Operator Evaluation of Ultrasound Fusion Imaging Usefulness in the Percutaneous Ablation of Hepatic Malignancies: A Prospective Study.

The purpose of the work described here was to evaluate the use of ultrasound fusion imaging (US-FI) in percutaneous ablation of hepatic malignancies with respect to its global usefulness, improvement of conspicuity, confidence increment, needle route changes, and time savings. Thirty-four hepatic tumors (28 hepatocellular carcinomas, 6 metastases) were prospectively ablated in 16 consecutive patients (64 ± 11 y, 75% males), first simulating B-mode-only planning and then synchronizing computed tomography/magnetic resonance images with US and proceeding to needle insertion and tumor ablation under US-FI guidance. Surveys were administered to the operators to evaluate their perception of US-FI advantages. First treatment and local recurrence were also compared. US-FI was judged useful in 91% of cases and more useful when the tumor was not conspicuous in B-mode (p < 0.001), in particular for ablation of local recurrences (p = 0.021). Forty-one percent of tumors were undetectable at B-mode evaluation, and 93% of them were completely ablated under US-FI guidance. The confidence of the operator was highly increased by US-FI in 68% of cases. In 71% of cases, the radiologist saved time using US-FI, especially in treatment of local recurrences (p = 0.024). In conclusion, US-FI significantly increases the detection of target tumors, improves the confidence of the operator and is a time-saving method, especially in the treatment of local recurrences.

Role of diffusion tensor imaging of sciatic nerve in symptomatic patients with inconclusive lumbar MRI.

OBJECTIVE: To assess fractional anisotropy (FA) of sciatic nerve roots within the pelvis by using diffusion tensor imaging (DTI) in patients suffering from sciatica with inconclusive lumbar MRI. METHODS: This IRB-approved prospective study included 32 consecutive subjects (11 males and 21 females; mean age 32.2 years) between September 2019 and February 2020. All patients underwent DTI (TR/TE 5800/97 ms; b = 1000; slice thickness 3,5 mm; directions = 20) on a 1.5 T scanner (Siemens Aera). Seventeen patients were symptomatic, whereas 15 patients served as control group. DTI data were analyzed by two radiologists (25 and 11 years of experience, respectively) blinded to clinical data. Each radiologist placed two ROIs on the nerve roots at three different levels. Diagnostic accuracy values of FA numbers were calculated by using receiver operator curves (ROC) and relative area under the curve (AUC), by using clinical findings as standard of reference. Inter-observer agreement was calculated with k-statistics. Paired T-test and Mann-Whitney test were used for comparison accordingly to data distribution. A value of p < 0.05 was considered statistically significant. RESULTS: Among the 17 symptomatic patients, FA values were significantly lower in the affected side at all levels (p < 0.05). The FA ratio (FA affected side/FA unaffected side) of symptomatic patients was significantly lower compared to control group at level 1 (p = 0.0005) and level 2 (p = 0.0006). Using a threshold of 0.90 for level 1 and 0.73 for level 2, 76 % and 71 % sensitivity and 100 % and 87 % specificity were achieved, respectively. CONCLUSION: DTI can quantitatively demonstrate sciatic nerve roots impairment within the pelvis.