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Sample records for ct-guided transpsoas approach

  1. A Novel CT-Guided Transpsoas Approach to Diagnostic Genitofemoral Nerve Block and Ablation

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    Parris, David; Fischbein, Nancy; Mackey, Sean; Carroll, Ian

    2010-01-01

    Background Inguinal hernia repair is associated with a high incidence of chronic postsurgical pain. This pain may be caused by injury to the iliohypogastric, ilioinguinal, or genitofemoral nerves. It is often difficult to identify the specific source of the pain, in part, because these nerves are derived from overlapping nerve roots and closely colocalize in the area of surgery. It is therefore technically difficult to selectively block these nerves individually proximal to the site of surgical injury. In particular, the genitofemoral nerve is retroperitoneal before entering the inguinal canal, a position that puts anterior approaches to the proximal nerve at risk of transgressing into the peritoneum. We report a computed tomography (CT)-guided transpsoas technique to selectively block the genitofemoral nerve for both diagnostic and therapeutic purposes while avoiding injury to the nearby ureter and intestines. Case A 39-year-old woman with chronic lancinating right groin pain after inguinal hernia repair underwent multiple pharmacologic interventions and invasive procedures without relief. Using CT and Stimuplex nerve stimulator guidance, the genitofemoral nerve was localized on the anterior surface of the psoas muscle and a diagnostic block with local anesthetic block was performed. The patient had immediate relief of her symptoms for 36 hours, confirming the diagnosis of genitofemoral neuralgia. She subsequently underwent CT-guided radiofrequency and phenol ablation of the genitofemoral nerve but has not achieved long-term analgesia. Conclusion CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes proximal to injury caused by inguinal surgery. PMID:20546515

  2. Minimally invasive lateral transpsoas approach for spinal discitis and osteomyelitis.

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    Patel, Neal B; Dodd, Zachary H; Voorhies, Jason; Horn, Eric M

    2015-11-01

    We present a series of patients with discitis and osteomyelitis who were surgically treated via a minimally invasive lateral transpsoas approach to the lumbar spine. Surgical treatment for spinal discitis and osteomyelitis presents challenges because of comorbidities that are common in patients undergoing this procedure. A retrospective review found six patients who met strict operative criteria including instability, intractable pain, neurological deficit, and disease progression. All patients were non-ambulatory before surgery because of intractable back pain. The patients underwent standard lateral minimally invasive surgery using either the extreme lateral interbody fusion (NuVasive, San Diego, CA, USA) or direct lateral interbody fusion (Medtronic Sofamor Danek, Memphis, TN, USA) system. The patients underwent debridement with a discectomy and partial or complete corpectomy, with polyetheretherketone or titanium cage placement. Two patients had additional posterior fixation with percutaneous pedicle screws, and none had immediate perioperative complications. The postoperative CT scans demonstrated satisfactory debridement and hardware placement. All patients experienced significant pain improvement and could ambulate within a few days of surgery. So far, the 1 year follow-up data have demonstrated stable hardware with solid fusion and continued pain improvements. One patient demonstrated hardware failure secondary to refractory infection, 2 months postoperatively, and required additional posterior decompression and debridement with pedicle screw fixation. The lateral transpsoas approach permits debridement and fixation coupled with percutaneous pedicle screw fixation to further stabilize the spine in a minimally invasive fashion. Due to the significant comorbidities in this patient population, a minimally invasive approach is a suitable surgical technique. A close follow-up period is necessary to detect early hardware failure which may necessitate more

  3. Minimally invasive lateral trans-psoas approach for tuberculosis of lumbar spine

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    Nitin Garg

    2014-01-01

    Full Text Available Anterior, posterolateral and posterior approaches are used for managing lumbar tuberculosis. Minimally invasive methods are being used increasingly for various disorders of the spine. This report presents the utility of lateral trans-psoas approach to the lumbar spine (LS using minimal access techniques, also known as direct lateral lumbar interbody fusion in 2 cases with tuberculosis of LS. Two patients with tuberculosis at L2-3 and L4-5 presented with back pain. Both had destruction and deformity of the vertebral body. The whole procedure comprising debridement and placement of iliac crest graft was performed using tubular retractors and was augmented by posterior fixation using percutaneous transpedicular screws. Both patients recovered well with no significant procedure related morbidity. Post-operative computed tomography scans showed appropriate position of the graft and instrumentation. At follow-up, both patients are ambulant with no progression of the deformity. Minimal access direct lateral transpsoas approach can be used for debridement and reconstruction of ventral column in tuberculous of Lumbar spine. This paper highlights the growing applications of minimal access surgery for spine.

  4. Safe zone for retractor placement to the lumbar spine via the transpsoas approach.

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    Spivak, Jeffery M; Paulino, Carl B; Patel, Ashish; Shanti, Nael; Pathare, Neil

    2013-04-01

    To measure anatomic variations of the lumbar plexus within the psoas in relation to the L2/3, L3/4, and L4/5 disc spaces and to delineate a safe zone to avoid nerve injury during retractor placement via the transpsoas approach. Six male and 6 female cadavers (24 psoas/ lumbar plexuses) aged 35 to 74 years were dissected. The lumbar plexus was isolated bilaterally. The L2, L3, and L4 nerve roots were identified and isolated without disturbing their natural anatomic course. The anteroposterior (AP) diameter of each intervertebral disc at L2/3, L3/4, and L4/5 was used as a reference. Four measurements were made using a caliper: the AP and mediolateral (ML) diameters of the psoas and AP and ML excursions of each nerve root. Percentages were calculated for the 4 measurements using the reference of the AP diameter of the intervertebral disc at each level. Comparison between left and right sides, between males and females, and between excursions of nerve roots were made. The AP diameter of the psoas increased from L2 to L4, with a mean vertebral body coverage of 80%, 86%, and 85% at L2/3, L3/4, and L4/5, respectively. Both the L2 and L3 nerve roots demonstrated substantial anterior trajectories as they coursed distally in the lumbar spine. No nerve root encroached anteriorly beyond 33% of the intervertebral disc space at L2 to L5. The lumbar plexus area corresponding to the anterior half of the intervertebral disc was the safe zone. Procedures to the lumbar spine via the transpsoas approach should be performed within the safe zone to avoid nerve injury.

  5. Improved outcomes with direct percutaneous CT guided lumbar synovial cyst treatment: advanced approaches and techniques.

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    Ortiz, A Orlando; Tekchandani, Leena

    2014-12-01

    To determine if lumbar synovial cyst rupture in symptomatic patients results in improved clinical outcome when using direct tandem and/or coaxial percutaneous CT guided techniques. 20 patients with unilateral lower extremity radiculopathy and/or low back pain underwent CT guided percutaneous treatment for their symptomatic lumbar synovial cysts. Cysts were identified with the use of a low osmolar non-ionic contrast agent via facet joint injection or through direct injection. Cyst rupture, using a direct tandem and/or coaxial technique, was attempted in all patients using an 18 gauge guide needle and a 22 gauge insert needle. Following attempted cyst aspiration, cyst rupture was performed using 1-3 mL of a mixture of methylprednisolone (2 mL, 80 mg) and bupivacaine (3 mL, 0.5%). All patients were followed-up in clinic for a minimum of 6 months after their procedures and up to a maximum of 24 months. 11 patients were male and nine were female, with an average age of 65.6 years. 17 patients presented with severe unilateral lower extremity radiculopathy and three patients were experiencing low back pain. One of the patients had two synovial cysts, and therefore a total of 21 lumbar synovial cysts were treated in this group of patients. Direct cyst puncture was achieved using a tandem technique in nine patients, a coaxial interlaminar approach in seven patients, a coaxial transforaminal approach in two patients, and a coaxial trans-facet approach in three patients. Cyst rupture was documented in all cases, as evidenced by CT confirmation of cyst decompression and contrast agent extravasation into the epidural space. The mean surveillance period in these patients was 18 months. Six patients experienced their usual radicular pain within 2 months of their treatment. Four of these patients were re-treated for recurrent smaller cysts. These patients have not had a recurrence at 24 months of follow up. Two of these six patients elected to undergo open

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

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    Lee, Jeong Min; Lee, Mi Suk; Jang, Young Ik; Kim, Jeong Hoi; Ym, Seong Hee; Lee, Jin Hee [Namwon Medical Center, Namwon (Korea, Republic of); Han, Young Min; Kim, Chong Soo; Choi, Ki Chul [Chonbuk National Univ. College of Medicine, Chonju (Korea, Republic of)

    1997-07-01

    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.

  7. Adult Degenerative Scoliosis with Spinal Stenosis Treated with Stand-Alone Cage via an Extreme Lateral Transpsoas Approach; a Case Report and Literature Review

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    Arvind von Keudell

    2015-04-01

    Full Text Available We report the case of a 73-year-old female with severe degenerative scoliosis and back and leg pain that wassuccessfully treated with stand- alone cages via an extreme lateral transpsoas approach. This patient had declinedopen surgery and instrumentation due to her advanced age concerns about potential side effects.

  8. CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia

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    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

  9. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

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    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.

  10. Transretroperitoneal CT-guided embolization of growing internal iliac artery aneurysm after repair of abdominal aortic aneurysm: a transretroperitoneal approach with intramuscular lidocaine injection technique.

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    Park, Joon Young; Kim, Shin Jung; Kim, Hyoung Ook; Kim, Yong Tae; Lim, Nam Yeol; Kim, Jae Kyu; Chung, Sang Young; Choi, Soo Jin Na; Lee, Ho Kyun

    2015-02-01

    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.

  11. CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years.

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    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.

  12. Single incision laparoscopic surgery approach for obscure small intestine bleeding localized by CT guided percutaneous injection of methylene blue

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    Juan Carlos Martinez

    2014-01-01

    PRESENTATION OF CASE: We present a new technique used in a patient with angiodysplasia of the small intestine, in where preoperative localization was done using percutaneous computed tomography (CT guided injection of methylene blue dye. This allowed us to perform a single incision laparoscopic small intestine resection of the culprit.

  13. Sagittal Plane Correction Using the Lateral Transpsoas Approach: A Biomechanical Study on the Effect of Cage Angle and Surgical Technique on Segmental Lordosis.

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    Melikian, Rojeh; Yoon, Sangwook Tim; Kim, Jin Young; Park, Kun Young; Yoon, Caroline; Hutton, William

    2016-09-01

    Cadaveric biomechanical study. To determine the degree of segmental correction that can be achieved through lateral transpsoas approach by varying cage angle and adding anterior longitudinal ligament (ALL) release and posterior element resection. Lordotic cage insertion through the lateral transpsoas approach is being used increasingly for restoration of sagittal alignment. However, the degree of correction achieved by varying cage angle and ALL release and posterior element resection is not well defined. Thirteen lumbar motion segments between L1 and L5 were dissected into single motion segments. Segmental angles and disk heights were measured under both 50 N and 500 N compressive loads under the following conditions: intact specimen, discectomy (collapsed disk simulation), insertion of parallel cage, 10° cage, 30° cage with ALL release, 30° cage with ALL release and spinous process (SP) resection, 30° cage with ALL release, SP resection, facetectomy, and compression with pedicle screws. Segmental lordosis was not increased by either parallel or 10° cages as compared with intact disks, and contributed small amounts of lordosis when compared with the collapsed disk condition. Placement of 30° cages with ALL release increased segmental lordosis by 10.5°. Adding SP resection increased lordosis to 12.4°. Facetectomy and compression with pedicle screws further increased lordosis to approximately 26°. No interventions resulted in a decrease in either anterior or posterior disk height. Insertion of a parallel or 10° cage has little effect on lordosis. A 30° cage insertion with ALL release resulted in a modest increase in lordosis (10.5°). The addition of SP resection and facetectomy was needed to obtain a larger amount of correction (26°). None of the cages, including the 30° lordotic cage, caused a decrease in posterior disk height suggesting hyperlordotic cages do not cause foraminal stenosis. N/A.

  14. Development of a CT-guided standard approach for tined lead implantation at the sacral nerve root S3 in minipigs for chronic neuromodulation

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    Foditsch EE

    2016-09-01

    Full Text Available Elena Esra Foditsch,1 Reinhold Zimmermann2 1Urology, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, 2University Clinic of Urology and Andrology, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria Purpose: The aim of this study was to develop a controlled approach for sacral neuromodulation (SNM to improve both nerve targeting and tined lead placement, for which a new computed tomography (CT-guided implantation technique was analyzed in minipigs.Materials and methods: This study included five female, adult Göttingen minipigs. In deep sedoanalgesia, the minipigs were placed in an extended prone position. Commercially available SNM materials were used (needle, introduction sheath, and quadripolar tined lead electrode. Gross anatomy was displayed by CT, and the nerves were bilaterally identified. The optimal angles to puncture the S3 foramen, the resulting access path, and the site for the skin incision were defined subsequently. The needle puncture and the tined lead placement were followed by successive CT scans/3D-reconstruction images. Once proper CT-guided placement of the needle and electrode was established, response to functional stimuli was intraoperatively checked to verify correct positioning.Results: Successful bilateral tined lead implantation was performed in four out of five minipigs. Implantation was different from the clinical situation because the puncture was done from the contralateral side at a 30° angle to the midline and 60° horizontal angle to ensure both passage through the foramen and nerve access. Surgery time was 50–150 minutes. Stimulation response comprised a twitch of the perianal musculature and tail rotation to the contralateral side.Conclusion: We have established a new, minimally invasive, highly standardized, CT-guided SNM electrode implantation technique. Functional outcomes are clearly defined and reproducible. All procedures can be

  15. Point-Counterpoint: The Use of Neuromonitoring in Lateral Transpsoas Surgery.

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    Cheng, Ivan; Acosta, Frank; Chang, Ki; Pham, Martin

    2016-04-01

    Expert opinion. The objective of this study is to debate the requirement for intraoperative neuromonitoring in 90° lateral transpsoas spine surgery (lateral lumbar interbody fusion [LLIF]) in a point-counterpoint style with an argument made for each side followed by a brief rebuttal of each. Dr. Ivan Cheng will argue in favor of the use of neuromonitoring in LLIF, and Dr. Frank Acosta will argue against the requirement for the use of neuromonitoring in LLIF. The lateral approach to the lumbar spine has been used since at least the 1990s and requires passage near or adjacent to the lumbar plexus. The mini-open lateral transpsoas approach was introduced in the literature in 2006 and uses evoked electromyography integrated into the approach and procedural instrumentation that stimulates in directional orientations and provides discrete threshold responses to avoid the nerves of the lumbar plexus. More recently, lateral transpsoas approaches to the lumbar spine have been developed that do not require or advocate for the use of neuromonitoring, instead relying on direct visualization and avoidance of nerves (shallow-docking). Two experienced lateral approach surgeons who regularly perform lateral transpsoas approaches with integrated neuromonitoring (IC) and without neuromonitoring (FA) present arguments for and against the requirement for neuromonitoring. Advocating for the use of neuromonitoring, points made include the broader literature validation of the lateral transpsoas approach with the use of advanced neuromonitoring and the relatively low rate of neural complications in neuromonitored transpsoas lateral approaches compared to those rates in shallow-docking literature. Advocating against the requirement for neuromonitoring in lateral transpsoas, points made include the potentially higher reliability of nerve avoidance with direct visualization as well as the favorable early results in the literature with respect to both new postoperative motor and sensory

  16. Lateral Transpsoas Fusion: Indications and Outcomes

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    Vishal C. Patel

    2012-01-01

    Full Text Available Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.

  17. Neurological Complications after Lateral Transpsoas Approach to Anterior Interbody Fusion with a Novel Flat-Blade Spine-Fixed Retractor

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    Pierce Nunley

    2016-01-01

    Full Text Available Introduction. The lateral lumbar interbody fusion (LLIF surgical approach has potential advantages over other approaches but is associated with some unique neurologic risks due to the proximity of the lumbosacral plexus. The present study analyzed complications following LLIF surgical approach using a novel single flat-blade retractor system. Methods. A retrospective data collection of patients receiving LLIF using a novel single flat-blade retractor system at two institutions in the US. Inclusion criteria were all patients receiving an LLIF procedure with the RAVINE® Lateral Access System (K2M, Inc., Leesburg, VA, USA. There was no restriction on preoperative diagnosis or number of levels treated. Approach-related neurologic complications were collected and analyzed postoperatively through a minimum of one year. Results. Analysis included 253 patients with one to four treated lateral levels. Immediate postoperative neurologic complications were present in 11.1% (28/253 of patients. At one-year follow-up the approach-related neurologic complications resolved in all except 5 patients (2.0%. Conclusion. We observed an 11.1% neurologic complication rate in LLIF procedures. There was resolution of symptoms for most patients by 12-month follow-up, with only 2% of patients with residual symptoms. This supports the hypothesis that the vast majority of approach-related neurologic symptoms are transient.

  18. Lordosis restoration after anterior longitudinal ligament release and placement of lateral hyperlordotic interbody cages during the minimally invasive lateral transpsoas approach: a radiographic study in cadavers.

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    Uribe, Juan S; Smith, Donald A; Dakwar, Elias; Baaj, Ali A; Mundis, Gregory M; Turner, Alexander W L; Cornwall, G Bryan; Akbarnia, Behrooz A

    2012-11-01

    In the surgical treatment of spinal deformities, the importance of restoring lumbar lordosis is well recognized. Smith-Petersen osteotomies (SPOs) yield approximately 10° of lordosis per level, whereas pedicle subtraction osteotomies result in as much as 30° increased lumbar lordosis. Recently, selective release of the anterior longitudinal ligament (ALL) and placement of lordotic interbody grafts using the minimally invasive lateral retroperitoneal transpsoas approach (XLIF) has been performed as an attempt to increase lumbar lordosis while avoiding the morbidity of osteotomy. The objective of the present study was to measure the effect of the selective release of the ALL and varying degrees of lordotic implants placed using the XLIF approach on segmental lumbar lordosis in cadaveric specimens between L-1 and L-5. Nine adult fresh-frozen cadaveric specimens were placed in the lateral decubitus position. Lateral radiographs were obtained at baseline and after 4 interventions at each level as follows: 1) placement of a standard 10° lordotic cage, 2) ALL release and placement of a 10° lordotic cage, 3) ALL release and placement of a 20° lordotic cage, and 4) ALL release and placement of a 30° lordotic cage. All four cages were implanted sequentially at each interbody level between L-1 and L-5. Before and after each intervention, segmental lumbar lordosis was measured in all specimens at each interbody level between L-1 and L-5 using the Cobb method on lateral radiography. The mean baseline segmental lordotic angles at L1-2, L2-3, L3-4, and L4-5 were -3.8°, 3.8°, 7.8°, and 22.6°, respectively. The mean lumbar lordosis was 29.4°. Compared with baseline, the mean postimplantation increase in segmental lordosis in all levels combined was 0.9° in Intervention 1 (10° cage without ALL release); 4.1° in Intervention 2 (ALL release with 10° cage); 9.5° in Intervention 3 (ALL release with 20° cage); and 11.6° in Intervention 4 (ALL release with 30° cage

  19. Clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in adults.

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    Zou, Authrors Dexin; Zhou, Junlin; Zhou, Xiaobin; Jiang, Xiaobing

    2017-09-12

    To evaluate the clinical efficacy of CT-guided percutaneous huge ilio-psoas abscesses drainage combined with posterior approach surgery for the management of dorsal and lumbar spinal tuberculosis in 16 adult cases. Between January 2006 and June 2013, a total of 16 dorsal and lumbar spinal tuberculosis patients with huge ilio-psoas abscesses underwent two-stage CT-guided percutaneous abscesses drainage and posterior debridement, decompression, intervertebral fusion and instrumentation. Standard quadruple antituberculous chemotherapy was performed both before and after surgery. The average follow-up period was 26.7 months (range 18-38 months). There is no severe complication and relapse of spinal tuberculosis. The blood loss was 921.0±141.3mL, operation time was 174.8±15.7minutes. Kyphotic angle improved from 36.6±10.0° preoperatively to 8.1±1.8° postoperatively with 2.2±1.5° loss of correction at final follow-up. The solid bone fusion was achieved in all cases at average 6.6±2.2 months after surgery. Neurologic deficits were recovered in varing degrees except 4 cases remained the same. The postoperative quality of life significantly improved. The Oswestry Disability Index (ODI) decreased from 32.8±10.6 preoperatively to 14.4±7.9 at the final follow-up. CT-guided percutaneous drainage combined with posterior approach surgery was proved to be safe and effective for the management of dorsal and lumbar spinal tuberculosis with huge ilio-psoas abscesses in adults. Level IV, retrospective. Copyright © 2017. Published by Elsevier Masson SAS.

  20. Radiation exposure in CT-guided interventions

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    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.

  1. Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Im [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Park, Chang Min; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of); Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of)

    2015-07-15

    To investigate the effect of rapid needle-out patient-rollover approach on the incidence of pneumothorax and drainage catheter placement due to pneumothorax in C-arm Cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions. From May 2011 to December 2012, 1227 PTNBs were performed in 1191 patients with a 17-gauge coaxial needle. 617 biopsies were performed without (conventional-group) and 610 with rapid-rollover approach (rapid-rollover-group). Overall pneumothorax rates and incidences of pneumothorax requiring drainage catheter placement were compared between two groups. There were no significant differences in overall pneumothorax rates between conventional and rapid-rollover groups (19.8 % vs. 23.1 %, p = 0.164). However, pneumothorax rate requiring drainage catheter placement was significantly lower in rapid-rollover-group (1.6 %) than conventional-group (4.2 %) (p = 0.010). Multivariate analysis revealed male, age > 60, bulla crossed, fissure crossed, pleura to target distance > 1.3 cm, emphysema along needle tract, and pleural punctures ≥ 2 were significant risk factors of pneumothorax (p < 0.05). Regarding pneumothorax requiring drainage catheter placement, fissure crossed, bulla crossed, and emphysema along needle tract were significant risk factors (p < 0.05), whereas rapid-rollover approach was an independent protective factor (p = 0.002). The rapid needle-out patient-rollover approach significantly reduced the rate of pneumothorax requiring drainage catheter placement after CBCT-guided PTNB. (orig.)

  2. TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion

    Directory of Open Access Journals (Sweden)

    Hardenbrook MA

    2013-06-01

    Full Text Available Mitchell A Hardenbrook,1,2 Larry E Miller,3,4 Jon E Block4 1Advanced Spine Institute of Greater Boston, North Billerica, MA, 2Department of Orthopedic Surgery, Tufts University School of Medicine, Boston, MA, 3Miller Scientific Consulting Inc, Arden, NC, 4The Jon Block Group, San Francisco, CA, USA Abstract: Minimally invasive approaches for lumbar interbody fusion have been popularized in recent years. The retroperitoneal transpsoas approach to the lumbar spine is a technique that allows direct lateral access to the intervertebral disc space while mitigating the complications associated with traditional anterior or posterior approaches. However, a common complication of this procedure is iatrogenic injury to the psoas muscle and surrounding nerves, resulting in postsurgical motor and sensory deficits. The TranS1 VEO system (TranS1 Inc, Raleigh, NC, USA utilizes a novel, minimally invasive transpsoas approach to the lumbar spine that allows direct visualization of the psoas and proximal nerves, potentially minimizing iatrogenic injury risk and resulting clinical morbidity. This paper describes the clinical uses, procedural details, and indications for use of the TranS1 VEO system. Keywords: fusion, lateral, lumbar, minimally invasive, transpsoas, VEO

  3. CT Guided Laser Ablation of Osteoid Osteoma

    Directory of Open Access Journals (Sweden)

    Manohar Kachare

    2015-10-01

    Full Text Available To present our experience of Computed Tomography (CT guided laser ablation of radiologically proven osteoid osteoma in the inter trochantric region of the femur. A19 year old female presented with severe pain in left upper thigh region since 6-7 months, which was exaggerated during nights and was relived on taking oral Non Steroid Anti Inflammatory Drugs (NSAIDs. On CT scan hypodense lesion with surrounding dense sclerosis noted in intertrochanteric region in left femur. Magnetic Resonance Imaging (MRI revealed small focal predominantly cortical, oval lytic lesion in the intertrochanteric region which appeared hypointense on T1 Weighted Image (T1WI and hyperintense on T2 Weighted Image (T2WI and Short Tau Inversion Recovery (STIR image. Diffuse extensive sclerosis and hyperostosis of bone was noted surrounding the lesion appearing hypointense on T1W and T2W images. Under local anesthesia the laser fibre was inserted in the nidus under CT guidance through bone biopsy needle and 1800 joules energy delivered in the lesion continuous mode. Complete relief of pain noted after 24 hours after the treatment. CT guided LASER ablation is a safe, simple and effective method of treatment for osteoid osteoma.

  4. Lateral retroperitoneal transpsoas interbody fusion in a patient with achondroplastic dwarfism.

    Science.gov (United States)

    Staub, Blake N; Holman, Paul J

    2015-02-01

    The authors present the first reported use of the lateral retroperitoneal transpsoas approach for interbody arthrodesis in a patient with achondroplastic dwarfism. The inherent anatomical abnormalities of the spine present in achondroplastic dwarfism predispose these patients to an increased incidence of spinal deformity as well as neurogenic claudication and potential radicular symptoms. The risks associated with prolonged general anesthesia and intolerance of significant blood loss in these patients makes them ideal candidates for minimally invasive spinal surgery. The patient in this case was a 51-year-old man with achondroplastic dwarfism who had a history of progressive claudication and radicular pain despite previous extensive lumbar laminectomies. The lateral retroperitoneal transpsoas approach was used for placement of interbody cages at L1/2, L2/3, L3/4, and L4/5, followed by posterior decompression and pedicle screw instrumentation. The patient tolerated the procedure well with no complications. Postoperatively his claudicatory and radicular symptoms resolved and a CT scan revealed solid arthrodesis with no periimplant lucencies.

  5. Minimally invasive CT guided treatment of intraspinal synovial cyst

    National Research Council Canada - National Science Library

    Sergeja Kozar; Miran Jeromel

    2014-01-01

    .... Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

  6. CT-guided cervical transforaminal steroid injections: where should the needle tip be located?

    Science.gov (United States)

    Hoang, J K; Massoglia, D P; Apostol, M A; Lascola, C D; Eastwood, J D; Kranz, P G

    2013-03-01

    The aim of CT-guided CTSI is to inject medication into the foraminal region where the nerve root is inflamed. The optimal location for needle placement and therapeutic delivery, however, remain uncertain. The purpose of this study was to investigate how needle positioning and angle of approach impact the transforaminal distribution of injectate. We retrospectively reviewed fluoroscopic images from 90 CT-guided CTSI procedures for needle-tip location, needle angle, and contrast distribution. Needle-tip position was categorized as either foraminal zone, junctional, or extraforaminal. Distribution of contrast injected immediately before steroid administration was categorized as central epidural, intraforaminal, or extraforaminal in location. Needle-tip location and angle were correlated with contrast distribution. The needle tip was most commonly placed in the junctional position (36 cases, 40%), followed by foraminal (30 cases, 33%) and extraforaminal (24 cases, 27%) locations. Intraforaminal contrast distribution was highest when the needle location was foraminal (30/30, 100%) or junctional (35/36, 97%), compared with extraforaminal (7/24, 29%) (P value <.0001). There was no relationship between needle angle and contrast distribution. Needle-tip location at the outer edge of the neural foramen (junctional location) correlated well with intraforaminal distribution of contrast for CT-guided CTSI and compared favorably with injectate distribution following foraminal zone needle positioning. Junctional needle positioning may be preferred over the foraminal zone by some proceduralists. Extraforaminal needle positioning resulted in less favorable contrast distribution, which may significantly diminish the therapeutic efficacy of CTSI.

  7. CT-guided core-needle biopsy in the diagnosis of mediastinal lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Sklair-Levy, M.; Shaham, D.; Applbaum, Y.H.; Libson, E. [Dept. of Radiology, Hadassah University Hospital, Jerusalem (Israel); Polliack, A.; Gillis, S.; Ben-Yehuda, D. [Dept. of Haematology, Hadassah University Hospital, Jerusalem (Israel); Sherman, Y. [Dept. of Pathology, Hadassah University Hospital, Jerusalem (Israel)

    2000-05-01

    The advent of radiologic guidance techniques for percutaneous biopsy has changed the approach to the routine diagnosis of mediastinal lymphoma. The aim of the present study was to evaluate the diagnostic accuracy of CT-guided percutaneous core-needle biopsy (PCNB) in the clinical management of patients with mediastinal lymphoma. The results of 49 CT-guided PCNB of mediastinal lymphoma performed under local anesthesia in 42 ambulatory patients were analyzed. A positive diagnosis of lymphoma was obtained in 30 of 42 patients, with an overall success rate of 71.5 %. The technique was equally successful in the diagnosis of Hodgkin's and non-Hodgkin's lymphoma. There were no major complications. Percutaneous CT-guided CNB of mediastinal lymphoma is a quick, safe, accurate, and efficient alternative to open biopsy in the evaluation of mediastinal lymphoma, mainly at presentation. It should become the preferred initial diagnostic procedure for obtaining histologic samples in patients with suspected mediastinal lymphoma. (orig.)

  8. Diagnostic usefulness of CT-guided percutaneous biopsy of the spine

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Kyung Jin; Kim, Won Hong; Byun, Joon Soo; Cho, Young Kook; Cho, Kyu Jung; Moon, Kyung Ho; Seok, Eul Hye; Shin, Seok Hwan; Han, Heon [Inha Univ. College of Medicine, Inchon (Korea, Republic of)

    1999-12-01

    To evaluate the diagnostic value of CT-guided percutaneous biopsy of inflammatory and tumorous lesions of the spine and paraspinal soft tissue. Twenty-three patients underwent CT-guided percutaneous biopsy of the spine and paraspinal soft tissue. Tentative clinical diagnoses determined before biopsy were tuberculous spondylitis(n=5), pyogenic spondylitis (n=4), butterfly vertebra (n=1), old compression fracture (n=3), discitis (n=1), hemangioma (n=1), metastasis (n=7) and multiple myeloma (n=1). Biopsy was performed at the following levels: cervical-(n=1), thoracic-(n=9), and lumbar-spine(n=13). The approach to biopsy of the spine and paraspinal soft tissue lesions was posterolateral (n=11), posterior (n=2), or transpedicular (n=10). Tissue considered adequate by the pathologist involved was obtained in 21 (91%) of the 23 cases. In 19 cases, pathologic findings supported the clinical diagnoses determined before biopsy. In two cases, pathologic and clinical diagnoses differed. Complications such as severe pain, bleeding, infection, neurologic deficit or damage to internal organs were detected neither during or after the procedure. CT-guided percutaneous biopsy is a safe and reliable method of obtaining a diagnosis in many cases involving different spinal and paraspinal lesions.

  9. Minimally invasive CT guided treatment of intraspinal synovial cyst.

    Science.gov (United States)

    Kozar, Sergeja; Jeromel, Miran

    2014-03-01

    Intraspinal synovial cysts of vertebral facet joints are uncommon cause of radicular pain as well as neurological deficits. They can be managed both conservatively and surgically. A 77-year old polymorbid patient presented with bilateral low back pain which worsened during the course of time and did not respond to the conservative treatment. A diagnosis of intraspinal synovial cyst was made using the magnetic resonance imaging (MRI). Percutaneous computed tomography (CT) guided injection with installation of local anesthetic together with corticosteroid and rupture of the cyst was successfully used. A month after the procedure his pain improved, the usage of analgesics diminished and his over-all quality of life improved. Percutaneous CT guided lumbar synovial cyst treatment is safe and reliable alternative to the surgical treatment in polymorbid patients with radiculopathy who are not able to tolerate general anesthesia and operation.

  10. 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.

  11. CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma

    Institute of Scientific and Technical Information of China (English)

    LIU Chen; LIU Xiao-guang; ZHU Bin; YUAN Hui-shu; HAN Song-bo; MA Yong-qiang

    2011-01-01

    Background This study evaluated the feasibility,efficacy and safety of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma.Methods Two patients suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia.Lesions located in sacral vertebrae and cervical vertebrae,which were adjacent to nerve root and spinal canal respectively.Tumors were treated under 90°C radiofrequency temperature lasting 4 minutes by an electrode placement.Visual analog scale was used to evaluate the pain improvement.Results No complications were observed pre- and post-operation.Patients recovered to normal activities immediately and achieved complete pain relief in 24 hours.No symptoms were recurrent in 5 months and 4 months follow up.Mild scoliosis has been recovered in case 2.Conclusions CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe,effective and has more clinical benefits.The long-term outcome needs further observation.

  12. Value of CT-guided percutaneous lung biopsy in diagnosing non-small cell lung cancer compared with biopsy from surgical approach%两种方法获得的非小细胞肺癌标本病理结果的差异

    Institute of Scientific and Technical Information of China (English)

    李波; 王菁; 李月川

    2015-01-01

    percutaneous lung biopsy (pathological types and using different analysis tools) and from surgical operation were compared. Results The coincidence rate of pathological type is 86.81%(79/91) using pathological results through percutaneous lung biopsy or oper⁃ation. Compared with the pathological results of operation, the coincidence rate of pathological type using percutaneous lung biopsy show no statistical significance [Squamous cell carcinoma 88.57%(31/35) vs Grandular cell carcinoma 86.27%(44/51) vs adeno-squamous carcinoma 80.00%(4/5),χ2=0.310,P>0.05];the coincidence rate of percutaneous lung biopsy pathologi⁃cal results using different approaches demonstrate statistical significance compared with surgical biopsy pathological results (χ2=9.698, P<0.05). The coincidence rate of pathological results obtained by Smear and biopsy [94.4%(51/54)] is higher than that of surgical biopsy pathological results using smear alone [60.0%(6/10)] and by biopsy alone [81.4%(22/27)]. Con⁃clusion Using CT-guided percutaneous lung biopsy, it can produce reliable results on pathological type of non-small cell lung cancer. But the reliability can be affected by different analysis approaches that were hired to exam samples from CT-guided percutaneous lung biopsy.

  13. Palmar hyperhidrosis - CT guided chemical percutaneous thoracic sympathectomy

    Energy Technology Data Exchange (ETDEWEB)

    Adler, O.B.; Engel, A.; Rosenberger, A. (Technion-Israel Inst. of Tech., Haifa (Israel). Dept. of Diagnostic Radiology); Dondelinger, R. (Centre Hospitalier, Luxembourg (Luxembourg). Dept. of Diagnostic Radiology)

    1990-10-01

    Palmar hyperhidrosis or excessive sweating of the hands causes, to those affected, emotional and physical disturbance and impediment in professional and social life. The cause is unknown. Sweat glands are innervated by the sympathic chain of the autonomous nervous system. The center of sympathic regulation of the upper extremities is located between the segments of D.2-D.9 of the spinal cord. Accepted treatment consists of surgery aimed to excise the third thoracic sympathic ganglion. CT guided chemical percutaneous thoracic sympathectomy presents an alternative, which in the event of failure does not prevent ensuing surgery. The preliminary experience with this procedure in 50 patients is presented and discussed. (orig./GDG).

  14. 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.

  15. 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.)

  16. CT guided diffuse optical tomography for breast cancer imaging

    Science.gov (United States)

    Baikejiang, Reheman; Zhang, Wei; Zhu, Dianwen; Li, Changqing

    2016-03-01

    Diffuse optical tomography (DOT) has attracted attentions in the last two decades due to its intrinsic sensitivity in imaging chromophores of tissues such as blood, water, and lipid. However, DOT has not been clinically accepted yet due to its low spatial resolution caused by strong optical scattering in tissues. Structural guidance provided by an anatomical imaging modality enhances the DOT imaging substantially. Here, we propose a computed tomography (CT) guided multispectral DOT imaging system for breast cancer detection. To validate its feasibility, we have built a prototype DOT imaging system which consists of a laser at wavelengths of 650 and an electron multiplying charge coupled device (EMCCD) camera. We have validated the CT guided DOT reconstruction algorithms with numerical simulations and phantom experiments, in which different imaging setup parameters, such as projection number of measurements, the width of measurement patch, have been investigated. Our results indicate that an EMCCD camera with air cooling is good enough for the transmission mode DOT imaging. We have also found that measurements at six projections are sufficient for DOT to reconstruct the optical targets with 4 times absorption contrast when the CT guidance is applied. Finally, we report our effort and progress on the integration of the multispectral DOT imaging system into a breast CT scanner.

  17. Low-dose techniques in CT-guided interventions.

    Science.gov (United States)

    Sarti, Marc; Brehmer, William P; Gay, Spencer B

    2012-01-01

    Computed tomography (CT)-guided interventions such as biopsy, drainage, and ablation may be significant sources of radiation exposure in both patients and radiologists. Simple CT techniques to reduce radiation dose may be employed without increasing the procedure time or significantly degrading image quality. To develop low-dose protocols, it is important to understand the key concepts of delivered radiation dose to patients and physicians during CT-guided interventions. Patient dose estimates are easily followed and are provided at CT workstations. Familiarity with dose estimates, which are expressed as CT dose index and dose-length product, is also important. Methods to reduce radiation exposure in patients and physicians include performing proper preprocedure planning and paying careful attention to technique during the planning stage, making use of personal protective equipment, performing CT fluoroscopy intermittently instead of in real time, and optimizing needle visualization. Representative examples of these techniques have resulted in dose reductions of as much as 89%. Alternative imaging technologies that do not use ionizing radiation, such as virtual and ultrasonographic guidance, may also be used to reduce radiation dose. Understanding dose contribution strategies to reduce radiation dose provides a safer, more efficient environment for patients and the radiology team.

  18. 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.)

  19. 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.)

  20. 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.)

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

    NARCIS (Netherlands)

    Heerink, W J; de Bock, G H; de Jonge, G J; Groen, H J M; Vliegenthart, R; Oudkerk, M

    2016-01-01

    OBJECTIVES: To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. METHODS: 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

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

    NARCIS (Netherlands)

    Heerink, W. J.; de Bock, G. H.; de Jonge, G. J.; Groen, H. J. M.; Vliegenthart, R.; Oudkerk, M.

    2017-01-01

    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 b

  3. Percutaneous CT-guided treatment of recurrent spinal cyst hydatid.

    Science.gov (United States)

    Ozdemir, Ozgur; Calisaneller, Tarkan; Yildirim, Erkan; Altinors, Nur

    2011-01-01

    The involvement of spinal column in cyst hydatid disease is rare and hard to treat. The gold standard treatment is total removal of the cysts without rupture. However, recurrence after surgery is almost inevitable and reoperations carries technical difficulties and higher morbidity. We present a 69-year-old woman with two cystic masses at the T12 level, which compress the spinal cord causing severe paresis in her left leg. Under local anestesia, the cysts were aspirated and irrigated with 20% hypertonic saline solution via bilateral T12 transpedicular route. We aimed to report that percutaneous CT guided treatment should be considered as an alternative therapeutic option in case of recurrent spinal cyst hydatid.

  4. 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.)

  5. Diagnostic Accuracy of PET/CT-Guided Percutaneous Biopsies for Malignant Peripheral Nerve Sheath Tumors in Neurofibromatosis Type 1 Patients.

    Directory of Open Access Journals (Sweden)

    Mehdi Brahmi

    biopsy gave 25 accurate diagnoses and one false negative (BPNST with atypical cells on the biopsy and MPNST on the operated tumor, resulting in a diagnostic accuracy rate of 96%. This false negative case may be explained by the high heterogeneity of the tumor: benign areas were contiguous with the malignant ones and associated with inflammation.PET/CT-guided percutaneous biopsies are an effective and relatively non-traumatic procedure for diagnosis of NF1-related MPNST. It is the most reliable approach for early detection of MPNST.

  6. CT-guided brachytherapy of prostate cancer: reduction of effective dose from X-ray examination

    Science.gov (United States)

    Sanin, Dmitriy B.; Biryukov, Vitaliy A.; Rusetskiy, Sergey S.; Sviridov, Pavel V.; Volodina, Tatiana V.

    2014-03-01

    Computed tomography (CT) is one of the most effective and informative diagnostic method. Though the number of CT scans among all radiographic procedures in the USA and European countries is 11% and 4% respectively, CT makes the highest contribution to the collective effective dose from all radiographic procedures, it is 67% in the USA and 40% in European countries [1-5]. Therefore it is necessary to understand the significance of dose value from CT imaging to a patient . Though CT dose from multiple scans and potential risk is of great concern in pediatric patients, this applies to adults as well. In this connection it is very important to develop optimal approaches to dose reduction and optimization of CT examination. International Commission on Radiological Protection (ICRP) in its publications recommends radiologists to be aware that often CT image quality is higher than it is necessary for diagnostic confidence[6], and there is a potential to reduce the dose which patient gets from CT examination [7]. In recent years many procedures, such as minimally invasive surgery, biopsy, brachytherapy and different types of ablation are carried out under guidance of computed tomography [6;7], and during a procedures multiple CT scans focusing on a specific anatomic region are performed. At the Clinics of MRRC different types of treatment for patients with prostate cancer are used, incuding conformal CT-guided brachytherapy, implantation of microsources of I into the gland under guidance of spiral CT [8]. So, the purpose of the study is to choose optimal method to reduce radiation dose from CT during CT-guided prostate brachytherapy and to obtain the image of desired quality.

  7. Feasibility study on CT guided percutaneous incisional needle biopsy for deep pelvic masses by different puncture approaches%CT导向盆腔深部肿块穿刺切割活检术不同穿刺路径的可行性探讨

    Institute of Scientific and Technical Information of China (English)

    郑家平; 邵国良; 陈玉堂; 樊树峰; 杨建民

    2009-01-01

    Objective To explore the feasibility of CT guided pereutaneous incisional needle biopsy (PINB) for deep pelvic masses at different locations via various puncture approaches.Methods PINBs under CT guidance were performed in 70 patients with 72 pelvic lesions through different puncture approaches.Their pathological findings and safety were evaluated after follow-up of a period of 1-34 months.Results PINBs were performed through transpiriform-muscle in 27 cases,16 through transgluteal approach,5 through posterior oblique approach in prone position,8 by anterior or lateral transabdominal route,8 through iliopsoas muscle and 8 by direct transosseous approach,respectively.Sixty-four malignant lesions were confirmed by pathology,including 30 adenocarcinomas,19 squamous cell carcinomas,5 unclassified malignant tumors,3 small cell carcinomas,2 malignant giant cell tumors of bone,2 hepatocellular carcinomas and 3 false negative lesions which were confirmed at the second PINBs as malignant tumors,respectively.Benign neoplasms were confirmed in 8 cases,including fibrosis tissue in 6 lesions,bone tuberculosis in 1 and ovarian cyst in 1.The sensitivity,specificity,and accuracy rate were 95.3% (61/64),100% (8/8),and 95.8% (69/72),respectively.Twenty-two cases via transpiriform-muscle approach suffered from transient deep pelvic pain which radiated to the lower limbs of the same side.No hematoma,nerve damage,infection,and tumor transplantation in pelvic cavity developed after the PINB procedure.Conclusion CT guided percutaneous incisional needle biopsy through different puncture approaches is safe and feasible for the patients with deep masses at different locations in the pelvic cavity.%目的 探讨根据盆腔深部肿块位置不同,设计相应穿刺路径进行CT导向下经皮穿刺切割活检术(PINB)的可行性.方法 70例患者的72个盆腔新发肿块,根据肿块部位以及肿块与周围组织脏器的关系,以避开重要脏器、组织为原则,采取不同

  8. CT-guided Perineural Injections for Chronic Pelvic Pain.

    Science.gov (United States)

    Wadhwa, Vibhor; Scott, Kelly M; Rozen, Shai; Starr, Adam J; Chhabra, Avneesh

    2016-01-01

    Chronic pelvic pain is a disabling condition that affects a large number of men and women. It may occur after a known inciting event, or it could be idiopathic. A common cause of pelvic pain syndrome is neuropathy of the pelvic nerves, including the femoral and genitofemoral nerves, ilioinguinal and iliohypogastric nerves, pudendal nerve, obturator nerve, lateral and posterior femoral cutaneous nerves, inferior cluneal nerves, inferior rectal nerve, sciatic nerve, superior gluteal nerve, and the spinal nerve roots. Pelvic neuropathy may result from entrapment, trauma, inflammation, or compression or may be iatrogenic, secondary to surgical procedures. Imaging-guided nerve blocks can be used for diagnostic and therapeutic management of pelvic neuropathies. Ultrasonography (US)-guided injections are useful for superficial locations; however, there can be limitations with US, such as its operator dependence, the required skill, and the difficulty in depicting various superficial and deep pelvic nerves. Magnetic resonance (MR) imaging-guided injections are radiation free and lead to easy depiction of the nerve because of the superior soft-tissue contrast; although the expense, the required skill, and the limited availability of MR imaging are major hindrances to its widespread use for this purpose. Computed tomography (CT)-guided injections are becoming popular because of the wide availability of CT scanners, the lower cost, and the shorter amount of time required to perform these injections. This article outlines the technique of perineural injection of major pelvic nerves, illustrates the different target sites with representative case examples, and discusses the pitfalls. (©)RSNA, 2016.

  9. The usefulness of CT guided drainage of abscesses caused by retained appendicoliths

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, O. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Geoghegan, T. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Ridgeway, P. [Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Colhoun, E. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Snow, A. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland); Torreggiani, W.C. [Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: william.torreggiani@amnch.ie

    2006-10-15

    Objectives: To determine the utility of percutaneous computed tomography (CT) guided drainage of abscesses formed secondary to retained appendicoliths. Materials and methods: A retrospective review was conducted over a 5-year period to identify patients who underwent CT guided drainage of abscesses related to retained appendicoliths. Inclusion criteria were a history of prior proven appendicitis treated by laparoscopic appendicectomy, identification of a post-operative abscess related to a visualised retained appendicolith and initial treatment by CT guided drainage. Data regarding initial technical success as well as long-term outcome was recorded in each case. Results: In total, five patients were identified who underwent CT guided abscess drainage related to retained appendicoliths. There were three males and two females (age range 12-54 years). Initial drainage under CT guidance was technically successful in all cases with successful catheter placement and resolution of the abscess cavity. In all five cases however, there was recurrence of abscess formation following catheter removal. In one case, a second attempt with CT guided drainage was performed. Again this was initially successful with abscess recurrence following catheter removal. In all five cases, formal surgical drainage with removal of retained appendicolith resulted in a successful outcome. Conclusion: CT guided percutaneous drainage of intra abdominal abscess secondary to retained appendicoliths is only successful in the short term. Formal surgical drainage and removal of the appendicolith is required for long-term success.

  10. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Hryhorczuk, Anastasia L. [University of Michigan, Department of Radiology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States); Harvard University School of Medicine, Department of Radiology, Boston Children' s Hospital, Boston, MA (United States); Strouse, Peter J. [University of Michigan, Department of Radiology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States); Biermann, J.S. [University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI (United States)

    2011-07-15

    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.)

  12. Curved Needles in CT-Guided Fine Needle Biopsies of Abdominal and Retroperitoneal Small Lesions.

    Science.gov (United States)

    De Filippo, Massimo; Saba, Luca; Rossi, Enrica; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Brunese, Luca; Rotondo, Antonio; Rossi, Cristina

    2015-12-01

    To demonstrate the advantages of using curved needles in fine needle aspiration (FNA) with CT-guided, for analyzing abdominal and/or retroperitoneal small lesions which are impossible to reach with conventional non-surgical biopsy techniques, particularly in cases in which the cytology sample was not possible to obtain by means of US or CT guide with axial images. An authorization for CT-guided FNA in patients with neoplasms is not required by the institutional review board of our Institute. From April 2012 to November 2014, the study included retrospectively 25 patients (16 M, 9 F) who underwent CT-guided FNA of abdominal and/or retroperitoneal small lesions (biopsy procedure because of the interposition of anatomical obstacles. Patients with suspected lymphomas or sarcomas, pediatric patients and patients with bleeding diathesis were excluded. Cytology reports were used for evaluating suitability. The biological material was considered to be suitable for cytological study, with a diagnostic value in all 25 cases, finding in particular: out of 23 neoplastic lesions (85%), 21 were malignant (90.2%) and 2 were benign (8%). 2 out 25 were non-neoplastic benign lesions (8%). No procedural complications arose in any of the cases (0%). Using curved needles, there is an effective improvement in CT-guided FNA of abdominal and retroperitoneal small lesions which are difficult to achieve with conventional CT or ultrasound guide.

  13. 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.)

  14. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Lingfeng; Xu, Xingxiang [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Song, Yong [Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, Jiangsu (China); Issahar, Ben-Dov [Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Wu, Jingtao; Zhang, Le; Huang, Qian [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Chen, Mingxiang, E-mail: chenmx1129@126.com [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China)

    2013-01-15

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.

  15. CT-guided radiofrequency ablation of osteoid osteoma using a novel battery-powered drill

    Energy Technology Data Exchange (ETDEWEB)

    Schnapauff, Dirk; Streitparth, Florian; Wieners, Gero; Collettini, Federico; Hamm, Bernd; Gebauer, Bernhard [Charite Universitaetsmedizin Berlin, Department of Radiology, Berlin (Germany); Joehrens, Korinna [Charite Universitaetsmedizin Berlin, Department of Pathology, Berlin (Germany)

    2015-05-01

    To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drilling, in radiofrequency ablation of osteoid osteoma as an alternative to conventional orthopedic drills. Between 2009 and 2013, altogether 33 patients underwent CT-guided radiofrequency ablation of an osteoid osteoma at our institution. To access the nidus of the clinically and radiologically suspected osteoid osteoma, a channel was drilled using the OnControl Bone Marrow Biopsy System (OBM, Arrow OnControl, Teleflex, Shavano Park, TX, USA) and a biopsy was taken. Procedure time (i.e., drilling including local anesthesia), amount of scans (i.e., single-shot fluoroscopy), radiation exposure, and the results of biopsy were investigated and compared retrospectively to a classical approach using either a manual bone biopsy system or a conventional orthopedic drill (n = 10) after ethical review board approval. Drilling the tract into the nidus was performed without problems in 22 of the 23 OBM cases. Median procedure time was 7 min compared to 13 min using the classical approach (p < 0.001). Median amount CT scans, performed to control correct positioning of the drill was comparable with 26 compared to 24.5 (p = NS) scans. Histologically, the diagnosis of osteoid osteomas could be determined in all 17 cases where a biopsy was taken. Radiofrequency ablation could be performed without problems in any case. The use of the battery-powered drill was feasible and facilitated the access to the osteoid osteoma's nidus offering the possibility to extract a specimen in the same step. (orig.)

  16. 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)

  17. 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.

  18. CT-guided percutaneous drainage within intervertebral space for pyogenic spondylodiscitis with psoas abscess

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Tomohiro; Morishita, Hiroyuki; Lida, Shigeharu; Asai, Shunsuke; Masui, Koji; Sato, Osamu (Department of Diagnostic Radiology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan)), Email: t-matsu@koto.kpu-m.ac.jp; Yamagami, Takuji; Nishimura, Tsunehiko (Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto (Japan)); Yamazoe, Shoichi (Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto (Japan))

    2012-02-15

    Background. Reports on CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis with a secondary psoas abscess are limited. Purpose. To evaluate CT-guided percutaneous drainage within the intervertebral space for pyogenic spondylodiscitis and a secondary psoas abscess in which the two sites appear to communicate. Material and Methods. Eight patients with pyogenic spondylodiscitis and a secondary psoas abscess showing communication with the intradiscal abscess underwent CT-guided percutaneous drainage within the intervertebral space. The clinical outcome was retrospectively assessed. Results. An 8-French pigtail catheter within the intervertebral space was successfully placed in all patients. Seven patients responded well to this treatment. The one remaining patient who had developed septic shock before the procedure died on the following day. The mean duration of drainage was 32 days (13-70 days). Only one patient with persistent back pain underwent surgery for stabilization of the spine after the improvement of inflammation. Among seven patients responding well, long-term follow-up (91-801 days, mean 292 days) was conducted in six patients excluding one patient who died of asphyxiation due to aspiration unrelated to the procedure within 30 days after the procedure. In these six patients, no recurrence of either pyogenic spondylodiscitis or the psoas abscess was noted. Conclusion. CT-guided percutaneous drainage within the intervertebral space can be effective for patients with pyogenic spondylodiscitis and a secondary psoas abscess if the psoas abscess communicates with the intradiscal abscess

  19. 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.)

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

    Science.gov (United States)

    Asai, Nobuhiro; Ohkuni, Yoshihiro; Yamazaki, Ikuo; Kaneko, Norihiro; Aoshima, Masahiro; 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 intra-abdominal 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.

  1. 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.

  2. Obscure gastrointestinal bleeding: preoperative CT-guided percutaneous needle localization of the bleeding small bowel segment.

    Science.gov (United States)

    Heiss, Peter; Feuerbach, Stefan; Iesalnieks, Igors; Rockmann, Felix; Wrede, Christian E; Zorger, Niels; Schlitt, Hans J; Schölmerich, Jürgen; Hamer, Okka W

    2009-04-01

    A 57-year-old woman presented with obscure gastrointestinal bleeding. Double balloon enteroscopy, angiography, and surgery including intraoperative enteroscopy failed to identify the bleeding site. Multidetector computed tomography (CT) depicted active bleeding of a small bowel segment. The bleeding segment was localized by CT-guided percutaneous needle insertion and subsequently removed surgically.

  3. 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.

  4. 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.)

  5. Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

    Directory of Open Access Journals (Sweden)

    Meng-Huang Wu

    2017-01-01

    Full Text Available This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT- guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490 and intraoperative blood loss was 407 cc (range, 50–1,200. The average duration of hospital stay was 48.9 days (range, 11–76. Out of a total of 54 pedicle screws employed, 53 screws (98.1% were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2 and Oswestry disability index (from 67.1% to 25.6% were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr and average C-reactive protein (from 54.4 to 4.8 mg/dL. Average kyphotic angle correction was 10.5° (range, 8.4°–12.6° postoperatively and 8.5° (range, 6.9°–10.1° after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient’s lateral decubitus position.

  6. Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis

    Science.gov (United States)

    Dubey, Navneet Kumar; Lee, Ching-Yu; Li, Yen-Yao; Cheng, Chin-Chang; Shi, Chung-Sheng

    2017-01-01

    This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT-) guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490) and intraoperative blood loss was 407 cc (range, 50–1,200). The average duration of hospital stay was 48.9 days (range, 11–76). Out of a total of 54 pedicle screws employed, 53 screws (98.1%) were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2) and Oswestry disability index (from 67.1% to 25.6%) were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr) and average C-reactive protein (from 54.4 to 4.8 mg/dL). Average kyphotic angle correction was 10.5° (range, 8.4°–12.6°) postoperatively and 8.5° (range, 6.9°–10.1°) after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient's lateral decubitus position.

  7. Uniportal video-assisted thoracic surgery resection of small ground-glass opacities (GGOs) localized with CT-guided placement of microcoils and palpation

    Science.gov (United States)

    Shi, Zhe; Jiang, Sen; Jiang, Gening

    2016-01-01

    Although uniportal video-assisted thoracic surgery (VATS) is becoming more popular, it’s still very challenging to conduct a wedge resection of small pulmonary ground-glass opacities (GGOs), especially deeply situated subpleural GGOs, via uniportal VATS. We successfully performed thirteen uniportal VATS wedge resections through an approach that combines radiologically guided microcoil localization with palpation, and we encountered no complications related to the new approach. Based on our experience, a combination of CT-guided microcoil localization with palpation in uniportal VATS for deeply situated subpleural GGOs is a safe and effective procedure for accurate diag¬nosis and resection of indeterminate GGOs. PMID:27499978

  8. 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.

  9. Liver CT-guided aspirative biopsies; Puncao aspirativa de figado dirigida por tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Gilda da Cunha; Carvalho, Leda Viegas de [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Divisao de Anatomia Patologica; Granero, Luzete Cristina Silva [Univeridade Federal de Sao Paulo (UNIFESP), SP (Brazil); Chojniak, Rubens [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Imagem; Morini, Sandra Regina

    1996-09-01

    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) 9 refs., 1 fig.

  10. Safety of 1000 CT-guided steroid injections with air used to localize the epidural space.

    Science.gov (United States)

    Chang, A; Pochert, S; Romano, C; Brook, A; Miller, T

    2011-10-01

    Historically, ESIs were performed without any imaging guidance, resulting in erroneous placement in up to 30% of injections. Fluoroscopic imaging is now used to guide most procedures. Recently, several reports have described the use of CT to guide ESIs instead of fluoroscopy. CT provides the ability to use air as contrast to localize the epidural space. This retrospective review will discuss findings in 1000 CT-guided ESIs with air localization.

  11. 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.)

  12. 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.

  13. 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.

  14. CT-guided thoracic sympathetic blockade for palmar hyperhidrosis: Immediate results and postoperative quality of life.

    Science.gov (United States)

    Guo, Jian-Guo; Fei, Yong; Huang, Bing; Yao, Ming

    2016-12-01

    The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent a CT-guided percutaneous puncture thoracic sympathetic blockade. A total of 186 patients underwent CT-guided thoracic sympathetic blockade based on case histories and a prospective pre- and postoperative questionnaire survey. The study sample was composed of 93 patients with an age range from 18 to 34years and a diagnosis with primary palmar hyperhidrosis (severe in some patients). Percutaneous puncture thoracic sympathetic blockade guided by CT was performed under local anesthesia in all patients. Heart rate (HR), non-invasive blood pressure (NIBP), arterial oxygen saturation (SPO2), perfusion index (PI), and palmar temperature (T) were monitored before and after treatment. Follow-up included a questionnaire on life quality and degree of satisfaction. Ten minutes after treatment, the SPO2, PI, and temperature all raised remarkably ([92.75±2.02]% vs. [98.85±1.09]%, [1.55±0.69]% vs. [8.60±0.94]%, [30.95±1.27]°C vs. [35.75±0.55]°C, respectively, Phyperhidrosis, 87.6% reported improvement in their quality of life. CT-guided percutaneous puncture thoracic sympathetic blockade is a safe, effective, and minimally invasive technique for the treatment of palmar hyperhidrosis. Despite the high rate of compensatory hyperhidrosis, it produces a high rate of patient satisfaction.

  15. 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.)

  16. 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.

  17. 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.)

  18. Percutaneous treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients

    Energy Technology Data Exchange (ETDEWEB)

    Sierre, Sergio; Lipsich, Jose; Questa, Horacio; Moguillansky, Silvia [Hospital Nacional de Pediatria, Department of Interventional Radiology, Buenos Aires (Argentina); Innocenti, Sergio; Lanfranchi, Lucas [Hospital Nacional de Pediatria, Department of Orthopedics, Buenos Aires (Argentina)

    2006-02-01

    Osteoid osteoma is a painful, benign, small osteogenic bone tumor. For a long time, surgery was the only treatment for these lesions. Different minimally invasive therapeutic techniques have been proposed. We report our experience in the treatment of osteoid osteoma by CT-guided drilling resection in pediatric patients. To evaluate the efficacy of CT-guided percutaneous drilling resection as a minimally invasive therapy for osteoid osteoma in children. Over a 5-year period, 18 patients (age range 6-17 years, mean age 11.6 years) with osteoid osteomas (femur, n=10; tibia, n=5; humerus, n=2; vertebral body, n=1) were treated with this technique. All procedures were performed under general anesthesia. All procedures were technically successful. Clinical success was achieved in 94.5% of patients (17/18). Only one patient had recurrence of symptoms 8 months after percutaneous resection and was surgically retreated. There were no complications. CT-guided percutaneous drilling resection is a safe, simple and effective minimally invasive technique for the treatment of osteoid osteoma in pediatric patients. (orig.)

  19. 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.)

  20. Percutaneous CT-guided biopsy of the musculoskeletal system: Results of 2027 cases

    Energy Technology Data Exchange (ETDEWEB)

    Rimondi, Eugenio, E-mail: eugenio.rimondi@ior.it [Radiology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Rossi, Giuseppe [Interventional Angiography Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Bartalena, Tommaso [Radiology Department, University of Bologna (Italy); Ciminari, Rosanna [Radiology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Alberghini, Marco [Surgical Pathology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Ruggieri, Pietro; Errani, Costantino; Angelini, Andrea; Calabro, Teresa; Abati, Caterina Novella [Orthopaedic Oncology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Balladelli, Alba [Laboratory of Experimental Oncology, Istituto Ortopedico Rizzoli, Bologna (Italy); Tranfaglia, Cristina [Nuclear Medicine Department, Maggiore Hospital, Bologna (Italy); Mavrogenis, Andreas F. [Orthopaedic Oncology Department, Istituto Ortopedico Rizzoli, Bologna (Italy); Vanel, Daniel [Bone Tumor Center, Istituto Ortopedico Rizzoli, Bologna (Italy); Mercuri, Mario [Orthopaedic Oncology Department, Istituto Ortopedico Rizzoli, Bologna (Italy)

    2011-01-15

    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.

