RESUMO
Human papillomaviruses (HPVs) are the causative agents of carcinoma of the uterine cervix. A number of HPV genotypes have been associated with cervical cancer and almost all tumors associated with HPV show strong p16 expression. However, there is little information on the possible impact of the HPV genotype and p16 immunostaining on the clinicopathological features or their prognostic value in cervical carcinoma. We evaluated a series of 194 patients with HPV-positive cervical cancers treated at our institution, focusing on the clinicopathological features and the relationship of the HPV genotypes and p16 immunostaining with the prognosis. A single HPV type was identified in 149 (77%) tumors, multiple HPV infection was detected in 30 cases (15%), and undetermined HPV type/s were identified in 15 (8%) carcinomas. HPV 16 and/or 18 were detected in 156 (80%) tumors. p16 was positive in 186 (96%) carcinomas, but eight tumors (4%) were negative for p16 (seven squamous cell carcinomas, one adenocarcinoma); 5/8 caused by HPV 16 and/or 18. Patients with HPV 16 and/or 18 were younger (49 ± 15 vs. 57 ± 17 years, p < 0.01) and more frequently had nonsquamous tumors than patients with other HPV types (24% [37/156] vs. 0% [0/38]; p = 0.01). Neither the HPV type nor multiple infection showed any prognostic impact. Patients with p16-negative tumors showed a significantly worse overall survival than women with p16-positive carcinomas (45 vs. 156 months, p = 0.03), although no significant differences in disease-free survival were observed. In the multivariate analysis, negative p16 immunostaining was associated with a worse overall survival together with advanced FIGO stage and lymph node metastases. In conclusion, the HPV genotype has limited clinical utility and does not seem to have prognostic value in cervical cancer. In contrast, a negative p16 result in patients with HPV-positive tumors is a prognostic marker associated with a poor overall survival.
Assuntos
Carcinoma/virologia , Inibidor p16 de Quinase Dependente de Ciclina/análise , Infecções por Papillomavirus/virologia , Neoplasias do Colo do Útero/virologia , Adulto , Idoso , Biomarcadores Tumorais/análise , Carcinoma/mortalidade , Intervalo Livre de Doença , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Infecções por Papillomavirus/mortalidade , Prognóstico , Neoplasias do Colo do Útero/mortalidadeRESUMO
PURPOSE: To describe radiologic findings, embolization technique, and clinical outcomes in patients with renal subcapsular hematoma and diffuse cortical hemorrhage. MATERIALS AND METHODS: Ten patients with renal subcapsular hematoma and diffuse cortical hemorrhage were reviewed. Nine of the 10 had undergone procedures (nephrostomy, n = 4; biopsy, n = 4; embolization of a cerebral aneurysm, n = 1) and 1 patient was receiving oral anticoagulation. Computed tomography (CT), angiography, and embolization of bleeding sites were performed in all patients. RESULTS: CT and angiography revealed subcapsular hematoma with diffuse cortical hemorrhage at the level of the interlobar and/or arcuate branches. Total embolization of intrarenal arterial branches was required in 3 patients. Partial embolization, which also resulted in permanent functional loss, was required in 4. The functional loss was likely caused by the embolization procedure and the underlying renal disease. In these 4 patients, renal failure was demonstrated by scintigraphy in 3 cases and based on the need to start chronic hemodialysis in 1 case. In the remaining three patients, embolization did not compromise renal function. CONCLUSIONS: Diffuse cortical hemorrhage unrelated to the site of puncture may be seen in some cases of subcapsular hematoma. The cause is likely the laceration of transcortical capsular arteries secondary to enlargement of the subcapsular hematoma. In the present case series, embolization achieved hemorrhage control, but loss of renal function was observed in patients with underlying renal disease.
