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Accurate imaging is crucial for lesion detection in abdominal organs, for the noninvasive characterization of focal and diffuse abnormalities, and for surgical planning. To accomplish these tasks, several imaging modalities such as multidetector computer tomography (MDCT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) are used for abdominal imaging, providing important morphological, functional or metabolic information. More recently, PET/MRI has been gaining attention due to the possibility of combining high-resolution imaging with metabolic imaging. PET/MRI is a novel hybrid imaging technology that in the near future might play a pivotal role in the clinical management of oncologic and inflammatory abdominopelvic diseases. Despite the still limited number of published clinical studies, PET/MRI has been proven to be at least equivalent to PET/CT and to standalone MRI in a variety of oncologic disease. Moreover, in selected and focused clinical studies, it has been proven to outperform current standard of care imaging, for example, in evaluating cholangiocarcinomas, liver metastases, untreated and treated rectal cancer. This has also had an impact on therapeuticmanagement in some studies. Therefore in some institutions, including those of the authors, PET/MRI is becoming the new standard imaging modality in staging treatment-naive intrahepatic massforming cholangiocarcinomas and prior to complicated hepatic surgery.

Background Angiotensin-converting enzyme 2, a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019. Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from March 27 to April 10, 2020, who tested positive for SARS-CoV-2 were included. Abdominal imaging studies performed in these patients were reviewed, and salient findings were recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results A total of 412 patients (average age, 57 years; range, 18 to >90 years; 241 men, 171 women) were evaluated. A total of 224 abdominal imaging studies were performed (radiography, n = 137; US, n = 44; CT, n = 42; MRI, n = 1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR], 1.03 per year of increase; P = .001) and intensive care unit (ICU) admission (OR, 17.3; P < .001). Bowel-wall abnormalities were seen on 31% of CT images (13 of 42) and were associated with ICU admission (OR, 15.5; P = .01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT images obtained in patients in the ICU (four of 20). Surgical correlation (n = 4) revealed unusual yellow discoloration of the bowel (n = 3) and bowel infarction (n = 2). Pathologic findings revealed ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles (n = 2). Right upper quadrant US examinations were mostly performed because of liver laboratory findings (87%, 32 of 37), and 54% (20 of 37) revealed a dilated sludge-filled gallbladder, suggestive of bile stasis. Patients with a cholecystostomy tube placed (n = 4) had negative bacterial cultures. Conclusion Bowel abnormalities and gallbladder bile stasis were common findings on abdominal images of patients with coronavirus disease 2019. Patients who underwent laparotomy often had ischemia, possibly due to small-vessel thrombosis. © RSNA, 2020.

Eine adaquate Bildgebung ist fur die Detektion mitunter kleinster Lasionen, die non-invasive Charakterisierung von fokalen und diffusen Veranderungen, sowie die Planung chirurgischer Eingriffe von entscheidender Bedeutung. Zur Bewaltigung dieser Aufgaben werden verschiedene bildgebende Verfahren wie die Multidetektor-Computertomographie (MDCT), Magnetresonanztomographie (MRT) und Positronen-Emissions-Tomographie/Computertomographie (PET/CT) eingesetzt, die wichtige morphologische, funktionelle oder metabolische Informationen liefern. In letzter Zeit gewinnt die PET/MRT aufgrund der Moglichkeit von Kombination hochauflosender Bildgebung und metabolischer Bildgebung zunehmend an Aufmerksamkeit. Die PET/MRT ist eine neuartige Hybridbildgebungstechnologie, die in naher Zukunft eine zentrale Rolle bei der klinischen Behandlung von onkologischen und entzundlichen Abdomen-Becken-Erkrankungen spielen konnte. Trotz der noch begrenzten Anzahl publizierter klinischer Studien hat sich die PET/MRT bei einer Vielzahl von onkologischen Erkrankungen als zumindest gleichwertig wie PET/CT und MRT als Einzeluntersuchung erwiesen. In ausgewahlten und fokussierten klinischen Studien wurde zudem nachgewiesen, dass es die derzeitige Standardbildgebung beispielsweise in der Beurteilung von Cholangiokarzinomen, Lebermetastasen sowie unbehandelten und behandelten Rektumkarzinomen ubertrifft. Dies hat sich in einigen Studien auch auf das therapeutische Management ausgewirkt. Daher ist die PET/MRT in einigen Institutionen zur neue Standardbildgebungsmethode, z. B. bei unbehandelten intrahepatischen Cholangiokarzinomen sowie vor komplizierten Leberoperationen geworden.

Endometriosis is often seen and sometimes initially diagnosed on hysterosalpingography (HSG), an imaging exam routinely performed on patients with infertility. Here we discuss the role of HSG in the evaluation of patients with infertility with a focus on patients with endometriosis. The HSG technique, including patient preparation as well as potential risks and complications, is detailed. Imaging findings in patients with endometriosis are illustrated and a template for exam reporting is presented. Common imaging pitfalls are described with examples.

18F-Fluciclovine is indicated for evaluation of suspected prostate cancer (PCa) biochemical recurrence. There are few studies investigating fluciclovine with PET/MR and none evaluated osseous metastases. Our aim was to assess the performance of 18F-fluciclovine PET/MR (fluciclovine-PET/MR) for detecting osseous metastases in patients with castration-resistant prostate cancer (CRPC). We also investigated possible correlations between SUVmax and ADCmean. We evaluated 8 patients with CRPC metastatic to bones, some before and some after radium therapy, who underwent 13 fluciclovine-PET/MR studies. We analyzed the performance of radionuclide bone scan (RBS), MR alone, fluciclovine-PET alone, and fluciclovine-PET/MR in detecting osseous metastases. Lesion size, characteristics (early sclerotic, late sclerotic, mixed, lytic), SUVmax, and ADCmean were assessed. The reference standard was a combination of clinical information and correlation with both prior and follow-up imaging. Of 347 metastatic bony lesions in 13 studies, 238/347 (68%) were detected by fluciclovine-PET alone, 286/347 (82%) by RBS, 344/347 (99%) by MR alone, and 347/347 (100%) by fluciclovine-PET/MR. Fluciclovine-PET/MR and MR had the best performance (p

