The clinical success of uterine artery embolization is determined by its endpoint. An aggressive UAE could lead to endometritis and increases the risk of unintended embolization of other organs. ...Conversely, an incomplete procedure may result in a poor clinical outcome due to regrowth of the fibroids. We present a case with innovative use of intraoperative contrast-enhanced ultrasonography (CEUS) for the assessment of vascularity of the targeted fibroid to determine the endpoint of embolization perioperatively. We aim to report a case of the use of intraoperative CEUS during UAE to highlight the potential pitfall of its use and provide a review of its application in the literature. Our case affirms the reported usefulness and the practical feasibility to assess the vascularity of fibroids during UAE and highlights that caution should be made by operators in cases of multiple fibroids.
Gastrointestinal stromal tumors (GISTs) are rare, but represent the most common mesenchymal neoplasms of the gastrointestinal tract. Tumor resection is the treatment of choice for localized disease. ...Tyrosine kinase inhibitors (imatinib, sunitinib) are the standard therapy for metastatic or unresectable GISTs. GISTs usually metastasize to the liver and peritoneum. Bone metastases are uncommon. We describe three cases of bone metastases in patients with advanced GISTs: two women (82 and 54 years of age), and one man (62 years of age). Bones metastases involved the spine, pelvis and ribs in one patient, multiple vertebral bodies and pelvis in one, and the spine and iliac wings in the third case. The lesions presented a lytic pattern in all cases. Two patients presented with multiple bone metastases at the time of initial diagnosis and one patient after seven years during the follow-up period. This report describes the diagnosis and treatment of the lesions and may help clinicians to manage bones metastases in GIST patients.
Hepatocellular carcinoma (HCC) is a major health concern, and early HCC diagnosis is a primary radiological concern. The goal of imaging liver cirrhosis is the early identification of high-grade ...dysplastic nodules/early HCC since their treatment is associated with a higher chance of radical cure and lower recurrence rates. The newly introduced MRI contrast agent gadoxetic acid (gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid, Gd-EOB-DTPA) has enabled the concurrent assessment of tumor vascularity and hepatocyte-specific contrast enhancement during the hepatobiliary phase (HBP), which can help to detect and characterize smaller HCCs and their precursors. HBP-EOB-MRI identifies hypovascular HCC nodules that are difficult to detect using ultrasonography or computed tomography, which do not show the diagnostic HCC hallmarks of arterial washin and portal/delayed washout. During the HBP, typical HCC and early HCC appear hypointense on EOB-MRI, whereas low-grade dysplastic or regenerative nodules appear as iso- or hyperintense lesions. The diagnostic accuracy of EOB-MRI for the diagnosis of early HCC is approximately 95-100%. One third of hypovascular hypointense nodules in HBP become hypervascular 'progressed' HCC, with a 1- and 3-year cumulative incidence of 25 and 41%, respectively. Therefore, these hypovascular nodules should be strictly followed up or definitely treated as typical HCC. Due to this capability of identifying the precursors and biological behavior of HCC, EOB-MRI has rapidly become a key imaging tool for the diagnosis of HCC and its precursors, despite the scarce MRI availability throughout Europe. With increasing experience, EOB-MRI may eventually be established as the diagnostic imaging modality of choice in this setting. Full recognition by the Western EASL-AASLD guidelines is expected.
Objectives
Incidental diagnosis of vertebral fractures (VFs) may represent a key point in the assessment of bone health status. Our purpose was to retrospectively evaluate localisation sequences ...(MR-loc) of breast MRI as a potential tool to detect osteoporotic VFs.
Methods
MR-loc sagittal images of 856 breast MRIs were reviewed by three expert musculoskeletal radiologists with a semiquantitative approach to detecting VFs. Anamnesis and data of patients were investigated. Official breast MRI and previous imaging reports were checked to understand if VFs or other relevant bone findings were known in patients’ clinical history.
Results
A total of 780/856 female patients (91.1 %) undergoing MRI for oncological reasons and 76/856 (8.9 %) with non-oncological aims were recruited into the study (54.7 ± 12.2 years old, 21–89 years); 57/856 MR-loc images (6.7 %) were considered inadequate for diagnostic purposes and were excluded from the analysis. MR-loc detected VFs in 71/799 patients (8.9 %). VFs were neither reported nor previously known in the clinical history of 63/71 patients (88.7 %;
P
< 0.001). No mention of VFs was found in any breast MR reports. In four patients MR-loc identified vertebral metastases.
Conclusions
A systematic evaluation of MR-loc may offer additional clinical information to prevent unrecognised VFs. MR-loc may screen for VFs in other imaging settings.
Key Points
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Vertebral fractures are usually a hallmark of osteoporosis.
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Localisation sequences before breast MR examinations can identify vertebral fractures.
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MR localisers should be inspected for vertebral fractures in other clinical settings.
Interim investigations with MRI neck and Positron Emission Tomography (PET)-CT demonstrated locoregional recurrence of squamous cell carcinoma and uptake within the pulmonary cavity attributed to ...metastases. The bronchial arteries are the most common source of haemorrhage, with pulmonary arteries second, accounting for 6%–11% of cases.2 3 Pulmonary artery pseudoaneurysms are associated with cavitating infections or malignancy, usually primary lung cancer, and rarely due to metastases.4 5 No difference in pseudoaneurysm morphology or response to treatment has been identified for different types of malignancy. When a pseudoaneurysm is evident on CT but not on catheter angiography (type D), empirical targeted embolisation based on CT findings may be considered.7 Where a massive haemoptysis pathway is in place, the patient may be transferred from the CT scanner to the interventional radiology suite to receive prompt endovascular treatment.
We analyzed overall survival (OS) following radioembolization according to macroscopic growth pattern (nodular vs infiltrative) and vascular invasion in intermediate-advanced hepatocellular carcinoma ...(HCC).
Between September 2005 and November 2013, 104 patients (50.0% portal vein thrombosis PVT, 29.8% infiltrative morphology) were treated.
Median OS differed significantly between patients with segmental and lobar or main PVT (p = 0.031), but was 17 months in both those with patent vessels and segmental PVT. Median OS did not differ for infiltrative and nodular HCC. Median OS was prolonged in patients with a treatment response at 3 months (p = 0.023). Prior TACE was also a significant predictor of improved OS.
A further indication for radioembolization might be infiltrative HCC, since OS was similar to nodular types.
Eisenmenger’s syndrome (ES) is the most advanced form of pulmonary arterial hypertension (PAH) associated with congenital heart diseases (CHD). It is caused by simple or complex CHD with a large ...systemic-to-pulmonary shunt. When the pulmonary pressure exceeds the systemic pressure, the shunt reverses and central cyanosis appears. ES is a progressive and fatal condition, and it is accompanied by an increased risk of a range of potentially life-threatening complications. Patients with ES are both at risk for bleeding, due to damaged capillaries and high pressure, and for in situ pulmonary thrombosis, related to hyper-viscosity and slow blood flow in dilated pulmonary arteries. Moreover, the enlarged main pulmonary arteries and cardiac chambers may determine displacement or extrinsic compression on airways, pulmonary veins, coronary arteries, and other mediastinal structures. The clinical effects may be diverse, such as respiratory difficulties, localized pulmonary edema, cardiac dysfunction, or sudden death. Multidetector computed tomography (MDCT) allows to accurately assess in a single examination, pulmonary parenchyma and vessels, coronary artery origin, and heart chambers. The aim of this review was to illustrate the thoracic MDCT angiography findings and complications of adult patients with PAH-CHD and in particular of those with ES.
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