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1.
Elisa Amzallag-Bellenger Philippe Soyer Coralie Barbe Truong Luong Francis Nguyen Nedjoua Amara Christine Hoeffel 《European radiology》2014,24(11):2916-2926
Purpose
To retrospectively investigate the added value of diffusion-weighted MR imaging (DWI) for detecting mesenteric small bowel tumours (MSBTs) via MR-enterography.Materials and methods
MR-enterographies of 98 patients with suspected MSBTs were blindly analyzed by two independent readers for the presence of MSBTs. Four imaging sets including “standard” (Haste and TrueFisp), “standard + DWI,” “standard + gadolinium-enhanced” and “standard + DWI + gadolinium-enhanced” were reviewed. Diagnostic performance of different readings were compared with McNemar’s test.Results
Twenty-nine MSBTs were pathologically confirmed. For R1 (junior radiologist) sensitivity, specificity, PPV, NPV and accuracy for the detection of MSBTs via standard MRI were 52 % [95 % CI: 34 %-70 %] (15/29), 94 % [95 % CI: 89 %-100 %] (65/69), 79 % [95 % CI: 61 %-97 %] (15/19), 82 % [95 % CI: 74 %-91 %] (65/79) and 82 % [95 % CI: 74 %-89 %] (80/98), respectively. For R2 (senior radiologist) they were 76 % [95 % CI: 60 %-91 %] (22/29), 96 % [95 % CI: 91-100 %] (66/69), 88 % [95 % CI: 75 %-100 %] (22/25), 90 % [95 % CI: 84 %-97 %] (66/73) and 90 % [95 % CI: 84 %-96 %] (88/98), respectively. Adding DWI they were 72 % [95 % CI: 56 %-89 %] (21/29), 91 % [95 % CI: 85 %-98 %] (63/69), 78 % [95 % CI: 62 %-94 %] (21/27), 89 % [95 % CI: 81 %-96 %] (63/71) and 87 % [95 % CI: 80 %-94 %] (85/98) for R1 and 79 % [95 % CI: 65 %-94 %] (23/29), 97 % [95 % CI: 93 %-100 %] (67/69), 92 % [95 % CI: 81 %-100 %] (23/25), 92 % [95 % CI: 86 %-98 %] (67/73) and 92 % [95 % CI: 86 %-97 %] (90/98) for R2. Sensitivities for tumour detection were higher after adding DWI to standard MRI, although only for R1 was this significant (P?=?0.03). Adding DWI to standard + gadolinium-enhanced MRI did not significantly increase MR performance.Conclusion
DWI improves MSBT detection via MR-enterography compared to standard unenhanced MR-enterography, especially for unexperienced readers.Key Points
? MR-enterography is accurate for the detection of mesenteric small-bowel tumours. ? Diffusion-weighted sequencing helps inexperienced readers detect small-bowel tumours with MR-enterography. ? Diffusion-weighted sequencing adds value to standard MR-enterography when gadolinium is contraindicated. 相似文献2.
Elisa Amzallag-Bellenger Philippe Soyer Coralie Barbe Marie-Danièle Diebold Guillaume Cadiot Christine Hoeffel 《European radiology》2013,23(7):1901-1910
Purpose
To prospectively evaluate magnetic resonance (MR) enterography for detecting mesenteric small-bowel tumours (MSBTs) and assess the added value of gadolinium-chelate injection.Material and methods
Over a 2-year period MR enterography examinations of 75 patients (33 men, 42 women; mean age, 53.8 years; range, 19–85) with suspected MSBT were blindly analysed by two readers for the presence of MSBT. Sensitivities, specificities, predictive positive values (PPVs), negative predictive values (NPVs) and accuracies of MR enterography for the detection of MSBT were calculated on per-patient and per-lesion bases. The McNemar test was used to compare sensitivities and specificities of the unenhanced and gadolinium-enhanced sets of MR enterographies.Results
Thirty-seven MSBTs were pathologically confirmed in 26 patients. The mean tolerance score of the examinations was 0.7. On a per-patient basis, sensitivity, specificity, PPV, NPV and accuracy for detection of MSBT were 96 % [95 % CI, 89–100 %], 96 % [90–100 %], 93 % [83–100 %], 98 % [94–100 %] and 96 % [92–100 %], respectively. On a per-lesion basis, sensitivity and PPV were 70 % [56–85 %] and 93 % [83–100 %], respectively. Gadolinium injection yielded higher sensitivities on both bases (P?=?0.008).Conclusion
MR enterography is an accurate and well-tolerated imaging modality for detecting MSBT. Intravenous administration of gadolinium-chelate improves sensitivity for MSBT detection.Key Points
? MR enterography accurately detects mesenteric small bowel tumours. ? MR enterography is a well-tolerated imaging technique. ? Intravenous administration of gadolinium chelate improves sensitivity for detecting small-bowel tumours. 相似文献3.
