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1.
J Int Med Res ; 50(1): 3000605211069485, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34994238

RESUMO

Poland syndrome is a rare congenital developmental deformity characterized by unilateral agenesis or hypoplasia of thoracic wall soft tissue. We report two adult cases of Poland syndrome detected by computed tomography (CT) images. CT images of the two cases depicted an asymmetric chest wall with the absence of a breast and agenesis of the pectoralis muscles. A physical examination of case 1 showed a thin right chest wall with depression of the right nipple region. Hand deformities were also observed, including brachydactyly and syndactyly. In case 2, hand deformities were not found in a physical examination. Using multi-planar reconstruction, the size, position, origin, and termination of bilateral pectoral muscles could be compared symmetrically. For patients with Poland syndrome, a timely diagnosis and treatment are important. The use of chest CT in clinical practice could play an important role in the early diagnosis and treatment of Poland syndrome.


Assuntos
Síndrome de Poland , Parede Torácica , Adulto , Humanos , Mamilos , Músculos Peitorais/diagnóstico por imagem , Síndrome de Poland/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Artigo em Chinês | MEDLINE | ID: mdl-34979613

RESUMO

Objective:To explore the combination of sinus CT score and serum allergen sIgE to construct a postoperative recurrence risk model for patients with eosinophilic CRSwNP. Methods:The clinical data of 183 patients with eosinophilic CRSwNP who were treated in Luohe Central Hospital from January 2016 to January 2019 were collected. The curative effect was evaluated one year after the operation. According to the postoperative recurrence, they were divided into recurrence group and non-recurrence group. Single factor analysis of clinical and pathological factors on the postoperative curative effect of patients, XGboost model and multivariate Cox analysis of factors affecting postoperative recurrence. Draw the receiver operating characteristic(ROC) curves of the two models to compare the prediction effects of the XGboost model. The Kaplan-Meier method draws survival curve and compares the recurrence-free survival rate of patients with different risk levels. Results:The results of Cox multivariate analysis showed postoperative adherence to comprehensive treatment, tissue EOS ratio, tissue NEU ratio, tissue lymphocyte ratio, tissue plasma cell ratio, peripheral blood NEU ratio, Allergen sIgE and total sinus CT score were independent risk factors for recurrence. The top six factors influencing postoperative recurrence in the XGboost model were allergen sIgE, total sinus CT score, tissue EOS ratio, postoperative adherence to comprehensive treatment, tissue lymphocyte ratio, and tissue plasma cell ratio. The ROC curve showed that the area under the ROC curve of the XGboost model was 0.818. Cox analysis (0.789) with more factors increased by 3.68%, and the sensitivity, specificity and Youden index of the model were significantly higher than the multivariate Cox analysis model. The factors included in the XGboost model were used to construct a postoperative recurrence risk model. The recurrence-free survival rate of high-risk group was significantly lower than that of low-risk group and intermediate-risk group (log-rank test value:21.946, P<0.001). Conclusion:The postoperative recurrence risk model established by the sinus CT score combined with serum allergen sIgE can effectively predict the incidence of postoperative recurrence in patients. The XGboost model is better than the multivariate Cox analysis model in predicting postoperative recurrence in patients with eosinophilic CRSwNP. It can be used to predict postoperative recurrence.


Assuntos
Pólipos Nasais , Rinite , Sinusite , Alérgenos , Doença Crônica , Eosinófilos , Humanos , Tomografia Computadorizada por Raios X
3.
Mymensingh Med J ; 31(1): 200-207, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34999703

