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Abstract No. 276: Gastrostomy to gastrojejunostomy tube conversion: Impact of the method of original gastrostomy placement
brachial index (ABI), six-minute walking test, four meter walking velocity (usual ⫹ fast speed), Short Form 12 (SF12) physical functioning score, Walking Impairment Questionnaire (WIQ) distance, speed, and stair climbing score were recorded. TR-MRA was performed using an echo sharing TWIST sequence on a 1.5T Siemens Espree MRI scanner. A single dose of Magnevist (gadopentetate dimeglumine, Berlex, NJ) was administered intravenously. Angiography images from one station, the groin to the knee, were acquired. Lesions were classified according to TASC II Classification, collateral vessels were counted and graded, arterio-venous transit time (AVTT) was calculated.
malposition, compared to 7.4% of radiologically placed GTs (p⫽0.01).
Results: Time resolved TWIST MRA was performed on 516 lower limbs, 12% (n⫽62) with TASC D lesions, 29% (n⫽148) with grade 3-4 collaterals, mean AVTT of 50.7 seconds. When the study population was divided based on TASC lesion severity (TASC 0,A versus TASC B,C,D), there is a significant difference in ABI (p⬍0.0001), WIQ distance score (p⫽0.0135) and WIQ speed score (p⫽0.0163). When the patients were divided based on collateral grade (grade 0,1,2 versus grade 3,4) there is a significant difference in ABI (p⬍0.0001), with a trend for WIQ climbing score (p⫽0.0707).
Evaluation of a real time MR-guided interactive navigation device D. Kim1, F.K. Wacker1, S. Valdeig1, B. Ferics2, E. Nevo2; 1 Johns Hopkins, Baltimore, MD; 2Robin Medical, Baltimore, MD.
Conclusion: Time resolved peripheral MRA lesion severity and collateral grade significantly correlates with lower limb functional impairment in patients with PAD. This noninvasive imaging technique can now potentially be reliably employed for PAD severity stratification. Abstract No. 276 Gastrostomy to gastrojejunostomy tube conversion: Impact of the method of original gastrostomy placement C.Y. Kim1, M. Miller1, A. Balius2, P. Suhocki1, T.P. Smith1; 1Duke University Medical Center, Durham, NC; 2Association of University Radiologists, Knoxville, TN. Purpose: To determine the success of gastrostomy tube (GT) to gastrojejunostomy tube (GJT) conversion based on the method of original gastrostomy tube placement.
Results: Of 124 GT to GJT conversions, 109 (87.9%) were successfully performed. One radiologically inserted GT (3.7%) demonstrated failure of conversion to a GJT. 14 conversion failures (14.4%) occurred for GTs originally placed non-radiologically (n⫽97) (p⫽0.19). A total of 18 cases (16.5%) of jejunal tip malposition occurred on follow up. Of these, four patients developed aspiration pneumonia (22%), which contributed to patient death in two. The incidence of jejunal tip malposition post-gastrostomy tube conversion was 3.8% for radiologically placed GTs compared to 20.5% with non-radiologically placed GTs (p⫽0.07). Overall, 32% of GTs placed non-radiologically resulted in either procedural failure or eventual jejunal tip
Abstract No. 277
Purpose: To evaluate the accuracy and usability of a sensor based navigation system for MR-guided punctures. Materials and Methods: The navigation system (EndoScout®, Robin Medical, Inc. Baltimore, MD) uses a sensor that determines location and orientation of a probe within the magnet using the MR gradient field. The sensor coils are embedded in a hand held device, which is attached to a probe. During imaging, the system acquires gradient signals in three dimensions, calculates a puncture trajectory, and overlays this trajectory on the MR scanner monitor. We used a biopsy phantom consisting of a square non-transparent gel. To mimic lesions within the phantom, plastic rings (14 mm x 2 mm) were used and embedded in the gel phantom at different locations. 20 real time MR-guided punctures aimed at the center of the rings were attempted using the interactive navigation system. As a comparison, we performed 20 real time MR-guided punctures without the navigation device. The duration of each puncture was recorded. After puncturing each target with a 20G 20 cm MR visible needle, images were obtained to determine the final position of the probe and the 3D distance from the ring center was calculated. Results: All targets were successfully punctured. The mean total error of the punctures using the navigation system was 4.56 ⫾ 1.8mm. Using the real time MR guidance alone yielded a mean total error of 3.78 ⫾ 1.0mm. The total puncture time was significantly longer without the navigation system, while the “skin” to target time was similar for both techniques. Conclusion: In our evaluation, the gradient based navigation system yielded a high technical accuracy by obtaining fast and exact needle placement within the targets. However, we did not observe a significant difference with regard to puncture precision between the two techniques. The shorter procedure time with the navigation system is based on two observations: finding the entry point is technically easy, and the graphical overlay of the puncture trajectory makes needle guidance more intuitive. We expect that this will become important as we further investigate which procedures will benefit most from using the real time MRguided interactive navigation system.
