Inaccurate preoperative imaging assessment on biliary anatomy not increases biliary complications after living donor liver transplantation

Backgrounds and aims

Accurate assessment of graft bile duct is important to plan surgical procedure. Magnetic resonance cholangiopancreatography (MRCP) has become an important diagnostic procedure in evaluation of pancreaticobiliary ductal abnormalities and has been reported as highly accurate. We aim to estimate the efficacy of preoperative MRCP on depicting biliary anatomy in living donor liver transplantation (LDLT), and to determine whether inaccurate preoperative imaging assessment would increase the biliary complications after LDLT.

Methods

The data of 118 cases LDLT were recorded. Information from preoperative MRCP was assessed using intraoperative cholangiography (IOC) as the gold standard. The possible risk factors of recipient biliary complications were analyzed.

Results

Of 118 donors, 84 had normal anatomy (type A) and 34 had anatomic variants (19 cases of type B, 9 cases of type C, 1 case of type E, 2 cases of type F and 3 cases of type I) confirmed by IOC. MRCP correctly predicted all 84 normal cases and 17 of 34 variant cases, and showed an accuracy of 85.6% (101/118). The incidence of biliary complications was comparable between cases with accurate and inaccurate classification of biliary tree from MRCP, and between cases with normal and variant anatomy of bile duct. While cases with graft duct opening ≤5 mm showed a significant higher incidence of total biliary complications (21.1% vs. 6.6%, P = 0.028) and biliary stricture (10.5% vs. 1.6%, P = 0.041) compared with cases with large duct opening >5 mm.

Conclusion

MRCP could correctly predict normal but not variant biliary anatomy. Inaccurate assessment of biliary anatomy from MRCP not increases the rate of biliary complications, while small-sized graft duct may cause an increase in biliary complications particularly biliary stricture after LDLT.     

The added value of diffusion-weighted MR imaging to MR cholangiopancreatography in differentiating malignant from benign extrahepatic biliary strictures

Purpose

To investigate the added value of diffusion-weighted imaging (DWI) to magnetic resonance cholangiopancreatography (MRCP) in differentiating benign from malignant extrahepatic biliary strictures.

Methods

Magnetic resonance examination including, T2-weighted imaging, MRCP and DWI using different b-values (0,500,800 s/mm²) were performed in 38 patients with suspicious extrahepatic biliary strictures. Apparent diffusion coefficient (ADC) value was calculated. The signal intensity of the lesions on DWI using b = 500 and 800 s/mm² was examined. Analysis of the DWI and MRCP images for the cause of the extrahepatic biliary stricutre was performed. Patients were further confirmed by histopathological diagnosis and follow up. Sensitivity, specificity, accuracy, positive predictive and negative predictive values were calculated for both the MRCP images and DWI.

Results

Of the 38 cases, 23 cases had malignant extrahepatic biliary strictures and 15 had benign strictures. DWI detected 21 out of the 23 malignant biliary strictures and 14 out of 15 benign biliary strictures. Malignant strictures more frequently appeared hyperintense than benign strictures on DWI using b-values of 500 and 800 s/mm². There was a significant difference in sensitivity (91.3% vs. 73%), specificity (93.3% vs. 64.7%), accuracy (92.1% vs. 73.6%), positive predictive value (95.4% vs. 81%), and negative predictive value (87.5% vs. 64.7%) between DWI and MRCP in differentiating biliary strictures.

Conclusion

Combined evaluation using DWI added to MRCP improves the differentiation of malignant from benign extrahepatic biliary strictures.     

Texture-based classification of different gastric tumors at contrast-enhanced CT

Purpose

To determine the feasibility of texture analysis for the classification of gastric adenocarcinoma, lymphoma, and gastrointestinal stromal tumors on contrast-enhanced hydrodynamic-MDCT images.

Materials and methods

The arterial phase scans of 47 patients with adenocarcinoma (AC) and a histologic tumor grade of [AC-G1, n = 4, G1, n = 4; AC-G2, n = 7; AC-G3, n = 16]; GIST, n = 15; and lymphoma, n = 5, and the venous phase scans of 48 patients with AC-G1, n = 3; AC-G2, n = 6; AC-G3, n = 14; GIST, n = 17; lymphoma, n = 8, were retrospectively reviewed. Based on regions of interest, texture analysis was performed, and features derived from the gray-level histogram, run-length and co-occurrence matrix, absolute gradient, autoregressive model, and wavelet transform were calculated. Fisher coefficients, probability of classification error, average correlation coefficients, and mutual information coefficients were used to create combinations of texture features that were optimized for tumor differentiation. Linear discriminant analysis in combination with a k-nearest neighbor classifier was used for tumor classification.

