Diagnostic and Interventional Radiology最新文献

PURPOSE We aimed to investigate whether the texture analysis and functional magnetic resonance imaging (fMRI) could differentiate rectal cancer pathological stages T1-2 (pT1-2) and T3a (pT3a). METHODS Eighty-two rectal adenocarcinoma patients at stage pT1-2 and pT3a received T2 and fMRI examination before surgery. The latter included apparent diffusion coefficient (ADC) sequence, dynamic contrast enhancement (DCE) MRI, and intravoxel incoherent motion (IVIM) diffusion weighted imaging. Patients were grouped into early stage (pT1-2) and advanced stage (pT3a). The MRI accuracy in diagnosing rectal cancer before surgery was calculated. The differences in clinicopathological variables, quantitative parameters including ADC values, IVIM parameters (perfusion fraction [f], true diffusion coefficient [D], and pseudo- diffusion coefficient [D*]), DCE MRI parameters (transfer constant [Ktrans], reflux constant [Kep], and extravascular extracellular fractional volume [Ve]), and texture features were compared between the groups. Receiver operating characteristic (ROC) curves of texture features and fMRI parameters were generated to distinguish pT1-2 and pT3a tumors. The multivariate analysis was used to develop a predictive model and to find independent risk factors. Hosmer-Lemeshow test was used to see the fitness of the model. DeLong test was applied to compare the ROC curves of different features. Correlation of texture features and fMRI parameters with stage were calculated using r (Spearman's rank correlation coefficient). RESULTS The preoperative accuracy in differentiating pT1-2 from pT3a rectal cancer using MRI was 74.39%. Kep, Ve, and ADC showed significant differences between the groups. Kep and ADC showed negative correlation with stage. Ve correlated positively with stage. Twenty-five texture features from T2 images showed significant differences between groups, and S(0,2)SumOfSqs and WavEnLH_s_2 among these showed better performance, showing negative correlation with stage. The area under the curve (AUC) values of S(0,2)SumOfSqs, WavEnLH_s_2, ADC, Kep, and Ve were 0.721, 0.699, 0.690, 0.666, and 0.653, respectively. The multivariate analysis showed that S(0,2) SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced tumors, and the logistic model built by Kep, Ve, S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has the AUC, sensitivity, and specificity of 0.833, 88.5%, and 73.3%, respectively. ROC curve of the model showed statistical significance between S(0,2)SumOfSqs, ADC, Kep, and Ve. The P value of the Hosmer-Lemeshow test was 0.65. CONCLUSION S(0,2)SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced rectal cancer, and the model built by Kep, Ve, S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has better performance than using a single method. The application of above combinations could be beneficial to patients' accurate and individualized treatments.

Worldwide, breast cancer constitutes the most common malignant neoplasm among females, impacting 2.1 million women annually. Interventional oncology techniques have been recently added as an additional therapeutic and palliative alternative in breast cancer metastatic disease, concerning mainly osseous, liver, and lung metastasis. In the current literature, there are reports of promising results and documented efficacy regarding the ablation of liver and lung metastasis from breast carcinoma, transarterial embolization or radioembolization, as well as the treatment of osseous metastatic disease. These literature studies are limited by the heterogeneity of breast cancer disease, the evaluation of variable different parameters, as well as the retrospective nature in most of the cases. Consequently, dedicated prospective series and randomized studies are required to identify the role of minimally invasive local therapies of interventional oncology armamentarium. The present review paper focuses upon the current role of interventional oncology techniques for the curative or palliative treatment of metastatic breast cancer disease. The purpose of this review paper is to present the current minimally invasive procedures in the treatment of metastatic breast disease, including local control rates and survival rates.

PURPOSE The aim of the study was to radiolabel, characterize, and perform in vitro and in vivo assessment of Technetium-99m (Tc-99m) tamoxifen for screening ER expressing lesions in breast cancer patients. METHODS In this study, tamoxifen has been radiolabeled with Tc-99m via Tc-99m-tricarbonyl core. The characterization and quality control tests of Tc-99m-tamoxifen were performed. In vitro recep- tor binding and blocking studies were performed in both positive control (MCF-7) and negative control cell lines (MDA-MB-231). Normal biodistribution studies were performed in female Wistar albino rats. The pilot clinical studies were performed in 4 ER-expressing breast cancer patients. Of the 4 patients, 1 was on tamoxifen therapy. All 4 patients had also undergone Fluorine-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography/computed tomography. RESULTS Tamoxifen was radiolabeled with Tc-99m via Tc-99m-tricarbonyl core with more than 95% radio- chemical yield. Mass spectra showed a peak corresponding to the molecular weight of Tc-99m- tricarbonyl and Tc-99m-tamoxifen. The site of binding of Tc-99m-tricarbonyl with tamoxifen was determined by proton nuclear magnetic resonance. The Tc-99m-tamoxifen showed 30% binding with MCF-7 and only 1%-2% receptor binding with MDA-MB-231 cell lines. Also, the percentage of receptor binding was drastically reduced (up to 72%) when ER was saturated with 50 times the excess molar ratio of unlabeled tamoxifen. In a pilot patient study, Tc-99m-tamoxifen uptake was observed in primary and metastatic lesions. However, no uptake was observed in a patient who was on tamoxifen therapy. The uptake of F-18-FDG was noted in all the patients. CONCLUSION Tamoxifen was radiolabeled with an in-house-synthesized Tc-99m-tricarbonyl core. The radio- labeled complex has been characterized and evaluated for receptor specificity in in vitro and in vivo studies. Also, this is the first clinical study using Tc-99m-tamoxifen for imaging ER. More patients need to be evaluated to further explore the role of Tc-99m-tamoxifen in ER-expressing lesions.

