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1.
Recenti Prog Med ; 113(12): 739-748, 2022 12.
Artigo em Italiano | MEDLINE | ID: mdl-36420850

RESUMO

PURPOSE: The aim of this study was to assess the role of oropharingoesophageal scintigraphy (OPES) in the management of neurological patients, investigating the clinical value of semiquantitative analysis. MATERIALS AND METHODS: We enrolled 39 neurological patients clinically evaluated and scored according to the Dysphagia Outcome Severity Scale (DOSS) scale who underwent fibrolaryngoscopic swallowing examination (FEES) and OPES using a 99mTc-nanocolloid-radioblabelled semiliquid bolus. We calculated the following semiquantitative parameters: Oral Transit Time (OTT), Pharyngeal Transit Time (PTT), Esophageal Transit Time (ETT), Retention Index (RI), and Esophageal Emptying Rate (EER10s). Differences in OPES semiquantitative parameters between patients classified according to the DOSS scale were performed using the nonparametric Mann-Whitney U test. Optimal semiquantitative parameters cut-off values that correlated with DOSS classification were investigated with ROC curves. The agreement between OPES, FEES and DOSS results was measured using Cohen's Kappa test (K). RESULTS: A significantly higher OTT (p=0.028), PTT (p=0.011) and ETT (p=0.030) and lower EER10s (p=0.016) values were identified. Moderate agreement resulted between OPES and DOSS results (k=0.429, 95%CI: 0.143-0.715, p=0.002). CONCLUSIONS: Our study revealed a significant correlation between clinical dysphagia graded using DOSS scale and semiquantitative parameters obtained by OPES evaluation. Despite reliable and reproducible OPES results, allowing an adequate study also of the esophageal phase, nowadays scintigraphic study remains an underestimated method to be considered in the diagnosis of dysphagia and related complications.


Assuntos
Transtornos de Deglutição , Humanos , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Deglutição , Cintilografia , Estatísticas não Paramétricas
2.
J Radiol Prot ; 41(4)2021 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-34134092

RESUMO

BACKGROUND AND PURPOSE: The potential for unintended and adverse radiation exposure in radiotherapy (RT) is real and should be studied because RT is a highly complex, multistep process, which requires input from numerous individuals from different areas and steps of the RT workflow. The 'Incident' (I) is an event the consequence of which is not negligible from the point of view of protection or safety. A 'near miss' (NM) is defined as an event that is highly likely to happen but did not occur. The purpose of this work is to show that through systematic reporting and analysis of these adverse events, their occurrence can be reduced. MATERIALS AND METHODS: Staff were trained to report every type of unintended and adverse radiation exposure and to provide a full description of it. RESULTS: By 2018, 110 worksheets had been collected, with an average of 6.1 adverse events per year (with 780 patients treated per year, meaning an average incident rate of 0.78%). In 2001-2009, 37 events were registered (13 I and 24 NM), the majority of them were in the decision phase (12/37), while in 2010-2013, there were 42 (1 I and 41 NM) in both the dose-calculation and transfer phase (19/42). In 2014-2018, 31 events (1 I and 30 NM) were equally distributed across the phases of the RT process. In 9/15 cases of I, some checkpoint was introduced. CONCLUSION: The complexity of the RT workflow is prone to errors, and this must be taken into account by encouraging a safety culture. The aim of this paper is to present the collected incidents and near misses and to show how organization and practice were modified by the acquired knowledge.


Assuntos
Radioterapia (Especialidade) , Gestão de Riscos , Humanos , Erros Médicos , Segurança do Paciente , Radioterapia/efeitos adversos , Gestão da Segurança , Fluxo de Trabalho
3.
Recenti Prog Med ; 110(3): 144-150, 2019 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-30968855

RESUMO

AIM: We aimed to evaluate the role of 18F-FDG PET/CT in the TNM staging of esophageal cancer in comparison with contrast-enhancement computed-tomography (CECT). Futhermore we set out to determine the role of semiquantitative PET parameters. METHODS: 55 patients performed 18F-FDG PET/CT and CECT. Values of Sensitivity (Se), specificity (Sp), accuracy and predictability (PPV and NPV) were evaluated. McNemar test was applied for comparison. Cohen's K was calculated to measure the agreement. 18F-FDG PET/CT semiquantitative parameters (SUVmax, SUVmean, MTV and TLG) in relation to site and histotype, were assessed by ANOVA test and post-hoc test. RESULTS: About T parameter, Se, Sp, accuracy, PPV and NPV of CECT and 18F-FDG PET/CT were respectively 82.35%, 94.48%, 85.00%, 93.33% and 76% for both the tecniques; the agreement resulted substantial. There were no statistically significant relationships between 18F-FDG PET/CT parameters and sites; MTV value differs in histotypes. About N parameter, Se, Sp, accuracy, PPV and NPV of CECT were respectively 82.35%, 57.89%, 65.00%, 46.67%, 88%; for 18F-FDG PET/CT were 88.23%, 60.53%, 61%, 50% and 92%; the agreement resulted fair. About M parameter, Se, Sp, accuracy, PPV and NPV PET/CT were equal for both techniques: 76.92%, 52.38%, 58.33%, 33%, 88%; the agreement resulted moderate. No statistical difference was observed in any comparison. CONCLUSION: 18F-FDG PET/CT is a useful tool for whole-body evaluation of patients with esophageal cancer, allowing an effective clinical TNM staging. In particular 18F-FDG PET/CT's ability in detecting distant metastases suggest its routinary performance as a second level of investigation.


