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Hadid-Beurrier L, Geryes BH, Jean-Pierre A, Gaudin PA, Feghali JA. Clinical benchmarking of a commercial software for skin dose estimation in cardiac, abdominal, and neurology interventional procedures. Med Phys 2024; 51:3687-3697. [PMID: 38277471 DOI: 10.1002/mp.16956] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Radiation exposure from interventional radiology (IR) could lead to potential risk of skin injury in patients. Several dose monitoring software like radiation dose monitor (RDM) were developed to estimate the patient skin dose (PSD) distribution in IR. PURPOSE This study benchmarked the accuracy of RDM software in estimating PSD as compared to GafChromic film baseline in-vivo measurements on patients during cardiac, abdominal, and neurology IR procedures. METHODS The prospective study conducted in four IR departments included 81 IR procedures (25 cardiac, 31 abdominal, and 25 neurology procedures) on three angiographic systems. PSD and field geometry were measured by placing GafChromic film under the patient's back. Statistical analyses were performed to compare the software estimation and film measurement results in terms of PSD and geometric accuracy. RESULTS Median values of measured/calculated PSD were 1140/1005, 591/655.9, and 538/409.7 mGy for neurology, cardiac, and abdominal procedures, respectively. For all angiographic systems, the median (InterQuartile Range, IQR) difference between calculated and measured PSD was -10.2% (-21.8%-5.7%) for neurology, -4.5% (-19.5%-15.5%) for cardiac, and -21.9% (-38.7%--3.6%) for abdominal IR procedures. These differences were not significant for all procedures (p > 0.05). Discrepancies increased up to -82% in lower dose regions where the measurement uncertainties are higher. Regarding the geometric accuracy, RDM correctly reproduced the skin dose map and estimated PSD area dimensions closely matched those registered on films with a median (IQR) difference of 0 cm (-1-0.8 cm). CONCLUSIONS RDM is proved to be a useful solution for the estimation of PSD and skin dose distribution during abdominal, cardiac and neurology IR procedures despite a geometry phantom which is not specific to the latter type of IR procedures.
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Affiliation(s)
- Lama Hadid-Beurrier
- Medical Physics and Radiation Protection Department, APHP Lariboisière University Hospital, Paris, France
| | - Bouchra Habib Geryes
- Radiology Department, APHP Necker-Enfants Malades University Hospital, Paris, France
| | - Antonella Jean-Pierre
- Medical Physics and Radiation Protection Department, APHP Lariboisière University Hospital, Paris, France
| | - Paul-Adrien Gaudin
- URC Lariboisière-Saint Louis, Hôpital Fernand Widal, PARIS Cedex, France
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Yang F, Du Y, Yuan C, Han L, Zhao Y, Xie Y, Peng W. Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy. Am J Transl Res 2024; 16:1018-1028. [PMID: 38586110 PMCID: PMC10994798 DOI: 10.62347/rxrn7802] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B during carotid endarterectomy (CEA). METHODS Patients who were prospectively enrolled to receive CEA under elective general anesthesia were randomized into an SGB group and a control group (ChiCTR2000033385). Before anesthesia, the SGB group underwent ipsilateral SGB under ultrasound guidance, while the control group did not. Ultrasound-guided right subclavian internal jugular vein catheterization was performed under general anesthesia. Mean arterial pressure (MAP) and heart rate (HR) were monitored at various time points (T0-T4). Arterial and internal jugular venous bulb blood were collected for blood gas analysis, determining jugular venous oxygen saturation (SjvO2), arteriovenous oxygen difference (AVDO2), cerebral oxygen extraction ratio (COER), lactate production rate (LPR), and lactate-oxygen index (LOI). The serum concentration of S100B in the internal jugular venous bulb at each time point was measured. RESULTS The results revealed significantly lower HR during anesthesia induction and surgery in the SGB group, with more stable MAP and HR during endotracheal intubation and surgery compared to the control group (P<0.05). The control group exhibited decreases at T3 and a slight increase at T4. SjvO2 was significantly higher in the SGB group, while AVDO2 and COER gradually decreased over time, but they were significantly higher in the control group (P<0.05). LPR and LOI in both groups peaked at T3 and were significantly different between T4 and T2 (P<0.05). Serum S100B levels in both groups rose and then decreased at each time point, but they were consistently lower in the SGB group (P<0.05). CONCLUSION SGB before CEA effectively suppresses the stress response, maintains intraoperative hemodynamic stability, improves brain tissue oxygen supply, and demonstrates a neuroprotective effect.
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Affiliation(s)
- Fen Yang
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Yulong Du
- School of Medicine, Shaoxing UniversityShaoxing 312000, Zhejiang, China
- Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua Hospital, Zhejiang University School of MedicineJinhua 321000, Zhejiang, China
| | - Chen Yuan
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Li Han
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Yue Zhao
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Yang Xie
- Department of Anesthesiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal HospitalSuzhou 215002, Jiangsu, China
| | - Wenyong Peng
- Department of Anesthesiology, Jinhua Municipal Central Hospital, Jinhua Hospital, Zhejiang University School of MedicineJinhua 321000, Zhejiang, China
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Winters KD, Byrne J, Eckholm N, Atayee RS, Furnish T. Palliation of Intractable Cancer-Related Pain With Low-Dose Epidural Bupivacaine. J Palliat Med 2024; 27:434-437. [PMID: 37610860 DOI: 10.1089/jpm.2023.0156] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Introduction: Patients with advanced cancer nearing end of life often present with complex multifactorial pain. Although epidural analgesia is routinely used in inpatient hospital settings for targeted pain control, there is scant description in the literature of the use of low-dose epidural analgesia for relief of cancer-related pain at end of life. In this study, we present a case of difficult to control cancer-related rectal and pelvic pain in a patient who responded well in her last days of life to a low-dose bupivacaine epidural. Case Description: A 66-year-old woman presented for inpatient hospital admission for pain control from home hospice with intractable cancer-related pain from metastatic colorectal adenocarcinoma marked by extensive erosive lesions extending from the anterior perineum to the posterior rectum, with rectovaginal fistula. The patient reported poor tolerance of medications and described spiritual beliefs (based in Buddhism) that caused her and her family to prioritize maintaining a lucid, clear mind above nearly all else while seeking symptom management. The patient was so debilitated by pain at the time of presentation that she was bedbound in a quadruped position. Case Management and Outcome: After 2 weeks of poor pain control in the hospital with multiple failed attempts at palliation-including bilateral pudendal block, as well as opioids and other routine, but potentially sedating or deliriogenic, medications to treat her pain-the patient permitted administration of a low-dose bupivacaine epidural that significantly reduced her pain and allowed the patient to remain clear-headed up until the time of her death. Twenty-three days after admission, and 5 days after initiation of low-dose bupivacaine epidural for pain control, the patient died peacefully in the hospital. Conclusion: Low-dose epidural analgesia for cancer-related pain at end of life from malignancy involving the pelvis-perineum, rectum, or vagina-may be a viable option for patients, particularly those who wish to avoid the risk of somnolence or confusion from systemic opioids and other analgesics.
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Affiliation(s)
- Kathryn D Winters
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Jennifer Byrne
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
| | - Natasha Eckholm
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
| | - Rabia S Atayee
- Department of Medicine, University of California San Diego Palliative Care Program, San Diego, California, USA
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, UC San Diego Section of Palliative Care, La Jolla, California, USA
- University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, USA
- Department of Pharmacy, University of California Health, La Jolla, California, USA
| | - Timothy Furnish
- Department of Anesthesiology, UC San Diego Health, San Diego, California, USA
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Yaxley J, Wilkinson C, Davidson-West S, Mantha M. Clavicular hook: Cuffed haemodialysis catheter insertion using a paramedian tunnel in patients with recurrent tip migration. J Vasc Access 2024; 25:669-672. [PMID: 36401348 DOI: 10.1177/11297298221138334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Tunnelled, cuffed central venous catheters are commonly used for the provision of haemodialysis. Internal jugular vein catheters are generally tunnelled subcutaneously to the anterolateral chest wall. However, the lateral subcutaneous tract may increase the risk of catheter migration, particularly in the setting of obesity or large breast tissue. Catheter tip migration is an important cause of catheter failure. We describe two cases in which a paramedian tunnel was fashioned in patients experiencing recurrent catheter migration.
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Affiliation(s)
- Julian Yaxley
- Department of Nephrology, Cairns Hospital, Cairns, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | | | | | - Murty Mantha
- Department of Nephrology, Cairns Hospital, Cairns, QLD, Australia
- School of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
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Lee D, Carrera EJ, Hagens R, Yeung G, Garvan CW, Rothman MS, Akuthota V. Serum cortisol level to screen for significant hypothalamic-pituitary-adrenal axis suppression in patients receiving multiple steroid injections. Pain Med 2024; 25:97-103. [PMID: 37819765 DOI: 10.1093/pm/pnad138] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 09/02/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Morning serum cortisol level (mSCL) is a practical screening tool for hypothalamic-pituitary-adrenal (HPA) axis suppression and has been used to assess for duration of cortisol deficiency after epidural and peripheral glucocorticoid injections. More evidence is needed to establish the utility of mSCL in patients undergoing repeat injections with increasing cumulative glucocorticoid equivalent dose (CGED) that could place them at higher risk of HPA axis suppression. OBJECTIVES To estimate the prevalence of spine injection candidates with significant HPA axis suppression (sigAS), to understand the correlation between 12 months of CGED and the presence of sigAS based on the timing of mSCL collection after the most recent glucocorticoid injection (within 6 weeks or between 6 weeks and 12 months), and to investigate demographic and clinical factors relating to sigAS. METHODS Retrospective chart review of patients scheduled for spine injection who had an associated mSCL and documented histories of prior glucocorticoid injections. The steroid name, dose, type, and procedure location were recorded for each injection that occurred within 12 months before mSCL. CGED was calculated from standard glucocorticoid equivalent conversion factors. RESULTS SigAS was present in 7.8% to 22% of the analysis cohorts. There was no association found between CGED and sigAS regardless of timing of mSCL. There was a trend toward lower mSCL and sigAS with increasing CGED. There were no significant relationships found between sigAS and overall demographic or clinical factors. CONCLUSIONS A 3-fold reduction in the rate of sigAS was noted 6 weeks after the most recent steroid injection. Using mSCL provides a template to investigate the impact of CGED and the best timing for mSCL collection in order to define a more practical guideline to identify patients at higher risk of sigAS earlier and plan for future spine injections.
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Affiliation(s)
- Debbie Lee
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Eduardo J Carrera
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Ryan Hagens
- Department of Physical Medicine and Rehabilitation, UCLA David Geffen School of Medicine/UCLA Medical Center/VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
| | - Gerald Yeung
- Department of Orthopedics Division of Physical Medicine and Rehabilitation, Stanford University, Redwood City, CA 94063, United States
| | - Cynthia W Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Micol S Rothman
- Department of Medicine-Endocrinology/Metabolism/Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Venu Akuthota
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
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Bahl A, Mielke N, DiLoreto E, Gibson SM. Operation STICK: A vascular access specialty program for the generalist emergency medicine clinician. J Vasc Access 2024:11297298231222060. [PMID: 38214160 DOI: 10.1177/11297298231222060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Comprehensive education and training programs are urgently needed to improve vascular access outcomes in the emergency department (ED). This study aimed to demonstrate the success of a formalized vascular access program in developing competent ED clinicians in traditional and ultrasound-guided insertion methods. METHODS This was a retrospective observational study exploring the success of trainees in obtaining competency in peripheral vascular access at an academic suburban ED with 120,000 annual visits. Eligible participants included healthcare workers that enrolled in the Operation STICK vascular access program and perform vascular access procedures as an aspect of their clinical practice. Competency in vascular access included both traditional and ultrasound-guided (US) peripheral intravenous catheter (PIVC) insertions. Competency was defined as demonstration of successful insertion of one traditional and one US PIVC in compliance with checklist. The primary objective was competency. Secondary objectives included trainee time to competency, trainee number of line encounters, and changes in program competency achievements over time. RESULTS From October 15, 2021, to April 15, 2023, 141 clinicians participated in peripheral vascular access training via the Operation STICK model, which included 72 (51.1%) nurses, 52 (36.9%) ED technicians, and 17 (12.0%) healthcare personnel with other medical training. Clinicians overall reported an average of 5.6 years of experience inserting peripheral intravenous catheters (PIVCs) and 23 (16.3%) had experience with using ultrasound. About 122 (86.5%) clinicians successfully completed the program and demonstrated competency in traditional and ultrasound-guided techniques. Time to competency varied over time, with a median of 124 days in the early phase, 32.5 days middle phase, and 10.6 h over 9.5 days in the later phase of the program (p < 0.001). CONCLUSIONS Achieving competency in PIVC insertion necessitates a focused effort on refining and systematizing education and training approaches. Recognizing the inherent challenges present in ED settings, it is feasible to effectively and efficiently train emergency clinicians to be expert in both basic and advanced PIVC placement techniques through participation in a well-organized vascular access training program.
