RESUMO
PURPOSE: To assess the feasibility of transarterial embolization (TAE) for recalcitrant nighttime shoulder pain in a multicentric study. MATERIALS AND METHODS: This prospective, open-label, feasibility trial included 100 patients treated at 5 institutions. TAE was performed in 76 patients with adhesive capsulitis (AC) and 24 patients with symptomatic rotator cuff tears (sRCTs). The ipsilateral radial artery was punctured, and imipenem/cilastatin sodium was infused as an embolic agent. Adverse events, 10 point pain numerical rating scale (NRS), range of motion (ROM) of the shoulder joint, and quality of life (via the EuroQol-5D [EQ-5D]) were evaluated. RESULTS: All patients exhibited neovascularity on baseline angiography, and all TAE procedures were performed successfully. No patient experienced a major adverse event. The mean nighttime pain NRS scores at baseline and 1, 3, and 6 months after TAE were 6.4 ± 2.2, 3.4 ± 2.6, 2.3 ± 2.5, and 1.6 ± 2.2, respectively (for all, P < .001). The mean ROM of anterior elevation at baseline and 1, 3, and 6 months after TAE were 97° ± 29°, 119° ± 28°, 135° ± 27°, and 151° ± 17°, respectively (for all, P < .001). The mean EQ-5D scores at baseline and 1, 3, and 6 months after TAE were 0.63 ± 0.17, 0.73 ± 0.16, 0.80 ± 0.17, and 0.84 ± 0.17, respectively (for all, P < .001). There was no significant difference in the clinical success rate between the AC and sRCT groups. CONCLUSIONS: TAE for nighttime shoulder pain caused by AC and sRCTs was feasible with sufficient safety and efficacy.
Assuntos
Bursite , Embolização Terapêutica , Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Dor de Ombro/diagnóstico por imagem , Dor de Ombro/etiologia , Dor de Ombro/terapia , Estudos Prospectivos , Qualidade de Vida , Estudos de Viabilidade , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Bursite/terapia , Lesões do Manguito Rotador/terapia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/irrigação sanguínea , Amplitude de Movimento Articular , Neovascularização Patológica , Resultado do TratamentoRESUMO
Subclavian artery dissecting aneurysm is relatively rare and can be caused by traumatic, nontraumatic, and iatrogenic etiologies. Surgical management of subclavian artery dissecting aneurysm has been sparsely reported. Recently, due advances in endovascular techniques making them less invasive, these approaches have become more standard as treatments. Subclavian artery dissecting aneurysm management usually depends on whether there is ischemia of the tissues supplied by the subclavian artery. Furthermore, treatment strategies depend on which section of the artery is involved. In particular, treatment is difficult if the dissecting aneurysm has branching vessels. In this case report, we show that endovascular repair using a covered stent graft is a promising approach to repair a subclavian artery dissecting aneurysm. In this case, the stent graft was highly effective, and follow-up examinations showed good patency of the subclavian artery. Additional use of IVUS (Volcano Inc.; Rancho Cordova, CA, USA) is helpful to obtain the precise location of the true lumen of a dissecting aneurysm.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Humanos , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
OBJECTIVES: This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency. METHODS: Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated. RESULTS: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency. CONCLUSIONS: TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency. KEY POINTS: ⢠Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications. ⢠The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively. ⢠The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.