  1. CT-guided percutaneous laser photocoagulation of osteoid osteomas of the hands and feet

    Energy Technology Data Exchange (ETDEWEB)

    Zouari, Leila; Bousson, Valerie; Hamze, Bassam; Roqueplan, Francois; Laredo, Jean-Denis [Hopital Lariboisiere, Service de Radiologie Osteo-Articulaire, Paris (France); Roulot, Eric [Clinique Jouvenet, Institut de la main, Paris (France)

    2008-11-15

    Percutaneous local ablation of osteoid osteoma has largely replaced surgery, except in the small bones of the hands and feet. The objective of this study was to describe the technical specificities and results of computed tomography (CT)-guided percutaneous laser photocoagulation in 15 patients with osteoid osteomas of the hands and feet. We retrospectively examined the medical charts of the 15 patients who were treated with CT-guided percutaneous laser photocoagulation therapy at our institution between 1994 and 2004. The 15 patients had a mean age of 24.33 years. None of them had received any prior surgical or percutaneous treatment for the osteoid osteoma. The follow-up period was 24 to 96 months (mean, 49.93). The pain resolved completely within 1 week. Fourteen patients remained symptom-free throughout the follow-up period; the remaining patient experienced a recurrence of pain after 24 months, underwent a second laser photocoagulation procedure, and was symptom-free at last follow-up 45 months later. No adverse events related to the procedure or to the location of the tumor in the hand or the foot were recorded. CT-guided percutaneous laser photocoagulation is an alternative to surgery for the treatment of osteoid osteomas of the hands and feet. (orig.)

  2. 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.)

  3. Percutaneous CT guided bone biopsy in patients with suspected bone neoplasm

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    Yasui, Kotaro; Kanazawa, Susumu; Tanaka, Akio; Hiraki, Yoshio [Okayama Univ. (Japan). School of Medicine

    1996-03-01

    Bone biopsy is necessary for the diagnosis of ambiguous, skeletal lesions. Although several merits of computed tomography (CT)-guided percutaneous needle biopsy have been documented, few radiologists have performed this procedure in Japan. We performed this procedure with a newly introduced bone biopsy needle (OSTYCUT, angiomed, Karlsruhe, Germany) under CT guidance and evaluated the results. CT-guided bone biopsy (pelvic [n=11] vertebral [n=10], femoral [n=1], stemal [n=1]) was performed in 19 consecutive patients. Seventeen patients were suspected metastatic disease, and the others were suspected primary bone tumor. All biopsies but one were diagnostic. Malignancy was proved in 11 lesions. Three patients with prostatic carcinoma were proved to show no malignancy of bone lesions after a series of hormonal and chemotherapies. In one patient with both malignant mesothelioma and cervical carcinoma, the biopsy specimen from thoracic vertebra proved metastasis from mesothelioma. CT-guided bone biopsy is useful to evaluate the presence of malignancy and the effect of therapy for it, and to determine the primary site. (author).

  4. CT Guided Bone Biopsy Using a Battery Powered Intraosseous Device

    Energy Technology Data Exchange (ETDEWEB)

    Schnapauff, Dirk, E-mail: dirk.schnapauff@charite.de; Marnitz, Tim, E-mail: tim.marnitz@charite.de; Freyhardt, Patrick, E-mail: Patrick.freyhardt@charite.de; Collettini, Federico, E-mail: Federico.collettini@charite.de [Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Department of Radiology (Germany); Hartwig, Kerstin, E-mail: kerstin.hartwig@charite.de [Charite Universitaetsmedizin Berlin, Campus Charite Mitte, Department of Haematology and Oncology (Germany); Joehrens, Korinna, E-mail: korinna.joehrens@charite.de [Charite Universitaetsmedizin Berlin, Campus Charite Mitte, Department of Pathology (Germany); Hamm, Bernd, E-mail: bernd.hamm@charite.de; Kroencke, Thomas, E-mail: thomas.kroencke@charite.de; Gebauer, Bernhard, E-mail: Bernhard.gebauer@charite.de [Charite Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Department of Radiology (Germany)

    2013-10-15

    Purpose: To evaluate the feasibility of a battery powered intraosseous device to perform CT-fluoroscopy guided bone biopsy. Methods: Retrospective analysis of 12 patients in whom bone specimen were acquired from different locations under CT-fluoroscopy guidance using the OnControl bone marrow biopsy system (OBM, Vidacare, Shavano Park, TX, USA). Data of the 12 were compared to a historic cohort in whom the specimen were acquired using the classic Jamshidi Needle, as reference needle using manual force for biopsy. Results: Technical success was reached in 11 of 12 cases, indicated by central localisation of the needle within the target lesion. All specimen sampled were sufficient for histopathological workup. Compared to the historical cohort the time needed for biopsy decreased significantly from 13 {+-} 6 to 6 {+-} 4 min (P = 0.0001). Due to the shortened intervention time the radiation dose (CTDI) during CT-fluoroscopy was lowered significantly from 169 {+-} 87 to 111 {+-} 54 mGy Multiplication-Sign cm (P = 0.0001). Interventional radiologists were confident with the performance of the needle especially when using in sclerotic or osteoblastic lesions. Conclusion: The OBM is an attractive support for CT-fluoroscopy guided bone biopsy which is safe tool and compared to the classical approach using the Jamshidi needle leading to significantly reduced intervention time and radiation exposure.

  5. Needle-in-Needle Technique for Percutaneous Retrieval of a Fractured Biopsy Needle during CT-Guided Biopsy of the Thoracic Spine.

    Science.gov (United States)

    Shaikh, Hamza; Thawani, Jayesh; Pukenas, Bryan

    2014-10-31

    Common complications related to CT-guided percutaneous thoracic bone biopsy procedures include pneumothorax and muscular hematoma. Serious, but rare complications include paralysis, nerve injury, CSF leak, and aortic injury. Device failure has not been well documented in the literature. We discuss our experience with biopsy needle breakage during retrieval of a core specimen and the technique used to help retrieve an embedded needle using a CT fluoroscopic-guided, needle-in-needle approach. A 43 year-old man with Stage IIIa NSCLC was found to have a T11 vertebral body lesion as seen on PET, CT, and MR imaging. The patient underwent a CT-guided biopsy in the prone position. The T11 vertebral body was localized and cannulated using the percutaneous Bonopty(®) (Apriomed, Upsala, Sweden) needle device. After fine needle aspiration samples were obtained, a core needle biopsy was attempted with a 16-gauge device. The needle fractured 4 cm deep to the skin during removal of a sclerotic lesion, leaving a retained portion within the pedicle and vertebral body. Using CT-guided fluoroscopy, a large diameter Murphy M2 needle was advanced over the distal portion of the fractured Bonopty needle. The Murphy M2 needle was advanced distal to the tip of the Bonopty needle and removed, capturing the broken Bonopty penetration needle along with a core specimen. Larger-bore biopsy needle systems and/or a coaxial system should be used to perform core biopsies in sclerotic lesions to prevent device fracture. If there is device fracture, a larger-bore needle may be used to help capture the fractured needle and prevent open surgery.

  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. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Shi Liangrong; Wu Jun; Jiang Jingting; Wu Changping

    2013-01-01

    Objective:To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods:Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on lfuorouracil drugs. Results:No severe complications was observed in all study subjects with 14 complete remission (60.9%), 5 particle remission (21.7%) and 4 progressive diseases (17.4%), while 1, 2 and 3 years of survival rates as well as median survival time being (87±7)%,(47±11)%, (13±9)% and (22.1±5.1) months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly inlfuence the prognosis (χ2=9.752, P=0.002), and the subgroups analysis relieved the signiifcant difference (χ2=5.828, P=0.016, log-rank test) with 3 cm being the cut-off value. Conclusion:CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  8. CT-guided 125I Radioactive Seed Implantation on Regional Lymph Node Metastasis after Gastrectomy

    Directory of Open Access Journals (Sweden)

    Liangrong Shi

    2013-09-01

    Full Text Available Objective: To evaluate the safety and short-term effect of CT-guided 125I radioactive seed implantation on regional lymph node metastasis after gastrectomy. Methods: Twenty-three patients with regional lymph node metastasis after gastrectomy received CT-guided 125I radioactive seed implantation from June, 2007 to July, 2011 in our hospital. The overall activity and amount of radioactive seeds were calculated by simulating source distribution of radioactive seed implantation plan system before operation. 125I seeds were implanted under the guidance of CT. Effective rate was evaluated according to RECIST criterion, 1, 2 and 3 years of survival rates were calculated by life table method, the effect of relative factors on survival was tested by univariate COX model, and the survival differences between subgroups were compared to draw survival curve by log-rank method. Additionally, systemic therapies were given to 20 patients based on fluorouracil drugs. Results: No severe complications was observed in all study subjects with 14 complete remission (60.9 % , 5 particle remission (21.7 % and 4 progressive diseases (17.4 % , while 1, 2 and 3 years of survival rates as well as median survival time being (87±7 %,(47±11 % , (13±9 % and (22.1±5.1 months, respectively. Univariate COX analysis showed that the maximum diameter of tumor could badly influence the prognosis (χ2 = 9.752, P = 0.002, and the subgroups analysis relieved the significant difference (χ2 = 5.828, P = 0.016, log-rank test with 3 cm being the cut-off value. Conclusion: CT-guided 125I radioactive seed implantation has high local control rate with small trauma and slight complications.

  9. CT-Guided Radioactive {sup 125}I Seed Implantation Therapy of Symptomatic Retroperitoneal Lymph Node Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Zhongmin, E-mail: wzm0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Lu, Jian; Gong, Ju; Zhang, Liyun [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital Luwan Branch (China); Xu, Yingjia [Shanghai Jiao Tong University, Department of Cardiology, Shanghai Chest Hospital (China); Song, Shaoli [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China); Chen, Kemin [Shanghai Jiaotong University School of Medicine, Department of Radiology, Ruijin Hospital (China); Liu, Fenju [Soochow University, School of Radiation Medicine and Public Health (China); Gang, Huang, E-mail: huanggang0722@hotmail.com [Shanghai Jiaotong University School of Medicine, Department of Nuclear Medicine, Renji Hospital (China)

    2013-04-12

    PurposeThis study explored the clinical efficacy of CT-guided radioactive {sup 125}I seed implantation in treating patients with symptomatic retroperitoneal lymph node metastases.MethodsTwenty-five patients with pathologically confirmed malignant tumors received CT-guided radioactive {sup 125}I seed implantation to treat metastatic lymph nodes. The diameter of the metastatic lymph nodes ranged from 1.5 to 4.5 cm. Treatment planning system (TPS) was used to reconstruct the three-dimensional image of the tumor and then calculate the corresponding quantity and distribution of {sup 125}I seeds.ResultsFollow-up period for this group of patients was 2–30 months, and median time was 16 months. Symptoms of refractory pain were significantly resolved postimplantation (P < 0.05), and Karnofsky score rose dramatically (P < 0.05). Most patients reported pain relief 2–5 days after treatment. Follow-up imaging studies were performed 2 months later, which revealed CR in 7 patients, PR in 13 patients, SD in 3 patients, and PD in 2 patients. The overall effective rate (CR + PR) was 80 %. Median survival time was 25.5 months. Seven patients died of recurrent tumor; 16 patients died of multiorgan failure or other metastases. Two patients survived after 30 months follow-up. Two patients reported localized skin erythema 1 week postimplantation, which disappeared after topical treatment.ConclusionsCT-guided radioactive {sup 125}I seed implantation, which showed good palliative pain relief with acceptable short-term effects, has proved in our study to be a new, safe, effective, and relatively uncomplicated treatment option for symptomatic retroperitoneal metastatic lymph nodes.

  10. 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.)

  11. Adrenal metastases: CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J.; Lehnert, Thomas; Eichler, Katrin; Proschek, Dirk; Floeter, Julius; Mack, Martin G. [Johann Wolfgang Goethe University, Department of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt am Main (Germany)

    2007-08-15

    The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7-75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1-4); mean applied laser energy 33 kJ (range 15.3-94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5-7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases. (orig.)

  12. Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation.

    Science.gov (United States)

    Ricke, Jens; Wust, Peter; Wieners, Gero; Beck, Alexander; Cho, Chie Hee; Seidensticker, Max; Pech, Maciej; Werk, Michael; Rosner, Christian; Hänninen, Enrique Lopez; Freund, Torsten; Felix, Roland

    2004-11-01

    To evaluate computed tomography (CT)-guided brachytherapy in patients with very large liver malignancies or with liver tumors located adjacent to the liver hilum. In this prospective nonrandomized phase II trial, we treated 20 patients (19 liver metastases and one cholangiocarcinoma) with CT-guided high-dose-rate (HDR) brachytherapy using a (192) Iridium source. All patients demonstrated no functional liver degradation prior to irradiation. Entry criteria were liver tumors > 5 cm (group A, n = 11, no upper limit) or liver tumors brachytherapy was performed with three dimensional (3D) CT data acquired after percutaneous applicator positioning. Magnetic resonance (MR) imaging follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control (absence of tumor growth after treatment followed by shrinkage of the lesion starting at 6 months) and progression-free survival. The mean tumor diameter was 7.7 cm (range, 5.5-10.8 cm) in group A, 3.6 cm (range, 2.2-4.9 cm) in group B. On average, a minimal dose of 17 Gy in the target volume was applied (range, 12-25 Gy). Severe side effects were recorded in two patients (10%). One patient demonstrated an obstructive jaundice caused by tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. One patient developed intra-abdominal hemorrhage that was treated by a single blood transfusion and has ceased. We frequently encountered moderate increases of liver enzymes (70% of patients) and bilirubin (50% of patients) without clinical symptoms and thus considered to be insignificant. The median follow-up was 13 months. In group A (tumors > 5 cm), primary local tumor control after 6 and 12 months was 74% and 40%, respectively; in group B, it was 100% and 71%, respectively. All but one local recurrence (in a patient with diffuse tumor progression) were successfully treated during another CT-guided brachytherapy leading to a primary assisted local

  13. CT-guided corticosteroid injection as a therapeutic management for the pyriformis syndrome: case report.

    Science.gov (United States)

    Kabataş, Serdar; Gümüş, Burçak; Yilmaz, Cem; Caner, Hakan

    2008-07-01

    The pyriformis syndrome is a rare entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle or other local structures. It is an important cause of buttock pain that may often be accompanied by sciatica. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The diagnosis relies on the clinical presentation and the electromyelography (EMG) findings. Other causes of symptoms should be excluded by careful examination and detailed neuroradiological studies of the lumbosacral spine, sacro-iliac and hip joints. A case of this syndrome seen in a 36-year-old man who recovered by CT-guided corticosteroid injection is reported.

  14. Therapeutical efficacy of CT-guided relief puncture in amebic liver abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Mansfeld, L.; Boitz, F.; Poehls, C.; Cimanowski, N.

    1987-09-01

    Amebic liver abscesses are the most frequent clinical manifestations of the extra-intestinal amebiasis and have to be considered as a serious complication in the course of disease. The abscesses have by their risk of rupturing and bacterial superinfection quoad vitam an unfavourable prognosis. CT-guided relief punctures can, as it is demonstrated by two cases of critical amebic abscesses, effectively improve the therapy with systemic amebicides, prevent imminent rupture and contribute to the healing of the abscesses. Thus a surgical treatment of the abscess was not necessary.

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

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, M.H., E-mail: martin.maurer@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Gebauer, B., E-mail: bernhard.gebauer@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Wieners, G., E-mail: gero.wieners@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); De Bucourt, M., E-mail: maximilian.de-bucourt@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Renz, D.M., E-mail: diane.renz@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Hamm, B., E-mail: bernd.hamm@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany); Streitparth, F., E-mail: florian.streitparth@charite.de [Charite - Universitaetsmedizin Berlin, Department of Radiology, Augustenburger Platz 1, 13353 Berlin (Germany)

    2012-11-15

    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.

  16. CT guided 125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Fu-jun; LI Chuan-xing; JIAO De-chao; ZHANG Nian-hua; WU Pei-hong; DUAN Guang-feng; WU Yue-xia

    2008-01-01

    Background This study evaluated the clinical application of CT guided 125iodine implantation in patients with portal vein tumor thrombus in primary hepatocellular carcinoma.Methods The ten patients (9 males and 1 female,aged from 36 to 72 years) with portal vein tumor thrombus accompanying hepatocellular carcinoma had been treated with comprehensive therapy including surgery,transcatheter arterial chemoembolization,radiotherapy ablation,microwave ablation or percutaneous ethanol injection.The average diameter of each tumor thrombus was 21.5 mm×30.5 mm.Seeds of 30 MBq 125I were implanted 5 mm apart within the portal vein tumor thrombus.The follow-up after 4 months included enhanced spiral CT.Results CT screening of the tumours indicated that 4 out of 10 patients showed complete response to the therapy,5 partial response and 1 stable disease.Adverse effects included aggravated abdominal dropsy and temporarily increased transaminase,which were controlled by medical management.Severe complications such as haemorrhage,biliary fistula,hepatic abscess,pancreatic fistula and hepatic function failure were not observed.Implanted seeds migrated to lung and left hepatic lobe in 1 case.Conclusion CT guided implantation of 125iodine seeds,can effectively treat portal vein tumor thrombus accompanying hepatocellular carcinoma with minimal damage and few complications.

  17. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Floris, R. [Rome-2 Univ., Rome (Italy). Dept. of Radiology]|[IRCCS Santa Lucia, Rome (Italy)]|[Via A. Caroncini 27, I-00197 Rome (Italy); Salvatore, C.; Simonetti, G. [Rome-2 Univ., Rome (Italy). Dept. of Radiology; Fraioli, B.; Pastore, F.S.; Vagnozzi, R. [Department of Neurosurgery, University of Rome ``Tor Vergata``, Rome (Italy)

    1998-10-01

    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.) With 3 figs., 1 tab., 30 refs.

  19. The kinematics modeling based on Spinor theory for CT-guided hybrid robot

    Institute of Scientific and Technical Information of China (English)

    Tang Can; Liu Da; Wang Tianmiao; Yun Chao

    2009-01-01

    This paper focused on a simplified method for solving the hybrid robot kinematics in CT-guided (computerized tomography, CT) surgery. By position constraint introduced, the hybrid robot can be transformed as a redundant serial 7-DOF robot. The forward displacement calculation was developed based on the product-of-exponential formula (POE). Because of the kinematics complexity of the hybrid and redundant robot, the combination technique of Ulrich two-step iteration method and paul variables detachment method (UTI-PVD) was introduced to fulfill the inverse kinematics of redundant robot, the novelty of which lay in the flexibility of various robots structures and in high calculation efficiency for real-time control. The process of solving the inverse displacement was analyzed. The UTI-PVD method can be applicable to kinematics of many robots, especially for redundant robots with more than 6DOF. The kinematics simulation was provided, and robot dexterity analysis was presented. The results indicated that the hybrid robot could implement the minimally invasive CT-guided surgery.

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

    Science.gov (United States)

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

    2017-04-01

    To 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. A 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. The 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. This application can transform a smartphone into a valuable tool that is capable of objectively and accurately assisting CT-guided puncture procedures.

  1. CT-guided aspiration lung biopsy for EGFR and ALK gene mutation analysis of lung cancer

    Science.gov (United States)

    Lian, Weisheng; Ouyang, Yong

    2017-01-01

    The present study investigated the rates of detection and the positive rates of computed tomography (CT)-guided aspiration of lung biopsy for epidermal growth factor receptor (EGFR) gene and anaplastic lymphoma kinase (ALK) gene, and analyzed the relationship between gene mutation and clinical characteristics to improve the rate of related factors of gene detection. The clinical data and CT-guided aspiration biopsy specimen of 250 patients with lung cancer. Data showed that the rate of EGFR gene mutation was 41.2% (103/250) in biopsy specimens of non-small cell lung cancer patients. The rate of EGFR gene mutation of adenocarcinoma (56.6%, P50 was higher. The rate of ALK protein immunohistochemical detection was 87.2%, and the rate of coarse needle biopsy detection was higher than that of the fine needle (91 and 72%, Pneedle biopsy and fine needle biopsy had no difference (P>0.05). The rate of detection was associated with tumor cell number (P0.05). The rate of detection of EGFR and ALK genes was associated with tumor cell number and had no correlation with the proportion of tumor cells. The rate of detection is higher when the number of tumor cells is more than 50. PMID:28521447

  2. Pain Outcomes in Patients Undergoing CT-Guided Celiac Plexus Neurolysis for Intractable Abdominal Visceral Pain.

    Science.gov (United States)

    Edelstein, Mark R; Gabriel, Ryan T; Elbich, Jeffrey D; Wolfe, Luke G; Sydnor, Malcolm K

    2017-03-01

    The purpose of this study was to assess outcomes in patients who have undergone celiac plexus neurolysis (CPN) as treatment for refractory abdominal visceral pain at a tertiary care medical center. This study involved retrospective analysis of all patients who had undergone computed tomography (CT)-guided CPN over a 7-year period, as identified in the medical record. Cases were categorized into 1 of 3 groups-group 1: patients getting at least moderate improvement in pain but with improvements subsiding within 2 days; group 2: patients with some sustained pain relief but still requiring heavy doses of narcotics; group 3: patients with major or complete sustained reduction in pain where the narcotic dose was able to be reduced. One hundred thirty-eight cases were identified, 51 of which had no or insufficient follow-up, leaving 87 cases for analysis. Of the 87 cases, 31 (36%) were categorized as group 1, 21 (24%) as group 2, and 35 (40%) as group 3. There were no statistical differences in outcomes based on patient age, gender, time since diagnosis, or type of cancer. Documented postoperative complications were diarrhea (11 cases) and 1 case each of obtundation, hypotension, and presyncopal event. We conclude that patients undergoing CT-guided CPN for abdominal visceral pain achieve moderate or major short-term pain relief in a majority of cases. The procedure is safe with minimal complications.

  3. 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.

  4. CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma

    Directory of Open Access Journals (Sweden)

    Rangaswamy M

    2010-01-01

    Full Text Available Pheochromocytoma is a rare tumor, accounting for <0.1% of the hypertensive population. Extra-adrenal pheochromocytomas (EAPs are rarer still, accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT as soft tissue masses closely associated with the entire length of the abdominal aorta. Here, we present a rare case of EAP in a 45-year-old male hypertensive patient diagnosed by CT-guided fine needle aspiration cytology. The smears showed loosely cohesive tumor cells with prominent anisokaryosis and abundant eosinophilic, granular cytoplasm. The diagnosis was later confirmed by histopathology. The present case also highlights the fact that fine needle aspiration of pheochromocytoma is not necessarily contraindicated.

  5. CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma.

    Science.gov (United States)

    Rangaswamy, M; Kumar, Sandeep P; Asha, M; Manjunath, Gv

    2010-01-01

    Pheochromocytoma is a rare tumor, accounting for accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT) as soft tissue masses closely associated with the entire length of the abdominal aorta. Here, we present a rare case of EAP in a 45-year-old male hypertensive patient diagnosed by CT-guided fine needle aspiration cytology. The smears showed loosely cohesive tumor cells with prominent anisokaryosis and abundant eosinophilic, granular cytoplasm. The diagnosis was later confirmed by histopathology. The present case also highlights the fact that fine needle aspiration of pheochromocytoma is not necessarily contraindicated.

  6. Cerebellar and brainstem infarction as a complication of CT-guided transforaminal cervical nerve root block

    Energy Technology Data Exchange (ETDEWEB)

    Suresh, S. [The Royal National Orthopaedic Hospital NHS Trust, London (United Kingdom); Berman, J. [The Royal National Orthopaedic Hospital NHS Trust, Anaesthetic Department, London (United Kingdom); Connell, David A. [The Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, London (United Kingdom)

    2007-05-15

    A 60-year-old man with a 4-year history of intractable neck pain and radicular pain in the C5 nerve root distribution presented to our department for a CT-guided transforaminal left C5 nerve root block. He had had a similar procedure on the right 2 months previously, and had significant improvement of his symptoms with considerable pain relief. On this occasion he was again accepted for the procedure after the risks and potential complications had been explained. Under CT guidance, a 25G spinal needle was introduced and after confirmation of the position of the needle, steroid was injected. Immediately the patient became unresponsive, and later developed a MR-proven infarct affecting the left vertebral artery (VA) territory. This is the first report of a major complication of a cervical root injection under CT guidance reported in the literature. We present this case report and the literature review of the potential complications of this procedure. (orig.)

  7. Successful percutaneous CT-guided microwave ablation of adrenal gland for ectopic Cushing syndrome.

    Science.gov (United States)

    Zener, Rebecca; Zaleski, Andrew; Van Uum, Stan H; Gray, Daryl K; Mujoomdar, Amol

    Adrenocorticotropic hormone production by pancreatic neuroendocrine tumor (PNET) is rare and results in hyperstimulation of the adrenal gland to produce ectopic Cushing syndrome. Our case showcases the safety and effectiveness of percutaneous CT-guided microwave ablation of the adrenal gland in a 49-year-old female with PNET and hepatic metastases who presented with ectopic Cushing syndrome despite surgical resection of the primary pancreatic tumor and left adrenal gland. Prior to ablation, the right adrenal gland measured 4.3×1.6×2.0cm and the patient had malignant hypertension with elevated morning serum cortisol level (1976nmol/L). After microwave ablation of the right adrenal gland, the hypertension resolved and the cortisol level decreased dramatically (74nmol/L). As expected after successful treatment, the patient developed adrenal insufficiency and was placed on glucocorticoid and mineralocorticoid supplementation. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Treatment of aneurysmal bone cysts by percutaneous CT-guided injection of calcitonin and steroid

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Kattapuram, Susan V.; Huang, Ambrose J.; Simeone, F.J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Department of Radiology Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States)

    2017-01-15

    To determine the efficacy and safety of percutaneous calcitonin and steroid injection in the treatment of aneurysmal bone cysts (ABCs). Our study was IRB-approved and HIPAA-compliant. We reviewed pre- and post-procedural imaging studies and medical records of all CT-guided percutaneous injections of ABCs with calcitonin and steroid performed at our institution between 2003 and 2015. Treatment success based on imaging was categorized as substantial (51-100 %), partial (1-50 %), or none (0 %) by comparing radiographs of the lesion before and after treatment. Our study group comprised 9 patients (7 female, 2 male; mean age 19 ± 5 (range 12-25) years). ABCs were located in the pubis (n = 3), femur (n = 2), and humerus/scapula/ilium/sacrum (n = 1 for each). One patient did not have any clinical or imaging follow-up. For the other 8 patients, clinical and imaging follow-up ranged from 1 to 93 months (mean 16 ± 29 months). One patient had two injections, and 1 patient had three injections. Six out of eight patients (75 %) had complete symptomatic relief and 2 patients (25 %) had partial symptomatic relief after initial injection. Imaging follow-up revealed substantial imaging response in 4 out of 8 patients (50 %). There was a partial imaging response in 2 patients (25 %) and no imaging response in 2 out of 8 patients (25 %), and all 4 of these patients had local recurrence. There were no complications. Percutaneous CT-guided injection of ABCs with calcitonin and steroid is a safe and effective treatment. Lack of imaging response may necessitate more aggressive treatment to minimize local recurrence. (orig.)

  9. CT-guided percutaneous cryoablation of osteoid osteoma in children: an initial study

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Bin; Xiao, Yue-Yong; Zhang, Xiao [Chinese PLA General Hospital, Department of Radiology, Beijing (China); Zhao, Lei [Brigham and Women' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States); Carrino, John A. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States)

    2011-10-15

    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.)

  10. CT-guided radiofrequency ablation of osteoid osteoma: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Cioni, Roberto; Armillotta, Nicola; Bargellini, Irene; Zampa, Virna; Cappelli, Carla; Vagli, Paola; Bartolozzi, Carlo [Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Boni, Giuseppe [Division of Nuclear Medicine, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Marchetti, Stefano; Consoli, Vincenzo [Department of Orthopedics, University of Pisa, Via Roma 67, 56126, Pisa (Italy)

    2004-07-01

    The aim of the study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma (OO). From 1997 to 2001, RF ablation was performed on 38 patients with OO, diagnosed clinically and by radiography, scintigraphy, contrast-enhanced MRI, and CT. Treatment was performed via percutaneous (n=29) or surgical (n=9) access, under CT guidance in all cases, with an 18-gauge straight electrode. Patients were discharged within 24 h and followed up clinically (at 1 week and every 6-12 months) and with MRI (at 6 months) and scintigraphy (after 1 year). The technical success rate was 100%. Complications occurred in two patients, consisting in local skin burns. The follow-up range was 12-66 months (mean {+-} SD, 35.5{+-}7.5 months). Prompt pain relief and return to normal activities were observed in 30 of 38 patients. Persistent pain occurred in eight patients; two patients refused further RF ablation and were treated surgically; RF ablation was repeated in six cases achieving successful results in five. One patient reported residual pain and is being evaluated for surgical excision. Primary and secondary clinical success rates were 78.9 (30/38 patients) and 97% (35/36 patients), respectively. CT-guided RF ablation of OO is safe and effective. Persistent lesions can be effectively re-treated. Several imaging modalities are needed for the diagnosis of OO and for the follow-up after treatment, particularly in patients with persistent symptoms. (orig.)

  11. 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)

  12. Percutaneous CT-guided catheter drainage of intrathoracic fluid collections. Perkutane CT-gefuehrte Katheterdrainage intrathorakaler Fluessigkeitsansammlungen

    Energy Technology Data Exchange (ETDEWEB)

    Barton, P.; Schurawitzki, H.; Karnel, F. (Universitaetsklinik, Vienna (Austria). Radiodiagnostik); Klepetko, W. (Ludwig-Boltzmann Inst. fuer Radiologisch-Physikalische Tumordiagnostik, Vienna (Austria). 2. Chirurgische Universitaetsklinik)

    1992-01-01

    To verify the value of percutaneous CT-guided drainage of thoracic fluid collections we studied the outcome in 39 patients retrospectively. 24 (61.5%) of the fluid collections were located in the pleural space 10 (25.6%) in the lungs and 5 (12.8%) in the mediastinum. 11 CT-guided drainages after a previous attempt were necessary in 9 patients, because of recurrent Cn = 6 or residual (n = 5) fluid collections. 80% of the drainage procedures were done using Seldinger's, 30% using trocar technique, mainly with 8.3 - 12 F catheters. The mean duration of drainage was 10.7 days. In 28 patients (71.8%) the percutaneous CT-guided drainage was curative. In 9 cases (23.1%) the patient's course was stabilised and surgery could be applied electively. 2 patients (5.1%) died because of their underlying endstage malignancy. None of the drainage procedures changed the patient's course to the worse. There was only 1 pneumothorax with no need of any treatment; no other complication occurred. Our results suggest that percutaneous CT-guided drainage of thoracic fluid collections is a safe and straightforward alternative to surgical treatment. (orig.).

  13. CT-guided radiofrequency ablation of spinal osteoid osteomas with concomitant perineural and epidural irrigation for neuroprotection

    Energy Technology Data Exchange (ETDEWEB)

    Klass, Darren [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom); Norfolk and Norwich University Hospital, Radiology Academy, Cotman Centre, Norwich (United Kingdom); Marshall, Tom; Toms, Andoni [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom)

    2009-09-15

    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.)

  14. Value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas using automated biopsy gun

    Institute of Scientific and Technical Information of China (English)

    Li Li; Qiu-Liang Wu; Li-Zhi Liu; Yun-Xian Mo; Chuan-Miao Xie; Lie Zheng; Lin Chen; Pei-Hong Wu

    2005-01-01

    AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas.METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA,USA) needle driven by a spring-loaded Bard biopsy gun.RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group.The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin's lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However,the success rates were relatively low in anaplastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin's disease (HD, 28.57%) in our group.CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas,and can be widely applied in the management of patients with suspected malignant lymphoma.

  15. Dose-volume parameters and clinical outcome of CT-guided free-hand high-dose-rate interstitial brachytherapy for cervical cancer

    Science.gov (United States)

    Wang, Yi; Ye, Wei-Jun; Du, Le-Hui; Li, Ai-Ju; Ren, Yu-Feng; Cao, Xin-Ping

    2012-01-01

    Currently, image-based 3-dimentional (3D) planning brachytherapy allows for a better assessment of gross tumor volume (GTV) and the definition and delineation of target volume in cervix cancer. In this study, we investigated the feasibility of our novel computed tomography (CT)-guided free-hand high-dose-rate interstitial brachytherapy (HDRISBT) technique for cervical cancer by evaluating the dosimetry and preliminary clinical outcome of this approach. Dose-volume histogram (DVH) parameters were analyzed according to the Gynecological GEC-ESTRO Working Group recommendations for image-based 3D treatment in cervical cancer. Twenty cervical cancer patients who underwent CT-guided free-hand HDRISBT between March 2009 and June 2010 were studied. With a median of 5 (range, 4–7) implanted needles for each patient, the median dose of brachytherapy alone delivered to 90% of the target volume (D90) was 45 (range, 33–54) Gyα/β10 for high-risk clinical target volume (HR-CTV) and 30 (range, 20–36) Gyα/β10 for intermediate-risk clinical target volume (IR-CTV). The percentage of the CTV covered by the prescribed dose (V100) of HR-CTV with brachytherapy alone was 81.9%–99.2% (median, 96.7%). With an additional dose of external beam radiotherapy (EBRT), the median D90 was 94 (range, 83–104) Gyα/β10 for HR-CTV and 77 (range, 70–87) Gyα/β10 for IR-CTV; the median dose delivered to 100% of the target volume (D100) was 75 (range, 66–84) Gyα/β10 for HR-CTV and 65 (range, 57–73) Gyα/β10 for IR-CTV. The minimum dose to the most irradiated 2 cc volume (D2cc) was 73–96 (median, 83) Gyα/β3 for the bladder, 64–98 (median, 73) Gyα/β3 for the rectum, and 52–69 (median, 61) Gyα/β3 for the sigmoid colon. After a median follow-up of 15 months (range, 3–24 months), two patients experienced local failure, and 1 showed internal iliac nodal metastasis. Despite the relatively small number of needles used, CT-guided HDRISBT for cervical cancer showed favorable

  16. Dose-volume parameters and clinical outcome of CT-guided freehand high-dose-rate interstitial brachytherapy for cervical cancer

    Institute of Scientific and Technical Information of China (English)

    Yi Wang; Wei-Jun Ye; Le-Hui Du; Ai-Ju Li; Yu-Feng Ren; Xin-Ping Cao

    2012-01-01

    Currently,image-based 3-dimentional (3D) planning brachytherapy allows for a better assessment of gross tumor volume (GTV) and the definition and delineation of target volume in cervix cancer.In this study,we investigated the feasibility of our novel computed tomography (CT)-guided free-hand high-doserate interstitial brachytherapy (HDRISBT) technique for cervical cancer by evaluating the dosimetry and preliminary clinical outcome of this approach.Dose-volume histogram (DVH) parameters were analyzed according to the Gynecological GEC-ESTRO Working Group recommendations for image-based 3D treatment in cervical cancer.Twenty cervical cancer patients who underwent CT-guided free-hand HDRISBT between March 2009 and June 2010 were studied.With a median of 5 (range,4-7) implanted needles for each patient,the median dose of brachytherapy alone delivered to 90% of the target volume (D90) was 45 (range,33-54) Gyα/β10 for high-risk clinical target volume (HR-CTV) and 30 (range,20-36)Gyα/β10 for intermediate-risk clinical target volume (IR-CTV).The percentage of the CTV covered by the prescribed dose (V100) of HR-CTV with brachytherapy alone was 81.9%-99.2% (median,96.7%).With an additional dose of external beam radiotherapy (EBRT),the median D90 was 94 (range,83-104) Gyα/β10 for HR-CTV and 77 (range,70-87) Gyα/β10 for IR-CTV; the median dose delivered to 100% of the target volume (D100) was 75 (range,66-84) Gyα/β10 for HR-CTV and 65 (range,57-73) Gyα/β10 for IR-CTV.The minimum dose to the most irradiated 2 cc volume (D2cc) was 73-96 (median,83) Gyα/β3 for the bladder,64-98 (median,73) Gyα/β3 for the rectum,and 52-69 (median,61) Gyα/β3 for the sigmoid colon.After a median follow-up of 15 months (range,3-24 months),two patients experienced local failure,and 1 showed internal lilac nodal metastasis.Despite the relatively small number of needles used,CT-guided HDRISBT for cervical cancer showed favorable DVH parameters and clinical outcome.

  17. Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules

    Energy Technology Data Exchange (ETDEWEB)

    Rotolo, Nicola; Imperatori, Andrea; Arlant, Veronica; Dominioni, Lorenzo [Insubria University, Center for Thoracic Surgery, Varese (Italy); Floridi, Chiara; Fontana, Federico; Ierardi, Anna Maria; Mangini, Monica; De Marchi, Giuseppe; Fugazzola, Carlo; Carrafiello, Gianpaolo [Insubria University, Radiology Department, Varese (Italy); Novario, Raffaele [Insubria University, Medical Physics Department, Varese (Italy)

    2016-02-15

    To compare the diagnostic performance of cone-beam CT (CBCT)-guided and CT fluoroscopy (fluoro-CT)-guided technique for transthoracic needle biopsy (TNB) of lung nodules. The hospital records of 319 consecutive patients undergoing 324 TNBs of lung nodules in a single radiology unit in 2009-2013 were retrospectively evaluated. The newly introduced CBCT technology was used to biopsy 123 nodules; 201 nodules were biopsied by conventional fluoro-CT-guided technique. We assessed the performance of the two biopsy systems for diagnosis of malignancy and the radiation exposure. Nodules biopsied by CBCT-guided and by fluoro-CT-guided technique had similar characteristics: size, 20 ± 6.5 mm (mean ± standard deviation) vs. 20 ± 6.8 mm (p = 0.845); depth from pleura, 15 ± 15 mm vs. 15 ± 16 mm (p = 0.595); malignant, 60 % vs. 66 % (p = 0.378). After a learning period, the newly introduced CBCT-guided biopsy system and the conventional fluoro-CT-guided system showed similar sensitivity (95 % and 92 %), specificity (100 % and 100 %), accuracy for diagnosis of malignancy (96 % and 94 %), and delivered non-significantly different median effective doses [11.1 mSv (95 % CI 8.9-16.0) vs. 14.5 mSv (95 % CI 9.5-18.1); p = 0.330]. The CBCT-guided and fluoro-CT-guided systems for lung nodule biopsy are similar in terms of diagnostic performance and effective dose, and may be alternatively used to optimize the available technological resources. (orig.)

  18. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan

    Energy Technology Data Exchange (ETDEWEB)

    Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduated School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan)]. E-mail: tomiyama@radiol.med.osaka-u.ac.jp; Yasuhara, Yoshifumi [Department of Radiology, National Hospital Organization Ehime National Hospital (Japan); Nakajima, Yasuo [Department of Radiology, St. Marianna University School of Medicine (Japan); Adachi, Shuji [Department of Radiology, Hyogo Medical Center for Adults (Japan); Arai, Yasuaki [Department of Diagnostic Radiology, National Cancer Center (Japan); Kusumoto, Masahiko [Department of Diagnostic Radiology, National Cancer Center (Japan); Eguchi, Kenji [Department of Oncology, Tokai University School of Medicine (Japan); Kuriyama, Keiko [Department of Radiology, Kinki Central Hospital of the Mutual Aid Association of Public School Teachers (Japan); Sakai, Fumikazu [Department of Radiology, Tokyo Metropolitan Komagome Hospital (Japan); Noguchi, Masayuki [Department of Pathology, Graduate School of Comprehensive Human Sciences, Institute of Basic Medical Sciences, University of Tsukuba (Japan); Murata, Kiyoshi [Department of Radiology, Shiga University of Medical Science (Japan); Murayama, Sadayuki [Faculty of Medicine, University of the Ryukyus (Japan); Mochizuki, Teruhito [Department of Radiology, Ehime University School of Medicine (Japan); Mori, Kiyoshi [Department of Thoracic Oncology, Tochigi Cancer Center (Japan); Yamada, Kozo [Department of Thoracic Oncology, Kanagawa Cancer Center (Japan)

    2006-07-15

    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.

  19. Intraspinal lumbar juxtaarticular cyst treatment through CT-guided percutaneus induced rupture results in a favorable patient outcome

    Directory of Open Access Journals (Sweden)

    Adisa Kursumovic

    2016-11-01

    Full Text Available Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients, were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years. Fifteen of twenty procedures were successful and cyst rupture was confirmed by CTscans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

  20. Intraspinal Lumbar Juxtaarticular Cyst Treatment Through CT-Guided Percutaneus Induced Rupture Results in a Favorable Patient Outcome.

    Science.gov (United States)

    Kursumovic, Adisa; Bostelmann, Richard; Gollwitzer, Maria; Rath, Stefan; Steiger, Hans Jakob; Petridis, Athanasios K

    2016-10-24

    Juxta-articular cysts are synovial cysts originating from the facet joints or the flava ligaments. If they grow intra-spinally they can compress nervous structures and cause a variety of symptoms. Micro-neurosurgery is usually the treatment of choice. Alternatively to surgical treatment the cyst can be approached and treated with a CT guided percutaneous injection inducing rupture. After fulfilling strict selection criteria twenty patients (25% of all treated lumbar synovial cyst patients), were treated minimally invasive by this method from 2010-2016. The facet joint was punctured under CT guidance and a mixture of a local anesthetic and contrast liquid was injected until the cyst was blasted. The mean follow-up period was 1.1 years (range 2 weeks - 5 years). Fifteen of twenty procedures were successful and cyst rupture was confirmed by CT-scans. Twelve of these fifteen patients experienced a significant improvement of their symptoms and needed no further intervention or surgical procedure up until now, three patients showed no clinical improvement and were treated surgically within one week after cyst rupture. In five patients it was technically not possible to rupture the cyst. These patients were treated microsurgically by cyst resection and dynamic stabilization or fusion procedures. The percutaneus rupture of juxtaarticular cysts has fewer risks and is cost effective compared to microsurgical resection. It may be an alternative to surgical treatment for a selected group of patients. However there are some limitations to the procedure though, such as difficult patient selection, unpredictable outcome or technical problems due to highly degenerated facet joints.

  1. A novel computer algorithm allows for volumetric and cross-sectional area analysis of indirect decompression following transpsoas lumbar arthrodesis despite variations in MRI technique.

    Science.gov (United States)

    Gates, Timothy A; Vasudevan, Ram R; Miller, Kai J; Stamatopoulou, Vasiliki; Mindea, Stefan A

    2014-03-01

    Many patients present for neurosurgical spine evaluation with MRI studies conducted at facilities outside of the treating medical center. These images often vary widely in technique, for example, variation in slice thickness, number of slices, and gantry angle. While these images may be sufficient in conjunction with a physical exam to make surgical evaluations, we have found they are often incapable of being used for objective post-operative volumetric comparisons. In order to overcome this, we created a computer program that compensates for these variations in MRI technique. For this study, we examined patients who had undergone outside MRI pre-operatively and were deemed appropriate for a lateral retroperitoneal transpsoas lumbar interbody arthrodesis procedure. Volumetric analysis was performed on sagittal and axial T2-weighted pre- and post-operative MRI. The percentage change of central canal volume and foraminal area was calculated for each level. The authors identified five levels with MRI sufficient for volumetric analysis and eight levels (16 foramina) sufficient for foraminal cross-sectional analysis. Through use of our computer algorithm, average central canal volume and foraminal cross-sectional area was calculated to increase by 32.8% and 67.6% respectively following the procedure. These results are consistent with previous study findings and support the idea that restoration of the anterior column via a lateral approach can result in significant indirect decompression of the neural elements. Additionally, the novel algorithm created and used for this study suggests that it can achieve quick measurement and comparison of MRI studies despite variations in pre- and post-operative technique.

  2. First case of 18F-FACBC PET/CT-guided salvage retroperitoneal lymph node dissection for disease relapse after radical prostatectomy for prostate cancer and negative 11C-choline PET/CT: new imaging techniques may expand pioneering approaches.

    Science.gov (United States)

    Schiavina, Riccardo; Concetti, Sergio; Brunocilla, Eugenio; Nanni, Cristina; Borghesi, Marco; Gentile, Giorgio; Cevenini, Matteo; Bianchi, Lorenzo; Molinaroli, Enrico; Fanti, Stefano; Martorana, Giuseppe

    2014-01-01

    We present the first case of salvage retroperitoneal lymph node dissection based on the results of (18)F-FACBC PET/CT performed for a prostate-specific antigen relapse after radical prostatectomy. The patients underwent (11)C-choline PET/CT, which turned out negative, while (18)F-FACBC PET/CT visualized two lymph node metastases confirmed at pathological examination. Preliminary clinical reports showed an improvement in the detection rate of 20-40% for (18)F-FACBC in comparison with (11)C-choline, rendering the (18)F-FACBC the potential radiotracer of the future. Salvage surgery for prostate cancer is a fascinating but controversial approach. New diagnostic tools may improve its potential by increasing the assessment and the selection of the patients.

  3. CT-guided vertebroplasty: analysis of technical results, extraosseous cement leakages, and complications in 500 procedures

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, Michael Bernhard; Herber, Sascha; Koch, Ulrike; Oberholzer, Katja; Dueber, Christoph [Johannes Gutenberg-University of Mainz, Department of Diagnostic and Interventional Radiology, Mainz (Germany); Drees, Philip [University Hospital, Johannes Gutenberg-University of Mainz, Department of Orthopedic Surgery, Mainz (Germany)

    2008-11-15

    The aim of this study was to analyze the technical results, the extraosseous cement leakages, and the complications in our first 500 vertebroplasty procedures. Patients with osteoporotic vertebral compression fractures or osteolytic lesions caused by malignant tumors were treated with CT-guided vertebroplasty. The technical results were documented with CT, and the extraosseous cement leakages and periinterventional clinical complications were analyzed as well as secondary fractures during follow-up. Since 2002, 500 vertebroplasty procedures have been performed on 251 patients (82 male, 169 female, age 71.5 {+-} 9.8 years) suffering from osteoporotic compression fractures (n = 217) and/or malignant tumour infiltration (n = 34). The number of vertebrae treated per patient was 1.96 {+-} 1.29 (range 1-10); the numbers of interventions per patient and interventions per vertebra were 1.33 {+-} 0.75 (range 1-6) and 1.01 {+-} 0.10, respectively. The amount of PMMA cement was 4.5 {+-} 1.9 ml and decreased during the 5-year period of investigation. The procedure-related 30-day mortality was 0.4% (1 of 251 patients) due to pulmonary embolism in this case. The procedure-related morbidity was 2.8% (7/251), including one acute coronary syndrome beginning 12 h after the procedure and one missing patellar reflex in a patients with a cement leak near the neuroformen because of osteolytic destruction of the respective pedicle. Additionally, one patient developed a medullary conus syndrome after a fall during the night after vertebroplasty, two patients reached an inadequate depth of conscious sedation, and two cases had additional fractures (one pedicle fracture, one rib fracture). The overall CT-based cement leak rate was 55.4% and included leakages predominantly into intervertebral disc spaces (25.2%), epidural vein plexus (16.0%), through the posterior wall (2.6%), into the neuroforamen (1.6%), into paravertebral vessels (7.2%), and combinations of these and others. During follow

  4. 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.)

  5. CT-guided percutaneous thymus microwave radiation and local injection of dexamethasone for myasthenia gravis

    Institute of Scientific and Technical Information of China (English)

    WANG Pei-jun; YANG Ji-jin; L(U) Tao-zhen; TU Lai-hui; ZUO Chang-jing; ZHANG Ren-qin; CHEN Wei; SHAO Cheng-wei; WANG Min-jie; LIU Dong-ming

    2001-01-01

    Objective: To develop an effective therapy for myasthenia gravis (MG) with little traumatic injury and low morCT-guided percutaneous thymus paracentesis via the upper margin of the sternum incisure and with local dexamethasone injection. Results: The symptoms and signs were relieved within 3 d of treatment in all the 13 MG patients; three had immediate response to the treatment with improved myodynamia. A 3-year follow-up study showed that the symptoms and signs improved significantly in 10 patients and turned for the better in 3. The size of the thymus reduced vertically, transversely and anteroposteriorly by 24.2%, 31.7% and 34.1% respectively. Low-density areas were seen in the thymus due to water gasification and coagulation necrosis of the thymus tissue. Conclusion: The technique has definite therapeutic effect on MG with advantages of easy manipulation, quick response and low morbidity. It is suitable for MG patients with hyperplasia or thymoma, and those who are unwilling to receive thymectomy, or whose thymoma is not resectable, or those who have poor response to radiotherapy.

  6. CT-guided resection of pulmonary metastases; CT-gesteuerte Resektion pulmonaler Metastasen

    Energy Technology Data Exchange (ETDEWEB)

    Gaffke, G.; Stroszczynski, C.; Felix, R. [Klinik fuer Strahlenheilkunde, Charite, Campus Rudolf-Virchow-Klinikum, Berlin (Germany); Rau, B.; Liebeskind, U.; Huenerbein, M.; Bayraktar, S.; Schlag, P.M. [Chirurgie und Chirurgische Onkologie, Charite, Helios-Klinikum Campus Buch, Robert-Roessle-Klinik, Berlin (Germany)

    2005-06-01

    Purpose: to evaluate the feasibility and potential use of intraoperative computed tomography (IOP CT) as guidance for video-assisted thoracic surgery (VATS). Material and methods: fifteen consecutive patients with peripheral intrapulmonary nodules underwent a thoracoscopy with IOP CT. Solitary lesions were known in 6/15 patients (40%, group II) whereas 9/15 (60%, group I) patients had multiple lesions (n {>=} 2). IOP CT was performed with the mobile CT scanner Philips Tomoscan M. Radiologists intraoperatively placed percutaneous marks of lung lesions after unsuccessful VATS by use of a lung marker set (Somatex, Teltow, Germany). VATS was performed under general anaesthesia and with double lumen endotracheal intubation for single lung ventilation. Imaging quality and imaging of pulmonary nodules were rated. Results: IOP CT was evaluated as feasible combined with VATS. Thoracotomy was avoided in 5/15 patients where lesions could not be detected by VATS. A CT-guided biopsy was performed in two patients after an unsuccessful attempt of thoracoscopy. There were no documented side effects. Conclusion: first clinical results suggest that a combination of VATS and IOP CT is feasible. Thus, the number of open thoracoscopies might be decreased. Intrapulmonary lesions not detectable with VATS could be marked under CT - guidance intraoperatively and then resected by thoracoscopy. (orig.)

  7. 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.)

  8. Augmented reality system for CT-guided interventions: system description and initial phantom trials

    Science.gov (United States)

    Sauer, Frank; Schoepf, Uwe J.; Khamene, Ali; Vogt, Sebastian; Das, Marco; Silverman, Stuart G.

    2003-05-01

    We are developing an augmented reality (AR) image guidance system, in which information derived from medical images is overlaid onto a video view of the patient. The interventionalist wears a head-mounted display (HMD) that presents him with the augmented stereo view. The HMD is custom fitted with two miniature color video cameras that capture the stereo view of the scene. A third video camera, operating in the near IR, is also attached to the HMD and is used for head tracking. The system achieves real-time performance of 30 frames per second. The graphics appears firmly anchored in the scne, without any noticeable swimming or jitter or time lag. For the application of CT-guided interventions, we extended our original prototype system to include tracking of a biopsy needle to which we attached a set of optical markers. The AR visualization provides very intuitive guidance for planning and placement of the needle and reduces radiation to patient and radiologist. We used an interventional abdominal phantom with simulated liver lesions to perform an inital set of experiments. The users were consistently able to locate the target lesion with the first needle pass. These results provide encouragement to move the system towards clinical trials.

  9. CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Heywang-Koebrunner, S.H.; Amaya, B.; Pickuth, D.; Spielmann, R.P. [Dept. of Diagnostic Radiology, Martin-Luther University Halle-Wittenberg (Germany); Okoniewski, M. [Dept. of Orthopaedics, Martin-Luther University Halle-Wittenberg (Germany)

    2001-06-01

    Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1 % mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain. (orig.)

  10. CT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior to operative intervention.

    Science.gov (United States)

    Lee, J-Y; Impekoven, P; Stenzel, W; Löhr, M; Ernestus, R-I; Klug, N

    2004-07-01

    Tarlov or perineural cysts are lesions of the nerve root most often found in the sacral region. Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. In this article, we report three cases of a sacral perineural cyst, causing sciatic pain, and emphasize the usefulness of CT-guided percutaneous aspiration as an important diagnostic and prognostic procedure prior to definitive operative treatment.

  11. 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.

  12. CT-guided bone biopsy: Initial experience with a commercially available hand held Black and Decker{sup TM} drill

    Energy Technology Data Exchange (ETDEWEB)

    Buckley, O. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland); Benfayed, W. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland); Geoghegan, T. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland); Al-Ismail, K. [Department of Radiology, King Faisal Hospital (Saudi Arabia); Munk, P.L. [Department of Radiology, Musculo-Skeletal division, Vancouver General Hospital, 899 W. 12th Ave., Vancouver, BC V5Z 1M9 (Canada); Torreggiani, William C. [Department of Radiology, Adelaide and Meath, Hospital, Tallaght, Dublin 24 (Ireland)]. E-mail: william.torreggiani@amnch.ie

    2007-01-15

    Purpose: To describe the use of a simple commercially available Black and Decker{sup TM} hand based drill in performing CT-guided bone biopsies. Materials and methods: Three international institutions were enrolled in the study. In each centre, a fellowship trained musculoskeletal radiologist directed the assessment of a hand based commercial drill for performing CT-guided bone biopsies. A specially designed component was engineered which allowed the connection of a standard bone biopsy set to a commercial drill. The component was distributed to the three centres involved. Over a 3-year period, data from all three institutions was collected. Information regarding technical success, diagnostic data and complication rates were all collated to assess the technical feasibility of this technique. Results: In total 68 patients underwent bone biopsy using a hand held commercial drill. Technical success was achieved in 65 patients. Diagnostic material was obtained in 53 patients. Non-diagnostic material was obtained in 12 patients. Five out of the 12 patients with non-diagnostic material had repeat biopsies with diagnostic material obtained in 2 of these. No major complications occurred in any patient. Conclusion: CT-guided bone biopsy using a hand held commercial drill has a technically high success rate with minimal complications.

  13. 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.)

  14. [Quality assurance of rapid on-site evaluation of CT-guided fine-needle aspiration cytology of lung nodules].

    Science.gov (United States)

    Bak, Mihály; Hidvégi, Judit; Andi, Judit; Bahéry, Mária; Kovács, Eszter; Schneider, Ferenc; Kostic, Szilárd; Rényi-Vámos, Ferenc; Szőke, János; Nyári, Tibor; Gődény, Mária; Kásler, Miklós

    2013-01-06

    The methods available for the diagnosis of lung cancer include radiologic, cytologic and pathologic procedures. The aim of this study was to determine the quality assurance of CT guided fine needle aspiration cytology of lung nodules. Cytology results were rated to 4 categories (positive; suspicious; negative; not representative). All cytology reports were compared with the final histology diagnosis. A total of 128 patients underwent CT-guided percutaneous fine-needle aspiration biopsy cytology (63 males; 65 females; mean age 62.8 years). Smears were adequate in 99 cases and inadequate in 29 cases. The average diameter of the nodules was 3.28 cm. Thirty three (25.6%) of the cases were histologically verified and 2 falsely negative and 2 falsely positive cases were detected. The sensitivity and the positive predictive value were 88.8% and 88.8%, respectively. Pneumothorax developed in 7 (5.4%) cases. These results suggest that CT-guided transthoracic fine needle aspiration cytology has a high diagnostic accuracy and an acceptable complication rate. The auditing valves of the results meet the proposed threshold values.

  15. 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

  16. Accessible or Inaccessible? Diagnostic Efficacy of CT-Guided Core Biopsies of Head and Neck Masses

    Energy Technology Data Exchange (ETDEWEB)

    Cunningham, Jane D., E-mail: janecunningham0708@gmail.com; McCusker, Mark W.; Power, Sarah; PearlyTi, Joanna; Thornton, John; Brennan, Paul; Lee, Michael J.; O’Hare, Alan; Looby, Seamus [Beaumont Hospital, Department of Radiology (Ireland)

    2015-04-15

    PurposeTissue sampling of lesions in the head and neck is challenging due to complex regional anatomy and sometimes necessitates open surgical biopsy. However, many patients are poor surgical candidates due to comorbidity. Thus, we evaluated the use of CT guidance for establishing histopathological diagnosis of head and neck masses.MethodsAll consecutive patients (n = 22) who underwent CT-guided core biopsy of head or neck masses between April 2009 and August 2012 were retrospectively reviewed using the departmental CT interventional procedures database. The indication for each biopsy performed was to establish or exclude a diagnosis of neoplasia in patients with suspicious head or neck lesions found on clinical examination or imaging studies. Patients received conscious sedation and 18 G, semiautomated core needle biopsies were performed by experienced neuroradiologists using 16-slice multidetector row CT imaging guidance (Somatom Definition Siemens Medical Solutions, Germany). Histopathology results of each biopsy were analysed.ResultsSixteen of 22 biopsies that were performed (73 %) yielded a pathological diagnosis. Anatomic locations biopsied included: masticator (n = 7), parapharyngeal (n = 3), parotid (n = 3), carotid (n = 3), perivertebral (n = 3), pharyngeal (n = 2), and retropharyngeal (n = 1) spaces. Six biopsies (27 %) were nondiagnostic due to inadequate tissue sampling, particularly small biopsy sample size and failure to biopsy the true sampling site due to extensive necrosis. No major complications were encountered.ConclusionsThe use of CT guidance to perform core biopsies of head and neck masses is an effective means of establishing histopathological diagnosis and reduces the need for diagnostic open surgical biopsy and general anaesthesia.

  17. Percutaneous CT-guided radiofrequency ablation of solitary small renal masses. A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Pieper, C.C.; Fischer, S.; Strunk, H.; Meyer, C.; Thomas, D.; Willinek, W.A.; Schild, H. [Univ. Bonn (Germany). Dept. of Radiology; Hauser, S. [Univ. Bonn (Germany). Dept. of Urology; Nadal, J. [Univ. Bonn (Germany). Inst. for Medical Biometry; Wilhelm, K. [Johanniter Hospital Bonn (Germany). Dept. of Radiology

    2015-07-15

    To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period. Patient records of renal RFAs (07/2003 - 11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier's method and compared with log-rank or cox tests. 38 patients (16 females, mean age 70.0 years [range 52 - 87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95 % of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4 ± 0.8 % and 50.3 ± 1.0 %, respectively (mean follow-up 54.6 months, range 1 - 127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS. There was no difference in survival between patients with benign and malignant tumors. RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression.

  18. CT -guided sclerotherapy for simple renal cysts: Value of ethanol concentration monitoring

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    Yu, Jin Hong; Du, Yong; Li, Yang; Yang, Han Feng; Xu, Xiao Xue; Zheng, Hou Jun [The Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2014-02-15

    The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.

  19. CT-guided percutaneous microwave ablation of pulmonary malignancies: Results in 69 cases

    Directory of Open Access Journals (Sweden)

    Lu Qiang

    2012-05-01

    Full Text Available Abstract Background Microwave ablation (MWA has attracted a worldwide attention gradually in treating inoperable pulmonary malignancies. However, in the lung tissues treated with MWA recurrence of tumor may still occur and few data in large patient groups till now were reported about the safety or effectiveness of microwave ablation in treating primary lung cancer and metastatic pulmonary malignancies. The purpose of this study is to evaluate the clinical curative effect (local control, survival data MWA and its safety as well. Methods From 1 January 2005 to 1 January 2008, retrospective analyses, 69 patients underwent computed tomography (CT-guided percutaneous MWA of pulmonary malignancies. All patients were deemed medically inoperable. The correlation of tumor sizes and local progression after ablation was analyzed and the survival rates within 3 years post surgery were compared between non-small-cell lung cancer and pulmonary metastases groups also. Results Pneumothorax was the most frequent complication and occurred in 24.64% patients after ablation. Neither needle track implantation was found nor did patient death occur in these patients within 30 days. The 1-, 2-, and 3-year overall survival rates were 66.7%, 44.9% and 24.6%, respectively. The overall survival rates for NSCLC patients in 1 year, 2 years, and 3 years were 75.0%, 54.2%, and 29.2%, respectively. The overall survival rates for pulmonary metastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 23.8%, and 14.3%, respectively. The recurrence-free survival rates for NSCLC patients in 1 year, 2 years, and 3 years were 72.9%, 50.0%, and 27.1%, respectively. The mortality rates for pulmonary metastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 19.0%, and 14.3%, respectively. Conclusions Percutaneous microwave coagulation therapy was one safe and effective method and could be beneficial for the improvement of inoperable

  20. CT-Guided Percutaneous Transthoracic Localization of Pulmonary Nodules Prior to Video-Assisted Thoracoscopic Surgery Using Barium Suspension

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    Lee, Nyoung Keun; Park, Chang Min; Kang, Chang Hyun; Jeon, Yoon Kyung; Choo, Ji Yung; Lee, Hyun Ju; Goo, Jin Mo [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2012-11-15

    To describe our initial experience with CT-guided percutaneous barium marking for the localization of small pulmonary nodules prior to video-assisted thoracoscopic surgery (VATS). From October 2010 to April 2011, 10 consecutive patients (4 men and 6 women; mean age, 60 years) underwent CT-guided percutaneous barium marking for the localization of 10 small pulmonary nodules (mean size, 7.6 mm; range, 3-14 mm): 6 pure ground-glass nodules, 3 part-solid nodules, and 1 solid nodule. A 140% barium sulfate suspension (mean amount, 0.2 mL; range, 0.15-0.25 mL) was injected around the nodules with a 21-gauge needle. The technical details, surgical findings and pathologic features associated with barium localizations were evaluated. All nodules were marked within 3 mm (mean distance, 1.1 mm; range, 0-3 mm) from the barium ball (mean diameter, 9.6 mm; range, 8-16 mm) formed by the injected barium suspension. Pneumothorax occurred in two cases, for which one needed aspiration. However, there were no other complications. All barium balls were palpable during VATS and visible on intraoperative fluoroscopy, and were completely resected. Both the whitish barium balls and target nodules were identifiable in the frozen specimens. Pathology revealed one invasive adenocarcinoma, five adenocarcinoma-in-situ, two atypical adenomatous hyperplasias, and two benign lesions. In all cases, there were acute inflammations around the barium balls which did not hamper the histological diagnosis of the nodules. CT-guided percutaneous barium marking can be an effective, convenient and safe pre-operative localization procedure prior to VATS, enabling accurate resection and diagnosis of small or faint pulmonary nodules.

