Search

Purpose To determine the effects of a thermal accelerant gel on temperature parameters during microwave liver ablation. Materials and Methods Sixteen consecutive liver ablations were performed in 5 domestic swine under general anesthesia with (n = 8) and without (n = 8) administration of thermal accelerant gel. Ablation zone temperature was assessed by real-time MR thermometry, measured as maximum temperature (Tmax) and the volume of tissue ≥ 60°C (V60). Tissue heating rate, ablation zone shape, and thermal energy deposition using the temperature degree-minutes at 43°C (TDM43) index were also measured. Differences between groups were analyzed using generalized mixed modeling with significance set at P = .05. Results Mean peak ablation zone temperature was significantly greater with thermal accelerant use (mean Tmax, thermal accelerant: 120.0°C, 95% confidence interval [CI] 113.0°C–126.9°C; mean Tmax, control: 80.3°C, 95% CI 72.7°C–88.0°C; P Conclusions Thermal accelerant use is associated with higher microwave ablation zone temperatures, greater thermal energy deposition, and faster and more spherical tissue heating compared with control ablations.

Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel’s proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed the effectiveness of ablation within specific patient populations, the effect of combination of ablation with radiotherapy and/or immunotherapy, and the potential of standardization of techniques, including modeling and monitoring, to improve the consistency and predictability of treatment outcomes.

CT-beam hardening artifact can make tumor margin visualization and its relationship to the ablation applicator tip challenging. To determine optimal scanning parameters for commonly-used applicators.Applicators were placed in ex-vivo cow livers with implanted mock tumors, surrounded by bolus gel. Various CT scans were performed at 440mA with 5mm thickness changing kVp, scan time, ASiR, scan type, pitch, and reconstruction algorithm. Four radiologists blindly scored the images for image quality and artifact quantitatively.A significant relationship between probe, kVp level, ASiR level, and reconstruction algorithm was observed concerning both image artifact and image quality (both p=0.0001). Specifically, there are certain combinations of kVp, ASiR, and reconstruction algorithm that yield better images than other combinations. In particular, one probe performed equivalently or better than any competing probe considered here, regardless of kVp, ASiR, and reconstruction algorithm combination.The findings illustrate the overall interaction of the effects of kVp, ASiR, and reconstruction algorithm within and between probes, so that radiologists may easily reference optimal imaging performance for a certain combinations of kVp, ASiR, reconstruction algorithm and probes at their disposal. Optimum combinations for each probe are provided.

Purpose To evaluate outcomes in a small cohort of patients with local or disseminated small-cell lung cancer (SCLC) who received percutaneous thermal ablation therapy. Materials and Methods Ten biopsy-proven SCLC tumors in 9 consecutive patients (5 men, 4 women; average age, 73.8 y ± 12.4) were retrospectively evaluated. Average tumor sizes were 1.8 cm ± 0.5 and 2.6 cm ± 1.2 among patients with local and disseminated disease, respectively. Microwave and radiofrequency ablation were each used for 5 tumors. None of the patients with local SCLC received adjuvant therapy following thermal ablation. Median follow-up duration was 16 months (range, 2–48 mo). Median and 1-year overall survival (OS) were compared for patients in the local and disseminated disease groups. Results Median and 1-year OS were better among patients treated for local SCLC compared with disseminated disease (47.0 vs 5.5 mo and 3 [100%] vs 2 [40%], respectively). Pneumothorax occurred in 5 patients (55.6%), and 3 patients received successful outpatient thoracostomy tube placement. No patients were hospitalized, and there were no major complications. Conclusions This preliminary analysis suggests favorable outcomes in selected patients with local SCLC who undergo percutaneous thermal ablation without adjuvant therapy.

Objective This study investigated differences in EEG coherence measures between two groups of children with Attention-Deficit/Hyperactivity Disorder (AD/HD) – one with the more common EEG profile (increased theta), and a group with excess alpha activity as the dominant EEG abnormality. Methods 26 children (aged 9–13years) with AD/HD were included in each of the excess-theta and excess-alpha groups, and were age- and sex-matched with 26 control subjects. EEG was recorded from 19 electrode sites during an eyes-closed resting condition. Wave-shape coherence was calculated for eight intrahemispheric and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta bands. Results In comparison with the controls, the excess-theta AD/HD group had increased theta intrahemispheric coherences at short-medium inter-electrode distances. Frontally, the excess-theta AD/HD group had increased interhemispheric theta and reduced beta coherences. The excess-alpha group primarily showed increased slow wave (delta and theta) intrahemispheric coherence at short-medium inter-electrode distances, and reduced alpha coherence at longer inter-electrode distances, compared with controls. An increase in frontal interhemispheric theta coherence was also found. Conclusions These results suggest that AD/HD children with excess alpha power have an underlying connectivity dysfunction in the frontal lobes, which is found in common with other subjects with the excess-theta EEG profile. However, a number of qualitative differences exist that could be associated with other aspects of the AD/HD diagnosis. The excess-alpha group appeared to have fewer frontal-lobe abnormalities than the excess-theta AD/HD group. Significance This is the first study to investigate coherence in AD/HD children who have the atypical profile of increased alpha power in their EEG.