Results

On arterial-phase scans, texture-based lesion classification was highly successful in differentiating between AC and lymphoma, and GIST and lymphoma, with misclassification rates of 3.1% and 0%, respectively. On venous-phase scans, texture-based classification was slightly less successful for AC vs. lymphoma (9.7% misclassification) and GIST vs. lymphoma (8% misclassification), but enabled the differentiation between AC and GIST (10% misclassification), and between the different grades of AC (4.4% misclassification). No texture feature combination was able to adequately distinguish between all three tumor types.

Conclusion

Classification of different gastric tumors based on textural information may aid radiologists in establishing the correct diagnosis, at least in cases where the differential diagnosis can be narrowed down to two histological subtypes.     

Impact of butylscopolamine on image quality of magnetic resonance cholangiopancreatography

Purpose

To assess the effect of parenteral butylscopolamine on magnetic resonance cholangiopancreatography (MRCP) image quality.

Materials and methods

The 3D free-breathing respiratory-compensated MRCP images (mean acquisition time 7 min) of 94 consecutive non-paired patients (47 with and 47 without 20 mg intramuscular butylscopolamine) were analysed retrospectively. Two experienced abdominal radiologists scored the image quality of five predefined pancreaticobiliary ductal segments on the MRCP images in a blinded fashion in both cohorts using a 5 point validated scale, ranging from perfect visualization of the entire ductal structure to the ductal structure being not visible. Interobserver agreement was determined.

Results

Parenteral butylscopolamine injection significantly reduced bowel peristalsis-related artefacts of the inferior common bile duct (CBD; p = 0.031) and the pancreatic duct (PD; p = 0.034) for reader 1 and the inferior CBD (p = 0.041) for reader 2. The difference in visualization of all remaining ductal segments, and of the overall pancreaticobiliary tree, was not statistically significant between the two cohorts. Interobserver agreement between the two readers was substantial for the superior CBD, common hepatic duct (CHD) and PD, was moderate for the inferior CBD, and was fair for the peripheral intrahepatic ducts.

Conclusion

On free-breathing 3D MRCP images, parenteral butylscopolamine improves only the visualization of the inferior CBD and the PD. However, no significant improvement in visualization of other ductal segments was demonstrated.     

Combined ultrasound and fluoroscopy guided port catheter implantation—High success and low complication rate

Purpose

To evaluate peri-procedural, early and late complications as well as patients’ acceptance of combined ultrasound and fluoroscopy guided radiological port catheter implantation.

Materials and methods

In a retrospective analysis, all consecutive radiological port catheter implantations (n = 299) between August 2002 and December 2004 were analyzed. All implantations were performed in an angio suite under analgosedation and antibiotic prophylaxis. Port insertion was guided by ultrasonographic puncture of the jugular (n = 298) or subclavian (n = 1) vein and fluoroscopic guidance of catheter placement. All data of the port implantation had been prospectively entered into a database for interventional radiological procedures. To assess long-term results, patients, relatives or primary physicians were interviewed by telephone; additional data were generated from the hospital information system. Patients and/or the relatives were asked about their satisfaction with the port implantion procedure and long-term results.

Results

The technical success rate was 99% (298/299). There were no major complications according to the grading system of SIR. A total of 23 (0.33 per 1000 catheter days) complications (early (n = 4), late (n = 19)) were recorded in the follow-period of a total of 72,727 indwelling catheter days. Infectious complications accounted for 0.15, thrombotic for 0.07 and migration for 0.04 complications per 1000 catheter days. Most complications were successfully treated by interventional measures. Twelve port catheters had to be explanted due to complications, mainly because of infection (n = 9). Patients’ and relatives’ satisfaction with the port catheter system was very high, even if complications occurred.

Conclusion

Combined ultrasound and fluoroscopy guided port catheter implantation is a very safe and reliable procedure with low peri-procedural, early and late complication rate. The intervention achieves very high acceptance by the patients and their relatives.     

