Transcatheter arterial chemoembolization (TACE) is the most widely used treatment modality for patients with hepatocellular carcinoma who are not eligible for surgery. Selective tumor embolization is very important, more so in patients with mild to moderate liver cell failure, but determining feeder vessels could be difficult with two-dimensional angiogram alone. Cone beam computed tomography and detection software are available for intraprocedural accurate feeder vessel detection; however, these facilities are not widely available. We have evaluated and successfully applied a very simple technique using only a portable ultrasonography machine to ensure superselective feeder cannulation prior to embolization.
{"title":"Agitated saline sonography: a simple technique for intraprocedural feeder identification during transcatheter arterial chemoembolization of hepatocellular carcinoma.","authors":"B. P. Krishna Prasad, Brijesh Ray","doi":"10.5152/dir.2015.15356","DOIUrl":"https://doi.org/10.5152/dir.2015.15356","url":null,"abstract":"Transcatheter arterial chemoembolization (TACE) is the most widely used treatment modality for patients with hepatocellular carcinoma who are not eligible for surgery. Selective tumor embolization is very important, more so in patients with mild to moderate liver cell failure, but determining feeder vessels could be difficult with two-dimensional angiogram alone. Cone beam computed tomography and detection software are available for intraprocedural accurate feeder vessel detection; however, these facilities are not widely available. We have evaluated and successfully applied a very simple technique using only a portable ultrasonography machine to ensure superselective feeder cannulation prior to embolization.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2015.15356","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71005771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Cai, B. Yeh, A. Westphalen, J. Roberts, Zhen J. Wang
Adult living donor liver transplantation (LDLT) is increasingly used for the treatment of end-stage liver disease. The three most commonly harvested grafts for LDLT are left lateral segment, left lobe, and right lobe grafts. The left lateral segment graft, which includes Couinaud's segments II and III, is usually used for pediatric recipients or small size recipients. Most of the adult recipients need either a left or a right lobe graft. Whether a left or right lobe graft should be harvested from the donors depends on estimated graft and donor remnant liver volume, as well as biliary and vascular anatomy. Detailed preoperative assessment of the potential donor liver volumetrics, biliary and vascular anatomy, and liver parenchyma is vital to minimize risks to the donors and maximize benefits to the recipients. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently the imaging modalities of choice in the preoperative evaluation of potential donors. This review provides an overview of key surgical considerations in LDLT that the radiologists must be aware of, and imaging findings on CT and MRI that the radiologists must convey to the surgeons when evaluating potential donors for LDLT.
{"title":"Adult living donor liver imaging.","authors":"L. Cai, B. Yeh, A. Westphalen, J. Roberts, Zhen J. Wang","doi":"10.5152/dir.2016.15323","DOIUrl":"https://doi.org/10.5152/dir.2016.15323","url":null,"abstract":"Adult living donor liver transplantation (LDLT) is increasingly used for the treatment of end-stage liver disease. The three most commonly harvested grafts for LDLT are left lateral segment, left lobe, and right lobe grafts. The left lateral segment graft, which includes Couinaud's segments II and III, is usually used for pediatric recipients or small size recipients. Most of the adult recipients need either a left or a right lobe graft. Whether a left or right lobe graft should be harvested from the donors depends on estimated graft and donor remnant liver volume, as well as biliary and vascular anatomy. Detailed preoperative assessment of the potential donor liver volumetrics, biliary and vascular anatomy, and liver parenchyma is vital to minimize risks to the donors and maximize benefits to the recipients. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently the imaging modalities of choice in the preoperative evaluation of potential donors. This review provides an overview of key surgical considerations in LDLT that the radiologists must be aware of, and imaging findings on CT and MRI that the radiologists must convey to the surgeons when evaluating potential donors for LDLT.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We read with interest the article entitled “Volumetric thin-section CT: evaluation of pulmonary interlobar fissures” by Guan et al. (1) in the November-December 2015 issue of Diagnostic and Interventional Radiology. The authors gave detailed information about interlobar fissures, their incompleteness, relationship to vascular structures, CT appearance, and defect location. The interlobar fissures and their variations are important for identifying pulmonary lesion locations, evaluating disease progression, and selecting appropriate surgical or interventional approaches. Therefore, it is important to know any detail about fissural anatomy and its variations. All horizontal (minor) interlobar fissures have been described as having one dome in the literature (2, 3). We would like to contribute by noting that they may also have a double dome. During the last five-year period, out of approximately 35 000 thorax CT scans, we came across five patients with double-domed horizontal fissure (Figs. 1, ,2).2). Those patients did not have any abnormality that might change fissural anatomy like atelectasis or fibrosis. Although double-domed horizontal fissure is a very rare entity, it is important to keep it in mind to avoid misinterpretation. Figure 1 A 35-year-old male patient. Axial CT image, 1 mm slice thickness, shows double-domed horizontal fissure (empty arrows, anterior dome; solid arrows, posterior dome; curved arrows, oblique fissure). Figure 2. a, b A 74-year-old male patient. Axial CT image 1 mm slice thickness (a) and sagittal oblique 2 mm reformatted CT image (b) show double-domed horizontal fissure (empty arrows, anterior dome; solid arrows, posterior dome; curved arrows, oblique fissure).
我们饶有兴趣地阅读了2015年11 - 12月刊《诊断与介入放射学》(Diagnostic and Interventional Radiology)上Guan等人(1)发表的题为“容积薄层CT:肺叶间裂的评估”的文章。作者详细介绍了脑叶间裂，其不完全性，与血管结构的关系，CT表现和缺陷位置。肺叶间裂及其变异对于确定肺病变位置、评估疾病进展以及选择合适的手术或介入方法具有重要意义。因此，了解裂缝解剖及其变化的任何细节是很重要的。所有水平的(小的)叶间裂隙在文献中都被描述为只有一个穹窿(2,3)。我们想通过指出它们也可能有双穹窿来做出贡献。在过去的五年里，在大约35000次胸部CT扫描中，我们遇到了5例双圆顶水平裂缝患者(图1、2)。这些患者没有任何可能改变裂解剖结构的异常，如肺不张或纤维化。虽然双圆顶水平裂缝是一种非常罕见的实体，但重要的是要记住它，以避免误解。图1男性，35岁。轴向CT图像，1mm层厚，显示双穹窿水平裂缝(空箭头，前穹窿;实箭头，后穹窿;弯曲的箭头，斜裂)。图2。a, b 74岁男性患者。轴向CT图像1mm切片厚度(a)和矢状斜2 mm重构CT图像(b)显示双穹窿水平裂缝(空箭头，前穹窿;实箭头，后穹窿;弯曲的箭头，斜裂)。
{"title":"Double-domed horizontal fissure.","authors":"I. Kabakus, Z. Atçeken, O. Arıyürek","doi":"10.5152/dir.2016.16020","DOIUrl":"https://doi.org/10.5152/dir.2016.16020","url":null,"abstract":"We read with interest the article entitled “Volumetric thin-section CT: evaluation of pulmonary interlobar fissures” by Guan et al. (1) in the November-December 2015 issue of Diagnostic and Interventional Radiology. The authors gave detailed information about interlobar fissures, their incompleteness, relationship to vascular structures, CT appearance, and defect location. The interlobar fissures and their variations are important for identifying pulmonary lesion locations, evaluating disease progression, and selecting appropriate surgical or interventional approaches. Therefore, it is important to know any detail about fissural anatomy and its variations. All horizontal (minor) interlobar fissures have been described as having one dome in the literature (2, 3). We would like to contribute by noting that they may also have a double dome. During the last five-year period, out of approximately 35 000 thorax CT scans, we came across five patients with double-domed horizontal fissure (Figs. 1, ,2).2). Those patients did not have any abnormality that might change fissural anatomy like atelectasis or fibrosis. Although double-domed horizontal fissure is a very rare entity, it is important to keep it in mind to avoid misinterpretation. \u0000 \u0000 \u0000 \u0000Figure 1 \u0000 \u0000A 35-year-old male patient. Axial CT image, 1 mm slice thickness, shows double-domed horizontal fissure (empty arrows, anterior dome; solid arrows, posterior dome; curved arrows, oblique fissure). \u0000 \u0000 \u0000 \u0000 \u0000 \u0000Figure 2. a, b \u0000 \u0000A 74-year-old male patient. Axial CT image 1 mm slice thickness (a) and sagittal oblique 2 mm reformatted CT image (b) show double-domed horizontal fissure (empty arrows, anterior dome; solid arrows, posterior dome; curved arrows, oblique fissure).","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Cieciera, C. Kratochwil, J. Moltz, H. Kauczor, Tim Holland Letz, P. Choyke, W. Mier, U. Haberkorn, F. Giesel
