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INTRODUCTION: Post-thrombectomy intraparenchymal hyperdensity (PTIH) in patients with acute ischemic stroke is a common CT sign, making it difficult for physicians to distinguish intracerebral hemorrhage in the early post-thrombectomy period. The aim of this study was to develop an effective model to differentiate intracerebral hemorrhage from contrast extravasation in patients with PTIH. METHODS: We retrospectively collected information on patients who underwent endovascular thrombectomy at two stroke centers between August 2017 and January 2023. A total of 222 patients were included in the study, including 118 patients in the development cohort, 52 patients in the internal validation cohort, and 52 patients in the external validation cohort. The nomogram was constructed using R software based on independent predictors derived from the multivariate logistic regression analysis, including clinical factors and CT texture features extracted from hyperdense areas on CT images. The performance and accuracy of the derived nomogram were assessed by the area under the receiver operating characteristic curve (AUC-ROC) and calibration curves. Additionally, decision curve analysis was conducted to appraise the clinical utility of the nomogram. RESULTS: Our nomogram was derived from two clinical factors (ASPECT score and onset to reperfusion time) and two CT texture features (variance and uniformity), with AUC-ROC of 0.943, 0.930, and 0.937 in the development, internal validation, and external validation cohorts, respectively. Furthermore, the calibration plot exhibited a strong agreement between the predicted outcome and the actual outcome. In addition, the decision curve analysis revealed the clinical utility of the nomogram in accurately predicting hemorrhage in patients with PTIH. CONCLUSION: The developed nomogram, based on clinical factors and CT texture features, proves to be effective in distinguishing intracerebral hemorrhage from contrast extravasation in patients with PTIH.
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Hemorragia Cerebral , Extravasamento de Materiais Terapêuticos e Diagnósticos , AVC Isquêmico , Nomogramas , Valor Preditivo dos Testes , Trombectomia , Humanos , Masculino , Feminino , Estudos Retrospectivos , Idoso , Trombectomia/efeitos adversos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/etiologia , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/terapia , AVC Isquêmico/etiologia , Pessoa de Meia-Idade , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Diagnóstico Diferencial , Reprodutibilidade dos Testes , Meios de Contraste , Resultado do Tratamento , Técnicas de Apoio para a Decisão , Idoso de 80 Anos ou mais , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: Pre- and post-endovascular treatment (EVT) imaging may aid in predicting functional outcomes in acute middle cerebral artery (MCA) ischemic stroke. Low post-EVT contrast extravasation (CE)-ASPECTS is associated with poor functional outcomes. Besides the MCA regions included in the ASPECTS score, CE may be seen in the mesial temporal (MT) region. In this study, we investigated the frequency and prognostic implication of MT-CE in acute ischemic stroke patients. METHODS: Patients with an acute ischemic stroke due to anterior large vessel occlusion who received EVT and post-EVT DECT between 2010 and 2019 were included. Iodine overlay maps of DECT were assessed for the occurrence of CE, using the ASPECTS for occurrence in the MCA region and, calculating a CE-ASPECTS, for whether the MT region was involved. Multivariable linear and logistic regression were used to assess the relationship between involvement of MT-CE and 24-48h NIHSS, mRS, and mortality on a multiple imputed dataset. All models were adjusted significant variables in univariate analyses and for total CE-ASPECTS. RESULTS: 501/651 patients met the inclusion criteria. MT-CE occurred in 97 (19 %) patients, and was more often present in patients with internal carotid artery occlusions. MT-CE was associated with higher NIHSS scores at 24-hours (aß 2.2, 95 % CI 0.09-4.31), with increased risk of higher mRS scores (acOR 1.88, 95 % CI 1.16-3.06), and with increased risk of mortality (aOR 2.12, 95 % CI 1.16-3.86). CONCLUSION: MT-CE is a common finding on post-EVT DECT and is an independent predictor for worse functional outcomes.
