Percutaneous Radiologic Gastrostomy Using the One-Anchor Technique in Patients after Partial Gastrectomy

Objective

The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success.

Materials and Methods

Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success.

Results

Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011).

Conclusion

Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.     

Modified Radiology-Guided Percutaneous Gastrostomy (MRPG) for Patients with Complete Obstruction of the Upper Digestive Tract and Who are without Endoscopic or Nasogastric Access

Objective

We wanted to report on our experience with modified radiology-guided percutaneous gastrostomy (MRPG) without endoscopic or nasogastric access for treating patients with complete obstruction of the upper digestive tract.

Materials and Methods

Fourteen oncology patients (13 had hypopharyngeal cancer and 1 had upper esophageal cancer) with complete obstruction of the upper digestive tract were recruited. Conventional percutaneous endoscopic gastrostomy (PEG) and radiologic (fluoroscopy-guided) percutaneous gastrostomy (RPG) were not feasible in all the patients. An MRPG technique (with a combination of ultrasound, an air enema and fluoroscopic guidance) was performed in these patients.

Results

We achieved successfully percutaneous gastrostomy using the modified technique in all patients without any major or minor complications after the procedure.

Conclusion

A modified radiology-guided percutaneous gastrostomy technique can be safely performed in patients who failed to receive conventional PEG or RPG due to the absence of nasogastric access in the completely obstructed upper digestive tract.     

Periprocedural Major Bleeding Risk of Image-Guided Percutaneous Chest Tube Placement in Patients with an Elevated International Normalized Ratio

PurposeTo evaluate the incidence of major hemorrhage after image-guided percutaneous chest tube placement in patients with an abnormal international normalized ratio (INR) measured before the procedure.Materials and MethodsBetween January 2013 and September 2017, 49 image-guided percutaneous chest tubes were placed in 45 adult patients who had an elevated INR of greater than 1.6. Data collected included routine serum pre-procedure coagulation studies, indication for chest tube placement, insertion technique, size of chest tube, and presence of complications after drain placement. Major bleeding complications were defined using the Society of Interventional Radiology classification system.ResultsMean patient age was 62 years (range, 22–94 years), with median American Society of Anesthesiologists score of 4. Mean INR was 2.1 (range, 1.7–3), with 21 (43%) procedures with an INR between 1.7 and 1.9, 20 (41%) procedures with an INR between 2.0 and 2.4, and 8 (16%) procedures with an INR between 2.5 and 3.0. Computed tomography guidance was used for 27 (55%) procedures; ultrasound guidance was used for 22 (45%) procedures. Median size of chest tube was 10 Fr (range, 8–14 Fr) used in 27 (55%) procedures. No major bleeding complications were observed. There was a small, significant decrease in mean hemoglobin after the procedure (mean = 0.9g/dL; P < .0001), which correlated to increasing chest tube size (P = .0269).ConclusionsNo major bleeding complications were observed after image-guided percutaneous chest tube placement in patients with an elevated INR. Major bleeding complications in these patients may be safer than initially considered, and this study encourages the conduct of larger trials for further evaluation.     

Safe Removal of an Encrusted Nephrostomy Tube Using a Vascular Sheath: A Technique Revisited

With the advent of interventional radiology and the decrease in mortality from chronic ailments, especially malignancy, percutaneous nephrostomy has become a commonly used safe technique for temporary relief of renal tract obstruction or for urinary diversion. However, these are associated with risks of infection, particularly septicaemia, colonisation, and blockage. Another significant complication is difficulty in removal due to encrustation. We describe a useful technique used in our department for the past few years and cite four cases of variable presentation and complexity for removal of an encrusted nephrostomy tube. No mention of this technique was found recent literature. An almost similar technique was described in the 1980s "Pollack and Banner (Radiology 145:203–205, 1982), Baron and McClennan (Radiology 141:824, 1981)". It is possible that experienced operators may have used this technique. We revisit it with pictographic representation, describing its use with currently available equipment, for benefit of operators who are not aware of this technique.     

