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1.
Eur J Nucl Med Mol Imaging ; 43(12): 2155-2165, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27260520

RESUMO

PURPOSE: In this retrospective review of prospectively collected data, we sought to investigate whether early FDG-PET assessment of treatment response based on total lesion glycolysis measured using a systemic approach (TLG-S) would be superior to either local assessment with EORTC (European Organization for Research and Treatment of Cancer) criteria or single-lesion assessment with PERCIST (PET Response Criteria in Solid Tumors) for predicting clinical outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib. We also examined the effect of bone flares on tumor response evaluation by single-lesion assessment with PERCIST in patients with metastatic bone lesions. METHODS: We performed a retrospective review of prospectively collected data from 23 patients with metastatic lung adenocarcinoma treated with erlotinib. All participants underwent FDG-PET imaging at baseline and on days 14 and 56 after completion of erlotinib treatment. In addition, diagnostic CT scans were performed at baseline and on day 56. FDG-PET response was assessed with TLG-S, EORTC, and PERCIST criteria. Response assessment based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) from diagnostic CT imaging was used as the reference standard. Two-year progression-free survival (PFS) and overall survival (OS) served as the main outcome measures. RESULTS: We identified 13 patients with bone metastases. Of these, four (31 %) with persistent bone uptake due to bone flares on day 14 were erroneously classified as non-responders according to the PERCIST criteria, but they were correctly classified as responders according to both the EORTC and TLG-S criteria. Patients who were classified as responders on day 14 based on TLG-S criteria had higher rates of 2-year PFS (26.7 % vs. 0 %, P = 0.007) and OS (40.0 % vs. 7.7 %, P = 0.018). Similar rates were observed in patients who showed a response on day 56 based on CT imaging according to the RECIST criteria. Patients classified as responders on day 14 according to the EORTC criteria on FDG-PET imaging had better rates of 2-year OS than did non-responders (36.4 % vs. 8.3 %, P = 0.015). CONCLUSIONS: TLG-S criteria may be of greater help in predicting survival outcomes than other forms of assessment. Bone flares, which can interfere with the interpretation of treatment response based on PERCIST criteria, are not uncommon in patients with metastatic lung adenocarcinoma treated with erlotinib.


Assuntos
Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Cloridrato de Erlotinib/administração & dosagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/mortalidade , Critérios de Avaliação de Resposta em Tumores Sólidos , Adenocarcinoma/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/normas , Prognóstico , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Taxa de Sobrevida , Resultado do Tratamento
3.
Pediatr Emerg Care ; 30(6): 415-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24892681

RESUMO

Methotrexate, a drug commonly used to treat juvenile idiopathic arthritis (JIA), has been reported to cause interstitial pneumonitis as a rare complication in adults with rheumatoid arthritis. Only 1 suspicious case of methotrexate pneumonitis in a child with JIA has been reported in 1998, though with no histopathologic proof. Given its rarity and nonspecific presenting symptoms, diagnosis may be challenging, and a life-threatening illness can occur without a high index of suspicion, as illustrated by this report of a 13-year-old girl with JIA who developed fever, nonproductive cough, and dyspnea as presenting features of interstitial pneumonitis after 1 year of methotrexate therapy. Chest high-resolution computed tomography revealed patchy ground-glass opacities and interlobular septal thickening without pleural effusion. Lung biopsy showed interstitial pneumonitis with diffuse alveolar damage. The symptoms and radiographs improved dramatically after withdrawal of methotrexate and administration of corticosteroids. A restrictive ventilatory defect with decreased diffusion capacity on pulmonary function testing persisted until 20 months after methotrexate withdrawal. There is no single pathognomic feature for methotrexate pneumonitis; rather, diagnosis relies on a constellation of clinical, radiologic, and pathologic findings. This report highlights the necessity for pediatricians to be continuously vigilant for interstitial pneumonitis in children receiving methotrexate who develop new unexplained pulmonary symptoms.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Juvenil/tratamento farmacológico , Doenças Pulmonares Intersticiais/induzido quimicamente , Pulmão/patologia , Metotrexato/efeitos adversos , Adolescente , Antirreumáticos/uso terapêutico , Criança , Feminino , Humanos , Metotrexato/uso terapêutico
4.
Aging (Albany NY) ; 15(7): 2721-2733, 2023 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-37036483