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Affiliation(s)
- Amit Bahl
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Nicholas Mielke
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Emily DiLoreto
- Department of Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
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Laney D, Ferral H, Fairchild A, Üstünsöz B. Techniques for portal vein targeting during a transjugular intrahepatic portosystemic shunt. Diagn Interv Radiol 2024; 30:42-47. [PMID: 36994881 PMCID: PMC10773176 DOI: 10.4274/dir.2022.221539] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/14/2022] [Indexed: 01/15/2023]
Abstract
A transjugular intrahepatic portosystemic shunt (TIPS) is one of the most challenging procedures in interventional radiology. Hepatic and portal venous anatomy can be highly variable, and access to the portal vein, which can be quite difficult even for experienced surgeons, is the most critical step in a TIPS. Although there are multiple techniques to achieve a portal venous puncture, each access technique carries a unique set of risks and benefits. Thus, knowledge of these assistive techniques will add to the resources available to the surgeon when planning and subsequently performing a TIPS and, ultimately, increase the likelihood of a safe and successful procedure.
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Affiliation(s)
- Dan Laney
- Louisiana State University Health Sciences Center, Department of Radiology, Division of Interventional Radiology, Los Angeles, USA
| | - Hector Ferral
- Louisiana State University Health Sciences Center, Department of Radiology, Division of Interventional Radiology, Los Angeles, USA
| | - Alexandra Fairchild
- Louisiana State University Health Sciences Center, Department of Radiology, Division of Interventional Radiology, Los Angeles, USA
| | - Bahri Üstünsöz
- Louisiana State University Health Sciences Center, Department of Radiology, Division of Interventional Radiology, Los Angeles, USA
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Im H, Oh SY, Lim L, Lee H, Kwon J, Ryu HG. Timing of prophylactic antibiotics administration and suspected systemic infection after percutaneous biliary intervention. J Hepatobiliary Pancreat Sci 2024; 31:34-41. [PMID: 37792597 DOI: 10.1002/jhbp.1366] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND/PURPOSE Prophylactic antibiotics administration before percutaneous biliary intervention (PBI) is currently recommended, but the underlying evidence is mostly extrapolated from prophylactic antibiotics before surgery. The aim of this study was to evaluate the impact of prophylactic antibiotics administration timing on the incidence of suspected systemic infection after PBI. METHODS The incidence of suspected systemic infection after PBI was compared in patients who received prophylactic antibiotics at four different time intervals between antibiotics administration and skin puncture for PBI. Suspected post-intervention systemic infection was assessed according to predetermined clinical criteria. RESULTS There were 98 (21.6%) suspected systemic infections after 454 PBIs in 404 patients. There were significant differences among the four groups in the incidence of suspected systemic infection after the intervention (p = .020). Fever was the most common sign of suspected systemic infection. Administration of prophylactic antibiotics more than an hour before PBI was identified as an independent risk factor of suspected systemic infection after adjusting for other relevant factors (adjusted odds ratio = 10.54; 95% confidence interval, 1.40-78.86). CONCLUSIONS The incidence of suspected systemic infection after the PBI was significantly lower when prophylactic antibiotics were administered within an hour before the intervention.
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Affiliation(s)
- Hyunjae Im
- Department of Critical Care Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Young Oh
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Leerang Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jina Kwon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Geol Ryu
- Department of Critical Care Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Papalexis N, Ponti F, Masi PD, Peta G, Savarese LG, Miceli M, Facchini G, Spinnato P. Transpedicular Contrast-enhanced CT-guided biopsy of the body and dens of the axis avoiding the trans-oral approach: Technical report and literature review. J Craniovertebr Junction Spine 2024; 15:118-122. [PMID: 38644913 PMCID: PMC11029103 DOI: 10.4103/jcvjs.jcvjs_183_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/21/2024] [Indexed: 04/23/2024] Open
Abstract
This technical report illustrates the technique to perform computed tomography (CT)-guided bone biopsies in the body and dens of the axis (C2 vertebra) through a posterior transpedicular approach with the use of preoperative contrast-enhanced scans to highlight the course of the vertebral artery. The technique is presented through two exemplification cases: a pediatric patient with osteoblastoma and secondary aneurysmal bone cyst and one adult patient with melanoma metastasis. This case highlights the potential of the CT-guided posterolateral/transpedicular approach for performing safe and effective biopsies in the body and dens of C2, even in pediatric patients.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paola Di Masi
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Leonor Garbin Savarese
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Velarde-Acosta K, Moscoso Ramirez JY, Rojas P, Baltodano-Arellano R. Acute left anterior descending artery occlusion after IVUS leading to urgent percutaneous coronary intervention complicated with coronary perforation: Case report. JRSM Cardiovasc Dis 2024; 13:20480040241248924. [PMID: 38736704 PMCID: PMC11082483 DOI: 10.1177/20480040241248924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 05/14/2024] Open
Abstract
Background Intravascular ultrasonography (IVUS) has become an important complementary tool in interventional cardiology, both for preprocedural planning and for optimizing the performance of percutaneous coronary intervention (PCI). However, this tool is not free of potential complications, because of that it is essential to be aware of them and their management. Over time, new uses of IVUS have emerged, and it is currently a potential tool for predicting the risk of coronary perforation. Case report We present the clinical case of a 51-year-old male patient who was admitted in the context of post-infarction angina. During coronary angiography, the patient presented with two acute complications, one of them associated with IVUS and the other associated with severe coronary calcification that predisposed to coronary perforation. Both complications were successfully treated. Conclusion IVUS, although a very useful imaging tool before and during PCI, is not without risk. The overall rate of complications with certain or possible relation to IVUS is 3.9%. Vascular spasm is the most frequent complication and acute vascular occlusion, with the need for emergency coronary artery by-pass grafting, the least frequent. On the other hand, IVUS can predict the risk of developing other complications, such as coronary perforation, by means of the C-CAT sign. Knowledge of the possible complications during PCI and the rapid procedure of the hemodynamic team allows adequate management of these potentially fatal complications.
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Affiliation(s)
- Kevin Velarde-Acosta
- Clinical Cardiology Department, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
| | | | - Paol Rojas
- Clinical Cardiology Department, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
- Interventional Cardiology Department, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| | - Roberto Baltodano-Arellano
- School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
- Cardiac Imaging Area of Cardiology Department, Hospital Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
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Jaubert O, Montalt‐Tordera J, Knight D, Arridge S, Steeden J, Muthurangu V. HyperSLICE: HyperBand optimized spiral for low-latency interactive cardiac examination. Magn Reson Med 2024; 91:266-279. [PMID: 37799087 PMCID: PMC10953456 DOI: 10.1002/mrm.29855] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Interactive cardiac MRI is used for fast scan planning and MR-guided interventions. However, the requirement for real-time acquisition and near-real-time visualization constrains the achievable spatio-temporal resolution. This study aims to improve interactive imaging resolution through optimization of undersampled spiral sampling and leveraging of deep learning for low-latency reconstruction (deep artifact suppression). METHODS A variable density spiral trajectory was parametrized and optimized via HyperBand to provide the best candidate trajectory for rapid deep artifact suppression. Training data consisted of 692 breath-held CINEs. The developed interactive sequence was tested in simulations and prospectively in 13 subjects (10 for image evaluation, 2 during catheterization, 1 during exercise). In the prospective study, the optimized framework-HyperSLICE- was compared with conventional Cartesian real-time and breath-hold CINE imaging in terms quantitative and qualitative image metrics. Statistical differences were tested using Friedman chi-squared tests with post hoc Nemenyi test (p < 0.05). RESULTS In simulations the normalized RMS error, peak SNR, structural similarity, and Laplacian energy were all statistically significantly higher using optimized spiral compared to radial and uniform spiral sampling, particularly after scan plan changes (structural similarity: 0.71 vs. 0.45 and 0.43). Prospectively, HyperSLICE enabled a higher spatial and temporal resolution than conventional Cartesian real-time imaging. The pipeline was demonstrated in patients during catheter pull back, showing sufficiently fast reconstruction for interactive imaging. CONCLUSION HyperSLICE enables high spatial and temporal resolution interactive imaging. Optimizing the spiral sampling enabled better overall image quality and superior handling of image transitions compared with radial and uniform spiral trajectories.
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Affiliation(s)
- Olivier Jaubert
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | | | - Daniel Knight
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
- Department of CardiologyRoyal Free London NHS Foundation TrustLondonUK
| | - Simon Arridge
- Department of Computer ScienceUniversity College LondonLondonUK
| | - Jennifer Steeden
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
| | - Vivek Muthurangu
- UCL Center for Translational Cardiovascular ImagingUniversity College LondonLondonUK
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Lee AJ, Campbell T, Ceraolo CA, Saxton A, Quarrier SO, Bandari J. The Changing Roles of Urologists, Radiologists, and Advanced Practice Providers in Uroradiology Procedures. Urol Pract 2024; 11:228-235. [PMID: 37903750 DOI: 10.1097/upj.0000000000000482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/13/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION Urology has seen shifts in the management of many urologic conditions with the advent of noninvasive procedures that rely on multidisciplinary radiological modalities. This study seeks to analyze changes in urologists, radiologists, and advanced practice providers (APPs) performing uroradiology procedures over time. METHODS The Centers for Medicare & Medicaid Services Physician/Procedure Summary data from 2010 to 2021 were utilized to examine uroradiology Current Procedural Terminology codes billed by urologists, radiologists, and APPs. Percent of total reimbursement and higher volume procedure count (after excluding providers with <11 procedures by per year) by each provider field was calculated and analyzed for changes in distribution from 2010 to 2021. RESULTS There were significant changes in all procedures when examining procedure reimbursement distribution in 2010 to 2021 (P < .001). During the period, urology saw decreases in reimbursement proportion as large as 28.7% for kidney cryoablation and increases as large as 14.2% for nephrostomy tube removals. Radiology saw the largest decreases in reimbursement proportion with an 18.9% decrease for nephrostograms, while the largest increase was 23.6% for suprapubic tube placements. APPs saw the largest increase in suprapubic tube changes reimbursement proportion, which rose 14.2% from 2010 to 2021. There were significant changes in proportion in all procedures, except for antegrade stent, renal cryoablation, renal biopsy, and renal thermoablation. CONCLUSIONS Uroradiology procedures have seen shifts in the distribution of which provider type performs each procedure. Most large changes in reimbursement and procedure proportion were shifted between urology and radiology, with APPs seeing smaller changes.
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Affiliation(s)
- Austin J Lee
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Timothy Campbell
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Carl A Ceraolo
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Aaron Saxton
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Jathin Bandari
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Carrasco M, Cabrito TMS, Montalbano MJ, Hołda MK, Walocha J, Tubbs RS, Loukas M. Cardiac ventricular false tendons: A meta-analysis. Clin Anat 2024; 37:114-129. [PMID: 37819143 DOI: 10.1002/ca.24116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023]
Abstract
Ventricular false tendons are fibromuscular structures that travel across the ventricular cavity. Left ventricular false tendons (LVFTs) have been examined through gross dissection and echocardiography. This study aimed to comprehensively evaluate the prevalence, morphology, and clinical importance of ventricular false tendons using a systematic review. In multiple studies, these structures have had a wide reported prevalence ranging from less than 1% to 100% of cases. This meta-analysis found the overall pooled prevalence of LVFTs to be 30.2%. Subgroup analysis indicated the prevalence to be 55.1% in cadaveric studies and 24.5% in living patients predominantly studied by echocardiography. Morphologically, left and right ventricular false tendons have been classified into several types based on their location and attachments. Studies have demonstrated false tendons have important clinical implications involving innocent murmurs, premature ventricular contractions, early repolarization, and impairment of systolic and diastolic function. Despite these potential complications, there is evidence demonstrating that the presence of false tendons can lead to positive clinical outcomes.