RESUMO

The COVID-19 pandemic has turned into a global calamity and affected millions of lives around the world. Even though the vaccination efforts have started, they are yet to have an effective impact on the lower to middle-income countries. Early detection and isolation are still the best way to control the spread of the virus. The standard practice for detecting COVID-19 is the RT-PCR (Reverse Transcription Polymerase Chain Reaction) test but this test has a high probability of producing false-negative results plus lack of availability at all the time due to shortage of kit. Since COVID-19 is a respiratory disease affecting the lungs and the imaging patterns caused by COVID-19 can be observed in chest HRCT (High Resolution Computed Tomography) scans. As a result, HRCT can be used as an alternative diagnostic modality for any suspected cases of COVID-19. In this cross-sectional study was carried out in the Department of Radiology and Imaging, BSMMU, Dhaka, Bangladesh from May 12, 2020 to August 10, 2020. Chest HRCT scans of 284 suspected patients irrespective of age and sex who had done RT-PCR test either positive or negative test result having symptoms suggesting COVID pneumonia were enrolled in this study. Patients who had not done RT-PCR and who were not willing to do HRCT chest were excluded. According to the study, ground glass opacity is the most common feature and found in 89.44% of patients. The other predominant features were including consolidation, crazy paving, fibrotic density and vascular enlargement. The diagnostic performance of the CT scan was also evaluated using the RT-PCR test result as the gold standard and the sensitivity, specificity, and accuracy of the CT scan diagnosis were found to be 83.2%, 50% and 79.9% respectively. The severity of the five lung lobes has also been studied. The right middle lobe and the left upper lobe seemed to be in more severe condition for most of the patients compared to the other lung lobes.


Assuntos
COVID-19 , Bangladesh , Estudos Transversais , Humanos , Pulmão/diagnóstico por imagem , Pandemias , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2 , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X
4.
Cancer Imaging ; 22(1): 6, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35022068

RESUMO

BACKGROUND: To demonstrate and analyze the relatively common imaging findings in this rare primary pleural angiosarcoma (PPA). CASE PRESENTATION: Three cases of PPA, proven by video-assisted thoracic surgery biopsies are retrospectively reviewed. Patients were all male. Age ranges from 65 to 75 years old age (mean; 69). Major chief complaints were dyspnea and chest pain. One has a history of colon cancer, the other has a tuberculosis history and the other has no known history. Multidetector chest CT and PET CT were all done. Immunohistochemical studies were performed including CD31, CD34, or factor VIII-related antigen, vimentin, and cytokeratin. We also review the literatures on recently published PPA. All masses were from 1 to 10 cm. All three patients had multiple pleural based masses, which were ovoid in shape with relatively sharp margin in unilateral hemithorax. Multiple small circumscribed pleural masses are limited in the pleural space in two patients, whereas two, huge lobulated masses about up to 10 cm were present with pleural and extrapleural involvement in one patient. In two patients with pleural mass only, multiple pleural masses were only seen in parietal pleura in one patient and were in both visceral and parietal pleura in one patient. Pleural effusion were found in one side in one patient and in both sides in one patient. One angiosarcoma was arised from chronic tuberculotic pleurisy sequelae. All pleural masses are heterogenous with irregular internal low densities in all patients. Hematogenous metastases were found in liver, vertebra, rib in one patient, and were in lungs with mediastinal lymph node metastases in the other patient. Three patients survived for longer than 3months after diagnosis, but continued to deteriorate rapidly. Two patients underwent chemotherapy after surgical excision, and the other one with multiple metastases treated chemotherapy after CT-guided biopsy, but eventually all died. As a result of comparative analysis of a total of 13 patients' images including 10 cases previously published, there was pleural effusion in all except 2 cases. CONCLUSIONS: PPA were all necrotic without any vascularized enhancing nature, and manifested as unilateral circumscribed or localized pleural-based masses.


Assuntos
Hemangiossarcoma , Derrame Pleural , Idoso , Hemangiossarcoma/diagnóstico por imagem , Humanos , Masculino , Pleura/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
5.
Cir Pediatr ; 35(1): 36-41, 2022 Jan 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35037439

RESUMO

OBJECTIVES: To review intestinal duplications isolated from the digestive tract. MATERIAL AND METHODS: Description of the 27 isolated intestinal duplication cases published; presentation of a new case. RESULTS: Intestinal duplication isolated from the digestive tract represents an extremely rare malformation. This type of duplication is not in close contact with any segment of the intestinal tract, and it has its own vascular pedicle. Preoperative diagnosis rates are lower than those found in classic duplications. In addition to the potential complications, malformation torsion is also to be considered. CONCLUSIONS: This infrequent variant is to be considered at differential diagnosis. Potential torsion should also be taken into account in order to decide when an asymptomatic patient should undergo surgery.