Purpose To experimentally characterize a microwave (MW) ablation applicator designed to produce directional ablation zones. Materials and Methods Using a 14-gauge, 2.45-GHz side-firing MW ablation applicator, 36 ex vivo bovine liver ablations were performed. Ablations were performed at 60 W, 80 W, and 100 W for 3, 5, and 10 minutes (n = 4 per combination). Ablation zone forward and backward depth and width were measured and directivity was calculated as the ratio of forward to backward depth. Thirteen in vivo ablations were performed in 2 domestic swine with the applicator either inserted into the liver (80 W, 5 min, n = 3; 100 W, 5 min, n = 3; 100 W, 10 min, n = 2) or placed on the surface of the liver with a nontarget tissue placed on the back side of the applicator (80 W, 5 min, n = 5). The animals were immediately euthanized after the procedure; the livers were harvested and sectioned perpendicular to the axis of the applicator. In vivo ablation zones were measured following viability staining and assessed on histopathology. Results Mean ex vivo ablation forward depth was 8.3–15.5 mm. No backward heating was observed at 60 W, 3–5 minutes; directivity was 4.7–11.0 for the other power and time combinations. In vivo ablation forward depth was 10.3–11.5 mm, and directivity was 11.5–16.1. No visible or microscopic thermal damage to nontarget tissues in direct contact with the back side of the applicator was observed. Conclusions The side-firing MW ablation applicator can create directional ablation zones in ex vivo and in vivo tissues.

To retrospectively evaluate the safety and efficacy of microwave ablation (MWA) as treatment for single, focal hepatic malignancies.Institutional review board approval was obtained for this HIPAA-compliant study. From December 2003 to May 2012, 64 patients were treated with MWA for a single hepatic lesion, in 64 sessions. Hepatocellular carcinoma (HCC) was treated in 25 patients (geometric mean tumor size, 3.33-cm; 95% CI, 2.65-4.18-cm; range, 1.0-12.0-cm), metastatic colorectal cancer (CRC) was treated in 27 patients (geometric mean tumor size, 2.7-cm; 95% CI, 2.20-3.40-cm; range, 0.8-6.0-cm), and other histological-types were treated in 12 patients (geometric mean tumor size, 3.79-cm; 95% CI, 2.72-5.26-cm; range, 1.7-8.0-cm). Kaplan-Meier (K-M) method was used to analyze time event data. Chi-square and correlation evaluated the relationship between tumor size and treatment parameters.Technical success rate was 95.3% (61/64). Treatment parameters were tailored to tumor size; as size increased more antennae were used (p0.001), treatment with multiple activations increased (p0.028), and treatment time increased (p0.001). There was no statistically significant relationship between time to recurrence and tumor size, number of activations, number of antennae, and treatment time. At one-year, K-M analysis predicted a likelihood of local recurrence of 39.8% in HCC patients, 45.7% in CRC metastases patients, and 70.8% in patients with other metastases. Median cancer specific survivals for patients were 38.3 months for HCC patients, 36.3 months for CRC metastases, and 13.9 months for other histological-types. Complications occurred in 23.4% (15/64) of sessions.In our sample, tumor size did not appear to impact complete ablation rates or local recurrence rates for focal hepatic malignancies treated with MWA.

We report the case of a 63-year-old female undergoing evaluation of symptomatic anemia, gastroesophageal reflux disease, and abdominal pain. After a thorough diagnostic workup, a large, ulcerated mass was identified in the patient's stomach, and surgical pathology in combination with molecular analysis yielded a diagnosis of primary extraskeletal Ewing sarcoma. In our report, we discuss the epidemiologic, clinicopathologic, and radiographic features of this rare disease and provide a review of the existing literature.

BackgroundTumour permittivity feedback control is a novel method for microwave ablation (MWA) that theoretically allows for larger, more predictable ablations. This prospective case series evaluates the feasibility and efficacy of MWA of liver malignancies using a device with tumour permittivity feedback control.MethodsTen consecutive patients initially determined to be candidates for surgical resection of a liver malignancy underwent intra-operative MWA with tumour permittivity feedback control followed by a surgical resection. A 14-gauge Medwaves microwave antenna was used to deliver a single treatment according to the manufacturer's recommendations. Tumours were assessed grossly as well as by haematoxylin and eosin (H&E) and tetrazolium chloride staining. The primary end point was per cent tumour necrosis.ResultsThe median maximum ablation diameter measured was 4.1cm (range 3.0–6.8). The median ablation volume was 8.7cm3 (range 4.84–17.55). Six of the 10 tumours demonstrated a pathological complete response (CR). Six of seven tumours ≤3cm demonstrated a pathological CR. Zero of the three tumours ≥3cm had a pathological CR, but all had ≥50% tumour necrosis. All patients survived and there were no ablation-related morbidities.DiscussionMWA of liver tumours with tumour permittivity feedback control is feasible and appears effective for the treatment of small (

This study investigated sex differences between the EEGs of Combined and Inattentive types of attention-deficit/hyperactivity disorder (AD/HD) within boys and girls aged 8–12 years. Subject groups included 80 AD/HD Combined type (40 boys and 40 girls), 80 AD/HD Inattentive type (40 boys and 40 girls) and 80 controls (40 boys and 40 girls). An eyes-closed resting EEG was recorded and Fourier transformed to provide estimates for absolute and relative power in the delta, theta, alpha and beta frequency bands, as well as total power and the theta/beta ratio. The boy AD/HD groups, compared with boy controls, had greater absolute and relative theta, greater theta/beta ratio, reduced absolute and relative alpha, and reduced absolute and relative beta. The girl AD/HD groups, compared with girl controls, had greater absolute delta, greater absolute and relative theta, greater theta/beta ratio, greater total power, and reduced relative delta and relative beta. Between AD/HD types, Combined type boys had globally greater absolute and relative theta, greater theta/beta ratio, and less relative alpha than Inattentive type boys. While topographical differences emerged, there were no significant global differences between AD/HD types in girls. That is, EEG differences between AD/HD types are dissimilar in boys and girls. Different EEG maturational patterns between boys and girls also obscure AD/HD-related EEG abnormalities. These results have important implications for our understanding of AD/HD in girls. Ignoring such sex differences may have compromised the value of previous AD/HD investigations, and these sex differences should be recognised in future research.

