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MBBS IV - Supplementary Courses > Diagnostic radiology - Interventional radiology > Flashcards

Diagnostic radiology - Interventional radiology Flashcards

1
Q

Indication for intervention radiology in vascular diseases?

A
  • Aortic aneurysms
  • Pulmonary embolism
  • Vascular access
  • Varicose veins
  • Vascular malformations
  • Peripheral artery disease
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2
Q

3 procedures for oncology treatment or assessment by IR?

A
  • Guided biopsy
  • Percutaneous Ablation: Curative treatment for small tumors
  • Endovascular embolization: Palliative/ curative treatment for multiple tumours
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3
Q

5 procedures for GI tract disease treatment by IR

A 
Abscess drainage 
Treat complications of transplant 
Biliary stenting and biliary drainage 
Liver cancer 
Nutritional support/ Gastrostomies
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4
Q

5 neurovascular conditions treated by IR

A 
Acute ischemic stroke 
Venous thrombosis
Aneurysms 
AVM 
Arteriovenous fistulae
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5
Q

5 genitourinary conditions treated by IR

A 
Stones 
BPH 
Fibroids 
Nephrostomies 
Renal cancer
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6
Q

4 procedures for MSS treatment by IR

A

Vertebroplasty/ kyphoplasty

Spinal injections

Joint injections

Biopsies and tumor ablation

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7
Q

3 advantages of IR over conventional surgery

A

 More precise = safer (avoid
hitting/injuring major vessels, organs)

 Most done under local anaesthesia = suitable for patients who may not be surgical candidates

 Reduced hospital stay (some can be done
as day case), faster recovery

 Provide additional diagnostic information

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8
Q

3 limitations of IR

A
  • Ionizing radiation (some)
  • Not universally applicable (e.g. huge lesions)
  • Emerging techniques with less clinical evidence
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9
Q

Function of Image guided biopsy?

Examples?

A

Obtain sample to help Dx: Microscopy, biochemistry, Histology or Cytology tests

Fluid or solid aspiration or drainage

  • Fine Needle Aspiration for cytology
  • Core biopsy for histology
  • Trephine biopsy for bone marrow
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10
Q

2 modalities of image guidance for biopsy?

give examples of procedures

A
  • US (e.g. endobiliary forceps biopsy, transrectal prostate biopsy)
  • CT (e.g. adrenal venous sampling, transjugular liver biopsy)
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11
Q

Advantage of CT guided biopsy over US?

A
  • Visualize structures without obstruction, wider field of view (US cannot penetrate bone, overlying fat, fluid …etc)

-

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12
Q

Indication for CT-guided biopsy?

A

 Thorax

 Abdomen: pancreas, adrenal gland, bowel, retroperitoneal masses (clearer visualization than US due to overlying bowel and fat)

 Neck masses not seen on US

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13
Q

Complications for CT guided biopsy

A

1) Vascular damage:
- Bleed (e.g. pararenal hematoma)
- Arteriovenous fistulas (e.g. post renal biopsy)
- Pseudoaneurysm

2) Infection

3) Organ injury:
e. g. Puncture normal pancreas = pancreatitis
e. g. Lung biopsy: Pneumothorax, Haemoptysis

4) Needle tract tumour seeding (rare)

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14
Q

4 modalities of image guidance for percutaneous drainage?

A

fluoroscopy, ultrasound, CT and MRI

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15
Q

Which approach is best for Image guided pelvic abscess drainage?

A
  • Posterior approach through gluteal muscle

- Insert catheter for continuous abscess drainage

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16
Q

Complications of image guided drainage of liver (or other) abscess?

