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Sample records for ct-guided lumbar sympathectomy

  1. Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia

    International Nuclear Information System (INIS)

    Pieri, Stefano; Agresti, Paolo; Di Cesare, Fabio; Ricci, Guiseppe

    2005-01-01

    Purpose: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. Materials and methods: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularization. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. Results: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the month immediately following the procedure. Discussion: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limb. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of Ct-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation [it

  2. Lumbar sympathectomy under CT guidance: therapeutic option in critical limb ischaemia; la simpaticolisi TC guidata: alternativa terapeutica delle ischemie critiche

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    Pieri, Stefano; Agresti, Paolo [Az. Osp. S. Camillo-Forlanini, Roma (Italy). U.O. di radiologia vascolare ed interventistica; Ialongo, Pasquale; Fedeli, Stefano [Radiologia diagnostica Busi, Roma (Italy); Di Cesare, Fabio; Ricci, Guiseppe [Az. Osp. S. Camillo-Forlanini, Roma (Italy). Chirurgia vascolare

    2005-04-01

    Purpose: Lumbar sympathectomy is a complementary therapeutic option for patients with severe peripheral vascular occlusive disease presenting rest pain or gangrene and not eligible for surgical revascularisation. Traditional surgical sympathectomy was widely used in the past. However, due to its invasive character, it has increasingly been replaced by percutaneous techniques and, in some recent cases, by laparoscopic procedures. Percutaneous lumbar sympathectomy is a safe, cost-effective and widely available treatment option. We report our experience on 19 patients subjected to percutaneous sympathectomy under CT guidance. Materials and methods: Between 1998 and 2000, 19 patients underwent percutaneous sympathectomy under CT guidance. All patients had severe vascular disease of the lower extremities (Fontaine stage IV), with rest pain and gangrene. They were not eligible for surgical revascularization. Phenol was injected at the level of L2 and L4 using two 22 G needles (15 cm long). Signs of interrupted sympathetic activity usually occur 2'-15' after the procedure with warmth and flushing and dryness of the lower extremities. Results: Percutaneous sympathectomy under CT guidance is a simple, safe and well-tolerated procedure with a low rate of complications. Of the 19 patients, 9 (47.3%) showed clinical improvement, whereas 5 experienced a worsening of ischaemia in the month immediately following the procedure. Discussion: Results suggest that percutaneous lumbar sympathectomy causes a sympathetic blockade in patients with advanced vascular disease of the limb. CT guidance ensures a high level of precision in drug dosing, thus lowering the risk of complications. Although the results are demoralizing. the impossibility of achieving surgical revascularisation in advanced peripheral arteriosclerosis enhances the role of Ct-guided percutaneous sympathectomy in relieving rest pain and healing ulcers in order to postpone the amputation. [Italian] Scopo: La

  3. CT-Guided Lumbar Sympathectomy: Results and Analysis of Factors Influencing the Outcome

    International Nuclear Information System (INIS)

    Heindel, Walter; Ernst, Stefan; Manshausen, Gudrun; Gawenda, Michael; Siemens, Peter; Krahe, Thomas; Walter, Michael; Lackner, Klaus

    1998-01-01

    Purpose: To prospectively analyze the effectiveness of computed tomography-guided percutaneous lumbar sympathectomy (CTLS) in patients with peripheral arterial occlusive disease in relation to angiographic findings and vascular risk factors. Methods: Eighty-three patients were treated by CTLS. After clinical evaluation of the risk profile and diagnostic intraarterial digital subtraction arteriography, 14 patients underwent unilateral, and 69 bilateral one-level treatment. Follow-up studies took place on the day following the intervention, after 3 weeks, and after 3 months. Results: A total of 152 interventions were performed in 83 patients. After 3 months, clinical examination of 54 patients (5 patients had died, 24 were lost to follow-up) revealed improvement in 46% (25/54), no change in 39% (21/54), and worsening (amputation) in 15% (8/54). There was no significant statistical correlation among any of the analyzed factors (diabetes mellitus, arterial hypertension, smoking, hyperlipidemia, obesity, hyperuricemia, number of risk factors, ankle-arm index, and angiography score) and the outcome after CTLS. Three major complications occurred: one diabetic patient developed a retroperitoneal abscess 2 weeks after CTLS, and in two other patients ureteral strictures were detected 3 months and 2 years after CTLS, respectively. Conclusion: As no predictive criteria for clinical improvement in an individual patient could be identified, CTLS, as a safe procedure, should be employed on a large scale in patients who are unsuitable for treatment by angioplasty or revascularization

  4. CT-guided percutaneous neurolysis methods. State of the art and first results

    International Nuclear Information System (INIS)

    Schneider, B.; Richter, G.M.; Roeren, T.; Kauffmann, G.W.

    1996-01-01

    We used 21G or 22G fine needles. All CT-guided percutaneous neurolysis methods require a proper blood coagulation. Most common CT scanners are suitable for neurolysis if there is enough room for maintaining sterile conditions. All neurolysis methods involve sterile puncture of the ganglia under local anesthesia, a test block with anesthetic and contrast agent to assess the clinical effect and the definitive block with a mixture of 96% ethanol and local anesthetic. This allows us to correct the position of the needle if we see improper distribution of the test block or unwanted side effects. Though inflammatory complications of the peritoneum due to puncture are rarely seen, we prefer the dorsal approach whenever possible. Results: Seven of 20 legs showed at least transient clinical improvement after CT-guided lumbar sympathectomies; 13 legs had to be amputated. Results of the methods in the literature differ. For lumbar sympathectomy, improved perfusion is reported in 39-89%, depending on the pre-selection of the patient group. Discussion: It was recently proved that sympathectomy not only improves perfusion of the skin but also of the muscle. The hypothesis of a steal effect after sympathectomy towards skin perfusion was disproved. Modern aggressive surgical and interventional treatment often leaves patients to sympathectomy whose reservers of collateralization are nearly exhausted. We presume this is the reason for the different results we found in our patient group. For thoracic sympathectomy the clinical treatment depends very much on the indications. Whereas palmar hyperhidrosis offers nearly 100% success, only 60-70% of patients with disturbance of perfusion have benefited. Results in celiac ganglia block also differ. Patients with carcinoma of the pancreas and other organs of the upper abdomen benefit in 80-100% of all cases, patients with chronic pancreatitis in 60-80%. (orig./VHE) [de

  5. Retroperitoneal hemorrhage from an unrecognized puncture of the lumbar right segmental artery during lumbar chemical sympathectomy: diagnosis and management.

    Science.gov (United States)

    Shin, Ho-Jin; Choi, Yun-Mi; Kim, Hye-Jin; Lee, Sun-Jae; Yoon, Seok-Hyun; Kim, Kyung-Hoon

    2014-12-01

    Lumbar chemical sympathectomy has been performed using fluoroscopic guidance for needle positioning. An 84 year old woman with atherosclerosis obliterans was referred to the pain clinic for intractable cold allodynia of her right foot. A thermogram showed decreased temperature of both feet compared with temperatures above both ankles. The patient agreed to undergo lumbar chemical sympathectomy using fluoroscopy after being informed of the associated risks of nerve injury, hemorrhage, infection, transient back pain, and transient hypotension. During the procedure and three hours afterward, no abnormal signs or symptoms were found except an increase in right leg temperature. The patient was ambulatory after the procedure. However, one day after undergoing lumbar chemical sympathectomy, she visited our emergency department for abdominal discomfort and postural dizziness. Her blood pressure was 80/50 mmHg, and flank tenderness was noted. Retroperitoneal hemorrhage from the second right lumbar segmental artery was shown on computed tomography and angiography. Vital signs were stabilized immediately after embolization into the right lumbar segmental artery. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. CT-guided periradicular therapy in cervical and lumbar radicular syndromes

    International Nuclear Information System (INIS)

    Nian Dingfang; Zhou Jun; Li Wenhua; Cao Qingxuan; Xia Baosu; Apitzsch, D.E.

    2007-01-01

    Objective: To evaluate the effectiveness of CT-guided periradicular therapy (PRT) in cervical and lumber radicular syndromes. Methods: Seventy two cases of cervical and lumbar radicular syndromes were treated by CT-guided PRT. During PRT, 10-20 mg of Triamhexal and 3-4 ml of Carbostesin 0.25%(Bupivacainhydrochlorid) were injected into the space around the corresponding spinal root, once a week, all together six times as a course. Results: Four hundreds and forty six PRT procedures were carried out in 72 patients having a successful puncture and a satisfying spread of Triamhexal and Carbostesin around the spinal nerve root space for every time. After 6 to 24 months follow up, 62 patients showed a significant pain reduction or complete disappearance. Moderate improvement was not noted in 6 and no improvement in 4. The effective rate was 94.4% without any correlative complication. Conclusions: CT-guided PRT is an effective, easy and safe procedure to treat patients with refractory cervical or lumbar radicular pain syndromes. (authors)

  7. CT-guided percutaneous neurolysis methods. State of the art and first results; CT-gesteuerte Neurolysen. Stand der Technik und aktuelle Ergebnisse

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    Schneider, B. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Richter, G.M. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Roeren, T. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany); Kauffmann, G.W. [Abt. Radiodiagnostik, Radiologische Universitaetsklinik Heidelberg (Germany)

    1996-09-01

    We used 21G or 22G fine needles. All CT-guided percutaneous neurolysis methods require a proper blood coagulation. Most common CT scanners are suitable for neurolysis if there is enough room for maintaining sterile conditions. All neurolysis methods involve sterile puncture of the ganglia under local anesthesia, a test block with anesthetic and contrast agent to assess the clinical effect and the definitive block with a mixture of 96% ethanol and local anesthetic. This allows us to correct the position of the needle if we see improper distribution of the test block or unwanted side effects. Though inflammatory complications of the peritoneum due to puncture are rarely seen, we prefer the dorsal approach whenever possible. Results: Seven of 20 legs showed at least transient clinical improvement after CT-guided lumbar sympathectomies; 13 legs had to be amputated. Results of the methods in the literature differ. For lumbar sympathectomy, improved perfusion is reported in 39-89%, depending on the pre-selection of the patient group. Discussion: It was recently proved that sympathectomy not only improves perfusion of the skin but also of the muscle. The hypothesis of a steal effect after sympathectomy towards skin perfusion was disproved. Modern aggressive surgical and interventional treatment often leaves patients to sympathectomy whose reservers of collateralization are nearly exhausted. We presume this is the reason for the different results we found in our patient group. For thoracic sympathectomy the clinical treatment depends very much on the indications. Whereas palmar hyperhidrosis offers nearly 100% success, only 60-70% of patients with disturbance of perfusion have benefited. Results in celiac ganglia block also differ. Patients with carcinoma of the pancreas and other organs of the upper abdomen benefit in 80-100% of all cases, patients with chronic pancreatitis in 60-80%. (orig./VHE) [Deutsch] Thorakale und lumbale Sympathikolyse sowie die Zoeliakusblockade

  8. Complications of CT guided lumbar sympathicolysis: own experience and review of literature

    International Nuclear Information System (INIS)

    Ernst, S.; Heindel, W.; Fischbach, R.; Langen, H.J.; Krahe, T.; Gawenda, M.; Neubauer, S.

    1998-01-01

    Aim: To review the complications of CT guided lumbar sympathicolysis (CTLS) on the basis of our own experience and the available literature. Methods: 241 CTLS were performed by a standard technique according to Haaga's method. Clinical follow-up revealed 4 serious complications; these were analysed and compared with published cases. Results: Amongst our patients there were three fibrotic ureter stenoses and one retroperitoneal abscess. Analysis of the serious complications described in the literature indicates that introduction of CT guided lumbar sympathicolysis has reduced the severity and frequency of complications as compared with surgical and 'blind' procedures. With CTLS, no deaths due to the procedure have been reported in the literature. The results indicate that damage to the ureters can be caused by substances used for the neurolysis. (orig./MG) [de

  9. Clinical application of percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation under CT guidance

    International Nuclear Information System (INIS)

    Wang Linyou; Li Yuan; Shao Yangtong

    2004-01-01

    Objective: To evaluate the effect of the percutaneous lumbar puncture to treat sciatica caused by lumbar disc herniation. Methods: 75 cases of lumbar disc herniation with significant clinical signs were confirmed by CT scan. The technique of the percutaneous lumbar puncture led the needle to approach nerve root and injected medicine diffusing into extraduramater, and then relieved the symptom of sciatica. Results: The rate of success of percutaneous lumbar puncture guided by CT reached to 100%. After two weeks of follow-up, the symptom of pain was obviously improved and disappeared in 63.3% cases. There were 23.0% cases needed a second procedure, and no change was obsesved in 9.3% cases. Conclusions: The percutaneous lumbar puncture guided by CT to treat sciatica resulted from lumbar disc herniation is one of the safe, reliable, effective new methods with no complication. The long term effectiveness is still in need of investigation. (authors)

  10. Radiation dose reduction in CT-guided periradicular injections in lumbar spine: Feasibility of a new institutional protocol for improved patient safety

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    Artner Juraj

    2012-08-01

    Full Text Available Abstract Background Image guided spinal injections are successfully used in the management of low back pain and sciatica. The main benefit of CT-guided injections is the safe, fast and precise needle placement, but the radiation exposure remains a serious concern. The purpose of the study was to test a new institutional low-dose protocol for CT-guided periradicular injections in lumbar spine to reduce radiation exposure while increasing accuracy and safety for the patients. Methods We performed a retrospective analysis of a prospective database during a 4-month period (Oct-Dec 2011 at a German University hospital using a newly established low-dose-CT-protocol for periradicular injections in patients suffering from lumbar disc herniation and nerve root entrapment. Inclusion criteria were acute or chronic nerve root irritation due to lumbar disc hernia, age over 18, compliance and informed consent. Excluded were patients suffering from severe obesity (BMI > 30, coagulopathy, allergy to injected substances, infection and non-compliant patients. Outcome parameters consisted of the measured dose length product (mGycm2, the amount of scans, age, gender, BMI and the peri-interventional complications. The results were compared to 50 patients, treated in the standard-interventional CT-protocol for spinal injections, performed in June-Oct 2011, who met the above mentioned inclusion criteria. Results A total amount of 100 patients were enrolled in the study. A significant radiation dose reduction (average 85.31% was achieved using the institutional low-dose protocol compared to standard intervention mode in CT-guided periradicular injections in lumbar spine. Using the low-dose protocol did not increase the complications rate in the analyzed cohort. Conclusions Low-dose-CT-protocols for lumbar perineural injections significantly reduce the exposure to radiation of non-obese patients without an increase of complications. This increases long-time patient

  11. CT-guided percutaneous laser disk decompression for cervical and lumbar disk hernia

    International Nuclear Information System (INIS)

    Shimizu, Kanichiro; Koyama, Tutomu; Harada, Junta; Abe, Toshiaki

    2008-01-01

    Percutaneous laser disk decompression under X-ray fluoroscopy was first reported in 1987 for minimally invasive therapy of lumbar disk hernia. In patients with disk hernia, laser vaporizes a small portion of the intervertebral disk thereby reducing the volume and pressure of the affected disk. We present the efficacy and safety of this procedure, and analysis of fair or poor response cases. In our study, 226 cases of lumbar disk hernia and 7 cases of cervical disk hernia were treated under CT guided PLDD. Japan Orthopedic Association (JOA) score and Mac-Nab criteria were investigated to evaluate the response to treatment. Improvement ratio based on the JOA score was calculated as follows. Overall success rate was 91.6% in cases lumber disk hernia, and 100% in cases of cervical disk hernia. We experienced two cases with two cases with postoperative complication. Both cases were treated conservatively. The majority of acute cases and post operative cases were reported to be 'good' on Mac-Nab criteria. Cases of fair or poor response on Mac-Nab criteria were lateral type, foraminal stenosis or large disk hernia. CT-guided PLDD is a safe and accurate procedure. The overall success rate can be increased by carefully selecting patients. (author)

  12. The effect of sympathectomy on bone blood flow in man

    International Nuclear Information System (INIS)

    Lahtinen, T.; Alhava, E.M.; Hyoedynmaa, S.; Hendolin, H.; Oksala, I.

    1982-01-01

    The effect of lumbar sympathectomy on bone blood flow was measured in seven patients with a Xe-133 washout method. On the third postoperative day there was a significant increase of blood flow in the proximal femur and a slight increase in the proximal tibia. Two months after the operation blood flow in the proximal part of the femur was no more significantly increased but in the proximal tibia there was a significant increase. The study suggests that the positive effect of sympathectomy on bone blood flow may be of value in cases where the increase of blood flow to peripheral bones is required

  13. MR-guided lumbar sympathicolysis

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    Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, University of Tuebingen (Germany); Schneider, Wilke [Department of Vascular Surgery, University of Tuebingen (Germany)

    2002-06-01

    The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

  14. MR-guided lumbar sympathicolysis

    International Nuclear Information System (INIS)

    Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H.; Schneider, Wilke

    2002-01-01

    The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

  15. Augmented Reality-Guided Lumbar Facet Joint Injections.

    Science.gov (United States)

    Agten, Christoph A; Dennler, Cyrill; Rosskopf, Andrea B; Jaberg, Laurenz; Pfirrmann, Christian W A; Farshad, Mazda

    2018-05-08

    The aim of this study was to assess feasibility and accuracy of augmented reality-guided lumbar facet joint injections. A spine phantom completely embedded in hardened opaque agar with 3 ring markers was built. A 3-dimensional model of the phantom was uploaded to an augmented reality headset (Microsoft HoloLens). Two radiologists independently performed 20 augmented reality-guided and 20 computed tomography (CT)-guided facet joint injections each: for each augmented reality-guided injection, the hologram was manually aligned with the phantom container using the ring markers. The radiologists targeted the virtual facet joint and tried to place the needle tip in the holographic joint space. Computed tomography was performed after each needle placement to document final needle tip position. Time needed from grabbing the needle to final needle placement was measured for each simulated injection. An independent radiologist rated images of all needle placements in a randomized order blinded to modality (augmented reality vs CT) and performer as perfect, acceptable, incorrect, or unsafe. Accuracy and time to place needles were compared between augmented reality-guided and CT-guided facet joint injections. In total, 39/40 (97.5%) of augmented reality-guided needle placements were either perfect or acceptable compared with 40/40 (100%) CT-guided needle placements (P = 0.5). One augmented reality-guided injection missed the facet joint space by 2 mm. No unsafe needle placements occurred. Time to final needle placement was substantially faster with augmented reality guidance (mean 14 ± 6 seconds vs 39 ± 15 seconds, P Augmented reality-guided facet joint injections are feasible and accurate without potentially harmful needle placement in an experimental setting.

  16. Spinal CT scan, 2. Lumbar and sacral spines

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    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

    1982-08-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

  17. An atypical case of postsurgical complex regional pain syndrome in a patient having nonhealing varicose venous ulcer treated by lumbar sympathectomy

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    Kailash Kothari

    2017-01-01

    Full Text Available Complex regional pain syndrome (CRPS of the lower limb is a relatively uncommon entity as compared to CRPS of the upper extremity. Literature search has revealed only 2 retrospective case series and a single case report of lower extremity CRPS type I from 1975 to 2014 on Pubmed, isolated cases of CRPS type I of lower extremity have also been reported following knee surgeries and arthroscopies. This report presents a case of lower limb CRPS type I, following surgery for varicose vein ulcer. Pain was not relieved with medications. Diagnostic lumbar sympathectomy was done and patient had tremendous relief of pain following that, proving sympathetic mediated pain of the involved limb.

  18. Percutaneous chemical lumbar sympathectomy for buerger's disease: Results in 147 patients

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    Reena Kothari

    2017-01-01

    Full Text Available Objectives: The objective of this study was to evaluate the efficacy, safety, and clinical outcome of percutaneous chemical lumbar sympathectomy (PCLS in Buerger's disease (thromboangiitis obliterans [TAO]. Design: This was a retrospective comparative study. Methods: TAO patients who underwent PCLS in surgery department of a teaching hospital in Central India. Diagnosis of TAO was made on clinical grounds and color Doppler study. PCLS was done under image guidance after amputation of gangrene or before if a clear line of demarcation was lacking. After PCLS, patients were followed up on next day and after 2, 4, 8, and 12 weeks. Outcome monitored were improvement in rest pain (using visual analog scale and healing of ischemic ulcers. Results: All patients were males, chronic bidi smokers, mostly in the third decade of life. All had involvement of lower limbs either ischemic rest pain or ischemic ulcers or gangrene of toes/forefoot. A total of 167 PCLS (20 bilateral were performed on 147 TAO patients from June 2008 to January 2016. Imaging modalities were computed tomography scan (n = 67, digital X-ray (n = 50, and C-arm fluoroscopy (n = 50. Success rate for chemical neurolysis was > 82%. Excellent long-lasting rest pain relief was obtained in > 80% patients. Ulcer healing was seen in majority of patients. Large number of limbs (103/167 had gangrene of toe/multiple toes/part of forefoot. Those with patent popliteal artery fared better. Conclusions: PCLS can provide safe and efficient treatment for rest pain and healing of ischemic ulcers in TAO.

  19. Pulse oximeter perfusion index as an early indicator of sympathectomy after epidural anesthesia.

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    Ginosar, Y; Weiniger, C F; Meroz, Y; Kurz, V; Bdolah-Abram, T; Babchenko, A; Nitzan, M; Davidson, E M

    2009-09-01

    The pulse oximeter perfusion index (PI) has been used to indicate sympathectomy-induced vasodilatation. We hypothesized that pulse oximeter PI provides an earlier and clearer indication of sympathectomy following epidural anesthesia than skin temperature and arterial pressure. Forty patients received lumbar epidural catheters. Patients were randomized to receive either 10 ml 0.5% bupivacaine or 10 ml 0.25% bupivacaine. PI in the toe, mean arterial pressure (MAP) and toe temperature were all assessed at baseline and at 5, 10 and 20 min following epidural anesthesia. The effect of epidural anesthesia over time was assessed by repeated measures analysis of variance. Additionally, we defined clinically evident sympathectomy criteria (a 100% increase in the PI, a 15% decrease in MAP and a 1 degrees C increase in toe temperature). The numbers of patients demonstrating these changes for each test were compared using the McNemar test for each time point. Twenty-nine subjects had photoplethysmography signals that met a priori signal quality criteria for analysis. By 20 min, PI increased by 326%, compared with a 10% decrease and a 3% increase in MAP and toe temperature, respectively. For PI 15/29, 26/29 and 29/29 of the subjects met the sympathectomy criteria at 5, 10 and 20 min, respectively, compared with 4/29, 6/29 and 18/29 for MAP changes and 3/29, 8/29 and 14/29 for toe temperature changes. PI was an earlier, clearer and more sensitive indicator of the development of epidural-induced sympathectomy than either skin temperature or MAP.

  20. Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization

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    Min-Gang Kim

    2013-12-01

    Full Text Available Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE, which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.

  1. CT recognition of lateral lumbar disk herniation

    International Nuclear Information System (INIS)

    Williams, A.L.; Haughton, V.M.; Daniels, D.L.; Thornton, R.S.

    1982-01-01

    Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

  2. Multiplanar reformatted CT applications in the lumbar spine

    International Nuclear Information System (INIS)

    Ueda, Takafumi; Kojima, Shinsaburo; Araki, Nobuto; Miyauchi, Sumihiko

    1986-01-01

    Diagnostic value and limitations of multiplanar reformatted CT were evaluated in 55 patients with lumbar diseases. Reformatted images in coronal, sagittal, paraxial, and oblique planes were acquired from the transverse axial images, thereby allowing three-dimensional visualization of lesions in the lumbar spine. Oblique images that were reformmated along the nervous root were useful in visualizing lesions in the root canal, which were not available on either conventional myelography or transverse axial CT. A definitive plane determination is required for reformation of images, taking curvature of the spinal column into account. (Namekawa, K.)

  3. Lumbar CT findings of patients with low back pain

    International Nuclear Information System (INIS)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang

    1986-01-01

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  4. Lumbar CT findings of patients with low back pain

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yong Chul; Kim, Yang Soo; Kim, Kyun Sang [Chung-Ang University, Seoul (Korea, Republic of)

    1986-04-15

    Low back pain is probably the second most common disease entity to upper respiratory infection in developed country. We were missing at least 50% of the pathologic conditions by using conventional diagnostic modalities in low back pain. They did tell us nothing or little about facet abnormalities, lateral recesses, vertebral canal and soft tissue surrounding lumbar spines. High resolutional CT has been the biggest turning point in the diagnosis and management of low back pain. CT make a contribution to reducing the morbidity and probably the cost of evaluating patients with low back pain, and to increasing diagnostic accuracy. We observed 100 cases of lumbar CT using TCT 80A scanner for the evaluation of low back pain during the period from Apr. 1985 to Sept. 1985 at Chung-Ang University Hospital. Lumbar CT scan reveals high-positive findings (98%) in low back pain patients. Common low back disorders in CT are disc bulging (53%), herniated nucleus pulposus (32%), degenerative arthritis in posterior facet joints (27%), spinal stenosis (20%) and postoperative spines (15%). Uncommon low back disorders in CT are compression fracture of vertebral bodies, spondylolysis or spondylolisthesis, tropism, transitional vertebra, Scheueman's disease, limbic fracture, transverse process or articular process fracture, sacroiliac joint subluxation, conjoined nerve root and meningocele.

  5. Diffusion-weighted imaging for pretreatment evaluation and prediction of treatment effect in patients undergoing CT-guided injection for lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Niu, Xiang Ke [Dept. of Radiology, Affiliated Hospital of Chengdu University, Chengdu (China); Bhetuwal, Anup; Yang, Han Feng [Schuan Key Laboratory of Medical Imaging and Dept. of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2015-08-15

    To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O{sub 2}-O{sub 3}) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O{sub 2}-O{sub 3} mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O{sub 2}-O{sub 3} therapy was determined. Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O{sub 2}-O{sub 3} injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

  6. Diffusion-weighted imaging for pretreatment evaluation and prediction of treatment effect in patients undergoing CT-guided injection for lumbar disc herniation

    International Nuclear Information System (INIS)

    Niu, Xiang Ke; Bhetuwal, Anup; Yang, Han Feng

    2015-01-01

    To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O 2 -O 3 ) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation. A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O 2 -O 3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) x 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O 2 -O 3 therapy was determined. Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up. This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O 2 -O 3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation

  7. Improving the trajectory of transpedicular transdiscal lumbar screw fixation with a computer-assisted 3D-printed custom drill guide

    Directory of Open Access Journals (Sweden)

    Zhen-Xuan Shao

    2017-07-01

    Full Text Available Transpedicular transdiscal screw fixation is an alternative technique used in lumbar spine fixation; however, it requires an accurate screw trajectory. The aim of this study is to design a novel 3D-printed custom drill guide and investigate its accuracy to guide the trajectory of transpedicular transdiscal (TPTD lumbar screw fixation. Dicom images of thirty lumbar functional segment units (FSU, two segments of L1–L4 were acquired from the PACS system in our hospital (patients who underwent a CT scan for other abdomen diseases and had normal spine anatomy and imported into reverse design software for three-dimensional reconstructions. Images were used to print the 3D lumbar models and were imported into CAD software to design an optimal TPTD screw trajectory and a matched custom drill guide. After both the 3D printed FSU models and 3D-printed custom drill guide were prepared, the TPTD screws will be guided with a 3D-printed custom drill guide and introduced into the 3D printed FSU models. No significant statistical difference in screw trajectory angles was observed between the digital model and the 3D-printed model (P > 0.05. Our present study found that, with the help of CAD software, it is feasible to design a TPTD screw custom drill guide that could guide the accurate TPTD screw trajectory on 3D-printed lumbar models.

  8. The results of CT-guided periradicular pain control

    International Nuclear Information System (INIS)

    Uhlenbrock, D.; Arlinghaus, J.

    1997-01-01

    The effectiveness of CT-guided periradicular pain therapy was studied. Material and method: 55 patients with lumbar and/or radicular pain were treated by periradicular injections of 40 ml triamcinolon, in some cases combined with injection of the facets of the lumbar vertebrae. 36 patients had chronic symptoms; in 7, these were acute, and 12 patients complained of renewed disc symptoms following previous disc surgery. Approximately 4 months after the conclusion of treatment, the patients were requested to complete a questionnaire giving information on the course and after-effects of treatment. The questionnaire was repeated after 5 months. Results: 55% of patients were free of symptoms or had had some improvement at the time of the questionnaire; 30% reported temporary improvement, and in 15% there was no change compared with the pre-treatment symptoms. At the time of the second questionnaire, the proportion of patients who had derived benefit from the treatment was somewhat lower. 49% reported that they were pain-free or improved, while temporary improvement was reported by 36% of patients. Conclusion: CT-guided periradicular pain therapy is a valuable procedure in patients in whom conservative measures prove ineffective, and when surgery is not indicated. However, only about half the treated patients maintain permanent improvement. (orig.) [de

  9. Lumbar apophyseal ring fracture and disc herniation: CT and MRI manifestations

    International Nuclear Information System (INIS)

    Lee, Hyeon Kyeong; Kang, Heung Sik; Song, Chi Sung

    1991-01-01

    To understand CT and MR findings and, furthermore, the pathophysiology of the lumbar apophyseal ring fracture (LARF) associated with lumbar disc herniation in 31 cases of LARF (CT was performed in 23, MRI in 18, and both CT and MRI in 12), we studied the age and sex distribution of the patients, history of trauma, shape of bony fragment, number of lesions, lesion sites, associated lumbar disc herniations, and evidence of Scheuermann's disease. Twenty-three out of 31 patients were male, 6 were adolescents, 21 were young adults, and 4 were middled-aged. Arcuate or nodular bone fragment and/or bone defects were detected at the posterior margin of L1 in 2, L2 in 1, L3 in 1, L4 in 10, L5 in 20 and S1 in 7 patients. Eight patients showed multiple LARF, and 13 showed multiple lumbar disc herniations. Radiologic evidence of Scheuermann's disease was obvious in 9 patients. Only 6 patients had a history of evident trauma. CT and MRI showed a similar detection rate of bone fragments and defects. We concluded that LARF would be encountered in young male patients with multiple lumbar disc herniations and evidence of Scheuermann's disease

  10. CT reconstruction technique in lumbar intraneuroforaminal disc herniation

    International Nuclear Information System (INIS)

    Volle, E.; Claussen, C.; Kern, A.; Stoltenburg, G.

    1988-01-01

    The CT appearance of the lumbar neural foramina and contents is described in detail and compared to histopathological specimens. Direct axial scans with secondary sagittal, coronal and paraxial reconstruction series of slices of the neuralforamen were derived from lumbar spine examination of fifty normal adults. These normal parameters were then used to evaluate and subdivide 20 patients with disc herniation involving the neuralforamen. The new paraxial reformation was able to show an intraneuroforaminal disc involvement. CT-reformation technique and operative results in intraneuroforaminal disc herniation correspond in 80%. This improvement in preoperative diagnosis demonstrates to the neurosurgeon the full extent of disc herniation and results in an optimized operative approach. (orig.)

  11. CT reconstruction technique in lumbar intraneuroforaminal disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Volle, E.; Claussen, C.; Kern, A.; Stoltenburg, G.

    1988-04-01

    The CT appearance of the lumbar neural foramina and contents is described in detail and compared to histopathological specimens. Direct axial scans with secondary sagittal, coronal and paraxial reconstruction series of slices of the neuralforamen were derived from lumbar spine examination of fifty normal adults. These normal parameters were then used to evaluate and subdivide 20 patients with disc herniation involving the neuralforamen. The new paraxial reformation was able to show an intraneuroforaminal disc involvement. CT-reformation technique and operative results in intraneuroforaminal disc herniation correspond in 80%. This improvement in preoperative diagnosis demonstrates to the neurosurgeon the full extent of disc herniation and results in an optimized operative approach.

  12. MR imaging and CT in osteoarthritis of the lumbar facet joints

    International Nuclear Information System (INIS)

    Weishaupt, D.; Zanetti, M.; Hodler, J.; Boos, N.

    1999-01-01

    Objective. To test the agreement between MR imaging and CT in the assessment of osteoarthritis of the lumbar facet joints, and thus to provide data about the need for an additional CT scan in the presence of an MR examination. Design and patients. Using a four-point scale, two musculoskeletal radiologists independently graded the severity of osteoarthritis of 308 lumbar facet joints on axial T2-weighted and on sagittal T1- and T2-weighted turbo-spin-echo images and separately on the corresponding axial CT scans. Kappa statistics and percentage agreement were calculated. Results. The weighted kappa coefficients for MR imaging versus CT were 0.61 and 0.49 for readers 1 and 2, respectively. The weighted kappa coefficients for interobserver agreement were 0.41 for MR imaging and 0.60 for CT, respectively. There was agreement within one grade between MR and CT images in 95% of cases for reader 1, and in 97% of cases for reader 2. Conclusion. With regard to osteoarthritis of the lumbar facet joints there is moderate to good agreement between MR imaging and CT. When differences of one grade are disregarded agreement is even excellent. Therefore, in the presence of an MR examination CT is not required for the assessment of facet joint degeneration. (orig.)

  13. Diagnostic value of multiplanar reconstruction in CT recognition of lumbar spinal disorders

    International Nuclear Information System (INIS)

    Im, S. K.; Choi, J. H.; Kim, C. H.; Sohn, M. H.; Lim, K. Y.; Choi, K. C.

    1984-01-01

    The computer tomography is useful in evaluation of bony structures and adjacent soft tissues of the lumbar spine. Recently, the multiplanar reconstruction of lumbar spine of CT of significant value for the anatomical localization and for the myelographic and surgical correlation. We observed 177 cases of lumbar spine CT, who complains of spinal symptom, during the period from Dec. 1982 to Aug. 1984. The results were as follows: 1. The sex distribution of cases were 113 males and 44 females. The CT diagnosis showed 152 cases of herniated lumbar disc, 15 cases of degenerative disease, 5 cases of spine tbc., 3 cases of spine trauma and 2 cases of meningocele. 2. CT findings of herniated disc were as follows: focal protrusion of posterior disc margin and obliteration of anterior epidural fat in all cases, indentation on dural sac in 92 cases (60.5%) soft tissue mass in epidural fat in 85 cases (55.9%), compression or displacement of nerve root sheath in 22 cases(14.4%). 3. Sites of herniated lumbar disc were at L4-L5 level in 100 cases(59.1%) and at L5-S1 level in 65 cases (38.4%). Location of it were central type in 70 cases(41.1%), left-central type in 46 cases (27.2%), right-central type in 44 cases(26.0%) and lateral type in 9 cases (5.1%). 4. The sagittal reconstruction images were helpful in evaluating neural foramina, size of disc bluge into spinal canal, especially at L5-S1, and patients with spondylolisthesis. The coronal reconstruction images were the least informative, although they contributed to the evaluation of lumbar nerve roots of course, the axial CT scans were the most sensitive and specific.

  14. Thoracic sympathectomy

    DEFF Research Database (Denmark)

    Hashmonai, Moshe; Cameron, Alan E P; Licht, Peter B

    2016-01-01

    sympathetic ablation for hypertension is obsolete, and direct endovascular renal sympathectomy still requires adequate clinical trials. There are rare publications of sympathetic ablation for primary phobias, but there is no scientific basis to support sympathetic surgery for any psychiatric indication....

  15. Treatment of lumbar facet joint syndrome by CT-guided intraarticular infiltration of fact joints

    International Nuclear Information System (INIS)

    Schleifer, J.; Fenzl, G.; Wolf, A.; Diehl, K.

    1994-01-01

    In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but hat additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis. Results were significantly in group 2 than in group 1. In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant. Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded. (orig.) [de

  16. [Feasibility and accuracy of ultrasound-guided methodology in the examination of lumbar spine facet joints].

    Science.gov (United States)

    Wen, Chuan-Bing; Li, Yong-Zhong; Tang, Qin-Qin; Sun, Lin; Xiao, Hong; Yang, Bang-Xiang; Song, Li; Liu, Hui

    2013-03-01

    To investigate the feasibility, accuracy of B ultrasound in the examination of joint space of lumbar spine facet joints compared with CT scan. Ten healthy adult volunteers were enrolled. The joint space of lumbar facet joints was measured by ultrasound. To identify the spinal levels, the posterior parasagittal sonograms were obtained at levels L1 to S1. The lumbar facet joints were delineated with the help of transverse sonograms at each level. Meanwhile, the lumbar facet joints were evaluated by spiral CT on the same plane, reformatted to 1-mm axial slices. A total of 88 lumbar facet joints from L1 to S1 were clearly visualized in the 10 volunteers. Both ultrasound and CT measurements showed the same average depth and lateral distance of lumbar facet joint space (P > 0.05). The lumbar facet joint space can be accurately demonstrated by ultrasound.

  17. Transforaminal Lumbar Puncture: An Alternative Technique in Patients with Challenging Access.

    Science.gov (United States)

    Nascene, D R; Ozutemiz, C; Estby, H; McKinney, A M; Rykken, J B

    2018-05-01

    Interlaminar lumbar puncture and cervical puncture may not be ideal in all circumstances. Recently, we have used a transforaminal approach in selected situations. Between May 2016 and December 2017, twenty-six transforaminal lumbar punctures were performed in 9 patients (25 CT-guided, 1 fluoroscopy-guided). Seven had spinal muscular atrophy and were referred for intrathecal nusinersen administration. In 2, CT myelography was performed via transforaminal lumbar puncture. The lumbar posterior elements were completely fused in 8, and there was an overlying abscess in 1. The L1-2 level was used in 2; the L2-3 level, in 10; the L3-4 level, in 12; and the L4-5 level, in 2 procedures. Post-lumbar puncture headache was observed on 4 occasions, which resolved without blood patching. One patient felt heat and pain at the injection site that resolved spontaneously within hours. One patient had radicular pain that resolved with conservative treatment. Transforaminal lumbar puncture may become an effective alternative to classic interlaminar lumbar puncture or cervical puncture. © 2018 by American Journal of Neuroradiology.

  18. Ultrasound-guided lumbar puncture in pediatric patients: technical success and safety.

    Science.gov (United States)

    Pierce, David B; Shivaram, Giri; Koo, Kevin S H; Shaw, Dennis W W; Meyer, Kirby F; Monroe, Eric J

    2018-06-01

    Disadvantages of fluoroscopically guided lumbar puncture include delivery of ionizing radiation and limited resolution of incompletely ossified posterior elements. Ultrasound (US) allows visualization of critical soft tissues and the cerebrospinal fluid (CSF) space without ionizing radiation. To determine the technical success and safety of US-guided lumbar puncture in pediatric patients. A retrospective review identified all patients referred to interventional radiology for lumbar puncture between June 2010 and June 2017. Patients who underwent lumbar puncture with fluoroscopic guidance alone were excluded. For the remaining procedures, technical success and procedural complications were assessed. Two hundred and one image-guided lumbar punctures in 161 patients were included. Eighty patients (43%) had previously failed landmark-based attempts. One hundred ninety-six (97.5%) patients underwent lumbar puncture. Five procedures (2.5%) were not attempted after US assessment, either due to a paucity of CSF or unsafe window for needle placement. Technical success was achieved in 187 (95.4%) of lumbar punctures attempted with US guidance. One hundred seventy-seven (90.3%) were technically successful with US alone (age range: 2 days-15 years, weight range: 1.9-53.1 kg) and an additional 10 (5.1%) were successful with US-guided thecal access and subsequent fluoroscopic confirmation. Three (1.5%) cases were unsuccessful with US guidance but were subsequently successful with fluoroscopic guidance. Of the 80 previously failed landmark-based lumbar punctures, 77 (96.3%) were successful with US guidance alone. There were no reported complications. US guidance is safe and effective for lumbar punctures and has specific advantages over fluoroscopy in pediatric patients.

  19. Evaluation of early tissue reactions after lumbar intertransverse process fusion using CT in a rabbit

    International Nuclear Information System (INIS)

    Shinbo, Jun; Mainil-Varlet, Pierre; Watanabe, Atsuya; Pippig, Suzanne; Koener, Jens; Anderson, Suzanne E.

    2010-01-01

    The objective of the study was to evaluate tissue reactions such as bone genesis, cartilage genesis and graft materials in the early phase of lumbar intertransverse process fusion in a rabbit model using computed tomography (CT) imaging with CT intensity (Hounsfield units) measurement, and to compare these data with histological results. Lumbar intertransverse process fusion was performed on 18 rabbits. Four graft materials were used: autograft bone (n=3); collagen membrane soaked with recombinant human bone morphogenetic protein-2 (rhBMP-2) (n=5); granular calcium phosphate (n=5); and granular calcium phosphate coated with rhBMP-2 (n=5). All rabbits were euthanized 3 weeks post-operatively and lumbar spines were removed for CT imaging and histological examination. Computed tomography imaging demonstrated that each fusion mass component had the appropriate CT intensity range. CT also showed the different distributions and intensities of bone genesis in the fusion masses between the groups. Each component of tissue reactions was identified successfully on CT images using the CT intensity difference. Using CT color mapping, these observations could be easily visualized, and the results correlated well with histological findings. The use of CT intensity is an effective approach for observing and comparing early tissue reactions such as newly synthesized bone, newly synthesized cartilage, and graft materials after lumbar intertransverse process fusion in a rabbit model. (orig.)

  20. CT findings of lumbar intervertebral disc: II. Disc herniation (HNP)

    International Nuclear Information System (INIS)

    Yang, W. J.; Lee, J. M.; Bahk, Y. W.

    1984-01-01

    In lumbar region the epidural fat pad is relatively abundant so that CT can provides sufficient information in diagnosis of lumbar HNP. Many authors have reported on the CT findings of HNP such as focal nodular protrusion of the posterior disc margin, obliteration of epidural fat pad, impingement of dural sac and nerve root, swelling of nerve root, soft tissue density in the spinal canal and calcification of disc. However there was so previous report describing incidence and reliability of the findings. It is the purpose of the present study to survey the frequency, reliability, and limitation of these CT findings. The clinical material was consisted of 30 operatively proven cases of HNP of the lumbar spine. Each lumbar CT scan was reviewed retrospectively and the findings were analysed by two radiologists independently. There were 20 males and 10 females and the mean age was 36.7 years. Involvement of L4-S5 level was 2.3 times more frequent than that of L5-S1 level. Of 30 cases, 22 were unilateral posterolateral types and 8 cases central or unilateral far lateral types. CT findings observed were nodular protrusion of the posterior margin of the disc, obliteration of epidural fat pad, impingement of dural sac or nerve root, soft tissue density in the spinal canal and calcification in the posterior portion of the protruded disc, in order of decreasing frequency. The conclusions are follows: 1. Nodular protrusion of the posterior disc margin accompanied by obliteration of epidural fat pad was observed in every case. The former findings was designated as direct sign and the latter indirect. 2. Obliteration of the epidural fat appears to be significant in lateral recesses especially when it occurs unilaterally. This was not true, however, in the centrally located fat pad. 3. Impingement of the dural sac and nerve root were observed in 90% and 67%, respectively, and were very helpful in establishing HNP diagnosis when the direct and indirect signs were equivocal

  1. Myelography, CT and MRI in leukaemic infiltration of the lumbar theca

    International Nuclear Information System (INIS)

    Shen, W.C.; Lee, S.K.; Ho, Y.J.; Lee, K.R.

    1993-01-01

    A 25-year-old woman with acute lymphoblastic leukaemia, while in remission, developed paraparesis, with faecal and urinary incontinence. CT demonstrated increased density of the lumbar theca and enlargement of the nerve roots. Myelography showed complete obstruction below the L3 level. MRI showed increased signal intensity in the lumbar sac on T1 weighting, and the cauda equina enhanced with gadolinium-DTPA. Lymphoblasts were seen in the lumbar spinal fluid. After chemoterhapy, these abnormalities resolved, as did the paraparesis and incontinence. (orig.)

  2. Study of CT-guided percutaneous biopsy for the spine lesions

    International Nuclear Information System (INIS)

    Zhang Ji; Wu Chungen; Cheng Yongde; Zhu Xuee; Gu Yifeng; Zhang Huijian

    2008-01-01

    Objective: To determine the successful rate, diagnostic accuracy and clinical usefulness of CT-guided percutaneous biopsy for the spine lesions. Methods: Eight-five patients (61 outpatients, 24 ward patients)underwent CT-guided percutaneous biopsy for the spine lesion. The imaging appearance of spinal lesions were lytic in 57 cases, osteosclerotic in 19 cases, and mixed in 9 cases. Biopsy specimens were sent for cytologic and histologic analysis in order to correct diagnosis. Bacterial studies were performed when ever infection was suspected. Results: The localization of puncture biopsy needle inside the spinal lesions, was conformed by computed tomography including 3 cervical, 26 thoracic, 37 lumbar, and 19 sacral lesions. Biopsy specimens included bone (29 cases), soft tissue (5 cases), mixed tissue (47 cases )and no specimen be obtained(4 cases). An adequate specimen for pathologic examination was obtained in 81 biopsies (95%). The pathologic examinations revealed 44 metastases, 17 primary bone neoplasms, 18 infections (included tuberculosis)and 2 normal tissues of vertebral body. The diagnostic accuracy reached 97.5% (79 of 81 patients). Conclusions: CT-guided percutaneous biopsy is an important tool in the evaluation of spinal lesions, providing accurate localization, less trauma and reliable pathologic diagnosis and worthwhile to be the routine before vertebroplasy. (authors)

  3. CT image-guided intensity-modulated therapy for paraspinal tumors using stereotactic immobilization

    International Nuclear Information System (INIS)

    Yenice, Kamil M.; Lovelock, D. Michael; Hunt, Margie A.; Lutz, Wendell R.; Fournier-Bidoz, Nathalie; Hua, C.-H.; Yamada, Josh; Bilsky, Mark; Lee, Henry; Pfaff, Karl; Spirou, Spiridon V.; Amols, Howard I.

    2003-01-01

    Purpose: To design and implement a noninvasive stereotactic immobilization technique with daily CT image-guided positioning to treat patients with paraspinal lesions accurately and to quantify the systematic and random patient setup errors occurring with this method. Methods and Materials: A stereotactic body frame (SBF) was developed for 'rigid' immobilization of paraspinal patients. The inherent accuracy of this system for stereotactic CT-guided treatment was evaluated with phantom studies. Seven patients with thoracic and lumbar spine lesions were immobilized with the SBF and positioned for 33 treatment fractions using daily CT scans. For all 7 patients, the daily setup errors, as assessed from the daily CT scans, were corrected at each treatment fraction. A retrospective analysis was also performed to assess what the impact on patient treatment would have been without the CT-based corrections (i.e., if patient setup had been performed only with the SBF). Results: The average magnitude of systematic and random errors from uncorrected patient setups using the SBF was approximately 2 mm and 1.5 mm (1 SD), respectively. For fixed phantom targets, the system accuracy for the SBF localization and treatment was shown to be within 1 mm (1 SD) in any direction. Dose-volume histograms incorporating these uncertainties for an intensity-modulated radiotherapy plan for lumbar spine lesions were generated, and the effects on the dose-volume histograms were studied. Conclusion: We demonstrated a very accurate and precise method of patient immobilization and treatment delivery based on a noninvasive SBF and daily image guidance for paraspinal lesions. The SBF provides excellent immobilization for paraspinal targets, with setup accuracy better than 2 mm (1 SD). However, for highly conformal paraspinal treatments, uncorrected systematic and random errors of 2 mm in magnitude can result in a significantly greater (>100%) dose to the spinal cord than planned, even though the

  4. Lumbar spine chordoma

    Directory of Open Access Journals (Sweden)

    M.A. Hatem, M.B.Ch.B, MRes, LMCC

    2014-01-01

    Full Text Available Chordoma is a rare tumor arising from notochord remnants in the spine. It is slow-growing, which makes it difficult to diagnose and difficult to follow up after treatment. Typically, it occurs in the base of the skull and sacrococcygeal spine; it rarely occurs in other parts of the spine. CT-guided biopsy of a suspicious mass enabled diagnosis of lumbar spine chordoma.

  5. Remote cerebellar hemorrhage after lumbar spinal surgery

    International Nuclear Information System (INIS)

    Cevik, Belma; Kirbas, Ismail; Cakir, Banu; Akin, Kayihan; Teksam, Mehmet

    2009-01-01

    Background: Postoperative remote cerebellar hemorrhage (RCH) as a complication of lumbar spinal surgery is an increasingly recognized clinical entity. The aim of this study was to determine the incidence of RCH after lumbar spinal surgery and to describe diagnostic imaging findings of RCH. Methods: Between October 1996 and March 2007, 2444 patients who had undergone lumbar spinal surgery were included in the study. Thirty-seven of 2444 patients were scanned by CT or MRI due to neurologic symptoms within the first 7 days of postoperative period. The data of all the patients were studied with regard to the following variables: incidence of RCH after lumbar spinal surgery, gender and age, coagulation parameters, history of previous arterial hypertension, and position of lumbar spinal surgery. Results: The retrospective study led to the identification of two patients who had RCH after lumbar spinal surgery. Of 37 patients who had neurologic symptoms, 29 patients were women and 8 patients were men. CT and MRI showed subarachnoid hemorrhage in the folia of bilateral cerebellar hemispheres in both patients with RCH. The incidence of RCH was 0.08% among patients who underwent lumbar spinal surgery. Conclusion: RCH is a rare complication of lumbar spinal surgery, self-limiting phenomenon that should not be mistaken for more ominous pathologic findings such as hemorrhagic infarction. This type of bleeding is thought to occur secondary to venous infarction, but the exact pathogenetic mechanism is unknown. CT or MRI allowed immediate diagnosis of this complication and guided conservative management.

  6. CT-guided puncture

    International Nuclear Information System (INIS)

    Noeldge, G.; Richter, G.M.; Grenacher, L.; Brado, M.; Kauffmann, G.W.

    1996-01-01

    Sonographic and CT-guided punctures allow the evaluation of suspected lesions in the head, thorax, abdomen, retroperitoneum and skeletal system. The size of the lesion to be evaluated determines the size and the diameter of the puncture needle. The quantity of the material obtained will be defined by the diameter of the needle, i.e. fine-needle biopsy is more adequate for cytological than for histological evaluation. Strict adherence to the indications and contraindications for puncture and painstaking performance of the procedure go a long why towards minimizing the complications. The advantage of CT-guided puncture, in contrast to an ultrasound-guided procedure, is visualization during the puncture procedure free from overshadowing. This permits punctures of lesions located deep in the thorax or the abdomen which are overshadowed by the lungs, by air in the small or large bowel or by bone structures. Moreover, this technique yields much more information about the tissues and organs surrounding the suspected lesion. This information is much more investigator-related with ultrasoundguided puncture. Therefore, the CT-guided puncture has become mandatory in the evaluation of suspected lesions. Moreover, using the same technique, percutaneous drainage of fluids in the interpleural space, abscesses in organs, hematomas, lymphoceles and urinomas; ablation of metastases; and sympathicolysis can be carried out. CT-guided puncture thus changes from a minimally invasive diagnostic procedure to a minimally invasive therapy. (orig./MG) [de

  7. Single incision thoracoscopic sympathectomy for palmar and axillary hyperhidrosis

    Directory of Open Access Journals (Sweden)

    Aram Baram

    2014-02-01

    Full Text Available Background: Primary hyperhidrosis is characterized by excessive sweating beyond physiological needs. It is a common disease (incidence 2.8% that causes intense discomfort for patients. In the last decade, advantages of Single-Incision Thoracoscopic Sympathectomy have become clear, particularly in decreasing morbidity of sympathectomy. Patients and methods: From January 2010 to December 2012, 39 patients (29 females and 10 males with primary palmar or axillary hyperhidrosis were treated by thoracoscopic sympathectomy. The age ranged from 18 to 40 years with a mean of 26.28 years. We used single incision thoracoscopic electrocoagulation through 10 mm incision for thoracic sympathetic chain (T2–T4. Results: The mean follow-up was 23.6 ± 14.2 months (range = 4–24 months. A total of 97.42% of patients were satisfied with the results. A total of 72.5% of patients had cure, one patient (2.5% and another patient (2.5% presented with recurrent axillary hyperhidrosis. The morbidity was 10.2% with no mortality. Percentage of compensatory sweating and gustatory sweating were 5.1% (p = .353 and 2.5% (p = .552, respectively. The result of sympathectomy in patients with both palmar and axillary hyperhidrosis was significantly better (17, 43.58% compared to palmar type (14, 35.89% or axillary type (7, 17.94%. Conclusion: Thoracoscopic sympathectomy is a simple, safe, and cost-effective therapy with good results and low complications.

  8. Video-assisted open supraclavicular sympathectomy following air embolism.

    Science.gov (United States)

    Shpolyanski, G; Hashmonai, M; Rudin, M; Abaya, N; Kaplan, U; Kopelman, D

    2012-01-01

    Air embolism is a relatively rare complication of thoracoscopic surgery. Open supraclavicular sympathectomy was indicated to overcome the risk of re-embolization. A novel video-assisted technique was performed. conclusions: The previously prevalent open supraclavicular sympathectomy is a good choice for avoiding air embolism. Laparoscopic instrumentation and technology can be used to improve open procedures, especially when exposure and visibility are limited. Sometimes we should remember to use the experience of our teachers.

  9. CT fluoroscopy-guided vs. multislice CT biopsy mode-guided lung biopsies: Accuracy, complications and radiation dose

    International Nuclear Information System (INIS)

    Prosch, Helmut; Stadler, Alfred; Schilling, Matthias; Bürklin, Sandra; Eisenhuber, Edith; Schober, Ewald; Mostbeck, Gerhard

    2012-01-01

    Background: The aim of this retrospective study was to compare the diagnostic accuracy, the frequency of complications, the duration of the interventions and the radiation doses of CT fluoroscopy (CTF) guided biopsies of lung lesions with those of multislice CT (MS-CT) biopsy mode-guided biopsies. Methods: Data and images from 124 consecutive patients undergoing CTF-guided lung biopsy (group A) and 132 MS-CT-biopsy mode-guided lung biopsy (group B) were reviewed. CTF-guided biopsies were performed on a Siemens Emotion 6 CT scanner with intermittent or continuous CT-fluoroscopy, MS-CT biopsy mode-guided biopsies were performed on a Siemens Emotion 16 CT scanner. All biopsies were performed with a coaxial needle technique. Results: The two groups (A vs. B) did not differ significantly regarding sensitivity (95.5% vs. 95.9%), specificity (96.7% vs. 95.5%), negative predictive value (87.9% vs. 84%) or positive predictive value (98.8% vs. 98.9%). Pneumothorax was observed in 30.0% and 32.5% of the patients, respectively. Chest tube placement was necessary in 4% (group A) and 13% (group B) of the patients. The duration of the intervention was significantly longer in group A (median 37 min vs. 32 min, p = 0.04). The mean CT dose index (CTDI) was 422 in group A and 36.3 in group B (p < 0.001). Conclusion: Compared to CTF-guided biopsies, chest biopsies using the MS-CT biopsy mode show dramatically lower CTDI levels. Although the diagnostic yield of the procedures do not differ significantly, biopsies using the MS-CT-biopsy mode have a three-fold higher rate of chest tube placement.

  10. Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

    Science.gov (United States)

    ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

    2018-01-01

    A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

  11. MR guided percutaneous laser lumbar disk hernia ablation

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takuo; Terao, Tohru; Ishibashi, Toshihiro; Yuhki, Ichiro; Harada, Junta; Tashima, Michiko [Jikei Univ., Chiba (Japan). Kashiwa Hospital; Abe, Toshiaki

    1998-03-01

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  12. MR guided percutaneous laser lumbar disk hernia ablation

    International Nuclear Information System (INIS)

    Hashimoto, Takuo; Terao, Tohru; Ishibashi, Toshihiro; Yuhki, Ichiro; Harada, Junta; Tashima, Michiko; Abe, Toshiaki.

    1998-01-01

    An MRI unit for interventional procedure is very useful for minimally invasive surgery of the brain and spine. Percutaneous laser disc decompression (PLDD) utilizing X-ray fluoroscopy is a relatively new less invasive procedure for treatment of lumbar disc herniation. MR guided laser surgery is applied to patients with disc herniation at our department. Approaching the target of the disc protrusion was easily conducted and vaporizing the disc hernia directly using a laser was possible under MR fluoroscopy. The purpose of the present study is to evaluate the usefulness of MR guided percutaneous laser disc hernia ablation (MR-guided PLDHA). As subjects, 36 patients with lumbar disc herniation, including 23 cases with L4/5 involvement and 13 cases with L5/S1 involvement were studied. Among these, 26 were males and 10 were females, age ranging from 24 to 62. We used an open type MR system (Hitachi, Airis 0.3T), a permanent, open configuration MR system. A YAG laser (LaserScope, USA) was used for PLDHA. An MR compatible 18G titanium needle 15 cm in length was used to puncture the herniated discs. The MR compatible needle was clearly visualized, and used to safely and accurately puncture the target herniated disc in each case with multidimensional guidance. Application of the laser was performed with MR guidance. The energy dose from the laser ranged from 800 to 2100 joules. In most cases, signs and symptoms improved in the patients immediately after disc vaporization. The overall success rate was 88.9%. The complication rate was 2.8%, including one case of discitis after PLDHA. MR fluoroscopy sequence permits near real time imaging and provides an easy approach to the therapeutic target of disc herniation. MR guided PLDHA is a minimally invasive procedure and is very useful for the treatment of lumbar disc protrusion. (author)

  13. CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine

    Energy Technology Data Exchange (ETDEWEB)

    Rimondi, Eugenio; Rossi, Giuseppe [Istituto Ortopedico Rizzoli, University of Bologna, Department of Radiology and Interventional Angiographic Radiology, Bologna (Italy); Mavrogenis, Andreas F. [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Orthopaedic Oncology Service, Bologna (Italy); Ussia, Giuseppe; Angelini, Andrea [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Ruggieri, Pietro [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Bologna (Italy)

    2011-06-15

    To evaluate the clinical and imaging outcome of patients with symptomatic eosinophilic granuloma of the spine treated with CT-guided intralesional methylprednisolone injection after biopsy. Patients (n =19) with symptomatic solitary eosinophilic granuloma of the spine treated by CT-guided intralesional methylprednisolone injection were retrospectively studied. There were 12 males and seven females with a mean age of 17 years (range, 3-43 years). The mean follow-up was 6 years (median, 4 years; range, 0.5-19 years). Spinal location included the cervical (two patients), thoracic (seven patients), lumbar spine (eight patients), and the sacrum (two patients). Vertebra plana was observed in two patients. All patients had biopsies before treatment. Complete resolution of pain and healing of the lesion was observed in 17 patients (89.5%); none of these patients had recurrence at the latest examination. Reconstitution of the T1 and L1 vertebra plana was observed in both patients. Two patients initially diagnosed and treated for a solitary eosinophilic granuloma had constant pain after the procedure; in these patients, 6 and 12 months after the procedure, respectively, imaging showed multifocal disease and systemic therapy was administered. Complications related to the procedure were not observed. General anesthesia was administered in two patients because of intolerable pain during the procedure. In view of the benign clinical course of eosinophilic granuloma, in patients with symptomatic lesions, CT-guided intralesional corticosteroid injection is a safe and effective outpatient treatment with a low complication rate. (orig.)

  14. Peripheral Sympathectomy for Raynaud's Phenomenon: A Salvage Procedure

    Directory of Open Access Journals (Sweden)

    Wen-Her Wang

    2006-10-01

    Full Text Available We retrospectively reviewed the effectiveness of peripheral sympathectomy for severe Raynaud's phenomenon. In this study, a total of 14 digits from six patients with chronic digital ischemic change were included. All patients had pain, ulcer, or gangrenous change in the affected digits and were unresponsive to pharmacologic or other nonsurgical therapies. In all cases, angiography showed multifocal arterial lesions, so microvascular reconstruction was unfeasible. Peripheral sympathectomy was performed as a salvage procedure to prevent digit amputation. The results were analyzed according to reduction of pain, healing of ulcers, and prevention of amputation. In 12 of the 14 digits, the ulcers healed and amputation was avoided. In the other two digits, the ulcers improved and progressive gangrene was limited. As a salvage procedure for Raynaud's phenomenon recalcitrant to conservative treatment, peripheral sympathectomy improves perfusion to ischemic digits and enables amputation to be avoided.

  15. CT-discography in the evaluation of the post-operative lumbar spine

    International Nuclear Information System (INIS)

    Crenier, N.; Greselle, J.F.; Richard, O.; Houang, B.; Pinol-Daubisse, H.; Caille, J.M.; Vital, J.M.; Senegas, J.

    1988-01-01

    Thirty-three patients with recurrent sciatica after lumbar-disk surgery were studied for recurrent herniated nucleus pulposus (HNP) by CT alone and CT-discography (CTD). Twenty-six patients underwent surgical reexploration allowing correlation with CTD. CTD made a correct diagnosis of recurrent HNP in twenty-one patients showing an extravasation of the contrast medium from the disk space into the medullary canal. In two cases CTD was positive for recurrent HNP but surgery showed only fibrosis. The amount of contrast leak was very small in these two cases along the posterior common longitudinal ligament, and the junction with the disk was very narrow. Because of their clinical presentation three patients with negative studies were operated upon. One showed only fibrosis and the two others showed an associated disk fragment. Among the twenty-one true-positive cases, seven showed a combination of recurrent HNP and scarring. Contamination of CSF by the contrast medium through the dura was observed in two patients. Although a prospective comparative study between CTD and IV-contrast-enhanced CT is necessary, CTD appears to be a useful diagnostic procedure for recurrent HNP after surgery of the lumbar spine. (orig.)

  16. CT-findings in pain syndromes originated from thoraco-lumbar junction

    International Nuclear Information System (INIS)

    Dimitrov, I.; Karadjova, M.; Malchanova, V.

    2007-01-01

    The thoraco-lumbar junction syndrome imitates, as far as clinical symptoms are concerned, low back pain, caused by disc protrusion in the lower lumbar vertebral segments. It is manifested by referred pain in the area, innervated by posterior and anterior primary rami (dorsal and ventral rami), belonging to thoraco-lumbar junction vertebral segments (Th11-L2). Eighty one patients with clinically diagnosed thoraco-lumbar junction syndrome underwent CT-investigations, that aimed establishing pathological processes, leading to this clinical symptomatology. 148 vertebral levels were examined. In 67 patients we scanned two consecutive levels to find the type of change of the zygapophyseal joints. We found facet tropism (asymmetry) in 72 patients (88.8%) or in 117 levels (79.6%), degenerated faced joints in 63 patients (77.8%), pathology of the intervertebral disc - in 33 patients (43.1%) including 5 patients (6.2%) with disc prolapse. When investigating on two subsequent segments (Th11-Th12 and Th12-L1) sudden anatomical change in orientation of facets occurred in 55 patients (82%). Our findings support the hypothesis of the facet-joint origin of this ailment. (authors)

  17. Microscopic lumbar hernietomiya under CT control, experience in the treatment of disk-articular disease

    International Nuclear Information System (INIS)

    Choneva, I.; Amoreti, N.; Kujelstadt, P.

    2013-01-01

    Full text: Introduction Lumbar disc herniation can be treated with lumbar micro-invasive herniotomy under CT control through transforaminal posterolateral or transchannel approach. Percutaneous access by the fine needle probe in combination with X-ray and CT control is a micro - invasive surgery of the spine, which may be considered as an alternative to traditional surgery. The advantages of this method are: the small diameter of the used probe (not more than 16 G or 1,5 mm), allowing the dermal incision to be only a few millimeters as well as the realization of transchannel access, thereby reducing the risk for susceptible ligament injury and the avoidance of bone lesions on the back arc or neighboring muscular structures. Materials and Methods: The aim of this study is to demonstrate that percutaneous lumbar herniotomy under CT control and on posterolateral and foraminal disc herniation with symptoms of pain and root irritation, leads to a significant improvement of the complaints at times immediately postinterventsional and within 6 months ( D1 , D2, D7 , 1, 2 , 6 months) . This lecture presents 55 consecutive patients with symptoms of pain and root irritation, who have made significant progress after percutaneous lumbar herniotomy under CT control and who did not have satisfactory results despite an adapted medical treatment. All patients were clinically evaluated by using visual analogue scales (VAS) for pain, lumbar and root irritation, as well as by MR images postoperatively. Results: All 55 patients showed immediate postoperative improvement of clinical symptoms and signs. Postoperative MR images also show root decompression. It is not reported about complications during the procedure. After the first week it was noted a reduction in average VAS values of 71% and 67% in patients treated for posterolateral and foraminal herniated disc; in medial disc hernia it was noted an average reduction of only 45% . Six months after micro surgery treatment a positive

  18. A single incision transaxillary thoracoscopic sympathectomy

    Directory of Open Access Journals (Sweden)

    Marić Nebojša

    2014-01-01

    Full Text Available Background/Aim. Primary hyperhidrosis causes are unknown. The disorder begins in early childhood. It intensifies in puberty and maturity. It is equally present in both sexes. The symptoms exacerbate when the body temperature rises and due to emotional stimuli affecting the sympathetic nerve system. The aim of this study was to demonstrate that videoassisted thoracoscopic surgery (VATS sympathectomy is a method for primary focal hyperhidrosis permanent treatment. The single incision method in properly selected patients maximizes the intervention effectiveness and minimizes aesthetic side effects. Methods. This prospective study analysed the findings in patients who had been operated on due to primary focal hyperhidrosis (face, palms, and armpits using a single small transaxilarry incision in the third inter-rib space at the level of the anterior axillary line with two 5 mm flexible ports. All the patients, with T2-T5 thoracoscopic sympathectomy of the sympathetic chain using a single small incision in the third inter-rib space in the anterior axillary line, were analysed in the period from September 2009 to November 2010 regarding the postoperative morbidity and outcomes of the operation (clinical evaluation and visual analogue scale with a view to assessing the effectiveness of the surgery conducted in this manner. Results. A total of 47 patients (18 men, 29 women, 18 to 48 years old (29 on average had underwent 94 bilateral video-assisted thoracoscopic sympathectomies. The sympathectomy was indicated in cases of facial blushing and sweating (6.38%, palmary sweating (34.04%, axillary sweating (14.89% or both palmary and axillary sweating (44.68%. The largest percentage of patients (98.6% had left the hospital the following day. The postoperative 30 day’s mortality was 0 and the conversion into open surgery was not necessary. As for complications, there had been an occurrence of partial pneumothorax in two patients treated by means of

  19. The prevalence of lumbar spondylolysis in young children: a retrospective analysis using CT.

    Science.gov (United States)

    Lemoine, Thibaut; Fournier, Joseph; Odent, Thierry; Sembély-Taveau, Catherine; Merenda, Pauline; Sirinelli, Dominique; Morel, Baptiste

    2017-10-13

    Although lumbar spondylolysis is encountered in general population with an incidence estimated to be 3-10%, limited information is available for children. The aim of the study is to determine the prevalence of spondylolysis according to associated vertebral bony malformation and spinopelvic parameters in children under eight requiring CT evaluation for unrelated lumbar conditions. Seven hundred and seventeen abdominal and pelvic multi-detector CT scans were obtained in patients under 8 years of age were reviewed. Two board certificated radiologists and two resident radiologists retrospectively evaluated CT scans for lumbar spondylolysis and associated malformations. Pelvic incidence and spondylolisthesis were reported. Our analysis included 717 CT scans in 532 children (259 girls and 273 boys). Twenty-five cases of spondylolysis were diagnosed (16 bilateral and 9 unilateral, 64 and 36%, respectively) in 14 boys (56%) and 11 girls (44%), associating with 12 grade I spondylolisthesis. The mean normal pelvic incidence was 45° (median 44°, SD 7°). The prevalence of spondylolysis was 1% in children under age 3 (n = 3 among 292 patients), 3.7% in children under age 6 (n = 17 among 454 patients) and 4.7% among the 532 patients. Unilateral spondylolysis was significantly associated with a spinal malformation (p = 0.04, Fisher's exact test), with normal pelvic incidence. Half of the patients with bilateral spondylolysis had high pelvic incidence. We observed a prevalence peak of unilateral spondylolysis in the context of a specific malformation in young infants under age 4 with normal pelvic incidence, and, then, a progressive increase in the prevalence of bilateral isolated spondylolysis.

  20. CT-guided stereotactic neurosurgery

    International Nuclear Information System (INIS)

    Takizawa, Takaaki; Sato, Shoju; Matsumoto, Akira; Sano, Akira; Takahashi, Kazunori; Murakami, Yuji; Ohta, Kosuke

    1985-01-01

    Brown-Roberts-Wells stereotactic instruments were used for CT guided stereotactic surgery in 54 cases (65 operations). Stereotactic biopsy was done in 9 cases and successive regional chemotherapy was done in 3 cases. Stereotactic drainage was done in 2 cases of bacterial abcess, 3 cases of cystic neoplasm and 33 cases (43 operations) of intracerebral hematoma. CT guided stereotactic procedure was valuable for the correct cannulation to the center of the cavity. We tried to utilize CT image for the selection of targets for stereotactic functional neurosurgical procedures in 6 cases. In the cases of thalamotomy, the information derived from CT made the operation safer than that by contrast ventriculography alone. In all cases of electrode implantation for deep brain stimulation, accurate and precise electrode placement was achieved from CT images alone. This rapid and easy surgical technique was useful also for poor risk patients. (author)

  1. CT-guided intradiscal ozone injection combined with intervertebral facet joint steroid injection for lumbar disk herniation accompanied with intervertebral arthritis

    International Nuclear Information System (INIS)

    Zhang Li; Chen Zhaohui; Sun Xijun; Liu Jianping; Li Jiakai

    2009-01-01

    Objective: To compare the clinical effectiveness of ozone (O 3 ) nucleus pulposus ablation only with that of O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome in treating lumbar disk herniation accompanied with intervertebral facet arthritis. Methods: Eighty patients with lumbar disk herniation and intervertebral facet arthritis were equally and randomly divided into two groups. Under CT guidance, O 3 nucleus pulposus ablation was performed in patients of group A(n=40), while O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome (0.5-1 ml) was carried out in patients of group B(n=40). Using double blind method the therapeutic effectiveness was evaluated before and 1 week,3,6-months after the procedure by an Oswestry Low Back Pain Disability Questionnaire. Results: One week after the procedure the effective rate of group A and group B was 65% and 82.5% respectively. Three and six months after the treatment, the effective rate was 75% and 70% respectively for group A, while it was 90% and 92.5% respectively for group B. The difference between two groups was significant (P 3 combined with intervertebral facet joint injection of compound Betamethasome is an effective and safe treatment for lumbar disk herniation accompanied with intervertebral facet arthritis.It is worth popularizing this technique in clinical practice. (authors)

  2. CT-guided interventions in children

    International Nuclear Information System (INIS)

    Honnef, D.; Wildberger, J.E.; Schubert, H.; Hohl, C.; Guenther, R.W.; Mahnken, A.

    2007-01-01

    In pediatric CT-guided interventions specific features have to be taken into account. Due to a lack of cooperation or limited ability to cooperate, procedures are often performed using analgosedation or general anesthesia. To provide radiation protection, justified indication for CT-guided intervention is necessary and sonography and MRI are to be preferred whenever possible. CT examinations also need to be dose-adapted with sequential scanning and a tube voltage and tube current reduction compared to pediatric diagnostic CT studies must be ensured. Gonad shields are recommended for male patients. Biopsy device selection depends on the assumed tumor entity since histology and also immunohistochemical, molecular pathological and cytogenetical analysis are necessary to differentiate pediatric tumors (small, round, blue cell tumors). In addition to diagnostic procedures, therapeutic interventions (drainage, injection therapies, neurolysis, and radiofrequency ablation) can also be used in children and can provide an alternative to surgery in selected cases. With justified indications and precise performance, CT-guided interventions can be successful in pediatric patients with limited risks. (orig.)

  3. Fluoroscopy-guided lumbar drainage of cerebrospinal fluid for patients in whom a blind beside approach is difficult

    Energy Technology Data Exchange (ETDEWEB)

    Chee, Choong Guen; Lee, Guen Young; Lee, Joon Woo; Lee, Eu Gene; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-08-15

    To evaluate the rates of technical success, clinical success, and complications of fluoroscopy-guided lumbar cerebrospinal fluid drainage. This retrospective study was approved by the Institutional Review Board of our hospital, and informed consent was waived. Ninety-six procedures on 60 consecutive patients performed July 2008 to December 2013 were evaluated. The patients were referred for the fluoroscopy-guided procedure due to failed attempts at a bedside approach, a history of lumbar surgery, difficulty cooperating, or obesity. Fluoroscopy-guided lumbar drainage procedures were performed in the lateral decubitus position with a midline puncture of L3/4 in the interspinous space. The catheter tip was positioned at the T12/L1 level, and the catheter was visualized on contrast agent-aided fluoroscopy. A standard angiography system with a rotatable C-arm was used. The definitions of technical success, clinical success, and complications were defined prior to the study. The technical and clinical success rates were 99.0% (95/96) and 89.6% (86/96), respectively. The mean hospital stay for an external lumbar drain was 4.84 days. Nine cases of minor complications and eight major complications were observed, including seven cases of meningitis, and one retained catheter requiring surgical removal. Fluoroscopy-guided external lumbar drainage is a technically reliable procedure in difficult patients with failed attempts at a bedside procedure, history of lumbar surgery, difficulties in cooperation, or obesity.

  4. Diagnostic Accuracy of the Volume Rendering Images of Multi-Detector CT for the Detection of Lumbar Transverse Process Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yun Hak; Chun, Tong Jin [Dept. of Radiology, Eulji University Hospital, Daejeon (Korea, Republic of)

    2012-01-15

    To compare the accuracy of three-dimensional computed tomographic (3D CT) volume rendering techniques with axial images of multi-detector row computed tomography to identify lumbar transverse process (LTP) fractures in trauma patients. We retrospectively evaluated 42 patients with back pain as a result of blunt trauma between January and June of 2010. Two radiologists examined the 3D CT volume rendering images independently. The confirmation of a LTP fracture was based on the consensus of the axial images by the two radiologists. The results of 3D CT volume rendering images were compared with the axial images and the diagnostic powers (sensitivity, specificity, and accuracy) were calculated. Seven of the 42 patients had twenty five lumbar transverse process fractures. The diagnostic power of the 3D CT volume rendering technique is as accurate as axial images. Reader 1, sensitivity 96%, specificity 100%, accuracy 99.9%; and Reader 2 sensitivity 100%, specificity 99.8%, accuracy 99.8%. The accordance of the two radiologists was 99.8%. 3D CT volume rendering images can alternate axial images to detect lumbar transverse process fractures with good image quality.

