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3.
Eur Radiol ; 32(3): 1456-1464, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34581843

ABSTRACT

OBJECTIVES: To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper. RESULTS: Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. CONCLUSION: Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures. KEY POINTS: • Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.


Subject(s)
Musculoskeletal System , Radiology , Anesthetics, Local , Consensus , Humans , Lower Extremity/diagnostic imaging , Radiography , Ultrasonography, Interventional
4.
Eur Radiol ; 32(2): 1384-1394, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34432122

ABSTRACT

OBJECTIVES: Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region. METHODS: We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval. RESULTS: A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement. CONCLUSION: According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton's neuroma, particularly using platelet-rich plasma and corticosteroids, respectively. KEY POINTS: • The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle. • Strong consensus was obtained for all statements. • The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton's neuroma and PRP for plantar fasciitis.


Subject(s)
Achilles Tendon , Musculoskeletal System , Radiology , Tendinopathy , Ankle/diagnostic imaging , Consensus , Humans
5.
Eur Radiol ; 32(3): 1438-1447, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34523008

ABSTRACT

OBJECTIVES: Interventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected. METHODS: We report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications. RESULTS: A list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus. CONCLUSIONS: Ultrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee. KEY POINTS: • A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR. • Strong consensus with 100% agreement was obtained for all statements. • Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.


Subject(s)
Radiology , Consensus , Humans , Knee Joint/diagnostic imaging , Knee Joint/surgery , Prospective Studies , Radiography , Radiology, Interventional , Ultrasonography, Interventional
6.
Eur Radiol ; 32(1): 551-560, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34146140

ABSTRACT

OBJECTIVES: Image-guided musculoskeletal interventional procedures around the hip are widely used in daily clinical practice. The need for clarity concerning the actual added value of imaging guidance and types of medications to be offered led the Ultrasound and the Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) to promote, with the support of its Research Committee, a collaborative project to review the published literature on image-guided musculoskeletal interventional procedures in the lower limb in order to derive a list of clinical indications. METHODS: In this article, we report the results of a Delphi-based consensus of 53 experts who reviewed the published literature for evidence on image-guided interventional procedures offered in the joint and soft tissues around the hip in order of their clinical indications. RESULTS: Ten statements concerning image-guided treatment procedures around the hip have been collected by the panel of ESSR experts. CONCLUSIONS: This work highlighted that there is still low evidence in the existing literature on some of these interventional procedures. Further large prospective randomized trials are essential to better confirm the benefits and objectively clarify the role of imaging to guide musculoskeletal interventional procedures around the hip. KEY POINTS: • Expert consensus produced a list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the hip. • The highest level of evidence was only reached for one statement. • Strong consensus was obtained for all statements.


Subject(s)
Musculoskeletal System , Radiology , Consensus , Humans , Prospective Studies , Radiography , Radiology, Interventional , Ultrasonography, Interventional
7.
Radiographics ; 40(4): 1188-1195, 2020.
Article in English | MEDLINE | ID: mdl-32469630

ABSTRACT

US-guided foreign body removal is a nonsurgical highly effective technique used to manage symptomatic foreign bodies and should be considered as a first-line treatment procedure. The authors describe a technique used for US detection and US-guided removal of various types of foreign bodies and discuss the efficacy of the procedure. Soft-tissue foreign bodies can result from accidents or medical procedures, and they are a relatively frequent reason that patients obtain medical consultation. Foreign body objects include vegetal, metallic, and glass objects, and they may be medical devices such as contraceptive implants. Frequently, physical examination is not sensitive enough to detect the presence of a foreign body, and imaging is necessary. US has demonstrated high specificity and moderate sensitivity for detection of foreign bodies, and it has the advantage of depicting all types of materials. Thus, US has become the imaging technique of choice for evaluating suspected foreign bodies. Although the US features are dependent on the foreign body type and shape, all foreign bodies are echogenic and frequently demonstrate posterior shadowing or reverberation artifact. US has an added value in that it can be used to plan the removal of a foreign body and also guide the entire percutaneous removal procedure. Through a small incision in the skin, just wide enough for the foreign body to pass through, surgical forceps can be inserted and directed under US guidance to reach the foreign body and remove it. The effectiveness of US-guided percutaneous removal can be near 100%. Online supplemental material is available for this article. ©RSNA, 2020.


