RESUMO
BACKGROUND. High-frequency jet ventilation (HFJV) facilitates accurate probe placement in percutaneous ablation of lung tumors but may increase risk for adverse events, including systemic air embolism. OBJECTIVE. The purpose of this study was to compare major adverse events and procedural efficiency of percutaneous lung ablation with HFJV under general anesthesia to spontaneous respiration (SR) under moderate sedation. METHODS. This retrospective study included consecutive adults who underwent CT-guided percutaneous cryoablation of one or more lung tumors with HFJV or SR between January 1, 2017, and May 31, 2023. We compared major adverse events (Common Terminology Criteria for Adverse Events grade ≥ 3) within 30 days postprocedure and hospital length of stay (HLOS) of 2 days or more using logistic regression analysis. We compared procedure time, room time, CT guidance acquisition time, CT guidance radiation dose, total radiation dose, and pneumothorax using generalized estimating equations. RESULTS. Overall, 139 patients (85 women, 54 men; median age, 68 years) with 310 lung tumors (82% metastases) underwent 208 cryoablations (HFJV, n = 129; SR, n = 79). HFJV showed greater rates than SR for the treatment of multiple tumors per session (43% vs 19%, respectively; p = .02) and tumors in a nonperipheral location (48% vs 24%, p < .001). Major adverse event rate was 8% for HFJV and 5% for SR (p = .46). No systemic air embolism occurred. HLOS was 2 days or more in 17% of sessions and did not differ significantly between HFJV and SR (p = .64), including after adjusting for probe number per session, chronic obstructive pulmonary disease, and operator experience (p = .53). Ventilation modalities showed no significant difference in procedure time, CT guidance acquisition time, CT guidance radiation dose, or total radiation dose (all p > .05). Room time was longer for HFJV than SR (median, 154 vs 127 minutes, p < .001). For HFJV, the median anesthesia time was 136 minutes. Ventilation modalities did not differ in the frequencies of pneumothorax or pneumothorax requiring chest tube placement (both p > .05). CONCLUSION. HFJV appears to be as safe as SR but had longer room times. HFJV can be used in complex cases without significantly impacting HLOS of 2 days or more, procedure time, or radiation exposure. CLINICAL IMPACT. Selection of the ventilation modality during percutaneous lung ablation should be based on patient characteristics and anticipated procedural requirements as well as operator preference.
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Criocirurgia , Ventilação em Jatos de Alta Frequência , Neoplasias Pulmonares , Humanos , Masculino , Feminino , Ventilação em Jatos de Alta Frequência/métodos , Neoplasias Pulmonares/cirurgia , Idoso , Estudos Retrospectivos , Criocirurgia/métodos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Complicações Pós-Operatórias , Radiografia Intervencionista/métodos , Respiração , Idoso de 80 Anos ou mais , Tempo de Internação/estatística & dados numéricosRESUMO
PURPOSE: To explore the association between risk factors established in the surgical literature and hospital length of stay (HLOS), adverse events, and hospital readmission within 30 days after percutaneous image-guided thermal ablation of lung tumors. MATERIALS AND METHODS: This bi-institutional retrospective cohort study included 131 consecutive adult patients (67 men [51%]; median age, 65 years) with 180 primary or metastatic lung tumors treated in 131 sessions (74 cryoablation and 57 microwave ablation) from 2006 to 2019. Age-adjusted Charlson Comorbidity Index, sex, performance status, smoking status, chronic obstructive pulmonary disease (COPD), primary lung cancer versus pulmonary metastases, number of tumors treated per session, maximum axial tumor diameter, ablation modality, number of pleural punctures, anesthesia type, pulmonary artery-to-aorta ratio, lung densitometry, sarcopenia, and adipopenia were evaluated. Associations between risk factors and outcomes were assessed using univariable and multivariable generalized linear models. RESULTS: In univariable analysis, HLOS was associated with current smoking (incidence rate ratio [IRR], 4.54 [1.23-16.8]; P = .02), COPD (IRR, 3.56 [1.40-9.04]; P = .01), cryoablations with ≥3 pleural punctures (IRR, 3.13 [1.07-9.14]; P = .04), general anesthesia (IRR, 10.8 [4.18-27.8]; P < .001), and sarcopenia (IRR, 2.66 [1.10-6.44]; P = .03). After multivariable adjustment, COPD (IRR, 3.56 [1.57-8.11]; P = .003) and general anesthesia (IRR, 12.1 [4.39-33.5]; P < .001) were the only risk factors associated with longer HLOS. No associations were observed between risk factors and adverse events in multivariable analysis. Tumors treated per session were associated with risk of hospital readmission (P = .03). CONCLUSIONS: Identified preprocedural risk factors from the surgical literature may aid in risk stratification for HLOS after percutaneous ablation of lung tumors, but were not associated with adverse events.
