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1.
PURPOSEBone tracers have been validated for many years in detecting transthyretin cardiac amyloidosis (TTR-CA). However, several new studies suggest conflicting results. Our study aimed to systematically evaluate the accuracy of bone radiotracers for diagnosis and differentiation of TTR-CA via a systematic review and meta-analysis.METHODSWe retrieved articles assessing the performance of bone tracer in diagnosing and differentiating TTR-CA from PubMed, the Cochrane Library, ScienceDirect, and DOAJ databases, dating up to 10 July 2020. The meta-analysis was conducted through Stata 16 software, and the risk of bias for the included studies was assessed by the QUADAS-2 tool. Moreover, we made a comprehensive review.RESULTSFourteen articles were included in the systematic review, and 9 in the meta-analysis. The pooled sensitivity was 0.97 (95% confidence interval [95% CI] 0.85–0.99) with heterogeneity (I2=73.5, 95% CI 55.6–91.2), and the specificity was 0.92 (95% CI 0.82–0.96) with heterogeneity (I2=42.0, 95% CI 0.0–86.9). The pooled positive and negative likelihood ratios were 11.49 (95% CI 5.07–26.0) and 0.03 (95% CI 0.01–0.18), respectively. The diagnostic odds ratio was 341 (95% CI 53–2194), and the area under the receiver operating characteristic curve was 0.96 (95% CI 0.94–0.97).CONCLUSIONThe findings evidence that the bone radiotracer is a valuable noninvasive approach that provides high accuracy for diagnosing TTR-CA and plays a modest role in differentiating TTR-CA from immunoglobulin amyloid light-chain cardiac amyloidosis. 99mTc-HMDP may be more accurate than 99mTc-PYP, 99mTc-DPD, and 18F-NaF in the TTR-CA detecting process, and 18F-NaF is a promising bone tracer to diagnose and differentiate TTR-CA.

Cardiac amyloidosis (CA) is a group of fatal diseases with poor prognosis (1, 2), which occurs when amyloid (misfolded protein fragments) are deposited in the myocardial extracellular matrix, small blood vessels, and the conduction system (1, 2). The two most frequent types of CA are transthyretin CA (TTR-CA) and immunoglobulin amyloid light-chain CA (AL-CA) (15). TTR-CA could be acquired from the aggregation of wildtype TTR (TTRwt), mutant TTR (TTRm), and other types of TTR (36). Without typical symptoms, TTR-CA is easily misdiagnosed and underdiagnosed (7, 8), especially in the early stage. From the clinical perspective, doctors often get frustrated in diagnosing TTR-CA and distinguishing TTR-CA from AL-CA, which would delay the optimal treatment and lead to poor prognosis (2).The well-known gold standard for diagnosing TTR-CA depends on endomyocardial biopsy (EMB) (1, 7, 9). Other diagnostic criteria have also been considered (6, 10, 11), such as biopsies from involved organs combined with significant echocardiography findings. Early diagnosis and differentiation of TTR-CA are crucial for the treatment and prognosis (7, 11). Although biopsy combined with additional measures (genotyping or immunohistochemistry) can diagnose and differentiate TTR-CA, biopsy, especially the EMB, cannot be used as a routine procedure due to its possible invasive complications (15). Recently, plenty of studies on noninvasive examinations emerged, trying to discuss the early diagnosis of TTR-CA and the differentiation between TTR-CA and AL-CA (10, 1226). The most representative method is the application of gamma-emitting bone tracers, such as 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD), 99mTc-pyrophosphate (99mTc-PYP), and 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) (1224). Besides, the positron emission tomography (PET) bone tracer 18F-sodium fluoride (18F-NaF) has also been used to explore the diagnosis and differentiation of TTR-CA (25, 26).Most studies suggest that bone tracers can diagnose and differentiate TTR-CA. A prior meta-analysis has partly reported the diagnostic accuracy of gamma-emitting bone tracers in TTR-CA (27). Nevertheless, the differentiation of TTR-CA from AL-CA was not fully elaborated, and it did not provide a systematic review and include the positron-emitting bone tracer 18F-NaF. More importantly, several new studies have indicated that bone radiotracers present suboptimal sensitivity in detecting some TTR-CA (28, 29), which contradicts previous analyses. Therefore, we sought to provide further evidence on the role of bone tracers in TTR-CA diagnosis and CA subtype differentiation by performing a more comprehensive systematic review and a meta-analysis.  相似文献   

2.
PURPOSEThe aim of our study was to evaluate the availability of magnetic resonance spectroscopy (MRS) for the differentiation of benign or malignant pulmonary nodules and masses.METHODSA total of 59 patients (45 male, 14 female) with pulmonary nodules and masses were included in this prospective study. MRS was applied to the pulmonary lesions of the patients and choline levels were determined. Afterwards CT-guided percutaneous needle biopsy was performed. According to the biopsy results, pulmonary lesions were benign in 25 patients and malignant in 34 patients.RESULTSCholine levels were significantly higher in malignant lesions compared with benign lesions (p < 0.001). When the other conditions were kept constant, the probability of malignancy significantly increased by 17.38-fold (95% CI, 3.78–79.93) in those with choline levels >1.65 μmol/g compared to those with choline levels ≤1.65 μmol/g (p < 0.001).CONCLUSIONMRS is a noninvasive method that can be used in the differential diagnosis of pulmonary nodules and masses.

The majority of the solitary pulmonary nodules have a benign character (1). However, all pulmonary nodules should be considered as malignant lesions unless proven otherwise (2). The differential diagnosis of these lesions may be an important problem in routine medical practice. Computed tomography (CT) is the standard method for the examination of the nodules and mass lesions (3). CT imaging of morphological features like size, margins, and calcification enables the investigation of malignancy (4). However, there is some overlap so that some malignant lesions may appear benign, while some benign nodules may show morphological features typical for malignancy (5). CT imaging for differantial diagnosis have problems like false-negative and false-positive results, over-diagnosis, benign nodule resections, and exposure to radiation (6). Biopsy is the most reliable and effective method for the diagnosis of the pulmonary nodules and mass lesions. However, it may cause serious complications such as pneumothorax, hemoptysis, air embolism, tumor cell seeding and death (7, 8). In addition, the tolerability of this invasive intervention is rather low among patients.Magnetic resonance imaging (MRI) provides information about the tumor morphology and magnetic resonance spectroscopy (MRS) provides biochemical information about the physiology and metabolism of the disease (9). MRS enables molecular analysis of the tissues based on the display of different chemical shifts of certain nuclei in the magnetic field (10). MRS was initially used in neuroradiology for characterization of tumor, stroke, epilepsy, infection, and neurodegenerative diseases. In recent years, it was also introduced in the evaluation of lesions in other organs like breast (11), liver (12), pancreas (13), and prostate (14). There are some in vitro studies in the literature on the use of MRS in lung cancer showing higher lactate and total choline peaks compared with normal tissues (15, 16). Also there is one case report in the literature regarding the feasibility of using MRS in lung cancer (17).The objective of this study was to demonstrate the value of MRS, which is a noninvasive method and does not require a contrast agent, in the differential diagnosis of pulmonary nodules and mass lesions.  相似文献   

3.
PURPOSEWe aimed to investigate the accuracy of density characteristics and washout values of lesions detected on computed tomography (CT) at the cutoff values obtained from the literature by taking the pathological results of adrenalectomy specimens as reference and to determine the cutoff values of parameters evaluated on CT for the differentiation of adenoma and nonadenoma lesions in the study group.METHODSHospital records and standard CT imaging data (noncontrast early phase [65 s] and late phase [15 min] ) of 84 patients with 87 lesions who underwent adrenalectomy between January 2012 and December 2018 were retrospectively reevaluated by two radiologists in consensus. The patients were categorized as having adenoma and nonadenoma lesions according to the pathology results. The sensitivity, specificity and diagnostic accuracy of CT parameters (density values and washout percentages) were evaluated. Differences in the CT parameters (size, noncontrast and early-late enhancement density and absolute and relative washout values) were investigated. The optimal cutoff values of CT parameters were determined by ROC analysis.RESULTSNoncontrast CT had a specificity of 87.75% and 95.9%, sensitivity of 60% and 48.6%, diagnostic accuracy of 77.7% and 89.47% for adenomas, at the cutoff values of ≤10 HU and ≤0 HU, respectively. For absolute washout value ≥ 60%, the sensitivity, specificity and accuracy were 64.7%, 52.38% and 56.75%, respectively; while these rates were 76.47%, 56.52% and 62.16%, respectively, for relative washout value ≥40%. Adenomas and nonadenomas showed significant difference in terms of size (p < 0.0001), unenhanced attenuation (p < 0.0001), relative washout (p = 0.020) and delay enhancement (p < 0.001). But there were no differences in terms of absolute washout (p = 0.230) and early enhancement (p = 0.264). The cutoff values for the differentiation of adenomas and nonadenomas were as follows: size ≤44 mm, noncontrast density <20 HU, early-phase density ≥45 HU, delayed-phase density ≤44 HU, absolute washout 74.83% and relative washout 57.76%.CONCLUSIONThe current washout criteria used in the differentiation of adenoma and nonadenoma lesions in dynamic CT imaging can give false negative and positive results. According to the existing criteria, the most reliable parameter in adenoma–nonadenoma differentiation is ≤ 0 HU noncontrast CT density value.

