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Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings

A rare case of combined soft-tissue and intraosseous arteriovenous malformation of the hand with diffuse periosteal elevation: imaging appearances

Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material

Absence of uterine arteries discovered at fibroid embolisation

Chordoma masquerading as a nerve root tumour a clinical lesson

CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect

Characteristics of in vivo radiotherapy dosimetry

Joint symposium 2009 on carbon ion radiotherapy

A description of CT features of Clostridium difficile infection of the small bowel in four patients and a review of literature

Conventional MRI and magnetisation transfer imaging of the brain and optic pathway in primary open-angle glaucoma

Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients

Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation

Warthins tumour: a retrospective case series

Reduction of dose to the female breast as a result of spectral optimisation for high-contrast thoracic CT imaging: a phantom study

Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein

Optimisation techniques in vaginal cuff brachytherapy

Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity

Personnel radiation dose considerations in the use of an integrated PETCT scanner for radiotherapy treatment planning

Thorax set-up verification with multiple oblique treatment portal images

Brain: non-infective and non-neoplastic manifestations of HIV

Persistent scrotal lesion

Magnetic Resonance Imaging in the Visualization of Benign Tumors and Tumor-like Lesions of Hand and Wrist

Publication year: 2010Source: Current Problems in Diagnostic Radiology, Volume 39, Issue 1, January-February 2010, Pages 1-16Tarkan, Ergun , Hatice, Lakadamyali , Alihan, Derincek , Nefise, Cagla Tarhan , Ahmet, OzturkThe differential diagnosis of benign tumors and tumor-like lesions of the hand and wrist region is important with regard to choosing the therapy (medical versus surgical), or to decide to just follow-up the lesion. In most of the cases the proper analysis of MRI findings in correlation with the patient's history is sufficient to meet a specific diagnosis. However, diagnostic confusion is not uncommon as there are numerous lesions affecting the hand and wrist region. This pictorial essay offers a practical radiological approach to benign tumors and tumor-like lesions of the hand and wrist region based on most frequently observed...

Cross-Sectional Imaging of Primary Thoracic Sarcomas with Histopathologic Correlation: A Review for the Radiologist

Publication year: 2010Source: Current Problems in Diagnostic Radiology, Volume 39, Issue 1, January-February 2010, Pages 17-29Jonathan R., Dillman , Perry G., Pernicano , Jonathan B., McHugh , Anil K., Attili , Bassem, Mourany , ...Numerous forms of primary sarcoma can arise from the heart, pericardium, great vessels, lungs, chest wall, and breasts. Magnetic resonance imaging and computed tomography currently play important roles in determining the extent of primary thoracic sarcoma involvement, potential for resectability, and response to therapy. The purpose of this article is to review the various forms of primary sarcoma that may affect the thorax as well as illustrate pertinent cross-sectional radiologic findings with histopathologic correlation.

Cutaneous Melanoma: Role of Ultrasound in the Assessment of Locoregional Spread

Publication year: 2010Source: Current Problems in Diagnostic Radiology, Volume 39, Issue 1, January-February 2010, Pages 30-36Orlando, Catalano , Alfredo, SianiThis article illustrates the various aspects of locoregional spread of cutaneous melanoma, as imaged with grayscale ultrasound (US) and Doppler techniques. High-resolution US allows recognition of small, clinically occult melanomatous foci within the skin and lymph nodes. Consequently, it plays a major role in locoregional staging and follow-up of patients with cutaneous melanoma. We discuss the possibilities and limitations of US in the initial staging (primary melanoma, satellite metastasis, in-transit metastasis, and lymphadenopathy), selection for sentinel lymph node biopsy procedure, patient follow-up, detection of recurrence, and US-guided intervention.

Dual-Source Cardiac Computed Tomographic Technique, Anatomy, and Normal Variants

Publication year: 2010Source: Current Problems in Diagnostic Radiology, Volume 39, Issue 1, January-February 2010, Pages 37-50Todd, Noce , Neil, Gupta , Anthony, Posteraro , Christine, KimThe advent of fast multislice computed tomography (CT) has ushered in a new era in the noninvasive evaluation of the heart. Cardiac structures can now be quickly evaluated with exquisite detail in a noninvasive manner. Cardiac CT is increasingly being used for the noninvasive evaluation of coronary arteries, procedural planning, and evaluating chest pain in certain clinical situations. Dual-source CT is a recent technological development that has helped improve spatial and temporal resolution for cardiac CT imaging. It is one of many “next generation” CT technologies that are now pushing image quality to new levels. The interpreting radiologist must now...

Upcoming Articles

Publication year: 2010Source: Current Problems in Diagnostic Radiology, Volume 39, Issue 1, January-February 2010, Page IBC[No author name available]

In Recent Issues

Publication year: 2010Source: Current Problems in Diagnostic Radiology, Volume 39, Issue 1, January-February 2010, Page OBC[No author name available]

Acute Knee Dislocation: Review of an Elusive Entity

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Pages 237-250Sangita, Kapur , Robert D., Wissman , Michael, Robertson , Sadhna, Verma , Michael C., Kreeger , ...The knee consists of three articulations: the patellofemoral, the tibiofemoral, and the proximal tibiofibular joint. Any of these joints can dislocate. Dislocations are uncommon, tend to spontaneously reduce, and can be difficult to detect on clinical examination. There are, however, telltale imaging features and the radiologist may be the first to suggest the correct diagnosis. A timely diagnosis is important as some forms are associated with limb-threatening complications. Lateral patellofemoral dislocation, in the acute setting, is typically an injury of young athletes and usually spontaneously reduces at the time of trauma. In transient lateral dislocation, contusions may be seen in...

Multidetector Computed Tomography Findings of Dense Pulmonary Emboli in Oncologic Patients

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Pages 251-263Alberto, Villanueva , Maria Lourdes, Díaz , Armando, Sánchez , Eva, Castañer , Gorka, Bastarrika , ...Pulmonary embolism is a frequent condition for which multidetector computed tomography (MDCT) plays an important role in its detection. Occasionally, on MDCT studies, dense linear branching opacities may be found within the pulmonary vessels. They represent dense emboli within the pulmonary arteries (DEPA). These may occur in oncologic patients that undergo specific treatments or interventional procedures, such as cement embolus from vertebroplasty, catheter or coil migration after embolization procedures, radioactive seed embolus in patients treated with local brachytherapy for prostate, lung, or liver cancer, and also in chronic pulmonary embolism. Usually DEPA does not have any clinical significance but may...

Computed Tomographic Appearances of Hepatic Vascular Lesions

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Pages 264-273Lye Quen, Hon , Arul, Ganeshan , Sarfraz, Nazir , Sara, Upponi , Helen, Bungay , ...Improvements in Imaging technology have revolutionized liver imaging and allowed the recognition of abnormalities arising from various architectural components such as vessels and biliary ducts of the liver. A spectrum of various hepatic vascular disorders as demonstrated by multidetector CT (MDCT) is presented in this review article.

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 6, November-December 2009, Page OBC[No author name available]

Hysterosalpingography: Technique and Applications

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 199-205Athanasios, Chalazonitis , Ioanna, Tzovara , Fotios, Laspas , Petros, Porfyridis , Nikos, Ptohis , ...Hysterosalpingography (HSG) remains an important radiologic procedure in the investigation of infertility and has become a commonly performed examination due to recent advances of reproductive medicine. HSG demonstrates the morphology of the uterine cavity, the lumina, and the patency of the fallopian tubes. In this review article, we present the technical parameters of the examination, indications, contraindications, and possible complications of HSG. We also illustrate a variety of abnormalities of the uterus and fallopian tubes that can be detected accurately with HSG. We believe that, with the increased demand for HSG, radiologists should be familiar with HSG technique and the...

Non-Electrocardiogram-Gated Multidetector-Row Computed Tomography Findings of Cardiac Pathology in Oncologic Patients

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 206-217Maria Lourdes, Díaz , Alberto, Villanueva , Gorka, Bastarrika , Beatriz, Zudaire , Loreto García, del Barrio , ...Multidetector-row computed tomography (MDCT) plays an essential role in oncologic imaging as the modality of mapping out the treatment strategy at staging, assessing response to the treatment, and following up patient outcome after the treatment. Even without electrocardiogram gating, MDCT provides accurate information about the heart. In the group of oncologic patients, different tumoral and non-tumoral-related heart disorders can be found, for example, metastatic cardiac involvement (approximately 10% of patients with lung or breast cancer will develop metastases to the heart), paraneoplastic cardiac disorders, non-tumor-related heart disorders, and chemotherapy- and radiotherapy-related cardiac side effects. MDCT plays a role in the...

Pediatric Cranial Doppler Sonography in Children: Non-Sickle Cell Applications

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 218-227Amy M., Soetaert , Lisa H., Lowe , Christopher, FormenThis article presents an overview of transcranial Doppler, well known for its use as a screening tool in children with sickle cell disease. However, there are many other pediatric applications in which cranial Doppler ultrasound can supply otherwise unavailable information regarding neurovascular flow dynamics. Images illustrate examples of normal anatomy and pathologic conditions that can be evaluated with cranial Doppler ultrasound. Characteristic imaging features of various pediatric applications of cranial Doppler ultrasound are discussed and illustrated. This image presentation discusses cranial Doppler ultrasound technique and normal findings and illustrates various pediatric disorders including benign enlargement of the subarachnoid space versus...

Radiological Manifestations of Skeletal Lymphoma

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Pages 228-236John, O'Neill , Karen, Finlay , Eric, Jurriaans , Lawrence, FriedmanLymphoreticular neoplasms primarily arise in extraskeletal locations with skeletal involvement usually secondary to hematogenous spread or by direct invasion from surrounding involved lymph nodes or soft tissues. Primary lymphoma of bone is relatively rare in comparison. Lymphoma encompasses Hodgkin's and non-Hodgkin's disease, Burkitt's lymphoma, and mycosis fungoides. Skeletal disease may present with symptoms localized to the site of bone involvement, as an incidental finding on imaging for other reasons, or as part of the staging of the disease. It is important that the radiologist is cognizant of the many presentations of skeletal lymphoma. We present a review of the radiological...

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 5, September-October 2009, Page OBC[No author name available]

Multidetector Computed Tomography of the Acute Abdomen in the Immunocompromised Host: A Pictorial Review

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 145-155Simon P., Spencer , Niall, Power , Rodney H., ReznekImmunocompromised patients include those receiving chemotherapy for malignant disease, post-transplant patients, patients with acquired immunodeficiency syndrome (AIDS), and those receiving steroids for autoimmune diseases. Advances in transplantation, oncology, and the treatment of AIDS have extended these patients' life expectancies and thereby increased the immunocompromised population. Classical clinical signs of abdominal sepsis may be absent in the immunocompromised host. Consequently, the radiologist is increasingly called on to diagnose specific acute intra-abdominal complications associated with immunodeficiency. This review describes the etiology of the acute abdomen in this heterogeneous group of immunocompromised patients, causes including opportunistic infections, neutropenic enterocolitis, complications of therapy, and...

