Endovascular Treatment of Veno-Occlusive Behcet’s Disease

Purpose

To retrospectively evaluate the outcome of endovascular treatments for patients with chronic veno-occlusive disease in different vascular beds secondary to Behcet’s disease (BD). There are few case reports on the subject, and this is the largest study to date.

Materials and Methods

From January 2001 through October 2009, chronic venous occlusions were treated in 10 patients (all male [age range 18–76?years]) with BD using percutaneous transluminal angioplasty and/or stent placement. All patients were symptomatic and had chronic iliofemoral deep venous thrombosis (DVT; n?=?5), central venous occlusion (n?=?3), or Budd–Chiari syndrome (BCS; n?=?2). All patients met criteria of the International Study Group on Behcet’s Disease.

Results

Two of five patients with DVT had unsuccessful recanalization attempts. Three patients had successful recanalization with stent placement. All three veins were occluded within 1?month with unsuccessful reinterventions. Three patients with chronic central venous occlusion had successful recanalization with percutaneous transluminal angioplasty (n?=?1) and stent placement (n?=?2). Two patients had reocclusion with successful reintervention. Two BCS patients had successful treatment with stent placements. Overall technical success was 69%, and no procedural complications were encountered. None of the patients with chronic DVT had patent veins; however, all patients with central venous occlusion or BCS had patent veins on color Doppler ultrasonography at follow-up ranging from 3 to 48?months after intervention.

Conclusion

Endovenous treatment for chronic iliofemoral DVT due to BD had a poor outcome. However, long-term outcome after endovenous treatment for upper-extremity central venous occlusion and BCS syndrome was good.     

Preoperative Embolization of Hypervascular Castleman’s Disease of the Mediastinum

We report the case of a 31-year-old woman with mediastinal Castleman’s disease of the hyaline vascular type. This large tumor was safely resected after arterial embolization. We describe the steps of this interventional procedure and discuss related necessary precautions.     

Reporting of CT cervical spine after office hours by radiology trainees—analysis of discrepancy rates and RADPEER scores

Purpose

To review the errors made by radiology trainees in the reporting of cervical spine CTs (CCT) and to compare the discrepancy rates between the stages of training.

Methods

All CCTs reported by trainees after office hours between January 2015 and December 2015 were retrospectively reviewed by a team of five musculoskeletal consultants with experience ranging between 7 and 15 years. Discrepancies between the provisional report by the trainee and the findings by the musculoskeletal consultants were graded according to the RADPEER scoring system. Sensitivity and specificity of the trainees were assessed.

Results

Of 254 CCT provisional reports, there were 12 (4.7%) discrepancies, of which 5 (2.0%) discrepancies were likely to be clinically significant. We found a clinically significant difference between the stage of training of the trainee and RADPEER score (P?=?0.023). The sensitivity and specificity of the senior radiology trainees were 97.0 and 98.1%, respectively, and that of the junior radiology trainees were 80 and 98.0% respectively (P?=?0.039). Conditions misinterpreted as fractures include degenerative changes (n?=?2) and nutrient vessel (n?=?1). Other missed abnormalities include ossification of the posterior longitudinal ligament (n?=?1), fracture of the foramen transversarium (n?=?2), vertebral body fractures (n?=?2), articular facet fractures (n?=?2), and transverse process fractures (n?=?2).

Conclusion

Cervical spine CTs performed after office hours can be safely interpreted by senior radiology trainees to a reasonable degree, although a targeted intervention to improve diagnostic performance of junior radiology trainees may be of clinical benefit.

     

Reporting radiographers in Norway – A qualitative interview study

IntroductionA number of Norwegian radiographers have attended an advanced programme of education and training in musculoskeletal reporting, some in the UK and some in Norway. The aim of this study was to examine how reporting radiographers, radiologists and managers experienced the education, competence, and role of reporting radiographers in Norway. To our knowledge, the role and function of reporting radiographers in Norway has not yet been explored.MethodsThe study had a qualitative design and was based on eleven individual interviews of reporting radiographers, radiologists, and managers. The participants represented five different imaging departments from four hospital trusts in Norway. The interviews were analyzed using inductive content analysis.ResultsThe analysis identified two main categories: “Education and training”, and “The reporting radiographer”. The subcategories were: “Education”, “Training”, “Competence”, and “The new role”.The study found the program to be demanding, challenging, and time-consuming. However, the reporting radiographers described it as motivating because they gained new competence. The competence of reporting radiographers was regarded as adequate. The participants found that reporting radiographers had a unique competence in both image acquisition and reporting, and they were described as a missing link between radiographers and radiologists.ConclusionReporting radiographers are experienced as an asset for the department. Reporting radiographers not only contribute to musculoskeletal imaging reports but are also important for collaboration, training, and professional development in imaging, and in collaborating with orthopedics. This was seen to increase the quality of musculoskeletal imaging.Implications for practiceReporting radiographers are a valuable resource in image departments, especially in smaller hospitals where the shortage of radiologists is noticeable.     

