1
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Machado P, Liu JB, Needleman L, Lazar M, Willis AI, Brill K, Nazarian S, Berger A, Forsberg F. Sentinel Lymph Node Identification in Post Neoadjuvant Chemotherapy Breast Cancer Patients Undergoing Surgical Excision Using Lymphosonography. J Ultrasound Med 2023; 42:1509-1517. [PMID: 36591785 DOI: 10.1002/jum.16164] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study evaluated the efficacy of lymphosonography in the identification of sentinel lymph nodes (SLNs) in post neoadjuvant chemotherapy patients with breast cancer scheduled to undergo surgical excision. METHODS Seventy-nine subjects scheduled for breast cancer surgery with SLN excision completed this IRB-approved study, out of which 18 (23%) underwent neoadjuvant chemotherapy before surgery. Subjects underwent percutaneous Sonazoid (GE Healthcare) injections around the tumor area for a total of 1.0 mL. Lymphosonography was performed using CPS on an S3000 HELX scanner (Siemens Healthineers) with a linear probe. Subjects received blue dye and radioactive tracer as part of their standard of care. Excised SLNs were classified as positive or negative for the presence of blue dye, radioactive tracer and Sonazoid. The results were compared between methods and pathology findings. RESULTS Seventy-two SLNs were surgically excised from 18 subjects, 29 were positive for blue dye, 63 were positive for radioactive tracer and 57 were positive for Sonazoid. Comparison with blue dye showed that both radioactive tracer and lymphosonography achieved an accuracy of 53% (P > .50). Comparison with radioactive tracer showed that blue dye had an accuracy of 53%, while lymphosonography achieved an accuracy of 67% (P < .01). Of the 72 SLNs, 15 were determined malignant by pathology; the detection rate was 47% for blue dye (7/15), 67% for radioactive tracer (10/15) and 100% for lymphosonography (15/15) (P < .001). CONCLUSIONS Lymphosonography achieved similar accuracy as radioactive tracer and higher accuracy than blue dye for identifying SLNs. The 15 SLNs positive for malignancy were all identified by lymphosonography.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alliric I Willis
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Susanna Nazarian
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Berger
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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2
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Machado P, Liu JB, Needleman L, Lee C, Forsberg F. Anatomy Versus Physiology: Is Breast Lymphatic Drainage to the Internal Thoracic (Internal Mammary) Lymphatic System Clinically Relevant? J Breast Cancer 2023; 26:286-291. [PMID: 37272244 PMCID: PMC10315328 DOI: 10.4048/jbc.2023.26.e16] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 03/18/2023] [Indexed: 06/06/2023] Open
Abstract
Approximately 15%-25% of breast lymphatic drainage passes through the internal thoracic (internal mammary) lymphatic system, draining the inner quadrants of the breast. This study aimed to use lymphosonography to identify sentinel lymph nodes (SLNs) in the axillary and internal thoracic lymphatic systems in patients with breast cancer. Seventy-nine patients received subcutaneous ultrasound contrast agent injections around the tumor. Lymphosonography was used to identify SLNs. In 14 of the 79 patients (17.7%), the tumor was located in the inner quadrant of the breast. Lymphosonography identified 217 SLNs in 79 patients, averaging 2.7 SLNs per patient. The 217 identified SLNs in the 79 patients were located in the axillary lymphatic system; none were located in the internal thoracic (internal mammary) lymphatic system, although it was expected in two to four patients (i.e., 4-11 SLNs). These results implied that SLNs associated with breast cancer are predominantly located in the axillary lymphatic system.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, USA.
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, USA
| | | | - Christine Lee
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, USA
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3
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Machado P, Liu JB, Needleman L, Lazar M, Willis AI, Brill K, Nazarian S, Berger A, Forsberg F. Sentinel Lymph Node Identification in Patients With Breast Cancer Using Lymphosonography. Ultrasound Med Biol 2023; 49:616-625. [PMID: 36446688 PMCID: PMC9943072 DOI: 10.1016/j.ultrasmedbio.2022.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/27/2022] [Accepted: 10/30/2022] [Indexed: 06/06/2023]
Abstract
The objective of the work described here was to evaluate the efficacy of lymphosonography in identifying sentinel lymph nodes (SLNs) in patients with breast cancer undergoing surgical excision. Of the 86 individuals enrolled, 79 completed this institutional review board-approved study. Participants received subcutaneous 1.0-mL injections of ultrasound contrast agent (UCA) around the tumor. An ultrasound scanner with contrast-enhanced ultrasound (CEUS) capabilities was used to identify SLNs. Participants were administered with blue dye and radioactive tracer to guide SLN excision as standard-of-care. Excised SLNs were classified as positive or negative for the presence of blue dye, radioactive tracer and UCA, and sent for pathology. Two hundred fifty-two SLNs were excised; 158 were positive for blue dye, 222 were positive for radioactive tracer and 223 were positive for UCA. Comparison with blue dye revealed accuracies of 96.2% for radioactive tracer and 99.4% for lymphosonography (p > 0.15). Relative to radioactive tracer, blue dye had an accuracy of 68.5%, and lymphosonography achieved 86.5% (p < 0.0001). Of 252 SLNs excised, 34 were determined to be malignant by pathology; 18 were positive for blue dye (detection rate = 53%), 23 for radioactive tracer (detection rate = 68%) and 34 for UCA (detection rate = 100%) (p < 0.0001). Lymphosonography was similar in accuracy to radioactive tracer and higher in accuracy than blue dye in identifying SLNs. All 34 malignant SLNs were identified by lymphosonography.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Melissa Lazar
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alliric I Willis
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristin Brill
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Susanna Nazarian
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Adam Berger
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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4
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Trunz LM, Lee P, Lange SM, Pomeranz CL, Needleman L, Ford RW, Karambelkar A, Sundaram B. Imaging approach to COVID-19 associated pulmonary embolism. Int J Clin Pract 2021; 75:e14340. [PMID: 33966326 PMCID: PMC8237008 DOI: 10.1111/ijcp.14340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
The novel coronavirus disease-2019 (COVID-19) illness and deaths, caused by the severe acute respiratory syndrome coronavirus-2, continue to increase. Multiple reports highlight the thromboembolic complications, such as pulmonary embolism (PE), in COVID-19. Imaging plays an essential role in the diagnosis and management of COVID-19 patients with PE. There continues to be a rapid evolution of knowledge related to COVID-19 associated PE. This review summarises the current understanding of prevalence, pathophysiology, role of diagnostic imaging modalities, and management, including catheter-directed therapy for COVID-19 associated PE. It also describes infection control considerations for the radiology department while providing care for patients with COVID-19 associated PE.
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Affiliation(s)
- Lukas M. Trunz
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Patrick Lee
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Steven M. Lange
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | | | | | - Robert W. Ford
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ajit Karambelkar
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPAUSA
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5
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Gornik HL, Rundek T, Gardener H, Benenati JF, Dahiya N, Hamburg NM, Kupinski AM, Leers SA, Lilly MP, Lohr JM, Pellerito JS, Rholl KS, Vickery MA, Hutchisson MS, Needleman L. Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee. Vasc Med 2021; 26:515-525. [PMID: 34009060 PMCID: PMC8493430 DOI: 10.1177/1358863x211011253] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), with overestimation of degree of stenosis for both moderate (50–69%) and severe (⩾ 70%) ICA lesions. The primary SRUCC parameter for ⩾ 50% ICA stenosis of peak-systolic velocity (PSV) of ⩾ 125 cm/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to ⩾ 180 cm/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA/common carotid artery (CCA) PSV ratio ⩾ 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For ⩾ 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for ⩾ 50% ICA stenosis to ⩾ 180 cm/sec as a single parameter or requiring the ICA/CCA PSV ratio ⩾ 2.0 in addition to PSV of ⩾ 125 cm/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.
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Affiliation(s)
- Heather L Gornik
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hannah Gardener
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - James F Benenati
- Miami Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | | | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University, Boston, MA, USA
| | - Ann Marie Kupinski
- Albany Medical College, Albany, NY, USA.,North Country Vascular Diagnostics, Inc., Altamont, NY, USA
| | - Steven A Leers
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael P Lilly
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MA, USA
| | - Joann M Lohr
- Department of Surgery, Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
| | - John S Pellerito
- Department of Radiology, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kenneth S Rholl
- Department of Cardiovascular and Interventional Radiology, Inova Alexandria Hospital, George Washington University, Alexandria, VA, USA
| | | | - Marge S Hutchisson
- Intersocietal Accreditation Commission (IAC), Vascular Testing Division, Ellicott City, MD, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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6
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Wessner CE, Nelson J, Mott S, Francesco M, Needleman L. A Sonographer’s Step-by-Step Approach for Preventing Transmission of COVID-19. Journal of Diagnostic Medical Sonography 2020. [DOI: 10.1177/8756479320959035] [Citation(s) in RCA: 2] [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] [Indexed: 01/12/2023]
Abstract
The 2019 novel coronavirus, known as COVID-19, has greatly affected the way sonographers care for their patients. Sonography can be a useful imaging tool for surveillance and diagnosis of various conditions associated with COVID-19 patients or patients under investigation (PUIs). Currently, there are limited resources and protocols for preventing the transmission of COVID-19 from ultrasound equipment. Our institution has created a detailed protocol for scanning COVID-19 patients or PUIs to address this important issue.
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Affiliation(s)
- Corinne E. Wessner
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - JoAnn Nelson
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Sarah Mott
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Maria Francesco
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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7
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Block P, Shinn B, Roth C, Needleman L, Rosato E, Hann HW. Vagaries of the Host Response in the Development of Hepatitis B-related Hepatocellular Carcinoma: A Case Series. CCTR 2020. [DOI: 10.2174/1573394716666200129121051] [Citation(s) in RCA: 2] [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] [Indexed: 01/05/2023]
Abstract
The hepatitis B virus (HBV) is one of the leading causes of hepatocellular carcinoma
(HCC) worldwide. In the endemic region, the infection is commonly spread through vertical
transmission in which mother and child possess genetically identical viral genotypes in the setting
of similar host genomes. Despite these genetic similarities, clinical outcomes from chronic hepatitis
B (CHB) can vary widely, ranging from lifelong asymptomatic infection to terminal HCC. Presented
here are the longitudinal observations over multiple decades of three family clusters, including
monozygotic twins with non-discordant HCC, that demonstrate the heterogeneity of
HBV-related outcomes. These findings emphasize the important need to untangle the role of genetic
and non-genetic host factors in the development of HBV-related HCC, as well as highlight
the novel research avenues that can clarify the contributions of such factors in HBV-related HCC.