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

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    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

  2. Renal Sympathetic Denervation by CT-Guided Ethanol Injection: A Phase II Pilot Trial of a Novel Technique

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J., E-mail: jens.ricke@med.ovgu.de; Seidensticker, M.; Becker, S. [Otto-von-Guericke University Magdeburg, Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöR (Germany); Schiefer, J. [Universitätsklinikum Magdeburg AöR, Department of Nephrology and Hypertension, Diabetes and Endocrinology (Germany); Adamchic, I.; Lohfink, K. [Otto-von-Guericke University Magdeburg, Department of Radiology and Nuclear Medicine, Universitätsklinikum Magdeburg AöR (Germany); Kandulski, M.; Heller, A.; Mertens, P. R. [Universitätsklinikum Magdeburg AöR, Department of Nephrology and Hypertension, Diabetes and Endocrinology (Germany)

    2016-02-15

    ObjectivesCT-guided ethanol-mediated renal sympathetic denervation in treatment of therapy-resistant hypertension was performed to assess patient safety and collect preliminary data on treatment efficacy.Materials and MethodsEleven patients with therapy-resistant hypertension (blood pressure of >160 mmHg despite three different antihypertensive drugs including a diuretic) and following screening for secondary causes were enrolled in a phase II single arm open label pilot trial of CT-guided neurolysis of sympathetic renal innervation. Primary endpoint was safety, and secondary endpoint was a decrease of the mean office as well as 24-h systolic blood pressure in follow-up. Follow-up visits at 4 weeks, 3, and 6 months included 24-h blood pressure assessments, office blood pressure, laboratory values, as well as full clinical and quality of life assessments.ResultsNo toxicities ≥3° occurred. Three patients exhibited worsened kidney function in follow-up analyses. When accounting all patients, office systolic blood pressure decreased significantly at all follow-up visits (maximal mean decrease −41.2 mmHg at 3 months). The mean 24-h systolic blood pressure values decreased significantly at 3 months, but not at 6 months (mean: −9.7 and −6.3 mmHg, respectively). Exclusion of five patients who had failed catheter-based endovascular denervation and/or were incompliant for antihypertensive drug intake revealed a more pronounced decrease of 24-h systolic blood pressure (mean: −18.3 and −15.2 mmHg at 3 and 6 months, p = 0.03 and 0.06).ConclusionCT-guided sympathetic denervation proved to be safe and applicable under various anatomical conditions with more renal arteries and such of small diameter.

  3. Evaluation of chronic infectious interstitial pulmonary disease in children by low-dose CT-guided transthoracic lung biopsy

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    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.)

  4. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less

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    Ng, Y.L. [Joint Department of Medical Imaging, Thoracic Division, University Health Network and Mount Sinai Hospital, Toronto, Ontario (Canada)], E-mail: yuenli_ng@hotmail.com; Patsios, D.; Roberts, H.; Walsham, A.; Paul, N.S.; Chung, T.; Herman, S.; Weisbrod, G. [Joint Department of Medical Imaging, Thoracic Division, University Health Network and Mount Sinai Hospital, Toronto, Ontario (Canada)

    2008-03-15

    Aim: To determine the value of computed tomography (CT)-guided fine-needle aspiration biopsy (FNAB) of small pulmonary nodules measuring 10 mm or less. Material and Methods: CT-guided FNABs of 55 nodules, measuring 10 mm or less, were performed between January 2003 and February 2006. A coaxial technique was used, with an outer 19 G Bard Truguide needle and inner 22 G disposable Greene biopsy needle. Adequacy of specimens was assessed on-site by a cytotechnologist. The sizes of the nodules, distance from pleura, number of pleural punctures and aspirates, complications encountered, cytological diagnosis, and outcome were recorded. Results: The mean nodule diameter was 9 mm (range 5-10 mm). The average distance from the costal pleura was 31 mm (range 0-88 mm). In 50 of the 55 FNABs, the pleura was crossed once. An average of four aspirates was performed per case. Twenty-five FNABs (45.5%) were adequate for diagnosis (24 malignant and one tuberculosis). In 11 cases, where no definite diagnosis was made following FNAB, the outcome was not affected. In 10 cases, samples were insufficient for diagnosis and the nodules were subsequently diagnosed as malignant. Eight cases were excluded in the final analysis as follow-up details were unavailable. The sensitivity for malignancy and overall accuracy were 67.7 and 78.8%, respectively. Pneumothorax occurred in 29 (52.7%) patients, with five (9.1%) requiring thoracostomy tubes. Conclusion: CT-guided FNAB is a useful tool in the diagnosis and management of small pulmonary nodules, despite the lower diagnostic accuracy and higher complication rate than those of larger pulmonary lesions.

  5. Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center

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    Nouh, Mohamed Ragab, E-mail: mragab73@yahoo.com [Department of Radiology, Faculty of Medicine, Alexandria University (Egypt); Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait); Abu Shady, Hamdy Mohamed, E-mail: hamdi_abushadi@yahoo.com [Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait)

    2014-02-15

    Introduction: Appendicular long bones are the target for a wide spectrum of bony lesions with variable clinical presentations. Biopsy procedures are needed for subsequent proper patient's management. Most of the available literature globally assessed musculoskeletal biopsies with inclusion of repeat biopsy results. We thought to retrospectively assess the diagnostic performance of initial CT-guided percutaneous core needle biopsy (PCNB) of extremity long bone lesions in a tertiary musculoskeletal referral center. Patients and methods: We retrospectively analyzed the outcome of initial CT-guided PCNB of 49 patients who presented with extremity long bone lesions which were biopsied in our hospital during a 36 months’ time period. The diagnostic performance was assessed in terms of diagnostic yield and accuracy. Results: There were 34 males and 15 females with a mean age of 33.69 years (range from 4 to 77 years). The overall diagnostic yield of initial biopsies was 87.75% with a diagnostic accuracy of 82.85% derived from the surgically proven cases. The higher diagnostic yield was recorded with malignancy, presence of extra-osseous soft-tissue component as well as mixed and sclerotic lesions. The pathologies of the non-diagnostic biopsies included large-cell lymphoma, giant-cell tumor, langerhans cell histiocytosis, osteoid osteoma and a non-ossifying fibroma. Conclusion: Initial CT-guided PCNB in extremities’ long bones lesions showed high diagnostic performance in malignant, mixed and/or sclerotic lesions as well as lesions with extra-osseous exophytic tissue growth. Lack of extra-osseous components, benign and lytic lesions all had worse diagnostic performance.

  6. Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy.

    Science.gov (United States)

    Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Matsumoto, Tomohiro; Kakizawa, Hideaki; Toyoda, Naoyuki; Hasebe, Terumitsu; Awai, Kazuo

    2014-05-01

    This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. • CT-guided needle biopsy is a well-established diagnostic technique. • Touch imprint cytological evaluation on site is helpful in improving quality of CT-guided biopsy. • The rate of diagnosing malignant lymphoma specifically with cytological examination is relatively low. • The rate of specific diagnosis of benign lesion in musculoskeletal regions is low.

  7. Percutaneous CT-Guided Cryoablation as an Alternative Treatment for an Extensive Pelvic Bone Giant Cell Tumor

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    Panizza, Pedro Sergio Brito; Albuquerque Cavalcanti, Conrado Furtado de [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil); Yamaguchi, Nise Hitomi [Instituto Avanços em Medicina (Brazil); Leite, Claudia Costa; Cerri, Giovanni Guido; Menezes, Marcos Roberto de, E-mail: marcos.menezes@hc.fm.usp.br [Sírio Libânes Hospital, Radiology and Imaged Guided Intervention Service (Brazil)

    2016-02-15

    A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.

  8. Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome.

    Science.gov (United States)

    Sarma, Asha; Shyn, Paul B; Vivian, Mark A; Ng, Ju-Mei; Tuncali, Kemal; Lorch, Jorchen H; Zaheer, Sarah N; Gordon, Michael S; Silverman, Stuart G

    2015-10-01

    Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: O ne was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.

  9. Single-Session CT-Guided Percutaneous Microwave Ablation of Bilateral Adrenal Gland Hyperplasia Due to Ectopic ACTH Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Sarma, Asha, E-mail: ashasarma@gmail.com; Shyn, Paul B., E-mail: pshyn@partners.org [Brigham and Women’s Hospital, Department of Radiology (United States); Vivian, Mark A. [University of Manitoba, Department of Radiology (Canada); Ng, Ju-Mei [Brigham and Women’s Hospital, Department of Anesthesiology (United States); Tuncali, Kemal [Brigham and Women’s Hospital, Department of Radiology (United States); Lorch, Jorchen H. [Dana Farber Cancer Institute, Department of Medicine (United States); Zaheer, Sarah N.; Gordon, Michael S. [Brigham and Women’s Hospital, Department of Endocrinology (United States); Silverman, Stuart G. [Brigham and Women’s Hospital, Department of Radiology (United States)

    2015-10-15

    Bilateral adrenalectomy is currently the only available treatment for adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome (ectopic ACTH syndrome) that is refractory to pharmacologic therapy. We describe two patients with refractory ectopic ACTH syndrome who were treated with CT-guided percutaneous microwave ablation of both hyperplastic adrenal glands in a single session: One was not a surgical candidate, and the other had undergone unsuccessful surgery. Following the procedure, both patients achieved substantial decreases in serum cortisol, symptomatic improvement, and decreased anti-hypertensive medication requirements.

  10. The Feasibility of Using CT-Guided ROI for Semiquantifying Striatal Dopamine Transporter Availability in a Hybrid SPECT/CT System

    Directory of Open Access Journals (Sweden)

    Chien-Chin Hsu

    2014-01-01

    Full Text Available A hybrid SPECT/CT system provides accurate coregistration of functional and morphological images. CT-guided region of interest (ROI for semiquantifying striatal dopamine transporter (DAT availability may be a feasible method. We therefore assessed the intra- and interobserver reproducibility of manual SPECT and CT-guided ROI methods and compared their semiquantitative data with data from MRI-guided ROIs. We enrolled twenty-eight patients who underwent Tc-99m TRODAT-1 brain SPECT/CT and brain MRI. ROIs of the striatal, caudate, putamen, and occipital cortex were manually delineated on the SPECT, CT, and MRI. ROIs from CT and MRI were transferred to the coregistered SPECT for semiquantification. The striatal, caudate, and putamen nondisplaceable binding potential (BPND were calculated. Using CT-guided ROIs had higher intra- and interobserver concordance correlation coefficients, closer Bland-Altman biases to zero, and narrower limits of agreement than using manual SPECT ROIs. The correlation coefficients of striatal, caudate, and putamen BPND were good between manual SPECT and MRI-guided ROI methods and even better between CT-guided and MRI-guided ROI methods. Conclusively, CT-guided ROI delineation for semiquantifying striatal DAT availability in a hybrid SPECT/CT system is highly reproducible, and the semiquantitative data correlate well with data from MRI-guided ROIs.

  11. The feasibility of using CT-guided ROI for semiquantifying striatal dopamine transporter availability in a hybrid SPECT/CT system.

    Science.gov (United States)

    Hsu, Chien-Chin; Chang, Yen-Hsiang; Lin, Wei-Che; Tang, Shu-Wen; Wang, Pei-Wen; Huang, Yung-Cheng; Chiu, Nan-Tsing

    2014-01-01

    A hybrid SPECT/CT system provides accurate coregistration of functional and morphological images. CT-guided region of interest (ROI) for semiquantifying striatal dopamine transporter (DAT) availability may be a feasible method. We therefore assessed the intra- and interobserver reproducibility of manual SPECT and CT-guided ROI methods and compared their semiquantitative data with data from MRI-guided ROIs. We enrolled twenty-eight patients who underwent Tc-99m TRODAT-1 brain SPECT/CT and brain MRI. ROIs of the striatal, caudate, putamen, and occipital cortex were manually delineated on the SPECT, CT, and MRI. ROIs from CT and MRI were transferred to the coregistered SPECT for semiquantification. The striatal, caudate, and putamen nondisplaceable binding potential (BPND) were calculated. Using CT-guided ROIs had higher intra- and interobserver concordance correlation coefficients, closer Bland-Altman biases to zero, and narrower limits of agreement than using manual SPECT ROIs. The correlation coefficients of striatal, caudate, and putamen BPND were good between manual SPECT and MRI-guided ROI methods and even better between CT-guided and MRI-guided ROI methods. Conclusively, CT-guided ROI delineation for semiquantifying striatal DAT availability in a hybrid SPECT/CT system is highly reproducible, and the semiquantitative data correlate well with data from MRI-guided ROIs.

  12. Diagnostic efficiency and complication rate of CT-guided lung biopsy: a single center experience of the procedures conducted over a 10-year period

    Institute of Scientific and Technical Information of China (English)

    YUAN Dong-mei; SONG Yong; L(U) Yan-ling; YAO Yan-wen; LIU Hong-bing; WANG Qian; XIAO Xin-wu; CAO E-hong; SHI Yi; ZHOU Xiao-jun

    2011-01-01

    Background Computed tomography (CT)-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions.The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population.Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010.A chest radiograph was taken after the biopsy.Data about basic patient information,final diagnosis,and complications secondary to biopsy procedure (pneumothorax and bleeding) were extracted.Results The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy.Final diagnoses found 639 malignant lesions (63.0%) and 322 benign lesions (31.8%).Pneumothoraxoccurred in 131 patients and 15 required insertion of an intercostal drain.Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients.The overall complication rate was 18.5%.Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy.It can be safely performed in clinical trials.

  13. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

    2015-09-15

    To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

  14. Symptomatic lumbar facet joint cysts treated by CT-guided intracystic and intra-articular steroid injections

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    Amoretti, Nicolas; Huwart, Laurent; Amoretti, Marie-Eve; Pellegrin, Amelie; Marcy, Pierre-Yves [Centre Hospital-Universitaire de Nice, Hopital Archet 2, Department of Radiology, Nice (France); Foti, Pauline [Centre Hospital-Universitaire de Nice, Departments of Epidemiology, Nice (France); Boileau, Pascal [Centre Hospital-Universitaire de Nice, Orthopaedic Surgery, Nice (France); Hauger, Olivier [Hopital Pellegrin, Centre Hospitalo-Universitaire de Bordeaux, Department of Radiology, Bordeaux (France)

    2012-12-15

    To evaluate percutaneous computed tomography (CT)-guided intracystic and intra-articular steroid injections for the treatment of lumbar facet joint cyst causing radicular pain. A single-centre prospective study involving 120 consecutive patients with symptomatic lumbar facet joint cyst-induced radicular pain was done (72 women, 48 men). The average age was 68.2 years (52-84). Patients were treated by percutaneous CT-guided intracystic and intra-articular steroid injections. The clinical course of nerve root pain was evaluated after 1 day, and 1, 3 and 6 months, with long-term follow-up after 12 months. Patient follow-ups in our series show supportive results: within 120 patients, 54% of patients were satisfied with a long-lasting result from the first intra-cystic and intra-articular steroid injections (n = 65), while 20.8% were satisfied with a long-lasting result from a second intervention. Combining these two results shows that 75% of patients were satisfied with a long-lasting result. Our results showed that percutaneous treatment of vertebral lumbar facet joint cysts by double injections is an effective and economic therapeutic technical management among 75% of our patients. Thus we recommend that it should be considered as a first choice of treatment. (orig.)

  15. Clinical efficacy of CT-guided iodine-125 seed implantation therapy in patients with advanced pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhongmin, Wang [Soochow University, School of Radiation Medicine and Public Health, Suzhou (China); Shanghai Ruijin Hospital Luwan Branch, Shanghai (China); Yu, Liu; Kemin, Chen [Shanghai Ruijin Hospital, Department of Radiology, Shanghai (China); Fenju, Liu [Soochow University, School of Radiation Medicine and Public Health, Suzhou (China); Suzhou Industrial Park, Suzhou (China); Gang, Huang [Shanghai Jiao Tong University, Nuclear Medicine, School of Medicine, Shanghai (China)

    2010-07-15

    To examine the clinical efficacy of CT-guided radioactive iodine-125 (125I) seeds implantation treatment in patients with unresectable pancreatic cancer. Thirty-one patients with inoperable pancreatic cancer were enrolled in this study. The 125I seeds were implanted into pancreatic tumor under CT guidance. In addition, 10 patients received routine gemcitabine and 5-fluorouracil chemotherapy 1 week after brachytherapy. Median diameter of the tumor was 5.8 cm. Follow-up period was 2 to 25 months. Symptoms of refractory pain were significantly resolved post-interventionally (P < 0.05), and Karnofsky physical score increased dramatically (P < 0.05). Tumor response which was demonstrated on repeated CT film 2 months post-treatment revealed complete response (CR) in 3 cases, partial response (PR) in 16 cases, stable disease (SD) in 9 cases, and progressive disease (PD) in 3 cases. Overall responding rate (CR+PR) was 61.3%. Median survival time for all patients was 10.31 months. Two seeds of radioactive 125I migrated to the liver in 2 patients. There were no serious complications detected during the follow-up period. This study suggests that CT-guided brachytherapy using 125I seeds implantation appears to be safe, effective, uncomplicated, and could produce adequate pain relief for treating unresectable pancreatic cancer. (orig.)

  16. Evaluation of the effectiveness of CT-guided infiltration in the treatment of Arnold's neuralgia

    Energy Technology Data Exchange (ETDEWEB)

    Aubry, Sebastien [CHU Sherbrooke, Departement de Radiologie, Sherbrooke, QC (Canada); Universite de Franche-Comte, Laboratoire Intervention, Imagerie, Ingenierie et Innovation en Sante, Besancon (France); Kastler, Bruno [Universite de Franche-Comte, Laboratoire Intervention, Imagerie, Ingenierie et Innovation en Sante, Besancon (France); CHU Jean Minjoz, Service de Radiologie A, Besancon (France); Bier, Vincent; Hussein, Hussein Haj [CHU Jean Minjoz, Service de Radiologie A, Besancon (France); Hadjidekov, Vassil [Alexandrovska Hospital, Radiology Department, Sofia (Bulgaria); Fergane, Bernard [CHU Jean Minjoz, Centre d' Evaluation et de Traitement de la Douleur, Besancon (France)

    2009-03-15

    The aim of this study was to evaluate the effectiveness of computed tomography (CT)-guided infiltration in the treatment of Arnold's neuralgia. A retrospective study included 31 patients suffering from Arnold's neuralgia and having undergone a total of 45 CT-guided infiltrations of the greater occipital nerve (GON), in a proximal site (emergence of the GON, technique 1, n = 24) or in two proximal sites (emergence of the GON and at the site of the first bend of the GON drawn by the GON, technique 2, n = 21). Infiltration was considered to be effective when pain relief was equal to or greater than 50% for at least 1 month. There was no significant difference between the two techniques regarding immediate pain relief effect (53.3% for technique 1 vs. 60.5% for technique 2, p = 0.5), but technique 2 yielded better persistence of pain relief effect (p = 0.01), leading to a significantly higher percentage of effective infiltrations with technique 2 (p = 0.03). Infiltrations carried out in a single site yield results that are comparable to those previously published. Infiltrations in two sites provide significantly better results and should now be preferred to other single-site techniques in order to reduce the rate of failure or recurrence of Arnold's neuralgia. (orig.)

  17. CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Collettini, Federico; Schreiber, Nadja; Schnapauff, Dirk; Denecke, Timm; Hamm, Bernd; Gebauer, Bernhard [ChariteUniversitaetsmedizin Berlin, Department of Diagnostic and Interventional Radiology, Berlin (Germany); Wust, Peter [ChariteUniversitaetsmedizin Berlin, Department of Radiation Oncology, Berlin (Germany); Schott, Eckart [Universitaetsmedizin Berlin, Department of Gastroenterology, Berlin (Germany)

    2015-05-01

    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 {sup 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.) [German] Zweck der vorliegenden Arbeit war die Analyse der klinischen Effektivitaet der CT-gesteuerten Hochdosis-Brachytherapie (CT-HDRBT) bei Patienten mit inoperablem hepatozellulaeren Karzinom (HCC). Ueber einen Zeitraum von 6 Jahren, wurden an unserer Klinik 98 Patienten mit 212 inoperablen HCC mittels CT-HDRBT mit {sup 192}Ir behandelt. MRT-Verlaufskontrollen erfolgten 6 Wochen nach der Intervention und dann alle 3 Monate. Primaerer Endpunkt der Studie war die lokale Tumorkontrolle (LTC); sekundaere Endpunkte waren das progressionsfreie Ueberleben (PFS) und Gesamtueberleben (OS). Die mittlere Nachbeobachtungszeit betrug 23,1 Monate (Spanne 4

  18. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kang Ji; Han, Young Min; Jin, Gong Yong; Song, Ji Soo [Chonbuk National Univ., Jeonju (Korea, Republic of)

    2015-10-15

    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{sup 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

  20. CT-guided Bipolar and Multipolar Radiofrequency Ablation (RF Ablation) of Renal Cell Carcinoma: Specific Technical Aspects and Clinical Results

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, C. M., E-mail: christof.sommer@med.uni-heidelberg.de [University Hospital Heidelberg, INF 110, Department of Diagnostic and Interventional Radiology (Germany); Lemm, G.; Hohenstein, E. [Minimally Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Clinic for Radiology (Germany); Bellemann, N.; Stampfl, U. [University Hospital Heidelberg, INF 110, Department of Diagnostic and Interventional Radiology (Germany); Goezen, A. S.; Rassweiler, J. [Clinic for Urology, SLK Kliniken Heilbronn GmbH (Germany); Kauczor, H. U.; Radeleff, B. A. [University Hospital Heidelberg, INF 110, Department of Diagnostic and Interventional Radiology (Germany); Pereira, P. L. [Minimally Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Clinic for Radiology (Germany)

    2013-06-15

    Purpose. This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. Methods. We included 22 consecutive patients (3 women; age 74.2 {+-} 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 {+-} 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Results. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 {+-} 13.6 min and 43.7 {+-} 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 {+-} 8.8 months, local recurrence-free survival was 14.4 {+-} 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 {+-} 16.6 ml/min/1.73 m{sup 2} before RF ablation vs. 47.2 {+-} 11.9 ml/min/1.73 m{sup 2} after RF ablation; not significant). Conclusions. CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

  1. CT guided biopsies as a part of the investigations in findings in the lung and thorax wall

    DEFF Research Database (Denmark)

    Vagn-Hansen, Chris Aksel; Pedersen, Malene Roland Vils; Rafaelsen, Søren Rafael

    was performed. Results: In 86 % of the biopsies, the tissue material was found sufficient. In 32 % of the biopsies there was a complication, mostly pneumothorax (30%), but in only 15 % of the 520 cases chest drainage was needed. There was one death in a known cancer patient with severe reduced lung and cardiac...... function. Patients with more than 10 cigarette pack years had a complication risk twice as high compared to patients with less pack years. We found that the risk of pneumothorax rises the further the lesion is from the skin surface, the smaller the lesions are and when the patient is biopsied in a lateral...... position. We found a higher risk of complications in females. Conclusion: CT guided biopsy is an excellent tool in the analysis of lesions in the lungs. This study clearly shows that the risk of developing a pneumothorax is significantly higher among smokers and former smokers with more than 10 pack years....

  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

    OBJECTIVE: To investigate the impact of including fluorine-18 fludeoxyglucose ((18)F-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 (18)F-FDG PET......) 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...

  3. CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung tumors: A preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Division of Interventional Radiology, Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncologic Diseases, Cagliari, Zip code 09100 (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy)

    2013-05-15

    Purpose: To report the data of our initial experience with CT-guided thin cryoprobes for percutaneous cryoablation (PCA) in patients with primary and secondary pulmonary tumors. Material and methods: CT-guided thin needles PCA was performed on 34 lung masses (11 NSCLC = 32%; 23 secondary lung malignancies = 68%) in 32 consecutive patients (24 men and 8 women; mean age 67 ± 10 years) not suitable for surgical resection. Lung masses were treated using two types of cryoprobes: IceRod and IceSeed able to obtain different size of iceball. The number of probes used ranged from 1 to 5 depending on the size of the tumor. After insertion of the cryoprobes into the lesion, the PCA were performed with two 2 (91%) or 3 (9%) cycles each of 12 min of freezing followed by a 4 min active thawing phase and a 4 min passive thawing phase for each one for all treatments. Results: All cryoablation sessions were successfully completed. All primary and metastatic lung tumors were ablated. No procedure-related deaths occurred. Morbidity consisted of 21% (7 of 34) pneumothorax and 3% (1 of 34) cases asymptomatic small pulmonary hemorrhage, respectively, all of CTCAE grade 1 (Common Terminology Criteria for Adverse Events). Low density of entire lesion, central necrosis and solid mass appearance were identify in 21 (62%), 7 (21%) and 6 (17%) of cryoablated tumors, respectively. No lymphadenopathy developed in the region of treated lesions. Technical success (complete lack of enhancement) was achieved in 82%, 97% and 91% of treated lesions at 1-, 3- and 6-months CT follow-up scan, respectively (p < .000). Comparing the tumor longest diameter between the baseline and at 6 month CT images, technical success was revealed in 92% cases (p < .000). Conclusion: Our preliminary experience suggests that PCA is a feasible treatment option. Well-designed clinical trials with a larger patient population are necessary to further investigate the long-term results and prognostic factors.

  4. Transcatheter arterial chemoembolization combined with CT-guided percutaneous thermal ablation versus hepatectomy in the treatment of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Liang Zhang; Zhi-Mei Huang; Pei-Hong Wu

    2015-01-01

    Introduction:Transcatheter arterial chemoembolization (TACE) plus thermal ablation has been widely used recently in the treatment of hepatocellular carcinoma (HCC). In this study, we aimed to compare results of the combination of TACE and percutaneous thermal ablation with those of hepatectomy in patients with HCC. Methods:The clinical data of 137 HCC patients who sequentially received TACE and computed tomography (CT)-guided percutaneous thermal ablation as an initial curative treatment (combination group) and 148 matched HCC patients who received hepatectomy (surgery group) between 2004 and 2011 were collected and analyzed. After TACE, multiphase contrast-enhanced CT was performed to identify the total number of tumors as well as lipiodol deposition in the liver. Survival was calculated by using the Kaplan-Meier method and compared by using the log-rank test. The prognostic factors were assessed with multivariate Cox proportional hazards regression analysis. Results:Of all 285 patients, 225 (79.0%) had cancerous lesions≤5 cm in diameter. In preoperative contrast-enhanced CT or magnetic resonance imaging, the number of tumors was 1–4 for each patient. The 1-, 3-, and 5-year overal survival rates were 95, 74%, and 67%in the combination group and 88, 66, and 47%in the surgery group, respectively (P=0.004);the corresponding recurrence-free survival rates for the two groups were 92, 69, and 61%and 75, 58, and 44%, respectively (P=0.001). In the multivariate analysis, treatment al ocation was an independent prognostic factor for survival. Only 60 patients in the combination group had sufficient imaging data, and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of 60 patients, whereas 20 new lesions were found in 11 of 148 patients in the surgery group. Conclusion:The combination of TACE and CT-guided percutaneous thermal ablation for HCC improves survival of HCC patients compared with hepatectomy.

  5. Treatment of 213 Patients with Symptomatic Tarlov Cysts by CT-Guided Percutaneous Injection of Fibrin Sealant.

    Science.gov (United States)

    Murphy, K; Oaklander, A L; Elias, G; Kathuria, S; Long, D M

    2016-02-01

    There has been a steady progression of case reports and a small surgical series that report successful surgical treatment of Tarlov cysts with concomitant relief of patients' symptoms and improvement in their neurological dysfunction, yet patients are still told that these lesions are asymptomatic by physicians. The purpose of this study was to analyze the efficacy and safety of intervention in 213 consecutive patients with symptomatic Tarlov cysts treated by CT-guided 2-needle cyst aspiration and fibrin sealing. This study was designed to assess outcomes in patients who underwent CT-guided aspiration and injection of ≥1 sacral Tarlov cyst at Johns Hopkins Hospital between 2003 and 2013. In all, 289 cysts were treated in 213 consecutive patients. All these patients were followed for at least 6 months, 90% were followed for 1 year, and 83% were followed for 3-6 years. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH). One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3-6 years postprocedure, 74.0% of patients followed were satisfied with treatment. There were no clinically significant complications. The aspiration-injection technique described herein constitutes a safe and efficacious treatment option that holds promise for relieving cyst-related symptoms in many patients with very little risk. © 2016 by American Journal of Neuroradiology.

  6. 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

  7. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique.

    Science.gov (United States)

    Anzidei, Michele; Argirò, Renato; Porfiri, Andrea; Boni, Fabrizio; Anile, Marco; Zaccagna, Fulvio; Vitolo, Domenico; Saba, Luca; Napoli, Alessandro; Leonardi, Andrea; Longo, Flavia; Venuta, Federico; Bezzi, Mario; Catalano, Carlo

    2015-05-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. • CT-guided biopsy is the main procedure to obtain diagnosis in lung tumours. • The robotic device facilitates percutaneous needle placement under CT guidance. • Robot-assisted CT-guided lung biopsy reduces procedure duration and radiation dose.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  9. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Torriani, Martin; Rosenthal, Daniel I. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Halpern, Elkan F. [Massachusetts General Hospital, Institute for Technology Assessment, Department of Radiology, Boston, MA (United States); Springfield, Dempsey S. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

    2015-12-15

    To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate ?This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ{sup 2} test or Fisher's exact test. In all, 140 of 963 (15 %) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96 %). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8 %), POC cytology (25 %), or neither (24 %) were significantly different (P < 0.0001). Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a

  10. CT-Guided Radiofrequency Ablation of T1a Renal Cell Carcinoma in Korea: Mid-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Jin; Park, Byung Kwan; Park, Jung Jae; Kim, Chan Kyo [Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351 (Korea, Republic of)

    2016-11-01

    To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0–3.9 cm) and 26 months (4–60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m{sup 2} (14.2–142.7 mL/min/1.73 m{sup 2}) and 72.0 mL/min/1.73 m{sup 2} (7.2–112.6 mL/min/1.73 m{sup 2}), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes.

  11. CT-guided radiofrequency ablation of T1a renal cell carcinma in Korea; Mid-erm outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hae Jin; Park, Byung Kwan; Park, Jung Jae; Kim, Chan Kyo [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-09-15

    To evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) treatment in patients with small (< 4 cm) renal cell carcinoma (RCC) in Korea. Between 2010 and 2015, 51 patients (40 men and 11 women; median age, 57 years) with biopsyproven 51 RCC were treated using CT-guided RFA. All patients were clinically staged T1aN0M0 prior to RFA. The median tumor size and follow-up period were 2.1 cm (range, 1.0–3.9 cm) and 26 months (4–60 months), respectively. Local tumor progression, distant metastasis, primary and secondary effectiveness rates, and major complication rates were recorded. Estimated glomerular filtration rates (GFRs) between pre-RFA and last follow-up were compared using paired t tests. The 2-year recurrence-free survival rate was calculated using Kaplan-Meier survival analysis. Of the 51 patients, 2 (3.9%) experienced local tumor progression, and 1 (2.0%) had lymph node metastasis after the first RFA session. Primary and secondary effectiveness rates were 96.1% (49/51) and 100% (1/1), respectively. Only 1 patient experienced a major complication (uretero-pelvic stricture) after the second RFA session for treating a local tumor progression, and the major complication rate was 1.9% (1/52). The median pre-RFA and last follow-up GFRs were 87.1 mL/ min/1.73 m{sup 2} (14.2–142.7 mL/min/1.73 m{sup 2}) and 72.0 mL/min/1.73 m{sup 2} (7.2–112.6 mL/min/1.73 m{sup 2}), respectively (p < 0.0001). The 2-year recurrence-free survival rate was 96.0%. CT-guided RFA is a safe and effective treatment in Korean patients with T1a RCC because of excellent mid-term outcomes.

  12. 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

  13. CT-guided interstitial brachytherapy of hepatocellular carcinoma before liver transplantation: an equivalent alternative to transarterial chemoembolization?

    Energy Technology Data Exchange (ETDEWEB)

    Denecke, Timm; Stelter, Lars; Schnapauff, Dirk; Steffen, Ingo; Gebauer, Bernhard; Lopez Haenninen, Enrique; Wust, Peter [Universitaetsmedizin Berlin, Klinik fuer Radiologie, Charite, Berlin (Germany); Sinn, Bruno [Charite - Universitaetsmedizin Berlin, Institut fuer Pathologie, Berlin (Germany); Schott, Eckart [Charite 2 - Universitaetsmedizin Berlin, Medizinische Klinik m.S. Hepatologie und Gastroenterologie, Berlin (Germany); Seidensticker, Ricarda [Universitaetsklinikum der Otto-v.-Gericke-Universitaet, Klinik fuer Radiologie und Nuklearmedizin, Magdeburg (Germany); Puhl, Gero; Neuhaus, Peter; Seehofer, Daniel [Charite - Universitaetsmedizin Berlin, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie, Berlin (Germany)

    2015-09-15

    Transarterial chemoembolization (TACE) is established as bridging therapy of HCC listed for transplantation (LT). CT-guided brachytherapy (CTB) has not been evaluated as a bridging concept. We compared CTB and TACE for bridging before LT in HCC patients. Twelve patients with HCC received LT after CTB (minimal tumour dose, 15-20 Gy). Patients were matched (CTB:TACE, 1:2) by sex, age, number and size of lesions, and underlying liver disease with patients who received TACE before transplantation. Study endpoints were extent of necrosis at histopathology and recurrence rate after OLT. There were no significant differences between the CTB and TACE groups regarding Child-Pugh category (p = 0.732), AFP (0.765), time on waiting list (p = 0.659), number (p = 0.698) and size (p = 0.853) of HCC lesions, fulfilment of Milan-criteria (p = 0.638), or previous liver-specific treatments. CTB achieved higher tumour necrosis rates than TACE (p = 0.018). The 1- and 3-year recurrence rate in the CTB group was 10 and 10 % vs. TACE, 14 and 30 % (p = 0.292). Our data show comparable or even better response and post-LT recurrence rates of CTB compared to TACE for treating HCC in patients prior to LT. CTB should be further evaluated as an alternative bridging modality, especially for patients not suited for TACE. (orig.)

  14. [CT-guided electrode placement for sacral nerve stimulation in the treatment of faecal incontinence (cSNS)].

    Science.gov (United States)

    Goos, M; Ruf, G; Jargon, D; Trummer, C; Thomusch, O; Grüneberger, J; Bulla, S; Kotter, E; Ruthmann, O

    2014-12-01

    The sacral nerve stimulation (SNS) can be performed in the screening phase under local anaesthesia. Implantation of the tined-lead electrodes is usually performed in an inpatient setting under general anaesthesia. An outpatient procedure for both PNE and implantation of the electrodes offers decisive advantages with respect to the accuracy of electrode placement. From 2006 to 2011 a total of 51 patients was treated with SNS in an outpatient setting. Of 51 patients having the PNE, in four patients the procedure could not successfully be completed. In 39 of the 47 patients screened, the testing was positive. Eight times the screening was negative. The functional results show a significant decline in the Cleveland scores from 14.9 to 6.4. The manometric resting pressure improved from 23.4 mmHg to 43.81 mmHg, the squeezing pressure improved from 42.2 mmHg to 76.12 mmHg. Due to patients' perception and according to the response on the stimulus, the electrodes were placed on the left in S4 11 times, 23 times in the left S3, 3 times in the right S3, once in the left S2 and once in the right S2. CT-guided electrode placement is safe for temporary (subchronic) and permanent (chronic) sacral nerve stimulation and provides a valuable means for placement of the stimulating material. Georg Thieme Verlag KG Stuttgart · New York.

  15. CT-guided percutaneous drainage of intra-abdominal abscesses: APACHE III score stratification of 1-year results

    Energy Technology Data Exchange (ETDEWEB)

    Betsch, Angelika; Belka, Claus [Department of Radiation Oncology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Wiskirchen, Jakub; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Manncke, Klaus H. [Department of General Surgery, Eberhard Karls University, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany)

    2002-12-01

    Our objective was to evaluate the clinical success rates of percutaneously drained intra-abdominal abscesses using a risk stratification score for severely ill patients (APACHE III; Acute Physiology, Age, Chronic Health Evaluation). In 75 patients CT-guided percutaneous abscess drainage was performed to treat intra-abdominal abscesses. The clinical success rate based on a 1-year follow-up was correlated with abscess etiology, size, and structure, as well as with the initial APACHE III score. Clinical success, i.e., the complete removal of the abscess without surgical treatment, was observed in 62 of 75 patients (83%). Abscess size (<200 cm{sup 3}) and abscesses with a simple structure correlated with higher clinical success rates. Patients presenting with APACHE III scores below 30 were treated by percutaneous abscess drainages (PAD) alone significantly more often than patients presenting with higher APACHE scores. The percutaneous drainage of intra-abdominal abscesses shows good long-term results as long as abscesses are singular, small (<200 cm{sup 3}), and located in well accessible regions in combination with low APACHE scores (<30). (orig.)

  16. CT-guided cutting needle biopsy of lung lesions - Safety and efficacy of an out-patient service

    Energy Technology Data Exchange (ETDEWEB)

    Charig, M.J.; Phillips, A.J

    2000-12-01

    AIM: To determine the safety and efficacy of CT-guided cutting needle biopsy of lung lesions as an out-patient procedure. MATERIALS AND METHODS:A total of 185 consecutive biopsies were performed under CT guidance on 183 patients between January 1991 and December 1998 using 20-gauge (n= 33), 18-gauge (n= 151) or 14-gauge (n= 1) core biopsy needles. A chest radiograph was taken after observation in the Radiology department for 1 h and asymptomatic patients were discharged. RESULTS: The histology was malignant in 150 biopsies (81.1%) and benign in 23 (12.4%) with 12 false-negative results (6.5%); there were no false-positive results. The sensitivity was 92.6%; specificity 100%; negative predictive value 65.7%; and overall accuracy 93.5%. Pneumothoraces occurred in 48 patients (25.9%); one required aspiration only and four required insertion of an intercostal drain. One patient developed a pneumothorax after discharge. Small haemoptyses occurred in 13 patients without pneumothorax (7.0%), one of whom was admitted. In-patient treatment was required in 10 patients (5.4%). CONCLUSION: Computed tomography-guided cutting needle biopsy of pulmonary lesions is a safe technique with a diagnostic accuracy and complication rate comparable to reported figures for fine needle aspiration biopsy. It can be safely performed on an out-patient basis. Charig, M.J., Phillips, A.J. (2000)

  17. Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Awai, Kazuo [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); Matsumoto, Tomohiro; Hasebe, Terumitsu [Tokai University Hachioji Hospital, Tokai University School of Medicine, Department of Radiology, Hachioji, Tokyo (Japan); Kakizawa, Hideaki [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Department of Diagnostic Radiology, Naka-Ku, Hiroshima (Japan); Toyoda, Naoyuki [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); National Hospital Organisation Kure Medical Centre, Department of Diagnostic Radiology, Kure, Hiroshima (Japan)

    2014-05-15

    This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. (orig.)

  18. 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.)

  19. CT-guided radiofrequency (RF) ablation of osteoid osteoma. Clinical long-term results; CT-gesteuerte Radiofrequenz(RF)-Ablation von Osteoidosteomen. Klinische Langzeitergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Diethard; Clasen, S.; Schaefer, J.F.; Rempp, H.; Koenig, C.W.; Claussen, C.D. [Universitaetsklinikum Tuebingen (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Duda, S.; Truebenbach, J. [Juedisches Krankenhaus, Berlin (Germany). Radiologen Praxis; Erdtmann, B. [Radiologie Zentrum Stuttgart, Bad Cannstatt (Germany). Praxis; Pereira, P.L. [SLK-Kliniken, Heilbronn (Germany). Klinik fuer Radiologie, Minimal-Invasive Therapien und Nuklearmedizin

    2011-04-15

    Purpose: To evaluate CT-guided radiofrequency (RF) ablation of osteoid osteoma using internally cooled monopolar RF electrodes for technical success, complications and clinical long-term success. Materials and Methods: Between April 1999 and July 2009, 23 patients were treated under general anesthesia with CT-guided RF ablation using an internally cooled monopolar single RF electrode (Cool-tip, Valleylab, TycoHealthcare, Boulder, USA; active tip: 10 mm). For the removal of the nidus, we used either a manual or an automated drill. The technical success was evaluated by a CT scan (MSCT, Siemens Medical Solutions, Forchheim). The clinical long-term success was investigated by questioning patients prior to discharge, and after 6, 12 and 18 months. After 18 months, patients were interviewed on an annual basis. Results: The technical success rate was 100 %. The nidus was located in n = 19 cases at the lower extremity and in n = 4 cases at the upper extremity. Minor complications were observed for n = 2 patients. The mean hospitalization time was 1.5 d (1-2 d). The mean follow-up was 75.9 months (18-120 months) for n = 23 patients. No local recurrence was observed. One patient had intermediate pain one week after RF ablation without recurrent symptoms. Conclusion: CT-guided RF ablation using an internally cooled monopolar single RF electrode is an effective and safe minimally invasive method for the treatment of osteoid osteoma with excellent clinical long-term success. (orig.)

  20. Preliminary clinical experience with a dedicated interventional robotic system for CT-guided biopsies of lung lesions: a comparison with the conventional manual technique

    Energy Technology Data Exchange (ETDEWEB)

    Anzidei, Michele; Argiro, Renato; Porfiri, Andrea; Boni, Fabrizio; Zaccagna, Fulvio; Napoli, Alessandro; Leonardi, Andrea; Bezzi, Mario; Catalano, Carlo [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Radiology - Sapienza, Rome (Italy); Anile, Marco; Venuta, Federico [University of Rome, Department of Thoracic Surgery - Sapienza, Rome (Italy); Vitolo, Domenico [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Pathology - Sapienza, Rome (Italy); Saba, Luca [Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari-Polo di Monserrato, Monserrato (Italy); Longo, Flavia [University of Rome, Department of Radiological, Oncological and Anatomopathological Sciences - Oncology - Sapienza, Rome (Italy)

    2015-05-01

    Evaluate the performance of a robotic system for CT-guided lung biopsy in comparison to the conventional manual technique. One hundred patients referred for CT-guided lung biopsy were randomly assigned to group A (robot-assisted procedure) or group B (conventional procedure). Size, distance from entry point and position in lung of target lesions were evaluated to assess homogeneity differences between the two groups. Procedure duration, dose length product (DLP), precision of needle positioning, diagnostic performance of the biopsy and rate of complications were evaluated to assess the clinical performance of the robotic system as compared to the conventional technique. All biopsies were successfully performed. The size (p = 0.41), distance from entry point (p = 0.86) and position in lung (p = 0.32) of target lesions were similar in both groups (p = 0.05). Procedure duration and radiation dose were significantly reduced in group A as compared to group B (p = 0.001). Precision of needle positioning, diagnostic performance of the biopsy and rate of complications were similar in both groups (p = 0.05). Robot-assisted CT-guided lung biopsy can be performed safely and with high diagnostic accuracy, reducing procedure duration and radiation dose in comparison to the conventional manual technique. (orig.)

  1. CT guided percutaneous pulmonary sextant biopsy clinical should%CT引导下经皮肺穿刺活检术的临床应用

    Institute of Scientific and Technical Information of China (English)

    李玉

    2010-01-01

    Objective To explore the lung CT guided percutaneous biopsy strategies in clinical application value. Methods Dltra2Cut needle biopsy tissue type 18G cut in SEMENS64 row spiral CT guided puncture 68 cases of lung disease around. Results 68 cases of lung biopsy, percutaneous by pathological diagnosis 61 cases diagnosed as 91% , postoperative pneumothorax in 5 cases ,3 cases of pulmonary hemorrhage, hemoptysis in both cases. Conclusion CT guided percutaneous pulmonary sextant biopsy safety, economy, high accuracy,slight trauma,has value of clinical applications.%目的 探讨CT引导下经皮肺穿刺活检术在临床应用中的价值.方法 采用Dltra2Cut型18G软组织切割活检针在SEMENS64排螺旋CT引导下穿刺68例肺周围病变患者.结果 68例经皮肺穿刺活检,经病理诊断明确61例,诊断率为91%,术后气胸5例,肺出血3例,咳血2例均愈.结论 CT引导下经皮肺穿刺活检术安全、经济、准确率高、创伤小,具有临床应用价值.

  2. Clinical application on CT guiding interventional radiology technology%CT导引介人技术的临床应用

    Institute of Scientific and Technical Information of China (English)

    何建华; 彭述文; 米霞

    2011-01-01

    Objective The Computer Tomography (CT) guiding interventional radiology technology already became an extremely adequate technology in the large-scale general hospital, which was brought in since 2008-2009 in our hospital, and it has carried out dozens of cases, we improved it into a new kind of technology suitable for our hospital after summing up and studying it. This technology should be extended for popular use among the primary hospitals. Methods TOSHIBA Activion 16 screw CT scanner was used with the puncture needle Cook19G.After skin lung puncture biopsy 12 cases, after skin kidney puncture 25 cases, after skin liver puncture 7 cases. Results Among 12 cases of lung puncture biopsy, 9 cases are periphery the lung cancer, 2 cases are the pulmonary tuberculoses, 1 cases is pneumonia change in sexuality. 32 cases livers, the kidney puncture biopsy is a cyst, after extracts the pouch fluid to involve the hardened treatment, biggest cyst 11 cm, smallest cyst approximately 6cm, the short-term reexamination cyst obviously reduces approximately, after half year of reexaminations, the cyst disappeared basically or completely. No serious complication occurred. Conclusion The CT guiding interventional radiology technology belongs to the interventional radiology technology category, its application scope is broad, involving the whole body various systems, becoming one of the important methods of clinical diagnosis and treatment domain with characteristics of high security, minimally invasive surgery and less complication, etc. It' s worth to be extended popularly in primary hospitals.%目的 归纳、总结并不断改进我院CT导引介入技术,形成适应本院的一种新技术.方法 使用TOSHIBA Activion 16螺旋CT扫描机.穿刺针为Cook19G.经皮肺穿刺活检12例,经皮肾穿刺25例,经皮肝穿刺7例.结果 12例肺穿刺活检,9例为周围型肺癌,2例为肺结核,1例为肺炎性变.32例肝、肾穿刺活检为囊肿,抽取囊液后介入

  3. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT-Guided Cyst Rupture with Intra-articular Steroid Injection.

    Science.gov (United States)

    Haider, Steffen J; Na, Nu R; Eskey, Clifford J; Fried, Jessica G; Ring, Natalie Y; Bao, Mike H; Pastel, David A

    2017-08-01

    To evaluate clinical outcomes following percutaneous rupture of symptomatic lumbar facet synovial cysts (LFSCs) with intra-articular steroid injection. In this retrospective review, 44 consecutive patients with symptomatic LFSCs received primary treatment with CT-guided synovial cyst rupture with intra-articular steroid injection. Outcomes questionnaires were obtained before and 1, 4, 26, and 52 weeks after LFSC rupture. Assessment included pain medication use and numeric rating scale (NRS), Oswestry Disability Index (ODI), and 12-item short form health survey (SF-12) physical and mental composite scores (PCS and MCS). Clinical endpoint was 52-week survey response or surgery. LFSC rupture was technically successful in 84% (37/44) of cases. Clinical endpoint was reached in 68% (30/44) of patients with 82% overall 1-year follow-up. Lumbar spine surgery was performed in 25% (11/44) of patients within 1 year after procedure. Mean NRS, ODI, and SF-12 PCS demonstrated significant improvement at all follow-up time points (P < .001). At 52-week follow-up, NRS decreased from 8.1 to 3.7 (P < .001), ODI improved from 35 to 24 (P = .006), and SF-12 PCS improved from 31 to 42 (P < .001). Daily pain medication decreased from 71% (31/44) of patients before procedure to 29% (9/26) at 52-week follow-up (P = .012). History of prior lumbar intervention was associated with poorer LFSC rupture success (P = .025) and ODI (P = .047). NRS, ODI, and SF-12 PCS indices improved and pain medication use decreased significantly at all time points over 1-year follow-up after percutaneous rupture of symptomatic LFSCs with intra-articular steroid injection. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. 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)

  6. Deformable image registration for cone-beam CT guided transoral robotic base-of-tongue surgery

    Science.gov (United States)

    Reaungamornrat, S.; Liu, W. P.; Wang, A. S.; Otake, Y.; Nithiananthan, S.; Uneri, A.; Schafer, S.; Tryggestad, E.; Richmon, J.; Sorger, J. M.; Siewerdsen, J. H.; Taylor, R. H.

    2013-07-01

    Transoral robotic surgery (TORS) offers a minimally invasive approach to resection of base-of-tongue tumors. However, precise localization of the surgical target and adjacent critical structures can be challenged by the highly deformed intraoperative setup. We propose a deformable registration method using intraoperative cone-beam computed tomography (CBCT) to accurately align preoperative CT or MR images with the intraoperative scene. The registration method combines a Gaussian mixture (GM) model followed by a variation of the Demons algorithm. First, following segmentation of the volume of interest (i.e. volume of the tongue extending to the hyoid), a GM model is applied to surface point clouds for rigid initialization (GM rigid) followed by nonrigid deformation (GM nonrigid). Second, the registration is refined using the Demons algorithm applied to distance map transforms of the (GM-registered) preoperative image and intraoperative CBCT. Performance was evaluated in repeat cadaver studies (25 image pairs) in terms of target registration error (TRE), entropy correlation coefficient (ECC) and normalized pointwise mutual information (NPMI). Retraction of the tongue in the TORS operative setup induced gross deformation >30 mm. The mean TRE following the GM rigid, GM nonrigid and Demons steps was 4.6, 2.1 and 1.7 mm, respectively. The respective ECC was 0.57, 0.70 and 0.73, and NPMI was 0.46, 0.57 and 0.60. Registration accuracy was best across the superior aspect of the tongue and in proximity to the hyoid (by virtue of GM registration of surface points on these structures). The Demons step refined registration primarily in deeper portions of the tongue further from the surface and hyoid bone. Since the method does not use image intensities directly, it is suitable to multi-modality registration of preoperative CT or MR with intraoperative CBCT. Extending the 3D image registration to the fusion of image and planning data in stereo-endoscopic video is anticipated to

  7. Deformable image registration with local rigidity constraints for cone-beam CT-guided spine surgery.

    Science.gov (United States)

    Reaungamornrat, S; Wang, A S; Uneri, A; Otake, Y; Khanna, A J; Siewerdsen, J H

    2014-07-21

    ). Target registration error (TRE) was similarly improved for FFD+OC+IC (0.7 mm), compared to 1.4 and 1.8 mm for uFFD and Demons. Results were validated in human cadaver studies using CT and CBCT images, with FFD+OC+IC providing excellent preservation of rigid morphology and equivalent or improved TRE. The approach therefore overcomes distortions intrinsic to uFFD and could better facilitate high-precision IGSS.

  8. Deformable image registration with local rigidity constraints for cone-beam CT-guided spine surgery

    Science.gov (United States)

    Reaungamornrat, S.; Wang, A. S.; Uneri, A.; Otake, Y.; Khanna, A. J.; Siewerdsen, J. H.

    2014-07-01

    , respectively). Target registration error (TRE) was similarly improved for FFD+OC+IC (0.7 mm), compared to 1.4 and 1.8 mm for uFFD and Demons. Results were validated in human cadaver studies using CT and CBCT images, with FFD+OC+IC providing excellent preservation of rigid morphology and equivalent or improved TRE. The approach therefore overcomes distortions intrinsic to uFFD and could better facilitate high-precision IGSS.

  9. Sacral-neuromodulation CT-guided; Nuova tecnica di centraggio TC-assistista nella neuromodulazione sacrale

    Energy Technology Data Exchange (ETDEWEB)

    Amoroso, Lamberto; Ricci, Stefano [INRCA, Ancona (Italy). Dipartimento di radiologia e medicina nucleare; Pelliccioni, Giuseppe; Scarpino, Osvaldo [INRCA, Ancona (Italy). Unita' operativa di radiologia; Ghiselli, Roberto; Saba, Vittorio [INRCA, Ancona (Italy). Dipartimento di chirurgia

    2005-04-01

    Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

  10. CT-guided high-dose-rate brachytherapy in the interdisciplinary treatment of patients with liver metastases of pancreatic cancer.

    Science.gov (United States)

    Wieners, Gero; Schippers, Alexander Christian; Collettini, Federico; Schnapauff, Dirk; Hamm, Bernd; Wust, Peter; Riess, Hanno; Gebauer, Bernhard

    2015-10-01

    CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation (15-20 Gy) using a 192Ir-source. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival. The mean tumor diameter was 29 mm (range 10-73). The mean irradiation time was 20 minutes (range 7-42). The mean coverage of the clinical target volume was 98% (range 88%-100%). The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis (20%) and overall 15%. The mean follow-up time was 13.7 months (range 1.4-55.0). The median progression-free survival was 4.9 months (range 1.4-42.9, mean 9.4). Local recurrence occurred in 5 (10%) of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months (range 1.5-55.3). Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months (mean 12.9). Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months (mean 5.0). The rate of local tumor control was 91% in both groups after 12 months. CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.

  11. Assessment and management of interfractional variations in daily diagnostic-quality-CT guided prostate-bed irradiation after prostatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Feng; Ahunbay, Ergun; Lawton, Colleen; Allen Li, X., E-mail: ali@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226 (United States)

    2014-03-15

    Purpose: To quantify interfractional anatomic variations and limitations of the current practice of image-guided radiation therapy (IGRT) for prostate-bed patients and to study dosimetric benefits of an online adaptive replanning scheme that addresses the interfractional variations. Methods: Contours for the targets and organs at risk (OARs) from daily diagnostic-quality CTs acquired with in-room CT (CTVision, Siemens) were generated by populating the planning contours using an autosegmentation tool based on deformable registration (ABAS, Elekta) with manual editing for ten prostate-bed patients treated with postoperative daily CT-guided IMRT. Dice similarity coefficient (DSC) obtained by maximizing the overlap of contours for a structure between the daily and plan contours was used to quantify the organ deformation between the plan and daily CTs. Three interfractional-variation-correction schemes, the current standard practice of IGRT repositioning, a previously developed online adaptive RT (ART), and the full reoptimization, were applied to these daily CTs and a number of dose-volume quantities for the targets and organs at risk were compared for their effectiveness to account for the interfractional variations. Results: Large interfractional organ deformations in prostate-bed irradiation were seen. The mean DSCs for CTV, rectum, and bladder were 86.6 ± 5.1% (range from 61% to 97%), 77.3% ± 7.4% (range from 55% to 90%), and 75.4% ± 11.2% (range from 46% to 96%), respectively. The fractional and cumulative dose-volume quantities for CTV and PTV: V100 (volume received at least 100% prescription dose), and rectum and bladder: V{sub 45Gy} and V{sub 60Gy} (volume received at least 45 or 60 Gy), were compared for the repositioning, adaptive, reoptimization, and original plans. The fractional and cumulative dosimetric results were nearly the same. The average cumulative CTV V100 were 88.0%, 98.4%, 99.2%, and 99.3% for the IGRT, ART, reoptimization, and original plans

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

    Directory of Open Access Journals (Sweden)

    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

  13. CT-guided percutaneous drainage in the treatment of abdominal abscess%CT引导下经皮穿刺引流术治疗腹部脓肿

    Institute of Scientific and Technical Information of China (English)

    钟涛; 王勇; 于红光

    2013-01-01

    Objective To evaluate the clinical effect of CT-guided percutaneous drainage in the treatment of abdominal abscess.Methods Thirty-two patients were treated with CT puntures percutaneous drainage,aspirated pusflushing the abscess,and set the flow antibiotics.Results Success rate of CT-guided percutaneous drainage therapy was 90.6%.Drainage catheter were kept from 7 to 20 days.No complication occurred in the course of treatment.All the patients' temperature dropped within 2 days,pain relieved,and the abscess volume significantly reduced after a week.Conclusions CT-guided percutaneous catheter drainage in the treatment of abdominal abscess,the operation is simple,accurate and has better safety,efficacy,and it is a worthy interventional treatment.%目的 对CT引导下经皮穿刺引流治疗腹部脓肿的效果进行临床评价.方法 对32例腹部脓肿患者行CT引导下经皮穿刺引流术,抽出脓液,冲洗脓腔,并留置抗生素.结果 CT引导下经皮穿刺引流术成功率为90.6%,引流后带管时间7~20 d,治疗过程中无并发症发生;患者2d内体温下降,疼痛减轻,1周后复查CT,脓肿体积明显缩小.结论 应用CT引导下经皮穿刺导管置入引流术治疗腹部脓肿,操作简单,准确安全,疗效较好,是一种值得推广的介入治疗手段.

  14. The clinical application of spiral CT guided percutaneous vertebroplasty --76 cases analysis%螺旋CT引导下经皮椎体成形术的临床应用--附76例病例分析

    Institute of Scientific and Technical Information of China (English)

    蔡国荣; 陈学琴; 胡双庆; 张仁军; 李智明

    2014-01-01

    目的:探讨CT引导下经皮椎体成形术的常规手术方法和对不同胸腰椎椎体疾病的临床治疗效果。方法对76例胸、腰椎椎体病变患者进行了经皮穿刺椎体成形术(PVP),CT引导下椎弓根入路穿刺进入椎体行骨髓腔造影并向椎体内加压注射聚甲基丙烯酸甲酯骨水泥。结果椎弓根穿刺成功率100%,骨水泥均匀充填椎体者49例次,27例为部分充填椎体,其中27例成形术后椎体前部高度部分恢复,有70例患者术后疼痛缓解,在注射骨水泥后15 min至3 d起效。结论经皮穿刺椎体成形术这一技术适用于椎体肿瘤和椎体压缩性骨折的治疗,有效而安全,尤其适用于年龄大、机体状况差和不能接受大型手术的高危患者,而在CT引导下解剖关系更精确,定位更准确,操作更安全。%Objective Study on CT-guided percutaneous vertebroplasty for conventional surgical Methods and the different thoracic and lumbar vertebral disease clinical treatment.Methods76 cases of thoracic and lumbar vertebral disease patients with percutaneous vertebroplasty (PVP),CT-guided percutaneous transpedicular approach in angiography of vertebral body marrow cavity and vertebral body to pressure injection of poly methyl methacrylate bone cement.ResultsSuccess rate of pedicle screw spinal puncture is 100%. Uniform iflling vertebral body with bone cement in 49 cases and 27 for iflling vertebral body, of which 27 cases of postoperative vertebral body height in the front part of the recovery, 70 cases of patients with postoperative pain relief, at 15 min after the injection of bone cement to 3d effect.ConclusionPercutaneous vertebroplasty for this technology is suitable for vertebral body compression fracture of vertebral body tumor and treatment, effective and safe, especially in older, poor body condition and not high risk patients undergoing major surgery, in CT-guided anatomy is more precise, more accurate positioning

  15. Prospective 1-year follow-up pilot study of CT-guided microwave ablation in the treatment of bone and soft-tissue malignant tumours

    Energy Technology Data Exchange (ETDEWEB)

    Aubry, Sebastien; Kastler, Bruno [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); University of Franche-Comte, I4S laboratory, INSERM EA4268, Besancon (France); Dubut, Jonathan; Nueffer, Jean-Philippe [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Chaigneau, Loic [University Hospital of Besancon, Department of Oncology, Besancon (France); Vidal, Chrystelle [University Hospital of Besancon, Clinical Investigation Center, INSERM CIT808, Besancon (France)

    2017-04-15

    The aims of this work were to assess the feasibility, efficacy, short-term outcome and safety of microwave ablation (MWA) in the treatment of malignant musculoskeletal tumours. Sixteen bone and soft-tissue malignant tumours were prospectively included and were treated by CT-guided MWA. The percentage and size of necrosis of the lesions were measured by contrast-enhanced MRI before the procedure and after 1, 3, 6 and 12 months. mRECIST criteria were used to assess tumour response. Procedural success was defined as ≥80 % necrosis. Patient pain (as assessed using a numeric visual scale (NVS)) and side effects were noted. Six osteolytic metastases, five osteoblastic metastases and five soft tissue sarcomas were treated. At 1 month, 40 % were treated completely, the percentage of necrosis was 85 ± 30.4 %, and the success rate was 80 %. At 3, 6 and 12 months the success rate was 80 %, 76.9 % and 63.6 %, respectively. At 12 months, four lesions (36.3 %) still had no recurrence. Mean NVS during the procedure was 3.5 ± 2.8. One patient had transitory sciatica without neurological deficit that was treated medically. CT-guided MWA of bone and soft-tissue malignant tumours is efficient, well tolerated and has good short-term anti-cancer effects. (orig.)

