G. Anil, Junwei Zhang, Nawal Ebrahim Al Hamar, M. Nga
PURPOSE We aimed to evaluate the imaging features of solid pseudopapillary neoplasm (SPN) of the pancreas with an emphasis on radiologic-pathologic correlation. METHODS Ten patients (all female; mean age, 32 years) with histologic or cytologic diagnosis of SPN encountered between January 2007 and December 2013 were included in this study. Preoperative computed tomography (CT) images were reviewed for location, attenuation, enhancement pattern, margin, shape, size, morphology, presence of capsule and calcification. CT appearances were correlated with histopathologic findings. RESULTS Tumors in the distal pancreatic body and tail had a tendency to be larger (mean size 12.6 cm vs. 4.0 cm). Six of the nine tumors that were resected had a fibrous pseudocapsule at histology, five of which could be identified on CT scan. Eight lesions had mixed hypoenhancing solid components and cystic areas corresponding to tumor necrosis and hemorrhage. The two smallest lesions were purely solid and nonencapsulated. Varied patterns of calcification were seen in four tumors. Three of the four pancreatic tail tumors invaded the spleen. At a median follow-up of 53 months, there was no evidence of recurrence in the nine patients who underwent surgical resection of the tumor. CONCLUSION A mixed solid and cystic pancreatic mass in a young woman is suggestive of SPN. However, smaller lesions may be completely solid. Splenic invasion can occur in pancreatic tail SPNs; however, in this series it did not adversely affect the long-term outcome.
{"title":"Solid pseudopapillary neoplasm of the pancreas: CT imaging features and radiologic-pathologic correlation.","authors":"G. Anil, Junwei Zhang, Nawal Ebrahim Al Hamar, M. Nga","doi":"10.5152/dir.2016.16104","DOIUrl":"https://doi.org/10.5152/dir.2016.16104","url":null,"abstract":"PURPOSE\u0000We aimed to evaluate the imaging features of solid pseudopapillary neoplasm (SPN) of the pancreas with an emphasis on radiologic-pathologic correlation.\u0000\u0000\u0000METHODS\u0000Ten patients (all female; mean age, 32 years) with histologic or cytologic diagnosis of SPN encountered between January 2007 and December 2013 were included in this study. Preoperative computed tomography (CT) images were reviewed for location, attenuation, enhancement pattern, margin, shape, size, morphology, presence of capsule and calcification. CT appearances were correlated with histopathologic findings.\u0000\u0000\u0000RESULTS\u0000Tumors in the distal pancreatic body and tail had a tendency to be larger (mean size 12.6 cm vs. 4.0 cm). Six of the nine tumors that were resected had a fibrous pseudocapsule at histology, five of which could be identified on CT scan. Eight lesions had mixed hypoenhancing solid components and cystic areas corresponding to tumor necrosis and hemorrhage. The two smallest lesions were purely solid and nonencapsulated. Varied patterns of calcification were seen in four tumors. Three of the four pancreatic tail tumors invaded the spleen. At a median follow-up of 53 months, there was no evidence of recurrence in the nine patients who underwent surgical resection of the tumor.\u0000\u0000\u0000CONCLUSION\u0000A mixed solid and cystic pancreatic mass in a young woman is suggestive of SPN. However, smaller lesions may be completely solid. Splenic invasion can occur in pancreatic tail SPNs; however, in this series it did not adversely affect the long-term outcome.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 2 1","pages":"94-99"},"PeriodicalIF":2.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42415401","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 evaluate the effectiveness of percutaneous transhepatic removal of bile duct stones in children. METHODS The study included 12 pediatric patients (4 males, 8 females; age range, 1-16 years; mean age, 6.6 years) who underwent percutaneous transhepatic removal of bile duct stones between September 2007 and December 2015. Demographic data, patient symptoms, indications for interventions, technical and clinical outcomes of the procedure, and complications were retrospectively evaluated. RESULTS Of 12 children, five children with cholelithiasis underwent cholecystectomy subsequently. The overall technical and clinical success rate was 100%. One patient had cholangitis as a complication during the follow-up and was treated medically. CONCLUSION Percutaneous transhepatic removal of bile duct stones is a safe and effective method for the treatment of children with biliary stone disease. It is a feasible alternative when the endoscopic procedure is unavailable or fails.
