Hepatic Artery Injection of 131I-Metuximab Combined with Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: A Prospective Nonrandomized, Multicenter Clinical Trial.

This prospective nonrandomized, multicenter clinical trial was performed to investigate the efficacy and safety of 131I-labeled metuximab in adjuvant treatment of unresectable hepatocellular carcinoma. Methods: Patients were assigned to treatment with transcatheter arterial chemoembolization (TACE) combined with 131I-metuximab or TACE alone. The primary outcome was overall tumor recurrence. The secondary outcomes were safety and overall survival. Results: The median time to tumor recurrence was 6 mo in the TACE + 131I-metuximab group (n = 160) and 3 mo in the TACE group (n = 160) (hazard ratio, 0.55; 95% CI, 0.43-0.70; P < 0.001). The median overall survival was 28 mo in the TACE + 131I-metuximab group and 19 mo in the TACE group (hazard ratio, 0.62; 95% CI, 0.47-0.82; P = 0.001). Conclusion: TACE + 131I-metuximab showed a greater antirecurrence benefit, significantly improved the 5-y survival of patients with advanced hepatocellular carcinoma, and was well tolerated by patients.

Biliary tract perforation following percutaneous endobiliary radiofrequency ablation: A report of two cases.

Endobiliary radiofrequency ablation (RFA) has recently been recognized as a beneficial treatment option for malignant biliary obstruction using percutaneous or endoscopic approaches. The feasibility and safety of this method has been demonstrated in clinical studies, with pain, cholangitis and asymptomatic biochemical pancreatitis reported as relatively common complications. By contrast, hepatic coma, newly diagnosed left bundle branch block and partial liver infarction have been reported as uncommon complications. Biliary tract perforation is a serious potential complication of percutaneous intraductal RFA, which may result in severe infection, peritonitis or even mortality, and which has not been previously reported in clinical research. The current study presents the first reports of biliary tract perforation in two patients with unresectable malignant biliary obstruction following percutaneous intraductal RFA. Although the patient in case 1 succumbed 12 days after RFA, the minor biliary tract perforation in case 2 was successfully treated by the deployment of a self-expanding metal stent. This study demonstrates that biliary tract perforation should be recognized as a serious potential complication of endobiliary RFA, and that metal stent deployment should be considered as a treatment option for minor biliary tract perforation.

MRI in the differential diagnosis of primary architectural distortion detected by mammography.

PURPOSE: We aimed to evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) values in lesions that manifest with architectural distortion (AD) on mammography. METHODS: All full-field digital mammography (FFDM) images obtained between August 2010 and January 2013 were reviewed retrospectively, and 57 lesions showing AD were included in the study. Two independent radiologists reviewed all mammograms and MRI data and recorded lesion characteristics according to the BI-RADS lexicon. The gold standard was histopathologic results from biopsies or surgical excisions and results of the two-year follow-up. Receiver operating characteristic curve analysis was carried out to define the most effective threshold ADC value to differentiate malignant from benign breast lesions. We investigated the sensitivity and specificity of FFDM, DCE-MRI, FFDM+DCE-MRI, and DCE-MRI+ADC. RESULTS: Of the 57 lesions analyzed, 28 were malignant and 29 were benign. The most effective threshold for the normalized ADC (nADC) was 0.61 with 93.1% sensitivity and 75.0% specificity. The sensitivity and specificity of DCE-MRI combined with nADC was 92.9% and 79.3%, respectively. DCE-MRI combined with nADC showed the highest specificity and equal sensitivity compared with other modalities, independent of the presentation of calcification. CONCLUSION: DCE-MRI combined with nADC values was more reliable than mammography in differentiating the nature of disease manifesting as primary AD on mammography.

Asthma COPD Overlap Syndrome on CT Densitometry: A Distinct Phenotype from COPD.

