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1.
Medicine (Baltimore) ; 98(33): e16868, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415422

RESUMO

Transjugular intra-hepatic portosystemic shunts (TIPS) had been considered a standard procedure in patients suffering from portal hypertension. The most challenging step in TIPS placement is blind puncture of the portal vein. We had established a localization method by introducing an Intra-Hepatic Arterial based puncture directing Localizer (IHAL) with the assistance of the enhanced computed tomography (CT) reconstruction. This study aimed to evaluate the feasibility, efficacy, and technical success of this method.From June 2018 to August 2018, 10 consecutive patients suffering from refractory ascites or esophageal gastric bleeding by liver cirrhosis were included in this retrospective study to evaluate feasibility, efficacy, and technical success of enhanced CT assisted IHAL-guided puncture of the portal vein. As a control, 10 patients receiving TIPS placement before Jun 2018 with cone beam CT (CBCT)-guided puncture were included to compare the reduction of portal-systemic pressure gradient (PSPG), portal entry time (PET), the number of puncture, dose area product (DAP) and contrast medium consumption.Technical success was 100% in the study group (IHAL-guided group) and in 90.0% of the control group (CBCT-guided group). Appropriate IHAL point could be achieved in all patients under the enhanced CT reconstruction assistance. The median number of punctures and DAP in IHAL group were significantly less than those in CBCT group. The reduction of PSPG, PET, and contrast medium consumption in IHAL group showed no significant differences than those in CBCT group.Enhanced CT reconstruction assisted IHAL-guided portal vein puncture is technically feasible and a reliable tool for TIPS placement resulting in a significant reduction of the number of punctures and DAP.


Assuntos
Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Humanos , Hipertensão Portal/etiologia , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Veia Porta/cirurgia , Punções/métodos , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 98(26): e16197, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261562

RESUMO

The aim of this study was to evaluate the clinical feasibility and effectiveness of bedside peripherally inserted central catheter (PICC) using portable digital radiography (DR) in intensive care unit (ICU) patients.Sixty-five ICU patients who underwent PICC were enrolled in this study between May 2016 and May 2017. Of these 65 patients, 45 (69.2%) underwent the procedures bedside in ICU using portable DR, and 20 (30.8%) underwent the procedures at the intervention clinic, both performed by a single interventional radiologist. We retrospectively reviewed electronic medical records for clinical presentation, total procedural time, total radiation dose, total patient transfer time, and clinical outcomes. We performed an independent t test to compare the clinical effectiveness between the 2 groups.The technical and clinical success rates were 100% in both groups, and there were no procedure-related complications. The total radiation dose of bedside PICC at ICU was significantly lower than that of conventional PICC at the intervention clinic (557.9 mGy*cm ± 209.2 vs 985.2 mGy*cm ± 547.6, P < .001). The total procedure time was significantly different between the bedside and conventional PICC groups (26.8 minutes ± 3.9 vs 24.1 minutes ± 5.55, P = .028). The average patient transfer time to the intervention clinic was 26.6 minutes ± 9.8.Bedside PICC using portable DR is a safe and effective procedure option to manage ICU patients in daily clinical practice.


Assuntos
Cateterismo Periférico/instrumentação , Cuidados Críticos , Sistemas Automatizados de Assistência Junto ao Leito , Radiografia Intervencionista/instrumentação , Idoso , Cateterismo Periférico/métodos , Cuidados Críticos/métodos , Estudos de Viabilidade , Feminino , Fluoroscopia/instrumentação , Fluoroscopia/métodos , Humanos , Masculino , Transferência de Pacientes , Doses de Radiação , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
3.
Eur J Radiol ; 116: 14-20, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153555

RESUMO

PURPOSE: To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS: We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS: The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS: IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.


Assuntos
Terapia Biológica/métodos , Pulmão/patologia , Pneumotórax/epidemiologia , Pneumotórax/prevenção & controle , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/efeitos adversos , Tubos Torácicos/estatística & dados numéricos , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
Presse Med ; 48(6): 684-695, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31153680

