Roberto Luigi Cazzato

Herlyn-werner-wunderlich syndrome: MRI findings, radiological guide (two cases and literature review), and differential diagnosis

BackgroundHerlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract involving Müllerian ducts and Wolffian structures, and it is characterized by the triad of didelphys uterus, obstructed hemivagina and ipsilateral renal agenesis. It generally occurs at puberty and exhibits non-specific and variable symptoms with acute or pelvic pain shortly following menarche, causing a delay in the diagnosis. Moreover, the diagnosis is complicated by the infrequency of this syndrome, because Müllerian duct anomalies (MDA) are infrequently encountered in a routine clinical setting.Cases presentationtwo cases of HWW syndrome in adolescents and a differential diagnosis for one case of a different MDA, and the impact of magnetic resonance (MR) imaging technology to achieve the correct diagnosis.ConclusionsMR imaging is a very suitable diagnostic tool in order to perform the correct diagnosis of HWW syndrome.

Determination of stature from skeletal and skull measurements by CT scan evaluation

The aim of this article is to find a correlation between height and femur/skull measurements through Computed Tomography (CT) scans and derive regression equations for total skeletal height estimation in the Caucasian population. We selected 200 Caucasian patients from March 2010 to July 2011 who had to perform a CT scan for cancer restaging. The mean age is 64.5 years. Both sexes are represented by the same number of persons. Patients have executed a total body CT scan with contrast; once scan accomplished, we measured height through a digital scales. We analyzed CT scans of each patient, obtaining multiplanar reconstruction in sagittal and coronal planes with 1mm of thickness, and we measured 10 diameters of skull and femur. Then we performed a single and a multiple regression analysis considering the three diameters that better correlated with height. The skeletal diameters with the highest correlation coefficients with stature were femur lengths, length of cranial base (Ba-N), and distance from the posterior extremity of the cranial base to the inferior point of the nasal bone (Ba-NB). Although both femur and skull are skeletal segments used for stature estimation, in our sample femur gave stronger correlation with height than skull. h=35.7+1.48·BaN+2.32·BaNB+2.53·FEM and h=3.06·FEM+72.6 are the formulae that provided the most accurate stature assessment using multiple and single regression analysis respectively.

Stature estimation from scapular measurements by CT scan evaluation in an Italian population

This study evaluated the correlation between scapula size and stature and developed standard equations in order to estimate stature by CT scan evaluation. A total of 200 healthy Italian subjects (100 men and 100 women, mean age 64.2±12.8years) underwent thoracic CT scan evaluation during pulmonary screening in our department; we measured the stature of each patient with standard anthropometric instruments and then analyzed images to calculate the longitudinal scapular length (LSL) and the transverse scapular length (TSL). The correlation between stature and each parameter measured was analyzed by dividing the population into two groups, males and females, and was examined by simple regression analysis using Pearsons correlation coefficient (r). Each anthropometric variable showed a significant difference between males and females (p value <0.001). The correlation coefficients (r-values) were LSL=0.74 and TSL=0.51 in males and LSL=0.70 and TSL=0.48 in females. In both sexes the r-values showed a significant correlation between stature and LSL. Our study demonstrates that scapulae can be used for stature estimation; in our sample LSL was found to have a better correlation with stature then TSL. hm=4.247*LSL+93.74 and hf=4.031*LSL+92.38 are the formulae that provide the most accurate stature assessment in males and females respectively.

Diffusion-weighted magnetic resonance imaging in patients selected for radical cystectomy: detection rate of pelvic lymph node metastases.

Study Type – Diagnostic (exploratory cohort)

Temperature monitoring during microwave ablation in ex vivo porcine livers

OBJECTIVE The aim of the present study was to assess the temperature map and its reproducibility while applying two different MWA systems (915 MHz vs 2.45 GHz) in ex vivo porcine livers. MATERIALS AND METHODS Fifteen fresh pig livers were treated using the two antennae at three different settings: treatment time of 10 min and power of 45 W for both systems; 4 min and 100 W for the 2.45 GHz system. Trends of temperature were recorded during all procedures by means of fiber optic-based probes located at five fixed distances from the antenna, ranging between 10 mm and 30 mm. Each trial was repeated twice to assess the reproducibility of temperature distribution. RESULTS Temperature as function of distance from the antenna can be modeled by a decreasing exponential trend. At the same settings, temperature obtained with the 2.45 GHz system was higher than that obtained with the 915 MHz thus resulting into a wider area of ablation (diameter 17 mm vs 15 mm). Both systems showed good reproducibility in terms of temperature distribution (root mean squared difference for both systems ranged between 2.8 °C and 3.4 °C). CONCLUSIONS When both MWA systems are applied, a decreasing exponential model can predict the temperature map. The 2.45 GHz antenna causes higher temperatures as compared to the 915 MHz thus, resulting into larger areas of ablation. Both systems showed good reproducibility although better results were achieved with the 2.45 GHz antenna.