  16. CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb

    Energy Technology Data Exchange (ETDEWEB)

    Kastler, Adrian [University Hospital CHU Gabriel Montpied, Radiology Department, Clermont-Ferrand (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); CHU Clermont-Ferrand, Hopital Gabriel Montpied, Clermont-Ferrand (France); Aubry, Sebastien; Kastler, Bruno [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Sailley, Nicolas; Michalakis, Demosthene [University Hospital CHU Jean Minjoz, Radiology and Interventional Pain Unit, Besancon (France); Siliman, Gaye [University Hospital CHU St Jacques, Clinical Investigation Center, Besancon (France); Gory, Guillaume [Franche Comte University, I4S Laboratory-EA 4268-IFR 133, Besancon (France); Lajoie, Jean-Louis [University Hospital CHU Jean Minjoz, Pain evaluation and Management Unit, Besancon (France)

    2013-05-15

    To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb. Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was {>=}50 %, lasting for at least 2 years. Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76. CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade. (orig.)

  17. CT-guided infiltration saves surgical intervention and fastens return to work compared to anatomical landmark-guided infiltration in patients with lumbosciatica.

    Science.gov (United States)

    Deml, Moritz C; Buhr, Michael; Wimmer, Matthias D; Pflugmacher, Robert; Riedel, Rainer; Rommelspacher, Yorck; Kabir, Koroush

    2015-07-01

    Infiltration procedures are a common treatment of lumbar radiculopathy. There is a wide variety of infiltration techniques without an established gold standard. Therefore, we compared the effectiveness of CT-guided transforaminal infiltrations versus anatomical landmark-guided transforaminal infiltrations at the lower lumbar spine in case of acute sciatica at L3-L5. A retrospective chart review was conducted of 107 outpatients treated between 2009 and 2011. All patients were diagnosed with lumbar radiculopathic pain secondary to disc herniation in L3-L5. A total of 52 patients received CT-guided transforaminal infiltrations; 55 patients received non-imaging-guided nerve root infiltrations. The therapeutic success was evaluated regarding number of physician contacts, duration of treatment, type of analgesics used and loss of work days. Defined endpoint was surgery at the lower lumbar spine. In the CT group, patients needed significantly less oral analgesics (p lumbosciatica caused by intervertebral disc herniation is significantly superior to non-imaging, anatomical landmark-guided infiltration, regarding the parameters investigated. The high number of treatment failures in the non-imaging group underlines the inferiority of this treatment concept.

  18. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions.

    Science.gov (United States)

    Mills, M; Choi, J; El-Haddad, G; Sweeney, J; Biebel, B; Robinson, L; Antonia, S; Kumar, A; Kis, B

    2017-08-26

    To investigate the technical success rate and procedure-related complications of computed tomography (CT)-guided needle biopsy of lung lesions and to identify the factors that are correlated with the occurrence of procedure-related complications. This was a single- institution retrospective study of 867 consecutive CT-guided needle biopsies of lung lesions performed on 772 patients in a tertiary cancer centre. The technical success rate and complications were correlated with patient, lung lesion, and procedure-related variables. The technical success rate was 87.2% and the mortality rate was 0.12%. Of the 867 total biopsies 25.7% were associated with pneumothorax, and 6.5% required chest tube drainage. The haemothorax rate was 1.8%. There was positive correlation between the development of pneumothorax and smaller lesion diameter (ptechnical success and a low rate of major complications. The present study has revealed several variables that can be used to identify high-risk procedures. A post-procedural chest X-ray within hours after the procedure is highly recommended to identify high-risk patients who require chest tube placement. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  19. CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: Clinical success and long-term follow up in 77 patients

    Energy Technology Data Exchange (ETDEWEB)

    Rehnitz, Christoph, E-mail: Christoph.Rehnitz@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Sprengel, Simon David, E-mail: SimonDavid.Sprengel@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Lehner, Burkhard, E-mail: Burkhard.Lehner@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Ludwig, Karl, E-mail: karl.ludwig@klinikum-herford.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Omlor, Georg, E-mail: Georg.Omlor@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Merle, Christian, E-mail: Christian.Merle@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Kauczor, Hans-Ulrich, E-mail: HU.Kauczor@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Ewerbeck, Volker, E-mail: Volker.Ewerbeck@med.uni-heidelberg.de [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Weber, Marc-Andre, E-mail: MarcAndre.Weber@med.uni-heidelberg.de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany)

    2012-11-15

    The purpose of this study was to retrospectively evaluate long-term success of CT-guided radiofrequency ablation (RFA) in patients with osteoid osteoma (OO) and osteoblastoma (OB) including tumors in critical locations. Eighty-one CT-guided RFA procedures were performed in 77 patients with OO (65 patients) and OB (12) including 6 spinal and 15 intra/periarticular tumors. Procedural techniques included multiple needle positions, three-dimensional access planning, as well as, thermal protection techniques. Long-term success was assessed using a questionnaire including, among others, several VAS (visual analogue scale) scores. All patients completed 3-6 months follow-up, overall response to the questionnaire was 64/77 (83.1%). Primary success rate was 74/77 (96.1%) of all patients. Retreatment with RFA in 3 patients resulted in a secondary success rate of 77/77 (100%). Long-term follow-up (mean, 38.5 months; range, 3-92) revealed a highly significant (p < 0.001) reduction of all assessed limitation scores reaching normal or almost normal values. One major complication, a cannula break leading to a secondary short hospital stay, occurred. In conclusion, RFA is a safe and effective long-lasting treatment of OO and OB. Advanced procedural techniques aid treating tumors in critical locations and in the coverage of larger tumors. Besides night pain, RFA also greatly improves other factors negatively affecting the quality of life.

  20. CT-guided injection of botulinic toxin for percutaneous therapy of piriformis muscle syndrome with preliminary MRI results about denervative process

    Energy Technology Data Exchange (ETDEWEB)

    Fanucci, E.; Masala, S.; Sodani, G.; Varrucciu, V.; Romagnoli, A.; Squillaci, E.; Simonetti, G. [Dept. of Radiology, Univ. of Rome (Italy)

    2001-12-01

    Piriformis muscle syndrome (PMS) is a cause of sciatica, leg or buttock pain and disability. The pain is usually increased by muscular contraction, palpation or prolonged sitting. The aim of our paper was to evaluate the feasibility of CT-guided percutaneous botulinic toxin (BTX) injection for the purpose of PMS treatment. Thirty patients suffering from PMS, suspected with clinical and electrophysiological criteria, after imaging examinations excluding other causes of sciatic pain, resulted positive at the lidocaine test and were treated by intramuscular injection of BTX type A under CT guidance. The follow-up (12 months) was performed with clinical examination in all cases and with MR 3 months after the procedure in 9 patients to evaluate the denervative process entity of the treated muscle. In 26 cases relief of symptoms was obtained after 5-7 days. In 4 patients an insufficient relief of pain justified a second percutaneous treatment which was clinically successful. No complications or side effects were recorded after BTX injection. The MR examination showed a signal intensity change of the treated muscle in 7 patients due to the denervative process of PM, whereas in the remaining 2 cases only an atrophy of the treated muscle was detected. Larger series are necessary to confirm these MRI preliminary results. The CT-guided BTX injection in the PMS is an emergent and feasible technique that obtains an excellent local therapeutic effect without risk of imprecise inoculation. (orig.)

  1. CT-guided percutaneous ethanol injection with disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes

    Institute of Scientific and Technical Information of China (English)

    Chang-Jing Zuo; Pei-Jun Wang; Cheng-Wei Shao; Min-Jie Wang; Jian-Ming Tian; Yi Xiao; Fang-Yuan Ren; Xi-Yan Hao; Min Yuan

    2004-01-01

    AIM: To explore the feasibility of computed tomography (CT)-guided percutaneous ethanol injection (PEI) using a disposable curved needle for treatment of malignant liver neoplasms and their metastases in retroperitoneal lymph nodes.METHODS: CT-guided PEI was conducted using a disposable curved needle in 26 malignant liver tumors smaller than 5 cm in diameter and 5 lymph node metastases of liver cancer in the retroperitoneal space. The disposable curved needle was composed of a straight trocar (21G) and stylet, a disposable curved tip (25 G) and a fine stylet. For the tumors found in deep sites and difficult to reach, or for hepatic masses inaccessible to the injection using a straight needle because of portal vein and bile ducts, the straight trocar was used at first to reach the side of the tumor. Then, the disposable curved needle was used via the trocar. When the needle reached the tumor center, appropriate amount of ethanol was injected. For relatively large malignant liver tumors,multi-point injection was carried out for a better distribution of the ethanol injected throughout the masses. The curved needle was also used for treatment of the metastasis in retroperitoneal lymph nodes blocked by blood vessels and inaccessible by the straight needle.RESULTS: All of the 26 liver tumors received 2 or more times of successful PEI, through which ethanol was distributed throughout the whole tumor mass. Effect of the treatment was monitored by contrast-enhanced multi-phase CT and magnetic resonance imaging (MRI) examinations three months later. Of the 18 lesions whose diameters were smaller than 3 cm, the necrotic change across the whole mass and that in most areas were observed in 15 and 3 tumors,respectively. Among the 8 tumors sizing up to 3 cm, 5 were completely necrotic and 3 largely necrotic. Levels of tumor seromarkers were significantly reduced in some of the cases.In 5 patients with metastases of liver cancer in retroperitoneal lymph nodes who received 1 to 3

  2. CT-guided Percutaneous Interventional Treatment for the Lumbar Disc Hernia%CT引导介入治疗腰椎间盘突出症

    Institute of Scientific and Technical Information of China (English)

    曾庭基; 许国增

    2015-01-01

    目的:探讨CT引导射频结合胶原酶介入治疗腰椎间盘突出症的临床应用价值。方法对48例临床诊断为腰椎间盘突出症、经CT检查证实的患者进行CT导引下射频联合胶原酶介入治疗,全部病例进行突出物内射频热凝和突出物内注射0.45 ml 275 U 胶原酶,其中L4/5椎间盘病变23例,L5/S1椎间盘病变25例。结果穿刺成功率100%,6个月后随访,腰椎间盘突出症状缓解情况:优25例、良20例、可3例、差0例。CT复查突出物明显变小26例,部分变小22例。本研究过程未出现过敏反应、神经根损伤等并发症。结论 CT引导介入治疗是腰椎间盘突出症的有效治疗方法。%Objective To investigate the clinical value of CT-guided percutaneous radiofrequency combined with collagenase treatment for lumbar disc hernia.Methods A total of 48 patients with lumbar disc hernia diagnosed by clinic and CT accepted CT-guided percutaneous radiofrequency combined with collagenase (0.45 ml 275 U) treatment. There were 23 cases of L4/5 lesions and 25 cases of L5/S1 lesions.Results Injection was done successfully in all patients. After 6 months, 48 patients were contacted for clinical follow-up and repeat CT examination were performed to verify the status of the herniated lumbar disc material. The clinical rate of excellence and good results were 93.7%. The protrusion reduced as by CT scan in 48 cases (100%). No allergic phenomena or neurologically adverse reactions were observed.Conclusion CT-guided percutaneous radiofrequency combined with collagenase is effective in treating lumbar disc hernia.

  3. Diagnostic accuracy and complication rate of CT-guided fine needle aspiration biopsy of lung lesions: A study based on the experience of the cytopathologist

    Energy Technology Data Exchange (ETDEWEB)

    Massimiliano Priola, Adriano; Priola, Sandro Massimo; Cataldi, Aldo; Paze, Francesco (Dept. of Diagnostic and Interventional Radiology, Univ. of Turin, S. Luigi Gonzaga Hospital, Turin (Italy)), e-mail: adriano.priola@inwind.it; Di Franco, Marisa (Dept. of Pharmacology, S. Luigi Gonzaga Hospital, Orbassano, Turin (Italy)); Marci, Valerio (Dept. of Pathology, S. Luigi Gonzaga Hospital, Orbassano, Turin (Italy)); Berruti, Alfredo (Dept. of Oncology, S. Luigi Gonzaga Hospital, Orbassano, Turin (Italy))

    2010-06-15

    Background: CT-guided transthoracic needle biopsy is a well-established technique for the diagnosis of focal lung lesions. Fine needle aspiration biopsy (FNAB) requires the presence of a cytopathologist on-site to assess the adequacy of samples. For this reason FNAB is less and less used, and core biopsy is the first-line procedure when an experienced cytopathologist is not immediately available. Purpose: To evaluate the accuracy and complication rate of CT-guided FNAB of lung lesions according to the experience of the cytopathologist on-site. Material and Methods: A total of 321 consecutive biopsies were considered. Immediate cytological assessment was performed by an experienced cytopathologist for the first 165 procedures (group A) and by two training pathologists for the remaining 156 biopsies (group B). At the time of FNAB the pathologist assigned a semiquantitative score (0-3) to each specimen to assess its diagnostic quality. All variables between the two groups were analyzed by chi-square and Student's t test. A P value <0.05 was considered statistically significant. Results: For all procedures, overall diagnostic accuracy was 80% for cytology alone, with no statistical difference between the two groups for diagnostic accuracy and sample score assigned. In all, 75% of the cytological samples (75% group A, 74% group B) obtained a higher score with a specific diagnosis of histotype. A post biopsy pneumothorax was detected in 27% of biopsies (25% group A, 28% group B). Thirteen patients (4.0%) required chest tube insertion for treatment. For all cases, the pneumothorax rate was significantly affected by the number of samples obtained (P=0.02), but not by the pleural punctures (P=0.15). There was no statistically significant difference between the two groups concerning the number of needle passes and complication rate (P>0.05). Conclusion: The efficacy and safety of CT-guided FNAB is not significantly affected by the training level of the cytopathologist

  4. 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

  5. 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

  6. CT-guided percutaneous screw fixation plus cementoplasty in the treatment of painful bone metastases with fractures or a high risk of pathological fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio; Ballicu, Nicola; Fele, Rosa Maria; Sotgia, Barbara; Melis, Luca [Oncological Hospital ' ' A. Businco' ' , Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Cagliari (Italy); Fancellu, Alessandro [University of Sassari, Department of Clinical and Experimental Medicine, Sassari (Italy)

    2017-04-15

    To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous screw fixation plus cementoplasty (PSFPC), for either treatment of painful metastatic fractures or prevention of pathological fractures, in patients who are not candidates for surgical stabilization. Twenty-seven patients with 34 metastatic bone lesions underwent CT-guided PSFPC. Bone metastases were located in the vertebral column, femur, and pelvis. The primary end point was the evaluation of feasibility and complications of the procedure, in addition to the length of hospital stay. Pain severity was estimated before treatment and 1 and 6 months after the procedure using the visual analog scale (VAS). Functional outcome was assessed by improved patient walking ability. All sessions were completed and well tolerated. There were no complications related to either incorrect positioning of the screws during bone fixation or leakage of cement. All patients were able to walk within 6 h after the procedure and the average length of hospital stay was 2 days. The mean VAS score decreased from 7.1 (range, 4-9) before treatment to 1.6 (range, 0-6), 1 month after treatment, and to 1.4 (range 0-6) 6 months after treatment. Neither loosening of the screws nor additional bone fractures occurred during a median follow-up of 6 months. Our results suggest that PSFPC might be a safe and effective procedure that allows the stabilization of the fracture and the prevention of pathological fractures with significant pain relief and good recovery of walking ability, although further studies are required to confirm this preliminary experience. (orig.)

  7. 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.

  8. Using a laser guidance system for CT-guided biopsy and treatment of nerve block; Verwendung eines Laserzielgeraetes fuer CT-gesteuerte Biopsien und Nervenblockaden

    Energy Technology Data Exchange (ETDEWEB)

    Zwaan, M. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Frahm, C. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Kloess, W. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Preuss, S. [Schmerzambulanz, Klinik fuer Anaesthesiologie, Medizinische Univ. Luebeck (Germany); Baumeier, W. [Schmerzambulanz, Klinik fuer Anaesthesiologie, Medizinische Univ. Luebeck (Germany); Grande-Nagel, I. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Gehl, H.B. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany); Weiss, H.D. [Inst. fuer Radiologie, Medizinische Univ. Luebeck (Germany)

    1996-07-01

    CT-guided intervention is a simple and pin-pointed modality for obtaining cytologic, biopsy, or microbiologic samples, and for treatment of the nerve blockade. In order to enhance the precision of punctures, and reduce complications, the authors developed and tested a novel laser guidance system (wavelength 365 nm at 4.5 mW). In 56 consecutive patients (representing 24 nerve blocks, 16 tumor biopsies, 16 microbiological punctures), a CT-guided intervention was performed. Despite a high accuracy (80 punctures), false punctures (6) could not be avoided in cases where anatomic conditions were misleading the needle, or due to patient movements. The system is not to be blamed for these unsuccessful attempts. As the system operates contactless guided by laser light, it is a good tool ensuring simple and sterile needle biopsy. (orig.) [Deutsch] Die computertomographisch gesteuerte Intervention ist ein einfaches und zielsicheres Verfahren fuer die Gewinnung zystologischer, bioptischer oder mikrobiologischer Proben und zur therapeutischen Nervenblockade. Zur Erhoehung der Punktionsgenauigkeit und zur Reduktion von Komplikationen haben wir fuer diese Indikationsgebiete ein neu entwickeltes Laserzielgeraet (Wellenlaenge 365 m bei 4,5 mW) erprobt. Es wurde bei 56 konsekutiven Patienten (24 Nervenblockaden, 16 Tumorbiopsien, 16 mikrobiologische Materialentnahmen) eine CT-gesteuerte Intervention duchgefuehrt. Trotz einer hohen Treffgenauigkeit (80 Punktionen) kann es aber weiterhin zu Fehlpunktionen (6) kommen, falls Koerperstrukturen zum Abweichen oder Abbiegen der Punktionsnadel fuehren oder der Patient sich bewegt. Dies ist dem System selbst nicht anzulasten. Da es mit Laserlicht beruehrungsfrei arbeitet, ist eine einfache und sterile Punktion sehr gut moeglich. (orig.)

  9. CT-guided corticosteroid injection of the sacroiliac joints: quality assurance and standardized prospective evaluation of long-term effectiveness over six months.

    Science.gov (United States)

    Althoff, Christian E; Bollow, Matthias; Feist, Eugen; Marticorena-Garcia, Stephan R; Eshed, Iris; Diekhoff, Torsten; Hamm, Bernd; Hermann, Kay Geert A

    2015-06-01

    Steroid injection of the sacroiliac joints is widely used for the management of active sacroiliitis in patients with spondyloarthritis (SpA). The aims of this study were to prospectively investigate the effectiveness of corticosteroid injection of the sacroiliac joints and to identify factors determining positive and negative outcome. Twenty-nine patients (18 female, 11 male) suffering from sacroiliitis were treated by computed tomography (CT)-guided administration of 40 or 60 mg triamcinolone acetonide per joint. Clinical outcome of the intervention was determined using a visual analog scale from days 1 to 7 as well as after 1, 3, and 6 months. Patients were grouped according to intra-articular (n = 22) and peri-articular positions (n = 7) of the tip of the puncture needle. In patients with intra-articular needle position (76 %), the mean pain score decreased significantly from 7.3 (±1.9) to 3.9 (±3.4) at day 7 and to 3.9 (±3.4) after 1 month, 4.2 (±3.3) after 3 months, and 5.2 (±2.9) after 6 months. The group with peri-articular needle position (24 %) did not show a statistically significant pain reduction throughout the entire 6-month follow-up period. A substantial reduction of inflammatory back pain (reduction of at least 4 visual analog scale (VAS) points) was reported by 55 % of patients after 3 months and 45 % of patients after 6 months. Our results demonstrate that intra-articular CT-guided steroid instillation can achieve sufficient pain and symptom control for 6 months in patients suffering from active sacroiliitis. It is therefore recommended to perform this intervention under appropriate image guidance to ensure proper positioning of the needle tip.

  10. Complications in CT-guided, semi-automatic coaxial core biopsy of potentially malignant pulmonary lesions; Komplikationen bei CT-gesteuerter, koaxialer Stanzbiopsie malignomverdaechtiger Lungenherde in halbautomatischer Technik

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, R. [Klinik Loewenstein (Germany). Dept. of Radiology; Seebacher, G.; Enderes, B.; Kugler, G.; Graeter, T.P. [Klinik Loewenstein (Germany). Dept. of Thoracic and Vascular Surgery; Fischer, J.R. [Klinik Loewenstein (Germany). Dept. of Oncology

    2015-08-15

    Histological verification of pulmonary lesions is important to ensure correct treatment. Computed tomographic (CT) transthoracic core biopsy is a well-established procedure for this. Comparison of available studies is difficult though, as technical and patient characteristics vary. Using a standardized biopsy technique, we evaluated our results for CT-guided coaxial core biopsy in a semi-automatic technique. Within 2 years, 664 consecutive transpulmonary biopsies were analyzed retrospectively. All interventions were performed using a 17/18G semi-automatic core biopsy system (4 to 8 specimens). The incidence of complications and technical and patient-dependent risk factors were evaluated. Comparing the histology with the final diagnosis, the sensitivity was 96.3 %, and the specificity was 100 %. 24 procedures were not diagnostic. In all others immunohistological staining was possible. The main complication was pneumothorax (PT, 21.7 %), with chest tube insertion in 6 % of the procedures (n = 40). Bleeding without therapeutic consequences was seen in 43 patients. There was no patient mortality. The rate of PT with chest tube insertion was 9.6 % in emphysema patients and 2.8 % without emphysema (p = 0.001). Smokers with emphysema had a 5 times higher risk of developing PT (p = 0.001). Correlation of tumor size or biopsy angle and the risk of PT was not significant. The risk of developing a PT was associated with an increasing intrapulmonary depth of the lesion (p = 0.001). CT-guided, semiautomatic coaxial core biopsy of the lung is a safe diagnostic procedure. The rate of major complications is low, and the sensitivity and specificity of the procedure are high. Smokers with emphysema are at a significantly higher risk of developing pneumothorax and should be monitored accordingly.

  11. Risk factor analysis of pulmonary hemorrhage complicating CT-guided lung biopsy in coaxial and non-coaxial core biopsy techniques in 650 patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo (Egypt); Alsubhi, Mohammed [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Naguib, Nagy N. [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany); Diagnostic and Interventional Radiology Department, Alexandria University Hospital, Alexandria (Egypt); Lehnert, Thomas; Emam, Ahmed; Beeres, Martin; Bodelle, Boris; Koitka, Karen; Vogl, Thomas J.; Jacobi, Volkmar [Institute for Diagnostic and Interventional Radiology, Johan Wolfgang Goethe – University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main (Germany)

    2014-10-15

    Purpose: To evaluate the risk factors involved in the development of pulmonary hemorrhage complicating CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques. Materials and methods: Retrospective study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD: 5.2) from November 2008 to June 2013. Patients were classified according to lung biopsy technique in coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were: lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension or refusal of the procedure. Risk factors for pulmonary hemorrhage complicating lung biopsy were classified into: (a) patient's related risk factors, (b) lesion's related risk factors and (d) technical risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher's exact tests for statistical analysis. p values <0.05 were considered statistically significant. Results: Incidence of pulmonary hemorrhage was 19.6% (65/332) in non-coaxial group and 22.3% (71/318) in coaxial group. The difference in incidence between both groups was statistically insignificant (p = 0.27). Hemoptysis developed in 5.4% (18/332) and in 6.3% (20/318) in the non-coaxial and coaxial groups respectively. Traversing pulmonary vessels in the needle biopsy track was a significant risk factor of the development pulmonary hemorrhage (incidence: 55.4% (36/65, p = 0.0003) in the non-coaxial group and 57.7% (41/71, p = 0.0013) in coaxial group). Other significant risk factors included: lesions of less than 2 cm (p value of 0.01 and 0.02 in non-coaxial and coaxial groups respectively), basal and middle zonal lesions in comparison to upper zonal lung lesions (p = 0.002 and 0.03 in non-coaxial and coaxial groups respectively), increased lesion

  12. PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

    Energy Technology Data Exchange (ETDEWEB)

    Guo, Wei; Hao, Bing; Chen, Hao-jun; Zhao, Long; Luo, Zuo-ming; Wu, Hua; Sun, Long [The First Affiliated Hospital of Xiamen University, Department of Nuclear Medicine and Minnan PET Center, Xiamen Cancer Hospital, Xiamen (China)

    2017-01-15

    {sup 18}F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of {sup 18}F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer. PET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and {sup 18}F-FDG-avid bone lesions after whole-body {sup 18}F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated. A total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin's lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min. PET/CT-guided percutaneous biopsy of {sup 18}F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer. (orig.)

  13. 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.

  14. CT-guided percutaneous catheter drainage in thetreatment of liverabscess%CT 引导经皮穿刺置管引流治疗肝脓肿

    Institute of Scientific and Technical Information of China (English)

    卢占兴; 陈新晖

    2014-01-01

    Objective To investigate the method and curative effect of the CT-guided percutaneous catheter drainage in hepatic ab-scess.Methods 36 patients with liver abscess were treated with “one-step”percutaneous 8F pig tail catheter tube under CT guidance. Results 36 patients were performed “one-step”percutaneous catheter drainage,the successful rate was 100%,no severe complica-tions occurred.Symptoms were improved after cathetering in all patients.Of these 36 patients,30 patients had single abscess and 6 patients had multiple abscesses.The mean duration of drainage catheterization was 21.2 days for 36 patients.The diameter of ab-scess was between 4.0-1 9.5 cm,the mean diameter of abscess was 8.3 cm.Conclusion CT-guided percutaneous hepatic abscess catheter drainage is a safe,effective,minimally-invasive treatment.%目的:探讨 CT 引导下经皮穿刺置管引流治疗肝脓肿的方法和疗效。方法对36例肝脓肿患者行 CT 引导下经皮穿刺放置8F 猪尾巴引流管持续引流。结果36例采用“一步法”穿刺均1次穿刺置管成功,无严重并发症发生,全部患者置管引流治疗后症状得到改善。30例为单一病灶,6例为多发病灶;平均引流置管时间为21.2 d。脓肿最大径为4.0~19.5 cm,平均8.3 cm。结论肝脓肿 CT 引导下置管治疗是一种安全、有效、微创且易被患者接受的治疗方法。

  15. 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 computation time despite the difference in the complexity of the algorithms (P = .71). The GPU-accelerated volume subdivision technique was as accurate as the B-spline technique and required significantly less processing time. The GPU-accelerated volume subdivision technique may enable the implementation of nonrigid

  16. Does pain relief by CT-guided indirect cervical nerve root injection with local anesthetics and steroids predict pain relief after decompression surgery for cervical nerve root compression?

    Science.gov (United States)

    Antoniadis, Alexander; Dietrich, Tobias J; Farshad, Mazda

    2016-10-01

    The relationship of pain relief from a recently presented CT-guided indirect cervical nerve root injection with local anesthetics and steroids to surgical decompression as a treatment for single-level cervical radiculopathy is not clear. This retrospective study aimed to compare the immediate and 6-week post-injection effects to the short- and long-term outcomes after surgical decompression, specifically in regard to pain relief. Patients (n = 39, age 47 ± 10 years) who had undergone CT-guided indirect injection with local anesthetics and steroids as an initial treatment for single cervical nerve root radiculopathy and who subsequently needed surgical decompression were included retrospectively. Pain levels (VAS scores) were monitored before, immediately after, and 6 weeks after injection (n = 34), as well as 6 weeks (n = 38) and a mean of 25 months (SD ± 12) after surgical decompression (n = 36). Correlation analysis was performed to find potential associations of pain relief after injection and after surgery to investigate the predictive value of post-injection pain relief. There was no correlation between immediate pain relief after injection (-32 ± 27 %) and 6 weeks later (-7 ± 19 %), (r = -0.023, p = 0.900). There was an association by tendency between immediate pain relief after injection and post-surgical pain relief at 6 weeks (-82 ± 27 %), (r = 0.28, p = 0.08). Pain relief at follow-up remained high at -70 ± 21 % and was correlated with the immediate pain amelioration effect of the injection (r = 0.37, p = 0.032). Five out of seven patients who reported no pain relief from injection had a pain relief from surgery in excess of 50 %. The amount of immediate radiculopathic pain relief after indirect cervical nerve root injection is associated with the amount of pain relief achieved at long-term follow-up after surgical decompression of single-level cervical radiculopathy

  17. Usefulness of CT-Guided Percutaneous Catheter Drainage Using a Modified Version of the Seldinger Technique for the Treatment of Intra-abdominal Small Abscess and Poorly Depicted Fluid Collection on Sonogram

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chi Sung [Boramae Hospital, Seoul (Korea, Republic of)

    2010-10-15

    To evaluate the usefulness of CT-guided percutaneous catheter drainage (PCD) using a modified version of the Seldinger technique for deep-seated, small abscesses and poorly depicted fluid collection on abdominal sonogram. Fifty-nine cases of CT-guided PCD were performed on 56 patients. Four techniques were applied to secure safe access routes, which include scan postural change, angulation of the gantry, traversal of organs, and using a dissecting needle which can push the intervening bowel. Three landmarks (depth of the front and back wall of the fluid collection and the end point of catheter advancement over the guide wire) were indicated on the drainage catheter for extracorporeal direct observation of moving distance and location of the catheter during the insertion process. The technical success rate, clinical outcome, complications, and instrumental impairments were reviewed. The technical success rate was 100% (59/59), and no grave complications occurred. Four cases (7%) of crooked guide wire insertion were noted. The clinical outcome revealed a 95% (56/59) successful treatment rate and a 5% (3/59) failed treatment rate, which was caused by undissolved hematoma (1/59) and fistula (2/59). The results of this study suggest that CT-guided PCD using a modified version of the Seldinger technique for deep-seated, small abscesses and poorly depicted fluid collections on an abdominal sonogram is useful in terms of accuracy and safety.

  18. Workflow efficiency for the treatment planning process in CT-guided high-dose-rate brachytherapy for cervical cancer.

    Science.gov (United States)

    Michaud, Anthony L; Benedict, Stanley; Montemayor, Eliseo; Hunt, Jon Paul; Wright, Cari; Mathai, Mathew; Mayadev, Jyoti S

    2016-01-01

    To investigate process efficiency, we present a prospective investigation of the treatment planning phase of image-guided brachytherapy (BT) for cervical cancer using a specific checklist. From October 2012 to January 2014, 76 BT procedures were consecutively performed. Prospective data on the CT-based treatment planning process was collected using a specific checklist which details the following steps: (1) dosimetry planning, (2) physician review start, (3) physician review time, (4) dosimetry processing, (5) physics review start, (6) physics review, and (7) procedural pause. Variables examined included the use of a pre-BT MRI, clinic duty conflicts, resident teaching, and the use of specific BT planners. Analysis was performed using descriptive statistics, t-test, and analysis of variance. Seventy-five prospectively gathered checklists comprised this analysis. The mean time for treatment planning was 95 minutes (med 94, std 18). The mean intervals in the above steps were (1) = 42, (2) = 5, (3) = 19, (4) = 10, (5) = 6, (6) = 13, and (7) = 26 minutes. There was no statistical difference in patients who had a pre-BT MRI. Resident teaching did not influence time, p = 0.17. Treatment planning time was decreased with a specific planner, p = 0.0015. A skillful team approach is required for treatment planning efficiency in image-guided BT. We have found that the specific BT planners can have a significant effect on the overall planning efficiency. We continue to examine clinical and workflow-related factors that will enhance our safety and workflow process with BT. Published by Elsevier Inc.

  19. CT-guided {sup 125}I brachytherapy for mediastinal metastatic lymph nodes recurrence from esophageal carcinoma: Effectiveness and safety in 16 patients

    Energy Technology Data Exchange (ETDEWEB)

    Gao, Fei, E-mail: gaof@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Li, Chuanxing, E-mail: licx@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Gu, Yangkui, E-mail: guyk@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Huang, Jinhua, E-mail: huangjh@sysucc.org.cn [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China); Wu, Peihong, E-mail: vivian-link@163.com [State Key Laboratory of Oncology in South China, Guangzhou 510060 (China); Department of Interventional Radiology, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060 (China)

    2013-02-15

    Objectives: To retrospectively evaluate effectiveness and safety of CT-guided {sup 125}I brachytherapy in 16 patients with mediastinal metastatic lymph nodes recurrence from esophageal carcinoma. Materials and methods: Sixteen metastatic lymph nodes in 16 patients were percutaneously treated in 19 {sup 125}I brachytherapy sessions. Each metastatic lymph node was treated with computed tomographic (CT) guidance. Follow-up contrast material-enhanced CT or positron emission tomographic (PET) scans were reviewed and the treatment's effectiveness was evaluated. Results: Months are counted from the first time of {sup 125}I brachytherapy and the median duration of follow-up was 11 months (range, 5–16 months). The local control rates after 3, 6, 10 and 15 months were 75.0, 50.0, 42.9 and 33.3% respectively. At the time of writing, four patients are alive without evidence of recurrence at 16, 9, 16 and 9 months. The 4 patients presented good control of local tumor and no systemic recurrence, and survived throughout the follow-up period. The other 12 patients died of multiple hematogenous metastases 5–15 months after brachytherapy. A small amount of local hematoma occurred in 2 patients that involved applicator insertion through the lung. Two patients presented pneumothorax with pulmonary compression of 30 and 40% after the procedure and recovered after drainage. One patient had minor displacement of radioactive seeds. Severe complications such as massive bleeding and radiation pneumonitis did not occur. Conclusion: {sup 125}I radioactive seed implantation is effective and may be safely applied to mediastinal metastatic lymph nodes recurrence from esophageal carcinoma.

  20. Debulking treatment with CT-guided percutaneous radiofrequency ablation and hepatic artery infusion of floxuridine improves survival of patients with unresectable pulmonary and hepatic metastases of colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    Sheng Li; Ni He; Wang Li; Pei-Hong Wu

    2014-01-01

    The survival of most patients with both unresectable hepatic and pulmonary metastases of colorectal cancer is poor. In this retrospective study, we investigated the efficacy of computed tomography (CT)-guided radiofrequency ablation (RFA) and systemic chemotherapy plus hepatic artery infusion of floxuridine (HAI-FUDR). Sixty-one patients were selected from 1,136 patients with pulmonary and hepatic metastases from colorectal cancer. Patients were treated with RFA and systemic chemotherapy plus HAI-FUDR (ablation group, n=39) or systemic chemotherapy plus HAI-FUDR (FUDR group, n=22). Patients in the two groups were matched by sex, age, number of metastases, and calendar year of RFA or FUDR. Survival data were evaluated by using univariate and multivariate analyses. Clinical characteristics were comparable between the two groups. Al patients in the ablation group underwent RFA and chemotherapy. Median fol ow-up was 56.8 months. The 1-, 3-, and 5-year overall survival (OS) rates were 97%, 64%, and 37%, respectively, for the ablation group, and 82%, 32%, and 19%, respectively, for the FUDR group. The 1-, 3-, and 5-year survival rates after metastasis were 97%, 49%, and 26%for the ablation group, and 72%, 24%, and 24%for the FUDR group, respectively. The median OS times were 45 and 25 months for the ablation and FUDR groups, respectively. In the multivariate analysis, treatment al ocation was a favorable independent prognostic factor for OS (P = 0.001) and survival after metastasis (P = 0.009). These data suggest that the addition of RFA to systemic chemotherapy plus HAI-FUDR improves the survival of patients with both unresectable hepatic and pulmonary metastases from colorectal cancer.

  1. CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT; CT-kontrollierte Schraubenosteosynthese von vertikalen Frakturen des hinteren Beckenringes in Lokalanaesthesie

    Energy Technology Data Exchange (ETDEWEB)

    Reuther, G.; Dehne, I. [Thueringen-Klinik, Saalfeld (Germany). Radiologische Klinik; Roehner, U.; Will, T.; Petereit, U. [Thueringen-Klinik, Saalfeld (Germany). Orthopaedics and Trauma Surgery

    2014-12-15

    To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1, 10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14-52 minutes) and 35 minutes (range: 21-60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy x cm (range: 162-1014 mGy x cm) for the unilateral and 470 mGy x cm (range: 270-1271 mGy x cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

  2. Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Pellegrin Hospital, Department of Radiology, Bordeaux (France); Silk, M.; Takaki, H.; Durack, J.C.; Erinjeri, J.P.; Sofocleous, C.T.; Siegelbaum, R.H.; Maybody, M.; Solomon, S.B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology, New York, NY (United States); Schoder, H. [Memorial Sloan-Kettering Cancer Center, Department of Nuclear Medicine, New York, NY (United States)

    2014-12-15

    We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural {sup 18}F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging. From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7-15.9 cm; SD, 2.9 cm) in bones (n = 33), liver (n = 26), soft tissues (n = 18), lung (n = 15) and abdomen (n = 14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed. Biopsies were positive for malignancy in 76 cases (71.7 %, 76/106) and for benign tissue in 30 cases (28.3 %, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3 %, 100/106) requiring no further exploration, and for the six others (5.7 %, 6/106) benign diagnoses were confirmed after surgery (n = 4) or follow-up (n = 2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100 %. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV > 4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7 %, 4/106). Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions. (orig.)

  3. CT-guided percutaneous cryoablation of osteoid osteoma%CT导向下冷冻消融术治疗儿童骨样骨瘤

    Institute of Scientific and Technical Information of China (English)

    张肖; 肖越勇; 杨杰; 吴斌; 马旭阳; 刘士榕; 任超

    2011-01-01

    Objective To evaluate the safety and efficacy of the CT-guided percutaneous cryoablation of osteoid osteoma in children.Methods Nine children with osteoid osteoma proved by histopathology were treated with CT-guided cryoablation from January 2007 to January 2010.There were 6 boys and 3 girls.Their mean age was ( 13.0 + 1.6 ) years ( ranging from 10.0-15.0 years ).The procedures were performed under local anesthesia.Eight G bone biopsy needles for biopsy and 17 G freezing needles were used in the procedure.CT guidance was used for procedural planning,instrument guidance,and monitoring.Each cryoablation included two freezing-thawing cycles.Follow-up was performed to assess technical and clinical outcome.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 Kruskal-Wallis rank sum test.Results Biopsy and cryoablation were successfully performed in all children.No major immediate or postponed complications were observed.Significant pain relief ( P < 0.01 ) was observed in all patients after procedure.The VAS of preoperation(8 points 1 case,7 points 3 cases,6 points 4 cases,5 points 1 case) compared with that of one month after operation ( 1 point 4 cases,0 point 5 cases),the difference was statistically significant( H =32.838,P < 0.01 ).These patients were allowed to fully weight-bear and function without limitation 3 days after the procedure.Pain was obviously released.Pain recurrence was not observed in all patients.Moderate fever (37.8 ℃ ) was observed in a patient one day after operation and fully recovered 2 days later.Conclusion CT-guided percutaneous cryoablation is a safe and effective minimally invasive method for the treatment of osteoid osteoma in children.%目的 评估CT导向下冷冻消融术治疗儿童骨样骨瘤的安全性及有效性.方法 2007年1月至2010年1月期间,对9例病理证实的骨样骨瘤儿童患者行CT导向

  4. Thoracolumbar instrumentation with CT-guided navigation (O-arm) in 270 consecutive patients: accuracy rates and lessons learned.

    Science.gov (United States)

    Rivkin, Mark A; Yocom, Steven S

    2014-03-01

    .21% for the 30 patients over the initial 6-month period with the O-arm. After certain modifications to the authors' technique, the subsequent 30 patients experienced a statistically significant decrease in breach rate at 5.6% (p = 0.014). Image-guided spinal surgery can be a great option in the operating room and provides high pedicle screw accuracy rates. With numerous systems commercially available, it is important to develop a systematic approach regardless of the technology in question. There is a learning curve for surgeons unfamiliar with image guidance that should be recognized and appreciated when transitioning to navigation-assisted spinal surgery. In fact, the authors' experience with a large patient cohort suggests that this learning curve may be more significant than previously reported.

  5. Value of spiral CT guided puncture ozone ablation in treatment of cervical disc hernia%螺旋CT引导下经皮颈椎钩突前侧穿刺臭氧消融治疗椎间盘突出的价值

    Institute of Scientific and Technical Information of China (English)

    朱亮旭; 黄河; 邓治强; 李洵; 余文毅

    2011-01-01

    Objective: To evaluate the value of spiral CT guided puncture ozone ablation in treatment of cervical disc hernia. Methods:112 patients with CT or MRI confirmed cervical disc hemia were enrolled in our study, and were treated with CT guided puncture ozone ablation. The treatment schedules were as follows: a total dose of 3~7 ml ozone with the concentration of 60% ~70 % μg/ml was injected into the central of intervertebral disk by needle through the approach of percutaneous-cervical vertebra-anterior border of the uncinate process; when needle was withdrew boundary of intervertebral disk, another ozone was injected with dose of 8~lOml at concentration of 30% ~40% μg/ml, respectively. Results: All patients were followed up for a period of 6 months. The evaluation of therapeutic effect was performed according to MacNab criterion. The therapeutic effects in terms of excellent, good and worse accounted for 42. 9 % (48/112) . 50. 9 % ( 57/112) and 6. 2 % ( 7/112) , respectively. Conclusion: As a minimally invasive method, Spiral CT guided puncture ozone ablation thraugh approach of percutaneous-cervical vertebra-anterior horder of the uncinate process is effective and safe to treat paitents with cervical dise hernia.%目的:探讨螺旋CT引导下经皮颈椎钩突前缘穿刺椎间盘靶点臭氧注射治疗颈椎间盘突出的价值.方法:112例证实经CT或MRI检查诊断为颈椎间盘突出患者,在螺旋CT引导下行穿刺臭氧消融治疗.治疗方式为经皮从颈椎钩突前侧进针,穿刺深度达到椎间盘中心部位注入3~7ml臭氧,浓度为60%~70%ug/ml;然后退针至钩突前侧椎间盘边缘注入8~10ml臭氧,浓度为30%~40%ug/ml.结果:对112例患者术后随访6个月,并按照疗效评价标准对治疗效果进行评定:效果优48例(48/112,占42.9%),效果良57例(57/112,占50.9%),效果差7例(7/112,占6.2%),优良率93.8%.结论:螺旋CT引导下经皮颈椎钩突穿刺椎间盘注射臭

  6. Imaging and dosimetric errors in 4D PET/CT-guided radiotherapy from patient-specific respiratory patterns: a dynamic motion phantom end-to-end study

    Science.gov (United States)

    Bowen, S. R.; Nyflot, M. J.; Herrmann, C.; Groh, C. M.; Meyer, J.; Wollenweber, S. D.; Stearns, C. W.; Kinahan, P. E.; Sandison, G. A.

    2015-05-01

    delivery under a dose painting paradigm is feasible within an integrated respiratory motion phantom workflow. For a limited set of cases, the magnitude of errors was comparable during PET/CT imaging and treatment delivery without motion compensation. Errors were moderately mitigated during PET/CT imaging and significantly mitigated during RT delivery with motion compensation. This dynamic motion phantom end-to-end workflow provides a method for quality assurance of 4D PET/CT-guided radiotherapy, including evaluation of respiratory motion compensation methods during imaging and treatment delivery.

  7. CT-guided sympathicolysis in peripheral artery disease. Indications, patient selection and long-term results; CT-gesteuerte Sympathikolyse bei peripherer arterieller Verschlusskrankheit. Indikationen, Patientenauswahl, Langzeitergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Huttner, S.; Huttner, M.; Antes, G. [Abt. fuer Radiologie, Klinikum Kempten (Germany); Neher, M. [Abt. fuer Allgemein- und Viszeralchirurgie, Klinikum Kempten (Germany)

    2002-04-01

    Purpose: Assessment of long-term results of CT-guided lumbar sympathicolysis (LSL) in advanced peripheral arterial vascular disease (pavd). Establishment of a suitable patient selection. Patients and Methods: LSL was performed in 138 cases with Fontaine stages III (13%) and IV (87%). 250 consecutive patients were examined with a radionuclide perfusion study of the feet prior to and during peridural anaesthesia (PDA) in order to select suitable patients for LSL. LSL was not performed in patients with impaired perfusion under PDA (n = 112). Early and long-term results after one to five years were evaluated. Results: In 79% an initial improvement was found after LSL. After more than one year success was established in 38%. 49% of the cases had a progression of the disease. This is significantly better compared to a control group with conservative treatment and an initial improvement of 36%. After more than one year only 21% revealed an improvement. In 82% the disease was progressive. Diabetics showed also a positive response to LSL. Conclusion: LSL has a positive influence on the course of pvad in patients selected by radionuclide perfusion studies. Diabetes and angiographic findings do not play any first role in patient selection for LSL. (orig.) [German] Ziel: Pruefung der Langzeitergebnisse der CT-gesteuerten lumbalen Sympathikolyse (LSL) bei fortgeschrittener peripherer arterieller Verschlusskrankheit (pAVK). Erarbeitung einer geeigneten Patientenauswahl. Material und Methode: Bei 138 Faellen von pAVK im Stadium III (13%) und IV (87%) nach Fontaine wurde eine LSL durchgefuehrt. Zur Auswahl geeigneter Patienten erfolgte bei 250 konsekutiven Patienten eine nuklearmedizinische Perfusionsstudie der Fuesse vor und unter Periduralanaesthesie (PDA). Bei Verschlechterung der Durchblutung wurde auf eine LSL (n = 112) verzichtet. Ausgewertet wurden die klinischen Fruehergebnisse und die Ergebnisse nach 1 - 5 Jahren. Ergebnisse: Eine initiale Besserung des Stadiums AVK fand

  8. Incidence of delayed complications following percutaneous CT-guided biopsy of bone and soft tissue lesions of the spine and extremities: A 2-year prospective study and analysis of risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Rosenthal, Daniel I. [Massachusetts General Hospital, Boston, MA (United States); Halpern, Elkan F. [Massachusetts General Hospital, Institute of Technology Assessment, Boston, MA (United States)

    2013-01-15

    To prospectively evaluate the incidence of delayed complications (bleeding, pain, infection) following CT-guided biopsies of bone or soft tissue lesions and to identify risk factors that predispose to their occurrence. All adults presenting for CT-guided biopsy of a bone or soft tissue lesion were eligible for the study. Risk factors considered included patient gender and age, bone versus soft tissue, lesion location, lesion depth, anticoagulation, conscious sedation, coaxial biopsy technique, bleeding during the biopsy, dressing type and duration of placement, final diagnosis, needle gauge, number of passes, and number of days to follow-up. Outcomes measured included fever, pain, bruising/hematoma formation, and swelling and were collected by a follow-up phone call within 14 days of the biopsy. Fisher's exact test, the Wald Chi-square test, and univariate, multivariate, and stepwise logistic regression were performed to evaluate the influence of the risk factors on the outcomes. A total of 386 patients participated in the study. The rates of post-biopsy fever, pain, bruising, and swelling were 1.0, 16.1, 15.6, and 9.6 %, respectively. Anticoagulants were identified as a risk factor for fever. Increasing patient age was identified as a risk factor for pain. Female gender and lesion location were identified as risk factors for bruising. Increasing patient age and lesion location were identified as risk factors for swelling. Patient age, female gender, and lesion location are risk factors for delayed minor complications following CT-guided biopsy of a bone or soft tissue lesion. There were no major complications. None of the complications in this series altered patient management. (orig.)

  9. CT引导下射频消融术治疗肝癌的临床效果评价%The Clinical Effect Assessment of CT-guided Radiofrequency Ablation(RFA)in Treatment of Liver Cancer

    Institute of Scientific and Technical Information of China (English)

    曾智明; 朱广志

    2014-01-01

    Objective:To explore and evaluate the clinical effect of CT-guided radiofrequency ablation(RFA) in treatment of liver cancer.Method:60 patients who were treated by CT-guided radiofrequency ablation(RFA)in our hospital from April 2012 to April 2013 were selected,and the clinical efficacy and prognosis of CT-guided radiofrequency ablation(RFA)in treatment of 60 liver cancer patients were explored and analyzed.Result:There had no significant differences in blood pressure,pulse and blood oxygen saturation between preoperative and intraoperative (P>0.05).After treatment,the average value of AFP and CEA were significantly lower than before treatment,the differences were statistically significant(P0.05),而治疗后平均AFP和CEA检测值均明显低于治疗前,差异均有统计学意义(P<0.05)。60例患者肿瘤完全坏死56例,占93.3%;不完全坏死3例,占5.0%;部分坏死1例,占1.7%。60例患者在1年内复发16例,占26.7%;1年内死亡患者1例,存活59例,1年生存率为98.3%。结论:CT引导下射频消融术(RFA)治疗肝癌的临床效果良好,值得在临床上推广。

  10. CT-guided semilunar ganglion radiofrequency thermocoagulation in treatment of trigeminal neuralgia%CT引导下半月神经节射频热凝治疗三叉神经痛

    Institute of Scientific and Technical Information of China (English)

    杨云春; 王昭斌; 武百山

    2011-01-01

    Objective To observe and analyze therapeutic effect by CT-guided semilunar ganglion radiofrequency thermocougulation in treatment trigeminal neuralgia. Methods 40 patients with trigeminal neuralgia received CT-guided semilunar ganglion apuncture, and then radiofrequency thermocougulation were performed under the thermal controlled from 65 to 80 ℃ and continued 3 minutes for 3 to 4 times. Results Pain was completed eliminated in 32 of the 40 patients, which was regarded as degree Ⅰ. 5 cases was of degree Ⅱ . 2 case was of degree Ⅲ. 1 case had no effect. The rate of satisfactory effectiveness was 92. 5% and the total rate of efficacy was 97.5%. Conclusion CT-guided semilunar ganglion radiofrequency thermocoagulation in treatment of trigeminal neuralgia is safe and effective to treat trigeminal neuralgia.%目的 观察CT引导下半月神经节射频热凝术治疗原发性三又神经痛的临床疗效.方法 40例三叉神经痛患者在CT引导下,经前入路法穿刺三又神经半月节后行射频热凝毁损治疗,温度控制在65~80℃持续时间3min,共3~4次.结果 40例患者中,32例疗效I级,5例疗效Ⅱ,2例疗效Ⅲ级;一次性治疗显效率92.5%,总有效率97.5%.1例为Ⅳ级无效.结论 CT引导行三又神经半月神经节射频热凝术是一种安全、可靠、有效的微创治疗技术,具有临床推广应用价值.

  11. Perioperative nursing care and follow-up for 118patients with liver abscess treated by CT-guided percutaneous drainage%CT引导下肝脓肿引流的围手术期护理及随访

    Institute of Scientific and Technical Information of China (English)

    虞岑琳; 曹传武; 潘慧; 李茂全

    2014-01-01

    Objective To investigate the perioperative effective nursing method for patients with liver abscess treated by CT-guided percutaneous drainage Methods Giving perioperative nursing care for 118 patients diagnosed with liver abscess treated by CT-guided percutaneous drainage, as lfushing drainage tube with antibiotics, abserving the condition of drainage lfuid till the absence of vomica and uprooting the tube. Results Out of the 118 patients, 114 patients received imaging examination which conifrmed the absence of vomica and abscess, and discharged with normal body temperature. Conclution Thorough nursing care is critical to the effectiveness of patient with liver abscess treated by CT-guided percutaneous drainage.%目的:探讨在CT引导下肝脓肿穿刺引流术患者的有效护理方法。方法:对118例确诊为肝脓肿的患者做好CT引导下穿刺引流术前护理,每日用抗生素反复冲洗,观察引流液的情况,直至脓腔消失,拔除引流管。结果118例肝脓肿患者,其中114例均影像学检查,脓腔消失,脓肿明显消失,体温正常,痊愈出院。结论周密细致的护理工作对CT引导穿刺引流治疗肝脓肿患者的治疗起到关键性的作用。

  12. Perioperative nursing of children in CT-guided radiofrequency ablation of osteoid osteoma%CT引导下骨样骨瘤射频消融术患儿的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    黄晓清; 古宏文; 杨叶香; 陈碧英

    2011-01-01

    Objective To sulnmarize the perioperative nursing experience of CT-guided radiofrequency ablation of fight tibia osteoid osteoma in children.Methods One case of CT-guided radiofrequency ablation was clinically observed and nursed.Results The patient underwent a successful surgery without complications,healing well.Condusions Good psychological care,safety care before the operation and improved preoperative preparation are the key to make sure that the operation goes smoothly.Strengthening the observation and care after surgery could effectively reduce complications and improve cure rate.%目的 总结CT引导下右胫骨骨样骨瘤射频消融术患儿的围手术期护理经验.方法 通过对1例需要行CT引导下射频消融治疗的患儿进行临床观察和护理.结果 该例患儿手术成功、无并发症发生,愈合良好.结论 术前做好心理护理、安全护理,以及完善各项术前准备是保证手术顺利进行的关键.术后加强观察和护理可有效减少各种并发症,提高治愈率.

  13. CT-guided Percutaneous Radiofrequency Ablation for Spinal Osteoid Osteoma: Report of 3 Cases%CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤3例报告

    Institute of Scientific and Technical Information of China (English)

    柳晨; 刘晓光; 祝斌; 袁慧书; 韩嵩博; 马永强

    2011-01-01

    Objective To evaluate the preliminary clinical outcome of CT-guided percutaneous radiofrequency ablation in patients with spinal osteoid osteoma. Methods Three patients who suffered spinal osteoid osteoma were treated with CT-guided percutaneous radiofrequency ablation under local anesthesia. The lesions located in the cervical vertebral body, lumbar vertebral transverse process and sacral vertebral body, respectively, which were all adjacent to the spinal cord and nerve root. The tumors were damaged with radiofrequency at 90 "C for 4 minutes. Results No complications occured pre- and postoperation. The mean follow-up was 5 months (2, 6, and 7 months, respectively). All the cases obtained satisfactory pain relief. The VAS decreased by6, 8, and 8 respectively. No recurrence or nerve dysfunction occurred during the follow-up. Conclusions CT-guided percutaneous radiofrequency ablation of spinal osteoid osteoma is safe, minimal invasive and well-tolerated. It has exact curative effect in short-term. Further observation is needed to determine whether it can replace traditional operative resection.%目的 评价CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤的临床效果.方法 3例脊柱骨样骨瘤,分别位于颈椎、腰椎和骶椎,肿瘤边缘紧邻脊髓或神经.局部麻醉后,CT引导下经皮穿刺将射频电极置入骨样骨瘤中心,应用90℃的射频高温持续4 rain对瘤巢进行损毁.结果 术中及术后无明显并发症发生.术后分别随访2、6、7个月(平均5个月),疼痛缓解满意,3例VAS评分分别下降了6、8、8分,随访期内疼痛无复发,无神经功能损害.结论 CT引导下经皮穿刺射频消融术治疗脊柱骨样骨瘤微创、安全,患者耐受性好,近期效果确切.

  14. Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com; Alsubhi, Mohammed, E-mail: mohammedal-subhi@yahoo.com; Emam, Ahmed, E-mail: morgan101002@hotmail.com; Lehnert, Thomas, E-mail: thomas.lehnert@kgu.de; Beeres, Martin, E-mail: beeres@gmx.net; Jacobi, Volkmar, E-mail: volkmar.jacobi@kgu.de; Gruber-Rouh, Tatjana, E-mail: tatjanagruber2004@yahoo.com; Scholtz, Jan-Erik, E-mail: janerikscholtz@gmail.com; Vogl, Thomas J., E-mail: t.vogl@em.uni-frankfurt.de; Naguib, Nagy N., E-mail: nagynnn@yahoo.com [Johan Wolfgang Goethe – University Hospital, Institute for Diagnostic and Interventional Radiology (Germany)

    2016-02-15

    PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, or refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both

  15. The clinical application of CT-guided craniocerebral puncture biopsy:initial experience in 23 cases%CT引导下颅脑穿刺活检术23例

    Institute of Scientific and Technical Information of China (English)

    刘健; 刘瑞青; 曹会存; 王振豫; 曹广劭; 刘诗义; 李天晓

    2015-01-01

    Objective To investigate the diagnostic value of CT-guided craniocerebral puncture biopsy, and to discuss its clinical safety. Methods During the period from April 2013 to June 2014 at authors’ hospital CT-guided craniocerebral puncture biopsy was carried out in 23 patients. All patients had clinical symptoms or signs of nervous system. Imaging examination revealed that all patients had intracranial space-occupying lesions. CT-guided craniocerebral puncture biopsy was performed to make pathological or bacteriological examinations. The results were statistically analyzed. Results In this group of patients, definite pathological diagnosis was made in 19 cases, biopsy positive diagnosis rate of biopsy was 82.6% (19/23), among them oncology-pathological diagnosis was obtained in 14 cases (60.9%), mainly including glioma, non-Hodgkin lymphoma, dysembryoplastic neuroepithelial tumor, choroid plexus papillary tumor, epidermoid cyst, etc. Non-neoplastic lesion was confirmed in 5 cases (21.7%), including suppurated meningitis, cerebral gliosis hyperplasia, cerebral telangiectasis, etc. Small amount of subdural hemorrhage was observed in one case (4.3%). No severe complications, such as intracranial infection or epilepsy, occurred in all patients. Conclusion CT-guided craniocerebral puncture biopsy is minimally-invasive with fewer complications, it can provide definite diagnosis for intracranial lesions, therefore, this technique has a broad development prospect in clinical practice.%目的:探讨CT引导下颅脑占位穿刺活检术对神经系统疾病的诊断意义及安全性。方法2013年4月至2014年6月行CT引导下行颅脑占位穿刺活检术共23例。所有患者均具有神经系统临床症状或体征,影像学检查提示颅内占位。 CT引导下颅脑占位穿刺活检术行病理学或细菌学检查,对其结果进行分析。结果本组患者中明确病理诊断19例,活检阳性诊断率82.6%(19/23)。其中14例(60.9%)

  16. Abdominal masses in the pediatric age. Characterization by CT guided fine needle aspiration biopsy; Masse addominali nell'eta' pediatrica. Caratterizzazione mediante biopsia computerizzata con ago sottile guidata con Tomografia Computerizzata

    Energy Technology Data Exchange (ETDEWEB)

    Marano, I.; Soscia, E.; Salvatore, M. [Naples Univ. Federico 2. (Italy). Dipt. di Scienze Biomorfologiche e Fuzionali, Cattedra di Radiologia

    1999-04-01

    CT-guided fine needle aspiration biopsy (FNAB) is known to improve diagnosis of expansive abdominal lesions, especially relative to more invasive procedure like explorative laparotomy. FNAB in not commonly use in pediatric patients because of their poor collaboration and of associated risks. The authors investigated the feasibility of FNAB in the pediatric age. [Italian] Sono noti i vantaggi che la biopsia percutanea con ago sottile guidato con TC puo' apportare per la diagnosi delle lesioni espansive addominali, soprattutto se confrontata con procedure piu' invasive come la laparatomia esplorativa. Questo tipo di metodica e' attalmente poco utilizzato nel caso di pazienti pediatrici a causa della scarsa collaborazione e dei rischi associati. Gli autori valutano l'applicabilita' di tale procedura nell'eta' pediatrica alla luce delle propria esperienza.

  17. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Mendiratta-Lala, Mishal [Henry Ford Hospital, Department of Radiology, Abdominal Interventional Radiology, 2799 West Grand Blvd, Detroit, MI 48202 (United States); Sheiman, Robert, E-mail: rsheiman@bidmc.harvard.edu [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States); Brook, Olga R. [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States); Gourtsoyianni, Sofia [King' s College London, St Thomas’ Hospital, Lambeth Palace Road, SE1 7EH London (United Kingdom); Mahadevan, Anand [Beth Israel Deaconess Hospital, Radiation Oncology, One Deaconess Road, Boston, MA 02215 (United States); Siewert, Bettina [Beth Israel Deaconess Hospital, Department of Radiology, Abdominal Imaging, One Deaconess Road, Boston, MA 02215 (United States)

    2014-04-15

    Objective: To determine if concomitant CT-guided biopsy and percutaneous fiducial seed placement in the lung can be performed in a selective patient population without increased complication or decreased success rates compared to either procedure alone. Materials and methods: An IRB approved retrospective analysis of 285 consecutive patients that underwent CT-guided placement of fiducial seeds in the lung alone (N = 63), with concomitant core biopsy (N = 53) or only core biopsy (N = 169) was performed. Variables compared included: patient demographics, lesion size, depth from pleura, needle size, number of passes through pleura, number and size of core biopsies, number of seeds placed and technical success rates. Statistical analysis was performed using univariate and multivariate pair-wise comparisons. Results: A pathologic diagnosis of malignancy was confirmed in all cases undergoing seed placement alone and seed placement with concurrent biopsy, and in 144 of the biopsy alone lesions. On univariate analysis, major complication rates were similar for all three groups as were lesion size, depth, number of pleural passes, and technical success. Pair-wise comparisons of the remaining variables demonstrated a significant younger age and smaller needle size in the biopsy only group, and less minor complications in the fiducial only group. Overall there were 80/285 (28.1%) minor and 29/285 (10.2%) major complications. All major complications leading to admission consisted of either pneumothorax or hemothorax, while minor complications included asymptomatic stable or resolving pneumothoraces, transient hemoptysis or small hemothoraces. Conclusions: A combined procedure of percutaneous pulmonary core biopsy and stereotactic seed placement can be performed without additional risk of a major complication when compared to performing these separately.