OBJETIVOS: Revisión de las duplicaciones intestinales aisladas, sin conexión con el tracto digestivo. MATERIAL Y METODOS: Se recopilan los 27 casos de duplicación intestinal aislada publicados hasta el momento y se presenta un nuevo caso. RESULTADOS: Las duplicaciones intestinales aisladas sin conexión con el tracto digestivo representan una variante de la malformación extremadamente rara. Este tipo de duplicaciones no están en contacto íntimo con ningún segmento del tracto intestinal y cuelgan de un pe­dículo vascular propio. Tienen menos tasa de diagnóstico prequirúrgico que las duplicaciones clásicas y a las posibles complicaciones hay que añadir la torsión de la malformación. CONCLUSIONES: Es interesante conocer esta variante infrecuente para considerarla en el diagnóstico diferencial. La posibilidad añadida de torsión debe tenerse en cuenta para decidir el momento de la cirugía en el paciente asintomático.


Assuntos
Anormalidades do Sistema Digestório , Diagnóstico Diferencial , Anormalidades do Sistema Digestório/diagnóstico , Anormalidades do Sistema Digestório/cirurgia , Humanos , Intestinos , Tomografia Computadorizada por Raios X
6.
Clin Nucl Med ; 47(2): 117-122, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35006105

RESUMO

PURPOSE: The aim is to investigate the diagnostic performance of multimodal imaging with 18F-FDG PET/CT, MRI, and contrast-enhanced CT (CECT) in cases with unilateral or bilateral ovarian mass without ancillary findings of malignancy. METHODS: Retrospectively, 307 patients who had unilateral or bilateral ovarian masses and underwent preoperative FDG PET/CT and/or MRI/CECT were included. The criterion standard for the ovarian mass was the final pathology. The peak standardized uptake value (SULpeak) among benign tumors (BTs), borderline ovarian tumors (BoTs), and malignant ovarian tumors (MTs) were compared. The cutoff value of SULpeak to discriminate between BT/BoT and MT was determined from the training (n = 200) and validation (n = 131) cohorts. Diagnostic performances of SULpeak, Ovarian-Adnexal Reporting Data System (O-RADS) MRI score, CECT findings, and combination of multimodal imagings were analyzed. RESULTS: SULpeak of MT was significantly higher than that of BT or BoT (P < 0.05). There was no significant difference in SULpeak between BT and BoT (P = 0.147). The cutoff value of SULpeak for discriminating between BT/BoT and MT was 1.76 (sensitivity, 87.0%; specificity, 83.0%). Diagnostic performance for BT/BoT versus MT of O-RADS MRI, CECT, FDG PET/CT plus O-RADS MRI score, and FDG PET/CT plus CECT yielded the respective sensitivities of 100%, 94%, 95%, and 82%, and specificities of 43%, 46%, 88%, and 91%, respectively. CONCLUSIONS: Multimodal imaging biomarkers including FDG PET/CT and MR/CECT could provide additional information to differentiate ovarian masses.


Assuntos
Neoplasias Ovarianas , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Biomarcadores , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Imagem Molecular , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
8.
BMC Pulm Med ; 22(1): 1, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980061

