Purpose:To characterize effects of combining radiofrequency (RF) ablation with proapoptotic intravenous liposome-encapsulated paclitaxel and doxorubicin on tumor destruction, apoptosis and heat-shock protein (HSP) production, intratumoral drug accumulation, and end-point survival. Materials andMethods:R3230 mammary adenocarcinomas ( n = 177) were implanted in 174 rats in this animal care committee-approved study. Tumors received (a) no treatment, (b) RF ablation, (c) paclitaxel, (d) RF ablation followed by paclitaxel (RF ablation-paclitaxel), (e) paclitaxel before RF ablation (paclitaxel-RF ablation), (f) RF ablation followed by doxorubicin (RF ablation-doxorubicin), (g) paclitaxel followed by doxorubicin without RF ablation (paclitaxel-doxorubicin), or (h) paclitaxel before RF ablation, followed by doxorubicin (paclitaxel-RF ablation-doxorubicin). Tumor coagulation area and diameter were compared at 24-96 hours after treatment. Intratumoral pacli taxel uptake with and without RF ablation were compared. Immunohistochemical staining revealed cleaved caspase-3 and 70-kDa HSP (HSP70 ) expression. Tumors were randomized into eight treatment arms for Kaplan-Meier analysis of defi ned survival end-point (3.0-cm diameter). Results:Paclitaxel-RF ablation increased tumor coagulation over RF ablation or paclitaxel (mean, 14.0 mm 6 0.9 [standard deviation ], 6.7 mm 6 0.6, 2.5 mm 6 0.6, respectively; P , .001). Paclitaxel-RF ablation-doxorubicin had similar tumor coagulation ( P , .05), compared with paclitaxel-RF ablation, at 24 and 96 hours. Mean intratumoral paclitaxel accumulation for paclitaxel-RF ablation (6.76 m g/g 6 0.35) and RF ablation-paclitaxel (9.28 m g/g 6 0.87) increased over that for paclitaxel (0.63 m g/g 6 0.25, P , .001). Paclitaxel substantially increased apoptosis and decreased HSP70 expression at coagulation margin. Mean endpoint survival for paclitaxel-RF ablation-doxorubicin (56.8 days 6 25.3) was greater, compared with that for paclitaxel-RF ablation or RF ablation-paclitaxel (17.6 days 6 2.5), RF ablationdoxorubicin (30.3 days 6 4.9, P , .002), or paclitaxel-doxorubicin (27.9 days 6 4.1, P , .001). Conclusion:Selecting adjuvant liposomal chemotherapies (paclitaxel, doxorubicin) to target cellular apoptosis and HSP production effectively increases RF ablation-induced tumor coagulation and end-point survival, and combined multidrug approach results in even better outcomes.q RSNA, 2010 Supplemental material: http://radiology.rsna.org/lookup/suppl

