Vascular anomalies, including vascular malformations and tumors, are frequently straightforward to detect; however, accurate diagnosis and appropriate treatment are often challenging. Misdiagnosis of these lesions can lead clinicians in the wrong direction when treating these patients, which can have unfavorable results. This review presents an overview of the classification systems that have been developed for the diagnosis of vascular lesions with a focus on the imaging characteristics. Pictorial examples of each lesion on physical examination, as well as non-invasive and minimally invasive imaging are presented. An overview of the endovascular treatment of these lesions is also given. In some cases, vascular anomalies may be associated with an underlying syndrome and several of the most commonly encountered syndromes are discussed. Understanding of the classification systems, familiarity with the treatment options and knowledge of the associated syndromes are essential for all physicians working with this patient population. The approach to the described entities necessitates an organized multi-disciplinary team effort, with diagnostic imaging playing an increasingly important role in the proper diagnosis and a combined interventional radiologic and surgical treatment method showing promising results.
Purpose:
Chemo‐radiation therapy (CRT) is widely used in treating patients with locally advanced non‐small cell lung cancer (NSCLC). Determination of the likelihood of patient response to treatment and optimization of treatment regime is of clinical significance. Up to date, no imaging biomarker has reliably correlated to NSCLC patient survival rate. This pilot study is to extract CT texture information from tumor regions for patient survival prediction.
Methods:
Thirteen patients with stage II‐III NSCLC were treated using CRT with a median dose of 6210 cGy. Non‐contrast‐enhanced CT images were acquired for treatment planning and retrospectively collected for this study. Texture analysis was applied in segmented tumor regions using the Local Binary Pattern method (LBP). By comparing its HU with neighboring voxels, the LBPs of a voxel were measured in multiple scales with different group radiuses and numbers of neighbors. The LBP histograms formed a multi‐dimensional texture vector for each patient, which was then used to establish and test a Support Vector Machine (SVM) model to predict patients’ one year survival. The leave‐one‐out cross validation strategy was used recursively to enlarge the training set and derive a reliable predictor. The predictions were compared with the true clinical outcomes.
Results:
A 10‐dimensional LBP histogram was extracted from 3D segmented tumor region for each of the 13 patients. Using the SVM model with the leave‐one‐out strategy, only 1 out of 13 patients was misclassified. The experiments showed an accuracy of 93%, sensitivity of 100%, and specificity of 86%.
Conclusion:
Within the framework of a Support Vector Machine based model, the Local Binary Pattern method is able to extract a quantitative imaging biomarker in the prediction of NSCLC patient survival. More patients are to be included in the study.
Sarcoidosis has a wide variety of radiologic manifestations. However, lesions that mimic tumors are rare presentations of this systemic disorder. Differentiating sarcoid granulomas from malignancy is critical, as management and prognosis for these two entities are drastically different. Therefore, it is imperative to be cognizant of the various radiologic appearances of pseudotumoral renal sarcoid. We report a case of a 61-year-old man with recently diagnosed prostate cancer and pulmonary sarcoidosis discovered on staging CT who presented with pseudotumoral renal sarcoid mimicking malignancy.
Transcatheter arterial embolization (TAE) is commonly used to control hemorrhage after pelvic trauma. Despite the procedure's reported safety, there can be severe complications, mostly related to ischemia of embolized tissues. Our purpose was to examine the complications of trauma patients resulting from the embolization techniques utilized at our level 1 trauma center. Materials: A retrospective chart review was conducted. 107 patients who underwent pelvic embolization between January 2003 and December 2013 were included. Patient demographics, ISS, angiography techniques, and major complications including gluteal and skin necrosis, wound breakdown, and deep infection were compared. Results: 9 patients (8.4%) developed major complications after undergoing TAE. This rate dropped to 5.1% after exclusion of patients with Morel-Lavallee lesions. Nonselective embolization trended towards a higher complication rate compared to superselective embolization. Patients who developed complications were more likely to have undergone pelvic surgery. Conclusions: The majority of patients who developed complications had nonselective TAE. Morel-Lavallee lesions are a confounding factor, but TAE likely imposes an additional risk. Pelvic surgery after TAE may further predispose patients to complications. We recommend superselective embolization as first line treatment and caution the use of prophylactic embolization, especially in patients with significant pelvic soft tissue injuries.
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