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BACKGROUND AND PURPOSE: Early glycemic variability (GV) in diabetic patients is a poor prognosis factor following cardiovascular events. However, its influence on the course of acute ischemic stroke (AIS) with large vessel occlusion remains unclear. We investigated the relationship between high GV during acute stroke and three-month functional outcome among patients treated with combined intravenous thrombolysis and endovascular therapy for large vessel occlusion. METHODS: A single-center retrospective analysis of AIS patients with proximal intracranial occlusion who underwent thrombolysis and mechanical thrombectomy between January 2015 and May 2017. Early GV was assessed using standard deviation (SD) of blood glucose levels for the first 24hours. The main outcome was functional status at three months as defined by the modified Rankin scale (mRS). Secondary outcomes were change in NIHSS score from baseline to 24hours and occurrence of severe hemorrhagic transformation. Multivariate logistic regression analyses including GV, admission glycemia and mean glycemia were performed. RESULTS: Among the 93 patients evaluated, 26 had early high GV (≥20.9mg/dl). High GV was associated with poor functional outcome (OR=8.00; 95%CI [1.34-47.89]; P=0.02) unlike admission glycemia and mean glycemia (OR=2.92; 95%CI [0.51-16.60]; P=0.23 and OR=0.36; 95%CI [0.05-2.6]; p=0.31, respectively). High GV was not associated with NIHSS at 24hours or hemorrhagic transformation. CONCLUSION: Acute high GV contributes to poorer functional outcome following AIS related to large vessel occlusion and should be considered as a new target in acute stroke management.
Assuntos
Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/complicações , Isquemia Encefálica/terapia , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/terapia , Trombectomia/efeitos adversos , Resultado do TratamentoRESUMO
A fundamental issue in the interpretation of chest CT lies in the ability to determine normality. Technical advances have resulted in an increasing number of submillimeter sections which in turn has resulted in the identification of a large number of minor abnormalities with no significant pathophysiological consequence. These images should be properly interpreted in order to avoid unnecessary follow-up examinations and radiation exposure. Often they are due to respiratory or cardiac motion artifacts. Others are explained by aging, anatomic variants, physiological phenomenon or tobacco use. These borderline imaging features detected on chest CT are described according to the main anatomical compartments of the thorax: lung and vessels, airways, pleura and chest wall, mediastinum and heart.
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Artefatos , Pulmão/diagnóstico por imagem , Pleura/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Diafragma/diagnóstico por imagem , Eletrocardiografia , Feminino , Forame Oval/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Radiografia Torácica/normas , Fumar/efeitos adversos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/normasRESUMO
PURPOSE: Complete intravascular ultrasound study examination of all three coronary arteries in patients with first acute coronary syndrome very frequently revealed one or more atherosclerotic plaque ruptures associated with the culprit lesion. The aim of this study was to evaluate using cardiac MRI the incidence of multiple necroses in patients with myocardial infarction. The study sought to detect delayed enhancement in a zone different from the necrosis area concerned by the culprit occlusion. METHODS: Eighty consecutive patients who were referred for a first myocardial infarction underwent angioplasty within the first 12 hours after chest pain beginning. Each patient was examined within four to eight days following the acute phase. Cardiac MRI evaluated left-ventricle function (TrueFISP sequence) and used a T2 weighted short-inversion-time, inversion recovery sequence (STIR) in order to visualize myocardial oedema; delayed enhancement imaging data were then acquired after injection of gadolinium. RESULTS: In eight patients (10%), we observed two delayed enhancement areas associated with wall-motion abnormalities. One was attributed to the culprit occlusion; the second corresponded to a different coronary artery. In five patients, this second zone was related to an old coronary occlusion confirmed by angiography and the STIR sequence. However, in three patients, the second delayed enhancement area corresponded to a coronary artery stenosis with normal flow. CONCLUSION: In patient with acute myocardial infarction, MRI sometimes detects a necrosis area which was not initially suspected. This observation illustrates the consequences of pancoronary destabilization.
