Tumor and Ablation Margin Visibility during Cryoablation of Musculoskeletal Tumors: Comparing Intraprocedural PET/CT Images with CT-Only Images

PurposeTo compare tumor and ice-ball margin visibility on intraprocedural positron emission tomography (PET)/computed tomography (CT) and CT-only images and report technical success, local tumor progression, and adverse event rates for PET/CT-guided cryoablation procedures for musculoskeletal tumors.Materials and MethodsThis Health Insurance Portability and Accountability Act (HIPAA)–compliant and institutional review board–approved retrospective study evaluated 20 PET/CT-guided cryoablation procedures performed with palliative and/or curative intent to treat 15 musculoskeletal tumors in 15 patients from 2012 to 2021. Cryoablation was performed using general anesthesia and PET/CT guidance. Procedural images were reviewed to determine the following: (a) whether the tumor borders could be fully assessed on PET/CT or CT-only images; and (b) whether tumor ice-ball margins could be fully assessed on PET/CT or CT-only images. The ability to visualize tumor borders and ice-ball margins on PET/CT images was compared with that on CT-only images.ResultsTumor borders were fully assessable for 100% (20 of 20; 95% CI, 0.83–1) of procedures on PET/CT versus 20% (4 of 20; 95 CI, 0.057–0.44) of procedures on CT only (P < .001). The tumor ice-ball margin was fully assessable in 80% (16 of 20; 95% CI, 0.56–0.94) of procedures using PET/CT versus 5% (1 of 20; 95% CI, 0.0013–0.25) of procedures using CT only (P < .001). Primary technical success was achieved in 75% (15 of 20; 95% CI, 0.51–0.91) of procedures. There was local tumor progression in 23% (3/13; 95% CI, 0.050–0.54) of the treated tumors with at least 6 months of follow-up. There were 3 adverse events (1 Grade 3, 1 Grade 2, and 1 Grade 1).ConclusionsPET/CT-guided cryoablation of musculoskeletal tumors can provide superior intraprocedural visualization of the tumor and ice-ball margins compared with that provided by CT alone. Further studies are warranted to confirm the long-term efficacy and safety of this approach.     

POEMS Syndrome—Clinical Picture and Management. Current Knowledge

POEMS syndrome is a rare form of plasma cell dyscrasia. Difficulties arise already at the stage of making the diagnosis (complex and heterogeneous clinical picture) and continue during the course of treatment (lack of guidelines for therapy, data coming mainly from reports and short series of patients). In this article we review the current state of knowledge on POEMS syndrome diagnostics, clinical characteristics, prognosis, reported treatment outcomes and the emergence of the new therapeutic strategies.     

高分辨率显微内镜对消化道正常黏膜的成像研究*

目的总结消化道正常黏膜的高分辨率显微内镜(HRME)的图片特点。方法选择正常食道黏膜、胃黏膜、十二指肠黏膜、小肠黏膜和结肠黏膜活检标本各10例为研究对象,利用HRME分别对其进行成像观察,根据采集的HRME图片对不同部位的消化道正常黏膜进行描述性分析,总结其HRME图片特点。成像结束后所有标本常规行病理检查。结果 50例活检标本共获得1 284张HRME图片,经筛查后,留取400张图片用于结果分析。不同部位消化道正常黏膜的HRME图片特点如下:1食道黏膜:细胞排列规则,细胞核圆而亮,大小一致,核间距正常,每个视野里细胞的数量基本一致;2胃底黏膜:浅层可见腺体排列规则,呈分枝状。胃小凹开口呈圆形或类椭圆形,周边裂隙呈线样,细胞核排列规则;3胃窦黏膜:浅层可见胃小凹开口呈不规则形或管状,腺腔呈裂隙状,小凹周围细胞排列规则,细胞核小且分布密集;4十二指肠黏膜:可见绒毛呈宽大的指状,绒毛两侧有锯齿状凹陷,立体感明显,呈簇状排列,间隙呈裂隙状;5小肠黏膜:绒毛状结构较宽,间隙较宽大,数量较十二指肠少;6结肠黏膜:细胞核大小一致、形态规则,为圆形或椭圆形以及菊花状的腺体结构。所有标本病理结果均证实为正常黏膜。结论 HRME可以准确地辨别不同部位消化道正常黏膜,与病理结果比较,具有很高的一致性。