It has been shown that magnetic resonance spectroscopy (MRS) can improve the specificity of the MR examination by the spectroscopic detection of choline (Cho). Commonly, the lesion is first visualized on postcontrast studies, and the MRS voxel is prescribed accordingly. The implicit assumption made in this approach is that the presence of gadolinium-based contrast agents will have a negligible effect on the MR spectra obtained from the lesion. In this work, we examined this assumption by determining the effects of six gadolinium-based contrast agents: Magnevist, Multihance, Omniscan, Optimark, ProHance, and Dotarem, on the Cho peak in phantoms and in a rat model for breast cancer. We found that only the three negatively-charged chelates: Magnevist, MultiHance, and Dotarem, broadened the Cho peak in phantoms and reduced the area of the Key words: breast MRS; contrast agents; interactions; choline; in vivoThere is increasing adoption of MRI of the breast both as a screening examination for younger women who are at high risk for developing breast cancer (1-3) or as a problemsolving tool following mammography and/or ultrasound imaging (4 -8). The visualization and characterization of breast lesions on MRI is based on a combination of morphological features of the lesion precontrast injection and patterns of dynamic contrast enhancement postinjection of gadolinium-based contrast agents. Recently, it has been shown that magnetic resonance spectroscopy (MRS) can improve the specificity of the MR examination by the spectroscopic detection of choline (Cho)-containing compounds (see Refs. 9 -13 for reviews). The majority of the in vivo MRS studies were performed using single-voxel methods, where the lesion was first visualized on the postcontrast studies and the MRS voxel prescribed accordingly. The implicit assumption made in this approach is that the presence of gadolinium-based contrast agents will have a negligible effect on the MR spectra obtained from the lesion. The only report that has addressed this issue explicitly in breast MRS is the study of Joe et al. (14), which showed that there were changes in both the linewidth (increase of 15-21%) and area (decrease of 11-18%) of the Cho peak, in the same subjects, pre-and postinjection of Omniscan (gadodiamide). There have been several reports addressing the effects of gadolinium-containing contrast agents on MR spectra both in vitro (15,16) and in vivo (17-22). All of the in vivo studies involved determining the effects of gadolinium diethylenetriamine penta acetate (Gd-DTPA; Magnevist) or gadolinium-tetraazacyclododecane tetra acetate (Gd-DOTA; Dotarem) on the proton MRS of brain tumors. Although the in vitro studies reported significant alterations in the spectral properties of Cho in phantoms, in the presence of Gd-DTPA, the in vivo studies reported smaller changes (10 -15%) in the Cho peak postcontrast administration. This smaller change was attributed to the fact that in the brain the Cho is predominantly intracellular and thus cannot come into direct contact wi...

Purpose. To compare the outcome following lateral plantar nerve release with or without calcaneal drilling for resistant plantar fasciitis. Methods. 30 women and 3 men aged 30 to 60 (mean, 45) years with resistant plantar fasciitis were randomised to undergo release of the first branch of the lateral plantar nerve with (group 1, n=18) or without (group 2, n=15) calcaneal drilling. Results. Patients were followed up for a mean of 27 months. According to the modified Mayo scoring system for plantar fasciotomy, group 1 was superior to group 2 in terms of score (93.9±6.97 vs. 83±8.2, p<0.001) and grading (15 excellent, 2 good, and one fair vs. 6 excellent, 4 good, and 5 fair; p=0.031). Three patients in group one and one patient in group 2 (16.7% vs. 6.6%, p=0.381) developed complications of heel numbness, foot oedema, and 2 cases of superficial wound infection, respectively. Conclusion. Adding calcaneal drilling to release of the first branch of the lateral plantar nerve achieves better outcome than release alone in patients with resistant plantar fasciitis.

Background: To evaluate the role of partial splenic artery embolization in corpuscular correction in cirrhotic patients. Results: Bleeding tendency was experienced in two thirds of patients (66.7%) and anemia in 63.3%. Splenic size ranged from 14.3 to 22 cm. PV diameter ranged from 11 to 18 mm. The mean platelet at the pre-operative laboratory was 34.9 ± 10.3 × 10 3 , corrected to 137.6 ± 37.1 × 10 3 within 1 month follow-up, and then 140 × 10 3 after 6 months. The mean of RBCs was 3.6 ± 0.3 × 10 6 , then 4 ± 0.5 × 10 6 at 1 month follow-up period. WBCs showed correction at the early post-operative period, 3.3 ± 0.4 × 10 3 , compared to 5.4 ± 1.4 × 10 3 at 1 month. Reduction in splenic size was achieved by 3-6 months. All patients (100%) had post-embolization syndrome. Gelfoam was used in 20 patients, PVA was used in 5 patients, and microspheres were used in 5 patients. Antiviral treatment regimen was started after an adequate rise in corpuscular counts in all patients. Conclusion: Partial splenic artery embolization is an effective alternative method to surgery in treatment of hypersplenism particularly in cirrhotic patients prepared for antiviral treatment with correction of the associated thrombocytopenia.

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