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1.
Radiol Med ; 126(3): 356-364, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32833196

RESUMEN

The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.


Asunto(s)
Técnicas de Imagen Cardíaca , Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Vasos Coronarios/diagnóstico por imagen , Corazón/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Adenosina/administración & dosificación , Antagonistas Adrenérgicos beta/administración & dosificación , Antagonistas Adrenérgicos beta/efectos adversos , Antagonistas Adrenérgicos beta/farmacocinética , Ansiolíticos/administración & dosificación , Atropina/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/efectos adversos , Contraindicaciones de los Medicamentos , Dipiridamol/administración & dosificación , Dobutamina/administración & dosificación , Humanos , Ivabradina/administración & dosificación , Ivabradina/efectos adversos , Nitroglicerina/administración & dosificación , Purinas/administración & dosificación , Purinas/efectos adversos , Pirazoles/administración & dosificación , Pirazoles/efectos adversos , Vasodilatadores/administración & dosificación
2.
Radiol Med ; 125(11): 1102-1113, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32964325

RESUMEN

The world of cardiac imaging is proposing to physicians an ever-increasing spectrum of options and tools with the disadvantages of patients presently submitted to multiple, sequential, time-consuming, and costly diagnostic procedures and tests, sometimes with contradicting results. In the last two decades, the CCTA has evolved into a valuable diagnostic test in today's patient care, changing the official existing guidelines and clinical practice with a pivotal role to exclude significant CAD, in the referral of patients to the Cath-Lab, in the follow-up after coronary revascularization, and finally in the cardiovascular risk stratification.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Angina Estable/diagnóstico por imagen , Servicio de Urgencia en Hospital , Humanos , Medición de Riesgo
3.
J Vasc Interv Radiol ; 28(9): 1234-1239, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28757286

RESUMEN

PURPOSE: To compare transfemoral approach (TFA) and transradial approach (TRA) in patients undergoing hepatic chemoembolization in terms of safety, feasibility, and procedural variables, including fluoroscopy time, radiation dose (reference air kerma [RAK]), and patient preference. MATERIALS AND METHODS: A single-center prospective intrapatient comparative study was conducted with 42 consecutive patients with hepatic malignancies who received 2 consecutive treatment sessions of unilobar hepatic chemoembolization within a 4-week interval over a 6-month period with both TRA and TFA. All procedures were performed by 1 interventional radiologist who assessed the eligibility of patients for inclusion in the study. The primary endpoint was intraprocedural conversion rate. Secondary endpoints were access site complications, angiographic and procedural variables, and evaluation of patient discomfort and preferences. RESULTS: A 100% technical success rate and a crossover rate of 0% were recorded. There were no major vascular complications and similar rates of minor complications (4.8% for TRA, 7.1% for TFA; P = .095), which were self-limited and without any clinical sequelae. TRA treatments required a significantly longer preparation time for the procedure (P = .008) with no significant differences for other procedural variables. Greater discomfort at the access route and patient inability to perform basic activities after the procedure were recorded for TFA (P < .001). TRA was preferred by 35 patients (35/42) for potential future transarterial procedures. CONCLUSIONS: TRA is safe and feasible for transarterial hepatic chemoembolization, with high technical success, low overall complications, and improved patient comfort.


Asunto(s)
Quimioembolización Terapéutica , Arteria Femoral , Neoplasias Hepáticas/terapia , Arteria Radial , Anciano , Estudios de Factibilidad , Femenino , Fluoroscopía , Humanos , Masculino , Dimensión del Dolor , Estudios Prospectivos , Punciones , Dosis de Radiación , Radiografía Intervencional , Resultado del Tratamiento
4.
Eur Radiol ; 26(3): 788-96, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26139314

RESUMEN

OBJECTIVES: To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). METHODS: Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. RESULTS: CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87%. CONCLUSIONS: These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. KEY POINTS: Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.