Assuntos
Neoplasias Esofágicas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Neoplasias Esofágicas/patologia , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos/administração & dosagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
4.
Medicine (Baltimore) ; 96(5): e5973, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28151888

RESUMO

We investigated the prognostic value of interim F-FDG PET/CT (PET-2) in pediatric Hodgkin lymphoma (pHL), evaluating both visual and semiquantitative analysis.Thirty pHL patients (age ≤16) underwent serial F-FDG PET/CT: at baseline (PET-0), after 2 cycles of chemotherapy (PET-2) and at the end of first-line chemotherapy (PET-T). PET response assessment was carried out visually according to the Deauville Score (DS), as well as semiquantitatively by using the semiquantitative parameters reduction from PET-0 to PET-2 (ΔΣSUVmax0-2, ΔΣSUVmean0-2). Final clinical response assessment (outcome) at the end of first-line chemotherapy was the criterion standard, considering patients as responders (R) or nonresponders (NR). Disease status was followed identifying patients with absence or relapsed/progression disease (mean follow-up: 24 months, range 3-78).Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of visual and semiquantitative assessment were calculated; furthermore, Fisher exact test was performed to evaluate the association between both visual and semiquantitative assessment and outcome at the end of the first-line chemotherapy. The prognostic capability of PET-2 semiquantitative parameters was calculated by ROC analysis and expressed as area under curve (AUC). Finally, progression-free survival (PFS) was analyzed according to PET-2 results based on the 5-point scale and semiquantitative criteria, using the Kaplan-Meier method.Based on the outcome at the end of first-line chemotherapy, 5 of 30 patients were NR, the remnant 25 of 30 were R. Sensitivity, specificity, PPV, NPV, and accuracy of visual analysis were 60%,72%,30%,90%,70%; conversely, sensitivity, specificity, PPV, NPV, and accuracy of semiquantitative assessment were 80%, 92%, 66.7%, 95.8%, 90%. The highest AUC resulted for ΔΣSUVmax0-2 (0.836; cut-off <12.5; sensitivity 80%; specificity 91%). The association between ΔΣSUVmax0-2 and outcome at the end of first-line chemotherapy resulted to have a strong statistical significance (P = 0.0026). Both methods demonstrated to influence PFS, even if the semiquantitative assessment allowed a more accurate identification of patients with a high risk of treatment failure (P = 0.005).Our preliminary results showed that PET-2 visual assessment, by using Deauville criteria, can be improved by using the semiquantitative analysis. The SUV max reduction (ΔΣSUVmax0-2) evaluation might provide a support for the interpretation of intermediate scores, predicting with good confidence those patients who will have a poor outcome and require alternative therapies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Fluordesoxiglucose F18 , Doença de Hodgkin/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/estatística & dados numéricos , Compostos Radiofarmacêuticos , Adolescente , Área Sob a Curva , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/patologia , Humanos , Lactente , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
5.
Clin Nucl Med ; 38(7): 546-9, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23640218

RESUMO

We report a case of a 73-year-old-man with systemic hydatidosis and concomitant Burkitt lymphoma. He came at our attention for fever and weight loss suspected for parasitic cyst discharge and also for lymphoproliferative disorder. We performed US, which showed disseminated parasitic cysts. CECT showed parasitic cysts and also several abdominal and thoracic lymphnodes and adrenal hypodense tissue. 18F-FDG PET/CT was performed and showed lack of 18F-FDG uptake in cysts and high 18F-FDG uptake in lymphnodes and adrenal glands. These findings permitted us to exclude the cyst discharge, to localize a site for biopsy, and to define and stage the Burkitt lymphoma.


Assuntos
Linfoma de Burkitt/diagnóstico por imagem , Equinococose/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Idoso , Linfoma de Burkitt/complicações , Linfoma de Burkitt/metabolismo , Equinococose/complicações , Equinococose/metabolismo , Humanos , Masculino , Imagem Multimodal
6.
Recenti Prog Med ; 103(11): 483-8, 2012 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-23096736

RESUMO

Assessment of the complex anatomy of the groin region using different imaging modalities is important to identify those pathological conditions that may present with atypical symptoms. In obese patients or in the presence of complications, physical examination may be unremarkable and instrumental studies based on non-invasive techniques (e.g., ultrasounds) do not allow accurate assessment of this region. Multidetector CT scanning and reconstruction can provide useful information on inguinal canal anatomy and its related diseases, contributing to timely therapeutic interventions.


