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A review of expected imaging findings and potential complications: after MR guided Focused Ultrasound Surgery (MRgFUS) of symptomatic fibroids 磁共振引导聚焦超声手术(MRgFUS)治疗有症状的肌瘤后的预期影像学表现和潜在并发症的综述
Pub Date : 2016-01-01 DOI: 10.14303/IMAGING-MEDICINE.1000029
K. Devulapalli, M. Kohi, V. Rieke, E. Ozhinsky, V. Jacoby, Westphalen, Antonio Stefanie Weinstein
MR-guided focused ultrasound surgery (MRgFUS) is a novel, completely noninvasive and outpatient treatment option for symptomatic uterine fibroids. This technique uses high intensity focused ultrasound energy to thermally ablate fibroids under continuous MR imaging. In this pictorial review we illustrate the relevant MR imaging features of fibroids that are amenable to MRgFUS, in addition to expected post-treatment findings and potential complications.
磁共振引导聚焦超声手术(MRgFUS)是一种新型的、完全无创的门诊治疗方法,用于治疗有症状的子宫肌瘤。该技术使用高强度聚焦超声能量在连续磁共振成像下热消融肌瘤。在这篇图片综述中,我们阐述了适用于MRgFUS的肌瘤的相关磁共振成像特征,以及预期的治疗后发现和潜在的并发症。
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引用次数: 1
Iatrogenic post-catheterization radial arteriovenous fistula in 64-old male patient 64岁男性患者置管后放射状动静脉瘘的医源性分析
Pub Date : 2016-01-01 DOI: 10.14303/Imaging-Medicine.1000022
R. Novotný, J. Hlubocký, P. Mitáš, J. Hrubý, M. Špaček, R. Špunda, J. Tošovský, J. Lindner
Background: We are presenting a case report of an iatrogenic left radial post-catheterization arteriovenous fistula. A 64-year-old male patient one year after percutaneous coronary intervention (PCI) with coronary stent implants was admitted with a pulsatile, palpable mass with bruit and intermittent pain in the region of the left radial artery. Finding: Ultrasonography of the left radial artery was performed, confirming a radial arteriovenous fistula (AVF) in the place of PCI. Method: Percutaneous embolization (PE) with thrombin was chosen as a treatment of choice based on the anatomical localization and characteristics of the AVF. The PE treatment was repeated twice with suboptimal post-procedural result. One day after the PE an ultrasonographic check-up was performed, confirming a suboptimal result of PE with a light palpable bruit present in the place of the AVF. Patient was indicated for surgical resection. After the surgical resection, patient was immediately relieved of all accompanying symptoms and was discharged two days after the procedure. Conclusion: The preferred treatment of choice for post-catheterization arteriovenous fistulas is percutaneous embolization. Surgical resection of post-catheterization AVF is used only when all percutaneous treatments fail.
背景:我们报告一例医源性左桡骨置管后动静脉瘘。一名64岁男性患者经皮冠状动脉介入治疗(PCI)置入冠状动脉支架一年后,因左桡动脉区域搏动,可触及肿块并伴有瘀伤和间歇性疼痛而入院。发现:行左桡动脉超声检查,证实PCI处有桡动脉动静脉瘘(AVF)。方法:根据AVF的解剖定位及特点,选择经皮凝血酶栓塞作为治疗方案。PE治疗重复两次,术后效果不理想。PE后一天进行超声检查,确认PE结果不理想,在AVF处可见轻可触及的肿块。患者需要手术切除。手术切除后,患者立即解除所有伴随症状,术后2天出院。结论:导管置管后动静脉瘘首选经皮栓塞治疗。手术切除置管后AVF仅在所有经皮治疗失败时使用。
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引用次数: 1
The evidence supporting radiation safety methods- working towards zero operator exposure 支持辐射安全方法的证据-努力实现操作人员零暴露
Pub Date : 2016-01-01 DOI: 10.14303/IMAGING-MEDICINE.1000018
R. Reeves, E. Mahmud
The potential dangers of exposure to X-rays were apparent early after the first clinical applications, prompting the eventual development of standards regarding exposure. Physicians performing interventional procedures that are guided by X-rays are not immune to these potential dangers despite remaining outside of the primary beam. Contemporary studies regarding deleterious subclinical and clinical effects associated with chronic exposure to medical radiation have raised awareness in the interventional community. In recent years, investigations regarding feasible processes to reduce operator exposure have been published and are summarized in this review. Immediate universal implementation of many of these methods may result in significant decreases in operator and patient exposure. Future research in this field will help further define the risk posed by X-ray guided procedures and lead to a safer interventional environment for patients, operators, and staff.
