OBJECTIVE. The purpose of this study was to investigate the role of flow parameters obtained with dynamic Doppler ultrasound in the objective follow-up of treatment response in patients with Raynaud phenomenon (RP).
OBJECTIVE. The objective of our study was to determine the impact of embedding a pretest probability rule that is required during the computerized physician order-entry (CPOE) process on the appropriateness of CT angiography (CTA) of the pulmonary arteries for the diagnosis of pulmonary embolism (PE) in the emergency department (ED).
OBJECTIVE. Extraabdominal desmoid (EAD) tumors pose a therapeutic challenge because they often recur locally and behave aggressively. Accepted management options include surgery, radiation, chemotherapy, and observation. The objective of this study was to assess the safety and efficacy of percutaneous cryoablation for the treatment of EAD tumors.
OBJECTIVE. Vertebra plana has been considered a contraindication for vertebroplasty for various reasons including difficulty in needle placement. Recently, vertebroplasty under conventional fluoroscopic guidance has been shown to be feasible in patients with vertebra plana.
OBJECTIVE. The purpose of this study is to determine the imaging-based parameters associated with the occurrence of persistent type II endoleaks after endovascular abdominal aortic aneurysm repair.
OBJECTIVE. The purpose of this study is to assess the performance of routinely used MRI sequences with and without contrast enhancement in the diagnostic evaluation of dural venous sinus thrombosis (DVST).
OBJECTIVE. The subclavian arteries (SCAs) may exhibit a wide spectrum of nontraumatic pathologic conditions ranging from common diseases, such as atherosclerosis, to vascular emergencies that are associated with a high morbidity and high mortality, such as type A aortic dissection and acute arterial thrombosis. MDCT angiography is an excellent modality to diagnose pathologic conditions of the SCAs.
We systematically reviewed the role of bronchial artery embolization (BAE) in hemoptysis. Literature search was done for studies on BAE published between 1976 and 2016. Twenty-two studies published in English, with sample size of at least 50 patients, reporting indications, technique, efficacy, and follow-up were included in the final analysis. Common indications for BAE included tuberculosis (TB), post-tubercular sequelae, bronchiectasis, and aspergillomas. Most common embolizing agent used was polyvinyl alcohol (size, 300–600 µm) with increasing use of glue in recent years. Overall immediate clinical success rate of BAE, defined as complete cessation of hemoptysis, varied from 70%–99%. However, recurrence rate remains high, ranging from 10%–57%, due to incomplete initial embolization, recanalization of previously embolized arteries, and recruitment of new collaterals. Presence of nonbronchial systemic collaterals, bronchopulmonary shunting, aspergillomas, reactivation TB, and multidrug resistant TB were associated with significantly higher recurrence rates (P < 0.05). Rate of major complications remained negligible and stable over time with median incidence of 0.1% (0%–6.6%). Despite high hemoptysis recurrence rates, BAE continues to be the first-line, minimally invasive treatment of hemoptysis in emergency settings, surgically unfit patients, or in patients with diffuse or bilateral lung disease.
Transjugular intrahepatic portosystemic shunt (TIPS) insertion is commonly performed for refractory ascites or variceal bleeding. However, TIPS dysfunction can be seen in both early and late settings, with shunt thrombosis a particular problem. Treatment of shunt dysfunction commonly involves angioplasty and re-lining, with or without embolectomy, mechanical thrombectomy, or thrombolysis. Ultrasound-assisted thrombolysis has been shown to be successful for treatment of pulmonary embolism, deep vein thrombosis, and peripheral arterial thromboembolism, but has not been described before for TIPS occlusion. Ultrasound is theorized to lead to a shortened duration of thrombolysis due to thinning of the fibrin clot and exposing plasminogen receptor sites. In this technical report, we describe the first published use of ultrasound-assisted thrombolysis in the declotting of an occluded TIPS. We found that the use of ultrasound-assisted thrombolysis allowed a relatively short duration of thrombolytic therapy, with removal of thrombus extending into the portal vein, facilitating stent re-lining. No complications were observed, in particular no bleeding complications. The TIPS remains patent at 8 months postprocedure.
We aimed to introduce an approach for image-guided positioning of electrodes for irreversible electroporation (IRE) in patients with prostate cancer using a magnetic resonance imaging-transrectal ultrasonography (MRI-TRUS) fusion technique. In 10 consecutive patients with biopsy-proven Gleason score <=3+4 prostate cancer, 19 G electrodes were inserted into the prostate using a transperineal access. Magnetic resonance images of the prostate acquired before IRE were fused with transrectal ultrasound images acquired during IRE. The position of the ultrasound probe was tracked via a sensor and corresponding magnetic resonance images were calculated in real-time. While MRI allowed delineation of the target volume, the position of the electrodes could be visualized on ultrasound images; the distance between individual electrode pairs was measured. Based on these measurements the software installed on the IRE unit was able to calculate the voltage necessary to generate the electric field for ablation. Using contrast-enhanced ultrasound, changes in perfusion within the ablation zone after IRE were documented. This technique allowed positioning of the electrodes around the target volume under image guidance in all patients treated with IRE. The target lesion and a safety margin were covered within the estimated ablation zone. MRI-TRUS guidance for IRE combines the advantages of good visualization of the target lesion on MRI with the ability of ultrasound to acquire imaging in real-time with a mobile device.
Purpose: We aimed to evaluate limb salvage, defined as freedom from major amputation, and to identify predictors of major amputation in patients with infrapopliteal peripheral arterial disease (PAD) based on the updated 2015 TASC II anatomic classification treated by percutaneous transluminal angioplasty (PTA).
Purpose: Imaging plays a crucial role in ablative therapies for prostate cancer (PCa). Irreversible electroporation (IRE) is a new treatment modality used for focal treatment of PCa. We aimed to demonstrate what imaging modalities can be used by descriptively reporting contrast-enhanced ultrasonography (CEUS), multiparametric magnetic resonance imaging (mpMRI), and grey-scale transrectal ultrasound (TRUS) results. Furthermore, we aimed to correlate quantitatively the ablation zone seen on mpMRI and CEUS with treatment planning to provide therapy feedback.
Purpose: We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma.
Lymphatic leak is a well-documented complication following neck dissection surgeries. When conservative methods fail to control the leak, thoracic duct embolization becomes an option. Transabdominal access is the standard for this procedure; however, it is not always feasible. We discuss a technique of selective lymphatic vessel embolization utilizing retrograde transvenous access.
Percutaneous image-guided ablation is performed throughout many areas of the body for various pathologies including hepatic malignancies. Heat and cold-based ablative technologies are effective and well-tolerated with an acceptable safety profile. However, ablative therapies may be technically more challenging and cause collateral thermal injury if the targeted lesion is adjacent to critical organs. Previously, techniques including artificial ascites and pneumoperitoneum have been utilized to displace or insulate critical structures from the ablation zone. This technical innovation describes (10–30 mL) fibrillar collagen dissolved in fluid as a focal thermal insulation technique. Small volume fibrillar collagen instillation, and thermal ablation were technically successful in three cases without complication. Clinical follow-up and 3-month imaging confirmed complete ablation of all hepatic malignancies without collateral injury.
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