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Iatrogenic pneumothorax is a relevant complication of computed tomography (CT)-guided percutaneous lung biopsy. The aim of the present study was to analyze the prognostic significance of texture analysis, emphysema score and muscle mass derived from CT-imaging to predict postinterventional pneumothorax after CT-guided lung biopsy. Consecutive patients undergoing CT-guided percutaneous lung biopsy between 2012 and 2021 were analyzed. Multivariate logistic regression analysis included clinical risk factors and CT-imaging features to detect associations with pneumothorax development. Overall, 479 patients (178 females, mean age 65 ± 11.7 years) underwent CT-guided percutaneous lung biopsy of which 180 patients (37.5%) developed pneumothorax including 55 patients (11.5%) requiring chest tube placement. Risk factors associated with pneumothorax were chronic-obstructive pulmonary disease (COPD) (p = 0.03), age (p = 0.02), total lung capacity (p < 0.01) and residual volume (p = 0.01) as well as interventional parameters needle length inside the lung (p < 0.001), target lesion attached to pleura (p = 0.04), and intervention duration (p < 0.001). The combined model demonstrated a prediction accuracy of the occurrence of pneumothorax with an AUC of 0.78 [95%CI: 0.70-0.86] with a resulting sensitivity 0.80 and a specificity of 0.66. In conclusion, radiomics features of the target lesion and the lung lobe CT-emphysema score are predictive for the occurrence of pneumothorax and need for chest insertion after CT-guided lung biopsy.
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Tubos Torácicos , Biopsia Guiada por Imagen , Neumotórax , Enfisema Pulmonar , Tomografía Computarizada por Rayos X , Humanos , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , Neumotórax/epidemiología , Femenino , Masculino , Tomografía Computarizada por Rayos X/métodos , Anciano , Enfisema Pulmonar/diagnóstico por imagen , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/efectos adversos , Persona de Mediana Edad , Estudios Retrospectivos , Pulmón/diagnóstico por imagen , Pulmón/patología , Factores de Riesgo , RadiómicaRESUMEN
OBJECTIVE: Body composition assessment derived from cross-sectional imaging has shown promising results as a prognostic biomarker in several tumor entities. Our aim was to analyze the role of low skeletal muscle mass (LSMM) and fat areas for prognosis of dose-limiting toxicity (DLT) and treatment response in patients with primary central nervous system lymphoma (PCNSL). METHODS: Overall, 61 patients (29 female patients, 47.5%) with a mean age of 63.8 ± 12.2 years, range 23-81 years, were identified in the data base between 2012 and 2020 with sufficient clinical and imaging data. Body composition assessment, comprising LSMM and visceral and subcutaneous fat areas, was performed on one axial slice on L3-height derived from staging computed tomography (CT) images. DLT was assessed during chemotherapy in clinical routine. Objective response rate (ORR) was measured on following magnetic resonance images of the head accordingly to the Cheson criteria. RESULTS: Twenty-eight patients had DLT (45.9%). Regression analysis revealed that LSMM was associated with objective response, OR = 5.19 (95% CI 1.35-19.94, p = 0.02) (univariable regression), and OR = 4.23 (95% CI 1.03- 17.38, p = 0.046) (multivariable regression). None of the body composition parameters could predict DLT. Patients with normal visceral to subcutaneous ratio (VSR) could be treated with more chemotherapy cycles compared to patients with high VSR (mean, 4.25 vs 2.94, p = 0.03). Patients with ORR had higher muscle density values compared to patients with stable and/or progressive disease (34.46 ± vs 28.18 ± HU, p = 0.02). CONCLUSIONS: LSMM is strongly associated with objective response in patients with PCNSL. Body composition parameters cannot predict DLT. CLINICAL RELEVANCE STATEMENT: Low skeletal muscle mass on computed tomography (CT) is an independent prognostic factor of poor treatment response in central nervous system lymphoma. Analysis of the skeletal musculature on staging CT should be implemented into the clinical routine in this tumor entity. KEY POINTS: ⢠Low skeletal muscle mass is strongly associated with the objective response rate. ⢠No body composition parameters could predict dose-limiting toxicity.
