Description: Purpose: To assess the value of intraoperative ultrasonography (US) for different types of pancreatic surgery. Materials and Methods: An institutional review board–approved, HIPAA-compliant retrospective review with waiver of informed consent was performed to evaluate all cases of pancreatic surgery with intraoperative US or laparoscopic US that occurred at a single institution during a 10-year period. Surgical notes, radiologic images, and clinical data for each surgical procedure and subsequent clinical course were reviewed by pancreatic surgeons and radiologists. Presumptive diagnosis, type of surgical procedure performed, and final pathologic data were recorded. A relative value score was established by consensus and assigned to each case with a grade of 0–3, which indicated the value of the intraoperative or laparoscopic US. The type of operation and pathologic data were compared in each of the value score groups. Categoric variables were compared by using either 2 or Fisher exact test. Results: One hundred ninety-three intraoperative or laparoscopic US procedures were performed in 189 patients. Of the patients, there were 102 men and 87 women. The mean age was 57.8 years (range, 18–86 years). Intraoperative or laparoscopic US value scores were as follows: value score 0, 3.6%; value score 1, 11.9%; value score 2, 31.1%; and value score 3, 53.4%. The most common contribution that resulted in a high score (value score 3) was facilitation of technical performance of the surgery ( n = 60). High value score was significantly associated with performance of pancreatitis-related surgery ( P 〈 .001). The surgical indication that most commonly resulted in a low value score of 0 or 1 was staging of pancreatic cancers. All cases that received a score of 0 occurred in the laparoscopic adenocarcinoma surgical setting (staging or pancreatic biopsy). Conclusion: Intraoperative or laparoscopic US can be a valuable procedure in multiple types of surgical procedures that involve the pancreas and shows clear patterns of value in the different types of surgery. © RSNA, 2012

Description: Purpose: To assess tumor conspicuity and radiation dose with a new multidetector computed tomography (CT) protocol for pancreatic imaging that combines spectral CT and split-bolus injection. Materials and Methods: This study was approved by the institutional review board and compliant with HIPAA. The requirement for informed consent was waived. One hundred sixty-three consecutive patients referred for possible pancreatic mass underwent CT with either a standard or split-bolus spectral CT protocol depending on scanner availability. Split-bolus spectral CT (CT unit with spectral imaging) combines pancreatic and portal venous phases in a single scan: 70 seconds before CT, 100 mL of contrast material is injected for the portal venous phase followed approximately 35 seconds later by injection of 40 mL of contrast material to boost the pancreatic phase. Bolus tracking after the second bolus initiates scanning 15 seconds after aorta enhancement reaches 280 HU. Images were reconstructed at 60 and 77 keV. The standard protocol (64–detector row unit) included unenhanced and pancreatic and portal venous phase imaging, with a single contrast material injection timed with bolus tracking 15 seconds after aortic enhancement of 300 HU for the pancreatic phase and 32 seconds later for the portal venous phase. Tumor conspicuity (difference in attenuation between tumor and pancreatic parenchyma) and contrast-to-noise ratio (CNR) were determined. Attenuation of aorta, main portal vein, and liver were measured. Patient size and per-examination radiation dose were recorded. The heteroscedastic t test, Fisher exact test, and Mann-Whitney test were used for statistical analysis. Results: There were no significant differences in age, weight, and body mass index between patients in the standard CT (46 of 80 patients had lesions) and split-bolus spectral CT (39 of 83 patients had lesions) groups; however, there were significantly more women in the split-bolus group ( P = .02). Tumor conspicuity and CNR were higher with the 60-keV split-bolus protocol (89.1 HU ± 56.6 and 8.8 ± 6.2, respectively) than with the pancreatic or portal venous phase of the standard protocol (43.5 HU ± 28.4 and 4.5 ± 3.0, and 51.5 HU ± 30.3 and 5.6 ± 4.0, respectively; P 〈 .01 for all comparisons). Dose-length product was 1112 mGy · cm ± 437 with the standard protocol and 633 mGy · cm ± 105 with the split-bolus protocol ( P 〈 .001). Conclusion: Split-bolus spectral multidetector CT resulted in vascular, liver, and pancreatic attenuation and tumor conspicuity equal to or greater than that with multiphase CT, with a 43% reduction in radiation dose. © RSNA, 2013 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121409/-/DC1

