Despite the rapid development of diagnostic and therapeutic modalities and techniques to manage LGIB patients from interventional radiology’s standpoint,a successful localization of the bleeding site that leads to an...Despite the rapid development of diagnostic and therapeutic modalities and techniques to manage LGIB patients from interventional radiology’s standpoint,a successful localization of the bleeding site that leads to an effective embolotherapy remains a significant technical challenge.The interventional radiologist’s decisions when managing patients with LGIB may significantly impact the clinical outcomes;therefore,management should be made based on careful and thorough considerations of factors such as etiology,locations,patient’s comorbidities,and potential post-procedure complications,among others.The purpose of this paper is to review the management of LGIB by interventional radiology,focusing on a few challenging and common clinical situations that require special consideration by interventional radiologists.展开更多
Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main tre...Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient's work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.展开更多
This paper performs a review of existing literature about neonatal imaging in intensive care;we notice that the multiplicity of approaches results in different and sometimes conflicting solutions to optimize acquisiti...This paper performs a review of existing literature about neonatal imaging in intensive care;we notice that the multiplicity of approaches results in different and sometimes conflicting solutions to optimize acquisition technique of X-ray images. European Guidelines still refer to screen-film combinations used in past decades, current usage of digital technology requires an additional effort to reduce dose to infants and to optimize the sensor’s response exploiting their properties. In this work we investigate response changes of digital medium (computed radiography plates), due to alterations of the beam through incubators components. All combinations in use in our Hospital were tested for evaluating dosimetry and image quality and new exposure solutions were devised to optimize radiology exams, taking into account solutions suggested by the equipments makers. Dose measured was compared with dose levels suggested by European Guidelines, evaluating radiation-induced risk too. Image quality was evaluated in a double-blind comparison by radiologists. An easily repeatable optimization procedure is proposed intended to reduce delivered dose well below European guidelines. The proposed study allowed us to instruct the technologists on the most appropriate methodology for performing the radiology exam, by standardizing the approach to Neonatal Intensive Care Units. We have demonstrated also to radiologic technologists reluctant to use the X-ray tray, as it may optimize imaging in the incubator. We were also able to reduce dose—and radiation-induced risk too—of 37% - 67% depending on the previously used operating mode.展开更多
AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) ...AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging(< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion.RESULTS Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(8.45 mm, 5.58%, 56.04 mm^2, and 11.48%, respectively, P = 0.01).CONCLUSION Passive expansion of sm TIPS does occur but clinical outcomes of sm TIPS and m TIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients.展开更多
Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circul...Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.展开更多
AIM:To identify multi-detector computed tomography(MDCT) features most predictive of serous cystadenomas(SCAs),correlating with histopathology,and to study the impact of cyst size and MDCT technique on reader performa...AIM:To identify multi-detector computed tomography(MDCT) features most predictive of serous cystadenomas(SCAs),correlating with histopathology,and to study the impact of cyst size and MDCT technique on reader performance.METHODS:The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs.Accuracy in lesion characterization and reader conf idence were correlated with lesion size(≤3cm or≥3cm) and scanning protocols(dedicated vs routine).RESULTS:28/164 cysts(mean size,39 mm;range,8-92mm) were diagnosed as SCA on pathology.The MDCT features predictive of diagnosis of SCA were microcystic appearance(22/28,78.6%),surface lobulations(25/28,89.3%) and central scar(9/28,32.4%).Stepwise logistic regression analysis showed that only microcystic appearance was signifi cant for CT diagnosis of SCA(P=0.0001).The sensitivity,specificity and PPV of central scar and of combined microcystic appearance and lobulations were 32.4%/100%/100% and 68%/100%/100%,respectively.The reader confidence was higher for lesions>3cm(P=0.02) and for MDCT scans performed using thin collimation(1.25-2.5mm) compared to routine 5 mm collimation exams(P>0.05).CONCLUSION:Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs.Microcystic morphology is the most significant CT feature in diagnosis of SCA.A combination of microcystic appearance and surface lobulations offers accuracy comparable to central scar with higher sensitivity.展开更多
