RESUMO
BACKGROUND: Asthma is the most common chronic respiratory disease in childhood. Aspergillus fumigatus sensitivity may be involved in the pathogenesis of asthma by leading to different clinical presentations. OBJECTIVE: To investigate the demographic, clinical, laboratory, and radiological characteristics of A. fumigatus sensitivity in childhood asthma and identify associated risk factors and diagnostic parameters. METHODS: A total of 259 children with asthma were included in the study, 7 (2.7%) with allergic bronchopulmonary aspergillosis (ABPA), 84 (32.4%) with A. fumigatus-sensitized asthma (Af-SA), and 168 (64.9%) with A. fumigatus-unsensitized asthma (Af-UA). RESULTS: Aspergillus sensitivity was associated with early asthma onset and longer asthma duration. Total IgE level and asthma severity are highest in ABPA and higher in Af-SA. Absolute eosinophil count was higher, and FEV1 was lower in Af-SA and ABPA. Aspergillus fumigatus was associated with greater odds of being male (odds ratio [OR], 2.45), having atopic dermatitis (OR, 3.159), Alternaria sensitivity (OR, 10.37), and longer asthma duration (OR, 1.266). The best cut-off values for detecting A. fumigatus positivity were 363.5 IU/mL for total IgE and 455 cells/µL for absolute eosinophil count. In Af-SA compared to Af-UA, centrilobular nodules and peribronchial thickening were more common, and the bronchoarterial ratio was higher. CONCLUSIONS: Aspergillus sensitivity is a strong allergic stimulus in asthma, leading to laboratory, structural, clinical, and functional consequences. Af-SA is a distinct asthma endotype independent of ABPA that is characterized by increased risk of severe clinical presentations and impaired lung function.
Assuntos
Aspergilose Broncopulmonar Alérgica , Aspergillus fumigatus , Asma , Imunoglobulina E , Humanos , Masculino , Feminino , Asma/diagnóstico , Asma/imunologia , Criança , Imunoglobulina E/sangue , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/imunologia , Aspergillus fumigatus/imunologia , Pré-Escolar , Fatores de Risco , Adolescente , Alérgenos/imunologia , Eosinófilos/imunologiaRESUMO
AIM: Our aim was to investigate the frequency of various splenic cysts, to define the sonographic differential diagnostic clues and to introduce the value of twinkling artefact in the diagnosis of epidermoid splenic cysts. MATERIAL AND METHODS: All the splenic cysts imaged by ultrasound in 3 university hospitals during the period of 2005 to 2022 were recorded, followed-up and analyzed. RESULTS: One hundred seventy-one patients with splenic cysts were detected and these were classified and 73% of the cysts were simple. Ten cysts were epidermoid cysts as proven by post-operative final histology. CONCLUSION: Cystic splenic lesions are rare. Most of them are small simple cysts. Epidermoid cysts are larger in volume, constitute 6% of the total and can be differentiated by the help of twinkling artefact by Doppler ultrasound.
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Artefatos , Cistos , Esplenopatias , Humanos , Feminino , Masculino , Diagnóstico Diferencial , Esplenopatias/diagnóstico por imagem , Pessoa de Meia-Idade , Adulto , Cistos/diagnóstico por imagem , Idoso , Adolescente , Ultrassonografia/métodos , Adulto Jovem , Idoso de 80 Anos ou mais , Cisto Epidérmico/diagnóstico por imagem , Criança , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
BACKGROUND: Generalized cystic lymphangiomatosis (GCL) is a rare disease characterized by the widespread proliferation of lymphatic vessels, often seen in the pediatric patient group. Imaging techniques are instrumental in revealing the extent and morphological features of the disease. OBJECTIVE: The objective of this study is to interpret the radiological findings of GCL and address the differential diagnosis between GCL and other lymphatic malformations in light of the relevant literature data. METHODS: The sample of this retrospective study consisted of six pediatric patients, four males and two females, diagnosed with GCL based on clinical, radiological, and histopathological findings between 2015 and 2022. The age of the patients at the time of diagnosis and their symptoms at admission were obtained from the hospital database. Radiological imaging findings were evaluated in detail based on the involved systems (thorax, abdomen, and musculoskeletal). RESULTS: The median age of the sample, 4/6 were male, was 9 years at admission (min. 3, max. 12). The most common symptom at admission was dyspnea, often accompanied by pleural effusion. Bone involvement was the most common extrathoracic finding. Abdominal involvement was primarily asymptomatic, and the spleen was the most frequently involved organ in the abdomen. CONCLUSION: The diagnosis of GCL is challenging because of its rarity and overlapping diseases. Whole-body magnetic resonance imaging is a valuable tool as it reveals the typical radiological features of GCL and how far it has spread throughout the body.
