Vogl, T. J., A. Zinn, E. Elhawash, L. S. Alizadeh, N. - E. A. Nour-Eldin, and N. N. N. Naguib, "MR angiography-planned prostatic artery embolization for benign prostatic hyperplasia: single-center retrospective study in 56 patients.", Diagnostic and interventional radiology (Ankara, Turkey), vol. 27, issue 6, pp. 725-731, 2021. Abstractdir-27-6-725_1.pdf

PURPOSE: We aimed to evaluate the advantages of magnetic resonance angiography (MRA)-planned prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).

METHODS: In this retrospective study, MRAs of 56 patients (mean age, 67.23±7.73 years; age range, 47-82 years) who underwent PAE between 2017 and 2018 were evaluated. For inclusion, full information about procedure time and radiation values must have been available. To identify prostatic artery (PA) origin, three-dimensional MRA reconstruction with maximum intensity projection was conducted in every patient. In total, 33 patients completed clinical and imaging follow-up and were included in clinical evaluation.

RESULTS: There were 131 PAs with a second PA in 19 pelvic sides. PA origin was correctly identified via MRA in 108 of 131 PAs (82.44%). In patients in which MRA allowed a PA analysis, a significant reduction of the fluoroscopy time (-27.0%, p = 0.028) and of the dose area product (-38.0%, p = 0.003) was detected versus those with no PA analysis prior to PAE. Intervention time was reduced by 13.2%, (p = 0.25). Mean fluoroscopy time was 30.1 min, mean dose area product 27,749 µGy•m2, and mean entrance dose 1553 mGy. Technical success was achieved in all 56 patients (100.0%); all patients were embolized on both pelvic sides. The evaluated data documented a significant reduction in IPSS (p < 0.001; mean 9.67 points).

CONCLUSION: MRA prior to PAE allowed the identification of PA in 82.44% of the cases. MRA-planned PAE is an effective treatment for patients with BPH.

Naguib, N. N. N., B. Kaltenbach, A. A. Abdel-Karim, A. Elabd, H. Abd-Elsalam, R. Hammerstingl, H. Ackermann, T. J. Vogl, and N. - E. A. Nour-Eldin, "MRI analysis of uterine ischaemia as a form of non-target embolisation following uterine artery embolisation: incidence, extent and outcome.", Clinical radiology, vol. 76, issue 12, pp. 924-929, 2021. Abstractlbhth_lwl.pdf

AIM: To study the incidence, extent and fate of uterine ischaemia as one of the forms of non-target embolisation following uterine artery embolisation (UAE), as detected on immediate post-embolisation and contrast-enhanced magnetic resonance imaging (MRI) examinations at the 3-month follow-up.

MATERIALS AND METHODS: A retrospective study was undertaken comprising 43 women (mean age: 44.8 ± 3.79 years). MRI was performed before, immediately after (within 6 h), and 3 months after successful UAE. Areas of uterine ischaemia were identified on immediate post-embolisation MRI as regions of newly developed (compared to pre-embolisation MRI) absent enhancement within the uterus not corresponding to the location of the leiomyoma. The volume of the ischaemic region was calculated using the formula (height × length × width × 0.523).

RESULTS: Uterine ischaemia was encountered in 29 patients (67.44%). The mean volume of the ischaemic region immediately after UAE was 29.29 ± 19.15 ml (range: 7.36-87.71 ml). At 3-month follow-up, it was 0.35 ± 0.95 ml (range: 0-3.5 ml) with 25 (86%) patients showing complete resolution of the ischaemia. The mean reduction in the volume of the ischaemic region at the 3-month follow-up was 98.24 ± 5.72% (range: 72-100%). This volume reduction was statistically significant (p<0.0001).

CONCLUSION: Uterine ischaemia as a form of non-target embolisation following UAE might be encountered in up to two thirds of patients. These ischaemic areas are significantly reduced at the 3-month follow-up with up to 86% of cases showing complete reversibility of the ischaemia.

TJ, V., B. LM, N. - E. NA, K. B, Ackermann H, and N. NNN, "Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA", AJR Am J Roentgenol, vol. 2019 Dec, issue 213(6), pp. 1388-1396, 2019.
Roman, A., B. Kaltenbach, T. Gruber-Rouh, N. N. Naguib, T. J. Vogl, and N. - E. A. Nour-Eldin, "The role of MRI in the early evaluation of lung microwave ablation.", International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group, vol. 34, issue 6, pp. 883-890, 2018 Sep. Abstract

PURPOSE: To retrospectively investigate the role of a contrast enhanced MRI (ceMRI) performed 24 h after a microwave ablation (MWA) of the lung, in predicting local tumour progression (LTP) and detecting complications compared to an unenhanced CT.

MATERIAL AND METHODS: Forty-nine patients who underwent MWA of 77 lung metastases between 2008 and 2015 were included. All patients received an unenhanced chest CT and a ceMRI (including T2 and ceT1) 24 h after MWA. The conspicuities of the peripheral rim and the ablated tumour were scored using 1-3 scales and compared between examinations. The safety margin was measured directly (both scores ≥2) and indirectly using a subtraction method. The ability of each imaging modality to predict LTP based on safety margin width was analysed using receiver operating characteristic curves. The MRI ability to detect a pneumothorax was compared to CT.

