Portal vein thrombosis and arterioportal shunts : effects on tumor response after chemoembolization of hepatocellular carcinoma

AIM: To evaluate the effect of portal vein thrombosis and arterioportal shunts on local tumor response in advanced cases of unresectable hepatocellular carcinoma treated by transarterial chemoembolization. METHODS: A retrospective study included 39 patients (mean age: 66.4 years, range: 45-79 years, SD: 7) with unresectable hepatocellular carcinoma (HCC) who were treated with repetitive transarterial chemoembolization (TACE) in the period between March 2006 and October 2009. The effect of portal vein thrombosis (PVT) (in 19 out of 39 patients), the presence of arterioportal shunt (APS) (in 7 out of 39), the underlying liver pathology, Child-Pugh score, initial tumor volume, number of tumors and tumor margin definition on imaging were correlated with the local tumor response after TACE. The initial and end therapy local tumor responses were evaluated according to the response evaluation criteria in solid tumors (RECIST) and magnetic resonance imaging volumetric measurements. RESULTS: The treatment protocols were well tolerated by all patients with no major complications. Local tumor response for all patients according to RECIST criteria were partial response in one patient (2.6%), stable disease in 34 patients (87.1%), and progressive disease in 4 patients (10.2%). The MR volumetric measurements showed that the PVT, APS, underlying liver pathology and tumor margin definition were statistically significant prognostic factors for the local tumor response (P = 0.018, P = 0.008, P = 0.034 and P = 0.001, respectively). The overall 6-, 12- and 18-mo survival rates from the initial TACE were 79.5%, 37.5% and 21%, respectively. CONCLUSION: TACE may be exploited safely for palliative tumor control in patients with advanced unresectable HCC; however, tumor response is significantly affected by the presence or absence of PVT and APS

Perkutane transthorakale Ablationstherapie von Lungentumoren mittels Radiofrequenz- und Mikrowellen-Ablations-Techniken

