RESUMO
Aim: Our aim was to make a detailed evaluation and cost analysis of the 10 most frequent angiography interventions in outpatients and inpatients at a university hospital. Material and Methods: Based on a detailed process-oriented model we calculated the cost and income for port and dialysis catheter implantation, PTA at the upper (UL) and lower leg (LL), TACE, SIRT, stent angioplasty (pelvis, visceral and supra-aortal vessels) and cerebral coil embolisation for the situations mentioned above. Various income models (DRG, GOÄ) were considered. A comprehensive evaluation of the overhead and personnel costs was performed. Results: The calculated data (in ) were as follows (overall, material, personnel costs, DRG income, GOÄ income inpatients, outpatients): port catheter: 375, 266, 59, 328, 260, 612; dialysis catheter: 456, 349, 59, 272, 343, 807; PTA UL: 595, 445, 99, 1 240, 425, 1 077; PTA LL: 732, 552, 129, 1 082, 425, 1 184; stent pelvis: 1 523, 1 338, 135, 1 323, 815, n/a; stent visceral: 2 124, 1 875, 199, 1 326, 912, n/a; stent supra-aortal: 1 901, 1 713, 138, 6 705, 1 138, n/a; TACE: 1 359, 1 120, 188, 2 588, 598, n/a; SIRT: 1 251, 1 054, 147, 2 289, 1 107, n/a; intracranial embolisation: 6 684, 6 367, 266, 6 531, n/a, n/a. Conclusion: Depending on the income model applied, most procedures caused a deficit, especially using GOÄ calculations. Outpatients covered by the private health insurance caused earnings for the procedures applied. Only TACE, SIRT and stent angioplasty of supra-aortal vessels caused profits in inpatients using InEK calculations.
Assuntos
Angiografia/economia , Custos Hospitalares/estatística & dados numéricos , Hospitais Universitários/economia , Programas Nacionais de Saúde/economia , Mecanismo de Reembolso/economia , Alemanha , HumanosRESUMO
PURPOSE: To evaluate the reliability of ultrasound elastography for delineating thermal ablation defects post-radiofrequency ablation (RFA) by comparing lesion dimensions determined by real-time elastography (RTE) with the findings of contrast-enhanced ultrasound (CEUS). MATERIALS AND METHODS: A total of 21 malignant liver tumors were percutaneously ablated using RFA. Color-coded elastography and CEUS were performed by one experienced examiner, using a 1â-â5âMHz multi-frequency convex transducer (LOGIQ E9, GE). Lesions were examined using CEUS and real-time elastography (RTE) to assess ablation defects. Measurements of lesions (long axis, short axis, and area) representing the same image plane used for elastography were taken during CEUS examination and compared to the measurements obtained from the elastograms. All measurements were performed by two independent observers. RESULTS: A statistically significant correlation in vivo between RTE and CEUS measurements with respect to the lesion's principal axis and area (râ=â0.876 long axis, râ=â0.842 short axis and râ=â0.889 area) was found. Inter-rater reliability assessed with the concordance correlation coefficient was substantial for all measurements (ρc ≥â0.96) Overall, elastography slightly underestimated the lesion size, as judged by the CEUS images. CONCLUSION: These results support that RTE could potentially be used for the routine assessment of thermal ablation therapies.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter , Meios de Contraste , Técnicas de Imagem por Elasticidade/métodos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia/métodos , Idoso , Feminino , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/diagnóstico por imagem , Variações Dependentes do Observador , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Prospectivos , Sensibilidade e Especificidade , Estatística como AssuntoRESUMO
BACKGROUND: Technological advances introduced hand-carried ultrasound (HCU) imagers in daily clinical workflow providing several benefits such as fast bedside availability and prompt diagnosis. PURPOSE: To evaluate the diagnostic yield of a latest generation HCU imager compared to contrast-enhanced multidetector computed tomography (MDCT) for the detection of pericardial effusion (PE) in cardiothoracic intensive care unit (ICU) patients. MATERIAL AND METHODS: Thirty-six patients from a cardiothoracic ICU were enrolled to this study irrespective of their underlying disease. All patients were examined with a new generation HCU for the presence of PE. Definite diagnosis of PE was based on findings of MDCT as standard of reference. Statistical analysis was performed using PASW 18. RESULTS: PE was identified in 20 patients by MDCT (prevalence 56%). The HCU examination was carried out technically successfully in all patients. Sensitivity, specificity, positive and negative predictive value of HCU for the diagnosis of PE were 75%, 88%, 88%, and 74%, respectively. CONCLUSION: HCU provides rapid, practical, reliable, and cost-effective diagnosis of PE in patients on cardiothoracic ICU.
