Effect of absorbable topical hemostatic agents on the relaxation time of blood: an in vitro study with implications for postoperative magnetic resonance imaging

Abstract

Surgicel alters the appearance of early postoperative MR images. To avoid misinterpretation, clinicians should be aware of this phenomenon.

Radiological and histopathological comparison of microporous polysaccharide hemospheres and oxidized regenerated cellulose in the rabbit brain: a study of efficacy and safety

“…Topical hemostatic agents in early post-operative images and their remnants in the follow-up period may cause misinterpretation since especially collagen-and cellulose-based agents may have effects on the pH and T1 values of blood and have hyperintense signal characteristics on T1-weighted images (9,16). These features may mimic a residual or recurrent tumor on post-contrast MR scans (10,13).…”

“…Minimal use of hemostatic agent for effective hemostasis and maximal cleaning of field from residual agents after achievement of hemostasis is recommended (18). The in-vitro antimicrobial activity of ORC in the early post-operative period via decreasing the local pH has been shown previously (15), but ORC may also cause granulation formation without bio-degradation in the late post-operative period and this may result complicate the radiological and clinical differential diagnosis of abscess, residual/recurrent tumors and granuloma (10,12,13,16). Furthermore, existence of residual material may serve as a bed for microorganisms in the late period.…”

“…Serving as a focus for infection and having a potential for inducing foreign body reaction are the other side effects of these agents. Topical hemostatic agents may also cause a mass effect and edema (16). Microporous polysaccharide hemospheres (MPH), a new generation hemostatic agent (Arista™; Medafor Inc, Minneapolis, MN) are derived from plant starch and powder-like agent.…”

Imaging Features of a Gelatin-Thrombin Matrix Hemostatic Agent in the Intracranial Surgical Bed: A Unique Space-Occupying Pseudomass

“…Therefore, normal immediate postoperative surgical cavities contain extra-axial fluid and a small amount of independent air and hemostatic agents such as Surgicel along the wall. 4,5 Gelatin-thrombin matrix (Floseal Hemostatic Matrix; Baxter Healthcare, Deerfield, Illinois) is an absorbable bovine gelatinhuman thrombin composite. Following the approval of Floseal in neurosurgery in 2001 by the US Food and Drug Administration based on the safety and efficacy data from a multicenter prospective randomized clinical trial, it has been increasingly used in spine, brain, pituitary, and endoscopic sinus surgeries.…”

Use of intraoperative MRI for resection of gliomas

“…In such cases, appearance of a lesion may look like deep seated gray matter making difficult to establish a reasonable margin of resection. It should be noted that haemostatic elements (like Surgicel®) produce subtle image artifacts that may mimic blood or residual tumor 17 . In our series there was no instance of intraoperative hematoma disclosed by MRI, though, if it were the case, an early detection could avoid further complications.…”