Volume-Assisted Estimation of Remnant Liver Function Based on Gd-EOB-DTPA Enhanced MR Relaxometry: A Prospective Observational Trial.

In the context of liver surgery, predicting postoperative liver dysfunction is essential. This study explored the potential of preoperative liver function assessment by MRI for predicting postoperative liver dysfunction and compared these results with the established indocyanine green (ICG) clearance test. This prospective study included patients undergoing liver resection with preoperative MRI planning. Liver function was quantified using T1 relaxometry and correlated with established liver function scores. The analysis revealed an improved model for predicting postoperative liver dysfunction, exhibiting an accuracy (ACC) of 0.79, surpassing the 0.70 of the preoperative ICG test, alongside a higher area under the curve (0.75). Notably, the proposed model also successfully predicted all cases of liver failure and showed potential in predicting liver synthesis dysfunction (ACC 0.78). This model showed promise in patient survival rates with a Hazard ratio of 0.87, underscoring its potential as a valuable tool for preoperative evaluation. The findings imply that MRI-based assessment of liver function can provide significant benefits in the early identification and management of patients at risk for postoperative liver dysfunction.

Changes in gadoxetic-acid-enhanced MR imaging during the first year after irreversible electroporation of malignant hepatic tumors.

PURPOSE: To evaluate the appearance and size of ablation zones in gadoxetic-acid-enhanced magnetic resonance imaging (MRI) during the first year after irreversible electroporation (IRE) of primary or secondary hepatic malignancies and to investigate potential correlations to clinical features. MATERIAL AND METHODS: The MRI-appearance of the ablation area was assessed 1-3 days, 6 weeks, 3 months, 6 months, 9 months and 1 year after IRE. The size of the ablation zone and signal intensities of each follow-up control were compared. Moreover, relationships between clinical features and the MRI-appearance of the ablation area 1-3 days after IRE were analyzed. RESULTS: The ablation zone size decreased from 5.6 ± 1.4 cm (1-3 days) to 3.7±1.2 cm (1 year). A significant decrease of central hypointensities was observed in T2-blade- (3 months), T2 haste- (6 weeks; 3 months; 6 months; 1 year), T1 arterial phase- (3 months; 1 year), and diffusion-sequences (6 weeks; 3 months; 6 months; 9 months; 1 year). The unenhanced T1-sequences showed significantly increasing central hypointensities (6 weeks; 3 months; 6 months; 9 months; 1 year). Significantly increasing peripheral hypointensities were detected in T1 arterial phase- (3 months; 6 months; 9 months; 1 year) and in T1 portal venous phase-sequences (6 weeks; 3 months; 6 months; 9 months; 1 year). Peripheral hypointensities of unenhanced T1-sequences decreased significantly 1 year after IRE. 1-3 days after IRE central T1 portal venous hypo- or isointensities were detected significantly more often than hyperintensities, if more than 3 IRE electrodes were used. CONCLUSION: Hepatic IRE results in continuous reduction of ablation zone size during the first postinterventional year. In addition to centrally decreasing T1-signal and almost steadily increasing signal in the enhanced T2 haste-, diffusion- and T1 arterial phase-sequences, there is a trend toward long-term decreasing T1 arterial- and portal venous MRI-signal intensity of the peripheral ablation area, probably representing a region of reversible electroporation.

CT-assisted sympathicolysis as an additional minimally invasive therapeutic option in primary focal plantar hyperhidrosis.

PURPOSE: The purpose of this retrospective study was to evaluate the benefit of lumbar computed tomography-assisted sympathicolysis (CTSy) in patients with primary focal hyperhidrosis of the feet. METHODS: A lumbar CTSy was conducted on 35 patients (mean age 36.6 ± 11.9 years) with primary focal hyperhidrosis of the feet, who experienced persistent symptoms after all conservative treatment options had been exhausted. The patients evaluated the severity of their symptoms before the intervention, 2 days after the intervention, and 6 and 12 months after the intervention on the basis of a Dermatology Quality of Life Index(©) (DLQI) and side effects experienced. RESULTS: The interventions performed led to a statistically significant decrease in the preinterventional severity of symptoms 2 days after the intervention, and 6 and 12 months after CTSy (p < 0.05). No major complications occurred. As the most common side effect, 12 of the patients reported compensatory sweating. CONCLUSIONS: After conservative measures have been exhausted or as a complement to the existing therapy regimen, CT-assisted sympathicolysis represents a therapeutic option low in side effects that provides a marked benefit to patients with primary, focal hyperhidrosis.

Treatment of iatrogenic IVC occlusion with implantation of a stent of a new shape dedicated to aortic aneurysms.

BACKGROUND: Successful treatment of chronic occlusion of inferior vena cava (IVC) and iliocaval confluence with angioplasty and stent implantation is very rare. CASE REPORT: We present a case of a 59-year-old patient with iatrogenic occlusion of IVC following L3/L4 discectomy. The wall of the ventral IVC was ruptured during the operation. RESULTS: The torn wall was treated by patch angioplasty, resulting in a permanent IVC occlusion, as confirmed by angiography. Iatrogenic permanent occlusion of IVC was successfully treated with recanalization and implantation of a non-covered aortic stent.