A. Ekinci, Tuba Yücel Uçarkuş, A. Okur, Mehmet Öztürk, S. Doğan
PURPOSE Pneumonia is an important cause of mortality and morbidity in immunocompromised patients. Computed tomography (CT) is the most sensitive imaging modality for the diagnosis and surveillance of these patients. Since CT exposes the patient to ionizing radiation, we investigated the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia. METHODS The study included 40 immunocompromised patients with pneumonia documented on CT. The patients were examined by MRI within 48 hours of CT examination. All images were obtained with three different sequences: balanced fast field echo, T1-weighted turbo spin-echo (TSE), and T2-weighted TSE. Lung abnormalities were evaluated using CT and MRI. RESULTS Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P < 0.001, for all). A significant difference was observed between the MRI sequences and CT in terms of the number of detected nodules (P < 0.001). The nodule detection rate of MRI significantly increased in proportion to the size of the nodule (P < 0.001). All MRI sequences had almost perfect agreement with CT for the detection of consolidation (к=0.950, P < 0.001), patchy increased density (к=1, P < 0.001), pleural effusion (к=0.870, P < 0.001), pericardial effusion (к=1, P < 0.001), reverse halo sign, (к=1 P < 0.001), 10-20 mm, nodules (к=0.896, P < 0.001 for CT and B-FFE; к=0.948, P < 0.001 for CT and T1- or T2-weighted imaging) 10-20 mm, >20 mm nodules (к=0.844, P < 0.001). CONCLUSION Although CT is superior to MRI in the diagnosis of pneumonia in immunocompromised patients, MRI is an important imaging modality that can be used, particularly in the follow-up of these patients, thus decreasing to avoid ionizing radiation exposure.
目的肺炎是免疫功能低下患者死亡和发病的重要原因。计算机断层扫描(CT)是诊断和监测这些患者最敏感的成像方式。由于CT使患者暴露于电离辐射，我们研究了磁共振成像(MRI)在肺炎免疫功能低下患者的诊断和监测中的应用。方法本研究纳入40例CT记录的免疫功能低下肺炎患者。患者在CT检查后48小时内行MRI检查。所有图像均采用三种不同的序列:平衡快速场回波、t1加权涡轮自旋回波(TSE)和t2加权TSE。用CT和MRI评估肺部异常。结果36例(90%)患者感染，4例(10%)患者病原菌未知。所有患者的CT表现均符合感染，但有3例患者MRI未见异常。CT在树芽结节、小叶中心结节和晕征的检测上优于MRI (P < 0.001)。MRI序列与CT在检测到的结节数量上有显著差异(P < 0.001)。MRI结节检出率与结节大小成比例显著增高(P < 0.001)。所有MRI序列与CT在实变(χ =0.950, P < 0.001)、斑片状密度增高(χ =1, P < 0.001)、胸膜积液(χ =0.870, P < 0.001)、心包积液(χ =1, P < 0.001)、反晕征(χ =1, P < 0.001)、10-20 mm、结节(χ =0.896, P < 0.001)的检测几乎完全一致;CT及T1或t2加权成像)10- 20mm、> - 20mm结节(χ =0.948, P < 0.001)。结论虽然CT对免疫功能低下患者肺炎的诊断优于MRI，但MRI是一种重要的影像学手段，尤其是在对免疫功能低下患者的随访中，可以减少以避免电离辐射暴露。
{"title":"MRI of pneumonia in immunocompromised patients: comparison with CT.","authors":"A. Ekinci, Tuba Yücel Uçarkuş, A. Okur, Mehmet Öztürk, S. Doğan","doi":"10.5152/dir.2016.16055","DOIUrl":"https://doi.org/10.5152/dir.2016.16055","url":null,"abstract":"PURPOSE Pneumonia is an important cause of mortality and morbidity in immunocompromised patients. Computed tomography (CT) is the most sensitive imaging modality for the diagnosis and surveillance of these patients. Since CT exposes the patient to ionizing radiation, we investigated the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia. METHODS The study included 40 immunocompromised patients with pneumonia documented on CT. The patients were examined by MRI within 48 hours of CT examination. All images were obtained with three different sequences: balanced fast field echo, T1-weighted turbo spin-echo (TSE), and T2-weighted TSE. Lung abnormalities were evaluated using CT and MRI. RESULTS Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P < 0.001, for all). A significant difference was observed between the MRI sequences and CT in terms of the number of detected nodules (P < 0.001). The nodule detection rate of MRI significantly increased in proportion to the size of the nodule (P < 0.001). All MRI sequences had almost perfect agreement with CT for the detection of consolidation (к=0.950, P < 0.001), patchy increased density (к=1, P < 0.001), pleural effusion (к=0.870, P < 0.001), pericardial effusion (к=1, P < 0.001), reverse halo sign, (к=1 P < 0.001), 10-20 mm, nodules (к=0.896, P < 0.001 for CT and B-FFE; к=0.948, P < 0.001 for CT and T1- or T2-weighted imaging) 10-20 mm, >20 mm nodules (к=0.844, P < 0.001). CONCLUSION Although CT is superior to MRI in the diagnosis of pneumonia in immunocompromised patients, MRI is an important imaging modality that can be used, particularly in the follow-up of these patients, thus decreasing to avoid ionizing radiation exposure.