  5. Treatment of lumbar facet joint syndrome by CT-guided intraarticular infiltration of fact joints; Behandlung des lumbalen Facettensyndroms durch CT-gesteuerte Infiltration der Zwischenwirbelgelenke

    Energy Technology Data Exchange (ETDEWEB)

    Schleifer, J. [Knappschaftsklinik Puettlingen/Saar (Germany). Orthopaedische Abteilung; Fenzl, G. [Knappschaftsklinik Puettlingen/Saar (Germany). Orthopaedische Abteilung; Wolf, A. [Knappschaftsklinik Puettlingen/Saar (Germany). Radiologische Abteilung; Diehl, K. [Knappschaftsklinik Puettlingen/Saar (Germany). Radiologische Abteilung

    1994-11-01

    In 62 patients with facet syndrome a total of 205 joints were infiltrated, CT monitoring being used in all cases. Each facet joint was infiltrated with 0.3 ml bupivacaine and 0.8 ml methylprednisolone. The patients were divided into three groups. Group 1 consisted of 24 persons who had undergone lumbar disc surgery, group 2 of 23 patients with spondylarthrosis of the facet joints, and group 3 of 15 patients who had undergone lumbar disc surgery but hat additional spondylarthrosis. Very good results were defined as pain relief for longer than 4 weeks, good results as pain relief for up to 4 weeks and poor results as brief pain relief or none at all. In 27 patients facet infiltration was performed for the purpose of diagnosis. Results were significantly in group 2 than in group 1. In group 3 results were better than in group 1, but worse than in group 2. These differences were not statistical by significant. Seven patients in the diagnostic group had no pain relief, and facet syndrome was excluded. (orig.) [Deutsch] Bei 62 Patienten mit lumbalem Facettensyndrom wurden insgesamt 205 Zwischenwirbelgelenke (Facettengelenke) perkutan CT-gesteuert infiltriert. Je Gelenk wurden 0,3 ml Bupivacain und 0,8 ml Methylprednisolon intraartikulaer infiziert. Die Patienten wurden in 3 Gruppen unterteilt. Die 1. Gruppe umfasste 24 Patienten mit Postnukleotomiesyndrom, die 2. Gruppe 23 Patienten mit spondylarthrotischen Veraenderungen, die 3. Gruppe 15 bandscheibenoperierte Patienten mit zusaetzlicher Spondylarthrose. In Gruppe 2 fanden sich signifikant bessere Ergebnisse als in Gruppe 1. Gute Resultate ergab auch die dritte Gruppe, sie waren jedoch nicht signifikant besser als die der Gruppe 1. Die sorgfaeltige Auswahl der Patienten ist fuer den Erfolg der Behandlung entscheidend. Die Infiltrationsbehandlung der Zwischenwirbelgelenke hat nahezu keine Nebenwirkungen. Ausser zur Therapie wird das Verfahren diagnostisch zum Ausschluss eines Facettensyndromes im Rahmen der Abklaerung

  6. Myositis Ossificans of the Psoas Muscle After Compression Fracture of Lumbar Spine: CT and MR Imaging Findings

    International Nuclear Information System (INIS)

    Choi, Mi Nyong; Lee, Gyung Kyu; Suh, Kyung Jin

    2010-01-01

    Myositis ossificans is a benign, self-limiting and non-neoplastic development of heterotopic bone in skeletal muscle following trauma. Although myositis ossificans can occur anywhere in the body, psoas muscle involvement is very rare. To the best of our knowledge, CT and MR imaging findings of myositis ossificans in the psoas muscle secondary to lumbar spine fracture have not been reported in the radiological literature. In this article, we describe the CT and MR imaging findings of myositis ossificans of the psoas muscle after lumbar spine fracture in a 64-year-old man, and conduct a review of the relevant literature

  7. Myositis Ossificans of the Psoas Muscle After Compression Fracture of Lumbar Spine: CT and MR Imaging Findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Mi Nyong; Lee, Gyung Kyu [Hallym University College of Medicine, Hangang Sacred Heart Hospital, Seoul (Korea, Republic of); Suh, Kyung Jin [Dongguk University College of Medicine, Gyungju Hospital, Gyeongju (Korea, Republic of)

    2010-02-15

    Myositis ossificans is a benign, self-limiting and non-neoplastic development of heterotopic bone in skeletal muscle following trauma. Although myositis ossificans can occur anywhere in the body, psoas muscle involvement is very rare. To the best of our knowledge, CT and MR imaging findings of myositis ossificans in the psoas muscle secondary to lumbar spine fracture have not been reported in the radiological literature. In this article, we describe the CT and MR imaging findings of myositis ossificans of the psoas muscle after lumbar spine fracture in a 64-year-old man, and conduct a review of the relevant literature

  8. CT-discography in the evaluation of the post-operative lumbar spine. Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Crenier, N; Greselle, J F; Richard, O; Houang, B; Pinol-Daubisse, H; Caille, J M; Vital, J M; Senegas, J

    1988-06-01

    Thirty-three patients with recurrent sciatica after lumbar-disk surgery were studied for recurrent herniated nucleus pulposus (HNP) by CT alone and CT-discography (CTD). Twenty-six patients underwent surgical reexploration allowing correlation with CTD. CTD made a correct diagnosis of recurrent HNP in twenty-one patients showing an extravasation of the contrast medium from the disk space into the medullary canal. In two cases CTD was positive for recurrent HNP but surgery showed only fibrosis. The amount of contrast leak was very small in these two cases along the posterior common longitudinal ligament, and the junction with the disk was very narrow. Because of their clinical presentation three patients with negative studies were operated upon. One showed only fibrosis and the two others showed an associated disk fragment. Among the twenty-one true-positive cases, seven showed a combination of recurrent HNP and scarring. Contamination of CSF by the contrast medium through the dura was observed in two patients. Although a prospective comparative study between CTD and IV-contrast-enhanced CT is necessary, CTD appears to be a useful diagnostic procedure for recurrent HNP after surgery of the lumbar spine.

  9. CT of lumbar spine disk herniation: correlation with surgical findings

    International Nuclear Information System (INIS)

    Firooznia, H.; Benjamin, V.; Kricheff, I.I.; Rafii, M.; Golimbu, C.

    1984-01-01

    Computed tomography (CT) of the lumbar spine was performed with selectively positioned 5-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. One hundred consecutive patients with 116 surgical disk explorations were reviewed. There was agreement between the CT and surgical findings in 89 patients (104 explorations) in determination of presence or absence of a herniated nucleus pulposus (HNP). Discrepancy occurred in 12 instances (11 patients): two because of incorrect interpretations, five in previously operated patients, three in spondylolisthesis, and two in spinal stenosis. There were 97 true-positives, eight false-negatives, seven true-negatives, and four false-positives. If nine previously operated patients are excluded from the study, then CT was accurate in detection of presence or absence of an HNP in 93% of the disk explorations

  10. Does surgical sympathectomy improve clinical outcomes in patients with refractory angina pectoris?

    Science.gov (United States)

    Holland, Luke C; Navaratnarajah, Manoraj; Taggart, David P

    2016-04-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 of the case series demonstrated an improvement in symptoms, exercise tolerance or quality of life in patients undergoing surgical sympathectomy. An early case series investigating an open approach had a high morbidity and mortality rate, but the 4 other series used a minimally invasive technique and had low morbidity and zero perioperative mortality rates. The cohort study compared surgical sympathectomy with transmyocardial laser revascularization (TMR) and concluded TMR to be superior. However, this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery. We conclude that the best currently available evidence does suggest that patients report an improvement in their symptoms and quality of life following surgical sympathectomy, but the low level of this evidence does not allow for a statistically proved recommendation. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  11. Biopsy system for CT-guided biopsies

    International Nuclear Information System (INIS)

    Onik, G.; Cosman, E.; Wells, T.; Goldberg, H.I.; Moss, A.; Costello, P.; Kane, R.

    1987-01-01

    CT stereotaxic brain biopsies have made brain biopsies safe and minimally invasive. CT-guided biopsies of the body, however, have traditionally used a hand-guidance method. CT biopsy guidance systems for the body have recently become available that have similar capabilities as those of brain biopsy systems. To compare the clinical utility of stereotaxically guided biopsies with hand-guided biopsies, the authors prospectively compared 40 biopsies performed with each method. In the stereotaxic method, a localizor grid was placed on the patient to define a reference point, and a frame was used to guide the needle along the intended path. Computer software programs calculated complex paths from one scan plane to another. Although the results disclosed no significant differences in lesion size or path length between the two groups, the stereotaxically guided biopsies required 75% fewer needle manipulations to hit the intended target. Consequently, the stereotaxically guided biopsies required 40% less time and 80% fewer localization scans to find the biopsy needle than did the hand-guided biopsies

  12. Clinical evaluation of lumbar CT assisted discography in comparison with human cadaver

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Shigehiko

    1988-04-01

    In order to estimate the clinical value of lumbar CT assisted discography (CTD), results obtained by this method were compared with histological findings of the cross section of the spine in fresh human cadavera. Based on these findings, preoperative CTD of lumbar disc herniation was investigated. In the discs of human cadavera, the contrast medium mainly invaded the fissures of nucleus pulposus and the ruptures of annulus fibrosus and then diffused to the surrounding tissues. These ruptures were classified into two categories: radial and circumferential. This indentification was possible only in CTD and was obscure in the usual discogram. Not all the ruptures could be dyed in a severe degenerative disc, and a rupture which was not communicated with nucleus pulposus was not dyed in a mild degenerative disc. In the preoperative CTD of lumbar disc herniation, the posterior radial ruptures representing the route of herniated nuclei were characteristic and the circumferential ruptures were found complicated.

  13. CT-guided percutaneous laser disc decompression with Ceralas D, a diode laser with 980-nm wavelength and 200-μm fiber optics

    International Nuclear Information System (INIS)

    Gevargez, A.; Groenemeyer, D.W.H.; Czerwinski, F.

    2000-01-01

    The aim of this study was to evaluate the compact, portable Ceralas-D diode laser (CeramOptec; 980+30 nm wavelength, 200-μm optical fiber) concerning clinical usefulness, handling, and clinical results in the CT-guided treatment of herniated lumbar discs. The positioning of the canula in intradiscal space, the placement of the laser fiber into the disc through the lying canula, and the vaporization itself were carried out under CT-guidance. Due to the thin fiber optic, it was possible to use a thin 23-gauge canula. The laser procedure was performed in 0.1- to 1-s shots with 1-s pulse pause and 4-W power output. A total of 1650-2300 J was applied on each percutaneous laser disc decompression (PLDD). Results in 26 patients were established with a visual-analogue scale (VAS). On the follow-up examinations, 46% of the patients were absolutely pain free (>85% VAS) and fully active in everyday life after 4 postoperative weeks. Thirty-one percent of patients were relieved of the leg pain but had occasional back pain without sensorimotor impairment. Fifteen percent sensed a slight alleviation (>50% VAS) of the radiate pain. Eight percent did not experience radicular or pseudo-radicular pain alleviation (<25% VAS). Cerales-D proves to be an efficient tool for CT-guided PLDD on non-sequestered herniated lumbar discs. (orig.)

  14. Radiation exposure in CT-guided interventions

    Energy Technology Data Exchange (ETDEWEB)

    Kloeckner, Roman, E-mail: Roman.Kloeckner@unimedizin-mainz.de [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany); Santos, Daniel Pinto dos; Schneider, Jens [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany); Kara, Levent [Department of Radiology, Inselspital Bern, Freiburgstraße 18, 3010 Bern (Switzerland); Dueber, Christoph; Pitton, Michael B. [Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University, Langenbeckstraße 1, 55131 Mainz (Germany)

    2013-12-01

    Purpose: To investigate radiation exposure in computed tomography (CT)-guided interventions, to establish reference levels for exposure, and to discuss strategies for dose reduction. Materials and methods: We analyzed 1576 consecutive CT-guided procedures in 1284 patients performed over 4.5 years, including drainage placements; biopsies of different organs; radiofrequency and microwave ablations (RFA/MWA) of liver, bone, and lung tumors; pain blockages, and vertebroplasties. Data were analyzed with respect to scanner settings, overall radiation doses, and individual doses of planning CT series, CT intervention, and control CT series. Results: Eighy-five percent of the total radiation dose was applied during the pre- and post-interventional CT series, leaving only 15% applied by the CT-guided intervention itself. Single slice acquisition was associated with lower doses than continuous CT-fluoroscopy (37 mGy cm vs. 153 mGy cm, p < 0.001). The third quartile of radiation doses varied considerably for different interventions. The highest doses were observed in complex interventions like RFA/MWA of the liver, followed by vertebroplasty and RFA/MWA of the lung. Conclusions: This paper suggests preliminary reference levels for various intervention types and discusses strategies for dose reduction. A multicenter registry of radiation exposure including a broader spectrum of scanners and intervention types is needed to develop definitive reference levels.

  15. CT-guided biopsies and drainage

    International Nuclear Information System (INIS)

    Scheppers, I.; Wollschlaeger, D.

    2011-01-01

    Following the implementation of computed tomography (CT) or ultrasound-guided biopsy of solid tumors and the puncture and drainage of liquid processes, the number of surgical open biopsies and curative operations for abscess drainage has declined. Such CT-guided interventions are performed in nearly every organ. Instead of aspiration biopsies, more and more core biopsies are being performed to allow histopathological evaluation and thus allowing targeted therapy. This article is intended to give a general overview of techniques, materials, indications and contraindications. Ultrasound-guided biopsies as well as large bore vacuum biopsies of the breast are not included in this review. (orig.) [de

  16. Thoracoscopic sympathectomy ganglia ablation in the management ...

    African Journals Online (AJOL)

    Thoracoscopic sympathectomy ganglia ablation in the management of palmer hyperhidrosis: A decade experience in a single institution. D Kravarusic, E Freud. Abstract. Background: Hyperhidrosis can cause significant professional and social handicaps. Surgery is the preferred treatment modality for hyperhidrosis.

  17. MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F. [Charite University Medicine Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Bretschneider, T. [Magdeburg Univ. (Germany). Dept. of Radiology and Nuclear Medicine; Hartwig, T.; Disch, A.C. [Charite University Medicine Berlin (Germany). Center for Musculoskeletal Surgery

    2014-06-15

    Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

  18. MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

    International Nuclear Information System (INIS)

    Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F.; Bretschneider, T.; Hartwig, T.; Disch, A.C.

    2014-01-01

    Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

  19. The value of the 3D CT imaging in diagnosis of lumbar spondylolysis

    International Nuclear Information System (INIS)

    Krupski, W.; Paslawski, M.; Zlomaniec, J.; Fatyga, M.; Majcher, P.

    2003-01-01

    The frequent cause of a low back pain is the lumbar spondylolysis and the spondylolisthesis. The purpose of the study was to assess of the value of three-dimensional CT imaging in diagnosis of the lumbar spondylolysis. Material comprises of 22 patients complaining from low back pain in which lateral radiograms, axial CT scans, MPR and 3D reconstructions were performed. The presence of spondylolysis, spondylolisthesis, stenosis of the spinal canal and intervertebral foramens were assessed. The differences in diagnostic value between analysed imaging modalities in revealing spondylolysis, spondylolisthesis and narrowing of intervertebral foramens, were statistically highly significant. The highest sensitivity in recognition of these pathologies was observed in 3D reconstruction. The 3D reconstructions were also useful in an assessment of the spinal canal stenosis, revealing degenerative changes, but the increased number of diagnosed pathologies was not statistically significant comparing with axial CT section. Spondylolysis was diagnosed in 22 patients based on 3D reconstructions, in 14 patients on MPR reconstructions, in 18 patients on axial sections and only in 8 cases on lateral radiograms. Spondylolisthesis was visible on lateral radiograms in 21 patients, on axial scans in 12 patients, and in 22 cases, on both MPR and 3D reconstruction. The stenosis of the spinal canal was found on lateral radiograms in 2 patients, on MPR reconstruction in 4 cases, and in 7 patients on 3D reconstruction. The intervertebral foramen stenosis was present in 5 patients, based on MPR reconstruction and in 17, on spatial images. Spatial 3D CT reconstructions are superior to lateral radiograms, axial CT sections and MPR reconstruction in revealing spondylolysis, spondylolisthesis and stenosis of intervertebral foramens. They are useful in assessment of spinal canal narrowing and evaluation of degenerative changes. In our opinion 3D CT reconstruction projected from the inside of the

  20. Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Hea Sang; Kim, Guk Hee; Kim, Dae Young [Kangnam General Hospital Public Corporation, Seoul (Korea, Republic of)

    1986-10-15

    'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7+-8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2+-8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

  1. The relationship between developmental lumbar spinal stenosis and its BMD value : comparison by single energy quantitative CT

    International Nuclear Information System (INIS)

    Kim, Hak Jin; Kim, Kun Il; Song, Keun Sung

    1996-01-01

    The purpose of this study is to evaluate the relationship between developmental lumbar spinal stenosis and its BMD value by using the single energy quantitative CT(SEQCT). Eighty normal volunteers(20-60years) were selected as a control group and 28 patients with developmental lumbar spinal stenosis were selected as a disease group. The two groups were divided into a younger (20-39 years) and an older subgroup (40-60 years), and were further divided into male and female subgroups. All the cases showed no evidence of metabolic disease, fracture, herniated nucleus pulposus, degererative spondylosis, infectious disease, tumors or had no history of absolute immobilization of more than two weeks. All underwent lumbar spine CT and SEQCT. we measured bone mineral density(BMD) at the cancellous bone of L1, 2, 3 and obtained the mean and its one standard deviation, and compared the data between each sub-group of the control and the disease group using ANOVA. There was a significant low BMD value in the younger male patient subgroup compared with the control subgroup(p<0.005). Developmental lumbar spinal stenosis in a young male may be a factor of decreasing BMD of the body of the spine

  2. The relationship between developmental lumbar spinal stenosis and its BMD value : comparison by single energy quantitative CT

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hak Jin; Kim, Kun Il; Song, Keun Sung [Pusan National Univ. Hospital, Pusan (Korea, Republic of)

    1996-03-01

    The purpose of this study is to evaluate the relationship between developmental lumbar spinal stenosis and its BMD value by using the single energy quantitative CT(SEQCT). Eighty normal volunteers(20-60years) were selected as a control group and 28 patients with developmental lumbar spinal stenosis were selected as a disease group. The two groups were divided into a younger (20-39 years) and an older subgroup (40-60 years), and were further divided into male and female subgroups. All the cases showed no evidence of metabolic disease, fracture, herniated nucleus pulposus, degererative spondylosis, infectious disease, tumors or had no history of absolute immobilization of more than two weeks. All underwent lumbar spine CT and SEQCT. we measured bone mineral density(BMD) at the cancellous bone of L1, 2, 3 and obtained the mean and its one standard deviation, and compared the data between each sub-group of the control and the disease group using ANOVA. There was a significant low BMD value in the younger male patient subgroup compared with the control subgroup(p<0.005). Developmental lumbar spinal stenosis in a young male may be a factor of decreasing BMD of the body of the spine.

  3. PET/CT-guided Interventions: Personnel Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States); Hsu, Meier [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics (United States); Quinn, Brian; Dauer, Lawrence T. [Memorial Sloan-Kettering Cancer Center, Department of Medical Physics (United States); Solomon, Stephen B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States)

    2013-08-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.

  4. Enlargement of lumbar spinal canal in lumbar degenerative spondylolisthesis. Evaluation with three-dimensional computed tomography

    International Nuclear Information System (INIS)

    Kunishi, Yoshihiko

    2003-01-01

    A number of clinical studies have demonstrated that enlargement of the lumbar spinal canal is one of the effective surgical procedures for the treatment of the lumbar degenerative spondylolisthesis and provides a good result. In the present study, we have evaluated the long-term outcome of the enlargement of the lumbar canal without fusion in thirty eight patients with lumbar degenerative spondylolisthesis using three-dimensional computed tomography (3D-CT) The improvement rate was excellent in 80% of the patients (mean improvement ratio, 83%) according to the Japanese Orthopedic Association scoring system. We found that the sufficient enlargement of the canal was obtained by the surgery and maintained for a long period of time. The results from 3D-CT suggested that a round shape was maintained in the canal after the surgery because of pressures of the dura mater against to the bony canal. None of patients showed lumbar instability. In conclusion, enlargement of lumbar canal without fusion is useful for the treatment of lumbar degenerative spondylolisthesis, and the enlarged canal has been maintained for a long period of time after the surgery. The results demonstrated the clinical utility of 3D-CT to evaluate the preoperative and postoperative shape of the spine. (author)

  5. Radiation exposure during CT-guided biopsies: recent CT machines provide markedly lower doses.

    Science.gov (United States)

    Guberina, Nika; Forsting, Michael; Ringelstein, Adrian; Suntharalingam, Saravanabavaan; Nassenstein, Kai; Theysohn, Jens; Wetter, Axel

    2018-03-28

    To examine radiation dose levels of CT-guided interventional procedures of chest, abdomen, spine and extremities on different CT-scanner generations at a large multicentre institute. 1,219 CT-guided interventional biopsies of different organ regions ((A) abdomen (n=516), (B) chest (n=528), (C) spine (n=134) and (D) extremities (n=41)) on different CT-scanners ((I) SOMATOM-Definition-AS+, (II) Volume-Zoom, (III) Emotion6) were included from 2013-2016. Important CT-parameters and standard dose-descriptors were retrospectively examined. Additionally, effective dose and organ doses were calculated using Monte-Carlo simulation, following ICRP103. Overall, radiation doses for CT interventions are highly dependent on CT-scanner generation: the newer the CT scanner, the lower the radiation dose imparted to patients. Mean effective doses for each of four procedures on available scanners are: (A) (I) 9.3mSv versus (II) 13.9mSv (B) (I) 7.3mSv versus (III) 11.4mSv (C) (I) 6.3mSv versus (II) 7.4mSv (D) (I) 4.3mSv versus (II) 10.8mSv. Standard dose descriptors [standard deviation (SD); CT dose index vol (CTDI vol ); dose-length product (DLP body ); size-specific dose estimate (SSDE)] were also compared. Effective dose, organ doses and SSDE for various CT-guided interventional biopsies on different CT-scanner generations following recommendations of the ICRP103 are provided. New CT-scanner generations involve markedly lower radiation doses versus older devices. • Effective dose, organ dose and SSDE are provided for CT-guided interventional examinations. • These data allow identifying organs at risk of higher radiation dose. • Detailed knowledge of radiation dose may contribute to a better individual risk-stratification. • New CT-scanner generations involve markedly lower radiation doses compared to older devices.

  6. Anaesthesia for left thoracoscopic sympathectomy for refractory long ...

    African Journals Online (AJOL)

    Congenital long QT syndrome (LQTS) is a rare genetic disorder that has been associated with various genetic mutations ... Left thoracoscopic sympathectomy is an effective treatment for patients ... frequency of cardiac events/ICD shocks postoperatively. The ... inheritance, dental abnormalities, clinodactyly, and bidirectional.

  7. Lumbar spine joint synovial cysts of intraspinal development. CT scan imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vallee, C.; Chevrot, A.; Benhamouda, M. and others

    CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intra-articular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

  8. PET/CT-guided Interventions: Personnel Radiation Dose

    International Nuclear Information System (INIS)

    Ryan, E. Ronan; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P.; Hsu, Meier; Quinn, Brian; Dauer, Lawrence T.; Solomon, Stephen B.

    2013-01-01

    PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0–0.13) mSv for the primary operator, 0.01 (range 0–0.05) mSv for the nurse anesthetist, and 0.02 (range 0–0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0–0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient

  9. Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

    International Nuclear Information System (INIS)

    Jeon, Hea Sang; Kim, Guk Hee; Kim, Dae Young

    1986-01-01

    'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7±8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2±8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

  10. Value of the lumbar lordotic angle taken from CT scanogram as an index of back pain

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Hea Sang; Kim, Guk Hee; Kim, Dae Young [Kangnam General Hospital Public Corporation, Seoul (Korea, Republic of)

    1986-10-15

    'Normal' spinal posture is generally accepted as moderate lordosis of the cervical and the lumbar sections of spine and moderate kyphosis of the thoracic and sacrococcygeal sections. Among these normal range of the lumbar lordosis is less well defined. CT is very useful method to identified the bony structure and adjacent soft tissue of the spine, so it is very available method to detect accurate lumbar lordotic angle by using lateral Scanogram. Analysis and comparison of lumbar lordotic angles, crossing angle are drawn each parallel line to the superior end plate of body of 1st. lumbar vertebra and to the inferior end plate of the 5th. lumbar vertebra, in 174 cases with backache and 50 cases normal groups at Kangnam General Hospital Public Corporation, from Aug. 1985 to Jul 1986. Male and female were almostly same affected in backache group (1.1:1). And most lumbar lordotic angles were 10 to 40 between all backache age group. On backache group, over all mean lumbar lordotic angles were 24.7+-8.9 but no significant difference at mean value of the each diseases, such as HIVD, Degenerative Spondylosis or No Remarkable Findings group. On control group, over all mean ones were 29.2+-8.0. So, significant difference of lumbar lordotic angle between backache and control group, and most difference is at 5th. decade group (p 0.01).

  11. Use of CT scanning for the study of posterior lumbar intervertebral articulations

    Energy Technology Data Exchange (ETDEWEB)

    Hermanus, N.; de Becker, D.; Baleriaux, D.; Hauzeur, J.P.

    1983-01-01

    CT scan is peculiarly effective in the study of architectural pathologies of the column; it appears that a number of etiological factors of low back pain are involved and they are often related. Indeed, dis herniation, for instance, is frequently associated with facetal asymmetry, the first signs of arthroses and ligamentous calcification after treatment. The three vertebral axes must be evaluated, one discal and two facetal, the slightest defect in one of which can affect the two others. Moreover, in view of the complexity of the innervation, the entire lumbar column from L1 to L5 S1 must be investigated: it is not uncommonly that low sciatica is caused by a more cranial lumbar pathology. This systematic study promotes better understanding of the etiology of low back pain and suggests a stet judicious therapeutic attitude.

  12. CT guided diagnostic foot injections

    International Nuclear Information System (INIS)

    Saifuddin, A.; Abdus-Samee, M.; Mann, C.; Singh, D.; Angel, J.C.

    2005-01-01

    AIM: To describe a CT technique for guiding diagnostic and therapeutic injections in the hind- and mid-foot. MATERIALS AND METHODS: Over a period of 50 months, 28 individuals were referred for diagnostic and therapeutic hind- and mid-foot injections before possible arthrodesis. A CT technique was developed that allowed entry into the various joints using a vertical approach. Numbers of joints injected were as follows: posterior subtalar, 21; talonavicular, 4; calcaneonavicular, calcaneocuboid, navicular-cuneiform and 5th metatarsocuboid joints, 1 each. RESULTS: All injections but one were technically successful. Significant relief of symptoms was noted by 16 participants, whereas for 9 there was no improvement and for 3 a partial response was achieved. CONCLUSION: CT is a simple and safe alternative to fluoroscopy for guiding diagnostic and therapeutic foot injections, and may be the technique of choice in cases of disordered anatomy

  13. CT-guided percutaneous vertebroplasty combined with 125I-seed implantation for metastatic vertebral carcinoma involving the spinal canal: analysis of 23 cases

    International Nuclear Information System (INIS)

    Xie Xiaoxi; Lu Yinxiang; Ji Yong; Wang Xiaowei; Zhang Guodong

    2014-01-01

    Objective: To evaluate the safety and efficacy of CT-guided percutaneous vertebroplasty (PVP) combined with 125 I-seed implantation for the treatment of metastatic vertebral carcinoma involving the spinal canal. Methods: A total of 28 involved vertebrae were detected in 23 patients with metastatic vertebral carcinoma. Each patient had 1-2 diseased vertebrae. The lesions included cervical vertebra (n=4), thoracic vertebra (n=13) and lumbar vertebra (n=11). Destroyed posterior vertebral wall was seen in all involved vertebrae. Thirteen vertebrae found in 12 patients showed involvement of the epidural space. According to treatment planning system (TPS) CT-guided implantation of 125 I seeds was carried out first for cervical lesions, which was followed by PVP. For the thoracic and lumbar lesions, unilateral or bilateral puncturing with several particle needles was employed to implant the 125 I seeds, then, PVP with bone cement injection was performed. The complications and the clinical efficacy were analyzed. Results: Successful operation was obtained in all patients. The number of implanted 125 I seeds ranged from 4 to 30 per vertebra, and the volume of injected bone cement was 1-6 ml per vertebra. After the operation the pain relief rate was 86.9% (n=20). The incidence of bone cement leakage was 17.8% (5/28). One patient had radicular pain caused by neuropore leakage, which was relieved after medication. No serious complications, such as spinal cord injury or radiation myelitis, occurred. Conclusion: CT-guided PVP combined with 125 I-seed implantation is effective and safe for the treatment of metastatic vertebral carcinoma involving the spinal canal. This therapy can effectively relieve the pain and control the deterioration of tumor, besides, the incidence of bone cement leakage is very low. (authors)

  14. Anaesthesia for left thoracoscopic sympathectomy for refractory long ...

    African Journals Online (AJOL)

    ... mutations including life-threatening cardiac arrhythmias and sudden death. Left thoracoscopic sympathectomy is an effective treatment for patients who are refractory to medical therapy or who need frequent epicardial internal cardio defibrillator intervention. The authors report three cases, one adult and two children, who ...

  15. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  16. CT five years after myelographic diagnosis of lumbar disk herniation

    Energy Technology Data Exchange (ETDEWEB)

    Hurme, M.; Katevuo, K.; Nykvist, F.; Aalto, T.; Alaranta, H.; Einola, S. (Turku Univ. Central Hospital (Finland). Dept. of Surgery Turku Univ. Central Hospital (Finland). Dept. of Diagnostic Radiology Social Insurance Inst., Turku (Finland). Rehabilitation Research Centre)

    1991-07-01

    Fifty-seven patients were examined with CT 5 years after primary myelography for disabling sciatica and suspected herniated lumbar disk. Forty were in an operated group, 22 with good and 18 with poor results evaluated by occupational handicap (21) 5 years after surgery. Seventeen patients had myelography indicating disk herniation, but were treated conservatively, 9 with good and 8 with poor result. Various spinal dimensions measured at CT did not correlate with outcome. Operated patients had narrower canals than others, and male canals were broader than those in females. Increased amount of scar tissue at L4 level correlated with poor result (p=0.008). Operated patients with poor result had more advanced lateral stenosis than those treated conservatively (p<0.001). Patients with good result after operation had more degeneration observed on CT of erector spinae muscle than those treated conservatively with good outcome. Only 9% of operated patients did not have muscle degeneration. A tendency for more frequent recurrent disk herniations could be ssen for conservatively treated patients. The narrowing of the spinal canal 5 years after operation did not correlate with the 5-year outcome. (orig.).

  17. Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT

    International Nuclear Information System (INIS)

    Peters, Marloes; Willems, Paul; Jutten, Liesbeth; Arts, Chris; Rhijn, Lodewijk van; Weijers, Rene; Wierts, Roel; Urbach, Christian; Brans, Boudewijn

    2015-01-01

    Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of 18 F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. A cohort of 36 patients was retrospectively included in the study after 18 F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) 18 F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following 18 F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. No correlation was found between symptom severity and fusion status. However, 18 F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest Oswestry Disability Index

  18. Pericardial Tamponade Following CT-Guided Lung Biopsy

    International Nuclear Information System (INIS)

    Mitchell, Michael J.; Montgomery, Mark; Reiter, Charles G.; Culp, William C.

    2008-01-01

    While not free from hazards, CT-guided biopsy of the lung is a safe procedure, with few major complications. Despite its safety record, however, potentially fatal complications do rarely occur. We report a case of pericardial tamponade following CT-guided lung biopsy. Rapid diagnosis and therapy allowed for complete patient recovery. Physicians who perform this procedure should be aware of the known complications and be prepared to treat them appropriately.

  19. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT

    International Nuclear Information System (INIS)

    Karantanas, A.H.; Zibis, A.H.; Papaliaga, M.; Georgiou, E.; Rousogiannis, S.

    1998-01-01

    The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient. (orig.)

  20. The comparative study of CT guided and ultrasound guided percutaneous ethanol injection in the treatment of intra-abdominal cyst

    International Nuclear Information System (INIS)

    Li Heping; Yang Jianyong; Chen Wei; Zhuang Wenquan; Huang Yulian; Chen Jianye

    2005-01-01

    Objective: An comparative study of the interventional approach of CT guided and ultiasound guided percutaneous ethanol injection(PEI) in the treatment of intra-abdominal cyst. Methods: CT guided PEI was performed in the treatment of intra-abdominal cyst in 38 patients while ultrasound guided PEI was performed in 45 cases. Results: The puncture procedure of CT guided PEI was totally performed 83 times in treating 56 intra-abdominal cysts in 38 patients and CT guided PEI was unsuccessful in 6 patients. The puncture procedure of ultrasound guided PEI were performed 87 times in treating 71 intra-abdominal cysts in 55 patients and ultrasound guided PEI only failed only in 1 patient. Conclusion: Ultrasound guided PEI is superior to CT guided PEI in the treatment of intra-abdominal cyst. (authors)

  1. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices

    DEFF Research Database (Denmark)

    Damgaard, Morten; Nimb, Lars; Madsen, Jan L

    2010-01-01

    PURPOSE: It is difficult to evaluate the stability of the lumbar spondylodesis with metallic fixation devices by conventional imaging methods such as radiography or magnetic resonance imaging. It is unknown whether single photon emission computed tomography/computed tomography (SPECT/CT) may be u...

  2. The use of CT scanning for the study of posterior lumbar intervertebral articulations

    International Nuclear Information System (INIS)

    Hermanus, N.; Becker, D. de; Baleriaux, D.; Hauzeur, J.P.

    1983-01-01

    CT scan is peculiarly effective in the study of architectural pathologies of the column; it appears that a number of etiological factors of low back pain are involved and they are often related. Indeed, dis herniation, for instance, is frequently associated with facetal asymmetry, the first signs of arthroses and ligamentous calcification after treatment. The three vertebral axes must be evaluated, one discal and two facetal, the slightest defect in one of which can affect the two others. Moreover, in view of the complexity of the innervation, the entire lumbar column from L1 to L5 S1 must be investigated: it is not uncommonly that low sciatica is caused by a more cranial lumbar pathology. This systematic study promotes better understanding of the etiology of low back pain and suggests a stet judicious therapeutic attitude. (orig.)

  3. Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: A cost comparison

    International Nuclear Information System (INIS)

    Maurer, M.H.; Gebauer, B.; Wieners, G.; De Bucourt, M.; Renz, D.M.; Hamm, B.; Streitparth, F.

    2012-01-01

    Objective: To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma. Materials and methods: Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3 ± 9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8 ± 13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures. Results: The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables. Conclusion: MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes.

  4. Raynaud's phenomenon: peripheral catecholamine concentration and effect of sympathectomy.

    Science.gov (United States)

    Nielsen, S L; Christensen, N J; Olsen, N; Lassen, N A

    1980-01-01

    The reaction to body and finger cooling was recorded in seven patients with relapse of primary Raynaud's phenomenon after sufficiently performed bilateral upper thoracic sympathectomy and for comparison in eight young women with primary Raynaud's phenomenon as well as in seven normal women. The forearm venous concentration of noradrenaline was lower and adrenaline concentration higher in the sympathectomized patients than in the other groups (p less than 0,05). Noradrenaline showed a significant increase during body cooling in normals and primary Raynaud's (p less than 0,05). There was no significant correlation between the vasoconstrictor response to cooling of a finger and the noradrenaline concentration probably due to the fact that skin vasoconstriction impeded release of noradrenaline from the skin. The relapse of Raynaud's phenomenon after surgically sufficient sympathectomy could not be treated by reserpine or alfa-adrenergic receptor blockers in two patients in whom this was tried.

  5. CT and fluoroscopy guided celiac ganglion block

    International Nuclear Information System (INIS)

    Lim, Sun Kyung; Kwon, Dae Ik; Ahn, Hyup; Kim, Jong Il; Kim, Byung Young; Lee, Jong Gil

    1994-01-01

    To evaluate the effects and usefulness of fluoroscopy guided celiac ganglion block after marking of needle path with CT scan. Celiac ganglion block with 100% ethyl alcohol was performed in 50 cancer patients who were inoperable and had intractable abdominal pain. Duration and degree of pain relief after the procedure and its complication were analyzed. Early pain relief was observed in 98% and long term relief in 68% without serious complication. Fluoroscopy guided celiac ganglion block after marking of needle path with CT scan was a safe and valuable procedure in relieving intractable pain in terminal cancer patients and reduced the time in the CT room

  6. Clinical significance of gas myelography and CT gas myelography of the thoracic spine and the lumbar spine

    International Nuclear Information System (INIS)

    Yoshinaga, Haruhiko

    1984-01-01

    Basic and clinical applications relating to air myelography of the cervical spine have already been studied and extensively been used as an adjuvant diagnostic method for diseases of the spine and the spinal cord. However, hardly any application and clinical evaluation have been made concerning gas myelography of the thoracic spine and the lumbar spine. The author examined X-ray findings of 183 cases with diseases of the thoracic spine and the lumbar spine, including contral cases. Gas X-ray photography included simple profile, forehead tomography, sagittal plane, and CT section. Morphological characteristics of normal X-ray pictures of the throacic spine and the lumbar spine were explained from 54 control cases, and all the diameters of the subarachnoidal space from the anterior to the posterior part were measured. X-ray findings were examined on pathological cases, namely 22 cases with diseases of the throacic spine and 107 cases with diseases of the lumbar spine, and as a result these were useful for pathological elucidation of spinal cord tumors, spinal carries, yellow ligament ossification, lumbar spinal canal stenosis, hernia of intervertebral disc, etc. Also, CT gas myelography was excellent in stereoobservation of the spine and the spinal cord in spinal cord tumors, yellow ligament ossification, and spinal canal stenosis. On the other hand, it is not suitable for the diagnoses of intraspinal vascular abnormality, adhesive arachinitis, and running abnormality of the cauda equina nerve and radicle. Gas myelography of the thoracic spine and the lambar spine, is very useful in clinics when experienced techniques are used in photographic conditions, and diagnoses are made, well understanding the characteristics of gas pictures. Thus, its application has been opened to selection of an operative technique, determination of operative ranges, etc. (J.P.N.)

  7. Clinical significance of gas myelography and CT gas myelography of the thoracic spine and the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Haruhiko (Tokyo Medical Coll. (Japan))

    1984-05-01

    Basic and clinical applications relating to air myelography of the cervical spine have already been studied and extensively been used as an adjuvant diagnostic method for diseases of the spine and the spinal cord. However, hardly any application and clinical evaluation have been made concerning gas myelography of the thoracic spine and the lumbar spine. The author examined X-ray findings of 183 cases with diseases of the thoracic spine and the lumbar spine, including contral cases. Gas X-ray photography included simple profile, forehead tomography, sagittal plane, and CT section. Morphological characteristics of normal X-ray pictures of the throacic spine and the lumbar spine were explained from 54 control cases, and all the diameters of the subarachnoidal space from the anterior to the posterior part were measured. X-ray findings were examined on pathological cases, namely 22 cases with diseases of the throacic spine and 107 cases with diseases of the lumbar spine, and as a result these were useful for pathological elucidation of spinal cord tumors, spinal carries, yellow ligament ossification, lumbar spinal canal stenosis, hernia of intervertebral disc, etc. Also, CT gas myelography was excellent in stereo observation of the spine and the spinal cord in spinal cord tumors, yellow ligament ossification, and spinal canal stenosis. On the other hand, it is not suitable for the diagnoses of intraspinal vascular abnormality, adhesive arachinitis, and running abnormality of the cauda equina nerve and radicle. Gas myelography of the thoracic spine and the lambar spine, is very useful in clinics when experienced techniques are used in photographic conditions, and diagnoses are made, well understanding the characteristics of gas pictures. Thus, its application has been opened to selection of an operative technique, determination of operative ranges, etc.

  8. A study on CT-guided stereotactic technique for functional neurosurgery

    International Nuclear Information System (INIS)

    Uetsuhara, Koichi; Asakura, Tetsuhiko; Hirahara, Kazuho; Gondo, Masazumi; Oda, Hiroshige

    1987-01-01

    Recently, CT-guided stereotactic surgery has become of major interest, and some authors have discussed its potential in functional neurosurgery. The following is a comparative study of the CT-guided stereotactic technique and the conventional roentogenographic stereotactic technique. The Brown-Roberts-Wells apparatus was used for both types of procedures. 37 stereotactic procedures were performed on 35 patients under local anesthesia; 16 for stereotactic biopsy and 21 for stereotactic functional neurosurgery. Target points for stereotactic biopsy were determined by the CT-guided technique and target points for functional neurosurgery were determined by the conventional roentogenographic technique. The correlation with the position of target point determined by both techniques was investigated in the 21 functional neurosurgical procedures. On these occasions the authors used the reformatted horizontal and sagittal CT through the anterior and posterior commissure to determine the position of target point by the CT-guided technique. Results: It was found that the AC-PC line crossed with Reid's base line at angle of 11 ± 1 deg, and therefore it is important to obtain a CT images including AC-PC line at this angle. When applying the CT guided stereotactic procedure for functional surgery, it should be known that there could be a discrepancy within 2 mm from the conventional target determination. (author)

  9. CT-guided core-needle biopsy in omental pathology

    International Nuclear Information System (INIS)

    Pombo, F.; Rodriguez, E.; Martin, R.; Lago, M.

    1997-01-01

    Purpose: To assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology. Material and Methods: We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n=2) or diffuse (n=23) omental pathology. These results were compared to the final diagnoses as determined by laparotomy (n=15), laparoscopic biopsy (n=3), endoscopic biopsy (n=1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n=6). The final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement. The CT-guided biopsies were performed with 1.0=1.8-mm Surecut core-needles. Results: In 16 patients, the final diagnosis was metastatic adenocarcinoma - with the primary tumor sites in the ovary (n=3), stomach (n=1), appendix (n=2), and unknown (n=10). In the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1. Sufficient histological (n=16) or cytological (n=8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case. In differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92%. It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders. There were no biopsy-related complications. Conclusion: CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology. (orig.)

  10. Predicting factors for conversion from fluoroscopy guided Percutaneous transthoracic needle biopsy to cone-beam CT guided Percutaneous transthoracic needle biopsy

    International Nuclear Information System (INIS)

    Lee, Kang Ji; Han, Young Min; Jin, Gong Yong; Song, Ji Soo

    2015-01-01

    To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson χ 2 test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 ± 1.57 cm, 3.40 ± 1.92 cm, 3.06 ± 1.81 cm, and 35.67 ± 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 ± 1.30 cm, 2.20 ± 1.45 cm, 1.91 ± 1.99 cm, and 18.32 ± 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65.8%) in

  11. Anti-dopamine beta-hydroxylase immunotoxin-induced sympathectomy in adult rats

    Science.gov (United States)

    Picklo, M. J.; Wiley, R. G.; Lonce, S.; Lappi, D. A.; Robertson, D.

    1995-01-01

    Anti-dopamine beta-hydroxylase immunotoxin (DHIT) is an antibody-targeted noradrenergic lesioning tool comprised of a monoclonal antibody against the noradrenergic enzyme, dopamine beta-hydroxylase, conjugated to saporin, a ribosome-inactivating protein. Noradrenergic-neuron specificity and completeness and functionality of sympathectomy were assessed. Adult, male Sprague-Dawley rats were given 28.5, 85.7, 142 or 285 micrograms/kg DHIT i.v. Three days after injection, a 6% to 73% decrease in the neurons was found in the superior cervical ganglia of the animals. No loss of sensory, nodose and dorsal root ganglia, neurons was observed at the highest dose of DHIT. In contrast, the immunotoxin, 192-saporin (142 micrograms/kg), lesioned all three ganglia. To assess the sympathectomy, 2 wk after treatment (285 micrograms/kg), rats were anesthetized with urethane (1 g/kg) and cannulated in the femoral artery and vein. DHIT-treated animals' basal systolic blood pressure and heart rate were significantly lower than controls. Basal plasma norepinephrine levels were 41% lower in DHIT-treated animals than controls. Tyramine-stimulated release of norepinephrine in DHIT-treated rats was 27% of controls. Plasma epinephrine levels of DHIT animals were not reduced. DHIT-treated animals exhibited a 2-fold hypersensitivity to the alpha-adrenergic agonist phenylephrine. We conclude that DHIT selectively delivered saporin to noradrenergic neurons resulting in destruction of these neurons. Anti-dopamine beta-hydroxylase immunotoxin administration produces a rapid, irreversible sympathectomy.

  12. Dimensions of the lumbar spinal canal: variations and correlations with somatometric parameters using CT

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, A.H. [Department of CT-MRI, Larissa General Hospital (Greece); Zibis, A.H.; Papaliaga, M.; Georgiou, E.; Rousogiannis, S. [Larissa Medical School, University of Thessaly, Larissa (Greece)

    1998-12-01

    The aim of this study was to investigate the correlation of vertebral dimensions with somatometric parameters in patients without clinical symptoms and radiological signs of central lumbar spinal stenosis. One hundred patients presenting with low back pain or sciatica were studied with CT. In each of the L3, L4 and L5 vertebra three slices were taken with the following measurements: 1. Slice through the intervertebral disc: (a) spinal canal area; (b) interarticular diameter; (c) interligamentous diameter. 2. Slice below the vertebral arcus: (a) dural sac area; (b) vertebral body area. 3. Pediculolaminar level: (a) anteroposterior diameter and interpedicular diameter of the spinal canal; (b) spinal canal area; (c) width of the lateral recesses. The Jones-Thomson index was also estimated. The results of the present study showed that there is a statistically significant correlation of height, weight and age with various vertebral indices. The conventional, widely accepted, anteroposterior diameter of 11.5 mm of the lumbar spinal canal is independent of somatometric parameters, and it is the only constant measurement for the estimation of lumbar spinal stenosis with a single value. The present study suggests that there are variations of the dimensions of the lumbar spinal canal and correlations with height, weight and age of the patient. (orig.) With 1 fig., 6 tabs., 24 refs.

  13. Pseudarthrosis after lumbar spinal fusion: the role of {sup 18}F-fluoride PET/CT

    Energy Technology Data Exchange (ETDEWEB)

    Peters, Marloes; Willems, Paul; Jutten, Liesbeth; Arts, Chris; Rhijn, Lodewijk van [Maastricht University Medical Center, Department of Orthopedic Surgery, Postbox 5800, Maastricht (Netherlands); Weijers, Rene; Wierts, Roel; Urbach, Christian; Brans, Boudewijn [Maastricht University Medical Center, Radiology /Nuclear Medicine, Maastricht (Netherlands)

    2015-11-15

    Painful pseudarthrosis is one of the most important indications for (revision) surgery after spinal fusion procedures. If pseudarthrosis is the source of recurrent pain it may require revision surgery. It is therefore of great clinical importance to ascertain if it is the source of such pain. The correlation between findings on conventional imaging (plain radiography and CT) and clinical well-being has been shown to be moderate. The goal of this study was to determine the possible role of {sup 18}F-fluoride PET in patients after lumbar spinal interbody fusion by investigating the relationship between PET/CT findings and clinical function and pain. A cohort of 36 patients was retrospectively included in the study after {sup 18}F-fluoride PET/CT for either persistent or recurrent low back pain (18 patients) or during routine postoperative investigation (18 patients) between 9 and 76 months and 11 and 14 months after posterior lumbar interbody fusion, respectively. Sixty minutes after intravenous injection of 156 - 263 MBq (mean 199 MBq, median 196 MBq) {sup 18}F-fluoride, PET and CT images were acquired using an integrated PET/CT scanner, followed by a diagnostic CT scan. Two observers independently scored the images. The number of bony bridges between vertebrae was scored on the CT images to quantify interbody fusion (0, 1 or 2). Vertebral endplate and intervertebral disc space uptake were evaluated visually as well as semiquantitatively following {sup 18}F-fluoride PET. Findings on PET and CT were correlated with clinical wellbeing as measured by validated questionnaires concerning general daily functioning (Oswestry Disability Index), pain (visual analogue scale) and general health status (EuroQol). Patients were divided into three categories based on these questionnaire scores. No correlation was found between symptom severity and fusion status. However, {sup 18}F-fluoride activity in the vertebral endplates was significantly higher in patients in the lowest

  14. Results and complications of CT-guided biopsy with CT fluoroscopy

    International Nuclear Information System (INIS)

    Saika, Yoshinori; Ogura, Yasuharu; Doi, Kenji; Misaki, Toshimasa; Shimizu, Masashi; Narabayashi, Isamu

    2002-01-01

    We studied the results and complications of CT-guided biopsy with CT fluoroscopy performed 66 lesions in 64 patients from March 1999 to February 2001. In addition to the conventional procedure of CT-guided biopsy, we use CT fluoroscopy for confirmation of the location of the tip of the biopsy needle and the accurate contact, in some cases, at the time of puncturing. Examination results showed malignancy in 36 lesions and benign findings in 30 lesions. The sensitivity was 85.7%, specificity was 100.0%, and accuracy was 90.9%. Pneumothorax occurred in 20 out of 64 patients (31.3%). In a study on 26 small lesions (≤2 cm) in 25 patients, the sensitivity was 81.8%, specificity was 100.0%, accuracy was 92.3%. Pneumothorax occurred in 12 out of 25 patients (48.0%), more frequently than in patients with large lesions. In a study on 6 false negative cases, they tended to be intrapulmonary on location, small in diameter, and far from the skin puncture point. Examination results were satisfactory, especially in terms of accuracy in small lesions (≤2 cm). However, when the lesions were small, pneumothorax occurred frequently (48.0%). (author)

  15. Confidence in Assessment of Lumbar Spondylolysis Using Three-Dimensional Volumetric T2-Weighted MRI Compared With Limited Field of View, Decreased-Dose CT.

    Science.gov (United States)

    Delavan, Joshua Adam; Stence, Nicholas V; Mirsky, David M; Gralla, Jane; Fadell, Michael F

    2016-07-01

    Limited z-axis-coverage computed tomography (CT) to evaluate for pediatric lumbar spondylolysis, altering the technique such that the dose to the patient is comparable or lower than radiographs, is currently used at our institution. The objective of the study was to determine whether volumetric 3-dimensional fast spin echo magnetic resonance imaging (3D MRI) can provide equal or greater diagnostic accuracy compared with limited CT in the diagnosis of pediatric lumbar spondylolysis without ionizing radiation. Volumetric 3D MRI can provide equal or greater diagnostic accuracy compared with low-dose CT for pediatric lumbar spondylolysis without ionizing radiation. Clinical review. Level 2. Three pediatric neuroradiologists evaluated 2-dimensional (2D) MRI, 2D + 3D MRI, and limited CT examinations in 42 pediatric patients who obtained imaging for low back pain and suspected spondylolysis. As there is no gold standard for the diagnosis of spondylolysis besides surgery, interobserver agreement and degree of confidence were compared to determine which modality is preferable. Decreased-dose CT provided a greater level of agreement than 2D MRI and 2D + 3D MRI. The kappa for rater agreement with 2D MRI, 2D + 3D MRI, and CT was 0.19, 0.32, and 1.0, respectively. All raters agreed in 31%, 40%, and 100% of cases with 2D MRI, 2D + 3D MRI, and CT. Lack of confidence was significantly lower with CT (0%) than with 2D MRI (30%) and 2D + 3D MRI (25%). For diagnosing spondylolysis, radiologist agreement and confidence trended toward improvement with the addition of a volumetric 3D MRI sequence to standard 2D MRI sequences compared with 2D MRI alone; however, agreement and confidence remain significantly greater using decreased-dose CT when compared with either MRI acquisition. Decreased-dose CT of the lumbar spine remains the optimal examination to confirm a high suspicion of spondylolysis, with dose essentially equivalent to radiographs. If clinical symptoms are not classic for

  16. [Neurolitic block of the lumbar sympathetic chain improves chronic pain in a patient with critical lower limb ischemia].

    Science.gov (United States)

    Barreto Junior, Elton Pereira de Sá; Nascimento, Jedson Dos Santos; de Castro, Anita Perpetua Carvalho Rocha

    Sympathectomy is one of the therapies used in the treatment of chronic obstructive arterial disease (COAD). Although not considered as first-line strategy, it should be considered in the management of pain difficult to control. This clinical case describes the evolution of a patient with inoperable COAD who responded properly to the lumbar sympathetic block. A female patient, afro-descendant, 69 years old, ASA II, admitted to the algology service due to refractory ischemic pain in the lower limbs. The patient had undergone several surgical procedures and conservative treatments without success. Vascular surgery considered the case as out of therapeutic possibility, unless limb amputation. At that time, sympathectomy was indicated. After admission to the operating room, the patient was monitored, positioned and sedated. The blockade was performed with the aid of radioscopy, bilaterally, at L2-L3-L4 right and L3 left levels. On the right side, at each level cited, 3mL of absolute alcohol with 0.25% bupivacaine were injected without vasoconstrictor, and on the left side only local anesthetic. The procedure was performed uneventfully. The patient was discharged with complete remission of the pain. Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  17. Measurements of the lumbar spinal canal by computed tomography in lumbar diseases

    International Nuclear Information System (INIS)

    Kido, Kenji; Kawai, Shinya; Oda, Hirotane; Saika, Minoru; Uminaga, Yasuo; Takano, Shinichi; Akiho, Yasushi

    1986-01-01

    To assess the significance of computed tomography (CT) in the elucidation of morphology of the lumbar spinal canal (LSC), the antero-posterior (AP) and transverse (T) diameter, and T area of the soft and bony LSC, and dural canal (DC) were measured by CT in 15 patients with lumbar canal stenosis, 45 patient with spondylosis, and 33 control subjects. The AP diameter failed to indicate the degree of stenosis because it was independent of morphology of the LSC. The T area of the LSC did not always help to determine the degree of DC compression, but showed some degree of stenosis. The T area of the DC was useful in determining the degree of stenosis and morphology of the stenosed site. With the use of the T area of the DC, the upper margin of articular segment was found to be most stenosed in patients with lumbar canal stenosis. (Namekawa, K.)

  18. CT guided transthoracic catheter drainage of intrapulmonary abscess.

    Science.gov (United States)

    Yunus, Mahira

    2009-10-01

    To determine the efficacy of CT- guided transthoracic catheter drainage of intrapulmonary abscess considering success rate versus complications. This prospective study was carried out at radiology department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from 1.1.2003 to 31.12.2005. Nineteen patients were selected for CT guided percutaneous drainage. Under CT guidance catheter placement was carried out using Seldinger technique. Nineteen patients with lung abscess were selected for the percutaneous CT guided drainage. Eight (42.105%) patients encountered no complications and lung abscess completely resolved with no residual cavity. Five (26.31%) patients developed pneumothorax, which was the most common complication of this study. These patients were kept under observation and followed-up by chest X-rays. Three (15.78%) had mild pneumothorax, which resolved and needed no further management, while two (10.52%) patients developed moderate pneumothorax and chest tube was inserted. Two (10.52%) patients developed mild haemoptysis which resolved within two hours, hence, no further management was required. Two (10.52%) patients had residual cavity and surgery was performed. Congenital cystic adenomatoid malformation (CCAM) was found in both cases. Two patients out of nineteen patients (10.52%) developed bronchopleural fistula and were operated. No mortality occurred during or after the procedure. CT allows optimal placement of catheter and hence enables safe and effective percutaneous evacuation of lung abscess. The morbidity and mortality of patients with percutaneous catheter drainage is lower than with surgical resection. Hence, CT guided drainage should be considered the first therapeutic choice in most patients of lung abscess who do not respond to medical therapy.

  19. Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

    Energy Technology Data Exchange (ETDEWEB)

    Amoretti, Nicolas, E-mail: amorettinicolas@yahoo.fr; Gallo, Giacomo, E-mail: giacomo.gallo83@gmail.com; Bertrand, Anne-Sophie, E-mail: asbertrand3@hotmail.com [Centre Hospitalier Universitaire de Nice (France); Bard, Robert L., E-mail: rbard@cancerscan.com [New York Medical College (United States); Kelekis, Alexis, E-mail: akelekis@med.uoa.gr [University General Hospital “ATTIKON” (Greece)

    2016-01-15

    We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4–L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

  20. The role of bone SPECT/CT in the evaluation of lumbar spinal fusion with metallic fixation devices

    DEFF Research Database (Denmark)

    Damgaard, Morten; Nimb, Lars; Madsen, Jan L

    2010-01-01

    PURPOSE: It is difficult to evaluate the stability of the lumbar spondylodesis with metallic fixation devices by conventional imaging methods such as radiography or magnetic resonance imaging. It is unknown whether single photon emission computed tomography/computed tomography (SPECT/CT) may......, whereas in 1 case loose pedicle screws were detected at a wrong vertebral level. CONCLUSION: SPECT/CT may be useful to detect a lack of fixation of the metallic implants, and hence instability of the spondylodesis by evaluating the focal bone mineralization activity in relation to the pedicle screws....

  1. Liver CT-guided aspirative biopsies

    International Nuclear Information System (INIS)

    Santos, Gilda da Cunha; Carvalho, Leda Viegas de; Chojniak, Rubens; Morini, Sandra Regina

    1996-01-01

    Sixty-eight CT-guided aspirative biopsies of hepatic nodules were performed at A.C. Camargo Hospital, Sao Paulo, Brazil, from 1992 to 1995. The cases were distributed as follow: 44(64.7%) with a positive diagnosis for neoplastic cells, 6(8.8%) with a negative diagnosis, and 14 (20.5%) with insufficient material. Of the positive cases (primary neoplasias and metastases), the cytological diagnosis was achieved in 39 cases. There were 36 cases of carcinoma (7 hepato carcinomas, 18 adenocarcinomas, 1 small cell carcinoma and 10 cases of unspecified differentiation), 2 cases of melanoma and 1 case of melanoma and 1 case of sarcoma. The correlation with histopathological exams showed no false positive cases and concordance between cytological and histopathological diagnosis. The results demonstrate that CT-guided aspirative biopsy of hepatic nodules permits a rapid diagnosis of neoplastic lesions, especially for the evaluation of metastases. (author)

  2. 3-dimensional reconstructions of computer tomograms of the lumbar spine

    International Nuclear Information System (INIS)

    Kern, A.; Waggershauser, T.; Zendel, W.; Astinet, A.; Felix, R.; Hansen, K.; Lanksch, W.R.

    1991-01-01

    In this study, 50 patients were examined by a Siemens 'Somatom Plus'; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondyloarthrosis, with narrowing of the invertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondyloarthrosis with narrowing of the root canals and of the spinal canal. This method of axial CT is superior to conventional radiography of the lumbar spine in the usual two planes. (orig./GDG) [de

  3. Spinal CT scan, 2

    International Nuclear Information System (INIS)

    Nakagawa, Hiroshi

    1982-01-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival. (Chiba, N.)

  4. CT-guided percutaneous aspiration and drainage of postoperative abdominal fluid collections

    International Nuclear Information System (INIS)

    Marano, I.; Mainenti, P.P.; Selva, G.; Cannavale, M.; Sodano, A.

    1999-01-01

    The authors report the personal techniques and the results of CT-guided percutaneous drainage of postoperative abdominal fluid collections. CT-guided percutaneous drainage offers many advantages over surgery: it is less invasive, can be repeated and requires no anesthesia, there are not surgery-related risks and lower morbidity and mortality rates. Moreover, subsequent hospitalization is shorter and costs are consequently reduced. The authors conclude that CT-guided percutaneous drainage is the method of choice in the treatment of postoperative abdominal fluid collections [it

  5. PET/CT scanning guided intensity-modulated radiotherapy in treatment of recurrent ovarian cancer

    Energy Technology Data Exchange (ETDEWEB)

    Du, Xue-lian, E-mail: duxuelian23800@yahoo.com.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Jiang, Tao, E-mail: melody23800@yahoo.com.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Sheng, Xiu-gui, E-mail: jnsd2000@yahoo.cn [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Li, Qing-shui, E-mail: lqs1966@126.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Wang, Cong, E-mail: jnwc1981@hotmail.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China); Yu, Hao, E-mail: jnyh2200@sina.com [Department of Gynecologic Oncology, Shandong Cancer Hospital, Jinan 250117 (China); Shandong Academy of Medical Science, Jinan 250012 (China)

    2012-11-15

    Objective: This study was undertaken to evaluate the clinical contribution of positron emission tomography using {sup 18}F-fluorodeoxyglucose and integrated computer tomography (FDG-PET/CT) guided intensity-modulated radiotherapy (IMRT) for treatment of recurrent ovarian cancer. Materials and methods: Fifty-eight patients with recurrent ovarian cancer from 2003 to 2008 were retrospectively studied. In these patients, 28 received PET/CT guided IMRT (PET/CT-IMRT group), and 30 received CT guided IMRT (CT-IMRT group). Treatment plans, tumor response, toxicities and survival were evaluated. Results: Changes in GTV delineation were found in 10 (35.7%) patients based on PET-CT information compared with CT data, due to the incorporation of additional lymph node metastases and extension of the metastasis tumor. PET/CT guided IMRT improved tumor response compared to CT-IMRT group (CR: 64.3% vs. 46.7%, P = 0.021; PR: 25.0% vs. 13.3%, P = 0.036). The 3-year overall survival was significantly higher in the PET-CT/IMRT group than control (34.1% vs. 13.2%, P = 0.014). Conclusions: PET/CT guided IMRT in recurrent ovarian cancer patients improved the delineation of GTV and reduce the likelihood of geographic misses and therefore improve the clinical outcome.

  6. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel (Dept. of Radiology, Medical Faculty, Univ. Duesseldorf, Duesseldorf (Germany)), email: Patric.Kroepil@med.uni-duesseldorf.de

    2011-10-15

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 +- 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 +- 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 +- 33 vs. n = 126 +- 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  7. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    International Nuclear Information System (INIS)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel

    2011-01-01

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 ± 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 ± 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 ± 33 vs. n = 126 ± 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  8. Automated Detection, Localization, and Classification of Traumatic Vertebral Body Fractures in the Thoracic and Lumbar Spine at CT.

    Science.gov (United States)

    Burns, Joseph E; Yao, Jianhua; Muñoz, Hector; Summers, Ronald M

    2016-01-01

    To design and validate a fully automated computer system for the detection and anatomic localization of traumatic thoracic and lumbar vertebral body fractures at computed tomography (CT). This retrospective study was HIPAA compliant. Institutional review board approval was obtained, and informed consent was waived. CT examinations in 104 patients (mean age, 34.4 years; range, 14-88 years; 32 women, 72 men), consisting of 94 examinations with positive findings for fractures (59 with vertebral body fractures) and 10 control examinations (without vertebral fractures), were performed. There were 141 thoracic and lumbar vertebral body fractures in the case set. The locations of fractures were marked and classified by a radiologist according to Denis column involvement. The CT data set was divided into training and testing subsets (37 and 67 subsets, respectively) for analysis by means of prototype software for fully automated spinal segmentation and fracture detection. Free-response receiver operating characteristic analysis was performed. Training set sensitivity for detection and localization of fractures within each vertebra was 0.82 (28 of 34 findings; 95% confidence interval [CI]: 0.68, 0.90), with a false-positive rate of 2.5 findings per patient. The sensitivity for fracture localization to the correct vertebra was 0.88 (23 of 26 findings; 95% CI: 0.72, 0.96), with a false-positive rate of 1.3. Testing set sensitivity for the detection and localization of fractures within each vertebra was 0.81 (87 of 107 findings; 95% CI: 0.75, 0.87), with a false-positive rate of 2.7. The sensitivity for fracture localization to the correct vertebra was 0.92 (55 of 60 findings; 95% CI: 0.79, 0.94), with a false-positive rate of 1.6. The most common cause of false-positive findings was nutrient foramina (106 of 272 findings [39%]). The fully automated computer system detects and anatomically localizes vertebral body fractures in the thoracic and lumbar spine on CT images with a

  9. CT guided percutaneous needle biopsy of the chest: initial experience

    African Journals Online (AJOL)

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015.

  10. Computed tomography as the primary radiological examination of lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Ilkko, E.; Laehde, S.

    1988-10-01

    A series of 235 patients examined by lumbar CT because of sciatica or other low back disorder was studied. The need of additional examinations and correlations to surgical findings were evaluated. Inadequate information was the cause of additional examination, mostly myelography in 20 patients (8,5%). It was concluded that lumbar CT is a suitable first examination of the lumbar spine in sciatica and low back pain. The indications to complementary myelography and its benefit are discussed.

  11. Computed tomography as the primary radiological examination of lumbar spine

    International Nuclear Information System (INIS)

    Ilkko, E.; Laehde, S.

    1988-01-01

    A series of 235 patients examined by lumbar CT because of sciatica or other low back disorder was studied. The need of additional examinations and correlations to surgical findings were evaluated. Inadequate information was the cause of additional examination, mostly myelography in 20 patients (8,5%). It was concluded that lumbar CT is a suitable first examination of the lumbar spine in sciatica and low back pain. The indications to complementary myelography and its benefit are discussed. (orig.) [de

  12. Automatic segmentation of lumbar vertebrae in CT images

    Science.gov (United States)

    Kulkarni, Amruta; Raina, Akshita; Sharifi Sarabi, Mona; Ahn, Christine S.; Babayan, Diana; Gaonkar, Bilwaj; Macyszyn, Luke; Raghavendra, Cauligi

    2017-03-01

    Lower back pain is one of the most prevalent disorders in the developed/developing world. However, its etiology is poorly understood and treatment is often determined subjectively. In order to quantitatively study the emergence and evolution of back pain, it is necessary to develop consistently measurable markers for pathology. Imaging based measures offer one solution to this problem. The development of imaging based on quantitative biomarkers for the lower back necessitates automated techniques to acquire this data. While the problem of segmenting lumbar vertebrae has been addressed repeatedly in literature, the associated problem of computing relevant biomarkers on the basis of the segmentation has not been addressed thoroughly. In this paper, we propose a Random-Forest based approach that learns to segment vertebral bodies in CT images followed by a biomarker evaluation framework that extracts vertebral heights and widths from the segmentations obtained. Our dataset consists of 15 CT sagittal scans obtained from General Electric Healthcare. Our main approach is divided into three parts: the first stage is image pre-processing which is used to correct for variations in illumination across all the images followed by preparing the foreground and background objects from images; the next stage is Machine Learning using Random-Forests, which distinguishes the interest-point vectors between foreground or background; and the last step is image post-processing, which is crucial to refine the results of classifier. The Dice coefficient was used as a statistical validation metric to evaluate the performance of our segmentations with an average value of 0.725 for our dataset.

  13. Association between CT-evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position

    Science.gov (United States)

    Kalichman, Leonid; Li, Ling; Hunter, David; Been, Ella

    2013-01-01

    Background Context Few studies have directly evaluated the association of lumbar lordosis and segmental wedging of the vertebral bodies and intervertebral disks with prevalence of spinal degenerative features. Purpose To evaluate the association of CT-evaluated lumbar lordosis, segmental wedging of the vertebral bodies and that of the intervertebral disks with various spinal degeneration features. Study design This cross-sectional study was a nested project to the Framingham Heart Study. Sample A random consecutive subset of 191 participants chosen from the 3590 participants enrolled in the Framingham Heart Study who underwent multi-detector CT to assess aortic calcification. Outcome Measures Physiologic Measures Dichotomous variables indicating the presence of intervertebral disc narrowing, facet joint osteoarthritis, spondylolysis, spondylolisthesis and spinal stenosis and density (in Hounsfield units) of multifidus and erector spinae muscles were evaluated on supine CT, as well as the lordosis angle (LA) and the wedging of the vertebral bodies and intervertebral disks. Sum of vertebral bodies wedging (ΣB) and sum of intervertebral discs wedging (ΣD) were used in analyses. Methods Mean values (±SD) of LA, ΣB and ΣD were calculated in males and females and compared using the t-test. Mean values (±SD) of LA, ΣB and ΣD in 4 age groups: 0.05) with increasing age. LA showed statistically significant association with presence of spondylolysis (OR(95%CI): 1.08(1.02–1.14)) and with density of multifidus (1.06 (1.01–1.11). as well as a marginally significant association with isthmic spondylolisthesis (1.07(1.00–1.14). ΣB showed a positive association with degenerative spondylolisthesis and disc narrowing ((1.14(1.06–1.23) and 1.04 (1.00–1.08), correspondingly), whereas ΣD showed negative one (0.93(0.87–0.98) and (0.93(0.89–0.97), correspondingly). Conclusions Significant associations were found between lumbar lordosis evaluated in supine position

  14. Usefulness and limitations of neuroradiological examinations in lumbar canal stenosis

    International Nuclear Information System (INIS)

    Nishi, Shogo; Hanakita, Junya; Suwa, Hideyuki; Ohta, Fumito; Sakaida, Hiroshi

    1989-01-01

    Since 1983, we have performed 434 spinal surgery operations. Among them are included 51 cases of lumbar canal stenosis. For these 51 cases, we performed several neuroradiological examinations, such as lumbar plain X-ray, myelography, metrizamide-CT scan (Met-CT) and magnetic resonance imaging (MRI). On myelography, these 51 patients were divided into three types; a complete block type with 29 patients, soy-beans type with 7 patients and strangulation type with 15 patients. Met CT was performed in 37 cases. In both strangulation type and soy-beans type which had been showed through myelography, Met-CT could clearly demonstrate the subarachnoid space, and several structures around the lumbar spinal canal could be clearly identified. In cases which myelography revealed as complete-block type, we identified two subtypes. In the first type subarachnoid space was clearly demonstrated by Met-CT. The second type was comprised of those cases where Met-CT scan could not demonstrate subarachnoid space at all. MRI was performed on 21 patients. MRI clearly showed the anatomical relationship of disc, subarachnoid space, yellow ligament and hypertrophied bony structure. MRI was thus able to bring useful information about lumbar canal stenosis even in cases where Met-CT gave little information due to the lack of metrizamide penetration of the stenotic subarachnoid space. (J.P.N.)

  15. Simple and inexpensive method for CT-guided stereotaxy

    Energy Technology Data Exchange (ETDEWEB)

    Wester, K; Sortland, O; Hauglie-Hanssen, E

    1981-01-01

    A simple and inexpensive method for CT-guided stereotaxy is described. The method requires neither sophisticated computer programs nor additional stereotactic equipment, such as special head holders for the CT, and can be easily obtained without technical assistance. The method is designed to yield the vertical coordinates.

  16. CT-guided biopsies and drainage; CT-gesteuerte Punktionen und Drainagen

    Energy Technology Data Exchange (ETDEWEB)

    Scheppers, I.; Wollschlaeger, D. [Staedtisches Klinikum Karlsruhe gGmbH, Zentralinstitut fuer Bildgebende Diagnostik, Karlsruhe (Germany)

    2011-11-15

    Following the implementation of computed tomography (CT) or ultrasound-guided biopsy of solid tumors and the puncture and drainage of liquid processes, the number of surgical open biopsies and curative operations for abscess drainage has declined. Such CT-guided interventions are performed in nearly every organ. Instead of aspiration biopsies, more and more core biopsies are being performed to allow histopathological evaluation and thus allowing targeted therapy. This article is intended to give a general overview of techniques, materials, indications and contraindications. Ultrasound-guided biopsies as well as large bore vacuum biopsies of the breast are not included in this review. (orig.) [German] Infolge der Durchfuehrung von bildgesteuerten Biopsien solider Raumforderungen und Punktionen mit Drainageeinlage bei liquiden Prozessen ist die Zahl chirurgischer Exzisionsbiopsien und Abszesssanierungen zurueckgegangen. Diese Eingriffe werden in nahezu allen Organgebieten durchgefuehrt. Neben den Aspirationsbiopsien werden haeufig Schneid- oder Stanzbiopsien durchgefuehrt. Nach histologischer und immunhistologischer Untersuchung der hierbei gewonnenen Proben in der Pathologie kann fruehzeitig die nachfolgende Therapie geplant werden. Der vorliegende Beitrag soll einen allgemeinen Ueberblick ueber Methoden, Materialien, Indikationen und Kontraindikationen geben. Die ultraschallgesteuerten Biopsien sowie die Vakuumsaugbiopsien im Rahmen des Mammographiescreenings werden bewusst nicht besprochen. (orig.)

  17. Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus

    International Nuclear Information System (INIS)

    Chellathurai, Amarnath; Kanhirat, Saneej; Chokkappan, Kabilan; Swaminathan, Thiruchendur S; Kulasekaran, Nadhamuni

    2009-01-01

    Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans

  18. CT Guided biopsies of musculoskeletal lesions, radiological and pathologic correlation

    International Nuclear Information System (INIS)

    Hadzihasanovic, B.; Milisic, L.; Zuban, J.; Mujic, E.; Jahic, E.; Gjikolli, B.; Hasanovic, B.; Lincender-Cvijetic, L.; Jaganjac, S.

    2006-01-01

    Full text: The aim of the study is to overview our experiences in taking the CT guided biopsies of musculoskeletal lesions during the period of sixteen months, analysis of validity of samples taken and correlation with pathological findings. CT guided biopsies of musculoskeletal lesions were performed in 32 patients during the period of sixteen months (from December 2004 until March 2006). Age range was from 13 to 78 years. Majorities of the biopsies were performed with coaxial cutting needle system (14 G and 16 G) with introducers size 13 and 15 G. Bone biopsies were performed with Yamsidi needles in purpose of taking the bone cylinder. Majorities of the biopsies were performed under local anaesthesia except a thirteen years old child to whom CT guided biopsy of corpus Th 6 was performed under general anaesthesia. Two samples of tissues were sent in formalin solutions to Pathology Institute for pathological verification. In one case of musculoskeletal lesions CT guided biopsies didn't yield a representative tissue sample. We had high level of congruence between radiological and pathological findings; precise presented in the article. CT guided biopsies of musculoskeletal lesions are method of choice for pathologic verification of musculoskeletal lesions proving incomparable less risk compared to 'open' biopsy which requires operating theatre and general anaesthesia. Coaxial needle systems has shown as suitable for yielding representative tissue samples (two samples for each patient), and samples are also appropriate for immunohistochemical analysis

  19. CT-guided fixation of sacral fractures and sacrolilac joint disruptions

    International Nuclear Information System (INIS)

    Nelson, D.W.; Duwelius, P.