RESUMO

Treatment of hemorrhagic strokes necessitates hospitalization in an accommodated hospital offering the possibility of a multidisciplinary approach. In this setting, over recent years interventional radiology has become increasingly important from the diagnostic as well as the therapeutic standpoint. In the context of subarachnoid hemorrhage by intracranial aneurysm rupture, the NICE (National Institute for Health and Clinical Excellence) and ASA (American Stroke Academy) recommendations suggest that endovascular coiling should be considered as an alternative to surgical clipping (class I, level of evidence B). As stenting is associated with increased morbidity and mortality in the ruptured aneurysms, it should be avoided (class III, level of evidence C). The patient's clinical status on presentation should be taken into account when deciding on therapeutic management and determining prognosis. Long-term clinical outcome depends on several factors: clinical status on arrival, comorbidities, age, occurrence of operative complications and complications of subarachnoid hemorrhage such as hydrocephaly, vasospasm and delayed cerebral ischemia, as well as complications stemming from prolonged bed rest. In the event of vasospasm refractory to maximal medical therapy, endovascular treatment by intra-arterial injection of Nimodipine and angioplasty can be envisioned. In the event of intracerebral hemorrhage (ICH) by rupture cerebral dural arteriovenous fistula, once the diagnosis has been confirmed, and given the exceedingly high risk of rebleeding, first-line treatment will consist in emergency endovascular embolization. In the event of intracerebral hemorrhage (ICH) by arteriovenous rupture, treatment is decided on during a multidisciplinary meeting and either carried out immediately or delayed according to several factors: clinical conditions, age of the patient, angioarchitecture and ICH location.


Assuntos
Hemorragias Intracranianas/cirurgia , Radiografia Intervencionista/métodos , Acidente Vascular Cerebral/cirurgia , Algoritmos , Procedimentos Endovasculares , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Neurorradiografia , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
5.
Presse Med ; 48(6): 672-683, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31153681

RESUMO

The risk of bleeding of unruptured aneurysms is increasing with aneurysm size. Small unruptured aneurysms can be treated conservatively with a regular MRI/MRA follow-up to detect a potential increase in size. If coiling is still the main endovascular technique for the treatment of unruptured aneurysms, several other techniques are now available including stent-assisted coiling, flow diversion, and flow disruption. After ARUBA study, there is no recommendation to treat unruptured brain AVMs. According to their hemorrhagic risk, dural arteriovenous fistulas with cortical venous drainage have to be treated, generally by endovascular approach through an arterial route.


Assuntos
Hemorragias Intracranianas/prevenção & controle , Radiografia Intervencionista/métodos , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Endovasculares , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Neurorradiografia , Guias de Prática Clínica como Assunto , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
6.
Ann R Coll Surg Engl ; 101(6): e136-e138, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155895

RESUMO

Completely endophytic renal tumours pose challenges in laparoscopic nephron-sparing tumour excisions, with the use of intraoperative imaging techniques (e.g. ultrasound) being crucial when managing such tumours. The use of a percutaneous hookwire for tumour localisations are in use in several other surgical fields, such as breast surgery. An asymptomatic 52-year-old man presented with an incidental small right sided solid 33-mm interpolar renal mass identified on computed tomography. A guided insertion of a percutaneous localisation wire was carried out prior to a laparoscopic partial nephrectomy to assist in intraoperative tumour landmark/margins identification. Operative time was 210 minutes with zero ischaemia time, with an estimated blood loss of 200 ml. No perioperative complications were observed and the patient was discharged two days postoperatively. Histology revealed the mass to be a Fuhrman grade 2 clear-cell carcinoma with a 2-mm clear surgical margin. The patient remained free of recurrence at 16 months of follow-up. We have reported our first experience of wire localisation prior to laparoscopic partial nephrectomy for an intrarenal mass, which to our knowledge could be the first of its kind in renal surgery. Percutaneous wire localisation of endophytic renal tumours is potentially safe and effective and can allow nephron-sparing surgery where laparoscopic ultrasound is not available. Longer-term and further evidence should be encouraged.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Instrumentos Cirúrgicos , Carcinoma de Células Renais/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Nefrectomia/instrumentação , Nefrectomia/métodos , Radiografia Intervencionista/instrumentação , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X
7.
Br J Radiol ; 92(1099): 20181021, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31045448

