RESUMO
Three-dimensional (3D) printing of vascular structures is of special interest for procedure simulations in Interventional Radiology, but remains due to the complexity of the vascular system and the lack of biological tissue mimicking 3D printing materials a technical challenge. In this study, the technical feasibility, accuracy, and usability of a recently introduced silicone-like resin were evaluated for endovascular procedure simulations and technically compared to a commonly used standard clear resin. Fifty-four vascular models based on twenty-seven consecutive embolization cases were fabricated from preinterventional CT scans and each model was checked for printing success and accuracy by CT-scanning and digital comparison to its original CT data. Median deltas (Δ) of luminal diameters were 0.35 mm for clear and 0.32 mm for flexible resin (216 measurements in total) with no significant differences (p > 0.05). Printing success was 85.2% for standard clear and 81.5% for the novel flexible resin. In conclusion, vascular 3D printing with silicone-like flexible resin was technically feasible and highly accurate. This is the first and largest consecutive case series of 3D-printed embolizations with a novel biological tissue mimicking material and is a promising next step in patient-specific procedure simulations in Interventional Radiology.
Assuntos
Impressão Tridimensional , Radiologia Intervencionista , Estudos de Viabilidade , Humanos , Silicones , Tomografia Computadorizada por Raios XRESUMO
CLINICAL/METHODICAL ISSUE: In daily routine, every radiologist is confronted with a variety of questions concerning the biliary tract and pancreatic system. STANDARD RADIOLOGICAL METHODS: Today, besides sonography, magnetic resonance cholangiopancreatography (MRCP) is considered the method of choice in the investigation of many disorders of the hepatobiliary and pancreatic system and is commonly preferred over invasive ERCP in a mere diagnostic setting. METHODICAL INNOVATIONS: Since its introduction in 1991, MRCP has constantly evolved. Major innovations have been the reduction of acquisition time by using fast spin echo (FSE) sequences, the use of respiratory gating and contrast-enhanced imaging of the bile ducts with hepatobiliary-specific MRI contrast agents. PERFORMANCE: Many diagnoses may already be made with noncontrast enhanced images. By supplemental administration of a hepatobiliary-specific contrast agent, it is also possible to evaluate the flow dynamics of the bile. This is of additional value especially in patients who underwent surgery of the biliodigestive system or endoscopic interventions. ACHIEVEMENTS: Aside from robustness and reproducibility, a major advantage of this technique is the modular design of imaging protocols, which can easily be adapted to the clinical question. PRACTICAL RECOMMENDATIONS: MRCP is a reliable and low-risk imaging method for primary diagnosis and follow-up of biliary and pancreatic pathologies.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Ductos Biliares , Humanos , Imageamento por Ressonância Magnética , Pâncreas , Reprodutibilidade dos TestesRESUMO
BACKGROUND: This multicentre international randomized trial compared the impact of gadoxetic acid-enhanced magnetic resonance imaging (MRI), MRI with extracellular contrast medium (ECCM-MRI) and contrast-enhanced computed tomography (CE-CT) as a first-line imaging method in patients with suspected colorectal cancer liver metastases (CRCLM). METHODS: Between October 2008 and September 2010, patients with suspected CRCLM were randomized to one of the three imaging modalities. The primary endpoint was the proportion of patients for whom further imaging after initial imaging was required for a confident diagnosis. Secondary variables included confidence in the therapeutic decision, intraoperative deviations from the initial imaging-based surgical plan as a result of additional operative findings, and diagnostic efficacy of the imaging modalities versus intraoperative and pathological extent of the disease. RESULTS: A total of 360 patients were enrolled. Efficacy was analysed in 342 patients (118, 112 and 112 with gadoxetic acid-enhanced MRI, ECCM-MRI and CE-CT respectively as the initial imaging procedure). Further imaging was required in 0 of 118, 19 (17.0 per cent) of 112 and 44 (39.3 per cent) of 112 patients respectively (P < 0.001). Diagnostic confidence was high or very high in 98.3 per cent of patients for gadoxetic acid-enhanced MRI, 85.7 per cent for ECCM-MRI and 65.2 per cent for CE-CT. Surgical plans were changed during surgery in 28, 32 and 47 per cent of patients in the respective groups. CONCLUSION: The diagnostic performance of gadoxetic acid-enhanced MRI was better than that of CE-CT and ECCM-MRI as the initial imaging modality. No further imaging was needed in the gadoxetic acid-enhanced MRI group and comparison of diagnostic efficacy parameters demonstrated the diagnostic superiority of gadoxetic acid-enhanced MRI. REGISTRATION NUMBER: NCT00764621(http://clinicaltrials.gov); EudraCT number: 2008-000583-16 (https://eudract.ema.europa.eu/).
