Are survival outcomes dependent on the tumour dose threshold of 139 Gy in patients with chemorefractory metastatic colorectal cancer treated with yttrium-90 radioembolization using glass particles? A real-world single-centre study.

OBJECTIVES: To compare the survival and objective response rate (ORR) of the patients receiving estimated tumour absorbed dose (ETAD) <140 Gy versus ETAD ≥140 Gy in patients with advanced chemorefractory colorectal carcinoma liver metastases (CRCLM) treated with yttrium-90 transarterial radioembolization (90Y TARE). METHODS: Between August 2016 and August 2023 adult patients with unresectable, chemorefractory CRCLM treated with 90Y TARE using glass particles, were retrospectively enrolled. Primary outcomes were overall survival (OS) and hepatic progression free survival (hPFS). Secondary outcome was ORR. RESULTS: A total of 40 patients with a mean age of 66.2 ± 7.8 years met the inclusion criteria. Mean ETAD for group 1 (ETAD <140 Gy) and group 2 (ETAD ≥140) were 131.2 ± 17.4 Gy versus 195 ± 45.6 Gy, respectively. The mean OS and hPFS for group 1 versus group 2 were 12 ± 10.3 months and 8.1 ± 9.3 months versus 9.3 ± 3 months and 7.1 ± 8.4 months, respectively and there were no significant differences (P = .181 and P = .366, respectively). ORR did not show significant difference between the groups (P = .432). CONCLUSION: In real-world practice, no significant difference was found in OS, hPFS, and ORR between patients who received ETAD <140 Gy versus ETAD ≥140 Gy in patients with CRCLM, in this series. ADVANCES IN KNOWLEDGE: This study demonstrated that increased tumour absorbed doses in radioembolization may not provide additional significant advantage for OS and hPFS for patients with CRCLM.

Comparison of Two Different Positions for Ultrasound-Guided Intervertebral Distance Evaluation.

Objective: During neuraxial anaesthesia, correct patient positioning is key for increased block success and (patient) comfort. The aim of this prospective study was to compare the lateral fetal decubitus (LFD) position with the sitting fetal lotus (SFL) regarding interspinous distance, transverse diameters of paravertebral muscles measured with ultrasonography, and patient comfort. Methods: Fifty adult participants who could sit cross-legged and had no lumbar anomalies were included in our prospective study. In both SFL and LFD positions, measurements were performed with ultrasonography; in the axial plane, interspinous distance at the level of L4-L5, in the sagittal plan, with the probe slightly tilted, subcutaneous tissue-spinous process depth, and transverse diameters of paravertebral muscles were measured. Stretcher, waist position, and abdominal comfort were scored on a scale of 1 (very bad) to 7 (perfect) with a verbal numeric satisfaction scale. Results: Interspinous distance was significantly larger in the SFL position than in the LFD position (P < 0.05). There was no significant difference between the two positions (P > 0.05) regarding patient comfort. Paravertebral muscle diameters were significantly broader in the SFL position than in the LFD position. The diameter of the left paravertebral muscle in the SFL position (45.8±8.8 mm) was larger than that in the LFD position (43±7.8 mm; P < 0.001). The diameter of the right paravertebral muscle in the SFL position was (47±9 mm) larger than that in the LFD position (43.4±7.6 mm; P < 0.001). Conclusion: Although there was no difference regarding the comfort between the two positions, the interspinous distance was larger in the SFL position than in the LFD position.

The value of 18F-FDG PET/MRI in prediction of microvascular invasion in hepatocellular carcinoma.

