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  • 1
    Language: English
    In: Seminars in interventional radiology, June 2013, Vol.30(2), pp.176-84
    Description: Standard treatment options in patients with lung cancer and pulmonary metastases are surgery, radiotherapy, chemotherapy, and immunotherapy. For reducing clinical complications of surgery and achieving a better local response, transpulmonary chemoembolization of the lungs is a possible interventional technique in which anticancer drugs are administered directly into a tumor through its feeding vessels followed by occlusive agents that are injected through the delivery catheter for blocking the vessel. This allows a longer contact period in the tumor with a higher cytostatic drug concentration. The technique is safe and results present promising local response rates, but the influence on survival is still questionable. This article describes the current role of intravascular therapies in the treatment of pulmonary malignancies.
    Keywords: Bronchial Artery Infusion ; Interventional Radiology ; Isolated Lung Perfusion ; Lung Suffusion ; Primary Lung Malignancy ; Secondary Lung Malignancy ; Transpulmonary Chemoembolization (Tpce)
    ISSN: 0739-9529
    E-ISSN: 10988963
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  • 2
    Language: English
    In: Visceral Medicine, December 2015, Vol.31(6), pp.406-413
    Description: Background: The purpose of this review is to demonstrate the clinical indications, technical developments, and outcome of liver-directed therapies in interventional oncology of non-colorectal liver metastases. Methods: Liver-directed therapies are classified into vascular transarterial techniques such as chemoperfusion (TACP), chemoembolization (TACE), radioembolization (selective internal radiation therapy (SIRT)), and chemosaturation, as well as thermal ablation techniques like microwave ablation (MWA), radiofrequency ablation (RFA), laser-induced thermotherapy (LITT), cryotherapy, and irreversible electroporation (IRE). The authors searched the database PubMed using the following terms: ‘image-guided tumor ablation', ‘thermal ablation therapies', ‘liver metastases of uveal melanoma', ‘neuroendocrine carcinoma', ‘breast cancer', and ‘non-colorectal liver metastases'. Results: Various combinations of the above-mentioned therapy protocols are possible. In neuroendocrine carcinomas, oligonodular liver metastases are treated successfully via thermal ablation like RFA, LITT, or MWA, and diffuse involvement via TACE or SIRT. Although liver involvement in breast cancer is a systemic disease, non-responding nodular metastases can be controlled via RFA or LITT. In ocular or cutaneous melanoma, thermal ablation is rarely considered as an interventional treatment option, as opposed to TACE, SIRT, or chemosaturation. Rarely liver-directed therapies are used in pancreatic cancer, most likely due to problems such as biliary digestive communications after surgery and the risk of infections. Rare indications for thermal ablation are liver metastases of other primary cancers like non-small cell lung, gastric, and ovarian cancer. Conclusion: Interventional oncological techniques play a role in patients with liver-dominant metastases.
    Keywords: Review Article ; Microwave Ablation ; Non-Colorectal Liver Metastases ; Radiofrequency Ablation ; Laser Ablation
    ISBN: 9783318030457
    ISBN: 3318030457
    ISSN: 2297-4725
    ISSN: 16626664
    E-ISSN: 2297-475X
    E-ISSN: 16626672
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  • 3
    Language: English
    In: European Journal of Radiology, 2010, Vol.75(1), pp.48-56
    Description: Evaluation of percutaneous recanalization of obstructed iliac as well as superficial femoral arteries (SFAs) in patients with peripheral arterial obstructive disease (PAOD). The data of 195 consecutive patients with 285 obstructions of the common and or external iliac artery as well as the data of 452 consecutive patients with 602 long occlusions (length 〉 5 cm) of the SFA were retrospectively analyzed. The lesions were either treated with percutaneous transluminal angioplasty (PTA) or Excimer laser assisted percutaneous transluminal angioplasty (LPTA). Overall 316 stents were implanted (Nitinol stents: 136; stainless steel stents: 180) in the iliac artery and 669 stents were implanted (Nitinol stents: 311; Easy Wallstents: 358) in the SFA. The follow-up period was 36–65 months (mean 46.98 ± 7.11 months) postinterventionally using clinical examination, ABI calculation, and color-coded duplex sonography. Patency rates were calculated on the basis of the Kaplan–Meier analysis. The overall primary technical success rate was 97.89% for the iliac arteries and 92.35% for the SFA. Minor complications (hematoma, distal emboli and vessel dissection) were documented in 11.79% for the iliac arteries and 7.97% for the SFA. The primary patency rate was 90.3% for the iliac and 52.8% for the SFA after 4 years. The secondary patency rate was 96.84% for the iliac and 77.8% for the SFA after 4 years. Percutaneous recanalization of iliac and superficial femoral artery obstructions is a safe and effective technique for the treatment of patients with PAOD. By consequent clinical monitoring high secondary patency rates can be achieved. The use of a stents seems to result in higher patency rate especially in the SFA when compared to the literature in long-term follow-up.