Patients with asthma COPD overlap syndrome (ACOS) are an important but poorly characterized group. This study sought to explore the distinct characteristics of ACOS on CT densitometry. The study population was randomly selected from communities via questionnaires. All participants underwent low-dose volumetric chest CT both before and after bronchodilator administration. Each CT scan was performed at full-inspiration and full-expiration for CT densitometry. Emphysema index (EI), air trapping (AT), mean lung density (MLD) and total lung volume (TLV) were measured and compared between the ACOS and COPD groups. The distributions of both EI and AT were compared between patients with ACOS and COPD. The variations between the pre- and post-BD measurements observed in patients with ACOS were compared with those in patients with COPD. A total of 71 patients completed the study, including 32 patients with COPD and 39 patients with ACOS. The patients with ACOS exhibited lower EI and more upper-zone-predominant EI distributions, compared with the patients with COPD. No significant differences were exhibited in AT and its distribution. Following bronchodilator administration, the variations in AT and expiratory MLD were greater in patients with ACOS than in patients with COPD. No differences were observed in the variations of EI and inspiratory MLD. Our results indicate that patients with ACOS have lower extent of emphysema and different emphysema distribution, as well as greater post-BD variations in air trapping, compared with patients with COPD. These findings suggest that CT densitometry characterizes ACOS as a distinct phenotype from COPD.

Percutaneous intraductal radiofrequency ablation combined with biliary stent placement for malignant biliary obstruction: A case report and review of the literature.

Percutaneous management of unresectable malignant biliary obstruction remains challenging. Biliary radiofrequency ablation (RFA) using the Habib EndoHBP catheter is a new palliation therapy for malignant biliary obstruction. We report our initial experience of RFA for the management of malignant biliary obstruction. A 58-year-old male was diagnosed with gallbladder cancer. Intraductal bipolar RFA was delivered at power of 10 W for 120 s, followed by stent placement. The patient had immediate stricture improvements after RFA. No severe adverse event occurred. Percutaneous RFA seems to be safe and feasible for the treatment of malignant biliary obstruction. Further studies are warranted.

Endovascular Treatment of Splenic Artery Aneurysm With a Stent-Graft: A Case Report.

Splenic artery aneurysm, one of the most common visceral aneurysms, accounts for 60% of all visceral aneurysm cases. Open surgery is the traditional treatment for splenic artery aneurysm but has the disadvantages of serious surgical injuries, a high risk of complications, and a high mortality rate.We report a case who was presented with splenic artery aneurysm. A 54-year-old woman complained of upper left abdominal pain for 6 months. An enhanced computed tomography scan of the upper abdomen indicated the presence of splenic artery aneurysm. The splenic artery aneurysm was located under digital subtraction angiography and a 6/60 mm stent graft was delivered and released to cover the aneurysm. An enhanced computed tomography scan showed that the splenic artery aneurysm remained well separated, the stent graft shape was normal, and the blood flow was unobstructed after 1 year.This case indicates a satisfactory efficacy proving the minimal invasiveness of stent graft exclusion treatment for splenic artery aneurysm.

Computed Tomography Number Measurement Consistency Under Different Beam Hardening Conditions: Comparison Between Dual-Energy Spectral Computed Tomography and Conventional Computed Tomography Imaging in Phantom Experiment.

PURPOSE: To compare computed tomography (CT) number measurement consistency under different beam hardening conditions in phantom experiment between dual-energy spectral CT and conventional CT imaging. MATERIALS AND METHODS: A phantom with 8 cells in periphery region and 1 cell in central region were used. The 8 conditioning tubes in the periphery region were filled with 1 of the 3 iodine solutions to simulate different beam hardening conditions: 0 for no beam hardening (NBH), 20 mg/mL for weak beam hardening (WBH) and 50 mg/mL for severe beam hardening (SBH) condition. Test tube filled with 0, 0.1, 0.5, 1, 2, 5, 10, 20, and 50 mg/mL iodine solution was placed in the central cell alternately. The phantom was scanned with conventional CT mode with 80, 100, 120, and 140 kVp and dual energy spectral CT mode. For spectral CT, 11 monochromatic image sets from 40 to 140 keV with interval of 10 keV were reconstructed. The CT number shift caused by beam hardening was evaluated by measuring the CT number difference (ΔCT) with and without beam hardening, with the following formulas: ΔCTWBH = |CTWBH - CTNBH| and ΔCTSBH = |CTSBH - CTNBH|. Data were compared with 1-way analysis of variance. RESULTS: Under both WBH and SBH conditions, the CT number shifts in all monochromatic image sets were less than those for polychromatic images (all P < 0.001). Under WBH condition, the maximum CT number shift was less than 6 Hounsfield units for monochromatic spectral CT images of all energy levels; under SBH condition, only monochromatic images at 70 keV and 80 keV had CT number shift less than 6 HU. CONCLUSION: Dual energy spectral CT imaging provided more accurate CT number measurement than conventional CT under various beam hardening conditions. The optimal keV level for monochromatic spectral CT images with the most accurate CT number measurement depends on the severities of beam hardening condition.

