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The purpose of this study was to determine if dual-energy CT (DECT) vital iodine tumor burden (ViTB), a direct assessment of tumor vascularity, allows reliable response assessment in patients with GIST compared to established CT criteria such as RECIST1.1 and modified Choi (mChoi). From 03/2014 to 12/2019, 138 patients (64 years [32-94 years]) with biopsy proven GIST were entered in this prospective, multi-center trial. All patients were treated with tyrosine kinase inhibitors (TKI) and underwent pre-treatment and follow-up DECT examinations for a minimum of 24 months. Response assessment was performed according to RECIST1.1, mChoi, vascular tumor burden (VTB) and DECT ViTB. A change in therapy management could be because of imaging (RECIST1.1 or mChoi) and/or clinical progression. The DECT ViTB criteria had the highest discrimination ability for progression-free survival (PFS) of all criteria in both first line and second line and thereafter treatment, and was significantly superior to RECIST1.1 and mChoi (p < .034). Both, the mChoi and DECT ViTB criteria demonstrated a significantly early median time-to-progression (both delta 2.5 months; both p < .036). Multivariable analysis revealed 6 variables associated with shorter overall survival: secondary mutation (HR = 4.62), polymetastatic disease (HR = 3.02), metastatic second line and thereafter treatment (HR = 2.33), shorter PFS determined by the DECT ViTB criteria (HR = 1.72), multiple organ metastases (HR = 1.51) and lower age (HR = 1.04). DECT ViTB is a reliable response criteria and provides additional value for assessing TKI treatment in GIST patients. A significant superior response discrimination ability for median PFS was observed, including non-responders at first follow-up and patients developing resistance while on therapy.
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BACKGROUND. CT-based criteria for assessing the gastrointestinal stromal tumor (GIST) response to tyrosine kinase inhibitor (TKI) therapy are limited in part because tumor attenuation is influenced by treatment-related changes including hemorrhage and calcification. The iodine concentration may be less impacted by such changes. OBJECTIVE. The purpose of this study was to determine whether the dual-energy CT (DECT) vital iodine tumor burden (TB) allows improved differentiation between treatment responders and nonresponders among patients with metastatic GIST who are undergoing TKI therapy compared with established CT and PET/CT criteria. METHODS. An anthropomorphic phantom with spherical inserts mimicking GIST lesions of varying iodine concentrations and having nonenhancing central necrotic cores underwent DECT to determine a threshold iodine concentration. Forty patients (25 women and 15 men; median age, 57 years) who were treated with TKI for metastatic GIST were retrospectively evaluated. Patients underwent baseline and follow-up DECT and FDG PET/CT. Response assessment was performed using RECIST 1.1, modified Choi (mChoi) criteria, vascular tumor burden (VTB) criteria, DECT vital iodine TB criteria, and European Organization for Research and Treatment of Cancer (EORTC) PET criteria. DECT vital iodine TB criteria used the same percentage changes as RECIST 1.1 response categories. Progression-free survival was compared between responders and nonresponders for each response criterion by use of Cox proportional hazard ratios and Harrell C-indexes (i.e., concordance indexes). RESULTS. The phantom experiment identified a threshold of 0.5 mg/mL to differentiate vital from nonvital tissue. With use of the DECT vital iodine TB, median progression-free survival was significantly different between responders and nonresponders (623 vs 104 days; p < .001).. For nonresponders versus responders, the hazard ratio for disease progression for DECT vital iodine TB was 6.9 versus 7.6 for EORTC PET criteria, 3.3 for VTB criteria, 2.3 for RECIST 1.1, and 2.1 for mChoi criteria. The C-index was 0.74 for EORTC PET criteria, 0.73 for DECT vital iodine TB criteria, 0.67 for VTB criteria, 0.61 for RECIST 1.1, and 0.58 for mChoi criteria. The C-index was significantly greater for DECT vital iodine TB criteria than for RECIST 1.1 (p = .02) and mChoi criteria (p = .002), but it was not different from that for VTB and EORTC PET criteria (p > .05). CONCLUSION. DECT vital iodine TB criteria showed performance comparable to that of EORTC PET criteria and outperformed RECIST 1.1 and mChoi criteria for response assessment of metastatic GIST treated with TKI therapy. CLINICAL IMPACT. DECT vital iodine TB could help guide early management decisions in patients receiving TKI therapy.
