Publications by authors named "Pouya Entezari"

15 Publications

  • Page 1 of 1

Role of Interventional Radiology in the Management of Acute Cholangitis.

Semin Intervent Radiol 2021 Aug 10;38(3):321-329. Epub 2021 Aug 10.

Division of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois.

Acute cholangitis presents with a wide severity spectrum and can rapidly deteriorate from local infection to multiorgan failure and fatal sepsis. The pathophysiology, diagnosis, and general management principles will be discussed in this review article. The focus of this article will be on the role of biliary drainage performed by interventional radiology to manage acute cholangitis. There are specific scenarios where percutaneous drainage should be preferred over endoscopic drainage. Percutaneous transhepatic and transjejunal biliary drainage are both options available to interventional radiology. Additionally, interventional radiology is now able to manage these patients beyond providing acute biliary drainage including cholangioplasty, stenting, and percutaneous cholangioscopy/biopsy.
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http://dx.doi.org/10.1055/s-0041-1731370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8354721PMC
August 2021

Post-embolization outcomes of splenic artery pseudoaneurysms: A single-center experience.

Clin Imaging 2021 Jul 26;80:160-166. Epub 2021 Jul 26.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA. Electronic address:

Purpose: Splenic artery pseudoaneurysms (PSA) are relatively rare but associated with high mortality/morbidity when presenting acutely. Embolization has emerged as the treatment of choice. We aim to evaluate the outcomes of embolization for the treatment of splenic artery PSAs.

Methods: From 2007 to 2019, all patients that underwent embolization for splenic artery PSAs were included in this IRB-approved review. Evaluated outcomes included complications, morbidity/mortality rates, and 30-day white blood cell count. Student t-tests were performed to compare laboratory values before and after embolization. 5-year survival rates were estimated using Kaplan Meier methodology.

Results: A retrospective analysis of 24 patients (14 males, mean age 51 ± 19 years) who underwent splenic artery PSA embolization was performed. Fifteen PSA embolizations were performed in an emergent setting. There was technical success in 23/24 patients. Etiologies included trauma (10), pancreatitis (9), post-surgical (3), and malignancy (2). Post-embolization patients had a mean length of stay of 19 days and within 30 days, 9 patients developed leukocytosis (median of 14,800/μl). The 5-year survival rate of these patients was 89% [95% CI 75% - 100%]. Post-procedure, 4 patients developed grade 2 complications. Grade 3 complications were observed in 5 patients. One (4.2%) splenic abscess was identified. Of the 19 patients with follow-up imaging, 14 patients had splenic infarcts (5 infarcts were >50% of splenic volume).

Conclusions: Splenic artery PSAs are encountered in the emergent setting and are most frequently secondary to trauma or pancreatitis. Embolization can be life-saving in these critically ill patients.
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http://dx.doi.org/10.1016/j.clinimag.2021.07.007DOI Listing
July 2021

Intrahepatic Cholangiocarcinoma.

Semin Intervent Radiol 2020 Dec 11;37(5):475-483. Epub 2020 Dec 11.

Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois.

Cholangiocarcinoma is the second most common primary malignancy of the liver. This review will focus on the mass-forming intrahepatic type of this disease and discuss the role of medical, surgical, and radiation oncology in managing this difficult disease. A global understanding to the management of intrahepatic cholangiocarcinoma (ICC) can help the interventional radiologist understand the role of locoregional therapies such as ablation, transarterial chemoembolization, and radioembolization in the management of ICC.
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http://dx.doi.org/10.1055/s-0040-1719188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732564PMC
December 2020

Percutaneous Ultrasound-Guided Superior and Inferior Mesenteric Vein Access for Portal Vein Recanalization-Transjugular Intrahepatic Portosystemic Shunt: A Case Series.

Cardiovasc Intervent Radiol 2021 Mar 23;44(3):496-499. Epub 2020 Nov 23.

Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, 676 N. St. Clair, Suite 800, Chicago, Illinois, 60611, USA.

Objective: To describe the technique and outcomes of mesenteric access under ultrasound guidance to perform portal vein recanalization-transjugular intrahepatic portosystemic shunt (PVR-TIPS).

Methods: Four patients (3 male: 1 female, mean age: 46.2 years; range 38-64 years) with portal vein thrombosis (PVT) and cavernous transformation were eligible for PVR-TIPS. Due to inaccessible splenic vein (one patient with history of splenectomy and 3 patients with unavailable splenic vein during the procedure), noninvasive direct puncture of superior (n = 3) and inferior (n = 1) mesenteric vein was conducted under ultrasound guidance to obtain access for PVR-TIPS.

Results: Trans-mesenteric access and PVR-TIPS were successful in all patients at first attempt. No immediate complication was observed following the procedures. Follow-up imaging with computed tomography (CT) scan and Doppler ultrasound revealed patent TIPS and portal venous vasculature in all patients.

Conclusion: Percutaneous noninvasive transmesenteric access is a feasible approach for PVR-TIPS in patients with inaccessible splenic veins.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00270-020-02713-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682948PMC
March 2021

Percutaneous Access of the Modified Hutson Loop for Retrograde Cholangiography, Endoscopy, and Biliary Interventions.

J Vasc Interv Radiol 2020 Dec 16;31(12):2113-2120.e1. Epub 2020 Sep 16.

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.

Purpose: The purpose of this study was to present the institutional experience of performing endoscopy, cholangiography, and biliary interventions through the modified Hutson loop by interventional radiology.

Materials And Methods: A total of 61 of 64 modified Hutson loop access procedures were successful. This single-center retrospective study included 61 successful procedures of biliary interventions using existing modified Hutson loops (surgically affixed subcutaneous jejunal limb adjacent to biliary anastomosis or anastomoses) for diagnostic or therapeutic purposes in 21 patients. Seventeen of 21 patients (81%) had undergone liver transplantation. Indications included biliary strictures (n = 18) and biliary leaks (n = 3). The clinical success and complications were evaluated.

Results: There were 3 of 26 modified Hutson loop retrograde biliary intervention failures (12%) before introduction of endoscopy and no failures (0 of 38 [0%]) subsequently (P = .06). Endoscopy or cholangioscopy was performed in 19 procedures by interventional radiologists. Retrograde biliary interventions included diagnostic cholangiography (n = 26), cholangioplasty (n = 25), stent placement (n = 29), stent retrieval (n = 25), and biliary drainage catheter placement (n = 5). No procedure-related mortality occurred. There was 1 major complication (duodenal perforation) (1.6%) and 12 minor complications (19%). In the 9 patients undergoing therapeutic interventions for biliary strictures, there was a significant decrease in median alkaline phosphatase (288.5 to 174.5 U/L; P = .03). There was a trend toward decrease in median bilirubin levels (1.7 to 1 mg/dL; P = .06) at 1 month post-intervention.

Conclusions: The modified Hutson loop provided interventional radiologists a safe and effective alternative access to manage biliary complications in patients with biliary-enteric anastomoses. Introduction of the endoscope in interventional radiology has improved the success rate of these procedures.
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http://dx.doi.org/10.1016/j.jvir.2020.06.011DOI Listing
December 2020

Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review.

Adv J Emerg Med 2020 16;4(1):e9. Epub 2019 Oct 16.

Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Context: This systematic review of clinical trials was conducted to compare the diagnostic accuracy of ultrasound in comparison to plain radiography in shoulder dislocation.

Evidence Acquisition: MEDLINE, Cochrane Database of Systematic Reviews, clinicaltrials.gov, Google scholar, and Scopus were searched for clinical trials. Diagnosis of shoulder dislocation and confirmation of shoulder reduction were the outcomes of interest. Sensitivity, specificity, positive predictive value and negative predictive value of included clinical trials were calculated.