Assuntos
Cuidados Críticos/métodos , Unidades de Terapia Intensiva , Derrame Pericárdico/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Intensificação de Imagem Radiográfica/métodos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Ultrassonografia , Adulto JovemRESUMO
AIM: To evaluate the diagnostic reliability of a new generation wireless point-of care ultrasound device for abdominal and thoracic findings. MATERIAL AND METHODS: 40 patients (16 females, 24 males 19 -80 years, on average 56.1 years) were scanned by an experienced examiner using the new wireless Vscan Air device for abdominal and thoracic findings. The probe frequencies were 2-5âMHz (convex probe) and 3-12âMHz for the linear probe. As a reference standard, all patients were also examined using high-end ultrasound (LOGIQ E9/LOGIQ E10). Results were interpreted independently by two examiners in consensus, also with regard to the image quality (0-4, from not assessableâ=â0, to excellent 4). RESULTS: In all 40 patients (100%) examination with conventional high-end ultrasound and the Vscan Air ultrasound device was feasible. Sensitivity, specificity, positive and negative predictive value for the diagnosis of abdominal and thoracic findings were 63.3%, 100%, 100%, and 40%, respectively. Most main diagnostic findings were detected using the mobile device compared to the high-end ultrasound. Limitations were found regarding characterization and classification of hepatic and renal tumorous lesions.Image quality revealed mostly minor diagnostic limitations for the mobile device, mean 2.9 (SD ± 0.300) and was excellent or with only minor diagnostic limitations for conventional high-end ultrasound, mean 3.25 (SD ± 0.438). CONCLUSION: Due to its easy application and its high diagnostic reliability, point-of-care ultrasound systems of the latest generation represent a valuable imaging method for the primary assessment of abdominal and thoracic findings, especially in patients on intensive care units or in emergency situations.
Assuntos
Abdome , Sistemas Automatizados de Assistência Junto ao Leito , Feminino , Humanos , Fígado , Masculino , Reprodutibilidade dos Testes , UltrassonografiaRESUMO
PURPOSE: To show the feasibility of the detection of endoleaks following endovascular treatment of aortic aneurysms using contrast harmonic imaging (CHI) in comparison to computed tomography angiography (CTA). MATERIALS AND METHODS: 51 patients with suspected endoleaks, who underwent previous endovascular treatment for abdominal aortic aneurysm, were examined using CTA and vascular ultrasound. Biphasic CTA in all cases and digital subtraction angiography (DSA) in 8 patients were evaluated by two radiologists in consensus and served as the standard of reference. Ultrasound was performed by an experienced examiner with a multi-frequency linear transducer (2 - 4 MHz) using CHI following bolus injection of 2.4 ml of SonoVue® IV (maximum 5 ml). All images were evaluated by two observers in consensus regarding the reperfusion of the abdominal aneurysm using time intensity curve (TIC) analysis. RESULTS: In 30 of 51 patients, endoleaks were detected concordantly in CHI and CTA. In 20 of 51 patients, no endoleak was found in CHI and CTA/DSA. In one patient, a type II endoleak could initially only be detected in CHI and was later confirmed in follow-up examinations by CTA (sens. 99%, spec. 93%, NPV 99 %, PPV 95%). TIC analysis allowed evaluation of the perfusion dynamics of endoleaks in all patients. Significant differences were found (p < 0.05, Mann Whitney U Test) regarding the perfusion within the aneurysm when an endoleak was present (10.39 ± 4.29 dB) or not present (6.42 ± 2.86 dB). CONCLUSION: CHI with perfusion analysis allows definite detection of endoleaks, especially if contraindications for CTA are present. CHI presents an alternative for follow-up monitoring.
