Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing.

Purpose: To determine the most common errors of epinephrine administration during severe allergic-like contrast reaction management using high-fidelity simulation surrogates.

Materials And Methods: IRB approval and informed consent were obtained for this HIPAA-compliant bi-institutional prospective study of 40 radiology residents, fellows, and faculty who were asked to manage a structured high-fidelity severe allergic-like contrast reaction scenario (i.e.

Carotid magnetic resonance imaging for monitoring atherosclerotic plaque progression: a multicenter reproducibility study.

This study sought to determine the multicenter reproducibility of magnetic resonance imaging (MRI) and the compatibility of different scanner platforms in assessing carotid plaque morphology and composition. A standardized multi-contrast MRI protocol was implemented at 16 imaging sites (GE: 8; Philips: 8). Sixty-eight subjects (61 ± 8 years; 52 males) were dispersedly recruited and scanned twice within 2 weeks on the same magnet.

An economic analysis of sublobar resection versus thermal ablation for early-stage non-small-cell lung cancer.

Purpose: To compare medical costs for a matched-pair cohort of Medicare patients with early-stage non-small-cell lung cancer (NSCLC) who underwent treatment with sublobar resection or thermal ablation.

Materials And Methods: Patients at least 65 years of age with stage IA/IB NSCLC treated with sublobar resection or thermal ablation from 2007 to 2009 were identified from Surveillance, Epidemiology, and End Results/Medicare-linked data and matched by propensity scores. The primary outcome of interest, cost from the payer's perspective, was derived from Medicare claims data.

Scan-rescan reproducibility of quantitative assessment of inflammatory carotid atherosclerotic plaque using dynamic contrast-enhanced 3T CMR in a multi-center study.

Background: The aim of this study is to investigate the inter-scan reproducibility of kinetic parameters in atherosclerotic plaque using dynamic contrast-enhanced (DCE) cardiovascular magnetic resonance (CMR) in a multi-center setting at 3T.

Methods: Carotid arteries of 51 subjects from 15 sites were scanned twice within two weeks on 3T scanners using a previously described DCE-CMR protocol. Imaging data with protocol compliance and sufficient image quality were analyzed to generate kinetic parameters of vessel wall, expressed as transfer constant (K trans ) and plasma volume (v p ).

A comparison between gadofosveset trisodium and gadobenate dimeglumine for steady state MRA of the thoracic vasculature.

Purpose: Retrospective comparison between gadofosveset trisodium and gadobenate dimeglumine steady state magnetic resonance angiography (SS-MRA) of the thoracic vasculature at 1.5T using signal-to-noise ratio (SNR) and vessel edge sharpness (ES) as markers of image quality.

Materials And Methods: IRB approval was obtained.

Comparing the diagnostic accuracy of contrast-enhanced computed tomographic angiography and gadolinium-enhanced magnetic resonance angiography for the assessment of hemodynamically significant transplant renal artery stenosis.

To compare diagnostic accuracy of contrast-enhanced computed tomographic angiography (CTA) and gadolinium-enhanced magnetic resonance angiography (MRA) for the assessment of hemodynamically significant transplant renal artery stenosis (TRAS). After institutional review board approval, records of 27 patients with TRAS confirmed on digital subtraction angiography (DSA) were retrospectively reviewed. A total of 13 patients had MRA and 14 had CTA before DSA.

The diagnostic impact of limited, screening obstetric ultrasound when performed by midwives in rural Uganda.

Objective: To evaluate the diagnostic impact of limited obstetric ultrasound (US) in identifying high-risk pregnancies when used as a screening tool by midwives in rural Uganda.

Study Design: This was an institutional review board-approved prospective study of expecting mothers in rural Uganda who underwent clinical and US exams as part of their standard antenatal care visit in a local health center in the Isingiro district of Uganda. The midwives documented clinical impressions before performing a limited obstetric US on the same patient.

Prediction of high-risk plaque development and plaque progression with the carotid atherosclerosis score.

Objectives: The goal of this prospective study was to evaluate the carotid atherosclerosis score (CAS) for predicting the development of high-risk plaque features and plaque burden progression.

Background: Previous studies have shown that carotid intraplaque hemorrhage (IPH) and a disrupted luminal surface (DLS), as identified by using magnetic resonance imaging, are associated with greater risk for cerebrovascular events. On the basis of data from a large cross-sectional study, a scoring system was developed to determine which plaque features are associated with the presence of IPH and DLS.

