Safety of Chemotherapeutic Infusion or Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Cystic Artery

Purpose

This study was designed to evaluate the safety of chemotherapeutic infusion or chemoembolization by way of the cystic artery in patients with hepatocellular carcinoma (HCC) supplied exclusively by the cystic artery.

Methods

Between Jan 2002 and Dec 2011, we performed chemotherapeutic infusion or chemoembolization using iodized oil for the treatment of 27 patients with HCC supplied exclusively by the cystic artery. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus.

Results

The cystic artery originated from the main right hepatic artery in 24 (89 %) patients, from the right anterior hepatic artery in 2 (7 %) patients, and from the left hepatic artery in 1 (4 %) patient. Selective catheterization of the cystic artery was achieved in all patients. Superselection of tumor-feeding vessels from the cystic artery was achieved in 7 patients (26 %). Chemotherapeutic infusion was performed in 18 patients (67 %), and chemoembolization was performed in 9 patients (33 %). There were no major complications and only 2 minor complications, including vasovagal syncope and nausea with vomiting. Individual tumor response supplied exclusively by the cystic artery at the follow-up enhanced CT scan were complete response (n = 16), partial response (n = 3), and stable disease (n = 8).

Conclusion

HCC supplied exclusively by the cystic artery can be safely treated without severe complications by chemotherapeutic infusion or chemoembolization using iodized oil through the cystic artery.     

Clinical features of hepatocellular carcinoma supplied by the left internal mammary artery

Purpose

To evaluate the clinical features of hepatocellular carcinoma (HCC) supplied by the left internal mammary artery (LIMA).

Materials and methods

This cohort included 12 HCCs of 12 patients supplied by the LIMA. The clinical features of these tumors were analyzed.

Results

The tumor diameters were 4.2 ± 4.4 cm (mean ± SD) located at the surface of segments 4 (n = 6), 3 (n = 3), 2 (n = 2), and 4–8 (n = 1), respectively. The tumor was supplied by the phrenic branch (n = 8) or musclophrenic artery (n = 4) entirely (n = 7) or partially (n = 5). Two patients with large tumors 10 and 16 cm in diameter, respectively, received no previous treatment. Ten patients had previously undergone 5.8 ± 3.7 TACE sessions including through extrahepatic collaterals. Selective TACE could not be completed in one. No TACE-related complications developed. Of 11 embolized tumors, six did not recur at 8.8 ± 4.6 months and five recurred 4.4 ± 2.6 months later.

Conclusion

The clinical features of HCC supplied by the LIMA can be divided into two categories, untreated large tumors and small tumors receiving multiple TACE sessions at the subcapsular area of the left hepatic lobe.     

Ablative zone size created by radiofrequency ablation with and without chemoembolization in small hepatocellular carcinomas

Purpose

We retrospectively evaluated whether combined use of chemoembolization expands ablative zone sizes created by radiofrequency (RF) ablation in patients with small hepatocellular carcinomas (HCCs).

Materials and methods

Fifty-seven patients treated with single RF ablation for solitary HCC measuring ??2?cm were assessed. RF ablation alone was done in nine patients and in 48 patients following chemoembolization, with an interval of 0?days in 6, 1?C14?days in 27, 15?C28?days in 6, and ??4?weeks in 9. Ablative zone sizes, disappearance of tumor enhancement, and creation of sufficient ablative margins (>5?mm) were evaluated on contrast-enhanced computed tomography (CT) images.

Results

Both mean long-axis (4.2?C4.7 vs. 3.6?±?0.4?cm, p?p?p?Conclusion Ablative zones created by RF ablation with chemoembolization become larger than RF ablation alone, leading to secure ablative margins.     

Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

Purpose

We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural ¹⁸?F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging.

Methods

From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7–15.9 cm; SD, 2.9 cm) in bones (n?=?33), liver (n?=?26), soft tissues (n?=?18), lung (n?=?15) and abdomen (n?=?14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed.

Results

Biopsies were positive for malignancy in 76 cases (71.7 %, 76/106) and for benign tissue in 30 cases (28.3 %, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3 %, 100/106) requiring no further exploration, and for the six others (5.7 %, 6/106) benign diagnoses were confirmed after surgery (n?=?4) or follow-up (n?=?2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100 %. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV?>?4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7 %, 4/106).

