CT-guided percutaneous lung biopsy: comparison of conventional CT fluoroscopy to CT fluoroscopy with electromagnetic navigation system in 60 consecutive patients

Purpose

To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm.

Materials/methods

86 consecutive patients with small lung masses (<2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below.

Results

Average fluoroscopy time using CTF was 28.2 s compared to 35.0 s for EMN (p = 0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p = 0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p = 0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p = 0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p = 0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p = 0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p = 0.4).

Conclusions

EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.     

Carbon fibre and nitinol needles for MRI-guided interventions: First in vitro and in vivo application

Objective

To assess the artefact properties of a MR-compatible carbon fibre needle with a nitinol mandrin in vitro and to report first clinical experiences.

Materials and methods

In vitro, the carbon fibre/nitinol needle was imaged at different angles against the main magnetic field (1.5 T open bore magnet). A gradient echo MR fluoroscopy sequence (GRE: TR 9.3 ms, TE 3.12 ms, bandwidth 200 Hz/pixel, flip-angle 12°) and a fast turbo spin echo sequence (FSE: TR 412 ms, TE 9.7 ms, bandwidth 200 Hz/pixel, flip-angle 150°) were used. Artefact width, needle intensity contrast and needle tip location errors were assessed. In vivo, lumbar periradicular corticosteroid injections and one sclerotherapy were performed with carbon fibre needles (10 procedures) and with titanium alloy needles (2 procedures). The artefact sizes and contrasts were measured.

Results

In vitro, artefact diameters of the carbon fibre needle ranged from 3.3 to 4.6 mm, contrasts from 0.11 to 0.52, with larger artefact contrasts and widths with the GRE sequence. Needle tip location errors of −2.1 to −2.8 mm were observed. Decreasing angles to the main field lead to smaller artefacts. In vivo, the carbon fibre/nitinol needle produced smaller artefacts (mean width FSE/GRE: 2.8 mm/4.6 mm) with lower contrast (0.30-0.42) than the titanium alloy needle (mean width FSE/GRE: 4.1 mm/7.5 mm, contrast 0.60-0.73).

Conclusions

The carbon fibre/nitinol needle is useful for performing MR-guided interventions at 1.5 T, producing more subtle artefacts than a titanium alloy needle, but with an incomplete depiction and thus inaccurate localization of the needle tip.     

First clinical use of a standardized three-dimensional ultrasound for breast imaging

Objectives

The feasibility, image quality, and diagnostic potential of the prototype of an automated ultrasound (US) breast scanner were examined.

Methods

Ninety-seven patients with suspicious breast lesions had mammograms, manual US, and an automated breast US. The data were evaluated according to the breast imaging reporting and data system (BIRADS) classification, image quality, and amount to diagnostic information. All lesions were confirmed histological.

Results

The image quality of the three-dimensional (3D) data sets was equal to or satisfactory compared with cross-sectional images from manual US in at least 72% of cases (p < 0.05). The diagnostic information was equal or superior in at least 63% of cases (p < 0.05).

Conclusions

Standardized 3D US scanning is a promising diagnostic adjunct to mammography, but is no substitute for manual US at the current stage of development.     

Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions

Objective

The diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity (GGO) pulmonary lesions was evaluated.

Materials and methods

Out of 90 patients who underwent CT fluoroscopy-guided core needle biopsy of GGO lesions at our institution, the biopsy results and the final diagnoses were retrospectively compared in 67 patients with available data (one lesion per patient). Diagnostic performance was also compared according to the lesion size (≤10 mm (n = 8) versus 11-20 mm (n = 42) versus >20 mm (n = 17)), the percentage of GGO component (50-90% (n = 31) versus >90% (n = 36)), and the length of needle path (≤7 cm (n = 45) versus >7 cm (n = 22)). Finally, all 90 cases were reviewed for complications.

