RESUMO
BACKGROUND: Nodular lymphoid hyperplasia (NLH) is one of the most common non-neoplastic splenic lesions in dogs, especially in old ones, showing a splenic enlargement. More recent studies have been focused on Contrast Enhanced Ultrasonography (CEUS) analysis of the spleen for establishing normal perfusion patterns and blood pool phase peculiarities of focal lesions. The aim of the study was to evaluate the qualitative and quantitative CEUS analysis of the canine splenic NLH, characterizing the CEUS pattern of this pathology on 20 clinical cases. RESULTS: A prospective, observational study was performed using a system equipped with contrast-tuned imaging technology. Mechanical Index was set from 0.08 to 0.11; the contrast medium was a second generation contrast medium composed of sulphur hexafluoride encapsulated of a shell of phospholipids (SonoVue®). Qualitative and quantitative assessment of the enhancement pattern of splenic NLH were performed. Cytology and histology identified 20 splenic NLH. All of the benign hyperplastic lesions assessed were isoechoic with a homogeneous pattern than the surrounding normal spleen, during the wash-in phase (10-20 s) of the CEUS exam. Before finishing the wash-in phase, 20-45 s from the contrast medium inoculation, 19/20 benign nodules became markedly hypoechoic to the adjacent spleen. Sensitivity of hypoechoic pattern for NLH was 95%. CONCLUSIONS: These findings should prove useful in the evaluation of focal splenic masses in dogs. Since enhancement and perfusion patterns of NLH seem to coincide with some neoplastic lesions of the spleen previously reported, in clinical practice attention must be paid to the final diagnosis of canine splenic lesions using only the CEUS exam.
Assuntos
Doenças do Cão/diagnóstico por imagem , Hiperplasia/veterinária , Doenças Linfáticas/veterinária , Esplenopatias/veterinária , Animais , Cães , Feminino , Hiperplasia/diagnóstico por imagem , Doenças Linfáticas/diagnóstico por imagem , Masculino , Fosfolipídeos/administração & dosagem , Estudos Prospectivos , Baço , Esplenopatias/diagnóstico por imagem , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia/métodos , Ultrassonografia/veterináriaRESUMO
PURPOSE: To determine factors predictive of anatomic, visual, and financial outcomes after traditional and nontraditional primary pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RD). DESIGN: Retrospective interventional case series and cost comparison. METHODS: Participants: Total of 178 eyes (156 patients) with PR-repaired primary RD by a single surgeon at a clinical practice from January 2001 to December 2013 and followed for ≥1 year. The cohort had 2 subgroups: traditional (TPR) and nontraditional (NTPR) PR. MAIN OUTCOME MEASURES: Characteristics associated with best-corrected visual acuity (BCVA) and anatomic outcomes. Cost analysis and potential cost savings comparing PR to scleral buckle and vitrectomy. RESULTS: One hundred thirty-one of 178 eyes (73.5%) were successfully treated at 1 year (postoperative year 1): 72.8% (75/103) in TPR and 74.6% (56/75) in NTPR. Macula-off detachment (-0.44 logMAR, P < .001) and clock hours of RD (-0.84 logMAR, P < .001) correlated with improved BCVA; pseudophakia (0.26 logMAR, P = .002) and inferior retinal tears (0.62 logMAR, P = .009) correlated with worsening BCVA. Pseudophakia (-0.15, P = .03), inferior quadrant RD (-0.27, P < .001), and proliferative vitreoretinopathy (-0.68, P < .001) correlated with anatomic failure. Total average cost for TPR and NTPR was $1248.37 ± $882.11 and $1471.91 ± $942.84, respectively (P = .10). PR had a potential cost savings of 62% and 60.8% when compared to scleral buckle and vitrectomy, respectively. CONCLUSIONS: PR results in successful anatomic and visual outcomes in both TPR and NTPR repair of primary RD. Preoperative pseudophakia is associated with worse visual outcomes and less anatomic success. The cost of primary PR and subsequent procedures to achieve final anatomic success was not significantly different between TPR and NTPR, and supports the possible cost-effectiveness of expanded indications for PR.
Assuntos
Crioterapia/economia , Custos de Cuidados de Saúde , Terapia a Laser/economia , Descolamento Retiniano/economia , Descolamento Retiniano/cirurgia , Acuidade Visual/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Crioterapia/métodos , Tamponamento Interno , Feminino , Humanos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/fisiopatologia , Estudos Retrospectivos , Recurvamento da Esclera/economia , Hexafluoreto de Enxofre/administração & dosagem , Resultado do Tratamento , Vitrectomia/economiaRESUMO
Methods capable of measuring blood flow in a tissue-specific manner are needed. The purpose of this study was to investigate whether contrast-enhanced ultrasound (CEUS) using bolus injections of SonoVue® is an useful method for assessing postprandial changes in microvascular perfusion in the vastus lateralis muscle. Ten healthy, young subjects were recruited for this study. Six subjects participated in washout and reproducibility protocols to assess washout time of SonoVue® and the reproducibility of the method when measuring microvascular blood volume (MBV). Six subjects (two of which also participated in the washout and reproducibility protocols) participated in exercise and nutrition protocols, to assess the ability of the method to detect changes in MBV in response to these interventions. Intraday variation (coefficients of variation) for MBV indices, as assessed by peak signal intensity (PI) or mean plateau signal intensity (mPI), was high (PI: 19 ± 4·2%; mPI: 23 ± 3·3%). The exercise protocol induced significant increases in MBV indices (PI:+113%, PË0·0001; mPI:+218%, PË0·0001) acutely after exercise cessation. There were no changes in MBV indices in response to feeding during the nutrition protocol (PI: P = 0·51; mPI: P = 0·51). We conclude that CEUS using bolus injections of SonoVue® is not capable of detecting changes in MBV of vastus lateralis in response to feeding. This is probably due to the low reproducibility of the method. However, the method is capable of measuring changes in MBV in response to exercise. This method could therefore be used when investigating exercise-induced changes in microvascular perfusion.
