RESUMO
BACKGROUND: This study's purpose was to demonstrate a relationship between growth of stroke volume measured on Diffusion-Weighted MRI (DWI) at admission (baseline) and 24 hours later (follow-up) and functional outcome at 90 days evaluated by the modified Rankin Scale (mRS). METHODS: DWI infarct volumes were calculated, using an Analyze Software. Clinical outcomes were assessed at 90 days by the mRS. Univariate regression analysis was performed to assess the relationship between changes in DWI lesion volume and mRS less or equal to 1. RESULTS: Sixty-nine cases had serial DWI scans with a measurable lesion at baseline and follow-up. The median baseline National Institutes of Health Stroke Scale (NIHSS) was 10, 5 and 7 at 24 hours. At 90 days, the proportion of patients with Rankin less or equal to 1 was 51.7%. The average baseline volume was 19.7 cm(3) and average follow-up volume was 46.1 cm(3). For each 10 cm(3) of growth in DWI infarct volume, the odds ratio for a mRS less or equal to 1 was 10,1 (IC 95%, 3-33.9). CONCLUSION: The results of this study provide evidence of a significant inverse relationship between infarct growth measured by DWI and good functional clinical outcome at 90 days.
Assuntos
Isquemia Encefálica/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Acidente Vascular Cerebral/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Distribuição de Qui-Quadrado , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Software , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Resultado do TratamentoRESUMO
BACKGROUND: We investigated a novel allotransplantation model using an aortocava patch in ewes. METHODS AND RESULTS: We carried out 10 uterine orthotopic allotransplantations in ewes with end-to-side anastomosis of the aortocava donor patch on the left external iliac vessel recipient. The immunosuppressive protocol was a combination of cyclosporine (10 mg/kg/day) and mycophenolic acid (3 g/day). An estimation of the immunosuppressive therapy exposure was performed by measuring the area under the curve (AUC) of immunosuppressive plasma concentrations. The graft was assessed by vaginoscopy, magnetic resonance imaging (MRI) and second look laparotomy at 6, 8 and 10 weeks, respectively. The median (range) times for cold and warm ischemia were 95 min (75-130) and 91 min (55-165), respectively. All the vascular anastomoses were patent at the end of the surgery. The median AUC of cyclosporine and mycophenolic acid were 1.24 mg h/l (0.34-3.85) and 18.40 mg h/l (3.76-42.35), respectively. Of the 10 ewes receiving a transplant, 6 could be assessed. Cervical biopsies showed signs of necrosis in all six ewes. The MRI results correlated with the macroscopic observations of the 'second look' laparotomy. The aortocava vascular pedicles were thrombosed, adding to the peripheral neovascularization. Graft histology showed endometrial tissue in two out of six ewes. CONCLUSIONS: Mobility of the transplant within the pelvis, the length of the vascular pedicle and rejection can explain the high rate of transplant necrosis. The particular digestive anatomy and physiology of ruminants makes it difficult to administer an optimal immunosuppressive treatment. MRI appears to be a good non-invasive examination for graft estimation.
Assuntos
Aorta/patologia , Útero/transplante , Animais , Área Sob a Curva , Ciclosporina/farmacologia , Endométrio/patologia , Feminino , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Imunossupressores/uso terapêutico , Isquemia , Imageamento por Ressonância Magnética/métodos , Ácido Micofenólico/uso terapêutico , Ovinos , Fatores de Tempo , Transplante Homólogo/métodos , Vagina/patologiaRESUMO
The purpose of this study was to analyze the feasibility and utility of 3D imaging to help lead positioning during a deep brain stimulation (DBS) procedure. A bilateral subthalamic DBS procedure was conducted in 2 patients for idiopathic Parkinson's disease. Subthalamic nucleus targeting was based on preoperative stereotactic MRI. We used the Medtronic O-arm to perform 2D-imaging control (frontal and lateral) as well as quick (<30 s) 3D acquisition. This allowed us to check the positioning of micro-macro electrodes and definite electrodes. 3D images were fused with postoperative CT to assess their accuracy, and with preoperative MRI to visualize the anatomical location of the electrodes. 3D imaging is a quick and safe method to ensure perioperative control of lead placement during DBS procedures.
