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DesRoche C, Callum J, Scholey A, Hajjaj OI, Flemming J, Mussari B, Tarulli E, Reza Nasirzadeh A, Menard A. Platelet and INR Thresholds and Bleeding Risk in Ultrasound Guided Percutaneous Liver Biopsy: A Before-After Implementation of the 2019 Society of Interventional Radiology Guidelines Observational Quality Improvement Study. Can Assoc Radiol J 2024:8465371241252059. [PMID: 38755999 DOI: 10.1177/08465371241252059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Purpose: To evaluate if implementation of the 2019 Society of Interventional Radiology (SIR) guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy is associated with increased haemorrhagic adverse events, change in pre-procedural blood product utilization, and evaluation of guideline compliance rate at a single academic institution. Methods: Ultrasound guided percutaneous liver biopsies from (January 2019-January 2023) were retrospectively reviewed (n = 504), comparing biopsies performed using the 2012 SIR pre-procedural coagulation guidelines (n = 266) to those after implementation of the 2019 SIR pre-procedural guidelines (n = 238). Demographic, preprocedural transfusion, laboratory, and clinical data were reviewed. Chart review was conducted to evaluate the incidence of major bleeding adverse events defined as those resulting in transfusion, embolization, surgery, or death. Results: Implementation of the 2019 SIR periprocedural guidelines resulted in reduced guideline non-compliance related to the administration of blood products, from 5.3% to 1.7% (P = .01). The rate of pre-procedural transfusion remained the same pre and post guidelines at 0.8%. There was no statistically significant change in the incidence of bleeding adverse events, 0.8% pre guidelines versus 0.4% post (P = 1.0). Conclusion: Implementation of the 2019 SIR guidelines for periprocedural management of bleeding risk in patients undergoing percutaneous ultrasound guided liver biopsy did not result in an increase in bleeding adverse events or pre-procedural transfusion rates. The guidelines can be safely implemented in clinical practice with no increase in major adverse events.
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Affiliation(s)
- Chloe DesRoche
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Aiden Scholey
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Omar I Hajjaj
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer Flemming
- Department of Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Ben Mussari
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Emidio Tarulli
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Amir Reza Nasirzadeh
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Alexandre Menard
- Department of Diagnostic Radiology, Queen's University and Kingston Health Sciences Centre, Kingston, ON, Canada
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Lee P, Dhillon G, Pourafkari M, DaBreo D, Jaff Z, Appireddy R, Jin A, Boissé Lomax L, Durafourt BA, Boyd JG, Nasirzadeh AR, Tampieri D, Jalini S. Non-ECG-gated cardiac CT angiography in acute stroke is feasible and detects sources of embolism. Int J Stroke 2024; 19:189-198. [PMID: 37515467 PMCID: PMC10811964 DOI: 10.1177/17474930231193335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A significant portion of cryptogenic stroke is hypothesized to be secondary to cardiac embolism. However, transthoracic echocardiogram is usually delayed after stroke, and more detailed cardiac imaging is not routinely done. AIMS This study aimed to determine whether non-ECG-gated cardiac CT angiography (cCTA) during hyperacute stroke would provide diagnostic quality images and act as an adjunct modality of cardiac imaging to detect sources of emboli. METHODS In this single-center prospective cohort study, modified Code Stroke imaging was implemented with a 64-slice CT scanner, where the longitudinal axis of CT angiography was extended from the carina to the diaphragm. The primary outcomes of image quality, recruitment feasibility, impact on hyperacute time metrics, and additional radiation dose were assessed. Secondary outcomes consisted of detection of high-risk cardiac sources of embolism, mediastinal or lung pathology, and impact on etiologic classification. RESULTS One hundred and twenty eligible patients were enrolled, of which 105 (87.5%) had good/moderate quality images for motion artifact and 119 (99.2%) for contrast opacification. Total CT time, door-to-needle time, and door-to-groin puncture time were unchanged with the addition of cCTA. Eighty-nine patients received a final diagnosis of ischemic stroke, of which 12/89 (13.5%) had high-risk cardioembolic findings on cCTA. Incidental findings, such as pulmonary embolism (PE) (7/89, 7.9%) and malignancy (6/89, 6.7%), were observed. cCTA led to changes in management for 19/120 (15.8%) of all patients, and reclassification of stroke etiology for 8/89 (9%) of patients. CONCLUSIONS Non-ECG-gated cCTA can be feasibly incorporated into Code Stroke and provide diagnostic quality images without delays in hyperacute time metrics. It can detect high-risk cardiac sources, and other findings impacting patient care. This may help reclassify a subset of cryptogenic stroke cases and improve secondary prevention.
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Affiliation(s)
- Peter Lee
- School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Gurmohan Dhillon
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Marina Pourafkari
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Dominique DaBreo
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Zardasht Jaff
- Division of Cardiology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Ramana Appireddy
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Albert Jin
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Lysa Boissé Lomax
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Bryce A Durafourt
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - John Gordon Boyd
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Amir Reza Nasirzadeh
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Donatella Tampieri
- Department of Radiology, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
| | - Shirin Jalini
- Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, ON, Canada
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Rubino JG, Nasirzadeh AR, van der Pol CB, Dhindsa K, Chung AD. Quantitative and qualitative liver CT: imaging feature association with histopathologically confirmed hepatic cirrhosis. Abdom Radiol (NY) 2022; 47:2314-2324. [PMID: 35583820 DOI: 10.1007/s00261-022-03550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the diagnostic performance of quantitative and qualitative imaging features of hepatic cirrhosis on CT. METHODS A single-center retrospective cohort study was performed on all patients who had undergone non-targeted liver biopsy < 3 months following abdominal CT imaging between 2007 and 2020. Histopathology was required as a reference standard for hepatic cirrhosis diagnosis. Two readers independently assessed all CT quantitative and qualitative features, blinded to the clinical history and the reference standard. The diagnostic performance of each imaging feature was assessed using multivariate regression and logistic regression in a recursive feature elimination framework. RESULTS 98 consecutive patients met inclusion criteria including 26 with histopathologically confirmed hepatic cirrhosis, and 72 without cirrhosis. Liver surface nodularity (p < 0.0001), lobar redistribution (p < 0.0001), and expanded gallbladder fossa (p < 0.0016) were qualitative CT features associated with liver cirrhosis consistent between both reviewers. Liver surface nodularity demonstrated highest sensitivity (73-77%) and specificity (79-82%). Falciform space width was the only quantitative feature associated with cirrhosis, for a single reviewer (p < 0.04). Using a recursive feature elimination framework, liver surface nodularity and falciform space width were the strongest performing features for identifying cirrhosis. No feature combinations strengthened diagnostic performance. CONCLUSION Many quantitative and qualitative CT imaging signs of hepatic cirrhosis have either poor accuracy or poor inter-observer agreement. Qualitative imaging features of hepatic cirrhosis on CT performed better than quantitative metrics, with liver surface nodularity the most optimal feature for diagnosing hepatic cirrhosis.
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Affiliation(s)
| | - Amir Reza Nasirzadeh
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada
| | - Christian B van der Pol
- Department of Radiology, Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada
| | - Kiret Dhindsa
- Berlin Institute of Health and Department of Neurology and Experimental Neurology, Brain Simulation Section, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andrew D Chung
- Department of Radiology, Kingston Health Sciences Centre, Queen's University, Kingston, ON, Canada.
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