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Vasos Coronários/patologia , Imageamento por Ressonância Magnética , Infarto do Miocárdio/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
INTRODUCTION: The aim of this study was to describe the anatomical landmarks for maxillary nerve block in the pterygopalatine fossa. The risk of injury to the skull base and maxillary artery was assessed. METHODS: This retrospective study was based on the analysis of 61 consecutive computed tomography angiographies obtained from patients suffering from different pathologies. Anatomical relationships between optic canal (OC), foramen rotundum (FR), inferior orbital fissure (IOF) and puncture point (PP) were assessed. A "maxillary section" was virtually carried out on the CTs, following a plane passing through PP, IOF and FR in order to mimic the anaesthesia needle route. RESULTS: No gender difference was observed except for the PP-OC distance that was longer in men. The mean PP-IOF distance was of 31.9 (± 0.7mm). PP-OC (43.9±0.5) and PP-FR (44.2±0.7) distances increased significantly with the patients height (PP-FR=17.25+0.16×height (cm); PP-OC=20.54+0.13×height (cm)). The route to the skull base was curved, with an angle of 168±1.6° at the FR level. The angle to reach the OC was greater than 7°. DISCUSSION: With a 35-mm needle length, the probability to reach the IOF was high (79%), while the risk to injure the skull base (2%) and the optical nerve (0%) was low. Artery injuries were only found in 13% of cases. Therefore, a 35-mm needle length allows for the best efficacy/risk ratio in maxillary nerve block.
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Pontos de Referência Anatômicos/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Nervo Maxilar/diagnóstico por imagem , Bloqueio Nervoso/métodos , Fossa Pterigopalatina/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/patologia , Anestesia por Condução , Feminino , França , Humanos , Injeções , Masculino , Maxila/diagnóstico por imagem , Maxila/patologia , Nervo Maxilar/efeitos dos fármacos , Nervo Maxilar/patologia , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Órbita/patologia , Fossa Pterigopalatina/patologia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/efeitos dos fármacos , Osso Esfenoide/patologia , Adulto JovemRESUMO
Imaging plays an essential role in management of patients of with pleural mesothelioma. In this article, we discuss the respective roles for ultrasonography, computed tomography, magnetic resonance imaging, and positon emission tomography for the diagnosis, staging, and postherapeutic evaluation of pleural mesothelioma.
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Diagnóstico por Imagem/métodos , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Humanos , Mesotelioma/terapia , Estadiamento de Neoplasias , Neoplasias Pleurais/terapiaAssuntos
Falso Aneurisma/terapia , Angiografia , Embolização Terapêutica , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Artéria Pulmonar , Tomografia Computadorizada Espiral , Tuberculose Pulmonar/complicações , Adulto , Falso Aneurisma/diagnóstico por imagem , Antituberculosos/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagemRESUMO
OBJECTIVE: Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and "true" myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population. METHODS: A search was made in the PubMed and Cochrane databases using the search terms "Myocardial infarction", "Coronary angiography", "Normal coronary arteries" and "MRI". All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented. RESULTS: A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 ± 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with "true" myocardial infarction. CONCLUSION AND RELEVANCE: The results of this meta-analysis of individual data showed that myocarditis and "true" myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients.
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Vasos Coronários , Imageamento por Ressonância Magnética , Infarto do Miocárdio/diagnóstico , Miocardite/diagnóstico , Miocárdio/patologia , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , Comorbidade , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , França/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/patologia , Miocardite/epidemiologia , Miocardite/patologia , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Fatores SexuaisRESUMO
Magnetic resonance (MR) phase mapping was used to noninvasively assess both blood flow and cross-sectional area (CSA) in the main pulmonary artery (MPA) of 12 healthy volunteers. Flow and CSA patterns exhibited two positive peaks: high systolic and small diastolic. This finding can be explained using a simple "distributed" theoretical model that takes into account the role of a reflected pressure wave from pulmonary vascular impedance in generating a diastolic flow. The mean reflection coefficient of pressure wave, MPA input impedance, and pulmonary vascular impedance were assessed. We verified, in this series, that pressure wave velocity appears to be age-dependent. MR phase mapping has been used to observe the tuning (resonance) of the right cardiovascular system at rest under physiological conditions. MR phase mapping could be used to assess pathological modifications of the tuning that occurs in cases of pulmonary arterial hypertension.
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Imageamento por Ressonância Magnética , Artéria Pulmonar/fisiologia , Circulação Pulmonar , Adulto , Fatores Etários , Idoso , Velocidade do Fluxo Sanguíneo , Feminino , Humanos , Pulmão/anatomia & histologia , Pulmão/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Artéria Pulmonar/anatomia & histologia , Resistência Vascular , Função Ventricular DireitaRESUMO
A chest radiograph may falsely be initially read as being normal or "apparently" normal. The clinical settings where such a false reading may occur are numerous and variable. The most significant situation is the initially missed single pulmonary nodule, with a reported estimated incidence ranging between 30% and 50%. Airway diseases are also typically silent on chest radiographs. The trachea and main bronchi are not well evaluated and some small airways diseases may have very little manifestations, even when advanced. Vascular diseases, when diffuse with bilateral symmetrical hypo- or hyperperfusion, are difficult to detect along with localized but symmetrical vascular disorders and endo- or transthoracic extracardiac shunts. Finally, any disease involving the pleura, pericardium, mediastinum, or lung interstium may be undetectable radiologically at the time of presentation. This paper reviews and illustrates these various diseases and their radiological findings.