    Keywords: Paod ; Iliac Arteries ; Superficial Femoral Artery ; Stent ; Angioplasty ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 4
    Language: English
    In: European Radiology, 2015, Vol.25(2), pp.454-462
    Description: Byline: Emmanuel C. Mbalisike (1), Thomas J. Vogl (2), Stefan Zangos (2), Katrin Eichler (2), Prakash Balakrishnan (3), Jijo Paul (2) Keywords: Microwave thermoablation; Robotic guided approach; Procedural accuracy; Hepatic tumours; Patient dose Abstract: Objective To evaluate and compare novel robotic guidance and manual approaches based on procedural accuracy, procedural time, procedural performance, image quality as well as patient dose during image-guided microwave thermoablation. Method The study was prospectively performed between June 2013 and December 2013 using 70 patients. Forty randomly selected patients (group 1) were treated with manual guidance and 30 patients (group 2) were treated using a novel robotic guidance. Parameters evaluated were procedural accuracy, total procedural time, procedural performance, quantitative/qualitative image quality and patient dose. Two-sided Student's t test and Wilcoxon rank-sum test were used to test the significance of the data and p values less than 0.05 were considered statistically significant. Result Accuracy parameters were significantly higher in group 2 (all p〈0.05). Total procedural time showed a mean time difference of 3 min (group 2〉group 1 p=0.0008). Volume CT dose index and dose--length product were significantly lower for group 2 compared to group 1 (all p〈0.05) for CT fluoroscopy imaging. Total procedural performance score was higher for group 2 compared to group 1 (p=0.0001). Image quality parameters were insignificant between examined groups. Conclusion The novel robotic guided approach improved the accuracy of targeting the target tumour, reduced patient dose and increased procedural performance (which influences the procedural safety) during ablation. Key Points acents Few reports are available in the literature regarding robotic-assisted liver microwave ablation. acents The robotic guided approach improved accuracy of localizing the target tumour. acents Radiation dose on patients was reduced with the robotic guidance. acents Numbers of insertions and readjustments were reduced, lowering chances of complications. Author Affiliation: (1) Institute for Diagnostic and Interventional Radiology, Klinikum Bad Salzungen, Lindigalle 3, 36433, Bad Salzungen, Germany (2) Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany (3) Perfint Healthcare Pvt. Ltd. (HO), No. 16, Southwest Boag Road, T. Nagar, Chennai, 600017, TN, India Article History: Registration Date: 13/08/2014 Received Date: 31/03/2014 Accepted Date: 13/08/2014 Online Date: 23/08/2014
    Keywords: Microwave thermoablation ; Robotic guided approach ; Procedural accuracy ; Hepatic tumours ; Patient dose
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 5
    Language: English
    In: European Radiology, 2010, Vol.20(1), pp.173-180
    Description: The purpose of this study was to evaluate the efficacy of transarterial chemoembolization (TACE) using different drug combinations in the treatment of breast cancer liver metastases in terms of local tumor control and survival rate. A total of 208 patients (mean age 56.4 years, range 29–81) with unresectable hepatic metastases of breast cancer were repeatedly treated with TACE at 4-week intervals. In total, 1,068 chemoembolizations were performed (mean 5.1 sessions/patient, range 3–25). The chemotherapy protocol consisted of mitomycin-C only (8 mg/m 2 ; n  = 76), mitomycin-C with gemcitabine ( n  = 111), and gemcitabine only (1,000 mg/m 2 ; n  = 21). Embolization was performed with lipiodol and starch microspheres. Tumor response was evaluated by MRI according to RECIST criteria. Survival rates were calculated using Kaplan-Meier method. For all protocols, local tumor control was partial response 13% (27/208), stable disease 50.5% (105/208), and progressive disease 36.5% (76/208). The 1-, 2-, and 3-year survival rates after TACE were 69, 40, and 33%. Median and mean survival times from the start of TACE were 18.5 and 30.7 months. Treatment with mitomycin-C only showed median and mean survival times of 13.3 and 24 months, with gemcitabine only they were 11 and 22.3 months, and with a combination of mitomycin-C and gemcitabine 24.8 and 35.5 months. TACE is an optional therapy for treatment of liver metastases in breast cancer patients with better results from the combined chemotherapy protocol.
