RESUMEN
BACKGROUND: Trials of the efficacy and safety of endovascular thrombectomy in patients with large ischemic strokes have been carried out in limited populations. METHODS: We performed a prospective, randomized, open-label, adaptive, international trial involving patients with stroke due to occlusion of the internal carotid artery or the first segment of the middle cerebral artery to assess endovascular thrombectomy within 24 hours after onset. Patients had a large ischemic-core volume, defined as an Alberta Stroke Program Early Computed Tomography Score of 3 to 5 (range, 0 to 10, with lower scores indicating larger infarction) or a core volume of at least 50 ml on computed tomography perfusion or diffusion-weighted magnetic resonance imaging. Patients were assigned in a 1:1 ratio to endovascular thrombectomy plus medical care or to medical care alone. The primary outcome was the modified Rankin scale score at 90 days (range, 0 to 6, with higher scores indicating greater disability). Functional independence was a secondary outcome. RESULTS: The trial was stopped early for efficacy; 178 patients had been assigned to the thrombectomy group and 174 to the medical-care group. The generalized odds ratio for a shift in the distribution of modified Rankin scale scores toward better outcomes in favor of thrombectomy was 1.51 (95% confidence interval [CI], 1.20 to 1.89; P<0.001). A total of 20% of the patients in the thrombectomy group and 7% in the medical-care group had functional independence (relative risk, 2.97; 95% CI, 1.60 to 5.51). Mortality was similar in the two groups. In the thrombectomy group, arterial access-site complications occurred in 5 patients, dissection in 10, cerebral-vessel perforation in 7, and transient vasospasm in 11. Symptomatic intracranial hemorrhage occurred in 1 patient in the thrombectomy group and in 2 in the medical-care group. CONCLUSIONS: Among patients with large ischemic strokes, endovascular thrombectomy resulted in better functional outcomes than medical care but was associated with vascular complications. Cerebral hemorrhages were infrequent in both groups. (Funded by Stryker Neurovascular; SELECT2 ClinicalTrials.gov number, NCT03876457.).
Asunto(s)
Isquemia Encefálica , Procedimientos Endovasculares , Accidente Cerebrovascular Isquémico , Trombectomía , Humanos , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/cirugía , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/métodos , Fibrinolíticos/efectos adversos , Fibrinolíticos/uso terapéutico , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/cirugía , Estudios Prospectivos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/cirugía , Trombectomía/efectos adversos , Trombectomía/métodos , Resultado del Tratamiento , Infarto de la Arteria Cerebral Media/complicaciones , Enfermedades de las Arterias Carótidas/complicaciones , Recuperación de la Función , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/etiologíaRESUMEN
BACKGROUND AND PURPOSE: Delayed evaluation of stroke may contribute to COVID-19 pandemic-related morbidity and mortality. This study evaluated patient characteristics, process measures and outcomes associated with the decline in stroke presentation during the early pandemic. METHODS: Volumes of stroke presentations, intravenous thrombolytic administrations, and mechanical thrombectomies from 52 hospitals from January 1-June 30, 2020 were analyzed with piecewise linear regression and linear spline models. Univariate analysis compared pandemic (case) and pre-pandemic (control) groups defined in relation to the nadir of daily strokes during the study period. Significantly different patient characteristics were further evaluated with logistic regression, and significantly different process measures and outcomes were re-analyzed after propensity score matching. RESULTS: Analysis of 7,389 patients found daily stroke volumes decreased 0.91/day from March 12-26 (p < 0.0001), reaching a nadir 35.0% less than expected, and increased 0.15 strokes/day from March 27-June 23, 2020 (p < 0.0001). Intravenous thrombolytic administrations decreased 3.3/week from February 19-March 31 (p = 0.0023), reaching a nadir 33.4% less than expected, and increased 1.4 administrations/week from April 1-June 23 (p < 0.0001). Mechanical thrombectomy volumes decreased by 1.5/week from February 19-March 31, 2020 (p = 0.0039), reaching a nadir 11.3% less than expected. The pandemic group was more likely to ambulate independently at baseline (p = 0.02, ORâ¯=â¯1.60, 95% CIâ¯=â¯1.08-2.42), and less likely to present with mild stroke symptoms (NIH Stroke Scale ≤ 5; p = 0.04, ORâ¯=â¯1.01, 95% CIâ¯=â¯1.00-1.02). Process measures and outcomes of each group did not differ, including door-to-needle time, door-to-puncture time, and successful mechanical thrombectomy rate. CONCLUSION: Stroke presentations and acute interventions decreased during the early COVID-19 pandemic, at least in part due to patients with lower baseline functional status and milder symptoms not seeking medical care. Public health messaging and initiatives should target these populations.