Milad Modabber Jason Martin Sriharsha Athreya 《Cardiovascular and interventional radiology》2014,37(1):176-185
Background
Percutaneous radiofrequency ablation (RFA) of renal carcinoma has become an established treatment modality. However, thermal (TB) versus impedance-based (IB)-RF generators have not been previously compared.Methods
A literature search on the application of RFA for renal masses using TB or IB-RF generators was performed. The safety, efficacy, and long-term outcomes of TB versus IB-based RFA were assessed using the outcome measures of technical success, local recurrence rate, complications, and preservation of renal function.Results
Across the 27 included studies, pooled results suggested comparable results for technical success (TB-RFA 98.53 % vs. IB-RFA 98.78 %, P = 0.9813). Clinical efficacy results were also similar across both generators (91.0 % TB-RFA vs. 91.5 % IB-RFA; P = 0.73). At follow-up, no differences in renal function (relative risk [RR] 0.5, 95 % confidence interval [CI] 0.45–5.48), and local recurrence (RR 0.717, 95 % CI 0.49–1.50) were observed. The pooled proportion of overall complication rates was 13.1 % for TB-RFA and 11.5 % for IB-RFA.Conclusion
No differences in the observed parameters were found either during surgery or at follow-up. 相似文献4.
Françoise Bonichon Jean Palussière Yann Godbert Marina Pulido Edouard Descat Anne Devillers Catherine Meunier Sophie Leboulleux Thierry de Baère Claire Galy-Lacour Laurent Lagoarde-Segot Anne-Laure Cazeau 《European journal of nuclear medicine and molecular imaging》2013,40(12):1817-1827
Purpose
To assess diagnostic accuracy of 18F-FDG PET/CT at 3 months for the detection of local recurrence after radiofrequency ablation (RFA) of lung metastases.Methods
The PET/CT scan at 3 months was compared with a baseline PET/CT scan from a maximum of 2 months before RFA, with the reference standard as recurrence diagnosed by CT during a 12-month follow-up. Local recurrence was diagnosed on the PET/CT scan if lesional uptake was greater than the mediastinal background. Maximum standardized uptake values (SUVmax) were recorded. ROC curve analysis for SUVmax was performed. Overall survival (OS) and time to local relapse were computed from the date of RFA using the Kaplan-Meier method (www.clinicaltrials.gov: NCT 00382252).Results
Between 2005 and 2009, 89 patients (mean age 65 years) underwent RFA for 115 lung metastases (mean size 16.2 ± 6.9 mm). The median SUVmax before RFA was 5.8?±?4. PET/CT at 3 months and the reference standard were available in 77 patients and 100 lesions. Accuracy was 66.00 % (95 % CI 55.85–75.18 %), sensitivity 90.91 % (95 % CI 58.72–99.77 %), specificity 62.92 % (95 % CI 52.03–72.93 %), PPV 23.26 % (95 % CI 11.76–38.63 %), and NPV 98.25 % (95 % CI 90.61–99.96 %). One-year OS was 94.2 % (95 % CI 86.6–97.5 %) and the probability of being free of local recurrence 1 year after RFA was 84.6 % (95 % CI 75.0–90.8 %).Conclusion
The specificity of PET/CT at 3 months is low because of persistent inflammation, especially when the lesion is close to the pleura. This technique is useful for its negative predictive value, but positive findings need to be confirmed by histology before new treatment is planned. 相似文献5.
