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1.
AJR Am J Roentgenol ; 217(4): 908-918, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-33336582

RESUMEN

BACKGROUND. In-gantry MRI-guided biopsy (MRGB) of the prostate has been shown to be more accurate than other targeted prostate biopsy methods. However, the optimal number of cores to obtain during in-gantry MRGB remains undetermined. OBJECTIVE. The purpose of this study was to assess the diagnostic yield of obtaining an incremental number of cores from the primary lesion and of second lesion sampling during in-gantry MRGB of the prostate. METHODS. This retrospective study included 128 men with 163 prostate lesions who underwent in-gantry MRGB between 2016 and 2019. The men had a total of 163 lesions sampled with two or more cores, 121 lesions sampled with three or more cores, and 52 lesions sampled with four or more cores. A total of 40 men underwent sampling of a second lesion. Upgrade on a given core was defined as a greater International Society of Urological Pathology (ISUP) grade group (GG) relative to the previously obtained cores. Clinically significant prostate cancer (csPCa) was defined as ISUP GG 2 or greater. RESULTS. The frequency of any upgrade was 12.9% (21/163) on core 2 versus 10.7% (13/121) on core 3 (p = .29 relative to core 2) and 1.9% (1/52) on core 4 (p = .03 relative to core 3). The frequency of upgrade to csPCa was 7.4% (12/163) on core 2 versus 4.1% (5/121) on core 3 (p = .13 relative to core 2) and 0% (0/52) on core 4 (p = .07 relative to core 3). The frequency of upgrade on core 2 was higher for anterior lesions (p < .001) and lesions with a higher PI-RADS score (p = .007); the frequency of upgrade on core 3 was higher for apical lesions (p = .01) and lesions with a higher PI-RADS score (p = .01). Sampling of a second lesion resulted in an upgrade in a single patient (2.5%; 1/40); both lesions were PI-RADS category 4 and showed csPCa. CONCLUSION. When performing in-gantry MRGB of the prostate, obtaining three cores from the primary lesion is warranted to optimize csPCa diagnosis. Obtaining a fourth core from the primary lesion or sampling a second lesion has very low yield in upgrading cancer diagnoses. CLINICAL IMPACT. To reduce patient discomfort and procedure times, operators may refrain from obtaining more than three cores or second lesion sampling.


Asunto(s)
Biopsia con Aguja Gruesa/métodos , Biopsia Guiada por Imagen/métodos , Imagen por Resonancia Magnética Intervencional/métodos , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Anciano , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estudios Retrospectivos
2.
J Ultrasound Med ; 38(10): 2541-2557, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30714653

RESUMEN

Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.


Asunto(s)
Medios de Contraste , Enfermedades del Sistema Digestivo/diagnóstico por imagen , Enfermedades Urogenitales Femeninas/diagnóstico por imagen , Aumento de la Imagen/métodos , Enfermedades Urogenitales Masculinas/diagnóstico por imagen , Enfermedades del Bazo/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Abdomen/diagnóstico por imagen , Femenino , Humanos , Masculino , Pelvis/diagnóstico por imagen
3.
Pediatr Radiol ; 47(6): 755-760, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28213627

RESUMEN

Real-time MRI-guided percutaneous sclerotherapy is a novel and evolving treatment for congenital lymphatic malformations in the head and neck. We elaborate on the specific steps necessary to perform an MRI-guided percutaneous sclerotherapy of lymphatic malformations including pre-procedure patient work-up and preparation, stepwise intraprocedural interventional techniques and post-procedure management. Based on our institutional experience, MRI-guided sclerotherapy with a doxycycline-gadolinium-based mixture as a sclerosant for lymphatic malformations of the head and neck region in children is well tolerated and effective.


Asunto(s)
Anomalías Linfáticas/terapia , Imagen por Resonancia Magnética Intervencional , Soluciones Esclerosantes/uso terapéutico , Escleroterapia/métodos , Adolescente , Niño , Medios de Contraste/uso terapéutico , Doxiciclina/uso terapéutico , Femenino , Cabeza , Humanos , Masculino , Cuello , Resultado del Tratamiento
4.
J Vasc Interv Radiol ; 27(12): 1907-1912, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27567997

