01 marzo 2014

RADIOLOGY. Perivascular versus Nonperivascular Small HCC Treated with Percutaneous RF Ablation: Retrospective Comparison of Long-term Therapeutic Outcomes

Tae Wook Kang, MD, Hyo Keun Lim, MD, Min Woo Lee, MD, Young-sun Kim, MD, Dongil Choi, MD, Hyunchul Rhim, MD

Although major advances in the prevention and treatment of hepatocellular carcinoma (HCC) have been made, it is still the sixth most prevalent cancer and the third most frequent cause of cancer-related death worldwide (1). A variety of modalities have been used to treat HCC, including surgical resection, local tumor ablation, liver transplantation, transcatheter arterial chemoembolization (TACE), and molecular-targeted therapy (2). Among many local tumor ablation therapies, radiofrequency (RF) ablation is now accepted as a first-line treatment for HCC (3). Randomized controlled trials (4,5) demonstrated that RF ablation was similar to surgical resection for early-stage HCC in terms of overall and disease-free survival.

01 marzo 2014

RADIOLOGY. Radiofrequency Ablation of Hepatocellular Carcinoma as First-Line Treatment: Long-term Results and Prognostic Factors in 162 Patients with Cirrhosis

Dong Ho Lee, MD, Jeong Min Lee, MD, Jae Young Lee, MD, Se Hyung Kim, MD, Jung Hwan Yoon, MD, Yoon Jun Kim, MD, Joon Koo Han, MD, Byung Ihn Choi, MD

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide and is the third most common cause of cancer-related death (1). Traditionally, hepatic resection and transplantation have been considered the treatments of choice for curative purposes (2). However, radiofrequency ablation (RFA) is emerging as an effective local treatment for curative intent in patients with cirrhosis and HCC smaller than 3 cm in diameter (3,4). Two randomized clinical trials showed that RFA was as safe and effective as hepatic resection for HCC smaller than 3 cm in diameter (4,5). Furthermore, RFA is less invasive and simpler to perform and requires shorter hospitalization compared with hepatic resection (6). For these reasons, RFA has been used in several medical centers as the first-line treatment option for HCC smaller than 3 cm in diameter (7).

01 marzo 2014

RADIOLOGY. Benign Prostatic Hyperplasia: Prostatic Arterial Embolization versus Transurethral Resection of the Prostate—A Prospective, Randomized, and Controlled Clinical Trial

Yuan-an Gao, MD, Yan Huang, MD, Rui Zhang, PhD, Yu-dong Yang, MD, Qing Zhang, MD, PhD, Min Hou, MD, Yi Wang, MD, PhD

Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH) (1). However, individuals older than 60 years are at high risk for surgical complications (2), including urinary tract infection, strictures, postoperative pain, incontinence or urinary retention, sexual dysfunction, and blood loss (2). As a growing trend for the clinical management of BPH, several minimally invasive treatments have been proposed (3–6). In the 1970s, prostatic arterial embolization (PAE) was introduced as a method to control massive hemorrhage after prostatectomy or prostate biopsy (7,8). In 2000, DeMeritt et al (9) reported a case study of a patient with BPH who underwent PAE for severe gross hematuria. DeMeritt et al incidentally discovered that PAE could successfully induce shrinkage of the enlarged prostate, thereby relieving the clinical symptoms.

28 febrero 2015

WORLD JOURNAL OF RADIOLOGY. Imaging and interventions in hilar cholangiocarcinoma: A review

Kumble Seetharama Madhusudhan, Shivanand Gamanagatti and Arun Kumar Gupta.

Hilar cholangiocarcinoma is a common malignant tumor of the biliary tree. It has poor prognosis with very low 5-year survival rates. Various imaging modalities are available for detection and staging of the hilar cholangiocarcinoma. Although ultrasonography is the initial investigation of choice, imaging with contrast enhanced computed tomography scan or magnetic resonance imaging is needed prior to management. Surgery is curative wherever possible. Radiological interventions play a role in operable patients in the form of biliary drainage and/or portal vein embolization. In inoperable cases, palliative interventions include biliary drainage, biliary stenting and intra-biliary palliative treatment techniques. Complete knowledge of application of various imaging modalities available and about the possible radiological interventions is important for a radiologist to play a critical role in appropriate management of such patients.We review the various imaging techniques and appearances of hilar cholangiocarcinoma and the possible radiological interventions.

01 enero 2014

RADIOLOGY. Active Hemorrhage and Vascular Injuries in Splenic Trauma: Utility of the Arterial Phase in Multidetector CT

Jennifer W. Uyeda, MD, Christina A. LeBedis, MD, David R. Penn, MD, Jorge A. Soto, MD, Stephan W. Anderson, MD

The advent of multidetector computed tomography (CT) has proved invaluable in the rapid evaluation of intraabdominal injuries in patients who sustain multiple trauma (1–9). Multidetector CT has high accuracy for detecting hollow- and solid-organ injury in the trauma setting, including the evaluation for traumatic splenic injuries (1–3,8–10). The detection of active splenic hemorrhage and contained vascular injuries is crucial for identifying the need for subsequent direct intervention (eg, surgery or transcatheter embolization) versus conservative, nonsurgical treatment (1–3,6,7,9,11–15).

