Postoperative Imaging Appearance Research Articles

Transoral Robotic Surgery in Head and Neck Cancer: What Radiologists Need to Know about the Cutting Edge

The evolution of oncologic surgical technology has moved toward reducing patient morbidity and mortality without compromising oncologic resection or oncologic outcomes. The goals in treating head and neck cancer are to cure patients, as well as to provide quality of life by improving functional and social outcomes through organ-preservation therapies, which may include surgery, chemotherapy, and/or radiation therapy. Transoral robotic surgery (TORS) is an emerging technique that provides several benefits over existing treatment regimens and over open surgery for head and neck cancer, including reductions in operative times, blood loss, intensive care unit stays, and overall duration of patient hospitalization. Transoral robotic techniques allow wide-view, high-resolution, magnified three-dimensional optics for visualization of the mucosal surfaces of the head and neck through an endoscope, while avoiding the extensive external cervical incisions often required for open surgeries. Radiologists play an important role in the successful outcome of these procedures, both before and after TORS. Determining a cancer patient's surgical candidacy for TORS requires a thorough preoperative radiologic evaluation, coupled with clinical and intraoperative assessment. Radiologists must pay particular attention to important anatomic landmarks that are clinical blind spots for surgeons. Knowledge of the expected postoperative imaging appearances, so that they can be distinguished from recurrent disease and second primary tumors, is essential for all radiologists involved in the care of these patients.

Surgical decompression of arachnoid cysts: a study on 44 pediatric patients

Abstract Background: There are yet to clarify some aspects regarding the surgical indications and surgical methods that are at choice for treating ACs. The purpose of the study is to contribute to the ongoing debate on the most appropriate treatment. Materials and methods: We included in the study 44 pediatric patients (aged < 18 years), operated for ACs in the Neurosurgery I Department, of the Emergency Clinical Hospital “Bagdasar- Arseni” in Bucharest, during the period January 2003 to December 2012. The surgical methods were either a craniotomy or cyst shunting. The information regarding these patients was retrospectively assessed based on their clinical and imaging records, and cross checked with the OR protocols. Treatment efficiency was evaluated considering postoperative clinical status, imaging appearance and postoperative complications. Results: 84.1% of the patients reported postoperative disappearance or reduction of symptoms, while 13.6 had the same complaints as prior surgery. Only one patient experienced worsening of symptoms. Follow-up imaging showed cyst disappearance in 29.5% patients and cyst reduction in 61.4% patients. 9.1% had no change in cyst volume. Craniotomy correlated with a better imaging appearance (p=0.02). There was no correlation between improved clinical status and cyst fluid reduction (p=0.6). 9 patients (20.4%), all with temporal cysts, experienced postoperative complications, and 7 of them (15, 9%) needed surgery. There was no severe or permanent dysfunction in any of the patients. 42.8% of the cyst shunting patients suffered postoperative complications, whereas only 10% of the craniotomy patients did. Conclusion: Cyst decompression results in significant clinical improvement and it can be performed with little risk for severe complications. Craniotomy seems to be a better surgical treatment option than cystoperitoneal shunt, with a better neuroimaging appearance and a lower complications rate

CT After Pancreaticoduodenectomy: Spectrum of Normal Findings and Complications

The purpose of this article is to discuss the normal findings and complications after pancreaticoduodenectomy. The Whipple procedure is associated with a set of common complications, including pancreatic fistula, postsurgical hemorrhage, postoperative pancreatitis, portomesenteric venous thrombosis, hepatic infarction, delayed gastric emptying, and anastomotic strictures. Appropriate diagnosis of these complications is contingent on an understanding of the surgical anatomy, normal postoperative imaging appearance in both the immediate postoperative and chronic settings, and typical CT appearance of each of these complications.