Assuntos
Angiografia Digital , Aneurisma da Aorta Abdominal/cirurgia , Aortografia , Endoleak/diagnóstico por imagem , Procedimentos Endovasculares/métodos , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Complicações Pós-Operatórias/diagnóstico por imagem , Fluxo Sanguíneo Regional/fisiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Hexafluoreto de EnxofreRESUMO
AIM: Pre-surgical evaluation of the extent of internal carotid artery stenosis (ICA) according to NASCT criteria using digital 3D ultrasound methods. MATERIAL/METHODS: In a prospective study, 25 patients (54-88 years, mean 75) with neurological deficits and the diagnosis of ICA stenosis underwent pre-surgical ultrasound examination using Color Coded Duplex Sonography (CCDS), 3D CCDS, 3D power Doppler, 3D B-flow, contrast enhanced 3D B-flow, and CTA/MRA. Ultrasound was performed by an experienced examiner with a multifrequency linear transducer (6-9 MHz, Logiq 9, GE). After bolus injection of 2.4 ml Sonovue i.v., low mechanical index technique (MI<0.16) was used for contrast enhanced 3D B-flow. As reference method for evaluation of the extent of ICA stenosis each patient underwent CTA (multislice CT, Sensation 16, Siemens) and/or MRA (1.5 T, Symphony Siemens). Indications for surgery (carotid EEA) followed the NASCET criteria. All images were interpreted and evaluated independently by two observers with three measurements of the degree of the ICA stenosis. For assessment of the extent of stenosis a 10%-scale from 50% to 99% was used. Statistical analysis was performed using Spearman Correlation and Wilcoxon Signed Rank Test with a significance threshold of p<0.05. RESULTS: Assessment of the extent of ICA stenosis during surgery and in CTA/MRA displayed a range from 60% to 99% (mean 80%). Non significant differences were found with paired Wilcoxon test only for 3D B-flow with and without contrast medium (p<0.05). Correlation with surgical evaluation regarding the extent of ICA stenosis using Spearman correlation teat was 0.77 for B-scan, 0.90 for 3D CCDS, 0.84 for 3D Power Doppler, 0.91 for B-flow and 0.93 for contrast enhanced 3D B-flow. When circular calcifications were present, contrast enhanced flow detection of 3D B-flow proved to be useful. Visualisation of intrastenotic variances of severe and profound stenosis (70-99%) without blooming and reverberation artefacts was possible only with 3D B-flow. This facilitates the detection of the morphology of plaques ulcers as an embolic source. CONCLUSION: In correlation with surgery and CTA/MRA, a valid evaluation of the extent and morphology of ICA stenosis using 3D B-flow, with and without contrast medium, is feasible.
Assuntos
Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Imageamento Tridimensional/métodos , Idoso , Idoso de 80 Anos ou mais , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia Doppler em CoresRESUMO
AIM: To establish the extent to which contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics facilitates the detection of hepatic tumors. METHODS: One hundred patients with histologically confirmed malignant or benign hepatic tumor (maximum size 5 cm) were analyzed. Contrast-enhanced ultrasound (bolus injection 2.5 mL SonoVue) was carried out with intermittent breath-holding technique using a multifrequency transducer (2.5-4 MHz). Native vascularization was analyzed with power Doppler. The contrast-enhanced dynamic ultrasound investigation was carried out with contrast harmonic imaging in true detection mode during the arterial, portal venous and late phases. Mechanical index was set at 0.15. Perfusion analysis was performed by post-processing of the raw data [time intensity curve (TIC) analysis]. The cut-off of the gray value differences between tumor and normal liver tissue was established using Receiver Operating Characteristic (ROC) analysis 64-line multi-slice computed tomography served as reference method in all cases. Magnetic resonance tomography was used additionally in 19 cases. RESULTS: One hundred patients with 59 malignant (43 colon, 5 breast, 2 endocrine metastases, 7 hepatocellular carcinomas and 2 kidney cancers) and 41 benign (15 hemangiomas, 7 focal nodular hyperplasias, 5 complicated cysts, 2 abscesses and 12 circumscribed fatty changes) tumors were included. The late venous phase proved to be the most sensitive for classification of the tumor type. Fifty-eight of the 59 malignant tumors were classified as true positive, and one as false negative. This resulted in a sensitivity of 98.3%. Of the 41 benign tumors, 37 were classified as true negative and 4 as false negative, which corresponds to a specificity of 90.2%. Altogether, 95.0% of the diagnoses were classified as correct on the basis of the histological classification. No investigator-dependency (P = 0.23) was noted. CONCLUSION: The results show the possibility of accurate prediction of malignancy of hepatic tumors with a positive prognostic value of 93.5% using advanced contrast-enhanced ultrasound. Contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics is a valuable tool to discriminate hepatic tumors.