RESUMO

OBJECTIVE: Cardiac catheterization procedures provide tremendous benefits to modern healthcare and the benefit derived by the patient should far outweigh the radiation risk associated with a properly optimized procedure. With increasing utilization of such procedures, there is growing concern regarding the magnitude and variations of dose to patients associated with procedure complexity and techniques parameters. Therefore, this study investigated radiation dose to patients from six cardiac catheterization procedures at our facility and suggest possible initial dose values for benchmark for patient radiation dose from these procedures. This initial benchmark data will be used for clinical radiation dose management which is essential for assessing the impact of any quality improvement initiatives in the cardiac catheterization laboratory. METHODS: We retrospectively analyzed the dose parameters of 1000 patients who underwent various cardiac catheterization procedures: left heart catheterization (LH), percutaneous coronary intervention (PCI), complex PCI, LH with complex PCI, LH with PCI and cardiac resynchronization therapy (CRT) pacemaker in our cardiac catheterization laboratories. Patient's clinical radiation dose data [kerma-area-product (KAP) and air-kerma at the interventional reference point (Ka,r)] and technique parameters (fluoroscopy time, tube potential, current, pulse width and number of cine images) along with demographic information (age, height and weight) were collected from the hospital's RIS (Synapse), Sensis/Syngo Dynamics and Siemens Sensis Stats Manager electronic database. Statistical analysis was performed with the IBM SPSS Modeler v. 18.1 software. RESULTS: The overall patient median age was 67.0 (range: 26.0-97.0) years and the median body mass index (BMI) was 28.8 (range: 15.9-61.7) kg/m2 . The median KAP for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 44.4 (4.1-203.2), 80.2 (18.9-208.5), 83.7 (48.0-246.1), 113.8 (60.9-284.5), 91.7 (6.0-426.0) and 51.1 (7.0-175.9) Gy-cm2 . The median Ka,r for the LH, PCI, LH with complex PCI, complex PCI, LH with PCI and CRT-pacemaker procedures are 701.0 (35.3-3794.0), 1384.7 (291.7-4021.8), 1607.0 (883.5-4448.3), 2260.2 (867.4-5311.9), 1589.3 (100.2-7237.4) and 463.8 (67.7-1695.9) mGy respectively. CONCLUSION: We have analyzed patient radiation doses from six commonly used procedures in our cardiac catheterization laboratories and suggested possible initial values for benchmark from these procedures for the fluoroscopy time, KAP and air-kerma at the interventional reference point based on our current practices. Our data compare well with published values reported in the literature by investigators who have also studied patient doses and established benchmark dose levels for their facilities. Procedure-specific benchmark dose data for various groups of patients can provide the motivation for monitoring practices to promote improvements in patient radiation dose optimization in the cardiac catheterization laboratories. ADVANCES IN KNOWLEDGE: We have investigated local patients' radiation doses and established benchmark radiation data which are essential for assessing the impact of any quality improvement initiatives for radiation dose optimization.


Assuntos
Cateterismo Cardíaco/métodos , Doses de Radiação , Radiografia Intervencionista/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
Ann Thorac Cardiovasc Surg ; 25(3): 158-163, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31068506

RESUMO

PURPOSE: In the treatment of the postsurgical pericardial effusions via pericardiocentesis, determination of the puncture site might be difficult. Contrast echocardiography may not be efficient due to surgical artefacts and pulmonary problems and therefore may lead to inaccurate evaluation. Alternative imaging methods might be helpful to perform the pericardiocentesis with decreased complications. METHODS: We retrospectively analyzed the patients who had undergone pericardiocentesis in our department from January 2008 through April 2018. The procedure was performed in slightly semi-seated position with the guidance of the echocardiography and fluoroscopy. Following the catheterization, percutaneous drainage was performed. RESULTS: There were 63 patients needed intervention due to pericardial effusion. 67% of the patients were using warfarin and the next patients were using acetyl salicylic acid and/or clopidogrel. All effusions were in the posterolateral localization. The mean volume of aspirated pericardial fluid was 404 ± 173 mL (150-980 mL). Control echocardiograms showed that almost all fluid was drained in all patients and there were no procedural or follow-up complications. CONCLUSION: In the treatment of postoperative pericardial effusion, fluoroscopy is an alternative method to locate the catheter accurately in challenging situations following cardiac surgery. Thus, procedural risk minimizes and drainage of pericardial fluid is performed safely.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Derrame Pericárdico/cirurgia , Pericardiocentese , Radiografia Intervencionista , Cateterismo Cardíaco , Ecocardiografia , Fluoroscopia , Humanos , Posicionamento do Paciente , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Pericardiocentese/efeitos adversos , Pericardiocentese/métodos , Radiografia Intervencionista/efeitos adversos , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Postura Sentada , Fatores de Tempo , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(18): e15437, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045810

RESUMO

RATIONALE: Cranial arterial air embolism is a rare but potentially fatal complication after computed tomography (CT)-guided pulmonary interventions. PATIENT CONCERNS: A 64-year-old man was diagnosed with a pulmonary nodule (diameter: approximately 1 cm) in the right lower lobe. The patient developed convulsions after CT-guided hook-wire localization. DIAGNOSIS: Cranial CT revealed arborizing/linearly distributed gas in the territory of the right middle cerebral artery. INTERVENTIONS: The patient was administered hyperbaric oxygen, antiplatelet aggregation therapy, and dehydration treatment. OUTCOMES: Clinical death occurred 55 hours after air embolism. LESSONS: Systemic air embolism is a serious complication of lung puncture. Clinicians should improve their understanding of this complication and remain vigilant against air embolism.


