RESUMO
BACKGROUND: Pain originating from the organs of the upper abdomen, especially in patients suffering from inoperable carcinoma of the pancreas or advanced inflammatory conditions, is difficult to treat in a significant number of patients. STANDARD RADIOLOGICAL PROCEDURES: Computed tomography (CT) guided neurolysis is the most commonly used technique for neurolysis of the celiac plexus. Ethanol is used to destroy the nociceptive fibers passing through the plexus and provides an effective means of diminishing pain arising from the upper abdomen. METHODS: Using either an anterior or posterior approach, a 22 G Chiba needle is advanced to the antecrural space and neurolysis is achieved by injecting a volume of 20-50 ml of ethanol together with a local anesthetic and contrast medium. PERFORMANCE: In up to 80% of patients suffering from tumors of the upper abdomen, CT-guided celiac plexus neurolysis diminishes pain or allows a reduction of analgesic medication; however, in some patients the effect may only be temporary necessitating a second intervention. In inflammatory conditions, celiac neurolysis is often less effective in reducing abdominal pain. PRACTICAL RECOMMENDATIONS: The CT-guided procedure for neurolysis of the celiac plexus is safe and effective in diminishing pain especially in patients suffering from tumors of the upper abdomen. The procedure can be repeated if the effect is only temporary.
Assuntos
Dor Abdominal/tratamento farmacológico , Anestésicos Locais/administração & dosagem , Plexo Celíaco/efeitos dos fármacos , Etanol/administração & dosagem , Bloqueio Nervoso/métodos , Radiografia Intervencionista/métodos , Dor Abdominal/diagnóstico por imagem , Analgésicos/administração & dosagem , Plexo Celíaco/diagnóstico por imagem , Quimioterapia Combinada/métodos , Humanos , Injeções/métodos , Soluções Esclerosantes/administração & dosagem , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: To evaluate the effect of slice thickness on semi-automated liver lesion segmentation. MATERIALS AND METHODS: In this retrospective study, liver MSCT scans from 60 patients were reconstructed at a slice thickness of 1.5 mm, 3 mm and 5 mm. 106 liver lesions (8 - 64 mm, mean size 25 ± 13 mm) were evaluated independently by two radiologists using semi-automated segmentation software (OncoTreat®). Lesions were classified as cystic, hypodense and hyperdense according to their contrast-to-noise ratio (CNR). The long axis diameter (LAD), short axis diameter (SAD) and volume were measured. The necessity for manual correction (NOC = relative difference between uncorrected and corrected volume) and the relative interobserver difference (RID) were determined. Precision was calculated in terms of relative measurement deviations (RMD) from the reference standard (mean of 1.5 mm data sets). Wilcoxon test, t-test and intraclass correlation coefficients (ICC) were employed for statistical analysis. All statistical analyses were intended to be exploratory. RESULTS: Regardless of the liver lesion subtype, the NOC was found to be significantly higher for 5 mm than for 3 mm (p = 0.035) and 1.5 mm (p = 0.0002). The RID was consistently low for metric and volumetric parameters with no difference in any of the slice thicknesses for all subtypes (ICC > 0.89). The RMD increased significantly for the LAD, SAD and volume at a slice thickness of 5 mm (p < 0.01), e. g. volume: 0.5 % at 1.5 mm, 5.5 % at 3.0 mm and 7.6 % at 5.0 mm. CONCLUSION: Since the deviations in measurements are significant, and manual corrections made during semi-automated assessment of the liver lesions are considerable, a slice thickness of 1.5 mm, and no more than 3.0 mm, should be used for reconstruction for inconsistently vascularized liver lesions.