Real-time contrast enhanced ultrasound imaging of focal splenic lesions

Objective

To investigate the imaging features of focal splenic lesions (FSLs) on contrast-enhanced ultrasound (CEUS).

Methods

Thirty two patients with FSLs proved by pathology were retrospectively analyzed. CEUS was performed using intravenous bolus injection of 2.4 ml sulfur hexafluoride-filled microbubble contrast agent and real time scanning. There were hemangioma (n = 7), lymphoma (n = 8), true cyst (n = 3), infarction (n = 4), hematolymphangioma (n = 2), metastasis tumor (n = 2), and one for each of the following entities extramedullary hemopoiesis, hamartoma, tuberculosis, Langerhans’ cell histiocytosis, inflammatory pseudotumor and myxofibrosarcoma.

Results

Among 21 benign lesions, 4 infarctions and 3 cysts presented non-enhancement throughout CEUS scanning, and the other 14 lesions displayed various enhancement levels with 6 (42.9%) hyper-enhancement, 2 (14.3%) iso-enhancement and 6 (42.9%) hypo-enhancement in arterial phase and 11 (78.6%) hypo-enhancement, 1 (7.1%) iso-enhancement and 2 (14.3%) hyper-enhancement in late phase, respectively. The enhancement pattern included 9 (64.3%) homogeneous, 4 (28.6%) heterogeneous and 1 (7.1%) rim-like enhancement. As for the malignant FSLs, all the lesions became completely or extensively hypo-enhancement during the late phase no matter their vascularity during arterial phase.

Conclusions

The CEUS features reported in this series may enrich the knowledge for CEUS characterization of FSLs.     

Infiltration patterns in monoclonal plasma cell disorders: correlation of magnetic resonance imaging with matched bone marrow histology

Objectives

To investigate how plasma cell infiltration patterns detected by MRI match the plasma cell distribution in bone marrow biopsy.

Methods

We assessed 50 patients with monoclonal plasma cell disorders of all clinical stages. MRI infiltration pattern was compared with matched BM histology from the same anatomic region.

Results

MRI revealed a minimal (n = 11, 22%), focal (n = 5, 10%), diffuse (n = 14, 28%) and mixed (n = 20, 40%) infiltration pattern. Diffuse MRI pattern was predominant in smoldering myeloma patients whereas the MRI patterns with “focal component” (i.e. focal and mixed) were most common in symptomatic myeloma (p < 0.01). In histology an interstitial (n = 13, 26%), nodular (n = 23, 46%) and packed marrow (n = 14, 28%) was found respectively. All three histological types of infiltration were observed in patients with diffuse and mixed MRI patterns. Minimal MRI pattern was found in all MGUS patients and was associated with an interstitial BM infiltration. In two patients with minimal MRI pattern an extensive micro-nodular BM infiltration was found in histology.

Conclusions

Infiltration patterns in MRI represent different histological growth patterns of plasma cells, but the MRI resolution is not sufficient to visualize micro-nodular aggregates of plasma cells.     

Characterization and staging of central bile duct stenosis—Evaluation of the hepatocyte specific contrast agent gadoxetate disodium

Objective

To assess the value of gadoxetate disodium for characterization and staging of central bile duct stenosis (CBDS).

Materials and methods

This prospective HIPAA-compliant study was IRB approved. 14 patients (8 male, 6 female; 36–80 years) with clinical suspicion of CBDS underwent preoperative MRI. To estimate the value of hepatocyte phase images (10, 20, 120 min p.i.), only T2w images (T2), only post-contrast images (CM), or both image datasets were assessed in three reading sessions by 3 readers. Agreement of each reading session with the intraoperative findings in terms of CBDS etiology and tumor extension (weighted kappa statistic) was calculated.

Results

CBDS was caused by hilar cholangiocarcinoma (n = 9), gallbladder carcinoma (n = 4) and pancreatic carcinoma (n = 1). Characterization of CBDS etiology was correct by use of: T2w images in 57%, 64%, 50%; CM images in 64%, 57%, 50%; both in 71%, 64%, 64%. Agreement comparing reading sessions and intraoperative findings regarding tumor extension was fair up to moderate (κ-range = 0.21–0.54) as a result of common underestimation. Interobserver agreement for tumor extension was fair (κ-range = 0.31–0.33).