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"22-28"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006833","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 define multiparametric magnetic resonance imaging (MRI) findings to differentiate between pulmonary artery sarcoma (PAS) and pulmonary thromboembolism (PTE). METHODS Eleven patients with suspected PTE were prospectively included to undergo pulmonary MRI before surgery or biopsy. MRI protocol included an unenhanced sequence, diffusion-weighted imaging (DWI, b=800 s/mm2) and a dynamic contrast-enhanced sequence. Morphologic characteristics including distribution, filling defect, and intensity were observed on T1-, T2-, and fat-suppressed T2-weighted imaging, DWI, and contrast-enhanced MRI. Apparent diffusion coefficient (ADC) values were calculated. RESULTS Six patients were pathologically diagnosed as PAS and the other five as chronic PTE. There were no significant differences in age, gender, presenting symptoms, D-dimer, and N-terminal pro-brain natriuretic peptide between the two groups (P > 0.05). Among MRI findings that were tested for their ability to diagnose PAS, area under the curve (AUC) was significantly higher than 0.5 for main pulmonary artery involvement (AUC, 0.83±0.13; P = 0.011), hyperintensity on fat-suppressed T2-weighted imaging (AUC, 0.82±0.14; P = 0.025), hyperintensity on DWI (AUC, 0.88±0.12; P = 0.002), contrast enhancement (AUC, 0.92±0.10; P < 0.001) and pleural effusion (AUC, 0.82±0.14; P = 0.025). Moreover, grape-like appearance in distal pulmonary artery and cardiac invasion had 100% specificity for diagnosis of PAS. However, ADC value of PAS was not significantly different than that of chronic PTE (U, 12.00; P = 0.584). CONCLUSION Hyperintense filling defect in main pulmonary artery on fat-suppressed T2-weighted imaging and DWI and contrast enhancement may help to discriminate PAS from PTE.
{"title":"Multiparametric MRI in differentiating pulmonary artery sarcoma and pulmonary thromboembolism: a preliminary experience.","authors":"Min Liu, Chun-e Luo, Ying Wang, Xiao-juan Guo, Zhan-hong Ma, Yuanhua Yang, Tianjing Zhang","doi":"10.5152/dir.2016.15584","DOIUrl":"https://doi.org/10.5152/dir.2016.15584","url":null,"abstract":"PURPOSE We aimed to define multiparametric magnetic resonance imaging (MRI) findings to differentiate between pulmonary artery sarcoma (PAS) and pulmonary thromboembolism (PTE). METHODS Eleven patients with suspected PTE were prospectively included to undergo pulmonary MRI before surgery or biopsy. MRI protocol included an unenhanced sequence, diffusion-weighted imaging (DWI, b=800 s/mm2) and a dynamic contrast-enhanced sequence. Morphologic characteristics including distribution, filling defect, and intensity were observed on T1-, T2-, and fat-suppressed T2-weighted imaging, DWI, and contrast-enhanced MRI. Apparent diffusion coefficient (ADC) values were calculated. RESULTS Six patients were pathologically diagnosed as PAS and the other five as chronic PTE. There were no significant differences in age, gender, presenting symptoms, D-dimer, and N-terminal pro-brain natriuretic peptide between the two groups (P > 0.05). Among MRI findings that were tested for their ability to diagnose PAS, area under the curve (AUC) was significantly higher than 0.5 for main pulmonary artery involvement (AUC, 0.83±0.13; P = 0.011), hyperintensity on fat-suppressed T2-weighted imaging (AUC, 0.82±0.14; P = 0.025), hyperintensity on DWI (AUC, 0.88±0.12; P = 0.002), contrast enhancement (AUC, 0.92±0.10; P < 0.001) and pleural effusion (AUC, 0.82±0.14; P = 0.025). Moreover, grape-like appearance in distal pulmonary artery and cardiac invasion had 100% specificity for diagnosis of PAS. However, ADC value of PAS was not significantly different than that of chronic PTE (U, 12.00; P = 0.584). CONCLUSION Hyperintense filling defect in main pulmonary artery on fat-suppressed T2-weighted imaging and DWI and contrast enhancement may help to discriminate PAS from PTE.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"15-21"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006602","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 describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. METHODS This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. RESULTS Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. CONCLUSION Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis.
