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Kessner R, Nakamoto DA, Kondray V, Partovi S, Ahmed Y, Azar N. Contrast-Enhanced Ultrasound Guidance for Interventional Procedures. J Ultrasound Med 2019; 38:2541-2557. [PMID: 30714653 DOI: 10.1002/jum.14955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.
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Affiliation(s)
- Rivka Kessner
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Victor Kondray
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasmine Ahmed
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Rafailidis V, Partovi S, Dikkes A, Nakamoto DA, Azar N, Staub D. Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta. Cardiovasc Diagn Ther 2018; 8:S118-S130. [PMID: 29850424 DOI: 10.21037/cdt.2017.09.09] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ultrasound (US) represents the initial modality in the workup of abdominal aortic pathology based on the plethora of advantages including widespread availability, low cost, safety profile and repeatability. However, US has inherent limitations including limited spatial information of pathologic processes to neighboring structures, lower sensitivity to slow blood flow and aortic luminal irregularities. For evaluation of aortic pathology angiography has long been considered the gold standard. Non-invasive cross-sectional imaging techniques like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have gradually replaced interventional angiography for the evaluation of aorta, currently being regarded as the diagnostic imaging modalities of choice for diagnosis of virtually every aortic disease. Interventional angiography is currently primarily performed for treatment purposes of aortic pathology. The introduction of microbubbles as ultrasonographic contrast agents has rendered contrast-enhanced ultrasound (CEUS) an evolving valuable complementary technique with markedly increased diagnostic accuracy for certain aortic applications. CEUS is characterized by the potential to be performed in patients with impaired renal function. Due to its superior spatial and temporal resolution, ability for prolonged scanning and dynamic and real-time imaging, it provides clinically significant additional information compared to the standard Duplex US. The purpose of this paper is to discuss the currently available literature regarding abdominal aortic applications of CEUS, briefly elaborate on CEUS technique and safety and present cases in order to illustrate the added value in aortic pathologies. Conditions discussed include abdominal aortic aneurysm (AAA), aneurysm rupture, aneurysm surveillance after endovascular repair, dissection and aortitis.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sasan Partovi
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alexander Dikkes
- Department of Vascular Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dean A Nakamoto
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, Center for Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Daniel Staub
- Department of Vascular Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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Partovi S, Lu Z, Kessner R, Yu A, Ahmed Y, Patel IJ, Nakamoto DA, Azar N. Contrast enhanced ultrasound guided biopsies of liver lesions not visualized on standard B-mode ultrasound-preliminary experience. J Gastrointest Oncol 2017; 8:1056-1064. [PMID: 29299367 DOI: 10.21037/jgo.2017.08.17] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To assess the technical success of contrast enhanced ultrasound (CEUS) guided biopsies of liver lesions poorly visualized on B-mode ultrasound. Methods Patients were selected during the procedure based on the real-time clinical scenario of unsatisfactory B-mode ultrasound lesion visualization and all patients would have otherwise undergone CT guided liver lesion biopsy. A total of 26 patients underwent CEUS guided biopsy and were included in this retrospective analysis. The review of the patients' files included demographic information, lesion characteristics on imaging, procedural details and pathology outcome. Technical success was defined as concordance between the radiological findings, pathology report and clinical follow-up-demonstrating lack of need for re-biopsy or re-biopsy with identical pathological results. Patients with less than 2 months follow-up were excluded from the study. Results CEUS guided liver biopsy was successful in 23 out of 26 patients (88.5%). The average procedure time was 30.7±12.3 minutes and the average lesion size was 2.2±1.7 cm. The majority of lesions (80.8%) were hypoenhancing on the delayed phase of CEUS. The mean number of samples taken from each lesion per procedure was 3.2 (±1.7). Conclusions CEUS guidance biopsies of focal liver lesions (FLL) that were difficult to visualize on B-mode ultrasound demonstrated high success rate and may be an evolving image guidance modality in selected patients to avoid CT guided procedures.