Assuntos
Neoplasias Colorretais , Meios de Contraste , Gadolínio DTPA , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Planejamento de Assistência ao Paciente , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
CLINICAL/METHODICAL ISSUE: Both computed tomography (CT) and magnetic resonance imaging (MRI) constitute the gold standard in radiological imaging of hepatocellular carcinoma (HCC). In cases of typical contrast behavior each modality as a single dynamic technique allows the diagnosis of HCC. There is still a challenge in detection of small HCCs < 2 cm, in differentiating HCC and high-grade dysplasia from other benign liver lesions as well as the evaluation of hypovascular liver lesions in the cirrhotic liver. PERFORMANCE: Nowadays, both modalities achieve high detection rates of 90-100 % for lesions > 2 cm. Regarding lesions between 1 and 2 cm there is a higher sensitivity for MRI ranging between 80 and 90 % compared to 60-75 % with CT. Besides the multimodal diagnostic criteria, MRI provides significant benefits with the use of hepatobiliary contrast. Especially in combination with diffusion- weighted imaging (DWI) increased sensitivity and diagnostic accuracy compared to CT has been described for lesions sized < 2 cm. Regarding the differentiation from other hepatic nodules in the cirrhotic liver there is strong evidence that the coexistence of arterial enhancement and hypointensity on hepatobiliary imaging is specific for HCC. Moreover, hypointensity on hepatobiliary imaging is associated with a high positive predictive value (PPV) of up to 100 % for the presence of high-grade dysplasia and HCC. ACHIEVEMENTS: The use of MRI including hepatobiliary imaging and DWI has to be regarded as the best non-invasive imaging modality for the detection of HCC and for the characterization of nodules in patients with liver cirrhosis. In comparison to CT there are benefits regarding detection of small lesions < 2 cm and evaluation of hypovascular liver lesions in the context of the hepatocarcinogenesis including prognostic values of premalignant lesions. PRACTICAL RECOMMENDATIONS: Both MRI and CT provide a high diagnostic performance in evaluation of HCC in liver cirrhosis. With MRI there are considerable advantages regarding the detection rate and specificity. For daily clinical routine, CT offers a fast, reliable and easy available modality with benefits for patients in reduced general state of health and restricted compliance.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Meios de Contraste , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico , Imagem Multimodal/métodos , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste/administração & dosagem , Humanos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeAssuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Oncologia/normas , Técnicas de Ablação/métodos , Técnicas de Ablação/normas , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , Protocolos de Quimioterapia Combinada Antineoplásica/normas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/genética , Braquiterapia/métodos , Braquiterapia/normas , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/patologia , Progressão da Doença , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Europa (Continente) , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/patologia , Hepatectomia/métodos , Hepatectomia/normas , Humanos , Incidência , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Cirrose Hepática/diagnóstico , Cirrose Hepática/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/patologia , Transplante de Fígado/métodos , Transplante de Fígado/normas , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Oncologia/métodos , Estadiamento de Neoplasias , Medicina de Precisão/métodos , Medicina de Precisão/normas , Radiocirurgia/normas , Medição de Risco/métodos , Medição de Risco/normas , Sociedades Médicas/normas , Sobrevivência , Resultado do TratamentoRESUMO
CLINICAL PROBLEM: Diffuse liver diseases show an increasing prevalence. The diagnostic gold standard of liver biopsy has several disadvantages. There is a clinical demand for non-invasive imaging-based techniques to qualitatively and quantitatively evaluate the entire liver. STANDARD RADIOLOGICAL METHODS: Ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used. METHODICAL INNOVATIONS: Steatosis: chemical shift and frequency selective imaging, MR spectroscopy (MRS). Hemochromatosis: MR-based iron quantification. Fibrosis: MR elastography, diffusion, intravoxel incoherent motion (IVIM) and MR perfusion. PERFORMANCE/ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS: T1-weighted in and opposed phase imaging is the clinically most frequently used MR technique to noninvasively detect and quantify steatosis. New methods for quantification that are not influenced by confounders like iron overload are under investigation. The most sensitive method to measure the fat content of the liver is MRS. As data acquisition and analysis remain complex and there is no whole organ coverage, MRS of the liver is not a routine method. With an optimized protocol incorporating T2* sequences, MRI is the modality of choice to quantify iron overload in hemochromatosis. Standard MR sequences cannot depict early stages of liver fibrosis. Advanced MR techniques (e.g. elastography, diffusion, IVIM and perfusion) for noninvasive assessment of liver fibrosis appear promising but their role has to be further investigated.