Assuntos
Malformações Arteriovenosas , Embolização Terapêutica , Veias Pulmonares , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Humanos , Angiografia por Ressonância Magnética , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the safety and effectiveness of hydrogel-coated coils for vessel occlusion in the body trunk. MATERIALS AND METHODS: A total of 77 patients with various peripheral vascular lesions, treatable by embolization with coils, were randomized (hydrogel group, n = 38; nonhydrogel group, n = 39). In the hydrogel group, embolization of the target vessel was conducted using 0.018-inch hydrogel-coated coils (AZUR 18; Terumo Medical Corporation, Tokyo, Japan) with or without bare platinum coils. The nonhydrogel group received both bare platinum coils and fibered coils without the use of hydrogel-coated coils. RESULTS: Complete target vessel occlusion was accomplished in 36 patients in the hydrogel group and 37 patients in the nonhydrogel group. No major adverse events were observed in either group. The median number of coils/vessel diameter and the median total coil length/vessel diameter were significantly larger in the nonhydrogel group than in the hydrogel group (P = .005 and P = .004, respectively). The median embolization length was significantly longer in the nonhydrogel group (31.95 mm) than in the hydrogel group (23.43 mm) (P = .002). If no expansion was assumed, the median packing density in the hydrogel group was 44.9%, which was similar to that in the nonhydrogel group (46.5%) (P = .79). With full expansion assumed, the median packing density in the hydrogel group was 125.7%. CONCLUSIONS: Hydrogel-coated coils can be safely used for peripheral vascular coil embolization, and hydrogel-coated and conventional coils in combination allow for a shorter embolization segment and shorter coil length.
Assuntos
Materiais Revestidos Biocompatíveis , Embolização Terapêutica/instrumentação , Doenças Vasculares/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolização Terapêutica/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Hidrogéis , Japão , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologiaRESUMO
OBJECTIVE. The purpose of this study was to clarify the natural history of unruptured visceral artery aneurysms due to segmental arterial mediolysis and the efficacy of transcatheter arterial embolization. MATERIALS AND METHODS. Patients with a pathologic or clinical diagnosis of visceral artery aneurysms due to segmental arterial mediolysis between 2005 and 2015 were enrolled. For patients with clinical diagnoses, images were collected and assessed by central radiologic review. To clarify the natural history of unruptured aneurysms, the morphologic changes were assessed. The efficacy and safety of transcatheter arterial embolization for aneurysms due to segmental arterial mediolysis were evaluated. RESULTS. Forty-five patients with 123 aneurysms due to segmental arterial mediolysis were enrolled. Among the 123 aneurysms, 70 unruptured aneurysms were evaluated for natural history. Forty-five of the 70 (64%) aneurysms had no change in morphology. Among the other 25 aneurysms, nine (13% of the 70) were reduced in size, 13 (19%) disappeared, and three (4%) were newly found at follow-up. Aneurysms of the middle colic artery were ruptured in 10 of 11 (91%) cases. Transcatheter arterial embolization was performed on 45 aneurysms and was successful in all cases but caused slight arterial injury in three cases (6.7%). CONCLUSION. At initial diagnosis, unruptured aneurysms due to segmental arterial mediolysis are likely to be stable or to resolve, but the risk of rupture of aneurysms of the middle colic artery appears high. Transcatheter arterial embolization is a useful treatment, but careful manipulation is necessary.
Assuntos
Aneurisma/terapia , Artérias , Embolização Terapêutica/métodos , Vísceras/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma/etiologia , Aneurisma/patologia , Aneurisma/cirurgia , Aneurisma Roto/etiologia , Artéria Celíaca , Embolização Terapêutica/efeitos adversos , Feminino , Artéria Gástrica , Artéria Gastroepiploica , Artéria Hepática , Humanos , Japão , Masculino , Artéria Mesentérica Inferior , Artéria Mesentérica Superior , Pessoa de Meia-Idade , Estudos Retrospectivos , Artéria Esplênica , Túnica MédiaRESUMO
OBJECTIVE: We aimed to evaluate the safety and efficacy of embolization using a 1.7-Fr catheter and soft bare coil to treat acute small intestinal bleeding. MATERIAL AND METHODS: Subjects were five consecutive patients who experienced onset of melena with small intestinal bleeding and underwent transcatheter arterial embolization with 1.7-Fr catheters and 0.010-inch detachable bare coils (five procedures in total). Technical success, clinical success, relative post-procedural complications, arterial bleeding source and cause, and relationship between coagulopathy and embolization efficacy were examined by capsule endoscopy. RESULTS: We achieved 100% technical and clinical success for the five transcatheter arterial embolizations. All catheterizations of the vasa recta of the bleeding artery (jejunal artery, n = 2; ileal artery, n = 3) were possible with a 1.7-Fr catheter. We achieved high embolization efficacy in two patients with coagulopathy. No rebleeding, intestinal ischemia, or necrosis was observed on follow-up capsule endoscopy. We confirmed that peptic ulcers/ulcer scars were the cause of bleeding for all patients. CONCLUSION: Embolization with 0.010-inch coils using a 1.7-Fr catheter and catheterization of the vasa recta of bleeding vessels was effective and safe for treating small intestinal bleeding.
