Percutaneous cryoablation of subcapsular hepatocellular carcinoma: a retrospective study of 57 cases.
Wang F1, Ma J2, Wu L3, Li N1, Luo R1, Wei G1, Yang J1.
Author information
1
Department of Interventional Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
2
Department of Radiology, The First Hospital of Jiaxing, Zhejiang, China.
3
Department of Oncology, Tengzhou Central People's Hospital, Shandong, China.
Abstract
PURPOSE:
This study aims to evaluate the safety and effectiveness of the percutaneous cryoablation for subcapsular hepatocellular carcinoma (HCC).

METHODS:
A total of 57 patients with subcapsular (<1 cm form the liver edge) HCCs (68 lesions), who were treated with CT-guided percutaneous cryoablation in the Department of Interventional Radiology of our hospital between July 1, 2016 and September 1, 2018, were retrospectively included. Complete ablation rate, local tumor progression (LTP) and treatment-related complications were evaluated. Furthermore, the degree of intraoperative and postoperative pain was measured with the visual analog scale (VAS), and laboratory findings were compared before and after the procedure.

RESULTS:
All patients successfully completed the treatment. The mean follow-up period was 12.8 months (range, 3-27 months), and the complete ablation rate was 97% (66/68). Local tumor progression occurred in 11 lesions (16.2%), and the 6-, 12- and 18-month cumulative LTP rates were 4.0%, 8.2% and 20.5%, respectively. Two patients (3.5%, 2/57) developed major complications, and 12 patients had minor complications (22.8%, 12/57). The mean VAS score during the operation was 1.65 points (range, 1-3 points). Postoperative pain worsened in 3 patients, and the VAS scores reached 4-5. Transient changes in biochemical and hematologic markers were observed.

CONCLUSION:
Percutaneous cryoablation for subcapsular HCC is safe and effective, the procedure is simple and the patients suffer less pain.

PMID: 31650975 DOI: 10.5152/dir.2019.18543
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2.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18579. [Epub ahead of print]
Effect of a dedicated inferior vena cava filter retrieval program on retrieval rates and number of patients lost to follow up.
Salei A1, Raborn J1, Manapragada PP1, Stoneburner CG1, Abdel Aal AK1, Gunn AJ1.
Author information
1
Department of Radiology, The University of Alabama at Birmingham, Alabama, United States.
Abstract
PURPOSE:
We aimed to assess the efficacy of a dedicated inferior vena cava (IVC) filter retrieval program on filter retrieval rates and number of patients lost to follow-up.

METHODS:
A dedicated IVC filter retrieval program began in July 2016. This consisted of tracking all patients with retrievable filters placed by interventional radiology (IR). At the time of filter placement, patients were scheduled for a retrieval consult in the IR clinic. Any missed appointments were followed up by a physician assistant. The program was overseen by a single IR physician. To assess this program's efficacy, we reviewed the records of all patients who had retrievable IVC filters placed by IR nine months prior to and nine months after program initiation. Demographics and clinical factors were then collected and compared. A P value of < 0.05 was considered statistically significant.

RESULTS:
Prior to the program, 76 patients (31 males, 45 females; mean age, 64.2 years) had retrievable filters placed; 75% were placed due to a contraindication to anticoagulation. From this group, five filters were removed (6.6%), 42 patients were lost to follow-up (55.3%), 22 patients died (29.0%), and seven filters were deemed permanent by a physician after placement (9.2%). All five retrievals were successful and no complications were reported. After program initiation, 106 patients (59 males, 47 females; mean age, 58.8 years) had retrievable filters placed; 75.5% were placed due to a contraindication to anticoagulation. In this group, 30 filters were retrieved (retrieval rate 28.3%), 17 patients were lost to follow-up (16%), 23 patients died (21.7%), 28 filters were deemed permanent by a physician after placement (26.4%), and decisions were still pending in eight patients (7.5%). One patient (3.3%) had a minor complication during filter retrieval. Initiation of a filter retrieval program increased our retrieval rate (6.6% vs. 28.3%; P < 0.001) and reduced the number of patients with filters that were lost to follow-up (55.3% vs. 16%; P < 0.001).