Successful treatment of complex cholangiolithiasis following orthotopic liver transplantation with interventional radiology.

Bile duct stones are a serious and the third most common complication of the biliary system that can occur following liver transplantation. The incidence rate of bile duct stones after liver transplantation is 1.8%-18%. The management of biliary stones is usually performed with endoscopic techniques; however, the technique may prove to be challenging in the treatment of the intrahepatic bile duct stones. We herein report a case of a 40-year-old man with rare, complex bile duct stones that were successfully eliminated with percutaneous interventional techniques. The complex bile duct stones were defined as a large number of bile stones filling the intra- and extrahepatic bile tracts, resulting in a cast formation within the biliary tree. Common complications such as hemobilia and acute pancreatitis were not present during the perioperative period. The follow-up period was 20 mo long. During the postoperative period, the patient maintained normal temperature, and normal total bilirubin and direct bilirubin levels. The patient is now living a high quality life. This case report highlights the safety and efficacy of the percutaneous interventional approach in the removal of complex bile duct stones following liver transplantation.

Interventional treatment for portal venous occlusion after liver transplantation: long-term follow-up results.

Portal vein (PV) occlusion after liver transplant is an uncommon clinical situation, and percutaneous interventional treatment for this condition has not been widely described. The aim of this study was to evaluate the long-term treatment effect of interventional treatment for PV occlusion after liver transplantation (LT). Follow-up data of 13 patients who received interventional treatment for PV occlusion after LT between July 2007 and April 2013 were analyzed. Of these, 10 patients had portal hypertension-related signs and symptoms. Percutaneous balloon angioplasty and stent placement were performed, with percutaneous thrombolysis treatment as appropriate. Embolization therapy was required for significant collateral circulation. Technical and clinical success, complications, and patency of PV were analyzed. Both technical and clinical success was achieved in 11 of the 13 patients (84.6%). Direct portogram showed limited PV occlusion in 7 patients and extensive PV occlusion in 4 patients. The former underwent balloon angioplasty followed by stent placement, while the latter underwent balloon angioplasty followed by stent placement and additional percutaneous thrombolysis treatment. Embolization therapy for collateral circulation was performed in all 4 patients with extensive PV occlusion and 1 patient with limited PV occlusion. All stents remained patency during the follow-up (28.5 ±â€Š6.8 months). No portal hypertension-related symptoms reoccurred during follow-up. In conclusion, interventional treatment for PV occlusion after LT showed a high success rate and good long-term results. Comprehensive interventional treatment should be used for extensive PV occlusion.

Anomalous origin of the left coronary artery from the pulmonary artery in infants: imaging findings and clinical implications of cardiac computed tomography.