  19. CT引导下经皮肺穿刺在肺弥漫性病变中诊断价值%Diagnostic value of CT guided percutaneous lung biopsy in diffuse lung diseases

    Institute of Scientific and Technical Information of China (English)

    宋新宇; 陈世雄; 曾凡军; 高宝安

    2013-01-01

    目的 评价CT引导下经皮肺穿刺在肺弥漫性病变中的诊断价值.方法 应用16 GBARD活检针穿刺32例肺部弥漫性病变患者,主要影像学改变包括弥漫性网格样结节或结节影,网状线形阴影和弥漫性磨玻璃影.结果 32例患者均取材成功,并获得明确诊断,10例恶性肿瘤,(其中5例肺泡癌,5例肺癌肺内转移),22例良性病变(7例粟粒性肺结核,7例间质性肺炎,2例肺泡蛋白沉积征,2例肺真菌病,1例闭塞性支气管炎伴机化性肺炎,1例肺结节病,1例过敏性肺炎,1例弥漫性泛细支气管炎).主要并发症是气胸(22.5%)和出血(21.9%).结论 CT引导下经皮肺穿刺是一种实用、安全、并发症低的技术,对弥漫性肺疾病有很高的确诊率.%Objective To assess the diagnostic value of CT-guided percutaneous lung biopsy in diffuse lung diseases. Methods CT-guided percutaneous lung biopsy was performed in 32 patients with diffuse lung diseases by 16G BARD biopsy needle. The main imaging changes of these patients included network of diffuse nodular or nodular, diffuse reticular lines shadow and diffuse ground-glass density in the lungs. Results Punctures were successful in all 32 patients, and the diseases were clearly diagnosed, which included 10 patients with malignant tumor ( 5 cases of bronchioloalveolar carcinoma and 5 cases of metastatic carcimoma ) and 22 patients with benign tumor ( 7 cases of disseminated pulmonary tuberculosis, 7 cases of interstitial pneumonia, 2 cases of pulmonary alveolar proteinosis, 2 cases of pulmonary mycoses, 1 case of hronchiolitis obliterans with organizing pneumonia, 1 case of sarcoidosis of lung, 1 case of allergic pneumonia and 1 diffuse panbronchiolitis ). The major complications of puncture were pneumothorax ( 22. 5% ) and bleeding ( 21. 9% ). Conclusion CT-guided percutaneous lung biopsy is a useful and safe technique with low complication and high accuracy rate in the diagnosis of patients with diffuse lung

  20. CT引导射频消融治疗结直肠癌肝转移的应用价值%Application value of CT-guided radiofreguency ablation on metastatic liver carciaoma caused by colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    李德周; 赵玉东; 赵玉鑫

    2014-01-01

    Objective To investigate the indications,therapeutic regimen and effects of CT-guided radio frequency ablation(RFA) in the treatment of metastatic liver carciaoma caused by colorectal cancer.Methods Fifty-six patients(124 lesions)clinically and pathologically diagnosed with metastatic liver carciaoma caused by colorectal cancer scheduled for RFA were included into this study.The average diameter of the tumors was (3.5 ± 1.4)cm,tumors with diameter≥4 cm accounting for 32.3% (40/124 leisions),single tumor accounting for 32.1% (18 leisions).All patients were examined by contrasted enhanced CT examination,the indications of RFA were made according to leision numbers,size,shape,infiltration range,location and relations with the surrounding structures.All the 56 patients were treated by conventional CT-guided percutanous RFA.The effects were evaluated by contrasted enhanced CT examination during the 1 to 4 months follow-up.Results According to the results of contrasted enhanced CT examination,56 patients (124 lesions) were given RFA staging treatment and expanding ablationtreatment.Tumor deactivation rate was 93.5% (116/124 lesions),local recurrence rate was 8.0% (10/124 lesions),and new metastasis rate was 39.3% (20/56 cases).Conclusions CT-guided radio frequency ablation is an important supplementary method for the treatment of metastatic liver carciaoma caused by colorectal cancer,enhanced CT examination can provide reference for indications selection and treatment scheme made of metastatic liver carciaoma.%目的 探讨CT引导下射频消融(RFA)治疗结直肠癌肝转移的适应证、治疗方案及疗效.方法 选择56例(124个病灶)经临床及病理确诊为结直肠癌肝转移并拟行RFA者纳入本研究.肿瘤平均直径为(3.5±1.4)cm,直径≥4 cm肿瘤占32.3%(40/124病灶),单发肿瘤占32.1%(18例).所有患者均行增强CT检查,根据病灶数目、大小、形态、浸润范围、位置、与周围结构关

  1. CT-guided ozone injection for the treatment of primary lumbar discitis: a therapeutic analysis of five cases%五例原发性腰椎间盘炎的臭氧治疗分析

    Institute of Scientific and Technical Information of China (English)

    江海亮; 潘剑成; 张宗明; 林阳; 潘建辉; 贺立新

    2012-01-01

    Objective To assess the clinical value of ozone injection under CT guidance in treating primary lumbar discitis. Methods During the period from March 2010 to March 2011, CT-guided ozone injection was carried out in five patients with primary lumbar discitis. The interval between the appearing of symptoms and the treatment ranged from one to eight months, with a mean of three months. The puncturing was performed via posterolateral access of the intervertebral disc, so-called the safe triangle access, or via the medial access of the articular facet. CT scanning was carried out first to determine that the puncture needle was right in the center of the intervertebral disc. During the course of the slow injection of ozone, the patient was kept under close observation for any sings of pain, the distribution of the ozone was carefully watched and suitable dose of ozone was injected. The clinical results were analyzed. Results CT-guided ozone injection was successfully accomplished in all five patients with primary lumbar discitis. Based on the Mac-Nab criteria for the evaluation of backache, excellent effectiveness was obtained in all five patients. Conclusion For the treatment of primary lumbar discitis, CT-guided ozone injection is very effective. This therapy can shorten the time to keep the patient in recumbent position and can also reduce the use of antibiotics. (J Intervent Radiol, 2012, 21: 165-167)%目的 评价CT引导下用臭氧治疗腰椎间盘炎的临床价值.方法 2010年3月- 2011年3月,对5例腰椎间盘炎患者进行CT引导下臭氧治疗.症状出现1 ~ 8个月,平均 3个月.采用椎间盘后外侧入路,即安全三角入路,或小关节内侧入路.CT扫描确定针尖位于椎间盘中心后,缓慢注入臭氧过程中,观察患者的疼痛反应及CT监视臭氧分布情况,并注入治疗剂量的臭氧.结果 5例腰椎间盘患者均完成CT引导下用臭氧行治疗,采用Mac-Nab腰痛痛评价,5例均获显效.结论 CT引导下用

  2. CT引导射频消融术治疗股骨颈骨样骨瘤六例%CT-guided radiofrequency ablation for the treatment of osteoid osteoma in femoral neck:preliminary experience in 6 cases

    Institute of Scientific and Technical Information of China (English)

    王玉涛; 汪建华; 王海涛; 于志海; 涂灿; 左长京; 田建明

    2014-01-01

    Objective To evaluate the feasibility, safety and efficacy of CT-guided radiofrequency ablation in treating osteoid osteoma located at femoral neck. Methods Six patients with osteoid osteomas in the femoral neck received CT-guided percutaneous radiofrequency ablation. In all patients the main complaint was pain at the hip, and the course of disease varied from one month to 2 years, with an average of 8 months. Under spinal anesthesia the surgery was performed. With the help of CT guidance , a 3.5 to 4.0 mm coaxial drill system was inserted into the nidus, and an osseous access was established, then the bone biopsy needle was used to obtain specimens for pathological examination. Subsequently, a 1.5 to 2.0 cm active tip was introduced through a non-cooled radiofrequency needle into the nidus. Radiofrequency ablation was performed with the therapeutic temperature of 90℃, lasting for 6 minutes. The pain visual analogue scale (VAS) was used to evaluate the clinical effectiveness. The postoperative MRI findings were compared with the preoperative ones. Results Three days after the treatment, different degrees of pain relief was obtained in all patients, and all patients could get out of bed and walked around in one week. Postoperative VSA was significantly decreased (P<0.01). No severe complications occurred during and after the procedure. And no recurrence was seen during the follow-up period. Conclusion For the treatment of osteoid osteoma located at femoral neck, CT-guided radiofrequency ablation is a safe and effective minimally invasive treatment with fewer complications and satisfactory clinical results.%目的:探讨CT引导下应用射频消融术(RFA)治疗股骨颈骨样骨瘤的可行性、安全性,并评估其疗效。方法对6例股骨颈骨样骨瘤患者采用CT引导下经皮穿刺RFA术治疗。患者均以髋关节疼痛症状为主,病程1个月~2年,平均8个月。手术在腰麻下进行,术中于 CT 引导下应用直径3.5~4

  3. Analysis of clinical application of percutaneous chest lesion puncture under CT guided%CT引导下经皮胸部病灶穿刺的临床应用分析

    Institute of Scientific and Technical Information of China (English)

    熊丽纹; 滕家俊; 李榕; 张雪艳; 楼煜清; 顾爱琴; 韩宝惠

    2013-01-01

    Background and purpose:Percutaneous transthoracic needle biopsy with computed tomographic (CT) guidance, following two diagnostic methods of needle biopsy and needle aspiration cytology, is a widely used non-vascular interventional technique, regarded as an extremely important technique for clinical qualitative diagnosis, treatment and the prognosis. This study aimed to evaluate and to compare the diagnostic value of needle biopsy and needle aspiration cytology in CT-guided percutaneous chest lesion puncture, and to analyze the variables affecting the diagnostic accuracy and rates of complications. Methods:A retrospective study was conducted of 1 027 patients who underwent CT-guided percutaneous thoracopathy puncture from Apr. 2006 to Mar. 2012. Results:There were no significant differences in diagnostic positive rate and accuracy between needle biopsy and needle aspiration cytology in CT-guided percutaneous chest lesion puncture (P>0.05). There were 859 malignant and 168 benign lesions. Overall diagnostic accuracy was 90.6%. The diagnostic accuracy for malignancy was 89.1%and for benign was 98.2%. There was significant correlation among the diagnostic accuracy and the final diagnosis (benign and malignant), lesion site, and lesion type (P0.05).1027例患者中,恶性病变859例,良性病变168例,诊断正确率为90.6%,其中对恶性肿瘤的诊断正确率为89.1%,良性病变的诊断正确率为98.2%.病灶的良恶性、疾病部位和病灶形态对诊断正确率的影响差异有统计学意义(P<0.05).不良反应(气胸和出血)的发生率为19.9%,与穿刺深度和病灶至胸膜距离密切相关(P<0.05).结论:CT引导下胸部穿刺术是安全、可靠的微创诊断方法.在某些条件下,CT引导下胸部穿刺针吸脱落细胞学检测可以代替活检,以避免那些需要通过增加穿刺风险获取足够组织进行的活检.诊断正确率与病灶的良恶性、发生部位和形态相关.并发症的发生与穿刺深度和

  4. CT-guided Irreversible Electroporation in an Acute Porcine Liver Model: Effect of Previous Transarterial Iodized Oil Tissue Marking on Technical Parameters, 3D Computed Tomographic Rendering of the Electroporation Zone, and Histopathology

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, C. M., E-mail: christof.sommer@med.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany); Fritz, S., E-mail: stefan.fritz@med.uni-heidelberg.de [University Hospital Heidelberg, Department of General Visceral and Transplantation Surgery (Germany); Vollherbst, D., E-mail: dominikvollherbst@web.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany); Zelzer, S., E-mail: s.zelzer@dkfz-heidelberg.de [German Cancer Research Center (dkfz), Medical and Biological Informatics (Germany); Wachter, M. F., E-mail: fredericwachter@googlemail.com; Bellemann, N., E-mail: nadine.bellemann@med.uni-heidelberg.de; Gockner, T., E-mail: theresa.gockner@med.uni-heidelberg.de; Mokry, T., E-mail: theresa.mokry@med.uni-heidelberg.de; Schmitz, A., E-mail: anne.schmitz@med.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany); Aulmann, S., E-mail: sebastian.aulmann@mail.com [University Hospital Heidelberg, Department of General Pathology (Germany); Stampfl, U., E-mail: ulrike.stampfl@med.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany); Pereira, P., E-mail: philippe.pereira@slk-kliniken.de [SLK Kliniken Heilbronn GmbH, Clinic for Radiology, Minimally-invasive Therapies and Nuclear Medicine (Germany); Kauczor, H. U., E-mail: hu.kauczor@med.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany); Werner, J., E-mail: jens.werner@med.uni-heidelberg.de [University Hospital Heidelberg, Department of General Visceral and Transplantation Surgery (Germany); Radeleff, B. A., E-mail: boris.radeleff@med.uni-heidelberg.de [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology (Germany)

    2015-02-15

    PurposeTo evaluate the effect of previous transarterial iodized oil tissue marking (ITM) on technical parameters, three-dimensional (3D) computed tomographic (CT) rendering of the electroporation zone, and histopathology after CT-guided irreversible electroporation (IRE) in an acute porcine liver model as a potential strategy to improve IRE performance.MethodsAfter Ethics Committee approval was obtained, in five landrace pigs, two IREs of the right and left liver (RL and LL) were performed under CT guidance with identical electroporation parameters. Before IRE, transarterial marking of the LL was performed with iodized oil. Nonenhanced and contrast-enhanced CT examinations followed. One hour after IRE, animals were killed and livers collected. Mean resulting voltage and amperage during IRE were assessed. For 3D CT rendering of the electroporation zone, parameters for size and shape were analyzed. Quantitative data were compared by the Mann–Whitney test. Histopathological differences were assessed.ResultsMean resulting voltage and amperage were 2,545.3 ± 66.0 V and 26.1 ± 1.8 A for RL, and 2,537.3 ± 69.0 V and 27.7 ± 1.8 A for LL without significant differences. Short axis, volume, and sphericity index were 16.5 ± 4.4 mm, 8.6 ± 3.2 cm{sup 3}, and 1.7 ± 0.3 for RL, and 18.2 ± 3.4 mm, 9.8 ± 3.8 cm{sup 3}, and 1.7 ± 0.3 for LL without significant differences. For RL and LL, the electroporation zone consisted of severely widened hepatic sinusoids containing erythrocytes and showed homogeneous apoptosis. For LL, iodized oil could be detected in the center and at the rim of the electroporation zone.ConclusionThere is no adverse effect of previous ITM on technical parameters, 3D CT rendering of the electroporation zone, and histopathology after CT-guided IRE of the liver.

  5. CT guided aspiration biopsy of thoracic tumors clinical analysis of 30 cases%CT导引下胸内肿物穿刺活检30例临床分析

    Institute of Scientific and Technical Information of China (English)

    邓磊

    2012-01-01

      Objective Discussion and analysis of CT guided puncture biopsy of thoracic masses in the safety and diagnostic value. Methods In 2005 June to 2009 June outpatient or inpatient by X-ray or CT revealed 30 patients with intrathoracic masses as the research object, its are to be under the guidance of CT intrathoracic tumor biopsy, retrospective analysis. Results 30 cases were successful, including 27 cases of tumor, the tumor in 3 cases, biopsy diagnosis rate was 96.7%. Biopsy of 4 cases had complications, which accounted for 13.3%, a small number of pneumothorax in 2 cases, appearance of blood in the sputum of 2 cases, all recovered after conservative treatment. Conclusion CT guided thoracic mass percutaneous needle biopsy is a safe and effective diagnostic method, is worth the clinical promoted application.%  目的分析探讨CT导引下胸内肿物穿刺活检的安全性与诊断价值.方法选择2005年6月-2009年6月门诊或住院经X线或CT检查显示胸内肿块的30例患者为研究对象,对其均予以CT导引下胸内肿物穿刺活检,回顾性分析其临床资料.结果30例患者均穿刺成功,其中肿瘤27例,非肿瘤3例,活检诊断率为96.7%.穿刺活检中共发生并发症4例,占13.3%,其中出现少量气胸2例,出现痰中带血2例,经保守治疗后均痊愈.结论 CT导引下胸内肿物穿刺活检是一种安全有效的诊断方法,值得临床推广运用.

  6. CT引导射频热凝术治疗三叉神经痛临床分析%Clinical analysis of CT guided percutaneous radiofrequency thermocoagulation for treatment of trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    王晓志

    2013-01-01

    Objective To analyze and evaluate the clinical effect of CT guided percutaneous semilunar ganglion radiofrequency thermocoagulation for treatment of trigeminal neuralgia.Methods 52 patients with trigeminal neuralgia treated in our hospital were selected.They underwent the CT three-dimensional guidance on trigeminal neuralgia Ⅱ,Ⅲ,Ⅱ + Ⅲ neuralgia neuralgia patients with anterior foramen ovale puncture semilunar ganglion,verify the operative target,and a standard radiofrequency target temperature damage under general anesthesia.Results Of the 52 patients,the treatment effect was excellent in 49 cases,good in 1 patient,the effect of other 2 cases was poor,the excellent and good rate was 96.15%.Conclusion CT guided percutaneous puncture semilunar ganglion radiofrequency thermocoagulation in the treatment of patients with trigeminal neuralgia is simple,safe,and easy to be accepted by patients,the cure rate is high,it is worth learning and promotion.%目的 对CT引导经皮穿刺半月神经节射频热凝术治疗三叉神经痛的临床效果进行分析和评价.方法 选取三叉神经痛患者52例,在CT三维引导下对三叉神经第Ⅱ支痛、第Ⅲ支痛、Ⅱ+Ⅲ支痛患者应用前入路卵圆孔穿刺半月神经节,术中验证靶点,并在全身麻醉下进行标准射频靶点温控毁损.结果 52例患者中,经治疗效果优49例,良1例,差2例,优良率为96.15%.结论 对三叉神经痛患者采用CT引导经皮穿刺半月神经节射频热凝术治疗,简单、安全,且患者易于接受,治愈率较高,值得借鉴和推广.

  7. CT引导经皮肺切割活检术诊断活动性韦格纳肉芽肿%Percutaneous CT -guided Core Needle Biopsy of Lungs in the Diagnosis of Active Wegener's Granulomatosis

    Institute of Scientific and Technical Information of China (English)

    陈敏; 郭佑民; 张少娟; 杨健; 牛刚; 汪军峰

    2005-01-01

    目的探讨CT引导下经皮肺芯针切割活检术(percutaneous CT-guided core needle biopsy,PTCB)对活动性韦格纳肉芽肿(WG)的诊断价值以及指导临床治疗的意义.方法8例经PTCB行病理组织学检查WG病人,根据其临床资料作BVAS评分,其结果与病理对照研究.结果8例病人经PTCB取得足够的组织学标本,病理结果:①坏死性血管炎(75%),②肉芽性炎症(62.5%),③实质坏死(50%),④肺出血改变(12.5%),⑤纤维化(12.5%).确诊时BVAS平均分数为10分,所有病人确诊后都进行了糖皮质激素联合细胞毒药物冲击治疗,临床有不同程度好转,治疗4周后平均分数为2.5分.结论多部位、多次经皮肺切割活检可以准确的诊断活动性WG,指导临床早期治疗.

  8. CT-guided vertebroplasty and kyphoplasty: comparing technical success rate and complications in 101 cases; CT-gesteuerte Vertebro- und Kyphoplastie: Vergleichende Untersuchung zu technischem Erfolg und Komplikationen bei 101 Eingriffen

    Energy Technology Data Exchange (ETDEWEB)

    Weber, C.H.; Kroetz, M.; Hoffmann, R.T.; Pfeifer, K.J.; Reiser, M.; Linsenmaier, U. [Inst. fuer Klinische Radiologie, LMU Muenchen (Germany); Euler, E.; Heining, S. [Chirurgische Klinik und Poliklinik, LMU Muenchen (Germany)

    2006-06-15

    Purpose: to compare the technical success and complication rates in CT-guided vertebroplasty and kyphoplasty. Materials and methods: from 2002 - 2005 69 patients (101 vertebrae) were treated with vertebroplasty (n = 82) or kyphoplasty (n = 19) using 4-slice MSCT with CT fluoroscopy as the sole guidance for the procedure. The underlying lesions were osteoporotic fractures in 78 vertebral bodies and 23 vertebral metastases. Results: technical success was achieved in all 101 procedures. Post-interventional CT demonstrated asymptomatic cement leakage in 51/101 vertebrae. Kyphoplasty resulted in leakage in 11/19 (57.9%) and vertebroplasty in 40/82 (48.8%) procedures. With p = 0.48 (Mann-Whitney test) there was no significant difference between kyphoplasty and vertebroplasty with respect to the number of cement leakage occurrences. There was one minor complication of an L5 root irritation following radiofrequency ablation and vertebroplasty of a sarcoma metastasis which subsided without treatment after 8 weeks. There was one major complication of intraspinal cement leakage during tumor vertebroplasty causing T5 root compression and requiring laminectomy for cement removal. The overall rate of major complications requiring treatment was 0.99%. (orig.)

  9. Related progress of CT-guided percutaneous biopsy in the thoracic complications of acquired immune deficiency syndrome and occupational exposure prevention%CT引导下经皮穿刺活检术在获得性免疫缺陷综合征胸部并发症中的应用及职业暴露防护相关进展

    Institute of Scientific and Technical Information of China (English)

    王青

    2011-01-01

    CT-guided percutaneous biopsy in the thoracic complications of acquired immunodeficiency syndrome (AIDS)is the main clear diagnosis method.The application of technical solutions, complications and prevention, occupational exposure protection principles and methods of CT-guided percutaneous biopsy in thoracic complications of AIDS were reviewed in this article.%CT引导下经皮穿刺活检术是确诊获得性免疫缺陷综合征(AIDS)胸部并发症的主要方法.本文对CT引导下经皮穿刺活检术在AIDS胸部并发症中应用的技术方案、并发症及预防,职业暴露防护原则及方法进行综述.

  10. CT-guided cervical nerve root injections: comparing the immediate post-injection anesthetic-related effects of the transforaminal injection with a new indirect technique

    Energy Technology Data Exchange (ETDEWEB)

    Sutter, Reto; Pfirrmann, Christian W.A.; Peterson, Cynthia K. [Orthopaedic University Hospital of Balgrist, Department of Radiology, Zuerich (Switzerland); Zanetti, Marco [Hirslanden Hospital, Department of Radiology, Zuerich (Switzerland); Hodler, Juerg [University Hospital, Department of Radiology, Zuerich (Switzerland)

    2011-12-15

    To describe an ''indirect'' cervical nerve root injection technique with a dorsal approach that should carry less inherent risk than the ''direct'' cervical transforaminal injection approach, and to compare the immediate post-injection results of the two procedures. The indirect and direct cervical nerve root injection procedures are described in detail. Fifty-three consecutive patients receiving the indirect nerve root injections during 2009-2010 were age- and gender-matched to 53 patients who underwent direct transforaminal nerve root injections performed in 2006. Pain level data were collected immediately before and 20-30 min after each procedure. The percentages of pain change in the two groups were compared using the unpaired Student's t test. Fifty-two men (mean age 49) and 54 women (mean age 55) were included. The mean percentage of pain reduction for patients receiving indirect nerve root injections was 38.4% and for those undergoing the direct nerve root injections approach it was 43.2%. This was not significantly different (P = 0.455). No immediate or late adverse effects were reported after either injection procedure. The indirect cervical nerve root injection procedure is a potentially safer alternative to direct cervical transforaminal nerve root injections. The short-term pain reduction is similar using the two injection methods. (orig.)

  11. Clinical Study of Pulmonary Ground Glass Nodules Under CT Guided Hook-wire and Thoracoscopic Resection%肺磨玻璃结节CT引导下Hook-wire定位及胸腔镜下切除的临床研究

    Institute of Scientific and Technical Information of China (English)

    冯为; 廖明; 李金昌; 董雷; 刘大胜; 潘鑫福

    2015-01-01

    Objective To evaluate the lung nodules suture of the value of preoperative CT guided positioning.Methods In July 2014 to January 2015,a total of 15 patients,15 smal nodules,vats resection,preoperative al row CT guided Hook-wire positioning. Record CT guided Hook-wire positioning operation time,complications,thoracoscope surgery to the risk of open chest surgery,length of hospital stay,etc. Lesion type organization credits in malignant probability calculation,discuss the lungs<10 mm of GGO actively the necessity of surgical treatment.Results A total of 15 patients with 15 tuberous thoracoscope resection,preoperative CT guided Hook-wire positioning success rate 100%,3 cases of benign lesions(20%),1 case of sclerosing hemangioma,2 cases of inflammatory pseudotumor. 12 cases of lung cancer,intraoperative CT scan is the most common complication occurs when a smal amount of pneumothorax,no needle fal off.Conclusion CT guided Hook-wire positioning for GGO preoperative location provides a very good method.%目的:评价肺小结节胸腔镜术前CT引导下定位的价值。方法2014年7月~2015年1月共15例患者,15个微小结节,行胸腔镜切除术,术前皆行CT引导下Hook-wire定位。记录CT引导下Hook-wire定位操作时间、并发症、胸腔镜手术转为开胸手术的机率、住院时间等,计算病灶组织学分型中的恶性机率,讨论肺部<10 mm的GGO积极手术治疗的必要性。结果共15个患者行15个结节胸腔镜切除术,术前CT引导下Hook-wire定位成功率100%,良性病灶3例(20%):硬化性血管瘤1例,炎性假瘤2例;肺癌12例,术中最常见的并发症是CT扫描时出现少量气胸,并无穿刺针脱落。结论 CT引导下Hook-wire定位为GGO术前定位提供了一个非常好的方法。

  12. CT引导下射频热凝联合臭氧消融术治疗腰椎间盘突出症%CT-guided radiofrequency thermocoagulation combined with ozone nucleus pulposus ablation in treatment of lumbar disc herniation

    Institute of Scientific and Technical Information of China (English)

    高笛

    2012-01-01

    目的 观察CT引导下射频热凝联合臭氧消融术治疗腰椎间盘突出症(LDH)的临床疗效及安全性.方法 选取80例LDH患者,随机分臭氧组(40例)和联合组(40例),臭氧组给予单纯的臭氧溶核术,联合组先行射频热凝治疗,后行椎间盘内、盘外臭氧溶核术.采用视觉模拟疼痛评分(VAS)作为疼痛水平评价指标,改良Macnab标准评估治疗效果.观察术后1、3、6、12个月VAS评分及术后12个月总有效率.结果 2组术后1、3、6、12个月腰腿痛VAS评分显著低于治疗前(P均<0.01);且联合组VAS评分显著低于臭氧组(P<0.05或P<0.01).术后12个月联合组的总有效率(91.9%)显著高于臭氧组(74.3%),差异有统计学意义(P<0.05).2组患者均无过敏反应、椎间隙感染或脊髓、神经、血管及腹腔脏器损伤等严重并发症.结论 CT引导下靶点射频热凝加臭氧消融术治疗LDH安全、微创,较单纯臭氧消融术疗效更好,恢复更快.%Objective To observe the effects and safety of CT-guided radiofrequency thennocoagulation combined with ozone nucleus pulposus ablation in treatment of lumbar disc hemiation. Methods Eighty cases with lumbar disc hemia-tion were randomly divided into ozone treatment group ( 40 cases ) and combination treatment group ( 40 cases ). The cases in the ozone group were treated with ozone nucleus pulposus ablation therapy alone, another 40 cases in the combination group were treated with ozone nucleus pulposus ablation therapy at once after radiofrequency thermocoagulation. Therapeutic effects were evaluated at the time points of 1 month, 3 months,6 months and 12 months after surgery by using the average scores of VAS and Macnabs standard. Results The average scores of VAS at the time points of 1 month,3 months,6 months and 12 months after surgery in both groups were significantly lower than before treatment ( all P < 0. 01 ), and it was more obviously in the combination treatment group than that in the

  13. Diagnostic Value of MSCT in Osteoid Osteoma and the results of CT-guided percutaneous removal of Osteoid Osteoma%骨样骨瘤的MSCT诊断与CT引导下切除的疗效分析

    Institute of Scientific and Technical Information of China (English)

    郑芸; 杨贤卫; 冷晓明; 朱丹; 许焕奇

    2011-01-01

    目的 分析骨样骨瘤的CT表现并探讨其诊断及治疗价值.方法 回顾性分析12例经手术病理证实的骨样骨瘤,12例均行普通X线及CT检查,其中3例同时行MRI检查,分析比较X线、CT和MRI对瘤巢及瘤巢周围骨质改变的显示能力.结果 瘤巢均表现为圆形或卵圆形透亮区,直径小于20mm,8例中心可见钙化,呈牛眼征.4例呈环征.瘤巢周围可有不同程度的骨质硬化、骨膜反应、骨髓水肿、软组织肿胀及相邻关节腔积液.CT术前诊断正确11例(91.7%),普通X线术前诊断正确7例 (58.3%),3例MRI检查中1例增强扫描术前诊断正确,2例平扫只提示诊断.7 例行CT导引下瘤巢毁损,5例CT引导定位后手术治疗,追访6个月-3年未见疼痛复发及明显并发症.结论 瘤巢是骨样骨瘤的特征性表现,CT对瘤巢显示最准确,MRI则对显示瘤巢周围骨髓、软组织及关节腔情况敏感.CT引导下经皮穿刺切除骨样骨瘤是一种简单有效、安全可靠的微创性治疗方法.%Objective To analysis the appearances and to evaluate the diagnostic value of CT imaging in osteoid osteoma.Methods 12 cases of osteoid osteoma proved by surgical pathology and their X-ray,CT and MR1 were re-viewed.All atients had X-ray and CT scanning,3with MR imaging.The ability of X-ray,CT and MRI to demonstrate the nidus and surrounding reaction were analyzed.Results The nidus were appeared as round or oval shape and the diameter was less than 20mm.8 nidus manifested as "ancox eye" sign of calcification in focuscenter.4 nidus manifested as an ringsign without calcification in focuscenter.There were different degree of bone sclerosis,periosteal reaction and soft tissues or bone marrow edema around the nidus.The diagnostic accuracy was 58.3% for X-ray,91.7% for CT.Accurate diagnosis was obtained before surgery in lease of MR1,the other 2 cases were only suggestive of the diagnosis.CT-guided percutaneous excision had undergone in twelve patients

  14. CT引导经皮置钉治疗病理性骶髂关节疼痛%Percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw for treating pathologic pain of sacroiliac joint

    Institute of Scientific and Technical Information of China (English)

    胡勇; Ebraheim NA; 徐荣明; 薛波

    2005-01-01

    BACKGROUND: Most patients with posterior pelvic and sacroiliac metastasis are terminally ill. Their treatment is usually palliative and directed toward relieving pain and improving the quality of life with the least possible intervention.OBJECTIVE: To investigate the possibility of percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw treatment for pathologic pain of sacroiliac joint.DESIGN: Preoperative and postoperative auto-control clinical trial was conducted.SETTING and PARTICIPANTS: The study was completed in Ningbo Sixth Hospital. Eight patients(4 males and 4 females, aged 12 years to 83 years)with metastatic tumor of sacroiliac joint were selected for our study.METHODS: After treatment with percutaneous CT-guided fixation of sacroiliac joint with cannulated lag screw, the sacroiliac joint of the 8 patients became pathologically unstable. Enneking pain scale was obtained preoperatively and postoperatively.MAIN OUTCOME MEASURES: Pain recovery was assessed preoperatively and postoperatively.RESULTS: After 2. 5 years' follow-up, pain of the patients was relieved with a range of 0 to 5(mean 3.2).CONCLUSION: Percutaneous cannulated lag screws with CT guidance help alleviate the patients' pain due to pathologically unstable sacroiliac joint.%背景:大多数后路骨盆和骶髂关节转移肿瘤患者为临终患者,其治疗目的主要是姑息治疗和减轻疼痛,提高患者生活质量.目的:探讨在CT引导下经皮微创技术置入空心拉力螺钉治疗病理性骶髂关节疼痛.设计:前后对照的临床试验.地点和对象:在浙江省宁波市第六医院完成.8例骶髂关节转移肿瘤患者,男4例,女4例;年龄12~83岁.方法:对8例骶髂关节转移肿瘤患者试行在CT引导下经皮微创技术置入空心拉力螺钉稳定病理性骶髂关节不稳.术前和术后进行Enneking疼痛评分.主要观察指标:手术前后疼痛恢复情况.结果:经2年5个月随访,患者疼痛减轻,平均3.2

  15. Perfusion-CT guided intravenous thrombolysis in patients with unknown-onset stroke: a randomized, double-blind, placebo-controlled, pilot feasibility trial

    Energy Technology Data Exchange (ETDEWEB)

    Michel, Patrik [Center Hospitalier Universitaire Vaudois and University of Lausanne, Department of Neurology Service, Lausanne (Switzerland); Centre Hospitalier Universitaire Vaudois and University of Lausanne, Neurology Service, Lausanne (Switzerland); Ntaios, George; Reichhart, Marc [Center Hospitalier Universitaire Vaudois and University of Lausanne, Department of Neurology Service, Lausanne (Switzerland); Schindler, Christian [Center Hospitalier Universitaire Vaudois and University of Lausanne, Pharmacy Department, Lausanne (Switzerland); Bogousslavsky, Julien [Genolier Swiss Medical Network, Glion (Switzerland); Maeder, Philip; Meuli, Reto [Center Hospitalier Universitaire Vaudois and University of Lausanne, Department of Radiology, Lausanne (Switzerland); Wintermark, Max [University of Virginia, Department of Radiology, Division of Neuroradiology, Charlottesville, VA (United States)

    2012-06-15

    Patients with unknown stroke onset are generally excluded from acute recanalisation treatments. We designed a pilot study to assess feasibility of a trial of perfusion computed tomography (PCT)-guided thrombolysis in patients with ischemic tissue at risk of infarction and unknown stroke onset. Patients with a supratentorial stroke of unknown onset in the middle cerebral artery territory and significant volume of at-risk tissue on PCT were randomized to intravenous thrombolysis with alteplase (0.9 mg/kg) or placebo. Feasibility endpoints were randomization and blinded treatment of patients within 2 h after hospital arrival, and the correct application (estimation) of the perfusion imaging criteria. At baseline, there was a trend towards older age [69.5 (57-78) vs. 49 (44-78) years] in the thrombolysis group (n = 6) compared to placebo (n = 6). Regarding feasibility, hospital arrival to treatment delay was above the allowed 2 h in three patients (25%). There were two protocol violations (17%) regarding PCT, both underestimating the predicted infarct in patients randomized in the placebo group. No symptomatic hemorrhage or death occurred during the first 7 days. Three of the four (75%) and one of the five (20%) patients were recanalized in the thrombolysis and placebo group respectively. The volume of non-infarcted at-risk tissue was 84 (44-206) cm{sup 3} in the treatment arm and 29 (8-105) cm{sup 3} in the placebo arm. This pilot study shows that a randomized PCT-guided thrombolysis trial in patients with stroke of unknown onset may be feasible if issues such as treatment delays and reliable identification of tissue at risk of infarction tissue are resolved. Safety and efficiency of such an approach need to be established. (orig.)

  16. CT-guided percutaneous lung biopsy: Comparison of conventional CT fluoroscopy to CT fluoroscopy with electromagnetic navigation system in 60 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Grand, David Justin, E-mail: dgrand@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Atalay, Michael A., E-mail: matalay@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Cronan, John J., E-mail: cronan@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Mayo-Smith, William W., E-mail: wmayo-smith@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States); Dupuy, Damian E., E-mail: ddupuy@lifespan.org [Department of Diagnostic Imaging, Warren Alpert School of Medicine, Brown University, Providence, RI 02903 (United States)

    2011-08-15

    Purpose: To determine if use of an electromagnetic navigation system (EMN) decreases radiation dose and procedure time of CT fluoroscopy guided lung biopsy in lesions smaller than 2.5 cm. Materials/methods: 86 consecutive patients with small lung masses (<2.5 cm) were approached. 60 consented and were randomized to undergo biopsy with CT fluoroscopy (CTF) (34 patients) or EMN (26 patients). Technical failure required conversion to CTF in 8/26 EMN patients; 18 patients completed biopsy with EMN. Numerous biopsy parameters were compared as described below. Results: Average fluoroscopy time using CTF was 28.2 s compared to 35.0 s for EMN (p = 0.1). Average radiation dose was 117 mGy using CTF and 123 mGy for EMN (p = 0.7). Average number of needle repositions was 3.7 for CTF and 4.4 for EMN (p = 0.4). Average procedure time was 15 min for CTF and 20 min for EMN (p = 0.01). There were 7 pneumothoracesin the CTF group and 6 pneumothoraces in the EMN group (p = 0.7). One pneumothorax in the CTF group and 3 pneumothoraces in the EMN group required chest tube placement (p = 0.1). One pneumothorax patient in each group required hospital admission. Diagnostic specimens were obtained in 31/34 patients in the CTF group and 22/26 patients in the EMN group (p = 0.4). Conclusions: EMN was not statistically different than CTF for fluoroscopy time, radiation dose, number of needle repositions, incidence of pneumothorax, need for chest tube, or diagnostic yield. Procedure time was increased with EMN.

  17. CT-guided marking of pulmonary nodules with a special lung marking wire before video-assisted thoracoscopic surgery. Review of 184 cases; CT-gestuetzte Drahtmarkierung vor videoassistierter thorakoskopischer OP von pulmonalen Rundherden. Eine Auswertung von 184 Faellen

    Energy Technology Data Exchange (ETDEWEB)

    Schulze, M.K.; Eichfeld, U.; Kahn, T.; Stumpp, P. [Universitaetsklinikum Leipzig AoeR (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

    2012-06-15

    Purpose: Minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) are currently the method of choice for the resection of small pulmonary nodules, when they are located in the periphery of the lungs. To guarantee quick and safe intraoperative identification of the nodule, preoperative marking is necessary and sensible. We report about our experiences in 184 markings with a special lung marking wire, which is placed in or around the pulmonary nodule using CT guidance. Materials and Methods: In 184 patients (97 m, 87f, mean age: 58.1 {+-} 13.7 years) with pulmonary nodules, scheduled for resection with VATS, a special lung marking wire was placed preoperatively under CT guidance. We evaluated the technical success, safety, necessity of conversion to thoracotomy and histology in all patients. Results: The marking wire could be positioned successfully in 181 cases (98.4 %). There was one major complication (uncontrollable pneumothorax). Minor adverse events like small pneumothorax (53.3 %) or a perifocal bleeding (30.4 %) did not necessitate treatment. Complete resection of the marked nodule was successful in 98.4 % of the patients. Conversion to thoracotomy was necessary in 29 patients (15.9 %) due to bleeding, adhesions, malignancy or wire dislocation. Histology revealed a benign nodule in 96 cases (54.4 %) and a malignant lesion in 78 cases (45.6 %), of which only 21 nodules (11.5 %) turned out to present a primary pulmonary carcinoma. Conclusion: CT-guided marking of pulmonary nodules using a special marking wire followed by thoracoscopic resection is an efficient and safe method for diagnosing suspicious nodules in the periphery of the lung. (orig.)

  18. 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.)

  19. CT-guided thoracal sympathicolysis for the treatment of peripheral arterial occlusive disease and chronic thoracal pain syndromes in 6 patients; CT-gesteuerte thorakale Sympathikolyse zur Behandlung der peripheren arteriellen Verschlusskrankheit und thorakaler Schmerzen in 6 Faellen

    Energy Technology Data Exchange (ETDEWEB)

    Finkenzeller, T.; Techert, J.; Lenhart, M.; Link, J.; Feuerbach, S. [Klinikum der Univ. Regensburg (Germany). Abt. Roentgendiagnostik

    2001-10-01

    Purpose: Retrospective evaluation of the safety and effectivity of CT-guided percutaneous thoracal sympathicolysis (CT-TSL) in the treatment of patients with peripheral arterial occlusive disease (PAOD) of the upper limb and chronic thoracal pain syndromes. Comparison of our own experience with literature reports. Material and Methods: Between 6/96 and 12/99, 4 patients with PAOD of the upper limb and two with chronic thoracal pain syndromes caused by herpes zoster were treated by unilateral CT-TSL. Results: 18, 21 and 32 months after the intervention 3 out of 4 patients treated for PAOD reported subjective improvements, and one remained unchanged. Two patients treated for pain syndromes showed no long-term benefit of the procedure. There were no serious complications. Conclusion: The CT-TSL is an alternative method in the treatment of PAOD in patients who are unsuitable for treatment by revascularization. (orig.) [German] Ziel: Retrospektive Betrachtung der Sicherheit und Effektivitaet der CT-gesteuerten thorakalen Sympathikolyse (CT-TSL) bei der Behandlung von Patienten mit peripherer arterieller Verschlusskrankheit (AVK) der oberen Extremitaet oder chronischer thorakaler Schmerzsyndrome, und Vergleich der eigenen Erfahrungen mit der Literatur. Material und Methoden: Von 6/96 bis 12/99 wurden 4 Patienten mit AVK der oberen Extremitaet und zwei mit chronischen thorakalen Herpes-zoster-Neuralgien mittels jeweils unilateral durchgefuehrter CT-TSL behandelt. Ergebnisse: 3 von 4 der wegen AVK behandelten Patienten gaben im Verlauf nach 18, 21 und 32 Monaten eine subjektiv empfundene Besserung an, ein Patient hatte unveraendert Beschwerden. Beide Schmerzpatienten zeigten nur kurzfristig eine Verbesserung ihrer Beschwerdesymptomatik. Es traten keine relevanten Komplikationen auf. Schlussfolgerung: Die CT-TSL ist eine alternative Moeglichkeit zur Behandlung der AVK der oberen Extremitaet bei Patienten, die keinem revaskularisierenden Eingriff unterzogen werden koennen

  20. Extra-pleuric coaxial system for CT-guided percutaneous fine-needle aspiration biopsy (FNAB) of small (≤20 mm) lung nodules: a novel technique using multiplanar reconstruction (MPR) images.

    Science.gov (United States)

    Capasso, Raffaella; Nizzoli, Rita; Tiseo, Marcello; Pedrazzi, Giuseppe; Brunese, Luca; Rotondo, Antonio; De Filippo, Massimo

    2017-02-01

    The aim of the study is to present the diagnostic feasibility, usefulness, and safety of a novel technique for coaxial CT-guided fine-needle aspiration biopsy of small (≤20 mm in diameter) lung nodules. A 18-gauge (G) (1.2 × 40 mm) needle is inserted through the skin in the depth of the thoracic wall tissues remaining outside the pleura. Its positioning is planned and adjusted using multiplanar reconstruction (MPR) images along the 18-G guide needle axis tracing a reference outline extended from the needle tip to the target nodule. When the insertion of the 18-G extra-pleuric needle (EPN) proves to be precise, a 22-G Chiba needle is then passed through the outer 18-G EPN until it reaches the thoracic lesion for the sampling procedure. Patient population included 153 males and 94 females, with a mean age of 61.3 ± 21.6 years. Mean nodule diameter was 14.1 ± 2.2 mm. The lesion depth from pleural plane ranged from 0 mm to 127 mm. An average of 1.29 aspirates were performed per lesion. The most common complication was pneumothorax in 27 cases; there were no cases of PNX requiring chest tube insertion. Intrapulmonary bleeding along the needle track was observed in 32 patients. Exploiting the advantage of MPR images, our novel technique of extra-pleuric coaxial system with a 18-G EPN allows the operator to multiple samplings of small (≤20 mm) target lesions in various locations with a thinner (22-G Chiba) needle, thus reducing the degree of pleural, parenchymal, or adjacent organs damage.

  1. CT 引导下经皮射频消融治疗肾上腺皮质腺瘤库欣综合征%CT-guided percutaneous radiofrequency ablation for adrenocortical adenoma with Cushing's syndrome

    Institute of Scientific and Technical Information of China (English)

    屈峰; 查振雷; 周科峰; 连惠波; 张古田; 汪维; 兰厚金; 甘卫东; 郭宏骞

    2015-01-01

    目的:评价CT引导下经皮射频消融( radiofrequency ablation ,RFA)治疗肾上腺皮质腺瘤库欣综合征( Cushing's syndrome )的可行性、安全性、疗效和不良反应。方法自2009年1月至2013年12月,采用CT引导下射频消融治疗肾上腺皮质腺瘤库欣综合征患者24例,共24个肿瘤。平均肿瘤直径(2.1±0.7)(1.1~3.9)cm。采用CT实时扫描引导下进行射频消融。术后1周复查增强CT扫描,肿瘤病灶无强化定义为消融成功。术后随访血清皮质醇及促肾上腺皮质激素较术前明显改善,且症状改善定义为临床治愈。射频消融术后肿瘤病灶穿刺活检取病理明确诊断。结果24例手术均获成功,无中转开放。术中患者出现血压波动,未发生高血压危象,6例术后出现腰部轻微疼痛。术后1周CT增强扫描显示24个肿瘤完全消融。24例平均随访18(3~36)个月,血清皮质醇及促肾上腺皮质激素基本恢复到正常水平,库欣综合征相关症状也逐渐改善,随访过程中未见肿瘤复发。病理活检结果均为肾上腺皮质腺瘤。所有患者均无严重并发症发生。结论 CT引导下RFA治疗具有库欣综合征的肾上腺皮质腺瘤是一种安全可行、有效、并发症少的微创治疗方法。%Objective To evaluate the feasibility , safety, therapeutic effects and adverse reactions of CT-guided radiofrequency ablation (RFA)for adrenocortical adenoma with Cushing's syndrome.Methods From Jan.2009 to Dec.2013, 24 patients with 24 tumors diagnosed as adrenocortical adenoma with Cushing's syn-drome received CT-guided percutaneous RFA.The average tumor size was(2.1 ±0.7)cm(ranging from 1.1 to 3.9 cm) .RFA was performed under real-time computed tomography guidance .Technical success was defined as disappearance of tumor enhancement on contrast CT imaging 1 week after RFA .Clinical success was defined as improvement in serum cortisol, adreno

  2. The clinical applications of CT-guided percutaneous microwave ablation of hip osteoid osteoma%CT引导下经皮穿刺微波热消融术治疗髋部骨样骨瘤

    Institute of Scientific and Technical Information of China (English)

    纪经涛; 胡永成; 夏群; 王林森

    2010-01-01

    目的 探讨CT引导下经皮穿刺微波热消融术治疗髋部骨样骨瘤的可行性.方法 2006年8月至2010年1月对8例髋部骨样骨瘤患者采用CT引导下经皮穿刺微波热消融治疗,男5例,女3例;年龄12~25岁,平均18.8岁.患者均有髋部疼痛症状,夜间加剧.病史2个月至10年.病变部位:股骨颈4例、股骨小转子2例、股骨大转子1例,股骨转子间1例.术中应用CT薄层横断扫描确定病灶部位,将骨穿刺针经皮穿入瘤巢中心.行CT扫描证实穿刺针位置准确后撤出针芯,用穿刺针套管刮除瘤壁及瘤巢内肿瘤组织送病理学检查.再将微波探针沿骨穿刺针穿入瘤巢中心,将瘤巢中心温度逐渐加热至90℃,保持4~6min.术后预防性应用抗生素2 d.结果 3例病理学检查诊断为骨样骨瘤,另5例仅获得诊断性描述.全部病例随访6~21个月.术后24 h内疼痛均有不同程度缓解,1例随访5个月时仍有轻度夜间隐痛,再次行微波热消融治疗,随访8个月无复发.所有患者均未见股骨头坏死及其他并发症.结论 CT引导下骨样骨瘤经皮穿刺微波热消融术可以有效缓解或消除髋部疼痛症状,术后并发症少,短期疗效好,是一种安全、有效的新方法.%Objective To evaluate the clinical effectiveness of the treatment for hip osteoid osteoma by CT-guided percutaneous microwave ablation. Methods From August 2006 to January 2010, 8 patients with the osteoid osteomas of the hip were treated with CT-guided percutaneous microwave ablation, including 5 males and 3 females with an average age of 18.8 years (range, 12 to 25). The history of local pain was ranging from 2 months to 10 years, with aggravation of pain at night. The locations of the lesions contained: 4cases in the neck of femur, 2 in the lesser trochanter, 1 in the greater trochanter and 1 in the femoral intertrochanteric line. After localization of the nidus with CT, osseous access was established with a Gallini puncturatio

  3. Application study of vertebral column metastasis tumor with embedment of 125I by CT guide%CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤

    Institute of Scientific and Technical Information of China (English)

    王歧峰; 胡效坤; 李子祥

    2014-01-01

    目的 探讨CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤的方法、疗效、安全性.方法 回顾分析山东省平阴县人民医院放射科和青岛大学附属医院介入医学中心自2004年9月至2012年3月收治的31例脊柱溶骨性转移瘤患者,行CT引导下经皮穿刺植入125I放射粒子治疗.应用放射性粒子近距离治疗计划系统(BI-TPSTM)计划125I放射粒子的活度和用量,处方剂量PD为110 ~ 140 Gy,粒子活度为26.0 ~ 29.6 Mbq/颗,术后行CT扫描并进行质量验证,定期CT随访,分析疗效.31例脊柱溶骨性转移瘤患者,分别于术后2、4、6、12个月复查CT,观察肿瘤变化,统计肿瘤局部控制有效率(RR),评价疼痛缓解情况.结果 19例合并椎旁软组织肿块患者2、4、6、12个月肿瘤RR依次是:19/19、19/19、18/19、17/19例;31例患者治疗后2、4、6、12个月疼痛降低1~3级的缓解率依次是96.8% (30/31)、96.8% (30/31)、90.3% (28/31)、71.0% (22/31);3例(9.68%)在植入部位被破坏的骨质内出现了明显的骨化.12例治疗后1个月出现皮肤色素沉着,未见脊髓坏死和皮肤溃疡.结论 CT引导下植入125I放射粒子治疗脊柱溶骨性转移瘤,疗效可靠、安全性高.%Objective To discuss the method,safety and effect of embedding 125I to Brachytherapy vertebral column metastasis tumor by CT guided.Methods 31 cases of vertebral column metastasis tumor were treated with percutaneous embedding 125I by CT guided.They were observed the preoperative size and contour of lesions and were planed the activity and dosage of 125I,the PD (prescribed dose) was 110-140 Gy,and the particle activity was 26.0-29.6 Mbq.CT scanning and therapeutic effect analysis were immediately carried out after operations.We also made CT scanning regularly to analyze the effect.Results 31 cases of vertebral column metastasis tumor were respectively re-examed of CT in 2,4,6 and 12 months after operation.We surveyed the local rate

  4. CT引导下经皮穿刺氩氦刀冷冻消融术治疗肾癌的临床应用研究%Clinical application of CT-guided percutaneous cryoablation for renal neoplasms

    Institute of Scientific and Technical Information of China (English)

    任超; 肖越勇; 吴斌; 张肖; 刘士榕; 马旭阳

    2012-01-01

    目的 探讨CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾癌的技术方法、安全性及临床疗效.方法 选取2008年9月至2011年1月于我院就诊的肾肿瘤患者27例,采用CT引导氩氦刀冷冻消融疗法,对治疗后局部靶病灶变化、术后肾功能变化、中位生存时间及生存率进行动态随访观察,并记录并发症情况.结果 本组27例患者,术后即刻CT扫描显示冰球覆盖率均为100%.术后3个月复查CT示靶病灶密度减低,瘤体不同程度缩小,按实体瘤评价标准,其中完全缓解(CR)23例,部分缓解(PR)2例,病灶稳定(SD)2例,缓解率(CR+PR)为92.6%.术后第3~4天复查肾功能(尿素氮、尿酸和肌酐等),与术前相比均未见明显变化.本组术后无严重并发症(包括皮肤冻伤、感染、穿刺种植转移等)发生,6例子术后1d出现发热(38℃左右),对症治疗后3~5d消退,8例出现局部轻度疼痛,服用止痛药后缓解;2例出现术后出血,应用凝血酶后迅速止血.结论CT引导监测,经皮穿刺氩氦刀冷冻消融术治疗肾肿瘤近期疗效肯定,是一种安全可靠、值得推广的微创治疗方法.%Objective To investigate the safety,efficacy and clinical value of CT-guided cryoablation for renal cellular carcinoma (RCC). Methods 27 patients with RCC were treated with CT-guided cryoablation from August 2008 to January 2011, CT scan were performed to monitor the dynamic changes at different stages after the cryosurgery. The treatment response and survival rate were tested to evaluated the efficacy of the surgery. Results All the patients underwent percutaneous conformal cryoablation, the immediate CT scan after cryosurgery showed the lesions of all the patients were completely covered by iceball. CT scan performed at 1 month,3 month,6 month and 1 year after the procedure, the lesions were showed abviousiy decrease on density, the tumor size decreased,and there was no enhancement. According to the CT scans,23

  5. CT-Guided Trigeminal Neuralgia in MS

    Directory of Open Access Journals (Sweden)

    Jalal Jalal Shokouhi

    2011-05-01

    Full Text Available Background/Objective: Multiple sclerosis has nonspecific"nsigns in MR images and clinic and also has pain,"none of the pain syndromes in MS cases is trigeminal"nneuralgia. 12 patients of our 38 trigeminal neuralgic"npatients etiology were known as MS cases. All of them"nwere young (20-40 years old."nIntroduction: Multiple sclerosis diagnosis is by clinic,"nMRI, CSF electrophoresis and evocked potensial tests."nImaging diagnostis is not suggestive and specific but in"nthis article we show imaging help not only in diagnosis"nalso in treatment of complications. Trigeminal neuralgia"nis the worse clinical condition in M.S patients and may"npush them to addiction or suicide."nMaterials and Methods: X-ray CT machine is used for"nguidance of L.P or coaxial 10cm needle with 22G, local"nanesthesia and ethanol injection. One time treatment"nmade for all patients and they were pain free after"ninterventional drug injection. 5-6 cc bupivicain 0.5%"nand 3-4cc ethanol 96% are used for treatment."nResults: All patients were pain free and very happy"nafter treatment. One of them had pain for 12 years"nand had tried all the other treatments with no good"nresponse. No complication was seen in our treatments."n15 to 20 minutes time is needed for each examination"nor treatment."nConclusion: Despite known MS cases and relative"ndrug therapies for patients it is not possible to treat"ntrigeminal paint except using interventional therapy"nand CT-guidance is exactive and easy. There was"nno complication except irritation in the middle ear"nbecause of Eustachian tube compression by injected"nvolume of drugs

  6. CT引导下经皮肺活检在弥漫性实质性肺疾病的临床应用%The diagnostic value of CT-guided percutaneous needle lung biopsy in diffuse parenchymal lung diseases

    Institute of Scientific and Technical Information of China (English)

    彭敏; 冯瑞娥; 刘鸿瑞; 朱元珏; 许文兵; 施举红; 蔡柏蔷; 田欣伦; 柳涛; 张弘; 肖教; 刘巍

    2012-01-01

    目的 探讨CT引导下经皮切割针肺活检在影像学表现为弥漫性实质性肺疾病诊断中的作用和应用范围.方法 选择2000年1月至2008年12月北京协和医院行CT引导下经皮肺活检、胸部CT表现为双肺弥漫病变且临床资料完整的弥漫性实质性肺疾病患者248例.排除胸部CT为单发病变及单肺病变的病例.回顾分析所有病例的病史、血免疫学、支气管镜、胸部高分辨CT及肺活检病理等检查结果.结果 男114例,女134例,年龄13~78岁,平均年龄(50±16)岁.248例中经皮肺活检获得病理形态学诊断130例(52.4%),确诊疾病分别为肺部感染性疾病46例(35.4%),肺部肿瘤33例(25.4%),闭塞型细支气管炎伴机化性肺炎/机化性肺炎(BOOP/OP) 29例(22.3%),血管炎8例(6.2%),肉芽肿病变6例(4.6%),结节病3例(2.3%),弥漫性肺泡损伤和肺淀粉样变各2例(1.5%),以及肺泡蛋白沉积症(PAP)1例(0.7%).经皮肺活检未确定诊断的118例患者中有37例进行了开胸或胸腔镜肺活检,36例确定诊断,分别为非特异性间质性肺炎(NSIP) 12例,寻常型间质性肺炎(UIP)3例,感染6例,肿瘤3例,淋巴细胞间质性肺炎(LIp)、肺血管炎和过敏性肺炎(HP)各2例,结节病、ABPA、肺透明样肉芽肿病、肺尘埃沉积症、Castleman病及淋巴增殖性疾病各1例.经皮肺活检未确定诊断的118例患者中有69例结合临床及其他检查获得诊断.结论 约半数弥漫性实质性肺疾病患者通过CT引导下经皮肺活检能够获得特定的病理形态学诊断,尤其是影像学表现为双肺弥漫病变的感染及肿瘤病例确诊阳性率较高,但对于特发性间质性肺炎诊断价值有限,应结合患者的临床实际情况选择应用.%Objective This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of diffuse parenchymal lung diseases (DPLD).Methods A total of 481 patients admitted

  7. CT-guided bone cement injection combined with artificial tiger bone meal to repair osteoporotic vertebral compression fractures:callus growth and bone healing%CT引导下骨水泥注入辅助人工虎骨粉修复骨质疏松性脊椎压缩性骨折:骨痂生长及骨愈合评价

    Institute of Scientific and Technical Information of China (English)

    闵朋; 张燕萍; 曹洪

    2015-01-01

      结果与结论:观察组术后骨痂生长良好,多为Ⅲ级与Ⅳ级患者;显著优于对照组(P OBJECTIVE:To observe calus formation and fracture healing in patients with osteoporotic vertebral compression fractures repaired by CT-guided minimaly invasive surgery with bone cement injection and artificial tiger bone meal. METHODS:A total of 85 cases of osteoporotic vertebral compression fractures were selected. Patients were randomly divided into observation group (n=43) and control group (n=42). Patients in the observation and control groups respectively received CT-guided minimaly invasive percutaneous vertebroplasty, matching with artificial tiger bone meal andJiegu Qili pil. Calus growth, fracture healing and pain relief time were observed in the two groups. RESULTS AND CONCLUSION:The calus growth was good in patients of the observation group, mainly grade III and IV, and significantly better than in the control group (P < 0.05). Pain relief time and healing time were significantly shorter in the observation group than in the control group (P < 0.05). The excelent and good rate of Japanese Orthopaedic Association score was significantly better in the observation group than in the control group (P < 0.05). These results suggested that CT-guided minimaly invasive percutaneous vertebroplasty in the combination with bone cement injection for osteoporotic vertebral compression fractures can obtain evident effects. The combined use of artificial tiger bone meal has a good promoting effect on fracture healing.

  8. Sacroiliitis in children with spondyloarthropathy: therapeutic effect of CT-guided intra-articular corticosteroid injection; Sakroiliitis bei Kinder mit Spondylarthropathie: Therapeutischer Effekt der CT-gestuetzten intraartikulaeren Kortikosteroid-Injektionen

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, T.; Hermann, K.G.A.; Diekmann, F.; Hamm, B. [Humboldt-Universitaet, Berlin (Germany). Universitaetsklinikum Charite, Inst. fuer Radiologie; Biedermann, T. [HELIOS Klinikum Berlin (Germany). II. Klinik fuer Kinderheilkunde und Jugendmedizin, Abt. Kinderrheumatologie; Braun, J. [Rheumazentrum Ruhrgebiet, St. Josefs-Krankenhaus (Germany); Bollow, M. [Augusta-Krankenhaus, Bochum (Germany). Inst. fuer Radiologie

    2003-06-01

    Purpose: The prospective investigation of the therapeutic effect of CT-guided intra-articular corticosteroid injection into inflammatory sacroiliac (SI) joints compared to conventional treatment with nonsteroidal anti-inflammatory drugs (NSAIDS) in children with juvenile spondyloarthropathy (jSpA) and the determination of the role of dynamic magnetic resonance imaging (MRI) in establishing the indication and monitoring the therapy. Materials and Methods: The study comprises 89 children with known jSpA who were diagnosed by MRI to have a unilateral or bilateral sacroiliitis. Therapy with NSAIDS was initiated or continued in all 89 patients. Four weeks after the diagnostic MRI, two groups were distinguished according to the clinical response of NSAIDS, with group 1 consisting of 22 responders and group 2 of 56 non-responders. The patients of group 2 were treated with CT-guided intra-articular corticosteroid injection (low-dose injection) while the therapy with NSAIDS was continued. A total of 83 SI joints were punctured without complications, 27 bilaterally and 29 unilaterally. The indication for the intervention was based on inflammatory activity as determined by MRI. The therapy was monitored by clinical follow-up every 8 to 12 weeks over a period of 20 months. Follow-up by dynamic MRI was performed in all 56 children of group 2 and 15 of the 33 children of group 1 within 8{+-}4 months of the initial examination. Results: A total of 87.5% of the children in group 2 showed a statistically signficant decrease in their subjective complaints from 6.9{+-}3.4 to 1.8{+-}1.7 (p<0.05) as measured on a visual analog scale (VAS from 0 to 10). Improvement was seen as early as 1.5{+-}1.0 weeks after the intervention and lasted for a mean of 12{+-}6 months. The children in group 1 already showed similar improvement of the VAS from 6.8{+-}3.2 to 1.5{+-}1.4 (p<0.05) during the initial four weeks of NSAIDS therapy, with the improvement lasting for the 20-month observation period

  9. Application of CT guided ozone therapy in the treatment of lumbar disc herniation complicated with acute muscle fiber%CT引导臭氧治疗椎间盘突出合并急性肌纤维炎的临床应用

    Institute of Scientific and Technical Information of China (English)

    彭浩; 彭丽静; 胡效坤; 李子祥

    2016-01-01

    目的:探讨CT引导臭氧( O3)消融术治疗椎间盘突出症合并急性肌纤维炎的适应症、消融方法,并判断其疗效。方法112例椎间盘突出症合并急性肌纤维炎行CT引导下O3消融治疗,其中颈椎间盘11例,腰椎间盘101例。结果本组病例随访1~12月。近期疗效急性疼痛消失65例,疼痛级别降低1~2级47例,有效率100%。远期疗效明显82例,有效26例,无效4例,总有效率达96.4%。无出现明显的并发症。结论 CT引导O3消融术治疗椎间盘突出症合并急性肌纤维炎效果明显,操作简便,定位准确,严格掌握适应症及消融方法对提高短期疗效及长期疗效有着重要的意义。%Objective To investigate the indications and ablation methods of CT guided ozone therapy in the treatment of lum -bar disc herniation with acute muscle fiber , and to judge the curative effect .Methods CT guided ozone therapy was performed in 112 patients with lumbar disc herniation complicated with acute muscle fiber .Among them , 11 cases of cervical intervertebral disc and 101 cases of lumbar intervertebral disc were treated .Results The patients were followed up for 1~12 months.The recent efficacy of acute pain disappeared in 65 cases, the pain level of 47 cases lower to 1~2, the effective rate was 100%.Long term curative effect was obvious in 82 cases, effective in 26 cases, ineffective in 4 cases, the total effective rate was 96.4%.There were no obvious complications .Conclusion CT guided ozone treatment of intervertebral disc herniation with acute muscle inflam -mation effect obviously has the advantages of simple operation , accurate positioning .Strictly grasping the indications and ablation method has important significance has important significanle in impruving the short -term and lorg-oerm curative effect .