Textiloma mimicking recurrent glioblastoma: A case report.

e13044 Background: Although uncommon, materials used for dissection or to achieve hemostasis during neurosurgical procedures can cause an inflammatory reaction called textiloma that can mimic recurrent tumor. We report a case where advanced magnetic resonance (MR) imaging suggested tumor, further mimicking previous reports of clinical and conventional MR patterns of tumor progression. Methods: A 61 year-old woman underwent an initial resection of a temporal lobe glioblastoma, followed by conventional chemoradiation, although maintenance temozolomide was stopped secondary to myelotoxicity. A nodular enhancing mass near to the surgical cavity was noted 10 months after diagnosis, leading to further evaluation with advanced MR imaging. Results: Brain MRI with advanced imaging studies including MR Spectroscopy (MRS), and perfusion imaging by dynamic contract-enhanced (DCE), and dynamic contrast susceptibility (DSC) were performed. There was progressive enlargement of an enhancing nodule in the wall of the resection cavity. MRS demonstrated an elevated choline-to-creatine ratio (approximately 2:1), while the DSC imaging demonstrated a mild amount of leak with a corrected cerebral blood volume value of about 1.93, and negative enhancement integral value 1.67. DCE demonstrated mild vascularity and mild-to-moderate leak, with an elevated peak enhancement integral value of ~22%. These imaging findings suggested recurrent GBM rather than post-treatment change. The mass was resected. Pathologic review showed both textiloma and radiation necrosis. Recurrent glioblastoma was not identified. Conclusions: Although very unusual, textiloma should be considered in the differential diagnosis of any growing mass lesion close to a surgical bed. Reparative granulomata show many of the hallmarks of cancer, including neovascularization, rapid growth and high lipid turnover, making it difficult to distinguish such lesions from true neoplasm, even with advanced imaging, without resorting to histology. Advanced imaging performs best in distinguishing conventional post-treatment change from tumor recurrence. This case highlights the major influence of surgical technique on postoperative imaging appearance.

Postoperative imaging of vestibular schwannomas

Symptomatic vestibular schwannomas can be treated with resection (translabyrinthine, retrosigmoid [suboccipital], or middle cranial fossa approaches) or stereotactic radiosurgery. When appropriate, auditory brainstem stimulators can also be implanted in patients with current or impending hearing loss due to bilateral vestibular schwannomas. Imaging plays a prominent role in determining management following these procedures. In this article, the expected postoperative imaging appearances are depicted. The radiological features of complications are also reviewed, including recurrent tumor, fat graft necrosis, CSF leakage, infection, hydrocephalus, cerebral infarction, venous sinus thrombosis, hemorrhage, and temporal lobe and cerebellar contusions.

Transient lateral patellar dislocation: review of imaging findings, patellofemoral anatomy, and treatment options

Transient patellar dislocation is a common sports-related injury in young adults. Although patients often present to the emergency department with acute knee pain and hemarthrosis, spontaneous reduction frequently occurs, and half of cases are unsuspected clinically. Characteristic magnetic resonance imaging (MRI) findings often lead to the diagnosis. The purpose of this review is to illustrate the MRI findings of lateral patellar dislocation and concomitant injuries, such as kissing contusions of the medial patella and lateral femoral condyle; osteochondral and avulsion fractures; and injuries of the medial patellofemoral ligament/retinacular complex. This article will also briefly review patellofemoral anatomy and passive, active, and static stabilizers. Predisposing factors for patellar instability, including trochlear dysplasia, patella alta, and lateralization of the patella or tibial tuberosity and their relevant measurements will also be highlighted. Treatment options, including surgery, such as medial patellofemoral ligament reconstruction, tibial tuberosity transfer, and trochleoplasty, and their postoperative imaging appearances will also be discussed.

Imaging of Whole-Organ Pancreas Transplants

Whole pancreas transplantation is an established treatment for selected patients with diabetic nephropathy or poorly controlled diabetes. Surgical techniques vary and have evolved over the past 4 decades. Imaging evaluation of the whole-pancreas transplant should begin with an understanding of the most commonly used surgical techniques and the spectrum of postoperative complications. Ultrasonography (US) should be the first-line modality in evaluating the pancreas allograft and vasculature. Computed tomography (CT) is useful in the assessment of extra-allograft processes, particularly in ruling out abscess formation or evaluating suspected bowel complications. Magnetic resonance (MR) imaging is reserved for cases in which complete evaluation with US or CT is not possible. MR angiography can help provide an accurate assessment of vascular abnormalities. The radiologist must be familiar with the spectrum of surgical techniques and the normal postoperative imaging appearances of the whole-pancreas transplant so as to be able to recognize abnormal postoperative findings. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.322115144/-/DC1.