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Affiliation(s)
- Peter Block
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Brianna Shinn
- Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Christopher Roth
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, United States
| | - Ernest Rosato
- Department of General Surgery, Thomas Jefferson University Hospital,, Philadelphia, PA 19107, United States
| | - Hie-Won Hann
- Division of Gastroenterology and Hepatology, Liver Disease Prevention Center, Philadelphia, PA 19107, United States
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8
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Abstract
This article looks at the likely future trends in home demand for four major electrical appliances—television sets, refrigerators, washing-machines and vacuum cleaners. The sales of all four have risen fast in the last decade (table 1, chart 1)—by an average of 16.5 per cent a year, taking all four together, compared with 2.2 per cent for total consumer demand.
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9
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Li J, Needleman L, Liu JB, Lyshchik A, Forsberg F, Stanczak M, McAlister J, Eisenbrey J. Influence of Data Parsing on Contrast Enhanced Ultrasound Exams. Acad Radiol 2019; 26:1030-1039. [PMID: 30316706 DOI: 10.1016/j.acra.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
RATIONALE AND OBJECTIVES To explore the influence of data parsing (either selection of frames at set time intervals or by an experienced sonographer) of contrast-enhanced ultrasound (CEUS) exams on physician diagnoses and confidence levels. MATERIALS AND METHODS Forty consecutive CEUS exams consisting of 10 cases each of indeterminate liver lesions, indeterminate renal lesions, renal cell carcinoma postablation follow-up, and hepatocellular carcinoma postchemoembolization follow-up were selected for analysis. Exams were parsed into sets consisting of five images selected by the performing sonographer and sets containing systematically stored frames every 10, 30, and 60 seconds. Three blinded physicians then reviewed the cine loop and each set of images in randomized order and provided a diagnosis and confidence level. RESULTS For all clinical applications investigated, no statistically significant differences in diagnostic performance measures or reader confidence were observed between review of the entire cine loop and images selected by the performing sonographer (p > 0.42). Diagnostic performance at 10-second intervals did not show statically significant changes compared to the full cine loop review for all applications (p > 0.18), although reader confidence decreased. At 30-60-second intervals, both diagnostic performance and reader confidence showed statistically significant reduction compared to review of the full cine loop (p < 0.045). CONCLUSIONS Transfer and review of large cine loops from CEUS exams represent a potential barrier to adoption within the United States workflows. This study demonstrates that images selected by a performing trained sonographer may provide the same value without the review time and data storage costs needed for full cine loop review. Parsing by time points reduced reader confidence and diagnostic performance.
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10
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Li J, Hua Y, Needleman L, Forsberg F, Eisenbray JR, Li Z, Liu R, Tian X, Jiao L, Liu JB. Arterial occlusions increase the risk of in-stent restenosis after vertebral artery ostium stenting. J Neurointerv Surg 2018; 11:574-578. [PMID: 30337379 DOI: 10.1136/neurintsurg-2018-014243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/06/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The study was designed to investigate if vascular occlusion in the internal carotid artery (ICA) or the contralateral vertebral artery (VA) contribute to developing in-stent restenosis (ISR) in patients with vertebral artery ostium stenosis (VAOS). METHODS 420 consecutive patients treated with VAOS stents (from a population of 8145 patients with VAOS) from January 2013 to December 2014 were analyzed in this retrospective study; 216 with drug eluted stents and 204 with bare metal stents. Based on pre-stent DSA findings, patients were divided into four groups: both carotid and vertebral arteries patent (PAT), ICA occlusion (ICA-OCC), contralateral VA occlusion (CVA-OCC), and combined occlusions (C-OCC). The incidence of ISR (stenosis >50%) was compared between groups using Cox regression analysis. RESULTS Of the 420 patients, the mean incidence of ISR was 36.4%, with a median 12 months of follow-up (IQR 3-12). Logistic regression analysis showed that drug eluting stent had less ISR than bare metal stent (OR=0.38, 95% CI 0.19 to 0.75, P=0.01). Cox regression analysis showed that CVA-OCC (HR=1.63, P=0.02) and C-OCC (HR=3.30, P=0.001) were risk factors for ISR but not ICA-OCC (P=0.31). In the CVA-OCC and C-OCC groups, in-stent peak systolic velocity (PSV) ≥140 cm/s, 1 day after successful stenting, was associated with subsequent development of ISR (OR=2.81, 95% CI 1.06 to 7.43, P=0.04). CONCLUSION Contralateral VA occlusion at the time of stenting increased the risk of ISR, especially if stent PSV on day 1 was >140 cm/s. Bare metal stents had more ISR than drug eluting stents.
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Affiliation(s)
- Jingzhi Li
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbray
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Zhaojun Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Tian
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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11
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Machado P, Stanczak M, Liu JB, Moore JN, Eisenbrey JR, Needleman L, Kraft WK, Forsberg F. Subdermal Ultrasound Contrast Agent Injection for Sentinel Lymph Node Identification: An Analysis of Safety and Contrast Agent Dose in Healthy Volunteers. J Ultrasound Med 2018; 37:1611-1620. [PMID: 29205451 PMCID: PMC5988650 DOI: 10.1002/jum.14502] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/14/2017] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Mapping of the lymphatic chain for identification of the sentinel lymph node (SLN) is an important aspect of predicting outcomes for patients with breast cancer, and it is usually performed as an intraoperative procedure using blue dye and/or radiopharmaceutical agents. Recently, the use of contrast-enhanced ultrasound (CEUS) has been proposed as an alternative imaging technique for this mapping. The objective of this study was to evaluate the use of subdermal administration of the ultrasound (US) contrast agent Sonazoid (GE Healthcare, Oslo, Norway) in terms of patient safety and to select the dose to be used for lymphatic applications in humans. METHODS This study was performed in 12 female volunteers who received bilateral subdermal injections of Sonazoid (1 or 2 mL dose) in the mid-upper outer quadrant of their breasts at 2 different time points. Contrast-enhanced US examinations were performed 0, 0.25, 0.5, 1, 2, 4, 6, and 24 hours after injection to identify SLNs. RESULTS Sentinel lymph nodes were identified within the first hour after injection as enhanced structures, and there was no significant difference by dose in the number of SLNs identified (P = .74). The volunteers only had minor adverse experiences (AEs) that resolved completely without intervention by study completion. CONCLUSIONS The subdermal use of Sonazoid in this study showed only minor local and nonsignificant AEs that were completely resolved without any intervention. Two different doses were compared with no significant differences observed between them. Hence, the lower dose studied (1 mL) was selected for use in future clinical studies.
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Affiliation(s)
- Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason N. Moore
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Walter K. Kraft
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
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12
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Abstract
Venous ultrasound is the standard imaging test for patients suspected of having acute deep venous thrombosis (DVT). There is variability and disagreement among authoritative groups regarding the necessary components of the test. Some protocols include scanning the entire lower extremity, whereas others recommend scans limited to the thigh and knee supplemented with serial testing. Some protocols use gray-scale ultrasound alone, whereas others include Doppler interrogation. Point-of-care ultrasound is recommended in some settings, and there is heterogeneity of these protocols as well. Heterogeneity of recommendations can lead to errors including incorrect application of guidelines, confusion among requesting physicians, and incorrect follow-up. In October 2016, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to evaluate the current evidence to develop recommendations regarding ultrasound protocols for DVT and the terminology used to communicate results to clinicians. Recommendations were made after open discussion and by unanimous consensus.
The panel recommends a comprehensive duplex ultrasound protocol from thigh to ankle with Doppler at selected sites rather than a limited or complete compression-only examination. This protocol is currently performed in many facilities and is achievable with standard ultrasound equipment and personnel. The use of these recommendations will increase the diagnosis of calf DVT and provide better data to explain the presenting symptoms. The panel recommends a single point-of-care protocol that minimizes underdiagnoses of proximal DVT.
The panel recommends the term chronic postthrombotic change to describe the residual material that persists after the acute presentation of DVT to avoid potential overtreatment of prior thrombus.
Adoption of a single standardized comprehensive duplex ultrasound and a single point-of-care examination will enhance patient safety and clinicians’ confidence.
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Affiliation(s)
| | - John J. Cronan
- Department of Diagnostic Imaging, Brown University, Providence, RI (J.J.C.)
| | - Michael P. Lilly
- Department of Surgery, University of Maryland School of Medicine, Baltimore (M.P.L.)
| | - Geno J. Merli
- Department of Medicine (G.J.M.), Thomas Jefferson University, Philadelphia, PA
| | - Srikar Adhikari
- Department of Emergency Medicine, University of Arizona, Tucson (S.A.)
| | - Barbara S. Hertzberg
- Department of Radiology, Duke University School of Medicine, Durham, NC (B.S.H.)
| | | | - Michael B. Streiff
- Department of Medicine (M.B.S.), Johns Hopkins School of Medicine, Baltimore, MD
| | - Mark H. Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle (M.H.M.)
