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Isolated hepatic perfusion (IHP) offers the advantage of high local drug exposure with limited systemic toxicity. To increase local drug exposure, we administered melphalan at a reduced flow in the hepatic artery during IHP (hepatic artery infusion, hepatic artery–portal vein perfusion, HI–HPP). Between December 2001 and December 2004, 30 patients with colorectal cancer liver metastases underwent HI–HPP with 200mg melphalan. Samples of the perfusate were taken for pharmacokinetic analysis. Patients were monitored for response, toxicity and survival. Perfusion was aborted prematurely in 2 patients due to leakage. During melphalan administration in the hepatic inflow cannula a mean flow rate of 121.3mL/min and mean pressure of 62.5mm Hg were achieved. One patient died within 30 days after HI–HPP. Four patients developed veno-occlusive disease (VOD), while 2 patients showed signs of VOD. Twelve patients showed hepatic response, with a median duration of response of 11.5 months, according to WHO criteria. Although HI–HPP results in high perfusate melphalan concentration levels, it is associated with a relatively high level of hepatotoxicity and a limited response rate. We believe that the low flow and pressure rates found in this study can result in reduced drug penetration of the tumour and thus limited tumour response.

Patient and staff dose during CT guided coagulation of osteoid osteoma, tissue biopsy and abscess drainage were evaluated retrospectively on a conventional CT scanner and prospectively on a scanner equipped with fluoroscopic CT. The computed tomography dose index (CTDI) and the individual dose equivalent, i.e. the penetrating dose for workers at a depth of 10 mm tissue, were measured. Evaluation of CTDI enabled effective dose and maximum skin entrance doses for the patient to be determined. Doses were assessed for 96 CT guided interventions, including 16 drainages with average effective doses of 13.5 mSv and 9.3 mSv for the conventional CT scanner and the scanner with spiral CT fluoroscopy, respectively, 49 biopsies (effective doses of 8 mSv and 6.1 mSv, respectively), and 31 coagulations of osteoid osteoma (effective doses of 2.1 mSv and 0.8 mSv, respectively). Effective doses to patients were in the same range as those observed for regular diagnostic CT examinations. Entrance skin doses were well below the 2 Gy threshold for deterministic skin effects on the CT scanner equipped with fluoroscopic function (0.03-0.33 Gy), whilst skin doses on the conventional scanner were considerably higher (0.09-1.61 Gy). This is mainly owing to the fact that on the conventional scanner mAs was rarely reduced for scans evaluating needle position whereas low mAs per rotation was selected on the scanner with the fluoroscopy option. The maximum dose to a worker measured outside the lead apron was 28 microSv for one single procedure. The mean dose per procedure was below 10 microSv for radiologists and below 1 microSv for radiographers. Correcting for attenuation of the lead apron, the doses to workers are very low.

The rapid technological development within CT has resulted in a continuing expansion of CT examinations. Due to the high radiation dose often delivered by CT it is important to ensure that the required diagnostic information is achieved with minimum dose to the patient. The European Guidelines on Quality Criteria for CT includes anatomical/diagnostic image quality criteria for six main groups of examinations: cranium, face and neck, spine, chest, abdomen and pelvis, and bones and joints. The clinical use of such criteria has been limited and a pilot multicentre study has therefore been performed with regard to their utility in clinical practice for five types of examinations: (1) face and sinuses, (2) vertebral trauma, (3) HRCT of the lung, (4) liver and spleen, and (5) osseous pelvis. The results show that the diagnostic criteria can be used to optimise CT procedures to achieve doses that are as low as consistent with required diagnostic image quality.

