Diagnostic ultrasound has been clinically used for decades. More recently, high intensity focused ultrasound (HIFU) has been developed for therapeutic use as a non-invasive technique for tissue ablation. HIFU is also being investigated for advanced applications at the cellular level. Under guidance by magnetic resonance or ultrasound imaging, HIFU can achieve precise biological effects in tissue with a high safety profile. In this article, we discuss the basic principles, advantages and limitations of HIFU. We will also address the food and drug administration (FDA) approved clinical applications in the United States and highlight active HIFU research with promising clinical outcomes.
Lung cancer is the leading cause of cancer-related deaths. Surgery remains the best option to treat lung cancer when feasible. However, many cases are diagnosed beyond the initial stages. There has been tremendous progress in the treatment of lung cancer over the last few years. Studies have shown that biomarker-driven targeted therapies lead to better outcomes. Due to the technical difficulties and significant procedural risk associated with repeated tissue biopsies, analysis of tumor constituents circulating in the blood, such as circulating tumor DNA (ctDNA) and various proteins, is becoming more widely recognized as an alternative method of tumor sampling, i.e., liquid biopsy. Liquid biopsy is superior to tissue biopsy, as it is minimally invasive and easily repeatable. Given the recent data on changes in mutations as the disease progresses or responds to treatment, liquid biopsies can help monitor the changes and guide us in giving targeted drugs. Here we present a case of advanced NSCLC who was initially started on Alectinib based on positivity for ALK gene rearrangement found in the FISH study. At the time of progression, molecular profiling liquid biopsy was obtained, which revealed KRAS-p.G12C mutation. Thus, the patient’s therapy was later on changed to sotorasib after the FDA approved a KRAS-p.G12C mutation inhibitor.
We present a case of an ectopic mediastinal parathyroid adenoma in a 58-year-old male patient. We show how different imaging modalities were successfully used to reach a diagnosis. We particularly focus on the role of four-dimensional CT scan in preoperative localization of ectopic adenomas and discuss how diverse imaging modalities can be integrated in the workup of ectopic parathyroid adenomas.
Hemangiomas are the most common benign lesions involving the spine. Metastasis is the most common malignant condition. The diagnosis of typical hemangiomas on conventional CT and MRI imaging is straightforward. However, when the hemangiomas are very large they may have atypical features making their diagnosis on these conventional imaging modalities inconclusive. In such cases nuclear medicine techniques such as Tc-99m RBC may aid in resolving the diagnostic conundrum. Awareness and use of proper diagnostic modality can prevent unnecessary biopsy. In this case report we try to highlight the added value of Tc-99m RBC scan to conventional imaging techniques in differentiating giant vertebral hemangioma from more aggressive malignant tumors.
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