Subject(s)
Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Soft Tissue Injuries/diagnostic imaging , Soft Tissue Injuries/surgery , Ultrasonography, Interventional , Humans , Surgical Instruments
8.
Eur Radiol ; 30(2): 903-913, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31529252

ABSTRACT

BACKGROUND: Image-guided interventional procedures around the shoulder are commonly performed in clinical practice, although evidence regarding their effectiveness is scarce. We report the results of a Delphi method review of evidence on literature published on image-guided interventional procedures around the shoulder with a list of clinical indications. METHODS: Forty-five experts in image-guided musculoskeletal procedures from the ESSR participated in a consensus study using the Delphic method. Peer-reviewed papers regarding interventional procedures around the shoulder up to September 2018 were scored according to the Oxford Centre for Evidence-based Medicine levels of evidence. Statements on clinical indications were constructed. Consensus was considered as strong if more than 95% of experts agreed and as broad if more than 80% agreed. RESULTS: A total of 20 statements were drafted, and 5 reached the highest level of evidence. There were 10 statements about tendon procedures, 6 about intra-articular procedures, and 4 about intrabursal injections. Strong consensus was obtained in 16 of them (80%), while 4 received broad consensus (20%). CONCLUSIONS: Literature evidence on image-guided interventional procedures around the shoulder is limited. A strong consensus has been reached for 80% of statements. The ESSR recommends further research to potentially influence treatment options, patient outcomes, and social impact. KEY POINTS: • Expert consensus produced a list of 20 evidence-based statements on clinical indications of image-guided interventional procedures around the shoulder. • The highest level of evidence was reached for five statements. • Strong consensus was obtained for 16 statements (80%), while 4 received broad consensus (20%).


Subject(s)
Orthopedic Procedures/methods , Shoulder/surgery , Surgery, Computer-Assisted/methods , Consensus , Delphi Technique , Humans , Musculoskeletal System/surgery , Radiography , Radiology , Societies, Medical
9.
Eur Radiol ; 30(4): 2220-2230, 2020 Apr.
Article in English | MEDLINE | ID: mdl-31844963

ABSTRACT

BACKGROUND: Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic. METHODS: A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as "strong" when more than 95% of panelists agreed and as "broad" if more than 80% agreed. RESULTS: Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%). CONCLUSIONS: There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice. KEY POINTS: • The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. • Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. • Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).


Subject(s)
De Quervain Disease/therapy , Elbow Tendinopathy/therapy , Radiography, Interventional , Trigger Finger Disorder/therapy , Ultrasonography, Interventional , Delphi Technique , Dry Needling , Elbow Joint , Fluoroscopy , Glucocorticoids/administration & dosage , Humans , Hyaluronic Acid/administration & dosage , Injections , Injections, Intra-Articular , Platelet-Rich Plasma , Prospective Studies , Radiography , Tenotomy , Viscosupplements/administration & dosage , Wrist Joint
10.
Eur Radiol ; 30(3): 1498-1506, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31712960