Asunto(s)
Esclerosis Amiotrófica Lateral/complicaciones , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/complicaciones , Tomografía Computarizada Multidetector/métodos , Esclerosis Amiotrófica Lateral/diagnóstico por imagen , Artropatía Neurógena/complicaciones , Artropatía Neurógena/diagnóstico por imagen , Angiografía Coronaria , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Neuropatías Diabéticas/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad
5.
J Surg Oncol ; 109(8): 791-7, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24643837

RESUMEN

OBJECTIVE: Purpose of this retrospective study was (1) to evaluate overall survival and survival to local recurrence of patients with unifocal and multifocal tumor and (2) to evaluate survival to local recurrence after intralesional or wide surgery. MATERIAL AND METHODS: We reviewed 62 patients with epithelioid hemangioendothelioma of bone, treated from 1985 to 2010. Histological sections and immunohistochemistry were evaluated. Tumor presented as unifocal in 49 patients and as multifocal in 13. RESULTS: Mean follow-up was 9 years. Five patients (10%) with unifocal tumor progressed to multifocal. Overall survival was 92% at 10 years. Survival with unifocal tumor was significantly higher than survival with multifocal tumor. Survival to local recurrence was 76% at 10 years, significantly higher after wide resection than after intralesional surgery, while there was no statistical difference comparing unifocal and multifocal tumor. At multivariate analysis both variables showed no statistically significance. CONCLUSION: Wide surgical excision reduces the risk of local recurrence, but functional results and morbidity need to be considered individually when defining surgical indications. Due to the risk of radiation-induced sarcomas, radiation therapy should be reserved to those cases not amenable to wide surgery or when lesions are seated locations difficult to treat.


Asunto(s)
Neoplasias Óseas/cirugía , Hemangioendotelioma Epitelioide/cirugía , Recurrencia Local de Neoplasia/cirugía , Adolescente , Adulto , Anciano , Neoplasias Óseas/patología , Niño , Femenino , Estudios de Seguimiento , Hemangioendotelioma Epitelioide/patología , Humanos , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Adulto Joven
6.
Skeletal Radiol ; 43(11): 1543-9, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-24934329

RESUMEN

Hemangiopericytoma is a rare neoplasm. Primary meningeal hemangiopericytomas account for 1 to 7% of all meningeal tumors. In the literature, meningeal hemangiopericytomas are mainly case reports, which confirm an aggressive behavior with a high rate of local recurrence and extracranial metastasis. Metastasis can be seen many years after initial surgical excision of the primary tumor, and the most common sites include the bone, liver and lung. We present a pathological study of four meningeal hemangiopericytomas with bone metastases. All patients are male with a mean age of 46.5 years. Metastases only involved bone. Three out of four lesions were initially misdiagnosed as meningiomas. Only one case was initially correctly diagnosed as meningeal hemangiopericytoma. All patients underwent surgery with complete resection. Only the patient immediately diagnosed with meningeal hemangiopericytoma received postoperative radiation therapy. Three patients had bone metastases without local recurrence including the one who received radiation therapy. One patient recurred locally after 7 years, and bone metastasis was found at the same time. Our cases confirm that meningeal hemangiopericytomas are a separate entity and have a high recurrence rate despite complete surgical resection, with extracranial metastases, mainly to bone, even after long intervals.


Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/secundario , Adulto , Anciano , Neoplasias Óseas/secundario , Diagnóstico Tardío , Humanos , Masculino , Meningioma/cirugía , Persona de Mediana Edad
7.
Skeletal Radiol ; 43(5): 633-9, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-24509814

RESUMEN

Lipofibromatosis is a rare, benign, but infiltrative, soft tissue tumor seen in children. We present three cases of lipofibromatosis, each with different magnetic resonance imaging features and correlate this with the histological findings. The patients comprised two males and one female who presented in infancy; at birth, 5 months, and 7 months of age. Clinically, the masses were painless and slow-growing. The masses ranged in size from 2 to 6 cm and involved the distal extremities in two cases (one foot, one wrist) and the trunk. Magnetic resonance imaging showed lipomatous lesions with varying amounts of adipose and solid components in each case. There were no capsules at the periphery of the lesions. One case showed a fat-predominant lesion, another an equal mixture of fat and solid tissue, and the third was predominantly solid. This was reflected in the histology, which showed corresponding features. Radiological and histopathological differential diagnoses are reviewed.


