To compare medical costs for a matched-pair cohort of Medicare patients with early-stage non–small-cell lung cancer (NSCLC) who underwent treatment with sublobar resection or thermal ablation.
Purpose: To analyze image quality and the factors that determine it for cone-beam computed tomography (CT) hepatic arteriography in chemoembolization for hepatocellular carcinoma (HCC).
Purpose: To compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient.
Hepatocellular carcinoma (HCC) is an epithelial tumor originating in the liver and composed of cells with characteristics similar to those of normal hepatocytes (1). It is the fifth most common tumor in the world, and its incidence is increasing, especially in Western nations (2). Cirrhosis is the most important clinical risk factor for HCC, with approximately 80% of cases of HCC developing in patients with a cirrhotic liver (3). In such patients, the annual incidence of HCC ranges from 2% to 8% (4,5). The exact incidence depends on the cause of cirrhosis (highest incidence in those infected with hepatitis C virus or hepatitis B virus), severity of cirrhosis (highest incidence in those with decompensated cirrhosis), geographic region (higher in Japan than in Europe or United States), and sex (higher in men than women). The risk is greater in individuals with multiple risk factors as well as in those coinfected with human immunodeficiency virus (6). Patients without cirrhosis also may develop HCC, especially those with long-standing chronic liver inflammation due to hepatitis B virus or hepatitis C virus infection (7) or nonalcoholic steatohepatitis (8), but at a much lower rate than those with cirrhosis. Other risk factors for HCC include heavy alcohol consumption, tobacco smoking (9), obesity, diabetes, hereditary hemochromatosis, high dietary consumption of aflatoxins, and family history of HCC (6). Importantly, cirrhosis and chronic hepatitis now are recognized as risk factors for intrahepatic cholangiocarcinoma (ICC) as well as HCC (10); thus, many patients at risk for HCC may develop ICC instead.
In the field of oncology, accurate liver imaging is critically important for appropriate management of cancer patients. The liver is the second most common site of metastatic disease after lymph node metastases and the most common metastatic site in patients with colorectal cancer (1,2). Primary liver tumors are common, with hepatocellular carcinoma (HCC) representing the most common primary hepatic malignancy and the third most common cause of cancer-related death worldwide. Accurate imaging techniques for early detection, staging, and monitoring of liver disease are of utmost importance (3).
Hepatocellular carcinoma (HCC) is the most common primary malignant disease of the liver and is the third leading cause of death from cancer worldwide. In the United States, the incidence of HCC has tripled to 4.9 in 100 000 between 1975 and 2005 (1). While mortality from most malignancies has decreased steadily in the past 20 years, mortality from liver cancer has increased substantially. Systemic chemotherapy, with the exception of sorafenib (Nexavar; Bayer HealthCare Pharmaceuticals, Wayne, NJ) (2), has a limited role in the treatment of HCC. Intraarterial therapy, especially transarterial chemoembolization, has been shown to improve survival in patients with unresectable HCC (3).
Prostate cancer is the most common form of cancer in the Western male population and has a significant socioeconomic impact (1). Approximately 25%–33% of patients with newly diagnosed prostate cancer undergo a form of radiation therapy. Of these patients, 26%–52% develop biochemical signs of tumor recurrence within 5 years of treatment (2–4). Salvage prostatectomy is a frequently used therapy option in patients with recurrence after radiation therapy. However, high rates of incontinence (0%–67%) or rectal injury (0%–8%) (5,6) have led to the search for other salvage treatment options. For this reason, ablative techniques such as cryoablation, high-intensity focused ultrasound, and photodynamic therapy have been explored.
The current standard of clinical practice for an initial prostate biopsy involves sampling 10 to 14 cores for an overall cancer detection rate of 27%–40.3% (1–4). However, in this approach, samples of only the posterior part of the gland are removed, and this restriction may lead to the underdiagnosis of anterior lesions that represent about 18% of cancers in unselected patients with a clinical suspicion of prostate cancer (PCa) (5). In addition, even though this standard improves cancer diagnosis, it is associated with detection of microfocal cancer lesions (tumor volume, ≤ 0.5 cm3) that may be clinically insignificant and are unlikely to require treatment. Multiparametric magnetic resonance (MR) imaging is a powerful tool for identifying clinically significant PCa, especially when localized in the anterior part of the gland (6) or in areas that usually are undersampled (extreme base and apex) at biopsy (7). When multiparametric MR imaging is performed before transrectal ultrasonography (US)-guided biopsy, it may provide information to help operators to perform targeted biopsy (TB) at areas suspicious for cancer, thereby improving clinically significant PCa diagnoses (8). The manner in which a lesion seen at MR imaging is targeted at biopsy varies. There are three broad categories of TB: (a) “cognitive” targeting, where the physician performing a transrectal US-guided biopsy reviews the MR imaging results before the procedure and uses this knowledge to select the most appropriate area for TB guided by US images (5) (the technique is routinely performed in most prostate imaging centers); (b) targeting using registration or fusion software to allow a lesion defined at MR imaging to be identified at US during a transrectal US–guided biopsy procedure, either with or without a tracking device (9); and (c) targeting within the magnet (in-bore targeting) (8). The techniques in b and c require additional equipment and training, but contrary to in-bore targeting in c, which is still undergoing evaluation, transrectal US–MR imaging image-fusion–guided biopsy, in b, is becoming available as an option on most US biopsy devices, and there is a growing need for assessing their capabilities.