RESUMO

BACKGROUND: Quantitative evaluation of radiographic images has been developed and suggested for the diagnosis of coronavirus disease 2019 (COVID-19). However, there are limited opportunities to use these image-based diagnostic indices in clinical practice. Our aim in this study was to evaluate the utility of a novel visually-based classification of pulmonary findings from computed tomography (CT) images of COVID-19 patients with the following three patterns defined: peripheral, multifocal, and diffuse findings of pneumonia. We also evaluated the prognostic value of this classification to predict the severity of COVID-19. METHODS: This was a single-center retrospective cohort study of patients hospitalized with COVID-19 between January 1st and September 30th, 2020, who presented with suspicious findings on CT lung images at admission (n = 69). We compared the association between the three predefined patterns (peripheral, multifocal, and diffuse), admission to the intensive care unit, tracheal intubation, and death. We tested quantitative CT analysis as an outcome predictor for COVID-19. Quantitative CT analysis was performed using a semi-automated method (Thoracic Volume Computer-Assisted Reading software, GE Health care, United States). Lungs were divided by Hounsfield unit intervals. Compromised lung (%CL) volume was the sum of poorly and non-aerated volumes (- 500, 100 HU). We collected patient clinical data, including demographic and clinical variables at the time of admission. RESULTS: Patients with a diffuse pattern were intubated more frequently and for a longer duration than patients with a peripheral or multifocal pattern. The following clinical variables were significantly different between the diffuse pattern and peripheral and multifocal groups: body temperature (p = 0.04), lymphocyte count (p = 0.01), neutrophil count (p = 0.02), c-reactive protein (p < 0.01), lactate dehydrogenase (p < 0.01), Krebs von den Lungen-6 antigen (p < 0.01), D-dimer (p < 0.01), and steroid (p = 0.01) and favipiravir (p = 0.03) administration. CONCLUSIONS: Our simple visual assessment of CT images can predict the severity of illness, a resulting decrease in respiratory function, and the need for supplemental respiratory ventilation among patients with COVID-19.


Assuntos
COVID-19/classificação , COVID-19/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Amidas/uso terapêutico , Antivirais/uso terapêutico , Temperatura Corporal , Proteína C-Reativa/metabolismo , COVID-19/tratamento farmacológico , COVID-19/fisiopatologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , L-Lactato Desidrogenase/sangue , Pulmão/diagnóstico por imagem , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Mucina-1/sangue , Neutrófilos , Valor Preditivo dos Testes , Prognóstico , Pirazinas/uso terapêutico , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos , SARS-CoV-2 , Esteroides/uso terapêutico
9.
BMC Musculoskelet Disord ; 23(1): 37, 2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34991568

RESUMO

Periarticular hardware placement can be challenging and a source of angst for orthopaedic surgeons due to fear of penetrating the articular surface and causing undue harm to the joint. In recent years, many surgeons have turned to computed tomography (CT) and other intraoperative or postoperative modalities to determine whether hardware is truly extraarticular in areas of complex anatomy. Yet, these adjuncts are expensive, time consuming, and often unnecessary given the advancement in understanding of intraoperative fluoroscopy. We present a review article with the goal of empowering surgeons to leave the operating room, with fluoroscopy alone, assured that all hardware is beneath the articular surface that is being worked on. By understanding a simple concept, surgeons can extrapolate the information in this article to any joint and bony surface in the body. While targeted at both residents and surgeons who may not have completed a trauma fellowship, this review can benefit all orthopaedic surgeons alike.


Assuntos
Parafusos Ósseos , Tomografia Computadorizada por Raios X , Fluoroscopia , Humanos
10.
In Vivo ; 36(1): 103-110, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34972705

RESUMO

BACKGROUND/AIM: This study evaluated the calculation accuracy of the stopping power ratio (SPR) using dual-energy computed tomography with fast kilovoltage switching (FKSCT) for particle therapy. MATERIALS AND METHODS: A tissue characterization phantom with various reference materials was scanned to obtain single-energy computed tomography (SECT) images and generate virtual monochromatic images at 77 keV (VMI77keV) and 140 keV (VMI140keV), water density (WD) images, and effective Z (Zeff) images. For SECT, VMI77keV and VMI140keV lookup tables were generated to convert the measured Hounsfield value into the theoretical SPR for a normal phantom size. Subsequently, the reference materials were scanned in small and large phantoms. The SPR was calculated using the lookup tables of SECT (SPRSECT) images, VMI77keV (SPR77keV), and VMI140keV (SPR140keV), and it was derived from the WD and Zeff (SPRWD). RESULTS: In the normal-sized phantom, the overall mean difference between SPRWD and theoretical SPR was -0.3%, and remained below 2% for most reference materials. For the large phantom, the overall mean absolute difference for SPR140keV (3.0%, p=0.006) and SPRWD (3.2%, p=0.002) for the reference materials was significantly lower than that for SPRSECT (5.9%). For the small phantom, a significant reduction in the mean difference in the SPR calculation was observed in SPR77keV (1.0%, p=0.001) and SPR140keV (1.1%, p=0.013) compared with SPRSECT (2.2%). CONCLUSION: VMI140keV generated using FKSCT significantly improves the estimation accuracy of SPR compared with SECT. Thus, FKSCT may be used to improve the dose calculation accuracy for treatment planning of particle therapy.