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Linfoma , Neoplasias , Sarcopenia , Humanos , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Sarcopenia/patología , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/patología , Pronóstico , Composición Corporal , Tomografía Computarizada por Rayos X , Neoplasias/patología , Sistema Nervioso Central/patología , Linfoma/diagnóstico por imagen , Linfoma/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
PURPOSE: Epicardial adipose tissue (EAT) detected by computed tomography (CT) is associated with morbidity and mortality in patients with COVID-19 and other critical care patient cohorts, whereas their prognostic relevance in trauma patients remains unclear. The present study explored associations with four potential short-term outcomes in trauma patients. METHODS: All consecutive trauma patients requiring emergency tracheal intubation and mechanical ventilation before initial whole-body CT imaging at a level-1 trauma center over a 12-year period (2008-2019) were reanalyzed for this study. EAT was measured semiquantitatively in initial CT and analyzed regarding associations with 24-hour and 30-day mortality using Cox proportional hazard models. In survivors, associations of EAT with intensive care unit length of stay (ICU LOS) and mechanical ventilation duration were analyzed using linear regression analyses. RESULTS: Four hundred fifty-five patients (74.7% male) with a median age of 49 years, and a median injury severity score (ISS) of 26 points were analyzed. In univariable analysis, EAT index was significantly associated with 24-hour and 30-day mortality (p = 0.007, and p = 0.013, respectively). After adjustment for significant predictors age, body mass index, and ISS, no significant associations were confirmed (p = 0.622, and p = 0.903, respectively). In a subanalysis of 353 survivors, EAT index was significantly associated with ICU LOS and mechanical ventilation duration in univariable analyses (p = 0.031, and p = 0.014, respectively), but not in multivariable analyses (p = 0.81 and p = 0.46, respectively). CONCLUSION: EAT index was associated with short-term outcomes in severely injured trauma patients, which not remained significant in multivariable analysis, suggesting that its prognostic capability is limited.
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Tejido Adiposo , Traumatismo Múltiple , Respiración Artificial , Tomografía Computarizada por Rayos X , Humanos , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Tejido Adiposo/diagnóstico por imagen , Traumatismo Múltiple/diagnóstico por imagen , Puntaje de Gravedad del Traumatismo , Pericardio/diagnóstico por imagen , Adulto , Pronóstico , Tiempo de Internación/estadística & datos numéricos , COVID-19/diagnóstico por imagen , SARS-CoV-2 , Anciano , Tejido Adiposo EpicárdicoRESUMEN
PURPOSE: To analyze relationships betweenapparent diffusion coefficient (ADC) and activity parameters of Crohn's disease, e.g., length and wall thickness, CRP, FCP, MaRIA, CDAI, SES-CD, histologic inflammatory activity score, and the histological fibrotic score, based upon published data. MATERIALS AND METHODS: MEDLINE library, Scopus, and Embase databases were screened for association between ADC and activity parameters of Crohn's disease in patients with Crohn's disease up to Mai 2021. Overall, 21 studies with 1053 patients were identified. The following data were extracted from the literature: number of patients, correlation coefficients between ADC and length as well as wall thickness, CRP, FCP, MaRIA, CDAI, and SES-CD, inflammatory activity score, and fibrotic score. Associations between ADC and activity parameters were analyzed by Spearman's correlation coefficient. The studies' methodologic quality was evaluated by using the Quality Assessment of Diagnostic Studies (QUADAS 2) instrument, revealing a low risk of bias. RESULTS: In the overall sample, the pooled correlation coefficient between ADC and CDAI was -0.8 (95% CI = [-0.94; -0.65]), between ADC and MaRIA -0.66 (95% CI = [-0.79; -0.53]). A strong association was observed between ADC and SES-CD with a pooled correlation of -0.66 (95% CI = [-0.87; -0.46]). The pooled sensitivity to discriminate between involved and non-involved bowel segments was 0.89, with an area under the curve of 0.89 CONCLUSIONS: ADC showed strong inverse correlations with CDAI, MaRIA, and SES-CD scores. However, the role of ADC in assessing fibrotic changes in the bowel wall is limited. ADC can reflect acute inflammatory reactions but not systemic inflammation. KEY POINTS: ⢠ADC value can reflect acute inflammatory reactions but not systemic inflammation. ⢠ADC is inversely correlated with CDAI, MaRIA, and SES-CD. ⢠The role of ADC in assessing fibrotic changes in the bowel wall is limited.
