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BACKGROUND: Clinical presentation of pulmonary embolism (PE) comprises a wide spectrum from asymptomatic incidental finding to typical symptoms with chest pain, dyspnea, hemoptysis and syncope/collapse. We aimed to investigate typical symptoms of PE and increasing number of these symptoms to predict outcome in acute PE. METHODS: Data of PE patients were analysed retrospectively. According to the typical symptoms patients were subdivided in groups with 0, 1, 2, or ≥3 symptoms, which were compared with Kruskal-Wallis-Test. Logistic regression models were computed to investigate the association between the symptoms as well as the groups with the outcome parameters in-hospital death, myocardial necrosis, Shock-Index ≥1.0 and (right ventricular dysfunction (RVD). ROC curves were calculated to test the effectiveness of increasing number of symptoms to predict the outcome parameters. RESULTS: One hundred eighty-two PE patients (61.5% female, mean age 68.5±15.3 years) were included in this study. 5 patients (2.7%) died in-hospital. Logistic regression models revealed associations between syncope/collapse and in-hospital death (OR 7.269, 95%CI 0.894-59.130, P=0.0636), myocardial necrosis (OR2.872, 0.904-9.130, P=0.0738), Shock-Index ≥1.0 (OR 4.906, 1.440-16.721, P=0.00110) and RVD (OR 5.265, 1.078-25.708, P=0.0401). Dyspnea and myocardial necrosis were also associated (OR 3.245, 1.127-9.348, P=0.0292). Increasing number of symptoms were not associated with in-hospital death, but absence of typical symptoms was associated with lower frequency of myocardial necrosis (OR 0.212, 0.046-0.976, P=0.0464). Effectiveness of increasing number of symptoms to predict myocardial necrosis was only moderate (AUC 0.608). CONCLUSIONS: The symptom syncope/collapse is connected with poorer outcome in acute PE. An increasing number of symptoms failed to be useful for outcome prediction and risk stratification in acute PE.
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Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/mortalidad , Disfunción Ventricular Derecha/diagnóstico por imagen , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Dolor en el Pecho/epidemiología , Comorbilidad , Disnea/epidemiología , Ecocardiografía , Femenino , Alemania , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Síncope/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: The objective of this study was to evaluate the diagnostic performance of 2 different imaging systems in adult bedside chest radiography and the impact on the visibility of selected diagnostically relevant structures in the images acquired with these systems, with and without an antiscatter grid. MATERIALS AND METHODS: We acquired bedside chest radiographs of 103 intensive-care patients (36 women, 67 men; age range, 17-90 years; mean age, 66.4 years) using 4 acquisition techniques (computed radiography [CR] and digital radiography [DR], with and without grid). Image quality was evaluated independently by 4 radiologists using a 9-point visibility scale. Evaluated were lung parenchyma, soft tissues, thoracic spine, foreign bodies, and the overall image quality. Interobserver agreement and differences between the systems were tested using an interclass correlation (ICC) test. Mean scores were compared using the analysis of variance, followed by the post hoc pairwise testing (the Tukey test) in case of multiple group comparisons and by the Student t test in case of single group comparisons (P < 0.05, significant). RESULTS: The image quality of the structures evaluated in the DR images with a grid was significantly higher than that obtained without a grid (P < 0.001) for all structures. The use of a grid in CR significantly improved the overall image quality, lung parenchyma, and soft tissue delineation (P < 0.001). Foreign body delineation, however, was significantly better in the CR images obtained without a grid (P < 0.001), whereas the 2 systems showed no significant difference regarding thoracic spine delineation (P = 0.554). The scores of the DR images were significantly higher than those of the CR images for all structures. The interobserver agreement was substantial for lung parenchyma (ICC, 0.77), soft tissue (ICC, 0.78), thoracic spine (ICC, 0.80), and the overall image quality (ICC, 0.78) and was almost perfect for foreign bodies (ICC, 0.81). CONCLUSIONS: The use of an antiscatter grid significantly improved the image quality of bedside DR radiographs. A similar effect was seen with CR radiographs but only for lung parenchyma, soft tissue, and the overall image quality. Mobile DR outperformed CR in all structures.
