Pre- and Post-Operative Cone Beam Computed Tomography Assessment of the Temporomandibular Joint in Patients with Orthognathic Surgery.

This study aimed to compare the pre- and post-operative temporomandibular joint (TMJ) condylar position in dentofacial deformity (DFD) patients who had orthognathic surgeries using cone beam computed tomography (CBCT). A retrospective study evaluating the pre- and post-operative CBCT for 79 DFD patients (equivalent to 158 TMJs) (mean age = 26.62 ± 9.5 years) with a bilateral sagittal split osteotomy with or without Le Fort I surgeries (n = 29 Class II DFD, n = 50 Class III DFD) was performed. This included the compartmental measurement of TMJ spaces, in addition to the measurement of intercondylar distances and angles. Condylar position centricity was assessed using the Pullinger and Hollender formula. Clinical data were analysed for DFD class, the type of surgery and post-operative CBCT timing. Pre- and post-operative measurements were compared statistically using a paired t-test, Wilcoxon signed-rank test, and Stuart-Maxwell test. TMJ condyles tended to relocate post-operatively in a posterosuperior position with internal rotation in Class II DFD and a superior position with internal rotation in Class III DFD. However, the overall changes were within <0.5 mm translation and <4° rotation and the number of concentrically positioned condyles (according to the Pullinger and Hollender formula) did not change significantly. Orthognathic surgery is associated with minor post-operative translational and rotational condylar positional changes in Class II and III DFDs.

Interventional Treatments of Colorectal Liver Metastases Using Thermal Ablation and Transarterial Chemoembolization: A Single-Center Experience over 26 Years.

The aim of this study was to analyze the long-term results of different locoregional treatments for colorectal cancer liver metastases (CRLM), including transarterial chemoembolization (TACE), laser-induced thermotherapy (LITT) and microwave ablation (MWA). A total of 2140 patients with CRLM treated at our department between 1993 and 2020 were included in this retrospective study. The patients were divided into the following groups: LITT (573 patients; median age: 62 years), TACE + LITT (346 patients; median age: 62 years), MWA (67 patients; median age: 59 years), TACE + MWA (152 patients; median age: 65 years), and TACE (1002 patients; median age: 62 years). Median survival was 1.9 years in the LITT group and 1.7 years in the TACE + LITT group. The median survival times in the MWA group and TACE + MWA group were 3.1 years and 2.1 years, respectively. The median survival in the TACE group was 0.8 years. The 1-, 3-, and 5-year survival rates were 77%, 27%, and 9% in the LITT group and 74%, 18%, and 5% in the TACE + LITT group, respectively. The corresponding survival rates were 80%, 55%, and 33% in the MWA group, 74%, 36%, and 20% in the TACE + MWA group and 37%, 3%, and 0% in the TACE group, respectively. The long-term results of this study demonstrate the efficacy of locoregional treatments in treating patients with CRLM. The longest survival was found in the MWA group, followed by the combination therapy of TACE and MWA.

Retrospective Long-Term Evaluation of Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma over 20 Years.

The aim of this study was to retrospectively evaluate the effects of conventional transarterial chemoembolization (cTACE) for the treatment of hepatocellular carcinoma over 20 years regarding overall survival (OS) and prognostic factors for OS. During the period from 1996 to 2016, 836 patients with HCC were treated with cTACE. Data evaluation was performed on the basis of pre- and postinterventional MRI and CT scans. Survival analysis was performed by Kaplan-Meier estimator; prognostic factors were determined by the use of Cox regression analysis. Overall, 4084 (mean 4.89 TACE sessions/patient) procedures were assessed. Median OS was 700 days (99% CI, 632.8-767.2). Depending on the indication, patients treated with a neoadjuvant intention showed the best OS (1229 days, 99% CI 983.8-1474.2) followed by curative intention (787 days, 99% CI 696.3-877.7), and then palliative intention (360 days, 99% CI 328.4-391.6). Portal vein thrombosis (HR 2.19, CI 1.63-2.96, and p < 0.01) and Child-Pugh class B or worse (HR 1.44, CI 1.11-1.86, and p < 0.001) were significantly associated with shorter OS. Patients with HCC benefit from TACE after careful patient selection. Portal vein thrombosis and Child-Pugh class B or worse are significantly unfavorable prognostic factors for patients' survival.

Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial.

PURPOSE: To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. MATERIALS AND METHODS: In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. RESULTS: The mean ablation volume was 66.5 cm³ for MWA and 29.2  cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ±â€Š4.0 min and 16.3 ±â€Š4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5 months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). CONCLUSION: The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. KEY POINTS: · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..

Unveiling the diagnostic enigma of D-dimer testing in cancer patients: Current evidence and areas of application.

BACKGROUND: Cancer is a well-known risk factor for venous thromboembolism (VTE). A combined strategy of D-dimer testing and clinical pre-test probability is usually used to exclude VTE. However, its effectiveness is diminished in cancer patients due to reduced specificity, ultimately leading to a decreased clinical utility. This review article seeks to provide a comprehensive summary of how to interpret D-dimer testing in cancer patients. METHODS: In accordance with PRISMA standards, literature pertaining to the diagnostic and prognostic significance of D-dimer testing in cancer patients was carefully chosen from reputable sources such as PubMed and the Cochrane databases. RESULTS: D-dimers have not only a diagnostic value in ruling out VTE but can also serve as an aid for rule-in if their values exceed 10-times the upper limit of normal. This threshold allows a diagnosis of VTE in cancer patients with a positive predictive value of more than 80%. Moreover, elevated D-dimers carry important prognostic information and are associated with VTE reoccurrence. A gradual increase in risk for all-cause death suggests that VTE is also an indicator of biologically more aggressive cancer types and advanced cancer stages. Considering the lack of standardization for D-dimer assays, it is essential for clinicians to carefully consider the variations in assay performance and the specific test characteristics of their institution. CONCLUSIONS: Standardizing D-dimer assays and developing modified pretest probability models specifically for cancer patients, along with adjusted cut-off values for D-dimer testing, could significantly enhance the accuracy and effectiveness of VTE diagnosis in this population.

Interventional oncological treatment of breast cancer liver metastasis (BCLM): single center long-term evaluation over 26 years using thermoablation techniques like LITT, MWA and TACE in a multimodal application.

The purpose of the study is to retrospectively evaluate the development and technological progress in local oncological treatments of patients with breast cancer liver metastasis (BCLM) using LITT (laser interstitial thermotherapy), MWA (microwave ablation) and TACE (transarterial chemoembolization) ablation techniques in a multimodal application. The study uses data generated between 1993 and 2020. Therapy results were evaluated using the Kaplan-Meier survival estimate, Cox proportional hazard regression and log-rank test. Cox regression analysis showed that the different treatment methods are statistically significant predictors of survival of patients. Median survival times for groups treated with LITT (212 patients) and LITT + TACE (215 patients) were 2.2 years and 2.1 years respectively; median survival times for groups treated with MWA (17 patients) and MWA + TACE (143 patients) were 5.6 and 2.4 years respectively. For LITT only treatments, the 1-, 3- and 5-year survival probability scored 80%, 37%, 22%. Results for combined LITT + TACE treatments were 76%, 34% and 15%. In group MWA, the 1-/3-/5-year survival probability rates were calculated as 89%, 89%, 89% (however, they should be interpreted carefully due to a relatively small sample size of n = 17 patients). Group MWA + TACE offered values of 77%, 38% and 22%. A separate group of 549 patients was analyzed with TACE monotherapy treatment. The estimated median survival time in this group was 0.8 years. The 1-/3-/5-year survival probability rates were 37%, 8% and 4%. Treatments with combined MWA and MWA + TACE resulted in the best median survival time estimations in this study.

Homoarginine in the cardiovascular system: Pathophysiology and recent developments.