Conclusion

Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions.     

Lung Radiofrequency Ablation for the Treatment of Unresectable Recurrent Non-Small-Cell Lung Cancer After Surgical Intervention

Purpose

A retrospective evaluation was done of clinical utility of lung radiofrequency (RF) ablation in recurrent non-small-cell lung cancer (NSCLC) after surgical intervention.

Methods

During May 2003 to October 2010, 44 consecutive patients (26 male and 18 female) received curative lung RF ablation for 51 recurrent NSCLC (mean diameter 1.7?±?0.9?cm, range 0.6 to 4.0) after surgical intervention. Safety, tumor progression rate, overall survival, and recurrence-free survival were evaluated. Prognostic factors were evaluated in multivariate analysis.

Results

A total of 55 lung RF sessions were performed. Pneumothorax requiring pluerosclerosis (n?=?2) and surgical suture (n?=?1) were the only grade 3 or 4 adverse events (5.5%, 3 of 55). During mean follow-up of 28.6?±?20.3?months (range 1 to 98), local tumor progression was found in 5 patients (11.4%, 5 of 44). The 1-, 3-, and 5-year overall survival rates were 97.7, 72.9, and 55.7%, respectively. The 1- and 3-year recurrence-free survival rates were 76.7 and 41.1%, respectively. Tumor size and sex were independent significant prognostic factors in multivariate analysis. The 5-year survival rates were 73.3% in 18 women and 60.5% in 38 patients who had small tumors measuring ??3?cm.

Conclusion

Our results suggest that lung RF ablation is a safe and useful therapeutic option for obtaining long-term survival in treated patients.     

Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial

Purpose

This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy.

Methods

Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n?=?81) or UAE (n?=?82). Endpoints at 1?year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention.

Results

UAE patients had shorter hospitalization (2 vs. 6?days, p?significant and equal improvements in QoL scores had occurred in both groups (myomectomy n?=?59; UAE n?=?61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not significant). By 2?years, among UAE patients (n?=?57) there were eight (14.0%) reinterventions for inadequate symptom control compared with one (2.7%) among myomectomy patients (n?=?37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US.

Conclusions

UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.     

Stereotactic Radiofrequency Ablation (SRFA) of Liver Lesions: Technique Effectiveness, Safety, and Interoperator Performance

Purpose

To evaluate technique effectiveness, safety, and interoperator performance of stereotactic radiofrequency ablation (SRFA) of liver lesions.

Methods

Retrospective review including 90 consecutive patients from January 2008 to January 2010 with 106 computed tomography-guided SRFA sessions using both single and multiple electrodes for the treatment of 177 lesions: 72 hepatocellular carcinoma (HCC) and 105 metastases with a mean size of 2.9?cm (range 0.5?C11?cm). Technique effectiveness and 1-year local recurrence were evaluated by computed tomographic scans. Complications, mortality, and hospital days were recorded. The performance between an experienced and inexperienced interventional radiologist was compared.

Results

The overall technique effectiveness after a single SRFA was 95.5% (93.1% for HCC and 97.1% for metastases). Four of the eight unsuccessfully treated lesions could be retreated (secondary technique effectiveness of 97.7%). Local recurrence at 1?year was 2.9%. Technique effectiveness was significantly different for lesions <5?cm (96.7%) and >5?cm (87.5%) (P?=?0.044) but not for lesions <3?cm (95.9%) and 3?C5?cm (100%). Compared to clear parenchymal property (97.3%), vessel vicinity (93.3%) (P?=?0.349) and subcapsular (95.2%) (P?=?0.532) had no, but hollow viscera vicinity (83.3%) had a significantly lower technique effectiveness (P?=?0.020). Mortality rate was 0.9%. Major complications and hospital days were higher for cirrhosis Child-Pugh B (20%, 7.2?days) than Child-Pugh A (3.1%, 4.7?days) patients and for metastases (5.1%, 4.3?days). There was no significant difference in interoperator performance.

Conclusion

SRFA allowed for efficient, reliable, and safe ablation of large-volume liver disease.     

Treatment of severe osteochondral defects of the knee by combined autologous bone grafting and autologous chondrocyte implantation using fibrin gel

Purpose

Severe symptomatic and unstable osteochondral defects of the knee are difficult to treat. A variety of surgical techniques have been developed. However, the optimal surgical technique is still controversial. We present a novel technique in which autologous bone grafting is combined with gel-type autologous chondrocyte implantation (GACI).

