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Hepaticojejunostomy is an essential component of many surgical procedures, including pancreaticoduodenectomy. Biliary leaks after HJS represent a major complication leading to relevant clinical problems: the postoperative mortality rate could reach 70% for surgical re-intervention, whereas endoscopic management is technically difficult due to the postoperative anatomy. Interventional Radiology plays a pivotal role for these patients. The case of a percutaneous biliary rendez-vous procedure performed to treat an HJA dehiscence after duodeno-cephalo-pancreasectomy is presented, which is successfully guaranteed to avoid a new surgical approach.

A vertebral compression fracture (VCF) is a pathological condition, which can be caused by osteoporotic degeneration or metastatic disease. It represents a socioeconomic burden on healthcare systems, due to increased pain, long-term morbidity, and disability. Vertebroplasty (VP) is an image-guided, minimally invasive, interventional procedure, in which bone cement is injected via a percutaneous approach into the vertebral soma, to provide structural support and to stabilize the weakened structure. The aim of this narrative review is to describe vertebral column biomechanics, as well as indications, contraindications, and techniques to successfully perform VP for the treatment of VCFs. Methods: We performed a narrative literature review on the main online databases regarding VP, and mainly focused on patient selection, preoperative imaging, procedural steps, complications, and outcomes. Results: The most recent evidence in the literature has shown that VP provides significant and sustained clinical benefits for patients with a VCF, and it is indicated in patients with comorbidities that make prolonged bed rest dangerous, patients with fractures that fail to heal, and as palliation in patients with a painful VCF due to metastatic disease. Conclusions: VP is considered to be a safe and effective treatment option for the treatment of osteoporotic and malignant VCFs that are resistant to adequate medical therapy. Patient selection, preprocedural evaluation, and proper technique execution are the key points to obtain the best outcomes and to minimize complications.

To evaluate efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) in unresectable lung malignancies.Data regarding patients with primary and secondary lung tumors treated with RFA or MWA from 2008 to 2020 were reviewed retrospectively. Primary study objectives such as technical success, primary and secondary technique efficacy rates, local tumor progression (LTP) rate, LPT-free survival (LPTFS) and overall survival (OS) were assessed. Secondary study objectives were side effects and complications. RFA and MWA were compared using the Chi-square test for continuous variables. Kaplan-Meier curves were calculated for survival statistical analysis.A total of 113 patients with primary or secondary lung tumor underwent 74 RFA (48%) and 81 MWA (52%). Technical success rate was 151/155 (97%); primary and secondary technique efficacy rates were 123/155 (79%) and 129/155 (83%), respectively. During the entire study follow-up, 32 cases experienced disease progression (20%), of which 18 underwent repeat ablation (12%), in 6 cases with success (4%). Residual unablated tumor happened in 4/155 cases (3%). LTP occurred in 28/155 cases (17%). The only factor associated with poorer LTP-FS was lesion diameter ≥ 30 mm (P 0.05). One-, 3- and 5-years LTP-FS was 83%, 82%, 82%, respectively. One-, 3- and 5-years OS of the entire population was 87%, 74%, 73%, respectively. Minor and major complication rates were 53/155 (34%) and 29/155 (19%), respectively.In conclusion, this study confirms the appropriateness of RFA and MWA for lung tumors treatment, in terms of safety and efficacy.

The aim of the study was to analyze the relationship between patient characteristics, including anagraphic and laboratoristic data and amount of adipose tissue measured in computed tomography (CT) scans in coronavirus disease 2019 (COVID-19) patients, and incidence of soft tissue bleeding requiring medical and/or interventional radiology management.A total of 132 patients hospitalized for COVID-19 pathology from October 2020 to May 2021 were included in the study and divided into two groups: a bleeding group of 70 cases with soft tissue bleeding occurring during hospitalization, and a control group of 62 hospitalized COVID-19 patients without bleeding events. In the bleeding group, two subgroups were considered: an embolization group including soft tissue bleeding cases requiring interventional radiology with transarterial embolization (TAE) (16/70; 22.9%) and a non-embolization group, clinically managed without TAE (54/70; 77.1%). Demographics and clinical data, visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area measured on CT images and VAT/SAT ratio were compared between bleeding and control groups and between embolization and non-embolization subgroups.Bleeding and control groups did not significantly differ for sex distribution, COVID-19, platelet (PLT) count, international normalized ratio (INR), SAT area, VAT area, and VAT/SAT ratio. Embolization and non-embolization groups did not significantly differ for age, COVID-19, PLT count, INR, SAT area, and VAT/SAT ratio. Bleeding group had lower body mass index (BMI) than control group as well as embolization group compared to non-embolization group. A statistically significant difference was observed between embolization and non-embolization groups for VAT area, with smaller values in embolization group (mean difference: 64.2 cmSoft tissue bleeding in COVID-19 is more frequent and severe in patients with low amount of VAT, demonstrating that fat mass may have a containing function on bleeding, limiting its progression in surrounding structures. There are some other factors that influence the risk of bleeding, such as age, thromboprophylaxis therapy and BMI.