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Affiliation(s)
- Mark Carrasco
- Department of Family Medicine, HealthQuest, Rhinebeck, New York, USA
| | | | | | - Mateusz K Hołda
- HEART-Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - R Shane Tubbs
- Department of Anatomical Sciences, St. George's University, West Indies
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, West Indies
- Department of Anatomy, University of Warmia and Mazury, Olsztyn, Poland
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Zhuang M, Lin Y, Wu S, Lu M, Jiang Z, Wei T, Wang L, Wang S, Zou J, He Y. Ultrasound-guided percutaneous thermal ablation of parotid tumors: experience from two-centers. Int J Hyperthermia 2023; 41:2290924. [PMID: 38159559 DOI: 10.1080/02656736.2023.2290924] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Objective: To evaluate the efficacy and feasibility of ultrasound-guided percutaneous thermal ablation (TA) for treating benign parotid tumors.Methods: Patients with benign parotid tumors who underwent ultrasound-guided microwave ablation (MWA) or radiofrequency ablation (RFA) between January 2020 and March 2023 were included in this retrospective study. Change in tumor size (maximum diameter, tumor volume(V), volume reduction rate (VRR)) and cosmetic score (CS) were evaluated during a one-year follow-up period. We also recorded the incidence of any complications associated with TA.Results: A total of 23 patients (13 males and 10 females; median age 65 years, range 5-91 years) were included. The mean VRR at 1, 3, 6, and 12 months after TA was 37.03%±10.23%, 56.52%±8.76%, 82.28%±7.89%, and 89.39%±6.45%, respectively. Mean CS also changed from 3.39 ± 0.66 to 1.75 ± 0.93 (p < 0.001) by the end of follow-up time. Subgroup analysis showed that tumors with smaller initial maximum diameter had a faster CS reduction rate than those with larger initial diameter. The incidence of facial nerve dysfunction was 8.70%.Conclusion: Ultrasound-guided percutaneous TA is an effective and safe treatment option for patients with benign parotid tumors.
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Affiliation(s)
- Min Zhuang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yucheng Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou No. 1 Hospital Affiliated with Fujian Medical University, Fuzhou, China
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Man Lu
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Zirui Jiang
- School of Health Science of Purdue University, West Lafayette, IN, USA
| | - Ting Wei
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Lu Wang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Shishi Wang
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Zou
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Yi He
- Ultrasonography Department, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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15
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Mull HJ, Foster MV, Higgins MCSS, Sturgeon DJ, Hederstedt K, Bart N, Lamkin RP, Sullivan BA, Ayeni C, Branch-Elliman W, Malloy PC. Development and Validation of an Electronic Adverse Event Model for Patient Safety Surveillance in Interventional Radiology. J Am Coll Radiol 2023:S1546-1440(23)01041-4. [PMID: 38157954 DOI: 10.1016/j.jacr.2023.12.022] [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: 09/13/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Comprehensive adverse event (AE) surveillance programs in interventional radiology (IR) are rare. Our aim was to develop and validate a retrospective electronic surveillance model to identify outpatient IR procedures that are likely to have an AE, to support patient safety and quality improvement. METHODS We identified outpatient IR procedures performed in the period from October 2017 to September 2019 from the Veterans Health Administration (n = 135,283) and applied electronic triggers based on posyprocedure care to flag cases with a potential AE. From the trigger-flagged cases, we randomly sampled n = 1,500 for chart review to identify AEs. We also randomly sampled n = 600 from the unflagged cases. Chart-reviewed cases were merged with patient, procedure, and facility factors to estimate a mixed-effects logistic regression model designed to predict whether an AE occurred. Using model fit and criterion validity, we determined the best predicted probability threshold to identify cases with a likely AE. We reviewed a random sample of 200 cases above the threshold and 100 cases from below the threshold from October 2019 to March 2020 (n = 20,849) for model validation. RESULTS In our development sample of mostly trigger-flagged cases, 444 of 2,096 cases (21.8%) had an AE. The optimal predicted probability threshold for a likely AE from our surveillance model was >50%, with positive predictive value of 68.9%, sensitivity of 38.3%, and specificity of 95.3%. In validation, chart-reviewed cases with AE probability >50% had a positive predictive value of 63% (n = 203). For the period from October 2017 to March 2020, the model identified approximately 70 IR cases per month that were likely to have an AE. CONCLUSIONS This electronic trigger-based approach to AE surveillance could be used for patient-safety reporting and quality review.
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Affiliation(s)
- Hillary J Mull
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Marva V Foster
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; VA Boston Healthcare System, Department of Quality Management, Boston, Massachusetts
| | | | - Daniel J Sturgeon
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Kierstin Hederstedt
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Nina Bart
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Rebecca P Lamkin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts
| | - Brian A Sullivan
- Duke University School of Medicine, Department of Gastroenterology, Durham, North Carolina; Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Christopher Ayeni
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Westyn Branch-Elliman
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, Massachusetts; VA Boston Healthcare System, Department of Medicine, Section of Infectious Diseases, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Patrick C Malloy
- Director of the VHA National Radiology Program, VA New York Harbor Healthcare System, New York, New York
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Coppola A, Grasso D, Fontana F, Piacentino F, Minici R, Laganà D, Ierardi AM, Carrafiello G, D’Angelo F, Carcano G, Venturini M. Innovative Experimental Ultrasound and US-Related Techniques Using the Murine Model in Pancreatic Ductal Adenocarcinoma: A Systematic Review. J Clin Med 2023; 12:7677. [PMID: 38137745 PMCID: PMC10743777 DOI: 10.3390/jcm12247677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/24/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a cancer with one of the highest mortality rates in the world. Several studies have been conductedusing preclinical experiments in mice to find new therapeutic strategies. Experimental ultrasound, in expert hands, is a safe, multifaceted, and relatively not-expensive device that helps researchers in several ways. In this systematic review, we propose a summary of the applications of ultrasonography in a preclinical mouse model of PDAC. Eighty-eight studies met our inclusion criteria. The included studies could be divided into seven main topics: ultrasound in pancreatic cancer diagnosis and progression (n: 21); dynamic contrast-enhanced ultrasound (DCE-US) (n: 5); microbubble ultra-sound-mediated drug delivery; focused ultrasound (n: 23); sonodynamic therapy (SDT) (n: 7); harmonic motion elastography (HME) and shear wave elastography (SWE) (n: 6); ultrasound-guided procedures (n: 9). In six cases, the articles fit into two or more sections. In conclusion, ultrasound can be a really useful, eclectic, and ductile tool in different diagnostic areas, not only regarding diagnosis but also in therapy, pharmacological and interventional treatment, and follow-up. All these multiple possibilities of use certainly represent a good starting point for the effective and wide use of murine ultrasonography in the study and comprehensive evaluation of pancreatic cancer.
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Affiliation(s)
- Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Dario Grasso
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
| | - Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.)
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.)
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
| | - Anna Maria Ierardi
- Radiology Unit, IRCCS Ca Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Fabio D’Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy;
- Orthopedic Surgery Unit, ASST Sette Laghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
- Emergency and Transplant Surgery Department, ASST Sette Laghi, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy
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17
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Sescleifer AM, Crane A, Teeter W, Scalea T, Twaddell WS, Alvarez-Casas J, Bhati C, Lominadze Z, Malik S, Maluf D, Meier RPH. A Case Report of Rescue of Primary Nonfunction following Liver Transplant Using the Molecular Adsorbent Recirculating System (MARS). Prog Transplant 2023; 33:358-359. [PMID: 37941345 DOI: 10.1177/15269248231212917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Anne M Sescleifer
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alice Crane
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Teeter
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Thomas Scalea
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William S Twaddell
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Josue Alvarez-Casas
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Chandra Bhati
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Zurabi Lominadze
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Saad Malik
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel Maluf
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Raphael P H Meier
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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Duong V, Tacey M, Shum E, Hannan L, See K, Muruganandan S. Early outcomes following the implementation of a specialised pleural disease service. Intern Med J 2023; 53:2270-2276. [PMID: 37070808 DOI: 10.1111/imj.16077] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/15/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Pleural effusion is a common cause of hospitalisation and a poor prognostic marker that is associated with morbidity and mortality. The evaluation and management of pleural effusion may be performed more effectively by a specialised pleural disease service (SPDS). AIMS To evaluate the impact of a SPDS established in 2017 at a 400-bed metropolitan hospital in Victoria, Australia. METHODS A retrospective observational study was undertaken comparing outcomes of individuals with pleural effusions. People with pleural effusion were identified using administrative data. Two 12-month time periods were compared, 2016 (Period 1, before SPDS) and 2018 (Period 2, after SPDS). RESULTS Period 1 had n = 76 and Period 2 had n = 96 individuals with pleural effusion receiving intervention. Age (69.8 ± 17.6 vs 71.8 ± 15.8), gender and Charlson Comorbidity Index (4.9 ± 2.8 vs 5.4 ± 3.0) were similar across both periods. Utilisation of point-of-care ultrasound for pleural procedures increased from Period 1 to 2, 57.3-85.7% (P < 0.001). There was a reduction in median days from admission to intervention (3.8-2.1 days, P = 0.048) and pleural-related re-intervention rate (32% vs 19%, P = 0.032). Pleural fluid testing was more consistent with recommendations (16.8% vs 43.2%, P < 0.001). Overall, there was no difference in the median length of stay (7.9 vs 6.4 days, P = 0.23), pleural-related readmissions (11% vs 16%, P = 0.69) or mortality (17.1% vs 15.6%, P = 0.79). Procedural complications were similar between the two periods. CONCLUSIONS The introduction of a SPDS was associated with increased point-of-care ultrasound utilisation for pleural procedures, shorter delays to intervention and improved standardisation of tests on pleural fluid.
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Affiliation(s)
- Victor Duong
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
| | - Mark Tacey
- Northern Health, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Evonne Shum
- Northern Health, Melbourne, Victoria, Australia
- Austin Health, Melbourne, Victoria, Australia
| | - Liam Hannan
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia
| | - Katharine See
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sanjeevan Muruganandan
- Department of Respiratory Medicine, Northern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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Lim JS, Jung GS, Oh KS, Seo KW, Jung K, Yun JH. Percutaneous radiologic gastrostomy with single gastropexy using balloon-assisted tract dilatation: comparison with peel-away sheath. Diagn Interv Radiol 2023; 29:813-818. [PMID: 37650523 PMCID: PMC10679556 DOI: 10.4274/dir.2023.232342] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/27/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous radiologic gastrostomy (PRG) with balloon-assisted tract dilatation (BATD) using a single gastropexy. METHODS This retrospective study was approved by the institutional review board. From August 2018 to October 2022, 61 patients (53 male and 8 female, mean age 67 years, age range 27-90 years) underwent PRG with balloon-retained tubes for enteral nutrition. Single gastropexy was performed in all cases. Patients were divided into two groups based on the tract dilatation technique used. In the first group, BATD (n = 48) was performed. In the second group, a 24-Fr peel-away sheath (PAS) was used for tract dilatation (n = 13). Patient demographics, technical success rate, clinical success rate, fluoroscopy time, cumulative radiation dose, and complications were retrospectively evaluated. The Mann-Whitney U test for continuous variables and Fisher's exact test for categorical variables were performed to compare the two groups. RESULTS All procedures were successfully performed with 100% technical and clinical success rates in both groups. The mean fluoroscopy time for the BATD group vs. the PAS group (1.68 ± 0.93 min vs. 3.56 ± 2.41 min, P < 0.001) and mean cumulative radiation dose (12.98 ± 9.28 mGy vs. 33.01 ± 15.14 mGy, P < 0.001) were significantly lower in the BATD group compared with the PAS group. There was one major complication of peritonitis that led to death in the PAS group (1/13, 7.7%) and no major complications in the BATD group. Minor complications such as pneumoperitoneum, abdominal pain, leakage, and balloon deflation occurred in 16 patients: 12 (12/48, 25.0%) patients in the BATD group and 4 (4/13, 38.5%) patients in the PAS group. The overall rate of major and minor complications was higher in the PAS group but did not show statistically significant differences (odds ratio: 1.875, 95%; confidence interval: 0.514-6.841, P = 0.486). CONCLUSION BATD using a single gastropexy is a safe and effective technique for PRG.
