A. Salei, J. Raborn, P. Manapragada, Charles G Stoneburner, A. A. Abdel Aal, A. Gunn
PURPOSE We aimed to assess the efficacy of a dedicated inferior vena cava (IVC) filter retrieval program on filter retrieval rates and number of patients lost to follow-up. METHODS A dedicated IVC filter retrieval program began in July 2016. This consisted of tracking all patients with retrievable filters placed by interventional radiology (IR). At the time of filter placement, patients were scheduled for a retrieval consult in the IR clinic. Any missed appointments were followed up by a physician assistant. The program was overseen by a single IR physician. To assess this program's efficacy, we reviewed the records of all patients who had retrievable IVC filters placed by IR nine months prior to and nine months after program initiation. Demographics and clinical factors were then collected and compared. A P value of < 0.05 was considered statistically significant. RESULTS Prior to the program, 76 patients (31 males, 45 females; mean age, 64.2 years) had retrievable filters placed; 75% were placed due to a contraindication to anticoagulation. From this group, five filters were removed (6.6%), 42 patients were lost to follow-up (55.3%), 22 patients died (29.0%), and seven filters were deemed permanent by a physician after placement (9.2%). All five retrievals were successful and no complications were reported. After program initiation, 106 patients (59 males, 47 females; mean age, 58.8 years) had retrievable filters placed; 75.5% were placed due to a contraindication to anticoagulation. In this group, 30 filters were retrieved (retrieval rate 28.3%), 17 patients were lost to follow-up (16%), 23 patients died (21.7%), 28 filters were deemed permanent by a physician after placement (26.4%), and decisions were still pending in eight patients (7.5%). One patient (3.3%) had a minor complication during filter retrieval. Initiation of a filter retrieval program increased our retrieval rate (6.6% vs. 28.3%; P < 0.001) and reduced the number of patients with filters that were lost to follow-up (55.3% vs. 16%; P < 0.001). CONCLUSION Dedicated filter retrieval program is effective in increasing filter retrieval rates and decreasing the number of patients lost to follow-up.
目的:评价下腔静脉专用滤器回收方案对滤器回收率和失访患者数量的影响。方法2016年7月启动专用IVC滤网检索项目。这包括跟踪所有通过介入放射学(IR)放置可回收滤光片的患者。在过滤器放置的时候，患者被安排在IR诊所进行检索咨询。任何错过的预约都由医师助理跟进。该项目由一名IR医生监督。为了评估该计划的疗效，我们回顾了所有患者的记录，这些患者在计划开始前9个月和计划开始后9个月使用IR放置的可回收的IVC过滤器。然后收集和比较人口统计学和临床因素。P值< 0.05认为有统计学意义。结果项目实施前，76例患者(男31例，女45例;平均年龄64.2岁)放置可回收过滤器;75%是由于抗凝禁忌而放置的。在该组中，5个滤镜被移除(6.6%)，42例患者失去随访(55.3%)，22例患者死亡(29.0%)，7个滤镜在放置后被医生认为是永久性的(9.2%)。5例拔牙均成功，无并发症报道。项目启动后，106例患者(男59例，女47例;平均年龄58.8岁)放置可回收过滤器;75.5%因抗凝禁忌而放置。在该组中，30个过滤器被检索(检索率28.3%)，17例患者失去随访(16%)，23例患者死亡(21.7%)，28例过滤器在放置后被医生认为是永久性的(26.4%)，8例患者(7.5%)仍未决定。1例(3.3%)患者在取滤器过程中出现轻微并发症。过滤器检索程序的启动提高了检索率(6.6% vs. 28.3%;P < 0.001)，并减少了丢失随访的过滤器患者数量(55.3% vs. 16%;P < 0.001)。结论专用滤器检索方案可有效提高滤器检索率，减少失访人数。
{"title":"Effect of a dedicated inferior vena cava filter retrieval program on retrieval rates and number of patients lost to follow up.","authors":"A. Salei, J. Raborn, P. Manapragada, Charles G Stoneburner, A. A. Abdel Aal, A. Gunn","doi":"10.5152/dir.2019.18579","DOIUrl":"https://doi.org/10.5152/dir.2019.18579","url":null,"abstract":"PURPOSE\u0000We aimed to assess the efficacy of a dedicated inferior vena cava (IVC) filter retrieval program on filter retrieval rates and number of patients lost to follow-up.\u0000\u0000\u0000METHODS\u0000A dedicated IVC filter retrieval program began in July 2016. This consisted of tracking all patients with retrievable filters placed by interventional radiology (IR). At the time of filter placement, patients were scheduled for a retrieval consult in the IR clinic. Any missed appointments were followed up by a physician assistant. The program was overseen by a single IR physician. To assess this program's efficacy, we reviewed the records of all patients who had retrievable IVC filters placed by IR nine months prior to and nine months after program initiation. Demographics and clinical factors were then collected and compared. A P value of < 0.05 was considered statistically significant.