Upcoming experimental and epidemiological data have identified the endogenous non-proteinogenic amino acid L-homoarginine (L-hArg) not only as a novel biomarker for cardiovascular disease but also as being directly involved in the pathogenesis of cardiac dysfunction. The association of low L-hArg levels with adverse cardiovascular events and mortality has proposed the idea of nutritional supplementation to rescue pathways inversely associated with cardiovascular health. Subsequent clinical and experimental studies contributed significantly to our knowledge of potential effects on the cardiorenal axis, acting either as a biomarker or a cardiovascular active agent. In this review article, we provide a comprehensive summary of the L-hArg metabolism, pathophysiological aspects, and current developments in the field of experimental and clinical evidence in favor of protective cardiovascular effects. Establishing a reliable biomarker to identify patients at high risk to die of cardiovascular disease represents one of the main goals for tackling this disease and providing individual therapeutic guidance.

Long-term outcomes following percutaneous microwave ablation for colorectal cancer liver metastases.

PURPOSE: To evaluate the overall survival (OS), local progression-free survival (PFS) and prognostic factors of patients with colorectal cancer liver metastases (CRLM) undergoing microwave ablation (MWA). METHOD: A total of 132 patients were retrospectively enrolled who had been treated between 2010 and 2018. For the evaluation of survival rates, all patients were divided according to their indications (curative n = 57 and debulking (patients with additional non-target extrahepatic metastases) n = 75). In total, 257 ablations were evaluated for prognostic factors: number of liver metastases, primary tumor origin (PTO), diameter and volume of metastases, duration and energy of ablation. RESULTS: The OS was 32.1 months with 93.2% of patients free from recurrence at 28.3 months (median follow-up time). The one- year and three-year OS were 82.72% and 41.66%, respectively. The OS and recurrence-free survival of the curative group were statistically significantly higher than the debulking group (p < .001). Statistically significant prognostic factors for OS included the location of the primary tumor (p < .038) and the number of metastases (all p < .017). Metastasis diameter and volume and ablation duration and energy had no significant correlation with survival (p > .05). CONCLUSIONS: Satisfactory OS and local tumor PFS can be achieved in patients with CRLM using MWA with the number of metastases and the location of the primary tumor influencing the outcome of patients. The metastasis's size and the duration and energy used for ablation were not of significant prognostic value.

Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization.

PURPOSE: Impact of pre-interventional magnetic resonance angiography (MRA) on prostatic artery embolization (PAE) regarding workflow, radiation dose, and clinical outcome. METHOD: Retrospective evaluation of 259 patients (mean age 68 ± 9, range 41-92) with benign prostatic hypertrophy (BPH) undergoing PAE between January 2017 and December 2020. MRA was performed in 137 cases. In 122 patients, no pre-interventional MRA was performed. Origin of the PA, volumetry of the prostatic gland and ADC values were evaluated. International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) were evaluated before and after PAE. RESULTS: Origin of the PA was identified in all cases. Significant differences regarding volume reduction (-20 ± 13 ml with MRA vs -17 ± 9 ml without MRA) and ADC value reduction were found (-78 ± 111 10-6 mm2/s with MRA vs -45 ± 99 10-6 mm2/s without MRA). PAE workflow was modified in 16 patients due to MRA findings. Radiation dose (5518.54 ± 6677.97 µGym2 with MRA vs 23963.50 ± 19792.25 µGym2 without MRA) and fluoroscopy times (19.35 ± 9.01 min. with MRA vs 27.45 ± 12.54 min. without MRA) significantly differed. IPSS reduction improved (-11 ± 8 points with MRA vs -7 ± 9 points without MRA, p < 0.001), while QOL (-2 ± 1 points with MRA and -2 ± 2 points without MRA) and IIEF (+2 ± 10 points with MRA and +1 ± 11 points without MRA) showed no significant differences (p > 0.05). CONCLUSIONS: Pre-interventional MRA facilitates improved workflow and patient safety of PAE while reducing radiation dose and intervention time.