Purpose of the Study: The purpose of the current study was to evaluate the role of radiofrequency (RF) and microwave (MW) ablation in the treatment of pulmonary neoplasms. Materials and Methods: From March 2004 to January 2009, 164 patients (92 males, 72 females; mean age 59.7 years, SD: 10.2) underwent computed tomography (CT)-guided percutaneous RFA of pulmonary malignancies. RFA was performed on 248 lung lesions (20 primary lesions and 228 metastatic lesions) in 248 sessions (one lesion per session). Tumors were pathologically proven and were classified as primary lung neoplasms in 20 patients (non-small cell lung cancer) and as metastatic lung neoplasms in 144 patients. RFA was performed using: a) CelonProSurge bipolar internally cooled applicator b) RITA®StarburstTMXL. From December 2007 to October 2009, 80 patients (30 males, 50 females; mean age 59.7 years, range: 48-68, SD: 6.4) underwent computed tomography (CT) guided percutaneous MW ablation of pulmonary metastases from variable histopathological primaries. MW was performed on 130 lung lesions in 130 sessions (one lesion per session) using Valleylab TM system. Results: The overall success rate of RFA was 67.7% (168/248 lesions), with overall failure rate either due to tumor residue or recurrence on follow up in 32.3% (80/248) with mean time to tumor progress was 5.6 months SD: 2.99 (Range:1-18 months). Complete successful ablation was achieved in patients treated by MWA in 73.1% (95/130 lesions), with failure rate either due to tumor residue or recurrence on follow up in 26.9% (35/130) with mean time to tumor progress 6 months SD: 2.83 (Range:1-12months). Correlation of the histopathological type of the lesion and the end result of ablation therapy revealed insignificant correlation in both RFA and MWA (p > 0.1). The preablation tumor size was one of the most significant factors that determined the end result of ablation. In RFA successful tumor ablation was significant statistically for lesions with maximal axial diameter up to 2.5 cm (110/140) in comparison to lesions of more than 2.5 cm in maximal axial diameter (58/108) (Fisher’s exact test: p 0.001). For successfully RFA ablated cases mean preablation tumor volumes 1.9 cc SD: 0.9 (range: 0.3 - 4.25 cc) while for failed cases the mean tumor volume was 3.7 SD: 2.4 (range: 0.8 – 6.8cc). For successfully MW ablated cases the mean preablation tumor volume: 2.4 cc SD: 2.2 (range: 0.25-8.2 cc) while for failed cases the mean tumor volume was 3.5 SD: 2.6 (range: 0.3 – 7.1 cc). In RFA the survival rates at 12, 24 and 36 months were 90%, 78% and 68% respectively while in MWA treated patients the survival rate within 12 months follow up period was 96% while at 20 month the survival rate was 77%. Complications associated with the ablation therapy were: a) procedure related mortality: 0.4% (1/248) in RFA due to massive pulmonary hemorrhage versus 0% (0/130) in MWA, b) pneumothorax: 11.3% (28/240) in RFA versus 8.5% (11/130) in MWA, c) pulmonary Hemorrhage: 17.7% (44 of 248 sessions) of which one patient had massive uncontrolled bleeding and immediate death versus 6.2% (8/130) in MWA, d) pleural effusion: 3.2 % (8 of 248 sessions) in RFA versus 3.8 % (6/130) in MWA, e) hemoptysis: 4% (10/248) in RFA versus 4.6% (6/130) in MWA ranging from mild tinged sputum to frank bleeding, f) infection: 0.4% (1/248) in RFA, versus 0% in MWA, and g) post ablation pain: 10% (25/248) in RFA versus 9.2% (12/130) in MWA. Pain was generally adequately controlled by analgesics. Conclusion: Radiofrequency and microwave ablation are effective minimally invasive tools and may be safely applied for management of lung malignancy. The success of ablation therapy is significantly correlated to the preablation tumor size, volume and tumor location.Hintergrund und Zielsetzung dieser Arbeit: Das Ziel der gegenwärtigen Studie war, die Rolle der Radiofrequenz- (RF-) und Mikrowellen- (MW-) Ablation bei der Behandlung von Lungentumoren zu evaluieren. Patienten und Methode: Von März 2004 bis Januar 2009 unterzogen sich 164 Patienten (92 männlich, 72 weiblich; Durchschnittsalter 59,7 Jahre; StA 10,2) der computertomographie- (CT-)gesteuerten RFA von Lungenmalignitäten. Die RFA wurde an 248 Lungenläsionen (20 primäre Läsionen und 228 Metastasen) in 248 Sitzungen (eine Läsion pro Sitzung) durchgeführt. Die RFA wurde mit folgenden Mitteln durchgeführt: a) Dem CelonProSurge bipolar, intern-gekühlten Applikator und b) Dem RITA®StarburstTMXL. Von Dezember 2007 bis Oktober 2009 unterzogen sich 80 Patienten (30 männlich, 50 weiblich; mittleres Alter 59,7 Jahre, Spannweite: 48- 68, StA: 6,4) der computertomographie- (CT-)gesteuerter perkutanen MWAblation pulmonaler Metastasen verschiedener histopathologischer Primarien. Die MWA wurde an 130 Lungenläsionen in 130 Sitzungen (eine Läsion pro Sitzung) durchgeführt. Alle MWAs wurden mit Valleylab MW-Antenne und ValleylabTM MW-Generator. Ergebnisse: Die generelle Erfolgsrate der RFA betrug 67,7% (168 von 248 Läsionen), die Rate des Therapieversagens durch entweder Tumor-Residuen oder Rezidiven während der Nachsorge (Follow-Up) entsprechend 23,3% (80 von 248 Läsionen). Die mittlere Dauer bis zu einem erfassten Tumorprogress betrug 5,6 Monate, StA: 2,99 (Spannweite: 1- 18 Monate). Bei Patienten welche durch MWA behandelt wurden, konnte eine komplett erfolgreiche Ablation in 73,1% (95 von 130 Läsionen) ermittelt werden. Die Rate des Therapieversagens betrug bei der MWA entsprechend, der während der Nachsorge erfassten Tumor-Residuen oder Rezidiven, 26,9% (35 von 130 Läsionen) mit einer mittleren Dauer bis zum Tumorprogress von 6 Monaten; StA: 2,83 (Spannweite: 1- 12 Monate). Bei der Korrelation der einzelnen histo-pathologischen Typen der Läsionen mit den Endergebnissen der Ablationstherapie, konnten keine signifikanten Unterschiede in beiden Therapiemethoden - MWA wie auch RFA - enthüllt werden (Signifikanzniveau p > 0,1). Die Tumorgröße vor Beginn der Ablationstherapie war einer der signifikantesten Faktoren welche das Endergebnis der Ablation determinierten. Durch die RFA erfolgreich abladierte Tumoren waren für alle Läsionen mit einem maximalen Durchmesser von bis zu 2,5 cm (110/ 140) im Vergleich zu Läsionen mit mehr als 2,5 cm Durchmesser (58/ 108) statistisch signifikant (Fisher’s exact test: p 0,001). Für einen erfolgreich RFA abladierten Tumor betrug das mittlere Volumen 1,9 cm3; StA: 0,9 (Spannweite: 0,3- 4,25 cm3), während bei erfolglosen Fälle das mittlere Tumorvolumen ein Maß von 3,7 cm3; StA 2,4 (Spannweite 0,8- 6,8 cm3) aufwies. Bei erfolgreich MWA abladierten Läsionen war das Tumorvolumen vor Ablationsbeginn 2,4 cm3; StA: 2,2 (Spannweite: 0,25- 8,2 cm3), wohingegen bei misserfolgter Ablation das mittlere Tumorvolumen 3,5 cm3; StA 2,6 (Spannweite: 0,3- 7,1 cm3) betrug. Die Überlebensrate war bei der RFA innerhalb von 12, 24 und 36 Monaten entsprechend 90%, 78% und 68%, während das Überleben bei den mit MWA behandelten Patienten innerhalb einer Zwölf-Monats-Periode 96% betrug; die Überlebensrate bei einer Nachsorgespanne von zwanzig Monaten 77%. Die Spannweite der Überlebensdauer von 1- 20 Monaten war im Mittel 15,2 Monate; StA: 4,9. Komplikationen die mit der Ablationstherapie assoziiert werden konnten, waren a) eine auf die Prozedur bezogene Mortalität von 0,4% (1/ 248) in der RFA durch eine massive pulmonale Blutung und von 0% (0/130) in der MWA, b) Pneumothoraces: 11,3% (28/ 240) bei der RFA und 8,5% (11/ 130) bei der MWA, c) pulmonale Blutungen: 17,7% (44 von 248 Sitzungen) in der RFA, von welchen ein Patient eine massive, unkontrollierbare, unmittelbar tödlich geendete Blutung erlitten hatte, und 6,2% (8/ 130) bei der MWA, d) Pleuraergüsse: 3,2% (8 von 248 Sitzungen) bei der RFA und 3,8% (6/ 130) bei der MWA, e) Hämoptysen: 4% (10/ 248) bei der RFA und 4,6% (6/ 130) bei der MWA, diese reichten von einem mild verfärbten Sputum bis hin zu einer offenen Blutung, f) Infektionen: 0,4% (1/ 248) bei der RFA und 0% bei der MWA und g) Post-Ablationsschmerz: 10% (25/ 248) bei der RFA und 9,2% (12/ 130) bei der MWA. Der Schmerz wurde im Allgemeinen adäquat mittels Analgetika kontrolliert. Schlussfolgerung: Radiofrequenz- und Mikrowellenablation sind effektive, minimalinvasive Methoden und können zur Behandlung von Lungenmalignitäten sicher durchgeführt werden. Der Erfolg der Ablationstherapie korreliert signifikant mit der vor Ablationsbeginn gemessenen Tumorgröße und dem vor Ablationsbeginn gemessenen Tumorvolumen sowie mit der Tumorlokalisation