CONCLUSION:
Dedicated filter retrieval program is effective in increasing filter retrieval rates and decreasing the number of patients lost to follow-up.

PMID: 31650974 DOI: 10.5152/dir.2019.18579
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3.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18138. [Epub ahead of print]
Embolization of variant hepatic arteries in patients undergoing percutaneous hepatic perfusion for unresectable liver metastases of ocular melanoma.
Meijer TS1, Geus-Oei LF1, Martini C2, Tijl F3, Sitsen E1, Erkel AV1, Meer RV1, Kapiteijn E4, Vahrmeijer A5, Burgmans M1.
Author information
1
Department of Radiology and Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands.
2
Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands.
3
Department of Extra Corporal Circulation, Leiden University Medical Center, Leiden, The Netherlands.
4
Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
5
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Abstract
PURPOSE:
In patients undergoing percutaneous liver perfusion with melphalan (M-PHP), the presence of variant hepatic arteries (HAs) may require catheter repositioning and thus prolong procedure time. Coil-embolization of variant HAs may enable M-PHP with a single catheter position as occlusion of variant HAs results in redistribution of flow through preexisting intrahepatic arterial collaterals. Aim of this study was to evaluate whether redistribution of flow has any negative effect on therapeutic response in ocular melanoma patients undergoing M-PHP.

METHODS:
We retrospectively analyzed pretreatment angiograms in all 32 patients that underwent M-PHP between January 2014 and March 2017 for unresectable liver metastases from ocular melanoma. Patients that underwent embolization of a variant left HA (LHA) or middle HA (MHA) during pretreatment angiography followed by at least one technically successful M-PHP, were included for further analysis. Redistribution of arterial flow was evaluated on angiography and cone-beam CT (CBCT) images. In each patient, tumor response in liver segments with redistributed blood flow was evaluated using RECIST 1.1 and mRECIST, and then compared to tumor response in segments without flow redistribution. Follow-up scans were reviewed to evaluate progression of liver metastases.

RESULTS:
A total of 12 patients were included. Replaced LHA embolization resulted in redistribution of flow to segment(s) 2 (n=3), 2 and 3 (n=6), and 2, 3 and 4 (n=1). MHA embolization resulted in redistribution of flow to segment 4 (n=2). Successful redistribution was confirmed by angiography and/or CBCT in all patients. Tumor response was similar for redistributed and non-redistributed liver segments in 8 out of 9 patients (88.9%) according to RECIST 1.1, and in 8 out of 8 patients (100.0%) according to mRECIST. In three patients, tumor response was not evaluable according to RECIST 1.1 or mRECIST as metastases were too small to be categorized as target lesions (n=1), or target lesions were confined to non-redistributed segments (n=2). In one patient, tumor response was not evaluable according to mRECIST as target lesions in the redistributed segments were hypovascular. After a median follow-up time of 17.1 months (range 9.1-38.5), hepatic progression was seen in 9 out of 12 patients with a median time to progression of 9.9 months (range 2.5-17.7). Progression of liver metastases was never seen in the redistributed liver segments only.

CONCLUSION:
Flow redistribution in liver segments by coil-embolization of variant HAs is a feasible technique that does not seem to compromise tumor response in patients undergoing M-PHP.

PMID: 31650973 DOI: 10.5152/dir.2019.18138
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4.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18061. [Epub ahead of print]
Feasibility and accuracy of CT-guided percutaneous needle biopsy of cavitary pulmonary lesions.
Kiranantawat N1, Petranovic M2, McDermott S2, Gilman M2, Digumarthy SR2, Shepard JO2, Sharma A2.
Author information
1
Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA;Division of Diagnostic Imaging, Department of Radiology, Prince of Songkla University School of Medicine, Songkhla, Thailand.
2
Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Abstract
PURPOSE:
To evaluate the feasibility, accuracy and complications of CT-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions.

METHODS:
Consecutive PTNB procedures in an academic institution over a 4 year period were reviewed, 53 of which were performed on patients with cavitary lesions The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathological results and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy.

