Adjusted Tumor Enhancement on Dual-Phase Cone-Beam CT: Predictor of Response and Overall Survival in Patients with Liver Malignancies Treated with Hepatic Artery Embolization.

The aim of this study was to examine the value of tumor enhancement parameters on dual-phase cone-beam CT (CBCT) in predicting initial response, local progression-free survival (L-PFS) and overall survival (OS) following hepatic artery embolization (HAE). Between Feb 2016 and Feb 2023, 13 patients with 29 hepatic tumors treated with HAE were analyzed. Pre- and post-embolization, subtracted CBCTs were performed, and tumor enhancement parameters were measured, resulting in three parameters: pre-embolization Adjusted Tumor Enhancement (pre-ATE), post-embolization ATE and the difference between pre- and post-ATE (∆ATE). Treatment response was evaluated using the mRECIST criteria at 1 month. Tumors were grouped into complete response (CR) and non-complete response (non-CR) groups. To account for the effect of multiple lesions per patient, a cluster data analytic method was employed. The Kaplan-Meier method was utilized for survival analysis using the lesion with the lowest ∆ATE value in each patient. Seventeen (59%) tumors showed CR and twelve (41%) showed non-CR. Pre-ATE was 38.5 ± 10.6% in the CR group and 30.4 ± 11.0% in the non-CR group (p = 0.023). ∆ATE in the CR group was 39 ± 12 percentage points following embolization, compared with 29 ± 11 in the non-CR group (p = 0.009). Patients with ∆ATE > 33 had a median L-PFS of 13.1 months compared to 5.7 in patients with ∆ATE ≤ 33 (95% CI = 0.038-0.21) (HR, 95% CI = 0.45, 0.20-0.9, p = 0.04). Patients with ∆ATE ≤ 33 had a median OS of 19.7 months (95% CI = 3.77-19.8), while in the ∆ATE > 33 group, median OS was not reached (95% CI = 20.3-NA) (HR, 95% CI = 0.15, 0.018-1.38, p = 0.04). CBCT-derived ATE parameters can predict treatment response, L-PFS and OS following HAE.

Outcomes of Y90 Radioembolization for Hepatocellular Carcinoma in Patients Previously Treated with Transarterial Embolization.

The aim of this study was to evaluate outcomes of transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) in patients previously treated with transarterial embolization (TAE). In this retrospective study, all HCC patients who received TARE from 1/2012 to 12/2022 for treatment of residual or recurrent disease after TAE were identified. Overall survival (OS) was estimated using the Kaplan-Meier method. Univariate Cox regression was performed to determine significant predictors of OS after TARE. Twenty-one patients (median age 73.4 years, 18 male, 3 female) were included. Median dose to the perfused liver volume was 121 Gy (112-444, range), and 18/21 (85.7%) patients received 112-140 Gy. Median OS from time of HCC diagnosis was 32.9 months (19.4-61.4, 95% CI). Median OS after first TAE was 29.3 months (15.3-58.9, 95% CI). Median OS after first TARE was 10.6 months (6.8-27.0, 95% CI). ECOG performance status of 0 (p = 0.038), index tumor diameter < 4 cm (p = 0.022), and hepatic tumor burden < 25% (p = 0.018) were significant predictors of longer OS after TARE. TARE may provide a survival benefit for appropriately selected patients with HCC who have been previously treated with TAE.

Erratum to "Mesenteric ectopic pregnancy with tubo-ovarian abscess" [Radiology Case Reports 16 (2021) 1165-1168].

[This corrects the article DOI: 10.1016/j.radcr.2021.02.043.].

A review of phase III clinical trials of US FDA-approved biologic therapies for chronic rhinosinusitis with nasal polyposis.

Chronic rhinosinusitis with nasal polyposis is a heterogenous disease with complex underlying pathophysiologic mechanisms. Biologics have been proven to be an effective add-on therapeutic option in severe and/or refractory cases. Currently, dupilumab, omalizumab and mepolizumab have phase III data to support their use in these patients and have received approval from the United States Food and Drug Administration specifically for the treatment of nasal polyposis. Each of these biologics has shown its ability to reduce nasal polyp size and improve nasal congestion/obstruction and sense of smell, but additional research is needed to directly compare the efficacy and safety of the different biologic agents for different nasal polyposis endotypes.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a complex disease that has many different causes. Biological therapies have been proven to be effective when added on to standard treatment in severe and/or cases that are not responsive to initial treatment. Currently, dupilumab, omalizumab and mepolizumab have data supporting their use in such patients and have received approval by the United States Food and Drug Administration for the treatment of CRSwNP. Each of these biologics has shown its ability to reduce nasal polyp size and improve nasal congestion/obstruction and sense of smell, but additional research is needed to directly compare the efficacy and safety of the different biologic agents for different CRSwNP subtypes.

Recurrent Left-Sided Pleural Effusions in a Patient With Chronic Lymphedema.

Chronic lymphedema can lead to several long-term complications. The causes of lymphedema can be primary, due to a genetic source, or secondary to procedures, trauma, or other conditions. Primary hereditary lymphedema, as in the case of Milroy's disease, is rare. Because of the condition's rarity, case reports mostly involve presentations to monitor for. Here we document a case of Milroy's disease in a 70-year-old woman with recurrent left lung effusions.

Gastric gastrointestinal stromal tumor (GIST) with co-occurrence of pancreatic neuroendocrine tumor.

Mesenchymal tumors make up only about 1% of primary GI tumors, with Gastrointestinal Stromal Tumors (GIST) being the most common nonepithelial GI neoplasms. They are derived from the Interstitial cells of Cajal (ICC), and occur predominantly in older individuals, with a mean age of diagnosis of 64 years. Here we discuss the case of a 39-year-old female with atypical thoracic back pain wrapping around to the front and migrating diffuse abdomen pain that sometimes radiates into the chest. Upon imaging, a gastric GIST of the greater curve of the stomach was found incidentally on investigation of a pancreatic mass that was revealed to be a co-occurring pancreatic neuroendocrine tumor. For management of the gastric GIST and pancreatic neuroendocrine tumor, this patient underwent partial gastrectomy with gastrojejunostomy, partial pancreatectomy, splenectomy, and cholecystectomy with no complications.

Mesenteric ectopic pregnancy with tubo-ovarian abscess.

An ectopic pregnancy is the implantation of a fertilized ovum in a location other than the main cavity of the uterus. Ectopic pregnancies are reported in approximately 1%-2% of pregnancies, and while 95% of ectopic pregnancies are in fallopian tubes, only 3% are in ovarian, cervical, or abdominal sites. We present a case of a 38-year-old female with acute onset of severe lower abdominal pain, sepsis, chills, and diarrhea who was evaluated with a CT of the abdomen and pelvis with IV contrast only. The imaging revealed a likely second trimester age fetal skeleton with a partially collapsed calvarium within the peritoneal cavity and an abnormal complex cystic lesion in the right adnexal area. In this case, the patient successfully underwent exploratory laparotomy with removal of both the abdominal ectopic pregnancy and the tubo-ovarian mass.