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COVID-19 , Diagnóstico Tardío/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Aceptación de la Atención de Salud , Accidente Cerebrovascular/terapia , Trombectomía/tendencias , Terapia Trombolítica/tendencias , Tiempo de Tratamiento/tendencias , Anciano , Anciano de 80 o más Años , Femenino , Estado Funcional , Humanos , Masculino , Persona de Mediana Edad , Indicadores de Calidad de la Atención de Salud/tendencias , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this study was to review the available armamentarium and most recent advances in minimally invasive, image-guided percutaneous thermal ablation for treatment of spinal metastases. CONCLUSION: Minimally invasive percutaneous spine thermal ablation technologies have proved safe and effective in management of selected patients with spinal metastases. Special attention to procedure techniques including choice of ablation modality, thermoprotection, adequacy of treatment, and postablation imaging is essential for improved patient outcomes.
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Ablación por Catéter , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Cirugía Asistida por Computador , Humanos , Imagen por Resonancia Magnética , Procedimientos Quirúrgicos Mínimamente Invasivos , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Isolated internal carotid artery (ICA) thrombus in the absence of underlying atherosclerotic disease is a rare entity. We report a case of a patient presenting with right arm weakness, slurred speech, and altered mental status in the setting of acute on chronic pancreatitis. The patient was found to have scattered left cerebral hemisphere cortical infarctions, and catheter angiography confirmed the presence of intraluminal left ICA thrombus, with no evidence of atherosclerotic disease in the cervical or intracranial vasculature. Further workup also demonstrated the presence of anemia of chronic disease. The patient was initiated on anticoagulation, and follow-up imaging demonstrated a complete resolution of the left ICA thrombus. In the reported case, coagulopathy in the setting of acute on chronic pancreatitis was presumably the primary etiology. Anemia of chronic disease, related to a proinflammatory state, may also play a contributory role.
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Enfermedades de las Arterias Carótidas/etiología , Arteria Carótida Interna , Infarto de la Arteria Cerebral Media/etiología , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Crónica/complicaciones , Trombosis/etiología , Adulto , Anticoagulantes/uso terapéutico , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/tratamiento farmacológico , Arteria Carótida Interna/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/tratamiento farmacológico , Imagen por Resonancia Magnética , Masculino , Pancreatitis Aguda Necrotizante/diagnóstico , Pancreatitis Crónica/diagnóstico , Flebografía/métodos , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
PURPOSE: Flow diversion constitutes a pivotal advancement in endovascular intracranial aneurysm treatment, but requires development of a new skill set. The aim of this study is to determine whether outcomes after treatment with the Pipeline Embolization Device improve with experience. METHODS: We retrospectively reviewed all patients with intracranial aneurysms treated with Pipeline at two centers over a 4.5-year period. Baseline patient and aneurysm characteristics, complications, and angiographic outcomes were analyzed. RESULTS: One hundred forty patients underwent 150 Pipeline procedures to treat 167 intracranial aneurysms during the study period, 109 women, mean age 55.4 years. One hundred twenty-six aneurysms were ICA, mean size 10.2 mm and mean neck 6.4 mm. Intra-procedural technical difficulties were higher during the first 75 procedures compared with the subsequent 75 (13.3 vs 2.7%; p = 0.03), as combined major morbidity and neurological mortality (14.7 vs 4%; p = 0.046). In multivariate regression analysis, increased operator experience with Pipeline remained an independent predictor of intra-procedural technical difficulties (p = 0.02, odds ratio (OR) 0.015, 95% CI 0.0004-0.55) and combined major morbidity and neurological mortality (p = 0.03, OR 0.16, 95% CI 0.03-0.84). At last follow-up, 123 aneurysms were completely occluded (81.5%, mean 24 months). In our cohort, age ≤ 53 years was an independent predictor of complete aneurysm occlusion at last follow-up (p = 0.001, OR 0.92, 95% CI 0.88-0.97). Five aneurysms were retreated (3.3%). CONCLUSION: The Pipeline embolization device is an effective treatment for intracranial aneurysms. The risk of intra-procedural technical difficulties and combined major morbidity and neurological mortality decreases significantly with increased operator experience in Pipeline deployment and patient management.
