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Biomedical subjects

R F Dondelinger

Publications and source records attributed to R F Dondelinger.

At least 19 recordsLinked to original sources
PubMed2005

Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism.

BACKGROUND: Patients with acute pulmonary embolism (APE) present with a broad spectrum of prognoses. Computed tomographic pulmonary angiography (CTPA) has progressively been established as a first line test in the APE diagnostic algorithm, but estimation of short term prognosis by this method remains to be explored. METHODS: Eighty two patients admitted with APE were divided into three groups according to their clinical presentation: pulmonary infarction (n = 21), prominent dyspnoea (n = 29), and circulatory failure (n = 32). CTPA studies included assessment of both pulmonary obstruction index and right heart overload. Haemodynamic evaluation was based on systolic aortic blood pressure, heart rate, and systolic pulmonary arterial pressure obtained non-invasively by echocardiography at the time of diagnosis of pulmonary embolism. RESULTS: The mortality rate was 0%, 13.8% and 25% in the three groups, respectively. Neither the pulmonary obstruction index nor the pulmonary artery pressure could predict patient outcome. In contrast, a significant correlation with mortality was found using the systolic blood pressure (p<0.001) and heart rate (p<0.05), as well as from imaging parameters including right to left ventricle minor axis ratio (p<0.005), proximal superior vena cava diameter (p<0.001), azygos vein diameter (p<0.001), and presence of contrast regurgitation into the inferior vena cava (p = 0.001). Analysis from logistic regression aimed at testing for mortality prediction revealed true reclassification of 89% using radiological variables. CONCLUSION: These results suggest that CTPA quantification of right ventricular strain is an accurate predictor of in-hospital death related to pulmonary embolism.

Acute Disease↗
PubMed2003

[Benefits and limitations of mammography].

The literature on screening mammography provides ample opportunity for doubt (the sceptics) and dogma (the screening zealots), and can be interpreted to prove both benefit and harm. The benefit of mammography screening, if any, is modest and the balance between beneficial (potentially, a 20% relative reduction in breast cancer mortality with no significant benefit on all-cause mortality) and harmful (physical and psychological morbidity related to the 15-40% missed cancers and the 80-90% false-positive diagnoses) effects is still delicate. The mammogram alone is a modest weapon. Concurrent clinical breast examination is mandatory. Women that are concerned about breast cancer should be fully informed of the potential benefits and risks of screening mammography. These women should benefit from mammography with concurrent clinical breast examination, and possible whole-breast ultrasound in heterogeneously dense and extremely dense breast patterns.

Age Factors↗
PubMed2002

Traumatic injuries: radiological hemostatic intervention at admission.

Blunt trauma victims and selected patients with penetrating trauma are systematically investigated after resuscitation and hemodynamic stabilization with cross-sectional imaging. Computed tomography is a good predictor of the need for hemostatic arteriographic embolization, based on contrast medium extravasation observed on CT. In centers admitting polytrauma patients, the CT and angiography units should be installed together within the emergency environment. Trauma-dedicated interventional radiologists should be on call for optimal patient management. Posttraumatic retroperitoneal and pelvic bleeding is a primary indication for angiographic hemostasis, together with orthopedic fixation of pelvic bone fractures. Angiography should be carried out rapidly, before the patient decompensates for considerable blood loss. In patients with visceral bleeding, arterial embolization can obviate primary surgery or potentializes surgical intervention and contributes to changing hierarchy of injuries to be treated surgically. Failure to achieve primary hemostasis may occur according to the type of specific organ injury and coagulation and metabolic parameters of the patient. Postembolization complications are few and are usually non-life-threatening and rarely carry definitive sequelae.

Angiography↗
PubMed2002

Percutaneous stereotactic en bloc excision of nonpalpable breast carcinoma: a step in the direction of supraconservative surgery.