PURPOSE Patients with neuroendocrine tumors (NET) often present with disseminated liver metastases and can be treated with a number of different nuclides or nuclide combinations in peptide receptor radionuclide therapy (PRRT) depending on tumor load and lesion diameter. For quantification of disseminated liver lesions, semi-automatic lesion detection is helpful to determine tumor burden and tumor diameter in a time efficient manner. Here, we aimed to evaluate semi-automated measurement of total metastatic burden for therapy stratification. METHODS Nineteen patients with liver metastasized NET underwent contrast-enhanced 1.5 T MRI using gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid. Liver metastases (n=1537) were segmented using Fraunhofer MEVIS Software for three-dimensional (3D) segmentation. All lesions were stratified according to longest 3D diameter >20 mm or ≤20 mm and relative contribution to tumor load was used for therapy stratification. RESULTS Mean count of lesions ≤20 mm was 67.5 and mean count of lesions >20 mm was 13.4. However, mean contribution to total tumor volume of lesions ≤20 mm was 24%, while contribution of lesions >20 mm was 76%. CONCLUSION Semi-automatic lesion analysis provides useful information about lesion distribution in predominantly liver metastasized NET patients prior to PRRT. As conventional manual lesion measurements are laborious, our study shows this new approach is more efficient and less operator-dependent and may prove to be useful in the decision making process selecting the best combination PRRT in each patient.
{"title":"Semi-automatic 3D-volumetry of liver metastases from neuroendocrine tumors to improve combination therapy with 177Lu-DOTATOC and 90Y-DOTATOC.","authors":"M. Cieciera, C. Kratochwil, J. Moltz, H. Kauczor, Tim Holland Letz, P. Choyke, W. Mier, U. Haberkorn, F. Giesel","doi":"10.5152/dir.2015.15304","DOIUrl":"https://doi.org/10.5152/dir.2015.15304","url":null,"abstract":"PURPOSE\u0000Patients with neuroendocrine tumors (NET) often present with disseminated liver metastases and can be treated with a number of different nuclides or nuclide combinations in peptide receptor radionuclide therapy (PRRT) depending on tumor load and lesion diameter. For quantification of disseminated liver lesions, semi-automatic lesion detection is helpful to determine tumor burden and tumor diameter in a time efficient manner. Here, we aimed to evaluate semi-automated measurement of total metastatic burden for therapy stratification.\u0000\u0000\u0000METHODS\u0000Nineteen patients with liver metastasized NET underwent contrast-enhanced 1.5 T MRI using gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid. Liver metastases (n=1537) were segmented using Fraunhofer MEVIS Software for three-dimensional (3D) segmentation. All lesions were stratified according to longest 3D diameter >20 mm or ≤20 mm and relative contribution to tumor load was used for therapy stratification.\u0000\u0000\u0000RESULTS\u0000Mean count of lesions ≤20 mm was 67.5 and mean count of lesions >20 mm was 13.4. However, mean contribution to total tumor volume of lesions ≤20 mm was 24%, while contribution of lesions >20 mm was 76%.\u0000\u0000\u0000CONCLUSION\u0000Semi-automatic lesion analysis provides useful information about lesion distribution in predominantly liver metastasized NET patients prior to PRRT. As conventional manual lesion measurements are laborious, our study shows this new approach is more efficient and less operator-dependent and may prove to be useful in the decision making process selecting the best combination PRRT in each patient.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2015.15304","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE We aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination, and find a CT criterion to determine whether an individual is adult or not. METHODS Chest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system. RESULTS Epiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males. CONCLUSION CT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years.
