T. J. Vogl

CT-guided percutaneous core biopsies of pulmonary lesions. Diagnostic accuracy, complications and therapeutic impact.

Purpose: To evaluate the diagnostic accuracy, complications, and therapeutic impact of CT-guided percutaneous core biopsies of pulmonary lesions. Material and Methods: Seventy-nine patients underwent diagnostic CT-guided percutaneous core biopsies of pulmonary lesions between July 1995 and March 1999. Evaluation included corresponding clinical data, pathologic results, and therapeutic consequences. Results: There were 29 benign and 50 malignant lesions. Percutaneous core biopsy had an overall diagnostic accuracy of 95%. For malignant lesions, core biopsy was positive in 48 patients (sensitivity 96%), and for benign lesions, in 27 (sensitivity 93%). There were no false-positive findings. Pneumothoraces were observed in 19 patients (24%) and 4 of them required a chest drain (5%). There were no hematothoraces or major bleeding complications; however, postinterventional local hemorrhages were observed in 23 patients (29%). No hemoptysis was noted. Conclusion: Percutaneous core biopsies of pulmonary lesions offer excellent diagnostic accuracy for both benign and malignant pulmonary lesions at a low complication rate.

Transjugular intrahepatic portosystemic shunt: Experiences at a liver transplantation center

Objective: Transjugular intrahepatic portosystemic shunt (TIPS) placement is an established therapy for portal hypertension that leads to variceal bleeding or refractory ascites. We present experiences of the role of TIPS at a liver transplantation center. Material and Methods: One hundred and ten patients were referred to the Radiological Department for TIPS placement. One of the 110 patients had recurrent cirrhosis after liver transplantation with refractory ascites. Function of the TIPS was controlled with Doppler US at 1 day, 1 week, 4 weeks and 4 months after TIPS placement and subsequently every 3 months. Shunt insufficiency was supposed when the blood flow velocity within the stent tract was under 50 cm/s and was an indication for TIPS revision. Results: TIPS was placed in 101 patients. After TIPS placement, 10 patients underwent liver transplantation. While waiting for the new liver, none of them developed variceal rebleeding, ascites or other complications of portal hypertension. Two of the 101 patients had episodes of rebleeding. The frequency of patients undergoing TIPS revision within the first year after TIPS placement was 67.5%, within the second year 38.0% and within the third year 24.4%. The revisions led to sufficient reduction of the portosystemic pressure gradient. Conclusion: In some liver transplant candidates, TIPS can be useful in minimizing the risk of complications of portal hypertension during the waiting time for a liver transplantation. TIPS can be monitored by Doppler US and revised if occlusion occurs.

PULMONARY DISEASE IN LIVER TRANSPLANT RECIPIENTS: Spectrum of CT features

Purpose: To determine the features of pulmonary disease in liver transplant recipients by CT. Material and Methods: Of 792 patients, 102 were referred to thoracic CT 3-2093 days after the transplantation procedure (median 107 days). All CT studies were retrospectively analyzed and correlated with clinical, microbiological, serological and histopathological findings. Results: Eighty-eight of 102 patients (86%) had an abnormal CT. In 25 patients (25%), an elevated right hemidiaphragm, basal atelectasis and small effusions were the only abnormalities. Fourty-one patients (40%) displayed an infiltrate and 13 (13%) a mass lesion. Evidence of cytomegalovirus (CMV) infection was found in 20 patients. CMV pneumonia was suggested by an interstitial pattern of pneumonia on CT (n=13). Pneumocystis carinii pneumonia was highlighted by peribronchovascular infiltrates (n=5/8), bacterial pneumonia (n=24) including legionellosis (n=13) by bilateral effusions (n=14) and lobar consolidation (n=13). In 7/41 patients (17%) with both clinically apparent pulmonary disease and CT signs of pneumonia, no pathogen could be detected. Neoplastic disease was mostly due to tumor recurrence (n=6). Conclusion: Thoracic CT of liver transplant recipients aids in detecting and classifying both infectious and neoplastic complications.

Abdominal CT features and survival in acquired immunodeficiency

Purpose: HIV-infected patients show a high incidence of abdominal disease. This investigation was made to determine whether abdominal CT provided prognostically relevant information in these patients Material and Methods: Images from 533 abdominal CT examinations in 339 HIV-infected patients were retrospectively reviewed for signs of abdominal disease, and correlated with clinical data and survival rates. the Kaplan-Meier analysis and rank testing of survival, and proportional hazards regression were used to define prognostic clinical and imaging findings Results: of the 339 patients, 278 (82%) showed abnormal abdominal findings on CT. Median survival was 29 months. of the imaging findings, hepatic masses (n=11), pathologically enlarged lymph nodes (n=48), and ascites (n=7) were associated with poor survival, giving a median survival of respectively 13 months, 15 months, and less than 1 month. These three features showed no association with CD4+-T-lymphocyte count or CDC category. Main determinants of survival were a low CD4+-T-lymphocyte count, and certain abnormal CT findings. Splenomegaly (n=147), hepatomegaly (n=144), and lymphadenopathy (n=111) were the most common abdominal findings on CT but lacked prognostic relevance Conclusion: Abdominal CT offered prognostic implications in HIV-infected patients and might serve in risk stratification in selected patients. CT features such as hepatic masses, grossly enlarged lymph nodes, or ascites indicate advanced immunosuppression

Laser-Induced and Microwave Thermotherapy of Hepatocellular Carcinoma

Small and unifocal hepatocellular nodules are currently treated best via hepatic resection of liver transplantation. Alternatively some studies present also excellent survival rates for local ethanol injection (percutaneous ethanol injection – PEI). In more advanced stages of hepatocellular carcinoma, transarterial chemoembolization (TAE) has proven in some studies to be effective in reducing tumor volume and increasing survival. MR-guided laser-induced thermotherapy presents a new alternative therapeutic approach in malignant liver lesions [1–3]. Additionally, microwave thermotherapy has proven to be therapeutically effective in some limited studies; recently developed cooled application systems might further expand the clinical use of that technique [4, 5].