The primary aim of the present study was to evaluate if PET/MR induced management changes versus standard of care imaging (SCI) in treated colorectal cancer patients. The secondary aim was to assess the staging performance of PET/MR and of SCI versus the final oncologic stage. Treated CRC patients who underwent PET/MR with 18F-FDG and SCI between January 2016 and October 2018 were enrolled in this retrospective study. Their medical records were evaluated to ascertain if PET/MR had impacted on their clinical management versus SCI. The final oncologic stage, as reported in the electronic medical record, was considered the true stage of disease. A total of 39 patients who underwent 42 PET/MR studies were included, mean age 56.7 years (range 39–75 years), 26 males, and 13 females. PET/MR changed clinical management 15/42 times (35.7%, standard error ± 7.4%); these 15 changes in management were due to upstaging in 9/42 (21.5%) and downstaging in 6/42 (14.2%). The differences in management prompted by SCI versus PET/MR were statistically significant, and PET/MR outperformed SCI (P value

The expansion in the use of image-guided percutaneous biopsy and abdominopelvic abscess drainage reflects the ability of these procedures to offer safe minimally invasive techniques with superior outcomes compared with previously utilized operative approaches. Advances in technique, instruments, and imaging modalities have made these procedures among the most commonly performed in both the inpatient and outpatient setting. Increasing demands from patients, referring physicians, and hospitals to offer and excel in these procedures highlight their importance.

Intrahepatic cholangiocarcinoma (ICC) is associated with a poor prognosis with surgical resection offering the best chance for long-term survival and potential cure. However, in up to 36% of patients who undergo surgery, more extensive disease is found at time of operation requiring cancellation of surgery. PET/MR is a novel hybrid technology that might improve local and whole-body staging in ICC patients, potentially influencing clinical management. This study was aimed to investigate the possible management implications of PET/MR, relative to conventional imaging, in patients affected by untreated intrahepatic cholangiocarcinoma. Retrospective review of the clinicopathologic features of 37 patients with iCCC, who underwent PET/MR between September 2015 and August 2018, was performed to investigate the management implications that PET/MR had exerted on the affected patients, relative to conventional imaging. Of the 37 patients enrolled, median age 63.5 years, 20 (54%) were female. The same day PET/CT was performed in 26 patients. All patients were iCCC-treatment-naive. Conventional imaging obtained as part of routine clinical care demonstrated early-stage resectable disease for 15 patients and advanced stage disease beyond the scope of surgical resection for 22. PET/MR modified the clinical management of 11/37 (29.7%) patients: for 5 patients (13.5%), the operation was cancelled due to identification of additional disease, while 4 “inoperable” patients (10.8%) underwent an operation. An additional 2 patients (5.4%) had a significant change in their operative plan based on PET/MR. When compared with standard imaging, PET/MR significantly influenced the treatment plan in 29.7% of patients with iCCC. 2018P001334

This study assessed radiation dose after CT-guided percutaneous radiofrequency ablations (RFAs) of hepatic and renal tumors and the effect of weight-based CT protocol modification for lowering overall dose in these procedures.CT-guided RFA for renal and hepatic ablations performed from January 1, 2009, through December 31, 2009, were retrospectively reviewed (90 men and 48 women; age, 42-81 years). The radiation dose was recorded during each of the following steps: planning, performing, and postprocedure. Weight-based protocol modification changes in tube voltage and tube current were then applied to renal and hepatic ablations performed subsequently (18 men and 11 women; age, 48-82 years). Image quality, needle localization, lesion detection, ability to detect complications, and overall operator satisfaction were noted for each case (score, 1-5). Dose reduction after modification was then calculated.Retrospective analysis found a mean (± SD) overall CT dose index (CTDI) for CT-guided RFA to be 16.5 ± 2.3 mGy. After protocol modification, the mean CTDI decreased to 6.63 ± 0.67 mGy, a 59.6% reduction overall; for hepatic ablations, the reduction was 65.96% (p0.0001) and the reduction for renal ablations was 38.97% (p = 0.0153). Image quality analysis showed high operator satisfaction (3-5), including adequate needle localization (4-5), lesion visibility (3-5), and high performer confidence (4-5). Higher dose reduction was noted for patients weighing more than 180 lb (82 kg) (p0.0001).Simple weight-based CT protocol modifications can significantly reduce radiation dose during CT-guided percutaneous ablations in the liver and kidneys without significantly sacrificing image quality.

This AUA Guideline focuses on evaluation/counseling and management of adult patients with clinically localized renal masses suspicious for cancer, including solid-enhancing tumors and Bosniak 3/4 complex-cystic lesions.Systematic review utilized research from the Agency for Healthcare Research and Quality and additional supplementation by the authors and consultant methodologists. Evidence-based statements were based on body of evidence strength Grade A/B/C (Strong/Moderate/Conditional Recommendations, respectively) with additional statements presented as Clinical Principles or Expert Opinions.Great progress has been made since the previous guidelines on management of localized renal masses were released (2009). The current guidelines provide updated, evidence-based recommendations regarding evaluation/counseling of patients with clinically localized renal masses, including the evolving role of renal mass biopsy. Given great variability of clinical, oncologic and functional characteristics, index patients are not utilized and the panel advocates individualized counseling/management. Management options (partial nephrectomy/radical nephrectomy/thermal ablation/active surveillance) are reviewed including recent data about comparative effectiveness and potential morbidities. Oncologic issues are prioritized while recognizing that functional outcomes are of great importance for survivorship for most patients with localized kidney cancer. A more restricted role for radical nephrectomy is recommended following well-defined selection criteria. Priority for partial nephrectomy is recommended for clinical T1a lesions, along with selective use of thermal ablation, particularly for tumors ≤3.0 cm. Important considerations for shared decision-making about active surveillance are explicitly defined.Several factors should be considered during counseling/management of patients with clinically localized renal masses, including general health/comorbidities, oncologic potential of the mass, pertinent functional issues and relative efficacy/potential morbidities of various management strategies.