Results: Seven studies met our inclusion criteria and were analyzed. All included studies except two had a sensitivity and specificity of 100% for ultrasound (one with a sensitivity of 54% and one with a specificity of 60%).

Conclusion: It can be suggested that ultrasound can be used as a reliable alternative diagnostic method for detection of both dislocation and reduction in shoulder joint. This may decrease the delay in treatment, cost, radiation exposure, and need for repeated sedation.
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http://dx.doi.org/10.22114/ajem.v0i0.285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6955034PMC
October 2019

Desmopressin/indomethacin combination efficacy and safety in renal colic pain management: A randomized placebo controlled trial.

Am J Emerg Med 2019 06 11;37(6):1009-1012. Epub 2018 Aug 11.

Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Introduction: Renal colic is a prevalent cause of abdominal pain in the emergency department. Although non-steroidal anti-inflammatory drugs and opioids are used for the treatment of renal colic, some adverse effects have been reported. Therefore, desmopressin -a synthetic analogue of vasopressin- has been proposed as another treatment choice. In the present study, indomethacin in combination with nasal desmopressin was compared with indomethacin alone in the management of renal colic.

Methods: Included in the study were 124 patients with initial diagnosis of renal colic and randomized to receive indomethacin suppository (100 mg) with either desmopressin intranasal spray (4 puffs, total dose of 40 micrograms) and or placebo intranasal spray.

Results: All the included patients were finally diagnosed with renal colic. There was no difference between the two groups in pain at the baseline (p = 0.4) and both treatments reduced pain successfully (p < 0.001). There was no significant difference between the two groups in pain reduction (p = 0.35).

Conclusions: While there was significant pain reduction in both patients groups, pain reduction of NSAIDs (e.g. indomethacin) in renal colic, does not significantly improve when given in combination with desmopressin.
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http://dx.doi.org/10.1016/j.ajem.2018.08.033DOI Listing
June 2019

Assessing the Relation of Epicardial Fat Thickness and Volume, Quantified by 256-Slice Computed Tomography Scan, With Coronary Artery Disease and Cardiovascular Risk Factors.

Arch Iran Med 2018 03 1;21(3):95-100. Epub 2018 Mar 1.

Department of Radiology, Shaheed Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: This study aimed to investigate the association between epicardial adipose tissue (EAT) and coronary artery disease (CAD) as well as cardiovascular risk factors.

Methods: Complete medical records of subjects were reviewed and cardiovascular risk factors were recorded. Epicardial fat volume (EFV) and epicardial fat thickness (EFT) were measured using digital volumetry of acquired images using a 256-slice CT-scanner. Calcium score was measured using Agatston method in non-contrast images. After contrast administration, bolus-tract images were obtained. Coronary arteries were assessed using reconstructed images in arterial phase of contrast-enhanced images. EFV and EFT measurements were compared to computed tomography angiography (CTA) findings of coronary arteries.

Results: A total of 269 patients (Mean age: 55.5 ± 12.1, 44% female) were included. Higher means of EFT and EFV were associated with coronary artery stenosis. However, the correlation coefficients of the arterial stenosis with EFT and EFV were weak. EFV and EFT had a significant association with age (P < 0.001, P < 0.001 respectively), body mass index (BMI) (P < 0.001, P < 0.001 respectively) and hypertension (P < 0.016, P < 0.003 respectively). Diabetes mellitus (DM) and hyperlipidemia were not significantly associated with EFV (P = 0.069 and 0.639 respectively) and EFT (P = 0.103 and 0.366 respectively). EFV and EFT showed a weak correlation coefficient with calcium scoring (Spearman correlation coefficients: 0.26 and 0.22 respectively, both P < 0.001). In multivariate logistic regression models considering coronary stenosis as dependent variable and EFV, EFT and other CAD risk factors as independent variables, EFV and EFT did not show significant P values and were omitted from the model by other CAD risk factors.