Results

The overall sensitivity, specificity, and accuracy were 97%, 100%, and 97%, respectively. The diagnostic sensitivity and accuracy tended to be lower in smaller lesions (≤10 mm; 86 and 88%, 11-20 mm; 97 and 98%, >20 mm; 100 and 100%, respectively, p > 0.05), and in lesions with lower percentage of GGO component (50-90%; 93 and 94%, >90%; 100 and 100%, respectively, p = 0.21), but statistical significances were not reached. The sensitivity and accuracy were not significantly affected by the length of needle path (≤7 cm; 98 and 98%, >7 cm; 95 and 96%, respectively, p = 1.00). Fourteen patients (16%) developed pneumothoraces, and 13 patients (14%) experienced mild hemoptysis, all of which resolved conservatively.

Conclusion

The diagnostic performance was satisfactory, and it was considered that the procedure was appropriate for GGO lesions regardless of lesion size, the percentage of GGO component, or the length of needle path. The procedure was also feasible without any major complications.     

US-guided interventional joint procedures in patients with rheumatic diseases—When and how we do it?

Objective

To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness.

Materials and methods

27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n = 11) had rheumatoid arthritis, 11% (n = 3) spondyloarthropathies, 18% (n = 5) psoriatic arthritis, 15% (n = 4) undifferentiated arthritis, 3% (n = 1) Sjögren syndrome and 11% (n = 3) had gout.Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists.Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy.

Results

In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period.

Conclusions

US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.     

Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

Purpose

To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions.

Materials and methods

Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique.

Results

A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver.

Conclusion

Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.     

A novel method for accurate needle-tip identification in trans-rectal ultrasound-based high-dose-rate prostate brachytherapy

Purpose

In real-time trans-rectal ultrasound (TRUS)-based high-dose-rate prostate brachytherapy, the accurate identification of needle-tip position is critical for treatment planning and delivery. Currently, needle-tip identification on ultrasound images can be subject to large uncertainty and errors because of ultrasound image quality and imaging artifacts. To address this problem, we developed a method based on physical measurements with simple and practical implementation to improve the accuracy and robustness of needle-tip identification.

Methods and Materials

Our method uses measurements of the residual needle length and an off-line pre-established coordinate transformation factor, to calculate the needle-tip position on the TRUS images. The transformation factor was established through a one-time systematic set of measurements of the probe and template holder positions, applicable to all patients. To compare the accuracy and robustness of the proposed method and the conventional method (ultrasound detection), based on the gold-standard X-ray fluoroscopy, extensive measurements were conducted in water and gel phantoms.

Results

In water phantom, our method showed an average tip-detection accuracy of 0.7 mm compared with 1.6 mm of the conventional method. In gel phantom (more realistic and tissue-like), our method maintained its level of accuracy while the uncertainty of the conventional method was 3.4 mm on average with maximum values of over 10 mm because of imaging artifacts.

Conclusions

A novel method based on simple physical measurements was developed to accurately detect the needle-tip position for TRUS-based high-dose-rate prostate brachytherapy. The method demonstrated much improved accuracy and robustness over the conventional method.     

Accelerated partial breast irradiation via brachytherapy: a patterns-of-care analysis with ASTRO consensus statement groupings

Purpose

The 2002 Food and Drug Administration approval of the MammoSite catheter (Hologic, Inc., Beford, MA) led to a surge of interest in accelerated partial breast irradiation (APBI). Until recently, guidelines as to the optimal candidates for this treatment were unavailable. We performed a patterns-of-care analysis for patients undergoing breast brachytherapy and compared these results with the American Society for Radiation Oncology (ASTRO) consensus statement.

Methods and Materials

The Surveillance, Epidemiology, and End Results database was used to examine female breast cancer patients treated with brachytherapy between 2002 and 2007. The patients were then categorized into suitable, cautionary, and unsuitable groups based on the ASTRO guidelines.