    1990-01-01

    Placement of sacral fixation screws at surgery is performed blindly (ie, by palpation). The authors of this paper employed CT to localize the screw between the neutral foramina and anterior sacral cortex and to decrease the morbidity associated with general anesthesia and surgery. Six patients underwent CT-guided sacral fixation performed by means of the 7.0 mm A0 cannulated screw system. All patients had reducible vertical sacral fractures or sacroiliac joint disruptions. Following placement of an epidural catheter for anesthesia, patients were scanned in the prone or decubitus position. Measurements for placement of the guide pin were made from the preliminary scans. Following CT confirmation of satisfactory guide pin placement across the fracture, the screw track was drilled, the screw length was determined, and the fixation screw was placed in position. A CT scan was obtained to evaluate the final position of the screw

  20. CT-guided interventions in children; Computertomografisch gesteuerte Interventionen bei Kindern

    Energy Technology Data Exchange (ETDEWEB)

    Honnef, D.; Wildberger, J.E.; Schubert, H.; Hohl, C.; Guenther, R.W.; Mahnken, A. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik

    2007-06-15

    In pediatric CT-guided interventions specific features have to be taken into account. Due to a lack of cooperation or limited ability to cooperate, procedures are often performed using analgosedation or general anesthesia. To provide radiation protection, justified indication for CT-guided intervention is necessary and sonography and MRI are to be preferred whenever possible. CT examinations also need to be dose-adapted with sequential scanning and a tube voltage and tube current reduction compared to pediatric diagnostic CT studies must be ensured. Gonad shields are recommended for male patients. Biopsy device selection depends on the assumed tumor entity since histology and also immunohistochemical, molecular pathological and cytogenetical analysis are necessary to differentiate pediatric tumors (small, round, blue cell tumors). In addition to diagnostic procedures, therapeutic interventions (drainage, injection therapies, neurolysis, and radiofrequency ablation) can also be used in children and can provide an alternative to surgery in selected cases. With justified indications and precise performance, CT-guided interventions can be successful in pediatric patients with limited risks. (orig.)

  1. Efficacy of cervicothoracic sympathectomy versus conservative management in patients suffering from incapacitating raynaud,s syndrome after frost bite

    International Nuclear Information System (INIS)

    Khan, M.I.; Rehman, A.; Tariq, M.; Sheen, S.N.

    2008-01-01

    Raynaud's syndrome is a known complication of cold injuries. Stress, smoking and metabolic diseases may further aggravate the disease course. The purpose of this study was to determine the efficacy of Cervico-thoracic sympathectomy as compared to conservative management in severe Raynaud's syndrome after frostbite. This non-randomized controlled trial was conducted at Railway Hospital, Rawalpindi and Islamic International Medical Complex, Islamabad between January 1999 and June 2006. All patients sustained severe cold trauma in the mountain ridges of Himalayas in Kashmir. In all cases, an informed consent was obtained from patients and families. All operations performed were free of charges. Out of the total 48 patients who developed incapacitating Raynaud's syndrome of the upper limbs after frost bite, 17 patients underwent thoracic sympathectomy through anterior supraclavicular route. Remaining 31 patients were treated conservatively and were placed in the control group. Data was collected on pre-designed proforma and assessed using SPSS (version 11). Chi-square test was applied to assess the effectiveness of the two treatment modalities. All operated cases initially showed improvement in symptoms and incapacitation. Among sympathectomised patients, 11 patients became symptom free and 3 patients showed mild but improved symptoms. Two patients after initial transient improvement developed incapacitating symptoms requiring further treatment, one patient developed gangrene of distal phalanx nine month after sympathectomy requiring amputation of the finger. Frequency of attacks and duration between the attacks reduced in all operated patients of cervical sympathectomy (p<0.05) as compared to conservative management. Cervical sympathectomy is a very effective modality of treatment in patients having severe Raynaud's disease of upper limbs secondary to frost bite. (author)

  2. Tearing of the left iliac vessels in lumbar surgery revealed by multiphase post-mortem CT-angiography (MPMCTA).

    Science.gov (United States)

    Vilariño Villaverde, Raquel; Bruguier, Christine; Zerlauth, Jean-Baptiste; De Froidmont, Sébastien; Grabherr, Silke

    2016-05-01

    Lumbar surgery is regularly applied in cases of discal hernia and acquired lumbar stenosis. In this report, we present a case of a laceration in the left common iliac artery and iliac vein during a lumbar surgery and discuss the literature concerning this kind of event. In the present case, the surgical procedure was followed by a sudden decrease in blood pressure, and the surgeon discovered an intra-abdominal haemorrhage that led to the patient's death. Postmortem investigation confirmed the intra-abdominal haemorrhage and revealed a laceration of the proximal portion of the left common iliac artery and left iliac vein. The source of bleeding could be detected especially thanks to multi-phase postmortem CT angiography (MPMCTA), which was performed prior to autopsy. We also found a haemorrhagic path through the intervertebral disc between the L4-L5 vertebrae, caused by the surgeon's instrument (pituitary rongeur). To date, a few cases have been described of iatrogenic death resulting from a tear in the iliac vessels during lumbar surgery, but not from the postmortem perspective. Such investigations have recently been modernized thanks to the introduction of forensic imaging. In particular, MPMCTA offers new possibilities in postmortem investigations and can be considered the new gold standard for investigating deaths related to medical intervention. Here we describe the first case of a death during lumbar surgery using this new method. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Particulate versus non-particulate corticosteroids for transforaminal nerve root blocks. Comparison of outcomes in 494 patients with lumbar radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Bensler, Susanne; Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopaedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2018-03-15

    We set out to compare outcomes in CT-guided lumbar transforaminal nerve root block patients receiving either particulate or non-particulate corticosteroids. This was a retrospective comparative effectiveness outcomes study on two cohorts of lumbar radiculopathy patients. 321 received particulate and 173 non-particulate corticosteroids at CT-guided transforaminal lumbar nerve root injections. The particulate steroid was used from October 2009 until May 2014 and the non-particulate steroid was used from May 2014. Pain levels were collected at baseline using an 11-point numerical rating scale (NRS) and at 1 day, 1 week and 1 month. Overall 'improvement' was assessed using the Patients' Global Impression of Change (PGIC) at these same time points (primary outcome). The proportions of patients 'improved' were compared between the two groups using the Chi-square test. The NRS change scores were compared using the unpaired t-test. A significantly higher proportion of patients treated with particulate steroids were improved at 1 week (43.2 % vs. 27.7 %, p = 0.001) and at 1 month (44.3 % vs. 33.1 %, p = 0.019). Patients receiving particulate steroids also had significantly higher NRS change scores at 1 week (p = 0.02) and 1 month (p = 0.007). Particulate corticosteroids have significantly better outcomes than non-particulate corticosteroids. (orig.)

  4. Accuracy of CT-guided biopsies in 158 patients with thoracic spinal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Hao, D.J.; He, B.R.; Liu, T.J.; Zhao, Q.P. (Dept. of Spinal Surgery, Xian Red Cross Hospital, Xian Shaanxi (China)), email: zqpddn1@gmail.com; Sun, H.H. (Dept. of Orthopaedic, Tangdu Hospital, Fourth Military Medical Univ., Xian Shaanxi (China)); Jiang, Y.H. (Dept. of Radiology, Xian Red Cross Hospital, Xian Shaanxi (China))

    2011-11-15

    Background. Inconsistent accuracies of CT-guided thoracic spinal biopsies have been reported in previous studies. Purpose. To determine the accuracy of CT-guided thoracic spinal biopsy, to compare the results with those previously reported, and to determine if there are any factors that influence the accuracy of CT-guided thoracic spinal biopsy. Material and Methods. In total, 158 consecutive CT-guided percutaneous thoracic spine procedures (performed at the Dept. of Spinal Surgery, Xian Red Cross Hospital between April 2000 and July 2010) were reviewed. The 158 lesions were categorized by location and radiographic features. Pathological and clinical follow-up were used to determine accuracy. Results. The diagnostic accuracy of CT-guided thoracic spinal biopsy was 90.5% overall. Biopsy of metastatic bone disease (98.2%) was significantly more accurate than biopsies of primary tumors (80.9%) and of hematological malignancies (47.0%) (P < 0.05 and P < 0.005, respectively). The diagnostic accuracy of CT-guided thoracic spinal biopsy was significantly higher for the lower thoracic spine (97.6%) than for the middle (90.0%) or upper thoracic spine (80.4%) (P < 0.05 and P < 0.025, respectively). The diagnostic accuracy was significantly higher for lytic lesions (96.4%) than for sclerotic lesions (81.3%) (P < 0.010). The accuracy of biopsies performed using the transpedicular approach (91.0%) was not significantly different from that of biopsies performed using posterolateral approaches (91.5%) (0.25 < P < 0.5). Conclusion. Percutaneous CT-guided thoracic spinal biopsy is a viable alternative to open surgical biopsy. The diagnostic accuracy was not affected by any of the variables except for lesion level, histology, and radiographic features

  5. Accuracy of CT-guided biopsies in 158 patients with thoracic spinal lesions

    International Nuclear Information System (INIS)

    Hao, D.J.; He, B.R.; Liu, T.J.; Zhao, Q.P.; Sun, H.H.; Jiang, Y.H.

    2011-01-01

    Background. Inconsistent accuracies of CT-guided thoracic spinal biopsies have been reported in previous studies. Purpose. To determine the accuracy of CT-guided thoracic spinal biopsy, to compare the results with those previously reported, and to determine if there are any factors that influence the accuracy of CT-guided thoracic spinal biopsy. Material and Methods. In total, 158 consecutive CT-guided percutaneous thoracic spine procedures (performed at the Dept. of Spinal Surgery, Xian Red Cross Hospital between April 2000 and July 2010) were reviewed. The 158 lesions were categorized by location and radiographic features. Pathological and clinical follow-up were used to determine accuracy. Results. The diagnostic accuracy of CT-guided thoracic spinal biopsy was 90.5% overall. Biopsy of metastatic bone disease (98.2%) was significantly more accurate than biopsies of primary tumors (80.9%) and of hematological malignancies (47.0%) (P < 0.05 and P < 0.005, respectively). The diagnostic accuracy of CT-guided thoracic spinal biopsy was significantly higher for the lower thoracic spine (97.6%) than for the middle (90.0%) or upper thoracic spine (80.4%) (P < 0.05 and P < 0.025, respectively). The diagnostic accuracy was significantly higher for lytic lesions (96.4%) than for sclerotic lesions (81.3%) (P < 0.010). The accuracy of biopsies performed using the transpedicular approach (91.0%) was not significantly different from that of biopsies performed using posterolateral approaches (91.5%) (0.25 < P < 0.5). Conclusion. Percutaneous CT-guided thoracic spinal biopsy is a viable alternative to open surgical biopsy. The diagnostic accuracy was not affected by any of the variables except for lesion level, histology, and radiographic features

  6. Complications in CT-guided Procedures: Do We Really Need Postinterventional CT Control Scans?

    Energy Technology Data Exchange (ETDEWEB)

    Nattenmüller, Johanna, E-mail: johanna.nattenmueller@med.uni-heidelberg.de; Filsinger, Matthias, E-mail: Matthias_filsinger@web.de; Bryant, Mark, E-mail: mark.bryant@med.uni-heidelberg.de; Stiller, Wolfram, E-mail: Wolfram.Stiller@med.uni-heidelberg.de; Radeleff, Boris, E-mail: boris.radeleff@med.uni-heidelberg.de; Grenacher, Lars, E-mail: lars.grenacher@med.uni-heidelberg.de; Kauczor, Hans-Ullrich, E-mail: hu.kauczor@med.uni-heidelberg.de; Hosch, Waldemar, E-mail: waldemar.hosch@urz.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany)

    2013-06-19

    PurposeThe aim of this study is twofold: to determine the complication rate in computed tomography (CT)-guided biopsies and drainages, and to evaluate the value of postinterventional CT control scans.MethodsRetrospective analysis of 1,067 CT-guided diagnostic biopsies (n = 476) and therapeutic drainages (n = 591) in thoracic (n = 37), abdominal (n = 866), and musculoskeletal (ms) (n = 164) locations. Severity of any complication was categorized as minor or major. To assess the need for postinterventional CT control scans, it was determined whether complications were detected clinically, on peri-procedural scans or on postinterventional scans only.ResultsThe complication rate was 2.5 % in all procedures (n = 27), 4.4 % in diagnostic punctures, and 1.0 % in drainages; 13.5 % in thoracic, 2.0 % in abdominal, and 3.0 % in musculoskeletal procedures. There was only 1 major complication (0.1 %). Pneumothorax (n = 14) was most frequent, followed by bleeding (n = 9), paresthesia (n = 2), material damage (n = 1), and bone fissure (n = 1). Postinterventional control acquisitions were performed in 65.7 % (701 of 1,067). Six complications were solely detectable in postinterventional control acquisitions (3 retroperitoneal bleeds, 3 pneumothoraces); all other complications were clinically detectable (n = 4) and/or visible in peri-interventional controls (n = 21).ConclusionComplications in CT-guided interventions are rare. Of these, thoracic interventions had the highest rate, while pneumothoraces and bleeding were most frequent. Most complications can be detected clinically or peri-interventionally. To reduce the radiation dose, postinterventional CT controls should not be performed routinely and should be restricted to complicated or retroperitoneal interventions only.

  7. Complications in CT-guided Procedures: Do We Really Need Postinterventional CT Control Scans?

    International Nuclear Information System (INIS)

    Nattenmüller, Johanna; Filsinger, Matthias; Bryant, Mark; Stiller, Wolfram; Radeleff, Boris; Grenacher, Lars; Kauczor, Hans-Ullrich; Hosch, Waldemar

    2014-01-01

    PurposeThe aim of this study is twofold: to determine the complication rate in computed tomography (CT)-guided biopsies and drainages, and to evaluate the value of postinterventional CT control scans.MethodsRetrospective analysis of 1,067 CT-guided diagnostic biopsies (n = 476) and therapeutic drainages (n = 591) in thoracic (n = 37), abdominal (n = 866), and musculoskeletal (ms) (n = 164) locations. Severity of any complication was categorized as minor or major. To assess the need for postinterventional CT control scans, it was determined whether complications were detected clinically, on peri-procedural scans or on postinterventional scans only.ResultsThe complication rate was 2.5 % in all procedures (n = 27), 4.4 % in diagnostic punctures, and 1.0 % in drainages; 13.5 % in thoracic, 2.0 % in abdominal, and 3.0 % in musculoskeletal procedures. There was only 1 major complication (0.1 %). Pneumothorax (n = 14) was most frequent, followed by bleeding (n = 9), paresthesia (n = 2), material damage (n = 1), and bone fissure (n = 1). Postinterventional control acquisitions were performed in 65.7 % (701 of 1,067). Six complications were solely detectable in postinterventional control acquisitions (3 retroperitoneal bleeds, 3 pneumothoraces); all other complications were clinically detectable (n = 4) and/or visible in peri-interventional controls (n = 21).ConclusionComplications in CT-guided interventions are rare. Of these, thoracic interventions had the highest rate, while pneumothoraces and bleeding were most frequent. Most complications can be detected clinically or peri-interventionally. To reduce the radiation dose, postinterventional CT controls should not be performed routinely and should be restricted to complicated or retroperitoneal interventions only

  8. The comparative study of lumbar disc disruption with MRI and CT discography

    International Nuclear Information System (INIS)

    Chen Xingcan; Liu Naifang; Li Xiaohong; Xu Wengen; Zou Qing; Yang Yonghong

    2005-01-01

    Objective: To compare MRI with CT discography (CTD) for diagnostic assessment of lumbar disc disruption. Methods: Paired comparative examination in 16 patients with chronic lower back pain without radicular pain and no disc herniation was conducted using CT or MRI. The standard of CTD classification and positive disc was formulated and the correlation between the induced lower back pain and dosage used in CTD was observed. Results: For a total of 21 discs in the 16 patients, CTD showed the disc as type 2 in 12 discs and type 5 in 1 disc with 13 positive discs, while MRI only showed the high-intensity zone of posterior annulus in 6 discs as the indirect sign of disc disruption and disc degeneration in 7 discs. Conclusion: CTD was the only method for showing the direct sign of disc disruption. The induced lower back pain was related with the type of disc disruption. MRI can show some of the indirect signs of disc disruption and CTD can show the direct sign of disc disruption. (authors)

  9. Efficacy of cervicothoracic sympathectomy versus conservative management in patients suffering from incapacitating Raynaud's syndrome after frost bite.

    Science.gov (United States)

    Khan, Mohammad Iqbal; Tariq, Mohammad; Rehman, Ahmed; Zafar, Afsheeen; Sheen, Salman Najam

    2008-01-01

    Raynaud's syndrome is a known complication of cold injuries. Stress, smoking and metabolic diseases may further aggravate the disease course. The purpose of this study was to determine the efficacy of Cervico-thoracic sympathectomy as compared to conservative management in severe Raynaud's syndrome after frostbite. This non-randomized controlled trial was conducted at Railway Hospital, Rawalpindi and Islamic International Medical Complex, Islamabad between January 1999 and June 2006. All patients sustained severe cold trauma in the mountain ridges of Himalayas in Kashmir. In all cases, an informed consent was obtained from patients and families. All operations performed were free of charges. Out of the total 48 patients who developed incapacitating Raynaud's syndrome of the upper limbs after frost bite, 17 patients underwent thoracic sympathectomy through anterior supraclavicular route. Remaining 31 patients were treated conservatively and were placed in the control group. Data was collected on pre-designed proforma and assessed using SPSS (version 11). Chi-square test was applied to assess the effectiveness of the two treatment modalities. All operated cases initially showed improvement in symptoms and incapacitation. Among sympathectomised patients, 11 patients became symptom free and 3 patients showed mild but improved symptoms. Two patients after initial transient improvement developed incapacitating symptoms requiring further treatment, one patient developed gangrene ofdistal phalanx nine month after sympathectomy requiring amputation of the finger. Frequency of attacks and duration between the attacks reduced in all operated patients of cervical sympathectomy (p frost bite.

  10. CT-guided percutaneous gastrostomy: success rate, early and late complications; CT-gesteuerte perkutane Gastrostomie: Technischer Erfolg, Frueh- und Spaetkomplikationen

    Energy Technology Data Exchange (ETDEWEB)

    Gottschalk, A.; Voelk, M. [Radiologie, Bundeswehrkrankenhaus Ulm (Germany); Strotzer, M. [Radiologie, Klinikum Hohe Warte (Germany); Feuerbach, S.; Rogler, G. [Radiologie, Klinikum der Universitaet Regensburg (Germany); Seitz, J. [Radiologie, MVZ Dr. Neumaier und Kollegen (Germany)

    2007-04-15

    Purpose: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are the standard methods of ensuring long-term enteral food intake in patients with dysphagia caused by neoplasia or neurological disorders. High-grade obstructions of the upper digestive tract or inadequate transillumination can prevent PEG. CT-guided percutaneous gastrostomy (PG) represents a special technique for enabling gastrostomy in patients for whom the endoscopic method is impossible. The aim of this study was to evaluate the results and complications of CT-guided percutaneous gastrostomy. Materials and Methods: CT-guided PG was performed in 83 patients, mostly with malignancy of the upper respiratory or digestive tract. Medical records for these patients were reviewed, and the results and complications of the CT-guided PG were analyzed retrospectively. Complications were grouped into four categories: Major and minor complications as well as early and late complications. Results: In 95.2 % of all cases (79/83), CT-guided PG was successful in the first attempt. Within the first 3 days, 5 major complications including 4 tube dislocations and one case of peritonitis were found in 4/79 patients (5.1 %). One of these patients experienced two early major complications. Early minor complications, mainly local skin irritations and temporary stomachache, were observed in 31 patients (39.2 %). Three days after CT-guided PG, 4 cases of major complications were documented, yielding a total rate of major complications was 8.7 % (7/79). Hemorrhage requiring blood transfusion or perforation after gastrostomy was not observed. 29.1 % of the patients (23/79) experienced late minor complications. (orig.)

  11. Spinal CT-guided injections. Clinical applications-limitations

    International Nuclear Information System (INIS)

    Stamatakis, V.; Vlachou, I.; Petrocheilou, G.; Safarika, V.; Geroukis, I.; Petinelli, A.; Stathopoulou, S.; Kokkinis, C.

    2012-01-01

    Full text: Introduction: Chronic spinal pain is an important health issue with serious social and financial consequences. Thus, application of minimal invasive procedures is a popular technique for immediate relief of pain. Objectives and tasks: Our purpose is to present CT guided intraspinal injection of pharmaceutical agents for the relief of persistent pain. Material and methods: Chronic localized or radicular spinal pain may be treated safely and efficiently with injection of various pharmaceutical agents (local anesthetic, opioid analgesic and steroids or combination of these). The possible sites of infiltration include: a) intervertebral joints (facets), b) sacroiliac joints, c)perineural infiltration of the affected nerve roots and d) the epidural space. We will mention the patients choice criteria (combination of clinical symptoms and specific pain evaluation questionnaire) as they are reported in the international bibliography. Finally, we will discuss the repeatability criteria of the method as well as its limitations. Results: CT-guided pharmaceutical agents injection for the relief of persistent spinal pain have an advantage against other methods because of the precision and safety that they offer to the localization and diagnosis of the pain cause. Conclusion: Small complications percentage and satisfactory results have made CT-guided spinal injections a popular technique for chronic back pain relief. In order to apply these techniques the good knowledge of the method, its possibilities and limitations is necessary

  12. Radiation dose associated with CT-guided drain placement for pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G. [University of North Carolina at Chapel Hill, Department of Radiology, UNC Health Care, Chapel Hill, NC (United States); Taylor, J.B. [University of North Carolina at Chapel Hill, Environment, Health and Safety, Chapel Hill, NC (United States)

    2017-05-15

    To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

  13. Radiation dose associated with CT-guided drain placement for pediatric patients

    International Nuclear Information System (INIS)

    Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G.; Taylor, J.B.

    2017-01-01

    To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

  14. Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules

    International Nuclear Information System (INIS)

    Ohno, Yoshiharu; Hatabu, Hiroto; Takenaka, Daisuke; Imai, Masatake; Ohbayashi, Chiho; Sugimura, Kazuro

    2004-01-01

    Objective: To evaluate the utility of multiplanar reconstruction (MPR) image for CT-guided biopsy and determine factors of influencing diagnostic accuracy and the pneumothorax rate. Materials and methods: 390 patients with 396 pulmonary nodules underwent transthoracic CT-guided aspiration biopsy (TNAB) and transthoracic CT-guided cutting needle core biopsy (TCNB) as follows: 250 solitary pulmonary nodules (SPNs) underwent conventional CT-guided biopsy (conventional method), 81 underwent CT-fluoroscopic biopsy (CT-fluoroscopic method) and 65 underwent conventional CT-guided biopsy in combination with MPR image (MPR method). Success rate, overall diagnostic accuracy, pneumothorax rate and total procedure time were compared in each method. Factors affecting diagnostic accuracy and pneumothorax rate of CT-guided biopsy were statistically evaluated. Results: Success rates (TNAB: 100.0%, TCNB: 100.0%) and overall diagnostic accuracies (TNAB: 96.9%, TCNB: 97.0%) of MPR were significantly higher than those using the conventional method (TNAB: 87.6 and 82.4%, TCNB: 86.3 and 81.3%) (P<0.05). Diagnostic accuracy were influenced by biopsy method, lesion size, and needle path length (P<0.05). Pneumothorax rate was influenced by pathological diagnostic method, lesion size, number of punctures and FEV1.0% (P<0.05). Conclusion: The use of MPR for CT-guided lung biopsy is useful for improving diagnostic accuracy with no significant increase in pneumothorax rate or total procedure time

  15. PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

    Energy Technology Data Exchange (ETDEWEB)

    Klaeser, Bernd; Wartenberg, Jan; Weitzel, Thilo; Krause, Thomas [Bern University Hospital and University of Bern, Department of Nuclear Medicine, Inselspital, Bern (Switzerland); Wiskirchen, Jakub [Bern University Hospital and University of Bern, Department of Nuclear Medicine, Inselspital, Bern (Switzerland); University Hospital Tuebingen, Department of Radiology, Neuroradiology, and Nuclear Medicine, Tuebingen (Germany); Schmid, Ralph A. [Bern University Hospital and University of Bern, Department of Thoracic Surgery, Inselspital, Bern (Switzerland); Mueller, Michel D. [Bern University Hospital and University of Bern, Department of Obstetrics and Gynaecology, Inselspital, Bern (Switzerland)

    2010-11-15

    In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions. We retrospectively reviewed the data of 20 consecutive patients who underwent multimodal image-guided bone biopsies using a dedicated PET/CT system in a step-by-step technique. Technical and clinical success rates of PET/CT-guided biopsies were evaluated. Questionnaires were sent to the referring physicians to assess the impact of biopsies on patient management and to check the clinical need for PET/CT-guided biopsies. Clinical indications for biopsy were to histologically verify the aetiology of metabolically active bone lesions without a morphological correlate confirming the suspicion of metastases in 15 patients, to determine the origin of suspected metastases in 3 patients and to evaluate the appropriateness of targeted therapy options in 2 patients. Biopsies were technically successful in all patients. In 19 of 20 patients a definite histological diagnosis was possible. No complications or adverse effects occurred. The result of PET/CT-guided bone biopsies determined a change of the planned treatment in overall 56% of patients, with intramodality changes, e.g. chemotherapy with palliative instead of curative intent, and intermodality changes, e.g. systemic therapy instead of surgery, in 22 and 50%, respectively. PET/CT-guided bone biopsies are a promising alternative to conventional techniques to make metabolically active bone lesions - especially without a distinctive morphological correlate - accessible for histological verification. PET/CT-guided biopsies had a major clinical impact in patients who otherwise cannot be reliably stage grouped at the time of treatment decisions. (orig.)

  16. Automatic path proposal computation for CT-guided percutaneous liver biopsy.

    Science.gov (United States)

    Helck, A; Schumann, C; Aumann, J; Thierfelder, K; Strobl, F F; Braunagel, M; Niethammer, M; Clevert, D A; Hoffmann, R T; Reiser, M; Sandner, T; Trumm, C

    2016-12-01

    To evaluate feasibility of automatic software-based path proposals for CT-guided percutaneous biopsies. Thirty-three patients (60 [Formula: see text] 12 years) referred for CT-guided biopsy of focal liver lesions were consecutively included. Pre-interventional CT and dedicated software (FraunhoferMeVis Pathfinder) were used for (semi)automatic segmentation of relevant structures. The software subsequently generated three path proposals in downward quality for CT-guided biopsy. Proposed needle paths were compared with consensus proposal of two experts (comparable, less suitable, not feasible). In case of comparable results, equivalent approach to software-based path proposal was used. Quality of segmentation process was evaluated (Likert scale, 1 [Formula: see text] best, 6 [Formula: see text] worst), and time for processing was registered. All biopsies were performed successfully without complications. In 91 % one of the three automatic path proposals was rated comparable to experts' proposal. None of the first proposals was rated not feasible, and 76 % were rated comparable to the experts' proposal. 7 % automatic path proposals were rated not feasible, all being second choice ([Formula: see text]) or third choice ([Formula: see text]). In 79 %, segmentation at least was good. Average total time for establishing automatic path proposal was 42 [Formula: see text] 9 s. Automatic software-based path proposal for CT-guided liver biopsies in the majority provides path proposals that are easy to establish and comparable to experts' insertion trajectories.

  17. Evidence for a local sympathetic venoarteriolar "reflex" in the dog hindleg

    DEFF Research Database (Denmark)

    Henriksen, O; Amtorp, O; Faris, I

    1983-01-01

    24%. In subcutaneous tissue, vascular resistance decreased by 12%. The effect of acute lumbar sympathectomy was studied in another group of seven dogs. Operation caused an immediate decrease in vascular resistance of 40%. The increase in vascular resistance during venous stasis in the total leg......, as well as in muscle and subcutaneous tissue, was not affected. However, acute lumbar sympathectomy combined with injection of phenoxybenzamine into the femoral artery almost abolished the vasoconstriction induced by venous stasis. In muscle, the increase in vascular resistance was still present...

  18. Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

    Science.gov (United States)

    Noh, Tae June; Lee, Chang Hoon; Kang, Young Ae; Kwon, Sung-Youn; Yoon, Ho-Il; Kim, Tae Jung; Lee, Kyung Won; Lee, Jae Ho

    2009-01-01

    Background/Aims This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. Methods Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. Results Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. Conclusions CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax. PMID:19949733

  19. CT guided celiac plexus and splanchnic nerve neurolysis : the modified anterior approach

    International Nuclear Information System (INIS)

    Lee, Jeong Min; Lee, Mi Suk; Ym, Seong Hee; Lee, Jin Hee

    1997-01-01

    Since it was first described by Kappis, celiac plexus neurolysis (CPN) has been performed under fluoroscopic guidance by anesthetists or surgeons for the relief of intractable pain caused by upper abdominal malignancy. Recently, however, several groups have reported a computed tomography (CT)-guided technique that increased the safety of the blocking procedure and improved its results. The authors present a new technique CT-guided celiac plexus and splanchic nerve block, to be used simultaneously with a modified anterior approach. Using CT to guide needle tip placement, an anterior approach that permitted direct neurolysis of the celiac ganglia and splanchnic nerve was developed

  20. Clinical Value of CT-Guided Needle Biopsy for Retroperitoneal Lesions

    International Nuclear Information System (INIS)

    Tomozawa, Yuki; Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kato, Mina; Kanamoto, Takaaki; Sakane, Makoto

    2011-01-01

    The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma.

  1. CT-guided conformal cryoablation for peripheral NSCLC: Initial experience

    International Nuclear Information System (INIS)

    Zhang, Xiao; Tian, Jinlin; Zhao, Lei; Wu, Bin; Kacher, Daniel S.; Ma, Xuyang; Liu, Shurong; Ren, Chao; Xiao, Yue-Yong

    2012-01-01

    Purpose: To study the feasibility of CT-guided and monitored percutaneous conformal cryoablation of Non-Small Cell Lung Cancer for patients who are not suitable for surgical resection. Materials and method: CT-guided percutaneous conformal cryoablation was performed on 46 patients with peripheral Non-Small Cell Lung Cancer. Patients with tumor sizes less than 3 cm in diameter were treated with double-needle clamping cryoablation, while the patients with 3–5 cm tumor sizes were treated with multiple-needle conformal cryoablation. CT was used to monitor the extent of cryoablation during the procedures. At month 1, 3, 6, 12, and 24 post-procedure, enhanced CT scans and/or PET-CT scans were performed to evaluate the impact of the therapy. Results: The average tumor CT values were 32 ± 10 HU and −21 ± 8 HU before and after cryoablation, respectively. The largest diameters of the lesions at month 1, 3, 6, 12, and 24 post-procedure were 2.63 ± 0.56 cm, 1.93 ± 0.51 cm, 1.55 ± 0.39 cm, 1.43 ± 0.40 cm, and 1.38 ± 0.38 cm, respectively, in patients with tumor diameter less than 3 cm, and 3.63 ± 0.39 cm, 2.98 ± 0.31 cm, 2.62 ± 0.32 cm, 2.54 ± 0.34 cm, and 2.56 ± 0.37 cm respectively in patients with the tumor diameters between 3 and 5 cm. At the 24th month, there were 36 cases of complete response (83.7%), 7 cases of partial response (16.3%), and no cases of stable disease or progressive disease. 3 patients died due to multiple metastases. Conclusion: CT-guided percutaneous conformal cryoablation is a safe, effective, and minimally invasive therapeutic method for peripheral lung cancer.

  2. CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, Katrin, E-mail: k.eichler@em.uni-frankfurt.d [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany); Zangos, Stephan; Thalhammer, Axel; Jacobi, Volkmar [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany); Walcher, Felix; Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University of Frankfurt, Frankfurt (Germany); Moritz, Anton [Department of Thoracic and Cardiovascular Surgery, University of Frankfurt, Frankfurt (Germany); Vogl, Thomas J.; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University of Frankfurt, Frankfurt (Germany)

    2010-07-15

    Objective: To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children. Methods: 20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative. The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion. Results: All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.

  3. CT-guided pericardiocenteses: Clinical profile, practice patterns and clinical outcome

    International Nuclear Information System (INIS)

    Eichler, Katrin; Zangos, Stephan; Thalhammer, Axel; Jacobi, Volkmar; Walcher, Felix; Marzi, Ingo; Moritz, Anton; Vogl, Thomas J.; Mack, Martin G.

    2010-01-01

    Objective: To assess the effectiveness and clinical outcome and technique of CT-guided pericardiocenteses in the treatment of pericardial effusions in adults and children. Methods: 20 drainages were performed in Seldinger-technique under CT-guidance on 20 patients suffering from pericardial effusions and haematomas. In 85%, the etiology of effusion was postoperative. The mean age of the patients was 59 years (minimum 9 years, maximum 86 years).There were 12 male and eight female patients. The inclusion criterion was an echocardiographically relevant proved pericardial effusion. Results: All catheters could be placed successfully (20/20) in the pericardial effusion and allowed for draining of the effusion in all cases under CT-guidance. The overall 30-day mortality rate was 0%. CT-guided pericardiocentesis was successful for withdrawing pericardial fluid and/or relieving tamponade in 100% of all procedures. No major complication was occurred. A total of one minor complication (5%) occurred that required no specific interventions, except for monitoring and appropriate follow-up. We observed one pneumothorax as a minor complication. Conclusions: Pericardial effusions of various causes can be safely, effectively, and quickly managed with CT-guided pericardiocenteses in adults and children. The ventrolateral entry side for the puncture should be preferred to reach the whole effusion and avoid complications, like a pneumothorax.

  4. Studies on the pathogenesis of the degenerative lumbar canal stenosis by CT, 3

    International Nuclear Information System (INIS)

    Kido, Kenji

    1988-01-01

    Computed tomography (CT) scans of lumbar canal stenosis (LCS, n = 20), osteoarthritis (OA, n = 65), disk herniation (n = 21), and lumbar pain (n = 23) were reviewed for the quanlitative evaluation of the vertebral canal and stenosis factors. Trefoil type on transverse sections of the bony vertebral canal was observed in 23 %, having no implications for pathologic significance at the L5 level. The degree of degeneration in soft tissues inside the vertebral canal varied according to diseases. This was most noticeable at the L4/L5 level in the LCS group. The morphological CT appearance of vertebral arch were divided into three types: I - the concave inner part, II - the linear inner part, and III - the convex inner part to the vertebral canal. In the group of LCS, the incidences of types II and III were high at the L5/S1 and at the L4/L5 levels, respectively. As for the angle of apophyseal joint, the incidence of sagittal joint was high at the L3/L4 and L4/L5 levels in the group of LCS. The incidence of degenerative changes was high in the groups of LCS and OA, suggesting some relationship between degenerative degree and both sagittal and asymmetric joints. This was noticeable at the L4/L5 level. Calcification surrounding the joint was seen in 13 %, reflecting the relationship to the degenerative changes. There was no relationship between degenerative changes and vacuum joint phenomenon observed in 18 %. As for the area less than 90 mm 2 of the dural canal, there was no morphological change between the LCS and OA groups. In the symptomatic mechanism in the case of LCS, morphological dynamic and unstable factors may be involved. (Namekawa, K.) 67 refs

  5. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT.

    Science.gov (United States)

    Chami, H A; Faraj, W; Yehia, Z A; Badour, S A; Sawan, P; Rebeiz, K; Safa, R; Saade, C; Ghandour, B; Shamseddine, A; Mukherji, D; Haydar, A A

    2015-12-01

    To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below -950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01-1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  6. [Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis].

    Science.gov (United States)

    Lu, Di; Xu, Wei-xing; Ding, Wei-Guo; Guo, Qiao-Feng; Ma, Gou-ping; Zhu, Wei-min

    2013-03-01

    To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis. From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed. Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15

  7. PET/CT-guided interventional procedures: rationale, justification, initial study, and research plan

    Energy Technology Data Exchange (ETDEWEB)

    Wong, K.; Rahill, J.; Cleary, K. [Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Georgetown Univ. Medical Center, Washington, DC (United States); Petrillo, S.; Earl-Graef, D. [Dept. of Radiology, Georgetown Univ. Hospital, MedStar Health, Washington, DC (United States); Banovac, F.; Levy, E. [Computer Aided Interventions and Medical Robotics (CAIMR), Imaging Science and Information Systems (ISIS) Center, Georgetown Univ. Medical Center, Washington, DC (United States); Dept. of Radiology, Georgetown Univ. Hospital, MedStar Health, Washington, DC (United States); Shekhar, R. [Dept. of Radiology, Univ. of Maryland Medical Center, Baltimore, MD (United States)

    2007-06-15

    Positron-emission tomography (PET) and PET/CT (computed tomography) are becoming increasingly important for diagnosis and treatment of cancer. Clinically relevant changes can sometimes be seen on PET that are not seen on other imaging modalities. However, PET is not suitable for guiding biopsy as the images are not obtained in real-time. Therefore, our research group has begun developing a concept for PET/CT-guided interventional procedures. This paper presents the rationale for this concept, outlines our research plan, and includes an initial study to evaluate the relative sensitivity of CT and PET/CT in detecting suspicious lesions. (orig.)

  8. Activity-based cost analysis of hepatic tumor ablation using CT-guided high-dose rate brachytherapy or CT-guided radiofrequency ablation in hepatocellular carcinoma.

    Science.gov (United States)

    Schnapauff, D; Collettini, F; Steffen, I; Wieners, G; Hamm, B; Gebauer, B; Maurer, M H

    2016-02-25

    To analyse and compare the costs of hepatic tumor ablation with computed tomography (CT)-guided high-dose rate brachytherapy (CT-HDRBT) and CT-guided radiofrequency ablation (CT-RFA) as two alternative minimally invasive treatment options of hepatocellular carcinoma (HCC). An activity based process model was created determining working steps and required staff of CT-RFA and CT-HDRBT. Prorated costs of equipment use (purchase, depreciation, and maintenance), costs of staff, and expenditure for disposables were identified in a sample of 20 patients (10 treated by CT-RFA and 10 by CT-HDRBT) and compared. A sensitivity and break even analysis was performed to analyse the dependence of costs on the number of patients treated annually with both methods. Costs of CT-RFA were nearly stable with mean overall costs of approximately 1909 €, 1847 €, 1816 € and 1801 € per patient when treating 25, 50, 100 or 200 patients annually, as the main factor influencing the costs of this procedure was the single-use RFA probe. Mean costs of CT-HDRBT decreased significantly per patient ablation with a rising number of patients treated annually, with prorated costs of 3442 €, 1962 €, 1222 € and 852 € when treating 25, 50, 100 or 200 patients, due to low costs of single-use disposables compared to high annual fix-costs which proportionally decreased per patient with a higher number of patients treated annually. A break-even between both methods was reached when treating at least 55 patients annually. Although CT-HDRBT is a more complex procedure with more staff involved, it can be performed at lower costs per patient from the perspective of the medical provider when treating more than 55 patients compared to CT-RFA, mainly due to lower costs for disposables and a decreasing percentage of fixed costs with an increasing number of treatments.

  9. CT-guided intratumoral gene therapy in non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Kauczor, H.U.; Heussel, C.P.; Thelen, M.; Schuler, M.; Huber, C.; Weymarn, A. von; Bongartz, G.; Rochlitz, C.

    1999-01-01

    The objective of this study was to prove the principle of CT-guided gene therapy by intratumoral injection of a tumor suppressor gene as an alternative treatment approach of incurable non-small-cell lung cancer. In a prospective clinical phase I trial six patients with non-small-cell lung cancer and a mutation of the tumor suppressor gene p53 were treated by CT-guided intratumoral gene therapy. Ten milliliters of a vector solution (replication-defective adenovirus with complete wild-type p53 cDNA) were injected under CT guidance. In four cases the vector solution was completely applied to the tumor center, whereas in two cases 2 ml aliquots were injected into different tumor areas. For the procedure the scan room had been approved as a biosafety cabinet. Gene transfer was assessed by reverse transcription and polymerase chain reaction in biopsy specimens obtained under CT guidance 24-48 h after therapy. Potential therapeutic efficacy was evaluated on day 28 after treatment using spiral CT. The CT-guided gene therapy was easily performed in all six patients without intervention-related complications. Besides flu-like symptoms, no significant adverse effects of gene therapy were noted. Three of the four patients with central injection exhibited gene transfer in the posttreatment biopsy. Gene transfer could not be proven in the two patients with multiple 2 ml injections. After 28 days, four of the six patients showed stable disease at the treated tumor site, whereas other tumor manifestations progressed. Computed tomography-guided injections are an adequate and easy-to-perform procedure for intratumoral gene therapy. (orig.)

  10. Prospective evaluation of the radiologist's hand dose in CT-guided interventions

    International Nuclear Information System (INIS)

    Rogits, B.; Jungnickel, K.; Loewenthal, D.; Dudeck, O.; Pech, M.; Ricke, J.; Kropf, S.; Nekolla, E.A.; Wieners, G.

    2013-01-01

    Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods: The following CT-guided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 - 3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 - 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 - 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 - 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. (orig.)

  11. CT guided percutaneous renal cysts puncture with ethanol therapy

    International Nuclear Information System (INIS)

    Zhang Xuezhe; Lu Yan; Wang Wu; Huang Zhengguo; Ren An

    2002-01-01

    Objective: To analyse our clinical experience with CT guided percutaneous renal cysts puncture and ethanol therapy. Methods: Five hundred and ten renal cysts in 445 patients were undergone CT guided percutaneous renal cysts puncture and ethanol therapy. Among the 445 cases, 385 cases had solitary renal cyst, 53 multiple renal cysts, and 7 polycystic kidneys. The renal cysts varied in size from 1.9 to 13.5 cm in diameter. The amount of aspirated fluid varied from 3 to 780 ml. A 18-21 gauge aspiration needles were used for all patients. A 25.0% cyst volume replacement with 99.7% ethanol was approved to be appropriate. Results: 427 renal cysts in 396 patients were followed up by computed tomographic (CT) or ultrasound for less than 3 months to more than one year duration. The curative effective rate and disappearance rate of the renal cystic cavity in solitary renal cysts were 97% and 82%, respectively. In multiple renal cysts, the corresponding values were 95% and 79%. In polycystic kidneys, the curative rate was 67%. The complications such as local abdominal pain (28 cases) and hematuria (four cases) were observed in this series. There were no fatal complications. Conclusions: CT guided percutaneous renal cyst puncture and ethanol therapy is an useful procedure for the treatment of solitary renal cysts and multiple renal cysts

  12. Localized Sympathectomy Reduces Mechanical Hypersensitivity by Restoring Normal Immune Homeostasis in Rat Models of Inflammatory Pain.

    Science.gov (United States)

    Xie, Wenrui; Chen, Sisi; Strong, Judith A; Li, Ai-Ling; Lewkowich, Ian P; Zhang, Jun-Ming

    2016-08-17

    Some forms of chronic pain are maintained or enhanced by activity in the sympathetic nervous system (SNS), but attempts to model this have yielded conflicting findings. The SNS has both pro- and anti-inflammatory effects on immunity, confounding the interpretation of experiments using global sympathectomy methods. We performed a "microsympathectomy" by cutting the ipsilateral gray rami where they entered the spinal nerves near the L4 and L5 DRG. This led to profound sustained reductions in pain behaviors induced by local DRG inflammation (a rat model of low back pain) and by a peripheral paw inflammation model. Effects of microsympathectomy were evident within one day, making it unlikely that blocking sympathetic sprouting in the local DRGs or hindpaw was the sole mechanism. Prior microsympathectomy greatly reduced hyperexcitability of sensory neurons induced by local DRG inflammation observed 4 d later. Microsympathectomy reduced local inflammation and macrophage density in the affected tissues (as indicated by paw swelling and histochemical staining). Cytokine profiling in locally inflamed DRG showed increases in pro-inflammatory Type 1 cytokines and decreases in the Type 2 cytokines present at baseline, changes that were mitigated by microsympathectomy. Microsympathectomy was also effective in reducing established pain behaviors in the local DRG inflammation model. We conclude that the effect of sympathetic fibers in the L4/L5 gray rami in these models is pro-inflammatory. This raises the possibility that therapeutic interventions targeting gray rami might be useful in some chronic inflammatory pain conditions. Sympathetic blockade is used for many pain conditions, but preclinical studies show both pro- and anti-nociceptive effects. The sympathetic nervous system also has both pro- and anti-inflammatory effects on immune tissues and cells. We examined effects of a very localized sympathectomy. By cutting the gray rami to the spinal nerves near the lumbar sensory

  13. Value of CT-guided biopsy in malignant lymphoma; Wertigkeit der CT-gesteuerten Biopsie maligner Lymphome

    Energy Technology Data Exchange (ETDEWEB)

    Libicher, M.; Noeldge, G.; Radeleff, B.; Gholipur, F.; Richter, G.M. [Abteilung Radiodiagnostik, Universitaetsklinikum Heidelberg (Germany)

    2002-12-01

    Management of diagnosing malignant lymphomas has changed with development of CT-guided techniques and reliable biopsy tools.Pathologists can use representative tissue samples for sub classification in more than 90%.Evaluation of residual lymphoma or relapse can be nearly as effective. Therefore percutaneous biopsy can be considered as primary diagnostic tool in the absence of peripheral lymphadenopathy. CT-guided biopsies can be performed on an outpatient basis under conscious sedation considering contraindications as well as regional complications. Acceptance of percutaneous biopsy by the pathologist and oncologist is based on diagnostic effectiveness that is significantly improved if more than 3{dagger}solid tissue samples are taken. This article reviews the value of CT-guided biopsy in comparison to surgical procedures in patients with malignant lymphoma. Essential aspects that lead to a diagnostic percutaneous biopsy are discussed on grounds of the current literature. (orig.) [German] Mit der Entwicklung CT-gesteuerter Biopsieverfahren sowie zuverlaessiger Biopsiesysteme hat sich die Vorgehensweise bei der Diagnostik maligner Lymphome geaendert. Repraesentative Stanzzylinder mit hoher Praeparatequalitaet ermoeglichen dem Pathologen eine Subklassifikation der Lymphome in ueber 90%. Eine aehnlich hohe Treffsicherheit ist auch bei der Rezidivdiagnostik moeglich. Deshalb sind perkutane Biopsien bei fehlender peripherer Lymphadenopathie als primaere diagnostische Methode geeignet. Unter Beachtung der Kontraindikationen sowie der regional unterschiedlichen Komplikationsmoeglichkeiten koennen die meisten CT-gesteuerten Biopsien ambulant unter Analgosedierung durchgefuehrt werden. Die Akzeptanz perkutaner Biopsien durch Pathologen und Onkologen ist an die diagnostische Genauigkeit gekoppelt. Diese wird durch Gewinnung von mindestens 3 repraesentativen Biopsiezylindern aus den soliden Anteilen eines Lymphoms signifikant erhoeht. Die vorliegende Uebersichtsarbeit

  14. CT-guided percutaneous treatment of solitary pyogenic splenic abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Pombo, F. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Suarez, I. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Marini, M. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Arrojo, L. [Dept. of Radiology, Hospital Juan Canalejo, La Coruna (Spain); Echaniz, A. [Dept. of Internal Medicine, Hospital Juan Canalejo, La Coruna (Spain)

    1991-08-01

    Six patients with solitary pyogenic splenic abscesses treated by CT-guided percutaneous drainage (by catheter or needle), are presented. There were 3 unilocular, purely intrasplenic abscesses and 3 complex lesions with loculations and perisplenic involvement. Percutaneous drainage and intravenous antibiotics were curative in 4 patients. In the other 2, who had multiloculated abscesses, despite initially successful drainage, splenectomy was performed because of intractable left upper quadrant pain in one case and persistent fever and drainage of pus after 30 days in the other. These patients also developed large, sterile left pleural effusions. Solitary pyogenic splenic abscesses - particularly if uniloculated - can be effectively treated by CT-guided percutaneous drainage. (orig.)

  15. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine

    International Nuclear Information System (INIS)

    Ganiyusufoglu, A.K.; Onat, L.; Karatoprak, O.; Enercan, M.; Hamzaoglu, A.

    2010-01-01

    Aim: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. Materials and methods: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. Results: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. Conclusion: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

  16. Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Ganiyusufoglu, A.K., E-mail: kursady33@yahoo.co [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Onat, L. [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Karatoprak, O.; Enercan, M.; Hamzaoglu, A. [Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul (Turkey)

    2010-11-15

    Aim: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. Materials and methods: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. Results: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. Conclusion: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

  17. Clinical potential and limitation of MRI for degenerative lumbar spinal diseases. Comparison of MRI, myelography, CT and selective nerve root infiltration

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Michihiro; Kikuchi, Shinichi [Fukushima Medical Coll. (Japan)

    1994-12-01

    To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.).

  18. Clinical potential and limitation of MRI for degenerative lumbar spinal diseases. Comparison of MRI, myelography, CT and selective nerve root infiltration

    International Nuclear Information System (INIS)

    Seki, Michihiro; Kikuchi, Shinichi

    1994-01-01

    To assess the clinical potential and limitations of magnetic resonance imaging (MRI) in degenerative lumbar spinal diseases, the findings of MR imaging were compared with those of myelography and CT. The subjects were 80 patients with intervertebral disc herniation (46), spondylosis (28), degenerative spondylolisthesis (5), and spondylolysis (one). There was a good correlation between sagittal MRI (T1-weighted images) and myelography in measuring the anteroposterior diameter and the compression rate of the injured dural canal in all disease categories. However, MRI was inferior, irrespective of sagittal and coronal images, to myelography in detecting blocking of the dural canal and intradural findings such as redundant nerve roots. MRI was inferior to selective nerve root infiltration in visualizing the compression of the nerve root, irrespective of diseases; however, there was no difference in abnormal findings of the running of nerve root between the two modalities. Transverse MRI was superior to CT in visualizing the nerve root. Thus, MRI alone is insufficient for the diagnosis of degenerative lumbar spinal diseases, and the other modalities should be supplementary for pathophysiological understanding of these diseases. (N.K.)

  19. CT-guided puncture for direct MR-arthrography of the shoulder: Description of possible techniques

    Directory of Open Access Journals (Sweden)

    Hauth E

    2016-07-01

    Full Text Available The following report describes the possible techniques of CT-guided puncture for direct magnetic resonance (MR arthrography of the shoulder. CT-guided puncture can be regarded as an alternative technique to fluoroscopic- or ultrasound-guided puncture for MR-arthrography of the shoulder with high efficiency, low dose and extremely low complication rate.

  20. A multi-level rapid prototyping drill guide template reduces the perforation risk of pedicle screw placement in the lumbar and sacral spine.

    Science.gov (United States)

    Merc, Matjaz; Drstvensek, Igor; Vogrin, Matjaz; Brajlih, Tomaz; Recnik, Gregor

    2013-07-01

    The method of free-hand pedicle screw placement is generally safe although it carries potential risks. For this reason, several highly accurate computer-assisted systems were developed and are currently on the market. However, these devices have certain disadvantages. We have developed a method of pedicle screw placement in the lumbar and sacral region using a multi-level drill guide template, created with the rapid prototyping technology and have validated it in a clinical study. The aim of the study was to manufacture and evaluate the accuracy of a multi-level drill guide template for lumbar and first sacral pedicle screw placement and to compare it with the free-hand technique under fluoroscopy supervision. In 2011 and 2012, a randomized clinical trial was performed on 20 patients. 54 screws were implanted in the trial group using templates and 54 in the control group using the fluoroscopy-supervised free-hand technique. Furthermore, applicability for the first sacral level was tested. Preoperative CT-scans were taken and templates were designed using the selective laser sintering method. Postoperative evaluation and statistical analysis of pedicle violation, displacement, screw length and deviation were performed for both groups. The incidence of cortex perforation was significantly reduced in the template group; likewise, the deviation and displacement level of screws in the sagittal plane. In both groups there was no significantly important difference in deviation and displacement level in the transversal plane as not in pedicle screw length. The results for the first sacral level resembled the main investigated group. The method significantly lowers the incidence of cortex perforation and is therefore potentially applicable in clinical practice, especially in some selected cases. The applied method, however, carries a potential for errors during manufacturing and practical usage and therefore still requires further improvements.

  1. [Biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy].

    Science.gov (United States)

    Qian, J; Yu, S S; Liu, J J; Chen, L; Jing, J H

    2018-04-03

    Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine ( q =8.823, 8.248, both P biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.

  2. CT-guided stereotactic evacuation of hypertensive intracerebral hematomas

    International Nuclear Information System (INIS)

    Hondo, Hideki

    1983-01-01

    Computerized tomography (CT) is now effective not only for definite diagnosis and location of intracerebral hematomas but also for coordination of the center of a hematoma. CT-guided stereotactic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 of basal ganglionic hematoma with or without ventricular perforation, 11 of subcortical hematoma, 3 of thalamic hematoma and 3 of cerebellar hematoma. Three dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. Then, a silicon tube (O.D. 3.5 phi, I.D. 2.1 phi) was inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquid or solid hematoma was aspirated as completely as possible with a syringe. Urokinase (6,000 I.U./5 ml saline) was administered through this silicon tube every 6 or 12 hours for several days until the hematoma had drained out competely. The silicon tube was taken out when repeated CT scanning revealed no hematoma. The results of clinical follow-ups indicated that this procedure is as good as, or rather better than conventional microsurgery with evacuation of hematoma under direct vision. Moreover this CT-guided stereotactic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe, 2) operation can be performed under local anesthesia, and 3) the hematoma is drained out completely with the aid of urokinase. This surgery seems indicated as an emergency treatment for high-age or high risk patients and also as a routine surgery for intracerebral hematomas in patients showing no herination signs. (author)

  3. Image-guided stereotactic surgery using ultrasonography and reconstructive three-dimensional CT-imaging system

    International Nuclear Information System (INIS)

    Kawamura, Hirotsune; Iseki, Hiroshi; Umezawa, Yoshihiro

    1991-01-01

    A new simulation and navigation system utilizing three-dimensional CT images has been developed for image-guided stereotactic surgery. Preoperative CT images are not always useful in predicting the intraoperative location of lesions, for cerebral lesions are easily displaced or distorted by gravity, brain retraction, and/or CSF aspiration during operative procedure. This new system, however, has the advantage that the intraoperative locations of intracranial lesions or the anatomical structures of the brain can be precisely confirmed during stereotactic surgery. Serial CT images were obtained from a patient whose head had been fixed to the ISEKI CT-guided stereotactic frame. The data of serial CT images were saved on a floppy disc and then transferred to the work station (IRIS) using the off line. In order to find the best approach angle for ultrasound-guided stereotactic surgery, three-dimenstional CT images were reconstructed using the work station. The site of the craniotomy or the angle of the trajectory of the ultrasound probe was measured preoperatively based on the three-dimensional CT images. Then, in the operating room, the patient's head was fixed to the ISEKI frame with the subframe at the same position as before according to the measurement of the CT images. In a case of cystic glioma, the predicable ultrasonograms from three-dimensional reconstructive CT images were ascertained to correspond well to the actual ultrasound images during ultrasound-guided stereotactic surgery. Therefore, the new simulation and navigation system can be judged to be a powerful operative supporting modality for correcting the locations of cerebral lesions; it allows one to perform stereotactic surgery more accurately and less invasively. (author)

  4. Radiation exposure of the radiologist's eye lens during CT-guided interventions.

    Science.gov (United States)

    Heusch, Philipp; Kröpil, Patric; Buchbender, Christian; Aissa, Joel; Lanzman, Rotem S; Heusner, Till A; Ewen, Klaus; Antoch, Gerald; Fürst, Günther

    2014-02-01

    In the past decade the number of computed tomography (CT)-guided procedures performed by interventional radiologists have increased, leading to a significantly higher radiation exposure of the interventionalist's eye lens. Because of growing concern that there is a stochastic effect for the development of lens opacification, eye lens dose reduction for operators and patients should be of maximal interest. To determine the interventionalist's equivalent eye lens dose during CT-guided interventions and to relate the results to the maximum of the recommended equivalent dose limit. During 89 CT-guided interventions (e.g. biopsies, drainage procedures, etc.) measurements of eye lens' radiation doses were obtained from a dedicated dosimeter system for scattered radiation. The sensor of the personal dosimeter system was clipped onto the side of the lead glasses which was located nearest to the CT gantry. After the procedure, radiation dose (µSv), dose rate (µSv/min) and the total exposure time (s) were recorded. For all 89 interventions, the median total exposure lens dose was 3.3 µSv (range, 0.03-218.9 µSv) for a median exposure time of 26.2 s (range, 1.1-94.0 s). The median dose rate was 13.9 µSv/min (range, 1.1-335.5 µSv/min). Estimating 50-200 CT-guided interventions per year performed by one interventionalist, the median dose of the eye lens of the interventional radiologist does not exceed the maximum of the ICRP-recommended equivalent eye lens dose limit of 20 mSv per year.

  5. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT

    International Nuclear Information System (INIS)

    Chami, H.A.; Faraj, W.; Yehia, Z.A.; Badour, S.A.; Sawan, P.; Rebeiz, K.; Safa, R.; Saade, C.; Ghandour, B.; Shamseddine, A.; Mukherji, D.; Haydar, A.A.

    2015-01-01

    Aim: To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. Materials and methods: One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below −950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Results: Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01–1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Conclusion: Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. - Highlights: • Examine the association between quantitative emphysema measures & post NLB pneumothorax. • The risk of post-NLB pneumothorax increases with every unit increase in percent emphysema. • Percent emphysema is a significant predictor of pneumothorax post transthoracic NLB. • Quantitative analysis of chest CT offers clinicians' objective measures to assess pneumothorax risk.

  6. CT-guided radiofrequency tumor ablation in children

    International Nuclear Information System (INIS)

    Botsa, Evanthia; Poulou, Loukia S.; Koundouraki, Antonia; Thanos, Loukas; Koutsogiannis, Ioannis; Ziakas, Panayiotis D.; Alexopoulou, Efthimia

    2014-01-01

    Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5-18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3-2.8 cm). The median time for ablation was 8 min (range 7-10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients. (orig.)

  7. CT-guided radiofrequency tumor ablation in children

    Energy Technology Data Exchange (ETDEWEB)

    Botsa, Evanthia [National and Kapodistrian University of Athens, First Pediatric Clinic, Agia Sofia Children' s Hospital, Athens (Greece); Poulou, Loukia S.; Koundouraki, Antonia; Thanos, Loukas [Sotiria General Hospital for Chest Diseases, Department of Medical Imaging and Interventional Radiology, Athens (Greece); Koutsogiannis, Ioannis [General Military Hospital NIMTS, Department of Medical Imaging, Athens (Greece); Ziakas, Panayiotis D. [Warren Alpert Medical School of Brown University Rhode Island Hospital, Division of Infectious Diseases, Providence, RI (United States); Alexopoulou, Efthimia [Attikon University Hospital, Second Department of Radiology, Athens University School of Medicine, Athens (Greece)

    2014-11-15

    Image-guided radiofrequency ablation is a well-accepted technique of interventional oncology in adults. To evaluate the efficacy and safety of CT-guided radiofrequency ablation as a minimally invasive treatment for metastatic neoplasms in children. A total of 15 radiofrequency ablation sessions were performed in 12 children and young adults (median age 9.5; range 5-18 years) with metastatic malignancies. Seven children and young adults had secondary hepatic lesions, three had pulmonary and two had bone lesions. Radiofrequency ablation was performed under conscious sedation. The median lesion size was 1.7 cm (range 1.3-2.8 cm). The median time for ablation was 8 min (range 7-10 min). Radiofrequency procedures were technically successful in all tumors. Postablation imaging immediately after, and 1 month and 3 months after radiofrequency ablation showed total necrosis in all patients. At 6-month follow-up, three patients (all with lesion size >2 cm) had local recurrence and underwent a second radiofrequency ablation session. At 2-year follow-up no patient had recurrence of the treated tumor. Post-ablation syndrome occurred in four children. No major complication occurred. CT-guided radiofrequency tumor ablation was safe and efficient for palliative treatment in our cohort of patients. (orig.)

  8. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

    Energy Technology Data Exchange (ETDEWEB)

    Gevargez, A.; Schirp, S.; Braun, M. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); Groenemeyer, D. [Department of Radiology and Microtherapy, University of Witten/Herdecke, Bochum (Germany); EFMT Development and Research Center for Microtherapy, Bochum (Germany)

    2002-06-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  9. CT-guided percutaneous radiofrequency denervation of the sacroiliac joint

    International Nuclear Information System (INIS)

    Gevargez, A.; Schirp, S.; Braun, M.; Groenemeyer, D.

    2002-01-01

    Defining the origin of low back pain is a challenging task. Among a variety of factors the sacroiliac joint (SIJ) is a possible pain generator, although precise diagnosis is difficult. Joint blocks may reduce pain, but are, in cases, of only temporary effect. This study was conducted to evaluate CT-guided percutaneous radiofrequency denervation of the sacroiliac joint in patients with low back pain. The procedure was performed on 38 patients who only temporarily responded to CT-guided SIJ blocks. The denervation was carried out in the posterior interosseous sacroiliac ligaments and on the dorsal rami of the fifth spinal nerve. All interventions were carried out under CT guidance as out-patient therapies. Three months after the therapy, 13 patients (34.2%) were completely free of pain. Twelve patients (31.6%) reported on a substantial pain reduction, 7 patients (18.4%) had obtained a slight and 3 patients (7.9%) no pain reduction. The data of 3 patients (7.9%) was missing. There were no intra- or postoperative complications. Computed tomography-guided percutaneous radiofrequency denervation of the sacroiliac joint appears safe and effective. The procedure may be a useful therapeutic modality, especially in patients with chronic low back pain, who only temporarily respond to therapeutic blocks. (orig.)

  10. 3-dimensional reconstructions of computer tomograms of the lumbar spine. Dreidimensionale Rekonstruktionsverfahren in der lumbalen Computertomographie

    Energy Technology Data Exchange (ETDEWEB)

    Kern, A.; Waggershauser, T.; Zendel, W.; Astinet, A.; Felix, R. (Universitaetsklinikum Rudolf Virchow, Berlin (Germany). Strahlenklinik und Poliklinik); Hansen, K.; Lanksch, W.R. (Universitaetsklinikum Rudolf Virchow, Berlin (Germany). Neurochirurgische Klinik und Poliklinik)

    1991-08-01

    In this study, 50 patients were examined by a Siemens 'Somatom Plus'; continuous 2 mm sections between the third lumbar and first sacral vertebra were obtained. All these imaging procedures were suitable for the diagnosis of osteochondrosis and chondrosis. Spondylosis was diagnosed more frequently on 3-D CT. Spondyloarthrosis, with narrowing of the invertebral foramina and root canals is shown particularly well by 3-D CT, since the entire extent of these structures can be seen. 3-D surface reconstruction of the lumbar spine is useful in the diagnosis of lumbar spondyloarthrosis with narrowing of the root canals and of the spinal canal. This method of axial CT is superior to conventional radiography of the lumbar spine in the usual two planes. (orig./GDG).

  11. Evaluation of usefulness of bone SPECT for lumbar spondylolysis

    International Nuclear Information System (INIS)

    Watanabe, Osamu; Hashimoto, Manabu; Tomura, Noriaki; Watarai, Jiro

    2002-01-01

    The purpose of this study was to evaluate the usefulness of 99m Tc-MDP SPECT (bone SPECT) for lumbar spondylolysis. We analyzed 11 cases with 17 lesions. All cases were compared using plain radiography, computed tomography (CT), planar bone scintigraphy (PBS), and bone SPECT. Four lesions that showed a wide defect on CT were negative on bone SPECT and may have been chronic lesions. Thirteen lesions that were positive on bone SPECT were narrow or showed no defect on CT and may have been early lesions. Two cases showed no defect on CT but were positive on bone SPECT, and one of them progressed to bilateral spondylolysis after one year. This may have been a very early lesion. Thus bone SPECT is useful for the diagnosis of lumbar spondylolysis, especially in its early stage. (author)

  12. Evaluation of usefulness of bone SPECT for lumbar spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Osamu; Hashimoto, Manabu; Tomura, Noriaki; Watarai, Jiro [Akita Univ. (Japan). School of Medicine

    2002-07-01

    The purpose of this study was to evaluate the usefulness of {sup 99m}Tc-MDP SPECT (bone SPECT) for lumbar spondylolysis. We analyzed 11 cases with 17 lesions. All cases were compared using plain radiography, computed tomography (CT), planar bone scintigraphy (PBS), and bone SPECT. Four lesions that showed a wide defect on CT were negative on bone SPECT and may have been chronic lesions. Thirteen lesions that were positive on bone SPECT were narrow or showed no defect on CT and may have been early lesions. Two cases showed no defect on CT but were positive on bone SPECT, and one of them progressed to bilateral spondylolysis after one year. This may have been a very early lesion. Thus bone SPECT is useful for the diagnosis of lumbar spondylolysis, especially in its early stage. (author)

  13. Usefulness of CT-guided trans-bronchial needle aspiration biopsy for mediastinal lymph nodes

    International Nuclear Information System (INIS)

    Cui Bing; Rong Fu

    2001-01-01

    Objective: To determine the nature of enlarged mediastinal lymph nodes, the study of CT-guided trans-bronchial needle aspiration biopsy (CT-TBNA) was conducted. Methods: According to classification and locating standard of mediastinal lymph nodes, CT-TBNA was performed in 158 mediastinal lymph nodes of 73 patients, including 54 primary lung cancer with enlarged mediastinal lymph nodes, 5 malignant lymphoma, 3 mediastinal abscess and 11 mediastinal inflammatory adenopathy. Results: CT confirmed that the needles were inside all 158 lymph nodes. Adequate aspirates for histologic and/or cytologic diagnosis were obtained in 136 of 158(86%) lymph node biopsies. No serious complications occurred. Conclusion: Locating standard of CT-guided TBNA was reliable. Puncture was safe and cost-effective. CT-TBNA was important for ascertaining the nature of mediastinal adenopathy and staging of neoplasms

  14. Tuning of automatic exposure control strength in lumbar spine CT.

    Science.gov (United States)

    D'Hondt, A; Cornil, A; Bohy, P; De Maertelaer, V; Gevenois, P A; Tack, D

    2014-05-01

    To investigate the impact of tuning the automatic exposure control (AEC) strength curve (specific to Care Dose 4D®; Siemens Healthcare, Forchheim, Germany) from "average" to "strong" on image quality, radiation dose and operator dependency during lumbar spine CT examinations. Two hospitals (H1, H2), both using the same scanners, were considered for two time periods (P1 and P2). During P1, the AEC curve was "average" and radiographers had to select one of two protocols according to the body mass index (BMI): "standard" if BMI 30.0 kg m(-2) (140 kV-280 mAs). During P2, the AEC curve was changed to "strong", and all acquisitions were obtained with one protocol (120 kV and 270 mAs). Image quality was scored and patients' diameters calculated for both periods. 497 examinations were analysed. There was no significant difference in mean diameters according to hospitals and periods (p > 0.801) and in quality scores between periods (p > 0.172). There was a significant difference between hospitals regarding how often the "large" protocol was assigned [13 (10%)/132 patients in H1 vs 37 (28%)/133 in H2] (p < 0.001). During P1, volume CT dose index (CTDIvol) was higher in H2 (+13%; p = 0.050). In both hospitals, CTDIvol was reduced between periods (-19.2% in H1 and -29.4% in H2; p < 0.001). An operator dependency in protocol selection, unexplained by patient diameters or highlighted by image quality scores, has been observed. Tuning the AEC curve from average to strong enables suppression of the operator dependency in protocol selection and related dose increase, while preserving image quality. CT acquisition protocols based on weight are responsible for biases in protocol selection. Using an appropriate AEC strength curve reduces the number of protocols to one. Operator dependency of protocol selection is thereby eliminated.

  15. Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms

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    Fagerlund, M.K.J.; Thelander, U.; Friberg, S. (Umeaa Univ. Hospital (Sweden). Dept. of Diagnostic Radiology Umeaa Univ. Hospital (Sweden). Dept. of Orthopedics)

    1990-11-01

    The change in the relative size of lumbar disc hernias and its relation to sciatic symptoms was investigated in 30 consecutive patients after conservative treatment of CT verified lumbar disc herniations. CT and clinical examination were performed before the start of therapy (CT1), as well as 3 months (CT2) and 24 months (CT3) after institution of treatment. In each patient the size of the lumbar disc herniation in relation to the size of the spinal canal was measured on identical CT slices and expressed as an index. The disc herniation index decreased markedly from CT1 to CT2 (p<0.001). Between CT2 and CT3 the reduction of the hernias was less pronounced and not significant for hernias located centrally but still significant for intermediate (p=0.03) and lateral (p=0.04) hernias. The degree of sciatic symptoms also decreased markedly between CT1 and CT2 (p=0.001) while no further improvement occurred from CT2 to CT3. There was a significant positive correlation between the improvement from sciatic pain and the reduction in the size of the individual hernia (CT1-CT2 p=0.02, CT2-CT3 p<0.001). Thus, the disc herniation index provided a method to study the anatomic effect of conservative treatment as well as a method to evaluate sciatic symptoms in relation to anatomic changes. (orig.).

  16. Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms

    International Nuclear Information System (INIS)

    Fagerlund, M.K.J.; Thelander, U.; Friberg, S.; Umeaa Univ. Hospital

    1990-01-01

    The change in the relative size of lumbar disc hernias and its relation to sciatic symptoms was investigated in 30 consecutive patients after conservative treatment of CT verified lumbar disc herniations. CT and clinical examination were performed before the start of therapy (CT1), as well as 3 months (CT2) and 24 months (CT3) after institution of treatment. In each patient the size of the lumbar disc herniation in relation to the size of the spinal canal was measured on identical CT slices and expressed as an index. The disc herniation index decreased markedly from CT1 to CT2 (p<0.001). Between CT2 and CT3 the reduction of the hernias was less pronounced and not significant for hernias located centrally but still significant for intermediate (p=0.03) and lateral (p=0.04) hernias. The degree of sciatic symptoms also decreased markedly between CT1 and CT2 (p=0.001) while no further improvement occurred from CT2 to CT3. There was a significant positive correlation between the improvement from sciatic pain and the reduction in the size of the individual hernia (CT1-CT2 p=0.02, CT2-CT3 p<0.001). Thus, the disc herniation index provided a method to study the anatomic effect of conservative treatment as well as a method to evaluate sciatic symptoms in relation to anatomic changes. (orig.)

  17. Smartphone-Guided Needle Angle Selection During CT-Guided Procedures.

    Science.gov (United States)

    Xu, Sheng; Krishnasamy, Venkatesh; Levy, Elliot; Li, Ming; Tse, Zion Tsz Ho; Wood, Bradford John

    2018-01-01

    In CT-guided intervention, translation from a planned needle insertion angle to the actual insertion angle is estimated only with the physician's visuospatial abilities. An iPhone app was developed to reduce reliance on operator ability to estimate and reproduce angles. The iPhone app overlays the planned angle on the smartphone's camera display in real-time based on the smartphone's orientation. The needle's angle is selected by visually comparing the actual needle with the guideline in the display. If the smartphone's screen is perpendicular to the planned path, the smartphone shows the Bull's-Eye View mode, in which the angle is selected after the needle's hub overlaps the tip in the camera. In phantom studies, we evaluated the accuracies of the hardware, the Guideline mode, and the Bull's-Eye View mode and showed the app's clinical efficacy. A proof-of-concept clinical case was also performed. The hardware accuracy was 0.37° ± 0.27° (mean ± SD). The mean error and navigation time were 1.0° ± 0.9° and 8.7 ± 2.3 seconds for a senior radiologist with 25 years' experience and 1.5° ± 1.3° and 8.0 ± 1.6 seconds for a junior radiologist with 4 years' experience. The accuracy of the Bull's-Eye View mode was 2.9° ± 1.1°. Combined CT and smart-phone guidance was significantly more accurate than CT-only guidance for the first needle pass (p = 0.046), which led to a smaller final targeting error (mean distance from needle tip to target, 2.5 vs 7.9 mm). Mobile devices can be useful for guiding needle-based interventions. The hardware is low cost and widely available. The method is accurate, effective, and easy to implement.

  18. CT-Guided, Ethanol Sympatholysis for Primary Axillary–Palmar Hyperhidrosis

    Energy Technology Data Exchange (ETDEWEB)

    Tsitskari, Maria, E-mail: mariadote@hotmail.com [American Medical Center, Vascular & Interventional Radiology (Cyprus); Friehs, Gerhard, E-mail: gerhardf@amc.com.cy; Zerris, Vassilis, E-mail: vassilisz@amc.com.cy [American Medical Center, Neurosurgery (Cyprus); Georgiades, Christos, E-mail: g-christos@hotmail.com [Johns Hopkins Hospital, Vascular & Interventional Radiology (United States)

    2016-12-15

    PurposePrimary hyperhidrosis is an excessive sweating due to an overactive sympathetic system. Our objective was to test the feasibility and provide early data on the safety/efficacy of CT-guided sympatholysis, for primary hyperhidrosis.Materials and MethodsNine consecutive patients with axillary–palmar hyperhidrosis were treated between 2013 and 2015. CT-guided sympathetic block was performed in the outpatients at T-2, T-3, and T-4, bilaterally using alcohol under local anesthesia. Immediate postprocedure CT was obtained to assess the complications as per Common Terminology Criteria for Adverse Events, version 4. Technical success and clinical success were recorded. Primary and secondary efficacy were assessed by phone and clinical visits; mean follow-up was 12 months (6–26 months). Descriptive statistics was used to report the outcomes.ResultsOne procedure was aborted due to eyelid ptosis after lidocaine injection. All other eight patients (5:3, F:M) (median age 32) had immediate cessation of sweating. Two major complications (pneumothorax, one requiring a chest tube) occurred. Two patients recurred with unilateral and one with bilateral symptoms. One of the unilateral recurrence and the bilateral recurrence patients was retreated successfully. Median follow-up was 1 year. No cases of Horner’s or compensatory hyperhidrosis were observed.ConclusionsCT-guided EtOH sympatholysis for axillary/palmar primary hyperhidrosis is feasible. Technical failure rate was 11 %. Primary and secondary efficacy are 75 and 94 %, respectively, to a median follow-up of 1 year. Risk profile appears favorable. Despite a small sample size, results confirm feasibility and encourage a larger study.

  19. Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions

    International Nuclear Information System (INIS)

    Hryhorczuk, Anastasia L.; Strouse, Peter J.; Biermann, J.S.

    2011-01-01

    CT-guided percutaneous core needle biopsy has been shown in adults to be an effective diagnostic tool for a large number of musculoskeletal malignancies. To characterize our experience with CT-guided percutaneous core needle biopsy of pediatric bone lesions and determine its utility in diagnosing pediatric osseous lesions, in a population where such lesions are commonly benign. From 2000 to 2009, 61 children underwent 63 CT-guided percutaneous biopsies. Radiological, pathological and clinical records were reviewed. Fourteen biopsies (22%) were performed on malignant lesions, while 49 biopsies (78%) were performed on benign lesions. Forty-nine of the 63 biopsies (78%) were adequate; these children underwent no further tissue sampling. Fourteen of the 63 biopsies (22%) were inadequate or non-conclusive. Of these patients, 12 underwent open biopsy. Retrospective analysis of percutaneous biopsies in these patients demonstrates that 9/12 provided clinically relevant information, and 4/12 patients received final diagnoses that confirmed initial core biopsy findings. No malignancies were diagnosed as benign on percutaneous biopsy. Overall, percutaneous core needle biopsy provided accurate diagnostic information in 84% (53/63) of biopsies. Our results demonstrate that CT-guided percutaneous biopsy is safe and beneficial in children. This study supports the use of CT-guided percutaneous core needle biopsy for primary diagnosis of pediatric bone lesions. (orig.)