Changes of Cine Cerebrospinal Fluid Dynamics in Patients with Multiple Sclerosis Treated with Percutaneous Transluminal Angioplasty: A Case-control Study

PurposeTo investigate characteristics of cine phase contrast-calculated cerebrospinal fluid (CSF) flow and velocity measures in patients with relapsing-remitting (RR) multiple sclerosis (MS) receiving standard medical treatment who had been diagnosed with chronic cerebrospinal venous insufficiency (CCSVI) and underwent percutaneous transluminal angioplasty (PTA).Materials and MethodsThis case-controlled, magnetic resonance (MR) imaging–blinded study included 15 patients with RR MS who presented with significant stenoses (≥50% lumen reduction on catheter venography) in the azygous or internal jugular veins. Eight patients underwent PTA in addition to medical therapy immediately following baseline assessments (case group) and seven had delayed PTA after 6 months of medical therapy alone (control group). CSF flow and velocity measures were quantified over 32 phases of the cardiac cycle by a semiautomated method. Outcomes were compared between groups at baseline and at 6 and 12 months of the study by mixed-effect model analysis.ResultsAt baseline, no significant differences in CSF flow or velocity measures were detected between groups. At month 6, significant improvement in flow (P<.001) and velocity (P = .013) outcomes were detected in the immediate versus the delayed group, and persisted to month 12 (P = .001 and P = .021, respectively). Within-group flow comparisons from baseline to follow-up showed a significant increase in the immediate group (P = .033) but a decrease in the delayed group (P = .024). Altered CSF flow and velocity measures were associated with worsening of clinical and MR outcomes in the delayed group.ConclusionsPTA in patients with MS with CCSVI increased CSF flow and decreased CSF velocity, which are indicative of improved venous parenchyma drainage.     

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

Objective

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis.

Materials and Methods

Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique.

Results

Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days).

Conclusion

Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis.     

Percutaneous Gastrojejunostomy Tube Insertion in Patients with Surgical Gastrojejunal Anastomoses: Analysis of Success Rates and Durability

Patients with a gastrojejunal anastomosis pose challenging anatomy for percutaneous gastrojejunostomy (GJ)-tube placement. A retrospective review of 24 patients (mean age 67.8 years, 13 males) with GJ anastomoses who underwent attempted GJ tube placement revealed infeasible placement in 6 patients (25%) due to an inadequate window for puncture. When a gastric puncture was achieved, GJ tube insertion was technically successful in 83% (15/18) of attempts, resulting in an overall technical success rate of 63% (15/24). The most common tube-related complication was the migration of the jejunal limb into the stomach, which occurred in 40% (6/15) of successful cases. No major procedure related complications were encountered.     

自动管电流调节联合低电压低剂量扫描技术在幼儿胸部CT扫描中的优化应用研究

目的 探讨64层CT自动管电流调节技术(ATCM)结合低电压在幼儿胸部低剂量扫描中的应用价值.方法 搜集行64层CT ATCM胸部扫描的幼儿(≤2岁)48例,其中A组(管电压100 kV)30例,B组(管电压80kV) 18例;并与既往采用固定管电流条件下的低剂量扫描数据进行对比分析,对照组C组(100 kV/60 mAs)30例;其余扫描参数一致.记录每次扫描的平均管电流(mAs)、CT容积剂量指数(CTDIvol)、剂量长度值(DLP),计算出有效剂量(ED)及剂量减低比值(DR),并比较3组的剂量及图像质量.结果 A组CTDIvol为(1.11±0.19)mGy,B组CTDIvol为(0.99 ±0.11)mGy,C组CTDIvol为(2.38±0.00) mGy;3组数据两两比较差异均有统计学意义(P＜0.05).A组相对C组DR约51.07％,B组相对C组DR降低约58.20％.3组图像质量均满足诊断要求,差异无统计学意义(P=0.50).结论 低电压联合ATCM技术在幼儿胸部扫描中可以广泛应用,能够有效降低辐射剂量且不影响图像质量.     