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Affiliation(s)
- Ji Su Lim
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Gyoo Sik Jung
- Department of Radiology, Ulsan Hospital, Ulsan, Korea
| | - Kyung Seung Oh
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Kyoungwon Jung
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Jong Hyouk Yun
- Department of Radiology, Kosin University Gospel Hospital, Busan, Korea
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De Nordenflycht D, Ayala A, Orellana L, Tesch RDS. Intra-articular injections in the TMJ inferior joint space: A scoping review. J Oral Rehabil 2023; 50:1316-1329. [PMID: 37323068 DOI: 10.1111/joor.13542] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To perform a scoping review to identify the available evidence regarding intra-articular injections in the inferior joint space (IJS) of the temporomandibular joint (TMJ). METHODS An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: "Arthrocentesis", "injection", "joint injection", "technique", "Temporomandibular joint", "Temporomandibular joint disorder". Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. Only articles with full-text access were included. RESULTS Thirteen articles were included for analysis-one technical note, three cadavers studies, one animal study, two case reports, five randomised clinical trials and one retrospective study; studies were classified as 'patients-based studies' and 'non-patients-based studies'. Most 'patients-based studies' show moderate or high risk of bias. Techniques were categorised as 'anatomical technique' and 'image-guided technique'. Most 'patients-based studies' show favourable outcomes such as pain reduction, increase in maximum mouth opening, improvement in quality of life and improvement in TMJ dysfunction indexes for the treatment of arthrogenic TMDs. Comparisons between superior and IJS injections are scarce. On the other hand, 'non-patients-based' studies show that image-guided or ultrasound-checked injection techniques achieved a higher effectiveness for needle location than anatomical (or blind) techniques. CONCLUSION The amount of available evidence is scarce, heterogeneous in design, and most 'patients-based studies' show moderate or high risk of bias, which demands the generation of new research to obtain definitive conclusions. The tendency observed suggests that intra-articular injections for the IJS of the TMJ are able to relieve TMJ pain, increase mouth opening and improve TMJ dysfunction, and image-guided injection techniques seem to be more effective than anatomical techniques to locate the needle in the IJS.
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21
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Kose HC, Akkaya OT. Predictive Factors Associated with Successful Response to Percutaneous Adhesiolysis in Chronic Lumbar Radicular Pain. J Clin Med 2023; 12:6337. [PMID: 37834981 PMCID: PMC10573688 DOI: 10.3390/jcm12196337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Percutaneous adhesiolysis (PEA) is of interest in the treatment of lumbar radicular pain. This study aimed to assess the effectiveness of PEA in patients with chronic lumbar radicular pain refractory to epidural steroid injections and to determine predictive factors, including demographic, clinical, and procedural data, to provide superior treatment efficacy. One hundred and ninety-three patients were reviewed. Successful treatment outcome was described as a 50% reduction in the visual analog scale score. Among the 193 patients, 109 (56.2%) exhibited a positive treatment response at 12 months. In multivariate logistic regression analysis, no depression (OR, 3.105; 95% CI, 1.127-8.547; p = 0.028), no spondylolisthesis (OR, 2.976; 95% CI, 1.246-7.092; p = 0.014), no previous lumbar surgery (OR, 2.242; 95% CI, 1.067-4.716; p = 0.033), mild foraminal stenosis (OR, 3.460; 95% CI, 1.436-8.333; p = 0.006), no opioid use (OR, 1.782; 95% CI, 0.854-3.717; p = 0.123), and baseline pain scores (OR, 0.787; 95% CI, 0.583-1.064; p = 0.120) were the predictive factors significantly associated with unsuccessful treatment outcome. PEA is a useful treatment option for patients with chronic lumbar radicular pain refractory to epidural steroid injections. A history of lumbar surgery, spondylolisthesis, depression, and severe foraminal stenosis could be associated with a poor prognosis.
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Affiliation(s)
- Halil Cihan Kose
- Department of Pain Medicine, Kocaeli City Hospital, 41060 Kocaeli, Turkey
| | - Omer Taylan Akkaya
- Department of Pain Medicine, Health Science University Etlik City Hospital, 06120 Ankara, Turkey;
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22
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Mooiweer R, Rogers C, Vidya Shankar R, Razavi R, Neji R, Roujol S. Feasibility of cardiac MR thermometry at 0.55 T. Front Cardiovasc Med 2023; 10:1233065. [PMID: 37859681 PMCID: PMC10584305 DOI: 10.3389/fcvm.2023.1233065] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
Radiofrequency catheter ablation is an established treatment strategy for ventricular tachycardia, but remains associated with a low success rate. MR guidance of ventricular tachycardia shows promises to improve the success rate of these procedures, especially due to its potential to provide real-time information on lesion formation using cardiac MR thermometry. Modern low field MRI scanners (<1 T) are of major interest for MR-guided ablations as the potential benefits include lower costs, increased patient access and device compatibility through reduced device-induced imaging artefacts and safety constraints. However, the feasibility of cardiac MR thermometry at low field remains unknown. In this study, we demonstrate the feasibility of cardiac MR thermometry at 0.55 T and characterized its in vivo stability (i.e., precision) using state-of-the-art techniques based on the proton resonance frequency shift method. Nine healthy volunteers were scanned using a cardiac MR thermometry protocol based on single-shot EPI imaging (3 slices in the left ventricle, 150 dynamics, TE = 41 ms). The reconstruction pipeline included image registration to align all the images, multi-baseline approach (look-up-table length = 30) to correct for respiration-induced phase variations, and temporal filtering to reduce noise in temperature maps. The stability of thermometry was defined as the pixel-wise standard deviation of temperature changes over time. Cardiac MR thermometry was successfully acquired in all subjects and the stability averaged across all subjects was 1.8 ± 1.0°C. Without multi-baseline correction, the overall stability was 2.8 ± 1.6°C. In conclusion, cardiac MR thermometry is feasible at 0.55 T and further studies on MR-guided catheter ablations at low field are warranted.
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Affiliation(s)
- Ronald Mooiweer
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Charlotte Rogers
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Rohini Vidya Shankar
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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23
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Machado M, Dionísio T, Rocha D, Campos M, Sousa P. Placenta Accreta: A Case Report on the Role of Interventional Radiology. Cureus 2023; 15:e47680. [PMID: 38022115 PMCID: PMC10673647 DOI: 10.7759/cureus.47680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Placenta accreta spectrum disorder is a pregnancy-related disorder responsible for important post-partum morbimortality, associated with intractable or massive hemorrhage, leading to uterine loss in up to 64% of women. Despite international recommendations advocating planned preterm cesarean hysterectomy for the management of these patients, uterus preservation management is being continuously reported with the implementation of minimally invasive bleeding reduction strategies, such as prophylactic balloon-assisted occlusion. We present the case of a 40-year-old pregnant woman with a previous cesarean, diagnosed with placenta previa and suspected placenta accreta on magnetic resonance after having second-trimester vaginal bleeding. A peri-operative multidisciplinary panel was involved, in collaboration with the interventional radiologist, and the c-section was scheduled for 36 weeks of gestation. The prophylactic balloon-assisted occlusion was successfully performed, minimizing the blood loss and allowing a uterus-preserving approach.
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Affiliation(s)
- Mafalda Machado
- Radiology, Centro Hospitalar Universitário do Algarve, Faro, PRT
| | - Teresa Dionísio
- Radiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
| | - Diogo Rocha
- Radiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
| | - Marta Campos
- Obstetrics and Gynaecology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
| | - Pedro Sousa
- Radiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia, PRT
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24
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Arıbal E. Future of Breast Radiology. Eur J Breast Health 2023; 19:262-266. [PMID: 37795010 PMCID: PMC10546805 DOI: 10.4274/ejbh.galenos.2023.2023-8-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023]
Abstract
The landscape of breast imaging has transformed significantly since mammography's introduction in the 1960s, accelerated by ultrasound and imageguided biopsies in the 1990s. The emergence of magnetic resonance imaging (MRI) in the 2000s added a valuable dimension to advanced imaging. Multimodality and multiparametric imaging have firmly established breast radiology's pivotal role in managing breast disorders. A shift from conventional to digital radiology emerged in the late 20th and early 21st centuries, enabling advanced techniques like digital breast tomosynthesis, contrast-enhanced mammography, and artificial intelligence (AI) integration. AI's impending integration into breast radiology may enhance diagnostics and workflows. It involves computer-aided diagnosis (CAD) algorithms, workflow support algorithms, and data processing algorithms. CAD systems, developed since the 1980s, optimize cancer detection rates by addressing false positives and negatives. Radiologists' roles will evolve into specialized clinicians collaborating with AI for efficient patient care and utilizing advanced techniques with multiparametric imaging and radiomics. Wearable technologies, non-contrast MRI, and innovative modalities like photoacoustic imaging show potential to enhance diagnostics. Imaging-guided therapy, notably cryotherapy, and theranostics, gains traction. Theranostics, integrating therapy and diagnostics, holds potential for precise treatment. Advanced imaging, AI, and novel therapies will revolutionize breast radiology, offering refined diagnostics and personalized treatments. Personalized screening, AI's role, and imaging-guided therapies will shape the future of breast radiology.
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Affiliation(s)
- Erkin Arıbal
- Acıbadem University Faculty of Medicine, Department of Radiology, İstanbul, Turkey
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25
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Cheema S, Anderson J, Angus-Leppan H, Armstrong P, Butteriss D, Carlton Jones L, Choi D, Chotai A, D'Antona L, Davagnanam I, Davies B, Dorman PJ, Duncan C, Ellis S, Iodice V, Joy C, Lagrata S, Mead S, Morland D, Nissen J, Pople J, Redfern N, Sayal PP, Scoffings D, Secker R, Toma AK, Trevarthen T, Walkden J, Beck J, Kranz PG, Schievink W, Wang SJ, Matharu MS. Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2023; 94:835-843. [PMID: 37147116 PMCID: PMC10511987 DOI: 10.1136/jnnp-2023-331166] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG). METHODS A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus. The SIG then developed guideline statements for a series of question topics using a modified Delphi process. This process was supported by a systematic literature review, surveys of patients and healthcare professionals and review by several international experts on SIH. RESULTS SIH and its differential diagnoses should be considered in any patient presenting with orthostatic headache. First-line imaging should be MRI of the brain with contrast and the whole spine. First-line treatment is non-targeted epidural blood patch (EBP), which should be performed as early as possible. We provide criteria for performing myelography depending on the spine MRI result and response to EBP, and we outline principles of treatments. Recommendations for conservative management, symptomatic treatment of headache and management of complications of SIH are also provided. CONCLUSIONS This multidisciplinary consensus clinical guideline has the potential to increase awareness of SIH among healthcare professionals, produce greater consistency in care, improve diagnostic accuracy, promote effective investigations and treatments and reduce disability attributable to SIH.
