Outpatient percutaneous image-guided microwave ablation with monitored anesthesia care: An exploratory study.

PURPOSE: To evaluate the feasibility, safety, and periprocedural perception of pain for a combination approach of moderate and deep sedation for image-guided percutaneous microwave ablation of both primary and secondary malignant lesions. METHODS: This was a retrospective study of 33 image-guided percutaneous microwave ablation procedures performed on 33 patients in an outpatient-based interventional radiology center. We used a combination of midazolam, fentanyl, propofol, and/or ketamine to achieve mild to moderate sedation for the procedure, and also to achieve deeper sedation as needed for the ablation portion. RESULTS: Technical success was achieved in all image-guided percutaneous microwave ablation procedures. Mean procedural time was 49.4 min. There were no major complications. Intraprocedural pain was absent in all patients. All 33 patients were deemed fit for discharge within 30 min following the procedure. CONCLUSION: The combination approach of moderate and deep sedation for anesthesia during image-guided percutaneous microwave ablation is an advantageous option. This approach has a strong safety profile, good technical success, short procedure times, low levels of intraprocedural and post-procedural pain, and short recovery from anesthesia.

Fatal retroperitoneal hematoma associated with Covid-19 prophylactic anticoagulation protocol.

Due to the association between Covid-19 and thromboembolic events, there has been a surge in anticoagulation use during the pandemic based on evolving guidelines for management of hospitalized Covid-19 patients. Spontaneous soft tissue hematoma can be a severe complication of anticoagulation. Herein we present a fatal case of severe spontaneous soft tissue hematoma secondary to anticoagulant therapy in a 67kg 81-year-old female with chronic kidney disease who was admitted to the hospital with Covid-19 pneumonia. There is currently no evidence of mortality benefit among Covid-19 patients on high-dose anticoagulation. In the future we hope that practitioners will consider the bleeding risks of anticoagulation and consider patients' age, weight and renal function when determining prophylactic anticoagulation regimens in Covid-19 patients.

Anticoagulation reduces iliocaval and iliofemoral stent thrombosis in patients with cancer stented for nonthrombotic venous obstruction.

OBJECTIVE: To identify factors associated with venous stent thrombosis in patients with cancer treated for nonthrombotic iliocaval or iliofemoral venous obstruction. METHODS: We performed a retrospective review of relevant imaging and medical records from 30 consecutive patients with cancer treated at a single center who underwent venous stent placement for nonthrombotic iliocaval or iliofemoral venous obstruction between 2008 and 2018. Follow-up imaging was used to assess stent patency. Variables examined included patient demographics, cancer type, stent characteristics, anticoagulant, and antiplatelet medications and complications of treatment. RESULTS: Overall primary stent patency was 83% (25/30). The median follow-up period was 44 days (range, 3-365 days). Ten percent of patients occluded owing to in-stent thrombosis and 7% owing to tumor compression of the stent without thrombosis. Therapeutic poststent anticoagulation with enoxaparin, warfarin, or a factor Xa inhibitor was initiated in 87% of the patients. Stent thrombosis occurred in one patient in the anticoagulation group (4%) at 50 days. Stent thrombosis occurred in two patients in the nonanticoagulation group (50%), one at 9 days and the other at 91 days. Anticoagulation was found to be protective against stent thrombosis in this population (hazard ratio, 0.015; P = .011). No statistically significant associations were found among the remaining variables. One patient in the anticoagulation group experienced major bleeding (1/26 [4%]). CONCLUSIONS: Iliocaval and iliofemoral stent placement for nonthrombotic malignant venous obstruction is safe with favorable primary patency rates. Therapeutic anticoagulation is associated with less stent thrombosis in patients with cancer stented for nonthrombotic iliocaval and iliofemoral venous obstruction.

Patients with falls from standing height and head or neck injury may not require body CT in the absence of signs or symptoms of body injury.

PURPOSE: To determine the rate of clinically impactful body injury among patients who had a fall from standing height with an associated head/neck injury, but without evidence of body injury on physical exam or plain radiographs. We also examine surgical/endovascular intervention related to body injury and mortality rates for head/neck and body injury. METHODS: Retrospective study of 288 patients with CT evidence of acute head/neck injury that underwent body CT despite the absence of clinical or radiographic evidence of body injury. Predictor variables were age, sex, race/ethnicity, and body mass index (BMI). RESULTS: There were 11.5% (n = 33) with body injury on CT (n = 33). There were 3.1% (n = 9) with clinically impactful body injury. No patient had either surgical/endovascular intervention or mortality related to body injury. Additionally, 8.7% (n = 25) had mortality from head/neck injury. Increased age (OR = 1.05, 95% CI: 1.01, 1.08, p = 0.01) and overweight BMI (25-29.99 kg/m2) (OR = 2.85, 95% CI: 1.07, 7.62, p = 0.04) were each significantly associated with increased odds for mortality from head/neck injury. CONCLUSION: Patients with falls from standing height and known head/neck injury had a low rate of clinically impactful body injury. None of the studied variables were associated with increased risk of body injury in this patient population. The low rate of clinically impactful body injury and the lack of any mortality, procedure, or transfusion resulting from body injury suggest that body CT may not be necessary in patients with head/neck injury in the absence of clinical or radiographic evidence of body injury.

Combined antegrade and retrograde thoracic duct embolization for complete transection of the thoracic duct.