PURPOSE: This study aimed to retrospectively analyze the imaging features of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) in pediatric patients, with cardiac computed tomography (CT) and echocardiography. MATERIALS AND METHODS: To define the precise location of ostium of the left coronary artery, we examined 9 patients using chest film, electrocardiogram, echocardiography, and cardiac CT 4 modalities, 2 of them also using cardiac MR and 1 of them using catheter cardiac angiography. Cardiac CT scan was performed in all 9 patients using a body size adapted low-dose protocol after bolus injection of intravenous nonionic contrast medium. Multiplane reconstruction, maximum intensity projection, and 3-dimensional coronary tree images were obtained for each patient. Two radiologists in consensus analyzed the cardiac CT findings for the origin of the anomalous coronary artery, course, and collateral vessels. The ALCAPA in these 9 patients was confirmed retrospectively by surgery. RESULTS: Cardiac CT can distinguish the site of origin of the anomalous left coronary artery and variants: 2 patients with inner ostium of the pulmonary trunk, 3 patients with left-sided ostium, 2 patients with posterior ostium, and 2 patients with sinus of the pulmonary root ostium; 1 patient combined with the right coronary artery arising from the left coronary sinus. CONCLUSIONS: Cardiac CT can provide fast and accurate depiction of complex coronary arteries, particularly in unstable and fragile patients with ALCAPA, and according to cardiac CT, surgical strategies can be decided.

[Diagnosis and differential diagnosis of testicular epidermoid cyst with MRI].

OBJECTIVE: To investigate the MRI characteristics and differential diagnosis of testicular epidermoid cyst. METHODS: The MRI imaging features of 7 testicular epidermoid cyst cases were retrospectively analyzed and compared with that of testicular seminoma. All cases were examined by contrast-enhanced MRI scans. RESULTS: The group of 7 cases of testicular epidermoid cyst MRI showed characteristic: On T1-weighted MR images, some lesions showed low signal-based, center with spotty high signal ("target sign"). On T2-weighted MRI, some lesions had a laminated appearance, with alternating low and high signal intensity areas ("onion skin" sign). On contrast-enhanced images, all lesions were sharply demarcated low signal intensity masses, and contrast enhancement were not seen in any of the cases. CONCLUSION: MRI characteristics of testicular epidermoid cyst are distinctive in certain extent. It may express "target sign", "onion skin" sign, T2 low signal intensity complete rings, and without enhancement.

Embolization of symptomatic renal angiomyolipoma with a mixture of lipiodol and PVA, a mid-term result.

OBJECTIVE: To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol (PVA) particles on symptomatic renal angiomyolipoma and to present the mid-term results from our single-center site. METHODS: We performed a retrospective review of the seven patients who underwent embolization with a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma in our center between February 2011 and December 2013. Medical records and follow-up results were reviewed and analyzed. RESULTS: Seven patients underwent eight episodes of embolization using a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma. One patient required a subsequent embolization of the right kidney 9 months after the initial embolization of the left kidney. No nephrectomy was required in any of these cases during follow-up. None had recurrence of tumor bleeding or rupture during follow-up. Decreased tumor size was achieved in six patients (85.7%) during the mid-term follow-up. CONCLUSIONS: Embolization with a mixture of lipiodol and PVA particles is an effective and safe treatment for symptomatic renal angiomyolipoma. Based on the durable mid-term results of the present study, a mixture of lipiodol and PVA particles is recommended for embolization.

Flow characteristics of the proximal pulmonary arteries and vena cava in patients with chronic thromboembolic pulmonary hypertension: correlation between 3.0 T phase-contrast MRI and right heart catheterization.