BACKGROUND: Augmented reality navigation system for percutaneous computed tomography (CT)-guided pulmonary biopsies has recently been introduced. There are no studies in literature about its use for ground glass lesions biopsies. The aim of this study is to evaluate the effectiveness of an augmented reality infrared navigation system performance on CT-guided percutaneous lung ground glass opacity (GGO) biopsy compared to a standard CT-guided technique. METHODS: A total of 80 patients with lung GGO who underwent to a percutaneous CT-guided lung biopsy with an augmented reality infrared navigation system were retrospectively enrolled in the study. Comparison was performed with a group of 80 patients who underwent to lung biopsy with the standard CT-guided technique. Evaluation of maximum lesion diameter (MLD), distance between lesion and pleural surface (DPS), distance travelled by the needle (DTP), procedural time, validity of histological sample, procedural complications and the radiation dose to the patient’s chest were recorded for each patient of both groups. In addition, each group was divided into two subgroups based on lesion size, according to a cut-off of 1.5 cm (

sequential or simultaneous applications of multiple antennas have been proposed to create larger ablation zone; however, there is a lack of data in patients affected by liver tumors, with potentially different results from animal liver models. The purpose of this study was to evaluate efficacy and safety of liver percutaneous microwave ablation using simultaneous activation of two antennas to treat lesions bigger than 2,5 cm; particularly the focus was assessing whether the ratio of ablation zone volume in millimeters to applied energy in kilojoules [R(AZ:E)] differs between hepatocellular carcinoma in a cirrhotic liver and liver metastasis and if it is correlated to complications incidence or recurrence of disease.Fifty-five liver microwave ablation performed with two simultaneous antennas from March 2017 to June 2021 were retrospectively reviewed; 9 procedures were excluded due to the association with Chemoembolization. Size, shape, volume of lesions and ablation zones were recorded. Technical success was defined as complete devascularization of the treated area at the post-procedural CT. R(AZ:E) was determined dividing the ablation zone volume in mm3 by the amount of energy in kilojoules applied in each procedure and complications were reported.Technical success was achieved in all the procedures. Mean R(AZ:E) was 0,75 ± 0,58. T-student test for patients with HCC and patients with metastasis about R(AZ:E) was significant (These results provide preliminary evidence of efficacy and safety of simultaneous liver MWA using two antennas, highlighting the importance of procedural indications.

Development of more sensitive imaging techniques has caused an increase in the number of diagnosed small renal tumors. Approximately 2–3% of these lesions are proved to be angiomyolipomas (AML), a rare benign tumor of the kidney sometimes causing pain and hematuria. The most required approach is observation, but in the case of recurrent symptoms or larger tumors, which may cause bleeding, a more active treatment is required. We present two cases of symptomatic AML tumors of different sizes in the kidney: one treated with transarterial embolization (TAE), and the other with percutaneous cryoablation (CRA). The lesions were diagnosed on the basis of contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI). Both treatments proved to be effective and safe for treating renal AMLs. A follow-up carried out, based on contrast-enhanced CT scan, confirmed complete treatment of AML and decreased lesion size. There are myriad minimally invasive approaches for the treatment of renal AMLs, and the preservation of renal function remains a priority. The most popular treatment option is the selective renal artery embolization. Owing to its limited invasiveness, CRA could be an attractive option for the preventive treatment of AML.

A 61-year-old female underwent a right radical nephrectomy and a left nephron sparing surgery in 2014 due to renal cell carcinoma. A renal cell carcinoma local recurrence, 28 mm in size, centrally located in the left kidney was treated using cryoablation in 2016. In November 2018, computed tomography (CT) scan showed three nodules (maximum size 15 × 11 mm) in the left kidney, and CT-guided needle biopsy was performed. For multifocal recurrence and the anatomical site of these three nodules, a simultaneous reversible electrochemotherapy treatment was performed in April 2019. At 6-month CT control, no evidence of residual disease was found. Electrochemotherapy could be used to treat locoregional renal cell carcinoma recurrence when other ablative techniques are not suitable. LEVEL OF EVIDENCE: Level 4, Case Report.