RESUMEN

PURPOSE: To evaluate the imaging, histologic changes and safety of computed tomography (CT)-guided cryoablation of the parotid glands in a porcine model. MATERIALS AND METHODS: Unilateral CT-guided parotid gland cryoablation was performed in 5 juvenile miniature pigs. The ablated parotid glands underwent 2 cycles of 10-minute freeze and 5-minute thaw using three 17-g cryoprobes. The animals were monitored daily for complications including pain, frostbite, infection, and sialocele or fistula formation. Follow-up CT was performed at 6 weeks postcryoablation. Pathologic evaluation was performed on 2 of the ablated parotid glands. RESULTS: All cryoablations in 5 right parotid glands, with 3 sites in each gland, were technically successful. No symptoms suggestive of facial nerve damage were observed during 6-week follow-up. One pig developed an infected sialocele, which was treated with percutaneous drainage and oral antibiotic therapy. No CT evidence of sialocele or other abnormality was identified at the 6-week follow-up in all pigs. Histologic evaluation was performed on 2 of the parotid gland specimens, 1 with the treated sialocele, and 1 of the remaining pigs without sialocele. Both glands demonstrated postprocedural intraglandular lymph nodes and reactive changes without evidence of sialocele or abscess on histopathology. CONCLUSIONS: Cryoablation of parotid glands was technically feasible in a porcine model. Only 1 pig developed sialocele, which was successfully treated. Further research is warranted to determine the potential use of salivary gland cryoablation to treat patients with drooling.


Asunto(s)
Criocirugía , Glándula Parótida/cirugía , Radiografía Intervencional/métodos , Sialorrea/cirugía , Tomografía Computarizada por Rayos X , Animales , Biopsia , Criocirugía/efectos adversos , Estudios de Factibilidad , Femenino , Modelos Animales , Glándula Parótida/diagnóstico por imagen , Glándula Parótida/patología , Glándula Parótida/fisiopatología , Radiografía Intervencional/efectos adversos , Salivación , Sialorrea/fisiopatología , Porcinos , Porcinos Enanos , Factores de Tiempo , Tomografía Computarizada por Rayos X/efectos adversos
5.
J Magn Reson Imaging ; 39(1): 189-94, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24123420

RESUMEN

PURPOSE: To evaluate image quality when using a CAIPIRINHA sampling pattern in comparison to a standard GRAPPA sampling pattern in patients undergoing a routine three-dimensional (3D) breathheld liver exam. CAIPIRINHA uses an optimized phase encoding sampling strategy to alter aliasing artifacts in 3D acquisitions to improve parallel imaging reconstruction. MATERIALS AND METHODS: Twenty patient volunteers were scanned using a 3D VIBE acquisition with an acceleration factor of four using a CAIPIRINHA and standard GRAPPA sampling pattern. CAIPIRINHA and GRAPPA images were evaluated by three radiologists in a two alternative forced choice test, and the Wilcoxon signed rank test was performed. RESULTS: The CAIPIRINHA sampling pattern was preferred in an average of 68% of the comparisons, and the Wilcoxon signed rank test showed a significant improvement in CAIPIRINHA images (P = 0.014). This analysis indicates that in the given sample set, CAIPIRINHA preference over the GRAPPA standard was statistically significant. CONCLUSION: This work shows that for an acceleration factor of four, a CAIPIRINHA accelerated VIBE acquisition provides significantly improved image quality in comparison to the current GRAPPA standard. This allows a further reduction in imaging time for similar spatial resolutions, which can reduce long breathhold requirements in abdominal imaging, and may be particularly helpful in patients who cannot provide requisite breathholds with current protocols.


Asunto(s)
Abdomen/patología , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Artefactos , Contencion de la Respiración , Medios de Contraste/química , Humanos , Imagenología Tridimensional/normas , Hígado/patología , Imagen por Resonancia Magnética/normas , Persona de Mediana Edad , Variaciones Dependientes del Observador , Programas Informáticos , Factores de Tiempo , Adulto Joven
6.
J Magn Reson Imaging ; 38(5): 1237-44, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23389970

