Entries Tagged as 'Eur J Radiol'
Central venous infusion port inserted via high versus low jugular venous approaches: retrospective comparison of outcome and complications.
Eur J Radiol. 2009 Dec;72(3):494-8
Authors: Park HS, Kim YI, Lee SH, Kim JI, Seo H, Lee SM, Lee Y, Lim MK, Park YS
PURPOSE: To retrospectively compare immediate and long-term outcome of central venous infusion port inserted via right high versus low jugular vein approaches. MATERIALS AND METHODS: The study included 163 patients (125 women patients, 38 men patients; age range, 18-79 years; mean age, 53 years); 142 patients underwent port insertion with low jugular vein approach and 21 patients with high jugular vein approach. The causes of high jugular vein puncture were metastatic lymphadenopathy (n=7), operation scar (n=6), radiation scar (n=5), failure of low jugular vein puncture (n=2), and abnormal course of right subclavian artery (n=1). Medical records and radiologic studies were reviewed retrospectively to determine and compare the outcome and the occurrence of complication related to port. RESULTS: The procedure-related complications were all minor (n=14, 8.6%) in both groups; hematoma (n=4, 2.8% in low jugular puncture group and n=1, 4.8% in high jugular puncture group, p=0.6295), air embolism (n=2, 1.4% in low jugular puncture group and n=0 in high jugular puncture group, p=0.5842) and minor bleeding (n=5, 3.5% in low jugular vein puncture group and n=2, 9.5% in high jugular vein puncture group, p=0.2054). The average length of follow-up was 431 days for low jugular vein puncture group and 284 days for high jugular vein puncture group. The difference between two groups was significant (p=0.0349). The reasons for catheter removal were patients’ death (59 in low jugular puncture group and 14 in high jugular puncture group, p=0.0465), suspected infection (11 in low jugular vein puncture group and 2 in high jugular vein puncture group, p=0.8242), catheter occlusion (four in low jugular vein puncture group and one in high jugular vein puncture group, p=0.6583). The catheter tip migrated upward an average of 1.86 cm (range, -0.5 to 5.0 cm) in low jugular vein puncture group and 1.56 cm (range, 0-3.6 cm) in high jugular vein puncture group and there was no significant difference (p=0.4232). CONCLUSIONS: Right high jugular vein approach can be a feasible alternative to right low jugular vein approach.
PMID: 19200682 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis in the treatment of symptomatic lower extremity deep venous thrombosis.
Eur J Radiol. 2009 Aug;71(2):350-5
Authors: Shi HJ, Huang YH, Shen T, Xu Q
PURPOSE: To evaluate the efficacy of percutaneous mechanical thrombectomy (PMT) combined with catheter-directed thrombolysis (CDT) in the treatment of massive symptomatic lower limb deep venous thrombosis (DVT). MATERIALS AND METHODS: One hundred and three clinically confirmed DVT patients were discharged from our institution. Sixteen patients with massive lower limb DVT were included in this retrospective study. After prophylactic placement of inferior vena cava filters (IVCFs), percutaneous mechanical thrombectomy (ATD, n=10; Straub, n=6) and catheter-directed thrombolysis were performed in all patients. Complementary therapy included percutaneous transluminal venous angioplasty (PTA, n=3) and stent placement (n=1). The doses of thrombolytic agents, length of hospital stay, peri-procedure complications and discharge status were reviewed. Oral anticoagulation was continued for at least 6 months during follow-up. RESULTS: The average hospital stay was 7 days. The technical success rate (complete and partial lysis of clot) was 89%, the other 11% patients only achieved less than 50% clot lysis. The mean dose of urokinase was 3.3 million IU. There were no significant differences of clinical outcome between the ATD and Straub catheter group. The only major complication was an elderly male who experienced a fatal intracranial hemorrhage while still in the hospital (0.97%, 1/103). Minor complications consisted of three instances of subcutaneous bleeding. No transfusions were required. Vascular patency was achieved in 12 limbs during follow-up. No pulmonary emboli occurred. There is one recurrent DVT 4.5 months after the treatment. CONCLUSIONS: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is an effective and safe method for the treatment of symptomatic DVT. A randomized prospective study is warranted.
PMID: 18524519 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
Role of CT colonography in inflammatory bowel disease.
Eur J Radiol. 2009 Mar;69(3):404-8
Authors: Regge D, Neri E, Turini F, Chiara G
CT colonography (CTC), or virtual colonoscopy, is a non-invasive imaging method that uses CT data sets combined with specialized imaging software to examine the colon. CTC is not used routinely in patients with inflammatory bowel disease (IBD). However, investigating contemporarily the colon, other abdominal organs and the peritoneum with CTC is at times useful in patients with IBD, especially when other diagnostic tools fail. Furthermore, since symptoms of colorectal cancer sometimes superimpose to those of inflammatory disease, it may happen to image patients with IBD incidentally. If clinical signs are suggestive for inflammatory disease, exam technique should be modified accordingly and distinguishing radiological findings searched for.
