RESUMO
The clinical diagnosis of pigmented genital lesions is challenging. Reflectance confocal microscopy (RCM) is effective for diagnosis but is limited in its application due to elevated costs. A more affordable dermatoscope with a 400x magnification (D400) has recently been brought to market. The aim of our study was to compare these two imaging techniques for the analysis of pigmented genital tumours. An observational, prospective and mono-centric study was carried out from October 2017 to May 2019, in which clinical, dermatoscopic (20x and 400x) and RCM data from 207 pigmented genital lesions were collected. The images generated via D400 and RCM were analysed by three expert investigators. Similarities between the criteria observed using D400 and RCM were evaluated by each investigator. In total, 207 lesions were included: 183 melanosis, 19 nevi, one basal cell carcinoma (BCC), two condylomas and two melanomas in situ. Our series correlates well with data found in the literature especially for the distribution of different lesions, their topography, and their aspect using x20 dermatoscopy and RCM. Pattern and cell criteria defined using RCM largely paralleled those observed with D400 for all three investigators. Correlation between D400 and RCM was moderate to strong with regards to the identification of the ring pattern and clustered round cells, strong for dendritic and plump cells, and perfect for isolated round cells and spindle cells. D400 is an easy-to-use, cost-effective alternative for the analysis of pigmented genital lesions, particularly for melanosis.
Assuntos
Dermoscopia , Melanose , Microscopia Confocal , Neoplasias Cutâneas , Humanos , Microscopia Confocal/métodos , Melanose/diagnóstico por imagem , Melanose/patologia , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Feminino , Masculino , Melanoma/diagnóstico por imagem , Melanoma/patologia , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/patologia , Pessoa de Meia-Idade , Adulto , Condiloma Acuminado/diagnóstico por imagem , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/patologia , Nevo Pigmentado/diagnóstico por imagem , Nevo Pigmentado/patologia , Idoso , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/patologia , Nevo/diagnóstico por imagem , Nevo/patologiaRESUMO
PURPOSE: In this cross-sectional study, we aimed to characterize how frequently the anatomy of interest (AOI) was excluded when evaluating genital pathology using the current CT pelvis protocol recommended by the American College of Radiology and evaluate how AOI exclusion affects patient management. METHODS: We retrospectively reviewed medical records, using diagnosis and CPT codes, of patients admitted with genital pathology who obtained a CT scan at our institution from July 1, 2020-April 30, 2023. Baseline patient demographics were included. Data about each index CT scan (scan obtained at our institution) were recorded and assessed for exclusion of the AOI. Statistical analysis was performed to determine the rate of AOI exclusion and to compare patient management between patients with AOI excluded versus those without AOI exclusion. RESULTS: 113 presentations for genital pathology included an index CT scan and were included for analysis. Patients were primarily men (98%) with a mean age of 53.1 years (SD 13.9). The most common diagnoses were Fournier's gangrene (35%), scrotal abscess (22%) and unspecified infection (19%). 26/113 scans (23%) did not capture the entire AOI. When the AOI was missed during the index scan, there was a higher rate of obtaining additional scans (38% vs. 21%), but a similar rate of intervention (77% vs. 63%) when compared to index scans that captured the entire AOI. 35 scans (31%) had protocol-extending instructions; index scans that captured the entire AOI were more likely to have specific protocol-extending instructions (38% vs. 8% p < 0.01). CONCLUSIONS: Creating a specific CT protocol for genital pathology could decrease the amount of inappropriate irradiation and improve AOI capture rates without relying on specific request for protocol deviation.