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Meios de Contraste , Procedimentos Endovasculares , Extravasamento de Materiais Terapêuticos e Diagnósticos , AVC Isquêmico , Valor Preditivo dos Testes , Humanos , Feminino , Masculino , Idoso , AVC Isquêmico/terapia , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/diagnóstico , AVC Isquêmico/fisiopatologia , AVC Isquêmico/mortalidade , Procedimentos Endovasculares/efeitos adversos , Pessoa de Meia-Idade , Resultado do Tratamento , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Fatores de Risco , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Fatores de Tempo , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/terapia , Infarto da Artéria Cerebral Média/mortalidade , Infarto da Artéria Cerebral Média/fisiopatologia , Avaliação da Deficiência , Estado Funcional , Medição de Risco , Recuperação de Função Fisiológica , Angiografia CerebralRESUMO
BACKGROUND: This study aimed to evaluate the management of blunt splenic injury (BSI) and highlight the role of splenic artery embolization (SAE). METHODS: We conducted a retrospective review of all patients with BSI over 15 years. Splenic injuries were graded by the 2018 revision of the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS). Our hospital provide 24/7 in-house surgeries and 24/7 in-house interventional radiology facility. Patients with BSI who arrived hypotensive and were refractory to resuscitation required surgery and patients with vascular injury on abdominal computed tomography were considered for SAE. RESULTS: In total, 680 patients with BSI, the number of patients who underwent nonoperative management with observation (NOM-obs), SAE, and surgery was 294, 234, and 152, respectively. The number of SAEs increased from 4 (8.3%) in 2001 to 23 (60.5%) in 2015 (p < 0.0001); conversely, the number of surgeries decreased from 21 (43.8%) in 2001 to 4 (10.5%) in 2015 (p = 0.001). The spleen-related mortality rate of NOM-obs, SAEs, and surgery was 0%, 0.4%, and 7.2%, respectively. In the SAE subgroup, according to the 2018 AAST-OIS, 234 patients were classified as grade II, n = 3; III, n = 21; IV, n = 111; and V, n = 99, respectively.; and compared with 1994 AST-OIS, 150 patients received a higher grade and the total number of grade IV and V injuries ranged from 96 (41.0%) to 210 (89.7%) (p < 0.0001). On angiography, 202 patients who demonstrated vascular injury and 187 achieved hemostasis after SAE with a 92.6% success rate. Six of the 15 patients failed to SAE preserved the spleen after second embolization with a 95.5% salvage rate. CONCLUSIONS: Our data confirm the superiority of the 2018 AAST-OIS and support the role of SAE in changing the trend of management of BSI.
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Embolização Terapêutica , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Humanos , Baço/diagnóstico por imagem , Artéria Esplênica/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: To compare the outcomes of blunt splenic injuries (BSI) managed with proximal (P) versus distal (D) versus combined (C) splenic artery embolization (SAE). METHODS: This retrospective study included patients with BSI who demonstrated vascular injuries on angiograms and were managed with SAE between 2001 and 2015. The success rate and major complications (Clavien-Dindo classification ≥ III) were compared between the P, D, and C embolizations. RESULTS: In total, 202 patients were enrolled (P, n = 64, 31.7%; D, n = 84, 41.6%; C, n = 54, 26.7%). The median injury severity score was 25. The median times from injury to SAE were 8.3, 7.0, and 6.6 h for the P, D, and C embolization, respectively. The overall haemostasis success rates were 92.6%, 93.8%, 88.1%, and 98.1% in the P, D, and C embolizations, respectively, with no significant difference (p = 0.079). Additionally, the outcomes were not significantly different between the different types of vascular injuries on angiograms or the materials used in the location of embolization. Splenic abscess occurred in six patients (P, n = 0; D, n = 5; C, n = 1), although it occurred more commonly in those who underwent D embolization with no significant difference (p = 0.092). CONCLUSIONS: The success rate and major complications of SAE were not significantly different regardless of the location of embolization. The different types of vascular injuries on angiograms and agents used in different embolization locations also did not affect the outcomes.
