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Purpose: To demonstrate and evaluate factors contributing to near-cures in patients with Gadolinium Deposition Disease (GDD) undergoing intravenous (IV) DTPA chelation. Methods: Patients who had undergone or are currently undergoing DTPA chelation for GDD were included in this report based on their medical records that showed their perceived improvement was at least 80% back to normal. A survey was developed that included factors commonly reported by patients treated in one clinic to determine if these 'near-cured' (pre-MRI baseline health) individuals possessed certain factors and lacked others. The anonymized survey was emailed to these individuals by the principal treating physician, the only investigator not blinded to the subjects. This report describes clinical documentation of patient status and their underlying factors in individuals treated by the primary author, and no research was performed. The survey was sent to sixteen individuals; Fourteen patients completed it (10 females; 41.1 ± 11.2 y/o). Results: The most common factor was the administration of ≤5 lifetime doses of a Gadolinium-Based Contrast Agents (GBCA) (12/14). Unconfounded agents triggering GDD were seen in nine subjects. Most subjects (12/14) initiated chelation in the first year after the causative GBCA, and most (11/14) underwent ≤10 chelations with DTPA. Good healthcare status prior to MRI was observed in 5 subjects. The majority (11/14) described their immune status as strong. Severe physical disability prior to chelation was seen in 1. Conclusion: Subjects with GDD can experience near-cure with IV DTPA chelation. Factors surveyed that predict near-cure include the start of chelation in the first year, few GBCA administrations, and good health status before MRI with GBCA injection. Nonetheless, a few patients with predictors of less successful outcomes still experienced near-cure.
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Percutaneous liver biopsy, although considered a safe procedure, can lead to tumoral needle tract seeding. We describe a case of a 65-year-old woman with a history of hepatocellular carcinoma (HCC) who presented with a painless abdominal lump 15 years post-liver biopsy and left hepatectomy. An MRI revealed an abdominal wall mass suggestive of HCC metastasis from needle tract seeding. Surgical removal confirmed a well-differentiated HCC. Distinctive imaging features of HCC in specific clinical settings reduce the need for biopsy, which should be limited to exceptional cases.
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Seminal vesicles play a crucial role in the male reproductive system, as they are responsible for secreting a fluid that forms most of the ejaculate. Seminal vesicles' pathology can present with non-specific symptoms, making imaging diagnosis essential for proper patient management. Various imaging modalities can be used to evaluate these glands, with MRI beneficial in illustrating the spectrum of seminal vesicle disease. Typical seminal vesicles appear as elongated fluid-containing structures, but congenital anomalies, inflammatory conditions, and neoplastic disorders can alter their appearance. Furthermore, differentiating mimics from actual pathology can be challenging but crucial for proper management. This article aims to provide an overview of the typical imaging appearance of the seminal vesicles and illustrate the principal imaging characteristics of conditions involving these structures. It will review the imaging characteristics of common and uncommon lesions involving the seminal vesicles by exploring congenital, infectious, and neoplastic in detail. As the seminal vesicles are often evaluated incidentally during prostate imaging, radiologists should be aware of the variability of normal findings and recognize the principal pathologies affecting these structures to ensure proper patient management.
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Imagen por Resonancia Magnética , Vesículas Seminales , Humanos , Vesículas Seminales/diagnóstico por imagen , Masculino , Imagen por Resonancia Magnética/métodos , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Diagnóstico Diferencial , Neoplasias de los Genitales Masculinos/diagnóstico por imagenRESUMEN
OBJECTIVES: The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. MATERIALS AND METHODS: A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m 2 ), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). RESULTS: Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. CONCLUSIONS: Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.
