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2.
Cancers (Basel) ; 12(10)2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32977605

RESUMO

PURPOSE: To evaluate the efficacy and safety of transcatheter arterial embolization (TAE) for pseudoaneurysms occurring secondary to pancreatitis or because of leakage of pancreatic juice after pancreatectomy. MATERIALS AND METHODS: This retrospective study included 42 consecutive patients (38 males and 4 females; mean age, 60 years; range, 33-80 years) who underwent TAE for bleeding visceral artery pseudoaneurysms between March 2004 and December 2018. The technical and clinical success rates, incidence of recurrent bleeding, complications, including pancreatitis, and overall survival after TAE were evaluated. RESULTS: Of the 42 enrolled patients, 23 had bleeding due to a complication of pancreatectomy and 19 had bleeding as a complication of pancreatitis. TAE with N-butyl cyanoacrylate (NBCA) or NBCA plus microcoils recurrent bleeding or inability to control bleeding was 15.8% (3 of 19) following TAE with NBCA and 17.4% (4 of 23) following TAE with coils. No clinically significant ischemic events of the pancreas or duodenum were observed in the embolized areas. Serum amylase did not increase compared with the initial levels after any of the procedures. At 30 days after TAE, 32 patients were alive. CONCLUSION: TAE has a high success rate for the management of hemorrhage, with few complications. The procedure appears to be safe and effective for pseudoaneurysms associated with either pancreatitis or pancreatectomy.

3.
Jpn J Radiol ; 38(11): 1052-1061, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32592003

RESUMO

PURPOSE: To evaluate the performance of a deep learning-based computer-aided diagnosis (CAD) system at detecting pulmonary nodules on CT by comparing radiologists' readings with and without CAD. MATERIALS AND METHODS: A total of 120 chest CT images were randomly selected from patients with suspected lung cancer. The gold standard of nodules ≥ 3 mm was established by a panel of three expert radiologists. Two less experienced radiologists read the images without and afterward with CAD system. Their reading times were recorded. RESULTS: The radiologists' sensitivity increased from 20.9% to 38.0% with the introduction of CAD. The positive predictive value (PPV) decreased from 70.5% to 61.8%, and the F1-score increased from 32.2% to 47.0%. The sensitivity significantly increased from 13.7% to 32.4% for small nodules (3-6 mm) and from 33.3% to 47.6% for medium nodules (6-10 mm). CAD alone showed a sensitivity of 70.3%, a PPV of 57.9%, and an F1-score of 63.5%. Reading time decreased by 11.3% with the use of CAD. CONCLUSION: CAD improved the less experienced radiologists' sensitivity in detecting pulmonary nodules of all sizes, especially including a significant improvement in the detection of clinically important-sized medium nodules (6-10 mm) as well as small nodules (3-6 mm) and reduced their reading time.


Assuntos
Aprendizado Profundo , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico por Computador , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
4.
Cancers (Basel) ; 12(6)2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32503262

RESUMO

The aim of this study was to investigate the impact of radiologic experience on the diagnostic accuracy of computed tomography (CT) vs. magnetic resonance imaging (MRI) reporting on the liver metastases of pancreatic ductal adenocarcinoma (LM of PDAC). Intra-individual CT and MRI examinations of 112 patients with clinically proven LM of PDAC were included. Four radiologists with varying years of experience (A > 20, B > 5, C > 1 and D < 1) assessed liver segments affected by LM of PDAC, as well as associated metastases occurring in each patient. Their sensitivity and specificity in evaluating the segments were compared. Cohen's Kappa (κ) for diagnosed liver segments and Intra-class Correlation Coefficients (ICC) for the number of metastatic lesions in each patient were calculated. The radiologists' sensitivity and specificity for the CT vs. MRI were, respectively: Reader A-94.4%, 90.3% vs. 96.6%, 94.8%; B-86.7%, 79.7% vs. 83.9%, 82.0%; C-78.0%, 76.7% vs. 83.3%, 78.9% and D-71.8%, 79.2% vs. 64.0%, 69.5%. Reviewers A and B achieved greater agreement in assessing results from the MRI (κ = 0.72, p < 0.001; ICC = 0.73, p < 0.001) vs. the CT (κ = 0.58, p < 0.001; ICC = 0.61, p < 0.001), in contrast to readers C and D (MRI: κ = 0.34, p < 0.001; ICC = 0.42, p < 0.001, and CT: κ = 0.48, p < 0.001; ICC = 0.59, p < 0.001). Our results indicate that the accurate diagnosis of LM of PDAC depends more on radiologic experience in MRI over CT scans.

5.
Br J Radiol ; 91(1092): 20180124, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30156870

RESUMO

OBJECTIVE:: To devise a simple new technique wherein absolute ethanol is injected via a sheath under proximal balloon occlusion of the right portal vein using a single-balloon catheter and to examine its feasibility and safety for ipsilateral portal vein embolization (PVE). METHODS:: Between 2010 and 2016, PVE was performed in 19 patients prior to undergoing extended right hepatectomy. PVE was performed via a percutaneous transhepatic ipsilateral approach, the right portal branch was embolized under ultrasound guidance, and a balloon catheter was placed in the proximal site of the main right portal branch. Absolute ethanol was injected through a sheath under proximal balloon occlusion of the right portal vein using a double-lumen catheter. We evaluated its technical success and complications following PVE and changes in liver enzyme levels. Furthermore, we calculated changes in future liver remnant (FLR) and FLR/total functional liver volume (TFLV) ratio and assessed complications following hepatic resection. RESULTS:: PVE was successfully performed in all patients. Mean FLR and FLR/TFLV significantly increased following PVE (p < 0.01). The change in the FLR and FLR/TFLV ratio was 39.6 ± 16.2%. One patient (6.5%) developed procedure-related complications following PVE (perihepatic hematoma). CONCLUSION:: The new technique for ipsilateral right PVE is safe, effective, and convenient. ADVANCES IN KNOWLEDGE:: This is the first study to investigate the efficacy of injecting ethanol via a sheath under proximal balloon occlusion of the right portal vein using a single-balloon catheter.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Hepáticas/cirurgia , Veia Porta , Idoso , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Etanol/administração & dosagem , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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