Are fibroids that become endocavitary after uterine artery embolization necessarily a complication?

OBJECTIVE: This commentary deals with the study by Verma et al. discussing submucosal and endocavitary fibroids after uterine artery embolization (UAE). CONCLUSION: UAE can infarct fibroids. Fibroids spontaneously infarct after childbirth. Because the postpartum cervix is patulous, infarcted fibroids that fall into the uterine cavity easily exit the uterus. Each patient contemplating UAE should anticipate that infarcted fibroids bordering on or inside the uterine cavity may require cervical dilatation or hysteroscopic resection for removal. The addition of either of these two gynecology procedures should not necessarily be regarded as a UAE complication or treatment failure.     

Is uterine artery embolization prior to myomectomy for giant fibroids helpful?

PURPOSE: To determine whether uterine artery embolization (UAE) prior to myomectomy is more effective than myomectomy alone. MATERIALS AND METHODS: The study included 15 consecutive infertile women with uterine fibroids > 10 cm (Group I) that underwent UAE with spherical particles using a microcatheter technique and a unilateral femoral approach between March 2005 and January 2007. The day after embolization all cases underwent myomectomy since the protocol for large fibroids in our hospital is myomectomy only. The control group was composed of 15 patients who underwent myomectomy only (Group II). Group II was established based on fibroid size (14 +/- 3 cm). Operating time, estimated blood loss and transfusion, complications, and hospital stay were calculated by retrospective chart reviews, and comparisons were made between the groups with Student's t-test. RESULTS: Mean operating time was 138 min in Group I and 240 minutes in Group II (P < 0.01). Mean estimated blood loss was 250 ml in Group I and 690 ml in Group II (P < 0.01). There was no need for transfusion in Group I, while transfusion was needed in 2 cases (13%) in Group II. Mean hospital stay in Group I was 5 days versus 8 days in Group II. Complications, including subsequent hysterectomy, were seen in 2 cases and bowel-bladder injuries in 1 case in Group II (a total of 20%), while no complications were observed in Group I. One of the cases in Group I later conceived and gave birth to a healthy child. CONCLUSION: UAE prior to myomectomy is more effective than myomectomy alone.     

Is a large fibroid a high-risk factor for uterine artery embolization?

OBJECTIVE: The objective of our study was to determine whether tumor size, specifically uterine fibroids of 10 cm or larger, predisposes a patient to an unacceptably high risk at uterine artery embolization. MATERIALS AND METHODS: One hundred fifty-two consecutive women underwent embolization for uterine fibroids. Complications and outcomes were analyzed using questionnaires and serial MRI between women with one or more uterine fibroids of 10 cm or larger diameter (mean, 12.4 cm; range, 10-19 cm) (n = 47, group 1) and women with each uterine fibroid of less than 10 cm diameter (mean, 6.8 cm; range, 2-9.5 cm) (n = 105, group 2). RESULTS: Thirty complications (19.7%, 30/152), which occurred in 27 women (17.8%, 27/152), were noted. However, 25 of 30 complications were minor, requiring no or nominal therapy. They occurred in 19.1% (9/47) of group 1 and in 15.2% (16/105) of group 2 women (p = 0.637). Major complications requiring major therapy, unplanned increased level of care, or unanticipated prolonged hospitalization (> 48 hr) or including permanent adverse sequelae were noted in 6.4% (3/47) of group 1 and in 1.9% (2/105) of group 2 women (p = 0.172). Of these five women, four underwent surgery because of sloughing fibroids. Permanent adverse sequelae were observed in one woman of group 1, who has had sexual dysfunction after embolization. No deaths occurred in either group. There was no significant difference in most outcomes or in intervals until the complete disappearance of postprocedural pain and full recovery between the two groups. CONCLUSION: We found no increased risk to patients undergoing uterine artery embolization for fibroids on the basis of tumor size. Successful outcomes can be obtained for such lesions.     

Can hyperplastic prostate follow uterine fibroids and be managed with transcatheter arterial embolization?

Sun et al used pigs to evaluate transcatheter arterial embolization (TAE) as a potential treatment for benign prostatic hyperplasia (BPH). Although more data regarding the effectiveness, durability, and side effects of TAE are needed, it may prove to be competitive with other accepted forms of treatment.     