Assuntos
Tomografia Computadorizada por Raios X , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Pessoa de Meia-Idade , Feminino , Estudos Transversais , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Femininos/diagnóstico por imagem , Adulto , IdosoRESUMO
OBJECTIVE: To perform a scoping review of the literature in which ultrasound elastography (UE) has been used in benign gynecology and identify avenues for its use in future research and clinical implementations. METHODS: A structured search of EMBASE, Medline and Cochrane databases was conducted (last search date April 15th, 2022). Eligible studies included adult participants with female pelvic anatomy. English language papers focusing on the utility of ultrasound elastography applied to benign gynecology were included. Narrative reviews, conference abstracts, and letters to the editor were excluded. Two independent reviewers screened titles and abstracts for inclusion, a third reviewer was consulted in cases of disagreement. Study quality was assessed by a checklist for study implementation and elastography technique. Extracted data included elastography technology, gynecologic application, opportunities for clinical implementation, and strengths and limitations. RESULTS: The search returned 2026 studies. A total of 40 studies, published between 2013 and 2022, were retained for data extraction. Studies most frequently used shear wave elastography as the method of UE (n = 23), followed by strain elastography (n = 13) and acoustic radiation force impulse (n = 4). Most common clinical applications for UE were the diagnosis of adenomyosis and uterine fibroids (27.5%), assessment of pelvic floor muscle function (22.5%), and describing the elastic properties of polycystic ovaries (17.5%) and the uterine cervix (15.0%). Limitations of the technology were identified as the lack of published reference values for gynecologic organs and difficulties in assessing tissues deep to the transducer. CONCLUSION: Future research is needed to validate the use of ultrasound elastography in gynecology under both normal and pathologic conditions.
Assuntos
Técnicas de Imagem por Elasticidade , Técnicas de Imagem por Elasticidade/métodos , Humanos , Feminino , Doenças dos Genitais Femininos/diagnóstico por imagem , Ginecologia/métodosRESUMO
This review aims to provide an overview of neoplastic lesions associated with genetic diseases affecting the female reproductive organs. It seeks to enhance our understanding of the radiological aspects in diagnosing genetic diseases including hereditary breast and ovarian cancer syndromes, Lynch syndrome, Peutz-Jeghers syndrome, nevoid basal cell carcinoma syndrome, and Swyer syndrome, and explores the patterns and mechanisms of inheritance that require elucidation. Additionally, we discuss the imaging characteristics of lesions occurring in other regions due to the same genetic diseases.
Assuntos
Doenças Genéticas Inatas , Humanos , Feminino , Doenças Genéticas Inatas/diagnóstico por imagem , Doenças dos Genitais Femininos/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Genitália Feminina/diagnóstico por imagemRESUMO
BACKGROUND: There is a huge demand-supply gap between the incidence of genital dermatoses (including sexually transmitted infections and non-venereal genital dermatoses) and physicians trained to manage them. OBJECTIVES: To find out the performance of an artificial intelligence (AI)-based mobile application in the image diagnosis of genital dermatoses, and to compare it with primary care physicians (PCPs) and dermatologists. METHODS: Photos of the genital diseases of consecutive patients presenting to the STD and genital diseases clinic were included. The gold standard diagnosis was established by the consensus of two certified dermatologists after examination and one positive investigation. Image diagnoses by the DermaAId application, two PCPs, and two dermatologists were recorded and compared to the gold standard diagnosis and to each other. RESULTS: A total of 257 genital disease images, including 95 (37.0%) anogenital warts, 60 (22.2%) lichen sclerosus, 20 (7.8%) anogenital herpes, 15 (5.8%) tinea cruris, 14 (5.4%) molluscum contagiosum, 9 (3.5%) candidiasis, 8 (3.1%) scabies, 6 (2.3%) squamous cell carcinomas, were included. The top-1 correct diagnosis rate of the application was 68.9%, compared to the 50.4% of the PCPs and 73.2% of the dermatologists. The application significantly outperformed PCPs with regard to the correlation with the gold standard diagnosis (P < 0.0001), and matched that of the dermatologists. CONCLUSIONS: AI-based image diagnosis platforms can potentially be a low-cost rapid decision support tool for PCPs, integrated with syndromic management programs and direct-to-consumer services, and address healthcare inequities in managing genital dermatoses.