Percutaneous Thermal Ablation Therapy of Hepatocellular Carcinoma (HCC): Microwave Ablation (MWA) versus Laser-Induced Thermotherapy (LITT)

The purpose of this study is to compare the efficacy and safety of microwave ablation (MWA) versus laser-induced thermotherapy (LITT) as a local treatment for hepatocellular carcinoma (HCC,) with regard to therapy response, survival rates, and complication rates as measurable outcomes. This retrospective study included 250 patients (52 females and 198 males; mean age: 66 ± 10 years) with 435 tumors that were treated by MWA and 53 patients (12 females and 41 males; mean age: 67.5 ± 8 years) with 75 tumors that were treated by LITT. Tumor response was evaluated using CEMRI (contrast-enhanced magnetic resonance imaging). Overall, 445 MWA sessions and 76 LITT sessions were performed. The rate of local tumor progression (LTP) and the rate of intrahepatic distant recurrence (IDR) were 6% (15/250) and 46% (115/250) in the MWA-group and 3.8% (2/53) and 64.2% (34/53) in the LITT-group, respectively. The 1-, 3-, and 5-year overall survival (OS) rates calculated from the date of diagnosis were 94.3%, 65.4%, and 49.1% in the MWA-group and 96.2%, 54.7%, and 30.2% in the LITT-group, respectively (p-value: 0.002). The 1-, 2-, and 3-year disease-free survival (DFS) rates were 45.9%, 30.6%, and 24.8% in the MWA-group and 54.7%, 30.2%, and 17% in the LITT-group, respectively (p-value: 0.719). Initial complete ablation rate was 97.7% (425/435) in the MWA-group and 98.7% (74/75) in the LITT-group (p-value > 0.99). The overall complication rate was 2.9% (13/445) in the MWA-group and 7.9% (6/76) in the LITT-group (p-value: 0.045). Based on the results, MWA and LITT thermal ablation techniques are well-tolerated, effective, and safe for the local treatment of HCC. However, MWA is recommended over LITT for the treatment of HCC, since the patients in the MWA-group had higher survival rates