Assuntos
Determinação do Volume Sanguíneo/métodos , Volume Sanguíneo , Meios de Contraste/administração & dosagem , Microcirculação , Microvasos/diagnóstico por imagem , Imagem de Perfusão/métodos , Fosfolipídeos/administração & dosagem , Músculo Quadríceps/irrigação sanguínea , Músculo Quadríceps/diagnóstico por imagem , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia , Adulto , Feminino , Humanos , Injeções Intravenosas , Masculino , Microbolhas , Microvasos/fisiologia , Força Muscular , Estado Nutricional , Período Pós-Prandial , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo , Adulto JovemRESUMO
PURPOSE: To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty. METHODS: This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD. RESULTS: Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure. CONCLUSION: HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation.
Assuntos
Doenças da Córnea/epidemiologia , Lâmina Limitante Posterior/patologia , Hemorragia Ocular/epidemiologia , Cirurgia Filtrante/efeitos adversos , Glaucoma de Ângulo Aberto/cirurgia , Facoemulsificação/efeitos adversos , Malha Trabecular/cirurgia , Adulto , Idoso , Câmara Anterior/efeitos dos fármacos , Anti-Hipertensivos/administração & dosagem , Doenças da Córnea/fisiopatologia , Doenças da Córnea/terapia , Tamponamento Interno , Hemorragia Ocular/fisiopatologia , Hemorragia Ocular/terapia , Feminino , Humanos , Incidência , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hexafluoreto de Enxofre/administração & dosagem , Tonometria Ocular , Acuidade Visual/fisiologiaRESUMO
BACKGROUND AND AIM: Novel biological therapies in Crohn's disease (CD) or Ulcerative colitis (UC) require a proper follow-up for the assessment of bowel inflammation. While endoscopy is the standard method, the imaging techniques using contrast, particularly contrast enhanced ultrasonography (CEUS), are better tolerated by the patients and can be used more frequently. Our aim was to find the usefulness of dynamic CEUS quantification as compared to endoscopy in the assessment of disease activity and in the follow-up under therapy of the patients suffering from either CD or UC. METHOD: We have prospectively evaluated 67 patients with UC and 46 with CD, diagnosed by ileo-colonoscopy and biopsy, comparing the endoscopic scores with clinical scores, C reactive protein (CRP), intestinal wall thickness, layer scores after CEUS and TIC parameters (using SonoLiver® software - Imax, RT, TTP, mTT and AUC). For 25 patients with UC and 13 with CD we performed comparisons of the parameters before and after 3 months of treatment and correlated them with the changes in the endoscopic scores. RESULTS: For UC, time-intensity curves (TIC) volume parameters (AUC) correlated better with endoscopy (ρ=0.64) than the clinical score (ρ =0.62). Other parameters such as CRP and thickness showed significant but less strong correlation, while TIC flow parameters (RT, TTP and mTT) did not show a significant correlation. Results were similar for CD (ρ=0.64 for Imax vs ρ=0.58 for CDAI). The best predictor for endoscopic improvement in both UC and CD was ln(AUC), with a Wilcoxon Z score of 3.76 and 2.61, respectively. There was also a good correlation between the difference of its values and the difference in endoscopic scores before and after the treatment (rho is 0.68 in UC and 0.73 in CD).
Assuntos
Colite Ulcerativa/diagnóstico por imagem , Colo/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Doença de Crohn/diagnóstico por imagem , Íleo/diagnóstico por imagem , Fosfolipídeos/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Idoso , Anti-Inflamatórios/uso terapêutico , Área Sob a Curva , Produtos Biológicos/uso terapêutico , Biópsia , Colite Ulcerativa/tratamento farmacológico , Colo/efeitos dos fármacos , Colo/patologia , Colonoscopia , Doença de Crohn/tratamento farmacológico , Feminino , Fármacos Gastrointestinais/uso terapêutico , Humanos , Íleo/efeitos dos fármacos , Íleo/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVE: To assess the feasibility of intraoperative OCT (iOCT) during pars plana vitrectomy with subretinal tissue plasminogen activator (tPA) injection for subretinal hemorrhage. PATIENTS AND METHODS: Eyes that underwent vitrectomy and subretinal injection of tPA were identified from the PIONEER study, a prospective clinical study assessing the feasibility and utility of iOCT in ophthalmic surgery. A microscope-mounted spectral-domain OCT system was utilized for iOCT imaging. Standardized scan protocol and image acquisition were followed for intraoperative imaging. RESULTS: iOCT was successfully obtained in four of four eyes. In all cases, increased subretinal fluid was noted, with differential reflectivity visualized between the hemorrhage-tPA interface confirming appropriate localization of tPA injection. Image quality variability was significant. CONCLUSION: iOCT can successfully be performed during pars plana vitrectomy with subretinal tPA injection. Utilizing iOCT, appropriate placement of tPA solution and corresponding retinal architectural changes were visualized.
