151
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Bárcena R, Moreno A, Foruny JR, Blázquez J, Graus J, Riesco JM, Blesa C, García-Hoz F, Sánchez J, Gil-Grande L, Nuño J, Fortún J, Rodriguez-Sagrado MA, Moreno A. Partial splenic embolization and peg-IFN plus RBV in liver transplanted patients with hepatitis C recurrence: safety, efficacy and long-term outcome. Clin Transplant 2009; 24:366-74. [PMID: 19863593 DOI: 10.1111/j.1399-0012.2009.01081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Rafael Bárcena
- Liver-Gastroenterology, Hospital Ramon y Cajal, Madrid 28034, Spain.
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152
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Affiliation(s)
- Michael D Kelly
- Department of Upper GI Surgery, Frenchay Hospital, Bristol, UK
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153
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Abstract
Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include a preoperative radiologic assessment to measure splenic volume and to detect the presence of accessory splenic tissue; the patient should undergo preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections. Prophylactic antibiotics are used in the perioperative period as well as prophylactic anticoagulation therapy which may be continued long-term in high-risk patients. LS is associated with a low morbidity and mortality; when compared to laparotomy, it reduces the length of hospital stay and improves the quality of life by decreasing postoperative ileus and pain. There are a variety of laparoscopic approaches; the hand-assisted technique and newer coagulating devices have facilitated the operative technique leading to increasing acceptance of laparoscopy as the preferred approach - even in patients with malignant hematologic disease and/or massive splenomegaly.
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Affiliation(s)
- F Borie
- Service de chirurgie digestive B, CHU Carémeau, place de Pr-Debré, 30029 Nimes, France.
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154
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Endovascular Treatment of a Distal Splenic Artery Aneurysm with Use of a Stent-graft. J Vasc Interv Radiol 2009; 20:687-9. [DOI: 10.1016/j.jvir.2009.01.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 01/28/2009] [Accepted: 01/30/2009] [Indexed: 01/23/2023] Open
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155
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Sidhu MK, Hogan MJ, Shaw DWW, Burdick T. Interventional radiology for paediatric trauma. Pediatr Radiol 2009; 39:506-15. [PMID: 19089416 DOI: 10.1007/s00247-008-1082-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 09/15/2008] [Accepted: 09/21/2008] [Indexed: 01/01/2023]
Abstract
Paediatric interventional radiology plays a cornerstone role in the management of paediatric trauma. In the acute setting, interventional radiology techniques allow minimally invasive control of haemorrhage or re-establishment of blood flow. Percutaneous stenting and drainage can allow disruptions in urinary or biliary systems to heal without the need for further surgery. Interventional radiology techniques also have a significant role in treating delayed complications of trauma, including embolization of arterial pseudoaneurysms and pulmonary embolism prophylaxis in individuals immobilized due to the trauma or its operative treatment.
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Affiliation(s)
- Manrita K Sidhu
- Seattle Radiologists, The Everett Clinic, AIC, Seattle, WA 98104, USA.
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156
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de la Fuente SG, Smith TP, Rice HE. Functional and anatomic correlation of splenic regeneration following embolization. Pediatr Int 2009; 51:302-5. [PMID: 19379265 DOI: 10.1111/j.1442-200x.2009.02807.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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157
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Sanyal R, Shah SN. Role of imaging in the management of splenic artery steal syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:471-477. [PMID: 19321675 DOI: 10.7863/jum.2009.28.4.471] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this study is to discuss the etiology and role of imaging in the management of splenic artery steal syndrome (SASS) following orthotropic liver transplantation (OLT). METHODS Hepatic arterial thrombosis and stenosis have been the most commonly recognized arterial complications following OLT. Splenic artery steal syndrome is a recently described entity in the transplant literature and thought to be an under-recognized cause of graft ischemia. It is characterized by hepatic arterial hypoperfusion accompanied by splenic arterial and portal venous hyperperfusion and leads to various vascular and biliary graft complications. Because the clinical manifestations of SASS are so non-specific, imaging plays a key role in the diagnosis of this condition. RESULTS This article discusses the role of imaging in the management of this potentially reversible cause of graft ischemia. CONCLUSIONS Awareness of the imaging features and having a high index of suspicion are essential for the early diagnosis and prompt management of this condition.