Aortic-neck dilation after endovascular abdominal aortic aneurysm repair (EVAR): can it be predicted?

Purpose

This study was performed to evaluate whether dynamic computed tomography (CT) can provide functional vessel information predicting outcomes of aortic neck in patients undergoing endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm (AAA).

Materials and methods

Twenty patients with and 20 without AAA were enrolled. Electrocardiographically (ECG)-gated data sets were acquired with a 64-slice CT scanner. Axial pulsatility measurements were taken at three levels: 2 cm above the highest renal artery; immediately below the lowest renal artery; 1 cm below the lowest renal artery. Three independent readers performed the measurements. Systolic and diastolic blood pressures were measured in the brachial artery to calculate arterial-wall distensibility expressed as pressure strain elastic modulus (Ep). Cross-sectional area change, wall distensibility and Ep value were statistically compared.

Results

No significant differences were found in terms of Ep values in the suprarenal and juxtarenal level. In the AAA group, a significantly higher value was obtained at the infrarenal level. A subgroup of patients with AAA (45%) had a significantly higher Ep value at the infrarenal level.

Conclusions

Dynamic CT provided insight into the abdominal aorta pathophysiology. Identifying patients with higher infrarenal distensibility could change selection of graft size to improve proximal fixation.     

Transcatheter arterial embolization of unresectable hepatocellular carcinoma: does selective treatment improve outcome?

PURPOSE: To evaluate whether selective transcatheter arterial embolization (TAE) contributes to preservation of liver function and improves local control and survival in patients with hepatocellular carcinoma. MATERIALS AND METHODS: One hundred patients with hepatocellular carcinoma who underwent single or multiple TAE were retrospectively analyzed. The incidence of deterioration of liver function caused by TAE was compared between patients with Child class A disease and those having Child B/C disease. The correlation between extent of embolization and incidence of deterioration of liver function was analyzed. In addition, factors affecting deterioration of liver function after TAE were determined. Recurrence-free and overall survival rate were calculated using the Kaplan-Meier method. A Cox proportional hazard model was used to analyze prognostic factors affecting recurrence-free and overall survival. RESULTS: The incidence of deterioration of liver function in the Child B/C group (47%) was significantly higher than that in the Child A group (21%). Pretreatment Child-Pugh classification and extent of embolization were significant factors in the deterioration of liver function after TAE. Recurrence-free survival rates at 1, 2, and 3 years were 38%, 19%, and 8%, respectively. Overall survival rates at 1, 3, 5, and 7 years were 89%, 59%, 22%, and 22%, respectively. Findings of multivariate analyses of prognostic factors showed that tumor size and selectivity of TAE were significant for recurrence-free survival and the initial Child-Pugh classification was the most important factor for overall survival. CONCLUSION: Selective TAE improves local control and avoids damage to nontumorous liver tissue. The selective technique appears to be associated with a favorable outcome.     

Pheochromocytomas and CT: can size predict malignancy?

OBJECTIVES: The purpose of this study was to determine clinical and imaging findings associated with malignancy in pheochromocytomas. MATERIAL: and methods. A multicentric retrospective CT study including 50 lesions (23 benign and 27 malignant histologically proven pheochromocytomas) was conducted. The diagnosis of malignancy was based on histological criteria (capsular rupture, local invasion), on synchronous metastases or on the occurrence of locoregional recurrences or metastases during the outcome. The analysis was based on clinical data (age, sex, secretion of the lesion and hypertension) and on radiological criteria (largest diameter of the tumor, side, homogeneity, regularity and sharpness of contours). RESULTS: A statistical difference was found between the median largest diameter, the regularity and sharpness of contours benign and malignant lesions (p<0.0001); other clinical and radiological criteria being non significantly different. A largest diameter greater than 45 mm enabled to suggest malignancy with a sensitivity of 100% and a specificity of 69%. CONCLUSION: A diameter larger than 50mm, presence of a locoregional invasion and of metastases are strong arguments favouring.     

Hepatic artery aneurysm in a patient with Behçet's disease and segmental pancreatitis developing after its embolization

Segmental pancreatitis is an unusual form of acute pancreatitis mostly seen in the head of pancreas. We present the CT findings of a segmental pancreatitis in the body and tail of the pancreas developed following endovascular embolization of a giant hepatic artery aneurysm and arterioportal fistula in a patient with Beh?et's disease.     

