Fotemustine chemoembolization of hepatic metastases from uveal melanoma: a retrospective single-center analysis.

OBJECTIVE: The purpose of the current study was to retrospectively evaluate response and survival in patients with hepatic metastasis from uveal melanoma treated by palliative transarterial chemoembolization (TACE) with fotemustine. MATERIALS AND METHODS: During the study period, 21 patients with hepatic metastases from uveal melanoma were treated by TACE. A series of TACE interventions (mean number per patient, 3.29 interventions; range, 1-6 interventions) was performed on each patient with an emulsion of fotemustine dissolved in 10 mL of saline mixed with 10 mL of an oily contrast agent. Tumor response based on the Response Evaluation Criteria in Solid Tumors was evaluated using contrast-enhanced CT scans obtained 6-10 weeks after embolization. RESULTS: CT showed partial regression after TACE in three patients (14%). Six patients (29%) presented with stable disease but no significant change in tumor size after TACE, and 12 patients (57%) presented with progressive disease after TACE treatment. The overall response rate was 43%. The mean survival after diagnosis of hepatic metastasis was 28.7 months. CONCLUSION: TACE of hepatic metastasis from uveal melanoma with fotemustine is well tolerated, and the survival rates in this study (mean, 28.7 months) are among the longest reported.

Computed tomography angiography of the carotid arteries at low kV settings: a prospective randomised trial assessing radiation dose and diagnostic confidence.

OBJECTIVE: To assess radiation dose and diagnostic image quality of a low-dose (80 kV) versus a standard-dose (120 kV) protocol for computed tomography angiography (CTA) of the supra-aortic arteries. METHODS: 64-slice CTA of the supra-aortic arteries was performed in 42 consecutive patients using randomly either 80 or 120 kV at 300 absolute mAs. Intravascular attenuation values, contrast-to-noise (CNR) and signal-to-noise ratio (SNR) measurements were performed at three levels. Two readers assessed image quality by using a four-point scale. The effective dose (ED) was calculated to assess the differences in radiation exposure. RESULTS: Intravascular attenuation values at 80 kV were higher in the common carotid artery, the carotid bifurcation and the internal carotid artery (p < 0.001). CNR and SNR differed at the internal carotid artery, with higher values in the 80-kV group (p > 0.05). Both readers revealed a significantly better image quality at 120 kV only at the common carotid artery (p < 0.001; p = 0.007). Mean ED was significantly lower at 80-kV (1.23 ± 0.09 vs. 3.99 ± 0.33 mSv; p < 0.001). CONCLUSION: Tube voltage reduction to 80 kV in CTA of the supra-aortic arteries allows for significant radiation dose reduction but has limitations at the level of the common carotid artery.

Pre-operative serum C-reactive protein as independent prognostic factor for survival but not infection in patients with high-grade osteosarcoma.

PURPOSE: The purpose of this study was to investigate (a) whether pre-operative serum CRP is a predictor of survival in patients with high-grade osteosarcoma, (b) whether post-operative infection is a predictor of survival in these patients and (c) whether CRP is a predictor of post-operative infection, and especially deep prosthetic infection. METHODS: In this retrospective single-centre study, pre-operative serum CRP levels in 79 patients (37 females, 42 males; average age, 18 years; mean follow-up, 46 months) undergoing resection of an osteosarcoma were correlated with clinical data and survival. RESULTS: The mean pre-operative serum CRP level of all 79 patients was 0.53 mg/dl (SD, 1.27 mg/dl). Patients dying of their underlying disease had significantly higher CRP levels compared to patients surviving throughout the follow-up period (1.09 mg/dl ± 2.02 mg/dl versus 0.32 mg/dl ± 0.75 mg/dl, respectively; p = 0.015). CRP levels were significantly correlated with survival (Pearson's correlation coefficient = -0.25; p = 0.026) and histological subtype (Pearson's correlation coefficient = -0.42; p < 0.001), but not with sex, age, histological response, tumour size or metastatic disease. In uni- and multivariate survival analysis, age, response to chemotherapy and serum CRP were associated with disease-specific survival. Patients with a CRP level over 1 mg/dl had a significantly lower disease-specific five-year survival of 36.7% compared to 73.8% in patients with normal CRP values (p = 0.020). Infection was not correlated with disease-specific survival. Pre-operative serum CRP levels were not correlated with post-operative infection or deep prosthetic infection. CONCLUSIONS: Pre-operative serum CRP seems to be an independent predictor of survival in patients with high-grade osteosarcoma. Further studies are needed to confirm these results on a large-scale basis.

Perceptibility and quantification of in-stent stenosis with six peripheral arterial stent types in vitro: comparison of 16-MDCT angiography, 64-MDCT angiography, and MR angiography.