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Enfermedad de Crohn , Humanos , Enfermedad de Crohn/diagnóstico por imagen , Estudios Prospectivos , Imagen de Difusión por Resonancia Magnética , Intestinos , Inflamación/diagnóstico por imagenRESUMEN
BACKGROUND: Computed tomography (CT)-defined fat quantification has been an emergent field of research in oncology. It was shown that this parameter is predictive and prognostic of several clinically relevant factors in several tumor entities. OBJECTIVE: Our aim was to establish the effect of visceral (VFA) and subcutaneous fat areas (SFA) on overall survival (OS), disease-free survival (DFS), and postoperative complications in gastric cancer patients based on a large patient sample. METHODS: MEDLINE library, EMBASE, and SCOPUS databases were screened for the associations between VFA and SFA defined by CT images and OS, DFS, and postoperative complications in gastric cancer patients up to August 2022. The primary endpoint of the systematic review was the hazard ratio for the outcome parameters. High VFA was, in most studies, defined by the threshold value of 100 cm2. In total, 9 studies were suitable for the analysis and included in the present study. RESULTS: The included studies comprised 3,713 patients. The identified frequency of visceral obesity was 44.9%. The pooled hazard ratio for the effect of high VFA on OS was 1.28 (95% CI 1.09-1.49, p = 0.002). For SFA, it was 1.87 (95% CI 1.45-2.42, p < 0.0001). The pooled hazard ratio for the influence of high VFA on DFS was 1.17 (95% CI 0.95-1.43, p = 0.14). The pooled odds ratio for the associations between VFA and postoperative complications was 1.36 (95% CI 1.09-1.69, p = 0.006). CONCLUSION: CT-defined VFA and SFA influence OS in patients with gastric cancer. VFA also influences the occurrence of postoperative complications. Therefore, assessment of fat areas should be included in clinical routine in patients with gastric cancer.
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Adenocarcinoma , Neoplasias Gástricas , Humanos , Pronóstico , Grasa Intraabdominal/diagnóstico por imagen , Grasa Intraabdominal/patología , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/cirugía , Adenocarcinoma/patología , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/epidemiología , Tomografía , Estudios RetrospectivosRESUMEN
INTRODUCTION: Body composition comprising low-skeletal muscle mass (LSMM) and subcutaneous and visceral adipose tissue (SAT and VAT) can be assessed by using cross-sectional imaging modalities. Previous analyses suggest that these parameters harbor prognostic relevance in various diseases. Aim of this study was to analyze possible associations of body composition parameters on mortality in patients with clinically suspected acute mesenteric ischemia (AMI). METHODS: All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. Overall, 137 patients (52 female patients, 37.9%) with a median age of 71 years were included in the present analysis. For all patients, the preoperative abdominal computed tomography (CT) was used to calculate LSMM, VAT, and SAT. RESULTS: Overall, 94 patients (68.6%) of the patient cohort died within 30 days within a median of 2 days, range 1-39 days. Of these, 27 patients (19.7%) died within 24 h. According to the CT, 101 patients (73.7%) were classified as being visceral obese, 102 patients (74.5%) as being sarcopenic, and 69 patients (50.4%) as being sarcopenic obese. Skeletal muscle index (SMI) was lower in non-survivors compared to survivors (37.5 ± 12.4 cm2/m2 vs. 44.1 ± 13.9 cm2/m2, p = 0.01). There were no associations between body composition parameters with mortality in days (SMI r = 0.07, p = 0.48, SAT r = -0.03, p = 0.77, and VAT r = 0.04, p = 0.68, respectively). In Cox regression analysis, a nonsignificant trend for visceral obesity was observed (HR: 0.62, 95% CI: 0.36-1.05, p = 0.07). CONCLUSION: SMI might be a valuable CT-based parameter, which could help discriminate between survivors and non-survivors. Further studies are needed to elucidate the associations between body composition and survival in patients with AMI.
