Objective: Transarterial chemo-embolization (TACE) is a palliative treatment option for hepatocellular carcinoma (HCC) with improved patient survival. The aim of the study was to see the outcome of our patients at our institution 2 years post TACE. Patients and Methods: Electronic records were retrospectively reviewed for patients who had TACE from 1st November 2009 – 31st October 2012. Baseline imaging, multidisciplinary team (MDT) and clinical notes, pathology labs, TACE angiograms and follow up imaging were reviewed for 2 years after first TACE. Procedure complications, clinical status and findings at follow up CT were reviewed and analyzed in SPSS version 19. Survival was assessed using Kaplan Meier curves. Results: A total of 104 patients had TACE for HCC. Amongst these 21 patients were lost to follow up and could not be contacted to reconfirm the outcome and had to be excluded to minimize bias. Amongst the included 83 patients, 57 (68.7%) were male and 65 (78.4%) were 51-70 years of age at time of first TACE. The commonest cause for HCC was HCV in 74 (89.2%) patients. Target lesion size at baseline CT was < 5 cm in 38 (45.8%) patients, 5-10 cm in 37 (44.6%) patients and >10 cm in 8 (9.6%) patients. A total of 25 (30%) patients needed more than 1 session of TACE. On post TACE CT, 46 (55.4%) patients had good packing of lipoidol in the lesion. A total of 18 (21.7%) patients progressed in TACED lesions while another 21 (25%) progressed with new lesions. One patient had metastasis to adrenal gland. Only 8 (9.6%) patients had liver failure after TACE and 1 patient had hepatorenal syndrome. Only 1 patient died within 30 days after TACE. Two years post TACE, 47 (56.6%) patients were alive indicating good outcome. Conclusion: TACE improves survival in HCC; 1 year survival was 80% and 2 year survival was 56.6%.
Osteosarcoma is the most common primary malignant bone tumor in children. In addition to pulmonary metastasis, computed tomography frequently detects indeterminate pulmonary nodules (IPN). We conducted this study to determine the clinical significance of IPN in terms of progression to pulmonary metastasis and its impact on survival. It was a retrospective cohort study of pediatric nonmetastatic osteosarcoma patients treated from January 2005 to December 2018. Baseline computed tomography scans were reviewed for the presence of IPN (defined as a single nodule of <10 mm or ≥3 nodules of <5 mm). Subsequent scans were reviewed for the development of pulmonary metastasis. Of 155 patients, 31.6% (n=49) had IPN at baseline. A total of 43% (n=21) of those with IPN subsequently progressed to pulmonary metastasis compared with only 26% (n=28) of those without IPN (P<0.001) with a relative risk of 1.6 (1.03 to 2.5) in the IPN group. Patients with ≥3 IPN at baseline were at significantly greater risk of pulmonary metastasis as compared with <3 IPN (P=0.013). Overall and event-free survival in patients with and without IPN was 58% and 35%, and 72% and 46%, respectively. Our results suggest that patients with IPN may be at greater risk for progressing to pulmonary metastasis.
The aim of this study was to determine the variations of extrahepatic arterial anatomy in 1000 Pakistani patients undergoing CTA of the liver for various reasons.
Mirels' scoring system quantifies the risk of sustaining a pathologic fracture in osseous metastases of weight bearing long bones. Conventional Mirels' scoring is based on radiographs. Our pilot study proposes Tc MDP bone SPECT-CT based modified Mirels' scoring system and its comparison with conventional Mirels' scoring. Cortical lysis was noted in 8(24%) by SPECT-CT versus 2 (6.3%) on X-rays. Additional SPECT-CT parameters were; circumferential involvement [1/4 (31%), 1/2 (3%), 3/4 (37.5%), 4/4 (28%)] and extra-osseous soft tissue [3%]. Our pilot study suggests the potential role of SPECT-CT in predicting risk of fracture in osseous metastases.
Renal cell carcinoma (RCC) is the most common solid renal malignancy that metastasizes typically to lungs, bones, liver, adrenals, and lymph nodes. Isolated pleural metastases of RCC are extremely rare, with only few cases reported in the literature. We report one such case of a 60-year-old woman, a known case of RCC of the left kidney who underwent nephrectomy, and on follow-up, PET/CT scan revealed diffuse thick nodular hypermetabolic left pleural thickening, which was later biopsied and turned out to be pleural metastases from RCC. No other site of metastases was found.
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