Recently, the advanced breast biopsy instrumentation (ABBI) system has been introduced as an alternative to conventional breast biopsy techniques. This study was prospectively conducted to evaluate the potential of the ABBI method in locoregional management of a consecutive series of patients with nonpalpable mammographically detected breast carcinomas. Sixty-one consecutive patients underwent an ABBI procedure as a first step before possible surgery for nonpalpable breast lesions that would in any case require complete excision. For the 27 patients in whom the ABBI biopsy revealed malignancy further surgery was recommended, including re-excision of the biopsy site and axillary dissection in cases of infiltrating carcinoma. We calculated the probabilities that the ABBI specimen would have tumor-free margins and that a definitely complete excision had been achieved as a function of the mammographic or pathological diameter of the cancer. For cancer with a pathological diameter less than 10 mm measured on the ABBI specimen, the probability (92%) of obtaining complete resection was significantly better than for larger lesions (P=0.01, Fisher's exact test). Although the therapeutic perspectives for the ABBI method are limited at present, we suggest that this approach is a first step in the direction of a surgical strategy that is better adapted to the pathological characteristics peculiar to these small tumors, whose incidence is increasing.

Journal Article↗
PubMed2001

En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

This study was prospectively conducted to evaluate the clinical potential of the advanced breast biopsy instrumentation (ABBI) system as an alternative to needle localization and open surgery in the management of nonpalpable breast lesions (NPBL). One hundred and eighty-six consecutive patients were referred for management of NPBL. Thirty-six underwent an ABBI procedure, offered as a first step before possible surgery for lesions which would in any case have required complete excision. The 18 patients with a malignant ABBI biopsy underwent re-excision of the biopsy site and axillary dissection was carried out in cases of infiltrating carcinoma. The other 150 patients underwent image-guided needle biopsy. Following these procedures, 60/150 (40%) patients underwent needle-guided surgery. Finally, 96/186 (51%) patients required complete excision. A total of 43 benign lesions and 53 carcinomas were confirmed. Thirty-six out of 96 (38%) excisions were obtained with the ABBI system; 17/43 (40%) benign lesions and 11/53 (21%) carcinomas were completely removed with the ABBI system. Out of 9 malignant specimens with a pathological size less than 10 mm, 5/9 (55%) had tumor-free margins and in 8/9 (89%) no residual disease was found at re-excision. The preliminary results of this study suggest that, in selected cases, en bloc excision using the ABBI procedure could be an alternative to conventional surgery.

Adult↗
PubMed2001

Evaluation of CT time-density curves of lower-limb veins.

UNLABELLED: Szapiro D, Ghaye B, Willems V, et al. Evaluation of CT time-density curves of lower-limb veins. Invest Radiol 2001;36:164-169. RATIONALE AND OBJECTIVES: To evaluate time-density curves of the lower-limb veins for optimization of CT venography. METHODS: Fifty patients referred for chest CT were randomized into five equal groups. Five anatomic levels (abdomen, pelvis, proximal thigh, knee, and midcalf) were evaluated by a dynamic acquisition during 7 minutes. Computed tomography attenuation values of the veins, arteries, and adjacent muscles were measured for each level and plotted into curves versus time. Venous enhancement was also assessed qualitatively. RESULTS: Mean peak enhancement values of the inferior vena cava and the iliac, femoral, popliteal, anterior tibial, posterior tibial, and peroneal veins were, respectively, 112 +/- 16, 103 +/- 17, 93 +/- 23, 98 +/- 30, 112 +/- 28, 137 +/- 28, and 124 +/- 29 Hounsfield units. These were reached at 93 +/- 9.5, 129 +/- 15, 135 +/- 20, 147 +/- 57, 124 +/- 32, 123 +/- 17, and 123 +/- 18 seconds. Homogeneous opacification was obtained after 210 seconds. An optimal time window for CT venography was obtained between 210 and 240 seconds for the calf level and between 180 and 300 seconds for above-knee veins. CONCLUSIONS: For sequential CT venography, a caudocranial acquisition of the lower-limb veins, starting at 210 seconds, should allow optimal clot detection.