Assuntos
Doenças Arteriais Cerebrais/etiologia , Embolia Aérea/etiologia , Radiografia Intervencionista/efeitos adversos , Nódulo Pulmonar Solitário/cirurgia , Doenças Arteriais Cerebrais/terapia , Embolia Aérea/terapia , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Radiografia Intervencionista/métodos
10.
Tech Vasc Interv Radiol ; 22(2): 49-57, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079710

RESUMO

The radiation segmentectomy technique may be defined as the administration of transarterial radioembolization delivered to 1 or 2 hepatic segments with the intention of segmental tissue ablation. Since first being described in 2011, radiation segmentectomy has quickly gained acceptance as a safe, effective, and potentially curative outpatient treatment for selected lower stage hepatocellular carcinomas. We describe our recommended techniques for radiation segmentectomy with glass or resin radiomicrospheres, including patient selection, dosimetry, microcatheter techniques, and clinical and imaging follow-up, accompanied by a brief review of the radiation segmentectomy literature. Radiation lobectomy, defined as the ablation of an entire hepatic lobe via transarterial radioembolization, is an area of growing interest in many centers. We also review the existing radiation lobectomy literature and suggest which patient and tumor factors may be associated with higher likelihood of successful treatment.


Assuntos
Carcinoma Hepatocelular/radioterapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Radiografia Intervencionista/métodos , Radioisótopos de Ítrio/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Microesferas , Seleção de Pacientes , Dosagem Radioterapêutica
11.
Tech Vasc Interv Radiol ; 22(2): 63-69, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079712

RESUMO

Radioembolization with yttrium-90 (Y90) microspheres is increasingly used to palliate patients with liver-dominant malignancy. With appropriate patient selection, this outpatient treatment is efficacious with limited toxicity profile. This article reviews common scenarios that can present in daily practice including evaluation of liver functions, evaluation of previous therapies, integrating Y90 into ongoing systemic therapy, determining performance status, and considering retreatment for patients who have already undergone Y90 who have hepatic dominant progression. Finally, we address the importance of evaluating tumors in potential watershed zones to maximize treatment response by using c-arm computed tomography. Many of these potential variables can overlap in an individual patient. By considering these factors individually, the consulting Interventional Radiologist can present a thorough treatment plan with a full description of expected outcomes and toxicities to clinic patients.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Seleção de Pacientes , Radiografia Intervencionista/métodos , Radioisótopos de Ítrio/uso terapêutico , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Microesferas , Tomografia Computadorizada por Raios X
12.
Tech Vasc Interv Radiol ; 22(2): 70-73, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079713

RESUMO

Y90 radioembolization is an alternative to transarterial chemoembolization for the intra-arterial treatment of hepatocellular carcinoma (HCC). However, the optimal treatment of HCC varies by tumor stage, underlying liver function and functional status, and local expertise. Therefore, the appropriate selection of patients for Y90 radioembolization is of paramount importance for optimal outcomes. Data on the role of Y90 radioembolization for HCC are most robust in the palliative treatment of inoperable, liver-confined disease. However, data are also present on the role of Y90 radioembolization as a bridge to or to downstage patients for transplant. Outcomes for radiation segmentectomy (ablative radiation doses) with curative intent or prior to resection are also discussed.


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Avaliação de Processos e Resultados (Cuidados de Saúde) , Seleção de Pacientes , Radiografia Intervencionista/métodos , Radioisótopos de Ítrio/uso terapêutico , Carcinoma Hepatocelular/diagnóstico por imagem , Humanos , Testes de Função Hepática , Neoplasias Hepáticas/diagnóstico por imagem , Transplante de Fígado , Pulmão/efeitos da radiação , Dosagem Radioterapêutica
13.
J Comput Assist Tomogr ; 43(3): 423-427, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31082947

