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Parvinian A, Thompson SM, Schmitz JJ, Welch BT, Hibbert R, Adamo DA, Kurup AN. Update on Percutaneous Ablation for Sarcoma. Curr Oncol Rep 2024:10.1007/s11912-024-01532-7. [PMID: 38647995 DOI: 10.1007/s11912-024-01532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW To provide an update on the current state of percutaneous thermal ablation in the treatment of sarcoma. RECENT FINDINGS Data continue to accrue in support of ablation for local control and palliation of specific sarcoma subtypes such as extra-abdominal desmoid fibromatosis and for broader indications such as the treatment of oligometastatic disease. The synergistic possibilities of various combination therapies such as cryoablation and immunotherapy represent intriguing areas of active investigation. Histotripsy is an emerging non-invasive, non-thermal ablative modality that may further expand the therapeutic arsenal for sarcoma treatment. Percutaneous thermal ablation is a valuable tool in the multidisciplinary management of sarcoma, offering a minimally invasive adjunct to surgery and radiation therapy. Although there remains a paucity of high-level evidence specific to sarcomas, ablation techniques are demonstrably safe and effective for achieving local tumor control and providing pain relief in select patients and are of particular benefit in those with metastatic disease or requiring palliative care.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Rebecca Hibbert
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Nakai H, Nagayama H, Takahashi H, Froemming AT, Kawashima A, Bolan CW, Adamo DA, Carter RE, Fazzio RT, Tsuji S, Lomas DJ, Mynderse LA, Humphreys MR, Dora C, Takahashi N. Cancer Detection Rate and Abnormal Interpretation Rate of Prostate MRI in Patients With Low-Grade Cancer. J Am Coll Radiol 2024; 21:387-397. [PMID: 37838189 DOI: 10.1016/j.jacr.2023.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE The aim of this study was to evaluate the utility of cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI for patients with low-grade prostate cancer (PCa). METHODS This three-center retrospective study included patients who underwent prostate MRI from 2017 to 2021 with known low-grade PCa (Gleason score 6) without prior treatment. Patient-level highest Prostate Imaging Reporting & Data System (PI-RADS®) score and pathologic diagnosis within 1 year after MRI were used to evaluate the diagnostic performance of prostate MRI in detecting clinically significant PCa (csPCa; Gleason score ≥ 7). The metrics AIR, CDR, and CDR adjusted for pathologic confirmation rate were calculated. Radiologist-level AIR-CDR plots were shown. Simulation AIR-CDR lines were created to assess the effects of different diagnostic performances of prostate MRI and the prevalence of csPCa. RESULTS A total of 3,207 examinations were interpreted by 33 radiologists. Overall AIR, CDR, and CDR adjusted for pathologic confirmation rate at PI-RADS 3 to 5 (PI-RADS 4 and 5) were 51.7% (36.5%), 22.1% (18.8%), and 30.7% (24.6%), respectively. Radiologist-level AIR and CDR at PI-RADS 3 to 5 (PI-RADS 4 and 5) were in the 36.8% to 75.6% (21.9%-57.5%) range and the 16.3%-28.7% (10.9%-26.5%) range, respectively. In the simulation, changing parameters of diagnostic performance or csPCa prevalence shifted the AIR-CDR line. CONCLUSIONS The authors propose CDR and AIR as performance metrics in prostate MRI and report reference performance values in patients with known low-grade PCa. There was variability in radiologist-level AIR and CDR. Combined use of AIR and CDR could provide meaningful feedback for radiologists to improve their performance by showing relative performance to other radiologists.