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Compuestos Organometálicos , Enfermedades de la Piel , Animales , Humanos , Medios de Contraste/toxicidad , Gadolinio DTPA , Gadolinio/toxicidad , Inhibidor Tisular de Metaloproteinasa-1 , Enfermedades de la Piel/inducido químicamente , Imagen por Resonancia Magnética , Riñón/diagnóstico por imagen , Riñón/fisiología , EncéfaloRESUMEN
ABSTRACT: This review describes the current knowledge of a form of gadolinium toxicity termed gadolinium deposition disease (GDD), supplemented with the opinions of the authors developed during 6 years of clinical experience treating GDD. Gadolinium deposition disease can also be considered a subset under the symptoms associated with gadolinium exposure rubric. Young and middle-aged White women of central European genetic origin are the most affected. The most common symptoms are fatigue, brain fog, skin pain, skin discoloration, bone pain, muscle fasciculations, and pins and needles, but a long list of additional symptoms is reported herein. The time of onset of symptoms ranges from immediate to 1 month after gadolinium-based contrast agent (GBCA) administration. The primary treatment is to avoid further GBCAs and metal removal through chelation. Presently, the most effective chelating agent is DTPA because of its high affinity with gadolinium. Flare development is an expected outcome, amenable to concurrent immune dampening. We emphasize in this review the critical nature of recognizing GDD when it first arises, as the disease becomes progressively more severe with each subsequent GBCA injection. It is generally very treatable after the first symptoms of GDD, often arising after the first GBCA injection. Future directions of disease detection and treatment are discussed.
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Testimonio de Experto , Gadolinio , Persona de Mediana Edad , Humanos , Femenino , Gadolinio/efectos adversos , Encéfalo , Medios de Contraste/efectos adversos , Gadolinio DTPA , Quelantes/uso terapéutico , Imagen por Resonancia MagnéticaRESUMEN
Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.
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PURPOSE: The aim of this study was to report early clinical experience with various forms of immune dampening to mitigate the expected flare reaction in patients suffering from gadolinium deposition disease (GDD) receiving DTPA chelation. MATERIALS AND METHODS: All patients were clinical subjects, and no prospective research was performed on them. The study included 31 consecutive patients (21 women; age, 46.2 ± 12.5 years). The diagnosis of GDD was clinically made. The severity of the flare over the week after each chelation session was rated on a scale from 1 to 10 (where 1 is negligible, 10 is intolerably severe). Patients were followed for up to 5 chelation sessions. Four immune dampening strategies were used: (1) no concurrent treatment; (2) antihistamine plus montelukast (AH); (3) steroid/antihistamine taper postchelation (SAHT); and (4) steroid/antihistamine extending from prechelation to 5 days postchelation (extended hypersensitivity medication regimen; EHMR). The data were analyzed with generalized linear mixed models and with linear regression. RESULTS: A total of 102 flare scores were obtained at different time points. Ten patients underwent 5 chelations. The severity of the flare after the first chelation was significantly higher in cases of no concurrent therapy (8.4 ± 2.6) and AH (7 ± 1.4) compared with SAHT (6 ± 1.3) and EHMR (5 ± 1.1). Patients who underwent SAHT and EHMR experienced less severity of flare after the first chelation (P = 0.0049 and P = 0.0005, respectively). Considering all time points, the results were also significantly better with SAHT and EHMR. CONCLUSION: Based on early clinical experience, EHMR seems to manage flare reactions in DTPA chelation well. This strategy may represent the first standard therapy in patients with GDD.
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Gadolinio DTPA , Antagonistas de los Receptores Histamínicos , Adulto , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Persona de Mediana Edad , PoliaminasRESUMEN
PURPOSE: The aim of this study was to investigate the feasibility of measuring early changes in serum cytokine levels after intravenous diethylenetriaminepentaacetic acid (Ca-DTPA) chelation in patients manifesting either gadolinium deposition disease (GDD) or gadolinium storage condition (GSC) and the possible usefulness of this method in further research. METHODS: Four patients with recent-onset GDD (≤1 year) and 2 patients with long-standing GSC (4 and 9 years) underwent chelation with intravenous bolus administration of Ca-DTPA. Multiple blood draws were performed to measure serum cytokines: at T = 0 (before Ca-DTPA injection) and 1, 5, 10, 30, 60 minutes, and 24 hours after Ca-DTPA injection. Patients rated the severity of GDD symptom flare at 24 hours. The 24-hour urine Gd amounts were measured prechelation and for the 24 hours after chelation. Serum samples were analyzed blind to whether patients had GDD or GSC but with knowledge of the time points characterizing each sample. RESULTS: Urine samples for both GDD and GSC patients showed increases in Gd postchelation. All GDD patients experienced flare reactions postchelation; the 2 GSC patients did not. Two cytokines, EGF and sCD40L, peaked at 30 minutes postchelation in at least 4 of the 6 participants. Three cytokines, ENA78/CXCL5, EOTAXIN/CCL11, and LEPTIN, peaked at 24 hours in at least 4 of the 6 participants. Two participants were high outliers for a large number of cytokines across time points. No clear distinction between GDD and GSC was apparent from the cytokine patterns, although differences were present. CONCLUSIONS: This pilot study describes precise temporal resolution (in the range of minutes) after a cytokine-inciting event. Select cytokines exhibited peak values at different time points. At this preliminary stage of investigation, peak cytokine release seems to reflect the amount of Gd mobilized rather than the severity of the patient symptomatic reaction. Too few subjects were studied to support statistical analysis between GDD and GSC groups, although differences were observed through visual data analysis.
