Efficacy and safety of CT-guided microwave ablation for stage T1a renal cell carcinoma in patients with a solitary kidney.

OBJECTIVE: To retrospectively evaluate early clinical outcomes of percutaneous microwave ablation (MWA) for stage T1a renal cell carcinomas (RCCs) in solitary kidney patients. MATERIALS AND METHODS: 15 solitary kidney patients with 16 stage T1a N0M0 biopsy-proved RCCs underwent CT-guided percutaneous microwave ablation between October 2016 and July 2020. The patients were followed up with contrast-enhanced computed tomography or magnetic resonance imaging at 1, 3, and 6 months and every 6 months thereafter. Serum creatinine levels of each patient pre MWA, 1 day after MWA and the most recent record were collected. Technical effectiveness, local recurrence, survival rates and complications were accessed. RESULTS: Complete ablation was achieved in all 16 tumors (100%) including 13 clear cell carcinomas and 3 papillary carcinomas. Within the follow-up time (median: 24 months) no tumor recurrence or major complication was detected. No significant change in serum creatinine level was noted. The cancer-specific survival rate was 100% (15 of 15), and 1-, 2-, and 3-year overall survival rates were 100%, 93.3%, and 93.3%, respectively. CONCLUSION: Percutaneous MWA is an effective and safe treatment option for stage T1a RCCs in solitary kidney patients; it can achieve high complete ablation rate in selected lesions of appropriate size and location.

Diagnostic value of 3.0 T cardiac MRI in children with suspected myocarditis: multi-parameter analysis for the evaluation of acute and chronic myocarditis.

BACKGROUND: Cardiac magnetic resonance (CMR) is an established tool for detection of myocarditis. However, no comprehensive data for CMR based on the "Lake Louise" criteria in pediatric myocarditis exists to date. PURPOSE: To evaluate the value of multi-parameter CMR in children with suspected acute (AMC) and chronic myocarditis (CMC). MATERIAL AND METHODS: We examined 73 pediatric patients with clinically suspected AMC (n = 25) and CMC (n = 48). We compared them to 17 controls. All individuals underwent CMR, including function analyses, T2 ratio, early gadolinium enhancement ratio (EGEr), and late gadolinium enhancement (LGE). RESULTS: In AMC, 19 (76%) patients were abnormal in any two of three parameters (T2 ratio, EGEr, and LGE). There was a significant difference between AMC and controls in LVEF (51.2% vs. 61.3%), mass (130.2 ± 14.0 vs. 120.5 ± 13.9 g), T2 ratio (1.96 ± 0.2 vs. 1.69 ± 0.13), and EGEr (4.1 ± 0.27 vs. 3.4 ± 0.39) (P < 0.05). In CMC, 26 (54.1%) patients were abnormal in any two of three parameters. There was no significant difference between CMC and controls in LVEF and mass, but there was a statistical difference in T2 ratio (1.88 ± 0.18 vs. 1.69 ± 0.13) and in EGEr (3.93 ± 0.22 vs. 3.4 ± 0.39) (P < 0.05). There was an increase in LVEF while both T2 ratio and EGEr significantly decreased (P < 0.05) during follow-up of acute fulminant myocarditis. CONCLUSION: Comprehensive CMR may serve as a powerful tool in children with suspected AMC. CMR in assessment of CMC may be valuable, but it is not satisfactory.

Efficacy and safety of artificial pneumothorax with position adjustment for CT-guided percutaneous transthoracic microwave ablation of small subpleural lung tumors.

BACKGROUND: To evaluate the efficacy and safety of artificial pneumothorax with position adjustment for computed tomograpy (CT)-guided percutaneous transthoracic microwave ablation (MWA) of small subpleural lung tumors. METHODS: Fifty-six patients with small subpleural lung tumors (< 3.0 cm) entered the study and underwent CT-guided MWA with (group I: 24 patients with 24 tumors) or without (group II: 32 patients with 34 tumors) the support of artificial pneumothorax. Follow-up contrast-enhanced CT scans were reviewed. Pain VAS (visual analog scale) scores at, during, and after ablation were compared between the two groups. Technical success, technique efficacy, local tumor control and complications were compared. RESULTS: Creation of the artificial pneumothorax was achieved for 24/24 (100%) in group I and no complication related to the procedure was observed. Technical success of MWA was achieved for all 58 tumors. Primary efficacy of MWA was achieved in 23 of 24 tumors (95.8%) treated in group I, and 32 of 34 tumors (94.1%) treated in group II (P = 0.771). The 12-month local tumor control was achieved in 87.5% (21/24) in group I compared with 88.2% (30/34) in group II (P = 0.833). Pain VAS scores in group I were significantly decreased after the pneumothorax induction at, during, and after ablation compared with group II (P < 0.05). There was no significant difference in MWA-related complications (P > 0.05). CONCLUSION: Artificial pneumothorax with position adjustment for CT-guided MWA is effective and may be safely applied to small subpleural lung tumors. Artificial pneumothorax is a reliable therapy for pain relief.

Ultralow dose computed tomography protocol for hook-wire localization of solitary pulmonary nodules prior to video-assisted thoracoscopic surgery.

BACKGROUND: This study prospectively investigated the efficacy and radiation dose of ultralow dose computed tomography (CT)-guided hook-wire localization (HWL) at 100 kV with tin filtration (100Sn kV) for small solitary pulmonary nodules. METHODS: All HWL procedures were performed on a third generation dual-source CT system. Eighty-eight consecutive patients undergoing CT-guided HWL were randomly assigned to standard dose CT (Group A: n = 44; reference 110 kV and 50 mA) or ultralow dose CT (Group B: n =44; 100 Sn kV and 96 mA) protocols. The technical success rate, complications, subjective image quality, and radiation dose were compared between the groups. RESULTS: The mean volume CT dose index and total dose-length product were significantly lower in Group B compared to Group A (0.32 mGy vs. 3.2 ± 1.1 mGy and 12.1 ± 0.97 mGy-cm vs. 120 ± 40.6 mGy-cm; P < 0.001). The effective dose in Group B was significantly lower than in Group A (0.17 ± 0.01 mSv vs. 1.68 ± 0.57 mSv, -89.8%; P < 0.001). The technical success rates were 100% for both groups. There were no significant differences in complication rates between the protocols (P > 0.05). The image quality of ultralow dose CT met the requirements for HWL procedure. CONCLUSION: Ultralow dose CT-guided HWL of solitary pulmonary nodules performed at 100 Sn kVp spectral shaping significantly reduced the radiation dose compared to standard dose CT, with high technical success and acceptable patient safety.