\u0000\u0000\u0000RESULTS\u0000Prior to the program, 76 patients (31 males, 45 females; mean age, 64.2 years) had retrievable filters placed; 75% were placed due to a contraindication to anticoagulation. From this group, five filters were removed (6.6%), 42 patients were lost to follow-up (55.3%), 22 patients died (29.0%), and seven filters were deemed permanent by a physician after placement (9.2%). All five retrievals were successful and no complications were reported. After program initiation, 106 patients (59 males, 47 females; mean age, 58.8 years) had retrievable filters placed; 75.5% were placed due to a contraindication to anticoagulation. In this group, 30 filters were retrieved (retrieval rate 28.3%), 17 patients were lost to follow-up (16%), 23 patients died (21.7%), 28 filters were deemed permanent by a physician after placement (26.4%), and decisions were still pending in eight patients (7.5%). One patient (3.3%) had a minor complication during filter retrieval. Initiation of a filter retrieval program increased our retrieval rate (6.6% vs. 28.3%; P < 0.001) and reduced the number of patients with filters that were lost to follow-up (55.3% vs. 16%; P < 0.001).\u0000\u0000\u0000CONCLUSION\u0000Dedicated filter retrieval program is effective in increasing filter retrieval rates and decreasing the number of patients lost to follow-up.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2020-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44320932","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}
Jaspreet Singh Sangha Brar, Saurav Gupta, S. H. Mohideen, L. Liauw, Narayan Lath
The association between immunoglobulin IgG4 and autoimmune pancreatitis was first shown in 2001. Since then many previously established fibrosclerotic diseases demonstrating synchronous or metachronous multiorgan involvement have been included within the ambit of IgG4-related disease. Diagnostic criteria have been proposed involving 1) serum IgG4 level elevated beyond 135 mg/dL, 2) IgG4+ to IgG+ plasma cell ratio >40% and >10 IgG4+ cells per high power field of biopsy sample and 3) a constellation of imaging features which involve a variety of organ systems. We present a pictorial essay demonstrating the spectrum of imaging findings for IgG4-related disease, including dacryosialadenitis, variety of renal lesions, tumefactive thickening of the extraocular muscles and orbital nerve, sclerosing cholangitis, and type I pancreatitis. Imaging plays an important role in diagnosis, screening for multiorgan involvement, and follow-up of the disease. You may cite this article as: Sangha Brar JS, Gupta S, Haja Mohideen SM, Liauw L, Lath N. The pancreatic and extrapancreatic manifestations of IgG4-related disease. Diagn Interv Radiol 2018; 24:10.5152/dir.2018.17319. Diagnostic and Interventional Radiology Brar et al. The intraorbital findings of the IgG4-RD may include orbital inflammatory pseudotumor, which may present as unilateral or bilateral intraconal, conal, or extraconal masses, as shown in Fig. 2. Although inflammatory pseudotumor may be within the spectrum of IgG4-RD, most cases have a different etiology (4). Thickening of the cranial nerves may be encountered, with trigeminal nerve and its branches being the most commonly involved nerve (Figs. 3, 4). It presents as tubuMain points Diagnostic criteria for IgG4-related disease include: • Organ involvement: i. Dacryosialadenitis: swelling of two pairs of glands ii. Lungs: solid nodular, round-shaped ground glass opacities, alveolar interstitial, or bronchovascular lesions iii. Eyes: extraocular muscle and orbital nerve mass-like thickening iv. Kidneys: tubulointerstitial nephritis, cortical nodules, peripheral cortical lesions and renal pelvis involvement v. Sclerosing cholangitis (with response to steroid trial) vi. Type I pancreatitis (with response to steroid trial) vii. Others: retroperitoneal fibrosis, lymphadenopathy, sclerosing mesenteritis • Serum IgG4 >135 mg/dL • IgG4+ / IgG+ cell ratio >40% and >10 IgG+ cells per high power field of biopsy sample Figure 1. Axial T1-weighted contrast-enhanced MRI of the orbits showing asymmetric thickening and enhancement of the left lacrimal gland (left arrow). Incisional biopsy showed IgG4-related sclerosing dacroadenitis. Figure 2. CT image of the orbits shows symmetrical thickening and enhancement of bilateral lacrimal glands, one of which was biopsied later to reveal IgG4-RD (horizontal arrows). Figure 3. T1-weighted contrast-enhanced image of the brain shows thickening and enhancement of the left V1 (first branch of trigeminal nerve) (left arrow). Fig