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Competencia Clínica , Embolización Terapéutica/instrumentación , Aneurisma Intracraneal/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Cerebral , Diseño de Equipo , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The purpose of this study was to evaluate the safety, technical success rate, and diagnostic efficacy of drill-assisted axial and appendicular bone biopsies. During a 3-y period, 703 drill-assisted biopsies were performed. The cohort included 54.2% men, with a mean age of 57.6 y ± 17.1. Median lesion volume was 10.9 mL (interquartile range, 3.4-30.2 mL). Lesions were lytic (31.7%), sclerotic (21.2%), mixed lytic and sclerotic (27.7%), or normal radiographic bone quality (19.3%). No complications were reported. The technical biopsy success rate was 99.9%. Crush artifact was present in 5.8% of specimens submitted for surgical pathologic examination, and 2.1% of specimens were inadequate for histologic evaluation.
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Biopsia con Aguja/métodos , Enfermedades Óseas/patología , Huesos/patología , Biopsia Guiada por Imagen/métodos , Radiografía Intervencional/métodos , Tomografía Computarizada por Rayos X , Adulto , Anciano , Artefactos , Biopsia con Aguja/efectos adversos , Biopsia con Aguja/instrumentación , Enfermedades Óseas/diagnóstico por imagen , Huesos/diagnóstico por imagen , Femenino , Humanos , Biopsia Guiada por Imagen/efectos adversos , Biopsia Guiada por Imagen/instrumentación , Masculino , Persona de Mediana Edad , Agujas , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
PURPOSE: To evaluate the safety and effectiveness of cryoablation of musculoskeletal metastases in terms of achieving pain palliation and local tumor control. MATERIALS AND METHODS: A retrospective review was performed of 92 musculoskeletal metastases in 56 patients treated with percutaneous image-guided cryoablation. Mean age of the cohort was 53.9 y ± 15.1, and cohort included 48% (27/56) men. Median tumor volume was 13.0 cm3 (range, 0.5-577.2 cm3). Indications for treatment included pain palliation (41%; 38/92), local tumor control (15%; 14/92), or both (43%; 40/92). Concurrent cementoplasty was performed after 28% (26/92) of treatments. RESULTS: In 78 tumors treated for pain palliation, median pain score before treatment was 8.0. Decreased median pain scores were reported 1 day (6.0; P < .001, n = 62), 1 week (5.0; P < .001, n = 70), 1 month (5.0; P < .001, n = 63), and 3 months (4.5; P = .01, n = 28) after treatment. The median pain score at 6-month follow-up was 7.5 (P = .33, n = 11). Radiographic local tumor control rates were 90% (37/41) at 3 months, 86% (32/37) at 6 months, and 79% (26/33) at 12 months after treatment. The procedural complication rate was 4.3% (4/92). The 3 major complications included 2 cases of hemothorax and 1 transient foot drop. CONCLUSIONS: Cryoablation is an effective treatment for palliating painful musculoskeletal metastases and achieving local tumor control.
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Neoplasias Óseas/secundario , Neoplasias Óseas/cirugía , Criocirugía/métodos , Neoplasias de los Músculos/secundario , Neoplasias de los Músculos/cirugía , Dolor Musculoesquelético/prevención & control , Cuidados Paliativos/métodos , Adulto , Anciano , Neoplasias Óseas/complicaciones , Neoplasias Óseas/diagnóstico por imagen , Cementoplastia , Criocirugía/efectos adversos , Femenino , Trastornos Neurológicos de la Marcha/etiología , Hemotórax/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Missouri , Neoplasias de los Músculos/complicaciones , Neoplasias de los Músculos/diagnóstico por imagen , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/etiología , Dimensión del Dolor , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Retrospectivos , Resultado del Tratamiento , Carga TumoralRESUMEN
Percutaneous image-guided ablation has been shown to be safe and effective for the treatment of benign osseous lesions and has evolved into the treatment of metastatic lesions for both pain palliation and local tumor control. Ablation is increasingly becoming part of the treatment algorithm of painful bone lesions, requiring multidisciplinary input from radiation, surgical, and medical oncologists. Substantial pain reduction is often possible in those who have failed to benefit from conventional therapies such as systemic and radiation therapy. This review details the basics of bone ablation including indications, treatment algorithms, ablation modalities, role of imaging, thermo-protective techniques, and the emerging use for local tumor control in patients with oligometastatic disease.