在第一次临床应用之后,暴露于x射线的潜在危险就很明显了,这促使了有关暴露标准的最终发展。在x射线引导下进行介入性手术的医生即使置身于主光束之外,也不能避免这些潜在的危险。关于慢性医疗辐射照射的有害亚临床和临床效应的当代研究提高了介入性社区的认识。近年来,关于减少操作人员接触的可行方法的研究已经发表,并在本综述中进行了总结。立即普遍实施这些方法中的许多方法可能导致操作人员和患者暴露的显着减少。该领域的未来研究将有助于进一步确定x射线引导手术所带来的风险,并为患者、操作人员和工作人员创造更安全的介入环境。
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引用次数: 2
Quantitative analysis of threedimensional branching systems from X-ray computed microtomography data 从x射线计算机微断层扫描数据中定量分析三维分支系统
Pub Date : 2016-01-01 DOI: 10.14303/Imaging-Medicine.1000036
Adriana L. McKinney, T. Varga
Branching structures such as lungs, blood vessels and plant roots play a critical role in life. Growth, structure, and function of these branching structures have an immense effect on our lives. Therefore, quantitative size information on such structures in their native environment is invaluable for studying their growth and the effect of the environment on them. X-ray computed tomography (XCT) has been an effective tool for in situ imaging and analysis of branching structures. We developed a costless tool that approximates the surface and volume of branching structures. Our methodology of noninvasive imaging, segmentation and extraction of quantitative information is demonstrated through the analysis of a plant root in its soil medium from 3D tomography data. XCT data collected on a grass specimen was used to visualize its root structure. A suite of open-source software was employed to segment the root from the soil and determine its isosurface, which was used to calculate its volume and surface. This methodology of processing 3D data is applicable to other branching structures even when the structure of interest is of similar X-ray attenuation to its environment and difficulties arise with sample segmentation.
肺、血管和植物根等分支结构在生命中起着至关重要的作用。这些分支结构的生长、结构和功能对我们的生活有着巨大的影响。因此,这些结构在其原生环境中的定量大小信息对于研究它们的生长和环境对它们的影响是非常宝贵的。x射线计算机断层扫描(XCT)已成为原位成像和分析分支结构的有效工具。我们开发了一种无成本的工具,可以近似分支结构的表面和体积。我们的无创成像、分割和提取定量信息的方法是通过对土壤介质中植物根的3D断层扫描数据的分析来证明的。在草标本上收集的XCT数据用于可视化其根结构。利用一套开源软件将根从土壤中分割出来,确定其等值面,并以此计算其体积和表面积。这种处理三维数据的方法适用于其他分支结构,即使感兴趣的结构与其环境具有相似的x射线衰减,并且在样本分割方面存在困难。
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引用次数: 0
Biodistribution and kinetics of 67Ga-beta-neurotoxin using SPECT molecular imaging 利用SPECT分子成像技术研究67ga - β神经毒素的生物分布和动力学
Pub Date : 2016-01-01 DOI: 10.14303/Imaging-Medicine.1000032
Irene Medina
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引用次数: 0
Breast metastasis from rectal adenocarcinoma: a case report with US and CT findings 直肠腺癌乳腺转移:附US和CT表现1例
Pub Date : 2016-01-01 DOI: 10.14303/IMAGING-MEDICINE.1000031
B. Arıbaş, A. Onursever, T. Kiziltepe, H. Aydın, S. Cosar, B. Şahin, Haci Uzun Filiz Erdil