Conclusion: Increased EFV and EFT are associated with CAD, age, BMI and hypertension. However, no remarkable association was found between them and calcium score, hyperlipidemia or DM. These variables could weakly predict CAD in univariate models but they are not independent predictive factors for CAD in multivariate models consisting of other CAD risk factors. Hence, EFT and EFV are not independent predictors for CADs when they are considered simultaneously with other CAD risk factors.
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March 2018

The analgesic action of desmopressin in renal colic.

Acta Clin Belg 2018 04 23;73(2):168. Epub 2017 Oct 23.

a Department of Emergency Medicine , Tehran University of Medical Sciences , Tehran , Iran.

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http://dx.doi.org/10.1080/17843286.2017.1393160DOI Listing
April 2018

Diagnostic Efficacy of Coronary Artery Three-Dimensional Steady-State Free Precession Magnetic Resonance Angiography in Comparison with Invasive Coronary Angiography for Detecting Coronary Artery Disease.

Arch Iran Med 2017 May;20(5):314-319

Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To assess the diagnostic value of three-dimensional steady-state free precession magnetic resonance angiography (3D-SSFP MRA) for detecting coronary artery disease (CAD).

Materials And Methods: Patients suspected of CAD based on clinical evaluation, underwent invasive coronary angiography (CAG) and Cardiac MRA (CMRA). Collected data in favor of any CAD findings in CMRA were compared to CAG results as the standard diagnostic method in CAD detection. Analysis was performed on per-patient, per-vessel and per-segment bases.

Results: A total of 30 patients (mean age: 43 ± 10 years, 19 men) were enrolled for analysis. On per-patient analysis, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under receiver operator characteristic (ROC) curve of CMRA for detection of coronary artery stenosis were 100% (CI95%: 75% - 100%), 50% (CI95%: 18% - 81%), 73.33% (CI95%: 46% - 90%), 100% (CI95%: 47% - 100%) and 0.827, respectively. On per-vessel analysis, CMRA had a sensitivity of 89.29% (CI95%: 71%-97%), specificity of 80.56% (CI95%: 63% - 91%), PPV of 78.13% (CI95%: 60% - 90%), NPV of 90.63% (CI95%: 74% - 98%) and area under ROC curve of 0.845. On per-segment analysis, sensitivity, specificity, PPV and NPV of CMRA for segmental stenosis detection were 77.78% (CI95%: 60% - 89%), 87% (CI95%: 81% - 92%), 62% (CI95%: 46% - 76%), and 93.89% (CI95%:  88% - 97%), respectively. Area under ROC curve was 0.835 on per-segment analysis.

Conclusion: 3D SSFP CMRA provides a promising non-invasive diagnostic tool for assessing coronary artery disease.
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http://dx.doi.org/0172005/AIM.0010DOI Listing
May 2017

Re: Pricop et al.: "Sublingual desmopressin is efficient and safe in the therapy of lithiasic renal colic".

Int Urol Nephrol 2017 07 23;49(7):1209. Epub 2017 Mar 23.

Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

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http://dx.doi.org/10.1007/s11255-017-1575-1DOI Listing
July 2017

Desmopressin effectiveness in renal colic pain management: Systematic review and meta-analysis.

Am J Emerg Med 2016 Aug 12;34(8):1535-41. Epub 2016 May 12.

Emergency Medicine Research Center, Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: This meta-analysis of trials was conducted to evaluate the impact of desmopressin on renal colic pain relief in comparison to more typically used medications (opioids and nonsteroidal anti-inflammatory drugs [NSAIDs]).

Methods: PubMed, EMbase, Scopus, CINHAL, and Cochrane Central Register of Controlled Trials were searched for clinical trials. Pain reduction and need for rescue treatment were the outcomes of interest.