RESUMEN

PURPOSE: To obtain a simultaneous 3D magnetic resonance angiography and perfusion (MRAP) using a single acquisition and to demonstrate MRAP in the lower extremities. A time-resolved contrast-enhanced exam was used in MRAP to simultaneously acquire a contrast-enhanced MR angiography (MRA) and dynamic contrast-enhanced (DCE) perfusion, which currently requires separate acquisitions and thus two contrast doses. MRAP can be used to assess large and small vessels in vascular pathologies such as peripheral arterial disease. MATERIALS AND METHODS: MRAP was performed on 10 volunteers following unilateral plantar flexion exercise (one leg exercised and one rested) on two separate days. Data were acquired after administration of a single dose of contrast agent using an optimized sampling strategy, parallel imaging, and partial-Fourier acquisition to obtain a high spatial resolution, 3D-MRAP frame every 4 seconds. Two radiologists assessed MRAs for image quality, a signal-to-noise ratio (SNR) analysis was performed, and pharmacokinetic modeling yielded perfusion (K(trans) ). RESULTS: MRA images had high SNR and radiologist-assessed diagnostic quality. Mean K(trans) ± standard error were 0.136 ± 0.009, 0.146 ± 0.012, and 0.191 ± 0.012 min(-1) in the resting tibialis anterior, gastrocnemius, and soleus, respectively, which significantly increased with exercise to 0.291 ± 0.018, 0.270 ± 0.019, and 0.338 ± 0.022 min(-1) . Bland-Altman analysis showed good repeatability. CONCLUSION: MRAP provides simultaneous high-resolution MRA and quantitative DCE exams to assess large and small vessels with a single contrast dose. Application in skeletal muscle shows quantitative, repeatable perfusion measurements, and the ability to measure physiological differences.


Asunto(s)
Interpretación de Imagen Asistida por Computador/métodos , Extremidad Inferior/fisiología , Imagen por Resonancia Magnética/métodos , Imagen Multimodal/métodos , Músculo Esquelético/fisiología , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Femenino , Humanos , Extremidad Inferior/irrigación sanguínea , Masculino , Músculo Esquelético/irrigación sanguínea , Proyectos Piloto , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
7.
Urol Int ; 90(4): 381-3, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23594736

RESUMEN

INTRODUCTION: Percutaneous cryoablation is an emerging treatment option for the small renal mass. It poses a risk of thermal injury to adjacent tissues, limiting its application. We describe pneumodissection, a novel technique for preventing thermal injury during percutaneous cryoablation. MATERIALS AND METHODS: The cases of 4 patients who underwent percutaneous renal cryoablation and pneumodissection were retrospectively reviewed. RESULTS: Pneumodissection mechanically separated four tumors from overlying bowel segments (mean distance 1.2 ± 0.4 cm), permitting successful cryoablation. There were no complications or recurrences with 7.5 months of follow-up. CONCLUSIONS: Pneumodissection is a feasible displacement technique that facilitates percutaneous cryoablation in at-risk patients. Further study is warranted.


Asunto(s)
Criocirugía/métodos , Disección/métodos , Neoplasias Renales/cirugía , Anciano , Criocirugía/efectos adversos , Disección/efectos adversos , Estudios de Factibilidad , Humanos , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Complicaciones Posoperatorias/prevención & control , Radiografía Intervencional , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Carga Tumoral
8.
J Vasc Interv Radiol ; 22(11): 1601-5, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-21924625

RESUMEN

PURPOSE: To evaluate the effectiveness of direct intraparenchymal injection of platelets or fresh frozen plasma (FFP) into the needle tract before cutting needle biopsy to decrease postprocedural blood loss in pigs with normal and abnormal hemostasis. MATERIALS AND METHODS: A total of 12 Yorkshire-cross pigs were anesthetized and maintained on a respirator. The pigs were divided into three groups: three with normal hemostasis, five treated with warfarin anticoagulation, and four treated with aspirin. Four types of biopsies were performed in the exposed livers and kidneys with 14-gauge Tru-Cut needles. The first was a standard (ie, control) biopsy, and the other three were performed with 2 mL normal saline solution, porcine FFP, or platelet-rich porcine plasma injected into the planned needle tract. Biopsy was then performed in the same needle tract. Blood loss was measured with gauze sponges. RESULTS: Significantly decreased postbiopsy blood loss was noted after FFP and platelet injection in the livers and kidneys of all groups except the kidney biopsy group after platelet injection in pigs with normal hemostasis. There was no significant difference in blood loss between the control and saline solution control groups in any of the pigs. CONCLUSIONS: Local injection of platelets or FFP significantly decreases postbiopsy blood loss in pigs with impaired hemostasis.