Anthony Dohan Clarisse Eveno Raluca Oprea Karine Pautrat Vinciane Placé Marc Pocard Christine Hoeffel Mourad Boudiaf Philippe Soyer 《European radiology》2014,24(11):2906-2915
Objective
To investigate the role of diffusion-weighted magnetic resonance imaging (DWMRI) in the diagnosis of abscess-complicating fistula-in-ano.Methods
This retrospective study was approved by our Institutional Review Board and informed consent was waived. MRI examinations, including fat-suppressed T2-weighted turbo spin-echo (T2-TSE) MRI and DWMRI, of 24 patients with a fistula-in-ano, were reviewed by two independent readers for the presence and number of visible fistulas, conspicuity and apparent diffusion coefficient (ADC) measurement of suspected fistula tracks and pelvic collections. The reference standard was surgical with follow-up findings.Results
Sensitivity was 91.2 % [95 % CI: 76 %-98 %] for T2-weighted TSE MRI and 100 % [95 % CI: 90 %-100 %] for DWMRI detecting fistulas. ADC values were lower in abscesses than in inflammatory masses (P?=?0.714.10-6). The area under the ROC curve was 0.971 and the optimal cut-off ADC value was 1.186?×?10-3 mm2/s, yielding a sensitivity of 100 % [95 % CI: 77 %-100 %], a specificity of 90 % [95 % CI: 66 %-100 %], a positive predictive value of 93 % [95 % CI: 82.8 %-100 %] and a negative predictive value of 90 % [95 % CI: 78 %-100 %] for an abscess diagnosis. Fistula conspicuity was greater with DWMRI than with T2-TSE MRI for the two observers (P?=?0.0034 and P?=?0.0007).Conclusion
DWMRI shows high sensitivity and specificity for the diagnosis of perianal abscesses and helps discriminate between an abscess and inflammatory mass. Conspicuity of fistulas-in-ano is greater with DWMRI than with T2-weighted TSE MRI.Key Points
? DWMRI can differentiate between pelvic abscess and inflammatory mass. ? DWMRI helps avoid gadolinium-chelate administration in patients with a suspected fistula-in-ano. ? DWMRI provides high degrees of conspicuity for fistula-in-ano. ? Conspicuity of fistulas is better with DWMRI imaging than with T2-TSE-weighted MRI. 相似文献6.
Hidefumi Mimura Yasuaki Arai Koichiro Yamakado Miyuki Sone Yoshito Takeuchi Tsuneharu Miki Hideo Gobara Yusuke Sakuhara Takanobu Yamamoto Yozo Sato Susumu Kanazawa 《Cardiovascular and interventional radiology》2016,39(5):717-723
Purpose
This multicenter phase I/II study evaluated the safety, feasibility, and initial efficacy of radiofrequency ablation (RFA) for small malignant renal tumors.Methods
Thirty-three patients were enrolled in the study. A single session of RFA was performed in patients with a renal tumor of 1–3 cm in greatest diameter, with the exception of lesions adjacent to the renal hilum. The primary endpoint was the safety of renal RFA, and the secondary endpoints were its feasibility and initial efficacy for local control, as well as the incidence and grade of adverse events. Clinical efficacy was evaluated by CT scans within 1 week and at a further 4 weeks after the procedure using the criteria adapted from the Response Evaluation Criteria in Solid Tumors.Results
The RFA procedure was completed in 100 % (95 % confidence interval [CI] 89–100 %) of all 33 patients. There were no severe adverse events (0 % [95 % CI 0–11 %]). Among the 33 patients, a complete response, partial response, progressive disease, and stable disease were seen in 28 (85 %), 0 (0 %), one (3 %), and one (3 %) patient(s), respectively, with a tumor response rate of 85 % [95 % CI 68–95 %]). Three patients (9 %), including one ineligible patient (3 %), were not evaluable. Out of 30 evaluable patients, a complete response was achieved in 28 (93 %).Conclusion
The current multicenter trial revealed that RFA is a safe, feasible, and effective treatment for small malignant renal tumors in patients who are not candidates for surgery.7.
