Image-guided percutaneous lung ablation has proven to be a valid treatment alternative in patients with early-stage non-small cell lung carcinoma or oligometastatic lung disease. Available ablative modalities include radiofrequency ablation, microwave ablation, and cryoablation. Currently, there are no sufficiently representative studies to determine significant differences between the results of these techniques. However, a common feature among them is their excellent tolerance with very few complications. For optimal treatment, radiologists must carefully select the patients to be treated, perform a refined ablative technique, and have a detailed knowledge of the radiological features following lung ablation. Although no randomized studies comparing image-guided percutaneous lung ablation with surgery or stereotactic radiation therapy are available, the current literature demonstrates equivalent survival rates. This review will discuss image-guided percutaneous lung ablation features, including available modalities, approved indications, possible complications, published results, and future applications.

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In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological complication. An English literature search was carried out from June 2018 through July 2022. The resulting selection, comprising observational studies, clinical trials, systematic reviews and society guidelines, was organized into four sections according to the four groups of neurological complications: ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac surgery could be performed without delay in cases of ischemic vascular neurological complication (provided the absence of severe damage, which can be avoided with the performance of mechanical thrombectomy in cases of major stroke), as well as infectious or asymptomatic complications. In the presence of intracranial hemorrhage, a delay of four weeks is recommended for most cases, although recent studies have suggested that performing cardiac surgery within four weeks could be a suitable option for selected cases. The findings of this review are mostly in line with the recommendations of the current European and American infective endocarditis guidelines.

BACKGROUND AND PURPOSE: CTP allows estimating ischemic core in patients with acute stroke. However, these estimations have limited accuracy compared with MR imaging. We studied the effect of applying WM-and GM-specific thresholds and analyzed the infarct growth from baseline imaging to reperfusion. MATERIALS AND METHODS:This was a single-center cohort of consecutive patients (n ¼ 113) with witnessed strokes due to proximal carotid territory occlusions with baseline CT perfusion, complete reperfusion, and follow-up DWI. We segmented GM and WM, coregistered CTP with DWI, and compared the accuracy of the different predictions for each voxel on DWI through receiver operating characteristic analysis. We assessed the yield of different relative CBF thresholds to predict the final infarct volume and an estimated infarct growth-corrected volume (subtracting the infarct growth from baseline imaging to complete reperfusion) for a single relative CBF threshold and GM-and WM-specific thresholds. RESULTS:The fixed threshold underestimated lesions in GM and overestimated them in WM. Double GM-and WM-specific thresholds of relative CBF were superior to fixed thresholds in predicting infarcted voxels. The closest estimations of the infarct on DWI were based on a relative CBF of 25% for a single threshold, 35% for GM, and 20% for WM, and they decreased when correcting for infarct growth: 20% for a single threshold, 25% for GM, and 15% for WM. The combination of 25% for GM and 15% for WM yielded the best prediction.CONCLUSIONS: GM-and WM-specific thresholds result in different estimations of ischemic core in CTP and increase the global accuracy. More restrictive thresholds better estimate the actual extent of the infarcted tissue.ABBREVIATIONS: ICC ¼ intraclass correlation coefficient; IG ¼ infarct growth; IQR ¼ interquartile range; rCBF ¼ relative CBF C TP is a widely available technique that allows measuring hypoperfused brain tissue and estimating ischemic core in patients with acute stroke. [1][2][3] The ischemic core is often defined by CBF thresholds. 4 However, despite their clinical usefulness, the most often used CBF-based definitions of ischemic core may not be accurate for research purposes. 5 They often overestimate the true infarct 6 (example in the Online Supplemental Data) and have limited accuracy compared with MR imaging. 7 In addition, differences in the neurochemical response to ischemia in GM and WM lead to a varied vulnerability to ischemia. 8 Applying homogeneous CBF thresholds in the whole brain may result in under-or overestimating the lesion in brain areas with different susceptibility to ischemia. 9 Also, ischemic core volumes estimated by CTP, especially those affecting WM, are often smaller than in follow-up MR imaging. 10 This overestimation, applied to routine clinical practice, could lead to not offering reperfusion treatment to patients who could benefit from it. These findings can be explained by the delay between baseline imaging and the followup imaging used to measure final infarct volume. The b...