Thermal Ablation for Treating Tumor-induced Osteomalacia in a Patient With IV Phosphate Dependency.

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome associated with tumors secreting fibroblast growth factor 23 that can be cured with complete surgical resection of the tumor. However, when these tumors are at difficult locations, less invasive modalities such as thermal ablation (TA) might be a good alternative. A 40-year-old woman was seen for a second opinion because of severe hypophosphatemia with complaints of fatigue, myalgia, and muscle weakness for which she needed IV phosphate for 15 to 18 hours per day in addition to oral alfacalcidol and phosphate. Initial laboratory results revealed hypophosphatemia (0.59 mmol/L [1.83 mg/dL]; reference range, 0.90-1.50 mmol/L [8.40-10.2 mg/dL]), increased fibroblast growth factor 23 levels (137 RU/mL; reference range, <125 RU/mL), and a reduced TmP-GFR (0.47 mmol/L; reference range, 0.8-1.4 mmol/L). Gallium-positron emission tomography/computed tomography (CT) showed moderately increased uptake at thoracic vertebra (Th) 8 and mildly increased uptake at Th7, suggestive of TIO. Complete tumor removal would have required resection of at least 1 vertebral body. Therefore, CT-guided TA was performed at Th8. No complications were observed, and in the months after, treatment with IV phosphate could be discontinued, indicating a satisfying result from the procedure. This extreme TIO case demonstrates that CT-guided TA can be an alternative to extensive or risky classical surgery.

Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique.

PURPOSE: To evaluate safety and feasibility of distal radial artery (DRA) access for noncoronary interventional radiology procedures. MATERIALS AND METHODS: All interventional radiology procedures by means of DRA puncture from July 2017 to August 2018 were retrospectively reviewed. Eighty-two punctures in 56 patients were included, mostly in male patients (84% vs 16%). Mean age was 67.8 years (range, 33.3-87.3 years); mean height was 172 cm (range, 142-190 cm); and mean weight was 83 kg (range, 43-120 kg). Procedural characteristics, technical success, and complication rates were gathered from the medical records and follow-up ultrasound when available. Prerequisites for DRA access were adequate radioulnar collateral circulation, sufficient radial artery diameter, and informed consent in patients initially intended for conventional transradial access. RESULTS: Procedures included transarterial chemoembolization (n = 34), yittrium-90 pretreatment angiography (n = 21), yittrium-90 administration (transarterial radioembolization; n = 20), and embolization of visceral organs (n = 7). Both 4-Fr (n = 35) and 5-Fr (n = 46) sheaths were used. Technical success of DRA access was 97.6%, with conversion to transfemoral access in 2 cases (2.4%). No major complications were reported as a result of DRA access. CONCLUSION: DRA access is a feasible and safe technique for abdominal interventional radiology embolization procedures. No radial artery occlusion or other major complications were observed in patients who underwent follow-up ultrasound.

Chronic anal and perianal pain resolved with MRI.

OBJECTIVE: The purpose of this study was to assess the diagnostic value of anorectal MRI in the care of patients with chronic anal and perianal pain but without findings of abnormalities in the clinical workup. MATERIALS AND METHODS: Patients referred from a tertiary department of colorectal surgery to the MRI unit with clinically occult chronic anal and perianal pain were included. MRI of the anorectum was performed with an endoanal or pelvic phased-array coil. The images from all examinations were read by two radiologists. MRI findings were correlated with clinical follow-up data. RESULTS: The study group (103 patients) was stratified into patients with no history of anorectal disease (n = 60) and those who had a history of surgery for anorectal disease (n = 43). MRI findings suggested the final diagnoses in 40 patients (39%). These diagnoses were 28 cases of suppurative lesions (27%), 11 cases of painful scarring of the anus (11%), and one case of metastasis to the sacrum (1%). Suppurative lesions were surgically proved with marked relief of pain after surgery. In the other patients the final diagnoses were 37 cases of levator ani syndrome (36%) and 26 cases of unspecified functional anorectal pain (25%). No MRI abnormalities were found in 33 of the patients with levator ani syndrome and 26 of the patients with unspecified anorectal pain. The two readers had very good agreement (κ = 0.92). The patients with a history of anorectal disease had significantly more MRI findings of abnormalities (60%) than did patients without a history of anorectal disease (23%). The positive predictive value of MRI was 91%, and the negative predictive value was 100%. CONCLUSION: In 39% of patients, MRI showed abnormalities that were clinically confirmed as the final diagnosis. Surgical treatment will especially benefit patients with suppurative lesions, resulting in relief of pain.