Laurence Bour Vinciane Placé Sandra Bendavid Yann Fargeaudou Jean-Jacques Portal Aude Ricbourg Delphine Sebbag Anthony Dohan Eric Vicaut Philippe Soyer 《European radiology》2014,24(12):3150-3160
Purpose
To determine the utility of magnetic resonance imaging (MRI) in diagnosing invasive placenta (IP).Materials and methods
MRI findings in 32 women with suspected IP were evaluated independently by four readers. Interobserver agreement was calculated with kappa (κ) statistics. Associations between MRI findings and IP were assessed by univariate and multivariate analyses. Sensitivity, specificity and accuracy of MRI for the diagnosis of IP were estimated.Results
Sixteen women (16/32; 50 %) had confirmed IP. Interobserver correlation for the diagnosis of IP was fair (κ?=?0.40). Univariate analysis revealed that thinning or focal defect of the uteroplacental interface (P?0.0001) was the most discriminating MRI variable in the differentiation between normal and IP. Overall sensitivity and specificity of MRI for the diagnosis of IP were 84 % [95 % CI: 75–94 %] and 80 % [95 % CI: 66–93 %], respectively. Thinning or focal defect of the uteroplacental interface was the most accurate finding (88 %) in the diagnosis of IP. Multivariate analysis revealed that thinning or focal defect of the uteroplacental interface was the single independent predictor of IP (P?=?0.0006; OR?=?64.99).Conclusion
MR imaging has 84 % sensitivity [95 % CI: 75–94 %] and 80 % specificity [95 % CI: 66–93 %] for the diagnosis of IP. Thinning or focal defect of the uteroplacental interface is the most discriminating independent MR variable in differentiating between normal placenta and IP.Key points
? MR imaging has acceptable degrees of accuracy to diagnose invasive placenta. ? Focal uteroplacental interface defect is the best finding to diagnose invasive placenta. ? Focal uteroplacental interface defect is the single independent predictor of invasive placenta. 相似文献8.
Wengen Chen Hongming Zhuang Gang Cheng Drew A. Torigian Abass Alavi 《Annals of nuclear medicine》2013,27(1):58-64
Purpose
Treatment effect of radiofrequency ablation (RFA) is traditionally accomplished with MRI and/or CT. The aim of the study was to assess the role of FDG-PET in post RFA hepatic tumor evaluation, in comparison with MRI and CT.Materials and methods
28 patients (33 hepatic RFA lesions) who had post RFA FDG-PET within 8 weeks of abdominopelvic MRI or CT were retrospectively reviewed. Accuracy of FDG-PET on post hepatic RFA evaluation was compared with MRI and/or CT based on clinical and imaging follow-up.Results
Among total of 33 RFA-treated lesions, 17 had residual or recurrent tumor (positive). PET identified 16 with a sensitivity of 94.1 %. Of these 17 lesions, 12 had concurrent MRI and 8 were positive with a sensitivity of 66.7 %. Similarly, 6 out of the 17 lesions had CT and 4 were positive with a sensitivity of 66.7 %. Sixteen lesions were successfully ablated (negative). Among them FDG-PET was negative in 13 with a specificity of 81.3 %; MRI was performed in 8 and 7 were negative with a specificity of 87.5 %; CT was performed in 8 and 5 were negative with a specificity of 62.5 %. The overall accuracy of PET, MRI and CT was 87.9, 75.0, and 64.3 %, respectively. The average scan numbers for PET, MRI and CT to achieve a final accurate diagnosis were 1.121, 1.316 and 1.250, with a corresponding cost of $1455.2, $1845.8, and $933.8, respectively.Conclusions
The study suggests that FDG-PET is superior to MRI and/or CT and is more cost-effective in post RFA hepatic tumor assessment. 相似文献9.
Afshin Mohammadi Mohammad Ghasemi-rad Miramir Aghdashi Nikol Mladkova Paria Baradaransafa 《Skeletal radiology》2013,42(2):219-224
Introduction
Spondyloarthropathies including ankylosing spondylitis (AS) require early diagnosis to prevent irreversible changes. Sacroiliitis is a common initial manifestation of AS and is frequently diagnosed by magnetic resonance imaging (MRI). The goal of our study was to assess color Doppler ultrasonography as a potential diagnostic tool in suspected sacroiliitis in comparison with MRI representing the gold standard.Materials and methods
Fifty-one consecutive patients with AS and sacroiliitis and 30 control subjects underwent contrast-enhanced MRI and high resolution color Doppler and duplex ultrasonography of both sacroiliac joints (SIJ) for the detection of vascularization and blood flow spectral Doppler waveform analysis.Results
MRI demonstrated active disease in 27 and inactive disease in 24 patients. CDUS detected pulsatile monophasic wave spectral waveform flow in 22 patients with the active disease, and triphasic in 7 patients with inactive disease and in 8 control patients. The sensitivity, specificity, positive predictive value and negative predictive value for active sacroiliitis detection with CDUS were 82 % (95 % CI, 68–91 %), 92 % (95 % CI, 85–96 %), 91 % (95 % CI, 84–96 %), and 84 % (95 % CI, 70–92 %), respectively, for pulsatile monophasic wave spectral waveform Doppler sonography. MRI of SIJ was negative in all 30 (60 SIJ) control participants.Conclusions
Our results show that CDUS is a practical and useful tool in the diagnosis of active sacroiliitis. 相似文献10.