The Role of “Cutting” Balloon Angioplasty for the Treatment of Short Femoral Bifurcation Steno-Obstructive Disease

This study was designed to report our experience with “cutting” balloon angioplasty (CBA) for the treatment of short femoral bifurcation arterial stenosis. Between March 2005 and September 2007, 18 consecutive patients who were high-risk for surgery with critical limb ischemia or severe lifestyle-limiting claudication underwent “cutting” balloon angioplasty (4–6 mm diameter/15–20-mm length) for the treatment of 27 focal (<3 cm) severe fibro-calcified stenosis of the common femoral artery (n = 14) and/or the proximal part of the superficial femoral artery (n = 6) or profunda femoris (n = 7). Baseline patient demographic data, pre- and post-procedural patient clinical data, and procedural results were recorded. Follow-up consisted of clinical check-up and color duplex ultrasonography (CDU) examination 1, 3, 6, 12, and 18 months after the procedure. All endovascular treatments were successfully performed with clinical success obtained for all patients. No complications occurred during all treatments and no patient required surgical conversion or placement of a stent because of recoil, dissection, or arterial tears. No acute vessel closure was registered. During a mean follow-up of 9.4 (range, 6–18) months, endovascular treatment (CBA) was performed for restenosis/occlusion of seven lesions (25.9%) in four patients, whereas surgical treatment (endarterectomy with patch) for restenosis/occlusion of three lesions (11.1%) was performed in two patients with a consequent reintervention rate of 37%. Primary and secondary patency rates were 84.6 and 88.4% at 6 months and 57.9 and 79.6% at 12 months, respectively. No major limb amputation was performed, with a 12-month limb salvage rate of 88.9%. CBA seems to be a valuable tool for the endovascular treatment of focal femoral bifurcation stenotic lesions for patients who are poor candidates for surgery.     

Disease and security: The effect of emerging and re‐emerging diseases

This article examines the role of emerging new and re‐emerging diseases in the failure of the ‘Health for All by 2000’ concept. The gap between infection and control has widened instead of closing, which has definite military and security implications. It is argued that there is a direct link between disease and the social order, and that the traditional view of development first, followed by an increase in health status, must change. However, the political will and the necessary resources to combat emerging and re‐emerging diseases are still lacking in many countries. Through the improper use of treatments and dosages, most notably antibiotics, new strains of previously eradicated diseases are appearing. Added to this are new patterns of relationships between man, his environment and the occurrence of disease leading to new diseases making their appearance. There is a direct relationship between war and disease, making disease something with political, military and security relevance. The aspect of intelligence which has the task of predicting the future, now has to take note of the occurrence of disease and its effects.     

Temporal changes in FFRCT-Guided Management of Coronary Artery Disease – Lessons from the ADVANCE Registry

BackgroundThe ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFR_CT). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FFR_CT within the ADVANCE registry.Methods5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Demographics, CCTA and FFR_CT findings, and clinical outcomes through 1-year follow-up, were recorded and compared between tertiles.ResultsThe number of patients with a ≥70% stenosis on CCTA was similar over time (33.6%, 30.9%, and 33.8% for cohort 1–3). The rate of positive FFR_CT ≤0.80 was higher for cohorts 2 (67.3%) and 3 (74.6%) than for cohort 1 (57.1%, p < 0.001). Invasive FFR rates decreased from 25.8% to 22.4% between cohort 1 and 3 (p = 0.023). Moreover, patients with a FFR_CT ≤0.80 were less frequently referred for invasive coronary angiography (ICA) (from 62.9% to 52.9%, p < 0.001), and underwent fewer revascularizations between cohort 1 and 3 (from 41.9% to 32.0%, p < 0.001). The prevalence of major events was low (1.2%) and similar between cohorts.ConclusionsGrowing experience with FFR_CT improved the likelihood of identifying hemodynamically significant CAD and safely reduced the need for ICA and revascularization in patients with anatomically significant disease even in the instance of an abnormal FFR_CT.     

Endovascular Treatment of Diabetic Foot in a Selected Population of Patients with Below-the-Knee Disease: Is the Angiosome Model Effective?