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13
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Brown SC, Wang K, Dong C, Yi L, Marinovic Gutierrez C, Di Tullio MR, Farrell MB, Burgess P, Gornik HL, Hamburg NM, Needleman L, Orsinelli D, Robison S, Rundek T. Accreditation Status and Geographic Location of Outpatient Echocardiographic Testing Facilities Among Medicare Beneficiaries: The VALUE-ECHO Study. J Ultrasound Med 2018; 37:397-402. [PMID: 28786137 DOI: 10.1002/jum.14349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/13/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Accreditation of echocardiographic testing facilities by the Intersocietal Accreditation Commission (IAC) is supported by the American College of Cardiology and American Society of Echocardiography. However, limited information exists on the accreditation status and geographic distribution of echocardiographic facilities in the United States. Our study aimed to identify (1) the proportion of outpatient echocardiography facilities used by Medicare beneficiaries that are IAC accredited, (2) their geographic distribution, and (3) variations in procedure type and volume by accreditation status. METHODS As part of the VALUE-ECHO (Value of Accreditation, Location, and Utilization Evaluation-Echocardiography) study, we examined the proportion of IAC-accredited echocardiographic facilities performing outpatient echocardiography in the 2013 Centers for Medicare and Medicaid Services outpatient limited data set (100% sample) and their geographic distribution using geocoding in ArcGIS (ESRI, Redlands, CA). RESULTS Among 4573 outpatient facilities billing Medicare for echocardiographic testing in 2013, 99.6% (n = 4554) were IAC accredited (99.7% in the 50 US states and 86.2% in Puerto Rico). The proportion IAC-accredited echocardiographic facilities varied by region, with 98.7%, 99.9%, 99.9%, 99.5%, and 86.2% of facilities accredited in the Northeast, South, Midwest, West, and Puerto Rico, respectively (P < .01, Fisher exact test). Of all echocardiographic outpatient procedures conducted (n = 1,890,156), 99.8% (n = 1,885,382) were performed in IAC-accredited echocardiographic facilities. Most procedures (90.9%) were transthoracic echocardiograms, of which 99.7% were conducted in IAC-accredited echocardiographic facilities. CONCLUSIONS Almost all outpatient echocardiographic facilities billed by Medicare are IAC accredited. This accreditation rate is substantially higher than previously reported for US outpatient vascular testing facilities (13% IAC accredited). The uniformity of imaging and interpretation protocols from a single accrediting body is important to facilitate optimal cardiovascular care.
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Affiliation(s)
- Scott C Brown
- Departments of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kefeng Wang
- Departments of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuanhui Dong
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Li Yi
- Geographic Information Systems Laboratory, University of Miami School of Architecture, Coral Gables, Florida, USA
| | | | - Marco R Di Tullio
- Department of Medicine, Columbia University, New York, New York, USA
| | - Mary Beth Farrell
- Intersocietal Accreditation Commission, Ellicott City, Maryland, USA
| | - Pamela Burgess
- Heart and Vascular Center, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Heather L Gornik
- Vascular Medicine Section, Cleveland Clinic, Cleveland, Ohio, USA
| | - Naomi M Hamburg
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - David Orsinelli
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Susana Robison
- Department of Vascular Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Tatjana Rundek
- Departments of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA
- Departments of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Castellani S, Selvaggio S, Castellini G, Needleman L, Brkljacic B, Ungar A, Cirami C, Baldereschi G, Acquafresca M, Modesti P, Pavlica P, Bertolotto M, Cruz B, Salvadori M, Di Mario C. 4122Renal arterial stenosis: long term clinical outcomes of percutaneous transluminal angioplasty and stent implantation for hypertension and renal function. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4122] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bilyk JR, Murchison AP, Leiby BT, Sergott RC, Eagle RC, Needleman L, Savino PJ. The Utility of Color Duplex Ultrasonography in the Diagnosis of Giant Cell Arteritis: A Prospective, Masked Study. (An American Ophthalmological Society Thesis). Trans Am Ophthalmol Soc 2017; 115:T9. [PMID: 29967570 PMCID: PMC6021029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the diagnostic yield and concordance of color duplex ultrasound (CDU) of the superficial temporal artery (STA), temporal artery biopsy (TAB), and American College of Rheumatology (ACR) criteria in the diagnosis of giant cell arteritis (GCA). METHODS Prospective, masked study of all patients evaluated in one institution suspected of having GCA. All patients with a suspected diagnosis of GCA were admitted for pulsed intravenous corticosteroids. Patients underwent serologic work-up and ACR criteria were documented. All patients had a CDU and TAB performed within 3 days of initiation of systemic corticosteroid therapy. Main outcome measure: Concordance of CDU and TAB. Secondary outcome measures: Concordance between unilateral and bilateral CDU and TAB by side and segment, concordance between TAB and ACR criteria, and statistical analysis of serologic markers for GCA. RESULTS The diagnosis of biopsy-proven GCA was found in 14 of 71 (19.7%) patients. The sensitivity of CDU compared to the reference standard of TAB ranged between 5.1% and 30.8% depending on the signs studied on CDU and correlation of specific TAB parameters. Of the serologic studies, a platelet count threshold of 400,000μL had the highest positive (18.32) and lowest negative (0.37) likelihood ratios for a diagnosis of GCA. CONCLUSIONS In this study, CDU showed minimal value in diagnosing GCA compared to TAB. There was poor correlation between CDU results and ACR criteria for GCA. The threshold platelet count had higher positive and negative predictive values for GCA than CDU and is a useful serologic marker for GCA.
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Affiliation(s)
- Jurij R Bilyk
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Ann P Murchison
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Benjamin T Leiby
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Robert C Sergott
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Ralph C Eagle
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Laurence Needleman
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Peter J Savino
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
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Jung IH, Kurnicka K, Enache R, Nagy AI, Martins E, Cereda A, Vitiello G, Magda SL, Styczynski G, Lo Iudice F, De Barros Viegas H, Shahab F, Trunina I, Mata Caballero R, De Barros Viegas H, Marques A, Shimoni S, Generati G, Generati G, Bendix Salkvist Jorgensen T, Chen TE, Andrianova A, Fernandez-Golfin C, Corneli MC, Ali M, Seo HS, Kim MJ, Lichodziejewska B, Goliszek S, Dzikowska-Diduch O, Zdonczyk O, Kozlowska M, Kostrubiec M, Ciurzynski M, Palczewski P, Pruszczyk P, Popa E, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Jurcut R, Venkateshvaran AI, Sola SC, Govind SC, Dash PK, Lund L, Manouras AI, Merkely B, Magne J, Aboyans V, Boulogne C, Lavergne D, Jaccard A, Mohty D, Casadei F, Spano F, Santambrogio G, Musca F, Belli O, De Chiara B, Bokor D, Giannattasio C, Corradi E, Colombo CA, Moreo A, Vicario ML, Castellani S, Cammelli D, Gallini C, Needleman L, Cruz BK, Maggi E, Marchionni N, Bratu VD, Mincu RI, Mihai CM, Gherghe AM, Florescu M, Cinteza M, Vinereanu D, Sobieraj P, Bielicki P, Krenke R, Szmigielski CA, Petitto M, Ferrone M, Esposito R, Vaccaro A, Buonauro A, Trimarco B, Galderisi M, Mendes L, Dores H, Melo I, Madeira V, Patinha J, Encarnacao C, Ferreia Santos J, Habib F, Soesanto AM, Sedyawan J, Abdurrazak G, Sharykin A, Popova NE, Karelina EV, Telezhnikova ND, Hernandez Jimenez V, Saavedra J, Molina L, Alberca MT, Gorriz J, L Pais J, Pavon I, Navea C, Alonso JJ, Mendes L, Sonia S, Madeira V, Encarnacao C, Patinha J, Melo I, Ferreia Santos J, Cruz I, Joao I, Gomes AC, Caldeira D, Lopes L, Fazendas P, Pereira H, Edri O, Edri O, Schneider N, Schneider N, Abaye N, Abaye N, Goerge J, Goerge J, Gandelman G, Gandelman G, Bandera F, Alfonzetti E, Guazzi M, Bandera F, Villani S, Ferraro O, Alfonzetti E, Guazzi M, Ramberg E, Bhardwaj P, Nepper ML, Binko TS, Olausson M, Fink-Jensen T, Andersen AM, Roland J, Gleerup Fornitz G, Ong K, Suri RM, Enrique-Sarano M, Michelena HI, Burkhart HM, Gillespie SM, Cha S, Mankad SV, Saidova MA, Bolotova MN, Salido Tahoces L, Izurieta C, Villareal G, Esteban A, Urena Vacas A, Ayala A, Jimenez Nacher JJ, Hinojar Baydes R, Gonzalez Gomez A, Garcia A, Mestre JL, Hernandez Antolin R, Zamorano Gomez JJ, Perea G, Covelli Y, Henquin R, Ronderos R, Hepinstall MJ, Cassidy CS, Pellikka PA, Pislaru SV, Kane G. P569Diastolic dyssynchrony is associated with exercise intolerance in hypertensive patients with left ventricular hypertrophyP570Echocardiographic pattern of acute pulmonary embolism, analysis of consecutive 511 patientsP571Clinical significance of ventricular interdependence and left ventricular function in patients with pulmonary hypertension receiving specific vasodilator therapyP572Haemodynamic characteristics and ventricular mechanics in post-capillary and combined pre- and post-capillary pulmonary hypertensionP573Relationship between hematological response and echocardiographic features in patients with light chains systemic amyloidosisP574Myocardial changes in patients with anorexia nervosaP575Giant cell arteritis presenting as fever of unknown origin: role of clinical history, early positron emission tomography and ultrasound screeningP576Subclinical systolic dysfunction in systemic sclerosis is not influenced by standard rheumatologic therapy - a 4D echocardiographic studyP577Cardiac index correlates with the degree of hepatic steathosis in obese patients with obstructive sleep apneaP578Myocardial mechanics in top-level endurance athletes: a three-dimensional speckle tracking studyP579The athlete heart: what happens to myocardial deformation in physiological adaptation to sportsP580Association between left ventricle intrinsic function and urine protein-creatinine ratio in preeclampsia before and after deliveryP581Dilatation of the aorta in children with bicuspid aortic valveP582Cardiovascular functional abnormalities in patients with osteogenesis imperfectaP583Dobutamine stress test fast protocol: diagnostic accuracy and securityP584Prognostic value of non-positive exercise echocardiography in the patients submitted to percutaneous coronary interventionP585The use of myocardial strain imaging in the detection of coronary artery disease during stress echocardiographyP586Preserved O2 extraction exercise response in heart failure patients with chronotropic insufficiency: evidence for a central cardiac rather than peripheral oxygen uptake limitationP587Major determinant of O2 artero-venous difference at peak exercise in heart failure and healthy subjectsP588Stress echocardiography with contrast perfusion analysis for a more sensitive test for ischemic heart diseaseP589Assessment of mitral annular physiology in myxomatous mitral disease with 3D transesophageal echocardiography: comparison between early severe mitral regurgitation and decompensated groupP590Three-dimensional transesophageal echocardiographic assessment of the mitral valve geometry in patients with mild, moderate and severe chronic ischemic mitral regurgitationP591Left atrial appendage closure. Multimodality imaging in device size selectionP592Contributions of three-dimensional transesophageal echocardiography in the evaluation of aortic atherosclerotic plaquesP593Agitated blood-saline is superior to agitated air-saline for echocardiographic shunt studies. Eur Heart J Cardiovasc Imaging 2016; 17:ii102-ii109. [DOI: 10.1093/ehjci/jew248.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cox M, Patel M, Li Z, Kamel S, Deshmukh S, Roth C, Needleman L. Detection of unsuspected pelvic DVTs on abdominopelvic CT scans: a potentially life-saving diagnosis. Emerg Radiol 2016; 24:127-131. [DOI: 10.1007/s10140-016-1456-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022]
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Brown SC, Wang K, Dong C, Farrell MB, Heller GV, Gornik HL, Hutchisson M, Needleman L, Benenati JF, Jaff MR, Meier GH, Perese S, Bendick P, Hamburg NM, Lohr JM, LaPerna L, Leers SA, Lilly MP, Tegeler C, Katanick SL, Alexandrov AV, Siddiqui AH, Rundek T. Intersocietal Accreditation Commission Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE Study. J Ultrasound Med 2016; 35:1957-1965. [PMID: 27466261 DOI: 10.7863/ultra.15.08021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/11/2015] [Accepted: 12/14/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) and equivalent organizations is supported by the Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of cerebrovascular testing facilities in the United States. Our study objectives were to identify the proportion of IAC-accredited outpatient cerebrovascular testing facilities used by Medicare beneficiaries, describe their geographic distribution, and identify variations in cerebrovascular testing procedure types and volumes by accreditation status. METHODS As part of the VALUE (Vascular Accreditation, Location, and Utilization Evaluation) Study, we examined the proportion of IAC-accredited facilities that conducted cerebrovascular testing in a 5% Centers for Medicare and Medicaid Services random Outpatient Limited Data Set in 2011 and investigated their geographic distribution using geocoding. RESULTS Among 7327 outpatient facilities billing Medicare for cerebrovascular testing, only 22% (1640) were IAC accredited. The proportion of IAC-accredited cerebrovascular testing facilities varied by region (χ(2)[3] = 177.1; P < .0001), with 29%, 15%, 13%, and 10% located in the Northeast, South, Midwest, and West, respectively. However, of the total number of cerebrovascular outpatient procedures conducted in 2011 (38,555), 40% (15,410) were conducted in IAC-accredited facilities. Most cerebrovascular testing procedures were carotid duplex, with 40% of them conducted in IAC-accredited facilities. CONCLUSIONS The proportion of facilities conducting outpatient cerebrovascular testing accredited by the IAC is low and varies by region. The growing number of certified stroke centers should be accompanied by more accredited outpatient vascular testing facilities, which could potentially improve the quality of stroke care.