Assuntos
Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Hematoma/diagnóstico por imagem , Hematoma/terapia , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Córtex Renal/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Nefropatias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of our study was to identify the most useful parameters to differentiate between renal cell carcinoma (RCC) and oncocytoma using four-phase CT. MATERIALS AND METHODS: Ninety-seven patients with solid renal lesions who underwent surgery with four-phase preoperative CT evaluation and with pathologic diagnosis of RCC or oncocytoma were included in the study. Features of tumors and the enhancement pattern in the four CT phases were evaluated and analyzed. Logistic regression models were used to assess independent predictors for malignancy. RESULTS: Histopathologically, 13 tumors were oncocytomas and 84 were RCCs. RCCs were larger (6.20 cm vs 3.21 cm, p = 0.0004) and more often enhanced heterogeneously (66 vs 6, p = 0.02). Lesions that were larger than 4 cm showed a significantly higher risk of malignancy (p = 0.0046). Significant differences were found in intensity of nodule enhancement between the nephrographic and the excretory phases with respect to the unenhanced phase (p = 0.003 and p = 0.0026). At multivariate analysis, parameters that were independent predictors of malignancy were enhancement pattern, with RCCs more often having heterogeneous enhancement than oncocytomas (odds ratio [OR], 0.18; 95% CI, 0.04-0.90), and nodule enhancement in the excretory phase in relation to the unenhanced phase, with RCCs showing lower enhancement (OR, 0.93; 95% CI, 0.88-0.97), and a size larger than 4 cm (OR, 4.01; 95% CI, 0.70-23.14). CONCLUSION: The combination of different CT parameters including lesion size larger than 4 cm, lesion enhancement in the excretory phase in relation to the unenhanced phase, and heterogeneous enhancement pattern helps distinguish RCC from oncocytoma.
Assuntos
Adenoma Oxífilo/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Idoso , Algoritmos , Meios de Contraste , Diagnóstico Diferencial , Diatrizoato de Meglumina , Feminino , Humanos , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , SoftwareRESUMO
OBJECTIVE: The prognosis of endometrial cancer depends on the correct surgical staging. In early stages, 18% to 30% rate of positive lymph nodes is reported with a myometrial invasion of 50% or more. According to this, patients with International Federation of Gynecology and Obstetrics stage Ib would benefit from staging lymphadenectomy. Therefore, it is important to classify these patients preoperatively to plan the surgery. In the recent years, 3-dimensional (3D) ultrasound and diffusion-weighted magnetic resonance imaging (DW-MRI) have been incorporated in the preoperative management of these patients. The aim of this study was to assess the usefulness of 3D ultrasound and DW-MRI as predictor of myometrial invasion in endometrial cancer. MATERIAL AND METHODS: We retrospectively compared the assessment of myometrial invasion by 3D ultrasound and DW-MRI with final pathologic evaluation on hysterectomy specimens, in 98 patients diagnosed of early-stage endometrial cancer, who underwent surgery at the Hospital Clinic of Barcelona between 2012 and 2015. RESULTS: Evaluation of the depth of myometrial invasion with 3D ultrasound had a sensitivity, specificity, and accuracy of 77%, 83% and 81%, respectively. Evaluation of the depth of myometrial invasion with DW-MRI had a sensitivity, specificity, and accuracy of 69%, 86%, and 81%, respectively. Association of both techniques improved all the values, showing a sensitivity, specificity, and accuracy of 87%, 93%, and 91%, respectively. In both 3D ultrasound and DW-MRI, the presence of leiomyomas was the first detectable cause of false negative (3% and 4%, respectively) and false-positive (3% and 1%, respectively). CONCLUSIONS: We conclude that the implementation of the 2 studies in early-stage endometrial cancer provides low false-negatives and false-positives rates. In cases of patients with leiomyomas, adenomiosis, or intrauterine fluid collection, definitive evaluation of myometrial invasion could be better deferred to intraoperative biopsy in an attempt to reduce false-negatives and false-positives rates.
