Frequency and Risk Factors of Various Complications After Computed Tomography–Guided Radiofrequency Ablation of Lung Tumors

Objective To retrospectively determine the frequency and risk factors of various side effects and complications after percutaneous computed tomography–guided radiofrequency (RF) ablation of lung tumors. Methods We reviewed and analyzed records of 112 treatment sessions in 57 of our patients (45 men and 12 women) with unresectable lung tumors treated by ablation. Risk factors, including sex, age, tumor diameter, tumor location, history of surgery, presence of pulmonary emphysema, electrode gauge, array diameter, patient position, maximum power output, ablation time, and minimum impedance during ablation, were analyzed using univariate and multivariate analyses. Results Total rates of side effects and minor and major complications occurred in 17%, 50%, and 8% of treatment sessions, respectively. Side effects, including pain during ablation (46% of sessions) and pleural effusion (13% of sessions), occurred with RF ablation. Minor complications, including pneumothorax not requiring chest tube drainage (30% of sessions), subcutaneous emphysema (16% of sessions), and hemoptysis (9% of sessions) also occurred after the procedure. Regarding major complications, three patients developed fever >38.5°C; three patients developed abscesses; two patients developed pneumothorax requiring chest tube insertion; and one patient had air embolism and was discharged without neurologic deficit. Univariate and multivariate analyses suggested that a lesion located ≤1 cm of the chest wall was significantly related to pain (p < 0.01, hazard index 5.76). Risk factors for pneumothorax increased significantly with previous pulmonary surgery (p < 0.05, hazard index 6.1) and presence of emphysema (p <0.01, hazard index 13.6). Conclusion The total complication rate for all treatment sessions was 58%, and 25% of patients did not have any complications after RF ablation. Although major complications can occur, RF ablation of lung tumors can be considered a safe and minimally invasive procedure.     

Pulmonary Artery Access Embolization in Patients with Massive Hemoptysis in Whom Bronchial and/or Nonbronchial Systemic Artery Embolization Is Contraindicated

The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.     

Management of malignant biliary obstruction: Technical and clinical results using an expanded polytetrafluoroethylene fluorinated ethylene propylene (ePTFE/FEP)-covered metallic stent after 6-year experience

To evaluate the efficacy and safety of an expanded polytetrafluoroethylene-fluorinated ethylene-propylene (ePTFE/FEP)-covered metallic stent in the management of malignant biliary obstruction. Eighty consecutive patients with malignant common bile duct strictures were treated by placement of 83 covered metallic stents. The stent-graft consists of an inner ePTFE/FEP lining and an outer supporting structure of nitinol wire. Clinical evaluation, assessment of serum bilirubin and liver enzyme levels were analyzed before biliary drainage, before stent-graft placement and during the follow-up period at 1, 3, 6, 9 and 12 months. Technical success was obtained in all cases. After a mean follow-up of 6.9±4.63 months, the 30-day mortality rate was 14.2%. Survival rates were 40% and 20.2% at 6 and 12 months, respectively. Stent-graft patency rates were 95.5%, 92.6% and 85.7% at 3, 6 and 12 months, respectively. Complications occurred in five patients (6.4%); among these, acute cholecystitis was observed in three patients (3.8%). A stent-graft occlusion rate of 9% was observed. The percentage of patients undergoing lifetime palliation (91%) and the midterm patency rate suggest that placement of this ePTFE/FEP-covered stent-graft is safe and highly effective in achieving biliary drainage in patients with malignant strictures of the common bile duct.     

Selective endovascular treatment of a traumatic basilar aneurysm after endoscopic third ventriculostomy

A 4-year-old girl suffered intraventricular and subarachnoid hemorrhage during endoscopic third ventriculostomy. Cerebral angiography revealed a traumatic basilar aneurysm secondary to basilar artery injury. The aneurysm was treated with selective endovascular embolization using Guglielmi detachable coils. We review some therapeutic features of traumatic basilar aneurysms after endoscopic third ventriculostomy and describe the feasibility of endovascular selective therapy to manage these lesions successfully.     