Pediatric abdominal and pelvic trauma: safety and efficacy of arterial embolization.

Purpose: Although transcatheter embolization is a well established technique to treat adults in the trauma setting, evidence is lacking in the pediatric population. This study assesses the safety and efficacy of arterial embolization for blunt abdominal and pelvic trauma in the pediatric population.

Materials And Methods: A retrospective review of abdominal and pelvic angiograms in 97 pediatric patients with blunt trauma was conducted over an 11-year period.

Prospective randomized study of contrast reaction management curricula: computer-based interactive simulation versus high-fidelity hands-on simulation.

Purpose: We developed a computer-based interactive simulation program for teaching contrast reaction management to radiology trainees and compared its effectiveness to high-fidelity hands-on simulation training.

Materials And Methods: IRB approved HIPAA compliant prospective study of 44 radiology residents, fellows and faculty who were randomized into either the high-fidelity hands-on simulation group or computer-based simulation group. All participants took separate written tests prior to and immediately after their intervention.

The sonographic stenosis index: computer simulation of a novel method for detecting and quantifying arterial narrowing.

Purpose: We introduce a new technique for quantifying arterial stenoses, stenosis index (SI), using frequency analysis of the spectral Doppler waveform.

Methods: Spectral Doppler waveforms obtained distal to arterial stenoses were enveloped, and the envelope was transformed into the frequency domain via Fourier transform. Stenosis index represents the ratio of the power in high-frequency harmonics to the power in the fundamental frequency.

Association of carotid atherosclerotic plaque features with acute ischemic stroke: a magnetic resonance imaging study.

Background And Purpose: It remains unclear whether direct vessel wall imaging can identify carotid high-risk lesions in symptomatic subjects and whether carotid plaque characteristics are more effective indicators for cerebral infarct severity than stenosis. This study sought to determine the associations of carotid plaque characteristics by MR imaging with stenosis and acute cerebral infarct (ACI) sizes on diffusion weighted imaging (DWI).

Materials And Methods: One hundred and fourteen symptomatic patients underwent carotid and brain MRI.

The effect of a no-denial policy on imaging utilization.

Purpose: Seeking to control advanced diagnostic imaging costs, health insurance plans have instituted broad-based utilization management systems. Most processes ultimately contain denial provisions, meaning that the health plans will refuse to pay for requested studies if performed. The aim of this analysis was to determine whether removal of a denial provision would result in increased utilization of imaging services.

Subclinical carotid atherosclerosis: short-term natural history of lipid-rich necrotic core--a multicenter study with MR imaging.

Purpose: To use magnetic resonance (MR) imaging to examine the short-term (6 months) natural history of the lipid-rich necrotic core (LRNC) in carotid artery plaques by examining the placebo group of a multicenter clinical trial.

Materials And Methods: Study procedures and consent forms were approved by the institutional review board for this HIPAA-compliant study. Written informed consent was obtained for all enrolled subjects.

Adventitial perfusion and intraplaque hemorrhage: a dynamic contrast-enhanced MRI study in the carotid artery.

Background And Purpose: Autopsy studies have suggested a relationship between intraplaque hemorrhage (IPH) and vasa vasorum, which arise primarily from the adventitia. Adventitial vasa vasorum can be characterized in the carotid arteries by estimating perfusion parameters via dynamic contrast-enhanced MRI. The purpose of this investigation was to use dynamic contrast-enhanced MRI to test in vivo in a clinical population whether adventitial perfusion, indicative of vasa vasorum microstructure, is associated with IPH.

Frequency of external iliac artery branch injury in blunt trauma: improved detection with selective external iliac angiography.

Purpose: To assess the utility of selective external iliac artery (EIA) angiography and the frequency of injury to branches of the EIA in cases of blunt pelvic trauma.

Materials And Methods: A retrospective review of pelvic angiograms in 66 patients with blunt pelvic trauma was conducted over a 12-month period. Pelvic and femur fracture patterns were correlated to the presence of EIA injury.

Safety and efficacy of drug-eluting bead chemoembolization for hepatocellular carcinoma: comparison of small-versus medium-size particles.

Purpose: To compare safety and imaging response with 100-300 μm and 300-500 μm doxorubicin drug-eluting bead (DEBs) to determine optimal particle size for chemoembolization of hepatocellular carcinoma (HCC).

