Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Genitourinary and Gastrointestinal Interventional Radiology

1 List the indications for percutaneous nephrostomy (PCN) ( Figure 73-1 ). To relieve obstruction in the setting of infection or to preserve renal function. To assist in the removal of a calculus or foreign body. To divert urine to permit healing of a leak or fistula. To provide access for ureteral intervention. 2 What is the indication for emergent PCN? Pyonephrosis (infected urinary obstruction) may…

Biliary and Portal Venous Interventions

1 What are the indications for percutaneous transhepatic biliary drainage? Percutaneous biliary drainage is indicated for the treatment of cholangitis or pruritus related to hyperbilirubinemia in the setting of benign or malignant obstructive biliary disease. Biliary drainage may also be performed in the setting of a traumatic bile leak to help divert bile and promote healing of the injured duct. Generally, percutaneous drainage is indicated only…

Embolization Techniques and Applications

1 Describe embolotherapy and some of its indications. Embolotherapy is temporary or permanent vascular occlusion induced by the intravascular administration of materials via a percutaneous route. Embolization has various clinical applications, including control of bleeding; treatment of vascular malformations; and tumor or organ ablation for curative, palliative, or preoperative purposes. 2 What materials are most commonly used for embolization? Various embolic materials are commercially available. The…

Peripheral Arterial Disease Diagnosis and Intervention

1 What is the appropriate landmark for a femoral artery puncture? Some risks of arteriography can be minimized by properly selecting the puncture site. Above the inguinal canal, the common femoral artery becomes the external iliac artery and dives posteriorly. Punctures above the inguinal canal may be problematic for several reasons. Because the artery is deep in relation to the puncture site, manual compression may be…

Advanced Procedures in Interventional Radiology

Endovascular Aneurysm Repair (EVAR) 1 What is the basic composition of a stent graft? A stent graft is composed of a metallic stent structure covered by a medical-grade fabric. The stents are typically made from stainless steel or nitinol (nickel titanium alloy), and the fabric is either Dacron (polyester) or expanded polytetrafluoroethylene (ePTFE). A stent graft comes compressed and loaded in a delivery catheter. Stent graft…

Image-Guided Percutaneous Needle Biopsy

1 What are the major indications for image-guided percutaneous needle biopsy? Image-guided percutaneous needle biopsy (IPNB) is an established, effective nonsurgical procedure that is performed in selected patients to obtain a pathologic diagnosis or to guide appropriate patient management. Indications for percutaneous needle biopsy include: To determine if a lesion is benign or malignant. To obtain material for microbiological analysis in suspected infection. To stage disease…

Inferior Vena Cava Filters

1 What is an inferior vena cava (IVC) filter? An IVC filter is a device inserted percutaneously into the IVC designed to prevent pulmonary emboli (PE) originating from lower extremity deep vein thrombosis (DVT) and to maintain caval patency. 2 What are some common indications for IVC filter placement? For patients with lower extremity DVT, accepted indications include: A contraindication to anticoagulation. Recurrent thromboembolic disease despite…

Equipment, Terms, and Techniques in Interventional Radiology

1 What are the characteristics of a diagnostic catheter? Catheters may be selected for a specific application based on many characteristics ( Figure 66-1 ). Although there are numerous catheters, experience and personal preference play a large role in the selection process. Length: Catheters are available in various lengths, the most common being 65 cm and 100 cm. The appropriate length is based on the access…

Patient Sedation and Pain Management

1 What is the purpose of sedation and pain management during an interventional radiology procedure? The purpose is to enable a patient to tolerate a potentially painful procedure yet still maintain satisfactory cardiopulmonary function and the ability to cooperate with verbal commands and tactile stimuli. 2 What is the difference between analgesia and anesthesia? Analgesia is the relief of pain without alteration of a patient's state…

Vascular Ultrasonography

1 List some of the most common indications for vascular ultrasonography (US). Vascular ultrasound is commonly used to evaluate the following: Extremity deep venous thrombosis. Carotid artery stenosis. Abdominal aortic aneurysm. Renal artery stenosis. Hepatic vasculature in the setting of cirrhosis and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Pseudoaneurysm and arteriovenous fistula. 2 How is vascular flow assessed with US? Flow within vessels is detected…

