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acrac_3158170_2 | Dialysis Fistula Malfunction | As high as 90% of accesses with abnormal physical examinations will have an underlying clinically significant finding on imaging [10]; and 2) surveillance, performed periodically with the aid of noninvasive and invasive device-based methods to assess blood access flow rate (Qa), access recirculation, and dialysis venou... | Dialysis Fistula Malfunction. As high as 90% of accesses with abnormal physical examinations will have an underlying clinically significant finding on imaging [10]; and 2) surveillance, performed periodically with the aid of noninvasive and invasive device-based methods to assess blood access flow rate (Qa), access rec... | 3158170 |
acrac_3158170_3 | Dialysis Fistula Malfunction | While DSA allows for assessing vascular stenoses, most investigators tend towards an antegrade puncture at the distal aspect of the efferent vein for diagnostic fistulography. This necessitates retrograde opacification of the juxta- anastomotic segments to illustrate a possible stenosis. In identifying a stenosis in th... | Dialysis Fistula Malfunction. While DSA allows for assessing vascular stenoses, most investigators tend towards an antegrade puncture at the distal aspect of the efferent vein for diagnostic fistulography. This necessitates retrograde opacification of the juxta- anastomotic segments to illustrate a possible stenosis. I... | 3158170 |
acrac_3158170_4 | Dialysis Fistula Malfunction | Measurement of the residual diameter of a stenotic lesion using B-mode US has also been proposed as a method for identifying a stenosis within an AVF or AVG [26]. The measurement of AVF or AVG blood flow by US is not considered as accurate when compared to other methods of measuring blood flow through the dialysis vasc... | Dialysis Fistula Malfunction. Measurement of the residual diameter of a stenotic lesion using B-mode US has also been proposed as a method for identifying a stenosis within an AVF or AVG [26]. The measurement of AVF or AVG blood flow by US is not considered as accurate when compared to other methods of measuring blood ... | 3158170 |
acrac_3158170_5 | Dialysis Fistula Malfunction | During fistulography to treat a stenosis, venography may reveal a narrowing that may represent a stenosis or vasospasm. Preprocedural US has the added advantage of differentiating structural stenoses from transient self-limiting vasospasm [32]. Duplex Doppler US can aid monitoring of the response postangioplasty or ste... | Dialysis Fistula Malfunction. During fistulography to treat a stenosis, venography may reveal a narrowing that may represent a stenosis or vasospasm. Preprocedural US has the added advantage of differentiating structural stenoses from transient self-limiting vasospasm [32]. Duplex Doppler US can aid monitoring of the r... | 3158170 |
acrac_3158170_6 | Dialysis Fistula Malfunction | Similarly, Heye et al [18] demonstrated an underestimation of stenoses on DSA when compared to MDCT angiography, where a stenosis was viewed in transverse and sagittal planes of planar reconstruction. CTV Extremity Area of Interest With IV Contrast CT venography (CTV) represents an alternative diagnostic study for many... | Dialysis Fistula Malfunction. Similarly, Heye et al [18] demonstrated an underestimation of stenoses on DSA when compared to MDCT angiography, where a stenosis was viewed in transverse and sagittal planes of planar reconstruction. CTV Extremity Area of Interest With IV Contrast CT venography (CTV) represents an alterna... | 3158170 |
acrac_3158170_7 | Dialysis Fistula Malfunction | MRA Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support the use of MRA of the extremity without IV contrast in evaluation of suspected dysfunction of a hemodialysis access. MRV Extremity Area of Interest Without and With IV Contrast There is no identified relevant litera... | Dialysis Fistula Malfunction. MRA Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support the use of MRA of the extremity without IV contrast in evaluation of suspected dysfunction of a hemodialysis access. MRV Extremity Area of Interest Without and With IV Contrast There is... | 3158170 |
acrac_3158170_8 | Dialysis Fistula Malfunction | The endovascular treatments of dysfunctional dialysis access with a stenotic lesion seen during diagnostic fistulography typically include percutaneous transluminal angioplasty (PTA) using a balloon and stent placement. The 2006 KDOQI guidelines established that PTA represents the first-line treatment for a stenosis in... | Dialysis Fistula Malfunction. The endovascular treatments of dysfunctional dialysis access with a stenotic lesion seen during diagnostic fistulography typically include percutaneous transluminal angioplasty (PTA) using a balloon and stent placement. The 2006 KDOQI guidelines established that PTA represents the first-li... | 3158170 |
acrac_3158170_9 | Dialysis Fistula Malfunction | Dialysis Fistula Malfunction cutting and high-pressure balloon angioplasty, which conflicted with a study by Aftab et al that did show significantly improved patency using cutting balloons compared to high-pressure balloons [47,48]. Drug-eluting balloons coated with paclitaxel have been shown in multiple prospective ra... | Dialysis Fistula Malfunction. Dialysis Fistula Malfunction cutting and high-pressure balloon angioplasty, which conflicted with a study by Aftab et al that did show significantly improved patency using cutting balloons compared to high-pressure balloons [47,48]. Drug-eluting balloons coated with paclitaxel have been sh... | 3158170 |
acrac_3158170_10 | Dialysis Fistula Malfunction | In one multicenter prospective randomized study, Haskal et al [63] demonstrated superior patency rates following the treatment of a stenosis in an AVG using a stent graft versus PTA with patency rates at 12 months of 47.6% versus 24.8% and at 24 months of 26.9% versus 13.5%, respectively. Surgical Consultation Multidis... | Dialysis Fistula Malfunction. In one multicenter prospective randomized study, Haskal et al [63] demonstrated superior patency rates following the treatment of a stenosis in an AVG using a stent graft versus PTA with patency rates at 12 months of 47.6% versus 24.8% and at 24 months of 26.9% versus 13.5%, respectively. ... | 3158170 |
acrac_3158170_11 | Dialysis Fistula Malfunction | This is secondary to the association of AV access with reduced vascular access-related events such as infection, thrombotic, and nonthrombotic complications [5]. In special circumstances, a temporary CVC may be required to manage a vascular access complication (<2 weeks). In such cases, a nontunneled CVC or nontunneled... | Dialysis Fistula Malfunction. This is secondary to the association of AV access with reduced vascular access-related events such as infection, thrombotic, and nonthrombotic complications [5]. In special circumstances, a temporary CVC may be required to manage a vascular access complication (<2 weeks). In such cases, a ... | 3158170 |
acrac_3158170_12 | Dialysis Fistula Malfunction | Indications for placement of a cuffed, tunneled dialysis catheter include the following: exhaustion of other AV access site options; temporary transition from another form of dialysis (eg, renal transplant-acute rejection, peritoneal dialysis-related complications such as pleural leak); waiting for a live-donor kidney ... | Dialysis Fistula Malfunction. Indications for placement of a cuffed, tunneled dialysis catheter include the following: exhaustion of other AV access site options; temporary transition from another form of dialysis (eg, renal transplant-acute rejection, peritoneal dialysis-related complications such as pleural leak); wa... | 3158170 |
acrac_3158170_13 | Dialysis Fistula Malfunction | The loss of AVF was decreased in the group preemptively treated with PTA when compared to the observation alone group, 5 (18%) versus 13 (43%). These correlated to AVF loss rates [event/AVF-year] of 0.066 and 0.186; P = . 041 [5]. US Duplex Doppler Hemodialysis Access Area of Interest Recent evidence supports the safet... | Dialysis Fistula Malfunction. The loss of AVF was decreased in the group preemptively treated with PTA when compared to the observation alone group, 5 (18%) versus 13 (43%). These correlated to AVF loss rates [event/AVF-year] of 0.066 and 0.186; P = . 041 [5]. US Duplex Doppler Hemodialysis Access Area of Interest Rece... | 3158170 |