{"title":"Endovascular treatment of iliofemoral deep vein thrombosis in pregnancy using US-guided percutaneous aspiration thrombectomy.","authors":"M. Gedikoglu, L. Oğuzkurt","doi":"10.5152/dir.2016.16199","DOIUrl":"https://doi.org/10.5152/dir.2016.16199","url":null,"abstract":"PURPOSE We aimed to describe ultrasonography (US)-guided percutaneous aspiration thrombectomy in pregnant women with iliofemoral deep vein thrombosis. METHODS This study included nine pregnant women with acute and subacute iliofemoral deep vein thrombosis, who were severe symptomatic cases with massive swelling and pain of the leg. Patients were excluded from the study if they had only femoropopliteal deep vein thrombosis or mild symptoms of deep vein thrombosis. US-guided percutaneous aspiration thrombectomy was applied to achieve thrombus removal and uninterrupted venous flow. The treatment was considered successful if there was adequate venous patency and symptomatic relief. RESULTS Complete or significant thrombus removal and uninterrupted venous flow from the puncture site up to the iliac veins were achieved in all patients at first intervention. Complete relief of leg pain was achieved immediately in seven patients (77.8%). Two patients (22.2%) had a recurrence of thrombosis in the first week postintervention. One of them underwent a second intervention, where percutaneous aspiration thrombectomy was performed again with successful removal of thrombus and establishment of in line flow. Two patients were lost to follow-up after birth. None of the remaining seven patients had rethrombosis throughout the postpartum period. Symptomatic relief was detected clinically in these patients. CONCLUSION Endovascular treatment with US-guided percutaneous aspiration thrombectomy can be considered as a safe and effective way to remove thrombus from the deep veins in pregnant women with acute and subacute iliofemoral deep vein thrombosis.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"71-76"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16199","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006762","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}
Z. Haber, H. Charles, J. Gross, Daniel Pflager, A. Deipolyi
PURPOSE We aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement. METHODS Following institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications. RESULTS A total of 149 patients (64 women, 85 men; mean age, 64.4±1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%-19%; P = 0.430), or major complication rates (6%-7%; P = 0.871) between the two techniques. CONCLUSION G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost.
