RESUMO
The Coronavirus Disease of 2019 (COVID-19) pandemic has caused significant delays in the delivery of cancer treatments in Canada. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging, and can affect multiple organ systems. The purpose of this review is to offer a unified resource for general radiologists regarding the imaging appearances of chemotherapy-induced toxicities.
Assuntos
Antineoplásicos , COVID-19 , Humanos , Diagnóstico por Imagem , CanadáRESUMO
BACKGROUND: Computed tomography (CT) is routinely used to determine the suitability of potential living donor liver transplants, providing important information about liver size, vascular anatomy, and the presence of other diseases that would preclude it from safe donation. CT is not routinely used, however, when evaluating eligible deceased organ donors after brain death, a group which comprises most orthotopic liver transplants. After the installation of a CT scanner at a local procurement facility, CTs have been performed on potential deceased organ donors and used, in conjunction with other evaluative protocols, to help direct donation decisions and assist in procurement procedures. STUDY DESIGN: A retrospective analysis of data from 373 cases spanning 5 years was systematically collected and analyzed, including information pertaining to patient's medical histories, biopsy results, operative findings, and CT results. RESULTS: CT findings directly impacted the directive decision-making process in 29% of cases in this patient cohort, likely an underestimate, and reliably evaluated important factors including variant vascular anatomy and the presence and severity of hepatic steatosis and cirrhosis. CONCLUSION: Overall, this study suggests that CT has the potential to play a significant role in procurement procedures and the directive decision-making process, thereby improving the efficiency and accuracy by which potential deceased organ donors are evaluated.
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Transplante de Fígado , Obtenção de Tecidos e Órgãos , Humanos , Fígado/diagnóstico por imagem , Doadores Vivos , Estudos Retrospectivos , Doadores de Tecidos , Tomografia Computadorizada por Raios XRESUMO
A pulmonary arteriovenous malformation (PAVM) is a fistulous connection between a pulmonary artery and a pulmonary vein that bypasses the normal pulmonary capillary bed resulting in a right-to-left shunt. Because of the potential for paradoxical emboli, PAVMs are treated when their feeding arteries exceed 3 mm or patients are symptomatic. PAVMs are often encountered in patients with suspected hereditary hemorrhagic telangiectasia (HHT). Sporadic cases are uncommon. The radiologist may be called on to diagnose a PAVM after positive transthoracic contrast-enhanced echocardiography in a patient with suspected HHT to direct patient management and avoid potential complications. The radiologist may also be required to evaluate a potential PAVM detected at CT performed for other reasons. Through the authors' experiences at an HHT Center of Excellence in an area endemic with histoplasmosis, the authors have gained a unique perspective on the diagnosis of PAVMs and differentiation of PAVMs from their mimics. Understanding the CT appearance of PAVMs limits misdiagnosis, directs appropriate treatment, and allows subsequent family screening for HHT (and avoidance of unnecessary screening when a PAVM mimic is encountered). Both vascular and nonvascular pulmonary lesions can mimic PAVMs. Vascular mimics include fibrosing mediastinitis, venovenous collaterals, arterial collaterals, pulmonary artery pseudoaneurysms, hepatopulmonary vessels, Sheehan vessels, meandering pulmonary veins, and pulmonary vein varices. Nonvascular mimics include granulomas, nodules, mucoceles, bronchoceles, ground-glass opacities, and atelectasis. The authors review the CT technique for evaluating PAVMs and the appearance of PAVMs and their mimics. ©RSNA, 2022.
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Malformações Arteriovenosas , Embolização Terapêutica , Veias Pulmonares , Telangiectasia Hemorrágica Hereditária , Malformações Arteriovenosas/diagnóstico por imagem , Humanos , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/terapia , Tomografia Computadorizada por Raios XRESUMO
A pulmonary cyst usually refers to an air-filled space with a smooth, thin wall. Fluid-filled cystic lesions of the lungs include a range of etiologies such as true cysts, congenital malformations, infections, and benign and malignant neoplasms. With relatively little solid component, these lesions often have similar imaging appearances to one another. This article focuses on key imaging features and clinical characteristics that can be used to narrow the differential diagnosis.