{"title":"The pancreatic and extrapancreatic manifestations of IgG4-related disease","authors":"Jaspreet Singh Sangha Brar, Saurav Gupta, S. H. Mohideen, L. Liauw, Narayan Lath","doi":"10.5152/dir.2018.14319","DOIUrl":"https://doi.org/10.5152/dir.2018.14319","url":null,"abstract":"The association between immunoglobulin IgG4 and autoimmune pancreatitis was first shown in 2001. Since then many previously established fibrosclerotic diseases demonstrating synchronous or metachronous multiorgan involvement have been included within the ambit of IgG4-related disease. Diagnostic criteria have been proposed involving 1) serum IgG4 level elevated beyond 135 mg/dL, 2) IgG4+ to IgG+ plasma cell ratio >40% and >10 IgG4+ cells per high power field of biopsy sample and 3) a constellation of imaging features which involve a variety of organ systems. We present a pictorial essay demonstrating the spectrum of imaging findings for IgG4-related disease, including dacryosialadenitis, variety of renal lesions, tumefactive thickening of the extraocular muscles and orbital nerve, sclerosing cholangitis, and type I pancreatitis. Imaging plays an important role in diagnosis, screening for multiorgan involvement, and follow-up of the disease. You may cite this article as: Sangha Brar JS, Gupta S, Haja Mohideen SM, Liauw L, Lath N. The pancreatic and extrapancreatic manifestations of IgG4-related disease. Diagn Interv Radiol 2018; 24:10.5152/dir.2018.17319. Diagnostic and Interventional Radiology Brar et al. The intraorbital findings of the IgG4-RD may include orbital inflammatory pseudotumor, which may present as unilateral or bilateral intraconal, conal, or extraconal masses, as shown in Fig. 2. Although inflammatory pseudotumor may be within the spectrum of IgG4-RD, most cases have a different etiology (4). Thickening of the cranial nerves may be encountered, with trigeminal nerve and its branches being the most commonly involved nerve (Figs. 3, 4). It presents as tubuMain points Diagnostic criteria for IgG4-related disease include: • Organ involvement: i. Dacryosialadenitis: swelling of two pairs of glands ii. Lungs: solid nodular, round-shaped ground glass opacities, alveolar interstitial, or bronchovascular lesions iii. Eyes: extraocular muscle and orbital nerve mass-like thickening iv. Kidneys: tubulointerstitial nephritis, cortical nodules, peripheral cortical lesions and renal pelvis involvement v. Sclerosing cholangitis (with response to steroid trial) vi. Type I pancreatitis (with response to steroid trial) vii. Others: retroperitoneal fibrosis, lymphadenopathy, sclerosing mesenteritis • Serum IgG4 >135 mg/dL • IgG4+ / IgG+ cell ratio >40% and >10 IgG+ cells per high power field of biopsy sample Figure 1. Axial T1-weighted contrast-enhanced MRI of the orbits showing asymmetric thickening and enhancement of the left lacrimal gland (left arrow). Incisional biopsy showed IgG4-related sclerosing dacroadenitis. Figure 2. CT image of the orbits shows symmetrical thickening and enhancement of bilateral lacrimal glands, one of which was biopsied later to reveal IgG4-RD (horizontal arrows). Figure 3. T1-weighted contrast-enhanced image of the brain shows thickening and enhancement of the left V1 (first branch of trigeminal nerve) (left arrow). Fig","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2018.14319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43358730","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}
Nantaka Kiranantawat, M. Petranović, S. McDermott, M. Gilman, S. Digumarthy, J. Shepard, Amita Sharma
PURPOSE To evaluate the feasibility, accuracy and complications of CT-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions. METHODS Consecutive PTNB procedures in an academic institution over a 4 year period were reviewed, 53 of which were performed on patients with cavitary lesions The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathological results and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy. RESULTS The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 non-infectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A non-significant higher chest tube insertion rate was seen in cavities with a thinner wall. CONCLUSION PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.