{"title":"Percutaneous management of bile duct stones in children: results of 12 cases.","authors":"N. Özcan, G. Kahriman, S. Görkem, D. Arslan","doi":"10.5152/dir.2016.16178","DOIUrl":"https://doi.org/10.5152/dir.2016.16178","url":null,"abstract":"PURPOSE\u0000We aimed to evaluate the effectiveness of percutaneous transhepatic removal of bile duct stones in children.\u0000\u0000\u0000METHODS\u0000The study included 12 pediatric patients (4 males, 8 females; age range, 1-16 years; mean age, 6.6 years) who underwent percutaneous transhepatic removal of bile duct stones between September 2007 and December 2015. Demographic data, patient symptoms, indications for interventions, technical and clinical outcomes of the procedure, and complications were retrospectively evaluated.\u0000\u0000\u0000RESULTS\u0000Of 12 children, five children with cholelithiasis underwent cholecystectomy subsequently. The overall technical and clinical success rate was 100%. One patient had cholangitis as a complication during the follow-up and was treated medically.\u0000\u0000\u0000CONCLUSION\u0000Percutaneous transhepatic removal of bile duct stones is a safe and effective method for the treatment of children with biliary stone disease. It is a feasible alternative when the endoscopic procedure is unavailable or fails.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 2 1","pages":"133-136"},"PeriodicalIF":2.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16178","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43365844","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}
Cristina Maciel, Y. Tang, A. Sahdev, A. Madureira, Paulo Vilares Morgado
This pictorial review aims to discuss and illustrate the up-to-date use of preprocedural magnetic resonance imaging (MRI) in selecting patients and planning uterine artery embolization (UAE). The merits of magnetic resonance angiography (MRA) in demonstrating the pelvic vasculature to guide UAE are highlighted. MRI features of fibroids and their main differential diagnoses are presented. Fibroid characteristics, such as location, size, and enhancement, which may impact patient selection and outcome, are presented based on recent literature. Pelvic arterial anatomy relevant to UAE, including vascular variants are illustrated, with conventional angiography and MRA imaging correlation. MRA preprocedural determination of the optimal projection angles for uterine artery catheterization is straightforward and constitutes an important strategy to minimize ionizing radiation exposure during UAE. A reporting template for MRI/MRA preassessement of UAE for fibroid treatment is provided.
{"title":"Preprocedural MRI and MRA in planning fibroid embolization.","authors":"Cristina Maciel, Y. Tang, A. Sahdev, A. Madureira, Paulo Vilares Morgado","doi":"10.5152/dir.2016.16623","DOIUrl":"https://doi.org/10.5152/dir.2016.16623","url":null,"abstract":"This pictorial review aims to discuss and illustrate the up-to-date use of preprocedural magnetic resonance imaging (MRI) in selecting patients and planning uterine artery embolization (UAE). The merits of magnetic resonance angiography (MRA) in demonstrating the pelvic vasculature to guide UAE are highlighted. MRI features of fibroids and their main differential diagnoses are presented. Fibroid characteristics, such as location, size, and enhancement, which may impact patient selection and outcome, are presented based on recent literature. Pelvic arterial anatomy relevant to UAE, including vascular variants are illustrated, with conventional angiography and MRA imaging correlation. MRA preprocedural determination of the optimal projection angles for uterine artery catheterization is straightforward and constitutes an important strategy to minimize ionizing radiation exposure during UAE. A reporting template for MRI/MRA preassessement of UAE for fibroid treatment is provided.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 2 1","pages":"163-171"},"PeriodicalIF":2.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16623","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46129706","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. Lavelle, D. Brady, S. McEvoy, D. Murphy, B. Gibney, A. Gallagher, M. Butler, F. Shortt, M. McMullen, A. Fabre, D. Lynch, M. Keane, J. Dodd
PURPOSE We aimed to prospectively evaluate anatomic chest computed tomography (CT) with tissue characterization late gadolinium-enhanced magnetic resonance imaging (MRI) in the evaluation of pulmonary fibrosis (PF). METHODS Twenty patients with idiopathic pulmonary fibrosis (IPF) and twelve control patients underwent late-enhanced MRI and high-resolution CT. Tissue characterization of PF was depicted using a segmented inversion-recovery turbo low-angle shot MRI sequence. Pulmonary arterial blood pool nulling was achieved by nulling main pulmonary artery signal. Images were read in random order by a blinded reader for presence and extent of overall PF (reticulation and honeycombing) at five anatomic levels. Overall extent of IPF was estimated to the nearest 5% as well as an evaluation of the ratios of IPF made up of reticulation and honeycombing. Overall grade of severity was dependent on the extent of reticulation and honeycombing. RESULTS No control patient exhibited contrast enhancement on lung late-enhanced MRI. All IPF patients were identified with late-enhanced MRI. Mean signal intensity of the late-enhanced fibrotic lung was 31.8±10.6 vs. 10.5±1.6 for normal lung regions, P < 0.001, resulting in a percent elevation in signal intensity from PF of 204.8%±90.6 compared with the signal intensity of normal lung. The mean contrast-to-noise ratio was 22.8±10.7. Late-enhanced MRI correlated significantly with chest CT for the extent of PF (R=0.78, P = 0.001) but not for reticulation, honeycombing, or coarseness of reticulation or honeycombing. CONCLUSION Tissue characterization of IPF is possible using inversion recovery sequence thoracic MRI.