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Tumores do Estroma Gastrointestinal , Iodo , Segunda Neoplasia Primária , Feminino , Fluordesoxiglucose F18 , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Carga TumoralRESUMO
Background Dual-energy (DE) CT allows reconstruction of virtual noncontrast (VNC) images from a single-phase contrast agent-enhanced examination, potentially reducing the need for multiphasic CT to characterize renal lesions. However, data regarding diagnostic performance of VNC images for the characterization of renal lesions are limited. Purpose To determine whether renal mass CT performed by using VNC images allows for reliable identification of renal lesions and differentiation of contrast-enhanced from unenhanced lesions, compared with unenhanced images. Materials and Methods This is a retrospective study of 293 patients (105 women [mean age, 65 years; age range, 18-91 years] and 188 men [mean age, 66 years; age range, 23-90 years] with 379 renal lesions [craniocaudal diameter, 1.0-4.0 cm]) who underwent a single-energy unenhanced CT examination followed by a nephrographic-phase DE CT between June 2013 and October 2017 by using one of four different DE CT platforms from two vendors. VNC images were calculated by using vendor-specific algorithms. Each lesion was classified in a blinded and independent fashion by using the VNC or unenhanced image in combination with the nephrographic images. Attenuation measurements were obtained on the VNC, unenhanced, and nephrographic images. Unenhanced images and pathologic or imaging follow-up for more than 24 months served as reference standard. Results There was strong overall agreement between VNC and unenhanced images for renal lesion characterization (Cramer V = 0.85). VNC images yielded a high diagnostic performance (area under the receiver operating characteristic curve, 0.91; 95% confidence interval: 0.86, 0.95) for facilitation of differentiation of contrast-enhanced from unenhanced renal lesions. However, there was a reduction in diagnostic performance for depicting contrast-enhanced renal lesions by using VNC compared with unenhanced images (area under the receiver operating characteristic curve, 0.91 [95% confidence interval: 0.86, 0.95] vs 0.96 [95% confidence interval: 0.93, 0.99]; P < .001). Mean absolute difference between the VNC and unenhanced attenuation was 9.2 HU ± 8.7. Conclusion Virtual noncontrast images enabled accurate renal lesion characterization, albeit with a reduction in diagnostic performance for contrast-enhanced lesion characterization. © RSNA, 2019 Online supplemental material is available for this article.
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Neoplasias Renais/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematúria/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , Adulto JovemRESUMO
Microvascular endothelial cells (ECs) display a high degree of phenotypic and functional heterogeneity among different organs. Organ-specific ECs control their tissue microenvironment by angiocrine factors in health and disease. Liver sinusoidal endothelial cells (LSECs) are uniquely differentiated to fulfill important organ-specific functions in development, under homeostatic conditions, and in regeneration and liver pathology. Recently, Bmp2 has been identified by us as an organ-specific angiokine derived from LSECs. To study angiocrine Bmp2 signaling in the liver, we conditionally deleted Bmp2 in LSECs using EC subtype-specific Stab2-Cre mice. Genetic inactivation of hepatic angiocrine Bmp2 signaling in Stab2-Cre;Bmp2fl/fl (Bmp2LSECKO) mice caused massive iron overload in the liver and increased serum iron levels and iron deposition in several organs similar to classic hereditary hemochromatosis. Iron overload was mediated by decreased hepatic expression of hepcidin, a key regulator of iron homeostasis. Thus, angiocrine Bmp2 signaling within the hepatic vascular niche represents a constitutive pathway indispensable for iron homeostasis in vivo that is nonredundant with Bmp6. Notably, we demonstrate that organ-specific angiocrine signaling is essential not only for the homeostasis of the respective organ but also for the homeostasis of the whole organism.
