Utilizing advanced practice providers in the paracentesis/thoracentesis clinic.

In an era of increasing radiology volumes, including image-guided procedures, as well as decreased reimbursements, radiology practices are seeking ways to become more efficient to prevent radiologist burnout. One such strategy involves the employment of advanced practice providers to perform certain procedures. We describe steps departments can pursue to involve advanced practice providers within the radiology workforce, specifically in implementing an advance practice provider-driven paracentesis and thoracentesis clinic.

Incidences of acute kidney injury, dialysis, and graft loss following intravenous administration of low-osmolality iodinated contrast in patients with kidney transplants.

PURPOSE: To determine the incidence of acute kidney injury (AKI), need for emergent dialysis, and renal graft loss in patients with kidney transplants, who underwent CT examinations with low-osmolality iodine-based contrast material (IBCM). MATERIALS AND METHODS: Our institutional review board approved this retrospective Health Insurance Portability and Accountability Act compliant study. From January 2005 to April 2015, a total of 224 CT examinations were performed using low-osmolality IBCM in patients with kidney transplants. Six patients who had septic or cardiogenic shock and 30 patients with documented, failed transplants were excluded from our analysis, yielding a total of 188 examinations. Of these, pre- and post-CT serum creatinine (SCr) values were available for 104 examinations, to allow evaluation of AKI. The mean baseline SCr and estimated glomerular filtration rate (eGFR) in this subgroup were 1.37 mg/dL (median 1.18, range 0.5-6.05) and 65.8 mL/min/1.73 m2, respectively (median 65, range 9-114). AKI was defined as a rise in SCr of either (a) ≥0.3 mg/dL or (b) ≥0.5 mg/dL in the 24- to 72-h period following IBCM administration. For all patients undergoing the 188 examinations, need for dialysis and graft loss 30 days after contrast administration were evaluated. RESULTS: In patients with pre- and post-CT SCr values, the incidence of AKI was 7% (7/104) based on a rise of ≥0.3 mg/dL and 3% (3/104) based on a rise of ≥0.5 mg/dL. All three patients with the more strict definition (≥0.5 mg/dL) had a pre-CT eGFR <60 mL/min/1.73 m2. No patient required dialysis or had renal graft loss 30 days after contrast administration. CONCLUSION: The incidence of AKI after administration of low-osmolality IBCM administration in renal transplant recipients is low, with no instances of emergent dialysis or graft loss at 30 days post contrast.

Sonographic Evaluation of Clinically Significant Perigraft Hematomas in Kidney Transplant Recipients.

OBJECTIVE: The purpose of this study was to assess the sensitivity of ultrasound in evaluating peritransplant hematomas that require surgical evacuation in recipients of kidney transplants. MATERIALS AND METHODS: Thirty-four patients who underwent 37 hematoma evacuations underwent ultrasound examinations in the 24 hours before surgical evacuation. The operative reports were evaluated for presence and size of collection, presence of active bleeding at operation, and composition of the hematoma. The clinical findings leading to the ultrasound examination were recorded. Ultrasound examinations were evaluated in consensus by two board-certified and fellowship-trained abdominal radiologists for the presence, size, and echogenicity of the collection; subjective perfusion visualized with color and power Doppler ultrasound; velocities of the renal arteries; and arcuate artery resistive indexes. RESULTS: Ten of the 37 imaged hematomas (27%) had either no or small (< 50 mL) fluid collections on ultrasound examination. With sonographic volumetry, the reported intraoperative volumes were underestimated by 46%. The mean arcuate artery resistive index was 0.82 in the superior pole, 0.81 in the mid pole, and 0.78 in the inferior pole of the kidney. A decrease in hemoglobin level was the most sensitive clinical finding for determining the presence of perigraft hematomas. CONCLUSION: Our results suggest that gray-scale sonography alone appears to have limited sensitivity in detecting clinically significant peritransplant hematomas and that its use may result in overall underestimates of hematomas.

Utility of MRI in the Characterization of Indeterminate Small Renal Lesions Previously Seen on Screening CT Scans of Potential Renal Donor Patients.

OBJECTIVE: The purpose of this study was to determine whether MRI could more confidently characterize indeterminate small renal lesions (< 15 mm) previously seen on CT scans of potential renal donor patients and whether such characterization could impact surgical management and donor candidate status. MATERIALS AND METHODS: After dedicated contrast-enhanced renal CT examinations of a population of renal donor patients identified indeterminate small renal lesions (< 15 mm), dedicated renal MRI examinations were performed for 55 of those patients. Two radiologists used consensus reading of established MRI characteristics to characterize indeterminate small lesions as simple cysts, hemorrhagic cysts, angiomyolipomas, or solid renal masses. RESULTS: A total of 94 indeterminate small renal lesions were detected on CT. MRI was able to confidently diagnose 93 of those lesions, including 83 cysts, eight hemorrhagic cysts, and two angiomyolipomas. MRI directly affected the surgical management of four of the patients (7%). CONCLUSION: For potential renal donor patients, MRI can be an effective means of characterizing lesions that are deemed to be too small to characterize by CT. MRI can also potentially alter the surgical management and donor status of this group of patients.

Sonographic appearance of a dermoid cyst (mature cystic teratoma) of the spleen.

Splenic dermoids are rare, with few published case reports and no ultrasound images in the English literature. We report the case of a 57-year-old woman with that diagnosis and illustrate it with ultrasound, CT, and pathology images. We discuss the differential diagnosis of solid splenic lesions.

A primer for fetal cardiac imaging: a stepwise approach for 2-dimensional imaging.

Detection of congenital heart disease (CHD) remains problematic, even with advances in imaging. Imaging modalities, such as magnetic resonance imaging, have been helpful in better understanding certain abnormalities, such as the fetal central nervous system. However, because of cardiac motion, screening and detection of CHD are best performed by sonography. Although newer technical advances in sonography, including 3-dimensional (3-D) dynamic multiplanar imaging and Doppler techniques, are extremely helpful in better delineating CHD, the mainstay of detection of CHD remains 2-D real-time imaging. Understanding 2-D imaging of the heart, using multiple views, is necessary to perform any type of multiplanar imaging as both require basic understanding of the same basic views. Although it is beyond the scope of this article to review all facets of fetal cardiac imaging, we will present a stepwise approach using 2-D imaging in the detection of CHD.