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Neoplasias Óseas/cirugía , Ablación por Catéter/métodos , Manejo del Dolor/métodos , Dolor/prevención & control , Algoritmos , Neoplasias Óseas/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Dolor/etiología , Cuidados Paliativos , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To determine the safety and effectiveness of radiofrequency ablation (RFA) to treat sacral metastases for pain palliation and local tumor control (LTC). MATERIALS AND METHODS: An institutional tumor ablation registry was retrospectively reviewed for sacral RFA procedures performed between January 2012 and December 2015. Clinical history, pre-procedural imaging, and procedural details were reviewed to document indication for treatment, primary tumor histology, tumor volumes, presence of concurrent cementoplasty after RFA, and the occurrence of peri-procedural complications. Pain scores before and 4 weeks after the procedure were recorded. Post-procedure imaging was reviewed for imaging evidence of tumor progression. Long-term complications and duration of clinical follow-up were recorded. RESULTS: During the study period, 11 RFA procedures were performed to treat 16 sacral metastases. All procedures were for pain palliation. Four procedures (36 %; 4 out of 11) were also performed with the intention of achieving LTC in patients with oligometastatic disease. Concurrent cementoplasty was performed in 63 % of cases (7 out of 11). The median pain score decreased from 8 (interquartile range, 6-9.25) at baseline to 3 (interquartile range, 1.75-6.3) 1 month following RFA (P = 0.004). In the 4 patients with oligometastatic disease, LTC was achieved in 3 patients (75 %; 3 out of 4) after a median follow-up of 7.6 months (range, 3.6-11.9 months). No acute or long-term complications were documented during the overall median clinical follow-up of 4.7 months (range, 0.9-28.7 months). CONCLUSIONS: Radiofrequency ablation maybe a safe and potentially effective treatment for patients with painful sacral metastases and can achieve LTC in selected patients.
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Neoplasias Óseas/secundario , Ablación por Catéter , Cementoplastia , Manejo del Dolor/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor , Estudios Retrospectivos , Sacro/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. MATERIALS AND METHODS: The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. RESULTS: During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). CONCLUSIONS: Palliative percutaneous acetabular radiofrequency ablation and cementoplasty can be feasibly performed from an anterior approach using a navigational ablation probe and ultrahigh viscosity cement instilled under CT-fluoroscopic guidance.
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Acetábulo/cirugía , Cementos para Huesos/uso terapéutico , Neoplasias Óseas/cirugía , Ablación por Catéter/instrumentación , Cementoplastia/métodos , Termografía/instrumentación , Acetabuloplastia/instrumentación , Acetabuloplastia/métodos , Adulto , Cementos para Huesos/química , Neoplasias Óseas/diagnóstico por imagen , Ablación por Catéter/métodos , Terapia Combinada/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Masculino , Radiografía Intervencional/métodos , Estudios Retrospectivos , Termografía/métodos , Transductores , Resultado del Tratamiento , ViscosidadRESUMEN
OBJECTIVES: Percutaneous biopsy of discitis-osteomyelitis is performed to isolate the causative microorganism and exclude alternative diagnoses. We compared drill-assisted and manual fluoroscopy-guided intervertebral disc biopsies with respect to conscious sedation requirements and histologic quality of obtained specimens. MATERIALS AND METHODS: Medical records of all single-level, fluoroscopy-guided intervertebral disc biopsies supervised by one of two musculoskeletal radiologists between January 2010 and March 2015 were reviewed. Duration and cumulative medication doses required for each biopsy were recorded. Pathology reports were reviewed to determine whether the obtained specimens were adequate for histopathologic evaluation. Microbiology reports were reviewed to determine whether the causative organism was isolated from the biopsy specimen. RESULTS: During the study period, 21 drill-assisted and 20 manual biopsies were performed. The median duration of conscious sedation for drill-assisted biopsies was 30 min (range, 17-40 min) compared with 39 min (range, 20-90 min) for manual biopsies (p < 0.01). Drill-assisted biopsies also required lower median cumulative doses of intravenous midazolam [2 mg (range, 0-5 mg) vs. 3 mg (range, 0-9 mg); p = 0.02]. All drill-assisted biopsy specimens were adequate for histopathologic evaluation. One manual biopsy specimen (5 %; 1/20) was inadequate for histopathologic evaluation owing to crush artifact. The microbiology yields of drill-assisted and manual biopsies were comparable [14 % (3/21) vs. 20 % (4/20); p = 0.62]. CONCLUSIONS: Fluoroscopically-guided intervertebral disc biopsies performed with drill assistance require less conscious sedation compared with manual biopsies and yield specimens that are adequate for histopathologic evaluation.
