The purpose of this study was to describe the treatment techniques and results of 38 consecutive imaging-guided percutaneous radiofrequency ablations of solid renal masses performed in 32 patients.
...Solid renal masses in 32 patients underwent 38 treatment sessions using imaging-guided percutaneous radiofrequency ablation. During 36 sessions, radiofrequency ablation was performed using CT guidance, and two, using sonographic guidance. The average patient age was 76 years (range, 52-87 years), and the average renal mass size was 2.6 cm (range, 1-5 cm). The average number of radiofrequency treatments per solid mass at each session was 2.4 (range, 1-6 treatments), and the average time per treatment was 9.2 min (range, 3-14 min). A single electrode was used in 12 sessions, and a cluster electrode was used in 26 sessions. The average follow-up time was 9 months (range, 1-36 months).
Twenty-six of 32 patients had successful treatment of the solid renal mass using percutaneous imaging-guided radiofrequency ablation after one treatment session. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT. Six of 32 patients had residual enhancing tissue after the first treatment session and returned for a second session. Five of these six retreatments were successful. Masses requiring a second treatment session were significantly larger than masses treated in a single session (3.5 vs 2.4 cm, respectively; p = 0.0013). Two patients had perinephric hematomas (which did not require transfusion), and one patient developed a 5-mm skin metastasis at the electrode insertion site, which was resected without recurrence.
Percutaneous imaging-guided radiofrequency ablation shows promise in the treatment of solid renal malignancies.
Computed tomography (CT) is an imaging test that is widely used worldwide to establish medical diagnoses and perform image-guided interventions. More recently, concern has been raised about the risk ...of carcinogenesis from medical radiation, with a focus on CT. The purpose of this article is to (a) describe the importance of educating radiology personnel, patients, and referring clinicians about the concerns over CT radiation, (b) describe commonly used CT parameters and radiation units, (c) discuss the importance of establishing a dedicated radiology team to manage CT radiation, and (d) describe specific CT techniques to minimize radiation while providing diagnostic examinations.
The purpose of our study was to determine the nature and prevalence of adrenal lesions identified on CT in patients with no known malignancy.
A computer search of abdominal CT reports using the term ..."adrenal" was performed in 65,231 consecutive patients with examinations performed from January 2000 to December 2003. An adrenal mass was identified in 3,307 (5%) patients. Patients with no known malignancy and no suspicion for a hyperfunctioning adrenal mass were further isolated. Nine hundred seventy-three patients with 1,049 adrenal masses fulfilled the study criteria. The nature of each lesion was determined by histopathology; imaging characterization with CT, MRI, or washout; a minimum of 1 year of stability on follow-up imaging; or clinical follow-up of at least 2 years.
One thousand forty-nine adrenal masses were characterized with the following methods: histopathology (n = 12), imaging characterization (n = 909), imaging follow-up (n = 87), and clinical follow-up (n = 41). There were 788 adenomas constituting 75% of all lesions. There were 68 myelolipomas (6%), 47 hematomas (4%), and 13 cysts (1%). Three pheochromocytomas (0.3%) and one cortisol-producing adenoma (0.1%) were found incidentally. One hundred twenty-eight lesions (12%) were presumed to be benign by imaging or clinical stability. No malignant adrenal masses were found, even among the 14 patients who later developed malignancy elsewhere.
In 973 consecutive patients with an incidental adrenal mass and no history of cancer, no malignant lesions were identified. Adenomas (75%) and myelolipomas (6%) were the most common lesions.
Purpose
Substantial variation in imaging terms used to describe the adrenal gland and adrenal findings leads to ambiguity and uncertainty in radiology reports and subsequently their understanding by ...referring clinicians. The purpose of this study was to develop a standardized lexicon to describe adrenal imaging findings at CT and MRI.
Methods
Fourteen members of the Society of Abdominal Radiology adrenal neoplasm disease-focused panel (SAR-DFP) including one endocrine surgeon participated to develop an adrenal lexicon using a modified Delphi process to reach consensus. Five radiologists prepared a preliminary list of 35 imaging terms that was sent to the full group as an online survey (19 general imaging terms, 9 specific to CT, and 7 specific to MRI). In the first round, members voted on terms to be included and proposed definitions; subsequent two rounds were used to achieve consensus on definitions (defined as ≥ 80% agreement).
Results
Consensus for inclusion was reached on 33/35 terms with two terms excluded (anterior limb and normal adrenal size measurements). Greater than 80% consensus was reached on the definitions for 15 terms following the first round, with subsequent consensus achieved for the definitions of the remaining 18 terms following two additional rounds. No included term had remaining disagreement.
Conclusion
Expert consensus produced a standardized lexicon for reporting adrenal findings at CT and MRI. The use of this consensus lexicon should improve radiology report clarity, standardize clinical and research terminology, and reduce uncertainty for referring providers when adrenal findings are present.
To determine whether quantification of pulmonary embolus (PE) with computed tomographic (CT) pulmonary angiography by using a standardized index is a predictor of patient outcome.
Multi-detector row ...CT was performed in 59 hospitalized patients (mean age, 61 years; age range, 22-89 years). PE was identified retrospectively by two radiologists who were blinded to patient outcome. A pulmonary arterial obstruction index was derived for each set of images on the basis of embolus size and location. By using logistic regression, PE indexes were compared with patient outcome-survival or death-to determine if there was a correlation between PE volume and survival.
