Progress of In-stent Restenosis after Vertebral Artery Ostium Stenosis and Imaging Assessments

Stenting has become one of the primary procedure to treat vertebral artery ostium stenosis patients. Postoperative in­stent restenosis (ISR) of the stenting is still one of the unsolved issues and requires systematic and further investigation. Through imaging assessments, ISR could be identified and evaluated in clinical practice and researches

Advances in Modern Clinical Ultrasound

Advances in modern clinical ultrasound include developments in ultrasound signal processing, imaging techniques and clinical applications. Improvements in ultrasound processing include contrast and high-fidelity ultrasound imaging to expand B-mode imaging and microvascular (or microluminal) discrimination. Similarly, volumetric sonography, automated or intelligent ultrasound, and fusion imaging developed from the innate limitations of planar ultrasound, including user-operator technical dependencies and complex anatomic spatial prerequisites. Additionally, ultrasound techniques and instrumentation have evolved towards expanding access amongst clinicians and patients. To that end, portability of ultrasound systems has become paramount. This has afforded growth into the point-of-care ultrasound and remote or tele-ultrasound arenas. In parallel, advanced applications of ultrasound imaging have arisen. These include high frequency superficial sonograms to diagnose dermatologic pathologies as well as various intra-cavitary or lesional interrogations by contrast-enhanced ultrasound. Properties such as real­time definition and ease-of-access have spumed procedural and interventional applications for vascular access. This narrative review provides an overview of these advances and potential future directions of ultrasound

Contrast-Enhanced Ultrasound LI-RADS: A Pictorial Review

The American College of Radiology has implemented the Liver Imaging Reporting and Data System (LI-RADS) to help detect, interpret, and guide the management of suspected lesions on surveillance imaging for hepatocellular carcinoma (HCC) in patients with cirrhosis. The classification of indeterminate nodules with a grading algorithm can be used for multiple imaging modalities (US, CT, and MRI) and incorporates multiple imaging features to appropriately classify observations with different likelihood of being HCC. Contrast-enhanced ultrasound (CEUS) LI-RADS has been fully implemented since 2017. The aim of this pictorial article is to provide a comprehensive review of CEUS LI-RADS utilization, discuss its advantages, and highlight areas for potential improvement

Contrast-Enhanced Endoscopic Ultrasound for Identification of Sentinel Lymph Nodes in Esophageal Cancer

Introduction: In esophageal carcinoma, lymph node involvement is a crucial aspect of nodal staging and determining treatment strategies. Although grayscale endoscopic ultrasound (EUS) is the standard of care for staging, it is unable to identify lymph node drainage from primary tumors or sentinel lymph nodes (SLN). The goal of this study was to determine if Contrast Enhanced Endoscopic Ultrasound (CE- EUS) is superior to EUS in the identification of SLNs and nodal staging in esophageal carcinoma. Methods: In the unblinded pilot study, patients with newly diagnosed esophageal carcinoma were recruited to undergo CE-EUS and standard EUS. EUS was performed and visible lymph nodes were noted. The contrast agent, Sonazoid was injected peri-tumorally. Fine needle aspiration (FNA) was performed on all lymph nodes considered suspicious by either modality. Specimens were compared, using cytology as a reference. Results: 55 peri-esophageal lymph nodes were collected from 14 enrolled patients, with tumor staging of T2 and T3. 10 nodes identified as suspicious by EUS and 19 nodes identified as suspicious by CE-EUS were sampled by FNA. 4 nodes (40% cytologic yield) identified by EUS and 12 nodes (63% cytologic yield) identified by CE-EUS showed signs of metastatic disease. Nodal staging was upgraded in 4 patients (29%) with the addition of SLNs identified by CE-EUS. Discussion: CE-EUS may increase the identification of SLNs and increase cytologic yield that would not have normally been biopsied using EUS. This increase in SLN identification and cytologic yield can provide more accurate lymph node staging in esophageal carcinoma. Further study is indicated

Higher Body Mass Index (BMI) and Low-Volume Surgeons Confer Increased Operative Complications in Anterior Spinal Exposures

Background Anterior spinal exposures performed by spine or vascular surgeons have a known complication rate of 2-11%. We present the largest single institution experience of anterior spinal exposures performed by Acute Care Surgeons. The purpose of this study was to characterize the incidence of vascular and visceral injuries during spinal exposures and to identify risk factors contributing to operative complications during the exposure. We hypothesized that patients with a BMI \u3e30 as well as low-volume surgeons (\u3c20 \u3eoperations) would have an increased complication rate. Poster presented at: American Association for Surgery of Trauma (AAST) in Hawaiihttps://jdc.jefferson.edu/surgeryposters/1004/thumbnail.jp