Metastasis to the breast from extramammary malignancies is unusual. We describe a case of rectal adenocarcinoma metastatic to the breast. A 21 year old woman had undergone abdominoperineal and vaginal resection and hysterectomy, right inguinal lymph node dissection for presenting vaginal bleeding ten months before. The patient was readmitted to our hospital for presenting edema and masses with severe pain in her breasts. US and contrasted CT was taken but mammography could not be performed due to severe tender and pain of her breasts. Breast US revealed diffuse skin thickening and bilateral multiple well-defined hypoechoic masses whereas contrasted CT delineated multiple, oval or round, and inhomogeneous superficial and invasive deep solid masses in her breasts with strong peripheral and moderate patchy central contrast enhancement and bilateral axillary lymph nodes. Breast biopsy and immunohistochemistry revealed rectal adenocarcinoma metastasis to the breast. To our knowledge, colorectal adenocarcinoma metastasis to the breast in women is extremely rare as 17 patients in the literature. Moreover, this is the fifth patient with bilateral breast metastasis from colorectal adenocarcinoma. This report also shows that CT is helpful to define axillary metastasis, the fixation and invasion of the deep metastatic lesions to the chest wall, which is unique feature of this metastatic tumor. CT could be used for early stage breast metastasis to some extent, but CT was diagnostic in late stage.
从乳腺外恶性肿瘤转移到乳腺是罕见的。我们报告一个直肠腺癌转移到乳房的病例。一位21岁的女性于10个月前因阴道出血接受了腹部会阴及阴道切除术、子宫切除术、右侧腹股沟淋巴结清扫术。患者因乳房水肿、肿块及剧烈疼痛再次入院。做了超声和对比CT检查,但由于乳房剧痛,不能做乳房x光检查。乳腺超声显示弥漫性皮肤增厚,双侧多发清晰的低回声肿块,而对比CT显示乳房多发、椭圆形或圆形、不均匀的浅表性和侵袭性深部实性肿块,伴明显的外周增强和中度斑片状中央增强,双侧腋窝淋巴结。乳腺活检及免疫组化显示直肠腺癌转移至乳腺。据我们所知,女性结直肠腺癌转移至乳房极为罕见,文献中仅有17例。此外,这是第五位双侧乳房转移的结直肠癌患者。本报告还显示,CT有助于确定腋窝转移、深部转移灶向胸壁的固定和浸润,这是该转移瘤的独特特征。CT对早期乳腺癌转移有一定的诊断价值,但在晚期才有诊断价值。
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引用次数: 5
Catheters and guide wires for interventional MRI: are we there yet? 介入性核磁共振成像的导管和导丝:我们做到了吗?
Pub Date : 2016-01-01 DOI: 10.14303/IMAGING-MEDICINE.1000024
H. Clogenson, J. J. Dobbelsteen
Clinical feasibility of interventional MRI has been shown for a number of procedures. However, MRI-guided endovascular interventions have not yet reached clinical routine due to the lack of suitable MR safe or MR conditional and MR visible devices. In this article, some of the MR tools currently under development are reviewed. Good handling and MR visibility properties both are critical factors for successful application of such novel devices. Finally, we argue that it is only when both MR catheters and guidewires are available on the market that real progress and impact will be made in the field of interventional MRI.