{"title":"Feasibility and accuracy of CT-guided percutaneous needle biopsy of cavitary pulmonary lesions.","authors":"Nantaka Kiranantawat, M. Petranović, S. McDermott, M. Gilman, S. Digumarthy, J. Shepard, Amita Sharma","doi":"10.5152/dir.2019.18061","DOIUrl":"https://doi.org/10.5152/dir.2019.18061","url":null,"abstract":"PURPOSE\u0000To evaluate the feasibility, accuracy and complications of CT-guided percutaneous transthoracic needle biopsy (PTNB) of cavitary lesions.\u0000\u0000\u0000METHODS\u0000Consecutive PTNB procedures in an academic institution over a 4 year period were reviewed, 53 of which were performed on patients with cavitary lesions The demographic data of patients, lesion characteristics, biopsy technique and complications, initial pathological results and final diagnosis were reviewed. A final diagnosis was established through surgical correlation, microbiology or clinico-radiologic follow-up for at least 18 months after biopsy.\u0000\u0000\u0000RESULTS\u0000The overall accuracy of PTNB was 81%. In 33 patients (62%) the cavitary lesion was found to be malignant (23 lung cancers and 10 metastases). The sensitivity and specificity for malignancy was 91% and 100%, respectively. In 20 patients (38%) a benign etiology was established (16 infections and 4 non-infectious etiologies), with PTNB demonstrating a sensitivity of 81% and specificity of 100% for infection. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Minor complications occurred in 28% of cases: 13 pneumothoraces (5 requiring chest tube), 1 small hemothorax, and 1 mild hemoptysis. A non-significant higher chest tube insertion rate was seen in cavities with a thinner wall.\u0000\u0000\u0000CONCLUSION\u0000PTNB of cavitary lesions provides high accuracy, sensitivity, and specificity for both malignancy and infection and has an acceptable complication rate. Wall thickness at the biopsy site, lesion in lower lobe, and malignancy were significant independent risk factors for diagnostic success. Samples for microbiology should be obtained in all patients, especially in the absence of on-site cytology, due to the high prevalence of infection in cavitary lesions.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45832566","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}
Yan Xu, Ting-ting Zhang, Zhihai Hu, Juan Li, Hong-jun Hou, Zu-shan Xu, Wen He
PURPOSE To evaluate the quality of chest CT images obtained with low-dose computed tomography (LDCT) using three iterative reconstruction (IR) algorithms. METHODS Two 64-detector spiral CT scanners (HDCT, iCT) were used to scan a chest phantom containing 6 ground-glass nodules (GGNs) at 11 radiation dose levels. CT images were reconstructed by FBP or three IR algorithms. Reconstructed images were analyzed for CT values, average noise, contrast-to-noise ratio (CNR) values, subjective image noise, and diagnostic acceptability of the GGNs. Repeated-measures analysis of variance was used for statistical analyses. RESULTS Average noise decreased and CNR increased with increasing radiation dose when the same reconstruction algorithm was applied. Image average noise reconstructed with MBIR was significantly lower than reconstructed with iDOSE4 at the same low radiation doses. The two radiologists showed good interobserver consistency in image quality with kappa 0.83. A significant relationship was found between image noise and diagnostic acceptability of the GGNs. CONCLUSION Three IR algorithms are able to reduce the image noise and improve the image quality in LDCT. In the same radiation dose, the LDCT images quality reconstructed with MBIR algorithms is better than that of other IR algorithms.
{"title":"Effect of iterative reconstruction techniques on image quality in low radiation dose chest CT: a phantom study.","authors":"Yan Xu, Ting-ting Zhang, Zhihai Hu, Juan Li, Hong-jun Hou, Zu-shan Xu, Wen He","doi":"10.5152/dir.2019.18539","DOIUrl":"https://doi.org/10.5152/dir.2019.18539","url":null,"abstract":"PURPOSE\u0000To evaluate the quality of chest CT images obtained with low-dose computed tomography (LDCT) using three iterative reconstruction (IR) algorithms.\u0000\u0000\u0000METHODS\u0000Two 64-detector spiral CT scanners (HDCT, iCT) were used to scan a chest phantom containing 6 ground-glass nodules (GGNs) at 11 radiation dose levels. CT images were reconstructed by FBP or three IR algorithms. Reconstructed images were analyzed for CT values, average noise, contrast-to-noise ratio (CNR) values, subjective image noise, and diagnostic acceptability of the GGNs. Repeated-measures analysis of variance was used for statistical analyses.\u0000\u0000\u0000RESULTS\u0000Average noise decreased and CNR increased with increasing radiation dose when the same reconstruction algorithm was applied. Image average noise reconstructed with MBIR was significantly lower than reconstructed with iDOSE4 at the same low radiation doses. The two radiologists showed good interobserver consistency in image quality with kappa 0.83. A significant relationship was found between image noise and diagnostic acceptability of the GGNs.\u0000\u0000\u0000CONCLUSION\u0000Three IR algorithms are able to reduce the image noise and improve the image quality in LDCT. In the same radiation dose, the LDCT images quality reconstructed with MBIR algorithms is better than that of other IR algorithms.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18539","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43919092","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}
Radiomics is a relatively new word for the field of radiology, meaning the extraction of a high number of quantitative features from medical images. Artificial intelligence (AI) is broadly a set of advanced computational algorithms that basically learn the patterns in the data provided to make predictions on unseen data sets. Radiomics can be coupled with AI because of its better capability of handling a massive amount of data compared with the traditional statistical methods. Together, the primary purpose of these fields is to extract and analyze as much and meaningful hidden quantitative data as possible to be used in decision support. Nowadays, both radiomics and AI have been getting attention for their remarkable success in various radiological tasks, which has been met with anxiety by most of the radiologists due to the fear of replacement by intelligent machines. Considering ever-developing advances in computational power and availability of large data sets, the marriage of humans and machines in future clinical practice seems inevitable. Therefore, regardless of their feelings, the radiologists should be familiar with these concepts. Our goal in this paper was three-fold: first, to familiarize radiologists with the radiomics and AI; second, to encourage the radiologists to get involved in these ever-developing fields; and, third, to provide a set of recommendations for good practice in design and assessment of future works.