Pre- and postoperative magnetic resonance imaging appearance of the normal residual pituitary gland following macroadenoma resection: Clinical implications

Background:To assess the relationship between the preoperative magnetic resonance imaging (MRI) appearance of the normal residual pituitary gland (NRPG) and pituitary functional outcome following transsphenoidal resection of pituitary macroadenomas.Methods:We retrospectively reviewed the medical records of 100 consecutive patients with a pituitary macroadenoma, who underwent transsphenoidal resection. The preoperative configuration of the displaced NRPG was stratified as superior, superolateral or lateral. The extent of postoperative restitution of the NRPG was divided into four groups: Group 1 — normal residual gland or almost normal; Group 2 — more than 50% restitution; Group 3 — less than 50% of the normal residual gland; and Group 4 — barely visible or absent residual gland. The pre- and postoperative NRPG appearance was correlated with pituitary functional status.Results:Preoperatively, the NRPG was identifiable in 79 patients, with extrasellar displacement in 53%. The displacement pattern was superior in 8%, superolateral in 32%, and lateral in 58% of the patients. If the NRPG was displaced laterally, the ipsilateral cavernous sinus was not invaded by the pituitary macroadenoma. Partial or complete pituitary function was lost in 6 / 23 (26.1%) patients with superior or superolateral displacement of the NRPG, compared to only 1 / 36 (2.8%) patients without superior displacement of the NRPG (P = 0.025). Progressive postoperative reconstitution of the NRPG was related to the preservation of the pituitary hormonal axis (Pearson Chi-Square P < 0.001).Conclusions:Progressive displacement of the NRPG preoperatively, and lack of restitution of the NRPG on postoperative MRI appeared to correlate with the postoperative pituitary functional loss.

The Elephant Trunk Procedure for Aortic Aneurysm Repair: An Illustrated Guide to Surgical Technique With CT Correlation

The purpose of this article is to provide a comprehensive overview of a relatively new surgical aortic procedure, the elephant trunk technique. In conjunction with information from the literature, a series of illustrations provide a detailed description of the surgical procedure and postoperative appearance with CT correlation. This article explains the rationale behind a staged thoracic aortic surgery, describes and illustrates the surgical technique used to perform the elephant trunk procedure and the normal postoperative imaging appearance, and discusses potential complications specific to the elephant trunk procedure.

MR imaging of the postoperative knee

Advances in orthopedic and arthroscopic surgical procedures of the knee such as, knee replacement, ligamentous reconstruction as well as articular cartilage and meniscus repair techniques have resulted in a significant increase in the number of patients undergoing knee arthroscopy or open surgery. As a consequence postoperative MR imaging examinations increase. Comprehensive knowledge of the normal postoperative MR imaging appearances and abnormal findings in the knee associated with failure or complications of common orthopedic and arthroscopic surgical procedures currently undertaken is crucial. This article reviews the various normal and pathological postoperative MR imaging findings following anterior and posterior cruciate ligament, medial collateral ligament and posterolateral corner reconstruction, meniscus and articular cartilage surgery as well as total knee arthroplasty with emphasis on those surgical procedures which general radiologists will likely be faced in their daily clinical routine.

Pelvi-perineal flap reconstruction: normal imaging appearances and post-operative complications on cross-sectional imaging

Radical pelvic surgery is often required in patients with advanced, persistent or recurrent gynaecological and anorectal malignancies. In the last decade, pedicled flap reconstructions have been increasingly used for pelvic floor and neovaginal reconstruction, introducing well-vascularised non-irradiated tissue into the wound cavity and hence reducing wound complications. The aim of this pictorial review is to describe the normal post-operative cross-sectional imaging appearances of the most commonly used pelvi-perineal flap reconstructions and to illustrate the complications that may arise at the flap donor and recipient sites.