Hugo J. A. Adams Thomas C. Kwee Malou A. Vermoolen Bart de Keizer John M. H. de Klerk Judit A. Adam Rob Fijnheer Marie José Kersten Jaap Stoker Rutger A. J. Nievelstein 《European radiology》2013,23(8):2271-2278
Objective
To assess and compare the value of whole-body MRI with FDG-PET for detecting bone marrow involvement in lymphoma.Methods
A total of 116 patients with newly diagnosed lymphoma prospectively underwent whole-body MRI and blind bone marrow biopsy (BMB) of the posterior iliac crest. Of 116 patients, 80 also underwent FDG-PET. Patient-based sensitivities of whole-body MRI for detecting bone marrow involvement were calculated using BMB as reference standard and compared with FDG-PET in aggressive and indolent lymphomas separately.Results
Sensitivity of whole-body MRI in all lymphomas was 45.5 % [95 % confidence interval (CI): 29.8–62.0 %]. Sensitivity of whole-body MRI in aggressive lymphoma [88.9 % (95 % CI: 54.3–100 %)] was significantly higher (P?=?0.0029) than that in indolent lymphoma [23.5 % (95 % CI: 9.1–47.8 %)]. Sensitivity of FDG-PET in aggressive lymphoma [83.3 % (95 % CI: 41.8–98.9 %)] was also significantly higher (P?=?0.026) than that in indolent lymphoma [12.5 % (95 % CI: 0–49.2 %)]. There were no significant differences in sensitivity between whole-body MRI and FDG-PET (P?=?1.00)Conclusion
Sensitivity of whole-body MRI for detecting lymphomatous bone marrow involvement is too low to (partially) replace BMB. Sensitivity of whole-body MRI is significantly higher in aggressive lymphoma than in indolent lymphoma and is equal to FDG-PET in both entities.Key Points
? Bone marrow involvement in lymphoma has prognostic and therapeutic implications. ? Blind bone marrow biopsy (BMB) is standard for bone marrow assessment. ? Neither whole-body MRI nor FDG-PET can yet replace BMB. ? Both techniques have higher sensitivity in aggressive than in indolent lymphoma. ? Both imaging techniques are complementary to BMB. 相似文献11.
Sarfraz Ahmad Jonathan Stevenson Charles Mangham Gillian Cribb Paul Cool 《Skeletal radiology》2014,43(12):1679-1686
Objective
Assessment of the extent of tumours using magnetic resonance imaging (MRI) is the basis for bone resection in limb-salvage surgery. We aimed to compare the accuracy of T1-weighted MRI and STIR sequences in measuring the extent of proximal femoral tumours, using the macroscopic specimens as the gold standard for comparison.Materials and methods
We compared single coronal T1-weighted with STIR sequences in 34 proximal femoral tumours, using bivalved resected macroscopic tumours for comparison. After randomisation, four observers measured longitudinal osseous tumour extent using MRI and specimen photographs on two separate occasions, 3 weeks apart.Results
There were 25 metastatic tumours, 8 chondrosarcomas and 1 myeloma. Eight patients presented with pathological fractures. The Pearson’s correlation coefficient for comparison of T1 with macroscopic tumours was 0.91 (95 % confidence interval [CI]: 0.83 to 0.96) for all observers and 0.90 (95 % CI: 0.81 to 0.95) for STIR images. This difference was not statistically significant, and T1 and STIR sequence measurements had similar precision and accuracy. Bland–Altman plots showed T1-weighted imaging to be unbiased, whereas STIR sequences were biased and had systematic error. Moreover, STIR measurements overestimated tumour size by 6.4 mm (95 % CI: ?26.9 to 39.7 mm) and 2 patients were outliers. T1 measurements were closer to the macroscopic measurements with a mean difference of 1.3 mm (95 % CI: ?28.9 mm to 31.5 mm), with 3 patients falling outside of this. The variance was greater for STIR measurements. This difference between T1 and STIR measurements was statistically significant (p?=?0.000003). The intra-observer reliability between separate measurements for MRI and specimen photographs achieved interclass correlation coefficients of 0.97, 0.96 and 0.95 (T1, STIR and macroscopic tumour respectively). T1 had greater interobserver correlation than for STIR and macroscopic tumour measurements (0.88 vs 0.85 and 0.85 respectively). These differences in interclass correlation were not statistically significant.Conclusion
This study has shown T1-weighted MRI sequences to be unbiased compared with STIR sequences at determining intra-osseous tumour extent. STIR overestimates the length of bone tumours. T1 is therefore preferred for pre-operative planning for the resection of bone tumours. 相似文献12.