acrac_3158170_14 | Dialysis Fistula Malfunction | Dialysis Fistula Malfunction Fluoroscopy Fistulography Hemodialysis Access Area of Interest Thrombosis of a hemodialysis vascular access (fistula or graft) connotes lack of blood flow and is a diagnosis that is readily made by physical examination [7]. Diagnostic fistulography is suggested for suspected thrombosis if t... | Dialysis Fistula Malfunction. Dialysis Fistula Malfunction Fluoroscopy Fistulography Hemodialysis Access Area of Interest Thrombosis of a hemodialysis vascular access (fistula or graft) connotes lack of blood flow and is a diagnosis that is readily made by physical examination [7]. Diagnostic fistulography is suggested... | 3158170 |
acrac_3158170_15 | Dialysis Fistula Malfunction | In conclusion, dynamic CTA was found to detect multiple pathologic findings not detected by US [85]. While no large studies exist, CTA is frequently performed in practice as a complementary imaging modality to diagnostic US and fistulography. CTV Extremity Area of Interest With IV Contrast There is no relevant literatu... | Dialysis Fistula Malfunction. In conclusion, dynamic CTA was found to detect multiple pathologic findings not detected by US [85]. While no large studies exist, CTA is frequently performed in practice as a complementary imaging modality to diagnostic US and fistulography. CTV Extremity Area of Interest With IV Contrast... | 3158170 |
acrac_3158170_16 | Dialysis Fistula Malfunction | However, the endovascular therapeutic options have largely superseded open surgical techniques for the restoration of a thrombosed dialysis access [88]. The SIR Standards and Practice Committee guidelines suggest that a stenosis with an associated thrombosis that occurs in a dialysis circuit ought to be managed with en... | Dialysis Fistula Malfunction. However, the endovascular therapeutic options have largely superseded open surgical techniques for the restoration of a thrombosed dialysis access [88]. The SIR Standards and Practice Committee guidelines suggest that a stenosis with an associated thrombosis that occurs in a dialysis circu... | 3158170 |
acrac_3158170_17 | Dialysis Fistula Malfunction | The KDOQI 2019 guidelines suggest that placement of a tunneled (cuffed) dialysis catheter is a valid option, supported by the goal of hemodialysis access use for limited duration (eg, <3 months) [5]. In such cases, when AV access is expected to be ready for use in the short term, it is preferred to place tunneled dialy... | Dialysis Fistula Malfunction. The KDOQI 2019 guidelines suggest that placement of a tunneled (cuffed) dialysis catheter is a valid option, supported by the goal of hemodialysis access use for limited duration (eg, <3 months) [5]. In such cases, when AV access is expected to be ready for use in the short term, it is pre... | 3158170 |
acrac_3158170_18 | Dialysis Fistula Malfunction | Under valid indications for tunneled dialysis catheter placement, the KDOQI guidelines suggests that when the duration of catheter use is anticipated to be prolonged (>3 months) without the anticipated use of AV access, a tunneled dialysis catheter may be placed in order of preference in the following vein, namely inte... | Dialysis Fistula Malfunction. Under valid indications for tunneled dialysis catheter placement, the KDOQI guidelines suggests that when the duration of catheter use is anticipated to be prolonged (>3 months) without the anticipated use of AV access, a tunneled dialysis catheter may be placed in order of preference in t... | 3158170 |
acrac_3158170_19 | Dialysis Fistula Malfunction | The KDOQI guidelines defines a mature fistula as one that dependably provides the prescribed dialysis using 2 needles for greater than two-thirds of the dialysis sessions over a 4 consecutive week period [5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest Given that early detection and intervention of a... | Dialysis Fistula Malfunction. The KDOQI guidelines defines a mature fistula as one that dependably provides the prescribed dialysis using 2 needles for greater than two-thirds of the dialysis sessions over a 4 consecutive week period [5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest Given that early d... | 3158170 |
acrac_3158170_20 | Dialysis Fistula Malfunction | US Duplex Doppler Hemodialysis Access Area of Interest Duplex Doppler US reflects a unique ability to reliably evaluate the functional and structural characteristics of the peripheral vasculature. As such, it has become a well-established imaging modality for vascular access follow-up. Duplex Doppler US reflects a reli... | Dialysis Fistula Malfunction. US Duplex Doppler Hemodialysis Access Area of Interest Duplex Doppler US reflects a unique ability to reliably evaluate the functional and structural characteristics of the peripheral vasculature. As such, it has become a well-established imaging modality for vascular access follow-up. Dup... | 3158170 |
acrac_3158170_21 | Dialysis Fistula Malfunction | In the report of their dedicated surveillance program aimed at optimizing the functional access rate at first dialysis, a functional outcome rate of 94.2% (145/154 patients) at the time of first dialysis or at the end of the studied period was noted. Forty reinterventions were needed secondary to failure to mature in 3... | Dialysis Fistula Malfunction. In the report of their dedicated surveillance program aimed at optimizing the functional access rate at first dialysis, a functional outcome rate of 94.2% (145/154 patients) at the time of first dialysis or at the end of the studied period was noted. Forty reinterventions were needed secon... | 3158170 |
acrac_3158170_22 | Dialysis Fistula Malfunction | MRV Extremity Area of Interest Without and With IV Contrast There is no identified relevant literature to support the use of MRV extremity without and with IV contrast in evaluating a failure of an AVF to mature. MRV Extremity Area of Interest Without IV Contrast There is no identified relevant literature to support th... | Dialysis Fistula Malfunction. MRV Extremity Area of Interest Without and With IV Contrast There is no identified relevant literature to support the use of MRV extremity without and with IV contrast in evaluating a failure of an AVF to mature. MRV Extremity Area of Interest Without IV Contrast There is no identified rel... | 3158170 |
acrac_3158170_23 | Dialysis Fistula Malfunction | While the long-term viability of fistulas that have been flagged as nonmaturing has been called into question, the early identification of suboptimal maturation and thus the treatment of the AVF may result in a functional fistula in the vast maturity of patients. Two prospective studies demonstrate that immature AVFs m... | Dialysis Fistula Malfunction. While the long-term viability of fistulas that have been flagged as nonmaturing has been called into question, the early identification of suboptimal maturation and thus the treatment of the AVF may result in a functional fistula in the vast maturity of patients. Two prospective studies de... | 3158170 |
acrac_3158170_24 | Dialysis Fistula Malfunction | Small venous tributaries or accessory veins are thought to shunt blood flow away from the venous outflow, thus impairing maturation. However, the accepted range of etiologies for nonmaturation of an AVF include a stenosis, lack of vein and artery dilation secondary to intimal hyperplasia, the presence of scarring in th... | Dialysis Fistula Malfunction. Small venous tributaries or accessory veins are thought to shunt blood flow away from the venous outflow, thus impairing maturation. However, the accepted range of etiologies for nonmaturation of an AVF include a stenosis, lack of vein and artery dilation secondary to intimal hyperplasia, ... | 3158170 |
acrac_3158170_25 | Dialysis Fistula Malfunction | They cite that it is reasonable to make an appropriate decision in the setting of a careful individualized approach to a given patient on the use of either endovascular or surgical techniques when the need to intervene on an AV access to promote its maturation postoperatively arises [5]. Placement of a New Tunneled Dia... | Dialysis Fistula Malfunction. They cite that it is reasonable to make an appropriate decision in the setting of a careful individualized approach to a given patient on the use of either endovascular or surgical techniques when the need to intervene on an AV access to promote its maturation postoperatively arises [5]. P... | 3158170 |
acrac_3158170_26 | Dialysis Fistula Malfunction | Adjuvant duplex US and/or phlebography was offered when physical examination was equivocal. AVF maturation was also confirmed by US and physical examination of the AVF. If indicated; however, a salvage intervention was performed or when a salvage procedure was not possible, a new AVF was created. Duplex US evaluation w... | Dialysis Fistula Malfunction. Adjuvant duplex US and/or phlebography was offered when physical examination was equivocal. AVF maturation was also confirmed by US and physical examination of the AVF. If indicated; however, a salvage intervention was performed or when a salvage procedure was not possible, a new AVF was c... | 3158170 |
