Purpose: To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)þmicrowave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. Methods: This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrastenhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. Results: Final analysis included 265 patients (154 men, 111 women; mean age ¼ 54.5 ± 11.8 years; range ¼ 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p ¼ 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p ¼ 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p ¼ 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. Conclusions: Combined therapy with cTACE þ MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.

SummaryBackgroundIn this prospective study, we looked for correlations between anatomic variants of paranasal sinuses and chronic or recurrent sinusitis.Material/MethodsTwo hundred and forty (240) patients with clinical features of chronic rhinosinusitis were examined; patients with first-onset or allergic sinusitis and pregnant females were excluded. Routine multi-slice CT of the paranasal sinuses was performed to look for mucosal disease of the paranasal sinuses, drainage pathways, and presence of anatomical variations and their relation to known sinus drainage pathways.ResultsAnatomic variations were very frequent, and we classified them into four easily recognized groups: nasal septum variations, middle turbinate variations, uncinate process variations, and ethmoidal variations. Deviated nasal septum was the most frequent variation in patients with chronic or recurrent sinusitis, and it was detected in 48.8% of cases. Agger nasi cells and concha bullosa were equally frequent (30.6%), and Haller cells were detected in 11.2%. Uncinate process variations were detected in 18.1%, and the large ethmoid bulla was detected in 10%.ConclusionsThe importance of anatomic variations is that they can compromise drainage pathway of the related sinus, which results in inflammatory sinus disease. Anatomical variations are not diseases on their own and may be present as incidental findings in patient with chronic sinusitis.

SummaryThe aim of this work is to study the usage of multi-detector HRCT chest in diagnosing pulmonary TB cases whose sputum smears are negative and making a correlation between their CT features and their sputum culture results.This study was carried out from December 2014 to December 2016 at Zagazig university hospitals, Radiodiagnosis department. It included 150 patients. Their ages ranged between 10 to 70 years with a mean age 40 years. They were referred from the outpatient respiratory medicine clinic of the hospital. All patients had been presented clinically with suspicion of PTB. Their clinical features and HRCT findings were investigated to predict the risk for PTB. We then designed provisional HRCT diagnostic criteria based on the results to rank the risk of PTB.A positive tuberculin skin test alone among clinical laboratory findings was significantly associated with an increase of risk of PTB. Centrilobular nodules, large nodules, tree-in-bud appearance and the main lesion being located in S1, S2, and S6 lung segments were significantly associated with an increased risk of PTB. At HRCT 40 out of 44 patients with class III ranking showed active pulmonary TB. 12 out of 51 patients presented with class II ranking and 8 out of 40 were ranked as class I. The sensitivity, specificity and positive likelihood ratio of class I ranking HRCT criteria to diagnose active pulmonary TB were 95%, 40% and 1.4, respectively. Class II ranking results were 85%, 72%, 3, respectively. Finally class III ranking results were 45%, 90%, 11.5, respectively.Cases suspected of having active pulmonary TB whose smears are negative can benefit from MD HRCT chest findings to predict those patients of high risk with good reproducibility.

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