Assuntos
Tomografia Computadorizada por Raios X , Imagens de Fantasmas
11.
Nihon Shokakibyo Gakkai Zasshi ; 119(1): 53-60, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-35022371

RESUMO

Schwannoma is a tumor that usually originates soft tissue peripheral nerves. Primary mesenteric schwannomas are rare, and furthermore, there are few reports of this with secondary ossification, which is extremely rare. Herein we report a case of primary mesenteric schwannoma with secondary ossification in a 46-year-old Japanese woman with recurrent postprandial abdominal pain and weight loss. Her vital signs were stable, and her blood test was almost normal except for a slight elevation of CA125. Computed tomography revealed a whirl sign indicative of superior mesenteric torsion. In contiguity with a constricted portion of the intestine, an approximately 70-mm, well-circumscribed tumor with calcifications, which was fed by the superior mesenteric artery was visible. On magnetic resonance imaging, the tumor appeared hypointense on T1-weighted images and inhomogeneous hyperintense on T2-weighted images. As a gastrointestinal mesenchymal tumor was suspected, we performed partial small intestinal resection including the tumor. Intraoperatively, the tumor was found to be incarcerated into a hernial orifice created by the adhesion of the sigmoid colon with the abdominal wall and uterus. Pathologically, the tumor had no continuity with the intestinal wall. It mainly consisted of hypocellular mucous, and spindle-shaped cells were sparsely distributed. Some areas were hypercellular with palisading arrangement cells. This was suggestive of an Antoni B>Antoni A type schwannoma. It also included secondary ossification and blood vessel assembly. The patient has had an uneventful postoperative course without recurrence for about 17 months. Primary mesenteric schwannoma is rare, and to our knowledge, only 20 cases including this case have been reported. Moreover, there has only been one report of primary mesenteric ossified schwannoma in 2018, and there has been no report in Japan so far. We report our experience with the successful treatment of primary mesenteric ossified schwannoma and review the literature.


Assuntos
Neurilemoma , Osteogênese , Feminino , Humanos , Imageamento por Ressonância Magnética , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Pessoa de Meia-Idade , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Tomografia Computadorizada por Raios X
12.
J Int Med Res ; 50(1): 3000605211072801, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35023386

RESUMO

Pulmonary embolism and splenic infarction are rare in patients with polycythemia vera. We herein describe a man in his early 60s whose main symptoms were chest tightness, cough, and sputum expectoration. Antibiotics, bronchodilators, and mucoactive agents did not improve his symptoms. Pulmonary artery computed tomography angiography showed pulmonary embolism, and abdominal computed tomography showed multiple hypodense foci in the spleen. Bone marrow aspiration cytology, biopsy, and genetic testing confirmed polycythemia vera. The patient's symptoms were relieved after treatment with hydroxyurea and rivaroxaban. This case emphasizes that although pulmonary embolism and splenic infarction are relatively rare in patients with polycythemia vera, the possibility of polycythemia vera should be considered in clinical practice.


Assuntos
Policitemia Vera , Embolia Pulmonar , Infarto do Baço , Angiografia , Humanos , Masculino , Policitemia Vera/complicações , Policitemia Vera/diagnóstico por imagem , Policitemia Vera/tratamento farmacológico , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X
13.
BMJ Case Rep ; 15(1)2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012937

RESUMO

A 57-year-old man with acute promyelocytic leukaemia (APML) received induction therapy including all-trans-retinoic acid (ATRA). At day 15, he developed dyspnoea, haemoptysis and hypoxia. Thorax CT demonstrated diffuse ground-glass opacity and consolidation predominantly in dorsal regions, which may reflect increased vascular permeability. He was diagnosed with differentiation syndrome. After dexamethasone was administered and chemotherapy suspended, his symptoms improved and abnormal lesions mostly disappeared on follow-up CT examinations. We report a short-term high-resolution CT series of differentiation syndrome.