  20. The contribution of CT-guided transthoracic lung biopsy to the diagnosis of organising pneumonia.

    Science.gov (United States)

    Metzger, F; Pernet, D; Manzoni, P; Ranfaing, E; Dalphin, J-C

    2010-09-01

    Organising pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organising pneumonia and to compare it to the usual diagnostic tools. Six cases of organising pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. The role of CT-guided lung biopsy in the diagnosis of organising pneumonia was also reviewed in the literature. CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92-100% versus 77-86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88-97% versus 26-55% in pulmonary nodules and 42-100% versus 66-75% in diffuse pulmonary disease). Complications were rare and generally not serious. CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia. Surgical lung biopsy remains the gold standard method for diagnosis. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  1. Micro-angiographic investigations of revascularisation of fracture in the canine tibia

    Energy Technology Data Exchange (ETDEWEB)

    Kagel, K.O.; Koecher, W.

    1987-03-01

    Micro-angiograms were performed between eight weeks and one year following osteotomies and pressure osteosyntheses in 34 dog tibiae. Seventeen animals also underwent lumbar sympathectomy. In more than half of the cases, vascularisation of the medulla was reduced by damage to the nutrient artery. Segmental connections could be demonstrated by means of transcortical anastomoses. Following sympathectomy, revascularisation was more marked as a result of numerous trans-osseus anastomoses. This, however, did not lead to improved healing; healing was worse after sympathectomy. Transcortical revascularisation and vessel growth along drill holes are of crucial significance.

  2. Micro-angiographic investigations of revascularisation of fracture in the canine tibia

    International Nuclear Information System (INIS)

    Kagel, K.O.; Koecher, W.; Ernst-Moritz-Arndt-Universitaet, Greifswald

    1987-01-01

    Micro-angiograms were performed between eight weeks and one year following osteotomies and pressure osteosyntheses in 34 dog tibiae. Seventeen animals also underwent lumbar sympathectomy. In more than half of the cases, vascularisation of the medulla was reduced by damage to the nutrient artery. Segmental connections could be demonstrated by means of transcortical anastomoses. Following sympathectomy, revascularisation was more marked as a result of numerous trans-osseus anastomoses. This, however, did not lead to improved healing; healing was worse after sympathectomy. Transcortical revascularisation and vessel growth along drill holes are of crucial significance. (orig.) [de

  3. CT Fluoroscopy-Guided Transsacral Intervertebral Drainage for Pyogenic Spondylodiscitis at the Lumbosacral Junction

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Tomohiro, E-mail: t-matsu@tokai-u.jp; Mine, Takahiko, E-mail: mine@tsc.u-tokai.ac.jp; Hayashi, Toshihiko, E-mail: t.hayashi@tokai.ac.jp [Tokai University School of Medicine, Department of Radiology, Tokai University Hachioji Hospital (Japan); Kamono, Masahiro, E-mail: kamono@tsc.u-tokai.ac.jp; Taoda, Akiko, E-mail: acco@is.icc.u-tokai.ac.jp; Higaki, Megumu, E-mail: higaki@hachioji-hosp.tokai.ac.jp [Tokai University School of Medicine, Department of General Internal Medicine, Tokai University Hachioji Hospital (Japan); Hasebe, Terumitsu, E-mail: hasebe@tokai-u.jp [Tokai University School of Medicine, Department of Radiology, Tokai University Hachioji Hospital (Japan)

    2017-01-15

    PurposeTo retrospectively describe the feasibility and efficacy of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction with a combination of two interventional radiological techniques—CT-guided bone biopsy and abscess drainage.Materials and methodsThree patients with pyogenic spondylodiscitis at the lumbosacral junction were enrolled in this study between July 2013 and December 2015. The procedure of CT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction was as follows: the sacrum at S1 pedicle was penetrated with an 11-gauge (G) bone biopsy needle to create a path for an 8-French (F) pigtail drainage catheter. The bone biopsy needle was withdrawn, and an 18-G needle was inserted into the intervertebral space of the lumbosacral junction. Then, a 0.038-inch guidewire was inserted into the intervertebral space. Finally, the 8-F pigtail drainage catheter was inserted over the guidewire until its tip reached the intervertebral space. All patients received six-week antibiotics treatment.ResultsSuccessful placement of the drainage catheter was achieved for each patient without procedural complications. The duration of drainage was 17–33 days. For two patients, specific organisms were isolated; thus, definitive medical therapy was possible. All patients responded well to the treatment.ConclusionsCT fluoroscopy-guided transsacral intervertebral drainage for pyogenic spondylodiscitis at the lumbosacral junction is feasible and can be effective with a combination of two interventional techniques—CT fluoroscopy-guided bone biopsy and abscess drainage.

  4. Comparative study of CT and MR guided cryoablation for hepatic tumors

    International Nuclear Information System (INIS)

    Wu Bin; Xiao Yueyong; Zhang Xiao; Li Hongjun; Li Jie; Yu Da

    2010-01-01

    Objective: To compare CT and MR imaging in guiding and monitor/ng cryoablation of hepatic tumors. Methods: A total of 131 lesions in 121 patients with malignant tumors of liver were treated with imaging-guided percutaneous cryotherapy. There were 73 males and 48 females, mean age 60 years. Of the 121 patients, 61 patients had cryoablation under CT guidance and 60 patients under the guidance of MRI. CT-guidance was performed with the Philips big-bore CT in spiral mode, with 5 mm slice thickness. The MR guidance was performed with GE 0.35 T scanner assisted with infrared navigator (Xinaomdt), and both fast gradient echo sequence and fast spin-echo sequence were used. The cryoablation system is a magnetic resonance compatible system (Galil, Israel), equipped with 17 G cryoprobes that are 1.47 mm in outside diameter. A combination of multiple cryo-probes and conformal cryoablation were adopted in accordance with the location, the shape and the adjacent structure of each lesion. Each cryoablation included two freezing-thawing cycles. Scanning was performed intermittently during the operation to monitor the degree of ablation. The mean scanning time, the lesion depiction and ablation process monitoring, the efficacies of lesion ablation, complications,and survival time were analyzed with χ 2 test. Results: The mean scanning time was (5.6±1.8) min for CT and (22.0±2.6) min for MR. CT provided a good depiction of the lesion and the ribs which were poorly displayed on MR images. The metal probe could create artifacts on the CT images and it was difficult for CT to show the formation of ice ball of the lesion formed after embolization with lipiodol. MR was superior to CT in displaying, guiding and monitoring of ablation of lesions near such special regions as the diaphragm dome, the hepatic hilum, and the gallbladder. MR was not affected by high-density embolization material and the metal probes, and thus was superior to CT in depicting the lesion, and monitoring the

  5. Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain

    Directory of Open Access Journals (Sweden)

    Bárbara Rosa

    2016-01-01

    Full Text Available We present a case of a 5th Lumbar Vertebra (L5 spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

  6. Evaluation of degenerative disease of the lumbar spine: MR/MR myelography versus conventional myelography/post-myelography CT.

    Science.gov (United States)

    Shiban, Ehab; von Lehe, Marec; Simon, Matthias; Clusmann, Hans; Heinrich, Petra; Ringel, Florian; Wilhelm, Kai; Urbach, Horst; Meyer, Bernhard; Stoffel, Michael

    2016-08-01

    To compare the use of magnetic resonance (MR)/MR myelography (MRM) with conventional myelography/post-myelography CT (convM) for detailed surgery planning in degenerative lumbar disease. Twenty-six patients with suspected complex lumbar degenerative disease underwent MRM in addition to convM as preoperative workup. Surgery was planned based on convM-as usual at our department. Post hoc, surgical planning was repeated planned again-now based on MRM. Furthermore, the MRM-based planning was performed by six independent neurosurgeons (three groups) of different degrees of specialisation. In only 31 % of the patients, post hoc MRM-based planning resulted in the same surgical decision as originally performed, whereas in 69 % (n = 18) a different procedure was indicated. In patients with non-concurring convM- and MRM-based surgical plans, a less extended procedure was the result of MRM in six patients (23 %), a more extended one in five (19 %), and a related to side/level of decompression or nucleotomy different plan in six patients (23 %). In one patient (4 %), the MRM-based planning would have led to a completely different surgery compared to convM. Overall interobserver agreement on the MRM-based planning was substantial. Detailed planning of operative procedures for complex lumbar degenerative disease is highly dependent on the image modality used.

  7. Analysis of diagnositc accuracy with CT-guided percutaneous transthoracic lung biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Wang Haiyan; Zhuang Yiping; Zhang Jin; Feng Yong; Zhang Xiao; Xu Lin

    2007-01-01

    Objective: To evaluate the factors which may affect the diagnostic accmracy of CT-guided percutaneous transthoracic lung biopsy for pulmonary lesions. Methods: CT-guided percutaneous transthoracic lung biopsy was performed in 264 patients, all of which were proved by surgical pathology or clinical follow-up. A logistic regression analysis was used to investigate the relationship between the location and the size of the lesions and insertion depth of biopsy needles and the diagnostic accuracy of CT-guided percutaneous transthomcic lung biopsy. The complication rate including pneumatothorax and bleeding rate were record. Results: The diagnostic accuracy was 87.5%. Both the pneumothorax and the bleeding of lesion were 1.9%. The size of lesion was suggested by Logistic regression analysis had a significant influence on the diagnostic accuracy (Wald=12.891, P=0.00034, OR=0.96). Conclusion: CT-guided pereumneous transthoracic lung biopsy has a high diagnostic accuracy for pulmonary lesions. The size of the lesions had significant effect on the diagnostic accuracy. (authors)

  8. Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures

    International Nuclear Information System (INIS)

    Sommer, C.M.; Huber, J.; Radeleff, B.A.; Hosch, W.; Stampfl, U.; Loenard, B.M.; Hallscheidt, P.; Haferkamp, A.; Kauczor, H.U.; Richter, G.M.

    2011-01-01

    Aim: To report our experience of combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. Patients and methods: Eighteen patients (23 kidneys) with non-obstructive uropathy due to urine leaks underwent combined CT- and fluoroscopy-guided nephrostomy. All procedures were indicated as second-line interventions after failed ultrasound-guided nephrostomy. Thirteen males and five females with an age of 62.3 ± 8.7 (40–84) years were treated. Urine leaks developed in majority after open surgery, e.g. postoperative insufficiency of ureteroneocystostomy (5 kidneys). The main reasons for failed ultrasound-guided nephrostomy included anatomic obstacles in the puncture tract (7 kidneys), and inability to identify pelvic structures (7 kidneys). CT-guided guidewire placement into the collecting system was followed by fluoroscopy-guided nephrostomy tube positioning. Procedural success rate, major and minor complication rates, CT-views and needle passes, duration of the procedure and radiation dose were analyzed. Results: Procedural success was 91%. Major and minor complication rates were 9% (one septic shock and one perirenal abscess) and 9% (one perirenal haematoma and one urinoma), respectively. 30-day mortality rate was 6%. Number of CT-views and needle passes were 9.3 ± 6.1 and 3.6 ± 2.6, respectively. Duration of the complete procedure was 87 ± 32 min. Dose-length product and dose-area product were 1.8 ± 1.4 Gy cm and 3.9 ± 4.3 Gy cm 2 , respectively. Conclusions: Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures was feasible with high technical success and a tolerable complication rate.

  9. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan))

    1991-05-01

    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.).

  10. The value of MRI and CT in the pre-operative diagnosis of lumbar disc herniation

    International Nuclear Information System (INIS)

    Hirabayashi, Shigeru; Kumano, Kiyoshi; Takahashi, Soichiro; Ishii, Jun

    1991-01-01

    A prospective analysis of computed tomography (CT) and magnetic resonance imaging (MRI) scans in 51 patients with lumbar disc herniation was made to determine the height of hernia for operation and, if impossible, the indications of myelography. Among the 51 patients, 40 (78%) received surgery based on these imaging modalities (Group A); and the remaining 11 (22%) underwent myelography for the confirmation of the height of hernia or detailed examination (Group B). Satisfactory or excellent surgical outcome was achieved in 95% in Group A and in 91% in Group B. Twenty seven patients had multiple disc herniation on CT and MRI; in 17 patients surgery was performed for one disc hernia that was radiologically found to compress the spinal nerve root; and in the other 10 hernia-related disc was not determined by either radiological or neurological manifestations. Satisfactory or excellent surgical outcome could, however, be achieved in 26 patients (96%). Myelography should be indicated when there is no neurological radicular sign in the lower extremities, and when there is no radiological evidence of the compressed spinal nerve root in spite of the presence of multiple disc herniation. The height of hernia may be determined when compression of the spinal nerve root is visualized on CT or MRI. (N.K.)

  11. Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

    Directory of Open Access Journals (Sweden)

    Terrence T. Kim

    2016-01-01

    Full Text Available We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

  12. Lumbar spondylolysis: a review.

    Science.gov (United States)

    Leone, Antonio; Cianfoni, Alessandro; Cerase, Alfonso; Magarelli, Nicola; Bonomo, Lorenzo

    2011-06-01

    Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its

  13. Lumbar spondylolysis: a review

    International Nuclear Information System (INIS)

    Leone, Antonio; Magarelli, Nicola; Bonomo, Lorenzo; Cianfoni, Alessandro; Cerase, Alfonso

    2011-01-01

    Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its

  14. Lumbar spondylolysis: a review

    Energy Technology Data Exchange (ETDEWEB)

    Leone, Antonio; Magarelli, Nicola; Bonomo, Lorenzo [Dept. of Bioimaging and Radiological Sciences, Catholic Univ., Rome (Italy); Cianfoni, Alessandro [Dept. of Radiology and Radiological Sciences, Medical Univ. of South Carolina, Charleston (United States); Cerase, Alfonso [General Hospital, Unit Neuroimaging and Neurointervention (NINT), Department of Neurosciences, Azienda Ospedaliera Universitaria Senese, Siena (Italy)

    2011-06-15

    Spondylolysis is an osseous defect of the pars interarticularis, thought to be a developmental or acquired stress fracture secondary to chronic low-grade trauma. It is encountered most frequently in adolescents, most commonly involving the lower lumbar spine, with particularly high prevalence among athletes involved in certain sports or activities. Spondylolysis can be asymptomatic or can be a cause of spine instability, back pain, and radiculopathy. The biomechanics and pathophysiology of spondylolysis are complex and debated. Imaging is utilized to detect spondylolysis, distinguish acute and active lesions from chronic inactive non-union, help establish prognosis, guide treatment, and to assess bony healing. Radiography with satisfactory technical quality can often demonstrate a pars defect. Multislice CT with multiplanar reformats is the most accurate modality for detecting the bony defect and may also be used for assessment of osseous healing; however, as with radiographs, it is not sensitive for detection of the early edematous stress response without a fracture line and exposes the patient to ionizing radiation. Magnetic resonance (MR) imaging should be used as the primary investigation for adolescents with back pain and suspected stress reactions of the lumbar pars interarticularis. Several imaging pitfalls render MR imaging less sensitive than CT for directly visualizing the pars defects (regional degenerative changes and sclerosis). Nevertheless, the presence of bone marrow edema on fluid-sensitive images is an important early finding that may suggest stress response without a visible fracture line. Moreover, MR is the imaging modality of choice for identifying associated nerve root compression. Single-photon emission computed tomography (SPECT) use is limited by a high rate of false-positive and false-negative results and by considerable ionizing radiation exposure. In this article, we provide a review of the current concepts regarding spondylolysis, its

  15. CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls

    International Nuclear Information System (INIS)

    Wilms, Guido E.; Demaerel, Philippe; Keyzer, Frederik de; Willems, Endry

    2012-01-01

    To examine the feasibility and results of calculating the volume of lumbar vertebral bodies in normal patients and patients with suspected hypoplasia of L5. Lumbar multi-detector CT was performed in 38 patients with bilateral spondylolysis and hypoplasia of L5 and in 38 normal patients. Lumbar vertebral body volume of L3, L4 and L5 was measured by CT volumetry with a semi-automated program, created with MeVisLab. In the control group, the average vertebral body volume (in cubic centimeters) of L3 was 35.93 (±7.33), 36.34 (±7.13) for L4 and 34.63 (±6.88) for L5. In patients with suspected hypoplasia L5 the average body volume (in cubic centimeters) of L3 was 36.85 (±7.37), 36.90 (±6.99) for L4 and 33.14 (±6.57) for L5. The difference in mean vertebral body volume for L3, L4 and L5 between both groups was statistically not significant. However, there was a statistically significant difference of the ratio L5/L4 (P < 0.001) between both groups: the mean ratio L5/L4 in the control group was 95.3 ± 3.9%, the ratio for the hypoplastic L5 group was 89.9 ± 6.3%. There was no significant difference in the vertebral body volume for L3, L4 and L5 between both groups due to inter-patient variability. However, the relation between the body volume of L5 and L4 is significantly different between both groups. The volume of the vertebral body of L5 proved to be on average 10.2% smaller than the volume of L4 in the group with hypoplasia L5 versus 4.7% in the control group. (orig.)

  16. CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls

    Energy Technology Data Exchange (ETDEWEB)

    Wilms, Guido E.; Demaerel, Philippe; Keyzer, Frederik de [UZ Leuven, Campus Gasthuisberg, Department of Radiology, Leuven (Belgium); Willems, Endry [ZOL, Department of Radiology, Genk (Belgium)

    2012-08-15

    To examine the feasibility and results of calculating the volume of lumbar vertebral bodies in normal patients and patients with suspected hypoplasia of L5. Lumbar multi-detector CT was performed in 38 patients with bilateral spondylolysis and hypoplasia of L5 and in 38 normal patients. Lumbar vertebral body volume of L3, L4 and L5 was measured by CT volumetry with a semi-automated program, created with MeVisLab. In the control group, the average vertebral body volume (in cubic centimeters) of L3 was 35.93 ({+-}7.33), 36.34 ({+-}7.13) for L4 and 34.63 ({+-}6.88) for L5. In patients with suspected hypoplasia L5 the average body volume (in cubic centimeters) of L3 was 36.85 ({+-}7.37), 36.90 ({+-}6.99) for L4 and 33.14 ({+-}6.57) for L5. The difference in mean vertebral body volume for L3, L4 and L5 between both groups was statistically not significant. However, there was a statistically significant difference of the ratio L5/L4 (P < 0.001) between both groups: the mean ratio L5/L4 in the control group was 95.3 {+-} 3.9%, the ratio for the hypoplastic L5 group was 89.9 {+-} 6.3%. There was no significant difference in the vertebral body volume for L3, L4 and L5 between both groups due to inter-patient variability. However, the relation between the body volume of L5 and L4 is significantly different between both groups. The volume of the vertebral body of L5 proved to be on average 10.2% smaller than the volume of L4 in the group with hypoplasia L5 versus 4.7% in the control group. (orig.)

  17. CT-guided preoperative needle localization of MRI-detected breast lesions

    Energy Technology Data Exchange (ETDEWEB)

    Giagounidis, Elektra M. E-mail: giagounjdis@online.de; Markus, Ruwe; Josef, Luetzeler; Wemer, Audretsch; Mahdi, Rezai; Bernward, Kurtz

    2001-08-01

    To assess the value of accurate preoperative CT-guided needle localization of occult breast lesions, we reviewed a total of 39 needle-directed biopsies of breast tumors in 24 women. The average age was 52.9 years (range 31-67). All lesions were nonpalpable and mammographically, as well as sonographically occult. They were solely seen on MR-images. After demonstrating the suspicious region on CT scans, a hookwire was inserted. The correct position was confirmed by a control scan. The subsequent histopathological examination showed that 28 of the lesions (71.8%) were benign, among them mastopathy, fibrosis, fibroadenoma, papilloma, intramammary lymph node, liponecrosis and epitheliosis. Eleven lesions (28%) were malignant and showed either lobular, ductal or tubular cancer. Our results endorse that CT guided needle localization is a helpful method that allows a precise surgical excision of the suspect area with the removal of a minimal amount of breast tissue.

  18. Interactive navigation-guided ophthalmic plastic surgery: the utility of 3D CT-DCG-guided dacryolocalization in secondary acquired lacrimal duct obstructions

    Directory of Open Access Journals (Sweden)

    Ali MJ

    2016-12-01

    Full Text Available Mohammad Javed Ali,1 Swati Singh,1 Milind N Naik,1 Swathi Kaliki,2 Tarjani Vivek Dave1 1Govindram Seksaria Institute of Dacryology, 2The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India Aim: The aim of this study was to report the preliminary experience with the techniques and utility of navigation-guided, 3D, computed tomography–dacryocystography (CT-DCG in the management of secondary acquired lacrimal drainage obstructions.Methods: Stereotactic surgeries using CT-DCG as the intraoperative image-guiding tool were performed in 3 patients. One patient had nasolacrimal duct obstruction (NLDO following a complete maxillectomy for a sinus malignancy, and the other 2 had NLDO following extensive maxillofacial trauma. All patients underwent a 3D CT-DCG. Image-guided dacryolocalization (IGDL was performed using the intraoperative image-guided StealthStation™ system in the electromagnetic mode. All patients underwent navigation-guided powered endoscopic dacryocystorhinostomy (DCR. The utility of intraoperative dacryocystographic guidance and the ability to localize the lacrimal drainage system in the altered endoscopic anatomical milieu were noted.Results: Intraoperative geometric localization of the lacrimal sac and the nasolacrimal duct could be easily achieved. Constant orientation of the lacrimal drainage system was possible while navigating in the vicinity of altered endoscopic perilacrimal anatomy. Useful clues with regard to modifications while performing a powered endoscopic DCR could be obtained. Surgeries could be performed with utmost safety and precision, thereby avoiding complications. Detailed preoperative 3D CT-DCG reconstructions with constant intraoperative dacryolocalization were found to be essential for successful outcomes.Conclusion: The 3D CT-DCG-guided navigation procedure is very useful while performing endoscopic DCRs in cases of secondary acquired and complex

  19. Isolate pulmonary nodule. CT-guided biopsy

    International Nuclear Information System (INIS)

    Bruneton, J.N.; Ettore, F.; Rogopoulos, A.; Geoffray, A.; Balu-Maestro, C.; Le Houcq, M.

    1989-01-01

    Transparietal CT-guided biopsy location can be successfully performed for isolate pulmonary nodules, defined as lesions with a maximal diameter of 3 cm, without any other parenchymal or mediastinal abnormality. A 21 G needle has been used according to an identical protocole in 64 cases (10 benign, 54 malignant). The biopsy was successful in 77.7% of the malignant cases. In relation to the diameter of the nodules, biopsy was successful in 66.7% of the nodules smaller than 2 cm and in 76% of the nodules ranging from 2 to 3 cm. The complications observed were rare (1 case of pneumothorax requiring drainage, 9 cases of pneumothorax without clinical signs and simply followed up, 4 cases of minor hemoptysis requiring no treatment and 5 cases of hematomas smaller than 5 cm on CT) [fr

  20. CT guided stereotaxy based on scout view imaging

    Energy Technology Data Exchange (ETDEWEB)

    Wester, K; Kjartansson, O; Bakke, S J

    1987-05-01

    A simple and inexpensive method for CT guided sterotaxy is described. The method requires no extra equipment in the interface between the computer tomograph and the stereotaxic frame, and could therefore easily be adopted in most neurosurgical units. With this method, information from the transaxial CT sections is transferred manually via the scout view image to the operation theater skull X-rays, and thereby to the stereotaxic frame. The method has proved to be sufficiently accurate for all current non-functional stereotaxic procedures in our department during 30 months of testing.

  1. CT guided stereotaxy based on scout view imaging

    International Nuclear Information System (INIS)

    Wester, K.; Kjartansson, O.; Bakke, S.J.; Rikshospitalet, Oslo

    1987-01-01

    A simple and inexpensive method for CT guided sterotaxy is described. The method requires no extra equipment in the interface between the computer tomograph and the stereotaxic frame, and could therefore easily be adopted in most neurosurgical units. With this method, information from the transaxial CT sections is transferred manually via the scout view image to the operation theater skull X-rays, and thereby to the stereotaxic frame. The method has proved to be sufficiently accurate for all current non-functional stereotaxic procedures in our department during 30 months of testing. (orig.)

  2. Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using a C-Arm Cone-Beam CT System: Comparison with Fluoroscopy-Guided Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, Joo Yeon; Kim, Yoo Kyung; Shim, Sung Shine; Lim, Soo Mee [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2011-02-15

    The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB). We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose. The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep ({>=} 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions {>=} 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%: group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 {+-} 4.0 minutes, 157.1 {+-} 76.5 mGy) than in group B (9.0 {+-} 3.5 minutes, 21.9 {+-} 15.2 mGy) (p < 0.05). Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions ({>=} 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose

  3. Clinical investigation of CT-guided ozone-blowing and fumigation ...

    African Journals Online (AJOL)

    Clinical investigation of CT-guided ozone-blowing and fumigation therapy for the chronic ... African Journal of Biotechnology ... In control group, seven patients were completely cured in 45 days after being treated by traditional surgery.

  4. Sacral-neuromodulation CT-guided

    International Nuclear Information System (INIS)

    Amoroso, Lamberto; Ricci, Stefano; Pelliccioni, Giuseppe; Scarpino, Osvaldo; Ghiselli, Roberto; Saba, Vittorio

    2005-01-01

    total of 38 centering. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a non consolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopic guidance. Only once was repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes. Conclusions: The PNE test under Ct guidance proved to be more efficient compared with the traditional technique as the direct view of the electrode position helped to define with greater reliability the patients who were non-responsive to sacral stimulation. Moreover, this method was particularly efficient in patients with sacral anomalies where the traditional guide might fail. The operators' reduced exposure to radiation is an advantage to be taken into consideration. Finally, the usage of mobile CT apparatus in an operating theatre can improve the technique for permanent implantations [it

  5. CT guided interventional therapy for hypertensive cerebral hemorrhage

    International Nuclear Information System (INIS)

    Lin Bo; Duan Bing

    2009-01-01

    Objective: To discuss the curative effect of CT-guided puncture and drainage in treating hypertensive cerebral hemorrhage. Methods: Adjusting the suitable point and direction of puncture according to the form and size of the haematoma and patient's status, the haematoma was eliminated by minimally invasive puncture and drainage guided under CT layer image in 40 cases of hypertensive cerebral hemorrhage. Results: Modality rate of treatment group was 12.5% (5/40), and is much lower than control group, which was 45% (13/30) (P<0.01). When asscess the Activities of Daily Living (ADL) after 6 months follow-up, the ADL1-ADL3 scale in treatment group was 27 cases (70%), and was much higher than that in control group, which was 29.4% (5/17), (P < 0.05). Conclusion: Minimal invasive therapy of cerebral hemorrhage has great superiority in elimination most part of the hematoma such as simple, accurate location, low cost, safe and effective, and is worthy of recommendation clinically. (authors)

  6. Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis - Due Diligence or Antiquated Practice?

    Science.gov (United States)

    April, Michael D; Long, Brit; Koyfman, Alex

    2017-09-01

    Various sources purport an association between lumbar puncture and brainstem herniation in patients with intracranial mass effect lesions. Several organizations and texts recommend head computed tomography (CT) prior to lumbar puncture in selected patients. To review the evidence regarding the utility of obtaining head CT prior to lumbar puncture in adults with suspected bacterial meningitis. Observational studies report a risk of post-lumbar puncture brainstem herniation in the presence of intracranial mass effect (1.5%) that is significantly lower than that reported among all patients with bacterial meningitis (up to 13.3%). It is unclear from existing literature whether identifying patients with intracranial mass effect decreases herniation risk. Up to 80% of patients with bacterial meningitis experiencing herniation have no CT abnormalities, and approximately half of patients with intracranial mass effect not undergoing lumbar puncture herniate. Decision rules to selectively perform CT on only those individuals most likely to have intracranial mass effect lesions have not undergone validation. Despite recommendations for immediate antimicrobial therapy prior to imaging, data indicate an association between pre-lumbar puncture CT and antibiotic delays. Recent data demonstrate shortened door-to-antibiotic times and lower mortality from bacterial meningitis after implementation of new national guidelines, which restricted generally accepted CT indications by removing impaired mental status as imaging criterion. Data supporting routine head CT prior to lumbar puncture are limited. Physicians should consider selective CT for those patients at risk for intracranial mass effect lesions based on decision rules or clinical gestalt. Patients undergoing head CT must receive immediate antibiotic therapy. Published by Elsevier Inc.

  7. Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma

    Energy Technology Data Exchange (ETDEWEB)

    Lassalle, Louis; Campagna, R.; Corcos, G.; Feydy, A. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service de Radiologie Osteo-Articulaire, Paris (France); Babinet, A. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service de Chirurgie Orthopedique, Paris (France); Larousserie, F. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service d' Anatomo-Pathologie, Paris (France); Stephanazzi, J. [Hopital Cochin-APHP Paris Universite Paris Descartes, Service d' Anesthesie, Paris (France)

    2017-07-15

    To assess the long-term outcome of computed tomography-guided radiofrequency ablation (CT-guided RFA) in patients with suspected osteoid osteoma (OO). Single-center retrospective study. Patients with clinical suspicion and imaging diagnosis of osteoid osteoma were treated by CT-guided RFA using the same device with either a 7- or 10-mm active tip electrode. Specific precautions were applied in case of articular or spinal OO. Patients were contacted by phone to evaluate the long-term outcome in terms of pain, ability to perform daily activities (including sports), and long-term complications. Success was defined as the absence of residual pain and ability to perform daily activities normally. From 2008 to 2015, 126 patients were treated by CT-guided RFA for OO in our institution. Mean patient age was 26.1 years (SD = 11, range 1-53); mean delay to diagnosis was 16.9 months (SD = 15.2, range 1-120). Among patients who answered the follow-up call (n = 88), the overall success rate was 94.3%: 79/88 (89.8%) had primary success of the procedure, and 4/88 (4.5%) had a secondary success (repeat-RFA after pain recurrence). Mean follow-up time was 34.6 months (SD = 24.7, range 3-90). Few complications occurred: two mild reversible peripheral nerve injuries, one brachial plexus neuropathy, one broken electrode tip fragment, and one muscular hematoma. Osteoid osteoma can be effectively and safely treated by CT-guided RFA using the presented ablation protocol. Beneficial effects of the treatment persist at long-term follow-up. (orig.)

  8. Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma

    International Nuclear Information System (INIS)

    Lassalle, Louis; Campagna, R.; Corcos, G.; Feydy, A.; Babinet, A.; Larousserie, F.; Stephanazzi, J.

    2017-01-01

    To assess the long-term outcome of computed tomography-guided radiofrequency ablation (CT-guided RFA) in patients with suspected osteoid osteoma (OO). Single-center retrospective study. Patients with clinical suspicion and imaging diagnosis of osteoid osteoma were treated by CT-guided RFA using the same device with either a 7- or 10-mm active tip electrode. Specific precautions were applied in case of articular or spinal OO. Patients were contacted by phone to evaluate the long-term outcome in terms of pain, ability to perform daily activities (including sports), and long-term complications. Success was defined as the absence of residual pain and ability to perform daily activities normally. From 2008 to 2015, 126 patients were treated by CT-guided RFA for OO in our institution. Mean patient age was 26.1 years (SD = 11, range 1-53); mean delay to diagnosis was 16.9 months (SD = 15.2, range 1-120). Among patients who answered the follow-up call (n = 88), the overall success rate was 94.3%: 79/88 (89.8%) had primary success of the procedure, and 4/88 (4.5%) had a secondary success (repeat-RFA after pain recurrence). Mean follow-up time was 34.6 months (SD = 24.7, range 3-90). Few complications occurred: two mild reversible peripheral nerve injuries, one brachial plexus neuropathy, one broken electrode tip fragment, and one muscular hematoma. Osteoid osteoma can be effectively and safely treated by CT-guided RFA using the presented ablation protocol. Beneficial effects of the treatment persist at long-term follow-up. (orig.)

  9. A clinical study on diagnostic value of CT-myelography in herniated lumbar disc and related disorders

    International Nuclear Information System (INIS)

    Endo, Tohru

    1984-01-01

    In order to evaluate the diagnostic value of CT-myelography (CTM) in herniated lumbar disc and related disorders, myelography and CTM were performed on 60 patients with sciatic pain and the findings obtained were compared. Among these patients, operation was undertaken in 30 including 5 reoperated patients, and preoperative findings on CTM were compared with the grades of herniated disc observed at operation. On the basis of abnormal myelographic findings of 55 patients, excluding 5 reoperated patients, morphological changes of the CTM were classified into the following seven types; normal, anterior defect, lateral defect, antero-lateral defect, root defect or thinning, total defect, and anterior plus unilateral root defect or thinning. Agreetment between myelographic and CTM findings was found in 85.1% of the cases. While myelography permitted only an indefinite diagnosis of lumbar disc lesion, CTM permitted a define diagnosis in 8 intervertebral discs including 2 giving nomal results by CTM. In cases of reoperation, CTM provided usefull information for an analysis of the pathological changes included disc herniation, whereas myelography rarely provided usefull findings. A comparative study of CTM and surgical findings revealed that the morphological changes in CTM were closely related with the grades of herniated discs. Consequently, CTM may be performed after myelography. If findings by the two techniques are synthesized, the diagnostic rate of herniated lumbar disc and related disorders will be considerably improved. Furthermore, it is concluded that CTM is an important technique for observing bony and neural changes inside the spinal canal in the axial transverse plane. (author)

  10. Development of the robot system to assist CT-guided brain surgery

    International Nuclear Information System (INIS)

    Koyama, H.; Funakubo, H.; Komeda, T.; Uchida, T.; Takakura, K.

    1999-01-01

    The robot technology was introduced into the stereotactic neurosurgery for application to biopsy, blind surgery, and functional neurosurgery. The authors have developed a newly designed the robot system to assist CT-guided brain surgery, designed to allow a biopsy needle to reach the targget such as a cerebral tumor within a brain automatically on the basis of the X,Y, and Z coordinates obtained by CT scanner. In this paper we describe construction of the robot, the control of the robot by CT image, robot simulation, and investigated a phantom experiment using CT image. (author)

  11. CT-guided biopsy: diagnostic relevance, therapeutic consequences and economic aspects

    International Nuclear Information System (INIS)

    Schwarzenberg, H.; Mueller-Huelsbeck, S.; Link, J.; Brossmann, J.; Fahl, M.; Quirin, A.; Heller, M.

    1996-01-01

    Purpose: To evaluate the diagnostic and clinical relevance and therapeutic consequences of CT-guided biopsy with regard to economic aspects. Methods: 213 CT-guided biopsies in 190 were evaluated. All information regarding patient referral, reason for request, body region, underlying diagnosis, and clinical consequences were registered over a period of 22.2±9.4 month. Results: Patient referral to biopsy was mainly from the departments of surgery, internal medicine, and radiotherapy with the question of tumor and metastasis. Less than 5% of biopsies were performed in outpatients. Main regions were the lung (39%), the abdomen (35%), and the skeleton (11%). Biopsy and surgical histology corresponded in 73%. Largest diagnosis groups were benign unspecific tissues or other benign lesions in 24%. As a result of CTP no further procedures necessary in 22.5%. Follow-up studies or conservative treatment were indicated in 11.3%. Surgical procedures were needed in only 15.5%. There was only one complication requiring therapy. Conclusion: CT-guided biopsy is a safe procedure, which helps to avoid unnecessary cost-intensive diagnostics and surgical treatment. If CTP is performed early and in outpatients residence time in the hospital is reduced and thus money is saved. (orig.) [de

  12. CT-guided cervical interlaminar epidural steroid injection for cervical radiculopathy

    International Nuclear Information System (INIS)

    Chen Wei; Wu Chungen; Wu Chaoxian; Cheng Yongde

    2009-01-01

    Objective: To evaluate the safety and effectiveness of CT-guided cervical interlaminar epidural steroid injection for the treatment of cervical radiculopathy. Methods: CT-guided cervical interlaminar epidural steroid injection was performed in 32 patients with cervical radioculopathy, encountered during the period of Dec. 2006 to June 2008, as the patients failed to respond to the conservative treatment in 2 weeks. The clinical data and the imaging findings were retrospectively analyzed. Before and after the procedure, visual analogue scale (VAS) and Odom criteria were used to evaluate the pain of the patient. Results: Three months after the injection, improvement judged by Odom criteria was seen in 28 patients (87.5%), and the mean pain relief value of VAS was 5.88 ± 1.10. No significant difference in effective rate and in VAS score (P>0.05) was found between protrusion group and degenerative group, between the group with the course over 6 months and the group with the course below 6 months, also between the group receiving one injection and the group receiving the second injection. Conclusion: CT-guided fine needle (23 gauge) puncture epidural steroid (Decadron) 'target spot' injection is an ideal alternative for the treatment of cervical radiculopathy, especially for the patients who fails to respond to the conservative treatment. (authors)

  13. Parametric modeling of the intervertebral disc space in 3D: application to CT images of the lumbar spine.

    Science.gov (United States)

    Korez, Robert; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2014-10-01

    Gradual degeneration of intervertebral discs of the lumbar spine is one of the most common causes of low back pain. Although conservative treatment for low back pain may provide relief to most individuals, surgical intervention may be required for individuals with significant continuing symptoms, which is usually performed by replacing the degenerated intervertebral disc with an artificial implant. For designing implants with good bone contact and continuous force distribution, the morphology of the intervertebral disc space and vertebral body endplates is of considerable importance. In this study, we propose a method for parametric modeling of the intervertebral disc space in three dimensions (3D) and show its application to computed tomography (CT) images of the lumbar spine. The initial 3D model of the intervertebral disc space is generated according to the superquadric approach and therefore represented by a truncated elliptical cone, which is initialized by parameters obtained from 3D models of adjacent vertebral bodies. In an optimization procedure, the 3D model of the intervertebral disc space is incrementally deformed by adding parameters that provide a more detailed morphometric description of the observed shape, and aligned to the observed intervertebral disc space in the 3D image. By applying the proposed method to CT images of 20 lumbar spines, the shape and pose of each of the 100 intervertebral disc spaces were represented by a 3D parametric model. The resulting mean (±standard deviation) accuracy of modeling was 1.06±0.98mm in terms of radial Euclidean distance against manually defined ground truth points, with the corresponding success rate of 93% (i.e. 93 out of 100 intervertebral disc spaces were modeled successfully). As the resulting 3D models provide a description of the shape of intervertebral disc spaces in a complete parametric form, morphometric analysis was straightforwardly enabled and allowed the computation of the corresponding

  14. Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study.

    Science.gov (United States)

    Bhatt, Kavita M; Tandon, Yasmeen K; Graham, Ruffin; Lau, Charles T; Lempel, Jason K; Azok, Joseph T; Mazzone, Peter J; Schneider, Erika; Obuchowski, Nancy A; Bolen, Michael A

    2018-03-01

    Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P guided sampling (P guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.

  15. Transpulmonary CT-guided percutaneous ethanol injection therapy (CT-PEIT) for hepatocellular carcinoma located in the subphrenic region of liver

    International Nuclear Information System (INIS)

    Ueda, Kazushige; Ohkawara, Tohru; Minami, Masahito; Sawa, Yoshihiko; Morinaga, Osamu; Kohli, Yoshihiro; Ohkawara, Yasuo

    2000-01-01

    The purpose of this study is to evaluate the feasibility of transpulmonary CT-guided percutaneous ethanol injection therapy (CT-PEIT) for hepatocellular carcinoma (HCC, 15 lesions) located in the subphrenic region and untreatable by ultrasonography-guided PEIT. The HCC was localized on Lipiodol CT image with a graduated grid system. We advanced a PEIT needle in a stepwise fashion, perpendicularly to the major axis of body through the lung with intermittent localization scans to position the tip of the needle in the lesion. Ethanol was injected with monitoring scans obtained after incremental volumes of injection, until perfusion was judged to be complete. A total of 20 CT-PEIT sessions were performed. The average number of needles passed from skin to liver in each CT-PEIT session was 2.7, the average volume of ethanol injected was 11.7 ml, and the average time required was 53.6 minutes. Complete perfusion of the lesion by ethanol was achieved in all lesions with only a single or double CT-PEIT procedure without severe complications. Local recurrence was detected in 3 to 15 followed up lesions for 14 months on average. In conclusion, transpulmonary CT-PEIT should prove to be a feasible, acceptable treatment for challenging cases of HCC located in the subphrenic region. (author)

  16. Study of CT and etiology In 11B cases of eoute headache without hemlplegla

    Institute of Scientific and Technical Information of China (English)

    Daoming Tong

    2000-01-01

    objectal To study the relation between CT and etiology of acute headache without hemiplegia. Methods 118 cases of acute headache without hemiplegia were studied with CT scan. The patients with normal CT were diagnosed with lumbar punc -tura or diagnostic standard for establishing disease. Results The first three etiologies were cerebrovescular disease (65 cases, 55%), migraine (25 cases, 21%), meningitis and encephalitis (19 cases, 155. 9%). 53% of patients with subarachnoid hemorrhage(SAH) was diagnosed in CT unnormal group, and 12.4% of patients with Sall was showed by lumbar puncture in CT normal group(P<0. 001). CT was normal in 18% of patients with a definite SAH(7/39). The positive rates of intracranial infection in CT normal group(by lumbar puncture) was reearkably higher than in CT unnormal group (18/58 versus 2/60, p<0.005), Conolusion CT is more sensitive to intracranial hemorrhage, tumor and infarction. SAH of a negative Ctscan is not rare. CT is far inferior to lumbar puncture in meningitis or encephalitis.

  17. Clinical experience of quantex coordinate software for CT guided stereotactic surgery

    International Nuclear Information System (INIS)

    Yabashi, Toshitake; Ichikawa, Hideo; Yasuda, Eisuke; Tsuruta, Hatsuo; Ishikawa, Yoshihisa; Kimura, Tokuji; Kanamori, Isao

    1991-01-01

    Recently, Quantex Coordinate Software was newly developed for CT-guided stereotactic surgery. We have the opportunity of using this software in 6 cases with intracerebral hematoma for evacuation and 2 cases with brain tumor for needle biopsy by using CT-guided stereotactic surgery. The followings are the features with a little clinical experience. One of the biggest features is that this software can simulate the best expected route of the puncture needle from burr hole to target point before inserting. Also compared with CT 9000 series Software, it has many new functions for more advanced hardware as well as advance standard software. Two cases of intracerebral hematoma for evacuation and 1 case of a brain tumor for a biopsy were carried out using this software mainly as a simulation. In all cases, this software proved to be very useful. (author)

  18. The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained.

    Science.gov (United States)

    Bydon, Mohamad; Macki, Mohamed; De la Garza-Ramos, Rafael; Youssef, Mina; Gokaslan, Ziya L; Meleka, Sherif; Bydon, Ali

    2014-10-01

    The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study. In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution. All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P  =  0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P sacroiliac injections was $2004·29. In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.

  19. Utility of CT-guided abdominal aspiration procedures

    International Nuclear Information System (INIS)

    Sundaram, M.; Wolverson, M.K.; Heiberg, E.; Pilla, T.; Vas, W.G.; Shields, J.B.

    1982-01-01

    Over 200 consecutive diagnostic needle aspiration procedures of the abdomen were performed under computed tomographic (CT) guidance. Biopsies were done of the liver in 88 patients, the pancreas in 28, the kidney in 20, and the retroperitoneum in 32; 30 underwent an aspiration procedure for characterization of an intraabdominal fluid collection. Accuracy of diagnosis was very high for hepatic (99%) and renal (100%) biopsies and in characterization of fluid collections (100%). Accuracy for retroperitoneal biopsy was 87.5% and for pancreatic biopsy 82%. Overall accuracy for all sites was 95%. There were one false-negative diagnosis for the liver and five false-negative diagnoses for the pancreas. Insufficient material was obtained for diagnosis in four instances of retroperitoneal biopsy. There were no false positives. The technique is facilitated by rapid CT scan time, large aperture gantry, and rapid CT image reconstruction. Twenty gauge needles were used more frequently than 22 gauge needles because of their greater rigidity and ease of control. CT-guided diagnostic aspiration procedures are particularly useful for diagnosis of small, deep-seated lesions and in evaluation of lesions found in severely ill patients. An experienced cytologist is essential to the success of the technique

  20. PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

    Science.gov (United States)

    Cazzato, Roberto Luigi; Garnon, Julien; Shaygi, Behnam; Koch, Guillaume; Tsoumakidou, Georgia; Caudrelier, Jean; Addeo, Pietro; Bachellier, Philippe; Namer, Izzie Jacques; Gangi, Afshin

    2018-02-01

    Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

  1. Therapeutic outcome of CT-guided radiofrequency ablation in patients with osteoid osteoma.

    Science.gov (United States)

    Lassalle, Louis; Campagna, R; Corcos, G; Babinet, A; Larousserie, F; Stephanazzi, J; Feydy, A

    2017-07-01

    To assess the long-term outcome of computed tomography-guided radiofrequency ablation (CT-guided RFA) in patients with suspected osteoid osteoma (OO). Single-center retrospective study. Patients with clinical suspicion and imaging diagnosis of osteoid osteoma were treated by CT-guided RFA using the same device with either a 7- or 10-mm active tip electrode. Specific precautions were applied in case of articular or spinal OO. Patients were contacted by phone to evaluate the long-term outcome in terms of pain, ability to perform daily activities (including sports), and long-term complications. Success was defined as the absence of residual pain and ability to perform daily activities normally. From 2008 to 2015, 126 patients were treated by CT-guided RFA for OO in our institution. Mean patient age was 26.1 years (SD = 11, range 1-53); mean delay to diagnosis was 16.9 months (SD = 15.2, range 1-120). Among patients who answered the follow-up call (n = 88), the overall success rate was 94.3%: 79/88 (89.8%) had primary success of the procedure, and 4/88 (4.5%) had a secondary success (repeat-RFA after pain recurrence). Mean follow-up time was 34.6 months (SD = 24.7, range 3-90). Few complications occurred: two mild reversible peripheral nerve injuries, one brachial plexus neuropathy, one broken electrode tip fragment, and one muscular hematoma. Osteoid osteoma can be effectively and safely treated by CT-guided RFA using the presented ablation protocol. Beneficial effects of the treatment persist at long-term follow-up.

  2. Functional and quantitative magnetic resonance myelography of symptomatic stenoses of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Eberhardt, Knut [District Hospital Castle of Werneck, MRI Center of Excellence, Werneck (Germany); Ganslandt, Oliver [University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany); Stadlbauer, Andreas [University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany); Medical University Vienna, Department of Radiology and Nuclear Medicine, Vienna (Austria)

    2014-12-15

    The objective of this study was to demonstrate that functional, quantitative magnetic resonance myelography (MRM) allows standardized diagnosis of symptomatic lumbar spinal stenoses which show at least equal detectability compared to functional myelography and postmyelographic CT (pmCT) based on intra- and postoperative findings. We investigated 43 volunteers and 47 patients with symptomatic lumbar spinal stenoses using MRM in normal position as well as in flexion and extension in a standard whole-body MR scanner. Twenty volunteers were additionally examined under axial loading. All patients were investigated by functional myelography and pmCT and 10 patients had a functional lumbar MRM postoperatively. Range of motion and cerebrospinal fluid (CSF) volumes in normal position, flexion, extension, and under axial loading (volunteers) were assessed for each segment. Detectability was determined by using intraoperative findings, and postoperative freedom of symptoms was correlated with CSF volume changes in MRM. The ranges of motion in a standard whole-body MR scanner provide adequate scope for investigations into function (flexion and extension) in both volunteers and patients. Axial loading was associated with a mechanism of extension, albeit to a far smaller extent. Detectability of lumbar stenoses was 100 % for MRM, 58 % for conventional myelography, and 68 % for pmCT. Postoperative changes in CSF volume of levels with stenoses in MRM strongly correlated with freedom of symptoms (R = 0.772). This MRM method allows for exact diagnosis and reproducible quantification of stenoses, motion-related changes, and spondylolistheses of the lumbar spine. It may be useful for early detection of alterations in order to avoid neuronal compression. (orig.)

  3. Percutaneous CT-guided cryoablation for the treatment of refractory pudendal neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Prologo, J.D.; Williams, Roger [Emory University Hospital, Department of Radiology and Imaging Sciences Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Lin, Roger C. [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David [Case Western Reserve University, Department of Biomedical Engineering, Cleveland, OH (United States)

    2015-05-01

    To evaluate the safety and efficacy of percutaneous CT-guided cryoablation of the pudendal nerve for the treatment of refractory pudendal neuralgia. Eleven patients were selected to undergo percutaneous CT-guided cryoablation of the pudendal nerve based on established diagnostic criteria. Brief Pain Inventory questionnaires were administered prior to the procedure, during the immediate 24 h post procedure, and 45 days and 6 months following the procedure. Prior to treatment, the average level of pain on a scale from 0 (no pain) to 10 (worst pain imaginable) was 7.6, with pain described as ''burning'' (80%), ''pulling'' (37.5%), ''crushing'' (50%), ''pressure'' (84.5%), ''throbbing'' (50%), ''knife-life'' (52%), and ''other'' (60%). At 24 h, 45 days, and 6 months post-treatment, pain intensity dropped to 2.6, 3.5, and 3.1, respectively (p < 0.005). There were no procedure-related complications. CT-guided percutaneous cryoablation may represent a safe and efficacious option for selected patients with refractory pudendal neuralgia. (orig.)

  4. [Finite element analysis of lumbar pelvic and proximal femur model with simulate lumbar rotatory manipulation].

    Science.gov (United States)

    Hu, Hua; Xiong, Chang-Yuan; Han, Guo-Wu

    2012-07-01

    To study the changes of displacement and stress in the model of lumbar pelvic and proximal femur during lumbar rotatory manipulation. The date of lumbar pelvic and proximal femur CT scan by Mimics 10.01 software was established a lumbar pelvic and proximal femur geometric model, then the model was modified with Geomagic 9, at last the modified model was imported into hypermesh 10 and meshed with tetrahedron, at the same time,add disc and ligaments. According to the principle of lumbar rotatory manipulation,the lumbar rotatory manipulation were decomposed. The mechanical parameters assigned into the three-dimensional finite element model. The changes of displacement and stress in the model of lunbar pelvic and proximal femur under the four conditions were calculated with Abaqus model of Hypermesh 10. 1) Under the same condition,the displacement order of lumbar was L1>L2>L3>L5 L5, anterior column > middle column > posterior column. 2) Under the different conditions, the displacement order of lumbar,case 3>case 1>case 4>case 2. 3) Under the same conditions, the displacement order of lumbar inter-vertebral disc from L1,2 to L5S1 was L1,2>L2,3>L3,4>L4,5>L5S1, as for the same inter-vertebral disc, the order was: second quadrant>third quadrant>first quadrant>fourth quadrant. 4) Under the different conditions,the displacement order of the inter-vertebral disc was L1,2>L2,3>L3,4>L4,5>L5S1, but to same inter-vertebral disc: case 3>case 4>case 1 >case 2. 5) There were apparent displacement and stress concentration in pelvis and hip during the manipulation. 1) The principles of lumbar rotation manipulation closely related to the relative displacement caused by rotation of various parts of lumbar pelvic and proximal femur model; 2) During the process of lumbar rotatory manipulation, the angle of lateral bending and flexion can not be randomly increased; 3) During the process of lumbar rotatory manipulation, all the conditions of lumbar pelvic and proximal femur must be

  5. CT-guided suprascapular nerve blocks: a pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Schneider-Kolsky, M.E.; Pike, J.; Connell, D.A. [Department of Medical Imaging, Victoria House Private Hospital, 316 Malvern Road, Prahran 3181, Melbourne, Victoria (Australia)

    2004-05-01

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean ({+-}SEM) pain score of 7.0 ({+-}0.4) to 3.5 ({+-}0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% ({+-}4.9, P<0.001) and 16.8% ({+-}4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  6. CT-guided suprascapular nerve blocks: a pilot study

    International Nuclear Information System (INIS)

    Schneider-Kolsky, M.E.; Pike, J.; Connell, D.A.

    2004-01-01

    The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies. CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards. Within 30 min of the block overall pain scores decreased from a mean (±SEM) pain score of 7.0 (±0.4) to 3.5 (±0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% (±4.9, P<0.001) and 16.8% (±4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted. In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability. (orig.)

  7. Ablation of lumbar sympathetic ganglia by absolute ethanol injection and paravertebral catheter placement under CT guidance: evaluation of the efficacy

    International Nuclear Information System (INIS)

    Xu Hua; Xiong Yuanchang; Shao Chengwei; Zuo Changjing; Sheng Jing; Tian Jianming

    2009-01-01

    Objective: To evaluate the ablation of lumbar sympathetic ganglia by using single injection of absolute ethanol and retaining a paravertebral catheter under CT guidance for the treatment of lower extremity ischemia. Methods: Single absolute ethanol injection of L2 sympathetic ganglia was done in 25 cases (group B), single absolute ethanol injection of L2 sympathetic ganglia together with placement of a paravertebral catheter at L3 was carried out in 23 cases (group BT). All the procedures were performed under CT guidance. Three days after the procedure, the pain severity of the lower limbs was evaluated based on VAS method. If the patient in group BT still had a VAS score ≥4 on the third day, 3 ml of 1% lidocaine was infected via the retained catheter in the prone position. If VAS score became ≤3 at 5 min after the injection, additional 5 ml of ethanol was given through the catheter. The pain severity was evaluated again one week later. VAS score, analgesic dose and temperature of lower limbs were recorded. Results: One week after the procedure the excellent rate and effective rate for group B were 32% and 80% respectively, while for group BT were 60.9% and 95.7% respectively, with a significant difference between two groups (P<0.01). Conclusion: For the ablation of lumbar sympathetic ganglia the combination of single absolute ethanol injection with paravertebral catheter placement under CT guidance is superior to the single absolute ethanol injection. This technique is more individual with better results and is more likely to be accepted by the patients. (authors)

  8. In-vitro study on the accuracy of a simple-design CT-guided stent for dental implants

    International Nuclear Information System (INIS)

    Huh, Young June; Choi, Bo Ram; Huh, Kyung Hoe; Yi, Won Jin; Heo, Min Suk; Lee, Sam Sun; Choi, Soon Chul

    2012-01-01

    An individual surgical stent fabricated from computed tomography (CT) data, called a CT-guided stent, would be useful for accurate installation of implants. The purpose of the present study was to introduce a newly developed CT-guided stent with a simple design and evaluate the accuracy of the stent placement. A resin template was fabricated from a hog mandible and a specially designed plastic plate, with 4 metal balls inserted in it for radiographic recognition, was attached to the occlusal surface of the template. With the surgical stent applied, CT images were taken, and virtual implants were placed using software. The spatial positions of the virtually positioned implants were acquired and implant guiding holes were drilled into the surgical stent using a specially designed 5-axis drilling machine. The surgical stent was placed on the mandible and CT images were taken again. The discrepancy between the central axis of the drilled holes on the second CT images and the virtually installed implants on the first CT images was evaluated. The deviation of the entry point and angulation of the central axis in the reference plane were 0.47±0.27 mm, 0.57±0.23 mm, and 0.64±0.16 degree, 0.57±0.15 degree, respectively. However, for the two different angulations in each group, the 20 degree angulation showed a greater error in the deviation of the entry point than did the 10 degree angulation. The CT-guided template proposed in this study was highly accurate. It could replace existing implant guide systems to reduce costs and effort.

  9. Imaging of the lumbar spine after diskectomy

    International Nuclear Information System (INIS)

    Laredo, J.D.; Wybier, M.

    1995-01-01

    The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs

  10. Significance of interfacet distance, facet joint orientation, and lumbar lordosis in spondylolysis.

    Science.gov (United States)

    Chung, Sang-Bong; Lee, Sungjoon; Kim, Hoon; Lee, Sun-Ho; Kim, Eun Sang; Eoh, Whan

    2012-04-01

    The aim of this study is to reveal the association between lumbar spondylolysis and several radiologic parameters, which had been suggested to be significant. The authors examine interfacet distance (IFD), facet joint orientation (FJO), and lumbar segmental lordosis (LSL) all together on the basis of lumbar computed tomography (CT) scan of 35 patients with L5 spondylolysis and 36 unaffected control groups. Thirty-five Korean military recruits, aged 19-23 (mean 20.9 years), were diagnosed as L5 spondylolysis by lumber CT scans. As a control group, 36 male Korean military recruits, aged 18-25 (mean 21.3 years), were reconfirmed as not affected by lumbar spondylolysis by CT scan when they visited our hospital complaining of back pain. This study compares IFD, FJO, and LSL for each lumbar segment between the spondylolytic and unaffected groups. We also propose the use of normal mean data of IFD, FJO, and LSL of lumbar vertebrae from 36 Korean young military recruits because each measurement has power as an absolute value, like data from an osteologic collection in other studies. Comparison of IFD between spondylolytic and unaffected individuals reveals significant differences at the L3, L4, and L5 level (P = 0.0384, P = 0.0219, and P spondylolysis, the increase of IFD from L4 to S1 was less pronounced (P spondylolysis and individuals without pars defect on L5. In the spondylolysis group, and the increase of IFD from L4 to S1 was less pronounced and the LSL at L5-S1 was more lordotic. Copyright © 2011 Wiley Periodicals, Inc.

  11. Correlation of (99m) Tc-DPD SPECT/CT Scan Findings and Diagnostic Blockades of Lumbar Medial Branches in Patients with Unspecific Low Back Pain in a Randomized-Controlled Trial.

    Science.gov (United States)

    Freiermuth, David; Kretzschmar, Martin; Bilecen, Denis; Schaeren, Stefan; Jacob, Augustinus Ludwig; Aeschbach, Armin; Ruppen, Wilhelm

    2015-10-01

    Zygapophyseal joints are the origin of pain in up to 30% of those with unspecific chronic low back pain. Until recently, no reliable clinical tests have been found to identify the patients who would benefit from denervation of the zygapophyseal joints by medial branch blockades. We performed a prospective randomized placebo-controlled trial to evaluate the value of high-resolution single-photon emission computed tomography (SPECT)/computed tomography (CT) of the lumbar spine prior to any diagnostic infiltration of the medial branches. Patients with suspected zygapophyseal joint-related pain were included in the study. After obtaining a SPECT/CT scan of the lumbar spine a set of infiltrations of the medial branches was done with local anesthetics and placebo on different days. Patients and anesthetists were blinded to the results of SPECT/CT and to the infiltrated agents. In a total of 29 study patients, 7 had positive and 22 negative infiltration tests, and 9 had positive and 20 negative SPECT/CT findings. Sensitivity of SPECT/CT for a positive response after diagnostic infiltration was 0.57 (95% confidence interval [CI] 0.18-0.90); specificity was 0.77 (CI 95% 0.55-0.92); odds ratio was 4.53 (CI 95% 0.75-27.40); and diagnostic accuracy was 0.72. Compared with diagnostic infiltrations SPECT/CT scans showed only a moderate sensitivity and specificity and, therefore, may not be recommended as a first line diagnostic tool prior to diagnostic infiltrations. Wiley Periodicals, Inc.

  12. Trans-sphenoidal treatment of postsurgical cerebrospinal fluid fistula: CT-guided closure

    International Nuclear Information System (INIS)

    Floris, R.; Salvatore, C.; Simonetti, G.

    1998-01-01

    Cerebrospinal fluid (CSF) leakage after trans-sphenoidal surgery is a troublesome complication with a risk of meningitis and pneumocephalus. We suggest CT-guided intrasphenoidal injection of fibrin sealant through a 12-gauge needle as a simple alternative to surgical management of CSF fistulae. We treated eight patients, operated via the trans-sphenoidal route (five pituitary adenomas, three craniopharyngiomas), for a postoperative CSF leak by CT-guided intrasphenoidal injection of fibrin sealant alone in three cases and fibrin sealant and autologous blood in 5. CT was obtained 10 days after the procedure in all cases. In four patients, the CSF leak was closed successfully at the first attempt. The procedure was repeated on the four remaining patients because only a reduction in leakage was obtained at the first attempt. This procedure preserves olfaction and avoids the risk of frontal lobe damage. It could therefore represent the treatment of choice in many cases of anterior cranial fossa postsurgical CSF leaks. (orig.) (orig.)

  13. Two-Step Incision for Periarterial Sympathectomy of the Hand

    Directory of Open Access Journals (Sweden)

    Seung Bae Jeon

    2015-11-01

    Full Text Available BackgroundSurgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire.MethodsA total of 40 patients (17 men and 23 women with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS and the Wake Forest University rating scale.ResultsThe total patient score was 8.59 (range, 6-15 in the two-step incision group and 9.62 (range, 7-18 in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034 but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03.ConclusionsCompared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.

  14. Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-aided implant placement. Part II: reliability of mucosa-supported stereolithographic guides.

    Science.gov (United States)

    Arisan, Volkan; Karabuda, Zihni Cüneyt; Pişkin, Bülent; Özdemir, Tayfun

    2013-12-01

    Deviations of implants that were placed by conventional computed tomography (CT)- or cone beam CT (CBCT)-derived mucosa-supported stereolithographic (SLA) surgical guides were analyzed in this study. Eleven patients were randomly scanned by a multi-slice CT (CT group) or a CBCT scanner (CBCT group). A total of 108 implants were planned on the software and placed using SLA guides. A new CT or CBCT scan was obtained and merged with the planning data to identify the deviations between the planned and placed implants. Results were analyzed by Mann-Whitney U test and multiple regressions (p < .05). Mean angular and linear deviations in the CT group were 3.30° (SD 0.36), and 0.75 (SD 0.32) and 0.80 mm (SD 0.35) at the implant shoulder and tip, respectively. In the CBCT group, mean angular and linear deviations were 3.47° (SD 0.37), and 0.81 (SD 0.32) and 0.87 mm (SD 0.32) at the implant shoulder and tip, respectively. No statistically significant differences were detected between the CT and CBCT groups (p = .169 and p = .551, p = .113 for angular and linear deviations, respectively). Implant placement via CT- or CBCT-derived mucosa-supported SLA guides yielded similar deviation values. Results should be confirmed on alternative CBCT scanners. © 2012 Wiley Periodicals, Inc.

  15. CT-guided core needle biopsy of pleural lesions: Evaluating diagnostic yield and associated complications

    International Nuclear Information System (INIS)

    Niu, Xiang Ke; Bhetuwal, Anup; Yang, Han Feng

    2015-01-01

    The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

  16. CT-guided core needle biopsy of pleural lesions: Evaluating diagnostic yield and associated complications

    Energy Technology Data Exchange (ETDEWEB)

    Niu, Xiang Ke [Dept. of Radiology, Affiliated Hospital of Chengdu University, Chengdu (China); Bhetuwal, Anup; Yang, Han Feng [Dept. of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2015-02-15

    The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

  17. CT guided fine needle aspiration biopsy of biliopancreatic lesions

    International Nuclear Information System (INIS)

    Geng, Jia-Zheng; Qin, Pan-Rui; Hui, Liu-De; Po, Pei-Dong

    1987-01-01

    CT guided percutaneous fine needle aspiration biopsy was performed on 30 patients with pancreatic and periampullary neoplasms, in the Department of Surgery, China-Japan Friendship Hospital, between March 1985 and January 1986. We obtained positive cytodiagnosis from all cases of carcinoma of the pancreatic head (9 cases), body and tail (4 cases), and ampullary carcinomas (5 cases) (100 per cent). In 2 of 3 duodenal carcinomas (66.6 per cent), and 6 of 7 distal common duct carcinomas (86 per cent), a positive cytodiagnosis was also obtained. On the other hand, 2 cases of pancreatitis both gave a negative cytodiagnosis, i.e. no false positives were obtained. Out of the 30 cases who underwent CT guided biopsy, a correct diagnosis was obtained in 28, i.e. a diagnostic accuracy of 93.3 per cent. The cytodiagnosis of the other two cases was either suspicious or false negative. There have been no clinical complications noted. (author)

  18. Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses

    International Nuclear Information System (INIS)

    Asai, Nobuhiro; Ohkuni, Yoshihiro; Kaneko, Norihiro; Aoshima, Masahiro; Yamazaki, Ikuo; Kawamura, Yasutaka

    2013-01-01

    Combination therapy of CT-guided percutaneous drainage and antibiotics is the first-line treatment for abscesses. Its effectiveness has been demonstrated. However, the therapeutic impact of this procedure for infection treatment has never been reported. We retrospectively analyzed all 47 patients who received CT-guided percutaneous drainage for infection treatment. Patients' characteristics, pathogens isolated, antibiotics administered, technical and clinical outcomes, complications related to this procedure and therapeutic impacts were investigated. Patients were 26 males and 21 females. The mean age was 63.5 years (±18.7). The diseases targeted were 19 retroperitoneal abscesses, 18 intraabdominal abscesses, three pelvic abscesses, and seven others. As for technical outcomes, all of the 54 procedures (100%) were successful. As for clinical outcomes, 44 (93.6%) were cured and three patients (6.4%) died. No complications related to this procedure were found in this study. A total of 42 patients (88%) had a change in the management of their infection as a result of CT-guided percutaneous drainage, such as selection and discontinuation of antibiotics. In conclusion, CT-guided percutaneous drainage is a safe and favorable procedure in the treatment of deep tissue abscesses. Therapeutic impact of these procedures helped physicians make a rational decision for antibiotics selection. (author)

  19. Therapeutic impact of CT-guided percutaneous catheter drainage in treatment of deep tissue abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Asai, Nobuhiro; Ohkuni, Yoshihiro; Kaneko, Norihiro; Aoshima, Masahiro; Yamazaki, Ikuo; Kawamura, Yasutaka, E-mail: nobuhiro0204@hotmail.com [Kameda Medical Center, Chiba (Japan)

    2013-03-15

    Combination therapy of CT-guided percutaneous drainage and antibiotics is the first-line treatment for abscesses. Its effectiveness has been demonstrated. However, the therapeutic impact of this procedure for infection treatment has never been reported. We retrospectively analyzed all 47 patients who received CT-guided percutaneous drainage for infection treatment. Patients' characteristics, pathogens isolated, antibiotics administered, technical and clinical outcomes, complications related to this procedure and therapeutic impacts were investigated. Patients were 26 males and 21 females. The mean age was 63.5 years ({+-}18.7). The diseases targeted were 19 retroperitoneal abscesses, 18 intraabdominal abscesses, three pelvic abscesses, and seven others. As for technical outcomes, all of the 54 procedures (100%) were successful. As for clinical outcomes, 44 (93.6%) were cured and three patients (6.4%) died. No complications related to this procedure were found in this study. A total of 42 patients (88%) had a change in the management of their infection as a result of CT-guided percutaneous drainage, such as selection and discontinuation of antibiotics. In conclusion, CT-guided percutaneous drainage is a safe and favorable procedure in the treatment of deep tissue abscesses. Therapeutic impact of these procedures helped physicians make a rational decision for antibiotics selection. (author)

  20. Simulation and training of lumbar punctures using haptic volume rendering and a 6DOF haptic device

    Science.gov (United States)

    Färber, Matthias; Heller, Julika; Handels, Heinz

    2007-03-01

    The lumbar puncture is performed by inserting a needle into the spinal chord of the patient to inject medicaments or to extract liquor. The training of this procedure is usually done on the patient guided by experienced supervisors. A virtual reality lumbar puncture simulator has been developed in order to minimize the training costs and the patient's risk. We use a haptic device with six degrees of freedom (6DOF) to feedback forces that resist needle insertion and rotation. An improved haptic volume rendering approach is used to calculate the forces. This approach makes use of label data of relevant structures like skin, bone, muscles or fat and original CT data that contributes information about image structures that can not be segmented. A real-time 3D visualization with optional stereo view shows the punctured region. 2D visualizations of orthogonal slices enable a detailed impression of the anatomical context. The input data consisting of CT and label data and surface models of relevant structures is defined in an XML file together with haptic rendering and visualization parameters. In a first evaluation the visible human male data has been used to generate a virtual training body. Several users with different medical experience tested the lumbar puncture trainer. The simulator gives a good haptic and visual impression of the needle insertion and the haptic volume rendering technique enables the feeling of unsegmented structures. Especially, the restriction of transversal needle movement together with rotation constraints enabled by the 6DOF device facilitate a realistic puncture simulation.

  1. Postvagotomy acid secretion and mucosal blood flow during beta-adrenoceptor stimulation and universal chemical sympathectomy in dogs

    DEFF Research Database (Denmark)

    Hovendal, C P

    1983-01-01

    The aim of the present study was to examine the effect of beta-adrenoceptor stimulation, alpha blockade, and elimination of the adrenergic nerve function on mucosal blood flow and acid secretion in parietal-cell-vagotomized (PCV) gastric fistula dogs. Isoprenaline inhibited pentagastrin-stimulate......The aim of the present study was to examine the effect of beta-adrenoceptor stimulation, alpha blockade, and elimination of the adrenergic nerve function on mucosal blood flow and acid secretion in parietal-cell-vagotomized (PCV) gastric fistula dogs. Isoprenaline inhibited pentagastrin...... to chemical sympathectomy with 6-hydroxy-dopamine, a false neurotransmitter that selectively destroys the adrenergic nerve terminals. Chemical sympathectomy increased the pentagastrin-stimulated gastric acid secretion and stabilized the mucosal blood flow at the level before vagotomy, but with an increased...... ratio between blood flow and acid secretion. One may conclude that the sympathetic nerve system influences gastric function after vagotomy....

  2. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

    International Nuclear Information System (INIS)

    Cornelis, F.; Takaki, H.; Laskhmanan, M.; Durack, J. C.; Erinjeri, J. P.; Getrajdman, G. I.; Maybody, M.; Sofocleous, C. T.; Solomon, S. B.; Srimathveeravalli, G.

    2015-01-01

    PurposeTo compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.Materials and MethodsManual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal–Wallis test.ResultsPaired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).ConclusionsCT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy

  3. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F.; Takaki, H. [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States); Laskhmanan, M. [Perfint Healthcare Inc (India); Durack, J. C.; Erinjeri, J. P.; Getrajdman, G. I.; Maybody, M.; Sofocleous, C. T.; Solomon, S. B.; Srimathveeravalli, G., E-mail: srimaths@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States)

    2015-10-15

    PurposeTo compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.Materials and MethodsManual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal–Wallis test.ResultsPaired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).ConclusionsCT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy.

  4. Magnetic resonance imaging of lumbar vertebral apophyseal ring fractures

    International Nuclear Information System (INIS)

    Peh, W.C.G.

    1998-01-01

    Posterior lumbar vertebral apophyseal ring fractures are described in three adolescents presenting with severe low back pain, spinal tenderness and lower limb neurological deficit. Magnetic resonance imaging showed severe L4/5 posterior disc protrusion in all three patients. The actual fracture fragment was visualized with difficulty on MRI alone. The diagnosis of apophyseal ring fracture was made by either radiography or CT. Computed tomography delineated the size, shape and site of the fracture fragment. Surgical confirmation was obtained in all cases. Posterior lumbar vertebral apophyseal ring fractures may be difficult to visualize on MR imaging. Careful review of radiographs, supplemented by targeted CT, is necessary for the correct diagnosis and management of this entity. Copyright (1998) Blackwell Science Pty Ltd

  5. Magnetic resonance imaging of lumbar vertebral apophyseal ring fractures

    Energy Technology Data Exchange (ETDEWEB)

    Peh, W.C.G. [University of Hong Kong (Hong Kong). Department of Diagnostics Radiology and Organ Imaging; Yip, D.K.H.; Leong, J.C.Y. [University of Hong Kong (Hong Kong). Department of Orthopaedic Surgery; Griffith, J.F. [Chinese University of Hong Kong (Hong Kong)

    1998-02-01

    Posterior lumbar vertebral apophyseal ring fractures are described in three adolescents presenting with severe low back pain, spinal tenderness and lower limb neurological deficit. Magnetic resonance imaging showed severe L4/5 posterior disc protrusion in all three patients. The actual fracture fragment was visualized with difficulty on MRI alone. The diagnosis of apophyseal ring fracture was made by either radiography or CT. Computed tomography delineated the size, shape and site of the fracture fragment. Surgical confirmation was obtained in all cases. Posterior lumbar vertebral apophyseal ring fractures may be difficult to visualize on MR imaging. Careful review of radiographs, supplemented by targeted CT, is necessary for the correct diagnosis and management of this entity. Copyright (1998) Blackwell Science Pty Ltd 12 refs., 3 figs.

  6. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Heerink, W.J.; Vliegenthart, R. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Radiology, University of Groningen, Groningen (Netherlands); Bock, G.H. de [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Epidemiology, University of Groningen, Groningen (Netherlands); Jonge, G.J. de [University Medical Center Groningen, Department of Radiology, University of Groningen, Groningen (Netherlands); Groen, H.J.M. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands); University Medical Center Groningen, Department of Pulmonary Medicine, University of Groningen, Groningen (Netherlands); Oudkerk, M. [University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, University of Groningen, Groningen (Netherlands)

    2017-01-15

    To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. Four databases were searched from 1/2000 to 8/2015 for studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis. For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3-43.5 %) and 24.0 % (95 % CI: 18.2-30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4-7.4 %) and 4.4 % (95 % CI: 2.7-7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified. In CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications. (orig.)

  7. [Clinical value of CT-guided high frequency-induced thermotherapy as a treatment for intrahepatic cholangiocarcinoma].

    Science.gov (United States)

    Fan, Wei-Jun; Zhang, Liang; Gu, Yang-Kui; Wang, Li-Gang; Ouyang, Yu-Shu

    2008-07-01

    To evaluate the therapeutic effect of CT-guided high frequency-induced thermotherapy (HiTT) for intrahepatic cholangiocarcinoma. Seventeen patients of intrahepatic cholangiocarcinoma with 21 lesions underwent comprehensive treatment with HiTT as the principle approach. As to the patients with obstructive jaundice, percutaneous trans-hepatic cholangial drainage (PTCD) or bile duct endoprosthesis placement was performed first to improve the liver function, then HiTT was performed; and patients without obstructive jaundice underwent CT-guided HiTT directly, 1-2 weeks later, chemotherapy was given for 4 - 6 courses. CT scan 1 week after HiTT showed a short-term achievement rate of 100% (17/17), and the single puncture in situ ablation rate was 76.1% (16/21). The average life span in the near future was 13.5 months. The adverse effects included topo-bleeding, pain after procedure, liver function damage, defervescence, etc. All the patients recovered after symptomatic treatment. The clinical value of CT-guided HiTT for intrahepatic cholangiocarcinoma is obvious.