Assuntos
Anormalidades Linfáticas , Imageamento por Ressonância Magnética , Feminino , Criança , Humanos , Masculino , Imageamento por Ressonância Magnética/métodos , Diagnóstico Diferencial , Estudos Retrospectivos , Imagem Corporal Total , Anormalidades Linfáticas/patologiaRESUMO
BACKGROUND: The splenic artery, an essential component of abdominal vascular anatomy, exhibits significant variations with clinical implications in surgical and radiological procedures. The lack of a standardized classification system for these variations hinders comparative studies and surgical planning. This study introduces the IPALGEA classification system, based on computed tomography angiography (CTA) findings, to address this gap. METHODS: A retrospective analysis was conducted on 302 patients who underwent CTA at a tertiary university hospital between August 2021 and January 2022. The study focused on the evaluation of splenic artery variations, including the origin, course, terminal branching patterns, and the relationship between the inferior polar artery and the left gastroepiploic artery. The IPALGEA classification was developed to standardize the reporting of these variations. RESULTS: The study highlighted a significant prevalence of splenic artery variations, with the most common pattern being a superior course relative to the pancreas. The IPALGEA classification effectively categorized these variations, emphasizing the relationship between the inferior polar artery and the left gastroepiploic artery. The findings revealed that the bifurcation distance of the celiac trunk varied significantly between genders and that the presence of an inferior polar artery correlated with a shorter hilus distance. CONCLUSION: The IPALGEA classification offers a comprehensive and standardized approach to categorize splenic artery variations. This system enhances our understanding of abdominal vascular anatomy and has significant implications for surgical and radiological procedures, potentially reducing surgical complications and improving patient outcomes.
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Angiografia por Tomografia Computadorizada , Artéria Esplênica , Humanos , Masculino , Feminino , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/anatomia & histologia , Estudos Retrospectivos , Angiografia/métodos , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/anatomia & histologiaRESUMO
BACKGROUND AND AIM: Since there is a limited number of predictive models designed for pediatric patients with pulmonary embolism (PE), healthcare providers have resorted to utilizing the Wells criteria and PE Rule-out Criteria (PERC) that have been validated for use in adults. The objective of the study is to identify the predictive factors for PE and assess the effectiveness of the PERC, Wells, and pediatric-specific PE (PPE) criteria. METHODS: The study included individuals between the ages of 0-18 years who underwent pulmonary CT angiography and/or ventilation-perfusion scintigraphy with suspicion of PE. Demographic characteristics, symptoms, physical examination findings, risk factors, and laboratory and imaging results were retrospectively analyzed, and PERC, Wells, and PPE criteria were applied to the study population. RESULTS: Of the 110 patients included in the study, 27 (24.5%) had PE. Saturation, albumin, cough, calf swelling, central catheter, and malignancy were found to significantly contribute to the model. The total weighted risk score, which represents the sum of all predictive scores, ranged from 0 to 16 with a mean of 5.41 ± 4.02. When the cut-off >6.5, the model had good discrimination power for positive PE (AUC 0.79, 77% sensitivity, and 70% specificity). In our study, the Wells criteria showed a sensitivity of 96% and a specificity of 24%. The PERC exhibited a sensitivity of 96% and a specificity of 21%, while the PPE demonstrated a sensitivity of 74% and a specificity of 30%. CONCLUSION: While the sensitivity of Wells, PERC, and PPE models was higher than our developed model, their specificities were considerably lower than our model.
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Serviço Hospitalar de Emergência , Embolia Pulmonar , Adulto , Humanos , Criança , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Estudos Retrospectivos , Fatores de Risco , Angiografia por Tomografia Computadorizada , Embolia Pulmonar/diagnóstico por imagemRESUMO
Langerhans cell histiocytosis (LCH) is a rare, proliferative disorder that occurs primarily in children. Periportal lesions were detected on ultrasound at different stages of evolution. In this article, we aim to discuss the sonographic findings in liver involvement of LCH.
