1-month Imaging Research Articles

Microwave Ablation of Very-Early- and Early-Stage HCC: Efficacy Evaluation by Correlation with Histology after Liver Transplantation.

Simple SummaryMicrowave (MW) ablation is increasingly used worldwide as a therapeutic option in very-early- and early-stage hepatocellular carcinoma (HCC). Up to now, there have been few published studied showing the correlation with pathology in ablated nodules. The aim of our study was to retrospectively correlate the necrosis obtained with MW ablation with histological findings in excised livers from the time of liver transplantation to assess the MW ablation effectiveness. We obtained, in a population of 30 patients with 36 nodules, a complete ablation at 1-month imaging in 30/36 nodules (83.3%). At pathology, of the 36 treated nodules, 28 (77.8%) showed complete necrosis, and 8 (22.2%) showed partial necrosis. Good agreement was found between the imaging performed 1-month after treatment and the complete pathological response. These data confirm the effectiveness of MW ablation to percutaneously treat HCC nodules smaller than 3 cm with a high sensitiveness of radiological imaging in detecting a complete response after ablation.Microwave (MW) ablation is a worldwide-diffused technique for the percutaneous ablation of hepatocellular carcinoma (HCC). Nevertheless, the efficacy of this technique still needs to be confirmed in pathological specimens. The purpose of this study was to evaluate the efficacy of MW ablation by correlation with histology in excised liver samples at the time of liver transplantation (LT). All patients with MW-ablated HCC who subsequently underwent LT between 2012 and 2020 were retrospectively evaluated. In the explanted livers, the treated lesions were evaluated at pathology, and the necrosis was classified as complete or partial. Thirty-six HCCs were ablated in 30 patients (20.9 ± 6.1 mm, a range of 10–30 mm). Ablations were performed with a single insertion of a MW antenna under ultrasound or CT guidance. A complete radiological response was demonstrated in 30/36 nodules (83.3%) in 24/30 patients (80%) at imaging performed one-month after MW ablation. At pathology, of the 36 treated nodules, 28 (77.8%) showed a complete necrosis, and 8 (22.2%) showed a pathological partial necrosis. Good agreement was found between the imaging performed one-month after treatment and the complete pathological response (Cohen’s k = 0.65). The imaging accuracy in detecting a complete response to treatment was 88.9%. All lesions with complete necrosis did not show recurrence at follow-up imaging until transplantation. The rad-path correlation in the explanted livers showed that MW ablation achieved a high rate of complete necrosis if a macroscopical complete ablation was obtained.

Proper technical procedures improved outcomes in a retrospective analysis of EVAS FORWARD IDE trial 3-year results

ObjectiveAdverse outcomes observed late in the Nellix EndoVascular Aneurysm Sealing (EVAS) System (Endologix, Inc, Irvine, Calif) investigational device exemption trial prompted refinement of the anatomic instructions for use (IFU). This study aimed to investigate the association of procedural factors during Nellix endograft deployment and patient outcomes. MethodsWe retrospectively reviewed 1-month imaging of 333 patients enrolled in the prospective, multicenter EVAS investigational device exemption trial between January 2014 and September 2016. Initial observations of those patients who met revised anatomic IFU yet still experienced late adverse events suggested that inadequate seal and low graft placement were common among these patients. Key procedural variables identified from a univariate analysis were applied to construct four cohorts stratified by procedural technical performance (technically adequate [P+] or technically inadequate [P−]) and the revised anatomic indications for use (anatomically within IFU [A+] or anatomically outside of IFU [A−]) and to compare them for aneurysm-related outcomes. A logistic regression analysis was performed to identify significant predictors of sac expansion or migration. ResultsProximal and distal seal zones and low graft placement were identified by logistic regression analysis as significant predictors of sac expansion or migration. Accordingly, acquisition of ≥10-mm proximal and distal seal zones and the position of the lowest stent within 10 mm of the lowest renal artery were clinically justified as thresholds for a technically adequate procedure. Patients who did not achieve these parameters were deemed to have a technically inadequate procedure. By use of the proposed procedural adequacy criteria and established anatomic criteria, patients were stratified into four cohorts: A+/P+ (n = 77), A+/P− (n = 54), A−/P+ (n = 71), and A−/P− (n = 131). Three-year estimates of freedom from migration of 10 mm were 98.6% in A+/P+, 95.9% in A+/P−, 85.8% in A−/P+, and 80.1% in A−/P−; freedom from type IA endoleak estimates were 98.6% in A+/P+, 100% in A+/P−, 96.4% in A−/ P+, and 90.3% in A−/P− cohorts. Freedom from sac expansion and secondary intervention were 96.9% and 90.6% in A+/P+, 86.0% and 93.6% in A+/P−, 87.1% and 83.1% in A−/P+, and 80.5% and 79.8% in A−/P− groups, respectively. Two early deaths (aneurysm-related mortality) on days 4 and 12 postoperatively were reported within the A+/P− group. Kaplan-Meier estimates of freedom from all-cause mortality and aneurysm-related mortality at 3 years were similar between cohorts. ConclusionsThis post hoc analysis suggests that achieving a 10-mm proximal and distal seal with adequate positioning of the endograft with respect to the renal arteries is associated with improved patient outcomes.