  8. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation

    Energy Technology Data Exchange (ETDEWEB)

    Baskin, Kevin M.; Cahill, Ann Marie; Kaye, Robin D. [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Born, Christopher T. [Temple University Hospital/Temple Children' s Hospital, Temple Sports Medicine, Marlton, NJ (United States); Grudziak, Jan S. [Children' s Hospital of Pittsburgh, Department of Orthopedic Surgery, Pittsburgh, PA (United States); Towbin, Richard B.

    2004-12-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability. (orig.)

  9. Closed reduction with CT-guided screw fixation for unstable sacroiliac joint fracture-dislocation

    International Nuclear Information System (INIS)

    Baskin, Kevin M.; Cahill, Ann Marie; Kaye, Robin D.; Born, Christopher T.; Grudziak, Jan S.; Towbin, Richard B.

    2004-01-01

    Unstable posterior pelvic ring fractures and dislocations are uncommon but potentially life-threatening injuries in children. Early definitive management reduces risk of immediate complications as well as chronic pain and gait dysfunction. Conventional operative therapy carries substantial risk of extensive blood loss and iatrogenic neurological and vascular injury. Minimally invasive image-guided intervention may further reduce immediate risk and improve long-term outcome. To describe CT-guided closed reduction and internal fixation (CRIF) and review outcomes of unstable fracture-dislocation of the sacroiliac (SI) joint in children. Between 2000 and 2003, three children (two girls, one boy) age 8-14 years were referred to interventional radiology for treatment of unstable SI joint fracture-dislocation not adequately treated with anterior external fixation alone. The three affected SI joints (two left, one right) were treated in a combined approach by pediatric interventional radiologists and orthopedic surgeons, using a percutaneous approach under CT guidance. Over a threaded guiding pin, 7.3 mm cannulated screws were used to achieve stable reduction of the affected SI joints. One screw was removed after slight (2 mm) migration. No neurovascular or other complications occurred. All patients had satisfactory healing with near-anatomic reduction, although recovery of the youngest was delayed by associated spinal injury. Compared to open surgical alternatives, CRIF under CT guidance reduces operating time, decreases blood loss, and allows early definitive fixation and immediate non-weight-bearing mobilization with a low rate of complication for unstable posterior pelvic ring fractures. In addition, CT-guided placement of the guide pin may allow safer screw positioning and may minimize the total number of screws needed to achieve pelvic stability. (orig.)

  10. Automatic labeling and segmentation of vertebrae in CT images

    Science.gov (United States)

    Rasoulian, Abtin; Rohling, Robert N.; Abolmaesumi, Purang

    2014-03-01

    Labeling and segmentation of the spinal column from CT images is a pre-processing step for a range of image- guided interventions. State-of-the art techniques have focused either on image feature extraction or template matching for labeling of the vertebrae followed by segmentation of each vertebra. Recently, statistical multi- object models have been introduced to extract common statistical characteristics among several anatomies. In particular, we have created models for segmentation of the lumbar spine which are robust, accurate, and computationally tractable. In this paper, we reconstruct a statistical multi-vertebrae pose+shape model and utilize it in a novel framework for labeling and segmentation of the vertebra in a CT image. We validate our technique in terms of accuracy of the labeling and segmentation of CT images acquired from 56 subjects. The method correctly labels all vertebrae in 70% of patients and is only one level off for the remaining 30%. The mean distance error achieved for the segmentation is 2.1 +/- 0.7 mm.

  11. Unresectable colorectal liver metastases. Percutaneous ablation using CT-guided high-dose-rate brachytherapy (CT-HDBRT); Nicht resektable kolorektale Lebermetastasen. Perkutane Ablation mittels CT-gesteuerter Hochdosisbrachytherapie (CT-HDBRT)

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Lutter, A.; Schnapauff, D.; Denecke, T.; Gebauer, B. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Hildebrandt, B. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Oncology; Puhl, G. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of General, Visceral and Transplantation Surgery; Wust, P. [Charite, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Radiation Oncology

    2014-06-15

    Purpose: To evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) of unresectable colorectal liver metastases (CRLMs). Materials and Methods: Retrospective analysis of all consecutive patients with unresectable CRLMs treated with CT-HDRBT between January 2008 and November 2012. Treatment was performed by CT-guided catheter placement and high-dose-rate brachytherapy with an iridium-192 source. MRI follow-up was performed after 6 weeks and then every 3 months post-intervention. The primary endpoint was local tumor control (LTC); secondary endpoints included time to progression (TTP) and overall survival (OS). Results: 80 heavily pretreated patients with 179 metastases were available for MRI evaluation for a mean follow-up time of 16.9 months. The mean tumor diameter was 28.5 mm (range: 8 - 107 mm). No major complications were observed. A total of 23 (12.9%) local tumor progressions were observed. Lesions ≥ 4 cm in diameter showed significantly more local progression than smaller lesions (< 4 cm). 50 patients (62.5%) experienced systemic tumor progression. The median TTP was 6 months. 28 (43%) patients died during the follow-up period. The median OS after ablation was 18 months. Conclusion: CT-HDRBT is an effective technique for the treatment of unresectable CRLMs and warrants promising LTC rates compared to thermal ablative techniques. A combination with other local and systemic therapies should be evaluated in patients with lesions > 4 cm in diameter, in which higher progression rates are expected. (orig.)

  12. CT-guided percutaneous conformal cryoablation for lung carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yueyong, Xiao; Bin, Wu; Xiao, Zhang; Hongjun, Li; Da, Yu; Jie, Li; Jun, Li [Department of Radiology, PLA General Hospital, Beijing (China)

    2010-02-15

    Objective: To investigate the safety, efficacy and feasibility of CT-guided percutaneous conformal cryoablation for lung cancer. Methods: The inclusion criteria were: (1) Poor respiratory function and aged patients who can not bear the thoracic surgical operation. (2) Peripheral lung cancer involving the pleura and chest wall which can not be resected. (3) Residual tumor after other comprehensive treatment. (4) Focal lung cancer but the patient refused surgical resection. The exclusion criteria were: (1) Multifocal lesions. (2) Lesion close to mediastinum with possible risk of vessel injury. (3) Severe impairment of pulmonary functions, the maximum voluntary ventilation is less than 39%. (4) Repeated cough or dyspnea, can not cooperate with the procedure. (5) Poor systemic conditions, cachexia or bleeding. Totally, 76 lung carcinoma lesions on 66 patients were treated by CT-guided percutaneous conformal cryoablation using 17 G cryoprobes. The maximum diameters of the tumors ranged from 1.5 cm to 1.6 cm. For the tumors with the maximum diameter less than 3.0 cm, they were treated by double-needle clamping cryoablation. For those with the maximum diameter between 3.0 and 5.0 cm, they were treated by multiple-needle conformal cryoablation. For those with the maximum diameter larger than 5.0 cm, they were treated with multiple-needle conformal cyroablation, with the needle distance less than 1.5 cm. All the patients were followed-up 6 to 24 months after the procedure using contrast-enhanced CT to evaluate the tumor size and enhancement. Results: For 18 cases with the maximum diameters less than 3.0 cm, CT scan during the procedure showed that the frozen areas extended beyond the edge of the lesions more than 1.0 cm, the lesion attenuated, narrow-band-like encircled translucency around the lesions and 'target sign' with ground-glass density of the peripheral lung tissue. There was no enhancement during the first 1 st, 3 rd month follow-up, only fibrosis scar in 6 th

  13. CT-guided percutaneous conformal cryoablation for lung carcinoma

    International Nuclear Information System (INIS)

    Xiao Yueyong; Wu Bin; Zhang Xiao; Li Hongjun; Yu Da; Li Jie; Li Jun

    2010-01-01

    Objective: To investigate the safety, efficacy and feasibility of CT-guided percutaneous conformal cryoablation for lung cancer. Methods: The inclusion criteria were: (1) Poor respiratory function and aged patients who can not bear the thoracic surgical operation. (2) Peripheral lung cancer involving the pleura and chest wall which can not be resected. (3) Residual tumor after other comprehensive treatment. (4) Focal lung cancer but the patient refused surgical resection. The exclusion criteria were: (1) Multifocal lesions. (2) Lesion close to mediastinum with possible risk of vessel injury. (3) Severe impairment of pulmonary functions, the maximum voluntary ventilation is less than 39%. (4) Repeated cough or dyspnea, can not cooperate with the procedure. (5) Poor systemic conditions, cachexia or bleeding. Totally, 76 lung carcinoma lesions on 66 patients were treated by CT-guided percutaneous conformal cryoablation using 17 G cryoprobes. The maximum diameters of the tumors ranged from 1.5 cm to 1.6 cm. For the tumors with the maximum diameter less than 3.0 cm, they were treated by double-needle clamping cryoablation. For those with the maximum diameter between 3.0 and 5.0 cm, they were treated by multiple-needle conformal cryoablation. For those with the maximum diameter larger than 5.0 cm, they were treated with multiple-needle conformal cyroablation, with the needle distance less than 1.5 cm. All the patients were followed-up 6 to 24 months after the procedure using contrast-enhanced CT to evaluate the tumor size and enhancement. Results: For 18 cases with the maximum diameters less than 3.0 cm, CT scan during the procedure showed that the frozen areas extended beyond the edge of the lesions more than 1.0 cm, the lesion attenuated, narrow-band-like encircled translucency around the lesions and 'target sign' with ground-glass density of the peripheral lung tissue. There was no enhancement during the first 1 st, 3 rd month follow-up, only fibrosis scar in 6 th

  14. Application of CT-guided percutaneous thyroid biopsy in basic study of interventional therapy for Graves disease

    International Nuclear Information System (INIS)

    Yi Genfa; Zhao Wei; Hu Jihong; Jin Cangzheng; Yang Huiying

    2007-01-01

    Objective: To evaluate the value of application of CT-guided percutaneous thyroid biopsy in basic study of interventional treatment for Graves disease. Methods: Fifteen patients of hyperthyroidism caused by Graves' disease had been undertaken transcathter arterial embolizsation with PVA micropheres including 52 core needle biopsy(CNB)of pre-or post-interventional procedure. All procedures were divided into 2 groups according to the size of the thyroid enlargement: (1) II degree enlargement (n=19)under palpation puncture. (2) No enlargement or under II degree enlargement (n=33)with palpation and CT-guided puncture. Results: In group (1), 17 of the 19 procedures with palpation puncture were succeeded, reaching a successful rate of 89.5%. For group (2), the successful rate of CT-guided puncture was 91.7%. The difference between the successful rate of two groups showed statistical significance (P<0.05). No complication occurred during procedures in all cases. Conclusions: CT-guided thyroid core needle biopsy is an accurate, safe and high successful procedure providing the basic study for post-interventional treatment of Graves disease. (authors)

  15. Initial experience of Fag-PET/CT guided Imr of head-and-neck carcinoma

    International Nuclear Information System (INIS)

    Wang Dian; Schultz, Christopher J.; Jursinic, Paul A.; Bialkowski, Mirek; Zhu, X. Ronald; Brown, W. Douglas; Rand, Scott D.; Michel, Michelle A.; Campbell, Bruce H.; Wong, Stuart; Li, X. Allen; Wilson, J. Frank

    2006-01-01

    Purpose: The purpose of this study is to evaluate the impact of 18 F-fluorodeoxyglucose positron emission tomography (Fag-PET) fused with planning computed tomography (CT) on tumor localization, which guided intensity-modulated radiotherapy (Imr) of patients with head-and-neck carcinoma. Methods and Materials: From October 2002 through April 2005, we performed Fag-PET/CT guided Imr for 28 patients with head-and-neck carcinoma. Patients were immobilized with face masks that were attached with five fiducial markers. Fag-PET and planning CT scans were performed on the same flattop table in one session and were then fused. Target volumes and critical organs were contoured, and Imr plans were generated based on the fused images. Results: All 28 patients had abnormal increased uptake in Fag-PET/CT scans. PET/CT resulted in CT-based staging changes in 16 of 28 (57%) patients. PET/CT fusions were successfully performed and were found to be accurate with the use of the two commercial planning systems. Volume analysis revealed that the PET/CT-based gross target volumes (GTVs) were significantly different from those contoured from the CT scans alone in 14 of 16 patients. In addition, 16 of 28 patients who were followed for more than 6 months did not have any evidence of locoregional recurrence in the median time of 17 months. Conclusion: Fused images were found to be useful to delineate GTV required in IMRT planning. PET/CT should be considered for both initial staging and treatment planning in patients with head-and-neck carcinoma

  16. Radiographic comparison between male and female patients with lumbar spondylolysis

    OpenAIRE

    Takao, Shoichiro; Sakai, Toshinori; Sairyo, Koichi; Kondo, Tadashi; Ueno, Junji; Yasui, Natsuo; Nishitani, Hiromu

    2010-01-01

    We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondyloly...

  17. Clinical evaluation of MRI for lumbar spinal disease

    International Nuclear Information System (INIS)

    Moriwaka, Yosuke; Nakayama, Sachiko; Murai, Nobuko; Watanabe, Katsushi; Kawano, Keiichiro; Tajima, Naoya; Kihara, Yasushi; Okada, Akihiko; Fujimoto, Toshiro.

    1985-01-01

    Thirty-two patients were examined to determine the clinical usefulness of magnetic resonance imaging (MRI) of the lumbar spine. MRI using a resistive magnet at 0.1 Tesla was compared with computed tomography (CT) and myelography. A saturation recovery (SR) technique with repetition time (TR) of 500 msec was used in all cases. There were 19 cases with disk herniation, 5 with canal stenosis, 2 with spondylosis deformans and 6 with other suspected disease. MRI showed the protrusion of disk, displacement of epidural fat and degenerative change of disk more clearly than CT and myelography. Of the 12 herniated disks, 8 disks were clearly shown and one was not detected by MRI. In some cases, herniated disk could not be differentiated from disk bulging. With further technical advance, MRI is likely to become the initial procedure for evaluation of lumbar spinal disease. (author)

  18. Manejo del síndrome doloroso lumbar Management of lumbar syndrome

    Directory of Open Access Journals (Sweden)

    Rafael Rivas Hernández

    2010-03-01

    Full Text Available Se realizó una revisión bibliográfica del síndrome doloroso lumbar y se seleccionaron los artículos relacionados con este síndrome publicados desde 1991 hasta 2009. Se hizo hincapié en la búsqueda de guías para el manejo del dolor lumbar en la práctica clínica, y sus criterios fueron revisados por el equipo de especialistas en Ortopedia y Traumatología del Servicio de columna vertebral del Hospital Ortopédico Docente "Fructuoso Rodríguez" y adaptados a las condiciones del Sistema Nacional de Salud cubano.A bibliographic review on painful syndrome was made selecting the articles published from 1991 to 2009 related to this syndrome. Authors emphasize in the search of guides for management of lumbar pain in the clinical practice, whose criteria were analyzed by the team Orthopedics and Traumatology team of the spinal column service from the "Fructuoso Rodríguez" Hospital and adjusted to conditions of the Cuban Health System.

  19. CT guided puncture aspiration and sclerosing treatment of ovary cyst

    International Nuclear Information System (INIS)

    Peng Yongjun; Du Xiumei; Yuan Jinrong; Chen Chanqing

    2007-01-01

    Objective: To analyze the method and the curative effect with CT guided percutaneous puncture aspiration and sclerosing treatment of ovary cyst. Method: 22 ovary cysts in 22 patients were treated with percutaneous puncture aspiration and underwent repeated sclerotherapy with 99.7% ethanol injection. Among the 22 patients, 18 patients had solitary ovary cyst and was aspirated with an 18-22G gauge aspiration needle. The amount of aspirated fluid varied from 30ml-500ml and 25%-30% cyst volume was replaced by appropriate ethanol Post treatment follow-up were achieved every 3 months. Results All the Punctures were successfully completed. During the 3 months to one year follow-up, 16 ovary cyst disappeared, 6 cysts were small over 50%, without main complication. Conclusion CT guided percutaneous puncture aspiration and sclerosing treatment of ovary cyst is a treatment of choice because of its safety, low complication, and high curative effect. (authors)

  20. Sudden headache, lumbar puncture, and the diagnosis of subarachnoid hemorrhage in patients with a normal computed tomography scans.

    Science.gov (United States)

    Valle Alonso, Joaquín; Fonseca Del Pozo, Francisco Javier; Vaquero Álvarez, Manuel; De la Fuente Carillo, Juan José; Llamas, José Carlos; Hernández Montes, Yelda

    2018-02-01

    To assess the usefulness of computed tomography (CT) to identify subarachnoid bleeding in patients with neurologic deficits seeking emergency care for sudden headache within 6 hours of onset of symptoms. Retrospective observational study of patients presenting with sudden nontraumatic headache peaking during the previous hour in the absence of neurologic deficits. We ordered CT scans for all patients, and if the scan was normal we performed a lumbar puncture. All patients were then followed for 6 months. Eighty-five patients were included. Subarachnoid bleeding was identified in 10 (10.2%) patients by CT. Seventy- four lumbar punctures were performed in patients with negative CTs; the lumbar puncture was positive in 1 patient and inconclusive in 2 patients. In all 3 patients, bleeding was ruled out with later images; thus, no cases of subarachnoid hemorrhage were confirmed in the 74 patients who underwent lumbar puncture. Nor were any cases found in any of these patients during follow-up. A CT scan taken within 6 hours of onset of sudden headache is sufficient for confirming or ruling out subarachnoid bleeding in patients with sudden headache who have no neurologic deficits.

  1. Using a Motion Sensor-Equipped Smartphone to Facilitate CT-Guided Puncture

    International Nuclear Information System (INIS)

    Hirata, Masaaki; Watanabe, Ryouhei; Koyano, Yasuhiro; Sugata, Shigenori; Takeda, Yukie; Nakamura, Seiji; Akamune, Akihisa; Tsuda, Takaharu; Mochizuki, Teruhito

    2017-01-01

    PurposeTo demonstrate the use of “Smart Puncture,” a smartphone application to assist conventional CT-guided puncture without CT fluoroscopy, and to describe the advantages of this application.Materials and MethodsA puncture guideline is displayed by entering the angle into the application. Regardless of the angle at which the device is being held, the motion sensor ensures that the guideline is displayed at the appropriate angle with respect to gravity. The angle of the smartphone’s liquid crystal display (LCD) is also detected, preventing needle deflection from the CT slice image. Physicians can perform the puncture procedure by advancing the needle using the guideline while the smartphone is placed adjacent to the patient. In an experimental puncture test using a sponge as a target, the target was punctured at 30°, 50°, and 70° when the device was tilted to 0°, 15°, 30°, and 45°, respectively. The punctured target was then imaged with a CT scan, and the puncture error was measured.ResultsThe mean puncture error in the plane parallel to the LCD was less than 2°, irrespective of device tilt. The mean puncture error in the sagittal plane was less than 3° with no device tilt. However, the mean puncture error tended to increase when the tilt was increased.ConclusionThis application can transform a smartphone into a valuable tool that is capable of objectively and accurately assisting CT-guided puncture procedures.

  2. Using a Motion Sensor-Equipped Smartphone to Facilitate CT-Guided Puncture

    Energy Technology Data Exchange (ETDEWEB)

    Hirata, Masaaki, E-mail: masaaki314@gmail.com [Matsuyama Shimin Hospital, Department of Radiology (Japan); Watanabe, Ryouhei; Koyano, Yasuhiro [Matsuyama Shimin Hospital, Department of Surgery (Japan); Sugata, Shigenori; Takeda, Yukie [Ehime Prefectural Imabari Hospital, Department of Radiology (Japan); Nakamura, Seiji; Akamune, Akihisa [Matsuyama Shimin Hospital, Department of Radiology (Japan); Tsuda, Takaharu; Mochizuki, Teruhito [Ehime University Graduate School of Medicine, Department of Radiology (Japan)

    2017-04-15

    PurposeTo demonstrate the use of “Smart Puncture,” a smartphone application to assist conventional CT-guided puncture without CT fluoroscopy, and to describe the advantages of this application.Materials and MethodsA puncture guideline is displayed by entering the angle into the application. Regardless of the angle at which the device is being held, the motion sensor ensures that the guideline is displayed at the appropriate angle with respect to gravity. The angle of the smartphone’s liquid crystal display (LCD) is also detected, preventing needle deflection from the CT slice image. Physicians can perform the puncture procedure by advancing the needle using the guideline while the smartphone is placed adjacent to the patient. In an experimental puncture test using a sponge as a target, the target was punctured at 30°, 50°, and 70° when the device was tilted to 0°, 15°, 30°, and 45°, respectively. The punctured target was then imaged with a CT scan, and the puncture error was measured.ResultsThe mean puncture error in the plane parallel to the LCD was less than 2°, irrespective of device tilt. The mean puncture error in the sagittal plane was less than 3° with no device tilt. However, the mean puncture error tended to increase when the tilt was increased.ConclusionThis application can transform a smartphone into a valuable tool that is capable of objectively and accurately assisting CT-guided puncture procedures.

  3. Design of three-dimensional visualization based on the posterior lumbar pedicle screw fixation

    Directory of Open Access Journals (Sweden)

    Kai XU

    2011-09-01

    Full Text Available Objective To establish a three-dimensional visualization model of posterior lumbar pedicle screw fixation.Methods A patient with lumbar intervertebral disc hernia and another patient with compression fracture of lumbar vertebra were involved in the present study.Both patients underwent multi-slice spiral CT scan before and after lumbar pedicle screw fixation.The degree of preoperative vertebral compression,vertebral morphology before and after surgery,postoperative pedicle screw position,and decompression effects were observed.The original data of the multi-slice spiral CT were inputted into the computer.The three-dimensional reconstructed images of the lumbar and implanted screws were obtained using the software Amira 4.1 to show the three-dimensional shape of the lumbar vertebrae before and after surgery and the location of the implanted screws.Results The morphology and structure of the lumbar vertebrae before and after surgery and of the implanted screws were reconstructed using the digital navigation platform.The reconstructed 3D images could be displayed in multicolor,transparent,or arbitrary combinations.In the 3D surface reconstruction images,the location and structure of the implanted screws could be clearly observed,and the decompression of the spinal cord or nerve roots and the severity of the fracture and the compression of lumbar vertebrae could be fully evaluated.The reconstructed images before operation revealed the position of the vertebral pedicles and provided reference for intraoperative localization.Conclusions The three-dimensional computerized reconstructions of lumbar pedicle screw fixation may be valuable in basic research,clinical experiment,and surgical planning.The software Amira is one of the bases of three-dimensional reconstruction.

  4. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    Energy Technology Data Exchange (ETDEWEB)

    Yegul, I. E-mail: iyegul@med.ege.edu.tr; Erhan, E. E-mail: elvanerhan@yahoo.com

    2003-11-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures.

  5. Bilateral CT-guided percutaneous cordotomy for cancer pain relief

    International Nuclear Information System (INIS)

    Yegul, I.; Erhan, E.

    2003-01-01

    AIM: CT-guided percutaneous cordotomy is a useful procedure for treating unilateral cancer pain, however, bilateral cordotomy can be required on some occasions. We evaluated the effectiveness and complications of bilateral cordotomy. MATERIALS AND METHODS: Two hundred and thirty-four patients who suffered from unilateral cancer pain underwent CT-guided percutaneous cordotomy. The procedure was repeated in 22 patients, and nine patients had bilateral cordotomy. Effectiveness and complications were recorded after each procedure. RESULTS: Of nine patents (three women and six men) having bilateral percutaneous cordotomy in our study, four patients had mirror pain after the first procedure. In the remaining five patients the contralateral pain was due to new pain sites. The pain scores before and after the first procedure were 9.3 (range 7-10) and 1.2 (range 0-3), respectively. After the first procedure complete or satisfactory pain relief was achieved in all patients. The duration between the two procedures ranged from 7-243 days (mean 59.8 days). The pain scores before and after the second procedure were 8.4 (range 5-10) and 1.6 (range 0-4), respectively. After the second procedure complete or satisfactory pain relief was reported in all patients. There were no complications in four patients. One patient developed transient motor deficit after the first procedure. Other complications (nausea/vomiting, headache, ipsilateral neck pain, postcordotomy dysesthesia) were mild and transient. CONCLUSION: CT-guided percutaneous cordotomy is a useful procedure for the treatment of severe unilateral cancer pain syndromes. The procedure can be repeated on the other side at least 1 week later. These results show that the success on the second side appears to be similar to the first side with low complication rate for both procedures

  6. CT-guided stereotaxic biopsy in 104 cases of brain tumors

    International Nuclear Information System (INIS)

    Niizuma, Hiroshi; Nakasato, Nobukazu; Jokura, Hidehumi; Otsuki, Taisuke; Katakura, Ryuichi; Suzuki, Jiro

    1988-01-01

    Biopsy of suspected brain tumor was performed on 104 cases using Leksell's CT-guided stereotaxic system. The entire operation was performed in the CT room. A Backlund's spiral biopsy needle was advanced to the target point in a stepwise fashion and two to nine tissue samples were obtained from one to three biopsy tracks. Tissue sampling was impossible in two cases because the tumors were too hard for biopsy needle to advance. Also, sampling was sometimes difficult in the case of soft and necrotic tumor, cystic tumor, already treated (irradiated) tumor and the lesion including old blood clot. After the biopsy, minimal bleeding occurred in nine cases, however, stopped within 10 minutes by controlling the blood pressure. A minimum sized hematoma was visible on the postoperative CT in four cases. Postoperative neurological deterioration was seen in two cases. One case was transient and the other seemed to be in his natural course. Anyway, there were neither cases of operative mortality nor severely complicated cases in these series. Useful pathological diagnosis was possible in 83 cases (80 %). Accurate diagnosis was not possible in the remaining 21 cases, however, their histological datum such as necrosis, blood clot, and so on were very useful to estimate the lesions. In summary, accurate diagnosis rate of CT-guided stereotaxic needle biopsy was 80 %. However, it appeared to be a safe and useful procedure in the diagnosis of intracranial mass lesions. (author)

  7. Atlas-guided generation of pseudo-CT images for MRI-only and hybrid PET-MRI-guided radiotherapy treatment planning

    Science.gov (United States)

    Arabi, Hossein; Koutsouvelis, Nikolaos; Rouzaud, Michel; Miralbell, Raymond; Zaidi, Habib

    2016-09-01

    Magnetic resonance imaging (MRI)-guided attenuation correction (AC) of positron emission tomography (PET) data and/or radiation therapy (RT) treatment planning is challenged by the lack of a direct link between MRI voxel intensities and electron density. Therefore, even if this is not a trivial task, a pseudo-computed tomography (CT) image must be predicted from MRI alone. In this work, we propose a two-step (segmentation and fusion) atlas-based algorithm focusing on bone tissue identification to create a pseudo-CT image from conventional MRI sequences and evaluate its performance against the conventional MRI segmentation technique and a recently proposed multi-atlas approach. The clinical studies consisted of pelvic CT, PET and MRI scans of 12 patients with loco-regionally advanced rectal disease. In the first step, bone segmentation of the target image is optimized through local weighted atlas voting. The obtained bone map is then used to assess the quality of deformed atlases to perform voxel-wise weighted atlas fusion. To evaluate the performance of the method, a leave-one-out cross-validation (LOOCV) scheme was devised to find optimal parameters for the model. Geometric evaluation of the produced pseudo-CT images and quantitative analysis of the accuracy of PET AC were performed. Moreover, a dosimetric evaluation of volumetric modulated arc therapy photon treatment plans calculated using the different pseudo-CT images was carried out and compared to those produced using CT images serving as references. The pseudo-CT images produced using the proposed method exhibit bone identification accuracy of 0.89 based on the Dice similarity metric compared to 0.75 achieved by the other atlas-based method. The superior bone extraction resulted in a mean standard uptake value bias of  -1.5  ±  5.0% (mean  ±  SD) in bony structures compared to  -19.9  ±  11.8% and  -8.1  ±  8.2% achieved by MRI segmentation-based (water

  8. CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Akio, E-mail: a.akahane@gmail.com; Kato, Kenichi, E-mail: kkato@iwate-med.ac.jp; Suzuki, Michiko, E-mail: mamimichiko@me.com [Iwate Medical University School of Medicine, Department of Radiology (Japan); Sone, Miyuki, E-mail: msone@me.com [National Cancer Center Hospital, Department of Diagnostic Radiology (Japan); Tanaka, Ryoichi, E-mail: rtanaka@iwate-med.ac.jp; Nakasato, Tatsuhiko, E-mail: nakasato@iwate-med.ac.jp; Ehara, Shigeru, E-mail: ehara@iwate-med.ac.jp [Iwate Medical University School of Medicine, Department of Radiology (Japan)

    2016-02-15

    PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC.

  9. CT-Guided Percutaneous Radiologic Gastrostomy for Patients with Head and Neck Cancer: A Retrospective Evaluation in 177 Patients

    International Nuclear Information System (INIS)

    Tamura, Akio; Kato, Kenichi; Suzuki, Michiko; Sone, Miyuki; Tanaka, Ryoichi; Nakasato, Tatsuhiko; Ehara, Shigeru

    2016-01-01

    PurposeThe purpose of this study was to assess the technical success rate and adverse events (AEs) associated with computed tomography (CT)-guided percutaneous gastrostomy for patients with head and neck cancer (HNC).Materials and MethodsThis retrospective study included patients with HNC who had undergone CT-guided percutaneous gastrostomy between February 2007 and December 2013. Information regarding the patients’ backgrounds, CT-guided percutaneous gastrostomy techniques, technical success rate, and AEs were obtained from the medical records. In all patients, the stomach was punctured under CT fluoroscopy with a Funada gastropexy device.ResultsDuring the study period, 177 patients underwent CT-guided percutaneous gastrostomy. The most common tumor location was the oral cavity, followed by the pharynx and maxilla. The indication for CT-guided percutaneous gastrostomy were tumor obstruction in 78 patients, postoperative dysphagia in 55 patients, radiation edema in 43 patients, and cerebral infarction in 1 patient. The technical success rate was 97.7 %. The overall mean procedure time was 25.3 min. Major AEs occurred in seven patients (4.0 %), including bleeding (n = 4), colonic injury (n = 1), gastric tear (n = 1), and aspiration pneumonia (n = 1). Minor AEs occurred in 15 patients (8.5 %), which included peristomal leakage (n = 6), irritation (n = 4), inadvertent removal (n = 2), peristomal hemorrhage (n = 1), peristomal infection (n = 1), and wound granulation (n = 1). The mean follow-up period was 111 days (range 1–1106 days).ConclusionOur study suggests that CT-guided gastrostomy may be suitable in patients with HNC

  10. Acute lumbar spondylolysis in intercollegiate athletes.

    Science.gov (United States)

    Sutton, Jeremy Hunter; Guin, Patrick D; Theiss, Stephen M

    2012-12-01

    A retrospective case series. The purpose of this study was to describe a unique group of intercollegiate athletes who are skeletally mature and who developed symptomatic acute lumbar spondylolysis and to study long-term return to play outcome of nonoperative and surgical repair of L3 and L4 spondylolysis in skeletally mature athletes. Traditionally, symptomatic acute lumbar spondylolysis is a defect found in skeletally immature athletes, most commonly in the pars interarticularis of L5, less commonly in the L3/L4 region, and even less commonly in skeletally mature athletes as described in this group. Eight intercollegiate athletes (2 women and 6 men, ages ranging from 19 to 21 y) with acute lumbar spondylolysis were diagnosed by means of computed tomography (CT) and single photon emission-CT bone scan. L3 lesions were present in 5 patients, and L4 lesions were present in 3 patients. All patients were treated initially nonoperatively with a protocol of bracing and activity modification. The healing progress was assessed through repeat CT scan. Patients who failed to respond to nonoperative procedures underwent direct repair of their pars defect through variable angle pedicle screw and sublaminar hook. Outcomes were measured by completion of the Oswestry Low Back Pain Disability Questionnaire (mean follow-up 6.5 y) and return to athletic participation. All patients successfully returned to full athletic competition. Two patients showed radiographic healing and resolution of pain following 3 months of nonoperative treatment. Five patients required surgical repair of the pars defect. All of these patients eventually returned to unrestricted participation in athletics. This study shows that this subgroup will generally respond well to surgical correction of the pars defect and return to uninhibited competition following conservative treatment and/or surgical repair.

  11. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Hwa [Inje University College of Medicine, Department of Emergency Medicine, Sanggye Paik Hospital, Nowon-gu (Korea, Republic of); Yun, Seong Jong; Jo, Hyeon Hwan; Kim, Dong Hyeon [Republic of Korea Air Force, Department of Radiology, Aerospace Medical Center, Cheongwon-gun, Chungcheongbuk-do (Korea, Republic of); Song, Jae Gwang [Republic of Korea Air Force, Department of Orthopedic Surgery, Aerospace Medical Center, Cheongwon-gun, Chungcheongbuk-do (Korea, Republic of); Park, Yong Sung [Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2018-04-15

    To compare the image quality, radiation dose, and diagnostic performance between low-dose (LD) and ultra-low-dose (ULD) lumbar-spine (L-spine) CT with iterative reconstruction (IR) for patients with chronic low back pain (LBP). In total, 260 patients with chronic LBP who underwent L-spine CT between November 2015 and September 2016 were prospectively enrolled. Of these, 143 underwent LD-CT with IR and 117 underwent ULD-CT with IR. The patients were divided according to their body mass index (BMI) into BMI1 (<22.9 kg/m{sup 2}), BMI2 (23.0-24.9 kg/m{sup 2}), and BMI3 (≥25 kg/m{sup 2}) groups. Two blinded radiologists independently evaluated the signal-to-noise ratio (SNR), qualitative image quality, and final diagnoses (lumbar disc disease and facet joint osteoarthritis). L-spine MRIs interpreted by consensus were used as the reference standard. All data were statistically analyzed. ULD protocol showed significantly lower SNR for all patients (p < 0.001) except the vertebral bodies and lower qualitative image quality for BMI3 patients (p ≤ 0.033). There was no statistically significant difference between ULD (sensitivity, 95.1-98.1%; specificity, 92.5-98.7%; accuracy, 94.6-98.0%) and LD protocols (sensitivity, 95.6-100%; specificity, 95.5-98.9%; accuracy, 97.4-98.1%), (all p≥0.1) in the BMI1 and BMI2; while dose was 60-68% lower with the ULD protocol. Interobserver agreements were excellent or good with regard to image quality and final diagnoses. For the BM1 and BMI2 groups, ULD-CT provided an acceptable image quality and exhibited a diagnostic accuracy similar to that of LD-CT. These findings suggest that it is a useful diagnostic tool for patients with chronic LBP who exhibit a BMI of <25 kg/m{sup 2}. (orig.)

  12. Diagnostic accuracy of low-dose versus ultra-low-dose CT for lumbar disc disease and facet joint osteoarthritis in patients with low back pain with MRI correlation

    International Nuclear Information System (INIS)

    Lee, Sun Hwa; Yun, Seong Jong; Jo, Hyeon Hwan; Kim, Dong Hyeon; Song, Jae Gwang; Park, Yong Sung

    2018-01-01

    To compare the image quality, radiation dose, and diagnostic performance between low-dose (LD) and ultra-low-dose (ULD) lumbar-spine (L-spine) CT with iterative reconstruction (IR) for patients with chronic low back pain (LBP). In total, 260 patients with chronic LBP who underwent L-spine CT between November 2015 and September 2016 were prospectively enrolled. Of these, 143 underwent LD-CT with IR and 117 underwent ULD-CT with IR. The patients were divided according to their body mass index (BMI) into BMI1 (<22.9 kg/m 2 ), BMI2 (23.0-24.9 kg/m 2 ), and BMI3 (≥25 kg/m 2 ) groups. Two blinded radiologists independently evaluated the signal-to-noise ratio (SNR), qualitative image quality, and final diagnoses (lumbar disc disease and facet joint osteoarthritis). L-spine MRIs interpreted by consensus were used as the reference standard. All data were statistically analyzed. ULD protocol showed significantly lower SNR for all patients (p < 0.001) except the vertebral bodies and lower qualitative image quality for BMI3 patients (p ≤ 0.033). There was no statistically significant difference between ULD (sensitivity, 95.1-98.1%; specificity, 92.5-98.7%; accuracy, 94.6-98.0%) and LD protocols (sensitivity, 95.6-100%; specificity, 95.5-98.9%; accuracy, 97.4-98.1%), (all p≥0.1) in the BMI1 and BMI2; while dose was 60-68% lower with the ULD protocol. Interobserver agreements were excellent or good with regard to image quality and final diagnoses. For the BM1 and BMI2 groups, ULD-CT provided an acceptable image quality and exhibited a diagnostic accuracy similar to that of LD-CT. These findings suggest that it is a useful diagnostic tool for patients with chronic LBP who exhibit a BMI of <25 kg/m 2 . (orig.)

  13. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

    Energy Technology Data Exchange (ETDEWEB)

    Brooks, Benjamin K.; Southam, Samuel L.; Mlady, Gary W.; Logan, Jeremy; Rosett, Matthew [University of New Mexico School of Medicine, Department of Radiology, Albuquerque, NM (United States)

    2010-07-15

    To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%(ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

  14. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain.

    Science.gov (United States)

    Brooks, Benjamin K; Southam, Samuel L; Mlady, Gary W; Logan, Jeremy; Rosett, Matthew

    2010-07-01

    To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%( ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

  15. Lumbar spine spondylolysis in the adult population: using computed tomography to evaluate the possibility of adult onset lumbar spondylosis as a cause of back pain

    International Nuclear Information System (INIS)

    Brooks, Benjamin K.; Southam, Samuel L.; Mlady, Gary W.; Logan, Jeremy; Rosett, Matthew

    2010-01-01

    To determine if new onset of low back pain in adults could be secondary to lumbar spondylolysis by establishing the age-related prevalence in the general population by examining patients undergoing computed tomography (CT) for reasons unrelated to back pain. The records of 2,555 patients who had undergone abdominal and pelvic CT in 2008 were reviewed electronically. In order to determine a true representation of the general population, we reviewed all indications for CT, excluding patients with a primary complaint of low back pain as the primary indication for imaging. Equal numbers of patients were separated into age groups by decade to ensure an even distribution of ages for statistical analysis. Patients older than 70 years were grouped together to provide case numbers comparable to those of the other decades. Logistic regression analysis was performed to evaluate the significance of the results. Three board-certified radiologists, including two musculoskeletal fellows and a radiology resident, retrospectively evaluated CT scans for lumbar spondylolysis, including unilateral and bilateral defects. Of the 2,555 cases evaluated, there were 203 positive cases of defects of the lumbar pars interarticularis. This corresponded to an overall prevalence of 8.0%. Prevalence per decade was fairly evenly distributed and ranged from 7.0%(ages 30-39 years) to 9.2% (ages 70 years and above). Prevalence of ages 20-49 years was 7.9%, and that of ages 50 years and older was 8.0%. Male to female ratio was 1.5:1. Logistic regression showed no significant increase in spondylolysis based on age. No significant increase in the prevalence of lumbar spondylolysis was demonstrated in patients older than 20 years. This suggests that the development of symptomatic lumbar pars defects do not occur in this population and should not be considered as a rare but potentially treatable cause of new onset low back pain in adults. This study demonstrated an overall prevalence of pars defects of 8

  16. Multi-institutional MicroCT image comparison of image-guided small animal irradiators

    Science.gov (United States)

    Johnstone, Chris D.; Lindsay, Patricia; E Graves, Edward; Wong, Eugene; Perez, Jessica R.; Poirier, Yannick; Ben-Bouchta, Youssef; Kanesalingam, Thilakshan; Chen, Haijian; E Rubinstein, Ashley; Sheng, Ke; Bazalova-Carter, Magdalena

    2017-07-01

    To recommend imaging protocols and establish tolerance levels for microCT image quality assurance (QA) performed on conformal image-guided small animal irradiators. A fully automated QA software SAPA (small animal phantom analyzer) for image analysis of the commercial Shelley micro-CT MCTP 610 phantom was developed, in which quantitative analyses of CT number linearity, signal-to-noise ratio (SNR), uniformity and noise, geometric accuracy, spatial resolution by means of modulation transfer function (MTF), and CT contrast were performed. Phantom microCT scans from eleven institutions acquired with four image-guided small animal irradiator units (including the commercial PXi X-RAD SmART and Xstrahl SARRP systems) with varying parameters used for routine small animal imaging were analyzed. Multi-institutional data sets were compared using SAPA, based on which tolerance levels for each QA test were established and imaging protocols for QA were recommended. By analyzing microCT data from 11 institutions, we established image QA tolerance levels for all image quality tests. CT number linearity set to R 2  >  0.990 was acceptable in microCT data acquired at all but three institutions. Acceptable SNR  >  36 and noise levels  1.5 lp mm-1 for MTF  =  0.2) was obtained at all but four institutions due to their large image voxel size used (>0.275 mm). Ten of the eleven institutions passed the set QA tolerance for geometric accuracy (2000 HU for 30 mgI ml-1). We recommend performing imaging QA with 70 kVp, 1.5 mA, 120 s imaging time, 0.20 mm voxel size, and a frame rate of 5 fps for the PXi X-RAD SmART. For the Xstrahl SARRP, we recommend using 60 kVp, 1.0 mA, 240 s imaging time, 0.20 mm voxel size, and 6 fps. These imaging protocols should result in high quality images that pass the set tolerance levels on all systems. Average SAPA computation time for complete QA analysis for a 0.20 mm voxel, 400 slice Shelley phantom microCT data set

  17. Surgical outcome of posterior lumbar interbody fusion with pedicle screw fixation for lumbar spondylolisthesis

    International Nuclear Information System (INIS)

    Shoda, Motoi; Kuno, Shigehiko; Inoue, Tatsushi

    2009-01-01

    Problems of lumbar spondylolisthesis treatment are many surgical tactics, elderly patient, osteoporosis, complications and recurrence of the symptoms. PLIF (posterior lumbar interbody fusion) and PS (pedicle screw) fixation technique for lumbar spondylolisthesis provide good patient satisfaction. Good outcome has been reported by only laminectomy alone, but patient satisfaction becomes worse year after year. The role of instrumentation for lumbar spondylolisthesis is decompression of the nerve root, correction of lumbar pathologies, bony fusion and early mobilization. We show our surgical technique and long term outcome of PLIF with PS for lumbar spondylolisthesis. Three hundred and fifty cases of lumbar spondylolisthesis were operated on in Department of Neurosurgery, Fujita Health University during the period of from December 1992 to August 2008. Patient background: age 16-84 years old (mean 62.5), Gender: male 153, female 197. Follow-up period 1-180 months (mean 61.2). Degenerative: 255, Isthmic: 63, Dysplastic: 10, Fracture: 5 and scoliosis 16 cases. Surgical procedure was PS with interbody fusion cage: 331, Hybrid cage (titanium cage with hydroxyapatite) 314, PS with Cerabone: 2 and PS with autograft: 17. CT was done to evaluate bony fusion postoperatively. Post operative improvements by JOA (Japan Orthopedic Association) score is 11.4 before surgery, 24.1 (post op. within 2 years), 25.4 (post op. 2-5 years), 25.0 (post op. 5-10 years) and 22.4 (post op. 10-15 years). Significant improvements were observed in %Slip and Slip angle but no remarkable change was observed in lumbar lordotic angle by postoperative X-ray evaluation. No root injury, and systemic complication except 4 cases of cerebrospinal fluid (CSF) leakage during surgery. Two cases were reoperated in whom cage with autograft migration due to pseudoarthrosis. Two cases had to undergo screw and cage system removal due to infection. Two cases of adjacent level stenosis had to undergo operation 10

  18. CT-guided celiac plexus block with absolute alcohol : the anterior approach

    International Nuclear Information System (INIS)

    Lee, Jeong Min; Lee, Mi Suk; Jang, Young Ik; Kim, Jeong Hoi; Ym, Seong Hee; Lee, Jin Hee; Han, Young Min; Kim, Chong Soo; Choi, Ki Chul

    1997-01-01

    To evaluate the safety and efficacy of CT-guided celiac plexus block (CPB) using an anterior approach, and to determine the role of CT in this procedure. CPB was attempted in 15 patients(10 men and 5 women;mean age, 62.3 years) with intractable upper abdominal pain due to terminal malignancy of the pancreas, liver, bowel,and kidney. To permit an anterior approach, patients lied supine on the CT scan table during the procedure. One or two 21-guage needles were placed just anterior to the diaphragmatic crus at or between the levels of the celiac and superior mesenteric arteries and 10-40ml of 99.9% alcohol was injected. Pain relief following the procedure was assessed and pain was graded on a visual analogue scale (VAS) from 0 to 10. There were no technical failures and no neurologic or hemorrhagic complications. Abdominal pain during alcohol injection occurred in all patients, and transient hypotension in three. One patient with recurrent cancer of the pancreatic head died of sepsis five days after the procedure;the cause of sepsis was difficult to determine, but there was thought to be a biliary source of infection. Two days after block, 13 of 15 procedures(86.7%) had produced at least partial pain relief;in 12 patients, relief was good. With CT guidance, more directed positioning of the needle is possible, allowing alcohol to be deposited in specific ganglion areas. CT-guided celiac plexus block using an anterior approach was an easy and effective way of reducing intractable upper abdominal pain due to terminal malignancies. CT guidance allowed precise needle placement and a safer procedure

  19. CT reconstruction from few-views with anisotropic edge-guided total variance

    International Nuclear Information System (INIS)

    Rong, Junyan; Liu, Wenlei; Gao, Peng; Liao, Qimei; Jiao, Chun; Ma, Jianhua; Lu, Hongbing

    2016-01-01

    To overcome the oversmoothing drawback in the edge areas when reconstructing few-view CT with total variation (TV) minimization, in this paper, we propose an anisotropic edge-guided TV minimization framework for few-view CT reconstruction. In the framework, anisotropic TV is summed with pre-weighted image gradient and then used as the object function for minimizing. It includes edge-guided TV minimization (EGTV) and edge-guided adaptive-weighted TV minimization (EGAwTV) algorithms. For EGTV algorithm, the weights of the TV discretization term are updated by anisotropic edge information detected from the image, whereas the weights for EGAwTV are determined based on edge information and local image-intensity gradients. To solve the minimization problem of the proposed algorithm, a similar TV-based minimization implementation is developed to address the raw data fidelity and other constraints. The evaluation results using both computer simulations with the Shepp-Logan phantom and experimental data from a physical phantom demonstrate that the proposed algorithms exhibit noticeable gains in the merits of spatial resolution compared with the conventional TV and other modified TV algorithms.

  20. Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Luo, T.Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.; Zheng, H.J.; Li, B.

    2014-01-01

    Aim: To evaluate the factors influencing diagnostic yield of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for bone lesions. Materials and methods: Between September 2005 and July 2011, 162 consecutive CT-guided CNB procedures were performed in 155 patients. The variables analysed were age, sex, lesion location, lesion type, lesion size, specimen size, biopsy needle gauge, and individual radiologist. The factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were determined by multivariate analysis of variables. Results: The diagnostic yield was 81.5%. Diagnostic yield was 89.9% for lytic bone lesions and 48.5% for sclerotic bone lesions (p < 0.001), and 89.2% for lesions ≥3 cm and 73.4% for lesions <3 cm (p = 0.010). The significant factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were lesion type [p < 0.001; odds ratio (OR) for a lytic lesion was approximately 12 times higher than that for a sclerotic lesion; 95% confidence interval (CI): 4.22–34.01], and lesion size (p = 0.012; OR for a lesion size ≥3 cm was about five-times higher than that for a lesion size <3 cm; 95% CI: 1.42–16.71). Conclusion: Lesion type and lesion size are determining factors in diagnostic yield. The higher diagnostic yield is correlated with lytic lesion and lesion size ≥3 cm

  1. In-room CT techniques for image-guided radiation therapy

    International Nuclear Information System (INIS)

    Ma, C.-M. Charlie; Paskalev, Kamen M.S.

    2006-01-01

    Accurate patient setup and target localization are essential to advanced radiation therapy treatment. Significant improvement has been made recently with the development of image-guided radiation therapy, in which image guidance facilitates short treatment course and high dose per fraction radiotherapy, aiming at improving tumor control and quality of life. Many imaging modalities are being investigated, including x-ray computed tomography (CT), ultrasound imaging, positron emission tomography, magnetic resonant imaging, magnetic resonant spectroscopic imaging, and kV/MV imaging with flat panel detectors. These developments provide unique imaging techniques and methods for patient setup and target localization. Some of them are different; some are complementary. This paper reviews the currently available kV x-ray CT systems used in the radiation treatment room, with a focus on the CT-on-rails systems, which are diagnostic CT scanners moving on rails installed in the treatment room. We will describe the system hardware including configurations, specifications, operation principles, and functionality. We will review software development for image fusion, structure recognition, deformation correction, target localization, and alignment. Issues related to the clinical implementation of in-room CT techniques in routine procedures are discussed, including acceptance testing and quality assurance. Clinical applications of the in-room CT systems for patient setup, target localization, and adaptive therapy are also reviewed for advanced radiotherapy treatments

  2. Extrapeural locating method: significance in CT-guided transthoracic pulmonary biopsy

    International Nuclear Information System (INIS)

    Tang Guangjian; Wang Rengui; Liu Jianxin; Sun Jingtao

    2008-01-01

    Objective: To evaluate the usefulness of extrapleural locating method in CT-guided transthoracic pulmonary biopsy to prevent or reduce the size of peumothorax. Methods: One hundred and fifteen cases of CT-guided transthoracic pulmonary biopsy with the pulmonary lesions not in direct contact with the pleura were selected. Of 115 cases, 46 were performed with extrapleural locating method (EPL) and 69 cases with lesion edge locating method (LEL). Taking the maximum distance between the partial and visceral pleura (MPVD) measured on the CT image after the procedure as the index of the volume of pneumothorax. The incidence and volume of pneumothorax of both groups were compared and statistically analysed with R x C Chi-Square test. The retention time of the biopsy needle in the lung parenchyma of the two group was documented and the average time was calculated in each group. Results: The incidence of pneumothorax was 45.7% (21/46), median 0.4 cm with EPL group, and 66.7% (46/69) and median 0.3cm with LEL group. When the distance between the lesion and pleura was equal or smaller than 2 cm (≤2cm), the incidence of pneumothorax was 39.4% (13/33) with EPL group and 73.2% (30/41) with LEL group, and the difference of incidence and volume of the pneumothorax between two groups was statistically significant(χ 2 =9.981, P=0.019). When the distance was larger than 2 cm (>2 cm), the incidence and volume of pneumothorax between two groups were not significant statistically. The average retention time of the biopsy needle in the lung parenchyma was (7.2 ± 1.8) s with EPL group and (58.3 ± 11.6) s with LEL group. Conclusion: The extrapleural locating method can reduce effectively the retention time of the biopsy needle in the lung parenchyma and the incidence and volume of pneumothorax in CT-guided transthoracic pulmonary biopsy. (authors)

  3. The Role of Lumbar Sympathetic Nerves in Regulation of Blood Flow to Skeletal Muscle during Anaphylactic Hypotension in Anesthetized Rats.

    Directory of Open Access Journals (Sweden)

    Jie Song

    Full Text Available During hypovolemic shock, skeletal muscle blood flow could be redistributed to vital organs via vasoconstriction in part evoked by activation of the innervating sympathetic nerve activity. However, it is not well known whether this mechanism operates during anaphylactic shock. We determined the femoral artery blood flow (FBF and lumbar sympathetic nerve activity (LSNA mainly regulating the hindquater muscle blood flow during anaphylactic hypotension in anesthetized rats. Anesthetized Sprague-Dawley rats were randomly allocated to the following groups (n = 7/group: (1 non-sensitized, (2 anaphylaxis, (3 anaphylaxis-lumbar sympathectomy (LS and (4 anaphylaxis-sinoaortic denervation (SAD groups. Anaphylaxis was induced by an intravenous injection of the ovalbumin antigen to the sensitized rats. The systemic arterial pressure (SAP, heart rate (HR, central venous pressure (CVP, FBF and LSNA were continuously measured. In the anaphylaxis group, LSNA and HR increased, while SAP and FBF decreased after antigen injection. In the anaphylaxis-SAD group, LSNA did not significantly change during the early phase, but the responses of SAP and FBF were similar to those in the anaphylaxis group. In the anaphylaxis-LS group, both FBF and SAP decreased similarly to the anaphylaxis group during anaphylactic hypotension. These results indicated that LSNA increased via baroreceptor reflex, but this sympathoexcitation or LS did not affect antigen-induced decreases in FBF or SAP. Lumbar sympathetic nerves are not involved in regulation of the blood flow to the hindlimb or systemic blood pressure during anaphylactic hypotension in anesthetized rats.

  4. CT- and MR-guided interventions in radiology. 2. ed.

    International Nuclear Information System (INIS)

    Mahnken, Andreas H.; Wilhelm, Kai E.; Ricke, Jens

    2013-01-01

    Revised and extended second edition that covers a broad range of non-vascular interventions guided by CT or MR imaging. Discusses in detail indications, materials, techniques, and results. Includes a comprehensive section on interventional oncology. Richly illustrated source of information and guidance for all radiologists who deal with non-vascular procedures. Interventional radiology is an indispensable and still expanding area of modern medicine that encompasses numerous diagnostic and therapeutic procedures. Cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance (MR) have emerged as important techniques for non-vascular interventions, including percutaneous biopsy, drainage, ablation, and neurolysis. Various organs, diseases, and lesions can be approached in this way, permitting the treatment and management of tumors, fluid collections, and pain, the embolization of endoleaks, the provision of access to hollow organs, etc. Accordingly, interventional radiology is now an integral component of the interdisciplinary management of numerous disorders. The revised and significantly extended second edition of this volume covers a broad range of non-vascular interventions guided by CT or MR imaging. Indications, materials, techniques, and results are all carefully discussed. A particularly comprehensive section is devoted to interventional oncology as the most rapidly growing branch of interventional radiology. In addition, detailed information is provided that will assist in establishing and developing an interventional service. This richly illustrated book will be a most valuable source of information and guidance for all radiologists who deal with non-vascular procedures.

  5. CT-guided procedures: evaluation of a phantom system to teach accurate needle placement

    International Nuclear Information System (INIS)

    Dimmick, S.; Jones, M.; Challen, J.; Iedema, J.; Wattuhewa, U.; Coucher, J.

    2007-01-01

    Aim: To evaluate the use of a phantom system to help teach the basic techniques of accurate CT-guided needle placement, thereby avoiding the risks associated with teaching on patients. Materials and Methods: Gelatine phantoms with five, 1.9 cm embedded spherical wooden targets were constructed. Four trainee operators performed 15 simulated biopsy procedures on the targets (series one) and repeated identical procedures 2 weeks later (series two). Statistical analysis of accuracy of needle placement and subject confidence were performed. Results: Significant sequential improvement in axial plane angular error was noted with the average error decreasing by 0.33 degrees after every five procedures performed (95% CI: -0.58 to -0.08, p = 0.01). Operator confidence indicated significant improvement both within each series and from series one to series two (95% CI: 0.08 to 1.17, p = 0.025 and 95% CI: 0.00 to 0.58, p = 0.05) respectively. However, variability in operator performance made statistically significant improvement in other variables unproven. Conclusion: Despite the study comprising a relatively small number of participants and procedures, it clearly demonstrated the effectiveness of teaching operators to perform CT-guided procedures using a phantom system. Needle placement accuracy significantly improved, with a reduction in axial angular error, and improved operator confidence without the risks associated with training on patients. Three of the operators in this study had never performed a CT-guided procedure previously, and their proficiency, after a relatively short but intense period of training, was impressive. The use of phantoms should be considered routinely for basic training of CT-guided needle placement

  6. CT Fluoroscopy-Guided Core Biopsy for Diagnosis of Small ({<=} 20 mm) Pulmonary Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hye Larn; Kim, Yoon Kyung; Woo, Ok Hee; Yong, Hwan Seok; Kang, Eun Young [Dept. of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Hyun Koo [Dept. of Thoracic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of); Shin, Bong Kyung [Dept. of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2011-10-15

    To evaluate the efficacy of CT fluoroscopy-guided core biopsy of small pulmonary nodules. This study included 62 patients (35 men, 27 women; age range, 36-85 years) that had a small ({<=} 20 mm) pulmonary nodule and underwent CT fluoroscopy-guided core biopsy. The overall diagnostic accuracy and complication rate were calculated. The diagnostic accuracy was compared between two groups according to the nodule size ({<=} 10 mm vs. > 10 mm), and nodule density (solid vs. subsolid). Malignant or premalignant lesions were finally diagnosed in 39 patients; 36 true-positive and three false-negative findings (sensitivity, 92%). A benign lesion was finally diagnosed in 23 patients, with no false-positive results (specificity, 100%). The overall diagnostic accuracy was 95%. The sensitivity and diagnostic accuracy were 85% and 91% for nodules {<=} 10 mm, and 96% and 97% for nodules > 10 mm (p > 0.05). The sensitivity and diagnostic accuracy were 93% and 96% in the solid group and 90% and 92% in the subsolid group (p > 0.05). Seventeen (27%) patients had a pneumothorax and two (3%) required a closed thoracostomy. CT fluoroscopy-guided core biopsy of small pulmonary nodules yields high diagnostic accuracy with acceptable complication rates.

  7. Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-08-01

    Full Text Available Juraj Artner, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: The sacroiliac (SI joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.Objective: To evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study design: Comparative study with technical considerations.Methods: A total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.Results: A significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy-guidance levels.Conclusion: Radiation dose of CT-guided SI joint injections can be

  8. CT-guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver malignancies; CT-gesteuerte Brachytherapie. Eine neue perkutane Technik zur interstitiellen Ablation von Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J.; Wust, P.; Stohlmann, A.; Beck, A.; Cho, C.H.; Pech, M.; Wieners, G.; Spors, B.; Werk, M.; Rosner, C.; Haenninen, E.L.; Felix, R. [Klinik fuer Strahlenheilkunde, Charite Virchow-Klinikum, Humboldt-Univ. zu Berlin (Germany)

    2004-05-01

    Purpose: to assess safety and efficacy of CT-guided brachytherapy of liver malignancies. Patients and methods: 21 patients with 21 liver malignancies (19 metastases, two primary liver tumors) were treated with interstitial CT-guided brachytherapy applying a {sup 192}Ir source. In all patients, the use of image-guided thermal tumor ablation such as by radiofrequency or laser-induced thermotherapy (LITT) was impeded either by tumor size {>=} 5 cm in seven, adjacent portal or hepatic vein in ten, or adjacent bile duct bifurcation in four patients. Dosimetry was performed using three-dimensional CT data sets acquired after CT-guided positioning of the brachytherapy catheters. Results: the mean tumor diameter was 4.6 cm (2.5-11 cm). The mean minimal tumor dose inside the tumor margin amounted to 17 Gy (12-20 Gy). The proportion of the liver parenchyma exposed to > 5 gy was 18% (5-39%) of total liver parenchyma minus tumor volume. Nausea and vomiting were observed in six patients after brachytherapy (28%). One patient demonstrated obstructive jaundice due to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. We commonly encountered asymptomatic increases of liver enzymes. Local control rates after 6 and 12 months were 87% and 70%, respectively. Conclusion: CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization. (orig.) [German] Ziel: Analyse der Sicherheit und Effektivitaet CT-gesteuerter Brachytherapie zur Ablation von Lebermalignomen. Patienten und Methodik: 21 Patienten mit 21 Lebermalignomen (19 Metastasen, zwei primaere Lebermalignome) wurden mit perkutaner, CT-gesteuerter interstitieller Brachytherapie mit {sup 192}Ir behandelt. Alle Patienten wiesen Umstaende auf, die eine bildgefuehrte thermische Ablation mit Radiofrequenz oder laserinduzierter Thermotherapie (LITT) einschraenkten

  9. Application of Real-Time 3D Navigation System in CT-Guided Percutaneous Interventional Procedures: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Priya Bhattacharji

    2017-01-01

    Full Text Available Introduction. To evaluate the accuracy of a quantitative 3D navigation system for CT-guided interventional procedures in a two-part study. Materials and Methods. Twenty-two procedures were performed in abdominal and thoracic phantoms. Accuracies of the 3D anatomy map registration and navigation were evaluated. Time used for the navigated procedures was recorded. In the IRB approved clinical evaluation, 21 patients scheduled for CT-guided thoracic and hepatic biopsy and ablations were recruited. CT-guided procedures were performed without following the 3D navigation display. Accuracy of navigation as well as workflow fitness of the system was evaluated. Results. In phantoms, the average 3D anatomy map registration error was 1.79 mm. The average navigated needle placement accuracy for one-pass and two-pass procedures, respectively, was 2.0±0.7 mm and 2.8±1.1 mm in the liver and 2.7±1.7 mm and 3.0±1.4 mm in the lung. The average accuracy of the 3D navigation system in human subjects was 4.6 mm ± 3.1 for all procedures. The system fits the existing workflow of CT-guided interventions with minimum impact. Conclusion. A 3D navigation system can be performed along the existing workflow and has the potential to navigate precision needle placement in CT-guided interventional procedures.

  10. Atlas of PET/CT. A quick guide to image interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Fanti, Stefano [Bologna Univ. (Italy). PET; Farsad, Mohsen [Central Hospital of Bolzano (Italy). Nuclear Medicine; Mansi, Luigi [Second Univ. of Naples (Italy). Nuclear Medicine

    2009-07-01

    This user-friendly atlas, featuring about 500 images, should be a quick guide to interpreting PET/CT images with FDG in oncology. It also illustrates how to recognize normal, para-physiological, and benign pathological uptakes in a case-based practical manner. The text, which includes most relevant technical and pathophysiological premises, covers the main clinical applications and clearly articulates learning points and pitfalls. This atlas aims to become a standard text for nuclear medicine physicians and radiologists, residents and technicians whose work involves PET/CT imaging. This book is also suitable for both undergraduate and postgraduate courses. (orig.)

  11. Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience)

    Energy Technology Data Exchange (ETDEWEB)

    Thanos, Loukas E-mail: loutharad@yahoo.com; Mylona, Sophia; Kalioras, Vasilios; Pomoni, Maria; Batakis, Nikolaos

    2004-06-01

    Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

  12. Interest of the SPECT-CT merging to detect pseudo-arthrosis after lumbar arthrodesis: preliminary results; Interet de la fusion TEMP-TDM pour la detection des pseudarthroses apres arthrodese lombaire: resultats preliminaires

    Energy Technology Data Exchange (ETDEWEB)

    Rager, O.; Ratib, O.; Tessitore, E. [Hopitaux universitaire de Geneve (Switzerland)

    2010-07-01

    Pseudo arthrosis is a potential complication after a lumbar arthrodesis. The symptoms are nonspecific and revision surgery is not always an effective treatment. Scintigraphy SPECT / CT with {sup 99m}Tc and CT were studied separately for the diagnosis of pseudo arthrosis before the widespread use of software fusion. It is well established that the diagnosis based on CT led to a number of false positive (10%). The purpose of this study is to evaluate the usefulness of SPECT-CT fusion imaging in the diagnosis of pseudo arthrosis. Conclusions: SPECT / CT fusion imaging may increase the specificity for the diagnosis of pseudo arthrosis at the level of inter body cages and increase sensitivity for the detection of degenerative diseases on the back joints. (N.C.)

  13. Ganglion block. When and how?

    International Nuclear Information System (INIS)

    Bale, R.

    2015-01-01

    Increasing understanding of the anatomy and physiology of neural structures has led to the development of surgical and percutaneous neurodestructive methods in order to target and destroy various components of afferent nociceptive pathways. The dorsal root ganglia and in particular the ganglia of the autonomous nervous system are targets for radiological interventions. The autonomous nervous system is responsible for the regulation of organ functions, sweating, visceral and blood vessel-associated pain. Ganglia of the sympathetic chain and non-myelinized autonomous nerves can be irreversibly destroyed by chemical and thermal ablation. Computed tomography (CT)-guided sympathetic nerve blocks are well established interventional radiological procedures which lead to vasodilatation, reduction of sweating and reduction of pain associated with the autonomous nervous system. Sympathetic blocks are applied for the treatment of various vascular diseases including critical limb ischemia. Other indications for thoracic and lumbar sympathectomy include complex regional pain syndrome (CRPS), chronic tumor associated pain and hyperhidrosis. Neurolysis of the celiac plexus is an effective palliative pain treatment particularly in patients suffering from pancreatic cancer. Percutaneous dorsal root ganglion rhizotomy can be performed in selected patients with radicular pain that is resistant to conventional pharmacological and interventional treatment. (orig.) [de

  14. Atlas-guided generation of pseudo-CT images for MRI-only and hybrid PET-MRI-guided radiotherapy treatment planning

    DEFF Research Database (Denmark)

    Arabi, H.; Koutsouvelis, N.; Rouzaud, M.

    2016-01-01

    Magnetic resonance imaging (MRI)-guided attenuation correction (AC) of positron emission tomography (PET) data and/or radiation therapy (RT) treatment planning is challenged by the lack of a direct link between MRI voxel intensities and electron density. Therefore, even if this is not a trivial t......-CT images from conventional Dixon MRI sequences with improved bone extraction accuracy. The approach is promising for potential use in PET AC and MRI-only or hybrid PET/MRI-guided RT treatment planning. © 2016 Institute of Physics and Engineering in Medicine.......Magnetic resonance imaging (MRI)-guided attenuation correction (AC) of positron emission tomography (PET) data and/or radiation therapy (RT) treatment planning is challenged by the lack of a direct link between MRI voxel intensities and electron density. Therefore, even if this is not a trivial...... the conventional MRI segmentation technique and a recently proposed multi-atlas approach. The clinical studies consisted of pelvic CT, PET and MRI scans of 12 patients with loco-regionally advanced rectal disease. In the first step, bone segmentation of the target image is optimized through local weighted atlas...

  15. Prospective evaluation of the radiologist's hand dose in CT-guided interventions; Prospektive Evaluation der Handdosis des Radiologen im Rahmen von CT-gestuetzten Interventionen

    Energy Technology Data Exchange (ETDEWEB)

    Rogits, B.; Jungnickel, K.; Loewenthal, D.; Dudeck, O.; Pech, M.; Ricke, J. [Magdeburg Univ. (Germany). Radiology and Nuclear Medicine; Kropf, S. [Magdeburg Univ. (Germany). Dept. of Biometry and Medical Informatics; Nekolla, E.A. [The Federal Office for Radiation Protection, Neuherberg (Germany). Dept. of Radiation Protection and Health; Wieners, G. [Charite CVC, Berlin (Germany). Dept. of Radiology

    2013-11-15

    Purpose: Assessment of radiologist's hand dose in CT-guided interventions and determination of influencing factors. Materials and Methods: The following CT-guided interventions were included: Core biopsy, drainage, periradicular therapy, and celiac plexus neurolysis. The hand dose was measured with an immediately readable dosimeter, the EDD-30 (Unfors, Sweden). The default parameters for CT fluoroscopy were 120 kV, 90 mA and a 4 mm slice thickness. All interventions were performed on a 16-slice CT unit (Aquilion 16 Toshiba, Japan). The tumor size, degree of difficulty (1 - 3), level of experience and device parameters (mAs, dose-length product, scan time) were documented. Results: 138 CT-guided interventions (biopsy n = 99, drainage n = 23, pain therapy n = 16) at different locations (lung n = 41, retroperitoneum n = 53, liver n = 25, spine n = 19) were included. The lesion size was 4 - 240 mm (median: 23 mm). The fluoroscopy time per intervention was 4.6 - 140.2 s (median: 24.2 s). The measured hand dose ranged from 0.001 - 3.02 mSv (median: 0.22 mSv). The median hand dose for lung puncture (n = 41) was slightly higher (median: 0.32 mSv, p = 0.01) compared to that for the liver, retroperitoneum and other. Besides physical influencing factors, the degree of difficulty (p = 0.001) and summed puncture depth (p = 0.004) correlated significantly with the hand dose. Conclusion: The median hand dose for different CT-guided interventions was 0.22 mSv. Therefore, the annual hand dose limit would normally only be reached with about 2000 interventions. (orig.)

  16. A New CT-Guided Modified Trocar Technique for Drainage of Difficult Locations Abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Tyng, Chiang J., E-mail: chiangjengtyng@gmail.com; Amoedo, Maurício K.; Bohrer, Yves; Bitencourt, Almir G. V.; Barbosa, Paula N. V.; Almeida, Maria Fernanda A.; Zurstrassen, Charles E. [AC Camargo Cancer Center, Department of Imaging (Brazil); Coimbra, Felipe J. F.; Costa, Wilson L. da [AC Camargo Cancer Center, Department of Abdominal Surgery (Brazil); Chojniak, Rubens [AC Camargo Cancer Center, Department of Imaging (Brazil)

    2017-05-15

    PurposeComputed tomography (CT) is commonly used to guide drainage of deep-seated abdominal fluid collections. However, in some cases, these collections seem to be inaccessible due to surrounding organs or their being in difficult locations. The aim of this study is to describe a modified Trocar technique to drain collections in difficult locations, especially those in the subphrenic space, without passing through intervening organs.Materials and MethodsThis retrospective case series study describes seven inpatients who underwent CT-guided drainage using a modified Trocar technique for abscesses that are difficult to access percutaneously. All patients provided written informed consent prior to the procedure. After placement of a 12–14F catheter inside the peritoneum, the Trocar stylet was removed so that the tip of the catheter became blunt and flexible to avoid injury to organs and structures in the catheter route, and the catheter was slowly advanced towards the collection using CT guidance and tactile sensation. After reaching the target, the stylet was reintroduced to enter the abscess wall.ResultsAll procedures were performed using an anterior abdominal wall access with adequate catheter positioning and resulted in clinical status improvement in the days after the drainage. No complications related to the procedure were identified in any of the patients.ConclusionsThe modified Trocar technique for percutaneous CT-guided drainage of abdominal abscesses may be feasible for lesions that are difficult to access with conventional methods.

  17. CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

    International Nuclear Information System (INIS)

    Klass, Darren; Marshall, Tom; Toms, Andoni

    2009-01-01

    Here we report our experience of a neuroprotective adaptation of the technique of CT-guided radiofrequency (RF) ablation of spinal osteoid osteomas. Over 9 years seven patients underwent eight CT-guided RF treatments for osteoid osteoma. CT-guided RF ablation was performed with general anaesthesia. The lesion was heated to 90 C for 2 min for two cycles by using a Cosman SMK TC-10 RF electrode. This was preceded by a bolus of room temperature sterile water (10 ml) injected through a 26G curved spinal needle into the exit foramen and adjacent epidural space for neuroprotection. The age of the patient, sex, lesion location, biopsy results and complications were recorded. All the biopsies (n = 7) demonstrated histological features of osteoid osteoma. All the procedures were technically successful. Clinical success was assessed up to 3 years post procedure. There was an 85% clinical success rate (6 of the 7 patients), with recurrence of a lesion at 6 months, necessitating a repeat procedure (successful). CT-guided percutaneous RF ablation of spinal osteoid osteoma preceded by bolus of sterile water, injected through a spinal needle into the exit foramen and adjacent epidural space for neuroprotection, is a safe and effective procedure. (orig.)

  18. Evaluation of the long-term efficacy of CT-guided epidural steroid injection for the treatment of sciatica

    International Nuclear Information System (INIS)

    Tong Guohai; Wang Wei; Chen Wei; Chen Kemin

    2005-01-01

    Objective: To evaluate the long-term efficacy of CT-guided epidural steroid injection for the treatment of sciatica. Methods: CT-guided epidural steroid injection was performed in 180 patients with sciatica from May 1998 to March 2004, and all patients had failure to previous conservative treatment. Visual analogue scale was used to evaluate the pain of the patient before and after the treatment. Results: Follow-up was taken for 112 cases during 1-6 years after the treatment, 89 patients (79.5%) had successful long-term outcome and 80 patients (71.4%) were satisfied. Conclusions: CT-guided epidural steroid injection can reduce low back pain and radical pain. It should be preferentially considered as the first choice when conservative treatments are failed. (authors)

  19. Temperature Measurements of the Low-Attenuation Radiographic Ice Ball During CT-Guided Renal Cryoablation

    International Nuclear Information System (INIS)

    Permpongkosol, Sompol; Link, Richard E.; Kavoussi, Louis R.; Solomon, Stephen B.

    2008-01-01

    During renal cryoablation a low-attenuation area on CT develops around the cryoprobe. Knowledge of the temperature of the growing low-attenuation area can guide therapy and ensure lethal temperatures. Herein, we report thermocouple results and correlating CT images during the development of the low-attenuation 'radiographic ice ball.' Five patients who underwent percutaneous CT-guided renal cryoablation were identified who had thermocouples inserted and serial intraprocedural CT images that included images with thermocouple measurements of 0 o and sub-0 o C. Thermocouples had been percutaneously placed just beyond the edge of the tumors either to ensure adequate cooling or to ensure safety to adjacent critical structures. Renal cryotherapy under CT guidance produced a growing low-attenuation area corresponding to the radiographic ice ball. When the thermocouple measured 0 o C, CT images showed the thermocouple tip at the edge of the low-attenuation ice ball. At lower temperatures the tip was within the low-attenuation ice ball. We conclude that knowledge of the temperature at the ice ball edge during cryoablation can be used to predict the extent of tissue necrosis and thus provide an estimate of cryotherapy effectiveness during the procedure. Further work is necessary to establish a firm relationship between the thermal conditions and the zone of damage

  20. CT-guided percutaneous spine biopsy in suspected infection or malignancy. A study of 214 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rehm, J.; Veith, S.; Kauczor, H.U.; Weber, M.A. [Heidelberg Univ. (Germany). Inst. of Diagnostic and Interventional Radiology; Akbar, M. [Heidelberg Univ. (Germany). Dept. of Orthopaedic Surgery and Rehabilitation Medicine

    2016-12-15

    To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. The accuracy was 94.4% for histopathological analysis and 97.7% for microbiological analysis. In 25% of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69%/78%. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81%/44%. In 52% of all cases, the biopsy result changed subsequent patient management. Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

  1. CT-guided percutaneous spine biopsy in suspected infection or malignancy. A study of 214 patients

    International Nuclear Information System (INIS)

    Rehm, J.; Veith, S.; Kauczor, H.U.; Weber, M.A.; Akbar, M.

    2016-01-01

    To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. The accuracy was 94.4% for histopathological analysis and 97.7% for microbiological analysis. In 25% of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy cross-sectional imaging concerning suspected malignancy was 69%/78%. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81%/44%. In 52% of all cases, the biopsy result changed subsequent patient management. Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

  2. A case of transitional cell carcinoma associated with pericalyceal diverticulum diagnosed by CT guided percutaneous cystgraphy

    International Nuclear Information System (INIS)

    Sasaki, Fumio; Koga, Sukehiko; Takeuchi, Akira; Anno, Hirofumi; Hujita, Tamio

    1983-01-01

    Computed tomography (CT) performed on a 42-year-old male patient with a chief complaint of hematuria revealed a renal cyst with a thickened and irregularly shaped wall. CT with contrast medium injected into the cyst by puncture under CT guide detected tumors on the cystic wall preoperatively. (Ueda, J.)