Assuntos
Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Processamento de Imagem Assistida por Computador/instrumentação , Imageamento Tridimensional/instrumentação , Monitorização Intraoperatória/instrumentação , Adulto , Estudos de Viabilidade , Feminino , Fluoroscopia/instrumentação , Fluoroscopia/métodos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/terapia , Núcleo Subtalâmico/diagnóstico por imagem , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/métodosRESUMO
Cavernous hemangioma is the most frequent benign tumor of the orbit. The clinical presentation is that of a slowly progressive intra-orbital mass with variable degree of exophthalmos. CT typically demonstrates the presence of a well defined oval or rounded shaped mass but MRI provides superior evaluation of the orbit. The tumor is intra-conal in 80% of cases and usually shows T1W hypo-isointensity, T2W hyperintensity and heterogeneous contrast enhancement that becomes more homogeneous on delayed imaging (5 minutes).
Assuntos
Hemangioma Cavernoso/diagnóstico , Neoplasias Orbitárias/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
Thanks to a superior resolution and contrast, MRI allows recognizing the post therapeutic modifications of female pelvis, often very subtle and nonvisible by the other imaging modalities. The main surgical or medical therapies in the female pelvis will be described as well as the normal post therapeutic anatomical aspects. The main complications and failures will be mentioned and informed. Finally the keys that will allow to understand these complications and failures will be boarded.
Assuntos
Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/terapia , Imageamento por Ressonância Magnética , Adulto , Diagnóstico Diferencial , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Doenças dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Femininos/diagnóstico , Neoplasias dos Genitais Femininos/tratamento farmacológico , Neoplasias dos Genitais Femininos/cirurgia , Neoplasias dos Genitais Femininos/terapia , Procedimentos Cirúrgicos em Ginecologia , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Resultado do TratamentoRESUMO
MRI is taking a growing place for pelvic prolapse diagnosis. A strict technical protocol with static and dynamic sequences is required with rectal and vaginal ultrasound gel. A good knowledge of physiology and anatomy of pelvic and perineal muscles is mandatory as well as a clinical approach of various pathologic prolapses. MRI fundings are presented and correlated with several clinical situations of prolapse and post operative features.
Assuntos
Imageamento por Ressonância Magnética , Diafragma da Pelve/anatomia & histologia , Cistocele/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Próteses e Implantes , Implantação de Prótese , Retocele/diagnóstico , Prolapso Uterino/diagnósticoRESUMO
Medical treatment of a couple's infertility depends upon the cause(s) of infertility. The goals of imaging are to determine these causes (male, female, mixed, unexplained), to evaluate their severity and type on the female side central, ovarian, uterine, tubal, peritoneal, endometriosis, in order to propose an adapted treatment. Imaging modalities are essentially non ionising (US and MRI). Hysterosalpingogram retains its indication to study tubal patency, it can be completed by tubal catheterisation in cases of proximal tubal obstruction.
Assuntos
Doenças dos Genitais Femininos/diagnóstico , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/etiologia , Imageamento por Ressonância Magnética , Ultrassonografia , Endometriose/diagnóstico , Endometriose/diagnóstico por imagem , Feminino , Fertilização in vitro , Doenças dos Genitais Femininos/diagnóstico por imagem , Humanos , Histerossalpingografia , Infertilidade Feminina/diagnóstico por imagem , Leiomioma/diagnóstico , Leiomioma/diagnóstico por imagem , Pólipos/diagnóstico , Salpingite/diagnóstico , Salpingite/diagnóstico por imagem , Ultrassonografia Doppler , Doenças Uterinas/diagnóstico , Doenças Uterinas/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/diagnóstico por imagemRESUMO
Pelvic endometriosis primarily affects the ovaries, pelvic peritoneum, utero-sacral ligaments, Douglas pouch, vagina, rectum and bladder. Clinical assessment is difficult, and imaging proves necessary to determine location and extent of the disease. We review pelvic endometriosis with regards to imaging modalities: technical considerations, imaging patterns, diagnostic performance and respective place of ultrasound and MRI.
Assuntos
Endometriose/diagnóstico por imagem , Endossonografia/métodos , Imageamento por Ressonância Magnética/métodos , Pelve/diagnóstico por imagem , Endometriose/diagnóstico , Endometriose/patologia , Feminino , Humanos , Pelve/patologiaRESUMO
We present a patient with double spinal dural arteriovenous fistulas revealed by progressive myelopathy. Numerous dilated veins extending along the entire length of the spinal cord were found on MR imaging. Angiography showed a first spinal dural fistula at the level of T7 with descending venous drainage and a second spinal dural fistula at the level of T5 with ascending venous drainage. Both fistulas were cured by therapeutic embolization.