Positron Emission Tomography/Computed Tomography Potential Pitfalls and Artifacts

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 156-169Xia, Wang , Spencer, KochWith the recent use of 18-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) for tumor staging and treatment response, it is important to recognize many pitfalls, artifacts, and benign uptakes that are commonly encountered. Normal physiology can explain many regions of increased FDG activity, as well as incidental benign tumors and benign metabolic conditions. Recognition of characterization of benign causes and physiologic variants for FDG uptake are discussed to avoid improper characterization as a malignancy. A basic understanding of PET/computed tomographic physics is also discussed, in relation to attenuation correction artifacts caused by metallic implants and contrast agents in the gastrointestinal tract,...

Diagnosis and Management of Pseudoaneurysms: An Update

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 170-188Baljendra S., Kapoor , Heather L., Haddad , Souheil, Saddekni , Mark E., Lockhart“Pseudoaneurysm” is a term that describes disruption of an artery with patent flow in a defined space beyond the confines of the vessels. A pseudoaneurysm can involve any vascular bed and is usually associated with direct arterial injury or erosion of an artery by an adjacent tumor or inflammation. In this article, we discuss different clinical settings and various imaging modalities such as ultrasound, computerized tomography, magnetic resonance imaging, as well as conventional angiography used for the diagnosis of pseudoaneurysms. We also describe the role of newer endovascular, percutaneous, and traditional surgical approaches for the treatment of visceral and peripheral...

The Great Mimicker: Fat Necrosis of the Breast—Magnetic Resonance Mammography Approach

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Pages 189-197Sergi, Ganau , Lidia, Tortajada , Fernanda, Escribano , Xavier, Andreu , Melcior, SentísFat necrosis of the breast is a common benign inflammatory process resulting from injury to breast fat. The pathogenesis of fat necrosis helps to explain its imaging features, which range from benign to malignant-appearing findings. This article reviews the role of magnetic resonance mammography and other conventional imaging techniques in the differential diagnosis of fat necrosis.

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 4, July-August 2009, Page OBC[No author name available]

Computed Tomographic Appearance of Chest Ports and Catheters: A Pictorial Review for Noninterventional Radiologists

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 99-110Maria Lourdes, Díaz , Alberto, Villanueva , Maria Jose, Herraiz , Jose Juan, Noguera , Alberto, Alonso-Burgos , ...Medical practice has expanded the need for long-term central venous catheterization. Chest ports play an important role in the management of oncology patients who need frequent blood products, chemotherapy, and other intravenous drugs. Imaging-guided placement of chest ports and catheters (CR) is a safe and efficacious procedure. Moreover, many cases of catheter-induced central thrombosis go unrecognized, but the incidence of pulmonary embolism in this group may be as high as 12%. Multi-detector computed tomography represents the main imaging method in the follow-up of oncologic patients. We review the radiologic features, mainly on multi-detector computed tomography, of CR commonly used for...

Ultrasound of Wrist Pain

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 111-125Srinivasan, Harish , John, O'Neill , Karen, Finlay , Erik, Jurriaans , Lawrence, FriedmanUltrasound is a valuable imaging modality for evaluation of patients presenting with wrist pain. An important advantage is the ability to correlate the site of pain or discomfort with the underlying sonographic appearance. The capacity to dynamically assess the wrist and use the contralateral asymptomatic wrist for comparison purposes are strengths of ultrasound as a diagnostic tool. This pictorial review deals with the sonographic assessment of the commonly encountered wrist pathologies.

Magnetic Resonance Imaging of the Liver and Biliary Tree in Children

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 126-134Pedro A.B., Albuquerque , D. Alicia, Morales Ramos , Ricardo, FaingoldMagnetic resonance imaging (MRI) is a great modality for the assessment of the liver and biliary tree in the pediatric population. In this review, we illustrate and discuss MRI technique and a variety of congenital abnormalities and acquired conditions including infectious, inflammatory, metabolic, benign, and malignant processes. The role of magnetic resonance angiography and magnetic resonance venography is discussed in hepatic tumors and portal hypertension. Magnetic resonance cholangiopancreatography protocol is also addressed. Although ultrasound remains a screening tool and computer tomography is readily available, MRI accurately depicts the pathology, leading to a better understanding of the disease process with optimal...

Radiofrequency and Microwave Ablation of the Liver, Lung, Kidney, and Bone: What Are the Differences?

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Pages 135-143Christopher L., BraceRadiofrequency (RF) ablation is becoming an accepted treatment modality for many tumors of the liver and is being explored for tumors in the lung, kidney, and bone. While RF energy is the most familiar heat source for tissue ablation, it has certain limitations that may hamper its efficacy in these new organ systems. Microwave energy may be a better source for tissue ablation but has technical hurdles that must be overcome as well. This article outlines the physics behind RF and microwave heating, discusses relevant properties of the liver, lung, kidney, and bone for thermal ablation and examines the roles...

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 3, May-June 2009, Page OBC[No author name available]

Technical Essentials of Hepatic Doppler Sonography

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 53-60Min Ju, Kim , Kyoung Won, Kim , So Yeon, Kim , Jeong Kon, Kim , Hyung Jin, Won , ...Doppler ultrasound is an important diagnostic tool for detecting hepatic vascular abnormalities, especially following liver transplantation. Doppler ultrasound has an advantage over computed tomography or other imaging modalities in that it is noninvasive, can be used intraoperatively or immediately postoperatively at the patient's bedside, and is free from radiation hazard. Doppler ultrasound is also sensitive to very slow flow and is not limited by an optimal temporal window because it is a real-time examination. However, this examination is highly operator-dependent. For a proper evaluation of patient hemodynamic status, optimization of Doppler parameters and liberal use of spectral analysis will help...

Microwave Ablation Technology: What Every User Should Know

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 61-67Christopher L., BraceMicrowave ablation is a relatively new technology under development and testing to treat the same types of cancer that can be treated with radiofrequency ablation. Microwave energy has several possible benefits over radiofrequency energy for tumor ablation but, because clinical microwave ablation systems are not widespread, the underlying principles and technologies may not be as familiar. The basic microwave ablation system contains many of the same components as a radiofrequency ablation system: a generator, a power distribution system, and an interstitial applicator. This article attempts to provide an overview of each of these components, outline their functions and roles, and...

Practical Applications of Nuclear Medicine in Imaging Breast Cancer

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 68-83Ba.D., Nguyen , Michael C., Roarke , Patricia J., Karstaedt , Christian J., Ingui , Panol C., RamThe rise in incidence, morbidity, and mortality of breast cancer has triggered multiple imaging efforts to detect this malignancy early, stage it accurately, and monitor it with precision in the posttherapeutic course. Among different imaging modalities, nuclear medicine provides an important contribution to the clinical management of breast cancer. This article discusses four practical applications based on the use of radionuclides in the evaluation of breast malignancy, focusing on scintimammography, preoperative tumor localization procedure using radioactive seeds, sentinel nodal scintigraphy, and F-18 fluorodeoxyglucose positron emission tomography/computed tomography.

Multidetector Computed Tomography of the Mesocolon: Review of Anatomy and Pathology

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 84-90Iswaran, Ramachandran , Peter, Rodgers , Moshier, Elabassy , Rakesh, SinhaThe anatomy of the mesocolon can be seen on multidetector computed tomography (MDCT) scans, and its most important anatomic landmarks are the mesocolic vessels. The high spatial resolution of the current generation scanner coupled with the ability to generate high quality multiplanar images is very helpful in the delineation of the mesocolon. These vessels include the ileocolic and right colic vessels for the ascending mesocolon, the middle colic vessels for the transverse mesocolon, and the inferior mesenteric vein for the sigmoid and descending mesocolon. Knowledge of the anatomic landmarks of the mesocolon can help the radiologist identify the pathways for...

Magnetic Resonance Arthrography of Superior Labrum Anterior-Posterior Lesions: A Practical Approach to Interpretation

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 2, March-April 2009, Pages 91-97Eugene, LinSuperior labrum anterior and posterior (SLAP) lesions are well-evaluated with magnetic resonance (MR) arthography. This article discusses a practical approach to interpretation of MR arthrography exams for the evaluation of suspected SLAP lesions.

Issues in Imaging Malignant Neoplasms of the Female Reproductive System

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 1-16Nagaraj-Setty, Holalkere , Avinash M., Katur , Susanna I., LeeRadiological evaluation of malignant neoplasms of the female reproductive system is invaluable in the initial diagnosis, staging, treatment planning, and follow-up management. Radiologists serving as consultants for the general primary care internist, gynecologists, and specialists in gynecologic oncology should be familiar with the strengths and limitations of various modalities used to evaluate gynecologic cancer patients. This article discusses the most common female reproductive tract neoplasms (ie, cervical, endometrial, and ovarian cancers) and the role of ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography in their diagnosis and management. Imaging features that impact on clinical diagnostic or treatment algorithms...

Pharyngeal Dysphagia: What the Radiologist Needs to Know

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 17-32Patrick D., Grant , Desiree E., Morgan , Francis J., Scholz , Cheri L., CanonDysphagia is defined as difficulty in swallowing. Oropharyngeal dysphagia is defined as difficulty in moving the bolus from the mouth to the esophagus. The best initial evaluation of suspected oropharyngeal dysphagia is a barium study which can evaluate motility of the oropharynx and hypopharynx and provide double-contrast views that may identify structural or mucosal abnormalities. Pharyngeal diverticula, Zenker's and Killian–Jamieson diverticula, and pharyngeal pouches are readily identified on these studies. Zenker's diverticula are the commonest diverticulum implicated in pharyngeal dysphagia and typically occur in the setting of cricopharyngeal dysfunction. The radiologist must not only diagnose these diverticula but also understand...

Vascular Closure Devices: A Comparative Overview

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 33-43Lye-Quen, Hon , Arul, Ganeshan , Steven Mark, Thomas , Dinuke, Warakaulle , Jagalpathy, Jagdish , ...The use of closure devices is widespread and becoming more common. Radiologists performing arterial access procedures should be aware of when and how to use them, as well as the advantages and disadvantages of various devices, and any complications that may occur. This review intends to provide an overview of these devices, focusing on how they work, their efficacy in achieving hemostasis, any risks associated with their use, and our view as to which should be used for particular indications. There are three main categories of vascular closure devices: collagen based, suture based, and staples and clips. Newer generation devices...