Multimodality Imaging of the Pediatric Diaphragm: Anatomy and Pathologic Conditions

Apart from serving as an important landmark for description and staging of pathologic conditions, the diaphragm is also affected by various types of pathologic conditions in children. Congenital abnormalities affecting the diaphragm include aplasia or hypoplasia, accessory diaphragm, eventration, and hernias. Congenital diaphragmatic hernias (CDHs) include Bochdalek, Morgagni, and hiatal hernias. Although survival rates are improving with the advent of new therapies, there is still significant morbidity and mortality associated with CDH. The morbidity and mortality depend on the associated congenital anomalies, the size of the hernia, and the degree of lung hypoplasia. Newer surgical repair techniques for the diaphragm have resulted in new postoperative complications and imaging appearances. Ultrasonography has become the modality of choice for evaluation of diaphragmatic paralysis. The diaphragm is uncommonly affected by trauma in children; when diaphragmatic injury is present, it usually indicates high-impact trauma associated with other severe injuries. Primary diaphragmatic tumors are very rare in children, with rhabdomyosarcoma being the most common. The diaphragm may also be secondarily involved by invasion of an adjacent tumor. Radiologists should have an understanding of the embryology, anatomy, and anatomic variations of the diaphragm and should be aware of the imaging appearances of pathologic conditions affecting the diaphragm in children.

An Overview of Lung Surgeries: Postoperative CT Findings and Complications

There are various types of surgeries performed on the lungs, airways, pleura, and chest wall. As radiologists, it is imperative to understand the various surgeries, their expected post-operative imaging appearance and possible complications. The thoracic surgeries are broadly divided into two categories: open surgery and minimally invasive surgery. This article is a multi-modality review of open and minimally-invasive surgeries performed on the lung, pleura, trachea and chest wall. Computed tomography (CT) images, positron emission tomography (PET) images and radiographs, as well as intra-operative photographs and original illustrations of surgeries are provided to enhance understanding.

Magnetic Resonance Imaging and Clinical Evaluation of Patellar Resurfacing with Press-Fit Osteochondral Autograft Plugs

Background Autologous osteochondral transplantation (AOT) has been successfully used in the femoral condyle and trochlea and is an attractive treatment option for full-thickness patellar cartilage lesions. Hypothesis Patients treated with AOT for the repair of symptomatic, isolated patellar cartilage lesions will demonstrate improvement in functional outcomes and postoperative magnetic resonance imaging appearance. Study Design Case series; Level of evidence, 4. Methods Between 2002 and 2006, patients with focal patellar cartilage lesions treated with AOT were prospectively followed. The mean age at the time of surgery was 30 years. Clinical assessment was performed with the International Knee Documentation Committee (IKDC), activities of daily living of the Knee Outcome Survey (ADL), and Short Form-36 (SF-36) at baseline and most recent follow-up. Magnetic resonance imaging was used to evaluate the cartilage repair morphologic characteristics in 14 cases. Results Twenty-two patients met the study criteria with a mean follow-up of 28.7 months (range, 17.7–57.8 months). The mean Patellar lesion size was 165.6 ± 127.8 mm and the mean size of the donor plug was 9.7 ± 1.1 mm in diameter with 1.8 ± 1.4 Plugs/defect. The mean preoperative IKDC score was 47.2 ± 14.0 and improved to 74.4 ± 12.3 (P = .028). The mean preoperative ADL score was 60.1 ± 16.9 and increased to 84.7 ± 8.3 (P = .022). The mean SF-36 also demonstrated an improvement, from 64.0 ± 14.8 at baseline to 79.4 ± 15.4 (P = .059). Nine patients underwent concomitant distal realignment and demonstrated improvement between preoperative and postoperative outcomes scores, but these differences were not statistically significant. Magnetic resonance imaging appearance demonstrated that all plugs demonstrated good (67%–100%) cartilage fill, 64% with fissures <2 mm at the articular cartilage interface, 71 % with complete trabecular incorporation, and 71 % with flush plug appearance. Conclusion Patellar AOT is an effective treatment for focal patellar chondral lesions, with significant improvement in clinical follow-up. This study suggests that patients with patellar malalignment may represent a subset of patients who have a poor Prognostic outlook compared with patients with normal alignment.

Pre- and Postoperative Evaluation of Urethral Diverticulum

The purpose of this article is to review the diagnostic imaging findings, differential diagnosis, complications, and postoperative imaging appearance of urethral diverticulum. With increased clinical awareness and advanced imaging techniques, diagnoses of urethral diverticula are more frequent, and radiologists need to be aware of the pre- and postoperative imaging appearances of this disorder.

MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage

The surgical management of knee injuries has increased in recent years. Postoperative magnetic resonance (MR) imaging of the knee following surgical intervention serves an important role in the diagnostic evaluation of patients with recurrent or residual symptoms following surgical intervention. MR imaging additionally assists in the noninvasive documentation of temporal changes at the surgical site potentially reflective of procedural success, or failure. Background understanding of the common surgical procedures performed, their normal postoperative MR imaging appearance, and imaging features of potential procedural complications are essential in the accurate evaluation of patients following prior knee surgery. The focus of the following article is to review the clinical and MR imaging features of the postoperative knee following prior surgical treatment of ligamentous, meniscal, and articular cartilage injuries of the joint.

Imaging of postoperative knee extensor mechanism

Disorders of the anterior knee are common and include patellofemoral syndrome, patella instability, patella fracture, and patellar and quadriceps tendon ruptures. Depending on the operative procedure performed, the post-operative imaging appearance of these knees may be confusing. It is crucial for the radiologist to be familiar with the procedures performed in order to recognize the postoperative findings. Radiologists must be able to interpret hardware (anchors, screw and wires) and disruptions in soft tissue planes that may persist with these types of procedures.

Imaging evaluation of post pancreatic surgery

The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy. Ultrasound examination may be used to detect peritoneal fluid in the early post-operative period as well as lesion recurrence in long-term follow-up. Radiological gastrointestinal studies has a major role in evaluation of intestinal functionality. In spite of the advent of other imaging modalities, CT is the most effective after pancreatic surgery. On post-operative CT, the most common findings were small fluid peritoneal or pancreatic collections, stranding of the mesenteric fat with perivascular cuffing, reactive adenopathy and pneumobilia. In addition, CT may demonstrate early (leakage of anastomosis, pancreatico-jejunal fistula, haemorrage, acute pancreatitis of the remnant pancreas, peritonitis), and late (chronic fistula, abscess, aneurysms, anastomotic bilio-digestive stenosis, perianastomotic ulcers, biloma, and intra-abdominal bleeding) surgical complications. In the follow-up evaluation, CT may show tumor recurrence, liver and lymph nodes metastasis. Magnetic resonance may be used as alternative imaging modality to CT, when renal insufficiency or contrast sensitivity prevents the use of iodinated i.v. contrast material or when the biliary tree study is primarily requested. The knowledge of the type of surgical procedures, the proper identification of the anastomoses as well as the normal post-operative imaging appearances are essential for an accurate detection of the complications and recurrent disease.

MR Imaging Evaluation of the Postoperative Knee

The increased number of patients undergoing arthroscopy or surgery of the knee for sports medicine injuries is leading to increased numbers of patients who require imaging after surgery because of failure to improve, recurrent symptoms, or new injury. As in preoperative patients, magnetic resonance (MR) imaging is the most valuable imaging method for postoperative evaluation of the knee. Surgical changes increase the difficulty of diagnosis of abnormalities in the knee with MR imaging. MR arthrography with direct intraarticular injection of contrast material can help improve evaluation of the postoperative meniscus and possibly help improve evaluation of anterior cruciate ligament grafts in patients after surgery. Recognition of the normal postoperative MR imaging appearance of the structures in the knee and of abnormalities is essential to accurate MR imaging evaluation of these patients.

Extracortical Bridging Callus After Limb Salvage Surgery About the Knee

The increasing survival of children treated for osteosarcoma has led to an increase in limb sparing surgery. Little published information is available about the postoperative imaging appearance of this technique. Thus, information gleaned from medical records and imaging reviews was correlated with clinical outcome of 19 consecutive children (median age at diagnosis, 12.3 years) treated for distal femoral osteosarcoma with a cemented rotating hinged knee endoprosthesis with porous coated collar. An extracortical bridging bony callus was identified in 16 patients who were followed up after surgery for a median of 2.8 years (range, 1.4-6 years). Extracortical bridging bony callus formation was circumferential in eight and preferentially posterior in nine, and ranged from 0.5 to 0.7 cm in thickness; 14 patients had lucent lines subjacent to the bridging bone. Thirteen patients had good functional use of the surgically treated leg. Five patients had progressive metastatic disease develop. One patient had local disease recurrence 8 months after surgery. Extracortical bridging bone was not identified in three patients, two of whom had infection develop 7 months and 17 months after surgery; both infections required amputation. Extracortical bridging bone preferentially develops posteriorly, along the compression side of the femur, often is associated with subjacent lucency, and seems to reflect increased prosthetic stability.