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Affiliation(s)
- Scott C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Kefeng Wang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida USA, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Chuanhui Dong
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida USA
| | | | - Gary V Heller
- Intersocietal Accreditation Commission, Ellicott City, Maryland USA
| | - Heather L Gornik
- Department of Vascular Medicine, Cleveland Clinic, Cleveland, Ohio USA
| | - Marge Hutchisson
- Intersocietal Accreditation Commission, Ellicott City, Maryland USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania USA
| | - James F Benenati
- Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida USA
| | - Michael R Jaff
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts USA
| | - George H Meier
- Department of Vascular Surgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio USA
| | - Susana Perese
- Department of Vascular Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California USA
| | - Phillip Bendick
- Vascular Laboratory, William Beaumont Hospital, Royal Oak, Michigan USA
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts
| | - Joann M Lohr
- Good Samaritan Outpatient Center, Cincinnati, Ohio USA
| | - Lucy LaPerna
- Riverside Radiology Associates, Columbus, Ohio USA
| | - Steven A Leers
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
| | - Michael P Lilly
- Vascular Laboratory, University of Maryland School of Medicine, Baltimore, Maryland USA
| | - Charles Tegeler
- Wake Forest Baptist Health, Winston-Salem, North Carolina USA
| | | | | | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York USA
| | - Tatjana Rundek
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida USA, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida USA
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Cox M, Li Z, Desai V, Brown L, Deshmukh S, Roth CG, Needleman L. Acute nontraumatic splenic infarctions at a tertiary-care center: causes and predisposing factors in 123 patients. Emerg Radiol 2016; 23:155-60. [DOI: 10.1007/s10140-016-1376-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/06/2016] [Indexed: 11/28/2022]
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Cox M, Balasubramanya R, Hou A, Deshmukh S, Needleman L. Incidental left atrial and ventricular thrombi on routine CT: outcome and influence on subsequent management at an urban tertiary care referral center. Emerg Radiol 2015; 22:657-60. [DOI: 10.1007/s10140-015-1342-5] [Citation(s) in RCA: 4] [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: 07/17/2015] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
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Baker MA, Maley WR, Needleman L, Doria C. Ex vivo resection of hepatic neoplasia and autotransplantation: a case report and review of the literature. J Gastrointest Surg 2015; 19:1169-76. [PMID: 25820488 DOI: 10.1007/s11605-015-2806-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/17/2015] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Ex situ liver resection is an uncommon procedure but offers an opportunity for R0 surgical resection of liver tumors that are otherwise unresectable. Liver insufficiency following extensive resections is a risk in this patient population; consequently, all measures should be taken to prevent this highly morbid complication. METHOD We report a case of a patient with an extensive cholangiocarcinoma involving all three hepatic veins that required ex vivo resection and liver autotransplantation to achieve an R0 resection. Postoperatively, the patient demonstrated signs of worsening liver function that, in addition to standard medical therapy, underwent a brief treatment with molecular adsorbent recirculating system (MARS) therapy. RESULTS Although the role of MARS remains unclear, the patient tolerated it well and her liver graft dysfunction and hepatic encephalopathy slowly resolved. The patient was discharged to a rehabilitation facility. She is currently alive and well with no evidence of recurrence 3 years later. CONCLUSION We present a review of the literature on ex situ resection and liver autotransplantation. In addition to numerous case reports, there are a few moderate series of ex situ resection and autotransplantation. We suggest that the use of artificial liver devices, if indicated, in the postoperative ex situ resection liver autotransplant patient may assist in the support of the patient while the transplanted liver remnant recovers.
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Affiliation(s)
- Meredith A Baker
- Department of Surgery, Division of Transplantation, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, 19107, USA
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Brown SC, Wang K, Dong C, Farrell MB, Heller GV, Gornik HL, Hutchisson M, Needleman L, Benenati JF, Jaff MR, Meier GH, Perese S, Bendick P, Hamburg NM, Lohr JM, LaPerna L, Leers SA, Lilly MP, Tegeler C, Katanick SL, Alexandrov AV, Rundek T. Abstract T P274: Accreditation Status of Outpatient Cerebrovascular Testing Facilities Among Medicare Beneficiaries: The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE:
Accreditation of cerebrovascular ultrasound laboratories by the Intersocietal Accreditation Commission (IAC) or equivalent bodies is supported by The Joint Commission certification of stroke centers. Limited information exists on the accreditation status and geographic distribution of these testing facilities in the US. The aims were to: (1) Identify the proportion of IAC accredited vascular testing facilities used by Medicare beneficiaries for outpatient cerebrovascular testing services; (2) Describe the geographical distribution of these facilities; and (3) Identify variation in the types and volumes of cerebrovascular testing procedures by accreditation status.
METHODS:
As a part of the VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study, we examined the proportion of IAC accredited facilities that conducted cerebrovascular testing in a 5% CMS random Outpatient Limited Data Set (LDS) for the US in 2011 and investigated their geographical distribution using the Medicare Provider of Services (POS) file.
RESULTS:
Of the 7,864 total facilities billing Medicare for cerebrovascular testing procedures, only 22% (n=1,723) were IAC accredited. The percentage of facilities conducting cerebrovascular testing that were IAC accredited varied by region (Χ2[3]=400.4, p<0.0001), with 43%, 21%, 17% and 13% located in the Northeast, South, Midwest, and West, respectively. However, when examining the total number of cerebrovascular outpatient procedures conducted in 2011 (total n=38,646), 41% (15,729) were conducted in IAC accredited facilities. Moreover, when examining procedure type across all sites, 98% (38,011) of all cerebrovascular testing procedures conducted were carotid duplex, of which 41% (15,417) were conducted in IAC accredited facilities. In contrast, 1% (n=315) of all cerebrovascular procedures were transcranial (TCD), of which 56% (n=177) were conducted in IAC accredited facilities.
CONCLUSIONS:
The proportion of IAC accredited facilities conducting outpatient cerebrovascular testing is low and varies by region. The growing number of certified stroke centers should be accompanied by more accredited vascular testing facilities that could potentially improve quality of stroke care.
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Affiliation(s)
- Scott C Brown
- Dept. of Public Health Sciences, Univ of Miami Miller Sch of Medicine, Miami, FL
| | - Kefeng Wang
- Dept. of Neurology, Univ of Miami Miller Sch of Medicine, Miami, FL
| | - Chuanhui Dong
- Dept. of Neurology, Univ of Miami Miller Sch of Medicine, Miami, FL
| | - Mary B Farrell
- Intersocietal Accreditation Commission (IAC), Ellicott City, MD
| | - Gary V Heller
- Intersocietal Accreditation Commission (IAC), Ellicott City, MD
| | | | | | | | - James F Benenati
- Baptist Cardiac & Vascular Institute, Baptist Hosp of Miami, Miami, FL
| | | | - George H Meier
- Dept. of Vascular Surgery, Univ of Cincinnati Academic Health Cntr, Cincinnati, OH
| | - Susana Perese
- Dept. of Vascular Surgery, Univ of Southern California, Los Angeles, CA
| | - Philip Bendick
- Vascular Laboratory, William Beaumont Hosp, Royal Oak, MI
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston Univ Sch of Medicine, Boston, MA
| | - Joann M Lohr
- Lohr Surgical Specialists, Good Samaritan Outpatient Cntr, Cincinnati, OH
| | - Lucy LaPerna
- Vascular Medicine, Riverside Radiology Associates, Columbus, OH
| | - Steven A Leers
- UPMC Heart and Vascular Institute, Univ of Pittsburgh Med Cntr, Pittsburgh, PA
| | - Michael P Lilly
- Vascular Laboratory, Univ of Maryland Sch of Medicine, Baltimore, MD
| | - Charles Tegeler
- Dept. of Neurology, Wake Forest Baptist Health, Winston-Salem, NC
| | | | | | - Tatjana Rundek
- Dept. of Neurology, Univ of Miami Miller Sch of Medicine, Miami, FL
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Abstract
Lower extremity venous ultrasonography is an accurate method to diagnose acute deep venous thrombosis (DVT). Recurrent DVT is often difficult diagnosis. The decision to order ultrasonography can be based on pretest risk assessment. If the ultrasonography study is negative, the report may recommend follow-up for patients whose clinical condition changes or for patients with specific risks. Lower extremity venous ultrasonography is the gold standard for diagnosis of DVT. It is accurate and objective, and because the clinical assessment of patients is limited and its potential complication, pulmonary embolism, is significant, the impact of a positive and negative test is high.