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Isquemia Mesentérica , Sarcopenia , Humanos , Femenino , Anciano , Pronóstico , Sarcopenia/complicaciones , Sarcopenia/diagnóstico por imagen , Estudios Retrospectivos , Isquemia Mesentérica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Composición Corporal , Obesidad , Grasa Intraabdominal/diagnóstico por imagenRESUMEN
BACKGROUND: Epicardial adipose tissue (EAT) has been established as a quantitative imaging biomarker associated with disease severity in coronary heart disease. Our aim was to use this prognostic marker derived from computed tomography pulmonary angiography (CTPA) for the prediction of mortality and prognosis in patients with acute pulmonary embolism. METHODS: The clinical database was retrospectively screened for patients with acute pulmonary embolism between 2015 and 2021. Overall, 513 patients (216 female, 42.1%) were included in the analysis. The study end-point was 30-day mortality. Epicardial adipose tissue was measured on the diagnostic CTPA in a semiquantitative manner. The volume and density of EAT were measured for every patient. RESULTS: Overall, 60 patients (10.4%) died within the 30-day observation period. The mean EAT volume was 128.3⯱ 65.0â¯cm3 in survivors and 154.6⯱ 84.5â¯cm3 in nonsurvivors (pâ¯= 0.02). The density of EAT was -79.4⯱ 8.3â¯HU in survivors and -76.0⯱ 8.4â¯HU in nonsurvivors (pâ¯= 0.86), and EAT density was associated with 30-day mortality (odds ratio [OR]â¯= 1.07; 95% confidence interval [CI]: 1.03; 1.1, pâ¯< 0.001) but did not remain statistically significant in multivariable analysis. No association was identified between EAT volume and 30-day mortality (ORâ¯= 1.0; 95% CI: 1.0; 1.0, pâ¯= 0.48). CONCLUSION: There might be an association between EAT density and mortality in patients with acute pulmonary embolism. Further studies are needed to elucidate the prognostic relevance of EAT parameters in patients with acute pulmonary embolism.
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INTRODUCTION: Low skeletal muscle mass (LSMM) can be assessed by cross-sectional imaging. LSMM is associated with several clinically relevant factors in various disorders with predictive and prognostic implications. METHODS: Our aim was to establish the effect of computed tomography (CT)-defined LSMM on mortality in renal cell cancer (RCC) and urothelial carcinoma (UC) undergoing palliative treatment. The MEDLINE library, Cochrane, and SCOPUS databases were screened for the associations between CT-defined LSMM up to May 2022. In total, 11 studies were suitable for the analysis. RESULTS: The included studies comprised 481 patients with RCC and 394 patients with UC. The pooled hazard ratio for the association between LSMM and overall survival was 1.64 (95% CI: 0.90-2.99), p = 0.10 in univariable analysis and 1.55 (95% CI: 0.91-2.63), p = 0.10 in multivariable analysis for RCC. For UC, the pooled hazard ratio was 2.75 (95% CI: 1.77-4.28), p < 0.00001 in univariable, and 2.77 (95% CI: 1.91-4.02), p < 0.00001 in multivariable analysis. For progression-free survival, it was 2.02 (95% CI: 1.24-3.27), p = 0.004 for RCC and 2.43 (95% CI: 1.59-3.74), p < 0.0001 for UC (univariable analysis). CONCLUSIONS: CT-defined LSMM predicts OS and PFS in RCC and UC in the palliative setting. The effect was higher in UC. Therefore, LSMM assessment should be included as a relevant prognostic biomarker in clinical routine.
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Carcinoma de Células Renales , Carcinoma de Células Transicionales , Neoplasias Renales , Neoplasias de la Vejiga Urinaria , Humanos , Pronóstico , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/terapia , Músculo Esquelético/diagnóstico por imagenRESUMEN
Introduction: The role of sarcopenia in malignant cutaneous melanoma is unclear. The aim of the present meta-analysis was to analyze the prevalence and clinical role of sarcopenia in patients with advanced cutaneous melanoma based on a large cohort. Methods: MEDLINE, Cochrane, and SCOPUS databases were checked for relationships between sarcopenia and clinical outcomes in melanoma up to September 2021. Overall, 6 studies including 719 patients met the inclusion criteria. The meta-analysis was performed using RevMan 5.3 software. Results: The prevalence of sarcopenia was 40.23%. Sarcopenia did not influence dose-limiting toxicity of treatment, hazard ratio (HR) 1.01, 95% CI (0.70-1.47). Sarcopenia was associated with lower progression-free survival (PFS): HR 1.49, 95% CI (0.98-2.26), and lower overall survival (OS): HR 1.67, 95% CI (1.11-2.52). Conclusions: The cumulative prevalence of sarcopenia in malignant cutaneous melanoma is 40.77%. Sarcopenia is slightly associated with PFS and OS and it is not associated with treatment toxicity.