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Affiliation(s)
- Sanjay Cheema
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jane Anderson
- Neurology Department, Addenbrooke's Hospital, Cambridge, UK
| | | | - Paul Armstrong
- Neuroradiology Department, Institute of Neurological Sciences, Glasgow, UK
| | - David Butteriss
- Department of Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Lalani Carlton Jones
- Neuroradiology Department, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Neuroradiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - David Choi
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Amar Chotai
- Department of Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Linda D'Antona
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Indran Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Brendan Davies
- Neurology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Paul J Dorman
- Department of Neurology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Simon Ellis
- Neurology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Valeria Iodice
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Autonomic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Clare Joy
- CSF Leak Association, Strathpeffer, UK
| | - Susie Lagrata
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
| | | | - Danny Morland
- Department of Anaesthesia, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Justin Nissen
- Neurosurgery Department, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Nancy Redfern
- Department of Anaesthesia, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Parag P Sayal
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Ahmed K Toma
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Jürgen Beck
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Peter George Kranz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Wouter Schievink
- Neurosurgery Department, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Shuu-Jiun Wang
- Neurology Department, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - Manjit Singh Matharu
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
- Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
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26
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Vivanco-Suarez J, Mendez-Ruiz A, Farooqui M, Bekelis K, Singer JA, Javed K, Altschul DJ, Fifi JT, Matsoukas S, Cooper J, Al-Mufti F, Gross B, Jankowitz B, Kan PT, Hafeez M, Orru E, Dajles A, Galecio-Castillo M, Zevallos CB, Wakhloo AK, Ortega-Gutierrez S. Safety and efficacy of the surpass streamline for intracranial aneurysms (SESSIA): A multi-center US experience pooled analysis. Interv Neuroradiol 2023; 29:589-598. [PMID: 35934939 PMCID: PMC10549718 DOI: 10.1177/15910199221118148] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/09/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Flow diversion has established as standard treatment for intracranial aneurysms, the Surpass Streamline is the only FDA-approved braided cobalt/chromium alloy implant with 72-96 wires. We aimed to determine the safety and efficacy of the Surpass in a post-marketing large United States cohort. MATERIALS AND METHODS This is a retrospective multicenter study of consecutive patients treated with the Surpass for intracranial aneurysms between 2018 and 2021. Baseline demographics, comorbidities, and aneurysm characteristics were collected. Efficacy endpoint included aneurysm occlusion on radiographic follow-up. Safety endpoints were major ipsilateral ischemic stroke or treatment-related death. RESULTS A total of 277 patients with 314 aneurysms were included. Median age was 60 years, 202 (73%) patients were females. Hypertension was the most common comorbidity in 156 (56%) patients. The most common location of the aneurysms was the anterior circulation in 89% (279/314). Mean aneurysm dome width was 5.77 ± 4.75 mm, neck width was 4.22 ± 3.83 mm, and dome/neck ratio was 1.63 ± 1.26. Small-sized aneurysms were 185 (59%). Single device was used in 94% of the patients, mean number of devices per patient was 1.06. At final follow-up, complete obliteration rate was 81% (194/239). Major stroke and death were encountered in 7 (3%) and 6 (2%) cases, respectively. CONCLUSION This is the largest cohort study using a 72-96 wire flow diverter. The Surpass Streamline demonstrated a favorable safety and efficacy profile, making it a valuable option for treating not only large but also wide-necked small and medium-sized intracranial aneurysms.
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Affiliation(s)
- Juan Vivanco-Suarez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Alan Mendez-Ruiz
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Mudassir Farooqui
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Kimon Bekelis
- Department of Neurological Surgery, Good Samaritan Hospital Medical Center, West Islip, NY, United States
| | - Justin A Singer
- Department of Neurological Surgery, Spectrum Health, Grand Rapids, MI, United States
| | - Kainaat Javed
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, United States
| | - David J Altschul
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, United States
| | - Johanna T Fifi
- Department of Neurological Surgery, The Mount Sinai Hospital, New York, NY, United States
| | - Stavros Matsoukas
- Department of Neurological Surgery, The Mount Sinai Hospital, New York, NY, United States
| | - Jared Cooper
- Department of Neurology, Neurosurgery & Radiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Fawaz Al-Mufti
- Department of Neurology, Neurosurgery & Radiology, Westchester Medical Center and New York Medical College, Valhalla, NY, United States
| | - Bradley Gross
- Department of Endovascular Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Brian Jankowitz
- Department of Endovascular Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, TX, United States
| | - Muhammad Hafeez
- Department of Neurological Surgery, University of Texas Medical Branch, Galveston, TX, United States
| | - Emanuele Orru
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Andres Dajles
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Milagros Galecio-Castillo
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Cynthia B Zevallos
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Ajay K Wakhloo
- Department of Interventional Neuroradiology, Lahey Hospital & Medical Center, Burlington, MA, United States
| | - Santiago Ortega-Gutierrez
- Department of Neurology, Neurosurgery & Radiology, The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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27
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Schmidt VF, Dietrich O, Seidensticker M, Wildgruber M, Erber B, Ricke J, Goller SS. Artifact characterization of Nitinol needles in magnetic resonance imaging-guided musculoskeletal interventions at 3.0 tesla: a phantom study. Diagn Interv Radiol 2023; 29:719-732. [PMID: 37592882 PMCID: PMC10679549 DOI: 10.4274/dir.2023.232262] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/11/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE To characterize the artifacts of an 18-gauge coaxial nickel-titanium needle using a balanced steady-state free precession sequence in magnetic resonance imaging-guided interventions at 3.0 tesla. METHODS The influence of flip angle (FA), bandwidth, matrix, slice thickness (ST), and read-out direction on needle artifact behavior was investigated for different intervention angles (IA). Artifact diameters were rated at predefined positions. Subgroup differences were assessed using Bonferroni-corrected non-parametric tests and correlations between continuous variables were expressed using the Bravais-Pearson coefficient. Interrater reliability was quantified using intraclass correlation coefficients (ICCs), and a contrast-enhanced target lesion to non-enhanced muscle tissue contrast ratio was quantified. RESULTS The artifact diameters decreased with an increase in FA for all IAs (P < 0.001) and with an increase in ST for IAs of 45°-90° (all P < 0.05). Tip artifacts occurred at low IAs (0°-45°) and gradually increased in size with a decrease in IA (P = 0.022). The interrater reliability was high (ICC: 0.994-0.999). The contrast-enhanced target lesion to non-enhanced muscle tissue contrast ratio presented positive correlations with increasing FAs and matrices (P < 0.001; P = 0.003) and a negative correlation with increasing STs (P = 0.007). CONCLUSION To minimize needle artifacts, it is recommended to use FAs of 40°-60°, a ST of >7 mm, and, if possible, an IA of 45°-60°. The visibility of the target lesion and the needle's artifact behavior must be weighed up against each other when choosing the ST, while higher FAs (40°-60°) and matrices (224 × 224/256 × 256) are associated with low artifacts and sufficient lesion visibility.
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Affiliation(s)
| | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Bernd Erber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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28
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Zhang Q, Li J, He G, Tang J, Zhang G. Utility of intra-procedural cone-beam computed tomography imaging for the determination of the artery of Adamkiewicz suspected by angiography during transarterial embolization for hemoptysis. Diagn Interv Radiol 2023; 29:713-718. [PMID: 36994610 PMCID: PMC10679543 DOI: 10.4274/dir.2022.221646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the role of cone-beam computed tomography (CT) performed for the determination of the artery of Adamkiewicz (AKA) suspected by angiography during trans-catheter bronchial artery embolization for hemoptysis. METHODS In this retrospective study, 17 patients with hemoptysis who underwent cone-beam CT for evaluation of the AKA prior to arterial embolization from December 2014 to March 2022 were included. During the angiographic session, two interventional radiologists selected the possible AKAs that were defined as obscured hairpin-curved vessels arising from the dorsal branch of the intercostal arteries and running towards the midline in the arterially enhanced phase. Contrast-enhanced cone-beam CT was performed as an adjunct to angiography to determine whether the indefinite AKA was a real AKA based on whether it was found to connect to the anterior spinal artery. RESULTS Selective cone-beam CT was performed at 17 possible AKAs detected by selective arteriogram of the intercostal artery (ICA). Cone-beam CT allowed for the determination of AKAs in 16 cases (94.1%). As a result of cone-beam CT findings, 9 of 16 study arteries (56.3%) were judged as definite AKAs, and the remaining 7 (43.7%) were judged as definitely not AKAs but as the musculocutaneous branching from the dorsal branch of the ICA. In 1 of 17 cases (5.9%), cone-beam CT could not determine the AKA because of poor image quality caused by inadequate breath holding. An additional anterior radiculomedullary artery arising from the dorsal branch of the lower ICA because of the inflow of the contrast medium through the anastomosis was detected in one case by conebeam CT but not by angiography. CONCLUSION Intraprocedural enhanced cone-beam CT performed as an adjunctive technique to angiography is sufficient for confident determination of the AKA, which is essential for the operators to perform accurate and safe arterial embolization for hemoptysis.
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Affiliation(s)
- Qingmeng Zhang
- Department of Emergency, Qilu Hospital of Shandong University, Shandong, China
| | - Jijun Li
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Shandong, China
| | - Guanghui He
- Department of Thoracic Surgery Division of Interventional Radiology, WeiFang People’s 2nd Hospital, Shandong, China
| | - Jun Tang
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Shandong, China
| | - Guodong Zhang
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Shandong, China
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29
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Farrell E, B Speaker R, O'Driscoll D, Skinner L. A Case Report of Wire-localised Excision of Impalpable Recurrent Papillary Thyroid Carcinoma and Discussion of Wire-guided Excision in the Head and Neck Pathology. Curr Med Imaging 2023; 20:CMIR-EPUB-133463. [PMID: 37553764 DOI: 10.2174/1573405620666230808161931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 06/14/2023] [Accepted: 07/01/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION/BACKGROUND Wire localisation techniques are used widely for precision surgery in many specialities. This convenient technique has not yet become mainstream in the field of head and neck surgery. With limited space and many vital structures coursing through the head and neck region, pathological nodes that are difficult to palpate can be a challenge for clinicians. CASE PRESENTATION A patient with a history of papillary thyroid cancer treated with surgery and radioactive iodine had a single pathological node detected on ultrasound surveillance. An isolated recurrence of papillary thyroid carcinoma was confirmed. An excisional biopsy was performed using ultrasound wire guidance to successfully remove the diseased node with minimal morbidity. CONCLUSION Wire-guided lymph node excision biopsy is a safe and effective method that can be applied to multiple pathologies. As of yet, it is not routine practice to employ this technique. Larger studies would increase the generalisability and safety profile of this technique in the head and neck region.
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Affiliation(s)
- Eric Farrell
- Specialist Trainee in ORL HNS, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard B Speaker
- Specialist Trainee in ORL HNS, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Liam Skinner
- Department of Otolaryngology, Head & Neck Surgery, University Hospital Waterford, Ireland
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30
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Xu W, Bao X, Jiang F, Chen F, Liu B, Yu F, He P. Factors influencing the prognosis of acute basilar artery occlusion patients treated endovascularly: the impact of treatment time window and preoperative symptoms. Front Neurol 2023; 14:1167442. [PMID: 37545731 PMCID: PMC10400006 DOI: 10.3389/fneur.2023.1167442] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Objective The aim of this study was to examine the factors influencing the prognosis of patients diagnosed with acute basilar artery occlusion (BAO) who receive endovascular treatment. Our particular emphasis was on the predictive implications of the time window for treatment (from symptom onset to femoral artery puncture) and preoperative symptoms for prognosis. Methods A retrospective analysis of data collected from 51 BAO patients who received endovascular treatment at the Neurosurgery Department of Jinhua Central Hospital from April 2018 to October 2021 was undertaken. The data included immediate post-interventional recanalization rates and the 90-day clinical prognoses of the patients. We used the Modified Rankin Scale (mRs) to categorize patients into two prognosis groups: a favorable prognosis group (mRs score ≤2) and an unfavorable prognosis group (mRs score >2). Preoperative symptoms were gauged using the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) scores. A logistic regression analysis was conducted to identify risk factors affecting the prognosis of BAO patients following endovascular treatment. Results The procedure resulted in complete recanalization in all patients (100%). However, four patients (7.8%) passed away during the postoperative hospitalization period. The remaining 47 patients were followed up for 3 months. It was found that 15 patients (31.91%) had a favorable prognosis, while 32 (68.09%) had an unfavorable prognosis. It was generally observed that patients with an unfavorable prognosis had notably higher preoperative GCS and NIHSS scores (p < 0.05). Logistic regression analysis revealed that preoperative symptom severity, as indicated by NIHSS score, and treatment time window were significant prognostic risk factors for patients undergoing endovascular treatment for BAO (p < 0.05). Conclusion Endovascular intervention for BAO appears to be safe and effective, with greater likelihood of a favorable prognosis in patients treated within ≤6 h. The chances of favorable prognosis could potentially be linked to the severity of the patient's preoperative symptoms.