01 enero 2014

RADIOLOGY. Radiofrequency Ablation versus Radical Nephrectomy: Clinical Outcomes for Stage T1b Renal Cell Carcinoma

Haruyuki Takaki, MD, Norihito Soga, MD, Hideki Kanda, MD, Atsuhiro Nakatsuka, MD, Junji Uraki, MD, Masashi Fujimori, MD, Takashi Yamanaka, MD, Takaaki Hasegawa, MD, Kiminobu Arima, MD, Yoshiki Sugimura, MD, Hajime Sakuma, MD, Koichiro Yamakado, MD

Recently, the detection of small renal cell carcinoma (RCC) measuring 4 cm or smaller (stage T1a) has been increasing because of the widespread use of various imaging modalities (1). However, up to 25% of RCCs are still detected at a size of 4.1–7.0 cm (stage T1b) (2,3).

01 febrero 2014

RADIOLOGY. Percutaneous Breast Biopsy: Effect on Short-term Quality of Life

Kathryn L. Humphrey, MD, Janie M. Lee, MD, MSc, Karen Donelan, ScD, Chung Y. Kong, PhD, Olubunmi Williams, MD, MPH, Omosalewa Itauma, MD, MPH, Elkan F. Halpern, PhD, Beverly J. Gerade, NP, Elizabeth A. Rafferty, MD, J. Shannon Swan, MD

In the United States, approximately 229 060 new cases of breast cancer were diagnosed in 2012 (1). Given the magnitude of this disease, efforts are continually focused on improving diagnostic techniques and treatment methods. Although the mortality benefit from screening mammography is well established, false-positive test results are a potential harm (2). Approximately 10% of women who undergo mammographic screening are recalled for additional diagnostic evaluation, and more than 500 000 women in the United States undergo a breast biopsy each year (1,3,4).

01 febrero 2014

RADIOLOGY. Intrabiliary RF Heat-enhanced Local Chemotherapy of a Cholangiocarcinoma Cell Line: Monitoring with Dual-Modality Imaging—Preclinical Study

Feng Zhang, MD, PhD, Thomas Le, MD, Xia Wu, MD, PhD1, Han Wang, MD, PhD, Tong Zhang, MD, PhD, Yanfeng Meng, MD, PhD, Baojie Wei, MD, PhD, Stephanie S. Soriano, MD, Patrick Willis, BS, Orpheus Kolokythas, MD, Xiaoming Yang, MD, PhD

Patients with biliary malignancies have poor prognoses. Unfortunately, by the time such malignancies are diagnosed, they are usually unresectable. However, for the minority of patients who have resectable tumors, surgical treatment is often associated with substantial postoperative morbidity and mortality (1,2).

01 febrero 2014

RADIOLOGY. Prostate Imaging: Evaluation of a Reusable Two-Channel Endorectal Receiver Coil for MR Imaging at 1.5 T

Masoom A. Haider, MD, Axel Krieger, PhD, Christine Elliott, BASc, Michael R. Da Rosa, MD, Laurent Milot, MD

Multiparametric magnetic resonance (MR) imaging for prostate cancer has been shown to provide valuable information in a variety of clinical settings: as a predictor of organ-confined disease in preoperative staging nomograms (1,2); as a detection and navigation tool to guide transrectal ultrasonographically (US)-guided (3), MR imaging–guided (4), and MR imaging and transrectal US fusion biopsy (5) and focal therapy (6); as a method of evaluating patients suspected of having prostate cancer despite previous negative biopsies (7,8); and as a risk stratification tool for active surveillance of patients (9).

01 febrero 2014

RADIOLOGY. Uterine Fibroids: Postsonication Temperature Decay Rate Enables Prediction of Therapeutic Responses to MR Imaging-guided High-Intensity Focused Ultrasound Ablation

Young-sun Kim, MD, Min Jung Park, MD, Bilgin Keserci, PhD, Kirsi Nurmilaukas, PhD, Max O. Köhler, PhD, Hyunchul Rhim, MD, Hyo Keun Lim, MD

Magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) ablation is increasingly being used worldwide to treat symptomatic uterine fibroids because of its excellent therapeutic efficacy in controlling symptoms and its excellent safety record (1–3). For these reasons, MR HIFU therapy is now considered a viable alternative to uterine artery embolization as the nonsurgical modality with which to treat uterine fibroids.

