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    February 01, 2013

    The following are highlights from current issues of RSNA’s two peer-reviewed journals.

    Interventional Oncologic Approaches to Liver Metastases

    Image-guided interventional techniques are powerful tools in the management of secondary liver malignancies. These approaches aim to either to allow patients with unresectable tumors to become surgical candidates, provide curative treatment options in nonsurgical candidates or improve survival in a palliative or even curative approach.

    In a State-of-the-Art Review and Commentary in the February issue of Radiology (RSNA.org/Radiology), Andreas H. Mahnken, M.D., M.B.A., M.M.E., E.B.I.R., and colleagues review the rationale, application and clinical results of each of these techniques on the basis of the current literature and discuss future prospects such as gene therapy and immunotherapy.

    Specifically, the authors discuss:

    • Portal vein embolization
    • Hepatic artery infusion chemotherapy
    • Transarterial chemoembolization
    • Radioembolization
    • Radiofrequency ablation

    “With modern ablation techniques such as microwave ablation on their way to routine practice and highly innovative techniques such as intraarterial gene therapy in very early stages of development, interventional oncology will gain further ground in the treatment of liver metastases,” the authors conclude.

    This article meets the criteria for AMA PRA Category 1 Credit™. CME is available online only. 

    US Appearance of Ductal Carcinoma in Situ

    Noncalcified grade 1 cribriform DCIS
    Noncalcified grade 1 cribriform DCIS in an 82-year-old woman who presented with a palpable mass that was diagnosed as invasive ductal carcinoma. Shear-wave elastographic image demonstrates diffuse stiffness of the surrounding tissue, a finding that may represent desmoplastic reaction. (RadioGraphics 2013;33;213–228) ©RSNA, 2013. All rights reserved. Printed with permission

    Ductal carcinoma in situ (DCIS), which accounts for 25 percent of all breast cancers diagnosed in the U.S., can have a variable appearance at ultrasound. Advances in ultrasound have improved the ability not only to characterize mammographic masses and asymmetries but also to detect calcifications. Because of increased implementation of ultrasound for screening and for targeted evaluation of breast MR imaging abnormalities, recognizing the ultrasound features of DCIS has become increasingly important.

    In an article in the January-February issue of RadioGraphics (RSNA.org/RadioGraphics), Lilian C. Wang, M.D., of Northwestern Memorial Hospital, Northwestern University, Chicago, and colleagues discuss the ultrasound features of calcified DCIS, noncalcified DCIS and DCIS diagnosed at MR imaging-directed (“second-look”) ultrasound. Optimal imaging techniques, relevant pathologic findings and the diagnostic utility of ultrasound in the detection of DCIS are also discussed by authors.

    Ultrasound features are nonspecific and careful correlation with respect to lesion location, size, shape and depth is needed, according to the authors. The presence of internal vascularity can help increase the positive predictive value of ultrasound in this setting.

    “With improved technology and the increased use of ultrasound and MR imaging, recognizing the ultrasound features of DCIS will become increasingly important for the detection of early-stage breast cancer,” the authors write.

    This article meets the criteria for AMA PRA Category 1 Credit™. CME is available online only. 
    A 3D portogram obtained via 5-F catheter
    A 3D portogram obtained via 5-F catheter inserted through left PV branch (arrow) shows usual PV anatomy in a patient scheduled for right PVE. (RadioGraphics 2013;266;2:407-430) ©RSNA, 2013. All rights reserved. Printed with permission
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