The "gunsight approach" was initially described as the use of overlapping snares and through- and-through puncture of the portal vein and inferior vena cava for the creation of a transcaval portosystemic shunt. This technique can be adapted for the creation of an extra-anatomic chan- nel between any 2 locations where snares can be deployed. We explain the technique, discuss finer technical points, and describe 2 cases where refractory vascular occlusions are crossed using this technique. The first case involves an extensively calcified femoral arterial chronic total occlusion where subintimal tracking past the occlusion is achieved, but luminal re-entry is ham- pered by dense calcific plaque refractory to multiple re-entry devices. The second case involves a chronic venous occlusion along the femoral vein with loss of in-line flow due to prior stenting. In both cases, the gunsight technique was successfully used as a bailout option after standard recanalization techniques were unsuccessful.

PURPOSE Differentiation of incidental adrenal lesions remains a challenge in diagnostic imaging, especially on single-phase portal venous computed tomography (CT) in the oncological setting. The aim of the study was to explore the ability of dual-energy CT (DECT)-based iodine quantification and virtual non-contrast (VNC) imaging and advanced radiomic analysis of DECT for differentiation of adrenal adenomas from metastases. METHODS A total of 46 patients with 49 adrenal lesions underwent clinically indicated staging DECT and magnetic resonance imaging. Median values of quantitative parameters such as VNC, fat frac- tion, and iodine density in DECT images were collected and compared between adenomas and metastases using non-parametric tests. Magnetic resonance imaging, washout CT, and clinical follow-up were used as a reference standard. Diagnostic accuracy was assessed by calculat- ing receiver operating characteristics. A DECT tumor analysis prototype software was used for semiautomatic segmentation of adrenal lesions and extraction of radiomic features. A radiomics prototype was used to analyze the data with multiple logistic regression and random forest clas- sification to determine the area under the curve (AUC). RESULTS The study cohort (60.87% women; mean age: 66.91 ± 12.93 years) consisted of 32 adenomas and 17 metastases. DECT-based VNC imaging (AUC=0.89) and fat quantification (AUC=0.86) differentiate between adrenal adenomas and metastases with high diagnostic accuracy (P < .001). Analysis of radiomic features revealed that DECT features such as VNC imaging and fat fraction (AUC = 0.87-0.89; < .001) and radiomic features such as 90th percentile and total energy (AUC = 0.88-0.93; P < .001) differentiate with high diagnostic accuracy between adrenal adeno- mas and metastases. Random forest classification revealed an AUC of 0.83 for separating adrenal adenomas from metastases. CONCLUSION Virtual non-contrast imaging and fat quantification as well as extraction of radiomic features accurately differentiate between adrenal adenomas and metastases on single-phase oncologic staging DECT.

PURPOSE The purpose of this study is to compare spectral segmentation, spectral radiomic, and single- energy radiomic features in the assessment of internal and common carotid artery (ICA/CCA) stenosis and prediction of surgical outcome. METHODS Our ethical committee-approved, Health Insurance Portability and Accountability Act (HIPAA)- compliant study included 85 patients (mean age, 73 ± 10 years; male : female, 56 : 29) who under- went contrast-enhanced, dual-source dual-energy CT angiography (DECTA) (Siemens Definition Flash) of the neck for assessing ICA/CCA stenosis. Patients with a prior surgical or interventional treatment of carotid stenosis were excluded. Two radiologists graded the severity of carotid ste- nosis on DECTA images as mild (<50% luminal narrowing), moderate (50%-69%), and severe (>70%) stenosis. Thin-section, low- and high-kV DICOM images from the arterial phase acquisi- tion were processed with a dual-energy CT prototype (DTA, eXamine, Siemens Healthineers) to generate spectral segmentation and radiomic features over regions of interest along the entire length (volume) and separately at a single-section with maximum stenosis. Multiple logistic regressions and area under the receiver operating characteristic curve (AUC) were used for data analysis. RESULTS Among 85 patients, 22 ICA/CCAs had normal luminal dimensions and 148 ICA/CCAs had luminal stenosis (mild stenosis: 51, moderate: 38, severe: 59). For differentiating non-severe and severe ICA/CCA stenosis, radiomic features (volume: AUC=0.94, 95% CI 0.88-0.96; section: AUC=0.92, 95% CI 0.86-0.93) were significantly better than spectral segmentation features (volume: AUC = 0.86, 95% CI 0.74-0.87; section: AUC = 0.68, 95% CI 0.66-0.78) (P < .001). Spectral radiomic features predicted revascularization procedure (AUC = 0.77) and the presence of ipsilateral intra- cranial ischemic changes (AUC = 0.76). CONCLUSION Spectral segmentation and radiomic features from DECTA can differentiate patients with differ- ent luminal ICA/CCA stenosis grades.