Description: OBJECTIVE. The purpose of this article is to compare the complication rate for ultrasound-guided percutaneous cholecystostomy in patients with coagulopathy to the rate in patients with normal coagulation. MATERIALS AND METHODS. We performed a database search for patients who underwent ultrasound-guided percutaneous cholecystostomy from January 2000 through December 2010. Patients were divided into those with normal coagulation and those with coagulopathy, as documented by abnormal laboratory values (international normalized ratio ≥ 1.5 and platelet count ≤ 50 x 10 9 /L) or history of anticoagulant medication in the preceding 5 days. Medical records were reviewed, and complication rates and subsequent treatment was recorded. Statistical analysis was performed using the Fisher exact and chi-square tests. RESULTS. Two hundred forty-two patients underwent ultrasound-guided percutaneous cholecystostomy (132 men and 110 women; mean [± SD] age, 73.9 ± 15.9 years; range, 22–104 years). One hundred thirty-two patients were coagulopathic and 110 had normal coagulation. Major complications related to ultrasound-guided percutaneous cholecystostomy were rare (4/242 cases [1.7%]) and included hemorrhage requiring transfusion ( n = 1), death directly related to the procedure ( n = 1), sepsis related to the procedure ( n = 1), and abscess or biloma formation ( n = 1). All of these occurred in the group with normal coagulation. Fourteen additional deaths (5.8%) that occurred within 30 days of the procedure were related to comorbidities. Minor catheter-related complications (15/242 [6.2%]) were due to catheter dislodgement ( n = 11 [4.5%]), failure of placement ( n = 1 [0.4%]), and hemorrhage not requiring transfusion ( n = 3 [1.2%]). Two of the minor hemorrhagic complications were seen in the coagulopathic group and one in the normal coagulation group ( p = 0.599). CONCLUSION. There is no difference in the complication rate for ultrasound-guided percutaneous cholecystostomy in patients who are coagulopathic compared with those who have normal coagulation.

Description: OBJECTIVE. The purpose of this study was to assess patient preferences about receiving radiology results and reviewing the images and findings directly with a radiologist after completion of an examination. SUBJECTS AND METHODS. A prospective survey of English-speaking outpatients undergoing either nononcologic CT of the chest, abdomen, and pelvis or nonobstetric ultrasound examinations was completed between December 2010 and June 2011. Responses to survey items such as preferences regarding communication of results, knowledge of a radiologist, and anxiety level before and after radiologist-patient consultation were recorded. The average wait time between the end of the imaging examination and the consultation and the duration of consultation were documented. RESULTS. Eighty-six patients (43 men, 43 women; mean age, 52 years) underwent 37 CT and 49 ultrasound examinations). Forty-eight patients (56%) identified a radiologist as a physician who interprets images. Before imaging, 70 patients (81%) preferred hearing results from both the ordering provider and the radiologist. This percentage increased to 78 (91%) after consultation ( p = 0.03). Before consultation, 84 of the 86 patients (98%) indicated they would be comfortable hearing normal results or abnormal results from the person interpreting the examination; the number increased to 85 (99%) after consultation. Eighty-five patients (99%) agreed or strongly agreed that reviewing their examination findings with a radiologist was helpful. Eighty-four patients (98%) indicated they wanted the option of reviewing or always wanted to review future examination findings with a radiologist. After consultation, anxiety decreased in 41 patients (48%), increased in 13 (15%), and was unchanged in 32 (37%) ( p = 0.0001). The average wait for consultation and the duration of consultation were 9.9 and 10.4 minutes for CT and 1.2 and 7.1 minutes for ultrasound. CONCLUSION. Patients prefer hearing examination results from both their ordering provider and the interpreting radiologist. Most patients find radiologist consultation beneficial. Patients are comfortable hearing results from the radiologist, with most displaying decreased anxiety after consultation.