RESULTS: The peripheral rim was best visualised on T2 followed by T1 and CT. The tumour was best visualised on CT, followed by T1 and T2. Direct safety margin measurement was possible on CT, ceT1 and T2 in 68.8%, 64.9% and 27.3% of cases, respectively. Direct CT (AUC = 0.77) and ceT1 (AUC = 0.76) measurements had better diagnostic performance than indirect CT (AUC = 0.72), ceT1 (AUC = 0.70) and T2 (AUC = 0.69) measurements. The MRI sensitivity and specificity for pneumothorax were 60.8% and 87.0%, respectively. Only one pneumothorax >1 cm was missed.

CONCLUSIONS: A ceMRI performed 24 h after MWA of lung tumours has a similar ability to predict LTP and detect important complications as a CT has.

Vogl, T. J., N. - E. A. Nour-Eldin, R. M. Hammerstingl, B. Panahi, and N. N. N. Naguib, "Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms - Review Article.", RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, vol. 189, issue 11, pp. 1055-1066, 2017 Nov. Abstract

 The locoregional interventional oncological treatment approach is an accepted modality for liver neoplasms, especially for hepatocellular carcinoma (HCC) and oligonodular liver metastases.  The main aim of ablation therapies like microwave ablation (MWA) is to eradicate all malignant cells in a minimally invasive technique under imaging guidance while preserving the healthy tissue with a sufficient safety margin (at least 5 mm) surrounding the ablated lesion.  Ablation therapy can be performed via a percutaneous, laparoscopic or intraoperative approach under ultrasound, MRI or CT guidance for adequate localization and monitoring of the ablation process.  Ablation is the method of choice for oligonodular HCCs ≤ 3 cm. The technical success rate varies from 88 % to 98 % and progression-free survival (PFS) at 3 years from 27 % to 91.7 %. The same criteria apply to the therapy of liver metastases.   · Careful selection of patients proves to be essential for optimum results of MWA. · Interventionists should be familiar with all aspects of complication and rapid assessment of imaging methods in order to evaluate induced damage by thermal ablation. · MWA seems to have some advantages over radiofrequency ablation, like shorter ablation time, less pain, less heat sink effect; however, scientific proof is needed. · Vogl TJ, Nour-Eldin A, Hammerstingl RM et al. Microwave Ablation (MWA): Basics, Technique and Results in Primary and Metastatic Liver Neoplasms - Review Article. Fortschr Röntgenstr 2017; 189: 1055 - 1066.

Gruber-Rouh, T., N. N. N. Naguib, M. Beeres, P. Kleine, T. J. Vogl, V. Jacobi, M. Alsubhi, and N. A. Nour-Eldin, "CT-guided hook-wire localisation prior to video-assisted thoracoscopic surgery of pulmonary lesions.", Clinical radiology, vol. 72, issue 10, pp. 898.e7-898.e11, 2017 Oct. Abstract

AIM: To assess the feasibility, safety, and efficacy of computed tomography (CT)-guided pulmonary nodule localisation using a hooked guide wire before video-assisted thoracoscopic surgery (VATS).

MATERIALS AND METHODS: The study included 79 patients with a history of malignancies outside the lung associated with pulmonary nodules. Mean lesion size was 0.7 cm (range 0.5-1.8 cm) and the mean lesion distance to the pleural surface was 1.5 cm (range 0.2-5 cm). All lesions (n=82) were marked with a 22-G hook wire. The technique was designed to insert the tip of the hook wire within or maximally 1 cm from the edge of the lesion. The Mann-Whitney U-test was used for univariate analyses and Fisher's exact test for categorical values.

RESULTS: The hooked guide wire was positioned successfully in all 82 pulmonary nodules within mean time of 9 minutes (8-20 minutes, SD: 2.5 minutes). The procedure time was inversely proportional to the size of the lesion (Spearman correlation factor 0.7). Minimal pneumothoraces were observed in five patients (7.6%). Pneumothorax was not correlated to the histopathology of the pulmonary nodules (p>0.09). Focal perilesional pulmonary haemorrhage developed in four patients (5%). Both haemorrhage and pneumothorax were significantly correlated to lesions <10 mm (p=0.02 and 0.01 respectively). The volume of resected lung tissue was significantly correlated to lesions of increased distance from the pleural surface ≥2.5 cm in comparison to lesions of <2.5 cm from the pleural surface.

CONCLUSION: CT-guided pulmonary nodule localisation prior to VATS could enable safe, accurate surgical guidance for the localisation of small pulmonary nodules.

Nour-Eldin, N. - E. A., M. Alsubhi, T. Gruber-Rouh, T. J. Vogl, B. Kaltenbach, H. H. Soliman, W. E. Hassan, S. M. Abolyazid, and N. N. Naguib, "CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery.", Cardiovascular and interventional radiology, vol. 40, issue 8, pp. 1223-1228, 2017 Aug. Abstract

PURPOSE: This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery.

