Irreversible Electroporation of a Hepatocellular Carcinoma Lesion Adjacent to a Transjugular Intrahepatic Portosystemic Shunt Stent Graft

We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.     

Recanalization of Chronic Noncirrhotic,Nonmalignant Splanchnic Thromboses is Feasible: A Transsplenic Assisted Patient-Tailored Approach

The purpose of this study was to evaluate the feasibility of recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses with a transsplenic assisted patient-tailored approach with or without transjugular intrahepatic portosystemic shunt (TIPS) creation. In this retrospective study, 10 patients (median age, 48.4 years; interquartile range, 5.1 years) underwent revascularization between November 2016 and August 2020. Portal cavernoma was present in all patients, with complete splenic vein thrombosis in 70%. The technical success rate was 80%. Additional TIPS creation was performed in 5 (50%) patients. At a median follow-up of 19.3 months (interquartile range, 17.9 months), the primary and secondary patency rate was 70% and 100%, respectively. During follow-up, 1 patient died due to recurrent upper gastrointestinal variceal hemorrhage. In conclusion, percutaneous transsplenic assisted recanalization of chronic noncirrhotic, nonmalignant splanchnic thromboses is feasible. However, multiple access points may still be needed. Additional TIPS creation appears to be necessary only in case of insufficient portal venous flow into the liver.     

Imaging update on soft tissue sarcoma

Soft tissue sarcomas (STS) are rare tumours presenting as soft tissue lumps. Ultrasound is often the primary modality for the initial assessment, with MRI the mainstay for lesion characterisation. PET/CT along with other emerging MRI sequences are used in certain situations as an adjunct and problem solving tool in STS staging and assessment of disease recurrence. Recent advances include the promise of whole body MRI, hybrid PET/MRI, diffusion weighted imaging, dynamic contrast enhanced MRI and advances in artificial intelligence. This article discusses current concepts in extremity STS imaging and highlights recent advances.     

Medical students’ skills in image interpretation before and after training: A comparison between 3rd-year and 6th-year students from two different medical curricula

The purpose of this study was to assess student's performance in the interpretation of images before and after training in radiology, by comparing two groups, 6th-year and 3rd-year students, from two different medical curricula. Students participated in an anonymous evaluation consisting of the interpretation of 12 radiological images accompanied with the salient history and clinical data by answering 60 open-ended questions about technique, anatomy, semiology, and clinics. The number of correct, incorrect and blank responses of each group was used to compare pre- and post-training results. Unpaired two-sample t-test was used to evaluate differences between groups. A significant increase in correct responses was found in both groups after training. The comparison between both groups did not show differences for incorrect answers of the whole test and correct answers about anatomy in the pre-training evaluation. The percentage of correct answers to the median question improved from 15.5% to 53.3% for 6th-year students and from 8.3% to 41.1% for 3rd-year students. The post-training evaluation showed a significant increase of correct answers of 6th-year students with respect to 3rd-year students (mean ± standard deviation 53.6 ± 31.3% and 38.7 ± 29.9% respectively), mainly due to differences in technical and clinical questions. This study provides objective and quantitative evidence of pre- and post-training student skills in image interpretation. The similarities found in the previous level of knowledge and skills of both groups emphasizes the suitable change of the first-time training in radiology, from the 6th to the 3rd year course in medical curricula.     

Exploratory Study of Apparent Diffusion Coefficient Histogram Metrics in Assessing Pancreatic Malignancy

PurposeTo evaluate whole-lesion 3D-histogram apparent diffusion coefficient (ADC) metrics for assessment of pancreatic malignancy.MethodsForty-two pancreatic malignancies (36 pancreatic adenocarcinoma [PDAC], 6 pancreatic neuroendocrine [PanNET]) underwent abdominal magnetic resonance imaging (MRI) with diffusion-weighted imaging before endoscopic ultrasound biopsy or surgical resection. Two radiologists independently placed 3D volumes of interest to derive whole-lesion histogram ADC metrics. Mann-Whitney tests and receiver operating characteristic analyses were used to assess metrics’ diagnostic performance for lesion histology, T-stage, N-stage, and grade.ResultsWhole-lesion ADC histogram metrics lower in PDACs than PanNETs for both readers (P ≤ .026) were mean ADC (area under the curve [AUC] = 0.787-0.792), mean of the bottom 10th percentile (mean_0-10) (AUC = 0.787-0.880), mean of the 10th-25th percentile (mean_10-25) (AUC = 0.884-0.917) and mean of the 25th-50th percentile (mean_25-50) (AUC = 0.829-0.829). For mean_10-25 (metric with highest AUC for identifying PDAC), for reader 1 a threshold > 0.94 × 10^?3 mm²/s achieved sensitivity 94% and specificity 83%, and for reader 2 a threshold > 0.82 achieved sensitivity 97% and specificity 67%. Metrics lower in nodal status ≥ N₁ than N₀ for both readers (P ≤ .043) were mean_0-10 (AUC = 0.789-0.822) and mean_10-25 (AUC = 0.800-0.822). For mean_10-25 (metric with highest AUC for identifying N₀), for reader 1 a threshold <1.17 achieved sensitivity 87% and specificity 67%, and for reader 2 a threshold <1.04 achieved sensitivity 87% and specificity 83%. No metric was associated with T-stage (P > .195) or grade (P > .215).ConclusionVolumetric ADC histogram metrics may serve as non-invasive biomarkers of pancreatic malignancy. Mean_10-25 outperformed standard mean for lesion histology and nodal status, supporting the role of histogram analysis.