Assuntos
Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Miométrio/diagnóstico por imagem , Miométrio/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Imageamento Tridimensional/métodos , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ultrassonografia/métodosRESUMO
Precise radiologic evaluation of regional adenopathic involvement in pelvic gynecologic tumors is fundamental to clinical practice because of its prognostic and therapeutic significance. Likewise, the identification of metastatic adenopathies at posttreatment imaging is essential for assessing response and detecting recurrence. Similar to urologic neoplasms, gynecologic neoplasms most often spread regionally to the pelvic and retroperitoneal lymph nodes, following the normal drainage pathways of the pelvic organs. Familiarity with routes of dissemination, treatment options, and means of analyzing lymph node characteristics is crucial to determine the extent of disease. Two staging systems can be used in characterizing gynecologic malignancies: the FIGO (International Federation of Gynecology and Obstetrics) system, which is the most commonly and universally used, and the TNM (tumor, node, metastasis) system, which is based on clinical and/or pathologic classification. Anatomic assessment with multidetector computed tomography (CT) and magnetic resonance (MR) imaging is still the most commonly used technique for the detection of lymph node spread, which is mainly based on morphologic criteria, the most important of which is nodal size. However, size has limited diagnostic specificity. Consequently, functional imaging techniques such as diffusion-weighted MR imaging, positron emission tomography combined with CT, lymphoscintigraphy, and sentinel lymph node mapping, which are based on molecular and physiologic activity and allow more precise evaluation, are often incorporated into diagnostic imaging protocols for staging of gynecologic malignancies.
Assuntos
Diagnóstico por Imagem , Neoplasias dos Genitais Femininos/patologia , Metástase Linfática , Feminino , Humanos , Estadiamento de Neoplasias , Prognóstico , Biópsia de Linfonodo SentinelaRESUMO
OBJECTIVE: The aim of this study was to assess the accuracy of Ultrasound (US) and contrast-enhanced ultrasound (CEUS) in the characterization of renal nodules indeterminate on CT by identifying benign cystic lesions not requiring further examination. METHODS: 72 patients with 83 indeterminate renal nodules on CT underwent baseline US and CEUS that classified lesions as benign (Bosniak I, II or IIF cysts) or potentially malignant (Bosniak III or IV cysts, solid nodules). The accuracy of US and CEUS in the differentiation between benign cysts and potentially malignant nodules was analyzed and compared with the final diagnosis obtained by histology or follow-up of at least 23 months with CEUS ± a conclusive CT/MR study. RESULTS: Final diagnoses comprised 50 benign complex cysts, 1 focal nephritis, 1 multilocular cystic nephroma, 3 oncocytomas, 1 transitional cell carcinoma and 27 renal cell carcinomas. Unenhanced US correctly classified 18/50 (36%) benign cysts and 17/33 (51.5%) of the potentially malignant lesions obtaining a sensitivity of 36%, specificity of 51.5%, and overall accuracy of 42.2%. The addition of CEUS allowed a correct diagnosis of 48 /50 (96%) benign cysts and of 31/33 (93.9%) nodules as potentially malignant, with a sensitivity of 96%, specificity of 93.9%, and overall accuracy of 95.2%. CONCLUSION: CEUS is very useful in the differentiation between benign complex cysts and other lesions that require further investigation in non-conclusive renal nodules detected on CT, improving the accuracy of baseline US from 42.2 to 95.2%.
