Radiology: Ultrasound technique enables rads to ID self injury

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Percutaneous radiologic treatment of self-imbedded soft-tissue foreign bodies (STFBs) via ultrasound and a minimally-invasive removal procedure is safe, precise and effective for radiopaque and nonradiopaque foreign bodies, and can allow radiologists to identify patients engaging in self injury, known as self-embedding behavior (SEB), according to a study published online Sept. 7 in Radiology.

Adam S. Young, BS, of the department of radiology and children’s radiological institute at Nationwide Children’s Hospital in Columbus, Ohio, and colleagues sought to demonstrate the effectiveness and clinical effect of image-guided foreign body removal (IGFBR) in the treatment of embedded STFBs. Additionally, the authors conducted the study in order to “provide the first series report of SEB as a distinct pathologic behavior and address the unique role of the radiologist in the recognition of the behavior, the initiation of intervention and the treatment of the self-injury."

The researchers conducted their study at the children’s hospital, as they noted that 13-23 percent of adolescents report a history of nonsuicidal self-injury, compared to 4 percent of the general population. Utilizing a database of 600 patients treated with IGFBR with ultrasonographic and/or fluoroscopic guidance, self-injury was identified in 1.8 percent of adolescent patients with an age range of 14-18 years and an average age of 16 years.

Young and colleagues evaluated the number of foreign bodies; number of repeat episodes of foreign body insertion; location, type, and size of foreign body; incision size; imaging modality; and success or failure of foreign body removal.

The authors found that the number of STFBs per case ranged from one to 15 and foreign body types included metal (40), plastic (15), graphite (12), glass (four), wood (three), crayon (one) and stone (one). The dimensions of STFBs were 2.5 mm to 160 mm in length by 0.25 mm to 3 mm in thickness. In the 11 patients, 76 foreign bodies were inserted into the arm (69), neck (four), ankle (one), foot (one) or hand (one).

Of the 76 STFBs, 68 were removed in the interventional radiology section and incision lengths averaged 6 mm. Forty-three of the STFBs were removed through ultrasound guidance, 15 with fluoroscopic guidance and 10 with a combination of the two modalities. All 68 removals were successful and without complications via IGFBR, wrote the authors.       

“Percutaneous IGFBR is a less invasive means of removing STFBs that leaves little or no scarring or deformity, which is critical for self-image and self-esteem,” said Young, noting that the treatment is safe for radiopaque and nonradiopaque foreign bodies, including those at risk for fragmentation during traditional surgical removal techniques.

“Radiologist awareness of this recently reported behavior can enable timely diagnosis, foreign body treatment and behavioral therapy to help resolve the underlying disorder causing the repetitive injury,” the study concluded.