Paolo Cabassa

Radiofrequency Ablation of Hepatocellular Carcinoma: Long-Term Experience with Expandable Needle Electrodes

OBJECTIVE Our objective was to determine the efficacy of radiofrequency ablation, using expandable electrodes, in the treatment of patients with hepatocellular carcinoma (HCC). SUBJECTS AND METHODS In a 5-year period (1998-2003), 68 HCCs in 59 patients (age range, 47-88 years) were treated percutaneously with radiofrequency ablation using expandable needle electrodes. The mean lesion diameter was 3.1 cm (range, 1-12 cm). Fifty-one of 59 patients were in Child-Pugh class A, and eight were in class B. Follow-up was performed by helical CT at 1, 4, and 6 months and every 6 months after that. The mean follow-up was 24.1 months (range, 6-60 months). Survival and disease-free survival rates were evaluated separately by statistical analysis. Any complications were reported during follow-up. RESULTS Cumulative survival rates were 94.4%, 65%, and 43.1% at 1, 3, and 5 years, respectively. Median survival time was 23.6 months (range, 4-62 months). Maximum tumor diameter was associated with the probability of survival: 73% among patients with lesion diameters of 3 cm or less, 76.5% among patients with lesion diameters of 3-5 cm, and only 40% among patients with lesion diameters of more than 5 cm (p = 0.05, log-rank test; p = 0.07, Tarone-Ware test). In 34 (57.6%) of 59 patients during follow-up, new nodules noncontiguous with the treated nodule developed in the liver (tumor recurrences). Median disease-free survival rates were 32.1%, 28.1%, and 17.5% at 1, 2, and 3 years, respectively. One major complication occurred (hemoperitoneum that required transfusion). CONCLUSION Radiofrequency ablation with expandable electrodes is safe and effective in the treatment of HCC.

Diagnostic value of hepatocellular nodule vascularity after microbubble injection for characterizing malignancy in patients with cirrhosis.

OBJECTIVE The purpose of this study was to assess the diagnostic value of hepatocellular nodule vascularity after microbubble injection for characterization of malignancy in patients with cirrhosis of the liver. MATERIALS AND METHODS After sulfur hexafluoride-filled microbubble injection, the vascularity of 236 hepatocellular nodules (1-5 cm in diameter) in 215 patients with cirrhosis (151 men, 64 women; mean age, 62 +/- 11 [SD] years) was evaluated by consensus of three reference radiologists. The relation between nodule vascularity in the arterial (10-40 seconds from injection) and portal venous (45 seconds to microbubble disappearance) phases and dimension of malignancy was evaluated by multivariate U statistical analysis. Two blinded independent reviewers using reference criteria classified nodules as benign or malignant after review of unenhanced and contrast-enhanced sonograms. RESULTS The final diagnoses were 96 malignant (84 hepatocellular carcinoma, 12 tumors not hepatocellular carcinoma) and 140 benign nodules (57 regenerative and 13 dysplastic nodules, 70 other benign lesions). Nodule hypervascularity during the arterial phase and hypovascularity during the portal venous phase (odds ratio, 27.78) and nodule diameter greater than 2 cm combined with hypervascularity during the arterial phase and isovascularity or hypervascularity during the portal venous phase (odds ratio, 3.3) were related to the presence of malignancy. Contrast-enhanced sonography improved diagnostic accuracy (unenhanced sonography vs contrast-enhanced sonography, 32% vs 71% for reviewer 1 and 22% vs 66% for reviewer 2; p < 0.05, McNemar test) even though hypervascular nodules 2 cm or smaller (malignant, n = 2; benign, n = 40) that appeared isovascular or hypervascular during the portal venous phase were misclassified. CONCLUSION Assessment of hepatocellular nodule vascularity after microbubble injection allowed characterization of malignancy, but characterization was limited for hypervascular nodules 2 cm or less in diameter.

