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O'Mara DM, Berges AJ, Fritz J, Weiss CR. MRI-guided percutaneous sclerotherapy of venous malformations: initial clinical experience using a 3T MRI system. Clin Imaging 2020; 65:8-14. [PMID: 32353719 DOI: 10.1016/j.clinimag.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/23/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Venous malformations (VMs) are low-flow vascular anomalies that are commonly treated with image-guided percutaneous sclerotherapy. Although many VMs can be safely accessed and treated using ultrasonography and fluoroscopy, some lesions may be better treated with magnetic resonance imaging (MRI)-guided sclerotherapy. The aim of this study is to evaluate the feasibility, efficiency, and outcomes of MRI-guided sclerotherapy of VMs using a 3T MRI system. METHODS Six patients with VMs in the neck (n = 2), chest (n = 1), and extremities (n = 3) underwent sclerotherapy with 3T MRI guidance. Feasibility was assessed by calculating the technical success rate and procedural efficiency. Efficiency was evaluated by using planning, targeting, intervention, and total procedure times. Outcomes were assessed by measuring VM volumes before and after sclerotherapy, patient-reported pain scores, and occurrence of complications. RESULTS Technical success was achieved in all 6 procedures. There was a non-significant 30% decrease in mean VM volume after the procedure (P = .350). The procedure resulted in a decrease in mean pain score (on an 11-point scale) of 2.6 points (P = .003). After the procedure, 4 patients reported complete pain resolution, 1 reported partial pain resolution, and 1 reported no change in pain. Procedural efficiency was consistent with similar sclerotherapy procedures performed at our institution. There were no major or minor complications. CONCLUSION 3T MRI guidance is feasible for percutaneous sclerotherapy of VMs, with promising initial technical success rates, procedural efficiency, and therapeutic outcomes without complications.
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Affiliation(s)
- Daniel M O'Mara
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States of America.
| | - Alexandra J Berges
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States of America.
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016, United States of America.
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States of America.
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Maingard J, Kok HK, Ranatunga D, Brooks DM, Chandra RV, Lee MJ, Asadi H. The future of interventional and neurointerventional radiology: learning lessons from the past. Br J Radiol 2017; 90:20170473. [PMID: 28972807 DOI: 10.1259/bjr.20170473] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The rapid progression of medical imaging technology and the ability to leverage knowledge from non-invasive imaging means that Interventional Radiologists (IRs) and Interventional Neuroradiologists are optimally placed to incorporate minimally invasive interventional paradigms into clinical management to advance patient care. There is ample opportunity to radically change the management options for patients with a variety of diseases through the use of minimally invasive interventional procedures. However, this will need to be accompanied by an increased clinical role of IRs to become active partners in the clinical management of patients. Unfortunately, the development of IR clinical presence has lagged behind and is reflected by declining rates of IR involvement in certain areas of practice such as vascular interventions. Current and future IRs must be willing to take on clinical responsibilities; reviewing patients in clinic to determine suitability for a procedure and potential contraindications, rounding on hospital inpatients and be willing to manage procedure related complications, which are all important parts of a successful IR practice. Increasing our clinical presence has several advantages over the procedure-driven model including enhanced patient knowledge and informed consent for IR procedures, improved rapport with patients and other clinical colleagues through active participation and engagement in patient care, visibility as a means to facilitate referrals and consistency of follow-up with opportunities for further learning. Many of the solutions to these problems are already in progress and the use of IR as a "hired gun" or "technician" is a concept that should be relegated to the past, and replaced with recognition of IRs as clinicians and partners in delivering modern high quality multidisciplinary team-based patient care. The following article will review the history of IR, the challenges facing this rapidly evolving profession and discuss recent developments occurring globally that are essential in maintaining expertise, securing future growth and improving patient outcomes in the modern multidisciplinary practice of medicine.
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Affiliation(s)
- Julian Maingard
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia.,2 Interventional Neuroradiology Service-Radiology Departmentz, Austin Hospital , Melbourne, VIC , Australia.,3 School of Medicine-Faculty of Healthz, Deakin University , Waurn Ponds, VIC , Australia
| | - Hong Kuan Kok
- 4 Department of Interventional Radiologyz, Guy's and St Thomas' NHS Foundation Trust , London , UK
| | - Dinesh Ranatunga
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia
| | - Duncan Mark Brooks
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia.,2 Interventional Neuroradiology Service-Radiology Departmentz, Austin Hospital , Melbourne, VIC , Australia.,5 The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne , Australia
| | - Ronil V Chandra
- 6 Department of Imagingz, Monash University , Melbourne, VIC , Australia.,7 Interventional Neuroradiology Unit-Monash Imagingz, Monash Health , Melbourne, VIC , Australia
| | - Michael J Lee
- 8 Interventional Radiology Service-Department of Radiologyz, Beaumont Hospital , Dublin , Ireland.,9 Department of Radiologyz, Royal College of Surgeons , Dublin , Ireland
| | - Hamed Asadi
- 1 Interventional Radiology Service-Department of Radiologyz, Austin Hospital , Melbourne, VIC , Australia.,2 Interventional Neuroradiology Service-Radiology Departmentz, Austin Hospital , Melbourne, VIC , Australia.,3 School of Medicine-Faculty of Healthz, Deakin University , Waurn Ponds, VIC , Australia.,4 Department of Interventional Radiologyz, Guy's and St Thomas' NHS Foundation Trust , London , UK.,5 The Florey Institute of Neuroscience and Mental Health, University of Melbourne , Melbourne , Australia.,7 Interventional Neuroradiology Unit-Monash Imagingz, Monash Health , Melbourne, VIC , Australia
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