Assuntos
Leucemia Promielocítica Aguda , Protocolos de Quimioterapia Combinada Antineoplásica , Seguimentos , Humanos , Leucemia Promielocítica Aguda/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Síndrome , Tomografia Computadorizada por Raios X , Tretinoína/uso terapêutico
14.
J Synchrotron Radiat ; 29(Pt 1): 254-265, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34985443

RESUMO

Tomographic algorithms are often compared by evaluating them on certain benchmark datasets. For fair comparison, these datasets should ideally (i) be challenging to reconstruct, (ii) be representative of typical tomographic experiments, (iii) be flexible to allow for different acquisition modes, and (iv) include enough samples to allow for comparison of data-driven algorithms. Current approaches often satisfy only some of these requirements, but not all. For example, real-world datasets are typically challenging and representative of a category of experimental examples, but are restricted to the acquisition mode that was used in the experiment and are often limited in the number of samples. Mathematical phantoms are often flexible and can sometimes produce enough samples for data-driven approaches, but can be relatively easy to reconstruct and are often not representative of typical scanned objects. In this paper, we present a family of foam-like mathematical phantoms that aims to satisfy all four requirements simultaneously. The phantoms consist of foam-like structures with more than 100000 features, making them challenging to reconstruct and representative of common tomography samples. Because the phantoms are computer-generated, varying acquisition modes and experimental conditions can be simulated. An effectively unlimited number of random variations of the phantoms can be generated, making them suitable for data-driven approaches. We give a formal mathematical definition of the foam-like phantoms, and explain how they can be generated and used in virtual tomographic experiments in a computationally efficient way. In addition, several 4D extensions of the 3D phantoms are given, enabling comparisons of algorithms for dynamic tomography. Finally, example phantoms and tomographic datasets are given, showing that the phantoms can be effectively used to make fair and informative comparisons between tomography algorithms.


Assuntos
Algoritmos , Tomografia Computadorizada por Raios X , Imagens de Fantasmas
15.
Pediatr Emerg Care ; 38(1): e27-e28, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34986584

RESUMO

OBJECTIVES: Children with hemophilia have the usual childhood risk of falls and head trauma. Head computed tomographies (HCTs) are fast, detailed, and readily available, but increased radiation exposure in the pediatric population is now recognized as causing increased brain malignancy. By examining the incidence of intracranial cerebral hemorrhage in this population, we will be able to weigh risks and benefits of HCT use more accurately. METHODS: Using a retrospective chart review, we examined past medical records of pediatric patients, aged 0 to 15 years, with hemophilia presenting to 1 academic medical center. Primary outcomes included number of head CTs ordered, total and per patient over the years studied, and the incidence of positive findings, as defined by presence of blood products as documented by radiologist final read/interpretation. RESULTS: The mean number of head CTs per child was 2.5 (range, 1-10). None of the HCT scans were read as intracranial cerebral hemorrhage, and none of the patients had findings that lead to neurosurgical intervention. In a sensitivity analysis, applying Pediatric Emergency Care Applied Research Network head injury criteria, 11 HCT scans would be ordered for a reduction of 80 HCTs, or a decrease of 2 HCT scans per child. No incidence of intracranial cerebral hemorrhage would have been missed. CONCLUSIONS: Our findings suggest that in the child with hemophilia and a history of minor head trauma, exposure to the radiation of a HCT based on the diagnosis of hemophilia alone may not be necessary but that imaging decisions need to be made in conjunction with clinical examination findings and neurologic status.


