In this paper we report on current experience and review magnetic resonance safety protocols and literature in order to define practices surrounding MRI-guided interventional and surgical procedures. Direct experience, the American College of Radiology White paper on MR Safety, and various other sources are summarized. Additional recommendations for interventional and surgical MRI-guided procedures cover suite location/layout, accessibility, safety policy, personnel training, and MRI compatibility issues. Further information is freely available for sites to establish practices to minimize risk and ensure safety. Interventional and intraoperative MRI is emerging from its infancy, with twelve years since the advent of the field and well over 10,000 cases collectively performed. Thus, users of interventional and intraoperative MRI should adapt guidelines utilizing universal standards and terminology and establish a site-specific policy. With policy enforcement and proper training, the interventional and intraoperative MR imaging suite can be a safe and effective environment.
Eleven patients with intracranial cystic collections were evaluated in the open-bore intraoperative MR system. In each case, the cystic collection or the surrounding cerebrospinal fluid (CSF) space was injected with .02 to .5 cc of .5 mol/l gadopentetate dimeglumine. Serial imaging was performed using T1-weighted imaging. In seven patients, free communication was demonstrated between the cystic collection and the surrounding CSF spaces. In four cases, the cyst did not communicate with the CSF; two of these were drained in the intraoperative MR system with reduction in symptoms. One patient developed an aseptic meningitis 10 days after the study, which was successfully treated with steroids; no other complications were noted. We conclude that the communication of intracranial cystic collections with the cisterns and ventricles can be safely and effectively elucidated with gadolinium injection in the intraoperative MR system.
A major goal of surgical treatment of intracranial tumors is to achieve complete resection of the lesion while also preserving normal brain tissue and function. Conventional stereotactic systems used today to localize intracranial lesions are based on previously acquired imaging data sets. These data sets cannot provide surgeons with information about dynamic changes that occur during surgery. The recent development of intraoperative magnetic resonance imaging allows surgical resection to be performed through the eyes of the surgeon with concurrent magnetic resonance images. This advancement has revolutionized the way neurosurgical procedures are being performed.
SurePath LBC cervical cytology sample was taken. This showed hyperchromatic cells with a high N : C ratio and cytoplasmic lumina (Figure 1b). It was reported as 'glandular neoplasia of non-cervical origin, most likely breast. ' There are several articles and case reports of breast carcinoma on cervical cytology reported in the literature. Haji et al. 2 found 20 cases of metastatic breast carcinoma detected on cervical cytology, six of which were lobular carcinomas. Agrawal et al. 3 reported the first case from the UK of metastatic lobular breast carcinoma detected on routine cervical cytology. Unlike the cases reported by Agrawal et al. and others in the literature, our patient did not have abnormal bleeding or known breast carcinoma at the time of screening. Lobular carcinoma comprises 10-15% of breast carcinomas and is more common in women aged 45-55 years. The incidence is increasing, perhaps as a result of the use of hormone replacement therapies. 4 Lobular carcinomas can present with distant metastasis, the identification of the primary lesion being difficult, both by examination and mammography, as it is often a thickened area lacking calcification rather than a discrete mass. 5 There are other reported cases of extra-uterine malignancies metastasizing to the cervix, including malignant melanoma and colorectal cancer, as well as breast carcinoma. 6 Although diagnosis will not be made on morphology alone, the identification of characteristic features, such as melanin pigment or cytoplasmic lumina, is important in identifying a likely tumour type, avoiding unnecessary cervical treatment and ensuring appropriate patient management. Diagnosis on cervical cytology will remain difficult, with confirmation usually relying on IHC and histology, but the much improved morphology seen in LBC samples may allow easier identification of these important features. LBC also facilitates additional testing, allowing the application of IHC techniques to improve reporting accuracy. In this case, the conventional cytology sample showed abnormal cells, but characteristic morphological features of lobular carcinoma were not visible and, consequently, the suspicion of metastatic disease was not raised.Although the reporting of severe dyskaryosis and the subsequent investigations led directly to the unexpected diagnosis of lobular carcinoma, had SurePath LBC technology been in place, it is possible that a more accurate and earlier diagnosis might have been made. Unfortunately, despite the opportunity afforded by LBC to improve reporting accu-racy, the diagnosis of extra-cervical disease will almost certainly be lost if primary screening with human papillomavirus detection is introduced. References 1. Giordano G, Gnetti L, Pilato FP, Viviano L, Silini EM. The role of cervical smear in the diagnosis and management of extrauterine malignancies metastatic to the cervix: three case reports. Diagn Cytopathol 2010;38:41-6. 2. Haji BE, Kapila K, Francis IM, Temmim L, Ahmed MS. Cytomorphological features of metastatic mammary lobular car...
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