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Gadolinio , Compuestos Organometálicos , Medios de Contraste , Citocinas , Gadolinio DTPA , Humanos , Imagen por Resonancia Magnética , Ácido Pentético , Proyectos PilotoRESUMEN
OBJECTIVE: The objective of this study was to allow physicians with self-diagnosed gadolinium deposition disease symptoms to report their own experience. MATERIALS AND METHODS: Nine physicians (seven females), with a mean age of 50.5 ± 8.3 years, participated in this case series. Nationalities were American (n = 6), British, Portuguese, and Romanian. Medical practices included internal medicine (n = 2), trauma surgery, ophthalmology, gastroenterology, psychiatry, family medicine, obstetrics/gynecology, and general practice. RESULTS: Genetically, eight of the physicians were of central European origin. Underlying autoimmune conditions were present in four. Symptoms developed after a single injection in one physician and after multiple injections in eight. The precipitating agent was gadobenate dimeglumine in four physicians, gadobutrol in three, gadoterate meglumine in one, and gadopentetate dimeglumine in one. The most consistent symptoms were a burning sensation, brain fog, fatigue, distal paresthesia, fasciculations, headache, and insomnia. Eight of the physicians were compelled to change their practice of medicine. CONCLUSION: In the various physicians, gadolinium deposition disease showed common features and had a substantial impact on daily activity. Physicians are educated reporters on disease, so their personal descriptions should spark interest in further research.
OBJETIVO: O objetivo deste estudo foi possibilitar que médicos com sintomas de doença de deposição de gadolínio autodiagnosticada relatassem sua própria experiência. MATERIAIS E MÉTODOS: Nove médicos (sete mulheres), com média de idade de 50,5 ± 8,3 anos, participaram desta série de casos. As nacionalidades foram americana (n = 6), britânica, portuguesa e romena. As práticas médicas incluíram medicina interna (n = 2), traumatologia, oftalmologia, gastroenterologia, psiquiatria, medicina de família, ginecologia/obstetrícia e clínica geral. RESULTADOS: Geneticamente, oito dos médicos tinham origem europeia central. Condições autoimunes subjacentes estavam presentes em quatro médicos. Os sintomas se desenvolveram após uma única injeção em um médico e após várias injeções em oito. O agente precipitante foi gadobenato dimeglumina em quatro médicos, gadobutrol em três, gadoterato meglumina em um e gadopentetato dimeglumina em um. Os sintomas mais consistentes foram sensação de queimação, confusão mental, fadiga, parestesia distal, fasciculações, cefaleia e insônia. Oito dos médicos foram forçados a alterar a sua prática médica. CONCLUSÃO: Em vários médicos, a doença de deposição de gadolínio mostrou características comuns e teve um impacto substancial na atividade diária. Os médicos são repórteres treinados sobre doenças, assim, suas descrições pessoais devem despertar interesse em pesquisas futuras.
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Abstract Objective: The objective of this study was to allow physicians with self-diagnosed gadolinium deposition disease symptoms to report their own experience. Materials and Methods: Nine physicians (seven females), with a mean age of 50.5 ± 8.3 years, participated in this case series. Nationalities were American (n = 6), British, Portuguese, and Romanian. Medical practices included internal medicine (n = 2), trauma surgery, ophthalmology, gastroenterology, psychiatry, family medicine, obstetrics/gynecology, and general practice. Results: Genetically, eight of the physicians were of central European origin. Underlying autoimmune conditions were present in four. Symptoms developed after a single injection in one physician and after multiple injections in eight. The precipitating agent was gadobenate dimeglumine in four physicians, gadobutrol in three, gadoterate meglumine in one, and gadopentetate dimeglumine in one. The most consistent symptoms were a burning sensation, brain fog, fatigue, distal paresthesia, fasciculations, headache, and insomnia. Eight of the physicians were compelled to change their practice of medicine. Conclusion: In the various physicians, gadolinium deposition disease showed common features and had a substantial impact on daily activity. Physicians are educated reporters on disease, so their personal descriptions should spark interest in further research.
