The Incidental Splenic Mass at CT: Does It Need Further Work-up? An Observational Study.

Purpose To evaluate whether an incidentally noted splenic mass at abdominal computed tomography (CT) requires further imaging work-up. Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, a search of a CT database was performed for patients with splenic masses at CT examinations of the abdomen and chest from 2002 to 2008. Patients were divided into three groups: group 1, patients with a history of malignancy; group 2, patients with symptoms such as weight loss, fever, or pain related to the left upper quadrant and epigastrium; and group 3, patients with incidental findings.

Thirty-day emergency room visits and hospital admissions after outpatient non-vascular image-guided procedures.

Purpose: To evaluate the rate of post-procedure emergency department (ED) visits and hospital admissions following outpatient non-vascular image-guided interventions performed under moderate sedation and to identify common and preventable causes of emergency department visits and hospital admissions.

Materials And Methods: Institutional review board approval was acquired for this HIPAA-compliant retrospective study with waiver of informed consent. 1426 consecutive patients undergoing 1512 outpatient image-guided procedures under moderate sedation from November 2012 to August 2014 were included.

Diagnostic yield and clinical impact of microbiologic diagnosis from CT-guided drainage in patients previously treated with empiric antibiotics.

Purpose: The purpose of the study was to evaluate diagnostic yield and the added value of culture results on the clinical management of patients empirically treated with antibiotics prior to CT-guided drainage.

Methods: This retrospective, HIPAA-compliant, IRB-approved study reviewed records of 300 consecutive patients who underwent CT-guided aspiration or drainage for suspected infected fluid collection while on empiric antibiotics (11/2011 to 9/2013) at a single institution. Patient imaging and clinical characteristics were evaluated by an abdominal imaging fellow and culture results, and patient management were evaluated by an infectious diseases fellow.

CT Imaging Findings after Stereotactic Radiotherapy for Liver Tumors.

Purpose. To study radiological response to stereotactic radiotherapy for focal liver tumors. Materials and Methods.

Cytologic rapid on-site evaluation of transthoracic computed tomography-guided lung needle biopsies: who should perform ROSE? A cross-institutional analysis of procedural and diagnostic outcomes.

Introduction: Cytologic rapid on-site evaluation (ROSE) during minimally invasive biopsy procedures is an increasingly important service provided by cytopathology to increase diagnostic yield and appropriately triage cellular material. Although ROSE can be performed by cytopathologists, cytotechnologists, or cytopathology fellows, few studies have directly compared both procedural and diagnostic outcome measures among different ROSE personnel.

Materials And Methods: We evaluated all transthoracic computed tomography (CT)-guided lung biopsies in which ROSE was performed during a 1-year period at 2 academic institutions with similar patient populations and procedural methods: Dartmouth-Hitchcock Medical Center (DHMC) (where ROSE is performed by cytopathologists) and the Beth Israel Deaconess Medical Center (BIDMC) (where ROSE is rendered by either cytotechnologists or cytopathology fellows).

Calcium score: semiautomatic calculation using different vendors versus fully automatic software.

Objectives: Recent advances in technology have resulted in a multitude of cardiac imaging postprocessing software products from vendors unrelated to the scanner on which the cardiac study was initially performed. A fully automatic calcium score software has also become available. We assess the intervendor variability of calcium score measurement using the semiautomatic software provided by the scanner vendor versus an unrelated vendor versus fully automatic software.

CT-guided core biopsy and percutaneous fiducial seed placement in the lung: can these procedures be combined without an increase in complication rate or decrease in technical success?

Objective: To determine if concomitant CT-guided biopsy and percutaneous fiducial seed placement in the lung can be performed in a selective patient population without increased complication or decreased success rates compared to either procedure alone.

Materials And Methods: An IRB approved retrospective analysis of 285 consecutive patients that underwent CT-guided placement of fiducial seeds in the lung alone (N=63), with concomitant core biopsy (N=53) or only core biopsy (N=169) was performed. Variables compared included: patient demographics, lesion size, depth from pleura, needle size, number of passes through pleura, number and size of core biopsies, number of seeds placed and technical success rates.

Pancreatic atrophy in patients with chronic graft-versus-host disease.