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Proteína Morfogenética Óssea 2/genética , Células Endoteliais/metabolismo , Hemocromatose/genética , Hepcidinas/genética , Homeostase/genética , Ferro/metabolismo , Fígado/metabolismo , Animais , Proteína Morfogenética Óssea 2/deficiência , Proteína Morfogenética Óssea 6/genética , Proteína Morfogenética Óssea 6/metabolismo , Capilares/metabolismo , Capilares/patologia , Moléculas de Adesão Celular Neuronais/genética , Moléculas de Adesão Celular Neuronais/metabolismo , Células Endoteliais/patologia , Feminino , Regulação da Expressão Gênica , Hemocromatose/metabolismo , Hemocromatose/patologia , Hepatócitos/metabolismo , Hepatócitos/patologia , Hepcidinas/metabolismo , Integrases/genética , Integrases/metabolismo , Fígado/irrigação sanguínea , Fígado/patologia , Masculino , Camundongos , Camundongos Transgênicos , Comunicação Parácrina , Transdução de Sinais , Transcrição GênicaRESUMO
Lung cancer screening with low-dose CT can save lives. This European Union (EU) position statement presents the available evidence and the major issues that need to be addressed to ensure the successful implementation of low-dose CT lung cancer screening in Europe. This statement identified specific actions required by the European lung cancer screening community to adopt before the implementation of low-dose CT lung cancer screening. This position statement recommends the following actions: a risk stratification approach should be used for future lung cancer low-dose CT programmes; that individuals who enter screening programmes should be provided with information on the benefits and harms of screening, and smoking cessation should be offered to all current smokers; that management of detected solid nodules should use semi-automatically measured volume and volume-doubling time; that national quality assurance boards should be set up to oversee technical standards; that a lung nodule management pathway should be established and incorporated into clinical practice with a tailored screening approach; that non-calcified baseline lung nodules greater than 300 mm3, and new lung nodules greater than 200 mm3, should be managed in multidisciplinary teams according to this EU position statement recommendations to ensure that patients receive the most appropriate treatment; and planning for implementation of low-dose CT screening should start throughout Europe as soon as possible. European countries need to set a timeline for implementing lung cancer screening.
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Detecção Precoce de Câncer/normas , Neoplasias Pulmonares/diagnóstico , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Tomografia Computadorizada por Raios X/métodos , Europa (Continente) , Feminino , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , MasculinoRESUMO
Purpose To prospectively evaluate the accuracy of left ventricle (LV) analysis with a two-dimensional real-time cine true fast imaging with steady-state precession (trueFISP) magnetic resonance (MR) imaging sequence featuring sparse data sampling with iterative reconstruction (SSIR) performed with and without breath-hold (BH) commands at 3.0 T. Materials and Methods Ten control subjects (mean age, 35 years; range, 25-56 years) and 60 patients scheduled to undergo a routine cardiac examination that included LV analysis (mean age, 58 years; range, 20-86 years) underwent a fully sampled segmented multiple BH cine sequence (standard of reference) and a prototype undersampled SSIR sequence performed during a single BH and during free breathing (non-BH imaging). Quantitative analysis of LV function and mass was performed. Linear regression, Bland-Altman analysis, and paired t testing were performed. Results Similar to the results in control subjects, analysis of the 60 patients showed excellent correlation with the standard of reference for single-BH SSIR (r = 0.93-0.99) and non-BH SSIR (r = 0.92-0.98) for LV ejection fraction (EF), volume, and mass (P < .0001 for all). Irrespective of breath holding, LV end-diastolic mass was overestimated with SSIR (standard of reference: 163.9 g ± 58.9, single-BH SSIR: 178.5 g ± 62.0 [P < .0001], non-BH SSIR: 175.3 g ± 63.7 [P < .0001]); the other parameters were not significantly different (EF: 49.3% ± 11.9 with standard of reference, 48.8% ± 11.8 with single-BH SSIR, 48.8% ± 11 with non-BH SSIR; P = .03 and P = .12, respectively). Bland-Altman analysis showed similar measurement errors for single-BH SSIR and non-BH SSIR when compared with standard of reference measurements for EF, volume, and mass. Conclusion Assessment of LV function with SSIR at 3.0 T is noninferior to the standard of reference irrespective of BH commands. LV mass, however, is overestimated with SSIR. © RSNA, 2016 Online supplemental material is available for this article.
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Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Suspensão da Respiração , Técnicas de Imagem de Sincronização Cardíaca , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
OBJECTIVES: To investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA). METHODS: We retrospectively included 73 patients (age 64 ± 14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients' chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA. RESULTS: There was no significant difference in BMI (26.0 ± 4.6 vs. 28.0 ± 6.7 kg/m2), PC (103 ± 7 vs. 104 ± 10 cm2) and TSA (92 ± 15 vs. 91 ± 19 cm2) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p < 0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7 ± 4.1 vs. 20.7 ± 10.7 mSv; p < 0.001). CONCLUSIONS: 100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction. KEY POINTS: ⢠100 kV protocols result in a significantly lower radiation dose. ⢠Mean vascular attenuation is significantly higher using 100 kV. ⢠SNR and CNR are not significantly different between 100 kV and 120 kV. ⢠100 kV CTA is feasible regardless of patient size while maintaining image quality.