Primary and metastatic liver tumors are an increasing global health problem,with hepatocellular carcinoma(HCC)now being the third leading cause of cancer-related mortality worldwide.Systemic treatment options for HCC ...Primary and metastatic liver tumors are an increasing global health problem,with hepatocellular carcinoma(HCC)now being the third leading cause of cancer-related mortality worldwide.Systemic treatment options for HCC remain limited,with Sorafenib as the only prospectively validated agent shown to increase overall survival.Surgical resection and/or transplantation,locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments,providing improved survival outcomes for both primary and metastatic tumors.Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors.For patients with low volume disease,these therapies have now been established into consensus practice guidelines.This review highlights technical aspects and outcomes of commonly utilized,minimally invasive local therapies including laparoscopic liver resection(LLR),radiofrequency ablation(RFA),microwave ablation(MWA),high-intensity focused ultrasound(HIFU),irreversible electroporation(IRE),and stereotactic body radiation therapy(SBRT).In addition,the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.展开更多
AIM: To investigate the survival rates after transarterial embolization(TAE).METHODS: One hundred third six hepatocellular carcinoma(HCC) patients [90 barcelona clinic liver cancer(BCLC) B] were submitted to TAE betwe...AIM: To investigate the survival rates after transarterial embolization(TAE).METHODS: One hundred third six hepatocellular carcinoma(HCC) patients [90 barcelona clinic liver cancer(BCLC) B] were submitted to TAE between August 2008 and December 2013 in a single center were retrospectively studied. TAE was performed via superselective catheterization followed by embolization with polyvinyl alcohol or microspheres. The date of the first embolization until death or the last follow-up date was used for the assessment of survival. The survival rates were calculated using the Kaplan-Meier method, and the groups were compared using the log-rank test.RESULTS: The overall mean survival was 35.8 mo(95%CI: 25.1-52.0). The survival rates of the BCLC A patients(33.7%) were 98.9%, 79.0% and 58.0% at 12, 24 and 36 mo, respectively, and the mean survival was 38.1 mo(95%CI: 27.5-52.0). The survival rates of the BCLC B patients(66.2%) were 89.0%, 69.0% and 49.5% at 12, 24 and 36 mo, respectively, and the mean survival was 29.0 mo(95%CI: 17.2-34). The survival rates according to the BCLC B sub-staging showed significant differences between the groups, with mean survival rates in the B1, B2, B3 and B4 groups of 33.5 mo(95%CI: 32.8-34.3), 28.6 mo(95%CI: 27.5-29.8), 19.0 mo(95%CI: 17.2-20.9) and 13 mo, respectively(P = 0.013).CONCLUSION : The BCLC sub-stagingsystem could add additional prognosis information for postembolization survival rates in HCC patients.展开更多
The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable ...The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization(PVE), associating liver partition and portal vein ligation(ALPPS), and the recently reported transhepatic liver venous deprivation(LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.展开更多
AIM:To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography(CT) and reveal its were relationship to rectocele. METHODS:A total of...AIM:To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography(CT) and reveal its were relationship to rectocele. METHODS:A total of twenty female volunteers without rectocele were examined by CT scan.We performed a middle level continuous horizontal pelvic scan from the upper part to the lower part and collected the measurement data to analyze the results using t-test. RESULTS:Twenty volunteers were enrolled in the study. The space between the posterior wall of the vagina and the anterior wall of the rectum was measured at three levels(upper 1/3,middle,lower 1/3 level of vagina). The results showed that the space from the posterior wall of the vagina to the anterior wall of the rectum at the upper 1/3 level and the middle level was 3.896 ±0.3617 mm and 4.6575±0.3052 mm,respectively. When the two groups of data were compared,we found the space at the upper 1/3 level was shorter than at the middle level(P<0.01).Moreover,at the lower 1/3 level the space measured was 10.058±0.4534 mm.The results revealed that the space at the lower 1/3 level was longer than that at the middle level(P<0.01). CONCLUSION:These measurement data may be helpful in assessing rectocele clinical diagnosis and functional outcomes of rectocele repair.展开更多
Significant advances in imaging technology have changed the management of pancreatic cancer. In computed tomography (CT), this has included development of multidetector row, rapid, thin-section imaging that has also f...Significant advances in imaging technology have changed the management of pancreatic cancer. In computed tomography (CT), this has included development of multidetector row, rapid, thin-section imaging that has also facilitated the advent of advanced reconstructions, which in turn has offered new perspectives from which to evaluate this disease. In magnetic resonance imaging, advances including higher field strengths, thin-section volumetric acquisitions, diffusion weighted imaging, and liver specific contrast agents have also resulted in new tools for diagnosis and staging. Endoscopic ultrasound has resulted in the ability to provide high-resolution imaging rivaling intraoperative ultrasound, along with the ability to biopsy via real time imaging suspected pancreatic lesions. Positron emission tomography with CT, while still evolving in its role, provides whole body staging as well as the unique imaging characteristic of metabolic activity to aid disease management. This article will review these modalities in the diagnosis and staging of pancreatic cancer.展开更多