RESUMO

The prevalence of type 2 diabetes (T2DM) in elderly people has expanded rapidly. Considering cognitive impairment and being prone to hypoglycemia of the elder, the pros and cons of oral hypoglycemic agents (OHA) should be reassessed in this population. Pioglitazone might be appropriate for elderly DM patients because of its insulin-sensitizing effect and low risk of hypoglycemia. By using Taiwan's National Health Insurance Research Database, 191,937 types 2 diabetes patients aged ≥65 years under treatment between 2005 and 2013 were identified and further divided into two groups according to whether they received pioglitazone (pioglitazone group) or other OHAs (non-pioglitazone group) in the 3 months preceding their first outpatient visit date after 65 years of age, with a diagnosis of T2DM. Propensity score stabilization weight (PSSW) was used to balance the baseline characteristics. In results, the pioglitazone group (n = 17,388) exhibited a lower rate (per person-years) of major advanced cardiovascular events MACCE (2.76% vs. 3.03%, hazard ratio [HR]: 0.91, 95% confidence interval [CI]: 0.87-0.95), new- diagnosis dementia (1.32% vs. 1.46%, HR: 0.91, 95% CI: 0.84-0.98) but a higher rate of new-diagnosis bone fractures (5.37% vs. 4.47%, HR: 1.24, 95% CI: 1.19-1.28) than the non-pioglitazone group (n = 174,549). In conclusion, using pioglitazone may reduce the risks of MACCE and dementia but increases the probability of bone fractures in the elderly DM population.


Assuntos
Doenças Cardiovasculares , Demência , Diabetes Mellitus Tipo 2 , Fraturas Ósseas , Hipoglicemia , Idoso , Humanos , Pioglitazona/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Estudos de Coortes , Hipoglicemiantes/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Demência/epidemiologia , Demência/prevenção & controle , Demência/induzido quimicamente , Hipoglicemia/complicações , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle
5.
Plast Reconstr Surg ; 2023 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-37384892

RESUMO

BACKGROUND: In periarterial sympathectomy for intractable Raynaud's phenomenon, the extent of adventitiectomy as well as postoperative outcomes and hand perfusion assessment tools remain debatable. We evaluated the outcome of neurectomy of the nerve of Henle combined with ulnar tunnel release and periarterial adventitiectomy in the treatment of refractory Raynaud's phenomenon using objective measurements and patient-reported outcomes. METHODS: Nineteen patients with 20 affected hands were prospectively enrolled and underwent the proposed procedures from 2015 to 2021. Relevant data, including Michigan Hand Outcomes Questionnaire and 36-Item Short Form health questionnaire scores, were documented for analysis during a 3-year follow-up. RESULTS: The average ingress value of the three measured fingers (index, long, and ring) on indocyanine green angiography increased after surgery (p=0.02). The median number of ulcers decreased (p<0.001) and the median digital skin temperature increased (p<0.001). Questionnaire scores showed improvement in physical aspects, such as overall hand function (p≤0.001), activities of daily living (p=0.001), work performance (p=0.02), pain (p<0.001), physical function (p=0.053), and general health (p=0.048), as well as mental aspects, such as patient satisfaction (p<0.001) and mental health (p=0.001). The average indocyanine green ingress value of the three measured fingers significantly correlated with the patient-reported outcomes, including overall hand function (r=0.46, p=0.04), work performance (r=0.68, p=0.001), physical function (r=0.51, p=0.02), and patient satisfaction (r=0.35, p=0.03). CONCLUSIONS: The proposed surgical procedures provided satisfactory outcomes, both subjectively and objectively, over a follow-up period of up to 3 years. Indocyanine green angiography may provide rapid and quantitative measurements for perioperative hand perfusion assessment.

6.
Magn Reson Med ; 68(1): 1-7, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22576623

RESUMO

Myocardial fat accumulation could occur in diseased hearts. The degree of heterogeneity is unknown because accurate assessment is difficult using conventional proton magnetic resonance spectroscopy techniques in a beating heart. The purpose of this study was to characterize the distribution of intramyocellular lipid content and to determine its association with disease characteristics. Proton magnetic resonance spectroscopy was performed on formalin-fixed slices of human hearts at various circumferential locations (N = 55). Twenty-nine percent of the hearts had the highest fat content measured in the septum, followed by posterior (27%), lateral (26%), and anterior (18%) wall. Age was significantly correlated with the mean fat percentages (r2 = 0.12, P = 0.007). Those who died from cardiovascular disease demonstrated significantly higher and more heterogeneous fat distribution than those who did not (1.62% ± 1.1% vs. 0.59% ± 0.4%, P = 0.002). In summary, septal fat content is representative of mean fat percentage. Fat content increases with age; fat distribution may be heterogeneous when associated with cardiovascular disease.