Assuntos
Meios de Contraste , Neoplasias Hepáticas/diagnóstico por imagem , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia Doppler , Ultrassonografia de Intervenção , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Alemanha , Humanos , Interpretação de Imagem Assistida por Computador , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/patologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: Comparison of the diagnostic findings of MRI, CT and CEUS in children with benign and malignant and portal venous anomalies of the liver. MATERIALS/METHODS: Retrospective analysis of the diagnostic findings of CEUS, MRI and CT scans in 56 children (age 0-17 years) with a total of 60 benign and malignant liver lesions and anomalies of the portal vein/perfusion. All patients underwent CEUS using sulphur hexafluoride microbubbles and a multi-frequency probe (1-5âMHz, 6-9âMHz). Cine-loops were stored up to 3 minutes. MRI was performed in 38 lesions. CT was performed in 8 lesions. RESULTS: Out of the 56 patients 49 liver lesions (48 benign, 1 malignant), 9 anomalies of the portal vein/perfusion and 2 of the biliary system were detected. 16/49 lesions were analyzed histopathologically. Using CEUS, the characterization of the lesions was possible in 45 out of 49 cases. In 32 cases, CEUS provided the exact diagnosis. Only two benign lesions were falsely categorized as malignant.Findings of MRI and CEUS were concordant in 84% of cases (nâ=â32/38). CEUS considered 1 benign lesion to be malignant. 2 lesions were not detectable and in 3 lesions no definite diagnosis was established using MRI.Findings of CT and CEUS were concordant in 5 of 8 cases. In 21 lesions CEUS as the only imaging modality was found to be sufficient for diagnostics. CONCLUSION: Despite the restricted indications for using CEUS in children, it offers a high diagnostic detection rate (93%) for characterization of liver lesions and portal vein anomalies.
Assuntos
Hepatopatias/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Fígado/diagnóstico por imagem , Veia Porta/anormalidades , Veia Porta/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Meios de Contraste , Feminino , Humanos , Lactente , Recém-Nascido , Fígado/irrigação sanguínea , Imageamento por Ressonância Magnética , Masculino , Microbolhas , Estudos Retrospectivos , Hexafluoreto de Enxofre , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The relationship between glucose concentrations in interstitial fluid (ISF) and blood has generated great interest due to its importance in minimally invasive and noninvasive techniques for measuring blood glucose. The relationship between glucose levels in dermal ISF, and capillary and venous blood was studied with the dermal ISF samples obtained using the suction blister technique. The study was conducted with intensely managed diabetics whose blood glucose levels were manipulated so as to induce rapid changes in blood glucose levels. Glucose levels in the three compartments exhibited high correlations both when individual subjects were considered separately and when data from all subjects were combined. No significant time lag during glucose excursions was observed among the ISF, and capillary and venous glucose levels.
Assuntos
Glicemia/metabolismo , Espaço Extracelular/metabolismo , Glucose/metabolismo , Adulto , Capilares/metabolismo , Feminino , Humanos , Masculino , Fluxo Sanguíneo Regional/fisiologia , Pele/irrigação sanguínea , Espectroscopia de Luz Próxima ao Infravermelho , Veias/metabolismoRESUMO
Fenestrations and duplications of the cervical and intracranial arteries are rare anatomic variants, reported to be associated with aneurysms or other vascular anomalies. We here present a patient with a supraclinoid ICA fenestration in combination with a duplication of the MCA originating from the ICA fenestration and an associated aneurysm.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Artéria Cerebral Média/anormalidades , Artéria Cerebral Média/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Aneurisma Intracraniano/cirurgia , Pessoa de Meia-Idade , Artéria Cerebral Média/cirurgia , Radiografia , Doenças Raras/diagnóstico por imagem , Doenças Raras/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to assess differences in enhancement effects of liver parenchyma between normal and cirrhotic livers on dynamic, Gd-EOB-DTPA enhanced MRI at 3T. MATERIALS AND METHODS: 93 patients with normal (n=54) and cirrhotic liver (n=39; Child-Pugh class A, n=18; B, n=16; C, n=5) underwent contrast-enhanced MRI with liver specific contrast media at 3T. T1-weighted volume interpolated breath hold examination (VIBE) sequences with fat suppression were acquired before contrast injection, in the arterial phase (AP), in the late arterial phase (LAP), in the portal venous phase (PVP), and in the hepatobiliary phase (HBP) after 20 min. The relative enhancement (RE) of the signal intensity of the liver parenchyma was calculated for all phases. RESULTS: Mean RE was significantly different among all evaluated groups in the hepatobiliary phase and with increasing severity of liver cirrhosis, a decreasing, but still significant reduction of RE could be shown. Phase depending changes of RE for each group were observed. In case of non-cirrhotic liver or Child-Pugh Score A cirrhosis mean RE showed a significant increase between AP, LAP, PVP and HBP. For Child-Pugh B+C cirrhosis RE increased until PVP, however, there was no change in case of B cirrhosis (p=0.501) and significantly reduced in case of C cirrhosis (p=0.043) during HBP. CONCLUSION: RE of liver parenchyma is negatively affected by increased severity of liver cirrhosis, therefore diagnostic value of HBP could be limited in case of Child Pugh B+C cirrhosis.