MATERIALS AND METHODS: The study included 128 consecutive patients (82 males, 46 females; mean age 66.6 years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion. The treatment criteria for intervention were evidence of pericardial tamponade with ejection fraction (EF) <50%. The preintervention ejection fraction was determined echocardiographically with value between 30 and 40%. Exclusion criteria for drainage were hemodynamically unstable patients or impaired coagulation profile (INR <1.8 or platelet count <75,000). Drains (8F-10F) were applied using Seldinger's technique under CT guidance.

RESULTS: Pericardiocentesis and placement of a percutaneous pericardial drain was technically successful in all patients. The mean volume of evacuated pericardial effusion was 260 ml (range 80-900 ml; standard deviation [SD]: ±70). Directly after pericardiocentesis, there was a significant improvement of the ejection fraction to 40-55% (mean: 45%; SD: ±5; p < 0.05). The mean percentage increase of the EF following pericardial effusion drainage was 10%. The drainage was applied anteriorly (preventricular) in 39 of 128 (30.5%), retroventricularly in 33 of 128 (25.8%), and infracardiac in 56 of 128 (43.8%). Recurrence rate of pericardial effusion after removal of drains was 4.7% (67/128). Complete drainage was achieved in retroventricular and infracardiac positioning of the catheter (p < 0.05) in comparison to the preventricular position of the catheter. Recorded complications included minimal asymptomatic pneumothorax and pneumomediastinum 2.3% (3/128) and sinus tachycardia 3.9% (5/128).

CONCLUSION: CT-guided drainage of postoperative pericardial effusion is a minimally invasive technique for the release of the tamponade effect of the effusion and improvement of cardiac output.

Gruber-Rouh, T., A. Thalhammer, T. Klingebiel, N. - E. A. Nour-Eldin, T. J. Vogl, K. Eichler, N. Naguib, and M. Beeres, "Computed tomography-guided biopsies in children: accuracy, efficiency and dose usage", Italian Journal of Pediatrics, pp. 43-44, 2017.
Nour-Eldin, N. - E. A., S. Exner, M. Al-Subhi, N. N. N. Naguib, B. Kaltenbach, A. Roman, and T. J. Vogl, "Ablation therapy of non-colorectal cancer lung metastases: retrospective analysis of tumour response post-laser-induced interstitial thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA).", International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group, vol. 33, issue 7, pp. 820-829, 2017 11. Abstract

PURPOSE: To retrospectively compare the local tumour response and survival rates in patients with non-colorectal cancer lung metastases post-ablation therapy using laser-induced thermotherapy (LITT), radiofrequency ablation (RFA) and microwave ablation (MWA).

MATERIAL AND METHODS: Retrospective analysis of 175 computed tomography (CT)-guided ablation sessions performed on 109 patients (43 males and 66 females, mean age: 56.6 years). Seventeen patients with 22 lesions underwent LITT treatment (tumour size: 1.2-4.8 cm), 29 patients with 49 lesions underwent RFA (tumour size: 0.8-4.5 cm) and 63 patients with 104 lesions underwent MWA treatment (tumour size: 0.6-5 cm). CT scans were performed 24-h post-therapy and on follow-up at 3, 6, 12, 18 and 24 months.

RESULTS: The overall-survival rates at 1-, 2-, 3- and 4-year were 93.8, 56.3, 50.0 and 31.3% for patients treated with LITT; 81.5, 50.0, 45.5 and 24.2% for patients treated with RFA and 97.6, 79.9, 62.3 and 45.4% for patients treated with MWA, respectively. The mean survival time was 34.14 months for MWA, 34.79 months for RFA and 35.32 months for LITT. In paired comparison, a significant difference could be detected between MWA versus RFA (p = 0.032). The progression-free survival showed a median of 23.49 ± 0.62 months for MWA,19.88 ± 2.17 months for LITT and 16.66 ± 0.66 months for RFA (p = 0.048). The lowest recurrence rate was detected in lesions ablated with MWA (7.7%; 8 of 104 lesions) followed by RFA (20.4%; 10 of 49 lesions) and LITT (27.3%; 6 of 22 lesions) p value of 0.012. Pneumothorax was detected in 22.16% of MWA ablations, 22.73% of LITT ablations and 14.23% of RFA ablations.

CONCLUSION: LITT, RFA and MWA may provide an effective therapeutic option for non-colorectal cancer lung metastases with an advantage for MWA regarding local tumour control and progression-free survival rate.

Gruber-Rouh, T., N. N. N. Naguib, M. Beeres, B. Kaltenbach, T. J. Vogl, and N. - E. A. Nour-Eldin, "Transarterial Chemoembolization (TACE) as A Palliative Treatment Option for Liver Metastases from Non-Small Cell Lung Cancer (NSCLC)", International Journal of Radiology and Imaging Technology, vol. 2, issue 3, pp. 19-25, 2016.