介入性MRI的临床可行性已经在许多手术中得到证实。然而,由于缺乏合适的MR安全或MR条件和MR可见设备,mri引导的血管内介入尚未进入临床常规。在本文中,回顾了目前正在开发的一些MR工具。良好的操控性和MR可见性都是这种新型器件成功应用的关键因素。最后,我们认为只有当MR导管和导丝都在市场上可用时,介入性MRI领域才会取得真正的进展和影响。
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引用次数: 8
Selective Arterial Prostatic Embolization (SAPE) for the Treatment of Lower Urinary Tract Symptoms in the Setting of Benign Prostatic Hyperplasia: A Brief Review 选择性前列腺动脉栓塞治疗良性前列腺增生患者下尿路症状:综述
Pub Date : 2016-01-01 DOI: 10.14303/Imaging-Medicine.1000023
C. Horn, A. Fischman, Rahul S. Patel, D. Siegel, A. Rastinehad
Tel: 212-241-9955 Benign prostatic hyperplasia (BPH) is a common condition related to aging that can lead to a cluster of chronic symptoms collectively known as lower urinary tract symptoms (LUTS), including urinary frequency, urinary urgency, nocturia, hematuria, and decreased urinary stream. It is estimated that BPH affects 75% of men in the United States by age 70, with more than $1 billion US dollars a year spent in direct health care expenditures related to BPH, exclusive of outpatient medications [1]. Treatment options for BPH are outlined out by the American Urologic Association Clinical Guidelines and include watchful waiting, medical therapy, minimally invasive therapies (including transurethral ablations), or surgical therapies including open prostatectomy or transurethral resection of the prostate (TURP) [2]. Medical therapy is often considered the first-line option for symptomatic patients; however, a large subset of patients does not respond to or cannot tolerate pharmacotherapy, in part owing to a number of side effects including sexual dysfunction [3]. TURP has remained the ‘gold standard’ surgical treatment for BPH for over half a century, owing to its high success rate in reducing LUTS. Over the past two decades, the TURP procedure has undergone significant technical improvements, with morbidity rates reported to be <1% [4]. However, with a general shift towards minimally invasive treatment options, the number of TURPs performed has fallen in more recent years [5]. Manuscript Click here to download Manuscript SAPE final (1).docx Embolization of the prostatic arteries has been used for many years as a technique to control severe bladder and prostate hemorrhage as well as hematuria following TURP [6-9]. A case report by DeMeritt et al in 2000 described a patient with BPH and refractory hematuria treated by prostatic artery embolization, who subsequently had alleviation in his LUTS and reduction in the volume of his prostate [10]. This case report introduced the idea that BPH could intentionally be treated by selective arterial prostatic embolization (SAPE). In 2008, Carnevale et al used SAPE as the primary treatment in two patients with BPH [11]. After 6-month follow-up, MRI demonstrated a relative prostate reduction of 47.8% in the patient who had undergone bilateral SAPE and 27.8% in the patient who had undergone unilateral SAPE. Since this initial study, there has been an enthusiastic response in the literature regarding the future role of this technique, and the Society of Interventional Radiology has encouraged further research into this intervention [12]. A growing body of literature suggests that SAPE enables reduction in prostate volume with improvements in uroflometry parameters, quality of life, and sexual function [13]. The largest prospective non-randomized series published to date looked at 255 patients who underwent SAPE [14]. The authors describe technical success in 250 of the patients (98%), with a clinical success