Patients with medically inoperable stage IA non-small-cell lung cancer have treatment options that include image-guided tumor ablation or stereotactic body radiation therapy. Literature to date with both techniques suggests similar overall survival; however, local control rates appear to be higher with SBRT. It is important for interventional radiologists to understand the differences and similarities between these two techniques. Future research is important to determine which patients would benefit from these therapies. This review summarizes the two techniques and available clinical literature, provides relevant commentary, and suggests future directions for research in this area.

Purpose To evaluate the clinical outcomes of ultrasound-guided percutaneous radiofrequency (RF) ablation and percutaneous ethanol injection (PEI) as salvage therapy for locoregional recurrence after resection of well-differentiated thyroid carcinoma. Materials and Methods There were 42 locoregional, biopsy-proven, papillary and follicular thyroid carcinoma lesions (0.5–3.7 cm) treated, 21 with RF ablation and 21 with PEI. Of treated lesions, 35 were located in the lateral compartments, and 7 were located in the central compartment. Data points in the retrospective analysis, determined beforehand by the investigators, were progression at the ablation site, serum thyroglobulin levels before and after the procedure, and procedural complications. Results Average follow-up after RF ablation was 61.3 months and after PEI was 38.5 months. No progression was detected in the region of ablation for any of the lesions treated with RF ablation. Local progression was detected 4–11 months after ablation in 5 of the 21 lesions treated with PEI, 3 in the lateral compartment and 2 in the central compartment; all of the lesions were successfully retreated with repeat PEI, RF ablation, or surgery. Permanent vocal cord paralysis occurred after one RF ablation procedure of a lateral compartment supraclavicular node. There were no complications after PEI. Conclusions This case series provides long-term follow-up evidence of the safety and efficacy of ultrasound-guided RF ablation and PEI for control of locoregional recurrence of well-differentiated thyroid carcinoma after surgery.

Purpose To retrospectively evaluate cost and mortality in 84 patients older than 65 years of age with stage IA or IB non–small-cell lung cancer treated with radiofrequency (RF) ablation or limited surgical resection (ie, wedge resection or segmentectomy) from the perspective of the payer, Medicare. Materials and Methods From August 2000 to November 2009, 56 patients were treated with RF ablation and 28 with surgery who met the inclusion criteria. Patient health histories and billing charges from initial treatment to the study endpoint were collected. Charges were converted to 2009 Medicare reimbursement fees and cumulated by month. Time–event data were analyzed by using the Kaplan–Meier method. Survival functions and median survival estimates were reported with standard errors. Patient cohorts' survival functions were compared based on the Wilcoxon weighted χ 2 statistic. Results Group demographics were comparable with the exception of age, with patients treated with RF ablation an average of 4 years older (95% confidence interval, 0.85–6.76). The overall mortality rate was lower in patients treated with surgery than in those treated with RF ablation (χ 2 = 8.0225, P = .0046), with a median cost per month lived for RF ablation recipients of $620.74, versus $1,195.92 for those treated with surgery ( P = .0002, Wilcoxon rank-sum test). Conclusions Patients treated with surgery showed a significant increase in survival; however, those treated with RF ablation were significantly older. For patients who are not surgical candidates, RF ablation provides an alternative treatment option at a significantly lower cost.

Purpose The Charlson Comorbidity Index (CCI) has been shown to be a significant prognostic indicator in the treatment of many types of cancer. The aim of this study is to evaluate the degree to which the CCI predicts survival in patients with inoperable non-small cell lung cancer (NSCLC) treated with radiofrequency ablation (RFA). Materials and methods Eighty-two (34 men, 48 women) consecutive RFA treatments for medically inoperable NSCLC were performed at our institution from 1/1/2000 to 1/30/2009. With institutional IRB approval and in full HIPAA compliance, the medical records of these patients were examined for data relating to pre-treatment comorbid conditions, and a retrospective analysis was conducted. Survival curves were estimated by the Kaplan–Meier method. Risk factors for mortality were determined by single-factor comparisons of curves using Wilcoxon-weighted chi-square and multiple Cox regressions. Results The patients ranged in age from 59 to 91 years (mean: 75.5). Eighty-eight percent (72 patients) were tumor stage IA or IB. Patients were followed for a total of five years; three-year overall survival was 50.6%. Hospital mortality was 0%. Gender, stage, histology and CCI score were each associated with significantly impaired survival (p IB, squamous histology and gender, multiple Cox regressions showed that an increasing CCI score was significantly associated with an increased risk of death (HR 1.3, 95% CI 25.5, 58.2). Conclusions The CCI is validated as an important, independent predictor of patient survival, in cases of inoperable NSCLC treated with RFA.