    Keywords: Breast cancer ; Laser ablation ; Liver metastases ; Chemoembolization
    ISSN: 0938-7994
    E-ISSN: 1432-1084
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  • 6
    Language: English
    In: Acta Radiologica, May 2012, Vol.53(4), pp.435-440
    Description: Background Today's gold standard for diagnostic imaging of inflammatory diseases of the paranasal sinus is computed tomography (CT). Purpose To evaluate diagnostic sensitivity and radiation dose of an ultra-low dose dual-source CT technique. Material and Methods Paranasal sinuses of 14 cadaveric heads were independently evaluated by two readers using a modern dual-source CT with lowest reasonable dosage in high-pitch mode (100 kV, 10 mAs, collimation 0.6 mm, pitch value 3.0). Additionally the head part of an anthropomorphic Alderson-Rando phantom was equipped with thermoluminiscent detectors to measure radiation exposure to the eye lenses and thyroid gland. Results Diagnostic accuracy regarding sinusoidal fluid, nasal septum deviation, and mucosal swelling was 100%. Mastoid fluid was detected in 76% and 92%, respectively. In the phantom study, average measured eye lens dosage was 0.64 mGy; radiation exposure of the thyroid gland was 0.085 mGy. Conclusion Regarding evaluation of inflammatory diseases of the paranasal sinus this study indicates sufficient accuracy of the proposed CT protocol at a very low dosage level.
    Keywords: Radiation Dose ; Dual-Source Computed Tomography ; Paranasal Sinus ; Medicine
    ISSN: 0284-1851
    E-ISSN: 1600-0455
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  • 7
    In: Journal of Thoracic Imaging, 2012, Vol.27(6), pp.382-386
    Description: PURPOSE:: The purpose of this study was to objectively analyze motion artifacts on thoracic computed tomography (CT) with dual-source high-pitch and single-source techniques when using a no–breath-hold technique to examine patients who have difficulty complying with breath-holding instructions. MATERIALS AND METHODS:: A total of 120 patients who received CT of the thorax with a free-breathing technique in single-source (16 slices and 128 slices; pitch=1.2) and dual-source (pitch=3.0) manners were evaluated retrospectively. In each of the 3 study groups, movements of the diaphragm and pulsations of the aortic root and main pulmonary artery were analyzed for their number and severity (blurred distance). RESULTS:: No motion artifacts of the diaphragm were identified using a pitch of 3.0 (compared with n=14 for single-source CT using 128 slices and n=24 using 16-slice CT). In single-source examinations, the severity of artifacts was similar between 128-slice CT and 16-slice CT: blurring distance of the lung parenchyma due to diaphragm movements was 14 versus 16 mm, and double contours of the aorta were measured as 8 and 9 mm, respectively. CONCLUSIONS:: A high-pitch, dual-source mode is potentially advantageous for evaluating the lung parenchyma and vascular structures in patients who have difficulty complying with breath-holding instructions. Increasing from 16 to 128 slices can significantly reduce the number and severity of motion artifacts.
    Keywords: Artifacts–Methods ; Female–Methods ; Humans–Methods ; Male–Methods ; Middle Aged–Methods ; Motion–Methods ; Radiographic Image Interpretation, Computer-Assisted–Methods ; Radiography, Thoracic–Methods ; Respiration–Methods ; Retrospective Studies–Methods ; Thorax–Methods ; Tomography, X-Ray Computed–Methods;
    ISSN: 0883-5993
    E-ISSN: 15360237
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  • 8
    Language: English
    In: European Journal of Radiology, December 2012, Vol.81(12), pp.4138-4142
    Description: To evaluate the radiation exposure for operating personel associated with rotational flat-panel angiography and C-arm cone beam CT. Using a dedicated angiography-suite, 2D and 3D examinations of the liver were performed on a phantom to generate scattered radiation. Exposure was measured with a dosimeter at predefined heights (eye, thyroid, breast, gonads and knee) at the physician's location. Analysis included 3D procedures with a field of view (FOV) of 24 cm × 18 cm (8 s/rotation, 20 s/rotation and 5 s/2 rotations), and 47 cm × 18 cm (16 s/2 rotations) and standard 2D angiography (10 s, FOV 24 cm × 18 cm). Measurements showed the highest radiation dose at the eye and thyroid level. In comparison to 2D-DSA (3.9 μSv eye-exposure), the 3D procedures caused an increased radiation exposure both in standard FOV (8 s/rotation: 28.0 μSv, 20 s/rotation: 79.3 μSv, 5 s/2 rotations: 32.5 μSv) and large FOV (37.6 μSv). Proportional distributions were measured for the residual heights. With the use of lead glass, irradiation of the eye lens was reduced to 0.2 μSv (2D DSA) and 10.6 μSv (3D technique with 20 s/rotation). Rotational flat-panel angiography and C-arm cone beam applications significantly increase radiation exposure to the attending operator in comparison to 2D angiography. Our study indicates that the physician should wear protective devices and leave the examination room when performing 3D examinations.