ABSTRACT

BACKGROUND: Image-guided interventional procedures of the nerves are commonly performed by physicians from different medical specialties, although there is a lack of clinical indications for these types of procedures. This Delphi-based consensus provided a list of indications on image-guided interventional procedures for nerves of the upper limb based on updated published evidence. METHODS: An expert panel of 45 members of the Ultrasound and Interventional Subcommittees of the ESSR participated in this Delphi-based consensus study. After revision of the published papers on image-guided interventional procedures for nerves of the upper limb updated to September 2018, the experts drafted a list of statements according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus on statements regarding clinical indications was considered as strong when more than 95% of experts agreed, and broad if more than 80% agreed. RESULTS: Ten statements were drafted on procedures for nerves of the upper limb. Only two statements reached the highest level of evidence (ultrasound guidance is a safe and effective method for brachial plexus block; ultrasound-guided non-surgical approaches are safe and effective methods to treat carpal tunnel syndrome in the short term, but there is sparse evidence on the mid- and long-term effectiveness of these interventions). Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%). CONCLUSIONS: This Delphi-based consensus study reported poor evidence on image-guided interventional procedures for nerves of the upper limb. Sixty percent of statements on clinical indications provided by the expert board reached a strong consensus. KEY POINTS: • An expert panel of the ESSR provided 10 evidence-based statements on clinical indications for image-guided interventional procedures for nerves of the upper limb • Two statements reached the highest level of evidence • Strong consensus was obtained on 6/10 statements (60%), while 4/10 statements reached broad consensus (40%).


Subject(s)
Consensus , Peripheral Nerves/surgery , Radiology , Societies, Medical , Surgery, Computer-Assisted/methods , Ultrasonography/methods , Upper Extremity/innervation , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/surgery , Delphi Technique , Humans , Peripheral Nerves/diagnostic imaging , Radiography , Upper Extremity/diagnostic imaging
11.
Eur Radiol ; 29(9): 4889-4896, 2019 Sep.
Article in English | MEDLINE | ID: mdl-30783787

ABSTRACT

OBJECTIVE: To evaluate the performance of core-needle biopsy (CNB) in thyroid using a cohort of patients in which it was used as first choice. METHODS: Our institutional review board approved this retrospective study. We reviewed all CNB performed in our center over a period of 11 years. Ultrasound-guided CNBs were performed using a spring-loaded 18-gauge biopsy needle. We used a classification with four diagnostic categories for CNB results: insufficient, benign, follicular lesion (indeterminate), and malignant. Final diagnosis was based on surgical diagnosis or follow-up of at least 2 years in non-operated patients. RESULTS: The study included 4412 CNB in 4112 nodules of 3768 patients, 300 of them repeated biopsies. Results were 148 insufficient (3.4%), 3706 benign (84%), 278 follicular lesions (6.3%), and 280 malignant (6.3%). Considering follicular lesion and malignancy CNB results as positive (both lead to the recommendation of surgery) sensitivity was 96% (CI 93.2-97.8) and specificity 93.7% (CI 92.9-94.5). Predictive positive value for a follicular lesion diagnosis was 12.2% and for a malignancy diagnosis, 98.6%. CNB likelihood ratio for malignancy of a malignant diagnosis was 841.9 (CI 315.8-2313.3), of a malignant/follicular lesion diagnosis was 23.4 (CI 20.1-27.3), and of a benign diagnosis was 0.04 (CI 0.02-0.07). Repeated CNB in 53 insufficient biopsies obtained 50 diagnostic results. Minor complications occurred in 2.2% of CNB, and major in four procedures (0.09%). CONCLUSIONS: CNB in thyroid nodules is accurate and has few complications and a low rate of non-diagnostic and indeterminate diagnoses. It can be an alternative method when FNAC has poor performance. Repeating biopsy is useful after non-diagnostic biopsies. KEY POINTS: • Core-needle biopsy of thyroid has a low ratio non-diagnostic and indeterminate results. • Core-needle biopsy results are highly reliable, especially benign results. • Complication rate of core-needle biopsy of thyroid is low.