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Cistos , Cistos/diagnóstico por imagem , Diagnóstico Diferencial , Diagnóstico por Imagem , Humanos , Pulmão/diagnóstico por imagemRESUMO
ABSTRACT: A 71-year-old man with coronary artery disease, sarcoid uveitis, and recurrent ventricular tachycardia treated with implantable cardioverter-defibrillator presented with increasing dyspnea for several months. Echocardiography showed a large echogenic mass causing severe narrowing of the proximal main pulmonary artery and a resultant gradient of 65 mm Hg. Ventilation-perfusion scintigraphy showed diffusely decreased perfusion of the left lung and an additional mismatched segmental perfusion defect in the left upper lobe. Cardiac MRI could not be performed because of the implantable cardioverter-defibrillator.
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Artéria Pulmonar/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Sarcoma/diagnóstico por imagem , Neoplasias Vasculares/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Imagem de PerfusãoRESUMO
Central venous catheters (CVCs) are commonly used in patients in a variety of clinical settings, including the intensive care unit, general ward, and outpatient settings. After placement, the radiologist is frequently requested to evaluate the location of CVCs and deem them suitable for use. An understanding of the ideal location of catheter tips as well as the approach to identifying malpositioned catheter tips is essential to prevent improper use, recognize and/or prevent further injury, and direct potential lifesaving care. An approach to CVC placement based on tip location can be helpful in localization and guiding management.
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Cateteres Venosos Centrais , Veias Jugulares/diagnóstico por imagem , Erros Médicos , Radiografia Torácica/métodos , Veia Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , HumanosRESUMO
An earlier incorrect version appeared online. This article was corrected on December 17, 2018.
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Glândulas Suprarrenais/diagnóstico por imagem , Fígado/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Neoplasias/diagnóstico por imagem , Sistema Respiratório/diagnóstico por imagem , Feminino , Humanos , Masculino , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Simultaneous acquisition positron emission tomography-magnetic resonance imaging (PET-MRI) has the ability to combine anatomic information derived from cardiac MRI with quantitative capabilities of cardiac PET and MRI and the promise of molecular imaging by specific PET tracers. This combination of cardiac PET and MRI delivers a robust and comprehensive clinical examination. It has the potential to assess various cardiovascular conditions, including assessment of myocardial ischemia, infarction, and function, as well as specific characterization of inflammatory and infiltrative heart diseases such as cardiac sarcoid and amyloid. It also offers fascinating possibilities in imaging other cardiovascular-related disease states, such as tumor imaging and vascular imaging. In this review, we begin with a general overview of the potentials of PET-MRI in cardiovascular imaging, followed by a discussion of the technical challenges unique to cardiovascular PET-MRI. We then discuss PET-MRI in various cardiovascular disease imaging applications. Potential limitations of PET-MRI and future directions are also considered.
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Doenças Cardiovasculares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons/métodos , Coração/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/tendências , Imagem Multimodal/tendências , Tomografia por Emissão de Pósitrons/tendênciasRESUMO
Coronary arterial abnormalities are uncommon findings in children that have profound clinical implications. Although anomalies of the coronary origins are well described, there are many other disease processes that affect the coronary arteries. Immune system-mediated diseases (eg, Kawasaki disease, polyarteritis nodosa, and other vasculiditides) can result in coronary arterial aneurysms, strictures, and abnormal tapering of the vessels. Because findings at imaging are an important component of diagnosis in these diseases, the radiologist's understanding of them is essential. Congenital anomalies may present at varying ages, and findings in hemodynamically significant anomalies, such as fistulas, are key for both diagnosis and preoperative planning. Pediatric heart surgery can result in wide-ranging postoperative imaging appearances of the coronary arteries and also predisposes patients to a multitude of complications affecting the heart and coronary arteries. In addition, although rare, accidental trauma can lead to injury of the coronary arteries, and awareness and detection of these conditions are important for diagnosis in the acute setting. Patients with coronary arterial conditions at presentation may range from being asymptomatic to having findings of myocardial infarction. Recognition of the imaging findings is essential to direct appropriate treatment. ©RSNA, 2017.