Intracranial carotid artery atherosclerosis: prevalence and risk factors in the general population.

BACKGROUND AND PURPOSE: Intracranial atherosclerosis is worldwide one of the leading causes of stroke. However, surprisingly little is known about its prevalence and risk factors in a community-dwelling population of white descent. In this study, we determined the prevalence and investigated risk factors of intracranial internal carotid artery calcification (ICAC) as a marker of intracranial atherosclerosis. METHODS: To quantify the volume of ICAC, 2495 participants (mean age, 69.6 years) from the population-based Rotterdam Study underwent a nonenhanced computed tomography of the intracranial internal carotid arteries. We calculated the prevalence of ICAC. Next, we defined sex-specific quartiles and defined the upper quartile as severe ICAC. Risk factors of ICAC were investigated by linear and logistic multivariate modeling and were stratified by sex. RESULTS: The overall prevalence of ICAC was 82.2%. The median volume of ICAC was 44 mm3 and was larger in men. Age was independently associated with ICAC in both men and women. In men, excessive alcohol intake and smoking (OR, 1.74 [95% CI, 1.28-2.37] and 1.72 [95% CI, 1.10-2.70]) were strong risk factors of ICAC, whereas diabetes and hypertension were in women (OR, 2.02 [95% CI, 1.29-3.17] and 1.79 [95% CI, 1.20-2.68]). A low high-density-lipoprotein concentration was not associated with ICAC. CONCLUSIONS: ICAC is highly prevalent and occurs in over 80% of older, white persons. Conventional cardiovascular risk factors are associated with ICAC, but risk factor profiles differ between men and women.

Age-related changes in normal-appearing brain tissue and white matter hyperintensities: more of the same or something else?

BACKGROUND AND PURPOSE: Cerebral white matter (WM) hyperintensities are a frequent finding in elderly people, and lowering of cerebral magnetization transfer ratio (MTR) has been observed. The aim of this study was to assess the relationship between age-related WM hyperintensities and MTR changes in the brain. METHODS: We performed MR imaging in a group of young subjects, a group of elderly individuals with minimal WM hyperintensities, and a group of elderly individuals with abundant WM hyperintensities. In addition, we performed volumetric MTR analysis of the whole brain and of the normal-appearing WM (NAWM) in these groups. RESULTS: Volumetric MTR parameters differed between elderly and young patients. Mean MTR +/- standard error of the mean (SEM) was 34.0% +/- 0.12% in the young, 33.0% +/- 0.08% in the elderly with minimal WM hyperintensities, 32.8% +/- 0.09%) in the group with abundant WM hyperintensities. Peak height (number of voxels +/- SEM) was 122 +/- 1.2 in the young, 99 +/- 1.5 in the elderly with minimal WM hyperintensities, and 98 +/- 1.6 in the group with abundant WM hyperintensities. Mean MTR of NAWM was lower in the elderly compared with the young (36.7% +/- 0.12%) but did not differ between subjects with minimal (36.0% +/- 0.11%) and those with abundant WM hyperintensities (35.9% +/- 0.13%). CONCLUSION: Our results show that aging gives rise to changes in normal-appearing brain tissue. These changes, which can be detected on magnetization transfer imaging, seem to have no relationship with age-related WM hyperintensities and might have a different etiology.