A

 Sepsis (pus release to blood/ surrounding)

 Hemorrhage (needle hits blood vessel)

 Death (secondary to sepsis or hemorrhage)

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17
Q

Hydatid cysts:

  • CT findings?
  • IR treatment?
A

CT findings:
 Well-defined, hypoattenuating, with distinguishable wall
 Wall calcification (50%)
 Daughter cysts (75%)

Percutaneous drainage:
 Pretreatment with metronidazole
 Instill sclerosing agent

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18
Q

Outline a simplified procedure of Percutaneous transhepatic biliary drainage

A
  1. Needle punctures bile duct through the skin and liver
    (e. g. with dilated ducts)
  2. Inject contrast material to opacify the bile ducts using fluoroscopy
  3. Pass a guide wire through the needle into the bile ducts and maneuver into the duodenum
  4. Pass a drainage catheter (with side holes) over the guide wire into the duodenum through the obstruction
  5. Withdraw the guide wire
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19
Q

Indications for Percutaneous transhepatic biliary drainage

A

relieves / drains biliary obstruction:

  • obstructive jaundice/ malignancy biliary obstruction- use stenting
  • biliary sepsis
  • Post-operative bile leaks
  • Before surgery to decompress the biliary system
  • During ablation to protect biliary tree
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20
Q

2 main types of Percutaneous drainage

1 precautionary procedure for both

A

Percutaneous transhepatic biliary drainage
Percutaneous nephrostomy

Antibiotic coverage for both

21
Q

4 acute complications of Percutaneous transhepatic biliary drainage

A

 Bleeding into biliary system/ post-PTBD bleed (most
common) = hypotensive

 Infection – septic shock

 Pancreatitis (rare)

 Puncture of other organs – lung, kidney

22
Q

Delayed complications of Percutaneous transhepatic biliary drainage

A

 Biliary sepsis (cholangitis) – bacteria attach to foreign body

 Catheter migration – dislodges when patient moves around

 Bile leak into peritoneal cavity

 Metastatic seeding

 Skin infection

23
Q

Image guidance modality for percutaneous nephrostomy

24
Q

Outline simplified procedure of percutaneous nephrostomy

A
  1. Puncture the calyx through the skin
  2. Inject contrast material to opacify the collecting
    system using fluoroscopy
  3. Pass a guide wire through the needle into the ureter
  4. Pass the drainage catheter over the wire and place into the ureter/ renal pelvis
25
Q

Indications for percutaneous nephrostomy

A
  • Kidney obstruction (benign or malignant) and hydronephrosis
  • Urinary leakage secondary to trauma/ infection/ neoplasm
  • Before instrumentation for stone extraction, stricture dilation
  • Create a tract for stone extraction during lithotripsy

Must use antibiotic coverage

26
Q

Complications of percutaneous nephrostomy

A

 Haemorrhage (pseudoaneurysm, post-PCNL bleeding, hypotensive, tachycardic, shock) / sepsis

 Pain, catheter malfunction

 Puncture: Pneumothorax, peritonitis, urinoma (urine
leaks into the hole created) (rare)

 Death: 0.2%

27
Q

4 types of image-guided vascular access

A
  • Peripherally inserted central catheter (PICC) at brachial and basilic veins
  • Temporary central line (IJV)
  • Tunneled catheter (Hickman)
  • Implanted subcutaneous port
28
Q

Function of image guided angiography and embolization? Give one example.

A

Transcatheter embolization of bleeding sites > stop acutely bleeding viscera

E.g. percutaneous coil embolization of the left testicular vein for varices
e.g. Gastroduodenal artery embolization from duodenal ulcer

29
Q

Image- guided Treatment for carotid blowout after radiotherapy for NPC?

A

Stenting and embolization of lacerated vessels

leaking pseudoaneurysm at cervical ICA&raquo_space; use
pipeline stent to seal off the leakage&raquo_space; no more carotid
blowout (lower risk of rupturing)

30
Q

Image- guided Treatment for intracranial aneurysms to reduce risk of rupture?

A

endovascular coiling for intracranial aneurysm

31
Q

Image- guided Treatment for transient ischemic attack from carotid artery plaque ?

A

Angioplasty & stenting

32
Q

Image- guided Treatment for renal artery stenosis

A

PTAS (percutaneous transluminal angioplasty with stent)

33
Q

Image-guided percutaneous treatment for tumors?
Which modality of imaging for guidance?
Mechanism?

