Percutaneous Computed Tomography–guided High-Dose-Rate Brachytherapy Ablation of Breast Cancer Liver Metastases: Initial Experience with 80 Lesions

PurposeTo analyze initial experience with computed tomography–guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM).Materials and MethodsBetween January 2008 and December 2010, 37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34–83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid–enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter.ResultsTwo patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3–32 mo). Mean tumor diameter was 25.5 mm (range 8–74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3–39 months (median 18 months).ConclusionsCT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM.     

Percutaneous CT–Guided Sympathicolysis with Radiofrequency for the Treatment of Palmar Hyperhidrosis

Purpose

To evaluate the benefits of computed tomography (CT)–guided percutaneous sympathicolysis with radiofrequency in patients with primary palmar hyperhidrosis (PPHH) in terms of safety, patient satisfaction, and short- and long-term efficacy.

Long-Term Hepatotoxicity of Yttrium-90 Radioembolization as Treatment of Metastatic Neuroendocrine Tumor to the Liver

Purpose

To determine long-term hepatotoxicity of yttrium-90 (⁹⁰Y) radioembolization in patients treated for metastatic neuroendocrine tumor (mNET) and evaluate if imaging and laboratory findings of cirrhosis-like morphology are associated with clinical symptoms.

Magnetic Resonance Imaging–Guided Vacuum-Assisted Breast Biopsy: An Initial Experience in a Community Hospital

Objective

To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program.

Methods

The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings.

Results

Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142).

Conclusions

This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions.     

CT–Guided Bone Biopsies in Metastatic Castration-Resistant Prostate Cancer: Factors Predictive of Maximum Tumor Yield

Purpose

To evaluate the success rate of CT–guided bone biopsies in metastatic castration-resistant prostate cancer (mCRPC) and to investigate associated technical, imaging, and clinical parameters affecting diagnostic yields.

Percutaneous MR Imaging–Guided Cryoablation of Small Renal Masses in a 3-T Closed-Bore MR Imaging Environment: Initial Experience

Purpose

To assess the feasibility of percutaneous magnetic resonance (MR) imaging–guided cryoablation of small renal masses (SRMs) in a 3-T environment and to evaluate intraprocedural imaging, procedural safety, and initial outcomes.

Phase II Feasibility Study on the Combination of Two Different Regional Treatment Approaches in Patients with Colorectal “Liver-Only” Metastases: Hepatic Interstitial Brachytherapy Plus Regional Chemotherapy

The aim of this study was to evaluate the feasibility, safety, and efficacy of combined treatment with hepatic interstitial brachytherapy (HIB) and hepatic arterial infusion (HAI) of chemotherapy after interventional implantation of port catheter systems. Thirty-three patients with unresectable “liver-only” metastases of colorectal cancer were treated with both HIB and HAI during the course of their disease. All 33 patients had recurrent disease and 27 had received previous chemotherapy. Of these, 15 received HAI first and were then consolidated with HIB, 9 started with HIB and were continued with HAI, and 9 received first HIB and subsequently HAI after hepatic disease progression. Patients were evaluated for treatment characteristics, side effects, and efficacy. Comparisons between treatment groups were also performed. The median tumor diameter of metastases treated with brachytherapy was 4.6 cm (range: 1–12 cm). The median minimal irradiation dose inside the tumor margin was 18 Gy administered to a mean of two metastases in 69 interventions. Minor (n = 4) and major (n = 3) complications occurred in 10% of interventions. WHO grade III adverse events of the regional chemotherapy were observed in seven patients; grade IV, in one patient. At a median follow-up of 28 months (range: 7–74 months), the median time to disease progression after first treatment was 10.5 months (range: 1–35 months). Of 138 metastases treated by brachytherapy, 16 local recurrences were seen (mean, 12.3 months; range, 3–45 months). No signs of hepatic failure were observed in any of our patients. In conclusion, combinations of two minimally invasive therapeutic methods are feasible, with acceptable complication rates, and provide promising results in colorectal cancer patients with unresectable hepatic metastases.     

Is a Diagnostic CT of the Brain Indicated in Patients with Choroidal Metastases Before Radiotherapy?

BACKGROUND AND PURPOSE: There is no evidence in the literature about the incidence of synchronous brain metastases in patients with choroidal metastases. This is of major importance, because the radiation fields of choroidal metastases and, later on, brain metastases, if treated consecutively, are partly overlapping, thus potentially increasing the rate of late side effects such as brain necrosis. The goal of this study was to determine the frequency of synchronous brain metastases. PATIENTS AND METHODS: 50 patients with choroidal metastases were enrolled into a study of the "Arbeitsgemeinschaft Radiologische Onkologie" of the German Cancer Society (ARO 95-08) with standardized 40 Gy radiotherapy, 2 Gy single dose. All patients were staged before treatment with a computed tomography of the brain (CCT). No patient showed clinical signs of brain metastases. RESULTS: 13 out of 50 patients (26%) had brain metastases in the CCT leading to radiotherapy of the brain and choroidal metastases in one volume. CONCLUSION: A CCT is indicated at the diagnosis of choroidal metastases for screening of synchronous brain metastases. The incidence is about 25%, and the diagnosis of brain metastases results in a different target volume: the whole brain including the posterior parts of the eyes compared to the posterior parts of the eyes alone. Therefore, the risk of late side effects could be reduced compared with an additional later radiotherapy of the whole brain with partly overlapping fields.     