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Traumatismos Abdominais , Embolização Terapêutica , Esplenopatias , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Humanos , Estudos Retrospectivos , Artéria Esplênica , Centros de Traumatologia , Resultado do Tratamento , Embolização Terapêutica/efeitos adversos , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapiaRESUMO
Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examinationãcytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.
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Hematoma Subdural Agudo , Hematoma Subdural Crônico , Leucemia Mielogênica Crônica BCR-ABL Positiva , Humanos , Hematoma Subdural Agudo/cirurgia , Artérias , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/cirurgia , Tomografia Computadorizada por Raios X/efeitos adversos , Angiografia por Tomografia Computadorizada , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologiaRESUMO
PURPOSE: While interventional radiologists occupy a critical role in adult trauma management, the role of interventionalist in pediatric trauma continues to evolve. The indications for transarterial embolization (TAE) are significantly different in pediatric patients in whom non-operative management (NOM) has a much more prominent role than in adults. Contrast extravasation on imaging may not require acute surgical or interventional management as it would in an adult. There are also areas in which pediatric interventional radiology is increasingly useful such as pelvic TAE in failed management, or splenic embolization to treat bleeding without the loss of splenic function inherent to surgical splenectomy. The rapid evolution of techniques and devices in pediatric patients is also changing what interventions are possible in pediatric trauma management which necessitates frequent reassessment of the guidelines and interventional radiology's role in caring for these patients. CONCLUSION: This review seeks to consolidate the recent literature to describe the evolving role of the interventional radiologist in pediatric trauma management.
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Papel Profissional , Radiologistas , Ferimentos e Lesões , Criança , Embolização Terapêutica/métodos , Humanos , Baço/diagnóstico por imagem , Baço/lesões , Baço/cirurgia , Esplenectomia , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/terapiaRESUMO
BACKGROUND: Contrast leakage after arthrography is common. We sought to investigate if immobilization could prevent it. PURPOSE: The purpose of this study was to determine the effects on contrast extravasation and image quality produced by strict immobilization of the shoulder between arthrography puncture and subsequent MR imaging. MATERIAL AND METHODS: Fifty patients underwent shoulder MR arthrography using a standard shoulder puncture in the anteroinferior quadrant. Ten milliliters of contrast mixture of saline, iodinated contrast, and gadolinium contrast was injected by a senior musculoskeletal (MSK) radiologist using a 21G needle. Half of the patients were immediately immobilized using a shoulder sling, and the other half were allowed to move their shoulder and arm freely during the time before MR imaging. MR arthrography was performed with a 3 T system using standard T1 and PD weighted sequences. The MR images were reviewed independently by 2 MSK radiologists and graded for extravasation using a five-point scale (1: none, 2: less than 2 cm, 3: 2-5 cm, 4: 5-10 cm, 5: more than 10 cm) and for image quality using a 5 point scale (1: poor, 5: good). The Pearson correlation was calculated to assess the correlation between leakage and image quality. RESULTS: There was no significant difference in amount of leakage between both groups, and global image quality was found equal in both groups. A negative correlation was found between leakage and quality assessment. CONCLUSION: This study shows that it cannot be avoided by strict shoulder immobilization and that it negatively affects image quality and interpretation.
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Artrografia/métodos , Meios de Contraste/administração & dosagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Aumento da Imagem/métodos , Imobilização/métodos , Imageamento por Ressonância Magnética/métodos , Articulação do Ombro/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To audit the radiology department of a health facility, focusing on contrast extravasations management pre- and post-implementation of a standard protocol. METHODS: The audit was conducted at the Radiology Department of Shifa International Hospital, Islamabad, Pakistan and comprised reported computed tomography contrast extravasation incidents from January 2017 to December 2019 in the retrospective phase before the implementation of a standard protocol. Post-implementation, re-audit was done prospectively to assess compliance from January 2020 to May 2021. Overall score of >80% was chosen arbitrarily as a qualifying standard for adequate documentation. RESULTS: Of the 49 total cases, 26(53%) related to the first phase and 23(47%) to the second. In the first phase, 2(20%) of the 10 parameters cleared the cut-off mark; 'study performed' 25(96%) and 'limb assessment by technician' 26(100%). In the second phase, 2(20%) parameters failed to clear the cut-off mark; site of cannula/extravasation' 18(78.3%) and 'volume of contrast' 15(65%). CONCLUSIONS: Lack of early identification and appropriate management, especially in cases of large-volume extravasation, may result in significant morbidity.