Subject(s)
Thyroid Nodule/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Large-Core Needle/adverse effects , Biopsy, Large-Core Needle/methods , Biopsy, Large-Core Needle/standards , Child , Child, Preschool , Cohort Studies , Female , Humans , Image-Guided Biopsy/methods , Image-Guided Biopsy/standards , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Thyroid Neoplasms/pathology , Ultrasonography, Interventional/methods , Ultrasonography, Interventional/standards , Young Adult
13.
Eur Radiol ; 28(7): 2934-2941, 2018 Jul.
Article in English | MEDLINE | ID: mdl-29387922

ABSTRACT

OBJECTIVES: To review the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) in the diagnosis of salivary gland tumours (SGT). METHODS: Retrospective, institutional review board approved, analysis of the CNB of SGT performed at our centre in 8 years. We used an automatic 18-G spring-loaded device. The final diagnosis was based on surgery in the cases that were operated on, and on clinical evolution and biopsy findings in the rest. RESULTS: Four hundred and nine biopsies were performed in 381 patients (ages, 2-97 years; mean, 55.9). There were two minor complications. Biopsy was diagnostic in 98.3%. There were eight false negatives. The diagnostic values for malignancy were: sensitivity 89.6%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 98%. For the detection of neoplasms were: sensitivity 98.7%, specificity 99%, PPV 99.7% and VPN 96.1%. CONCLUSIONS: Accuracy of CNB in SGT is very high, with a very high sensitivity and an absolutely reliable diagnosis of malignancy. Complication rate is very low. It should be considered the technique of choice when a STG is detected. Normal tissue results warrant repeating biopsy. KEY POINTS: • Ultrasound-guided core-biopsy is the technique of choice in salivary glands nodules • Sensitivity, specificity for detecting neoplasms (which should be resected) are around 99% • Diagnosis of malignancy in core-biopsy is absolutely reliable • A CNB result of "normal tissue", however, warrants repeating the biopsy • Complication rate is very low.


Subject(s)
Salivary Gland Neoplasms/diagnostic imaging , Salivary Gland Neoplasms/pathology , Ultrasonography, Interventional/methods , Adolescent , Adult , Aged , Aged, 80 and over , Biopsy, Large-Core Needle/methods , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Image-Guided Biopsy/methods , Male , Middle Aged , Reproducibility of Results , Retrospective Studies , Salivary Glands/diagnostic imaging , Salivary Glands/pathology , Sensitivity and Specificity , Young Adult
14.
Eur Radiol ; 26(1): 1-8, 2016 Jan.
Article in English | MEDLINE | ID: mdl-25956937

ABSTRACT

OBJECTIVES: To analyze the diagnostic accuracy of ultrasound-guided core-needle biopsy (CNB) of thyroid nodules. METHODS: Of 3517 CNBs performed using an 18G spring-loaded device in one institution, we retrospectively reviewed 676 nodules in 629 consecutive patients who underwent surgery. CNB and pathological examination were compared. CNB diagnosis was standardized in four categories: insufficient (I), benign (B), follicular lesion (FOL), and malignant (M). Main outcome measures were predictive positive values (PPV), false positives (FP), and false negatives (FN). RESULTS: CNB showed a low rate of insufficient and FOL diagnoses (5.8 % and 4.5 %). On surgery, there were eight FNs in 374 benign CNBs and three FPs in 148 malignant CNBs. The 154 nodules classified as FOL in CNB included, at surgery, 122 neoplasms; 28 of them malignant. PPV for malignancy of a malignant CNB was 98 %, and for a CNB diagnosis of FOL 18.2 %. Sensitivity for malignancy if CNB of FOL and M are considered positive was 95.6. Only one major complication was observed. CONCLUSIONS: CNB is reliable, safe, and accurate to evaluate thyroid nodules and can be an alternative technique to FNA. It has low rate of non-diagnostic and undetermined cases, with high sensitivity and PPV. KEY POINTS: Thyroid core-needle biopsy (CNB) has high sensitivity and PPV. Pitfalls of CNB are rare. Pitfalls are due to cystic cancer, histological heterogeneity, and mistakes in analysis. CNB is a reliable, safe, and accurate method to approach thyroid nodules. CNB can be used primarily or after insufficient or indeterminate FNA.