The influence of the lower patellar pole in the pathogenesis of chronic patellar tendinopathy

Resection of the lower patellar pole provides good results in the treatment of jumper’s knee. Therefore we hypothesized that the length of the lower patellar pole is increased in patients with chronic patellar tendinopathy. Cohort study, level of evidence 2. Between 2000 and 2005, 25 patients with chronic patellar tendinopathy underwent conservative and surgical treatment in our clinic. All of them had preoperative MRI were three independent examiners measured the Caton Index, the length and the ratio of the articular and non-articular patellar surface, tendon length and thickness and the thickness and length of the hypodens lesions in the patellar tendon. The measurements were compared with 50 MRI of a control group with no clinical patellofemoral disorders or patellar tendinopathy. Significant changes in tendon thickness (9.42 ± 2.87 vs. 4.88 ± 1.13; P < 0.0001), a longer non-articular surface of the patella (10.62 ± 2.86 vs. 7.098 ± 2.53; P < 0.0001) and significant higher ratio between the articular and the non-articular patellar surface (0.32 vs. 0.24; P < 0.0001) were found in the jumper’s knee group. No significant changes were seen in the length of the articular surface or the Caton Index. The development of chronic patellar tendinopathy in athletes might be associated with a longer lower patellar pole as patients with jumper’s knee showed a longer non-articular patellar surface compared with the control group.     

Ossifying chondroid lipoma

Chondroid lipoma is a rare variant of lipoma that pathologically can mimic liposarcoma or possibly other sarcomas. Variants of lipoma, including chondroid lipoma, may demonstrate radiological evidence of fat within the tumor, but often display heterogeneous features on imaging studies, making a clinical diagnosis difficult. A large collective experience with the imaging characteristics of chondroid lipoma is lacking due to the rarity of this tumor. We present a case of chondroid lipoma of the upper thigh in a 37-year-old woman who had regions of metaplastic bone formation within the tumor. Radiologically, the tumor presented as a large soft tissue mass with calcification and ossification. Although metaplastic bone formation in conventional lipoma is well described, it has been rarely reported to occur in chondroid lipoma and has not been pathologically documented or illustrated. The imaging findings and histopathology of this unusual tumor are presented, along with a review of the literature.     

Distal Embolic Protection for Renal Arterial Interventions

Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices. Dr. Murphy has support as follows: supported by grants HL071556-01 and HL077221 from the National Heart, Lung, & Blood Institute, and also received research grants from Boston Scientific, Guidant, Cordis, and Otsuka Pharmaceuticals.     

Computer-assisted total knee arthroplasty versus the conventional technique: how precise is navigation in clinical routine?

Restoration of the mechanical leg axis and component positioning are crucial factors affecting long-term results in total knee arthroplasty (TKA). In a prospective study, 1,000 patients were operated on either using a CT-free navigation system or the conventional jig-based technique. Leg alignment and component orientation were determined on postoperative X-rays. The mechanical leg axis was significantly better in the computer-assisted group (95%, within ±3° varus/valgus) compared to the conventional group (74%, within ±3° varus/valgus) (P < 0.001). On average, the operating time was increased by 8 min in the computer-assisted group. No significant differences were seen between senior and younger surgeons regarding postoperative leg alignment and operating time. Computer-assisted TKA leads to a more accurate restoration of leg alignment and component orientation compared to the conventional jig-based technique. Potential benefits in long-term outcome and functional improvement require further investigation.     

An automated procedure for the assessment of white matter hyperintensities by multispectral (T1, T2, PD) MRI and an evaluation of its between-centre reproducibility based on two large community databases

Introduction An automated procedure for the detection, quantification, localization and statistical mapping of white matter hyperintensities (WMH) on T2-weighted magnetic resonance (MR) images is presented and validated based on the results of a between-centre reproducibility study. Methods The first step is the identification of white matter (WM) tissue using a multispectral (T1, T2, PD) segmentation. In a second step, WMH are identified within the WM tissue by segmenting T2 images, isolating two different classes of WMH voxels – low- and high-contrast WMH voxels, respectively. The reliability of the whole procedure was assessed by applying it to the analysis of two large MR imaging databases (n = 650 and n= 710, respectively) of healthy elderly subjects matched for demographic characteristics. Results Average overall WMH load and spatial distribution were found to be similar in the two samples, (1.81 and 1.79% of the WM volume, respectively). White matter hyperintensity load was found to be significantly associated with both age and high blood pressure, with similar effects in both samples. With specific reference to the 650 subject cohort, we also found that WMH load provided by this automated procedure was significantly associated with visual grading of the severity of WMH, as assessed by a trained neurologist. Conclusion The results show that this method is sensitive, well correlated with semi-quantitative visual rating and highly reproducible.     

Skull base: pseudolesion or true lesion?

The skull base is a complex anatomical structure. Therefore, radiologists often use “side-to-side” comparison for detection of abnormalities. This approach is compromised by the high frequency of anatomical variations involving the skull base and the common presence of flow-related artifacts within vessels at the skull base that might mimic true lesions. The spectrum of “pseudolesions” ranging from different anatomical variations, such as unusual arachnoid granulations, asymmetric pneumatization and/or appearance of neurovascular foramina, to flow-related artifacts will be discussed in this review article, and tips for their distinction from a true lesion in a similar location will be given.