Effectiveness and safety of CT-guided drainage of abdominal abscesses with small and extra-small-bore drains: a single-centre observational study.

Purpose: Computed tomography (CT)-guided percutaneous drainage is an established method for the treatment of abdominal abscesses. The purpose of this study is to evaluate the effectiveness and safety of drainage of abdominal abscesses with small-bore (6F and 9F) drains. Material and methods: The analysis of a prospectively maintained database included 135 consecutive patients from a single centre with abdominal or pelvic abscesses, who underwent CT-guided drainage. Procedures were performed using a one-step trocar technique with 6F (40 procedures) or 9F (95 procedures) catheters. Technical success was defined as insertion of the drain into the abscess cavity and aspiration of the fluid sample. Clinical success was defined as resolution of infection without surgical intervention or upsizing of the drain. Results: The mean size of abscesses was 77.0 ± 28.8 mm (32-220 mm). Thick fluid was aspirated from 129 collections; 6 collections contained thin fluid. Technical success was achieved in 100% of procedures. Clinical success was achieved in 94.8% of patients. Surgical drainage was necessary in 3.7% of patients and upsizing in 1.5% of patients. Complications of Clavien-Dindo grade III were noted in 2.2% of patients without grade IV or V adverse events. The mean radiation dose in terms of Dose Length Product was 617 ± 467 mGy x cm. The mean procedure time was 28.0 ± 11.3 min. Conclusions: CT-guided drainage of abdominal abscesses with small- and very small-bore drains is usually sufficient to obtain clinical success with a low complication rate in the case of thick fluid collections.

Long-term nusinersen treatment across a wide spectrum of spinal muscular atrophy severity: a real-world experience.

BACKGROUND: Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by a biallelic mutation in the SMN1 gene, resulting in progressive muscle weakness and atrophy. Nusinersen is the first disease-modifying drug for all SMA types. We report on effectiveness and safety data from 120 adults and older children with SMA types 1c-3 treated with nusinersen. METHODS: Patients were evaluated with the Hammersmith Functional Motor Scale Expanded (HFMSE; n = 73) or the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND; n = 47). Additionally, the Revised Upper Limb Module (RULM) and 6-minute walk test (6MWT) were used in a subset of patients. Patients were followed for up to 30 months of nusinersen treatment (mean, SD; 23, 14 months). Subjective treatment outcomes were evaluated with the Patients Global Impression-Improvement (PGI-I) scale used in all patients or caregivers at each follow-up visit. RESULTS: An increase in the mean HFMSE score was noted at month 14 (T14) (3.9 points, p < 0.001) and month 30 (T30) (5.1 points, p < 0.001). The mean RULM score increased by 0.79 points at T14 (p = 0.001) and 1.96 points (p < 0.001) at month 30 (T30). The mean CHOP-INTEND increased by 3.6 points at T14 (p < 0.001) and 5.6 points at month 26 (p < 0.001). The mean 6MWT improved by 16.6 m at T14 and 27 m at T30 vs. baseline. A clinically meaningful improvement in HFMSE (≥ 3 points) was seen in 62% of patients at T14, and in 71% at T30; in CHOP INTEND (≥ 4 points), in 58% of patients at T14 and in 80% at T30; in RULM (≥ 2 points), in 26.6% of patients at T14 and in 43.5% at T30; and in 6MWT (≥ 30-meter increase), in 26% of patients at T14 and in 50% at T30. Improved PGI-I scores were reported for 75% of patients at T14 and 85% at T30; none of the patients reporting worsening at T30. Adverse events were mild and related to lumbar puncture. CONCLUSIONS: In our study, nusinersen led to continuous functional improvement over 30-month follow-up and was well tolerated by adults and older children with a wide spectrum of SMA severity.

An X-ray lead screen may be used to reduce an interventional radiologist's radiation exposure during CT-guided procedures.

Purpose: The exposure of both patient and operator to radiation is one of the limitations of computed tomography (CT)-guided interventions, and it should be kept as low as reasonably possible. The purpose of the study was to evaluate the efficacy of a lead screen in reducing the radiation dose to an operator in the course of CT-guided interventions. Material and methods: This prospective study analysed data collected from 72 consecutive CT-guided procedures, all of which were performed with an X-ray protective lead screen placed between the scanner and the operator. Five dosimeters were placed in the CT scanning room, and accumulated radiation doses were measured for each dosimeter. Results: The dosimeter placed on the gantry side of the lead screen revealed highest levels of radiation (11.33 ± 1.93 mSv), which were significantly higher than those at all other dosimeters. The radiation dose behind the lead screen was almost the same when measured by dosimeters on the CT scanner gantry side and 3 metres away from it. The presence of the screen caused no discomfort for operators. Conclusions: A lead screen reduces an operator's radiation exposure significantly, while not posing any obstacles or causing any discomfort while CT-guided procedures are carried out.

MRI-guided fiducial marker implantation as a method of tagging an ultrasound- and non-enhanced CT-invisible liver tumor before thermal ablation.

Some liver tumors are not visible on ultrasound or non-enhanced CT (NECT) which are main modalities used in image-guided ablations. This is a report of MR-guided implantation of fiducial marker to tag a neuroendocrine tumor metastasis in a patient with renal insufficiency precluding the use of contrast - enhanced CT during ablation. The marker was well visible on NECT which allowed for precise needle placement and complete ablation which was confirmed in 12-months follow-up.