Non-alcoholic fatty liver disease(NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases ...Non-alcoholic fatty liver disease(NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases of simple steatosis are non-progressive, whereas nonalcoholic steatohepatitis may result in chronic liver injury and progressive fibrosis in a significant minority. Effective risk stratification and management of NAFLD requires evaluation of hepatic parenchymal fat, fibrosis, and inflammation. Liver biopsy remains the current gold standard; however, non-invasive imaging methods are rapidly evolving and may replace biopsy in some circumstances. These methods include well-established techniques, such as conventional ultrasonography, computed tomography, and magnetic resonance imaging and newer imaging technologies, such as ultrasound elastography, quantitative ultrasound techniques, magnetic resonance elastography, and magnetic resonancebased fat quantitation techniques. The aim of this article is to review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability.展开更多
Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent im...Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.展开更多
Tumor staging defines the point in the natural history of the malignancy when the diagnosis is made. The most common staging system for cancer is the tumor, node, metastases classification. Staging of cancers provides...Tumor staging defines the point in the natural history of the malignancy when the diagnosis is made. The most common staging system for cancer is the tumor, node, metastases classification. Staging of cancers provides useful parameters in the determination of the extent of disease and prognosis. Cholangiocarcinoma are rare and refers to cancers that arise from the biliary epithelium. These tumors can occur anywhere along the biliary tree. These tumors have been previously divided into extrahepatic and intrahepatic lesions. Until recently the extrahepatic bile duct tumors have been considered as a single entity per American Joint Com- mission on Cancer (AJCC) staging classification. The most recent changes to the AJCC classification of bile duct cancers divide the tumors into two major catego- ries: proximal and distal tumors. This practical classifi- cation is based on anatomy and surgical management. High quality cross-sectional computed tomography (CT) and/or magnetic resonance (MR) imaging of the abdomen are essential information to accurately stage this tumors. Imaging plays an important role in diag-nosis, localization, staging and optimal management of cholangiocarcinoma. For example, it helps to localize the tumor to either perihilar or distal bile duct, both of which have different management. Further, it helps to accurately stage the disease and identify the presence of significant nodal and distant metastasis, which may preclude surgery. Also, it helps to identify the extent of local invasion, which has a major impact on the management. For example, extensive involvement of hepatic duct reaching up to second-order biliary radi- cals or major vascular encasement of portal vein or hepatic arteries precludes curative surgery and patient may be managed by palliative therapy. Further, imag- ing helps to identify any anatomical variations in the hepatic arterial or venous circulation and biliary ductal system, which is vital information for surgical planning. This review presents relevant clinical presentation and imaging acquisition and presentation for the accurate staging classification of bile duct tumors based on the new AJCC criteria. This will be performed with the as- sistance of anatomical diagrams and representative CT and MR images. The image interpretation must include all relevant imaging information for optimum staging. Detailed recommendations on the items required on the radiology report will be presented.展开更多
AIM:To evaluate the response to treatment in patients with neuroendocrine tumor liver metastases following yttrium-90 ( 90 Y) radioembolotherapy, as a function of image patterns at presentation for 90 Y radioembolothe...AIM:To evaluate the response to treatment in patients with neuroendocrine tumor liver metastases following yttrium-90 ( 90 Y) radioembolotherapy, as a function of image patterns at presentation for 90 Y radioembolotherapy. METHODS: The study cohort consisted of patients with hepatic metastatic neuroendocrine tumors treated with 90 Y at our institution during a two-year time period. Hepatic metastases were evaluated on a pretherapy study assessing relative arterial enhancement compared to liver, lesion size, necrosis of the lesion, and associated tumor burden in the liver. We used six response criteria: Response Evaluation Criteria in Solid Tumors (RECIST) size, World Health Organization (WHO) size, European Association for the Study of the Liver (EASL) necrosis guidelines, Choi size, Choi necrosis and combination of Choi size and necrosis. RESULTS: About 65 lesions in 17 patients met study criteria and formed the cohort. Statistically significant response was found for lesions 【 5 cm vs those ≥5 cm with RECIST (P = 0.04), WHO (P = 0.002) and combined Choi criteria (P = 0.02). Hyperenhancing lesions demonstrated greater response only with the Choi size criteria (P = 0.04). Lesions with ≤ 50% necrosis on the pre-scan had statistically significant greater response with the Choi necrosis criteria (P = 0.01). There was no statistical significance for response comparing lesions 【 2 cm vs ≥ 2 cm or in comparing the degrees of tumor burden. CONCLUSION: Based on our findings in this study, it is suggested that initial imaging findings, as listed above, are not a good predictor of response to 90 Y radioembolization.展开更多