RATIONALE AND OBJECTIVES: Investigating the association between maximum standardized uptake value (SUVmax), peritumoral and intratumoral apparent diffusion coefficient (ADC) values and whether these parameters are useful in predicting the preoperative microvascular invasion (MVI) of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty-four patients [8 women and 36 men, median age of 62 (21-76)] with single HCCs (≥2 cm) who underwent preoperative 18F-FDG PET/MRI were retrospectively evaluated. The peritumoral and intratumoral ADC values were evaluated on diffusion-weighted images using Image J an open software and the intratumoral SUVmax values were measured on fusion 18F-FDG PET/MRI images. Univariate and multivariate logistic regression analyses were performed to determine the most influential factor predicting MVI. Interobserver agreement was checked using the intraclass correlation coefficient (ICC). RESULTS: Univariate analysis showed that the histologic grade, tumor size, maximum peritumoral ADC (PTband ADCmax), mean peritumoral ADC (PTband ADCmean), mean intratumoral ADC (IT ADCmean), and maximum SUV (SUVmax) correlated with MVI (p < 0.05). On multivariate analysis, the SUVmax was the only independent risk factor for the MVI of HCC [OR, 1.68; 95% CI (1.04-2.70); p = 0.032)]. An AUC value of 0.896, 95% CI, 0.786-1.0) had a sensitivity of 75% and specificity of 97% using the best cut-off SUVmax 5.85 to differentiate MVI-positive HCCs from MVI-negative. The PPV, NPV, and accuracy were 92.3%, 87%, and 89%, respectively. The ICC values were 0.95-0.99, a nearly perfect level of agreement. CONCLUSION: 18F-FDG PET/MRI is a useful noninvasive imaging tool for predicting the MVI of HCC.

Utility of 'dual phase' cone beam computed tomography during radioembolisation in patients with hepatocellular carcinoma: what is really changing in flow dynamics before and after 90Y delivery?

PURPOSE: The aims of the study were: 1) to compare two phases of dual-phase cone beam computed tomography (DP-CBCT) achieved before and after Yttrium-90 (90Y) administration and to evaluate additional benefits during radioembolisation (RE) procedures; and 2) to compare DP-CBCT with pre-procedure contrast enhanced cross-sectional images in terms of tumour detection. MATERIAL AND METHODS: Twenty-three hepatocellular carcinoma patients undergoing RE treatment were scanned with DP-CBCT consisting of early arterial (EA) and late arterial (LA) phases before and after 90Y administration. The CT-like datasets were compared according to embolisation effect, enhancement patterns, lesion detectability, image quality, and artifacts by two interventional radiologists blinded to each other. The compatibility of the two radiologists was evaluated with kappa statistical analysis, and the difference between EA and LA phases was evaluated with marginal homogeneity test. Also, DP-CBCT images were compared with preprocedural cross-sectional images (CT/MRI). RESULTS: For 23 patients 92 data were acquired. Thirteen patients showed a decrease on post-embolisation images both visually and on Hounsfield unit (HU) measurements. No statistical difference was found for tumour detection between EA and LA phases (p = 1.0). Tumour enhancement was visually superior at LA phases whereas EA phases were better for arterial mapping for selective catheterisation. DP-CBCT images were not inferior to preprocedural cross-sectional imaging findings. CONCLUSIONS: DP-CBCT is a promising tool for predicting tumour response to therapy and is not inferior to preprocedural cross-sectional imaging in terms of tumour detection. It allows better assessment during RE procedures because early phases provide good mapping for superselective catheterisation whereas late phases are better for visualisation of tumour enhancement.

Radiology-pathology correlation in staging of liver fibrosis using superb microvascular imaging.