Assuntos
Adiposidade , Envelhecimento/metabolismo , Cardiomiopatias/metabolismo , Transtornos do Metabolismo dos Lipídeos/metabolismo , Metabolismo dos Lipídeos , Espectroscopia de Ressonância Magnética/métodos , Feminino , Humanos , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Prótons , Distribuição Tecidual
7.
Arch Osteoporos ; 16(1): 153, 2021 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-34626252

RESUMO

DeepDXA is a deep learning model designed to infer bone mineral density data from plain pelvis X-ray, and it can achieve good predicted value for clinical use. PURPOSE: Osteoporosis is defined as a systemic disease of the bone characterized by a decrease in bone strength and deterioration of bone structure at the microscopic level, leading to bone fragility and increased risk of fracture. Bone mineral density (BMD) is the preferred method for the diagnosis of osteoporosis, and dual-energy x-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. Conventional radiography is more suited for the screening of osteoporosis rather than diagnosis, and osteoporosis can be detected on radiographs by experienced physicians only. This study explored the possibility of predicting BMD relative to DXA using patient radiographs. METHODS: A deep learning algorithm of convolutional neural network (CNN) was used for the purpose. The method includes image segmentation, CNN learning, and a convolution-based regression model (DeepDXA) that links the isolated images of the femur bone to predict BMD value. Data were obtained in a single medical center from 2006 to 2018, with a total amount of 3472 pairs of pelvis X-ray and DXA examination within 1 year. RESULTS: The proposed workflow successfully predicted BMD values of the femur bone with the correlation coefficient (R) of 0.85 (P < 0.001) and the accuracy of 0.88 for prediction osteoporosis, a finding that could be reliably ready for further clinical use. CONCLUSION: When suspicious osteoporosis is seen on plain films using the deep learning method we developed, further referral to DXA for the definite diagnosis of osteoporosis is indicated.


Assuntos
Densidade Óssea , Aprendizado Profundo , Absorciometria de Fóton , Humanos , Redes Neurais de Computação , Radiografia , Raios X
8.
Acta Neurochir (Wien) ; 152(2): 263-9; discussion 269, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19784547

RESUMO

PURPOSE: Recent advances in computed tomographic angiography (CTA) have resulted in its replacing digital subtraction angiography (DSA). However, CTA requires a powerful workstation and experienced technicians for image postprocessing. OsiriX, a free open-source medical imaging software with powerful three-dimensional (3D) capability, enables neurosurgeons to perform 3D rendering without extensive training. In this study, we examined the sensitivity and specificity of CTA with OsiriX as the primary diagnostic tool for intracranial aneurysms. METHOD: From May 2006 to March 2009, 121 patients with spontaneous subarachnoid hemorrhage (SAH) underwent CTA. The CTA source images were 3D rendered by neurosurgeons using OsiriX. All the possible locations for aneurysms were carefully reviewed. DSA was performed on every patient in any of the following conditions: for negative CTA findings, after surgical clipping of aneurysms or before transarterial embolization of aneurysms. RESULT: Of the 121 patients, 8 were excluded because DSA data were not available. In the remaining 113 patients, 20 patients had negative CTA findings. CTA with OsiriX detected 106 aneurysms in 93 patients, of which 103 were confirmed by DSA or postoperative DSA; 3 infundibular dilated pouches of small arteries were mistaken for aneurysms. Two anterior communicating artery aneurysms (1.5 mm and 1 mm) were missed by CTA from among all 113 patients. The sensitivity and specificity of CTA for detecting aneurysms on a per-patient basis were 98.9% and 100%, respectively. The sensitivity and specificity of CTA for detecting aneurysms on a per-aneurysm basis for detecting aneurysms were 98.1% and 86.3%, respectively. CONCLUSION: CTA with OsiriX enables accurate detection of intracranial aneurysms. Cerebral DSA should be reserved for those patients with negative CTA findings.


Assuntos
Angiografia Cerebral/métodos , Processamento de Imagem Assistida por Computador/métodos , Software , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Artérias Cerebrais/fisiopatologia , Erros de Diagnóstico , Embolização Terapêutica , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/terapia , Espaço Subaracnóideo/diagnóstico por imagem , Espaço Subaracnóideo/patologia , Espaço Subaracnóideo/fisiopatologia , Adulto Jovem
9.
Heart Surg Forum ; 13(4): E269-70, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20719736

RESUMO

The causes of aortic regurgitation (AR) include rheumatic heart disease, infective endocarditis, and various congenital and degenerative defects. We report an unusual case of AR in a 72-year-old man due to an aortic root pouch. The diagnosis AR was made by cardiac echocardiography, and the cause was revealed by cardiac catheterization and 64-slice cardiac computed tomography. During aortic valve replacement, a saccular pouch between the noncoronary cusp and the right coronary cusp of the aortic valve was noted.