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Affiliation(s)
- Laurence Needleman
- Sidney Kimmel Medical College of Thomas Jefferson University, 763 Main Building, 132 South 10th Street, Philadelphia, PA 19107-5244, USA.
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Rundek T, Brown SC, Wang K, Dong C, Farrell MB, Heller GV, Gornik HL, Hutchisson M, Needleman L, Benenati JF, Jaff MR, Meier GH, Perese S, Bendick P, Hamburg NM, Lohr JM, LaPerna L, Leers SA, Lilly MP, Tegeler C, Alexandrov AV, Katanick SL. Accreditation status and geographic location of outpatient vascular testing facilities among Medicare beneficiaries: The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study. Vasc Med 2014; 19:376-84. [DOI: 10.1177/1358863x14547561] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: There is limited information on the accreditation status and geographic distribution of vascular testing facilities in the US. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement to facilities regardless of accreditation status. The aims were to: (1) identify the proportion of Intersocietal Accreditation Commission (IAC) accredited vascular testing facilities in a 5% random national sample of Medicare beneficiaries receiving outpatient vascular testing services; (2) describe the geographic distribution of these facilities. Methods: The VALUE (Vascular Accreditation, Location & Utilization Evaluation) Study examines the proportion of IAC accredited facilities providing vascular testing procedures nationally, and the geographic distribution and utilization of these facilities. The data set containing all facilities that billed Medicare for outpatient vascular testing services in 2011 (5% CMS Outpatient Limited Data Set (LDS) file) was examined, and locations of outpatient vascular testing facilities were obtained from the 2011 CMS/Medicare Provider of Services (POS) file. Results: Of 13,462 total vascular testing facilities billing Medicare for vascular testing procedures in a 5% random Outpatient LDS for the US in 2011, 13% ( n=1730) of facilities were IAC accredited. The percentage of IAC accredited vascular testing facilities in the LDS file varied significantly by US region, p<0.0001: 26%, 12%, 11%, and 7% for the Northeast, South, Midwest, and Western regions, respectively. Conclusions: Findings suggest that the proportion of outpatient vascular testing facilities that are IAC accredited is low and varies by region. Increasing the number of accredited vascular testing facilities to improve test quality is a hypothesis that should be tested in future research.
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Affiliation(s)
- Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Scott C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kefeng Wang
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chuanhui Dong
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mary Beth Farrell
- Intersocietal Accreditation Commission (IAC), Ellicott City, MD, USA
| | - Gary V Heller
- Intersocietal Accreditation Commission (IAC), Ellicott City, MD, USA
| | - Heather L Gornik
- Department of Vascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Marge Hutchisson
- Intersocietal Accreditation Commission (IAC), Ellicott City, MD, USA
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, PA, USA
| | - James F Benenati
- Baptist Cardiac & Vascular Institute, Baptist Hospital of Miami, Miami, FL, USA
| | - Michael R Jaff
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - George H Meier
- Department of Vascular Surgery, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Susana Perese
- Department of Vascular Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Phillip Bendick
- Vascular Laboratory, William Beaumont Hospital, Royal Oak, MI, USA
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Joann M Lohr
- Good Samaritan Outpatient Center, Cincinnati, OH, USA
| | - Lucy LaPerna
- Riverside Radiology Associates, Columbus, OH, USA
| | - Steven A Leers
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Michael P Lilly
- University of Maryland School of Medicine, Vascular Laboratory, Baltimore, MD, USA
| | | | | | - Sandra L Katanick
- Intersocietal Accreditation Commission (IAC), Ellicott City, MD, USA
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25
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Palmer J, Deshmukh S, Needleman L, Yeung V, Burkhart R, Leiby B, Hurwitz M, Anne P, Lavu H, Winter J, Lewis N, Sama A, Rosato E, Koniaris L, Yeo C, Bar-Ad V. Patterns of Failure in Periampullary Cancer Following Pancreaticoduodenectomy and Adjuvant Chemoradiation Therapy With Implications on Radiation Treatment Planning. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1184] [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: 10/24/2022]
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26
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Zhu L, Farrell M, Bezold L, Choi J, Cockroft K, Heller G, Jerome S, Katanick S, Manning W, Needleman L, Gornik H. ACCREDITATION IS PERCEIVED TO IMPROVE THE QUALITY OF VASCULAR TESTING FACILITIES: RESULTS OF AN INTERSOCIETAL ACCREDITATION COMMISSION (IAC) SURVEY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)62118-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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Periwal V, Gaillard JR, Needleman L, Doria C. Mathematical model of liver regeneration in human live donors. J Cell Physiol 2014; 229:599-606. [PMID: 24446196 DOI: 10.1002/jcp.24482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 09/30/2013] [Indexed: 01/31/2023]
Abstract
Liver regeneration after injury occurs in many mammals. Rat liver regenerates after partial hepatectomy over a period of 2 weeks while human liver regeneration takes several months. Notwithstanding this enormous difference in time-scales, with new data from five human live liver transplant donors, we show that a mathematical model of rat liver regeneration can be transferred to human, with all biochemical interactions and signaling unchanged. Only six phenomenological parameters need change, and three of these parameter changes are rescalings of rate constants by the ratio of human lifespan to rat lifespan. Data from three donor subjects with approximately equal resections were used to fit the three parameters and the data from the other two donor subjects was used to independently verify the fit.
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Affiliation(s)
- V Periwal
- Laboratory of Biological Modeling, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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28
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Hann HW, Coben R, Brown D, Needleman L, Rosato E, Min A, Hann RS, Park KB, Dunn S, DiMarino AJ. A long-term study of the effects of antiviral therapy on survival of patients with HBV-associated hepatocellular carcinoma (HCC) following local tumor ablation. Cancer Med 2014; 3:390-6. [PMID: 24519810 PMCID: PMC3987088 DOI: 10.1002/cam4.197] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/20/2013] [Accepted: 12/26/2013] [Indexed: 12/17/2022] Open
Abstract
The ultimate goal of antiviral therapy for chronic hepatitis B (CHB) is prevention of hepatocellular carcinoma (HCC). Earlier we reported favorable effects of antiviral therapy on survival of HCC patients following curative tumor ablation (Int J Cancer online 14 April 2010; doi: 10.1002/ijc.25382). It was the first observation made in the United States. We now report 12 year follow-up of this patient group. CHB patients with no prior antiviral therapy with a single HCC (≤7 cm) were studied. All patients underwent local tumor ablation as their first option. Patients diagnosed before 1999 received no antiviral treatment while those diagnosed after 1999 received antiviral treatment. Survival between the treated and untreated groups was compared. Among 555 HCC patients seen at our clinic between 1991 and 2013, 25 subjects were eligible. Nine subjects (all male patients, median age 53 years [46–66]) did not receive antiviral therapy while 16 (14 male patients, median age 56 years [20–73]) received treatment. Between the two groups, there was no difference in their median tumor size and levels of alpha-fetoprotein and albumin. However, the survival was significantly different (P = 0.001): the median survival of the untreated was 16 months (3–36 months) while that of the treated was 80 months (15–152 months). Fourteen of 16 treated patients are alive to date with two longest survivors alive for ≥151 months. In conclusion, concomitant antiviral therapy for CHB patients with HCC reduces and prevents new/recurrent tumor and improves survival. This novel treatment strategy offers an alternative to liver transplantation in patients with HBV-associated HCC.
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Affiliation(s)
- Hie-Won Hann
- Liver Disease Prevention Center, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Division of Gastroenterology and Hepatology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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29
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Gerding AL, Fox TB, Lown L, Needleman L. Nerve Hematoma Mimicking DVT. Journal of Diagnostic Medical Sonography 2013. [DOI: 10.1177/8756479313493007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This case study describes a patient who underwent an upper extremity venous examination to evaluate for possible deep vein thrombosis (DVT). Sonography showed no evidence of thrombus in the veins of the deep or superficial system. Adjacent to the veins of the peripheral arm, however, an enlarged hypoechoic structure was visualized that had a very similar appearance to DVT. With further imaging, hyperechoic linear bands were visualized at the proximal end of the hypoechoic structure. The appearance suggested that this structure was related to the median nerve, but its normal appearance was altered by a large mass inside the nerve sheath. Given the patient’s history, the finding most likely represents a nerve hematoma.