Assuntos
Histiocitose de Células de Langerhans , Criança , Humanos , Histiocitose de Células de Langerhans/diagnóstico por imagemRESUMO
PURPOSE: The present study aimed to evaluate the relationship between tumor volume and apparent diffusion coefficient (ADC) in preoperative magnetic resonance imaging and deep myometrial invasion, tumor grade, and lymphovascular space invasion (LVSI) in patients with early-stage endometrial cancer. METHODS: The study included 73 patients diagnosed with early-stage endometrial cancer based on histopathological examination between May 2014 and July 2019. Receiver operating characteristic (ROC) curve analysis was used to estimate the accuracy of ADC and tumor volume in predicting the LVSI, the depth of myometrial invasion (DMI), and the histopathological tumor grade in these patients. RESULTS: The areas under the ROC curves (AUCs) of ADC and tumor volume in predicting LVI, DMI, and high tumor grade were significantly greater than those for superficial myometrial invasion and low-grade tumors. The ROC analysis revealed that higher tumor volume was significantly associated with the prediction of DMI and tumor grade (pâ¯= 0.002 and pâ¯= 0.015). The corresponding cut-off values of tumor volume were >â¯7.12 and >â¯9.38â¯mL. The sensitivity of ADC in predicting DMI was higher than its sensitivity in predicting LVSI and grade 1 tumors. Furthermore, tumor volume was significantly associated with the prediction of DMI and tumor grade. CONCLUSION: In the absence of pathological pelvic lymph nodes in early-stage endometrial cancer, tumor volume in DWI sequences determines the active tumor load and tumor aggressiveness. Furthermore, a low ADC indicates deep myometrial invasion and helps differentiate stage IA and stage IB tumors.
Assuntos
Neoplasias do Endométrio , Feminino , Humanos , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/cirurgia , Neoplasias do Endométrio/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/métodos , Endométrio/patologia , Curva ROCRESUMO
PURPOSE: The present study comparatively evaluates the performance of conventional Doppler ultrasound and superb microvascular imaging (SMI) in delineating the cortical microvessels of the transplanted kidney and compares the chronic allograft damage index (CADI) based on the examination of biopsy specimens with Doppler ultrasound and SMI findings. METHODS: Sixty-eight renal transplant recipients underwent kidney biopsy with the pre-diagnosis of rejection before undergoing renal Doppler ultrasound examination between January 2020 and October 2020. The distance between the kidney capsule and the vascular structure closest to the kidney capsule was measured at the level of the lower pole in the transplanted kidney using color Doppler ultrasound (CDUS), power Doppler ultrasound (PDUS), and the SMI technique. The kidney size, resistive index at the level of the arcuate artery in the lower pole of the kidney, and renal artery flow rates were also measured. RESULTS: The mean distance between the kidney capsule and the vessel was 2.44 ± 2.0 mm on CDUS, 1.34 ± 1.2 mm on PDUS, 0.99 ± 1.8 mm using the color SMI (cSMI) technique, and 0.86 ± 1.8 mm using the monochrome SMI (mSMI) technique. The study found that the SMI technique was superior to CDUS and PDUS in delineating the cortical microvasculature of the kidney. Both Doppler ultrasound examinations and the SMI technique proved effective in predicting the CADI (P = 0.006 for CDUS, P = 0.002 for PDUS, P = 0.018 for cSMI, and P = 0.027 for mSMI). Among conventional Doppler ultrasound examinations and the SMI technique, PDUS had the highest sensitivity, and cSMI had the highest specificity in differentiating high and low CADI values. Both the cSMI and mSMI techniques had similar sensitivity values, whereas only cSMI exhibited high specificity. CDUS had the lowest specificity value (P = 0.003 for CDUS, P = 0.002 for PDUS, P = 0.005 for cSMI, and P = 0.004 for mSMI). CONCLUSION: The present study is the first in the literature to demonstrate the utility of the distance between the kidney capsule and the vessels in predicting the CADI score and to compare the Doppler ultrasound examinations and SMI technique in doing so.
Assuntos
Transplante de Rim , Humanos , Transplante de Rim/efeitos adversos , Ultrassonografia/métodos , Ultrassonografia Doppler/métodos , Rim/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , AloenxertosRESUMO
OBJECTIVE: This study was carried out to investigate the effects of abdominal subcutaneous adiposity and visceral adiposity on osteoporotic compression fractures. MATERIAL AND METHODS: The study group consisted of a total of 152 individuals aged 50-80 years; 76 were included in the vertebral fracture group and 76 in the healthy control group, whose bone mineral density was calculated. In order to determine the distribution of abdominal fat in both groups, four different measurements, i.e., sagittal abdominal diameter (SAD), abdominal diameter (AD), ventral subcutaneous thickness (VST), and dorsal subcutaneous thickness (DST), were made using lumbar magnetic resonance imaging (MRI). The visceral fat ratio (VFR) was also calculated based on these measurements. RESULTS: There was a significant difference between the patient and control groups in VST and DST values, both when gender distribution was and was not taken into account (p < 0.006 for all cases). There was no significant difference between the patient and control groups in SAD and AS values, both when only female patients were considered, and gender distribution was not taken into account (p > 0.25 for all cases). On the other hand, in the analysis, when only male patients were considered, the SAD and AD values of the patient group were found to be significantly lower than those of the control group (p = 0.046 and p = 0.048, respectively). CONCLUSION: In conclusion, the study findings indicated that high SAD values in the male gender and high VST and DST values in both genders were associated with low lumbar vertebral fracture risk.
