Radiation-Induced Cholecystitis after Hepatic Radioembolization: Do We Need to Take Precautionary Measures?

Controversy exists over the need to take precautionary measures during hepatic radioembolization to minimize the risk of radiation-induced cholecystitis. Strategies for a variety of clinical scenarios are discussed on the basis of a literature review. Precautionary measures are unnecessary in the majority of patients and should be taken only when single photon-emission computed tomography (CT; SPECT)/CT shows a significant concentration of technetium-99m macroaggregated albumin in the gallbladder wall. In this case report with quantitative SPECT analysis, it is illustrated how an adjustment of the catheter position can effectively reduce the absorbed dose of radiation delivered to the gallbladder wall by more than 90%.     

Small-Animal PET: What Is It, and Why Do We Need It?

Small-animal PET refers to imaging of animals such as rats and mice using dedicated PET scanners. Small-animal PET has been used extensively in modern biomedical research. It provides a quantitative measure of the 3-dimensional distribution of a radiopharmaceutical administered to a live subject noninvasively. In this article, we will discuss the operational and technical aspects of small-animal PET; make some comparisons between small-animal PET and human PET systems; identify the challenges of, opportunities for, and ultimate limitations in applying small-animal PET; and discuss some representative small-animal PET applications. Education objectives: After reading this article, the technologist will be able to explain the requirements and benefits of small-animal PET in biomedical research, describe the design and general characteristics of a small-animal PET system, list and describe some of the challenges of imaging small animals, and discuss several small-animal PET applications.     

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

Purpose

The 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.

Methods

Retrospective 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.

Results

The 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).

Conclusion

Complications 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.     

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

BACKGROUND AND PURPOSE: Blunt carotid and vertebral artery injury (BCVI) is rare but potentially devastating. The objective of our study was to prospectively evaluate the usefulness of a dedicated and optimized CT angiography (CTA) protocol of the craniocervical vessels as part of a whole-body CT work-up of patients with multiple trauma in a population of patients with blunt trauma.MATERIAL AND METHODS: From February 2006 to July 2007, a total of 368 consecutive patients with trauma were evaluated. All examinations were performed on a 16-row multisection CT (MSCT) scanner. CTA was performed from the level of the T2 vertebra to the roof of the lateral ventricles with 40 mL of iodinated contrast agent. Images were reconstructed with use of the angiography and bone window settings to evaluate vessels and bones.RESULTS: Of all eligible patients imaged, 100 had injuries to the head and neck including 35 skull base fractures (9.5%), 24 maxillofacial (6.5%), and 11 cervical spine fractures (3%). CTA was diagnostic in all patients. BCVI was diagnosed in 6 cases (6 lesions of the internal carotid artery, 3 lesions of the vertebral artery); among them were 2 who did not meet the screening criteria. No patient with negative results on CTA subsequently had development of neurologic deficits suspicious for BCVI.CONCLUSION: This study confirms that optimized craniocervical CTA can be easily integrated into a whole-body CT protocol for patients with multiple trauma. No additional screening technique is necessary to identify clinically relevant vascular injuries. Earlier recognition enables earlier treatment and may decrease mortality and morbidity rates of these rare but potentially devastating injuries.

Blunt carotid and vertebral artery injury (BCVI) is a rare event. The diagnosis is quite challenging because of the relatively low incidence of BCVI and delayed onset of clinical manifestations.^1,2 Although early series reported an incidence of carotid dissections of less than 0.1% of patients with blunt trauma,^3,4 recent studies have found BCVI in up to 1.6% of patients admitted for trauma.^5–8 In the light of the potential devastating consequences of BCVI, much effort has focused on improving detection and treatment during the past decade.^9,10 Initially, neurologic deficits were thought to be inevitable in these patients, but prompt systemic anticoagulation before the onset of stroke has significantly reduced ischemic neurologic events in such patients.^8,11 On the basis of these insights and increased awareness of BCVI, subsequent efforts have been directed toward the identification of injuries before the onset of stroke, resulting in screening protocols^7,12,13 according to mechanism of injury and specific injury patterns^9,10,14,15 6,16 and of how to screen patients at risk.¹Table 1.Findings that are suspicious for BCVI and should trigger screening

Prostate Imaging Reporting and Data System (PI-RADS): What the radiologists need to know?

We aim to review the new modifications in MR imaging technique, image interpretation, lexicon, and scoring system of the last version of Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1) in a simple and practical way. This last version of PI-RADS v2.1 describes the new technical modifications in the protocol of Multiparametric MRI (MpMRI) including T2, diffusion-weighted imaging (DWI), and dynamic contrast enhancement (DCE) parameters. It includes also; new guidelines in the image interpretation specifications in new locations (lesions located in the central zone and anterior fibromuscular stroma), clarification of T2 scoring of lesions of the transition zone, the distinction between DWI score 2 and 3 lesions in the transition zone and peripheral zone, as well as between positive and negative enhancement in DCE. Biparametric MRI (BpMRI) along with simplified PI-RADS is gaining more acceptances in the assessment of clinically significant prostatic cancer.