Purpose To retrospectively evaluate the effectiveness and safety of image-guided ablation of adrenal tumors. Materials and methods : This HIPAA-compliant study was IRB approved and informed consent was waived. From 5/1999-6/2008, 20 consecutive adrenal metastases (mean diameter 4.2 cm; range, 2–8) and 3 hormonally active primary adrenal tumors (mean diameter 2.3 cm; range, 1–4), including an aldosteronoma and 2 pheochromocytomas in 22 patients (14 men, 8 women; mean age 61 years; range 40–84) were ablated in 23 sessions. Bilateral metastases were treated in a single patient. Radiofrequency ablation was used to treat 16 adrenal metastases and the 3 hyperfunctioning tumors. Microwave ablation was used to treat 4 metastases. Successful treatment was defined as a lack of both enhancement on follow-up contrast enhanced CT and/or up-take on FDG PET-CT and for functioning tumors, resolution of biochemical abnormalities. Results Technical success was achieved in all sessions. Mean follow-up was 45.1 months (range, 1–91) Local tumor progression (focal enhancement at ablation site ≥1 cm in short axis) was detected in 4 of 23 tumors, two of which were identified bilaterally in a single patient prompting re-treatment. Of 19 patients with metastatic disease, 16 had fatal extra-adrenal disease progression, and 3 remain alive. Two of the 3 patients who underwent ablation of hyperfunctioning tumors remain alive, including the patient with an aldosteronoma who had recurrent symptoms 91 months post ablation. Intra-ablative hypertension occurred in 9% (2/23) of sessions and was successfully treated pharmacologically. Conclusion Ablation of metastatic and hyperfunctioning adrenal tumors is safe and may provide local control and treatment of pathologic biochemical activity.

Purpose The treatment options for non-small-cell lung cancer (NSCLC) that recurs after irradiation are limited. Image-guided percutaneous thermal ablation is an effective option in treating NSCLC that may provide an alternative to reirradiation. The purpose of this paper is to determine the survival and palliative benefit of image-guided percutaneous thermal ablation in the treatment of NSCLC that recurred within the treatment field of prior external beam radiation therapy. Methods Twenty patients, median age 70, who had NSCLC recurrences following irradiation were treated with image-guided thermal ablation. Kaplan–Meier analysis was used to assess survival benefit and subjective pain reports were used to investigate pain relief. Results The median survival time was 13.1 ± SE 1.4 months and the median survival time without local recurrence was 8.5 ± 1.6 months. Eight patients (40%) recurred locally after a median of 3.3 months. Seven out of ten patients (70%) presenting with significant pain had decreased pain at initial post-ablation evaluation. Following the 25 ablations, there were no Grade IV or V, 1 Grade III, 3 Grade II, and 23 Grade I complications. Conclusion Thermal ablation offers a potential survival benefit compared with other available modalities for the treatment of NSCLC recurring within a previously irradiated field. This promising technique has a good safety profile and may also be useful in providing symptomatic relief.

Purpose To identify malfunction of implanted cardiac devices during or after thermal ablation of tumors in lung, kidney, liver or bone, using radiofrequency (RF) or microwave (MW) energy. Materials and methods After providing written consent, 19 patients (15 men and 4 women; mean age 78 years) with pacemakers or pacemaker/defibrillators underwent 22 CT image-guided percutaneous RF or MW ablation of a variety of tumors. Before and after each procedure, cardiac devices were interrogated and reprogrammed by a trained cardiac electrophysiology fellow. Possible pacer malfunctions included abnormalities on electrocardiographic (EKG) monitoring and alterations in device settings. Our institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. Informed consent for participation in this retrospective study was deemed unnecessary by our review board. Results During 20 of 22 sessions, no abnormalities were identified in continuous, EKG tracings or pacemaker functions. However, in two sessions significant changes, occurred in pacemaker parameters: inhibition of pacing during RF application in one, session and resetting of mode by RF energy in another session. These changes did not, result in hemodynamic instability of either patient. MW ablation was not associated with, any malfunction. In all 22 sessions, pacemakers were undamaged and successfully reset to original parameters. Conclusion RF or MW ablation of tumors in liver, kidney, bone and lung can be performed safely in patients with permanent intra-cardiac devices, but careful planning between radiology and cardiology is essential to avoid adverse outcomes.

To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm.86 consecutive patients with small lung masses (2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below.Average fluoroscopy time using CTF was 28.2s compared to 35.0 s for EMN (p=0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p=0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p=0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p=0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p=0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p=0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p=0.4).EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.

Objective We compared EEG coherence in children with and without AD/HD, and sought to relate observed anomalies to AD/HD symptoms. Methods Forty children with AD/HD and 40 age- and sex-matched controls had eyes-closed resting EEG coherence calculated for eight interhemispheric electrode pairs and eight intrahemispheric pairs (four within each hemisphere) in the delta, theta, alpha, beta and “40 Hz” gamma bands. Results At short-medium inter-electrode distances, the AD/HD group had increased intrahemispheric coherence in delta and theta, and reduced (L > R) laterality in delta, alpha, beta and gamma. Over longer inter-electrode distances, the AD/HD group had reduced intrahemispheric coherence in alpha. In interhemispheric comparisons, the AD/HD group had reduced frontal coherence in delta, alpha and gamma, increased temporal theta and reduced temporal alpha coherences, and increased central/parietal/occipital coherence in theta. Smaller left-lateralized coherences in AD/HD correlated negatively with DSM Inattentive and DSM Total scores, and smaller frontal interhemispheric coherence in alpha correlated negatively with DSM Hyperactive/Impulsive score. Conclusions The negative correlations between AD/HD coherence anomalies and symptoms suggest that several anomalies reflect compensatory brain function. Significance Coherence differences in AD/HD may reflect anomalous frontal right-hemisphere linkages that help compensate functional brain anomalies in the left frontal regions in this disorder.