As the number of clinical applications of 2-[fluorine 18]fluoro-2-deoxy-D-glucose(FDG) positron emission tomography/computed tomography(PET-CT) grows,familiarity with the conditions that can be diagnosed by this modal...As the number of clinical applications of 2-[fluorine 18]fluoro-2-deoxy-D-glucose(FDG) positron emission tomography/computed tomography(PET-CT) grows,familiarity with the conditions that can be diagnosed by this modality and when relevant pieces of additional information can be obtained becomes increasingly important for both requesting physicians and nuclear medicine physicians or radiologists who interpret the findings.Apart from its heavy use in clinical oncology,FDG PET-CT is widely used in a variety of non-oncologic conditions interconnecting to such disciplines as general internal medicine,infectious diseases,cardiology,neurology,surgery,traumatology,orthopedics,pediatrics,endocrinology,rheumatology,psychiatry,neuropsychology,and cognitive neuroscience.The aim of this review was to summarize the current evidence of FDG PET-CT applications in evaluating non-oncologic pathologies and the relevant information it can add to achieve a final diagnosis.展开更多
AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt(TIPS) in 15 years.METHODS: Using the National Inpatient Sample which is a part ...AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt(TIPS) in 15 years.METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality.RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospitalmortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients(OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients(OR = 1.347 vs non-transferred, P < 0.001), emergency admissions(OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region(OR = 1.449 vs West, P < 0.001) had significantly higher odds of inhospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death(OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure(OR = 8.246), acute kidney failure(OR = 4.359), hepatic encephalopathy(OR = 2.217) and esophageal variceal bleeding(OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites(OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders(OR = 2.823), coagulopathy(OR = 2.016), and lymphoma(OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay has remained relatively constant. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of TIPS in-hospital death.展开更多
文摘Despite the rapid development of diagnostic and therapeutic modalities and techniques to manage LGIB patients from interventional radiology’s standpoint,a successful localization of the bleeding site that leads to an effective embolotherapy remains a significant technical challenge.The interventional radiologist’s decisions when managing patients with LGIB may significantly impact the clinical outcomes;therefore,management should be made based on careful and thorough considerations of factors such as etiology,locations,patient’s comorbidities,and potential post-procedure complications,among others.The purpose of this paper is to review the management of LGIB by interventional radiology,focusing on a few challenging and common clinical situations that require special consideration by interventional radiologists.
文摘Acute upper and lower gastrointestinal bleeding, enteral feeding, cecostomy tubes and luminal strictures are some of the common reasons for gastroenterology service. While surgery was initially considered the main treatment modality, the advent of both therapeutic endoscopy and interventional radiology have resulted in the paradigm shift in the management of these conditions. In this paper, we discuss the patient's work up, indications, and complementary roles of endoscopic and angiographic management in the settings of gastrointestinal bleeding, enteral feeding, cecostomy tube placement and luminal strictures. These conditions often require multidisciplinary approaches involving a team of interventional radiologists, gastroenterologists and surgeons. Further, the authors also aim to describe how the fields of interventional radiology and gastrointestinal endoscopy are overlapping and complementary in the management of these complex conditions.
文摘This paper performs a review of existing literature about neonatal imaging in intensive care;we notice that the multiplicity of approaches results in different and sometimes conflicting solutions to optimize acquisition technique of X-ray images. European Guidelines still refer to screen-film combinations used in past decades, current usage of digital technology requires an additional effort to reduce dose to infants and to optimize the sensor’s response exploiting their properties. In this work we investigate response changes of digital medium (computed radiography plates), due to alterations of the beam through incubators components. All combinations in use in our Hospital were tested for evaluating dosimetry and image quality and new exposure solutions were devised to optimize radiology exams, taking into account solutions suggested by the equipments makers. Dose measured was compared with dose levels suggested by European Guidelines, evaluating radiation-induced risk too. Image quality was evaluated in a double-blind comparison by radiologists. An easily repeatable optimization procedure is proposed intended to reduce delivered dose well below European guidelines. The proposed study allowed us to instruct the technologists on the most appropriate methodology for performing the radiology exam, by standardizing the approach to Neonatal Intensive Care Units. We have demonstrated also to radiologic technologists reluctant to use the X-ray tray, as it may optimize imaging in the incubator. We were also able to reduce dose—and radiation-induced risk too—of 37% - 67% depending on the previously used operating mode.