Assuntos
Traumatismos Craniocerebrais , Hemofilia A , Exposição à Radiação , Criança , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/epidemiologia , Hemofilia A/complicações , Hemofilia A/diagnóstico por imagem , Hemofilia A/epidemiologia , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
16.
Pediatr Emerg Care ; 38(1): e431-e435, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34986595

RESUMO

INTRODUCTION: We hypothesized that imaging is overused in the initial workup of dog bite patients. To reduce radiation exposure, we aim to determine which circumstances surrounding dog bites, patient population, and injury patterns would necessitate imaging studies for management. METHODS: A retrospective review was performed on all patients presenting with dog bites to our level I pediatric trauma center between 2013 and 2015. Data collected included: circumstances surrounding the injury, patient demographics, injuries, and imaging studies performed. Our analysis focused on maxillofacial and head CT scans, and plain radiographic studies of the limbs, hands, and feet. Imaging studies were considered positive if there was evidence of bony injury. RESULTS: We identified 615 patients with dog bites, with 114 patients having had at least one imaging study performed (a total of 145 imaging studies to analyze). Only 13 (11%) patients had a positive study. In the CT scan group, 6 (22.2%) of 27 studies were positive. In the plain radiographic group, 7 (5.9%) of 118 studies were positive. CONCLUSIONS: Our review indicates that imaging studies are overused in the initial workup of these patients, and the majority of these studies are negative. This study confirms that it is feasible to institute guidelines for ordering imaging studies in dog bite patients. This will ultimately reduce radiation exposure and the cost of care for these injuries.


Assuntos
Mordeduras e Picadas , Animais , Mordeduras e Picadas/diagnóstico por imagem , Cães , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Centros de Traumatologia , Extremidade Superior
17.
BMC Neurol ; 22(1): 20, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012485

RESUMO

BACKGROUND: Pontocerebellar hypoplasia (PCH) is increasingly known as a degenerative disease rather than simple "hypoplasia". At least 21 disease-causing genes have been identified for PCH so far. Because PCH is very heterogenous, prognostic prediction based solely on clinical or radiologic findings is not feasible. CASE PRESENTATION: Here, we report two siblings who had a fulminant neonatal course. The documentation of pontocerebellar hypoplasia by postmortem brain CT imaging in one of the siblings and a subsequent complex and comprehensive whole genome analysis established that both siblings had bi-allelic compound heterozygous variants (a splicing variant and a deletion) in the SLC25A46 gene which encodes a solute carrier protein essential for mitochondrial function. Long-read whole genome sequencing was required to confirm the presence of the deletion. The fulminant courses suggest that SLC25A46-related PCH is an acutely progressive degenerative condition starting in utero, rather than a simple static hypoplasia. CONCLUSION: The genomic analysis was instrumental and essential to solving the enigma of the unexplained neonatal deaths of these two siblings and to provide accurate genetic counseling.


Assuntos
Doenças Cerebelares , Proteínas Mitocondriais , Proteínas de Transporte de Fosfato , Irmãos , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/genética , Evolução Fatal , Genômica , Humanos , Recém-Nascido , Proteínas Mitocondriais/genética , Mutação , Proteínas de Transporte de Fosfato/genética , Tomografia Computadorizada por Raios X
18.
Arq Bras Cir Dig ; 34(3): e1591, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35019117

RESUMO

BACKGROUND: Abdominal obesity or android obesity, that is, the increase in adipose tissue in the abdominal region, is considered a risk factor for several morbidities. Different ways of quantifying it have been proposed, one method is the measurement of the abdominal fat area by computed tomography. AIM: To establish correspondence between the groups defined by degree of obesity in relation to the total, subcutaneous and visceral fat area. METHODS: Cross-sectional observational study carried out through the analysis of tomographic examinations. Horos v3.3.5 medical image visualization software was used, with abdominal tomography in a single cut including the L4 vertebral body and the umbilical scar, to obtain the areas of total, visceral and subcutaneous fat. RESULTS: Of the 40 patients, 10 had grade II obesity, 23 grade III and 7 superobese. The amount of total fat showed an increase in relation to the degree of obesity. Visceral fat did not show significant differences between the degrees of obesity, but the data showed a lower average in the group of obesity grade II. The area of subcutaneous fat, as well as total fat, showed an increase in its measurements, according to the progression of the patients' BMI, but there was no statistical significance in this difference between the groups of grade II and super-obese individuals. CONCLUSION: The area of total and subcutaneous fat showed an increase in its measurements according to the progression of the BMI groups, which did not happen with visceral fat.