According to the autopsy studies, adrenal masses are among the most common tumors detected in humans (1). In autopsy series, this prevalence has been reported as 1% to 9.8% (1). With the advances in imaging techniques and their increasing use, there has also been a recent increase in radiologically reported adrenal masses (25), varying between 0.35% and 5% for CT examinations (6). Adenomas are the most common adrenal lesions in patients without primary malignancy (1, 7, 8). Although adrenal gland is a common site for distant metastases in patients with known malignancies, adenomas are more common than metastases in these patients. Since the majority of adrenal adenomas are benign and nonfunctional lesions, a clinical and radiological follow-up is sufficient. In nonadenoma lesions, a biopsy or direct surgical resection can be recommended according to the characteristics of the patient. Therefore, determination of whether a detected adrenal mass is an adenoma or nonadenoma is critically important in patient management and changes the form of treatment (9).Computed tomography (CT) is the radiological method of choice in the characterization of adrenal mass lesions (8, 10). Adenomas have low density values in noncontrast CT scans due to their intracytoplasmic fat content (3, 6, 10, 11). However, as much as 30% of adrenal adenomas are poor in fat, thus making it impossible to distinguish them from other masses based on noncontrast CT density (8, 10). In this case, most authors reported that the washout character determined by dynamic contrast-enhanced CT examination differentiates adrenal adenomas from other lesions (1013). Due to their rich capillary network, adenomas are stained early with the contrast agent, causing them to exhibit a high level of washout (8). However, some nonadenoma lesions, particularly pheochromocytoma, have been reported to show a similar washout pattern (4, 1418). In the literature, there are many studies that investigated noncontrast and contrast-enhanced CT density and the washout criterion for the differentiation of adenoma and nonadenoma lesions (4, 6, 1018). However, the scan parameters used in these studies, the characteristics of the devices, the time of wash-in and washout, contrast agent dose, and iodine concentration are not standard and show differences (e.g., 2.5–10 mm collimation; 3–5 mm reconstruction intervals; 80–140 kVp; 150–370 mA; 0.75–3:1 pitch; nonhelical, helical, or multi-slice device; 35–120 s wash-in time; 3–45 min washout time; 100–150 mL contrast agent dose; 300–370 mg/L iodine concentration). In a study using different minutes as washout criteria in the same lesions, different specificity and sensitivity values were found according to the washout time (19). In studies evaluating the effectiveness of adrenal CT in the literature, the reference method also differs. For these reasons, the available literature data is far from being standard. Nonadenoma lesions, which are evaluated as adenoma based on the available data, may cause serious problems in patient management.In the current study, we aimed to investigate the accuracy of density characteristics and washout values of lesions detected on CT at the cutoff values obtained from the literature by taking the pathological results of adrenalectomy specimens as reference to determine the cutoff values of parameters evaluated on CT for the differentiation of adenoma and nonadenoma lesions in the study group.  相似文献   

4.
5.
PURPOSEOur purpose is to clarify the optimal timing of surgery after transarterial embolization (TAE) for renal cell carcinoma (RCC) bone metastases.METHODSThis retrospective study included 41 patients with RCC bone metastases embolized between 2013 and 2019. Different-sized particulate and/or liquid embolic agents were used for TAE. Embolizations were categorized into groups 1–3 according to the interval between TAE and surgery (group 1: <1 day, group 2: 1–3 days, group 3: >3 days). Degree of embolization after TAE was graded visually based on angiographic images (<50%, 50%–75%, 75%–90%, >90%). The relationship between the TAE–surgery interval and intraoperative blood loss (IBL) and the correlation between IBL and embolization grade were examined. Lesion sizes and the relationships among lesion localizations and contrast media usage, intervention time, and IBL were also analyzed.RESULTSForty-six pre-operative TAEs (single lesion at each session) were performed in this study (26 in group 1, 13 in group 2, 7 in group 3). Lesion sizes and distributions were similar between groups (p = 0.897); >75% devascularization was achieved in 40 (TAEs 86.96%), but the IBL showed no correlation with the embolization rate (r=0.032, p = 0.831). The TAE–surgery interval was 1–7 days. The median IBL in group 1 (750 mL; range, 150–3000 mL) was significantly lower than those in the other groups (p = 0.002). Contrast media usage (p = 0.482) and intervention times (p = 0.261) were similar for metastases at different localizations. IBL values after TAE were lower for extremity metastases (p = 0.003).CONCLUSIONBone metastases of RCC are well-vascularized, and to achieve lowest IBL values, surgery should preferably be performed <1 day after TAE.

Renal cell carcinomas (RCCs) are one of the leading causes of cancer-related death worldwide (1). About one-third of RCCs are metastatic at initial diagnosis, and skeletal metastases are the second most frequent type of RCC metastases following lung metastases (43%) (2, 3). Surgical intervention is an option for the treatment of skeletal metastases of RCCs. Although local ablative therapies like thermal ablation may be preferred for tumors <3 cm, systemic chemotherapy and radiotherapy are other options for suitable patients (4). However, RCCs are usually chemo/radio-resistant (50%), and these treatment options are usually favored for palliative intent (35).The 5-year overall survival of patients with RCC bone metastases increases when surgical metastasectomy is performed (4). However, since RCC metastases in the skeletal system are usually hypervascular, the operative blood loss could be as high as 18500 mL, which could threaten patients’ lives (6). Transarterial embolization (TAE) of bone tumors was first described in 1975 (7). The operative blood loss can be reduced by adequate devascularization after TAE of the bone metastases (811), and a blood loss of less than 3000 mL was defined as clinical success for spinal tumor surgeries (12). Selective TAE of bone metastases can be performed pre-operatively in a single session. Successful embolization can clarify the tumor margins from the surrounding tissue planes, simplifying surgical manipulation of the tumors. Thus, recurrence rates may be lower in patients undergoing this treatment combination (13, 14). Different types of permanent and temporary embolic agents can be selected for TAE of bone metastases. The rationale behind TAE is occlusion of the capillary bed of the tumors; therefore, proximal occlusion should not be preferred due to the presence of numerous collateral capillary vessels (5, 8, 15).This study aimed to clarify the optimal interval between TAE and surgery for RCC bone metastasis to minimize blood loss at the time of surgery.  相似文献   

6.
PURPOSEThere is increasing interest in the distal radial artery in the anatomic snuffbox as an alternative arterial access point, but the durability of the distal radial artery to support repetitive accesses over multiple procedures is not well established. The purpose of this study was therefore to evaluate success rates for repeated left-sided distal transradial access (ldTRA) in the anatomic snuffbox.METHODSIn this single institution retrospective study, all patients undergoing radioembolization treatments from January 1st, 2019 to May 1st, 2020 were prospectively evaluated for ldTRA. ldTRA was performed by 15 different operators. Exclusion criteria were a left radiocephalic hemodialysis fistula, inability to properly position the arm, Barbeau D waveform, or failed prior ldTRA due to tortuosity. Barbeau patterns, arterial sizes, and success rates at the first, second, and third ldTRA were compared.RESULTSFifty patients were evaluated for ldTRA and 44, 39, and 10 underwent one, two, and three ldTRA attempts for a total of 93 procedures. There was no significant change in Barbeau patterns between the first and second (p = 0.13) or first and third (p = 1.0) ldTRA. There was no significant change in artery size between the first (mean, 2.3 mm; range, 1.5–3.4 mm) and second (mean, 2.3 mm; range, 1.6–3.3 mm) (p = 0.59) and first and third (mean, 2.4 mm; range, 1.9–3.3) (p = 0.45) ldTRA. The success rate was not significantly different between the first (93%, 41/44, 95% CI 81%–99%), second (95%, 37/39, 95% CI 83%–99%), and third (100%, 10/10, 95% CI 69%–100%) procedure (p = 1.0). The asymptomatic occlusion rate was 4.1% (2/49, 95% CI 0%–14%), and subsequent ldTRA was successfully completed in both patients with occlusions. There were no hemorrhagic or ischemic complications.CONCLUSIONSuccess rates are indistinguishable among first, second, and third time ldTRA suggesting that this is a durable access point.

