To evaluate the safety of radioembolization (RE) with (90)Yttrium ((90)Y) resin microspheres depending on coiling or no-coiling of aberrant/high-risk vessels.
Early and late toxicity after 566 RE ...procedures were analyzed retrospectively in accordance with the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE v3.0). For optimal safety, aberrant vessels were either coil embolized (n = 240/566, coiling group) or a more peripheral position of the catheter tip was chosen to treat right or left liver lobes (n = 326/566, no-coiling group).
Clinically relevant late toxicities (≥ Grade 3) were observed in 1% of our overall cohort. The no-coiling group had significantly less "any" (P = 0.0001) or "clinically relevant" (P = 0.0003) early toxicity. There was no significant difference (P > 0.05) in delayed toxicity in the coiling versus the no-coiling group. No RE-induced liver disease was noted after all 566 procedures.
RE with (90)Y resin microspheres is a safe and effective treatment option. Performing RE without coil embolization of aberrant vessels prior to treatment could be an alternative for experienced centers.
Purpose
To evaluate feasibility of automatic software-based path proposals for CT-guided percutaneous biopsies.
Methods
Thirty-three patients (60
±
12 years) referred for CT-guided biopsy of focal ...liver lesions were consecutively included. Pre-interventional CT and dedicated software (FraunhoferMeVis Pathfinder) were used for (semi)automatic segmentation of relevant structures. The software subsequently generated three path proposals in downward quality for CT-guided biopsy. Proposed needle paths were compared with consensus proposal of two experts (comparable, less suitable, not feasible). In case of comparable results, equivalent approach to software-based path proposal was used. Quality of segmentation process was evaluated (Likert scale, 1
=
best, 6
=
worst), and time for processing was registered.
Results
All biopsies were performed successfully without complications. In 91 % one of the three automatic path proposals was rated comparable to experts’ proposal. None of the first proposals was rated not feasible, and 76 % were rated comparable to the experts’ proposal. 7 % automatic path proposals were rated not feasible, all being second choice (
n
=
1
) or third choice (
n
=
6
). In 79 %, segmentation at least was good. Average total time for establishing automatic path proposal was 42
±
9 s.
Conclusion
Automatic software-based path proposal for CT-guided liver biopsies in the majority provides path proposals that are easy to establish and comparable to experts’ insertion trajectories.
Abstract
Background
Oral anticoagulation (OAC) is the mainstay of secondary prevention in ischemic stroke patients with atrial fibrillation (AF). However, in AF patients with large vessel occlusion ...stroke treated by endovascular therapy (ET) and acute carotid artery stenting (CAS), the optimal antithrombotic medication remains unclear.
Methods
This is a subgroup analysis of the German Stroke Registry—Endovascular Treatment (GSR-ET), a prospective multicenter cohort of patients with large vessel occlusion stroke undergoing ET. Patients with AF and CAS during ET were included. We analyzed baseline and periprocedural characteristics, antithrombotic strategies and functional outcome at 90 days.
Results
Among 6635 patients in the registry, a total of 82 patients (1.2%, age 77.9 ± 8.0 years, 39% female) with AF and extracranial CAS during ET were included. Antithrombotic medication at admission, during ET, postprocedural and at discharge was highly variable and overall mortality in hospital (21%) and at 90 days (39%) was high.
Among discharged patients (n = 65), most frequent antithrombotic regimes were dual antiplatelet therapy (DAPT, 37%), single APT + OAC (25%) and DAPT + OAC (20%). Comparing DAPT to single or dual APT + OAC, clinical characteristics at discharge were similar (median NIHSS 7.5 interquartile range, 3–10.5 vs 7 4–11,
p
= 0.73, mRS 4 IQR 3–4 vs. 4 IQR 3–5,
p
= 0.79), but 90-day mortality was higher without OAC (32 vs 4%,
p
= 0.02).
Conclusions
In AF patients who underwent ET and CAS, 90-day mortality was higher in patients not receiving OAC.
Registration
:
https://www.clinicaltrials.gov
; Unique identifier: NCT03356392.
Percutaneous vertebroplasty is a minimally invasive, radiologically guided procedure in which bone cement is injected into structurally weakened or destructed vertebrae in order to achieve additional ...biomechanical stability. In addition to treating osteoporotic vertebral fractures, this technique gains popularity to relieve pain by stabilizing vertebrae compromised by, for example, metastases, aggressive hemangiomas or multiple myeloma that are at risk of pathologic fracture. Since conservative treatment with narcotic analgesics, bed rest, biphosphonates and back bracing for several weeks is often ineffective and the analgesic effect of radiation therapy is delayed, percutaneous vertebroplasty may play a beneficial role in the management of metastases to the spine.
In clinical trials with yttrium-90-resin-microspheres for the management of colorectal cancer liver metastases, it was observed that radioembolization might result in splenomegaly and an increase in ...portal vein size. Subclinical hepatitis in normal liver tissue as well as the effects of radioembolization and prior chemotherapy are suspected to be responsible for this phenomenon. The purpose of this study was to quantify the changes in liver and spleen volume and portal vein diameter after radioembolization.
Twenty-seven patients with liver-dominant metastatic disease from breast cancer who had not responded to chemotherapy or had to abandon chemotherapy because of its toxic effects were evaluated. Changes in liver and spleen volume and portal vein diameter as well as liver tumor volume and diameter were quantified using computed tomography scans.