High-risk lesions diagnosed at MRI-guided vacuum-assisted breast biopsy: can underestimation be predicted?

Objectives

To evaluate the frequency of diagnosis of high-risk lesions at MRI-guided vacuum-assisted breast biopsy (MRgVABB) and to determine whether underestimation may be predicted.

Methods

Retrospective review of the medical records of 161 patients who underwent MRgVABB was performed. The underestimation rate was defined as an upgrade of a high-risk lesion at MRgVABB to malignancy at surgery. Clinical data, MRI features of the biopsied lesions, and histological diagnosis of cases with and those without underestimation were compared.

Results

Of 161 MRgVABB, histology revealed 31 (19%) high-risk lesions. Of 26 excised high-risk lesions, 13 (50%) were upgraded to malignancy. The underestimation rates of lobular neoplasia, atypical apocrine metaplasia, atypical ductal hyperplasia, and flat epithelial atypia were 50% (4/8), 100% (5/5), 50% (3/6) and 50% (1/2) respectively. There was no underestimation in the cases of benign papilloma without atypia (0/3), and radial scar (0/2). No statistically significant differences (p?>?0.1) between the cases with and those without underestimation were seen in patient age, indications for breast MRI, size of lesion on MRI, morphological and kinetic features of biopsied lesions.

Conclusions

Imaging and clinical features cannot be used reliably to predict underestimation at MRgVABB. All high-risk lesions diagnosed at MRgVABB require surgical excision.     

Unilateral hip osteoarthritis: can we predict the outcome of the other hip?

OBJECTIVE: The objective of this study was to define, in unilateral hip osteoarthritis (OA), factors predicting the outcome of the other hip. MATERIALS AND METHODS: We examined the anteroposterior radiographs of the pelvis of 95 white patients with unilateral idiopathic (56 patients) or secondary to congenital hip diseases (39 patients) OA. The other hip was free from symptoms (pain or limping) at the initial examination and without radiographic evidence of OA; it was what we call a "normal" hip. Two parameters were evaluated: (1) the type of osteoarthritis of the involved hip and (2) the range of four radiographic indices of the contralateral hip: the sourcil inclination "(weight-bearing surface), the acetabular angle, the Wiberg's center-edge angle, and the neck-shaft angle. Follow-up radiographs for the hips that remained OA-free were available for 10 to 35 years and for those that developed OA, at the time of initial symptoms, range 2 to 31 years. RESULTS: Logistic regression analysis showed that the presence of idiopathic OA in one hip had a statistically significant effect on the development of OA on the other hip (p < 0.001). Minor deviations of radiographic indices of the contralateral hip is not a predictive factor for its outcome. When the radiographic indices are examined together with the pathology of the involved hip, only WBS was shown to have a significant effect to the development of OA and its type (p < 0.001). CONCLUSIONS: The following conclusions can be drawn from this study: 1. Patient with idiopathic OA of one hip is at increased risk of developing OA in the other hip. 2. The outcome of the other hip cannot be predicted only on the basis of the evaluation of its radiographic indices. 3. Among the different indices, WBS seems to have a strong influence toward the development of OA.     

Metastatic melanoma: can FDG-PET predict success of anti-PD-1 therapy and help determine when it can be discontinued?

European Journal of Nuclear Medicine and Molecular Imaging -     

Value of fluorodeoxyglucose positron emission tomography before radiotherapy for head and neck cancer: does the standardized uptake value predict treatment outcome?

Purpose  The aim of this study was to determine if the standardized uptake value (SUV) of fluorodeoxyglucose positron emission tomography (FDG-PET) for head and neck cancer can predict the outcome of radiotherapy and if the SUV is correlated with histological grade, mitosis, and apoptosis. Materials and methods  The study included 45 head and neck cancer patients who underwent FDG-PET scanning before radiotherapy. The maximum SUV (SUVmax) of their primary lesions were measured. Biopsy was performed in all patients to determine the histological diagnosis. Altogether, 14 biopsy specimens were available for mitotic and apoptotic cell counts. Results  The mean SUVmax of T3 tumors was significantly higher than that of T1 (P = 0.01) and T2 (P = 0.011) tumors. The mean SUVmax of stage II disease was signifirfcantly lower than that of stage III (P = 0.028) and stage IV (P = 0.007) disease. There was a tendency toward a better locoregional control rate and disease-free survival for the lower SUV group using a cutoff value of 5.5. For 41 patients with squamous cell carcinoma or undifferentiated carcinoma, SUVmax did not reflect the histological grade. There was no correlation between the SUVmax and the mitotic/apoptotic status. Conclusion  SUVmax may correlate with the T classification and stage, but there was no predictive value for outcome of radiation therapy. Neither histological grading nor mitotic/apoptotic status is correlated with SUVmax.     