{"title":"Radiomics with artificial intelligence: a practical guide for beginners.","authors":"B. Koçak, E. S. Durmaz, Ece Ateş, Ö. Kılıçkesmez","doi":"10.5152/dir.2019.19321","DOIUrl":"https://doi.org/10.5152/dir.2019.19321","url":null,"abstract":"Radiomics is a relatively new word for the field of radiology, meaning the extraction of a high number of quantitative features from medical images. Artificial intelligence (AI) is broadly a set of advanced computational algorithms that basically learn the patterns in the data provided to make predictions on unseen data sets. Radiomics can be coupled with AI because of its better capability of handling a massive amount of data compared with the traditional statistical methods. Together, the primary purpose of these fields is to extract and analyze as much and meaningful hidden quantitative data as possible to be used in decision support. Nowadays, both radiomics and AI have been getting attention for their remarkable success in various radiological tasks, which has been met with anxiety by most of the radiologists due to the fear of replacement by intelligent machines. Considering ever-developing advances in computational power and availability of large data sets, the marriage of humans and machines in future clinical practice seems inevitable. Therefore, regardless of their feelings, the radiologists should be familiar with these concepts. Our goal in this paper was three-fold: first, to familiarize radiologists with the radiomics and AI; second, to encourage the radiologists to get involved in these ever-developing fields; and, third, to provide a set of recommendations for good practice in design and assessment of future works.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.19321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48359024","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}
T. Türker, J. Sheppard, A. Klauser, Stephen S. Johnston, H. Amerongen, M. Taljanovic
PURPOSE Our hypothesis in this study is that the radial and ulnar collateral ligaments of the wrist exist and are true ligaments which can be visualized by high resolution ultrasound. METHODS High-resolution ultrasound examination of the radial and ulnar collateral ligaments of the wrist was performed on 56 fresh cadaveric wrists. The visibility of these ligaments was assessed by four observers who classified the ligaments in consensus as well seen, adequately seen or not seen. Surgical dissections of 12 radial collateral ligaments and 12 ulnar collateral ligaments were then performed and the ligaments were classified as present or absent. The ultrasound and dissection results were then compared. To confirm that the dissected structures represent true ligaments a histologic examination of the ligaments was performed. RESULTS All examined radial and ulnar collateral ligaments were seen on the ultrasound examination. The radial collateral ligament was seen between the radial styloid and radial aspect of the scaphoid. The ulnar collateral ligament was seen between ulnar styloid process and the triquetrum. On all surgical dissections, the radial collateral ligament was present at the floor of the first extensor compartment and the ulnar collateral ligament was at the floor of the sixth extensor compartment. Both ligaments were proven to be true capsular ligaments on both dissection and histological examinations. CONCLUSION The radial and ulnar collateral ligaments of the wrist are true ligaments and can be seen at the floor of the first and the sixth extensor compartments, respectively, using a high-resolution ultrasound. Based on their anatomic location, they most likely provide static stability to the wrist joint.
{"title":"The radial and ulnar collateral ligaments of the wrist are true ligaments.","authors":"T. Türker, J. Sheppard, A. Klauser, Stephen S. Johnston, H. Amerongen, M. Taljanovic","doi":"10.5152/dir.2019.19036","DOIUrl":"https://doi.org/10.5152/dir.2019.19036","url":null,"abstract":"PURPOSE\u0000Our hypothesis in this study is that the radial and ulnar collateral ligaments of the wrist exist and are true ligaments which can be visualized by high resolution ultrasound.\u0000\u0000\u0000METHODS\u0000High-resolution ultrasound examination of the radial and ulnar collateral ligaments of the wrist was performed on 56 fresh cadaveric wrists. The visibility of these ligaments was assessed by four observers who classified the ligaments in consensus as well seen, adequately seen or not seen. Surgical dissections of 12 radial collateral ligaments and 12 ulnar collateral ligaments were then performed and the ligaments were classified as present or absent. The ultrasound and dissection results were then compared. To confirm that the dissected structures represent true ligaments a histologic examination of the ligaments was performed.\u0000\u0000\u0000RESULTS\u0000All examined radial and ulnar collateral ligaments were seen on the ultrasound examination. The radial collateral ligament was seen between the radial styloid and radial aspect of the scaphoid. The ulnar collateral ligament was seen between ulnar styloid process and the triquetrum. On all surgical dissections, the radial collateral ligament was present at the floor of the first extensor compartment and the ulnar collateral ligament was at the floor of the sixth extensor compartment. Both ligaments were proven to be true capsular ligaments on both dissection and histological examinations.\u0000\u0000\u0000CONCLUSION\u0000The radial and ulnar collateral ligaments of the wrist are true ligaments and can be seen at the floor of the first and the sixth extensor compartments, respectively, using a high-resolution ultrasound. Based on their anatomic location, they most likely provide static stability to the wrist joint.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.19036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49117056","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}
Tuğba İlkem Kurtoğlu Özçağlayan, Sibel Özkan Gürdal, M. Öznur, Ömer Özçağlayan, M. Dogru, B. Topçu
PURPOSE In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods. METHODS From July 2015 to December 2016, a total 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed. RESULTS After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015). CONCLUSION BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.