Assuntos
Algoritmos , Gadolínio DTPA , Aumento da Imagem/métodos , Cirrose Hepática/patologia , Fígado/patologia , Imageamento por Ressonância Magnética/métodos , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: This study was designed to determine the feasibility and efficacy of endovascular embolization with liquid embolic agent ethylene vinyl alcohol copolymer (Onyx) in patients with acute traumatic arterial bleeding. METHODS: This is a retrospective review of 13 patients (9 men and 4 women; mean age 45 years) with severe trauma who underwent embolotherapy using Onyx from November 2003 to February 2009. Bleeding was located in the pelvis (5 patients), kidney (3 patients), mesenteric region (2 patients), retroperitoneal space (2 patients), neck (1 patient), and thigh (1 patient). In three cases (23.1%), Onyx was used in conjunction with coils. We evaluate the technical and clinical success, procedural and embolization time, occurrence of rebleeding, and embolotherapy-related complications, such as necrosis or migration of Onyx into nontarget vessels. RESULTS: In all patients, embolotherapy was technically and clinically successful on the first attempt. Control of bleeding could be reached with a mean time of 19 (range, 4-63) min after correct placement of the microcatheter in the feeding artery. No recurrent bleeding was detected. No unintended necrosis or migration of Onyx into a nontarget region was observed. During the follow-up period, three patients (23.1%) died due to severe intracranial hemorrhage, cardiac arrest, and sepsis. CONCLUSIONS: Transcatheter embolization with new liquid embolic agent Onyx is technically feasible and effective in trauma patients with acute arterial hemorrhage.
Assuntos
Artérias/lesões , Dimetil Sulfóxido/administração & dosagem , Embolização Terapêutica/métodos , Hemorragia/terapia , Polivinil/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Hemorragia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: Service characteristics in hospital care in general have a high influence on patients' contentment. One of the key features of good service is waiting time. The aim of this study was to analyze the influence of ambience and individual care while waiting for a radiological examination on patient satisfaction. MATERIALS AND METHODS: The study was conducted prospectively and included and total of 100 patients at a tertiary care center. All patients waiting for contrast-enhanced computed tomography (CT) and were randomly divided into two groups. 50 patients waited under regular circumstances, i.e. the normal waiting ara of our radiological department, whilst the remaining 50 patients spent their waiting time in a separate small waiting area with intensified care and service. Both subjective and objective waiting time and the patients' contentment were raised with a standardized questionnaire. Quality criteria mentioned by the patients were then ranked according to their importance. RESULTS: Of all included patients 76 % were ambulant with an average age of 60 years (range 22 - 83 years) and 69 % female. These characteristics were identical in both groups. With a mean waiting time of 90 minutes (Group intensified care 100 minutes, group regular care 81 minutes) most patients evaluated the overall service during waiting time as "good" to "ideal", only 2 % as of "low quality". No significant differences between the two study arms concerning the patient satisfaction could be detected. Patients with intensified care estimated their delay time significantly shorter by an average of 24 minutes (p < 0.02). For 40 % a detailed consent discussion was the main quality criterion, while a short waiting time only for 24 %. CONCLUSION: An optimized, i.e. intensified care during the waiting time for a radiological examination results in a significant reduction of the subjective waiting time, but does not lead to a significantly higher patient contentment. The subjective judgement of examination quality seems to influence the acceptance of prolonged latency to a high degree.