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Melanoma , Sarcopenia , Neoplasias Cutáneas , Humanos , Inmunoterapia/efectos adversos , Melanoma/tratamiento farmacológico , Sarcopenia/etiología , Neoplasias Cutáneas/tratamiento farmacológico , Melanoma Cutáneo MalignoRESUMEN
Sarcopenia, defined as low-skeletal muscle mass (LSMM), can be assessed by imaging modalities. Our aim was to establish the effect of LSMM on overall survival (OS) and progression-free survival (PFS) in gastric cancer patients undergoing palliative chemotherapy based on a large patient sample. MEDLINE library, Cochrane and SCOPUS databases were screened for the associations between LSMM and mortality in advanced gastric cancer patients. The primary endpoint of the systematic review was the hazard ratio of LSMM on OS and PFS. In total, seven studies were suitable for the analysis and included into the present study. The included studies comprised 668 patients with advanced gastric cancer. The identified frequency of LSMM was 48.05%. The pooled hazard ratio for the effect of LSMM on OS was 1.31 [95% CI 0.96-1.77], p = 0.08, in univariate analysis and 1.21 [95% CI 0.94-1.56], p = 0.13, in multivariate analysis. For PFS, the pooled hazard ratio for the effect of LSMM on PFS was 1.76 [95% CI 0.66-4.66], p = 0.26. LSMM did not significantly affect OS and PFS in patients with advanced gastric cancer undergoing palliative chemotherapy. Further research is needed to elucidate possible influences of LSMM on survival in this tumor entity.
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Sarcopenia , Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Humanos , Cuidados Paliativos , Pronóstico , Sarcopenia/etiologíaRESUMEN
BACKGROUND: Tractography has become a standard tool for planning neurosurgical operations and has been proven to be useful for risk stratification. In various conditions, tractography-derived white matter integrity has been shown to be associated with neurological outcome. Postoperative performance has been shown to be a prognostic marker in glioma. We aimed to assess the relation of preoperative corticospinal tract (CST) integrity with postoperative neurological deterioration in patients with malignant glioma. METHODS: We retrospectively analyzed a cohort of 24 right-handed patients (41.7% female) for perioperative neurological performance score (NPS) and applied our anatomical tractography workflow to extract the median fractional anisotropy (FA) of the CST in preoperative magnetic resonance imaging (MRI). RESULTS: Median FA of the CST ipsilateral to the tumor correlated significantly with preoperative NPS (p = 0.025). After rank order correlation and multivariate linear regression, we found that the preoperative median FA of the right CST correlates with preoperative NPS, independently from epidemiological data (p = 0.019). In patients with lesions of the right hemisphere, median FA of the right CST was associated with a declining NPS in multivariate linear regression (p = 0.024). Receiver operating characteristic (ROC) analysis revealed an optimal FA cutoff at 0.3946 in this subgroup (area under the curve 0.83). Patients below that cutoff suffered from a decline in neurological performance significantly more often (p = 0.020). CONCLUSIONS: Assessment of preoperative white matter integrity may be a promising biomarker for risk estimation of patients undergoing craniotomy for resection of malignant glioma.
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Glioma , Sustancia Blanca , Humanos , Femenino , Masculino , Tractos Piramidales/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Imagen de Difusión Tensora/métodos , Estudios Retrospectivos , Glioma/diagnóstico por imagen , Glioma/cirugíaRESUMEN
BACKGROUND AND PURPOSE: Diffusion-weighted imaging (DWI) is a cornerstone in diagnostic of ischemic stroke. The aim of this study was to investigate the usefulness of high-b-value computed DWI (c-DWI) in comparison to standard DWI in patients with acute brainstem infarction. MATERIALS AND METHODS: 56 patients with acute brainstem infarction were retrospectively analysed by two readers. DWI was obtained with the b-values 0, 500 and 1000â¯s/mm² on either a 1.5 or 3â¯T magnetic resonance imaging (MRI) scanner. c-DWI was calculated with a monoexponential model with high b-values 2000, 3000, 4000 and 5000â¯s/mm². All c-DWI series with high-b-values were compared to the standard DWI sequence at b-value of 1000â¯s/mm² in terms of image artifacts, lesion extent and contrast. RESULTS: There was no statistically significant difference between 1.5 and 3â¯T MRI regarding the measured ischemic lesion size. There were no statistically significant differences between the ischemic lesion sizes on DWI at b-values of 1000â¯s/mm² and on c-DWI at higher b-values. Overall, the contrast between the lesion and the surrounding normal areas improved with increasing b-value on the isotropic DWIs: maximum at bâ¯=â¯5000, followed by that at b 2000 and b 1000â¯s/mm², in order. The best relation between artifacts and lesion contrast was identified for b 2000â¯s/mm². CONCLUSION: High b-value DWI derived from c-DWI has a higher visibility for ischemic brainstem lesions compared to standard DWI without additional time cost. The b-2000 image is recommended to use in clinical routine, higher b-value images lead to more imaging artifacts, which might result in misdiagnosis.