Assuntos
Ablação por Cateter , Neoplasias Pulmonares , Doença Pulmonar Obstrutiva Crônica , Sarcopenia , Masculino , Adulto , Humanos , Idoso , Tempo de Internação , Estudos Retrospectivos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Doença Pulmonar Obstrutiva Crônica/cirurgia , HospitaisRESUMO
PURPOSE: To compare diagnostic yield and utility of a novel core biopsy needle (NCBN) with shortened tip dead space for percutaneous musculoskeletal biopsies with an established core biopsy needle (ECBN). METHODS: This study was IRB approved and HIPAA compliant. All percutaneous biopsies using an NCBN performed between July 2020 and August 2021 were retrospectively reviewed. Data on patient demographics, biopsy technique, biopsy needle, and histopathology were collated. RESULTS: Thirty-six patients were included in this study, 16 (44%) undergoing biopsy with both an NCBN and an ECBN, and 20 (56%) with an NCBN only. All 36 NCBN biopsies were 16 gauge. Fifteen (94%) of the ECBN biopsies were 14 gauge, and 1 (6%) was 16 gauge. Thirty-four (94%) of the NCBN and 15 (94%) of the ECBN biopsies were diagnostic. No adverse events were identified. CONCLUSION: Both the NCBN and ECBN have high diagnostic rates. No adverse events were identified. NCBN could be considered for biopsy of lesions limited by anatomic location or near adjacent critical structures.
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Biópsia Guiada por Imagem , Tomografia Computadorizada por Raios X , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Biópsia Guiada por Imagem/métodos , Biópsia com Agulha de Grande Calibre/efeitos adversosRESUMO
OBJECTIVE: To compare temporal changes of ablation zones and lymph nodes following lung microwave ablation (MWA) and cryoablation. METHODS: This retrospective cohort study compared lung ablation zones and thoracic lymph nodes following MWA and cryoablation performed 2006-2020. In the ablation zone cohort, ablation zone volumes were measured on serial CT for 12 months. In the lymph node cohort, the sum of bidimensional products of lymph node diameters was measured before (baseline) and up to 6 months following ablation. Cumulative incidence curves estimated the time to 75% ablation zone reduction and linear mixed-effects regression models compared the temporal distribution of ablation zones and lymph node sizes between modalities. RESULTS: Ablation zones of 59 tumors treated in 45 sessions (16 MWA, 29 cryoablation) in 36 patients were evaluated. Differences in the time to 75% volume reduction between modalities were not detected. Following MWA, half of the ablation zones required an estimated time of 340 days to achieve a 75% volume reduction compared to 214 days following cryoablation (p = .30). Thoracic lymph node sizes after 33 sessions (13 MWA, 20 cryoablation) differed between modalities (baseline-32 days, p = .01; 32-123 days, p = .001). Following MWA, lymph nodes increased on average by 38 mm2 (95%CI, 5.0-70.7; p = .02) from baseline to 32 days, followed by an estimated decrease of 50 mm2 (32-123 days; p = .001). Following cryoablation, changes in lymph nodes were not detected (baseline-32 days, p = .33). CONCLUSION: The rate of ablation zone volume reduction did not differ between MWA and cryoablation. Thoracic lymph nodes enlarged transiently after MWA but not after cryoablation. KEY POINTS: ⢠Contrary to current belief, the rate of lung ablation zone volume reduction did not differ between microwave and cryoablation. ⢠Transient enlargement of thoracic lymph nodes after microwave ablation was not associated with regional tumor spread and decreased within six months following ablation. ⢠No significant thoracic lymph node enlargement was observed following cryoablation.