Assuntos
Agendamento de Consultas , Meios de Contraste/administração & dosagem , Satisfação do Paciente , Assistência Centrada no Paciente/métodos , Serviço Hospitalar de Radiologia , Tomografia Computadorizada por Raios X , Listas de Espera , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de Saúde , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Adulto JovemRESUMO
Postoperative monitoring of transplanted free flaps is an essential tool to reveal possible complications. The aim of this study was to compare the value of time-intensity-curve- (TIC-) analysis based on grey scale data of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced (DCE-) magnetic resonance imaging (MRI). Postoperative imaging was performed in 11 patients following free flap transplantation and TIC analysis was obtained in identical regions of interest (ROI) of CEUS and DCE MRI data. Microcirculation was assessed in superficial (0-1 cm), middle (1-2 cm), and deep (2-3 cm) ROIs in one or two different positions within the flap resulting in a total of 46 ROIs evaluated (in very thin flaps only superficial and middle ROIs were assessed). For both imaging methods, mean signal increase was found to be significantly higher in ROIs of normally perfused flaps (n = 40) compared to ROIs with compromised microcirculation (n = 6). Although TIC analysis allows quantification of microcirculation in different regions of the flap, in this preliminary study no distinct threshold could be defined to differentiate flaps with normal and compromised microcirculation.
Assuntos
Retalhos de Tecido Biológico , Transplante de Pele , Pele/irrigação sanguínea , Pele/diagnóstico por imagem , Adolescente , Adulto , Idoso , Meios de Contraste , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Microcirculação , Pessoa de Meia-Idade , Projetos Piloto , Ultrassonografia/métodos , Adulto JovemRESUMO
PURPOSE: To evaluate the diagnostic yield of 16-row multidetector computed tomography (CT) mesentericography in patients with obscure gastrointestinal bleeding. MATERIALS AND METHODS: The radiological information system database was used to retrospectively identify all patients in whom CT mesentericography (CTM) was performed for the diagnosis of obscure gastrointestinal bleeding between July 2002 and September 2006. A subsequent prospective study was conducted between October 2006 and September 2009 to evaluate CTM in patients with major obscure gastrointestinal bleeding. The retrospectively identified patients (six patients) as well as the prospectively evaluated patients (seven patients) constitute the study population. Following mesenteric DSA the catheter was left in the superior mesenteric artery, the patient was transferred to the CT suite and CTM was carried out by scanning the abdomen after contrast material injection via the catheter. Active bleeding was suspected if a focal area of high attenuation consistent with contrast material extravasation was found within the bowel lumen. RESULTS: CTM detected the site of active bleeding in three of 13 patients (23 %). In the subpopulation of patients who were prospectively evaluated, CT mesentericography identified the site of active bleeding in one of seven patients (14 %). Depiction of active bleeding by CTM prompted surgical intervention in each case and surgery confirmed the findings of CT mesentericography. CONCLUSION: Due to the relatively low rate of positive findings and inherent drawbacks, we feel that CTM cannot be recommended in general. However, in selected patients who are continuously bleeding at a low rate and in whom iv-CT was negative, CT mesentericography might be helpful.
Assuntos
Hemorragia Gastrointestinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Angiodisplasia/diagnóstico por imagem , Angiodisplasia/cirurgia , Meios de Contraste/administração & dosagem , Diverticulite/diagnóstico por imagem , Diverticulite/cirurgia , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/efeitos adversos , Resultado do TratamentoRESUMO
AIM: To evaluate, whether image fusion of contrast enhanced ultrasound (CEUS) with CT or MRI affects the diagnosis and characterization of liver lesions or the therapeutic strategy of surgical or interventional procedures compared to the preliminary diagnosis. MATERIAL AND METHODS: In a retrospective study the image fusion scans of CEUS with contrast enhanced CT or MRI of 100 patients (71 male, mean age 59 years, 0.3-85 years) with benign or malignant liver lesions were evaluated. Fundamental B-scan, color Doppler imaging and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1-5 MHz, LOGIQ 9/GE) and volume navigation (Vnav). After a bolus injections of up to 2.4 ml SonoVue® (BRACCO, Italy) digital raw data was stored as cine-loops up to 5 min. In 74 patients, CEUS was fused with a pre-existing ceCT, in 26 patients a ceMRI was used. RESULTS: In all 100 patients (100%) the image quality in all modalities (ceCT, ceMRI and CEUS) was excellent or with only minor diagnostic limitations. Regarding the number of lesions revealed in image fusion of CEUS/ceCT/ceMRI and the preceding diagnostic method, concordant results were found in 84 patients. In 12 patients, additional lesions were found using fusion imaging causing subsequently a change of the therapeutical strategy. In 15 out of 21 patients with either concordant or discordant results regarding the number of lesions, image fusion allowed a definite diagnosis due to a continuous documentation of the microcirculation of the tumor and its contrast enhancement. A significant coherency (p < 0.05) among image fusion with either ceCT or ceMRI and CEUS and a subsequent change of therapeutic strategy was found. CONCLUSION: Image fusion with volume navigation (VNav) of CEUS with ceCT or ceMRI frequently allows a definite localization and diagnosis of hepatic lesions in patients with primary hepatic carcinoma or metastatic diseases. This might cause a change of the therapeutic strategy in many patients with hepatic lesions.