title: Retrospective Study in 40 Patients of Utility of C-arm FDCT as an Adjunctive Modality in Technically Challenging Image-Guided Percutaneous Drainage Procedures.
abstract: OBJECTIVE
  To explore the utility of C-arm flat detector computed tomography (FDCT) as an adjunctive modality in technically challenging image-guided percutaneous drainage procedures.
  
  
  METHODS
  Clinical and image data were reviewed on 40 consecutive patients who underwent percutaneous drainage of fluid collections in technically challenging anatomic locations that required the use of C-arm FDCT between 2009 and 2013. Percutaneous drainage was performed under ultrasound and fluoroscopic guidance with the use of C-arm FDCT as a problem-solving tool to identify appropriate needle/wire placement prior to drainage catheter placement (n = 33) or to confirm catheter positioning within the fluid collection (n = 8). Technical success and procedural complications were recorded and retrospectively analyzed.
  
  
  RESULTS
  Forty one fluid collections were identified in 40 patients. Mean number of C-arm FDCT rotational acquisitions per patient was 1.25. Mean procedure time per patient was 59.3 min. Mean fluoroscopy time was 5.5 min, and mean air kerma was 394.3 mGy. Percutaneous drainage with the use of C-arm FDCT was successful in 35 of 40 patients (87.5%). Technical failure was encountered in 5 of 40 patients due to too narrow window (n = 1), too small or no fluid collection noted on C-arm FDCT images (n = 2), and poor image quality requiring the use of a conventional CT scan (n = 2). Three procedure-related complications occurred (7.5%), which included traversed rectum, traversed spleen, and sepsis.
  
  
  CONCLUSIONS
  C-arm FDCT is useful as an adjunctive modality in the interventional suite for technically challenging percutaneous drainage procedures by providing sufficient anatomic detail. Complications of catheter misplacement can be avoided if C-arm FDCT is used prior to tract dilatation. If C-arm FDCT image quality of needle and/or wire placement is poor, conventional CT guidance is recommended.
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA. poyanrafiei@hotmail.com.
authors.forename: Poyan
authors.initials: P
authors.lastname: Rafiei
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA. kims@mir.wustl.edu.
authors.forename: Seung Kwon
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA. kamranm@mir.wustl.edu.
authors.forename: Mudassar
authors.initials: M
authors.lastname: Kamran
authors.affiliation: Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA. saadn@mir.wustl.edu.
authors.forename: Nael E
authors.initials: NE
authors.lastname: Saad
mesh_terms: D004322:Drainage / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015641:Radiography, Interventional / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*; D018084:Ultrasonography, Interventional
keywords: Abscess; Catheter drainage; Non-vascular interventions