{"title":"CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults.","authors":"F. Ufuk, Kadir Ağladıoğlu, N. Karabulut","doi":"10.5152/dir.2016.15355","DOIUrl":"https://doi.org/10.5152/dir.2016.15355","url":null,"abstract":"PURPOSE\u0000We aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination, and find a CT criterion to determine whether an individual is adult or not.\u0000\u0000\u0000METHODS\u0000Chest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system.\u0000\u0000\u0000RESULTS\u0000Epiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males.\u0000\u0000\u0000CONCLUSION\u0000CT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PURPOSE We aimed to compare various tumor-related radiologic morphometric changes and computed tomography (CT) perfusion parameters before and after treatment, and to determine the optimal imaging assessment technique for the prediction of early response in a rat tumor model treated with radiotherapy. METHODS Among paired tumors of FN13762 murine breast cancer cells implanted bilaterally in the necks of eight Fischer rats, tumors on the right side were treated with a single 20 Gy dose of radiotherapy. Perfusion CT studies were performed on day 0 before radiotherapy, and on days 1 and 5 after radiotherapy. Variables based on the size, including the longest diameter, tumor area, and volume, were measured. Quantitative perfusion analysis was performed for the whole tumor volume and permeabilities and blood volumes (BVs) were obtained. The area under the curve (AUC) difference in the histograms of perfusion parameters and texture analyses of uniformity and entropy were quantified. Apoptotic cell density was measured on pathology specimens immediately after perfusion imaging on day 5. RESULTS On day 1 after radiotherapy, differences in size between the irradiated and nonirradiated tumors were not significant. In terms of percent changes in the uniformity of permeabilities between tumors before irradiation and on day 1 after radiotherapy, the changes were significantly higher in the irradiated tumors than in the nonirradiated tumors (0.085 [-0.417, 0.331] vs. -0.131 [-0.536, 0.261], respectively; P = 0.042). The differences in AUCs of the histogram of voxel-by-voxel vascular permeability and BV in tumors between day 0 and day 1 were significantly higher in treated tumors compared with the control group (permeability, 21.4 [-2.2, 37.5] vs. 9.5 [-8.9, 33.8], respectively, P = 0.030; BV, 52.9 [-6186.0, 419.2] vs. 11.9 [-198.3, 346.7], respectively, P = 0.049). Apoptotic cell density showed a significantly positive correlation with the AUC difference of BV, the percent change of uniformity in permeability and BV (r=0.202, r=0.644, and r=0.706, respectively). CONCLUSION By enabling earlier tumor response prediction than morphometric evaluation, the histogram analysis of CT perfusion parameters appears to have a potential in providing prognostic predictive information in an irradiated rat model.