This retrospective study investigated differences in regional derivations of EEG coherence between good and poor responders to methylphenidate (MPH) in children (aged 8-12 years) with the combined type of attention-deficit/hyperactivity disorder (AD/HD). Participants included groups of good and poor male MPH responders and an aged-matched group of male controls. An eyes-closed, resting electroencephalogram (EEG) was recorded from 21 electrode sites. Coherence was calculated from eight intrahemispheric and eight interhemispheric electrode pairs, for the delta, theta, alpha and beta frequency bands. Compared with controls, the AD/HD participants had enhanced laterality over short-medium inter-electrode distances, and elevated frontal interhemispheric coherences, in the theta band. Good MPH responders had higher intrahemispheric coherences than poor MPH responders over short-medium and long inter-electrode distances in the beta band. Enhanced laterality at short-medium inter-electrode distances suggests that the AD/HD children may have a developmental lag in short-axonal connections in the left hemisphere. Elevated frontal interhemispheric theta coherence consistently indicates some frontal dysfunction in AD/HD. The beta coherence differences found between good and poor MPH responders could indicate that good MPH responders have some type of structural dysfunction associated with cortical connections involved in attention/arousal.

Adrenal tumors comprise a broad spectrum of benign and malignant neoplasms, and include functional adrenal adenomas, pheochromocytomas, primary adrenocortical carcinoma and adrenal metastases. Percutaneous ablative approaches that have been described and used in the treatment of adrenal tumors include percutaneous radiofrequency ablation (RFA), cryoablation, microwave ablation and chemical ablation. Local tumor ablation in the adrenal gland presents unique challenges, secondary to the adrenal gland’s unique anatomic and physiologic features. The results of clinical series employing percutaneous ablative techniques in the treatment of adrenal tumors are reviewed in this article. Clinical and technical considerations unique to ablation in the adrenal gland are presented, including approaches commonly used in our practices, and risks and potential complications are discussed.

Objective. We evaluated two new radiofrequency devices in an in vivo porcine model. Materials and methods. Multiprobe radiofrequency ablation (RFA) was used in a porcine model with an impedance-based algorithm in one experiment and clustered probes with and without switcher controllers in another; a Pringle maneuver was used with half of the ablations. Results. The impedance experiment included 13 ablations, with a mean length of 7.0 cm and width of 2.9 cm (95% CI) and an average time of 596 s. Ablation volumes were significantly larger (54.1±11.7 cc3 vs 34.9±4.8 cc3, p

Thermal ablation can be applied to treat any thoracic malignancy: primary lung cancers, recurrent primary lung cancers, metastatic disease, chest wall masses, and painful, bony metastases. Since the first reported use of thermal ablation for lung cancer in 2000 there has been an explosive use of the procedure, and by 2010 the number of procedures to treat thoracic malignancy is expected to exceed 150,000 per year. Presently, thermal ablation is best used for patients with early-stage lung cancers in patients who are not surgical candidates, patients with small and favorably located pulmonary metastases, and patients in whom palliation of tumor-related symptoms is the goal. Radiofrequency ablation, microwave ablation, and cryoablation are novel treatment modalities for lung cancer and can safely accomplish tumor destruction and even complete eradication of tumor in patients who are not candidates for surgical resection. In this article, we discuss technical considerations for each modality and the periprocedure and postprocedure management of patients with this disease.

Background: Thermal ablation techniques have become important treatment options for patients with unresectable hepatic malignancies. Microwave ablation (MWA) is a new thermal ablative technique that uses electromagnetic energy to produce coagulation necrosis. We report outcomes from the first clinical trial in the United States using MWA and a 915MHz generator. Patients and methods: Patients with unresectable primary or metastatic liver cancer were enrolled in a multi-institutional trial from March 2004 through May 2006. Demographic information, diagnosis, treatment, and outcomes were documented. Results: Eighty-seven patients underwent 94 ablation procedures for 224 hepatic tumors. Forty-two ablations (45%) were performed open, 7 (7%) laparoscopically, and 45 (48%) percutaneously. The average tumor size was 3.6cm (range 0.5–9.0 cm). Single antenna ablation volumes were 10.0ml (range 7.8–14.0 ml), and clustered antennae ablation volumes were 50.5ml (range 21.1–146.5 ml). Outcome variables were measured with a mean follow-up of 19 months. Local recurrence at the ablation site occurred in 6 (2.7%) tumors, and regional recurrence occurred in 37 (43%) patients. With a mean follow-up of 19 months, 41 (47%) patients were alive with no evidence of disease. There were no procedure-related deaths. The overall mortality rate was 2.3%. Conclusions: Microwave ablation is a safe and effective technology for hepatic tumor ablation. In our study, clustered antennae resulted in larger ablation volumes. Further studies with histological confirmation are needed to verify clinical results.