Image-guided radiofrequency (RF) ablation has been widely accepted as a minimally invasive therapy for the treatment of early-stage hepatocellular carcinoma (HCC) (1). Because surgical margins of approximately 1 cm are required for successful resection, an ablative margin of 5–10 mm is needed to achieve therapeutic results similar to those achieved with surgery (2–4). However, current RF ablation technology, with internally cooled (5) or expandable electrodes (6), shows limited ability to reliably create a volume of coagulation necrosis that includes the tumor and adequate safety margins (7). Therefore, the insufficient safety margins of RF ablation treatment have led to marginal recurrence rates up to 41%, especially in tumors greater than 3 cm in diameter (8–12). Several types of electrodes have been developed to overcome this limitation and achieve greater ablation zones, including perfused (5), clustered (13), saline-infused expandable (14), and multipolar electrodes (15). Although expandable electrodes can create a large ablation area, needle-type electrodes, such as the internally cooled or clustered electrodes, are more frequently used for ultrasonographically (US)-guided RF ablation. This is so because it is difficult to see all of the tines or the saline distribution when expandable electrodes are used (14,16). However, for achieving adequate ablation volumes with single electrodes, multiple overlapping ablations are required (17,18). In clinical practice, repositioning electrodes with US guidance is time consuming and technically challenging because gas bubbles formed by previous ablations may interfere with locating the electrode tip and identifying the unablated residual tumor (19).
Endovascular aneurysm repair (EVAR) is the preferred treatment for infrarenal abdominal aortic aneurysms when appropriate patient selection is practiced. The aneurysm-associated short-term mortality after endograft implantation is significantly reduced compared to that with surgery (1,2). In addition, surgical morbidity is lower, and the hospital stay and intensive care time are shorter. However, repeat intervention owing to endograft-related complications is necessary in approximately 15% of patients (1,2). As a result, endoleak, migration, and other endograft-related complications following EVAR require long-term postoperative surveillance. Endoleaks, which are defined as the flow of blood within the aneurysm sac but outside the endovascular graft, are particularly important. They can help predict post-EVAR rupture and therefore indicate the need for post-EVAR endoleak surveillance (3,4). Static computed tomographic (CT) angiography, usually including an arterial and venous phase, is the current standard method for pre- and postoperative imaging evaluation of abdominal aortic aneurysms (5–11). The recent introduction of time-resolved dynamic CT angiography with repetitive bidirectional table movement allows the assessment of temporal enhancement patterns in the endograft, aneurysm sac, and adjacent aortic branches with a high temporal resolution. The aim of this study was to determine the time course of enhancement patterns in the aorta and endoleaks at dynamic CT angiography as well as their effect on the endoleak detection rate in patients who have undergone abdominal aortic EVAR.
Variceal bleeding is one of the leading causes of death in patients with cirrhosis. After the first episode of variceal bleeding, the risk of recurrent bleeding in the next 2 years is particularly high, ranging between 50% and 80% (1). Several treatment options, such as surgical shunts (2), endoscopic therapy (3), and transjugular intrahepatic portosystemic shunt (TIPS) placement (4), are used for secondary prophylaxis of recurrent variceal bleeding. However, surgical shunts are less often used to prevent recurrent variceal bleeding because of the high risk of morbidity and mortality. Placement of TIPS is a well-established technique that is highly effective in preventing recurrent variceal bleeding (4), especially if the TIPS is created with an expanded polytetrafluoroethylene (ePTFE)-covered stent, which has a significantly lower risk of shunt dysfunction than does TIPS created with bare stents, thereby greatly improving long-term clinical outcomes (4–6). Study results have demonstrated that TIPS may be more effective than endoscopic therapy combined with propranolol in the prevention of recurrent variceal bleeding (4,7).
Bone is the third most common site of metastasis, and metastases from almost all primary anatomic cancer sites have been identified in bone at autopsy (1). Pain from osseous metastases remains refractory to treatment in many cases, despite a persistent attempt to develop a method of reliable analgesia over the past 40 years (2–9). Recent comprehensive reviews detail the current understanding of bone cancer pain pathophysiology (10,11), as well as the pharmacologic, hormonal, radiotherapeutic, radiopharmaceutical, and interventional treatment options currently used to treat such pain (12). The effectiveness and safety of image-guided percutaneous radiofrequency (RF) ablation as a treatment option for painful osseous metastases has been established (9,13–15), but the imaging features associated with successful palliation have not been reported. The purpose of this study was to identify the correlation of pre- and postablation imaging features with pain relief, pain intensity, and patient mood after RF ablation of solitary painful osseous metastases.
PURPOSE: We aimed to determine the correlation between flow characteristics of the proximal pulmonary arteries and vena cava obtained by 3.0 T phase-contrast magnetic resonance imaging (MRI) and hemodynamic characteristics by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension.
PURPOSE: We aimed to assess the correlation between pulmonary hemorrhage and pneumothorax in computed tomography (CT)-guided transthoracic fine needle aspiration (TTFNA), particularly its possible value as protection against the development of pneumotorax.
PURPOSE: Exoseal is a vascular closure device consisting of a plug applier and a bio-absorbent polyglycolic acid plug available in sizes 5 F, 6 F, and 7 F. In this study, we aimed to evaluate the effectiveness and safety of the Exoseal vascular closure device (Cordis Corporation, Bridgewater, New Jersey, USA) for puncture site closure after antegrade endovascular procedures in peripheral arterial occlusive disease (PAOD) patients.
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