Radioembolization was associated with a significant mean decrease in the whole liver volume of 10.2% (median 16.7%; P = 0.0024), mainly caused by a reduction in the right lobe volume (mean 16.0%; P < 0.0001). These changes were accompanied by a significant increase in the diameter of the main portal vein (mean 6.8%; P < 0.0001) as well as splenic volume (mean 50.4%; P < 0.0001). Liver-tumor volume and diameter decreased by a median of 24 and 39.7%.
Radioembolization is an effective treatment for tumor size reduction in patients with breast cancer liver metastases. Treatment is associated with changes of hepatic parenchymal volume, splenic volume, and portal vein size that appear not to represent clinically important sequelae in this patient cohort.
During the last few years, vertebroplasty has gained a wide acceptance for the treatment of painful osteoporotic vertebral body fractures and osteolytic changes. However, new guidelines with ...significant changes in indications and technique were published recently in Europe. Therefore, the aim of this review is to highlight recent changes in indications for vertebroplasty, patient work-up and changes in procedural technique, and to give an overview of patient outcome and possible complications. Therefore, technical details like different types of fluoroscopy, needle placement, pain management during the intervention, recommended equipment, including bone cement, and the use of venography are discussed. Postprocedural issues are noted, including the risk of minor and major complications and the expected outcome of the treated patients.
Abstract
Background
Lower grade gliomas show heterogenous appearance on T2-weighted MRI. Some tumors grow diffusely along axonal structures whereas others distort adjacent brain tissue through local ...mass effect. The diagnostic, therapeutic and prognostic implication of differential growth patterns on MRI remain unknown and are difficult to assess quantitatively.
Material and Methods
A web-based application allowing for image preprocessing and providing a comprehensive edge detection tool by means of quantifying tumor border delineation on T2-weighted images based on the canny edge detection algorithm was developed. A sigma value between 1 and 100 determined the threshold where tumor borders where not detected by the algorithm anymore, with 1 equating to the lowest threshold and thus detection of all edges contained in the image. Two experienced faculty members assigned sigma values to axial T2 images of a random sample of 20 WHO grade 2 astrocytomas, IDH-mutant and 1p/19q-non-codeleted. The sigma values were then compared with a binary, subjective rating by the same faculty staff according to the perceived predominant growth pattern (diffuse versus circumscript) of each glioma.
Results
When subjectively categorizing tumors binarily (diffuse versus circumscript), there was moderate interrater variability between observers (cohen’s kappa=0.6). Raters agreed in 16 of 20 cases, terming 7 gliomas unanimously diffuse and 9 gliomas circumscript. In 4 cases, the raters opinions diverged. The sigma values differed significantly between diffuse and circumscript tumors in both raters (rater 1, p=0.002; rater 2, p=0.018). For rater 1, the mean sigma difference between diffuse and circumscript tumors was 10.7 and 9.3 for rater 2.
Conclusion
Edge detection algorithms can be efficiently applied on MRI scans and are highly accurate in differentiating diffuse from circumscript gliomas. Objectification demands defining imaging criteria for diffuse and circumscript appearance of lower grade gliomas on MRI.
This retrospective study aimed to compare feasibility, complication rate and local tumor control after radiofrequency ablation (RFA) of pulmonary tumors under conscious analgo-sedation (AS) versus ...general anaesthesia (GA).
Within 36 months 21 patients had RFA (36 tumors, 26 treatment sessions). One patient suffered from NSCLC, 20 had metastases (breast (8/20), colorectal (6/20), renal cell (2/20), pharyngeal carcinoma (1/20), malignant melanoma (3/20)). Patients were no surgical candidates due to underlying comorbidities. Eleven of 26 treatments were performed under GA, while in 15 of 26 treatments AS was used. Follow-up was scheduled 24
h, 6 weeks, 3 months, 6 months and then every 6 months after treatment.
RFA was feasible in all treatments under GA, while under AS targeting of the lesion was not possible in 2/15. Six adverse events occurred in the GA group (three major, three minor), while seven complications happened in the AS group (three major, four minor) (
p
=
0.57). During follow-up of 3–36 months local recurrence was detected in 3 of 21 tumors in the GA group and in 2 of 15 tumors in the AS group (
p
=
0.79).
Hospitalization, complication rates and types, and the rate of local tumor control did not differ substantially among both groups. Furthermore, there was no significant difference in technical success and feasibility.
RFA of pulmonary tumors under GA or AS did not result in different tumor control and complication rates, respectively. Therefore, AS should be used except in anxious or agitated patients.
In addition to teleradiological reporting as a nighthawking or a regular service, teleradiological communication can be used for interdisciplinary expert consultation. We intended to evaluate an ...interdisciplinary consultation system based on a teleradiology platform with regard to its impact on therapeutic decision-making, directed patient referrals to an academic tertiary care center and the economic benefit for the hospital providing the service. Therefore, consultations from five secondary care centers and consecutive admissions to an academic tertiary care center were prospectively evaluated over a time period of six months. A total of 69 interdisciplinary expert consultations were performed. In 54 % of the cases the patients were consecutively referred to the university hospital for further treatment. In all acutely life-threatening emergencies (n = 9), fast and focused treatment by referral to the academic tertiary care center was achieved (average time to treat 130 min). The admissions to the academic tertiary care center led to improved utilization of its facilities with additional revenue of more than 1,000000 euro p. a. An interdisciplinary expert consultation via a teleradiology platform enables fast and efficient expert care with improved and accelerated patient management and improved utilization of the service providing hospital.
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