RESUMO

PURPOSE: To compare the fenestrated intravenous (IV) catheter and nonfenestrated conventional IV catheter in terms of contrast enhancement and injection pressure for coronary computed tomography angiography. METHODS: Three hundred patients were prospectively and consecutively enrolled to either the 20-gauge nonfenestrated conventional (group 1) IV catheter group or the 20-gauge fenestrated (group 2) or 22-gauge fenestrated (group 3) IV catheter groups. We analyzed mean vascular attenuations in the ascending aorta, left main coronary artery, left ventricular (LV) cavity, and descending aorta. Injection pressure using pound-force per square inch (PSI) and extravasation of contrast media were recorded. RESULTS: Mean attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 2 than in group 1 (P ≤ 0.001, P ≤ 0.001, P ≤ 0.001, respectively). Moreover, injection pressure was significantly lower in group 2 than in group 1 (208.3 vs 216.9 PSI, P = 0.006). Mean vascular attenuations of the left main coronary artery, LV cavity, and descending aorta were significantly higher in group 3 than in group 1 (P = 0.016, P = 0.029, P = 0.001, respectively). However, injection pressure was not statistically significant between group 3 and group 1 (213.6 vs 216.9 PSI, P = 0.355). No extravasation occurred in any patient groups during the study. CONCLUSIONS: We suggest that fenestrated IV catheter is useful in terms of higher vascular attenuation and lower injection pressure for coronary computed tomography angiography. It has a potential merit in patients with fragile and small veins.


Assuntos
Cateterismo Venoso Central/métodos , Meios de Contraste/administração & dosagem , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Cateteres Venosos Centrais , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Intervencionista/métodos
14.
Jpn J Radiol ; 37(6): 487-493, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30927199

RESUMO

PURPOSE: To assess the change in hepatic arterial blood pressure (HABP) and computed tomography during hepatic arteriography (CTHA) using the double balloon technique. MATERIALS AND METHODS: Nine patients with hepatocellular carcinoma (HCC) were enrolled. We inserted a 5.2-Fr balloon catheter into the common or proper hepatic artery and a 1.8-Fr microballoon catheter into the lobar or segmental artery feeding the HCC. HABPs were measured with the 1.8-Fr microballoon catheter (usual-HABP), with the 1.8-Fr balloon inflated (B-HABP), and with both the 5.2-Fr and 1.8-Fr balloons inflated (BB-HABP). CTHAs were performed via a 1.8-Fr microcatheter (usual-CTHA), with the 1.8-Fr balloon inflated (B-CTHA selective), with both the 5.2-Fr and 1.8-Fr balloons inflated (BB-CTHA selective), and via the 5.2-Fr catheter with the 1.8-Fr balloon inflated (B-CTHA whole) and with both the 5.2-Fr and 1.8-Fr balloons inflated (BB-CTHA whole). RESULTS: In all cases, B-HABP was lower than usual-HABP. There was a decrease in BB-HABP in comparison with B-HABP in cases with occlusion of the proper hepatic artery. The contrast effect of B-CTHA selective increased in four cases. The contrast effect on B-CTHA whole remained in all cases. CONCLUSION: This technique can be useful in decreasing HABP and collateral blood flow from the adjacent hepatic segment.


Assuntos
Pressão Arterial/fisiologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Angiografia por Tomografia Computadorizada/métodos , Artéria Hepática/fisiopatologia , Neoplasias Hepáticas/terapia , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Quimioembolização Terapêutica/instrumentação , Feminino , Hemodinâmica/fisiologia , Artéria Hepática/diagnóstico por imagem , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia Intervencionista/métodos
15.
Eur Radiol ; 29(7): 3401-3409, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887198

RESUMO

PURPOSE: Ultrasound-guided spinal injections are less common than fluoroscopy-guided injections. Although unable to penetrate bones, ultrasound guidance has a number of advantages including convenience and reduced exposure to ionizing radiation. However, it is not known how ultrasound-guided injections compare to fluoroscopy-guided injections in the management of lower back pain. Our objective is to systematically review the literature comparing ultrasound-guided injections to fluoroscopy-guided injections for the management of lower back pain. METHODS: Medline, Cochrane CENTRAL Register of Controlled Trials, Embase, and NHSEED were searched from 2007 to September 26, 2017. Inclusion criteria included (1) randomized controlled trial design, (2) compared ultrasound-guided and fluoroscopy-guided injections for lower back pain, (3) dose and volume of medications injected were identical between trial arms, and (4) reported original data. RESULTS: One hundred one unique records were identified, and 21 studies were considered for full-text inclusion. Nine studies formed the final data set. Studies comparing ultrasound- and fluoroscopy-guided injections for lower back pain management reported no difference in pain relief, procedure time, number of needle passes, changes in disability indices, complications or adverse events, post-procedure opioid consumption, or patient satisfaction. CONCLUSION: Fluoroscopic guidance of injections for the management of lower back pain is similar in efficacy to ultrasound guidance. The exact role of ultrasound guidance needs to be further studied, especially for nerve root injections, where safety is the major concern. KEY POINTS: • There were no differences in pain relief, procedure time, number of needle passes, changes in disability indices, complications or adverse events, post-procedure opioid consumption, or patient satisfaction between ultrasound- and fluoroscopy-guided injections for the management of lower back pain. • Given the lack of evidence to demonstrate superior efficacy and the added harms with fluoroscopic guidance, ultrasound guidance may be the preferred method of guidance for injections to manage lower back pain in appropriate patients. Further study is required to understand the exact role of ultrasound in image-guided injections.