{"title":"Pulmonary fibrosis: tissue characterization using late-enhanced MRI compared with unenhanced anatomic high-resolution CT.","authors":"L. Lavelle, D. Brady, S. McEvoy, D. Murphy, B. Gibney, A. Gallagher, M. Butler, F. Shortt, M. McMullen, A. Fabre, D. Lynch, M. Keane, J. Dodd","doi":"10.5152/dir.2016.15331","DOIUrl":"https://doi.org/10.5152/dir.2016.15331","url":null,"abstract":"PURPOSE\u0000We aimed to prospectively evaluate anatomic chest computed tomography (CT) with tissue characterization late gadolinium-enhanced magnetic resonance imaging (MRI) in the evaluation of pulmonary fibrosis (PF).\u0000\u0000\u0000METHODS\u0000Twenty patients with idiopathic pulmonary fibrosis (IPF) and twelve control patients underwent late-enhanced MRI and high-resolution CT. Tissue characterization of PF was depicted using a segmented inversion-recovery turbo low-angle shot MRI sequence. Pulmonary arterial blood pool nulling was achieved by nulling main pulmonary artery signal. Images were read in random order by a blinded reader for presence and extent of overall PF (reticulation and honeycombing) at five anatomic levels. Overall extent of IPF was estimated to the nearest 5% as well as an evaluation of the ratios of IPF made up of reticulation and honeycombing. Overall grade of severity was dependent on the extent of reticulation and honeycombing.\u0000\u0000\u0000RESULTS\u0000No control patient exhibited contrast enhancement on lung late-enhanced MRI. All IPF patients were identified with late-enhanced MRI. Mean signal intensity of the late-enhanced fibrotic lung was 31.8±10.6 vs. 10.5±1.6 for normal lung regions, P < 0.001, resulting in a percent elevation in signal intensity from PF of 204.8%±90.6 compared with the signal intensity of normal lung. The mean contrast-to-noise ratio was 22.8±10.7. Late-enhanced MRI correlated significantly with chest CT for the extent of PF (R=0.78, P = 0.001) but not for reticulation, honeycombing, or coarseness of reticulation or honeycombing.\u0000\u0000\u0000CONCLUSION\u0000Tissue characterization of IPF is possible using inversion recovery sequence thoracic MRI.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 2 1","pages":"106-111"},"PeriodicalIF":2.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46406598","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 A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed. METHODS Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital. Results of all clinical investigations (including computed tomography, magnetic resonance imaging, ultrasonography, and plain radiography) while the IVC filters were in situ were reviewed. RESULTS In total, 393 retrievable IVC filters were inserted, 254 with the indication of preoperative thromboembolic prophylaxis. Recurrent PE was reported in five patients (1.9%) despite the IVC filter. Of the 254 retrievable filters inserted prior to surgery, an attempt at retrieval was made in 168 filters (66.1%). Successful retrieval at the first attempt occurred in 143 cases (85.1%), while 25 cases failed or were aborted (14.9%). No attempt at retrieval was made in 86 (33.9%) patients and a significant proportion of these patients had undergone cancer surgery (P < 0.0107). In those patients where there was no attempt at retrieval, there was an association between cancer surgery and a shorter absolute survival time (P < 0.0001). CONCLUSION The majority of attempted filter retrievals were successful, and a proportion of nonretrieved IVC filters are accounted for in patients who underwent cancer surgery and ultimately died with the filter in situ. A departmental protocol is recommended to ensure the filter is removed where appropriate and possible.
