Abstract This retrospective study shows the results of a 2 years application of a clinical pathway concerning the indications to NOM based on the patient's hemodynamic answer instead of on the injury grade of the lesions. We conducted a retrospective study applied on a patient's cohort, admitted in “Azienda Ospedaliero-Universitaria Ospedali Riuniti of Ancona” and in the Digestive and Emergency Surgery Department of the Santa Maria of Terni hospital between September 2015 and December 2017, all affected by blunt abdominal trauma, involving liver, spleen or both of them managed conservatively. Patients were divided into 3 main groups according to their hemodynamic response to a fluid administration: stable (group A), transient responder (group B) and unstable (group C). Management of patients was performed according to specific institutional pathway, and only patients from category A and B were treated conservatively regardless of the injury grade of lesions. From October 2015 to December 2017, a total amount of 111 trauma patients were treated with NOM. Each patient underwent CT scan at his admission. No contrast pooling was found in 50 pts. (45.04%). Contrast pooling was found in 61 patients (54.95%). The NOM overall outcome resulted in success in 107 patients (96.4%). NOM was successful in 100% of cases of liver trauma patients and was successful in 94.7% of splenic trauma patients (72/76). NOM failure occurred in 4 patients (5.3%) treated for spleen injuries. All these patients received splenectomy: in 1 case to treat pseudoaneurysm, (AAST, American Association for the Surgery of Trauma, grade of injury II), in 2 cases because of re-bleeding (AAST grade of injury IV) and in the remaining case was necessary to stop monitoring spleen because the patient should undergo to orthopedic procedure to treat pelvis fracture (AAST grade of injury II). Non-operative management for blunt hepatic and splenic lesions in stable or stabilizable patients seems to be the choice of treatment regardless of the grade of lesions according to the AAST Organ Injury Scale.
(1) Background: The value of dual-energy CT angiography (DE-CTA) in the detection of peripheral arterial disease (PAD) has been widely recognized. We aim to evaluate the diagnostic accuracy of virtual non-contrast (VNC) imaging of DE-CTA compared to true non-contrast phase (TNC). (2) Methods: Our Internal Review Board (IRB) approved prospective study enrolled 40 patients (28 men, 12 women; median age 69 y, range 41–93 y) who underwent lower extremity DE-CTA for symptomatic PAD. Mean attenuation values of TNC and VNC were obtained by placing circular regions of interest (ROI) at five levels from the aortic to the popliteal arterial lumen, reported in Hounsfield units (HU), and compared using a two-sample t-test. The subjective quality of VNC images was assessed by two independent radiologists with 10 and 4 years of CTA-imaging experience according to a 4-point scale and verified by the intra-class correlation coefficient (ICC). Dose Length Product (DLP) values of each DE-CTA examination were also considered. (3) Results: Except for the external iliac artery, VNC attenuation values were significantly lower than the corresponding TNC values at all levels, with a mean difference ranging from 14.1 and 8.7 HU. At qualitative analysis, VNC images were considered excellent to diagnose in 40%, good in 50%, and sufficient in 10% of cases. No cases of non-diagnostic VNC imaging were reported. Avoiding the TNC phase, a mean reduction in DLP of 54% for each DE-CTA was estimated. (4) Conclusions: TNC and VNC images showed comparable reliability and diagnostic accuracy in the detection of PAD. VNC may be considered a promising substitute for TNC from the perspectives of dose reduction and workflow optimization.
(1) Background: Type 2 diabetes is a major cause of incidences and the progression of peripheral artery disease (PAD). Bone marrow edema (BME) is an important finding suggestive of underlying bone inflammation in non-traumatic diabetic patients with PAD. Our aim was to evaluate the presence, severity, and clinical implications of BME detected by virtual non-calcium application (VNCa) of dual-energy CT angiography (DE-CTA). (2) Methods: A consecutive series of 76 diabetic patients (55 men; mean age 71.6 ± 11.2 yrs) submitted to lower limb DE-CTA for PAD evaluation and revascularization planning, which were retrospectively analyzed. VNCa images were independently and blindly revised for the presence, location, and severity of BME by two radiologists with 10 years of experience. BME and non-BME groups were evaluated in terms of PAD clinical severity and 6-month secondary major amputation rate. (3) Results: BME was present in 17 (22%) cases, while 59 (78%) patients were non-BME. The BME group showed a significantly higher incidence of major amputation (p < 0.001) and a significantly higher number of patients with advanced clinical stages of PAD compared to the non-BME group (p = 0.024). (4) Conclusions: Lower limb DE-CTA with VNCa application is a useful tool in the detection of BME in diabetic patients with PAD, simultaneously enabling the evaluation of the severity and location of the arterial disease for revascularization planning. BME presence could be a marker of clinically severe PAD and a possible risk factor for revascularization failure.