Assuntos
Fluoroscopia/métodos , Dor Lombar/diagnóstico por imagem , Dor Lombar/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Anestésicos Locais/administração & dosagem , Quimioterapia Combinada , Glucocorticoides/administração & dosagem , Humanos , Injeções Epidurais , Manejo da Dor/métodos , Radiografia Intervencionista/métodos
16.
Eur Radiol ; 29(7): 3379-3389, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887207

RESUMO

OBJECTIVES: To compare pain relief after CT-guided lumbar epidural steroid injections (ESI) using particulate (triamcinolone) and non-particulate (dexamethasone) steroids, and to explore factors affecting the effectiveness of both steroid types. METHODS: This retrospective observational study included 806 patients with lumbar radiculopathy and corresponding MRI or CT abnormalities of the lumbar spine, who were matched using the propensity score method, yielding two cohorts of 209 patients each. Pain intensity was evaluated prior to the procedure using a pain numerical rating scale (NRS) with range 0-10. Reevaluation took place 1 day and 4 weeks post-injection. Logistic regression analysis and cubic splines applied to generalized additive models were implemented to assess the differences in pain reduction after ESI in the analyzed patient groups. RESULTS: Four weeks post-injection, the overall chance of ≥ 50% pain reduction was lower in the dexamethasone group than that in the triamcinolone group (odds ratio [OR] = 0.55; p < 0.012). In the dexamethasone cohort, the intensity of baseline pain and the presence of a herniated intervertebral disc in the infiltrated segment were both significant and independent predictors of ≥ 50% pain relief. Patients with baseline NRS score ≥ 7 points had markedly less chance of ≥ 50% pain relief than patients with NRS score < 7 (OR = 0.53; p < 0.032), whereas disc herniation increased the chances more than twofold (OR = 2.29; p < 0.044). There was no significant correlation between the effectiveness of triamcinolone and any analyzed concomitant variables. CONCLUSIONS: Triamcinolone was superior for lumbar radiculopathy of severe intensity. For mild to moderate pain, no benefit of using triamcinolone over dexamethasone was found. The effectiveness of dexamethasone was lower for stenotic spinal lesions than for disc herniation. KEY POINTS: • Triamcinolone is superior to dexamethasone for epidural treatment of severe lumbar radiculopathy. • For mild to moderate pain, dexamethasone could be equally effective. • Dexamethasone reduces pain caused by disc herniation much better than it does to pain caused by fixed stenotic spinal lesions.


Assuntos
Dor nas Costas/tratamento farmacológico , Dexametasona/análogos & derivados , Glucocorticoides/administração & dosagem , Radiculopatia/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Adulto , Idoso , Dor nas Costas/etiologia , Bupivacaína/administração & dosagem , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Injeções Epidurais/métodos , Deslocamento do Disco Intervertebral/complicações , Lidocaína/administração & dosagem , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor/métodos , Radiculopatia/complicações , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Estenose Espinal/complicações , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Triancinolona Acetonida/uso terapêutico
17.
Pain Physician ; 22(2): 139-146, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30921977

RESUMO

BACKGROUND: Recently, genicular nerve block and radiofrequency ablation were introduced to alleviate knee pain in patients with chronic knee osteoarthritis. Both ultrasound- and fluoroscopy-guided genicular nerve blocks have been used. However, whether one is superior to the other remains unknown. OBJECTIVES: The present study compares the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. STUDY DESIGN: This research used a prospective randomized comparison design. SETTING: The study took place at a single pain clinic within a tertiary medical center in Seoul, Republic of Korea. METHODS: From July 2015 to September 2017, a randomized controlled study was performed to analyze the difference in the efficacy of ultrasound- vs fluoroscopy-guided genicular nerve blocks. The Numeric Rating Scale (NRS-11), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Global Perceived Effect Scales (GPES), and complications were evaluated pre-procedure, and 1 and 3 months after genicular nerve block. RESULTS: A total of 80 patients were enrolled and randomly distributed to groups U (ultrasound-guided, n = 40) and F (fluoroscopy-guided, n = 40). Those who were lost to follow-up or had undergone other interventions were excluded, resulting in 31 and 30 patients in groups U and F, respectively. No differences in NRS-11 or WOMAC were observed between the 2 groups at baseline or during the follow-up period. GPES and complication rates were also similar between both groups. LIMITATIONS: We were unable to perform double-blind randomization and did not evaluate patients' baseline emotional states. CONCLUSIONS: Pain relief, functional improvement, and safety were similar between groups receiving ultrasound- and fluoroscopy-guided genicular nerve blocks. Therefore, either of the 2 imaging devices may be utilized during a genicular nerve block for chronic knee pain relief. However, considering radiation exposure, ultrasound guidance may be superior to fluoroscopic guidance.The study protocol was approved by our institutional review board (2015-0369), and written informed consent was obtained from all patients. The trial was registered with the Clinical Research Information Service (KCT 0002846). This work was presented in part as D-H Kim's MS thesis at the University of Ulsan College of Medicine (2018). KEY WORDS: Genicular nerve block, ultrasound, fluoroscopy, knee osteoarthritis, Numeric Rating Scale, The Western Ontario and McMaster Universities Osteoarthritis Index.