{"title":"Ten-year experience of retrievable inferior vena cava filters in a tertiary referral center.","authors":"G. Tse, T. Cleveland, S. Goode","doi":"10.5152/dir.2016.16022","DOIUrl":"https://doi.org/10.5152/dir.2016.16022","url":null,"abstract":"PURPOSE\u0000A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed.\u0000\u0000\u0000METHODS\u0000Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital. Results of all clinical investigations (including computed tomography, magnetic resonance imaging, ultrasonography, and plain radiography) while the IVC filters were in situ were reviewed.\u0000\u0000\u0000RESULTS\u0000In total, 393 retrievable IVC filters were inserted, 254 with the indication of preoperative thromboembolic prophylaxis. Recurrent PE was reported in five patients (1.9%) despite the IVC filter. Of the 254 retrievable filters inserted prior to surgery, an attempt at retrieval was made in 168 filters (66.1%). Successful retrieval at the first attempt occurred in 143 cases (85.1%), while 25 cases failed or were aborted (14.9%). No attempt at retrieval was made in 86 (33.9%) patients and a significant proportion of these patients had undergone cancer surgery (P < 0.0107). In those patients where there was no attempt at retrieval, there was an association between cancer surgery and a shorter absolute survival time (P < 0.0001).\u0000\u0000\u0000CONCLUSION\u0000The majority of attempted filter retrievals were successful, and a proportion of nonretrieved IVC filters are accounted for in patients who underwent cancer surgery and ultimately died with the filter in situ. A departmental protocol is recommended to ensure the filter is removed where appropriate and possible.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 2 1","pages":"144-149"},"PeriodicalIF":2.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45888067","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}
Ç. Uzun, Z. Akkaya, Ebru Düşünceli Atman, E. Üstüner, E. Peker, B. Gülpınar, A. Elhan, K. Ceyhan, K. Ç. Atasoy
PURPOSE We aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique. METHODS We analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax. RESULTS Diagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax. CONCLUSION CT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.
{"title":"Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy of pulmonary lesions with non-coaxial technique: a single center experience with 442 biopsies.","authors":"Ç. Uzun, Z. Akkaya, Ebru Düşünceli Atman, E. Üstüner, E. Peker, B. Gülpınar, A. Elhan, K. Ceyhan, K. Ç. Atasoy","doi":"10.5152/dir.2016.16173","DOIUrl":"https://doi.org/10.5152/dir.2016.16173","url":null,"abstract":"PURPOSE\u0000We aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique.\u0000\u0000\u0000METHODS\u0000We analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk factors for diagnostic failure and pneumothorax.\u0000\u0000\u0000RESULTS\u0000Diagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneumothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax.\u0000\u0000\u0000CONCLUSION\u0000CT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 2 1","pages":"137-143"},"PeriodicalIF":2.1,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43516720","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}
A. Panda, Atin Kumar, S. Gamanagatti, R. Das, Swati Paliwal, Amit Gupta, Subodh Kumar
PURPOSE We aimed to assess the performance of computed tomography (CT) in localizing site of traumatic gastrointestinal tract (GIT) injury and determine the diagnostic value of CT signs in site localization. METHODS CT scans of 97 patients with surgically proven GIT or mesenteric injuries were retrospectively reviewed by radiologists blinded to surgical findings. Diagnosis of either GIT or mesenteric injuries was made. In patients with GIT injuries, site of injury and presence of CT signs such as focal bowel wall hyperenhancement, hypoenhancement, wall discontinuity, wall thickening, extramural air, intramural air, perivisceral infiltration, and active vascular contrast leak were evaluated. RESULTS Out of 97 patients, 90 had GIT injuries (70 single site injuries and 20 multiple site injuries) and seven had isolated mesenteric injury. The overall concordance between CT and operative findings for exact site localization was 67.8% (61/90), partial concordance rate was 11.1% (10/90), and discordance rate was 21.1% (19/90). For single site localization, concordance rate was 77.1% (54/70), discordance rate was 21.4% (15/70), and partial concordance rate was 1.4% (1/70). In multiple site injury, concordance rate for all sites of injury was 35% (7/20), partial concordance rate was 45% (9/20), and discordance rate was 20% (4/20). For upper GIT injuries, wall discontinuity was the most accurate sign for localization. For small bowel injury, intramural air and hyperenhancement were the most specific signs for site localization, while for large bowel injury, wall discontinuity and hypoenhancement were the most specific signs. CONCLUSION CT performs better in diagnosing small bowel injury compared with large bowel injury. CT can well predict the presence of multiple site injury but has limited performance in exact localization of all injury sites.