{"title":"Percutaneous radiologically guided gastrostomy tube placement: comparison of antegrade transoral and retrograde transabdominal approaches.","authors":"Z. Haber, H. Charles, J. Gross, Daniel Pflager, A. Deipolyi","doi":"10.5152/dir.2016.15626","DOIUrl":"https://doi.org/10.5152/dir.2016.15626","url":null,"abstract":"PURPOSE We aimed to compare the antegrade transoral and the retrograde transabdominal approaches for fluoroscopy-guided percutaneous gastrostomy tube (G-tube) placement. METHODS Following institutional review board approval, all G-tubes at two academic hospitals (January 2014 to May 2015) were reviewed retrospectively. Retrograde approach was used at Hospital 1 and both antegrade and retrograde approaches were used at Hospital 2. Chart review determined type of anesthesia used during placement, dose of radiation used, fluoroscopy time, procedure time, medical history, and complications. RESULTS A total of 149 patients (64 women, 85 men; mean age, 64.4±1.3 years) underwent G-tube placement, including 93 (62%) placed via the retrograde transabdominal approach and 56 (38%) placed via the antegrade transoral approach. Retrograde placement entailed fewer anesthesiology consultations (P < 0.001), less overall procedure time (P = 0.023), and less fluoroscopy time (P < 0.001). A comparison of approaches for placement within the same hospital demonstrated that the retrograde approach led to significantly reduced radiation dose (P = 0.022). There were no differences in minor complication rates (13%-19%; P = 0.430), or major complication rates (6%-7%; P = 0.871) between the two techniques. CONCLUSION G-tube placement using the retrograde transabdominal approach is associated with less fluoroscopy time, procedure time, radiation exposure, and need for anesthesiology consultation with similar safety profile compared with the antegrade transoral approach. Additionally, it is hypothesized that decreased procedure time and anesthesiology consultation using the transoral approach are likely associated with reduced cost.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"55-60"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006958","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}
Guodong Zhang, Maoqiang Wang, F. Duan, K. Yuan, Kai Li, Jieyu Yan, Z. Chang
PURPOSE We aimed to evaluate the therapeutic effect and safety of transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for the treatment of symptomatic hepatic focal nodular hyperplasia (FNH). METHODS This retrospective study included 23 consecutive patients with symptomatic hepatic FNH, who underwent embolization using bleomycin-iodinated oil and polyvinyl alcohol particles between January 2005 and December 2012. Patients were followed-up with radiologic and clinical evaluation. Therapeutic effects including changes in lesion size and symptomatic improvement were evaluated after the procedure. RESULTS Embolization was performed for 27 lesions in 23 patients. Follow-up period ranged from three months to 89 months. The mean lesion diameters decreased significantly from 5.0±2.4 cm to 3.2±1.5 cm at 3-9 months after embolization (P < 0.001). Five lesions had complete resolution in the follow-up period. The clinical symptoms were significantly relieved in all patients. Contrast-enhanced scans at follow-up showed complete lack of residual arterial blood supply in the majority of lesions. Local recurrence was found in one treated lesion at the 54-month follow-up. There were no major complications associated with the procedure. CONCLUSION Transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for hepatic FNH is a safe and effective alternative treatment with good long-term symptomatic control and reduction in lesion size after embolization.
{"title":"Transarterial embolization with bleomycin for symptomatic hepatic focal nodular hyperplasia.","authors":"Guodong Zhang, Maoqiang Wang, F. Duan, K. Yuan, Kai Li, Jieyu Yan, Z. Chang","doi":"10.5152/dir.2016.16061","DOIUrl":"https://doi.org/10.5152/dir.2016.16061","url":null,"abstract":"PURPOSE We aimed to evaluate the therapeutic effect and safety of transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for the treatment of symptomatic hepatic focal nodular hyperplasia (FNH). METHODS This retrospective study included 23 consecutive patients with symptomatic hepatic FNH, who underwent embolization using bleomycin-iodinated oil and polyvinyl alcohol particles between January 2005 and December 2012. Patients were followed-up with radiologic and clinical evaluation. Therapeutic effects including changes in lesion size and symptomatic improvement were evaluated after the procedure. RESULTS Embolization was performed for 27 lesions in 23 patients. Follow-up period ranged from three months to 89 months. The mean lesion diameters decreased significantly from 5.0±2.4 cm to 3.2±1.5 cm at 3-9 months after embolization (P < 0.001). Five lesions had complete resolution in the follow-up period. The clinical symptoms were significantly relieved in all patients. Contrast-enhanced scans at follow-up showed complete lack of residual arterial blood supply in the majority of lesions. Local recurrence was found in one treated lesion at the 54-month follow-up. There were no major complications associated with the procedure. CONCLUSION Transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for hepatic FNH is a safe and effective alternative treatment with good long-term symptomatic control and reduction in lesion size after embolization.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"66-70"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71007151","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}