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma/secundário , Quimioembolização Terapêutica , Meios de Contraste/administração & dosagem , Gadolínio DTPA , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Microbolhas , Fosfolipídeos , Radiografia Intervencionista/métodos , Hexafluoreto de Enxofre , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/irrigação sanguínea , Carcinoma/diagnóstico por imagem , Carcinoma/terapia , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/terapia , Criança , Pré-Escolar , Sistemas Computacionais , Feminino , Humanos , Lactente , Circulação Hepática , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Masculino , Microcirculação , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Carga Tumoral , Ultrassonografia Doppler em Cores , Adulto JovemRESUMO
AIM: To judge the possibilities of detection of orbital foreign bodies in multidetector CT (MDCT) with a focus on glass slivers. MATERIALS AND METHODS: Experimental systematic measuring of Hounsfield Units (HU) of 20 different materials, containing 16 different types of glass with 4 different types of ophthalmic lenses among them. The measurements were performed using a standardized protocol with an orbita phantom being scanned with 16-slice MDCT. Using the resulting density values, the smallest detectable volume was calculated. Using this data we produced slivers of 5 different glass types in the sub-millimeter range and calculated their volume. Those micro-slivers underwent another CT scan using the same protocol as mentioned above to experimentally discern and confirm the detection limit for micro-slivers made of different materials. RESULTS: Glass has comparatively high density values of at least 2000 HU. The density of glasses with strong refraction is significantly higher and reaches up to 12 400 HU. We calculated a minimum detectable volume of 0.07 mm (3) for glass with a density of 2000 HU. Only glass slivers with a density higher than 8300 HU were experimentally detectable in the sub-millimeter range up to a volume as small as 0.01 mm (3). Less dense glass slivers could not be seen, even though their volume was above the theoretically calculated threshold for detection. CONCLUSION: Due to its high density of at least 2000 HU, glass is usually easily recognizable as an orbital foreign body. The detection threshold depends on the object's density and size and can be as low as 0.01 mm (3) in the case of glass with strong refraction and thus high density. The detection of glass as an orbital foreign body seems to be secure for slivers with a volume of at least 0.2 mm (3) for all types of glass.
Assuntos
Corpos Estranhos no Olho/diagnóstico por imagem , Vidro/análise , Tomografia Computadorizada por Raios X , Sensibilidade e Especificidade , Madeira/análiseRESUMO
AIM: The assessment of the immediate post-interventional microcirculation and perfusion following transcatheter arterial chemoembolization (TACE) with new real time imaging fusion technique (VNav) of computed tomography (CT) or magnetic resonance imaging (MRI) with contrast enhanced ultrasound (CEUS) compared to follow-up. MATERIAL: Following TACE an image fusion of CEUS with CT or MRI of the liver was performed in 20 patients (18 men, 2 women; age 29-75 years) with confirmed hepatocelluar carcinoma (HCC) to evaluate the post-interventional tumor vascularization and perfusion of HCC tumor lesions. Image fusion with CEUS performed immediately was compared with the result at the end of TACE (DSA), with post TACE CT (non-enhanced CT within 24 hours) and with follow up CT (enhanced CT after 6 weeks) after embolization. Ultrasound was performed using a 1-5 MHz multifrequency SonoVue transducer (LOGIQ 9/GE) after a bolus injection of 2-4ml SonoVue® with contrast harmonic imaging (CHI). Thirteen examinations were fused with a contrast enhanced CT, 7 with a MRI performed before TACE. RESULTS: The post-interventional volume navigation image fusion of CT or MRI with CEUS showed differences regarding the residual tumor perfusion compared to other modalities. The correlation (Spearman-test) between the perfusion result at the end of TACE, non-enhanced CT after TACE and image fusion with CEUS was 0.42 and 0.50. The difference between the result at the end of TACE and the fusion with CEUS was significant (p < 0.05, Wilcoxon-test). The correlation between fusion of CEUS with CT/MRI and follow-up CT (after 6 weeks) was 0.64, the difference was not significant (p > 0.05). The differences between native CT within 24 hours after TACE and follow up CT after 6 weeks or fusion of CEUS and CT/MRI were significant (p < 0.05). The inter-observer variability was 0.61 at the end of TACE, 0.58 at non-enhanced CT (within 24 hours), 0.87 at fusion CEUS with CT/MRI and 0.74 at follow up CT after 6 weeks (Cohens Kappa test). CONCLUSION: Image fusion with volume navigation (VNav) of CEUS with CT or MRI allows an accurate localisation of foci in patients with HCC. This exact mapping permits an easier control and evaluation of the results after TACE. The fusion of CEUS and CT or MRI allows a better evaluation of the microcirculation and the residual tumor perfusion at an earlier point of time than usual modalities of therapy control like non-enhanced CT. This might lead to a more differentiated monitoring of therapy.