文摘AIM To assess for passive expansion of sub-maximally dilated transjugular intrahepatic portosystemic shunts(TIPS) and compare outcomes with maximally dilated TIPS.METHODS Polytetrafluoroethylene covered TIPS(Viatorr) from July 2002 to December 2013 were retrospectively reviewed at two hospitals in a single institution. Two hundred and thirty patients had TIPS maximally dilated to 10 mm(m TIPS), while 43 patients who were at increased risk for hepatic encephalopathy(HE), based on clinical evaluation or low pre-TIPS portosystemic gradient(PSG), had 10 mm TIPS sub-maximally dilated to 8 mm(sm TIPS). Group characteristics(age, gender, Model for End-Stage Liver Disease score, post-TIPS PSG and clinical outcomes were compared between groups, including clinical success(ascites or varices), primary patency,primary assisted patency, and severe post-TIPS HE. A subset of fourteen patients with sm TIPS underwent follow-up computed tomography imaging after TIPS creation, and were grouped based on time of imaging(< 6 mo and > 6 mo). Change in diameter and crosssectional area were measured with 3D imaging software to evaluate for passive expansion.RESULTS Patient characteristics were similar between the sm TIPS and m TIPS groups, except for pre-TIPS portosystemic gradient, which was lower in the sm TIPS group(19.4 mm Hg ± 6.8 vs 22.4 mm Hg ± 7.1, P = 0.01). Primary patency and primary assisted patency between sm TIPS and m TIPS was not significantly different(P = 0.64 and 0.55, respectively). Four of the 55 patients(7%) with sm TIPS required TIPS reduction for severe refractory HE, while this occurred in 6 of the 218 patients(3%) with m TIPS(P = 0.12). For the 14 patients with follow-up computed tomography(CT) imaging, the median imaging follow-up was 373 d. There was an increase in median TIPS diameter, median percent diameter change, median area, and median percent area change in patients with CT follow-up greater than 6 mo after TIPS placement compared to follow-up within 6 mo(8.45 mm, 5.58%, 56.04 mm^2, and 11.48%, respectively, P = 0.01).CONCLUSION Passive expansion of sm TIPS does occur but clinical outcomes of sm TIPS and m TIPS were similar. Sub-maximal dilation can prevent complications related to overshunting in select patients.
文摘Percutaneous angioplasty and stenting for the treatment of extracranial vertebral artery(VA) stenosis seems a safe,effective and useful technique for resolving symptoms and improving blood flow to the posterior circulation,with a low complication rate and good long-term results.In patients with severe tortuosity of the vessel,stent placement is a real challenge.The new coronary balloon-expandable stents may be preferred.A large variability of restenosis rates has been reported.Drug-eluting stents may be the solution.After a comprehensive review of the literature,it can be concluded that percutaneous angioplasty and stenting of extracranial VA stenosis is technically feasible,but there is insufficient evidence from randomized trials to demonstrate that endovascular management is superior to best medical management.
文摘AIM:To identify multi-detector computed tomography(MDCT) features most predictive of serous cystadenomas(SCAs),correlating with histopathology,and to study the impact of cyst size and MDCT technique on reader performance.METHODS:The MDCT scans of 164 patients with surgically verified pancreatic cystic lesions were reviewed by two readers to study the predictive value of various morphological features for establishing a diagnosis of SCAs.Accuracy in lesion characterization and reader conf idence were correlated with lesion size(≤3cm or≥3cm) and scanning protocols(dedicated vs routine).RESULTS:28/164 cysts(mean size,39 mm;range,8-92mm) were diagnosed as SCA on pathology.The MDCT features predictive of diagnosis of SCA were microcystic appearance(22/28,78.6%),surface lobulations(25/28,89.3%) and central scar(9/28,32.4%).Stepwise logistic regression analysis showed that only microcystic appearance was signifi cant for CT diagnosis of SCA(P=0.0001).The sensitivity,specificity and PPV of central scar and of combined microcystic appearance and lobulations were 32.4%/100%/100% and 68%/100%/100%,respectively.The reader confidence was higher for lesions>3cm(P=0.02) and for MDCT scans performed using thin collimation(1.25-2.5mm) compared to routine 5 mm collimation exams(P>0.05).CONCLUSION:Central scar on MDCT is diagnostic of SCA but is seen in only one third of SCAs.Microcystic morphology is the most significant CT feature in diagnosis of SCA.A combination of microcystic appearance and surface lobulations offers accuracy comparable to central scar with higher sensitivity.