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Affiliation(s)
| | - Hiroki Nagayama
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | | | - Adam T Froemming
- Division Chair of Abdominal Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Candice W Bolan
- Chief, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Vice Chair, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Robert T Fazzio
- Division Chair of Breast Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Chandler Dora
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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Nagayama H, Nakai H, Takahashi H, Froemming AT, Kawashima A, Bolan CW, Adamo DA, Carter RE, Fazzio RT, Tsuji S, Lomas DJ, Mynderse LA, Humphreys MR, Dora C, Takahashi N. Cancer Detection Rate and Abnormal Interpretation Rate of Prostate MRI Performed for Clinical Suspicion of Prostate Cancer. J Am Coll Radiol 2024; 21:398-408. [PMID: 37820833 DOI: 10.1016/j.jacr.2023.07.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To report cancer detection rate (CDR) and abnormal interpretation rate (AIR) in prostate MRI performed for clinical suspicion of prostate cancer (PCa). MATERIALS AND METHODS This retrospective single-institution, three-center study included patients who underwent MRI for clinical suspicion of PCa between 2017 and 2021. Patients with known PCa were excluded. Patient-level Prostate Imaging-Reporting and Data System (PI-RADS) score was extracted from the radiology report. AIR was defined as number of abnormal MRI (PI-RADS score 3-5) / total number of MRIs. CDR was defined as number of clinically significant PCa (csPCa: Gleason score ≥7) detected at abnormal MRI / total number of MRI. AIR, CDR, and CDR adjusted for pathology confirmation rate were calculated for each of three centers and pre-MRI biopsy status (biopsy-naive and previous negative biopsy). RESULTS A total of 9,686 examinations (8,643 unique patients) were included. AIR, CDR, and CDR adjusted for pathology confirmation rate were 45.4%, 23.8%, and 27.6% for center I; 47.2%, 20.0%, and 22.8% for center II; and 42.3%, 27.2%, and 30.1% for center III, respectively. Pathology confirmation rate ranged from 81.6% to 88.0% across three centers. AIR and CDR for biopsy-naive patients were 45.5% to 52.6% and 24.2% to 33.5% across three centers, respectively, and those for previous negative biopsy were 27.2% to 39.8% and 11.7% to 14.2% across three centers, respectively. CONCLUSION We reported CDR and AIR in prostate MRI for clinical suspicion of PCa. CDR needs to be adjusted for pathology confirmation rate and pre-MRI biopsy status for interfacility comparison.
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Affiliation(s)
- Hiroki Nagayama
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Radiology, Nagasaki University School of Medicine, Nagasaki, Japan
| | | | | | - Adam T Froemming
- Division Chair of the Abdominal Imaging in Minnesota, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Candice W Bolan
- Chief, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Vice Chair, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Robert T Fazzio
- Division Chair of the Breast Imaging, Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Chandler Dora
- Department of Urology, Mayo Clinic, Jacksonville, Florida
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Adamo DA, Greenwood BM, Ghanouni P, Arora S. MR Imaging-Guided Prostate Cancer Therapies. Radiol Clin North Am 2024; 62:121-133. [PMID: 37973238 DOI: 10.1016/j.rcl.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Prostate cancer is the most common malignancy diagnosed in men. MR imaging-guided therapies for prostate cancer have become an increasingly common treatment alternative to traditional whole-gland therapies, such as radical prostatectomy or radiation therapy. This is especially true in men with localized, low- to intermediate-risk prostate cancer. Although long-term oncologic data remain limited, the authors describe several MR imaging-guided therapeutic options for the treatment of prostate cancer, including cryoablation, laser ablation, transrectal high-intensity focused ultrasound, and transurethral ultrasound ablation.
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Affiliation(s)
- Daniel A Adamo
- Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | | | - Pejman Ghanouni
- Department of Radiology, Stanford University, Lucas Center for Imaging, 1201 Welch Road, Room P267, Stanford, CA 94305, USA
| | - Sandeep Arora
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, 330 Cedar Street, TE-2, PO Box 208042, New Haven, CT 06520-8042, USA.