PURPOSE: Progression of liver fibrosis to end-stage disease can potentially be prevented with antiviral treatment. Thus, diagnosis of fibrosis is important in determining treatment protocols. This study aims first, to determine the sensitivity of a novel Doppler method, superb microvascular imaging (SMI), in detecting small vascular structures of the liver compared with other Doppler methods; and second, to choose the best method among these Doppler applications to determine the morphologic changes that occur due to chronic fibrosis. By doing so, the study would be able to provide an ultrasound grading that might differentiate and predict mild and severe liver fibrosis, thus giving rise to a possible alternative to biopsy. METHODS: A total of 43 patients diagnosed with chronic hepatitis and scheduled for liver biopsy were included. Color Doppler, power Doppler, advanced dynamic flow (ADF) Doppler, color SMI (cSMI) and monochrome SMI (mSMI) Doppler were performed in subcapsular areas of right anterior lobe. Depth from the capsule of the most peripherally located detectable vessel was measured for each Doppler subgroup. Appearance of the vascular tree was categorized into four groups and correlated with pathology results. ROC curve analysis was used to determine if this Doppler classification was statistically significant in differentiating mild and severe forms of fibrosis. Finally, multiple regression analysis was used to determine which Doppler parameter can significantly predict severity. RESULTS: mSMI and cSMI were found to be superior to other Doppler techniques in detecting the most superficially located vessels of the liver, 4.4 mm and 3.3 mm deep from the capsule, respectively (P < 0.001). Among the changes identified in the vascular tree, small vessel blunting was the most prevalent finding in predicting the presence of severe fibrosis (multiple regression test, t=5.969, P < 0.0001). ROC analysis identified that the presence of at least two pathologic findings in the vascular tree was highly predictive of severe fibrosis (AUC=0.881, sensitivity 86.67%, specificity 89.29%, positive and negative predictive values 8.09 and 0.15, respectively). CONCLUSION: Our study proves that SMI is superior to other Doppler techniques in detecting the smallest vessels visible to ultrasound. Using this method, it is possible to determine the vascular changes in terms of blunting and tortuosity and thus predict the severity of fibrosis. This method might be a practical alternative to biopsy.

Stercoral colitis: diagnostic value of CT findings.

PURPOSE: We aimed to evaluate the CT findings of stercoral colitis (SC). METHODS: Forty-one patients diagnosed with SC between February 2006 and April 2015 were retrospectively reviewed. RESULTS: Rectosigmoid colon was the most frequently involved segment (100%, n=41). CT findings can be summarized as follows: dilatation >6 cm and wall thickening >3 mm of the affected colon segment (100%, n=41), pericolonic fat stranding (100%, n=41), mucosal discontinuity (14.6 %, n=6), presence of free air (14.6%, n=6), free fluid (9.7%, n=4), and pericolonic abscess (2.4%, n=1). The sign most related with mortality was the length of the affected colon segment >40 cm. CONCLUSION: CT has an important role in SC, since life-threatening complications can be easily revealed by this imaging modality. Increased length of involved colon segment (>40 cm) is more likely to be associated with mortality.

Rare presentation of pseudosequestration in childhood: CT and CT angiography findings.

Anomalous systemic arterial supply to the lungs with normal bronchial branching and pulmonary arterial supply is an unusual variant of the sequestration spectrum. Pseudosequestration is referred as the combination of systemic arterial supply to lung with normal bronchial connection. Thorax computed tomography (CT) and CT angiography are non-invasive and useful techniques in making the definitive diagnosis. Herein, we report two paediatric patients with anomalous systemic arterial supply to normal basal segments of the lower lobes.

Magnetic resonance imaging of pulmonary infection in immunocompromised children: comparison with multidetector computed tomography.

BACKGROUND: Computed tomography (CT) is commonly used to detect pulmonary infection in immunocompromised children. OBJECTIVE: To compare MRI and multidetector CT findings of pulmonary abnormalities in immunocompromised children. MATERIALS AND METHODS: Seventeen neutropaenic children (6 girls; ages 2-18 years) were included. Non-contrast-enhanced CT was performed with a 64-detector CT scanner. Axial and coronal non-enhanced thoracic MRI was performed using a 1.5-T scanner within 24 h of the CT examination (true fast imaging with steady-state free precession, fat-saturated T2-weighted turbo spin echo with motion correction, T2-weighted half-Fourier single-shot turbo spin echo [HASTE], fat-saturated T1-weighted spoiled gradient echo). Pulmonary abnormalities (nodules, consolidations, ground glass opacities, atelectasis, pleural effusion and lymph nodes) were evaluated and compared among MRI sequences and between MRI and CT. The relationship between MRI sequences and nodule sizes was examined by chi- square test. RESULTS: Of 256 CT lesions, 207 (81%, 95% confidence interval [CI] 76-85%) were detected at MRI. Of 202 CT-detected nodules, 157 (78%, 95% CI 71-83%) were seen at motion-corrected MRI. Of the 1-5-mm nodules, 69% were detected by motion-corrected T2-weighted MRI and 38% by HASTE MRI. CONCLUSION: Sensitivity of MRI (both axial fat-saturated T2-weighted turbo spin echo with variable phase encoding directions (BLADE) images and HASTE sequences) to detect pulmonary abnormalities is promising.

