99mTc-macroaggregated albumin SPECT/CT predictive dosimetry and dose-response relationship in uveal melanoma liver metastases treated with first-line selective internal radiation therapy.

First-line selective internal radiation therapy (SIRT) showed promising outcomes in patients with uveal melanoma liver metastases (UMLM). Patient survival depends on liver's disease control. SIRT planning is essential and little is known about dosimetry. We investigated whether 99mTc-MAA-SPECT/CT dosimetry could predict absorbed doses (AD) evaluated on 90Y-PET/CT and assess the dose-response relationship in UMLM patients treated with first-line SIRT. This IRB-approved, single-center, retrospective analysis (prospectively collected cohort) included 12 patients (median age 63y, range 43-82). Patients underwent MRI/CT, 18F-FDG-PET/CT before and 3-6 months post-SIRT, and 90Y-PET/CT immediately post-SIRT. Thirty-two target lesions were included. AD estimates in tumor and non-tumor liver were obtained from 99mTc-MAA-SPECT/CT and post-SIRT 90Y-PET/CT, and assessed with Lin's concordance correlation coefficients (ρc and Cb), Pearson's coefficient correlation (ρ), and Bland-Altman analyses (mean difference ± standard deviation; 95% limits-of-agreement (LOA)). Influence of tumor characteristics and microsphere type on AD was analyzed. Tumor response was assessed according to size-based, enhancement-based and metabolic response criteria. Mean target lesion AD was 349 Gy (range 46-1586 Gy). Concordance between 99mTc-MAA-SPECT/CT and 90Y-PET/CT tumor dosimetry improved upon dose correction for the recovery coefficient (RC) (ρ = 0.725, ρc = 0.703, Cb = 0.969) with good agreement (mean difference: - 4.93 ± 218.3 Gy, 95%LOA: - 432.8-422.9). Without RC correction, concordance was better for resin microspheres (ρ = 0.85, ρc = 0.998, Cb = 0.849) and agreement was very good between predictive 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (mean difference: - 4.05 ± 55.9 Gy; 95%LOA: - 113.7-105.6). After RC correction, 99mTc-MAA-SPECT/CT dosimetry overestimated AD (- 70.9 ± 158.9 Gy; 95%LOA: - 382.3-240.6). For glass microspheres, concordance markedly improved with RC correction (ρ = 0.790, ρc = 0.713, Cb = 0.903 vs without correction: ρ = 0.395, ρc = 0.244, Cb = 0.617) and 99mTc-MAA-SPECT/CT dosimetry underestimated AD (148.9 ± 267.5 Gy; 95%LOA: - 375.4-673.2). For non-tumor liver, concordance was good between 99mTc-MAA-SPECT/CT and 90Y-PET/CT dosimetry (ρ = 0.942, ρc = 0.852, Cb = 0.904). 99mTc-MAA-SPECT/CT slightly overestimated liver AD for resin (3.4 ± 3.4 Gy) and glass (11.5 ± 13.9 Gy) microspheres. Tumor AD was not correlated with baseline or post-SIRT lesion characteristics and no dose-response threshold could be identified. 99mTc-MAA-SPECT/CT dosimetry provides good estimates of AD to tumor and non-tumor liver in UMLM patients treated with first-line SIRT.

Virtually Augmented Self-Hypnosis applied to endovascular interventions (VA-HYPO): Randomized Controlled Trial Protocol.

Endovascular interventions (EVI) are increasingly performed as minimally-invasive alternatives to surgery and have many advantages, including a decreased need for general anesthesia. However, EVI can be stressful for patients and often lead to anxiety and pain related to the procedure. The use of local anesthetics, anxiolytics, and analgesic drugs can help avoid general anesthesia. Nevertheless, these drugs have potential side effects. Alternative nonpharmacological therapies can improve patients' experience during conscious interventions and reduce the need for additional medications. The added value of virtually augmented self-hypnosis (VA-HYPO) and its potential to reduce pain and anxiety during peripheral and visceral arterial and venous EVI is unknown. This is a prospective two-arm trial designed to randomize 100 patients in two groups according to the use or not of VA-HYPO during peripheral EVI as a complementary nonpharmacological technique to improve patient comfort. The main objective is to compare per-procedural anxiety, and the secondary aim is to compare the rated per-procedural pain in both groups. The potential significance is that VA-HYPO may improve patients' experience during peripheral and visceral arterial and venous EVI and other minimally invasive interventions performed under local anesthesia. Trial registration: Our study is registered on clinicaltrials.gov, with trial registration number: NCT04561596.

Abbreviated MRI for Preoperative Assessment of Breast Cancer: is Maximal Intensity Projection (MIP) of the First Post Contrast Acquisition Subtracted (Fast) Sequence Sufficient for Disease Evaluation?