{"title":"Can multidetector CT detect the site of gastrointestinal tract injury in trauma? - A retrospective study.","authors":"A. Panda, Atin Kumar, S. Gamanagatti, R. Das, Swati Paliwal, Amit Gupta, Subodh Kumar","doi":"10.5152/dir.2016.15481","DOIUrl":"https://doi.org/10.5152/dir.2016.15481","url":null,"abstract":"PURPOSE We aimed to assess the performance of computed tomography (CT) in localizing site of traumatic gastrointestinal tract (GIT) injury and determine the diagnostic value of CT signs in site localization. METHODS CT scans of 97 patients with surgically proven GIT or mesenteric injuries were retrospectively reviewed by radiologists blinded to surgical findings. Diagnosis of either GIT or mesenteric injuries was made. In patients with GIT injuries, site of injury and presence of CT signs such as focal bowel wall hyperenhancement, hypoenhancement, wall discontinuity, wall thickening, extramural air, intramural air, perivisceral infiltration, and active vascular contrast leak were evaluated. RESULTS Out of 97 patients, 90 had GIT injuries (70 single site injuries and 20 multiple site injuries) and seven had isolated mesenteric injury. The overall concordance between CT and operative findings for exact site localization was 67.8% (61/90), partial concordance rate was 11.1% (10/90), and discordance rate was 21.1% (19/90). For single site localization, concordance rate was 77.1% (54/70), discordance rate was 21.4% (15/70), and partial concordance rate was 1.4% (1/70). In multiple site injury, concordance rate for all sites of injury was 35% (7/20), partial concordance rate was 45% (9/20), and discordance rate was 20% (4/20). For upper GIT injuries, wall discontinuity was the most accurate sign for localization. For small bowel injury, intramural air and hyperenhancement were the most specific signs for site localization, while for large bowel injury, wall discontinuity and hypoenhancement were the most specific signs. CONCLUSION CT performs better in diagnosing small bowel injury compared with large bowel injury. CT can well predict the presence of multiple site injury but has limited performance in exact localization of all injury sites.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"29-36"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15481","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006350","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. Dowell, Summit Shah, K. Cooper, V. Yildiz, X. Pan
PURPOSE Adverse events associated with retrievable inferior vena cava filters (IVCFs) have generated an increased interest in improving IVCF retrieval rates to improve patient safety and quality care. This study aims to demonstrate the cost-benefit of implementing an IVCF clinic to improve patient care in an institution in the United States. METHODS An IVCF clinic was established at a single institution in September 2012 and for ten months referring physicians were contacted to facilitate retrieval when appropriate. Additionally, a retrospective review was conducted on filter placements over the eight preclinic months. Cost-benefit analysis was conducted by creating a model, which incorporated the average cost and reimbursement for permanent and retrievable IVCFs. RESULTS A total of 190 IVCFs (152 retrievable IVCFs and 38 permanent IVCFs) were implanted during the IVCF clinic period. Twenty-nine percent of the retrievable IVCFs were successfully retrieved compared to 10 of 119 retrievable IVCFs placed during the preclinic period (8.4%). Cost-benefit analysis, using the average of the institution's six most common reimbursement schedules, demonstrated an average net financial loss per permanent or retrievable IVCF not removed. However, a net financial gain was realized for each retrievable IVCF removed. The additional hospital cost to maintain the IVCF clinic was offset by removing an additional 3.1 IVCFs per year. CONCLUSION An IVCF clinic significantly increases retrieval rates, promotes patient safety, and is economically feasible. Given the adverse event profile of retrievable IVCFs, strategic efforts such as these ultimately can improve quality care for patients with in-dwelling IVCFs.
