CT-guided aspiration and steroid injection of symptomatic paralabral cysts of the hip.

PURPOSE: The objective of this article is to present the clinical use of aspiration and steroid injection under CT guidance for symptomatic paralabral cysts of the hip. MATERIALS AND METHODS: Four cases of symptomatic paralabral cysts of the hip were treated with aspiration and steroid injection after MR examinations had been performed. The imaging characteristics of the cysts, including the location, size, extracapsular extension, and associated labral tears, were evaluated. Under CT guidance, an 18-gauge spinal needle punctured the cyst, and aspiration was performed using local anesthesia. After irrigation with 50 % diluted iodine contrast material, steroid alone or a mixture of steroid and 1 % lidocaine was injected into the cyst. CT images during and after the procedure, procedural reports, and medical records were reviewed for analysis. RESULTS: Three cysts were located in the anteroinferior region, while one cyst was located in the posterior region. At the 1-month follow-up, symptom improvement had been achieved in all four patients. However, in the patient who had the largest cyst with extracapsular extension, symptoms recurred after 5 months, and the patient underwent surgery. CONCLUSION: CT-guided aspiration and steroid injection were feasible for the treatment of symptomatic paralabral cysts of the hip. During the procedures, all four cysts collapsed.

Quantitative CT variables enabling response prediction in neoadjuvant therapy with EGFR-TKIs: are they different from those in neoadjuvant concurrent chemoradiotherapy?

BACKGROUND AND PURPOSE: To correlate changes of various CT parameters after the neoadjuvant treatment in patients with lung adenocarcinoma with pathologic responses, focused on their relationship with different therapeutic options, particularly of EGFR-TKI and concurrent chemoradiation therapy (CCRT) settings. MATERIALS AND METHODS: We reviewed pre-operative CT images of primary tumors and surgical specimens obtained after neoadjuvant therapy (TKI, n = 23; CCRT, n = 28) from 51 patients with lung adenocarcinoma. Serial changes in tumor volume, density, mass, skewness/kurtosis, and size-zone variability/intensity variability) were assessed from CT datasets. The changes in CT parameters were correlated with histopathologic responses, and the relationship between CT variables and histopathologic responses was compared between TKI and CCRT groups. RESULTS: Tumor volume, mass, kurtosis, and skewness were significant predictors of pathologic response in CCRT group in univariate analysis. Using multivariate analysis, kurtosis was found to be independent predictor. In TKI group, intensity variability and size-zone variability were significantly decreased in pathologic responder group. Intensity variability was found to be an independent predictor for pathologic response on multivariate analysis. CONCLUSIONS: Quantitative CT variables including histogram or texture analysis have potential as a predictive tool for response evaluation, and it may better reflect treatment response than standard response criteria based on size changes.

Value of diffusion-weighted imaging at 3 T for prediction of extracapsular extension in patients with prostate cancer: a preliminary study.

OBJECTIVE: The purpose of this study was to retrospectively investigate the value of adding diffusion-weighted imaging (DWI) to T2-weighted imaging for the prediction of extracapsular extension (ECE) in patients with prostate cancer, as well as to compare apparent diffusion coefficients (ADCs) between patients with and without ECE. MATERIALS AND METHODS: Seventy-six patients with suspected prostate cancer underwent T2-weighted imaging and DWI at 3 T using a phased-array coil, followed by radical prostatectomy. For prediction of ECE, the prostate was divided into six sectors. Two experienced radiologists analyzed T2-weighted images alone and in combination with DWI in consensus and rated the likelihood of ECE on a five-point scale. Tumor ADC values were measured, and the results were compared between patients with and without ECE. RESULTS: Of the 456 sectors studied, 74 (16%) were positive for ECE in 31 patients. For prediction of ECE, the specificity and accuracy of combined T2-weighted imaging and DWI were 94.5% and 91.7%, respectively, superior to those of T2-weighted imaging alone (87.2% and 81.2%, respectively) (p < 0.001). On receiver operating characteristic analysis, the area under the curve (Az) of combined T2-weighted imaging and DWI (Az = 0.900) was significantly greater than that of T2-weighted imaging alone (Az = 0.828) (p < 0.001). The mean tumor ADC values were significantly lower in patients with ECE than patients without ECE (p < 0.001). CONCLUSION: DWI at 3 T in addition to T2-weighted imaging improves the ability to predict ECE in patients with prostate cancer. Furthermore, tumor ADC values in patients with and without ECE are significantly different.

Fusion imaging-guided radiofrequency ablation for hepatocellular carcinomas not visible on conventional ultrasound.

OBJECTIVE: The objective of our study was to assess whether fusion imaging of conventional ultrasound and liver CT or MR images can improve the conspicuity of lesions and feasibility of percutaneous radiofrequency ablation (RFA) for the treatment of hepatocellular carcinomas (HCCs) not visible on ultrasound. Whether peritumoral anatomic landmarks can be used for the placement of an electrode in HCCs not visible on ultrasound even after image fusion was also evaluated. MATERIALS AND METHODS: Planning ultrasound for percutaneous RFA was performed using conventional ultrasound first and then using fusion imaging later during the same session. The visibility of HCCs and feasibility of RFA on conventional ultrasound and on fusion imaging were assessed. We evaluated how many HCCs initially not visible on conventional ultrasound could be visualized and ablated after applying the fusion imaging technique. One hundred twenty HCCs not visible on conventional ultrasound in 96 patients were included. RESULTS: When fusion imaging was applied, 38 of the 120 (31.7%) HCCs that were initially not visible could be seen and RFA was feasible. Among the remaining 82 HCCs still not visible after image fusion, 26 (31.7%) were ablated under the guidance of fusion imaging the technique based on peritumoral anatomic landmarks. Overall, 64 of 120 (53.3%) HCCs (59.4%, 57 of 96 patients) not visible on conventional ultrasound could be ablated under the guidance of the fusion imaging technique. CONCLUSION: Fusion imaging can improve the conspicuity of HCCs and the feasibility of percutaneous RFA of HCCs not visible on conventional ultrasound. Peritumoral anatomic landmarks can be used for electrode placement in HCCs that are still not visible even after image fusion.

Cribriform-morular variant of papillary thyroid carcinoma: ultrasonographic and clinical characteristics.

BACKGROUND: The cribriform-morular variant of papillary thyroid carcinoma (cmvPTC) is rare. There are few if any studies of the ultrasonographic (US) features of cmvPTC. The aim of this study was to determine the characteristic US and clinical features of the cmvPTC. METHODS: A retrospective review of the US and clinical features was performed on 18 surgically confirmed cmvPTCs in five patients who were seen at our institution between January 2000 and December 2010. RESULTS: All patients were female with a mean age of 28 years (range, 19-46 years). Two patients presented with palpable lesions, and the other patients were incidentally detected during screening US. On US, the majority of nodules had well-defined, oval to round shapes, and were hypoechoic and solid without calcifications. However, 6 (33.3%) of 18 nodules did have a cystic change. The size of the lesions varied from 0.3 to 3.0 cm (mean, 1.11 cm). None of the nodules were diagnosed as malignant based on the US criteria, but all except one patient had a cytology of their thyroid nodules that was read as malignant, without revealing the subtype of their PTC. Two of the five patients had familial adenomatous polyposis (FAP), and they had bilateral multiple nodules. No metastatic lymph nodes or extrathyroidal extension were identified. To date, none of the patients has had recurrence or metastasis during their mean follow-up of 25 months after thyroidectomy. CONCLUSION: It appears that most cases of cmvPTC do not have features of malignancy on US and that they are indolent tumors as far as their clinical and histological features are concerned.