CT appearance of the larynx after conservative and radical surgery for carcinomas

Abstract. The purpose of this study was to evaluate the normal CT appearance of the larynx after conservative and radical surgery. Postoperative (conservative surgery n = 52, radical surgery n = 21) CT examinations of 73 patients suspected of local/regional recurrence (n = 53) or asymptomatic (n = 20) were retrospectively analysed. The CT findings of 45 patients negative at biopsy were utilised to assess the normal appearance after surgery. Changes in the laryngeal framework represented constant landmarks, whereas the variety of soft tissues resection often resulted in a more unpredictable appearance of the neolarynx. Considerable thickening of the mucosa covering the arytenoid cartilage(s) has been detected after horizontal supraglottic laryngectomy (40 %) or supracricoid laryngectomies (SL; 100 %). A “pseudocord” due to scar tissue appeared to be a constant finding following vertical haemilaryngectomy, frequently after SL. Dilation of a lateral recess of the hypopharynx was observed after SL. This “pharyngeal pouch” had considerable size and air or liquid content. The most frequent CT findings among 28 tumours recurrent after conservative or total surgery were a mass larger than 10 mm spreading beyond the larynx (63.1 %), thickening of anterior commissure (57.9 %), erosion of residual cartilages (16.9 %). Although CT detected one subclinical recurrence, its employment is justified only to assess the submucosal extent of the lesion. This requires a thorough knowledge of normal postoperative findings.

The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature

OBJECTIVE To evaluate the initial experience at our centre in the treatment of monochorionic twin pregnancies complicated by twin reversed arterial perfusion sequence (TRAP), using radiofrequency ablation (RFA) with expandable needles, and to review the existing literature on the subject. STUDY DESIGN Between July 2007 and October 2010, 11 monochorionic twin pregnancies complicated by TRAP were referred to our centre. Seven patients underwent intrafetal ablation of the acardiac twin with RFA using LeVeen™ expandable needle electrodes. Data on the procedures and the obstetric outcome were reviewed, and subsequently we performed a review of the literature on the use of RFA in TRAP. RESULTS Median gestational age at the intervention was 17(+3) weeks (range 14(+1)-23(+1) weeks). Technical success was obtained in all cases. Preterm premature rupture of membranes (PPROMs) occurred in 4/7 (57%) patients. Intrauterine death of the pump twin occurred in one patient at 21(+5) weeks, and one patient opted for termination of pregnancy because of PPROM at 21(+4) weeks. Five fetuses were delivered alive at a median gestational age of 33(+0) weeks (range 31(+0)-39(+5) weeks). All five infants (71%) were alive and had a normal examination at 6 months of age. The review identified 6 studies, for a total of 78 pregnancies (either monochorionc twins or triplets with a monochorionic component). Including our data, overall neonatal survival was 75/88 (85%). CONCLUSION RFA appears to be a relatively safe and reliable technique in the treatment of TRAP sequence pregnancies. Further research is needed to define the best timing of the procedure.

Epstein–Barr Virus–Associated Adrenal Smooth Muscle Tumors and Disseminated Diffuse Large B-Cell Lymphoma in a Child With Common Variable Immunodeficiency A Case Report and Review of the Literature

This article reports the clinical and the histological features in a 7-year-old girl affected by common variable immunodeficiency (CVID) who developed multiple Epstein–Barr virus–associated tumors, represented by bilateral adrenal smooth muscle tumors (EBV-SMT) and multifocal diffuse large B-cell lymphoma. The EBV-SMTs showed features compatible with a benign or at least a low-malignant potential neoplasm. A peculiar feature observed in both EBV-SMTs was the occurrence of numerous lymphocytes intermingled with the spindle cells, which consisted of CD3+ CD5+ T-cells, with a predominant cytotoxic CD8+ component. Interestingly, EBV status differed in the neoplasms, since the EBV-SMTs were negative for LMP1 and positive for EBER, whereas the B-cell lymphoma expressed both EBV markers. Furthermore, EBV-LMP1 deletion was positive only in the EBV-SMTs, thus indicating that these tumors were the consequence of 2 distinct, EBV-dependent transformations. Similarly, lymphocyte clonality assay also showed different clonal bands in different sites (skin and nasal cavity), suggesting the development of intratumoral mutations. Finally, the authors review all 127 previously reported EBV-SMT, with discussion of their clinical and pathological features.