acrac_3158170_27 | Dialysis Fistula Malfunction | Causes and exacerbating processes include intravascular CVC, deep venous thromboses, pacemakers and other cardiac rhythm devices, as well as the presence of the hemodialysis AV access itself [4,5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest There is consensus that central vein occlusions and stenose... | Dialysis Fistula Malfunction. Causes and exacerbating processes include intravascular CVC, deep venous thromboses, pacemakers and other cardiac rhythm devices, as well as the presence of the hemodialysis AV access itself [4,5]. Fluoroscopy Fistulography Hemodialysis Access Area of Interest There is consensus that centr... | 3158170 |
acrac_3158170_28 | Dialysis Fistula Malfunction | For example, in a study comparing duplex US in symptomatic patients with venography as the reference standard, a significant yield with duplex US in addition to 90% agreement with venography was noted. The preferred threshold to detect a >50% stenosis by duplex US was suggested by a poststenotic to prestenotic peak vei... | Dialysis Fistula Malfunction. For example, in a study comparing duplex US in symptomatic patients with venography as the reference standard, a significant yield with duplex US in addition to 90% agreement with venography was noted. The preferred threshold to detect a >50% stenosis by duplex US was suggested by a postst... | 3158170 |
acrac_3158170_29 | Dialysis Fistula Malfunction | It may be concluded that in cases where MDCT angiography is utilized with inadequate contrast opacification of the central vessels or suspicion for pseudostenosis artifacts, thorough examination of the vascular tree with diagnostic fistulography would be indicated [84]. Additionally, prior review articles support the u... | Dialysis Fistula Malfunction. It may be concluded that in cases where MDCT angiography is utilized with inadequate contrast opacification of the central vessels or suspicion for pseudostenosis artifacts, thorough examination of the vascular tree with diagnostic fistulography would be indicated [84]. Additionally, prior... | 3158170 |
acrac_3158170_30 | Dialysis Fistula Malfunction | Depiction of the central venous outflow is critical as subclavian vein stenoses are not uncommon in patients on hemodialysis. As such, there is no identified relevant literature to support the use of MRA extremity without and with IV contrast in evaluation of suspected central stenosis or occlusion suggested by swellin... | Dialysis Fistula Malfunction. Depiction of the central venous outflow is critical as subclavian vein stenoses are not uncommon in patients on hemodialysis. As such, there is no identified relevant literature to support the use of MRA extremity without and with IV contrast in evaluation of suspected central stenosis or ... | 3158170 |
acrac_3158170_31 | Dialysis Fistula Malfunction | Fluoroscopy Fistulography Hemodialysis Access with Intervention Employing diagnostic fistulography to support endovascular treatment of a CVS is indicated when a stenosis >50% of the endoluminal diameter is detected, when there is hemodynamic compromise in the dialysis vascular access circuit or when the AVF is nonmatu... | Dialysis Fistula Malfunction. Fluoroscopy Fistulography Hemodialysis Access with Intervention Employing diagnostic fistulography to support endovascular treatment of a CVS is indicated when a stenosis >50% of the endoluminal diameter is detected, when there is hemodynamic compromise in the dialysis vascular access circ... | 3158170 |
acrac_3158170_32 | Dialysis Fistula Malfunction | In a second retrospective study by Ozyer et al in patients undergoing hemodialysis without CVCs, primary patency, marked by time from intervention to the subsequent intervention, was 24.5 months and 13.4 months, in the angioplasty and stent group, respectively [5,119]. Stents ought to be used cautiously or avoided regi... | Dialysis Fistula Malfunction. In a second retrospective study by Ozyer et al in patients undergoing hemodialysis without CVCs, primary patency, marked by time from intervention to the subsequent intervention, was 24.5 months and 13.4 months, in the angioplasty and stent group, respectively [5,119]. Stents ought to be u... | 3158170 |
acrac_3158170_33 | Dialysis Fistula Malfunction | In such cases, intervention is unindicated for these asymptomatic lesions or those with minimal associated symptoms [110]. Of note, it is common for a degree of arm edema to occur in patients after AV access construction, possibly related to operative trauma and/or mild venous hypertension. Its postoperative resolution... | Dialysis Fistula Malfunction. In such cases, intervention is unindicated for these asymptomatic lesions or those with minimal associated symptoms [110]. Of note, it is common for a degree of arm edema to occur in patients after AV access construction, possibly related to operative trauma and/or mild venous hypertension... | 3158170 |
acrac_3158170_34 | Dialysis Fistula Malfunction | Given that the presence of skin erosion or active or impending hemorrhage from an AV access in the setting of a pseudoaneurysm is a surgical emergency, there is no relevant identified literature to support the use of fluoroscopy fistulography in the evaluation of abnormal skin changes associated with the hemodialysis a... | Dialysis Fistula Malfunction. Given that the presence of skin erosion or active or impending hemorrhage from an AV access in the setting of a pseudoaneurysm is a surgical emergency, there is no relevant identified literature to support the use of fluoroscopy fistulography in the evaluation of abnormal skin changes asso... | 3158170 |
acrac_3158170_35 | Dialysis Fistula Malfunction | Variant 10: Abnormal skin changes associated with the upper or lower extremity hemodialysis access cannulation site, including marked thinning, ulceration, eschar formation, spontaneous bleeding, pseudoaneurysm formation, superficial or deep infection. Treatment and procedures. Fluoroscopy Fistulography Hemodialysis Ac... | Dialysis Fistula Malfunction. Variant 10: Abnormal skin changes associated with the upper or lower extremity hemodialysis access cannulation site, including marked thinning, ulceration, eschar formation, spontaneous bleeding, pseudoaneurysm formation, superficial or deep infection. Treatment and procedures. Fluoroscopy... | 3158170 |
acrac_3158170_36 | Dialysis Fistula Malfunction | In the absence of concomitant infection, this may support an initial diagnostic assessment followed by treatment of any underlying venous outflow or central venous stenoses that may have caused the aneurysm or pseudoaneurysm [123]. Endovascular occlusion of the hemodialysis access using vascular plugs has also been sug... | Dialysis Fistula Malfunction. In the absence of concomitant infection, this may support an initial diagnostic assessment followed by treatment of any underlying venous outflow or central venous stenoses that may have caused the aneurysm or pseudoaneurysm [123]. Endovascular occlusion of the hemodialysis access using va... | 3158170 |
acrac_3158170_37 | Dialysis Fistula Malfunction | Given associated increased risks for catheter-associated infection, higher mortality, and lower patency when compared to AVF and AVG, tunneled dialysis catheters should be avoided if possible or considered a temporizing measure until other hemodialysis access is available [108]. Continued Hemodialysis Access Use with S... | Dialysis Fistula Malfunction. Given associated increased risks for catheter-associated infection, higher mortality, and lower patency when compared to AVF and AVG, tunneled dialysis catheters should be avoided if possible or considered a temporizing measure until other hemodialysis access is available [108]. Continued ... | 3158170 |
acrac_3158170_38 | Dialysis Fistula Malfunction | Given that distal hypoperfusion may develop in the absence or presence of arterial stenoses, diagnostic arteriography of the extremity and the entirety of its inflow is a foundational part of the diagnostic evaluation prior to determining management. The subsequent choice of management may only be made after considerin... | Dialysis Fistula Malfunction. Given that distal hypoperfusion may develop in the absence or presence of arterial stenoses, diagnostic arteriography of the extremity and the entirety of its inflow is a foundational part of the diagnostic evaluation prior to determining management. The subsequent choice of management may... | 3158170 |