Percutaneous Thermal Ablation Therapy of Hepatocellular Carcinoma (HCC): Microwave Ablation (MWA) versus Laser-Induced Thermotherapy (LITT).

The purpose of this study is to compare the efficacy and safety of microwave ablation (MWA) versus laser-induced thermotherapy (LITT) as a local treatment for hepatocellular carcinoma (HCC,) with regard to therapy response, survival rates, and complication rates as measurable outcomes. This retrospective study included 250 patients (52 females and 198 males; mean age: 66 ± 10 years) with 435 tumors that were treated by MWA and 53 patients (12 females and 41 males; mean age: 67.5 ± 8 years) with 75 tumors that were treated by LITT. Tumor response was evaluated using CEMRI (contrast-enhanced magnetic resonance imaging). Overall, 445 MWA sessions and 76 LITT sessions were performed. The rate of local tumor progression (LTP) and the rate of intrahepatic distant recurrence (IDR) were 6% (15/250) and 46% (115/250) in the MWA-group and 3.8% (2/53) and 64.2% (34/53) in the LITT-group, respectively. The 1-, 3-, and 5-year overall survival (OS) rates calculated from the date of diagnosis were 94.3%, 65.4%, and 49.1% in the MWA-group and 96.2%, 54.7%, and 30.2% in the LITT-group, respectively (p-value: 0.002). The 1-, 2-, and 3-year disease-free survival (DFS) rates were 45.9%, 30.6%, and 24.8% in the MWA-group and 54.7%, 30.2%, and 17% in the LITT-group, respectively (p-value: 0.719). Initial complete ablation rate was 97.7% (425/435) in the MWA-group and 98.7% (74/75) in the LITT-group (p-value > 0.99). The overall complication rate was 2.9% (13/445) in the MWA-group and 7.9% (6/76) in the LITT-group (p-value: 0.045). Based on the results, MWA and LITT thermal ablation techniques are well-tolerated, effective, and safe for the local treatment of HCC. However, MWA is recommended over LITT for the treatment of HCC, since the patients in the MWA-group had higher survival rates.

Lung Opacity and Coronary Artery Calcium Score: A Combined Tool for Risk Stratification and Outcome Prediction in COVID-19 Patients.

PURPOSE: To assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System). METHODS: This retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score. RESULTS: CAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis. CONCLUSIONS: Coronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.

Minimally Invasive Treatment of Kommerell's Diverticulum and Left Aberrant Subclavian Artery.

Kommerell's diverticulum is an aneurysmatic offspring of the left aberrant subclavian artery, which is a rare vascular anomaly of the aortic arch. Here, we present our less invasive approach to the repair of a symptomatic Kommerell's diverticulum in a 31-year-old patient, without the use of cardiopulmonary bypass.

A prospective randomized trial comparing microwave and radiofrequency ablation for the treatment of liver metastases using a dual ablation system ─ The Mira study.

PURPOSE: The aim of this study was to prospectively compare the therapy response and safety of microwave (MWA) and radiofrequency ablation (RFA) for the treatment of liver metastases using a dual ablation system. METHODS: Fifty patients with liver metastases (23 men, mean age: 62.8 ± 11.8 years) were randomly assigned to MWA or RFA for thermal ablation using a one generator dual ablation system. Magnetic resonance imaging (MRI) was acquired before treatment and 24 h post ablation. The morphologic responses to treatment regarding size, volume, necrotic areas, and diffusion characteristics were evaluated by MRI. Imaging follow-up was obtained for one year in three months intervals, whereas clinical follow-up was obtained for two years in all patients. RESULTS: Twenty-six patients received MWA and 24 patients received RFA (mean diameter: 1.6 cm, MWA: 1.7 cm, RFA: 1.5 cm). The mean volume 24 h after ablation was 37.0 cm3 (MWA: 50.5 cm3, RFA: 22.9 cm3, P < 0.01). The local recurrence rate was 0% (0/26) in the MWA-group and 8.3% (2/24) in the RFA-group (P = 0.09). The rate of newly developed malignant formations was 38.0% (19/50) for both groups (MWA: 38.4%, RFA: 37.5%, P = 0.07). The overall survival rate was 70.0% (35/50) after two years (MWA: 76.9%, RFA: 62.5%, P = 0.60). No major complications were reported. CONCLUSION: In conclusion, MWA and RFA are both safe and effective methods for the treatment of liver metastases with MWA generating greater volumes of ablation. No significant differences were found for overall survival, rate of neoplasm, or major complications between both groups.