Assuntos
Inteligência Artificial , Doenças dos Genitais Femininos , Doenças dos Genitais Masculinos , Aplicativos Móveis , Dermatopatias , Humanos , Estudos Prospectivos , Feminino , Masculino , Estudos Transversais , Dermatopatias/diagnóstico , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico , Adulto , Pessoa de Meia-Idade , Fotografação , Dermatologistas/estatística & dados numéricos , Adulto Jovem , Dermatologia/métodos , Dermatologia/estatística & dados numéricosRESUMO
Acute pelvic pain is defined as a new symptom that has been present for less than 3 months. It is a common symptom seen in 15%-24% of women and is the indication for 20% of laparoscopies and 2%-10% of outpatient gynecologic visits. The pregnancy status and correlation of the physical symptoms with clinical findings are important. Ultrasound is the imaging modality of choice, not only to diagnose gynecological causes, but also bowel or urinary tract related causes of pelvic pain. When an ultrasound scan is inconclusive, a computed tomography scan is the preferred means of additional imaging and is particularly useful in gastrointestinal and urogenital causes of pelvic pain. Gynecological causes of acute pelvic pain include uterine, tubal, or ovarian pathology; non-gynecological causes include bowel diseases, such as appendicitis and diverticulitis; urogenital causes such as ureteral, bladder stones, and urinary tract infection as well as vascular causes. Ultrasound imaging alone may provide a definitive diagnosis in underlying conditions that require prompt medical or surgical intervention in gynecological conditions, such as ovarian torsion, ectopic pregnancy, and non-gynecological condition, such as in acute appendicitis.
Assuntos
Apendicite , Doenças dos Genitais Femininos , Gravidez Ectópica , Cálculos Ureterais , Gravidez , Feminino , Humanos , Apendicite/diagnóstico por imagem , Doenças dos Genitais Femininos/complicações , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/terapia , Dor Pélvica/diagnóstico por imagem , Dor Pélvica/etiologia , Dor Pélvica/terapia , UltrassonografiaRESUMO
BACKGROUND: The efficacy and safety of ultrasound-guided interventional procedures for gynecologic diseases have not been evaluated comprehensively. Therefore, we aimed to provide an evidence-based medical reference for clinical treatment in this meta-analysis. METHODS: The literature searches were conducted in databases of PubMed, Embase, and Web of Science for eligible studies published from 2002 to May 2022. All literature was searched, screened, and reviewed by 2 researchers separately. RevMan 5.3.0 was used to analyze the relevant data. RESULTS: A total of 12 articles consisting of 2854 patients were included. Compared with the control group, meta-analysis showed that ultrasound-guided technique in the experimental group was associated with a higher effective rate [risk ratio = 0.84, 95% confidence interval (CI) (0.84, 0.84)], a lower probability of recurrence [odds ratio = 0.13, 95% CI (0.13, 0.13), P < .00001], and a greater effective reintervention rate [odds ratio = 3.39, 95% CI (1.29, 8.86), P = .01]. However, it was not significantly associated with fewer adverse reactions. CONCLUSIONS: Ultrasound-guided technique in treating gynecologic diseases exerted a positive effect and had fewer adverse reactions, which could be popularized and applied in clinical practice.
Assuntos
Doenças dos Genitais Femininos , Ultrassonografia de Intervenção , Feminino , Humanos , Ultrassonografia de Intervenção/métodos , Ultrassonografia , Doenças dos Genitais Femininos/diagnóstico por imagemRESUMO
OBJECTIVE: Based on resting-state functional magnetic resonance imaging (rs-fMRI), to observe the changes of brain function of bilateral uterine points stimulated by electroacupuncture, so as to provide imaging basis for acupuncture in the treatment of gynecological and reproductive diseases. METHODS: 20 healthy female subjects were selected to stimulate bilateral uterine points (EX-CA1) by electroacupuncture. FMRI data before and after acupuncture were collected. The ReHo values before and after acupuncture were compared by using the analysis method of regional homogeneity (ReHo) of the whole brain, so as to explore the regulatory effect of acupuncture intervention on brain functional activities of healthy subjects. RESULTS: Compared with before acupuncture, the ReHo values of the left precuneus lobe, left central posterior gyrus, calcarine, left lingual gyrus, and cerebellum decreased significantly after acupuncture. CONCLUSION: Electroacupuncture at bilateral uterine points can induce functional activities in brain areas such as the precuneus, cerebellum, posterior central gyrus, talform sulcus, and lingual gyrus. The neural activities in these brain areas may be related to reproductive hormone level, emotional changes, somatic sensation, and visual information. It can clarify the neural mechanism of acupuncture at uterine points in the treatment of reproductive and gynecological diseases to a certain extent.