acrac_3158170_39 | Dialysis Fistula Malfunction | Of those presenting with hand pain, 7 out of 10 patients were found to accurately depict the presence of arterial stenoses. Imaging revealed 3 cases of excessive flow into the access via the arterial anastomosis. To assess for the presence of arterial stenosis in patients with a hemodialysis access who have presented w... | Dialysis Fistula Malfunction. Of those presenting with hand pain, 7 out of 10 patients were found to accurately depict the presence of arterial stenoses. Imaging revealed 3 cases of excessive flow into the access via the arterial anastomosis. To assess for the presence of arterial stenosis in patients with a hemodialys... | 3158170 |
acrac_3158170_40 | Dialysis Fistula Malfunction | Of note, the demonstration of retrograde flow on CDUS evaluation of an AV access does not reliably predict or provide the presence of a clinical steal syndrome. While hemodynamic findings of arterial steal can be illustrated in most patients with forearm as well as proximal AV accesses, development of ischemic symptoms... | Dialysis Fistula Malfunction. Of note, the demonstration of retrograde flow on CDUS evaluation of an AV access does not reliably predict or provide the presence of a clinical steal syndrome. While hemodynamic findings of arterial steal can be illustrated in most patients with forearm as well as proximal AV accesses, de... | 3158170 |
acrac_3158170_41 | Dialysis Fistula Malfunction | Endovascular treatment of the culprit stenoses was accomplished after obtaining a confirmatory DSA. In 1 of 2 patients with symptoms of steal, the reported symptoms resolved postangioplasty [12]. MRA Extremity Area of Interest Without IV Contrast There is no identifiable relevant literature to support the use of MRA ex... | Dialysis Fistula Malfunction. Endovascular treatment of the culprit stenoses was accomplished after obtaining a confirmatory DSA. In 1 of 2 patients with symptoms of steal, the reported symptoms resolved postangioplasty [12]. MRA Extremity Area of Interest Without IV Contrast There is no identifiable relevant literatur... | 3158170 |
acrac_3158170_42 | Dialysis Fistula Malfunction | Gumus et al [128] reported 21 patients who underwent endovascular occlusion of their native fistulas. Of the studied patients, 2 patients had hyperdynamic heart failure, 2 exhibited DASS and 5 patients had findings of critical hand ischemia with a nonhealing ulcer or necrosis. Successful embolization of all fistulas us... | Dialysis Fistula Malfunction. Gumus et al [128] reported 21 patients who underwent endovascular occlusion of their native fistulas. Of the studied patients, 2 patients had hyperdynamic heart failure, 2 exhibited DASS and 5 patients had findings of critical hand ischemia with a nonhealing ulcer or necrosis. Successful e... | 3158170 |
acrac_3158170_43 | Dialysis Fistula Malfunction | Distal radial artery embolization combined with recanalization and angioplasty of any present ulnar artery stenoses and occlusions may provide equivalent results with the DRIL operation, which is regarded as the most efficient and effective treatment option for correcting the hemodynamics in DASS. While coil occlusion ... | Dialysis Fistula Malfunction. Distal radial artery embolization combined with recanalization and angioplasty of any present ulnar artery stenoses and occlusions may provide equivalent results with the DRIL operation, which is regarded as the most efficient and effective treatment option for correcting the hemodynamics ... | 3158170 |
acrac_3097049_0 | Imaging After Shoulder Arthroplasty PCAs | Introduction/Background There has been a rapid increase in the number of shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, performed in the United States over the past 2 decades [1]. The most recent p... | Imaging After Shoulder Arthroplasty PCAs. Introduction/Background There has been a rapid increase in the number of shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, performed in the United States over... | 3097049 |
acrac_3097049_1 | Imaging After Shoulder Arthroplasty PCAs | The construct moves the center of rotation medial and distal, which allows the deltoid muscle to serve as a main stabilizer of the arthroplasty and joint [4]. Additionally, the more medial and distal center of rotation decreases the risk of glenoid loosening [4,5]. Symptoms related to postoperative difficulties include... | Imaging After Shoulder Arthroplasty PCAs. The construct moves the center of rotation medial and distal, which allows the deltoid muscle to serve as a main stabilizer of the arthroplasty and joint [4]. Additionally, the more medial and distal center of rotation decreases the risk of glenoid loosening [4,5]. Symptoms rel... | 3097049 |
acrac_3097049_2 | Imaging After Shoulder Arthroplasty PCAs | Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Imaging After Shoulder Arthroplasty surrounding osseous and soft-tissue structures. The selection of the next imaging moda... | Imaging After Shoulder Arthroplasty PCAs. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Imaging After Shoulder Arthroplasty surrounding osseous and soft-tissue structur... | 3097049 |
acrac_3097049_3 | Imaging After Shoulder Arthroplasty PCAs | The standard single-phase bone scan involves imaging 2 to 3 hours after MDP administration. The 3-phase bone scan consists of a 1-minute radionuclide angiogram followed by immediate blood pool images and 2- to 3-hour delayed views. The 3-phase scan can be helpful in the assessment of acute fracture and differentiating ... | Imaging After Shoulder Arthroplasty PCAs. The standard single-phase bone scan involves imaging 2 to 3 hours after MDP administration. The 3-phase bone scan consists of a 1-minute radionuclide angiogram followed by immediate blood pool images and 2- to 3-hour delayed views. The 3-phase scan can be helpful in the assessm... | 3097049 |
acrac_3097049_4 | Imaging After Shoulder Arthroplasty PCAs | Fluoride PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluoride PET/CT skull base to mid-thigh in the follow-up of the asymptomatic patient with a primary shoulder arthroplasty. MRI Shoulder MRI examinations are not typically ordered for evaluation of the asymptomatic patient. Rad... | Imaging After Shoulder Arthroplasty PCAs. Fluoride PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluoride PET/CT skull base to mid-thigh in the follow-up of the asymptomatic patient with a primary shoulder arthroplasty. MRI Shoulder MRI examinations are not typically ordered for e... | 3097049 |
acrac_3097049_5 | Imaging After Shoulder Arthroplasty PCAs | The addition of SPECT or SPECT/CT improves diagnosis by allowing more accurate anatomical localization of new bone formation [20]. The specificity of Tc-99m bone scans for periprosthetic fractures increases in older prostheses once postoperative remodeling has decreased. Bone Scan Shoulder There is no relevant literatu... | Imaging After Shoulder Arthroplasty PCAs. The addition of SPECT or SPECT/CT improves diagnosis by allowing more accurate anatomical localization of new bone formation [20]. The specificity of Tc-99m bone scans for periprosthetic fractures increases in older prostheses once postoperative remodeling has decreased. Bone S... | 3097049 |
acrac_3097049_6 | Imaging After Shoulder Arthroplasty PCAs | CT can also be used when a fracture is suspected clinically but the radiographs are negative such as in the setting of a suspected acromial stress fracture in the patient with a reverse total shoulder arthroplasty [23]. Fluoride PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluori... | Imaging After Shoulder Arthroplasty PCAs. CT can also be used when a fracture is suspected clinically but the radiographs are negative such as in the setting of a suspected acromial stress fracture in the patient with a reverse total shoulder arthroplasty [23]. Fluoride PET/CT Skull Base to Mid-Thigh There is no releva... | 3097049 |
acrac_3097049_7 | Imaging After Shoulder Arthroplasty PCAs | Infection, including osteomyelitis and septic arthritis, after total shoulder arthroplasty is an uncommon albeit potentially devastating complication, with a prevalence of 0.7% to 2.9%. Infection is more common in males and a younger age group [3,26,27]. A 97% infection-free rate at 20 years has been reported [28]. Pre... | Imaging After Shoulder Arthroplasty PCAs. Infection, including osteomyelitis and septic arthritis, after total shoulder arthroplasty is an uncommon albeit potentially devastating complication, with a prevalence of 0.7% to 2.9%. Infection is more common in males and a younger age group [3,26,27]. A 97% infection-free ra... | 3097049 |
