Ezio Lanza

Percutaneous Image-Guided Cryoablation of Breast Cancer: A Systematic Review.

A systematic review of the clinical safety and efficacy of percutaneous breast cancer cryoablation was performed. Of 202 papers screened, seven matched the inclusion criteria. Cryoablation was mainly performed under ultrasound guidance, and on average two cryoprobes were used. Complete local tumor control was noted in 73% of patients (mean follow-up, 8 mo). No major complications were noted. The cosmetic outcome was satisfactory. Breast cancer cryoablation is safe, although local tumor control is suboptimal. The best results are achieved with small (<15 mm) ductal tumors treated by application of multiple cryoprobes.

Transarterial Therapies for Hepatocellular Carcinoma

Background: The treatment of hepatocellular carcinoma (HCC) is still a major health issue because of its increasing incidence and because of the complexity of its management. Transarterial embolization (TAE) and transarterial chemoembolization (TACE) are two widely used locoregional therapies in the treatment of HCC, especially for unresectable intermediate and advanced HCCs. Summary: The modern use of TAE and TACE opens new scenarios for the treatment of unresectable HCC and has yielded interesting results. The present work describes the role of transarterial therapies for HCC and focuses on the different Western and Eastern approaches to the study of response predictors. Key Messages: Recent refinements in interventional radiology techniques and in HCC patient selection have facilitated better local control of the disease. The molecular profiling of HCC to predict the response to TACE and TAE will greatly help clinicians identify the optimum therapy.

Dose absorption in lumbar and femoral dual energy x-ray absorptiometry examinations using three different scan modalities: An anthropomorphic phantom study

The aim of this study was to measure the effective dose on an anthropomorphic phantom undergoing lumbar and femoral dual energy X-ray absorption (DXA) examinations, using 3 different scan modalities (fast-array [FA], array [A], high-definition [HD]), and assess the differences in the lifetime attributable risk (LAR) of cancer due to radiation. An anthropomorphic phantom was used. Thermoluminescent dosimeters were placed over 12 anatomic phantom regions and outside the room (to measure background radiation). Fifty scans on the femur and spine were performed for each mode. The dose relative to a single DXA scan for each dosimeter was measured (mean over the 50 scans) and the background radiation was then subtracted. The equivalent dose per organ was obtained. The total body effective dose was calculated by adding the equivalent doses. We estimated the lifetime dose absorption and LAR for cancer for a male and a female patient undergoing 36 DXA studies (18 lumbar, 18 femoral) every 21 months for 32 years. The effective dose for lumbar scans was FA = 17.79 μSv, A = 32.88 μSv, HD = 31.08 μSv; for femoral scans, FA = 5.29 μSv, A = 9.55 μSv, HD = 7.54 μSv. LAR estimation showed a minimal increase in cancer risk (range 4.55 × 10⁻⁴% [FA, femoral, male] to 4.02 × 10⁻³% [A, lumbar, female]). The lifetime dose absorption and LAR for cancer for a male and a female patient undergoing 36 DXA studies (18 lumbar, 18 femoral) every 21 months for 32 years were 0.756 mSv, 3.82 × 10(-3)% and 0.756 mSv, 5.11 × 10⁻³%, respectively. DXA examinations cause radiation levels that are comparable to the background radiation. Regardless of the scan modality or the anatomic site, a patient undergoing DXA scans for a lifetime has a negligible increased risk of developing cancer.

Endovascular treatment of an anastomotic iliac pseudoaneurysm after surgical aortic repair using a Cardiatis multilayer stent

The Cardiatis multilayer stent (Cardiatis, Isnes, Belgium) is a cobalt, self-expandable bare stent made of two interconnected layers without any covering that allows a pressure decrease and thrombus formation into an aneurysmal sac, while improving laminar flow in the main artery and surrounding vital branches. We report a case of an anastomotic iliac pseudoaneurysm successfully treated with the deployment of a Cardiatis multilayer stent.

