A Technique for MRI-Guided Transrectal Deep Pelvic Abscess Drainage
Sherif Gamal Nour1,2,3,
Jamal J. Derakhshan1,2,
Nila J. Akhtar1,
Martin A. Ayres1,
Mark E. Clampitt1,
Thomas A. Stellato4 and
Jeffrey L. Duerk1,2,5
1 Department of Radiology, University Hospitals of Cleveland, Case Western
Reserve University School of Medicine, 11100 Euclid Ave., Cleveland, OH
44106.
2 Department of Biomedical Engineering, Case Western Reserve University,
Cleveland, OH.
3 Department of Diagnostic Radiology, Cairo University Hospitals, Cairo,
Egypt.
4 Department of Surgery, University Hospitals of Cleveland, Case Western Reserve
University School of Medicine, Cleveland, OH.
5 Department of Oncology, University Hospitals of Cleveland, Case Western
Reserve University School of Medicine, Cleveland, OH.
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Fig. 1A —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Preprocedural sagittal (A) and axial
(B) true fast imaging with steady-state free precession (true-FISP)
images (TR/TE, 4.35/2.18; field of view, 250 x 250 mm, matrix, 192
x 192; slice thickness, 5 mm; flip angle, 60°; number of signals
averaged, 3) show typical setup for triorthogonal image plane guidance.
Desired trajectory is planned so that fluid component of presacral abscess
(arrowheads) cavity resides along sagittal (1), oblique coronal (2),
and axial (3) planes of guidance. Trajectory can subsequently be modified to
any combination of three planes during needle navigation in time-efficient
manner.
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Fig. 1B —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Preprocedural sagittal (A) and axial
(B) true fast imaging with steady-state free precession (true-FISP)
images (TR/TE, 4.35/2.18; field of view, 250 x 250 mm, matrix, 192
x 192; slice thickness, 5 mm; flip angle, 60°; number of signals
averaged, 3) show typical setup for triorthogonal image plane guidance.
Desired trajectory is planned so that fluid component of presacral abscess
(arrowheads) cavity resides along sagittal (1), oblique coronal (2),
and axial (3) planes of guidance. Trajectory can subsequently be modified to
any combination of three planes during needle navigation in time-efficient
manner.
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Fig. 1C —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Under real-time MR "fluoroscopy"
using true FISP images (C, sagittal; D, coronal oblique;
E, axial), puncture needle (arrowheads) has been advanced
through rectum. Needle tip (arrows) is seen within fluid component of
abscess cavity. Ability to observe continuous update of needle tip location on
simultaneously displayed three planes allows fast and confident puncture of
abscess cavity.
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Fig. 1D —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Under real-time MR "fluoroscopy"
using true FISP images (C, sagittal; D, coronal oblique;
E, axial), puncture needle (arrowheads) has been advanced
through rectum. Needle tip (arrows) is seen within fluid component of
abscess cavity. Ability to observe continuous update of needle tip location on
simultaneously displayed three planes allows fast and confident puncture of
abscess cavity.
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View larger version (88K):
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Fig. 1E —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Under real-time MR "fluoroscopy"
using true FISP images (C, sagittal; D, coronal oblique;
E, axial), puncture needle (arrowheads) has been advanced
through rectum. Needle tip (arrows) is seen within fluid component of
abscess cavity. Ability to observe continuous update of needle tip location on
simultaneously displayed three planes allows fast and confident puncture of
abscess cavity.
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Fig. 1F —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Final confirmation sagittal (F) and
axial (G) true FISP images of drainage catheter in place show catheter
shaft (arrowheads) extending through rectum and within air component
of abscess cavity. Pigtail end (arrows) has been locked in dependent
portion of fluid component.
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Fig. 1G —62-year-old man with presacral abscess secondary to
anastomotic leakage after resection of invasive rectal adenocarcinoma who was
referred for abscess drainage. Final confirmation sagittal (F) and
axial (G) true FISP images of drainage catheter in place show catheter
shaft (arrowheads) extending through rectum and within air component
of abscess cavity. Pigtail end (arrows) has been locked in dependent
portion of fluid component.
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