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04-22 Transjugular intrahepatic portosystemic shunts: The Kansas university experience and a review of the literature
04-18 Creation of a Community-Wide Database for Dialysis Access Wael E. Saad, MD, University of Rochester Medical Center, Rochester, NY, David L. Waldman, MD, PhD, David Lee, MD, Rodolfo Queiroz, MD Purpose: To create a point-of-service community-wide dialysis access database. Materials and Methods: Microsoft Access was used to write a dialysis-specific database. The database is housed on the Department of Radiology server. The database operates over the University of Rochester intranet and is accessible from the interventional, dialysis, and transplant clinics and offices. The information collected includes current and historical data on all dialysis fistulae, grafts, and catheters. Information on function, interventions (surgical and radiological), and complications is also collected. Results: The database went on-line 45 days prior to this writing. There are 250 patients in the university dialysis system. There are currently 112 patients entered into the system. Complete patient accrual should occur within 3 months. Conclusion: An interdisciplinary approach to thalysis access can be achieved and may be necessary to deliver adequate patient care. Commitment from the involved services to collate historical and current data of access creation, function, and intervention should allow the implementation of sensible clinical pathways. 04-19 Prophylactic Antibiotic Use Prior to Biliary Tract Procedure in Liver Transplant Patient Kenny S. Yoo, MD, University of Rochester Medical Center, Rochester, NY, David L. Waldman, MD, PhD, David Lee. MD, Rodolfo Queiroz, MD, Wael E. Saad, MD Purpose: To evaluate prophylactic antibiotic administered in our liver transplant population prior to bdiary interventional procedures. Materials and Methods: Retrospective analysis was performed on 51 bile cultures obtained from liver transplant recipients from November 1994 through August 1999. Data were collected from the patient chart and transplant chart and through the computerized hospital database. Results: 51 separate bile cultures were performed in 36 liver transplant patients. More than one microorganism was cultured in 33 (65%) of the bile samples. 47 samples (92%) showed positive growth of 106 organisms. The most common organism which grew out from the bile culture was Enterococcus sp (19). Conclusion: Enterococcus is the most common organism seen in the biliary tree of our transplant population. The current practice of using cephalosporin prior to a biliary tract procedure is not appropriate for our immunocompromised liver transplant patients. As a result of this study, ampicillin sodium and sulbactam were chosen in consultation with the transplant pharmacist. Further study is needed to look at the differences in the complication rate. 04-20 Contrast-enhanced Ultrasound Angiography of Carotid Arteries in Human Subjects Scan Pinnell, MD, UCSD Medical Center, San Diego, CA, Yuko Kono, MD, Claude B. Sirlin, MD, Wade H. Wong, DO, Robert F. Mattrey, MD Purpose: Preclinical studies have shown the benefit of utilizing ultrasound (US) contrast-enhanced B mode to more accurately define the arterial lumen by delineating intimal thickening, plaque ulceration, and degree of stenosis. This study evaluates the use of contrast-enhanced US angiography in human subjects with carotid artery stenosis.