Pascal Rousset Pierre-Fleury Chaillot Etienne Audureau Caroline Rey-Salmon Bertrand Becour Isabelle Fitton Dominique Vadrot Marie-Pierre Revel 《European radiology》2013,23(8):2146-2155
Objective
To evaluate the accuracy of abdominal radiography (AXR) for the detection of residual cocaine packets by comparison with computed tomography (CT).Methods
Over a 1-year period unenhanced CT was systematically performed in addition to AXR for pre-discharge evaluation of cocaine body packers. AXR and CT were interpreted independently by two radiologists blinded to clinical outcome. Patient and packet characteristics were compared between the groups with residual portage and complete decontamination.Results
Among 138 body packers studied, 14 (10 %) had one residual packet identified on pre-discharge CT. On AXR, at least one reader failed to detect the residual packet in 10 (70 %) of these 14 body packers. The sensitivity and specificity of AXR were 28.6 % (95 % CI: 8.4–58.1) and 100.0 % (95 % CI: 97.0–100.0) for reader 1 and 35.7 % (95 % CI: 12.8–64.9) and 97.6 % (95 % CI: 93.1–99.5) for reader 2. There were no significant patient or packet characteristics predictive of residual portage or AXR false negativity. All positive CT results were confirmed by delayed expulsion or surgical findings, while negative results were confirmed by further surveillance.Conclusion
Given the poor performance of AXR, CT should be systematically performed to ensure safe hospital discharge of cocaine body packers.Key Points
? Both abdominal radiography and computed tomography can identify gastrointestinal cocaine packets. ? Ten per cent of body packers had residual packets despite two packet-free stools. ? Seventy per cent of these residual packets were missed on AXR. ? No patient or packet characteristics predicted residual packets or AXR false negativity. ? CT is necessary to ensure safe medical discharge of body packers. 相似文献13.
P. Balageas F. Cornelis Y. Le Bras R. Hubrecht J. C. Bernhard J. M. Ferrière A. Ravaud N. Grenier 《European radiology》2013,23(7):1925-1932
Objectives
To evaluate survival and outcomes after percutaneous radiofrequency ablation (RFA) of malignant renal tumours in high-risk patients with long-term follow-up.Methods
Between 2002 and 2009, 62 patients (71 tumours), with a median age of 73.5 years (20–87), consecutively treated with RFA under ultrasound or computed tomography guidance for malignant renal tumours were retrospectively selected and prospectively followed until 2012, including 25 patients (40.3 %) with solitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 and 46 mm (median: 23 mm).Results
Radiofrequency ablation was technically possible for all patients. Mean follow-up was 38.8 months (range: 18–78 months). Primary and secondary technique effectiveness was 95.2 % and 98.4 % per patient respectively. The rates of local tumour progression and metastatic evolution were 3.2 % and 9.7 % per patient and were associated with tumour size >4 cm (P?=?0.005). The disease-free survival rates were 88.3 % and 61.9 % at 3 and 5 years. No significant difference in glomerular filtration rates before and after the procedure was observed (P?=?0.107). The major complications rate was 5.9 % per session with an increased risk in the case of central locations (P?=?0.006).Conclusions
Percutaneous renal RFA appears to be safe and effective with useful nephron-sparing results.Key Points
? Radiofrequency ablation (RFA) is a well-tolerated technique according to mid-term results. ? RFA for malignant renal tumours preserved renal function in high-risk patients. ? Mid-term efficacy of RFA was close to that of formal conservative surgery. ? Tumour size and central location limit the efficacy and safety of RFA. 相似文献14.