{"title":"Cost-benefit analysis of establishing an inferior vena cava filter clinic.","authors":"J. Dowell, Summit Shah, K. Cooper, V. Yildiz, X. Pan","doi":"10.5152/dir.2016.16007","DOIUrl":"https://doi.org/10.5152/dir.2016.16007","url":null,"abstract":"PURPOSE Adverse events associated with retrievable inferior vena cava filters (IVCFs) have generated an increased interest in improving IVCF retrieval rates to improve patient safety and quality care. This study aims to demonstrate the cost-benefit of implementing an IVCF clinic to improve patient care in an institution in the United States. METHODS An IVCF clinic was established at a single institution in September 2012 and for ten months referring physicians were contacted to facilitate retrieval when appropriate. Additionally, a retrospective review was conducted on filter placements over the eight preclinic months. Cost-benefit analysis was conducted by creating a model, which incorporated the average cost and reimbursement for permanent and retrievable IVCFs. RESULTS A total of 190 IVCFs (152 retrievable IVCFs and 38 permanent IVCFs) were implanted during the IVCF clinic period. Twenty-nine percent of the retrievable IVCFs were successfully retrieved compared to 10 of 119 retrievable IVCFs placed during the preclinic period (8.4%). Cost-benefit analysis, using the average of the institution's six most common reimbursement schedules, demonstrated an average net financial loss per permanent or retrievable IVCF not removed. However, a net financial gain was realized for each retrievable IVCF removed. The additional hospital cost to maintain the IVCF clinic was offset by removing an additional 3.1 IVCFs per year. CONCLUSION An IVCF clinic significantly increases retrieval rates, promotes patient safety, and is economically feasible. Given the adverse event profile of retrievable IVCFs, strategic efforts such as these ultimately can improve quality care for patients with in-dwelling IVCFs.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"37-42"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71007078","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, M. Onur, S. Balci, Ayşegül Görmez, E. Akpınar, M. Böge
PURPOSE We aimed to evaluate the CT findings of stercoral colitis (SC). METHODS Forty-one patients diagnosed with SC between February 2006 and April 2015 were retrospectively reviewed. RESULTS Rectosigmoid colon was the most frequently involved segment (100%, n=41). CT findings can be summarized as follows: dilatation >6 cm and wall thickening >3 mm of the affected colon segment (100%, n=41), pericolonic fat stranding (100%, n=41), mucosal discontinuity (14.6 %, n=6), presence of free air (14.6%, n=6), free fluid (9.7%, n=4), and pericolonic abscess (2.4%, n=1). The sign most related with mortality was the length of the affected colon segment >40 cm. CONCLUSION CT has an important role in SC, since life-threatening complications can be easily revealed by this imaging modality. Increased length of involved colon segment (>40 cm) is more likely to be associated with mortality.
{"title":"Stercoral colitis: diagnostic value of CT findings.","authors":"E. Ünal, M. Onur, S. Balci, Ayşegül Görmez, E. Akpınar, M. Böge","doi":"10.5152/dir.2016.16002","DOIUrl":"https://doi.org/10.5152/dir.2016.16002","url":null,"abstract":"PURPOSE We aimed to evaluate the CT findings of stercoral colitis (SC). METHODS Forty-one patients diagnosed with SC between February 2006 and April 2015 were retrospectively reviewed. RESULTS Rectosigmoid colon was the most frequently involved segment (100%, n=41). CT findings can be summarized as follows: dilatation >6 cm and wall thickening >3 mm of the affected colon segment (100%, n=41), pericolonic fat stranding (100%, n=41), mucosal discontinuity (14.6 %, n=6), presence of free air (14.6%, n=6), free fluid (9.7%, n=4), and pericolonic abscess (2.4%, n=1). The sign most related with mortality was the length of the affected colon segment >40 cm. CONCLUSION CT has an important role in SC, since life-threatening complications can be easily revealed by this imaging modality. Increased length of involved colon segment (>40 cm) is more likely to be associated with mortality.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"5-9"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71007024","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 Occlusion time (OT) is an important factor in the treatment of pulmonary arteriovenous malformations (PAVMs) since it can lead to serious complications. The purpose of our study is to calculate the OT of Amplatzer vascular plug (AVP, St Jude Medical), and correlate it to the type of the device used (AVP or AVP 2) and the percent of device oversizing. Technical success rates and complications were also recorded. METHODS We retrospectively studied a total of 19 patients with 47 PAVMs who received percutaneous transcatheter embolization therapy using either AVP or AVP 2. We recorded the location, type, feeding artery diameter, AVP device used, and OT of each PAVM. We correlated the percent of device oversizing and the type of AVP with the OT. We also studied the rate of persistence of PAVM for both devices. RESULTS Forty-six (98%) of the PAVMs were simple. Device diameters ranged from 4.0-16.0 mm with device oversizing ranging between 14% and 120%. There was a statistically significant difference in the OT of AVP and AVP 2 (3 min 54 s vs. 5 min 30 s, P = 0.030). There was a weak positive correlation between OT and device oversizing for AVP (r=0.246, P = 0.324) and AVP 2 (r=0.261, P = 0.240). No major complications were identified. Immediate technical success rate was 100%. CONCLUSION The use of AVP 2, and increase in device oversizing were not associated with reduction in the OT of PAVMs. There was no reported difference in safety between the two devices, and no major complications were noted.