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Affiliation(s)
- Rupan Sanyal
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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158
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Dominguez EP, Barshes NR, Sherman V, Albo D, Kougias P, Chen C, Sweeney JF, Lin PH. Effect of catheter-directed arterial embolization and laparoscopic endovascular stapling on stapled vessel integrity in a porcine model. Vascular 2008; 16:80-4. [PMID: 18377836 DOI: 10.2310/6670.2008.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arterial embolization is a frequently performed adjunctive maneuver prior to laparoscopic splenectomy or nephrectomy to facilitate laparoscopic dissection and reduce intraoperative bleeding. However, little is known regarding the effect of laparoscopic stapling across thrombosed vessels with imbedded embolic materials. This study analyzed the stapled line integrity by comparing visceral arteries treated with either platinum coils or polyvinyl alcohol (PVA) particles. Using a porcine model, 30 visceral vessels including splenic and renal arteries were treated with either coil or PVA embolization, which was followed by laparoscopic stapling. Vessel integrity and bursting pressure analysis was performed using an in vitro flow circuitry. The mean bursting pressure of the coil and the PVA group was 158 +/- 56 and 350 +/- 34 mm Hg, respectively (p < .001). The lowest bursting pressure in the coil and the PVA group was 70 and 280 mm Hg, respectively. The highest bursting pressure in the coil and the PVA group was 225 and 420 mm Hg, respectively. The bursting pressure in the splenic artery between the PVA and the coil group was 345 +/- 29 and 150 +/- 54 mm Hg, respectively (p < .001). Significant difference in the bursting pressure in the renal artery was noted in the PVA and the coil group, which was 350 +/- 40 and 160 +/- 40 mm Hg, respectively (p < .001). Our findings showed that preoperative coil embolization followed by laparoscopic vessel stapling sustained a poor busting pressure. Such a practice appears to be unsafe based on our findings and should be performed with caution in a clinical setting.
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Affiliation(s)
- Edward P Dominguez
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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159
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Bellows CF, Choi YU, Sweeney JF, Jaffe BM, Dominguez EP. Splenic Artery Embolization and Endovascular Stapler Integrity in a Porcine Model. Am Surg 2008. [DOI: 10.1177/000313480807400409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Splenic artery embolization is often used before laparoscopic splenectomy in cases of splenomegaly to reduce blood loss and facilitate the procedure. The aim of this study was to examine the general reliability of endovascular staplers when fired at the site of embolization coil deployment using a porcine model. Ex vivo and in vivo experiments were conducted on porcine abdominal aortas, which are similar in diameter to those of the splenic artery in the human. When the endovascular staplers were fired across the porcine vessels at the area of embolization coil deployment ex vivo, the staple lines all failed. In contrast, in vivo, the staple lines remained intact with no bleeding despite resistance imposed by the intravascular coils. Despite consistent failure in the ex vivo studies, in vivo all staple lines held and permitted safe transection of the vessel. We presume that the hemostatic properties of the coils caused sufficient thrombosis in this model, which mimics the clinical situation, to permit division of the previously embolized splenic vessel.
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Affiliation(s)
- Charles F. Bellows
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas and the
| | - Yong U. Choi
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas and the
| | - John F. Sweeney
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas and the
| | - Bernard M. Jaffe
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Edward P. Dominguez
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas and the
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160
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Abstract
Partial splenic embolization (PSE) is a non-surgical procedure developed to treat hypersplenism as a result of hepatic disease and thus avoid the disadvantages of splenectomy. A femoral artery approach is used for selective catheterization of the splenic artery. Generally, the catheter tip is placed as distally as possible in an intrasplenic artery. After an injection of antibiotics and steroids, embolization is achieved by injecting 2-mm gelatin sponge cubes suspended in a saline solution containing antibiotics. PSE can benefit patients with thrombocytopenia, esophagogastric varices, portal hypertensive gastropathy, encephalopathy, liver dysfunction, splenic aneurysm, and splenic trauma. The contraindications of PSE include secondary splenomegaly and hypersplenism in patients with terminal-stage underlying disease; pyrexia or severe infections are associated with a high risk of splenic abscess after PSE. Complications of PSE include daily intermittent fever, abdominal pain, nausea and vomiting, abdominal fullness, appetite loss, and postembolization syndrome. Decreased portal-vein flow and a rapid increase in the platelet count after excessive embolization may cause portal-vein or splenic-vein thrombosis.