The radial artery has been established as a favorable arterial access point for endovascular procedures, with the potential benefits of reduced risk of complications (1) and increased patient comfort (2, 3) compared with the common femoral artery. As an extension to conventional transradial access (cTRA) upstream of the radial styloid, there has recently been interest in distal transradial access (dTRA) in the anatomic snuffbox as an alternative radial artery access point (4, 5).For interventional radiologists several benefits of left-sided distal transradial access (ldTRA) have been proposed. ldTRA with the patient’s hand across the lower abdomen simulates the positioning of right common femoral artery access, a potentially more ergonomic configuration for operators used to working right-handed (6). In this location, the left arm is tucked across the body in a more compact position for cone beam computed tomography (CT) (4). Beyond these ergonomic considerations, it has been suggested that dTRA may reduce the risk of injury to the palmar arch compared with cTRA (4) although this remains to be shown empirically (5).One limitation of dTRA compared with cTRA is that dTRA is less extensively studied. In particular, the durability of this slightly smaller (4) access point which is associated with a slightly higher failure rate (5, 7) for repeat procedures is not well established. Although the occlusion rate is reportedly low (5), few studies have specifically reported outcomes for repeated ldTRA attempts (6, 8).The purpose of this study was to evaluate success rates for repeated left-sided distal transradial access in the anatomic snuffbox.  相似文献   

7.
A 46-year-old man with a history of hepatitis B cirrhosis and hepatocellular carcinoma (HCC) status post liver transplantation two years ago complicated by HCC recurrence and biliary stenosis presented with hypovolemic shock and melena one month after endoscopic exchange of plastic biliary stents. During endoscopic retrograde cholangiopancreatography, patient was found to have hemobilia and developed uncontrollable bleeding after a common bile duct (CBD) sweep managed by insertion of a stent-graft across major papilla into presumed CBD. The bleeding continued with subsequent negative angiography, and a computed tomography angiography showed malpositioned stent-graft between major papilla and inferior vena cava (IVC). This was successfully managed by the deployment of a vascular plug inside the stent graft and excluding it by deploying a stent across the affected area in IVC.

Endoscopic retrograde cholangiopancreatography (ERCP) is the most common procedure used to diagnose and treat primary pancreaticobiliary disorders and manage postoperative complications. Overall, ERCP has a high technical success and is considered a safe procedure (1). Although with increasing operator experience and advances in technology the safety profile of ERCP is improving, it still could potentially result in severe complications (2). In liver transplant recipients, biliary complications such as biliary stenosis and Oddi sphincter dysfunction are common and can happen in 5%–20% of the patients (3, 4). With the refinement of orthotopic liver transplantation surgical technique, especially donor to recipient biliary duct-to-duct anastomosis and preserving the gastrointestinal anatomy, ERCP plays a central role for the minimally invasive management of biliary complications (5). ERCP outcomes and complications in the general population is very well understood; however, the evidence regarding post-ERCP complications in liver transplant recipients is poor, and few more recent studies suggest an overall complication rate of 9%–15% (5, 6), including a bleeding risk of 2%–3.8% (5, 6) and perforation risk of 0.6% (6), which is higher than what is reported in the general population (7).Interventional radiology (IR) procedures such as percutaneous transhepatic cholangiography and drainage are the second line in managing biliary complications of liver transplant recipients. However, IR still plays a vital role in managing procedural complications, such as bleedings that are challenging to control. We are reporting a rare severe ERCP complication in a liver transplant recipient resulting in uncontrolled bleeding. The bleeding was due to perforation between the common bile duct and inferior vena cava (IVC) and inadvertent deployment of a stent-graft connecting the IVC and duodenum. The complication resulted in massive hematemesis and pulmonary emboli and was successfully managed by an unusual IR approach.  相似文献   

8.
PURPOSEWe aimed to assess the diagnostic performance of radiomics using machine learning algorithms to predict the methylation status of the O6-methylguanine-DNA methyltransferase (MGMT) promoter in glioma patients.METHODSA comprehensive literature search of PubMed, EMBASE, and Web of Science until 27 July 2021 was performed to identify eligible studies. Stata SE 15.0 and Meta-Disc 1.4 were used for data analysis.RESULTSA total of 15 studies with 1663 patients were included: 5 studies with training and validation cohorts and 10 with only training cohorts. The pooled sensitivity and specificity of machine learning for predicting MGMT promoter methylation in gliomas were 85% (95% CI 79%–90%) and 84% (95% CI 78%–88%) in the training cohort (n=15) and 84% (95% CI 70%–92%) and 78% (95% CI 63%–88%) in the validation cohort (n=5). The AUC was 0.91 (95% CI 0.88–0.93) in the training cohort and 0.88 (95% CI 0.85–0.91) in the validation cohort. The meta-regression demonstrated that magnetic resonance imaging sequences were related to heterogeneity. The sensitivity analysis showed that heterogeneity was reduced by excluding one study with the lowest diagnostic performance.CONCLUSIONThis meta-analysis demonstrated that machine learning is a promising, reliable and repeatable candidate method for predicting MGMT promoter methylation status in glioma and showed a higher performance than non-machine learning methods.

Glioma is the most common type of primary malignant central nervous system (CNS) tumor and accounts for approximately 75% of primary malignant CNS tumors (1). Despite developments in surgery, chemotherapy, and radiotherapy, patients with glioma still suffer an unpleasant prognosis (2). In recent years, increasing attention has been given to molecular markers in patients with glioma. O6-methylguanine-DNA methyltransferase (MGMT) is a key gene that encodes a DNA repair enzyme. The methylated MGMT promoter is usually related to better overall survival in temozolomide (TMZ)-treated gliomas (35). In addition, the MGMT gene is a potential attractive therapeutic target in the molecularly targeted therapy field (6, 7). Moreover, it has been reported that MGMT promoter methylation status is significantly associated with glioma pseudo-progression in recent studies (8, 9).At present, the approaches for determining MGMT promoter methylation status in glioma are based on surgical sampling (10), which is an invasive procedure and may induce severe complications. The results always take a relatively long period, which may delay important therapeutic decisions and be influenced by intra-tumoral heterogeneity. Thus, identifying a noninvasive, preoperative, and robust means to detect MGMT promoter status is of great significance. Radiomics, which is an advanced imaging analysis technique, utilizes algorithms to automatically extract a large number of data features to convert imaging data into a high-dimensional and mineable feature space (11). Machine learning algorithms have been used to create credible statistical models for classification in radiomics (12), and they have already had a powerful influence on radiology practice and could further change the area of radiology (1315). For the CNS, magnetic resonance imaging (MRI) is the most common and noninvasive preoperative diagnostic imaging method. Increasing evidence in neuro-oncology has indicated that radiomics features based on MRI can predict the molecular subtype of glioma (1618).In recent years, a few studies have demonstrated that machine learning performs well in predicting MGMT promoter methylation status in glioma (16, 1822). However, to our knowledge, no study has performed a systematic assessment of the diagnostic accuracy of machine learning for predicting MGMT promoter methylation status. Thus, our meta-analysis aimed to systematically evaluate the diagnostic efficacy of machine learning for predicting MGMT promoter methylation status in patients with glioma.  相似文献   

9.
PURPOSEWe aimed to assess the association between complication rate and time to feeding in a cohort of patients undergoing radiologically guided placement of gastrostomy tubes.METHODSA retrospective study was conducted of all patients receiving pull-type and push-type gastrostomy tubes placed by interventional radiologists between January 1st, 2017 and December 31st, 2018 at a single institution. Primary outcomes included procedural and tube-related complications per medical chart review with a follow-up interval of 30 days. Exclusion criteria were enteral nutrition delayed more than 48 hours, no feeding information, and tubes placed for venting (n=20). Overall, 303 gastrostomy tubes (pull-type, n=184; push-type, n=119) were included. The most common indications for placement included head and neck carcinoma for push-type tubes (n=76, 63.9%) and cerebral vascular accident for pull-type tubes (n=78, 42.4%).RESULTSIn a multiple regression analysis, there was no statistically significant association between complications and time to feeding (p = 0.096), age (p = 0.758), gender (p = 0.127), indication for tube placement (p = 0.206), or type of tube placed (p = 0.437). Average time to initiation of enteral nutrition was 12.3 hours for the pull-type and 21.7 hours for the push-type cohort (p < 0.001). Additional multiple regression analyses of pull-type tubes and push-type tubes separately also did not find any significant association between complications and the above factors (p > 0.05).CONCLUSIONThere was no statistically significant correlation between time to feed and complications, suggesting that there is no clinical difference between early and late feeding following gastrostomy tube placement.

