Seminars in Interventional Radiology最新文献

Percutaneous image-guided needle biopsies are a safe and minimally invasive method of obtaining tissue of bone lesions. Radiologists are an integral part of a multidisciplinary team (MDT) approach to patient care in obtaining tissue for both pathologic diagnosis and advanced genetic/molecular testing. By utilizing image guidance, radiologists can target bone lesions with a very low complication rate. This review will discuss our approach to image-guided biopsies of bone lesions. Radiologists should be familiar with patient selection and imaging workup prior to performing biopsies, as well as the importance of coordinating the biopsy approach and sampling with the patient's clinical team. Management of bleeding and thrombotic risk in patients undergoing bone biopsies is also an important preprocedural consideration and will be discussed. The majority of bone biopsies are performed utilizing moderate sedation for patient analgesia and comfort, but close attention should be paid to patient comorbidities and potential interacting medications. Although computed tomography guidance remains the mainstay of image-guided biopsy, there are some circumstances in which ultrasound or fluoroscopic guidance may be beneficial. New advances in powered drill technology have made tissue sampling of bone lesions particularly sclerotic bone lesions both safer and faster with increased tissue yield. Finally, we will discuss image-guided biopsy of difficult anatomic regions that require special techniques to yield tissue safely.

Liver biopsy is a crucial aspect of interventional radiology and plays a significant role in the management of hepatobiliary diseases. Radiologists commonly perform two major image-guided liver biopsy techniques: percutaneous and transjugular approaches. It is essential for radiologists to understand the role of liver biopsy in diagnosing and treating hepatobiliary conditions, the procedural details involved, and how to manage potential complications. This article reviews the indications, contraindications, techniques, and efficacy of image-guided liver biopsy, with a focus on both percutaneous and transjugular methods.

Percutaneous cholecystostomy (PC) is a recognized treatment option for the management of acute cholecystitis and is an integral component of the treatment algorithm in the 2018 Tokyo Guidelines. The utilization of PC has significantly increased over the past 30 years, particularly in the setting of critically ill patients and those with extensive comorbidities who are poor surgical candidates. The indications, complications, patient selection considerations, and technical complexities of the procedure will be discussed. Postprocedural drain management and the potential for shortened indwelling time are reviewed.

Endoscopic ultrasound (EUS) has transitioned from a primarily diagnostic to a therapeutic procedure. EUS-guided drainage of intra-abdominal fluid collections is common practice with vast data in the management of symptomatic, mature pancreatic fluid collections. Evidence has demonstrated that EUS-guided drainage for these intra-abdominal fluid collections is effective with an acceptable safety profile. These techniques are being utilized for the management of other intra-abdominal fluid collections with equally positive results. This review will discuss the utilization of EUS for the management of various intra-abdominal fluid collections, discussing efficacy, safety, and limitations.

When consulted for percutaneous catheter drainage (PCD) of abdominopelvic collections, interventional radiologists (IRs) should consider the appropriateness of this technique in the context of other options such as conservative, endoscopic, or surgical management. Whenever possible, published data should be considered prior to performing percutaneous drainage, especially as regards controversial scenarios such as the use of fibrinolytic therapy, the primary placement of large-bore drainage catheters, the drainage of cystic tumors, the drainage of splenic abscesses, and the treatment of collections lacking an in-line drainage window. This article examines past and present published data on PCD to dispel some common myths and guide IRs toward the best applications of PCD.

Thyroid nodules are prevalent, estimated to affect up to 68% of the population, and the incidence increases with age. With the advances in medical imaging utilization, the detection of incidental thyroid nodules continues to rise, and given the low rate of malignancy in incidentally discovered thyroid nodules (4-15%), diagnostic guidelines are imperative for their management. Several guidelines have been developed: the most commonly used guidelines in the United States include the American Thyroid Association (ATA) Guidelines and the American College of Radiology Thyroid Imaging Reporting Data System (TI-RADS). These guidelines call for the utilization of a biopsy of nodules depending on a sonographic morphologic categorization. This article aims to briefly review these two main guidelines and discuss the techniques for ultrasound-guided biopsy of thyroid nodules.

This article explores various techniques and tips for performing successful percutaneous biopsies of the breast and axillary lymph nodes using different imaging modalities. The discussion includes detailed image guidance on ultrasound-guided, stereotactic/tomosynthesis-guided, and MRI-guided biopsies. Advice for draining fluid collections in the breast is also reviewed. Key findings include the comparative effectiveness of different imaging techniques and practical advice for improving procedural outcomes. This information is particularly relevant for radiologists involved in diagnostic and interventional breast care. Recommendations for optimizing biopsy procedures and managing complications are also presented.

Percutaneous biopsy and drainage of pancreatic lesions, though less frequent due to advancements in endoscopic techniques, remain vital skills for interventional radiologists. This review details the indications, options, approaches, and technical considerations for pancreatic biopsy and (peri)pancreatic fluid drainage by examining a comprehensive range of literature. The importance of a multidisciplinary approach is emphasized to ensure optimal patient care and outcomes, highlighting current best practices and recent advancements.

Computed tomography guidance enables deep neck biopsies beyond the range of ultrasound and spares the patient more invasive open surgery. This review article describes proper patient preparation, devices, and techniques. Cases illustrate the favored access routes in the suprahyoid neck including the subzygomatic, retromandibular, transfacial, submastoid, transoral, and posterior approaches, as well as in the infrahyoid neck including the anterolateral and posterolateral approaches. A thorough understanding of the neck anatomy, assessment of prior imaging with respect to eloquent structures such as arteries and nerves, and a sound knowledge of the technique will result in an extremely low complication rate.