Asunto(s)
Biopsia con Aguja/efectos adversos , Plaquetas , Hemorragia/prevención & control , Hemostasis , Técnicas Hemostáticas , Plasma , Animales , Anticoagulantes/farmacología , Aspirina/farmacología , Plaquetas/efectos de los fármacos , Hemorragia/sangre , Hemorragia/etiología , Hemostasis/efectos de los fármacos , Inyecciones , Modelos Animales , Inhibidores de Agregación Plaquetaria/farmacología , Porcinos , Warfarina/farmacología
9.
Cardiovasc Diagn Ther ; 8(Suppl 1): S118-S130, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29850424

RESUMEN

Ultrasound (US) represents the initial modality in the workup of abdominal aortic pathology based on the plethora of advantages including widespread availability, low cost, safety profile and repeatability. However, US has inherent limitations including limited spatial information of pathologic processes to neighboring structures, lower sensitivity to slow blood flow and aortic luminal irregularities. For evaluation of aortic pathology angiography has long been considered the gold standard. Non-invasive cross-sectional imaging techniques like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have gradually replaced interventional angiography for the evaluation of aorta, currently being regarded as the diagnostic imaging modalities of choice for diagnosis of virtually every aortic disease. Interventional angiography is currently primarily performed for treatment purposes of aortic pathology. The introduction of microbubbles as ultrasonographic contrast agents has rendered contrast-enhanced ultrasound (CEUS) an evolving valuable complementary technique with markedly increased diagnostic accuracy for certain aortic applications. CEUS is characterized by the potential to be performed in patients with impaired renal function. Due to its superior spatial and temporal resolution, ability for prolonged scanning and dynamic and real-time imaging, it provides clinically significant additional information compared to the standard Duplex US. The purpose of this paper is to discuss the currently available literature regarding abdominal aortic applications of CEUS, briefly elaborate on CEUS technique and safety and present cases in order to illustrate the added value in aortic pathologies. Conditions discussed include abdominal aortic aneurysm (AAA), aneurysm rupture, aneurysm surveillance after endovascular repair, dissection and aortitis.

10.
Phlebology ; 33(5): 344-352, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28516809

RESUMEN

Purpose This manuscript describes the technique of real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck based on our institutional experience. Materials and methods Ethanolamine oleate is used as the sclerosant and is mixed with gadolinium for visualization during the procedure. The five procedural steps include: (I) an initial tri-plane T2-weighted sequence to visualize the lesion; (II) a T1 FSE or trueFISP sequence to assess needle placement and advancement within the lesion; (III) a tri-plane T1 FLASH sequence to monitor sclerosant injection; (IV) a T1 FSE or VIBE sequence to assess sclerosant coverage of the malformation before needle removal; (V) a post-procedural tri-plane T1 fat-saturated sequence to confirm sclerosant coverage of the lesion. Periprocedural medications typically include steroids, antibiotic prophylaxis, and non-steroidal anti-inflammatory medication. Patients are typically admitted for overnight observation. Conclusion Real-time MRI-guided sclerotherapy for low-flow venous malformations in the head and neck is effective and safe.


Asunto(s)
Imagen por Resonancia Magnética , Ácidos Oléicos/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Escleroterapia , Enfermedades Vasculares/terapia , Malformaciones Vasculares/diagnóstico por imagen , Malformaciones Vasculares/terapia , Adolescente , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Encéfalo/diagnóstico por imagen , Femenino , Gadolinio/química , Cabeza/diagnóstico por imagen , Cabeza/fisiopatología , Humanos , Persona de Mediana Edad , Cuello/diagnóstico por imagen , Cuello/fisiopatología , Esteroides/uso terapéutico , Procesos Estocásticos , Enfermedades Vasculares/diagnóstico por imagen
11.
AIDS ; 21(8): 921-7, 2007 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-17457085