Assuntos
Angiografia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico , Embolização Terapêutica , Imageamento por Ressonância Magnética , Medula Espinal/irrigação sanguínea , Malformações Vasculares do Sistema Nervoso Central/terapia , Seguimentos , Lateralidade Funcional/fisiologia , Humanos , Músculos Intercostais/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Exame Neurológico , RetratamentoRESUMO
Chilaïditi's syndrome is the association of a radiological and clinical semiology of the interposition of large colon or small intestine between the lower side of diaphragm and liver. We report the case of a 32-year-old woman, primigravida, who undergone a caesarean section at 39 weeks of amenorrhoea, for a clinical picture of persistent abdominal pain and a beginning hepatic cytolysis. The patient presented one day after the ceasarean section an occlusive syndrome of the small intestine. The etiology of the occlusion of the small intestine in post-partum was a Chilaïditi's syndrome with inter hepatodiaphragmatic incarceration of the small intestine discovered at the computed tomography. An exploratory laparotomy confirmed and permitted to treat Chilaïditi's syndrome complicated by an occlusion.
Assuntos
Cesárea/efeitos adversos , Obstrução Intestinal/etiologia , Intestino Delgado/anormalidades , Dor Abdominal , Adulto , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Necrose , Gravidez , Síndrome , Tomografia Computadorizada por Raios XRESUMO
RATIONAL AND OBJECTIVES: The feasibility of tubal occlusion by selective salpingography was tested in an animal model; three novel occluding materials also were tested for this application. METHODS: Unilateral selective salpingography was performed in three groups of six rabbits; fallopian tubes were embolized with ethanol (group 1), a hydrogel (group 2), or an occluding emulsion (Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; tubal patency and histologic modifications were evaluated. RESULTS: Selective tubal catheterization was obtained in 100% of the cases. In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. CONCLUSION: Selective salpingography proved a suitable method for gaining access to the fallopian tube and allowed selective injection of occluding materials. More research is needed to determine a suitable occluding material, focusing on biocompatibility and on long-term efficacy.
PIP: Unilateral selective salpingography was performed in 3 groups of 6 rabbits. 4-6 month old, virgin New Zealand White female rabbits were used with a mean weight of 4.4 kg. The fallopian tubes were embolized with ethanol (group 1); a viscous radiopaque solution which solidifies rapidly after injection to produce a biocompatible and inert hydrogel (group 2); or an occluding emulsion (a radiopaque heterogeneous alcoholic solution of zein, poppy seed oil, propylene glycol, and sodium amidotrizoate from Ethibloc, Laboratoire Princeps, Neuilly sur Seine, France) (group 3). Animals were killed 2 days or 30 days after the procedure, according to randomization; and tubal patency and histologic modifications were evaluated. Selective tubal catheterization was possible in all 18 cases, in 12 cases on the right side (66%), in 6 cases on the left side (33%); in 11 cases with a 5F catheter (61%), in 7 cases with a 2.5F catheter (39%). In group 1, no satisfactory occlusion was obtained; in group 2, 65% of the tubes were occluded with little histologic damage; and in group 3, 80% of the tubes were occluded, but significant inflammation and tissue necrosis were noted. The fallopian tubes were selectively catheterized over variable lengths: over 10 mm in 5 rabbits (28%), between 5 and 10 mm in 4 rabbits (22%), and between 1 and 5 mm in 9 rabbits (50%). Before injection of the occluding materials, all the catheterized tubes were patent. Mean volume of occluding material injected was 0.36 mL in group 1, 0.30 mL in group 2, and 0.83 mL in group 3. The ethanol injected reached the peritoneum in all 6 rabbits. The gel was injected an average length of 11 mm in the tube, while the emulsion opacified all the volume of the tubes with a peritoneal spill of emulsion in 3 of 6 cases. Reflux of occluding material into the uterus was noted in 1 of 6 rabbits in group 1, in 4 of 6 rabbits in group 2, in 3 of 6 rabbits in group 3. Selective salpingography proved a suitable method and allowed selective injection of occluding materials.