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Materials and Methods: The carotid arteries of 15 patients were scanned using B-mode US wideband harmonic imaging (Siemens Ultrasound). US contrast, Optison (Mallinckrodt Inc.. St Louis, MO), was used under a physician-sponsored IND in multiple doses of 1 to 3 ml. US angiograms and duplex sonograms were compared to x-ray angiograms done within one week. In 2 specimens, high-resolution ex vivo MRI was performed. Results: The percent stenosis measured on US and x-ray angiograms correlated strongly (r = 0.993). When patients were grouped by stenoses greater or lesser than 70% on x-ray angiography, US angiography was 100% sensitive and 93% specific, and duplex US was 82% sensitive and 87% specific. While duplex US only estimated the category of stenosis, US angiography also detected unsuspected wall irregularities, ulceration, and dissection. Conclusion: Contrast US angiography was comparable to x-ray angiography and superior to duplex US in assessing stenoses. It delineated plaque surface ulceration and identified a dissection that was missed using duplex sonography alone. 04-21 Uterine Fibroid Embolization: The Kansas University Experience and a Review of the Literature A. James Beyer III, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Julia A. Chapman, MD, Edward L. Siegel, MD Purpose: We reviewed our experience with as well as the available literature concerning fibroid embolization to determine the indications, results, and complications of this procedure. Materials and Methods: We reviewed the Kansas University Medical Center's Interventional Radiology Database to find all patients undergoing fibroid embolization at KUMC. The medical records of these patients, as well as the pertinent medical literature, were reviewed to determine the indications, complications, and short-term and longterm results of fibroid embolization. Results: Thirty-nine women underwent fibroid embolization at KUMC between January of 1997 and December of 1999. Our results and those in the literature suggest that bleeding and pelvic pain are the most common indication for the procedure. The procedure is technically successful in over 95% of patients. Complications include bleeding and infection at the arterial puncture site, contrast reaction, and postprocedural pain. Patients leave the hospital within 24 hours of the procedure's completion. Symptomatic relief of pelvic pain is achieved in 85-90% of patients. Follow-up with sonography and magnetic resonance imaging demonstrates an average reduction m fibroid size of 72%. Conclusion: Embolization provides a cost-effective, minimally invasive treatment for uterine fibroids. 04-22 Transjugular Intrahepatic Portosystemic Shunts: The Kansas University Experience and a Review of the Literature A. James Beyer HI, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Philip L. Johnson, MD, Edward L. Siegel, MD Purpose: We examined our experience with TIPS, as well as the available literature, to determine the indications for and the results and complications of TIPS placement. Materials and Methods: Kansas University Medical Center's Interventional Radiology Database was searched to produce a list of all patients undergoing TIPS at KUMC. The medical records for all of these patients were reviewed, as well as the pertinent medical literature, to determine the indications for TIPS, as well as the short-term and longterm results of the procedure and the expected complications.
Results: Between January 1994 and December 1999, 153 patients underwent TIPS placement at KUMC. In our series and other series from the literature, the most common indication for TIPS was portal hypertension with ascites or variceal hemorrhage. Initial TIPS placement is successful in 95% of patients. Complications of TIPS placement include hemorrhage, infection, contrast reaction, and, rarely, liver injury. The primary patency rate of TIPS one year after placement is as low as 55%. However, with careful sonographic follow-up and revision as necessary, secondary patency rates as high as 92% at two years can be obtained. Conclusion: TIPS provides an effective, minimally invasive treatment for portal hypertension which fails medical management.
05-23 Three-Year Experience with Exclusive Use of Speech Recognition in Radiology Oliver Esch, MD, University of Texas Medical Branch, Galveston, TX, Orhan S. Ozkan, MD, Babak Khademi, MD, Brian W. Goodacre, MD, Gerhard R. WiNch, MD. Eric vanSonnenberg, MD Purpose: We describe the implementation of and conversion to a continuous speech recognition (CSR) system in radiology. Materials and Methods: In four phases, 30 Speech Recognition Workstations were deployed throughout a large academic department (240,000 examinations/year). Changes in turnaround times and work flow were analyzed for both faculty and resident dictation, in all modalities. Results: Initial training was completed for 95% of radiologists after 6 months. Voluntary use of CSR grew steadily and is >98% since August 1999. Mean turnaround times decreased from 227 hours (1996) to 95 hours (1997) to 30 hours (1999) for faculty dictation and from 195 hours (1996) to 23 hours (1999) for resident dictation. Transcription staff was reduced from 9 to 1 FTE one year after implementation. Interruptions via calls from clinicians markedly decreased with rapid availability of reports; reports decreased in length. Conclusion: Introduction of a CSR system, even in the early phase, showed few if any technical problems and resulted in a massive decrease in turnaround time over three years. In spite of changes in dictation patterns, user acceptance was high and cost-benefit analysis favorable.