Acute left colonic diverticulitis: can CT findings be used to predict recurrence?

OBJECTIVE: We explored CT and demographic predictors for unfavorable outcome of nonoperative treatment in patients with a first event of left colonic diverticulitis. MATERIALS AND METHODS: We retrospectively analyzed the medical files and CT scans of 312 consecutive patients who were diagnosed as having diverticulitis on an admission CT report or who had a final diagnosis of left colonic diverticulitis. Patients who did not undergo nonoperative treatment or were lost to follow-up (n = 144) were excluded from the study. Admission CT scans of 168 consecutive patients with a diagnosis of left colonic diverticulitis who underwent nonoperative treatment and had an 18-month follow-up were reassessed by three radiologists unaware of the clinical findings. Nonoperative treatment was defined as an attempt to treat the patient with only antibiotics without scheduling them for elective (delayed) surgery. Unfavorable outcome was defined as a failure of nonoperative treatment 18 months after admission that required either surgery or rehospitalization for antibiotic treatment. The risk of unfavorable outcome was modeled using logistic regression as a function of sex, age, and CT criteria including the maximum number of diverticula per 10 cm of colon; the presence of intraabdominal abscess or extraintestinal gas bubbles (< 5 mm diameter) or gas pockets (>or=5 mm); the length and location of the abnormal colonic segment; the maximum thickness of the colonic wall; the presence of associated free intraperitoneal fluid; and the extent of fatty infiltration. RESULTS: Among these 168 patients, 115 (68%) had an uneventful outcome, but nonoperative treatment failed in 53 (32%). The presence of an abscess (n = 19) or extraintestinal gas pocket (n = 14) were the only CT findings significantly associated with failure of nonoperative treatment. Adjusted odds ratios (95% confidence interval) for failure were 6.18 (1.76-21.68) when an abscess was diagnosed and 4.26 (1.04-17.57) when pockets of free air were observed. Sex and age were not significantly associated with unfavorable outcome of nonoperative treatment. CONCLUSION: Abscess and pockets of extraintestinal gas 5 mm in diameter or larger correlated with unfavorable outcome of nonoperative treatment. None of the other criteria evaluated were predictive of failure of nonoperative treatment, including bubbles of extraintestinal gas smaller than 5 mm in diameter.     

Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted?

PURPOSE: To determine whether mammographic or histologic features can be used to predict which cases diagnosed as ductal carcinoma in situ (DCIS) without invasion by means of stereotactic core needle biopsy (SCNB) will have invasive disease at surgery. MATERIALS AND METHODS: From July 1992 to March 1999, DCIS without invasion was diagnosed by means of SCNB in 59 patients. Seventeen (29%) were found to have invasive disease after surgery. The underestimation rate for SCNB was compared with that obtained by means of open surgical biopsy. Mammographic and histologic features of cases with and those without invasion were compared. RESULTS: All patients had calcifications on mammograms. There was no significant difference (P: =.26) between the underestimation rate for SCNB with the 11-gauge vacuum-assisted device and that for open surgical biopsy. No statistically significant differences between cases with and those without invasion were seen in patient age, mean number of core specimens, level of suspicion, size of lesion, distribution and morphology of the calcifications, presence of an associated mass or density, subtype of DCIS, nuclear grade, or presence of necrosis or desmoplasia. CONCLUSION: Mammographic and histologic features cannot be used reliably to predict cases that are underestimated with SCNB. However, SCNB with the 11-gauge vacuum-assisted device was as reliable as open surgical biopsy for diagnosing DCIS without invasion.     

Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?

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 (3–5).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 (8–11), 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.