We conclude that Squidperi can be considered as an option for treatment of spontaneous iliopsoas hematomas.

Which needle in the treatment of thyroid nodules?

Thyroid nodules are a common finding in general population, with a prevalence of 20% to 70% at ultrasound (US) examination. Many of them are benign but treatment can be necessary to relief compressive symptoms. In the last years, percutaneous ablations have achieved amazing development in the treatment of thyroid nodules as they provide a minimally invasive but effective approach. We aimed to summarize the main aspects related to treatment of thyroid nodules with radiofrequency ablation (RFA), focusing on the use of different types of needles. A narrative review was performed and all papers analyzed reported good results in terms of nodule's size reduction and symptoms relief. No major complications have been reported, even though needles of bigger size seemed related with major risks of post-procedural local edema. Thus, thinner internally cooled multi tined needles [18-19 Gauge (G)] rather than larger needles (14 G) seem to have better results and less complications.

Clinical impact of computed tomography in the emergency department in nontraumatic chest and abdominal conditions.

AIM: To evaluate the clinical impact of CT scan in modifying the clinical management in patients referred to the emergency department. METHODS: We prospectively evaluated 300 patients (177 males, 63 ± 18 years old) admitted in the emergency department (ED) of a single institution, who underwent a CT examination for thoracic and/or abdominal complains. Demographic and clinical data were collected. Hypothesized outcome prior to CT scan and final management (i.e., discharge, short observation in the ED, hospitalization, and department of admission) were compared. RESULTS: After CT examination, a major variation in diagnosis occurred in 37% of cases and clinical management changed in 43%, occurring in 51% of patients who underwent abdominal CT, in 40% of chest CT, and in 29% of chest/abdominal CT (P = 0.015). Department of hospitalization changed in 26% of cases (P < 0.001). Clinical impact of CT scan was significantly associated (P = 0.001) with the color code at admission. In particular, the more severe was the clinical condition, the lower was the variation of management after CT examination. CONCLUSIONS: This work confirms the crucial role of CT examination in the management of nontraumatic patients admitted to the ED, both in terms of better clarifying the diagnosis and in influencing the clinical management.

Rotator cuff calcific tendinopathy: from diagnosis to treatment.

Rotator cuff calcific tendinopathy (RCCT) is a very common condition caused by the presence of calcific deposits in the rotator cuff (RC) or in the subacromial-subdeltoid (SASD) bursa when calcification spreads around the tendons. The pathogenetic mechanism of RCCT is still unclear. It seems to be related to cell-mediated disease in which metaplastic transformation of tenocytes into chondrocytes induces calcification inside the tendon of the RC. RCCT is a frequent finding in the RC that may cause significant shoulder pain and disability. It can be easily diagnosed with imaging studies as conventional radiography (CR) or ultrasound (US). Conservative management of RCCT usually involves rest, physical therapy, and oral NSAIDs administration. Imaging-guided treatments are currently considered minimally-invasive, yet effective methods to treat RCCT with about 80% success rate. Surgery remains the most invasive treatment option in chronic cases that fail to improve with other less invasive approaches.