POSTER SESSIONS
Materials and Methods: 124 patients (age range 13-87 years; 72 males) underwent conversion of a primarily placed gastrostomy tube to a gastrojejunostomy tube at our institution over an 8 year interval. The method of original GT placement was radiologic (n⫽27), endoscopic (n⫽75), laparoscopic (n⫽2), or open surgery (n⫽20). The method of placement was correlated with the success rates of GT to GJT conversion, defined as successful placement of the jejunal portion of the catheter into either the 4th portion of the duodenum or into the proximal jejunum. Medical records and radiographic images were also reviewed to determine the incidence of proximal migration of the tip into the stomach.
Conclusion: Although successful gastrostomy tube to gastrojejunostomy tube conversion was accomplished with acceptable frequency regardless of the method of original gastrostomy tube placement, radiologically placed gastrostomy tubes demonstrate a significantly lower incidence of procedural failure or eventual jejunal tip malposition compared to non-radiologically inserted gastrostomy tubes.
Abstract No. 278 Evaluation of a newly developed basket thrombectomyfragmentation device in vitro J. Koizumi, T. Hashimoto, T. Fukushima, K. Myojin, Y. Nagata, R. Wray; Tokai University, Isehara, Japan. S105
malposition, compared to 7.4% of radiologically placed GTs (p⫽0.01).
Results: Time resolved TWIST MRA was performed on 516 lower limbs, 12% (n⫽62) with TASC D lesions, 29% (n⫽148) with grade 3-4 collaterals, mean AVTT of 50.7 seconds. When the study population was divided based on TASC lesion severity (TASC 0,A versus TASC B,C,D), there is a significant difference in ABI (p⬍0.0001), WIQ distance score (p⫽0.0135) and WIQ speed score (p⫽0.0163). When the patients were divided based on collateral grade (grade 0,1,2 versus grade 3,4) there is a significant difference in ABI (p⬍0.0001), with a trend for WIQ climbing score (p⫽0.0707).
Evaluation of a real time MR-guided interactive navigation device D. Kim1, F.K. Wacker1, S. Valdeig1, B. Ferics2, E. Nevo2; 1 Johns Hopkins, Baltimore, MD; 2Robin Medical, Baltimore, MD.
Conclusion: Time resolved peripheral MRA lesion severity and collateral grade significantly correlates with lower limb functional impairment in patients with PAD. This noninvasive imaging technique can now potentially be reliably employed for PAD severity stratification. Abstract No. 276 Gastrostomy to gastrojejunostomy tube conversion: Impact of the method of original gastrostomy placement C.Y. Kim1, M. Miller1, A. Balius2, P. Suhocki1, T.P. Smith1; 1Duke University Medical Center, Durham, NC; 2Association of University Radiologists, Knoxville, TN. Purpose: To determine the success of gastrostomy tube (GT) to gastrojejunostomy tube (GJT) conversion based on the method of original gastrostomy tube placement.