RESULTS:
The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 non-infectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A non-significant higher chest tube insertion rate was seen in cavities with a thinner wall.

CONCLUSION:
PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.

PMID: 31650972 DOI: 10.5152/dir.2019.18061
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Select item 31650971
5.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.19036. [Epub ahead of print]
The radial and ulnar collateral ligaments of the wrist are true ligaments.
Türker T1, Sheppard JE1, Klauser AS2, Johnston SS3, Amerongen H4, Taljanovic MS5.
Author information
1
Department of Orthopaedics, Arizona University School of Medicine, Arizona, United States.
2
Department of Radiology, Division of Rheumatology and Sports Imaging, Medical University Innsbruck, Innsbruck, Austria.
3
Consultant Radiologist, Arizona State Radiology, Arizona, United States.
4
Department of Cellular and Molecular Medicine, Arizona University School of Medicine, Arizona, United States.
5
Department of Medical Imaging, Arizona University School of Medicine, Arizona, United States.
Abstract
PURPOSE:
Our hypothesis in this study is that the radial and ulnar collateral ligaments of the wrist exist and are true ligaments which can be visualized by high resolution ultrasound.

METHODS:
High-resolution ultrasound examination of the radial and ulnar collateral ligaments of the wrist was performed on 56 fresh cadaveric wrists. The visibility of these ligaments was assessed by four observers who classified the ligaments in consensus as well seen, adequately seen or not seen. Surgical dissections of 12 radial collateral ligaments and 12 ulnar collateral ligaments were then performed and the ligaments were classified as present or absent. The ultrasound and dissection results were then compared. To confirm that the dissected structures represent true ligaments a histologic examination of the ligaments was performed.

RESULTS:
All examined radial and ulnar collateral ligaments were seen on the ultrasound examination. The radial collateral ligament was seen between the radial styloid and radial aspect of the scaphoid. The ulnar collateral ligament was seen between ulnar styloid process and the triquetrum. On all surgical dissections, the radial collateral ligament was present at the floor of the first extensor compartment and the ulnar collateral ligament was at the floor of the sixth extensor compartment. Both ligaments were proven to be true capsular ligaments on both dissection and histological examinations.

CONCLUSION:
The radial and ulnar collateral ligaments of the wrist are true ligaments and can be seen at the floor of the first and the sixth extensor compartments, respectively, using a high-resolution ultrasound. Based on their anatomic location, they most likely provide static stability to the wrist joint.

PMID: 31650971 DOI: 10.5152/dir.2019.19036
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Select item 31650970
6.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18539. [Epub ahead of print]
Effect of iterative reconstruction techniques on image quality in low radiation dose chest CT: a phantom study.
Xu Y1, Zhang T1, Hu Z1, Li J1, Hou H2, Xu Z2, He W1.
Author information
1
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
2
Department of Radiology, Weihai Wendeng Central Hospital, Weihai, Shandong, China.
Abstract
PURPOSE:
To evaluate the quality of chest CT images obtained with low-dose computed tomography (LDCT) using three iterative reconstruction (IR) algorithms.

METHODS:
Two 64-detector spiral CT scanners (HDCT, iCT) were used to scan a chest phantom containing 6 ground-glass nodules (GGNs) at 11 radiation dose levels. CT images were reconstructed by FBP or three IR algorithms. Reconstructed images were analyzed for CT values, average noise, contrast-to-noise ratio (CNR) values, subjective image noise, and diagnostic acceptability of the GGNs. Repeated-measures analysis of variance was used for statistical analyses.

RESULTS:
Average noise decreased and CNR increased with increasing radiation dose when the same reconstruction algorithm was applied. Image average noise reconstructed with MBIR was significantly lower than reconstructed with iDOSE4 at the same low radiation doses. The two radiologists showed good interobserver consistency in image quality with kappa 0.83. A significant relationship was found between image noise and diagnostic acceptability of the GGNs.