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Affiliation(s)
- Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ziang Lu
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rivka Kessner
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alice Yu
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yasmine Ahmed
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Indravadan J Patel
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Partovi S, Lu Z, Vidal L, Nakamoto DA, Buethe J, Coffey M, Patel IJ. Real-time MRI-guided percutaneous sclerotherapy treatment of venous low-flow malformations in the head and neck. Phlebology 2017; 33:344-352. [PMID: 28516809 DOI: 10.1177/0268355517710110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose This manuscript describes the technique of real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck based on our institutional experience. Materials and methods Ethanolamine oleate is used as the sclerosant and is mixed with gadolinium for visualization during the procedure. The five procedural steps include: (I) an initial tri-plane T2-weighted sequence to visualize the lesion; (II) a T1 FSE or trueFISP sequence to assess needle placement and advancement within the lesion; (III) a tri-plane T1 FLASH sequence to monitor sclerosant injection; (IV) a T1 FSE or VIBE sequence to assess sclerosant coverage of the malformation before needle removal; (V) a post-procedural tri-plane T1 fat-saturated sequence to confirm sclerosant coverage of the lesion. Periprocedural medications typically include steroids, antibiotic prophylaxis, and non-steroidal anti-inflammatory medication. Patients are typically admitted for overnight observation. Conclusion Real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck is effective and safe.
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Affiliation(s)
- Sasan Partovi
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ziang Lu
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Lorenna Vidal
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Dean A Nakamoto
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ji Buethe
- 2 Department of Radiology, Section of Vascular and Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Coffey
- 3 Department of Radiology, Section of Neuroradiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Indravadan J Patel
- 1 Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Partovi S, Vidal L, Lu Z, Nakamoto DA, Buethe J, Clampitt M, Coffey M, Patel IJ. Real-time MRI-guided percutaneous sclerotherapy of low-flow head and neck lymphatic malformations in the pediatric population - a stepwise approach. Pediatr Radiol 2017; 47:755-760. [PMID: 28213627 DOI: 10.1007/s00247-017-3789-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/18/2016] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Abstract
Real-time MRI-guided percutaneous sclerotherapy is a novel and evolving treatment for congenital lymphatic malformations in the head and neck. We elaborate on the specific steps necessary to perform an MRI-guided percutaneous sclerotherapy of lymphatic malformations including pre-procedure patient work-up and preparation, stepwise intraprocedural interventional techniques and post-procedure management. Based on our institutional experience, MRI-guided sclerotherapy with a doxycycline-gadolinium-based mixture as a sclerosant for lymphatic malformations of the head and neck region in children is well tolerated and effective.
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Affiliation(s)
- Sasan Partovi
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Lorenna Vidal
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Ziang Lu
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Dean A Nakamoto
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Ji Buethe
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Mark Clampitt
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Michael Coffey
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Indravadan J Patel
- Department of Radiology, Section of Vascular and Interventional Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
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Buethe JY, Abboud S, Brock K, Nizialek G, Rezaee R, Wasman J, Frankel J, Nakamoto DA. Percutaneous CT–Guided Cryoablation of the Salivary Glands in a Porcine Model. J Vasc Interv Radiol 2016; 27:1907-1912. [DOI: 10.1016/j.jvir.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022] Open
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Abboud SE, Soriano S, Abboud R, Patel I, Davidson J, Azar NR, Nakamoto DA. The Radiologist Is in, but Was it Worth the Wait? Radiology Resident Note Quality in an Outpatient Interventional Radiology Clinic. Curr Probl Diagn Radiol 2016; 46:177-180. [PMID: 28162863 DOI: 10.1067/j.cpradiol.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/16/2016] [Accepted: 11/08/2016] [Indexed: 11/22/2022]
Abstract
Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents.