PMID: 19167180 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
MRCP findings in recurrent pyogenic cholangitis.
Eur J Radiol. 2008 Apr;66(1):79-83
Authors: Jain M, Agarwal A
OBJECTIVE: In this essay, we present the spectrum of intrahepatic and extrahepatic bile duct abnormalities seen on MRCP in patients with recurrent pyogenic cholangitis. CONCLUSION: MRCP is a promising, noninvasive alternative to more invasive direct cholangiography for evaluating the intrahepatic and extrahepatic bile ducts in patients with recurrent pyogenic cholangitis.
PMID: 17590555 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
Partial splenic embolization using polyvinyl alcohol particles for hypersplenism in cirrhosis: a prospective randomized study.
Eur J Radiol. 2008 Apr;66(1):100-6
Authors: Zhu K, Meng X, Li Z, Huang M, Guan S, Jiang Z, Shan H
PURPOSE: To prospectively evaluate the efficacy and safety of partial splenic embolization (PSE) using polyvinyl alcohol (PVA) particles for hypersplenism in cirrhosis, as compared to PSE using gelfoam particles. MATERIALS AND METHODS: PSE was performed in 60 consecutive patients with hypersplenism caused by cirrhosis. The patients were randomly assigned into 2 groups: gelfoam group, 32 patients received PSE using gelfoam particles as the embolic material; PVA group, 28 patients received PSE using PVA particles. The follow-up contents included peripheral blood cell counts (leukocyte, platelet and red blood cell) and complications associated with PSE. RESULTS: Prior to PSE, there was no significant difference between the two groups in sex, age, Child-Pugh grade, the extent of embolization and peripheral blood cell counts. After PSE, no matter in which group, leukocyte and platelet counts kept significantly higher than pre-PSE during the 3-year follow-up period (P<.0001), but the post-PSE improvement of leukocyte and platelet counts was significantly better in PVA group than in gelfoam group (P<.05). Red blood cell counts showed no remarkable changes after PSE (P>.05). Severe complications occurred in 8 patients (25.0%) in gelfoam group and 6 patients (21.4%) in PVA group (P>.05), but the degree of abdominal pain was higher in the latter than in the former (P<.05). Among 17 patients who received more than 70% embolization of spleen, 10 (58.8%) developed severe complications, while among 43 patients who received 70% or less embolization of spleen, only four (9.3%) had severe complications. This difference was statistically significant (P<.05). CONCLUSION: PVA particles could be used as the embolic material in PSE; in comparison with PSE using gelfoam particles, PSE using PVA particles can achieve even better efficacy in alleviating hypersplenism, but the extent of embolization should be strictly limited to not more than 70% of splenic volume.
PMID: 17532166 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
Nephrogenic system fibrosis: a radiologist’s practical perspective.
Eur J Radiol. 2008 May;66(2):220-4
Authors: Martin DR
This manuscript will provide the background current understanding of Nephrogenic Systemic Fibrosis (NSF) necessary to be appreciated by radiologists who are practicing cross-sectional imaging including gadolinium based contrast agent (Gd-CA) enhanced MRI. Examination of the known risk factors for NSF provides a practical list of considerations including an appreciation of the degree of patient renal function, or dysfunction, and the type and dose of Gd-CA used. Data is presented to argue that we must consider not only the one-time dose, but particularly the cumulative Gd-CA life-time dose administered to a patient. Using the foundation of known risk factors for NSF, we can then assemble a working list of strategies that can be utilized in an imaging practice to minimize the risk of NSF for all patients, including those at highest risk for this disorder. This list includes a discussion of high stability Gd-CAs, cumulative dose monitoring and limits, dialysis, and more specific documentation in the medical records. Finally, the issues required to understand the information that should be provided to the patient prior to obtaining informed consent are discussed. The objectives of an informed consent is to ensure that the patient is properly informed and involved in the decision to proceed with a contrast enhanced MRI, and to provide documentation to establish that the medical facilities and the radiologist are themselves well-versed in the risks and benefits when making the decision to use contrast enhanced MRI for particular patients. The process of informed consent requires that there be a consideration of the risks of not performing the contrast enhanced MRI, or the relative risk of performing another test, particularly a contrast enhanced CT. This requires an appreciation of the risks of CT-related ionizing radiation and cancer, and the risk of iodine based contrast agents (I-CA) and contrast induced nephropathy (CIN). Data is presented to show that many, and perhaps the vast majority, of renal dysfunction patients are at greater risk of harm from I-CA related to CT as compared to high stability Gd-CAs used for MRI.