PURPOSE To evaluate the clinical outcomes in patients with early-stage non–small-cell lung cancer (NSCLC) after combined treatment with thermal ablation and radiation therapy (RT). MATERIALS AND METHODS Forty-one patients with inoperable stage I/II NSCLC tumors underwent thermal ablation and RT at our institution between 1998 and 2005. Thirty-seven radiofrequency (RF) ablation procedures and four microwave ablation procedures were performed. Ablations were followed by standard-fraction external-beam RT within 90 days ( n = 27) or postprocedural brachytherapy ( n = 14). Survival and local recurrence were the primary endpoints evaluated by Kaplan-Meier analysis. RESULTS The median follow-up was 19.5 months. The overall survival rates were 97.6% at 6 months, 86.8% at 1 year, 70.4% at 2 years, and 57.1% at 3 years. Patients with tumors smaller than 3 cm ( n = 17) had an average survival time of 44.4 ± 5.4 months (SE). Patients with tumors 3 cm or larger ( n = 24) had an average survival time of 34.6 ± 7.0 months ( P = .08). Local recurrence occurred in 11.8% of tumors smaller than 3 cm after an average of 45.6 ± 4.1 months and in 33.3% of the larger tumors after an average of 34.0 ± 7.8 months ( P = .03). Outcomes in the brachytherapy and RT groups did not differ significantly. Nine of 15 pneumothoraces required chest tube drainage (22.0%). CONCLUSIONS Thermal ablation followed by RT for inoperable stage I/II NSCLC has a relatively low rate of complications that are easily managed. Combined therapy may result in an improved survival compared with either modality alone.

Ozone volume mixing ratio (VMR) profiles are measured by the Michelson Interferometer for passive atmospheric sounding (MIPAS) on ENVISAT. The data sets produced by the science data processor at Institut fur Meteorologic und Klimaforschung (IMK), Germany are compared with those obtained by halogen occultation experiment (HALOE) on UARS and by sub-millimetre radiometer (SMR) on ODIN. For the stratospheric measurements taken during September/October 2002, the three instruments show reasonable agreement, with global mean differences within 0.1-0.3 ppmv. The typical zonal mean differences are of 0.4 ppmv for HALOE and 0.6 ppmv for SMR (4-6%) in the ozone VMR peak region at 25-30 km near the equator, though larger differences of 0.8-1 ppmv (8-10%) are also observed in a small latitude-altitude region in the tropic. A positive bias of about 0.2-0.4 ppmv in the MIPAS data in the 35-40 km region has also been found. Further studies are under way to explain these differences.

Image-guided radiofrequency (RF) ablation is an emerging alternative therapy for treatment of cancer in patients who can not undergo surgical resection. We have performed RF ablation on patients to locally treat and palliate painful osseous metastatic disease for several years. We present an overview of various applications of RF ablation for treating osseous metastatic disease.

Background. Regional recurrence of well-differentiated thyroid cancer (WTC) is primarily detected with ultrasonography (US), and current treatment is surgical. Radiofrequency ablation (RFA) has been used primarily for liver tumors as an alternative to a surgical procedure. We have applied RFA to a group of patients with locally recurrent WTC. Methods. Eight patients underwent percutaneous RFA for biopsy-proven recurrent WTC in the neck (mean size, 2.4 cm; range, 0.8-4.0 cm) while under intravenous conscious sedation and with US guidance. The RF electrode was inserted into the site of recurrence and treated with the maximum allowable current for between 2 and 12 minutes. Follow-up consisted of US in 8 patients, thyroglobulin levels in 6 patients, biopsy in 4 patients, and surgical treatment in 2 patients. Results. All 8 patients with no bleeding or infectious complications were treated as outpatients. A minor skin burn and 1 vocal cord paralysis occurred. No recurrent disease at the treatment site was detected, with a mean follow-up of 10.3 months. Histological examination showed no evidence of a tumor in the treated lymph nodes in 6 patients. Follow-up US examinations showed disappearance of previously detected color Doppler flow, as well as mass shrinkage and internal cystic change, or both. Conclusions. US-guided RFA is an exciting new treatment modality that appears to have a future role in treating locally recurrent WTC. (Surgery 2001;130:971-7.)

AIM: To compare power and colour Doppler ultrasonography (US) with nuclear medicine scintigraphy (NM) in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT). MATERIALS AND METHODS: Thirty-one patients with biochemical evidence of PHPT underwent pre-operative US and NM for parathyroid adenoma localization. Both studies were interpreted independently without prior knowledge of the other study's findings. All patients had surgical removal of the parathyroid adenoma utilizing standard neck exploration or minimally invasive unilateral surgical techniques with rapid serum assay of circulating parathyroid hormone levels. RESULTS: All patients had single parathyroid adenomas at surgery. Prospective sensitivities for US, NM and both studies combined were 65%, 68%, and 74%, respectively, with a positive predictive value of 100% each. The adenoma was localized by only one imaging modality in 16% of cases. CONCLUSIONS: US and NM provide complementary roles in the pre-operative localization of parathyroid adenomas in patients with PHPT. Scheiner, J. D. et al . (2001). Clinical Radiology 56 , 984–988.