Postoperative radiological assessment of the mastoid facial canal in cochlear implant patients in correlation with facial nerve stimulation.

OBJECTIVES: To correlate the radiological assessment of the mastoid facial canal in postoperative cochlear implant (CI) cone-beam CT (CBCT) and other possible contributing clinical or implant-related factors with postoperative facial nerve stimulation (FNS) occurrence. METHODS: Two experienced radiologists evaluated retrospectively 215 postoperative post-CI CBCT examinations. The mastoid facial canal diameter, wall thickness, distance between the electrode cable and mastoid facial canal, and facial-chorda tympani angle were assessed. Additionally, the intracochlear position and the insertion angle and depth of electrodes were evaluated. Clinical data were analyzed for postoperative FNS within 1.5-year follow-up, CI type, onset, and causes for hearing loss such as otosclerosis, meningitis, and history of previous ear surgeries. Postoperative FNS was correlated with the measurements and clinical data using logistic regression. RESULTS: Within the study population (mean age: 56 ± 18 years), ten patients presented with FNS. The correlations between FNS and facial canal diameter (p = 0.09), wall thickness (p = 0.27), distance to CI cable (p = 0.44), and angle with chorda tympani (p = 0.75) were statistically non-significant. There were statistical significances for previous history of meningitis/encephalitis (p = 0.001), extracochlear-electrode-contacts (p = 0.002), scala-vestibuli position (p = 0.02), younger patients' age (p = 0.03), lateral-wall-electrode type (p = 0.04), and early/childhood onset hearing loss (p = 0.04). Histories of meningitis/encephalitis and extracochlear-electrode-contacts were included in the first two steps of the multivariate logistic regression. CONCLUSION: The mastoid-facial canal radiological assessment and the positional relationship with the CI electrode provide no predictor of postoperative FNS. Histories of meningitis/encephalitis and extracochlear-electrode-contacts are important risk factors. KEY POINTS: • Post-operative radiological assessment of the mastoid facial canal and the positional relationship with the CI electrode provide no predictor of post-cochlear implant facial nerve stimulation. • Radiological detection of extracochlear electrode contacts and the previous clinical history of meningitis/encephalitis are two important risk factors for postoperative facial nerve stimulation in cochlear implant patients. • The presence of scala vestibuli electrode insertion as well as the lateral wall electrode type, the younger patient's age, and early onset of SNHL can play important role in the prediction of post-cochlear implant facial nerve stimulation.

Feasibility of diffusion-weighted magnetic resonance imaging in evaluation of early therapeutic response after CT-guided microwave ablation of inoperable lung neoplasms.