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Discitis/patología , Disco Intervertebral/patología , Osteomielitis/patología , Radiografía Intervencional/métodos , Adulto , Anciano , Biopsia/instrumentación , Femenino , Fluoroscopía/métodos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The Metastatic Spine Disease Multidisciplinary Working Group consists of medical and radiation oncologists, surgeons, and interventional radiologists from multiple comprehensive cancer centers who have developed evidence- and expert opinion-based algorithms for managing metastatic spine disease. The purpose of these algorithms is to facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding the use of available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation. This consensus document details the evidence supporting the Working Group algorithms and includes illustrative cases to demonstrate how the algorithms may be applied.
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Neoplasias de la Columna Vertebral/terapia , Terapia Combinada , Fracturas por Compresión/etiología , Fracturas por Compresión/terapia , Humanos , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/terapia , Guías de Práctica Clínica como Asunto , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/terapia , Fracturas de la Columna Vertebral/etiología , Fracturas de la Columna Vertebral/terapia , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/secundarioRESUMEN
Radiofrequency ablation (RFA) and vertebral augmentation is an emerging combination therapy for painful osseous metastases that cannot be or are incompletely palliated with radiation therapy. Herein, we report our experience performing RFA and vertebral augmentation of spinal metastases for pain palliation. Institutional review board approval was obtained to retrospectively review our tumor ablation database for all patients who underwent RFA of osseous metastases between April 2012 and July 2014. Patient demographics, lesion characteristics, concurrent palliative therapies, and complications were recorded. Pre- and post-procedure mean worst pain scores 1 and 4 weeks after treatment were measured using the Numeric Rating Scale (10-point scale) and compared. During the study period, 72 RFA treatments of 110 spinal metastases were performed. Eighty one percent (89/110) of metastases involved the posterior vertebral body and 45 % (49/110) involved the pedicles. Vertebral augmentation was performed after 95 % (105/110) of ablations. Mean and median pre-procedure pain scores were 8.0 ± 1.9 and 8.0, respectively. Patients reported clinically significant decreased pain scores at both 1-week (mean, 3.9 ± 3.0; median, 3.25; P < 0.0001) and 4-week (mean, 2.9 ± 3.0; median, 2.75; P < 0.0001) follow-up. No major complications occurred related to RFA and there were no instances of symptomatic cement extravasation. Combination RFA and vertebral augmentation is a safe and effective therapy for palliation of painful spinal metastases, including tumor involving the posterior vertebral body and/or pedicles.
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Ablación por Catéter , Dolor/cirugía , Cuidados Paliativos , Neoplasias de la Columna Vertebral/complicaciones , Neoplasias de la Columna Vertebral/cirugía , Vertebroplastia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Retrospectivos , Neoplasias de la Columna Vertebral/secundario , Resultado del TratamientoRESUMEN
OBJECTIVE: The purpose of this article is to describe the role of imaging in the management of metastatic spine disease with percutaneous ablation and vertebral augmentation. Topics include the imaging diagnosis of spinal metastases, imaging factors related to patient selection and procedural planning, intraprocedural imaging guidance, and posttreatment imaging assessment. CONCLUSION: Radiologists should be familiar with pertinent imaging findings related to the percutaneous management of metastatic spine disease.