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Affiliation(s)
- Salim E Abboud
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH.
| | - Stephanie Soriano
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Rayan Abboud
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Indravadan Patel
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Jon Davidson
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Nami R Azar
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center and Seidman Cancer Center, Cleveland, OH
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Ansari-Gilani K, Seddigh Tonekaboni B, Nakamoto DA, Modaresi Esfeh J. Utility of Doppler ultrasonography for predicting improvement of platelet count after transjugular intrahepatic portosystemic shunt. Gastroenterol Rep (Oxf) 2016; 5:305-308. [PMID: 27694618 PMCID: PMC5691615 DOI: 10.1093/gastro/gow031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/16/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Portal pressure gradient (PPG) after transjugular intrahepatic portosystemic shunt (TIPS) <12 mmHg has been reported as the only factor predictive of increase in platelet count. As flow velocities measured on Doppler ultrasound are related to pressure gradient based on the Bernoulli equation, we used this parameter to predict increased platelet count after TIPS placement. METHODS A total of 161 consecutive patients who underwent TIPS placement entered this retrospective study. The platelet count was measured before, one week after and one month after TIPS placement. Clinically significant thrombocytopenia was defined as platelet count ≤100 000. Pre- and post-TIPS PPGs were measured. The velocity of blood flow in the proximal, mid and distal TIPS stent was measured using Doppler ultrasound, and the difference in the highest and lowest measured velocity was entitled flow velocity gradient (FVG), which was considered normal when ≤100 cm/s. RESULTS In 121 patients with pre-TIPS thrombocytopenia, the mean platelet count one week and one month after TIPS placement increased 25.7 x 103 and 35.0 x 103 in 90 patients with PPG≤12 mmHg (P=0.028 and P=0.015), while there was no significant change in platelet count in patients with a PPG >12 mmHg (P=0.098 and P=0.075). Platelets increased significantly when FVG≤ 100 cm/s (n=95) vs FVG >100 cm/s (n=26) one week (37.0x103 vs 11.0x103; P = 0.005 vs 0.07) and one month after TIPS placement (17.0x103 vs 5.2x103; P = 0.01 vs 0.21). CONCLUSION FVG >100 cm/s is not associated with increase in post-TIPS platelet count. On the other hand, findings suggestive of proper TIPS function (FVG ≤100 cm/s and PPG≤ 12 mmHg) predict a significant increase in post-TIPS platelet count.
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Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Diagnostic Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Dean A Nakamoto
- Department of Diagnostic Radiology, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Jamak Modaresi Esfeh
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
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Wright KL, Harrell MW, Jesberger JA, Landeras L, Nakamoto DA, Thomas S, Nickel D, Kroeker R, Griswold MA, Gulani V. Clinical evaluation of CAIPIRINHA: comparison against a GRAPPA standard. J Magn Reson Imaging 2013; 39:189-94. [PMID: 24123420 DOI: 10.1002/jmri.24105] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 02/11/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate image quality when using a CAIPIRINHA sampling pattern in comparison to a standard GRAPPA sampling pattern in patients undergoing a routine three-dimensional (3D) breathheld liver exam. CAIPIRINHA uses an optimized phase encoding sampling strategy to alter aliasing artifacts in 3D acquisitions to improve parallel imaging reconstruction. MATERIALS AND METHODS Twenty patient volunteers were scanned using a 3D VIBE acquisition with an acceleration factor of four using a CAIPIRINHA and standard GRAPPA sampling pattern. CAIPIRINHA and GRAPPA images were evaluated by three radiologists in a two alternative forced choice test, and the Wilcoxon signed rank test was performed. RESULTS The CAIPIRINHA sampling pattern was preferred in an average of 68% of the comparisons, and the Wilcoxon signed rank test showed a significant improvement in CAIPIRINHA images (P = 0.014). This analysis indicates that in the given sample set, CAIPIRINHA preference over the GRAPPA standard was statistically significant. CONCLUSION This work shows that for an acceleration factor of four, a CAIPIRINHA accelerated VIBE acquisition provides significantly improved image quality in comparison to the current GRAPPA standard. This allows a further reduction in imaging time for similar spatial resolutions, which can reduce long breathhold requirements in abdominal imaging, and may be particularly helpful in patients who cannot provide requisite breathholds with current protocols.