PURPOSE: We aimed to determine the correlation between flow characteristics of the proximal pulmonary arteries and vena cava obtained by 3.0 T phase-contrast magnetic resonance imaging (MRI) and hemodynamic characteristics by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension. MATERIALS AND METHODS: Twenty consecutive patients with chronic thromboembolic pulmonary hypertension and 20 sex- and age-matched healthy volunteers were included prospectively. All patients and controls underwent phase-contrast MRI to determine the flow characteristics including peak velocity, mean velocity, and mean blood flow of the proximal pulmonary artery and vena cava. All patients underwent right heart catheterization to determine the hemodynamics. RESULTS: Peak velocity and mean velocity of the proximal pulmonary artery were significantly lower in the patient group. In patients, both peak velocity and mean blood flow were sequentially decreased in the main pulmonary artery, left and right pulmonary arteries, and left and right interlobar pulmonary arteries. Inferior vena cava had higher peak velocity, mean velocity, and mean blood flow than superior vena cava. Peak velocity of the main pulmonary artery correlated with mean and diastolic pulmonary artery pressure. Peak velocity of both inferior and superior vena cava strongly correlated with the pulmonary vascular resistance index (PVRI) (r=-0.68, P < 0.001 and r=-0.74, P < 0.001, respectively). Mean velocity of the main pulmonary artery and right pulmonary artery strongly correlated with PVRI and mean pulmonary artery pressure. Mean velocity of the superior vena cava and mean blood flow of the main pulmonary artery strongly correlated with PVRI and right cardiac work index. CONCLUSION: Blood flow in the proximal pulmonary artery and vena cava evaluated by phase-contrast MRI correlate with hemodynamic parameters of right heart catheterization and can be used to noninvasively evaluate the severity of chronic thromboembolic pulmonary hypertension and, potentially, to follow up the treatment response.

Comparison of gadolinium-enhanced magnetic resonance imaging with ultrasound in evaluation of cesarean scar pregnancy.

AIM: The aim of this study was to evaluate the validity of gadolinium-enhanced magnetic resonance imaging (MRI) in diagnosing cesarean scar pregnancy (CSP) and to compare this with ultrasound results. MATERIAL AND METHODS: Forty-two consecutive patients underwent both gadolinium-enhanced MRI and ultrasound to evaluate CSP before treatment from May 2010 to September 2013. The results of both MRI and ultrasound were reviewed and compared to each other with diagnosis of CSP confirmed by pathological findings and clinical outcome. RESULTS: MRI and ultrasound were performed in all 42 patients, with ultrasound performed more than twice in 29 cases. Pathological findings confirmed CSP in all 42 patients, 41 of whom were diagnosed correctly using MRI, with one misdiagnosed as uterine fibroid. Misdiagnosis occurred in seven cases in the first ultrasound, and report was inconclusive in one case. However, correct and definite diagnosis was achieved in repeated ultrasound in seven of the eight cases. The case misdiagnosed as uterine fibroid using MRI was also misdiagnosed as blood clot by ultrasound. The specificity of MRI in diagnosing CSP was 97.6% (41/42) versus 81% (34/42) of the initial ultrasound (P < 0.05). No contrast-agent-related complications occurred in our series. CONCLUSIONS: Gadolinium-enhanced MRI is highly specific in the diagnosis of CSP. Ultrasound is relatively less specific when initially performed, but it can be repeated conveniently, with specificity greatly improved. Repeated ultrasound is as specific as MRI in confirming diagnosis of CSP.

The use of contrast-enhanced magnetic resonance imaging to diagnose cesarean scar pregnancies.

OBJECTIVE: To evaluate whether contrast-enhanced magnetic resonance imaging (MRI) could be used as a routine method for diagnosing cesarean scar pregnancy (CSP). METHODS: A retrospective study was performed, with review and analysis of medical records, ultrasonography results, MRI results, and clinical outcomes of 44 women with CSP admitted to Beijing Chaoyang Hospital, Beijing, China, between May 2010 and November 2013. The women initially underwent ultrasonography followed approximately 5 days later by contrast-enhanced MRI. RESULTS: CSP was accurately diagnosed in 42 cases (95.5%) using contrast-enhanced MRI compared with 39 cases (88.6%) using ultrasonography (P<0.05). Two cases with a heterogeneous signal intensity pattern using MRI were initially misdiagnosed as a uterine leiomyoma and a trophoblastic tumor. No contrast agent-related complications occurred. The typical findings of a gestational sac embedded in the anterior lower part of the uterus in the sagittal T2-weighted views were identified in all the patients. All patients recovered well without experiencing major morbidity after treatment. CONCLUSION: Contrast-enhanced MRI could be used as a reliable adjunct and initial imaging modality for diagnosing CSP in select cases. The imaging features of contrast-enhanced MRI may result in a more accurate diagnosis before specific treatment for CSP.