acrac_3097049_8 | Imaging After Shoulder Arthroplasty PCAs | Fracture confirmation can also be identified with anatomic imaging (eg, radiographs, CT with metal artifact reduction techniques). Normal uncomplicated postoperative change tends to decrease over time and up to 2 years or longer after surgery [21,22], whereas aseptic loosening generally tends to progress. Discordant ac... | Imaging After Shoulder Arthroplasty PCAs. Fracture confirmation can also be identified with anatomic imaging (eg, radiographs, CT with metal artifact reduction techniques). Normal uncomplicated postoperative change tends to decrease over time and up to 2 years or longer after surgery [21,22], whereas aseptic loosening ... | 3097049 |
acrac_3097049_9 | Imaging After Shoulder Arthroplasty PCAs | Postoperative change and fracture healing tend to decrease over time. Fracture confirmation can also be identified with anatomic imaging (eg, radiographs, CT with metal artifact reduction techniques). Normal uncomplicated postoperative change tends to decrease over time and up to 2 years or longer after surgery [21,22]... | Imaging After Shoulder Arthroplasty PCAs. Postoperative change and fracture healing tend to decrease over time. Fracture confirmation can also be identified with anatomic imaging (eg, radiographs, CT with metal artifact reduction techniques). Normal uncomplicated postoperative change tends to decrease over time and up ... | 3097049 |
acrac_3097049_10 | Imaging After Shoulder Arthroplasty PCAs | The addition of SPECT or SPECT/CT improves anatomic localization of new bone formation [20] but remains nonspecific. A positive 3-phase bone scan can be seen in periprosthetic infection, periprosthetic fracture, and in the early postoperative state. Postoperative change and fracture healing tend to decrease over time. ... | Imaging After Shoulder Arthroplasty PCAs. The addition of SPECT or SPECT/CT improves anatomic localization of new bone formation [20] but remains nonspecific. A positive 3-phase bone scan can be seen in periprosthetic infection, periprosthetic fracture, and in the early postoperative state. Postoperative change and fra... | 3097049 |
acrac_3097049_11 | Imaging After Shoulder Arthroplasty PCAs | The standard Tc-99m bone scan is a sensitive modality for the identification of abnormal bone in acute osteomyelitis, particularly in the setting of normal radiographs. However, the 3-phase bone scan is often preferred to assess for associated hyperemia in acute fracture and acute osteomyelitis. Bone scans remain low i... | Imaging After Shoulder Arthroplasty PCAs. The standard Tc-99m bone scan is a sensitive modality for the identification of abnormal bone in acute osteomyelitis, particularly in the setting of normal radiographs. However, the 3-phase bone scan is often preferred to assess for associated hyperemia in acute fracture and ac... | 3097049 |
acrac_3097049_12 | Imaging After Shoulder Arthroplasty PCAs | Fluoride PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluoride PET/CT for the next imaging study of a symptomatic patient with a primary shoulder arthroplasty when infection has been not excluded. MRI Shoulder MRI with metal reduction protocols can play a useful role in the diagn... | Imaging After Shoulder Arthroplasty PCAs. Fluoride PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluoride PET/CT for the next imaging study of a symptomatic patient with a primary shoulder arthroplasty when infection has been not excluded. MRI Shoulder MRI with metal reduction pro... | 3097049 |
acrac_3097049_13 | Imaging After Shoulder Arthroplasty PCAs | An isolated In-111-labeled WBC study is a sensitive but nonspecific technique for the evaluation of acute neutrophilic dominant periprosthetic infection [11]. Its specificity can be increased when interpreted alongside Tc-99m sulfur colloid imaging or, less optimally, bone scan imaging; the latter may not be indicated ... | Imaging After Shoulder Arthroplasty PCAs. An isolated In-111-labeled WBC study is a sensitive but nonspecific technique for the evaluation of acute neutrophilic dominant periprosthetic infection [11]. Its specificity can be increased when interpreted alongside Tc-99m sulfur colloid imaging or, less optimally, bone scan... | 3097049 |
acrac_3097049_14 | Imaging After Shoulder Arthroplasty PCAs | A positive 3-phase bone scan can be seen in the early postoperative state, periprosthetic fracture, aseptic prosthetic loosening, and periprosthetic infection. Postoperative change and fracture healing tend to decrease over time. Fracture confirmation can also be identified with anatomic imaging (eg, radiographs, CT wi... | Imaging After Shoulder Arthroplasty PCAs. A positive 3-phase bone scan can be seen in the early postoperative state, periprosthetic fracture, aseptic prosthetic loosening, and periprosthetic infection. Postoperative change and fracture healing tend to decrease over time. Fracture confirmation can also be identified wit... | 3097049 |
acrac_3097049_15 | Imaging After Shoulder Arthroplasty PCAs | Imaging After Shoulder Arthroplasty Image degradation can occur because of beam hardening artifact and other hardware-related artifacts, especially with older CT scanners. The use of newer metal reduction CT software has decreased the artifact-related limitations, improving evaluation [50-52]. Furthermore, dual-energy ... | Imaging After Shoulder Arthroplasty PCAs. Imaging After Shoulder Arthroplasty Image degradation can occur because of beam hardening artifact and other hardware-related artifacts, especially with older CT scanners. The use of newer metal reduction CT software has decreased the artifact-related limitations, improving eva... | 3097049 |
acrac_3097049_16 | Imaging After Shoulder Arthroplasty PCAs | MRI Shoulder Evolving MRI methods with improved image quality and metal artifact reduction have rendered the modality a more feasible technique for the diagnosis of component loosening, rotator cuff tearing, and, in the presence of hemiarthroplasty, glenoid cartilage wear [37-39,58]. Because of developments in metal re... | Imaging After Shoulder Arthroplasty PCAs. MRI Shoulder Evolving MRI methods with improved image quality and metal artifact reduction have rendered the modality a more feasible technique for the diagnosis of component loosening, rotator cuff tearing, and, in the presence of hemiarthroplasty, glenoid cartilage wear [37-3... | 3097049 |
acrac_3097049_17 | Imaging After Shoulder Arthroplasty PCAs | The presence and degree of fatty muscle replacement can also be used as an indirect sign of a rotator cuff tear [60,61]. Administration of IV contrast does not improve evaluation. CT Shoulder The inherent limited tissue-contrast resolution of CT detracts from its ability to detect rotator cuff tears. CT shows promise i... | Imaging After Shoulder Arthroplasty PCAs. The presence and degree of fatty muscle replacement can also be used as an indirect sign of a rotator cuff tear [60,61]. Administration of IV contrast does not improve evaluation. CT Shoulder The inherent limited tissue-contrast resolution of CT detracts from its ability to det... | 3097049 |
acrac_69502_0 | Sinonasal Disease | Introduction/Background According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the term rhinosinusitis refers to symptomatic inflammation of the nasal cavity and paranasal sinuses and is preferred over the term sinusitis, because inflammation of the nasal cavity nearly always accompanies ... | Sinonasal Disease. Introduction/Background According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), the term rhinosinusitis refers to symptomatic inflammation of the nasal cavity and paranasal sinuses and is preferred over the term sinusitis, because inflammation of the nasal cavity nearly ... | 69502 |
acrac_69502_1 | Sinonasal Disease | Patients with a sinonasal mass may present with nasal congestion, nasal fullness, anosmia, rhinorrhea, and epistaxis [8,9]. Benign lesions include papilloma, respiratory epithelial adenomatoid hamartoma, pleomorphic adenoma, juvenile nasopharyngeal angiofibroma, nerve sheath tumor, and meningioma [7,8]. The most common... | Sinonasal Disease. Patients with a sinonasal mass may present with nasal congestion, nasal fullness, anosmia, rhinorrhea, and epistaxis [8,9]. Benign lesions include papilloma, respiratory epithelial adenomatoid hamartoma, pleomorphic adenoma, juvenile nasopharyngeal angiofibroma, nerve sheath tumor, and meningioma [7,... | 69502 |