Assuntos
Aumento da Imagem/métodos , Hepatopatias/patologia , Fígado/patologia , Imageamento por Ressonância Magnética/métodos , HumanosRESUMO
This article describes the architecture of a project aiming to implement a DIN EN ISO 9001 quality management system in a radiological department. It is intended to be a practical guide to demonstrate each step of the project leading to certification of the system. In a planning phase resources for the implementation of the project have to be identified and a quality management (QM) group as core team has to be formed. In the first project phase all available documents have to be checked and compiled in the QM manual. Moreover all relevant processes of the department have to be described in so-called process descriptions. In a second step responsibilities for the project are identified. Customer and employee surveys have to be carried out and a nonconformity management system has to be implemented. In this phase internal audits are also needed to check the new QM system, which is finally tested in the external certification audit with reference to its conformity with the standards.
Assuntos
Implementação de Plano de Saúde/organização & administração , Programas Nacionais de Saúde/legislação & jurisprudência , Serviço Hospitalar de Radiologia/organização & administração , Serviço Hospitalar de Radiologia/normas , Gestão da Qualidade Total/organização & administração , Certificação/legislação & jurisprudência , Certificação/normas , Documentação/normas , Alemanha , Implementação de Plano de Saúde/legislação & jurisprudência , Humanos , Licenciamento Hospitalar/normas , Serviço Hospitalar de Radiologia/legislação & jurisprudência , Design de Software , Gestão da Qualidade Total/legislação & jurisprudênciaRESUMO
Diffusion-weighted magnetic resonance imaging (DW-MRI) provides qualitative and quantitative information of tissue cellularity and the integrity of cellular membranes. Since DW-MRI can be performed without ionizing radiation exposure and contrast media application, DW-MRI is a particularly attractive tool for patients with allergies for gadolinium-based contrast agents or renal failure. Recent technical developments have made DW-MRI a robust and feasible technique for abdominal imaging. DW-MRI provides information on the detection and characterization of focal liver lesions and can also visualize treatment effects and early changes in chronic liver disease. In addition DW-MRI is a promising tool for the detection of inflammatory changes in patients with Crohn's disease.
Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças do Sistema Digestório/diagnóstico , Neoplasias do Sistema Digestório/diagnóstico , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Contagem de Células/métodos , Membrana Celular/patologia , Doença de Crohn/diagnóstico , Doença de Crohn/patologia , Diagnóstico Diferencial , Doenças do Sistema Digestório/terapia , Neoplasias do Sistema Digestório/terapia , Líquido Extracelular/metabolismo , Humanos , Líquido Intracelular/metabolismo , Fígado/patologia , Hepatopatias/diagnóstico , Hepatopatias/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapiaRESUMO
PURPOSE: The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. MATERIALS AND METHODS: This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. RESULTS: Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. CONCLUSION: Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.
