RESUMO
Background: The incidence of pyogenic spondylodiscitis has been increasing in countries of Europe and North America, probably due to an increasing number of persons with risk factors for this infection. It is unclear whether HIV infection in the era of antiretroviral therapy (ART) increases the risk for spondylodiscitis. Method: We present 7 cases of pyogenic spondylodiscitis of the cervical, thoracic, and lumbar spine in six individuals living with HIV under ART with suppressed viral load. Results: All patients presented with severe non-radicular pain and elevated inflammatory markers. Diagnosis was confirmed by magnetic resonance imaging (MRI) scan and isolation of the pathogen. Staphylococcus aureus was the causative pathogen in five patients. One patient suffered from an infection with Klebsiella pneumoniae followed by a mixed infection with Cutibacterium acnes and Bacillus circulans 18 months later. All patients needed surgical intervention, and the mean duration of antibiotic treatment was 17 weeks (range 12-26). Five patients recovered fully, including two persons who also suffered from endocarditis. One patient died from multi-organ failure. Conclusion: Spondylodiscitis may be seen more frequently in persons living with HIV as they grow older and suffer from comorbidities which put them at risk for this infection. HIV physicians should be aware of the infection and its risk factors.
Assuntos
Discite , Infecções por HIV , Infecções Estafilocócicas , Humanos , Discite/tratamento farmacológico , Discite/diagnóstico , Discite/microbiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , DorRESUMO
PURPOSE: Endovascular aneurysm repair has emerged as the standard therapy for abdominal aortic aneurysms. In 9-30% of cases, retrograde filling of the aneurysm sac through patent branch arteries may result in persistence of blood flow outside the graft and within the aneurysm sac. This condition is called an endoleak type II, which may be treated by catheter-based embolization in case of continued sac enlargement. If an endovascular access is not possible, percutaneous targeting of the perfused nidus remains the only option. However, this can be very challenging due to the difficult access and deep puncture with risk of organ perforation and bleeding. Innovative targeting techniques such as robotics may provide a promising option for safe and successful targeting. METHODS: In nine consecutive patients, percutaneous embolization of type II endoleaks was performed using a table-mounted micro-robotic targeting platform. The needle path from the skin entry to the perfused nidus was planned based on the C-arm CT image data in the angio-suite. Entry point and path angle were aligned using the joystick-operated micro-robotic system under fluoroscopic control, and the coaxial needle was introduced until the target point within the perfused nidus was reached. RESULTS: All punctures were successful, and there were no puncture-related complications. The pre-operative C-arm CT was executed in 11-15 s, and pathway planning required 2-3 min. The robotic setup and sterile draping were performed in 1-2 min, and the alignment to the surgical plan took no longer than 30 s. CONCLUSION: Due to the small size, the micro-robotic platform seamlessly integrated into the routine clinical workflow in the angio-suite. It offered significant benefits to the planning and safe execution of double-angulated deeply localized targets, such as type II endoleaks.
Assuntos
Aneurisma da Aorta Abdominal , Embolização Terapêutica , Endoleak , Humanos , Endoleak/etiologia , Embolização Terapêutica/métodos , Aneurisma da Aorta Abdominal/cirurgia , Masculino , Procedimentos Endovasculares/métodos , Idoso , Feminino , Procedimentos Cirúrgicos Robóticos/métodos , Idoso de 80 Anos ou mais , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Robótica/métodosRESUMO
OBJECTIVES: Public campaigns such as the "Go-red-for-women"-initiative have raised heart-disease awareness and may trigger overutilization of coronary computed tomography angiography (CTA). Objective was to investigate the diagnostic efficacy of coronary CTA stratified by age and gender. METHODS: 1882 consecutive patients (58.9 ± 11 years;42.5% females) with low-to-intermediate pre-test-probability of coronary artery disease (CAD) referred to coronary CTA according to ESC-2019 guidelines, were included. Diagnostic efficacy was defined by the 1)negative CTA-rate 2)obstructive CAD (>50%stenosis) 3)High-risk-plaque and 4)CAC-score. RESULTS: The negative CTA rate was higher in females compared to males with 360/801 vs 292/1081 (45% vs 27%;p < 0.001). Females had a higher likelihood (OR 2.2:95%CI:1.81-2.67) of a negative CTA than males, despite they were older (p < 0.001). Obstructive disease prevalence was 25.6% and acceptable in both sexes (males vs females: 28.4% vs 21.8%;p = 0.0012). Males had more high-risk-plaque (23.6% vs 11.5%;p < 0.001). When stratifying age groups, negative CTA rate was highest in females <47 years (82.8%), but lower in males with 68.1% (p < 0.001), while obstructive disease prevalence was not different (males:6.5% vs females:4.6%:p = 0.874). Above 50 years, negative CTA rate (39.1% vs 17.6%,p < 0.001;OR 3.02:95%CI:2.381-3.823) was higher, and the obstructive disease rate was lower in females (24.8% vs 34.7%,p = 0.0003). SSPSTm(V.25,IBM) was used for statistical analysis. CONCLUSIONS: Above 50 years of age, diagnostic efficacy of coronary CTA is high in both males and females. In females <47 years, the negative CTA rate was highest with 82.8% and obstructive disease prevalence was low (4.6%), still justifying testing but recommending the use of specific tools (PROMISE minimal risk score) or other clinical tests for pre-selection.