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Extravasamento de Materiais Terapêuticos e Diagnósticos , Radiologia , Humanos , Estudos Retrospectivos , Paquistão , Centros de Atenção Terciária , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagemRESUMO
OBJECTIVE: To investigate whether contrast extravasation on dual-energy computed tomography (DECT) in patients with acute ischemic stroke (AIS) after endovascular therapy (EVT) are related to hemorrhagic transformation (HT) and poor short-term clinical outcomes. METHODS: A retrospective analysis was conducted on AIS patients who underwent EVT at Xuanwu hospital between November 2016 and January 2019. DECT was performed on all patients within 24 hours after EVT. Baseline demographic and clinical data were analyzed between patients with and without contrast extravasation and between patients with HT and non-HT, good and poor outcomes at 3 months post-EVT. RESULTS: A total of 166 patients were included in the study with 51 (30.7%) patients experiencing contrast extravasation. Compared to patients without contrast extravasation, patients with contrast extravasation had longer onset to reperfusion time (444.8 minutes versus 374.0 minutes, Pâ¯=â¯.044) and higher percentages of greater than 3 retriever passes (16.7% versus 31.4%, Pâ¯=â¯.030). Contrast extravasation was associated with higher risk of HT (Pâ¯=â¯.038), poor outcome after discharge (Pâ¯=â¯.030), and longer hospital stay (Pâ¯=â¯.034). Multivariate analysis showed that contrast extravasation occurrence was an independent factor for HT (ORâ¯=â¯2.150, 95% CI 1.060-4.360, Pâ¯=â¯.034) and poor short-term outcome (ORâ¯=â¯2.936; 95% CI 1.147-7.518, Pâ¯=â¯.025). CONCLUSIONS: The presence of contrast extravasation within 24 hours of EVT may be associated with higher risks of HT and may be predictive of unfavorable functional outcomes in AIS patients.
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Isquemia Encefálica/terapia , Meios de Contraste/administração & dosagem , Procedimentos Endovasculares/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos , Hemorragias Intracranianas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pequim , Isquemia Encefálica/diagnóstico por imagem , Feminino , Humanos , Hemorragias Intracranianas/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico por imagem , Fatores de Tempo , Resultado do TratamentoRESUMO
Hyperintense reperfusion marker (HARM) on post-contrast magnetic resonance imaging (MRI) fluid attenuated inversion recovery (FLAIR) represents gadolinium contrast extravasation in the setting of acute ischemic stroke and is a common finding after revascularization therapies. Clinically, it is a marker of blood brain barrier (BBB) disruption, predictor of hemorrhagic transformation, and predictor of poor clinical outcome in ischemic stroke. Here, we describe a case where a patient underwent mechanical thrombectomy and was later found to have evidence of contrast extravasation on CT imaging, in the same locations found on the post-contrast FLAIR MRI, demonstrating that MRI-HARM and CT contrast extravasation may mimic similar phenomena. Thus, this case demonstrates that we may be able to extrapolate what we know about HARM detected on MRI to a CT imaging biomarker that would be more readily obtainable in most stroke patients.