CONCLUSION:
Three IR algorithms are able to reduce the image noise and improve the image quality in LDCT. In the same radiation dose, the LDCT images quality reconstructed with MBIR algorithms is better than that of other IR algorithms.

PMID: 31650970 DOI: 10.5152/dir.2019.18539
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Select item 31650969
7.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18478. [Epub ahead of print]
Evaluation of skeletal muscle perfusion in a canine hindlimb ischemia model using CT perfusion imaging.
Wang T1, Su H2, Gu J2, Chen Q3, Xu Q3, Chen BT4.
Author information
1
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China;Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States.
2
Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
3
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
4
Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States.
Abstract
PURPOSE:
To evaluate skeletal muscle perfusion in a canine hind limb ischemia model using CT perfusion imaging (CTPI).

METHODS:
Twelve beagles underwent embolization at the branch of the left deep femoral artery. The right hind limbs were used as controls. CTPI was performed immediately after embolization. The perfusion parameters of the regions of interest (ROI), including blood volume (BV), blood flow (BF), mean transit time (MTT) and permeability (PMB), were obtained in both the lateral and posterior hind limb muscle groups.

RESULTS:
After embolization, the BV, BF and PMB values in the lateral muscles of the left hind limbs were significantly lower than those in the right hind limbs (P > 0.05), and the MTT was significantly prolonged (P > 0.05). The values for BV, BF, MTT and PMB in the posterior muscles of the left hind limbs were not significantly different from those in the right hind limbs (P > 0.05). The values for BV, BF and PMB in the lateral muscles of the left hind limbs were significantly lower than those in the posterior muscles of the left hind limbs (P > 0.05).

PMID: 31650969 DOI: 10.5152/dir.2019.18478
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8.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18535. [Epub ahead of print]
Hyperintensity at fat spared area in steatotic liver on the hepatobiliary phase MRI.
Ünal E1, İdilman İS1, Karaosmanoğlu AD1, Özmen MN1, Akata D1, Karcaaltıncaba M1.
Author information
1
Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
Abstract
PURPOSE:
We aimed to investigate the reasons for hyperintensity at fat spared area in steatotic liver at hepatobiliary phase (HBP) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver magnetic resonance imaging.

METHODS:
Twenty-two patients with focal fat spared area demonstrating hyperintensity on HBP images were included. A region of interest was placed on in- and opposed-phase images at fat spared area and liver to measure the fat. The measurement was also performed on precontrast T1-weighted and HBP images. The signal intensities of spleen, kidney, muscle, intervertebral disc, and spinal cord were also recorded.

RESULTS:
The mean fat fraction of liver and fat spared area was 24.86% (8%-46%) and 8.41% (1%-34%), respectively (P < 0.001). There was a significant positive correlation between liver parenchyma fat fraction and delta fat fraction (r=0.74, P < 0.001). The mean signal intensity values of fat spared areas were higher compared with liver on precontrast T1-weighted and HBP images (P < 0.001). The mean relative enhancement ratio of liver and fat spared areas were 0.98 (0.05-1.90) and 1.15 (0.22-2.03), respectively (P < 0.001). However, in 6 patients, the relative enhancement ratio of liver and fat spared areas were almost equal. The uptake of Gd-EOB at fat spared area was not correlated with the degree of steatosis (r = -0.01, P = 0.95).

CONCLUSION:
Fat spared area in steatotic liver appears hyperintense on HBP images due to increased relative enhancement ratio and/or baseline hyperintensity on precontrast images.

PMID: 31650968 DOI: 10.5152/dir.2019.18535
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Select item 31650967
9.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18537. [Epub ahead of print]
Assessment of the compliance with minimum acceptable technical parameters proposed by PI-RADS v2 guidelines in multiparametric prostate MRI acquisition in tertiary referral hospitals in the Republic of Turkey.
Coşkun M1, Sarp AF2, Karasu Ş3, Gelal MF3, Türkbey B4.
Author information
1
Department of Radiology, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, , İzmir, Turkey.
2
Department of Radiology, Osmangazi University School of Medicine, Eskişehir, Turkey.
3
Department of Radiology, İzmir Katip Çelebi University Atatürk Training and Research Hospital, İzmir, Turkey.
4
Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Abstract
PURPOSE:
Although the clinical use of multiparametric prostate magnetic resonance imaging (mpMRI) is increasing, the adherence to parameters for mpMRI which had been described in the Prostate Imaging-Reporting and Data System version 2 (PI-RADSv2) for an optimum image acquisition is unknown. In this paper, we aimed to determine the compliance with the minimum acceptable technical parameters for prostate mpMRI defined by PI-RADSv2 in tertiary care centers in Turkey.