{"title":"Perfusion parameters as potential imaging biomarkers for the early prediction of radiotherapy response in a rat tumor model.","authors":"Ho Yun Lee, Namkug Kim, J. Goo, E. Chie, H. Song","doi":"10.5152/dir.2015.15171","DOIUrl":"https://doi.org/10.5152/dir.2015.15171","url":null,"abstract":"PURPOSE\u0000We aimed to compare various tumor-related radiologic morphometric changes and computed tomography (CT) perfusion parameters before and after treatment, and to determine the optimal imaging assessment technique for the prediction of early response in a rat tumor model treated with radiotherapy.\u0000\u0000\u0000METHODS\u0000Among paired tumors of FN13762 murine breast cancer cells implanted bilaterally in the necks of eight Fischer rats, tumors on the right side were treated with a single 20 Gy dose of radiotherapy. Perfusion CT studies were performed on day 0 before radiotherapy, and on days 1 and 5 after radiotherapy. Variables based on the size, including the longest diameter, tumor area, and volume, were measured. Quantitative perfusion analysis was performed for the whole tumor volume and permeabilities and blood volumes (BVs) were obtained. The area under the curve (AUC) difference in the histograms of perfusion parameters and texture analyses of uniformity and entropy were quantified. Apoptotic cell density was measured on pathology specimens immediately after perfusion imaging on day 5.\u0000\u0000\u0000RESULTS\u0000On day 1 after radiotherapy, differences in size between the irradiated and nonirradiated tumors were not significant. In terms of percent changes in the uniformity of permeabilities between tumors before irradiation and on day 1 after radiotherapy, the changes were significantly higher in the irradiated tumors than in the nonirradiated tumors (0.085 [-0.417, 0.331] vs. -0.131 [-0.536, 0.261], respectively; P = 0.042). The differences in AUCs of the histogram of voxel-by-voxel vascular permeability and BV in tumors between day 0 and day 1 were significantly higher in treated tumors compared with the control group (permeability, 21.4 [-2.2, 37.5] vs. 9.5 [-8.9, 33.8], respectively, P = 0.030; BV, 52.9 [-6186.0, 419.2] vs. 11.9 [-198.3, 346.7], respectively, P = 0.049). Apoptotic cell density showed a significantly positive correlation with the AUC difference of BV, the percent change of uniformity in permeability and BV (r=0.202, r=0.644, and r=0.706, respectively).\u0000\u0000\u0000CONCLUSION\u0000By enabling earlier tumor response prediction than morphometric evaluation, the histogram analysis of CT perfusion parameters appears to have a potential in providing prognostic predictive information in an irradiated rat model.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71005256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tae Ho Kim, C. Park, Sang Min Lee, H. Page McAdams, Young Tae Kim, J. Goo
PURPOSE We aimed to describe our initial experience with percutaneous transthoracic localization (PTL) of pulmonary nodules using a C-arm cone-beam CT (CBCT) virtual navigation guidance system. METHODS From February 2013 to March 2014, 79 consecutive patients (mean age, 61±10 years) with 81 solid or ground-glass nodules (mean size, 12.36±7.21 mm; range, 4.8-25 mm) underwent PTLs prior to video-assisted thoracoscopic surgery (VATS) excision under CBCT virtual navigation guidance using lipiodol (mean volume, 0.18±0.04 mL). Their procedural details, radiation dose, and complication rates were described. RESULTS All 81 target nodules were successfully localized within 10 mm (mean distance, 2.54±3.24 mm) from the lipiodol markings. Mean number of CT acquisitions was 3.2±0.7, total procedure time was 14.6±5.14 min, and estimated radiation exposure during the localization was 5.21±2.51 mSv. Postprocedural complications occurred in 14 cases (17.3%); complications were minimal pneumothorax (n=10, 12.3%), parenchymal hemorrhage (n=3, 3.7%), and a small amount of hemoptysis (n=1, 1.2%). All target nodules were completely resected; pathologic diagnosis included invasive adenocarcinoma (n=53), adenocarcinoma-in-situ (n=10), atypical adenomatous hyperplasia (n=4), metastasis (n=7), and benign lesions (n=7). CONCLUSION PTL procedures can be performed safely and accurately under the guidance of a CBCT virtual navigation system.