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Affiliation(s)
| | - Traci B. Fox
- Thomas Jefferson University Hospital, Trenton, NJ, USA
| | - Lauren Lown
- Thomas Jefferson University Hospital, Trenton, NJ, USA
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30
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Gornik HL, Needleman L, Benenati J, Bendick PP, Hutchisson M, Katanick S, Naylor A, Sloper T, Jaff M. SUPPORT FOR STANDARDIZATION OF DUPLEX ULTRASOUND DIAGNOSTIC CRITERIA FOR INTERNAL CAROTID ARTERY STENOSIS: A SURVEY FROM THE INTERSOCIETAL ACCREDITATION COMMISSION (IAC). J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)62020-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Fong ZV, Palazzo F, Needleman L, Brown DB, Eschelman DJ, Chojnacki KA, Yeo CJ, Rosato EL. Combined hepatic arterial embolization and hepatic ablation for unresectable colorectal metastases to the liver. Am Surg 2012; 78:1243-1248. [PMID: 23089443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Liver-directed therapy for hepatic metastases includes: intra-arterial techniques such as transarterial chemoembolization (TACE) and yttrium-90 resin ((90)Y) microsphere radioembolization and ablative technologies: cryoablation, radiofrequency ablation, and microwave ablation. Combining embolization techniques with liver ablation may enhance the therapeutic benefit of each and result in improved patient survival. We retrospectively reviewed our experience with combined intra-arterial therapies and ablation for unresectable hepatic colorectal metastases from 1996 to 2011. Patient demographics, tumor characteristics, specific liver-directed treatments, procedure-related morbidity and mortality, and overall survival were recorded. There were 17 (53%) males and 15 (47%) females. Average age for the group was 74.1 years (median, 75.5 years). Fifteen patients (46.9%) had a single hepatic metastasis. Eleven (34%) patients had bilobar tumor distribution and seven (22%) patients had vascular invasion of the portal vein or hepatic/caval venous structures. Seven (21%) tumors were greater than 5 cm in diameter. Twenty-seven (84.4%) patients received TACE and five (15.6%) received (90)Y. Fourteen (43%) were embolized before any ablation. Fifty-three per cent of patients required multiple hepatic ablation sessions. Median length of hospital stay was 1 day. There were no procedure-related mortalities and complications occurred in six (18.8%) patients. Mean follow-up for the group was 33 months. Kaplan-Meier 1-, 3-, and 5-year estimated survival was 93.8, 50.0, and 10.1 per cent, respectively. Median survival for the group was 46 months. Hepatic ablation and embolization techniques can be combined safely with minimal morbidity. In our series, we observed 5-year survival in 10 per cent of patients.
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Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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32
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Ven Fong Z, Palazzo F, Needleman L, Brown DB, Eschelman DJ, Chojnacki KA, Yeo CJ, Rosato EL. Combined Hepatic Arterial Embolization and Hepatic Ablation for Unresectable Colorectal Metastases to the Liver. Am Surg 2012. [DOI: 10.1177/000313481207801133] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Liver-directed therapy for hepatic metastases includes: intra-arterial techniques such as trans-arterial chemoembolization (TACE) and yttrium-90 resin (90Y) microsphere radioembolization and ablative technologies: cryoablation, radiofrequency ablation, and microwave ablation. Combining embolization techniques with liver ablation may enhance the therapeutic benefit of each and result in improved patient survival. We retrospectively reviewed our experience with combined intra-arterial therapies and ablation for unresectable hepatic colorectal metastases from 1996 to 2011. Patient demographics, tumor characteristics, specific liver-directed treatments, procedure-related morbidity and mortality, and overall survival were recorded. There were 17 (53%) males and 15 (47%) females. Average age for the group was 74.1 years (median, 75.5 years). Fifteen patients (46.9%) had a single hepatic metastasis. Eleven (34%) patients had bilobar tumor distribution and seven (22%) patients had vascular invasion of the portal vein or hepatic/caval venous structures. Seven (21%) tumors were greater than 5 cm in diameter. Twenty-seven (84.4%) patients received TACE and five (15.6%) received 90Y. Fourteen (43%) were embolized before any ablation. Fifty-three per cent of patients required multiple hepatic ablation sessions. Median length of hospital stay was 1 day. There were no procedure-related mortalities and complications occurred in six (18.8%) patients. Mean follow-up for the group was 33 months. Kaplan-Meier 1-, 3-, and 5-year estimated survival was 93.8, 50.0, and 10.1 per cent, respectively. Median survival for the group was 46 months. Hepatic ablation and embolization techniques can be combined safely with minimal morbidity. In our series, we observed 5-year survival in 10 per cent of patients.
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Affiliation(s)
- Zhi Ven Fong
- Departments of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Francesco Palazzo
- Departments of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Laurence Needleman
- Departments of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Daniel B. Brown
- Departments of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - David J. Eschelman
- Departments of Radiology, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Karen A. Chojnacki
- Departments of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Charles J. Yeo
- Departments of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
| | - Ernest L. Rosato
- Departments of Surgery, Thomas Jefferson University, Jefferson Medical College, Philadelphia, Pennsylvania
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Dave JK, Liu JB, Halldorsdottir VG, Eisenbrey JR, Merton DA, Machado P, Zhao H, Altemus J, Needleman L, Brown DB, Forsberg F. Acute portal hypertension models in dogs: low- and high-flow approaches. Comp Med 2012; 62:419-26. [PMID: 23114046 PMCID: PMC3472607] [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] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 03/16/2011] [Accepted: 04/03/2012] [Indexed: 06/01/2023]
Abstract
Effective animal models are needed to evaluate the feasibility of new techniques to assess portal hypertension (PH). Here we developed 2 canine models of acute PH by increasing intrasinusoidal resistance and by increasing the portal vein (PV) flow volume to test the efficacy of a noninvasive technique to evaluate PH. The acute low-flow PH model was based on embolization of liver circulation by using a gelatin sponge material. The acute high-flow PH model was based on increasing the PV flow volume by using an arteriovenous (A-V) shunt from the femoral artery and saline infusion. PV pressures and diameters were assessed before and after inducing PH. Pressure values and diameters were obtained from the inferior vena cava in 3 unmanipulated controls. The low-flow model of PH was repeatable and successfully increased PV pressure by an average of 16.5 mm Hg within 15 min. The high-flow model of PH failed to achieve increased PV pressures. However, saline supplementation of the portal circulation in the high-flow model led to mean increases in PV pressures of 12.8 mm Hg within 20 min. Pulsatility in the PV was decreased in the low-flow model and increased in the high-flow model relative to baseline. No changes in PV diameter were noted in either model. These acute PH models are relatively straightforward to implement and may facilitate the evaluation of new techniques to assess PH.
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Affiliation(s)
- Jaydev K Dave
- Department of Radiology and
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; and
| | | | - Valgerdur G Halldorsdottir
- Department of Radiology and
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania; and
| | | | | | | | - Hongjia Zhao
- Department of Radiology and
- Department of Ultrasound, The Second People's Hospital of Fujian, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
| | - Joseph Altemus
- Office of Animal Resources, Thomas Jefferson University, and
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Affiliation(s)
- Andrei V. Alexandrov
- From the Comprehensive Stroke Center (A.V.A.), University of Alabama Hospital, Birmingham, AL; Department of Radiology (L.N.), Thomas Jefferson University, Philadelphia, PA
| | - Laurence Needleman
- From the Comprehensive Stroke Center (A.V.A.), University of Alabama Hospital, Birmingham, AL; Department of Radiology (L.N.), Thomas Jefferson University, Philadelphia, PA
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Low G, Sidhu PS, Albrecht T, Needleman L, Leen E. Reply to letter to the editor re: contrast enhanced ultrasound in the detection of liver metastases: a prospective multi-centre dose testing study using a perfluorobutane microbubble contrast agent (NC100100). Eur Radiol 2011. [DOI: 10.1007/s00330-011-2176-5] [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: 11/29/2022]
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36
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Correas JM, Low G, Needleman L, Robbin ML, Cosgrove D, Sidhu PS, Harvey CJ, Albrecht T, Jakobsen JA, Brabrand K, Jenett M, Bates J, Claudon M, Leen E. Contrast enhanced ultrasound in the detection of liver metastases: a prospective multi-centre dose testing study using a perfluorobutane microbubble contrast agent (NC100100). Eur Radiol 2011; 21:1739-46. [PMID: 21479856 DOI: 10.1007/s00330-011-2114-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 02/18/2011] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To conduct a dose testing analysis of perfluorobutane microbubble (NC100100) contrast-enhanced ultrasound (CEUS) to determine the optimal dose for detection of liver metastases in patients with extra-hepatic primary malignancy. METHODS 157 patients were investigated with conventional US and CEUS. CEUS was performed following intravenous administration of perfluorobutane microbubbles (using one dose of either 0.008, 0.08, 0.12 or 0.36 μL/kg body weight). Three blinded off-site readers recorded the number and locations of metastatic lesions detected by US and CEUS. Contrast enhanced CT and MRI were used as the "Standard Of Reference" (SOR). Sensitivity, specificity and accuracy of liver metastasis detection with US versus CEUS, for each dose group were obtained. Dose group analysis was performed using the Chi-square test. RESULTS 165 metastases were present in 92 patients who each had 1-7 lesions present on the SOR. Sensitivity of US versus CEUS (for all doses combined) was 38% and 67% (p = 0.0001). The 0.12 dose group with CEUS (78%) had significantly higher sensitivity and accuracy (70%) compared to other dose groups (p < 0.05). CONCLUSION The diagnostic performance of CEUS is dose dependent with the 0.12 μL/kg NC100100 dose group showing the greatest sensitivity and accuracy in detection of liver metastases.
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Affiliation(s)
- Jean-Michel Correas
- Department of Adult Radiology, Groupe Hospitalier Necker Enfants-Malades, Paris, France
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Bloomenthal A, Rosato F, Chojnacki K, Berger A, Needleman L, Fong Z, Kennedy E, Rosato E. Ablation-Assisted Hepatic Resection Of Metastatic And Benign Tumors. J Surg Res 2011. [DOI: 10.1016/j.jss.2010.11.814] [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: 11/25/2022]
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Forsberg F, Stein AD, Merton DA, Lipcan KJ, Herzog D, Parker L, Needleman L. Carotid stenosis assessed with a 4-dimensional semiautomated Doppler system. J Ultrasound Med 2008; 27:1337-44. [PMID: 18716143 PMCID: PMC2679685 DOI: 10.7863/jum.2008.27.9.1337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The purpose of this study was to compare peak systolic velocities (PSVs) and the degree of stenosis obtained with a real-time 3-dimensional (ie, 4-dimensional) Doppler ultrasound scanner (Encore PV; VueSonix Sensors Inc, Wayne, PA) to conventional Doppler ultrasound imaging of the carotid arteries (common [CCA], internal [ICA], and external [ECA]). A secondary goal was to assess Encore volume flow measurements. METHODS Seventy patients referred for clinical carotid ultrasound participated in this pilot study. Peak systolic velocities of the CCA, ECA, and ICA were obtained bilaterally. The degree of stenosis in the ICA was calculated based on the ICA PSV and ICA/CCA PSV ratio. The Encore detects all 3-dimensional blood flow velocity vectors within 10-s longitudinal volumes of the ICA, ECA, and CCA. On the Encore, a reader determined the centerline of the vessels. The PSV and volume flow were then automatically calculated. The flow measurement error was obtained by comparing the CCA flow to the ICA and ECA flow. Data were compared using linear regression, intraclass correlation coefficients (ICCs), and Bland-Altman analysis. RESULTS Due to technical difficulties, only 59 patients (323 vessel segments) were available for analysis. There was good agreement between methods for assessing the degree of stenosis based on the ICA PSV (ICC = 0.83; P < .0001) and, to a lesser degree, on the ICA/CCA PSV ratio (ICC = 0.65; P < .0001). Peak systolic velocity measurements obtained with conventional ultrasound and the Encore correlated in all vessels (r >or= 0.32; P < .002), and Bland-Altman analysis showed reasonable variations. The Encore mean volume flow error +/- SD was -4.1% +/- 66.4% and was not biased (P = .57). CONCLUSIONS A new semiautomated 4-dimensional Doppler device is comparable to conventional Doppler ultrasound for assessment of carotid stenosis.