Percutaneous radiologic gastrostomy is a well-established safe and effective feeding method (15). Early initiation of feeding after tube placement has several benefits, including decreased hospital stay and shorter time on intravenous nutrition, but the theoretical risk of increased complication rate has led many physicians to delay feeding initiation. While several studies have found that early initiation of feeding after tube placement is safe in the endoscopic literature (610), the association between time to feed and complications has been less frequently studied in the radiologic literature. Studies that have done so have been limited in the methods of tube placement included, sample size, and types of patients included (11, 12). Furthermore, despite evidence in the endoscopic literature, many physicians do not initiate early feeding after either endoscopic or radiologic gastrostomy placement (13).Within interventional radiology, the time to initiation of enteric feeding is one variable that remains discrepant between institutions and may pose consequence with respect to complications in the early post-placement setting (69, 11, 14, 15). Fora of interventional radiologists have demonstrated physicians are using a wide variety of fasting times following tube placement ranging from “early” (commonly less than 6 hours) to “delayed” (commonly 24 hours or greater) that is neither directly based on evidence nor guideline based (16). Furthermore, time to feeding following gastrostomy remains an important clinical metric that may impact initiation of therapy, feeding, and hospital discharge. The purpose of this study was to analyze the rate of feeding related complications in a cohort of all patients undergoing either “push” or “pull” type radiologic gastrostomy placement at a single institution based on time to initiation of feeding following tube placement.  相似文献   

10.

PURPOSE

Diffusion-weighted imaging (DWI) - fluid attenuated inversion recovery (FLAIR) mismatch was proven useful to time the onset of wake-up stroke; however, identifying the status of FLAIR imaging has been mostly subjective. We aimed to evaluate the value of relative DWI signal intensity (rDWI), and relative apparent diffusion coefficient (rADC) in identifying the FLAIR status in the acute period.

METHODS

Autologous clot was used to embolize left middle cerebral artery in 20 dogs. Magnetic resonance imaging was performed 3–6 hours and 24 hours after embolization. DWI-FLAIR mismatch was defined as hyperintense signal detected on DWI, but not on FLAIR. The mean values of rDWI or rADC of FLAIR− and FLAIR+ lesions were compared and the critical cutoff values of rDWI and rADC for identifying the FLAIR status were determined.

RESULTS

Stroke models were successfully established in all animals. DWI+ lesions were found in all 20 dogs from three hours, while FLAIR+ lesions were found in three, 11, 16, 19, and 20 dogs at five time points after embolization, respectively. The mean rDWI values were significantly different between FLAIR− and FLAIR+ lesions (P < 0.001), but rADC values were not (P = 0.73). Using rDWI=1.90 as the threshold value, excellent diagnostic efficacy was achieved (AUC, 0.88; sensitivity, 0.77; specificity, 0.88). However, rADC appeared not useful (AUC, 0.48; sensitivity, 0.52; specificity, 0.58) in identifying the FLAIR status.

CONCLUSION

In our embolic canine stroke model, rDWI was useful to identify FLAIR imaging status in the acute period, while rADC was not.Diffusion-weighted imaging (DWI) - fluid attenuated inversion recovery (FLAIR) mismatch refers to the situation where an ischemic lesion is detected on DWI in the absence of a corresponding lesion on FLAIR imaging. Recently, several studies indicated that DWI-FLAIR mismatch might aid to predict whether the stroke onset time is within 4.5 hours or not (16). Furthermore, this mismatch pattern, which is based on the detection time difference between DWI and FLAIR imaging, would help to time the stroke lesions in patients with unclear onset time. This information is important for clinicians to select the optimal treatment, because more ischemic stroke patients would benefit from thrombolytic therapy (7). However, in previous studies, assessment of FLAIR imaging has been subjective. An objective, simple, and quantitative measurement to help judge the status of FLAIR imaging is yet to be found.DWI can detect a hyperacute ischemic lesion as soon as 30 minutes after stroke, and it is viewed as a sensitive and effective tool to detect ischemic stroke events (8, 9). Meanwhile, several studies observed that the relative signal intensity (SI) of lesions on DWI could be a reliable parameter to demonstrate the secondary pathologic process after ischemic stroke (10). Therefore, we hypothesized that, quantitative parameters derived from DWI, such as relative DWI signal intensity (rDWI) and relative ADC value (rADC), might be useful to evaluate the status of FLAIR imaging.In this study, we aimed to determine the value of rDWI and rADC in evaluating the status of FLAIR imaging, based on our embolic canine ischemic stroke model, considering different temporal evolution of the volume of ischemic lesions demonstrated on DWI and FLAIR imaging.  相似文献   

11.
PURPOSEClinical studies conducted in different geographic regions using different methods to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) have demonstrated discordant results. Meta-analyses in this field indicate comparable overall survival (OS) with TACE and TARE, while reporting a longer time to progression and a higher downstaging effect with TARE treatment. In terms of isolated procedure costs, treatment with TARE is 2 to 3 times more, and in some countries even more, expensive than TACE. However, relevant literature indicates that TARE is more advantageous compared to TACE regarding the need for repeat procedures, costs of complication management, total hospital stay and quality of life. Heterogeneity of hepatocellular carcinoma (HCC) patients as well as the shortcomings of clinical classifications, randomized clinical trials and cost-effectiveness studies make it difficult to choose between treatment alternatives in this field. As in other countries, these challenges lead to differences in treatment choice across different centers in Turkey.METHODSThe present expert panel used two round modified Delphi method to investigate the resources and clinical parameters referenced while selecting patients for drug-eluting beads (DEB)-TACE and TARE treatment modalities in Turkish clinical practice. The cost-effectiveness parameters and comparisons of these treatments have also been evaluated at a prediction level.RESULTSThe panelists stated that they most commonly use the BCLC staging system for the management of HCC patients in Turkey. However, they did not find any of the staging systems or treatment guidelines sufficient enough for their clinical practice in terms of covering the down-staging intent of treatments. Since living donor transplant preference is higher in Turkey than the rest of the Western countries, down-staging treatments are thought to be more prioritized in Turkey than that in other Western countries. The panelists reached a consensus that TARE may provide improved OS and reduce the number of repeat procedures compared to DEB-TACE in intermediate-stage patients with a single tumor spanning a diameter above 5 cm who experience recurrence after previous treatment with TACE and most TACE-naïve patient groups in intermediate stage.CONCLUSIONBased on the consensus on OS and the number of procedures, the panelists assumed that TARE would be more cost-effective than DEB-TACE in most groups of TACE-naïve patients in intermediate stage and in those with a single tumor spanning a diameter above 5 cm. It was also stated that the predicted cost-effectiveness advantage of TARE could be more pronounced in patients with a tumor diameter greater than 7 cm.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death (1). Unlike other cancers, disease course and treatment vary based on the underlying liver disease and remaining liver reservoir in addition to tumor burden (2). Based on the treatment guidelines in this field, cases in the early stage are candidates for curative treatment options such as ablation, resection, and transplantation (24). Available clinical data show that only a limited number of cases are diagnosed at early stage and HCC cases encountered in daily clinical practice are often in more advanced stages of the disease (1, 5).According to the Barcelona Clinic Liver Cancer (BCLC) staging system, which is commonly referenced in this field, and treatment guidelines that adopt this system, transarterial chemoembolization (TACE) is the standard of care for patients with intermediate HCC (BCLC-B) (2, 611). Currently, the transarterial chemoembolization with drug-eluting beads (DEB-TACE) method is a novel TACE modality and a candidate to replace the lipiodol-TACE (conventional TACE) approach, which has been in use for a long time (12). Although transarterial radioembolization (TARE; selective internal yttrium-90 radiotherapy or SIRT) is not included in the BCLC staging system, it appears to be an alternative treatment method with increasing indications in parallel with the advances in angiography techniques and dosimetry at every stage included in BCLC guidelines (13).Clinical studies conducted in different geographic regions using different methods to compare TACE and TARE have demonstrated discordant results. Meta-analyses in this field indicate comparable overall survival (OS) with TACE and TARE, while reporting a longer time to progression (TTP) and a higher downstaging effect with TARE treatment (1421).In terms of isolated procedure costs, treatment with TARE is 2 to 3 times more, and in some countries even more, expensive than TACE (22, 23). However, relevant literature indicate that TARE is more advantageous compared to TACE with regard to need for repeat procedures, costs of complication management, total hospital stay, and quality of life (24). Globally, there is only a limited number of studies investigating the effects of TACE and TARE on national health budgets and comparing the cost-effectiveness of these methods (23, 25).Heterogeneity of HCC patients as well as the shortcomings of clinical classifications, randomized clinical trials and cost-effectiveness studies make it difficult to choose between treatment alternatives in this field (2). As in other countries, these challenges lead to differences in treatment choice across different centers in Turkey.The present expert panel used the modified Delphi method to investigate the resources and clinical parameters referenced while selecting patients for DEB-TACE and TARE treatment modalities in Turkish clinical practice. The cost-effectiveness parameters and comparisons of these treatments have also been evaluated at a prediction level.  相似文献   