Assuntos
Cistos/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
PURPOSE: To prospectively assess the accuracy of contrast agent-enhanced (CE) ultrasonography (US) with a second-generation US contrast agent in the detection and classification of endoleaks after endovascular repair of abdominal aortic aneurysms (EVAR), with computed tomographic (CT) angiography as the reference standard. MATERIALS AND METHODS: Institutional review board and written informed consent were obtained. Thirty-five patients who underwent EVAR were enrolled in a prospective study that consisted of CT angiography and CE US studies performed at 1- and 6-month follow-up and performed yearly thereafter. CE US was performed after bolus injection of 2.4 mL of sulfur hexafluoride by using equipment with specific software for contrast studies. Angiography was performed in patients who had type II endoleaks with an increase in aneurysm sac size and in patients with type I or III endoleaks. CE US sensitivity, specificity, positive and negative predictive values, and accuracy were determined for endoleak detection, and Cohen κ statistic was used to assess agreement of CE US and CT angiographic findings for endoleak classification. RESULTS: A total of 126 CT angiographic and CE US studies were performed. CT angiography depicted 34 endoleaks in 16 patients (type IA, n=1; type IB, n=1; type II inferior mesenteric artery, n=2; type II lumbar artery, n=28; type II complex, inferior mesenteric, and lumbar arteries, n=2). CE US depicted 33 endoleaks. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CE US in endoleak detection were 97%, 100%, 100%, 98%, and 99%, respectively. CE US enabled correct classification of 26 of 33 endoleaks. No clinically important endoleak was missed at CE US. CONCLUSION: CE US yields good sensitivity, specificity, and accuracy in endoleak detection, and it might represent a noninvasive tool that can be used in the follow-up of patients who undergo EVAR.
Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Meios de Contraste , Endoleak/diagnóstico por imagem , Hexafluoreto de Enxofre , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Resultado do Tratamento , UltrassonografiaRESUMO
Postpartum hemorrhage is one of the leading causes of maternal mortality worldwide. According to the time when postpartum hemorrhage develops, it is classified as (a) primary, or early, postpartum hemorrhage (within the first 24 hours after delivery) or (b) secondary, or late, postpartum hemorrhage (>24 hours to 6 weeks after delivery). Primary postpartum hemorrhage may be caused by uterine atony (75%-90% of cases), trauma of the lower portion of the genital tract, uterine rupture, uterine inversion, bladder flap hematoma, retention of blood clots or placental fragments, and coagulation disorders. Secondary postpartum hemorrhage may be caused by uterine subinvolution, coagulopathies, and abnormalities of the uterine vasculature. Extrauterine sources of bleeding include rectus sheath hematoma, direct arterial injuries, and the HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Severe postpartum hemorrhage is a life-threatening condition that is diagnosed on the basis of the findings from clinical examination, with or without ultrasonography. Computed tomography (CT) and magnetic resonance imaging are useful in the characterization of postpartum hemorrhage when medical treatment fails. Multidetector CT has an important role when intraabdominal bleeding is suspected and can be considered in cases of recurrent bleeding after embolization, as well as for the evaluation of postsurgical complications. A proposed clinical and CT imaging algorithm for postpartum hemorrhage is presented. A multidisciplinary approach to postpartum hemorrhage is essential to optimize the role of diagnostic and interventional radiology in obstetric hemorrhage, to avoid hysterectomy and thus preserve fertility.
Assuntos
Hemorragia Pós-Parto/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Feminino , Humanos , Gravidez , Adulto JovemRESUMO
PURPOSE: To evaluate the diagnostic value of computed tomography (CT) performed immediately after excretory urography (EU) in patients with delayed renal opacification or dilated upper urinary system with nonconclusive diagnosis after EU. MATERIALS AND METHODS: CT was performed immediately after EU in 39 patients with delayed opacification or dilated upper urinary system of unknown cause, without additional intravenous contrast administration for the CT study. We classified EU + CT findings as benign or malignant causes and we compared our results with the final diagnosis. RESULTS: The combination of EU + CT correctly diagnosed 38 out of the 39 cases with a sensitivity of 97%. Correct diagnosis was established in all malignant cases (n = 17) but one benign case consistent with blood clots in the upper urinary tract was incorrectly diagnosed as a multicentric urothelial carcinoma. Sensitivity, specificity, and accuracy for the diagnosis of the underlying cause with EU + CT was 100%, 95%, and 97%, respectively. The final diagnoses were: urothelial carcinoma (n = 10), stone disease (n = 10), bladder tumor (n = 4), benign post-treatment ureteral stenosis (n = 4), ureteral invasion (n = 3), benign bladder disease (n = 2), urinary tract infections (n = 2), crossing vessels (n = 1), ureteropelvic junction obstruction (n = 1), retrocaval ureter (n = 1), and blood clots in the upper urinary tract due to bleeding renal metastasis from lung cancer (n = 1). CONCLUSION: Combined EU and CT study allowed correct diagnosis of the underlying cause of delayed excretion or upper urinary tract dilatation in 97% of cases. The combination of EU and CT provides diagnosis reducing time and radiation.