Radiofrequency Ablation of Lung Lesions: Practical Applications and Tips

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Pages 44-52A. Molly, Roy , Clare, Bent , Tim, FotheringhamRadiofrequency ablation (RFA) therapy is a minimally invasive technique that can be used in the management of inoperable non-small-cell lung cancer and for palliation in selected patients with pulmonary metastases. Surgical resection remains the gold standard of treatment; however, many patients are ineligible due to comorbidities or poor cardiopulmonary reserve. Others may simply decline radical surgical intervention. Alternative treatment options are limited mainly to chemotherapy and external beam radiation. With the development of RFA, a new promising technique has evolved that can be offered to many, as an alternative choice or as part of combination therapy. The published results of...

Upcoming Articles

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Page IBC[No author name available]

In Recent Issues

Publication year: 2009Source: Current Problems in Diagnostic Radiology, Volume 38, Issue 1, January-February 2009, Page OBC[No author name available]

Magnetic Resonance Imaging Features of the Discrete Epiphyseal Radiolucency: A Problem-Solving Approach to Differential Diagnosis

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 6, November-December 2008, Pages 243-261José M., Mellado , Jenny T., Bencardino , Laura, Pérez del PalomarDiscrete radiolucencies in the epiphysis of the long bones may be a major radiographic finding in many arthropathies and synovial-based processes, and also in various osteolytic tumors and tumor-like lesions. In addition, a number of miscellaneous bone disorders, particularly infection and avascular necrosis, may present as discrete epiphyseal radiolucencies. Magnetic resonance imaging is frequently used in the diagnostic workup of these lesions. Our purpose was to review and illustrate, in a problem-solving approach, the potential contributions of magnetic resonance imaging in the characterization of discrete epiphyseal radiolucent lesions.

Computed Tomography and Magnetic Resonance Imaging Features of Lesions of the Renal Medulla and Sinus

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 6, November-December 2008, Pages 262-278Paul, Nikolaidis , Helena, Gabriel , Kathleen, Khong , Michael, Brusco , Nancy, Hammond , ...The kidneys can harbor a wide variety of lesions, many of which can be visualized by computed tomography and magnetic resonance imaging. In this article, the pertinent renal anatomic relationships as well as the histologic composition and function of the renal medulla and sinus are reviewed. Additionally, computed tomography and magnetic resonance imaging features of renal sinus and medullary lesions in adult patients are presented. This article reviews the salient imaging features of various malignant, benign neoplastic, and nonneoplastic lesions of the sinus and medulla.

Computed Tomographic Enterography and Enteroclysis: Pearls and Pitfalls

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 6, November-December 2008, Pages 279-287Hetal, Dave-Verma , Scott, Moore , Ajay, Singh , Noel, Martins , John, ZawackiComputed tomographic (CT) enterography and enteroclysis improve visualization of the small bowel mucosa and wall in comparison with traditional CT and fluoroscopic studies by distending the small bowel through enteric hyperhydration with a negative contrast agent. Although CT enterography is performed with oral hyperhydration, CT enteroclysis requires the placement of an enteroclysis tube, often in patients who are unable to orally consume the amount of liquid. When tolerated, CT enterography is often preferred due to its lack of invasiveness. Magnetic resonance enterography and enteroclysis are other modalities that are still being studied and show promise in the imaging of small...

Editorial Board

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page IFC[No author name available]

Information for Readers

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page i[No author name available]

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Page ii[No author name available]

More Than Just Stones: A Pictorial Review of Common and Less Common Gallbladder Pathologies

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 189-202Janice, Ash-Miles , Huw, Roach , Jim, Virjee , Mark, CallawayAlthough stone disease is by far the most commonly encountered pathology of the gallbladder, there are several other important disease processes affecting it. These include adenomyomatosis, cholesterolosis, polyps, porcelain gallbladder, acalculous cholecystitis, xanthogranulomatous cholecystitis, emphysematous cholecystitis, gallbladder cancer, and gallbladder hemorrhage. The purpose of this article was to review the different gallbladder pathologies encountered in everyday radiological practice and to describe their features in the standard imaging modalities.

Ultrasound-Guided Therapeutic Procedures in the Musculoskeletal System

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 203-218Jose Luis, del CuraUltrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for...

Ultrasound of Muscle

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 219-230Marianna, Vlychou , James, TehThis pictorial review illustrates the ultrasound appearances of pathological conditions affecting muscle with particular emphasis on extended field-of-view imaging.

Magnetic Resonance Imaging Findings of Golf-Related Injuries

Publication year: 2008Source: Current Problems in Diagnostic Radiology, Volume 37, Issue 5, September-October 2008, Pages 231-241Joseph, Sutcliffe , Justin Q., Ly , Amy, Kirby , Douglas P., BeallInjuries related to participation in golf are becoming more common given the increasing popularity of the sport itself. Golf is considered to be an activity associated with a moderate risk for sports injuries. Golf injuries are usually attributable to overuse or traumatic mechanisms and primarily occur at the elbow, wrist, shoulder, and lumbar spine. None of these injuries are unique to golf, but each of these injuries represent the most common injuries associated with golfing. This article reviews a wide range of injuries that are encountered in golfers and describes the magnetic resonance imaging findings of each of these injuries.

Re: Flexi-Seal continence device mimicking a pelvic collection.

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Re: Competency-based training versus traditional experiences in radiology; how best to educate the radiologists of the future?

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Cerebellar haemangioblastoma with spontaneous subarachnoid haemorrhage: a rare presentation.

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External herniation of a subareolar intraductal papilloma: a rare, yet beneficial, complication of conventional ductography.

Related Articles External herniation of a subareolar intraductal papilloma: a rare, yet beneficial, complication of conventional ductography. Clin Radiol. 2009 Dec;64(12):1238-40 Authors: Ginat DT, Sahler LG, Siddall KA PMID: 19913136 [PubMed - in process]

Adult cor triatriatum--the measurement of opening in the membrane using ECG-gated multidetector CT.

Related Articles Adult cor triatriatum--the measurement of opening in the membrane using ECG-gated multidetector CT. Clin Radiol. 2009 Dec;64(12):1235-7 Authors: Yoo SM, Lee HY, Jeudy J, White CS PMID: 19913135 [PubMed - in process]

Intussusception following transmural migration and defecation of a surgical sponge.

Related Articles Intussusception following transmural migration and defecation of a surgical sponge. Clin Radiol. 2009 Dec;64(12):1231-4 Authors: Horvat JV, Machado RC, Vandesteen L, Moll RS, Oliveira GA PMID: 19913134 [PubMed - in process]

MRI and CT appearances of cardiac tumours in adults.

Related Articles MRI and CT appearances of cardiac tumours in adults. Clin Radiol. 2009 Dec;64(12):1214-30 Authors: Hoey ET, Mankad K, Puppala S, Gopalan D, Sivananthan MU Primary cardiac tumours are rare, and metastases to the heart are much more frequent. Myxoma is the commonest benign primary tumour and sarcomas account for the majority of malignant lesions. Clinical manifestations are diverse, non-specific, and governed by the location, size, and aggressiveness. Imaging plays a central role in their evaluation, and familiarity with characteristic features is essential to generate a meaningful differential diagnosis. Cardiac magnetic resonance imaging (MRI) has become the reference technique for evaluation of a suspected cardiac mass. Computed tomography (CT) provides complementary information and, with the advent of electrocardiographic gating, has become a powerful tool in its own right for cardiac morphological assessment. This paper reviews the MRI and CT features of primary and secondary cardiac malignancy. Important differential considerations and potential diagnostic pitfalls are also highlighted. PMID: 19913133 [PubMed - in process]

Measurement of defect angle in superior semicircular canal dehiscence.

Related Articles Measurement of defect angle in superior semicircular canal dehiscence. Clin Radiol. 2009 Dec;64(12):1210-3 Authors: Lip G, Nichols DM PMID: 19913132 [PubMed - in process]

Leiomyoma of the sinonasal cavity: CT and MRI findings.

Related Articles Leiomyoma of the sinonasal cavity: CT and MRI findings. Clin Radiol. 2009 Dec;64(12):1203-9 Authors: Yang BT, Wang ZC, Xian JF, Hao DP, Chen QH AIM: To determine the computed tomography (CT) and magnetic resonance imaging (MRI) features of leiomyoma of the sinonasal cavity. MATERIALS AND METHODS: Six patients with histology-proven leiomyomas in the sinonasal cavity were retrospectively reviewed. All six patients underwent CT and three patients also underwent MRI. The following imaging features were reviewed: size, margin, CT attenuation, MRI signal intensity, and lesion extent. In addition, the time-intensity curve (TIC) of dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) were analysed in two patients. RESULTS: All leiomyomas had well-defined margins. The mean size was 36 mm (range 20-51 mm). On unenhanced CT, the lesions appeared isodense to cerebral grey matter in four (67%) and slightly hypodense in two (33%) patients. Leiomyomas appeared isointense On T1-weighted imaging (WI) and slightly hyperintense on T2WI in three patients. The lesions showed moderate contrast enhancement. Two patients underwent DCE MRI, and the TIC showed a rapidly enhancing and slow washout pattern. The mean apparent diffusion coefficient (ADC) value were 1.66x10(-3) mm(2)/s and 1.78x10(-3) mm(2)/s for the two lesions, respectively. CONCLUSIONS: Well-defined, homogeneous, expansile masses without bony erosion are typical features of leiomyoma. Althrough rare, this entity should be included in the differential diagnosis of benign tumours in this region. PMID: 19913131 [PubMed - in process]

Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description.

Related Articles Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol. 2009 Dec;64(12):1196-202 Authors: Drakonaki EE, Allen GM, Wilson DJ AIM: To investigate the feasibility and reproducibility of real-time freehand ultrasound elastography (RTE) of the normal Achilles tendon and to describe its elastographic appearances. MATERIALS AND METHODS: Fifty normal Achilles tendons were prospectively examined using RTE performed by tissue compression using the hand-held transducer. The information was colour-coded (red=soft, green=medium, blue=hard) and superimposed on the B-mode image. Each tendon was examined three times transversely and longitudinally by two radiologists and the ratio between tendon and retro-Achilles fat strain (strain index) was calculated. The reproducibility of the elastograms was assessed qualitatively and quantitatively using the strain index inter and intra observer variation coefficient (intra/inter-CV and intra/inter-CC, respectively). RESULTS: All tendons were clearly visualized on the elastograms. Nineteen tendons (19/50, 38%) appeared homogeneously green/blue (type 1). Thirty-one tendons (31/50, 62%) appeared green with longitudinal red stripes (type 2). The intra- and inter-CC values of the strain index were lower for the transverse plane than for the longitudinal plane (0.43, 0.45, 0.41 and 0.78, 0.66, 0.51, respectively). The intra-CV and inter-CV values were higher for the transverse than for the longitudinal plane measurements (39%, 37%, 30% and 30.50%, 30.10%, 29.60%, respectively). CONCLUSION: RTE of the normal Achilles tendon is a feasible method. The reproducibility of the strain index is good and higher for longitudinal elastograms. Qualitative assessment enables the discrimination of two distinct elastographic patterns. Further studies are required to assess the clinical value of this method. PMID: 19913130 [PubMed - in process]

Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver.