Results

We identified 4172 female breast cancer patients treated within the stated years. The number of brachytherapy cases increased nearly 10-fold over the time period studied from 163 in 2002 to 1427 in 2007 (p < 0.0001). Patients with data missing were excluded, leaving a total of 3593 patients available for analysis. The mean patient age was 64 years. Most patients had small (<2 cm in 80.9%) estrogen receptor-positive (86.7%) invasive (88.6%) tumors. The percentage of patients treated for ductal carcinoma in situ increased with time (p < 0.001), whereas the percentage of patients treated with positive lymph nodes decreased with time (p < 0.001). Using the data available, 1369 (38.1%), 1563 (43.5%), and 661 (18.3%) patients were characterized as suitable, cautionary, and unsuitable, respectively.

Conclusions

More than 60% of patients who received APBI via brachytherapy would fall into the ASTRO cautionary or unsuitable groupings. This is the largest patterns-of-care analysis for APBI patients and serves as a baseline for future comparison.     

Ultrasound guided single injection technique for infraclavicular block in arterio-venous shunt

Purpose

To evaluate the efficacy and safety of ultrasound technology for infraclavicular brachial plexus block in chronic renal failure patients undergoing arterio-venous shunt operations.

Material and methods

Our study included 40 patients with fulfilled clinical criteria of chronic renal failure. All patients (32 RT and 8 LT sided) were subjected to infraclavicular block using ultrasound visualization with 7.5-10 MHz linear probe. The anesthetic mixture consisted of 20 ml lidocain hydrocarbonate 2% and 20 ml of plain bupivacaine 0.5%. Sensory block, motor block and supplementation rate were evaluated for the musculocutaneous, median, radial and ulnar nerves.

Results

Surgical anesthesia was achieved without supplementation in 38 patients (95%) and 2 patients needed supplementation with infiltration anesthesia (5%). No patient in the study needed general anesthesia. Duration of surgery, administration, onset and complete blocks in minutes were (165 ± 11.7, 11 ± 4.5, 4.5 ± 1.5 and 8.5 ± 3.4), respectively. No vascular injury was reported in this study.

Conclusion

We concluded that real-time ultrasound imaging during infraclavicular brachial plexus blocks can facilitate nerve localization, needle placement and provide high success rate. Also it improves safety for ICBPB.     

Urine sensor device for fluoroscopy time reduction in pediatric voiding cystourethrography

Purpose

We evaluated the feasibility of a using urine sensor for voiding cystourethrography (VCUG) and its implications for fluoroscopy time reduction.

Materials and methods

Institutional Review Board approved the study protocol. Study population included children less than 5 years old referred to our institution for VCUG. Patients with known vesicoureteral reflux or any pacing device were excluded from the study. The urine sensor consists of an electrode that senses the fluid, an electrical circuit and an indicator to provide visual signal. The urine sensor electrode was placed on the medial thigh in the proximity of the catheter close to the urethral opening, but without direct contact to it. A standard VCUG examination was performed with retrograde filling of the urinary bladder. Once the bladder was full, fluoroscopy of the voiding stage was initiated when the indicator blinked. Peak kV and fluoroscopy time were recorded.

Results

Seven patients underwent VCUG with urine sensor and 22 patients without urine sensor. The urine sensor provided a reliable indication of voiding onset. The fluoroscopy time was significantly shorter with urine sensor use (1.99 min) than without urine sensor use (4.33 min) (p = 0.001). In patients with normal VCUG, fluoroscopy time was also significantly shorter with urine sensor use (2.13 min) than without urine sensor use (4.39 min) (p < 0.001).

Conclusion

VCUG studies with the help of the urine sensor are feasible and its use may result in significant reduction in fluoroscopy time.     

Percutaneous needle aspiration biopsy (PCNAB) of lung lesions: 5 years results with focusing on repeat PCNAB

Purpose

To evaluate 5 years results of percutaneous needle aspiration biopsy (PCNAB) for lung lesions and usefulness of the reaspiration or rebiopsy of lung lesions (repeat PCNAB).