Safety and Efficacy of Transjugular Liver Biopsy in Patients with Left Lobe–Only Liver Transplants

PurposeTo evaluate efficacy and safety of transjugular liver biopsy (TJLB) via the left hepatic vein in patients with left lobe–only liver transplants (LLOTs).Materials and MethodsRetrospective review revealed 43 TJLBs performed in 26 patients with LLOTs (mean age 51.3 y; range, 18–73 y) between January 2009 and June 2016 at a single institution. A comparison group of 44 randomly selected TJLBs performed in 37 orthotopic whole liver transplant (OWLT) recipients (mean age 57.6 y; range, 35–74 y) during the same time period was evaluated. Patient demographics, type and age of transplant, technical success, adequacy of samples, number of portal tracts obtained, pathologic diagnosis, and complication rate were reviewed.ResultsTechnical success was achieved in 98% (42/43) of LLOT procedures. TJLB failed in 1 patient with LLOT, in whom no patent hepatic veins were identified. Technical success was achieved in 100% (44/44) in the OWLT group. Mean (SD) number of needle passes was 4.12 (1.25) in the LLOT group vs 3.95 (1.28) in the OWLT group (P = .54). Mean (SD) specimen length was 1.16 (0.75) cm in the LLOT group vs 1.19 (0.58) cm in the OWLT group (P = .78). Mean (SD) number of portal tracts obtained in the LLOT group was 10.7 (5.26) vs 12.3 (4.68) in the OWLT group (P = .17). No major complications were observed in either group.ConclusionsTJLB in adult patients with LLOTs appears safe and feasible, with favorable rates of technical success and adequacy of sampling.     

Percutaneous Microwave versus Radiofrequency Ablation of Colorectal Liver Metastases: Ablation with Clear Margins (A0) Provides the Best Local Tumor Control

Purpose

To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs).

Is the Adjuvant Albendazole Treatment Really Needed with PAIR in the Management of Liver Hydatid Cysts? A Prospective,Randomized Trial with Short-Term Follow-Up Results

Objective

The purpose of this study was to determine the safety and efficacy of adjuvant albendazole medication in percutaneous liver hydatid cyst treatment with puncture, aspiration, injection, and reaspiration (PAIR) method.

Methods

Between November 2007 and May 2011, total of 39 patients with newly diagnosed liver hydatid cyst (total of 77 cysts) were prospectively randomized and enrolled in 3 groups. In the first group, cysts (n = 14) were treated with PAIR without albendazole. In the second (n = 16) and third groups (n = 47), cysts were treated with PAIR with albendazole 1 week before and 1 month after the procedure, with albendazole 1 week before and 3 months after the procedure respectively.

Results

Technical and clinical success rates were 100 and 96.1 % respectively. In 3 of 77 cysts (3.9 %), findings of recurrence were detected on US imaging. All recurrent cysts were in group 1 and recurrence rates in this group were statistically different from cysts of second and third groups (p = 0.005). Side effects of albendazole were detected in 7 of 29 patients (24.1 %), and no statistically significant difference was observed between the second (15.3 %) and third (38.4 %) groups (p = 0.378).

Conclusions

Use of albendazole medication as an adjuvant to percutaneous treatment of liver hydatid cyst decreases the recurrence rate. Although there is no statistically significant difference between groups 2 and 3 in terms of efficacy and recurrence rate, patients in group 3 had a higher rate of side effect. Therefore, we conclude that albendazole treatment 1 week before and 1 month after PAIR treatment is sufficient to reduce/prevent recurrences.     

Role of CT in the diagnosis of jejunal–ileal perforations

Purpose

The purpose of this study was to evaluate the computed tomography (CT) signs of free and covered small-bowel perforations and the potential of CT in recognising the aetiology.

Materials and methods

Thirty-five patients with surgically proven small-bowel perforation were retrospectively evaluated. Fundamental signs (extraluminal air, solution of continuity) and secondary signs (thickening of the mesentery, free or perilesional fluid, wall thickening) were considered.

Results

CT alterations were found in 31/35 (88.6 %) patients: extraluminal air (30/35, 85.7 %), solution of continuity (11/35, 31.4 %), intra-abdominal fluid (27/35, 77.1 %), thickening of the mesentery (20/35, 57.1 %), and wall thickening (14/35, 40 %). In 25/35 cases (71.4 %) pneumoperitoneum was detected, associated with secondary signs (23/25, 82 %), confirmed as free perforations at surgery. In 5/35 patients (14.2 %), peri-intestinal air bubbles and secondary signs were evident, while in 1/35 cases (2.8 %) only secondary signs were seen, namely covered perforations. In 4/35 patients (11.4 %) with a covered perforation, the CT scan was negative. The nature of the perforations was completely recognisable in 26/31 cases (83.9 %), partially identifiable in 4/31 (12.9 %), not evident in 1/31 (3.2 %).