Purpose: To determine if patients with chronic graft-versus-host disease (cGVHD) following allogeneic hematopoietic stem cell transplantation (HSCT) develop greater loss of pancreatic tissue than patients without cGVHD.

Materials And Methods: This is an IRB-approved, HIPAA-compliant retrospective study of patients receiving allogeneic HSCT at our institution from 01/2006 to 01/2010 with abdominal CT performed within 3 months prior to HSCT and CT performed at least 3 months after HSCT. Measurement of glandular tissue thickness of the head, body, and tail of the pancreas was performed independently by two radiologists blinded to clinical data.

Diagnostic radiology of transjugular intrahepatic portosystemic shunts.

Transjugular intrahepatic portosystemic shunts (TIPS) are an effective method for treating the complications of portal hypertension. Specific indications for TIPS include secondary prevention of variceal bleeding and refractory ascites. The purpose of this review is to summarize the role of diagnostic radiology in the creation and assessment of TIPS, to highlight the complications that can occur post-TIPS, and to critically evaluate the literature regarding ultrasound evaluation of TIPS.

Critically compromised airway secondary to expanding esophageal mucocele.

Expanding mucocele is a known but rare complication of bypass and surgical exclusion of the thoracic esophagus. When functional esophageal mucosa secretes mucin into the blind esophageal loop, tissue expansion can cause mass effect on nearby structures. We report the case of a critically compromised airway secondary to a dilated esophageal mucocele initially managed with right thoracotomy, partial esophagectomy and mucosectomy.

In vivo determination of a modified heat capacity of small hepatocellular carcinomas prior to radiofrequency ablation: correlation with adjacent vasculature and tumour recurrence.

Purpose: To calculate a modified heat capacity (mHC) of small hepatocellular carcinomas (HCCs) in vivo during radio frequency ablation (RFA) and to determine if mHC correlates with tumour vascularity, adjacent vessels or local recurrence.

Patients And Methods: This study was IRB approved and informed consent was obtained from all patients. Before formal RFA, ambient HCC temperature and temperature 1 min after heating at constant wattage were measured in 29 patients.

Safety profile and technical success of imaging-guided percutaneous fiducial seed placement with and without core biopsy in the abdomen and pelvis.

Objective: The purpose of this study is to determine whether complications associated with combining biopsy and percutaneous fiducial seed placement in the abdomen and pelvis exceeds that of either procedure alone or prohibits completion of the combined procedure.

Materials And Methods: A retrospective review was performed of 188 consecutive patients who underwent CT- or ultrasound-guided placement of fiducial seeds in the abdomen or pelvis, either alone (group 1, n = 117) or with concomitant biopsy (group 2, n = 71), from October 2005 through April 2010. Complications classified according to the Society of Interventional Radiology guidelines were compared between both groups using the Z test for proportions, as were the number of seeds per patient and seed migration and technical success rates.

Incidentally detected misty mesentery on CT: risk of malignancy correlates with mesenteric lymph node size.

Objective: To determine the natural history of incidentally detected misty mesentery on computed tomography (CT) and to correlate the risk of malignancy with size of mesenteric lymph nodes.

Methods: A retrospective review of all CT abdomen/pelvic examinations from January 1, 2004 through December 31, 2008 identified cases of misty mesentery. The largest mesenteric lymph node was measured, and additional areas of lymphadenopathy were identified.

Can Doppler sonography discern between hemodynamically significant and insignificant portal vein stenosis after adult liver transplantation?

Objective: The purpose of our study was to determine whether Doppler sonography, using a strict reference standard, can specifically identify hemodynamically significant portal vein anastomotic stenosis after liver transplantation in adults.

Materials And Methods: The duplex and color Doppler examinations of 13 consecutive adult patients who underwent portal venography for suspected portal vein stenosis after liver transplantation were retrospectively examined. Peak systolic velocity (PSV) and change in PSV (ΔPSV) along the portal vein were correlated with portal venography.

Efficacy of radiofrequency ablation in the treatment of small functional adrenal neoplasms.

Purpose: To evaluate the use of radiofrequency (RF) ablation as a primary treatment for symptomatic primary functional adrenal neoplasms and determine the efficacy of treatment with use of clinical and biochemical follow-up.