RESUMEN

OBJECTIVES: To assess carotid intima media thickness (IMT) and cardiac biomarkers in HIV infected children on antiretroviral therapy (ART). METHODS: This was a single site, cross sectional, controlled observational study. We assessed carotid IMT, homocysteine, high-sensitivity C-reactive protein and myeloperoxidase levels in HIV infected children on stable ART for >or= 6 months. Carotid IMT was reported as internal carotid artery (ICA) and common carotid artery (CCA) thickness; left and right sides were measured separately. Groups were compared using appropriate two-sample tests. RESULTS: Of the 62 subjects enrolled, 31 were HIV positive (50%), 66% were female, and 69% were African-American. Median CD4% was 32% and 26 patients (84%) had HIV-1 RNA< 400 copies/ml. Sixteen patients had been taking protease inhibitors for a median duration of 27 months. None had hypertension or smoked. HIV infected children had higher HOMA-IR, waist-to-hip ratio, cholesterol, triglycerides, myeloperoxidase and lower homocysteine levels. Left and right CCA IMT, and left and right ICA IMT were significantly higher in the HIV infected group. Significant predictors of carotid IMT measurements in uninfected controls were body mass index and homocysteine, but only the duration of ARV therapy was predictive of IMT in the HIV infected group. CONCLUSION: Higher levels of carotid IMT and some cardiac markers were found in ART treated HIV infected children when compared to matched uninfected controls. These results suggest that HIV infected children receiving ART may be at increased risk of cardiovascular disease.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Arterias Carótidas/patología , Infecciones por VIH/patología , Túnica Íntima/patología , Túnica Media/patología , Adolescente , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Biomarcadores/sangre , Composición Corporal , Proteína C-Reactiva/metabolismo , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/patología , Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Común/patología , Arteria Carótida Interna/patología , Niño , Preescolar , Estudios Transversales , Esquema de Medicación , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Homocisteína/sangre , Humanos , Lípidos/sangre , Masculino , Peroxidasa/sangre , Túnica Íntima/diagnóstico por imagen , Túnica Media/diagnóstico por imagen , Ultrasonografía
13.
Gastroenterol Rep (Oxf) ; 5(4): 305-308, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-27694618

RESUMEN

OBJECTIVE: Portal pressure gradient (PPG) after transjugular intrahepatic portosystemic shunt (TIPS) <12 mmHg has been reported as the only factor predictive of increase in platelet count. As flow velocities measured on Doppler ultrasound are related to pressure gradient based on the Bernoulli equation, we used this parameter to predict increased platelet count after TIPS placement. METHODS: A total of 161 consecutive patients who underwent TIPS placement entered this retrospective study. The platelet count was measured before, one week after and one month after TIPS placement. Clinically significant thrombocytopenia was defined as platelet count ≤100 000. Pre- and post-TIPS PPGs were measured. The velocity of blood flow in the proximal, mid and distal TIPS stent was measured using Doppler ultrasound, and the difference in the highest and lowest measured velocity was entitled flow velocity gradient (FVG), which was considered normal when ≤100 cm/s. RESULTS: In 121 patients with pre-TIPS thrombocytopenia, the mean platelet count one week and one month after TIPS placement increased 25.7 x 103 and 35.0 x 103 in 90 patients with PPG≤12 mmHg (P=0.028 and P=0.015), while there was no significant change in platelet count in patients with a PPG >12 mmHg (P=0.098 and P=0.075). Platelets increased significantly when FVG≤ 100 cm/s (n=95) vs FVG >100 cm/s (n=26) one week (37.0x103 vs 11.0x103; P = 0.005 vs 0.07) and one month after TIPS placement (17.0x103 vs 5.2x103; P = 0.01 vs 0.21). CONCLUSION: FVG >100 cm/s is not associated with increase in post-TIPS platelet count. On the other hand, findings suggestive of proper TIPS function (FVG ≤100 cm/s and PPG≤ 12 mmHg) predict a significant increase in post-TIPS platelet count.

14.
J Gastrointest Oncol ; 8(6): 1056-1064, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29299367

RESUMEN

BACKGROUND: To assess the technical success of contrast enhanced ultrasound (CEUS) guided biopsies of liver lesions poorly visualized on B-mode ultrasound. METHODS: Patients were selected during the procedure based on the real-time clinical scenario of unsatisfactory B-mode ultrasound lesion visualization and all patients would have otherwise undergone CT guided liver lesion biopsy. A total of 26 patients underwent CEUS guided biopsy and were included in this retrospective analysis. The review of the patients' files included demographic information, lesion characteristics on imaging, procedural details and pathology outcome. Technical success was defined as concordance between the radiological findings, pathology report and clinical follow-up-demonstrating lack of need for re-biopsy or re-biopsy with identical pathological results. Patients with less than 2 months follow-up were excluded from the study. RESULTS: CEUS guided liver biopsy was successful in 23 out of 26 patients (88.5%). The average procedure time was 30.7±12.3 minutes and the average lesion size was 2.2±1.7 cm. The majority of lesions (80.8%) were hypoenhancing on the delayed phase of CEUS. The mean number of samples taken from each lesion per procedure was 3.2 (±1.7). CONCLUSIONS: CEUS guidance biopsies of focal liver lesions (FLL) that were difficult to visualize on B-mode ultrasound demonstrated high success rate and may be an evolving image guidance modality in selected patients to avoid CT guided procedures.