12.
PURPOSEThe present work aims to evaluate whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can monitor the blocking effect of combretastatin-A4-phosphate (CA4P) on microvessels and assess the therapeutic efficacy.METHODSForty rabbits were implanted VX2 tumor specimens. Two weeks later, serial MRI (T1-weighted imaging, T2-weighted imaging, and DCE) were performed at 0 h, 4 h, 24 h, 3 days, and 7 days after CA4P (10 mg/kg) or saline treatment. The parameters of DCE (Ktrans, Kep, Ve and iAUC60) enhancement of tumor portions were measured. Then all tumor samples were stained to count microvessel density (MVD). Finally, two-way repeated measures ANOVA was used to analyze the difference between and within groups. Correlation between the DCE parameters and MVD was analyzed by using the Pearson correlation and Spearman rank correlation.RESULTSKtrans and iAUC60 values at 4 h after CA4P treatment were significantly lower than those in the control group (D-value: −0.133 min−1, 95%CI: −0.169 to −0.097 min−1, F= 59.109, p < 0.001 for Ktrans; D-value: −10.533 mmol/s, 95%CI: −17.147 to −3.919 mmol/s, F= 11.110, and p = 0.003 for iAUC60). In the CA4P group, Ktrans and iAUC60 reached the minimum values at 4 h, and both parameters showed significant difference between 4 h and other time points (all p < 0.01). Seven-day values of Ktrans (r=0.532, p = 0.016 and r=0.681, p = 0.001, respectively) and iAUC60 (r=0.580, p = 0.007 and r=0.568, p = 0.009, respectively) showed correlation with MVD in both groups, while Kep and Ve did not show correlation with MVD (p > 0.05).CONCLUSIONThe blocking effect of microvessels after CA4P treatment can be evaluated by DCE-MRI, and the parameters of quantitative Ktrans and semi-quantitative iAUC60 can assess the change in tumor angiogenesis noninvasively.

Hepatocellular carcinoma (HCC) has the third highest mortality rate worldwide among cancers (1). Although the 5-year survival rate can reach up to 70% of HCC patients by surgical operation, only less than 30% are suitable for surgery. Transarterial chemoembolization (TACE) treated tumors can stimulate angiogenesis and require repeated treatment (2). As HCC is generally hypervascular, vascular targeting strategies can be used to improve the 5-year survival rate (3).There are two kinds of tumor vascular targeted agents (4): angiogenesis inhibitors (AIs) and vascular disrupting agents (VDAs). AIs can prevent the formation of new blood vessels by inhibiting angiogenesis. VDAs can damage the tumor endothelium directly, shutdown vascular development rapidly and selectively and cause tumor cell ischemia; tumor vascular shutdown occurs within 1 h of administration, and lasts for 24 hours (5, 6). Combretastatin A-4-phosphate (CA4P) is a new-style VDA that progressed into clinical trial stage (79).The vascular disrupting effects of VDAs can be assessed by microvessel density (MVD), which is the “gold standard” measurement to evaluate angiogenesis. However, the invasiveness of MVD measurement limits its use (10).During the development of targeted treatments, imaging plays an important role in monitoring the treatment efficacy against malignant tumors (11). Although change in tumor size may not be a reliable method to measure treatment efficacy, plenty of imaging sequences have been developed to overcome the drawbacks of traditional efficacy assessments by size measurement (1214).DCE-MRI could reflect the microvascular structure and function indirectly, noninvasively and quantitatively, and it has been widely applied to predict and evaluate the treatment response (15). DCE-MRI is expected to be useful in evaluating early vascular disrupting efficacy after CA4P administration. But studies focusing on the changes of DCE parameters at different time points after CA4P administration in the VX2 rabbits have been scarce (1618). The VX2 liver tumor is supplied by liver artery which is similar with high-grade human HCC, and can be used to simulate the microenvironment of human HCC (19).In this study, we aimed to investigate whether quantitative parameters in DCE-MRI can monitor the change in microvasculature of liver tumors at different time points after CA4P treatment.  相似文献   

13.

PURPOSE

We aimed to evaluate diffusion-weighted imaging (DWI) findings in patients with treated and untreated retroperitoneal fibrosis (RPF).

METHODS

We analyzed magnetic resonance imaging examinations of 44 RPF patients (36 male, 8 female), of which 15 were untreated and 29 were under therapy. Qualitative DWI and T1 postcontrast signal intensities and the largest perivascular extent of RPF were compared between treated and untreated groups and correlated to erythrocyte sedimentation rate and C-reactive protein values. Quantitative DWI signal intensities and apparent-diffusion-coefficients were calculated in regions-of-interest, together with a relative index between signal intensities of RPF and psoas muscle in 15 untreated patients and 14 patients under treatment with remaining perivascular fibrosis of more than 5 mm.

RESULTS

The extent of RPF in untreated patients was significantly larger compared with the extent of RPF in treated patients (P < 0.0001). DWI signal intensities were significantly higher in untreated patients than in patients under therapy (mean, 27 s/mm2 vs. 20 s/mm2; P = 0.009). The calculated DWI-index was significantly higher in untreated patients than in patients under therapy (P = 0.003).