Conclusions

By means of combined evaluation of T2 and CM images a more reliable characterization of CBDS was possible. Even though CBDS tended to be underestimated assessment of exact tumor extension was improved by contrast administration.     

Underestimation of invasive lesions in patients with ductal carcinoma in situ of the breast diagnosed by ultrasound-guided biopsy: A comparison between patients with and without HER2/neu overexpression

Purpose

To determine the rate of underestimation of ductal carcinoma in situ (DCIS) diagnosed at imaging-guided biopsy and to analyze its association with HER2/neu oncogene, an important biomarker in assessing the tumour aggressiveness and guiding hormone therapy for breast cancer.

Methods

We retrospectively reviewed 162 patients with DCIS diagnosed by imaging-guided core needle biopsy between January 2008 and March 2013. All of these patients received surgical excision, and in 25, the diagnosis was upgraded to invasive breast cancer. In this study, we examined the ultrasound, mammographic features and histopathological results for each patient, and compared these parameters between those with and without HER2/neu overexpression.

Results

Of the 162 DCIS lesions, 110 (67.9%) overexpressed HER2/neu. Nineteen patients with HER2/neu overexpressing DCIS (n = 19/110, 17.3%) were upgraded after surgery to a diagnosis of invasive breast cancer. In this group, the upgrade rate was highest in patients with a dilated mammary duct pattern (42.1%, n = 8/19, p = 0.02) and the presence of abnormal axillary nodes (40.0%, n = 12/30, p < 0.01) at ultrasound and was significantly associated with comedo tumour type on pathology.

Conclusions

Biopsy may underestimate the invasive component in DCIS patients. Sonographic findings of dilated mammary ducts and presence of abnormal axillary lymph nodes may help predicting the invasive components and possibly driving more targeted biopsy procedures.     

High spatial resolution 3D MR cholangiography with high sampling efficiency technique (SPACE): comparison of 3T vs. 1.5T

Purpose

The aim of this study was to evaluate image quality of 3D MR cholangiography (MRC) using high sampling efficiency technique (SPACE) at 3 T compared with 1.5 T.

Methods and materials

An IRB approved prospective study was performed with 17 healthy volunteers using both 3 and 1.5 T MR scanners. MRC images were obtained with free-breathing navigator-triggered 3D T2-weighted turbo spin-echo sequence with SPACE (TR, >2700 ms; TE, 780 ms at 3 T and 801 ms at 1.5 T; echo-train length, 121; voxel size, 1.1 mm × 1.0 mm × 0.84 mm). The common bile duct (CBD) to liver contrast-to-noise ratios (CNRs) were compared between 3 and 1.5 T. A five-point scale was used to compare overall image quality and visualization of the third branches of bile duct (B2, B6, and B8). The depiction of cystic duct insertion and the highest order of bile duct visible were also compared. The results were compared using the Wilcoxon signed-ranks test.

Results

CNR between the CBD and liver was significantly higher at 3 T than 1.5 T (p = 0.0006). MRC at 3 T showed a significantly higher overall image quality (p = 0.0215) and clearer visualization of B2 (p = 0.0183) and B6 (p = 0.0106) than at 1.5 T. In all analyses of duct visibility, 3 T showed higher scores than 1.5 T.

Conclusion

3 T MRC using SPACE offered better image quality than 1.5 T. SPACE technique facilitated high-resolution 3D MRC with excellent image quality at 3 T.     

Potential impact of PET/CT on the initial staging of lymphoma

Purpose

The aim of this study was to investigate the potential impact of PET/CT on the initial staging of lymphoma with comparison to each of the PET and CT components alone.

Materials and methods

PET/CTs from 37 patients with lymphoma undergoing initial staging were studied. Review of PET, CT and PET/CT images were done and staging of each patient by each modality was assigned and compared together. Clinical follow-up, additional imaging and histology served as the standard of reference.

Results

PET/CT correctly diagnosed 83 nodal regions as positive for lymphomatous involvement versus 61 and 57 detected by PET and CT respectively. The respective sensitivities, specificities, and accuracies for the detection of nodal involvement were: PET: 88.4%, 65%, 94%, CT 89.1%, 60.1%, 96.1%, PET/CT 96.3%, 88.3%, 98.2%. PET/CT also correctly identified more extra-nodal lesions (n = 24) than CT (n = 16) and PET (n = 15). Correct staging was more accurate at PET/CT (n = 31) in comparison to PET alone (n = 23) and CT alone (n = 21).