acrac_69502_2 | Sinonasal Disease | Reprint requests to: publications@acr.org Arteriography Craniofacial There is no relevant literature to support the use of arteriography in the evaluation of acute uncomplicated rhinosinusitis. CT Cone Beam Paranasal Sinuses As per clinical practice guidelines from the AAO-HNS, CT imaging of the sinuses is unnecessary ... | Sinonasal Disease. Reprint requests to: publications@acr.org Arteriography Craniofacial There is no relevant literature to support the use of arteriography in the evaluation of acute uncomplicated rhinosinusitis. CT Cone Beam Paranasal Sinuses As per clinical practice guidelines from the AAO-HNS, CT imaging of the sinu... | 69502 |
acrac_69502_3 | Sinonasal Disease | MRI Orbits, Face, and Neck As per clinical practice guidelines from the AAO-HNS, imaging is unnecessary for patients with a clinical diagnosis of ARS [1]. There is no relevant literature to support the use of MRI of the orbits, face, and neck in the evaluation of acute uncomplicated rhinosinusitis. Radiography Paranasa... | Sinonasal Disease. MRI Orbits, Face, and Neck As per clinical practice guidelines from the AAO-HNS, imaging is unnecessary for patients with a clinical diagnosis of ARS [1]. There is no relevant literature to support the use of MRI of the orbits, face, and neck in the evaluation of acute uncomplicated rhinosinusitis. R... | 69502 |
acrac_69502_4 | Sinonasal Disease | Vascular complications include cavernous sinus thrombosis and rarely pseudoaneurysm formation [2,24]. Arteriography Craniofacial Arteriography may be performed for the evaluation of a pseudoaneurysm, although this would not be performed in the initial imaging evaluation. There is no relevant literature to support the u... | Sinonasal Disease. Vascular complications include cavernous sinus thrombosis and rarely pseudoaneurysm formation [2,24]. Arteriography Craniofacial Arteriography may be performed for the evaluation of a pseudoaneurysm, although this would not be performed in the initial imaging evaluation. There is no relevant literatu... | 69502 |
acrac_69502_5 | Sinonasal Disease | Given its detailed depiction of bony anatomy, CT can also accurately demonstrate the presence of erosions of the sinus and orbital walls. Studies have demonstrated a higher accuracy of CT compared with clinical examination for detecting orbital complications, with an accuracy of 87% to 91% [23]. CT also enables surgica... | Sinonasal Disease. Given its detailed depiction of bony anatomy, CT can also accurately demonstrate the presence of erosions of the sinus and orbital walls. Studies have demonstrated a higher accuracy of CT compared with clinical examination for detecting orbital complications, with an accuracy of 87% to 91% [23]. CT a... | 69502 |
acrac_69502_6 | Sinonasal Disease | Combined pre- and postcontrast imaging provides the best opportunity to identify and characterize potential intracranial complications. Restricted diffusion on diffusion- weighted sequences can accurately identify the presence of purulent material within extra-axial collections and brain abscesses. MRI Orbits, Face, an... | Sinonasal Disease. Combined pre- and postcontrast imaging provides the best opportunity to identify and characterize potential intracranial complications. Restricted diffusion on diffusion- weighted sequences can accurately identify the presence of purulent material within extra-axial collections and brain abscesses. M... | 69502 |
acrac_69502_7 | Sinonasal Disease | The presence of 2 or more of these symptoms for >12 weeks is highly sensitive for the diagnosis of CRS, but because these symptoms are nonspecific, documentation of inflammation on endoscopy or imaging is required to confirm the diagnosis [26]. Imaging findings that confirm CRS include mucosal thickening, sinus opacifi... | Sinonasal Disease. The presence of 2 or more of these symptoms for >12 weeks is highly sensitive for the diagnosis of CRS, but because these symptoms are nonspecific, documentation of inflammation on endoscopy or imaging is required to confirm the diagnosis [26]. Imaging findings that confirm CRS include mucosal thicke... | 69502 |
acrac_69502_8 | Sinonasal Disease | Similar to standard multidetector CT, CBCT can confirm the diagnosis of CRS and identify anatomic variants for presurgical planning. One study showed decreased detection of intrasinus calcifications in patients with noninvasive fungal sinusitis compared with multidetector CT, although comparison between the 2 modalitie... | Sinonasal Disease. Similar to standard multidetector CT, CBCT can confirm the diagnosis of CRS and identify anatomic variants for presurgical planning. One study showed decreased detection of intrasinus calcifications in patients with noninvasive fungal sinusitis compared with multidetector CT, although comparison betw... | 69502 |
acrac_69502_9 | Sinonasal Disease | Contrast-enhanced CT is not necessary to demonstrate findings of CRS or for surgical planning of paranasal sinus inflammatory disease. There is no relevant literature to support the use of combined pre- and postcontrast CT imaging. Silent sinus syndrome is atelectasis of the maxillary sinus due to intrasinus negative p... | Sinonasal Disease. Contrast-enhanced CT is not necessary to demonstrate findings of CRS or for surgical planning of paranasal sinus inflammatory disease. There is no relevant literature to support the use of combined pre- and postcontrast CT imaging. Silent sinus syndrome is atelectasis of the maxillary sinus due to in... | 69502 |
acrac_69502_10 | Sinonasal Disease | MRI Orbits, Face, and Neck MRI is not useful as the first-line study for routine sinus imaging because of the lack of bony detail. In addition, inspissated secretions may demonstrate a signal void that mimics air on T2-weighted sequences [39]. However, one study examined 89 adult patients imaged with both CT and MRI wi... | Sinonasal Disease. MRI Orbits, Face, and Neck MRI is not useful as the first-line study for routine sinus imaging because of the lack of bony detail. In addition, inspissated secretions may demonstrate a signal void that mimics air on T2-weighted sequences [39]. However, one study examined 89 adult patients imaged with... | 69502 |
acrac_69502_11 | Sinonasal Disease | Affected patients are typically immunocompromised and include patients with neutropenia, hematologic malignancies, poorly controlled diabetes, acquired immunodeficiency syndrome, and organ transplantation and patients on immunosuppressive therapy including systemic steroids and chemotherapy [4,5]. Aspergillus and Mucor... | Sinonasal Disease. Affected patients are typically immunocompromised and include patients with neutropenia, hematologic malignancies, poorly controlled diabetes, acquired immunodeficiency syndrome, and organ transplantation and patients on immunosuppressive therapy including systemic steroids and chemotherapy [4,5]. As... | 69502 |
acrac_69502_12 | Sinonasal Disease | There is no relevant literature to support the use of noncontrast CT head or combined pre- and postcontrast CT imaging. CT Maxillofacial Noncontrast CT is effective in the evaluation of fungal sinusitis because it can demonstrate hyperattenuation in the involved sinus, bony erosions, and infiltration of the surrounding... | Sinonasal Disease. There is no relevant literature to support the use of noncontrast CT head or combined pre- and postcontrast CT imaging. CT Maxillofacial Noncontrast CT is effective in the evaluation of fungal sinusitis because it can demonstrate hyperattenuation in the involved sinus, bony erosions, and infiltration... | 69502 |
acrac_69502_13 | Sinonasal Disease | There is no relevant literature to support the use of CTA head in the initial evaluation of suspected acute invasive fungal sinusitis. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT in the evaluation of acute invasive fungal sinusitis. MRA Head MRA head may be perfor... | Sinonasal Disease. There is no relevant literature to support the use of CTA head in the initial evaluation of suspected acute invasive fungal sinusitis. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of FDG-PET/CT in the evaluation of acute invasive fungal sinusitis. MRA Head MRA... | 69502 |
acrac_69502_14 | Sinonasal Disease | In a study from Korea evaluating 23 patients with acute invasive fungal rhinosinusitis, extrasinonasal extension was demonstrated in all cases on MRI, with orbital extension in 65%; lack of contrast enhancement was seen in 48% of patients and was found to be a prognostic factor for disease-specific mortality [46]. Alth... | Sinonasal Disease. In a study from Korea evaluating 23 patients with acute invasive fungal rhinosinusitis, extrasinonasal extension was demonstrated in all cases on MRI, with orbital extension in 65%; lack of contrast enhancement was seen in 48% of patients and was found to be a prognostic factor for disease-specific m... | 69502 |