Assuntos
Valva Aórtica/anormalidades , Idoso , Angiografia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Cateterismo Cardíaco , Ecocardiografia , Seguimentos , Próteses Valvulares Cardíacas , Humanos , Masculino , Tomografia Computadorizada por Raios X/métodos
10.
PLoS One ; 15(3): e0229648, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32119707

RESUMO

BACKGROUND: Hemopericardium is a common and hazardous complication of acute type A aortic dissection (ATAAD). This retrospective study aimed to clarify the short-term and mid-term outcomes in patients who underwent surgical rescues for hemopericardium complicated by ATAAD. METHODS: Between January 2007 and March 2019, 586 consecutive patients underwent ATAAD repair at our institution. According to preoperative computed tomography, hemopericardium was found in 191 patients (32.6%), 150 were stabilized with medical treatment, and 41 underwent surgical rescues for critical hemodynamics. The 41 patients were classified into groups according to their rescue procedures: emergent subxiphoid pericardiotomy (E-SXP group, n = 26, 63.4%) or emergent cardiopulmonary bypass (E-CPB group, n = 15, 36.6%). Clinical features, surgical information, postoperative complications, and 3-year survival were analyzed and compared. RESULTS: Demographics, comorbidities and aortic repair procedures were generally homogenous between the two groups, except for sex. The average systolic blood pressure was 62.4 ± 13.3 mmHg and 67.1 ± 13.1 mmHg in the E-SXP and E-CPB groups, respectively. A total of 29.3% of patients underwent cardiopulmonary resuscitation (CPR) before surgical rescues. The in-hospital mortality was similar (30.8% versus 33.3%, P = 0.865) in the two groups. Multivariate analysis revealed that preoperative CPR was an in-hospital predictor of mortality. For patients who survived to discharge, 3-year cumulative survival rates were 87.8% ± 8.1% and 60.0% ± 19.7% in the E-SXP and E-CPB groups, respectively (P = 0.170). CONCLUSIONS: Patients who underwent surgical rescues for ATAAD-complicated hemopericardium are at a high risk of in-hospital mortality. The two rescue procedures revealed similar short-term and mid-term outcomes.


Assuntos
Dissecção Aórtica/cirurgia , Ponte Cardiopulmonar/métodos , Derrame Pericárdico/cirurgia , Idoso , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Reanimação Cardiopulmonar/métodos , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Derrame Pericárdico/complicações , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida , Resultado do Tratamento
11.
Eur J Nucl Med Mol Imaging ; 36(4): 607-15, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19050875

RESUMO

PURPOSE: Breathing causes artefacts on PET/CT images. Cine CT has been used to reduce respiratory artefacts by acquiring multiple images during a single breathing cycle. The aim of this prospective study in non-small-cell lung cancer (NSCLC) patients was twofold. Firstly, we sought to compare the motion artefacts in PET/CT images attenuation-corrected with helical CT (HCT) and with averaged CT (ACT), which provides an average of cine CT images. Secondly, we wanted to evaluate the differences in maximum standardized uptake values (SUV(max)) between HCT and ACT. METHODS: Enrolled in the study were 80 patients with NSCLC. PET images attenuation-corrected with HCT (PET/HCT) and with ACT (PET/ACT) were obtained in all patients. Misregistration was evaluated by measurement of the curved photopenic area in the lower thorax of the PET images for all patients and direct measurement of misregistration for selected lesions. SUV(max) was measured separately at the primary tumours, regional lymph nodes, and background. RESULTS: A total of 80 patients with NSCLC were included. Significantly lower misregistrations were observed in PET/ACT images than in PET/HCT images (below-thoracic misregistration 0.25+/-0.58 cm vs. 1.17+/-1.17 cm, p<0.001; lesion misregistration 1.38+/-2.10 vs. 3.10+/-4.09, p=0.013). Significantly higher SUV(max) were noted in PET/ACT images than in PET/HCT images in the primary tumour (p<0.001) and regional lymph nodes (p<0.001). Compared with PET/HCT images, the magnitude of SUV(max) in PET/ACT images was higher by 0.35 for the main tumours and 0.34 for lymph nodes. CONCLUSION: Due to its significantly reduced misregistration, PET/ACT provided more reliable SUV(max) and may be useful in treatment planning and monitoring the therapeutic response in patients with NSCLC.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Fluordesoxiglucose F18/farmacologia , Neoplasias Pulmonares/diagnóstico , Compostos Radiofarmacêuticos/farmacologia , Respiração , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/métodos
12.
Eur Heart J Cardiovasc Imaging ; 20(2): 168-176, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30325426