Conclusion

CT investigation is essential in the recognition of a small-bowel perforation and in the definition of its nature.     

Radiofrequency Ablation of Liver Metastases—Software-Assisted Evaluation of the Ablation Zone in MDCT: Tumor-Free Follow-Up Versus Local Recurrent Disease

The purpose of this study was to investigate differences in change of size and CT value between local recurrences and tumor-free areas after CT-guided radiofrequency ablation (RFA) of hepatic metastases during follow-up by means of dedicated software for automatic evaluation of hepatic lesions. Thirty-two patients with 54 liver metastases from breast or colorectal cancer underwent triphasic contrast-enhanced multidetector-row computed tomography (MDCT) to evaluate hepatic metastatic spread and localization before CT-guided RFA and for follow-up after intervention. Sixteen of these patients (65.1 ± 10.3 years) with 30 metastases stayed tumor-free (group 1), while the other group (n = 16 with 24 metastases; 62.0 ± 13.8 years) suffered from local recurrent disease (group 2). Applying an automated software tool (SyngoCT Oncology; Siemens Healthcare, Forchheim, Germany), size parameters (volume, RECIST, WHO) and attenuation were measured within the lesions before, 1 day after, and 28 days after RFA treatment. The natural logarithm (ln) of the quotient of the volume 1 day versus 28 days after RFA treament was computed: lnQ1//28/0_volume. Analogously, ln ratios of RECIST, WHO, and attenuation were computed and statistically evaluated by repeated-measures ANOVA. One lesion in group 2 was excluded from further evaluation due to automated missegmentation. Statistically significant differences between the two groups were observed with respect to initial volume, RECIST, and WHO (p < 0.05). Furthermore, ln ratios corresponding to volume, RECIST, and WHO differed significantly between the two groups. Attenuation evaluations showed no significant differences, but there was a trend toward attenuation assessment for the parameter lnQ28/0_attenuation (p = 0.0527), showing higher values for group 1 (–0.4 ± 0.3) compared to group 2 (–0.2 ± 0.2). In conclusion, hepatic metastases and their zone of coagulation necrosis after RFA differed significantly between tumor-free and local-recurrent ablation zones with respect to the corresponding size parameters. A new parameter (lnQ1//28/0_{volume/RECIST/WHO/attenuation}) was introduced, which appears to be of prognostic value at early follow-up CT.     

Utility of a Power Aspiration–Based Extraction Technique as an Initial and Secondary Approach in the Treatment of Peripheral Arterial Thromboembolism: Results of the Multicenter PRISM Trial

Purpose

To investigate the safety and initial efficacy of XTRACT, a power aspiration–based extraction technique for treatment of peripheral arterial thromboembolism with the use of the Penumbra/Indigo system.

Pulmonary Intraparenchymal Blood Patching Decreases the Rate of Pneumothorax-Related Complications following Percutaneous CT–Guided Needle Biopsy

Purpose

To investigate whether an autologous intraparenchymal blood patch (IPB) reduces the rate of pneumothorax-related complications associated with computed tomography (CT)–guided lung biopsies.

Dual-Energy CT–Derived Volumetric Iodine Concentration for the Assessment of Therapeutic Response after Microwave Ablation in a Rabbit Model with Intrahepatic VX2 Tumor

Purpose

To evaluate whether changes in volumetric iodine concentration (VIC) could serve as a suitable predictor of therapeutic response to microwave (MW) ablation in a rabbit intrahepatic VX2 tumor model.

Selective Arterial Embolization with Ethylene–Vinyl Alcohol Copolymer for Control of Massive Lower Gastrointestinal Bleeding: Feasibility and Initial Experience

PurposeTo evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene–vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, California) as the primary treatment for acute and massive lower gastrointestinal bleeding (LGIB).Materials and MethodsBetween January 2008 and October 2013, all patients with focal massive LGIB who were treated by embolization were retrospectively analyzed. The study was approved by the hospital’s ethics committee; informed consent was obtained in all cases. Onyx was chosen as the embolic agent in all cases in an intention-to-treat fashion. Embolization was indicated in 31 consecutive patients (mean age, 80 y ± 11.1). Multidetector computed tomography and digital subtraction angiography were performed in all patients.ResultsActive bleeding was detected in all cases. A colonoscopy was performed in 11 patients. The correlation between multidetector computed tomography and angiography findings was 96.7%. The causes of bleeding were diverticula in 15 patients, iatrogenic in 7 patients, neoplasia in 3 patients, hemorrhoids in 2 patients, angiodysplasia in 2 patients, and unknown in 2 patients. Embolization was not possible in one patient, who required urgent left hemicolectomy. The technical success rate was 93.5%. The embolic material refluxed in one patient, causing an undesired embolization, without any clinical consequences. In the 30 patients who received embolization, the immediate bleeding control rate was 100%. Rebleeding at 30 days occurred in three patients (10%). There were no major complications, intestinal ischemia, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 23.7 months (range, 1–71 mo).ConclusionsControl of massive LGIB using superselective embolization with Onyx is feasible and safe.