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161
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Habermalz B, Sauerland S, Decker G, Delaitre B, Gigot JF, Leandros E, Lechner K, Rhodes M, Silecchia G, Szold A, Targarona E, Torelli P, Neugebauer E. Laparoscopic splenectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 2008; 22:821-48. [PMID: 18293036 DOI: 10.1007/s00464-007-9735-5] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 11/23/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although laparoscopic splenectomy (LS) has become the standard approach for most splenectomy cases, some areas still remain controversial. To date, the indications that preclude laparoscopic splenectomy are not clearly defined. In view of this, the European Association for Endoscopic Surgery (EAES) has developed clinical practice guidelines for LS. METHODS An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. A consensus development conference using a nominal group process convened in May 2007. Its recommendations were presented at the annual EAES congress in Athens, Greece, on 5 July 2007 for discussion and further input. After a further Delphi process between the experts, the final recommendations were agreed upon. RESULTS Laparoscopic splenectomy is indicated for most benign and malignant hematologic diseases independently of the patient's age and body weight. Preoperative investigation is recommended for obtaining information on spleen size and volume as well as the presence of accessory splenic tissue. Preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections is recommended in elective cases. Perioperative anticoagulant prophylaxis with subcutaneous heparin should be administered to all patients and prolonged anticoagulant prophylaxis to high-risk patients. The choice of approach (supine [anterior], semilateral or lateral) is left to the surgeon's preference and concomitant conditions. In cases of massive splenomegaly, the hand-assisted technique should be considered to avoid conversion to open surgery and to reduce complication rates. The expert panel still considered portal hypertension and major medical comorbidities as contraindications to LS. CONCLUSION Despite a lack of level 1 evidence, LS is a safe and advantageous procedure in experienced hands that has displaced open surgery for almost all indications. To support the clinical evidence, further randomized controlled trials on different issues are mandatory.
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Affiliation(s)
- B Habermalz
- Institute for Research in Operative Medicine, University Witten/Herdecke, Witten/Herdecke, IFOM, Ostmerheimer Strasse 200, 51109, Köln, Germany
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162
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Lin WC, Chen YF, Lin CH, Tzeng YH, Chiang HJ, Ho YJ, Shen WC, Chen JH. Emergent transcatheter arterial embolization in hemodynamically unstable patients with blunt splenic injury. Acad Radiol 2008; 15:201-8. [PMID: 18206619 DOI: 10.1016/j.acra.2007.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 08/21/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES Splenic preservation is currently the trend for treatment of patients with splenic trauma to avoid complications of splenectomy. This study aimed to evaluate the feasibility of emergent transcatheter arterial embolization (TAE) for hemodynamically unstable patients with blunt splenic injury. MATERIALS AND METHODS In a period of 2 years, 65 patients of blunt splenic trauma were studied. Patients with initial systolic blood pressure < 90 mmHg and showed initial response including rapid response and transient response to the emergent fluid resuscitation were included. Angiography and TAE was undertaken if contrast medium extravasation or pseudoaneurysm formation was noted in the computed tomography (CT) images, according to the criteria of American Association for the Surgery of Trauma. All patients who underwent TAE were admitted for observation of the possibility of delayed rupture. RESULTS Thirteen hemodynamically unstable patients who were responsive to initial fluid resuscitation received angiography due to abnormal CT findings including contrast agent extravasation in 12 patients, 2 patients with arteriovenous fistula, and 8 patients with pseudoaneurysm formation. TAE was successfully performed in all of these 13 patients, including 2 patients with associated left renal injuries and 1 patient associated with bilateral internal mammary arteries injuries, without complications. CONCLUSIONS TAE is a safe and effective procedure for treating blunt splenic injury even in hemodynamically unstable patients who responded to initial fluid resuscitation.
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163
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Aneurisma de arteria esplénica aberrante. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)05007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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164
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Vanhoenacker FM, Op de Beeck B, De Schepper AM, Salgado R, Snoeckx A, Parizel PM. Vascular disease of the spleen. Semin Ultrasound CT MR 2007; 28:35-51. [PMID: 17366707 DOI: 10.1053/j.sult.2006.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A wide range of vascular disorders can affect the spleen. Although clinical presentation is often nonspecific, early diagnosis and treatment are mandatory in most conditions. Noninvasive imaging techniques are well suited to meet these objectives. Familiarity with normal macroscopic and microscopic vascular anatomy is a prerequisite to understand the pathophysiology of vascular disorders of the spleen. This article deals with diseases of the splenic vasculature (aneurysms, arteriovenous fistula, splenic vein thrombosis, collateral circulation in portal hypertension) as well as vascular disorders affecting the splenic parenchyma (splenic infarct, Gamna-Gandy bodies). Primary vascular tumors and tumor-like conditions of the spleen will be discussed very briefly.
