[Show abstract][Hide abstract] ABSTRACT: Interventional radiologists have played a main role in the technical evolution of gastrostomy, from the first surgical/endoscopical approaches to percutaneous interventional procedures. This study evaluated the results obtained in a 12-year series.
During the period December 1996 to December 2008, 254 new consecutive gastrostomies and 275 replacement procedures were performed in selected patients. All of the cases were treated by a T-fastener gastropexy and tube placement. The procedures were assessed by analyzing indications, patient selection, duration of the procedures, and mortality.
All 254 first gastrostomies were successful; replacement procedures were also successfully performed. One (0.2%) patient with severe neurologic disorders died after the procedure without signs of procedure-related complications, and seven (1.3%) major complications occurred (four duodenal lesions with peritoneal leakage, two gastric bleedings, and one gastric lesion). Minor complications were easily managed; three tube ruptures were resolved.
This long-term series and follow-up showed that a group of interventional radiologist can effectively provide gastrostomy placement and long-term tube management. Percutaneous gastrostomy is less invasive than other approaches and it satisfies the needs even of high-risk patients.
[Show abstract][Hide abstract] ABSTRACT: The projectional nature of radiogram limits its amount of information about the instrumented spine. MRI and CT imaging can be more helpful, using cross-sectional view. However, the presence of metal-related artifacts at both conventional CT and MRI imaging can obscure relevant anatomy and disease. We reviewed the literature about overcoming artifacts from metallic orthopaedic implants at high-field strength MRI imaging and multi-detector CT. The evolution of multichannel CT has made available new techniques that can help minimizing the severe beam-hardening artifacts. The presence of artifacts at CT from metal hardware is related to image reconstruction algorithm (filter), tube current (in mA), X-ray kilovolt peak, pitch, hardware composition, geometry (shape), and location. MRI imaging has been used safely in patients with orthopaedic metallic implants because most of these implants do not have ferromagnetic properties and have been fixed into position. However, on MRI imaging metallic implants may produce geometric distortion, the so-called susceptibility artifact. In conclusion, although 140 kV and high milliamperage second exposures are recommended for imaging patients with hardware, caution should always be exercised, particularly in children, young adults, and patients undergoing multiple examinations. MRI artifacts can be minimized by positioning optimally and correctly the examined anatomy part with metallic implants in the magnet and by choosing fast spin-echo sequences, and in some cases also STIR sequences, with an anterior to posterior frequency-encoding direction and the smallest voxel size.
Preview · Article · Jun 2009 · European Spine Journal
[Show abstract][Hide abstract] ABSTRACT: Aggressive fibromatosis is an invasive non-metastasizing soft-tissue tumor. Until recently, the standard treatment combined surgery and radiation therapy, but new studies reported that conservative strategies with or without medical treatment could be the best management. The aim of this study was to analyze and correlate the size and MR imaging signal features of aggressive fibromatosis with its behavior in order to choose the best treatment.
Between March 1985 and December 2005, 27 patients with at least 2 consecutive MRI examinations and no surgery or radiation therapy in between were recorded. There were 9 men and 18 women, and median age was 31 years. They underwent 107 MRI examinations of 47 lesions, 29 of which were medically treated, while the remaining 18 did not receive any drug administration. The size and signal changes of each lesion were studied over time on T2- and/or T1-weighted sequences after injection of contrast medium. RECIST criteria were used for size: only a 30% decrease or a 20% increase in the size of the main dimension was considered significant. We classified the appearance of the signal into six categories in order of increasing intensity and then we established the related variations over time.
The size of 79% of the lesions in the treated group and 82% in the untreated group remained stable. The initial signal of stable lesions or those exhibiting an increase in size was most frequently high. There was a high rate of signal stability over time, whatever the initial signal and size changes. Changes in size were not correlated with the initial MR signal. A decrease in size associated with a decreased signal was observed in three cases exclusively in the treated group.
Fibromatoses are a group of soft-tissue tumors with variable characteristics on MRI, but it is not possible to predict their behavior based on the MRI signal.
Full-text · Article · Dec 2008 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: To retrospectively evaluate the outcome of carotid artery stent placement (CAS) without the use of embolic protection devices (EPDs) in a large cohort of patients.
Institutional review board approval and informed consent from all patients were obtained. Preprocedure color Doppler ultrasonography (US), magnetic resonance (MR) imaging, or computed tomography (CT) were used to evaluate stenosis severity (70% or greater). Clinical findings and combined 30-day complication rates in 400 patients (289 men, 111 women; mean age, 73 years +/- 8 [standard deviation]) who underwent unprotected CAS for asymptomatic (n = 156; 39%) or symptomatic (n = 244, 61%) stenoses were analyzed. Follow-up at 30 days included neurologic evaluation and color Doppler US.
Self-expanding stents were successfully deployed in 397 of 400 (99.25%) patients. Among the 397 patients, nine (2.27%) major complications (all in patients with prior symptoms) had occurred at 30 days, including three (0.76%) major (all in patients who had stopped antiplatelet prophylaxis) and six (1.5%) minor strokes--three intraprocedural and three delayed. Minor complications included 16 (4%) transient ischemic attacks, four in asymptomatic and 12 in symptomatic patients. The 30-day combined adverse outcomes (transient ischemic attack, ipsilateral stroke, death) were significantly correlated with prior presence of symptoms (symptomatic, 8.6%; asymptomatic, 2.6%; P < .03).
Stent placement without EPD was performed with a high technical success rate. For asymptomatic patients, the combined 30-day adverse-outcomes rate was within the limits recommended by the American Heart Association for carotid endarterectomy and compared favorably with results reported for CAS with EPD. When a transient ischemic attack is excluded, the 30-day combined death and stroke rate among patients with prior symptoms also compared favorably with published results.
[Show abstract][Hide abstract] ABSTRACT: Stenoses of internal carotid artery (ICA) are one of the most common causes of cerebral stroke. It is well stated in the current Literature that when the stenosis is >70%, invasive treat- ment, whether by surgery or by stent place- ment, decreases the risk of a cerebral accident. Cerebral aneurysm is a relevant cause of stroke but the pathophysiological mechanism of the possible stroke due to the aneurysm rupture is completely different. The incidence of cerebral aneurysm in patients with ICA stenosis is esti- mated to be 2.3-4.9%. The coexistence of the two diseases, although uncommon, may present a diagnostic and therapeutic dilemma. We have to take into account that the treatment of this patients may be performed by physicians with different cultural background ( Vascular Surgeon, Interventional Cardiologist, Interven- tional Radiologist, Interventional Neuroradi- ologist ) and this has a dramatic impact on the diagnostic point of view despite the guidelines in this field are well known. The common use of Eco-color Doppler and Cerebral CT does not allow the array of informations needed for carotid intervention. On the other hand DSA is not the alternative for the great invasivity and the iatrogenic risk of complex examinations ( extra - intracranial). The significant diagnostic impact of Brain MRI and Extra & Intracranial Angio MRI may be the added value for the non invasive diagnosis and mainly in the rare situation of cerebral aneurysm in patients with ICA. In any case the MRI pattern allows defining valid indications to the procedure. The assessment of not valid indications to the procedure are instead the presence of multiple lacunar infarcts (the treatment could not change the prognosis), disease of the small arteries (an unsuitable treatment could get worse the prog- nosis towards the insanity) and the concomitant intracranial stenoses.