{"title":"Percutaneous transthoracic localization of pulmonary nodules under C-arm cone-beam CT virtual navigation guidance.","authors":"Tae Ho Kim, C. Park, Sang Min Lee, H. Page McAdams, Young Tae Kim, J. Goo","doi":"10.5152/dir.2015.15297","DOIUrl":"https://doi.org/10.5152/dir.2015.15297","url":null,"abstract":"PURPOSE\u0000We aimed to describe our initial experience with percutaneous transthoracic localization (PTL) of pulmonary nodules using a C-arm cone-beam CT (CBCT) virtual navigation guidance system.\u0000\u0000\u0000METHODS\u0000From February 2013 to March 2014, 79 consecutive patients (mean age, 61±10 years) with 81 solid or ground-glass nodules (mean size, 12.36±7.21 mm; range, 4.8-25 mm) underwent PTLs prior to video-assisted thoracoscopic surgery (VATS) excision under CBCT virtual navigation guidance using lipiodol (mean volume, 0.18±0.04 mL). Their procedural details, radiation dose, and complication rates were described.\u0000\u0000\u0000RESULTS\u0000All 81 target nodules were successfully localized within 10 mm (mean distance, 2.54±3.24 mm) from the lipiodol markings. Mean number of CT acquisitions was 3.2±0.7, total procedure time was 14.6±5.14 min, and estimated radiation exposure during the localization was 5.21±2.51 mSv. Postprocedural complications occurred in 14 cases (17.3%); complications were minimal pneumothorax (n=10, 12.3%), parenchymal hemorrhage (n=3, 3.7%), and a small amount of hemoptysis (n=1, 1.2%). All target nodules were completely resected; pathologic diagnosis included invasive adenocarcinoma (n=53), adenocarcinoma-in-situ (n=10), atypical adenomatous hyperplasia (n=4), metastasis (n=7), and benign lesions (n=7).\u0000\u0000\u0000CONCLUSION\u0000PTL procedures can be performed safely and accurately under the guidance of a CBCT virtual navigation system.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2015.15297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71005674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies.
{"title":"Percutaneous perirenal thrombin injection for the treatment of acute hemorrhage after renal biopsy.","authors":"S. Mafeld, M. Mcneill, P. Haslam","doi":"10.5152/dir.2015.15241","DOIUrl":"https://doi.org/10.5152/dir.2015.15241","url":null,"abstract":"Percutaneous renal biopsy is a valuable diagnostic approach. While commonly safe, it is not without risk and the most feared vascular complications include hemorrhage, pseudoaneurysm, and arteriovenous fistula formation. We report a case of acute hemorrhage after renal biopsy that was immediately identified by ultrasonography and successfully treated with percutaneous perirenal thrombin injection. This technique may prove a useful addition to the armamentarium of any operator performing renal biopsies.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71005288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Salsamendi, K. Pereira, D. Quintana, D. Bleicher, M. Tabbara, M. Goldstein, G. Narayanan
Hemodialysis access options become complex in long-term treatment for patients with renal disease, while awaiting renal transplantation (RT). Once upper extremity sites are exhausted, lower extremities are used. RT is preferably in the contralateral iliac fossa, rarely ipsilateral. In current literature, RT dysfunction secondary to the hemodynamic effects of an ipsilateral femoral arteriovenous graft (AVG) has been rarely described. To our knowledge, AVG ligation is the only published technique for hemodynamic correction of an ipsilateral AVG. We present a simple, potentially reversible endovascular approach to manage the hemodynamic effects of an AVG, without potentially permanently losing future AVG access.