  10. CT引导下选择性穿刺圆孔射频热凝术在上颌神经痛治疗中的应用%Application of CT-Guided Selective Foramen Rotundum Puncture Radiofrequency Thermocoagulation in the Treatment of Maxillary Neuralgia

    Institute of Scientific and Technical Information of China (English)

    赵传军; 王烈伟

    2014-01-01

    Objective To evaluate the application value of CT-guided selective foramen rotundum puncture radiofrequency thermocoagulation in the treatment of maxillary neuralgia. Methods CT-guided puncture of 18 patients with maxillary neuralgia was conducted and then the veriifcation of the puncture positions was also conducted. Based on the correct puncture positions, radiofrequency thermocoagulation of maxillary nerve within the target region was conducted. Results After radiofrequency thermocoagulation, the pain condition of 12 patients was completely mitigated and that of 4 patients was partial mitigated while that of 2 patients was unchanged, which showed that the total effective rate of radiofrequency thermocoagulation was 88.8﹪. The results of 6 months follow-up showed that the relapse of maxillary neuralgia occurred in 4 patients. Conclusion CT-guided selective foramen rotundum puncture radiofrequency thermocoagulation with accurate positioning, favourable curative effect and simple operation methods is suitable for the treatment of maxillary neuralgia.%目的:探讨CT引导下选择性穿刺圆孔射频热凝术在上颌神经痛治疗中的应用价值。方法在CT引导下,对18例上颌神经痛患者进行穿刺并对穿刺位置进行验证;确保穿刺位置无误后,对靶区域的上颌神经进行射频热凝毁损。结果术后疼痛完全消失12例,减轻4例,无缓解2例,总有效率88.8%;经6个月随访,4例复发。结论CT引导下选择性穿刺圆孔射频热凝术治疗定位准确、疗效好、操作简单,适用于上颌神经痛的治疗。

  11. The clinical effect and value in the treatment of elderly patients with severe acute cholecystitis with CT guided gallbladder drainage tube%CT引导胆囊穿刺引流在高龄急性重症胆囊炎治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    张安红; 马杰; 张宝民; 胡孝祯; 姜远辉

    2014-01-01

    目的:分析CT引导下胆囊穿刺置管引流在治疗高龄急性重症胆囊炎病人中的临床效果及价值。方法回顾性分析2014年2月至2015年8月共38例高龄急性重症胆囊炎病人,经CT引导下胆囊穿刺置管引流,观察并分析此干预方法在病人临床转归中的作用和价值。结果38例病人均经急诊行CT引导胆囊穿刺引流成功且效果明显,术后2天体温恢复正常,术后当天腹痛缓解率84.2%(32/38)。其中28例(73.7%)病人术后1~8周顺利实施二期手术治疗,无1例死亡。结论CT引导胆囊穿刺引流作为一种安全有效的高龄急性重症胆囊炎的急症干预手段,不仅能缓解病人的急症病情,而且能为二期手术治疗创造有利准备条件。%Objective TTo analyze the clinical effect and value in the treatment of elderly patients withsevere acute cholecystitis with CT guided gallbladder drainage tube. Methods To review and analyze the 38cases of elderly patients with severe acute cholecystitis, since February 2014 to August 2014, in order to observe andanalyze the role of this intervention method in the patient's clinical outcomes and value. Results 38 patientsreceived successfully emergency row CT guided puncture drainage of gallbladder and had obvious effects; thetemperature returned to normal after two days of postoperative; the abdominal pain remission rate is 84.2%(32/38) at that day. 28 cases (73.7%) patients received the surgical treatment after the drainage treatment 1 to8 weeks, no one case died. Conclusion CT guided puncture drainage of gallbladder as a safe and effectiveemergency interventions - severe acute cholecystitis, can not only alleviate the acute illness of the patient, butalso gain the better conditions for the second stage surgery treatment.

  12. 术前CT引导Hookwire穿刺联合亚甲蓝染色定位在胸腔镜治疗孤立性肺结节病变的应用%Preoperative CT-guided biopsy combined methylene blue staining Hookwire positioned thoracoscopic treatment of solitary pulmonary nodules applications

    Institute of Scientific and Technical Information of China (English)

    许剑扬; 李建新; 赵志龙; 薛洪省

    2014-01-01

    目的:探讨术前CT引导Hookwire穿刺联合亚甲蓝染色定位在胸腔镜治疗孤立性肺结节病变的临床价值。方法:我院92例共108枚孤立性肺结节,行术前CT引导Hookwire穿刺联合亚甲蓝染色定位,后行胸腔镜下楔形切除术。若为原发性肺癌,行肺叶切除术加系统性淋巴结清扫术。统计穿刺定位时间、并发症、肺楔形切除术时间、出血量等。结果:穿刺定位时间10-25m i n,平均14m i n,气胸(18/92),胸膜反应(3/92),少量咯血(4/92),肺楔形切除时间5-20m i n,平均10min,出血量5-20ml。结论:CT引导Hookwire穿刺联合亚甲蓝染色定位可提高VATS下SPNs切除的成功率,并发症少,经济方便,在临床有很大的应用价值。%Objective To evaluate the preoperative CT-guided biopsy combined methylene blue staining Hookwire positioned thoracoscopic treatment of solitary pulmonary nodules clinical value. Methods: 92 cases in our hospital 108 meter solitary pulmonary nodules, preoperative CT-guided biopsy combined methylene blue staining Hookwire positioning, underwent thoracoscopic wedge resection. For primary lung cancer, lobectomy plus systematic lymphadenectomy. Statistics puncture positioning time, complications, pulmonary wedge resection time, blood loss and so on. The results puncture positioning time 10 -25min, an average of 14min, pneumothorax (18/92), pleural reaction (3/92), a smal amount of hemoptysis (4/92), pulmonary wedge resection time 5 -20min, an average of 10min, bleeding 5-20ml . Conclusion CT-guided biopsy combined methylene blue staining Hookwire positioned under VATS SPNs resection may improve the success rate, fewer complications, economical, convenient, great clinical value.

  13. Efficacy and Safety of CT Guided Percutaneous Radiofrequency Thermocoagulation in the Treatment of Recurrent Trigeminal Neuralgia After Other Surgical Treatment%CT 引导下经皮三叉神经半月节射频热凝术治疗其他术式术后复发三叉神经痛的疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    杨惠婕; 唐元章; 倪家骧

    2016-01-01

    目的:探讨 CT 引导下经皮三叉神经半月节射频热凝术(PRT)治疗其他术式术后复发三叉神经痛的临床疗效及安全性。方法选取2002—2013年首都医科大学宣武医院疼痛科收治的采用 CT 引导下 PRT 治疗其他术式术后复发三叉神经痛的88例患者的临床资料。采用巴罗神经学研究所(BNI)分级评定标准评定患者临床疗效(疼痛缓解、疼痛未缓解)。记录患者术后并发症:面部麻木、咀嚼力下降、角膜炎、复视、脑脊液漏、死亡等。采用生存分析中的 Kaplan - Meier 法计算患者术后1、2、5、10年疼痛缓解率。结果本组88例患者均成功行 CT 引导下 PRT。83例(94.3%)患者术后疼痛缓解,5例(5.7%)患者术后疼痛未缓解。88例患者术后1年疼痛缓解率为83.0%,术后2年疼痛缓解率为75.0%,术后5年疼痛缓解率为59.0%,术后10年疼痛缓解率为49.0%。76例(93.8%)患者在随访期间存在持续麻木;咀嚼肌力下降8例(9.1%);角膜炎4例(4.5%),其中三叉神经第一支受累1例、三叉神经三支均受累3例,采用人工泪液滴眼后症状缓解;无复视、脑脊液漏等严重并发症发生;无因 CT 引导下 PRT 死亡患者。结论 CT 引导下 PRT 治疗其他术式术后复发三叉神经痛安全、有效,值得临床借鉴。%Objective To investigate the efficacy and safety of CT guided percutaneous radiofrequency thermocoagulation(PRT)in the treatment of recurrent trigeminal neuralgia after other surgical treatment. Methods From 2002 to 2013,we collected the clinical data of 88 patients with recurrent trigeminal neuralgia after other surgical treatment who were treated through CT guided PRT in Department of Pain Management,Xuanwu Hospital Capital Medical University. The clinical efficacy(pain remission and no pain remission)was evaluated using the grading scale of Barrow Neurological Institute(BNI). Postoperative

  14. Single-session combined therapy with chemoembolization and DSA-CT guided radiofrequency ablation in hepatocellular carcinoma larger than 5 cm:A primary clinical study%肝动脉化疗栓塞联合同步DSA-CT引导下射频消融治疗大肝癌的临床研究

    Institute of Scientific and Technical Information of China (English)

    王志军; 王茂强; 段峰; 宋鹏; 刘凤永; 常中飞; 王燕; 阎洁羽; 李凯

    2014-01-01

    ObjectiveTo assess the safety and efifcacy of single-session combined therapy with transcatheter arterial chemoembolization (TACE) and DSA-CT guided radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) larger than 5 cm.Methods A total of 21 patients were treated with TACE immediately followed by DSA-CT-guided RFA. Rate of technical success, local-regional tumor response, recurrence-free survival time, survival rate and complications were evaluated at follow-up images and AFP (α-fetoprotein).Results Technical success was achieved in all 25 visible HCC. No major complications was observed in any patient. Nineteen patients were complete response (CR) and 2 were partial response (PR) after the 1st months. Coagulation necrosis was the major appearance. CR occupied 90.48% (19/21). PR occupied 9.52% (2/21). Local-regional tumor response in solitary nodular lesions (17/17, 100%) was superior to multiple nodular lesions (2/4, 50.00%;P=0.034). During follow-up period, mean recurrence-free survival time was 11.8±6.0 months in 19 cases with CR. The estimated overall survival rate at 6, 12 months and 18 months was 100%.Conclusions Single-session combined therapy with TACE and DSA-CT guided RFA in large hepatocellular carcinoma was safe and effective, especially for solitary nodular lesions.%目的:评估肝动脉化疗栓塞(TACE)联合同步DSA-CT引导下射频消融(RFA)治疗大肝癌(肿瘤最大直径≥5 cm)的安全性和疗效。方法2010年1月~2012年3月21例原发性肝细胞癌患者接受同步联合治疗。术后定期进行影像学检查并复查甲胎蛋白,评估联合技术成功率、局部肿瘤治疗反应、无疾病复发时间、患者存活情况和技术相关并发症。结果技术成功率100%,无重要并发症发生。介入术后1个月复查,病灶完全缓解19例(19/21,90.48%)、部分缓解2例(2/21,9.52%)。肿瘤坏死以凝固性坏死为主。在局部灭活肿瘤方面,

  15. Value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia%射频热凝术前磁共振B-FFE序列三叉神经成像评估

    Institute of Scientific and Technical Information of China (English)

    胡芸; 金朝林; 王翔; 张树桐; 蔡毅

    2015-01-01

    目的:探讨 CT 定位射频温控热凝治疗原发性三叉神经痛术前,磁共振平衡式快速梯度回波(B-FFE)序列三叉神经成像检查的必要性和临床意义。方法采用B-FFE 序列扫描63例拟行射频温控热凝治疗的原发性三叉神经痛患者的患侧三叉神经,观察三叉神经脑池段、半月神经节及其三大分支的解剖形态、走行方式,半月神经节与卵圆孔之间的位置关系,指导术中CT定位穿刺。结果本研究63例患者中,23例(37%)病变侧三叉神经跨岩骨尖时呈聚拢束状,40例(63%)病变侧三叉神经跨岩骨尖时呈三支分散状。眼神经走行于前内侧,下颌神经走行于后外方,上颌神经则走行于两者之间。三叉神经跨岩骨尖角度(150.11±8.32)°。卵圆孔至半月神经节距离(12.37±3.21) cm。结论三叉神经痛射频热凝温控治疗术前行磁共振B-FFE 序列三叉神经成像检查,明确相应解剖结构关系,可以提高术中 CT 定位的准确性,缩短手术时间,减低手术风险,具有较高的临床实用价值。%Objective To analyze the value of B-FFE MR sequence before CT-guided radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia..Methods The B-FFE Sequence were performed on 63 patients with primary trigeminal neuralgia before CT-guided radiofrequency thermocoagulation..MR images were analyzed to identify the relationship between trigeminal nerves and surrounding vessels,.the anatomy of trigeminal ganglion in Meckel′s caves and their branches,.the relationship between the trigeminal semilunar ganglion and the oval foramen..Results The affected trigeminal nerve roots were bundled (23/63, 37%) or divided (40/63, 63%) at (150.11±8.32) angle at the petrous apex before entering the Meckel′s caves. The ophthalmic division travelled anteromedially,.maxillary division in the middle,.and mandibular division posterolaterally

  16. The factor analysis of the incidence of pneumothorax after CT-guided 125I radioactive seed implantation for lung cancer%CT引导下125I粒子植入治疗肺癌术后气胸发生率的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    霍小东; 杨景魁; 闫卫亮; 郑广钧; 柴树德; 孟娜; 杨瑞杰; 王俊杰

    2014-01-01

    Objective To analyze the impact factors of incidence of pneumothorax after CT guided puncture with radioactive 125I seed implantation in lung cancer patients.Methods 821 cases with lung cancer were treated with CT-guided percutaneous with radioactive particles implantation.198 cases of pneumothorax patients were collected.The impact factors of incidence of pneumothorax were analyzed by parallel unconditioned logistic regression.Results 24.1% (198/821) of cases had pneumothorax after CT guided puncture.Single variate analysis showed that the incidence of pneumothorax was ralated with seven factors,such as patients with the average depth of implanted needle,whether patients with COPD(chronic obstructive pulmonary diseases),atelectasis,implantation pin number and operation time,puncture angle,and the diameter of the tumor(x2 =10.293,11.463,5.310,8.868,13.348,9.326,16.504,P <0.05).176 patients of intercurrent COPD with postoperative pneumothorax suffered from 65 cases.The cases of distance between the chest wall and needle less than 6 cm(205 cases),8-12 cm(378 cases)and greater than 12 cm (238 cases),the postoperative pneumothorax occurred in 29 (14.1%),98 (25.9%),71 (29.8%)cases,respectively.The number of needles were less than 5(183 cases),5-10 (408 cases),more than 10 (230 cases),the postoperative pneumothorax occurred in 31 (16.9%),92 (22.5 %),75 (32.6%),respectively.The surgery time was less than 10 min(198 cases),10-20 min(412 cases)and more than 30 min(211 cases),the postoperative pneumothorax occurred in 27(13.6%),101 (24.5%),70(33.2%) respectively.19 cases(14.4%) with COPD (132 case) suffered from pneumothorax.The multivariate logistic regression analysis showed that the prior four factor were risk factors of pneumothorax (OR =1.676,2.147,1.827,2.368,P <0.05),and the last one is protective factor(OR =0.367,P < 0.05).Conclusions COPD disease history,long distance between lesion and chest wall,plenty of needles surgery time can affect

  17. Study on the clinical efficacy of CT guided percutaneous argon helium knife for the treatment of metastatic bone tumor%CT 引导下经皮穿刺氩氦刀冷冻技术对转移性骨肿瘤的临床疗效观察与研究

    Institute of Scientific and Technical Information of China (English)

    赵朝阳; 邓少杰; 叶军; 张在恒; 刘文华

    2016-01-01

    目的:观察研究 CT 引导下经皮穿刺氩氦刀冷冻技术对转移性骨肿瘤的临床疗效。方法选取我院98例转移性骨肿瘤患者,回顾性分析上述患者临床治疗效果,比较患者治疗前后视觉模拟评分(VAS)及卡氏功能状态评分标准(KPS)评分变化,以及术后不良反应及并发症发生情况,总结 CT 引导下经皮穿刺氩氦刀冷冻技术优缺点。结果98例转移性骨肿瘤患者,均穿刺获得满意标本,一次性成功。其中活检穿刺发现肺癌骨转移人数最多,共72例,占73.47%,其次为肝癌骨转移,共19例,占19.39%,恶性黑色素瘤7例,占7.14%。本组98例 CT 引导下经皮穿刺氩氦刀冷冻治疗后并发症发生率为30.06%(30/98),其中血压升高严重者为3例,占3.06%,皮肤严重冻伤者1例,占1.02%。98例患者治疗后 VAS 和 KPS 评分较治疗前有显著下降(P <0.01)。结论 CT 引导下经皮穿刺氩氦刀冷冻技术不仅可以达到与常规方法治疗的准确率,且对恶性病灶的敏感度高,氩氦刀冷冻组织时定位准确,创口小,成功度较高,在保留骨诱导活性和保存肢体的前提下进行治疗。对转移性骨肿瘤患者进行 CT 引导下经皮穿刺氩氦刀冷冻治疗在降低局部复发率,保留骨诱导活性以及改善关节功能方面的临床应用前景广阔。%Objective To observe the clinical effect of CT guided percutaneous argon helium knife in the treatment of metastatic bone tumor.Methods Ninety-eight patients with metastatic bone tumor in our hospital were analyzed retrospectively.The clinical treatment and changes of VAS and KPS score were studied.Results 98 cases of patients with metastatic bone tumor were successfully sampled.Biopsy puncture showed that the largest number of lung cancer bone metastasis is 72,accounting for 73.47%;followed by 19 cases of bone metastasis of liver cancer,accounting for

  18. CT 引导下经皮椎体成形术治疗骨质疏松椎体压缩骨折的疗效评价%Clinical efficacy of CT -guided percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures

    Institute of Scientific and Technical Information of China (English)

    徐玉生; 朱海洋; 钟斌; 崔浩; 汪鑫; 理阳

    2016-01-01

    目的:评估 CT 精确引导下经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的疗效及其并发症的预防。方法87例脊柱病变患者(共98个伤椎)行 CT 精确引导下经皮椎体成形术,记录术前、术后患者视觉模拟疼痛评分(visual analogue scale,VAS)、Oswestry 功能障碍指数(oswestry disability index,ODI)以及远期疗效评估,并对结果进行统计学分析。结果术中应用优化的 CT 引导经皮椎体穿刺成功率100.00%,注入骨水泥2~9 ml,平均(4.17±1.34)ml。VAS 评分术前(7.96±0.48)分,术后6月(1.89±0.47)分;术前 ODI 平均(72.85±6.84)分、术后6个月(9.24±8.30)分;两指标术后与术前比较,差异具有统计学意义(P <0.05)。远期疗效 WHO 评估:总有效率为97.70%。术后即刻 CT证实,共4例患者发生无症状性骨水泥渗漏,其中1例出现暂时性神经根性痛。结论术中 CT 精确引导可优化椎体成形术的手术操作,有效控制椎体骨折引起的疼痛,提高患者的生活质量,是一种微创、安全、高效的治疗方法。%Objective To assess the clinical efficacy of intraoperative CT -guided percutaneous vertebroplasty (PVP)in the treatment of osteoporotic vertebral compression fractures and prevention of complications.Methods Total 98 fracture vertebra of the 87 cases with vertebra accepted optimization of accurate CT -guided percutaneous vertebroplasty.The visual analogue scale, oswestry disability index and long -term curative effect evaluation in preoperation and postoperation were recorded,and the re-sults were statistically analyzed.Results The success rate of optimized CT -guided PVP was 1 00.00%.Bone cements were in-jected 2 ~9 ml,with an average of (4.1 7 ±1 .34)ml.The average score of VAS were (7.96 ±0.48)and (1 .89 ±0.47) scores at preoperation and last follow up after the operation respectively

  19. APPLICATION OF CT-GUIDED BRONCHOALVEOLAR LAVAGE IN THE TREATMENT OF PATIENTS WITH SEVERE PNEUMONIA COMBINED SEPSIS SHOCK%CT 导引支气管镜肺泡灌洗对治疗重症肺炎合并脓毒症休克的效果

    Institute of Scientific and Technical Information of China (English)

    白静; 张军伟; 王建军; 程爱斌; 王红阳

    2014-01-01

    目的:探讨CT导引支气管镜肺泡灌洗对治疗肺感染合并脓毒症休克的疗效。方法对重症医学科2012年10月-2013年6月收治的47例重症肺炎合并脓毒症休克患者的临床资料进行回顾性分析。患者入选标准参照2001年国际脓毒症会议。将入选患者随机分为C T 导引支气管镜肺泡灌洗组(A组)和对照组(B组),二组均行早期目标导向治疗(EGDT ),CT 导引支气管镜肺泡灌洗组给予支气管镜肺泡灌洗连续做3d ,1次/d ,而对照组不给予支气管肺泡灌洗。记录患者年龄,性别,开始试验时、治疗后3d、7d的APACHEⅡ评分、肺感染评分、白细胞计数,乳酸降至2mmol/L的时间,机械通气时间,ICU住院时间。结果 A、B二组性别、年龄差异无统计学意义(P>0.05),开始治疗时APACHEⅡ评分、肺感染评分以及开始治疗时二组白细胞计数差异无统计学意义(P>0.05);治疗后3d和7d时 A组 APACHEⅡ评分、肺感染评分、白细胞计数明显低于B组(P<0.05);A组乳酸降至2mmol/L的时间、机械通气时间和ICU住院时间明显短于B组(P<0.05);CT 导引支气管镜肺泡灌洗操作无任何并发症的发生。结论CT导引支气管镜肺泡灌洗对治疗重症肺炎合并脓毒症休克患者安全有效,值得临床推广。%Objective To evaluate the significance of CT -guided bronchoscope alveolar lavage in severe pneumonia with sepsis shock patients .Methods The clinical experience and data of 47 patients of severe pneumonia with sepsis shock from October 2012 to June 2013 in author's hospital were retrospectively ana-lyzed .The selection criteria was in accordance with criteria set by International Conference On Sepsis in 2001 .All patients were randomly divided into treatment group(n=24)and control group(n=23) .Early goal-directed therapy(EGDT)was used in the first 6 hours of fluid resuscitation .In treatment group

  20. First case of 18F-FACBC PET/CT-guided salvage radiotherapy for local relapse after radical prostatectomy with negative 11C-Choline PET/CT and multiparametric MRI: New imaging techniques may improve patient selection

    Directory of Open Access Journals (Sweden)

    Eugenio Brunocilla

    2014-09-01

    Full Text Available We present the first case of salvage radiotherapy based on the results of 18F-FACBC PET/CT performed for a PSA relapse after radical prostatectomy. The patients underwent 11CCholine PET/CT and multiparametric MRI that were negative while 18F-FACBC PET/CT visualized a suspected local relapse confirmed by transrectal ultrasound-guided biopsy. No distant relapse was detected. Thus the patient was submitted to salvage radiotherapy in the prostatic fossa. After 20 months of follow-up, the PSA was undetectable and 18F-FACBC PET/CT was negative. Salvage radiotherapy after surgery, provided that it is administered at the earliest evidence of the biochemical relapse, may improve cancer control and favourably influence the course of disease as well as the adjuvant approach. New imaging techniques may increase the efficacy of the salvage radiotherapy thus helping in the selection of the patients. Preliminary clinical reports showed an improvement in the detection rate of 20-40% of 18F-FACBC in comparison with 11C-Choline for the detection of disease relapse after radical prostatecomy, rendering the 18F-FACBC the potential radiotracer of the future for prostate cancer.

  1. First case of 18F-FACBC PET/CT-guided salvage radiotherapy for local relapse after radical prostatectomy with negative 11C-Choline PET/CT and multiparametric MRI: New imaging techniques may improve patient selection.

    Science.gov (United States)

    Brunocilla, Eugenio; Schiavina, Riccardo; Nanni, Cristina; Borghesi, Marco; Cevenini, Matteo; Molinaroli, Enrico; Vagnoni, Valerio; Castellucci, Paolo; Ceci, Francesco; Fanti, Stefano; Gaudiano, Caterina; Golfieri, Rita; Martorana, Giuseppe

    2014-09-30

    We present the first case of salvage radiotherapy based on the results of 18F-FACBC PET/CT performed for a PSA relapse after radical prostatectomy. The patients underwent 11CCholine PET/CT and multiparametric MRI that were negative while 18F-FACBC PET/CT visualized a suspected local relapse confirmed by transrectal ultrasound-guided biopsy. No distant relapse was detected. Thus the patient was submitted to salvage radiotherapy in the prostatic fossa. After 20 months of follow-up, the PSA was undetectable and 18F-FACBC PET/CT was negative. Salvage radiotherapy after surgery, provided that it is administered at the earliest evidence of the biochemical relapse, may improve cancer control and favourably influence the course of disease as well as the adjuvant approach. New imaging techniques may increase the efficacy of the salvage radiotherapy thus helping in the selection of the patients. Preliminary clinical reports showed an improvement in the detection rate of 20-40% of 18F-FACBC in comparison with 11C-Choline for the detection of disease relapse after radical prostatecomy, rendering the 18F-FACBC the potential radiotracer of the future for prostate cancer.

  2. CT-guided percutaneous intratumoral chemotherapy with a novel cisplatin/epinephrine injectable gel for the treatment of unresectable malignant liver tumors; CT-gesteuerte perkutane intratumorale Chemotherapie mit Cisplatin-/Adrenalin-Gel zur Behandlung inoperabler maligner Lebertumoren. Ergebnisse einer klinischen Phase-II-Pruefung

    Energy Technology Data Exchange (ETDEWEB)

    Engelmann, K.; Mack, M.G.; Straub, R.; Eichler, K.; Zangos, S.; Vogl, T.J. [Universitaetsklinikum Frankfurt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Orenberg, E. [Matrix Pharmaceutical Inc., Fremont, CA (United States)

    2000-12-01

    Purpose: To evaluate prospectively the volumetric changes of tumor and necrosis in unresectable malignant liver tumors and the clinical aspects after CT-guided direct intratumoral administration of a novel cisplatin/epinephrine injectable gel in a clinical phase II study. Patients and methods: 8 patients with 17 colorectal liver metastases with a mean volume of 42 ml were treated with a mean of 5.1 injections and 8 patients with 11 HCC nodules (mean volume of 22.1 ml) with a mean of 3.25 treatments with CT-guided local administration of a novel cisplatin/epinephrine gel. This method of administration provides a higher local and lower systemic drug concentration. Volumes of tumor and necrosis prior to and after treatment were measured by computer-generated volumetric analysis. Results: Contrast-enhanced studies verified pretherapeutic tumor necrosis with a value of 12.6% in the metastases and 0.6% in the HCC nodules. Intratumoral drug administration resulted in a necrotic volume of 110% in metastases and 128% in HCC versus the mean initial tumor volume, at least 4 treatments resulted in 122% necrosis in metastases and 130% in HCC. Local therapy control rate for the follow-up to 6 months was 38% and 83.3% for the group of metastases and HCC, respectively. Conclusions: Direct intratumoral injection of a novel cisplatin/epinephrine injectable gel results in an induction of a relevant necrosis in malignant liver tumors, with a substantially higher local therapy control rate for HCC compared to colorectal metastases. (orig.) [German] Zielsetzung: Evaluation der Volumenaenderungen von Tumor und Nekrose nach CT-gesteuerter perkutaner intratumoraler Injektion eines neuartigen Cisplatin-/Adrenalin-Gels sowie der klinischen Aspekte diesewr Therapie bei Patienten mit inoperablen malignen Lebertumoren im Rahmen einer klinischen Phase-II-Studie. Patienten und Methoden: 8 Patienten mit 17 kolorektalen Lebermetastasen mit einem mittleren Volumen von 42 ml wurden mit

  3. Feasibility of 3 D print individual template combined with CT-guided 125 I seed implantation for malignant tumors%3 D打印个体化模板联合CT引导125 I粒子植入治疗恶性肿瘤质量评价

    Institute of Scientific and Technical Information of China (English)

    张颖; 林琦; 袁苑; 戴建建; 耿宝成; 徐瑞彩; 刘亚坤; 韩明勇

    2016-01-01

    Objective To evaluate the feasibility of 3 D print individual template and CT-guided 125 I seed implantation for malignant tumors.Methods A total of 30 patients were involved in this study.Before 125 I seed implantation,the patients received CT simulation orientation as the predicted posture.The individual template was designed by the brachytherapy treatment planning system (BTPS),and printed by 3D print technique.Every patient received 125 I seed implantation under the guidance of 3 D print individual template and CT scan.After implantation,treatment quality was evaluated with CT and BTPS.Results The 3D print individual templates were successfully designed and manufac-tured.Of all 30 cases,28 were successfully implanted with the 3 D print templates,and 2 failed.Of the 28 successful cases,22 had the same number of seeds implanted as scheduled before operation,and the other 6 cases optimized the number of seeds during operation.Postoperative evaluation indicated that 14 (50.0%)cases had excellent implants,10 (35.7%)had good implants,4 (14.3%)had suboptimal implants,and no case had poor implants.Conclusion The 3 D print individual template and CT-guided 125 I seed implantation appears to be a feasible,safe and effective modality for the treatment of malignant tumors.%目的:对3 D打印个体化模板联合CT引导125 I粒子植入术后验证的剂量学参数进行评价,探讨其治疗肿瘤的可行性。方法收集2015年12月至2016年7月住院患者30例,全部患者术前行CT模拟定位,设计并应用3D打印机打印个体化模板。手术时,将患者进行复位、模板与体表术区对合、按术前计划进针、植入粒子,术后即刻行CT扫描,进行剂量学验证。按照英国哥伦比亚癌症研究中心粒子植入质量评价标准对植入质量进行评价。结果30例患者均成功设计并打印个体化模板。28例技术成功,其中22例患者术后实际植入粒子数与术前计划一致,另外6例给

  4. CT 引导下穿刺灌注化疗联合放疗治疗盆腔囊性恶性肿瘤疗效观察%Efficacy observation of intracapsular perfusion of chemotherapeutic drugs combining with radiotherapy on cystic pelvic malignancies under CT-guided puncture

    Institute of Scientific and Technical Information of China (English)

    李平; 张庆怀; 张彦秋; 华海侠; 刘立杰; 顾涛; 付占昭

    2014-01-01

    Objective To evaluate the efficacy and safety of CT-guided puncture and intracapsular perfusion of chemotherapeutic drugs combining with radiotherapy on pelvic cystic malignancies.Methods Cisplatin was infused into the tumor through the percuta-neous catheter under the CT guidance.At the same time the radiation therapy was performed.During the follow-up,the patient’s complications,clinical efficacy,safety and clinical application value were evaluated.Results All 18 patients were punctured success-fully for the first time with an accuracy rate 100%.After treatment for 4 weeks,all patients were responded to the treatment with a partial response rate 100%.The duration of partial response ranged from 6 to 25 months.One patient was completely responded. Severe gastrointestinal adverse reactions and bone marrow suppression were not found in all patients.The duration of the puncture procedure ranged from 20 to 42 minutes with an average duration 24 min,and no complications such as infection,bleeding and perfo-ration were found.Conclusion The treatment of intracapsular perfusion of chemotherapeutic drugs combining with radiotherapy un-der CT-guided puncture on cystic pelvic malignancies is effective and safe with fewer adverse reactions.%目的:评价 CT 引导下穿刺灌注化疗联合放疗治疗盆腔囊性恶性肿瘤的疗效,分析其安全性,探讨其临床应用价值。方法 CT 引导下经皮穿刺置管于盆腔囊性肿物内,局部灌注顺铂化疗,同步行放射治疗。对穿刺患者随访,进行疗效评价,了解并发症情况,分析临床疗效、安全性及临床应用价值。结果18例患者中一次性穿刺成功率100%。其中4周内部分缓解率为100%,局部缓解时间最短为6个月,最长为25个月,1例达完全缓解。18例患者均未出现Ⅲ度以上胃肠道不良反应、骨髓抑制等。整个手术操作时间20~42 min,平均24 min,未出现感染、出血、穿孔等并发症。结论 CT 引导下穿刺灌注化疗

  5. CT 引导下胸交感神经化学阻断术治疗手多汗症的临床观察%CT -Guided Chemical Thoracic Sympathectomy for the Treatment of Palmar Hyperhidrosis:a Prospective Study of 26 Patients

    Institute of Scientific and Technical Information of China (English)

    杨红军; 邓兵梅; 程飚; 彭凯润; 武肖娜; 项薇

    2015-01-01

    目的:探讨 CT 引导下胸交感神经化学阻断术治疗手多汗症的临床疗效。方法:纳入手多汗症患者26例,参照多汗症量表评估其出汗严重程度。在 CT 引导下行胸交感神经化学阻断术,观察患者手术前后出汗评分、起效时间、并发症等指标。结果:本组患者术后手出汗明显减少,效果持久,其并发症轻微且多为一过性。结论:CT 引导下胸交感神经化学阻断术是治疗手多汗症安全、有效且实用的方法。%Objective: To assess the effect of CT-guided chemical thoracic sympathectomy treatment on patients with palmar hyperhidrosis. Methods: The study included 26 patients diagnosised as palmar hyperhidrosis and the severity of hyperhidrosis was measured by The Hyperhidrosis Disease Severity Scale (HDSS). All patients complet-ed a questionnaire including the following information: time to effect of thoracic sympathectomy, local or systemic complication, and severity of hyperhidrosis before and after thoracic sympathectomy. Results: There was a signifi-cant reduction in the severity of hyperhidrosis after performing thoracic sympathectomy. The side effects of treat-ment were slight and short. Conclusion: Treatment of palmar hyperhidrosis with thoracic sympathectomy was safe, effective and applicable.

  6. Application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung%CT引导下带钩钢丝定位行肺部磨玻璃影结节全腔镜下肺切除术28例分析

    Institute of Scientific and Technical Information of China (English)

    束余声; 赵伟刚; 石维平; 陆世春

    2015-01-01

    Objective To evaluate the application of preoperative CT-guided Hook-wire localization of pulmonary nodules in thoracoscopic lobectomy of lung.Method Twenty eight patients with 31 pulmonary nodules of ground-glass opacity (GGO) detected by CT scan were admitted in our hospital from December 2008 to December 2013,including 17 males and 11 females with an average age of 55.The lesions were located by CT-guided Hook-wire technique,and lobectomy plus lymphadenectomy or pulmonary wedge resection were performed according to the results of fast frozen pathology.The characteristics of pulmonary nodules and general condition of the patients were analyzed.Results Among 31 nodules,19 were malignant and 12 benign with an average size of (1.8 ± 0.6) cm and thickness of (1.2-± 0.4) cm.The vertical distance from pleural to nodules was (1.5 ± 0.7) cm and the insert depth of needle was (2.5 ± 0.9) cm.The time for CT-guided Hook-wire localization was (16.5 ± 5.2) min.The operation time for pulmonary wedge resection and pulmonary lobectomy was (18.5 ± 5.5) min and (54.7 ± 12.5) min,respectively.Intraoperative frozen section showed malignant tumors in 18 patients (19 GGO nodules),lobectomy plus lymphadenectomy were performed in 16 cases; 2 patients did not undergo pulmonary lobectomy because of poor physical condition or 2 GGO nodules in different lobes.There were no operation complications in this series.Postoperative pathologic findings of 31 nodules showed 9 cases of adenocarcinoma,10 bronchioloalveolar carcinoma,5 atypical adenomatous hyperplasia,2 epithelioid hemangioendothelioma,2 chronic inflammation,1 hamartoma,1 inflammatory pseudotumor and 1 sarcoidosis.The average postoperative hospital stay was (6.6 ± 1.9) days.Conclusions Endoscopic resection of pulmonary GGO nodules with CT-guided Hook-wire localization technique is feasible and safe,with less complications and less time consuming.%目的 探讨术前CT引导下Hook-wire定位在全腔镜下肺部磨玻璃影(GGO

  7. Application of C-arm CT-guided targeted puncturing technique in performing non-vascular interventional procedures%C臂CT引导经皮靶向穿刺术在非血管介入诊疗中的应用

    Institute of Scientific and Technical Information of China (English)

    何玉圣; 周春泽; 吕维富

    2014-01-01

    Objective To investigate the clinical value of C-arm CT-guided targeted puncturing technique in performing non-vascular interventional procedures.Methods DSA-guided percutaneous puncturing biopsy or interventional therapy was performed in 33 patients, and the clinical effect and complication were observed and analyzed.Results Percutaneous puncturing interventional therapy was performed successfully in 15 patients,and percutaneous puncturing biopsy was performed in 18 patients and pathological results were obtained in 17 pa-tients.Conclusion The percutaneous targeted puncturing technique with C-arm CT-guidance combines the advantages of both CT and X-ray,which can meet the need of accuracy,efficiency and safety in non-vascular interventional therapy.%目的:探讨C臂CT引导下靶向穿刺技术在非血管介入诊疗中的应用价值。方法33例患者在DSA引导下行经皮穿刺活检术或经皮穿刺介入治疗,观察分析临床效果、并发症等。结果经皮穿刺介入治疗15例,均取得成功,另外18例为经皮穿刺病理活检,17例取得明确病理结果。结论 C臂CT引导下靶向穿刺技术实现了CT和X线透视优势互补,达到精确、高效、安全的非血管介入诊疗要求,值得推广应用。

  8. 术前CT引导下亚甲蓝与Hookwire联合定位肺小结节临床应用价值%CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules before video-assisted thoracoscopic resection:the clinic application

    Institute of Scientific and Technical Information of China (English)

    俞同福; 徐海; 刘希胜; 宗敏; 陈亮; 朱全; 邵永峰; 詹必成

    2012-01-01

    目的 探讨CT引导下亚甲蓝与Hookwire联合定位在胸腔镜下孤立性肺小结节(SPN)切除术中的临床应用价值.方法 对56例患者的60枚SPN术前行CT引导下亚甲蓝与Hookwire联合定位后行胸腔镜(VATS)肺楔形切除术.全组患者男19例,女37例;年龄35~81岁,平均(61.1±8.9)岁.结果 56例60枚SPN直径为(6.80±4.12) mm,距壁层胸膜(15.38±4.63) mm.CT引导下定位成功率100%,定位时间(10.76±8.17) min.定位后5例(8.9%)发生局部少量气胸,4例(7.1%)发生肺出血,均无需治疗.60枚肺小结节病灶均准确定位,VATS楔形切除术成功率100%.术后病理显示,肺泡细胞癌(BAC)33枚(55.0%),肺泡细胞癌伴腺癌(BAC+ AC) 11枚(18.3%),肺泡细胞不典型增生(AAH)7枚(ll.8%),炎性肉芽肿4枚(6.7%),错构瘤3枚(5.0%),结核性肉芽肿2枚(3.3%).结论 胸腔镜术前CT引导下亚甲蓝与Hookwire联合定位准确率高,对胸腔镜手术(VATS)楔形切除病灶有极大的帮助作用,具有良好的临床应用价值.%Objective To evaluate the clinical application of CT-guided localization with combination of methylene blue and a Hookwire system for small pulmonary nodules (SPNs) before video-assisted thoracoscopic resection.Methods CTguided localization the SPNs before resection in 56 patients and 60 nodules,then underwent video-assisted thoracic surgery (VATS) resection.Among 56 patients,19 males and 37 females,aged from 35 to 81 years,mean age was (61.1 ±8.9)years.Results SPNs diameter (6.80 ±4.12) mm,distance from the parietal pleura (15.38 ±4.63) mm.CT-guided localization success rate was 100%,positioning time (10.76 ± 8.17) min,8.9% (5/56) had micro pneumothorax aftet positioning,7.1% (4/56) occurrence of needle tract bleeding,no conservative treatment.VATS resection rate was 100%.The pathology of 60 lesions were shown:Bronchiolo-alveolar carcinoma(BAC) were 33 lesions(55.0%),BAC and adenocarcinoma were 11 lesions(18.3

  9. 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.

  10. Long - term Efficacy and Safety of CT Guided Sphenopalatine Ganglion Radiofrequency Thermocoagulation in the Treatment of Sphenopalatine Neuralgia%CT 引导下蝶腭神经节射频热凝术治疗蝶腭神经痛的长期疗效及安全性分析

    Institute of Scientific and Technical Information of China (English)

    李娜; 郭玉娜; 秦红军; 贾绍芳; 左欣鹭; 杨惠婕; 倪家骧

    2016-01-01

    目的:探讨 CT 引导下蝶腭神经节射频热凝术治疗蝶腭神经痛( SPN)的长期疗效及安全性。方法选取2005年10月—2014年5月首都医科大学宣武医院疼痛科收治的行 CT 引导下蝶腭神经节射频热凝术治疗的 SPN患者8例,自2005年10月开始对患者进行电话随访,随访至2015年12月,随访时间为19~122个月,平均(55.4±12.8)个月。记录患者术前疼痛数字评分(NRS)和视觉模拟评分(VAS),术后3 d 和术后1个月、3个月、6个月、1年、2年、3年、5年、7年、10年的 NRS、VAS 及疼痛缓解情况,术后不良反应(包括视力障碍、面部血肿、颅内感染、体位性低血压、晕厥等)情况。结果术后3 d 疼痛缓解率为100.0%。患者均顺利完成随访,术后1个月、3个月、6个月、1年、3年、5年、7年、10年的疼痛缓解率均为100.0%;术后2年疼痛缓解率为87.5%,1例(12.5%)患者术后第16个月症状复发,口服盐酸曲马多缓释片控制疼痛,准备再次行 CT 引导下射频热凝术。术前患者(8例)NRS 为(8.4±1.4)分、VAS 为0分;术后3 d 患者(8例) NRS 为(0.3±0.7)分、VAS 为(2.6±5.6)分;术后1、3、6、12个月患者(8例)NRS 均为0分,VAS 分别为(1.5±1.3)分、(1.1±1.1)分、(0.5±0.9)分、0分;术后2年患者(6例)NRS 为0分、VAS 为0分;术后3、5年患者(4例)NRS 分别为0分、(0.5±1.0)分,VAS 均为0分;术后7年患者(2例)NRS、VAS 均为0分;术后10年患者(1例) NRS 为2分、VAS为0分。患者术后未出现视力障碍、面部血肿、颅内感染、体位性低血压甚至晕厥等严重不良反应。结论 CT 引导下蝶腭神经节射频热凝术治疗 SPN 可有效缓解疼痛,且维持时间长,是一种安全、有效的微创治疗方法。%Objective To investigate the long - term efficacy and safety of CT guided sphenopalatine ganglion

  11. CT引导下经皮穿刺微波消融联合125Ⅰ粒子植入治疗肝癌的术后护理%Postoperative nursing of liver cancer patients undergoing CT-guided PMCT combined with implantation of 125Ⅰ seeds

    Institute of Scientific and Technical Information of China (English)

    何晶晶; 陈英梅; 王秀臣

    2012-01-01

    目的 总结肝癌患者经皮穿刺微波消融联合125Ⅰ放射性粒子植入术术后护理要点.方法 对34例肝癌患者行CT引导下经皮穿刺微波消融联合125Ⅰ放射性粒子植入术,并配合做好术后护理工作.结果 本组患者完全缓解(CR)6例,部分缓解(PR)24例,稳定(SD)4例,总有效率为88.2%.术后并发症:发热6例、肝区疼痛7例、呕心、呕吐4例、穿刺点伤口感染1例、胸腔积液1例、穿刺部位出血1例.结论 CT引导下经皮穿刺微波消融联合125Ⅰ粒子植入治疗肝癌效果较好,术后做好患者病情观察与并发症护理是治疗成功的重要措施.%Objective To summarize the methods for nursing liver cancer patients undergoing percutaneous microwave coagulation therapy (PMCT) combined with 125I seeds implantation. Method 34 liver cancer patients were treated with CT-guided PMCT combined with implantation of 128I seeds. The postoperative nursing was conducted intensively. Results 6 of them had complete remission (CR), 24 partial remission (PR) and 4 stable disease (SD). The effective rate was 88.2%. The main postoperative complications included fever (6 cases), liver pain (7 cases), nausea and vomiting (4 cases), infection at the puncture site (1 case), chest fluid (1 case), and hemorrhage at the puncture site (1 case). Conclusions PMCT combined with implantation of 125I seeds is effective in treating liver cancer. The observing and nursing of the complications after operation is critical as well for the successful treatment.

  12. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  13. 微波消融联合125I粒子植入治疗腹腔恶性软组织肿瘤的临床观察%CT-guided 125 I radioactive seeds implantation and microwave ablation for treatment of intraperitoneal soft tissue sarcomas

    Institute of Scientific and Technical Information of China (English)

    吴孟孟; 孙亚红; 宋鹏远; 盛立军

    2016-01-01

    OBJECTIVE Soft tissue sarcoma has high recurrence and metastatic rate,and it is difficult to find a uni-fied treatment program after recurrence and metastasis.The aim of this paper was to investigate the safety,efficacy,and clinical value of CT-guided percutaneous microwave ablation combined with 125 I radioactive seeds implantation for the treatment of intraperitoneal soft tissue sarcomas.METHODS A retrospective study included 25 patients with intraperito-neal soft tissue sarcomas in Affiliated Hospital of Shandong Academy of Medical Sciences from February 1,2013 to March 1,2015.All patients received microwave ablation,followed by CT review one week later.With the help of TPS treatment planning system,implantation of 125 I seeds was performed as planned.Therapeutic effects and patients’follow-up survival rate were assessed according to WHO Response Evaluation Criteria in Solid Tumors.RESULTS Operations were com-pleted in 25 patients.Progression-free survival (PFS)was 5 months,with 6 cases of complete remission (CR),10 cases of partial response (PR),7 cases of stable disease (SD),and 2 cases of progressive disease (PD).The response rate (RR) was 64% and disease control rate (DCR)was 92%.The case of severe postoperative complications was 0/25.Twenty-four patients are still alive now.The longest followed span was 32 months,and the shortest was 6 months.The average survival period was 14 months,1 cases of death.CONCLUSION CT-guided percutaneous microwave ablation combined with 125 I radioactive seeds implantation is a minimally invasive,safe and effective treatment method for intraperitoneal soft tissue sarcomas.%目的:软组织肿瘤复发率及转移率高,复发或转移后没有统一的治疗方案。探讨 CT 引导下经皮穿刺微波消融术联合125 I 粒子植入治疗腹腔恶性软组织肿瘤的安全性、有效性及应用价值。方法回顾性分析山东省医学科学院附属医院2013-02-01-2015-03-01收治的25例腹腔恶性软组

  14. CT-guided percutaneous irreversible electroporation for the treatment of locally advanced pancreatic cancer%CT引导不可逆电穿孔消融术治疗局部晚期胰腺癌的有效性和安全性

    Institute of Scientific and Technical Information of China (English)

    魏颖恬; 肖越勇; 张肖; 何晓锋; 张欣; 李婕; 杨杰; 张啸波

    2016-01-01

    目的:评价CT引导不可逆电穿孔(IRE)消融术治疗局部晚期胰腺癌的有效性和安全性。方法前瞻性收集经穿刺病理证实的影像表现提示为Ⅲ期胰腺癌患者14例,术前常规行实验室检查和影像检查(CT、MRI、PET-CT等)了解患者的疾病状况。在全身麻醉下行IRE消融术,于CT引导下经皮穿刺置入消融电极,根据肿瘤大小、位置及电极针数目进行消融参数设置,电极针尖端裸露1 cm,消融模式为拔针分段消融。术后第1~3天、1周、1.0个月、3.0个月复查影像及实验室检查,采用改良的WHO实体瘤疗效评价标准评价IRE消融治疗的有效性。观察并发症发生情况。结果14例患者手术均顺利完成。消融完成后即刻行CT增强扫描,消融区均呈低密度坏死改变,无强化,消融边界清晰。术后1周复查CT,14例肿瘤坏死彻底,周围组织结构无破坏。术后1.0个月行CT或MRI显示所有病灶消融区域均呈低密度(信号)改变,增强扫描未见异常强化,周围血管及胰管形态完整。术后胰淀粉酶及CA199一过性升高,而后逐渐降低,术后1周及1.0个月后复查明显降低,癌胚抗原未见明显升高。并发症包括胰周炎性渗出3例、腹膜后感染1例、肠系膜上静脉血栓2例、门静脉主干血栓2例、十二指肠狭窄1例。1例术后2.5个月死于消化道大出血。其余13例于术后3个月评价疗效,完全缓解4例、部分缓解7例、病变稳定2例。结论 CT引导下IRE消融术治疗局部晚期胰腺癌有效、安全。%Objective To investigate the safety and efficacy of treatment with CT-guided percutaneous irreversible electroporation (IRE) of locally advanced pancreatic cancer(LAPC). Methods Patients with unresectable radiographic stage ⅢLAPC were prospectively collected. Comprehensive blood and imaging (CT,MRI,PET-CT) baseline examinations were completed and analyzed preoperatively

  15. CT 引导下穿刺定位联合单操作孔胸腔镜切除肺磨玻璃密度微小结节的临床研究%Clinic research of CT guided localization with a hook-wire system for small ground glass opacity pulmo-nary nodules united with single port video-assisted thoracoscopic resection

    Institute of Scientific and Technical Information of China (English)

    王波; 王彬; 张连斌; 初向阳

    2015-01-01

    目的:评价术中应用 CT 引导下穿刺定位后行单操作孔胸腔镜切除 CT 病灶直径<1.5 cm且胸膜无明显改变的磨玻璃样小结节的临床效果。方法2009年8月至2014年9月共15例肺磨玻璃样小结节患者,手术室内麻醉、体位固定后行术中 CT 引导下带钩钢丝针穿刺定位,随即行胸腔镜切除术。评价术中 CT 引导下穿刺定位技术的准确性、并发症、单操作孔胸腔镜手术切除率及病理结果等。结果15个磨玻璃样小结节均在术中 CT 引导下穿刺定位明确并行单操作孔胸腔镜切除术。术中 CT 定位成功率100%,平均定位时间(13.60±2.06)min,仅1例穿刺后出现少量气胸。单操作孔胸腔镜手术切除率为100%,其中肺叶切除1例,肺段切除1例,局部切除13例。术后病理诊断结果:原位腺癌9例,不典型腺瘤样增生(AAH)5例,AAH 合并原位腺癌1例。术后随访患者均存活,无复发、转移征象。结论术中麻醉下应用 CT 引导能准确将 CT 直径<1.5 cm 且胸膜无明显改变的磨玻璃样小结节行穿刺定位,并能联合单操作孔胸腔镜将其切除,准确、快捷、安全,具有很好的临床价值。%Objective To evaluate the clinical effect of CT guided localization with a hook-wire system united with single port video-assisted thoracoscopic resection (VATS)for small ground glass opacity (GGO) pulmonary nodules (CT lesion diameter <1 .5 cm and no pleural changes).Methods Fifteen patients with small GGO pulmonary nodules who underwent CT-guided transthoracic localization with a hook-wire system in operation room after anesthesia were performed with single port VATS from August 2009 to March 201 3.The accuracy of puncture location,complications,resection rate and pathological results were evaluated.Results All patients underwent CT-guided hook-wire localization and single port VATS resection.The success rate of localization was 1 00

  16. Lumbar Plexus Anatomy within the Psoas Muscle: Implications for the Transpsoas Lateral Approach to the L4-L5 Disc%腰大肌内腰神经丛解剖:L4-5椎间盘经腰大肌外侧入路的可行性研究

    Institute of Scientific and Technical Information of China (English)

    Timothy T. Davis; Hyun W. Bae; MAJ James M. Mok; Alexandre Rasouli; Rick B. Delamarter; 彭宝淦

    2012-01-01

    背景:在脊柱微创手术中,经腰大肌外侧手术途径可取代直接前路手术.然而,采用外侧手术途径,术后常发现大腿疼痛,麻木,或者无力.本文进行尸体解剖研究的目的是提供与经腰大肌外侧手术途径相关的腰丛解剖.方法:对18个尸体解剖标本进行腰丛解剖学研究.将穿刺针于正中冠状位水平扎入L2-3,L3-4和L4-5椎间盘内.观察穿刺针近端神经结构及其它解剖结构的关系.结果:18个标本中,其中13个标本L2-4神经根分出后,在L4-5椎间盘水平形成股神经.在所有标本中,股神经经过椎间盘背侧或正对中点.在3个标本中,针使股神经移位或接近股神经.其中13个标本在L4-5椎间盘水平发现股神经在穿刺针和L4-5椎间盘背侧面之间.结论:由于近端的神经因素,尤其是股神经,正对L4-5椎间盘中央,对L4-5椎间盘经腰大肌外侧入路可能引起在牵开扩张的过程中可能引起术中神经结构从其解剖路径中移位.因此,在扩张牵开的过程中,尤其在L4-5椎间盘经腰大肌外侧途径时,应非常小心.临床相关性:在L4-5椎间盘经腰大肌外侧手术路径中,由于股神经的位置和手术扩张牵开器的大小,股神经有术中损伤的危险.

  17. CT-guided brachytherapy as salvage therapy for intrahepatic recurrence of HCC after surgical resection.

    Science.gov (United States)

    Schnapauff, Dirk; Collettini, Federico; Hartwig, Kerstin; Wieners, Gero; Chopra, Sascha; Hamm, Bernd; Gebauer, Bernhard

    2015-01-01

    Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previous resection is rising. The purpose of this study was to determine survival of patients undergoing computed tomography-guided brachytherapy (CT-HDRBT). Altogether 19 patients with unresectable HCC recurrence were treated with CT-HDRBT at our Institution. Patients underwent single-fraction high-dose irradiation by an iridium-192 source after CT fluoroscopy-guided catheter placement. The median tumor-enclosing target dose was 20 Gy. The median follow-up was 33 months. According to the Kaplan-Meier method, median overall survival after CT-HDRBT was 50 months, and median survival after first hepatic resection was 87 months. The median duration of local tumor control was 32 months and time to disease progression was 20 months. There were no serious complications after CT-HDRBT and no treatment-related deaths. CT-HDRBT is a safe, potentially life prolonging technique in patients with recurrence of HCC who have few therapeutic options. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. Treatment of osteoid osteoma with CT-guided percutaneous radiofrequency thermoablation.

    Science.gov (United States)

    de Palma, Luigi; Candelari, Roberto; Antico, Ettore; Politano, Rocco; Luniew, Eugenio; Giordanengo, Maurizio; Di Giansante, Silvio; Marinelli, Mario; Paci, Enrico

    2013-05-01

    Osteoid osteoma is a benign bone tumor with a male predominance occurring mainly in children and young adults. The most common symptom is intermittent pain that worsens at night and is at least partially relieved by nonsteroidal anti-inflammatory drugs. The purpose of this study was to assess the long-term effectiveness of computed tomography-guided percutaneous radiofrequency thermoablation in patients with a minimum follow-up of 2 years. Twenty patients with osteoid osteoma (15 men and 5 women) with a mean age of 20.7 years (range, 4-61 years; 12 patients aged 20 years or younger) underwent computed tomography-guided percutaneous radiofrequency thermoablation. Lesion sites were the femur (n=9), tibia (n=7), pelvis (n=1), talus (n=1), cuneiform bone (n=1), and humerus (n=1). Mean follow-up was 44 months (range, 3-106 months). Pain relief was significant in 95% of patients; it disappeared within 24 hours in 14 patients, within 3 days in 4, and within 7 days in 1. The patient with persistent symptoms underwent another percutaneous radiofrequency thermoablation procedure that was successful. The difference between pre- and postoperative pain was significant (P ≤ .01). No recurrences occurred. Computed tomography-guided percutaneous radiofrequency thermoablation is a safe, minimally invasive, and economical procedure with high technical and clinical success rates, and it effectively and durably enhances quality of life.

  19. CT-guided fine needle aspiration cytology diagnosis of extra-adrenal pheochromocytoma

    OpenAIRE

    Rangaswamy M; Kumar Sandeep; Asha M; Manjunath G

    2010-01-01

    Pheochromocytoma is a rare tumor, accounting for <0.1% of the hypertensive population. Extra-adrenal pheochromocytomas (EAPs) are rarer still, accounting for 10% of all pheochromocytomas. Pheochromocytomas are functional catecholamine-secreting tumors of the paraganglionic chromaffin cells found in the adrenal medulla and the extra-adrenal paraganglia cells. EAPs are readily detected by computed tomography (CT) as soft tissue masses closely associated with the entire length o...

  20. Accuracy and complications of CT-guided core needle biopsy of peripheral nerve sheath tumours

    Energy Technology Data Exchange (ETDEWEB)

    Pianta, Marcus; Chock, Eric; Schlicht, Stephen [St Vincent' s Hospital, Fitzroy, VIC (Australia); McCombe, David [St Vincent' s Hospital and Victorian Hand Surgery Associates, Victoria (Australia)

    2015-09-15

    This single-centre study retrospectively reviews the complications in patients that have occurred following peripheral nerve sheath tumour biopsy, and assesses whether there is an association with biopsy technique or underlying lesion characteristics. 41 consecutive core needle biopsies of proven peripheral nerve sheath tumours over a 2-year period in a tertiary teaching hospital were reviewed. Patient demographics and symptoms, tumour characteristics and radiological appearances were recorded. Biopsy and surgical histology were correlated, and post-biopsy and surgical complications analyzed. 41 biopsies were performed in 38 patients. 68 % schwannomas, 24 % neurofibromas and 7 % malignant peripheral nerve sheath tumours. Biopsy histology correlated with surgery in all cases. 71 % of lesions were surgically excised. 60 % of patients reported pain related to their lesion. Following the biopsy, 12 % reported increased pain, which resolved in all cases. Pain exacerbation was noted in tumours smaller in size, more superficial and in closer proximity of the biopsy needle tip to the traversing nerve. Number of biopsy needle passes was not associated with an increased incidence of procedure-related pain. Core biopsy of a suspected peripheral nerve sheath tumour may be performed safely before excisional surgery to confirm lesion histology and assist prognosis. There is excellent correlation between core biopsy and excised surgical specimen histology. The most common complication of pain exacerbation is seen in a minority and is temporary, and more likely with smaller, more superficial lesions and a closer needle-tip to traversing nerve distance during biopsy. (orig.)