{"title":"Effectiveness of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions?","authors":"Tuğba İlkem Kurtoğlu Özçağlayan, Sibel Özkan Gürdal, M. Öznur, Ömer Özçağlayan, M. Dogru, B. Topçu","doi":"10.5152/dir.2019.18427","DOIUrl":"https://doi.org/10.5152/dir.2019.18427","url":null,"abstract":"PURPOSE\u0000In this study, we aimed to investigate the breast lesion excision system (BLES) as a tool and a practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions. We also wanted to share our initial experience with BLES and compare it with standard percutaneous biopsy methods.\u0000\u0000\u0000METHODS\u0000From July 2015 to December 2016, a total 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or had high-risk factors, high-grade anxiety, or suspicious follow-up lesions were enrolled in the study. These lesions were classified as Breast Imaging Reporting and Data System (BI-RADS) 3 or 4, which are under 2 cm. Pathologic diagnoses before and after BLES were evaluated comparatively. The diagnostic and therapeutic success and the complications of CNB and BLES were analyzed.\u0000\u0000\u0000RESULTS\u0000After BLES, two cases were diagnosed as atypical lobular hyperplasia and atypical ductal hyperplasia. Since the surgical margin was negative, re-excision was not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 cases (2%), and spontaneous remission was observed. Two patients (4%) complained of pain during the procedure. Radiofrequency-related thermal damage to the specimen showed: Grade 0 (<0.5 mm) damage in 88%, Grade 1 (0.5-1.5 mm) in 10%, Grade 2 (>1.5 mm or thermal damage in diffuse areas) in 2%, and Grade 3 (diffuse thermal damage or inability to diagnose) in 0%. We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015).\u0000\u0000\u0000CONCLUSION\u0000BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and atypical lobular hyperplasia with high complete excision rates without fragmentation of lesions.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49661991","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}
E. Ünal, I. Idilman, A. Karaosmanoğlu, M. Özmen, D. Akata, M. Karçaaltıncaba
PURPOSE We aimed to investigate the reasons for hyperintensity at fat spared area in steatotic liver at hepatobiliary phase (HBP) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver magnetic resonance imaging. METHODS Twenty-two patients with focal fat spared area demonstrating hyperintensity on HBP images were included. A region of interest was placed on in- and opposed-phase images at fat spared area and liver to measure the fat. The measurement was also performed on precontrast T1-weighted and HBP images. The signal intensities of spleen, kidney, muscle, intervertebral disc, and spinal cord were also recorded. RESULTS The mean fat fraction of liver and fat spared area was 24.86% (8%-46%) and 8.41% (1%-34%), respectively (P < 0.001). There was a significant positive correlation between liver parenchyma fat fraction and delta fat fraction (r=0.74, P < 0.001). The mean signal intensity values of fat spared areas were higher compared with liver on precontrast T1-weighted and HBP images (P < 0.001). The mean relative enhancement ratio of liver and fat spared areas were 0.98 (0.05-1.90) and 1.15 (0.22-2.03), respectively (P < 0.001). However, in 6 patients, the relative enhancement ratio of liver and fat spared areas were almost equal. The uptake of Gd-EOB at fat spared area was not correlated with the degree of steatosis (r = -0.01, P = 0.95). CONCLUSION Fat spared area in steatotic liver appears hyperintense on HBP images due to increased relative enhancement ratio and/or baseline hyperintensity on precontrast images.