Renal cell carcinoma is a relatively common tumor, with an estimated 63,000 new cases being diagnosed in the United States in 2016. Surgery, be it with partial or total nephrectomy, is considered the mainstay of treatment for many patients. However, those patients with small renal masses, typically less than 3 to 4 cm in size who are deemed unsuitable for surgery, may be suitable for percutaneous thermal ablation. We review the various treatment modalities, including radiofrequency ablation, microwave ablation, and cryoablation; discuss the advantages and disadvantages of each method; and review the latest data concerning the performance of the various ablative modalities compared with each other, and compared with surgery.

OBJECTIVE. The purpose of this article is to provide a primer for radiologists performing MRI for suspected placenta accreta, illustrating normal and abnormal findings and diagnostic pitfalls. Appropriate examination indications and recommendations for optimizing image acquisition and interpretation are summarized. CONCLUSION. MRI increases the accuracy of the workup of high-risk patients and aids in multidisciplinary delivery planning to improve maternal outcome. Reader accuracy and confidence require adherence to examination performance, image interpretation criteria, and awareness of common pitfalls.

The purpose of this article is to compare the effectiveness of a treatment algorithm for small renal tumors incorporating the nephrometry score, a renal tumor anatomy scoring system developed by urologists, with the current standard of uniformly recommended partial nephrectomy in patients with mild-to-moderate chronic kidney disease (CKD).We developed a state-transition microsimulation model to project life expectancy (LE) in hypothetic patients with baseline mild or moderate CKD undergoing treatment of small renal masses. Our model incorporated the nephrometry score, which is predictive of postsurgical renal function loss. The two tested strategies were uniform treatment with partial nephrectomy and selective treatment based on nephrometry score and CKD stage, including percutaneous ablation for CKD stages 2 or 3a and intermediate-to-high nephrometry score or stage 3b CKD and any nephrometry score; otherwise, partial nephrectomy was assumed for other CKD stages and nephrometry scores. The model accounted for benign and malignant lesions, renal function decline, recurrence, and metastatic disease rates specific to each treatment, mortality by CKD stage, and comorbidities. Sensitivity analysis tested the stability of results when varying key parameters.Selective treatment with partial nephrectomy resulted in an average LE benefit of 0.48 year (95% interpercentile range, 0.42-0.54 year) in 65-year-old men and 0.37 year (95% interpercentile range, 0.30-0.43 year) in 65-year-old women relative to nondiscriminatory surgery, due to worsening CKD and cardiovascular mortality associated with partial nephrectomy. Model results were most sensitive to the rate of renal function decline and CKD-related mortality.Nephron-sparing treatment selection for small renal masses based on nephrometry score may improve LE in patients with mild or moderate CKD.

Management of primary and secondary hepatic malignancy is a complex problem. Achieving optimal care for this challenging population often requires the involvement of multiple medical and surgical disciplines. Because of the wide variety of potential therapies, treatment protocols for various malignancies continue to evolve. Consequently, development of appropriate therapeutic algorithms necessitates consideration of medical options, such as systemic chemotherapy; surgical options, such as resection or transplantation; and loco-regional therapies, such as thermal ablation and transarterial embolization techniques. This article provides a review of treatment strategies for the three most common subtypes of hepatic malignancy treated with loco-regional therapies: hepatocellular carcinoma, neuroendocrine metastases, and colorectal metastases. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited. Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy. We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure. All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P

OBJECTIVE: To evaluate quantitative changes in Diffusion Tensor Magnetic Resonance Tractography in prostate cancer following androgen deprivation and radiation therapy. METHODS: 22 patients with elevated PSA and biopsy proven prostate carcinoma who underwent MRI of the prostate at 1.5 T with an endorectal coil were included. Group A) was the study group (n = 11), participants who underwent androgen deprivation and/or radiation therapy and group B) were Gleason-matched control group (n = 11) participants who did not undergo such therapy. Diffusion weighted images were used to generate three-dimensional (3D) map of fiber tracts from DTI. 3D regions of interest (ROI) were drawn over the tumor and healthy prostatic parenchyma in both groups to record tract number and tract density. Tumor region and normal parenchymal tract densities within each group were compared. RESULTS: Mean tract density in the tumor region and normal parenchyma was 2.3 and 3.3 in study group (tract numbers: 116.6 and 170.2 respectively) and 1.6 and 2.7 in the control group respectively (tract numbers: 252.5 and 346.3 respectively). The difference between these values was statistically significant for the control group (p = 0.0018) but not for the study group (p = 0.11). The difference between the tract numbers of tumor and normal parenchyma appears to narrow following therapy. CONCLUSION: The study demonstrated utility in using tractography as a biomarker in prostate cancer patients post treatment. ADVANCES IN KNOWLEDGE: Quantitative DTI fiber tractography is a promising imaging biomarker to quantitatively assess treatment response in the setting of post-androgen deprivation and radiation therapy for prostate cancer.

Infected fluid collections are common and occur in a variety of clinical scenarios throughout the body. Minimally invasive image-guided management strategies for infected fluid collections are often preferred over more invasive options, given their low rate of complications and high rates of success. However, specific clinical scenarios, anatomic considerations, and prior or ongoing treatments must be considered when determining the optimal management strategy. As such, several common scenarios relating to infected fluid collections were developed using evidence-based guidelines for management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Rationale and Objectives To determine trends in nonvascular image-guided procedures at an urban general hospital over a 10-year period and to compare utilization of nonvascular interventional radiology (IR) over the decade 2001–2010 to a previously reported analysis for 1991–2000. Methods With institutional review board approval, a 20-year quality assurance database verified against the radiology information system was queried for procedure location (eg, pleura, liver, bowel, and abdomen) and type (eg, biopsy, catheter insertion, and transient drainage), demographics, and change over time. Yearly admissions and new hospital numbers assigned each year served to normalize for overall hospital activity. Results A total of 50,195 IR procedures were performed in 24,309 distinct patients (male:female, 12,625:11,684; average age, 60 years), 940 procedures performed in age P P P Conclusions Referrals for nonvascular IR procedures have doubled over 2 decades, outpacing growth in new hospital patients and requiring increased resource allocation.