Assuntos
Fibrinolíticos/uso terapêutico , Hemorragia Retiniana/tratamento farmacológico , Ativador de Plasminogênio Tecidual/uso terapêutico , Vitrectomia , Idoso , Idoso de 80 Anos ou mais , Tamponamento Interno , Feminino , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Postura , Estudos Prospectivos , Hemorragia Retiniana/diagnóstico , Hexafluoreto de Enxofre/administração & dosagem , Cirurgia Assistida por Computador , Tomografia de Coerência Óptica/métodos , Acuidade VisualRESUMO
BACKGROUND: Contrast-enhanced voiding urosonography (ce-VUS) is commonly requested simultaneously to other diagnostic imaging necessitating intravenous contrast agents. To date there is limited knowldedge about intravesical interactions between different types of contrast agents. OBJECTIVE: To assess the effect of excreted intravenous iodinated and gadolinium-based contrast agents on the intravesical distribution of ultrasound contrast within contrast-enhanced voiding urosonography. MATERIALS AND METHODS: Iodinated (iomeprol, iopamidol) and gadolinium-based (gadoterate meglumine) contrast agents were diluted to bladder concentration and injected into balloons filled with saline solution. CT scans were performed to assess the contrast distribution in these phantoms. Regions of interest were placed at the top and bottom side of each balloon and Hounsfield units (HU) were measured. Three other balloons were filled with saline solution and contrast media likewise. The ultrasound contrast agent sulphur hexafluoride was added and its distribution was assessed using sonography. RESULTS: MDCT scans showed a separation of two liquid layers in all bladder phantoms with the contrast layers located at the bottom and the saline solution at the top. Significant differences of the HU measurements at the top and bottom side were observed (P < 0.001-0.007). Following injection of ultrasound contrast agent, US showed its distribution exclusively among the saline solution. CONCLUSIONS: False-negative results of contrast-enhanced voiding urosonography may occur if it is performed shortly after imaging procedures requiring intravenous contrast.
Assuntos
Refluxo Vesicoureteral/diagnóstico por imagem , Administração Intravesical , Meios de Contraste , Reações Falso-Negativas , Humanos , Injeções Intravenosas , Iopamidol/administração & dosagem , Iopamidol/análogos & derivados , Meglumina/administração & dosagem , Tomografia Computadorizada Multidetectores , Compostos Organometálicos/administração & dosagem , Imagens de Fantasmas , Hexafluoreto de Enxofre/administração & dosagem , UltrassonografiaRESUMO
PURPOSE: To evaluate the intrasurgical retinal architectural and macular hole (MH) geometric alterations that occur during surgical MH repair using intraoperative optical coherence tomography. METHODS: A retrospective, multisurgeon, single-center, consecutive case series of 21 eyes undergoing surgical repair for MH with concurrent intraoperative optical coherence tomography using a custom microscope-mounted optical coherence tomography system was performed. All patients underwent surgical repair with pars plana vitrectomy, membrane peel, and gas tamponade. A novel three-dimensional segmentation algorithm was used for volumetric analysis of intrasurgical changes of MH geometry after surgical repair. Intraoperative optical coherence tomographic characteristics analyzed included MH volume, minimum diameter, base area, and hole height. Outer retinal architecture changes were analyzed both quantitatively and qualitatively. RESULTS: All 21 eyes were successfully imaged with intraoperative optical coherence tomography. Nineteen of 21 eyes had images of sufficient signal strength to allow for quantitative analysis. Significant changes were noted in MH geometry after internal limiting membrane peeling including increased MH volume, increased base area, and decreased top area (all P < 0.03). Additionally, increased subretinal hyporeflectance was noted by expansion of the height between the inner segment/outer segment and retinal pigment epithelium bands (P = 0.008). Peeling methods and surgeon experience did not correlate with the magnitude of architectural alterations. Macular hole algorithm measurements and alterations were associated with visual outcome and MH closure. CONCLUSION: Significant alterations occur in MH geometry and outer retinal structure after internal limiting membrane peeling. These changes are subclinical and unable to be appreciated with en face surgical microscope viewing and require intraoperative optical coherence tomography for visualization. Preliminary analysis of these measurements identified an association with visual outcome and successful MH closure. The functional significance of these changes deserves further study.