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Doenças Respiratórias/diagnóstico por imagem , Doenças Torácicas/diagnóstico por imagem , Humanos , RadiografiaRESUMO
We report one case of traumatic rupture of the inferior vena cava. CT was performed during the acute phase and showed retroperitoneal hematoma near the inferior vena cava with extravasation of contrast agent. After stabilization angiography showed pseudo-aneurysmal picture of inferior vena cava.
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Veia Cava Inferior/lesões , Adulto , Angiografia , Feminino , Humanos , Prognóstico , Remissão Espontânea , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagemRESUMO
We report a case of endobronchial tuberculosis located in the main left bronchus suspected on a CT scan and assessed by fiberoptic bronchoscopy. This localisation is not unusual, and is often associated with a normal chest radiography. Air trapping present on high resolution CT scan led to focus the examination on proximal airways and to suspect their involvement. This observation underlines the value of expiratory CT scan in demonstrating proximal stenosis of main bronchi.
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Ar , Broncopatias/diagnóstico por imagem , Radiografia Torácica , Tomografia Computadorizada por Raios X/métodos , Tuberculose Pulmonar/diagnóstico por imagem , Adulto , Broncopatias/diagnóstico , Broncoscopia , Feminino , Humanos , Respiração , Tuberculose Pulmonar/diagnósticoRESUMO
Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification and a common echocardiographic finding. CCMA discovery is mostly incidental, considered as benign tumor and may be unrelated to patient symptoms. Multimodality imaging may have an additional value for the diagnosis of CCMA. We report the cases of two CCMA revealed by acute pulmonary oedema and stroke, respectively. The aims of this presentation are: to illustrate the variety of cardiac symptoms that led to the diagnosis of CCMA; and to highlight the usefulness of thoracic multisliced computed tomography for the diagnosis of CCMA.
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Calcinose/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso , Calcinose/complicações , Diagnóstico Diferencial , Feminino , Humanos , Achados Incidentais , Masculino , Estenose da Valva Mitral/etiologia , Índice de Gravidade de Doença , UltrassonografiaRESUMO
OBJECTIVE: To develop a new method for the cardiac MR (CMR) quantification of peri-infarct ischaemia using fused perfusion and delayed-enhanced images and to evaluate this method using quantitative single photon emission CT (SPECT) imaging as a reference. METHODS: 40 patients presenting with peri-infarct ischaemia on a routine stress (99m)Tc-SPECT imaging were recruited. Within 8 days of the SPECT study, myocardial perfusion was evaluated using stress adenosine CMR. Using fused perfusion and delayed-enhanced images, peri-infarct ischaemia was quantified as the percentage of myocardium with stress-induced perfusion defect that was adjacent to and larger than a scar. This parameter was compared with both the percent myocardium ischaemia (SD%) and the ischaemic total perfusion deficit (TPD). The diagnostic performance of CMR in detection of significant coronary artery stenosis (of ≥70%) was also determined. RESULTS: On SPECT imaging, in addition to peri-infarct ischaemia, reversible perfusion abnormalities were detected in a remote zone in seven patients. In the 33 patients presenting with only peri-infarct ischaemia, the agreement between CMR peri-infarct ischaemia and both SD% and ischaemic TPD was excellent [intraclass coefficient of correlation (ICC) = 0.969 and ICC = 0.877, respectively]. CMR-defined peri-infarct ischaemia for the detection of a significant coronary artery stenosis showed an areas under receiver-operating characteristic curve of 0.856 (95% confidence interval, 0.680-0.939). The best cut-off value was 8.1% and allowed a 72% sensitivity, 96% specificity, 60% negative predictive value and 97% positive predictive value. CONCLUSION: This proof-of-concept study shows that CMR imaging has the potential as a test for quantification of peri-infarct ischaemia. ADVANCES IN KNOWLEDGE: This study demonstrates the proof of concept of a commonly known intuitive idea, that is, evaluating the peri-infarct ischaemic burden by subtracting delayed enhancement from first-pass perfusion imaging on CMR.
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Imageamento por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico , Imagem de Perfusão do Miocárdio/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Isquemia Miocárdica/etiologia , Estudos Prospectivos , Curva ROC , Sensibilidade e EspecificidadeRESUMO
In the field of thoracic pathology, the indications for MRI are well established in pleural, mediastinal and vascular disease. Compared to CT, MRI, with its superior contrast resolution, allows better tissue characterization of tumours, as well as an accurate assessment of mediastinal or parietal invasion prior to surgery. MRI is a non-ionizing imaging technique, which can be repeated for the follow-up of aortic diseases such as dissections or aneurysms. Clinicians should be aware of the contraindications to MRI and the adverse effects of gadolinium.