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Ablação por Cateter , Criocirurgia , Neoplasias Pulmonares , Humanos , Micro-Ondas/uso terapêutico , Estudos Retrospectivos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Linfonodos/patologiaRESUMO
PURPOSE: To investigate the relationship between anatomic factors and primary patency of brachiocephalic arteriovenous fistulae (AVFs) after stent graft (SG) placement for cephalic arch stenosis (CAS). MATERIALS AND METHODS: This retrospective study reviewed all cephalic arch SGs placed in brachiocephalic AVFs in a tertiary academic medical center between 2014 and 2017. Sixty-three patients were included in the study. The mean patient age at the time of SG placement was 62.6 years ± 19, and the mean patient follow-up was 1,994 days ± 353. A cohort of patients (n = 31) who underwent brachiocephalic fistulograms for CAS but only received percutaneous transluminal angioplasty (PTA) was the control group. Patient demographic characteristics, AVF anatomy, SG type, and clinical outcomes were reviewed. The duration of primary cephalic arch patency after SG placement was compared with that after previous PTA. RESULTS: The median AVF age at the time of data retrieval was 345 days. The primary patency of CAS after SG placement at 6 months, 12 months, and 3 years was 64%, 49.9%, and 23.5%, respectively. Primary cephalic arch patency was significantly associated with the SG diameter (P = .007) but not with cephalic vein-axillary vein junction anatomy, size of feeding artery, or SG length (P > .05). The primary patency of CAS in patients treated with PTA only (n = 31) at 6 months, 12 months, and 3 years was 61%, 35%, and 0%, respectively, which was significantly lower than that in patients treated with SG placement (P = .01). CONCLUSIONS: This study showed that the primary patency of CAS after SG placement was significantly higher than that of PTA-only treatment. Moreover, primary cephalic arch patency after SG placement was significantly associated with the SG diameter.
Assuntos
Derivação Arteriovenosa Cirúrgica , Humanos , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/terapia , Grau de Desobstrução Vascular , Constrição Patológica/etiologia , Estudos Retrospectivos , Diálise Renal/efeitos adversos , Resultado do Tratamento , StentsRESUMO
Percutaneous image-guided thermal ablation (IGTA) has been endorsed by multiple societies as a safe and effective lung-preserving treatment of primary lung cancer and metastases involving the lung and chest wall. This article reviews the role of IGTA in the care continuum of patients with thoracic neoplasms and discusses strategies to identify the optimal local therapy considering patient and tumor characteristics. The advantages and disadvantages of percutaneous thermal ablation compared with surgical resection and stereotactic body radiotherapy are summarized. Principles of radiofrequency ablation, microwave ablation, and cryoablation, as well as the emerging use of transbronchial thermal ablation, are described. Specific considerations are presented regarding the role of thermal ablation for early-stage non-small cell lung cancer (NSCLC), multifocal primary NSCLC, pulmonary metastases, salvage of recurrent NSCLC after surgery or radiation, and pain palliation for tumors involving the chest wall. Recent changes to professional society guidelines regarding the role of thermal ablation in the lung, including for treatment of oligometastatic disease, are highlighted. Finally, recommendations are provided for imaging follow-up after thermal ablation of lung tumors, accompanied by examples of expected postoperative findings and patterns of disease recurrence.