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Nakai H, Takahashi H, Adamo DA, LeGout JD, Kawashima A, Thomas JV, Froemming AT, Kuanar S, Lomas DJ, Humphreys MR, Dora C, Takahashi N. Decreased prostate MRI cancer detection rate due to moderate to severe susceptibility artifacts from hip prosthesis. Eur Radiol 2023:10.1007/s00330-023-10345-4. [PMID: 37889268 DOI: 10.1007/s00330-023-10345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES To evaluate the impact of susceptibility artifacts from hip prosthesis on cancer detection rate (CDR) in prostate MRI. MATERIALS AND METHODS This three-center retrospective study included prostate MRI studies for patients without known prostate cancer between 2017 and 2021. Exams with hip prosthesis were searched on MRI reports. The degree of susceptibility artifact on diffusion-weighted images was retrospectively categorized into mild, moderate, and severe (> 66%, 33-66%, and < 33% of the prostate volume are evaluable) by blind reviewers. CDR was defined as the number of exams with Gleason score ≥7 detected by MRI (PI-RADS ≥3) divided by the total number of exams. For each artifact grade, control exams without hip prosthesis were matched (1:6 match), and CDR was compared. The degree of CDR reduction was evaluated with ratio, and influential factors were evaluated by expanding the equation. RESULTS Hip arthroplasty was present in 548 (4.8%) of the 11,319 MRI exams. CDR of the cases and matched control exams for each artifact grade were as follows: mild (n = 238), 0.27 vs 0.25, CDR ratio = 1.09 [95% CI: 0.87-1.37]; moderate (n = 143), 0.18 vs 0.27, CDR ratio = 0.67 [95% CI: 0.46-0.96]; severe (n = 167), 0.22 vs 0.28, CDR ratio = 0.80 [95% CI: 0.59-1.08]. When moderate and severe artifact grades were combined, CDR ratio was 0.74 [95% CI: 0.58-0.93]. CDR reduction was mostly attributed to the increased frequency of PI-RADS 1-2. CONCLUSION With moderate to severe susceptibility artifacts from hip prosthesis, CDR was decreased to 74% compared to the matched control. CLINICAL RELEVANCE STATEMENT Moderate to severe susceptibility artifacts from hip prosthesis may cause a non-negligible CDR reduction in prostate MRI. Expanding indications for systematic prostate biopsy may be considered when PI-RADS 1-2 was assigned. KEY POINTS • We proposed cancer detection rate as a diagnostic performance metric in prostate MRI. • With moderate to severe susceptibility artifacts secondary to hip arthroplasty, cancer detection rate decreased to 74% compared to the matched control. • Expanding indications for systematic prostate biopsy may be considered when PI-RADS 1-2 is assigned.
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Affiliation(s)
| | | | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - John V Thomas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Shiba Kuanar
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Derek J Lomas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | - Chandler Dora
- Department of Urology, Mayo Clinic, Jacksonville, FL, USA
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Pitot MA, Gu CN, Adamo DA, Kurup AN, Schmitz JJ, Packard AT. Safety and accuracy of aortic and periaortic CT-guided percutaneous core needle biopsy. Abdom Radiol (NY) 2023; 48:2148-2156. [PMID: 36939909 DOI: 10.1007/s00261-023-03867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The purpose of this study was to determine the safety and accuracy of aortic and periaortic computed tomography (CT)-guided percutaneous core needle biopsy performed at a single center over 12 years. MATERIALS AND METHODS A retrospective review was conducted of cases performed between February 2010 and August 2022 in which the biopsied region was in direct contact with the aorta or great vessels including the pericardium and common iliac arteries. Clinical notes were reviewed for any early or delayed complications following the procedure, which if present were graded using the National Institute of Health's Common Terminology Criteria for Adverse Events, version 5.0. Pathology results were compared to subsequent outside biopsy results or follow-up surgical pathology, if available, as well as subsequent clinical decision making and/or clinical course, to determine concordance. Sensitivity, specificity, predictive value, and accuracy (indicative of diagnostic yield) were calculated. RESULTS 32 core needle biopsies were reviewed from 30 patients (average lesion longest diameter 3.1 cm, range 0.5-10.9 cm; average needle proximity to the vessel endothelium or deep side of the pericardium 1.0 cm, range 0.3-1.8 cm). Complications occurred in 46.9% of cases (15/32), 93.3% (14/15) of which were minor and included small amounts of bleeding or pain. One patient developed a small nonemergent pneumothorax. Of biopsies obtained, 96.9% provided adequate tissue for diagnosis (31/32). When evaluating concordance between pathological and final diagnosis, sensitivity was 94.7% and specificity was 83.3%; positive and negative predictive value were 90.0% and 90.9%, respectively. Accuracy (diagnostic yield) of biopsy was 90.3%. CONCLUSION CT-guided percutaneous aortic and periaortic core needle biopsies are safe and efficacious procedures with high diagnostic yield.