Assuntos
Catéteres , Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
A 35-year-old pregnant woman was referred to our institution at 33 weeks' gestation for evaluation of a fetal abdominal tumor. B-mode ultrasonography demonstrated a massive lesion. Bidirectional power Doppler mode showed abundant blood flow surrounding the tumor. On superb micro-vascular imaging, various Doppler signal patterns were observed within the tumor, including diffuse fine dotted-like signals, linear flow, and internal shunt flow. Sequential observations of the tumor and cardiac cycles also revealed pulsatile flow beneath the edges of the tumor and continuous fine flow in the central area, resembling a 'centripetal fill-in' appearance on contrast computed tomography. Therefore, we assumed the fetal tumor to be a hepatic hemangioma. Fetal heart failure was detected at 37 weeks' gestation, and a 2,484-g female infant was delivered with 1- and 5-min Apgar scores of 7 and 8, respectively. A postnatal contrast computed tomography examination showed a progressive centripetal fill-in appearance, leading to a diagnosis of hepatic hemangioma. Kasabach-Merritt syndrome was also noted. Intensive treatment was performed, and the infant was discharged at 3 months after birth. In summary, we experienced a case of hepatic hemangioma diagnosed in utero using superb micro-vascular imaging. And basing seamless postnatal treatments on prenatal imaging findings may help to reduce the perinatal mortality.
Assuntos
Hemangioma , Neoplasias Hepáticas , Ultrassonografia Pré-Natal , Humanos , Feminino , Neoplasias Hepáticas/diagnóstico por imagem , Gravidez , Adulto , Hemangioma/diagnóstico por imagem , Ultrassonografia Doppler , Recém-Nascido , Síndrome de Kasabach-Merritt/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Microvasos/diagnóstico por imagemRESUMO
INTRODUCTION: Postpancreaticoduodenectomy hemorrhage (PPH) is a serious complication. Fatty or nonfibrous pancreas, or both, is a risk factor for pancreatic fistula. This study assessed various prognostic factors for interventional procedures for PPH, also focusing on the degree of pancreatic fatty infiltration/fibrosis evaluated histopathologically. MATERIAL AND METHODS: The participants were 29 patients with PPH who underwent endovascular treatment from September 2001 to March 2020. Univariate analysis was performed to determine whether the histopathological degree of pancreatic fatty infiltration/fibrosis and other factors were associated with complications and mortality after endovascular treatment for PPH. RESULTS: Of 39 treatment sessions overall, 38 (97%) achieved technical success and 34 (87%) had clinical success. In-hospital mortality occurred in five patients (17%). No association was found between the pancreatic fistula and the histopathological degree of pancreatic fatty infiltration/fibrosis. Fourteen patients with hemorrhagic shock before endovascular treatment included all five patients with in-hospital mortality, while the 15 patients without hemorrhagic shock survived (P = 0.017). A bleeding tendency was associated with complications after endovascular treatment for PPH (P = 0.033). CONCLUSIONS: Although our results revealed no significant relation between the histopathological degree of pancreatic fatty infiltration/fibrosis and clinical success, including prognosis, endovascular treatment may be effective for PPH.