S. M. Gregory C. J. Anderson U. Patel 《Cardiovascular and interventional radiology》2013,36(3):682-689
Purpose
To study the feasibility of percutaneous radiofrequency ablation (RFA) of large angiomyolipomas (AMLs) using saline-cooled electrodes.Materials and Methods
Institutional Review Board approval for the study was received. Four patients (all female, age range 33–67 years) with large AMLs (maximal axis 6.1–32.4 cm) not suitable for embolotherapy or surgery consented to a trial of RFA. Procedures were performed under computerized tomographic guidance using 14G saline-infused electrodes. Two ablations (diameter 4–7 cm) were undertaken in each patient. Variables studied were technical success, treatment safety, alteration of tumor consistency, tumor size, effect on renal function, and medium-term freedom from haemorrhage.Results
All four patients underwent successful RFA without any intraprocedural complications. There has been no haemorrhage, or new renal specific symptom, during a minimum 48-month period, and normal renal function has been normal. On follow-up radiological imaging, the tumors have become fattier with involution of the soft-tissue elements (soft tissue–to–total tumor ratio decreased mean [range] of 0.26 [0.14–0.48] to 0.17 [0.04–0.34] U; p = 0.04 [paired Student t test]). Further evidence of treatment effect was the development of a capsule around the ablation zone, but there was no change in overall tumor volume (mean [range] 1,120 [118–2,845] to 1150 [90–3,013] ml; p = 1 [paired Student t test]).Conclusion
RFA of large AMLs is technically feasible using saline-infused electrodes. The soft-tissue elements decreased in volume; the tumors become fattier; and there has been no renal haemorrhage during a 48-month period. 相似文献15.
Claus Koelblinger Sandra Strauss Alice Gillams 《Cardiovascular and interventional radiology》2014,37(1):147-153
Purpose
Resection is the mainstay of management in patients with sarcoma lung metastases, but there is a limit to how many resections can be performed. Some patients with inoperable disease have small-volume lung metastases that are amenable to thermal ablation. We report our results after radiofrequency ablation (RFA).Methods
This is a retrospective study of patients treated from 2007 to 2012 in whom the intention was to treat all sites of disease and who had a minimum CT follow-up of 4 months. Treatment was performed under general anesthesia/conscious sedation using cool-tip RFA. Follow-up CT scans were analyzed for local control. Primary tumor type, location, grade, disease-free interval, prior resection/chemotherapy, number and size of lung tumors, uni- or bilateral disease, complications, and overall and progression-free survival were recorded.Results
Twenty-two patients [15 women; median age 48 (range 10–78) years] with 55 lung metastases were treated in 30 sessions. Mean and median tumor size and initial number were 0.9 cm and 0.7 (range 0.5–2) cm, and 2.5 and 1 (1–7) respectively. Median CT and clinical follow-up were 12 (4–54) and 20 (8–63) months, respectively. Primary local control rate was 52 of 55 (95 %). There were 2 of 30 (6.6 %) Common Terminology Criteria grade 3 complications with no long-term sequelae. Mean (median not reached) and 2- and 3-year overall survival were 51 months, and 94 and 85 %. Median and 1- and 2-year progression-free survival were 12 months, and 53 and 23 %. Prior disease-free interval was the only significant factor to affect overall survival.Conclusion
RFA is a safe and effective treatment for patients with small-volume sarcoma metastases. 相似文献16.
M. Fusari S. Maurea M. Imbriaco C. Mollica G. Avitabile F. Soscia L. Camera M. Salvatore 《La Radiologia medica》2010,115(3):453-466
Purpose
This study compared the results of multislice computed tomography (MSCT) and high-field magnetic resonance imaging (MRI) in the diagnostic evaluation of pancreatic masses.Materials and methods
Forty patients with clinical and ultrasonographic evidence of pancreatic masses underwent MSCT and MRI. The majority of patients (31/40, 78%) had proven malignant pancreatic tumours (24 ductal adenocarcinoma, six mucinous cystadenocarcinoma, one intraductal papillary mucinous carcinoma), whereas the remaining patients (9/40, 22%) were found to have benign lesions (eight chronic pancreatitis, one serous cystadenoma). Results of the imaging studies were compared with biopsy (n=33) and/or histology (n=7) findings to calculate sensitivity, specificity, accuracy and positive (PPV) and negative (NPV) predictive value for correct identification of tumours and evaluation of resectability of malignancies.Results
Both for tumour identification and resectability, MSCT and MRI had comparable diagnostic accuracy, with no statistically significant differences between them. Tumour identification CT/MRI: accuracy 98/98%, sensitivity 100/100%, specificity 88/88%, PPV 97/97%, NPV 100/100%; tumour resectability CT/MRI: accuracy 94/90%, sensitivity 92/88%, specificity 100/100%, PPV 100/100%, NPV 78/70%.Conclusions
MRI represents a valid diagnostic alternative to CT in the evaluation of patients with pancreatic masses, both for correct identification and characterisation of primary lesions and to establish resectability in the case of malignancies. New high-field MRI equipment allows optimal imaging quality with good contrast resolution in evaluating the upper abdomen. 相似文献17.