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Imageamento por Ressonância Magnética , Doenças Torácicas/diagnóstico , Doenças da Aorta/diagnóstico , Contraindicações , Meios de Contraste , Gadolínio , Humanos , Aumento da Imagem , Pneumopatias/diagnóstico , Neoplasias do Mediastino/diagnóstico , Neoplasias Pleurais/diagnóstico , Neoplasias Torácicas/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
The authors report two cases of congenital pericardial defect and emphasize the role of MRI as a diagnostic tool. A review of the development of the pericardium and of the various possible explanations dealing with these abnormalities is then presented. Finally, clinical data and diagnosis and therapeutic options are discussed.
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Cardiopatias Congênitas/diagnóstico , Pericárdio/anormalidades , Adolescente , Adulto , Meios de Contraste , Diagnóstico Diferencial , Ecocardiografia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Imageamento por Ressonância Magnética , Toracoscopia , Tomografia Computadorizada por Raios XRESUMO
The prevalence of coronary arteries congenital anomalies is 1 to 2% in the general population. Although the spectrum of their clinical manifestations is very broad from total inocuity to lethal, anomalies of coronary arteries need to be recognized by clinicians in certain circumstances: they are the first cause of death in young adults under physical exercise and an abnormal course of a coronary artery can complicate a cardiac surgery. Therefore, a non-invasive test is highly suitable for detecting anomalies of coronary arteries and multidetector computed tomography (MDCT) is likely to be the best one. To understand how anomalies of coronary arteries may occur, we have reviewed the recent literature about their development. Then, the main types of anomalies are presented with their clinical context, and representative MDCT images from our personal database are used for illustration.
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Anomalias dos Vasos Coronários/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Angiografia Coronária , Vasos Coronários/anatomia & histologia , HumanosRESUMO
A thickened bronchial wall is the morphological substratum of most diseases of the airway. Theoretical and clinical models of bronchial morphometry have so far focused on bronchial lumen diameter, and bronchial length and angles, mainly assessed from bronchial casts. However, these models do not provide information on bronchial wall thickness. This paper reports in vivo values of cross-sectional wall area, lumen area, wall thickness and lumen diameter in ten healthy subjects as assessed by multi-detector computed tomography. A validated dedicated software package was used to measure these morphometric parameters up to the 14th bronchial generation, with respect to Weibel's model of bronchial morphometry, and up to the 12th according to Boyden's classification. Measured lumen diameters and homothety ratios were compared with theoretical values obtained from previously published studies, and no difference was found when considering dichotomic division of the bronchial tree. Mean wall area, lumen area, wall thickness and lumen diameter were then provided according to bronchial generation order, and mean homothety ratios were computed for wall area, lumen area and wall thickness as well as equations giving the mean value of each parameter for a given bronchial generation with respect to its value in generation 0 (trachea). Multi-detector computed tomography measurements of bronchial morphometric parameters may help to improve our knowledge of bronchial anatomy in vivo, our understanding of the pathophysiology of bronchial diseases and the evaluation of pharmacological effects on the bronchial wall.
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Brônquios/anatomia & histologia , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Modelos Anatômicos , Tomografia Computadorizada por Raios X/métodos , Adulto , Anatomia Transversal , Broncografia , HumanosRESUMO
This study compared a three-dimensional volumetric threshold-based method to a two-dimensional Simpson's rule based short-axis multiplanar method for measuring right (RV) and left ventricular (LV) volumes, stroke volumes, and ejection fraction using electrocardiography-gated multidetector computed tomography (MDCT) data sets. End-diastolic volume (EDV) and end-systolic volume (ESV) of RV and LV were measured independently and blindly by two observers from contrast-enhanced MDCT images using commercial software in 18 patients. For RV and LV the three-dimensionally calculated EDV and ESV values were smaller than those provided by two-dimensional short axis (10%, 5%, 15% and 26% differences respectively). Agreement between the two methods was found for LV (EDV/ESV: r=0.974/0.910, ICC=0.905/0.890) but not for RV (r=0.882/0.930, ICC=0.663/0.544). Measurement errors were significant only for EDV of LV using the two-dimensional method. Similar reproducibility was found for LV measurements, but the three-dimensional method provided greater reproducibility for RV measurements than the two-dimensional. The threshold value supported three-dimensional method provides reproducible cardiac ventricular volume measurements, comparable to those obtained using the short-axis Simpson based method.