RESUMO

Aims: We used contrast-enhanced cardiac magnetic resonance (CMR) to evaluate differences in myocardial fibrosis measured at the year-10 examination between participants with and without cardiovascular (CV) events accrued in a large population based study over the preceding 10-year follow-up period in this retrospective study. Methods and results: The MESA study enrolled 6814 participants free of CV disease at baseline (2000-2002). We included MESA participants who underwent contrast-enhanced CMR at the MESA year-10 exam (N = 1840). We defined a composite CV endpoint of coronary heart disease, heart failure, atrial fibrillation, stroke, and peripheral artery disease. Using CMR, we characterized myocardial fibrosis with late-gadolinium enhancement for scar and T1 mapping indices of diffuse fibrosis. Demographic and CV-risk adjusted logistic (presence of scar) and linear regression (pre-contrast T1, T1 at 12 and 25 min post-contrast, and extracellular volume fraction or ECV) models were used to assess the relationship between fibrosis and events. The mean values of T1 indices were-pre-contrast T1: 977 ± 45 ms; T1 at 12': 456 ± 40 ms; T1 at 25': 519 ± 41 ms; ECV: 27.1 ± 3.2%. One-hundred and forty-six (7.9%) participants had myocardial scar. The presence of scar was strongly associated with prior CV events (adjusted coeff: 1.36, P < 0.001). Lower post-contrast T1 times and higher ECV, indicative of greater diffuse fibrosis were strongly associated with CV events (T1 at 12': coeff = -10.0 ms, P = 0.004; T1 at 25': coeff =-9.2 ms, P = 0.008; ECV: coeff = 1.31%, P < 0.001). Conclusion: Individuals who suffered prior CV events have greater likelihood of diffuse myocardial fibrosis when compared with event-free individuals living in the same community.


Assuntos
Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/patologia , Imageamento por Ressonância Magnética/métodos , Miocárdio/patologia , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Fibrose/patologia , Gadolínio DTPA , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
13.
Acad Radiol ; 25(8): 1010-1017, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29395796

RESUMO

RATIONALE AND OBJECTIVES: We aimed to evaluate integrated adaptive iterative dose reduction 3D (AIDR 3D) algorithm in automatic tube current modulation (ATCM) for the quantification of coronary artery calcium score (CACS) and cardiac risk stratification. MATERIALS AND METHODS: A thoracic phantom with calcium inserts of known densities was scanned with filtered back projection (FBP) and AIDR 3D algorithms in small- and medium-sized phantoms. Twenty-four patients underwent two consecutive scans of CACS with FBP and AIDR 3D algorithms. The absolute Agatston score, Agatston score risk, volume score, and Agatston score percentile-based risk were compared, and concordance coefficients and agreement plots were made. RESULTS: Agatston and volume scores were significantly different between the phantom sizes (P < .01). There were no significant differences in the Agatston scores between FBP and AIDR 3D for the medium phantoms (P = .25). In the patients, there were no significant differences in Agatston and volume scores between FBP and AIDR 3D (P = .06 and P = .09, respectively). The correlation coefficients of Agatston and volume scores with AIDR 3D were excellent compared to those of FBP. There were no significant differences in Agatston score risk and Agatston score percentile-based risk between FBP and AIDR 3D (P = .74 and P = 1, respectively). There was mean dose reduction of 57.8% ± 18.6% for AIDR 3D. CONCLUSION: The absolute Agatston score differed between FBP and AIDR 3D reconstructions. However, the cardiac risk categorizations of the two methods were comparable. An integrated AIDR 3D algorithm with automatic tube current modulation enables radiation dose savings at a consistent noise level without sacrificing CACS.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Cálcio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Doses de Radiação
14.
PLoS One ; 12(8): e0183402, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28817662