acrac_69502_15 | Sinonasal Disease | The main role of imaging in these cases is to delineate the extent of disease for treatment planning. Arteriography Craniofacial Catheter angiography is typically not useful in the initial imaging evaluation of a sinonasal mass. It may be useful for preoperative planning, preoperative embolization of a vascular mass, o... | Sinonasal Disease. The main role of imaging in these cases is to delineate the extent of disease for treatment planning. Arteriography Craniofacial Catheter angiography is typically not useful in the initial imaging evaluation of a sinonasal mass. It may be useful for preoperative planning, preoperative embolization of... | 69502 |
acrac_69502_16 | Sinonasal Disease | If an MRI is also planned or performed, the CT can be performed without IV contrast because the main purpose of the CT is to evaluate osseous involvement. Although MRI is superior for evaluating the soft tissues, contrast-enhanced CT can also be useful for evaluating the soft-tissue and intracranial extent of the mass ... | Sinonasal Disease. If an MRI is also planned or performed, the CT can be performed without IV contrast because the main purpose of the CT is to evaluate osseous involvement. Although MRI is superior for evaluating the soft tissues, contrast-enhanced CT can also be useful for evaluating the soft-tissue and intracranial ... | 69502 |
acrac_69502_17 | Sinonasal Disease | Decreased T2 signal and apparent diffusion coefficient correlate with increased cellularity of tumors [9]. Perfusion MRI can also potentially provide diagnostic information of sinonasal masses [52,53]. For tumor mapping, MRI is more helpful than CT for soft tissue contrast and can better distinguish tumors from the mor... | Sinonasal Disease. Decreased T2 signal and apparent diffusion coefficient correlate with increased cellularity of tumors [9]. Perfusion MRI can also potentially provide diagnostic information of sinonasal masses [52,53]. For tumor mapping, MRI is more helpful than CT for soft tissue contrast and can better distinguish ... | 69502 |
acrac_69502_18 | Sinonasal Disease | The primary limitation of CT cisternography is that the patient needs to have an active CSF leak at the time of this examination for the study to be potentially diagnostic. Studies comparing CT cisternography with MRI have demonstrated CT cisternography to have a lower sensitivity of 33% to 72% versus 67% to 93% for MR... | Sinonasal Disease. The primary limitation of CT cisternography is that the patient needs to have an active CSF leak at the time of this examination for the study to be potentially diagnostic. Studies comparing CT cisternography with MRI have demonstrated CT cisternography to have a lower sensitivity of 33% to 72% versu... | 69502 |
acrac_69502_19 | Sinonasal Disease | MRI Head MRI with the inclusion of heavily T2-weighted images is often referred to as an MR cisternogram and is considered the second choice of study and should be done only in conjunction with HRCT [12,55,61]. The heavily T2-weighted sequence covering the roof of the sinonasal cavity in the coronal plane can be includ... | Sinonasal Disease. MRI Head MRI with the inclusion of heavily T2-weighted images is often referred to as an MR cisternogram and is considered the second choice of study and should be done only in conjunction with HRCT [12,55,61]. The heavily T2-weighted sequence covering the roof of the sinonasal cavity in the coronal ... | 69502 |
acrac_69502_20 | Sinonasal Disease | The site of the CSF leak can be demonstrated on MRI with identification of CSF extending from the subarachnoid space into the sinonasal space with or without an associated cephalocele. Sensitivity of 56% to 94% and specificity of 57% to 100% have been reported for the identification of the site of the CSF leak [12- 14,... | Sinonasal Disease. The site of the CSF leak can be demonstrated on MRI with identification of CSF extending from the subarachnoid space into the sinonasal space with or without an associated cephalocele. Sensitivity of 56% to 94% and specificity of 57% to 100% have been reported for the identification of the site of th... | 69502 |
acrac_69339_0 | Staging of Colorectal Cancer | In patients with locally advanced rectal cancer (LARC), established risk factors for poorer outcomes include circumferential resection margin involvement, extramural depth of spread >5 mm, extramural vascular invasion (EMVI), mucinous phenotype, and poor response to chemoradiotherapy (CRT) [9,10]. Multiple studies hav... | Staging of Colorectal Cancer. In patients with locally advanced rectal cancer (LARC), established risk factors for poorer outcomes include circumferential resection margin involvement, extramural depth of spread >5 mm, extramural vascular invasion (EMVI), mucinous phenotype, and poor response to chemoradiotherapy (CRT... | 69339 |
acrac_69339_1 | Staging of Colorectal Cancer | pUniversity of California San Francisco, San Francisco, California. qEmory University, Atlanta, Georgia, Primary care physician. rSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the dev... | Staging of Colorectal Cancer. pUniversity of California San Francisco, San Francisco, California. qEmory University, Atlanta, Georgia, Primary care physician. rSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with ... | 69339 |
acrac_69339_2 | Staging of Colorectal Cancer | Special Imaging Considerations In rectal tumors, because of the need for high-resolution anatomic detail in determining local tumor extension, the local staging of the tumor is often considered separately from the evaluation of distant metastatic disease, resulting in the need for a combination of modalities to fully s... | Staging of Colorectal Cancer. Special Imaging Considerations In rectal tumors, because of the need for high-resolution anatomic detail in determining local tumor extension, the local staging of the tumor is often considered separately from the evaluation of distant metastatic disease, resulting in the need for a combin... | 69339 |
acrac_69339_3 | Staging of Colorectal Cancer | CT Colonography Virtual colonoscopy (or CT colonography) has proven to be a valid tool in identifying both primary and synchronous colonic lesions. Limited information is available regarding the performance of CT colonography for rectal cancer staging. In a study of 45 patients with low rectal adenocarcinomas, CT colon... | Staging of Colorectal Cancer. CT Colonography Virtual colonoscopy (or CT colonography) has proven to be a valid tool in identifying both primary and synchronous colonic lesions. Limited information is available regarding the performance of CT colonography for rectal cancer staging. In a study of 45 patients with low re... | 69339 |
acrac_69339_4 | Staging of Colorectal Cancer | In addition to initial staging prognostic features, MRI response to neoadjuvant treatment has been shown to be an indicator of long-term outcomes, including recurrence and survival [48-51]. Reduced field of view diffusion-weighted images (DWI) may demonstrate better image quality than full field of view DWIs [52]. For ... | Staging of Colorectal Cancer. In addition to initial staging prognostic features, MRI response to neoadjuvant treatment has been shown to be an indicator of long-term outcomes, including recurrence and survival [48-51]. Reduced field of view diffusion-weighted images (DWI) may demonstrate better image quality than full... | 69339 |
acrac_69339_5 | Staging of Colorectal Cancer | Evaluation of the extent of the tumor infiltration into the mesorectum (differentiating minimal from advanced T3 tumors and minimal T3 from T2 tumors) is of clinical interest in determining the need for neoadjuvant treatment but remains a challenge for TRUS [59,60]. Although TRUS performs better than MRI for T1 tumors,... | Staging of Colorectal Cancer. Evaluation of the extent of the tumor infiltration into the mesorectum (differentiating minimal from advanced T3 tumors and minimal T3 from T2 tumors) is of clinical interest in determining the need for neoadjuvant treatment but remains a challenge for TRUS [59,60]. Although TRUS performs ... | 69339 |
acrac_69339_6 | Staging of Colorectal Cancer | In early studies, accuracy of CT in predicting pathological T stage after radiotherapy was low (37%) but more accurate in the identification of involved circumferential resection margin (71%) [67]. Other studies demonstrated higher accuracy of T stage, up to 61% and CT correlation with pathologic tumor regression, with... | Staging of Colorectal Cancer. In early studies, accuracy of CT in predicting pathological T stage after radiotherapy was low (37%) but more accurate in the identification of involved circumferential resection margin (71%) [67]. Other studies demonstrated higher accuracy of T stage, up to 61% and CT correlation with pat... | 69339 |