Conclusions

PET/CT was superior to PET and CT in the initial staging of lymphoma with significant better performance compared to PET and CT to clarify nodal and extra-nodal involved sites. The application of PET/CT rather than CT or PET is likely to be more beneficial.     

Bile duct evaluation of potential living liver donors with Gd-EOB-DTPA enhanced MR cholangiography: Single-dose,double dose or half-dose contrast enhanced imaging

Introduction

Detailed knowledge of the biliary anatomy is essential to avoid complications in living donor liver transplantation. The aim of this study was to determine the optimal dosage of Gd-EOB-DTPA for contrast-enhanced magnetic resonance cholangiography (ce-MRC) with reference to contrast-enhanced CT cholangiography (ce-CTC).

Materials and methods

30 potential living liver donors (PLLD) underwent both ce-CTC and ce-MRC. Ten candidates each received single, double or half-dose Gd-EOB-DTPA. Ce-MRC images with and without inversion recovery pulses (T1w ± IR) were acquired 20–30 min after intravenous contrast injection. Image data was quantitatively and qualitatively reviewed by two radiologists based on a on a 5-point scale. Data sets were compared using a Mann–Whitney-U-test or Wilcoxon-rank-sum-test. Kappa values were also calculated.

Results

All image series provided sufficient diagnostic information both showing normal biliary anatomy and variant bile ducts. Ce-CTC showed statistically significant better results compared to all ce-MRC data sets. T1w MRC with single dose Gd-EOB-DTPA proved to be superior to half and double dose in subjective and objective evaluation without a statistically significant difference.

Conclusions

Ce-MRC is at any dosage inferior to ce-CTC. As far as preoperative planning of bile duct surgery is focused on the central biliary anatomy, ce-MRC can replace harmful ce-CTC strategies, anyway. Best results were seen with single dose GD-EOB-DTPA on T1w MRC+IR.     

Characterization and guided-procedures of breast suspicious microcalcifications: can MicroPure ultrasound do it?

Objective

To assess the diagnostic value of high-frequency (MicroPure) ultrasound in evaluating suspicious microcalcifications and to determine its capability in biopsy guidance.

Subjects and methods

Sixty-two cases with suspicious microcalcifications detected on mammographic examination had been re-evaluated by MicroPure US. The studied cases underwent true cut tissue/surgical excision biopsy. Histopathology revealed 25 benign and 37 malignant lesions and was considered the gold standard of reference.

Results

Malignant microcalcifications were easier to be visible at MicroPure US, as they were detected in 86.5% (n = 32/39) compared to only 68% (n = 17/25) of the benign lesions. US depicted more breast masses associated with malignant microcalcifications in 78% (n = 29/37) than those associated with benign ones seen in 36% (n = 9/25).Visibility of suspicious microcalcifications at US was aided by preliminary mammogram. Given known mammography location of these microcalcifications had made their visualization accessible by MicroPure US in 79% (n = 49) of the cases.

Conclusion

MicroPure ultrasound cannot discriminate benign from malignant breast microcalcifications. MicroPure can be useful in detecting clustered microcalcifications that are not accessible by B-mode ultrasound; provided knowledge of their mammographic location and thus can provide better guidance for pre-surgical wire localization and ultrasound-guided biopsies.     

Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

Purpose

To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication.

Materials and methods

A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port.

Results

Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction.

Conclusion

FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required.     

An increased flip angle in late phase Gd-EOB-DTPA MRI shows improved performance in bile duct visualization compared to T2w-MRCP

Objectives

To estimate the additional value of an increased flip angle of 35° in late phase Gd-EOB-DTPA-enhanced magnetic resonance cholangiography, as compared to T2w-MRCP.

Methods

40 adult patients underwent Gd-EOB-DTPA enhanced MRI of the liver including a T2-weighted 3D TSE MRCP (T2w-MRCP) as well as a late phase T1-weighted THRIVE sequences applying a flip angle of 35° (fa35). Two experienced observers evaluated the images regarding the delineation of the different biliary regions using a three-point grading system. A five-point scale was applied to determine the readers’ confidence in identifying anatomical variations of the biliary tree. ROI analysis was performed to compare the signal-to-noise (SNR) and contrast-to-noise (CNR) ratios.