Assuntos
Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana , Perimenopausa , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Idoso , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Fatores Sexuais , Estudos Retrospectivos , Caracteres SexuaisRESUMO
BACKGROUND: A better understanding of the peritumoral stroma changes due to tumour invasion using non-invasive diagnostic methods may improve the differentiation between benign and malignant breast lesions. This study aimed to assess the correlation between breast lesion differentiation and intra- and peritumoral shear-wave elastography (SWE) gradients. METHODS: A total of 135 patients with newly diagnosed breast lesions were included. Intratumoral, subsurface, and three consecutive peritumoral SWE value measurements (with three repetitions) were performed. Intratumoral, interface, and peritumoral gradients (Gradient 1 and Gradient 2) were calculated using averaged SWE values. Statistical analysis included descriptive statistics and an ordinary one-way ANOVA to compare overall and individual gradients among Breast Imaging-Reporting and Data System (BI-RADS) 2, 3, and 5 groups. RESULTS: Malignant tumours showed higher average SWE velocity values at the tumour centre (BI-RADS 2/3: 4.1 ± 1.8 m/s vs. BI-RADS 5: 4.9 ± 2.0 m/s, p = 0.04) and the first peritumoral area (BI-RADS 2/3: 3.4 ± 1.8 m/s vs. BI-RADS 5: 4.3 ± 1.8 m/s, p = 0.003). No significant difference was found between intratumoral gradients (0.03 ± 0.32 m/s vs. 0.0 ± 0.28 m/s; p > 0.999) or gradients across the tumour-tissue interface (-0.17 ± 0.18 m/s vs. -0.13 ± 0.35 m/s; p = 0.202). However, the first peritumoral gradient (-0.16 ± 0.24 m/s vs. -0.35 ± 0.31 m/s; p < 0.0001) and the second peritumoral gradient (-0.11 ± 0.18 m/s vs. -0.22 ± 0.28 m/s; p = 0.037) were significantly steeper in malignant tumours. The AUC was best for PTG1 (0.7358) and PTG2 (0.7039). A threshold value for peritumoral SWI PT1 above 3.76 m/s and for PTG1 below -0.238 m/s·mm-1 indicated malignancy in 90.6% of cases. CONCLUSIONS: Evaluating the peritumoral SWE gradient may improve the diagnostic pre-test probability, as malignant tumours showed a significantly steeper curve of the elasticity values in the peritumoral stroma compared to the linear regression with a relatively flat curve of benign lesions.
RESUMO
INTRODUCTION: Aneurysmal wall enhancement (AWE) of non-ruptured sacular intracranial aneurysms (IA) after endovascular treatment (ET) is a frequently observed imaging finding using AWE-sequences in brain magnetic resonance imaging (MRI). So far, its value remains unclear. We aimed to investigate the effect of AWE on aneurysm reperfusion rates in a longitudinal cohort. METHODS: This is a retrospective MRI study over the timespan of up to 5 years, assessing the correlation of increased AWE of non-ruptured IAs and events of aneurysm reperfusion and retreatment, PHASES Score and grade of AWE. T1 SPACE fat saturation (FS) and T1 SE FS blood suppression sequences after contrast administration were used for visual interpretation of increased AWE. The IAs' sizes were assessed via the biggest diameter. The grade of enhancement was defined in a grading system from grade 1 to grade 3. RESULTS: 127 consecutive non ruptured IA-patients (58.9 ± 9.0 years, 94 female, 33 male) who underwent elective aneurysm occlusion were included. AWE was observed in 40.2% of patients (51/127) after ET, 6 patients already showed AWE before treatment. In large IAs (which were defined as a single maximum diameter of over 7.5 mm), AWE was significantly associated with aneurysm reperfusion in contrast to large aneurysm without AWE). All grades of AWE were significantly associated with reperfusion. CONCLUSIONS: Our data suggests that in patients with initially large IAs, AWE is correlated with aneurysm reperfusion.