目的肺动静脉畸形(pulmonary arteriovenous malformations, PAVMs)的治疗中，栓塞时间(OT)是一个重要的因素，因为它会导致严重的并发症。我们研究的目的是计算Amplatzer血管塞(AVP, St Jude Medical)的OT，并将其与所使用的设备类型(AVP或avp2)和设备过大的百分比相关联。记录技术成功率和并发症。方法回顾性分析19例47例经皮动脉栓塞治疗的pavm患者，均采用AVP或avp2栓塞治疗。记录每个PAVM的位置、类型、供动脉直径、使用的AVP装置和OT。我们将设备过大的百分比和AVP的类型与OT联系起来。我们还研究了两种设备的PAVM持续率。结果单纯性pavm 46例(98%)。器件直径范围为4.0-16.0 mm，器件外径范围为14% - 120%。AVP和avp2的OT (3 min 54 s vs 5 min 30 s, P = 0.030)差异有统计学意义。AVP (r=0.246, P = 0.324)和avp2 (r=0.261, P = 0.240)的OT与器械过大呈弱正相关。未发现重大并发症。即时技术成功率为100%。结论avp2的使用和器械尺寸的增加与pavm的OT降低无关。两种装置的安全性无差异报道，也未发现重大并发症。
{"title":"Does the type and size of Amplatzer vascular plug affect the occlusion time of pulmonary arteriovenous malformations?","authors":"A. A. Abdel Aal, M. Massoud, Dina Elantably","doi":"10.5152/dir.2016.16120","DOIUrl":"https://doi.org/10.5152/dir.2016.16120","url":null,"abstract":"PURPOSE Occlusion time (OT) is an important factor in the treatment of pulmonary arteriovenous malformations (PAVMs) since it can lead to serious complications. The purpose of our study is to calculate the OT of Amplatzer vascular plug (AVP, St Jude Medical), and correlate it to the type of the device used (AVP or AVP 2) and the percent of device oversizing. Technical success rates and complications were also recorded. METHODS We retrospectively studied a total of 19 patients with 47 PAVMs who received percutaneous transcatheter embolization therapy using either AVP or AVP 2. We recorded the location, type, feeding artery diameter, AVP device used, and OT of each PAVM. We correlated the percent of device oversizing and the type of AVP with the OT. We also studied the rate of persistence of PAVM for both devices. RESULTS Forty-six (98%) of the PAVMs were simple. Device diameters ranged from 4.0-16.0 mm with device oversizing ranging between 14% and 120%. There was a statistically significant difference in the OT of AVP and AVP 2 (3 min 54 s vs. 5 min 30 s, P = 0.030). There was a weak positive correlation between OT and device oversizing for AVP (r=0.246, P = 0.324) and AVP 2 (r=0.261, P = 0.240). No major complications were identified. Immediate technical success rate was 100%. CONCLUSION The use of AVP 2, and increase in device oversizing were not associated with reduction in the OT of PAVMs. There was no reported difference in safety between the two devices, and no major complications were noted.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"31 1","pages":"61-65"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006726","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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