Resumo Objetivo: O objetivo deste estudo foi possibilitar que médicos com sintomas de doença de deposição de gadolínio autodiagnosticada relatassem sua própria experiência. Materiais e Métodos: Nove médicos (sete mulheres), com média de idade de 50,5 ± 8,3 anos, participaram desta série de casos. As nacionalidades foram americana (n = 6), britânica, portuguesa e romena. As práticas médicas incluíram medicina interna (n = 2), traumatologia, oftalmologia, gastroenterologia, psiquiatria, medicina de família, ginecologia/obstetrícia e clínica geral. Resultados: Geneticamente, oito dos médicos tinham origem europeia central. Condições autoimunes subjacentes estavam presentes em quatro médicos. Os sintomas se desenvolveram após uma única injeção em um médico e após várias injeções em oito. O agente precipitante foi gadobenato dimeglumina em quatro médicos, gadobutrol em três, gadoterato meglumina em um e gadopentetato dimeglumina em um. Os sintomas mais consistentes foram sensação de queimação, confusão mental, fadiga, parestesia distal, fasciculações, cefaleia e insônia. Oito dos médicos foram forçados a alterar a sua prática médica. Conclusão: Em vários médicos, a doença de deposição de gadolínio mostrou características comuns e teve um impacto substancial na atividade diária. Os médicos são repórteres treinados sobre doenças, assim, suas descrições pessoais devem despertar interesse em pesquisas futuras.
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OBJECTIVES: The aim of this study was to determine the following in patients who have undergone magnetic resonance imaging with gadolinium-based contrast agents (GBCAs) and meet the proposed diagnostic criteria for gadolinium deposition disease (GDD): (1) the effectiveness of chelation therapy (CT) with intravenous Ca-diethylenetriaminepentaacetic acid in removing retained gadolinium (Gd) and factors affecting the amount removed; (2) the frequency of CT-induced Flare, that is, GDD diagnostic symptom worsening, and factors affecting Flare intensity; (3) whether, as reported in a separate cohort, GDD patients' serum cytokine levels differ significantly from those in healthy normal controls and change significantly in response to CT; and (4) whether urine Gd, Flare reaction, and serum cytokine findings in GDD patients are mimicked in non-ill patients described as having gadolinium storage condition (GSC). MATERIALS AND METHODS: Twenty-one GDD subjects and 3 GSC subjects underwent CT. Patients provided pre-CT and post-CT 24-hour urine samples for Gd content determination along with pre-CT and 24-hour post-CT serum samples for cytokine analysis. Patients rated potential Flare 24 hours after CT. Pre-CT and post-CT 24-hour urine Gd analyses and Luminex serum cytokine assays were performed blind to patients' GDD and GSC status and all other data except age and sex. Serum cytokine levels in a healthy normal control group of age- and sex-matched subjects drawn from Stanford influenza vaccination studies were measured once, contemporaneously with those of GDD and GSC patients, using the same Luminex assay. RESULTS: Urine Gd amounts increased post-CT by 4 times or more after 87% of the 30 CT sessions. The most important factors appeared to be the time since the last GBCA dose and the cumulative dose received. Urine Gd amounts for GDD and GSC patients fell in the same ranges. All GDD patients, and no GSC patient, reported a Flare 24 hours post-CT. Linear regression found that Flare intensity was significantly predicted by a model including pre- and post-CT Gd amounts and the number of GBCA-enhanced magnetic resonance imaging. Post-CT, multiple cytokines showed strong positive relationships with GDD patients' Flare intensity in multivariable models. The pre-CT serum levels of 12 cytokines were significantly different in GDD patients compared with healthy flu vaccine controls. The small number of GSC patients precluded analogous statistical testing. Post-CT, GDD patients' serum levels of 20 cytokines were significantly decreased, and 2 cytokines significantly increased. These cytokines did not exhibit the same change pattern in the 3 GSC patients. The small number of GSC patients precluded statistical comparisons of GSC to GDD patients' results. CONCLUSIONS: In this preliminary study, 24-hour urine Gd content increased markedly and similarly in GDD and GSC patients after Ca-diethylenetriaminepentaacetic acid CT. Post-CT Flare reaction developed only in GDD patients. The current study is the second finding significantly different serum cytokine levels in GDD patients compared with healthy normal controls. These differences and the difference between GDD and GSC patients' Flare and cytokine responses to CT suggest some inflammatory, immunologic, or other physiological differences in patients with GDD. Further research into the treatment and physiological underpinnings of GDD is warranted.