To demonstrate the clinical translation of optical molecular imaging (OMI) for the localization of focal hepatic lesions during percutaneous hepatic interventions.Institutional review board approval was obtained for this prospective, single-center, HIPAA-compliant trial. Patients who were suspected of having hepatocellular carcinoma or liver metastases from colorectal cancer and were scheduled for percutaneous liver biopsy or thermal ablation were eligible for this study. Patients (n = 5) received 0.5 mg per kilogram of body weight of indocyanine green (ICG) intravenously 24 hours prior to their scheduled procedure in this study. Intraprocedurally, a handheld device composed of an endoscope that fits coaxially through a standard 17-gauge introducer needle was advanced into the liver, and real-time measurements of ICG fluorescence were obtained. A point-of-care fluorescence imaging system was used to image ICG fluorescence in biopsy samples. Target-to-background ratios (TBRs) were calculated by dividing the mean fluorescence intensity in the lesion by the mean fluorescence intensity in the adjacent liver parenchyma. The reference standard for determination of proper needle positioning in patients undergoing biopsy was final pathologic analysis of biopsy specimens or follow-up imaging.Intraprocedural OMI was successfully performed in six lesions (two lesions in patient 3) in five patients. The median size of the targeted lesions was 16 mm (range, 10-21 mm). Four of five biopsies (80%) yielded an accurate pathologic diagnosis, and one biopsy specimen showed benign liver parenchyma; both ablated lesions showed no residual disease 1 month after the procedure. The median overall added procedure time to perform OMI was 2 minutes. ICG was found to localize with TBRs greater than 2.0 (median, 7.9; range, 2.4-13.4) in all target lesions. No trial-related adverse events were reported.The clinical translation of OMI to percutaneous hepatic interventions was demonstrated.

To evaluate whether the Aorta-Lesion-Attenuation-Difference on contrast-enhanced CT can aid in the differentiation of malignant and benign oncocytic renal neoplasms. Two independent cohorts—an initial (biopsy) dataset and a validation (surgical) dataset—with oncocytomas and chromophobe renal cell carcinomas (chRCC) were included in this IRB-approved retrospective study. A region of interest was placed on the renal mass and abdominal aorta on the same CT image slice to calculate an Aorta-Lesion-Attenuation-Difference (ALAD). ROC curves were plotted for different enhancement phases, and diagnostic performance of ALAD for differentiating chRCC from oncocytomas was calculated. Seventy-nine renal masses (56 oncocytomas, 23 chRCC) were analyzed in the initial (biopsy) dataset. Thirty-six renal masses (16 oncocytomas, 20 chRCC) were reviewed in the validation (surgical) cohort. ALAD showed a statistically significant difference between oncocytomas and chromophobes during the nephrographic phase (p

Hybrid PET/MR scanners are innovative imaging devices that simultaneously or sequentially acquire and fuse anatomical and functional data from magnetic resonance (MR) with metabolic information from positron emission tomography (PET) (Delso et al. in J Nucl Med 52:1914-1922, 2011; Zaidi et al. in Phys Med Biol 56:3091-3106, 2011). Hybrid PET/MR scanners have the potential to greatly impact not only on medical research but also, and more importantly, on patient management. Although their clinical applications are still under investigation, the increased worldwide availability of PET/MR scanners, and the growing published literature are important determinants in their rising utilization for primarily clinical applications. In this manuscript, we provide a summary of the physical features of PET/MR, including its limitations, which are most relevant to clinical PET/MR implementation and to interpretation. Thereafter, we discuss the most important current and emergent clinical applications of such hybrid technology in the abdomen and pelvis, both in the field of oncologic and non-oncologic imaging, and we provide, when possible, a comparison with clinically consolidated imaging techniques, like for example PET/CT.

The purpose of this study was to evaluate the efficacy of CT-guided percutaneous biopsy of isoattenuating liver lesions using anatomic landmarks (ALs) to guide needle placement and added value of intravenous (IV) contrast. An interventional radiology database was reviewed to identify patients with CT-guided percutaneous biopsy of isoattenuating focal liver lesions using ALs to guide needle placement. The cohort was further divided into two groups: lesions biopsied using ALs only and lesions biopsied using ALs and intravenous contrast (AL+IV). Pathology results or follow-up imaging served as reference standard. Sensitivity and accuracy were calculated, Student’s t test and Fisher’s exact test were used for statistical comparison between the two groups. Between January 2000 and December 2011, CT-guided percutaneous biopsy of 133 isoattenuating focal liver lesions was performed in 133 patients. The AL group included 54 patients (M:F = 29:25) with 54 lesions (size range 7–90 mm, mean 32.1 ± 18.1) and AL+IV group included 79 patients (M:F = 44:35) with 79 lesions (size range 7–100 mm, mean 25.6 ± 15.0). AL group included 23 (43%) benign and 31 (57%) malignant lesions; AL+IV group included 31 (39%) benign and 48 (61%) malignant lesions. Sensitivity and accuracy for CT-guided biopsy of focal isoattenuating liver lesions were, overall 94% and 96%, AL group 97% and 98% and AL+IV group 92% and 94%, with no statistical significant difference between the AL and AL+IV groups (P = 0.88–1.00). Accurate planning and utilizing of internal reference ALs is successful in yielding a diagnostic sample for CT-guided percutaneous biopsy of isoattenuating focal liver lesion. The confidence of accurate targeting can be enhanced by administering IV contrast, however, since the visualization provided by IV contrast can be short-lived; use of IV contrast does not obviate the need for precise planning based on ALs.