Assuntos
Pontos de Acupuntura , Eletroacupuntura/métodos , Imageamento por Ressonância Magnética/métodos , Útero/diagnóstico por imagem , Adulto , Encéfalo/fisiologia , Mapeamento Encefálico , Biologia Computacional , Feminino , Neuroimagem Funcional/métodos , Neuroimagem Funcional/estatística & dados numéricos , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/fisiopatologia , Voluntários Saudáveis , Humanos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Útero/fisiologia , Adulto JovemRESUMO
Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the "gold standard" among gynecological imaging methods. They are important diagnostic tools used to determine the site of origin of a pelvic mass and to characterize the adnexal lesions. This paper summarizes the diagnostic performance of ultrasound, computed tomography, and magnetic resonance imaging in various gynecological diseases and tumours diagnostics.
Assuntos
Doenças dos Genitais Femininos , Ginecologia , Feminino , Humanos , Tomografia Computadorizada por Raios X , Ultrassonografia/métodos , Imageamento por Ressonância Magnética/métodos , Doenças dos Genitais Femininos/diagnóstico por imagemRESUMO
US-guided procedures have an essential role in the diagnosis and treatment of multiple obstetric and gynecologic conditions, can be performed with either transvaginal or transabdominal approaches, and include biopsy of masses, aspiration of fluid collections, injection of therapeutic materials, and saline-infused sonohysterography and hysterosalpingo contrast-enhanced sonography. The full digital presentation is available online. ©RSNA, 2021.
Assuntos
Doenças dos Genitais Femininos , Biópsia , Feminino , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/terapia , Humanos , Gravidez , Primeiro Trimestre da Gravidez , UltrassonografiaRESUMO
Abdominal pain represents 5% to 7% of all emergency department presentations. Many patients require imaging for diagnosis, and choosing the appropriate imaging modality is a crucial decision point. Modern medicine offers a fantastic array of options including abdominal radiograph, computed tomography, MRI, and ultrasonography, but the plethora of alternatives can be paralyzing. This article introduces the commonly available modalities, discusses the advantages and disadvantages, and presents current recommendations for commonly diagnosed conditions.
Assuntos
Abdome/diagnóstico por imagem , Dor Abdominal/etiologia , Aneurisma Aórtico/diagnóstico por imagem , Doenças do Sistema Digestório/diagnóstico por imagem , Serviço Hospitalar de Emergência , Feminino , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico por imagem , Humanos , Masculino , Isquemia Mesentérica/diagnóstico por imagem , Gravidez , Gravidez Ectópica/diagnóstico por imagemRESUMO
Acute pelvic pain (APP) requires urgent medical evaluation and treatment. Differential diagnosis of APP is broad, including a variety of gynecologic and non-gynecologic/ urinary, gastrointestinal, vascular and other entities. Close anatomical and physiological relations of pelvic structures, together with similar clinical presentation of different disorders and overlapping of symptoms, especially in the emergency background, make the proper diagnosis of APP challenging. Imaging plays a crucial role in the fast and precise diagnosis of APP. Ultrasonography is the first-line imaging modality, often accompanied by CT, while MRI is utilized in specific cases, using short, tailored protocols. Recognizing the cause of APP in females is a challenging task, due to the wide spectrum of possible origin and overlap of their imaging features. Therefore, the radiologist has to be familiar with the possible causes of APP, and, relying on clinical presentation, together with laboratory findings, choose the best imaging strategy in order to establish a fast and accurate diagnosis.
Assuntos
Diagnóstico por Imagem/métodos , Gastroenteropatias/complicações , Doenças dos Genitais Femininos/complicações , Dor Pélvica/etiologia , Doenças Urológicas/complicações , Doenças Vasculares/complicações , Dor Aguda/etiologia , Feminino , Gastroenteropatias/diagnóstico por imagem , Doenças dos Genitais Femininos/diagnóstico por imagem , Humanos , Masculino , Doenças Urológicas/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagemRESUMO
Point-of-care ultrasound has become an essential part of pediatric emergency medicine training and practice. It can have significant clinical benefits, including improving diagnostic accuracy and decreasing length of stay, and does not require radiation exposure for patients. In this review, we summarize the current diagnostic point-of-care ultrasound applications in pediatric emergency medicine, their evidence, and techniques.