  1. Improving CT-guided transthoracic biopsy of mediastinal lesions by diffusion-weighted magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, Marcos Duarte; TyngI, Chiang Cheng; Bitencourt, Almir Galvao Vieira; Gross, Jefferson Luiz; Zurstrassen, Charles Edouard, E-mail: marcosduarte500@gmail.com [AC Camargo Cancer Center, Sao Paulo, SP (Brazil); Hochhegger, Bruno [Universidade Federal de Ciencias da Saude de Porto Alegre (UFCSPA), RS (Brazil). Dept. de Radiologia; Benveniste, Marcelo Felipe Kuperman; Odisio, Bruno Calazans [University of Texas, MD Anderson Cancer Center, Houston, TX (United States); Marchiori, Edson [Universidade Federal do Rio de Janeiro (UFRJ), Petropolis, RJ (Brazil)

    2014-11-15

    Objectives: to evaluate the preliminary results obtained using diffusion-weighted magnetic resonance imaging and the apparent diffusion coefficient for planning computed tomography-guided biopsies of selected mediastinal lesions. Methods: eight patients with mediastinal lesions suspicious for malignancy were referred for computed tomography-guided biopsy. Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient measurement were performed to assist in biopsy planning with diffusion/computed tomography fused images. We selected mediastinal lesions that could provide discordant diagnoses depending on the biopsy site, including large heterogeneous masses, lesions associated with lung atelectasis or consolidation, lesions involving large mediastinal vessels and lesions for which the results of biopsy using other methods and histopathological examination were divergent from the clinical and radiological suspicion. Results: in all cases, the biopsy needle was successfully directed to areas of higher signal intensity on diffusion weighted sequences and the lowest apparent diffusion coefficient within the lesion (mean, 0.8 [range, 0.6–1.1]610{sup -3} mm{sup 2}/s), suggesting high cellularity. All biopsies provided adequate material for specific histopathological diagnoses of four lymphomas, two sarcomas and two thymoma s. Conclusion: functional imaging tools, such as diffusion-weighted imaging and the apparent diffusion coefficient, are promising for implementation in noninvasive and imaging-guided procedures. However, additional studies are needed to confirm that mediastinal biopsy can be improved with these techniques. (author)

  2. Passive breath gating equipment for cone beam CT-guided RapidArc gastric cancer treatments.

    Science.gov (United States)

    Hu, Weigang; Li, Guichao; Ye, Jinsong; Wang, Jiazhou; Peng, Jiayuan; Gong, Min; Yu, Xiaoli; Studentski, Matthew T; Xiao, Ying; Zhang, Zhen

    2015-01-01

    To report preliminary results of passive breath gating (PBG) equipment for cone-beam CT image-guided gated RapidArc gastric cancer treatments. Home-developed PBG equipment integrated with the real-time position management system (RPM) for passive patient breath hold was used in CT simulation, online partial breath hold (PBH) CBCT acquisition, and breath-hold gating (BHG) RapidArc delivery. The treatment was discontinuously delivered with beam on during BH and beam off for free breathing (FB). Pretreatment verification PBH CBCT was obtained with the PBG-RPM system. Additionally, the reproducibility of the gating accuracy was evaluated. A total of 375 fractions of breath-hold gating RapidArc treatments were successfully delivered and 233 PBH CBCTs were available for analysis. The PBH CBCT images were acquired with 2-3 breath holds and 1-2 FB breaks. The imaging time was the same for PBH CBCT and conventional FB CBCT (60s). Compared to FB CBCT, the motion artifacts seen in PBH CBCT images were remarkably reduced. The average BHG RapidArc delivery time was 103 s for one 270-degree arc and 269 s for two full arcs. The PBG-RPM based PBH CBCT verification and BHG RapidArc delivery was successfully implemented clinically. The BHG RapidArc treatment was accomplished using a conventional RapidArc machine with high delivery efficiency. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. Preoperative visualization of the trajectory for CT-guided stereotactic surgery; A technical note

    Energy Technology Data Exchange (ETDEWEB)

    Ohira, Takayuki; Toya, Shigeo; Momoshima, Hirotaka; Shiga, Hayao (Keio Univ., Tokyo (Japan). School of Medicine)

    1989-04-01

    A method is reported for confirming the entire trajectory on CT images using Komai's CT stereotactic apparatus and a GE 8800 CT scanner. For this purpose, we used the 'oblique reformation software with a parameter mode' contained in the GE 8800 CT scanner and made a 'Y-angle ring' for Komai's stereotactic apparatus. The value of the angle between the axial plane and the arc (Y angle) was put on the scale of the ring during operation. Pseudo-coronal and pseudo-sagittal images containing the entire trajectory were re-formed by this software using 6 values of the X, Y, and Z coordinates for the target and trephination points. This method allows the quick visualization of various potential routes, thus aiding the optimal selection of the best actual surgical paths. (author).

  4. Comparison of two electromagnetic navigation systems for CT-guided punctures. A phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Putzer, D.; Arco, D.; Schamberger, B.; Schanda, F.; Mahlknecht, J.; Widmann, G.; Schullian, P.; Jaschke, W.; Bale, R. [Innsbruck Medical University (Austria). Dept. of Radiology

    2016-05-15

    We compared the targeting accuracy and reliability of two different electromagnetic navigation systems for manually guided punctures in a phantom. CT data sets of a gelatin filled plexiglass phantom were acquired with 1, 3, and 5 mm slice thickness. After paired-point registration of the phantom, a total of 480 navigated stereotactic needle insertions were performed manually using electromagnetic guidance with two different navigation systems (Medtronic Stealth Station: AxiEM; Philips: PercuNav). A control CT was obtained to measure the target positioning error between the planned and actual needle trajectory. Using the Philips PercuNav, the accomplished Euclidean distances were 4.42 ± 1.33 mm, 4.26 ± 1.32 mm, and 4.46 ± 1.56 mm at a slice thickness of 1, 3, and 5 mm, respectively. The mean lateral positional errors were 3.84 ± 1.59 mm, 3.84 ± 1.43 mm, and 3.81 ± 1.71 mm, respectively. Using the Medtronic Stealth Station AxiEM, the Euclidean distances were 3.86 ± 2.28 mm, 3.74 ± 2.1 mm, and 4.81 ± 2.07 mm at a slice thickness of 1, 3, and 5 mm, respectively. The mean lateral positional errors were 3.29 ± 1.52 mm, 3.16 ± 1.52 mm, and 3.93 ± 1.68 mm, respectively. Both electromagnetic navigation devices showed excellent results regarding puncture accuracy in a phantom model. The Medtronic Stealth Station AxiEM provided more accurate results in comparison to the Philips PercuNav for CT with 3 mm slice thickness. One potential benefit of electromagnetic navigation devices is the absence of visual contact between the instrument and the sensor system. Due to possible interference with metal objects, incorrect position sensing may occur. In contrast to the phantom study, patient movement including respiration has to be compensated for in the clinical setting.

  5. Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Inês Correia

    2016-01-01

    Full Text Available Spontaneous intracranial hypotension (SIH is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.

  6. Percutaneous CT-Guided Treatment of Osteochondritis Dissecans of the Sacroiliac Joint

    Energy Technology Data Exchange (ETDEWEB)

    Becce, Fabio, E-mail: fabio.becce@chuv.ch [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Mouhsine, Elyazid [Clinique Hirslanden Bois-Cerf, Department of Orthopaedic Surgery (Switzerland); Mosimann, Pascal John; Anaye, Anass [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland); Letovanec, Igor [University Institute of Pathology, Centre Hospitalier Universitaire Vaudois (Switzerland); Theumann, Nicolas [University of Lausanne, Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois (Switzerland)

    2012-08-15

    Osteochondritis dissecans (OCD) is a joint disorder that affects the articular cartilage and subchondral bone, most commonly at the knee. OCD of the sacroiliac joint is extremely rare. Management of OCD remains controversial, and surgery is often needed, especially when conservative treatment fails. We present a rare case of OCD involving the left sacroiliac joint successfully treated by percutaneous computed tomography-guided retrograde drilling and debridement.

  7. CT-guided biopsy of lung lesions: defining the best needle option for a specific diagnosis

    Science.gov (United States)

    Guimarães, Marcos Duarte; Marchiori, Edson; Hochhegger, Bruno; Chojniak, Rubens; Gross, Jefferson Luiz

    2014-01-01

    OBJECTIVES: To evaluate the performance of fine and cutting needles in computed tomography guided-biopsy of lung lesions suspicious for malignancy and to determine which technique is the best option for a specific diagnosis. METHODS: This retrospective study reviewed the data from 362 (71.6%) patients who underwent fine-needle aspiration biopsy and from 97 (19.7%) patients who underwent cutting-needle biopsy between January 2006 and December 2011. The data concerning demographic and lesion characteristics, procedures, biopsy sample adequacy, specific diagnoses, and complications were collected. The success and complication rates of both biopsy techniques were calculated. RESULTS: Cutting-needle biopsy yielded significantly higher percentages of adequate biopsy samples and specific diagnoses than did fine-needle aspiration biopsy (pneedle biopsy were 93.8%, 97.3%, and 95.2%, respectively; those of fine-needle aspiration biopsy were 82.6%, 81.3%, and 81.8%, respectively (all pfine-needle aspiration biopsy, and that of hematoma was higher for cutting-needle biopsy (both pbiopsy showed that cutting-needle biopsy yielded better results than did fine-needle aspiration biopsy and that there was no significant increase in complication rates to indicate the best option for specific diagnoses. PMID:24838899

  8. Treatment of radiation-induced cystitis and vulvodynia via a ganglion impar block using a lateral approach under computed tomography guidance: a case report

    Science.gov (United States)

    Lee, Jeong-Eun; Kwak, Kyung-Hwa; Hong, Seong Wook; Jung, Hoon; Chung, Seung-Yeon

    2017-01-01

    Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas. PMID:28184272

  9. A hybrid approach to appendicitis with right external iliac artery pseudo aneurysm: A case report.

    Science.gov (United States)

    Chandler, Benjamin T; Ryer, Evan J; Keyser, Benjamin M; Elmore, James R

    2017-01-01

    While acute appendicitis is a common surgical problem, the simultaneous occurrence of appendicitis and an infected iliac artery pseudoaneurysm is exceedingly rare. We report the successful treatment of an infected right external iliac artery pseudo aneurysm in the 1setting of acute appendicitis. The patient is an 83-year-old male who presents with severe sepsis, right lower quadrant and right leg pain. Additional past medical history is significant for rectal cancer status post resection and radiation therapy in 1997. Computed tomography (CT) on admission revealed a right iliopsoas muscle abscess, an inflamed Appendix and a pseudo aneurysm arising from the right external iliac artery. After consultations by multiple specialties, the plan was to proceed with percutaneous drainage of the abscess, antibiotic therapy and subsequent repair of the pseudoaneurysm. CT guided drainage of the iliopsoas abscess was performed with return of hemorrhagic fluid. Due to the concern of contained pseudoaneurysm rupture, the patient was taken for expedited repair. Due to the patient's frailty and hostile abdomen, we performed embolization of the right external iliac artery pseudoaneurysm with Amplatzer I plugs (St. Jude Medical, St. Paul MN) and left common femoral to right superficial femoral bypass with cryopreserved cadaveric femoral vein. Following pseudoaneurysm exclusion, continued percutaneous drainage and antibiotic therapy, the patient has done well with no further evidence of infection. Repair of infected pseudo aneurysms can prove challenging. Ongoing infection, a hostile surgical abdomen and patient frailty further complicates the treatment of these patients. This case displays a minimally invasive approach to this rare but morbid condition. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  10. Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Tomas, Xavier; Garcia-Diez, Ana Isabel; Pomes, Jaime [Universidad de Barcelona, Department of Radiology, Hospital Clinic, Barcelona (Spain); Bori, Guillem; Garcia, Sebastian; Gallart, Xavier; Martinez, Juan Carlos; Riba, Josep [Universidad de Barcelona, Department of Orthopaedics, Hospital Clinic, Barcelona (Spain); Soriano, Alex; Mensa, Josep [Universidad de Barcelona, Department of Infectious Diseases, Hospital Clinic, Barcelona (Spain); Rios, Jose [Statistical Unit de Suport a la Estadistica I Metodologia IDIBAPS, Barcelona (Spain); Almela, Manel [Universidad de Barcelona, Department of Microbiology, Hospital Clinic, Barcelona (Spain)

    2011-01-15

    To determine the accuracy of guided computed tomography aspiration in the detection of septic hip prosthesis before surgery. Sixty-three patients (35 women and 28 men; age range, 29-86 years; mean age, 71 years) with clinically suspected septic hip prosthesis were prospectively studied with independent review board (IRB) approval. Volume and microbiological cultures of aspirated fluid and several computed tomography imaging findings such as periprosthetic fluid collections, prosthetic acetabular malposition, and heterotopic ossification were analyzed. All patients underwent revision surgery and infection was finally diagnosed in 33 patients. Statistical comparative analysis was performed comparing computed tomography aspiration and surgical findings (95% CI; level of significance at P = 0.05 two-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% positive predictive value, and 75% negative predictive value. Using Fisher's exact test, the presence of periprosthetic fluid collections (P = 0.001), prosthetic acetabular malposition (P = 0.025) and aspirated fluid volume (P = 0.009) were significantly higher in infected than in non-infected prostheses, whereas heterotopic ossification was not (P = 0.429). Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis. (orig.)

  11. Laser Guidance in C-Arm Cone-Beam CT-Guided Radiofrequency Ablation of Osteoid Osteoma Reduces Fluoroscopy Time

    NARCIS (Netherlands)

    Kroes, M.W.; Busser, W.M.H.; Hoogeveen, Y.L.; Lange, F. de; Schultze Kool, L.J.

    2017-01-01

    PURPOSE: To assess whether laser guidance can reduce fluoroscopy and procedure time of cone-beam computed tomography (CBCT)-guided radiofrequency (RF) ablations of osteoid osteoma compared to freehand CBCT guidance. MATERIALS AND METHODS: 32 RF ablations were retrospectively analyzed, 17

  12. Cone-beam CT-guided radiotherapy in the management of lung cancer. Diagnostic and therapeutic value

    Energy Technology Data Exchange (ETDEWEB)

    Elsayad, Khaled; Kriz, Jan; Reinartz, Gabriele; Scobioala, Sergiu; Ernst, Iris; Haverkamp, Uwe; Eich, Hans Theodor [University Hospital of Muenster, Department of Radiation Oncology, Muenster (Germany)

    2016-02-15

    Recent studies have demonstrated an increase in the necessity of adaptive planning over the course of lung cancer radiation therapy (RT) treatment. In this study, we evaluated intrathoracic changes detected by cone-beam CT (CBCT) in lung cancer patients during RT. A total of 71 lung cancer patients treated with fractionated CBCT-guided RT were evaluated. Intrathoracic changes and plan adaptation priority (AP) scores were compared between small cell lung cancer (SCLC, n = 13) and non-small cell lung cancer (NSCLC, n = 58) patients. The median cumulative radiation dose administered was 54 Gy (range 30-72 Gy) and the median fraction dose was 1.8 Gy (range 1.8-3.0 Gy). All patients were subjected to a CBCT scan at least weekly (range 1-5/week). We observed intrathoracic changes in 83 % of the patients over the course of RT [58 % (41/71) regression, 17 % (12/71) progression, 20 % (14/71) atelectasis, 25 % (18/71) pleural effusion, 13 % (9/71) infiltrative changes, and 10 % (7/71) anatomical shift]. Nearly half, 45 % (32/71), of the patients had one intrathoracic soft tissue change, 22.5 % (16/71) had two, and three or more changes were observed in 15.5 % (11/71) of the patients. Plan modifications were performed in 60 % (43/71) of the patients. Visual volume reduction did correlate with the number of CBCT scans acquired (r = 0.313, p = 0.046) and with the timing of chemotherapy administration (r = 0.385, p = 0.013). Weekly CBCT monitoring provides an adaptation advantage in patients with lung cancer. In this study, the monitoring allowed for plan adaptations due to tumor volume changes and to other anatomical changes. (orig.) [German] Neuere Studien haben eine zunehmende Notwendigkeit der adaptiven Bestrahlungsplanung im Verlauf der Bestrahlungsserie bei Patienten mit Lungenkrebs nachgewiesen. In der vorliegenden Studie haben wir intrathorakale Aenderungen mittels Cone-beam-CT (CBCT) bei Lungenkrebspatienten waehrend der Radiotherapie (RT) analysiert. Analysiert wurden 71 Patienten, die eine fraktionierte CBCT-basierte RT bei Lungenkrebs erhalten haben. Intrathorakale Veraenderungen und Prioritaet-Scores fuer die adaptive Plananpassung (AP) wurden zwischen kleinzelligem (SCLC: 13 Patienten) und nicht-kleinzelligem Bronchialkarzinom (NSCLC: 58 Patienten) verglichen. Die mediane kumulative Strahlendosis betrug 54 Gy (Spanne 30-72 Gy), die mediane Einzeldosis 1,8 Gy (Spanne 1,8-3,0 Gy). Alle Patienten wurden mit einem CBCT-Scan mindestens einmal woechentlich (Spanne 1-5/Woche) untersucht. Wir beobachteten intrathorakale Aenderungen in 83% der Patienten im Verlauf der RT [58 % (41/71) Regression, 17 % (12/71) Progression, 20 % (14/71) Atelektase, 25 % (18/71) Pleuraerguss, 13 % (9/71) infiltrative Veraenderungen und 10 % (7/71) anatomische Verschiebung des Tumors]. Fast die Haelfte der Patienten hatte eine intrathorakale Weichgewebeveraenderung (45 %, 32/71) 22,5 % (16/71) hatten zwei. Drei oder mehr Veraenderungen wurden in 15,5 % (11/71) der Patienten beobachtet. Planmodifikationen wurden in 60 % (43/71) der Patienten durchgefuehrt. Die visuelle Volumenreduktion korrelierte mit der Anzahl der erworbenen CBCT-Scans (r = 0,313; p = 0,046) als auch mit dem Zeitpunkt der Verabreichung der Chemotherapie (r = 0,385; p = 0,013). Das woechentliche CBCT-Monitoring bietet einen Adaptationsvorteil bei Patienten mit Lungenkrebs. In dieser Studie hat das Monitoring die adaptiven Plananpassungen auf Basis der Tumorvolumenveraenderungen sowie der anderen intrathorakalen anatomischen Veraenderungen ermoeglicht. (orig.)

  13. Economical aspect of PET/CT-guided diagnosis of suspected infective endocarditis in a patient with implantable cardioverter-defibrillator.

    Science.gov (United States)

    Farkowski, Michal M; Milkowski, Maciej; Dziuk, Mirosław; Pytkowski, Mariusz; Marciniak, Marta; Kraska, Alicja; Szwed, Hanna; Sterlinski, Maciej

    2014-01-01

    We present a case report of potential reduction of hospitalization costs due to utilization of PET/CT in a diagnostic work-up of a patient with an implantable cardioverter-defibrillator and suspicion of infective endocarditis. The PET/CT scan would have shorten hospital stay, prevented clinical complications and reduced the cost of hospitalization by 45%.

  14. CT-guided biopsy for Langerhans cell histiocytosis of the atlas: a case report and literature review.

    Science.gov (United States)

    Yang, Biao; Zhan, Rui-Yu; Guo, Wen-Hao; Liao, Zheng-Yin

    2016-07-14

    Langerhans cell histiocytosis (LCH) is a rare disease, and involvement of the atlas is extremely uncommon. Biopsy of atlas lesions is difficult and risky. In this case report, we describe the performance of percutaneous computed tomography-guided biopsy of an atlantal LCH in a patient with no complication.

  15. Robot arm based flat panel CT-guided electromagnetic tracked spine interventions: phantom and animal model experiments

    Energy Technology Data Exchange (ETDEWEB)

    Penzkofer, Tobias; Isfort, Peter; Bruners, Philipp; Mahnken, Andreas H. [RWTH Aachen University, Applied Medical Engineering, Helmholtz-Institute Aachen, Aachen (Germany); RWTH Aachen University, Department of Diagnostic Radiology, Aachen University Hospital, Aachen (Germany); Wiemann, Christian; Guenther, Rolf W. [RWTH Aachen University, Department of Diagnostic Radiology, Aachen University Hospital, Aachen (Germany); Kyriakou, Yiannis; Kalender, Willi A. [Friedrich-Alexander University of Erlangen-Nuremberg, Institute for Medical Physics, Erlangen (Germany); Schmitz-Rode, Thomas [RWTH Aachen University, Applied Medical Engineering, Helmholtz-Institute Aachen, Aachen (Germany)

    2010-11-15

    To evaluate accuracy and procedure times of electromagnetic tracking (EMT) in a robotic arm mounted flat panel setting using phantom and animal cadaveric models. A robotic arm mounted flat panel (RMFP) was used in combination with EMT to perform anthropomorphic phantom (n = 90) and ex vivo pig based punctures (n = 120) of lumbar facet joints (FJ, n = 120) and intervertebral discs (IVD, n = 90). Procedure accuracies and times were assessed and evaluated. FJ punctures were carried out with a spatial accuracy of 0.8 {+-} 0.9 mm (phantom) and 0.6 {+-} 0.8 mm (ex vivo) respectively. While IVD punctures showed puncture deviations of 0.6 {+-} 1.2 mm (phantom) and 0.5 {+-} 0.6 mm (ex vivo), direct and angulated phantom based punctures had accuracies of 0.8 {+-} 0.9 mm and 1.0 {+-} 1.3 mm. Planning took longer for ex vivo IVD punctures compared to phantom model interventions (39.3 {+-} 17.3 s vs. 20.8 {+-} 5.0 s, p = 0.001) and for angulated vs. direct phantom FJ punctures (19.7 {+-} 5.1 s vs. 28.6 {+-} 7.8 s, p < 0.001). Puncture times were longer for ex vivo procedures when compared to phantom model procedures in both FJ (37.9 {+-} 9.0 s vs. 23.6 {+-} 7.2 s, p = 0.001) and IVD punctures (43.9 {+-} 16.1 s vs. 31.1 {+-} 6.4 s, p = 0.026). The combination of RMFP with EMT provides an accurate method of navigation for spinal interventions such as facet joint punctures and intervertebral disc punctures. (orig.)

  16. RS3PE Syndrome with Iliopsoas Bursitis Distinguished from an Iliopsoas Abscess Using a CT-guided Puncture.

    Science.gov (United States)

    Fukui, Shoichi; Iwamoto, Naoki; Tsuji, Sosuke; Umeda, Masataka; Nishino, Ayako; Nakashima, Yoshikazu; Suzuki, Takahisa; Horai, Yoshiro; Koga, Tomohiro; Kawashiri, Shin-ya; Ichinose, Kunihiro; Hirai, Yasuko; Tamai, Mami; Nakamura, Hideki; Origuchi, Tomoki; Kawakami, Atsushi

    2015-01-01

    A 55-year-old man was diagnosed with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Contrast-enhanced computed tomography for cancer screening showed a mass with low-density centers with an enhanced rim in the left iliopsoas muscle. We suspected an iliopsoas abscess and performed computed-tomography-guided puncture of the mass. Both Gram staining and the culture of the fluid were negative. We diagnosed the patient with RS3PE syndrome with iliopsoas bursitis and administered low-dose corticosteroids without antibiotics. The symptoms, including left hip pain, quickly disappeared following treatment. Clinicians should be aware that iliopsoas bursitis may resemble an iliopsoas abscess. As a result, it is important to make an accurate differential diagnosis.

  17. Use of spirometry to predict risk of pneumothorax in CT-guided needle biopsy of the lung

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Rio, F.; Pino, J.M.; Diaz-Lobato, S.; Villamor, S. [Autonoma Univ., Madrid (Spain)] [and others

    1996-01-01

    Our goal was to assess the usefulness of spirometry to estimate the risk of pneumothorax in patients undergoing percutaneous needle biopsy with CT guidance for solitary pulmonary nodule (SPN). We studied the results of 51 consecutive percutaneous needle biopsies with CT guidance for SPN obtained between 1988 and 1990. Forty-five men and six women, aged 65 {+-} 11 (36-86) years, were included in the study. All biopsies were performed under CT guidance, with 90 mm 25G needles (0.5 mm thickness) fitted into luer-type syringes. The number of needle pass attempts never exceeded three. A spirometry before biopsy was performed in all patients. Pneumothorax occurred in only 10 cases (19%). The patients with pneumothorax showed lower lesion size, forced vital capacity (FVC), forced expiratory volume (FEV{sub 1}), and FEV{sub 1}/FVC ratio. The contribution of these factors to pneurnothorax was analyzed by a logistic regression model. The FEV{sub 1} was most strongly associated with the incidence of pneumothorax. We developed an equation for predicting the risk of this complication. We conclude that decreasing FEV{sub 1} is associated with a higher neurnothorax rate. 15 refs., 2 figs., 2 tabs.

  18. Tracker-on-C for cone-beam CT-guided surgery: evaluation of geometric accuracy and clinical applications

    Science.gov (United States)

    Reaungamornrat, S.; Otake, Y.; Uneri, A.; Schafer, S.; Mirota, D. J.; Nithiananthan, S.; Stayman, J. W.; Khanna, A. J.; Reh, D. D.; Gallia, G. L.; Taylor, R. H.; Siewerdsen, J. H.

    2012-02-01

    Conventional surgical tracking configurations carry a variety of limitations in line-of-sight, geometric accuracy, and mismatch with the surgeon's perspective (for video augmentation). With increasing utilization of mobile C-arms, particularly those allowing cone-beam CT (CBCT), there is opportunity to better integrate surgical trackers at bedside to address such limitations. This paper describes a tracker configuration in which the tracker is mounted directly on the Carm. To maintain registration within a dynamic coordinate system, a reference marker visible across the full C-arm rotation is implemented, and the "Tracker-on-C" configuration is shown to provide improved target registration error (TRE) over a conventional in-room setup - (0.9+/-0.4) mm vs (1.9+/-0.7) mm, respectively. The system also can generate digitally reconstructed radiographs (DRRs) from the perspective of a tracked tool ("x-ray flashlight"), the tracker, or the C-arm ("virtual fluoroscopy"), with geometric accuracy in virtual fluoroscopy of (0.4+/-0.2) mm. Using a video-based tracker, planning data and DRRs can be superimposed on the video scene from a natural perspective over the surgical field, with geometric accuracy (0.8+/-0.3) pixels for planning data overlay and (0.6+/-0.4) pixels for DRR overlay across all C-arm angles. The field-of-view of fluoroscopy or CBCT can also be overlaid on real-time video ("Virtual Field Light") to assist C-arm positioning. The fixed transformation between the x-ray image and tracker facilitated quick, accurate intraoperative registration. The workflow and precision associated with a variety of realistic surgical tasks were significantly improved using the Tracker-on-C - for example, nearly a factor of 2 reduction in time required for C-arm positioning, reduction or elimination of dose in "hunting" for a specific fluoroscopic view, and confident placement of the x-ray FOV on the surgical target. The proposed configuration streamlines the integration of C-arm CBCT with realtime tracking and demonstrated utility in a spectrum of image-guided interventions (e.g., spine surgery) benefiting from improved accuracy, enhanced visualization, and reduced radiation exposure.

  19. A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited

    Directory of Open Access Journals (Sweden)

    James A. Stephenson

    2015-01-01

    Full Text Available Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4–18 mm located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.

  20. Long-term results after CT-guided percutaneous ethanol ablation for the treatment of hyper functioning adrenal disorders

    Energy Technology Data Exchange (ETDEWEB)

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina; Menezes, Marcos Roberto de, E-mail: menezesmr@gmail.com [Instituto do Cancer do Estado de Sao Paulo, SP (Brazil)

    2016-10-15

    Objectives: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyper functioning adrenal disorders. Method: We retrospectively evaluated the long-term results of nine patients treated with computed tomography guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macro nodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. Results: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macro nodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. Conclusion: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyper functioning adrenal disorders and is not without risks. (author)

  1. Computed tomography (CT)-guided interstitial permanent implantation of (125)I seeds for refractory chest wall metastasis or recurrence.

    Science.gov (United States)

    Jiang, Ping; Liu, Chen; Wang, Junjie; Yang, Ruijie; Jiang, Yuliang; Tian, Suqing

    2015-02-01

    To evaluate the efficacy and safety of 125I seeds implantation for refractory chest wall (CW) metastasis or recurrence under CT guidance. In addition we assessed initial data obtained on the therapeutic response for refractory CW metastasis or recurrence. Twenty consecutive patients underwent permanent implantation of 125I seeds (from Jul. 2004 to Jan. 2011) under computed tomography (CT) guidance. Postoperative dosimetry was routinely performed for all patients. The actuarial D90 of the implanted 125I seeds ranged from 100 Gy to 160 Gy (median: 130 Gy). The activity of 125I seeds ranged from 0.5 mCi to 0.78 mCi (median: 0.71 mCi). The total number of seeds implanted ranged from 8 to 269 (median: 53). The follow-up period ranged from 3 to 54 months (median: 11.5 months). The survival and local control probabilities were calculated by the Kaplan-Meier method. Among all the 20 patients, 3 patients had complete remission CR (15%), 12 patients had partial remission PR (60%), 5 patients had stable disease SD. The 1-, 2-, 3- and 4-year tumor control rates were all 88.7% respectively. The 1- and 2-, 3-, 4-year cancer specific survival rates were 56.5% and 47.1%, 47.1%, 47.1% respectively. The 1- and 2-, 3-, 4-year overall survival rates were 53.3% and 35.6%, 35.6%, 35.6% respectively, with a median survival of 15 months (95% CI, 7.0-22.9). Mild brachial plexus injury was seen in one patient; grade 1 or 2 skin reactions were seen in 6 patients (30%) who had received external beam radiation therapy (EBRT) before. No grade 3 and 4 skin side effects were found. Rib fracture, ulceration, pneumothorax or hemopneumothorax were not seen. Interstitial permanent implantation of 125I seeds under CT guidance is feasible, efficacious and safe for refractory CW metastasis or recurrence.

  2. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders

    Directory of Open Access Journals (Sweden)

    Nathan Elie Frenk

    Full Text Available OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.

  3. The Effect of the Retroperitoneal Transpsoas Minimally Invasive Lateral Interbody Fusion on Segmental and Regional Lumbar Lordosis

    Directory of Open Access Journals (Sweden)

    Tien V. Le

    2012-01-01

    Full Text Available Background. The minimally invasive lateral interbody fusion (MIS LIF in the lumbar spine can correct coronal Cobb angles, but the effect on sagittal plane correction is unclear. Methods. A retrospective review of thirty-five patients with lumbar degenerative disease who underwent MIS LIF without supplemental posterior instrumentation was undertaken to study the radiographic effect on the restoration of segmental and regional lumbar lordosis using the Cobb angles on pre- and postoperative radiographs. Mean disc height changes were also measured. Results. The mean follow-up period was 13.3 months. Fifty total levels were fused with a mean of 1.42 levels fused per patient. Mean segmental Cobb angle increased from 11.10° to 13.61° (<0.001 or 22.6%. L2-3 had the greatest proportional increase in segmental lordosis. Mean regional Cobb angle increased from 52.47° to 53.45° (=0.392. Mean disc height increased from 6.50 mm to 10.04 mm (<0.001 or 54.5%. Conclusions. The MIS LIF improves segmental lordosis and disc height in the lumbar spine but not regional lumbar lordosis. Anterior longitudinal ligament sectioning and/or the addition of a more lordotic implant may be necessary in cases where significant increases in regional lumbar lordosis are desired.

  4. The effect of the retroperitoneal transpsoas minimally invasive lateral interbody fusion on segmental and regional lumbar lordosis.

    Science.gov (United States)

    Le, Tien V; Vivas, Andrew C; Dakwar, Elias; Baaj, Ali A; Uribe, Juan S

    2012-01-01

    The minimally invasive lateral interbody fusion (MIS LIF) in the lumbar spine can correct coronal Cobb angles, but the effect on sagittal plane correction is unclear. A retrospective review of thirty-five patients with lumbar degenerative disease who underwent MIS LIF without supplemental posterior instrumentation was undertaken to study the radiographic effect on the restoration of segmental and regional lumbar lordosis using the Cobb angles on pre- and postoperative radiographs. Mean disc height changes were also measured. The mean follow-up period was 13.3 months. Fifty total levels were fused with a mean of 1.42 levels fused per patient. Mean segmental Cobb angle increased from 11.10° to 13.61° (P lordosis. Mean regional Cobb angle increased from 52.47° to 53.45° (P = 0.392). Mean disc height increased from 6.50 mm to 10.04 mm (P lordosis and disc height in the lumbar spine but not regional lumbar lordosis. Anterior longitudinal ligament sectioning and/or the addition of a more lordotic implant may be necessary in cases where significant increases in regional lumbar lordosis are desired.

  5. Computed Tomography-guided Pericardiocentesis: An alternative approach for accessing the pericardium.

    Science.gov (United States)

    Melvan, John Nicholas; Madden, David; Vasquez, Julio C; DeLaRosa, Jacob

    2016-07-01

    Pericardial effusions compress the heart, decrease cardiac output, and lead to haemodynamic collapse. Ultrasound (US)-guided pericardiocentesis is the gold standard for treating pericardial effusions. Recently, the incorporation of computed tomography (CT) guidance has increased patient safety while entering the pericardium. Despite the superior performance of CT-guided pericardiocentesis in smaller, complex effusions, this procedure is not routinely performed by cardiologists and surgeons. Unlike those with an intact pericardium, patients with mediastinal trauma, pericardial adhesions, temporary pacing wires, and vascular conduits are high risk for pericardiocentesis. Tamponade physiology also increases patient susceptibility to the hypotensive effects of anaesthesia during surgical drainage. Here we illustrate the technique of CT-guided pericardiocentesis and demonstrate its application in specific clinical scenarios. We conclude that CT-guided pericardiocentesis provides a useful, alternative strategy for treating cardiac tamponade in high risk patients. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  6. Narrative approaches

    DEFF Research Database (Denmark)

    Stelter, Reinhard

    2012-01-01

    as a narrative-collaborative practice, an approach that is based on phenomenology, social constructionism and narrative theory. Seeing narrative coaching as a collaborative practice also leads to reflecting on the relationship between coach and coachee(s) in a new way, where both parts contribute to the dialogue......Narrative coaching is representative of the new wave – or third generation – of coaching practice . The theory and practice of narrative coaching takes into account the social and cultural conditions of late modern society, and must be seen as intertwined with them. Some initial conceptualizations...... and coachee. The conceptual framework will be tested by presenting central results of a research project. The ideas discussed in this chapter expand upon earlier concepts of the narrative approach (mainly formulated by White in 2007) by integrating ideas from phenomenology and experiential approaches...

  7. Capability approach

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal; Kjeldsen, Christian Christrup

    Lærebogen er den første samlede danske præsentation af den af Amartya Sen og Martha Nussbaum udviklede Capability Approach. Bogen indeholder en præsentation og diskussion af Sen og Nussbaums teoretiske platform. I bogen indgår eksempler fra såvel uddannelse/uddannelsespolitik, pædagogik og omsorg....

  8. Pedagogical approaches

    DEFF Research Database (Denmark)

    Lund Larsen, Lea

    and their particular needs, which teachers must be aware of and deal with. Secondly, I propose a combination of adult learners’ characteristics with ‘teaching orientations’, as a basis for further research on teachers of adults’ professional development. Some of the competencies that teachers need can be taught...... in formal settings, but in most teaching settings, the teachers act alone and develop their pedagogical approaches/- teaching strategies with no synchronous sparring from a colleague. Adult learners have particular needs and characteristics that their teachers must be able to address (cf. Knowles......This paper is a part of an on-going qualitative empirical research project: “Teachers of adults as learners. A study on teachers’ experiences in practice”. Data is collected at a Danish Adult Education Centre. The aim of the study is to understand teachers’ learning experiences. The research...

  9. Experimental Study of CT Guided 32P-CP-PLLA Microparticle Implantation in the Treatment of Rabbit VX2 Lung Tumor

    Directory of Open Access Journals (Sweden)

    Donghui PAN

    2011-01-01

    Full Text Available Background and objective 32P-chromic phosphate-poly (L-lactic acid (32P-CP-PLLA microparticle is a novel potent brachytherapy implant, which has good biocompatibility and biodegradability. The aim of this study is to investigate the changes of pathology and PET/CT images in VX2 rabbit tumor after treatment with intratumorol administration of 32P-CP-PLLA microparticles, and to explore the effects and influence of tumor growth and apoptosis related proteins in VX2 lung tumor treatment with 32P-CP-PLLA microparticles. Methods Twenty-four tumor bearing rabbits were randomly divided into 4 groups (6 in each group. Group 1, 2 and 3 were treated groups; group 4 was the control. Under CT guidance, 32P-CPPLLA microparticles were implanted into tumors. Low, medium and high treatment doses were 93 MBq (group 1, 185 MBq (group 2 and 370 MBq (group 3, respectively. 18F-FDG PET/CT was performed at d0, d3, d7 and d14 after intratumoral administration. In the control group, 18F-FDG PET/CT images were acquired at the same time points but without treatment. The standardized uptake value (SUV of tumor regions were calculated. After last PET/CT imaging, the rabbits were euthanized and the tumors were removed for histological and immunohistochemical examination. The pathology and the expression of apoptosis related proteins (bcl-2, bax were compared. Results No significant difference of SUVmax was observed between the treatment groups and the control group at d0. At d14, the SUVmax values for group 1, 2 and 3 were 0.80±0.10, 1.1±0.19 and 2.85±0.15, respectively, and were significantly lower than that of the control group (5.61±0.50(P < 0.05. Significant dose-response relationship was observed in SUVmax between group 1 and group 2, and the SUV values gradually decreased from d7 to d14 after treatment. In group 3, SUVmax gradually increased and reached a peak at d7 then significantly decreased. The SUVmax values of group 3 were significantly lower than those of the control at the same time point (P < 0.05. HE staining found degenerative necrosis at the site was nearby the microparticle. Necrosis became serious increasing with the radioactivity. Inflammatory cell infiltration was rarely seen in tumors treated with 93 MBq or 185 MBq 32P-CP-PLLA microparticles. In contrast, the necrotic area was surrounded by marked inflammatory cell infiltration in group 3. IHC analysis showed that the expression of bcl-2 in treated groups were lower than those in the control group, and the expression of bax in treated group was higher than those in the control group (P < 0.05. The ratio of bcl-2/bax protein significantly decreased in the treated group (P < 0.05. Dose dependence was seen in the expression of apoptosis related proteins. Conclusion The sustained irradiation of 32P-CP-PLLA microparticles can direct kill the VX2 tumor cell, thus the glycolysis of which were suppressed. Although the alive tumor cells still presented faraway from the microparticle, the expression of apoptosis related proteins in which were significantly different from the control. Bcl-2 and bax gene were induced to participate in regulation for the apoptosis of VX2 tumor cell by ionizing radiation from 32P-CP-PLLA microparticles, so that the tumor growth was inhibited.

  10. 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 unklarer lumbaler Schmerzzustaende eingesetzt. (orig.)

  11. Long term outcomes from CT-guided indirect cervical nerve root blocks and their relationship to the MRI findings. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

    To investigate long-term pain reduction and 'improvement' in patients with indirect cervical nerve-root-blocks in comparison to MRI findings. One hundred and twelve patients with MRI confirmed cervical radiculopathy and an indirect cervical nerve-root-block were included. Two radiologists independently evaluated the MRI examinations. 12 different MRI abnormalities at the level and side of infiltration were compared to pain relief and 'improvement' at 1-month, 3-months and 1-year post injection. The proportion of patients reporting clinically relevant 'improvement' was 36.7 % at 1-month, 53.9 % at 3-months and 68.1 % at 1-year. At 1-month post injection, a statistically significantly lower percentage of patients eventually requiring surgery reported improvement and lower NRS change scores compared to those who did not undergo surgery (p = 0.001). Patients with extrusion of the disc were around 4-times more likely to have surgery. At 1-year post-injection the presence of nerve-root compromise was significantly linked to treatment outcome (p = 0.011). Patients with nerve root compression were more likely to report improvement at 1 year. Patients with disc extrusions have less pain relief and are 4 times more likely to go to surgery than patients with disc protrusions. (orig.)

  12. Discussion of Cone-beam CT-guided Radiotherapy for Breast Cancer%锥形束CT引导乳腺癌放射治疗的探讨

    Institute of Scientific and Technical Information of China (English)

    叶森林; 梁廷; 荣青碧

    2010-01-01

    目的:探讨锥形束CT(Cone-Beam CT,CBCT)在乳腺癌三维适形或调强放射治疗位置精度保证中的应用.方法:采用Varian-21EX直线加速器机载影像系统(OBI),在适形或调强放射治疗前行锥形束CT扫描,系统自动重建成断层图像,获得患者三维方向的摆位数据,直接与治疗计划CT扫描图像相匹配后得出两者间的误差数据,对误差予以校正后行精确治疗.结果:经锥形束CT扫描并校正后,左右、腹背和头脚方向的位置误差值分别由(1.7±3.25)mm、(0.9±1.27)mm、(2.1±4.31)mm下降至(0.6±1.38)mm、(0.2±0.72)mm、(0.8±1.65)mm.结论:CBCT对于乳腺癌适形或调强放射治疗的精确实施具有重要作用.

  13. The Role of C11-Choline-PET/CT-Guided Secondary Lymphadenectomy in Patients with PSA Failure after Radical Prostatectomy: Lessons Learned from Eight Cases

    Directory of Open Access Journals (Sweden)

    Thomas Martini

    2012-01-01

    Full Text Available Introduction. 11C-choline-PET/CT is a promising technique for detection/restaging of patients with biochemical failure (BF after curative therapy for prostate cancer (PCA. The aim of this paper was to evaluate the PSA response in patients with BF after radical prostatectomy (RP who underwent secondary lymphadenectomy (LAD due to 11C-choline-PET/CT findings. Material and Methods. Eight patients with BF and positive lymph nodes in 11C-choline-PET/CT after RP were retrospectively included in the study. Extended LAD until the common iliac arteries was performed in all patients. Results. Six of 8 patients had histologically proven lymph node metastases. Four patients showed an initial PSA reduction after LAD, and in 4 patients the PSA increased. Two of the latter had no histological lymph node metastases. Conclusions. Because 50% of our patients showed an initial PSA response, our data suggest that positive 11C-choline-PET/CT after RP and BF could help to select patients that could benefit from secondary LAD.

  14. The Role of 11C-Choline-PET/CT-Guided Secondary Lymphadenectomy in Patients with PSA Failure after Radical Prostatectomy: Lessons Learned from Eight Cases

    OpenAIRE

    Thomas Martini; Roman Mayr; Emanuela Trenti; Salvatore Palermo; Evi Comploj; Armin Pycha; Maria Zywica; Michele Lodde

    2011-01-01

    Introduction. 11C-choline-PET/CT is a promising technique for detection/restaging of patients with biochemical failure (BF) after curative therapy for prostate cancer (PCA). The aim of this paper was to evaluate the PSA response in patients with BF after radical prostatectomy (RP) who underwent secondary lymphadenectomy (LAD) due to 11C-choline-PET/CT findings. Material and Methods. Eight patients with BF and positive lymph nodes in 11C-choline-PET/CT after RP were retrospectively included in...

  15. CT-guided ozone/steroid therapy for the treatment of degenerative spinal disease - effect of age, gender, disc pathology and multi-segmental changes

    Energy Technology Data Exchange (ETDEWEB)

    Oder, Bernhard; Loewe, Maria; Reisegger, Michael; Thurnher, Siegfried A. [Hospital Brothers of St. John of God, Department of Radiology and Nuclear Medicine, Vienna (Austria); Lang, Wilfried [Hospital Brothers of St. John of God, Department of Neurology, Vienna (Austria); Ilias, Wilfried [Hospital Brothers of St. John of God, Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Vienna (Austria)

    2008-09-15

    Oxygen-ozone nucleolysis (ONL) is a new, minimally invasive procedure for the treatment of discogenic low back pain with or without radicular symptoms. The aim of the present study was to determine associations between the morphology of the basic disease, patient-specific factors and the outcome of the treatment. Six hundred and twelve patients not responding to conservative therapy were divided into five groups (disc bulging, disc herniation, postoperative patients, osteochondrosis, others) and subjected to nucleolysis with ozone and to periradicular infiltration with steroids and local anaesthesia. The success of treatment was assessed by means of a visual analog pain scale (VAS) and the Oswestry Disability Index (ODI). A significant reduction in the VAS was registered after 2 and 6 months (from 8.6 to 5.4 and 6.0; p<0.001) in all patient groups; an excellent therapy response (VAS below 3.0) was achieved by about a third of the patients. A significant improvement in ODI was registered in all patients (46 to 31; p<0.001), most pronounced in the herniation group (25.5, p=0.015). Patients below 50 years had significantly better values in the VAS and ODI score 6 months after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0, in two affected segments 6.5 and 32 and in three segments 6.7 and 38.5 (p<0.001 and p=0.051). ONL with periradicular steroid therapy might exert a functional and sustained analgesic effect in patients with degenerative changes in the lumbar spine not responding to conservative therapy and was most effective below 50 years with disc herniation in one segment. (orig.)

  16. CT-guided percutaneous radiofrequency ablation in osteoid osteoma. Re-assessments of results with optimized technique and possible pain patterns in mid-term follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Omlor, G.; Merle, C.; Lehner, B.; Ewerbeck, V. [Universitaetsklinik Heidelberg (Germany). Orthopaedische Universitaetsklinik; Rehnitz, C.; Weber, M.A. [Universitaetsklinik Heidelberg (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Ludwig, K. [Klinikum Herford (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie

    2012-04-15

    To re-assess radiofrequency ablation (RFA) of osteoid osteoma (OO) with an optimized technique and to evaluate patterns of post-interventional pain important for the detection of recurrence. 44 consecutive patients with OO treated with precise inclusion criteria by RFA were examined retrospectively. RFA was performed with an optimized technique. Technical success (TS), primary and secondary clinical success (PCS/SCS) and minor and major complications (MIC/MAC) were evaluated. Pain patterns defined as 'osteoid osteoma-specific pain' (OOSP) and 'unspecific pain' (UP), 'limitations in daily activity' (LDA) and 'patient satisfaction' (PS) were evaluated using a numeric rating scale (0 - 10; 0 = no pain, 0 = no limitation, 10 = fully satisfied). The pain intensity before and after RFA was compared. The mean follow-up time was 35 months (n = 40, range 2 - 60 months). TS was 100 % (n = 44), PCS 98 % (n = 44), and SCS 100 % (n = 40). MIC and MAC were 0 % (n = 44). OOSP was 0 after RFA in all 44 patients. UP was 0 in 24 of 40 patients (60 %), 1 in 11 patients (28 %) for up to 7 days and 1 - 4 in 5 patients (13 %) for 30 - 180 days. LDA was 0 in 39 of 40 patients (98 %), and 1 in 1 patient. PS was 10 in all patients. The pain after RFA was significantly less than before RFA (p < 0.0001). Using an optimized technique primary clinical success rates in the high nineties have to be expected. Unspecific pain of low intensity is not unusual after RFA and has to be distinguished from pain caused by recurrent disease. (orig.)

  17. Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study.

    Science.gov (United States)

    Beyer, Lukas Philipp; Michalik, Katharina; Niessen, Christoph; Platz Batista da Silva, Natascha; Wiesinger, Isabell; Stroszczynski, Christian; Wiggermann, Philipp

    2016-09-20

    BACKGROUND The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. MATERIAL AND METHODS Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. RESULTS Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. CONCLUSIONS Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time.

  18. Imaging-guided thoracoscopic resection of a ground-glass opacity lesion in a hybrid operating room equipped with a robotic C-arm CT system.

    Science.gov (United States)

    Hsieh, Chen-Ping; Hsieh, Ming-Ju; Fang, Hsin-Yueh; Chao, Yin-Kai

    2017-05-01

    The intraoperative identification of small pulmonary nodules through video-assisted thoracoscopic surgery remains challenging. Although preoperative CT-guided nodule localization is commonly used to detect tumors during video-assisted thoracoscopic surgery (VATS), this approach carries inherent risks. We report the case of a patient with stage I lung cancer presenting as an area of ground-glass opacity (GGO) in the right upper pulmonary lobe. He successfully underwent a single-stage, CT-guided localization and removal of the pulmonary nodule within a hybrid operating room (OR) equipped with a robotic C-arm.

  19. Splenic tuberculosis. Report of twelve cases; La tuberculose splenique

    Energy Technology Data Exchange (ETDEWEB)

    Adil, A.; Chikhaoui, N.; Ousehal, A.; Kadiri, R. [Centre Hospitalier Universitaire Ibn Rochd, Casablanca (Morocco)

    1995-12-31

    Tuberculosis of the spleen is not exceptional. The authors report ten cases which occurred with a predominance in young male adults. All patients had at least one other site of tuberculosis without any HIV infection. All patients had focal splenic lesions in the form of scattered hypo-echogenic and hypodense nodules. These nodules had a pseudo-tumor appearance in one case. CT-guided puncture was performed in one case. Splenic tuberculosis is not as rare as is sometimes thought. The CT-guided splenic puncture is now performed routinely and remains the ideal diagnostic approach. (authors). 9 refs., 5 figs.

  20. Complementary Health Approaches

    Science.gov (United States)

    ... on some complementary approaches, such as acupuncture and yoga, but there have been fewer studies on other approaches, so much less is known about them. The National Institutes of Health (NIH) is sponsoring research to learn more about ...

  1. Evaluating six soft approaches

    Directory of Open Access Journals (Sweden)

    Lene Sørensen

    2008-09-01

    Full Text Available The paper introduces and evaluates six soft approaches used in strategy development and planning. We take a planner’s perspective on discussing the concepts of strategy development and planning. This means that we see strategy development and planning as learning processes based on Ackoff’s interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable for supporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using such a conceptual framework for evaluations of soft approaches increases the understanding of them, their transparency, and their usability in practice.

  2. The sustainable livelihoods approach

    DEFF Research Database (Denmark)

    Oelofse, Myles; Jensen, Henning Høgh

    2008-01-01

    food chain has on producers and their families, an analysis was conducted of the use of the Sustainable Livelihoods Approach (SLA). The SLA provides a holistic and integrative approach which researchers can use as the overriding frame for their research. The application of the approach is recommended...... as it enables us to maintain important elements of the sustainability vision, yet emphasises that a number of assets influence farmers' livelihoods and it maintains the focus on salience, legitimacy, and credibility in the research....

  3. Evaluating six soft approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Vidal, Rene Victor Valqui

    2008-01-01

    's interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable forsupporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology......, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using...

  4. Evaluating Six Soft Approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Valqui Vidal, René Victor

    2008-01-01

    's interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable forsupporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology......, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using...

  5. Intradural anterior transpetrosal approach.

    Science.gov (United States)

    Ichimura, Shinya; Hori, Satoshi; Hecht, Nils; Czabanka, Marcus; Vajkoczy, Peter

    2016-10-01

    The standard anterior transpetrosal approach (ATPA) for petroclival lesions is fundamentally an epidural approach and has been practiced for many decades quite successfully. However, this approach has some disadvantages, such as epidural venous bleeding around foramen ovale. We describe here our experience with a modified technique for anterior petrosectomy via an intradural approach that overcomes these disadvantages. Five patients with petroclival lesions underwent surgery via the intradural ATPA. The intraoperative hallmarks are detailed, and surgical results are reported. Total removal of the lesions was achieved in two patients with petroclival meningioma and two patients with pontine cavernoma, whereas subtotal removal was achieved in one patient with petroclival meningioma without significant morbidity. No patient experienced cerebrospinal fluid leakage. The intradural approach is allowed to tailor the extent of anterior petrosectomy to the individually required exposure, and the surgical procedure appeared to be more straightforward than via the epidural route. Caveats encountered with the approach were the temporal basal veins that could be spared as well as identification of the petrous apex due to the lack of familial epidural landmarks. The risk of injury to the temporal bridging veins is higher in this approach than in the epidural approach. Intradural approach is recommended in patients with a large epidural venous route, such as sphenobasal and sphenopetrosal vein. Navigation via bone-window computed tomography is useful to identify the petrous apex.

  6. Alternative Auditing Approaches

    Energy Technology Data Exchange (ETDEWEB)

    Kandt, Alicen J [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-15

    This presentation for the 2017 Energy Exchange in Tampa, Florida, offers information about advanced auditing technologies and techniques including alternative auditing approaches and considerations and caveats.

  7. Evaluating six soft approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene Tolstrup; Vidal, Rene Victor Valqui

    2008-01-01

    's interactive planning principles to be supported by soft approaches in carrying out the principles in action. These six soft approaches are suitable forsupporting various steps of the strategy development and planning process. These are the SWOT analysis, the Future Workshop, the Scenario methodology......, Strategic Option Development and Analysis, Strategic Choice Approach and Soft Systems Methodology. Evaluations of each methodology are carried out using a conceptual framework in which the organisation, the result, the process and the technology of the specific approach are taken into consideration. Using...

  8. Percutaneous Catheter Drainage of Periappendiceal abscess due to Appendicolith : A case report

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Dae Sik; Kim, Heung Chueol; Han, Tae Kyun; Hur, Hun; Yum, Kung Tae; Namkung, Sook; Park, Man Soo; Hwang, Woo Chueol [Hallym University College of Medicine, Chuncheon (Korea, Republic of)

    1996-12-15

    Percutaneous catheter drainage of periappendiceal abscess is an effective and safe method of treatment. It is known that CT guided approach is the first choice of method. We experienced a successful percutaneous catheter drainage under ultrasound guidance for periappendiceal abscess with appendicolith

  9. A Comparison on the Audiolingual Approach and the Communicative Approach

    Institute of Scientific and Technical Information of China (English)

    代海娜

    2015-01-01

    Audiolingual approach and communicative approach are two important approaches in language teaching.In this paper,some differences and both advantages and diadvantages will be discussed.Thus,to conduct the important usage of approachs in language teaching.

  10. The TLC Approach.

    Science.gov (United States)

    Welker, William A.

    2002-01-01

    Notes how the author has developed the Teaching and Learning Cues (TLC) approach, an offspring of textbook organizational patterns instruction that stresses the significance of certain words and phrases in reading. Concludes that with the TLC approach, students learn to appreciate the important role cue words and phrases play in understanding…

  11. Articulating Design Approaches?

    DEFF Research Database (Denmark)

    Kensing, Finn; Bødker, Keld; Simonsen, Jesper

    We are working on an approach for designing CSCW systems since we advocate the importance of generalizing from own work practice as designers and from studies of designers working under industrial conditions. We use the term approach as something in between commodified methods and isolated techni...

  12. Stuttering-Psycholinguistic Approach

    Science.gov (United States)

    Hategan, Carolina Bodea; Anca, Maria; Prihoi, Lacramioara

    2012-01-01

    This research promotes psycholinguistic paradigm, it focusing in delimitating several specific particularities in stuttering pathology. Structural approach, on language sides proves both the recurrent aspects found within specialized national and international literature and the psycholinguistic approaches dependence on the features of the…

  13. Ten practice redesign approaches.

    Science.gov (United States)

    Slayton, Val

    2013-01-01

    As healthcare delivery continues to evolve at a rapid pace, practices need to consider redesign approaches to stay ahead of the pack. From national policy and private payer initiatives to societal macro trends and the growing use of mobile technologies, delivering value, understanding customer needs, and assessing satisfaction are important elements to achieve and maintain success. This article discusses 10 practice redesign approaches.

  14. Modular Approach for Ethics

    Science.gov (United States)

    Wyne, Mudasser F.

    2010-01-01

    It is hard to define a single set of ethics that will cover an entire computer users community. In this paper, the issue is addressed in reference to code of ethics implemented by various professionals, institutes and organizations. The paper presents a higher level model using hierarchical approach. The code developed using this approach could be…

  15. Approaches to understand culture

    DEFF Research Database (Denmark)

    Rasmussen, Lauge Baungaard; Rauner, Felix

    1996-01-01

    Different approaches to understand the concept ofculture are presented and evaluated. The author'sconcept of culture is defined. Different aspectsof the concept are discussed.......Different approaches to understand the concept ofculture are presented and evaluated. The author'sconcept of culture is defined. Different aspectsof the concept are discussed....

  16. The TLC Approach.

    Science.gov (United States)

    Welker, William A.

    2002-01-01

    Notes how the author has developed the Teaching and Learning Cues (TLC) approach, an offspring of textbook organizational patterns instruction that stresses the significance of certain words and phrases in reading. Concludes that with the TLC approach, students learn to appreciate the important role cue words and phrases play in understanding…

  17. Life Span Developmental Approach

    Directory of Open Access Journals (Sweden)

    Ali Eryilmaz

    2011-03-01

    Full Text Available The Life Span Developmental Approach examines development of individuals which occurs from birth to death. Life span developmental approach is a multi-disciplinary approach related with disciplines like psychology, psychiatry, sociology, anthropology and geriatrics that indicates the fact that development is not completed in adulthood, it continues during the life course. Development is a complex process that consists of dying and death. This approach carefully investigates the development of individuals with respect to developmental stages. This developmental approach suggests that scientific disciplines should not explain developmental facts only with age changes. Along with aging, cognitive, biological, and socioemotional development throughout life should also be considered to provide a reasonable and acceptable context, guideposts, and reasonable expectations for the person. There are three important subjects whom life span developmental approach deals with. These are nature vs nurture, continuity vs discontinuity, and change vs stability. Researchers using life span developmental approach gather and produce knowledge on these three most important domains of individual development with their unique scientific methodology.

  18. Otoplasty: A graduated approach.

    Science.gov (United States)

    Foda, H M

    1999-01-01

    Numerous otoplastic techniques have been described for the correction of protruding ears. Technique selection in otoplasty should be done only after careful analysis of the abnormal anatomy responsible for the protruding ear deformity. A graduated surgical approach is presented which is designed to address all contributing factors to the presenting auricular deformity. The approach starts with the more conservative cartilage-sparing suturing techniques, then proceeds to incorporate other more aggressive cartilage weakening maneuvers. Applying this approach resulted in better long-term results with less postoperative lateralization than that encountered on using the cartilage-sparing techniques alone.

  19. Introducing Systems Approaches

    Science.gov (United States)

    Reynolds, Martin; Holwell, Sue

    Systems Approaches to Managing Change brings together five systems approaches to managing complex issues, each having a proven track record of over 25 years. The five approaches are: System Dynamics (SD) developed originally in the late 1950s by Jay Forrester Viable Systems Model (VSM) developed originally in the late 1960s by Stafford Beer Strategic Options Development and Analysis (SODA: with cognitive mapping) developed originally in the 1970s by Colin Eden Soft Systems Methodology (SSM) developed originally in the 1970s by Peter Checkland Critical Systems Heuristics (CSH) developed originally in the late 1970s by Werner Ulrich

  20. Flipped Classroom Approach

    Directory of Open Access Journals (Sweden)

    Fezile Ozdamli

    2016-07-01

    Full Text Available Flipped classroom is an active, student-centered approach that was formed to increase the quality of period within class. Generally this approach whose applications are done mostly in Physical Sciences, also attracts the attention of educators and researchers in different disciplines recently. Flipped classroom learning which wide-spreads rapidly in the world, is not well recognized in our country. That is why the aim of study is to attract attention to its potential in education field and provide to make it recognize more by educators and researchers. With this aim, in the study what flipped classroom approach is, flipped classroom technology models, its advantages and limitations were explained.

  1. Revitalizing the setting approach

    DEFF Research Database (Denmark)

    Bloch, Paul; Toft, Ulla; Reinbach, Helene Christine

    2014-01-01

    ¿s everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society......BackgroundThe concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have.......DiscussionThe supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable...

  2. The transformativity approach

    DEFF Research Database (Denmark)

    Holm, Isak Winkel; Lauta, Kristian Cedervall

    2017-01-01

    During the last five to ten years, a considerable body of research has begun to explore how disasters, real and imagined, trigger social transformations. Even if the contributions to this this research stems from a multitude of academic disciplines, we argue in the article, they constitute...... an identifiable and promising approach for future disaster research. We suggest naming it the transformativity approach. Whereas the vulnerability approach explores the social causation of disasters, the transformativity approach reverses the direction of the gaze and investigates the social transformation...... brought about by disasters. Put simply, the concept of vulnerability is about the upstream causes of disaster and the concept of transformativity about the downstream effects. By discussing three recent contributions (by the historian Greg Bankoff, the legal sociologist Michelle Dauber...

  3. Revitalizing the setting approach

    DEFF Research Database (Denmark)

    Bloch, Paul; Toft, Ulla; Reinbach, Helene Christine

    2014-01-01

    BackgroundThe concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have.......DiscussionThe supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable.......SummaryThe supersetting approach is a relevant and useful conceptual framework for developing intervention-based initiatives for sustainable impact in community health promotion. It strives to attain synergistic effects from activities that are carried out in multiple settings in a coordinated manner. The supersetting...

  4. Hormonal approach in Hirsutism

    OpenAIRE

    Abdullah, Nusratuddin

    2015-01-01

    Hinsutism is a clinical sign that primarily indicate androgen excess and open caused hy relatively benign junctional conditions. Hirsutism requires a careful and systematic clinical evaluation coztoleal with a rational approach to treatment. Initiate therapy only in patients who give informed consent after a complete explanation of the potential benejits and risks of a particular treatment and alternative approaches. The goals ofthe correct management of hirsutism are to ame...

  5. Sustainable fashion: New approaches

    OpenAIRE

    Niinimäki, Kirsi

    2013-01-01

    This publication is intended to be used as a source of inspiration for designers and companies, and all stakeholders whose interest lies in the area of sustainable fashion. While the strategies for sustainability are complex and approaches are many, this publication presents only a few ways to approach sustainable fashion. I hope the publication offers inspiration on how to make positive change in current practices and how to effect new mindsets, creating transformative fashion. Theoretica...

  6. The electronic approach VSCF

    Science.gov (United States)

    Hladky, Mark

    The advantages of the high-power electronic approach to variable speed constant frequency (VSCF) systems are examined. It is shown, in particular, how the inherent flexibility of the VSCF approach allows it to be configured for different applications, contributing to the evolution towards the more electric aircraft. The discussion covers criteria for selection, aircraft electric power system architectures, power level, performance, reliability, and maintainability. The future trends of the VSCF converter technology are also briefly discussed.