Correct staging is imperative for colorectal cancer (CRC) since it influences both prognosis and management. Several imaging methods are used for this purpose, with variable performance. Positron emission tomography–magnetic resonance (PET/MR) is an innovative imaging technique recently employed for clinical application. The present study was undertaken to compare the staging accuracy of whole-body positron emission tomography–computed tomography (PET/CT) with whole-body PET/MR in patients with both newly diagnosed and treated colorectal cancer. Twenty-six patients, who underwent same day whole-body (WB) PET/CT and WB-PET/MR, were evaluated. PET/CT and PET/MR studies were interpreted by consensus by a radiologist and a nuclear medicine physician. Correlations with prior imaging and follow-up studies were used as the reference standard. Correct staging was compared between methods using McNemar’s Chi square test. The two methods were in agreement and correct for 18/26 (69%) patients, and in agreement and incorrect for one patient (3.8%). PET/MR and PET/CT stages for the remaining 7/26 patients (27%) were discordant, with PET/MR staging being correct in all seven cases. PET/MR significantly outperformed PET/CT overall for accurate staging (P = 0.02). PET/MR outperformed PET/CT in CRC staging. PET/MR might allow accurate local and distant staging of CRC patients during both at the time of diagnosis and during follow-up.

The purpose of this article is to review the spectrum of early and delayed normal cross-sectional imaging findings after percutaneous radiofrequency ablation of hepatic tumors.Knowledge of postablation imaging changes is vital not only for the interventionalist who performs the procedure but also for the diagnostician who interprets the postablation imaging. Recognition of normal postprocedural changes and differentiation from abnormal imaging findings prevent overcalling benign changes as abnormal and can thus avoid needless treatment.

Fluid collections that are incompletely drained despite adequate catheter position, size, and number represent a minority of abscesses but a source of great frustration for patients, surgeons, and interventional radiologists. Drainage of such complex collections is known to be more effective with the adjunctive use of intracavitary fibrinolytic agents instilled via the drainage catheter. In this review article, we discuss the role of fibrinolytics specifically tissue plasminogen activator as explored by interventional radiologists in enhancing effective drainage of these complex abdominal and pelvic collections as well as complex pleural collections.

Percutaneous urologic biopsy is a safe and effective technique and can comprise a significant proportion of the daily workload of the interventional radiologist. This article discusses the indications and rationale for the performance of renal, ureter, and bladder biopsy as well as the approach to performing such biopsies, pitfalls, and potential complications.

Purpose To retrospectively evaluate positron emission tomography (PET)/magnetic resonance (MR) enterography for the differentiation of fibrotic strictures from inflammatory strictures in patients with Crohn disease. Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board. Patients gave their written informed consent for study enrollment. PET/MR enterography images were evaluated in 19 patients with Crohn disease who had strictures that underwent surgical resection with pathologic confirmation. Two radiologists and a nuclear medicine physician in consensus evaluated the following bowel wall PET/MR enterography biomarkers: signal intensity (SI) on T2-weighted images, apparent diffusion coefficient (ADC), PET maximum standardized uptake value (SUVmax), SI on T2-weighted images × SUVmax, and ADC × SUVmax values at levels that corresponded to pathologic specimens. MR, PET, and hybrid PET/MR biomarkers were compared, and the performance for differentiation of inflammatory strictures from fibrotic strictures was assessed. Mixed-model regression analysis was used to compare the mean imaging parameters between groups; the P values were corrected for the five comparisons by using the Bonferroni method. Results Three of the PET/MR enterography biomarkers, SUVmax, SI on T2-weighted images × SUVmax, and ADC × SUVmax, showed significant differences in the fibrosis group compared with the fibrosis with active inflammation group and the active inflammation only group. The best discriminator between fibrosis and active inflammation was the combined PET/MR enterography biomarker ADC × SUVmax cutoff of less than 3000, which was associated with accuracy, sensitivity, and specificity values of 0.71, 0.67, and 0.73, respectively. Conclusion PET/MR enterography offers a potential noninvasive technique for the differentiation of purely fibrotic strictures from mixed or inflammatory strictures. A hybrid biomarker that incorporates both MR and PET information performed better for stricture evaluation than either modality alone. (©) RSNA, 2015.

In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.

Percutaneous ablation in the kidney is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection. Its increasing use has been largely prompted by the rising incidental detection of renal cell carcinomas with cross-sectional imaging and the need to preserve renal function in patients with comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. Clinical studies to date indicate that radiofrequency ablation and cryoablation are effective therapies with acceptable short- to intermediate-term outcomes and with a low risk in the appropriate setting, with attention to pre-, peri-, and postprocedural detail. The results following percutaneous radiofrequency ablation and cryoablation in the treatment of renal cell carcinoma are reviewed in this article, including those of several larger scale studies of ablation of T1a tumors. Clinical and technical considerations unique to ablation in the kidney are presented, and potential complications are discussed.

OBJECTIVE. This report reviews the current clinical status of percutaneous ablation of hepatocellular carcinoma (HCC). CONCLUSION. HCC is increasing in incidence. Multiple percutaneous ablation methods are now available for primary treatment or for bridging to transplantation. Percutaneous ethanol instillation and radiofrequency ablation are the most extensively evaluated percutaneous treatments for HCC. Newer technologies are being evaluated and may change future practice patterns.

A 17-year-old boy was admitted to the hospital because of a 6-week history of abdominal pain, constipation, and weight loss. Gastrointestinal radiographs showed narrowing of the cecum. CT scans showed peritoneal implants and a mediastinal mass.