RESUMO

INTRODUCTION: We aimed to evaluate whether the hyperemic myocardial blood flow (MBF) can be estimated using cadmium zinc telluride (CZT)-based single-photon emission computed tomography (SPECT) cameras with a single, rapid rest/stress dynamic scan. Dynamic contrast-enhanced (DCE) cardiac magnetic resonance imaging (MRI) was used as a reference modality for flow measurement. MATERIALS AND METHODS: The proposed protocol included both the rest and stress acquisitions within a 24-min scan. Patients were first injected with 99mTc-Sestamibi at the resting state. Sixty minutes after the first injection, the subject was positioned via scintigraphy, after which the list-mode data acquisition was initiated and continued for 24 minutes. Five minutes after data acquisition was initiated, a stressed state was induced via dipyridamole infusion, after which a second dose of 99mTc-Sestamibi was injected. Dynamic SPECT images were reconstructed for all subjects, who also underwent T1-weighted cardiac DCE-MRI performed on days other than those of the SPECT studies. MBF values were estimated for the rest and stress MRI studies, and for the stress portion of the SPECT study. The SPECT-measured hyperemic MBF was compared with the MR-measured hyperemic MBF and coronary flow reserve (CFR), based on the regions of interest. RESULTS: A total of 30 subjects were included in this study. The hyperemic MBF estimated from SPECT showed a strong correlation with the MR-measured hyperemic MBF (r2 = 0.76) and a modest correlation with the MR-measured CFR (r2 = 0.56). Using MR-measured CFR <1.3 as a cutoff for coronary stenosis, we found that the SPECT-measured hyperemic MBF served as a useful clinical index with 94% sensitivity, 90% specificity, and 93% accuracy. CONCLUSIONS: Hyperemic MBF can be measured with a rapid, single-scan rest/stress study with CZT-based SPECT cameras.


Assuntos
Cádmio/administração & dosagem , Coração/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Tecnécio Tc 99m Sestamibi/administração & dosagem , Telúrio/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Zinco/administração & dosagem , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Scand J Trauma Resusc Emerg Med ; 22: 12, 2014 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-24502644

RESUMO

OBJECTIVES: Venoarterial extracorporeal life support (VA-ECLS) is an effective support of acute hemodynamic collapse caused by miscellaneous diseases. However, using VA-ECLS for post-traumatic shock is controversial and may induce a disastrous hemorrhage. To investigate the feasibility of using VA-ECLS to treat post-traumatic shock or cardiac arrest (CA), a single-center experience of VA-ECLS in traumatology was reported. MATERIALS AND METHODS: This retrospective study included nine patients [median age: 37 years, interquartile range (IQR): 26.5-46] with post-traumatic shock/CA who were treated with VA-ECLS in a single institution between November 2003 and October 2012. The causes of trauma were high-voltage electrocution (n = 1), penetrating chest trauma (n = 1), and blunt chest or poly-trauma (n = 7). Medians of the injury severity score and the maximal chest abbreviated injury scale were 34 (IQR: 15.5-41) and 4 (IQR: 3-4), respectively. All patients received peripheral VA-ECLS without heparin infusion for at least 24 hours. RESULTS: The median time from arrival at our emergency department (ED) to VA-ECLS was 6 h (IQR: 4-47.5). The median duration of VA-ECLS was 91 h (IQR: 43-187) with a duration < 24 h in 2 patients. Among the 9 patients, 5 received VA-ECLS to treat the post-traumatic shock/CA presenting during (n = 2) or following (n = 3) damage-control surgeries for initial trauma, and another 4 patients were supported for non-surgical complications associated with initial trauma. VA-ECLS was terminated in 2 non-survivors owing to uncontrolled hemothorax or retroperitoneal hemorrhage. Three patients survived to hospital discharge. All of them received damage-control surgeries for initial trauma and experienced a complicated hospitalization after weaning off VA-ECLS. CONCLUSION: Using VA-ECLS to treat post-traumatic shock/CA is challenging and requires multidisciplinary expertise.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Cuidados para Prolongar a Vida/métodos , Traumatismo Múltiplo , Insuficiência Respiratória/terapia , Choque Traumático/terapia , Adulto , Feminino , Seguimentos , Parada Cardíaca/terapia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Choque Traumático/complicações , Choque Traumático/diagnóstico , Resultado do Tratamento
16.
Circ Cardiovasc Imaging ; 7(2): 292-302, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24550436