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Affiliation(s)
- Marika A Pitot
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Chris N Gu
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Anil Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Annie T Packard
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
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Ehman EC, Adamo DA, Welch BT, Thompson SM, Uyeda JW. Toolkit for young professionals: how to get involved in the society of abdominal radiology-workshops, disease focus panels, emerging technology committees, and more. Abdom Radiol (NY) 2021; 46:5466-5470. [PMID: 34086092 DOI: 10.1007/s00261-021-03138-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022]
Abstract
The Society of Abdominal Radiology (SAR) has grown rapidly in the last decade and with growth comes opportunity. The purpose of this article is to highlight the many potential ways in which early career radiologists (those within the first 7 years of their career) can become involved with the SAR, both at the annual meeting and throughout the year. At the annual meeting, there are opportunities for presentation of scientific sessions as well as submission of clinically oriented workshops. Workshops are a great way to develop presentation skills and highlight subspecialty clinical expertise. Disease focus panels (DFPs) and Emerging Technology Committees (ETCs) meet at the annual meeting but continue their work throughout the year, targeting improvements in clinical care and research. Finally, a variety of volunteer staffed committees are essential to the fulfillment of the mission of the SAR, and several of these are targeted at involving early career members, providing opportunities for leadership and exposure to other members of the society.
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Affiliation(s)
- Eric C Ehman
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Scott M Thompson
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Jennifer W Uyeda
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
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Bowman AW, Tan N, Adamo DA, Chen F, Venkatesh SK, Baumgarten DA. Implementation of peer learning conferences throughout a multi-site abdominal radiology practice. Abdom Radiol (NY) 2021; 46:5489-5499. [PMID: 33999282 DOI: 10.1007/s00261-021-03114-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To initiate a peer learning conference for our abdominal radiology division across multiple geographically separated sites and different time zones, and to determine radiologist preference for peer learning versus traditional score-based peer review. METHODS We implemented a monthly peer learning videoconference for our abdominal radiology division. Surveys regarding radiologist opinion regarding traditional peer review and the new peer learning conferences were conducted before and after 6 months of conferences. RESULTS Peer learning conferences were well attended across our multiple sites, with an average of 43 participants per conference. Radiologist opinion regarding peer review was poor, with survey radiologists responding positively to only 1 out of 12 process questions. Opinion regarding peer learning was extremely favorable, with radiologists responding positively to 12 out of the same 12 process questions. After 6 months of peer learning conferences, 87.9% of surveyed radiologists wished to continue them in some fashion, and no one preferred to return to score-based peer review alone. CONCLUSION We successfully implemented a peer learning conference for our abdominal radiology division spread out over multiple geographic sites. Our radiologists strongly preferred peer learning conferences over our traditional peer review system for quality control.