The purpose of this study was to assess the technical and clinical success and complications of imaging-guided percutaneous catheter drainage of peripancreatic fluid collections after distal pancreatectomy.Between January 2001 and February 2009, the cases of patients who underwent distal pancreatectomy were selected from a surgical database, and the cases of those who underwent subsequent interventional radiologic percutaneous drainage were identified. Details of percutaneous catheter drainage were recorded, and technical and clinical success was determined. Technical success was defined as successful percutaneous imaging-guided placement of a drainage catheter. Primary clinical success was defined as resolution of peripancreatic fluid collection with percutaneous drainage only. Secondary clinical success was defined as resolution of peripancreatic fluid collection with percutaneous drainage and additional manipulations (i.e., tube repositioning, additional catheter drainage) and no surgical débridement. Multifactor logistic regression analysis was used to identify predictors of drain failure.Between January 2001 and February 2009, 365 patients underwent distal pancreatectomy. Of these, 51 patients (14%; 25 men, 26 women; mean age, 53.4 years; range, 18-81 years) underwent 57 CT-guided percutaneous procedures for drainage of postsurgical peripancreatic fluid collection. The mean interval between surgery and drainage was 23.5 days (median, 17 days; range, 2-120 days), and the mean collection size was 7.3 cm in transverse dimension (median, 6.9 cm; range, 2.3-16 cm). The mean duration of catheter drainage was 39.7 days (median, 24 days; range, 3-220 days). The technical success rate was 100%, primary clinical success rate was 60%, and primary and secondary clinical success rates together were 95%. Three of the 51 patients (6%) needed surgery for definitive management of the collection. One of 51 patients (2%) had a complication of the interventional radiologic procedure. Catheter size and the need for additional catheter manipulation were significantly associated with drainage failure (p0.05).Catheter drainage of peripancreatic fluid collections after distal pancreatectomy is a technically safe and clinically effective procedure. Although extra manipulations may be needed to achieve clinical success, the combined primary and secondary clinical success rates are high.

The purpose of this article is to describe our experience draining deep muscular and musculoskeletal abscess collections with CT guidance, emphasizing clinicopathologic factors associated with drain failure, and to further analyze patient outcomes according to whether the process involves muscle alone or also involves adjacent bone or joint (skeletal involvement).The details of percutaneous catheter drainage were retrospectively recorded for all drainages performed over a 9-year period. The technical and clinical successes of percutaneous catheter drainage were determined. Multifactor logistic regression analysis was used to identify predictors of drain failure (malignancy, age, chemotherapy, surgery, infection, complexity, size, days in situ, and skeletal involvement). These parameters were assessed in all patients, those with muscle involvement alone and those with musculoskeletal collections.Eighty-nine of 94 patients underwent one percutaneous drainage procedure and 5 of 94 patients underwent two drainages for a total of 99 drainages in 94 patients (one drainage [n = 89] and two drainages [n = 5]). There were 62 men and 32 women with a mean age of 58.5 years (age range [±SD], 22.3-88.0 ± 16 years). The abscess diameters ranged from 1.8 to 13 cm (mean, 5.3 ± 2.5 cm), volume aspirated ranged from 0 to 200 mL (mean, 45 ± 44 mL), and mean duration of drainage was 16.2 days (range, 2-110 ± 18.7 days). The iliopsoas muscle was the most common site of drainage, accounting for 87.8% of the total. Catheter insertion was possible in all patients, with the muscular component successfully drained in 82% (81/99) overall: 85% (46/54) of those with muscle involvement alone and 77% (35/45) of those with musculoskeletal collections. Catheter drainage and antibiotic administration resulted in 65.6% (65/99) not requiring any surgical intervention and resolution of abnormal white cell count or fevers in 98.8% (79/80) of those with abnormal parameters before treatment. Skeletal infection was associated with increased risk of drainage failure (p = 0.0001).Percutaneous imaging-guided musculoskeletal drainage is clinically useful, safe, and effective for draining complex musculoskeletal collections. It is highly effective for draining collections involving muscle alone; however, skeletal infection is associated with a higher risk of drain failure.

Purpose To evaluate the technical and clinical success rates of computed tomography (CT)–guided percutaneous drainage of mediastinal abscesses. Materials and Methods An interventional radiology database was used to identify patients who underwent CT-guided percutaneous drainage of mediastinal abscesses. Medical records were reviewed to evaluate abscess etiology, drainage technique, clinical outcome, and complications. Results Over a 10-year period, 23 patients (20 men; average age, 54 y; range, 34–77 y) with 24 mediastinal abscesses underwent 25 CT-guided drainage procedures. Abscess etiologies included esophageal leak after esophagectomy (n = 6), perforated esophageal cancer (n = 4), Nissen fundoplication (n = 3), emetogenic esophageal rupture (n = 3), infectious (n = 2), cardiac surgery (n = 1), iatrogenic (n = 1), gastric strangulation (n = 1), Whipple procedure (n = 1), and thoracotomy for lung cancer (n = 1). Drainages were performed with tandem trocar (n = 14) or Seldinger (n = 11) technique. A total of 25 catheters were used: 8.5 F (n = 9), 10 F (n = 8), 12 F (n = 6), 14 F (n = 1), and 16 F (n = 1). The mean time of catheter drainage was 13.6 days. Technical success was achieved in all 25 attempts (100%). Twenty-two of the 23 patients had complete resolution of the abscess without the need for surgical debridement, for a clinical success rate of 95.6%. One patient underwent technically and clinically successful abscess drainage but required surgical exploration for repair of an anastomotic leak after esophagogastrectomy. There was one complication. One patient had inadvertent placement of a catheter within a pulmonary vein. The catheter was removed after 24 hours without hemodynamic consequences. Conclusions Percutaneous CT-guided drainage of mediastinal abscesses is an uncommon procedure, but the results of this study suggest that it is associated with high technical and clinical success rates.

PURPOSE To evaluate the effectiveness, cost, and cost-effectiveness of using renal mass biopsy to guide treatment decisions for small incidentally detected renal tumors. MATERIALS AND METHODS A decision-analytic Markov model was developed to estimate life expectancy and lifetime costs for patients with small (< or = 4-cm) renal tumors. Two strategies were compared: renal mass biopsy to triage patients to surgery or imaging surveillance and empiric nephron-sparing surgery. The model incorporated biopsy performance, the probability of track seeding with malignant cells, the prevalence and growth of benign and malignant tumors, treatment effectiveness and costs, and patient outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference under a willingness-to-pay threshold of $75,000 per quality-adjusted life-year (QALY). Effects of changes in key parameters on strategy preference were evaluated in sensitivity analysis. RESULTS Under base-case assumptions, the biopsy strategy yielded a minimally greater quality-adjusted life expectancy (4 days) than did empiric surgery at a lower lifetime cost ($3466), dominating surgery from a cost-effectiveness perspective. Over the majority of parameter ranges tested in one-way sensitivity analysis, the biopsy strategy dominated surgery or was cost-effective relative to surgery based on a $75,000-per-QALY willingness-to-pay threshold. In two-way sensitivity analysis, surgery yielded greater life expectancy when the prevalence of malignancy and propensity for biopsy-negative cancers to metastasize were both higher than expected or when the sensitivity and specificity of biopsy were both lower than expected. CONCLUSION The use of biopsy to guide treatment decisions for small incidentally detected renal tumors is cost-effective and can prevent unnecessary surgery in many cases.