Assuntos
Tecido Adiposo , Obesidade , Índice de Massa Corporal , Estudos Transversais , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
19.
BMC Musculoskelet Disord ; 23(1): 9, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980066

RESUMO

BACKGROUND: There is a great deal of controversy on whether routine MRI examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures (TPFs) receive preoperative X-ray and CT examinations. The purpose of the study was to analyze the exact correlation between CT images of lateral plateau and lateral meniscus injuries in Schatzker II TPFs. METHODS: A total of 296 patients with Schatzker II TPFs from August 2012 to January 2021 in two trauma centers were enrolled for the analysis. According to the actual situation during open reduction internal fixation (ORIF) and knee arthroscopic surgery, patients were divided into meniscus injury (including rupture, incarceration, etc.) and non-meniscus injury groups. The values of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on CT images were measured, and their correlation with lateral meniscus injury was then analyzed. The relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal cut-off point of the two indicators which could predict meniscus injury. RESULTS: The intra- and inter-observer reliabilities of LPD and LPW were acceptable (intraclass correlation coefficient (ICC) > 0.8). The average LPD was 13.2 ± 3.2 mm while the average value of the group without meniscus injury was 9.4 ± 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in meniscus injury and non-meniscus injury groups with a significant difference (P < 0.05). The optimal predictive cut-off value of LPD and LPW was 7.9 mm (sensitivity-95.0%, specificity-58.8%, area under the curve (AUC-0.818) and 7.5 mm (sensitivity-70.0%, specificity - 70.6%, AUC - 0.724), respectively. The meniscus injury group mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.1%, 157/160). CONCLUSIONS: The mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients with Schatzker II TPFs when LPD > 7.9 mm and/or LPW > 7.5 mm on CT. These findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention is required be paid to the treatment of the meniscus and the possible fracture reduction difficulties and poor alignment caused by meniscus rupture and incarceration should be fully considered in order to achieve better surgical results.


Assuntos
Fraturas da Tíbia , Lesões do Menisco Tibial , Fixação Interna de Fraturas , Humanos , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/cirurgia , Tomografia Computadorizada por Raios X
20.
Br J Radiol ; 95(1129): 20210644, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34709948

RESUMO

OBJECTIVE: Dual energy CT (DECT) has been shown to estimate stopping power ratio (SPR) map with a higher accuracy than conventional single energy CT (SECT) by obtaining the energy dependence of photon interactions. This work presents a learning-based method to synthesize DECT images from SECT image for proton radiotherapy. METHODS: The proposed method uses a residual attention generative adversarial network. Residual blocks with attention gates were used to force the model to focus on the difference between DECT images and SECT images. To evaluate the accuracy of the method, we retrospectively investigated 70 head-and-neck cancer patients whose DECT and SECT scans were acquired simultaneously. The model was trained to generate both a high and low energy DECT image based on a SECT image. The generated synthetic low and high DECT images were evaluated against the true DECT images using leave-one-out cross-validation. To evaluate our method in the context of a practical application, we generated SPR maps from synthetic DECT (sDECT) using a dual-energy based stoichiometric method and compared the SPR maps to those generated from DECT. A dosimetric comparison for dose obtained from DECT was performed against that derived from sDECT. RESULTS: The mean of mean absolute error, peak signal-to-noise ratio and normalized cross-correlation for the synthetic high and low energy CT images was 36.9 HU, 29.3 dB, 0.96 and 35.8 HU, 29.2 dB, and 0.96, respectively. The corresponding SPR maps generated from synthetic DECT showed an average normalized mean square deviation of about 1% with reduced noise level and artifacts than those from original DECT. Dose-volume histogram (DVH) metrics for the clinical target volume agree within 1% between the DECT and sDECT calculated dose. CONCLUSION: Our method synthesized accurate DECT images and showed a potential feasibility for proton SPR map generation. ADVANCES IN KNOWLEDGE: This study investigated a learning-based method to synthesize DECT images from SECT image for proton radiotherapy.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Aprendizado de Máquina , Terapia com Prótons , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Estudos Retrospectivos
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