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Angiografia por Tomografia Computadorizada/normas , Sobrepeso/diagnóstico por imagem , Aorta/diagnóstico por imagem , Índice de Massa Corporal , Tamanho Corporal , Angiografia por Tomografia Computadorizada/métodos , Vasos Coronários/diagnóstico por imagem , Eletrocardiografia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar , Doses de Radiação , Estudos Retrospectivos , Razão Sinal-RuídoRESUMO
OBJECTIVES: To evaluate detectability and quantification of coronary calcifications for CT with a tin filter for spectral shaping. METHODS: Phantom inserts with 100 small and 9 large calcifications, and a moving artificial artery with 3 calcifications (speed 0-30 mm/s) were placed in a thorax phantom simulating different patient sizes. The phantom was scanned in high-pitch spiral mode at 100 kVp with tin filter (Sn100 kVp), and at a reference of 120 kVp, with electrocardiographic (ECG) gating. Detectability and quantification of calcifications were analyzed for standard (130 HU) and adapted thresholds. RESULTS: Sn100 kVp yielded lower detectability of calcifications (9 % versus 12 %, p = 0.027) and lower Agatston scores (p < 0.008), irrespective of calcification, patient size and speed. Volume scores of the moving calcifications for Sn100 kVp at speed 10-30 mm/s were lower (p < 0.001), while mass scores were similar (p = 0.131). For Sn100 kVp with adapted threshold of 117 HU, detectability (p = 1.000) and Agatston score (p > 0.206) were similar to 120 kVp. Spectral shaping resulted in median dose reduction of 62.3 % (range 59.0-73.4 %). CONCLUSIONS: Coronary calcium scanning with spectral shaping yields lower detectability of calcifications and lower Agatston scores compared to 120 kVp scanning, for which a HU threshold correction should be developed. KEY POINTS: ⢠Sn100kVp yields lower detectability and lower Agatston scores compared to 120kVp ⢠Adapted HU threshold for Sn100kVp provides Agatston scores comparable to 120kVp ⢠Sn100 kVp considerably reduces dose in calcium scoring versus 120 kVp.
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Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Eletrocardiografia , Estudos de Viabilidade , Humanos , Imagens de Fantasmas , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVES: To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. METHODS: Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions. RESULTS: Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p < 0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p < 0.001). CONCLUSIONS: Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians. KEY POINTS: ⢠Structured MRI reports of the shoulder improve readability. ⢠Structured reporting facilitates information extraction. ⢠Referring physicians prefer structured reports to narrative free text reports. ⢠Structured MRI reports of the shoulder can reduce radiologist re-consultations.
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Relatório de Pesquisa/normas , Ombro/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Radiologia/normas , Encaminhamento e Consulta , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Iatrogenic aorto-coronary dissections following percutaneous coronary interventions (PCI) represent a rare but potentially life threatening complication. This restrospective and observational study aims to describe our in-house experience for timely diagnostics and therapy including cardiovascular imaging to follow-up securely high-risk patients with Dunning dissections. METHODS: Dunning dissections (DD) occurred during clinical routine PCIs, which were indicated according to current ESC guidelines. Diagnostic assessment, treatment and follow-up were based on coronary angiography with PCI or conservative treatment and cardiac computed tomography (cCTA) imaging. RESULTS: A total of eight patients with iatrogenic DD were included. Median age was 69 years (IQR 65.8-74.5). Patients revealed a coronary multi-vessel-disease in 75% with a median SYNTAX-II-score of 35.3 (IQR 30.2-41.2). The most common type of DD was type III (50%), followed by type I (38%) and type II (13%). In most patients (88%) the DD involved the right coronary arterial ostium. 63% were treated by PCI, the remaining patients were treated conservatively. 88% of patients received at least one cCTA within 2 days, 50% were additionally followed-up by cCTA within a median of 6 months (range: 4-8 months) without any residual. CONCLUSION: Independently of the type of DD (I-III) it was demonstrated that cCTA represents a valuable imaging modality for detection and follow-up of patients with DDs.
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Aneurisma Aórtico/etiologia , Dissecção Aórtica/etiologia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/efeitos adversos , Idoso , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Angiografia Coronária , Feminino , Seguimentos , Humanos , Doença Iatrogênica , Masculino , Estudos RetrospectivosRESUMO
Dynamic CT angiography provides haemodynamic assessment combined with detailed information on complex cardiac anatomy in patients with congenital malformations such as multistage correction of Fallot's Pentalogy.