Assuntos
Retina/ultraestrutura , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica , Vitrectomia , Idoso , Algoritmos , Tamponamento Interno , Feminino , Fluorocarbonos/administração & dosagem , Humanos , Período Intraoperatório , Masculino , Decúbito Ventral , Estudos Retrospectivos , Hexafluoreto de Enxofre/administração & dosagemRESUMO
PURPOSE: To provide insight into the preoperative factors that affect outcome after pneumatic retinopexy (PR) for treatment of primary rhegmatogenous retinal detachment repair. Additionally, we sought to analyze the cost of rhegmatogenous retinal detachment repair in the United States to determine potential cost savings with pneumatic retinopexy. DESIGN: Single-center, retrospective, observational consecutive case series and third party payer-perspective comparative cost analysis. PARTICIPANTS: We included 141 eyes undergoing pneumatic retinopexy for the treatment of primary rhegmatogenous retinal detachment. METHODS: Preoperative characteristics, anatomic outcomes, and best-available visual acuity were collected. Anatomic and visual outcomes were analyzed based on the presence of selected preoperative factors. The primary cohort was divided into 2 groups based on preoperative characteristics: (1) traditional pneumatic retinopexy and (2) nontraditional pneumatic retinopexy. Comparative cost analyses were performed between pneumatic retinopexy, scleral buckling, and vitrectomy. MAIN OUTCOME MEASURES: Anatomic and visual outcomes at 6 months. RESULTS: Overall anatomic success was 78.7% and visual acuity improved significantly (logarithm of the minimum angle of resolution [logMAR] 0.48-0.25; P <0.005). A 97.6% final anatomic success rate was achieved. Anatomic outcomes were similar between traditional versus nontraditional (84.1% vs 74.4%; P = 0.16), phakic versus pseudophakic (79.1% vs 78.0%; P = 0.88), and macula-on versus macula-off (77.9% vs 81.1%; P = 0.68) groups. Anatomic failure was predicted by the presence of an inferior retinal break (P <0.005) or visible vitreous traction on a retinal break (P = 0.04). Visual outcomes were similar between each of the traditional versus nontraditional (logMAR 0.21 vs 0.27; P >0.05) and phakic versus pseudophakic groups (logMAR 0.23 vs 0.28; P >0.05). Visual outcomes were better in macula-on detachments compared with those in which the macula was detached (logMAR 0.18 vs 0.42; P <0.005). Annual health care cost savings in the United States ranging from $6 to $30 million are theoretically possible by increasing pneumatic retinopexy utilization from the current rate of 15% to 20%-35%. CONCLUSIONS: Pneumatic retinopexy is an effective treatment modality for primary rhegmatogenous retinal detachment. Anatomic and visual outcomes are similar for traditional and nontraditional preoperative inclusion criteria, as well as phakic and pseudophakic eyes. Inferior breaks and visible vitreous traction on a tear predicted failure. Increased utilization of pneumatic retinopexy would achieve significant cost savings while maintaining outcomes.
Assuntos
Redução de Custos/economia , Criocirurgia/economia , Descolamento Retiniano/economia , Descolamento Retiniano/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Local , Custos e Análise de Custo , Tamponamento Interno , Feminino , Fluorocarbonos/administração & dosagem , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Recurvamento da Esclera/economia , Hexafluoreto de Enxofre/administração & dosagem , Resultado do Tratamento , Estados Unidos , Acuidade Visual , Vitrectomia/economiaRESUMO
PURPOSE: To ascertain the difference of intraocular pressure (IOP) measurement between vitrectomized air-filled and fluid-filled eyes. METHODS: Thirty-one eyes of 31 consecutive patients who underwent conventional vitrectomy and intraocular gas tamponade were assessed. After vitrectomy, IOP of the fluid-filled eyes was measured by Tono-Pen. Thereafter, fluid-air exchange was performed, and IOP of the air-filled eyes was measured again. The IOP within each fluid- and air-filled eye was varied by selecting settings on the vitrectomy system, from 10 to 50 mmHg with 5-mmHg increments. Postoperatively, IOP was assessed by both Tono-Pen and Goldmann applanation tonometry (GAT). Linear and nonlinear regression analyses were conducted between intraoperatively measured Tono-Pen readings and actual IOPs. Bland-Altman plot was used to assess the agreements between postoperatively measured Tono-Pen readings and GAT readings. RESULTS: The discrepancy between Tono-Pen readings and actual IOP in fluid-filled eyes was not significant, except for the profound high pressures over 45 mmHg. However, Tono-Pen readings in air-filled eyes were significantly lower than actual IOPs in all ranges, and Tono-Pen increasingly underestimates IOP at higher levels. Intraoperative Tono-Pen readings were correlated significantly with actual IOP and a quadratic equation evidenced the best fit (R(2) = 0.996). Postoperatively, difference of the measurements between Tono-Pen and GAT was not significant. CONCLUSION: Tono-Pen and GAT significantly underestimate actual IOP in air-filled eyes. It should be considered that actual IOP would be greater than the measured IOP in gas-filled eyes, even though the IOP is measured as normal.