Materials and methods

Six hundred and fifteen cases of PCNAB (591 initial PCNAB and 24 repeat PCNAB) performed under the CT or fluoroscopy guidance in 591 patients was enrolled. The procedure was done using an automated biopsy gun with a 20-G needle (519 cases) or a 20-G aspiration needle (96 cases). The pathologic results, type and rate of complications in the initial and repeat PCNAB were evaluated. The pathologic agreement rate between the initial and repeat PCNAB, and reasons of the repeat PCNAB were also evaluated.

Results

Of the 615 PCNAB cases, 345 cases yielded tumors and 270 cases yielded non-tumorous lesions. Of the tumorous lesions, 307 cases were primary lung malignancies, 34 cases were metastases, and 4 were benign tumors. The repeat PCNAB rate was 4.1% (24/591). There was no statistically significant difference between automated gun biopsy and needle aspiration as a biopsy tool for calling repeat PCNAB (p = 0.4034). The causes for a repeat PCNAB were inconclusive (n = 14) and unexpected pathologic results (n = 10). Of the 14 pathologically inconclusive cases on initial PCNAB, 9 cases revealed malignancy after the repeat PCNAB. Of the 10 cases with unexpected pathologic results on initial PCNAB, 3 cases yielded different pathologic results on repeat PCNAB from initial PCNAB. The cumulative complication rate of PCNAB was 11.4% (70/615).

Conclusion

PCNAB was useful for the diagnosis of pulmonary lesions. Repeat PCNAB might be helpful for the exact diagnosis of lung lesions where initial PCNAB yields inconclusive or unexpected pathologic results.     

Percutaneous CT-guided biopsy of the musculoskeletal system: Results of 2027 cases

Introduction

Biopsy of the musculoskeletal system is useful in the management of bone lesions particularly in oncology but they are often challenging procedures with a significant risk of complications. Computed tomography (CT)-guided needle biopsies may decrease these risks but doubts still exist about their diagnostic accuracy. This retrospective analysis of the experience of a single institution with percutaneous CT-guided biopsy of musculoskeletal lesions evaluates the results of these biopsies for bone lesions either in the appendicular skeleton or in the spine, and defines indications.

Materials and methods

We reviewed the results of 2027 core needle biopsies performed over the past 18 years at the authors’ institution. The results obtained are subject of this paper.

Results

In 1567 cases the correct diagnosis was made with the first CT-guided needle biopsy (77.3% accuracy rate), in 408 cases the sample was not diagnostic and in 52 inadequate. Within 30 days these 408 patients underwent another biopsy, which was diagnostic in 340 cases with a final diagnostic accuracy of 94%. Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, flogistic, and systemic pathologies. There were 22 complications (18 transient paresis, 3 haematomas, 1 retroperitoneal haematoma) which had no influence on the treatment strategy, nor on patient outcome.

Conclusion

This technique is reliable and safe and should be considered nowadays the gold standard for biopsies of the musculoskeletal system.     

Patient dose during interventional neuroradiology procedures: Results from a multi-center study

Purpose

The purpose of this multicenter study was to determine the doses received by patients during interventional neuroradiology procedures and to consider establishing reference standards.

Materials and methods

A retrospective study of nine interventional neuroradiology departments was conducted. Seven diagnostic (cerebral and spinal angiography) and therapeutic (embolization and vertebroplasty) procedures were reviewed. For each procedure, three dosimetric parameters were recorded: dose-area product (DAP), fluoroscopy time, and number of images.

Results

Results showed interdepartment variations, up to four-fold for diagnostic procedures and seven-fold for therapeutic procedures. However, applying the 75th percentile method to the entire dataset, reference standards can be proposed for six types of procedures including diagnostic cerebral angiography (230 Gy cm²), follow-up selective cerebral angiography (80 Gy cm²), aneurysm embolization (350 Gy cm²), AVM embolization (440 Gy cm²). Reference standards are also proposed with regards to fluoroscopy time and number of images.