S. Bakan, S. Kandemirli, A. S. Dikici, E. Erşen, O. Yıldırım, C. Samancı, Ş. Batur, D. Çebi Olgun, F. Kantarcı, C. Akman
PURPOSE We aimed to assess the role of computed tomography (CT) perfusion in differentiation of thymoma from thymic hyperplasia, lymphoma, thymic carcinoma, and lung cancer invading anterior mediastinum. METHODS In this study, 25 patients with an anterior mediastinal lesion underwent CT perfusion imaging from January 2015 to February 2016. Diagnoses included thymoma (n=7), thymic hyperplasia (n=8), lymphoma (n=4), thymic carcinoma (n=3), and invasive lung cancer (n=3). Lymphoma, thymic carcinoma, and lung cancer were grouped as malignant tumors for statistical analysis. Values for blood flow, blood volume, and permeability surface were measured in CT perfusion. RESULTS Blood flow and blood volume values were higher in thymoma in comparison to thymic hyperplasia; however, the difference was not statistically significant. Blood volume values were significantly higher in thymoma (mean, 11.4 mL/100 mL; range, 5.2-20.2 mL/100 mL) compared with lymphoma (mean, 5.3 mL/100 mL; range, 2.5-7.2 mL/100 mL) (P = 0.023). Blood flow and blood volume values were significantly higher in thymoma compared with non-thymoma malignant tumors (P = 0.025). CONCLUSION CT perfusion is helpful in differentiating thymoma from non-thymoma malignancies including lymphoma, thymic carcinoma, and invasive lung cancer involving the anterior mediastinum.
{"title":"Evaluation of anterior mediastinal solid tumors by CT perfusion: a preliminary study.","authors":"S. Bakan, S. Kandemirli, A. S. Dikici, E. Erşen, O. Yıldırım, C. Samancı, Ş. Batur, D. Çebi Olgun, F. Kantarcı, C. Akman","doi":"10.5152/dir.2016.16093","DOIUrl":"https://doi.org/10.5152/dir.2016.16093","url":null,"abstract":"PURPOSE We aimed to assess the role of computed tomography (CT) perfusion in differentiation of thymoma from thymic hyperplasia, lymphoma, thymic carcinoma, and lung cancer invading anterior mediastinum. METHODS In this study, 25 patients with an anterior mediastinal lesion underwent CT perfusion imaging from January 2015 to February 2016. Diagnoses included thymoma (n=7), thymic hyperplasia (n=8), lymphoma (n=4), thymic carcinoma (n=3), and invasive lung cancer (n=3). Lymphoma, thymic carcinoma, and lung cancer were grouped as malignant tumors for statistical analysis. Values for blood flow, blood volume, and permeability surface were measured in CT perfusion. RESULTS Blood flow and blood volume values were higher in thymoma in comparison to thymic hyperplasia; however, the difference was not statistically significant. Blood volume values were significantly higher in thymoma (mean, 11.4 mL/100 mL; range, 5.2-20.2 mL/100 mL) compared with lymphoma (mean, 5.3 mL/100 mL; range, 2.5-7.2 mL/100 mL) (P = 0.023). Blood flow and blood volume values were significantly higher in thymoma compared with non-thymoma malignant tumors (P = 0.025). CONCLUSION CT perfusion is helpful in differentiating thymoma from non-thymoma malignancies including lymphoma, thymic carcinoma, and invasive lung cancer involving the anterior mediastinum.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"10-14"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16093","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006713","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}
Dong Yi, M. Feng, Wang Wen Ping, Ji Zheng Biao, P. Fan
PURPOSE We aimed to explore the value of contrast-enhanced ultrasonography (CEUS) in guidance of percutaneous biopsy of anterior mediastinal lesions. METHODS Ninety patients with solitary anterior mediastinal lesions (55 males, 35 females; mean age, 46±4 years) were included. Patients were randomly divided into CEUS group (n=45) and conventional ultrasonography (US) group (n=45). Real-time US-guided core needle (16 G) percutaneous biopsies were performed in all lesions. The display of internal mammary arteries, internal necrosis, and active areas were recorded and compared. Biopsy success rate and diagnostic accuracy were compared between the two groups. RESULTS Display rate of unenhanced internal necrosis was higher in the CEUS group than in the US group (88.9% vs. 46.7%, P = 0.041). With real-time CEUS guidance, internal mammary arteries were effectively displayed and avoided during biopsies in 68.9% of the lesions (31/45). Of the lesions, 88.9% (80/90) were histologically proven, including 13 benign lesions and 67 malignancies. There was a significant difference in the rate of successful puncture attempts between the two groups (P = 0.041). CEUS group had a higher biopsy success rate (100% vs. 95.5%, P = 0.045) and higher diagnostic accuracy (97.8% vs. 82.2%, P = 0.035) compared with the US group (P = 0.035). CONCLUSION CEUS guidance is a promising technique in depicting internal necrotic areas, viable areas, and internal mammary arteries during percutaneous biopsy of anterior mediastinal lesion, with satisfying safety, accuracy, and success rates.