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Carcinoma Pulmonar de Células não Pequenas , Ablação por Cateter , Hipertermia Induzida , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/patologia , Ablação por Cateter/métodos , Humanos , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/cirurgia , Resultado do TratamentoAssuntos
Debilidade Muscular , Mialgia , Adulto , Feminino , Humanos , Debilidade Muscular/etiologia , Mialgia/etiologiaRESUMO
OBECTIVE: The aim of this study was to report outcomes following percutaneous microwave and cryoablation of lung metastases from adenoid cystic carcinoma (ACC) of the head and neck. MATERIAL AND METHODS: This bi-institutional retrospective cohort study included 10 patients (6 females, median age 59 years [range 28-81]) who underwent 32 percutaneous ablation sessions (21 cryoablation, 11 microwave) of 60 lung metastases (median 3.5 tumors per patient [range 1-16]) from 2007 to 2019. Median tumor diameter was 16 mm [range 7-40], significantly larger for cryoablation (22 mm, p = 0.002). A median of two tumors were treated per session [range 1-7]. Technical success, local control, complications, and overall survival were assessed. RESULTS: Primary technical success was achieved for 55/60 tumors (91.7%). Median follow-up was 40.6 months (clinical) and 32.5 months (imaging, per tumor). Local control at 1, 2, and 3 years was 94.7%, 80.8%, and 76.4%, respectively, and did not differ between ablation modalities. Five of fifteen recurrent tumors underwent repeat ablation, and secondary technical success was achieved in four (80%). Assisted local tumor control at 1, 2, and 3 years was 96.2%, 89.8%, and 84.9%, respectively. Complications occurred following 24/32 sessions (75.0%) and 57.2% Common Terminology Criteria for Adverse Events (CTCAE) lower than grade 3. Of 13 pneumothoraces, 7 required chest tube placements. Hemoptysis occurred after 7/21 cryoablation sessions, and bronchopleural fistula developed more frequently with microwave (p = 0.037). Median length of hospital stay was 1 day [range 0-10], and median overall survival was 81.5 months (IQR 40.4-93.1). CONCLUSION: Percutaneous computed tomography-guided microwave and cryoablation can treat lung metastases from ACC of the head and neck. Complications are common but manageable, with full recovery expected.
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Carcinoma Adenoide Cístico , Criocirurgia , Neoplasias Renais , Neoplasias Pulmonares , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Adenoide Cístico/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Differentiation of benign from malignant lymphadenopathy remains challenging in pediatric radiology. Textural analysis (TA) quantitates heterogeneity of tissue signal intensities and has been applied to analysis of CT images. OBJECTIVE: The purpose of this study was to establish whether CT textural analysis of enlarged lymph nodes visualized on pediatric CT can distinguish benign from malignant lymphadenopathy. MATERIALS AND METHODS: We retrospectively identified enlarged lymph nodes measuring 10-20 mm on contrast-enhanced CTs of patients age 18 years and younger that had been categorized as benign or malignant based on the known diagnoses. We placed regions of interest (ROIs) over lymph nodes of interest and performed textural analysis with and without feature size filtration. We then calculated test performance characteristics for TA features, along with multivariate logistic regression modeling using Akaike Information Criterion (AIC) minimization, to determine the optimal thresholds for distinguishing benign from malignant lymphadenopathy. RESULTS: We identified 34 enlarged malignant nodes and 29 benign nodes from 63 patients within the 10- to 20-mm size range. Filtered image TA exhibited 82.4% sensitivity, 86.2% specificity and 84.1% accuracy for detecting malignant lymph nodes using mean and entropy parameters, whereas unfiltered TA exhibited 88.2% sensitivity, 72.4% specificity and 81.0% accuracy using mean and mean value of positive pixels parameters. CONCLUSION: This preliminary study demonstrates that the use of TA features improves the utility of pediatric CT to distinguish benign from malignant lymphadenopathy. The addition of TA to pediatric CT protocols has great potential to aid the characterization of indeterminate lymph nodes. If definitive differentiation between benign and malignant lymphadenopathy is possible by TA, it has the potential to reduce the need for follow-up imaging and tissue sampling, with reduced associated radiation exposure. However future studies are needed to confirm the clinical applicability of TA in distinguishing benign from malignant lymphadenopathy.