15.
Curr Probl Diagn Radiol ; 46(3): 177-180, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28162863

RESUMEN

Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents.


Asunto(s)
Atención Ambulatoria/normas , Documentación/normas , Radiología Intervencionista/educación , Radiología Intervencionista/normas , Competencia Clínica , Educación de Postgrado en Medicina , Humanos , Indicadores de Calidad de la Atención de Salud , Derivación y Consulta , Estudios Retrospectivos
16.
Radiol Clin North Am ; 42(2): 457-78, 2004 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15136028

RESUMEN

The interventionist can perform many emergent procedures with ultrasound guidance, because of its real-time, multiplanar imaging capability and portability. With the use of color Doppler, additional important information, such as aberrant vessels, can be ascertained to help plan needle trajectory. Ultrasound is also useful for nonemergent procedures, such as biopsies. All interventionists are encouraged to be facile with the use of ultrasound.


Asunto(s)
Endosonografía/métodos , Ultrasonografía Doppler en Color/métodos , Ultrasonografía Intervencional/métodos , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/terapia , Biopsia con Aguja , Colecistectomía Laparoscópica/métodos , Drenaje/instrumentación , Urgencias Médicas , Femenino , Humanos , Masculino , Medición de Riesgo , Sensibilidad y Especificidad
17.
J Cancer Res Ther ; 7(4): 481-3, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-22269414

RESUMEN

Computed Tomography (CT)-guided percutaneous cryoablation was performed in a 43-year-old patient with intractable epigastric abdominal pain caused by advanced adenocarcinoma of the pancreas and extensive celiac trunk involvement. Initial treatment with celiac plexus nerve neurolysis using local ethanol injection was unsuccessful. A 17-gauge 17-cm cryoablation probe (Galil Medical Inc. Plymouth Meeting, PA) was placed into the expected location of the celiac plexus through a left paraspinal approach under CT guidance and two cycles of freeze-thaw were performed. Patient's pain decreased from 10 of 10 (subjective pain scoring using a visual analog scale; VAS; 0-10) to 3. No post-procedure complication was observed. His pain has remained stable after 6 months of follow up. Percutaneous cryoablation appears to be an effective alternative to neurolytic celiac plexus block for palliative treatment of celiac plexus involvement. Further study with larger number of patients is needed to evaluate the safety and efficacy.


Asunto(s)
Plexo Celíaco/cirugía , Criocirugía/métodos , Dolor Intratable/cirugía , Neoplasias Pancreáticas/fisiopatología , Adulto , Humanos , Masculino , Tomografía Computarizada por Rayos X
18.
Radiology ; 234(3): 674-83, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15650038

RESUMEN

Surgery currently appears to be the most effective method to curtail the effects of morbid obesity and all of its comorbid conditions. Although the ideal procedure has yet to be devised, Roux-en-Y gastric bypass has proved to be successful for many morbidly obese patients pursuing weight loss and increased health. As the technical aspects of this procedure become less cumbersome and the patient population increases, it is vital for radiologists to be proficient in the specific evaluation of these patients, in order to provide optimal care. Complications can be minimized, managed more efficiently, or prevented with prompt evaluation by the radiologist. It is important to appreciate the patency of both the gastrojejunostomy and the jejunojejunostomy, as well as adequate progression of contrast material before the patient is discharged (preferably 24-72 hours after surgery). Follow-up complications include anastomotic leak, staple-line disruption, stomal stenosis, occlusion of the Roux limb, small-bowel obstruction due to adhesions or internal hernia, and obstruction of the enteroenterostomy leading to acute gastric distention. These complications may be life threatening, since clinical symptoms are often inconclusive. To achieve optimal outcome, therefore, conventional radiographic and computed tomographic studies should not be delayed.


Asunto(s)
Anastomosis en-Y de Roux , Derivación Gástrica/métodos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Estómago/diagnóstico por imagen , Medios de Contraste , Humanos , Radiografía Intervencional , Tomografía Computarizada por Rayos X
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