Cellular and Widefield Imaging of Sound Frequency Organization in Primary and Higher Order Fields of the Mouse Auditory Cortex.

The mouse auditory cortex (ACtx) contains two core fields-primary auditory cortex (A1) and anterior auditory field (AAF)-arranged in a mirror reversal tonotopic gradient. The best frequency (BF) organization and naming scheme for additional higher order fields remain a matter of debate, as does the correspondence between smoothly varying global tonotopy and heterogeneity in local cellular tuning. Here, we performed chronic widefield and two-photon calcium imaging from the ACtx of awake Thy1-GCaMP6s reporter mice. Data-driven parcellation of widefield maps identified five fields, including a previously unidentified area at the ventral posterior extreme of the ACtx (VPAF) and a tonotopically organized suprarhinal auditory field (SRAF) that extended laterally as far as ectorhinal cortex. Widefield maps were stable over time, where single pixel BFs fluctuated by less than 0.5 octaves throughout a 1-month imaging period. After accounting for neuropil signal and frequency tuning strength, BF organization in neighboring layer 2/3 neurons was intermediate to the heterogeneous salt and pepper organization and the highly precise local organization that have each been described in prior studies. Multiscale imaging data suggest there is no ultrasonic field or secondary auditory cortex in the mouse. Instead, VPAF and a dorsal posterior (DP) field emerged as the strongest candidates for higher order auditory areas.

Lipostructure Plus Platelet Rich Plasma Injections for Enophthalmos Treatment in Patients Carrying Prosthetic Eye- Safety and Efficacy

Purpose: To describe one-year functional and aesthetic outcomes in patients with post-enucleation enophthalmos who underwent lipostructure plus platelet-rich plasma injections. Materials and Methods: 26 patients treated with orbital lipostructure and three platelet rich plasma injections at 1, 2 and 6 months after surgery were retrospectively assessed. Photographs of all patients were taken preoperatively and at 1 and 12 months after surgery. The area of each eye lid esthetic unit/subunit was calculated, both in frontal and profile images. Statistical analysis was performed using SPSS software (SPSS Inc., Chicago, Illinois, USA). Paired t-test was used to compare the unit/subunit areas before and after surgery. Differences were considered significant when P <0.05. Results: Comparing baseline to 1-month images, an improvement of the enophthalmos appearance was observed in all patients. Analysis of each single esthetic units was performed, with an overall unit area reduction of 19.8%. Comparing the two postoperative images, the overall amount of resorption was 12.75%. The surgical procedure appeared to be well tolerated in all cases. Minor complications regarding the lower eyelid were recorded in 6 cases. Conclusions: lipostructure plus platelet rich plasma injections proved to be a valid and effective option for the treatment of post enucleation socket syndrome.

Spatiotemporal regression Kriging to predict precipitation using time-series MODIS data

Accurate prediction of the spatiotemporal distribution of precipitation is an important guide for more efficient agricultural production. However in the Xinjiang Uygur Autonomous Region, China, it is difficult to ensure accuracy due to sparse and unevenly distributed precipitation monitoring stations. The precipitation on raster grids must be predicted from point data. The combined China monthly mean meteorological data sets were used to build spatiotemporal geostatistical models to predict mean monthly precipitation in Xinjiang. Predictions in space and time were made for precipitation using spatiotemporal regression Kriging with some covariates. The Moderate Resolution Imaging Spectroradiometer 1-month images time series, topographic layers representing the normalized difference vegetation index and digital elevation model, and a temporal index to adjust for yearly periodic were used as covariates. The optimal covariates were selected by the all subset regression method to determine which predictor variables to be included in the multiple regression models. The accuracy of our mean monthly precipitation predictions was assessed by leave-one-out cross-validation. The prediction accuracy of the proposed spatiotemporal regression Kriging approach was compared with spatiotemporal multi-linear regression and spatiotemporal Kriging. These experimental results show that the normalized difference vegetation index, latitude, longitude, elevation, and time periodicity index are the optimal covariates for mean monthly precipitation prediction. The spatiotemporal distribution of precipitation in Xinjiang exhibits a distinctive pattern; in the north and west, there is more precipitation than in the south and east, respectively and more precipitation in the mountains than on the plains. Precipitation is closely related to topography. Annually, summer precipitation is the highest, followed by, spring and autumn, with winter the driest season in Xinjiang. Considering regression residuals the product---sum model was found to be suitable to fit the spatiotemporal variogram at higher accuracy. Precipitation maps generated by spatiotemporal regression Kriging were more accurate than those produced by the other tested methods, with lower MAE, RMSE, and BIAS values, and higher COR values for validation sampling sites. Spatiotemporal regression Kriging is an efficient method for accurate spatiotemporal prediction of precipitation in Xinjiang.