扩散张量成像对多发性硬化脑深部灰质核团纵向定量研究

目的 利用3.0T MR扩散张量成像(DTI)技术纵向定量测量复发-缓解型多发性硬化(RRMS)患者脑深部灰质核团相关参数的动态变化及其与临床相关性.方法 选取RRMS患者30例及健康对照组30名,检查前根据临床残疾状态量表(EDSS)对患者进行评分.患者行间隔平均时间约2年共2次常规MRI及DTI检查,必要时行增强扫描.选取测量大脑深部灰质核团的部分各向异性分数(FA)值及平均扩散率(MD)值,比较两次测量结果的变化并评价与临床的相关性.结果 (1)与对照组相比患者脑深部部分灰质核团FA值降低,MD值增高;(2)分析各指标与EDSS评分的相关性,结果EDSS评分与丘脑(r=0.25,P=0.04)和黑质(r=0.27,P=0.046) MD值呈正相关,与丘脑(r =0.24,P=0.03)、尾状核(r=0.414,P=0.024)FA值呈负相关性.(3)患者前后两次参数对比各核团的FA值无明显变化(P＞0.05),但尾状核(=2.36,P=0.013)、丘脑(t=3.01,P=0.009)、黑质(t=2.35,P=0.015)、红核(t=2.50,P=0.012)等核团MD值增高,以丘脑增高最明显.结论 DTI能够提示RRMS患者脑深部灰质核团受累,并且在纵向观测中可以监测患者深部灰质的病理改变.     

扩散张量成像对多发性硬化及视神经脊髓炎脑深部核团的定量研究

目的运用3.0 T MR扩散张量成像(DTI)技术探讨复发-缓解型多发性硬化(RRMS)和复发型视神经脊髓炎(RNMO)患者脑深部核团的DTI指标是否存在差异,以及该指标与临床残疾评分(EDSS)是否存在相关性。方法用3.0 T MR分别对RRMS患者(MS组)、RNMO患者(NMO组)及健康志愿者(对照组)各30名进行脑部DTI扫描,分别测量脑深部核团的平均扩散率(MD)和部分各向异性分数(FA),并分析所得结果与临床评分的相关性。统计学分析采用单因素方差分析、Dunnett-t检验、Spearman相关分析、配对t检验等。结果 (1)MS组与对照组比较:前者丘脑(t=0.239,P=0.002)和黑质(t=0.667,P=0.016)的MD值升高,苍白球(t=-0.057,P=0.002)和齿状核(t=-0.052,P=0.012)的FA值降低;NMO组与对照组比较:前者红核的MD值升高(t=-0.034,P=0.034),差异有统计学意义;MS组与NMO组比较,两者壳核的FA值差异显著(t=-0.339,P=0.034)。(2)分析各指标同EDSS评分的相关性,结果 EDSS评分与丘脑(r=0.26,P=0.045)和黑质(r=0.329,P=0.01)MD值呈正相关,与FA值无显著相关性(P>0.05)。结论 MS和NMO患者灰质均有受累,壳核对鉴别MS与NMO具有潜在的应用价值,其FA值可作为监测MS及NMO临床进展的重要生物学指标。     

Erratum to: Short-Segment Coil Embolization Using a Double-Balloon Technique in an Experimental Vascular Model

CardioVascular and Interventional Radiology -     

A Novel Method of Island Blocking in Whole Abdominal Radiotherapy Using a Modified Electronic Tissue Compensation Technique

Traditionally, large fields requiring island blocking used external beam radiation therapy (EBRT) with Cerrobend blocks to limit dose to the critical structures. It is laborious to construct blocks and use them on a daily basis. We present a novel technique for island blocking using a modified electronic tissue compensation (MECOMP) technique. Five patients treated at our institution were selected for this study. The study compared two planning techniques: a novel MECOMP and a conventional EBRT technique. Conventional fields were defined using anterior-posterior and posterior-anterior (PA) fields. The kidneys were contoured and an aperture cut-out block was fitted to the OAR with a 1-cm margin (OAR_CTV) and placed in the PA field. A dynamic multileaf collimation (DMLC) plan with ECOMP was developed using identical beam and blocking strategy; this tissue compensation–based fluence map was modified to deliver a “zero” dose to the CTV_OAR from the PA field. There were no significant differences in the mean, maximum, and minimum doses to the right or left kidney between the two methods. The mean, maximum, and minimum doses to the peritoneal cavity were also not significantly different. The number of monitor units (MUs) required was increased using the MECOMP (273 vs. 1152, p < 0.01). The MECOMP is effectively able to deliver DMLC-based radiotherapy, even with island blocks present. This novel use of MECOMP for whole abdominal radiotherapy should substantially reduce the labor, daily treatment time, and treatment-related errors through the elimination of cerrobend blocks.