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Affiliation(s)
- Katherine L Wright
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA; Case Center for Imaging Research, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, USA
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Maurice MJ, Haaga JR, Nakamoto DA, Ponsky LE. Pneumodissection: an alternative protective technique for the percutaneous cryoablation of small renal masses. Urol Int 2013; 90:381-3. [PMID: 23594736 DOI: 10.1159/000346332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Percutaneous cryoablation is an emerging treatment option for the small renal mass. It poses a risk of thermal injury to adjacent tissues, limiting its application. We describe pneumodissection, a novel technique for preventing thermal injury during percutaneous cryoablation. MATERIALS AND METHODS The cases of 4 patients who underwent percutaneous renal cryoablation and pneumodissection were retrospectively reviewed. RESULTS Pneumodissection mechanically separated four tumors from overlying bowel segments (mean distance 1.2 ± 0.4 cm), permitting successful cryoablation. There were no complications or recurrences with 7.5 months of follow-up. CONCLUSIONS Pneumodissection is a feasible displacement technique that facilitates percutaneous cryoablation in at-risk patients. Further study is warranted.
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Affiliation(s)
- Matthew J Maurice
- Center for Urologic Oncology & Minimally Invasive Therapies, Urology Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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Wright KL, Seiberlich N, Jesberger JA, Nakamoto DA, Muzic RF, Griswold MA, Gulani V. Simultaneous magnetic resonance angiography and perfusion (MRAP) measurement: initial application in lower extremity skeletal muscle. J Magn Reson Imaging 2013; 38:1237-44. [PMID: 23389970 DOI: 10.1002/jmri.24020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 12/07/2012] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To obtain a simultaneous 3D magnetic resonance angiography and perfusion (MRAP) using a single acquisition and to demonstrate MRAP in the lower extremities. A time-resolved contrast-enhanced exam was used in MRAP to simultaneously acquire a contrast-enhanced MR angiography (MRA) and dynamic contrast-enhanced (DCE) perfusion, which currently requires separate acquisitions and thus two contrast doses. MRAP can be used to assess large and small vessels in vascular pathologies such as peripheral arterial disease. MATERIALS AND METHODS MRAP was performed on 10 volunteers following unilateral plantar flexion exercise (one leg exercised and one rested) on two separate days. Data were acquired after administration of a single dose of contrast agent using an optimized sampling strategy, parallel imaging, and partial-Fourier acquisition to obtain a high spatial resolution, 3D-MRAP frame every 4 seconds. Two radiologists assessed MRAs for image quality, a signal-to-noise ratio (SNR) analysis was performed, and pharmacokinetic modeling yielded perfusion (K(trans) ). RESULTS MRA images had high SNR and radiologist-assessed diagnostic quality. Mean K(trans) ± standard error were 0.136 ± 0.009, 0.146 ± 0.012, and 0.191 ± 0.012 min(-1) in the resting tibialis anterior, gastrocnemius, and soleus, respectively, which significantly increased with exercise to 0.291 ± 0.018, 0.270 ± 0.019, and 0.338 ± 0.022 min(-1) . Bland-Altman analysis showed good repeatability. CONCLUSION MRAP provides simultaneous high-resolution MRA and quantitative DCE exams to assess large and small vessels with a single contrast dose. Application in skeletal muscle shows quantitative, repeatable perfusion measurements, and the ability to measure physiological differences.
