Recurrence of tumoral calcinosis: a case report.

We describe radiographic, contrast-enhanced MDCT and MRI findings with pathologic correlations of an unusual recurrence of tumoral calcinosis, also called Teutschlander disease. The disease was silent in the first decade of life, when it appeared with elbows recurring lesions, until the seventh decade of life, when a left hip active growth lesion developed. A review about tumoral calcinosis pathogenesis, clinical course and imaging differential diagnosis is reported. (www.actabiomedica.it).

Percutaneous CT-guided irreversible electroporation followed by chemotherapy as a novel neoadjuvant protocol in locally advanced pancreatic cancer: Our preliminary experience.

INTRODUCTION: Irreversible electroporation (IRE) is a non-thermal ablation technique recently used in pancreatic cancer. In our prospective study we evaluated safety, feasibility and efficacy of a neoadjuvant protocol based on CT-guided percutaneous IRE followed by chemotherapy in patients with locally advanced pancreatic cancer (LAPC). METHODS: We performed CT-guided percutaneous IRE in 20 patients with LAPC, followed by a combination of gemcitabine (1000 mg/mq) and oxaliplatin (100 mg/mq) biweekly. Imaging follow-up was performed by a contrast enhanced CT scan at 1, 3, 6 months and then every 3 months. RESULTS: No major complications occurred. Two patients died 3 and 4 months after IRE because of rapidly progressive disease. In the remaining 18 patients 6-month imaging follow-up showed a mean lesions volumetric decrease percentage of 42.89% (95% Confidence Interval: 34.90-54.88%). Thanks to lesions downstaging, three patients underwent R0 resection. At last available follow-up (mean follow-up 91 months; range 6-14), imaging showed no disease progression or post-surgical relapse in all 18 cases. The mean estimated survival was 12,950 months (95% CI: 11,570-14,332). CONCLUSIONS: Our preliminary study suggests that IRE followed by chemotherapy is safe, feasible and effective in producing local control of LAPC, with a possible downstaging effect to resectable lesions.

Combined magnetic resonance spectroscopy and dynamic contrast-enhanced imaging for prostate cancer detection.

BACKGROUND: The use of magnetic resonance spectroscopy imaging (MRSI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) have emerged as a valid diagnostic tools for prostate cancer (CaP). METHODS: Men with PSA levels below 10 ng/ml were enrolled in a prospective cohort study and underwent combined MRSI and DCE-MRI and transrectal ultrasound-guided prostate biopsy. Imaging was performed using a 1.5 T MR scanner (Symphony TIM; Siemens, Erlangen, Germany) with an endorectal coil (Medrad; Pittsburg, PA), inflated with 60 cc of air. Three-dimensional magnetic resonance spectroscopic data were acquired by using water and a lipid-suppressed double-spin-echo point-resolved spectroscopy sequence, which was optimized for quantitative detection of both choline and citrate. Dynamic contrast-enhanced MRI sequences were obtained with 3D T1-weighted FLASH images before and during rapid bolus administration of intravenous paramagnetic contrast medium gadoteric acid. Specificity, sensitivity, positive predictive value, negative predictive value, and accuracy were computed considering patients, each of the 2 lobes, each of the 6 sextants, and each 12th part of the prostate gland as single measurements. RESULTS: Overall, 106 patients were included in the analysis. Median age was 65.9 years (range, 61.2-70.5 years) and median PSA level at study entry was 7.1 ng/ml (range, 2.5-9.9). CaP was detected at biopsy in 24 patients (22.6 % of the population) with a median Gleason score of 8 (range 4-10). Diagnostic accuracy of combined MRSI and DCE-MRI was 85%, sensitivity was 71%, and specificity was 48%, considering patients as single measurements, with a negative predictive value of 91%, but a positive predictive value of only 19%. Positive predictive value of the examination improved to 25% for patients who repeated biopsy. CONCLUSIONS: Although this study confirms the potential usefulness of MRI for the diagnosis of CaP, the positive predictive value obtained was unacceptably low due to the high number of false positives recorded. Nevertheless, the high negative predictive value of the examination may serve to avoid unnecessary biopsies. Future research should be directed at assessing the value of combining MRI-based techniques with novel biochemical markers for the diagnosis of CaP in patients with low PSA levels.

CT-guided radiofrequency ablation in the treatment of recurrent rectal cancer.

OBJECTIVE: Locally recurrent rectal adenocarcinoma remains a therapeutic challenge that is unsatisfactorily managed by surgery and radiation therapy or chemotherapy. Palliative CT-guided radiofrequency ablation was used in 14 patients with recurrent rectal adenocarcinoma who had been previously treated with abdominoperineal resection and radiation therapy. Follow-up CT or MRI was performed at 3, 6, 12, and 24 months. Pain palliation was monitored by the brief pain inventory (BPI). CONCLUSION: One month after radiofrequency ablation, 11 patients reported satisfactory BPI mean scores reduction compared to baseline (from 7.6 to 3.4 and from 5.1 to 1.6 for worst and average pain, respectively). In two unresponsive patients, retreatment was successfully performed at 3 months. After 24 months, worst and average pain scores further decreased (to 2.6 and 0.8, respectively) in 10 patients, who, at imaging, showed an ablation zone covering the entire original lesion in two patients and incomplete ablation in eight. In our experience, radiofrequency ablation is a safe and effective palliative treatment for patients with recurrent rectal adenocarcinoma.