RESUMO

BACKGROUND: Tagged cardiac magnetic resonance provides detailed information on regional myocardial function and mechanical behavior. T1 mapping by cardiac magnetic resonance allows noninvasive quantification of myocardial extracellular expansion (ECE), which has been related to interstitial fibrosis in previous clinical and subclinical studies. We assessed sex-associated differences in the relation of ECE to left ventricular (LV) remodeling and myocardial systolic and diastolic deformation in a large community-based multiethnic population. METHODS AND RESULTS: Midventricular midwall peak circumferential shortening and early diastolic strain rate and LV torsion and torsional recoil rate were determined using cardiac magnetic resonance tagging. Midventricular short-axis T1 maps were acquired in the same examination pre- and postcontrast injection using Modified Look-Locker Inversion-Recovery sequence. Multivariable linear regression (estimated regression coefficient, B) was used to adjust for risk factors and subclinical disease measures. Of 1230 participants, 114 had a visible myocardial scar by late gadolinium enhancement. Participants without a visible myocardial scar (n=1116) had no history of previous clinical events. In the latter group, multivariable linear regression demonstrated that lower postcontrast T1 times, reflecting greater ECE, were associated with lower circumferential shortening (B=-0.1; P=0.0001), lower LV end-diastolic volume index (B=0.6; P=0.0001), and lower LV end-diastolic mass index (B=0.4; P=0.0001). In addition, lower postcontrast T1 times were associated with lower early diastolic strain rate (B=0.01; P=0.03) in women only and lower LV torsion (B=0.005; P=0.03) and lower LV ejection fraction (B=0.2, P=0.01) in men only. CONCLUSIONS: Greater ECE is associated with reduced LV end-diastolic volume index and LV end-diastolic mass index in a large multiethnic population without history of previous cardiovascular events. In addition, greater ECE is associated with reduced circumferential shortening, lower early diastolic strain rate, and a preserved ejection fraction in women, whereas in men, greater ECE is associated with greater LV dysfunction manifested as reduced circumferential shortening, reduced LV torsion, and reduced ejection fraction.


Assuntos
Aterosclerose/diagnóstico , Etnicidade , Cardiopatias/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Contração Miocárdica/fisiologia , Vigilância da População/métodos , Remodelação Ventricular , Idoso , Aterosclerose/etnologia , Aterosclerose/fisiopatologia , Progressão da Doença , Feminino , Fibrose/diagnóstico , Fibrose/etnologia , Fibrose/fisiopatologia , Cardiopatias/etnologia , Cardiopatias/fisiopatologia , Humanos , Masculino , Miocárdio/patologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Volume Sistólico , Estados Unidos/epidemiologia , Função Ventricular Esquerda/fisiologia
17.
Biomed Res Int ; 2013: 472347, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23586041

RESUMO

This work aims to validate the clinical significance of coronary artery calcium score (CACS) in predicting coronary artery disease (CAD) and cardiac events in 100 symptomatic patients (aged 37-87 years, mean 62.5, 81 males) that were followed up for a mean of 5 years. Our results showed that patients with CAD and cardiac events had significantly higher CACS than those without CAD and cardiac events, respectively. The corresponding data were 1450.42 ± 3471.24 versus 130 ± 188.29 (P < 0.001) for CAD, and 1558.67 ± 513.29 versus 400.46 ± 104.47 (P = 0.031) for cardiac events. Of 72 patients with CAD, cardiac events were found in 56 (77.7%) patients. The prevalence of cardiac events in our cohort was 13.3% for calcium score 0, 50% for score 11-100, 56% for score 101-400, 68.7% for score 401-1,000, and 75.0% for score >1000. Increased CACS (>100) was also associated with an increased frequency of multi-vessel disease. Nonetheless, 3 (20%) out of 15 patients with zero CACS had single-vessel disease. Significant correlation (P < 0.001) was observed between CACS and CAD on a vessel-based analysis for coronary arteries. It is concluded that CACS is significantly correlated with CAD and cardiac events.


Assuntos
Calcinose , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/patologia , Vasos Coronários/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/metabolismo , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
18.
Resuscitation ; 84(10): 1365-70, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23583612

RESUMO

OBJECTIVES: To investigate the effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support (ECLS) in high-risk acute pulmonary embolism (aPE) treated with pulmonary embolectomy. MATERIALS AND METHODS: This retrospective study included 25 consecutive patients of aPE treated with pulmonary embolectomy in a single institution between June 2005 and July 2012. All patients had high-risk aPE identified by computed tomographic angiography and were not suitable for thrombolytic therapy. High-risk aPE here was defined as aPE with (1) hemodynamic instability, (2) a pulmonary artery obstruction index (PAOI)≥0.5, (3) a diameter ratio of right ventricle-to-left ventricle (RV-to-LV)≥1.0, or (4) right heart thrombi. Once the eligibility was confirmed, a 3-staged therapeutic algorithm was adopted to perform an aggressive preoperative resuscitation, an expeditious pulmonary embolectomy with multidisciplinary postoperative care, and a thorough surveillance for recurrence. RESULTS: Among the 25 patients, 24 had a PAOI≥0.5 and 23 had a RV-to-LV diameter ratio≥1.0. Four patients had right heart thrombi. Sixteen patients developed preoperative instability requiring inotropic and/or mechanical support. Eight in the 16 had a preoperative cardiac arrest (CA) and six of these were bridged to surgery on ECLS. Three in the 6 patients weaned ECLS after surgery and survived to discharge. The overall in-hospital mortality was 20% (n=5). A preoperative CA (Odds ratio [OR]: 16, 95% confidence interval [CI]: 1.4-185.4, p=0.027, c-index: 0.80) and a postoperative requirement of ECLS (OR: 36, 95% CI: 2.1-501.3, p=0.008, c-index: 0.85) was the pre- and postoperative predictor of in-hospital mortality. No late deaths or re-admission for recurrence were found during a median follow-up of 19 months (interquartile range: 8-29). CONCLUSION: Pulmonary embolectomy was an effective intervention of high-risk aPE. However, the occurrence of preoperative CA still carried a high mortality in spite of the assistance of ECLS.


