Multidetector CT in Vascular Injuries Resulting from Pelvic Fractures: A Primer for Diagnostic Radiologists.

Pelvic vascular injuries are typically caused by high-energy trauma. The majority of these injuries are caused by motor vehicle collisions, and the rest are caused by falls and industrial or crush injuries. Pelvic vascular injuries are frequently associated with pelvic ring disruption and have a high mortality rate due to shock as a result of pelvic bleeding. Morbidity and mortality resulting from pelvic vascular injury are due to pelvic hemorrhage and resultant exsanguination, which is potentially treatable and reversible if it is diagnosed early with multidetector CT and treated promptly. The pelvic bleeding source can be arterial, venous, or osseous, and differentiating an arterial (high-pressure) bleed from a venous-osseous (low-pressure) bleed is of paramount importance in stratification for treatment. Low-pressure venous and osseous bleeds are initially treated with a pelvic binder or external fixation, while high-pressure arterial bleeds require angioembolization or surgical pelvic packing. Definitive treatment of the pelvic ring disruption includes open or closed reduction and internal fixation. Multidetector CT is important in the trauma setting to assess and characterize pelvic vascular injuries with multiphasic acquisition in the arterial and venous phases, which allows differentiation of the common vascular injury patterns. This article reviews the anatomy of the pelvic vessels and the pelvic vascular territory; discusses the multidetector CT protocols used in diagnosis and characterization of pelvic vascular injury; and describes the spectrum of pelvic vascular injuries, the differentiation of common injury patterns, mimics, and imaging pitfalls. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Dreizin.

Evaluation of Diagnostic Value of SPECT/CT Imaging in Post-radioiodine Therapy in Thyroid Cancer.

Objectives: This study aimed to investigate the value of single photon emission computed tomography/computed tomography (SPECT/CT) imaging in well-differentiated thyroid cancer (DTC) after radioiodine (I-131) ablation/therapy for clinical staging and risk stratification. It also aimed to determine whether SPECT/CT would change the management plan or predict the clinical outcomes of DTC patients. Methods: A total of 78 DTC patients underwent first post radioiodine therapy "Whole body iodine-131 scintigraphy (WBS) along with SPECT/CT" at the Department of Radiology and Molecular imaging, Sultan Qaboos University Hospital, Muscat, Oman, between January 2014 and August 2017. Differences between WBS and SPECT/CT, change in clinical staging, risk stratification and management were recorded. The clinical outcome at 6-12 months was recorded. A generalised McNemar test was used to assess disagreement between WBS and SPECT/CT. Results: According to the American Thyroid Association (ATA) risk stratification, the sample showed low (35.8%), intermediate (53.8%) and high-risk groups (10.2%) on WBS, which changed to 44.8%, 38.4% and 16.6%, respectively, on SPECT/CT imaging. Overall change in risk stratification was noted in 16.7% and TNM stage in 11.5% of patients after SPECT/CT imaging. SPECT/CT changed the therapeutic plan and clinical outcome in 19.2% of patients. Conclusion: SPECT/CT allows better detection and characterisation of metastatic lymph nodes and distant metastasis in DTC patients compared to WBS imaging alone. It alters TNM staging, ATA risk classification and management in a significant number of patients. It is recommended that SPECT/CT should be done routinely along with WBS in well-differentiated thyroid carcinoma.

Complications and Management of Totally Implantable Central Venous Access Ports in Cancer Patients at a University Hospital in Oman.

OBJECTIVES: Totally implantable central venous access ports (port-a-caths) are increasingly used for the safe administration of chemotherapy; however, their use is associated with complications. This study reviews patterns of complications, reasons for premature removal and the duration of the use of port-a-caths in patients receiving cancer treatment at Sultan Qaboos University Hospital (SQUH) and compares the infection rate with the literature and the researchers' experiences. METHODS: This retrospective follow-up study included patients who had received cancer treatment through a port-a-cath and were admitted to SQUH between January 2007 and April 2019. Demographic features, underlying diagnosis, clinical stage, treatment, duration of use and the cause of premature removal of the port-a-cath were recorded. RESULTS: A total of 516 port-a-caths were inserted in 482 cancer patients. The majority of devices were implanted by interventional radiologists (n = 459; 89.0%) and the right internal jugular vein was most frequently accessed (n = 396; 76.7%). The mean indwelling time of a port-a-cath was 288 days (range: 3-1,872 days) for patients with complications and 550 days (range: 7-3,123 days) for patients without complications. Port-a-cath-related infection was the main complication (n = 63; 12.2%). Patient age, gender, treatment intent, underlying diagnosis, clinical stage, chemotherapy regimen, number of treatment courses, operator implanting the port, the type of micro-organism isolated from the port-a-cath and body mass index were significant factors affecting catheter indwelling time (P <0.05). On multivariate analysis, however, none of the factors was found to be significant. CONCLUSION: Infection was the most common complication necessitating port-a-cath removal. The infection rate was much lower than the researchers' previous experience and compares favorably with several published reports.