RESUMO
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in the world. The majority of HCCs develops on the basis of a chronic liver disease. This often complicates diagnosis and therapy. Non-invasive diagnostic criteria are based on dynamic imaging techniques and the serum level of AFP (alpha-fetoprotein). When evaluating HCC patients for therapy, besides tumor burden and localisation, the therapeutic evaluation must also consider the general condition of the patient and his/her liver function. For this purpose, the BCLC algorithm of the Barcelona Clinic for Liver Disease has proven helpful. Only one-third of the patients can be cured by resection, transplantation or local tumour ablation. In locally advanced cases transarterial procedures including transarterial chemoembolisation and radioembolisation are applied. HCC is a chemo-resistant tumour and chemotherapy is not accepted as standard of care in HCC. Sorafenib is the first systemic treatment with proven efficacy approved for the treatment of advanced and metastatic HCC. Interdisciplinary management of HCC patients is essential in order to provide every patient with the optimal therapy at his specific stage of disease.
Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Equipe de Assistência ao Paciente , Ácido Acético/administração & dosagem , Antineoplásicos/uso terapêutico , Braquiterapia , Carcinoma Hepatocelular/diagnóstico , Ablação por Cateter , Quimioembolização Terapêutica , Terapia Combinada , Meios de Contraste/administração & dosagem , Etanol/administração & dosagem , Hepatectomia , Humanos , Aumento da Imagem , Injeções Intralesionais , Neoplasias Hepáticas/diagnóstico , Transplante de Fígado , Imageamento por Ressonância Magnética , Cuidados Paliativos/métodos , Guias de Prática Clínica como Assunto , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Acute intestinal inflammation is common. In most cases the medical history, clinical investigations and laboratory parameters alone are not sufficient for a conclusive diagnosis because of the wide variety of differential diagnoses and the striking similarity of symptoms. Modern imaging methods can help to clarify the diagnosis and multi-slice CT (MSCT) is highly useful in this diagnostic dilemma. It is widely available, employs standardized protocols, is cost-effective and can be performed within an acceptable examination time. MSCT enables the location and extension of the underlying pathology to be assessed and detection of complications which require immediate therapeutic intervention.
Assuntos
Abdome Agudo/diagnóstico , Abdome Agudo/terapia , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/tendências , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/terapia , Abdome Agudo/etiologia , Humanos , Doenças Inflamatórias Intestinais/complicaçõesRESUMO
The purpose of this study was to perform an economic evaluation of hepatocyte-specific Gd-EOB-DTPA enhanced MRI (PV-MRI) compared to extracellular contrast-media-enhanced MRI (ECCM-MRI) and three-phase-MDCT as initial modalities in the work-up of patients with metachronous colorectal liver metastases. The economic evaluation was performed with a decision-tree model designed to estimate all aggregated costs depending on the initial investigation. Probabilities on the need for further imaging to come to a treatment decision were collected through interviews with 13 pairs of each a radiologist and a liver surgeon in Germany, Italy and Sweden. The rate of further imaging needed was 8.6% after initial PV-MRI, 18.5% after ECCM-MRI and 23.5% after MDCT. Considering the cost of all diagnostic work-up, intra-operative treatment changes and unnecessary surgery, a strategy starting with PV-MRI with 959 Euro was cost-saving compared to ECCM-MRI (1,123 Euro) and MDCT (1,044 Euro) in Sweden. In Italy and Germany, PV-MRI was cost-saving compared to ECCM-MRI and had total costs similar to MDCT. In conclusion, our results indicate that PV-MRI can lead to cost savings by improving pre-operative planning and decreasing intra-operative changes. The higher cost of imaging with PV-MRI is offset in such a scenario by lower costs for additional imaging and less intra-operative changes.
Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/economia , Gadolínio DTPA/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias Hepáticas , Imageamento por Ressonância Magnética/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Neoplasias Colorretais/epidemiologia , Meios de Contraste/economia , Alemanha/epidemiologia , Humanos , Itália/epidemiologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/economia , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/secundário , Imageamento por Ressonância Magnética/estatística & dados numéricos , Suécia/epidemiologiaRESUMO
PURPOSE: To determine the value of MR enteroclysis (MRE) in the localization and characterization of primary carcinoid tumors of the small bowel and to describe typical imaging features. MATERIAL AND METHODS: Twenty patients with suspicion of primary small bowel carcinoid tumors (pCT) were recruited to undergo MRE following nasojejunal intubation and small bowel filling with 2.5 l of 0.5% methylcellulose solution under MR fluoroscopic guidance. MRE was performed on a 1.5 T MR scanner including T2w SSFSE, SSFP and contrast enhanced T1w GRE sequences with fat saturation. Fifteen patients, who subsequently had surgery for resection of their pCT, were retrospectively included in the study. All MRE were analyzed as for the presence, location, number, size, multiplicity and morphologic appearance of the pCT by two board certified radiologists in consensus. The conspicuity of the tumors was rated for each sequence type separately, according to a 4-point rating scale. Signal intensity measurements were performed in tumor and muscle. The presence of desmoplastic reaction, vascular involvement and lymph node metastases was also analyzed. RESULTS: pCT were correctly identified and localized in 14/15 patients. Due to their hyperenhancement tumors was best detected on contrast-enhanced T1w fat saturated GRE sequences. SSFSE was clearly inferior with the tumors being either hyperintense or isointense to muscle. pCT appeared as nodular intraluminal masses in 40% of the cases, as focal wall thickening in 33.3% and in 20% with both. Mean size was 25 (7-46 mm) with a tendency to smaller size for ileal tumors. MRE failed to depict superficial micronodular peritoneal spread in one patient. Desmoplastic reaction was observed in 73.3% of the cases with mesenteric masses exhibiting lower signal than the pCT due to fibrotic changes. CONCLUSION: MRE is a valuable method for the detection and localization of primary carcinoid tumors, provided that appropriate bowel distension is achieved. Various characteristic morphologic features could be identified which may contribute to characterize pCT and their loco-regional metastases.
Assuntos
Tumor Carcinoide/diagnóstico , Meios de Contraste/administração & dosagem , Processamento de Imagem Assistida por Computador , Neoplasias Intestinais/diagnóstico , Intestino Delgado , Imageamento por Ressonância Magnética , Metilcelulose/administração & dosagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Progressão da Doença , Feminino , Fluoroscopia , Gadolínio DTPA , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Intubação Gastrointestinal , Neoplasias do Jejuno/diagnóstico , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Prognóstico , Estudos RetrospectivosRESUMO
PURPOSE: To evaluate the safety of radioembolization (RE) with (90)Yttrium ((90)Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels. MATERIALS AND METHODS: Early and late toxicity after 566 RE procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group). RESULTS: Clinically relevant late toxicities (≥ Grade 3) were observed in 1% of our overall cohort. The no-coiling group had significantly less "any" (P = 0.0001) or "clinically relevant" (P = 0.0003) early toxicity. There was no significant difference (P > 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures. CONCLUSION: RE with (90)Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.
Assuntos
Braquiterapia/efeitos adversos , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Radioisótopos de Ítrio/uso terapêutico , Humanos , Fígado/efeitos da radiação , Microesferas , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To retrospectively evaluate the overall survival, safety, and efficacy of metastatic uveal melanoma patients after radioembolization as salvage therapy. MATERIALS AND METHODS: Thirteen patients were treated with radioembolization of branches of the hepatic artery with resin-based yttrium-90 ((90)Y)-labelled microspheres. Twelve patients underwent a single application, and 1 patient underwent 4 interventions. Dosages from 644 to 2,450 MBq (mean activity 1,780) were applied. Treatment response was evaluated by way of liver magnetic resonance imaging and computed tomography (CT) as well as whole-body fluorodeoxyglucose positron emission tomography (PET)/CT with evaluation of percentage changes in SUV(max) before and at 2-3 months after therapy. Kaplan-Meier analysis was calculated to determine overall survival. RESULTS: Partial remission (PR) was observed in 8 (62 %), stable disease (SD) in 2 (15 %), and progressive disease (PD) in 3 (23 %) patients under terms of standard criteria and PR in 3 (23 %), SD in 3 (23 %), and PD in 7 (54 %) patients according to PET criteria. Neither RECIST nor PET criteria showed a significant difference in predicting overall survival (P = 0.12 and 0.11, respectively). Median survival time after radioembolization was 7 months. No acute toxicity with in-hospital morbidity was observed. One patient developed hepatomegaly, and 1 patient developed gastric ulceration. Throughout follow-up, progression of extrahepatic metastases was observed. CONCLUSION: Radioembolization may be a promising therapy in uveal melanoma patients with predominant hepatic metastases. At first follow-up, we observed PR or SD in 77 % patients under terms of standard criteria with an acceptable toxicity profile.