Related Articles Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver. Clin Radiol. 2009 Dec;64(12):1190-5 Authors: Ames JT, Federle MP, Chopra K AIM: Nodular regenerative hyperplasia (NRH) and large regenerative nodules (LRN) are distinct types of hepatocellular nodules that have been confused in the radiology literature. However, distinction is critical because their clinical significance is quite different. Our purpose was to review the clinical and imaging findings in a series of patients with NRH and LRN in order to identify distinguishing clinical and imaging features. MATERIALS AND METHODS: This was a retrospective case series. The clinical and imaging features were compared in 36 patients with pathological proof of NRH and 23 patients with pathological evidence of LRN. RESULTS: NRH and LRN have different predisposing factors and imaging findings. NRH is often associated with organ transplantation, myeloproliferative disease, or autoimmune processes. Livers with NRH typically do not have enhancing nodules; none of the present patients with NRH had enhancing liver masses. In contrast, LRN are often associated with Budd-Chiari syndrome. Enhancing liver masses were noted in 19 (83%) of the 23 patients with LRN. The p values for the comparisons were less than 0.001 for both enhancing liver masses and hepatic vein thrombosis. CONCLUSION: NRH and LRN can have distinct clinical presentations and imaging appearances. LRN often result in enhancing liver nodules, whereas NRH usually does not. Clinical and imaging information enables the distinction of LRN and NRH in many cases. PMID: 19913129 [PubMed - in process]

Commentary on reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia.

Related Articles Commentary on reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia. Clin Radiol. 2009 Dec;64(12):1188-9 Authors: Bartram C PMID: 19913128 [PubMed - in process]

Reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia.

Reliability of the bright liver echo pattern in diagnosing steatosis in patients with cryptogenic and HCV-related hypertransaminasaemia. Clin Radiol. 2009 Dec;64(12):1181-7 Authors: Soresi M, Giannitrapani L, Florena AM, La Spada E, Di Gesaro V, Rappa F, Alessandri A, Tripi S, Romano M, Montalto G AIM: To evaluate the reliability of the bright liver (BL) echo pattern on ultrasound to detect histological steatosis in chronic cryptogenic hypertransaminasaemia (CCH) and hepatitis C virus (HCV)-related forms of hypertransaminasaemia. MATERIALS AND METHODS: One hundred and fifty patients, 54 with CCH and 96 with HCV hypertransaminasaemia (76 genotype 1/2 and 20 genotype 3), were enrolled. Histological steatosis was measured as the percentage of hepatocytes involved. The reliability of the BL sign was estimated using the sensitivity, specificity, positive and negative predictive values. RESULTS: Histological steatosis was present in 102/150 patients (68%) divided into 59/96 (62%) in the HCV group and 43/54 (79.6%) in the CCH group (chi(2)=4.4; p=0.035). In a multivariate analysis, the variable associated with the BL echo pattern was steatosis percentage (p=0.0018). Steatosis percentage was higher in CCH group than in the HCV genotype 1/2 and 3 groups (p=0.02). The sensitivity of the BL echo pattern was 88% in the CCH group [confidence interval (CI) 95% 74-95] versus 61% (CI 95% 44-73) in the HCV genotype 1/2 group. The CI indicates that ultrasound can provide evidence for steatosis in a statistically significant way in the CCH versus HCV genotype 1/2 patients. In the genotype 3 group, the sensitivity was high (90%), but the limited number of cases limited the statistical significance due to the high CI. CONCLUSION: In CCH the BL echo pattern has excellent reliability in diagnosing steatosis, better than in HCV hypertransaminasaemia because of the higher prevalence and extent of steatosis. PMID: 19913127 [PubMed - in process]

Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection.

Related Articles Diagnosis of breast cancer at dynamic MRI in patients with breast augmentation by paraffin or silicone injection. Clin Radiol. 2009 Dec;64(12):1175-80 Authors: Youk JH, Son EJ, Kim EK, Kim JA, Kim MJ, Kwak JY, Lee SM AIM: To determine the diagnostic performance of dynamic magnetic resonance imaging (MRI) for breast cancer in breasts augmented with liquid paraffin or silicone injection. MATERIALS AND METHODS: Among 62 patients with breast augmentation by liquid paraffin or silicone injection who had undergone dynamic breast MRI at our institution, 27 women, who had pathological diagnosis or at least 1-year MRI follow-up, were included in this retrospective study and their MRI images were reviewed. For enhancing lesions on MRI, the morphological features, enhancement kinetics, and BI-RADS assessment category were analysed. The lesion characteristics at MRI were correlated with the final diagnosis based on the histopathological result or at least 1-year MRI follow-up. RESULTS: Of the 27 patients, 17 enhancing lesions in 13 patients were found on MRI. All six lesions that were confirmed as malignancy showed suspicious morphological findings and type 2 or 3 enhancement kinetics, assigned to BI-RADS category 4 or 5. Of the remaining 11 benign lesions, 10 showed benign-favouring morphological findings, and all showed type 1 enhancement kinetics, assigned to BI-RADS category 2 or 4. CONCLUSION: In patients with breasts injected with foreign material, MRI was used to successfully diagnose malignant breast lesions and could be the diagnostic method of choice. Analysis of the morphological and kinetic features at MRI in conjunction with clinical findings is essential. PMID: 19913126 [PubMed - in process]

Can breast MRI computer-aided detection (CAD) improve radiologist accuracy for lesions detected at MRI screening and recommended for biopsy in a high-risk population?

Related Articles Can breast MRI computer-aided detection (CAD) improve radiologist accuracy for lesions detected at MRI screening and recommended for biopsy in a high-risk population? Clin Radiol. 2009 Dec;64(12):1166-74 Authors: Arazi-Kleinman T, Causer PA, Jong RA, Hill K, Warner E AIM: To evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) computer-aided detection (CAD) for breast MRI screen-detected lesions recommended for biopsy in a high-risk population. MATERIAL AND METHODS: Fifty-six consecutive Breast Imaging Reporting and Data System (BI-RADS) 3-5 lesions with histopathological correlation [nine invasive cancers, 13 ductal carcinoma in situ (DCIS) and 34 benign] were retrospectively evaluated using a breast MRI CAD prototype (CAD-Gaea). CAD evaluation was performed separately and in consensus by two radiologists specializing in breast imaging, blinded to the histopathology. Thresholds of 50, 80, and 100% and delayed enhancement were independently assessed with CAD. Lesions were rated as malignant or benign according to threshold and delayed enhancement only and in combination. Sensitivities, specificities, and negative predictive values (NPV) were determined for CAD assessments versus pathology. Initial MRI BI-RADS interpretation without CAD versus CAD assessments were compared using paired binary diagnostic tests. RESULTS: Threshold levels for lesion enhancement were: 50% to include all malignant (and all benign) lesions; and 100% for all invasive cancer and high-grade DCIS. Combined use of threshold and enhancement patterns for CAD assessment was best (73% sensitivity, 56% specificity and 76% NPV for all cancer). Sensitivities and NPV were better for invasive cancer (100%/100%) than for all malignancies (54%/76%). Radiologists' MRI interpretation was more sensitive than CAD (p=0.05), but less specific (p=0.001) for cancer detection. CONCLUSION: The breast MRI CAD system used could not improve the radiologists' accuracy for distinguishing all malignant from benign lesions, due to the poor sensitivity for DCIS detection. PMID: 19913125 [PubMed - in process]

Targeted testicular excision biopsy: when and how should we try to avoid radical orchidectomy?

Related Articles Targeted testicular excision biopsy: when and how should we try to avoid radical orchidectomy? Clin Radiol. 2009 Dec;64(12):1158-65 Authors: Kirkham AP, Kumar P, Minhas S, Freeman AA, Ralph DJ, Muneer A, Allen C Small, incidental testicular lesions are often benign, but in the past have usually been treated by orchidectomy. An alternative is an operative excision biopsy, with localization by ultrasound if necessary, and characterization of the lesion by frozen section analysis. The present review summarizes the indications for the procedure, lists the likely diagnoses, and describes the technique. Frozen section is accurate for distinguishing benign from malignant lesions, testicular function is usually preserved, and there is no evidence that oncological safety is impaired. Such testis-preserving surgery is a rewarding ground for collaboration between urologists, radiologists, and pathologists. PMID: 19913124 [PubMed - in process]

Imaging assessment of penetrating craniocerebral and spinal trauma.

Related Articles Imaging assessment of penetrating craniocerebral and spinal trauma. Clin Radiol. 2009 Dec;64(12):1146-57 Authors: Offiah C, Twigg S Craniocerebral and spinal penetrating trauma, which may be either missile (most typically gun-related) or non-missile (most typically knife-related), is becoming an increasingly common presentation to the urban general and specialized radiology service in the UK. These injuries carry significant morbidity and mortality with a number of criteria for prognosis identifiable on cross-sectional imaging. Potential complications can also be pre-empted by awareness of certain neuroradiological features. Not all of these injuries are criminal in origin, however, a significant proportion will be, requiring, on occasion, provision of both ante-mortem and post-mortem radiological opinion to the criminal investigative procedure. This review aims to highlight certain imaging features of penetrating craniocerebral and spinal trauma including important prognostic, therapeutic, and forensic considerations. PMID: 19913123 [PubMed - in process]

UK Government policy announcement on EMFs ICNIRP consultation on new ELF exposure guidelines Basic Safety Standards Launch of new WHO Handbook on Indoor Radon: A Public Health Perspective

South West Conference on Personal Decontamination and Internal Dosimetry

The use of mobile computed tomography in intensive care: regulatory compliance and radiation protection

Taming the Rays: A History of Radiation and Protection IAEA-TECDOC-1616: Quantification of Radionuclide Transfer in Terrestrial and Freshwater Environments for Radiological Assessments

Application of a wrist dosimeter prototype for radiation monitoring (153Sm) during a therapeutic procedure simulation

Author index with titles

Survey of the cosmetic use of lasers and other strong optical radiation sources

Summaries of articles in this issue

Assessment of radiological risk factors in the Zonguldak coal mines, Turkey

External dose assessment from the measured radioactivity in soil samples collected from the Islamabad capital territory, Pakistan

Low level determination of 226Ra in water using a micro-precipitate track method for large-scale environmental monitoring

The effects of the Brazilian regulatory inspection programme on nuclear medicine facilities

Updated estimates of the proportion of childhood leukaemia incidence in Great Britain that may be caused by natural background ionising radiation

Accuracy of Diffusion-weighted MR Imaging for Differentiation of Pulmonary Lesions.