Asunto(s)
Fibroma/patología , Lipoma/patología , Imagen por Resonancia Magnética/métodos , Neoplasias de los Tejidos Blandos/patología , Biopsia , Diagnóstico Diferencial , Femenino , Humanos , Lactante , Recién Nacido , Masculino
8.
J Surg Oncol ; 108(1): 19-27, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23681650

RESUMEN

BACKGROUND: Studies for patients with pelvic chondrosarcomas are limited. This study determines the outcome of patients with pelvic chondrosarcomas, and whether there is any association with tumors' grade, type, stage, margins and pelvic location. MATERIALS AND METHODS: We retrospectively studied 215 patients with pelvic chondrosarcomas. All patients had biopsy and histological diagnosis of their tumors followed by limb salvage or amputation. We staged patients using the Musculoskeletal Tumor Society system. We performed a univariate and multivariate analysis of the survival to death, local recurrence and metastasis with respect to grade, type (central vs. peripheral), stage, margins, and pelvic location, and the survival to death of patients with and without local recurrence. RESULTS: Grade was the most important univariate and multivariate predictor of the survival of the patients. Dedifferentiation was associated with significantly lower overall survival. Peripheral chondrosarcomas predicted survival only in the univariate analysis. Surgical margins predicted local recurrence only in the multivariate analysis. Periacetabular location was associated with lower survival to death and local recurrence. The occurrence of local recurrence compromises the overall survival. CONCLUSION: Grade was the most important predictor of the overall survival of patients with chondrosarcomas of the pelvis.


Asunto(s)
Neoplasias Óseas/mortalidad , Condrosarcoma/mortalidad , Huesos Pélvicos/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/patología , Neoplasias Óseas/terapia , Quimioterapia Adyuvante , Condrosarcoma/patología , Condrosarcoma/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Clasificación del Tumor , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Huesos Pélvicos/cirugía , Estudios Retrospectivos , Adulto Joven
9.
Acta Radiol ; 54(3): 249-58, 2013 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-23446750

RESUMEN

Significant literature on MDCT coronary angiography (MDCT-CA) has emerged in the last decade concerning patient's selection, technical aspects of different generations of CT equipment, ECG gating, contrast material and beta-blockade administration, acquisition parameters, and radiation dose. However, the literature regarding postprocessing, reading, and reporting is not so extensive. This review highlights the main elements of MDCT-CA data analysis, thereby allowing the radiologist to take full advantage of this technology and enable a structured report to be generated, promoting best practice with high-quality results.


Asunto(s)
Angiografía Coronaria/métodos , Enfermedad Coronaria/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Técnicas de Imagen Sincronizada Cardíacas , Humanos , Sistemas de Información Radiológica , Programas Informáticos
10.
Clin Imaging ; 78: 74-92, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33773447

RESUMEN

Competitive athletes of all skill levels are at risk of sudden cardiac death (SCD) due to certain heart conditions. Prior to engagement in high-intensity athletics, it is necessary to screen for these conditions in order to prevent sudden cardiac death. Cardiac-CT angiography (CCTA) is a reliable tool to rule out the leading causes of SCD by providing an exceptional overview of vascular and cardiac morphology. This allows CCTA to be a powerful resource in identifying cardiac anomalies in selected patients (i.e. unclear symptoms or findings at ECG or echocardiography) as well as to exclude significant coronary artery disease (CAD). With the advancement of technology over the last few years, the latest generations of computed tomography (CT) scanners provide better image quality at lower radiation exposures. With the amount of radiation exposure per scan now reaching the sub-millisievert range, the number of CT examinations it is supposed to increase greatly, also in the athlete's population. It is thus necessary for radiologists to have a clear understanding of how to make and interpret a CCTA examination so that these studies may be performed in a responsible and radiation conscious manner especially when used in the younger populations. Our work aims to illustrate the main radiological findings of CCTAs and highlight their clinical impact with some case studies. We also briefly describe critical features of state-of-the-art CT scanners that optimize different acquisitions to obtain the best quality at the lowest possible dose.


