Introduction
To assess the performance of pre-ablation computed tomography texture features of adrenal metastases to predict post-treatment local progression and survival in patients who underwent ...ablation using machine learning as a prediction tool.
Materials and Methods
This is a pilot retrospective study of patients with adrenal metastases undergoing ablation. Clinical variables were collected. Thirty-two texture features were extracted from manually segmented adrenal tumors. A univariate cox proportional hazard model was used for prediction of local progression and survival. A linear support vector machine (SVM) learning technique was applied to the texture features and clinical variables, with leave-one-out cross-validation. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess performance between using clinical variables only versus clinical variables and texture features.
Results
Twenty-one patients (61% male, age 64.1 ± 10.3 years) were included. Mean time to local progression was 29.8 months. Five texture features exhibited association with progression (
p
< 0.05). The SVM model based on clinical variables alone resulted in an AUC of 0.52, whereas the SVM model that included texture features resulted in an AUC 0.93 (
p
= 0.01). Mean overall survival was 35 months. Fourteen texture features were associated with survival in the univariate model (
p
< 0.05). While the trained SVM model based on clinical variables resulted in an AUC of 0.68, the SVM model that included texture features resulted in an AUC of 0.93 (
p
= 0.024).
Discussion
Pre-ablation texture analysis and machine learning improve local tumor progression and survival prediction in patients with adrenal metastases who undergo ablation.
To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders.
We retrospectively ...evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years.
Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients.
Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.
Purpose
To review technical details, indications for use, success rates and complications of gun-sight technique for transjugular intra-hepatic portosystemic shunt (TIPS) creation.
Materials and ...Methods
A multicenter retrospective review was performed. Forty-two TIPS procedures with gun-sight technique were identified between 2016 and 2021. Eighty-six percent of patients had portal vein thrombosis (PVT), and 21% had undergone prior failed TIPS creation. Demographics, procedure details and outcomes were reviewed. Differences between the groups, event rates and patency rates were evaluated using nonparametric two-sample Wilcoxon rank-sum (Mann–Whitney) test, Fisher’s exact test, Kaplan–Meier curves, and log-rank test.
Results
Technical success was 98%. Sixty-seven percent of subjects had transsplenic and 26% had transhepatic access for TIPS creation. Twenty-one adverse events were noted (48%), four of which were definitely related and four were probably related to the use of gun-sight technique. Early (within 90 days) thrombosis occurred in 7/41 patients (17%), all of whom had existing PVT.
Conclusion
Gun-sight technique for TIPS creation has a high success rate in this challenging cohort of patients. While complications can occur, most of the adverse events noted were likely associated with TIPS creation itself rather than gun-sight. Early thrombosis only occurred in patients with PVT.
Level of Evidence
Level 4, Case Series.
Graphic Abstract
CT-guided percutaneous biopsy is a resourceful and widely used tool to evaluate pulmonary nodules that frequently avoids costly and unnecessary surgeries. Severe complications occur in less than 1% ...of cases and include gas embolism, which is rarely documented. We report a case of gas embolism after transthoracic biopsies and discuss the pathophysiology and the benefits of early diagnosis and proper management.
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