Large-bore nitinol stents are highly effective for malignant superior vena cava syndrome. The survival rates of patients with caval vein stenosis due to either the primary tumor or secondary enlarged adenopathies were equal. An additional balloon-expandable stent was required in 22% of cases owing to incomplete expansion of the nitinol stent but was not associated with higher thrombosis rate.

The endovascular management of arterial haemorrhage after RP is safe and effective, without post-embolization ischaemic events.

Background Abdominal computed tomography (CT) is the standard imaging method for patients with suspected colorectal liver metastases (CRLM) in the diagnostic workup for surgery or thermal ablation. Diffusion-weighted and gadoxetic-acid-enhanced magnetic resonance imaging (MRI) of the liver is increasingly used to improve the detection rate and characterization of liver lesions. MRI is superior in detection and characterization of CRLM as compared to CT. However, it is unknown how MRI actually impacts patient management. The primary aim of the CAMINO study is to evaluate whether MRI has sufficient clinical added value to be routinely added to CT in the staging of CRLM. The secondary objective is to identify subgroups who benefit the most from additional MRI. Methods In this international multicentre prospective incremental diagnostic accuracy study, 298 patients with primary or recurrent CRLM scheduled for curative liver resection or thermal ablation based on CT staging will be enrolled from 17 centres across the Netherlands, Belgium, Norway, and Italy. All study participants will undergo CT and diffusion-weighted and gadoxetic-acid enhanced MRI prior to local therapy. The local multidisciplinary team will provide two local therapy plans: first, based on CT-staging and second, based on both CT and MRI. The primary outcome measure is the proportion of clinically significant CRLM (CS-CRLM) detected by MRI not visible on CT. CS-CRLM are defined as liver lesions leading to a change in local therapeutical management. If MRI detects new CRLM in segments which would have been resected in the original operative plan, these are not considered CS-CRLM. It is hypothesized that MRI will lead to the detection of CS-CRLM in ≥10% of patients which is considered the minimal clinically important difference. Furthermore, a prediction model will be developed using multivariable logistic regression modelling to evaluate the predictive value of patient, tumor and procedural variables on finding CS-CRLM on MRI. Discussion The CAMINO study will clarify the clinical added value of MRI to CT in patients with CRLM scheduled for local therapy. This study will provide the evidence required for the implementation of additional MRI in the routine work-up of patients with primary and recurrent CRLM for local therapy. Trial registration The CAMINO study was registered in the Netherlands National Trial Register under number NL8039 on September 20th 2019.

Hepatic adenomatosis occurs predominantly in women during the 4 th and 5 th decades of life (1). Hepatic adenomatosis is rare, although its real frequency could be underestimated because many patients are asymptomatic. Hepatic adenomatosis is defined as the presence of multiple adenomas (arbitrarily > 10) involving both lobes of the liver. Patients with glycogen storage disease or with a history of steroid intake are not considered to have liver adenomatosis (1, 2).Although the exact aetiology of hepatic adenomatosis is still unclear, congenital or acquired hepatic vascular abnormalities, mutations of the hepatocyte nuclear factor 1alpha (HNF1A) gene, and non-alcoholic fatty liver disease have been proposed as potential causes for the development of hepatic adenomatosis (1, 2). Hepatocellular adenomas in patients with hepatic adenomatosis may be of the inflammatory, HNF-1alpha-mutated, or beta-catenin-mutated subtypes, and as a consequence may show variable imaging findings.We describe the magnetic resonance imaging (MRI) findings in a 39-year-old woman presenting with non-alcoholic fatty liver disease and hepatic adenomatosis characterized by the inflammatory subtype of hepatic adenomas. minimal or no signal drop-off on chemical shift sequences. On T1-weighted in-phase images, lesions were isointense or mildly hyperintense compared to liver parenchyma (Fig. 1). On fat suppressed T1-weighed images, due to liver steatosis, lesions were markedly hyperintense (Fig. 2). One lesion measuring 8 cm demonstrated an irregular central T1-and T2-weighted hypointense area. Case reportA 39-year-old female with unremarkable previous medical history was referred for MRI after detecting a large liver mass during routine ultrasound examination. Patient had taken oral contraceptives for 12 years. Physical examination showed slight overweight (body mass index 29). The laboratory evaluations and blood biochemistry profile showed elevated C-reactive protein (11,4 mg/dl; normal value < 0,5), alkaline phosphatase (417 U/L, normal values 27-126) and γ-glutamyltransferase (101 U/L, normal values 5-43) levels. Hepatitis B surface antigen, anti-hepatitis B surface antibody and anti-hepatitis C antibody were negative.Serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and carbohydrate antigenic determinant (CA) 19-9 were normal. On MRI, liver parenchyma showed marked signal drop-off on T1-weighted out-ofphase images and corresponded to steatosis of the liver parenchyma. Multiple, approximately 14, well-delineated focal liver lesions with variable size (1-10 cm diameter) involving both liver lobes were noted. Lesions were diffusely hyperintense on T2-weighted images, with higher signal intensity in the periphery of the lesion (Fig. 1) We report a case with the inflammatory subtype of hepatic adenomatosis in a 39-year-old woman with liver steatosis. the magnetic resonance imaging features using extracellular gadolinium chelates and hepatocytetargeted contrast agents are described.

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