良性前列腺增生(BPH)是一种与衰老相关的常见疾病,可导致一系列慢性症状,统称为下尿路症状(LUTS),包括尿频、尿急、夜尿、血尿和尿流减少。据估计,在美国,到70岁时,前列腺增生影响75%的男性,每年与前列腺增生有关的直接医疗支出超过10亿美元,不包括门诊药物。美国泌尿外科协会临床指南概述了BPH的治疗选择,包括观察等待,药物治疗,微创治疗(包括经尿道消融)或手术治疗,包括开放性前列腺切除术或经尿道前列腺切除术(TURP)[2]。药物治疗通常被认为是有症状患者的一线选择;然而,很大一部分患者对药物治疗没有反应或不能耐受,部分原因是包括性功能障碍在内的一些副作用。由于TURP在减少LUTS方面的高成功率,半个多世纪以来一直是BPH手术治疗的“黄金标准”。在过去的二十年中,TURP手术经历了重大的技术改进,据报道发病率<1%。然而,随着微创治疗方案的普遍转变,近年来进行turp的数量有所下降。前列腺动脉栓塞作为一种控制TURP术后严重膀胱和前列腺出血以及血尿的技术已经使用多年[6-9]。DeMeritt等人在2000年的一篇病例报告中描述了一位前列腺增生并难治性血尿的患者通过前列腺动脉栓塞治疗,随后其LUTS得到缓解,前列腺bbb体积减小。本病例报告介绍了BPH可以通过选择性动脉前列腺栓塞(SAPE)治疗的想法。2008年,Carnevale等人将SAPE作为2例BPH患者的主要治疗方法。经过6个月的随访,MRI显示双侧SAPE患者的前列腺相对减少47.8%,单侧SAPE患者的前列腺相对减少27.8%。自这项初步研究以来,文献中对该技术的未来作用有了热烈的回应,介入放射学会鼓励对该介入疗法进行进一步研究。越来越多的文献表明,SAPE可以减少前列腺体积,改善尿流测量参数、生活质量和性功能。迄今为止发表的最大的前瞻性非随机系列研究观察了255名接受SAPE[14]治疗的患者。作者描述了250例患者(98%)的技术成功,临床成功率从一个月的82%下降到3年的72%。在迄今为止唯一一项评估SAPE的随机对照试验中,57名患者被分配到前列腺动脉栓塞治疗,57名患者被分配到TURP治疗。作者证明,所有参数:包括国际前列腺症状评分(IPSS)、生活质量(QOL)、尿流量峰值和空后残留(PVR)尿量的改善,在两种治疗方式下均得到改善,两组治疗两年后无差异。这篇论文确实指出,PAE的并发症发生率较高,如果控制术后急性尿潴留,两组的并发症发生率相似。SAPE的技术包括单侧进入股动脉和随后的髂内动脉前段导管置入。数字减影血管造影用于确认动脉解剖,并允许前列腺动脉超选择性置管。许多不同的栓塞材料已被使用,包括聚乙烯醇颗粒、三丙基明胶微球和Embozene选择性动脉前列腺栓塞(SAPE)用于治疗良性前列腺增生的下尿路症状:简要回顾
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引用次数: 0
Short commentary on the imaging spectrum of pulmonary tuberculosis: a critical appraisal 简短的评论成像谱肺结核:一个关键的评估
Pub Date : 2016-01-01 DOI: 10.14303/IMAGING-MEDICINE.1000019
L. Cardinale, G. Dalpiaz, G. Rea
Pulmonary tuberculosis (TB) is currently one of the most important infection related morbidity and mortality causes in the world. The differential diagnosis between TB and some others pathologic conditions is an emerging problem, as pulmonary TB may easily show etherogenous aspects. Differential diagnosis can be particularly challenging when TB mimicks sarcoidosis, lymphoma and pulmonary neoplasms.
肺结核(TB)是目前世界上最重要的感染相关发病和死亡原因之一。结核病和其他病理状况的鉴别诊断是一个新出现的问题,因为肺结核很容易表现出醚源性。当结核病与结节病、淋巴瘤和肺肿瘤相似时,鉴别诊断尤其具有挑战性。
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引用次数: 0
Peripheral vein locating techniques 外周静脉定位技术
Pub Date : 2016-01-01 DOI: 10.14303/IMAGING-MEDICINE.1000034
Gali Cantor-Peled, Moshe Halak Zehava Ovadia-Blechman
This article summarizes available methods for improving venous prominence and reviews the variety of devices for locating peripheral veins. The technologies underlying these devices, both those in use and under development, are described in terms of the advantages and disadvantages of their physical properties, their success rate in difficult cases and their current market price. The selection of the optimal technology for different conditions is also described. All existing technologies improve the success rate of nurses and paramedics in locating veins, save time and money and increase patient and medical staff satisfaction.
本文总结了改善静脉突出的现有方法,并回顾了各种定位外周静脉的装置。这些设备的基础技术,包括正在使用的和正在开发的,都是根据其物理特性的优缺点、在困难情况下的成功率和当前的市场价格来描述的。并对不同条件下的最佳工艺选择进行了阐述。所有现有的技术都提高了护士和护理人员定位静脉的成功率,节省了时间和金钱,提高了患者和医务人员的满意度。
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引用次数: 13
期刊
Imaging in Medicine
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