Adult↗
PubMed2001

Safety and effectiveness of single- versus triple-dose gadodiamide injection- enhanced MR angiography of the abdomen: a phase III double-blind multicenter study.

PURPOSE: To evaluate the safety and effectiveness of gadodiamide-enhanced magnetic resonance (MR) angiography with single and triple doses in the assessment of abdominal arterial stenoses. MATERIALS AND METHODS: One hundred five patients were included in the randomized, double-blind, phase III multicenter trial. Results of MR angiography with 0.1 mmol/kg and 0.3 mmol/kg doses of gadodiamide were compared with those of digital subtraction angiography (DSA) and according to dose. RESULTS: No serious adverse events were observed. The mean contrast index at the region proximal to the primary stenosis was significantly higher in the triple-dose group (P =.03). Mean 95% CI values for the difference in depicted degree of stenosis between DSA and postcontrast MR angiography improved from -3.4% +/- 4.7 (SD) in the single-dose group to -1.2% +/- 4.7 in the triple-dose group. Mean values for overall image quality on the visual analogue scale improved with the triple dose (P =.02). Confidence in diagnosis was high at postcontrast MR angiography in 88% and 96% of cases in the single- and triple-dose groups, respectively. CONCLUSION: Gadodiamide-enhanced MR angiography performed with single and triple doses is safe and effective for assessing major abdominal arterial stenoses. Although high agreement between MR angiography and DSA was achieved with both doses, triple-dose MR angiography was superior in the evaluations of image quality, degree of arterial stenoses, and confidence in diagnosis.

Abdomen↗
PubMed2001

Imaging guided thoracic interventions.

Interventional Radiology is a technique based medical specialty, using all available imaging modalities (fluoroscopy, ultrasound, computed tomography, magnetic resonance, angiography) for guidance of interventional techniques for diagnostic or therapeutic purposes. Actual, percutaneous transthoracic needle biopsy includes core needle biopsy besides fine needle aspiration. Any pleural, pulmonary or mediastinal fluid or gas collection is amenable to percutaneous pulmonary catheter drainage. Treatment of haemoptysis of the bronchial artery or pulmonary artery origin, transcatheter embolization of pulmonary arteriovenous malformations and pseudoaneurysms, angioplasty and stenting of the superior vena caval system and percutaneous foreign body retrieval are well established routine procedures, precluding unnecessary surgery. These techniques are safe and effective in experienced hands. Computed tomography is helpful in pre- and postoperative imaging of patients being considered for endobronchial stenting. Many procedures can be performed on an outpatient basis, thus increasing the cost-effectiveness of radiologically guided interventions in the thorax.

Biopsy, Needle↗
PubMed2000

Sedation, analgesia and anesthesia for interventional radiological procedures in adults. Part I. Survey of interventional radiological practice in Belgium.

A questionnaire was mailed to 217 interventional radiologists to evaluate current practice in analgesia and sedation in adults. Response rate was 15% (33/217). Diagnostic angiography was performed with local anesthesia in 94% to 99%; for PTA, local thrombolysis or stent placement, light sedation was added in 0.1%. Premedication was given in 43% of diagnostic angiographies and in 68% of therapeutic procedures. Radiologists consulted an anesthesiologist before administration of intravenous sedation, always in 54% of cases, occasionally in 19% and never in 27%. General anesthesia with artificial ventilation was applied in 56% of TIPS, in 70% of aortic stent grafting and in 82% of neuroradiological interventions. Intravenous sedation was applied given in 53% of percutaneous biliary drainage, in 42% of bile duct dilatation or stenting, in 40% of percutaneous nephrostomy and in 72% of ureteral balloon dilatation. Patient monitoring during an interventional procedure was always carried out by an anesthesiologist in 52% of cases. 21% of radiologists never visited the patient before a therapeutic procedure, and 36% never did so after completion of a procedure. This survey showed that high standard practice of sedation and analgesia, with the assistance of anesthesiologists, is underused by interventional radiologists in Belgium.