05-24 Web-based Quality Assurance Monitor Michael S. Valade, MD, University of Virghfia Health System, Charlottesville, VA, Spencer B. Gay, MD Purpose: Interpretation of chest radiographs is the single most frequent task performed by radiologists. A quality assurance monitor was developed to ensure that our cfinical faculty maintains a high level of expertise and consistency in this area. Materials and Methods: We developed a web site using Dreamweaver 2 by Macromedia. Images were selected from the University of Virginia caseload as representative examples and scanned using a Vidar film digitizer. Image enhancement was accomplished using Adobe Photoshop 5.5 and ImageReady. Results: The quality assurance monitor had previously been performed as a series of twenty cases placed in hard copy on a common rollerscope and graded using paper and pencil. This interacttve web site replaced that system with an infinitely expandable database of cases that can be viewed and scored on any computer at any time at the convenience of each faculty member. Conclusion: The quality assurance interactive web site was designed to make the chest radiography monitor self-sustainable, easy to update, and convenient to use.
05-25 Spectrum of MRI Findings Post Suboccipital Resection of Acoustic Schwannomas Vibha Agrawal, MD, Thomas Jefferson University, Philadelphia, PA, Vijay M. Rat, MD, Gregory Boger, MD, Thomas Wilcox, MD, William A. Buchheit, MD Purpose: To study a) postoperative enhancement in the internal auditory canal (IAC), labyrinth, and posterior cranial fossa, b) correlatton of cochlear enhancement with hearing loss, and c) changes due to packing material. Materials and Methods: We reviewed 52 MR studies of 42 patients following resection of acoustic schwannoma via the suboccopital approach. Patterns of IAC, dural, and labyrinthine enhancement were noted. Results: Enhancement patterns included linear, peripheral enhancement along the walls of the IAC in 32 patients (76%), masslike enhancement within the canal in 4 patients (9.5%), and nodular enhancement within the IAC in 7 patients (17%) and at the site of drilling in 6 patients (14%). Cochlear enhancement was seen in 22 patients (52%). Conclusion: Linear, peripheral enhancement within the IAC is the most common postoperative MR finding. Nodular enhancement at the site of IAC drilling along the posterior wall is within the expected spectrum. Masslike enhancement within the IAC warrants follow-up studies. Postoperative cochlear enhancement was encountered only in patients who did not have hearing preservation surgery and may be secondary to the surgical procedure. Among the packing materials used, dural and cerebellar enhancement was seen only with the use of hydroxyapatite bone cement.
05-26 Imaging Heavy Eye Syndrome Bruce H. Lin, MD, University of Chicago, Chicago, IL, Hwei Y. Lin, MD, Ai H. Wang, MD, PhD, Sundeep M. Nayak, MD Purpose: To describe the imaging characteristics and current role of imaging in the presurgical evaluation of a rare ophthalmologic condition manifested by high myopia and resmctive esotropia. Materials and Methods: Over a period of three years, four patients with long-standing high myopia presented to the ophthalmology clinic with unilateral or bilateral esodeviation. None had endocrine pathologies. All patients underwent examination by noncontrast cranial CT. Two of them underwent contrast-enhanced MR imaging of the brain. The results were crucial for presurgical planning. Results: CT examination of all patients revealed marked elongation in the longitudinal axis, characteristic deviation of the lens (esotropia), and compression of the lateral rectus muscle. These findings were confirmed on MRI. The appearance and measurements were important in determining the surgical treatment by ophthalmologists. Histologic evaluation of a rectus muscle revealed muscular atrophy and fibrosis. All patients underwent surgery including myotomies and partial resection of the medial and/or lateral rectus muscle(s). Pathology was available in one case. Conclusion: Heavy eye syndrome, while uncommonly reported, is gaining increasing recognition in the ophthalmology literature. Our experience in this small series indicates that ophthalmologists rely substantially on imaging for the evaluation and presurgical planning of this entity, and radiologists should be aware of its imaging findlngs to provide appropriate consultation.
