Application of side-hole catheter technique for transradial arterial chemoembolization in patients with hepatocellular carcinoma.

PURPOSE: The purpose of this study was to retrospectively evaluate the efficacy and safety of side-hole catheter technique for transarterial chemoembolization (TACE) via transradial artery access (TRA) in patients with hepatocellular carcinoma. MATERIALS AND METHODS: From November 2015 to August 2017, a total of 1040 TACE procedures were performed via TRA for hepatocellular carcinoma. In 10 (1%) of these 1040 TACE procedures via TRA, conventional microcatheter technique (CMT) failed and side-hole catheter technique was attempted. RESULTS: Ten procedures of selective catheterizations by CMT failed due to the poor stability of the angiographic catheters or the target artery arising from the very proximal portion of the parent artery. These arteries included the right inferior phrenic artery in eight patients, one left gastric artery, and one right renal capsular artery. Cobra or MPA catheter with the microcatheter through the side-hole yielded a technical success rate of 100%. No procedure-related complications were observed. The mean time required to catheterize the target artery with the side-hole catheter was 9.5 min (5-15 min). CONCLUSION: Side-hole catheter technique may enable the completion of chemoembolization in cases that a potential tumor-feeding vessel cannot be catheterized by means of CMT for TACE via TRA.

Effect of CT window settings on size measurements of the solid component in subsolid nodules: evaluation of prediction efficacy of the degree of pathological malignancy in lung adenocarcinoma.

OBJECTIVE: To investigate the predictive value of size measurements of the solid components in pulmonary subsolid nodules with different CT window settings and to evaluate the degree of pathological malignancy in lung adenocarcinoma.  Methods: The preoperative chest CT images and pathological data of 125 patients were retrospectively evaluated. The analysis included 127 surgically resected lung adenocarcinomas that manifested as subsolid nodules. All subsolid nodules were divided into two groups: 69 in group A, including 22 adenocarcinomas in situ (AIS) and 47 minimally invasive adenocarcinomas (MIA); 58 in group B that included invasive pulmonary adenocarcinomas (IPA). The size of the solid component in the pulmonary subsolid nodules were calculated in one dimensional, two dimensional and three dimensional views using lung and mediastinal windows that were recorded as 1D-SCLW, 2D-SCLW, 3D-SCLW, 1D-SCMW, 2D-SCMW and 3D-SCMW, respectively. Furthermore, the volume of solid component with a threshold of -300HU was measured using lung window (3D-SCT). All the quantitative features were evaluated by the Mann-Whitney U test. Multivariate analysis was used to identify the significant predictor of the degree of pathological malignancy.  Results: The 1D-SCLW, 2D-SCLW, 3D-SCLW, 1D-SCMW, 2D-SCMW, 3D-SCMW and 3D-SCT views of group B were significantly larger than those of group A (p < 0.001). The multivariate logistic regression analysis indicated that 3D-SCT (OR = 1.018, 95%CI: 1.005 ~ 1.03, p <0.05＝was the independent predictive factor. The larger SCT was significantly associated with IPAs.  Conclusion: 3D-SCT of subsolid nodules during preoperative CT can be used to predict the degree of pathological malignancy in lung adenocarcinoma, which may provide a more objective and convenient selection criterion for clinical application.  Advances in knowledge:  Applying threshold of -300 HU with lung window setting would be better than other window setting for the evaluation of solid component in subsolid nodules. Computer-aided volumetry of the solid component in subsolid nodules can more accurately predict the degree of pathological malignancy than the other dimensional measurements.

Quantitative CT analysis of pulmonary pure ground-glass nodule predicts histological invasiveness.

OBJECTIVE: To assess whether quantitative computed tomography (CT) can help predict histological invasiveness of pulmonary adenocarcinoma appearing as pure ground glass nodules (pGGNs). METHODS: A total of 110 pulmonary pGGNs were retrospectively evaluated, and pathologically classified as pre-invasive lesions, minimally invasive adenocarcinoma (MIA) and invasive pulmonary adenocarcinoma (IPA). Maximum nodule diameters, largest cross-sectional areas, volumes, mean CT values, weights, and CT attenuation values at the 0th,2th,5th, 25th, 50th,75th, 95th, 98th and100th percentiles on histogram, as well as 2th to 98th, 5th to 95th, 25th to 75th,and 0th to 100thslopes, respectively, were compared among the three groups. RESULTS: Of the 110 pGGNs, 50, 28, and 32 were pre-invasive lesions, MIA, and IPA, respectively. Maximum nodule diameters, largest cross-sectional areas, andmass weights were significantly larger in the IPA group than in pre-invasive lesions. The 95th, 98th, 100th percentiles, and 2th to 98th, 25th to 75th, and 0th to 100thslopes were significantly different between pre-invasive lesions and MIA or IPA. Logistic regression analysis showed that the maximum nodule diameter (OR=1.21, 95%CI: 1.071-1.366, p<0.01) and 100th percentile on histogram (OR=1.02, 95%CI: 1.009-1.032, p<0.001) independently predicted histological invasiveness. CONCLUSIONS: Quantitative analysis of CT imaging can predict histological invasiveness of pGGNs, especiallythe maximum nodule diameter and 100th percentile on CT number histogram; this can instruct the long-term follow-up and selective surgical management.