acrac_69339_7 | Staging of Colorectal Cancer | FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has traditionally been used in initial staging of rectal cancer to further evaluate equivocal findings on CT/MRI, to definitively exclude extrahepatic metastatic disease before surgical resection/liver directed therapy, and to identify occult disease in patients with rising... | Staging of Colorectal Cancer. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT has traditionally been used in initial staging of rectal cancer to further evaluate equivocal findings on CT/MRI, to definitively exclude extrahepatic metastatic disease before surgical resection/liver directed therapy, and to identify occult d... | 69339 |
acrac_69339_8 | Staging of Colorectal Cancer | Although the absence of nodes at DWI is not a frequent finding, it appears to be a reliable predictor of yN0 status after CRT and may support the decision to consider organ-preservation treatment. Decreased lymph node size posttreatment is significantly associated with disease-free survival [103]. US Pelvis Transrectal... | Staging of Colorectal Cancer. Although the absence of nodes at DWI is not a frequent finding, it appears to be a reliable predictor of yN0 status after CRT and may support the decision to consider organ-preservation treatment. Decreased lymph node size posttreatment is significantly associated with disease-free surviva... | 69339 |
acrac_69339_9 | Staging of Colorectal Cancer | CT Chest, Abdomen, and Pelvis Most studies show comparable or improved sensitivity for detection of colorectal liver metastases with IV conventional extracellular gadolinium agent-enhanced MRI compared with CT [110,111]. Abdominal/pelvic CT with IV contrast has a high negative predictive value of 90% [112]. Detection o... | Staging of Colorectal Cancer. CT Chest, Abdomen, and Pelvis Most studies show comparable or improved sensitivity for detection of colorectal liver metastases with IV conventional extracellular gadolinium agent-enhanced MRI compared with CT [110,111]. Abdominal/pelvic CT with IV contrast has a high negative predictive v... | 69339 |
acrac_69339_10 | Staging of Colorectal Cancer | PET/CT is useful for determining overall stage and identifying patients with metastatic disease (sensitivity of 89% and specificity of 64%); however, the accuracy on a lesion-by-lesion basis is relatively low compared with contrast- enhanced CT and MRI for liver metastases (55% versus 89% in a study comparing PET/CT to... | Staging of Colorectal Cancer. PET/CT is useful for determining overall stage and identifying patients with metastatic disease (sensitivity of 89% and specificity of 64%); however, the accuracy on a lesion-by-lesion basis is relatively low compared with contrast- enhanced CT and MRI for liver metastases (55% versus 89% ... | 69339 |
acrac_71095_0 | Suspected Pulmonary Hypertension | Diagnosis of PH remains challenging because of the diverse group of diseases that can cause PH as well as its nonspecific symptoms. Signs and symptoms of PH include dyspnea, fatigue, palpitations, angina, peripheral edema, hepatomegaly, ascites, syncope, and, rarely, unilateral vocal cord paralysis [4,10]. A careful h... | Suspected Pulmonary Hypertension. Diagnosis of PH remains challenging because of the diverse group of diseases that can cause PH as well as its nonspecific symptoms. Signs and symptoms of PH include dyspnea, fatigue, palpitations, angina, peripheral edema, hepatomegaly, ascites, syncope, and, rarely, unilateral vocal ... | 71095 |
acrac_71095_1 | Suspected Pulmonary Hypertension | Multiple historic studies have shown that chest radiography is a useful study in the initial evaluation of PH [13-19]. Miniati et al [20] found that chest radiography has a high sensitivity (96.9%) and specificity (99.1%) for detection of moderate to severe PH. Additionally, chest radiography can show findings of diffu... | Suspected Pulmonary Hypertension. Multiple historic studies have shown that chest radiography is a useful study in the initial evaluation of PH [13-19]. Miniati et al [20] found that chest radiography has a high sensitivity (96.9%) and specificity (99.1%) for detection of moderate to severe PH. Additionally, chest radi... | 71095 |
acrac_71095_2 | Suspected Pulmonary Hypertension | US Echocardiography Transthoracic Resting Transthoracic Doppler echocardiography is a noninvasive test that is a useful part of the initial evaluation of suspected PH [22]. A recent meta-analysis by Ni et al [23] showed that, overall, it has good sensitivity and fair specificity (85% and 74%, respectively) for detectin... | Suspected Pulmonary Hypertension. US Echocardiography Transthoracic Resting Transthoracic Doppler echocardiography is a noninvasive test that is a useful part of the initial evaluation of suspected PH [22]. A recent meta-analysis by Ni et al [23] showed that, overall, it has good sensitivity and fair specificity (85% a... | 71095 |
acrac_71095_3 | Suspected Pulmonary Hypertension | In addition, pressure gradient-volume diagrams derived from 3-D echocardiography data can be used to reliably estimate RV stroke work in patients with PH [29]. Populations including those with a known genetic mutation associated with PAH, first degree relative with PAH, scleroderma spectrum, congenital heart disease, a... | Suspected Pulmonary Hypertension. In addition, pressure gradient-volume diagrams derived from 3-D echocardiography data can be used to reliably estimate RV stroke work in patients with PH [29]. Populations including those with a known genetic mutation associated with PAH, first degree relative with PAH, scleroderma spe... | 71095 |
acrac_71095_4 | Suspected Pulmonary Hypertension | This is comparable to a prior study by Tunariu et al [36], which found that V/Q scintigraphy was more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease amenable to surgery, with V/Q scans demonstrating a sensitivity of 96% to 97% and a specificity of 90% to 95% compared with a sens... | Suspected Pulmonary Hypertension. This is comparable to a prior study by Tunariu et al [36], which found that V/Q scintigraphy was more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease amenable to surgery, with V/Q scans demonstrating a sensitivity of 96% to 97% and a specificity ... | 71095 |
acrac_71095_5 | Suspected Pulmonary Hypertension | In addition to demonstrating findings suggestive of PH, chest CT can also characterize various pulmonary etiologies that cause PH, including IPAH, pulmonary capillary hemangiomatosis (PCH), pulmonary veno-occlusive disease (PVOD), and many diffuse lung diseases. IPAH is characterized by plexiform lesions, which are net... | Suspected Pulmonary Hypertension. In addition to demonstrating findings suggestive of PH, chest CT can also characterize various pulmonary etiologies that cause PH, including IPAH, pulmonary capillary hemangiomatosis (PCH), pulmonary veno-occlusive disease (PVOD), and many diffuse lung diseases. IPAH is characterized b... | 71095 |
acrac_71095_6 | Suspected Pulmonary Hypertension | RV functional abnormalities secondary to PH-related cardiac remodeling include RV hypokinesis, leftward bowing and/or paradoxical movement of the interventricular septum, RV dysfunction (increased end-diastolic volume, reduced ejection fraction, reduced cardiac index, reduced stroke volume), and pulmonary and tricuspid... | Suspected Pulmonary Hypertension. RV functional abnormalities secondary to PH-related cardiac remodeling include RV hypokinesis, leftward bowing and/or paradoxical movement of the interventricular septum, RV dysfunction (increased end-diastolic volume, reduced ejection fraction, reduced cardiac index, reduced stroke vo... | 71095 |
acrac_71095_7 | Suspected Pulmonary Hypertension | More recently, 4-D flow has been used to assess the MPA and detect the hemodynamic alterations that occur with PH: decreased wall shear stress, increased tricuspid regurgitation velocity, and abnormal vortex blood flow pattern within the MPA that is associated with early-onset systolic retrograde flow [65,72-74]. MRA C... | Suspected Pulmonary Hypertension. More recently, 4-D flow has been used to assess the MPA and detect the hemodynamic alterations that occur with PH: decreased wall shear stress, increased tricuspid regurgitation velocity, and abnormal vortex blood flow pattern within the MPA that is associated with early-onset systolic... | 71095 |
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