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Affiliation(s)
- Katherine L Wright
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA; Case Center for Imaging Research, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, USA
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Ansari-Gilani K, Deurdulian C, Azar N, Nakamoto DA. Use of sonographic guidance for selected biopsies in the lung and superior mediastinum. J Ultrasound Med 2012; 31:1697-1702. [PMID: 23091239 DOI: 10.7863/jum.2012.31.11.1697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Kianoush Ansari-Gilani
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, USA
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Nakamoto DA, Wilkins LR, Haaga JR. Hemostasis Effects of Direct Intraparenchymal Injection of Platelets and Fresh Frozen Plasma before Cutting Needle Biopsy in an Animal Model. J Vasc Interv Radiol 2011; 22:1601-5. [DOI: 10.1016/j.jvir.2011.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 07/18/2011] [Accepted: 07/22/2011] [Indexed: 01/05/2023] Open
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McComsey GA, O'Riordan M, Hazen SL, El-Bejjani D, Bhatt S, Brennan ML, Storer N, Adell J, Nakamoto DA, Dogra V. Increased carotid intima media thickness and cardiac biomarkers in HIV infected children. AIDS 2007; 21:921-7. [PMID: 17457085 DOI: 10.1097/qad.0b013e328133f29c] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess carotid intima media thickness (IMT) and cardiac biomarkers in HIV infected children on antiretroviral therapy (ART). METHODS This was a single site, cross sectional, controlled observational study. We assessed carotid IMT, homocysteine, high-sensitivity C-reactive protein and myeloperoxidase levels in HIV infected children on stable ART for >or= 6 months. Carotid IMT was reported as internal carotid artery (ICA) and common carotid artery (CCA) thickness; left and right sides were measured separately. Groups were compared using appropriate two-sample tests. RESULTS Of the 62 subjects enrolled, 31 were HIV positive (50%), 66% were female, and 69% were African-American. Median CD4% was 32% and 26 patients (84%) had HIV-1 RNA< 400 copies/ml. Sixteen patients had been taking protease inhibitors for a median duration of 27 months. None had hypertension or smoked. HIV infected children had higher HOMA-IR, waist-to-hip ratio, cholesterol, triglycerides, myeloperoxidase and lower homocysteine levels. Left and right CCA IMT, and left and right ICA IMT were significantly higher in the HIV infected group. Significant predictors of carotid IMT measurements in uninfected controls were body mass index and homocysteine, but only the duration of ARV therapy was predictive of IMT in the HIV infected group. CONCLUSION Higher levels of carotid IMT and some cardiac markers were found in ART treated HIV infected children when compared to matched uninfected controls. These results suggest that HIV infected children receiving ART may be at increased risk of cardiovascular disease.
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Affiliation(s)
- Grace A McComsey
- Rainbow Babies and Childrens' Hospital, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Haaga JR, Nakamoto DA. Multidetector CT of the Abdomen. Radiol Clin North Am 2005. [DOI: 10.1016/j.rcl.2005.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Merkle EM, Hallowell PT, Crouse C, Nakamoto DA, Stellato TA. Roux-en-Y Gastric Bypass for Clinically Severe Obesity: Normal Appearance and Spectrum of Complications at Imaging. Radiology 2005; 234:674-83. [PMID: 15650038 DOI: 10.1148/radiol.2343030333] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Surgery currently appears to be the most effective method to curtail the effects of morbid obesity and all of its comorbid conditions. Although the ideal procedure has yet to be devised, Roux-en-Y gastric bypass has proved to be successful for many morbidly obese patients pursuing weight loss and increased health. As the technical aspects of this procedure become less cumbersome and the patient population increases, it is vital for radiologists to be proficient in the specific evaluation of these patients, in order to provide optimal care. Complications can be minimized, managed more efficiently, or prevented with prompt evaluation by the radiologist. It is important to appreciate the patency of both the gastrojejunostomy and the jejunojejunostomy, as well as adequate progression of contrast material before the patient is discharged (preferably 24-72 hours after surgery). Follow-up complications include anastomotic leak, staple-line disruption, stomal stenosis, occlusion of the Roux limb, small-bowel obstruction due to adhesions or internal hernia, and obstruction of the enteroenterostomy leading to acute gastric distention. These complications may be life threatening, since clinical symptoms are often inconclusive. To achieve optimal outcome, therefore, conventional radiographic and computed tomographic studies should not be delayed.
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Affiliation(s)
- Elmar M Merkle
- Department of Radiology, Duke University Medical Center, Erwin Rd, Duke North, Rm 1417, Durham, NC 27710, USA.