Assuntos
Acetatos , Ar , Tamponamento Interno , Pressão Intraocular/fisiologia , Minerais , Cloreto de Sódio , Tonometria Ocular/normas , Vitrectomia , Combinação de Medicamentos , Fluorocarbonos/administração & dosagem , Humanos , Período Intraoperatório , Pessoa de Meia-Idade , Facoemulsificação , Período Pós-Operatório , Reprodutibilidade dos Testes , Descolamento Retiniano/cirurgia , Hexafluoreto de Enxofre/administração & dosagemRESUMO
OBJECTIVES: To investigate the diagnostic accuracy, through quantitative analysis, of contrast-enhanced ultrasound (CEUS), using a microbubble contrast agent, in the differentiation of thyroid nodules. METHODS: This prospective study enrolled 46 patients with solitary, scintigraphically non-functional thyroid nodules. These patients were scheduled for surgery and underwent preoperative CEUS with pulse-inversion harmonic imaging after intravenous microbubble contrast medium administration. Using histology as a standard of reference, time-intensity curves of benign and malignant nodules were compared by means of peak enhancement and wash-out enhancement relative to the baseline intensity using a mixed model ANOVA. ROC analysis was performed to assess the diagnostic accuracy in the differentiation of benign and malignant nodules on CEUS. RESULTS: The complete CEUS data of 42 patients (31/42 [73.8%] benign and 11/42 [26.2%] malignant nodules) revealed a significant difference (P < 0.001) in enhancement between benign and malignant nodules. Furthermore, based on ROC analysis, CEUS demonstrated sensitivity of 76.9%, specificity of 84.8% and accuracy of 82.6%. CONCLUSIONS: Quantitative analysis of CEUS using a microbubble contrast agent allows the differentiation of benign and malignant thyroid nodules and may potentially serve, in addition to grey-scale and Doppler ultrasound, as an adjunctive tool in the assessment of patients with thyroid nodules. KEY POINTS: ⢠Contrast-enhanced ultrasound (CEUS) helps differentiate between benign and malignant thyroid nodules. ⢠Quantitative CEUS analysis yields sensitivity of 76.9% and specificity of 84.8%. ⢠CEUS may be a potentially useful adjunct in assessing thyroid nodules.
Assuntos
Algoritmos , Interpretação de Imagem Assistida por Computador/métodos , Fosfolipídeos/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Injeções Intravenosas , Masculino , Microbolhas , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto JovemRESUMO
OBJECTIVE: To investigate the relationship of vision-related quality of life (VRQOL) and visual function in patients undergoing macular-hole (MH) repair with and without cataract surgery and short-duration, 3-day prone posturing. Previous communications have assessed VRQOL in European and Japanese populations, but this is the first study to investigate VRQOL after MH surgery in a Canadian population. DESIGN: Prospective interventional case series. PARTICIPANTS: We studied 20 consecutive eyes in 19 patients with stage 2 and 3 idiopathic macular holes. Of those, 15 received combined cataract and MH surgery, and 5 received MH repair alone. METHODS: Patients completed the self-administered National Eye Institute 25-item Visual Function Questionnaire before and after surgery. All patients received full ocular examinations pre- and postsurgery. Along with the questionnaire scores, we examined macular-hole closure rates, complications, postoperative visual acuity, and intraocular pressure. RESULTS: Macular-hole closure was achieved in 20 of 20 eyes (100%). Mean postoperative logMAR decreased (i.e., improved) by -0.303 (95% CI, -0.501-- -0.105, p = 0.0047). The Visual Function Questionnaire composite score rose from 82.019 ± 12.612 SD to 88.499 ± 7.963 SD (p = 0.012). Subscale scores, including general vision, near activities, mental health, role difficulties, and dependency were all significantly improved (p < 0.05). No complications or intraocular pressure increases were observed. CONCLUSIONS: Macular-hole surgery followed by short-duration, 3-day face-down positioning significantly improved VRQOL and visual acuity in a group of Canadian patients. The use of VRQOL tools alongside anatomic outcomes provide a more comprehensive overview of patients' experiences and satisfaction after surgical intervention.