Percutaneous transhepatic biliary stenting in patients with intradiverticular papillae and biliary strictures caused by ampullary carcinoma: A case report.

Endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy is a well-established procedure for the treatment of bile duct strictures. However, the procedure is difficult to perform in patients with intradiverticular papillae or tumor infiltration of the major papilla. Percutaneous transhepatic biliary stenting (PTBS) is commonly used in the management of malignant biliary stricture. The current study reports two cases of PTBS performed to treat malignant obstructive jaundice caused by ampullary carcinoma complicated with intradiverticular papillae. PTBS is potentially a safe technique for this relatively rare condition.

Endovascular management of two episodes of late intraperitoneal hemorrhage following laparoscopic gastrectomy for gastric cancer.

Endovascular treatment for hemorrhagic complications following surgery has recently gained wide acceptance due to its minimal invasiveness compared to surgery. A 56-year-old male patient underwent laparoscopic gastrectomy for gastric cancer. There were two episodes of late intraperitoneal hemorrhage and endovascular treatment was performed. Transcatheter coil embolization of the gastroduodenal artery stump was successful in controlling the bleeding initially; however, hemorrhage recurred 7 days later. Repeated angiography revealed an obvious hemorrhage from the right gastric artery stump and embolization of the hepatic artery proper was performed to achieve immediate hemostasis. The endovascular treatment process was analyzed and the literature on similar situations was reviewed. In the present case, endovascular procedures were performed successfully to control bleeding in two episodes of late intraperitoneal hemorrhage. Angiography is recommended as the first-line modality for late intraperitoneal hemorrhage following laparoscopic gastrectomy and transcatheter coil embolization of the hepatic artery proper is safe and effective in selected cases.

[The value of soft tissue neurogenic tumors in the extremities with 3.0 T magnetic resonance imaging].

OBJECTIVE: To explore the diagnostic value of 3.0T MRI in neurogenic tumor of soft tissue in the extremities. METHODS: The MRI appearance of 17 neurogenic tumors with pathological confirmation was retrospectively analyzed. Various imaging characteristics of tumors were evaluated and different imaging findings were compared. The diagnosis value of each MRI features was evaluated with receiver-operating-characteristics (ROC) analysis. RESULTS: In the benign tumors significant differences between neurilemmoma and neurofibromas were noted for the position (P = 0.044). Heterogenicity on T(2)-weighted fat suppression images was also significant in differentiating between neurilemmoma and neurofibromas ( P = 0.020) . The shape of tumors, maximum length of tumor short diameter, edem around masses, relationship with adjoining fascia had the best discriminatory ability. The ROC analysis yield the area under curve (AUC) of them was 0.967 (P = 0.037), 0.923 (P = 0.048) , 0.981 (P = 0.034) , 0.981 (P = 0.034), respectively. CONCLUSION: If the neurogenic tumors of soft tissue in the extremities had one or several features of these characteristics (irregular margin, big volume, edem around masses, aggressive behavior with adjoining fascia) on 3.0T MRI, they had more possibility to be malignant. T(2)-weighted fat suppression series on 3.0TMRI was very important for discrimination of tumor histological characteristics.

Successful management of splenic artery steal syndrome with hepatic artery stenosis in an orthotopic liver transplant recipient.

BACKGROUND: Splenic artery steal syndrome is an uncommon but serious complication of orthotopic liver transplantation. We report a case of splenic artery steal syndrome with hepatic artery stenosis in a 65-year-old male liver transplant recipient who was successfully managed by hepatic artery stenting and splenic artery embolization in a single procedure. CASE REPORT: A 65-year-old man underwent orthotopic liver transplantation due to alcoholic cirrhosis using a piggyback technique. Relevant parameters were measured. The splenic blood flow was apparently reduced and arterial perfusion of the graft was restored. The patient was still in good condition after 4 months of follow-up. CONCLUSIONS: The success of this strategy indicates that the patency of the hepatic artery should be maintained and the splenic artery should be embolized to assure sufficient blood supply of the graft.