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.

Minimally invasive treatments of painful bone lesions: state of the art

Abstract The role of the interventional radiology (IR) in the musculoskeletal system, and in particular in the bone, is a field of knowledge that is growing significantly in the last years with indications for treatment of both benign and malign lesions. In this paper, we review the state of the art of this application of the IR in the bone (bone metastasis and benign bone lesions) with discussion about all the techniques today used.

Bile Leak Refilling an Intrahepatic Biloma Managed with AMPLATZER Vascular Plug

tumor sizes. Although hysterectomy remains the gold-standard treatment for uterine myomas, it is an unacceptable treatment option for patients who want their uterus to be preserved. For this group of patients, several treatment options exist, including myomectomy and uterine artery embolization. As myomectomy is an invasive surgical procedure, it is associated with the risks of intraoperative blood loss, emergency hysterectomy, cesarean section, and uterine rupture during pregnancy after treatment (3). In patients with submucosal myomas treated with uterine artery embolization, complications of infection and pain during vaginal myoma expulsion have been reported (4). Currently, in cases of submucosal myomas, transvaginal resection with resectoscopy is a good option, but the indications for this technique are limited to small myomas with penetration into the uterine cavity greater than 50% (3). MRgFUS treatment of uterine myomas has clearly demonstrated myoma shrinkage and significant symptom reduction, with only minor complications such as skin burn and nerve heating, which have shown complete improvement with conservative therapy (1). A report of vaginal expulsion of a very large necrotic submucosal myoma after MRgFUS describes removal by hysteroscopy without injury to the uterine endometrium (5). Here we have described successful MRgFUS treatment of an intracavitary submucosal myoma by selective targeting of the stalk connecting it to the uterus, and the resulting disconnection of the myoma, without the need for any additional invasive procedures and without associated complications of infection, pain, or excessive vaginal bleeding during spontaneous expulsion of the myoma. In addition, during the 3-month follow-up period after MRgFUS treatment, the patient experienced decreased menstrual bleeding. In cases of very large submucosal myomas, there may be complications related to the expulsion of the large mass through the vagina, for which a subsequent hysteroscopic resection would be required. The present case suggests the potential exploratory use of MRgFUS for the disconnection of an intracavitary submucosal myoma to the uterine cavity, but further work is required to provide additional knowledge of possible outcomes or complications.

Curved Needles: Beyond Diagnostic Procedures.

To the Editor, We read with great interest the article of De Filippo et al., published in CVIR 2015 [1]. The authors report using a coaxial 18-G cannula with a 22-G curved needle to circumvent anatomic obstacles and sample lesions deemed inaccessible via a linear approach. We fully agree with the authors’ comments regarding the utility of curved needles for diagnostic procedures; however, the technique may also be useful during non-vascular interventional therapies. We report our experience of using curved needles to facilitate thermoprotection (using hydrodissection and thermal monitoring) during two percutaneous image-guided thermal ablation procedures. The first patient was a 71-year-old male referred to the department of interventional radiology for curative percutaneous CT-guided cryoablation of a 3-cm clear cell carcinoma of the upper pole of the left kidney. The procedure was performed under general anaesthesia in the prone position. Four cryoprobes (IceRod, Galil Medical, Yokneam, Israel) were positioned within the tumour via a posterior approach. Since the lesion was significantly exophytic and abutted the lower pole of the spleen, it was elected to perform hydrodissection to avoid collateral thermal damage. Initial attempts using a straight 22-G spinal needle positioned adjacent to the inferior aspect of the lesion were unsuccessful. Optimal hydrodissection required precise needle placement in the fat-plane between the lesion and spleen, which was inaccessible via a linear approach due to the presence of an overlying rib. We therefore utilised a curved needle within a coaxial straight trocar to perform the procedure. A straight 18-G, 8.8-cm spinal needle was initially introduced along the posterior rib border via a linear approach. We then manually bent a 22-G, 15-cm Chiba needle-tip to the estimated degree of curvature (approximately 30 ) and carefully advanced the curved needle inside the trocar. Control CT scan demonstrated satisfactory needle-tip placement between the lesion and spleen, and hydrodissection was performed using 50 ml aliquots of a 5 % iodinated contrast solution (Visipaque, GE Healthcare, Little Chalfont, UK; 270 mg I/ml) injected via a 50-cm connecting tube, with excellent separation of the target lesion (Fig. 1). A standard doublefreeze cryoablation protocol was conducted without unintended freezing of the spleen. One-month follow-up MRI & Julien Garnon juliengarnon@gmail.com

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art

Abstract Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.