METHODS:
We sent a survey to all radiology departments of tertiary referral hospitals in Turkey (n = 120) to evaluate their adherence to PI-RADSv2 technical specifications. Statistical analysis was performed using Chi-square, Fisher Exact, ANOVA, and the Student`s t tests. The cut-off values for image acquisition times were also determined with ROC analysis. P - values <0.05 were considered statistically significant.

RESULTS:
One hundred and eleven clinics responded to our survey (response rate = 92.5%). Prostate MRI was reported to be performed in 61 centers. 26 (42.6%) centers used 3 T (Tesla) scanner while 1.5T was used in 35 (57.4%) centers. The adherence to slice thickness (ST), in-plane phase and frequency resolutions on T2WI were 68.9%, 41% and 9.8% respectively. The adherence to the same parameters on DWI were higher compared to T2WI (85.2%, 62.3% and 78.7%, respectively). In comparative analysis, the adherence to ST, field of view (FOV) and in-plane phase resolution on T2WI were higher for 3T compared with 1.5T scanners (P = 0.004, P = 0.041 and P = 0.001, respectively). T2WI acquisition time was significantly longer for the centers adhered to T2WI-FOV (P = 0.034) and in-plane T2WI phase resolution (P = 0.028). The DWI scan time was significantly longer when they adhered to DWI-FOV (P = 0.014) and b-value≥1400s/mm2 (P = 0.008). The calculated cut-off values were 220 seconds in T2WI and 312 seconds in DWI to ensure the compliance with voxel sizes and b-value criterias.

CONCLUSION:
The tertiary referral centers in Turkey did not meet most of the technical specifications of PI-RADSv2 during prostate MRI acquisition. Awareness to the minimum acceptable technical parameters of mpMRI should be increased to potentially improve the quality of prostate cancer imaging.

PMID: 31650967 DOI: 10.5152/dir.2019.18537
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10.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18593. [Epub ahead of print]
Calcific tendinitis: intramuscular and intraosseous migration.
Kalaycı CB1, Kızılkaya E1.
Author information
1
Department of Diagnostic Radiology, Acıbadem University Atakent Hospital, İstanbul, Turkey.
Abstract
Calcific tendinitis is a well-documented and extensively studied disease in the literature. Intramuscular and intraosseous migration are rare complications, which may present diagnostic challenges. This pictorial essay illustrates the imaging findings of these complications. Considering that neoplastic processes and infectious diseases are included in the differential diagnosis, recognizing the imaging findings of these complications is of critical importance.

PMID: 31650966 DOI: 10.5152/dir.2019.18593
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Select item 31650965
11.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.19038. [Epub ahead of print]
Percutaneous transgastric pancreatic-duct drainage for pancreaticojejunal leak after pancreaticoduodenectomy.
Kamo M1, Miyazawa R2, Nisiyama T2, Nakamura K3, Yagihashi K4.
Author information
1
Department of Radiology, St. Luke's International Hospital, Tokyo, Japan; Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
2
Department of Radiology, St. Luke's International Hospital, Tokyo, Japan.
3
Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan.
4
Department of Radiology, St. Luke's International Hospital, Tokyo, Japan; Department of Radiology, Kawasaki Municipal Tama Hospital, Kawasaki, Japan.
Abstract
Pancreaticojejunal anastomotic leakage is one of the severe complications after pancreaticoduodenectomy and is often difficult to manage. A 64-year-old man status post pancreaticoduodenectomy had the gastroduodenal artery stump bleeding caused by the pancreaticojejunal anastomotic leakage, successfully treated by placing a covered stent. To control the leakage, subsequent percutaneous transgastric pancreatic duct puncture was performed under fluoroscopic guidance, targeting a surgically placed pancreaticojejunal internal drainage catheter. A 5 F catheter with side holes was inserted into the main pancreatic duct, the tip of which was placed in the anastomosed jejunum. The leak was successfully treated using this catheter. Percutaneous transgastric pancreatic duct drainage might be a useful and feasible option to resolve the condition.