Outcomes of partial splenic embolization in patients with massive splenomegaly due to idiopathic portal hypertension.

AIM: To determine the outcomes of partial splenic embolization (PSE) for massive splenomegaly due to idiopathic portal hypertension (IPH). METHODS: In this prospective study, we evaluated the characteristics and prognosis of consecutive patients with IPH who underwent PSE for all indications at a single medical center between June 2009 and January 2015. The inclusion criteria were: presence of hypersplenism, massive splenomegaly, and resultant pancytopenia. The exclusion criteria were: presence of other diseases causing portal hypertension. During the post-PSE period, the patients were hospitalized. All patients underwent abdominal computed tomography imaging 4 wk post-PSE to determine total splenic and non-infarcted splenic volumes. RESULTS: A total of 11 patients, with median age of 33.27 ± 4.8 years, were included in the study. Mean spleen size was 22.9 cm (21-28 cm), and severe hypersplenism was diagnosed in all patients before PSE. Post-PSE, leukocyte and platelet counts increased significantly, reaching peak levels in the second week with gradual decreases thereafter. Liver function tests did not exhibit significant changes during post-intervention follow-up. All patients developed post-embolization syndrome, and one patient experienced serious complications; all complications were successfully treated with conservative therapy and no death occurred. CONCLUSION: Our findings showed that PSE has a lower complication rate than previously-reported surgical complication rates, which supports this intervention as a viable alternative for high-risk operable patients with severe hypersplenism.

Accessory Anterolateral Talar Facet in Populations With and Without Symptoms: Prevalence and Relevant Associated Ankle MRI Findings.

OBJECTIVE: The purpose of this study was to determine the prevalence of and relevant findings associated with the accessory anterolateral talar facet, which may have a role in talocalcaneal impingement and sinus tarsi syndrome, on ankle MR images of persons with and those without symptoms. SUBJECTS AND METHODS: In this case-control study, three observers independently reviewed 1.5-T or 3-T MR images of 110 ankles with symptoms in 100 consecutively registered patients (age range, 16-79 years; mean, 41.5 years) and limited 1.5-T MR images of 104 age-, sex-, and side-matched ankles in 104 volunteers without symptoms for the presence of an accessory anterolateral talar facet, calcaneal cortical thickness, subjacent talar or calcaneal cystic and bone marrow edema-like changes at the angle of Gissane, and sinus tarsi fat obliteration. RESULTS: An accessory anterolateral talar facet was present in 36 (32.7%) ankles with symptoms versus 27 (26.0%) symptom-free ankles (p = 0.297). Interobserver agreement was almost perfect (κ = 0.851; 95% CI, 0.772-0.929) for the detection of accessory anterolateral talar facet and substantial for the detection of sinus tarsi fat obliteration (κ = 0.671; 95% CI, 0.427-0.915). The angle of Gissane was significantly smaller in persons with an accessory anterolateral talar facet, either with or without symptoms (p < 0.0001). Subjacent talar (p = 0.003) and calcaneal (p = 0.033) bone marrow edema-like change and sinus tarsi fat obliteration (p = 0.034) were significantly more frequent in persons with accessory anterolateral talar facet, but chronic reactive osseous changes at the angle of Gissane were not (p > 0.05). CONCLUSION: The higher prevalence of the MRI finding of an accessory anterolateral talar facet in ankles with symptoms is not statistically significant. This facet may be associated with subjacent talar bone marrow edema-like change on MR images of individuals with and those without symptoms and with sinus tarsi fat obliteration in individuals with symptoms.