{"title":"Endovascular management of renal transplant dysfunction secondary to hemodynamic effects related to ipsilateral femoral arteriovenous graft.","authors":"J. Salsamendi, K. Pereira, D. Quintana, D. Bleicher, M. Tabbara, M. Goldstein, G. Narayanan","doi":"10.5152/dir.2016.15134","DOIUrl":"https://doi.org/10.5152/dir.2016.15134","url":null,"abstract":"Hemodialysis access options become complex in long-term treatment for patients with renal disease, while awaiting renal transplantation (RT). Once upper extremity sites are exhausted, lower extremities are used. RT is preferably in the contralateral iliac fossa, rarely ipsilateral. In current literature, RT dysfunction secondary to the hemodynamic effects of an ipsilateral femoral arteriovenous graft (AVG) has been rarely described. To our knowledge, AVG ligation is the only published technique for hemodynamic correction of an ipsilateral AVG. We present a simple, potentially reversible endovascular approach to manage the hemodynamic effects of an AVG, without potentially permanently losing future AVG access.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71005899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Si, R. Zhai, Xiao-juan Liu, Kaiyan Yang, Li Wang, T. Jiang
PURPOSE We aimed to evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) values in lesions that manifest with architectural distortion (AD) on mammography. METHODS All full-field digital mammography (FFDM) images obtained between August 2010 and January 2013 were reviewed retrospectively, and 57 lesions showing AD were included in the study. Two independent radiologists reviewed all mammograms and MRI data and recorded lesion characteristics according to the BI-RADS lexicon. The gold standard was histopathologic results from biopsies or surgical excisions and results of the two-year follow-up. Receiver operating characteristic curve analysis was carried out to define the most effective threshold ADC value to differentiate malignant from benign breast lesions. We investigated the sensitivity and specificity of FFDM, DCE-MRI, FFDM+DCE-MRI, and DCE-MRI+ADC. RESULTS Of the 57 lesions analyzed, 28 were malignant and 29 were benign. The most effective threshold for the normalized ADC (nADC) was 0.61 with 93.1% sensitivity and 75.0% specificity. The sensitivity and specificity of DCE-MRI combined with nADC was 92.9% and 79.3%, respectively. DCE-MRI combined with nADC showed the highest specificity and equal sensitivity compared with other modalities, independent of the presentation of calcification. CONCLUSION DCE-MRI combined with nADC values was more reliable than mammography in differentiating the nature of disease manifesting as primary AD on mammography.
{"title":"MRI in the differential diagnosis of primary architectural distortion detected by mammography.","authors":"L. Si, R. Zhai, Xiao-juan Liu, Kaiyan Yang, Li Wang, T. Jiang","doi":"10.5152/dir.2016.15017","DOIUrl":"https://doi.org/10.5152/dir.2016.15017","url":null,"abstract":"PURPOSE\u0000We aimed to evaluate the diagnostic accuracy of a combination of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and apparent diffusion coefficient (ADC) values in lesions that manifest with architectural distortion (AD) on mammography.\u0000\u0000\u0000METHODS\u0000All full-field digital mammography (FFDM) images obtained between August 2010 and January 2013 were reviewed retrospectively, and 57 lesions showing AD were included in the study. Two independent radiologists reviewed all mammograms and MRI data and recorded lesion characteristics according to the BI-RADS lexicon. The gold standard was histopathologic results from biopsies or surgical excisions and results of the two-year follow-up. Receiver operating characteristic curve analysis was carried out to define the most effective threshold ADC value to differentiate malignant from benign breast lesions. We investigated the sensitivity and specificity of FFDM, DCE-MRI, FFDM+DCE-MRI, and DCE-MRI+ADC.\u0000\u0000\u0000RESULTS\u0000Of the 57 lesions analyzed, 28 were malignant and 29 were benign. The most effective threshold for the normalized ADC (nADC) was 0.61 with 93.1% sensitivity and 75.0% specificity. The sensitivity and specificity of DCE-MRI combined with nADC was 92.9% and 79.3%, respectively. DCE-MRI combined with nADC showed the highest specificity and equal sensitivity compared with other modalities, independent of the presentation of calcification.\u0000\u0000\u0000CONCLUSION\u0000DCE-MRI combined with nADC values was more reliable than mammography in differentiating the nature of disease manifesting as primary AD on mammography.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71005793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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