Liver resection (LR) with negative margins confers survival advantage in many patients with hepatic malignancies. However, an adequate future liver remnant (FLR) is imperative for safe LR. Presently, in patients with an inadequate FLR; the 2 most established clinical techniques performed to induce liver hypertrophy are portal vein embolization (PVE) and portal vein ligation. More recently, it has been observed that patients who undergo treatment via Y90 radioembolization experience hypertrophy of the contra-lateral untreated liver lobe. Based on these observations, several investigators have proposed the potential use of this modality as an alternative technique for increasing the FLR prior to liver resection. Y90 radioembolization induces hypertrophy at a slower rate than PVE but has the added advantage of concomitant local disease control and tumour down-staging.
AIM: To compare outcomes from radiofrequency ablation (RFA) and hepatectomy for treatment of colorectal liver metastasis (CRLM).
AIM: To evaluate the diagnostic accuracy of magnetic resonance cholangiopancreatography (MRCP) in patients with choledocholithiasis.
Although surgical resection remains the standard for the treatment of liver metastases from colon cancer, less than 20% of patients are eligible for curative resection (1). Radiofrequency ablation (RFA) is one of the most common alternative curative treatment options for small tumors that are not appropriate for resection. RFA includes delivering a high-frequency alternating current with an electrode placed percutaneously or surgically in the tumor. This current causes agitation of ions, which generates frictional heat in the core of the tumor (2). The created hyperthermia extends into the tissue by means of conduction but rapidly decreases in the probe. Therefore, tumor cells are killed rapidly in the tumor center because of high temperatures, while less cellular damage occurs at the tumor periphery where temperatures are lower. Near the tumor center, these lower temperatures result in ongoing necrosis, which consists of dying cells. However, at the tumor periphery the temperature is not sufficient to induce cell death, resulting in viable area that leads to tumor recurrence. (3). In clinical practice this means that RFA is less effective in large tumors (4–6). Patients with colorectal metastases with diameters smaller than 3 cm have 5-year survival rates of approximately 50%, with local recurrence in 15%–30% (7,8). Local recurrence in tumors larger than 3 cm reaches 25%–60%, and 5-year survival rates are approximately 15% (7,9). Therefore, treatment that increases tumor sensitivity to moderate hyperthermia without increasing normal tissue toxicity could improve the efficacy of RFA in large tumors or those located near large vessels or bile ducts.
Hepatocellular carcinoma (HCC) is often diagnosed at an advanced stage, which restricts therapeutic options (1,2). Transcatheter arterial chemoembolization (TACE) is widely accepted for treating nonresectable liver-confined HCC in an effort to control tumor growth, prolong survival, or downstage disease in patients with borderline resectable or transplantable status (3,4). Owing to its better toxicity profile, repeating TACE after achieving demonstrable treatment response is preferred, rather than repeating TACE at predetermined times. In clinical practice, disease progression after two cycles of TACE is generally used as an indicator to preclude further treatment (5). Accurate early assessment of the effectiveness of TACE is critical for treatment planning and can, in patients with favorable response, facilitate the decision to conduct early repeat treatment, in an effort to eradicate small remaining viable tumor portions, or, conversely, delay treatment, with the aim of decreasing toxicity and treatment-related morbidity. Early identification of nonresponders can facilitate timely conversion to a second-line local-regional or systemic treatment. However, TACE often results in low initial response rates, as assessed with Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, despite effectively delaying tumor progression (6). The European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases have proposed the EASL and modified RECIST (mRECIST) response criteria on the basis of changes in tumor contrast material enhancement (7,8), which have shown superior association with survival compared with RECIST (9). However, change in the degree of radiologic contrast material enhancement may not always accurately indicate tumor response after one TACE procedure or allow one to completely differentiate between histopathologically viable and necrotic tumor (10–12).
Purpose: To compare efficacy of transarterial chemoembolization with and without radiation therapy (RT) versus sorafenib for advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).
Purpose: To retrospectively evaluate long-term survival outcomes of radiofrequency (RF) ablation of colorectal lung metastases and evaluate factors associated with improved survival.
Purpose: To compare retrospectively the outcomes and complications of transcatheter arterial chemoembolization with drug-eluting embolic agents combined with radiofrequency (RF) ablation or microwave (MW) ablation in treatment of hepatocellular carcinoma (HCC).
OBJECTIVE. This article will describe the elements of performing a thorough venous ultrasound evaluation of the lower extremity in patients with manifestations of chronic venous disorder. The emphasis will be on the evaluation of superficial venous reflux. Only the specific aspects of the evaluation of the deep system pertaining to chronic venous disease will be discussed.
OBJECTIVE. The purpose of this study is to retrospectively evaluate the prevalence and extent of Celect inferior vena cava (IVC) filter penetration.
OBJECTIVE. The objective of our study was to evaluate image quality and overall adequacy of low-dose CT angiography (CTA) with model-based iterative reconstruction (MBIR) in patients who had undergone endovascular aneurysm repair (EVAR) of a thoracic or abdominal aortic aneurysm.
OBJECTIVE. The aim of this article is to illustrate the imaging findings and analyze the spectrum of findings seen in patients with acute aortic syndrome. We also will discuss the overlaps in pathophysiologic and imaging findings among aortic syndromes.
OBJECTIVE. The aim of this article is to illustrate the imaging findings and spectrum of disease entities affecting the aorta. The clinical presentation and assessment of acute aortic pathology can be elusive or deceptive, making the diagnosis challenging. The widespread availability of advanced cross-sectional imaging technology in the emergency setting puts the radiologist at the forefront of accurate and timely diagnosis.
A multidisciplinary approach to the treatment of patients with unresectable hepatocellular carcinoma (HCC) has led to improvements in screening, detection, and treatments. Interventional techniques include thermal ablation, transarterial chemoembolization, and radioembolization whilst stereotactic body radiation therapy also uses imaging to target the radiation. Both survival rates and cure rates have improved markedly since the introduction of these techniques. This review article describes the image guided techniques used for the treatment of HCC.
Renal cell carcinoma (RCC) accounts for 3% of malignancies in adults and 80%–90% of malignant renal tumors (1). Because of improved availability of thin-section abdominal imaging, early detection of small, low-grade RCC lesions has emerged during the last decades. Together with early detection, multiple treatment options are currently available to treat early RCCs. These treatments include traditional open radical nephrectomy (ORN) and newer nephron-sparing approaches (eg, open or laparoscopic partial nephrectomy, percutaneous thermal ablative techniques). Because of the advantages of shorter recovery times and preservation of renal function, less extensive therapies, such as percutaneous thermal ablative techniques, are gaining popularity. However, despite the trend toward the newer less-invasive approaches, ORN remains the standard treatment in the management of localized RCC for a number of indications (2).
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