Assuntos
Cateterismo , Radiografia Intervencionista , Esterilização Tubária/métodos , Animais , Diatrizoato/administração & dosagem , Combinação de Medicamentos , Etanol/administração & dosagem , Tubas Uterinas/patologia , Ácidos Graxos/administração & dosagem , Feminino , Hidrogel de Polietilenoglicol-Dimetacrilato , Histerossalpingografia , Polietilenoglicóis/administração & dosagem , Propilenoglicóis/administração & dosagem , Coelhos , Distribuição Aleatória , Zeína/administração & dosagemRESUMO
RATIONALE AND OBJECTIVES: The authors compared two methods of selective fallopian tube catheterization in female rabbits. METHODS: Technical success rates and procedure times in two groups of animals were compared. Group 1 consisted of 20 female rabbits catheterized with a fluoroscopic technique. Group 2 consisted of 55 rabbits catheterized with a combination of endoscopic and fluoroscopic guidance. RESULTS: The technique used in group 2 allowed a statistically significant reduction in the time required for cervical catheterization and the total procedural time (P < .01). There was a parallel statistically significant reduction in fluoroscopy time (P < .01). Technical success rates and adverse effects were similar for the two techniques. CONCLUSION: The combined endoscopic-fluoroscopic technique requires a shorter time than the established fluoroscopic technique and should be considered for future selective tubal catheterization experiments in rabbits.
Assuntos
Cateterismo/métodos , Endoscopia , Tubas Uterinas , Animais , Colo do Útero , Feminino , Fluoroscopia , Coelhos , Radiografia IntervencionistaRESUMO
PURPOSE: In an attempt to determine the visceral risk secondary to a direct percutaneous puncture of the upper renal calix, the anatomic relations of the upper pole of the kidney were studied by magnetic resonance imaging. METHODS: Examination was performed on 25 normal volunteers placed successively in the right and left prone oblique position. The kidney axis and minimal distances from the cutaneous plane at the level of the upper and lower poles were measured. Axial and tangential simulated percutaneous approaches to the upper renal calix were compared in term of risk of damage to the pulmonary, splenic, and hepatic parenchyma. RESULTS: The transversal anteversion angle was statistically comparable for right and left kidneys, but the sagittal anteversion angle was significantly higher for right kidneys (p = 0.05). The minimal distance from the cutaneous plane was statistically comparable for the upper and lower poles. The lower pole was significantly deeper for left than right kidneys (p = 0.01). The visceral risk was statistically comparable for left and right kidneys and was significantly higher in case of an approach in the axis of the upper renal calix or through the 10th intercostal space compared to a puncture via the l1th space (p = 0.0001). CONCLUSION: A percutaneous puncture of the upper pole of the kidney above the 11th rib increases the risk of visceral damage. Preoperative evaluation, with the aid of CT scan or MRI, of the risk of pulmonary, splenic, or hepatic injury could be carried out in these cases.
Assuntos
Rim/anatomia & histologia , Imageamento por Ressonância Magnética , Punções/métodos , Adulto , Feminino , Humanos , Nefropatias/diagnóstico , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrostomia Percutânea/métodos , Decúbito Ventral , Valores de Referência , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
We report on a patient presenting with rapidly progressive painless paraplegia, amyotrophy and fasciculations masquerading as motoneuron disease. There were no bowel or bladder involvement but the patient noted mild paresthesia on the external part of the right foot and hypertrophy of the right calve was present. While lumbar CT Scan was normal, MRI showed a large cyst of the conus. Analysis of the cyst concluded to a benign cyst of the conus. Paraplegia resolved after surgery and after one year, no relapse was observed so that an hidden ependymoma appeared unlikely.
Assuntos
Cauda Equina/patologia , Cistos/patologia , Doença dos Neurônios Motores/diagnóstico , Doenças do Sistema Nervoso Periférico/patologia , Cauda Equina/cirurgia , Cistos/cirurgia , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/cirurgiaRESUMO
Static and dynamic pelvic IRM is nowadays part of the diagnostic work up of pelvic prolapse. It is a second line examination, diagnosis being made primarily on the basis of findings at physical pelvic examination. Advantages of MR imaging include lack of ionising radiation, simplicity, multiplanar imaging capability, and possibility to explore at the same time the three compartments and the pelvic floor. The dynamic MR Imaging can be coupled with a clinical examination at the magnet. Imaging is useful in patients in whom findings at physical examination are equivocal. Dynamic MR imaging can be useful in evaluating pelvic organ prolapse. It allows detection of hidden prolapses and assessment of muscle trophycity. Post-operatively it allows assessment of surgical results and failures or recurrences.