{"title":"Hyperintensity at fat spared area in steatotic liver on the hepatobiliary phase MRI.","authors":"E. Ünal, I. Idilman, A. Karaosmanoğlu, M. Özmen, D. Akata, M. Karçaaltıncaba","doi":"10.5152/DIR.2019.18535","DOIUrl":"https://doi.org/10.5152/DIR.2019.18535","url":null,"abstract":"PURPOSE\u0000We aimed to investigate the reasons for hyperintensity at fat spared area in steatotic liver at hepatobiliary phase (HBP) on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) enhanced liver magnetic resonance imaging.\u0000\u0000\u0000METHODS\u0000Twenty-two patients with focal fat spared area demonstrating hyperintensity on HBP images were included. A region of interest was placed on in- and opposed-phase images at fat spared area and liver to measure the fat. The measurement was also performed on precontrast T1-weighted and HBP images. The signal intensities of spleen, kidney, muscle, intervertebral disc, and spinal cord were also recorded.\u0000\u0000\u0000RESULTS\u0000The mean fat fraction of liver and fat spared area was 24.86% (8%-46%) and 8.41% (1%-34%), respectively (P < 0.001). There was a significant positive correlation between liver parenchyma fat fraction and delta fat fraction (r=0.74, P < 0.001). The mean signal intensity values of fat spared areas were higher compared with liver on precontrast T1-weighted and HBP images (P < 0.001). The mean relative enhancement ratio of liver and fat spared areas were 0.98 (0.05-1.90) and 1.15 (0.22-2.03), respectively (P < 0.001). However, in 6 patients, the relative enhancement ratio of liver and fat spared areas were almost equal. The uptake of Gd-EOB at fat spared area was not correlated with the degree of steatosis (r = -0.01, P = 0.95).\u0000\u0000\u0000CONCLUSION\u0000Fat spared area in steatotic liver appears hyperintense on HBP images due to increased relative enhancement ratio and/or baseline hyperintensity on precontrast images.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/DIR.2019.18535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42517764","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}
T. S. Meijer, L. de Geus-Oei, C. H. Martini, Fred G. J. Tijl, M. Elske Sitsen, A. V. van Erkel, R. W. van der Meer, E. Kapiteijn, A.L. Vahrmeijer, M. Burgmans
PURPOSE In patients undergoing percutaneous liver perfusion with melphalan (M-PHP), the presence of variant hepatic arteries (HAs) may require catheter repositioning and thus prolong procedure time. Coil-embolization of variant HAs may enable M-PHP with a single catheter position as occlusion of variant HAs results in redistribution of flow through preexisting intrahepatic arterial collaterals. Aim of this study was to evaluate whether redistribution of flow has any negative effect on therapeutic response in ocular melanoma patients undergoing M-PHP. METHODS We retrospectively analyzed pretreatment angiograms in all 32 patients that underwent M-PHP between January 2014 and March 2017 for unresectable liver metastases from ocular melanoma. Patients that underwent embolization of a variant left HA (LHA) or middle HA (MHA) during pretreatment angiography followed by at least one technically successful M-PHP, were included for further analysis. Redistribution of arterial flow was evaluated on angiography and cone-beam CT (CBCT) images. In each patient, tumor response in liver segments with redistributed blood flow was evaluated using RECIST 1.1 and mRECIST, and then compared to tumor response in segments without flow redistribution. Follow-up scans were reviewed to evaluate progression of liver metastases. RESULTS A total of 12 patients were included. Replaced LHA embolization resulted in redistribution of flow to segment(s) 2 (n=3), 2 and 3 (n=6), and 2, 3 and 4 (n=1). MHA embolization resulted in redistribution of flow to segment 4 (n=2). Successful redistribution was confirmed by angiography and/or CBCT in all patients. Tumor response was similar for redistributed and non-redistributed liver segments in 8 out of 9 patients (88.9%) according to RECIST 1.1, and in 8 out of 8 patients (100.0%) according to mRECIST. In three patients, tumor response was not evaluable according to RECIST 1.1 or mRECIST as metastases were too small to be categorized as target lesions (n=1), or target lesions were confined to non-redistributed segments (n=2). In one patient, tumor response was not evaluable according to mRECIST as target lesions in the redistributed segments were hypovascular. After a median follow-up time of 17.1 months (range 9.1-38.5), hepatic progression was seen in 9 out of 12 patients with a median time to progression of 9.9 months (range 2.5-17.7). Progression of liver metastases was never seen in the redistributed liver segments only. CONCLUSION Flow redistribution in liver segments by coil-embolization of variant HAs is a feasible technique that does not seem to compromise tumor response in patients undergoing M-PHP.