Musculoskeletal Ultrasonography

1 What are some benefits of ultrasonography (US) for musculoskeletal applications? There are multiple benefits and unique advantages that US offers in musculoskeletal imaging. US does not involve the use of ionizing radiation, which is especially attractive when imaging pediatric and pregnant patients, and there are no absolute contraindications to diagnostic US. In addition, US has a higher spatial tissue resolution than magnetic resonance imaging (MRI)…

Abdominal Ultrasonography

1 List some of the most common indications for abdominal ultrasonography (US). Abdominal, flank, and/or back pain. Abnormal laboratory values (e.g., abnormal liver function tests). Palpable abdominal mass. Signs or symptoms referred from abdomen (e.g., jaundice or hematuria). 2 What is the sonographic appearance of the liver? The liver is normally homogeneous in echotexture, equal to or slightly more echogenic than the renal cortex, and hypoechoic…

Neck Ultrasonography

1 What is the basic normal anatomy and sonographic imaging appearance of the thyroid gland? The thyroid gland is a butterfly-shaped organ located in the anterior neck, just below the thyroid cartilage and anterior to the trachea. It extends posteriorly to the esophagus and laterally to the carotid sheath, and consists of two lateral conically shaped lobes and the isthmus, a narrow band of midline tissue…

Advanced Fetal Ultrasonography and Therapy

1 What is a “level II” obstetric ultrasound examination, and what elements of fetal anatomy are included? A level II obstetric ultrasound examination is a comprehensive real-time ultrasonography (US) evaluation of fetal anatomy to detect fetal anomalies, whereas a level I obstetric ultrasound is a more general evaluation to detect obstetric problems. For the elements of fetal anatomy that are included in a level II obstetric…

Obstetric Ultrasonography in the Second Trimester

1 What are the indications for obstetric ultrasonography (US) in the second (and third) trimester? There are numerous indications for US imaging in the second (and third) trimester, the most common ones including screening evaluation of fetal anatomy; screening for fetal anomalies; estimation of gestational age; and evaluation of fetal growth, fetal well-being, fetal presentation, cervical insufficiency, amniotic fluid status, placental location, and vaginal bleeding. In…

Obstetric Ultrasonography in the First Trimester

1 What are the indications for ultrasonography (US) in the first trimester? First-trimester US is commonly performed for both symptomatic and asymptomatic pregnant patients for a variety of reasons, including: Confirmation, dating, and assessing viability of an intrauterine pregnancy, especially when the last menstrual date is uncertain. Evaluating the etiology of vaginal bleeding, pelvic pain, or a pelvic mass. Measuring embryonic nuchal translucency (NT) as part…

MRI of the Foot and Ankle

1 What are the compartments of the ankle joint, and what structures do they contain? The ankle joint contains four compartments: Anterior, medial, lateral, and posterior. Anterior compartment: From medial to lateral, the anterior compartment contains the anterior t ibialis tendon, extensor h allucis longus tendon, peroneal nerve, dorsalis pedis artery, and extensor d igitorum longus tendon. The tendons in the anterior compartment can be remembered…

MRI of the Knee

1 What sequences are typically included in a routine magnetic resonance imaging (MRI) examination of the knee? Routine knee MRI typically includes: Sagittal fat-suppressed proton density (PD)-weighted and fat-suppressed T2-weighted images. Coronal T1-weighted and fat-suppressed T2-weighted images. Axial fat-suppressed T2-weighted images. Please see Figure 56-1 for some normal knee anatomy on MRI. 2 Describe the clinical presentation of meniscal injury. What part of the meniscus is…

MRI of the Hip

1 What is the basic normal anatomy of the hip? The hip is a ball-and-socket joint formed by the femoral head and the acetabulum, providing a large range of multidirectional motion. The acetabulum is tilted anteriorly, allowing a greater degree of flexion than extension. It covers 40% of the femoral head, and its depth is increased by the acetabular labrum, a horseshoe-shaped fibrocartilagenous structure covering the…

MRI of the Hand and Wrist

1 What are some common indications for performing magnetic resonance imaging (MRI) of the hand and wrist? MRI of the wrist is routinely used to assess a wide variety of osseous and soft tissues abnormalities, including radiographically occult fractures; tendon, ligament, or cartilage injuries; tunnel syndromes; palpable abnormalities; and wrist pain. This chapter will concentrate predominantly on MRI of the wrist. MRI of the hand is…