A

Percutaneous ablation of cancer

US/CT/MRI/ Laparoscopy

Cause cell death by radiofrequency/ heat, ice or chemicals

34
Q

List 6 types of percutaneous ablation of cancers

A

Heat:

  • Radiofrequency ablation
  • Microwave ablation/ coagulation
  • High intensity focused ultrasound

Ice:
- Cryoablation

Electric:
- Irreversible electroporation (IRE)

Chemical:
- Percutaneous ethanol injection

35
Q

Radiofrequency ablation vs Microwave ablation of cancer cells. Which is better?

A 
Radiofrequency:
\+ Faster heat production and dissipation
\+ Easy to use, low cost 
_ 
- charcoal accumulates at tips over time
36
Q

Indication for percutaneous ablation of cancers?

A

Curative for small tumours

Oligometastasis > limited metastatic sites

Palliative symptomatic relief (e.g. decompression from mass on nerves)

37
Q

Indications for image-guided central venous access

Advantage over peripheral lines?

A

Drug infusion:
- Antibiotics, Chemo

Dialysis

Resuscitation and monitoring

Recurrent blood taking

For prolong treatment, inject into SVC, lower risk of phlebitis and thrombosis from using limb veins

38
Q

2 techniques to manage blocked central venous access lines

A
  • Line stripping (e.g. fibrin deposit in catheter line during dialysis > narrow tube)
  • Fistuloplasty (put catheter to site of narrowing in fistula > keep using line)
39
Q

Image-guided trans-arterial treatment for liver cancer?
Indications?
Mechanism?

A

Trans-arterial chemo-embolization (TACE)
Intermediate stage HCC (supplied by hepatic arteries)
Inject agents to block supplying arteries and cause tumor cell death

40
Q

4 types of trans-arterial embolization

A

TAE - PVA particles for embolization

TACE: cisplatin + Lipiodol

TARE: Y-90 microspheres, Glass, resin

DEB-TACE: Doxorubicin

41
Q

Contraindications to TACE

A

Main portal vein tumour thrombosis

Extrahepatic metastases

Poor liver function

42
Q

Complications of TACE

A

Post-embolization syndrome (massive tumour cell death release toxins): nausea, vomiting, pain, fever

Cholecystitis, gastric/ duodenal necrosis, pancreatitis., liver abscess

43
Q

Function of DEB-TACE?
Advantage over normal IV chemo?
Advantage over convention TACE with lipiodol?

A
  • Soft deformable microsphere loaded with doxorubicin
  • Slow release of doxorubicin enhances local anti-tumor effect & decreases systemic exposure
  • Much easier to enhance residual active disease via CT without lipidiol
44
Q

3 types of TARE? (radio-embolization)

A

Yttrium-90 (Beta-radiation)

Therasphere (glass microsphere)

SIR-sphere (resin)

45
Q

Compare TACE and TARE

  • Occlusion of hepatic artery
  • Degree of embolization
  • Portal vein thrombosis
  • Bio-distribution
A
  • Occlusion of hepatic artery
    TACE: occlusive TARE: not occlusive
  • Degree of embolization
    TACE: Macro-embolization TARE: Microembolization
  • Portal vein thrombosis
    Treat with TARE, not TACE
  • Bio-distribution
    TACE: drug concentrated to tumor
    TARE: biodistribution inconsistent
46
Q

Which type of trans-arterial embolization is indicated before liver transplant?

A

TARE:

Causes hypertrophy of spared/ normal parts of liver to take up functional capacity of disease lobes

47
Q

HIFU.

  • Mechanism
  • Image guidance modality
A

Mechanism:

  • Thermal coagulative necrosis
  • Acoustic cavitation
  • Damage tumor vasculature

US or MRI guidance

48
Q

HIFU

  • Advantage
  • Disadvantage
A

Adv:

  • Avoid risk and complication of needle or electrode placement
  • Ability to treat large tumor >5cm

Disadv:

  • Long treatment time
  • Need general anesthesia
  • Less precise localization

MBBS IV - Supplementary Courses (54 decks)

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