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Affiliation(s)
- Andrew W Bowman
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Nelly Tan
- Department of Radiology, Mayo Clinic, 5777 Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Frederick Chen
- Department of Radiology, Mayo Clinic, 5777 Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Sudhakar K Venkatesh
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Deborah A Baumgarten
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
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Augustine MR, Thompson SM, Powell GM, Koepsel EK, Adamo DA, Bendel EC, Anderson KR, Bjarnason H, Tollefson M, Woodrum DA. Percutaneous MR Imaging-Guided Laser Ablation and Cryoablation for the Treatment of Pediatric and Adult Symptomatic Peripheral Soft Tissue Vascular Anomalies. J Vasc Interv Radiol 2021; 32:1417-1424. [PMID: 34332090 DOI: 10.1016/j.jvir.2021.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of percutaneous magnetic resonance (MR) imaging-guided laser ablation and cryoablation for the treatment of symptomatic soft tissue vascular anomalies (VAs) of the trunk and extremities. MATERIALS AND METHODS An institutional review board-approved retrospective review was undertaken of all pediatric and adult patients who underwent MR imaging-guided and monitored laser ablation and/or cryoablation for the treatment of symptomatic peripheral soft tissue VA. Preablation and postablation MR imaging was independently reviewed. Pain scores on the visual analog scale (0 to 10) and self-reported subjective symptomatic improvement were assessed. Change in VA size and pain scores were compared using a paired t test. RESULTS Thirty patients (24 females; age, 10-75 years) with 34 VAs were treated for moderate to severe pain (n = 27) or swelling/mass effect (n = 3) with 60 total ablation sessions. The baseline maximum VA diameter was 9.5 cm ± 8.6. At baseline, all VAs (100%) demonstrated variable T2-weighted signal hyperintensity and enhancement. The baseline pain score was 6.4 ± 1.6. Clinical follow-up was available for 23 patients. At a mean follow-up time of 12.2 months ± 10.1, 19 of 20 (95%) patients treated for pain and 2 of 3 (67%) patients treated for swelling/mass effect reported partial or complete symptomatic relief. There was a significant decrease in the postablation pain scores (-5.7 ± 1.0, P < .001) and maximum VA size (-2.3 cm ± 2.7, P = .004), with >50% reduction in VA T2 signal (59%) and enhancement (73%). Nine of 30 (30%) patients experienced minor complications. CONCLUSIONS MR imaging-guided and monitored percutaneous laser ablation and cryoablation appear to be safe and effective for the treatment of symptomatic peripheral soft tissue VAs.
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Affiliation(s)
| | | | | | | | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Emily C Bendel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Megha Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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Nisar US, Erickson LA, Folpe AL, Hartley CP, Littrell LA, Adamo DA, Sturgis CD. Eccrine angiomatous hamartoma: First case in the cytology literature. Ann Diagn Pathol 2021; 54:151796. [PMID: 34311301 DOI: 10.1016/j.anndiagpath.2021.151796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 11/28/2022]
Abstract
A 34-year-old male presented with a swelling on the volar surface of the third digit of his right hand. This swelling was associated with pain and erythema. Ultrasound-guided needle biopsy was performed. Cytologic and histologic preparations together confirmed the diagnosis of a rarely encountered mixed epithelial and mesenchymal proliferation, an eccrine angiomatous hamartoma. To our knowledge, this case is the first to illustrate the cytomorphologic features of this rare lesion.
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Affiliation(s)
- U Salma Nisar
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | | | | | | | - Charles D Sturgis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA.
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Abstract
Acute appendiceal diverticulitis is a difficult prospective diagnosis due to both its rarity and clinical overlap with other ileocecal diseases, such as acute appendicitis. Few preoperative radiological images of acute appendiceal diverticulitis have been presented in the literature. We report a case of acute appendiceal diverticulitis initially diagnosed with outpatient ultrasound and confirmed with contrast-enhanced computed tomography in an 85-year-old male who presented with right lower quadrant pain. Appendiceal diverticulitis is an often overlooked diagnosis, and given its association with appendiceal neoplasms and relatively high rate of perforation, it is important to consider this entity in patients with right lower quadrant pain in order to ensure that they are managed appropriately. The addition of high quality ultrasound and computed tomography (CT) images to the literature may heighten awareness of this rare condition and facilitate accurate preoperative diagnosis and management in these patients.