Colonic Ischemia, Perforation, and Colectomy after a Complicated Endovascular Embolization for Type II Endoleak with the Use of Cyanoacrylate Glue

one case, postmortem examination revealed a catheter fragment lodged in the valve after the malpositioned catheter had been pulled back at bedside and the tip unknowingly left behind. These events did not result in immediate lethal malfunction; rather, acute alterations in cardiac output eventually progressed to unrecoverable circulatory collapse over the span of 2–5 days. Recognition of catheter or wire entanglement with the artificial valve may allow for immediate retrieval with only transient cardiovascular impairment. It is unclear what the long-term sequelae of such an event would be and whether normal flow dynamics could be restored. This event remains a significant risk that should be mentioned while obtaining informed consent from the patient and during documentation after the procedure. In the right clinical setting, similar transvenous procedures can be offered to patients with a Total Artificial Heart. We chose an A-shaped multipurpose catheter because it is easily torqued and allows directional passage of a wire. This is our standard access catheter for transvenous liver biopsies; however, any similar type of catheter would have sufficed. A stiff exchange wire

Refining the management of patients with hepatocellular carcinoma integrating 11C-choline PET/CT scan into the multidisciplinary team discussion

Objective The aim of this study was to report the impact of 11C-choline PET/CT on the management of patients with hepatocellular carcinoma (HCC) and incorporate into a refined algorithm combining diagnostic imaging and multidisciplinary team (MDT) discussion. Patients and methods From February 2010 to February 2016, the charts of all patients discussed in the liver MDT were revised. Suspected or confirmed HCC lesions or Barcelona Clinic Liver Cancer stages A, B or C with a 11C-choline PET/CT performed in our hospital were included in the analyses. Overall, 73 patients (male : female=59 : 14; median age: 75 years) were enrolled. Forty-two (57%) patients were newly diagnosed, whereas 31 (43%) came to our attention at disease recurrence. Seven (10%) patients were Barcelona Clinic Liver Cancer stage 0, 31 (42%) patients were stage A, 15 (20%) patients were stage B, and 18 (25%) patients were stage C. The reference standards for ultimate imaging validation were either histology or MDT consensus. A minimum follow-up of 6 months was established. Results Overall eight (10%) patients were initially referred for chemotherapy (sorafenib), 43 (59%) for surgery, two (3%) for surgery or transarterial embolization, five (7%) for follow-up only, one (1%) for extrahepatic radiotherapy, seven (10%) for stereotactic body radiation therapy of the liver, six (8%) for transarterial embolization, and one (1%) for liver transplant. After 11C-choline PET/CT and MDT discussion, in seven patients the diagnosis changed, in six patients the treatment was changed, and in nine patients both the diagnosis and the treatment were changed. Overall, in 30% of our patients, the diagnosis or treatment was altered on the basis of our algorithm of management. Conclusion The incorporation of 11C-choline PET/CT into the MDT discussion altered the diagnosis/treatment of one-third of HCC patients. We propose a novel diagnostic algorithm to be refined in referral centers for HCC management.

Iatrogenic Pulmonary Pseudoaneurysm Treated with Percutaneous Coil and Glue Embolization

A 76-year-old female patient experienced recurrent hemoptysis in the first 48 hours after thoracotomy for mitral valve replacement. On multidetector computed tomography (CT), a large lung pseudoaneurysm of the right middle lobe was detected (Fig 1), which showed contrast enhancement similar to that of the aorta. The patient was, therefore, referred to the interventional radiology service to undergo endovascular embolization. Despite selective angiography of multiple bronchial arteries, no feeding vessels were detected. Pulmonary angiography (Fig 2) ruled out supply from the pulmonary arteries. Therefore, the pseudoaneurysm was directly punctured with a Chiba needle under fluoroscopic guidance, and a small amount (0.5 mL) of n-butyl cyanoacrylate (NBCA; Glubran 2; GEM, Viareggio, Italy) was injected in the pseudoaneurysm sac. However,

Noncardiac findings in clinical cardiac magnetic resonance: Prevalence in 300 examinations after blind reassessment

Purpose To assess the prevalence of noncardiac findings (NCFs) in a consecutive series of 300 cardiac magnetic resonance (CMR) studies. Methods We retrospectively evaluated CMRs of 192 males and 108 females (42 ± 22 years), comparing findings included in reports to those detected after focused reassessment of CMR images. Noncardiac findings were classified as relevant if additional workup was required. Results We found 19 NCFs, 14 (4.7%) tagged as nonrelevant and 5 (1.7%) as relevant. Images’ reassessment presented 45 NCFs, 26 (8.7%) nonrelevant and 16 (5.3%) relevant (P < 0.003). Conclusions Cardiac magnetic resonance involves the study of areas larger than the heart alone, and NCFs are found in 1 of 7 patients; more than a half of them are not included in the initial CMR report. A small part is relevant, but detection can be unnecessarily stressful and harmful for patients and could increase costs. Risks of overdiagnosis or underreporting are to be taken into account.