01 febrero 2014

RADIOLOGY. Lightweight Bilayer Barium Sulfate–Bismuth Oxide Composite Thyroid Collars for Superior Radiation Protection in Fluoroscopy-guided Interventions: A Prospective Randomized Controlled Trial

Heiko Uthoff, MD, Matthew J. Benenati, Barry T. Katzen, MD, Constantino Peña, MD, Ripal Gandhi, MD, Daniel Staub, MD, Melanie Schernthaner, MD

Fluoroscopy-guided diagnostic and interventional procedures have increased substantially during the past decades (1). An increased incidence of cataracts, and possibly cancer and other diseases, has been associated with occupational radiation exposure (2,3). Although in recent years, several lighter leaded and lead-free materials have been approved by the Food and Drug Administration for radiation protection, apron weight–associated discomfort and fatigue during prolonged procedures, as well as chronic back problems, are well known among interventional operators (4,5). There is a clinical need for improvements in radiation attenuation capability, as well as comfort of personal radiation protection. Preliminary experimental data showed that a newer bilayer barium sulfate–bismuth oxide composite (XPF) provides better radiation attenuation per weight (in the range of 60–130 kVp) than do other commercially available 0.5-mm lead-equivalent materials (6). However, the attenuation measured in an experimental in vitro setting refers to primary beams only and does not include scatter radiation, which is a major portion of the occupational radiation exposure in clinical practice. Thus, the quality of radiation protection of a device is best measured in the specific clinical setting to account for patient and procedural factors that affect scatter radiation, as well as for the positioning, shape, and size of the shield. Because of a lack of power, a previous small clinical pilot study failed to meet the prespecified noninferiority limit for XPF compared with standard protection (7). However, the reported 95% confidence interval of the radiation protection difference between XPF and standard protection was wide (range, −5.9% to 21.6%) and indicated that XPF might provide up to 21.6% greater radiation protection. The purpose of this larger study was to test in a clinical setting whether newer XPF thyroid collars (TCs) provide superior radiation protection (primary objective) and comfort (secondary objective) during fluoroscopy-guided interventions compared with standard 0.5-mm lead-equivalent TCs.

01 enero 2014

AMERICAN JOURNAL OF ROENTGENOLOGY. Hepatic Arterial Infusion Chemotherapy by the Fixed-Catheter-Tip Method: Retrospective Comparison of Percutaneous Left Subclavian and Femoral Port-Catheter System Implantation

Tomohiro Matsumoto, Takuji Yamagami, Rika Yoshimatsu, Hiroyuki Morishita, Noriko Kitamura, Osamu Sato and Terumitsu Hasebe

OBJECTIVE. The purpose of this study was to retrospectively compare the subclavian and femoral approaches to a fixed-catheter-tip method of implantation of a port-catheter system for hepatic arterial infusion chemotherapy with respect to complications and dysfunctions.

01 febrero 2014

AMERICAN JOURNAL OF ROENTGENOLOGY. Incidence and Predictive Factors of Inadequate Fine-Needle Aspirates for BRAFV600E Mutation Analysis in Thyroid Nodules

Kwang Hwi Lee, Hyun Su Kim, Boo-Kyung Han, Eun Young Ko, Chang-Seok Ki and Jung Hee Shin

OBJECTIVE. BRAFV600E mutation (valine-to-glutamate substitution at residue 600 of the B-type Raf kinase gene) analysis from thyroid aspirates is increasingly used as a prognostic or diagnostic marker. However, it is limited under some conditions. The purpose of this study was to assess the incidence and predictive factors of thyroid nodules with specimens inadequate for BRAFV600E mutation analysis.

01 febrero 2014

AMERICAN JOURNAL OF ROENTGENOLOGY. Techniques to Expand Patient Selection for MRI-Guided High-Intensity Focused Ultrasound Ablation of Uterine Fibroids

Young-sun Kim, Duk-Soo Bae, Min Jung Park, Antti Viitala, Bilgin Keserci, Hyunchul Rhim and Hyo Keun Lim

OBJECTIVE. MRI-guided high-intensity focused ultrasound (HIFU) ablation is increasingly adopted for treating symptomatic uterine fibroids. As a noninvasive therapy performed on an outpatient basis, it has been viewed by patients to have distinct advantages over other treatment options. However, its breadth of clinical application is still limited. To address this issue, various techniques have been implemented.

01 febrero 2014

AMERICAN JOURNAL OF ROENTGENOLOGY. Prediction of Contrast-Induced Nephropathy in Patients With Serum Creatinine Levels in the Upper Normal Range by Cystatin C: A Prospective Study in 374 Patients

Annette Wacker-Gußmann, Katharina Bühren, Caroline Schultheiss, Siegmund Lorenz Braun, Sharon Page, Bernd Saugel, Sebastian Schmid, Sebastian Mair, Albert Schoemig, Roland M. Schmid and Wolfgang Huber

OBJECTIVE. Preexisting renal impairment is a risk factor for contrast-induced nephropathy (CIN). In patients with creatinine in the upper normal level, cystatin C might be a more sensitive predictor of CIN than creatinine. Therefore, in this study, we investigated the usefulness of cystatin C to predict CIN.