Methods

Isolated severe osteochondral defects of the medial or lateral femoral condyle were treated by a two-step procedure. Firstly, chondrocytes were harvested during arthroscopy and cultured for 6?weeks. Secondly, a full thickness corticospongious autologuos bone graft, harvested from the medial or lateral femur condyle, is impacted in the defect and covered by GACI. The fibrin gel fills up to the exact shape of the chondral lesion and polymerizes within 3?min after application.

Results

From 2009 to 2011, 9 patients, median age 35?years (range 23–47), were treated by the combined autologous bone grafting and GACI technique. Median defect size was 7.1?cm² (range 2.5–12.0), and median depth of the lesion was 0.9?cm (range 0.8–1.2). Median follow-up was 9?months (range 6–12?months). Six patients were available for 12-month follow-up. The mean IKDC score showed a 6-month improvement from 35 (SD?±?16) to 51 (SD?±?18) (n?=?9; p?=?0.01), and a 1-year improvement from 35 (SD?±?16) to 57 (SD?±?20) (n?=?6; p?=?0.03). The mean KOOS improved from 44 (SD?±?16) to 62 (SD?±?19) (n?=?9; p?=?0.07) at 6-month follow-up and from 44 (SD?±?16) to 65 (SD?±?24) (n?=?6; p?=?0.1) at 12-month follow-up. There was one failure that needed conversion to a unicompartmental knee arthroplasty.

Conclusion

Combined autologous bone grafting and GACI may offer an alternative surgical option for severe and unstable osteochondral defects of the knee.

Level of evidence

IV.     

Somatostatin receptor scintigraphy with 111In-octreotide in pulmonary carcinoid tumours correlated with pathological and 18FDG PET/CT findings

Purpose

Pulmonary carcinoid (PC) tumors are rare neoplasms of the lung with good prognosis but diagnosis may be demanding since there is no exclusive modality alone to clearly differentiate a PC tumor. The purpose of this study is to establish the diagnostic features of somatostatin receptor scintigraphy (SRS), comparatively (where available) with ¹⁸FDG PET/CT (PET/CT) correlated with histopathologic findings.

Methods

Twenty-one patients who underwent SRS with ¹¹¹In-octreotide and were diagnosed as having PC tumors were retrospectively studied. Thirteen patients were performed PET/CT. Primary tumour size, Ki-67 indexes, image analysis data of SRS and PET/CT including maximum standardized uptake values (SUVmax) together with false negative, false positive, true positive and true negative lesions were documented and discussed.

Results

Eleven (52.4?%) patients were typical (TC) and 10 (47.6?%) were atypical carcinoids (AC) with mean Ki-67 indexes of 2.1 and 24?%, respectively. Patients underwent SRS for solitary pulmonary nodule (SPN) characterization (n?=?12) and determination of disease extension (n?=?9). Overall sensitivity and specificity of SRS in the detection of primary tumour, lymph nodes (LN) and distant metastasis (DM) were 76 and 97?%, respectively, whereas, positive and negative predictive values were 95 and 86?%. PET/CT was performed for determining disease spread (n?=?3) and metabolic characterization (n?=?10) of SPNs. Mean SUVmax in the primary pulmonary lesion in TCs and ACs were 2.9?±?0.8 and 7.9?±?5.4, respectively. Nodal involvement (n?=?5) and DM (n?=?3) were also detected. Sensitivity and specificity of PET/CT in the detection of primary tumour, LNs and DM were 85 and 89.4?%, respectively.

Conclusion

SRS is useful in the diagnosis and monitoring of PC tumors when incorporated with ¹⁸FDG PET/CT as a primary staging tool particularly in the determination of disease spread.     

A classification of patterns of fetal middle cerebral artery velocity waveforms as seen on Doppler ultrasound

Purpose

To identify, classify, and study the clinical significance of different patterns of fetal middle cerebral artery peak systolic velocity waveforms that can be seen on Doppler ultrasound.

Materials and methods

The patterns of fetal middle cerebral artery (MCA) velocity waveforms encountered in our study (n?=?1128) conducted on a rural obstetric population were analyzed.