The purpose of this study was to evaluate the efficacy of imaging-guided percutaneous radiofrequency ablation to treat metastatic retroperitoneal disease in patients with gynecologic malignancies.Patients with retroperitoneal metastatic disease due to gynecologic malignancies were evaluated for imaging-guided percutaneous radiofrequency ablation in this study. Efficacy of treatment was assessed by post-radiofrequency ablation activity on PET/CT scans.Eight patients were considered for imaging-guided percutaneous radiofrequency ablation of retroperitoneal metastatic disease. Radiofrequency ablation was successfully completed in five patients with six metastatic tumors. All procedures were performed with the use of hydrodissection as an adjunct maneuver to displace adjacent structures. All patients showed absence of FDG activity on post-radiofrequency ablation PET/CT scans. Three (60%) of the five patients showed absence of FDG activity of the treated disease at 23.5 months after radiofrequency ablation.Imaging-guided percutaneous radiofrequency ablation may be considered as an alternative to currently available therapies to treat recurrent metastatic disease due to endometrial carcinoma.

OBJECTIVE. The purpose of this article is to discuss the history of, indications and rationale for, and approach to imaging-guided percutaneous renal biopsies.CONCLUSION. With the progressive increase in the number of incidentally discovered renal masses, increased use of percutaneous ablation as a treatment alternative for the management of renal cell carcinoma and improvements in immunohistochemistry techniques, imaging-guided renal biopsy will continue to serve as a useful tool for the evaluation and management of renal diseases.

The purposes of this study were to determine the frequency with which percutaneous abdominopelvic abscess drainage catheters must be replaced because of inadequate drainage, to assess the effect of percutaneous catheter exchange on clinical outcome, and to determine the predictors of clinical success after catheter exchange.A database of interventional radiology procedures performed at a single tertiary care hospital from 2001 to 2006 was searched to identify the cases of patients who underwent percutaneous catheter drainage of abdominal or pelvic abscesses that was followed by exchange of the drainage catheter at a later date. The electronic medical records and imaging studies of these patients were retrospectively reviewed to determine the abscess characteristics, details of drainage catheter manipulation, and clinical outcome.Among the 3,027 percutaneous abscess drainage catheters placed, 82 were exchanged because of lack of improvement (imaging evidence of undrained fluid and persistent fever and leukocytosis), for an overall frequency of catheter exchange of 2.7% of abscesses in 3.7% of patients. The success rate of catheter replacement, defined as resolution of the fluid collection without open surgical drainage, was 76.8% (63/82). Prognostic factors favorably influencing the clinical success of catheter exchange included a larger number of drainage catheter sideholes, absence of a fistula, low residual abscess volume after initial catheter drainage, and low CT attenuation of abscess fluid.In cases of persistent abscess despite adequate catheter placement, percutaneous catheter exchange over a wire is useful for salvage after the large majority of primary failures. In addition, performance of CT and fluoroscopic catheter injection before catheter exchange facilitates recognition of the predictors of a likely response to catheter exchange.

A 65-year-old man with a history of well-controlled hypertension presents for a follow-up visit after an incidental finding of a small mass in the right kidney on an abdominal computed tomographic scan (ordered to evaluate lower-quadrant pain, which has since resolved). The mass is 3.2 cm, anterior, heterogeneous, and solid, and is in the right renal hilum near the main renal artery, vein, and ureter; the left kidney appears normal. The patient feels well, his physical examination is unremarkable. His serum creatinine level is 1.2 mg per deciliter. How should this patient be further evaluated and treated?

The objective of this study was to evaluate the effectiveness of CT-guided injection of 5% dextrose in water solution (D5W) into the retroperitoneum to displace organs adjacent to renal cell carcinoma.An interventional radiology database was searched to identify the cases of patients who underwent CT-guided percutaneous radiofrequency ablation of biopsy-proven renal cell carcinoma in which D5W was injected into the retroperitoneal space to displace structures away from the targeted renal tumor. The number of organs displaced and the distance between the renal tumor and adjacent organs before and after displacement with D5W were assessed.The cases of 135 patients with 139 biopsy-proven renal cell carcinomas who underwent 154 percutaneous CT-guided radiofrequency ablation procedures were found in the search. Thirty-one patients with 33 renal cell carcinomas underwent 36 ablation procedures after injection of D5W into the retroperitoneal space. Fifty-five organs were displaced away from renal cell carcinoma with this technique. The average distance between adjacent structures and renal cell carcinomas before displacement was 0.36 cm (range, 0.1-1.0 cm). The average distance between structures and adjacent renal cell carcinomas after displacement was 1.94 cm (range, 1.1-4.3 cm) (p0.0001). The average volume of D5W used to achieve organ displacement was 273.5 mL. No complications were associated with this technique.CT-guided injection of D5W into the retroperitoneum is an effective method for displacing vital structures away from renal cell carcinoma.