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Gadolinio , Compuestos Organometálicos , Terapia por Quelación , Medios de Contraste , Citocinas , Gadolinio DTPA , Humanos , Imagen por Resonancia Magnética , AutoinformeRESUMEN
The liver is commonly affected by metastatic disease. Therefore, it is essential to detect and characterize liver metastases, assuming that patient management and prognosis rely on it. The imaging techniques that allow non-invasive assessment of liver metastases include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI. In this paper, we review the imaging findings of liver metastases, focusing on each imaging modality's advantages and potential limitations. We also assess the importance of different imaging modalities for the management, follow-up, and therapy response of liver metastases. To date, both CT and MRI are the most appropriate imaging methods for initial lesion detection, follow-up, and assessment of treatment response. Multiparametric MRI is frequently used as a problem-solving technique for liver lesions and has evolved substantially over the past decade, including hardware and software developments and specific intravenous contrast agents. Several studies have shown that MRI performs better in small-sized metastases and moderate to severe liver steatosis cases. Although state-of-the-art MRI shows a greater sensitivity for detecting and characterizing liver metastases, CT remains the chosen method. We also present the controversial subject of the "economic implication" to use CT over MRI.
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OBJECTIVE: To determine the predictive value of esophageal dilatation as observed in high-resolution computed tomography (HRCT) for the diagnosis of systemic sclerosis (SSc) in patients with interstitial lung disease (ILD). METHODS: Our sample consisted of patients diagnosed with SSc and proven interstitial lung involvement with available HRCT exams (n = 20). Individuals with other forms of rheumatic ILD were included as a control group (n = 20). Two blinded radiologists independently reviewed the images for the presence of esophageal dilatation, measured at 3 different levels. Interobserver agreement was tested with Lin's concordance correlation coefficient (CCC). Independent t-test was used to compare maximum esophageal diameters between groups. Friedman's test was used to evaluate differences between the 3-level measurements. Receiver operating characteristic analysis was performed. RESULTS: There was a substantial correlation between both readers (CCC = 0.9802-0.9919). Esophageal dilatation was significantly associated with SSc (P = .0012). The optimal calculated cut-off value to differentiate SSc from other ILDs was 18.5 mm (sensitivity and specificity of 70 and 90%, respectively; area under the curve 0.819), measured 1 cm above the diaphragmatic hiatus. CONCLUSION: HRCT may have a discriminative role in the presence of both ILD and esophageal dilatation for the diagnosis of SSc. Our results suggest that a cut-off value for the esophageal diameter of 18.5 mm might propose the diagnosis of SSc with reasonable confidence.
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OBJECTIVE: To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. MATERIALS AND METHODS: This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. RESULTS: The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. CONCLUSION: Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
OBJETIVO: Avaliar, prospectivamente, a acurácia da angiografia por ressonância magnética (angio-RM) sem contraste, com a sequência steady-state free precession (SSFP) 1,5 T, para a identificação de artérias renais múltiplas, usando para isso a angiografia por tomografia computadorizada (angio-TC) como padrão de referência. MATERIAIS E MÉTODOS: Trinta e nove pacientes (26 do sexo masculino; idade média de 62,6 anos) foram submetidos a angio-TC e angio-RM para avaliação dos segmentos proximais e médios das artérias renais. A análise dividiu-se em duas partes: inicialmente, a qualidade das imagens de angio-RM foi classificada como diagnóstica ou não diagnóstica por dois avaliadores independentes; posteriormente, outros dois avaliadores analisaram as imagens consideradas diagnósticas quanto à presença de múltiplas artérias renais. Sensibilidade, especificidade e acurácia da angio-RM foram calculadas utilizando-se a angio-TC como referência. Estatística kappa foi utilizada para cálculo da concordância interobservador. RESULTADOS: A qualidade das imagens de angio-RM foi considerada diagnóstica em 70-90% dos segmentos arteriais extrarrenais. A angio-TC revelou 19 artérias renais múltiplas (8 direitas e 11 esquerdas). A acurácia da angio-RM para identificação de artérias renais múltiplas foi maior que 90%, com sensibilidade variando de 72,7% a 100% e especificidade variando de 96,3% a 100%. CONCLUSÃO: A angio-RM sem contraste proporciona imagens de alta qualidade dos segmentos extrarrenais das artérias renais. Este método pode ser alternativamente utilizado para avaliação renal, com acurácia comparável à da angio-TC.