Conclusion

Such standards are useful for clinicians to evaluate and improve their practices.     

Radiofrequency ablation in the treatment of osteoid osteoma—5-year experience

Purpose

This study aimed to determine the success and complication rates of radiofrequency ablation (RFA) in treatment of osteoid osteoma (OO) and duration of pain relief. Furthermore value of bone biopsy prior to the RFA was evaluated.

Materials and methods

Within 61 months 39 patients (23 male, 16 female, 7-53 years, mean 18.7 years, median 17 years) suffering from osteoid osteoma were treated. Lesions were located in femur (n = 20), tibia (n = 10), spine (n = 5), humerus (n = 1), radius (n = 1), talus (n = 1) and pelvis (n = 1). In children, RFA was performed under general anaesthesia, in adults conscious sedation was preferred. In 29 of 39 (74%) lesion biopsies were obtained. Cooling of skin was performed in OOs located in bones with minor soft tissue covering (tibia, radius) and saline flushing via an additional needle was performed if the OO was adjacent to nerval structures. Primary success rate, complications, symptom-free interval, follow-up and biopsy results were evaluated.

Results

Within observation period (1-61 months; median: 32 months) 38 of 39 patients were successfully treated and had no more complaints. In 3 of 38 patients relapse occurred after 1, 14 and 32 months and RFA was repeated. Two major complications (broken drill, infection) and 2 minor complications (hematoma, prolonged pain) were observed. Biopsy was able to prove diagnosis in 14 of 29 (48%) cases.

Conclusions

Biopsy prior to treatment is not mandatory due to a remarkable amount of false negative findings in clinically and morphologically unambiguous cases of OO. RFA is a highly effective, efficient, minimally invasive and safe method for the treatment of OO.     

Multidetector helical CT in the evaluation of acute small bowel obstruction: comparison of non-enhanced (no oral, rectal or IV contrast) and IV enhanced CT

Purpose

To compare accuracy of non-enhanced CT (NECT) (no oral or IV contrast) and enhanced CT (ECT) (IV enhanced only) to diagnose small bowel obstruction and evaluate reviewer's experience impact.

Materials and methods

Ninety-nine adult patients underwent 105 NECT and ECT (6 patients had 2 examinations) on a four-detector CT. An abdominal radiologist, an abdominal imaging fellow, a second-year radiology resident retrospectively reviewed NECTs and ECTs separately and independently blinded to outcome. Discrepancy of diameter of proximal and distal small bowel ± a transition was considered indication of mechanical bowel obstruction. Reference standard was surgery in 26 and chart review in 79.

Results

Mechanical obstruction was present in 56% (59/105). The average sensitivity, specificity, negative and positive predictive and accuracy values for NECT were 88.1% (CI: 80-96%), 77% (CI: 65-89%), 83.0% (CI: 72-95%), 83% (CI: 74-92%), and 83% (CI: 76-90%) with no significant difference between three reviewers. The corresponding numbers for ECT were 87.6% (CI: 79-96%), 75% (CI: 63-88%), 82.6.0% (CI: 71-94%), 82.1% (CI: 73-92%), and 82% (CI: 75-90%) (p > 0.5). Area under curve (AUC) of ROC curves of three reviewers did not show significant statistical difference (p > 0.5).

Conclusions

NECT and ECT have comparable accuracy to diagnose mechanical small bowel obstruction and can be interpreted by reviewers with different levels of expertise.     

Osteoid osteoma in atypical locations: the added value of dynamic gadolinium-enhanced MR imaging

Purpose

To compare the results of dynamic gadolinium-enhanced magnetic resonance imaging (MRI), unenhanced MRI and computed tomography (CT), in terms of nidus conspicuity and diagnostic confidence of osteoid osteoma in atypical sites.