Assuntos
Bloqueio Nervoso/métodos , Osteoartrite do Joelho/cirurgia , Radiografia Intervencionista/métodos , Ultrassonografia de Intervenção/métodos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Estudos Prospectivos , República da Coreia , Resultado do Tratamento
18.
Pain Physician ; 22(2): 165-176, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30921982

RESUMO

BACKGROUND: Cervical epidural injections for treating neck and upper limb pain are performed by 2 methods: transforaminal and interlaminar. Many serious complications caused by inadvertent intravascular injection have been reported with the use of cervical transforaminal epidural steroid injection through the anterior-lateral approach. Despite international practical guidelines that have been proposed, cervical transforaminal epidural injection is still less recommended than cervical interlaminar epidural injection. OBJECTIVES: The objective of this study is to introduce Th1-transforaminal epidural injection (Th1-TFEI) through the posterior-lateral approach, compare the injectate spread in Th1-TFEI with that of Th1/2-parasaggital interlaminar epidural injection (Th1/2-pILEI), and clarify the clinical characteristics of Th1-TFEI. STUDY DESIGN: This research involved a prospective study of 30 patients receiving both Th1-TFEI and Th1/2-pILEI. METHODS: Thirty patients with unilateral upper limb pain were enrolled for this prospective study. Th1-TFEI and Th1/2-pILEI were administered on each case in random order under fluoroscopy, and computed tomographic (CT) epidurograms were compared. Changes in circulatory dynamics, presence of Horner's syndrome, changes in the Numerical Rating Scale (NRS-11), and adverse events were investigated. RESULTS: Patients included 15 men and 15 women and included 24 cases of cervical spine disease and 6 cases with other upper limb pain. The Th1-TFEI group had significantly higher rates of "Th1 root filling" (100%), "ventral spread" (70.0%), and "lateral limitation" (26.7%) compared to the Th1/2-pILEI group. In the Th1-TFEI group, cephalad spread averaged 2.97 vertebral bodies, reaching approximately up to C6. The Th1/2-pILEI group had an average of 4.76 vertebral bodies, approximately up to C4. The 2 groups showed significant differences in cephalad spread. Horner's syndrome appeared in the Th1-TFEI group at a rate of 56.7%, significantly higher than that in the Th1/2-pILEI group at 17.2%. The presence of Horner's syndrome showed significant correlations with "ventral spread" and "spread up to C6." There were no significant differences in NRS-11 improvement and changes in circulatory dynamics between the groups. There were no major complications. LIMITATIONS: The components of injectate were standardized; however, the needle gauge numbers were varied. In addition, interpretation of the CT-epidurogram was not blinded. The sample size was small; therefore, multivariate analysis was not possible. CONCLUSIONS: CT-epidurogram comparison revealed that Th1/2-pILEI was not localized on the injection side, and there was better dorsal spread - although ventral spread was small. Contrarily, Th1-TFEI was localized on the injection side, and better ventral spread was shown while cephalad spread was limited. We expected the addition of a sympathetic block effect suggested by the Horner's syndrome as well as the merits of the ventral spread. However, short-term clinical effects were equal to those of Th1/2 pILEI. In future research, we need to standardize the diseases to include and to increase the number of cases to enable evaluation of clinical effectiveness. KEY WORDS: Epidural, cervical, transforaminal, interlaminar, fluoroscopy, CT-epidurogram, dorsal, ventral, cephalad, Horner's syndrome.