Asunto(s)
Enfermedad de la Arteria Coronaria , Tomografía Computarizada por Rayos X , Atletas , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Humanos , Dosis de Radiación
11.
J Thorac Imaging ; 36(2): 122-130, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32384413

RESUMEN

PURPOSE: This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management. MATERIALS AND METHODS: Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO). RESULTS: CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3±11.0 y) and 22 AORCA (18 males; 29.1±16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6±39.5 months. CONCLUSION: CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.


Asunto(s)
Anomalías de los Vasos Coronarios , Seno Aórtico , Angiografía , Atletas , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Humanos , Masculino , Seno Aórtico/diagnóstico por imagen , Flujo de Trabajo
12.
Eur J Radiol ; 144: 109983, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34627107

RESUMEN

PURPOSE: The aim of the study was to investigate differences in non-small cell lung cancer (NSCLC) intra-thoracic staging by using contrast-enhanced computed tomography (ce-CT) at the arterial phase (AP), at the arterial plus delayed phases (AP + DEP), and at the delayed phase (DEP), and to evaluate their potential impact on disease staging. MATERIALS AND METHODS: Two chest radiologists with different level of expertise and a general radiologist independently reviewed the chest CT exams of 150 patients with NSCLC; CT scans were performed 40 s (AP) and 60 s (DEP) after contrast material injection. Image assessment included three reading sessions: session A (AP), session B (AP + DEP) and session C (DEP). CT descriptors for the primary tumour (T), regional nodal involvement (N), and intra-thoracic metastases (M) were evaluated in each reading session. Readers had to assign a confidence level (CL) for the assessment of each descriptor and define the TNM stage. Friedman and Cochran Q test was used to compare the assessments of the 3 reading sessions; inter-reader agreement was determined (Intraclass Correlation Coefficient - ICC). RESULTS: The CL was significantly higher in sessions B and C than in session A for all descriptors, with the exception of pulmonary arterial invasion. Primary tumour inner necrosis and regional nodal involvement were detected in a significantly higher number of cases in sessions B and C as compared to session A (p ≤ 0.001). DEP significantly changed N stage determination (p < 0.001), particularly N3, and excluded chest wall invasion (p = 0.05) and venous invasion (p = 0.001). The agreement was good among the 3 readers (ICC = 0.761) and excellent between the 2 chest radiologists (ICC ≥ 0.940), regardless of the contrast phase. CONCLUSIONS: The 60-second DEP ce-CT for staging NSCLC significantly increased the readers' CL, changed the N stage determination, and helped excluding chest wall invasion and venous invasion.


Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico por imagen , Carcinoma de Pulmón de Células no Pequeñas/patología , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Estadificación de Neoplasias , Tórax/patología , Tomografía Computarizada por Rayos X
13.
Eur J Radiol ; 131: 109217, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32861174

RESUMEN

Due to its pandemic diffusion, SARS- CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection represents a global threat. Despite a multiorgan involvement has been described, pneumonia is the most common manifestation of COVID-19 (Coronavirus disease 2019) and it is associated with a high morbidity and a considerable mortality. Especially in the areas with high disease burden, chest imaging plays a crucial role to speed up the diagnostic process and to aid the patient management. The purpose of this comprehensive review is to understand the diagnostic capabilities and limitations of chest X-ray (CXR) and high-resolution computed tomography (HRCT) in defining the common imaging features of COVID-19 pneumonia and correlating them with the underlying pathogenic mechanisms. The evolution of lung abnormalities over time, the uncommon findings, the possible complications, and the main differential diagnosis occurring in the pandemic phase of SARS-CoV-2 infection are also discussed.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Animales , COVID-19 , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Imagen Multimodal , Pandemias , SARS-CoV-2 , Tomografía Computarizada por Rayos X/métodos
14.
Diagn Interv Radiol ; 25(5): 368-374, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31348005