RESUMO
One of the main causes of the dismal prognosis in patients who survive the initial bleeding after aneurysmal subarachnoidal hemorrhage is the delayed cerebral ischaemia caused by vasospasm. Studies suggest that cerebral magnesium and pH may potentially play a role in the pathophysiology of this adverse event. Using phosphorous magnetic resonance spectrocopy (31P-MRS), we calculated the cerebral magnesium (Mg) and pH levels in 13 patients who suffered from aSAH. The values between the group that developed clinically significant vasospasm (n = 7) and the group that did not (n = 6) were compared. The results of this study show significantly lower cerebral Mg levels (p = 0.019) and higher pH levels (p < 0.001) in the cumulative group (all brain voxels together) in patients who developed clinically significant vasospasm. Further clinical studies on a larger group of carefully selected patients are needed in order to predict clinically significant vasospasm.
RESUMO
Objectives: Changes in the microvascular environment are considered crucial in the pathogenesis of compression neuropathies. Several studies have demonstrated elevated intraneural vascularity in severe neuropathy compared with healthy subjects, where intraneural vascularity is considered predominantly undetectable. The aim of this study was to assess and quantify intraneural vasculature by superb microvascular imaging (SMI) in healthy volunteers in the median, ulnar and common peroneal nerve. Methods: Intraneural vascularity was quantified in 26 healthy volunteers (312 segments overall) by SMI sonography using a 22-MHz linear transducer. Individual nerve segment vascularity was compared with the mean vascularity using one-way ANOVA and Kruskal-Wallis tests, respectively. Vendor-provided quantification and manual vessel count were compared by linear regression analysis. Results: Intraneural vascularity was detectable in all nerve segments (100.0%). Vessel density was highest in the median nerve at the wrist (1.54 ± 0.44/mm2, P < 0.0001) and lowest in the sulcal ulnar nerve (0.90 ± 0.34/mm2, P < 0.0001). Vendor-provided automated quantification severely overestimated vascular content compared with manual quantification. Conclusion: Superb microvascular imaging can facilitate the visualisation of nerve vascularity and even detect local variations in vessel density. The pathophysiological implications for peripheral neuropathies, especially compression neuropathies, warrant further investigation, but the absence of visible intraneural vasculature as a negative finding in the diagnostic of compression neuropathies should be interpreted with caution, as the intraneural vascularity may lie beyond the 18 MHz resolution power of a transducer.
RESUMO
Arterial pseudoaneurysms (PSAs) typically occur after (iatrogenic) damage (i.e., puncture) to the arterial wall and are the most frequent complication following percutaneous interventions.In this article we report on successful treatments of two iatrogenic PSAs in two patients (87-year-old male; 69-yearold-female) with a brachial (10 x 7 mm; 10 mm-length "neck") and radial (17 x 7 mm; 3 mm-length "neck") artery PSA by US-guided fibrin glue injection (UGFI). Both PSAs were effectively occluded without any complications. To our knowledge this is the first report on successful treatments of upper limb artery PSAs using UGFI, which may represent a valid first-line, minimally invasive treatment option for brachial artery PSA.
Assuntos
Falso Aneurisma , Masculino , Humanos , Feminino , Idoso de 80 Anos ou mais , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Falso Aneurisma/etiologia , Adesivo Tecidual de Fibrina/uso terapêutico , Antígeno Prostático Específico , Ultrassonografia de Intervenção , Extremidade Superior , Doença Iatrogênica , Artérias , Artéria Femoral/diagnóstico por imagem , Resultado do TratamentoRESUMO
To evaluate the diagnostic utility of the maximum ultrasound strain elastography (SE) halo depth in newly diagnosed and histologically confirmed breast lesions, a retrospective study approval was granted by the local Ethical Review Board. Overall, the maximum strain elastography peritumoural halos (SEPHmax)-the maximum distance between the SE stiffening area and the B-mode lesion size-in 428 cases with newly diagnosed breast lesions were retrospectively analysed alongside patient age, affected quadrant, tumour echogenicity, size, acoustic shadowing, and vascularity. Statistical analysis included an ordinary one-way ANOVA to compare the SEPHmax between BI-RADS 2, 3, and 5 groups and between tumour grades 1, 2, and 3. A binary regression analysis was used to determine the correlation between tumour malignancy and the above-mentioned demographic and imaging factors. SEPHmax was significantly higher in BI-RADS 5 tumours (5.5 ± 3.9 mm) compared to BI-RADS 3 (0.9 ± 1.7 mm, p < 0.0001) and 2 (0.6 ± 1.4 mm, p < 0.0001). The receiver operating characteristic area under the curve was 0.933 for the detection of BI-RADS 5 lesions. Furthermore, tumour grades 2 (5.6 ± 3.6 mm, p = 0.001) and 3 (6.8 ± 4.2 mm, p < 0.0001) exhibited significantly higher SEPHmax than grade 1 tumours (4.0 ± 3.9 mm). Similarly, St. Gallen Ki67-stratified low-risk (p = 0.005) and intermediate-risk (p = 0.013) tumours showed smaller SEPHmax than high-risk tumours. Multivariate analysis revealed a significant correlation between malignant differentiation and SEPHmax (standardized regression coefficient 3.17 [95% confidence interval (CI) 2.42-3.92], p < 0.0001), low tumour echogenicity (1.68 [95% CI 0.41-3.00], p = 0.03), and higher patient age (0.89 [95% CI 0.52-1.26], p < 0.0001). High SEPHmax is a strong predictor for tumour malignancy and a higher tumour grade and can be used to improve tumour characterisation before histopathological evaluation. It may also enable radiologists to identify lesions warranting observation rather than immediate biopsy.