Background: to analyze the relationship between patient characteristics, including anagraphic, laboratoristic data and amount of adipose tissue measured in Computed Tomography (CT)-scans in COVID-19 patients, and incidence of soft-tissue bleeding requiring medical and/or interventional radiology management. A total of 132 patients hospitalized for COVID-19 pathology from October 2020 to May 2021, were included in the study, considering two groups: a bleeding group, 70 cases of soft-tissue bleeding occurred during hospitalization, and a control group, 62 hospitalized COVID-19 patients without bleeding events. In the bleeding group, two subgroups were considered: an embolization group including soft tissue bleeding cases requiring interventional radiology TAE (Transarterial Embolization) (16/70; 22.9%) and a non-embolization group, clinically managed without TAE (54/70; 77.1%). Demographics and clinical data, visceral adipose tissue (VAT), sub-cutaneous adipose tissue (SAT) areas measured on CT images and VAT/SAT ratio were compared between bleeding and control groups and between embolization and non-embolization subgroups. Results: Bleeding and control groups did not significantly differ for sex distribution, Covid-19, platelet count, SAT-area, VAT-area and VAT/SAT ratio. Embolization and non-embolization groups did not significantly differ for age, Covid-19, platelet count, SAT area, and VAT/SAT ratio. A statistically significant difference was observed between embolization and non-embolization groups for VAT area, with smaller values in embolization group (mean difference: 64.2 cm², 95% CI, 8.3 – 120.1; p

Development of more sensitive imaging techniques has caused an increase in the number of diagnosed small renal tumors. Approximately 2–3% of these lesions are proved to be angiomyolipomas (AML), a rare benign tumor of the kidney sometimes causing pain and hematuria. The most required approach is observation, but in the case of recurrent symptoms or larger tumors, which may cause bleeding, a more active treatment is required. We present two cases of symptomatic AML tumors of different sizes in the kidney: one treated with transarterial embolization (TAE), and the other with percutaneous cryoablation (CRA). The lesions were diagnosed on the basis of contrast-enhanced computed tomography (CT) scan and magnetic resonance imaging (MRI). Both treatments proved to be effective and safe for treating renal AMLs. A follow-up carried out, based on contrast-enhanced CT scan, confirmed complete treatment of AML and decreased lesion size. There are myriad minimally invasive approaches for the treatment of renal AMLs, and the preservation of renal function remains a priority. The most popular treatment option is the selective renal artery embolization. Owing to its limited invasiveness, CRA could be an attractive option for the preventive treatment of AML.

(1) Background: The aim of this retrospective study is to assess safety and efficacy of lung radiofrequency (RFA) and microwave ablation (MWA) using an augmented reality computed tomography (CT) navigation system (SIRIO) and to compare it with the standard CT-guided technique. (2) Methods: Lung RFA and MWA were performed with an augmented reality CT 3D navigation system (SIRIO) in 52 patients. A comparison was then performed with a group of 49 patients undergoing the standard CT-guided technique. All the procedures were divided into four groups based on the lesion diameter (&gt, 2 cm or ≤2 cm), and procedural time, the number of CT scans, radiation dose administered, and complications rate were evaluated. Technical success was defined as the presence of a “ground glass” area completely covering the target lesion at the immediate post-procedural CT. (3) Results: Full technical success was achieved in all treated malignant lesions for all the considered groups. SIRIO-guided lung thermo-ablations (LTA) displayed a significant decrease in the number of CT scans, procedure time, and patients’ radiation exposure (p &lt, 0.001). This also resulted in a dosage reduction in hypnotics and opioids administrated for sedation during LTA. No significant differences were observed between the SIRIO and non-SIRIO group in terms of complications incidence. (4) Conclusions: SIRIO is an efficient tool to perform CT-guided LTA, displaying a significant reduction (p &lt, 0.001) in the number of required CT scans, procedure time, and patients’ radiation exposure.