RESUMEN

PURPOSE: We aimed to analyze transradial access (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success. METHODS: We enrolled 60 consecutive patients who received two unilobar hepatic chemoembolizations within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral access (TFA) procedures, but without any previous practical experience in TRA procedures and with a preliminary 2-day theoretical training only. Consecutive patients were prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 to 40), and C (cases 41 to 60). All patients underwent one hepatic chemoembolization using TRA and the other one using TFA in random order. All TFA procedures performed by the same operator in the same series of patients were considered as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve. RESULTS: Technical success was obtained in all patients, with a crossover rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared with TFA, CM volumes and RD values were significantly higher only in group A (cases 1-20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and postprocedural outcomes was found. Higher postprocedural complaints at the access route and more limitations in performing basic activities were recorded after TFA vs. TRA (P < 0.001). CONCLUSION: TRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greater TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures.


Asunto(s)
Quimioembolización Terapéutica/métodos , Competencia Clínica/estadística & datos numéricos , Curva de Aprendizaje , Neoplasias Hepáticas/terapia , Radiología Intervencionista/educación , Anciano , Femenino , Humanos , Masculino
15.
J Thorac Imaging ; 33(4): 217-224, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29389808

RESUMEN

PURPOSE: An accurate evaluation of left ventricular volumes, mass, and ejection fraction (EF) and an early exclusion or detection of significant coronary artery disease or cardiac allograft vasculopathy are mandatory for clinical management and prognosis assessment of heart-transplanted patients (HTP). The purpose of this article was to evaluate the role of dual-step prospective electrocardiography-triggered Dual-Source CT (pECGdual-step-DSCT) in HTP for the assessment of left-ventricular function, in comparison with echocardiography (echo) and cardiac magnetic resonance (CMR) performed on the same day, and of the coronary arteries as well. MATERIALS AND METHODS: Left-ventricular EF, end-diastolic volume, end-systolic volume, stroke volume, cardiac output (CO), and mass were assessed in 11 HTP by pECGdual-step-DSCT in comparison with CMR and echo performed on the same day. During all the examinations, the heart rate was recorded. CT coronary artery assessment was also performed. RESULTS: Heart rate was lower during DSCT (75.6±7.8 bpm; P<0.001). EF resulted slightly lower for DSCT (55.7%±5.0%; P≥0.05) in comparison with CMR (57.8%±5.3%; P≥0.05) and echo (59.2%±5.6%; P≥0.05). DSCT showed statistically significant higher end-diastolic volume (153.7±24.2 mL), end-systolic volume (67.8±11.5 mL), and stroke volume (85.9±17.6 mL) (P<0.01 up to 0.001) than CMR, but with a high correlation (P<0.001). Cardiac output was almost similar for DSCT versus CMR, with a very high correlation coefficient (r=0.914; P<0.001). DSCT showed higher mass values than CMR (P<0.001), but with a high correlation (r=0.866; P<0.001). DSCT versus echo results were less correlated. No significant coronary artery disease was detected. CONCLUSION: pECGdual-step-DSCT allows reliable assessment of left-ventricular function in HTP, with good agreement and correlation with CMR, within a global diagnostic approach including coronary artery evaluation in one single-volume acquisition.


Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Electrocardiografía/métodos , Trasplante de Corazón , Imagen por Resonancia Magnética/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Ecocardiografía , Femenino , Estudios de Seguimiento , Corazón/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados
16.
Diagn Interv Radiol ; 23(6): 420-427, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29097345

RESUMEN

In the medical era of early detection of diseases and tailored therapies, an accurate characterization and staging of the disease is pivotal for treatment planning. The widespread use of computed tomography (CT)-often with the use of contrast material (CM)-probably represents the most important advance in diagnostic radiology. The result is a marked increase in radiation exposure of the population for medical purposes, with its intrinsic carcinogenic potential, and CM affecting kidney function. The radiologists should aim to minimize patient's risk by reducing radiation exposure and CM amount, while maintaining the highest image quality. To achieve this goal, it is necessary to perform "patient-centric imaging". The purpose of this review is to provide radiologists with "tips and tricks" to control radiation dose at CT, summarizing technical artifices in order to reduce image noise and increase image contrast. Also chest CT tailored protocols are supplied, with particular attention to three most common thoracic CT protocols: aortic/cardiac CT angiography (CTA), pulmonary CTA, and routine chest CT.


Asunto(s)
Dosis de Radiación , Radiografía Torácica/métodos , Enfermedades Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Humanos
17.
Int J Cardiol ; 241: 330-343, 2017 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-28343765

RESUMEN

AIMS: In the present study, we aimed to develop a percutaneous approach and a reproducible methodology for the isolation and expansion of Cardiac Progenitor Cells (CPCs) from EndoMyocardial Biopsies (EMB) in vivo. Moreover, in an animal model of non-ischemic heart failure (HF), we would like to test whether CPCs obtained by this methodology may engraft the myocardium and differentiate. METHODS AND RESULTS: EMB were obtained using a preformed sheath and a disposable bioptome, advanced via right femoral vein in 12 healthy mini pigs, to the right ventricle. EMB were enzymatically dissociated, cells were expanded and sorted for c-kit. We used 3D-Electro-Anatomic Mapping (3D-EAM) to obtain CPCs from 32 patients affected by non-ischemic cardiomyopathy. The in vivo regenerative potential of CPCs was tested in a rodent model of drug-induced non-ischemic cardiomyopathy. c-kit positive CPCs replicative capacity was assessed in 30 patients. Telomere length averaged 7.4±0.4kbp and telomerase activity was present in all preparations (1.7×105 copies). The in situ hybridization experiments showed that injected human CPCs may acquire a neonatal myocyte phenotype given the expression of the alpha-sarcomeric actin together with the presence of the Alu probe, suggesting a beneficial impact on LV performance. CONCLUSIONS: The success in obtaining CPCs characterized by high regenerative potential, in vitro and in vivo, from EMB indicates that harvesting without thoracotomy in patients affected by either ischemic or non-ischemic cardiomyopathy is feasible. These initial results may potentially expand the future application of CPCs to all patients affected by HF not undergoing surgical procedures.


Asunto(s)
Ecocardiografía Tridimensional/métodos , Endocardio/citología , Endocardio/diagnóstico por imagen , Imagenología Tridimensional/métodos , Miocitos Cardíacos/fisiología , Células Madre/fisiología , Adulto , Animales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miocitos Cardíacos/trasplante , Regeneración/fisiología , Porcinos , Porcinos Enanos
20.
Chest ; 127(4): 1371-7, 2005 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15821218

RESUMEN

Multidetector row CT scanners with submillimeter spatial resolution and high temporal resolution are now available and are increasingly used for noninvasive assessment of vascular disease including coronary arteries and grafts. The entire heart and graft course can be scanned within a single breath-hold, and contrast-enhanced images are reconstructed through retrospective ECG gating. In this pictorial review, we describe the CT findings of the most commonly used coronary artery bypass grafts on both axial images and two-dimensional and three-dimensional images providing a correlation with conventional coronary angiography.


Asunto(s)
Angiografía Coronaria , Puente de Arteria Coronaria , Imagenología Tridimensional , Tomografía Computarizada por Rayos X , Angiografía Coronaria/métodos , Humanos
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