Results

Broadly, three different waveform-patterns (type I to type III) were identified from 1100 cases on which satisfactory studies were conducted. Types IA and IB were found in normal fetuses of the first (n?=?254, 23.1?%) and second (n?=?386, 35.1?%) trimesters, respectively. Type IC (n?=?418, 38?%) included normal fetuses in the second (n?=?25) and third (n?=?317) trimesters, and 76 of 118 IUGR fetuses. Type II consisted of IUGR category; 17 (1.5?%) cases in type IIA, 10 (0.9?%) in IIB, and 11 (1.0?%) in IIC. Type III (n?=?4, 0.4?%) was found in the critical cases with severe anemia secondary to feto-maternal hemorrhage.

Conclusion

Although different patterns of uterine and umbilical artery velocity waveforms have been described in the obstetric literature, there is no mention of patterns of fetal MCA velocity waveforms. This is the first study to demonstrate, classify, and state the clinical significance of different patterns of fetal middle cerebral artery peak systolic velocity waveforms.     

Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension

Introduction

This study aimed to evaluate the diagnostic imaging findings and treatment results of patients with idiopathic intracranial hypotension (IIH) due to cerebrospinal fluid (CSF) leaks.

Methods

Between February 2009 and April 2012, 26 IIH patients (15 men, median age 49?years) presenting with orthostatic headache (n?=?20) and/or with spontaneous subdural effusions or subarachnoid hemorrhage (n?=?19) were enrolled. Twenty-three patients underwent a whole spine CT and MRI myelography, starting 45?min after the intrathecal injection of 9?cc of iomeprol (Imeron 300 M) and 1?cc of gadobutrolum (Gadovist). Three patients only underwent MR myelography after intrathecal gadobutrolum injection. Adjacent to the level(s) of the detected CSF leak(s) along the nerve roots, 20?cc of fresh venous blood with 0.5?cc Gadovist was injected epidurally (blood patch, BP). The distribution of the BP was visualized by MRI the following day. Treatment results were evaluated clinically and by myelography 2?weeks after the application of the BP. Retreatment was offered to patients with persistent symptoms and continued CSF leakage.

Results

CSF leaks were detected at the cervical (n?=?12), thoracic (n?=?25), or lumbar (n?=?21) spine. In 23 patients, more than one spinal segment was affected. One patient refused treatment. BP were applied in one (n?=?9) or several (n?=?16) levels. Clinical and/or radiological improvement was achieved after one (n?=?16), two (n?=?5), three (n?=?3), or five (n?=?1) BPs.

Conclusion

CT and MRI myelography allow the reliable detection of spinal CSF leaks. The targeted and eventually repeated epidural BP procedure is a safe and efficacious treatment.     

Origins of Feeding Arteries of Hepatocellular Carcinoma Located Near the Umbilical Fissure of the Left Hepatic Lobe: Angiographic Evaluation

Purpose

To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe.

Methods

Twenty-eight HCCs with a mean?±?SD tumor diameter of 3.4?±?1.0?cm (range 1–4.4?cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1?week after TACE.

Results

Twenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3.

Conclusion

This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.     

Fetal liver iron overload: the role of MR imaging

Objective

To assess the potential role of MR imaging in the diagnosis of fetal liver iron overload.

Methods

We reviewed seven cases of abnormal liver signal in fetuses referred to MR imaging in a context of suspected congenital infection (n?=?2), digestive tract anomalies (n?=?3) and hydrops fetalis (n?=?2). The average GA of the fetuses was 31?weeks. The antenatal diagnoses were compared with histological data (n?=?6) and postnatal work-up (n?=?1).

Results

Magnetic resonance imaging demonstrated unexpected abnormal fetal liver signal suggestive of iron overload in all cases. The iron overload was confirmed on postnatal biopsy (n?=?2) and fetopathology (n?=?4). The final diagnosis was hepatic hemosiderosis (haemolytic anaemia (n?=?2) and syndromal anomalies (n?=?2)) and congenital haemochromatosis (n?=?3). In all cases, the liver appeared normal on US.

Conclusions

Magnetic resonance is the only imaging technique able to demonstrate liver iron overload in utero. Yet, the study outlines the fundamental role of MR imaging in cases of congenital haemochromatosis. The antenatal diagnosis of such a condition may prompt ante??(in the case of recurrence) or neonatal treatment, which might improve the prognosis.     

Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia

Objective

To analyse cerebrospinal fluid (CSF) hydrodynamics in patients with Chiari type I malformation (CM) with and without syringomyelia using 4D magnetic resonance (MR) phase contrast (PC) flow imaging.

Methods

4D-PC CSF flow data were acquired in 20 patients with CM (12 patients with presyrinx/syrinx). Characteristic 4D-CSF flow patterns were identified. Quantitative CSF flow parameters were assessed at the craniocervical junction and the cervical spinal canal and compared with healthy volunteers and between patients with and without syringomyelia.

Results

Compared with healthy volunteers, 17 CM patients showed flow abnormalities at the craniocervical junction in the form of heterogeneous flow (n?=?3), anterolateral flow jets (n?=?14) and flow vortex formation (n?=?5), most prevalent in patients with syringomyelia. Peak flow velocities at the craniocervical junction were significantly increased in patients (?15.5?±?11.3 vs. ?4.7?±?0.7 ?cm/s in healthy volunteers, P?P?Conclusions 4D-PC flow imaging allowed comprehensive analysis of CSF flow in patients with Chiari I malformation. Alterations of CSF hydrodynamics were most pronounced in patients with syringomyelia.

Key Points

? Analysis of CSF flow is important in patients with Chiari I malformation ? 4D-PC MRI allows analysis of CSF in patients with Chiari I. ? Chiari I patients show characteristic qualitative and quantitative alterations of CSF flow. ? Alterations of CSF hydrodynamics are most pronounced in patients with associated syringomyelia.     

Conventional transarterial chemoembolisation in combination with sorafenib for patients with hepatocellular carcinoma: a pilot study

Objectives

To investigate the safety of transarterial chemoembolisation (TACE) in combination with sorafenib in patients with hepatocellular carcinoma (HCC).

Methods

Patients with Child–Pugh A/B liver function, ECOG performance status 0–2 and HCC treatable with TACE received continuous sorafenib 800?mg/day, and TACE with doxorubicin (75, 50 and 25?mg/m² according to serum bilirubin: <1.5, 1.5–3, and >3?mg/dL) and lipiodol 2?weeks after sorafenib initiation and repeated every 4?weeks.

Results

Fifteen patients were included (Child–Pugh A/B, n?=?12/3; Barcelona Clinic Liver Cancer-A/B/C, n?=?1/9/5; ECOG 0/2, n?=?14/1). Median time on sorafenib was 5.2?months (2.6–7.4?months); median number of TACE sessions was 3. Common adverse events were abdominal pain (n?=?14), weight loss (n?=?13), alopecia (n?=?12), fatigue (n?=?12) and hyperbilirubinaemia (n?=?11). There were 32 serious adverse events (grade ≥3); 9/10-unscheduled hospital admissions and 4/5 deaths were considered TACE-related. The study was stopped prematurely because of safety concerns. At 6?months, 2 and 5 patients had complete or partial responses; 1 had stable disease. Median overall survival was 10.6?months (95% CI: 5.2–16?months).

Conclusion

These findings do not support use of an intensive, high-dose doxorubicin-based TACE regimen in combination with sorafenib in this study population.

Key Points

? Transarterial chemoembolisation (TACE) is widely used in patients with hepatocellular carcinoma (HCC) ? Various antiangiogenic and other agents have been used to augment this treatment ? We tested lipiodol-TACE with bilirubin-adjusted doxorubicin dosing in combination with sorafenib ? This trial was stopped prematurely because of safety reasons ? Our safety results do not support the combination of sorafenib with this TACE regimen     

Frequency and predictors of endoleaks and long-term patency after covered stent placement for the treatment of intracranial aneurysms: a prospective, non-randomised multicentre experience

Objective

We investigated immediate/late endoleaks and long-term patency following stent-graft placement for treatment of intracranial aneurysms located within the distal internal carotid artery (ICA) or vertebral artery (VA).

Methods

Forty-five aneurysms in 41 patients receiving covered stents in three centres were followed. Outcome measures included aneurysm occlusion rate, endoleaks, late in-stent stenosis rate, clinical improvement, neurological deficiencies and death.