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Infartos del Tronco Encefálico , Imagen de Difusión por Resonancia Magnética , Artefactos , Humanos , Imagen por Resonancia Magnética , Estudios RetrospectivosRESUMEN
OBJECTIVES: Systemic mastocytosis (SM) is a heterogeneous haematological entity characterised by proliferation of mast cells. Skeletal abnormalities of SM include osteolysis, osteopenia and osteoporosis but also osteosclerosis. A routinely used modality to assess bone density is dual-energy x-ray absorptiometry (DXA). The present study sought to elucidate possible associations between DXA findings with both clinical and bone marrow biopsy findings in SM. METHODS: Patient records of the local oncology and haematology department from 2007 to 2018 were screened for patients with SM. Overall, 39 patients (18 women and 21 men) with sufficient DXA images and clinical data were identified. We evaluated cKit mutation, tryptase level in serum, alkaline phosphatase, calcium level in serum, haemoglobin level, leucocytes and thrombocytes. Bone marrow biopsies were also evaluated. RESULTS: There were no significant differences between the different bone marrow patterns and in regard of cKit mutations. Significant lower bone mineral density (BMD) - T-score and Z-score values were identified for the indolent type compared to aggressive type. Correlation analysis revealed an association between BMD and tryptase level (r=0.35, p=0.049), mast cell proportion in bone marrow biopsy (r=0.45, p=0.01) and with the years since diagnosis (r=-0.42, p=0.02). Moreover, the correlations differed between the indolent and aggressive type. CONCLUSIONS: DXA findings are associated with clinical and bone marrow biopsy parameters in SM. A positive association with tryptase level and mast cell amount in bone marrow biopsies was identified. This corroborates the usefulness of DXA in SM beyond the sole assessment of osteopenia and osteoporosis.
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Mastocitosis Sistémica , Osteoporosis , Biopsia , Densidad Ósea , Médula Ósea/diagnóstico por imagen , Femenino , Humanos , Masculino , Mastocitosis Sistémica/diagnóstico por imagen , Osteoporosis/diagnóstico por imagen , Osteoporosis/etiologíaRESUMEN
OBJECTIVES: Magnetic resonance imaging (MRI) is a cornerstone in diagnosis of myopathies. Recently, imaging techniques, such as histogram analysis are used to obtain novel imaging biomarkers. The present study sought to elucidate possible associations between histopathology derived from muscle biopsies and histogram parameters derived from clinical MRI in myositis and other myopathies. METHODS: 20 patients with myopathies were included in this retrospective study. MRI was performed using a 1.5T MRI scanner including T2- and T1- weighted images. The histogram parameters of the MRI sequences were obtained of the biopsied muscle. The histopathology analysis included the scoring systems proposed by Tateyama et al., Fanin et al., Allenbach et al. and immunohistochemical stainings for MHC-I, CD68, CD8 and CD4. RESULTS: Entropy derived from T2-weighted images showed strong positive associations with the inflammation scores (r=0.71, p=0.0005 with Allenbach et al score and r=0.68, p=0.001 with Tateyama score). Furthermore, there were strong associations between entropy derived from T2-weighted images with MHC-I staining (r=0.67, p=0.022), with the amount of CD20 cells (r=0.70, p=0.022), with the amount of CD4 positive cells (r=0.78, p=0.0075) and with the amount of CD8 positive cells (r=0.79, p=0.004). Other parameters showed no associations with the investigated histopathology features. CONCLUSIONS: Entropy derived from T2-weighted images showed strong associaitions with inflammation scores and with the sole amount of immune cells in myopathies. These results need to be confirmed by clinical studies, whether it is also related to clinical performance or can predict treatment response.