Assuntos
Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Neoplasias Hepáticas/secundário , Melanoma/secundário , Radioisótopos de Ítrio/uso terapêutico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Imageamento por Ressonância Magnética/métodos , Masculino , Melanoma/mortalidade , Melanoma/terapia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons/métodos , Dosagem Radioterapêutica , Estudos Retrospectivos , Medição de Risco , Terapia de Salvação/métodos , Fatores Sexuais , Análise de Sobrevida , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Neoplasias Uveais/mortalidade , Neoplasias Uveais/patologia , Neoplasias Uveais/terapiaRESUMO
Renal cell cancer is the most frequently encountered malignant tumor of the kidney. The modern imaging techniques computed tomography (CT) and magnetic resonance imaging (MRI) play a vital role in the diagnostic work-up of renal masses. Contrast-enhanced ultrasound (CEUS) is able to visualize subtle enhancement in hypovascular tumors with high sensitivity. Recent advances in multidetector CT (MDCT) enable high resolution imaging of local findings. CT is able to provide large volume coverage of the chest and abdomen within seconds for the assessment of lymph node and distant metastasis staging. Local renal cell cancer staging can be achieved with similar diagnostic accuracy using CT or MRI. Both modalities allow visualization of a tumor's relationship to the renal collecting system and pelvis, the renal artery and veins including the IVC. It is the radiologist's task to accurately detect and stage renal malignances in order that each individual patient receives the therapy best suited to them.
Assuntos
Carcinoma de Células Renais/diagnóstico , Aumento da Imagem/métodos , Neoplasias Renais/diagnóstico , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/tendências , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , HumanosRESUMO
OBJECTIVE: The aim of this study was to describe the imaging findings for inflammatory pseudotumors in patients with chronic pancreatitis as detected in computed tomography (CT). MATERIALS AND METHODS: In this retrospective study 20 patients with chronic pancreatitis were included, who underwent an abdominal CT scan. In all patients the diagnosis was confirmed by surgery and histopathology. Imaging findings which have previously been described as typical for chronic pancreatitis and for inflammatory pseudotumors were assessed by two radiologists in consensus. Values of tissue density (HU) at CT were measured within the lesions and in the surrounding pancreatic tissue. RESULTS: In 90% of patients with histologically proven chronic pancreatitis, CT showed corresponding indicative findings. In 10 patients the resected specimen revealed an inflammatory pseudotumor, which was located in all cases within the pancreatic head. Using CT these 10 patients presented with calcifications within the lesion in 50% of the cases, an irregular dilatation of the main pancreatic duct in 90%, a "double duct sign" in 70%, an interrupted main pancreatic duct in the area of the lesion in 50%, a "duct penetrating sign" in 30%, an infiltration of adjacent structures in 10% and pathologically enlarged lymph nodes in 100% of the cases. In the venous contrasting phase six tumors were hypodense and four isodense compared to the surrounding pancreatic tissue. In six patients biphasic CT was performed and the mean difference in attenuation between inflammatory pseudotumors and surrounding parenchyma was significantly higher in the pancreatic phase than in the venous phase. DISCUSSION: Differentiation between inflammatory pseudotumors and adenocarcinoma remains difficult or even impossible. Typical signs indicative of an adenocarcinoma of the pancreatic head, such as dilatation of the common bile duct and/or the main pancreatic duct as well as enlarged lymph nodes, were also found in patients with inflammatory pseudotumors. Inflammatory pseudotumors showed low contrast between lesions and parenchyma in the venous phase and calcifications within the solid part of the tumor.