CONCLUSION

Our data show significant differences in the DWI findings (b800 signal intensities and relative DWI-index) of patients with treated and untreated RPF. DWI is a promising technique in the assessment of disease activity and the selection of patients suitable for medical therapy.Retroperitoneal fibrosis (RPF) is a rare disease affecting the retroperitoneal space (13). It presents as retroperitoneal proliferation of fibrous tissue surrounding the retroperitoneal vascular structures and abutting the medial aspect of the ureters. Clinical findings of RPF are non-specific; the most common symptom is chronic back pain. Further symptoms include lower extremity edema, deep vein thrombosis, oliguria, and urinary tract infection (3). Computed tomography (CT) and magnetic resonance imaging (MRI) are the preferred imaging modalities for the diagnosis of RPF (3). Retroperitoneal fibrosis shows contrast enhancement of gadolinium containing contrast media in MRI (4). Medical treatment is classically based on steroids like prednisone (3). Recent studies suggested tamoxifen as another safe and effective treatment alternative (5).The assessment of disease activity is relevant for planning of further medical or surgical therapy (6, 7). Nowadays the disease activity is assessable by positron emission tomography tracer uptake (3), with a relatively low resolution and the need of ionized radiation. As an alternative, dynamic contrast-enhanced MRI was suggested for the evaluation of disease activity (7, 8). However, gadolinium may be contraindicated in patients with impaired renal function due to the potential development of nephrogenic systemic fibrosis (NSF) (9). This is especially relevant in RPF patients with postrenal failure due to ureteral compression. For those cases a supplemental method for the determination of disease activity would be helpful.Diffusion-weighted imaging (DWI) is a radiation-free unenhanced MRI modality that has been applied for the detection of bowel inflammation in patients with chronic inflammatory bowel diseases (10, 11), as well as for oncological retroperitoneal and abdominal applications (1214). Therefore, we aimed to evaluate the application and findings of DWI in patients with treated and untreated RPF disease.  相似文献   

14.
PURPOSEWe aimed to evaluate the advantages of magnetic resonance angiography (MRA)-planned prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).METHODSIn this retrospective study, MRAs of 56 patients (mean age, 67.23±7.73 years; age range, 47–82 years) who underwent PAE between 2017 and 2018 were evaluated. For inclusion, full information about procedure time and radiation values must have been available. To identify prostatic artery (PA) origin, three-dimensional MRA reconstruction with maximum intensity projection was conducted in every patient. In total, 33 patients completed clinical and imaging follow-up and were included in clinical evaluation.RESULTSThere were 131 PAs with a second PA in 19 pelvic sides. PA origin was correctly identified via MRA in 108 of 131 PAs (82.44%). In patients in which MRA allowed a PA analysis, a significant reduction of the fluoroscopy time (−27.0%, p = 0.028) and of the dose area product (−38.0%, p = 0.003) was detected versus those with no PA analysis prior to PAE. Intervention time was reduced by 13.2%, (p = 0.25). Mean fluoroscopy time was 30.1 min, mean dose area product 27,749 μGy·m2, and mean entrance dose 1553 mGy. Technical success was achieved in all 56 patients (100.0%); all patients were embolized on both pelvic sides. The evaluated data documented a significant reduction in international prostate symptom scores (p < 0.001; mean 9.67 points).CONCLUSIONMRA prior to PAE allowed the identification of PA in 82.44% of the cases. MRA-planned PAE is an effective treatment for patients with BPH.

A profound knowledge about pelvic vessel anatomy is essential for achieving successful prostatic artery embolization (PAE), to improve the safety of PAE and to avoid major complications as non-target embolization (16). This knowledge can be achieved by using angiographic techniques to show pelvic artery anatomy, although the best method is still controversially discussed. In some studies, computed tomography (CT) angiography (CTA) was used for pre-interventional evaluation as it is described to have high certainty in analyzing prostatic artery (PA) anatomy (1, 3, 7). Other institutes use digital subtraction angiography (DSA) and cone beam CT (CBCT) for analysis without any pre-procedural vessel imaging (811). Since peri-interventional DSA findings may be ambiguous and CTA or CBCT would imply additional radiation, magnetic resonance angiography (MRA) seems to be a promising method to analyze PA origin without radiation. However, Maclean et al. (3) recommend CT for planning PAE instead of magnetic resonance imaging (MRI) as the latter is more expensive and more time-consuming. Pisco et al. (5, 12) state that MRA does not have enough resolution for clear identification of PA origin and does not provide the same information as CTA.Currently only a few studies discuss the suitability of MRA for preprocedural planning of PAE. Kim et al. (13) first investigated this subject with a sample size of 17 patients and documented an accuracy of 76.5% for PA origin analysis. However, in this study no clinical evaluation was included. Zhang et al. (4) investigated MRA analysis prior to PAE in a randomized clinical trial with 100 patients. A sensitivity of 91.5% and a significant reduction of procedure time, fluoroscopy time, radiation dose, and contrast medium volume due to pre-interventional MRA were documented. In his review, Prince (14) agrees with Zhang et al. (4) that MRA may be a suitable method for planning PAE.Because of the skeptical comments whether performing MRA prior to PAE is practical on a daily basis in a radiological institution, an assessment of these parameters in a less selective nature was necessary. In addition, contrary to Zhang et al. (4) who used MIP-reconstructions and 5° interval images for their assessment, we used a three-dimensional (3D) reconstruction of the pelvic arterial tree based on the MRA sequences. The main advantage of the 3D reconstruction is that it can be freely rotated in all directions which allowed an easy identification and tracking of the PA.In this study, the advantages and clinical outcome of pre-interventional analysis of PA via MRA as a possible radiation-free planning method and its influence on procedure time and radiation dose were investigated.  相似文献   

15.
PURPOSEIn this study, we aimed to assess the effectiveness of malignancy stratification algorithms of the American College of Radiology (ACR) and European Thyroid Association (ETA) in the delineation of thyroid nodules using a database of nodules that were unequivocally diagnosed by means of histopathological examination and meticulously matched with the imaged nodules.METHODSA total of 165 patients having 251 thyroid nodules with histopathologically proven definitive diagnoses during a 5-year period were included in this study. All patients had preoperatively undergone ultrasonography (US) examination, and US characteristics of the thyroid nodules were retrospectively analyzed and assigned in compliance with the thyroid imaging reporting and data system categories recommended by the ACR (ACR-TIRADS) and ETA (EU-TIRADS). The diagnostic effectiveness in the delineation of thyroid nodules and unnecessary fine-needle aspiration (FNAB) rates were evaluated.RESULTSOverall, 189 nodules (75.30%) were diagnosed as benign, while 62 nodules (24.70%) were reported to be malignant based on histopathological assessment. Sensitivity and specificity rates were 71% and 75% for ACR-TIRADS and 73% and 80% for EU-TIRADS. The area under the curve values were 0.78 and 0.80 for ACR-TIRADS and EU-TIRADS, respectively. The unnecessary FNAB rates were 61% for ACR-TIRADS and 64% for EU-TIRADS as per the recommended criteria of each algorithm.CONCLUSIONThe diagnostic performance of both malignancy stratification systems was signified to be moderate and sufficient in a cohort of nodules with definite histopathological diagnosis. In light of our results, we demonstrated the strengths and weaknesses of the ACR- and EU-TIRADS for physicians who should be familiar with them for optimal management of thyroid nodules.

The number of detected thyroid nodules has been increasing in recent years with the widespread application of ultrasonography (US). The reported incidence varies from 20% to 68% in patients undergoing high-frequency US examination (1, 2). In case of a newly detected nodule, the primary concern is to discriminate benign ones, which constitute almost 90%, from malignant ones that require additional invasive procedures (3, 4). Fine-needle aspiration biopsy (FNAB) is the primary diagnostic tool due to its high sensitivity and specificity in distinguishing malignancy, yet it has several shortcomings, including inconclusive results and potential overdiagnosis (5).The particular nodular US features suggestive of malignancy are well known and thus US is employed for the indication of FNAB (6, 7). Nevertheless, none of those characteristics individually predicts the malignancy risk sufficiently (8, 9). Hence, various risk-stratification systems that consider a set of nodular US features have been established to predict the malignancy risk, mitigate superfluous FNABs, and enhance interobserver concordance. Among them, the Thyroid Imaging Reporting and Data System of the American College of Radiology (ACR-TIRADS) was set up in 2017 to classify all detected thyroid nodules according to its issued lexicon (1012). Similarly, the European Thyroid Association TIRADS (EU-TIRADS) was developed to improve the sensitivity together with high negative predictive value (NPV) in characterization with a more straightforward scoring method (12, 13). Several studies have compared the effectiveness of these two risk-stratification systems (1418), yet their performance in different thyroid nodules with various histopathologic results and subtypes still needs to be investigated.The objectives of our study were to appraise the diagnostic effectiveness of the ACR- and EU-TIRADS classification systems in nodular characterization and to analyze the rates of inappropriate FNABs according to the proposed criteria based on unequivocal histopathological results.  相似文献   

16.
PURPOSEWe aimed to evaluate the usefulness of guidewire-catheter induced hydrodissection (GIH) to assist radiofrequency ablation (RFA) for subcapsular hepatocellular carcinoma (HCC) with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion.METHODSThis retrospective study included 17 patients with small subcapsular HCC ineligible for ultrasonography-guided RFA who received RFA under guidance of fluoroscopy and cone-beam computed tomography immediately after iodized oil transarterial chemoembolization (TACE) between April 2011 and January 2016. In the study patients, creation of artificial ascites to protect the perihepatic structures failed due to perihepatic adhesion and GIH was attempted to separate the perihepatic structures from the ablation zone. The technical success rate of GIH, technique efficacy of RFA with GIH, local tumor progression (LTP), peritoneal seeding, and complications were evaluated.RESULTSThe technical success rate of GIH was 88.24% (15 of 17 patients). Technique efficacy was achieved in all 15 patients receiving RFA with GIH. During an average follow-up period of 48.1 months, LTP developed in three patients. Cumulative LTP rates at 1, 2, 3, and 5 years were 13.3%, 20.6%, 20.6%, and 20.6%, respectively. No patient had peritoneal seeding. Two of the 15 patients receiving RFA with GIH had a CIRSE grade 3 liver abscess, but none had complications associated with thermal injury to the diaphragm or abdominal wall near the ablation zone.CONCLUSIONGIH can be a useful method to assist RFA for subcapsular HCC with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion.