PERCUTANEOUS image-guided ablation with use of radiofrequency (RF) or other thermal energy sources such as microwave, high-intensity focused ultrasonography (US), cryotherapy, and laser have recently received much attention as minimally invasive strategies for the local treatment of solid malignancies (1–4). In the first part of this review, we provided a brief synopsis of current RF techniques and reviewed the basic principles of RF ablation and challenges facing the successful implementation of this technology (5). In the second part of this review, we will describe some of the many opportunities that RF ablation affords in an overview of potential clinical applications. The organ systems discussed, such as the liver, bone, lung, and kidney, are those currently receiving the greatest amount of attention from interventional radiologists. However, many additional applications are likely to emerge over the course of the next several years. CLINICAL OPPORTUNITIES FOR RF TUMOR ABLATION

Resume Introduction. – Frequentes dans la maladie de Behcet, les atteintes vasculaires (23 a 64 % des cas selon les series) sont le plus souvent veineuses (95 % des atteintes vasculaires) et plus rarement arterielles (2 a 7 % des cas). Les atteintes arterielles consistent en stenoses, occlusions et anevrismes particulierement graves du fait de leur risque imprevisible de rupture. Les anevrismes intracrâniens associes a la maladie de Behcet sont exceptionnels. Seuls dix cas ont ete publies jusqu’a present. Exegese. – Nous rapportons le cas d’un homme de 36 ans, d’origine armenienne, chez qui le diagnostic de maladie de Behcet a ete porte lors d’une hemorragie meningee liee a la rupture d’un anevrisme de l’artere cerebelleuse superieure gauche. Le traitement endovasculaire de l’anevrisme a ete associe a un traitement immunosuppresseur par cyclophosphamide, corticoides et de la colchicine. L’evolution a ete favorable avec un recul de six mois. Il s’agit du premier cas publie d’anevrisme de la circulation posterieure et du premier traite par voie endovasculaire. Une revue de la litterature est faite. Conclusion. – Les anevrismes intracrâniens constituent une localisation exceptionnelle mais grave d’atteinte vasculaire dans la maladie de Behcet. Comme dans les autres atteintes arterielles, les recidives sont frequentes. Le traitement est neurochirurgical, mais doit associer un traitement par immunosuppresseurs et corticoides. La colchicine a sa place dans la prevention des rechutes.

Purpose: To examine the effect of perioperative irradiation on bone graft healing and functional integrity. Methods and Materials: Fifty-five bone grafts (10 autologus and 45 allogeneic) performed between 1978 and 1995 were evaluated retrospectively. Sixteen received preoperative radiation, 11 received postoperative, and 13 were treated with a combination of pre- and postoperative radiation. Fifteen nonirradiated grafts were randomly selected to serve as controls. Twenty-three of the grafts were placed in patients who received chemotherapy in the perioperative period. Functional graft survival and radiographic healing quality were evaluated. Results: Overall rates of graft survival at 1 year were 89% for autografts and 79% for allografts. Graft survival rates were 86% and 68% at 1 and 5 years for the irradiated group, and 67% and 58% for the control group. No significant difference was seen in the Kaplan-Meier graft survival curves of the two groups. There was a nonsignificant trend toward improved radiographic healing quality in the control group. No significant differences in outcome based on treatment chronology were found with survival rates of 88% for preoperative treatment and 100% for postoperative treatment. No relation between outcome and bone dose (preoperative + postoperative dose), graft dose (postoperative dose), or mean dose/day was found. There was a trend ( p = 0.0525) toward worse outcome seen in the Kaplan-Meier curves of patients who received chemotherapy. This difference, however, was not seen in the 1-year survival rates or healing quality. Tobacco use tended toward predicting failure, with 63% graft survival compared to 85% in nonsmokers ( p = 0.09). Healing quality was significantly lower in the smoking group. Conclusion: The low failure rate of grafts in irradiated sites, overall and compared to controls from this study and relevant literature, as well as the lack of dose and time effects, does not support significant deviation from the indicated treatment regimen for patients who have received or are expected to receive a graft. The trend toward decreased quality of radiographic bone healing, and data published in relevant literature indicating improved healing when radiation is withheld until 3–4 weeks postoperatively suggest this delay should be attempted when not expected to otherwise compromise patient outcome. A nonsignificant trend only for the effect of chemotherapy on bone grafts was seen, thus we do not recommend changes in its use as appropriate for disease management other than a preference against use during the immediate perioperative period.

BACKGROUND In the last few years, the association of deep vein thrombosis with frequent biological risk factors and genetic polymorphisms has significantly modified the field of venous thrombosis. In this study, we measured plasma homocysteine levels and tested the C677T methylenetetrahydrofolate reductase (MTHFR) mutation. PATIENTS AND METHODS Plasma homocysteine levels and test for C677T MTHFR mutation were performed in 120 consecutive patients with objectively diagnosed deep vein thrombosis, and in 120 controls. RESULTS We found a strong association between hyperhomocysteinemia and thrombosis (odd ratio: 2.43 IC 95% [1.27-4.7]). Conversely the C677T MTHFR gene polymorphism is only associated with hyperhomocysteinemia but not associated with thrombosis. CONCLUSION This is a preliminary study to the ongoing international multicentric study of SNFMI (Societe nationale francaise de m0+edecine interne) concerning hyperhomocysteinemia and venous thrombosis.