PMID: 31650965 DOI: 10.5152/dir.2019.19038
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Select item 31650964
12.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18427. [Epub ahead of print]
Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions?
Kurtoğlu Özçağlayan Tİ1, Özkan Gürdal S2, Öznur M3, Özçağlayan Ö1, Doğru M1, Topçu B4.
Author information
1
Department of Radiology, Namık Kemal University School of Medicine, Tekirdağ, Turkey.
2
Department of General Surgery, Namık Kemal University School of Medicine, Tekirdağ, Turkey.
3
Department of Pathology, Namık Kemal University School of Medicine, Tekirdağ, Turkey.
4
Department of Biostatistics, Namık Kemal University School of Medicine, Tekirdağ, Turkey.
Abstract
PURPOSE:
In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods.

METHODS:
From July 2015 to December 2016, a total 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed.

RESULTS:
After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015).

CONCLUSION:
BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.

PMID: 31650964 DOI: 10.5152/dir.2019.18427
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Select item 31650963
13.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18470. [Epub ahead of print]
Transjugular insertion of biliary stent in patients with malignant biliary obstruction complicated by ascites with/without coagulopathy: a prospective study of 12 patients.
Shim DJ1, Gwon DI2, Ko GY2, Yoon HK2, Sung KB2.
Author information
1
Department of Radiology, Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Seoul, Republic of Korea.
2
Department of Radiology and Research Institute of Radiology, Ulsan University School of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Abstract
PURPOSE:
In patients with malignant biliary obstruction and complicated by massive ascites, when endoscopy failed, safe routes for biliary decompression are needed alternative to percutaneous approach. We evaluated the safety and efficacy of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.

METHODS:
From March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS was enrolled in this study. Five patients had jaundice with cholangitis and seven had only jaundice. Clinical parameters including technical and clinical success rate and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis.

RESULTS:
The indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean=30 days, range=1-146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval=16-22 days) and 19 days (95% confidence interval=12-26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage.

CONCLUSION:
TIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.

PMID: 31650963 DOI: 10.5152/dir.2019.18470
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Select item 31650962
14.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18542. [Epub ahead of print]
Percutaneous sclerotherapy with gelified ethanol of low-flow vascular malformations of the head and neck region: preliminary results.
Ierardi AM1, Colletti G2, Biondetti P1, Dessy M2, Carrafiello G1.
Author information
1
Department of Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy.
2
Department of Maxillofacial Surgery, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan University, Milan, Italy.
Abstract
PURPOSE:
Evaluation of safety and efficacy of percutaneous sclerotherapy using gelified ethanol in patients with low-flow malformations.

METHODS:
A retrospective study was performed, analyzing treatment and outcome data of 6 patients that presented with 7 low-flow malformations (LF-Ms) (3 lymphatic and 3 venous). Median diameter of LF-Ms was 6 cm (iqr 4.5-8.5 cm). Data regarding pain, functional and/or cosmetic issues were assessed. Diagnosis was performed clinically and confirmed Doppler Ultrasound, while extension of disease was assessed by Magnetic Resonance Imaging (MRI). Percutaneous puncture was performed with 23G needle directly or with ultrasound guidance. All the LF-Ms were treated with gelified ethanol injection. The median volume injected per treatment session resulted 4.4 mL.