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Linfadenopatia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Humanos , Linfadenopatia/patologia , Masculino , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , Sensibilidade e EspecificidadeAssuntos
Exantema/etiologia , Fígado/patologia , Linfonodos/patologia , Pele/patologia , Tuberculose Cutânea/patologia , Dor Abdominal/etiologia , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Fígado/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Linfadenopatia/etiologia , Transtornos Linfoproliferativos/diagnóstico , Masculino , Radiografia Torácica , Sarcoidose/diagnóstico , Tomografia Computadorizada por Raios X , Tuberculose Cutânea/complicações , Tuberculose Cutânea/diagnósticoAssuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/diagnóstico por imagem , Miocárdio/patologia , Feocromocitoma/diagnóstico , Choque Cardiogênico/etiologia , Cardiomiopatia de Takotsubo/diagnóstico , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/patologia , Glândulas Suprarrenais/patologia , Pressão Sanguínea/fisiologia , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Feminino , Coração Auxiliar , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/patologia , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Volume Sistólico , Cardiomiopatia de Takotsubo/etiologia , Troponina I/sangueRESUMO
BACKGROUND AND AIM: Cystic pancreatic neoplasms (CPNs) are an increasingly diagnosed entity. Their heterogeneity poses complex diagnostic and management challenges. Despite frequently encountering these entities, particularly in the context of the increased imaging of patients in modern medicine, doctors have to rely on incomplete and ambiguous published literature. The aim of this project was to review the guidelines relating to CPNs using evidence-based practice (EBP) methods. METHODS: A search of both the primary and secondary literature was performed. Five sets of guidelines were identified which were then methodologically appraised by the AGREE II instrument, a validated and widely utilised tool for guideline development assessment. RESULTS: The 2014 'Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms' were found to be the most methodologically sound guidelines, on the basis of both the overall score and average weighted domain score. CONCLUSIONS: The current best guidelines were identified. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument can be used for retrospective review of published guidelines or as a roadmap for guideline-writing groups. All guidelines found were methodologically limited. Further longitudinal/prospective studies are required to improve the level of evidence. KEY POINTS: ⢠Cystic pancreatic neoplasms (CPNs) are an increasingly encountered entity in modern medicine. ⢠Clinical uncertainty remains with regard to optimal diagnostic and management strategies. ⢠The Italian consensus guidelines for cystic pancreatic neoplasms are currently the best guidelines.
Assuntos
Cisto Pancreático/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Guias de Prática Clínica como Assunto , Assistência ao Convalescente , Consenso , Medicina Baseada em Evidências , Humanos , Itália , Cisto Pancreático/terapia , Neoplasias Pancreáticas/terapia , Estudos Prospectivos , Estudos RetrospectivosRESUMO
PURPOSE: Superior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA). METHODS: An institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty. RESULTS: Primary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30 days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1 days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention. CONCLUSIONS: Treatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study.