Assuntos
Decúbito Ventral , Qualidade de Vida , Perfurações Retinianas/cirurgia , Acuidade Visual/fisiologia , Idoso , Idoso de 80 Anos ou mais , Membrana Basal/cirurgia , Extração de Catarata , Corantes , Tamponamento Interno , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Perfurações Retinianas/fisiopatologia , Perfil de Impacto da Doença , Hexafluoreto de Enxofre/administração & dosagem , Inquéritos e Questionários , Fatores de Tempo , VitrectomiaRESUMO
PURPOSE: To quantify tumor blood flow by using contrast material-enhanced destruction-replenishment ultrasonography (US) to evaluate tumor response to different doses of an agent for antiangiogenic treatment in hepatoma-bearing mice, with histologic measurements of microvascular density (MVD) as the reference standard. MATERIALS AND METHODS: Experiments were approved by the regional animal care committee. Mice bearing subcutaneous H22 hepatoma were treated with different doses of thalidomide, 100 mg/kg in group B and 200 mg/kg in group C. Group A (control group) was treated with 0.5% carboxylmethylcellulose. Treatment groups and the control group included 10 mice each. Contrast-enhanced US was used to evaluate the percentage of nonenhanced area, and contrast-enhanced destruction-replenishment US was used to evaluate tumor blood flow. Tumor blood flow was compared with measurements of MVD. Comparisons were made by using one-way analysis of variance and the post hoc least significant difference test for multiple comparisons. RESULTS: Contrast-enhanced gray-scale US showed significant increases in the percentage of nonenhanced area in group C (mean, 10.56% ± 7.25 [standard deviation]), as compared with groups A (mean, 2.40% ± 3.12; P = .004) and B (mean, 3.75% ± 5.55; P = .012). Contrast-enhanced destruction-replenishment US showed significant decreases of tumor blood flow in groups B and C, as compared with group A (P = .003 and P < .001, respectively), and the blood flow in group C was significantly lower than that of group B (P = .01). Immunohistochemical analysis revealed significant decreases of MVD in groups B and C, as compared with MVD in group A (P = .002 and P < .001, respectively); however, there was no significant difference in MVD between groups B and C (P = .21). CONCLUSION: Quantification of tumor blood flow by using contrast-enhanced destruction-replenishment US shows the potential to guide drug dosage during antiangiogenic therapy.
Assuntos
Inibidores da Angiogênese/farmacologia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/tratamento farmacológico , Neoplasias Hepáticas Experimentais/diagnóstico por imagem , Neoplasias Hepáticas Experimentais/tratamento farmacológico , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/tratamento farmacológico , Talidomida/farmacologia , Análise de Variância , Animais , Carboximetilcelulose Sódica/farmacologia , Linhagem Celular Tumoral , Meios de Contraste/administração & dosagem , Camundongos , Distribuição Aleatória , Estatísticas não Paramétricas , Hexafluoreto de Enxofre/administração & dosagem , UltrassonografiaRESUMO
We investigated the use of contrast-enhanced ultrasonography (CEUS) with quantitative measurements to assess the stages of liver fibrosis in patients with chronic hepatitis B. One-hundred twenty-two patients with chronic hepatitis B were divided into three groups according to the Scheuer scoring system pathologically and according to clinical evidence: mild fibrosis (S0 and S1, n = 36); moderate fibrosis (S2 and S3, n = 24); and cirrhosis (S4 and clinically typical cirrhosis, n = 62). CEUS of hepatic vessels and parenchyma was performed using the Cadence contrast pulse sequencing technique, with an intravenous bolus injection of a contrast agent (SonoVue). Real-time CEUS imaging of the liver was recorded and analyzed offline. Contrast arrival time, baseline, and peak intensity in the hepatic artery, portal vein, right hepatic vein, and liver parenchyma were used to calculate intrahepatic transit times, hepatic artery to hepatic vein transit time (HA-HVTT) and portal vein to hepatic vein transit time (PV-HVTT), as well as increased signal intensity (ISI). The correlations between these quantitative parameters and the stages of fibrosis were analyzed using Spearman rank correlation coefficients. HA-HVTT and PV-HVTT were shortened gradually with the progression of liver fibrosis. PV-HVTT was statistically significant differences existed between the two paired groups (mild vs. moderate vs. cirrhosis groups, p < 0.001), whereas HA-HVTT was changed significantly between mild and moderate or cirrhosis groups (p < 0.001). HA-HVTT and PV-HVTT changes were significantly correlated with liver fibrosis severity (r = -0.5930, p < 0.001; r = -0.8215, p < 0.001). Area under receiver operating characteristic curves for HA-HVTT and PV-HVTT were 0.891 +/- 0.034 and 0.955 +/- 0.020 at fibrosis scores >or=S2, and 0.785 +/- 0.040 and 0.946 +/- 0.018 at fibrosis score >or=S4, respectively. ISI values in the portal vein and liver parenchyma decreased with the severity of fibrosis. This study demonstrated that hepatic CEUS with quantitative measurements of intrahepatic transit time reflected the severity of liver fibrosis. The real-time CEUS imaging with use of software-based quantitative analysis could provide reliable information of hepatic hemodynamic changes to noninvasively assess the severity of liver fibrosis in patients with chronic hepatitis B.