Andrew Shawyer Nicos I. Fotiadis Girish Namagondlu Arun Iyer Mark Blunden Martin Raftery Magdi Yaqoob 《Cardiovascular and interventional radiology》2013,36(1):133-139
Purpose
Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS.Methods
Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up.Results
The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482–0.977] at 6 months and 72.7 % (95 % CI 0.390–0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587–0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156–2,282).Conclusion
The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents. 相似文献18.
Miltiadis Krokidis Stavros Spiliopoulos Magdalena Jarzabek Nikos Fotiadis Tarun Sabharwal Tim O’Brien Andy Adam 《European radiology》2013,23(7):1933-1939
Objectives
To evaluate the long-term results of percutaneous radiofrequency ablation (RFA) of small renal tumours in patients with a single functioning kidney (SFK).Methods
This is a single-centre prospective study. Patients with an SFK and a tumour smaller than 3.5 cm, treated with RFA over a 7.5-year period, were included. Nineteen consecutive patients (12 male), aged between 33 and 83 years (mean 61.4), were treated for 23 lesions. Primary endpoints were technical success and tumour recurrence rate. Secondary endpoints were the deterioration of renal function and overall survival rate.Results
The mean follow-up was 56.1 months (range 36–102). Primary technical success was 100 %. There were no major peri-procedural complications. In two cases, minor complications occurred. There was no significant difference between the baseline glomerular filtration rate (GFR) and GFR at 3, 12 and 24 months post-procedure. In four lesions (17 %), recurrence was detected and an additional RFA session was performed. None of the patients developed renal failure during their lifetime. Three of the patients died because of other reasons.Conclusions
Percutaneous RFA of small renal tumours in patients with an SFK offers very satisfactory long-term results regarding preservation of renal function, local tumour control and overall survival.Key Points
? Tumour in a single functioning kidney requires minimally invasive treatment. ? Radiofrequency ablation plays an established role in managing small renal tumours. ? Long-term results of radiofrequency ablation have shown satisfactory local tumour control. ? Long-term results have also shown that renal function may be preserved. 相似文献19.
Håkan Geijer Lars H. Breimer 《European journal of nuclear medicine and molecular imaging》2013,40(11):1770-1780
Purpose
Neuroendocrine tumours (NET) are uncommon and may be localized in many different places in the body. Traditional imaging has mainly been performed with CT and somatostatin receptor scintigraphy (SRS). Recently, it has become possible to use somatostatin receptor PET/CT (SMSR PET) instead, which might improve diagnostic quality. To evaluate the diagnostic quality of SMSR PET we performed a meta-analysis as an update of a previous study published in 2012.Methods
A literature search was performed searching MEDLINE, Embase and five other databases with a combination of the expressions “PET”, “positron emission tomography”, “neuroendocrine” and “NET”. The search was updated to 31 December 2012. Studies were selected which evaluated the sensitivity and specificity of SMSR PET for NET in the thorax or abdomen with a study size of at least eight patients. The methodological quality of the included studies was evaluated with QUADAS-2.Results
Eight studies fulfilled the inclusion criteria and were selected for final analysis, and 14 articles from a previous meta-analysis were added for a total of 22 articles. A total of 2,105 patients were included in the studies, an increase from 567 in the previous meta-analysis. The pooled sensitivity was 93 % (95 % CI 91 – 94 %) and specificity 96 % (95 % CI 95 – 98 %). The area under the summary ROC curve was 0.98 (95 % CI 0.95 – 1.0). In the previous meta-analysis the pooled sensitivity was 93 % (95 % CI 91 – 95 %) and specificity 91 % (95 % CI 82 – 97 %).Conclusion
SMSR PET has good diagnostic performance for evaluation of NET in the thorax and abdomen, better than SRS which has been the previous standard method. This meta-analysis gives further support for switching to SMSR PET. 相似文献20.
G. Kuhan G. A. Antoniou M. Nikam S. Mitra F. Farquharson J. Brittenden N. Chalmers 《Cardiovascular and interventional radiology》2013,36(3):699-705