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Anomalias dos Vasos Coronários/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Lactente , Recém-NascidoRESUMO
BACKGROUND: Blunt cardiac injury (BCI) may manifest as cardiac contusion or, more rarely, as pericardial or myocardial rupture. Computed tomography (CT) is performed in the vast majority of blunt trauma patients, but the imaging features of cardiac contusion are not well described. PURPOSE: To evaluate CT findings and associated injuries in patients with clinically diagnosed BCI. MATERIALS AND METHODS: We identified 42 patients with blunt cardiac injury from our institution's electronic medical record. Clinical parameters, echocardiography results, and laboratory tests were recorded. Two blinded reviewers analyzed chest CTs performed in these patients for myocardial hypoenhancement and associated injuries. RESULTS: CT findings of severe thoracic trauma are commonly present in patients with severe BCI; 82% of patients with ECG, cardiac enzyme, and echocardiographic evidence of BCI had abnormalities of the heart or pericardium on CT; 73% had anterior rib fractures, and 64% had pulmonary contusions. Sternal fractures were only seen in 36% of such patients. However, myocardial hypoenhancement on CT is poorly sensitive for those patients with cardiac contusion: 0% of right ventricular contusions and 22% of left ventricular contusions seen on echocardiography were identified on CT. CONCLUSION: CT signs of severe thoracic trauma are frequently present in patients with severe BCI and should be regarded as indirect evidence of potential BCI. Direct CT findings of myocardial contusion, i.e. myocardial hypoenhancement, are poorly sensitive and should not be used as a screening tool. However, some left ventricular contusions can be seen on CT, and these patients could undergo echocardiography or cardiac MRI to evaluate for wall motion abnormalities.
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Ecocardiografia , Lesão Pulmonar/diagnóstico por imagem , Contusões Miocárdicas/diagnóstico por imagem , Fraturas das Costelas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Escala de Gravidade do Ferimento , Lesão Pulmonar/etiologia , Lesão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Contusões Miocárdicas/etiologia , Contusões Miocárdicas/fisiopatologia , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fraturas das Costelas/complicações , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/fisiopatologia , Adulto JovemRESUMO
The pregnant trauma patient presents an important and challenging encounter for the clinical team and radiologist. In this article, we present several key aspects of the imaging workup of pregnant trauma patients, beginning with a review of the modalities that are used in this setting. Ultrasonography plays an important role in initial evaluation of the fetus but a limited role in evaluation of maternal injuries. Given that conventional radiography and computed tomography are the "workhorse" modalities for evaluation of pregnant trauma patients, radiologists must pay particular attention to radiation dose concerns. Magnetic resonance imaging can be used after the initial evaluation and for follow-up imaging, and safety concerns related to its use in pregnant patients are addressed. At imaging interpretation, radiologists must contend not only with the typical spectrum of injuries that can be seen in any trauma patient but also with pregnancy-specific injuries, such as placental abruption and uterine rupture. Particularly unusual situations, such as a ruptured ectopic pregnancy in a trauma patient, are presented. Although pregnant trauma patients are infrequently encountered, familiarity with imaging findings of injuries in these patients is essential to providing the best care for the mother and fetus.
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Complicações na Gravidez/diagnóstico por imagem , Ferimentos e Lesões/diagnóstico por imagem , Traumatismos Abdominais/diagnóstico por imagem , Anormalidades Induzidas por Radiação/prevenção & controle , Feminino , Monitorização Fetal , Humanos , Histerossalpingografia , Imageamento por Ressonância Magnética , Gravidez , Doses de Radiação , Tomografia Computadorizada por Raios X/efeitos adversos , Ultrassonografia Pré-NatalRESUMO
Erdheim-Chester disease is an uncommon non-Langerhans cell histiocytosis with systemic manifestations. Most cases discuss radiologic findings once a pathologic diagnosis has already been established. We describe a patient with symptoms and no previously known diagnosis who was imaged with computed tomography, magnetic resonance imaging, and positron emission tomography. This case is unusual in that radiologic imaging demonstrated interatrial septum and diffuse cardiac involvement, in addition to the other characteristic lesions of Erdheim-Chester disease. The importance of this case to the radiologist is the expansion of the differential diagnosis of processes involving the interatrial septum and retroperitoneum.