Results

The quality for visualizing the biliary tree differed between T2w-MRCP and fa35 (p = <0.001). Late phase EOB-MRC was rated as good for delineating the entire biliary system, whereas T2w-MRCP received an overall poor rating. Especially the depiction of the intrahepatic bile ducts was estimated as problematic in T2w-MRCP. T2w-MRCP and fa35 revealed a discordant assessment of anatomical variations in 12.5% of the cases, comprising a generally higher confidence level for fa35 (4.0 ± 1.1 vs. 2.2 ± 1.2, p = <0.001). SNR proofed to be significantly higher in fa35 (p = <0.001), whereas T2w-MRCP revealed a significantly higher CNR (<0.001).

Conclusions

Gd-EOB-DTPA enhanced magnetic resonance cholangiography acquired with a flip angle of 35° revealed a better diagnostic performance compared to T2w-MRCP and might be a valuable adjunct in assessing functional bile duct abnormalities.     

The clinical utility of FDG-PET/CT in follow up and restaging of breast cancer patients

Background

Early diagnosis and accurate staging of loco-regional and distant recurrence after treatment of breast cancer is decisive for further therapeutic planning. Our aim was to evaluate the role of FDG-PET/CT in the follow up and restaging of breast cancer patients.

Methods

We retrospectively evaluated 34 female patients with a history of breast cancer. Patients were referred for a PET/CT scan because of suspected recurrence (n = 15), whole body staging in already confirmed cases of recurrence (n = 5), follow up and reassurance in asymptomatic patients (n = 7), follow up after local ablative therapy of liver metastases (n = 5), follow up after treatment of bone metastases (n = 2). PET-CT findings were compared with the findings obtained by other imaging modalities, histopathology, together with clinical and imaging follow up for at least 6 months.

Results

The PET/CT was considered pathological in 21/34 patients. Incorrect interpretations of PET/CT images occurred in 3 patients (8.8%). PET/CT showed an overall diagnostic accuracy of 91.2% with a sensitivity of 90.5% and a specificity of 92.3%. The PPV and NPV were 95% and 85.7%, respectively.

Conclusion

FDG-PET/CT may play a substantial role in the restaging and follow up of patients with breast cancer showing high sensitivity and specificity.     

Neoadjuvant TACE before laser induced thermotherapy (LITT) in the treatment of non-colorectal non-breast cancer liver metastases: Feasibility and survival rates

Purpose

To evaluate safety, feasibility and overall survival rates for transarterial chemoembolization (TACE) alone or combined with MR-guided laser-induced-thermotherapy (LITT) in liver metastases of non-colorectal and non-breast cancer origin.

Methods and materials

Included were patients with unresectable non-colorectal non-breast cancer liver metastases with progression under systemic chemotherapy. Excluded were patients with Karnofsky score ≤70, respiratory, renal and cardiovascular failure, and general TACE contraindications. TACE using Mitomycin alone, Mitomycin–Gemcitabine or Mitomycin–Gemcitabine–Cisplatin was performed to all patients. After TACE 146 metastases were ablated with MR-guided LITT. To be eligible for LITT metastases should be <5 cm in size and ≤5 in number. Tumor response was evaluated using MRI according to RECIST. Survival was evaluated using Kaplan–Meier analysis.

Results

A total of 110 patients (mean age 59.2 years) with 371 metastases received TACE (mean 5.4 sessions/patient, n = 110) with 76 (69%) receiving LITT (mean 1.6 session/patient) afterwards. TACE resulted in a mean decrease of mean maximum diameter of 52% ± 26.6 and volume change of −68.5% ± 22.9 in the 25 patients (23%) with partial response. Stable disease (n = 59, 54%). Progressive disease (n = 26, 23%). The RECIST outcome after LITT showed complete response (n = 13, 17%), partial response (n = 1, 1%), stable situation (n = 41, 54%) and progressive disease (n = 21, 28%). The mean time to progression (TTP) was 8.6 months. Median survival of all patients was 21.1 months.