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Meios de Contraste/administração & dosagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Infarto da Artéria Cerebral Média/terapia , Trombectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Idoso , Circulação Cerebrovascular , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Humanos , Infarto da Artéria Cerebral Média/diagnóstico por imagem , Infarto da Artéria Cerebral Média/fisiopatologia , Imageamento por Ressonância Magnética , Valor Preditivo dos Testes , Resultado do TratamentoRESUMO
BACKGROUND: Antidepressants that inhibit the reuptake of serotonin (SRIs) have been related to the appearance of intracerebral haemorrhage (ICH). Some studies have described bigger haematoma volumes in these patients. So far, no studies have demonstrated an association between SRIs and contrast extravasation (CE). We propose to investigate the relationship of SRIs with CE and clinical outcome. PATIENTS AND METHODS: We aimed a prospective registry of 294 patients with ICH. All previous treatments were registered, including SRIs intake. The presence of CE and the number of spot sign in CT angiography were collected. Early neurological deterioration (END) and late neurological deterioration (LND) were registered. Follow-up was completed at day 90. RESULTS: Two hundred and ninety-four patients were included, mean age 66.5 years, 27.6% female. A total of 28 (9.5%) were taking SRIs at the time of the ICH. This group of patients presented statistically significantly more CE (46.4 vs. 19.9%, p = 0.012), ≥2 spot sign (25 vs. 6.8%, p = 0.017), END (46.4 vs. 25.2%, p = 0.018) and LND (14.3 vs. 4.9%, p = 0.032). In addition, this group of patients showed a tendency to have higher mortality (32.1 vs. 22.2%, p = 0.553) and a lower functional independence (modified Rankin Scale 0-2) at day 90 (25 vs. 36.5%, p = 0.230). In the multivariate analysis, SRIs intake was identified as an independent predictor of CE (adjusted OR 3.37; 95% CI 1.033-10.989; p = 0.044) together with hematoma volume at baseline and alcohol use. CONCLUSIONS: In our studied population, previous SRIs intake in patients with ICH was independently associated to CE. Further studies are needed to confirm this association.
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Angiografia Cerebral/métodos , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/patologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Idoso , Feminino , Hematoma/diagnóstico por imagem , Hematoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodosRESUMO
Accumulation of contrast medium in the subdural space after diagnostic intraarterial contrast administration is a rare observation. The authors report the case of a subdural contrast effusion (SCE) presenting during endovascular treatment of an intracranial dural arteriovenous fistula (DAVF) mimicking an acute subdural hematoma. Differentiation between the two by computed tomography (CT) or intraprocedural Dyna CT and early neurological examination can be crucial for patient management. We believe that repeated large-volume contrast injections via large-bore intermediate catheters into the territory of an (even partly) occluded DAVF may induce leakage of contrast medium into the extravascular subdural space thereby causing a SCE.
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Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Derrame Subdural/etiologia , Tomografia Computadorizada por Raios X/efeitos adversos , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Diagnóstico Diferencial , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Subdural/diagnósticoRESUMO
Extravasation of intravenous contrast agents in the hand and forearm during computed tomography scanning is rising with the use of automated pressure injectors. The main concern in such a situation is progression to acute compartment syndrome and necrosis of the overlying skin. Management has been mainly nonsurgical comprising upper limb elevation and orthosis, with surgical techniques such as liposuction and saline evacuation mainly used for large volume (>50 mL) extravasations. We have developed a technique of multiple stab incisions and drainage for the treatment of contrast extravasations.