Assuntos
Fraturas por Compressão , Fraturas por Osteoporose , Fraturas da Coluna Vertebral , Humanos , Masculino , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Gordura Abdominal , Imageamento por Ressonância Magnética , Densidade Óssea , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/patologiaRESUMO
Purpose: The aim of this study is to describe the radiological findings of adhesive capsulitis due to different etiological factors and reveal that different clues due to different etiological causes should be considered in the diagnosis of adhesive capsulitis. Methods: The study group comprised 24 primary and 22 supraspinatus tendon rupture-related adhesive capsulitis patients with 24 individuals without adhesive capsulitis and with normal shoulder magnetic resonance imaging. Independent samples t-test and one-way analysis of variance tests were used to compare the measurements between the groups. Paired sample t-test and Cohen's kappa statistic were used to determine inter-observer reliability. The chi-squared test was used to determine the relationships between groups and categorical variables. Study participants were evaluated both qualitatively and quantitatively. Quantitative measurements included the thickness of the humeral and glenoid segment of the joint capsule and the thickness of the anterior joint capsule and the fluid depth within the biceps tendon sheath. The qualitative assessments included the detection of any signal abnormality at the rotator interval, the grading of the humeral and glenoid segment of the joint capsule, and the detection of any signal abnormality in respect of the anterior joint capsule. Results: A statistically significant difference was found between the groups of patients with primary adhesive capsulitis and with supraspinatus tear-related adhesive capsulitis in terms of the thickness of the humeral segment of the joint capsule at the axillary recess level (AUC = .729) (P: .006). Furthermore, setting the cutoff value for the thickness of the humeral segment of the capsule to 4.6 mm allowed the differentiation of primary adhesive capsulitis and supraspinatus tear-related adhesive capsulitis with a sensitivity of 70.8% and a specificity of 87.3%. Conclusion: In conclusion, the humeral segment of the joint capsule thickness at the axillary recess was found to be affected by different degrees depending on whether it is a primary or supraspinatus tear-related adhesive capsulitis.
Assuntos
Bursite , Articulação do Ombro , Humanos , Articulação do Ombro/diagnóstico por imagem , Reprodutibilidade dos Testes , Bursite/diagnóstico por imagem , Bursite/patologia , Membrana Sinovial , Imageamento por Ressonância Magnética/métodosRESUMO
AIM: We aimed to evaluate the effectiveness of combining 2-dimensional shear wave elastography (2D-SWE) with ultrasonography (US) in diagnosing acute appendicitis in patients with suspected acute appendicitis. METHODS: Clinical and laboratory findings, gray-scale US and 2D-SWE imaging features, operation information, and pathology results of 48 patients diagnosed with acute appendicitis who presented with right lower quadrant pain were prospectively evaluated. We compared the findings to the US and SWE imaging features of 79 asymptomatic patients. RESULTS: Mean Alvarado score and appendix diameter were statistically significantly higher for acute appendicitis (p < 0.001). In patients with acute appendicitis, mesenteric lymphadenopathy and fat stranding were also more frequent (p < 0.001). The mean velocity and kPa values for appendix and mesenteric fat were statistically significantly higher in acute appendicitis (p < 0.001). CONCLUSION: In the diagnosis of acute appendicitis, 2D-SWE increases the diagnostic performance of gray-scale US in the differentiation of inflamed and normal appendixes.