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Affiliation(s)
- F M Vanhoenacker
- Department of Radiology, University Hospital Antwerp, Wilrijkstraat, 10, B-2650 Edegem, Belgium.
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165
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Chang CY, Singal AK, Ganeshan SV, Schiano TD, Lookstein R, Emre S. Use of splenic artery embolization to relieve tense ascites following liver transplantation in a patient with paroxysmal nocturnal hemoglobinuria. Liver Transpl 2007; 13:1532-7. [PMID: 17969202 DOI: 10.1002/lt.21317] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recurrent venous thrombosis following liver transplantation for Budd-Chiari syndrome is common, particularly in the setting of an underlying myeloproliferative disorder. We describe a patient who developed refractory ascites due to portal vein thrombosis following liver transplantation for Budd-Chiari syndrome in the setting of paroxysmal nocturnal hemoglobinuria. Extensive portal vein thrombosis, dense abdominal adhesions, and portosystemic collaterals precluded the use of a transjugular intrahepatic portosystemic shunt or surgical portosystemic shunt to manage the patient's ascites. Splenic artery embolization to decrease portal hypertension was performed, and this resulted in complete resolution of ascites. This case demonstrates the successful use of splenic artery embolization to manage ascites due to portal vein thrombosis following liver transplantation. Splenic artery embolization may be considered as an alternative option for the management of refractory ascites due to portal hypertension in patients who are unable to undergo safe transjugular intrahepatic portosystemic shunt or surgical shunt placement.
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Affiliation(s)
- Charissa Y Chang
- Recanati Miller Transplant Institute, Mount Sinai Hospital, Mount Sinai School of Medicine, New York, NY, USA.
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166
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Uchiyama D, Koganemaru M, Abe T, Hirose Y, Hayabuchi N, Akashi H. Coil Embolization of Splenic Artery Aneurysm with Preservation of the Parent Artery Using a Neck Remodeling Technique. J Vasc Interv Radiol 2007; 18:447-50. [PMID: 17377193 DOI: 10.1016/j.jvir.2006.12.727] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe a case of a large and wide neck splenic artery aneurysm, treated by coil embolization using a balloon neck remodeling technique. The patency of the splenic artery was preserved without technical complications. This method should be considered as an alternative method for transcatheter management of splenic artery aneurysms.
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Affiliation(s)
- Daiji Uchiyama
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka 830-0011, Japan.
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167
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Ríos A, Ramírez P, Pons JA, Parrilla P. [Splenic artery steal syndrome in orthotopic liver transplant]. Med Clin (Barc) 2006; 127:676. [PMID: 17169289 DOI: 10.1157/13094825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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168
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Blake MA, Singh A, Setty BN, Slattery J, Kalra M, Maher MM, Sahani DV, Fischman AJ, Mueller PR. Pearls and Pitfalls in Interpretation of Abdominal and Pelvic PET-CT. Radiographics 2006; 26:1335-53. [PMID: 16973768 DOI: 10.1148/rg.265055208] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The interpretation of images obtained in the abdomen and pelvis can be challenging, and the coregistration of positron emission tomographic (PET) and computed tomographic (CT) scans may be especially valuable in the evaluation of these anatomic areas. PET-CT represents a major technologic advance, consisting of generally complementary modalities whose combined strength tends to overcome their respective weaknesses. However, this combined functional-structural imaging approach raises a number of controversial questions and presents some unique interpretative challenges. Accurate PET-CT scan interpretation requires awareness of the various pitfalls associated with the imaging components, both individually and in combination. The results of recent PET-CT studies have been very encouraging, but larger prospective studies will be needed to establish optimal hybrid scanning protocols. Applying sound imaging principles, paying attention to detail, and staying abreast of advances in this exciting new modality are necessary for harnessing the full diagnostic power of abdominopelvic PET-CT.
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Affiliation(s)
- Michael A Blake
- Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, White 270, 55 Fruit St, Boston MA 02114, USA
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169
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Affiliation(s)
- A Luana Stanescu
- Harborview Medical Center, University of Washington, Seattle, Washington, USA
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