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Background and Purpose: Percutaneous tissue biopsy is a key step in the diagnosis and management of spondylodiscitis, often utilizing CT-guided bone biopsy or fluoroscopic-guided disc aspirations. Our objective was to compare radiation exposure, procedure time, sedation requirement & yield between the two modalities.Materials and Methods: 103 patients in 2 cohorts underwent fluoroscopic-guided disc aspirations (n = 47) or CTguided bone biopsy (n = 46) for diagnosis of spondylodiscitis. Patient and imaging data were gathered to ensure matched cohorts. Interventional and post-procedural data included radiation exposure, procedure time, complications, and microbiological details. Yield was calculated using MRI findings as the gold standard for infection.Results: There were no significant differences between cohorts in demographics, symptom duration, or pre-procedure antibiotics use. CT-guided bone biopsy required more general anesthesia (26% vs 0%, P < 0.001), had longer radiation exposure time (60 ± 24s vs 2 ± 3s, P < 0.001), radiation dose (114.4 ± 71.6 mGy vs 70.4 ± 147.2 mGy), and procedure time (62 ± 14m vs 31 ± 23m, P < 0.001) than fluoroscopic-guided disc aspirations. There was no significant difference in yield (34% vs 32%, P = 0.661), and it was not affected by antibiotic use.Conclusions: Both modalities have similar utility in isolating causative organisms in suspected cases of spondylodiscitis. Our results suggest that increased radiation exposure, longer procedure time, and increased anesthesia use are relative disadvantages of CT-guided biopsy without an increase in yield. Controlled trials may be beneficial in determining the optimal choice in different scenarios. [ABSTRACT FROM AUTHOR]

Purpose: CT angiography (CTA) of the head and neck plays a key role in the evaluation of patients with stroke in the emergency department, particularly to evaluate for large-vessel occlusion and consider patients for mechanical thrombectomy. However, CTA is not always indicated and has various costs. The aim of this study was to examine the correlation between ACR imaging appropriateness recommendations and findings explanatory for stroke on CTA of the head and neck.Methods: CTA head and neck examinations of emergency department patients performed to evaluate for stroke between January 1, 2019, and June 30, 2019, were retrospectively reviewed. Patients with previously known acute infarct, with primary concern for or discovered hemorrhage, or being evaluated for trauma were excluded. Presenting symptoms were classified on the basis of the most recent ACR Appropriateness Criteria, into three categories: "usually appropriate" (UA), "may be appropriate" (MBA), or "usually not appropriate" (UNA). The percentage of examinations with findings explanatory for stroke were compared among the three groups using the Fisher exact test.Results: A total of 707 cases were reviewed, of which 317 were included; 199 fell into the UA category, 38 MBA, and 80 UNA. For UA, 57 of 199 CTAs (29%) had findings explanatory for stroke, compared with 1 of 38 (3%) in the MBA group (difference, 26%; 95% confidence interval, 13%-34%; P < .001) and 1 of 80 (1%) in the UNA group (difference, 27%; 95% confidence interval, 19%-35%; P < .001).Conclusions: ACR Appropriateness Criteria recommendations correlate with imaging findings explanatory for stroke and may guide the judicious use of CTA for suspected stroke workup. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To identify retrospectively hypercoagulable events that occurred over time in patients who underwent image-guided percutaneous renal cryoablation and compare the incidence with a cohort of patients who underwent surgical partial nephrectomy (PN) during the same time period. Materials and Methods: An electronic medical record database was queried for patients who underwent percutaneous image-guided renal mass cryoablation or PN between September 2006 and June 2012. Records were examined for thrombotic events during the year following the procedure in each group. Incidence rates, Kaplan-Meier estimates, and patient demographic variables were compared using the stratified log-rank test and t test for independent samples. Results: The study comprised 114 cryoablation cases. The cumulative incidence of thrombotic events after 1 year was 4.39%. The incidence per 100 person-years was 4.84. There were 105 PN cases. The cumulative incidence of thrombotic events after 1 year was 1.0%. The incidence per 100 person-years was 1.14. The person-time incidence rate difference for these two groups did not reach statistical significance (P = .0894). Conclusions: The incidence of thrombotic events in patients who underwent percutaneous renal cryoablation in this study was not significantly different than a comparable cohort who underwent surgical PN during the same time period. [Copyright &y& Elsevier]