Subject(s)
Thyroid Neoplasms/pathology , Thyroid Nodule/pathology , Biopsy, Fine-Needle/methods , Biopsy, Large-Core Needle/methods , Female , Humans , Image-Guided Biopsy , Male , Middle Aged , Retrospective Studies , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/surgery , Thyroid Nodule/diagnostic imaging , Thyroid Nodule/surgery , Ultrasonography, Interventional/methods
15.
Eur Thyroid J ; 2(1): 29-36, 2013 Mar.
Article in English | MEDLINE | ID: mdl-24783036

ABSTRACT

BACKGROUND: Thyroid core biopsies obtained with ultrasound (US)-guided needles are an alternative to conventional fine-needle aspiration and, according to various authors, have greater sensitivity and specificity. The technique is inexpensive, rapid and reliable with a low rate of complications, similar to conventional fine-needle aspiration procedures. OBJECTIVES: This paper critically reviews the methodology for obtaining samples and processing them in the pathology laboratory. METHODS: Accumulated experience with 1,065 cases of US-guided core biopsy of the thyroid gland in a 15-year period. RESULTS: US-guided core biopsy is a useful, inexpensive and safe method in the histological diagnosis of thyroid gland pathology. Thyroid samples obtained this way are not a substitute for fine-needle aspiration cytology. Indeed, some authors assert that the best results are obtained by combining the two approaches, the methods being complementary. CONCLUSIONS: To take best advantage of the findings from these techniques, pathologists must know which types of diagnoses can be made and the fundamentals of how and, lastly, what cannot be diagnosed and the reasons why. Best results are obtained with a multidisciplinary approach in a hospital committee composed of endocrinologists, surgeons, radiologists and pathologists, who analyse and provide a background on each case.

16.
Eur Urol ; 57(3): 459-65, 2010 Mar.
Article in English | MEDLINE | ID: mdl-19926208

ABSTRACT

BACKGROUND: Radiofrequency ablation (RFA) is a minimally aggressive, therapeutic alternative for renal tumors. It can be an alternative to nephrectomy in patients with previous nephrectomy, bilateral tumors, von Hippel-Lindau disease, or small renal carcinomas and in those with contraindications for surgery. OBJECTIVE: To assess the effectiveness of the treatment of renal tumors by RFA in the short and medium term and to identify the possible complications and the factors that determine therapeutic success. DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of patients with renal tumors treated with RFA between May 2005 and December 2008 was performed in a tertiary academic hospital. Patients were selected among those with previous nephrectomy, bilateral neoplasms, von Hippel-Lindau disease, surgical risk, comorbidity, advanced age, or patient's refusal to surgery. Tumors with evidence of extrarenal extension were excluded. Patients were followed up for 10-50 mo using computed tomography and magnetic resonance imaging. INTERVENTION: Ultrasound-guided RFA was performed on 65 tumors (range: 1.2-5.3 cm) of 58 patients using multitined electrodes. MEASUREMENTS: Incomplete ablation rate, therapeutic success rate, and complications rate. RESULTS AND LIMITATIONS: Therapeutic success was achieved in 59 of 65 tumors (91%): 53 in a single session, 5 in two sessions, and 1 in three sessions. A significant relationship was observed between size and growth pattern of the tumor and both therapeutic success and incomplete ablation rates. Therapeutic success in tumors >5 cm was 60%. Complications were detected in 10 patients (13%); 5% were considered major complications. Limitations include the lack of pathologic studies to confirm a complete ablation and the lack of a control group to compare with the results of those who underwent nephrectomy. CONCLUSIONS: RFA is safe and effective in renal tumors. Corticomedullary lesions and tumors >3 cm have greater possibility of incomplete ablation. In tumors >5 cm, RFA has a significant failure rate.


Subject(s)
Catheter Ablation/instrumentation , Catheter Ablation/methods , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Catheter Ablation/adverse effects , Electrodes/adverse effects , Equipment Design , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Ultrasonography
17.
Can Assoc Radiol J ; 60(5): 263-72, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19931132

ABSTRACT

Calcific tendinitis is caused by the pathologic deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any joint can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on magnetic resonance imaging. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration and steroid injection of calcific tendinitis are useful techniques performed by the radiologist for the treatment of symptomatic cases. Familiarity with these procedures and their imaging appearance is an important aspect in the management of this common disease.