Materials and methods

CT and MR (nonenhanced T1- and T2-weighted and dynamic MRI) images of 19 patients with histologically proven osteoid osteoma located in atypical sites were retrospectively reviewed. Time-enhancement curves of the nidus and the adjacent bone marrow were generated. Images from each technique were scored for nidus conspicuity by two independent radiologists. Another blinded radiologist was asked to assess final diagnosis of the bone lesion on MR and CT images, independently.

Results

In all cases, nidus contrast uptake started in the arterial phase and was higher compared to the surrounding bone marrow. Dynamic MRI significantly increased nidus conspicuity compared to nonenhanced MRI (P < .0001) and CT (P = .04). In 6/19 (31.6%) cases nidus conspicuity was higher at dynamic MRI compared to CT. Confident diagnosis of osteoid osteoma was achieved in all patients with MRI and in 10/19 (52.6%) patients with CT.

Conclusion

In patients with osteoid osteoma located in atypical sites, dynamic MRI increases nidus conspicuity, allowing confident diagnosis.     

The outcome of partial splenic embolization for hypersplenism in the cirrhotic patients

Background

Although partial splenic embolization (PSE) has been widely used for treatment of leucocytopaenia and thrombocytopaenia in cirrhosis, only few studies evaluate both benefits and complications of it.

Objective

To evaluate outcome of partial splenic embolization benefits on both platelet and leukocytes counts and its complications in treatment of cirrhotic patients.

Patients and methods

Cirrhotic patients with hypersplenism-induced thrombo-cytopenia underwent partial splenic embolization (PSE). From All patients complete history and full clinical examination were taken and subjected to Laboratory investigations. After PSE was performed, the precise extent of embolization was calculated on CT examinations 2 weeks after PSE. Prophylactic antibiotics was given for 5 days after PSE. All patients were then followed up at the outpatient clinic. Peripheral blood cell parameters including white blood cell (WBC), platelet (PLT) and red blood cell (RBC) counts were monitored prior to PSE, on the 3rd, 14th, 30th day after PSE, and subsequently at 3-month intervals during the 2-year follow-up period. The complications associated with PSE were appropriately recorded. All patients underwent abdominal CT scanning before and 2 weeks after PSE.

Results

Twenty three patients were included in this study. 13 (57%) males and 10 (43%) females with mean age 42.37 years. PSE was successfully performed in all 23 patients. Post-embolization syndrome 91.3% (21/23) was the most frequent side effect. Other minor complications as puncture site hematoma occurred to one patient at site of femoral artery. Severe complications occurred in eight patients (34.8%). two patients had a large amount of pleural effusion and ascites. One patients developed bacterial peritonitis and died of septicemia. One patient complicated by splenic abscess. One patient had recurrent thrombo-cytopenia and treated by PSE. Portal vein thrombosis was found in one patient. One patient presented with huge splenomegaly and improved after splenectomy. Post-PSE, the platelets and leukocytes counts showed increase in the number. Best results obtained with larger splenic infarction area but in the expense of more major complications.

Statistical analysis

Blood parameters were compared using paired t test. P < 0.05 means significant differences.

Conclusion

PSE is a useful treatment in patients with hypersplenism caused by cirrhosis. PSE is safe in advanced disease patients, not suitable for splenectomy, with good long-term effect on the hematological parameters and a reduction in bleeding episodes from esophageal varices.     

Evaluation of stereotactic core biopsies of the breast with the 10-gauge Vacora® biopsy device: a review of 541 procedures

Purpose

To evaluate stereotactic core biopsies of the breast with the 10-gauge Vacora^® biopsy device.

Patients and methods

Retrospective study of 541 procedures in 502 patients performed between 2007 and 2009.