PMID: 18321672 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
Nephrogenic systemic fibrosis–implications for nephrologists.
Eur J Radiol. 2008 May;66(2):208-12
Authors: Saab G, Abu-Alfa A
Nephrogenic systemic fibrosis (NSF) is a debilitating disorder seen in-patient with advanced chronic kidney disease (CKD). Recent evidence suggests a link between NSF and the administration of gadolinium-based contrast agents (Gd-CA). In addition, other risk factors have also been suggested to facilitate the development of NSF in this population after Gd-CA. These include metabolic acidosis, high-dose erythropoietin therapy, and the altered mineral metabolism of CKD. While it is possible that these factors may increase the risk of NSF after Gd-CA exposure, they may also simply reflect conditions that increase the risk of getting exposed to Gd-CA, particularly at high doses. Furthermore, given the risk of NSF in CKD, physicians must weigh the risks of NSF versus the risk of contrast-induced nephropathy (CIN) with iodinated agents in this population. In this review, we will provide a nephrologist’s perspective on these issues and the nephrologist’s role in the prevention of NSF.
PMID: 18342470 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
Importance of MRI in the diagnosis and treatment of rhabdomyolysis.
Eur J Radiol. 2008 Feb;65(2):311-5
Authors: Moratalla MB, Braun P, Fornas GM
BACKGROUND: Rhabdomyolysis is a common disorder resulting from a large variety of causes. We describe the MRI features and their importance for diagnosis and treatment. PATIENTS AND METHODS: Between 2003 and 2006, four male patients (age range: 25-33 years) with rhabdomyolysis were studied via 1.5 T MRI (GE, Siemens). In all the patients, T1- and T2-weighted sequences with and without fat suppression, short tau inversion recovery (STIR) and gradient-echo sequences were obtained in axial, coronal and sagittal planes. In one patient, contrast material was given. RESULTS: Two patients presented rhabdomyolysis due to drug abuse, one due to intense exercise and the last one due to long unconsciousness with compression of the paravertebral musculature. Two patients had acute kidney failure. The affected muscles showed an increased signal intensity on T2-weighted and STIR sequences and decreased on T1-weighted sequences. In one patient, intramuscular hemorrhage was observed on T1-weighted and gradient-echo sequences. In the patient with kidney failure, a globular swelling of the kidney with alteration of the corticomedullary differentiation on T2-weighted sequences with fat saturation and hypointensity of the renal medulla on T1-weighted contrast enhanced images was found. DISCUSSION: Immediate recognition of rhabdomyolysis is important to prevent late complications. MRI is the method of choice to evaluate the distribution and extension of the affected muscles, especially when fasciotomy is considered for treatment. Even though the MRI findings are non-specific, the sensitivity in the detection of muscle involvement is higher than CT or US.
PMID: 17482406 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
US-guided placement of central vein catheters in patients with disorders of hemostasis.
Eur J Radiol. 2008 Feb;65(2):253-6
Authors: Tercan F, Ozkan U, Oguzkurt L
OBJECTIVE: To prospectively evaluate the technical success and immediate complication rates of temporary central catheter placement in a homogenous patient population with disorders of hemostasis. MATERIALS AND METHODS: One hundred and thirty three temporary central vein catheters inserted under ultrasound guidance in 119 patients with bleeding disorders were analyzed over a 4-year period. Patients were males (n=51; 43%) and females (n=68; 57%) with a mean age of 56.6 years (age range 18-95 years). A catheter was inserted in IJV in 129 (97%) procedures, subclavian vein in 2 (1.5%) procedures and femoral vein in 2 (1,5%) procedures. Thirty-three (24.8%) procedures were performed on bedside. Of 119 patients, 106 (89%) had only one catheter placement and the rest had had more than one catheter placement (range 1-3). RESULTS: Technical success was achieved in all patients (100%). Average number of puncture was 1.01 (range 1-2). One hundred and nineteen insertions (89.5%) were single-wall punctures, whereas 14 insertions were double-wall punctures. Eight (6%) minor complications occurred including oozing of blood around the catheter in five (3.8%) procedures, small hematoma in two (1.5%) procedure and both in one patient. There was no inadvertent arterial puncture or major complications like hemothorax or pneumothorax in any patients. CONCLUSION: US-guided placement of central vein catheters in patients with disorder of hemostasis is safe with high technical success and low complication rates. US guidance for central venous catheterization should be the preferred method in this group of patients, if available in the hospital setting.
PMID: 17482407 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Eur J Radiol