    Keywords: Flat-Panel Computed Tomography ; Angiography ; Interventional CT ; Cone-Beam CT ; Radiation Exposure ; Medicine
    ISSN: 0720-048X
    E-ISSN: 1872-7727
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  • 9
    Language: English
    In: Journal of Vascular and Interventional Radiology, March 2014, Vol.25(3), pp.347-354
    Description: To determine the minimal follow-up time point to predict therapeutic response to radiofrequency (RF) ablation of lung tumors. A retrospective study design was approved by the institutional review board. From January 2008 to January 2010, 78 patients (46 men and 32 women; mean age, 58.9 y) underwent computed tomography (CT)–guided percutaneous RF ablation of pulmonary malignancies. A single RF multitined electrode was used to treat 100 index tumors, 6 primary lesions, and 94 metastatic lesions. CT volumetric measurements of ablated tumors were made before ablation and 24 hours, 3–6 weeks, 3 months, 6 months, 9 months, and 12 months after ablation. An unpaired test and Spearman rank correlation coefficient were used to analyze the volumetric changes. Complete successful ablation was achieved in 80% of index tumors. The mean time to detection of tumor residue or recurrence tumor residue or recurrence was 6.7 months after ablation. In successfully ablated lesions, the mean volume before ablation was 1.81 cm (standard deviation [SD], 1.71); in failed ablation lesions, the mean volume before ablation was 2.58 cm (SD, 2.8) ( = .42). The earliest statistically significant follow-up time point that showed a difference in the volumetric measurements of failed and successful ablations as well as the earliest significant correlation with the 12-month point was 3 months ( = .025, Spearman = 0.72). Secondary tumor control after repeat ablation was statistically significant for lesions ablated at a 3-month interval (four out of five lesions) ( = .04). CT volumetric assessment of ablated tumors revealed that 3 months was the earliest time point that may determine the response of a pulmonary ablation or repeat intervention.
    Keywords: Medicine
    ISSN: 1051-0443
    E-ISSN: 1535-7732
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  • 10
    Language: English
    In: AJR. American journal of roentgenology, January 2011, Vol.196(1), pp.W66-72
    Description: The purpose of this study was to evaluate local tumor control and survival after use of a downstaging protocol of repeated transarterial chemoembolization (TACE) with two chemotherapeutic combinations followed by laser-induced thermotherapy in the care of patients with liver metastasis of breast cancer. This prospective study included 161 patients with liver metastasis of breast cancer origin. TACE (mean, 3.5 [SD, 1.3] sessions per patient; range, 1-9 sessions) was performed as downstaging treatment to achieve the size and number of metastatic lesions that met the requirements for laser-induced thermotherapy (diameter 〈 5 cm, number ≤ 5). The TACE protocol was performed with either mitomycin C alone (n = 53) or mitomycin C in combination with gemcitabine (n = 108). In response to TACE overall, the mean reduction in diameter based on the longest diameter of the target lesions was 27%. The difference between diameter reduction in the mitomycin C group and that in the mitomycin C-gemcitabine group was not statistically significant (p = 0.65). The mean survival time of all patients was 32.5 months, calculation starting from the first TACE treatment. The mean local tumor control period calculated as of completion of therapy was 13 months, and the mean time to progression was 8 months. In the mitomycin-gemcitabine group, mean time to progression was 10.7 months, and in the mitomycin group it was 6.9 months (p = 0.5). TACE can be used for sufficient downstaging of liver metastatic lesions of breast cancer to allow laser-induced thermotherapy. A combination of mitomycin C and gemcitabine seems to improve the reduction achieved with TACE.
    Keywords: Antineoplastic Combined Chemotherapy Protocols -- Therapeutic Use ; Breast Neoplasms -- Pathology ; Chemoembolization, Therapeutic -- Methods ; Laser Therapy -- Methods ; Liver Neoplasms -- Therapy
    ISSN: 0361803X
    E-ISSN: 1546-3141
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