Assuntos
Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Meios de Contraste , Feminino , Humanos , Iohexol/análogos & derivados , Fígado/diagnóstico por imagem , Hepatopatias/classificação , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/classificação , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valores de Referência , Estudos Retrospectivos , Software , Carga TumoralRESUMO
PURPOSE: To determine regional and global left ventricular (LV) functional parameters and to perform segmental wall thickness (SWT) and motion (WM) analysis of dual-source CT (DSCT) with optimized temporal resolution versus MRI. MATERIALS AND METHODS: 30 patients with known or suspected CAD, non-obstructive HCM, DCM, ARVCM, Fallot Tetralogy, cardiac sarcoidosis and cardiac metastasis underwent DSCT and MRI. The DSCT and MR images were evaluated: end-systolic (ESV), end-diastolic LV (EDV) volumes, stroke volume (SV), ejection fraction (EF), and myocardial mass (MM) as well as LV wall thickening and segmental WM applying the AHA model were obtained and statistically analyzed. RESULTS: The mean LV-EDV (r = 0.96) and ESV (r = 0.98) as well as LV-EF (r = 0.97), SV (r = 0.83), and MM (r = 0.95) correlated well. Bland Altman analysis revealed little systematic underestimation of LV-EF (-1.1 +/- 7.8 %), EDV (-0.3 +/- 18.2 ml), SV (-1.3 +/- 16.7 ml) and little overestimation of ESV (1.1 +/- 7.8 ml) and MM (12.8 +/- 14.4 g) determined by DSCT. Systolic reconstruction time points correlated well (DSCT 32.2 +/- 6.7 vs. MRI 35.6 +/- 4.4 % RR-interval). The LV wall thickness obtained by DSCT and MRI showed close correlation in all segments (Ø diff 0.42 +/- 1 mm). In 413 segments (89 %) WM abnormalities were equally rated, whereas DSCT tended to underestimate the degree of wall motion impairment. CONCLUSION: DSCT with optimized temporal resolution enables regional and global LV function analysis as well as segmental WM analysis in good correlation with MRI. However, the degree of WM impairment is slightly underestimated by DSCT.
Assuntos
Cardiopatias/diagnóstico por imagem , Imageamento por Ressonância Magnética , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada Espiral/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Idoso , Volume Cardíaco/fisiologia , Diástole/fisiologia , Feminino , Cardiopatias/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Volume Sistólico/fisiologia , Sístole/fisiologia , Disfunção Ventricular Esquerda/etiologiaRESUMO
PURPOSE: Determination of an adequate scan delay for routine abdominal 64-slice CT examinations with body weight-adapted contrast application. MATERIALS AND METHODS: 57 patients underwent abdominal CT with a 64-slice scanner. The contrast material was adapted to patient body weight. All patients were randomized into five groups with varying scan delay and scan direction (group 1: delay 65 sec; group 2: 75 sec; group 3: 85 sec, craniocaudal; group 4: 85 sec, caudocranial; group 5: 95 sec). Two blinded radiologists evaluated the image quality. CT values (HU) were obtained in different segments of the aorta, inferior vena cava, iliac veins, portal vein, hepatic veins and liver, spleen and pancreas. Statistical analysis was performed using the independent sample t-test and ANOVA test. RESULTS: The diagnostic acceptability of protocols 3 and 4 were rated equally good and significantly/substantially superior to protocol 1 (p = 0.004/0.008) and protocol 5, respectively. Contrast enhancement in the aorta and portal vein peaked at 65 sec. Contrast enhancement in the hepatic and iliac veins peaked at 85 sec independently of the scan direction but was substantially lower at 75 sec. Liver parenchyma enhancement was lowest at 95 sec. CONCLUSION: This data suggests an optimal scan delay for routine abdominal 64-slice CT of 85 sec regardless of scan direction.
Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/patologia , Peso Corporal , Meios de Contraste/administração & dosagem , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Iopamidol/análogos & derivados , Tomografia Computadorizada Espiral/métodos , Neoplasias Abdominais/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Aortografia , Artéria Celíaca/diagnóstico por imagem , Artéria Celíaca/patologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Veias Hepáticas/diagnóstico por imagem , Veias Hepáticas/patologia , Humanos , Injeções Intravenosas , Iopamidol/administração & dosagem , Iopamidol/farmacocinética , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Baço/diagnóstico por imagem , Baço/patologia , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: To assess the accuracy of liver lesion measurement using automated measurement and segmentation software depending on the vascularization level. MATERIALS AND METHODS: Arterial and portal venous phase multislice CT (MSCT) was performed for 58 patients. 94 liver lesions were evaluated and classified according to vascularity (hypervascular: 13 hepatocellular carcinomas, 20 hemangiomas; hypovascular: 31 metastases, 3 lymphomas, 4 abscesses; liquid: 23 cysts). The RECIST diameter and volume were obtained using automated measurement and segmentation software and compared to corresponding measurements derived visually by two experienced radiologists as a reference standard. Statistical analysis was performed using the Wilcoxon test and concordance correlation coefficients. RESULTS: Automated measurements revealed no significant difference between the arterial and portal venous phase in hypovascular (mean RECIST diameter: 31.4 vs. 30.2 mm; p = 0.65; kappa = 0.875) and liquid lesions (20.4 vs. 20.1 mm; p = 0.1; kappa = 0.996). The RECIST diameter and volume of hypervascular lesions were significantly underestimated in the portal venous phase as compared to the arterial phase (30.3 vs. 26.9 mm, p = 0.007, kappa = 0.834; 10.7 vs. 7.9 ml, p = 0.0045, kappa = 0.752). Automated measurements for hypovascular and liquid lesions in the arterial and portal venous phase were concordant to the reference standard. Hypervascular lesion measurements were in line with the reference standard for the arterial phase (30.3 vs. 32.2 mm, p = 0.66, kappa = 0.754), but revealed a significant difference for the portal venous phase (26.9 vs. 32.1 mm; p = 0.041; kappa = 0.606). CONCLUSION: Automated measurement and segmentation software provides accurate and reliable determination of the RECIST diameter and volume in hypovascular and liquid liver lesions. Hypervascular lesions are prone to be underestimated with regard to size in the portal venous phase and therefore should preferentially be segmented in the arterial phase.
Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Cistos/diagnóstico por imagem , Hemangioma/irrigação sanguínea , Hemangioma/diagnóstico por imagem , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Abscesso Hepático/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Software , Tomografia Computadorizada de Feixe Cônico Espiral/métodos , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo/fisiologia , Diagnóstico Diferencial , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
The purpose of this study was to visualize both the vessel wall and atherosclerotic plaques in virtual intra-arterial angioscopy (VIA) based on helical CT data sets. To achieve this in vitro, the optimal reconstruction threshold of the vessel wall was determined to be 56.4% of the maximum enhancement. Using this threshold, 20 patients suffering from symptomatic carotid disease were examined in a helical CT scanner. The degree of stenosis was defined using the North American Symptomatic Endarterectomy Trial (NASCET) criteria and compared with results from digital substraction angiography (DSA). Grading of stenoses was only possible by adding the separately computed plaque geometry to the geometry of the vessel wall in a second step. Correlation between VIA and DSA in low grade, medium grade and high grade stenosis was 88%, 93% and 71%, respectively. Complete occlusions were diagnosed correctly in all patients. Sensitivity and specificity for the correct diagnosis of high grade stenosis was 93.7% and 91.3%, respectively. A realistic depiction of intraluminal structures in carotid arteries can only be generated by displaying both the vessel wall and plaque structures simultaneously.
Assuntos
Artérias Carótidas/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Idoso , Angioscopia/métodos , Simulação por Computador , Coleta de Dados , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Imagens de FantasmasRESUMO
PURPOSE: To describe the incidence and management of the intraoperative, perioperative and late complications of endovascular aortic aneurysm repair. METHODS: Endovascular aneurysm repair was attempted in 130 patients between October, 1995 and January, 2000. Follow-up including computed tomography (CT) was performed in the immediate postoperative period and then at 3, 6, 9 and 12 months and biannually thereafter. The median follow-up period was 20 months. RESULTS: Intra- and perioperative problems occurred in 26 patients (20%). Conversion to open surgery was required in five cases (4%). The primary technical success rate was 86%. Three patients (2%) died within the first 30 postoperative days. Late problems occurred in 28 patients (26%). These included: endoleaks (type I: 5%; type II: 10%; type III: 1%) and limb occlusion (3%). The cumulative rate of freedom from secondary intervention was in the first 65 patients treated: 86% and 65% after 1 and 3 years, respectively, and in the last 65 patients: 90% at 1 year. CONCLUSIONS: Endovascular aneurysm repair is associated with a higher complication rate than open surgery.
Assuntos
Aneurisma da Aorta Abdominal/mortalidade , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas. METHODS: Four patients (3 women; ages 26-78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT). RESULTS: The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months. CONCLUSIONS: Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.
Assuntos
Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/complicações , Ruptura Aórtica/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Tomografia Computadorizada por Raios XRESUMO
This pilot study investigated the feasibility and clinical value of high-resolution virtual real-time laryngoscopy based on helical CT data sets. Nine patients with laryngeal pathology (three with tumors of the vocal cords, two laryngeal carcinomas, one with invasion of the larynx by thyroid carcinoma and six subglottic stenoses) underwent examination by helical CT at a collimation of 1 mm. Following acquisition, the images were processed at a workstation with standard visualization software, such that virtual endoscopy (VE) in real time was possible. The images were then compared with the findings of conventional endoscopy. Because of swallowing artifacts, reconstruction failed in 2 of 12 patients. None of the carcinomas of the vocal cords was recognized at VE or in the cross-sectional CT images. VE provided the correct diagnosis in 8 of 12 cases (laryngeal tumors, subglottic stenoses). Virtual laryngoscopy is capable of simulating the visual findings of endoscopy in cases of laryngeal tumors and subglottic stenoses. Small tumors of the vocal cords are not adequately visualized. The major problem affecting results is motion artifacts resulting from involuntary swallowing.