Radiofrequency ablation (RFA) is widely accepted as a curative treatment for patients with small (≤3 cm) hepatocellular carcinoma (HCC) not suitable for surgery (1, 2). However, when the tumor is located close to the liver surface, RFA carries a risk of unintended collateral thermal injury to the perihepatic structures (i.e., diaphragm and abdominal wall). To overcome this problem, adjunctive techniques such as introduction of artificial ascites or pleural effusion have been applied (38). Nonetheless, patients with perihepatic peritoneal adhesion may still be at risk of collateral thermal injury as adhesion prevents separation of the perihepatic structures by artificial ascites from the ablation zone (6, 9, 10). Some investigators have used an alternative technique making localized hydrodissection by using an 18–22 G needle at the contact point between the index tumor and perihepatic structure (9, 11). However, this also seems to be not applicable when the lung or bowel interposes on the access route.Prior iodized oil transarterial chemoembolization (TACE) enhances the feasibility of subsequent RFA for small tumors with poor conspicuity (12, 13). This is because intratumoral retention of radio-opaque iodized oil provides radiographic contrast to the index tumor. As the index tumor with iodized oil retention is clearly seen on fluoroscopy and the perihepatic peritoneal space is easily accessed by traditional methods of making artificial ascites (6, 9, 14), an angiographic catheter and guidewire system can reach the region near the tumor through the perihepatic space under fluoroscopic guidance. Therefore, in patients with perihepatic adhesion, if forceful advancement of the catheter and guidewire system could dissect the adhesion, introduction of fluid via the catheter tip at the region near the tumor may protect the perihepatic structures from thermal injury during RFA for subcapsular HCC.The aim of this study was to evaluate the usefulness of guidewire-catheter induced hydrodissection (GIH) to assist RFA for subcapsular HCC with iodized oil retention in patients with failed artificial ascites due to perihepatic adhesion.  相似文献   

17.
PURPOSEWe aimed to compare the effects of misregistration (stair-step artifact) occurrence during coronary computed tomography angiography (CCTA) using third- and second-generation dual-source computed tomography (DSCT) scanners.METHODSCCTA was performed in consecutive patients with suspected coronary heart disease. Patients were randomly assigned to two groups and imaged using a third-generation (n=68; group A) or second-generation (n=63; group B) DSCT scanner. Heart rate (HR), heart rate variability (HRV), the number of acquisition steps required, and the anatomical cardiac length of each patient were recorded and compared between the two groups. Qualitative interpretation and analyses were scored with respect to subjective image quality and misregistration (stair-step artifact) by two interpreters. Cohen’s kappa was used to evaluate the consistency between the observers.RESULTSAll CCTA images (100%) on both DSCT scanners yielded satisfactory image quality, with a subjective image quality score of 4.21±0.17. The consistency between the two observers with respect to misregistration and subjective scores were good (κ= 0.91 and 0.92, respectively). Both the number of acquisition steps required and the scan length of each patient in group A differed significantly (p < 0.001) from those in group B; there were significantly fewer artifacts in group A than in group B (p < 0.001). Misregistration artifacts did not correlate with the HRs or HRVs between two required acquisition steps (p > 0.20).CONCLUSIONAs compared with second-generation DSCT, the reduced number of acquisition steps required and the shorter scan length in third-generation DSCT reduced the occurrence of misregistration artifacts in CCTA images.

Coronary computed tomography angiography (CCTA) has gained widespread acceptance as the first choice for noninvasive assessment of a wide variety of cardiac diseases, as it has strong negative-predictive value and is effective in ruling out coronary artery disease in symptomatic patients, particularly those with intermediate risk (1). However, despite recent advances in cardiac computed tomography (CT) technologies, such as faster gantry rotation and an increased number of detector rows, CCTA images remain vulnerable to a number of artifacts due to patient- and technique-specific causes. Artifacts in cardiac CT may cause image degradation and interference in diagnosis (24), leading to either underdiagnosis or overtreatment, both of which are associated with increased patient morbidity and mortality (5).Misregistration (stair-step) artifact, a type of cardiac motion artifact, appears when the heart is not in an identical position during consecutive heartbeats, because of arrhythmias (5). Avoiding misregistration artifacts between adjacent acquisition steps remains a challenge in step-and-shoot CCTA (6). Numerous studies have investigated step-and-shoot CCTA with different types of CT scanners. A previous study investigated misregistration artifacts with a 64-slice single-source CT (7), another study investigated image quality obtained with 128-slice dual-source CT (DSCT) (8), while yet another study investigated the effect of heart rate (HR) and heart rate variability (HRV) on image quality when using a 256-slice CT scanner (6). Most guidelines state that decreasing the mean HR and HRV is the most important factor for minimizing cardiac motion artifacts (9, 10), including misregistration artifacts. However, it is not clear whether the incidence of misregistration artifacts would be similar in the new-generation DSCT scanners, with their faster gantry speed and increased Z-coverage.Hence, the aim of this study was to investigate the frequency of occurrence of misregistration artifacts in step-and-shoot CCTA with a third-generation DSCT scanner, as compared with that of a second-generation DSCT scanner.  相似文献   

18.
PURPOSEWe aimed to evaluate the clinical benefit of 125I seed brachytherapy under DynaCT guidance for palliative local treatment of bone metastases.METHODSFrom December 2014 to September 2017, 82 patients with painful bone metastases, who experienced treatment failure using standard strategies or rejected treatment were enrolled in this retrospective study. All patients underwent 125I seed brachytherapy under DynaCT guidance. Technical success, visual analogue scale (VAS), numerical rating scale (NRS), verbal rating scale (VRS), Karnofsky performance status (KPS) and complications were analyzed.RESULTSThe success rate of 125I seed implantation was 100%. The VAS and NRS scores for the most severe pain were 7.0 (5.0–9.0) and 8.0 (6.0–9.0) before brachytherapy. The pain scores assessed every 2 hours gradually decreased within 12 hours (p < 0.001). A comparison of KPS scores showed that patients had significantly better quality of life on weeks 1, 4, and 8 than on week 0 (p < 0.001). The associated complications were mild subcutaneous hemorrhage 25.6% (21/82), fever 7.3% (6/82), minor displacement of radioactive seeds 5.0% (4/82), pathologic fracture 2.4% (2/82), and local skin reaction 2.4% (2/82). After symptomatic treatment, all complications were relieved. Minor displacement of radioactive seeds did not cause damage to adjacent tissues. No serious life-threatening complications occurred in the study group.CONCLUSIONDynaCT-guided 125I seed implantation is a safe and effective method for palliation of painful bone metastases from cancer after failure or rejection of conventional treatments.