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Junior AR, Volpi EM, Schmid BP, Falsarella PM, Garcia RG. The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules. Diagn Interv Radiol 2023; 29:628-631. [PMID: 36994971 PMCID: PMC10679636 DOI: 10.4274/dir.2022.221467] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/10/2022] [Indexed: 01/15/2023]
Abstract
Diving thyroid nodules are a limitation of radiofrequency ablation because the mediastinal component cannot be adequately identified by ultrasound (US). We aim to describe a new technique, the iceberg technique, to overcome this issue and explain our three-year experience of using this novel method. The iceberg technique consists of a two-stage treatment. First, the ablation of the cervical portion of the nodules (easily visualized during the initial US exam) using trans-isthmic access is performed using the moving-shot technique. After three to six months, there is a volumetric reduction of the treated portion, leading to retraction of the thyroid parenchyma. This brings the mediastinal component to the cervical region, thereby enabling a perfect visualization by US. Then, the second stage of treatment is carried out with complete nodule ablation, and the region that was treated first is looked at a second time. From April 2018 to April 2021, nine patients with nine benign nodules were submitted for the iceberg technique. No complications occurred during the entire follow-up period. The patients displayed normal hormonal levels after the procedures, and there was a significant volume reduction of the nodules until three months post-ablation. The iceberg technique is an effective and safe option for the radiofrequency treatment of diving goiters.
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Affiliation(s)
- Antônio Rahal Junior
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Bruno Pagnin Schmid
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Rodrigo Gobbo Garcia
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Tiralongo F, Giurazza F, Di Pietro S, Lucatelli P, Mosconi C, Contegiacomo A, Vacirca F, Ciaglia S, Cocozza MA, Castiglione DG, Falsaperla D, Ini' C, Zanghì GN, Granata A, Venturini M, Basile A. Spontaneous Abdominal Wall Hematoma Treated with Percutaneous Transarterial Embolization: Diagnostic Findings, Procedural Outcome, and Efficacy-A Multicenter Study. J Clin Med 2023; 12:4779. [PMID: 37510894 PMCID: PMC10381274 DOI: 10.3390/jcm12144779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Endovascular management of abdominal wall hematomas (AWHs) is now the primary treatment option in hemodynamically stable patients, and it is often preferred to surgical interventions. The purpose of this multicentric study was to assess the safety, technical, and clinical success of percutaneous transarterial embolization (PTAE) of spontaneous AWHs to evaluate the efficacy of blind or empiric embolization compared to targeted embolization and to compare the outcome of the endovascular treatment approach in patients affected by COVID-19 and non-COVID-19 patients. We retrospectively enrolled 112 patients with spontaneous AWHs who underwent PTAE, focusing on signs of bleeding at pre-procedural CTA and DSA. Patients were separated into two groups depending on whether a blind or targeted embolization approach was used. We also divided patients into COVID-19 and non-COVID-19 groups. The mean age of the study population was 68.6 ± 15.8 years. CTA and DSA revealed signs of active bleeding in 99 and 88 patients, respectively. In 21 patients, blind embolization was performed. The overall technical success rate was 99%. Clinical success was obtained in 96 patients (86%), while 16 (14%) re-bled within 96 h. One patient reported a major peri-procedural complication. The comparison between blind and targeted embolization approaches showed no statistically significant differences in the characteristics of groups and technical and clinical success rates. No significant differences were found in the procedural outcome between COVID-19 and non-COVID-19 groups. Our study confirmed that PTAE is effective for treating spontaneous AWHs, even in COVID-19 patients. It suggests that the efficacy and safety of blind embolization are comparable to targeted embolization.
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Affiliation(s)
- Francesco Tiralongo
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Francesco Giurazza
- Interventional Radiology Department, Cardarelli Hospital of Naples, 80131 Naples, Italy
| | - Stefano Di Pietro
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Andrea Contegiacomo
- Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Vacirca
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Simone Ciaglia
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS, Azienda Ospedaliero-Universitaria Di Bologna, Sant'Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Davide Giuseppe Castiglione
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Daniele Falsaperla
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | - Corrado Ini'
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
| | | | - Antonio Granata
- Nephrology and Dialysis Unit, "Cannizzaro" Hospital, 95123 Catania, Italy
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, 21100 Varese, Italy
| | - Antonio Basile
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy
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Liu H, Wang R, Zhang L, Shi J, Yao J. Clinical Observation of Uninterrupted Thrombolytic Therapy via Indwelling Catheter for Lower Limb Deep Vein Thrombosis. Int J Gen Med 2023; 16:2493-2501. [PMID: 37342406 PMCID: PMC10278963 DOI: 10.2147/ijgm.s416814] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
Purpose Observe uninterrupted thrombolytic therapy via indwelling catheter for lower limb deep vein thrombosis. Methods We retrospectively studied data from 32 patients with lower extremity deep vein thrombosis who received comprehensive treatment, consisting of general treatment, inferior vena cava filter implantation, interventional thrombolysis, angioplasty, stenting, and post-operative monitoring. Results The efficacy and safety of the comprehensive treatment were observed for a follow-up period of 6-12 months. The treatment was 100% effective; patient results indicated no serious bleeding, acute pulmonary embolism, or death after surgery. Conclusion The combination of intravenous and healthy side femoral vein puncture and directed thrombolysis to treat acute lower limb deep vein thrombosis is safe, effective, and minimally invasive while still achieving a good therapeutic effect.
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Affiliation(s)
- Haoyuan Liu
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Rurong Wang
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Liang Zhang
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Jingming Shi
- Department of Intervention, Hexi University Affiliated Zhangye People’s Hospital, Zhangye City, Gansu Province, 734000, People’s Republic of China
| | - Jiaxi Yao
- Institute of Urology, Hexi University, Zhangye City, Gansu Province, 734000, People’s Republic of China
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Shaikh R, Weil BR, Weldon CB, Chen N, London WB, Krush M, Anderson M, Gebhardt M, Church AJ, DuBois SG, Pikman Y, Spidle J, Wall CB, Feraco A, Ullrich NJ, Mack JW, Mullen E, Kamihara J, Forrest S, Shusterman S, Janeway KA, Alomari A, Padua H, Rodriguez-Galindo C, O'Neill AF. A single-institution pediatric and young adult interventional oncology collaborative: Novel therapeutic options for relapsed/refractory solid tumors. Cancer Med 2023. [PMID: 37264747 DOI: 10.1002/cam4.6026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Pediatric interventional oncology (PIO) is a growing field intended to provide additional or alternative treatment options for pediatric patients with benign or malignant tumors. Large series of patients treated uniformly and subjected to rigorous endpoints for efficacy are not available. METHODS We designed a collaborative initiative to capture data from pediatric patients with benign and malignant tumors who underwent a therapeutic interventional radiology procedure. Modified Response Evaluation Criteria in Solid Tumors (mRECIST) was utilized as a measure of radiologic response and data were collected regarding improvement in pain and functional endpoints. Cumulative incidence of progressive disease was calculated using both the treated site and the patient as the analytic unit. FINDINGS Forty patients, 16 with malignant tumors and 24 with benign tumors, underwent a total of 88 procedures. Cryo- and radiofrequency ablation were the most frequently utilized techniques for both cohorts of patients. A complete or partial response, or prolonged disease stability, were achieved in approximately 40% of patients with malignant tumors and 60% of patients with benign tumors. No patients had progressive disease as their best response. Resolution of pain and improved mobility with return-to-baseline activity were demonstrated across patients from both cohorts. Only minor complications were experienced. INTERPRETATION Interventional radiology-guided interventions can serve as an alternative or complementary approach to the treatment of benign and malignant tumors in pediatric patients. Prospective, multi-institutional trials are required to adequately study utility, treatment endpoints, and durability of response.
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Affiliation(s)
- Raja Shaikh
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brent R Weil
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher B Weldon
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Nan Chen
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Wendy B London
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan Krush
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Megan Anderson
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Gebhardt
- Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Alanna J Church
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Steven G DuBois
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Yana Pikman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Spidle
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine B Wall
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Angela Feraco
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole J Ullrich
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer W Mack
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth Mullen
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Junne Kamihara
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne Forrest
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne Shusterman
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine A Janeway
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Alomari
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Horacio Padua
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Rodriguez-Galindo
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Allison F O'Neill
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts, USA
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Gül Mutlu Y, Balık Aydın B, Çakır A, Canöz Ö, Erol C, Sevindik ÖG. Should Core Needle Lymph Node Biopsy be a Relevant Alternative to Surgical Excisional Biopsy in Diagnostic Work Up of Lymphomas? Eurasian J Med 2023; 55:114-119. [PMID: 37403909 PMCID: PMC10440969 DOI: 10.5152/eurasianjmed.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE Surgical excisional biopsy is accepted as the standard of care approach in the diagnosis of lympho- mas. Financial issues related to the increased cost and the invasive nature of the procedure forced physicians to use some alternative diagnostic methods. Percutaneous core needle biopsy, which gained a reputation for the diagnosis of lymphomas with the advent of improved pathological, immunohistochemical, and molecular analysis, made it possible to have an accurate diagnosis with limited tissue samples. In this retrospective study, we aimed to compare the diagnostic yield of surgical excisional biopsy and core needle biopsy. MATERIALS AND METHODS This study included 131 patients who were diagnosed with lymphoma with a nodal biopsy which was acquired via surgical excisional biopsy or core needle biopsy between 2014 and 2020 in our center. Around 68 patients underwent surgical excisional biopsy and the remaining 63 underwent core needle biopsy. Samples that allowed to the identification of the exact tumor type and/or subtype were accepted as fully diagnostic. Sufficient amount of tissue that the pathologist could have any suspicious findings considering malignant lymphoma was classified as partial diagnostic group. Inadequate samples were the ones who were not enough to report any final diagnosis. RESULTS The patients who underwent a core needle biopsy were significantly older than the patients who underwent to surgical excisional biopsy (56.8 vs. 47.6, P = .003). Despite the full diagnostic ability of surgical excisional biopsy outperformed core needle biopsy (95.2 % vs. 83.8 %, P=.035), in 92.6% of the patients whose tissue samples were obtained via core needle biopsy were accepted to have a sufficient diagnosis to initiate the treatment and not required a second biopsy, which was comparable with the ones achieved by surgical excisional biopsy (92.6% vs. 95.2%, P = .720). CONCLUSION According to the results obtained in our study, we may conclude that core needle biopsy is a viable and comparable alternative to surgical excisional biopsy, offering a less invasive and less-expansive approach.
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Affiliation(s)
- Yaşa Gül Mutlu
- Department of Hematology, Istanbul Medipol University, Istanbul, Turkey
| | | | - Aslı Çakır
- Department of Pathology, Istanbul Medipol University, Istanbul, Turkey
| | - Özlem Canöz
- Department of Pathology, Erciyes University, Kayseri, Turkey
| | - Cengiz Erol
- Department of Radiology, Istanbul Medipol University, Istanbul, Turkey
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Jinushi R, Koizumi K, Masuda S, Ryozawa S. Successful endoscopic hemostasis for waterfall-like gastroduodenal artery hemorrhage. Clin Case Rep 2023; 11:e7355. [PMID: 37251748 PMCID: PMC10220454 DOI: 10.1002/ccr3.7355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/21/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
Endoscopic hemostasis is the first step in cessation of gastrointestinal bleeding. Although IVR may sometimes be required for preventing rebleeding, prophylactic IVR was not considered necessary in this case because of complete endoscopic hemostasis.