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Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Tomografia Computadorizada Quadridimensional/métodos , Artéria Pulmonar/fisiopatologia , Circulação Pulmonar/fisiologia , Estenose de Artéria Pulmonar/diagnóstico , Tetralogia de Fallot/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/métodos , Circulação Colateral/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/etiologia , Estenose de Artéria Pulmonar/fisiopatologiaRESUMO
PURPOSE: Conventional radiography is frequently performed in pediatric patients in whom fractures and dislocations are suspected. However, until now, the rate of positive findings of the most commonly performed radiographic examinations in pediatric patients is unknown. The aim of this study was to evaluate the number of positive findings in the 20 most frequently requested standard radiographic examinations in pediatric patients in a level 1 trauma center systematically. METHODS: A transversal cohort study was conducted at a level 1 trauma center in Germany (2008-2014). In a statistical pre hoc analysis, a sample size of 200 images of each standard radiograph was determined. The picture archiving and communication system (PACS) was searched for radiographic examinations in patients under 18 years. RESULTS: The following fracture rates for the investigated 20 most common examinations were found: 70.5% clavicle, 54.5% forearm, 53% wrist, 41.5% elbow, 30.5% lower leg, 20% hand, 18.5% finger, 12.5% toe, 12% forefoot, 11.5% ankle, 9% shoulder, 6.5% patella, 5.5% foot, 4% knee, 2% conventional rib series, 1.5% lumbar spine, 1% Towne view, 0.5% skull, 0% cervical spine, and 0% odontoid. Differences in the mean age of analyzed pediatric trauma patients in correlation to different standard radiographs were found. CONCLUSIONS: In our study, a relevant amount of different standard radiographs revealed a low fracture rate. Therefore, indications for X-ray should be checked properly and alternative procedures should be discussed with the patient and the parents. Clinical decision rules should be developed and pathways have to be implemented to minimize radiation exposure, waiting time, and costs.
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Fraturas Ósseas/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/epidemiologia , Alemanha/epidemiologia , Humanos , Lactente , Masculino , Centros de TraumatologiaRESUMO
BACKGROUND: Capsular contracture remains the most frequent long-term complication after augmentation mammoplasty with silicone implants. Thereby, the main part of the fibrotic capsule is collagen. The collagenase of the bacterium Clostridium histolyticum is approved for the treatment of fibrotic diseases and has been demonstrated to be effective for capsular fibrosis treatment in the short term. However, long-term effectiveness is currently unknown but mandatory for clinical utilization. MATERIALS AND METHODS: Forty-eight rats received miniature silicone implants and an injection with either collagenase (treatment group) or plain solvent solution (control group) 120 days post insertion. Ten and 60 days after the injections, the rats underwent 7-Tesla magnetic resonance imaging (MRI) and high-resolution ultrasound (HR-US). Capsule tissue was harvested, and capsule thickness and collagen density were evaluated through histology. Furthermore, the expression levels of inflammatory (CD68, IL4, IL10, IL12, IL13), pro-, and anti-fibrotic (TGFb1, TGFb3, Smad3, Col1-4) genes were analyzed using qRT-PCR. RESULTS: On days 10 and 60 after injection of collagenase, histology showed that capsule thickness was significantly reduced in the treatment group when compared with the control (p < 0.05). Thickness measurements were verified by MRI and HR-US analysis. Skin perforation occurred in two cases after collagenase injection. The initial up-regulation of pro-fibrotic and inflammatory genes 10 days after collagenase injection did not persist in the long term. Contrarily, on day 60, a slight trend towards lower expression levels with a significant down-regulation of TGFb3 was detected in the treatment group. CONCLUSION: The collagenase of the bacterium C. histolyticum effectively degrades capsular fibrosis around silicone implants with stable outcomes throughout 60 days post injection. Skin perforation and adequate and uniform drug distribution within the implant pocket are issues that need to be addressed. Further studies are warranted to clarify whether collagenase injections have the potential to become a viable treatment option for capsular contracture. NO LEVEL ASSIGNED: This journal requires that authors 46 assign a level of evidence to each article. For a full 47 description of these Evidence-Based Medicine ratings, 48 please refer to the Table of Contents or the online 49 Instructions to Authors. www.springer.com/00266 .
