Treatment of a hemorrhage secondary to nephrostomy tube placement for derivation of monstrous hydronephrosis in upper tract urothelial carcinoma.

A 85-year-old female patient underwent nephrostomy tube insertion for a huge hydronephrosis due to a papillary mass involving the right ureteral ostium diagnosed by at computed tomography scan. As soon as the nephrostomy tube was inserted, a pulsatile bleeding was found and a renal angiography was done. A massive bleeding from the main and unique right renal artery was found such as to require prompt endovascular embolization. A transurethral resection of the bladder was performed and the pathology report confirmed high-grade pTa transitional cell carcinoma. An open drainage was then placed to empty the contents of the pyelocalyceal system of the kidney. Once obtained the volumetric reduction of the abdominal mass the patient underwent the right nephroureterectomy.

CIRSE Standards of Practice on Thermal Ablation of Liver Tumours.

This CIRSE Standards of Practice document reviews current literature and provides best practices for image guided thermal ablation of liver tumours, including radiofrequency, microwave and cryoablation techniques.

Radiomics of cholangiocarcinoma on pretreatment CT can identify patients who would best respond to radioembolisation.

OBJECTIVES: Results after trans-arterial radioembolisation (TARE) for intrahepatic cholangiocarcinoma (iCC) depend on the architecture of the tumour. This latter can be quantified through computed tomography (CT) texture analysis. The aims of the present study were to analyse relationships between CT textural features prior to TARE and objective response (OR), progression-free survival (PFS), and overall survival (OS). METHODS: Texture analysis was retrospectively applied to 55 pre-TARE CT scans of iCCs, focusing attention on the histogram-based features and the grey-level co-occurrence matrix (GLCM). Texture features were harmonised using the ComBat procedure. Objective response was assessed using the Response Evaluation Criteria In Solid Tumours 1.1. The least absolute shrinkage and selection operator (LASSO) method was applied to select the most useful textural features related to OR. RESULTS: Of the 55 patients, 53 had post-TARE imaging available, showing OR in 56.6% of cases. Texture analysis showed that iCCs showing OR after TARE had a higher uptake of iodine contrast in the arterial phase (higher mean histogram values, p < 0.001) and more homogeneous distribution (lower kurtosis, p = 0.043; GLCM contrast, p = 0.004; GLCM dissimilarity, p = 0.005, and higher GLCM homogeneity, p = 0.005; and GLCM correlation p = 0.030) at the pre-TARE CT scan. A favourable radiomic signature was calculated and observed in 15 of the 55 patients. The median PFS of these 15 patients was 12.1 months and that of the remaining 40 patients was 5.1 months (p = 0.008). CONCLUSIONS: Texture analysis of pre-TARE CT scans can quantify vascularisation and homogeneity of iCC architecture, providing clinical information useful in identifying ideal TARE candidates. KEY POINTS: • Hypervascular tumours with a more homogeneous uptake of iodine contrast in the arterial phase were those most likely to be effectively treated by TARE. • The arterial phase was observed to be the best acquisition phase for providing information regarding the "sensitivity" of the tumour to TARE. • Patients with favourable radiomic signature showed a median progression-free survival of 12.1 months versus 5.1 months of patients with an unfavourable signature (p = 0.008).

Monitoring of Thermal-Induced Changes in Liver Stiffness During Controlled Hyperthermia and Microwave Ablation in an Ex Vivo Bovine Model Using Point Shear Wave Elastography.

PURPOSE: To investigate liver stiffness changes-evaluated by point shear wave elastography (pSWE)-in controlled hyperthermia and microwave ablation (MWA) in an ex vivo animal model. MATERIALS AND METHODS: Five samples of ex vivo bovine liver were uniformly heated to temperatures ranging from 40 to 100 °C. B-mode ultrasound imaging and pSWE were acquired simultaneously, and shear wave velocity (SWV) was measured in a region of interest (ROI). The threshold value of SWV at 60 °C (avg60) was identified. Subsequently, MWA was performed in 11 liver samples at 60 W until avg60 + 0.5 m/s was reached. SWV was measured in ROIs at 10-40 mm from the antenna feed. The correlation of mean values of SWV with location (within, border, or outside necrotic area) at gross pathology was evaluated. RESULTS: In controlled hyperthermia experiments, a steep transition in liver stiffness was observed at 63.0 ± 2.4 °C (SWV 3.54 ± 0.68 m/s). Avg60 was of 2.5 m/s. In 8/9 MWA experiments, interrupted when SWV of 3 m/s was measured, the ROI was at the inner side of the necrotic area border at pathology (accuracy 89%). No correlation between SWV values for outside, border, and within necrosis could be identified. CONCLUSIONS: pSWE can provide a velocity threshold predictive of the presence of coagulation necrosis during MWA in ex vivo liver model. However, pSWE is not able to reliably capture changes in stiffness within, at the border, and outside the necrotic zone in this experimental model.