  3. Clinical application of CT-guided percutaneous puncturing biopsy of subcarinal lymph node

    International Nuclear Information System (INIS)

    Yuan Xiaodong; Wang Jianhua; Zuo Changjing; Tian Jianming

    2011-01-01

    Objective: To discuss the safety and clinical significance of CT-guided percutaneous puncturing biopsy of subcarinal lymph node. Methods: During the period of July 2006-July 2010, CT-guided percutaneous puncturing biopsy of subcarinal lymph node was carried out in 17 patients (11 males and 6 females, with an average age of 54 years) with enlarged subcarinal lymph nodes. The clinical data were retrospectively analyzed. Immediately after the puncturing procedure was completed, CT scanning was performed to observe if there any complications and to evaluate the safety of puncturing biopsy. Biopsy specimens were sent for pathological examination to assess the puncturing accuracy and to make the pathologic diagnosis. The clinical usefulness of this technique was evaluated. Results: Of the total 17 cases, successful puncturing into the enlarged subcarinal lymph nodes with single procedure was achieved in 14 and sufficient tissue sample was obtained. The biopsy failed in three cases at initial puncturing procedure as the needle could not be placed into the enlarged subcarinal lymph nodes, the puncturing biopsy had to given up in two patients because of hemoptysis and in another patient the second puncturing biopsy performed one week later was successful. The total technical successful rate was 88.2% (15/17). Of the fifteen cases with successful puncturing, definitive pathological diagnosis was obtained in 13 and the diagnosis was uncertain in the remaining two, with a diagnosis positive rate of 86.7% (13/15). Pathologically, the diagnoses included metastatic lymphadenopathy from lung cancer (n=10), proliferative inflammatory lymphadenopathy (n=2) and tuberculous enlargement of lymph nodes (n=1). Complications occurred in 4 patients (23.5%, 4/17), which mainly were pneumothorax and pulmonary hemorrhage. Conclusion: With high successful rate and diagnostic accuracy, CT-guided percutaneous puncturing biopsy of subcarinal lymph node is a safe and effective technique if the

  4. Routine Cranial Computed Tomography before Lumbar Puncture in ...

    African Journals Online (AJOL)

    Background: Current international guidelines recommend that a cranial computed tomography (CT) be performed on all HIV-positive patients presenting with new onset seizures, before a lumbar puncture (LP) is performed. In the South African setting, however this delay could be life threatening. The present study sought to ...

  5. The reasons for delay lumbar puncture

    Directory of Open Access Journals (Sweden)

    MH. Lotfi

    2017-04-01

    Full Text Available Early diagnosis of meningitis and encephalitis and prompt initiation of appropriate therapy is vital and any delay will lead to high mortality and serious and permanent morbidity. The main purpose of this study was to evaluate the management of 220 patients with suspected central nervous system (CNS infections (meningitis and encephalitis to determine the percentage of patients’ suspected CNS infection undergo lumbar puncture in acceptable time (in accordance with conventional algorithms. In this descriptive study, patients with suspected CNS infections admitted to Bu-Ali and Qods hospitals, in the period July 2013 to December 2015 were studied. Information of 220 patients was collected. Continuous variables were summarized as means ± standard deviation and categorical variables as frequencies and percentages. Lumbar puncture (LP in patients was delayed in 200 cases (91%. Most common causes of delay in performing LP were prolongation of the process of determining patient needs to puncture, satisfying patients, CT scan delay and the delay in allowing LP by neurologist. In this study, delaying LP rate was higher than other studies. It seems certain pattern in assistants’ visits for counseling. CT requests and neurologic consultation before LP performed for all adult patients.

  6. Radiographic comparison between male and female patients with lumbar spondylolysis.

    Science.gov (United States)

    Takao, Shoichiro; Sakai, Toshinori; Sairyo, Koichi; Kondo, Tadashi; Ueno, Junji; Yasui, Natsuo; Nishitani, Hiromu

    2010-02-01

    We studied the lumbar spines of 117 adults (39 women and 78 men) with spondylolysis unrelated to low back pain using multidetector computed tomography (CT). Of the 117 subjects with spondylolysis, including five with multiple-level spondylolysis, there were 124 vertebrae with spondylolysis. In adult lumbar spines with unilateral spondylolysis, there was no significant difference between the incidence of spondylolisthesis in female and male subjects. However, in those with bilateral spondylolysis, there was a significantly higher incidence of spondylolisthesis in female subjects (90.9%) than in males (66.2%). Furthermore, females with bilateral spondylolysis had significant more slippage than males. Lumbar index and lumbar lordosis were not significantly different between male and female subjects, and did not significantly correlate with slippage. In conclusion, to treat acute spondylolysis in adolescents, it is important to obtain bony union at least unilaterally, especially in female subjects, to prevent further slippage.

  7. CT-guided percutaneous transthoracic aspiration biopsy of lung lesions: factors influencing the diagnostic accuracy

    International Nuclear Information System (INIS)

    Huang Zhenguo; Zhang Xuezhe; Wang Wu

    2006-01-01

    Objective: To investigate the factors influencing the diagnostic accuracy in CT-guided percutaneous transthoracic aspiration biopsy of lung lesions. Methods: CT-guided percutaneous transthoracic biopsy was performed in 435 patients with surgical pathologic confirmation or clinical follow-up. Univariant statistical analysis and multivariant stepwise Logistic regression analysis were used to study the influence of lesion-related factors (benignancy or malignancy, size, location, depth, presence of cavity), procedure factors (laser-guidance, position of patient) and patient-related factors (sex, age, presence of emphysema); with the accuracy of the diagnosis. Results: 1)289 lesions were diagnosed as malignant ones and 146 as benign ones. The accuracy of CT-guided biopsy was 83.4%(363/435). Univariant analysis showed that the diagnostic accuracies for malignant and benign lesions were 88.9%(257/289) and 72.6%(106/146), respectively (χ 2 =18.71, P=0.00002). Laser-group was superior to non-laser group (88.4% versus 80.9%, respectively, χ 2 =4.00, P=0.0456). Mean diameters of lesions in correct diagnostic group and non-correct diagnostic group were 3.78±1.64 cm and 3.02±1.26 cm, respectively (F=13.79, P=0.0002). 2)Multivariant stepwise Logistic regression analysis showed that among the various factors influencing the final benign or malignant diagnoses (Wald χ 2 =14.01, P=0.0002) and using laser-guidance(Wald χ 2 =3.92, P=0.0477) were significantly associated with the diagnostic accuracy. Conclusions: Final correct diagnoses (benign, malignant) are closely related to the application of laser-guidance for determining the diagnostic accuracy in CT-guided transcutaneous thoracic needle aspiration biopsy. (authors)

  8. CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection.

    Directory of Open Access Journals (Sweden)

    Daniel Spira

    Full Text Available To search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis.34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients.Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002. Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%.Inflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.

  9. CT-Guided Biopsy of Small Liver Lesions: Visibility, Artifacts, and Corresponding Diagnostic Accuracy

    International Nuclear Information System (INIS)

    Stattaus, Joerg; Kuehl, Hilmar; Ladd, Susanne; Schroeder, Tobias; Antoch, Gerald; Baba, Hideo A.; Barkhausen, Joerg; Forsting, Michael

    2007-01-01

    Purpose. Our study aimed to determine the visibility of small liver lesions during CT-guided biopsy and to assess the influence of lesion visibility on biopsy results. Material and Methods. Fifty patients underwent CT-guided core biopsy of small focal liver lesions (maximum diameter, 3 cm); 38 biopsies were performed using noncontrast CT, and the remaining 12 were contrast-enhanced. Visibility of all lesions was graded on a 4-point-scale (0 = not visible, 1 = poorly visible, 2 = sufficiently visible, 3 = excellently visible) before and during biopsy (with the needle placed adjacent to and within the target lesion). Results. Forty-three biopsies (86%) yielded diagnostic results, and seven biopsies were false-negative. In noncontrast biopsies, the rate of insufficiently visualized lesions (grades 0-1) increased significantly during the procedure, from 10.5% to 44.7%, due to needle artifacts. This resulted in more (17.6%) false-negative biopsy results compared to lesions with good visualization (4.8%), although this difference lacks statistical significance. Visualization impairment appeared more often with an intercostal or subcostal vs. an epigastric access and with a subcapsular vs. a central lesion location, respectively. With contrast-enhanced biopsy the visibility of hepatic lesions was only temporarily improved, with a risk of complete obscuration in the late phase. Conclusion. In conclusion, visibility of small liver lesions diminished significantly during CT-guided biopsy due to needle artifacts, with a fourfold increased rate of insufficiently visualized lesions and of false-negative histological results. Contrast enhancement did not reveal better results

  10. The diagnostic significance of CT-guided percutaneous transthoracic cutting needle biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Wang Hui; Zhang Fuchen; Ji Hongjian; Chen Liping

    2009-01-01

    Objective: To evaluate the diagnostic significance of CT-guided percutaneous transthoracic cutting needle biopsy for pulmonary lesions. Methods: The clinical data of CT-guided transthoracic cutting needle biopsy in 436 patients performed in past 10 years were retrospectively analyzed. Of 436 cases with pulmonary lesions, primary lung cancer was confirmed in 341, pulmonary metastasis in 62, non-malignant lesions in 33. The diagnostic accuracy and sensitivity were statistically analyzed. The occurrence of complications was discussed. Results: The diagnostic accuracy rate and sensitivity rate in primary lung cancer group were 94.7% and 94.1% respectively, in pulmonary metastasis group were 58.2% and 51.6% respectively and in non-malignant lesions group were 57.6% and 57.6% respectively. The successful rate of biopsy was 97.9%. The occurrence of complications was 15.6%. Conclusion: CT-guided percutaneous transthoracic cutting needle biopsy is a safe and valuable diagnostic technique with high diagnostic accuracy and less complications. It is very helpful in confirming the diagnosis in the patients with suspected primary pulmonary cancer, although the technical procedures need to be further improved for metastatic and non-malignant lung lesions. (authors)

  11. CT and Ultrasound Guided Stereotactic High Intensity Focused Ultrasound (HIFU)

    Science.gov (United States)

    Wood, Bradford J.; Yanof, J.; Frenkel, V.; Viswanathan, A.; Dromi, S.; Oh, K.; Kruecker, J.; Bauer, C.; Seip, R.; Kam, A.; Li, K. C. P.

    2006-05-01

    animals and humans for HIFU-induced ablation and drug delivery. Integrated CT-guided focused ultrasound holds promise for tissue ablation, enhancing local drug delivery, and CT thermometry for monitoring ablation in near real-time.

  12. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy track

    International Nuclear Information System (INIS)

    Billich, Christian; Brenner, Gerhard; Schmidt, Stefan A.; Brambs, Hans-Juergen; Pauls, Sandra; Muche, Rainer; Krueger, Stefan

    2008-01-01

    This study was conducted to evaluate whether instillation of NaCl 0.9% solution into the biopsy track reduces the incidence of pneumothoraces after CT-guided lung biopsy. A total of 140 consecutive patients with pulmonary lesions were included in this prospective study. All patients were alternatingly assigned to one of two groups: group A in whom the puncture access was sealed by instillation of NaCl 0.9% solution during extraction of the guide needle (n 70) or group B for whom no sealing was performed (n = 70). CT-guided biopsy was performed with a 18-G coaxial system. Localization of lesion (pleural, peripheral, central), lesion size, needle-pleural angle, rate of pneumothorax and alveolar hemorrhage were evaluated. In group A, the incidence of pneumothorax was lower compared to group B (8%, 6/70 patients vs. 34%, 24/70 patients; P < 0.001). All pneumothoraces occurred directly post punctionem after extraction of the guide needle. One patient in group A and eight patients in group B developed large pneumothoraces requiring chest tube placement (P 0.01). The frequency of pneumothorax was independent of other variables. After CT-guided biopsy, instillation of NaCl 0.9% solution into the puncture access during extraction of the needle significantly reduces the incidence of pneumothorax. (orig.)

  13. CT-guided lung biopsy: incidence of pneumothorax after instillation of NaCl into the biopsy track

    Energy Technology Data Exchange (ETDEWEB)

    Billich, Christian; Brenner, Gerhard; Schmidt, Stefan A.; Brambs, Hans-Juergen; Pauls, Sandra [University of Ulm, Department of Diagnostic and Interventional Radiology, Ulm (Germany); Muche, Rainer [University of Ulm, Institute of Biometrics, Ulm (Germany); Krueger, Stefan [University of Ulm, Department of Internal Medicine, Ulm (Germany)

    2008-06-15

    This study was conducted to evaluate whether instillation of NaCl 0.9% solution into the biopsy track reduces the incidence of pneumothoraces after CT-guided lung biopsy. A total of 140 consecutive patients with pulmonary lesions were included in this prospective study. All patients were alternatingly assigned to one of two groups: group A in whom the puncture access was sealed by instillation of NaCl 0.9% solution during extraction of the guide needle (n = 70) or group B for whom no sealing was performed (n = 70). CT-guided biopsy was performed with a 18-G coaxial system. Localization of lesion (pleural, peripheral, central), lesion size, needle-pleural angle, rate of pneumothorax and alveolar hemorrhage were evaluated. In group A, the incidence of pneumothorax was lower compared to group B (8%, 6/70 patients vs. 34%, 24/70 patients; P < 0.001). All pneumothoraces occurred directly post punctionem after extraction of the guide needle. One patient in group A and eight patients in group B developed large pneumothoraces requiring chest tube placement (P = 0.01). The frequency of pneumothorax was independent of other variables. After CT-guided biopsy, instillation of NaCl 0.9% solution into the puncture access during extraction of the needle significantly reduces the incidence of pneumothorax. (orig.)

  14. Renal Sympathetic Denervation by CT-scan-Guided Periarterial Ethanol Injection in Sheep

    Energy Technology Data Exchange (ETDEWEB)

    Firouznia, Kavous, E-mail: k-firouznia@yahoo.com; Hosseininasab, Sayed jaber, E-mail: dr.hosseininasab@gmail.com [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Amanpour, Saeid, E-mail: saeidamanpour@yahoo.com [Tehran University of Medical Science, Cancer Models Research Center, Cancer Institute of Iran (Iran, Islamic Republic of); Haj-Mirzaian, Arya, E-mail: arya.mirzaian@gmail.com [Tehran University of Medical Science, Department of Radiology and Imaging, MIC, Imam Khomeini Hospital (Iran, Islamic Republic of); Miri, Roza, E-mail: rosa.miri@yahoo.com [Tehran University of Medical Science, Department of Pathology, Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Muhammadnejad, Ahad, E-mail: mohamadnejad@yahoo.com [Tehran University of Medical Science, Cancer Research Center, Cancer Institute of Iran (Iran, Islamic Republic of); Muhammadnejad, Samad, E-mail: s-muhammadnejad@sina.tums.ac.ir [Tehran University of Medical Sciences, Research Center for Molecular and Cellular Imaging (Iran, Islamic Republic of); Jalali, Amir H., E-mail: amirjalali51@yahoo.com [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Ahmadi, Farrokhlagha, E-mail: ahmadi@tums.ac.ir [Tehran University of Medical Sciences, Nephrology Research Center, Imam Khomeini Hospital Complex (Iran, Islamic Republic of); Rokni-Yazdi, Hadi, E-mail: rokniyaz@tums.ac.ir [Tehran University of Medical Sciences (TMUS), Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital Complex (Iran, Islamic Republic of)

    2015-08-15

    BackgroundRenal nerves are a recent target in the treatment of hypertension. Renal sympathetic denervation (RSD) is currently performed using catheter-based radiofrequency ablation (RFA) and because this method has limitations, percutaneous magnetic resonance (MR)-guided periarterial ethanol injection is a suggested alternative. However, few studies have been conducted on the effectiveness of percutaneous ethanol injection for RSD.AimTo evaluate the feasibility, efficacy, and complications of computed tomography (CT)-guided periarterial ethanol injection.MethodsEthanol (10 ml, 99.6 %) was injected around the right renal artery in six sheep under CT guidance with the left kidney serving as a control. Before and after the intervention, the sheep underwent MR imaging studies and the serum creatinine level was measured. One month after the intervention, the sheep were euthanized and norepinephrine (NE) concentration in the renal parenchyma was measured to evaluate the efficacy of the procedure. The treated tissues were also examined histopathologically to evaluate vascular, parenchymal, and neural injury.ResultsThe right kidney parenchymal NE concentration decreased significantly compared with the left kidney after intervention (average reduction: 40 %, P = 0.0016). Histologic examination revealed apparent denervation with no other vascular or parenchymal injuries observed in the histological and imaging studies.ConclusionEffective and feasible RSD was achieved using CT-guided periarterial ethanol injection. This technique may be a potential alternative to catheter-based RFA in the treatment of hypertension.

  15. Renal Sympathetic Denervation by CT-scan-Guided Periarterial Ethanol Injection in Sheep

    International Nuclear Information System (INIS)

    Firouznia, Kavous; Hosseininasab, Sayed jaber; Amanpour, Saeid; Haj-Mirzaian, Arya; Miri, Roza; Muhammadnejad, Ahad; Muhammadnejad, Samad; Jalali, Amir H.; Ahmadi, Farrokhlagha; Rokni-Yazdi, Hadi

    2015-01-01

    BackgroundRenal nerves are a recent target in the treatment of hypertension. Renal sympathetic denervation (RSD) is currently performed using catheter-based radiofrequency ablation (RFA) and because this method has limitations, percutaneous magnetic resonance (MR)-guided periarterial ethanol injection is a suggested alternative. However, few studies have been conducted on the effectiveness of percutaneous ethanol injection for RSD.AimTo evaluate the feasibility, efficacy, and complications of computed tomography (CT)-guided periarterial ethanol injection.MethodsEthanol (10 ml, 99.6 %) was injected around the right renal artery in six sheep under CT guidance with the left kidney serving as a control. Before and after the intervention, the sheep underwent MR imaging studies and the serum creatinine level was measured. One month after the intervention, the sheep were euthanized and norepinephrine (NE) concentration in the renal parenchyma was measured to evaluate the efficacy of the procedure. The treated tissues were also examined histopathologically to evaluate vascular, parenchymal, and neural injury.ResultsThe right kidney parenchymal NE concentration decreased significantly compared with the left kidney after intervention (average reduction: 40 %, P = 0.0016). Histologic examination revealed apparent denervation with no other vascular or parenchymal injuries observed in the histological and imaging studies.ConclusionEffective and feasible RSD was achieved using CT-guided periarterial ethanol injection. This technique may be a potential alternative to catheter-based RFA in the treatment of hypertension

  16. Percutaneous CT-guided biopsy of the musculoskeletal system: Results of 2027 cases

    International Nuclear Information System (INIS)

    Rimondi, Eugenio; Rossi, Giuseppe; Bartalena, Tommaso; Ciminari, Rosanna; Alberghini, Marco; Ruggieri, Pietro; Errani, Costantino; Angelini, Andrea; Calabro, Teresa; Abati, Caterina Novella; Balladelli, Alba; Tranfaglia, Cristina; Mavrogenis, Andreas F.; Vanel, Daniel; Mercuri, Mario

    2011-01-01

    Introduction: Biopsy of the musculoskeletal system is useful in the management of bone lesions particularly in oncology but they are often challenging procedures with a significant risk of complications. Computed tomography (CT)-guided needle biopsies may decrease these risks but doubts still exist about their diagnostic accuracy. This retrospective analysis of the experience of a single institution with percutaneous CT-guided biopsy of musculoskeletal lesions evaluates the results of these biopsies for bone lesions either in the appendicular skeleton or in the spine, and defines indications. Materials and methods: We reviewed the results of 2027 core needle biopsies performed over the past 18 years at the authors' institution. The results obtained are subject of this paper. Results: In 1567 cases the correct diagnosis was made with the first CT-guided needle biopsy (77.3% accuracy rate), in 408 cases the sample was not diagnostic and in 52 inadequate. Within 30 days these 408 patients underwent another biopsy, which was diagnostic in 340 cases with a final diagnostic accuracy of 94%. Highest accuracy rates were obtained in primary and secondary malignant lesions. Most false negative results were found in cervical lesions and in benign, pseudotumoral, flogistic, and systemic pathologies. There were 22 complications (18 transient paresis, 3 haematomas, 1 retroperitoneal haematoma) which had no influence on the treatment strategy, nor on patient outcome. Conclusion: This technique is reliable and safe and should be considered nowadays the gold standard for biopsies of the musculoskeletal system.

  17. Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation

    International Nuclear Information System (INIS)

    Golimbu, C.; Firooznia, H.; Rafii, M.; Engler, G.; Delman, A.

    1984-01-01

    Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and a spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods

  18. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares, E-mail: fabianonatividade@terra.com.br [Rio Preto-Ultra-X Radiological Diagnosis Institute, São José do Rio Preto, SP (Brazil)

    2014-07-15

    Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively). Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. (author)

  19. CT-guided biopsy with cutting-edge needle for the diagnosis of malignant lymphoma: Experience of 267 biopsies

    International Nuclear Information System (INIS)

    Agid, R.; Sklair-Levy, M.; Bloom, A.I.; Lieberman, S.; Polliack, A.; Ben-Yehuda, D.; Sherman, Y.; Libson, E.

    2003-01-01

    AIM: We performed a retrospective study of 267 core needle aspiration biopsies in order to estimate the accuracy of CT-guided aspiration core needle biopsies for the diagnosis and subsequent treatment of malignant lymphoma. MATERIALS AND METHODS: Between 1989 and 1999, 267 CT-guided core needle biopsies were performed in 241 patients with either primary or recurrent malignant lymphoma. Patients age ranged from 4--88 years. One hundred and sixty-six (62.2%) nodal and 101 (37.8%) extranodal aspiration biopsies were performed using either 18 G or 20 G Turner needles. Statistical method used was Chi-square analysis. RESULTS: An accurate histological diagnosis was made in 199 (82.5%) patients, the remaining 42 (17.4%) patients had non-diagnostic CT biopsies. Thirty-seven of them were diagnosed by a surgical biopsy, four by bone marrow biopsy and in one patient by paracentesis. One hundred and seventy-nine patients had non-Hodgkin's lymphoma (NHL) and 62 had Hodgkin's disease (HD); 23 (9.54%) patients underwent repeated CT biopsy which was diagnostic in 17 (73.9%) and non-diagnostic in six (26%). CONCLUSION: CT-guided aspiration core biopsies were sufficient to establish a diagnosis in lymphoproliferative disorders in 82.5% of cases. In the light of this experience we suggest that imaging-guided core needle biopsy be used as the first step in the work up of many patients with lymphoma Agid,R. et al. (2003). Clinical Radiology58, 143-147

  20. CT-guided percutaneous ethanol injection in the treatment of thyroid adenoma

    International Nuclear Information System (INIS)

    Zheng Jiasheng; Zhao Xia; Cui Xiongwei; Li Hua

    2001-01-01

    Objective: To evaluate the safety and efficacy of CT-guided percutaneous ethanol injection (CT-PEI) in the treatment of thyroid adenoma. Methods: Fifty-four patients with 73 nodules were included in the study. Thyroid adenoma was confirmed by pathology. The serum level T3, T4 and TSH were normal in all cases. CT-PEI (0.3-2.5 ml ethanol/cm 3 nodular tissue) was given for 115 times (mean 1.58 +- 0.78 times/nodule). Results: Complete cure was observed in 37 nodules (50.7%). In 28 nodules (38.3%) volume reduction was greater than 80%. A significant nodule reduction (50%-80%) was observed in 7 nodules. Only 1 (1.4%) nodule volume reduction was 28.9%. Apart from 1 case of transient dysphonia and 2 cases of mild pain and burning sensation, no side effect was observed. Conclusion: CT-PEI is a safe and effective therapeutic procedure with few side effects for thyroid adenoma

  1. Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping, E-mail: yipingzhuang2010@sina.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Wang, Hai-Yan, E-mail: mycherishgirl@sohu.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Zhang, Jin, E-mail: yari_zj@hotmail.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Feng, Yong, E-mail: fengyong119@sohu.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Zhang, Lei, E-mail: motozl163@163.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China)

    2013-01-15

    Objective: CT-guided transthoracic biopsy is a well-established method in the cytologic or histologic diagnosis of pulmonary lesions. The knowledge of its diagnostic performance and complications for cavitary pulmonary lesions is limited. The purpose of this study was to determine the diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy (FNAB) in cavitary pulmonary lesions. Materials and methods: 102 consecutive patients with pulmonary cavitary lesions received CT-guided FNAB with use of an 18-gauge (n = 35) or 20-gauge (n = 67) Chiba for histology diagnosis. The sensitivity, specificity, and diagnostic accuracy of FNAB were calculated as compared with the final diagnosis. Complications associated with FNAB were observed. The diagnostic accuracy and complications were compared between patients with different lesion sizes and different cavity wall thickness. Results: The overall sensitivity, specificity, and accuracy of FNAB were 96.3%, 98.0%, and 96.1%, respectively. The sensitivity, specificity, and diagnosis accuracy in different lesion size (<2 cm vs ≥2 cm), or different cavity wall thickness (<5 mm vs ≥5 mm) were not different (P > 0.05; 0.235). More nondiagnostic sample was found in wall thickness <5 mm lesions (P = 0.017). Associated complications included pneumothorax in 9 (8.8%) patients and alveolar hemorrhage in 14 patients (13.7%) and hemoptysis in 1 patient (1%). No different rate of complications was found with regard to lesion size, wall thickness, length of the needle path and needle size (P > 0.05). Conclusion: CT-guided FNAB can be effectively ad safely used for patients with pulmonary cavitary lesions.

  2. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    DEFF Research Database (Denmark)

    Kornerup, Josefine S.; Brodin, N. P.; Bjork-Eriksson, T.

    2015-01-01

    ) and estimated risk of secondary cancer (SC). RESULTS: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target...... or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. ADVANCES IN KNOWLEDGE: (18)F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11...... patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT....

  3. Comparison of CT and PET/CT for biopsy guidance in oncological patients

    Energy Technology Data Exchange (ETDEWEB)

    Cerci, Juliano J.; Bogoni, Mateos; Cunha Pereira, Carlos; Cerci, Rodrigo J.; Krauzer, Cassiano; Vicente Vitola, Joao [Quanta - Diagnostico e Terapia, Curitiba, PR (Brazil); Tabacchi, Elena; Fanti, Stefano [University Hospital S. Orsola-Malpighi, Nuclear Medicine Department, Bologna (Italy); Delbeke, Dominique [Vanderbilt University, Nashville, TN (United States); Giacometti Sakamoto, Danielle [Byori - Laboratorio de Patologia, Curitiba (Brazil)

    2017-08-15

    To compare FDG PET/CT and CT for the guidance of percutaneous biopsies with histological confirmation of lesions. We prospectively evaluated 323 patients of whom 181 underwent FDG PET/CT-guided biopsy (total 188 biopsies) and 142 underwent CT-guided biopsy (total 146 biopsies). Biopsies were performed using the same PET/CT scanner with a fluoroscopic imaging system. Technical feasibility, clinical success and complication rates in the two groups were evaluated. Of the 188 biopsies with PET/CT guidance, 182 (96.8%) were successful with conclusive tissue samples obtained and of the 146 biopsies with CT guidance, 137 (93.8%) were successful. Therefore, 6 of 188 biopsies (3.1%) with PET/CT guidance and 9 of 146 (6.1%) with CT guidance were inconclusive (p = 0.19). Due to inconclusive histological results, 4 of the 188 lesions (2.1%) were rebiopsied with PET/CT guidance and 3 of 146 lesions (2.0%) were rebiopsied with CT guidance. Histology demonstrated that 142 of 188 lesions (75.5%) were malignant, and 40 (21.2%) were benign in the PET/CT-guided group, while 89 of 146 lesions (60.9%) were malignant and 48 (32.8%) were benign in the CT-guided group (p = 0.004 and 0.01, respectively). Patients with a histological diagnosis of benign lesion had no recurrence of disease with a minimum of 6 months follow-up. Of the 188 PET/CT-guided biopsies, 6 (3.1%) were repeat biopsies due to a previous nondiagnostic CT-guided biopsy performed in a different diagnostic centre. The interval between the two biopsies was less than a month in all cases. Histology revealed five malignant lesions and one benign lesion among these. The complication rate in the PET/CT-guided biopsy group was 12.7% (24 of 188), while in the CT-guided group, was 9.5% (14 of 146, p = 0.26). Therefore, there was no significant difference in complication rates between PET/CT and CT guidance. PET/CT-guided biopsy is already known to be a feasible and accurate method in the diagnostic work-up of suspected malignant

  4. Comparison of CT and PET/CT for biopsy guidance in oncological patients

    International Nuclear Information System (INIS)

    Cerci, Juliano J.; Bogoni, Mateos; Cunha Pereira, Carlos; Cerci, Rodrigo J.; Krauzer, Cassiano; Vicente Vitola, Joao; Tabacchi, Elena; Fanti, Stefano; Delbeke, Dominique; Giacometti Sakamoto, Danielle

    2017-01-01

    To compare FDG PET/CT and CT for the guidance of percutaneous biopsies with histological confirmation of lesions. We prospectively evaluated 323 patients of whom 181 underwent FDG PET/CT-guided biopsy (total 188 biopsies) and 142 underwent CT-guided biopsy (total 146 biopsies). Biopsies were performed using the same PET/CT scanner with a fluoroscopic imaging system. Technical feasibility, clinical success and complication rates in the two groups were evaluated. Of the 188 biopsies with PET/CT guidance, 182 (96.8%) were successful with conclusive tissue samples obtained and of the 146 biopsies with CT guidance, 137 (93.8%) were successful. Therefore, 6 of 188 biopsies (3.1%) with PET/CT guidance and 9 of 146 (6.1%) with CT guidance were inconclusive (p = 0.19). Due to inconclusive histological results, 4 of the 188 lesions (2.1%) were rebiopsied with PET/CT guidance and 3 of 146 lesions (2.0%) were rebiopsied with CT guidance. Histology demonstrated that 142 of 188 lesions (75.5%) were malignant, and 40 (21.2%) were benign in the PET/CT-guided group, while 89 of 146 lesions (60.9%) were malignant and 48 (32.8%) were benign in the CT-guided group (p = 0.004 and 0.01, respectively). Patients with a histological diagnosis of benign lesion had no recurrence of disease with a minimum of 6 months follow-up. Of the 188 PET/CT-guided biopsies, 6 (3.1%) were repeat biopsies due to a previous nondiagnostic CT-guided biopsy performed in a different diagnostic centre. The interval between the two biopsies was less than a month in all cases. Histology revealed five malignant lesions and one benign lesion among these. The complication rate in the PET/CT-guided biopsy group was 12.7% (24 of 188), while in the CT-guided group, was 9.5% (14 of 146, p = 0.26). Therefore, there was no significant difference in complication rates between PET/CT and CT guidance. PET/CT-guided biopsy is already known to be a feasible and accurate method in the diagnostic work-up of suspected malignant

  5. Clinical application of CT-guided radiofrequency ablation for the treatment of metastatic bone neoplasms

    International Nuclear Information System (INIS)

    Gong Ju; Lu Zhijun; Wang Zhongmin; Zhang Liyun; Zheng Yunfeng; Chen Kemin

    2009-01-01

    Objective: To investigate the clinical efficacy of CT-guided radiofrequency ablation (RFA) for the treatment of metastatic bone neoplasms. Methods: Under intravenous aneaesthesia, CT- guided RFA was performed in 20 patients with metastatic bone tumor. The degree of pain was evaluated at 24 hours, 3 and 6 months after the operation by brief pain inventory (BPI). Results: All patients were followed up for 6 months and survived so far. The average peak pain score before the operation was 8.1 (6-10), which decreased significantly to 6.1, 4.6, 3.3 and 3.0 at 24 hours, 1, 3 and 6 months after the operation respectively (P<0.001). The mean pain score before the operation was 6.3, which decreased significantly to 4.0, 2.3, 2.13 and 1.9 at 24 hours, 1, 3 and 6 months after the operation respectively (P<0.001). After RFA treatment, the KPS scores of all patients increased while the CT values of the bone lesions decreased. No major complications occurred both during and after the operation. One patient with vertebral lamina destruction suffered from lower limb hypoesthesia after RFA procedure, and the lower limb sensation was restored within 48 hours after the injection of prednisone was employed. Conclusion: CT-guided radiofisequency ablation is a safe, effective, minimally-invasive and up-to-date technique for the treatment of metastatic bone neoplasms with excellent anti-pain effect, its short-term response is sure and reliable. (authors)

  6. Assessment of trunk muscle density using CT and its association with degenerative disc and facet joint disease of the lumbar spine.

    Science.gov (United States)

    Sebro, Ronnie; O'Brien, Liam; Torriani, Martin; Bredella, Miriam A

    2016-09-01

    The purpose of this study was (1) to evaluate the association of trunk muscle density assessed by computed tomography (CT) with age, gender, and BMI and (2) to evaluate the association between trunk muscle CT density and degenerative disc and facet joint disease of the lumbar spine. The study was IRB approved and HIPAA compliant. The study group comprised 100 subjects (mean age 44.4 ± 22.2 years, 51 % male) who underwent CT of the abdomen and pelvis without intravenous contrast. Exclusion criteria included prior abdominal or spine surgery, active malignancy and scoliosis. CTs were reviewed and the attenuation of the rectus abdominis, transverse abdominis, internal and external obliques, psoas, multifidus, longissimus and gluteus maximus were measured bilaterally at consistent levels. Degenerative disc and bilateral facet joint disease were scored using established methods. Univariate analyses were performed using linear regression. Multivariate linear regression was performed to adjust for age, gender and BMI. CT density of each trunk muscle correlated inversely with age (p degenerative disc and facet joint disease in the univariate analyses (p degenerative disc and facet joint disease respectively in the multivariate analysis. Fatty infiltration of trunk musculature increases with age and BMI. Fatty infiltration of the gluteus maximus and transverse abdominis are associated with degenerative disc and facet joint disease, independent of age, gender and BMI.

  7. Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Luo, T.Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.; Zheng, H.J.; Li, B.

    2015-01-01

    Aim: To determine whether the use of normal saline for sealing the needle track can reduce the incidence of pneumothorax and chest tube placement after computed tomography (CT)-guided lung biopsy. Materials and methods: A prospective, randomised, controlled trial enrolling 322 patients was conducted. All patients were randomly assigned to one of two groups: those in whom the needle track was not sealed with normal saline (n=161, Group A) and those who did receive normal saline (n=161, Group B). CT-guided biopsy was performed with coaxial technique. Normal saline, which ranged from 1–3 ml, was injected while the trocar needle was being withdrawn. Patient characteristics, lesion, and procedure variables were analysed as potential risk variables for occurrence of pneumothorax and chest tube placement. Results: The incidence of pneumothorax was 26.1% in Group A and 6.2% in Group B (p<0.001). Nine patients in Group A and one patient in Group B required chest tube placement (p=0.010). Using multiple logistic regression analysis, smaller lesion size, greater needle–pleural angle, longer lesion–pleural distance, presence of emphysema, and no sealing the needle track with normal saline were significantly associated with an increased risk of pneumothorax, and that the latter three factors were also associated with an increased risk of pneumothorax requiring chest tube placement. Conlusion: Normal saline for sealing the needle track significantly reduces the incidence of pneumothorax and prevents subsequent chest tube placement after CT-guided lung biopsy. - Highlights: • Normal saline is an effective sealant for use in lung biopsy. • This technique reduced the incidence of pneumothorax and chest tube placement. • This technique should be recommended for CT-guided lung biopsy.

  8. The suprasacral parallel shift vs lumbar plexus blockade with ultrasound guidance in healthy volunteers - a randomised controlled trial

    DEFF Research Database (Denmark)

    Bendtsen, T F; Pedersen, E M; Haroutounian, S

    2014-01-01

    -guided blockade of the lumbar plexus. The objective was to investigate whether the suprasacral technique is equally effective for anaesthesia of the terminal lumbar plexus nerves compared with a lumbar plexus block, and more effective for anaesthesia of the lumbosacral trunk. Twenty volunteers were included...

  9. Enabling image fusion for a CT guided needle placement robot

    Science.gov (United States)

    Seifabadi, Reza; Xu, Sheng; Aalamifar, Fereshteh; Velusamy, Gnanasekar; Puhazhendi, Kaliyappan; Wood, Bradford J.

    2017-03-01

    Purpose: This study presents development and integration of hardware and software that enables ultrasound (US) and computer tomography (CT) fusion for a FDA-approved CT-guided needle placement robot. Having real-time US image registered to a priori-taken intraoperative CT image provides more anatomic information during needle insertion, in order to target hard-to-see lesions or avoid critical structures invisible to CT, track target motion, and to better monitor ablation treatment zone in relation to the tumor location. Method: A passive encoded mechanical arm is developed for the robot in order to hold and track an abdominal US transducer. This 4 degrees of freedom (DOF) arm is designed to attach to the robot end-effector. The arm is locked by default and is released by a press of button. The arm is designed such that the needle is always in plane with US image. The articulated arm is calibrated to improve its accuracy. Custom designed software (OncoNav, NIH) was developed to fuse real-time US image to a priori-taken CT. Results: The accuracy of the end effector before and after passive arm calibration was 7.07mm +/- 4.14mm and 1.74mm +/-1.60mm, respectively. The accuracy of the US image to the arm calibration was 5mm. The feasibility of US-CT fusion using the proposed hardware and software was demonstrated in an abdominal commercial phantom. Conclusions: Calibration significantly improved the accuracy of the arm in US image tracking. Fusion of US to CT using the proposed hardware and software was feasible.

  10. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia

    International Nuclear Information System (INIS)

    Datir, A.; Connell, D.

    2010-01-01

    Aim: To evaluate the role of computed tomography (CT) in needle placement for ganglion impar blocks, and to determine the efficacy of CT-guided ganglion impar blocks in the management of coccydynia. Materials and methods: The results of ganglion impar blockade in eight patients with coccydynia secondary to trauma or unknown cause were reviewed. The diagnosis of coccydynia was based on clinical history, location of pain, and response to previous diagnostic and therapeutic procedures. The eight patients were treated with CT-guided ganglion impar blocks to manage their coccyx pain after conservative procedures, including oral medication and cushions, failed to provide relief. All patients were subjected to ganglion impar blocks under a thin-section CT-guided technique for needle placement, using a mixture of bupivacaine and triamcinolone. The patients were followed-up for a period of 6-months. Results: Eight patients were treated in this study with a total of 11 injections. A technical success of 100% was achieved in all cases with accurate needle placement without any complications and all the patients tolerated the procedure well. Out of eight, three patients (37%) had complete relief of pain on the follow-up intervals up to 6 months. Three out of eight patients (37%), had partial relief of symptoms and a second repeat injection was given at the 3 month interval of the follow-up period. At the end of the 6-month follow-up period, six out of eight patients (75%) experienced symptomatic relief (four complete relief and two partial relief) without any additional resort to conventional pain management. Twenty-five percent (two out of eight) did not have any symptomatic improvement. The mean visual analogue score (VAS) pre-procedure was 8 (range 6-10) and had decreased to 2 (range 0-5) in six out of eight patients. Conclusion: CT can be used as an imaging method to identify the ganglion and guide the needle in ganglion impar blockade. The advantages of CT-guided

  11. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia

    Energy Technology Data Exchange (ETDEWEB)

    Datir, A., E-mail: apdatir@gmail.co [Jackson Memorial Hospital, Miami, FL (United States); Connell, D. [Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex (United Kingdom)

    2010-01-15

    Aim: To evaluate the role of computed tomography (CT) in needle placement for ganglion impar blocks, and to determine the efficacy of CT-guided ganglion impar blocks in the management of coccydynia. Materials and methods: The results of ganglion impar blockade in eight patients with coccydynia secondary to trauma or unknown cause were reviewed. The diagnosis of coccydynia was based on clinical history, location of pain, and response to previous diagnostic and therapeutic procedures. The eight patients were treated with CT-guided ganglion impar blocks to manage their coccyx pain after conservative procedures, including oral medication and cushions, failed to provide relief. All patients were subjected to ganglion impar blocks under a thin-section CT-guided technique for needle placement, using a mixture of bupivacaine and triamcinolone. The patients were followed-up for a period of 6-months. Results: Eight patients were treated in this study with a total of 11 injections. A technical success of 100% was achieved in all cases with accurate needle placement without any complications and all the patients tolerated the procedure well. Out of eight, three patients (37%) had complete relief of pain on the follow-up intervals up to 6 months. Three out of eight patients (37%), had partial relief of symptoms and a second repeat injection was given at the 3 month interval of the follow-up period. At the end of the 6-month follow-up period, six out of eight patients (75%) experienced symptomatic relief (four complete relief and two partial relief) without any additional resort to conventional pain management. Twenty-five percent (two out of eight) did not have any symptomatic improvement. The mean visual analogue score (VAS) pre-procedure was 8 (range 6-10) and had decreased to 2 (range 0-5) in six out of eight patients. Conclusion: CT can be used as an imaging method to identify the ganglion and guide the needle in ganglion impar blockade. The advantages of CT-guided

  12. Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Heyer, Christoph M.; Lemburg, Stefan P.; Kagel, Thomas; Nicolas, Volkmar [Ruhr-University of Bochum, Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, BG Clinics Bergmannsheil, Bochum (Germany); Mueller, Klaus-Michael [Ruhr-University of Bochum, Institute of Pathology, BG Clinics Bergmannsheil, Bochum (Germany); Nuesslein, Thomas G.; Rieger, Christian H.L. [Ruhr-University of Bochum, Pediatric Hospital, Bochum (Germany)

    2005-07-01

    Children with chronic infectious interstitial lung disease often have to undergo open lung biopsy to establish a final diagnosis. Open lung biopsy is an invasive procedure with major potential complications. Transthoracic lung biopsy (TLB) guided by computed tomography (CT) is a less-invasive well-established procedure in adults. Detailing the role of low-dose CT-guided TLB in the enhanced diagnosis of chronic lung diseases related to infection in children. A group of 11 children (age 8 months to 16 years) underwent CT-guided TLB with a 20-gauge biopsy device. All investigations were done under general anaesthesia on a multidetector CT scanner (SOMATOM Volume Zoom, Siemens, Erlangen, Germany) using a low-dose protocol (single slices, 120 kV, 20 mAs). Specimens were processed by histopathological, bacteriological, and virological techniques. All biopsies were performed without major complications; one child developed a small pneumothorax that resolved spontaneously. A diagnosis could be obtained in 10 of the 11 patients. Biopsy specimens revealed chronic interstitial alveolitis in ten patients. In five patients Chlamydia pneumoniae PCR was positive, in three Mycoplasma pneumoniae PCR was positive, and in two Cytomegalovirus PCR was positive. The average effective dose was 0.83 mSv. Low-dose CT-guided TLB can be a helpful tool in investigating chronic infectious inflammatory processes in children with minimal radiation exposure. It should be considered prior to any open surgical procedure performed for biopsy alone. In our patient group no significant complication occurred. A disadvantage of the method is that it does not allow smaller airways and vessels to be assessed. (orig.)

  13. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.

    Science.gov (United States)

    Smith, A F; Hall, P S; Hulme, C T; Dunn, J A; McConkey, C C; Rahman, J K; McCabe, C; Mehanna, H

    2017-11-01

    A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Appreciation of CT-negative, lumbar puncture-positive subarachnoid haemorrhage: risk factors for presence of aneurysms and diagnostic yield of imaging.

    Science.gov (United States)

    Bakker, Nicolaas A; Groen, Rob J M; Foumani, Mahrouz; Uyttenboogaart, Maarten; Eshghi, Omid S; Metzemaekers, Jan D M; Luijckx, Gert Jan; Van Dijk, J Marc C

    2014-08-01

    Patients without a subarachnoid haemorrhage (SAH) on brain CT scan (CT-negative), but a lumbar puncture (LP)-proven SAH, are a challenging patient category. The optimal diagnostic approach is still a matter of debate. Also, there is little knowledge on the probability of finding an underlying vascular lesion. In this observational study, a consecutive cohort of 94 patients with CT-negative, LP-positive SAH was prospectively collected between 1998 and 2013. The yield of diagnostic modalities as well as patient outcome was studied. In addition, risk factors for the presence of a vascular lesion were analysed. In 40 patients (43%), an intracranial vascular abnormality was detected: 37 aneurysms and three arterial dissections. Female gender was significantly associated with detection of a vascular lesion. Time between ictus and diagnosis of SAH was not associated with the presence of vascular pathology. Overall, 99% of patients had a modified Rankin Score of 0-2 after a median follow-up of 72 months. The yield of additional digital subtraction angiography in patients with a negative CT angiography was zero. In this study, the chance of finding a vascular lesion in a patient with CT-negative, LP-positive SAH was 43%, underlining the need for an adequate diagnostic workup. In general, the patient outcome was favourable. Female gender was found to be predictive for detecting a vascular lesion. In contrast with previous reports, the interval between ictus and LP was not associated with the presence of an aneurysm. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Sciatica caused by lumbar epidural gas.

    Science.gov (United States)

    Belfquih, Hatim; El Mostarchid, Brahim; Akhaddar, Ali; gazzaz, Miloudi; Boucetta, Mohammed

    2014-01-01

    Gas production as a part of disc degeneration can occur but rarely causes nerve compression syndromes. The clinical features are similar to those of common sciatica. CT is very useful in the detection of epidural gas accumulation and nerve root compression. We report a case of symptomatic epidural gas accumulation originating from vacuum phenomenon in the intervertebral disc, causing lumbo-sacral radiculopathy. A 45-year-old woman suffered from sciatica for 9 months. The condition worsened in recent days. Computed tomography (CT) demonstrated intradiscal vacuum phenomenon, and accumulation of gas in the lumbar epidural space compressing the dural sac and S1 nerve root. After evacuation of the gas, her pain resolved without recurrence.

  16. Three-dimensional C-arm CT-guided transjugular intrahepatic portosystemic shunt placement: Feasibility, technical success and procedural time

    Energy Technology Data Exchange (ETDEWEB)

    Ketelsen, Dominik; Groezinger, Gerd; Maurer, Michael; Grosse, Ulrich; Horger, Marius; Nikolaou, Konstantin; Syha, Roland [University of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Lauer, Ulrich M. [University of Tuebingen, Internal Medicine I, Department of Gastroenterology, Hepatology and Infectious disease, Tuebingen (Germany)

    2016-12-15

    Establishment of transjugular intrahepatic portosystemic shunts (TIPS) constitutes a standard procedure in patients suffering from portal hypertension. The most difficult step in TIPS placement is blind puncture of the portal vein. This study aimed to evaluate three-dimensional mapping of portal vein branches and targeted puncture of the portal vein. Twelve consecutive patients suffering from refractory ascites by liver cirrhosis were included in this retrospective study to evaluate feasibility, technical success and procedural time of C-arm CT-targeted puncture of the portal vein. As a control, 22 patients receiving TIPS placement with fluoroscopy-guided blind puncture were included to compare procedural time. Technical success could be obtained in 100 % of the study group (targeted puncture) and in 95.5 % of the control group (blind puncture). Appropriate, three-dimensional C-arm CT-guided mapping of the portal vein branches could be achieved in all patients. The median number of punctures in the C-arm CT-guided study group was 2 ± 1.3 punctures. Procedural time was significantly lower in the study group (14.8 ± 8.2 min) compared to the control group (32.6 ± 22.7 min) (p = 0.02). C-arm CT-guided portal vein mapping is technically feasible and a promising tool for TIPS placement resulting in a significant reduction of procedural time. (orig.)

  17. Assessment of trunk muscle density using CT and its association with degenerative disc and facet joint disease of the lumbar spine

    International Nuclear Information System (INIS)

    Sebro, Ronnie; O'Brien, Liam; Torriani, Martin; Bredella, Miriam A.

    2016-01-01

    The purpose of this study was (1) to evaluate the association of trunk muscle density assessed by computed tomography (CT) with age, gender, and BMI and (2) to evaluate the association between trunk muscle CT density and degenerative disc and facet joint disease of the lumbar spine. The study was IRB approved and HIPAA compliant. The study group comprised 100 subjects (mean age 44.4 ± 22.2 years, 51 % male) who underwent CT of the abdomen and pelvis without intravenous contrast. Exclusion criteria included prior abdominal or spine surgery, active malignancy and scoliosis. CTs were reviewed and the attenuation of the rectus abdominis, transverse abdominis, internal and external obliques, psoas, multifidus, longissimus and gluteus maximus were measured bilaterally at consistent levels. Degenerative disc and bilateral facet joint disease were scored using established methods. Univariate analyses were performed using linear regression. Multivariate linear regression was performed to adjust for age, gender and BMI. CT density of each trunk muscle correlated inversely with age (p < 0.001) and BMI (p < 0.001). CT density of each trunk muscle correlated inversely with degenerative disc and facet joint disease in the univariate analyses (p < 0.001); however, only the gluteus maximus and the transverse abdominis remained significant predictors of degenerative disc and facet joint disease respectively in the multivariate analysis. Fatty infiltration of trunk musculature increases with age and BMI. Fatty infiltration of the gluteus maximus and transverse abdominis are associated with degenerative disc and facet joint disease, independent of age, gender and BMI. (orig.)

  18. Brachial Plexus Injury from CT-Guided RF Ablation Under General Anesthesia

    International Nuclear Information System (INIS)

    Shankar, Sridhar; Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Flanagan, Hugh L.; Whang, Edward E.

    2005-01-01

    Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexus palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication

  19. Diagnostic Yield of CT-Guided Percutaneous Transthoracic Needle Biopsy for Diagnosis of Anterior Mediastinal Masses.

    Science.gov (United States)

    Petranovic, Milena; Gilman, Matthew D; Muniappan, Ashok; Hasserjian, Robert P; Digumarthy, Subba R; Muse, Victorine V; Sharma, Amita; Shepard, Jo-Anne O; Wu, Carol C

    2015-10-01

    The purpose of this study was to evaluate the diagnostic yield and accuracy of CT-guided percutaneous biopsy of anterior mediastinal masses and assess prebiopsy characteristics that may help to select patients with the highest diagnostic yield. Retrospective review of all CT-guided percutaneous biopsies of the anterior mediastinum conducted at our institution from January 2003 through December 2012 was performed to collect data regarding patient demographics, imaging characteristics of biopsied masses, presence of complications, and subsequent surgical intervention or medical treatment (or both). Cytology, core biopsy pathology, and surgical pathology results were recorded. A per-patient analysis was performed using two-tailed t test, Fisher's exact test, and Pearson chi-square test. The study cohort included 52 patients (32 men, 20 women; mean age, 49 years) with mean diameter of mediastinal mass of 6.9 cm. Diagnostic yield of CT-guided percutaneous biopsy was 77% (40/52), highest for thymic neoplasms (100% [11/11]). Non-diagnostic results were seen in 12 of 52 patients (23%), primarily in patients with lymphoma (75% [9/12]). Fine-needle aspiration yielded the correct diagnosis in 31 of 52 patients (60%), and core biopsy had a diagnostic rate of 77% (36/47). None of the core biopsies were discordant with surgical pathology. There was no statistically significant difference between the diagnostic and the nondiagnostic groups in patient age, lesion size, and presence of necrosis. The complication rate was 3.8% (2/52), all small self-resolving pneumothoraces. CT-guided percutaneous biopsy is a safe diagnostic procedure with high diagnostic yield (77%) for anterior mediastinal lesions, highest for thymic neoplasms (100%), and can potentially obviate more invasive procedures.

  20. Multiple Levels of Lumbar Spondylolysis - A Case Report -

    Science.gov (United States)

    Park, Kwang-Hwan; Ha, Joong-Won; Kim, Hak-Sun; Moon, Seong-Hwan; Lee, Hwan-Mo; Kim, Ho-Joong; Kim, Ju-Young

    2009-01-01

    We report here on an unusual case of multiple levels of asymmetric lumbar spondylolysis in a 19-year-old woman. The patient had severe low back pain of increasing intensity with lumbar instability, which was evident on the dynamic radiographs. MRI demonstrated the presence of abnormalities and the three dimensional CT scan revealed asymmetric complete spondylolysis at the left L2, L3 and L4 levels and the right L1, L2 and L3 levels. This case was treated surgically by posterior and posterolateral fusion at L2-3-4 with intersegmental fixation using pedicle screws and an auto iliac bone graft. The patient was relieved of her low back pain after the surgery. PMID:20404945

  1. CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Collettini, Federico; Schreiber, Nadja; Schnapauff, Dirk; Denecke, Timm; Hamm, Bernd; Gebauer, Bernhard; Wust, Peter; Schott, Eckart

    2015-01-01

    The purpose of the present study was to evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) in patients with unresectable hepatocellular carcinoma (HCC). Over a 6-year period, 98 patients with 212 unresectable HCC underwent CT-HDRBT applying a 192 Ir source at our institution. Magnetic resonance imaging (MRI) follow-up was performed 6 weeks after the intervention and then every 3 months. The primary endpoint was local tumor control (LTC); secondary endpoints included progression-free survival (PFS) and overall survival (OS). Patients were available for MRI evaluation for a mean follow-up of 23.1 months (range 4-64 months; median 20 months). Mean tumor diameter was 5 cm (range 1.8-12 cm). Eighteen of 212 (8.5 %) tumors showed local progression after a mean LTC of 21.1 months. In all, 67 patients (68.4 %) experienced distant tumor progression. The mean PFS was 15.2 months. Forty-six patients died during the follow-up period. Median OS was 29.2 months. Actuarial 1-, 2-, and 3-year OS rates were 80, 62, and 46 %, respectively. CT-HDRBT is an effective therapy to attain local tumor control in patients with unresectable HCC. Prospective randomized studies comparing CT-HDRBT with the standard treatments like Radiofrequency ablation (RFA) and chemoembolization (TACE) are mandatory. (orig.) [de

  2. Synovial chondromatosis in a lumbar apophyseal joint

    Energy Technology Data Exchange (ETDEWEB)

    Burrafato, V.; Campanacci, D.A.; Capanna, R. [Department of Orthopedic Oncology, Centro Traumatologico Ortopedico, Florence (Italy); Franchi, A. [Institute of Pathology, University of Florence, Florence (Italy)

    1998-07-01

    A 31-year-old woman presented with painful swelling in the right paravertebral region that had been present for 2 years. Radiography and CT revealed an area of increased density due to multiple calcifications localized at the fourth lumbar vertebra. Histological examination revealed that the lesion consisted of nodules of hyaline cartilage, with focal areas of calcification, growing within synovial tissue. (orig.) With 5 figs., 11 refs.

  3. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan

    International Nuclear Information System (INIS)

    Tomiyama, Noriyuki; Yasuhara, Yoshifumi; Nakajima, Yasuo; Adachi, Shuji; Arai, Yasuaki; Kusumoto, Masahiko; Eguchi, Kenji; Kuriyama, Keiko; Sakai, Fumikazu; Noguchi, Masayuki; Murata, Kiyoshi; Murayama, Sadayuki; Mochizuki, Teruhito; Mori, Kiyoshi; Yamada, Kozo

    2006-01-01

    Purpose: The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey. Materials and methods: Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions. Results: Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died. Conclusions: This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions

  4. Surgical management of multilevel lumbar spondylolysis: a case report and review of the literature.

    Science.gov (United States)

    Darnis, A; Launay, O; Perrin, G; Barrey, C

    2014-05-01

    Multilevel lumbar spondylolysis accounts for less than 6% of the cases of lumbar spondylolysis and its treatment, as reported in the literature, has not been consistent. Fewer than ten cases presenting triple lumbar spondylosis have been published. We describe the case of a 33-year-old male presenting bilateral L3, L4, and L5 isthmic lysis with no spondylolisthesis or disc degeneration. The MRI and CT of the lumbar spine were decisive elements in the therapeutic choice and the surgical treatment performed was bilateral L3 and L4 isthmic repair via a combined anterior and posterior L5S1 approach. The clinical and radiological results were good at the last follow-up visit. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  5. An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

    Directory of Open Access Journals (Sweden)

    Leon Neve

    2010-09-01

    Full Text Available Leon Neve1, John Orchard2, Nathan Gibbs3, Willem van Mechelen4, Evert Verhagen4, Ken Sesel5, Ian Burgess6, Brett Hines61VU University, Amsterdam, The Netherlands; 2School of Public Health, University of Sydney, Sydney, NSW, Australia; 3South Sydney Sports Medicine, Sydney, NSW, Australia; 4EMGO, VU University, Amsterdam, The Netherlands; 5Sydney X-ray Centre, Sydney, NSW, Australia; 6Mater Imaging, Sydney, NSW, AustraliaBackground: Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2. These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI or computed tomography (CT, even though this treatment scenario has not been adequately studied for this last diagnosis.Objectives: To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain.Study design: Retrospective case series.Methods: Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N.Results: 153 patients were eligible for the study (Group D: 93/Group N: 60. Eventually 110 patients responded (Group D: 67/Group N: 43. Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the

  6. Image-guided lumbar facet joint infiltration in nonradicular low back pain

    International Nuclear Information System (INIS)

    Chaturvedi, Arti; Chaturvedi, Sunil; Sivasankar, Rajiv

    2009-01-01

    To assess the efficacy of facet joint infiltrations for pain relief in 44 selected patients with chronic nonradicular low back pain (LBP). Forty-four patients with chronic LBP of more than 3 months' duration were selected for facet joint infiltration. The majority (n = 24) had facetal pain with no evidence of significant facetal arthropathy on imaging. Fifteen patients had radiological evidence of facetal arthropathy, one had a facet joint synovial cyst, three were post–lumbar surgery patients, and two patients had spondylolysis. Facet joint injections were carried out under fluoroscopic guidance in 39 patients and under CT guidance in 5 cases. Pain relief was assessed using the visual analog scale at 1 h post-procedure and, thereafter, at 1, 4, 12, and 24 weeks. A total of 141 facet joints were infiltrated in 44 patients over a 2-year period. There was significant pain relief in 81.8% patients 1 h after the procedure, in 86.3% after 1 week, in 93.3% after 4 weeks, in 85.7% after 12 weeks, and in 62.5% after 24 weeks. No major complications were encountered. Facet nerve block was found to be a simple, minimally invasive, and safe procedure. With meticulous patient selection, we achieved long-term success rates of over 60%. We conclude that this method represents an important alternative treatment for nonradicular back pain

  7. Transforaminal lumbar interbody fusion using unilateral pedicle screw fixation plus contralateral translaminar facet screw fixation in lumbar degenerative diseases.

    Science.gov (United States)

    Liu, Fubing; Jiang, Chun; Cao, Yuanwu; Jiang, Xiaoxing; Feng, Zhenzhou

    2014-07-01

    Transforaminal lumbar interbody fusion (TLIF) has been used in lumbar degenerative diseases. Some researchers have applied unilateral fixation in TLIF to reduce operational trauma without compromising the clinical outcome, but it is always suspected biomechanically unstable. The supplementary contralateral translaminar facet screw (cTLFS) seemed to be able to overcome the inherent drawbacks of unilateral pedicle screw (uPS) fixation theoretically. This study evaluates the safety, feasibility and efficacy of TLIF using uPS with cTLFS fixation in the treatment of lumbar degenerative diseases (LDD). 50 patients (29 male) underwent the aforementioned surgical technique for their LDD between December 2009 and April 2012. The results were evaluated based on visual analogue scale (VAS) of the leg and back, Japanese Orthopedic Association (JOA) score and Oswestry Disability Index (ODI) were recorded. The radiographic examinations in form of X-ray, computed tomography (CT) or magnetic resonance imaging was done preoperatively and 1 week, 3 months, 6 months, 12 months and 24 months postoperatively. The student t-test was used for comparison between the preoperative values and postoperative counterparts. P degenerative diseases short termly.

  8. CT outperforms radiographs at a comparable radiation dose in the assessment for spondylolysis.

    Science.gov (United States)

    Fadell, Michael F; Gralla, Jane; Bercha, Istiaq; Stewart, Jaime R; Harned, Roger K; Ingram, James D; Miller, Angie L; Strain, John D; Weinman, Jason P

    2015-07-01

    Lumbar spondylolysis, a unilateral or bilateral fracture at pars interarticularis, is a common cause of low back pain in children. The initial imaging study in the diagnosis of lumbar spondylolysis has historically been lumbar spine radiographs; however, radiographs can be equivocal or false-negative. Definitive diagnosis can be achieved with computed tomography (CT), but its use has been limited due to the dose of ionizing radiation to the patient. By limiting the z-axis coverage to the relevant anatomy and optimizing the CT protocol, we are able to provide a definitive diagnosis of fractures of the pars interarticularis at comparable or lower radiation dose than commonly performed lumbar spine radiographs. As there is no gold standard for the diagnosis of spondylolysis besides surgery, we compared interobserver agreement and degree of confidence to determine which modality is preferable. Sixty-two patients with low back pain ages 5-18 years were assessed for the presence of spondylolyis. Forty-seven patients were evaluated by radiography and 15 patients were evaluated by limited field-of-view CT. Both radiographic and CT examinations were assessed anonymously in random order for the presence or absence of spondylolyisis by six raters. Agreement was assessed among raters using a Fleiss Kappa statistic for multiple raters. CT provided a significantly higher level of agreement among raters than radiographs (P < 0.001). The overall Kappa for rater agreement with radiographs was 0.24, 0.34 and 0.40 for 2, 3 or 4 views, respectively, and 0.88 with CT. Interobserver agreement is significantly greater using limited z-axis coverage CT when compared with radiographs. Radiologist confidence improved significantly with CT compared to radiographs regardless of the number of views.

  9. CT outperforms radiographs at a comparable radiation dose in the assessment for spondylolysis

    Energy Technology Data Exchange (ETDEWEB)

    Fadell, Michael F.; Stewart, Jaime R.; Harned, Roger K.; Ingram, James D.; Miller, Angie L.; Strain, John D.; Weinman, Jason P. [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States); University of Colorado Hospital, Department of Radiology, Aurora, CO (United States); Gralla, Jane [University of Colorado Denver, Department of Pediatrics, Aurora, CO (United States); Bercha, Istiaq [Children' s Hospital Colorado, Department of Radiology, Aurora, CO (United States)

    2015-07-15

    Lumbar spondylolysis, a unilateral or bilateral fracture at pars interarticularis, is a common cause of low back pain in children. The initial imaging study in the diagnosis of lumbar spondylolysis has historically been lumbar spine radiographs; however, radiographs can be equivocal or false-negative. Definitive diagnosis can be achieved with computed tomography (CT), but its use has been limited due to the dose of ionizing radiation to the patient. By limiting the z-axis coverage to the relevant anatomy and optimizing the CT protocol, we are able to provide a definitive diagnosis of fractures of the pars interarticularis at comparable or lower radiation dose than commonly performed lumbar spine radiographs. As there is no gold standard for the diagnosis of spondylolysis besides surgery, we compared interobserver agreement and degree of confidence to determine which modality is preferable. Sixty-two patients with low back pain ages 5-18 years were assessed for the presence of spondylolysis. Forty-seven patients were evaluated by radiography and 15 patients were evaluated by limited field-of-view CT. Both radiographic and CT examinations were assessed anonymously in random order for the presence or absence of spondylolysis by six raters. Agreement was assessed among raters using a Fleiss Kappa statistic for multiple raters. CT provided a significantly higher level of agreement among raters than radiographs (P < 0.001). The overall Kappa for rater agreement with radiographs was 0.24, 0.34 and 0.40 for 2, 3 or 4 views, respectively, and 0.88 with CT. Interobserver agreement is significantly greater using limited z-axis coverage CT when compared with radiographs. Radiologist confidence improved significantly with CT compared to radiographs regardless of the number of views. (orig.)

  10. CT outperforms radiographs at a comparable radiation dose in the assessment for spondylolysis

    International Nuclear Information System (INIS)

    Fadell, Michael F.; Stewart, Jaime R.; Harned, Roger K.; Ingram, James D.; Miller, Angie L.; Strain, John D.; Weinman, Jason P.; Gralla, Jane; Bercha, Istiaq

    2015-01-01

    Lumbar spondylolysis, a unilateral or bilateral fracture at pars interarticularis, is a common cause of low back pain in children. The initial imaging study in the diagnosis of lumbar spondylolysis has historically been lumbar spine radiographs; however, radiographs can be equivocal or false-negative. Definitive diagnosis can be achieved with computed tomography (CT), but its use has been limited due to the dose of ionizing radiation to the patient. By limiting the z-axis coverage to the relevant anatomy and optimizing the CT protocol, we are able to provide a definitive diagnosis of fractures of the pars interarticularis at comparable or lower radiation dose than commonly performed lumbar spine radiographs. As there is no gold standard for the diagnosis of spondylolysis besides surgery, we compared interobserver agreement and degree of confidence to determine which modality is preferable. Sixty-two patients with low back pain ages 5-18 years were assessed for the presence of spondylolysis. Forty-seven patients were evaluated by radiography and 15 patients were evaluated by limited field-of-view CT. Both radiographic and CT examinations were assessed anonymously in random order for the presence or absence of spondylolysis by six raters. Agreement was assessed among raters using a Fleiss Kappa statistic for multiple raters. CT provided a significantly higher level of agreement among raters than radiographs (P < 0.001). The overall Kappa for rater agreement with radiographs was 0.24, 0.34 and 0.40 for 2, 3 or 4 views, respectively, and 0.88 with CT. Interobserver agreement is significantly greater using limited z-axis coverage CT when compared with radiographs. Radiologist confidence improved significantly with CT compared to radiographs regardless of the number of views. (orig.)

  11. Simple localization of peripheral pulmonary nodules - CT-guided percutaneous hook-wire localization

    International Nuclear Information System (INIS)

    Poretti, F.P.; Vorwerk, D.; Brunner, E.

    2002-01-01

    Background: Video-assisted thoracoscopic surgery (VATS) is an alternative approach to small intrapulmonary nodules, if transbronchial or percutaneous biopsy have failed. We investigated the feasibility and effectiveness of the percutaneous CT-guided placement of hook-wires to localize such nodules before video-assisted thoracoscopy. Subjects and Methods: 19 patients with new by diagnosed intrapulmonary nodules underwent CT-guided hook-wire localization by application of a X-Reidy-Set (Cook, Inc., Bjaeverskov, Denmark). The average age of the patient was 63 years (range: 19-80 years), the mean distance between the nodule and the pleura visceral was 7.58 mm (range: 0-25 mm) and the mean diameter was 11.58 mm (range: 5-25 mm). After localization, the patients underwent a VATS resection of the lesion within a mean time of 30 min (range 10-48 min). Results: In all cases, resection of the nodules was successful. In 4 older patients the marking was complicated by poor cooperability. At the end of manipulation the end of the hook was distanced from the nodule. But also in these cases, resection was successfully performed. 8 patients developed an asymptomatic pneumothorax: 5 of them in a minor (max. 1.5 cm rim), three of them in a moderate (max. 3 cm rim) dimension. In 4 patients, in whom the tumor was hit directly by the needle, local bleeding occurred. In one case, haemoptoe was present. In no patient did a dislocation of the hookwire-system occur. Conclusion: CT-guided placement of a hook-wire system is a simple and reasonable procedure which facilitates safe VATS resection of small pulmonary nodules. (orig.) [de

  12. Use of Low-Fidelity Simulation Laboratory Training for Teaching Radiology Residents CT-Guided Procedures.

    Science.gov (United States)

    Picard, Melissa; Nelson, Rachel; Roebel, John; Collins, Heather; Anderson, M Bret

    2016-11-01

    To determine the benefit of the addition of low-fidelity simulation-based training to the standard didactic-based training in teaching radiology residents common CT-guided procedures. This was a prospective study involving 24 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by low-fidelity simulation-based training on three common CT-guided procedures: random liver biopsy, lung nodule biopsy, and drain placement. Baseline knowledge, confidence, and performance assessments were obtained after the didactic session and before the simulation training session. Approximately 2 months later, all residents participated in a simulation-based training session covering all three of these procedures. Knowledge, confidence, and performance data were obtained afterward. These assessments covered topics related to preprocedure workup, intraprocedure steps, and postprocedure management. Knowledge data were collected based on a 15-question assessment. Confidence data were obtained based on a 5-point Likert-like scale. Performance data were obtained based on successful completion of predefined critical steps. There was significant improvement in knowledge (P = .005), confidence (P simulation-based training to the standard didactic curriculum for all procedures. This study suggests that the addition of low-fidelity simulation-based training to a standard didactic-based curriculum is beneficial in improving resident knowledge, confidence, and tested performance of common CT-guided procedures. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  13. Usefulness of CT fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy

    International Nuclear Information System (INIS)

    O, Dong Hyun; Cho, Young Jun; Park, Yong Sung; Hwang, Cheol Mok; Kim, Keum Won; Kim, Ji Hyung

    2006-01-01

    When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothorax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: ≤ 1 cm in distance for group 1 (81.8%) and group 2 (18.2%), and > 1 cm in distance for group 1 (30%) and group 2 (70%), ρ 0.05). When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule

  14. Lambda-guided calculation method (LGC method) for xenon/CT CBF

    Energy Technology Data Exchange (ETDEWEB)

    Sase, Shigeru [Anzai Medical Co., Ltd., Tokyo (Japan); Honda, Mitsuru; Kushida, Tsuyoshi; Seiki, Yoshikatsu; Machida, Keiichi; Shibata, Iekado [Toho Univ., Tokyo (Japan). School of Medicine

    2001-12-01

    A quantitative CBF calculation method for xenon/CT was developed by logically estimating time-course change rate (rate constant) of arterial xenon concentration from that of end-tidal xenon concentration. A single factor ({gamma}) was introduced to correlate the end-tidal rate constant (Ke) with the arterial rate constant (Ka) in a simplified equation. This factor ({gamma}) is thought to reflect the diffusing capacity of the lung for xenon. When an appropriate value is given to {gamma}, it is possible to calculate the arterial rate constant (Calculated Ka) from Ke. To determine {gamma} for each xenon/CT CBF examination, a procedure was established which utilizes the characteristics of white matter lambda; lambda refers to xenon brain-blood partition coefficient. Xenon/CT studies were performed on four healthy volunteers. Hemispheric CBF values (47.0{+-}9.0 ml/100 g/min) with use of Calculated Ka were close to the reported normative values. For a 27-year-old healthy man, the rate constant for the common carotid artery was successfully measured and nearly equal to Calculated Ka. The authors conclude the method proposed in this work, lambda-guided calculation method, could make xenon/CT CBF substantially reliable and quantitative by effective use of end-tidal xenon. (author)

  15. Lambda-guided calculation method (LGC method) for xenon/CT CBF

    International Nuclear Information System (INIS)

    Sase, Shigeru; Honda, Mitsuru; Kushida, Tsuyoshi; Seiki, Yoshikatsu; Machida, Keiichi; Shibata, Iekado

    2001-01-01

    A quantitative CBF calculation method for xenon/CT was developed by logically estimating time-course change rate (rate constant) of arterial xenon concentration from that of end-tidal xenon concentration. A single factor (γ) was introduced to correlate the end-tidal rate constant (Ke) with the arterial rate constant (Ka) in a simplified equation. This factor (γ) is thought to reflect the diffusing capacity of the lung for xenon. When an appropriate value is given to γ, it is possible to calculate the arterial rate constant (Calculated Ka) from Ke. To determine γ for each xenon/CT CBF examination, a procedure was established which utilizes the characteristics of white matter lambda; lambda refers to xenon brain-blood partition coefficient. Xenon/CT studies were performed on four healthy volunteers. Hemispheric CBF values (47.0±9.0 ml/100 g/min) with use of Calculated Ka were close to the reported normative values. For a 27-year-old healthy man, the rate constant for the common carotid artery was successfully measured and nearly equal to Calculated Ka. The authors conclude the method proposed in this work, lambda-guided calculation method, could make xenon/CT CBF substantially reliable and quantitative by effective use of end-tidal xenon. (author)

  16. Osteoid osteoma of the spine: CT-guided monopolar radiofrequency ablation

    Energy Technology Data Exchange (ETDEWEB)

    Martel, Jose [Departamento de Diagnostico por Imagen, Fundacion Hospital Alcorcon, Alcorcon, Madrid (Spain)], E-mail: jmartel@fhalcorcon.es; Bueno, Angel [Departamento de Diagnostico por Imagen, Fundacion Hospital Alcorcon, Alcorcon, Madrid (Spain); Nieto-Morales, M Luisa [Servicio de Radiologia, Hospital Universitario de Tenerife (Spain); Ortiz, Eduardo J. [Departamento de Cirugia Ortopedica, Fundacion Hospital Alcorcon, Alcorcon, Madrid (Spain)

    2009-09-15

    CT-guided percutaneous radiofrequency ablation and laser photocoagulation have become the methods of choice for the treatment of all osteoid osteomas except those in contact with neural structures. We report 10 patients with spinal osteoid osteoma adjacent to the neural elements treated with 12 sessions of CT-guided monopolar radiofrequency ablation. The size range of the lesion was 3-14 mm (mean, 7.5 mm) and the distance between the nidus and the adjacent spinal cord or nerve root was 2-12 mm (mean, 5 mm). No intact cortex between the tumor and the spinal cord or nerve roots constituted an exclusion criterion because of a higher risk of undesirable neurotoxic effects. Patients were under general anesthesia. After location of the lesion, a 11G-bone biopsy was introduced into the nidus. The radiofrequency electrode was inserted through the biopsy needle and heated at 90 deg. C for 4 min. Primary success was obtained in eight patients. At follow-up (mean, 19.5 months; range, 6-24 months), pain persisted in two patients after 2 months. Both of them were re-treated. All patients are currently pain-free and complications were not detected. In our opinion, radiofrequency ablation can also be considered the treatment of choice for spinal osteoid osteoma.

  17. Osteoid osteoma of the spine: CT-guided monopolar radiofrequency ablation

    International Nuclear Information System (INIS)

    Martel, Jose; Bueno, Angel; Nieto-Morales, M Luisa; Ortiz, Eduardo J.

    2009-01-01

    CT-guided percutaneous radiofrequency ablation and laser photocoagulation have become the methods of choice for the treatment of all osteoid osteomas except those in contact with neural structures. We report 10 patients with spinal osteoid osteoma adjacent to the neural elements treated with 12 sessions of CT-guided monopolar radiofrequency ablation. The size range of the lesion was 3-14 mm (mean, 7.5 mm) and the distance between the nidus and the adjacent spinal cord or nerve root was 2-12 mm (mean, 5 mm). No intact cortex between the tumor and the spinal cord or nerve roots constituted an exclusion criterion because of a higher risk of undesirable neurotoxic effects. Patients were under general anesthesia. After location of the lesion, a 11G-bone biopsy was introduced into the nidus. The radiofrequency electrode was inserted through the biopsy needle and heated at 90 deg. C for 4 min. Primary success was obtained in eight patients. At follow-up (mean, 19.5 months; range, 6-24 months), pain persisted in two patients after 2 months. Both of them were re-treated. All patients are currently pain-free and complications were not detected. In our opinion, radiofrequency ablation can also be considered the treatment of choice for spinal osteoid osteoma.