Assuntos
Medicina de Emergência Pediátrica , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia , Doenças Biliares/diagnóstico por imagem , Criança , Oftalmopatias/diagnóstico por imagem , Feminino , Avaliação Sonográfica Focada no Trauma , Doenças da Vesícula Biliar/diagnóstico por imagem , Gastroenteropatias/diagnóstico por imagem , Doenças dos Genitais Femininos/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Humanos , Nefropatias/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Masculino , Gravidez , Torção do Cordão Espermático/diagnóstico por imagem , Doenças da Bexiga Urinária/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagemRESUMO
Hidradenitis Suppurativa is a chronic inflammatory disease manifesting in painful nodules, abscesses and malodorous draining tunnels with a pre-disposition to flexural regions of skin. Traditional surgical interventions include excision of clinically visible lesions and in severe cases - excision down to fascia of entire anatomical regions (axilla, groin) and repair with split-thickness grafting or skin substitutes. However, such techniques are plagued by long healing times (up to several months), extensive tissue loss and high recurrence rates given that a large proportion of disease is not clinically visible. Deroofing is a tissue-saving surgical technique, ideal for Hurley Stage 2 disease, which when combined with bedside pre-operative sonography can allow for the accurate identification and removal of occult dermal tunnels whilst minimising the risks of pain, infection, minimising healing times and can be safely conducted in the setting of immunomodulatory therapy.
Assuntos
Hidradenite Supurativa/diagnóstico por imagem , Hidradenite Supurativa/cirurgia , Ultrassonografia de Intervenção/métodos , Feminino , Seguimentos , Doenças dos Genitais Femininos/diagnóstico por imagem , Doenças dos Genitais Femininos/cirurgia , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/cirurgia , Humanos , Masculino , ReepitelizaçãoRESUMO
Sonography is the imaging modality of choice for diagnosing diseases of the female genital tract due to its high resolution, easy availability, low cost and lack of radiation. CT is not advocated for the primary evaluation of the female pelvis. However, with the advent of Multidetector CT (MDCT), females of all ages undergo CT scan of the abdomen and pelvis for myriad non-gynaecological diseases, e.g. subacute intestinal obstruction, abdominal lump, abdominal tuberculosis, appendicitis, ureteric colic, pancreatitis, oncological staging, follow-up, etc. Incidental female genital tract disorders were seen on these scans that are a dilemma for both, the radiologists and the clinicians. The objective of this pictorial review is to characterise the incidentally detected lesions of the female genital tract observed on 64-slice MDCT by correlating with sonography, if necessary, and establishing a clinico-radiological diagnosis. Our aim is to emphasise that the radiologist may be the first person to recognise a gynaecologic disorder and hence can play a significant role in patient management.
Assuntos
Apendicite , Doenças dos Genitais Femininos , Feminino , Doenças dos Genitais Femininos/diagnóstico por imagem , Genitália Feminina/diagnóstico por imagem , Humanos , Tomografia Computadorizada Multidetectores , PelveRESUMO
Interventional radiology is continuing to reshape current practice in many specialties of clinical care and the fields of gynecology and obstetrics are no exception. Imaging skills, clinical knowledge as well as vascular and non-vascular interventional technical ability, are essential to practice interventional radiology effectively. Patient safety is of paramount importance in interventional radiology as in all branches of medicine. Potential failures occur throughout successful procedures and are attributed to a spectrum of errors, including equipment unavailability, planning errors, and communication errors. These are mainly preventable by improved preprocedural planning and teamwork. Of all the targeted and effective actions that can be undertaken to reduce adverse events, the use of safety checklists might have a prominent role. The advantage of a safety checklist for interventional radiology is that it guarantees that human error in terms of forgetting key steps in patient preparation, intraprocedural care, and postoperative care are not forgotten.