Assessing Inner Ear Volumetric Measurements by Using Three-Dimensional Reconstruction Imaging of High-Resolution Cone-Beam Computed Tomography

<jats:title>Abstract</jats:title><jats:p>The aim of the study was to obtain volumetric data of the components of the inner ear using three-dimensional reconstruction of high-resolution cone-beam computed tomography (CBCT) images. Two hundred three CBCT image series of the temporal bone from 118 anatomically normal patients (55 women and 63 men; mean age: 49.4 ± 20.4 years) with different suspected disorders were included in this study. Normative volumetric measurements of the inner ear, the cochlea, the semicircular canals (SSC), and the vestibule were determined using a semi-automated reconstruction method of the Workstation. Volumetric measurements were successfully completed in all 118 patients. Mean inner ear, cochlear, and vestibule volumes were statistically significantly larger in males than in females on both sides (<jats:italic>p</jats:italic> < 0.001). Regarding the semicircular canals, no statistically significant (<jats:italic>p</jats:italic> = 0.053) volume difference was found. The difference between the volumes on both sides was not significant. No correlation between the patient’s age and the volume of the compartments was seen (<jats:italic>p</jats:italic> > 0.05). There was no significant difference between mean bony inner ear volumes when the clinical diagnoses were compared (<jats:italic>p</jats:italic> > 0.05 for all clinical diagnoses and volumes). Our study concluded that three-dimensional reconstruction and assessment of the volumetric measurements of the inner ear can be obtained using high-resolution CBCT imaging.</jats:p&gt

A prospective randomized trial comparing microwave and radiofrequency ablation for the treatment of liver metastases using a dual ablation system ─ The Mira study

Purpose: The aim of this study was to prospectively compare the therapy response and safety of microwave (MWA) and radiofrequency ablation (RFA) for the treatment of liver metastases using a dual ablation system. Methods: Fifty patients with liver metastases (23 men, mean age: 62.8 ± 11.8 years) were randomly assigned to MWA or RFA for thermal ablation using a one generator dual ablation system. Magnetic resonance imaging (MRI) was acquired before treatment and 24 h post ablation. The morphologic responses to treatment regarding size, volume, necrotic areas, and diffusion characteristics were evaluated by MRI. Imaging follow-up was obtained for one year in three months intervals, whereas clinical follow-up was obtained for two years in all patients. Results: Twenty-six patients received MWA and 24 patients received RFA (mean diameter: 1.6 cm, MWA: 1.7 cm, RFA: 1.5 cm). The mean volume 24 h after ablation was 37.0 cm3 (MWA: 50.5 cm3, RFA: 22.9 cm3, P < 0.01). The local recurrence rate was 0% (0/26) in the MWA-group and 8.3% (2/24) in the RFA-group (P = 0.09). The rate of newly developed malignant formations was 38.0% (19/50) for both groups (MWA: 38.4%, RFA: 37.5%, P = 0.07). The overall survival rate was 70.0% (35/50) after two years (MWA: 76.9%, RFA: 62.5%, P = 0.60). No major complications were reported. Conclusion: In conclusion, MWA and RFA are both safe and effective methods for the treatment of liver metastases with MWA generating greater volumes of ablation. No significant differences were found for overall survival, rate of neoplasm, or major complications between both groups

Computed tomography-guided biopsies in children : accuracy, efficiency and dose usage