目的探讨超声造影(CEUS)对前纵隔病变经皮穿刺活检的指导价值。方法孤立性前纵隔病变90例(男55例，女35例;平均年龄(46±4岁)。随机分为超声造影组(n=45)和常规超声组(n=45)。所有病变均行实时us引导芯针(16g)经皮活检。记录并比较乳腺内动脉、内部坏死和活动区域的显示。比较两组活检成功率和诊断准确率。结果CEUS组未增强内坏死显示率高于US组(88.9% vs. 46.7%， P = 0.041)。在实时超声造影引导下，68.9%的病变(31/45)在活检中有效显示和避免了乳腺内动脉。88.9%(80/90)病变组织学证实，其中良性病变13例，恶性病变67例。两组间穿刺成功率比较，差异有统计学意义(P = 0.041)。CEUS组活检成功率(100% vs. 95.5%， P = 0.045)和诊断准确率(97.8% vs. 82.2%， P = 0.035)均高于US组(P = 0.035)。结论超声引导在前纵隔病变经皮穿刺活检中描绘内坏死区、活区和乳腺内动脉是一种有前景的技术，具有良好的安全性、准确性和成功率。
{"title":"Contrast-enhanced US-guided percutaneous biopsy of anterior mediastinal lesions.","authors":"Dong Yi, M. Feng, Wang Wen Ping, Ji Zheng Biao, P. Fan","doi":"10.5152/dir.2016.15590","DOIUrl":"https://doi.org/10.5152/dir.2016.15590","url":null,"abstract":"PURPOSE We aimed to explore the value of contrast-enhanced ultrasonography (CEUS) in guidance of percutaneous biopsy of anterior mediastinal lesions. METHODS Ninety patients with solitary anterior mediastinal lesions (55 males, 35 females; mean age, 46±4 years) were included. Patients were randomly divided into CEUS group (n=45) and conventional ultrasonography (US) group (n=45). Real-time US-guided core needle (16 G) percutaneous biopsies were performed in all lesions. The display of internal mammary arteries, internal necrosis, and active areas were recorded and compared. Biopsy success rate and diagnostic accuracy were compared between the two groups. RESULTS Display rate of unenhanced internal necrosis was higher in the CEUS group than in the US group (88.9% vs. 46.7%, P = 0.041). With real-time CEUS guidance, internal mammary arteries were effectively displayed and avoided during biopsies in 68.9% of the lesions (31/45). Of the lesions, 88.9% (80/90) were histologically proven, including 13 benign lesions and 67 malignancies. There was a significant difference in the rate of successful puncture attempts between the two groups (P = 0.041). CEUS group had a higher biopsy success rate (100% vs. 95.5%, P = 0.045) and higher diagnostic accuracy (97.8% vs. 82.2%, P = 0.035) compared with the US group (P = 0.035). CONCLUSION CEUS guidance is a promising technique in depicting internal necrotic areas, viable areas, and internal mammary arteries during percutaneous biopsy of anterior mediastinal lesion, with satisfying safety, accuracy, and success rates.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"43-48"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006629","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 assess the usefulness and safety of the God's Hand pneumatic compression device for hemostasis in patients undergoing percutaneous endovascular procedures via femoral artery. METHODS Two hundred thirty-seven patients in whom hemostasis of femoral catheterization was achieved using a God's Hand pneumatic compression device were enrolled. The patients were divided into group A, those in whom the device was applied for four hours, and group B, those in whom the device was applied for two hours, with an additional two hours of bed rest in both groups. Groups A and B were regrouped to groups A' and B' using the propensity score matching method (n=65, for both). Chi-squared test and logistic regression models were used to analyze the relationship between the complication rate and patient characteristics and procedure-related factors. RESULTS Clinical success was achieved in 216 of 237 patients (91.1%): 63 in group A (84%) and 153 in group B (94.4%); in propensity score matched groups, clinical success was seen in 47 patients in group A' (81.5%) and 62 patients in group B' (95.4%). Group B' showed a higher clinical success rate than group A' (P = 0.028). There were no major complications. In logistic regression models, a negative association was noted between the complication rate and the duration of God's Hand application; however, this association was not statistically significant. CONCLUSION The God's Hand pneumatic compression device is effective and safe for the hemostasis of femoral catheterization, and four hours of bed rest is sufficient for hemostasis in selected patients.