Assuntos
Tomografia Computadorizada por Raios X/métodos , Urografia/métodos , Doenças Urológicas/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Doenças Urológicas/patologiaRESUMO
Regional lymph node involvement in urogenital malignancies (category N in the TNM classification system) is a significant radiologic finding, with important implications for treatment and prognosis. Male urogenital pelvic cancers commonly spread to iliopelvic or retroperitoneal lymph nodes by following pathways of normal lymphatic drainage from the pelvic organs. The most likely pathway of nodal spread (superficial inguinal, pelvic, or paraaortic) depends on the tumor location in the prostate, penis, testis, or bladder and whether surgery or other therapy has disrupted normal lymphatic drainage from the tumor site; knowledge of both factors is needed for accurate disease staging. At present, lymph node status is most often assessed with standard anatomic imaging techniques such as multidetector computed tomography or magnetic resonance (MR) imaging. However, the detection of nodal disease with these techniques is reliant on lymph node size and morphologic characteristics, criteria that provide limited diagnostic specificity. Functional imaging techniques, such as diffusion-weighted MR imaging performed with or without a lymphotropic contrast agent and positron emission tomography, may allow a more accurate nodal assessment based on molecular or physiologic activity.
Assuntos
Neoplasias Urogenitais/diagnóstico por imagem , Neoplasias Urogenitais/patologia , Virilha , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática , Imageamento por Ressonância Magnética , Masculino , Pelve , Tomografia Computadorizada por Raios XRESUMO
Contrast-enhanced ultrasound (CEUS) has been proved to be a useful imaging modality to characterize complex renal cysts using the Bosniak classification in a similar way as Computed Tomography (CT). CEUS helps not only in the characterization of complex cysts detected on baseline US but also in the characterization of indeterminate cystic lesions on CT or Magnetic Resonance (MR).
Assuntos
Doenças Renais Císticas/diagnóstico por imagem , Adulto , Meios de Contraste , Humanos , Doenças Renais Císticas/classificação , UltrassonografiaRESUMO
Multidetector computed tomography (CT) is the choice technique for preoperative evaluation of living renal donors. Living donor transplantation, as opposed to cadaveric donation, is the best option for recipient and graft survival. The need for kidney transplantation has undergone exponential growth over the past 40 years, and cadaveric donations are inadequate to meet this ever-increasing demand. These factors have led to a continued increase in organ donation from living related donors. From January 2007 to October 2009, 199 potential renal donors were studied in one center with 64-row multidetector CT. Of these candidates, 94 were rejected for donation. The remaining 105 potential donors were evaluated by a multidisciplinary committee, and 101 donor-recipient couples were accepted for renal donation and transplantation. Laparoscopic nephrectomy is the preferred surgical procedure for harvesting kidneys from living donors. Radiologists are responsible for providing accurate anatomic information about the donor's renal parenchyma, arteries, veins, and collecting system. Accurate reporting depends on the radiologist's level of expertise, attention to detail, and commitment to careful image evaluation. Knowledge of the surgical techniques and the difficulties that surgeons face during laparoscopic nephrectomy and renal transplantation is essential for compiling accurate radiologic reports.
Assuntos
Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Transplante de Rim/diagnóstico por imagem , Doadores Vivos , Seleção de Pacientes , Tomografia Computadorizada por Raios X/métodos , HumanosRESUMO
Contrast-enhanced ultrasound imaging represents a new approach to imaging tumoral neovascularity. This review describes the application of contrast-enhanced ultrasound in the detection, differential diagnosis, and staging of bladder cancer.