Purpose

To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in a selected population of diabetic patients with below-the-knee (BTK) disease and to analyze the reliability of the angiosome model.

Methods

We made a retrospective analysis of the results of PTA performed in 201 diabetic patients with BTK-only disease treated at our institute from January 2005 to December 2011. We evaluated the postoperative technical success, and at 1, 6, and 12 months’ follow-up, we assessed the rates and values of partial and complete ulcer healing, restenosis, major and minor amputation, limb salvage, and percutaneous oximetry (TcPO₂) (Student’s t test). We used the angiosome model to compare different clinicolaboratory outcomes in patients treated by direct revascularization (DR) from patients treated with indirect revascularization (IR) technique by Student’s t test and the χ² test.

Results

At a mean ± standard deviation follow-up of 17.5 ± 12 months, we observed a mortality rate of 3.5 %, a major amputation rate of 9.4 %, and a limb salvage rate of 87 % with a statistically significant increase of TcPO₂ values at follow-up compared to baseline (p < 0.05). In 34 patients, treatment was performed with the IR technique and in 167 by DR; in both groups, there was a statistically significant increase of TcPO₂ values at follow-up compared to baseline (p < 0.05), without statistically significant differences in therapeutic efficacy.

Conclusion

PTA of the BTK-only disease is a safe and effective option. The DR technique is the first treatment option; we believe, however, that IR is similarly effective, with good results over time.     

The Utility of Segmental Analysis in Cardiac I-123 MIBG SPECT in Parkinson’s Disease

Purpose

Cardiac images using I-123 metaiodobenzylguanidine (MIBG) are widely used to evaluate cardiac sympathetic denervation in Parkinson’s disease (PD). The aim of this study was to evaluate the utility of segmental analysis on cardiac MIBG SPECT in PD patients.

Materials and Methods

In total, 36 patients with PD (n = 26) or essential tremor (ET, n = 10) who underwent MIBG cardiac SPECT were enrolled. The heart-to-mediastinum (H/M) ratios of MIBG uptake were acquired on planar images. For the segmental analysis of SPECT images, we evaluated the summed defect score (SDS) using a 17-segment model. The diagnostic abilities of H/M ratios and segmental parameters on MIBG SPECT were assessed by ROC curve analysis.

Results

The H/M ratios were significantly lower in PD than in ET patients (p < 0.05). On segmental analysis, SDS was significantly higher in PD patients than in the ET group (7.04 ± 4.09 vs. 2.90 ± 2.80; p = 0.006). The defect score of the anteroseptal region showed a significant difference between the groups (p = 0.002). The ROC analysis suggested only SDS (AUC = 0.785, p = 0.0003) and defect scores in the anteroseptal (AUC = 0.800, p < 0.0001) and inferior (AUC = 0.667, p = 0.013) regions showed significant diagnostic ability to differentiate PD from ET.

Conclusions

Segmental parameters from cardiac MIBG SPECT images can provide additional information to differentiate PD from ET patients. Beyond H/M ratios from planar images, we recommend an MIBG SPECT study to evaluate sympathetic denervation in PD.     

Radiofrequency Ablation of Liver Metastases—Software-Assisted Evaluation of the Ablation Zone in MDCT: Tumor-Free Follow-Up Versus Local Recurrent Disease

The purpose of this study was to investigate differences in change of size and CT value between local recurrences and tumor-free areas after CT-guided radiofrequency ablation (RFA) of hepatic metastases during follow-up by means of dedicated software for automatic evaluation of hepatic lesions. Thirty-two patients with 54 liver metastases from breast or colorectal cancer underwent triphasic contrast-enhanced multidetector-row computed tomography (MDCT) to evaluate hepatic metastatic spread and localization before CT-guided RFA and for follow-up after intervention. Sixteen of these patients (65.1 ± 10.3 years) with 30 metastases stayed tumor-free (group 1), while the other group (n = 16 with 24 metastases; 62.0 ± 13.8 years) suffered from local recurrent disease (group 2). Applying an automated software tool (SyngoCT Oncology; Siemens Healthcare, Forchheim, Germany), size parameters (volume, RECIST, WHO) and attenuation were measured within the lesions before, 1 day after, and 28 days after RFA treatment. The natural logarithm (ln) of the quotient of the volume 1 day versus 28 days after RFA treament was computed: lnQ1//28/0_volume. Analogously, ln ratios of RECIST, WHO, and attenuation were computed and statistically evaluated by repeated-measures ANOVA. One lesion in group 2 was excluded from further evaluation due to automated missegmentation. Statistically significant differences between the two groups were observed with respect to initial volume, RECIST, and WHO (p < 0.05). Furthermore, ln ratios corresponding to volume, RECIST, and WHO differed significantly between the two groups. Attenuation evaluations showed no significant differences, but there was a trend toward attenuation assessment for the parameter lnQ28/0_attenuation (p = 0.0527), showing higher values for group 1 (–0.4 ± 0.3) compared to group 2 (–0.2 ± 0.2). In conclusion, hepatic metastases and their zone of coagulation necrosis after RFA differed significantly between tumor-free and local-recurrent ablation zones with respect to the corresponding size parameters. A new parameter (lnQ1//28/0_{volume/RECIST/WHO/attenuation}) was introduced, which appears to be of prognostic value at early follow-up CT.     

Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center’s Experience

Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions.Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery–to–coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients.Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively.Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.     

Do We Need a National Incident Reporting System for Medical Imaging?

The essential role of an incident reporting system as a tool to improve safety and reliability has been described in high-risk industries such as aviation and nuclear power, with anesthesia being the first medical specialty to successfully integrate incident reporting into a comprehensive quality improvement strategy. Establishing an incident reporting system for medical imaging that effectively captures system errors and drives improvement in the delivery of imaging services is a key component of developing and evaluating national quality improvement initiatives in radiology. Such a national incident reporting system would be most effective if implemented as one piece of a comprehensive quality improvement strategy designed to enhance knowledge about safety, identify and learn from errors, raise standards and expectations for improvement, and create safer systems through implementation of safe practices. The potential benefits of a national incident reporting system for medical imaging include reduced morbidity and mortality, improved patient and referring physician satisfaction, reduced health care expenses and medical liability costs, and improved radiologist satisfaction. The purposes of this article are to highlight the positive impact of external reporting systems, discuss how similar advancements in quality and safety can be achieved with an incident reporting system for medical imaging in the United States, and describe current efforts within the imaging community toward achieving this goal.     

Difficulties associated with Reporting Radiographer working practices – A narrative evidence synthesis

ObjectivesThis narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on working practices affecting trainees and qualified Reporting Radiographers.Key findingsFourteen studies informed the themes of this article, they were published between 2014 and 2021.Delays to commencement of reporting roles and variance in performance monitoring was common. Lack of formalisation, overly restrictive and out of date scopes of practice were also found. Whilst, staffing shortages contributed to underutilisation. Failure to utilise skills was most prevalent in cross sectional imaging modalities. Considerable variance in practice was also found between centres. Meanwhile, Reporting Radiographer involvement in professional development, education and research is far from universal and often dependant on individuals sacrificing their own time.ConclusionGovernance in many centres would benefit from renewal and standardisation, particularly relating to scopes of practice and performance monitoring audits. Measures are also required to encourage compliance with guidance, address staffing issues and reduce variation between centres. Failure to address these issues has the potential to impair collaboration, delay patient care and increase economic inefficiencies whilst negatively impacting satisfaction for service users and staff.Lack of involvement in professional development, education and research suggests Reporting Radiographers are not accomplishing their full potential, educating the next generation of the reporting workforce and driving evidence-based change for further development of the specialism.Implications for practiceBetter use of the existing workforce is essential to increase productivity, value, and security of Reporting Radiographer services, which are essential to improve patient outcomes and efficiency.     

Clinical Significance of F-18 FP-CIT Dual Time Point PET Imaging in Idiopathic Parkinson’s Disease

Purpose

The purpose of this study was to investigate the diagnostic value of dual time point F-18 FP-CIT PET imaging in idiopathic Parkinson’s disease (PD).

Materials and Methods

Twenty-four patients with PD (mean age 69.6) and 18 healthy people (mean age 70.26) underwent two sequential PET/CT scans (dual time point imaging) at 90 and 210 min after F-18 FP-CIT injection. Tracer activity of region of interest was measured in the caudate, putamen and a reference region in the brain from both time points. The outcome parameter was the striatooccipital ratio (SOR). Normal SOR values were obtained in the control group. The percent change in tracer activity between 90- and 210-min images was calculated. The SOR values and the percent change in tracer activity were compared between the patients and healthy control group.

Results

The SOR values for the caudate, anterior and posterior putamen at both 90- and 210-min images were significantly reduced in the patients with PD. The lowest P value was obtained for the anterior and posterior putamen (p < 0.001) at both time points. There were significant differences of the percent change in tracer activity for the anterior and posterior putamen in the two groups (p = 0.01).

Conclusions

F-18 FP-CIT PET scans at 90 and 210 min after injection are both able to diagnose PD. Therefore, the 90-min image by itself is sufficient for diagnosing PD.