Assuntos
Algoritmos , Embolectomia , Oxigenação por Membrana Extracorpórea , Embolia Pulmonar/terapia , Doença Aguda , Adulto , Idoso , Criança , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
19.
Pulm Med ; 2013: 795140, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24381758

RESUMO

Study Objectives. The aim of this study is to investigate the correlation between serum high-sensitivity C-reactive protein (hs-CRP) and other clinical tools including high-resolution computed tomography (HRCT) in patients with stable non-CF bronchiectasis. Design. A within-subject correlational study of a group of patients with stable non-CF bronchiectasis, who were recruited from our outpatient clinic, was done over a two-year period. Measurements. Sixty-nine stable non-CF bronchiectasis patients were evaluated in terms of hs-CRP, 6-minute walk test, pulmonary function tests, and HRCT. Results. Circulating hs-CRP levels were significantly correlated with HRCT scores (n = 69, r = 0.473, P < 0.001) and resting oxygenation saturation (r = -0.269, P = 0.025). HRCT severity scores significantly increased in patients with hs-CRP level of 4.26 mg/L or higher (mean ± SD 28.1 ± 13.1) compared to those with hs-CRP level less than 4.26 mg/L (31.7 ± 9.8, P = 0.004). Oxygenation saturation at rest was lower in those with hs-CRP level of 4.26 mg/L or higher (93.5 ± 4.4%) compared to those with hs-CRP level less than 4.26 mg/L (96.4 ± 1.6%, P = 0.001). Conclusion. There was a good correlation between serum hs-CRP and HRCT scores in the patients with stable non-CF bronchiectasis.

20.
J Am Coll Cardiol ; 62(14): 1280-1287, 2013 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-23871886

RESUMO

OBJECTIVES: This study sought to determine the relationship of cardiovascular magnetic resonance (CMR) measures of tissue composition to age in the Multi-Ethnic Study of Atherosclerosis (MESA). BACKGROUND: Animal and human studies have demonstrated increased collagen deposition in senescent hearts. New CMR indices of tissue composition by using T1 mapping are sensitive to the presence of myocardial fibrosis. METHODS: A total of 1,231 study participants (51% women; age range 54 to 93 years) of the MESA cohort were evaluated with T1 mapping by using 1.5-T CMR scanners. None of the participants had focal scar on delayed enhancement CMR. Single-slice T1 mapping was performed at the midventricular level before and at 12- and 25-min delay after administration of gadolinium contrast by using a modified Look-Locker inversion recovery sequence. The partition coefficient was determined by the slope of the linear relationship of (1/T1myo vs. 1/T1blood). The extracellular volume fraction (ECV) was derived accounting for the hematocrit level. Multivariable regression analyses were performed, adjusting for traditional risk factors and left ventricular structure. RESULTS: Women had significantly greater partition coefficient, ECV, and precontrast T1 than men, as well as lower post-contrast T1 values (all p < 0.05). In general, linear regression analyses demonstrated that greater partition coefficient, pre-contrast T1 values, and ECV were associated with older age in men (multivariate regression coefficients = 0.01; 5.9 ms; and 1.04% per 10 years' change; all p < 0.05). ECV was also significantly associated with age in women after multivariable adjustments. CONCLUSIONS: CMR parameters that have been associated with myocardial fibrosis were related to older age in the MESA study. Women had higher ECV than men but less ECV change over time.


Assuntos
Envelhecimento/patologia , Aterosclerose/diagnóstico , Cardiomiopatias/diagnóstico , Meios de Contraste , Etnicidade , Imagem Cinética por Ressonância Magnética/métodos , Miocárdio/patologia , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/etnologia , Cardiomiopatias/etnologia , Feminino , Fibrose/diagnóstico , Fibrose/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia
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