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Materials and Methods: The carotid arteries of 15 patients were scanned using B-mode US wideband harmonic imaging (Siemens Ultrasound). US contrast, Optison (Mallinckrodt Inc.. St Louis, MO), was used under a physician-sponsored IND in multiple doses of 1 to 3 ml. US angiograms and duplex sonograms were compared to x-ray angiograms done within one week. In 2 specimens, high-resolution ex vivo MRI was performed. Results: The percent stenosis measured on US and x-ray angiograms correlated strongly (r = 0.993). When patients were grouped by stenoses greater or lesser than 70% on x-ray angiography, US angiography was 100% sensitive and 93% specific, and duplex US was 82% sensitive and 87% specific. While duplex US only estimated the category of stenosis, US angiography also detected unsuspected wall irregularities, ulceration, and dissection. Conclusion: Contrast US angiography was comparable to x-ray angiography and superior to duplex US in assessing stenoses. It delineated plaque surface ulceration and identified a dissection that was missed using duplex sonography alone. 04-21 Uterine Fibroid Embolization: The Kansas University Experience and a Review of the Literature A. James Beyer III, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Julia A. Chapman, MD, Edward L. Siegel, MD Purpose: We reviewed our experience with as well as the available literature concerning fibroid embolization to determine the indications, results, and complications of this procedure. Materials and Methods: We reviewed the Kansas University Medical Center's Interventional Radiology Database to find all patients undergoing fibroid embolization at KUMC. The medical records of these patients, as well as the pertinent medical literature, were reviewed to determine the indications, complications, and short-term and longterm results of fibroid embolization. Results: Thirty-nine women underwent fibroid embolization at KUMC between January of 1997 and December of 1999. Our results and those in the literature suggest that bleeding and pelvic pain are the most common indication for the procedure. The procedure is technically successful in over 95% of patients. Complications include bleeding and infection at the arterial puncture site, contrast reaction, and postprocedural pain. Patients leave the hospital within 24 hours of the procedure's completion. Symptomatic relief of pelvic pain is achieved in 85-90% of patients. Follow-up with sonography and magnetic resonance imaging demonstrates an average reduction m fibroid size of 72%. Conclusion: Embolization provides a cost-effective, minimally invasive treatment for uterine fibroids. 04-22 Transjugular Intrahepatic Portosystemic Shunts: The Kansas University Experience and a Review of the Literature A. James Beyer HI, MD, University of Kansas Medical Center, Kansas City, KS, Tim G. Raveill, MD, Philip L. Johnson, MD, Edward L. Siegel, MD Purpose: We examined our experience with TIPS, as well as the available literature, to determine the indications for and the results and complications of TIPS placement. Materials and Methods: Kansas University Medical Center's Interventional Radiology Database was searched to produce a list of all patients undergoing TIPS at KUMC. The medical records for all of these patients were reviewed, as well as the pertinent medical literature, to determine the indications for TIPS, as well as the short-term and longterm results of the procedure and the expected complications.
Results: Between January 1994 and December 1999, 153 patients underwent TIPS placement at KUMC. In our series and other series from the literature, the most common indication for TIPS was portal hypertension with ascites or variceal hemorrhage. Initial TIPS placement is successful in 95% of patients. Complications of TIPS placement include hemorrhage, infection, contrast reaction, and, rarely, liver injury. The primary patency rate of TIPS one year after placement is as low as 55%. However, with careful sonographic follow-up and revision as necessary, secondary patency rates as high as 92% at two years can be obtained. Conclusion: TIPS provides an effective, minimally invasive treatment for portal hypertension which fails medical management.
05-23 Three-Year Experience with Exclusive Use of Speech Recognition in Radiology Oliver Esch, MD, University of Texas Medical Branch, Galveston, TX, Orhan S. Ozkan, MD, Babak Khademi, MD, Brian W. Goodacre, MD, Gerhard R. WiNch, MD. Eric vanSonnenberg, MD Purpose: We describe the implementation of and conversion to a continuous speech recognition (CSR) system in radiology. Materials and Methods: In four phases, 30 Speech Recognition Workstations were deployed throughout a large academic department (240,000 examinations/year). Changes in turnaround times and work flow were analyzed for both faculty and resident dictation, in all modalities. Results: Initial training was completed for 95% of radiologists after 6 months. Voluntary use of CSR grew steadily and is >98% since August 1999. Mean turnaround times decreased from 227 hours (1996) to 95 hours (1997) to 30 hours (1999) for faculty dictation and from 195 hours (1996) to 23 hours (1999) for resident dictation. Transcription staff was reduced from 9 to 1 FTE one year after implementation. Interruptions via calls from clinicians markedly decreased with rapid availability of reports; reports decreased in length. Conclusion: Introduction of a CSR system, even in the early phase, showed few if any technical problems and resulted in a massive decrease in turnaround time over three years. In spite of changes in dictation patterns, user acceptance was high and cost-benefit analysis favorable.