{"title":"Usefulness and safety of the \"God's Hand\" pneumatic compression device for hemostasis in femoral catheterization.","authors":"Sungwon Kim, J. Kwon, Y. Han, Jeung-Sook Kim","doi":"10.5152/dir.2016.15451","DOIUrl":"https://doi.org/10.5152/dir.2016.15451","url":null,"abstract":"PURPOSE We aimed to assess the usefulness and safety of the God's Hand pneumatic compression device for hemostasis in patients undergoing percutaneous endovascular procedures via femoral artery. METHODS Two hundred thirty-seven patients in whom hemostasis of femoral catheterization was achieved using a God's Hand pneumatic compression device were enrolled. The patients were divided into group A, those in whom the device was applied for four hours, and group B, those in whom the device was applied for two hours, with an additional two hours of bed rest in both groups. Groups A and B were regrouped to groups A' and B' using the propensity score matching method (n=65, for both). Chi-squared test and logistic regression models were used to analyze the relationship between the complication rate and patient characteristics and procedure-related factors. RESULTS Clinical success was achieved in 216 of 237 patients (91.1%): 63 in group A (84%) and 153 in group B (94.4%); in propensity score matched groups, clinical success was seen in 47 patients in group A' (81.5%) and 62 patients in group B' (95.4%). Group B' showed a higher clinical success rate than group A' (P = 0.028). There were no major complications. In logistic regression models, a negative association was noted between the complication rate and the duration of God's Hand application; however, this association was not statistically significant. CONCLUSION The God's Hand pneumatic compression device is effective and safe for the hemostasis of femoral catheterization, and four hours of bed rest is sufficient for hemostasis in selected patients.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"49-54"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006265","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}
U. Bracale, D. Narese, I. Ficarelli, Mario De Laurentis, Flavia Spalla, E. Dinoto, G. Vitale, D. Solari, G. Bajardi, F. Pecoraro
Renal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for the treatment of RAAs. Here, we aimed to report three cases of wide-necked complex renal artery aneurysms treated endovascularly using stent-assisted coil embolization with self-expandable stent nitinol Solitaire AB and Concerto Axium coils. In addition, we describe the use of the waffle-cone technique in a case of wide-necked saccular RAA involving the renal artery bifurcation. Technical success was achieved in all three cases with no early or late complications and no recurrences.