OBJECTIVE: To determine the early treatment response after microwave ablation (MWA) of inoperable lung neoplasms using the apparent diffusion coefficient (ADC) value calculated 24 h after the ablation. MATERIALS AND METHODS: This retrospective study included 47 patients with 68 lung lesions, who underwent percutaneous MWA from January 2008 to December 2017. Evaluation of the lesions was done using MRI including DWI sequence with ADC value calculation pre-ablation and 24 h post-ablation. DWI-MR was performed with b values (50, 400, 800 mm2/s). The post-ablation follow-up was performed using chest CT and/or MRI within 24 h following the procedure; after 3, 6, 9, and 12 months; and every 6 months onwards to determine the local tumor response. The post-ablation ADC value changes were compared to the end response of the lesions. RESULTS: Forty-seven patients (mean age: 63.8 ± 14.2 years, 25 women) with 68 lesions having a mean tumor size of 1.5 ± 0.9 cm (range: 0.7-5 cm) were evaluated. Sixty-one lesions (89.7%) showed a complete treatment response, and the remaining 7 lesions (10.3%) showed a local progression (residual activity). There was a statistically significant difference regarding the ADC value measured 24 h after the ablation between the responding (1.7 ± 0.3 × 10-3 mm2/s) and non-responding groups (1.4 ± 0.3 × 10-3 mm2/s) with significantly higher values in the responding group (p = 0.001). A suggested ADC cut-off value of 1.42 could be used as a reference point for the post-ablation response prediction (sensitivity: 66.67%, specificity: 84.21%, PPV: 66.7%, and NPV: 84.2%). No significant difference was reported regarding the ADC value performed before the ablation as a factor for the prognosis of treatment response (p = 0.86). CONCLUSION: ADC value assessment following ablation may allow the early prediction of treatment efficacy after MWA of inoperable lung neoplasms. KEY POINTS: • ADC value calculated 24 h post-treatment may allow the early prediction of MWA efficacy as a treatment of pulmonary tumors and can be used in the early immediate post-ablation imaging follow-up. • The pre-treatment ADC value of lung neoplasms is not different between the responding and non-responding tumors.

MR angiography-planned prostatic artery embolization for benign prostatic hyperplasia: single-center retrospective study in 56 patients.

PURPOSE: We aimed to evaluate the advantages of magnetic resonance angiography (MRA)-planned prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH). METHODS: In this retrospective study, MRAs of 56 patients (mean age, 67.23±7.73 years; age range, 47-82 years) who underwent PAE between 2017 and 2018 were evaluated. For inclusion, full information about procedure time and radiation values must have been available. To identify prostatic artery (PA) origin, three-dimensional MRA reconstruction with maximum intensity projection was conducted in every patient. In total, 33 patients completed clinical and imaging follow-up and were included in clinical evaluation. RESULTS: There were 131 PAs with a second PA in 19 pelvic sides. PA origin was correctly identified via MRA in 108 of 131 PAs (82.44%). In patients in which MRA allowed a PA analysis, a significant reduction of the fluoroscopy time (-27.0%, p = 0.028) and of the dose area product (-38.0%, p = 0.003) was detected versus those with no PA analysis prior to PAE. Intervention time was reduced by 13.2%, (p = 0.25). Mean fluoroscopy time was 30.1 min, mean dose area product 27,749 µGy•m2, and mean entrance dose 1553 mGy. Technical success was achieved in all 56 patients (100.0%); all patients were embolized on both pelvic sides. The evaluated data documented a significant reduction in IPSS (p < 0.001; mean 9.67 points). CONCLUSION: MRA prior to PAE allowed the identification of PA in 82.44% of the cases. MRA-planned PAE is an effective treatment for patients with BPH.

Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA.