Results: Of 124 GT to GJT conversions, 109 (87.9%) were successfully performed. One radiologically inserted GT (3.7%) demonstrated failure of conversion to a GJT. 14 conversion failures (14.4%) occurred for GTs originally placed non-radiologically (n⫽97) (p⫽0.19). A total of 18 cases (16.5%) of jejunal tip malposition occurred on follow up. Of these, four patients developed aspiration pneumonia (22%), which contributed to patient death in two. The incidence of jejunal tip malposition post-gastrostomy tube conversion was 3.8% for radiologically placed GTs compared to 20.5% with non-radiologically placed GTs (p⫽0.07). Overall, 32% of GTs placed non-radiologically resulted in either procedural failure or eventual jejunal tip
Abstract No. 277
Purpose: To evaluate the accuracy and usability of a sensor based navigation system for MR-guided punctures. Materials and Methods: The navigation system (EndoScout®, Robin Medical, Inc. Baltimore, MD) uses a sensor that determines location and orientation of a probe within the magnet using the MR gradient field. The sensor coils are embedded in a hand held device, which is attached to a probe. During imaging, the system acquires gradient signals in three dimensions, calculates a puncture trajectory, and overlays this trajectory on the MR scanner monitor. We used a biopsy phantom consisting of a square non-transparent gel. To mimic lesions within the phantom, plastic rings (14 mm x 2 mm) were used and embedded in the gel phantom at different locations. 20 real time MR-guided punctures aimed at the center of the rings were attempted using the interactive navigation system. As a comparison, we performed 20 real time MR-guided punctures without the navigation device. The duration of each puncture was recorded. After puncturing each target with a 20G 20 cm MR visible needle, images were obtained to determine the final position of the probe and the 3D distance from the ring center was calculated. Results: All targets were successfully punctured. The mean total error of the punctures using the navigation system was 4.56 ⫾ 1.8mm. Using the real time MR guidance alone yielded a mean total error of 3.78 ⫾ 1.0mm. The total puncture time was significantly longer without the navigation system, while the “skin” to target time was similar for both techniques. Conclusion: In our evaluation, the gradient based navigation system yielded a high technical accuracy by obtaining fast and exact needle placement within the targets. However, we did not observe a significant difference with regard to puncture precision between the two techniques. The shorter procedure time with the navigation system is based on two observations: finding the entry point is technically easy, and the graphical overlay of the puncture trajectory makes needle guidance more intuitive. We expect that this will become important as we further investigate which procedures will benefit most from using the real time MRguided interactive navigation system.
POSTER SESSIONS
Materials and Methods: 124 patients (age range 13-87 years; 72 males) underwent conversion of a primarily placed gastrostomy tube to a gastrojejunostomy tube at our institution over an 8 year interval. The method of original GT placement was radiologic (n⫽27), endoscopic (n⫽75), laparoscopic (n⫽2), or open surgery (n⫽20). The method of placement was correlated with the success rates of GT to GJT conversion, defined as successful placement of the jejunal portion of the catheter into either the 4th portion of the duodenum or into the proximal jejunum. Medical records and radiographic images were also reviewed to determine the incidence of proximal migration of the tip into the stomach.
Conclusion: Although successful gastrostomy tube to gastrojejunostomy tube conversion was accomplished with acceptable frequency regardless of the method of original gastrostomy tube placement, radiologically placed gastrostomy tubes demonstrate a significantly lower incidence of procedural failure or eventual jejunal tip malposition compared to non-radiologically inserted gastrostomy tubes.
Abstract No. 278 Evaluation of a newly developed basket thrombectomyfragmentation device in vitro J. Koizumi, T. Hashimoto, T. Fukushima, K. Myojin, Y. Nagata, R. Wray; Tokai University, Isehara, Japan. S105