Seminars in Interventional Radiology最新文献

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.

Interventional radiology plays a vital role in performing noninvasive, nonvascular genitourinary interventions. This article discusses practical aspects of the biopsy technique using the cortical tangential approach for native and transplant kidneys. Additionally, the indications, contraindications, and procedure details of the nephrostomy tube and nephroureteral placement will be reviewed.

Imaging plays a central role in the management of patients with aortic disease. Such imaging can be made particularly complex by changing terminology and definitions, overlapping pathologies, and unfamiliarity with evolving endovascular treatment approaches. This article will review basic principles of aortic imaging that can be applied across a variety of settings and pathologies, with a description of key best practices and potential pitfalls for image acquisition, diagnostic assessment, and reporting. Additionally, the topic of imaging in the setting of endovascular aortic repair will be addressed, as well as a variety of imaging-related diagnostic challenges in the setting of chronic aortic dissection, including surgically repaired type A and uncomplicated type B dissections. Finally, recent developments in advanced aortic imaging will be highlighted with descriptions of several areas of promising research that may yield significant advances in imaging of aortic disease.