Rationale and Objectives. The authors mapped articular cartilage (AC) and subchondral bone (SB) thicknesses in human acetabula in vitro by using magnetic resonance (MR) imaging and validated AC measurements by using light microscopy. Materials and Methods. Left and right acetabula from a deceased patient who had undergone left hemiarthroplasty were imaged with fat-suppressed spoiled gradient-recalled acquisition in the steady state (repetition time = 55 msec, echo time = 15 msec, flip angle = 50°, matrix = 256 × 256, field of view = 8 cm). AC and SB thickness maps were generated from image data by using analytic geometry, which enabled correction for thickness overestimation due to oblique sectioning. Cartilage bone plugs were extracted from the acetabula, and light microscopy was used to validate the thickness measurements obtained with MR imaging. Results. Standard errors between thickness measurements obtained with MR imaging and light microscopy were 0.37 and 0.33 mm for the left and right AC, respectively, which is consistent with the voxel resolution of the MR imaging sequence (0.31 × 0.31 × 0.8 mm). SB thickness of the cartilage plugs could not be reliably measured with light microscopy and, therefore, could not be validated. Contour maps showed that SB thickness gradients were rapid and focal compared with the rather smooth gradients in AC thickness; however, thicker AC was accompanied by thicker SB for left ( r 2 = .261, P = .0001) and right ( r 2 = .308, P = .0001) acetabula. Average thickness differences between left and right acetabular AC and SB were 0.13 mm ( P = .015) and 0.11 mm ( P = .026), respectively. Although it was the operated hip that had thicker articular tissues, the differences were within the pixel resolution ( Conclusion. AC and SB thickness distribution can be accurately determined by combining noninvasive MR imaging and analytic geometry, which may also provide a means for quantitative, longitudinal assessment of focal AC defects.

Experiments carried out in lysimeters filled with two calcareous clayey soils (ca 40% CaCO3; ca 40% clay), showed that a 2m layer of soil almost completely removed the organic and inorganic components of olive oil mill wastewater (OMW) when it was applied in doses of 5000-10000m3ha-1year-1. This efficiency was maintained for at least 2 years. In field experiments, the application of OMW to one of these soils during three successive years at an annual rate of up to 6000m3ha-1 caused changes in some chemical properties of the soil, especially in the upper layer (0-50cm). Concentrations of soil organic matter, Kjeldahl N, soluble NO3 and available P increased enhancing soil fertility. On the other hand, soil electrical conductivity and sodium adsorption ratio also increased but below the levels representing salinization or sodification hazard for the soil. Furthermore, leaching of Na+ and NO3 - below the 1m layer were detected. © 1997 Elsevier Science Limited. All rights reserved., This work was supported by the IGM and CICYT of Spain (Project AGR 91-0600).

Introduction et but de l’etude L’etat nutritionnel et la composition corporelle sont bien definis comme facteurs pronostics de mortalite chez les patients BPCO. L’index BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) cote de 0 a 10 est un index pronostique de la severite de la maladie; il est compose de l’IMC, du rapport de Tiffeneau (rT = VEMS/CVF, VEMS = volume expiratoire maximal par seconde, CVF = capacite vitale fonctionnelle), du score sur l’echelle de Sadoul (Sadoul) cote de 1 a 5 qui exprime le degre de dyspnee, et du test de marche (TDM). La rehabilitation respiratoire (RR) a pour but un conditionnement physique des patients BPCO. C’est la masse maigre qui va directement avoir un impact sur les capacites respiratoires (pression inspiratoire maximale = Pimax) ou des capacites physiques (TDM) et indirectement sur la qualite de vie (QdV), et la dyspnee (Sadoul).Le but de l’etude etait d’evaluer l’effet d’une intervention nutritionnelle sur la composition corporelle et les parametres associes (voir ci-dessus). Materiel et methodes Il s’agit d’une etude prospective, non-ran-domisee, observationnelle, monocentrique. Les patients ont ete recrutes en RR entre 2006 et 2012. Au total 108 patients ont participe au programme de RR. Quatre-vingt-onze patients inclus presentaient le diagnostic de BPCO tabagique ou par empoussierage. Le rapport de Tiffeneau (VEMS/CVF) etait Resultats et Analyse statistique La cohorte finale (n = 61) etait constituee de 78 % d’hommes. A l’inclusion, 26,2 % des patients presentaient une denutrition, definie par: IMC 10 % en 6 mois ; 41 % des patients etaient en surpoids ou obeses. La mortalite etait respectivement de 6,6 % dans le groupe des non denutris vs. 25 % chez les patients denutris. La relation negative entre masse musculaire et mortalite etait confirmee dans notre cohorte (p = 0,026). La moyenne de l’index BODE etait de 3,80 ± 2,15 et a 3,2 ± 1,0 pour le Sadoul. Dans le groupe denutri, nous avons mis en evidence entre inclusion et visite de suivi une augmentation du poids, de l’IMC et une diminution de l’index de BODE (tous P Conclusion 1. Cette etude confirme que la prevalence de la denutrition est elevee (26,2 %) chez les patients ambulatoires recrutes pour un programme de rehabilitation respiratoire, et que l’index de masse maigre est un facteur pronostic independant de mortalite. 2. Le conseil nutritionnel individualise permet d’obtenir une amelioration de l’etat nutritionnel chez des patients denutris avec amelioration de l’index pronostic BODE. Au contraire nous n’avons pas pu demontrer d’effet benefique sur la masse maigre ni les autres composantes de l’index BODE. 3. Cette intervention n’a eu aucun effet sur les parametres observes dans groupe des patients en bon etat nutritionnel. D’autres pistes restent a explorer comme le dosage des androgenes et leur supplementation au taux physiologique.