Assuntos
Canal Inguinal/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Recenti Prog Med ; 103(11): 500-4, 2012 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-23096739

RESUMO

REM sleep Behaviour Disorder (RBD) is a sleep disorder that can precedes the development of motor signs of Parkinson's disease by years. The aim of this study was to assess the functional integrity of nigrostriatal dopaminergic system in RBD patients using 123I-2b-carbomethoxy-3b-(4-iodophenyl)-N-(3-fluoropropyl) nortropane (123I-FP-CIT) Single-Photon Emission Computed Tomography (SPECT). 5 patients with RBD and 5 normal healthy controls were included in the study and underwent SPECT imaging 3 hours after injection of 111-185 MBq of 123I-FP-CIT. All RBD patients showed reduced 123I-FP-CIT striatal binding. 123I-FP-CIT SPECT is a useful diagnostic tool in RBD patients.


Assuntos
Corpo Estriado/diagnóstico por imagem , Corpo Estriado/metabolismo , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Radioisótopos do Iodo , Transtorno do Comportamento do Sono REM/diagnóstico por imagem , Transtorno do Comportamento do Sono REM/metabolismo , Tomografia Computadorizada de Emissão de Fóton Único , Tropanos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada de Emissão de Fóton Único/métodos
8.
Recenti Prog Med ; 103(11): 515-9, 2012 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-23096742

RESUMO

The aim of this study was to determine the role of 18F-FDG-PET/CT in the evaluation of carotid plaques and its relationship with cardiovascular risk factors. 18F-FDG-PET/CT scan was performed in 25 patients with ultrasound diagnosis of carotid atherosclerosis and ≥70% stenosis, who were scheduled for carotid endoarterectomy. 18F-FDG uptake was measured by ROIs drawn on PET/CT carotid artery slices. A statistically significant difference in 18F-FDG uptake was observed in relation to body mass index values between 25 and 29 kg/m2. Our results suggest that PET/CT imaging has utility in risk stratification of atherosclerotic patients.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Fluordesoxiglucose F18 , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Clin Nucl Med ; 35(10): 838-9, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20838306

RESUMO

A 22-year-old man diagnosed with neurofibromatosis-I was admitted to the neurology department because of progressive hemianopsia and chronic headache. Magnetic resonance imaging, magnetic resonance spectroscopy (MRS), and F-18 fluorocholine revealed a splenial mass with imaging features compatible with malignant astrocytoma. At follow-up examination, the sharp decrease in F-18 fluorocholine uptake and in choline/creatine ratio supported a conservative management. Molecular imaging of optic pathway gliomas may be a valuable tool in the selection of therapeutic options.


Assuntos
Encéfalo , Colina/análogos & derivados , Glioma/diagnóstico , Neurofibromatose 1/diagnóstico , Nervo Óptico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Encéfalo/diagnóstico por imagem , Glioma/diagnóstico por imagem , Humanos , Masculino , Neurofibromatose 1/diagnóstico por imagem , Adulto Jovem
10.
J Nucl Med ; 45(4): 532-6, 2004 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15073246

RESUMO

UNLABELLED: Anomalous coronary arteries (ACAs) may be clinically silent and totally benign or associated with catastrophic and fatal presentations. It has been postulated that the proximal course of an ACA is a decisive factor in risk stratification and surgical approach. Particularly, a course between the aorta and pulmonary trunk carries a high risk of major adverse events. We sought to evaluate the anatomic course of documented ACAs by transesophageal echocardiography (TEE) and to study their functional importance using stress-rest (99m)Tc-sestamibi ((99m)Tc-MIBI) myocardial perfusion SPECT. METHODS: From a cohort of patients undergoing coronary angiography in our department between January 1997 and April 2003, we selected 14 with ACAs but without CAD (9 men and 5 women; mean age, 50.7 +/- 14.6 y). All patients underwent TEE and stress-rest (99m)Tc-MIBI myocardial perfusion SPECT. RESULTS: TEE correctly identified the origin of all ACAs and revealed an anomalous course between the great vessels in 5 patients. At exercise myocardial perfusion SPECT, 4 of 14 patients demonstrated a reversible myocardial perfusion defect. All these patients had an anomalous course between the aorta and pulmonary artery. CONCLUSION: In this study, 4 of 5 (80%) anomalous courses between the aorta and pulmonary artery were associated with the finding of a reversible perfusion defect on stress-rest SPECT. An integrated evaluation of anatomic course and hemodynamic importance could be useful in the management of ACA.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Tecnécio Tc 99m Sestamibi , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adulto , Idoso , Estudos de Coortes , Angiografia Coronária , Ecocardiografia Transesofagiana , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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