Preliminary experience with microwave ablation for selective feticide in monochorionic twin pregnancies.

Microwave ablation (MWA) is an alternative technique to radiofrequency ablation and laser ablation in the treatment of some solid tumors. In contrast to radiofrequency and laser ablation, we are not aware of previous experiences with MWA in fetal procedures, and report here our preliminary experience. Two cases of monochorionic–diamniotic twins, discordant for fetal abnormalities, underwent selective feticide by MWA between November 2011 and March 2012. Both patients were informed about the nature of the treatment and possible alternatives and gave their written informed consent. MWA was performed using a 2.45-MHz generator (AMICA-GEN, HS Hospital Service, Aprilia, Italy) delivering energy through a 16-gauge internally cooled coaxial antenna. All the procedures were performed percutaneously under ultrasound guidance. Conscious sedation (delorazepam, 5 mg intravenously) and local anesthetic (10 mL of 2% lidocaine) were administered. The antenna was centered in the abdomen of the abnormal fetus close to the insertion of the umbilical cord (Figure 1a). A single microwave energy application was delivered at 50 W net power at the applicator end for 3 min. In both cases, MWA was technically easy, and ultrasound evidence of tissue coagulation was seen immediately after the beginning of energy delivery (Figure 1b). In the first case, one of the twins had a complex cardiac abnormality (dextrocardia, tricuspid atresia, ventricular septal defect, pulmonary stenosis) complicated by hydrops; cervical length was 22 mm. MWA was performed at 17 + 3 weeks’ gestation. There was premature rupture of membranes of the terminated twin 4 days later, and the entire pregnancy miscarried after 7 days. In the second case, one of the twins had anencephaly; cervical length was 40 mm. MWA was performed at 16 + 2 weeks. The pregnancy carried on uneventfully, and a healthy female infant was delivered vaginally at 39 weeks’ gestation. MWA has many potential advantages over radiofrequency and laser ablation: there is immediate evidence of tissue coagulation on ultrasound; the technique is less dependent on tissue properties, as microwave Figure 1 Ultrasound images showing microwave ablation in Case 2. (a) Antenna is centered in abdomen of abnormal fetus close to insertion of umbilical cord. (b) Two min after start of energy delivery, evidence of tissue coagulation can be seen.

Computed tomography scanning of supraglottic neoplasms: Its cost-effective use in preoperative staging†

Acad Radio11996;3:

OP06.07: Preliminary experience with microwave ablation for selective feticide in monochorionic twin pregnancies: Short Oral Presentation (OP) Abstracts

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Use of cine phase-contrast MRI in the assessment of distal splenorenal shunt function.

59 9 1996, Association of University Radiologists C omputed tomography (CT) scanning has become the accepted imaging 9 standard for mapping submucosal spread of laryngeal neoplasms, significantly improving the accuracy of preoperative staging [1]. However, its clinical efficacy in predicting the feasibility of conservative surgery of supraglottic neoplasms has not been completely proved [2]. The purpose of this retrospective study was to assess the role of CT scanning in the selection of treatment of supraglottic neoplasms (partial versus total laryngectomy) and to evaluate its cost-effectiveness compared with clinical staging.

Caratterizzazione di lesioni focali epatiche

a drop in saturation to 90% despite an FiO2 of 0.8. These values immediately normalized after adjusting the insufflation pressure. Fetal demise was observed after four procedures but could not be attributed to PACI (three fetuses did not tolerate anesthesia, one fetus died from placental hemorrhage). Conclusions: In this still small clinical series, PACI was well tolerated by pregnant women and her fetuses during fetoscopic surgery for spina bifida aperta. Careful monitoring and adjustments of insufflation pressure at all times may aid in avoiding undesired maternal hemodynamic events.