Background: Computed-tomography-guided interventions are attractive for tissue sampling of paediatric tumor lesions; however, it comes with exposure to ionizing radiation. The aim of this study was to analyse the radiation dose, accuracy and speed of CT-guided interventions in paediatric patient cohort. Methods: We retrospectively reviewed CT-guided interventions over a 10 -year period in 65 children. The intervention site consisted of bones in 38, chest (lung) in 15 and abdomen (liver, lymph nodes) in 12 cases. Radiation dose and duration of the procedures were analysed. The statistical analysis was performed using dedicated statistical software (BiAS 8.3.6 software, Epsilon Verlag, North Hasted). Results: All interventions were performed successfully. Mean target access path to lesion within the patients was 6.0 cm (min 3.5 cm, max 11.2 cm). Time duration to complete intervention was 25:15 min (min 17:03 min, max 43:00 min). The dose-length product (DLP) of intervention scan was 29.5 mGy · cm (min 6 mGy · cm, max 85 mGy · cm) with the lowest dose for biopsies in the region of the chest (p = 0.04). Conclusions: With justified indications, CT-guided paediatric interventions are safe, effective and can be performed both, with short intervention times and low radiation exposure

Feasibility of diffusion-weighted magnetic resonance imaging in evaluation of early therapeutic response after CT-guided microwave ablation of inoperable lung neoplasms

Objective!#!To determine the early treatment response after microwave ablation (MWA) of inoperable lung neoplasms using the apparent diffusion coefficient (ADC) value calculated 24 h after the ablation.!##!Materials and methods!#!This retrospective study included 47 patients with 68 lung lesions, who underwent percutaneous MWA from January 2008 to December 2017. Evaluation of the lesions was done using MRI including DWI sequence with ADC value calculation pre-ablation and 24 h post-ablation. DWI-MR was performed with b values (50, 400, 800 mm!##!Results!#!Forty-seven patients (mean age: 63.8 ± 14.2 years, 25 women) with 68 lesions having a mean tumor size of 1.5 ± 0.9 cm (range: 0.7-5 cm) were evaluated. Sixty-one lesions (89.7%) showed a complete treatment response, and the remaining 7 lesions (10.3%) showed a local progression (residual activity). There was a statistically significant difference regarding the ADC value measured 24 h after the ablation between the responding (1.7 ± 0.3 × 10!##!Conclusion!#!ADC value assessment following ablation may allow the early prediction of treatment efficacy after MWA of inoperable lung neoplasms.!##!Key points!#!• ADC value calculated 24 h post-treatment may allow the early prediction of MWA efficacy as a treatment of pulmonary tumors and can be used in the early immediate post-ablation imaging follow-up. • The pre-treatment ADC value of lung neoplasms is not different between the responding and non-responding tumors

Postoperative radiological assessment of the mastoid facial canal in cochlear implant patients in correlation with facial nerve stimulation

Objectives: To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical or implant-related factors with postoperative facial nerve stimulation (FNS) occurrence. Methods: Two experienced radiologists evaluated retrospectively 215 postoperative post-CI CBCT examinations. The mastoid facial canal diameter, wall thickness, distance between the electrode cable and mastoid facial canal, and facial-chorda tympani angle were assessed. Additionally, the intracochlear position and the insertion angle and depth of electrodes were evaluated. Clinical data were analyzed for postoperative FNS within 1.5-year follow-up, CI type, onset, and causes for hearing loss such as otosclerosis, meningitis, and history of previous ear surgeries. Postoperative FNS was correlated with the measurements and clinical data using logistic regression. Results: Within the study population (mean age: 56 ± 18 years), ten patients presented with FNS. The correlations between FNS and facial canal diameter (p = 0.09), wall thickness (p = 0.27), distance to CI cable (p = 0.44), and angle with chorda tympani (p = 0.75) were statistically non-significant. There were statistical significances for previous history of meningitis/encephalitis (p = 0.001), extracochlear-electrode-contacts (p = 0.002), scala-vestibuli position (p = 0.02), younger patients’ age (p = 0.03), lateral-wall-electrode type (p = 0.04), and early/childhood onset hearing loss (p = 0.04). Histories of meningitis/encephalitis and extracochlear-electrode-contacts were included in the first two steps of the multivariate logistic regression. Conclusion: The mastoid-facial canal radiological assessment and the positional relationship with the CI electrode provide no predictor of postoperative FNS. Histories of meningitis/encephalitis and extracochlear-electrode-contacts are important risk factors