文摘Primary and metastatic liver tumors are an increasing global health problem,with hepatocellular carcinoma(HCC)now being the third leading cause of cancer-related mortality worldwide.Systemic treatment options for HCC remain limited,with Sorafenib as the only prospectively validated agent shown to increase overall survival.Surgical resection and/or transplantation,locally ablative therapies and regional or locoregional therapies have filled the gap in liver tumor treatments,providing improved survival outcomes for both primary and metastatic tumors.Minimally invasive local therapies have an increasing role in the treatment of both primary and metastatic liver tumors.For patients with low volume disease,these therapies have now been established into consensus practice guidelines.This review highlights technical aspects and outcomes of commonly utilized,minimally invasive local therapies including laparoscopic liver resection(LLR),radiofrequency ablation(RFA),microwave ablation(MWA),high-intensity focused ultrasound(HIFU),irreversible electroporation(IRE),and stereotactic body radiation therapy(SBRT).In addition,the role of combination treatment strategies utilizing these minimally invasive techniques is reviewed.
文摘AIM: To investigate the survival rates after transarterial embolization(TAE).METHODS: One hundred third six hepatocellular carcinoma(HCC) patients [90 barcelona clinic liver cancer(BCLC) B] were submitted to TAE between August 2008 and December 2013 in a single center were retrospectively studied. TAE was performed via superselective catheterization followed by embolization with polyvinyl alcohol or microspheres. The date of the first embolization until death or the last follow-up date was used for the assessment of survival. The survival rates were calculated using the Kaplan-Meier method, and the groups were compared using the log-rank test.RESULTS: The overall mean survival was 35.8 mo(95%CI: 25.1-52.0). The survival rates of the BCLC A patients(33.7%) were 98.9%, 79.0% and 58.0% at 12, 24 and 36 mo, respectively, and the mean survival was 38.1 mo(95%CI: 27.5-52.0). The survival rates of the BCLC B patients(66.2%) were 89.0%, 69.0% and 49.5% at 12, 24 and 36 mo, respectively, and the mean survival was 29.0 mo(95%CI: 17.2-34). The survival rates according to the BCLC B sub-staging showed significant differences between the groups, with mean survival rates in the B1, B2, B3 and B4 groups of 33.5 mo(95%CI: 32.8-34.3), 28.6 mo(95%CI: 27.5-29.8), 19.0 mo(95%CI: 17.2-20.9) and 13 mo, respectively(P = 0.013).CONCLUSION : The BCLC sub-stagingsystem could add additional prognosis information for postembolization survival rates in HCC patients.
文摘The ability to modulate the future liver remnant(FLR) is a key component of modern oncologic hepatobiliary surgery practice and has extended surgical candidacy for patients who may have been previously thought unable to survive liver resection. Multiple techniques have been developed to augment the FLR including portal vein embolization(PVE), associating liver partition and portal vein ligation(ALPPS), and the recently reported transhepatic liver venous deprivation(LVD). PVE is a well-established means to improve the safety of liver resection by redirecting blood flow to the FLR in an effort to selectively hypertrophy and ultimately improve functional reserve of the FLR. This article discusses the current practice of PVE with focus on summarizing the large number of published reports from which outcomes based practices have been developed. Both technical aspects of PVE including volumetry, approaches, and embolization agents; and clinical aspects of PVE including data supporting indications, and its role in conjunction with chemotherapy and transarterial embolization will be highlighted. PVE remains an important aspect of oncologic care; in large part due to the substantial foundation of information available demonstrating its clear clinical benefit for hepatic resection candidates with small anticipated FLRs.
基金Supported by The key project of Tianjin nature science foundation, China, No07JCZDJC07800
文摘AIM:To measure the normal space between the posterior wall of the vagina and the anterior wall of the respectively rectum using computed tomography(CT) and reveal its were relationship to rectocele. METHODS:A total of twenty female volunteers without rectocele were examined by CT scan.We performed a middle level continuous horizontal pelvic scan from the upper part to the lower part and collected the measurement data to analyze the results using t-test. RESULTS:Twenty volunteers were enrolled in the study. The space between the posterior wall of the vagina and the anterior wall of the rectum was measured at three levels(upper 1/3,middle,lower 1/3 level of vagina). The results showed that the space from the posterior wall of the vagina to the anterior wall of the rectum at the upper 1/3 level and the middle level was 3.896 ±0.3617 mm and 4.6575±0.3052 mm,respectively. When the two groups of data were compared,we found the space at the upper 1/3 level was shorter than at the middle level(P<0.01).Moreover,at the lower 1/3 level the space measured was 10.058±0.4534 mm.The results revealed that the space at the lower 1/3 level was longer than that at the middle level(P<0.01). CONCLUSION:These measurement data may be helpful in assessing rectocele clinical diagnosis and functional outcomes of rectocele repair.