Subject(s)
Calcinosis/diagnostic imaging , Tendinopathy/diagnostic imaging , Finger Joint/diagnostic imaging , Foot/diagnostic imaging , Hip Joint/diagnostic imaging , Humans , Shoulder Joint/diagnostic imaging , Tendons/diagnostic imaging , Tomography, X-Ray Computed/methods , Wrist Joint/diagnostic imaging
18.
Todo hosp ; (255): 217-221, abr. 2009. tab
Article in Spanish | IBECS | ID: ibc-85268

ABSTRACT

La formación médica se desarrolla en tres fases: en las Facultades de Medicina, Durante la residenica y finalmente, como formación continuada para los especialistas. Todas estas fases se desarrollan, a menos en alguna parte de ellas, en el seno de las organizaciones sanitarias: como consecuencia, van a tener un impacto significativo en el funcionamiento de los Servicios de Radiología. La formación es un reto y una oportunidad para las organizacines sanitarias. Consume recursos, humanos ymateriales, pero bien organizada devuelve con creces el esfuerzo dedicao. La formación dealumnos y residentes va a proporcionar profesionales entusiastas capaces de asumir buena parte de la carga asistencial y es un elemento de motivación del personal de plantilla. La formación continuada es imprescindible para mantener el niel de calidad de la organización y de sus profesionles a lo largo del tiempo. Adema´s es una parte fundamental del compromiso ético que todo profesional médico tiene con la sociedad de mantener su competencia profesional. La formación requiere planificación, dedicación y conocimeinto de lametodología docente. Y también, como comonenete fundamental del proceso, una evaluación, tanto del nivel alcanzdo por los que se forman como del propio programa de formación (AU)


Medical training is carried out in three phases: in Faculties of medicine, while working in the hospital and, finally, as on-going training for specialists. All these phases are carried out, at least some part of them, in health organizations: consequently, the will have a significant impact on the functioning of the Radiology Services (AU)


Subject(s)
Radiology Information Systems/trends , Information Management/trends , Education, Medical, Continuing/trends , Diagnostic Imaging/trends , Image Processing, Computer-Assisted/trends
19.
Curr Probl Diagn Radiol ; 37(5): 203-18, 2008.
Article in English | MEDLINE | ID: mdl-18662599

ABSTRACT

Ultrasound allows the exploration of most of the musculoskeletal system, including lytic bone lesions. Its flexibility, availability, and low cost make it the best tool to guide interventional therapeutic procedures in any musculoskeletal system lesion visible on ultrasound. These techniques include drainages of abscesses, bursitis, hematomas or muscular strains, treatment of cystic lesions (ganglions, Baker's cysts), arthrocentesis, injection of substances in joints and soft tissues, and aspiration of calcific tendinitis. Although the puncture of joints for arthrocentesis and injection of substances are performed by clinicians using palpation, the use of ultrasound guidance improves the effectiveness of the technique especially for small or poorly accessible lesions and joints and for obese patients. Drainage can be performed using catheters or needles and can avoid a more aggressive approach most of the time. Intracavitary urokinase helps when the aim is to drain clotted hematomas or fibrinous collections. Injection of corticoids is useful in the treatment of ganglia, Baker's cysts, tendinitis, and noninfected arthritis. Calcific tendinitis of the shoulder can be effectively treated using percutaneous "lavage" with lidocaine. Calcifications usually disappear and symptoms improve in nearly 90% of the cases within a year. Most of these techniques are low cost and require only a moderate skill. Ultrasound-guided procedures are useful tools to effectively treat some diseases of the musculoskeletal system and should be routine in any imaging department.


Subject(s)
Musculoskeletal Diseases/diagnostic imaging , Musculoskeletal Diseases/therapy , Humans , Ultrasonography
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