  7. Theoretical Approaches to Coping

    Directory of Open Access Journals (Sweden)

    Sofia Zyga

    2013-01-01

    Full Text Available Introduction: Dealing with stress requires conscious effort, it cannot be perceived as equal to individual's spontaneous reactions. The intentional management of stress must not be confused withdefense mechanisms. Coping differs from adjustment in that the latter is more general, has a broader meaning and includes diverse ways of facing a difficulty.Aim: An exploration of the definition of the term "coping", the function of the coping process as well as its differentiation from other similar meanings through a literature review.Methodology: Three theoretical approaches of coping are introduced; the psychoanalytic approach; approaching by characteristics; and the Lazarus and Folkman interactive model.Results: The strategic methods of the coping approaches are described and the article ends with a review of the approaches including the functioning of the stress-coping process , the classificationtypes of coping strategies in stress-inducing situations and with a criticism of coping approaches.Conclusions: The comparison of coping in different situations is difficult, if not impossible. The coping process is a slow process, so an individual may select one method of coping under one set ofcircumstances and a different strategy at some other time. Such selection of strategies takes place as the situation changes.

  8. Insights Through Performative Approaches

    Directory of Open Access Journals (Sweden)

    Martina Battisti

    2008-05-01

    Full Text Available This script aims to explore how performative approaches can be used to enhance the understanding of social situations by going beyond the presenting or outermost layer of a problem. The script evolves in six acts and focuses on a group of academics and consultants who meet to develop a theoretical understanding of performative approaches, to experiment with performative approaches by applying them to a consulting case, and finally to reflect on the learning experiences and the understanding of social situations implicit in the case. We found that with traditional scientific methods it may be difficult to understand the underlying—often unconscious—dynamics, emotions and resistances within social situations. Using performative approaches opens up the possibility to gain an understanding of the social situation beyond the rational and cognitive level. In particular, the use of creative approaches like painting, role-plays or fairy tales may allow new and alternative perspectives and interpretations of a social situation to emerge. The script concludes with practical implications for action research in the context of organizational consulting and development. URN: urn:nbn:de:0114-fqs0802444

  9. Personal Approaches to Career Planning.

    Science.gov (United States)

    DeMont, Billie; DeMont, Roger

    1983-01-01

    Identifies four approaches to career planning based on situational leadership theory: the network approach, self-help approach, engineering approach, and mentor approach. Guidelines for the selection of a planning method based on the nature of the work environment and personal preference are discussed. (JAC)

  10. Personal Approaches to Career Planning.

    Science.gov (United States)

    DeMont, Billie; DeMont, Roger

    1983-01-01

    Identifies four approaches to career planning based on situational leadership theory: the network approach, self-help approach, engineering approach, and mentor approach. Guidelines for the selection of a planning method based on the nature of the work environment and personal preference are discussed. (JAC)

  11. Approaching a Postcolonial Arctic

    DEFF Research Database (Denmark)

    Jensen, Lars

    2016-01-01

    This article explores different postcolonially configured approaches to the Arctic. It begins by considering the Arctic as a region, an entity, and how the customary political science informed approaches are delimited by their focus on understanding the Arctic as a region at the service...... of the contemporary neoliberal order. It moves on to explore how different parts of the Arctic are inscribed in a number of sub-Arctic nation-state binds, focusing mainly on Canada and Denmark. The article argues that the postcolonial can be understood as a prism or a methodology that asks pivotal questions to all...... approaches to the Arctic. Yet the postcolonial itself is characterised by limitations, not least in this context its lack of interest in the Arctic, and its bias towards conventional forms of representation in art. The article points to the need to develop a more integrated critique of colonial and neo...

  12. Life History Approach

    DEFF Research Database (Denmark)

    Olesen, Henning Salling

    2015-01-01

    as in everyday life. Life histories represent lived lives past, present and anticipated future. As such they are interpretations of individuals’ experiences of the way in which societal dynamics take place in the individual body and mind, either by the individual him/herself or by another biographer. The Life...... History approach was developing from interpreting autobiographical and later certain other forms of language interactive material as moments of life history, i.e. it is basically a hermeneutic approach. Talking about a psycho-societal approach indicates the ambition of attacking the dichotomy...... of the social and the psychic, both in the interpretation procedure and in some main theoretical understandings of language, body and mind. My article will present the reflections on the use of life history based methodology in learning and education research as a kind of learning story of research work....

  13. Approaches to Methadone Treatment

    DEFF Research Database (Denmark)

    Järvinen, Margaretha

    2008-01-01

    The paper analyses methadone treatment in Copenhagen – as it is described by methadone users and staff at different outpatient centres. The starting point is a theoretical model distinguishing between two different approaches to methadone treatment: ‘palliative’ and ‘curative’. Included...... in the model are three dimensions (1) treatment goals at the methadone centres (abstinence vs. stabilisation) (2) treatment focus (focus on addiction vs. focus on the consequences of addiction) and (3) conceptualisation of methadone (methadone as similar to or different from heroin). The paper shows...... that there is a discrepancy between the attitudes of the staff and those of the users. While the staff favour an almost clear-cut palliative approach to methadone treatment, defining curative goals as both unrealistic and as belonging to the past, the users prefer an approach that does not exclude the goal of abstinence...

  14. Life History Approach

    DEFF Research Database (Denmark)

    Olesen, Henning Salling

    2015-01-01

    as in everyday life. Life histories represent lived lives past, present and anticipated future. As such they are interpretations of individuals’ experiences of the way in which societal dynamics take place in the individual body and mind, either by the individual him/herself or by another biographer. The Life...... History approach was developing from interpreting autobiographical and later certain other forms of language interactive material as moments of life history, i.e. it is basically a hermeneutic approach. Talking about a psycho-societal approach indicates the ambition of attacking the dichotomy...... of the social and the psychic, both in the interpretation procedure and in some main theoretical understandings of language, body and mind. My article will present the reflections on the use of life history based methodology in learning and education research as a kind of learning story of research work....

  15. Technical approach document

    Energy Technology Data Exchange (ETDEWEB)

    1989-12-01

    The Uranium Mill Tailings Radiation Control Act (UMTRCA) of 1978, Public Law 95-604 (PL95-604), grants the Secretary of Energy the authority and responsibility to perform such actions as are necessary to minimize radiation health hazards and other environmental hazards caused by inactive uranium mill sites. This Technical Approach Document (TAD) describes the general technical approaches and design criteria adopted by the US Department of Energy (DOE) in order to implement remedial action plans (RAPS) and final designs that comply with EPA standards. It does not address the technical approaches necessary for aquifer restoration at processing sites; a guidance document, currently in preparation, will describe aquifer restoration concerns and technical protocols. This document is a second revision to the original document issued in May 1986; the revision has been made in response to changes to the groundwater standards of 40 CFR 192, Subparts A--C, proposed by EPA as draft standards. New sections were added to define the design approaches and designs necessary to comply with the groundwater standards. These new sections are in addition to changes made throughout the document to reflect current procedures, especially in cover design, water resources protection, and alternate site selection; only minor revisions were made to some of the sections. Sections 3.0 is a new section defining the approach taken in the design of disposal cells; Section 4.0 has been revised to include design of vegetated covers; Section 8.0 discusses design approaches necessary for compliance with the groundwater standards; and Section 9.0 is a new section dealing with nonradiological hazardous constituents. 203 refs., 18 figs., 26 tabs.

  16. Radiolab - three different approaches

    DEFF Research Database (Denmark)

    Lønstrup, Ansa

    2012-01-01

    different scholarly approaches to sound studies. The object was selected by Torben Sangild, who was familiar with the chosen context: the signature of the US radio programme and podcast Radiolab. The two other participants did not know the context and chose to analyse the sound object without further...... object with a global audience, taken from one of the most popular podcasts worldwide, accessible on the internet. Finally, it is a piece of functional sound design, rather than a work of art, which raises the question of context more clearly. The result is three rather different approaches: 1) a process...

  17. Financial Management: An Organic Approach

    Science.gov (United States)

    Laux, Judy

    2013-01-01

    Although textbooks present corporate finance using a topical approach, good financial management requires an organic approach that integrates the various assignments financial managers confront every day. Breaking the tasks into meaningful subcategories, the current article offers one approach.

  18. Approaches to acceptable risk

    Energy Technology Data Exchange (ETDEWEB)

    Whipple, C.

    1997-04-30

    Several alternative approaches to address the question {open_quotes}How safe is safe enough?{close_quotes} are reviewed and an attempt is made to apply the reasoning behind these approaches to the issue of acceptability of radiation exposures received in space. The approaches to the issue of the acceptability of technological risk described here are primarily analytical, and are drawn from examples in the management of environmental health risks. These include risk-based approaches, in which specific quantitative risk targets determine the acceptability of an activity, and cost-benefit and decision analysis, which generally focus on the estimation and evaluation of risks, benefits and costs, in a framework that balances these factors against each other. These analytical methods tend by their quantitative nature to emphasize the magnitude of risks, costs and alternatives, and to downplay other factors, especially those that are not easily expressed in quantitative terms, that affect acceptance or rejection of risk. Such other factors include the issues of risk perceptions and how and by whom risk decisions are made.

  19. Orion Emergency Mask Approach

    Science.gov (United States)

    Tuan, George C.; Graf, John C.

    2009-01-01

    Emergency mask approach on Orion poses a challenge to the traditional Shuttle or Station approaches. Currently, in the case of a fire or toxic spill event, the crew utilizes open loop oxygen masks that provide the crew with oxygen to breath, but also dumps the exhaled oxygen into the cabin. For Orion, with a small cabin volume, the extra oxygen will exceed the flammability limit within a short period of time, unless a nitrogen purge is also provided. Another approach to a fire or toxic spill event is the use of a filtering emergency masks. These masks utilize some form of chemical beds to scrub the air clean of toxic providing the crew safe breathing air for a period without elevating the oxygen level in the cabin. Using the masks and a form of smoke-eater filter, it may be possible to clean the cabin completely or to a level for safe transition to a space suit to perform a cabin purge. Issues with filters in the past have been the reaction time, breakthroughs, and high breathing resistance. Development in a new form of chemical filters has shown promise to make the filtering approach feasible.

  20. The Knowledge Governance Approach

    DEFF Research Database (Denmark)

    Foss, Nicolai

    2005-01-01

    An attempt is made to characterize a `knowledge governance approach' as a distinctive, emerging field that cuts across the fields of knowledge management, organisation studies, strategy and human resource management. Knowledge governance is taken up with how the deployment of administrative...... represents various challenges to more `closed' social science disciplines, notably economics....

  1. Evaluating six soft approaches

    DEFF Research Database (Denmark)

    Sørensen, Lene; Vidal, Rene Victor Valqui

    2006-01-01

    The paper introduces and evaluates six soft approaches used in strategy development and planning. We take a planner’s perspective on discussing the concepts of strategy development and planning. This means that we see strategy development and planning as learning processes based on Ackoff’s inter...

  2. Islamic approach in counseling.

    Science.gov (United States)

    Hanin Hamjah, Salasiah; Mat Akhir, Noor Shakirah

    2014-02-01

    A religious approach is one of the matters emphasized in counseling today. Many researchers find that there is a need to apply the religious element in counseling because religion is important in a client's life. The purpose of this research is to identify aspects of the Islamic approach applied in counseling clients by counselors at Pusat Kaunseling Majlis Agama Islam Negeri Sembilan (PKMAINS). In addition, this research also analyses the Islamic approach applied in counseling at PKMAINS with reference to al-Quran and al-Sunnah. This is a qualitative research in the form of case study at PKMAINS. The main method used in this research is interview. The research instrument used is interview protocol. The respondents in this study include 9 counselors who serve in one of the counseling centers in Malaysia. This study also uses questionnaire as an additional instrument, distributed to 36 clients who receive counseling service at the center. The findings of the study show that the Islamic approach applied in counseling at PKMAINS may be categorized into three main aspects: aqidah (faith), ibadah (worship/ultimate devotion and love for God) and akhlaq (moral conduct). Findings also show that the counseling in these aspects is in line with Islamic teachings as contained in al-Quran and al-Sunnah.

  3. Adopting a Pluricentric Approach

    Science.gov (United States)

    van Kerckvoorde, Colette

    2012-01-01

    This article argues for a "D-A-CH" approach, which stands for Germany (D), Austria (A), and Switzerland (CH), in language classes from the introductory level on. I begin by tracing the emergence and development of distinct Standard Swiss and Austrian German varieties. I then discuss marketing efforts for Swiss and Austrian German, and…

  4. Marxian Approaches to Education.

    Science.gov (United States)

    Carnoy, Martin

    Traditional Marxist approaches to the state relegate superstructural institutions like the school to a minor role in the process of social change. More recent theories like those of Gramsci, Althusser, and Poulantzas raise the state and the class struggle in the state apparatuses to a much more prominent position: superstructure, including the…

  5. Implementation of Communicative Approach

    Science.gov (United States)

    Jabeen, Shazi Shah

    2014-01-01

    In the contemporary age of high professional requirements such as excellent communicative skills, the need for successful learning of communicative skills of English language suggests communicative ability to be the goal of language teaching. In other words, to teach English language using communicative approach becomes essential. Studies to…

  6. Comparing Information Access Approaches.

    Science.gov (United States)

    Chalmers, Matthew

    1999-01-01

    Presents a broad view of information access, drawing from philosophy and semiology in constructing a framework for comparative discussion that is used to examine the information representations that underlie four approaches to information access--information retrieval, workflow, collaborative filtering, and the path model. Contains 32 references.…

  7. The Capability Approach

    NARCIS (Netherlands)

    I.A.M. Robeyns (Ingrid)

    2011-01-01

    textabstract In its most general description, the capability approach is a flexible and multi-purpose normative framework, rather than a precise theory of well-being, freedom or justice. At its core are two normative claims: first, the claim that the freedom to achieve well-being is of primary mora

  8. Ecosystem approach in education

    Science.gov (United States)

    Nabiullin, Iskander

    2017-04-01

    Environmental education is a base for sustainable development. Therefore, in our school we pay great attention to environmental education. Environmental education in our school is based on ecosystem approach. What is an ecosystem approach? Ecosystem is a fundamental concept of ecology. Living organisms and their non-living environments interact with each other as a system, and the biosphere planet functions as a global ecosystem. Therefore, it is necessary for children to understand relationships in ecosystems, and we have to develop systems thinking in our students. Ecosystem approach and systems thinking should help us to solve global environmental problems. How do we implement the ecosystem approach? Students must understand that our biosphere functions as a single ecosystem and even small changes can lead to environmental disasters. Even the disappearance of one plant or animal species can lead to irreversible consequences. So in the classroom we learn the importance of each living organism for the nature. We pay special attention to endangered species, which are listed in the Red Data List. Kids are doing projects about these organisms, make videos, print brochures and newspapers. Fieldwork also plays an important role for ecosystem approach. Every summer, we go out for expeditions to study species of plants and animals listed in the Red Data List of Tatarstan. In class, students often write essays on behalf of any endangered species of plants or animals, this also helps them to understand the importance of each living organism in nature. Each spring we organise a festival of environmental projects among students. Groups of 4-5 students work on a solution of environmental problems, such as water, air or soil pollution, waste recycling, the loss of biodiversity, etc. Participants shoot a clip about their project, print brochures. Furthermore, some of the students participate in national and international scientific Olympiads with their projects. In addition to

  9. Domain Approach: An Alternative Approach in Moral Education

    Science.gov (United States)

    Vengadasalam, Chander; Mamat, Wan Hasmah Wan; Mail, Fauziah; Sudramanian, Munimah

    2014-01-01

    This paper discusses the use of the domain approach in moral education in an upper secondary school in Malaysia. Moral Education needs a creative and an innovative approach. Therefore, a few forms of approaches are used in the teaching-learning of Moral Education. This research describes the use of domain approach which comprises the moral domain…

  10. Sociocultural approach to textbook

    Directory of Open Access Journals (Sweden)

    Pešić Jelena M.

    2005-01-01

    Full Text Available The aim of this paper is to present an overview of textbook research at the Institute of psychology, intended to postulate socio-cultural approach to textbook. Shifting the textbook from classical pedagogical-psychological context into the broader and more inspiring cultural context, has led to the conceptualization of textbook as a cultural-supportive system of individual development. We consider firstly, the theoretical background of this conception, founded in Vygotskian idea of cultural mediation of development and then, its operationalization through the concept of cultural-supportive tools. The transfer from theory to practice is presented through the most important practical implications, such as defining the genre specificities of textbook and principles of educational design of textbooks. As a distinctive issue, we also consider the way this approach to textbook (theoretical articulation, analytical concepts, and practical implications contributes to development of socio-cultural paradigm in psychology.

  11. A Personal Approach

    Directory of Open Access Journals (Sweden)

    Kellyn Weir

    2015-12-01

    Full Text Available This study explored the process of taking a personal approach to my son’s problems with computer games. As a psychology student, I should have been in a good position to explore the paradoxical emotions and this situation of conflict. Yet I was also aware that relating closely to the people we are studying has long been a taboo even in qualitative research. I nevertheless adopted a collaborative methodology in which I balanced a dual role of parent and researcher. Taking a personal approach, allowing intimate, reciprocal negotiation, I was not only able to put this taboo to the rare empirical test but also achieved an insight that would otherwise have not been available to me. By engaging in dialogue and encouraging the ability to object, a first-person plural (We, position was achieved in which an understanding of this situation developed and has transferred to our everyday lives.

  12. Rail transport systems approach

    CERN Document Server

    2017-01-01

    This book shows how the systems approach is employed by scientists in various countries to solve specific problems concerning railway transport. In particular, the book describes the experiences of scientists from Romania, Germany, the Czech Republic, the UK, Russia, Ukraine, Lithuania and Poland. For many of these countries there is a problem with the historical differences between the railways. In particular, there are railways with different rail gauges, with different signaling and communication systems, with different energy supplies and, finally, with different political systems, which are reflected in the different approaches to the management of railway economies. The book’s content is divided into two main parts, the first of which provides a systematic analysis of individual means of providing and maintaining rail transport. In turn, the second part addresses infrastructure and management development, with particular attention to security issues. Though primarily written for professionals involved...

  13. Thermodynamics an engineering approach

    CERN Document Server

    Cengel, Yunus A

    2014-01-01

    Thermodynamics, An Engineering Approach, eighth edition, covers the basic principles of thermodynamics while presenting a wealth of real-world engineering examples so students get a feel for how thermodynamics is applied in engineering practice. This text helps students develop an intuitive understanding by emphasizing the physics and physical arguments. Cengel and Boles explore the various facets of thermodynamics through careful explanations of concepts and use of numerous practical examples and figures, having students develop necessary skills to bridge the gap between knowledge and the confidence to properly apply their knowledge. McGraw-Hill is proud to offer Connect with the eighth edition of Cengel/Boles, Thermodynamics, An Engineering Approach. This innovative and powerful new system helps your students learn more efficiently and gives you the ability to assign homework problems simply and easily. Problems are graded automatically, and the results are recorded immediately. Track individual stude...

  14. The Knowledge Governance Approach

    DEFF Research Database (Denmark)

    Foss, Nicolai

    2005-01-01

    An attempt is made to characterize a `knowledge governance approach' as a distinctive, emerging field that cuts across the fields of knowledge management, organisation studies, strategy and human resource management. Knowledge governance is taken up with how the deployment of administrative...... apparatus influences knowledge processes, such as sharing, retaining and creating knowledge. It insists on clear behavioural foundations, adopts an economizing perspective and examines efficient alignment between knowledge transactions with diverse characteristics and governance structures and mechanisms...... with diverse capabilities of handling these transactions. Various open research issues that a knowledge governance approach may illuminate are sketched. Although knowledge governance draws clear inspiration from organizational economics and `rational' organization theory, it recognizes that knowledge...

  15. Transaction based approach

    Science.gov (United States)

    Hunka, Frantisek; Matula, Jiri

    2017-07-01

    Transaction based approach is utilized in some methodologies in business process modeling. Essential parts of these transactions are human beings. The notion of agent or actor role is usually used for them. The paper on a particular example describes possibilities of Design Engineering Methodology for Organizations (DEMO) and Resource-Event-Agent (REA) methodology. Whereas the DEMO methodology can be regarded as a generic methodology having its foundation in the theory of Enterprise Ontology the REA methodology is regarded as the domain specific methodology and has its origin in accountancy systems. The results of these approaches is that the DEMO methodology captures everything that happens in the reality with a good empirical evidence whereas the REA methodology captures only changes connected with economic events. Economic events represent either change of the property rights to economic resource or consumption or production of economic resources. This results from the essence of economic events and their connection to economic resources.

  16. Breakfast: a multidisciplinary approach

    OpenAIRE

    Affinita, Antonio; Catalani, Loredana; Cecchetto, Giovanna; De Lorenzo, Gianfranco; Dilillo, Dario; Donegani, Giorgio; Fransos, Lucia; Lucidi, Fabio; Mameli, Chiara; Manna, Elisa; Marconi, Paolo; Mele, Giuseppe; Minestroni, Laura; Montanari, Massimo; Morcellini, Mario

    2013-01-01

    Background The role of breakfast as an essential part of an healthy diet has been only recently promoted even if breakfast practices were known since the Middle Age. The growing scientific evidences on this topic are extremely sector-based nevertheless breakfast could be regarded from different point of views and from different expertises. This approach, that take into account history, sociology, anthropology, medicine, psychology and pedagogy, is useful to better understand the value of this...

  17. Towards a Tectonic Approach

    DEFF Research Database (Denmark)

    Hvejsel, Marie Frier; Kirkegaard, Poul Henning; Mortensen, Sophie Bondgaard

    2015-01-01

    Given the increasing environmental and legislative demands to reduce energy consumption, not only new constructions but also the existing urban fabric is about to change radically in the coming decades. Existing buildings cannot simply be restored but must undergo a transformation to comply with ...... the building envelope as an aesthetic ‘gesture’, this paper discusses the architectural challenges related to energy renovation in a Danish context and tectonic design method as an approach to these challenges in everyday practice....

  18. The Branding Management Approaches

    Institute of Scientific and Technical Information of China (English)

    YAKOUBI; Mohamed Lamine

    2014-01-01

    [Abstract]We wil try to present,through the display of the various branding concepts and theories, the different branding management approaches.This wil present the different visions of the discipline depending on the author to try and demonstrate their differences,at first, and their complementarities at last to help the different branding management practitioners (brand managers,marketing managers,advertisers,media-planners……) apprehend the right brand positioning strategy to engage.

  19. Approaching Service Innovation Patterns

    OpenAIRE

    Nagy, Andrea

    2013-01-01

    The present paper aims at analyzing the types of innovation in the field of services. First, the concept of innovation is defined and second, field literature is reviewed from the perspective of service innovation. The main types of innovation are identified based on several attempts at defining innovation, the most notable being Schumpeter’s. Thus, it is possible to approach concepts such as product and process innovation, incremental and radical innovation. Another aim has been to regard se...

  20. APPROACHES FOR SUSTAINABLE MANUFACTURING

    Institute of Scientific and Technical Information of China (English)

    G(U)NTHER Seliger; SEBASTIAN Kernbaum; MARCO Zettl

    2007-01-01

    Sustainable development is a holistic approach harmonizing ecological, economical and socio-political needs with respect to the superior objective of enhancing human living standards. Thereby the availability of natural resources and the conservation of the ecosystems have to be considered that future generations have the possibility to meet their own needs. A long-term economical development demands the transition from a source-sink economy to a cycle economy as a result of limited resources, limited environmental capacities to absorb waste and emissions as well as increasing needs of a growing population. A reference model for sustainability in manufacturing is presented and used to illustrate sustainable approaches with respect to management, technology, process and product. Adaptation of products and components is a vital element for supporting efficient reuse of products and components. Consequently adaptation contributes to the ambitious goals of sustainability. Technological enablers for adaptation as modularity, information and communication technology are exemplarily introduced. Moreover, approaches for disseminating knowledge in sustainability are given.

  1. Multivariate Bioclimatic Ecosystem Change Approaches

    Science.gov (United States)

    2015-02-06

    conclude that an analogous patch did not exist. It must exist somewhere, but some of the other MVA techniques were restricted by the mathematical ...found that the Primarily Analogous Multivariate approach developed during this research clearly distinguished itself from the other five approaches in...Principally Analogous Multivariate (PAM) approach ............................................... 29 4.6.1 Introduction to the PAM approach

  2. [Approaches to radial shaft].

    Science.gov (United States)

    Bartoníček, J; Naňka, O; Tuček, M

    2015-10-01

    In the clinical practice, radial shaft may be exposed via two approaches, namely the posterolateral Thompson and volar (anterior) Henry approaches. A feared complication of both of them is the injury to the deep branch of the radial nerve. No consensus has been reached, yet, as to which of the two approaches is more beneficial for the proximal half of radius. According to our anatomical studies and clinical experience, Thompson approach is safe only in fractures of the middle and distal thirds of the radial shaft, but highly risky in fractures of its proximal third. Henry approach may be used in any fracture of the radial shaft and provides a safe exposure of the entire lateral and anterior surfaces of the radius.The Henry approach has three phases. In the first phase, incision is made along the line connecting the biceps brachii tendon and the styloid process of radius. Care must be taken not to damage the lateral cutaneous nerve of forearm.In the second phase, fascia is incised and the brachioradialis identified by the typical transition from the muscle belly to tendon and the shape of the tendon. On the lateral side, the brachioradialis lines the space with the radial artery and veins and the superficial branch of the radial nerve running at its bottom. On the medial side, the space is defined by the pronator teres in the proximal part and the flexor carpi radialis in the distal part. The superficial branch of the radial nerve is retracted together with the brachioradialis laterally, and the radial artery medially.In the third phase, the attachment of the pronator teres is identified by its typical tendon in the middle of convexity of the lateral surface of the radial shaft. The proximal half of the radius must be exposed very carefully in order not to damage the deep branch of the radial nerve. Dissection starts at the insertion of the pronator teres and proceeds proximally along its lateral border in interval between this muscle and insertion of the supinator

  3. Mitochondrial diseases: therapeutic approaches.

    Science.gov (United States)

    DiMauro, Salvatore; Mancuso, Michelangelo

    2007-06-01

    Therapy of mitochondrial encephalomyopathies (defined restrictively as defects of the mitochondrial respiratory chain) is woefully inadequate, despite great progress in our understanding of the molecular bases of these disorders. In this review, we consider sequentially several different therapeutic approaches. Palliative therapy is dictated by good medical practice and includes anticonvulsant medication, control of endocrine dysfunction, and surgical procedures. Removal of noxious metabolites is centered on combating lactic acidosis, but extends to other metabolites. Attempts to bypass blocks in the respiratory chain by administration of electron acceptors have not been successful, but this may be amenable to genetic engineering. Administration of metabolites and cofactors is the mainstay of real-life therapy and is especially important in disorders due to primary deficiencies of specific compounds, such as carnitine or coenzyme Q10. There is increasing interest in the administration of reactive oxygen species scavengers both in primary mitochondrial diseases and in neurodegenerative diseases directly or indirectly related to mitochondrial dysfunction. Aerobic exercise and physical therapy prevent or correct deconditioning and improve exercise tolerance in patients with mitochondrial myopathies due to mitochondrial DNA (mtDNA) mutations. Gene therapy is a challenge because of polyplasmy and heteroplasmy, but interesting experimental approaches are being pursued and include, for example, decreasing the ratio of mutant to wild-type mitochondrial genomes (gene shifting), converting mutated mtDNA genes into normal nuclear DNA genes (allotopic expression), importing cognate genes from other species, or correcting mtDNA mutations with specific restriction endonucleases. Germline therapy raises ethical problems but is being considered for prevention of maternal transmission of mtDNA mutations. Preventive therapy through genetic counseling and prenatal diagnosis is

  4. Peritonitis: laparoscopic approach

    Directory of Open Access Journals (Sweden)

    Agresta Ferdinando

    2006-03-01

    Full Text Available Abstract Background Laparoscopy has became as the preferred surgical approach to a number of different diseases because it allows a correct diagnosis and treatment at the same time. In abdominal emergencies, both components of treatment – exploration to identify the causative pathology and performance of an appropriate operation – can often be accomplished via laparoscopy. There is still a debate of peritonitis as a contraindication to this kind of approach. Aim of the present work is to illustrate retrospectively the results of a case-control experience of laparoscopic vs. open surgery for abdominal peritonitis emergencies carried out at our institution. Methods From January 1992 and January 2002 a total of 935 patients (mean age 42.3 ± 17.2 years underwent emergent and/or urgent surgery. Among them, 602 (64.3% were operated on laparoscopically (of whom 112 -18.7% – with peritonitis, according to the presence of a surgical team trained in laparoscopy. Patients with a history of malignancy, more than two previous major abdominal surgeries or massive bowel distension were not treated Laparoscopically. Peritonitis was not considered contraindication to Laparoscopy. Results The conversion rate was 23.2% in patients with peritonitis and was mainly due to the presence of dense intra-abdominal adhesions. Major complications ranged as high as 5.3% with a postoperative mortality of 1.7%. A definitive diagnosis was accomplished in 85.7% (96 pat. of cases, and 90.6% (87 of these patients were treated successfully by Laparoscopy. Conclusion Even if limited by its retrospective feature, the present experience let us to consider the Laparoscopic approach to abdominal peritonitis emergencies a safe and effective as conventional surgery, with a higher diagnostic yield and allows for lesser trauma and a more rapid postoperative recovery. Such features make Laparoscopy a challenging alternative to open surgery in the management algorithm for abdominal

  5. URBAN POLITICS: KEY APPROACHES

    Directory of Open Access Journals (Sweden)

    Ledyaeva Ol'ga Mikhaylovna

    2012-10-01

    Full Text Available Several approaches that underlie urban politics are discussed in the paper. They include neo-liberalism, political economy discourse, elitist/pluralist debates, and postmodernism. The neoliberal approach focuses on the limited role of the state and individual responsibility. The legal framework protects both the rights and responsibilities of individuals and regulates the operation of the market. It is the market that fosters individual choices and provides goods and services by virtue of the processes which are flexible, efficient and transparent. The political economy approaches (regulation theory, public choice theory, neo-Marxism explain urban politics via the analysis of national and international economic processes and changes in contemporary capitalism. Changes in national and international economies determine what solutions are possible. The discourse has been influenced by the debate on globalization of capital and labour markets. Modern elitism and neopluralism are represented by theories of "growth machines" and "urban regimes". The former focuses on bargaining alliances between political and business leaders in order to manage the urban system and to promote its growth. The latter develops neopluralist explanations of power within local communities with an emphasis on the fragmented nature of the government where local authorities lack comprehensive governing powers. Postmodernism views the city as the site of the crisis of late capitalism which leads to segregation of neighbourhoods onto prosperous areas and ghettoes. In contrast to the modern city, the postmodern city is not defined by its industrial base; rather, it is determined by its consumerist environment of malls and museums, characterized by revivalist architecture. At the same time, the suburban shopping mall and a motorway network make nonsense of the idea of the city as a unique and well-defined space. These and other approaches encompass a wide spectrum of possibilities

  6. Approaching Service Innovation Patterns

    Directory of Open Access Journals (Sweden)

    Andrea NAGY

    2013-06-01

    Full Text Available The present paper aims at analyzing the types of innovation in the field of services. First, the concept of innovation is defined and second, field literature is reviewed from the perspective of service innovation. The main types of innovation are identified based on several attempts at defining innovation, the most notable being Schumpeter’s. Thus, it is possible to approach concepts such as product and process innovation, incremental and radical innovation. Another aim has been to regard service innovation as a standout type of innovation.

  7. [Regenerative approach for COPD].

    Science.gov (United States)

    Kubo, Hiroshi

    2011-10-01

    No treatment to cure of chronic obstructive pulmonary disease (COPD) is available. Regenerative medicine is one of promising areas for this intractable disease. Several reagents and growth factors are known to promote lung regeneration in small animal models. However, regenerative medicines for human lungs are not achieved yet. Recent advances in stem cell biology and tissue engineering have expanded our understanding of lung endogenous stem cells, and this new knowledge provides us with new ideas for future regenerative therapy for lung diseases. Although lungs are the most challenging organ for regenerative medicine, our cumulative knowledge of lung regeneration and of endogenous progenitor cells makes clear the possibilities for regenerative approach to COPD.

  8. Papilledema. An updated approach.

    Directory of Open Access Journals (Sweden)

    Yaney González Yglesias

    2009-07-01

    Full Text Available The term papilledema refers to the edema that appears in the optic papilla after intracranial hypertension. Some of its most frequent causes are intracranial lesions, hydrocephaly, thrombosis venous sinus and meningitis. The increase of intracranial tension is related with the results of the eye´s fundus examination, which are classified differently: incipient, established, chronic, and atrophic, depending on its severity or development. It is indispensable to carry out imaging tests before performing lumbar puncture. This article is an approach to the diagnosis and treatment of this gnoseological entity.

  9. [Cystic pyeloureteritis. Our approach].

    Science.gov (United States)

    Castillo Jimeno, J M; González de Garibay, A S; Ruiz Rubio, J L; Sebastián Borruel, J L

    1992-05-01

    We report a case of massive cystic pyeloureteritis that had been diagnosed by ureterorenoscopy in a patient with recurrent urinary infection and episodes of nephritic colic. The reports published in the literature indicate there is no specific treatment for this disease whose etiology is unknown. Its pathogenesis has not been well-established and it is difficult to distinguish from other urothelial filling defects. Although it has also been reported that it may progress to malignancy, we believe that the therapeutic approach should be conservative.

  10. Experimental approaches and applications

    CERN Document Server

    Crasemann, Bernd

    1975-01-01

    Atomic Inner-Shell Processes, Volume II: Experimental Approaches and Applications focuses on the physics of atomic inner shells, with emphasis on experimental aspects including the use of radioactive atoms for studies of atomic transition probabilities. Surveys of modern techniques of electron and photon spectrometry are also presented, and selected practical applications of inner-shell processes are outlined. Comprised of six chapters, this volume begins with an overview of the general principles underlying the experimental techniques that make use of radioactive isotopes for inner-sh

  11. Towards a Dual Approach

    DEFF Research Database (Denmark)

    Holli, Anne Maria; Harder, Mette Marie Stæhr

    2016-01-01

    countries acknowledged as forerunners in gender equality, which also have ‘fairly strong’ parliamentary standing committees. The results show that both committees on gender equality can be regarded as ‘feminist’ in character and both interact with relevant civil society organisations. Their impact......Drawing on insights from state feminism and legislative studies on parliamentary committees, this article develops a dual approach for the comparative analysis of committees on gender equality. Empirically, it compares the standing committees on gender equality in Denmark and Finland, two Nordic...

  12. The collaboratory approach

    Energy Technology Data Exchange (ETDEWEB)

    Peskin, A.M.

    1997-04-01

    A {open_quotes}collaboratory{close_quotes} has been defined as a center without walls, in which researchers can perform their work without regard to geographical location. To an increasing degree, engineering design and development is also taking the form of far-flung collaborations among divisions of a plant, subcontractors, university consultants and customers. It has long been recognized that quality engineering education presents the student with an environment that duplicates as much as possible that which the graduate will encounter in industry. To that end, it is important that engineering schools begin to introduce the collaboratory approach in its preparation, and even use it in delivery of subject matter to students.

  13. An evolutionary approach

    Science.gov (United States)

    Healy, Thomas J.

    1993-04-01

    The paper describes an evolutionary approach to the development of aerospace systems, represented by the introduction of integrated product teams (IPTs), which are now used at Rockwell's Space Systems Division on all new programs and are introduced into existing projects after demonstrations of increases in quality and reductions in cost and schedule due to IPTs. Each IPT is unique and reflects its own program and lasts for the life of the program. An IPT includes customers, suppliers, subcontractors, and associate contractors, and have a charter, mission, scope of authority, budget, and schedule. Functional management is responsible for the staffing, training, method development, and generic technology development.

  14. Interstage Flammability Analysis Approach

    Science.gov (United States)

    Little, Jeffrey K.; Eppard, William M.

    2011-01-01

    The Interstage of the Ares I launch platform houses several key components which are on standby during First Stage operation: the Reaction Control System (ReCS), the Upper Stage (US) Thrust Vector Control (TVC) and the J-2X with the Main Propulsion System (MPS) propellant feed system. Therefore potentially dangerous leaks of propellants could develop. The Interstage leaks analysis addresses the concerns of localized mixing of hydrogen and oxygen gases to produce deflagration zones in the Interstage of the Ares I launch vehicle during First Stage operation. This report details the approach taken to accomplish the analysis. Specified leakage profiles and actual flammability results are not presented due to proprietary and security restrictions. The interior volume formed by the Interstage walls, bounding interfaces with the Upper and First Stages, and surrounding the J2-X engine was modeled using Loci-CHEM to assess the potential for flammable gas mixtures to develop during First Stage operations. The transient analysis included a derived flammability indicator based on mixture ratios to maintain achievable simulation times. Validation of results was based on a comparison to Interstage pressure profiles outlined in prior NASA studies. The approach proved useful in the bounding of flammability risk in supporting program hazard reviews.

  15. Approaches for Stereo Matching

    Directory of Open Access Journals (Sweden)

    Takouhi Ozanian

    1995-04-01

    Full Text Available This review focuses on the last decade's development of the computational stereopsis for recovering three-dimensional information. The main components of the stereo analysis are exposed: image acquisition and camera modeling, feature selection, feature matching and disparity interpretation. A brief survey is given of the well known feature selection approaches and the estimation parameters for this selection are mentioned. The difficulties in identifying correspondent locations in the two images are explained. Methods as to how effectively to constrain the search for correct solution of the correspondence problem are discussed, as are strategies for the whole matching process. Reasons for the occurrence of matching errors are considered. Some recently proposed approaches, employing new ideas in the modeling of stereo matching in terms of energy minimization, are described. Acknowledging the importance of computation time for real-time applications, special attention is paid to parallelism as a way to achieve the required level of performance. The development of trinocular stereo analysis as an alternative to the conventional binocular one, is described. Finally a classification based on the test images for verification of the stereo matching algorithms, is supplied.

  16. Diagnostic approaches for cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Cholangiocarcinomas arise from the epithelial cells of the bile ducts and are associated with poor prognosis. Despite new diagnostic approaches, the definite diagnosis of this malignancy continues to be challenging. Cholangiocarcinomas often grow longitudinally along the bile duct rather than in a radial direction. Thus, large tumor masses are frequently absent and imaging techniques, including ultrasound, CT, and MRI have only limited sensitivity. Tissue collection during endoscopic (ERCP) and/or percutaneous transhepatic (PTC) procedures are usually used to confirm a definitive diagnosis of cholangiocarcinoma. However, forceps biopsy and brush cytology provide positive results for malignancy in about only 50% of patients. Percutaneous and peroral cholangioscopy using fiber-optic techniques were therefore developed for direct visualization of the biliary tree, yielding additional information about endoscopic appearance and tumor extension, as well as a guided biopsy acquistion. Finally, endoscopic ultrasonography (EUS) complements endoscopic and percutaneous approaches and may provide a tissue diagnosis of tumors in the biliary region through fine- needle aspiration. In the future, new techniques allowing for early detection, including molecular markers, should be developed to improve the diagnostic sensitivity in this increasing tumor entity.

  17. Modular Approach to Spintronics.

    Science.gov (United States)

    Camsari, Kerem Yunus; Ganguly, Samiran; Datta, Supriyo

    2015-06-11

    There has been enormous progress in the last two decades, effectively combining spintronics and magnetics into a powerful force that is shaping the field of memory devices. New materials and phenomena continue to be discovered at an impressive rate, providing an ever-increasing set of building blocks that could be exploited in designing transistor-like functional devices of the future. The objective of this paper is to provide a quantitative foundation for this building block approach, so that new discoveries can be integrated into functional device concepts, quickly analyzed and critically evaluated. Through careful benchmarking against available theory and experiment we establish a set of elemental modules representing diverse materials and phenomena. These elemental modules can be integrated seamlessly to model composite devices involving both spintronic and nanomagnetic phenomena. We envision the library of modules to evolve both by incorporating new modules and by improving existing modules as the field progresses. The primary contribution of this paper is to establish the ground rules or protocols for a modular approach that can build a lasting bridge between materials scientists and circuit designers in the field of spintronics and nanomagnetics.

  18. Advanced intelligence and mechanism approach

    Institute of Scientific and Technical Information of China (English)

    ZHONG Yixin

    2007-01-01

    Advanced intelligence will feature the intelligence research in next 50 years.An understanding of the concept of advanced intelligence as well as its importance will be provided first,and detailed analysis on an approach,the mechanism approach.suitable to the advanced intelligence research will then be flolowed.And the mutual relationship among mechanism approach,traditional approaches existed in artificial intelligence research,and the cognitive informatics will be discussed.It is interesting to discover that mechanism approach is a good one to the Advanced Intelligence research and a tmified form of the existed approaches to artificial intelligence.

  19. The Point Approach and the Phrase Approach to Vocabulary Learning

    Institute of Scientific and Technical Information of China (English)

    刘梦媛

    2013-01-01

      As is known to all, vocabulary acquisition plays an essential role in English learning. However, it was supposed very dif⁃ficult to many Chinese learners. For the reason that so many kinds of approaches exists in the real life, English learners are always do not know which one is suitable and more effective. To solve this problem, the paper will analyze two approaches (point approach and phrase approach) for you.

  20. Bioengineering a conceptual approach

    CERN Document Server

    Pavlovic, Mirjana

    2015-01-01

    This book explores critical principles and new concepts in bioengineering, integrating the biological, physical and chemical laws and principles that provide a foundation for the field. Both biological and engineering perspectives are included, with key topics such as the physical-chemical properties of cells, tissues and organs; principles of molecules; composition and interplay in physiological scenarios; and the complex physiological functions of heart, neuronal cells, muscle cells and tissues. Chapters evaluate the emerging fields of nanotechnology, drug delivery concepts, biomaterials, and regenerative therapy. The leading individuals and events are introduced along with their critical research. Bioengineering: A Conceptual Approach is a valuable resource for professionals or researchers interested in understanding the central elements of bioengineering. Advanced-level students in biomedical engineering and computer science will also find this book valuable as a secondary textbook or reference.

  1. Microscopic approach to polaritons

    DEFF Research Database (Denmark)

    Skettrup, Torben

    1981-01-01

    contrary to experimental experience. In order to remove this absurdity the semiclassical approach must be abandoned and the electromagnetic field quantized. A simple microscopic polariton model is then derived. From this the wave function for the interacting exciton-photon complex is obtained...... of light of the crystal. The introduction of damping smears out the excitonic spectra. The wave function of the polariton, however, turns out to be very independent of damping up to large damping values. Finally, this simplified microscopic polariton model is compared with the exact solutions obtained...... for the macroscopic polariton model by Hopfield. It is seen that standing photon and exciton waves must be included in an exact microscopic polariton model. However, it is concluded that for practical purposes, only the propagating waves are of importance and the simple microscopic polariton wave function derived...

  2. Integration a functional approach

    CERN Document Server

    Bichteler, Klaus

    1998-01-01

    This book covers Lebesgue integration and its generalizations from Daniell's point of view, modified by the use of seminorms. Integrating functions rather than measuring sets is posited as the main purpose of measure theory. From this point of view Lebesgue's integral can be had as a rather straightforward, even simplistic, extension of Riemann's integral; and its aims, definitions, and procedures can be motivated at an elementary level. The notion of measurability, for example, is suggested by Littlewood's observations rather than being conveyed authoritatively through definitions of (sigma)-algebras and good-cut-conditions, the latter of which are hard to justify and thus appear mysterious, even nettlesome, to the beginner. The approach taken provides the additional benefit of cutting the labor in half. The use of seminorms, ubiquitous in modern analysis, speeds things up even further. The book is intended for the reader who has some experience with proofs, a beginning graduate student for example. It might...

  3. Radiolab - three different approaches

    DEFF Research Database (Denmark)

    Lønstrup, Ansa

    2012-01-01

    Radiolab – three different approaches The three papers in this ‘suite’ have a special background and context. At the 2010 conference SoundActs in Aarhus the three panellists were each given the task to provide a paper with an analysis of the same sound object, thus exhibiting and contrasting...... contextual investigation. This object was chosen for several reasons. First of all, it is brief (less than 17 seconds), which meant that it was possible to make a detailed analysis; at the same time, though, it is relatively complex, which means that it can accommodate three different analyses. It is a sound......, who methodologically operates within tree levels of investigation: 1) the syntax, 2) the semantic and 3) the ontology level. Accordingly, this analysis is conducted, as if the sound object was performed by a vocal ensemble oscillating ‘between a musical and a speech act’. Torben Sangild’s paper...

  4. Cognitive approaches to emotions.

    Science.gov (United States)

    Oatley, Keith; Johnson-Laird, P N

    2014-03-01

    Cognitive approaches offer clear links between how emotions are thought about in everyday life and how they are investigated psychologically. Cognitive researchers have focused on how emotions are caused when events or other people affect concerns and on how emotions influence processes such as reasoning, memory, and attention. Three representative cognitive theories of emotion continue to develop productively: the action-readiness theory, the core-affect theory, and the communicative theory. Some principles are common to them and divergences can be resolved by future research. Recent explanations have included how emotions structure social relationships, how they function in psychological illnesses, and how they are central to music and fiction. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. Therapeutic approaches for shankopathies.

    Science.gov (United States)

    Wang, Xiaoming; Bey, Alexandra L; Chung, Leeyup; Krystal, Andrew D; Jiang, Yong-Hui

    2014-02-01

    Despite recent advances in understanding the molecular mechanisms of autism spectrum disorders (ASD), the current treatments for these disorders are mostly focused on behavioral and educational approaches. The considerable clinical and molecular heterogeneity of ASD present a significant challenge to the development of an effective treatment targeting underlying molecular defects. Deficiency of SHANK family genes causing ASD represent an exciting opportunity for developing molecular therapies because of strong genetic evidence for SHANK as causative genes in ASD and the availability of a panel of Shank mutant mouse models. In this article, we review the literature suggesting the potential for developing therapies based on molecular characteristics and discuss several exciting themes that are emerging from studying Shank mutant mice at the molecular level and in terms of synaptic function.

  6. The Indirect Approach

    Directory of Open Access Journals (Sweden)

    Geir H Moshuus

    2016-07-01

    Full Text Available How do we do good guesswork at meaning if our informant lives in a secret world? Doing research often includes awkward moments, unforeseen events, and incidents. Here we name some of these “happenstances.” We suggest that happenstances may offer a solution to the problem of meaning discrepancies: The happenstance is one of those moments that allow the researcher to temporarily bridge into the meanings of his or her informant. We have carried out research on marginal youth. In both of our studies, happenstances have turned interview situations upside down. Here we identify how these unforeseen events provided us with valuable insights into our informants’ contexts. We conclude by addressing how these happenstances, though they appear to be a product of pure accident, may become part of a systematic approach in discovering contextual knowledge.

  7. Editorial: Approaching 125.

    Science.gov (United States)

    Goodman, Sherryl

    2012-02-01

    With this issue, beginning Volume 121, the editorial team shifts from the strong leadership of David Watson to a team under my direction. Approaching 125 years of publication, the Journal of Abnormal Psychology has earned its place as the preeminent outlet for research in psychopathology. With gratitude to the newly assembled team of associate editors (AEs), consulting editors, and ad hoc reviewers, I look forward to guiding the journal through this next term. Nine well-respected scholars have agreed to serve as AEs: Timothy Brown, Laurie Chassin, Jeff Epstein, Jutta Joormann, Pamela Keel, Kate Keenan, Scott Lilienfeld, Angus MacDonald, and Michael Young. The new team is dedicated to working tirelessly to maintain and enhance the journal's esteemed tradition of excellence. Given the well-established strengths of the journal, I will not suggest any fundamental changes.

  8. Laparoscopic approach to hysterectomy

    Directory of Open Access Journals (Sweden)

    Hakan Nazik

    2013-04-01

    Full Text Available Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding. When hysterectomy is going to be performed, the surgeon should decide which method is safer and more cost-effective. This paper aims to make a review of the indications, techniques and advantages of laparoscopic hysterectomy as well as the criteria to be used for appropriate patient selection.

  9. [Orthopedic approach to asymmetry].

    Science.gov (United States)

    Bardinet, Etienne; Duhart, Anne-Marie

    2002-06-01

    Asymmetry being a clinical manifestation of various pathologies, the orthopedic attitude greatly varies from one practitioner to another. Thanks to a better knowledge of the etiopathogenesis, the orthopedic approach in some particular cases reveals very effective, either alone or together with other therapeutics. In mandibular laterodeviations most often consecutive to a maxillary contraction, the best treatment is to expand maxilla which will allow a mandibular centric repositioning. This therapy is often achieved early to limit the asymmetric expression of growth and normalize the dental eruption. In unilateral condylar hypoplasias of variable extension, from a simple defect in condylar growth to a hemifacial microsomia, the therapeutic attitude has mostly evolved. A surgical orthodontic protocol can integrate an increasingly significant orthopedic phase in the course of time. Some authors show that a surgical case may be treated originally only with the help of orthopedics. The devices used are of activator or hyperpropulsor type. In unilateral condylar hyperplasias, orthopedic therapy must be considered with reservations.

  10. Slurry pipeline design approach

    Energy Technology Data Exchange (ETDEWEB)

    Betinol, Roy; Navarro R, Luis [Brass Chile S.A., Santiago (Chile)

    2009-12-19

    Compared to other engineering technologies, the design of a commercial long distance Slurry Pipeline design is a relatively new engineering concept which gained more recognition in the mid 1960 's. Slurry pipeline was first introduced to reduce cost in transporting coal to power generating units. Since then this technology has caught-up worldwide to transport other minerals such as limestone, copper, zinc and iron. In South America, the use of pipeline is commonly practiced in the transport of Copper (Chile, Peru and Argentina), Iron (Chile and Brazil), Zinc (Peru) and Bauxite (Brazil). As more mining operations expand and new mine facilities are opened, the design of the long distance slurry pipeline will continuously present a commercially viable option. The intent of this paper is to present the design process and discuss any new techniques and approach used today to ensure a better, safer and economical slurry pipeline. (author)

  11. Management practice: phenomenological approach

    Directory of Open Access Journals (Sweden)

    Myriam Siqueira da Cunha

    2005-01-01

    Full Text Available This work has the aim of understanding the lived experiences by managers in relation to organizational changes in an enterprise in the food area, located in the State of Rio Grande do Sul, Brazil. The role of managers has been constantly evaluated and their capacity of continuous learning and also the ability of transforming the learning in good organizational results is reacquired every instant. In this work, my intention is to show, using an interpretative analysis, real and practical situations, from lived experiences. The methodological way followed was the hermeneutic phenomenological approach, trying to give a global and a contextual treatment to the theme. The results achieved offer subsides for a new look over the management practice and point out the importance of the study of what is lived, as an inspiration source for the strategic decisions in the enterprises.

  12. Approaching attometer laser vibrometry

    Energy Technology Data Exchange (ETDEWEB)

    Rembe, Christian; Kadner, Lisa; Giesen, Moritz [Research and Development, Polytec GmbH, Polytec Platz 1-7, 76337 Waldbronn (Germany)

    2014-05-27

    The heterodyne two-beam interferometer has been proven to be the optimal solution for laser-Doppler vibrometry regarding accuracy and signal robustness. The theoretical resolution limit for a two-beam interferometer of laser class 3R (up to 5 mW visible measurement-light) is in the regime of a few femtometer per square-root Hertz and well suited to study vibrations in microstructures. However, some new applications of RF-MEM resonators, nanostructures, and surface-nano-defect detection require resolutions beyond that limit. The resolution depends only on the noise and the sensor sensitivity to specimen displacements. The noise is already defined in nowadays systems by the quantum nature of light for a properly designed optical sensor and more light would lead to an inacceptable influence like heating of a very tiny structure. Thus, noise can only be improved by squeezed-light techniques which require a negligible loss of measurement light which is impossible for almost all technical measurement tasks. Thus, improving the sensitivity is the only possible path which could make attometer laser vibrometry possible. Decreasing the measurement wavelength would increase the sensitivity but would also increase the photon shot noise. In this paper, we discuss an approach to increase the sensitivity by assembling an additional mirror between interferometer and specimen to form an optical cavity. A detailed theoretical analysis of this setup is presented and we derive the resolution limit, discuss the main contributions to the uncertainty budget, and show a first experiment proving the sensitivity amplification of our approach.

  13. Treatment Approaches for Drug Addiction

    Science.gov (United States)

    ... Approaches for Drug Addiction Treatment Approaches for Drug Addiction Email Facebook Twitter Revised July 2016 NOTE: This ... treatment options in your state. What is drug addiction? Drug addiction is a chronic disease characterized by ...

  14. SOME REFLECTIONS ON STRUCTURAL APPROACH

    Institute of Scientific and Technical Information of China (English)

    GuiQingyang

    1997-01-01

    The present paper is intended to expound the advantages and disadvantages of the trathtional Structural Approach in the Chinese context and discuss the necessity and feasibility of implementing the Communicative Approach and the Self--service Approach,both of which evaluate highly the position of subjective activity in learning and bring the obligation of professional development back to learners themselves,KEY WORD approach structural communicative self service critique adaptadopt

  15. Pragmatic approaches to genetic screening.

    NARCIS (Netherlands)

    Mallia, P.; Have, H.A.M.J. ten

    2005-01-01

    Pragmatic approaches to genetic testing are discussed and appraised. Whilst there are various schools of pragmatism, the Deweyan approach seems to be the most appreciated in bioethics as it allows a historical approach indebted to Hegel. This in turn allows the pragmatist to specify and balance prin

  16. A Narrative Approach to Research

    Science.gov (United States)

    Bell, Anne

    2003-01-01

    In this paper I present a narrative approach to environmental education research. This approach evolved through a dynamic interplay between research questions, theory, experience, conversation, and reflection. I situate the approach with respect to narrative inquiry and clarify the key conceptual metaphors underpinning my study, including…

  17. APPROACH TO ORGANIC ACIDEMIA

    Directory of Open Access Journals (Sweden)

    Gholamreza ZAMANI

    2012-03-01

    Full Text Available Organic acidemias, also known as organic acidurias, are a group of disorders characterized by increased excretion of organic acids in urine. They result primarily from deficiencies of specific enzymes in the breakdown pathways of amino acids or from enzyme deficiencies in beta oxidation of fatty acids or carbohydrate metabolism. Organic acids also are found in the urine of some patients with mitochondrial disease.Most organic acidemias become clinically apparent during the newborn period or early infancy. After an initial period of well-being, affected children develop a life-threatening episode of metabolic acidosis characterized by an increased anion gap. This presenting episode may be mistaken for sepsis, and if unrecognized, is associated with significant mortality.Children with an organic acidemia are susceptible to metabolic decompensation during episodes of increased catabolism, such as intercurrent illness, trauma, or surgery. Parents and clinicians must be well informed about the initial signs of decompensation and trained in applying an emergency regimen . Surgeons and anesthesiologists should be aware of potential complications and their prevention during anesthesia and surgery.Diagnosis has been facilitated through the use of gas chromatograph-mass spectrometry (GC-MS and tandem mass spectrometry .Prenatal diagnosis is available for most disorders by detection of diagnostic compounds in amniotic fluid; by analysis of enzyme activities in amniocytes or chorionic villi; by molecular analysis; or by a combination of the three . Diagnosis also may be made through newborn screening by tandem mass spectrometry .Laboratory findings are an essential part of the diagnostic approach to organic acidemias. In most organic acidemias, metabolism of glucose, ketone bodies, and ammonia is deranged primarily or secondarily, in addition to derangement of the acid-base balance. Hypoglycemia, lactic and/or ketoacidosis, and hyperammonemia of varying

  18. Approach focused on people

    Directory of Open Access Journals (Sweden)

    Roa Ruben

    2010-11-01

    Full Text Available Family and community medicine assumes a new epistemological landmark that also provides the use of instruments and tools related to it. This care model permits carrying out a visit where all categories which the health-disease process is expressed are present. Family Medicine intends to combine both visions and, for such, it gifts elements to incorporate disease as an essential part of our patient's approach systematic being the main focus the approach by problems, which is nothing but that which concerns the individual, his family or the physician, or all of them, and at times there will be nuisances while at other times, there will be diseases, and mil in other instances, all of them will co-exist. It is known that the impact of a health problem on an individual affects not only himself, but also his surroundings. In turn, the environment around this individual can act as the origin or perpetuator of the crisis, or else serve to help in solving the conflict. Distinct tools serve the purpose of knowing the context in which health crisis is developed, such as: genogram, individual and family vital cycle. Every time two people communicate, the agreement or disagreement generate possible variables. In the physician-patient relationship, this is no exception. Values, beliefs, feelings, and information of each individual different and physicians not necessarily in agreement in several issues during a visit. The objective is the need to achieve a minimum of agreements so that this visit has therapeutic effectiveness, thus being if/rpm -taw to find a common territory. Relations in general involve power; care, feelings, trust and goals. The objective in this type of relationship must be obviously shared ly both and cannot be any other than that of achieving, the highest level of health to our patient. So, our specialty, considered of low complexity, becomes a highly cognitive complexity, special and there is no doubt that it is a lot easier to handle

  19. Text Steganographic Approaches: A Comparison

    Directory of Open Access Journals (Sweden)

    Monika Agarwal

    2013-02-01

    Full Text Available This paper presents three novel approaches of text steganography. The first approach uses the theme ofmissing letter puzzle where each character of message is hidden by missing one or more letters in a wordof cover. The average Jaro score was found to be 0.95 indicating closer similarity between cover andstego file. The second approach hides a message in a wordlist where ASCII value of embedded characterdetermines length and starting letter of a word. The third approach conceals a message, withoutdegrading cover, by using start and end letter of words of the cover. For enhancing the security of secretmessage, the message is scrambled using one-time pad scheme before being concealed and cipher text isthen concealed in cover. We also present an empirical comparison of the proposed approaches with someof the popular text steganographic approaches and show that our approaches outperform the existingapproaches.

  20. APPROACHES TO PUBLIC INTEGRITY

    Directory of Open Access Journals (Sweden)

    Simona-Roxana ULMAN

    2015-08-01

    Full Text Available Both concepts, integrity and public integrity, are always asked qualities in the social and economic environment, but they are never well defined. In this context, finding precise definitions and offering an ample explanation of the concepts are desired and useful for both economic theoretical and practical levels and become the aim of the present paper. Without a good understanding of a concept, no one is capable to attain it. In this context, it is impossible to ask for a public sector of integrity if both public actors and the citizens do not know what it really means. Therefore, the public actors first have to understand what integrity really supposes, and, then, to be capable to respect its principles. Taking into consideration the effects of public integrity or, on its opposite, of the divergence from it, especially represented by the phenomenon of corruption, on the economy at the macro, but also, on the micro level, public integrity in itself becomes a real economic problem that is aimed to be extensively analyzed through our interdisciplinary approach.

  1. Approaches to refractory epilepsy

    Directory of Open Access Journals (Sweden)

    Jerome Engel

    2014-01-01

    Full Text Available Epilepsy is one of the most common serious neurological conditions, and 30 to 40% of people with epilepsy have seizures that are not controlled by medication. Patients are considered to have refractory epilepsy if disabling seizures continue despite appropriate trials of two antiseizure drugs, either alone or in combination. At this point, patients should be referred to multidisciplinary epilepsy centers that perform specialized diagnostic testing to first determine whether they are, in fact, pharmacoresistant, and then, if so, offer alternative treatments. Apparent pharmacoresistance can result from a variety of situations, including noncompliance, seizures that are not epileptic, misdiagnosis of the seizure type or epilepsy syndrome, inappropriate use of medication, and lifestyle issues. For patients who are pharmacoresistant, surgical treatment offers the best opportunity for complete freedom from seizures. Surgically remediable epilepsy syndromes have been identified, but patients with more complicated epilepsy can also benefit from surgical treatment and require more specialized evaluation, including intracranial EEG monitoring. For patients who are not surgical candidates, or who are unwilling to consider surgery, a variety of other alternative treatments can be considered, including peripheral or central neurostimulation, ketogenic diet, and complementary and alternative approaches. When such alternative treatments are not appropriate or effective, quality of life can still be greatly improved by the psychological and social support services offered by multidisciplinary epilepsy centers. A major obstacle remains the fact that only a small proportion of patients with refractory epilepsy are referred for expert evaluation and treatment.

  2. Halitosis: the multidisciplinary approach.

    Science.gov (United States)

    Bollen, Curd M L; Beikler, Thomas

    2012-06-01

    Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover,halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear-nose-throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear-nose-throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo.Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

  3. The Community Reinforcement Approach.

    Science.gov (United States)

    Meyers, Robert J; Smith, Jane Ellen; Lash, Denise N

    2003-01-01

    This chapter reviews two behavioral substance abuse treatments: The Community Reinforcement Approach (CRA) and Community Reinforcement and Family Training (CRAFT). Both of these programs were built on the concept that an individual's recovery is greatly affected by his or her unique environment. This environment, or reinforcing "community," is composed of family, friends, work/school, social activities, and perhaps spiritual affiliations. CRA, the first of these two programs to be developed, was created specifically for the problem drinker (Hunt & Azrin, 1973). The goal of CRA is to rearrange multiple aspects of an individual's "community" so that a clean and sober lifestyle is more rewarding than one that is dominated by alcohol and drugs. Subsequently, CRAFT was developed for the many individuals with substance abuse problems who are vehemently opposed to treatment (Institute of Medicine, 1990). CRAFT works through concerned family members and friends of these treatment refusers in an effort to get them to seek therapy (Sisson & Azrin, 1986). Descriptions and the empirical support for CRA and CRAFT follow.

  4. Voyager Approaches Final Frontier

    Science.gov (United States)

    2003-01-01

    An artist's concept illustrates the pos