Assuntos
Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/terapia , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Adulto , Idoso , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Feminino , Seguimentos , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: Detailed evaluation and cost analysis of a cranial contrast-enhanced MRI (c-ceMRI) in outpatients, inpatients, patients in an intensive care unit and children under anesthesia. MATERIALS AND METHODS: Based on a detailed process-oriented model, we calculated the cost of a cranial MRI for the four situations mentioned above. A comprehensive evaluation of the overhead and personnel costs was performed. RESULTS: We performed 5108 MRI examinations on 2 scanners in the year 2008. 2150 examinations (42 %) were identified as c-ceMRI. For inpatients we calculated a total cost of 242.46 per examination with a personnel cost of 81.71 for the radiological department. In outpatients we calculated total costs of 181.97 with radiological personnel costs of 68.67. Patients coming from an intensive care unit were treated by an intensive care team, which resulted in total costs of 416.58 with 283 in costs for radiological personnel (32.8 %). MRI examinations of children under anesthesia resulted in costs of 616.79 for the hospital, of which 285.78 were radiological personnel costs (34.5 %). CONCLUSION: In this study we evaluated for the first time different radiological scenarios of a c-ceMRI at a university hospital. Considering the present reimbursement situation, all outpatients covered by statutory health insurance resulted in a deficit for the hospital. Particularly high costs for patients in intensive care units as well as for children under anesthesia have to be taken into account and are currently not adequately covered by care providers.
Assuntos
Encéfalo/patologia , Meios de Contraste/economia , Hospitais Universitários/economia , Processamento de Imagem Assistida por Computador/economia , Imageamento por Ressonância Magnética/economia , Adulto , Assistência Ambulatorial/economia , Criança , Meios de Contraste/administração & dosagem , Custos e Análise de Custo , Alemanha , Custos Hospitalares/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Unidades de Terapia Intensiva/economia , Programas Nacionais de Saúde/economia , Equipe de Assistência ao Paciente/economia , Serviço Hospitalar de Radiologia/economia , Mecanismo de Reembolso/economia , Cuidados de Saúde não Remunerados/economiaRESUMO
AIM: Evaluation of high resolution linear ultrasound and intra-operative linear contrast enhanced ultrasound (CEUS) and its benefit for the detection and characterization of tumor lesions. MATERIAL AND METHODS: Twenty patients were investigated preoperatively regarding tumor detection using CT (n = 8) or MRI (n = 12) and image fusion (VNav) (n = 3). All patients had surgery for their hepatic tumor (hepatocellular carcinoma (HCC), cholangiocellular carcinoma (CCC), metastasis, and adenoma). Ultrasound was performed intra-operatively first with B-scan using a convex probe. Than multifrequency linear transmitters (6-9 MHz, 6-15 MHz, LOGIQ E9, GE) were applied for B-scan, coulor coded Doppler sonography (CCDS) and Power Doppler followed by dynamic CEUS with Contrast Harmonic Imaging (CHI) after bolus injection of a maximum of 15 mL SonoVue®. RESULTS: In 9 cases with the use of intra-operative CEUS additional tumor lesions (diameter 4-15 mm) could be detected and were histologically confirmed after surgical resection (7 cases) or intra-operative biopsy (2 cases). Using intraoperative CEUS 64 tumor lesions could be detected compared to 51 tumor lesions detected by preoperative CT or MRI (p < 0.05). Using the 6-15 MHz multifrequency linear transducer with CHI, arterial perfusion of adenomas, neuroendocrine metastases and HCC lesions was detectable. In 3 cases a resection was not achievable. Two of these cases were treated with radio frequency ablation (RFA). The other case had no curable option due to multifocal tumor manifestation. CONCLUSION: The intra-operative use of high-resolution linear transducer techniques with CEUS offers new diagnostic perspectives for an effective liver surgery.