Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization.

PURPOSE: Impact of pre-interventional magnetic resonance angiography (MRA) on prostatic artery embolization (PAE) regarding workflow, radiation dose, and clinical outcome. METHOD: Retrospective evaluation of 259 patients (mean age 68 ± 9, range 41-92) with benign prostatic hypertrophy (BPH) undergoing PAE between January 2017 and December 2020. MRA was performed in 137 cases. In 122 patients, no pre-interventional MRA was performed. Origin of the PA, volumetry of the prostatic gland and ADC values were evaluated. International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) were evaluated before and after PAE. RESULTS: Origin of the PA was identified in all cases. Significant differences regarding volume reduction (-20 ± 13 ml with MRA vs -17 ± 9 ml without MRA) and ADC value reduction were found (-78 ± 111 10-6 mm2/s with MRA vs -45 ± 99 10-6 mm2/s without MRA). PAE workflow was modified in 16 patients due to MRA findings. Radiation dose (5518.54 ± 6677.97 µGym2 with MRA vs 23963.50 ± 19792.25 µGym2 without MRA) and fluoroscopy times (19.35 ± 9.01 min. with MRA vs 27.45 ± 12.54 min. without MRA) significantly differed. IPSS reduction improved (-11 ± 8 points with MRA vs -7 ± 9 points without MRA, p < 0.001), while QOL (-2 ± 1 points with MRA and -2 ± 2 points without MRA) and IIEF (+2 ± 10 points with MRA and +1 ± 11 points without MRA) showed no significant differences (p > 0.05). CONCLUSIONS: Pre-interventional MRA facilitates improved workflow and patient safety of PAE while reducing radiation dose and intervention time.

Feasibility of diffusion-weighted magnetic resonance imaging in evaluation of early therapeutic response after CT-guided microwave ablation of inoperable lung neoplasms.

OBJECTIVE: To determine the early treatment response after microwave ablation (MWA) of inoperable lung neoplasms using the apparent diffusion coefficient (ADC) value calculated 24 h after the ablation. MATERIALS AND METHODS: This retrospective study included 47 patients with 68 lung lesions, who underwent percutaneous MWA from January 2008 to December 2017. Evaluation of the lesions was done using MRI including DWI sequence with ADC value calculation pre-ablation and 24 h post-ablation. DWI-MR was performed with b values (50, 400, 800 mm2/s). The post-ablation follow-up was performed using chest CT and/or MRI within 24 h following the procedure; after 3, 6, 9, and 12 months; and every 6 months onwards to determine the local tumor response. The post-ablation ADC value changes were compared to the end response of the lesions. RESULTS: Forty-seven patients (mean age: 63.8 ± 14.2 years, 25 women) with 68 lesions having a mean tumor size of 1.5 ± 0.9 cm (range: 0.7-5 cm) were evaluated. Sixty-one lesions (89.7%) showed a complete treatment response, and the remaining 7 lesions (10.3%) showed a local progression (residual activity). There was a statistically significant difference regarding the ADC value measured 24 h after the ablation between the responding (1.7 ± 0.3 × 10-3 mm2/s) and non-responding groups (1.4 ± 0.3 × 10-3 mm2/s) with significantly higher values in the responding group (p = 0.001). A suggested ADC cut-off value of 1.42 could be used as a reference point for the post-ablation response prediction (sensitivity: 66.67%, specificity: 84.21%, PPV: 66.7%, and NPV: 84.2%). No significant difference was reported regarding the ADC value performed before the ablation as a factor for the prognosis of treatment response (p = 0.86). CONCLUSION: ADC value assessment following ablation may allow the early prediction of treatment efficacy after MWA of inoperable lung neoplasms. KEY POINTS: • ADC value calculated 24 h post-treatment may allow the early prediction of MWA efficacy as a treatment of pulmonary tumors and can be used in the early immediate post-ablation imaging follow-up. • The pre-treatment ADC value of lung neoplasms is not different between the responding and non-responding tumors.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.