Abstract Purpose Percutaneous transarterial embolization (PTE) represents a fast, safe and effective option for life-threatening anterior abdominal wall hematomas (AWHs) and those unresponsive to conservative treatment. Our study aims to assess cumulative results of safety, technical and clinical success of PTE performed in three high-volume tertiary referral centers and to evaluate the efficacy of the different embolic materials employed. Materials and methods A consecutive series of 124 patients (72.8 ± 14.4 years) with AWHs of different etiology submitted to PTE were retrospectively collected and analyzed. Clinical success, defined as absence of recurrent bleeding within 96 h from PTE, was considered as primary endpoint. The results of the comparison of three groups based on embolic agent employed were also analyzed. Results Spontaneous AWHs accounted for 62.1%, iatrogenic for 21.8% and post-traumatic for 16.1% of cases. SARS-CoV-19 infection was present in 22.6% of patients. The most commonly embolized vessels were epigastric inferior artery ( n = 127) and superior epigastric artery ( n = 25). Technical and clinical success were 97.6 and 87.1%, respectively. Angiographic signs of active bleeding were detected in 85.5% of cases. Four (4%) major complications were reported. The comparison of the three groups of embolic agents (mechanical, particulate/fluid and combined) showed no statistically significant differences in terms of clinical success. SARS-CoV-2 infection was found to be an independent factor for recurrent bleeding and poor 30-day survival. Conclusion PTE performed with all the embolic agent employed in our centers is a safe and effective tool in the treatment of life-threatening anterior AWH of each origin.
Tubulocystic renal cell carcinoma is a rare subtype of renal tumor according to the 2016 World Health Organization, and less than 100 cases have been documented up to date in literature. The imaging features are not well known and to the best of our knowledge, there is not a radiology description of recurrence from tubulocystic renal cell carcinoma in the literature. We describe the case of a 70-year-old man with unusual cystic lesions in the left hypochondrium 11 years after a nephrectomy for tubulocystic renal cell carcinoma on the same side, and we report a review of the clinical characteristics of metastatic tubulocystic renal cell carcinoma.
Introduction: Ultrasound-guided renal masses biopsy (RMB) is a useful and underestimated tool to evaluate suspected renal tumors. This study aimed to assess the safety and feasibility of this technique. Materials and Methods: Data of 80 patients with suspected primary or secondary kidney tumors who underwent RMB between January 2012 and December 2020 were included in this retrospective study. Twelve patients were excluded due to incomplete data. Biopsy outcomes were collected through our electronic medical records system and then compared with definitive pathology. Results: RMB was performed in 68 cases. Pathological examination reported 43 (63%) malignant cases, while RMB was negative in 15 (22%) samples. On the other hand, a benign lesion was present in 8 (12%) cases, and 2 (3%) biopsies were non diagnostic. One major and one minor post-procedure complication were reported among the patients. A total of 31 patients underwent renal surgery including 19 partial and 12 radical nephrectomies. Out of them, 4 patients had a negative biopsy, but radiological imaging strongly suggested malignancy. The concordance between biopsy and definitive pathology occurred in 22 out of 31 (71%) cases, with a higher rate among the masses greater than 4 cm, 9/11 (82%) compared to smaller ones 13/20 (65%). Pathologic examination of the 4 cases with negative biopsy showed 3 renal cell and a translocation renal cell carcinoma. Conclusions: Ultrasound-guided biopsy for renal masses is a safe and effective procedure. Its ability to identify malignancy is evident, especially for primary renal tumors. However, low concordance between biopsy and definitive pathology in cases with negative biopsies, especially for tumors < 4 cm, does not reliably guarantee the absence of tumor and, therefore, strict follow-up or repeat biopsy may be indicated.
Abstract More data about TACE and pTACE seem necessary to better define the global treatment strategy for HCC. Aim of our analysis was to evaluate the role of TACE, either with lipiodol (traditional) or drug-eluting microspheres in terms of response rate (RR), time to progression (TTP), overall survival (OS) and toxicity in HCC. Patients with HCC undergoing traditional TACE or pTACE (either alone or in combination with other treatment options) were eligible One hundred and fifty patients were analyzed. In the global patient population median OS was 46 months for lipiodol TACE and 19 months for pTACE (p < 0.0001), TTP was 30 months versus 16 months for patients receiving TACE or pTACE respectively (p = 0.003). These results were confirmed also among the group of patients who received exclusive TACE or pTACE. Neither RR nor toxicity was different between TACE or pTACE. At multivariate analysis, age, the Okuda stage, type of TACE and number of TACE proved to be independent prognostic factors influencing overall survival. In our experience, lipiodol TACE showed a better OS and TTP over pTACE, without difference in toxicity profile and RR. Among the staging systems analyzed only the Okuda stage seemed able to reliably predict patients outcome.