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Miositis , Biopsia , Recuento de Células , Humanos , Imagen por Resonancia Magnética , Miositis/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
BACKGROUND: Our aim was to provide data regarding use of diffusion-weighted imaging (DWI) for distinguishing metastatic and non-metastatic lymph nodes (LN) in rectal cancer. METHODS: MEDLINE library, EMBASE, and SCOPUS database were screened for associations between DWI and metastatic and non-metastatic LN in rectal cancer up to February 2021. Overall, 9 studies were included into the analysis. Number, mean value, and standard deviation of DWI parameters including apparent diffusion coefficient (ADC) values of metastatic and non-metastatic LN were extracted from the literature. The methodological quality of the studies was investigated according to the QUADAS-2 assessment. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian, and Laird random-effects models with inverse-variance weights were used to account the heterogeneity between the studies. Mean DWI values including 95% confidence intervals were calculated for metastatic and non-metastatic LN. RESULTS: ADC values were reported for 1376 LN, 623 (45.3%) metastatic LN, and 754 (54.7%) non-metastatic LN. The calculated mean ADC value (× 10-3 mm2/s) of metastatic LN was 1.05, 95%CI (0.94, 1.15). The calculated mean ADC value of the non-metastatic LN was 1.17, 95%CI (1.01, 1.33). The calculated sensitivity and specificity were 0.81, 95%CI (0.74, 0.89) and 0.67, 95%CI (0.54, 0.79). CONCLUSION: No reliable ADC threshold can be recommended for distinguishing of metastatic and non-metastatic LN in rectal cancer.
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Ganglios Linfáticos , Neoplasias del Recto , Imagen de Difusión por Resonancia Magnética , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Metástasis Linfática/diagnóstico por imagen , Neoplasias del Recto/diagnóstico por imagen , Sensibilidad y EspecificidadRESUMEN
PURPOSE: Incidental pulmonary embolism (IPE) is a common finding on computed tomography (CT). IPE is frequent in oncologic patients undergoing staging CT. The aim of this analysis was to provide the pooled frequency of IPE and frequencies of IPE in different primary tumors. METHODS: MEDLINE, SCOPUS, and EMBASE databases were screened for studies investigating frequency of IPE in oncologic staging CT up to February 2020. Overall, 12 studies met the inclusion criteria and were included into the present study. RESULTS: The pooled analysis yielded a total of 28,626 patients. IPE was identified in 963 patients (3.36%, 95% CI = 3.15; 3.57). The highest frequency was found in prostate cancer (8.59%, 95%CI = 3.74; 13.44), followed by hepatobiliary carcinoma (6.07%, 95%CI = 3.09; 9.05) and pancreatic cancer (5.65%, 95%CI = 3.54; 7.76). The lowest frequencies were identified in tumors of male reproductive organs (0.79%, 95%CI = 0.21; 1.37) and hematological diseases (1.11% 95%CI = 0.74; 1.48). CONCLUSION: The overall frequency of IPE in oncologic patients was 3.36%. There are considerable differences in regard to primary tumors with the highest frequency in prostate cancer and pancreatic and hepatobiliary carcinomas.
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Neoplasias/complicaciones , Embolia Pulmonar/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Texture analysis derived from Computed tomography (CT) might be able to better characterize fluid collections undergoing CT-guided percutaneous drainage treatment. The present study tested, whether texture analysis can reflect microbiology results in fluid collections suspicious for septic focus. METHODS: Overall, 320 patients with 402 fluid collections were included into this retrospective study. All fluid collections underwent CT-guided drainage treatment and were microbiologically evaluated. Clinically, serologically parameters and conventional imaging findings as well as textures features were included into the analysis. A new CT score was calculated based upon imaging features alone. Established CT scores were used as a reference standard. RESULTS: The present score achieved a sensitivity of 0.78, a specificity of 0.69, area under curve (AUC 0.82). The present score and the score by Gnannt et al. (AUC 0.81) were both statistically better than the score by Radosa et al. (AUC 0.75). Several texture features were statistically significant between infected fluid collections and sterile fluid collections, but these features were not significantly better compared with conventional imaging findings. CONCLUSIONS: Texture analysis is not superior to conventional imaging findings for characterizing fluid collections. A novel score was calculated based upon imaging parameters alone with similar diagnostic accuracy compared to established scores using imaging and clinical features.