{"title":"Embolization of variant hepatic arteries in patients undergoing percutaneous hepatic perfusion for unresectable liver metastases of ocular melanoma.","authors":"T. S. Meijer, L. de Geus-Oei, C. H. Martini, Fred G. J. Tijl, M. Elske Sitsen, A. V. van Erkel, R. W. van der Meer, E. Kapiteijn, A.L. Vahrmeijer, M. Burgmans","doi":"10.5152/dir.2019.18138","DOIUrl":"https://doi.org/10.5152/dir.2019.18138","url":null,"abstract":"PURPOSE\u0000In patients undergoing percutaneous liver perfusion with melphalan (M-PHP), the presence of variant hepatic arteries (HAs) may require catheter repositioning and thus prolong procedure time. Coil-embolization of variant HAs may enable M-PHP with a single catheter position as occlusion of variant HAs results in redistribution of flow through preexisting intrahepatic arterial collaterals. Aim of this study was to evaluate whether redistribution of flow has any negative effect on therapeutic response in ocular melanoma patients undergoing M-PHP.\u0000\u0000\u0000METHODS\u0000We retrospectively analyzed pretreatment angiograms in all 32 patients that underwent M-PHP between January 2014 and March 2017 for unresectable liver metastases from ocular melanoma. Patients that underwent embolization of a variant left HA (LHA) or middle HA (MHA) during pretreatment angiography followed by at least one technically successful M-PHP, were included for further analysis. Redistribution of arterial flow was evaluated on angiography and cone-beam CT (CBCT) images. In each patient, tumor response in liver segments with redistributed blood flow was evaluated using RECIST 1.1 and mRECIST, and then compared to tumor response in segments without flow redistribution. Follow-up scans were reviewed to evaluate progression of liver metastases.\u0000\u0000\u0000RESULTS\u0000A total of 12 patients were included. Replaced LHA embolization resulted in redistribution of flow to segment(s) 2 (n=3), 2 and 3 (n=6), and 2, 3 and 4 (n=1). MHA embolization resulted in redistribution of flow to segment 4 (n=2). Successful redistribution was confirmed by angiography and/or CBCT in all patients. Tumor response was similar for redistributed and non-redistributed liver segments in 8 out of 9 patients (88.9%) according to RECIST 1.1, and in 8 out of 8 patients (100.0%) according to mRECIST. In three patients, tumor response was not evaluable according to RECIST 1.1 or mRECIST as metastases were too small to be categorized as target lesions (n=1), or target lesions were confined to non-redistributed segments (n=2). In one patient, tumor response was not evaluable according to mRECIST as target lesions in the redistributed segments were hypovascular. After a median follow-up time of 17.1 months (range 9.1-38.5), hepatic progression was seen in 9 out of 12 patients with a median time to progression of 9.9 months (range 2.5-17.7). Progression of liver metastases was never seen in the redistributed liver segments only.\u0000\u0000\u0000CONCLUSION\u0000Flow redistribution in liver segments by coil-embolization of variant HAs is a feasible technique that does not seem to compromise tumor response in patients undergoing M-PHP.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46861324","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 In patients with malignant biliary obstruction and complicated by massive ascites, when endoscopy failed, safe routes for biliary decompression are needed alternative to percutaneous approach. We evaluated the safety and efficacy of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy. METHODS From March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS was enrolled in this study. Five patients had jaundice with cholangitis and seven had only jaundice. Clinical parameters including technical and clinical success rate and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis. RESULTS The indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean=30 days, range=1-146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval=16-22 days) and 19 days (95% confidence interval=12-26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage. CONCLUSION TIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.
{"title":"Transjugular insertion of biliary stent in patients with malignant biliary obstruction complicated by ascites with/without coagulopathy: a prospective study of 12 patients.","authors":"Dong Jae Shim, D. Gwon, G. Ko, H. Yoon, K. Sung","doi":"10.5152/dir.2019.18470","DOIUrl":"https://doi.org/10.5152/dir.2019.18470","url":null,"abstract":"PURPOSE\u0000In patients with malignant biliary obstruction and complicated by massive ascites, when endoscopy failed, safe routes for biliary decompression are needed alternative to percutaneous approach. We evaluated the safety and efficacy of transjugular insertion of biliary stent (TIBS) in patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.\u0000\u0000\u0000METHODS\u0000From March 2012 to December 2017, a total of 12 consecutive patients with malignant biliary obstructions treated with TIBS was enrolled in this study. Five patients had jaundice with cholangitis and seven had only jaundice. Clinical parameters including technical and clinical success rate and complications following TIBS were evaluated. Overall survival and stent occlusion-free survival were assessed using Kaplan-Meier analysis.\u0000\u0000\u0000RESULTS\u0000The indications for transjugular approach were massive ascites with (n=2) or without (n=10) coagulopathy. TIBS was technically successful in 11 of 12 patients. Clinical success was defined as successful internal drainage and achieved in eight patients. The mean serum bilirubin level was initially 13.9±6.3 mg/dL and decreased to 4.9±5.3 mg/dL within 1 month after stent placement (P = 0.037). Two patients had procedure-related complications (hemobilia). During the follow-up period (mean=30 days, range=1-146 days), all 12 patients died of disease progression. The median overall survival and stent occlusion-free survival times were 19 days (95% confidence interval=16-22 days) and 19 days (95% confidence interval=12-26 days), respectively. There was no stent dysfunction in the eight patients that had successful internal drainage.\u0000\u0000\u0000CONCLUSION\u0000TIBS appears to be safe, technically feasible, and clinically effective for patients with malignant biliary obstruction complicated by massive ascites with or without coagulopathy.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2019.18470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49467671","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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