RESUMO
BACKGROUND Tumor-induced osteomalacia (TIO) is a paraneoplastic syndrome caused by aberrant fibroblast growth factor-23 (FGF-23)-producing tumors. Early surgical resection is the optimal strategy for preventing TIO progression. Thus, tumor localization is a priority for successful treatment. A simple and safe examination method to identify functional endocrine tumors is essential to achieve better outcomes in patients with TIO. CASE REPORT A 64-year-old Japanese man with recurrent fractures, hypophosphatemia, and elevated alkaline phosphatase and FGF-23 levels (109 pg/mL) was admitted to our university hospital and was diagnosed with FGF23-related hypophosphatemic osteomalacia. Notably, the superficial dorsal vein in the patient's left foot exhibited a high FGF-23 level (7510 pg/mL). Octreotide and ¹8F-fluorodeoxyglucose (FDG) scintigraphy and systemic venous sampling revealed that the tumor in the third basal phalanx of the left foot was responsible for FGF-23 overproduction. Tumor resection resulted in a rapid decrease in serum FGF-23 levels and an increase in serum phosphorus levels. CONCLUSIONS Octreotide scintigraphy, FDG-positron emission tomography, and systemic venous sampling are the standard methods for localizing functional endocrine tumors. However, the limited availability and invasive nature of these examinations hinder effective treatment. Here, we highlight the importance of peripheral superficial blood sampling as an alternative to conventional systemic methods for confirming the presence of FGF-23-producing tumors. Clinicians should consider TIO as a potential cause of acquired hypophosphatemic osteomalacia. Furthermore, peripheral superficial vein blood sampling may be useful for confirming the localization of FGF-23-producing tumors.
Assuntos
Neoplasias , Osteomalacia , Síndromes Paraneoplásicas , Masculino , Humanos , Pessoa de Meia-Idade , Osteomalacia/etiologia , Fator de Crescimento de Fibroblastos 23 , Fluordesoxiglucose F18 , OctreotidaAssuntos
Aneurisma/terapia , Embolização Terapêutica/instrumentação , Artéria Esplênica , Aneurisma/diagnóstico por imagem , Aneurisma/fisiopatologia , Angiografia , Embolização Terapêutica/métodos , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Retratamento , Artéria Esplênica/diagnóstico por imagem , Artéria Esplênica/fisiopatologia , Resultado do TratamentoRESUMO
Arteriovenous malformations (AVMs) are vascular malformations that present high-flow direct communication between the arteries and veins, not involving the capillary beds. They can be progressive and lead to various manifestations, including abnormal skin or mucosal findings, ischemia, hemorrhage, and high-output heart failure in severe cases. AVMs often involve the head and neck region. Head and neck AVMs can present region-specific clinical manifestations, angioarchitecture, and complications, especially in cosmetic appearance and ingestion, respiratory, and neuronal functions. Therefore, when planning endovascular treatment of head and neck AVMs, physicians should consider not only the treatment strategy but also the preservation of the cosmetic appearance and critical functions. Knowledge of the functional vascular anatomy as well as treatment techniques should facilitate a successful management. This review summarizes AVMs' clinical manifestations, imaging findings, treatment strategy, and complications.