Ultra-low radiation dose protocol for CT-guided intrathecal nusinersen injections for patients with spinal muscular atrophy and severe scoliosis.

PURPOSE: Intrathecal injection of nusinersen is an approved treatment of spinal muscular atrophy (SMA). CT-guided injection is a method of nusinersen administration in patients with severe scoliosis, in whom standard lumbar puncture is not feasible. The injections are repeated every 4 months for life, and accumulated radiation doses absorbed by the patient can increase the risk of cancer. In this study, we present the results of CT-guided intrathecal nusinersen injections with an ultra-low radiation dose protocol. METHODS: Eighteen patients (15 adults and three children) in whom standard lumbar puncture was not feasible due to severe scoliosis or spinal stabilization were included in this retrospective study. The first 23 injections were performed with a standard radiation dose protocol and the next 42 injections with an ultra-low-dose protocol. The radiation doses, measured as total dose length product (DLP), were acquired and compared between the protocols. RESULTS: Injections were successful in 100% of patients with both ultra-low-dose and standard protocols. The radiation dose, measured as DLP, was 111.2-1100.7 (Me = 248.1) mGy*cm for the standard protocol. For the ultra-low-dose protocol, the dose range was 5.0-54.4 (Me = 26.7) mGy*cm, which was significantly lower than with the standard protocol (p < 0.001, η2 = 0.67). CONCLUSION: Radiation doses can be significantly decreased in the CT-guided injection of nusinersen. The proposed protocol allows for effective CT-guided intrathecal nusinersen administration in patients with SMA and severe scoliosis.

Percutaneous Bilateral Adrenal Radiofrequency Ablation in Severe Adrenocorticotropic Hormone-dependent Cushing Syndrome.

OBJECTIVES: The objectives of the study were to evaluate adrenal radiofrequency ablation (RFA) as a method of treatment in patients with severe adrenocorticotropic hormone (ACTH)-dependent Cushing syndrome, among whom bilateral adrenalectomy is not a suitable option. MATERIAL AND METHODS: Five patients with ACTH-dependent Cushing syndrome underwent RFA of both adrenal glands. Four of them presented with Cushing disease unsuccessfully treated with pituitary surgery and medical therapy, while one patient had ACTH-dependent Cushing syndrome due to pancreatic endocrine tumor with liver metastases. All patients were disqualified from adrenalectomy due to morbid obesity or lack of consent. RESULTS: A technical success was obtained in all cases, with only one re-intervention necessitated by a cooling effect of the inferior vena cava. Despite pre-procedural adrenergic blockade, severe hypertension was noted during the procedure in three cases, this being treated immediately using direct-acting vasodilators. No complications occurred otherwise. In all cases, significant improvement of clinical symptoms was observed, as well as marked decreases in levels of serum cortisol, free urine cortisol, and dehydroepiandrosterone sulfate. CONCLUSION: Bilateral RFA under CT-guidance is technically feasible and clinical improvement can be achieved using the method. In patients disqualified from adrenal surgery, RFA might be considered as an alternative method of ACTH-dependent Cushing syndrome treatment.

Supporting diagnostics and therapy planning for percutaneous ablation of liver and abdominal tumors and pre-clinical evaluation.

Percutaneous ablation methods are used to treat primary and metastatic liver tumors. Image guided navigation support minimally invasive interventions of rigid anatomical structures. When working with the displacement and deformation of soft tissues during surgery, as in the abdomen, imaging navigation systems are in the preliminary implementation stage. In this study a multi-stage approach has been developed to support percutaneous liver tumors ablation. It includes CT image acquisition protocol with the amplitude of respiratory motion that yields images subjected to a semi-automatic method able to deliver personalized abdominal model. Then, US probe and ablation needle calibration, as well as patient position adjustment method during the procedure for the preoperative anatomy model, have been combined. Finally, an advanced module for fusion of the preoperative CT with intraoperative US images was designed. These modules have been tested on a phantom and in the clinical environment. The final average Spatial calibration error was 1,7 mm, the average error of matching the position of the markers was about 2 mm during the entire breathing cycle, and average markers fusion error 495 mm. The obtained results indicate the possibility of using the developed method of navigation in clinical practice.

Correlation Between Findings of Multislice Helical Computed Tomography (CT), Endoscopic Examinations, Endovascular Procedures, and Surgery in Patients with Symptoms of Acute Gastrointestinal Bleeding.

BACKGROUND: Endoscopic methods (gastroscopy and colonoscopy) are considered fundamental for the diagnosis of gastrointestinal bleeding. In recent years, multidetector computed tomography (MDCT) has also gained importance in diagnosing gastrointestinal bleeding, particularly in hemodynamically unstable patients and in cases with suspected lower gastrointestinal tract bleeding. CT can detect both the source and the cause of active gastrointestinal bleeding, thereby expediting treatment initiation. MATERIAL/METHODS: The study group consisted of 16 patients with clinical symptoms of gastrointestinal bleeding in whom features of active bleeding were observed on CT. In all patients, bleeding was verified by means of other methods such as endoscopic examinations, endovascular procedures, or surgery. RESULTS: The bleeding source was identified on CT in all 16 patients. In 14 cases (87.5%), bleeding was confirmed by other methods. CONCLUSIONS: CT is an efficient, fast, and readily available tool for detecting the location of acute gastrointestinal bleeding.