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The aim of this study was to investigate the safety and effectiveness of percutaneous radiofrequency ablation (RFA) in locally advanced pancreatic cancer (LAPC) of the pancreatic body by assessing the overall survival of patients and evaluating the effects of the procedure in the clinical and radiological follow-up. Patients with unresectable LAPC after failed chemoradiotherapy for at least six months were retrospectively included. Percutaneous RFA was performed after a preliminary ultrasound (US) feasibility evaluation. Contrast-enhanced computed tomography (CT) and CA 19.9 sampling were performed before and 24 hours and 30 days after the procedure to evaluate the effects of the ablation. Patients were followed-up after discharge considering the two main endpoints: procedure-related complications and death. 35 patients were included, 5 were excluded. All patients underwent RFA with no procedure-related complications reported. The mean size of tumors was 49 mm before treatment. The mean dimension of the ablated necrotic zone was 32 mm, with a mean extension of 65 % compared to the whole tumor size. Tumor density was statistically reduced one day after the procedure (p 0.001). The mean CA 19.9 levels before and 24 hours and 30 days after the procedure were 285.8 U/mL, 635.2 U/mL, and 336.0 U/mL, respectively, with a decrease or stability at the 30-day evaluation in 80 % of cases. The mean survival was 310 (65-718) days. Percutaneous RFA of LAPC is a feasible technique in patients who cannot undergo surgery, with great debulking effects and a very low complication rate.ZIEL: Ziel dieser Studie war es, die Sicherheit und Wirksamkeit der perkutanen Radiofrequenzablation (RFA) bei lokal fortgeschrittenem Pankreaskarzinom (LAPC) zu untersuchen, indem das Gesamtüberleben der Patienten beurteilt wurde und die Auswirkungen des Verfahrens in der klinischen und radiologischen Nachsorge bewertet wurden. Patienten mit inoperablem LAPC nach fehlgeschlagener Radiochemotherapie über mindestens 6 Monate wurden retrospektiv eingeschlossen. Die perkutane RFA wurde nach einer vorläufigen Ultraschall (US)-Machbarkeitsbewertung durchgeführt. Eine kontrastverstärkte Computertomografie (CT) und eine Probenentnahme für CA 19-9 wurden vor dem Verfahren und 24 Stunden sowie 30 Tage danach durchgeführt, um die Auswirkungen der Ablation zu beurteilen. Die Patienten wurden nach Entlassung unter Berücksichtigung der beiden wichtigsten Endpunkte nachbeobachtet: verfahrensbedingte Komplikationen und Tod. Es wurden 35 Patienten eingeschlossen und 5 ausgeschlossen. Alle Patienten wurden der RFA unterzogen, wobei keine verfahrensbezogenen Komplikationen gemeldet wurden. Die durchschnittliche Tumorgröße betrug vor der Behandlung 49 mm. Das mittlere Ausmaß der abgetragenen nekrotischen Zone betrug 32 mm, mit einer mittleren Ausdehnung von 65 % im Vergleich zur gesamten Tumorgröße. Die Tumordichte war einen Tag nach dem Eingriff statistisch signifikant reduziert (p 0,001). Die mittleren CA-19-9-Werte vor dem Eingriff und 24 Stunden bzw. 30 Tage danach betrugen 285,8 U/ml, 635,2 U/ml bzw. 336,0 U/ml, mit einer Abnahme oder Stabilität der Werte in der 30-Tage-Auswertung bei 80 % der Fälle. Die mittlere Überlebenszeit betrug 310 (65–718) Tage. Die perkutane RFA der LAPC ist eine durchführbare Technik bei Patienten, die nicht operiert werden können, mit großen Debulking-Effekten und einer sehr niedrigen Komplikationsrate.

OBJECTIVES First aim of study was to compare the diagnostic accuracy of high resolution T2-WI (HRT2-WI) and gadolinium-enhanced T1-weighted image (Gd T1-WI) sequences in quantitative evaluation of vestibular schwannomas (VS). The second one was to determine through qualitative evaluation when Gd-injection should be recommended. METHODS Two observers in consensus retrospectively reviewed 137 magnetic resonance imaging (MRI) scans of patients with histological diagnosis of VS (33 women, 26 men), 116 with both HRT2-WI and Gd T1-WI. The examinations were subdivided in: surveillance (10), pretreatment (30), posttreatment (43), and posttreatment follow-up (33) studies. Quantitative evaluation was based on size measurement of the lesion. Structural details of the lesion, facial nerve course, and involvement of the fundus of the internal auditory canal were assessed for the qualitative evaluation in both sequences. RESULTS No statistically significant changes were demonstrated between size measurement in the HRT2-WI and Gd T1-WI (p = 0.329). Sensitivity, specificity, and accuracy of HRT2-WI in the detection of lesional size were 90.4, 98.9, 92.5%, respectively. HRT2-WI was worse for characterization of structural details in pretreatment, posttreatment, and posttreatment follow-up examinations. HRT2-WI showed better or equal capability for all the groups in the demonstration of the facial nerve course. In the evaluation of the involvement of the fundus of the internal auditory canal, HRT2-WI showed worse results or had a complementary role for the posttreatment and posttreatment follow-up groups, while in the other groups was considered mainly equal or complementary. Only in the surveillance group, HRT2-WI was never worse for all the criteria. CONCLUSION Results for quantitative evaluation were similar in both the sequences. Gadolinium injection can be avoided only in surveillance studies.