{"title":"Stent-assisted detachable coil embolization of wide-necked renal artery aneurysms.","authors":"U. Bracale, D. Narese, I. Ficarelli, Mario De Laurentis, Flavia Spalla, E. Dinoto, G. Vitale, D. Solari, G. Bajardi, F. Pecoraro","doi":"10.5152/dir.2016.15551","DOIUrl":"https://doi.org/10.5152/dir.2016.15551","url":null,"abstract":"Renal artery aneurysms (RAAs) are rare with an estimated incidence of 0.1% in the general population, and they represent approximately 25% of all visceral aneurysms. The gold standard of treatment is open surgery, but it is associated with a high risk of nephrectomy, mortality, and morbidity. Less invasive endovascular therapies are becoming increasingly common for the treatment of RAAs. Here, we aimed to report three cases of wide-necked complex renal artery aneurysms treated endovascularly using stent-assisted coil embolization with self-expandable stent nitinol Solitaire AB and Concerto Axium coils. In addition, we describe the use of the waffle-cone technique in a case of wide-necked saccular RAA involving the renal artery bifurcation. Technical success was achieved in all three cases with no early or late complications and no recurrences.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"77-80"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.15551","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006667","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 great interest the article entitled “Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts” by Ozgen (1), which has been recently published in Diagnostic and Interventional Radiology. However, we would like to address some limitations. First, simple breast cysts do not need any follow-up, as they do not show malignant transformation. Therefore, they do not require any treatment, particularly in asymptomatic patients (2). In this study, minimum lesion volume was reported as 4 mL. Such a small lesion probably does not cause complaint in the patient. Secondly, in cases treated for pain relief, it would be interesting to see how much benefit was obtained, whether the symptoms improved after the treatment, and which symptoms were resolved after the ethanol injection treatment. Thirdly, in this article, the intervention was performed on three asymptomatic patients. The reason for ethanol injection treatment in these patients remains to be elucidated. Furthermore, after the ethanol injection treatment, ultrasonography was performed at one week, one month, three months, and six months for all patients and at 12 months, 18 months, and 24 months for all available patients. However, the follow-up of patients with simple breast cysts with repeated ultrasonography is not a cost-effective management modality, and not acceptable. Although ethanol injection might be used as an alternative for the treatment of recurrent breast cysts (3), selection of patients and duration and frequency of follow-up should be arranged meticulously.
我们饶有兴趣地阅读了Ozgen(1)最近发表在《诊断与介入放射学》(Diagnostic and Interventional Radiology)上的一篇题为“超声引导下单次经皮乙醇硬化治疗单发乳腺囊肿的有效性”的文章。然而，我们想解决一些限制。首先，单纯性乳腺囊肿不需要任何随访，因为它们没有恶性转化。因此，它们不需要任何治疗，特别是在无症状的患者中(2)。在本研究中，最小病变体积为4ml。如此小的病变可能不会引起患者的主诉。其次，在以缓解疼痛为目的的病例中，观察获得了多少益处，治疗后症状是否改善，哪些症状在乙醇注射治疗后得到了缓解，这将是一件有趣的事情。第三，本文对三名无症状患者进行了干预。对这些患者进行乙醇注射治疗的原因仍有待阐明。此外，在乙醇注射治疗后，所有患者在1周、1个月、3个月、6个月以及所有患者在12个月、18个月、24个月进行超声检查。然而，对单纯性乳腺囊肿患者进行反复超声随访并不是一种经济有效的治疗方式，也是不可接受的。虽然乙醇注射可作为复发性乳腺囊肿治疗的一种替代方法(3)，但患者的选择、随访时间和频率应精心安排。
{"title":"Simple breast cysts: should we treat or not?","authors":"N. Voyvoda","doi":"10.5152/dir.2016.16257","DOIUrl":"https://doi.org/10.5152/dir.2016.16257","url":null,"abstract":"We read with great interest the article entitled “Effectiveness of single-session ultrasound-guided percutaneous ethanol sclerotherapy in simple breast cysts” by Ozgen (1), which has been recently published in Diagnostic and Interventional Radiology. However, we would like to address some limitations. First, simple breast cysts do not need any follow-up, as they do not show malignant transformation. Therefore, they do not require any treatment, particularly in asymptomatic patients (2). In this study, minimum lesion volume was reported as 4 mL. Such a small lesion probably does not cause complaint in the patient. Secondly, in cases treated for pain relief, it would be interesting to see how much benefit was obtained, whether the symptoms improved after the treatment, and which symptoms were resolved after the ethanol injection treatment. Thirdly, in this article, the intervention was performed on three asymptomatic patients. The reason for ethanol injection treatment in these patients remains to be elucidated. Furthermore, after the ethanol injection treatment, ultrasonography was performed at one week, one month, three months, and six months for all patients and at 12 months, 18 months, and 24 months for all available patients. However, the follow-up of patients with simple breast cysts with repeated ultrasonography is not a cost-effective management modality, and not acceptable. Although ethanol injection might be used as an alternative for the treatment of recurrent breast cysts (3), selection of patients and duration and frequency of follow-up should be arranged meticulously.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"23 1 1","pages":"86"},"PeriodicalIF":2.1,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2016.16257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71006816","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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