Percutaneous vascular intervention based on gadolinium-enhanced MR angiography.

PURPOSE: To determine if gadolinium-enhanced magnetic resonance angiography (Gd-MRA) could be used to reliably plan percutaneous vascular procedures. PATIENTS AND METHODS: Over the course of 13 months, 31 patients underwent attempted percutaneous intervention solely on the basis of a preceding Gd-MRA study. A total of 49 arterial segments were targeted (28 extremities, 21 visceral). Five segments in four patients were not treated (less impressive disease severity on conventional catheter angiography [CA] in four segments, diffuse intrarenal atherosclerosis in one segment). Interventions attempted were percutaneous transluminal angioplasty (n = 10), angioplasty with stent placement (n = 29), and thrombolysis (n = 3). Interventions were successful in all segments, except two because of the inability to cross an occlusion. RESULTS: Good to strong correlation was noted between Gd-MRA and CA regarding stenosis severity and length and the presence of poststenotic dilatation. MRA underestimated the complexity of stenosis. Subjective quality and preintervention confidence were excellent in the majority of MRA studies and satisfactory in the rest. The overall value in "procedural planning" was judged high in 40 segments, satisfactory in five segments, and poor in four segments. The procedural planning and positive predictive values of MRA were significantly lower for visceral arteries compared to iliac and peripheral arteries. CONCLUSION: In most cases, Gd-MRA reliably yielded the anatomic and diagnostic information necessary to plan percutaneous vascular interventions noninvasively and without iodinated contrast. In the authors' practice, Gd-MRA is becoming a key imaging modality in the workup of patients in whom percutaneous intervention is anticipated.

One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses.

OBJECTIVE: This retrospective study was undertaken to show the efficacy and safety of one-step needle aspiration and lavage for the treatment of nonenteric, nonpancreatic abdominal and pelvic abscesses. MATERIALS AND METHODS: Eighty-two nonconsecutive patients (age range, 4-81 years old) with 97 abdominal and pelvic abscesses were treated over 16 years with a one-step percutaneous needle aspiration and lavage technique. Abscesses were drained with sonographic or CT guidance in a single session. An 18-gauge needle was used for aspiration and repeated saline lavage; no drainage catheter was left in place. For collections that appeared multiloculated, needle repositioning and repeated aspiration and lavage were performed during the single session. All patients received i.v. antibiotics. RESULTS: Eighty-seven (90%) of 97 abscesses in 72 of 82 patients were successfully treated, including 17 (85%) of 20 abscesses that were multiloculated. The only two complications were transient sepsis in one patient and hemorrhage in one patient that resolved with transfusion and conservative treatment. Needle aspiration and lavage failures were associated with diffuse peritonitis, occult malignancy, unsuspected enteric communication, and a dropped surgical clip. CONCLUSION: Percutaneous needle aspiration and lavage can be a safe, effective alternative to the more conventional treatment of prolonged catheter drainage. In selected patients, including certain patients with multiloculated abscesses, one-step needle aspiration and lavage should be considered as the initial method of treatment.

A comparison of whole-body turboSTIR MR imaging and planar 99mTc-methylene diphosphonate scintigraphy in the examination of patients with suspected skeletal metastases.

OBJECTIVE: This study was undertaken to compare whole-body turbo short inversion time inversion recovery MR imaging and 99mTc-methylene diphosphonate planar scintigraphy in the examination of patients with suspected skeletal metastases. SUBJECTS AND METHODS: Twenty-five patients with known or suspected skeletal metastatic disease underwent both whole-body turbo short inversion time inversion recovery MR imaging and whole-body 99mTc-methylene diphosphonate scintigraphy. RESULTS: MR imaging revealed metastases at 57 of 175 possible sites (sensitivity, 96.5%, specificity, 100%; positive predictive value, 100%). Scintigraphy revealed metastases at 43 of 175 possible sites (sensitivity, 72%; specificity, 98%; positive predictive value, 95%) (McNemar test, 0.01; p = .016). Discrepancies in skeletal evaluation by whole-body MR imaging and scintigraphy were observed in six (24%) of 25 patients. Soft-tissue abnormalities were identified in 13 (52%) of 25 patients with MR imaging alone. CONCLUSION: Preliminary results suggest that whole-body MR imaging is an effective method of examining patients with suspected skeletal metastases, with better sensitivity than conventional planar 99mTc-methylene diphosphonate scintigraphy.

Symptomatic hepatic cysts: percutaneous drainage and sclerosis.

PURPOSE: To evaluate the authors' experience with treatment of symptomatic hepatic cysts by means of percutaneous catheterization and sclerosis. MATERIALS AND METHODS: Twenty patients with 24 symptomatic hepatic cysts underwent percutaneous drainage and sclerosis. Ten patients had polycystic disease, and 10 had solitary cysts. Sclerosants used were alcohol, tetracycline, doxycycline, or a combination. RESULTS: Twenty-one of 24 cysts in 17 of 20 patients were treated successfully. Treatment was unsuccessful in three patients: one patient with innumerable medium-size and small cysts, one patient in whom only a needle was inserted (no catheter), and one patient with a cystic metastasis (rather than a simple cyst) that recurred. Complications included pleural effusion in two patients and secondary infection in one patient. The range of blood alcohol levels was 0-0.8 mg%. CONCLUSION: Percutaneous catheter drainage with sclerosis is an effective method of therapy for symptomatic hepatic cysts; careful patient selection is essential for proper therapy.