05-24 Web-based Quality Assurance Monitor Michael S. Valade, MD, University of Virghfia Health System, Charlottesville, VA, Spencer B. Gay, MD Purpose: Interpretation of chest radiographs is the single most frequent task performed by radiologists. A quality assurance monitor was developed to ensure that our cfinical faculty maintains a high level of expertise and consistency in this area. Materials and Methods: We developed a web site using Dreamweaver 2 by Macromedia. Images were selected from the University of Virginia caseload as representative examples and scanned using a Vidar film digitizer. Image enhancement was accomplished using Adobe Photoshop 5.5 and ImageReady. Results: The quality assurance monitor had previously been performed as a series of twenty cases placed in hard copy on a common rollerscope and graded using paper and pencil. This interacttve web site replaced that system with an infinitely expandable database of cases that can be viewed and scored on any computer at any time at the convenience of each faculty member. Conclusion: The quality assurance interactive web site was designed to make the chest radiography monitor self-sustainable, easy to update, and convenient to use.
05-25 Spectrum of MRI Findings Post Suboccipital Resection of Acoustic Schwannomas Vibha Agrawal, MD, Thomas Jefferson University, Philadelphia, PA, Vijay M. Rat, MD, Gregory Boger, MD, Thomas Wilcox, MD, William A. Buchheit, MD Purpose: To study a) postoperative enhancement in the internal auditory canal (IAC), labyrinth, and posterior cranial fossa, b) correlatton of cochlear enhancement with hearing loss, and c) changes due to packing material. Materials and Methods: We reviewed 52 MR studies of 42 patients following resection of acoustic schwannoma via the suboccopital approach. Patterns of IAC, dural, and labyrinthine enhancement were noted. Results: Enhancement patterns included linear, peripheral enhancement along the walls of the IAC in 32 patients (76%), masslike enhancement within the canal in 4 patients (9.5%), and nodular enhancement within the IAC in 7 patients (17%) and at the site of drilling in 6 patients (14%). Cochlear enhancement was seen in 22 patients (52%). Conclusion: Linear, peripheral enhancement within the IAC is the most common postoperative MR finding. Nodular enhancement at the site of IAC drilling along the posterior wall is within the expected spectrum. Masslike enhancement within the IAC warrants follow-up studies. Postoperative cochlear enhancement was encountered only in patients who did not have hearing preservation surgery and may be secondary to the surgical procedure. Among the packing materials used, dural and cerebellar enhancement was seen only with the use of hydroxyapatite bone cement.
05-26 Imaging Heavy Eye Syndrome Bruce H. Lin, MD, University of Chicago, Chicago, IL, Hwei Y. Lin, MD, Ai H. Wang, MD, PhD, Sundeep M. Nayak, MD Purpose: To describe the imaging characteristics and current role of imaging in the presurgical evaluation of a rare ophthalmologic condition manifested by high myopia and resmctive esotropia. Materials and Methods: Over a period of three years, four patients with long-standing high myopia presented to the ophthalmology clinic with unilateral or bilateral esodeviation. None had endocrine pathologies. All patients underwent examination by noncontrast cranial CT. Two of them underwent contrast-enhanced MR imaging of the brain. The results were crucial for presurgical planning. Results: CT examination of all patients revealed marked elongation in the longitudinal axis, characteristic deviation of the lens (esotropia), and compression of the lateral rectus muscle. These findings were confirmed on MRI. The appearance and measurements were important in determining the surgical treatment by ophthalmologists. Histologic evaluation of a rectus muscle revealed muscular atrophy and fibrosis. All patients underwent surgery including myotomies and partial resection of the medial and/or lateral rectus muscle(s). Pathology was available in one case. Conclusion: Heavy eye syndrome, while uncommonly reported, is gaining increasing recognition in the ophthalmology literature. Our experience in this small series indicates that ophthalmologists rely substantially on imaging for the evaluation and presurgical planning of this entity, and radiologists should be aware of its imaging findlngs to provide appropriate consultation.
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