To compare respiratory-triggered inversion-recovery (IR) gradient- and spin-echo (GRASE) magnetic resonance (MR) imaging with respiratory-triggered T2-weighted fast spin-echo (SE) imaging in the diagnosis of liver metastases.In this prospective study, two radiologists independently identified focal hepatic lesions on respiratory-triggered IR GRASE and respiratory-triggered fast SE MR images in 28 consecutive patients with 186 (135 malignant and 51 benign) proved lesions. A combination of findings at surgery, intraoperative ultrasonography (US), and histologic examination served as the standard of reference. Contrast-to-noise ratios (CNRs) were obtained from 86 lesions larger than 10 mm.The sensitivity in the detection of liver metastases was, independent of lesion size and observer, higher for IR GRASE imaging (55%) than for fast SE imaging (44%-50%) (observer 1, P = .014; observer 2, P = .21). Confidence levels with IR GRASE imaging were higher, but not significantly so, than those with fast SE imaging (P.098). Both observers characterized liver lesions better with IR GRASE than with fast SE imaging (observer 1, P = .04; observer 2, P = .48). The metastasis-liver CNR was significantly higher (P = .012) with IR GRASE imaging.The respiratory-triggered IR GRASE sequence is a fast alternative to the respiratory-triggered fast SE sequence in the evaluation of suspected liver metastases.

Item does not contain fulltext BACKGROUND: To compare the median overall survival of patients with isolated nonresectable liver metastases in comparable groups of patients treated with either isolated hepatic perfusion (IHP) with melphalan or systemic chemotherapy. PATIENTS AND METHODS: Colorectal cancer patients with isolated liver metastases, who underwent IHP, were included in this study. The control group consisted of a subgroup of colorectal cancer patients with liver metastases only, who were enrolled in the randomized CApecitabine, IRinotecan, Oxaliplatin (CAIRO) phase III study. RESULTS: Ninety-nine patients were treated with IHP, and 111 patients were included in the control group. All patient characteristics were comparable except for age. Median follow-up was 78.1 months for IHP versus 54.7 months in the control group. Median overall survival was 25.0 [95% confidence interval (CI) 19.4-30.6] months for IHP and 21.7 (95% CI 19.6-23.8) months for systemic treatment and did not differ significantly (P = 0.29). Treatment-related mortality was 2% for the systemic treatment and 6% for IHP (P = 0.11). CONCLUSION: Compared with a patient group with comparable characteristics treated with systemic chemotherapy, IHP does not provide a benefit in overall survival in patients with isolated nonresectable colorectal liver metastases. Currently, the use of IHP cannot be advocated outside the scope of clinical studies. 01 augustus 2010

Nitrogen-containing bisphosphonates (NCBs) are potent inhibitors of bone resorption and are used in the treatment of adults with various skeletal disorders. Little is known about their effects on the growing skeleton. The authors retrospectively studied the skeletal radiographs obtained in nine children before, during, and after NCB administration. Bandlike metaphyseal sclerosis and concentric epi- and apophyseal sclerosis developed in all patients. The extent of sclerosis depended on the duration of treatment and was related to local, and probably general, skeletal growth activity. In the maturing spine, NCBs caused a "picture-frame" or "bone-within-bone" appearance, depending on continuation or cessation of administration. In addition, metaphyseal undertubulation of long bones was noted in five patients. After discontinuation of bisphosphonate treatment and/or closure of the growth plates, the degree of sclerosis decreased, and sclerosis tended to disappear, indicating that this is a reversible phenomenon.

A case described of spontaneous retroperitoneal haemorrhage due to rupture of a high-flow aneurysm of the posterior pancreaticoduodenal arcade. Treatment consisted of exclusion of the aneurysm by Histoacryl/Lipiodol injection through a microcatheter superselectively placed in the arcade. Both diagnosis and treatment options are discussed.

The Quality Criteria concept has recently been extended to Computed Tomography with the European Guidelines on Quality Criteria for CT (EUR 16262) produced under the 4th Framework Research Programme in a Concerted Action. The adaptation of the quality criteria to CT has become necessary due to the relatively high collective dose which derives from CT within Europe, where in some countries it accounts for more than one third of the total collective dose from diagnostic X ray examinations, whilst representing only about 2-4% of all examinations. The Guidelines include diagnostic requirements specifying anatomical/diagnostic image quality criteria for six main groups of examinations: cranium, face and neck, spine, chest, abdomen and pelvis, and bones and joints. The image criteria refer to characteristic features of imaged anatomical structures with a specific degree of visibility. Two diagnostic reference dose quantities have been defined on the basis of measurements of the Computed Tomography Dose Index (CTDI).