Assuntos
Apendicite , Apêndice , Técnicas de Imagem por Elasticidade , Humanos , Técnicas de Imagem por Elasticidade/métodos , Apendicite/diagnóstico por imagem , Ultrassonografia , Apêndice/diagnóstico por imagem , Doença AgudaRESUMO
BACKGROUND: There exists insufficient information about the natural course of incidental pulmonary nodules (IPN) determined on tomography in children. The aim was to determine the characteristic features and factors affecting the course of IPN. METHODS: This retrospective study included patients who presented at the Pediatric Pulmonology, Allergy & Immunology Section of Akdeniz University Hospital between January 2014-2020, and were determined with pulmonary nodules on high-resolution computed tomography (HRCT). The patients were separated into two groups as those with a nodule decreased in size or which had disappeared on the follow-up HRCT (Group 1) and those with a nodule which had remained at the same size (Group 2). These two groups were compared in respect to demographic data, nodule size and characteristics, and accompanying findings on HRCT. RESULTS: A total of 177 nodules were determined in the 66 patients included in the study. A follow-up HRCT was taken within mean 16.29±11.38 months in 27 patients. In these patients, 78 nodules were determined on the initial HRCT. On the follow-up, twelve of the nodules were seen to have shrunk or disappeared compared to the initial images, 66 had remained the same size, and none had grown. The mean age of the patients in Group 1 was statistically significantly lower than that of patients in Group 2 (p < 0.001). The rates of an accompanying mosaic attenuation pattern (p < 0.001) on HRCT and subsolid density (p=0.011) of the nodules in Group 1 were statistically significantly higher compared to Group 2 and the rate of calcification content was statistically significantly lower (p=0.002). No suspicious or confirmed malignancy was observed in any case throughout the mean follow-up period of 38.33±16.5 months after the initial HRCT. CONCLUSIONS: The young age of patients, subsolid structure of nodules, calcification content and the presence of an accompanying mosaic attenuation pattern on HRCT, could be useful factors in the estimation of size in the follow-up of nodules.
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Neoplasias Pulmonares , Nódulos Pulmonares Múltiplos , Nódulo Pulmonar Solitário , Criança , Humanos , Achados Incidentais , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Estudos Retrospectivos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/patologia , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: Benign essential blepharospasm (EB) is a focal facial dyskinesia that occurs with the involuntary contraction of muscles around the eyes. In the literature, studies on blepharospasm focus on elucidating the pathophysiology of this condition in the brain. To the best of our knowledge, there is no research evaluating the orbital imaging findings of patients with EB. Therefore, the current study aimed to determine whether there was any change in the blood supply of muscles around the eye or ocular blood flow in patients with blepharospasm and investigate flow changes that may be caused by spasm. METHODS: Thirty patients with EB and 30 controls were included in the study. Orbital Doppler ultrasound was performed in all cases to measure ophthalmic and temporal artery peak systolic velocity and end diastolic velocity and calculate resistive index values. Superior ophthalmic vein blood flow velocity (SOVBFV) was also measured. RESULTS: There was no significant difference between the groups in terms of age and gender distribution (P = 0.345 and 0.870, respectively). SOVBFV was found to be significantly higher in the EB group (P = 0.001). No significant difference was observed in the remaining investigated parameters. CONCLUSIONS: In conclusion, our study suggested that ocular spasm in patients with EB had no effect on blood flow other than SOVBFV. When SOVBFV was compared between the EB and control groups, it was found to be increased in the EB group. We consider that this statistical difference may be clinically and pathophysiologically significant.
Assuntos
Blefarospasmo , Artéria Retiniana , Blefarospasmo/diagnóstico por imagem , Velocidade do Fluxo Sanguíneo/fisiologia , Humanos , Artéria Oftálmica/diagnóstico por imagem , Artéria Oftálmica/fisiologia , Artéria Retiniana/diagnóstico por imagem , Artéria Retiniana/fisiologia , Espasmo , Ultrassonografia Doppler , Ultrassonografia Doppler em CoresRESUMO
Kidney cysts are quite common in adults. Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, are very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. These sonographic signs are occasionally specific for diagnosis, but in many cases sonographic clues should be evaluated together with the other genetic and clinical data to reach diagnosis.The first part of this pictorial essay included the introduction into the subject and the classification of non-genetic cystic renal diseases. The key features for the non-genetic cystic renal diseases are illustrated. In the second part, eye-catching features of genetic cystic renal diseases are demonstrated.
Assuntos
Cistos , Doenças Renais Císticas , Neoplasias Renais , Adulto , Criança , Meios de Contraste , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/genética , UltrassonografiaRESUMO
Kidney cysts are quite common in adults. Though small simple renal cysts in an adult over 30-40 years of age are not too unusual, however, if the same cysts are seen in a child, and especially if there are additional findings, then several diagnostic possibilities may come to mind. The role of ultrasound, together with the help of intravenous contrast agents and Doppler mode, is very critical in describing the morphologic features and follow-up of the complex or multiple and bilateral renal cysts. Sonographic signs are occasionally specific for diagnosis, but in many cases they should be evaluated together with the other genetic and clinical data to reach a diagnosis.The first part of this pictorial essay includes "non-genetic cystic renal diseases" and the second part will include "genetic cystic renal diseases".