Results

The procedure failed in 2 % of cases, non-complicated hematomas occurred in 5 % of cases and unsightly scars in two cases. A clip was deployed in 70 % of cases, successfully in 99 % of cases. The procedure was well tolerated in 88 % of cases. Core biopsies confirmed a benign lesion in 55 % of cases, borderline lesions in 19 % of cases and malignant lesions in 26 % of cases with complementary surgery performed in 40 % of cases. For surgical lesions, sensitivity, specificity, PPV and NPV were 89 %, 100 %, 100 % and 84 % respectively. Atypical ductal dysplasia was under-estimated in 8 % of cases while DCIS was under-estimated in 14 % of cases. After review of the mammograms, 3 % of Bi-Rads 4 lesions were reclassified as Bi-Rads 3 lesions, all benign at core biopsy. Half of these results were from screening mammography programs.

Conclusion

Results with the 10-gauge Vacora^® biopsy device are similar to reports from the literature, mainly using the Mammotome system, with regards to tolerability and reliability for a lesser cost.     

The influence of liquid crystal display monitors on observer performance for the detection of interstitial lung markings on both storage phosphor and flat-panel-detector chest radiography

Purpose

To compare observer performance with a flat-panel liquid crystal display (LCD) monitor and with a high-resolution gray-scale cathode ray tube (CRT) monitor in the detection of interstitial lung markings using a silicon flat-panel-detector direct radiography (DR) and storage phosphor computed radiography (CR) in a clinical setting.

Materials and methods

We displayed 39 sets of posteroanterior chest radiographs from the patients who were suspected of interstitial lung disease. Each sets consisted of DR, CR and thin-section CT as the reference standard. Image identities were masked, randomly sorted, and displayed on both five mega pixel (2048 × 2560 × 8 bits) LCD and CRT monitors. Ten radiologists independently rated their confidence in detection for the presence of linear opacities in the four fields of the lungs; right upper, left upper, right lower, and left lower quadrant. Performance of a total 6240 (39 sets × 2 detector systems × 2 monitor system × 4 fields × 10 observers) observations was analyzed by multi-reader multi-case receiver operating characteristic (ROC) analysis. Differences between monitor systems in combinations of detector systems were compared using ANOVA and paired-samples t-test.

Results

Area under curves (AUC) for the presence of linear opacities measured by ROC analysis was higher on the LCDs than CRTs without statistical significance (p = 0.082). AUC was significantly higher on the DR systems than CR systems (p = 0.006). AUC was significantly higher on the LCDs than CRTs for DR systems (p = 0.039) but not different for CR systems (p = 0.301).

Conclusion

In clinical conditions, performance of the LCD monitor appears to be better for detecting interstitial lung markings when interfaced with DR systems.     

Radiofrequency ablation of large size liver tumours using novel plan-parallel expandable bipolar electrodes: Initial clinical experience

Purpose

Although radiofrequency ablation (RFA) is a promising method for local treatment of liver malignancies, with conventional monopolar systems recurrence rates for large size tumours (≥3.5 cm) remain high. The objective of this study was to evaluate the safety, feasibility and local effectiveness of a novel bipolar plan-parallel expandable system for these larger tumours.

Methods and materials

Eight consecutive patients with either unresectable colorectal liver metastases (CRLM in 6 patients), carcinoid liver metastases (1 patient) and hepatocellular carcinoma (HCC in 1 patient) of ≥3.5 cm were treated with bipolar RFA during laparotomy with ultrasound guidance. Early and late, major and minor complications were recorded. Local success was determined on 3-8 month follow-up CT scans of the upper abdomen.

Results

Nine CRLM, one carcinoid liver metastases and one HCC (3.5-6.6 cm) were ablated with bipolar RFA. Average ablation time was 16 min (range 6-29 min.). Two patients developed a liver abscess which required re-laparotomy. In both cases bowel surgery during the same session probably caused bacterial spill. There were no mortalities. The patients were released from hospital between 5 and 29 days after the procedure (median 12 days). The 6-12 month follow-up PET-CT scans showed signs for marginal RFA-site tumour recurrence in three patients with CRLM (3/11 lesions).

Conclusion

Preliminary results suggest bipolar RFA to be a reasonably safe, fast and feasible technique which seems to improve local control for large size hepatic tumour ablations.