Assuntos
Imageamento por Ressonância Magnética , Prolapso Uterino/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Recidiva , Resultado do TratamentoRESUMO
Ninety years after it was first performed, hysterosalpingography remains one of the most important tests in helping an infertile couple decide between numerous treatment options. The application of angiographic techniques to hysterosalpingography has revolutionized diagnosis and treatment of proximal tubal obstruction. Results from worldwide centers have shown that nonsurgical catheter recanalization of proximally obstructed tubes can be accomplished in up to 90% of patients using standard techniques. Pregnancy incidence in a population who was recommended for tubal microsurgery or in vitro fertilization, but who underwent catheter tubal recanalization instead without any other therapy, was 58% at one year and all pregnancies were intrauterine. Fluoroscopic fallopian tube catheterization should be the first treatment for proximal tubal obstruction, with the more expensive and invasive procedures reserved for the small number of women who fail the radiologic procedure.
Assuntos
Doenças das Tubas Uterinas/diagnóstico por imagem , Cateterismo/métodos , Feminino , Fluoroscopia , HumanosRESUMO
A case of acquired uterine arteriovenous fistula in a 28 Year old patient is reported that probably is secondary to a "difficult" delivery. Sono-graphic, MRI and angiographic findings are reported, before and after endovascular management.
Assuntos
Fístula Arteriovenosa/diagnóstico , Transtornos Puerperais/diagnóstico , Útero/irrigação sanguínea , Adulto , Amenorreia/etiologia , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Feminino , Humanos , Histerossalpingografia , Angiografia por Ressonância Magnética , Imageamento por Ressonância Magnética , Prognóstico , Transtornos Puerperais/complicações , Transtornos Puerperais/terapia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
Seven cases of pelvic endometriosis of the urinary or digestive tracts are reported: 4 cases of vesical endometriosis, 1 case of ureteral involvement, 1 rectal case and 1 sigmoid location. The authors point out the difficulty of the clinical preoperative diagnosis--in despite of cyclic troubles--and underline the interest of complementary explorations performed at the time of periods: ultrasound, cystoscopy, rectosigmoidoscopy and coelioscopy. The MR imaging, showing high intensity a T1-weighted images and prominent high intensity on T2-weighted images, is very suggestive of an endometrial lesions. A joint medical and surgical treatment is required. Endoscopic excision, endoprosthetic tube, excision-suture, resection-anastomosis and a complementary medical treatment using Danazol. Decapeptyl or progestational agents have to be proposed. Per-operative microscopy is advised as routine procedure in order to avoid excessive surgery.
Assuntos
Neoplasias do Sistema Digestório/diagnóstico , Endometriose/diagnóstico , Neoplasias Pélvicas/diagnóstico , Neoplasias Urológicas/diagnóstico , Adulto , Neoplasias do Sistema Digestório/cirurgia , Endometriose/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Neoplasias Pélvicas/cirurgia , Estudos Retrospectivos , Neoplasias Urológicas/cirurgiaRESUMO
A positive diagnosis of benign ovarian tumor indicates a laparoscopic approach or a conservative treatment. Benign ovarian tumors are often easy to recognize with non ionizing modalities such as US and MRI. The most common benign ovarian tumors are: mature teratomas including dermoid cysts, tumors in the fibro-thecal group including fibromas and thecomas, benign serous and mucinous tumors (cystadenomas). Apart from ovarian tumors, endometriomas are more commonly extra ovarian, but may involve the ovarian stroma.
Assuntos
Imageamento por Ressonância Magnética , Doenças Ovarianas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Ultrassonografia , Cistadenoma/diagnóstico , Cisto Dermoide/diagnóstico , Diagnóstico Diferencial , Endometriose/diagnóstico , Feminino , Fibroma/diagnóstico , Humanos , Ovário/patologia , Teratoma/diagnóstico , Tumor da Célula Tecal/diagnósticoRESUMO
Female genital tract anomalies are common (1 to 2% of the female population), and may lead to multiple clinical manifestations: amenorrhea, infertility, spontaneous repeated miscarriage, pelvic pain, endometriosis. They are caused by intra-uterine insults between weeks 6 and 18 of gestation. They are classified according to their embryologic origin. Imaging relies essentially on ultrasound and MRI, and indications for hysterosalpingography are less common. Imaging must classify the malformation and detect complications in order to assess the fertility prognosis and treat complications.