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Síndromes Compartimentais/prevenção & controle , Meios de Contraste/efeitos adversos , Drenagem/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Antebraço , Mãos , Síndromes Compartimentais/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , HumanosRESUMO
INTRODUCTION: Vascular access procedures are among the most commonly performed procedures in the emergency department. The objective of the current study was to compare the contrast extravasation rate for ultrasound-guided peripheral intravenous (USGPIV) catheter placement by emergency nurses with peripheral intravenous catheters placed by standard landmark techniques. METHODS: A retrospective chart review of all ED patients at our urban tertiary-care institution who underwent contrasted computed tomography examination and suffered contrast extravasation events was performed. A logbook of all ED patients who underwent USGPIV placement and an institution-wide electronic patient safety incident-reporting system was reviewed for all contrast extravasation events between May 2014, and February 2017. Data were analyzed using descriptive statistics, Student t-tests for continuous data, and χ2 or Fisher's exact test for categorical data. RESULTS: One thousand five hundred USGPIV catheters were placed by 27 emergency nurses. Contrast material was administered 29,508 times, and, of these, 291 were administered via USGPIV placement. There were 74 peripheral IV lines with documented contrast extravasations (0.25%) as reported in the safety-event database; 12 (4.1%) were from the USGPIV population, and 62 (0.21%) occurred in the standard landmark technique population. Relative risk of contrast extravasation events with USGPIV placement was 19.4 (95% confidence interval [CI], 10.6-35.6), and the absolute risk difference was 3.9% (95% CI 1.6%-6.2%). DISCUSSION: USGPIV placement by trained emergency nurses has higher rates of contrast extravasation than with standard landmark technique placement.
Assuntos
Cateterismo Periférico/métodos , Enfermagem em Emergência/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Ultrassonografia de Intervenção/métodos , Humanos , Recursos Humanos de Enfermagem Hospitalar , Estudos RetrospectivosRESUMO
PURPOSE: To characterize the management, outcomes, and emergency department (ED) length of stay (LOS) following iodinated contrast media extravasation events in the ED. METHODS: All ED patients who developed iodinated contrast media extravasation following contrast-enhanced CT (CECT) from October 2007-December 2016 were retrospectively identified. Medical records were reviewed and management, complications, frequency of surgical consultation, and ED LOS were quantified using descriptive statistics. The Wilcoxon rank sum test was used to compare ED LOS in patients who did and did not receive surgical consultation. RESULTS: A total of 199 contrast extravasation episodes occurred in ED patients during the 9-year study period. Of these, 42 patients underwent surgical consultation to evaluate the contrast extravasation event. No patient developed progressive symptoms, compartment syndrome, or tissue necrosis, and none received treatment beyond supportive care (warm/cold packs, elevation, compression). Median ED LOS for patients who did and did not receive surgical consultation was 11.3h versus 9.0h, respectively (p<0.01). CONCLUSION: Close observation and supportive care are sufficient for contrast extravasation events in the ED without concerning symptoms (progressive pain/swelling, altered tissue perfusion, sensory changes, or blistering/ulceration). Routine surgical consultation is likely unnecessary in the absence of these symptoms - concordant with the current American College of Radiology guidelines - and may be associated with longer ED LOS without impacting management.
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Meios de Contraste/efeitos adversos , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: Hypertension is an important etiology of intracerebral hemorrhage (ICH) in neurosurgical practice. Contrast extravasation on computed tomography angiography, known as the "spot sign", has been described as an independent predictor of hematoma progression and clinical deterioration. However, its role in hypertensive ICH alone has not been determined and is the primary aim of this study. MATERIALS AND METHODS: A retrospective review was carried out of patients with hypertensive ICH admitted to our institution between May 2014 and December 2016. Evaluation of the neuroimaging studies of these patients revealed two distinct morphologies, "spot" and "blush" sign. These distinct signs and covariates were tested for association with hematoma expansion and mortality using multivariate logistic regression. The accuracy of the "spot" and "blush" signs as predictors of hematoma expansion and mortality was determined using receiver-operator characteristic (ROC) analysis. RESULTS: A total of 54 patients were identified as hypertensive ICH during the study period. "spot" sign was observed in 11 (20.4%) of the study population. Contrast extravasation (blush-sign) was seen in 7 (14.8%) patients. The "blush" was an independent predictor of hematoma expansion (odds ratio [OR] 6.052; confidence interval [CI] 1.036-15.945 [P = .012]) and mortality (OR 3.305; CI 1.240-25.414 [P = .032]). With ROC analysis, the "blush" sign was found to have a better predictive value for significant hematoma expansion (area under the curve [AUC]: .795) than the spot sign (AUC: .432). CONCLUSION: The "blush" sign has better accuracy for predicting hematoma expansion in hypertensive ICH and could be used to risk stratify these patients for early therapeutic interventions.