Related Articles Accuracy of Diffusion-weighted MR Imaging for Differentiation of Pulmonary Lesions. Radiology. 2009 Dec;253(3):899-900 Authors: Karabulut N, Uto T, Takehara Y, Nakamura Y, Inui N, Suda T, Chida K PMID: 19952031 [PubMed - in process]

The need for oversight of graduate medical education.

Related Articles The need for oversight of graduate medical education. Radiology. 2009 Dec;253(3):898-9 Authors: Amis ES, Gunderman RB PMID: 19952030 [PubMed - in process]

Time-of-Flight MR Angiography Not for Diagnosing Subclavian Steal Syndrome.

Related Articles Time-of-Flight MR Angiography Not for Diagnosing Subclavian Steal Syndrome. Radiology. 2009 Dec;253(3):897-8 Authors: Huang HH, Tyan YS, Tsao TF, Köhrmann M, Schellinger PD PMID: 19952029 [PubMed - in process]

Case 152: orbital metastatic disease from breast carcinoma.

Related Articles Case 152: orbital metastatic disease from breast carcinoma. Radiology. 2009 Dec;253(3):893-6 Authors: Meltzer DE, Chang AH, Shatzkes DR PMID: 19952028 [PubMed - in process]

Case 156.

Related Articles Case 156. Radiology. 2009 Dec;253(3):891-2 Authors: Kim JH, Park SH, Ha HK PMID: 19952027 [PubMed - in process]

Cystic fibrosis genotype and assessing rates of decline in pulmonary status.

Related Articles Cystic fibrosis genotype and assessing rates of decline in pulmonary status. Radiology. 2009 Dec;253(3):813-21 Authors: Cleveland RH, Zurakowski D, Slattery D, Colin AA Purpose: To evaluate the hierarchical phenotypic expression of cystic fibrosis transmembrane conductance regulator (CFTR) genotypes in the respiratory system as has been documented in the pancreas. Materials and Methods: This study was institutional review board approved; informed consent was not required. HIPAA guidelines were followed. Genotype effects were assessed by using chest radiographic and pulmonary function test (PFT) results in 93 patients. Serial chest radiographic and PFT (percentage of predicted forced expiratory volume in 1 second [FEV(1)], percentage of predicted forced vital capacity [FVC]) results were compared by using analysis of variance with repeated measures. By using CFTR class of mutations, two groups were created: group S (severe disease) and group M (mild disease). Within group S, three subgroups were created: A consisted of patients with two class I alleles; B, class I allele and class II or III allele; C, class II allele and class II or III allele. Group M consisted of patients with at least one allele from class IV-VI. Results: Within group S, subgroup A had a faster deterioration than B or C according to radiographic data (A vs B, P = .014; A vs C, P = .009), with only a borderline difference in FEV(1) for subgroups A versus C (P = .031). Otherwise, PFTs were not sensitive for distinguishing subgroups. Only radiographic results identified that subgroup B had faster progression than C (P = .003); all parameters had trends of decline in the same direction. Group S had a faster decline than group M (radiography, P = .005; FVC, P = .011; FEV(1), P = .529). Conclusion: Disease progressed more rapidly with gene class hierarchical correlations seen in pancreatic disease. Radiography was more sensitive for identifying differences. (c) RSNA, 2009. PMID: 19952026 [PubMed - in process]

Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management.

Related Articles Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology. 2009 Dec;253(3):606-22 Authors: Godoy MC, Naidich DP Pulmonary nodule characterization is currently being redefined as new clinical, radiologic, and pathologic data are reported, necessitating a reevaluation of the clinical management, especially of subsolid nodules. These are now known to frequently, although not invariably, fall into the spectrum of peripheral adenocarcinomas of the lung. Strong correlation between the Noguchi histologic classification and computed tomographic (CT) appearances of these lesions, in particular, has been reported. Serial CT findings have further documented that stepwise progression of lesions with ground-glass opacity, manifested as an increase in size or the appearance and/or subsequent increase of solid components, does occur in a select subset of patients. As a consequence, recognition of the potential association between subsolid nodules and peripheral adenocarcinomas requires a review of current guidelines for the management of these lesions, further necessitated by a differential diagnosis that includes benign lesions such as focal inflammation, focal fibrosis, and organizing pneumonia. Specific issues that need to be addressed are the need for consensus regarding an appropriate CT classification, methods for precise measurement of subsolid nodules, including the extent of both ground-glass and solid components, as well as accurate assessment of the growth rates as means for predicting malignancy and prognosis. It is anticipated that interim guidelines may serve to standardize our current management of these lesions, pending further clarification of their natural history. (c) RSNA, 2009. PMID: 19952025 [PubMed - in process]

Comparative effectiveness research: what it means for radiology.

Related Articles Comparative effectiveness research: what it means for radiology. Radiology. 2009 Dec;253(3):600-5 Authors: Pandharipande PV, Gazelle GS PMID: 19952024 [PubMed - in process]

Value in radiology.

Related Articles Value in radiology. Radiology. 2009 Dec;253(3):597-9 Authors: Gunderman RB, Boland GW PMID: 19952023 [PubMed - in process]

Receiver operating characteristic analysis for the evaluation of diagnosis and prediction.

Related Articles Receiver operating characteristic analysis for the evaluation of diagnosis and prediction. Radiology. 2009 Dec;253(3):593-6 Authors: Gatsonis CA PMID: 19952022 [PubMed - in process]

The Annotation and Image Mark-up Project.

Related Articles The Annotation and Image Mark-up Project. Radiology. 2009 Dec;253(3):590-2 Authors: Channin DS, Mongkolwat P, Kleper V, Rubin DL PMID: 19952021 [PubMed - in process]

Mammography: yet another challenge.

Related Articles Mammography: yet another challenge. Radiology. 2009 Dec;253(3):587-9 Authors: Kopans DB PMID: 19952020 [PubMed - in process]

Book reviewers: a note of thanks.

Related Articles Book reviewers: a note of thanks. Radiology. 2009 Dec;253(3):586 Authors: McLoud TC, Kressel HY, Ouellette HA PMID: 19952019 [PubMed - in process]

Manuscript reviewers: a note of thanks.

Related Articles Manuscript reviewers: a note of thanks. Radiology. 2009 Dec;253(3):579-85 Authors: McLoud TC, Kressel HY PMID: 19952018 [PubMed - in process]

Can Focused US with a Diagnostic US Contrast Agent Favorably Affect Renal Function?

Related Articles Can Focused US with a Diagnostic US Contrast Agent Favorably Affect Renal Function? Radiology. 2009 Dec;253(3):577-8 Authors: Sica DA PMID: 19952017 [PubMed - in process]

This month in radiology.

Related Articles This month in radiology. Radiology. 2009 Dec;253(3):3A-4A Authors: PMID: 19952016 [PubMed - in process]

Re: "quantifying radiation safety and quality in medical imaging, part 1: creating the infrastructure".

Related Articles Re: "quantifying radiation safety and quality in medical imaging, part 1: creating the infrastructure". J Am Coll Radiol. 2009 Dec;6(12):895; author reply 895-6 Authors: Paley RH PMID: 19945051 [PubMed - in process]

Author's Reply.

Related Articles Author's Reply. J Am Coll Radiol. 2009 Dec;6(12):895-6 Authors: Reiner BI PMID: 19945050 [PubMed - in process]

John william pierson.

Related Articles John william pierson. J Am Coll Radiol. 2009 Dec;6(12):893-4 Authors: Linton O PMID: 19945049 [PubMed - in process]

NCRP Report Number 160: its significance to medical imaging.

Related Articles NCRP Report Number 160: its significance to medical imaging. J Am Coll Radiol. 2009 Dec;6(12):890-2 Authors: Mahesh M PMID: 19945048 [PubMed - in process]

Enhancing quality assurance and quality control programs: IT tools can help.

Related Articles Enhancing quality assurance and quality control programs: IT tools can help. J Am Coll Radiol. 2009 Dec;6(12):888-9 Authors: Prevedello L, Khorasani R PMID: 19945047 [PubMed - in process]

The Red Flags Rule: what does it mean for health care providers?

Related Articles The Red Flags Rule: what does it mean for health care providers? J Am Coll Radiol. 2009 Dec;6(12):886-7 Authors: Mancino PB, Larson SP PMID: 19945046 [PubMed - in process]

Establishment of a simple and inexpensive remote radiology conference.

Related Articles Establishment of a simple and inexpensive remote radiology conference. J Am Coll Radiol. 2009 Dec;6(12):884-5 Authors: Shah CC, Deloney LA, Donepudi C, Bhutta ST, James CA PMID: 19945045 [PubMed - in process]

Utilization of advanced imaging technologies for target delineation in radiation oncology.

Related Articles Utilization of advanced imaging technologies for target delineation in radiation oncology. J Am Coll Radiol. 2009 Dec;6(12):876-83 Authors: Simpson DR, Lawson JD, Nath SK, Rose BS, Mundt AJ, Mell LK PURPOSE: The aim of this study was to evaluate the utilization of advanced imaging technologies for target delineation among radiation oncologists in the United States. METHODS: A random sample of 1,600 radiation oncologists was contacted by Internet, e-mail, and fax and questioned regarding the use of advanced imaging technologies, clinical applications, and future plans for use. Advanced imaging technologies were defined as any of the following that were directly incorporated into radiation therapy planning: MRI, PET, single-photon emission CT, 4-D CT, functional MRI, and MR spectroscopy. RESULTS: Of 1,089 contactable physicians, 394 (36%) responded. Of respondents, 65% were in private practice and 35% were in academic practice. The proportion using any advanced imaging technology for target delineation was 95%. However, the majority reported only rare (in <25% of their patients; 46.6%) or infrequent (in 25%-50% of their patients; 26.0%) utilization. The most commonly used technologies were 2-[(18)F]fluoro-2-deoxyglucose PET (76%), MRI (72%), and 4-D CT (44%). The most common cancers treated using image-guided target delineation were those of the lung (83%), central nervous system (79%), and head and neck (79%). Among users of advanced imaging technologies, 66% planned to increase use; 30% of nonusers planned to adopt these technologies in the future. CONCLUSIONS: Advanced imaging technologies are widely used by US radiation oncologists for target delineation. Although the majority of respondents used them in <50% of their patients, the frequency of utilization is expected to increase. Studies determining the optimal application of these technologies in radiation therapy planning are needed. PMID: 19945044 [PubMed - in process]

Radiology Teacher: a free, Internet-based radiology teaching file server.