  18. CT-guided spinal injection: initial experience with Sprotte tip needles

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei [Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore (Singapore)

    2010-09-15

    The purpose of this paper is to describe our initial experience and to illustrate the potential benefits of using small caliber (25 and 27 G), noncutting pencil point needles (Sprotte) with single puncture coaxial technique in CT-guided spinal intervention (CTSI). From January 2009 to June 2009, Sprotte needles with single puncture coaxial technique were used in a total of ten patients for selective nerve root block (SNRB), facet joint block, and pars block under CT fluoroscopy (total of 16 target structures). All procedures were performed without conscious sedation, and visual analog scale (VAS) scores were recorded to determine pain related to needle placement. Total CT fluoroscopy time and out-of-plane needle deviation were obtained. Final needle position was documented by contrast injection for SNRBs and image capture for joint space cannulation. Sixteen out of the 16 structures were successfully targeted. No increase in VAS scores associated with needle placement was recorded, after infiltration of local anesthesia. Optimal peri-neurograms were obtained in all cases of SNRB, despite the side-hole opening in the Sprotte needles. Mean CT fluoroscopy time was 2 s (range 2-8 s per structure), and there was no case of out-of-plane needle deviation that required adjustment of the CT gantry. The use of small caliber Sprotte needles in CTSI is technically feasible and represents a potential refinement to current techniques in the management of chronic spinal pain. (orig.)

  19. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Bos, Stijn A.; Torriani, Martin; Simeone, F.J.; Chang, Connie Y.; Pomerantz, Stuart R.; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2017-01-15

    To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention. (orig.)

  20. Dynamic telecytologic evaluation of imprint cytology samples from CT-guided lung biopsies: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut [Otto Wagner Hospital, Department of Radiology, Vienna (Austria); Medical University of Vienna, Department of Radiology, Vienna (Austria); Medical University of Vienna, Vienna General Hospital, Department of Radiology, Vienna (Austria); Hoffmann, Elisabeth; Schober, Ewald; Mostbeck, Gerhard [Otto Wagner Hospital, Department of Radiology, Vienna (Austria); Bernhardt, Klaus; Schalleschak, Johann [Otto Wagner Hospital, Department of Laboratory Medicine, Vienna (Austria); Rowhani, Marcel [Otto Wagner Hospital, Department of Respiratory and Critical Care Medicine, Vienna (Austria); Weber, Michael [Medical University of Vienna, Department of Radiology, Vienna (Austria)

    2011-09-15

    This study assessed the feasibility of telecytological evaluation of samples from CT-guided lung biopsies using a dynamic telecytological system in which the microscope was operated by personnel from the radiology department at the site of the biopsy and a cytologist off-site diagnosed the biopsy sample. 45 imprint samples from CT-guided biopsies of lung lesions were reviewed by two cytologists using a telecytological microscope (Olympus BX51, Tokyo, Japan). The telecytological microscope was operated by one radiologist and one radiology technician. The cytological samples were classified by a cytologist into four categories: benign, malignant, atypical cells of undetermined significance, and non-diagnostic. The results were compared with those of a previous consensus reading of two independent cytologists (gold standard). When the radiologist was operating the microscope, the diagnostic accuracy was 100% as both cytologists came to the correct diagnosis in all samples. When the technician operated the microscope, two diagnoses of cyotologist 1 differed from the gold standard. Thus, the accuracy for the technician was 95.56%. Telecytological evaluation of imprint samples from CT-guided lung biopsies is feasible because it can be performed with high diagnostic accuracy if personnel from the radiology department operate the microscope. (orig.)

  1. CT-guided percutaneous radiofrequency ablation of hepatic malignancies located in unusual regions under general anesthesia

    International Nuclear Information System (INIS)

    Pan Jie; Chen Shaohui; Lu Xin; Mao Yilei; Sang Xinting; Chen Fang; Li Yumei; Huang Yuguang; Jin Zhengyu

    2010-01-01

    Objective: To discuss the feasibility of CT-guided percutaneous radiofrequency ablation (RFA) of liver malignancies located in unusual regions under general anesthesia, and to assess its clinical value. Methods: Eighteen patients with a total of 26 malignant hepatic lesions were enrolled in this study. The lesions were located at diaphragmatic surface, hepatic hilum, hepatic subcapsular site,side of inferior vena cava, side of gallbladder or near by colon. Transcatheter arterial chemoembolization was performed in all patients, which was followed by CT-guided percutaneous RFA under general anesthesia. The time used for puncturing and the time used for putting the needles to the scheduled sites were recorded. A follow-up for 115 months was conducted. The complications and the therapeutic results were observed. Results: For all patients,the procedure of puncture and needle placement was completed in 1-3 minutes. A total of 35 RFA procedures were conducted for 26 lesions. No severe complications occurred. Complete necrosis was observed in 20 tumors and partial necrosis in 6 tumors. Conclusion: The result of this study indicates that CT-guided percutaneous RFA under general anesthesia is a feasible technique for the treatment of liver malignancies located at unusual regions. This technique is very helpful for reducing the manipulating difficulty and lowing the complication risk of RFA procedures. (authors)

  2. Prostate biopsy after ano-rectal resection: value of CT-guided trans-gluteal biopsy

    International Nuclear Information System (INIS)

    Cantwell, Colin P.; Hahn, Peter F.; Gervais, Debra A.; Mueller, Peter R.

    2008-01-01

    We describe our single-institutional experience with computed tomography (CT)-guided percutaneous transgluteal biopsy of the prostate in patients in whom transrectal ultrasound-guided biopsy is precluded by prior ano-rectal resection. Between March 1995 and April 2007, 22 patients had 34 prostate biopsies (mean age 68; mean PSA 29 ng/ml; mean follow-up 6.1 years). The charts of patients who had transgluteal biopsy were reviewed for demographic, complications and pathology. Ninety-five percent (21/22) of primary biopsies were diagnostic. Of the 21 diagnostic biopsies, 11 were positive for prostate cancer and ten were definitive benign samples. Seventy-three percent (8/11) of the patients had progressive PSA elevation that mandated 11 further prostate biopsies. Six patients had a second biopsy, one patient had a third and one patient had a fourth biopsy. Among patients who had serial biopsies, 38% (3/8) had prostate cancer. No complications or death occurred. A malignant biopsy was not significantly associated with core number (P = 0.58) or a high PSA level (P 0.15). CT-guided transgluteal biopsy of the prostate is safe and effective. (orig.)

  3. Integration of PET-CT and cone-beam CT for image-guided radiotherapy with high image quality and registration accuracy

    Science.gov (United States)

    Wu, T.-H.; Liang, C.-H.; Wu, J.-K.; Lien, C.-Y.; Yang, B.-H.; Huang, Y.-H.; Lee, J. J. S.

    2009-07-01

    Hybrid positron emission tomography-computed tomography (PET-CT) system enhances better differentiation of tissue uptake of 18F-fluorodeoxyglucose (18F-FDG) and provides much more diagnostic value in the non-small-cell lung cancer and nasopharyngeal carcinoma (NPC). In PET-CT, high quality CT images not only offer diagnostic value on anatomic delineation of the tissues but also shorten the acquisition time for attenuation correction (AC) compared with PET-alone imaging. The linear accelerators equipped with the X-ray cone-beam computed tomography (CBCT) imaging system for image-guided radiotherapy (IGRT) provides excellent verification on position setup error. The purposes of our study were to optimize the CT acquisition protocols of PET-CT and to integrate the PET-CT and CBCT for IGRT. The CT imaging parameters were modified in PET-CT for increasing the image quality in order to enhance the diagnostic value on tumour delineation. Reproducibility and registration accuracy via bone co-registration algorithm between the PET-CT and CBCT were evaluated by using a head phantom to simulate a head and neck treatment condition. Dose measurement in computed tomography dose index (CTDI) was also estimated. Optimization of the CT acquisition protocols of PET-CT was feasible in this study. Co-registration accuracy between CBCT and PET-CT on axial and helical modes was in the range of 1.06 to 2.08 and 0.99 to 2.05 mm, respectively. In our result, it revealed that the accuracy of the co-registration with CBCT on helical mode was more accurate than that on axial mode. Radiation doses in CTDI were 4.76 to 18.5 mGy and 4.83 to 18.79 mGy on axial and helical modes, respectively. Registration between PET-CT and CBCT is a state-of-the-art registration technology which could provide much information on diagnosis and accurate tumour contouring on radiotherapy while implementing radiotherapy procedures. This novelty technology of PET-CT and cone-beam CT integration for IGRT may have a

  4. Integration of PET-CT and cone-beam CT for image-guided radiotherapy with high image quality and registration accuracy

    International Nuclear Information System (INIS)

    Wu, T-H; Liang, C-H; Wu, J-K; Lien, C-Y; Yang, B-H; Lee, J J S; Huang, Y-H

    2009-01-01

    Hybrid positron emission tomography-computed tomography (PET-CT) system enhances better differentiation of tissue uptake of 18 F-fluorodeoxyglucose ( 18 F-FDG) and provides much more diagnostic value in the non-small-cell lung cancer and nasopharyngeal carcinoma (NPC). In PET-CT, high quality CT images not only offer diagnostic value on anatomic delineation of the tissues but also shorten the acquisition time for attenuation correction (AC) compared with PET-alone imaging. The linear accelerators equipped with the X-ray cone-beam computed tomography (CBCT) imaging system for image-guided radiotherapy (IGRT) provides excellent verification on position setup error. The purposes of our study were to optimize the CT acquisition protocols of PET-CT and to integrate the PET-CT and CBCT for IGRT. The CT imaging parameters were modified in PET-CT for increasing the image quality in order to enhance the diagnostic value on tumour delineation. Reproducibility and registration accuracy via bone co-registration algorithm between the PET-CT and CBCT were evaluated by using a head phantom to simulate a head and neck treatment condition. Dose measurement in computed tomography dose index (CTDI) was also estimated. Optimization of the CT acquisition protocols of PET-CT was feasible in this study. Co-registration accuracy between CBCT and PET-CT on axial and helical modes was in the range of 1.06 to 2.08 and 0.99 to 2.05 mm, respectively. In our result, it revealed that the accuracy of the co-registration with CBCT on helical mode was more accurate than that on axial mode. Radiation doses in CTDI were 4.76 to 18.5 mGy and 4.83 to 18.79 mGy on axial and helical modes, respectively. Registration between PET-CT and CBCT is a state-of-the-art registration technology which could provide much information on diagnosis and accurate tumour contouring on radiotherapy while implementing radiotherapy procedures. This novelty technology of PET-CT and cone-beam CT integration for IGRT may have a

  5. Separation of left and right lungs using 3D information of sequential CT images and a guided dynamic programming algorithm

    Science.gov (United States)

    Park, Sang Cheol; Leader, Joseph Ken; Tan, Jun; Lee, Guee Sang; Kim, Soo Hyung; Na, In Seop; Zheng, Bin

    2011-01-01

    Objective this article presents a new computerized scheme that aims to accurately and robustly separate left and right lungs on CT examinations. Methods we developed and tested a method to separate the left and right lungs using sequential CT information and a guided dynamic programming algorithm using adaptively and automatically selected start point and end point with especially severe and multiple connections. Results the scheme successfully identified and separated all 827 connections on the total 4034 CT images in an independent testing dataset of CT examinations. The proposed scheme separated multiple connections regardless of their locations, and the guided dynamic programming algorithm reduced the computation time to approximately 4.6% in comparison with the traditional dynamic programming and avoided the permeation of the separation boundary into normal lung tissue. Conclusions The proposed method is able to robustly and accurately disconnect all connections between left and right lungs and the guided dynamic programming algorithm is able to remove redundant processing. PMID:21412104

  6. Model studies on segmental movement in lumbar spine using a semi-automated program for volume fusion.

    Science.gov (United States)

    Svedmark, P; Weidenhielm, L; Nemeth, G; Tullberg, T; Noz, M E; Maguire, G Q; Zeleznik, M P; Olivecrona, H

    2008-01-01

    To validate a new non-invasive CT method for measuring segmental translations in lumbar spine in a phantom using plastic vertebrae with tantalum markers and human vertebrae. One hundred and four CT volumes were acquired of a phantom incorporating three lumbar vertebrae. Lumbar segmental translation was simulated by altering the position of one vertebra in all three cardinal axes between acquisitions. The CT volumes were combined into 64 case pairs, simulating lumbar segmental movement of up to 3 mm between acquisitions. The relative movement between the vertebrae was evaluated visually and numerically using a volume fusion image post-processing tool. Results were correlated to direct measurements of the phantom. On visual inspection, translation of at least 1 mm or more could be safely detected and correlated with separation between the vertebrae in three dimensions. There were no significant differences between plastic and human vertebrae. Numerically, the accuracy limit for all the CT measurements of the 3D segmental translations was 0.56 mm (median: 0.12; range: -0.76 to +0.49 mm). The accuracy for the sagittal axis was 0.45 mm (median: 0.10; range: -0.46 to +0.62 mm); the accuracy for the coronal axis was 0.46 mm (median: 0.09; range: -0.66 to +0.69 mm); and the accuracy for the axial axis was 0.45 mm (median: 0.05; range: -0.72 to + 0.62 mm). The repeatability, calculated over 10 cases, was 0.35 mm (median: 0.16; range: -0.26 to +0.30 mm). The accuracy of this non-invasive method is better than that of current routine methods for detecting segmental movements. The method allows both visual and numerical evaluation of such movements. Further studies are needed to validate this method in patients.

  7. [Dose-response relationship of ropivacaine for epidural block in early herpes zoster guided by CT].

    Science.gov (United States)

    Xie, K Y; Ma, J B; Xu, Q; Huang, B; Yao, M; Ni, H D; Deng, J J; Chen, G D

    2017-12-26

    Objective: To determine the dose-response relationship of ropivacaine for epidural block in early herpes zoster by CT guided. Methods: From January 2015 to February 2017, according to the principle of completely random digital table, 80 patients with early herpes zoster who were prepared for epidural block were divided into 4 groups(each group 20 patients): in group A the concentration of ropivacaine was 0.08%, in group B was 0.10%, in group C was 0.12% and in group D was 0.14%.Under CT guidance, epidural puncture was performed in the relevant section, mixing liquid 5.0 ml (with 10% iodohydrin)were injected into epidural gap.CT scan showed that the mixing liquid covered the relevant spinal nerve segmental.The numeric rating scale(NRS) values before treatment and at 30 minutes, the incidence of adverse reactions were recorded, and the treatment were evaluated. The response to ropivacaine for epidural block in early herpes zoster was defined as positive when the NRS values was less than or equal to one.The ED(50), ED(95) and 95% confidence interval ( CI ) of ropivacaine for epidural block in early herpes zoster guided by CT were calculated by probit analysis. Results: The NRS values before treatment were 5.00(4.00, 6.00), 5.00(4.25, 6.00), 5.50(5.00, 6.00) and 5.00(4.00, 6.00), the difference was no significant( Z =2.576, P =0.462). The NRS values at 30 minutes decreased and the effective rate of the treatment increased(χ(2)=8.371, P =0.004), following ropivacaine dose gradient increasing, they were 1.50(1.00, 2.00), 1.00(1.00, 2.00), 0.50(0.00, 1.00) and 0.00(0.00, 1.00), the difference was statistically significant ( Z =17.421, P =0.001). There was one case in group C and four cases in group D were hypoesthesia, others were no significant adverse reactions occurred. The ED(50) and ED(95) (95% CI ) of ropivacaine for epidural block in early herpes zoster guided by CT were 0.078%(0.015%-0.095%)and 0.157%(0.133%-0.271%), respectively. Conclusion: Ropivacaine for

  8. Point of Technique

    African Journals Online (AJOL)

    .

    Minimally invasive techniques are becoming popular choice for the recent times. These techniques are lowering the cost and giving the best cosmetic results. For cardiovascular surgery these techniques are much more newer and much more unknown. Open lumbar sympathectomy for certain indications is a very well ...

  9. Preliminary results of a new workflow for MRI/CT-based image-guided brachytherapy in cervical carcinoma.

    Science.gov (United States)

    Nemoto, Miho Watanabe; Iwai, Yuma; Togasaki, Gentaro; Kurokawa, Marie; Harada, Rintarou; Kobayashi, Hiroki; Uno, Takashi

    2017-12-01

    We propose a method of image-guided brachytherapy (IGBT) that combines MRI-based target volume delineation for the first fraction with CT datasets of subsequent fractions, using an automatic, applicator-based co-registration, and report our preliminary experience. The MRI of the first fraction was used for the first brachytherapy planning. For each subsequent brachytherapy fraction, after the same applicator insertion, a new CT scan with the applicator in place was obtained. The MR image set was registered to the subsequent brachytherapy treatment planning CT using the applicator for rigid body registration. To demonstrate the registration quality, we used here the Dice index as a measurement of tandem delineation overlap between CT and MRI. The median Dice index was 0.879 (range 0.610-0.932), which indicated that the contours on CT and MRI fitted well. With this combination method, the median D90 of HR CTV and the calculated D2 cm 3 of the bladder, rectum, and sigmoid in each fraction were 7.2 (4.0-10.4), 5.9 (2.3-7.7), 4.0 (1.9-6.7), and 3.8 (0.6-7.2) Gy, respectively. Our described method of MRI-guided IGBT offers a practical option for the benefits of target delineation.

  10. CREST Calcinosis Affecting the Lumbar and Cervical Spine and the Use of Minimally-Invasive Surgery

    OpenAIRE

    Faraj, Kassem; Perez-Cruet, Kristin; Perez-Cruet, Mick

    2017-01-01

    Calcinosis in CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome can affect the spinal and paraspinal areas. We present the first case to our knowledge where a CREST syndrome patient required surgery for spinal calcinosis in both the cervical and lumbar areas.?A 66-year-old female with a history of CREST syndrome presented with right-sided lower extremity radicular pain. A computed tomography (CT) scan showed bilateral lumbar masses (5...

  11. CT fluoroscopy guided transpleural cutting needle biopsy of small ({<=}2.5 cm) subpleural pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut; Oschatz, Elisabeth; Eisenhuber, Edith; Wohlschlager, Helmut [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria); Mostbeck, Gerhard H., E-mail: gerhard.mostbeck@wienkav.at [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria)

    2011-01-15

    Purpose: Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions. Material and methods: Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura. Results: Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required. Conclusion: The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.

  12. Fiducial marker guided stereotactic liver radiotherapy: Is a time delay between marker implantation and planning CT needed?

    DEFF Research Database (Denmark)

    Worm, Esben S; Bertholet, Jenny; Høyer, Morten

    2016-01-01

    To minimize the risk of marker migration in fiducial marker guided liver SBRT it is common to add a delay of a week between marker implantation and planning CT. This study found that such a delay is unnecessary and could be avoided to minimize the treatment preparation time.......To minimize the risk of marker migration in fiducial marker guided liver SBRT it is common to add a delay of a week between marker implantation and planning CT. This study found that such a delay is unnecessary and could be avoided to minimize the treatment preparation time....

  13. Imaging of the lumbar spine after diskectomy; Imagerie du rachis lombaire apres discectomie

    Energy Technology Data Exchange (ETDEWEB)

    Laredo, J.D.; Wybier, M. [Hopital Lariboisiere, 75 - Paris (France)

    1995-12-31

    The radiological investigation of persistent or recurrent sciatica after lumbar diskectomy essentially consists of demonstrating recurrent disk herniation. Comparison between plain and contrast enhanced CT or MR examinations at the level of the diskectomy is the main step of the radiological survey. The meanings of the various radiological findings are discussed. Other lesions that may induce persistent sciatica after lumbar diskectomy include degenerative narrowing of the lateral recess, spinal instability, stress fracture of the remaining neural arch, pseudo-meningomyelocele after laminectomy. (authors). 34 refs., 5 tabs.

  14. Iatrogenic intraspinal epidermoid tumor: Myelo-CT and MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Visciani, A.; Balestrini, M.R.; Solero, C.L.; Savoiardo, M.

    1989-07-01

    An 11-year-old boy, treated for acute lymphatic leukemia at the age of 2 with intrathecal injections of Methotrexate, presented with a two year history of pain and signs of lumbo-sacral lesion. MRI, myelography and myelo-CT demonstrated an intradural L4-L5 epidermoid tumor which was removed. Iatrogenic implantation of epithelial cells at the age of two with lumbar punctures is most likely. Decline in incidence of lumbar iatrogenic epidermoid cysts, now an exceedingly rare event, is probably related to improved needles for lumbar punctures. (orig.).

  15. Iatrogenic intraspinal epidermoid tumor: Myelo-CT and MRI diagnosis

    International Nuclear Information System (INIS)

    Visciani, A.; Balestrini, M.R.; Solero, C.L.; Savoiardo, M.

    1989-01-01

    An 11-year-old boy, treated for acute lymphatic leukemia at the age of 2 with intrathecal injections of Methotrexate, presented with a two year history of pain and signs of lumbo-sacral lesion. MRI, myelography and myelo-CT demonstrated an intradural L4-L5 epidermoid tumor which was removed. Iatrogenic implantation of epithelial cells at the age of two with lumbar punctures is most likely. Decline in incidence of lumbar iatrogenic epidermoid cysts, now an exceedingly rare event, is probably related to improved needles for lumbar punctures. (orig.)

  16. Posterior pelvic ring fractures: Closed reduction and percutaneous CT-guided sacroiliac screw fixation

    International Nuclear Information System (INIS)

    Jacob, Augustinus Ludwig; Messmer, Peter; Stock, Klaus-Wilhelm; Suhm, Norbert; Baumann, Bernard; Regazzoni, Pietro; Steinbrich, Wolfgang

    1997-01-01

    Purpose. To assess the midterm results of closed reduction and percutaneous fixation (CRPF) with computed tomography (CT)-guided sacroiliac screw fixation in longitudinal posterior pelvic ring fractures. Methods. Thirteen patients with 15 fractures were treated. Eleven patients received a unilateral, two a bilateral, screw fixation. Twenty-seven screws were implanted. Continuous on-table traction was used in six cases. Mean radiological follow-up was 13 months. Results. Twenty-five (93%) screws were placed correctly. There was no impingement of screws on neurovascular structures. Union occurred in 12 (80%), delayed union in 2 (13%), and nonunion in 1 of 15 (7%) fractures. There was one screw breakage and two axial dislocations. Conclusion. Sacroiliac CRPF of longitudinal fractures of the posterior pelvic ring is technically simple, minimally invasive, well localized, and stable. It should be done by an interventional/surgical team. CT is an excellent guiding modality. Closed reduction may be a problem and succeeds best when performed as early as possible

  17. Edge-oriented dual-dictionary guided enrichment (EDGE) for MRI-CT image reconstruction.

    Science.gov (United States)

    Li, Liang; Wang, Bigong; Wang, Ge

    2016-01-01

    In this paper, we formulate the joint/simultaneous X-ray CT and MRI image reconstruction. In particular, a novel algorithm is proposed for MRI image reconstruction from highly under-sampled MRI data and CT images. It consists of two steps. First, a training dataset is generated from a series of well-registered MRI and CT images on the same patients. Then, an initial MRI image of a patient can be reconstructed via edge-oriented dual-dictionary guided enrichment (EDGE) based on the training dataset and a CT image of the patient. Second, an MRI image is reconstructed using the dictionary learning (DL) algorithm from highly under-sampled k-space data and the initial MRI image. Our algorithm can establish a one-to-one correspondence between the two imaging modalities, and obtain a good initial MRI estimation. Both noise-free and noisy simulation studies were performed to evaluate and validate the proposed algorithm. The results with different under-sampling factors show that the proposed algorithm performed significantly better than those reconstructed using the DL algorithm from MRI data alone.

  18. Percutaneous treatment of cervical and lumbar herniated disc

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A., E-mail: akelekis@med.uoa.gr; Filippiadis, D.K., E-mail: dfilippiadis@yahoo.gr

    2015-05-15

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4–6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75–94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine.

  19. Percutaneous treatment of cervical and lumbar herniated disc

    International Nuclear Information System (INIS)

    Kelekis, A.; Filippiadis, D.K.

    2015-01-01

    Therapeutic armamentarium for symptomatic intervertebral disc herniation includes conservative therapy, epidural infiltrations (interlaminar or trans-foraminal), percutaneous therapeutic techniques and surgical options. Percutaneous, therapeutic techniques are imaging-guided, minimally invasive treatments for intervertebral disc herniation which can be performed as outpatient procedures. They can be classified in 4 main categories: mechanical, thermal, chemical decompression and biomaterials implantation. Strict sterility measures are a prerequisite and should include extensive local sterility and antibiotic prophylaxis. Indications include the presence of a symptomatic, small to medium sized contained intervertebral disc herniation non-responding to a 4–6 weeks course of conservative therapy. Contraindications include sequestration, infection, segmental instability (spondylolisthesis), uncorrected coagulopathy or a patient unwilling to provide informed consent. Decompression techniques are feasible and reproducible, efficient (75–94% success rate) and safe (>0.5% mean complications rate) therapies for the treatment of symptomatic intervertebral disc herniation. Percutaneous, imaging guided, intervertebral disc therapeutic techniques can be proposed either as an initial treatment or as an attractive alternative prior to surgery for the therapy of symptomatic herniation in both cervical and lumbar spine. This article will describe the mechanism of action for different therapeutic techniques applied to intervertebral discs of cervical and lumbar spine, summarize the data concerning safety and effectiveness of these treatments, and provide a rational approach for the therapy of symptomatic intervertebral disc herniation in cervical and lumbar spine

  20. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.

    2013-01-01

    Aim: To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions. Materials and methods: A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables. Results: The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion–pleural distance (p = 0.008) and needle–pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion–pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27–149.95) and a needle–pleural angle ≥51° (OR = 8.22; 95%CI: 2.14–31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion–pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion–pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73–36.43). Conclusion: CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion–pleural distance of ≥21 mm and needle–pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle–pleural angle is a novel predictor of pneumothorax. A lesion–pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate.

  1. Efficacy of different bone volume expanders for augmenting lumbar fusions.

    Science.gov (United States)

    Epstein, Nancy E

    2008-01-01

    A wide variety of bone volume expanders are being used in performing posterolateral lumbar noninstrumented and instrumented lumbar fusions. This article presents a review of their efficacy based on fusion rates, complications, and outcomes. Lumbar noninstrumented and instrumented fusions frequently use laminar autografts and different bone graft expanders. This review presents the utility of multiple forms/ratios of DBMs containing allografts. It also discusses the efficacy of artificial bone graft substitutes, including HA and B-TCP. Dynamic x-ray and/or CT examinations were used to document fusion in most series. Outcomes were variously assessed using Odom's criteria or different outcome questionnaires (Oswestry Questionnaire, SF-36, Dallas Pain Questionnaire, and/or Low Back Pain Rating Scale). Performing noninstrumented and instrumented lumbar posterolateral fusions resulted in comparable fusion rates in many series. Similar outcomes were also documented based on Odom's criteria or the multiple patient-based questionnaires. However, in some studies, the addition of spinal instrumentation increased the reoperation rate, operative time, blood loss, and cost. Various forms of DBMs, applied in different ratios to autografts, effectively supplemented spinal fusions in animal models and patient series. beta-Tricalcium phosphate, which is used to augment autograft fusions addressing idiopathic scoliosis or lumbar disease, also proved to be effective. Different types of bone volume expanders, including various forms of allograft-based DBMs, and artificial bone graft substitutes (HA and B-TCP) effectively promote posterolateral lumbar noninstrumented and instrumented fusions when added to autografts.

  2. Graphics Processing Unit-Accelerated Nonrigid Registration of MR Images to CT Images During CT-Guided Percutaneous Liver Tumor Ablations.

    Science.gov (United States)

    Tokuda, Junichi; Plishker, William; Torabi, Meysam; Olubiyi, Olutayo I; Zaki, George; Tatli, Servet; Silverman, Stuart G; Shekher, Raj; Hata, Nobuhiko

    2015-06-01

    Accuracy and speed are essential for the intraprocedural nonrigid magnetic resonance (MR) to computed tomography (CT) image registration in the assessment of tumor margins during CT-guided liver tumor ablations. Although both accuracy and speed can be improved by limiting the registration to a region of interest (ROI), manual contouring of the ROI prolongs the registration process substantially. To achieve accurate and fast registration without the use of an ROI, we combined a nonrigid registration technique on the basis of volume subdivision with hardware acceleration using a graphics processing unit (GPU). We compared the registration accuracy and processing time of GPU-accelerated volume subdivision-based nonrigid registration technique to the conventional nonrigid B-spline registration technique. Fourteen image data sets of preprocedural MR and intraprocedural CT images for percutaneous CT-guided liver tumor ablations were obtained. Each set of images was registered using the GPU-accelerated volume subdivision technique and the B-spline technique. Manual contouring of ROI was used only for the B-spline technique. Registration accuracies (Dice similarity coefficient [DSC] and 95% Hausdorff distance [HD]) and total processing time including contouring of ROIs and computation were compared using a paired Student t test. Accuracies of the GPU-accelerated registrations and B-spline registrations, respectively, were 88.3 ± 3.7% versus 89.3 ± 4.9% (P = .41) for DSC and 13.1 ± 5.2 versus 11.4 ± 6.3 mm (P = .15) for HD. Total processing time of the GPU-accelerated registration and B-spline registration techniques was 88 ± 14 versus 557 ± 116 seconds (P processing time. The GPU-accelerated volume subdivision technique may enable the implementation of nonrigid registration into routine clinical practice. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  3. FDG-PET/CT in a patient with poor-risk non-seminoma testis with mature teratoma and secondary gliosarcoma: Multimodality imaging for guiding multimodality treatment

    Energy Technology Data Exchange (ETDEWEB)

    Quak, Elske; Kovacs, Iringo; Oyen, Wim J. G.; Van der Graaf, Winette T. A. [Radboud University Nijmegen Medical Centre, Nijmegen (Nauru)

    2015-09-15

    The value of F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting viable tumours in patients with metastasised non-seminomatous testicular cancer and residual and new masses post chemotherapy remains to be determined. We describe the case of a 41-year-old patient with metastasised non-seminomatous testicular cancer, with both retroperitoneal and extra-retroperitoneal residual masses post chemotherapy, for whom FDG-PET/CT guided major treatment decisions. FDG-PET/CT correctly identified the locations of viable tumour, as was proved by histology, and successfully guided surgery. In conclusion, in selected cases surveillance of patients with non-seminomatous testicular cancer with FDG-PET/CT can guide major treatment decisions when considering surgery for metastatic disease.

  4. CT-guided stereotactic operation for hypertensive intracerebral hematoma

    International Nuclear Information System (INIS)

    Takahashi, Shinichiro; Sonobe, Makoto; Koshu, Keiji; Kusunose, Mutsuo; Tsumura, Kotaro

    1989-01-01

    CT-guided stereotactic operation was performed in 55 patients with hypertensive intracerebral hematoma. Location of the hematoma was putamen in 28 cases, thalamus in 14 cases, subcortical area in 9 cases, cerebellum in 3 cases and pons in one case. Ages ranged from 36 to 85 years (mean 59.5). The mean timing of the surgery after bleeding was 4.2 days. The estimated volume of the hematoma on CT was 8 ml to 57 ml in putaminal, 9 ml to 40 ml in thalamic, 18 ml to 77 ml in subcortical, 17 ml to 26 ml in cerebellar and 5 ml in pontine hemorrhage. Aspiration rate at surgery was 60.4% in putaminal, 37.9% in thalamic, 41.7% in subcortical, 45.2% in cerebellar and 30% in pontine hemorrhage. In addition, we evaluated ADL at 6 months postoperatively in patients with putaminal and thalamic hamorrhage. It is concluded that stereotactic operation is advisable in those cases with 10 to 50 ml hematoma volumes in putamen or thalamus. On the other hand, in cases with over 50ml volume, hematoma should be evacuated by craniotomy. (author)

  5. The top 100 classic papers in lumbar spine surgery.

    Science.gov (United States)

    Steinberger, Jeremy; Skovrlj, Branko; Caridi, John M; Cho, Samuel K

    2015-05-15

    Bibliometric review of the literature. To analyze and quantify the most frequently cited papers in lumbar spine surgery and to measure their impact on the entire lumbar spine literature. Lumbar spine surgery is a dynamic and complex field. Basic science and clinical research remain paramount in understanding and advancing the field. While new literature is published at increasing rates, few studies make long-lasting impacts. The Thomson Reuters Web of Knowledge was searched for citations of all papers relevant to lumbar spine surgery. The number of citations, authorship, year of publication, journal of publication, country of publication, and institution were recorded for each paper. The most cited paper was found to be the classic paper from 1990 by Boden et al that described magnetic resonance imaging findings in individuals without back pain, sciatica, and neurogenic claudication showing that spinal stenosis and herniated discs can be incidentally found when scanning patients. The second most cited study similarly showed that asymptomatic patients who underwent lumbar spine magnetic resonance imaging frequently had lumbar pathology. The third most cited paper was the 2000 publication of Fairbank and Pynsent reviewing the Oswestry Disability Index, the outcome-measure questionnaire most commonly used to evaluate low back pain. The majority of the papers originate in the United States (n=58), and most were published in Spine (n=63). Most papers were published in the 1990s (n=49), and the 3 most common topics were low back pain, biomechanics, and disc degeneration. This report identifies the top 100 papers in lumbar spine surgery and acknowledges those individuals who have contributed the most to the advancement of the study of the lumbar spine and the body of knowledge used to guide evidence-based clinical decision making in lumbar spine surgery today. 3.

  6. Multiplanar CT of the spine

    International Nuclear Information System (INIS)

    Rothman, S.L.G.; Glenn, W.V. Jr.

    1986-01-01

    This is an illustrated text on computed tomography (CT) of the lumbar spine with an emphasis on the role and value of multiplanar imaging for helping determine diagnoses. The book has adequate discussion of scanning techniques for the different regions, interpretations of various abnormalities, degenerative disk disease, and different diagnoses. There is a 50-page chapter on detailed sectional anatomy of the spine and useful chapters on the postoperative spine and the planning and performing of spinal surgery with CT multiplanar reconstruction. There are comprehensive chapters on spinal tumors and trauma. The final two chapters of the book are devoted to CT image processing using digital networks and CT applications of medical computer graphics

  7. Automatic prostate localization on cone-beam CT scans for high precision image-guided radiotherapy

    NARCIS (Netherlands)

    Smitsmans, Monique H. P.; de Bois, Josien; Sonke, Jan-Jakob; Betgen, Anja; Zijp, Lambert J.; Jaffray, David A.; Lebesque, Joos V.; van Herk, Marcel

    2005-01-01

    PURPOSE: Previously, we developed an automatic three-dimensional gray-value registration (GR) method for fast prostate localization that could be used during online or offline image-guided radiotherapy. The method was tested on conventional computed tomography (CT) scans. In this study, the

  8. First clinical results of minimally invasive vector lumbar interbody fusion (MIS-VLIF) in spondylodiscitis and concomitant osteoporosis: a technical note.

    Science.gov (United States)

    Rieger, Bernhard; Jiang, Hongzhen; Ruess, Daniel; Reinshagen, Clemens; Molcanyi, Marek; Zivcak, Jozef; Tong, Huaiyu; Schackert, Gabriele

    2017-12-01

    First description of MIS-VLIF, a minimally invasive lumbar stabilization, to evaluate its safety and feasibility in patients suffering from weak bony conditions (lumbar spondylodiscitis and/or osteoporosis). After informed consent, 12 patients suffering from lumbar spondylodiscitis underwent single level MIS-VLIF. Eight of them had a manifest osteoporosis, either. Pre- and postoperative clinical status was documented using numeric rating scale (NRS) for leg and back pain. In all cases, the optimal height for the cage was preoperatively determined using software-based range of motion and sagittal balance analysis. CT scans were obtained to evaluate correct placement of the construct and to verify fusion after 6 months. Since 2013, 12 patients with lumbar pyogenic spondylodiscitis underwent MIS-VLIF. Mean surgery time was 169 ± 28 min and average blood loss was less than 400 ml. Postoperative CT scans showed correct placement of the implants. Eleven patients showed considerable postoperative improvement in clinical scores. In one patient, we observed screw loosening. After documented bony fusion in the CT scan, the fixation system was removed in two cases to achieve lower material load. The load-bearing trajectories (vectors) of MIS-VLIF are different from those of conventional coaxial pedicle screw implantation. The dorsally converging construct combines the heads of the dorsoventral pedicle screws with laminar pedicle screws following cortical bone structures within a small approach. In case of lumbar spondylodiscitis and/or osteoporosis, MIS-VLIF relies on cortical bony structures for all screw vectors and the construct does not depend on conventional coaxial pedicle screws in the presence of inflamed, weak, cancellous or osteoporotic bone. MIS-VLIF allows full 360° lumbar fusion including cage implantation via a small, unilateral dorsal midline approach.

  9. MR imaging findings of ring apophyseal fractures in lumbar vertebrae

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yong Soo; Kwon, Soon Tae; Song, Chang Joon; Lee, Young Hwan; Kim, Hyoung Seob; Lee, Hwan Do; Cho, June Sik; Ahn, Jae Sung; Lee, June Kyu [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1997-07-01

    To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7%. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery.

  10. MR imaging findings of ring apophyseal fractures in lumbar vertebrae

    International Nuclear Information System (INIS)

    Kang, Yong Soo; Kwon, Soon Tae; Song, Chang Joon; Lee, Young Hwan; Kim, Hyoung Seob; Lee, Hwan Do; Cho, June Sik; Ahn, Jae Sung; Lee, June Kyu

    1997-01-01

    To assess the location and associated findings of fractures of the posterior lumbar vertebral ring apophysis as seen on MRI We retrospectively evaluated MR findings in 77 patients (86 lesions) with lumbar apophyseal ring fractures. Their age ranged from ten to 67 (mean 33-1) years. To confirm the presence of verterbral ring fractures, CT was performed in 29 patients (31 lesions) within two weeks of MR imaging. Open laminectomy was performed in ten patients, percutaneous automated nucleotomy in three, and LASER operation in four. The most common location of fractures was the superior margin of L5 (36 lesions 41.9%), next was superior margin of S1 (21 lesions, 24.4%). On CT, a bony fragment was seen in 28 patients (30 lesions); the positive predictive value of MR was 99.7%. Multiple lesions were seen in nine patients. Associated disc herniation and bulging were noted in 64 (74.4%) and 15 lesions (17.4%), respectively, and a high signal intensity rim aound the bony fragment on T1 weighted image was noted in 33 (38.4%). Other associated findings were spondylolysis in eight patients, retrolisthesis in five, and spondylolisthesis in three. Operative outcomes were variable. The results of open laminectomy were better than those of percutaneous automated laminectomy or LASER operation. In patients with lumbar apophyseal ring fractures, their exact location and associated findings could be evalvated by MRI, which was therefore useful in the planning of appropriate surgery

  11. Electromagnetic tracking for CT-guided spine interventions: phantom, ex-vivo and in-vivo results

    International Nuclear Information System (INIS)

    Bruners, Philipp; Penzkofer, Tobias; Nagel, Markus; Elfring, Robert; Schmitz-Rode, Thomas; Gronloh, Nina; Guenther, Rolf W.; Mahnken, Andreas H.

    2009-01-01

    An electromagnetic-based tracking and navigation system was evaluated for interventional radiology. The electromagnetic tracking system (CAPPA IRAD EMT, CASinnovations, Erlangen, Germany) was used for real-time monitoring of punctures of the lumbar facet joints and intervertebral disks in a spine phantom, three pig cadavers and three anaesthesized pigs. Therefore, pre-interventional computed tomography (CT) datasets were transferred to the navigation system and puncture trajectories were planned. A coaxial needle was advanced along the trajectories while the position of the needle tip was monitored in real time. After puncture tracts were marked with pieces of wire another CT examination was performed and distances between wires and anatomical targets were measured. Performing punctures of the facet joints mean needle positioning errors were 0.4 ± 0.8 mm in the spine phantom, 2.8 ± 2.1 mm ex vivo and 3.0 ± 2.0 mm in vivo with mean length of the puncture tract of 54.0 ± 10.4 mm (phantom), 51.6 ± 12.6 mm (ex vivo) and 50.9 ± 17.6 mm (in vivo). At first attempt, intervertebral discs were successfully punctured in 15/15 in the phantom study, in 12/15 in the ex-vivo study and 14/15 in the in-vivo study, respectively. Immobilization of the patient and optimal positioning of the field generator are essential to achieve a high accuracy of needle placement in a clinical CT setting. (orig.)

  12. Lumbar Disc Herniation in a Patient With Congenital Vertebral Body Anomaly: A Case Report

    Science.gov (United States)

    Atabey, Cem; Topuz, Ali Kivanc; Velioğlu, Murat; Demircan, Mehmet Nusret

    2014-01-01

    Lumbar disc herniation is characterized with low back and leg pain resulting from the degenerated lumbar disc compressing the spinal nerve root. The etiology of degenerative spine is related to age, smoking, microtrauma, obesity, disorders of familial collagen structure, occupational and sports-related physical activity. However, disc herniations induced by congenital lumbar vertebral anomalies are rarely seen. Vertebral fusion defect is one of the causes of congenital anomalies. The pathogenesis of embryological corpus vertebral fusion anomaly is not fully known. In this paper, a 30-year-old patient who had the complaints of low back and right leg pain after falling from a height is presented. She had right L5-S1 disc herniation that had developed on the basis of S1 vertebra corpus fusion anomaly in Lumbar computed tomography. This case has been discussed in the light of literature based on evaluations of Lumbar Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). This case is unique in that it is the first case with development of lumbar disc herniation associated with S1 vertebral corpus fusion anomaly. Congenital malformations with unusual clinical presentation after trauma should be evaluated through advanced radiological imaging techniques. PMID:25620987

  13. Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas

    Energy Technology Data Exchange (ETDEWEB)

    Prud' homme, Clara; Nueffer, Jean-Philippe; Runge, Michel; Dubut, Jonathan [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Kastler, Bruno [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); I4S Laboratory, INSERM EA4268, University of Franche-Comte, Besancon (France); Aubry, Sebastien [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon (France)

    2017-03-15

    The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 x 15 x 16 mm. CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions. (orig.)

  14. Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas

    International Nuclear Information System (INIS)

    Prud'homme, Clara; Nueffer, Jean-Philippe; Runge, Michel; Dubut, Jonathan; Kastler, Bruno; Aubry, Sebastien

    2017-01-01

    The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 x 15 x 16 mm. CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions. (orig.)

  15. Anaesthesia management of a case of Jervell and Lange-Nielsen syndrome for minimally invasive bilateral thoracoscopic cervicothoracic sympathectomy

    Directory of Open Access Journals (Sweden)

    Preety Mittal Roy

    2016-01-01

    Full Text Available Long QT syndrome (LQTS is an arrhythmogenic cardiac disorder resulting from the malfunction of cardiac ion channels. Patient with LQTS may present with syncope, seizures or sudden cardiac death secondary to polymorphic ventricular tachycardia (VT or torsades de pointes. Patient may be asymptomatic in the pre-operative period but may develop VT for the first time in operation theatre. We are reporting anaesthetic management of a child with LQTS planned for bilateral thoracoscopic cervicothoracic sympathectomy.

  16. Intraosseous lipomata in Paget's disease: an unusual CT appearance

    International Nuclear Information System (INIS)

    Robbie, M.J.; Pratsis, K.K.; Lockie, D.J.

    1991-01-01

    A case of multiple intraosseous lumbar vertebral lipomata is reported occurring in the prescence of Paget's disease. The pathology and radiology are correlated. An 84 year old man with Paget's disease presented after a cerebrovascular accident which caused him a mild right hemiparesis. Lumbar vertebral lesions were noted incidentally on abdominal radiographs and a CT scan was performed to define the abnormal areas. CT appearance favoured a slow growing non-invasive lesion. However, it failed to show the lower attenuation expected of a fatty lesion such as a lipoma. It is estimated that CT can be diagnostic if it does show fat level attenuation while Magnetic Resonance Imaging can define the lesion in the sagittal and coronal planes as well as provide the signal characteristics of fat (high signal on T1 and T2 weighted images) irrespective of its myxoid ground substance content

  17. Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

    2009-04-15

    To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

  18. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study.

    Science.gov (United States)

    Quak, Elske; Blanchard, David; Houdu, Benjamin; Le Roux, Yannick; Ciappuccini, Renaud; Lireux, Barbara; de Raucourt, Dominique; Grellard, Jean-Michel; Licaj, Idlir; Bardet, Stéphane; Reznik, Yves; Clarisse, Bénédicte; Aide, Nicolas

    2018-04-01

    To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients

  19. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive. The APACH1 study

    Energy Technology Data Exchange (ETDEWEB)

    Quak, Elske; Lireux, Barbara; Bardet, Stephane [Francois Baclesse Cancer Centre, Department of Nuclear Medicine and Thyroid Unit, Caen (France); Blanchard, David; Raucourt, Dominique de [Francois Baclesse Cancer Centre, Department of Head and Neck Surgery, Caen (France); Houdu, Benjamin [University Hospital, Department of Nuclear Medicine, Caen (France); Le Roux, Yannick [University Hospital, Department of General and Endocrine Surgery, Caen (France); Ciappuccini, Renaud [Francois Baclesse Cancer Centre, Department of Nuclear Medicine and Thyroid Unit, Caen (France); Caen University, INSERM 1086 ANTICIPE, Caen (France); Grellard, Jean-Michel; Licaj, Idlir; Clarisse, Benedicte [Francois Baclesse Cancer Centre, Department of Clinical Research, Caen (France); Reznik, Yves [University Hospital, Department of Endocrinology, Caen (France); Aide, Nicolas [Francois Baclesse Cancer Centre, Department of Nuclear Medicine and Thyroid Unit, Caen (France); University Hospital, Department of Nuclear Medicine, Caen (France); Caen University, INSERM 1086 ANTICIPE, Caen (France)

    2018-04-15

    To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients with primary

  20. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive. The APACH1 study

    International Nuclear Information System (INIS)

    Quak, Elske; Lireux, Barbara; Bardet, Stephane; Blanchard, David; Raucourt, Dominique de; Houdu, Benjamin; Le Roux, Yannick; Ciappuccini, Renaud; Grellard, Jean-Michel; Licaj, Idlir; Clarisse, Benedicte; Reznik, Yves; Aide, Nicolas

    2018-01-01

    To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients with primary

  1. Usefulness of CT-guided automatic needle biopsy of solitary pulmonary nodule smaller than 15 mm

    International Nuclear Information System (INIS)

    Jin, Gong Yong; Lim, Yeong Su

    2004-01-01

    To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications

  2. CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years.

    Science.gov (United States)

    Yin, Zhongyuan; Liang, Zhiwen; Li, Pengcheng; Wang, Qiong

    2017-08-01

    To retrospectively evaluate the diagnostic performance and complications of a CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach. From January 2009 to December 2014, we used a coaxial positioning system and an 18G cutting-type biopsy device to perform CT-guided percutaneous transpulmonary needle biopsies of mediastinal nodes for 127 patients. The diagnostic performance, complication rate, influencing factors, distribution of mediastinal nodes and pathological diagnoses were investigated. Among 127 patients, pathologic analyses showed that all of the biopsies were technically successful. The sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. As for complications, the ratios for pneumothorax and hemoptysis were 33.9% and 4.7%, respectively. Multivariate analyses revealed that the distance from the pleura to the target lesion (P = 0.008) and the numbers of visceral pleura injuries (P = 0.006) were the two most significant risk factors for pneumothorax, and that the distance from the pleura to the target lesion (P = 0.004) was the most significant risk factor for hemoptysis. CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach is a safe and efficient diagnostic method. • CT-guided core needle biopsy is an accurate technique for diagnosing mediastinal nodes. • The rates of complications are similar to those for pulmonary lesion biopsy. • Pneumothorax risk factors include distance from pleura to target lesion and number of visceral pleura. • Distance from pleura to target lesion is the risk factor for hemoptysis. • CT-guided core needle biopsy is an important diagnostic method for mediastinal nodes.

  3. Relationships between cone beam CT value and physical density in image guided radiation therapy

    International Nuclear Information System (INIS)

    Jiang Xiaoqin; Bai Sen; Zhong Renming; Tang Zhiquan; Jiang Qinfeng; Li Tao

    2007-01-01

    Objective: To evaluate the main factors affecting the relationship between physical density and CT value in cone-beam computed tomography(CBCT) for imaging guided radiation therapy(IGRT) by comparing the CT value in the image from cone-beam scanner and from fan-beam (FBCT) scanner of a reference phantom. Methods: A taking-park reference phantom with a set of tissue equivalent inserts was scanned at different energies different fields of view (FOV) for IGRT-CBCT and FBCT. The CT value of every insert was measured and compared. Results: The position of inserts in phantom, the size of phantom, the FOV of scanner and different energies had more effect on the relationships between physical density and the CT value from IGRT-CBCT than those from the normal FBCT. The higher the energy was, the less effect of the position of inserts in phantom, the size of phantom and the FOV of scanner on CT value, and the poorer density contrast was observed. Conclusion: At present, the CT value of IGRT-CBCT is not in the true HU value since the manufacturer has not corrected its number. Therefore, we are not able to use the CT value of CBCT for dose calculation in TPS. (authors)

  4. CT-guided percutaneous cryoablation of osteoid osteoma in children: an initial study

    International Nuclear Information System (INIS)

    Wu, Bin; Xiao, Yue-Yong; Zhang, Xiao; Zhao, Lei; Carrino, John A.

    2011-01-01

    The purpose of this study was to evaluate the safety and efficacy of CT-guided percutaneous cryoablation for osteoid osteoma in children. This study was approved by the institutional ethics committee. From January 2007 to July 2008, six children (four boys, two girls, mean age 12.6 years old) with osteoid osteoma were treated with CT-guided percutaneous cryoablation. The procedures were carried out under conscious sedation and local anesthesia. CT guidance was used for procedural planning, instrument guidance, and monitoring. An argon-based cryoablation system was used. Each cryoablation included two freezing-thawing cycles. Follow-up was performed to assess technical and clinical outcome for a minimum of 12 months. A visual analog scale (VAS) was used to assess severity of pain pre- and post-procedure, and mean VAS for the group was compared pre- and post-procedure with a t-test. The mean clinical follow-up period was 28.7 months (ranging from 18 to 36 months). Cryoablation was technically and clinically successful for all patients. No major immediate or delayed complications were observed. Significant pain relief (P <0.05) was observed in all patients after operation. Mean VAS were 6.57 ± 0.55 pre-procedure and 0.57 ± 0.10 1 month post-procedure. Patients were allowed to fully bear their weight and function without limitation within 3 days after the procedure. Pain recurrence was not observed in any patient. Percutaneous cryoablation is safe and effective for the treatment of osteoid osteomas in children. Notably, this procedure can be accomplished without general anesthesia. (orig.)

  5. CT diagnosis of lumbosacral conjoined nerve roots

    International Nuclear Information System (INIS)

    Torricelli, P.; Martinelli, C.; Spina, V.

    1987-01-01

    The authors report the observations derived from CT evaluation of 19 cases of lumbosacral conjoined nerve roots; 11 of these have been confirmed by lumbar myelography and/or at surgery. They conclude that CT without intrathecal metrizamide allows the recognition in most cases the presence of conjoined nerve roots and to differentiate them from a herniated disk fragment; this is especially usefull avoid surgical damage of anomalous roots. (orig.)

  6. Protocol of image guided off-line using cone beam CT megavoltage; Protocolo de imagen guiada off-line mediante Cone Beam CT de megavoltaje

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Ruiz-Zorrilla, J.; Fernandez Leton, J. P.; Perez Moreno, J. M.; Zucca Aparicio, D.; Minambres Moro, A.

    2013-07-01

    The goal of image guided protocols offline is to reduce systematic errors in positioning of the patient in the treatment unit, being more important than the random errors, since the systematic have one contribution in the margin of the CTV to the PTV. This paper proposes a protocol for image guided offline with the different actions to take with their threshold values evaluated previously by anatomic location in a sample of 474 patients and 4821Cone beam Megavoltaje CT (CBCT). (Author)

  7. Nursing care for patients with local recurrent rectal cancer after CT-guided 125I seed implantation therapy

    International Nuclear Information System (INIS)

    Yuan Li; Wei Fan; Ren Caifeng; Tu Mingmei; Qian Guixiang

    2010-01-01

    Objective: To discuss the nursing care strategy for patients with local recurrent rectal cancer who has been treated with CT-guided 125 I seed implantation therapy. Methods: Twenty patients with local recurrent rectal cancer received a series of nursing interventions, including comfort care and pain care. The clinical results were observed and analyzed. Results: The therapy was smoothly accomplished in all patients. The pain was remarkably relived and the anxiety was alleviated. No displacement of implanted 125 I seed occurred. Conclusion: For patients with local recurrent rectal cancer occurred after CT-guided 125 I seed implantation therapy, careful nursing can effectively relieve the pain and anxiety feeling,and the living quality can also be markedly improved. (authors)

  8. The Lumbar Lordosis in Males and Females, Revisited.

    Directory of Open Access Journals (Sweden)

    Ori Hay

    Full Text Available Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females.Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height.Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined.Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis. The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

  9. The Lumbar Lordosis in Males and Females, Revisited.

    Science.gov (United States)

    Hay, Ori; Dar, Gali; Abbas, Janan; Stein, Dan; May, Hila; Masharawi, Youssef; Peled, Nathan; Hershkovitz, Israel

    2015-01-01

    Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

  10. [Lumbar spondylosis].

    Science.gov (United States)

    Seichi, Atsushi

    2014-10-01

    Lumbar spondylosis is a chronic, noninflammatory disease caused by degeneration of lumbar disc and/or facet joints. The etiology of lumbar spondylosis is multifactorial. Patients with lumbar spondylosis complain of a broad variety of symptoms including discomfort in the low back lesion, whereas some of them have radiating leg pain or neurologenic intermittent claudication (lumbar spinal stenosis). The majority of patients with spondylosis and stenosis of the lumbosacral spine can be treated nonsurgically. Nonsteroidal anti-inflammatory drugs and COX-2 inhibitors are helpful in controlling symptoms. Prostaglandin, epidural injection, and transforaminal injection are also helpful for leg pain and intermittent claudication. Operative therapy for spinal stenosis or spondylolisthesis is reserved for patients who are totally incapacitated by their condition.

  11. CT-guided percutaneous vertebroplasty for the treatment of metastases in the cervical spine

    International Nuclear Information System (INIS)

    Wang Jianhua; Wang Zhentang; Zuo Changjing; Shao Chenwei; Chen Wei; Lv Taozhen; Dong Aisheng

    2009-01-01

    Objective: To assess the clinical efficacy and complications of CT-guided percutaneous vertebroplasty in the treatment of metastases of the cervical spine, and to discuss the proper needle path for different cervical vertebra. Methods: CT-guided percutaneous vertebroplasty was performed in 17 patients with cervical vertebral metastatic neoplasm, and the results of the treatment were retrospectively analyzed. Close observation was carded out after the procedure and a follow-up of 3-17 months was conducted. A comparison of the visual analogue pain scale (VAS) and Frankel's classification between pre-and post- operation was made. The occurrence of complications was recorded. The optimal needle path was summarized. Results: (1) The successful puncture was achieved in all 17 cases. The needle pathway included: the front of carotid sheath (n=4), between carotid sheath and vertebral artery (n=11) and behind the vertebral artery and carotid sheath (n=2). (2) Before the procedure the VAS was 7.24 ± 1.01, and at the time of one hour, one week and three months after the procedure it was decreased to 3.24 ± 1.09, 2.40 ± 0.80 and 1.82 ± 0.53 respectively. Wilcoxon signed-rank test showed that the difference in VAS between pre-and post- operation was statistically significant (T=76.5, P 2 =4.52, P=0.033 and P<0.05 when Kruskal-Wallis test was adopted. (3) CT scanning immediately after the procedure showed that slight leakage of cement to the adjacent disc, epidural fat, parosteal tissue or to the needle path occurred in 35.3% with no serious complications. In a follow-up period of 3-17 months, the metastatic lesions remained stable in 14 cases (82.4%). Conclusion: (1) The optimal needle path for upper cervical vertebrae is posterolateral transpedicular approach while for the lower cervical vertebrae it is more reasonable to puncture via the front carotid sheath or between carotid sheath and vertebral artery. Nevertheless, the puncture pathway should be devised individually

  12. Assessment of Lumbar Lordosis and Lumbar Core Strength in Information Technology Professionals.

    Science.gov (United States)

    Mehta, Roma Satish; Nagrale, Sanket; Dabadghav, Rachana; Rairikar, Savita; Shayam, Ashok; Sancheti, Parag

    2016-06-01

    Observational study. To correlate lumbar lordosis and lumbar core strength in information technology (IT) professionals. IT professionals have to work for long hours in a sitting position, which can affect lumbar lordosis and lumbar core strength. Flexicurve was used to assess the lumbar lordosis, and pressure biofeedback was used to assess the lumbar core strength in the IT professionals. All subjects, both male and female, with and without complaint of low back pain and working for two or more years were included, and subjects with a history of spinal surgery or spinal deformity were excluded from the study. Analysis was done using Pearson's correlation. For the IT workers, no correlation was seen between lumbar lordosis and lumbar core strength (r=-0.04); however, a weak negative correlation was seen in IT people who complained of pain (r=-0.12), while there was no correlation of lumbar lordosis and lumbar core in IT people who had no complains of pain (r=0.007). The study shows that there is no correlation of lumbar lordosis and lumbar core strength in IT professionals, but a weak negative correlation was seen in IT people who complained of pain.

  13. Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules.

    Science.gov (United States)

    Lendeckel, Derik; Kromrey, Marie-Luise; Ittermann, Till; Schäfer, Sophia; Mensel, Birger; Kühn, Jens-Peter

    2017-01-01

    Pneumothoraces are the most frequently occurring complications of CT-guided percutaneous transthoracic pulmonary biopsies (PTPB). The aim of this study was to evaluate the influence of pre-diagnostic lung emphysema on the incidence and extent of pneumothoraces and to establish a risk stratification for the evaluation of the pre-procedure complication probability. CT-guided PTPB of 100 pre-selected patients (mean age 67.1±12.8 years) were retrospectively enrolled from a single center database of 235 PTPB performed between 2012-2014. Patients were grouped according to pneumothorax appearance directly after PTPB (group I: without pneumothorax, n = 50; group II: with pneumothorax, n = 50). Group II was further divided according to post-interventional treatment (group IIa: chest tube placement, n = 24; group IIb: conservative therapy, n = 26). For each patient pre-diagnostic percentage of emphysema was quantified using CT density analysis. Emphysema stages were compared between groups using bivariate analyses and multinomial logistic regression analyses. Emphysema percentage was significantly associated with the occurrence of post-interventional pneumothorax (p = 0.006). Adjusted for potential confounders (age, gender, lesion size and length of interventional pathway) the study yielded an OR of 1.07 (p = 0.042). Absolute risk of pneumothorax increased from 43.4% at an emphysema rate of 5% to 73.8% at 25%. No differences could be seen in patients with pneumothorax between percentage of emphysema and mode of therapy (p = 0.721). The rate of lung emphysema is proportionally related to the incidence of pneumothorax after CT-guided PTPB and allows pre-interventional risk stratification. There is no association between stage of emphysema and post-interventional requirement of chest tube placement.

  14. Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Cristiano Dias de; Nunes, Rodolfo Acatauassu; Saito, Eduardo Haruo; Higa, Claudio; Cardona, Zanier Jose Fernando; Santos, Denise Barbosa dos, E-mail: cristianodiaslima@gmail.co [Hospital Universitario Pedro Ernesto (HUPE/UERJ), Rio de Janeiro, RJ (Brazil). Dept. Cirurgia Toracica

    2011-03-15

    Objective: to analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. Methods: a retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. Results: the main indication for the procedure was suspicion of advanced stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5%. The lesion was confirmed as cancer in 73% of the patients. The major complication was pneumothorax (27.8%), which required chest tube drainage in 12.4% of the procedures. Conclusions: the principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure. (author)

  15. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability

    Energy Technology Data Exchange (ETDEWEB)

    Desai, Amidevi; Saha, Shouvik; Sharma, Naveen; Huckerby, Lauren; Houghton, Russell [Guy' s and St. Thomas' Hospitals, Department of Radiology, London (United Kingdom)

    2014-07-15

    CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone. Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months. In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant. CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure. (orig.)

  16. The short- and medium-term effectiveness of CT-guided selective cervical nerve root injection for pain and disability

    International Nuclear Information System (INIS)

    Desai, Amidevi; Saha, Shouvik; Sharma, Naveen; Huckerby, Lauren; Houghton, Russell

    2014-01-01

    CT-guided cervical nerve root injection with corticosteroid and/or local anesthetic is a recognized technique in the evaluation and treatment of cervical radiculopathy. There are few prospective studies on the efficacy of the various techniques employed in cervical nerve root injection. We present our results from a 1-year prospective series using a CT-guided anterolateral transforaminal approach for cervical nerve root injection of bupivacaine and dexamethasone. Pain using a numeric rating scale was assessed at pre-injection, 15 min post-injection, 1 month, and 3 months. Disability was assessed using the Oswestry Neck Disability Index (NDI) questionnaire at pre-injection, 1 month post-injection, and 3 months. In total, 50 patients were followed for 3 months. The mean reductions in pain were: 15 min (77 %), 1 month (39 %), and 3 months (33 %). The mean reductions in NDI were: 1 month (26 %) and 3 months (also 26 %). Results were statistically significant. CT-guided selective cervical nerve root injection in the treatment of cervical radicular pain and related disability produces statistically significant reductions in pain and disability to at least 3 months post-procedure. (orig.)

  17. CT-guided transgluteal biopsy for systematic sampling of the prostate in patients without rectal access: a 13-year single-center experience.

    Science.gov (United States)

    Olson, Michael C; Atwell, Thomas D; Mynderse, Lance A; King, Bernard F; Welch, Timothy; Goenka, Ajit H

    2017-08-01

    The purpose of our study was to examine the safety and diagnostic utility of transgluteal CT-guided prostate biopsy for prostate sampling in patients without rectal access. Seventy-three biopsies were performed in 65 patients over a 13-year period (2002-2015). Mean prostate-specific antigen (PSA) at biopsy was 7.8 ng/mL (range 0.37-31.5). Electronic medical records were reviewed for procedural details and complications. Mean PSA and number of cores in malignant and benign cohorts were compared with Student's t test. Technical success rate was 97.3% (71/73; mean cores 8, range 3-28). Of these, 43.6% (31/71) yielded malignancy (mean Gleason score 7, range 6-10) and 56.3% (40/71) yielded benign tissue. The only complication was an asymptomatic periprostatic hematoma (1/73; 1.4%). In 14 patients who underwent surgery, Gleason scores were concordant in 71.4% (10/14) and discordant in 28.6% (4/14; Gleason 6 on biopsy but Gleason 7 on surgical specimen). Mean effective radiation dose was 18.5 mSv (median 15.0, range 4.4-86.2). There was no significant difference in either mean PSA (p = 0.06) or number of core specimens (p = 0.33) between malignant and benign cohorts. CT-guided transgluteal prostate biopsy is highly safe and reliable for the detection of prostate cancer in men without rectal access. • Prostate cancer detection in men without rectal access is challenging. • CT-guided transgluteal prostate biopsy is safe and effective in these patients. • CT-guided biopsy may be particularly effective in diagnosing high-grade prostate cancer. • Unilateral CT-guided biopsy may be effective in patients with focal lesions. • The radiation exposure with this technique is acceptable.

  18. The variation of cancellous bones at lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep.

    Science.gov (United States)

    Zhang, Yongqiang; Li, Yongfeng; Gao, Qi; Shao, Bo; Xiao, Jianrui; Zhou, Hong; Niu, Qiang; Shen, Mingming; Liu, Baolin; Hu, Kaijin; Kong, Liang

    2014-07-01

    This study aimed to compare the variation of cancellous bones at four skeletal sites: lumbar vertebra, femoral neck, mandibular angle and rib in ovariectomized sheep. Sixteen adult sheep were randomly divided into two groups: eight sheep were ovariectomized served as experimental group; the other eight untreated sheep were served as control group. Bone mineral density was assessed by dual-energy X-ray absorptiometry on lumbar vertebrae at baseline and twelve months after ovariectomy. After 12 months, lumbar vertebrae L3 and L4, femoral necks, mandibular angles and the fourth ribs were harvested for micro-CT scanning, histological analysis and biomechanical test. The results showed that bone mineral density of lumbar vertebra decreased significantly in twelfth month (pbone volume/total volume decreased by 45.6%, 36.1% 21.3% and 18.7% in lumbar vertebrae, femoral necks, mandibular angles and ribs in experimental group (pbones to oestrogen deficiency in ovariectomized sheep was site-specific on a pattern as follows: lumbar vertebra, femoral neck, mandibular angle and rib. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Clinical Outcomes of Patients Receiving Integrated PET/CT-Guided Radiotherapy for Head and Neck Carcinoma

    International Nuclear Information System (INIS)

    Vernon, Matthew R.; Maheshwari, Mohit; Schultz, Christopher J.; Michel, Michelle A.; Wong, Stuart J.; Campbell, Bruce H.; Massey, Becky L.; Wilson, J. Frank; Wang Dian

    2008-01-01

    Purpose: We previously reported the advantages of 18 F-fluorodeoxyglucose-positron emission tomography (PET) fused with CT for radiotherapy planning over CT alone in head and neck carcinoma (HNC). The purpose of this study was to evaluate clinical outcomes and the predictive value of PET for patients receiving PET/CT-guided definitive radiotherapy with or without chemotherapy. Methods and Materials: From December 2002 to August 2006, 42 patients received PET/CT imaging as part of staging and radiotherapy planning. Clinical outcomes including locoregional recurrence, distant metastasis, death, and treatment-related toxicities were collected retrospectively and analyzed for disease-free and overall survival and cumulative incidence of recurrence. Results: Median follow-up from initiation of treatment was 32 months. Overall survival and disease-free survival were 82.8% and 71.0%, respectively, at 2 years, and 74.1% and 66.9% at 3 years. Of the 42 patients, seven recurrences were identified (three LR, one DM, three both LR and DM). Mean time to recurrence was 9.4 months. Cumulative risk of recurrence was 18.7%. The maximum standard uptake volume (SUV) of primary tumor, adenopathy, or both on PET did not correlate with recurrence, with mean values of 12.0 for treatment failures vs. 11.7 for all patients. Toxicities identified in those patients receiving intensity modulated radiation therapy were also evaluated. Conclusions: A high level of disease control combined with favorable toxicity profiles was achieved in a cohort of HNC patients receiving PET/CT fusion guided radiotherapy plus/minus chemotherapy. Maximum SUV of primary tumor and/or adenopathy was not predictive of risk of disease recurrence

  20. CT follow-up of conservatively treated lumbar disc herniation

    International Nuclear Information System (INIS)

    Schumacher, M.; Fischer, R.; Thoden, U.

    1990-01-01

    A CT study was carried out on 43 patients with low back pain and sciatica who were treated conservatively. They were followed up for over 20 months (mean) clinically and monitored by CT before and after treatment. Initially, 38 of them had herniation and 5 had protrusion of the disc. At the time of follow-up only 24 of the initial 40 patients still had neurological deficits. In 76.7% of the patients CT showed an improvement (clear regression in 15 patients, moderate decrease in 18 patients). A favourable tendency towards regression was observed in disc herniation at the L5-S1 level and in cases showing sequestration. The prognosis was unfavourable in herniations at higher levels than L5-S1 and in lateral herniation reaching the intervertebral foramen. (orig.) [de

  1. Bertolotti's syndrome revisited. Transitional vertebrae of the lumbar spine.

    Science.gov (United States)

    Elster, A D

    1989-12-01

    Bertolotti's syndrome refers to the association of back pain with lumbosacral transitional vertebrae. Such vertebrae were observed in 140 of 2,000 adults with back pain over a 4-year period of study. Each patient had radiographic evaluation of the lumbar spine by plain films as well as a sectional imaging modality (magnetic resonance [MR] or computed tomography [CT]). The overall incidence of structural pathology (eg, spinal stenosis and disc protrusion) detected by CT or MR was not apparently higher in patients with transitional vertebrae, but the distribution of these lesions was significantly different. Disc bulge or herniation, when it occurred, was nearly nine times more common at the interspace immediately above the transitional vertebra than at any other level. Spinal stenosis and nerve root canal stenosis were more common at or near the interspace above the transitional vertebra than at any other level. Degenerative change at the articulation between the transverse process of the transitional vertebra and the pelvis was an uncommon occurrence; when seen there was no significant correlation with the reported side of pain. It is postulated that hypermobility and altered stresses become concentrated in the spine at the level immediately above a lumbar transitional vertebra. Accelerated disc and facet joint degeneration at this level may then result.

  2. Quality assurance in CT: implementation of the updated national diagnostic reference levels using an automated CT dose monitoring system.

    Science.gov (United States)

    Appel, E; Kröpil, P; Bethge, O T; Aissa, J; Thomas, C; Antoch, G; Boos, J

    2018-03-20

    To evaluate the implementation of the updated computed tomography (CT) diagnostic reference levels (DRLs) from the German Federal Office for Radiation Protection into clinical routine using an automatic CT dose monitoring system. CT radiation exposure was analysed before and after implementing the updated national DRLs into routine clinical work in 2016. After the implementation process, institutional CT protocols were mapped to the anatomical regions for which DRLs were provided. Systematically, protocols that exceeded the thresholds were optimised and analysed in detail. The CT radiation output parameters analysed were volumetric CT dose index (CTDIvol) and dose-length product (DLP). Three radiologists evaluated subjective image quality using a three-point Likert scale. The study included 94,258 CT series (from 27,103 CT examinations) in adult patients performed in 2016. When averaged over all body regions with available DRL, institutional CTDIvol/DLP values were always below the DRLs (65.2±32.9%/67.3±41.5% initially; 59.4±32%/60.5±39.9% after optimisation). Values exceeding the national DRLs were found for pelvis (n=268; CTDIvol 107.7±65.7%/DLP 106.3±79.3%), lumbar spine (n=91; 160.8±74.7%/175.2±104.1%), and facial bones (n=527; 108±39%/152.7±75.7%). After optimisation, CTDIvol and DLP were 87.9±73%/87.8±80.8% for the pelvis, 67.8±33.2%/74.5±50.6% for the lumbar spine and 95.1±45.8%/133.3±74.6% for the viscerocranium. An automatic CT dose monitoring system enabled not only comprehensive monitoring of a DRL implementation process but can also help to optimise radiation exposure. Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Measurement of renal index on X-CT

    International Nuclear Information System (INIS)

    Iguchi, Takashi

    1991-01-01

    Morphological measurements of the kidney were made using X-CT images. Anteroposterior (AP) width of the kidney as well as the renal sinus on both right and left sides and the transverse width of the first lumbar vertebral body were measured from CT images. Changes according to age in AP width of the kidney and the transverse width of the lumbar vertebral body were investigated. As to the ratio of the AP width of the kidney (both right and left) to the transverse width of the lumbar vertebral body, and the ratio of the AP width of the kidney to the AP width of the renal sinus, the changes due to aging and the differences between male and female were studied. The average AP width of the right kidney was 47 mm, while that of the left kidney was 49 mm. The left kidney was slightly larger than the right kidney with statistical significance. In subjects up to 19 years of age, both the AP width of the kidney and the transverse width of the lumbar vertebral body showed correlation with age, while after the age of 20, there was no age-related correlation. The average ratio of the AP width of the kidney to the transverse width of the lumbar vertebral body was 1.13 for the right kidney and 1.19 for the left kidney. The difference between those two items was statistically significant and the changes due to aging were slight. During the age between 4 and 64 years, they were constant and no significant change was noticed. No difference between male and female was found. From the age of 65 years, a decreasing tendency was noticed. The ratios of AP width of the kidney to the AP width of renal sinus for both kidneys in males and females were found to be inversely correlated with age. They were similar to the changes due to aging in renal functions of the cortex system. On CT images, the ratio of AP width could be the index of both the size of the kidney and the thickness of the renal parenchyma respectively. (author)

  4. Clinical evaluation of CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas

    International Nuclear Information System (INIS)

    Kimura, Masato; Yoshinaga, Shiya; Nakayama, Yoshiya; Hirakawa, Toshihiko; Tanaka, Akira; Tomonaga, Masamichi

    1989-01-01

    The clinical results of CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas which had been done in our department during the last 16 months were evaluated. They included 18 cases; 8 of thalamic, 9 of putaminal and one of cerebellar hematoma. The patients were 11 males and 7 females, with an average age of 57. The time interval from oneset to surgery was 1-21 days, 9.5 days on average. The hematoma volume estimated on a CT scan was 6-35 ml and the average rate of hematoma removal by surgery was 75%. Intraoperative monitoring with ultrasonography and postoperative infusion of Urokinase increased the removal rate. In 14 cases, the mental ability and motor function improved within days after surgery and rehabilitation was started within a short period. However, the recovery in aged people was generally poor. Rebleeding occurred postoperatively in one case, necessitating a subsequent craniotomy. (author)

  5. Development and Evaluation of a Novel Curved Biopsy Device for CT-Guided Biopsy of Lesions Unreachable Using Standard Straight Needle Trajectories

    Energy Technology Data Exchange (ETDEWEB)

    Schulze-Hagen, Maximilian Franz, E-mail: mschulze@ukaachen.de; Pfeffer, Jochen; Zimmermann, Markus; Liebl, Martin [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology (Germany); Stillfried, Saskia Freifrau von [University Hospital RWTH Aachen, Department of Pathology (Germany); Kuhl, Christiane; Bruners, Philipp; Isfort, Peter [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology (Germany)

    2017-06-15

    PurposeTo evaluate the feasibility of a novel curved CT-guided biopsy needle prototype with shape memory to access otherwise not accessible biopsy targets.Methods and MaterialsA biopsy needle curved by 90° with specific radius was designed. It was manufactured using nitinol to acquire shape memory, encased in a straight guiding trocar to be driven out for access of otherwise inaccessible targets. Fifty CT-guided punctures were conducted in a biopsy phantom and 10 CT-guided punctures in a swine corpse. Biposies from porcine liver and muscle tissue were separately gained using the biopsy device, and histological examination was performed subsequently.ResultsMean time for placement of the trocar and deployment of the inner biopsy needle was ~205 ± 69 and ~93 ± 58 s, respectively, with a mean of ~4.5 ± 1.3 steps to reach adequate biopsy position. Mean distance from the tip of the needle to the target was ~0.7 ± 0.8 mm. CT-guided punctures in the swine corpse took relatively longer and required more biopsy steps (~574 ± 107 and ~380 ± 148 s, 8 ± 2.6 steps). Histology demonstrated appropriate tissue samples in nine out of ten cases (90%).ConclusionsTargets that were otherwise inaccessible via standard straight needle trajectories could be successfully reached with the curved biopsy needle prototype. Shape memory and preformed size with specific radius of the curved needle simplify the target accessibility with a low risk of injuring adjacent structures.

