RESUMEN
PURPOSE: To evaluate the trends in utilization and results of computed tomography pulmonary angiography (CTPA study) for detection of acute pulmonary embolism (PE) in the Emergency Department (ED) during different phases of COVID-19 public health emergency. METHODS: We conducted a retrospective review of CTPA studies ordered through our ED in the months of March through May during five consecutive years from 2019 to 2023, designated as pre-pandemic, early, ongoing, recovery, and post-pandemic periods respectively. Collected characteristics included patient age, patient sex, and result of the study. RESULTS: The utilization of CTPA studies for ED patients increased during the early, ongoing, and recovery periods. CTPA study utilization in the post-pandemic period was not significantly different from the pre-pandemic period (p = 0.08). No significant difference in CTPA study utilization was noted in the other periods when stratified by age group or sex, compared to the pre-pandemic period. The positivity rate of acute PE in ED patients was not significantly different in other periods compared to the pre-pandemic period. CONCLUSION: At our institution, the utilization and positivity rates of CTPA studies for the ED patients were not significantly different in the post-pandemic period compared to the pre-pandemic period. While studies spanning a larger timeframe and involving multiple institutions are needed to test the applicability of this observation to a wider patient population beyond our defined post-pandemic period, we conclude that our study provides some confidence to the ordering provider and the radiologist in embracing the end of COVID-19 public health emergency by the WHO and the United States HHS with respect to CTPA studies.
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COVID-19 , Angiografía por Tomografía Computarizada , Servicio de Urgencia en Hospital , Pandemias , Embolia Pulmonar , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/diagnóstico por imagen , Masculino , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Embolia Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Angiografía por Tomografía Computarizada/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Adulto , Anciano de 80 o más AñosRESUMEN
PURPOSE: To evaluate technical success, efficacy and safety of portomesenteric venous (PMV) intervention for PMV stenosis or occlusion following nontransplant hepatobiliary or pancreatic (HPB) surgery. MATERIALS AND METHODS: A retrospective review identified 42 patients (mean age 60 y) with PMV stenosis (n = 33; 79%) or occlusion (n = 9; 21%) who underwent attempted PMV intervention following HPB surgery between June 1, 2011, and April 1, 2018. Main outcomes were technical success, primary patency rates, and complications. Technical success was compared by venous pathology and primary PMV patency based on anticoagulation status after the procedure using Fisher exact test. Rates of primary patency by stent group were estimated using Kaplan-Meier method. RESULTS: Technical success was 91% (n = 38/42) and significantly higher in patients with stenosis (n = 33/33; 100%) vs occlusion (n = 5/9; 56%) (P = .001). Primary presenting symptom resolved in 28 (87%) patients, including 6 (100%) patients with gastrointestinal bleeding. At mean imaging follow-up of 8.6 months ± 8.8, primary stent patency was 76%. There was no significant difference in primary stent patency based on anticoagulation status after the procedure (P = .48). There were 2 (4.8%) periprocedural complications. CONCLUSIONS: Portomesenteric venoplasty and stent placement following nontransplant HPB surgery is safe with a high rate of technical success if performed before chronic occlusion.
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Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Endovasculares , Isquemia Mesentérica/terapia , Oclusión Vascular Mesentérica/terapia , Venas Mesentéricas , Vena Porta , Trombectomía , Trombosis de la Vena/terapia , Adulto , Anciano , Anticoagulantes/administración & dosificación , Procedimientos Quirúrgicos del Sistema Biliar/efectos adversos , Constricción Patológica , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Hepatectomía/efectos adversos , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/etiología , Isquemia Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/etiología , Oclusión Vascular Mesentérica/fisiopatología , Venas Mesentéricas/diagnóstico por imagen , Venas Mesentéricas/fisiopatología , Persona de Mediana Edad , Pancreatectomía/efectos adversos , Pancreaticoduodenectomía/efectos adversos , Vena Porta/diagnóstico por imagen , Vena Porta/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Stents , Trombectomía/efectos adversos , Trombectomía/instrumentación , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/etiología , Trombosis de la Vena/fisiopatología , Adulto JovenRESUMEN
Evaluate the quantitative, subjective (Deauville score [DS]) and reader agreement differences between standard ordered subset expectation maximization (OSEM) and Bayesian penalized likelihood (BPL) positron emission tomography (PET) reconstruction methods. A retrospective review of 104 F-18 fluorodeoxyglucose PET/computed tomography (CT) exams among 52 patients with diffuse large B-cell lymphoma. An unblinded radiologist moderator reviewed both BPL and OSEM PET/CT exams. Four blinded radiologists then reviewed the annotated cases to provide a visual DS for each annotated lesion. Significant (Pâ <â .001) differences in BPL and OSEM PET methods were identified with greater standard uptake value (SUV) maximum and SUV mean for BPL. The DS was altered in 25% of cases when BPL and OSEM were reviewed by the same radiologist. Interobserver DS agreement was higher for OSEM (>1 cm lesionâ =â 0.89 and ≤1 cm lesionâ =â 0.84) compared to BPL (>1 cm lesionâ =â 0.85 and ≤1 cm lesionâ =â 0.81). Among the 4 readers, average intraobserver visual DS agreement between OSEM and BPL was 0.67 for lesions >1cm and 0.4 for lesions ≤1 cm. F-18 Fluorodeoxyglucose PET/CT of diffuse large B-cell lymphoma reconstructed with BPL has higher SUV values, altered DSs and reader agreement when compared to OSEM. This report finds volumetric PET measurements such as metabolic tumor volume to be similar between BPL and OSEM PET reconstructions. Efforts such as adoption of European Association Research Ltd accreditation should be made to harmonize PET data with an aim at balancing the need for harmonization and sensitivity for lesion detection.