Results of a prospective multicenter trial of CTAG thoracic endograft

As thoracic aortic aneurysms (TAAs) are more frequently being treated with endografts, the anatomic challenges of the thoracic aorta have led to design modifications of endografts. The Conformable GORE TAG (CTAG) device (W. L. Gore & Associates, Flagstaff, Ariz) was specifically designed to be more conformable in tortuous anatomy, more resistant to compression, and more accommodating to various aortic diameters compared with the original GORE TAG device. This prospective, multicenter study evaluated the safety and effectiveness of the CTAG endograft in the repair of descending TAA. This was a prospective, multicenter regulatory study with a primary end point of freedom from major device event through 1 month after treatment. Two-year outcomes included aneurysm-related morbidity (endoleaks and morphology changes), aneurysm-related mortality, and all-cause mortality. Fifty-one patients were enrolled between October 2009 and October 2010, with at least one endograft implanted in 50 patients. After the regulatory study successfully completed its primary end point and expanded to a continued-access phase, 15 additional patients were enrolled in the continued-access arm of the study from February 2011 until September 2011, for a total treatment group of 66 patients for the early results and 65 patients for the long-term clinical results with imaging evaluation. There was one 30-day death (1.5%), two patients (3%) with spinal cord ischemia, and two central strokes (3%) ≤30 days. Five patients (7.6%) died ≤1 year; 1 of ascending aortic aneurysm rupture, 2 of cardiac disease, and 2 of respiratory failure. The core laboratory adjudicated 1-month imaging in 60 patients (92.3%), where nine endoleaks (15.0%) were identified (1 type Ia, 4 type II, and 4 indeterminate). Forty-five patients (69.2%) had 2-year imaging with five endoleaks (11.1%; two type II and three indeterminate), and one patient had a distal aortic dilatation that required a secondary intervention. At 2 years, 20 of 38 imaged patients (52.6%) had aneurysm shrinkage ≥5 mm, 15 (39.5%) had no change in diameter, and three patients (7.9%) had an increase in aneurysm diameter of ≥5 mm. There were no conversions, fractures, compressions, or aneurysm ruptures of the treated segment through 2 years. This next-generation thoracic endograft has a low rate of major device events through 2 years, with no graft compressions or device failures. The data for this new endograft demonstrate favorable outcomes and confirm low risks for treatment for patients with TAA. Follow-up will be continued for 5 years.

Safety and Efficacy of 70–150 μm and 100–300 μm Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma

PurposeTo compare the safety and efficacy of using 70–150 μm drug-eluting beads (DEBs) (LC BeadM1; Biocompatibles UK Ltd, Farnham, Surrey, United Kingdom) in addition to 100–300 μm DEBs with 100–300 μm DEBs alone in transarterial chemoembolization for treatment of hepatocellular carcinoma (HCC). Materials and MethodsA cohort of patients with HCC who underwent transarterial chemoembolization with two vials of 100–300 μm DEBs (group 1, 55 procedures among 42 patients, 33 men, average Model for End-Stage Liver Disease score 10 ± 0.6, 67% Child-Pugh A, 33% Child-Pugh B) was retrospectively compared with a cohort of patients who underwent transarterial chemoembolization with one vial of 70–150 μm DEBs followed by one vial of 100–300 μm DEBs (group 2, 51 procedures among 42 patients, 29 men, average Model for End-Stage Liver Disease score 9 ± 0.6, 73% Child-Pugh A, 27% Child-Pugh B) in regard to adverse events and response on 1-month follow-up imaging using modified Response Evaluation Criteria In Solid Tumors criteria. ResultsThere was no difference in 1-month imaging response (P = .3). Patients in group 2 were readmitted more often within 1 month for hepatobiliary adverse events (group 2, 25%; group 1, 9%; P < .0001), including ascites, gastrointestinal hemorrhage, biliary dilatation, and cholecystitis. ConclusionsDespite similar efficacy based on short-term follow-up imaging, transarterial chemoembolization with smaller DEBs (70–150 μm) followed by larger DEBs (100–300 μm) may cause more hepatobiliary adverse events.

A rare case of peripheral osteoma of the zygoma.

A rare case of peripheral osteoma of the zygoma.