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Affiliation(s)
- Flemming Forsberg
- Department of Radiology, Division of Ultrasound, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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39
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Liu JB, Wansaicheong G, Merton DA, Chiou SY, Sun Y, Li K, Forsberg F, Edmonds PR, Needleman L, Halpern EJ. Canine prostate: contrast-enhanced US-guided radiofrequency ablation with urethral and neurovascular cooling--initial experience. Radiology 2008; 247:717-25. [PMID: 18413888 DOI: 10.1148/radiol.2473071334] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To prospectively evaluate in a canine model contrast material-enhanced ultrasonography (US) for guiding and monitoring radiofrequency (RF) ablation of the entire prostate, with urethral and vascular cooling to protect the surrounding structures. MATERIALS AND METHODS After approval by the institutional animal use and care committee, an RF electrode was used to ablate the entire prostate in 15 dogs. During ablation, pulse-inversion harmonic US was performed by using an endocavitary probe after an intravenous bolus injection (0.04 mL/kg) and infusion (0.015 muL/kg/min) of a US contrast agent. In group 1 (n = 4), no cooling protection was used during ablation. In group 2 (n = 5), urethral and bladder protection was provided by inserting a 12-F catheter infused with cold saline (8 degrees C +/- 4 [standard deviation]) at a rate of 100 mL/min. In group 3 (n = 6), further protection of the neurovascular bundles (NVBs) was provided by infusing cold saline (8 degrees C +/- 4) into the iliac arteries at a rate of 50 mL/min by means of catheterization of the femoral artery. Pathologic findings among the three groups were compared by using the Wilcoxon rank sum test. RESULTS The average volumes of prostate ablation achieved in the three groups were 96.6%, 91.9%, and 92%. Contrast-enhanced pulse-inversion harmonic US allowed visualization and monitoring of urethral and NVB blood flow during the ablation. Without protection, damage to the urethra and the NVB was demonstrated at both US and pathologic examination. There was highly significant difference in urethral damage between groups with and the group without urethral cooling (P = .002), while intraarterial cooling demonstrated a nonsignificant trend toward a decreased NVB damage (P = .069). CONCLUSION Contrast-enhanced US can guide RF ablation of the entire prostate. Infusion of cold saline provides effective protection for the urethra during such procedures. The application of intraarterial cooling did not provide a significant improvement in the protection of the NVB in this small study.
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Affiliation(s)
- Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, 7th Floor Main Building, 132 S 10th St, Philadelphia, PA 19107, USA.
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Francesco FD, Sandro SD, Doria C, Ramirez C, Iaria M, Navarro V, Silvestry S, Needleman L, Frank A. Diaphragmatic Hernia Occurring 15 Months after Percutaneous Radiofrequency Ablation of a Hepatocellular Cancer. Am Surg 2008. [DOI: 10.1177/000313480807400207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | - Victor Navarro
- Department of Medicine, Division of Gastroenterology and Hepatology
| | - Scott Silvestry
- Department of Surgery, Division of Cardiothoracic Surgery, and
| | - Laurence Needleman
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam Frank
- Department of Surgery, Division of Transplantation
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di Francesco F, di Sandro S, Doria C, Ramirez C, Iaria M, Navarro V, Silvestry S, Needleman L, Frank A. Diaphragmatic hernia occurring 15 months after percutaneous radiofrequency ablation of a hepatocellular cancer. Am Surg 2008; 74:129-132. [PMID: 18306862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Fabrizio di Francesco
- Department of Surgery, Division of Transplantation, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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Bertino RE, Grassi CJ, Bluth EI, Cardella JF, Frates M, Gooding GA, Needleman L, Pellerito JS, Rumack CM, Sacks D. Practice guideline for the performance of physiologic evaluation of extremity arteries. J Vasc Interv Radiol 2008; 18:1203-6. [PMID: 17911508 DOI: 10.1016/j.jvir.2007.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chiou SY, Forsberg F, Fox TB, Needleman L. Comparing differential tissue harmonic imaging with tissue harmonic and fundamental gray scale imaging of the liver. J Ultrasound Med 2007; 26:1557-1563. [PMID: 17957050 DOI: 10.7863/jum.2007.26.11.1557] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to compare fundamental gray scale sonography, tissue harmonic imaging (THI), and differential tissue harmonic imaging (DTHI) for depicting normal and abnormal livers. METHODS The in vitro lateral resolution of DTHI, THI, and sonography was assessed in a phantom. Sagittal and transverse images of right and left hepatic lobes of 5 volunteers and 20 patients and images of 27 liver lesions were also acquired. Three independent blinded readers scored all randomized images for noise, detail resolution, image quality, and margin (for lesions) on a 7-point scale. Next, images from the same location obtained with all 3 modes were compared blindly side by side and rated by all readers. Contrast-to-noise ratios were calculated for the lesions, and the depth of penetration (centimeters) was determined for all images. RESULTS In vitro, the lateral resolution of DTHI was significantly better than fundamental sonography (P = .009) and showed a trend toward significance versus THI (P = .06). In the far field, DTHI performed better than both modes (P < .04). In vivo, 450 images were scored, and for all parameters, DTHI and THI did better than sonography (P < .002). Differential tissue harmonic imaging scored significantly higher than THI with regard to detail resolution and image quality (P < .001). The average increase in penetration with THI and DTHI was around 0.6 cm relative to sonography (P < .0001). The contrast-to-noise ratio for DTHI showed a trend toward significance versus THI (P = .06). Side-by-side comparisons rated DTHI better than THI and sonography in 54% of the cases (P < .007). CONCLUSIONS Tissue harmonic imaging and DTHI do better than fundamental sonography for hepatic imaging, with DTHI being rated the best of the 3 techniques.
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Affiliation(s)
- See-Ying Chiou
- Department of Radiology, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Abstract
OBJECTIVE The purpose of this article was to review the current clinical applications of sonographically guided radiofrequency ablation (RFA) techniques. METHODS Publications regarding RFA extracted from a computerized database (MEDLINE) and from references cited in these articles were reviewed to evaluate the clinical effect and patient outcome. RESULTS Radiofrequency ablation has shown some promising effects in the treatment of tumors in various parts of the body. The recent advances in RFA technology enable larger volumes of treatment and make RFA clinically practical. It is most often used for hepatic and renal tumors, and applications for other organs and structures are increasing and rapidly developing. Sonography provides a convenient way to guide and monitor the procedure in most situations. CONCLUSIONS Effectiveness of RFA in the treatment of tumors in various body parts has been achieved. Radiofrequency ablation should be considered as an alternative or complementary method in the integration of oncologic management to obtain the greatest benefit to patients.
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Affiliation(s)
- See-Ying Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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Forsberg F, Stein AD, Liu JB, Deng X, Ackerman W, Herzog D, Abend K, Needleman L. Validating volume flow measurements from a novel semiautomated four-dimensional Doppler ultrasound scanner. Acad Radiol 2006; 13:1204-10. [PMID: 16979069 DOI: 10.1016/j.acra.2006.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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] [Received: 03/13/2006] [Revised: 06/21/2006] [Accepted: 06/21/2006] [Indexed: 01/19/2023]
Abstract
RATIONALE AND OBJECTIVES Accurate measurement of blood volume flow (in ml/min) is an important clinical goal. This project compared in vitro and in vivo volume flow measurements obtained with a novel, real-time three-dimensional (i.e., four-dimensional) ultrasound scanner (Encore PV; Vuesonix Sensors, Wayne, PA) with those from an invasive transit time flowmeter. MATERIALS AND METHODS A flow pump was used to generate pulsatile flow rates from 60 to 600 ml/min. The Encore detected absolute blood velocity vectors within a volume. The scanner determined the centerline of the vessel and volume flow was then automatically calculated. Results were compared with those of an invasive technique for volumetric blood flow measurements utilizing a transit-time flowmeter (TS420; Transonic Systems Inc., Ithaca, NY). In vivo, 10 second datasets of the volume flow in the distal aorta of six rabbits were obtained simultaneously with the Encore PV and the flowmeter. Data were compared using linear regression and Bland-Altman analysis (due to the lack of independence). RESULTS In vitro, Encore and flowmeter measurements both matched the flow pump (r2 > 0.99; P < .0001) with mean errors of -11.8% and -0.3%, respectively. Marked underestimation of the true flow rates was encountered with the Encore at the lowest pump setting. In vivo mean volume flows between 10.6 and 79.3 ml/min were measured. Mean and maximum volume flows obtained with the two techniques correlated significantly (P < .0001) with r2 values of 0.86 and 0.62, respectively. The corresponding root-mean-square errors were 6.9% for mean flow and 61.2% for maximum volume flow measurements. CONCLUSION A new semiautomated four-dimensional Doppler device has been tested in vitro and in vivo. Mean volume flow measurements with this unit are comparable to those of an invasive flowmeter.
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Affiliation(s)
- Flemming Forsberg
- Department of Radiology, Suite 763J Main Building, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA 19107, USA.
