Clinical radiology
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Central venous catheters provide an important means of long-term vascular access in a variety of clinical situations. Catheter placement and evaluation is now forming an increasing part of the workload of interventional radiologists. ⋯ We outline the causes of catheter related problems and discuss the treatment options. We include examples of catheter malfunction resulting from malposition, displacement, kinking and occlusion.
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Peripherally inserted central catheters (PICCs) are an increasingly used means of medium to long-term intravenous access. We have established an ultrasound (US) guided PICC insertion service at our institution that has largely replaced blind bedside insertions. One hundred and six PICCs were inserted in the upper arms of 89 patients, over a 6-month period with a 100% success rate. ⋯ Catheter blockage, breakage and partial unintentional removal are potentially remediable complications using guide-wire techniques under fluoroscopic guidance. The management of catheter related infection is discussed. We have encouraged early communication with our clinical colleagues in order to facilitate the management of such complications and minimize unnecessary catheter removal.
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Clinical Trial
Percutaneous laser discectomy: MR findings within the first 24 hours after treatment and their relationship to clinical outcome.
The purpose of this study was to evaluate the early MR appearances of the intervertebral disc obtained within 24 h after percutaneous laser discectomy and to determine if a correlation exists between the MR images and the clinical outcome. ⋯ Although immediate postoperative MR imaging shows early tissue changes induced by laser, our study has not proven that immediate postoperative MR imaging could predict the clinical outcome after percutaneous laser discectomy.
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The aim of this study is to assess the ability of conventional lumbar spine magnetic resonance imaging (MRI) to demonstrate the pars interarticularis. The right and left L4 and L5 pars in 50 patients undergoing lumbar spine MRI for low back pain, with or without radiculopathy, were assessed and classified into four types. ⋯ The gold standard was set by the consensus opinion of two consultant musculoskeletal radiologists on the available plain radiographs of the lumbar spine. MRI was found to have a sensitivity of 57% to 86%, specificity of 81% to 82%, positive predictive value of 14% to 18% and negative predictive value of 97% to 99% for the diagnosis of a pars defect.
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Review
Pictorial review: magnetic resonance angiography of arterial variants at the Circle of Willis.
As intracranial MR angiography becomes more widely used and spatial resolution improves, anomalies at the Circle of Willis which have been previously well described on angiographic studies and anatomic dissections will become more frequently appreciated by MR angiography. Recognition of these variants is important to avoid confusion of the anomalies with aneurysms, evaluate collateral pathways in the intracerebral circulation, and enhance pre-operative planning in patients undergoing surgery at the skull base. In this review, we illustrate several of the more common types of anomalies at the Circle of Willis and discuss the possible clinical significance of each.