RESUMO
PURPOSE: This study aimed to evaluate the value of fat-suppressed T2-weighted imaging (FS-T2WI) for predicting short-term pain relief after polidocanol sclerotherapy for painful venous malformations (VMs) in the extremities. MATERIALS AND METHODS: This retrospective study included patients with painful VMs in the extremities between October 2014 and September 2021, had their first sclerotherapy without history of surgical therapy, and underwent magnetic resonance imaging before sclerotherapy. Pain relief was assessed 2 months after 3% polidocanol sclerotherapy and was categorized as follows: progression, no change, partial relief, or free of pain. The associations between pain relief and imaging features on FS-T2WI were analyzed. RESULTS: The study included 51 patients. The no change, partial relief, and free of pain groups included 6 (11.8%), 25 (49.0%), and 20 (39.2%) patients, respectively. No patient experienced progressive pain. The lesion diameter was ≤ 50 mm in 13 (65.0%) patients in the free of pain group, whereas it was > 50 mm in all patients in the no change group (p = 0.019). The lesions showed well-defined margin in 15 (75.0%) patients in the free of pain group, whereas they showed ill-defined margin in 5 (83.3%) patients in the no change group (p = 0.034). The most common morphological type was cavitary in the free of pain group (14 [70.0%] patients), whereas there was no patient with cavitary type lesion in the no change group (p = 0.003). Drainage vein was demonstrated in 6 (100%), 22 (88.0%), and 11 (55.0%) patients in the no change, partial relief, and free of pain group, respectively (p = 0.011). CONCLUSION: A lesion size of 50 mm or less, a well-defined margin, a cavitary type, and no drainage vein on FS-T2WI were significant features for predicting short-term pain relief after polidocanol sclerotherapy for painful VMs in the extremities.
Assuntos
Escleroterapia , Malformações Vasculares , Humanos , Escleroterapia/métodos , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Estudos Retrospectivos , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/terapia , Dor/etiologia , Imageamento por Ressonância Magnética , Extremidades/diagnóstico por imagem , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to find useful imaging features on non-contrast-enhanced magnetic resonance imaging (MRI) that can divide patients with thymic epithelial tumor (TET) into clinical stage I-II and III-IV groups under assumption that contrast media are contraindicated. MATERIALS AND METHODS: This retrospective study included 106 patients (median age, 60 years; range, 27-82 years; 62 women) with surgically resected TET who underwent MRI between August 1986 and July 2015. All cases were classified according to the 2015 WHO classification and staged using the eighth edition of the TNM system. Two radiologists independently evaluated 14 categories of MRI findings; the findings in patients with stage I-II were compared with those of patients with stage III-IV using a logistic regression model. Disease-specific survival associated with significant findings was calculated using the Kaplan-Meier method. RESULTS: Univariate analysis showed that stage III-IV patients were more likely to have tumors with an irregular contour, heterogeneity on T1WI, low-signal intensity on T2WI, irregular border with lung, findings of great vessel invasion (GVI) (hereafter, GVI sign), pericardial thickening/nodule, and lymphadenopathy (all, P < 0.01). On multivariable analysis, only two findings, irregular border between tumor and lung (odds ratio [OR], 272.8; 95% CI 26.6-2794.1; P < 0.001) and positive GVI sign (OR, 49.3; 95% CI 4.5-539.8; P = 0.001) remained statistically significant. Patients with one or both features had significantly worse survival (log-rank test, P < 0.001). CONCLUSION: For patients with TET who are unable to receive contrast for preoperative staging, the two image findings of an irregular border between tumor and lung and the positive GVI sign on non-contrast-enhanced MRI could be helpful in determining stage III-IV disease which is associated with a worse survival.
Assuntos
Neoplasias do Timo , Humanos , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Prognóstico , Imageamento por Ressonância Magnética/métodos , Estadiamento de NeoplasiasAssuntos
Embolização Terapêutica/métodos , Hepatopatias/cirurgia , Transplante de Fígado/efeitos adversos , Fígado/irrigação sanguínea , Impressão Tridimensional , Idoso , Humanos , Fígado/anatomia & histologia , Fígado/cirurgia , Hepatopatias/etiologia , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Tamanho do Órgão , Derivação Portocava Cirúrgica/efeitos adversos , Derivação Portocava Cirúrgica/métodosRESUMO
OBJECTIVE: The purpose of this article is to document our experiences with ultraselective arterial embolization to manage acute colonic hemorrhage using a 1.7-French microcatheter with small-sized detachable coils and to discuss the feasibility and clinical efficacy of this new technique. CONCLUSION: We achieved technical success in all four patients with the sole use of short-segment embolization of the long branch of the vasa recta. Our findings suggest that this technique is useful for embolization in cases of colonic hemorrhage.