Assuntos
Neoplasias da Bexiga Urinária/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Humanos , Ultrassonografia , Bexiga Urinária/diagnóstico por imagemRESUMO
OBJECTIVE: The purpose of this study is to validate a multivariable predictive model previously developed to differentiate between renal cell carcinoma (RCC) and oncocytoma using CT parameters. METHODS AND MATERIALS: We included 100 renal lesions with final diagnosis of RCC or oncocytoma studied before surgery with 4-phase multidetector CT (MDCT). We evaluated the characteristics of the tumors and the enhancement patterns at baseline, arterial, nephrographic and excretory MDCT phases. RESULTS: Histopathologically 15 tumors were oncocytomas and 85 RCCs. RCCs were significantly larger (median 4.4 cm vs 2.8 cm, p = 0.006). There were significant differences in nodule attenuation in the excretory phase compared to baseline (median: 31 vs 42, p = 0.015), with RCCs having lower values. Heterogeneous enhancement patterns were also more frequent in RCCs (85.9% vs 60%, p = 0.027).Multivariable analysis showed that the independent predictors of malignancy were the enhancement pattern, with oncocytomas being more homogeneous in the nephrographic phase [Odds Ratio (OR) 0.16 (95% CI 0.03 to 0.75, p = 0.02)], nodule enhancement in the excretory phase compared to baseline, with RCCs showing lower enhancement [OR 0.96 (95% CI 0.93 to 0.99, p = 0.005)], and a size > 4 cm, with RCCs being larger [OR 5.89 (95% CI 1.10 to 31.58), p = 0.038]. CONCLUSION: The multivariable predictive model previously developed which combines different MDCT parameters, including lesion size > 4 cm, lesion enhancement in the excretory phase compared to baseline and enhancement heterogeneity, can be successfully applied to distinguish RCC from oncocytoma. ADVANCES IN KNOWLEDGE: This study confirms that multiparametric assessment using MDCT (including parameters such as size, homogeneity and enhancement differences between the excretory and the baseline phases) can help distinguish between RCCs and oncocytomas. While it is true that this multiparametric predictive model may not always correctly classify renal tumors such as RCC or oncocytoma, it can be used to determine which patients would benefit from pre-surgical biopsy to confirm that the tumor is in fact an oncocytoma, and thereby avoid unnecessary surgical treatments.
Assuntos
Adenoma Oxífilo/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Adenoma Oxífilo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Carcinoma de Células Renais/patologia , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Estudos Retrospectivos , Carga TumoralRESUMO
The behavior of dynamic enhancement using imaging modalities such as enhanced computed tomography, enhanced magnetic resonance, and contrast-enhanced ultrasound is one of the most important features of imaging characterization of kidney diseases. The enhancement pattern depends on the macrovasculature and microvasculature and is correlated with specific pathologic features. This review focuses on the enhancement pattern of different renal conditions including inflammatory, vascular, and oncologic diseases, with emphasis on the pathophysiological bases of altered perfusion.
Assuntos
Meios de Contraste , Diagnóstico por Imagem , Aumento da Imagem/métodos , Nefropatias/diagnóstico , HumanosRESUMO
OBJECTIVE: To assess the effect of surgeon's increasing experience in conservative laparoscopic surgery of women with rectovaginal endometriosis on the surgical outcome of these patients recurrence rate. DESIGN: Prospective cohort study. SETTING: University teaching hospital. PATIENT(S): The first 60 consecutive patients undergoing laparoscopic conservative surgery for symptomatic rectovaginal endometriosis at our institution during a 4- year period. INTERVENTION(S): Cases were classified into two groups according to the date of the patient's operation: the first 30 cases were defined as the early cases and the subsequent 30 cases as the late cases. MAIN OUTCOME MEASURE(S): Operating time, perioperative complications, and surgical outcome. Univariate and multivariate analyses for risk factors with recurrence of disease. RESULT(S): The two groups were similar in patient characteristics. There was a reduction in the rate of laparoconversion, operating time, estimated amount of blood loss, cases with incomplete removal, and recurrence rate with increasing surgeon's experience. Surgical completeness was significantly associated with recurrence of disease. CONCLUSION(S): A learning curve is demonstrated in the conservative laparoscopic management of patients with rectovaginal endometriosis. After gaining experience in performing 30 cases, the recurrence rate is significantly reduced.