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Implantes de Mama/efeitos adversos , Clostridium histolyticum , Contratura Capsular em Implantes/terapia , Colagenase Microbiana/administração & dosagem , Géis de Silicone/efeitos adversos , Animais , Biópsia por Agulha , Implante Mamário/efeitos adversos , Implante Mamário/métodos , Modelos Animais de Doenças , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Fibrose/terapia , Humanos , Imuno-Histoquímica , Contratura Capsular em Implantes/diagnóstico por imagem , Contratura Capsular em Implantes/patologia , Injeções Intralesionais , Imageamento por Ressonância Magnética/métodos , Gravidez , Distribuição Aleatória , Ratos , Ratos Endogâmicos Lew , Reação em Cadeia da Polimerase em Tempo Real/métodos , Valores de Referência , Resultado do Tratamento , Ultrassonografia Doppler/métodosRESUMO
OBJECTIVES AND BACKGROUND: Atrial fibrillation (AF) is associated with clinical deterioration, stroke and disability in patients with hypertrophic cardiomyopathy (HCM). Therefore, the objective of this study was to evaluated cardiac magnetic resonance (CMR)-derived determinants for the occurrence of AF in patients with HCM. METHODS: 98 Patients with HCM and 30 healthy controls underwent CMR and were followed-up for 6 ± 3 years. RESULTS: 19 (19.4%) patients presented with AF at initial diagnosis, 19 (19.4%) developed AF during follow-up and 60 (61.2%) remained in sinus rhythm (SR). Compared to healthy controls, patients with HCM who remained in SR presented with significantly increased left ventricular mass, an elevated left ventricular remodeling index, enlarged left atrial volumes and reduced septal mitral annular plane systolic excursion (MAPSE) compared to healthy controls. Whereas HCM patients who presented with AF at initial diagnosis and those who developed AF during follow-up additionally presented with reduced tricuspid annular plane systolic excursion (TAPSE) and right atrial (RA) dilatation. Receiver-operator curve analysis indicated good predictive performance of TAPSE, RA diameter and septal MAPSE (AUC 0.73, 0.69 and 0.71, respectively) to detect patients at risk of developing AF. CONCLUSION: Reduced MAPSE measurements and enlarged LA volumes seems to be a common feature in patients with HCM, whereas reduced TAPSE and RA dilatation only seem to be altered in patients with history of AF and those developing AF. Therefore, they could serve as easy determinable markers of AF in patients with HCM.
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Fibrilação Atrial/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética , Adulto , Idoso , Fibrilação Atrial/fisiopatologia , Cardiomiopatia Hipertrófica/fisiopatologia , Meios de Contraste/química , Feminino , Gadolínio/química , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
BACKGROUND: A standardized imaging proposal evaluating implanted left atrial appendage (LAA) occlusion devices by cardiac computed tomography angiography (cCTA) has never been investigated. METHODS: cCTA datasets were acquired on a 3(rd) generation dual-source CT system and reconstructed with a slice thickness of 0.5 mm. An interdisciplinary evaluation was performed by two interventional cardiologists and one radiologist on a 3D multi-planar workstation. A standardized multi-planar reconstruction algorithm was developed in order to assess relevant clinical aspects of implanted LAA occlusion devices being outlined within a pictorial essay. RESULTS: The following clinical aspects of implanted LAA occlusion devices were evaluated within the most appropriate cCTA multi-planar reconstruction: (1) topography to neighboring structures, (2) peri-device leaks, (3) coverage of LAA lobes, (4) indirect signs of neo-endothelialization. These are illustrated within concise CT imaging examples emphasizing the potential value of the proposed cCTA imaging algorithm: Starting from anatomical cCTA planes and stepwise angulation planes perpendicular to the base of the LAA devices generates an optimal LAA Occluder View for post-implantation Evaluation (LOVE). Aligned true axial, sagittal and coronal LOVE planes offer a standardized and detailed evaluation of LAA occlusion devices after percutaneous implantation. CONCLUSIONS: This pictorial essay presents a standardized imaging proposal by cCTA using multi-planar reconstructions that enables systematical follow-up and comparison of patients after LAA occlusion device implantation.