Related Articles Radiology Teacher: a free, Internet-based radiology teaching file server. J Am Coll Radiol. 2009 Dec;6(12):871-5 Authors: Talanow R Teaching files are an essential ingredient in residency education. The online program Radiology Teacher was developed to allow the creation of interactive and customized teaching files in real time. Online access makes it available anytime and anywhere, and it is free of charge, user tailored, and easy to use. No programming skills, additional plug-ins, or installations are needed, allowing its use even on protected intranets. Special effects for enhancing the learning experience as well as the linking and the source code are created automatically by the program. It may be used in different modes by individuals and institutions to share cases from multiple authors in a single database. Radiology Teacher is an easy-to-use automatic teaching file program that may enhance users' learning experiences by offering different modes of user-defined presentations. PMID: 19945043 [PubMed - in process]

Accuracy of preliminary interpretation of neurologic CT examinations by on-call radiology residents and assessment of patient outcomes at a level I trauma center.

Related Articles Accuracy of preliminary interpretation of neurologic CT examinations by on-call radiology residents and assessment of patient outcomes at a level I trauma center. J Am Coll Radiol. 2009 Dec;6(12):864-70 Authors: Miyakoshi A, Nguyen QT, Cohen WA, Talner LB, Anzai Y PURPOSE: The aims of this study were to evaluate the accuracy of preliminary interpretations of emergency neurologic CT scans after hours by on-call radiology residents and to assess the clinical impact of residents' errors at a level I trauma center. METHODS: A quality assurance database of neurologic CT examinations was reviewed to compare preliminary interpretations by on-call residents with final analyses by attending neuroradiologists during a 12-month period. All disagreements were reviewed for confirmation of the findings and categorized as significant or nonsignificant. Significant errors were further classified as acute intracranial, acute extracranial, and nonacute. Medical records for scans with significant errors were reviewed to evaluate any negative impact on the patient for each significant case. Residents' postgraduate years were also recorded. RESULTS: There were 252 cases (3.7%) with disagreements among 6,852 total cases. Of those, 226 (3.3%) were confirmed as resident errors, which included 171 (2.5%) that were significant. There were 73 (1.1%) acute intracranial, 77 (1.1%) acute extracranial, and 21 (0.3%) nonacute misinterpretations. Among the 171 significant cases, 105 (1.5%) had no changes in clinical management, and 55 (0.8%) required some changes. CONCLUSION: The rate of significant errors by on-call radiology residents was low. These errors had a minimal impact on clinical outcomes. Continued monitoring of residents' performance is important to maintain or improve patient safety. PMID: 19945042 [PubMed - in process]

ACR BI-RADS for breast imaging communication: a roadmap for the rest of radiology.

Related Articles ACR BI-RADS for breast imaging communication: a roadmap for the rest of radiology. J Am Coll Radiol. 2009 Dec;6(12):861-3 Authors: Langlotz CP PMID: 19945041 [PubMed - in process]

The ACR BI-RADS experience: learning from history.

The ACR BI-RADS experience: learning from history. J Am Coll Radiol. 2009 Dec;6(12):851-60 Authors: Burnside ES, Sickles EA, Bassett LW, Rubin DL, Lee CH, Ikeda DM, Mendelson EB, Wilcox PA, Butler PF, D'Orsi CJ The Breast Imaging Reporting and Data System (BI-RADS) initiative, instituted by the ACR, was begun in the late 1980s to address a lack of standardization and uniformity in mammography practice reporting. An important component of the BI-RADS initiative is the lexicon, a dictionary of descriptors of specific imaging features. The BI-RADS lexicon has always been data driven, using descriptors that previously had been shown in the literature to be predictive of benign and malignant disease. Once established, the BI-RADS lexicon provided new opportunities for quality assurance, communication, research, and improved patient care. The history of this lexicon illustrates a series of challenges and instructive successes that provide a valuable guide for other groups that aspire to develop similar lexicons in the future. PMID: 19945040 [PubMed - in process]

Strategies for managing imaging utilization.

Related Articles Strategies for managing imaging utilization. J Am Coll Radiol. 2009 Dec;6(12):844-50 Authors: Bernardy M, Ullrich CG, Rawson JV, Allen B, Thrall JH, Keysor KJ, James C, Boyes JA, Saunders WM, Lomers W, Mollura DJ, Pyatt RS, Taxin RN, Mabry MR Imaging represents a substantial and growing portion of the costs of American health care. When performed correctly and for the right reasons, medical imaging facilitates quality medical care that brings value to both patients and payers. When used incorrectly because of inappropriate economic incentives, unnecessary patient demands, or provider concerns for medical-legal risk, imaging costs can increase without increasing diagnostic yields. A number of methods have been tried to manage imaging utilization and achieve the best medical outcomes for patients without incurring unnecessary costs. The best method should combine a prospective approach; be transparent, evidence based, and unobtrusive to the doctor-patient relationship and provide for education and continuous quality improvement. Combining the proper utilization of imaging and its inherent cost reduction, with improved quality through credentialing and accreditation, achieves the highest value and simultaneous best outcomes for patients. PMID: 19945039 [PubMed - in process]

ACR Appropriateness Criteria on percutaneous catheter drainage of infected fluid collections.

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In through the out door: AMCLC 2009 council perceptions of self-referral.

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Editorial Board

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 3, September 2009, Page i[No author name available]

Introduction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 3, September 2009, Page 171Wael E.A., Saad

Percutaneous Nephrostomy: Native and Transplanted Kidneys

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 3, September 2009, Pages 172-192Wael E.A., Saad , Meena, Moorthy , Daniel, GinatPercutaneous nephrostomy is a procedure in which access to the renal collecting system of a native (nontransplanted) or transplanted kidney is obtained through the skin, providing external drainage and/or a portal for additional minimally invasive procedures. Such additional minimal invasive procedures include nephrolithotripsy, ureteric stent placement, ureteric dilation, ureteric embolization/obliteration, and rendezvous procedures with cystoscopy. Percutaneous nephrostomy has been proven to be an effective and safe minimally invasive image-guided procedure. This article discusses the indications, techniques, imaging guidance modalities, and outcomes related to percutaneous nephrostomy. Extensions of the nephrostomy procedures, such as ureteric stent placement and nephro–ureteral stent placement are...

Management of Nephrostomy Drains and Ureteral Stents

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 3, September 2009, Pages 193-204Robert, Adamo , Wael E.A., Saad , Daniel B., BrownNephroureteral and double J stents are routinely placed by interventional radiologists but quality literature on placement and management of these devices is limited. The purpose of this review is to detail indications for ureteral stent placement, review the types of antegrade and retrograde devices that are placed including technical tips, and discuss management of common complications that occur in this patient population. An algorithm for placement and management is included.

Percutaneous Ureteral Interventions

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 3, September 2009, Pages 205-215Robert, Adamo , Wael E.A., Saad , Daniel B., BrownUrinary strictures are commonly managed by interventional radiologists and can result from both benign and malignant etiologies. Many patients end up with lifelong catheters. Although stricture dilation is commonly unsuccessful, some patients can eventually become catheter free. This review describes current outcomes with a variety of dilation and stenting techniques. Management of complex ureteral and urinary complications is also reviewed, including ureteral/arterial fistulas and ureteral embolization for permanent diversion.

Uretro-Arterial Fistulas

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 3, September 2009, Pages 216-221Michael, DarcyUreteral arterial fistula (UAF) is an uncommon condition but one that has been increasing with over 100 cases reported. The presentation is gross hematuria in a patient with predisposing factors, such as prior pelvic surgery, past radiation therapy, and chronic ureteral stenting. When not correctly diagnosed, the associated mortality is significant. Diagnosis is best accomplished by careful angiography with frequent use of provocative maneuvers. The current best therapeutic option is sealing off the UAF by deploying a stent graft in the artery.

Introduction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page 79T. Gregory, Walker

Acute Gastrointestinal Hemorrhage

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 80-91T. Gregory, WalkerAlthough most cases of acute gastrointestinal (GI) hemorrhage either spontaneously resolve or respond to medical management and/or endoscopic treatment, there remain a significant number of patients who require emergency evaluation and treatment by the interventional radiologist. Any angiographic evaluation should begin with selective catheterization of the artery supplying the most likely site of bleeding, as determined by the available clinical, endoscopic, and imaging data. If a source of hemorrhage is identified, superselective catheterization followed by transcatheter embolization with microcoils is the most effective means of successfully controlling hemorrhage while minimizing potential complications. This is now well-recognized as a viable and...

Transjugular Intrahepatic Portosystemic Shunt for Acute Variceal Hemorrhage

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 92-101Sanjeeva P., Kalva , Gloria M., Salazar , T. Gregory, WalkerAcute variceal hemorrhage is life-threatening and requires a multidisciplinary approach for effective therapy. Transfusion of blood products, systemic therapy with vasopressin, octreotide, and selective β-blockers and early endoscopic therapy are often effective; however, uncontrollable variceal hemorrhage is best treated with transjugular intrahepatic porto-systemic shunt (TIPS) creation. This procedure involves establishment of a direct pathway between the hepatic veins and the portal veins to decompress the portal venous hypertension that is the source of the patient's hemorrhage. The procedure is technically challenging, especially in critically ill patients, and has a mortality of 30%-50% in the emergency setting, but has greater than...

Evaluation and Management of Acute Vascular Trauma

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 102-116Gloria M.M., Salazar , T. Gregory, WalkerWith the technical advances and the increasing availability of sophisticated imaging equipment, techniques, and protocols, and with continually evolving transcatheter endovascular therapies, minimally invasive imaging and treatment options are being routinely used for the clinical management of trauma patients. Thus, the primary treatment algorithm for managing acute vascular trauma now increasingly involves the interventional radiologist or other endovascular specialist. Endovascular techniques represent an attractive option for both stabilizing and definitively treating patients who have sustained significant trauma, with resultant vascular injury. Endovascular treatment frequently offers the benefit of a focused definitive therapy, even in the presence of massive hemorrhage that...

Acute Limb Ischemia

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 117-129T. Gregory, WalkerAcute limb ischemia occurs when there is an abrupt interruption of blood flow to an extremity usually because of either embolic or thrombotic vascular occlusion. When profound ischemia ensues, this represents an emergency in which restoration of perfusion through early intervention can lead to limb salvage, whereas delay may result in significant morbidity, including limb loss and, potentially, death. Patients in whom urgent or semi-urgent surgical or endovascular revascularization is indicated may undergo catheter angiography unless there is a contraindication, such as profound critical limb ischemia, renal dysfunction, or contrast allergy. Alternative imaging modalities include ultrasound, contrast-enhanced computed tomographic angiography,...