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Exudados y Transudados/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE. PURPOSE: To search possible CTPA predictors of 24-h and 30-day mortality in PE. MATERIAL AND METHODS: Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC). RESULTS: Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3-17.7; P < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01-1.21; P = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82-1.01, P = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99-1.02, P = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7-7.0; P = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97-1.12; P = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89-1.04; P = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976-0.999, P = 0.045). CONCLUSION: Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.
Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Medios de Contraste/farmacocinética , Embolia Pulmonar/mortalidad , Intensificación de Imagen Radiográfica/métodos , Vena Cava Inferior/diagnóstico por imagen , Enfermedad Aguda , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Arteria Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Vena Cava Inferior/fisiopatologíaRESUMEN
BACKGROUND: Prostate MRI has become a corner stone in diagnosis of prostate cancer (PC). Diffusion weighted imaging and the apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. The present analysis sought to compare ADC values of clinically insignificant with clinical significant PC based upon a large patient sample. METHODS: MEDLINE library and SCOPUS databases were screened for the associations between ADC and Gleason score (GS) in PC up to May 2019. The primary endpoint of the systematic review was the ADC value of PC groups according to Gleason score. In total 26 studies were suitable for the analysis and included into the present study. The included studies comprised a total of 1633 lesions. RESULTS: Clinically significant PCs (GS ≥ 7) were diagnosed in 1078 cases (66.0%) and insignificant PCs (GS 5 and 6) in 555 cases (34.0%). The pooled mean ADC value derived from monoexponenantially fitted ADCmean of the clinically significant PC was 0.86 × 10- 3 mm2/s [95% CI 0.83-0.90] and the pooled mean value of insignificant PC was 1.1 × 10- 3 mm2/s [95% CI 1.03-1.18]. Clinical significant PC showed lower ADC values compared to non-significant PC. The pooled ADC values of clinically insignificant PCs were no lower than 0.75 × 10- 3 mm2/s. CONCLUSIONS: We evaluated the published literature comparing clinical insignificant with clinically prostate cancer in regard of the Apparent diffusion coefficient values derived from magnetic resonance imaging. We identified that the clinically insignificant prostate cancer have lower ADC values than clinically significant, which may aid in tumor noninvasive tumor characterization in clinical routine.
Asunto(s)
Imagen de Difusión por Resonancia Magnética , Neoplasias de la Próstata/diagnóstico por imagen , Humanos , Masculino , Clasificación del Tumor , Neoplasias de la Próstata/patologíaRESUMEN
OBJECTIVES: Magnetic resonance imaging (MRI) is a cornerstone in diagnosis of myopathies. The present study sought to elucidate possible associations between electromyography (EMG) findings and histogram parameters derived from clinical MRI in myositis and other myopathies. MATERIALS AND METHODS: Twenty six patients with myopathies were included in this retrospective study. Clinical MRI was performed with a 1.5T MRI scanner including T2- and T1-weighted images. EMG analysis was performed during clinical diagnostic workup. The histogram parameters of the MRI sequences were obtained of the same muscle, which was investigated with EMG. RESULTS: Several correlations were identified between mean duration of the motor unit potentials (MUP) and histogram parameters derived from T1- and T2-weighted images. The highest for T1-weighted images was mode (r = -.73, P < .0001) and for T2-weighted images was p25 (r = -.57, P = .022). There were significant differences for several histogram parameters between muscles with pathological spontaneous activity and without. So, for T1-weighted images, the best discrimination was achieved with mean (P = .096), and for T2-weighted images for p10 (P = .05). Mean SI values derived from T1-weighted images achieved an AUC of 0.84 with a sensitivity of 0.81 and a specificity of 0.86 to discriminate patients with and without pathological spontaneous activity (PSA). CONCLUSIONS: The present study identified strong associations between histogram analysis derived from morphological MRI sequences and the duration of the MUP derived from EMG in myopathies strengthening the fact that both diagnostic modalities can reflect disease state in a similar fashion. Histogram parameters can predict muscles with PSA.