Long-Term Effects of Proximal Splenic Artery Embolization on Splenic Volume and Platelet Count.

BACKGROUND: The spleen is the most commonly injured visceral organ in blunt abdominal trauma. Post-splenectomy infection risk has led to the shift toward spleen preserving procedures and splenic artery embolization (SAE) is now the treatment of choice for hemodynamically stable patients with splenic injury. This study aims to assess the long-term effect of SAE on splenic volume and platelet count. MATERIALS AND METHODS: Using CPT codes, 66 patients who underwent SAE were identified, and 14 of those who had the necessary imaging and laboratory follow-up were included in the study. Indications for SAE were portal hypertension in 8 patients, bleeding in 4 patients, and thrombocytopenia in 1, and one patient had a separate indication. Splenic volume was calculated by automated volumetric software (Aquarius, TeraRecon, Inc.). Paired t-tests were performed to compare splenic volume and platelets before and after SAE. RESULTS: Fourteen patients (7 males, 7 females) with a mean age of 51 ± 11.95 years underwent SAE and were followed by a repeat computed tomography scan at an average of 733.57 days. Nine SAEs were performed using vascular plugs, 3 using micro coils, and 2 out of that were with Gelfoam slurry, and 2 using coils only. All embolizations were technically successful with complete cessation of flow. Mean splenic volumes pre- and post-SAE were 903.5 ± 523.73 cm3 and 746.5 ± 511.95 cm3, respectively, representing a mean decrease of 8.31% compared to baseline [P = 0.346]. Minimum platelet counts (x103) pre-SAE (within 3 months) and post-SAE (2 weeks to 3 months after the procedure) were 55.79 ± 57.11 and 116 ± 145.40, respectively. The minimum platelet count showed a statistically significant mean increase of 134.92% (P = 0.033). CONCLUSIONS: The splenic volume is not altered significantly by SAE in the long term. Similarly, the platelet count is also not significantly altered at 3 months follow-up. This study, although small, suggests that SAE is a safe intervention that can preserve splenic volume and function in the long term.

Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound.

BACKGROUND: Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. OBJECTIVES: To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. METHODS: The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. RESULTS: All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. CONCLUSIONS: We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.

Value of fat suppression in the MRI evaluation of suspected arrhythmogenic right ventricular dysplasia.

OBJECTIVE: Arrhythmogenic right ventricular dysplasia (ARVD) is characterized by intramyocardial fibrofatty change. Fat suppression performed during conventional spin-echo imaging has been used to confirm fatty infiltration. The utility of fat suppression for enhancing the interpretation of studies of suspected ARVD has not previously been formally tested. We investigated the value of fat suppression for enhancing the interpretation of intramyocardial fatty infiltration. MATERIALS AND METHODS: Twenty-six consecutive patients clinically referred for evaluation of possible ARVD underwent cardiac MRI. Two independent observers reviewed the images retrospectively. Intramyocardial areas (n = 101) that had increased signal intensity relative to normal surrounding myocardium on T1-weighted conventional spin-echo images ("index areas") were identified. The index areas were interpreted for presence of fatty infiltration using two sets of images: The first set was obtained without fat suppression, and the second set was obtained with fat suppression. Agreement between reviewers and confidence of interpretation were determined and compared. RESULTS: Interobserver agreement was measured using a 5-point scale: 1, definitely not fat; 2, probably not fat; 3, equivocal; 4, probably fat; and 5, definitely fat. The resulting kappa values were 0.35 for non-fat-suppressed images and 0.55 for fat-suppressed images. Interobserver kappa increased from 0.67 without fat suppression to 0.90 with fat suppression using a 3-point scale: 1, not fat; 2, equivocal; and 3, fat. Confidence in the diagnosis increased from 7.2 without fat suppression to 8.8 with fat suppression (p < 0.0001) on a 10-point scale ranging from 1, not confident, to 10, very confident. CONCLUSION: The use of fat-suppressed in addition to non-fat-suppressed conventional T1-weighted spin-echo imaging increased interobserver agreement and confidence in diagnosis and evaluation of intramyocardial fatty infiltration in patients who were suspected to have ARVD.