Results: Ten studies met our inclusion criteria and were analyzed. Pooling of data showed that, on a scale of 1-10, pain reduction after 30 minutes was significantly higher in NSAID in comparison to desmopressin (3.39 with a 95% confidence interval [CI] of 4.62-2.16; P<.01), but this reduction was not significantly different between NSAID and desmopressin-NSAID combination (-0.28 with 95% CI of -0.62 to 0.05; P=.01). Summary of relative risk (RR) for the need for rescue treatment in desmopressin in comparison to NSAID was 0.31 with a 95% CI of 0.13-0.74 and a significant RR (P<.04), but no difference was shown in desmopressin-NSAID combination in comparison to NSAID (0.70 with a 95% CI of 0.49-1.00; P<.19). On this outcome, desmopressin in comparison to opioid showed insignificant RR (1.82 with a 95% CI of 0.36-4.34; P=.72), but this need in desmopressin in comparison to desmopressin-opioid combination was 0.75 with a 95% CI of 0.56-0.99 and a significant RR (P=.042).

Conclusion: In conclusion, the results of this systematic review suggest that, according to the present low-quality studies, desmopressin can be used as an adjuvant therapy in renal colic management in combination with opioids.
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http://dx.doi.org/10.1016/j.ajem.2016.05.020DOI Listing
August 2016

The finger lesion.

Intern Emerg Med 2016 Apr 28;11(3):481-2. Epub 2015 Sep 28.

Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1007/s11739-015-1300-yDOI Listing
April 2016

A cutaneous lesion.

Intern Emerg Med 2015 Oct 8;10(7):879-80. Epub 2015 Apr 8.

Department of pathology, Dr Daneshbod Laboratory, Shiraz, Iran.

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http://dx.doi.org/10.1007/s11739-015-1234-4DOI Listing
October 2015

Impact of microscopic duodenitis on symptomatic response to Helicobacter pylori eradication in functional dyspepsia.

Dig Dis Sci 2015 Jan 8;60(1):163-7. Epub 2014 Aug 8.

Division of Gastroenterology, Department of Internal Medicine, Amir Alam Hospital, Tehran University of Medical Sciences, North Sa'adi Street, 13145-784, Tehran, Iran.

Background And Aim: There is no consensus regarding the benefit of eradicating Helicobacter pylori (H. pylori) infection in patients with functional dyspepsia (FD). We intended to compare the symptom response to H. pylori eradication in FD patients in presence or absence of microscopic duodenitis (MD).

Methods: Patients with dyspepsia, normal upper gastrointestinal endoscopy and no psychological comorbidity according to the 12-item General Health Questionnaire underwent duodenal biopsy sampling. Of those, subjects with positive rapid urease test and H. pylori colonization in Wright-Giemsa staining were included in the study and evaluated histologically for presence of MD. All patients received sequential H. pylori eradication therapy and underwent urea breath test 4 weeks after the completion of the treatment to confirm the H. pylori eradication. The severity of dyspepsia was assessed using the Leeds Dyspepsia Questionnaire (LDQ) at baseline, 3rd and 6th months after the H. pylori infection was eradicated.

Results: Thirty seven patients were included in the study [mean age: 34.9 (8.1), 54.05 % female]. MD was observed in 16 (43.2 %) of the subjects. The mean LDQ score in patients with MD decreased from 12.5 (4.1) at baseline to 4.3 (2.1) at 3rd month and 2.6 (1.9) at 6th month. In patients without microscopic duodenitis, the mean LDQ score decreased from 10.6 (5.2) at baseline to 6.8 (4.1) and 6.2 (3.8) at 3rd and 6th months, respectively. The improvement in severity of symptoms in presence of MD was significantly greater than when it was absent (P < 0.001).

Conclusion: FD patients with MD achieved greater symptomatic response with H. pylori eradication than those without microscopic duodenitis.
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http://dx.doi.org/10.1007/s10620-014-3285-1DOI Listing
January 2015
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