Purpose Magnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic MR with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of pancreatic IPMN by using pathological analysis as gold standard. Materials and methods Ninety-one preoperative MR with histopathological diagnosis of IPMN were reviewed by two radiologists. Presence, number and size of mural nodule, signal intensity of the nodule on T1-weighted imaging (T1-WI) after contrast medium administration and on DWI. Inter-observer agreement was evaluated. Results Significant correlation (p 5 mm on MR and pathological specimen, size and number of mural nodules evaluated on pathological review and degree of dysplasia, size and number of mural nodules evaluated on MR and tumoral dysplasia, presence of nodule > 5 mm with enhancement after contrast medium administration and hyperintensity on DWI and degree of dysplasia. Interobserver agreement was moderate for the presence of mural nodule (K = 0.56), for the presence of high signal intensity on DWI (K = 0.57) and enhancement of mural nodule (K = 0.58). Apparent Diffusion Coefficient (ADC) map histogram analysis showed a correlation between Entropy of the entire cystic lesion and the degree of dysplasia (p Conclusions MR with dynamic and DWI sequences was an accurate method for the identification of ≥ 5 mm solid nodules of the IPMNs and correlate with the lesion malignancy. Entropy, calculated from the histogram analysis of the IPMN ADC map, correlated with the lesion dysplasia.

Pancreatic neuroendocrine tumors (p-NETs) are a rare group of neoplasms that often present with liver metastases. Histological characteristics, metabolic behavior, and liver tumor burden (LTB) are important prognostic factors. In this study, the usefulness of texture analysis of liver metastases in evaluating the biological aggressiveness of p-NETs was assessed. Fifty-six patients with liver metastases from p-NET were retrospectively enrolled. Qualitative and quantitative CT features of LTB were evaluated. Histogram-derived parameters of liver metastases were calculated and correlated with the tumor grade (G) and 18F-fluorodeoxyglucose (18F-FDG) standardized uptake value (SUV). Arterial relative enhancement was inversely related with G (&minus, 0.37, p = 0.006). Different metastatic spread patterns of LTB were not associated with histological grade. Arterialentropy was significantly correlated to G (&minus, 0.368, p = 0.038) and to Ki67 percentage (&minus, 0.421, p = 0.018). The ROC curve for the Arterialentropy reported an area under the curve (AUC) of 0.736 (95% confidence interval 0.545&ndash, 0.928, p = 0.035) in the identification of G1&ndash, 2 tumors. Arterialuniformity values were correlated to G (0.346, p = 0.005) and Ki67 levels (0.383, p = 0.033). Arterialentropy values were directly correlated with the SUV (0.449, p = 0.047) which was inversely correlated with Arterialuniformity (&minus, 0.499, p = 0.025). Skewness and kurtosis reported no significant correlations. In conclusion, histogram-derived parameters may predict adverse histological features and metabolic behavior of p-NET liver metastases.

Pancreatic neuroendocrine tumors (p-NETs) are a rare group of neoplasms that often present with liver metastases. Histological characteristics, metabolic behavior, and liver tumor burden (LTB) are important prognostic factors. In this study, the usefulness of texture analysis of liver metastases in evaluating the biological aggressiveness of p-NETs was assessed. Fifty-six patients with liver metastases from p-NET were retrospectively enrolled. Qualitative and quantitative CT features of LTB were evaluated. Histogram-derived parameters of liver metastases were calculated and correlated with the tumor grade (G) and 18F-fluorodeoxyglucose (18F-FDG) standardized uptake value (SUV). Arterial relative enhancement was inversely related with G (−0.37, p = 0.006). Different metastatic spread patterns of LTB were not associated with histological grade. Arterialentropy was significantly correlated to G (−0.368, p = 0.038) and to Ki67 percentage (−0.421, p = 0.018). The ROC curve for the Arterialentropy reported an area under the curve (AUC) of 0.736 (95% confidence interval 0.545–0.928, p = 0.035) in the identification of G1–2 tumors. Arterialuniformity values were correlated to G (0.346, p = 0.005) and Ki67 levels (0.383, p = 0.033). Arterialentropy values were directly correlated with the SUV (0.449, p = 0.047) which was inversely correlated with Arterialuniformity (−0.499, p = 0.025). Skewness and kurtosis reported no significant correlations. In conclusion, histogram-derived parameters may predict adverse histological features and metabolic behavior of p-NET liver metastases.

Radiofrequency ablation (RFA) is emerging as a safe and feasible technique to treat various pancreatic lesions. In particular, pancreatic ductal adenocarcinoma (PDAC) is the most frequent treated lesion. Nowadays, PDAC treatment by means of RFA is limited to locally advanced, non-resectable, but non-metastatic lesions. The aim of this article is to describe the RFA technique, its results and possible complications.

Contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly used, diagnostic imaging modality. In recent years, due to its safety, quickness, and repeatability, several studies have demonstrated the accuracy, specificity, and sensitivity of CEUS. The European Federation of Societies for Ultrasound in Medicine and Biology has recently updated the previous guidelines from 2012 for the use of CEUS in non-hepatic applications. This review deals with the clinical use and applications of CEUS for the evaluation of non-hepatic abdominal organs, focusing on renal, splenic, and pancreatic applications.

Liver diseases represent an important health problem, diffuse worldwide. The diagnosis of liver fibrosis is crucial in order to make decisions about treatment, evaluate treatment efficacy and assess patient prognosis.