文摘Significant advances in imaging technology have changed the management of pancreatic cancer. In computed tomography (CT), this has included development of multidetector row, rapid, thin-section imaging that has also facilitated the advent of advanced reconstructions, which in turn has offered new perspectives from which to evaluate this disease. In magnetic resonance imaging, advances including higher field strengths, thin-section volumetric acquisitions, diffusion weighted imaging, and liver specific contrast agents have also resulted in new tools for diagnosis and staging. Endoscopic ultrasound has resulted in the ability to provide high-resolution imaging rivaling intraoperative ultrasound, along with the ability to biopsy via real time imaging suspected pancreatic lesions. Positron emission tomography with CT, while still evolving in its role, provides whole body staging as well as the unique imaging characteristic of metabolic activity to aid disease management. This article will review these modalities in the diagnosis and staging of pancreatic cancer.
基金Supported by NIBIB of the National Institutes of Health(to Samir C),No.K23 EB020710
文摘Non-alcoholic fatty liver disease(NAFLD) is the most common diffuse liver disease, with a worldwide prevalence of 20% to 46%. NAFLD can be subdivided into simple steatosis and nonalcoholic steatohepatitis. Most cases of simple steatosis are non-progressive, whereas nonalcoholic steatohepatitis may result in chronic liver injury and progressive fibrosis in a significant minority. Effective risk stratification and management of NAFLD requires evaluation of hepatic parenchymal fat, fibrosis, and inflammation. Liver biopsy remains the current gold standard; however, non-invasive imaging methods are rapidly evolving and may replace biopsy in some circumstances. These methods include well-established techniques, such as conventional ultrasonography, computed tomography, and magnetic resonance imaging and newer imaging technologies, such as ultrasound elastography, quantitative ultrasound techniques, magnetic resonance elastography, and magnetic resonancebased fat quantitation techniques. The aim of this article is to review the current status of imaging methods for NAFLD risk stratification and management, including their diagnostic accuracy, limitations, and practical applicability.
文摘Ultrasound is an invaluable imaging modality in the evaluation of pediatric gastrointestinal pathology; it can provide real-time evaluation of the bowel without the need for sedation or intravenous contrast. Recent improvements in ultrasound technique can be utilized to improve detection of bowel pathology in children: Higher resolution probes, color Doppler, harmonic and panoramic imaging are excellent tools in this setting. Graded compression and cine clips provide dynamic information and oral and intravenous contrast agents aid in detection of bowel wall pathology. Ultrasound of the bowel in children is typically a targeted exam; common indications include evaluation for appendicitis, pyloric stenosis and intussusception. Bowel abnormalities that are detected prenatally can be evaluated after birth with ultrasound. Likewise, acquired conditions such as bowel hematoma, bowel infections and hernias can be detected with ultrasound. Rare bowel neoplasms, vascular disorders and foreign bodies may first be detected with sonography, as well. At some centers, comprehensive exams of the gastrointestinal tract are performed on children with inflammatory bowel disease and celiac disease to evaluate for disease activity or to confirm the diagnosis. The goal of this article is to review up-to-date imaging techniques, normal sonographic anatomy, and characteristic sonographic features of common and uncommon disorders affecting the gastrointestinal tract in children.