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Affiliation(s)
- James M Williams
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905 USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905 USA
| | - Michael C Olson
- Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905 USA
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Jang S, Schmitz JJ, Atwell TD, Welch TL, Welch BT, Hobday TJ, Adamo DA, Moynagh MR. Percutaneous Image-Guided Core Needle Biopsy of Neuroendocrine Tumors: How Common Is Intraprocedural Carcinoid Crisis? J Vasc Interv Radiol 2021; 32:745-751. [PMID: 33608193 DOI: 10.1016/j.jvir.2021.01.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To retrospectively evaluate the incidence of carcinoid crisis, other complications, and physiologic disturbances during percutaneous image-guided core needle biopsy of neuroendocrine tumors (NETs) in the lung and the liver. MATERIALS AND METHODS Between January 2010 and January 2020, 106 computed tomography (CT) or ultrasound (US)-guided core needle biopsies of lung and liver NETs were performed in 95 consecutive adult patients. The mean age was 64 ± 13 years, and 48% were female. The small bowel was the most common primary site (33%, 31/95), and 32 (34%) patients had pre-existing symptoms of carcinoid syndrome. The mean tumor size was 3.2 ± 2.6 cm, and mean number of passes was 3.4 ± 1.6. A 17/18-gauge needle was used in 91% (96/106) of the biopsies. Thirteen (12%) patients received either outpatient or prophylactic octreotide. RESULTS No patients experienced carcinoid crisis or needed octreotide, inotropes, vasopressors, or resuscitation. A single biopsy procedure (0.9%, 1/106) was complicated by bleeding that required angiographic hepatic artery embolization. Changes in pre-biopsy- versus post-biopsy systolic blood pressure and heart rate were -1.6 mm Hg (P = .390) and 0.6 beat/min (P = .431), respectively. Tumor functional status, overall tumor burden, and the elevation of neuroendocrine markers were not associated with intraprocedural physiologic disturbances. There were 4 minor complications (0.4%, 4/106) associated with the biopsy procedure that were not attributed to hormone excretion from tumor manipulation. CONCLUSIONS Percutaneous image-guided core biopsy of NETs is safe, with low complication rate and no definite carcinoid crisis in the current cohort.
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Affiliation(s)
- Samuel Jang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Tasha L Welch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Timothy J Hobday
- Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
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13
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Jaykel TJ, Clark MS, Adamo DA, Welch BT, Thompson SM, Young JR, Ehman EC. Thoracic positron emission tomography: 18F-fluorodeoxyglucose and beyond. J Thorac Dis 2020; 12:6978-6991. [PMID: 33282403 PMCID: PMC7711422 DOI: 10.21037/jtd-2019-cptn-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ongoing technologic and therapeutic advancements in medicine are now testing the limits of conventional anatomic imaging techniques. The ability to image physiology, rather than simply anatomy, is critical in the management of multiple disease processes, especially in oncology. Nuclear medicine has assumed a leading role in detecting, diagnosing, staging and assessing treatment response of various pathologic entities, and appears well positioned to do so into the future. When combined with computed tomography (CT) or magnetic resonance imaging (MRI), positron emission tomography (PET) has become the sine quo non technique of evaluating most solid tumors especially in the thorax. PET/CT serves as a key imaging modality in the initial evaluation of pulmonary nodules, often obviating the need for more invasive testing. PET/CT is essential to staging and restaging in bronchogenic carcinoma and offers key physiologic information with regard to treatment response. A more recent development, PET/MRI, shows promise in several specific lung cancer applications as well. Additional recent advancements in the field have allowed PET to expand beyond imaging with 18F-flurodeoxyglucose (FDG) alone, now with the ability to specifically image certain types of cell surface receptors. In the thorax this predominantly includes 68Ga-DOTATATE which targets the somatostatin receptors abundantly expressed in neuroendocrine tumors, including bronchial carcinoid. This receptor targeted imaging technique permits targeting these tumors with therapeutic analogues such as 177Lu labeled DOTATATE. Overall, the proper utilization of PET in the thorax has the ability to directly impact and improve patient care.
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Affiliation(s)
| | - Michael S Clark
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel A Adamo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brain T Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jason R Young
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Abstract
MR enterography is frequently ordered for patients with suspected small bowel disorders. In this article, disease-causing malabsorption, vasculitides, and some of the less common small bowel diseases are reviewed. The clinical presentations, diagnostic criteria, and imaging findings of these diseases are discussed. Because the imaging findings in several small bowel diseases are nonspecific and/or overlap, radiologists must correlate clinical data with imaging to develop a narrower differential diagnosis. The unique or characteristic findings in certain diseases are also emphasized.
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Affiliation(s)
- Daniel A Adamo
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55902, USA.
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15
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Stone JJ, Adamo DA, Khan DZ, Packard AT, Broski SM, Nathan MA, Howe BM, Spinner RJ. Multimodal Imaging Aids in the Diagnosis of Perineural Spread of Prostate Cancer. World Neurosurg 2019; 122:e235-e240. [DOI: 10.1016/j.wneu.2018.09.221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/30/2022]
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