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Affiliation(s)
- Ryuhei Jinushi
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Kazuya Koizumi
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Sakue Masuda
- Department of Gastroenterology Medicine CenterShonan Kamakura General HospitalKamakuraKanagawaJapan
| | - Shomei Ryozawa
- Department of GastroenterologySaitama Medical University International Medical CenterSaitamaJapan
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Aslan A, Stevens C, Aldine AS, Mamilly A, De Alba L, Arevalo O, Ahuja C, Cuellar HH. The reproducibility of interventional radiology randomized controlled trials and external validation of a classification system. Diagn Interv Radiol 2023; 29:529-534. [PMID: 37070845 PMCID: PMC10679611 DOI: 10.4274/dir.2023.222052] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/24/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The fragility index (FI) measures the robustness of randomized controlled trials (RCTs). It complements the P value by taking into account the number of outcome events. In this study, the authors measured the FI for major interventional radiology RCTs. METHODS Interventional radiology RCTs published between January 2010 and December 2022 relating to trans-jugular intrahepatic portosystemic shunt, trans-arterial chemoembolization, needle biopsy, angiography, angioplasty, thrombolysis, and nephrostomy tube insertion were analyzed to measure the FI and robustness of the studies. RESULTS A total of 34 RCTs were included. The median FI of those studies was 4.5 (range 1-68). Seven trials (20.6%) had a number of patients lost to follow-up that was higher than their FI, and 15 (44.1%) had a FI of 1-3. CONCLUSION The median FI, and hence the reproducibility of interventional radiology RCTs, is low compared to other medical fields, with some having a FI of 1, which should be interrupted cautiously.
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Affiliation(s)
- Assala Aslan
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Christopher Stevens
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Amro Saad Aldine
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Ahmed Mamilly
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Luis De Alba
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Octavio Arevalo
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Chaitanya Ahuja
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
| | - Hugo H. Cuellar
- Department of Radiology and Interventional Radiology, Ochsner-Louisiana State University, Shreveport, United States
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Vedavyas R, Saravanan R, Mirunalini G, Gayathri B. A Randomized Controlled Trial to Compare the Efficacy of Single versus Triple Injection Technique for Ultrasound-Guided Infraclavicular Block in Upper Limb Surgeries. Local Reg Anesth 2023; 16:51-58. [PMID: 37223488 PMCID: PMC10202210 DOI: 10.2147/lra.s409211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Introduction The ultrasound-guided infraclavicular brachial plexus block by triple-point injection method was aimed at blocking the three individual cords in the infraclavicular region. Recently, a single-point injection method which does not require visualization of cords to produce nerve block has been introduced. This study compared the block onset time, performance time, patient's satisfaction, and complications between the ultrasound guided triple-point injection and single-point injection methods. Patients and Method This randomized controlled trial was conducted in a tertiary care hospital. Sixty patients were divided into two groups - Group S: 30 patients received single-point injection method of infraclavicular block. Group T: 30 patients received triple-point injection method of infraclavicular block. Drugs used were 0.5% ropivacaine with 8 mg dexamethasone. Results The sensory onset time was significantly longer in Group S (11.13 ±1.83 min) than Group T (6.20 ±1.19min). No statistically significant difference was found between the two groups regarding mean motor onset time. The composite sensorimotor onset time was similar between the groups. The mean time to perform the block was significantly lesser in Group S (1.35 ±0.38 min) when compared to group T (3.44 ±0.61min). The patient satisfaction score, conversion to general anesthesia and complications were not significant among the two groups. Conclusion We concluded that single-point injection method had a shorter performance time and similar total onset time with less procedural complications compared with triple point injection method.
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Affiliation(s)
- Raksha Vedavyas
- Department of Anesthesiology, SRM Medical College Hospital and Research Center, SRMIST, Kattankulathur, Tamil Nadu, India
| | - Ravi Saravanan
- Department of Anesthesiology, SRM Medical College Hospital and Research Center, SRMIST, Kattankulathur, Tamil Nadu, India
| | - Gunaseelan Mirunalini
- Department of Anesthesiology, SRM Medical College Hospital and Research Center, SRMIST, Kattankulathur, Tamil Nadu, India
| | - Balasubramaniam Gayathri
- Department of Anesthesiology, SRM Medical College Hospital and Research Center, SRMIST, Kattankulathur, Tamil Nadu, India
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Ponti F, Arioli A, Longo C, Miceli M, Colangeli M, Papalexis N, Spinnato P. Ultrasound-Guided Percutaneous Bone Biopsy: Feasibility, Diagnostic Yield and Technical Notes. Diagnostics (Basel) 2023; 13:diagnostics13101773. [PMID: 37238257 DOI: 10.3390/diagnostics13101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
While nowadays, CT-guided bone biopsy represents the gold standard tool for histopathological and microbiological diagnosis of skeletal lesions, the role of US-guided bone biopsy has not yet been fully explored. US-guided biopsy offers several advantages, such as the absence of ionizing radiation, fast acquisition time, as well as good intra-lesional echo, and structural and vascular characterization. Despite that, a consensus in regard to its applications in bone neoplasms has not been established. Indeed CT-guided technique (or fluoroscopic ones) still represents the standard choice in clinical practice. This review article aims to review the literature data about US-guided bone biopsy, underlying clinical-radiological indications, advantages of the procedure and future perspectives. Bone lesions taking the best advantages of the US-guided biopsy are osteolytic, determining the erosion of the overlying bone cortex and/or with an extraosseous soft-tissue component. Indeed, osteolytic lesions with extra-skeletal soft-tissue involvement represent a clear indication for US-guided biopsy. Moreover, even lytic bone lesions with cortical thinning and/or cortical disruption, especially located in the extremities or pelvis, can be safely sampled with US guidance with very good diagnostic yield. US-guided bone biopsy is proven to be fast, effective and safe. Additionally, it offers real-time needle evaluation, an advantage when compared to CT-guided bone biopsy. In the current clinical settings, it seems relevant to select the exact eligibility criteria for this imaging guidance since the effectiveness can vary depending on the type of lesion and body site involved.
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Affiliation(s)
- Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessio Arioli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Chiara Longo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Colangeli
- Orthopaedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Protty MB, Valenzuela T, Sharaf A, Shome J, Hasan S, Chase A, UlHaq Z, Ionescu A, Khurana A, Jenkins G, Obaid DR, Choudhury A, Hailan A. Predictors of 1- and 12-month mortality in bifurcation coronary intervention: a contemporary perspective. Future Cardiol 2023; 19:353-361. [PMID: 37449460 DOI: 10.2217/fca-2023-0058] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Aim: Bifurcation-PCI is performed frequently, although without extensive evidence to back up a definitive solution for its complexity. We set out to identify factors associated with 1- and 12-month mortality after bifurcation-PCI between 2017 and 2021 in our tertiary center in Wales, UK. Results: Of 732 bifurcation PCI cases (mean age 69; 25% female), 67% were in ACS, 42% were left main PCI and 25.3% involved two-stent strategy. 30-day and 12-month mortality were 1.9 and 8.2%, respectively. Age, diabetes, smoking and renal failure are associated with mortality after bifurcation-PCI, while the choice between provisional and 2-stent strategies did not impact mortality/TLR. Conclusion: Awareness of 'real-world' outcomes of bifurcation-PCI should be used for appropriate patient selection, technique planning and procedural consent.
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Affiliation(s)
- Majd B Protty
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Systems Immunity University Research Institute, Cardiff University, Cardiff, CF14 4XN, UK
| | - Tom Valenzuela
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Ahmed Sharaf
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Joy Shome
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Saad Hasan
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Alexander Chase
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Zia UlHaq
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Adrian Ionescu
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Ayush Khurana
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Geraint Jenkins
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
| | - Daniel R Obaid
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Anirban Choudhury
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
- Swansea University Medical School, Swansea, SA1 8EN, UK
| | - Ahmed Hailan
- Department of Cardiology, Morriston Cardiac Centre, Swansea, SA6 6NL, UK
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Sidhu C, Ratnagobal S, Thomas R, Lee GYC, Drudy E, Francis RJ. Targeted alveo-pleural fistula endobronchial valve treatment using ventilation scintigraphy. Respirol Case Rep 2023; 11:e01146. [PMID: 37082168 PMCID: PMC10111169 DOI: 10.1002/rcr2.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
Persistent air-leaks can be difficult to localize in radiology. Bronchoscopic management of air-leaks requires identification of the leak's location to allow suitable targeted treatment. One-way endobronchial valves have become a suitable option for persistent air-leaks. In this report, a combination scintigraphy and one-way endobronchial valve treatment successfully resolved a persistent air-leak.
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Affiliation(s)
- Calvin Sidhu
- School of Medical and Health SciencesEdith Cowan UniversityPerthWestern AustraliaAustralia
| | - Shoba Ratnagobal
- Nuclear Medicine DepartmentSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Rajesh Thomas
- Respiratory DepartmentSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Gary Y. C. Lee
- Respiratory DepartmentSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
- School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Enya Drudy
- Nuclear Medicine DepartmentSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Roslyn J. Francis
- Nuclear Medicine DepartmentSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
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Machado CN, de Freitas OB, de Melo JAC, Ribeiro G. Musculoskeletal disorders in interventional radiology workers: an integrative review. Rev Bras Med Trab 2023; 21:e2022860. [PMID: 38313081 PMCID: PMC10835390 DOI: 10.47626/1679-4435-2022-860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2024] Open
Abstract
This integrative review analyzed scientific production on musculoskeletal disorders related to personal protective equipment used by interventional radiology teams. The PubMed, Embase, and SciELO databases were searched using a strategy developed with the help of a librarian. The double-blind selection process involved the Rayyan online tool. A total of 12 articles were included, which were organized according to year of publication, country research subjects, study type, and main outcomes. Five thematic categories emerged from the analysis: "personal protective equipment"; "ergonomics in the interventional radiology environment"; "the composition of personal protective equipment"; "radiation protection for interventional teams" and "the prevalence of musculoskeletal symptoms in interventional teams". Outcomes associated with musculoskeletal disorders among interventional teams predominated in the studies, and advances in radiological protection were reported, especially in shielding technologies, as well as continuing efforts toward more ergonomic protective equipment to reduce the risk of musculoskeletal disorders.
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Affiliation(s)
- Carolina Neis Machado
- Departamento Acadêmico de Saúde e Serviços, Instituto
Federal de Educação, Ciência e Tecnologia de Santa Catarina,
Florianópolis, SC, Brazil
| | - Otávio Bitencourt de Freitas
- Departamento Acadêmico de Saúde e Serviços, Instituto
Federal de Educação, Ciência e Tecnologia de Santa Catarina,
Florianópolis, SC, Brazil
| | - Juliana Almeida Coelho de Melo
- Departamento Acadêmico de Saúde e Serviços, Instituto
Federal de Educação, Ciência e Tecnologia de Santa Catarina,
Florianópolis, SC, Brazil
| | - Gerusa Ribeiro
- Departamento Acadêmico de Saúde e Serviços, Instituto
Federal de Educação, Ciência e Tecnologia de Santa Catarina,
Florianópolis, SC, Brazil
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Brönnimann MP, Hirzberger L, Keller PM, Gsell-Albert M. Antibacterial Effects of X-ray and MRI Contrast Media: An In Vitro Pilot Study. Int J Mol Sci 2023; 24. [PMID: 36834880 DOI: 10.3390/ijms24043470] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Some radiological contrast agents have been shown to have effects on bacterial growth. In this study, the antibacterial effect and mechanism of action of iodinated X-ray contrast agents (Ultravist 370, Iopamiro 300, Telebrix Gastro 300 and Visipaque) and complexed lanthanide MRI contrast solutions (MultiHance and Dotarem) were tested against six different microorganisms. Bacteria with high and low concentrations were exposed to media containing different contrast media for various lengths of time and at pH 7.0 and 5.5. The antibacterial effect of the media was examined in further tests using agar disk diffusion analysis and the microdilution inhibition method. Bactericidal effects were found for microorganisms at low concentrations and low pH. Reductions were confirmed for Staphylococcus aureus and Escherichia coli.
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44
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Dachepally R, Garcia AD, Liu W, Flechler C, Hanna WJ. Assessing the utility of ultrasound-guided vascular access placement with longer catheters in critically ill pediatric patients. Paediatr Anaesth 2023; 33:460-465. [PMID: 36756680 DOI: 10.1111/pan.14645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/25/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions. AIM The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access. METHODS This single-center retrospective cohort study included children 0-18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018-06/01/2021. RESULTS One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR = 2.20, 95% CI [1.45-3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28-3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18-0.85] p = .017). CONCLUSION In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.