Assuntos
Hepatite C Crônica/diagnóstico por imagem , Hepatite C Crônica/metabolismo , Interpretação de Imagem Assistida por Computador/métodos , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/metabolismo , Fosfolipídeos/farmacocinética , Hexafluoreto de Enxofre/farmacocinética , Adulto , Algoritmos , Simulação por Computador , Meios de Contraste/administração & dosagem , Meios de Contraste/farmacocinética , Feminino , Hepatite C Crônica/complicações , Humanos , Aumento da Imagem/métodos , Cirrose Hepática/etiologia , Masculino , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Modelos Biológicos , Fosfolipídeos/administração & dosagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Hexafluoreto de Enxofre/administração & dosagem , UltrassonografiaRESUMO
PURPOSE: To determine if the number of nontargeted microbubbles retained in human carotid plaque is sufficient to be detected with ultrasonography (US). MATERIALS AND METHODS: The study protocol was approved by the local research ethics committee. Informed consent was obtained. A total of 37 subjects with carotid atherosclerosis (mean age, 69.9 years; age range, 49-86 years), of whom 27 (73%) were men (mean age, 69.7 years; age range, 58-86 years) and 10 (27%) were women (mean age, 70.3 years; age range, 49-86 years), were studied between December 2008 and May 2009 with late-phase (LP) contrast material-enhanced US by using flash imaging with a nonlinear mode at an intermediate mechanical index of 0.34 6 minutes after bolus contrast agent injection. Plaques were defined as symptomatic if symptoms consistent with stroke, transient ischemic attack, or amaurosis fugax had occurred in the neurovascular territory of the plaque studied within 12 months prior to entry into the study. Plaques were defined as asymptomatic if no such events had ever occurred within the neurovascular territory. Raw linear data were used to quantify echogenicity of the plaque, which was normalized to lumen echogenicity. Gray-scale median score was also calculated. RESULTS: Of the 37 subjects, 16 (43%) had symptomatic plaques and 21 (57%) had asymptomatic plaques. All examinations yielded evaluable LP contrast-enhanced US data. Normalized LP plaque echogenicity was greater in the symptomatic group (0.39; 95% confidence interval: -0.11, 0.89) than in the asymptomatic group (0.69; 95% confidence interval: -1.04, -0.34) (P = .0005). There was a moderate (rho = -0.44, P = .016) inverse correlation between normalized LP plaque echogenicity and gray-scale median score. CONCLUSION: By quantifying microbubble retention within the carotid plaque, LP contrast-enhanced US depicts clear differences between groups of subjects with plaque ipsilateral to symptoms and asymptomatic plaques. This technique has promise as a tissue-specific marker of inflammation and a potential role in the risk stratification of atherosclerotic carotid stenosis.
Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Doenças das Artérias Carótidas/patologia , Meios de Contraste/administração & dosagem , Feminino , Humanos , Inflamação/diagnóstico por imagem , Inflamação/patologia , Injeções Intravenosas , Masculino , Microbolhas , Pessoa de Meia-Idade , Fosfolipídeos/administração & dosagem , Estudos Prospectivos , Sensibilidade e Especificidade , Hexafluoreto de Enxofre/administração & dosagem , UltrassonografiaRESUMO
BACKGROUND AND AIM: Aim of this study was to compare contrast-enhanced ultrasound and multi-detector row computed tomography in detecting arterial hypervascularity in small cirrhotic nodules. PATIENTS AND METHODS: Sixty-two nodules (41 measuring 1.0-2.0 cm, 21 measuring 2.1-3.0 cm) found in 55 cirrhotic patients were examined with both methods. Lesions displaying arterial hypervascularity with washout in the portal/venous phase on both studies were considered hepatocellular carcinomas and treated; all other nodules were subjected to ultrasound-guided fine-needle biopsy. RESULTS: The larger nodules (2.1-3.0 cm) included 19 hepatocellular carcinomas (90%), 1 macroregenerative nodule type I and 1 macroregenerative nodule type II; 35 (87%) of the smaller nodules were hepatocellular carcinomas, 2 were macroregenerative nodules type I, 2 macroregenerative nodules type II and 2 hemangiomas. The two studies yielded concordant findings for 54 nodules (87%), including 46 hypervascular on both examinations and 8 that were consistently hypovascular. Two of the latter nodules were hepatocellular carcinomas. The other eight nodules displayed arterial hypervascularity on only one of the studies. Six of these (75%) were hepatocellular carcinomas, including five that were negative in the contrast-enhanced ultrasound study. CONCLUSION: Computed tomography and contrast-enhanced ultrasound show high agreement in the vascular classification of small nodules detected by ultrasound in cirrhotic livers, although the former technique was slightly more sensitive in the detection of arterial hypervascularization.
