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St. Louis, MO, United States

Wallace A.N.,Mallinckrodt Institute of Radiology | Wallace A.N.,University of Washington | Dines J.N.,University of Washington
Stroke | Year: 2013

Background and Purpose-Patients suspected of having aneurysmal subarachnoid hemorrhage (SAH) are initially evaluated with noncontrast head computed tomography. If the computed tomography is negative, but clinical concern for SAH is high, a lumbar puncture with cerebrospinal fluid analysis is typically performed. The purpose of this study was to evaluate the accuracy of cerebrospinal fluid xanthochromia and erythrocytosis for aneurysmal SAH. Methods-Medical records of all patients who underwent catheter angiography at Barnes Jewish Hospital between July 2002 and April 2012 for clinical suspicion of a ruptured brain aneurysm after a negative computed tomography scan and a lumbar puncture suspicious for SAH were reviewed. The cerebrospinal fluid analysis results, angiographic findings, and outcomes of each case were recorded. Results-Fifty-seven patients were identified. Two angiographic lesions were identified in patients with xanthochromia (2/24 patients, ie, 8.3%), both of which were confirmed to have ruptured. The diagnostic yield in patients with nonclearing erythrocytosis and no xanthochromia was 6.3% (1/16 patients), although this lesion was not considered the source of SAH. Conclusions-Catheter angiography should be performed in patients with computed tomography negative but suspicious lumbar puncture, particularly in the presence of xanthochromia. The benefit of angiography in patients with erythrocytosis only is unclear and deserves future study. © 2013 American Heart Association, Inc.

Foltz G.,Mallinckrodt Institute of Radiology
Seminars in Interventional Radiology | Year: 2014

The liver is a common site of primary and secondary malignancies, often resulting in significant morbidity and mortality. Evaluating these patients in a multidisciplinary setting allows for optimal utilization of all oncologic therapies including surgery, radiation, systemic chemotherapy, transarterial therapies, and ablation. While surgical intervention often provides the best outcomes when treating most hepatic tumors, many patients are not surgical candidates due to extensive tumor burden, underlying liver disease, or other comorbid conditions. The evolution of imaging and ablation devices has allowed for the increased utilization of percutaneous ablation as definitive and palliative treatment of primary and metastatic hepatic malignancies. Ablation induces tumor necrosis by injection of chemicals (chemical ablation) or temperature modification (thermal ablation). The goal of this review is to provide an overview of different ablation techniques commonly used for hepatic malignancies, discuss the oncologic outcomes of these interventions, and outline the current indications, contraindications, and reported complications of these therapies. © 2014 by Thieme Medical Publishers, Inc.

Rubin D.A.,Mallinckrodt Institute of Radiology
American Journal of Roentgenology | Year: 2013

OBJECTIVE. Proponents of femoroacetabular impingement (FAI) now claim that FAI is an important risk factor for hip osteoarthritis and argue that early, aggressive treatment is indicated to stave off long-term complications. The result is more young patients undergoing corrective surgery; does the literature support these claims or has hype trumped reality? This article critically reviews these assertions together with the current scientific evidence that defends (or refutes) them. CONCLUSION. Each reader will need to weigh the evidence carefully when interpreting images or planning management for patients with possible FAI. © American Roentgen Ray Society.

Shenoy S.,Washington University in St. Louis | Darcy M.,Mallinckrodt Institute of Radiology
American Journal of Roentgenology | Year: 2013

OBJECTIVE. The rising prevalence of end-stage renal disease has resulted in increasing focus on delivery of vascular access care for hemodialysis. Duplex Doppler ultrasound, with its unique ability to reliably evaluate both structural and functional aspects of the peripheral vessels, is the preferred imaging modality for access planning and follow-up. CONCLUSION. This article will review how ultrasound is currently used to evaluate patients pre-, intra-, and postoperatively for vascular access. © American Roentgen Ray Society.

Rubin D.A.,Mallinckrodt Institute of Radiology
American Journal of Roentgenology | Year: 2012

OBJECTIVE. Hamstring injuries are common in sports. Although management and outcomes are sport specific, clinical evaluation alone is a poor guide for treatment planning and prognostication. Cross-sectional imaging has added value in these cases. CONCLUSION. Specifically, the location (tendon attachment, classic or intramuscular myotendinous junction, or extramuscular portion of the tendon), specific muscles involved, and anatomic extent are factors that can influence the immediate treatment, expected convalescent period, and risk of recurrence in these athletes. © American Roentgen Ray Society.

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