Assuntos
Competência Clínica , Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Adulto , Estudos de Coortes , Endometriose/prevenção & controle , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos , Reto/cirurgia , Estudos Retrospectivos , Prevenção Secundária , Fatores de Tempo , Resultado do Tratamento , Vagina/cirurgiaRESUMO
We describe the case of a 68-year-old woman who presented with an arteriovenous fistula (AVF) between the common carotid artery and internal jugular vein following several failed attempts of right jugular catheter insertion. Sonographic examination revealed an AVF between both vessels with a high-velocity turbulent flow inside and an arterialized waveform in the jugular vein. Angiography confirmed the sonographic findings, and endovascular treatment was performed with a covered stent.
Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Artéria Carótida Primitiva/diagnóstico por imagem , Veias Jugulares/diagnóstico por imagem , Stents , Idoso , Fístula Arteriovenosa/etiologia , Feminino , Humanos , Doença Iatrogênica , Veias Jugulares/lesões , Veias Jugulares/cirurgia , Ultrassonografia Doppler em CoresRESUMO
OBJECTIVE: The goal of our study was to investigate the contributing factors, clinical repercussions, and implications for prognosis of high-resistance flow at the hepatic artery detected on Doppler sonography during the period immediately after orthotopic liver transplantation. MATERIALS AND METHODS: We retrospectively studied the transplanted livers of 90 patients who had been examined on Doppler sonography within the first 3 days after grafting. Seventeen variables from organ donors, transplant recipients, graft characteristics, and surgical procedures were investigated. Early clinical evolution was also analyzed. Follow-up was performed for 5 years. RESULTS: Forty-one (45.6%) of the 90 patients showed a high resistive index at the hepatic artery during the first 72 hr after transplantation. Two factors showed a statistically significant effect on the occurrence of a high resistive index at the hepatic artery immediately after transplantation: an older liver donor (p = 0.008) and extended preservation time (p = 0.005). No relation with early graft function was detected. The incidence of bile duct complications, retransplantation, or death was not higher at follow-up in patients with high-resistance flow than in those with normal flow. CONCLUSION: High-resistance flow at the hepatic artery detected on Doppler sonography during the period immediately after transplantation is a frequent finding and is related to older donor age and prolonged period of ischemia. This finding has neither significant clinical repercussions nor prognosis implications for early and long-term follow-up.
Assuntos
Artéria Hepática/diagnóstico por imagem , Artéria Hepática/fisiopatologia , Falência Hepática/diagnóstico por imagem , Falência Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Complicações Pós-Operatórias , Ultrassonografia Doppler , Resistência Vascular/fisiologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Falência Hepática/fisiopatologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
To evaluate the role of transrectal ultrasonography (TRUS) in the diagnosis of acute bacterial prostatitis (ABP) and to analyse the possible relationship between sonographic findings and clinical presentation and evolution, a prospective study using TRUS in patients with ABP was conducted. 45 patients (aged 58.2 +/- 14.6 y; mean +/- SD) with a clinical diagnosis of ABP admitted to a university hospital were studied prospectively. Clinical, analytical and microbiological data were recorded. TRUS was performed on admission and after 1 month of antibiotic therapy. Findings were correlated with clinical and evolutive data. The mean prostatic volume on admission was 40.5 +/- 17.9 ml. 21 patients (46.6%) had sonographically demonstrable lesions in peripheral prostatic lobules. One month later, when treatment had ended, lesions had disappeared or improved in 61.1% of patients, and the mean prostatic volume was 24.3 +/- 10.5 ml (p < 0.0005). Clinical, analytical and microbiological data and evolution of ABP were not significantly different in patients with or without sonographically demonstrable lesions. TRUS does not need to be performed in every patient with suspicion of ABP; the only indication for TRUS in ABP is the exclusion of prostatic abscess.