Assuntos
Encéfalo/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Hematoma Subdural/diagnóstico por imagem , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/irrigação sanguínea , Meios de Contraste , Progressão da Doença , Feminino , Hematoma Subdural/mortalidade , Hematoma Subdural/fisiopatologia , Humanos , Hemorragia Intracraniana Hipertensiva/mortalidade , Hemorragia Intracraniana Hipertensiva/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Curva ROC , Estudos RetrospectivosRESUMO
Aim: This study investigated whether contrast extravasation on computed tomography (CT) angiography in patients with traumatic brain injury (TBI) is associated with death or surgical procedures. Methods: Patients over 18 years old, directly brought in by ambulance with an isolated head injury and confirmed to have acute intracranial hemorrhage on a CT scan upon admission between 2010 and 2020, were included. The primary outcome was mortality, and the secondary outcome was neurosurgical procedures performed from admission to discharge from the intensive care unit. Multivariable logistic regression analyses were performed to evaluate the association between these outcomes and contrast extravasation. Results: The analysis included 188 patients with a median age of 65 years, 123 men (65.4%), 34 deaths (18.1%), and 91 surgeries (48.4%). Among the 66 patients with contrast extravasation, 22 (33.3%) died and 47 (71.2%) required surgery. Among the 122 patients with no contrast extravasation, 12 (9.8%) died, and 44 (36.1%) required surgery. The presence or absence of extravascular leakage was associated with death (odds ratio, 3.6 [95% CI: 1.2-12.2]) and surgery (odds ratio, 7.6 [95% CI: 2.5-22.7]). Conclusion: Contrast extravasation was associated with mortality and performance of surgery in patients with an isolated head injury.
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BACKGROUND: This study aimed to assess whether the grade of contrast extravasation (CE) on CT scans was associated with massive transfusion (MT) requirements in pediatric blunt liver and/or spleen injuries (BLSI). METHODS: This multicenter retrospective cohort study included pediatric patients (≤16 years old) who sustained BLSI between 2008 and 2019. MT was defined as transfusion of all blood products ≥40 mL/kg within the first 24 h of admission. Associations between CE and MT requirements were assessed using multivariate logistic regression analysis with cluster-adjusted robust standard errors to calculate the adjusted odds ratio (AOR). RESULTS: A total of 1407 children (median age: 9 years) from 83 institutions were included in the analysis. Overall, 199 patients (14 %) received MT. CT on admission revealed that 54 patients (3.8 %) had CE within the subcapsular hematoma, 100 patients (7.1 %) had intraparenchymal CE, and 86 patients (6.1 %) had CE into the peritoneal cavity among the overall cohort. Multivariate analysis, adjusted for age, sex, age-adjusted shock index, injury severity, and laboratory and imaging factors, showed that intraparenchymal CE and CE into the peritoneal cavity were significantly associated with the need for MT (AOR: 2.50; 95 % CI, 1.50-4.16 and AOR: 4.98; 95 % CI, 2.75-9.02, respectively both p < 0.001). The latter significant association persisted in the subgroup of patients with spleen and liver injuries. CONCLUSION: Active CE into the free peritoneal cavity on admission CT was independently associated with a greater probability of receiving MT in pediatric BLSI. The CE grade may help clinicians plan blood transfusion strategies. LEVEL OF EVIDENCE: Level 4; Therapeutic/Care management.