文摘Tumor staging defines the point in the natural history of the malignancy when the diagnosis is made. The most common staging system for cancer is the tumor, node, metastases classification. Staging of cancers provides useful parameters in the determination of the extent of disease and prognosis. Cholangiocarcinoma are rare and refers to cancers that arise from the biliary epithelium. These tumors can occur anywhere along the biliary tree. These tumors have been previously divided into extrahepatic and intrahepatic lesions. Until recently the extrahepatic bile duct tumors have been considered as a single entity per American Joint Com- mission on Cancer (AJCC) staging classification. The most recent changes to the AJCC classification of bile duct cancers divide the tumors into two major catego- ries: proximal and distal tumors. This practical classifi- cation is based on anatomy and surgical management. High quality cross-sectional computed tomography (CT) and/or magnetic resonance (MR) imaging of the abdomen are essential information to accurately stage this tumors. Imaging plays an important role in diag-nosis, localization, staging and optimal management of cholangiocarcinoma. For example, it helps to localize the tumor to either perihilar or distal bile duct, both of which have different management. Further, it helps to accurately stage the disease and identify the presence of significant nodal and distant metastasis, which may preclude surgery. Also, it helps to identify the extent of local invasion, which has a major impact on the management. For example, extensive involvement of hepatic duct reaching up to second-order biliary radi- cals or major vascular encasement of portal vein or hepatic arteries precludes curative surgery and patient may be managed by palliative therapy. Further, imag- ing helps to identify any anatomical variations in the hepatic arterial or venous circulation and biliary ductal system, which is vital information for surgical planning. This review presents relevant clinical presentation and imaging acquisition and presentation for the accurate staging classification of bile duct tumors based on the new AJCC criteria. This will be performed with the as- sistance of anatomical diagrams and representative CT and MR images. The image interpretation must include all relevant imaging information for optimum staging. Detailed recommendations on the items required on the radiology report will be presented.
文摘AIM:To evaluate the response to treatment in patients with neuroendocrine tumor liver metastases following yttrium-90 ( 90 Y) radioembolotherapy, as a function of image patterns at presentation for 90 Y radioembolotherapy. METHODS: The study cohort consisted of patients with hepatic metastatic neuroendocrine tumors treated with 90 Y at our institution during a two-year time period. Hepatic metastases were evaluated on a pretherapy study assessing relative arterial enhancement compared to liver, lesion size, necrosis of the lesion, and associated tumor burden in the liver. We used six response criteria: Response Evaluation Criteria in Solid Tumors (RECIST) size, World Health Organization (WHO) size, European Association for the Study of the Liver (EASL) necrosis guidelines, Choi size, Choi necrosis and combination of Choi size and necrosis. RESULTS: About 65 lesions in 17 patients met study criteria and formed the cohort. Statistically significant response was found for lesions 【 5 cm vs those ≥5 cm with RECIST (P = 0.04), WHO (P = 0.002) and combined Choi criteria (P = 0.02). Hyperenhancing lesions demonstrated greater response only with the Choi size criteria (P = 0.04). Lesions with ≤ 50% necrosis on the pre-scan had statistically significant greater response with the Choi necrosis criteria (P = 0.01). There was no statistical significance for response comparing lesions 【 2 cm vs ≥ 2 cm or in comparing the degrees of tumor burden. CONCLUSION: Based on our findings in this study, it is suggested that initial imaging findings, as listed above, are not a good predictor of response to 90 Y radioembolization.
文摘As the number of clinical applications of 2-[fluorine 18]fluoro-2-deoxy-D-glucose(FDG) positron emission tomography/computed tomography(PET-CT) grows,familiarity with the conditions that can be diagnosed by this modality and when relevant pieces of additional information can be obtained becomes increasingly important for both requesting physicians and nuclear medicine physicians or radiologists who interpret the findings.Apart from its heavy use in clinical oncology,FDG PET-CT is widely used in a variety of non-oncologic conditions interconnecting to such disciplines as general internal medicine,infectious diseases,cardiology,neurology,surgery,traumatology,orthopedics,pediatrics,endocrinology,rheumatology,psychiatry,neuropsychology,and cognitive neuroscience.The aim of this review was to summarize the current evidence of FDG PET-CT applications in evaluating non-oncologic pathologies and the relevant information it can add to achieve a final diagnosis.
文摘AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt(TIPS) in 15 years.METHODS: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and Quality.RESULTS: Overall, 12.3% of patients died during hospitalization with downward trend in-hospitalmortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients(OR = 1.809 vs Caucasian patients, P < 0.001), transferred patients(OR = 1.347 vs non-transferred, P < 0.001), emergency admissions(OR = 3.032 vs elective cases, P < 0.001), patients in the Northeast region(OR = 1.449 vs West, P < 0.001) had significantly higher odds of inhospital mortality. Number of diagnoses and number of procedures showed positive correlations with in-hospital death(OR = 1.249 per one increase in number of procedures). Patients diagnosed with acute respiratory failure(OR = 8.246), acute kidney failure(OR = 4.359), hepatic encephalopathy(OR = 2.217) and esophageal variceal bleeding(OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites(OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders(OR = 2.823), coagulopathy(OR = 2.016), and lymphoma(OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is steadily decreasing, though the length of stay has remained relatively constant. Specific patient ethnicity, location, transfer status, primary diagnosis and comorbidities correlate with increased odds of TIPS in-hospital death.