Assuntos
Cistos , Doenças Renais Císticas , Neoplasias Renais , Adulto , Criança , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/genética , UltrassonografiaRESUMO
Umbilical venous catheters (UVCs) have become a part of routine perinatal care. In the case of its misplacement, extravasation into liver parenchyma might be observed and unusual findings might be detected and a suspicion of tumoral lesions emerges during the ultrasound examination. To avoid the unnecessary liver biopsies and catastrophic complications of UVC misplacement in the pediatric population, clinicians and radiologists must be familiar with the radiological findings. We aimed to present sonographic and computed tomographic images of liver collections resulting from UVC malposition.
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Catéteres , Fígado , Criança , Humanos , Fígado/diagnóstico por imagem , Ultrassonografia , Veias Umbilicais/diagnóstico por imagemRESUMO
PURPOSE: This study aims to evaluate the capacity of the clinical and radiological findings and the extrapancreatic necrotic tissue volume in early (2-6 days) computerized tomography (CT) images of patients diagnosed with AP to predict reliably the temporary or permanent organ failure and other local or systemic complications due to pancreatitis. MATERIALS AND METHODS: Adult patients who were diagnosed with AP based on Revised Atlanta classification and underwent abdomen CT scans between May 2015 and May 2018 were examined retrospectively. Extrapancreatic necrosis volume was compared to various clinical parameters that indicate the prognosis of AP such as C-reactive protein (CRP) at 48-72th h, organ failure, infection, requirement for percutaneous or surgical intervention, length of hospital stay, and mortality, and to various imaging-based scoring systems such as the computerized tomography severity index (CTSI) and the modified CTSI (mCTSI). The receiver operating characteristic (ROC) curve was used to estimate the optimal threshold for predicting clinical prognosis. RESULTS: Extrapancreatic necrosis volume had moderate positive correlation with length of hospital stay (p = 0.0001) and CRP (at 48-72th h) (p = 0.0001) and strong positive correlation with CTSI (p = 0.0001), mCTSI (p = 0.0001), and white blood cell count (p = 0.0001). CONCLUSION: Extrapancreatic necrosis volume was found to be particularly better in predicting organ failure and infection compared to the imaging-based scoring systems (Balthazar, CTSI, and mCTSI) and the laboratory-based scoring systems (CRP at 48-72th h).
Assuntos
Necrose/complicações , Pancreatite/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Proteína C-Reativa/análise , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pancreatite/classificação , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Peripheral arterial disease is an atherosclerotic disease characterized by an increase in morbidity and mortality. For these reasons early diagnosis of peripheral arterial disease is important. Ankle-brachial systolic pressure index measurement is frequently used in screening studies. Evaluating waveforms of distal lower extremities with Doppler ultrasound can be used as a screening program and provides more accurate information on peripheral arterial disease. AIM: We investigate the prevalence of peripheral arterial disease, compare the efficacy of Doppler ultrasound evaluation of distal lower extremity waveforms and ankle-brachial systolic pressure index measurement in screening programs, and discuss the importance of early diagnosis of asymptomatic cases. MATERIAL AND METHODS: A total of 457 patients over the age of 65 (between 65 and 94, mean age: 71.4) including 270 males and 187 females were examined with Doppler ultrasound, had ankle-brachial systolic pressure index measurement taken and were screened for peripheral arterial disease. The correlation between Doppler ultrasound findings and ankle-brachial systolic pressure index was examined. RESULTS: According to the Doppler ultrasound findings, in the aortoiliac (r = 0.648) and femoropopliteal (r = 0.564) area, there is a medium level of correlation between severe stenosis and occlusions and a low ankle-brachial systolic pressure index value, and a low level of correlation between such abnormalities in the tibioperoneal region (r = 0.116) and a low ankle-brachial systolic pressure index value. Therefore, while the sensitivity of ankle-brachial systolic pressure index increases in proximal stenosis, it decreases in distal stenosis. CONCLUSION: Despite the fact that ankle-brachial systolic pressure index is a diagnostic test commonly used in screening studies, evaluation of distal arteries by means of Doppler ultrasound provides more accurate information in terms of the identification of peripheral arterial disease.