Assuntos
Baço , Ferimentos não Penetrantes , Criança , Humanos , Adolescente , Baço/diagnóstico por imagem , Baço/lesões , Estudos Retrospectivos , Fígado/diagnóstico por imagem , Fígado/lesões , Transfusão de Sangue , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/complicações , Escala de Gravidade do FerimentoRESUMO
OBJECTIVES: This study aimed to identify factors influencing in-hospital mortality in adult patients with active vascular contrast extravasation (AVCE) on abdominopelvic computed tomography (CT). METHODS: All consecutive patients with AVCE detected on CT between January 2019 and May 2022 were retrospectively included. Their data were compared through uni- and multivariable analyses between patients with and without in-hospital mortality. Path analysis was utilized to clarify the relationships among factors affecting mortality. RESULTS: There were 272 patients (60.2 ± 19.4 years, 150 men) included, of whom 70 experienced in-hospital mortality. Multivariable analysis revealed nonsurgery, chronic kidney disease (CKD) stage 4-5 or dialysis, prolonged partial thromboplastin time (PTT), minimum AVCE length > 8 mm, and a lower rate of packed red cell (PRC) transfusion were identified as independent predictors of in-hospital mortality (p = 0.005-0.048). Path analysis demonstrated direct influences of CKD4-5 or dialysis, prolonged PTT, and minimum AVCE length on mortality (coefficients 0.525-0.616; p = 0.009 to < 0.001). PRC transfusion impacted mortality through nonsurgery (coefficient 0.798, p = 0.003) and intensive care unit (ICU) admission (coefficients 0.025, p = 0.016), leading to subsequent death. Three AVCE spaces (free, loose, and tight) defined on CT were not directly associated with in-hospital mortality. CONCLUSION: In adults with AVCE on CT, AVCE size had a direct independent influence on mortality, highlighting the critical role of radiologists in detecting and characterizing this finding. Additionally, CKD4-5 or dialysis and prolonged PTT also directly influenced mortality, while the lower rate of PRC transfusion impacted mortality through nonsurgery and ICU admission. CLINICAL RELEVANCE STATEMENT: In patients with active vascular contrast extravasation (AVCE) on abdominopelvic CT, larger AVCE directly increased in-hospital mortality. Radiologists' detection and characterization of this finding is crucial, along with recognizing factors like CKD4-5, dialysis, and prolonged PTT to improve patient outcomes. KEY POINTS: Several factors independently predicted in-hospital mortality in patients with abdominopelvic AVCE. Extravasation length > 8 mm was the only imaging marker predictive of in-hospital mortality. Non-imaging factors correlated with in-hospital mortality, and PRC transfusion impacted mortality through nonsurgery and ICU admission pathways.
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BACKGROUND: Recent advancements in animal studies have demonstrated the potential of normobaric hyperoxia (NBO) as a promising intervention for preserving the integrity of the blood-brain barrier (BBB). However, there is still limited understanding of the effects of NBO on BBB function in patients with clinical stroke. Therefore, the objective of this study was to investigate the efficacy of NBO therapy in attenuating BBB damage and reducing brain injury in individuals undergoing endovascular treatment (EVT) for acute stroke. METHODS AND RESULTS: This study enrolled patients from the OPENS-1 (Normobaric Hyperoxia Combined With Reperfusion for Acute Ischemic Stroke) study, with 43 patients receiving NBO combined with EVT and 43 patients receiving EVT alone. The main outcome measures included serum levels of occludin, MMP-9 (matrix metalloproteinase-9), NSE (neuron-specific enolase), and S100b at 24 hours and 7 days, as well as the intracranial extravasation rate at 24 hours. Serum markers were assessed using ELISA, and intracranial contrast extravasation was visualized using dual-energy computed tomography scan. We analyzed a total of 86 patients and found that the 24-hour serum markers levels of BBB damage and brain injury were significantly lower in the group receiving NBO therapy combined with EVT compared with the group receiving EVT alone. Similarly, at 7 days, the levels of occludin, MMP-9, and NSE were lower in the NBO+EVT group. We also found that the 24-hour serum levels of occludin and MMP-9 were correlated with intracranial contrast extravasation. Additionally, the incidence of intracranial contrast extravasation was lower in the NBO+EVT group compared with the EVT group (35.9% versus 60.5%, P=0.031). CONCLUSIONS: This study offers valuable insights into the positive impact of NBO on maintaining BBB integrity and reducing brain injury in patients with acute stroke undergoing EVT.