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Bases de Dados Factuais , Desenho de Prótese , Stents , Síndrome da Veia Cava Superior , Grau de Desobstrução Vascular , Humanos , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/terapia , Síndrome da Veia Cava Superior/fisiopatologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso , Fatores de Tempo , Adulto , Fatores de Risco , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/efeitos adversos , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: To investigate the relationship between arteriovenous fistula (AVF) arterial diameter (AD) and AVF aneurysm development and progression. METHODS: This study identified all patients who underwent fistulograms which demonstrated AVF aneurysms meeting criteria and requiring surgical intervention between 01/01/2014 and 7/30/2016. Patient demographics were collected and AVF dimensions were measured on fistulograms. A control group with nonaneurysmal AVFs who had undergone serial fistulograms between 2013 and 2016 were identified and identical datasets collected. Statistical analysis was performed with STATA 14.0 using student's t-test, Chi square tests and linear regression. RESULTS: 45 eligible patients were identified in the AVF aneurysm study group and 24 in the control group, with the mean age of AVF creation being older in the control group (61.8 vs 53 years, p = 0.03). The mean interval between AVF creation and first fistulogram in the study group was 1464 ± 282 days, compared to an interval of 263 ± 101 days in the control group (p = 0.003). The AD on the first fistulogram in those study group patients with aneurysms evident on first fistulogram was greater than in the control group (6.5±1.8 mm vs 5.0 ± 1.8 mm, p = 0.003). The AD on first fistulogram of the study group predicted maximum aneurysm diameter on last fistulogram (r = 0.6, p = 0.03) as well as the interval between first fistulogram and surgical revision (r = -0.33, p = 0.03). CONCLUSION: AVF aneurysms are a later complication in access natural history and AD may help to predict their progression.
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Aneurisma , Fístula Arteriovenosa , Derivação Arteriovenosa Cirúrgica , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Humanos , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Grau de Desobstrução VascularRESUMO
The axilla contains several important structures which exist in a relatively confined anatomic space between the neck, chest wall, and upper extremity. While neoplastic lymphadenopathy may be among the most common axillary conditions, many other processes may be encountered. For example, expanded use of axillary vessels for access routes for endovascular procedures will increase the need for radiologists to access vessel anatomy, patency, and complications that may arise. Knowledge of axillary anatomy and pathology will allow the imager to systematically evaluate the axillae using various imaging modalities.
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Artéria Axilar , Procedimentos Endovasculares , Axila/diagnóstico por imagem , Humanos , Tórax , Extremidade Superior/irrigação sanguíneaRESUMO
Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.
RESUMO
We report on the feasibility of C-arm cone-beam computed tomography (CBCT) parenchymal blood volume imaging (PBVI) performed immediately following transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) to assess the need for repeat treatment. Eighteen TACE procedures were included. A retrospective assessment was made for the presence or absence of residual disease requiring treatment on immediate post-TACE PBVI and on interval follow-up multidetector computed tomography (MDCT) or magnetic resonance imaging (MRI). In 9/18 cases, both PBVI and MDCT/MRI showed that no further treatment was required. In 6/18 cases, further treatment was required on both PBVI and MDCT/MRI. In three cases, PBVI showed that further treatment was not required but MDCT/MRI showed residual disease requiring repeat treatment. There were no cases with PBVI showing residual disease not detected on follow-up MDCT/MRI. The PBVI sensitivity for detecting disease requiring repeat TACE was 67% (95% confidence interval [CI] 30-93%), and specificity was 100% (95% CI 66-100%). The use of C-arm CBCT PBVI for the detection of residual viable tumor within a treated lesion immediately after TACE is feasible. It may allow repeat TACE to be planned without performing interval imaging with MDCT or MRI.
Assuntos
Determinação do Volume Sanguíneo/métodos , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Tomografia Computadorizada de Feixe Cônico , Neoplasias Hepáticas/terapia , Adulto , Idoso , Artérias , Carcinoma Hepatocelular/fisiopatologia , Tomografia Computadorizada de Feixe Cônico/instrumentação , Tomografia Computadorizada de Feixe Cônico/métodos , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Magnetic resonance imaging (MRI) plays an integral role in the management of multiple sclerosis (MS), from both diagnostic and therapeutic perspectives. This 2-part review aims to detail the evolving and expanding role of MRI for both radiologists and neurologists. In this article, we discuss the diagnostic criteria for MS relevant to radiologists, as well as its varying imaging manifestations. The role of MRI in therapeutic modification and complications are discussed.