Assuntos
Cirrose Hepática/diagnóstico por imagem , Fígado/irrigação sanguínea , Neovascularização Patológica/diagnóstico por imagem , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia Doppler/métodos , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Carcinoma Hepatocelular/diagnóstico , Diagnóstico Diferencial , Feminino , Seguimentos , Hemangioma/diagnóstico , Humanos , Injeções Intravenosas , Fígado/diagnóstico por imagem , Cirrose Hepática/patologia , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/patologia , Fosfolipídeos/administração & dosagem , Estudos Prospectivos , Hexafluoreto de Enxofre/administração & dosagem , Tomografia Computadorizada por Raios XRESUMO
The objective of this study was to assess the efficacy of contrast-enhanced ultrasonography (CEUS) with SonoVue to evaluate the response to percutaneous treatment (ethanol injection/radiofrequency) of hepatocellular carcinoma in comparison with spiral computed tomography (CT) immediately and 1 month after treatment. Forty-one consecutive cirrhotic patients with early stage tumor (not suitable for resection) were included. Spiral CT and CEUS were performed in all patients before treatment, in the following 24 h, and 1 month later. The results of each examination were compared with the 1-month spiral CT, considered the gold standard technique. The 24-h CEUS and the 24-h spiral CT sensitivity to detect residual disease were 27% and 20%, respectively. The 24-h CEUS and the 24-h spiral CT positive predictive value of persistent vascularization detection were 75% and 66%, respectively. The 1-month CEUS detected partial responses in ten out of 11 cases (91% sensitivity, 97% specificity, 95% accuracy). Spiral CT and CEUS performed in the 24 h following treatment are slightly useful to evaluate therapeutic efficacy. The 1-month CEUS has a high diagnostic accuracy compared with spiral-CT in the usual assessment of percutaneous treatment response.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Ablação por Cateter , Aumento da Imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Microbolhas , Ultrassonografia de Intervenção/métodos , Administração Cutânea , Idoso , Carcinoma Hepatocelular/cirurgia , Depressores do Sistema Nervoso Central/uso terapêutico , Etanol/uso terapêutico , Reações Falso-Positivas , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fosfolipídeos/administração & dosagem , Fosfolipídeos/metabolismo , Estudos Prospectivos , Sensibilidade e Especificidade , Hexafluoreto de Enxofre/administração & dosagem , Hexafluoreto de Enxofre/metabolismo , Fatores de Tempo , Tomografia Computadorizada Espiral , Resultado do Tratamento , Carga TumoralRESUMO
The purpose of this study was to demonstrate the improvement in diagnostic quality and diagnostic accuracy of SonoVue microbubble contrast-enhanced ultrasound (CE-US) versus unenhanced ultrasound imaging during the investigation of extracranial carotid or peripheral arteries. 82 patients with suspected extracranial carotid or peripheral arterial disease received four SonoVue doses (0.3 ml, 0.6 ml, 1.2 ml and 2.4 ml) with Doppler ultrasound performed before and following each dose. Diagnostic quality of the CE-US examinations was evaluated off-site for duration of clinically useful contrast enhancement, artefact effects and percentage of examinations converted from non-diagnostic to diagnostic. Accuracy, sensitivity and specificity were assessed as agreement of CE-US diagnosis evaluated by an independent panel of experts with reference standard modality. The median duration of clinically useful signal enhancement significantly increased with increasing SonoVue doses (p< or =0.002). At the dose of 2.4 ml of SonoVue, diagnostic quality evaluated as number of inconclusive examinations significantly improved, falling from 40.7% at baseline down to 5.1%. Furthermore, SonoVue significantly (p<0.01) increased the accuracy, sensitivity and specificity of assessment of disease compared with baseline ultrasound. SonoVue increases the diagnostic quality of Doppler images and improves the accuracy of both spectral and colour Doppler examinations of extracranial carotid or peripheral arterial disease.
Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças Vasculares Periféricas/diagnóstico por imagem , Fosfolipídeos , Hexafluoreto de Enxofre , Adulto , Idoso , Idoso de 80 Anos ou mais , Artefatos , Estudos Cross-Over , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfolipídeos/administração & dosagem , Sensibilidade e Especificidade , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia Doppler em Cores/normas , Ultrassonografia Doppler Transcraniana/normasAssuntos
Meios de Contraste/administração & dosagem , Neoplasias Mamárias Experimentais/diagnóstico por imagem , Neovascularização Patológica/diagnóstico por imagem , Neovascularização Patológica/tratamento farmacológico , Fosfolipídeos/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia Mamária/métodos , Animais , Everolimo , Feminino , Microcirculação/efeitos dos fármacos , Ratos , Ratos Endogâmicos F344 , Sirolimo/análogos & derivados , Sirolimo/farmacologia , Fator de Necrose Tumoral alfa/farmacologiaRESUMO
OBJECTIVE: To study the feasibility of continuous intravenous SonoVue contrast echocardiography for qualitative assessment of reversible myocardial perfusion in dipyridamole stress tests. METHODS: Eleven patients (10 male and 1 female, mean age 66 years) with a history of chest pain and a clinical indication for stress sestamibi single photon emission computed tomography (SPECT) underwent concurrent SonoVue 99mTc myocardial contrast echocardiography (MCE). RESULTS: Of the total 176 segments obtained, 53 (30%) were regarded as indeterminate, 39 (22%) as discordant, and 84 (48%) as concordant between MCE and SPECT imaging. Two patients had abnormal SPECT results. The overall feasibility and specificity of MCE were 70 and 74%, respectively. The concordant (p = 0.59) and discordant (p = 0.55) segments were comparable with either MCE technique. However, continuous low-mechanical-index imaging produced fewer indeterminate segments (17 segments, 32%) than intermittent harmonic B-mode imaging (36 segments, 68%) (p = 0.04). Significantly more indeterminate segments were found in the left anterior descending artery territory. However, the overall concordance was similar (p = 0.5) in all three coronary artery territories. The concordance and discordance rates at different left ventricular levels (i.e., basal, mid, and apical) were similar (p = 0.50 and 0.08, respectively). CONCLUSION: Continuous-infusion SonoVue contrast echocardiography is feasible, with high specificity, for detecting myocardial perfusion defects as assessed by dipyridamole SPECT.