(1) Background: The purpose of this study is to evaluate the impact of an augmented reality navigation system (SIRIO) for percutaneous biopsies and ablative treatments on bone lesions, compared to a standard CT-guided technique. (2) Methods: Bioptic and ablative procedures on bone lesions were retrospectively analyzed. All procedures were divided into SIRIO and Non-SIRIO groups and in &lt, 2 cm and &gt, 2 cm groups. Number of CT-scans, procedural time and patient’s radiation dose were reported for each group. Diagnostic accuracy was obtained for bioptic procedures. (3) Results: One-hundred-ninety-three procedures were evaluated: 142 biopsies and 51 ablations. Seventy-four biopsy procedures were performed using SIRIO and 68 under standard CT-guidance, 27 ablative procedures were performed using SIRIO and 24 under standard CT-guidance. A statistically significant reduction in the number of CT-scans, procedural time and radiation dose was observed for percutaneous procedures performed using SIRIO, in both &lt, 2 cm groups. The greatest difference in all variables examined was found for procedures performed on lesions &lt, 2 cm. Higher diagnostic accuracy was found for all SIRIO-assisted biopsies. No major or minor complications occurred in any procedures. (4) Conclusions: The use of SIRIO significantly reduces the number of CT-scans, procedural time and patient’s radiation dose in CT-guided percutaneous bone procedures, particularly for lesions &lt, 2 cm. An improvement in diagnostic accuracy was also achieved in SIRIO-assisted biopsies.

Purpose To assess the safety and efficacy of a two-step single-session procedure, combining transarterial embolization (TAE) and percutaneous microwave ablation (MWA), in the treatment of > 3 cm unresectable liver metastases. We also compared the final volume obtained by the two techniques (VE-T) and the expected ablation volume of the stand-alone MWA (VT). Methods From January 2015 to December 2017, 22 consecutive patients, with a total of 24 unresectable hepatic metastases >3 cm in diameter underwent a two-step single-session combined treatment of TAE and MWA. Follow-up computed tomography scans were performed at 1-, 3-, 6-, 12, and 24 months post-procedure. VE-T as final ablation volume induced by the combined treatment (TAE-MWA), VN as initial nodule volume, VT as expected ablation volume of MWA treatment alone were evaluated and compared. Results Tumor dimensions ranged from 32 to 73 mm. Technical success was achieved in all treated tumors with no local tumor recurrence. Final ablation volumes ranged from 50 to 450 cm3 and the short-axis diameter of the ablation zone ranged from 12 to 48 mm. The mean ΔV increment in the final ablation volume with respect to the stand-alone MWA was 196% (ranging from 25 cm3 − 210 cm3) (p 3 cm in diameter.

Background: Lung cancer is a malignant tumor with high lethality, responsible for about 28% of all cancer deaths. In this study, using a quantitative CT imaging-based approach, we aimed to investigate the differences of abdominal adipose tissue distribution in patients with non-small cell lung cancer (NSCLC) according to gender. Methods: A group of 66 patients with NSCLC at first diagnosis [male: 45, mean age: 67.3 years (range, 51.0–88.0 years); female: 21, mean age: 62.4 years (range, 44.0–84.0 years)] was included. As a control group, 70 patients without history of malignancies who have undergone a chest-abdomen CT for pre-operative cardiovascular surgery planning [male: 42, mean age: 62.7 years (range, 40.0–83.0 years); female: 28, mean age: 66.4 years (range, 39.0–83.0 years)] was included. We calculated total adipose area (TAA), visceral adipose area (VAA) and subcutaneous adipose area (SAA) using OsiriX to analyze cross-sectional CT images. The differences were analyzed using the Student’s t -test (P Results: In the female group, the visceral/subcutaneous (V/S) ratio was higher in the control group than in patients. Conversely, in the male group we found a higher V/S ratio in patients then controls. Considering male and female together, the age parameter showed a significant positive correlation with the amount of visceral (r=0.390; P=0.001) and total (r=0.270; P=0.030) fat in the patients. Dividing the groups between male and female, the age parameter showed a significant positive correlation with the amount of visceral fat in the female patients (r=0.440; P=0.049), visceral fat in the male patients (r=0.320; P=0.030), subcutaneous fat in the female patients (r=0.480; P=0.030) and total fat in the female patients (r=0.490; P=0.020). Conclusions: The results of this study are in line with the concept of differential gender-based relationships among abdominal fat distribution, age and NSCLC.

Objective: To assess in a cohort of twin pregnancies the prevalence of obstetric cholestasis (OC) and its correlation with the type of conception and chorionicity.Methods: A retrospective cohort study including all the twin pregnancies delivered between 2005 and 2013 at our University Hospital was carried out. In the study population, the prevalence of OC was investigated in relationship to the impact of assisted reproductive technology (ART) and of chorionicity.Results: Overall, 569 twin pregnancies were included in the study population. Among those complicated by OC, the rate of ART was 3-fold higher (OR 3.4, 95% CI 1.2–9.5, p = 0.02), whereas the rate of dichorionicity did not differ significantly (OR 1.6, 95% CI 0.3–7.9, p = 0.53).Conclusion: The risk of developing OC seems to be significantly higher among twin pregnancies obtained after ART in comparison with those conceived spontaneously.