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Abstract
The interventionist can perform many emergent procedures with ultrasound guidance, because of its real-time, multiplanar imaging capability and portability. With the use of color Doppler, additional important information, such as aberrant vessels, can be ascertained to help plan needle trajectory. Ultrasound is also useful for nonemergent procedures, such as biopsies. All interventionists are encouraged to be facile with the use of ultrasound.
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Affiliation(s)
- Dean A Nakamoto
- Department of Radiology, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Affiliation(s)
- R H Beigi
- Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
RATIONALE AND OBJECTIVES Infection is a serious complication of metallic prosthesis implantation and may necessitate removal of the prosthesis. This study uses an animal model to evaluate the effects of coating stainless steel wire implants with fibrinolytic agents to prevent infection after bacterial contamination. METHODS Three types of steel wire implants were used: plain stainless steel, heparin-coated steel, and urokinase-heparin-coated steel. Wire implants were incubated in a known concentration of Staphylococcus epidermidis and placed into the subcutaneous tissues of three groups of anesthetized hamsters. The implants and surrounding tissues were excised after 1 week and submitted for quantitative cultures. RESULTS Using 100 organisms as the upper allowable limit to categorize abscesses as noninfected, the following rates of noninfectivity were observed: group 1 (control), 0% noninfected; group 2 (heparin-coated wire), 40% noninfected; and group 3 (urokinase-heparin-coated wire), 50% noninfected. The noninfectivity rates of groups 2 and 3 were significantly higher than the rate of group 1 (P < 0.001). There was no significant difference between groups 2 and 3 (P = 0.19). CONCLUSIONS Both the heparin-coated and urokinase-heparin-coated wire exhibited significantly decreased infection rates compared with uncoated wire; the heparin coating may inhibit bacterial adherence. The urokinase coating of the heparin-coated wire appears to further decrease the infection rate, but not to a statistically significant degree.
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Affiliation(s)
- D A Nakamoto
- Department of Radiology, University Hospitals of Cleveland, OH 44106, USA
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Nakamoto DA, Rosenfield ML, Haaga JR, Merritt K, Sachs PB, Hutton MC, Graham RC, Rowland DY. Young Investigator Award. In vivo treatment of infected prosthetic graft material with urokinase: an animal model. J Vasc Interv Radiol 1994; 5:549-52. [PMID: 7949709 DOI: 10.1016/s1051-0443(94)71552-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE Pyogenic infection of vascular grafts represents a serious complication that may necessitate graft removal. If better treatment methods could be developed, perhaps some infected grafts could be salvaged and not removed. This study reports an animal model that evaluates the sterilization of contaminated vascular graft material implants with urokinase and antibiotics. MATERIALS AND METHODS Polytetrafluoroethylene (PTFE) implants were incubated overnight in a known concentration of bacteria (Staphylococcus epidermidis) and were then implanted subcutaneously into four groups of anesthetized hamsters. The first group (control) received no treatment. The second group received urokinase injections twice daily into each abscess. The third group received intraabscess urokinase and systemic gentamicin twice daily. The fourth group received only systemic gentamicin. The hamsters were killed after 1 week. The graft implants and surrounding tissues were excised and submitted for quantitative cultures. RESULTS With use of a cutoff value of 100 organisms per milliliter, below which the abscesses were considered noninfected, the following rates of noninfectivity were observed: group 1 (control), 5% noninfected; group 2 (urokinase only), 19.4%; group 3 (urokinase and gentamicin), 63.2%; and group 4 (gentamicin only), 32.5%. The noninfectivity rate of group 3 was significantly higher than that of all other groups combined (P < .001) and was significantly better than that of group 4 alone (P = .013). CONCLUSION The combination of intraabscess urokinase and systemic gentamicin is very synergistic in graft sterilization. Urokinase may assist in the degradation of both fibrin and the biofilm produced by S epidermidis, thus improving penetration of antibiotics and local host defense mechanisms.
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Affiliation(s)
- D A Nakamoto
- Department of Radiology, University Hospitals of Cleveland, OH 44106
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