RESUMO
The progressive increase in numbers of noninvasive cardiac imaging examinations broadens the spectrum of knowledge radiologists are expected to acquire in the management of drugs during CT coronary angiography (CTCA) and cardiac MR (CMR) to improve image quality for optimal visualization and assessment of the coronary arteries and adequate MR functional analysis. Aim of this review is to provide an overview on different class of drugs (nitrate, beta-blockers, ivabradine, anxiolytic, adenosine, dobutamine, atropine, dipyridamole and regadenoson) that can be used in CTCA and CMR, illustrating their main indications, contraindications, efficacy, mechanism of action, metabolism, safety, side effects or complications, and providing advices in their use.
Assuntos
Técnicas de Imagem Cardíaca , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Adenosina/administração & dosagem , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/farmacocinética , Ansiolíticos/administração & dosagem , Atropina/administração & dosagem , Bloqueadores dos Canais de Cálcio/administração & dosagem , Bloqueadores dos Canais de Cálcio/efeitos adversos , Contraindicações de Medicamentos , Dipiridamol/administração & dosagem , Dobutamina/administração & dosagem , Humanos , Ivabradina/administração & dosagem , Ivabradina/efeitos adversos , Nitroglicerina/administração & dosagem , Purinas/administração & dosagem , Purinas/efeitos adversos , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Vasodilatadores/administração & dosagemRESUMO
The world of cardiac imaging is proposing to physicians an ever-increasing spectrum of options and tools with the disadvantages of patients presently submitted to multiple, sequential, time-consuming, and costly diagnostic procedures and tests, sometimes with contradicting results. In the last two decades, the CCTA has evolved into a valuable diagnostic test in today's patient care, changing the official existing guidelines and clinical practice with a pivotal role to exclude significant CAD, in the referral of patients to the Cath-Lab, in the follow-up after coronary revascularization, and finally in the cardiovascular risk stratification.
Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Angina Estável/diagnóstico por imagem , Serviço Hospitalar de Emergência , Humanos , Medição de RiscoRESUMO
BACKGROUND: Accurate nodal restaging is becoming clinically more important in patients with locally advanced rectal cancer (LARC) with the emergence of organ-preserving treatment after a good response to neoadjuvant chemoradiotherapy (nCRT). PURPOSE: To evaluate the accuracy of MRI in identifying negative N status (ypN0 patients) in LARC after nCRT. MATERIAL AND METHODS: 191 patients with LARC underwent MRI before and 6-8â¯weeks after nCRT and subsequent total mesorectal excision. Short-axis diameter of mesorectal lymph nodes was evaluated on the high resolution T2-weighted images to compare MRI restaging with histopathology.. RESULTS: 146 and 45 patients had a negative N status (ypN0) and positive N status (ypNâ¯+â¯), respectively. On restaging MRI, the 70â¯% reduction in size of the largest node was associated with an area under the curve (AUC) of 0.818 to predict ypN0 stage, with a sensitivity of 93.3â¯% and a negative predictive value (NPV) of 95.4â¯%. No nodes were observed in 38 pts (37 pts ypN0 and 1 patient ypNâ¯+â¯), with sensitivity and NPV of nodes disappearance for ypN0 stage of 93.3â¯% and 92.5â¯% respectively. A 2.2â¯mm cut-off in short-axis diameter was associated with an AUC of 0.83 for the prediction of ypN0 nodal stage, with sensitivity and NPV of 79,5% and 91.1â¯% respectively. CONCLUSION: A reduction in size of 70â¯% of the largest limph-node on MRI at rectal cancer restaging has high sensitivity and NPV for prediction of ypN0 stage after nCRT. The high NPV of node disappearance and of aâ¯≤â¯2.2â¯mm short-axis diameter is confirmed.