Adult↗
PubMed2000

MRI guided percutaneous abdominal biopsy in a closed magnet: assessment in an animal study.

MRI guided percutaneous abdominal biopsy was evaluated in an animal model, using a closed magnet and different types of needles. Thirty-six single pass biopsies were performed in 6 piglets with 6 types of MR compatible needles. Virtual targets of a diameter of 2 cm were drawn on the images of the right and left lobe of the liver and the upper and lower poles of both kidneys. FMPSPGR sequences were applied during an apnea of 19 to 23 seconds in axial, sagittal, coronal or axial oblique planes using a closed 1.0 T magnet and the body coil. Piglets were autopsied 1 hour after the procedure. Mean duration of the procedure was 16.9 (11-37) minutes; mean number of acquisitions per procedure was 5.9 (3-12); mean number of redirections of the needle was 0.6 (0-4). Pathological samples from the liver and kidneys of good quality were obtained in 22/36 (72.2%) cases. A subcapsular hematoma was observed in 18/24 (75.0%) cases of renal biopsies and in 1/12 (8.3%) of hepatic biopsies. No statistically significant correlation could be established between duration of the procedure and site of biopsy and between the type of biopsy needle and complication (p = 0.18 to 0.85). In conclusion, MRI guided percutaneous needle biopsy in the abdomen is a reliable technique in piglets using a closed magnet.

Abdomen↗
PubMed2000

Diagnosis of pancreatic injury: a need to improve performance.

A direct frontal upper abdominal impact and a bicycle fall in a child are classical mechanisms of blunt pancreatic injury. Clinical symptoms are not characteristic. Serum amylase level is frequently normal at admission and peritoneal lavage fluid amylase is not diagnostic. CT is the most powerful imaging technique to evidence pancreatic contusion and associated injuries but remains normal or doubtful at admission in about 15% of children and 40% of adults. US is sensitive in about 70%. Both modalities are unable to detect pancreatic duct rupture. As ERP cannot be performed in all trauma patients, only patients with minor pancreatic injury can be enrolled in a conservative management without surgical revision. The role of multislice CT at admission and MRP has to be investigated to increase diagnostic efficiency in pancreatic duct injury.

Abdominal Injuries↗
PubMed2000

Combined CT venography of the lower limbs and spiral CT angiography of pulmonary arteries in acute pulmonary embolism: preliminary results of a prospective study.

PURPOSE: To determine the clinical accuracy of combined CT venography (CTV) and spiral CT angiography (SCTA) in patients suspicious of acute pulmonary thrombo-embolism. MATERIALS AND METHODS: 278 consecutive patients referred for SCTA for suspicion of acute pulmonary embolism (APE) underwent subsequent evaluation of the veins of the lower limbs and abdomen (CTV) within one examination without additional injection of contrast medium. Sixty-nine patients had no further study. Two hundred and nine patients were included in the study, 199 had US and 51 phlebography (PG) within 48 hours from SCTA-CTV. The investigators were blinded to the results of CT. When results of CTV and US were discordant, phlebography was indicated. RESULTS: SCTA was positive in 89 patients, negative in 119 and indeterminate in 1. CTV was positive in 99 patients, negative in 103 and indeterminate in 7. US was positive in 87 patients, negative in 97 and indeterminate in 15. PG was positive in 21 patients, negative in 29 and indeterminate in 1. Excellent correlation was found between CTV and US (k = 0.84) and moderate correlation between CTV and PG, and US and PG (k = 0.53). CONCLUSIONS: Combined SCTA and CTV is a rapid and accurate one-session examination in patients suspicious of acute pulmonary thrombo-embolism.

Acute Disease↗