Bronchial Artery Embolization

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 130-138Sanjeeva P., KalvaMassive hemoptysis is a life-threatening emergency. Chest radiograph, computed tomography, and bronchoscopy play a complementary role in diagnosing the underlying cause of hemorrhage and localizing the bleeding site. Bronchial artery embolization remains the primary and most effective method in controlling massive hemoptysis. Bronchial and nonbronchial systemic arteries are the main source of bleeding and are embolized with polyvinyl alcohol particles or gelatin sponge. Immediate cessation of bleeding occurs in more than 75% of patients; however, long-term recurrences are common in patients with progressive lung disease. Complications are infrequent except for a rare occurrence of spinal cord ischemia.

Transcatheter Endovascular Techniques for Management of Obstetrical and Gynecologic Emergencies

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 139-147Gloria M.M., Salazar , John C., Petrozza , T. Gregory, WalkerSince the initial description of selective uterine artery embolization for the treatment of postpartum hemorrhage in 1979, transcatheter embolization and other endovascular techniques have become the second-line therapeutic option for the management of intractable obstetrical and gynecologic bleeding. Advances in catheter-based techniques, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as postpartum hemorrhage, menorrhagia, and postmenopausal bleeding. Transcatheter interventions include the following: (1) prophylactic selective catheterization of the internal iliac arteries, with either temporary balloon occlusion or embolotherapy;...

Acute Deep Vein Thrombosis and Thrombolysis

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 148-153Stephan T., WickyPulmonary embolism is a well-known and feared complication of deep venous thrombosis (DVT). Patients who present with acute DVT are treated with anticoagulation therapy whenever possible. Nonetheless, anticoagulation therapy does not actually treat DVT by dissolution of thrombus but instead prevents the propagation of the existing acute DVT. Unfortunately, a significant number of patients, particularly those with femoral or iliofemoral DVT, will develop the postthrombotic syndrome (PTS), despite receiving anticoagulation therapy. PTS is clinically manifested by leg pain, swelling, skin discoloration, and venous claudication; venous ulceration is the most severe form of PTS. The natural course of DVT is that...

Emergent Nephrostomy Tube Placement for Acute Urinary Obstruction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 154-161Raul N., UppotObstructive uropathy and urosepsis constitute a medical emergency and require emergent decompression of the urinary collecting system. Image-guided percutaneous nephrostomy tube placement using ultrasound and fluoroscopy allows for decompression of the obstructed renal collecting system with minimal complications.

Biliary Tract Interventions

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Pages 162-170Benjamin J., PomerantzBiliary tract interventions remain a tremendous technical challenge to the interventionalist and require appropriate clinical postprocedural management. The increased use of endoscopy for biliary tract evaluation and intervention has served to largely replace percutaneous techniques, resulting in a decreased number of patients requiring primary percutaneous transhepatic biliary interventions. However, those patients who do present for percutaneous biliary procedures often represent a more technically difficult subset. Thorough familiarity with normal and variant biliary tract anatomy, and experience with a variety of techniques, will allow for successful biliary tract interventions in complex situations. This article reviews the current role of percutaneous transhepatic...

Editorial Board

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page i[No author name available]

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page iii[No author name available]

Forthcoming Topics

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 2, June 2009, Page iv[No author name available]

Editorial Board

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Page ii[No author name available]

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Page iii[No author name available]

Introduction

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Page 1Walter S., Bartynski

Clinical, Anatomic, and Imaging Correlation in Spine-Related Pain: The Essential Elements

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 2-10Walter S., BartynskiSuccessful treatment of a patient's spine-related pain depends on accurate targeting of its location and cause. At a basic level, a focused history and physical examination is essential. Understanding of spine anatomy, in particular, spine innervation, is fundamental. Correlation with preprocedure imaging is important to confirm the suspected location(s) of the pain generator and is helpful in planning the approach for image-guided treatment. Understanding the variations in spine anatomy, subtle imaging features, or correlates of root irritation and factors that can affect the patient's presentation at the time of treatment are also critical to accurate targeting and effective treatment. This...

Epidural Steroid Injections and Selective Nerve Root Blocks

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 11-21Timothy S., Eckel , Walter S., BartynskiEpidural steroid injections and lumbar nerve root block/steroid injection are commonly performed interventional treatments for spine-related pain. These procedures are the foundation of any image-guided spine pain management practice. While more generic and not target-specific, epidural steroid injections are highly effective in a large proportion of patients, including patients with axial pain (neck or low back pain), radiculopathy, or spinal stenosis with neurogenic claudication. When isolated lumbar nerve root irritation is more clearly suspected, transforaminal nerve root blocks can provide useful diagnostic information as well as deliver more specifically targeted steroid treatment. Sustained pain relief can be achieved in a...

Treatment of Facet and Sacroiliac Joint Arthropathy: Steroid Injections and Radiofrequency Ablation

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 22-32Jeffrey A., Stone , Walter S., BartynskiFacet and sacroiliac joint arthropathy are common, specific causes of low back pain. With a combination of a focused physical examination and image guidance, pain originating from these joints can be accurately targeted and these joints respond well to the direct application of long-acting deposition preparation steroids. When routine steroid treatment of the facet joint is not effective and more advanced treatment is required, denervation of the facet joint through the use of radiofrequency ablation (RFA) is a preferred method. Image guidance is a critical tool in targeting facet joint innervation, performing a central role in the techniques used in...

Interventional Assessment of the Lumbar Disk: Provocation Lumbar Diskography and Functional Anesthetic Diskography

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 33-43Walter S., Bartynski , A. Orlando, OrtizThe diagnosis of diskogenic low back pain (LBP) can be elusive. Physical examination of the lumbar disk is limited and imaging offers few objective clues. While invasive, lumbar diskography is a method available to examine or “provoke” the disk directly and determine if LBP is coming from a disk and which disk(s) is responsible for the pain. Once identified, features of the abnormal disk can be evaluated, including the disk's response to intradiskal local anesthetic and disk architecture as observed on diskography imaging and postdiskogram computed tomography. Response to anesthetic can be correlated with imaging features potentially impacting treatment but...

Vertebroplasty and Vertebral Augmentation Techniques

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 44-50Timothy S., Eckel , Wayne, OlanVertebroplasty, the percutaneous administration of acrylic bone cement into a vertebral body, was developed in France in 1984, initially as a treatment for a painful vertebral hemangioma. Subsequent adaptations of the technique, development of materials and devices, and expansion of indications have led to many vertebral augmentation variants that have proven highly successful in treating pain related to osteoporotic compression fractures and vertebral body pathology, such as metastasis and myeloma. Vertebroplasty involves the image-guided percutaneous placement of a bone access needle into the affected vertebral body, followed by injection of the bone cement under intermittent imaging to assure appropriate placement...

Sacroplasty

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 51-63A. Orlando, Ortiz , Allan L., BrookSacral vertebroplasty, or sacroplasty, entails the percutaneous insertion of 1 or more bone needles into the sacral ala and, less commonly, the sacral vertebra with fluoroscopic and/or computed tomographic guidance. Acrylic bone cement is then injected under imaging guidance to treat the lesion and stabilize the sacrum. Sacroplasty is indicated for the treatment of painful sacral insufficiency fractures and painful sacral masses, both of which destabilize the sacrum. In properly selected patients, sacroplasty is an extremely efficacious procedure with a low-risk profile when performed with meticulous imaging guidance and a thorough appreciation of the complex sacral anatomy. Complete pain relief...

Spinal Cord Stimulation: A Basic Approach

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 64-70Allan L., Brook , Bassem A., Georgy , Wayne J., OlanChronic back pain and other refractory pain syndromes are a documented burden on our society. They also are a huge cost in quality of life and dollars spent on health care. Neuromodulation and specifically dorsal column stimulation of the spinal cord has been shown to decrease pain with minimal risk to the patient. We describe in this article the basic techniques and methods of both the stimulation trial and the permanent implantation of the leads and generator. With advanced imaging and the minimally invasive approach we further explain how to minimize any risk associated with this percutaneous procedure.

Percutaneous Image-Guided Augmentation for Spinal Metastatic Tumors

Publication year: 2009Source: Techniques in Vascular and Interventional Radiology, Volume 12, Issue 1, March 2009, Pages 71-77Bassem A., GeorgyThe purpose of this article is to review the current state of the art for treating symptomatic spinal fractures associated with malignant lesions by image-guided interventional techniques. Epidemiology, clinical presentation, and biomechanical ramifications of these lesions are summarized. A suggested treatment algorithm is also presented. The second part of the article deals with how to approach these lesions, explaining the issues that pertain to patient evaluation, preoperative, operative, and postoperative treatment regimes. Tips for certain difficult situations and potential complications are also discussed.

Editorial Board

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Page i[No author name available]

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Page iii[No author name available]

Introduction

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 201-202Timothy, Clark

Portal Anatomic Variants Relevant to Transjugular Intrahepatic Portosystemic Shunt

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 203-207Nael, Saad , Michael, Darcy , Wael, SaadTransjugular intrahepatic portosystemic shunt (TIPS) creation is an accepted treatment for portal hypertension. TIPS creation remains a challenging procedure because it involves the successful passage of a needle from a point of origin (hepatic vein) to a target point (portal vein) through the liver substance. An understanding of the anatomy of these two vascular beds facilitates overcoming the challenge of the spatial relationship between these two points. In this article the authors review the vascular and parenchymal anatomic variations, both congenital and acquired that impact the success of TIPS creation.

Stepwise Placement of a Transjugular Intrahepatic Portosystemic Shunt Endograft

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 208-211Timothy W.I., ClarkEndografts continue to evolve the role of transjugular intrahepatic portosystemic shunts for patients with complications of portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) created with bare stents, although associated with high rates of short-term portal decompression, are plagued by shunt stenosis and thrombosis over the long term. In contrast, TIPS created with endografts achieve durable, sustained patency in most patients with portal hypertension. The technique of successful endograft placement does have technical nuances that differ from TIPS creation with bare stents. This article provides a step-by-step approach for the interventional radiologist for placement of the via Torr device, which is...

Management of Shunt Dysfunction in the Era of TIPS Endografts

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 212-216Timothy W.I., ClarkSignificantly improved long-term patency can be achieved with transjugular intrahepatic portosystemic shunt (TIPS) endografts compared to conventional bare stents. In the USA, approximately 80% of TIPS procedures are performed using these devices. The phenomenon of early shunt thrombosis with TIPS created with bare stent TIPS, attributed to biliary fistulae, is seldom observed in patients with TIPS endografts. Intrashunt stenoses within the polytetrafluoroethylene-lined conduit are also rare. However, as with shunts created with bare stents, distinct patterns of dysfunction can occur with TIPS endografts. Some of these are inherent to the learning curve of placing these devices and others are secondary...