  6. Comparison of diagnostic protocols and the equivalent effective dose in renal cancer and herniated lumbar disc

    International Nuclear Information System (INIS)

    Ruiz Perez de Villar, M.J.; Vano Carruana, E.; Lanzos Gonbzalez, E.; Perez Torrubia, A.

    1994-01-01

    Renal cancer (RC) and herniated lumbar disc (HLD) were the two pathologies selected for the study of the diagnostic protocols applied in different centers to determine how their variability is reflected in the effective equivalent dose (EED) and establish the optimal radiological protocol for diagnostic purposes, while using the lowest possible dose. On the basis of 222 case histories, it was observed that the EED resulting from the diagnosis of HLD can vary as much as a factor of 3(6.2-18.9 mSv). Likewise, the EED related to the diagnosis of RC can be modified by a factor of 1.5(32.6-48.3 mSv), depending on the diagnostic protocol employed. It can be considered that the optimal protocol to reach a diagnosis of HLD includes chest x-ray, lumbar spine x-ray and lumbar CT scan, while that required for the diagnosis of RC involves chest x-ray, IVU, abdominal CT scan and digital subtraction angiography. The optimization of the study protocols-especially the reduction of the number of exposures, modernization and quality control of the equipment, among other aspects, can reduce the EED by a factor of 2. (Author)

  7. Effects of a Multidisciplinary Approach to Improve Volume of Diagnostic Material in CT-Guided Lung Biopsies.

    Science.gov (United States)

    Ferguson, Philip E; Sales, Catherine M; Hodges, Dalton C; Sales, Elizabeth W

    2015-01-01

    Recent publications have emphasized the importance of a multidisciplinary strategy for maximum conservation and utilization of lung biopsy material for advanced testing, which may determine therapy. This paper quantifies the effect of a multidisciplinary strategy implemented to optimize and increase tissue volume in CT-guided transthoracic needle core lung biopsies. The strategy was three-pronged: (1) once there was confidence diagnostic tissue had been obtained and if safe for the patient, additional biopsy passes were performed to further increase volume of biopsy material, (2) biopsy material was placed in multiple cassettes for processing, and (3) all tissue ribbons were conserved when cutting blocks in the histology laboratory. This study quantifies the effects of strategies #1 and #2. This retrospective analysis comparing CT-guided lung biopsies from 2007 and 2012 (before and after multidisciplinary approach implementation) was performed at a single institution. Patient medical records were reviewed and main variables analyzed include biopsy sample size, radiologist, number of blocks submitted, diagnosis, and complications. The biopsy sample size measured was considered to be directly proportional to tissue volume in the block. Biopsy sample size increased 2.5 fold with the average total biopsy sample size increasing from 1.0 cm (0.9-1.1 cm) in 2007 to 2.5 cm (2.3-2.8 cm) in 2012 (Pstrategy to CT-guided lung biopsies was effective in significantly increasing tissue volume and number of blocks available for advanced diagnostic testing.

  8. CT guided stereotactic evacuation for hypertensive intracerebral hematoma

    International Nuclear Information System (INIS)

    Nakajima, Hideo

    1990-01-01

    Sixty-one cases of hypertensive intracerebral hematoma were evacuated by CT guided stereotactic method. The operation was performed in the CT room under general anesthesia using the KOMAI-NAKAJIMA STEREOTACTIC DEVICE. This instrument has a micromanipulater that can be used for various kinds of stereotactic procedures. Three dimensional position of the target point (aspiration point of the hematoma) was determined on the film obtained from CT scanning of the patient in the stereotactic system. If the hematoma was small, the target point was enough to be one point at the center of the hematoma, but in case of the large hematoma, several target points were given according to the shape of hematoma. The probe, ordinarily a steel tube 4 mm in outer diameter, was inserted through brain to the target point and the hematoma was aspirated through a silicon tube connected to a vacuum system. Among 61 cases examined, 30 cases of thalamic hemorrhage were operated upon and 36 cases were not operated. They were classified according to the volume of hematoma into 3 groups as follows: A=less than 10 ml, B=11-25 ml, C=more than 25 ml. The operated cases were compared with the non operated cases on the improvement of consciousness in each group. In the A group, the operated patients in the level I recovered more slowly than the non operated patients, but in the level II patients, this was reversed. In the B group, the operated patients improved more quickly except the level I patients. In the C group, almost all of non operated patients died. Thus, this operation was very useful in improving consciousness of level II or III patients independent of hematoma volume. It accelerated the recovery of motor function in the level I. This non inversive technique is considered effective for the removal of deep intracerebral hematoma. (author)

  9. Incidence of lumbar spondylolysis in the general population in Japan based on multidetector computed tomography scans from two thousand subjects.

    Science.gov (United States)

    Sakai, Toshinori; Sairyo, Koichi; Takao, Shoichiro; Nishitani, Hiromu; Yasui, Natsuo

    2009-10-01

    Epidemiological analysis using CTs. To investigate the true incidence of lumbar spondylolysis in the general population in Japan. Although there have been several reports on the incidence of lumbar spondylolysis, they had some weakness. One of them concerns the subjects investigated, because the incidence of lumbar spondylolysis varies considerably, and some patients are asymptomatic. In addition, most of the past studies used plain radiograph films or skeletal investigation. Therefore, the past reported incidence may not correspond to that of the general population. We reviewed the computed tomography (CT) scans of 2000 subjects (age: 20-92 years) who had undergone abdominal and pelvic CT on a single multidetector CT scanner for reasons unrelated to low back pain. We reviewed them for spondylolysis, spondylolytic spondylolisthesis, and spina bifida occulta (SBO) in the lumbosacral region. The grade (I-IV) of spondylolisthesis was measured using midsagittal reconstructions. Lumbar spondylolysis was found in 117 subjects (5.9%). Their male-female ratio was 2:1. Multiple-level spondylolysis was found in 5 subjects (0.3%). Among these 117 subjects, there were 124 vertebrae with spondylolysis. Of them, 112 (90.3%) corresponded to L5, and 26 (21.0%) had unilateral spondylolysis.SBO was found in 154 subjects. Of them, 25 had spondylolysis (16.2%), whereas, in 1846 subjects without SBO, 92 had spondylolysis (5.0%). The incidence of spondylolysis among the patients with SBO was significantly higher than that in subjects without SBO (Odd ratio was 3.7-fold).Of 124 vertebrae with spondylolysis, 75 (60.5%) showed low-grade (Meyerding grade I or II) spondylolisthesis, and no subject presented high-grade spondylolisthesis. Spondylolisthesis was found in 74.5% of the subjects with bilateral spondylolysis, and in 7.7% of those with unilateral spondylolysis. The incidence of lumbar spondylolysis in the Japanese general population was 5.9% (males: 7.9%, females: 3.9%).

  10. Adaptive statistical iterative reconstruction reduces patient radiation dose in neuroradiology CT studies

    Energy Technology Data Exchange (ETDEWEB)

    Komlosi, Peter; Zhang, Yanrong; Leiva-Salinas, Carlos; Ornan, David; Grady, Deborah [University of Virginia, Department of Radiology and Medical Imaging, Division of Neuroradiology, PO Box 800170, Charlottesville, VA (United States); Patrie, James T.; Xin, Wenjun [University of Virginia, Department of Public Health Sciences, Charlottesville, VA (United States); Wintermark, Max [University of Virginia, Department of Radiology and Medical Imaging, Division of Neuroradiology, PO Box 800170, Charlottesville, VA (United States); Centre Hospitalier Universitaire Vaudois, Department of Radiology, Lausanne (Switzerland)

    2014-03-15

    Adaptive statistical iterative reconstruction (ASIR) can decrease image noise, thereby generating CT images of comparable diagnostic quality with less radiation. The purpose of this study is to quantify the effect of systematic use of ASIR versus filtered back projection (FBP) for neuroradiology CT protocols on patients' radiation dose and image quality. We evaluated the effect of ASIR on six types of neuroradiologic CT studies: adult and pediatric unenhanced head CT, adult cervical spine CT, adult cervical and intracranial CT angiography, adult soft tissue neck CT with contrast, and adult lumbar spine CT. For each type of CT study, two groups of 100 consecutive studies were retrospectively reviewed: 100 studies performed with FBP and 100 studies performed with ASIR/FBP blending factor of 40 %/60 % with appropriate noise indices. The weighted volume CT dose index (CTDI{sub vol}), dose-length product (DLP) and noise were recorded. Each study was also reviewed for image quality by two reviewers. Continuous and categorical variables were compared by t test and free permutation test, respectively. For adult unenhanced brain CT, CT cervical myelography, cervical and intracranial CT angiography and lumbar spine CT both CTDI{sub vol} and DLP were lowered by up to 10.9 % (p < 0.001), 17.9 % (p = 0.005), 20.9 % (p < 0.001), and 21.7 % (p = 0.001), respectively, by using ASIR compared with FBP alone. Image quality and noise were similar for both FBP and ASIR. We recommend routine use of iterative reconstruction for neuroradiology CT examinations because this approach affords a significant dose reduction while preserving image quality. (orig.)

  11. Adaptive statistical iterative reconstruction reduces patient radiation dose in neuroradiology CT studies

    International Nuclear Information System (INIS)

    Komlosi, Peter; Zhang, Yanrong; Leiva-Salinas, Carlos; Ornan, David; Grady, Deborah; Patrie, James T.; Xin, Wenjun; Wintermark, Max

    2014-01-01

    Adaptive statistical iterative reconstruction (ASIR) can decrease image noise, thereby generating CT images of comparable diagnostic quality with less radiation. The purpose of this study is to quantify the effect of systematic use of ASIR versus filtered back projection (FBP) for neuroradiology CT protocols on patients' radiation dose and image quality. We evaluated the effect of ASIR on six types of neuroradiologic CT studies: adult and pediatric unenhanced head CT, adult cervical spine CT, adult cervical and intracranial CT angiography, adult soft tissue neck CT with contrast, and adult lumbar spine CT. For each type of CT study, two groups of 100 consecutive studies were retrospectively reviewed: 100 studies performed with FBP and 100 studies performed with ASIR/FBP blending factor of 40 %/60 % with appropriate noise indices. The weighted volume CT dose index (CTDI vol ), dose-length product (DLP) and noise were recorded. Each study was also reviewed for image quality by two reviewers. Continuous and categorical variables were compared by t test and free permutation test, respectively. For adult unenhanced brain CT, CT cervical myelography, cervical and intracranial CT angiography and lumbar spine CT both CTDI vol and DLP were lowered by up to 10.9 % (p < 0.001), 17.9 % (p = 0.005), 20.9 % (p < 0.001), and 21.7 % (p = 0.001), respectively, by using ASIR compared with FBP alone. Image quality and noise were similar for both FBP and ASIR. We recommend routine use of iterative reconstruction for neuroradiology CT examinations because this approach affords a significant dose reduction while preserving image quality. (orig.)

  12. The clinical application of percutaneous auto-biopsy of small lung nodular under CT-Guided

    International Nuclear Information System (INIS)

    Zhou Yuanmin; Ye Genxin; Zhang Chenghui; Wang Yu; Chen Wei

    2008-01-01

    Objective: To evaluated the clinical value of technology of petcutaneous auto-biopsy of small lung nodular under CT- Guide. Methods: 44 cases of small single lung nodular were underwent biopsy with 20G auto-biopsy needle under CT guidance. All cases underwent pathological diagnosis. Results: All 44 cases were punctured successfully. 41 cases were succeeded in first puncturation. The success ratio was 93.02%. Other 3 cases needed second puncturation. 39 of 44 cases pathological diagnosis were malignant. Only 1 case could not be diagnosed. 6 patients had lightly pneumatothorax after biopsy. 10 cases had mild pneumonorrhagia after biopsy. 2 of them had haemptysis. All cases had no complication such as infection, needle track implantation. Conclusion: The technology of CT Guidance auto-biopsy of small lung nodular is safe and effective; it has extreme diagnostic ratio and less complication. (authors)

  13. Percutaneous CT-guided high-dose brachytherapy (CT-HDRBT) ablation of primary and metastatic lung tumors in nonsurgical candidates; Perkutane CT-gesteuerte Hochdosis-Brachytherapie (CT-HDRBT) von primaeren und metastatischen Lungentumoren in nicht chirurgischen Kandidaten

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, F.; Schnapauff, D.; Poellinger, A.; Denecke, T.; Banzer, J.; Golenia, M.J.; Gebauer, B. [Charite - Universitatesmedizin Berlin (Germany). Inst. fuer Radiologie; Wust, P. [Charite - Universitatesmedizin Berlin (Germany). Klinik fuer Strahlentherapie

    2012-04-15

    To evaluate the safety and efficacy of CT-guided high-dose brachytherapy (CT-HDRBT) ablation of primary and metastatic lung tumors. Between November 2007 and May 2010, all consecutive patients with primary or metastatic lung tumors, unsuitable for surgery, were treated with CT-HDRBT. Imaging follow-up after treatment was performed with contrast-enhanced CT at 6 weeks, 3 months and every 6 months after the procedure. The endpoints of the study were local tumor control and time to progression. The Kaplan-Meier method was used to estimate survival functions and local tumor progression rates. 34 procedures were carried out on 33 lesions in 22 patients. The mean diameter of the tumors was 33.3 mm (SD = 20.4). The first contrast-enhanced CT showed that complete ablation was achieved in all lesions. The mean minimal tumor enclosing dose was 18.9 Gy (SD = 2). Three patients developed a pneumothorax after the procedure. The mean follow-up time was 13.7 (3 - 29) months. 2 of 32 lesions (6.25 %) developed a local tumor progression. 8 patients (36.3 %) developed a distant tumor progression. After 17.7 months, 13 patients were alive and 9 patients had died. CT-HDRBT ablation is a safe and attractive treatment option for patients with lung malignancies and allows targeted destruction of tumor tissue with simultaneous preservation of important lung structures. Furthermore, CT-HDRBT is independent of the size of the lesion and its location within the lung parenchyma. (orig.)

  14. The experimental study of CT-guided hepatocyte growth factor gene therapy for cerebral ischemic diseases

    International Nuclear Information System (INIS)

    Zhang Xiaobo; Jin Zhengyu; Li Mingli; Wang Renzhi; Li Guilin; Kong Yanguo; Wang Jianming; Gao Shan; Guan Hongzhi; Wang Detian; Luo Yufeng

    2006-01-01

    Objectives: To investigate the feasibility of CT guided hepatocyte growth factor (HGF) gene therapy for cerebral ischemic diseases. Methods: Human HGF cDNA was ligated to pIRES 2 -EGFP vector. The recombinant plasmid was transfected into the penumbra tissue with liposome, guided by CT perfusion images. After seven days of transfer with recombinant plasmid, the cut sections of rat brain tissues of the treated and control groups were analyzed including immunohistochemistry, vessel count, cerebral blood flow and infarct volume etc. in order to investigate HGF gene expression and biological effect. Results: Enzymatic digestion and electrophoresis confirmed that HGF fragments had been correctly cloned into the space between the BamH I and Sal I sites of pIRES 2 -EGFP. After 7 days of HGF gene transfection, expression of HGF in transfected neurocytes of treated group was observed with immunohistochemistry. The number of vessels in penumbra tissues transfected with HGF vectors and the CBF measured by perfusion CT all were significantly increased than those of the controls (P 2 -EGFP-HGF complexes can transfect the penumbra tissues and definitely express HGF protein. The HGF gene products can stimulate angiogenesis, promote collateral circulation formation and reduce infarct volume in vivo and therefore is beneficial to the treatment of cerebral ischemia. (authors)

  15. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy

    International Nuclear Information System (INIS)

    Khan, M.F.; Straub, R.; Moghaddam, S.R.; Maataoui, A.; Gurung, J.; Thalhammer, A.; Vogl, T.J.; Jacobi, V.; Wagner, T.O.F.; Ackermann, H.

    2008-01-01

    The influence of various variables on the rate of pneumothorax and intrapulmonal hemorrhage associated with computed tomography (CT)-guided transthoracic needle biopsy of the lung were evaluated retrospectivly. One hundred and thirty-three patients underwent CT guided biopsy of a pulmonary lesion. Two patients were biopsied twice. Variables analyzed were lesion size, lesion location, number of pleural needle passes, lesion margin, length of intrapulmonal biopsy path and puncture time. Eighteen-gauge (18G) cutting needles (Trucut, Somatex, Teltow, Germany) were used for biopsy. Pneumothorax occured in 23 of 135 biopsies (17%). Chest tube placement was required in three out of 23 cases of pneumothorax (2% of all biopsies). Pneumothorax rate was significantly higher when the lesions were located in the lung parenchyma compared with locations at the pleura or chest wall (P < 0.05), but all pneumothorax cases which required chest tube treatment occured in lesions located less than 2 cm from the pleura. Longer puncture time led to an increase in pneumothorax rate (P < 0.05). Thirty-seven (27%) out of 135 biopsies showed perifocal hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage and pneumothorax (P < 0.05). Significantly more hemorrhage occured when the pleura was penetrated twice during the puncture (P < 0.05). Lesion size <4 cm is strongly correlated with higher occurence of perifocal hemorrhage (P < 0.05). Lesion margination showed no significant effect on complication rate. CT-guided biopsy of smaller lesions correlates with a higher bleeding rate. Puncture time should be minimized to reduce pneumothorax rate. Passing the pleura twice significantly increases the risk of hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage as well as pneumothorax. (orig.)

  16. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    Energy Technology Data Exchange (ETDEWEB)

    Sopov, V.; Groshar, D. [Dept. of Nuclear Medicine, Technion-Israel Inst. of Technology, Haifa (Israel); Fuchs, D. [Dept. of Orthopaedics, Technion-Israel Inst. of Technology, Haifa (Israel); Bar-Meir, E. [Dept. of Radiology, Technion-Israel Inst. of Technology, Haifa (Israel)

    2001-02-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  17. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    International Nuclear Information System (INIS)

    Sopov, V.; Groshar, D.; Fuchs, D.; Bar-Meir, E.

    2001-01-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  18. CT-guided radiolabelled aerosol studies for assessing pulmonary impairment in children with bronchiectasis

    International Nuclear Information System (INIS)

    Pifferi, M.; Baldini, M.; Caramella, D.; Bartolozzi, C.; Di Mauro, M.; Cangiotti, A.M.

    2000-01-01

    Objective. To determine whether CT-guided mucociliary clearance studies allow differentiation between bronchiectasis associated with primary ciliary dyskinesia (PCD) and those unrelated to congenital or genetically transmitted defects. Materials and methods. Fifteen children aged 4-18 years with a CT diagnosis of bronchiectasis were included in the study. Six had PCD, while in nine cases no congenital disorder was demonstrated. Results. CT showed bronchiectasis in 26 (29 %) of 90 lung regions. Radiolabelled aerosol studies were conducted globally for each lung and on the regions affected by bronchiectasis. Global half-time of activity (t 1/2 ) values of patients with PCD were significantly higher (P 1/2 values. Patients with bronchiectasis unrelated to congenital disorders showed significantly higher regional t 1/2 values in the affected regions with respect to the corresponding global pulmonary t 1/2 (P < 0.06). Conclusions. The combination of morphological CT information with functional data concerning the clearance of radiolabelled aerosol adds to our understanding of pulmonary impairment in children with bronchiectasis. In particular, regional studies allow the recognition of different mucociliary clearance patterns in bronchiectasis associated with PCD and those unrelated to congenital or genetically transmitted defects. (orig.)

  19. LUMBAR CORSETS CAN DECREASE LUMBAR MOTION IN GOLF SWING

    Directory of Open Access Journals (Sweden)

    Koji Hashimoto

    2013-03-01

    Full Text Available Swinging a golf club includes the rotation and extension of the lumbar spine. Golf-related low back pain has been associated with degeneration of the lumbar facet and intervertebral discs, and with spondylolysis. Reflective markers were placed directly onto the skin of 11young male amateur golfers without a previous history of back pain. Using a VICON system (Oxford Metrics, U.K., full golf swings were monitored without a corset (WOC, with a soft corset (SC, and with a hard corset (HC, with each subject taking 3 swings. Changes in the angle between the pelvis and the thorax (maximum range of motion and angular velocity in 3 dimensions (lumbar rotation, flexion-extension, and lateral tilt were analyzed, as was rotation of the hip joint. Peak changes in lumbar extension and rotation occurred just after impact with the ball. The extension angle of the lumbar spine at finish was significantly lower under SC (38° or HC (28° than under WOC (44° conditions (p < 0.05. The maximum angular velocity after impact was significantly smaller under HC (94°/sec than under SC (177°/sec and WOC (191° /sec conditions, as were the lumbar rotation angles at top and finish. In contrast, right hip rotation angles at top showed a compensatory increase under HC conditions. Wearing a lumbar corset while swinging a golf club can effectively decrease lumbar extension and rotation angles from impact until the end of the swing. These effects were significantly enhanced while wearing an HC

  20. Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

    Directory of Open Access Journals (Sweden)

    Guang HAN

    2016-04-01

    Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

  1. Biomechanical analysis of press-extension technique on degenerative lumbar with disc herniation and staggered facet joint

    Directory of Open Access Journals (Sweden)

    Hong-gen Du

    2016-05-01

    Full Text Available This study investigates the effect of a new Chinese massage technique named “press-extension” on degenerative lumbar with disc herniation and facet joint dislocation, and provides a biomechanical explanation of this massage technique. Self-developed biomechanical software was used to establish a normal L1–S1 lumbar 3D FE model, which integrated the spine CT and MRI data-based anatomical structure. Then graphic technique is utilized to build a degenerative lumbar FE model with disc herniation and facet joint dislocation. According to the actual press-extension experiments, mechanic parameters are collected to set boundary condition for FE analysis. The result demonstrated that press-extension techniques bring the annuli fibrosi obvious induction effect, making the central nucleus pulposus forward close, increasing the pressure in front part. Study concludes that finite element modelling for lumbar spine is suitable for the analysis of press-extension technique impact on lumbar intervertebral disc biomechanics, to provide the basis for the disease mechanism of intervertebral disc herniation using press-extension technique.

  2. The influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination during weightlifting.

    Science.gov (United States)

    Hu, Boyi; Ning, Xiaopeng

    2015-01-01

    Lumbar muscle fatigue is a potential risk factor for the development of low back pain. In this study, we investigated the influence of lumbar extensor muscle fatigue on lumbar-pelvic coordination patterns during weightlifting. Each of the 15 male subjects performed five repetitions of weightlifting tasks both before and after a lumbar extensor muscle fatiguing protocol. Lumbar muscle electromyography was collected to assess fatigue. Trunk kinematics was recorded to calculate lumbar-pelvic continuous relative phase (CRP) and CRP variability. Results showed that fatigue significantly reduced the average lumbar-pelvic CRP value (from 0.33 to 0.29 rad) during weightlifting. The average CRP variability reduced from 0.17 to 0.15 rad, yet this change ws statistically not significant. Further analyses also discovered elevated spinal loading during weightlifting after the development of lumbar extensor muscle fatigue. Our results suggest that frequently experienced lumbar extensor muscle fatigue should be avoided in an occupational environment. Lumbar extensor muscle fatigue generates more in-phase lumbar-pelvic coordination patterns and elevated spinal loading during lifting. Such increase in spinal loading may indicate higher risk of back injury. Our results suggest that frequently experienced lumbar muscle fatigue should be avoided to reduce the risk of LBP.

  3. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Tantawy, Wahid H., E-mail: tantawyw@yahoo.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); El-Gemeie, Emad H. [Pathology Department, National Cancer Institute, Fom El Khalige Faculty of Medicine, Cairo University (Egypt); Ibrahim, Ahmed S., E-mail: asibrahima@gmail.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); Mohamed, Mona A. [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt)

    2012-10-15

    Purpose: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. Materials and methods: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. Results: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. Conclusion: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.

  4. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes

    International Nuclear Information System (INIS)

    Tantawy, Wahid H.; El-Gemeie, Emad H.; Ibrahim, Ahmed S.; Mohamed, Mona A.

    2012-01-01

    Purpose: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. Materials and methods: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. Results: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. Conclusion: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening

  5. Application of C-arm CT-guided targeted puncturing technique in performing non-vascular interventional biopsy or interventional therapy

    International Nuclear Information System (INIS)

    Li Zhen; Han Xinwei; Jiao Dechao; Ren Jianzhuang; Su Yu; Ye Hui

    2011-01-01

    Objective: to investigate the clinical value of C-arm CT-guided targeted puncturing technique in performing non, vascular interventional biopsy or interventional therapy. Methods: Thirty, one patients, who were encountered in authors' hospital during the period from July 2010 to September 2010, were involved in this study. C-arm CT-guided percutaneous targeted puncturing biopsy or interventional therapy was performed in all 31 patients. All patients had complete clinical data. The complications and positive rate of biopsy were recorded and analyzed. Results: Under C-arm CT-guidance, percutaneous interventional therapy was carried out in 13 patients. The interventional procedures included radiofrequency ablation therapy for hepatic cellular carcinoma (n=2), pelvic abscess draining (n=1), hepatic abscess draining (n=1), ethanol injection for liver cancer (n=4), sclerotic therapy with ethanol injection for renal cyst (n=2), sclerotic therapy with ethanol injection for liver cyst (n=2) and catheter-indwelling drainage for pancreatic pseudocyst (n=1). percutaneous interventional biopsy was performed in the remaining 18 cases, including liver (n=4), lung (n=7), mediastinum (n=2), bone and soft tissue (n=4) and neck mass (n=1). All the procedures were successfully accomplished, no technique, related complications occurred during the operation. For biopsy examination in 18 cases, the positive rate was 94.4% (17/18) and false, negative results was seen in one case with lung lesion. Conclusion: The percutaneous targeted puncturing technique with C, arm CT-guidance combines the advantages of both CT scanning and fluoroscopy. The use of real, time road, mapping function can effectively guide the puncturing and therapeutic management, which can not only optimize the workflow, save the operation time, but also improve the success rate and technical safety. Therefore, it is of great value to popularize this targeted puncturing technique. (authors)

  6. CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure.

    Science.gov (United States)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

    2018-01-01

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. • CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield. • CT fluoroscopy-guided renal tumour biopsy is safe. • Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

  7. Diagnosis of lumbar central spinal stenosis by plain radiography

    International Nuclear Information System (INIS)

    Ilkko, E.

    1989-01-01

    The usefulness of plain radiography in the diagnosis of lumbar central spinal stenosis was studied in 116 patients using computed tomography (CT) as a reference. The most significant signs found in central spinal stenosis were short pedicles, high narrow intervertebral foramina, small interlaminar windows and deep posterior concavity of the vertebral bodies. The sensitivity of plain radiography in the diagnosis of central spinal stenosis as compared to CT was 66%, the specificity was 93% and the accuracy was 86%. The midsagittal and interpedicular diameters were measured from plain radiograms and were compared with corresponding CT diameters. In approximately half of the cases, the sagittal diameters were compatible. The maximum error was 6 mm. On average, the interpedicular distances were measured as too wide. The reliability of CT measurements were established by taking the measurements from the vertebral column of a moose calf, and then comparing these to the real measurements obtained with a calibrated ruler. The maximal differences were 2 mm. (author). 24 refs.; 8 figs.; 3 tabs

  8. Patient dose in CT fluoroscopy examinations

    International Nuclear Information System (INIS)

    Ito, Yusuke; Kobayashi, Masanao; Kataoka, Yumi; Ida, Yoshihiro; Kato, Ryoichi; Katada, Kazuhiro; Asada, Yasuki; Suzuki, Shoichi

    2008-01-01

    CT fluoroscopy(CTF) results in a high dose for the area under investigation in comparison with other types of examination. On the basis of data from April 2005 to March 2008, we measured the X-ray doses at the target site in CTF of the lungs, lumbar vertebrae, and pelvis as well as the X-ray dose to the female reproductive organs, and calculated the effective dose. The CT equipment used was an Aquilion 16. TLDs were inserted into an anthropomorphic phantom in positions corresponding to the target sites and the reproductive organs. Standard tube voltage and tube current were used as measurement conditions, and the scanning time used was the average value for each type of examination during the two years. Dose measurements were taken in the following order: scanography, helical scan, CTF, helical scan. X-ray element calibration was carried out through reciprocal comparison made between an ionization chamber dosimeter corrected according to government standards and the TLD for each tube voltage used for measurement. Dose estimation software was used to calculate the effective doses. During the two years there were 136 CTF examinations. These included 43 scans of the lungs, 13 of lumbar vertebrae, and 18 of the pelvis. The X-ray doses were 0.1 mGy at both the ovaries and the uterus for lung scans, 2 mGy at the ovaries and 1 mGy at the uterus for lumbar vertebrae scans, and 40 mGy at the ovaries and 20 mGy at the uterus for pelvic scans. The effective dose was highest for the lumbar vertebrae, followed by the lungs and finally the pelvis. (author)

  9. CT-guided stereotaxic implantation of Ommaya reservoir for cystic brain tumor

    Energy Technology Data Exchange (ETDEWEB)

    Nakasato, Nobukazu; Niizuma, Hiroshi; Johkura, Hidefumi; Katoh, Seiya; Otsuki, Taisuke; Katakura, Ryuichi; Suzuki, Jiro

    1988-02-01

    We report the use of CT-guided stereotaxic system to implant Ommaya reservoir in 26 patients with cystic brain tumors consisting of 16 gliomas, 3 craniopharyngiomas, 3 metastatic brain tumors and 5 other and unknown pathologies, on the way of their biopsy. The entire procedure was carried out in the CT room using Leksell's CT stereotaxic system. In 24 cases with supratentorial tumors, it was at the option of the operator to take any approach such as frontal, posterior temporal and parietal approaches. Especially in 3 cases of craniopharyngioma, we inserted the tube into their cyst directly so that the ventricle should not be open to the cyst. Also in cases of a pontine glioma and a C-P angle metastatic tumor, we used retromastoid approach to the posterior fossa by making patient's heads turned about 30 to 40 deg to contralateral side of the approach, with slight flexion of the neck. Minimal bleeding occurred during operation in one case, however, it showed no clinical symptoms. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can check the course of the cannula and position of the tip of Ommaya tube even at operation, and can modify it, if necessary.

  10. CT-guided stereotaxic implantation of Ommaya reservoir for cystic brain tumor

    International Nuclear Information System (INIS)

    Nakasato, Nobukazu; Niizuma, Hiroshi; Johkura, Hidefumi; Katoh, Seiya; Otsuki, Taisuke; Katakura, Ryuichi; Suzuki, Jiro

    1988-01-01

    We report the use of CT-guided stereotaxic system to implant Ommaya reservoir in 26 patients with cystic brain tumors consisting of 16 gliomas, 3 craniopharyngiomas, 3 metastatic brain tumors and 5 other and unknown pathologies, on the way of their biopsy. The entire procedure was carried out in the CT room using Leksell's CT stereotaxic system. In 24 cases with supratentorial tumors, it was at the option of the operator to take any approach such as frontal, posterior temporal and parietal approaches. Especially in 3 cases of craniopharyngioma, we inserted the tube into their cyst directly so that the ventricle should not be open to the cyst. Also in cases of a pontine glioma and a C-P angle metastatic tumor, we used retromastoid approach to the posterior fossa by making patient's heads turned about 30 to 40 deg to contralateral side of the approach, with slight flexion of the neck. Minimal bleeding occurred during operation in one case, however, it showed no clinical symptoms. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can check the course of the cannula and position of the tip of Ommaya tube even at operation, and can modify it, if necessary. (author)

  11. Use of CT-guided fine needle aspiration biopsy in epidermal growth factor receptor mutation analysis in patients with advanced lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping; Wang, Hai-Yan; Zhang, Jin; Feng, Yong (Dept. of Radiology, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China)), email: yipingzhuang2010@sina.com; Shi, Mei-Qi (Dept. of Chemotherapy, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China))

    2011-12-15

    Background. The safety of using a cutting needle when performing a core-needle biopsy is of major concern, in particular for small lung tumors or tumors near the hilum. Purpose. To investigate the usefulness of CT-guided fine needle aspiration biopsy (FNAB) of the lung in obtaining tumor tissue for epidermal growth factor receptor (EGFR) mutation analysis in advanced lung cancer patients. Material and Methods. Forty-three patients with stage IIIB-IV lung cancer were enrolled. In all patients, CT-guided FNAB was performed using an 18-gauge or 20-gauge Chiba aspiration needle for histology diagnosis and EGFR mutation analysis. Complications associated with CT-guided FNAB were observed, and the specimen mutational assessments were recorded. Results. The obtained tumor samples ranged from 0.5-1.5 cm in length and were adequate for histological and DNA analyses in all patients. No patient had a pneumothorax or hemoptysis. Minor needle tract bleeding appeared in eight patients. Mutation analysis was satisfactorily demonstrated in 23 mutations and 20 non-mutations. Ten and 13 mutations were identified by 18-gauge and 20-gauge needle biopsies, respectively. EFGR mutations, including 12 cases of EGFR exon 19 deletion and 11 cases of exon 21 point mutation, were present in 21 patients with adenocarcinomas, one with squamous cell carcinoma, and one with undifferentiated carcinoma. Conclusion. CT-guided FNAB is a feasible and safe technique for obtaining lung tumor tissues for EGFR gene mutation analysis

  12. Diagnostic management of patients with SAPHO syndrome: use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up

    International Nuclear Information System (INIS)

    Kirchhoff, Timm; Rosenthal, Herbert; Prokop, Mathias; Chavan, Ajay; Galanski, Michael; Merkesdal, Sonja; Wagner, Annette; Zeidler, Henning; Mai, Uwe; Hammer, Michael

    2003-01-01

    Propionibacterium acnes (P. acnes) is suspected to be involved in the pathophysiology of SAPHO syndrome, since it has been isolated repeatedly through open surgical bone biopsy. This study demonstrates the role of MRI in identifying inflamed bone areas in patients with SAPHO syndrome and the role of CT-guided bone biopsies in obtaining samples from these areas for microbiological and histopathological investigations, thus obviating open surgery. Fourteen consecutive patients with SAPHO syndrome were investigated by MRI to identify acute inflammatory changes in hyperostotic periarticular bone. The CT-guided biopsies for microbiological investigations were taken from the areas identified. Patients positive for P. acnes were started on long-term antibiotic therapy according to antibiotic susceptibility. On MRI the inflammatory changes appeared as hyperintense areas on fat-saturated T2 fast-spin-echo (FSE) images and showed signal increase on fat-saturated T1 SE images after Gd-DTPA. With MR localization CT-guided bone biopsies yielded P. acnes in 8 patients. No bacteria could be isolated from the remaining 6 patients. Acute inflammatory bone changes in SAPHO syndrome are well localized by MRI. With MR localization, CT-guided bone biopsies offer a minimally invasive alternative to open surgery in the detection of. P. acnes leading to the institution of a specific antibiotic therapy. (orig.)

  13. CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses.

    Science.gov (United States)

    Iguchi, T; Hiraki, T; Matsui, Y; Fujiwara, H; Sakurai, J; Masaoka, Y; Uka, M; Tanaka, T; Gobara, H; Kanazawa, S

    2018-02-01

    To retrospectively evaluate the safety, diagnostic yield, and risk factors of diagnostic failure of computed tomography (CT) fluoroscopy-guided biopsies of anterior mediastinal masses. Biopsy procedures and results of anterior mediastinal masses in 71 patients (32 women/39 men; mean [±standard deviation] age, 53.8±20.0years; range, 14-88years) were analyzed. Final diagnoses were based on surgical outcomes, imaging findings, or clinical follow-up findings. The biopsy results were compared with the final diagnosis, and the biopsy procedures grouped by pathologic findings into diagnostic success and failure groups. Multiple putative risk factors for diagnostic failure were then assessed. Seventy-one biopsies (71 masses; mean size, 67.5±27.3mm; range 8.6-128.2mm) were analyzed. We identified 17 grade 1 and one grade 2 adverse events (25.4% overall) according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Sixty-nine biopsies (97.2%) provided samples fit for pathologic analysis. Diagnostic failure was found for eight (11.3%) masses; the 63 masses diagnosed successfully included thymic carcinoma (n=17), lung cancer (n=14), thymoma (n=12), malignant lymphoma (n=11), germ cell tumor (n=3), and others (n=6). Using a thinner needle (i.e., a 20-gauge needle) was the sole significant risk factor for diagnostic failure (P=0.039). CT fluoroscopy-guided biopsy of anterior mediastinal masses was safe and had a high diagnostic yield; however, using a thinner biopsy needle significantly increased the risk of a failed diagnosis. Copyright © 2017 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  14. PET/CT-guided treatment planning for paediatric cancer patients: a simulation study of proton and conventional photon therapy

    Science.gov (United States)

    Brodin, N P; Björk-Eriksson, T; Birk Christensen, C; Kiil-Berthelsen, A; Aznar, M C; Hollensen, C; Markova, E; Munck af Rosenschöld, P

    2015-01-01

    Objective: To investigate the impact of including fluorine-18 fludeoxyglucose (18F-FDG) positron emission tomography (PET) scanning in the planning of paediatric radiotherapy (RT). Methods: Target volumes were first delineated without and subsequently re-delineated with access to 18F-FDG PET scan information, on duplicate CT sets. RT plans were generated for three-dimensional conformal photon RT (3DCRT) and intensity-modulated proton therapy (IMPT). The results were evaluated by comparison of target volumes, target dose coverage parameters, normal tissue complication probability (NTCP) and estimated risk of secondary cancer (SC). Results: Considerable deviations between CT- and PET/CT-guided target volumes were seen in 3 out of the 11 patients studied. However, averaging over the whole cohort, CT or PET/CT guidance introduced no significant difference in the shape or size of the target volumes, target dose coverage, irradiated volumes, estimated NTCP or SC risk, neither for IMPT nor 3DCRT. Conclusion: Our results imply that the inclusion of PET/CT scans in the RT planning process could have considerable impact for individual patients. There were no general trends of increasing or decreasing irradiated volumes, suggesting that the long-term morbidity of RT in childhood would on average remain largely unaffected. Advances in knowledge: 18F-FDG PET-based RT planning does not systematically change NTCP or SC risk for paediatric cancer patients compared with CT only. 3 out of 11 patients had a distinct change of target volumes when PET-guided planning was introduced. Dice and mismatch metrics are not sufficient to assess the consequences of target volume differences in the context of RT. PMID:25494657

  15. CT thermometry for cone-beam CT guided ablation

    Science.gov (United States)

    DeStefano, Zachary; Abi-Jaoudeh, Nadine; Li, Ming; Wood, Bradford J.; Summers, Ronald M.; Yao, Jianhua

    2016-03-01

    Monitoring temperature during a cone-beam CT (CBCT) guided ablation procedure is important for prevention of over-treatment and under-treatment. In order to accomplish ideal temperature monitoring, a thermometry map must be generated. Previously, this was attempted using CBCT scans of a pig shoulder undergoing ablation.1 We are extending this work by using CBCT scans of real patients and incorporating more processing steps. We register the scans before comparing them due to the movement and deformation of organs. We then automatically locate the needle tip and the ablation zone. We employ a robust change metric due to image noise and artifacts. This change metric takes windows around each pixel and uses an equation inspired by Time Delay Analysis to calculate the error between windows with the assumption that there is an ideal spatial offset. Once the change map is generated, we correlate change data with measured temperature data at the key points in the region. This allows us to transform our change map into a thermal map. This thermal map is then able to provide an estimate as to the size and temperature of the ablation zone. We evaluated our procedure on a data set of 12 patients who had a total of 24 ablation procedures performed. We were able to generate reasonable thermal maps with varying degrees of accuracy. The average error ranged from 2.7 to 16.2 degrees Celsius. In addition to providing estimates of the size of the ablation zone for surgical guidance, 3D visualizations of the ablation zone and needle are also produced.

  16. A simplified CT-guided approach for greater occipital nerve infiltration in the management of occipital neuralgia.

    Science.gov (United States)

    Kastler, Adrian; Onana, Yannick; Comte, Alexandre; Attyé, Arnaud; Lajoie, Jean-Louis; Kastler, Bruno

    2015-08-01

    To evaluate the efficacy of a simplified CT-guided greater occipital nerve (GON) infiltration approach in the management of occipital neuralgia (ON). Local IRB approval was obtained and written informed consent was waived. Thirty three patients suffering from severe refractory ON who underwent a total of 37 CT-guided GON infiltrations were included between 2012 and 2014. GON infiltration was performed at the first bend of the GON, between the inferior obliqus capitis and semispinalis capitis muscles with local anaesthetics and cortivazol. Pain was evaluated via VAS scores. Clinical success was defined by pain relief greater than or equal to 50 % lasting for at least 3 months. The pre-procedure mean pain score was 8/10. Patients suffered from left GON neuralgia in 13 cases, right GON neuralgia in 16 cases and bilateral GON neuralgia in 4 cases. The clinical success rate was 86 %. In case of clinical success, the mean pain relief duration following the procedure was 9.16 months. Simplified CT-guided infiltration appears to be effective in managing refractory ON. With this technique, infiltration of the GON appears to be faster, technically easier and, therefore, safer compared with other previously described techniques. • Occipital neuralgia is a very painful and debilitating condition • GON infiltrations have been successful in the treatment of occipital neuralgia • This simplified technique presents a high efficacy rate with long-lasting pain relief • This infiltration technique does not require contrast media injection for pre-planning • GON infiltration at the first bend appears easier and safer.

  17. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

    Energy Technology Data Exchange (ETDEWEB)

    Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  18. Application of low-dose radiation protocols in survey CT scans

    International Nuclear Information System (INIS)

    Fu Qiang; Liu Ting; Lu Tao; Xu Ke; Zhang Lin

    2009-01-01

    Objective: To characterize the protocols with low-dose radiation in survey CT scans for localization. Methods: Eighty standard adult patients, head and body phantoms were recruited. Default protocols provided by operator's manual setting were that all the tube voltage for head, chest, abdomen and lumbar was 120 kV; the tube currents were 20,10,20 and 40 mA, respectively. Values of kV and mA in the low-dose experiments were optimized according to the device options. For chest and abdomen, the tube position were compared between default (0 degree) and 180 degree. Phantoms were scanned with above protocols, and the radiation doses were measured respectively. Paired t-test were used for comparisons of standard deviation in CT value, noise and exposure surface dose (ESD) between group with default protocols and group with optimized protocols. Results: The optimized protocols in low-dose CT survey scans were 80 kV, 10 mA for head, 80 kV, 10 mA for chest, 80 kV, 10 mA for abdomen and 100 kV, 10 mA for lumbar. The values of ESD for phantom scan in default and optimized protocols were 0.38 mGy/0.16 mGy in head, 0.30 mGy/0.20 mGy in chest, 0.74 mGy/0.30 mGy in abdomen and 0.81 mGy/0.44 mGy in lumbar, respectively. Compared with default protocols, the optimized protocols reduced the radiation doses 59%, 33%, 59% and 46% in head, chest, abdomen and lumbar. When tube position changed from 0 degree to 180 degree, the ESD were 0.24 mGy/0.20 mGy for chest; 0.37 mGy/0.30 mGy for abdomen, and the radiation doses were reduced 20% and 17%. Conclusion: A certain amount of image noise is increased in low-dose protocols, but image quality is still acceptable without problem in CT localization. The reduction of radiation dose and the radiation harm to patients are the superiority. (authors)

  19. Computed Tomography of the lumbar facet joints

    International Nuclear Information System (INIS)

    Choi, Mi Ryoung; Kim, Yung Soon; Lee, Joo Hyuk; Jeon, Hae Sang; Kim, Dae Yung

    1989-01-01

    The lumbar facet disease is a frequently overlooked cause of sciatic pain, but the lumbar facet joints are well-recognized source of low back pain and radiating leg pain which can be confused with sciatica due to herniated disc. We measured the angulation of the facet joints on axial spine CT films in 149 cases which contains 41 normal group and 108 abnormal group and studied the relationship between the angulation and degeneration of the facets, the asymmetry of each sided facets and facet degeneration, the asymmetry and disc protrusion, and the asymmetry and annular bulging of the disc. The results were as follows: 1. Facet angulation in abnormal group were more sagittally oriented than the normal group. 2. The angulation of right facet was more sagittally oriented than the left in L4-5 level of abnormal group. 3. Degeneration of facet joints occur asymmetrically, and the more facet joint degenerates, the more it orients sagittally, particularly in L4-5. 4. Asymmetry in facet joint degeneration and unilateral disc protrusion of L5-SI level is greater than the normal group

  20. CT diagnosis in the evaluation of vertebral trauma

    International Nuclear Information System (INIS)

    Emori, Takumi; Kadoya, Satoru; Nakamura, Tsutomu; Ito, Shotaro; Kwak, Ryungchan

    1984-01-01

    The diagnostic capability of the CT scan of the vertebral trauma and a comparison with the results of a routine roentgenogram and tomogram were studied in 11 patients. In total, there were 15 fractured vertebrae: 3 in the upper cervical, 3 in the lower cervical, and 9 in the thoracic and thoraco-lumbar vertebrae. In the detailed evaluation of the vertebral fractures, CT provided more information than plain films in all 15 fractured vertebrae, with a better visualization of the spinal bony details, particularly at the upper cervical, thoracic, and thoraco-lumbar levels, where the interpretation of the spinal abnormalities is usually difficult because of adjacent structures such as the skull and thorax. Only CT was able to demonstrate impingements on the vertebral canal by bony fragments. Post-traumatic syringomyelia was incidentally demonstrated in one patient on a plain CT. In 6 patients, conventional tomography was done, but no additional information with regard to spinal instability and spinal-cord compression was obtained. The usage of sagittal tomography was also limited, because it required a change in the patient's position, which might worsen the neurological deficits. On the other hand, a plain roentgenogram and conventional tomography were superior in the evaluation of spinal malalignment and fractures running horizontally. In summary, both plain roentgenograms and CT images provided detailed information about vertebral injury, whereas conventional tomography is judged to be inferior and not always necessary. Based on these results, our new diagnostic and therapeutic approaches using CT for the vertebral injuries were presented. (author)

  1. Synovial cysts of the lumbar spine

    International Nuclear Information System (INIS)

    Rosa, Ana Claudia Ferreira; Machado, Marcio Martins; Figueiredo, Marco Antonio Junqueira; Cerri, Giovanni Guido

    2002-01-01

    Intraspinal synovial cysts of the lumbar spine are rare and commonly associated with osteoarthritis of the facet joints, particularly at level L4-L5. Symptoms are uncommon and may include low-back pain or sciatica. These cysts are accurately diagnosed by using computed tomography and magnetic resonance imaging. Diagnosis is essential for the correct management of the cysts. Several treatment options are available including rest and immobilization, computed tomography guided corticosteroid injection, and surgery in patients that are nonresponsive to other treatment methods. (author)

  2. Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy.

    LENUS (Irish Health Repository)

    Duane, Frances K

    2014-08-07

    This study quantifies the inter- and intraobserver variations in contouring the organs at risk (OARs) in CT-guided brachytherapy (BT) for the treatment of cervical carcinoma. The dosimetric consequences are reported in accordance with the current Gynecological Groupe Européen de Curiethérapie\\/European Society for Therapeutic Radiology and Oncology guidelines.

  3. Location of pulmonary modules prior to video thoracoscopic surgery by CT-guided hook wire placement: Preliminary study

    International Nuclear Information System (INIS)

    Ferreiras, J.; Salmeron, I.; Bustos Garcia de Castro, A.; Hernando, F.; Gomez, A.; Torres, A.

    1996-01-01

    Despite the efficacy of computerized tomography (CT) or radiologically-guided percutaneous biopsy and that offluoroscopically-guided trans bronchial biopsy in characterizing pulmonary nodules, it is not always possible to determine the etiology using these techniques, making it necessary to resort to thoracotomy. Recent developments in endoscopicsurgery equipment and the availability of advance video imaging technology have extended the indications for both diagnostic and therapeutic thoracoscopy. Thus, a number of procedures that previously could only be performed bymeans of thoracotomy, such as resection of peripheral pulmonary nodules, can nowbe carried out by means of video thoracoscopic (VT) surgery. Palpation orvisual location of pulmonary nodules by thoracoscopy is essential but is not always possible when the nodules measure less than 20 mm or when their location is not subpleural. In such cases, a procedure for their prior location is useful. In eight patients with pulmonary nodules who were to undergo subsequent VT surgery, the attempt was made to locate the nodules by CT-guided placementof a hook wire, similar to that employed in breast, and methylene blue injection. The hook wire was correctly introduced without significant complications in all eight cases. The eight nodules were successfully resected during the thoracoscopic procedure, in which the hook wire and methylene blue staining were of great assistance. In certain cases, the location of pulmonary nodules by means of CT-guidehook wire placement and methylene blue injection allows the video thoracoscopic resection of lesions of difficult access. (Author)

  4. Effect of aging and lumbar spondylosis on lumbar lordosis

    Directory of Open Access Journals (Sweden)

    Francis Osita Okpala

    2018-01-01

    Full Text Available Background: Lumbar lordosis (LL, the anterior convexity of the lumbar spine in the mid-sagittal plane, gives the spine some resilience and helps in protecting it from compressive forces because some of the force is taken by the anterior longitudinal ligaments. In aging and lumbar spondylosis, the intervertebral discs undergo the same degenerative changes though at different rates, and in both, while some authors reported a straightening of LL, others reported no significant change. This morphologic information would hopefully influence therapeutic decision-making, particularly in lumbar spondylosis, which though usually asymptomatic, is a common cause of low back pain. Aim: The aim of the study was to investigate the effect of aging and lumbar spondylosis on LL. Subjects and Methods: Lumbosacral joint angle (LSJA, an angular measure of LL, was retrospectively measured in 252 normal and 329 spondylotic adolescent and adult supine lateral lumbosacral spine archival radiographs, and data were analyzed with IBM SPSS Statistics 23.0 (New York, USA. Results: Normal LSJA range was 5°–39°; the mean was 18.7° and showed insignificant variation with gender and aging. Spondylotic range was 5°–40° and the mean (20.8° differed from the normal mean by about 2°, which probably have inconsequential effect on the lumbar curvature, suggesting that the normal and spondylotic mean values are essentially equal. The spondylotic mean also showed insignificant variation with aging and inconsequential 1° gender difference in favor of females. Conclusion: LL is substantially maintained in aging and lumbar spondylosis.

  5. The factor analysis of the incidence of pneumothorax after CT-guided transthoracic needle aspiration biopsy

    International Nuclear Information System (INIS)

    Zhong Tao; Yu Hongguang; Wang Yong; Yang Sifu; Wang Xiaoxuan

    2007-01-01

    Objective: To analyze the impact of multiple factors on the incidence of pneumothorax associated with CT-guided transthoracic needle aspiration biopsy. Methods: The sign of pneumothorax after 162 cases (lesion diameter from 1 cm to 6 cm) CT-guided transthoracic needle aspiration biopsy was observed and its relationship with multivariate factors were analyzed by multivariate logistic regression model. Results: Thirty-two cases presented pneumothorax accounting for 19. 8%. Single variate analysis showed that the sign of pneumothorax related to intercurrent COPD, distance from lesion and chest wall, needle dwelling time and lesion diameter. 67 patients of intercurrent COPD with postoperative pneumothorax occurred in 22 cases (32.8%); With respect to those having lesions close to the chest wall (48 cases), and the cases with the distance between the chest wall and lesions less than 2 cm (55 cases) and greater than 2 cm (59 cases), the postoperative pneumothorax occurred in 0, 14 (25.5%), 18 (30.5%) cases respectively; For those patients with needle in the chest residence time of less than 10 minutes (82 cases), 10-20 minutes (51 cases), more than 20 minutes (28 cases) after the occurrence of pneumothorax were 8 (9.6%), 10(19.6%), 14 (50%) cases respectively; In contrast, those with lesion diameter less than 2 cm (65 cases), 2-4 cm(52 cases), more than 4cm(45 cases) were 19 (29.2%), 8 (15.4%) and 5 (11.1% ) respectively. The multivariate logistic regression analysis showed that the prior three factor's were risk factors of pneumothorax (OR=4.652, 4.030, 2.855 respectively). Conclusions: To avoid the pneumothorax, caution must be taken with respect to CT-guided transthoracic needle aspiration biopsy, patients with intercurrent COPD, long distance between lesion and chest wall, and smaller lesion diameter. For operation the needle dwell time within thorax should be minimized. (authors)

  6. Can MRI Localise the Cause of Chronic Low Backache in Lumbar Spondylosis and Help Guide Specific Management?

    Directory of Open Access Journals (Sweden)

    Joish Upendra Kumar

    2017-10-01

    Full Text Available Introduction: MRI is a primary imaging modality in assessing chronic low backache. Many of the findings identified on MRI may not be symptomatic. Nerve root compressions, compression of cauda equina, posterior annular tear, facetal arthropathy are more likely to be symptomatic. Management of each of these pathologies vary. It is essential to identify the pathologies that can cause pain and symptoms in lumbar spondylosis. Aim: To identify the specific finding/pathology on MRI that corresponds to the clinical presentation of the patient with lumbar spondylosis. Materials and Methods: The study was done between May and December 2016 and included 100 patients who were referred for MRI of lumbosacral spine with history of debilitating backache for more than 2 weeks. After ruling out other causes, clinical evaluation of patients was done to localize leve; and type of pain. T1, T2 weighted and STIR imaging of lumbo-sacral spine was done. The images were studied to localize the pathology which most likely caused the pattern of pain the patient experienced. Results: The study included 55 ladies and 45 men. 42 people had radiculopathy. In 86% of cases, MRI helped in localizing the exact pathology responsible for the pattern of pain the patients experienced. Nerve compressions were seen in 86% of patients with radiculopathy. Among the people without radiculopathy, the cause for pain could be localized in 86%. The most common cause of pain identified was horizontal posterior annular fissure (40%. Conclusion: In a significant number of patients with chronic low backache, we can identify the specific pathology that corroborates with the clinical symptomatology of the patient. This aids in guiding specific management to provide symptomatic relief.

  7. Minimally Invasive Direct Repair of Bilateral Lumbar Spine Pars Defects in Athletes

    Directory of Open Access Journals (Sweden)

    Gabriel A. Widi

    2013-01-01

    Full Text Available Spondylolysis of the lumbar spine has traditionally been treated using a variety of techniques ranging from conservative care to fusion. Direct repair of the defect may be utilized in young adult patients without significant disc degeneration and lumbar instability. We used minimally invasive techniques to place pars interarticularis screws with the use of an intraoperative CT scanner in three young adults, including two athletes. This technique is a modification of the original procedure in 1970 by Buck, and it offers the advantage of minimal muscle dissection and optimal screw trajectory. There were no intra- or postoperative complications. The detailed operative procedure and the postoperative course along with a brief review of pars interarticularis defect treatment are discussed.

  8. CT perfusion-guided patient selection for endovascular recanalization in acute ischemic stroke: a multicenter study.

    Science.gov (United States)

    Turk, Aquilla S; Magarick, Jordan Asher; Frei, Don; Fargen, Kyle Michael; Chaudry, Imran; Holmstedt, Christine A; Nicholas, Joyce; Mocco, J; Turner, Raymond D; Huddle, Daniel; Loy, David; Bellon, Richard; Dooley, Gwendolyn; Adams, Robert; Whaley, Michelle; Fanale, Chris; Jauch, Edward

    2013-11-01

    The treatment of acute ischemic stroke is traditionally centered on time criteria, although recent evidence suggests that physiologic neuroimaging may be useful. In a multicenter study we evaluated the use of CT perfusion, regardless of time from symptom onset, in patients selected for intra-arterial treatment of ischemic stroke. Three medical centers retrospectively assessed stroke patients with a National Institute of Health Stroke Scale of ≥ 8, regardless of time from symptom onset. CT perfusion maps were qualitatively assessed. Patients with defined salvageable penumbra underwent intra-arterial revascularization of their occlusion. Functional outcome using the modified Rankin Score (mRS) was recorded. Two hundred and forty-seven patients were selected to undergo intra-arterial treatment based on CT perfusion imaging. The median time from symptom onset to procedure was 6 h. Patients were divided into two groups for analysis: ≤ 8 h and >8 h from symptom onset to endovascular procedure. We found no difference in functional outcome between the two groups (42.8% and 41.9% achieved 90-day mRS ≤ 2, respectively (p=1.0), and 54.9% vs 55.4% (p=1.0) achieved 90-day mRS ≤ 3, respectively). Overall, 48 patients (19.4%) had hemorrhages, of which 20 (8.0%) were symptomatic, with no difference between the groups (p=1.0). In a multicenter study, we demonstrated similar rates of good functional outcome and intracranial hemorrhage in patients with ischemic stroke when endovascular treatment was performed based on CT perfusion selection rather than time-guided selection. Our findings suggest that physiologic imaging-guided patient selection rather than time for endovascular reperfusion in ischemic stroke may be effective and safe.

  9. CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

    International Nuclear Information System (INIS)

    Wang Ganggang; Chen Long; Yang Chao; Ni Caifang

    2013-01-01

    Objective: To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by 'double needle' technique to treat sacral cyst. Methods: Clinical data of 20 cases with 'double-needle' injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed. All patients had varying degrees of sacral nerve root compression symptoms. The treatment for sacral cyst was carried out after clear diagnosis was made. On the basis of CT-guided percutaneous injection of fibrin glue, the improved CT-guided percutaneous injection of fibrin glue by 'double-needle' technique was used to treat these patients. The average dose of fibrin glue was (5.9 ± 2.4) ml. The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months. The assessment criteria were as follows: excellent, complete resolution of signs and symptoms, with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up, good, symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region, which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up), fair, no improvement in clinical symptoms, but a decrease in cyst size on the imaging study, poor, no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results: Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Nine patients reported excellent recovery, 8 reported good recovery, 2 reported fair recovery, and 1 reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 85%. No serious postoperative complications were discovered. Conclusions: CT guided percutaneous injection of the fibrin glue by

  10. CT-Guided Superior Vena Cava Puncture: A Solution to Re-Establishing Access in Haemodialysis-Related Central Venous Occlusion Refractory to Conventional Endovascular Techniques

    Energy Technology Data Exchange (ETDEWEB)

    Khalifa, Mohamed, E-mail: mkhalifa@nhs.net; Patel, Neeral R., E-mail: neeral.patel06@gmail.com; Moser, Steven, E-mail: steven.moser@imperial.nhs.uk [Hammersmith Hospital, Department of Radiology, Imperial College Healthcare NHS Trust (United Kingdom)

    2016-04-15

    PurposeThe purpose of this technical note is to demonstrate the novel use of CT-guided superior vena cava (SVC) puncture and subsequent tunnelled haemodialysis (HD) line placement in end-stage renal failure (ESRF) patients with central venous obstruction refractory to conventional percutaneous venoplasty (PTV) and wire transgression, thereby allowing resumption of HD.MethodsThree successive ESRF patients underwent CT-guided SVC puncture with subsequent tract recanalisation. Ultrasound-guided puncture of the right internal jugular vein was performed, the needle advanced to the patent SVC under CT guidance, with subsequent insertion of a stabilisation guidewire. Following appropriate tract angioplasty, twin-tunnelled HD catheters were inserted and HD resumed.ResultsNo immediate complications were identified. There was resumption of HD in all three patients with a 100 % success rate. One patient’s HD catheter remained in use for 2 years post-procedure, and another remains functional 1 year to the present day. One patient died 2 weeks after the procedure due to pancreatitis-related abdominal sepsis unrelated to the Tesio lines.ConclusionCT-guided SVC puncture and tunnelled HD line insertion in HD-related central venous occlusion (CVO) refractory to conventional recanalisation options can be performed safely, requires no extra equipment and lies within the skill set and resources of most interventional radiology departments involved in the management of HD patients.

  11. Diagnostic feasibility and safety of CT-guided core biopsy for lung nodules less than or equal to 8 mm. A single-institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ying-Yueh [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); Chen, Chun-Ku [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China); National Yang-Ming University, Institute of Clinical Medicine, Taipei (China); Yeh, Yi-Chen [National Yang-Ming University, School of Medicine, Taipei (China); Taipei Veterans General Hospital, Department of Pathology and Laboratory Medicine, Taipei (China); Wu, Mei-Han [Taipei Veterans General Hospital, Department of Radiology, Taipei (China); National Yang-Ming University, School of Medicine, Taipei (China)

    2018-02-15

    This retrospective study evaluated the diagnostic yield and safety of CT-guided core biopsy of pulmonary nodules ≤8 mm. We determined the diagnostic yield and safety profile of CT-guided lung biopsies for 125 pulmonary nodules ≤8 mm. Pathological diagnoses were made by a combination of histopathological examination and imprint cytology. Results were compared with biopsy results for 134 pulmonary nodules >8 and ≤10 mm. Final diagnoses were established in 94 nodules ≤8 mm. The sensitivity, specificity and diagnostic accuracy of CT-guided core biopsy for nodules ≤8 mm were 87.1 % (61/70 nodules), 100 % (24/24) and 90.4 % (85/94), respectively. Diagnostic failure rates were comparable for nodules ≤8 mm and nodules >8 mm and ≤10 mm (9/94, 9.6 % and 7/111, 6.3 %, respectively, P=0.385). The rate of tube thoracostomy for nodules ≤8 mm was comparable to that for nodules >8 and ≤10 mm (1.6 % vs. 0.7 %, P=0.611). Nodules ≤6 mm had a higher non-diagnostic result rate of 15.4 % (6/39) than did nodules >8 and ≤10 mm (3.7 %, 5/134, P=0.017). CT-guided pulmonary biopsy is feasible for lung nodules ≤8 mm, especially those >6 mm, and has an acceptable diagnostic yield and safety profile. (orig.)

  12. Ultrasound-guided versus computed tomography-scan guided biopsy of pleural-based lung lesions.

    Science.gov (United States)

    Khosla, Rahul; McLean, Anna W; Smith, Jessica A

    2016-01-01

    Computed tomography (CT) guided biopsies have long been the standard technique to obtain tissue from the thoracic cavity and is traditionally performed by interventional radiologists. Ultrasound (US) guided biopsy of pleural-based lesions, performed by pulmonologists is gaining popularity and has the advantage of multi-planar imaging, real-time technique, and the absence of radiation exposure to patients. In this study, we aim to determine the diagnostic accuracy, the time to diagnosis after the initial consult placement, and the complications rates between the two different modalities. A retrospective study of electronic medical records was done of patients who underwent CT-guided biopsies and US-guided biopsies for pleural-based lesions between 2005 and 2014 and the data collected were analyzed for comparing the two groups. A total of 158 patients underwent 162 procedures during the study period. 86 patients underwent 89 procedures in the US group, and 72 patients underwent 73 procedures in the CT group. The overall yield in the US group was 82/89 (92.1%) versus 67/73 (91.8%) in the CT group (P = 1.0). Average days to the procedure was 7.2 versus 17.5 (P = 0.00001) in the US and CT group, respectively. Complication rate was higher in CT group 17/73 (23.3%) versus 1/89 (1.1%) in the US group (P guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate and a significantly reduced time to the procedure.

  13. Design and validation of a CT-guided robotic system for lung cancer brachytherapy.

    Science.gov (United States)

    Dou, Huaisu; Jiang, Shan; Yang, Zhiyong; Sun, Luqing; Ma, Xiaodong; Huo, Bin

    2017-09-01

    Currently, lung brachytherapy in clinical setting is a complex procedure. Operation accuracy depends on accurate positioning of the template; however, it is difficult to guarantee the positioning accuracy manually. Application of robotic-assisted systems can simplify the procedure and improve the manual positioning accuracy. Therefore, a novel CT-guided robotic system was developed to assist the lung cancer brachytherapy. A four degree-of-freedom (DOF) robot, controlled by a lung brachytherapy treatment planning system (TPS) software, was designed and manufactured to assist the template positioning. Target position of the template can be obtained from the treatment plan, thus the robot is driven to the target position automatically. The robotic system was validated in both the laboratory and the CT environment. In laboratory environment, a 3D laser tracker and an inertial measurement unit (IMU) were used to measure the mechanical accuracy in air, which includes positioning accuracy and position repeatability. Working reliability was also validated in this procedure by observing the response reliability and calculating the position repeatability. Imaging artifacts and accuracy of the robot registration were validated in the CT environment by using an artificial phantom with fiducial markers. CT images were obtained and used to test the image artifact and calculate the registration accuracy. Phantom experiments were conducted to test the accuracy of needle insertion by using a transparent hydrogel phantom with a high imitation artificial phantom. Also, the efficiency was validated in this procedure by comparing time costs in manual positioning with robotic positioning under the same experimental conditions. The robotic system achieved the positioning accuracy of 0.28 ± 0.25 mm and the position repeatability of 0.09 ± 0.11 mm. Experimental results showed that the robot was CT-compatible and responded reliably to the control commands. The mean registration accuracy

  14. Intraoperative "Analgesia Nociception Index"-Guided Fentanyl Administration During Sevoflurane Anesthesia in Lumbar Discectomy and Laminectomy: A Randomized Clinical Trial.

    Science.gov (United States)

    Upton, Henry D; Ludbrook, Guy L; Wing, Andrew; Sleigh, Jamie W

    2017-07-01

    The "Analgesia Nociception Index" (ANI; MetroDoloris Medical Systems, Lille, France) is a proposed noninvasive guide to analgesia derived from an electrocardiogram trace. ANI is scaled from 0 to 100; with previous studies suggesting that values ≥50 can indicate adequate analgesia. This clinical trial was designed to investigate the effect of intraoperative ANI-guided fentanyl administration on postoperative pain, under anesthetic conditions optimized for ANI functioning. Fifty patients aged 18 to 75 years undergoing lumbar discectomy or laminectomy were studied. Participants were randomly allocated to receive intraoperative fentanyl guided either by the anesthesiologist's standard clinical practice (control group) or by maintaining ANI ≥50 with boluses of fentanyl at 5-minute intervals (ANI group). A standardized anesthetic regimen (sevoflurane, rocuronium, and nonopioid analgesia) was utilized for both groups. The primary outcome was Numerical Rating Scale pain scores recorded from 0 to 90 minutes of recovery room stay. Secondary outcomes included those in the recovery room period (total fentanyl administration, nausea, vomiting, shivering, airway obstruction, respiratory depression, sedation, emergence time, and time spent in the recovery room) and in the intraoperative period (total fentanyl administration, intraoperative-predicted fentanyl effect-site concentrations over time [CeFent], the correlation between ANI and predicted CeFent and the incidence of movement). Statistical analysis was performed with 2-tailed Student t tests, χ tests, ordinal logistic generalized estimating equation models, and linear mixed-effects models. Bonferroni corrections for multiple comparisons were made for primary and secondary outcomes. Over the recovery room period (0-90 minutes) Numerical Rating Scale pain scores were on average 1.3 units lower in ANI group compared to the control group (95% confidence interval [CI], -0.4 to 2.4; P= .01). Patients in the ANI group

  15. CT-guided percutaneous acetic acid injection therapy for liver metastasis

    International Nuclear Information System (INIS)

    Yu Tongfu; Wang Dehang; Zhuang Zhenwu; Li Linxun; Shi Haibin

    2002-01-01

    Objective: To evaluate the efficacy of CT-guided percutaneous acetic acid injection (PAI) for liver metastasis. Methods: Thirty-five cases (40 lesions) with liver metastasis were treated with PAI. 4-10 ml of 30% acetic acid with 1 ml contrast media was injected into every lesion. PAI was performed twice a week, and repeated for 2 to 3 weeks. Results: The tumors shrunk in 23 lesions, and remained unchanged in 12 lesions. The efficiency was 87.5%. All cases were followed up for 3 months to 3 years. One year survival rates was 62.9% (22 cases), 2 years 40.0% (14 cases), and 3 years 22.9% (8 cases). Conclusion: PAI was an effective therapy for liver metastasis

  16. Diagnostic significance of CT discography

    International Nuclear Information System (INIS)

    Nishiyama, Toru; Tomita, Yu; Maeda, Katsuhisa; Takayama, Atsuya; Takada, Shunichi; Murakami, Masazumi; Saito, Yasufumi.

    1986-01-01

    In a total of 179 patients, comprising 161 with intervertebral disorder and 18 with spondylolysis or spondylolisthesis, CT discographic findings of 456 intervertebral discs were reviewed. Computed tomographic discography showed the direction of herniation, the size of hernial masses, and the deformity of the intervertebral disc and joint, being helpful in deciding indications for surgery and selecting surgical procedures. Computed tomographic discographic patterns of disk deformity were classified as types A, B, and C. This classification almost concurred with the findings of conventional discography. Discography or CT discography is recommended to be used when deformity at the L5-S1 level may be missed on myelography and there is extraforaminal lateral disc herniation. Combined use of myelography, discography, and CT discography would increase the diagnostic accuracy for lumbar diseases. (Namekawa, K.)

  17. The activL® Artificial Disc: a next-generation motion-preserving implant for chronic lumbar discogenic pain

    Directory of Open Access Journals (Sweden)

    Yue JJ

    2016-05-01

    Full Text Available James J Yue,1 Rolando Garcia Jr,2 Larry E Miller3 1Department of Orthopaedic Surgery, Yale School of Medicine, New Haven, CT, 2Orthopedic Care Center, Miami, FL, 3Miller Scientific Consulting, Inc., Asheville, NC, USA Abstract: Degeneration of the lumbar intervertebral discs is a leading cause of chronic low back pain in adults. Treatment options for patients with chronic lumbar discogenic pain unresponsive to conservative management include total disc replacement (TDR or lumbar fusion. Until recently, only two lumbar TDRs had been approved by the US Food and Drug Administration - the Charité Artificial Disc in 2004 and the ProDisc-L Total Disc Replacement in 2006. In June 2015, a next-generation lumbar TDR received Food and Drug Administration approval - the activL® Artificial Disc (Aesculap Implant Systems. Compared to previous-generation lumbar TDRs, the activL® Artificial Disc incorporates specific design enhancements that result in a more precise anatomical match and allow a range of motion that better mimics the healthy spine. The results of mechanical and clinical studies demonstrate that the activL® Artificial Disc results in improved mechanical and clinical outcomes versus earlier-generation artificial discs and compares favorably to lumbar fusion. The purpose of this report is to describe the activL® Artificial Disc including implant characteristics, intended use, surgical technique, postoperative care, mechanical testing, and clinical experience to date. Keywords: activL® Artificial Disc, artificial disc, degenerative disc disease, discogenic, implant, lumbar, motion preservation, pain

  18. Effects of anatomic conformation on three-dimensional motion of the caudal lumbar and lumbosacral portions of the vertebral column of dogs.

    Science.gov (United States)

    Benninger, Monika I; Seiler, Gabriela S; Robinson, Leanne E; Ferguson, Stephen J; Bonél, Harald M; Busato, André R; Lang, Johann

    2006-01-01

    To determine the association between the 3-dimensional (3-D) motion pattern of the caudal lumbar and lumbosacral portions of the canine vertebral column and the morphology of vertebrae, facet joints, and intervertebral disks. Vertebral columns of 9 German Shepherd Dogs and 16 dogs of other breeds with similar body weights and body conditions. Different morphometric parameters of the vertebral column were assessed by computed tomography (CT) and magnetic resonance imaging. Anatomic conformation and the 3-D motion pattern were compared, and correlation coefficients were calculated. Total range of motion for flexion and extension was mainly associated with the facet joint angle, the facet joint angle difference between levels of the vertebral column in the transverse plane on CT images, disk height, and lever arm length. Motion is a complex process that is influenced by the entire 3-D conformation of the lumbar portion of the vertebral column. In vivo dynamic measurements of the 3-D motion pattern of the lumbar and lumbosacral portions of the vertebral column will be necessary to further assess biomechanics that could lead to disk degeneration in dogs.

  19. Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation

    Energy Technology Data Exchange (ETDEWEB)

    Notohamiprodjo, S.; Stahl, R.; Braunagel, M.; Kazmierczak, P.M.; Thierfelder, K.M.; Treitl, K.M.; Wirth, S. [University Hospital of Munich, LMU Munich, Institute for Clinical Radiology, Munich (Germany); Notohamiprodjo, M. [University Hospital Tuebingen, Eberhard Karls University Tuebingen, Diagnostic and Interventional Radiology, Tuebingen (Germany)

    2017-08-15

    To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference. Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ. Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms. MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI. (orig.)

  20. The SNAP trial: a double blind multi-center randomized controlled trial of a silicon nitride versus a PEEK cage in transforaminal lumbar interbody fusion in patients with symptomatic degenerative lumbar disc disorders: study protocol

    Science.gov (United States)

    2014-01-01

    Background Polyetheretherketone (PEEK) cages have been widely used in the treatment of lumbar degenerative disc disorders, and show good clinical results. Still, complications such as subsidence and migration of the cage are frequently seen. A lack of osteointegration and fibrous tissues surrounding PEEK cages are held responsible. Ceramic implants made of silicon nitride show better biocompatible and osteoconductive qualities, and therefore are expected to lower complication rates and allow for better fusion. Purpose of this study is to show that fusion with the silicon nitride cage produces non-inferior results in outcome of the Roland Morris Disability Questionnaire at all follow-up time points as compared to the same procedure with PEEK cages. Methods/Design This study is designed as a double blind multi-center randomized controlled trial with repeated measures analysis. 100 patients (18–75 years) presenting with symptomatic lumbar degenerative disorders unresponsive to at least 6 months of conservative treatment are included. Patients will be randomly assigned to a PEEK cage or a silicon nitride cage, and will undergo a transforaminal lumbar interbody fusion with pedicle screw fixation. Primary outcome measure is the functional improvement measured by the Roland Morris Disability Questionnaire. Secondary outcome parameters are the VAS leg, VAS back, SF-36, Likert scale, neurological outcome and radiographic assessment of fusion. After 1 year the fusion rate will be measured by radiograms and CT. Follow-up will be continued for 2 years. Patients and clinical observers who will perform the follow-up visits will be blinded for type of cage used during follow-up. Analyses of radiograms and CT will be performed independently by two experienced radiologists. Discussion In this study a PEEK cage will be compared with a silicon nitride cage in the treatment of symptomatic degenerative lumbar disc disorders. To our knowledge, this is the first randomized controlled