Assuntos
Catéteres , Colo/lesões , Embolização Terapêutica/instrumentação , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/terapia , Doença Aguda , Angiografia , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Falha de Tratamento , Resultado do TratamentoRESUMO
BACKGROUND: Treating arteriovenous malformation (AVM) is challenging because of the high recurrence rate and because incomplete resection or embolization can induce aggressive growth. However, a standard strategy is not fully established. Although transcatheter arterial embolization (TAE) is currently almost always part of the treatment, in many cases, single treatment is not curative and only palliative. Additionally, the success and complication rates associated with TAE alone are unclear, and there has been limited study of staged TAE for facial AVMs. Furthermore, few reports have described the details of the procedure. CASE-PRESENTATION: We report two cases of AVM of the upper lip in patients who were successfully treated by staged super-selective TAE at several-month intervals using ultra-thin microcatheters and n-butyl-2-cyanoacrylate. CONCLUSION: Staged and super-selective TAE may prevent complications and provide high curability and might be a useful treatment in cases of AVM.
Assuntos
Hemorragia , Artéria Renal , Dor nas Costas/etiologia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Hematoma/diagnóstico por imagem , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Renal/diagnóstico por imagem , Espaço Retroperitoneal , Resultado do TratamentoAssuntos
Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Região Lombossacral/patologia , Fraturas da Coluna Vertebral/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Idoso , Transfusão de Sangue , Angiografia Coronária , Hemotórax/diagnóstico por imagem , Humanos , Região Lombossacral/diagnóstico por imagem , Masculino , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/patologiaRESUMO
Adenocarcinoma is the most common histological type of non-small cell lung cancer (NSCLC), and various biomarkers for predicting its prognosis after surgical resection have been suggested, particularly in early-stage lung adenocarcinoma. Periostin (also referred to as POSTN, PN or osteoblast-specific factor) is an extracellular matrix protein, the expression of which is associated with tumor invasiveness in patients with NSCLC. In the present study, the novel approach, in which the thin-section CT findings prior to surgical resection and periostin expression of resected specimens were analyzed in combination, was undertaken to assess whether the findings could be a biomarker for predicting the outcomes following resection of T1 invasive lung adenocarcinoma. A total of 73 patients who underwent surgical resection between January 2000 and December 2009 were enrolled. A total of seven parameters were assessed in the thin-section CT scans: i) Contour; ii) part-solid ground-glass nodule or solid nodule; iii) percentage of solid component (the CT solid score); iv) presence of air-bronchogram and/or bubble-like lucencies; v) number of involved vessels; vi) shape linear strands between the nodule and the visceral pleura; and vii) number of linear strands between the nodule and the visceral pleura. Two chest radiologists independently assessed the parameters. Periostin expression was evaluated on the basis of the strength and extent of staining. Univariate and multivariate analyses were subsequently performed using the Cox proportional hazards model. There was a substantial to almost perfect agreement between the two observers with regard to classification of the seven thin-section CT parameters (κ=0.64-0.85). In the univariate analysis, a CT solid score >80%, pathological lymphatic invasion, tumor and lymph node status and high periostin expression were significantly associated with recurrence (all P<0.05). Multivariate analysis demonstrated that a CT solid score >80% and high periostin expression were risk factors for recurrence (P=0.002 and P=0.011, respectively). The cumulative recurrence rates among the three groups (both negative, CT solid score >80% or high periostin expression, or both positive) were significantly different (log-rank test, P<0.001). Although the solid component is already known to be a major predictor of outcome in lung adenocarcinomas according to previous studies, the combined analysis of CT solid score and periostin expression might predict the likelihood of tumor recurrence more precisely.