Assuntos
Apêndice Atrial/diagnóstico por imagem , Átrios do Coração/cirurgia , Interpretação de Imagem Assistida por Computador/normas , Algoritmos , Apêndice Atrial/cirurgia , Átrios do Coração/diagnóstico por imagem , Humanos , Dispositivo para Oclusão Septal , Tomografia Computadorizada por Raios X/normasRESUMO
BACKGROUND: Near-infrared indocyanine green video angiography (ICG-NIR-VA) has been introduced for free-flap surgery and may provide intraoperative flap designing as well as postoperative monitoring. Nevertheless, the technique has not been established in clinical routine because of controversy over benefits. Improved technical features of the novel Visionsense ICG-NIR-VA surgery system are promising to revisit the field of application. It features a unique real-time fusion image of simultaneous NIR and white light visualization, with highlighted perfusion, including a color-coded perfusion flow scale for optimized anatomical understanding. METHODS: In a feasibility study, the Visionsense ICG-NIR-VA system was applied during 10 free-flap surgeries in 8 patients at our center. Indications included anterior lateral thigh (ALT) flap (n = 4), latissimus dorsi muscle flap (n = 1), tensor fascia latae flap (n = 1), and two bilateral deep inferior epigastric artery perforator flaps (n = 4). The system was used intraoperatively and postoperatively to investigate its impact on surgical decision making and to observe perfusion patterns correlated to clinical monitoring. RESULTS: Visionsense ICG-NIR-VA aided assessing free-flap design and perfusion patterns in all cases and correlated with clinical observations. Additional interventions were performed in 2 cases (22%). One venous anastomosis was revised, and 1 flap was redesigned. Indicated by ICG-NIR-VA, 1 ALT flap developed partial flap necrosis (11%). CONCLUSIONS: The Visionsense ICG-NIR-VA system allowed a virtual view of flap perfusion anatomy by fusion imaging in real-time. The system improved decision making for flap design and surgical decisions. Clinical and ICG-NIR-VA parameters correlated. Its future implementation may aid in improving outcomes for free-flap surgery, but additional experience is needed to define its final role.
Assuntos
Angiofluoresceinografia , Retalhos de Tecido Biológico/irrigação sanguínea , Verde de Indocianina , Imagem Óptica/métodos , Imagem de Perfusão/métodos , Procedimentos de Cirurgia Plástica/métodos , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Miocutâneo/irrigação sanguínea , Retalho Miocutâneo/transplante , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos de AmostragemRESUMO
OBJECTIVES: To prospectively evaluate radiation dose and image quality of a third generation dual-source CT (DSCT) without z-axis filter behind the patient for temporal bone CT. METHODS: Forty-five patients were either examined on a first, second, or third generation DSCT in an ultra-high-resolution (UHR) temporal bone-imaging mode. On the third generation DSCT system, the tighter focal spot of 0.2 mm(2) removes the necessity for an additional z-axis-filter, leading to an improved z-axis radiation dose efficiency. Images of 0.4 mm were reconstructed using standard filtered-back-projection or iterative reconstruction (IR) technique for previous generations of DSCT and a novel IR algorithm for the third generation DSCT. Radiation dose and image quality were compared between the three DSCT systems. RESULTS: The statistically significantly highest subjective and objective image quality was evaluated for the third generation DSCT when compared to the first or second generation DSCT systems (all p < 0.05). Total effective dose was 63%/39% lower for the third generation examination as compared to the first and second generation DSCT. CONCLUSIONS: Temporal bone imaging without z-axis-UHR-filter and a novel third generation IR algorithm allows for significantly higher image quality while lowering effective dose when compared to the first two generations of DSCTs. KEY POINTS: ⢠Omitting the z-axis-filter allows a reduction in radiation dose of 50% ⢠A smaller focal spot of 0.2 mm (2) significantly improves spatial resolution ⢠Ultra-high-resolution temporal-bone-CT helps to gain diagnostic information of the middle/inner ear.
Assuntos
Algoritmos , Diagnóstico por Imagem/métodos , Tomografia Computadorizada Multidetectores/métodos , Osso Temporal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Reprodutibilidade dos TestesRESUMO
The aim of the study is to describe the spectrum of indications for pediatric ECG-synchronized CT angiography (CTA), the main determinants of radiation exposure, and trends in radiation dose over time at a single, tertiary referral center. The study was IRB approved and HIPAA compliant with informed consent waived. Between 2005 and 2013, 324 pediatric patients underwent ECG-synchronized CTA to evaluate known or suspected cardiovascular abnormalities (109 female, median age 8.1 years). The effective dose (ED) was calculated using age-specific correction factors. Univariate and multivariate regression analyses were performed to identify predictors of radiation dose. The most common primary indications for the CTA examinations included known or suspected coronary pathologies (n = 166), complex congenital heart disease (n = 73), and aortic pathologies (n = 41). Median radiation exposure decreased from 12 mSv for patients examined in the years 2005-2007 to 1.2 mSv for patients examined in the years 2011-2013 (p < 0.001). Patients scanned using a tube potential of 80 kV (n = 259) had a significantly lower median radiation dose (1.4 mSv) compared to patients who were scanned at 100 kV (n = 46, median 6.3 mSv) or 120 kV (n = 19, median 19 mSv, p < 0.001). Tube voltage, followed by tube current and the method of ECG-synchronization were the strongest independent predictors of radiation dose. Growing experience with dose-saving techniques and CTA protocols tailored to the pediatric population have led to a tenfold reduction in radiation dose over recent years and now allow routinely performing ECG-synchronized CTA in children with a radiation dose on the order of 1 mSv.