RESULTS:
Technical and clinical success were obtained in all cases. No recurrences were registered during a median follow up of 17 months (iqr 12-19 months). Among the 6 patients, 83% of the patients had complete relief (5/6) and the other showed improvement of symptoms. The median VAS score was 7 (iqr 6-7.5) before and 0 (iqr 0-0) after treatment. All patients had functional and aesthetic improvement (100%). Four patients (66.7%) had a very good acceptance and two patients (33.3%) a good acceptance. No major complications neither systemic side effects were observed.

CONCLUSION:
Gelified ethanol may be considered easy to handle, well-tolerated, safe and effective in the short-term follow up. Longer follow up efficacy is mandatory for further conclusions.

PMID: 31650962 DOI: 10.5152/dir.2019.18542
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Select item 31650961
15.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.18587. [Epub ahead of print]
The orthogonal measurements approach in estimating spleen size on CT images.
İmamoğlu H1, Zararsız G2, Özdemir M1, Erdoğan N1.
Author information
1
Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey.
2
Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey; Turcosa Analytics Solutions Ltd Co, Kayseri, Turkey.
Abstract
PURPOSE:
To find out which single measurement and/or linear regression model correlates well with splenic volume using the orthogonal measurements approach.

METHODS:
The study relied on retrospective analysis of 205 contrast-enhanced abdominal CT examinations carried out in adult patients using a 320-detector CT system. CT volumetry was conducted by a semi-automated, model and threshold based segmentation algorithm that enables voxel-based volume calculation of abdominal organs. The orthogonal measurements were carried out in axial sections by measuring the maximum diameters of spleen projected in sagittal, coronal and transverse planes. In addition, we calculated the diagonal diameter of spleen, which is a derivative of orthogonal measurements. Statistical analysis included calculation of interobserver agreement on orthogonal measurements, followed by model building using linear regression analysis of the measurements.

RESULTS:
The interobserver agreement between two radiologists was very strong for all orthogonal measurements (r ≥ 0.971). The highest model performance was detected with the diagonal diameter (r2 = 0.956), followed by the superoinferior diameter (r2 = 0.857). Agreement statistics revealed that the regression formula derived from the diagonal diameter outperformed that of superoinferior diameter.

CONCLUSION:
The diagonal diameter appears to be the best parameter which correlates with splenic volume, whereas the superoinferior diameter can be an alternative in daily CT reporting practice. The orthogonal measurements approach not only provides a high interobserver agreement, but also the diagonal diameter can be translated into ultrasound studies.

PMID: 31650961 DOI: 10.5152/dir.2019.18587
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Select item 31650960
16.
Diagn Interv Radiol. 2019 Oct 25. doi: 10.5152/dir.2019.19321. [Epub ahead of print]
Radiomics with artificial intelligence: a practical guide for beginners.
Koçak B1, Durmaz EŞ2, Ateş E1, Kılıçkesmez Ö1.
Author information
1
Department of Radiology İstanbul Training and Research Hospital, İstanbul, Turkey.
2
Department of Radiology, Büyükçekmece Mimar Sinan State Hospital, İstanbul, Turkey.
Abstract
Radiomics is a relatively new word for the field of radiology, meaning the extraction of a high number of quantitative features from medical images. Artificial intelligence (AI) is broadly a set of advanced computational algorithms that basically learn the patterns in the data provided to make predictions on unseen data sets. Radiomics can be coupled with AI because of its better capability of handling a massive amount of data compared with the traditional statistical methods. Together, the primary purpose of these fields is to extract and analyze as much and meaningful hidden quantitative data as possible to be used in decision support. Nowadays, both radiomics and AI have been getting attention for their remarkable success in various radiological tasks, which has been met with anxiety by most of the radiologists due to the fear of replacement by intelligent machines. Considering ever-developing advances in computational power and availability of large data sets, the marriage of humans and machines in future clinical practice seems inevitable. Therefore, regardless of their feelings, the radiologists should be familiar with these concepts. Our goal in this paper was three-fold: first, to familiarize radiologists with the radiomics and AI; second, to encourage the radiologists to get involved in these ever-developing fields; and, third, to provide a set of recommendations for good practice in design and assessment of future works.

PMID: 31650960 DOI: 10.5152/dir.2019.19321