OBJECTIVE:

Arteriovenous fistulas (AVFs) are abnormal communications with shunting of blood from an artery to a vein. AVFs mainly involve the peripheral vascular system but can affect virtually any organ or system in the body. They may be congenital, created surgically for hemodialysis, or caused by pathologic processes. This review describes the diverse origins of AVFs and illustrates the spectrum of imaging findings at radiography, ultrasound, CT, MRI, and digital angiography for AVFs in different locations: the CNS, thorax, abdomen, musculoskeletal system, and peripheral vascular system. We also discuss syndromes associated with AVFs and describe recent interventional techniques for treating AVFs.

CONCLUSION:

Familiarity with the spectrum of imaging findings in AVFs is essential for the accurate interpretation of images and facilitates diagnosis and therapeutic management. Radiologists can play a critical role in the diagnosis and treatment of AVFs. Digital angiography is helpful in elaborating a vascular map for endovascular treatment.

Keywords: arteriovenous fistulas - arteriovenous malformations - fistula therapeutic embolization - hemodynamics - vascular system

Purpose:

The aim of this study was to seek patients' perspectives on radiology reporting systems, so that reporting systems can begin to be reorganized and made more patient-centered by giving patients greater access to their personal health information.

Methods:

Focus group methodology was used to explore which aspects of radiology information are important to patients and to identify their preferred means of access to and format of this information. Subjects for the two groups were outpatients who had recently undergone MR imaging at a single academic medical center. Transcripts were analyzed using thematic content analysis.

Results:

Most subjects were dissatisfied with current reporting systems, citing delays and a lack of detail as the most important problems. Subjects varied with regard to preferences for who should relay results to them, with some expressing a desire for increased direct input from radiologists because they have greater expertise in imaging interpretation. Most subjects wanted results in writing and in detail, with attached lay language explanations, though a few subjects preferred less detail. Subjects were decidedly in favor of having the option to access results immediately via an online system, proposing some potential problems and potentially multiple benefits of such a system.

Conclusions:

Whatever system revisions are attempted to increase the patient-centeredness of care as regards to radiology reporting, patients will need to be able to choose their preferred levels of access and will need to have the option of accessing full details.

Key Words: Patient-centered, radiology reporting, qualitative

ABSTRACT:

Sarcoidosis is a systemic disorder of unknown cause that is characterized by the presence of noncaseating granulomas. The radiological findings associated with sarcoidosis have been well described. The findings include symmetric, bilateral hilar and paratracheal lymphadenopathy, with or without concomitant parenchymal abnormalities (multiple small nodules in a peribronchovascular distribution along with irregular thickening of the interstitium). However, in 25% to 30% of cases, the radiological findings are atypical and unfamiliar to most radiologists, which cause difficulty for making a correct diagnosis. Many atypical forms of intrathoracic sarcoidosis have been described sporadically. We have collected cases with unusual radiological findings associated with pulmonary sarcoidosis (unilateral or asymmetric lymphadenopathy, necrosis or cavitation, large opacity, ground glass opacity, an airway abnormality and pleural involvement) and describe the typical forms of the disorder as well. The understanding of a wide range of the radiological manifestations of sarcoidosis will be very helpful for making a proper diagnosis.

Keywords: Sarcoidosis, Thorax, Computed tomography (CT).

Abstract:

Purpose: To investigate whether ethanol ablation by using a multipronged needle delivery system (multipronged ethanol ablation) could eradicate hepatocellular carcinoma (HCC) up to 5.0 cm in diameter with a single-session high-dose strategy.

Materials and Methods: The hospital ethics committee approved the prospective study, and each patient provided written informed consent. One hundred forty-one patients (125 men, 16 women; mean age, 53 years; range, 27–76 years) with 164 primary or recurrent HCC ranging from 1.3 to 5.0 cm in diameter (mean, 2.9 cm ± 0.9) were treated with high-dose multipronged ethanol ablation. Patients were unsuitable for surgery, declined surgery and radiofrequency ablation, or had tumors located at unfavorable sites. Primary technique effectiveness (PTE) (complete ablation within two sessions), local tumor progression (LTP), and complications after the treatment were observed. Twenty risk factors of local effectiveness and complications were analyzed by means of univariate and multivariate analysis.

Results: Mean number of treatment sessions was 1.1. The mean volume of ethanol per tumor was 31 mL (range, 8–68 mL). PTE was achieved in 134 (95%) of 141 patients and was significantly associated with tumor pattern (capsulated vs noncapsulated, P = .018). After a mean follow-up period of 25 months, LTP was observed in 16 (12%) of 134 patients, and in nine (56%) patients, LTP occurred in tumors 3.1–5.0 cm in diameter. Alanine aminotransferase level (P = .023) was the independent risk factor for LTP. Three (2%) of 141 patients had major complications.

Conclusion: Multipronged ethanol ablation with a high-dose strategy can be used to treat HCC up to 5.0 cm in diameter effectively and safely, often in a single session.