OBJECTIVE: The purpose of this study was to evaluate and compare the perceptibility of 75% and 95% in-stent stenoses with CT angiography and MR angiography using six stent types in a phantom model. MATERIALS AND METHODS: Six different stent types were placed into tubes filled with contrast agent (ioversol or gadoteric acid), and nylon cylinders (8 mm diameter) bored in the central axis (2 and 4 mm) to mimic 75% and 95% stenoses were inserted into the stents inside the tubes. CT angiography (16- and 64-MDCT scanners using three different kernels at 120 and 140 kV) and MR angiography (1.5 T) were performed. On 2-mm coronal sections, signal intensities in the stenosed stents were compared with unstenosed segments. In addition, perceptibility of the residual lumen was assessed using a subjective score. Image analysis was performed by two experienced and blinded radiologists. RESULTS: Sixteen-slice CT angiography showed relative in-stent signal intensities of 72-87%, whereas 64-MDCT angiography showed relative in-stent signal intensities of 63-99%. Sixty-four-slice CT angiography showed nearly no difference between 75% and 95% stenoses in the subjective scores. The high-contrast kernel was superior to intermediate- and low-contrast kernels. MR angiography showed relative in-stent signal intensities of 57-98%. The presence of localized artifacts and resulting inhomogeneous luminal signal caused lower subjective perceptibility ratings than the objective score would suggest. CONCLUSION: CT angiography was superior in the differentiation between 95% stenoses and occlusions. 64-MDCT angiography was superior to 16-MDCT (mean +/- SD, 83.0 +/- 2.9 vs 78.3 +/- 3.3; p = 0.006), especially with high-contrast kernels (89.7 +/- 2.1 vs 78.3 +/- 3.3; p = 0.001). For detection of 75% stenoses, MR angiography seems to be suitable subjectively, even though no statistical significance was found.

Endovascular repair of the descending aorta and the aortic arch with the Relay stent graft.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of thoracic endovascular aortic repair with a newly designed Relay thoracic stent graft (Bolton Medical, Sunrise, FL). DESCRIPTION: Between 2005 and 2007, 22 patients (71.8 +/- 8.5) received 24 stent grafts. Indications were aneurysms (n = 13), penetrating atherosclerotic ulcers (n = 7), and dissections (n = 2). Due to the proximity of the lesions to the aortic arch, rerouting procedures (ie, subclavian transposition [n = 1], double transposition [n = 12], and total arch rerouting [n = 6] were performed pre-interventionally; three patients did not undergo rerouting). All patients were followed-up with a computed tomographic scan of the entire aorta at discharge, 3 months, 6 months, and annually thereafter (mean follow-up, 13 months). EVALUATION: Primary technical success was obtained in 20 of 22 patients, with one persisting type I endoleak and one asymptomatic type II endoleak. One patient died due to malignant arrhythmia 3 days after stent-graft placement. During follow-up, 1 nonaortic related death was observed. No additional endoleaks were observed. Finally, all supra-aortic rerouting procedures remained patent. CONCLUSIONS: In the treatment of degenerative disease of the descending aorta and the aortic arch, the Bolton Relay stent graft offers acceptable efficacy and safety in short-term follow-up.

Breast Cancer Treatment in the Era of Molecular Imaging.

Molecular imaging employs molecularly targeted probes to visualize and often quantify distinct disease-specific markers and pathways. Modalities like intravital confocal or multiphoton microscopy, near-infrared fluorescence combined with endoscopy, surface reflectance imaging, or fluorescence-mediated tomography, and radionuclide imaging with positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are increasingly used for small animal high-throughput screening, drug development and testing, and monitoring gene therapy experiments. In the clinical treatment of breast cancer, PET and SPECT as well as magnetic resonance-based molecular imaging are already established for the staging of distant disease and intrathoracic nodal status, for patient selection regarding receptor-directed treatments, and to gain early information about treatment efficacy. In the near future, reporter gene imaging during gene therapy and further spatial and qualitative characterization of the disease can become clinically possible with radionuclide and optical methods. Ultimately, it may be expected that every level of breast cancer treatment will be affected by molecular imaging, including screening.

Quantification and detectability of in-stent stenosis with CT angiography and MR angiography in arterial stents in vitro.

OBJECTIVE: The purpose of this study was to compare CT angiography (CTA) and MR angiography (MRA) for the detectability of 75% and 95% stenoses in phantoms using six different stents. MATERIALS AND METHODS: Six different stents (Expander, Hemobahn, SelfX, Smart, Symphony, and Wallstent) were inserted into tubes filled with contrast agent (ioversol or gadoteric acid). To mimic stenoses of 75% and 95% of the patent lumen, 8-mm-diameter nylon cylinders were bored in the central axis (2 mm and 4 mm, respectively) and placed into the stent lumen. Intensity profiles across stenoses on 2-mm coronal reformatted sections of CTA or MRA were compared, and the detectability of the residual lumen was assessed using a subjective score. RESULTS: CTA showed relative in-stent signal attenuation for the in-stent stenoses of the tested stents ranging from 75% to 100% of the signal intensity of the control. SelfX and Symphony showed further shading of the residual lumen due to beam-hardening artifacts. Overestimation of stenosis was associated with low-grade stenoses in which the border of the lumen was closer to the stent struts. MRA showed relative in-stent signal attenuation of the in-stent stenoses ranging from 30% to 100% of the signal intensity of the control. Strut thickness tended to correlate with higher attenuation at CT. CONCLUSION: CTA may be more suitable for differentiation between 95% stenosis and occlusion; MRA has higher sensitivity in detecting 75% stenoses. Strut thickness and mesh size did not prove to be significant predictors for signal attenuation or overall image quality.