Results

Total aneurysm exclusion was achieved in 69.2% (n?=?27), with 30.8% (n?=?12) experiencing immediate residual endoleaks. Angiographic follow-up (mean 43.5?±?14.3 months) revealed that 87.2% (n?=?34) were completely occluded with only 12.8% (n?=?5) showing residual endoleaks. Predictors of immediate endoleaks in our patient group were stent number (P?=?0.023) and stent diameter (P?=?0.022), while predictors of late endoleaks in our patient group were stent diameter (P?=?0.035) and stent angulation (P?=?0.021). Late in-stent stenosis rates were 18.0?±?13.3 and 29.0?±?18.5% compared with the period immediately following implantation at 2- and 6-year follow-ups respectively. Smoking (P?=?0.017) and stent angulation (P?=?0.020) were predictors of late in-stent stenosis.

Conclusion

Treating intracranial aneurysms with Willis stent-grafts has an acceptable immediate and late occlusion rate and long-term stented artery patency rate.

Key Points

? Covered stents can be a treatment option for intracranial aneurysms. ? Technical success for treating distal ICA and VA aneurysms can reach 97.6%. ? However immediate and late endoleaks occur in 30.8 and 12.8% respectively. ? The number, diameter and angulation of stents are possible predictors of endoleaks. ? Smoking and stent angulation seem to predict late in-stent stenosis.     

Five year colorectal cancer outcomes in a large negative CT colonography screening cohort

Objectives

To assess the 5-year incidence of clinically presenting colorectal cancers following a negative CT colonography (CTC) screening examination, as few patient outcome data regarding a negative CTC screening result exist.

Methods

Negative CTC screening patients (n?=?1,050) in the University of Wisconsin Health system over a 14-month period were included. An electronic medical record (EMR) review was undertaken, encompassing provider, colonoscopy, imaging and histopathology reports. Incident colorectal cancers and other important GI tumours were recorded.

Results

Of the 1,050 cohort (mean [±SD] age 56.9?±?7.4?years), 39 (3.7%) patients were excluded owing to lack of follow-up within our system beyond the initial screening CTC. The remaining 1,011 patients were followed for an average of 4.73?±?1.15?years. One incident colorectal adenocarcinoma represented a crude cancer incidence of 0.2 cancers per 1,000 patient years. EMR revealed 14 additional patients with clinically important GI tumours including: advanced adenomas (n?=?11), appendiceal goblet cell carcinoid (n?=?1), appendiceal mucinous adenoma (n?=?1) and metastatic ileocolonic carcinoid (n?=?1). All positive patients including the incident carcinoma are alive at the time of review.

Conclusions

Clinically presenting colorectal adenocarcinoma is rare in the 5?years following negative screening CTC, suggesting that current strategies, including non-reporting of diminutive lesions, are appropriate.

Key Points

? CT colonography (CTC) screening is increasingly used to identify potential colorectal cancer. ? Clinically presenting cancers are rare for 5?years following negative CTC screening. ? The practice of setting a 6?mm polyp size threshold seems safe. ? An interval of 5?years for routine CTC screening is appropriate.     

Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions

Objective

To evaluate the diagnostic yield of ultrasound-guided core-needle biopsy of extra-ocular orbital lesions.

Methods

Fifty-five patients with monolateral exophthalmos prospectively underwent computed tomography (CT) to investigate the presence of an extra-ocular mass (n?=?25). Excluding benign lesions (n?=?7) and patients in whom CT revealed an unknown primitive malignancy (n?=?5), 13 patients (7 male, 6 female; mean age 62?±?16 years) underwent ultrasound. Lesion appearance (echotexture, power Doppler vascularisation), size, position with respect to the cone and to the globe were recorded. Ultrasound-guided biopsies were performed (automatic, n?=?9; semi-automatic 18-G needle, n?=?4). Sample adequacy and complication rate were recorded.

Results

Ultrasound demonstrated hypoechoic lesions with mild power Doppler vascularity, that were completely (n?=?7) or partially extra-conal (n?=?6), located laterally (n?=?8) or posteriorly (n?=?5) to the globe. Mean size was 3.25 cm. All biopsies yielded adequate material for histological and immunohistochemical analysis (nine non-Hodgkin’s lymphomas, two adenocarcinomas, one lymphoid hyperplasia, one inflammatory pseudotumour). Complications included cutaneous eyelid haematoma (n?=?3) and retro-bulbar haematoma (n?=?1), treated conservatively and resolved at 10-day follow-up. No immediate or delayed vision reduction was reported.