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Affiliation(s)
- Rashmitha Dachepally
- Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Alvaro Donaire Garcia
- Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christine Flechler
- Department of Nursing, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - William J Hanna
- Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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45
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Hashiba N, Nakae R, Yasui D, Inoue M, Maejima R, Takiguchi T, Onda H, Kim S, Yokobori S. Two Cases of Bronchial Artery Racemose Hemangioma Successfully Treated with Bronchial Artery Embolization. J NIPPON MED SCH 2023; 89:594-598. [PMID: 34840218 DOI: 10.1272/jnms.jnms.2022_89-601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Rupture of a racemose hemangioma causing dilatation and tortuosity of the bronchial artery can result in massive bleeding and respiratory failure. Bronchial artery embolization (BAE) can treat this life-threatening condition, as we show in two cases. The first case was of an 89-year-old female complaining of sudden-onset chest and back pain. Bronchial artery angiography demonstrated a racemose hemangioma with a 2 cm aneurysm. The second case was of a 50-year-old male with hemoptysis and dyspnea, eventually requiring intubation. Bronchial arteriography showed a racemose hemangioma and a bronchial artery-pulmonary arterial fistula. BAE was successfully performed in both cases, with no recurrent hemorrhage. Therapeutic interventions in bronchial artery racemose hemangiomas include lobectomy or segmentectomy, bronchial arterial ligation, and BAE. BAE should be considered as first-line therapy for bleeding racemose hemangiomas of the bronchial artery because of its low risk of adverse effects on respiratory status, minimal invasiveness, and faster patient recovery.
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Affiliation(s)
- Natsuki Hashiba
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | | | - Masaaki Inoue
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Riko Maejima
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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Duus LA, Junker T, Rasmussen BS, Bojsen JA, Pedersen AL, Anthonsen A, Lund L, Pedersen M, Graumann O. Safety, efficacy, and mid-term oncological outcomes of computed tomography-guided cryoablation of T1 renal cancer. Acta Radiol 2023; 64:814-820. [PMID: 35297745 DOI: 10.1177/02841851221081825] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Cryoablation is a promising minimally invasive, nephron-sparing treatment of small renal carcinoma (RCC) in co-morbid patients. PURPOSE To assess the safety, efficacy, and cancer-specific outcomes of computed tomography (CT)-guided cryoablation of stage T1 (RCC). MATERIAL AND METHODS A retrospective evaluation of 122 consecutive patients with 128 tumors treated with cryoablation during 2016-2017. All patients had biopsy-verified T1 RCC. RESULTS Median age was 69 years (IQR=59-76); 69% were male. Median tumor size was 26 mm (± 20-33); 9% were stage T1b. Mean follow-up time was 36.3±12.0 months. In total, 14 (11%) procedures led to complications, of which 4 (3%) were intraoperative, 5 (4%) appeared ≤30 days and 5 (4%) >30 days after treatment. Major complications arose after 4 (3%) procedures. Statistically significant associations were found between major complications and stage T1b (P = 0.039), RENAL score (P = 0.010), and number of needles used in cryoablation (P = 0.004). Residual tumor was detected after 4 (3%) procedures and 5 (4%) tumors had local tumor progression. Of 122 patients, 3 (2%) advanced to metastatic disease. Significant statistical associations were found between local tumor progression and T1b stage tumors and number of needles used in cryoablation (P = 0.05 and P = 0.004, respectively). For patients with T1a tumors, the one- and three-year disease-free survival was 98% and 95%, respectively, and for T1b 100% after one year and 75% after three years. CONCLUSIONS This study showed that cryoablation is a safe and effective treatment of stage T1 RCC and suggests that in selecting candidates for cryoablation of RCC, the tumor characteristics are more critical than patients' baseline health status.
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Affiliation(s)
- Louise A Duus
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, SDU, Odense C, Denmark
| | - Theresa Junker
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, SDU, Odense C, Denmark
| | - Benjamin S Rasmussen
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Jonas A Bojsen
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Allan L Pedersen
- Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Andrea Anthonsen
- Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark
| | - Lars Lund
- Department of Urology, OUH, Odense C, Denmark.,Institute of Clinical Research, SDU, Odense C, Denmark
| | - Michael Pedersen
- Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Ole Graumann
- Department of Radiology, 11286Odense University Hospital (OUH), Odense C, Denmark.,Research and Innovation Unit of Radiology, 6174University of Southern Denmark (SDU), Odense C, Denmark.,OPEN, Odense Patient data Explorative Network, SDU, Odense C, Denmark
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Alexandratou A, Mah Y, Ramsey D, Kandasamy N, Tolias CM, Gadapa N, Ankolekar S. Dural arteriovenous fistula causing reversible cognitive impairment. Pract Neurol 2023; 23:82-84. [PMID: 35981860 DOI: 10.1136/pn-2021-003332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2022] [Indexed: 02/02/2023]
Abstract
A previously independent 82-year-old woman presented with 5 months of worsening confusion, mobility and cognitive decline, with deficits in orientation, language and executive function. A cerebral dural arteriovenous fistula was identified and successfully embolised, after which her cognitive ability and independence dramatically improved. Although rare, a dural arteriovenous fistula may mimic a rapidly progressive dementia, but its early recognition and treatment can completely reverse the dementia.
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Affiliation(s)
- Anna Alexandratou
- Department of Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
| | - Yee Mah
- Department of Neurosciences, King's College Hospital NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Deborah Ramsey
- Department of Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
| | - Naga Kandasamy
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Christos M Tolias
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Naveen Gadapa
- Department of Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
| | - Sandeep Ankolekar
- Department of Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
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Ojha V, Raju SN, Deshpande A, Ganga KP, Kumar S. Catheters in vascular interventional radiology: an illustrated review. Diagn Interv Radiol 2023; 29:138-145. [PMID: 36960563 PMCID: PMC10679593 DOI: 10.5152/dir.2022.21233] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/13/2021] [Indexed: 01/15/2023]
Abstract
The past five decades have seen significant developments in the knowledge and practice of interventional radiology. Advancements in angiographic equipment have made interventional radiology a safe, minimally invasive preferred option in the treatment of a variety of diseases. Today, a range of catheters are available in the armamentarium of the interventional radiologist to suit different needs when conducting diagnostic angiograms or performing interventions in various vascular territories. The hardware required for interventions includes needles, wires, catheters, balloons, and stents. Catheters, in particular, are an invaluable tool for interventionists. The purpose of this review is to describe the identification characteristics, properties, and uses of the common angiographic catheters used in interventional radiology, with a special focus on peripheral vascular interventions (excluding neurointerventions).
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Deshpande
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik P. Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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49
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Rezaei-Kalantari K, Fahrni G, Rotzinger DC, Qanadli SD. Insights into pelvic venous disorders. Front Cardiovasc Med 2023; 10:1102063. [PMID: 36742076 PMCID: PMC9892065 DOI: 10.3389/fcvm.2023.1102063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Pelvic venous disorders (PeVD), sometimes referred to as pelvic congestion syndrome (PCS), widely impact affected patients-mainly young women's quality of life, causing puzzling, uncomfortable symptoms sometimes requiring months or years to get an explanation, while simply remaining undiagnosed in other cases. Because pelvic pain is a non-specific symptom, an appropriate diagnosis requires a careful patient workup, including a correlation between history and non-invasive imaging. Invasive imaging is frequently required to confirm the diagnosis and plan treatment. Current therapeutic approaches principally rely on minimally invasive techniques delivered through endovascular access. However, while comprehensive descriptive classifications such as the symptoms-varices-pathophysiology (SVP) classification exist, universally accepted guidelines regarding therapy to apply for each SVP category are still lacking. This review strongly focuses on PeVD imaging and discusses available therapeutic approaches with regard to pathophysiological mechanisms. It proposes a new classification scheme assisting clinical decision-making about endovascular management to help standardize the link between imaging findings and treatment.
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Affiliation(s)
- Kiara Rezaei-Kalantari
- Department of Radiology, Rajaie Cardiovascular, Medical and Research Center, Cardio-Oncology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Guillaume Fahrni
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland,*Correspondence: Guillaume Fahrni,
| | - David C. Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Salah D. Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Division, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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50
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Wong JZW, Dewey HM, Campbell BCV, Mitchell PJ, Parsons M, Phan T, Chandra RV, Ma H, Warwick A, Brooks M, Thijs V, Low E, Wijeratne T, Jones S, Clissold B, Ngun MY, Crompton D, Sriamareswaran RK, Rupasinghe J, Smith K, Bladin C, Choi PMC. Door-in-door-out times for patients with large vessel occlusion ischaemic stroke being transferred for endovascular thrombectomy: a Victorian state-wide study. BMJ Neurol Open 2023; 5:e000376. [PMID: 36684479 PMCID: PMC9853123 DOI: 10.1136/bmjno-2022-000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
Background Time to reperfusion is an important predictor of outcome in ischaemic stroke from large vessel occlusion (LVO). For patients requiring endovascular thrombectomy (EVT), the transfer times from peripheral hospitals in metropolitan and regional Victoria, Australia to comprehensive stroke centres (CSCs) have not been studied. Aims To determine transfer and journey times for patients with LVO stroke being transferred for consideration of EVT. Methods All patients transferred for consideration of EVT to three Victorian CSCs from January 2017 to December 2018 were included. Travel times were obtained from records matched to Ambulance Victoria and the referring centre via Victorian Stroke Telemedicine or hospital medical records. Metrics of interest included door-in-door-out time (DIDO), inbound journey time and outbound journey time. Results Data for 455 transferred patients were obtained, of which 395 (86.8%) underwent EVT. The median DIDO was 107 min (IQR 84-145) for metropolitan sites and 132 min (IQR 108-167) for regional sites. At metropolitan referring hospitals, faster DIDO was associated with use of the same ambulance crew to transport between hospitals (75 (63-90) vs 124 (99-156) min, p<0.001) and the administration of thrombolysis prior to transfer (101 (79-133) vs 115 (91-155) min, p<0.001). At regional centres, DIDO was consistently longer when patients were transported by air (160 (127-195) vs 116 (100-144) min, p<0.001). The overall door-to-door time by air was shorter than by road for sites located more than 250 km away from the CSC. Conclusion Transfer times differ significantly for regional and metropolitan patients. A state-wide database to prospectively collect data on all interhospital transfers for EVT would be helpful for future study of optimal transport mode at regional sites and benchmarking of DIDO across the state.
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Affiliation(s)
- Joseph Zhi Wen Wong
- Department of Neurosciences, Eastern Health, Box Hill, Victoria, Australia,Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Helen M Dewey
- Department of Neurosciences, Eastern Health, Box Hill, Victoria, Australia,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Bruce C V Campbell
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter J Mitchell
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Mark Parsons
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Thanh Phan
- Department of Neurology, Monash Health, Clayton, Victoria, Australia,School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Ronil V Chandra
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia,Neurointerventional Radiology, Monash Health Imaging, Clayton, Victoria, Australia
| | - Henry Ma
- Department of Neurology, Monash Health, Clayton, Victoria, Australia,School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Alexandra Warwick
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Mark Brooks
- Department of Radiology, Austin Health, Heidelberg, Victoria, Australia
| | - Vincent Thijs
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Essie Low
- Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Health, Footscray, Victoria, Australia
| | - Sharon Jones
- Department of Neurology, Barwon Health, Geelong, Victoria, Australia
| | - Ben Clissold
- Department of Neurology, Barwon Health, Geelong, Victoria, Australia
| | - Mei Yan Ngun
- Department of Neurology, Northern Hospital Epping, Epping, Victoria, Australia
| | - Douglas Crompton
- Department of Neurology, Northern Hospital Epping, Epping, Victoria, Australia
| | | | | | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
| | - Chris Bladin
- Victorian Stroke Telemedicine, The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia,Ambulance Victoria, Doncaster, Victoria, Australia
| | - Philip M C Choi
- Department of Neurosciences, Eastern Health, Box Hill, Victoria, Australia,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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