Point-of-Care Ultrasound for High-Risk Pregnancy Screening in Rural Nepal.

By training nurses and midwives on the basics of obstetric ultrasound, high-risk pregnancies in remote Nepalese villages can be identified and triaged. American radiology residents traveling to Nepal can improve their real-time, hands-on ultrasound scanning skills while learning the intricacies of practicing medicine in a low- and middle-income country. Global outreach work is increasing in popularity among US radiologists, emphasizing the importance of training radiology residents in point-of-care ultrasound.

Penetration of Bone by Inferior Vena Cava Filters: Safety and Technical Success of Percutaneous Retrieval.

PURPOSE: The technical success and safety of percutaneous inferior vena cava filters (IVCF) retrieval when filter elements are penetrating into adjacent bony structures is unknown. Therefore, our purpose was to evaluate the technical success and safety of IVCF retrieval when filter elements are penetrating into adjacent bone. MATERIALS AND METHODS: Using percutaneous IVCF retrievals from 2008 to 2018 in adult patients, we conducted a multi-institutional, retrospective review of filters found to penetrate lumbar vertebrae by computed tomography scans. Technical success following the retrieval procedure was recorded. Patient records were assessed for complications from retrieval. RESULTS: 13 patients (2 males; 11 females; mean age: 53.2 years (range: 22-71) were included. Hundred percent of the filters were optional (retrievable) filters. Venous thromboembolism (VTE) with a contraindication to anticoagulation (n = 7; 53.8%) and prophylaxis without venous thromboembolism (n = 3; 23.1%) were the 2 most common indications for IVCF placement. Two filters (15.4%) had >15° of tilt relative to the IVC prior to retrieval while no IVCFs had migrated or caused caval thrombosis. One filter (7.7%) was found to have a fractured strut prior to retrieval. Ten patients (76.9%) were either on anticoagulants or antiplatelet medications at the time of retrieval. No patients were on antibiotics and no patients received periprocedural antibiotics. Median dwell time was 116.5 days (range: 49-5395). All 13 IVCFs were successfully retrieved in a single session (technical success: 100%). Standard snare technique was used in 8 cases (61.5%), endobronchial forces were used in 3 cases (23.1%), and wire loop snare technique was used in 2 cases (15.4%). There were no complications in any patient. Percutaneous retrieval of IVCFs with elements that have penetrated into adjacent vertebrae is both safe and technically feasible.

Bowel Penetration by Inferior Vena Cava Filters: Feasibility and Safety of Percutaneous Retrieval.

OBJECTIVE. The purpose of this study was to evaluate the safety and technical feasibility of inferior vena cava filter (IVCF) removal when filter elements penetrate adjacent bowel. MATERIALS AND METHODS. A multicenter retrospective review of IVCF retrievals between 2008 and 2018 was performed. Adult patients with either CT or endoscopic evidence of filter elements penetrating bowel before retrieval were included. Technical success of IVCF retrieval was recorded. Patient records were assessed for immediate, 30-day, and 90-day complications after retrieval. RESULTS. Thirty-nine consecutive adult patients (11 men and 28 women; mean age, 51.2 years; age range, 18-81 years) qualified for inclusion. Filter dwell time was a median of 148 days (range, 32-5395 days). No IVCFs were known to have migrated or caused iliocaval thrombosis. Five IVCFs (12.8%) had more than 15° tilt relative to the inferior vena cava (IVC) before retrieval. Three IVCFs (7.7%) had fractured elements identified at the time of retrieval. Mean international normalized ratio (INR) was 1.24 ± 0.53 (SD), and mean platelet count was 262 ± 139 × 103/µL. Ten patients (25.6%) were on antibiotics at the time of retrieval. All 39 IVCFs were successfully retrieved (technical success = 100%). Two patients experienced minor complications in the immediate postprocedural period, which resulted in a minor complication rate of 5.1%. There were no complications (major or minor) identified in any patient at 30 or 90 days after retrieval. The overall major complication rate was 0%. CONCLUSION. Endovascular retrieval of IVCFs with CT evidence of filter elements that have penetrated adjacent bowel is both safe and technically feasible.

Percutaneous Cryoablation of Stage T1b Renal Cell Carcinoma: Safety, Technical Results, and Clinical Outcomes.

PURPOSE: The use of percutaneous cryoablation for T1b (4.1-7.0 cm) renal cell carcinoma, has not yet been widely adopted. The purpose of this study was to describe our experience in the cryoablation of stage T1b tumors with an emphasis on safety, technical results, and clinical outcomes. MATERIALS AND METHODS: A retrospective review of hospital records identified 37 patients who underwent cryoablation for T1b lesions from 2008 to 2018. Patient demographics, comorbidities, tumor characteristics, technical parameters, and outcomes were recorded and analyzed. Recurrence-free, overall, and cancer-specific survival rates were estimated using the Kaplan-Meier method. RESULTS: Thirty-seven patients (22 males, 15 females; mean age 66.5 ± 11.3) with 37 T1b tumors (mean diameter 47.3 ± 6.3 mm) were included. A median of 3 probes were used (range: 1-7). Angio-embolization was used in 3/37 (8.1%) and 2/37 patients (5.4%) required hydrodissection. The mean number of total cryoablation procedures for each patient was 1.5 (median 1; range: 1-4). Technical success was achieved in 88.2% of patients. Recurrence-free survival was 96.5%, 86.1%, and 62.6% at 1, 2, and 3 years respectively. Cancer-specific survival was 100% at 1, 2, and 3 years respectively. Overall survival was 96.7%, 91.8%, and 77.6% at 1, 2, and 3 years respectively. Complications classified as CIRSE grade 2 or higher occurred in 6/37 (16.2%) patients. CONCLUSION: T1b cryoablation is associated with high rates of technical success, excellent cancer-specific survival, and an acceptable safety profile. LEVEL OF EVIDENCE: Level 4, Case Series.

Renal Cell Carcinoma Ablation: Preprocedural, Intraprocedural, and Postprocedural Imaging.

The rising incidence of renal cell carcinoma (RCC) in recent decades necessitates careful consideration of additional treatment options, especially for patients who may be poor surgical candidates. An emerging body of evidence suggests that ablation may be performed effectively and safely even in patients with multiple comorbidities. Accordingly, clinical guidelines now include thermal ablation as an alternative for such patients with localized tumors that are 4.0 cm or smaller. Recent experience with these minimally invasive techniques has led to a greater understanding of the imaging findings that merit close attention when ablation is anticipated, or after it is performed. These imaging findings may guide the interventionalist's perception of the risks, technical challenges, and likelihood of treatment success associated with RCC ablation. The present review provides an overview of clinically relevant radiologic findings during the preprocedural, intraprocedural, and postprocedural period in the context of image-guided renal ablation. Keywords: Interventional-Body, Kidney, Percutaneous, Urinary © RSNA, 2019.