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Ablación por Catéter/métodos , Diagnóstico por Imagen , Neoplasias de la Columna Vertebral/diagnóstico , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/cirugía , Vertebroplastia/métodos , Diagnóstico Diferencial , Humanos , Planificación de Atención al Paciente , Selección de Paciente , Radiografía IntervencionalRESUMEN
INTRODUCTION: Cerebrospinal fluid shunts are primarily used for the treatment of hydrocephalus. Shunt complications may necessitate multiple non-contrast head CT scans resulting in potentially high levels of radiation dose starting at an early age. A new head CT protocol using automatic exposure control and automated tube potential selection has been implemented at our institution to reduce radiation exposure. The purpose of this study was to evaluate the reduction in radiation dose achieved by this protocol compared with a protocol with fixed parameters. METHODS: A retrospective sample of 60 non-contrast head CT scans assessing for cerebrospinal fluid shunt malfunction was identified, 30 of which were performed with each protocol. The radiation doses of the two protocols were compared using the volume CT dose index and dose length product. The diagnostic acceptability and quality of each scan were evaluated by three independent readers. RESULTS: The new protocol lowered the average volume CT dose index from 15.2 to 9.2 mGy representing a 39 % reduction (P < 0.01; 95 % CI 35-44 %) and lowered the dose length product from 259.5 to 151.2 mGy/cm representing a 42 % reduction (P < 0.01; 95 % CI 34-50 %). The new protocol produced diagnostically acceptable scans with comparable image quality to the fixed parameter protocol. CONCLUSION: A pediatric shunt non-contrast head CT protocol using automatic exposure control and automated tube potential selection reduced patient radiation dose compared with a fixed parameter protocol while producing diagnostic images of comparable quality.
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Derivaciones del Líquido Cefalorraquídeo , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/terapia , Dosis de Radiación , Exposición a la Radiación/prevención & control , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Niño , Preescolar , Protocolos Clínicos , Falla de Equipo , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Adulto JovenRESUMEN
Hemangiomas of the submandibular space are very rare. Only 11 cases have been reported in the English literature, all of which were cavernous hemangiomas. In this report, we describe the case of a venous hemangioma in a 70-year-old woman. Ultrasound examination revealed a lobulated, homogeneous, hypoechoic mass, and minimal flow was detected on power Doppler evaluation. The mass and the submandibular gland were surgically excised, and the endothelium was found to be positive for CD31 and D2-40 markers, consistent with venous hemangioma. To our knowledge, this is the first reported case of a venous hemangioma in the submandibular space.
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Hemangioma/diagnóstico por imagen , Glándula Submandibular/irrigación sanguínea , Glándula Submandibular/diagnóstico por imagen , Anciano , Biopsia con Aguja Fina , Diagnóstico Diferencial , Femenino , Hemangioma/cirugía , Humanos , Biopsia Guiada por Imagen , Glándula Submandibular/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
OBJECTIVE: The objective of this article is to describe an approach to imaging CSF shunts. Topics reviewed include the components and imaging appearances of the most common types of shunts and the utility of different imaging modalities for the evaluation of shunt failure. Complications discussed include mechanical failure, infection, ventricular loculation, overdrainage, and unique complications related to each shunt type. CONCLUSION: This article reviews the imaging features of common CSF shunts and related complications with which radiologists should be familiar.
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Derivaciones del Líquido Cefalorraquídeo , Diagnóstico por Imagen , Complicaciones Posoperatorias/diagnóstico , HumanosRESUMEN
BACKGROUND AND PURPOSE: Patients suspected of having aneurysmal subarachnoid hemorrhage (SAH) are initially evaluated with noncontrast head computed tomography. If the computed tomography is negative, but clinical concern for SAH is high, a lumbar puncture with cerebrospinal fluid analysis is typically performed. The purpose of this study was to evaluate the accuracy of cerebrospinal fluid xanthochromia and erythrocytosis for aneurysmal SAH. METHODS: Medical records of all patients who underwent catheter angiography at Barnes Jewish Hospital between July 2002 and April 2012 for clinical suspicion of a ruptured brain aneurysm after a negative computed tomography scan and a lumbar puncture suspicious for SAH were reviewed. The cerebrospinal fluid analysis results, angiographic findings, and outcomes of each case were recorded. RESULTS: Fifty-seven patients were identified. Two angiographic lesions were identified in patients with xanthochromia (2/24 patients, ie, 8.3%), both of which were confirmed to have ruptured. The diagnostic yield in patients with nonclearing erythrocytosis and no xanthochromia was 6.3% (1/16 patients), although this lesion was not considered the source of SAH. CONCLUSIONS: Catheter angiography should be performed in patients with computed tomography negative but suspicious lumbar puncture, particularly in the presence of xanthochromia. The benefit of angiography in patients with erythrocytosis only is unclear and deserves future study.