Conclusion

TACE with different protocols alone and in combination with LITT is a feasible palliative treatment option resulting in a median survival of 21.1 months for unresectable liver metastases of non-colorectal and non-breast cancer origin.     

Abdominal ultrasonography in preterm necrotizing enterocolitis. Is it superior to plain radiography?

Purpose

To explore whether abdominal ultrasound (AUS) provide additional information over plain radiography in cases of necrotizing enterocolitis (NEC).

Methods

This study is a prospective study of 30 premature neonates with NEC in our neonatal intensive care unit between August 2010 and November 2011. Fifteen premature control neonates were also included in the study.

Results

Patients were classified into two groups: the first group with suspected NEC (stage I) (n = 14) and the second with definite NEC (stage II or III) (n = 16). In group I abdominal ultrasound (AUS) revealed intramural air (n = 9) and portal venous gas (PVG) (n = 1) while plain radiography showed only gaseous distension. In group II, intramural air (n = 10), PVG (n = 2), free fluid (n = 6) focal fluid (n = 1) and free air (n = 6) detected by AUS compared to pneumatosis intestinalis (PI) (n = 2) PVG (n = 1) and free air (n = 5) by plain radiography. Additionally bowel wall thinning was detected in 2 neonates of group I and 3 of group II.

Conclusion

Our results suggest AUS to be superior to plain radiography in early detection of complication as intestinal perforation by eliciting PVG and fluid collection and so early surgical management. Therefore this may decrease morbidity and mortality rates.     

Worsening respiratory function in mechanically ventilated intensive care patients: Feasibility and value of xenon-enhanced dual energy CT

Objectives

To evaluate the feasibility and incremental diagnostic value of xenon-enhanced dual-energy CT in mechanically ventilated intensive care patients with worsening respiratory function.

Methods

The study was performed in 13 mechanically ventilated patients with severe pulmonary conditions (acute respiratory distress syndrome (ARDS), n = 5; status post lung transplantation, n = 5; other, n = 3) and declining respiratory function. CT scans were performed using a dual-source CT scanner at an expiratory xenon concentration of 30%. Both ventilation images (Xe-DECT) and standard CT images were reconstructed from a single CT scan. Findings were recorded for Xe-DECT and standard CT images separately. Ventilation defects on xenon images were matched to morphological findings on standard CT images and incremental diagnostic information of xenon ventilation images was recorded if present.

Results

Mean xenon consumption was 2.95 l per patient. No adverse events occurred under xenon inhalation. In the visual CT analysis, the Xe-DECT ventilation defects matched with pathologic changes in lung parenchyma seen in the standard CT images in all patients. Xe-DECT provided additional diagnostic findings in 4/13 patients. These included preserved ventilation despite early pneumonia (n = 1), more confident discrimination between a large bulla and pneumothorax (n = 1), detection of an airway-to-pneumothorax fistula (n = 1) and exclusion of a suspected airway-to-mediastinum fistula (n = 1). In all 4 patients, the additional findings had a substantial impact on patients’ management.

Conclusions

Xenon-enhanced DECT is safely feasible and can add relevant diagnostic information in mechanically ventilated intensive care patients with worsening respiratory function.     

Role of magnetic resonance spectroscopy in differentiation between recurrence of glioma and post radiation injury

Purpose

This study aims to evaluate the role of MR spectroscopy in the detection of recurrent glioma and differentiation from post radiation injury.

Patients and methods

32 patients (20 males and 12 females) complaining of different neurological symptoms were enrolled prospectively in this study between September 2011 and December 2013. These patients were selected on the basis that they were known patients with pathologically proved glioma who underwent radiotherapy. All patients underwent standard MRI examination and MR spectroscopy.

Results

This study included 32 patients, twenty four patients (75%) proved histologically to be of recurrent glioma (group I) and 8 cases (25%) diagnosed as post radiation injury (group II). Peri-tumoral infiltration was present in 18 cases (56.25%) of recurrent glioma. Significantly increased Cho/Cr and Cho/NAA ratios were observed in neoplastic (n = 24) compared with non-neoplastic lesions (n = 8). Presence of lactate and lipid yielded correct classification as neoplastic and non-neoplastic lesions.

Conclusion

Magnetic resonance spectroscopy is a useful tool for the detection of recurrent glioma and differentiation from post radiation injury.