Assuntos
Envelhecimento , Angiografia/efeitos adversos , Eletrocardiografia/efeitos adversos , Cardiopatias Congênitas/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Angiografia/métodos , Técnicas de Imagem de Sincronização Cardíaca/efeitos adversos , Técnicas de Imagem de Sincronização Cardíaca/métodos , Criança , Pré-Escolar , Meios de Contraste/administração & dosagem , Eletrocardiografia/métodos , Feminino , Cardiopatias Congênitas/diagnóstico , Humanos , Lactente , Recém-Nascido , Masculino , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
OBJECTIVE: We investigated the association of cerebral and coronary artery atherosclerosis with the presence, burden and type of atherosclerotic plaques of the aorta (AP) in patients with ischemic stroke of undetermined etiology. METHODS: 48 consecutive patients (32 males, mean age 68 ± 11 years) with acute ischemic stroke of unknown etiology after thorough stroke workup were investigated using ECG-gated CT-Angiography (CTA) for the detection of embolic AP. Intima media thickness (IMT), presence of carotid plaques and stenosis ≥ 50% and intracranial stenosis were assessed as parameters of cerebral atherosclerosis, the Agatston score (AS) and coronary artery stenosis ≥ 50% (CAS) in CTA as parameters of coronary atherosclerosis. Plaque burden was classified as mild or severe and plaque types were classified according to their morphology in calcified, non-calcified or mixed. RESULTS: APs were found in 36 patients (75%). AP presence was associated with higher IMT values (p = 0.029), intracranial stenosis (p = 0.047), CAS (p = 0.033) and AS (p = 0.026). Twenty-three of 31 (74.2%) patients with both carotid atherosclerosis and AP revealed plaque calcification (p = 0.041). Ten of 14 (71.4%) patients with AP and intracranial stenosis had calcified plaques (p = 0.030). AP in more than one aortic segment was found in patients with bilateral carotid stenosis ≥ 50% (p = 0.038), intracranial stenosis (p = 0.042), high IMT (p = 0.040) and higher AS (p = 0.019). CONCLUSIONS: Aortic atherosclerotic plaques are common in patients with ischemic stroke of undetermined etiology and in particular those with carotid, intracranial and coronary atherosclerosis or high IMT values. In these patients, CTA of aorta should be seriously considered.
Assuntos
Doenças da Aorta/diagnóstico , Isquemia Encefálica/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Arteriosclerose Intracraniana/diagnóstico , Placa Aterosclerótica/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Calcificação Vascular/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Arteriosclerose Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Radiografia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagemRESUMO
Trauma centers, trauma management concepts, as well as integration of whole-body computed tomography (CT) reduced mortality significantly. The accuracy of a trauma care algorithm with emergency CT in children was evaluated. Data of 71 children with emergency CT were recorded retrospectively. In addition to epidemiological data admission date, kind of CT scan, mechanism of injury, missed diagnoses, injury severity score (ISS), admission to and time on intensive care unit (ICU), and time of hospitalization were observed. The algorithm for CT scanning was based on mechanism of injury, pattern of injury, and altered vital signs. Sixty-nine percent of the children reached the ER during on-call service hours. A percentage of 32.4 received a whole-body scan and 67.6 % a cranial scan. The mean ER ISS was 9.9 points (1-57). Children have different trauma mechanisms compared to adults. A percentage of 33.8 of the children had relevant trauma related findings in the CT scan. In 2 children, (2.8 %) 3 diagnoses (2.2 %) were initially missed. After reevaluation of the CT data, all diagnoses were identified. Thus, the accuracy of our algorithm in children was 100 %. In children, our algorithm detected all injuries, but only one third of the children had relevant trauma related findings in the CT scan. In order to reduce radiation exposure but preserve the advantages of CT, a new algorithm was developed with more flexibility taking the child's age and mental status more into account as well as clinical findings. The mechanism of injury itself is not anymore an indication for CT scanning.