Materials And Methods: After obtaining institutional review board approval, the authors retrospectively evaluated images and medical records from 13 consecutive patients with symptomatic functional adrenal neoplasms (<3.2 cm in diameter) who underwent RF ablation during a 7-year period.

Incidentally detected gallbladder polyps: is follow-up necessary?--Long-term clinical and US analysis of 346 patients.

Purpose: To determine the natural history of gallbladder (GB) polyps incidentally detected at ultrasonography (US) and to propose management guidelines for these lesions based on polyp size.

Materials And Methods: The HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. A database search for "polyp" in all US examinations of the GB between January 1, 1999, and December 31, 2001, at a single institution was performed.

Quality initiatives: strategies for anticipating and reducing complications and treatment failures in hepatic radiofrequency ablation.

Radiofrequency (RF) ablation is one of several local treatment strategies that can be used for the destruction of a variety of primary and secondary liver tumors. As experience with RF ablation grows, it becomes increasingly evident that successful ablation requires meticulous technique. In addition, knowledge of potential complications is critical for both the interventionalist and the radiologist, whose postablation interpretation can facilitate identification of complications and treatment failures.

Feasibility of measurement of pancreatic perfusion parameters with single-compartment kinetic model applied to dynamic contrast-enhanced CT images.

Purpose: To examine the feasibility of measuring pancreatic perfusion parameters by using a single-compartment kinetic model applied to contrast material-enhanced computed tomographic (CT) images.

Materials And Methods: This study received institutional review board approval and was HIPAA compliant. Informed consent was waived.

Screening carotid sonography before elective coronary artery bypass graft surgery: who needs it.

Objective: The purpose of this study was to determine whether selection criteria for performing carotid sonographic screening before elective coronary artery bypass graft surgery can decrease the number of negative examinations without overlooking patients with significant carotid disease.

Subjects And Methods: A history of peripheral vascular disease, a prior cerebrovascular event, smoking, diabetes, hypertension, cervical carotid disease, left main coronary disease, and patient sex were criteria prospectively gathered for 295 consecutive patients undergoing screening carotid sonography before elective coronary artery bypass surgery. Logistic regression modeling was used to determine if any single criterion or combination of criteria could be applied to decrease the number of screening examinations without sacrificing detection of significant (> or = 50% cross-sectional narrowing) carotid stenosis.

Femoral-to-port through-and-through wire access to reestablish subcutaneous port function.

Objective: Central venous catheter malfunction often results from fibrin sheath formation and is routinely addressed with thrombolytic therapy or mechanical stripping. Mechanical stripping from a distant access site such as a femoral vein is the only option for a subcutaneous port that has failed thrombolytic therapy. When a fibrin sheath has rendered the catheter tip inaccessible to snaring, catheter salvage cannot be achieved, requiring port exchange.

Restoration of patency in failing tunneled hemodialysis catheters: a comparison of catheter exchange, exchange and balloon disruption of the fibrin sheath, and femoral stripping.

Purpose: To compare median patency times after treatment of malfunctioning tunneled hemodialysis catheters by one of three techniques: over-the-wire catheter exchange (CE), fibrin sheath stripping (FSS) from a femoral vein approach, and over-the-wire catheter removal with balloon dilation of fibrin sheath (DFS) followed by catheter replacement with use of the same tract.

Materials And Methods: Retrospective study was conducted of 66 consecutive procedures performed over a period of 47 months for poor flow through tunneled hemodialysis catheters despite tissue plasminogen activator infusion trials (CE, n=33; FSS, n=18; DFS, n=15). Baseline parameters (time since initial catheter placement, number of previous catheter interventions, catheter access site, and patient age and sex) were recorded to identify possible pretreatment differences among groups.

Small-bowel perfusion measurement: feasibility with single-compartment kinetic model applied to dynamic contrast-enhanced CT.

This study was institutional review board approved and HIPAA compliant. Informed consent was obtained from all patients. The purpose of the study was to prospectively examine the feasibility of measuring small-bowel quantitative blood flow by using motion-corrected, contrast-enhanced computed tomographic (CT) images and a single-compartment kinetic model.