Chylothorax is an uncommon complication after thoracoabdominal surgery and is typically due to injury of the thoracic duct (TD) or one of its tributaries. Patients who fail conservative management benefit from thoracic duct embolization (TDE). TDE is a percutaneous technique that includes pedal or intranodal lymphangiography, transabdominal catheterization of the TD, and glue embolization of the TD. Alternative access to the TD can be achieved via retrograde transvenous approach or direct US-guided puncture in the left neck followed by TDE. This case involves chylothorax in a 58-year-old male due to disruption of the main TD during esophagectomy, resulting in disjointed leaks from 2 separate areas related to a single complex injury. Lymphangiography and embolization via both transcervical and transabdominal approaches were performed to stop the leak.

Vaping-associated pulmonary disease (VAPD): An unusual pattern of CT findings.

There has been a recent increase in vaping which has been accompanied by an increase in otherwise unexplained acute pulmonary disease in young people. Case series and expert opinion suggest there is a correlation. This case involves "Vaping-Associated Pulmonary Disease" in a man who vapes and has no other medical history. The patient improved with steroids, similar to other recent cases. However, CT findings demonstrated a different pattern than those described in the literature.

Fluorodeoxyglucose-PET for Ablation Treatment Planning, Intraprocedural Monitoring, and Response.

PET has become an essential tool for staging and response assessment in oncologic imaging. Over the past decade it has also evolved into a tool for image-guided interventions, specifically in the rapidly growing field of interventional oncology. PET-guided biopsies have greater sensitivity and diagnostic yield for fluorodeoxyglucose-avid lesions. Real-time PET imaging can also provide valuable image guidance during therapeutic minimally invasive procedures such as ablation of PET-avid tumors. The increasing use of PET in the assessment of therapeutic response results in earlier identification of disease that is amenable to image-guided therapies.

Telephone reminders reduce no-shows: A quality initiative at a breast imaging center.

PURPOSE: To improve the workflow and productivity at a Breast Imaging Center, primarily by decreasing the no-show rate. MATERIALS AND METHODS: Mammography clinic data were recorded and analyzed for a 6-month period prior to our intervention. Personal pre-appointment phone calls were then instituted for all patients, following which data was recorded and analyzed for a 2-month period. Analyses compared pre- and post-intervention data. RESULTS: No-shows were significantly reduced (p < 0.001) from 20.99% (907/3775) pre-intervention to 7.07% (69/976) post-intervention. Calling ahead to cancel an appointment from those who either were no-shows or canceled their appointment significantly improved (p < 0.001) from only 2.81% (22/784) calling to cancel pre-intervention to 25.00% (23/92) calling to cancel post-intervention. CONCLUSIONS: Through systematic pre-appointment phone calls and documentation, we were able to achieve a very significant decrease in the no-show rate at our Breast Imaging Center. We believe that our intervention can be useful for other radiology groups to implement in their practices to reduce no-show rates.

Radiology and Political Advocacy: Characterizing Radiology Political Action Committee Donors.

PURPOSE: To identify factors associated with radiologist donations to radiology political action committees (PACs). MATERIALS AND METHODS: A survey was emailed to 4474 radiologists. Factors investigated include demographics, donor history, and knowledge of the federal advocacy process. Logistic regression analysis was performed to determine factors associated with donor behavior. RESULTS: In total, 336 radiologists completed the survey. Overall, 152 (46.2%) radiologists reported donating to a radiology PAC in the past year. Those with annual personal income ≥$450,000 had greater odds to donate than those with annual personal income <$450,000 (odds ratio [OR]: 2.58, 95% confidence interval [CI]: 1.47-4.52; p < 0.001). More than three-quarters (77.2%, n = 254) reported limited or no knowledge of the federal advocacy process. Those with good or excellent knowledge of the federal advocacy process had greater odds to donate than those with no knowledge (OR: 2.63, 95% CI: 1.01-6.84; p = 0.047). Those with awareness that membership dues and foundation funds do not fund Society of Interventional Radiology Political Action Committee had greater odds to donate (OR: 3.54, 95% CI: 2.00, 6.25; p < 0.001). CONCLUSIONS: Radiologists' personal income and knowledge of the federal advocacy process were identified as key factors influencing donations. PAC donation may benefit from raising awareness of the federal advocacy process, as well as from targeted fundraising strategies aimed at higher earners.

Age-stratified Patterns of Thymic Involution on Multidetector CT.

PURPOSE: The aim of this study was to better assess the prevalence and appearance of thymic tissue in adults stratified by age using multidetector computed tomography (MDCT) in order to prevent misinterpretation of normal thymic tissue as pathology. MATERIALS AND METHODS: This study examined the CT appearance of the thymus in 597 trauma patients aged 30 to 69 years (M=48.0 y, SD=11.3). Three body fellowship-trained attending radiologists independently reviewed the CT scans. Reviewers assigned one of 5 grades on the basis of the relative proportions of fat and soft tissue in the thymic bed: complete fatty replacement (grade 0), predominantly fat (grade 1), even mix of soft tissue and fat (grade 2), predominantly soft tissue (grade 3), and discrete confluent thymic tissue (grade 4). Objectively, fixed-area region of interest values of the thymic bed were obtained. Interrater reliability was calculated. RESULTS: Increased fatty replacement of the thymus occurred with increasing age. We found residual thymic tissue (≥grade 1) in the following age categories: 30 to 39 years (83.0%), 40 to 49 years (71.9%), 50 to 59 years (52.6%), and 60 to 69 years (34.8%). Kappa comparisons for the entire sample were excellent (κ=0.86). Higher grades had higher region of interest values. CONCLUSIONS: Residual thymic tissue in adults on MDCT is both more prevalent and more prominent than that reported in earlier studies and can be visible into the seventh decade. We recommend that radiologists and clinicians familiarize themselves with the normal range appearances of the thymus on MDCT, in order to prevent misinterpretation of normal thymic tissue as pathology, which may result in unnecessary procedures.