Purpose: Chemosaturation with percutaneous hepatic perfusion (PHP; Hepatic CHEMOSAT? Delivery System; Delcath Systems Inc, USA) is a minimally invasive, repeatable regional therapy for unresectable hepatic metastases. It uses a system of catheters and filters to isolate hepatic venous blood from the systemic circulation, allowing delivery of high-dose chemotherapy to the hepatic artery. Effluent hepatic venous blood is filtered before being returned to the systemic circulation, thereby reducing exposure to chemotherapy. We describe our experiences with chemosaturation-PHP at 2 European centers. Materials and Methods: 14 patients presented unresectable hepatic metastases from solid tumors; 13 received 1???3 sessions of chemosaturation-PHP. Melphalan 2.0 (n?=?1) or 3.0 (n?=?12) mg/kg was given as a 30-minute infusion into the hepatic artery. 12 patients were evaluable for tumor response. Results: One complete (cholangiocarcinoma, n?=?1) and 6 partial responses (ocular, n?=?3 or cutaneous melanoma, n?=?3) were observed, 5 patients had stable disease (ocular melanoma, n?=?3; breast cancer, n?=?1; gastric cancer, n?=?1). Mild to moderate filter-related toxicity (i.?e. thrombocytopenia, anemia) was observed immediately post-procedure. Grade 3/4 melphalan-related pancytopenia developed after 1???2 weeks. All hematological events were managed effectively with transfusions and/or other supportive measures. The new high-efficiency filter showed milder toxicity and faster recovery. In one case, chemosaturation-PHP was abandoned prematurely due to heparin-induced vaginal bleeding, and one patient died due to retroperitoneal hemorrhage from heparin anti-coagulation. Conclusion: Chemosaturation-PHP for non-resectable liver metastases is a feasible treatment option when performed by an experienced multi-disciplinary team. It may be a promising regional therapy for patients with no effective treatment options. Citation Format: ??Vogl TJ, Zangos S, Scholtz JE et?al. Chemosaturation with Percutaneous Hepatic Perfusions of Melphalan for Hepatic Metastases: Experience from Two European Centers. Fortschr R?ntgenstr 2014; 186: 937???944

Pneumothorax complicating CT-guided core biopsy of pulmonary lesions, showed the insignificant difference between coaxial and non-coaxial techniques. However, both techniques have the same significant risk factors including small and basal lesions, increased lesion's depth from pleural surface, and increased length of aerated lung parenchyma crossed by biopsy needle and passing through pulmonary fissures in the needle tract.

Purpose To evaluate whether a dual-energy (DE) computed tomographic (CT) virtual noncalcium technique can improve the detection rate of acute thoracolumbar vertebral compression fractures in patients with osteoporosis compared with that at magnetic resonance (MR) imaging depending on the level of experience of the reading radiologist. Materials and Methods This retrospective study was approved by the institutional ethics committee. Informed consent was obtained from all patients. Forty-nine patients with osteoporosis who were suspected of having acute vertebral fracture underwent DE CT and MR imaging. Conventional linear-blended CT scans and corresponding virtual noncalcium reconstructions were obtained. Five radiologists with varying levels of experience evaluated gray-scale CT scans for the presence of fractures and their suspected age. Then, virtual noncalcium images were evaluated to detect bone marrow edema. Findings were compared with those from MR imaging (the standard of reference). Sensitivity and specificity analyses for diagnostic performance and matched pair analyses were performed on vertebral fracture and patient levels. Results Sixty-two fractures were classified as fresh and 52 as old at MR imaging. The diagnostic performance of all readers in the detection of fresh fractures improved with the addition of virtual noncalcium reconstructions compared with that with conventional CT alone. Although the diagnostic accuracy of the least experienced reader with virtual noncalcium CT (accuracy with CT alone, 61%; accuracy with virtual noncalcium technique, 83%) was within the range of that of the most experienced reader with CT alone, the latter improved his accuracy with the noncalcium technique (from 81% to 95%), coming close to that with MR imaging. The number of vertebrae rated as unclear decreased by 59%-90% or from 15-53 to 2-13 in absolute numbers across readers. The number of patients potentially referred to MR imaging decreased by 36%-87% (from 11-23 to 2-10 patients). Considering the gain in true decisions with the virtual noncalcium technique on a patient level, between 12 (most experienced reader) and 17 (least experienced reader) MR examinations could have been avoided. Conclusion The DE CT-based virtual noncalcium technique may enable depiction of bone marrow edema in thoracolumbar vertebral compression fractures in patients with osteoporosis, with good accordance with MR imaging when images are read by experienced radiologists. Although less experienced readers improved their diagnostic performance to some degree, the experienced reader's diagnostic performance approached that with MR imaging. (©) RSNA, 2016.

General image quality of DE-CTA examinations can be substantially improved using the VMI+ algorithm with observer preference of 70 keV, while 40 to 50 keV series provide superior contrast and improved visualization of small arterial branches compared with traditional VMI and standard linearly blended series.