Assuntos
Injeções Epidurais/métodos , Neuralgia/terapia , Manejo da Dor/métodos , Radiografia Intervencionista/métodos , Adulto , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/terapia , Estudos Prospectivos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Extremidade Superior
19.
Pain Physician ; 22(2): E119-E125, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30921989

RESUMO

BACKGROUND: Fluoroscopic imaging guidance is frequently used in performing spinal interventional techniques. Reference level standards are a quality improvement tool to help reduce radiation dose and serve as benchmarks for physicians and their technologists to achieve reasonable radiation exposure while performing fluoroscopically-guided spinal procedures. There are limited data describing radiation dose for musculoskeletal injections - in particular, spinal injections without any published reference standards. OBJECTIVE: The purpose of this study is to perform a practice audit of radiation doses of fluoroscopically-guided spinal injections to establish preliminary reference levels as a quality improvement tool for potential use in future radiation reduction measures. STUDY DESIGN: Retrospective, observational study. SETTINGS: An academic-based subspecialty, high volume pain medicine practice. METHODS: A retrospective analysis of 6,234 spinal injections of 9 different types performed by experienced practitioners between January and December 2012 was conducted under an institutional review board's approval with HIPAA compliance and waiver of informed consent. Cumulative radiation dose (in mGy) and exposure time (in seconds) distributions (percentiles) as displayed on the C-arm were calculated per injection for each type of fluoroscopically-guided spinal injection. Confidence intervals for the dose distributions were determined by using bootstrap resampling and were used to determine preliminary reference levels. RESULTS: Proposed preliminary reference levels of cumulative radiation dose (in mGy) and exposure time (in seconds) for fluoroscopically-guided spinal interventional procedures are provided for lumbar transforaminal (13 mGy, 30 s), cervical transforaminal (6 mGy, 49 s), caudal epidural (12 mGy, 23s), cervical facet injection (3 mGy, 36 s), lumbar facet injection (9 mGy, 20s), interlaminar (13mGy, 39s), lumbar radiofrequency denervation (7 mGy, 17s), lumbar sympathetic block (21 mGy, 39s), cervical medial branch block (2 mGy, 25 s), lumbar medial branch block (4 mGy, 12s) and sacroiliac joint injections (18 mGy, 37s). LIMITATIONS: Study performed at a single subspecialty institution using only one type of C-arm which limits generalizability. CONCLUSIONS: Radiation doses and preliminary reference levels of fluoroscopically-guided interventional spine procedures performed by experienced practitioners are made available without correction for body habitus or field of view, magnification or subtraction techniques or continuous vs pulsed mode. A registry of radiation-dose data for fluoroscopically-guided interventional spine procedures would be the next step to refine this data. KEY WORDS: Spinal procedures, radiation dose, patient safety.


Assuntos
Fluoroscopia/métodos , Injeções Espinhais/métodos , Doses de Radiação , Radiografia Intervencionista/métodos , Cirurgia Assistida por Computador/métodos , Auditoria Clínica , Humanos , Estudos Retrospectivos
20.
Int J Cardiovasc Imaging ; 35(7): 1327-1337, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30847659

RESUMO

This study was performed to evaluate the feasibility of intra-procedural visualization of optimal pacing sites and image-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT). In fifteen patients (10 males, 68 ± 11 years, 7 with ischemic cardiomyopathy and ejection fraction of 26 ± 5%), optimal pacing sites were identified pre-procedurally using cardiac imaging. Cardiac magnetic resonance (CMR) derived scar and dyssynchrony maps were created for all patients. In six patients the anatomy of the left phrenic nerve (LPN) and coronary sinus ostium was assessed via a computed tomography (CT) scan. By overlaying the CMR and CT dataset onto live fluoroscopy, aforementioned structures were visualized during LV lead implantation. In the first nine patients, the platform was tested, yet, no real-time image-guidance was implemented. In the last six patients real-time image-guided LV lead placement was successfully executed. CRT implant and fluoroscopy times were similar to previous procedures and all leads were placed close to the target area but away from scarred myocardium and the LPN. Patients that received real-time image-guided LV lead implantation were paced closer to the target area compared to patients that did not receive real-time image-guidance (8 mm [IQR 0-22] vs 26 mm [IQR 17-46], p = 0.04), and displayed marked LV reverse remodeling at 6 months follow up with a mean LVESV change of -30 ± 10% and a mean LVEF improvement of 15 ± 5%. Real-time image-guided LV lead implantation is feasible and may prove useful for achieving the optimal LV lead position.


Assuntos
Dispositivos de Terapia de Ressincronização Cardíaca , Terapia de Ressincronização Cardíaca , Cardiomiopatias/terapia , Ventrículos do Coração/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Imagem por Ressonância Magnética Intervencionista/métodos , Tomografia Computadorizada Multidetectores , Imagem Multimodal/métodos , Radiografia Intervencionista/métodos , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/fisiopatologia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda , Remodelação Ventricular
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