The objective of our study was to determine the likelihood of malignancy in thyroid nodules and the risk of a nondiagnostic fine-needle aspiration biopsy (FNAB) on the basis of the demographic characteristics of the patients and sonographic features of the nodules.Between January 2002 and November 2007, 2,338 ultrasound-guided thyroid, thyroid bed, and cervical lymph node FNABs were performed at a tertiary referral center. Entry criteria for our retrospective study were adult patients who underwent thyroid nodule FNAB and had previously undergone diagnostic sonography. From previous reports for 944 thyroid nodules (739 nodules in women and 205 nodules in men), four sonographic features were recorded: longest dimension, morphology, presence of microcalcifications, and presence of lymphadenopathy. The final diagnosis of each nodule was classified as benign, malignant, or nondiagnostic on the basis of surgical pathology when available and cytology otherwise and was analyzed for correlation with individual sonographic features and combinations of features.The prevalence of malignancy and of nondiagnostic FNAB in this study was 11.0% and 11.8%, respectively. Statistically significant (p0.05) findings in malignant nodules were younger patient age (or = 45 years; odds ratio [OR], 1.54) and solid nodule morphology (OR, 2.38). The significant predictors of a nondiagnostic-quality FNAB were older patient age (75 years; OR, 1.95) and a noduleor = 10 mm (OR, 1.45). Adding information about the other evaluated ultrasound features did not lead to a significant result.Malignant thyroid nodules tend to be solid (86.5%). Patients older than 75 years showed a clearly increased risk of nondiagnostic FNAB, but to predict a higher risk of malignancy or of nondiagnostic FNAB using ultrasound remains difficult.

Purpose To compare the effectiveness of percutaneous abscess drainage in patients with pyogenic liver abscesses of the following types: single, single multiloculated, multiple, and multiple multiloculated. Materials and Methods One hundred nine patients with 149 liver abscesses who underwent percutaneous drainage during an 11-year period were divided into a single abscess group and a multiple abscess group. Of the 109 patients, 54 had multiloculated abscesses and were divided into single and multiple multiloculated abscess groups. Technical success was defined as the ability to place the catheter within the abscess cavity and clinical success was defined as improvement in the patient's symptoms. Clinical findings, management strategy, complication rate, and success rate were analyzed. Results Technical success rates were 96% (82 of 85) for a single abscess and 96% (23 of 24) for multiple abscesses ( P = 1.0). Clinical success was achieved in 74 of 85 patients (87%) with a single abscess and 22 of 24 patients (92%) with multiple abscesses ( P = .729). Technical success rates were 94% (32 of 34) for a single multiloculated abscess and 95% (19 of 20) for multiple multiloculated abscesses ( P = 1.0). Clinical success was achieved in 30 of 34 patients (88%) with a single multiloculated abscess and 18 of 20 patients (90%) with multiple multiloculated abscesses ( P = 1). No significant difference in hospital stay was seen between single and multiple abscess groups ( P = .373) or between single multiloculated and multiple multiloculated abscess groups ( P = .180). There were no major complications or mortality related to the procedure. Conclusions Percutaneous drainage is a safe and effective procedure in the treatment of pyogenic liver abscess, regardless of abscess complexity and/or multiplicity.

To determine the effectiveness of percutaneous balloon dilation of benign postoperative biliary strictures.We received approval from our institutional review board to undertake this retrospective HIPAA-compliant study, and informed consent was waived. From April 1, 1977, to April 1, 2007, percutaneous biliary balloon dilation (PBBD) was performed in 85 patients with benign biliary strictures. In the 75 patients with follow-up (31 male, 44 female; mean age, 56 years; mean follow-up, 8 years), 205 PBBD procedures were performed during 112 treatments of 84 biliary strictures. PBBD of the stricture was performed with a noncompliant balloon (8-12-mm diameter). PBBD procedures were repeated at 2- to 14-day intervals until cholangiography demonstrated free drainage of contrast material to the bowel and no residual stenosis. An internal-external biliary drain was left in situ for a mean of 14-22 days and removed after a clinical trial of catheter clamping and a normal cholangiogram.All procedures were technically successful, and 52, 11, 10, and two patients underwent a total of one, two, three, and four PBBD treatments, respectively. Four of 205 procedures (2%) led to major complications: two subphrenic abscesses, one hepatic arterial pseudoaneurysm, and one case of hematobilia treated with transfusion. Six patients died from unrelated causes and three from hepatitis C-related liver failure. The probability of a patient not developing clinically significant restenosis at 5, 10, 15, 20, and 25 years was 0.52, 0.49, 0.49, 0.41, and 0.41, respectively, after the first PBBD treatment and 0.43, 0.30, 0.20, 0.20, and 0.20, respectively, after the second PBBD treatment. No significant difference was found in the rate of clinically significant restenosis after the first PBBD between strictures at anastomotic and nonanastomotic sites (P = .75). During the follow-up period, 56 of 75 patients (75%) had successful management with PBBD.PBBD of benign strictures demonstrates long-term effectiveness. No significant difference was found in the rate of clinically significant restenosis after PBBD of biliary strictures at anastomotic and nonanastomotic sites.

The purpose of this study was to review our 13-year experience with sonographically guided transvaginal drainage procedures in terms of type of transvaginal procedure, that is, aspiration or catheter drainage, complication rate, and long-term success.A search of an interventional radiology database identified 85 transvaginal drainage procedures on 67 patients. Pertinent medical records and images were reviewed. Clinical success was defined as no need for surgery.The mean follow-up period was 36.6 months (range, 7 days-132 months). Forty-five aspiration and 40 catheter drainage procedures were performed on 67 patients. Indications for the procedures included postoperative fluid collection (n = 25), tuboovarian abscess unresponsive to medical therapy (n = 17), symptomatic ovarian cyst (n = 17), and miscellaneous causes (n = 8). Clinical success was achieved in 50 of 67 cases (75%), including all cases of 25 postoperative fluid collection, 12 of 17 tuboovarian abscesses (71%), and seven of 17 ovarian cysts (41%). No complications were found in patients who underwent aspiration alone. The following minor complications occurred in patients who underwent catheter drainage: two cases of bladder transgression, one case of infection, and one case of catheter-related pain. Premature dislodgment of the catheter was an issue for four of 40 patients (10%).Postoperative fluid collections can be managed with a high rate of success by means of transvaginal aspiration or catheter drainage. Transvaginal catheter drainage is an alternative to surgery in the management of tuboovarian abscesses unresponsive to medical management. Aspiration alone is sufficient to drain ovarian cysts and provide symptomatic relief. Most cysts recur, however, ultimately necessitating surgery. Aspiration is safe, but catheter drainage is associated with a 10% rate of minor complications.