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Abstract Objective: To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods: This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results: The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion: Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
Resumo Objetivo: Avaliar, prospectivamente, a acurácia da angiografia por ressonância magnética (angio-RM) sem contraste, com a sequência steady-state free precession (SSFP) 1,5 T, para a identificação de artérias renais múltiplas, usando para isso a angiografia por tomografia computadorizada (angio-TC) como padrão de referência. Materiais e Métodos: Trinta e nove pacientes (26 do sexo masculino; idade média de 62,6 anos) foram submetidos a angio-TC e angio-RM para avaliação dos segmentos proximais e médios das artérias renais. A análise dividiu-se em duas partes: inicialmente, a qualidade das imagens de angio-RM foi classificada como diagnóstica ou não diagnóstica por dois avaliadores independentes; posteriormente, outros dois avaliadores analisaram as imagens consideradas diagnósticas quanto à presença de múltiplas artérias renais. Sensibilidade, especificidade e acurácia da angio-RM foram calculadas utilizando-se a angio-TC como referência. Estatística kappa foi utilizada para cálculo da concordância interobservador. Resultados: A qualidade das imagens de angio-RM foi considerada diagnóstica em 70-90% dos segmentos arteriais extrarrenais. A angio-TC revelou 19 artérias renais múltiplas (8 direitas e 11 esquerdas). A acurácia da angio-RM para identificação de artérias renais múltiplas foi maior que 90%, com sensibilidade variando de 72,7% a 100% e especificidade variando de 96,3% a 100%. Conclusão: A angio-RM sem contraste proporciona imagens de alta qualidade dos segmentos extrarrenais das artérias renais. Este método pode ser alternativamente utilizado para avaliação renal, com acurácia comparável à da angio-TC.
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Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/tratamiento farmacológico , Infecciones por VIH/virología , Neoplasias Hepáticas/tratamiento farmacológico , Sorafenib/uso terapéutico , Anciano , Carcinoma Hepatocelular/virología , Coinfección/complicaciones , Coinfección/tratamiento farmacológico , Coinfección/virología , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Hepacivirus , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , Hepatitis C/virología , Humanos , Quimioterapia de Inducción , Neoplasias Hepáticas/virología , MasculinoRESUMEN
We present a case of a spontaneous splenoazygos shunt in a patient with liver cirrhosis and portal hypertension, detected by abdominal magnetic resonance imaging. Multiplanar reconstruction demonstrated communication of the splenic vein with the azygos vein that was dilated with a winding course along the mediastinum. This pathway for decompression of the portal vein is an exceedingly rare occurrence.
Asunto(s)
Vena Ácigos/diagnóstico por imagen , Circulación Colateral , Hipertensión Portal/diagnóstico por imagen , Vena Esplénica/diagnóstico por imagen , Várices/diagnóstico por imagen , Anciano , Vena Ácigos/anomalías , Humanos , Imagen por Resonancia Magnética , Masculino , Ilustración Médica , Vena Esplénica/anomalíasRESUMEN
Cytomegalovirus (CMV) is the most common cause of severe opportunistic viral disease among patients with acquired immunodeficiency syndrome, and colitis is the most frequent manifestation of CMV infection. Nevertheless, the development of a colonic pseudotumor is a rare benign entity that can be easily misdiagnosed as a colonic neoplasm if the radiologist is not aware of this condition. We present a case of a 42-year-old male with a CMV pseudotumor of the colon. Imaging findings on computed tomography and magnetic resonance imaging are illustrated. Discussion of the differential diagnoses, based on clinical and imaging findings, is performed in order to propose the right diagnosis, which was histologically confirmed.