Conclusions

Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions is feasible and accurate, being free from long-term complications. This procedure provided 100 % adequate samples to achieve final diagnosis.

Key Points

? Ultrasound-guided core-needle biopsy of extra-ocular orbital lesions seems feasible and accurate. ? In this series it provided a final diagnosis in 13/13 cases. ? It appears free from long-term complications. ? It provides immunohistochemical analysis of the specimen. ? It should represent a valuable alternative to surgical biopsy.     

Coil embolization of anterior circulation aneurysms supported by the Solitaire™ AB Neurovascular Remodeling Device

Introduction

The purpose of the study is to evaluate patients with wide-necked or complex aneurysms of the anterior circulation who underwent Solitaire? AB Neurovascular Remodeling Device-assisted coil embolization.

Methods

From February 2008 to March 2009, consecutive data were collected from 45 patients with anterior circulation aneurysms. Eighteen of the patients presented with acute subarachnoid hemorrhage. Forty-six aneurysms were treated with the aid of different applications (n?=?49) of the Solitaire? AB Remodeling Device followed by standard coiling procedure (n?=?43) using bioactive coils or/and bare coils.

Results

Successful positioning of the remodeling device was obtained in 95.9% of the cases. There were two thromboembolic complications (4.1%) and one severe vasospasm requiring retrieval of the device. Permanent procedural morbidity was observed in one patient (2%). The proportion of patients in whom Raymond class 1 occlusion was obtained was 53.5% (n?=?23). Raymond class 2 occlusion was achieved in 42% (n?=?18) and Raymond class 3 occlusion in 4.7% (n?=?2). Thirty-nine patients left the hospital with a good clinical status.

Conclusion

The initial technical and clinical results of Solitaire? AB device-assisted coiling of aneurysms in the anterior circulation are highly encouraging. This technique may enhance the possibilities of the endovascular treatment of these aneurysms in clinical routine.     

Increased FDG uptake in breast cancer is associated with prognostic factors

Purpose

To evaluate the relationship between FDG uptake and prognostic factors of breast cancer such as hormone receptors (estrogen and progesterone), expression of c-erbB-2, axillary lymph node status, tumor histology, grade and size.

Materials and methods

Between May 2009 and February 2011; 79 patients (mean age?±?SD: 52.9?±?13.9?years) with biopsy proven breast cancer underwent F-18 FDG PET/CT scanning for staging. Patients with excisional biopsy or neoadjuvant chemotherapy were excluded from the study. Histological types included were invasive ductal carcinoma (n?=?68), invasive lobular carcinoma (n?=?2), and invasive ductal plus lobular mixed carcinoma (n?=?9). Maximum standardized uptake values (SUVmax) were compared with estrogen (ER) and progesterone receptors (PR), expression of c-erbB-2, as well as tumor grade and tumor size. For the evaluation of relationship between tumor SUVmax values and prognosticators such as hormone receptors, tumor histologic grade, and tumor size, statistical analyses were performed using Student t test, Mann?CWhitney U Test and Pearson correlation coefficient and p values of less than 0.05 were considered to indicate statistically significant differences.

Results

All primary breast neoplasms were detected by PET/CT scanner. The mean SUVmax values and breast cancer tumor sizes ranged from 2.09 to 39.0 and 0.7 to 10?cm, respectively. Tumors with negative ER [(n?=?19); SUVmax median (min?Cmax): 15 (2.09?C39.0)] were associated with higher SUVmax values (p?=?0.01). Tumors with overexpression of C-erbB-2 [(n?=?28); SUVmax median (min?Cmax): 16.0 (5.0-39.0)]; tumor grade 3 [(n?=?25); SUVmax median (min?Cmax): 15 (6.43?C39)]; axillary lymph node involvement [(n?=?60); SUVmax median (min?Cmax): 13.61 (4.0?C39.0)]; tumor histopathology and increased tumor size were associated with higher maximum standardized uptake values. However, PR did not show any relationship with SUVmax values.

Conclusion

In the present report, strong relationships were detected between the negativity of ER, overexpression of c-erbB-2, tumor grade, tumor size, histopathology, axillary lymph node involvement and SUVmax values. Accordingly, we believe that SUVmax values obtained with ¹⁸F-FDG PET/CT may provide some information about tumor biology of breast cancer.