RESUMO
BACKGROUND: Compared to conventional 2D mammography, digital breast tomosynthesis (DBT) offers greater breast lesion detection rates. Ring-like hypodense artifacts surrounding dense lesions are a common byproduct of DBT. This study's purpose was to assess whether minuscule changes spanning this halo-termed the "broken halo sign"-could improve lesion classification. METHODS: This retrospective study was approved by the local ethics review board. After screening 288 consecutive patients, DBT studies of 191 female participants referred for routine mammography with a subsequent histologically verified finding of the breast were assessed. Examined variables included patient age, histological diagnosis, architectural distortion, maximum size, maximum halo depth, conspicuous margins, irregular shape and broken halo sign. RESULTS: While a higher halo strength was indicative of malignancy in general (p = 0.031), the broken halo sign was strongly associated with malignancy (p < 0.0001, odds ratio (OR) 6.33), alongside architectural distortion (p = 0.012, OR 3.49) and a diffuse margin (p = 0.006, OR 5.49). This was especially true for denser breasts (ACR C/D), where the broken halo sign was the only factor predicting malignancy (p = 0.03, 5.22 OR). CONCLUSION: DBT-associated halo artifacts warrant thorough investigation in newly found breast lesions as they are associated with malignant tumors. The "broken halo sign"-the presence of small lines of variable diameter spanning the peritumoral areas of hypodensity-is a strong indicator of malignancy, especially in dense breasts, where architectural distortion may be obfuscated due to the surrounding tissue.
Assuntos
Neoplasias da Mama , Mama , Feminino , Humanos , Estudos Retrospectivos , Mama/diagnóstico por imagem , Mamografia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologiaRESUMO
Repetitive vibratory trauma in cyclists is one of the most common causes of ulnar nerve compression at the wrist. This study describes five cases of clinically suspected compression syndrome of the deep terminal branch of the ulnar nerve (DBUN) defined by high-resolution ultrasound (HRUS) with a 18-MHz linear transducer. Reliable HRUS visualization of the DBUN was feasible in all patients. The affected nerves had focally swollen and hypo-echoic changed segments. HRUS is a good imaging tool for the evaluation of a suspicious DBUN neuropathy if no electrodiagnostic testing is available or in patients with mild to moderate clinical symptoms with inconclusive electrodiagnostic results.
Assuntos
Ciclismo/lesões , Mãos/inervação , Síndromes de Compressão do Nervo Ulnar/diagnóstico por imagem , Síndromes de Compressão do Nervo Ulnar/etiologia , Nervo Ulnar/diagnóstico por imagem , Nervo Ulnar/lesões , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Adulto JovemRESUMO
RATIONALE AND OBJECTIVES: Pulley ruptures are the most common injuries in sport climbing. Ruptures of the A2 and A4 pulleys have been studied extensively, and ultrasound has proven to be a highly sensitive and specific tool for their diagnosis. However, the correct diagnosis of A3 pulley ruptures continues to be a challenge. Therefore, we investigated a novel approach to this pathology. MATERIAL AND METHODS: Eighteen fingers from nine different human cadavers were examined using high-resolution, dynamic ultrasound before and after being subjected to different combinations of singular and multiple iatrogenic pulley ruptures in a standardised fashion. Special attention was paid to the behaviour of the volar plate (VP) with respect to the proximal interphalangeal joint (PIP) and the flexor tendons before and after pulley rupture. RESULTS: Injuries to the A2 and A4 pulleys were diagnosed via ultrasound with sensitivities of 90â% and 94â% and specificities of 100â% and 97â%, respectively. A direct visualisation of the A3 pulley was achieved in 61â% of the fingers. The VP became significantly thicker and shorter during finger flexion as well as after A3 pulley rupture. The distance between tendon and VP became significantly more pronounced after A3 pulley rupture. For distances greater than 0.9âmm between VP and tendon, a sensitivity of 76â% and a specificity of 94â% were achieved for determining A3 pulley ruptures. CONCLUSION: The distance measurement between VP and tendon was found to be a valid indirect method for the diagnosis of A3 pulley ruptures. This approach is the first ultrasound method for accurately diagnosing A3 pulley ruptures.