OBJECTIVE. The objective of our study was to evaluate the clinical performance of a new high-frequency (HF) microwave ablation (MWA) technology with spatial energy control for treatment of lung malignancies in comparison with a conventional low-frequency (LF) MWA technology. MATERIALS AND METHODS. In this retrospective study, 59 consecutive patients (mean age, 58.9 ± 12.6 [SD] years) were treated in 71 sessions using HF spatial-energy-control MWA. Parameters collected were technical success and efficacy, tumor diameter, tumor and ablation volumes, ablation time, output energy, complication rate, 90-day mortality, local tumor progression (LTP), ablative margin size, and ablation zone sphericity. Results were compared with the same parameters retrospectively collected from the last 71 conventional LF-MWA sessions. This group consisted of 56 patients (mean age, 60.3 ± 10.8 years). Statistical comparisons were performed using the Wilcoxon-Mann-Whitney test. RESULTS. Technical success was 98.6% for both technologies; technical efficacy was 97.2% for HF spatial-energy-control MWA and 95.8% for LF-MWA. The 90-day mortality rate was 5.1% (3/59) in the HF spatial-energy-control MWA group and 5.4% (3/56) in the LF-MWA group; for both groups, there were zero intraprocedural deaths. The median ablation time was 8.0 minutes for HF spatial-energy-control MWA and 10.0 minutes for LF-MWA (p < 0.0001). Complications were recorded in 21.1% (15/71) of HF spatial-energy-control MWA sessions and in 31.0% (22/71) of LF-MWA sessions (p = 0.182); of these complications, 4.2% (3/71) were major complications in the HF spatial-energy-control MWA group, and 9.9% (7/71) were major complications in the LF-MWA group. The median deviation from ideal sphericity (1.0) was 0.195 in the HF spatial-energy-control MWA group versus 0.376 in the LF-MWA group (p < 0.0001). Absolute minimal ablative margins per ablation were 7.5 ± 3.6 mm (mean ± SD) in the HF spatial-energy-control MWA group versus 4.2 ± 3.0 mm in the LF-MWA group (p < 0.0001). In the HF spatial-energy-control MWA group, LTP at 12 months was 6.5% (4/62). LTP at 12 months in the LF-MWA group was 12.5% (7/56). Differences in LTP rate (p = 0.137) and time point (p = 0.833) were not significant. CONCLUSION. HF spatial-energy-control MWA technology and conventional LFMWA technology are safe and effective for the treatment of lung malignancies independent of the MWA system used. However, HF spatial-energy-control MWA as an HF and high-energy MWA technique achieves ablation zones that are closer to an ideal sphere and achieves larger ablative margins than LF-MWA (p < 0.0001).

Traumatic bone marrow edema of the calcaneus: Evaluation of color-coded virtual non-calcium dual-energy CT in a multi-reader diagnostic accuracy study.

PURPOSE: To investigate the diagnostic accuracy of dual-energy computed tomography (CT) virtual non-calcium (VNCa) reconstructions for the depiction of traumatic bone marrow edema of the calcaneus. METHOD: Data from 62 patients (33 women, 29 men; mean age: 41 years, range: 19-84 years) with acute tarsal trauma who had undergone third-generation dual-source dual-energy CT and 3-T magnetic resonance imaging (MRI) within seven days between January 2017 and July 2018 were retrospectively analyzed. Five radiologists, blinded to clinical and MRI information, independently assessed conventional grayscale dual-energy CT series for the presence of fractures; after at least eight weeks, readers re-evaluated all cases using color-coded VNCa reconstructions for the presence of bone marrow edema. Quantitative analysis of CT numbers on VNCa reconstructions was performed by a sixth radiologist. Two additional experienced radiologists, blinded to clinical and CT information, assessed MRI series in consensus to define the reference standard. Sensitivity, specificity and the area under the curve (AUC) were the primary indices for diagnostic accuracy. RESULTS: MRI revealed 62 areas with bone marrow edema in 39 patients. In the qualitative analysis, VNCa showed high overall sensitivity (286/310 [92%]) and specificity (899/930 [97%]) for the depiction of bone marrow edema. A cut-off value of -53 Hounsfield units (HU) provided a sensitivity of 82% (51/62) and specificity of 95% (176/186]) for differentiating bone marrow edema. The overall AUC was 0.98. CONCLUSIONS: In both quantitative and qualitative analyses, dual-energy CT VNCa reconstructions show excellent diagnostic accuracy for the visualization of traumatic calcaneal bone marrow edema compared to MRI.

Patient radiation dose in percutaneous biliary interventions: recommendations for DRLs on the basis of a multicentre study.

OBJECTIVE: Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs. METHODS: A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs. RESULTS: Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm2) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07-180.33 min). CONCLUSIONS: DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended. KEY POINTS: • DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.