Portal Vein Imaging and Access for Transjugular Intrahepatic Portosystemic Shunts

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 217-224Timothy, Scanlon , Robert K., Ryu

Balloon-occluded Retrograde Transvenous Occlusion

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 225-229Hector, FerralThe current article describes a patient with acute, massive upper gastrointestinal bleeding from isolated gastric varices. The patient had a large gastrosystemic shunt and was managed with a combination of splenic artery embolization followed by balloon-occluded retrograde transvenous occlusion (BORTO) of the gastric varices. BORTO is a procedure that was recently described in Japan by Dr Kanagawa. This technique is extensively used in Japan as first-line therapy in the management of bleeding gastric varices but has not been popularized in the USA. The purpose of this review is to present the technique used to perform BORTO at our institution and...

Direct Intrahepatic Portocaval Shunt

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 230-234Bryan D., Petersen , Timothy W.I., ClarkThe direct intrahepatic portacaval shunt (DIPS) is a modification of the TIPS procedure, using intravascular ultrasound-guidance, combined with fluoroscopy. The DIPS procedure was initially conceived to increase the durability of shunt patency and extend the spectrum of patients with portal hypertension for whom endovascular portocaval shunting can be performed. The DIPS procedure involves intravascular ultrasound-guided puncture from the inferior vena cava to the portal vein through the caudate lobe of the liver. The shunt is completed with a polytetrafluoroethylene-covered stent graft. This article describes the indications, technique, and outcomes of the DIPS procedure to enable the interventional radiologist currently experienced...

Placement of Transjugular Intrahepatic Portosystemic Shunts in Children

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 4, December 2008, Pages 235-240Jonathan M., LorenzPerformance of transjugular intrahepatic portosystemic shunting (TIPS) in children requires an awareness of the technical challenges posed by pediatric anatomy and physiology. Any interventional radiologist skilled in adult TIPS and contemplating performing their first pediatric TIPS should consider adding a second set of more experienced hands. This article reviews some of the more salient technical considerations for performing TIPS in this unique patient population.

Editorial Board

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page i[No author name available]

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page iii[No author name available]

Forthcoming Topics

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page iv[No author name available]

Introduction

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Page 155Dmitry J., Rabkin

Clinical Surveillance and Monitoring of Arteriovenous Access for Hemodialysis

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 156-166Gary A., GelbfishClinical surveillance and monitoring of arteriovenous access for hemodialysis can best ensure long term access function. The failing access can be identified and referred for intervention prior to complete access failure. This article reviews the basic science of access function and the various techniques for detecting the failing access. These techniques are utilized by the dialysis unit staff and by the physician, often the interventionalist, who takes primary care of the access. A combination of various techniques to detect dysfunction and trend analysis of various parameters is most likely to identify in a timely manner, those patients who need intervention.

Hemodialysis Fistula Interventions: Diagnostic and Treatment Challenges and Technical Considerations

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 167-174Boris, NikolicEnd-stage renal disease is one of the main epidemiologic health problems and dialysis access continues to be the Achilles' heel of its treatment. Consequently, hemodialysis fistula maintenance is of great importance which can best be accomplished by close collaboration between primary care, nephrology, surgery and interventional radiology services, routine access monitoring as well as early intervention in cases of impending access failure. Also, knowledge and application of specific interventional techniques that are additionally described in this article may increase intervention efficiency, decrease the incidence of complications and overcome technical challenges thus improving procedural outcome and maximizing access patency rates.

Endovascular Management of the “Failing to Mature” Arteriovenous Fistula

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 175-180George M., NassarThe “failing to mature” arteriovenous fistula (AVF) is frequently encountered among patients in need of hemodialysis (HD). It is essential that its prompt recognition and management are conducted in a timely manner to allow its use in HD. The physical examination is essential in early identification of the “failing to mature” AVF and helps guide initial endovascular management. In most instances, endovascular evaluation successfully identifies all the lesions that have contributed to AVF derangement and retarded its proper maturation. It is common to find juxta-arterial stenosis as well as venous stenosis in the body of the AVF, or its venous...

Tunneled Dialysis Catheters: Pearls and Pitfalls

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 181-185Jeffrey B., SiegelA review of the issues involved in placement of Tunneled Dialysis Catheter with a suggested scheme for maximizing good catheter placement and function.

Selecting Optimal Hemodialysis Catheters: Material, Design, Advanced Features, and Preferences

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 186-191Michael G., Tal , Nina, NiHemodialysis catheters are a necessary evil. They provide an immediate and effective lifeline for hemodialysis patients, and their use is steadily increasing. This increasingly important role has lead to the development of many generations of dialysis catheters. Some aspects of novel designs have shown potential to reduce complications, while others provide options for physician insertion preference. The two major biomaterials for catheter construction are currently polyurethane and silicone, while copolymers such as carbothane are becoming more widespread. Catheter coatings such as heparin, antibiotics, and silver ion are designed to minimize thrombosis and infection. Finally, many lumen and tip designs are...

Minimally Invasive Outpatient Centers

Publication year: 2008Source: Techniques in Vascular and Interventional Radiology, Volume 11, Issue 3, September 2008, Pages 192-194James, McGuckin , Kim, ParkinsonMinimally-invasive medicine has continually progressed from its beginning in the 1960's. Evolution of technology and techniques have led to treatment of new disease states in minimally-invasive therapies. Now the venue of those therapies is shifting outpatient procedures from the hospital and into outpatient centers.

Journals RSS : Gourt

Vertebral artery duplication and aneurysms: 64-slice multidetector CT findings

A rare case of combined soft-tissue and intraosseous arteriovenous malformation of the hand with diffuse periosteal elevation: imaging appearances

Intractable bronchopleural fistula caused by radiofrequency ablation: endoscopic bronchial occlusion with silicone embolic material

Absence of uterine arteries discovered at fibroid embolisation

Chordoma masquerading as a nerve root tumour a clinical lesson

CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect

Characteristics of in vivo radiotherapy dosimetry

Joint symposium 2009 on carbon ion radiotherapy

A description of CT features of Clostridium difficile infection of the small bowel in four patients and a review of literature

Conventional MRI and magnetisation transfer imaging of the brain and optic pathway in primary open-angle glaucoma

Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients

Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation

Warthins tumour: a retrospective case series

Reduction of dose to the female breast as a result of spectral optimisation for high-contrast thoracic CT imaging: a phantom study

Therapeutic effect of balloon-occluded retrograde transvenous obliteration for gastric varices in relation to haemodynamics in the short gastric vein

Optimisation techniques in vaginal cuff brachytherapy

Implantation of fiducial markers for image guidance in prostate radiotherapy: patient-reported toxicity

Personnel radiation dose considerations in the use of an integrated PETCT scanner for radiotherapy treatment planning

Thorax set-up verification with multiple oblique treatment portal images

Brain: non-infective and non-neoplastic manifestations of HIV

Persistent scrotal lesion

Magnetic Resonance Imaging in the Visualization of Benign Tumors and Tumor-like Lesions of Hand and Wrist

Cross-Sectional Imaging of Primary Thoracic Sarcomas with Histopathologic Correlation: A Review for the Radiologist

Cutaneous Melanoma: Role of Ultrasound in the Assessment of Locoregional Spread

Dual-Source Cardiac Computed Tomographic Technique, Anatomy, and Normal Variants

Upcoming Articles

In Recent Issues

Acute Knee Dislocation: Review of an Elusive Entity

Multidetector Computed Tomography Findings of Dense Pulmonary Emboli in Oncologic Patients

Computed Tomographic Appearances of Hepatic Vascular Lesions

Upcoming Articles

In Recent Issues

Hysterosalpingography: Technique and Applications

Non-Electrocardiogram-Gated Multidetector-Row Computed Tomography Findings of Cardiac Pathology in Oncologic Patients

Pediatric Cranial Doppler Sonography in Children: Non-Sickle Cell Applications

Radiological Manifestations of Skeletal Lymphoma

Upcoming Articles

In Recent Issues

Multidetector Computed Tomography of the Acute Abdomen in the Immunocompromised Host: A Pictorial Review

Positron Emission Tomography/Computed Tomography Potential Pitfalls and Artifacts

Diagnosis and Management of Pseudoaneurysms: An Update

The Great Mimicker: Fat Necrosis of the Breast—Magnetic Resonance Mammography Approach

Upcoming Articles

In Recent Issues

Computed Tomographic Appearance of Chest Ports and Catheters: A Pictorial Review for Noninterventional Radiologists

Ultrasound of Wrist Pain

Magnetic Resonance Imaging of the Liver and Biliary Tree in Children

Radiofrequency and Microwave Ablation of the Liver, Lung, Kidney, and Bone: What Are the Differences?

Upcoming Articles

In Recent Issues

Technical Essentials of Hepatic Doppler Sonography

Microwave Ablation Technology: What Every User Should Know

Practical Applications of Nuclear Medicine in Imaging Breast Cancer

Multidetector Computed Tomography of the Mesocolon: Review of Anatomy and Pathology

Magnetic Resonance Arthrography of Superior Labrum Anterior-Posterior Lesions: A Practical Approach to Interpretation

Issues in Imaging Malignant Neoplasms of the Female Reproductive System

Pharyngeal Dysphagia: What the Radiologist Needs to Know

Vascular Closure Devices: A Comparative Overview

Radiofrequency Ablation of Lung Lesions: Practical Applications and Tips

Upcoming Articles

In Recent Issues

Magnetic Resonance Imaging Features of the Discrete Epiphyseal Radiolucency: A Problem-Solving Approach to Differential Diagnosis

Computed Tomography and Magnetic Resonance Imaging Features of Lesions of the Renal Medulla and Sinus

Computed Tomographic Enterography and Enteroclysis: Pearls and Pitfalls

Editorial Board

Information for Readers

Table of Contents

More Than Just Stones: A Pictorial Review of Common and Less Common Gallbladder Pathologies

Ultrasound-Guided Therapeutic Procedures in the Musculoskeletal System

Ultrasound of Muscle

Magnetic Resonance Imaging Findings of Golf-Related Injuries

Re: Flexi-Seal continence device mimicking a pelvic collection.

Re: Competency-based training versus traditional experiences in radiology; how best to educate the radiologists of the future?

Cerebellar haemangioblastoma with spontaneous subarachnoid haemorrhage: a rare presentation.

External herniation of a subareolar intraductal papilloma: a rare, yet beneficial, complication of conventional ductography.

Adult cor triatriatum--the measurement of opening in the membrane using ECG-gated multidetector CT.

Intussusception following transmural migration and defecation of a surgical sponge.

MRI and CT appearances of cardiac tumours in adults.

Measurement of defect angle in superior semicircular canal dehiscence.