Materials And Methods: DEB chemoembolization using 100-300 μm (n = 39) or 300-500 μm (n = 22) LC beads loaded with 50 mg of doxorubicin was performed in 61 patients with HCC. Patient age, sex, etiology of liver disease, degree of underlying liver disease, tumor burden, and performance status were similar between the groups.

Postembolization syndrome after hepatic transarterial chemoembolization: effect of prophylactic steroids on postprocedure medication requirements.

Purpose: To evaluate the impact of prophylactic use of dexamethasone and scopolamine on analgesic and antiemetic agent requirements after transarterial chemoembolization.

Materials And Methods: A total of 148 patients underwent 316 rounds of chemoembolization for hepatocellular carcinoma at a single institution over a 17-month period. Patient charts were retrospectively reviewed for demographic data, procedural technique, and use of analgesic and antiemetic medications.

Quantitative evaluation of high intensity signal on MIP images of carotid atherosclerotic plaques from routine TOF-MRA reveals elevated volumes of intraplaque hemorrhage and lipid rich necrotic core.

Background: Carotid intraplaque hemorrhage (IPH) and lipid rich necrotic core (LRNC) have been associated with accelerated plaque growth, luminal narrowing, future surface disruption and development of symptomatic events. The aim of this study was to evaluate the quantitative relationships between high intensity signals (HIS) in the plaque on TOF-MRA and IPH or LRNC volumes as measured by multicontrast weighted CMR.

Methods: Seventy six patients with a suspected carotid artery stenosis or carotid plaque by ultrasonography underwent multicontrast carotid CMR.

Challenges to protocol optimization due to unexpected variation of CT contrast dose amount and flow.

High-quality computed tomography (CT) exams are critical to maximizing radiologist's interpretive ability. Exam quality in part depends on proper contrast administration. We examined injector data from consecutive abdominal and pelvic CT exams to analyze variation in contrast administration.

Predictors of functional outcome after emergency carotid artery stenting and intra-arterial thrombolysis for treatment of acute stroke associated with obstruction of the proximal internal carotid artery and tandem downstream occlusion.

Background And Purpose: Patients who develop severe stroke symptoms due to acute internal carotid artery occlusion eventually in combination with a thromboembolic obstruction of the middle cerebral artery incur a major risk of developing extensive MCA infarction with a poor outcome. The purpose of this study was to evaluate the outcome for patients with tandem occlusions in the MCA and/or distal ICA, retrospectively, who had undergone stent implantation in the proximal segment of the ICA in addition to intra-arterial thrombolysis.

Materials And Methods: Thirty-five patients with tandem occlusions of the MCA and/or distal ICA and acute occlusion of the proximal ICA underwent stent implantation for the proximal ICA occlusion and IAT for the tandem occlusion.

Characterization of distensibility, plaque burden, and composition of the atherosclerotic carotid artery using magnetic resonance imaging.

Purpose: Arterial distensibility is a marker that can measure vessel wall functional and structural changes resulting from atherosclerosis with applications including estimation of mechanical properties of the wall. We sought to assess the feasibility of using magnetic resonance imaging (MRI) to include wall distensibility in the characterization of atherosclerotic carotid arteries and to analyze the relationship between distensibility and morphological and compositional plaque features.

Methods: Five healthy volunteers were imaged with a multiple-slice CINE MR sequence twice, within 24 h, to determine the interscan reproducibility of distensibility measurements.

Sustained acceleration in carotid atherosclerotic plaque progression with intraplaque hemorrhage: a long-term time course study.

Objectives: This study sought to determine the immediate and long-term effects of intraplaque hemorrhage (IPH) on plaque progression in the carotid artery.

Background: Previous studies have associated IPH in the carotid artery with more rapid plaque progression. However, the time course and long-term effect remain unknown.

Simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) imaging for carotid atherosclerotic disease evaluation.

A simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP) MR imaging technique is proposed to detect both luminal stenosis and hemorrhage in atherosclerosis patients in a single scan. Thirteen patients with diagnosed carotid atherosclerotic plaque were admitted after informed consent. All scans were performed on a 3T MR imaging system with SNAP, 2D time-of-flight and magnetization-prepared 3D rapid acquisition gradient echo sequences.