Stenting of the gastric outlet is an accepted method for palliation of symptoms secondary to inoperable malignancy and is successful in most cases. Failure of stenting is most commonly due to inability to cross the stricture. We describe a rendezvous technique of duodenal stenting via transhepatic biliary access when conventional endoscopic or fluoroscopic methods fail.

PURPOSE We aimed to evaluate the safety and efficacy of 12 mm diameter polytetrafluoroethylene (PTFE)- covered stents for the creation of transjugular intrahepatic portosystemic shunt (TIPS) in cir- rhotic patients with portal hypertension complicated by variceal bleeding and volume-overload. METHODS This retrospective study included 360 patients who had TIPS created between January 2004 and December 2017 using 12 mm diameter PTFE-covered stents. Demographic data, model for end- stage liver disease (MELD) score, etiology of cirrhosis, and Charlson comorbidity index were recorded. Symptoms of hepatic encephalopathy (HE), variceal re-bleeding, improvement in vol- ume-overload, TIPS revisions and the need for intervention, and overall survival were assessed. RESULTS The mean age of the patients was 56.8 ± 9.9 years, and the technical success rate was 99.4%. The rates of improvement of volume-overload post-TIPS were 59.5%, 69.8%, and 81.7% at 3, 6, and 12 months, respectively. About 93.3% of patients were free from paracentesis or thoracentesis at 12 months. The rates of re-bleeding post-TIPS were 4%, 12%, and 12.9% at 3, 6, and 12 months, respectively. The rate of TIPS revision at 12 months was 6.5%. Percentage of patients with any symptoms of HE were 34.4%, 42.9%, and 49.5% at 3, 6, and 12 months, respectively. All HE were appropriately medically managed and no patients required a TIPS reduction. CONCLUSION TIPS placement using 12 mm PTFE-covered stents is efficacious in cirrhotic patients with portal hypertension complicated by variceal bleeding or refractory volume-overload, with an accept- able safety profile.

PURPOSE This study aimed to evaluate the use of stone density variation coefficient (SDVC) as an indicator of stone heterogeneity and previously reported parameters for predicting extracorporeal shock wave lithotripsy (ESWL) outcome in urinary calculi. Moreover, a new formula that could be used to predict ESWL success was suggested. METHODS A total of 850 patients, who underwent the first session of ESWL for urinary stones between 2015 and 2020, were examined, and 220 eligible patients were included in the study. Stone density variation coefficient and other parameters associated with stone attenuation values and stone size parameters were studied as potential predictors based on noncontrast com- puted tomography (NCCT). Extracorporeal shock wave lithotripsy success was considered after 3 months by radiography or NCCT. Logistic regression analysis was performed to determine the factors contributing to treatment success. RESULTS For the 220 patients, ESWL success rate was 39.5%. The receiver operating characteristic analysis showed that SDVC (AUC=0.82; 95% confidence interval [CI]: 0.76-0.87; P < .001), mean stone density (AUC=0.81; 95% CI:0.75-0.87; P < .001), maximum stone density (AUC=0.70; 95% CI: 0.63-0.78; P < .001), stone volume (AUC=0.70; 95% CI: 0.62-0.77; P < .001), and major diam- eter (AUC=0.67; 95% CI: 0.59-0.74; P < .001) had significant prediction accuracy from high to low. Additionally, SDVC was found to be successful in predicting ESWL success, especially for patients with high mean stone density (OR = 10; 95% CI: 3.55-28.57; P < .001). The logistic regres- sion model, in which the "stone disintegration probability" (SDP) formula was found, correctly predicted ESWL success with a single session by 79.1%. CONCLUSION In conclusion, size and attenuation values were predictors of treatment success, and the best predictor was SDVC. Evaluation of SDP formula prior to ESWL could predict treatment outcomes and facilitate the decisions regarding treatment strategies.