The PE index is a significant predictor of patient outcome (P =.002). One of 53 patients (1.9%) with an index of less than 60% died. Cause of death was end-stage malignancy. Five of six patients (83%) with an index of 60% and higher died. All five deaths were related to the presence of PE. The one survivor with a PE index higher than 60% received thrombolytic therapy. By using a cutoff of 60%, the PE index was used to identify 52 of 53 (98%) patients who survived and five of six (83%) patients who died.
Preliminary evidence suggests that quantification of clot with CT pulmonary angiography is an important predictor of patient death in the setting of PE.
The purpose of this study is to examine the utility of appendix MRI in evaluation of pediatric patients with right lower quadrant pain and inconclusive appendix sonography findings.
A search of the ...radiology electronic database was performed for all appendix MRI examinations performed of pediatric patients within 24 hours after inconclusive appendix sonography from December 1, 2009, through April 26, 2012. Sixty patients underwent appendix MRI within 24 hours of inconclusive sonography and represented the study cohort. MRI examinations were reviewed independently by two radiologists blinded to the diagnosis and were graded as "positive," "negative," or "indeterminate" for acute appendicitis. The final diagnosis was established by review of the surgical and pathology reports and patients' electronic medical records.
Ten of 60 patients (17%) had acute appendicitis. Both readers graded the same 12 examinations as positive and the same 48 examinations as negative for acute appendicitis, with a kappa value of 1.00 (expected agreement, 0.695). No MRI examination was interpreted as indeterminate. The sensitivity and specificity of MRI for acute appendicitis in children with inconclusive appendix ultrasound findings were 100% (95% CI, 0.72-1.00) and 96% (95% CI, 0.87-0.98), respectively. The positive predictive value for the examination was 83%, the negative predictive value was 100%, and overall test accuracy was 97%.
Our study shows that MRI has a sensitivity of 100% and specificity of 96% for appendicitis in pediatric patients after inconclusive appendix sonography. We think that MRI may supplant CT as the secondary modality to follow inconclusive appendix sonography.
Objective
To review the current evidence and guidelines for diagnosis and management of incidental adrenal masses with a focus on the recent changes made by the American College of Radiology (ACR) ...Incidental Findings Committee.
Conclusion
Incidentally detected adrenal nodules are a commonly encountered finding estimated to occur in 5–7% of the adult population. By following current recommendations, radiologists can improve patient care by efficiently determining which masses require further diagnostic testing and which masses can be considered benign and not require further follow-up.
To evaluate initial experience with radiofrequency (RF) ablation of adrenal neoplasms.
Thirteen adrenal masses in 12 patients (bilateral metastases in one patient) were treated with computed ...tomography (CT)-guided percutaneous RF ablation. Eleven adrenal lesions were metastases (five from lung cancer, four from renal cell carcinoma, and two from melanoma); one lesion was a pheochromocytoma and one was an aldosteronoma. There were 10 men and two women (average age, 58 years; range, 40-77 years) in the study; average adrenal mass diameter was 3.9 cm (range, 1-8 cm). Average number of RF applications per adrenal mass was 2.7 (range, 1-5 applications); average time per application was 7.8 minutes (range, 4-13 minutes). An internally cooled single electrode was used in five sessions; an internally cooled cluster electrode was used in eight sessions.
Average follow-up was 11.2 months (range, 1-46 months). Eleven of 13 lesions were treated successfully with RF ablation after one session. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT images and resolution of the biochemical abnormality in two patients. In two patients with large adrenal lesions (4 and 8 cm in diameter), enhancement of residual tissue was observed after one treatment session; this finding was indicative of residual tumor. One patient with thrombocytopenia that resulted from chemotherapy had a small hematoma, but no transfusion was required. No patient developed hypertension during the RF application. No patient with metastases had recurrent tumor at the treated site, and this lack of recurrence indicated effective local control; 11 patients had progression of metastatic disease at extraadrenal sites.
Preliminary data suggest that CT-guided RF ablation is an effective technique for local control of adrenal neoplasms.
To estimate whether the delay of surgery impacts the risk of adverse maternal and fetal outcomes in patients diagnosed with an adnexal mass during pregnancy.
A review was performed of pregnant ...patients diagnosed with an adnexal mass 5 cm or greater in diameter. Data collected included age, gravity/parity, gestational age at diagnosis, and presenting symptoms. Ultrasound examinations were evaluated for mass size and complexity. Pregnancy outcome, complications, and surgical pathology were reviewed.
Between 1990 and 2003, 127,177 deliveries were performed at our institution. An adnexal mass 5 cm in diameter or greater was diagnosed in 63 (0.05%) patients. Pathologic diagnosis was available for 59 (94%) patients. The remaining 4 patients were lost to follow-up and excluded from the analysis. Antepartum surgery was performed in 17 patients (29%): 13 because of ultrasound findings that suggested malignancy and 4 secondary to ovarian torsion. The remaining patients were observed, with surgery performed in the postpartum period or at time of cesarean delivery. The majority of masses were dermoid cysts (42%). Four patients were diagnosed with ovarian cancer (6.8% of masses, 0.0032% of deliveries), and one patient (1.7%) had a tumor of low malignant potential. Antepartum surgery due to ultrasound findings that caused concern was performed on all 5 women diagnosed with a malignancy or borderline tumor, compared with 12 (22%) of the patients with benign tumors (P < .01).
In select cases, close observation is a reasonable alternative to antepartum surgery in patients with an adnexal mass during pregnancy.
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