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Liu JB, Merton DA, Wansaicheong G, Forsberg F, Edmonds PR, Deng XD, Luo Y, Needleman L, Halpern E, Goldberg BB. Contrast Enhanced Ultrasound for Radio Frequency Ablation of Canine Prostates: Initial Results. J Urol 2006; 176:1654-60. [PMID: 16952709 DOI: 10.1016/j.juro.2006.06.090] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We determined the feasibility of contrast enhanced ultrasound for radio frequency ablation of the entire prostate as a method of minimally invasive treatment for prostate cancer in a canine model. MATERIALS AND METHODS Approval of the Institutional Animal Use and Care committee was obtained. Initially 5 dogs (group 1) were tested using variable power (5 to 30 W), time (4 to 12 minutes), bolus (0.01 to 0.04 ml/kg) and infusion (3 to 11 ml per minute at 0.015 microl/kg) injections of an ultrasound contrast agent with conventional grayscale power Doppler and pulse inversion harmonic imaging to establish optimal parameters. Subsequently 4 dogs (group 2) underwent entire prostate ablation using parameters based on group 1. The size of the thermal lesions and residual viable tissue was measured with ImageJ software (National Institutes of Health, Bethesda, Maryland) on ultrasound and pathological study. Linear regression and Student's t test were used for statistical analysis. RESULTS A bolus of 0.04 ml/kg, an infusion of 11 ml per minute at 0.015 microl/kg and the contrast enhanced pulse inversion harmonic imaging mode were ranked best for guiding ablation. Thermal lesion volume was proportional to ablation power and time. There was no significant difference in measured thermal lesion size in group 1 between ultrasound and pathological findings (mean +/- SD 1.51 +/- 0.74 and 1.46 +/- 0.74 cm3, p = 0.56) or in residual viable tissue in group 2 (0.43 +/- 0.043 and 0.41 +/- 0.291 cm3, p = 0.21). The average volume of prostate ablation achieved in group 2 was 96.3%. CONCLUSIONS Contrast enhanced pulse inversion harmonic imaging is able to guide, monitor and control radio frequency ablation of the entire prostate.
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Affiliation(s)
- Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
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Forsberg F, Goldberg BB, Merritt CRB, Parker L, Maitino AJ, Palazzo JJ, Merton DA, Schultz SM, Needleman L. Diagnosing breast lesions with contrast-enhanced 3-dimensional power Doppler imaging. J Ultrasound Med 2004; 23:173-182. [PMID: 14992354 DOI: 10.7863/jum.2004.23.2.173] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To compare mammography with contrast-enhanced 2- and 3-dimensional power Doppler imaging for the diagnosis of breast cancer. METHODS Fifty-five patients, who underwent breast biopsies with histopathologic assessment, participated in a study of mammography and contrast-enhanced sonography. Levovist (Berlex Laboratories, Montville, NJ) and Optison (Mallinckrodt, St Louis, MO) were administrated to 22 and 33 patients, respectively. Precontrast and postcontrast 2-dimensional power Doppler data of the lesion were obtained with an HDI 3000 system (Philips Medical Systems, Bothell, WA), and 3-dimensional data were acquired with an LIS 6000A system (Life Imaging Systems Inc, London, Ontario, Canada). Two independent and blinded readers assessed diagnosis. Receiver operating characteristic curves were computed individually and in combination for mammography and 2- and 3-dimensional sonography (before and after contrast). Histopathologic and imaging parameters were compared by Mann-Whitney statistics. RESULTS Mammographic findings were available for 50 patients, biopsy for 54, and 2- and 3-dimensional sonographic images for 53 and 52, respectively. Of the 50 patients who had all 4 measures, 15 (30%) had malignancies. The areas under the receiver operating characteristic curve for the diagnosis of breast cancer were 0.51 for 2-dimensional contrast-enhanced imaging, 0.60 for 3-dimensional power Doppler imaging, and 0.76 for 3-dimensional contrast-enhanced imaging (P < .01). Mammography produced an area of 0.86, which increased when combined with 3-dimensional contrast-enhanced imaging to 0.90 and with all sonographic modalities to 0.96 (P < .001). The histopathologic diagnosis of benign or malignant correlated with the presence or absence of anastomoses and with the degree of vascularity assessed with contrast-enhanced 3-dimensional power Doppler imaging (P = .007 and .02). CONCLUSIONS Contrast-enhanced 3-dimensional power Doppler imaging increases the ability to diagnose breast cancer relative to conventional 2- and 3-dimensional sonographic imaging.
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Affiliation(s)
- Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katarick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler E. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis--Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 2004; 19:190-8. [PMID: 14730262 DOI: 10.1097/00013644-200312000-00005] [Citation(s) in RCA: 175] [Impact Index Per Article: 8.8] [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: 11/26/2022]
Abstract
The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: First, all internal carotid artery (ICA) examinations should be performed with grayscale, color Doppler, and spectral Doppler US. Second, the degree of stenosis determined at grayscale and Doppler US should be stratified into the categories of normal (no stenosis), less than 50% stenosis, 50 to 69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. Third, ICA peak systolic velocity (PSV) and the presence of plaque on grayscale and/or color Doppler images are primarily used in the diagnosis and grading of ICA stenosis. Two additional parameters (the ICA-to-common carotid artery PSV ratio and ICA end diastolic velocity) may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. Fourth, ICA should be diagnosed as normal when ICA PSV is less than 125 cm/second and no plaque or intimal thickening is visible, less than 50% stenosis when ICA PSV is less than 125 cm/second and plaque or intimal thickening is visible, 50 to 69% stenosis when ICA PSV is 125 to 230 cm/second and plaque is visible, > or =70% stenosis to near occlusion when ICA PSV is more than 230 cm/second and visible plaque and lumen narrowing are seen, near occlusion when there is a markedly narrowed lumen on color Doppler US, and total occlusion when there is no detectable patent lumen on grayscale US and no flow on spectral, power, and color Doppler US. Fifth, the final report should discuss velocity measurements and grayscale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in these categories. The panel also considered various technical aspects of carotid US and methods for quality assessment, and identified several important unanswered questions meriting future research.
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Affiliation(s)
- Edward G Grant
- Department of Radiology, University of Southern California (USC), Keck School of Medicine, USC University Hospital, Los Angeles, CA 90033, USA.
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Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katanick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler RE. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003; 229:340-6. [PMID: 14500855 DOI: 10.1148/radiol.2292030516] [Citation(s) in RCA: 892] [Impact Index Per Article: 42.5] [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: 11/11/2022]
Abstract
The Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts in the field of vascular ultrasonography (US) to come to a consensus regarding Doppler US for assistance in the diagnosis of carotid artery stenosis. The panel's consensus statement is believed to represent a reasonable position on the basis of analysis of available literature and panelists' experience. Key elements of the statement include the following: (a) All internal carotid artery (ICA) examinations should be performed with gray-scale, color Doppler, and spectral Doppler US. (b) The degree of stenosis determined at gray-scale and Doppler US should be stratified into the categories of normal (no stenosis), <50% stenosis, 50%-69% stenosis, > or =70% stenosis to near occlusion, near occlusion, and total occlusion. (c) ICA peak systolic velocity (PSV) and presence of plaque on gray-scale and/or color Doppler images are primarily used in diagnosis and grading of ICA stenosis; two additional parameters, ICA-to-common carotid artery PSV ratio and ICA end-diastolic velocity may also be used when clinical or technical factors raise concern that ICA PSV may not be representative of the extent of disease. (d) ICA should be diagnosed as (i) normal when ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible; (ii) <50% stenosis when ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible; (iii) 50%-69% stenosis when ICA PSV is 125-230 cm/sec and plaque is visible; (iv) > or =70% stenosis to near occlusion when ICA PSV is greater than 230 cm/sec and visible plaque and lumen narrowing are seen; (v) near occlusion when there is a markedly narrowed lumen at color Doppler US; and (vi) total occlusion when there is no detectable patent lumen at gray-scale US and no flow at spectral, power, and color Doppler US. (e) The final report should discuss velocity measurements and gray-scale and color Doppler findings. Study limitations should be noted when they exist. The conclusion should state an estimated degree of ICA stenosis as reflected in the above categories. The panel also considered various technical aspects of carotid US and methods for quality assessment and identified several important unanswered questions meriting future research.
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Affiliation(s)
- Edward G Grant
- Department of Radiology, University of Southern California, Keck School of Medicine, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033, USA.
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Feld RI, Rosenberg AL, Nazarian LN, Needleman L, Lev-Toaff AS, Segal SR, Johnson PT, Parker L, O'Reilly T. Intraoperative sonographic localization of breast masses: success with specimen sonography and surgical bed sonography to confirm excision. J Ultrasound Med 2001; 20:959-966. [PMID: 11549156 DOI: 10.7863/jum.2001.20.9.959] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the use of intraoperative sonography for localization of breast masses at excisional biopsy, with specimen and surgical bed sonography to confirm excision. METHODS A computer search of the 5-year period from January 1993 through January 1998 revealed 138 consecutive women referred for sonographically guided excisional biopsy of 148 masses; 35 masses were excluded because they had no postoperative mammograms. One hundred thirteen masses constituted the study group. Specimen sonography (n = 60) or surgical bed sonography (n = 53) was performed as the initial evaluation to confirm excision, but ultimately, surgical bed sonography may have been necessary after specimen sonography, and specimen sonography may have been necessary after surgical bed sonography. The miss rates determined by postoperative imaging were calculated for each group and compared with those of mammographically guided needle localization series from the literature. RESULTS Follow-up physical examination and mammography showed no residual mass in the region of surgery in any patient. However, follow-up sonography had 1 miss in the initial specimen sonogram group (1 [1.7%] of 60) and 1 miss in the initial surgical bed group (1 [1.9%] of 53). As shown by the Fisher exact test, there was no significant difference between the miss rates of the 2 initial methods of confirming lesion excision or between the miss rates of these initial methods, both groups combined, and 6 mammographic localization series from the literature. CONCLUSION Intraoperative breast sonography, using specimen sonography and scanning the surgical bed, has miss rates comparable with those of mammographic needle localization. Follow-up sonography must be performed if there is any doubt of complete excision.
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Affiliation(s)
- R I Feld
- Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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