Bone metastasis is a common problem in patients with advanced cancer, which is detrimental to their quality of life (1, 2). The incidence of bone metastasis and metastatic sites varies significantly depending on the primary tumor (3). It is estimated that about 50% or more cancer patients will have bone metastasis (4, 5). In fact, patients with bone metastases still suffer from poorly controlled pain during the treatment or progression of the disease, which can seriously affect diet, sleep, emotion, and daily activities (6). Therefore, the most important task of advanced cancer treatment is not only to improve survival rate, but also to relieve pain and improve the quality of life.Palliative radiation therapy combined with analgesia is the standard treatment of painful bone metastasis (7, 8). Although external beam radiotherapy (EBRT) is an important method to relieve bone pain, it remains ineffective in 30% of patients, while nearly 50% of patients have recurrent pain after EBRT (911). Furthermore, due to previous EBRT treatment, patients with bone metastases (particularly spine metastases) may have reached the value of dose tolerance, limiting their treatment options. As an alternative to EBRT, percutaneous iodine-125 (125I) seed brachytherapy may resolve this issue by providing a high dose of radiation straight to the tumor target, while reducing the effects on adjacent normal tissues (12). This study focused on the safety and efficacy of DynaCT-guided 125I seed brachytherapy for bone metastases at different sites.  相似文献   

19.
PURPOSEFew studies have examined conventional catheter-directed thrombolysis (CDT) for the treatment of submassive pulmonary embolism (PE). Moreover, angiographic resolution of thrombus burden following CDT has infrequently been characterized. This study describes a single-center experience treating submassive PE with CDT while utilizing repeat angiography to determine treatment effectiveness.METHODSA retrospective analysis of 140 consecutive patients who underwent CDT for submassive PE from December 2012 to June 2019 was performed. Angiographic resolution of thrombus burden after CDT was reported as high (>75%), moderate (51%–75%), low (26%–50%), or insignificant (≤25%). All angiograms were reviewed by two interventional radiologists. Secondary endpoints included reduction in pulmonary artery pressure (PAP) and clinical outcomes. Bleeding events were classified according to the Society of Interventional Radiology (SIR) adverse event criteria.RESULTSCDT was performed in 140 patients with a mean recombinant tissue plasminogen activator (rtPA) dose of 25.3 mg and a mean treatment time of 26.0 hours. Angiographic resolution of thrombus burden was high in 70.0%, moderate in 19.3%, low in 5.7%, and insignificant in 3.6%; in 2 patients (1.4%) repeat angiography was not performed. Systolic PAP was reduced (47 vs. 35 mmHg, p < 0.001), mean PAP was reduced (25 vs. 21 mmHg, p < 0.001), and 129 patients (92.1%) improved clinically. Patients with high or moderate resolution of thrombus burden had a clinical improvement rate of 95.2%, while patients with low or insignificant thrombus burden resolution had a clinical improvement rate of 76.9% (p = 0.011). Ten patients (7.1%) had hemodynamic or respiratory decompensation requiring mechanical ventilation, systemic thrombolysis, cardiopulmonary resuscitation, or surgical intervention. Seven patients (5.0%) experienced moderate bleeding events and one patient (0.7%) with metastatic disease developed severe gastrointestinal bleeding that resulted in death. Thirty-day mortality was 1.4%.CONCLUSIONIn patients with submassive PE undergoing CDT, angiographic resolution of thrombus burden is a safe and directly observable metric that can be used to determine procedural success. In this study, CDT with repeat angiography was associated with a 5.7% bleeding event rate and 30-day mortality of 1.4%.

Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States, with an estimated 300 000–600 000 cases per year resulting in 100 000–180 000 deaths (1). Among patients with acute PE, there is significant heterogeneity in clinical presentation. Submassive or intermediate-risk PE comprises at least 25% of PE cases and has a 30-day mortality rate of approximately 2%–3% (25). Patients with submassive PE have signs of right ventricle (RV) dysfunction demonstrated on imaging studies or elevated cardiac biomarkers (6). Several catheter-directed therapies for submassive PE have been explored, including conventional catheter-directed thrombolysis (CDT), ultrasound-assisted CDT (UACDT), and various types of mechanical thrombectomy.UACDT has been the subject of multiple investigations and is effective in reducing pulmonary artery pressure (PAP) and right ventricular to left ventricular (RV/LV) ratio in patients with submassive or massive PE (79). Despite the recent focus on UACDT, conventional CDT remains an effective treatment option and several authors have demonstrated no differences between UACDT and conventional CDT in terms of thrombolytic dose, bleeding complications, PAP reduction, follow-up echocardiographic findings, or mortality (7, 1012). Mechanical thrombectomy devices are of particular interest in treating PE since they reduce PAP, RV/LV ratio, and thrombus burden with a low risk of bleeding events (13, 14).Currently there is little in the literature to recommend the routine use of CDT for submassive PE, and endpoints evaluating the effectiveness of CDT in this indication have been inconsistent (15). Several studies have used reductions in PAP or RV/LV ratio as endpoints, while others have focused on improvement of clinical symptoms (8, 9, 1618). The goal of this study was to describe a single-center experience treating submassive PE with conventional CDT while utilizing repeat angiography to determine treatment effectiveness. In addition, this study attempted to contribute to the standardization of terms that describe angiographic resolution of thrombus burden.  相似文献   

20.
PURPOSEWe aimed to evaluate the long-term outcomes of computed tomography-guided percutaneous cryoablation (PCA) for biopsy-confirmed renal cell carcinoma (RCC).METHODSThis was a single-center, retrospective study investigating all patients treated with PCA between January 2010 and February 2019 for RCC tumors. Primary outcome measures included overall survival (OS), disease-free survival (DFS), progression-free survival (PFS) and cancer-specific survival (CSS). Secondary outcome measures included kidney function, complications, technical success, hospital stay, procedural time, and the identification of factors affecting the primary outcomes.RESULTSFifty-three consecutive patients with 54 lesions (T1a: 49/54; T1b: 5/54) were included. Mean tumor diameter was 28.0±8.5 mm and mean R.E.N.A.L. score was 7.2±2.0. Technical success was 100% (54/54 lesions) after two reinterventions for incomplete ablation. Mean follow-up time was 46.7±28.6 months (range, 3–122 months). Local recurrence was noted in 5 patients (9.2%). According to Kaplan-Meyer analysis, OS was 98.2%, 94.2%, 71.2%, and 58.2% at 1, 3, 5, and 8 years. One patient (1.9%) died of cancer and CSS was 95.8% at 8 years. DFS was 100.0%, 95.5%, and 88.6%, and PFS was 100%, 94.3%, and 91.0%, at 1, 2, and 5 years. Clavien–Dindo grade II complication rate was 7.8% (5/64 procedures). There were no complications classified as grade III or greater. Mean creatinine increase was 7.1±6.3 μm/L (p = 0.31). No patient advanced to dialysis during follow up. Mean procedural time was 163±45 min. Median hospital stay was 2.0 days (IQR, 1–2.5 days). Diabetes was the only independent predictor of decreased OS (hazard ratio 4.3, 95% CI 0.043–0.914; p = 0.038).CONCLUSIONPCA for stage T1a and T1b RCC provides favorable long-term oncological and renal function preservation outcomes, with acceptable complication rates.

Renal cancer has been listed as the 14th most common malignancy worldwide accounting for 2.2% of all cancers, while in Europe it represents 3.5% of all newly diagnosed cancers with an estimated incidence of 136 500 new cases in 2018 (1, 2). Renal cell carcinoma (RCC) is the most frequent renal cancer, which most commonly affects men between ages of 50 and 70 years, although its incidence in younger population has been steadily increasing over the years. It has been reported that in 2018, approximately 54 700 patients died of kidney and renal pelvis malignancies in Europe, a percentage representing 2.8% of all oncologic deaths (13).Although surgery remains the gold standard treatment for localized RCC and partial nephrectomy (PN) is indicated for T1 renal masses (<7 cm), percutaneous, minimally invasive, nephron-sparing, curative modalities (image-guided, thermal ablation) are continuously gaining ground as valid alternatives to surgery, especially for high surgical risk patients and in cases in which PN is not technically feasible (4). Specifically, the two more recent meta-analyses have reported similar oncological outcomes between thermal ablation and surgical treatments for localized renal masses, while complication and renal function outcomes favored the thermal ablation groups (5, 6).Percutaneous cryoablation (PCA) is another efficient minimally invasive ablative modality for the treatment of localized T1a and T1b RCCs, demonstrating a particularly favorable safety profile and extremely favorable oncological 5-year outcomes, comparable to those of PN and thermal ablation (79). Advantages of the cryoablation over thermal ablative methods include the possibility of intraprocedural, real-time visualization of the ablation zone, less urothelial injury and more uniform ablation (9, 10). Long-term, oncological data following PCA for the treatment of RCC remain limited, while over 5-year outcomes are missing. We sought to evaluate the long-term outcomes of computed tomography (CT)-guided PCA performed in our institution for the treatment of RCC.  相似文献   

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