Objectives: The aim of this study was to assess the diagnostic performance of abbreviated MRI (AMRI) using the maximal intensity projection (MIP) reconstruction of the first post-contrast acquisition subtracted (FAST) compared with MIP+FAST and full-protocol MRI (fpMRI) for the preoperative assessment of breast cancer (BC) in a biopsy-proven cancer population. Methods: In this monocentric retrospective study, two readers consensually assessed two AMRI protocols consisting of MIP reconstruction of the FAST (MIP) and MIP+FAST. 228 patients were included with a breast MRI performed between 2013 and 2014, 207 of them (90.8%) had biopsy-proven cancer with 256 lesions. Data of MIP and MIP+FAST were compared to full-protocol MRI (fpMRI) reading and to the reference standard including 6-month follow-up imaging and pathology as the reference. Results: MIP, MIP+FAST and fpMRI demonstrated a per-lesion sensitivity for BC detection of 87.5% (224/256, 95%CI: 82.9-91.3%) and 97.7% (250/256, 95-99.1%) and 98.4% (252/256, 96.1-99.6%), respectively with a statistical difference between MIP compared to MIP+FAST and fpMRI when considering confidence intervals. Per-lesion specificity was not different [MIP: 47.6% (10/21, 25.7-70.2%), MIP+FAST: 52.4% (11/21,29.8-74.3%, fpMRI: 66.7% (14/21, 43-85.4%)]. Conclusion: AMRI using only MIP is not accurate for the pre-operative assessment of BC due to lower sensitivity when compared to MIP+FAST and fpMRI. AMRI using the MIP+FAST acquisition in the preoperative setting seems promising as it could be used as the same protocol for both screening and staging in case of positive cases, without need for a recall fpMRI. This needs confirmation with cohort including higher rate of negative cases in order to evaluate the specificity.

Insights Into Endovascular Management of Superior Vena Cava Obstructions.

Superior vena cava obstruction results from any limitation of blood flow through the superior vena cava. Circulation to the heart may persist through various collateral vessels whose development depends on the level of obstruction. Depending on the level and degree of occlusive disease, the severity of clinical symptoms may vary considerably, up to lethal. Etiologies have changed dramatically in recent years, mainly due to the increasing use of intravascular devices. However, guidelines for treatment are lacking, and various options are available. Endovascular therapies developed considerably in recent years, may offer a rapid improvement in symptoms and proved to be safe. However, knowledge and selection of appropriate techniques are essential to venous angioplasty, involving specific tools to guarantee satisfying outcomes. This review aims to discuss the particular venous anatomy of the upper body, the physiopathology of superior vena cava obstruction, and specificities of endovascular treatment compared with other management options.

First-Line Selective Internal Radiation Therapy in Patients with Uveal Melanoma Metastatic to the Liver.

Survival of patients with uveal melanoma metastatic to the liver correlates strongly with disease control in the liver. Unfortunately, there are no standardized treatments for this chemoresistant disease. Selective internal radiation therapy (SIRT) has been tested as salvage therapy, but no data exist about its use as first-line therapy. The purpose of this study was to investigate the safety and efficacy of SIRT as first-line therapy in patients with uveal melanoma metastatic to the liver. Methods: This retrospective analysis of a prospectively collected cohort included 22 patients treated with first-line SIRT. Biochemical and clinical toxicities were recorded. Tumor response was determined according to the European Association for the Study of Liver Disease (EASL) criteria. Predictive factors of survival were analyzed by univariate and multivariate analysis. Overall survival was calculated using the Kaplan-Meier method with the log-rank test. Results: Grade 3-4 biologic and clinical toxicities occurred in 24% of patients (for both). According to the EASL criteria, disease control at 6 mo after SIRT was achieved in 15 (52%) of the 29 SIRT patients and was predictive of survival. Median overall survival from the first SIRT was 18 mo (95% confidence interval [95%CI], 8-28 mo). At the time of the analysis, 5 patients (23%) were still alive. In multivariate analysis, largest lesion size (hazard ratio [HR], 1.22; 95%CI, 0.98-1.53], liver tumor volume (HR, 1.002; 95%CI, 1.0004-1.003), subsequent systemic therapy (HR, 0.04; 95%CI, 0.006-0.24), and liver-directed locoregional therapy (HR, 0.204; 95%CI, 0.04-0.94) were predictive of survival. Conclusion: First-line SIRT is safe and produced promising outcomes in patients with uveal melanoma metastatic to the liver. Subsequent systemic and liver-directed locoregional therapies ameliorated survival, highlighting the potential for improved outcomes with combination approaches. The results of this study suggest that prospective trials using first-line SIRT should be considered.

Cytological features of uterine tumors resembling ovarian sex-cord tumors in liquid-based cervical cytology: a potential pitfall. Report of a unique and rare case.

Uterine tumors resembling ovarian sex-cord tumors (UTROSCTs) are rare uterine neoplasms of uncertain etiology that resemble the sex cord tumors of the ovary and display a combined sex cord, epithelial, and smooth muscle immunophenotype. Most tumors are associated with a benign clinical course. We report the first cytological description of uterine UTROSCTs in liquid-based cervical cytology (LBC). A menopausal woman was discovered to have a uterine intraluminal polypoid mass protruding through the vagina. A Pap test was performed, and the LBC preparation showed isolated tumor cells with scant cytoplasm and slightly irregular, ovoid nuclei with fine chromatin and small nucleoli. Final histological evaluation identified a UTROSCT. This diagnostic possibility, albeit rare, should be included in the differential diagnosis when isolated malignant-appearing adenocarcinomatous cells are seen in women in the above scenario. As these features are not specific, they may result in misinterpretation with tumors that are more common and aggressive.

Left sinus of Valsalva aneurysm as a cause of chronic stable angina.

Sinus of Valsalva aneurysms are unusual, particularly when located on the left coronary sinus. They are mainly asymptomatic, however once ruptured, they are associated with high mortality. We present hereinafter an atypical case of a 71-year-old patient with an unruptured left sinus of Valsalva aneurysm causing myocardial ischaemia due to a compressed left main coronary artery. Surgical endoaneurysmorrhaphy was performed; however, a dehiscence of the suture line between the patch and the aortic wall required additional percutaneous implantation of a vascular occluder.

Direct origin of the right colic artery from the abdominal aorta.

An isolated right colic artery originating directly from the abdominal aorta was incidentally observed during diagnostic spinal angiography. Variations in origin of the right colic artery are reviewed, and their embryology and potential clinical implications discussed.