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Sistemas de Atención de Punto , Intensificación de Imagen Radiográfica/instrumentación , Radiografía Torácica/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Pantallas Intensificadoras de Rayos X , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diseño de Equipo , Análisis de Falla de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miniaturización , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Dispersión de Radiación , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/métodos , Rayos X , Adulto JovenRESUMEN
PURPOSE: To quantify the change in volume in herniated lumbar disk after computed tomography (CT)-guided intradiscal and periganglionic ozone-oxygen injection and to assess the effects of patient age, sex, and initial disk volume on disk volume changes. MATERIALS AND METHODS: A total of 283 patients with lumbar radiculopathy received a single intradiscal (3 mL) and periganglionic (7 mL) injection of an ozone-oxygen mixture (ratio, 3:97; ozone concentration, 30 µg/mL). Under CT guidance, intradiscal and periganglionic injection was performed through an extraspinal lateral approach with a 22-gauge spinal needle. All disk volume changes were evaluated on CT 6 months after the procedure in all patients. RESULTS: Initial mean disk volume was 17.37 cm(3) ± 4.70 (standard deviation; range, 8.12-29.15 cm(3)). Disk volume reduction (mean, 7.70% ± 5.45; range, 0.29%-22.31%) was seen in 96.1% of treated disks (n = 272) at 6 months after treatment and was found to be statistically significant (P < .0001). In 3.9% of patients (n = 11), disk volume increased (mean, 0.59% ± 0.24; range, 0.11%-0.81%). Patient age correlated negatively with disk volume reduction (r = -0.505; P < .0001) at 6 months after treatment, whereas initial disk volume correlated positively with volume reduction (r = 0.225; P = .00014) after therapy. No correlation was noted between patient sex and disk volume reduction after treatment (P = .09). CONCLUSIONS: Intradiscal administration of medical ozone is associated with a statistically significant volume reduction of the herniated lumbar disk. The volume-reduction effect of ozone correlates negatively with the patient's age and positively with initial disk volume.
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Quimiólisis del Disco Intervertebral/métodos , Desplazamiento del Disco Intervertebral/terapia , Disco Intervertebral/efectos de los fármacos , Vértebras Lumbares/efectos de los fármacos , Ozono/administración & dosificación , Radiología Intervencionista/métodos , Tomografía Computarizada por Rayos X , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Femenino , Humanos , Inyecciones Espinales , Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The purpose of this article is to compare workflow efficiency between a conventional computed radiography (CR) system and a novel, portable, cassette-sized, and wireless flat-panel digital radiography (DR) system. MATERIALS AND METHODS: Observational time-motion analyses were performed at one site at which CR and the new portable DR system are used concurrently. The workflow steps of both systems were identified and categorized to facilitate comparison. The times required for examination preparation, patient positioning, exposure, postacquisition processing, and the examination as a whole were recorded by a neutral observer. Timing differences between the CR and portable DR systems were compared, and all data were analyzed using commercially available statistical software. Nine general radiographic examination types were selected, with approximately 50 patients per examination type. RESULTS: A total of 941 examinations (CR, n = 474; portable DR, n = 467) were timed in this study. Total examination time differences between CR and portable DR system (mean, 26.44 seconds; median 26.99 seconds) were found to be statistically significant (p < 0.001), with DR proving faster than CR. The single largest contributor to the time difference between CR and portable DR was postacquisition processing (mean, 26.58 seconds; median, 25.91 seconds), which was a composite of multiple individual steps, including cassette transport (CR only, mean, 13.22 seconds; median, 12.74 seconds), cassette readout (mean, 10.15 seconds; median, 10.4 seconds), and postprocessing (mean, 3.21 seconds; median, 3.11 seconds). CONCLUSION: Overall radiographer time was significantly shorter when performing examination-related tasks with the novel, portable DR system than when performing comparable tasks with the CR system, a difference that appears to result largely from technology configuration.
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Intensificación de Imagen Radiográfica/instrumentación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Eficiencia Organizacional , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Posicionamiento del Paciente , Interpretación de Imagen Radiográfica Asistida por Computador , Programas Informáticos , Estudios de Tiempo y Movimiento , Pantallas Intensificadoras de Rayos XRESUMEN
The accuracy of 16-row multidetector CT in the visualization of different peripheral artery stents and in the appraisal of in-stent stenosis was assessed. Nine different stent types (nitinol and stainless steel) with three diameters (6, 8 and 10 mm) were used; altogether 27 stents were analyzed in a barrel-shaped vascular model. Low-grade (<40%) and high-grade (>60%) in-stent stenoses were simulated by polyurethane sticks (70 HU) of differing diameters (2-6 mm). Imaging was performed with 16x0.75-mm detector collimation, 130 mAs, 120 kV, 12-mm table feed/rotation, 1.0-mm slice thickness and 0.5-mm increment. The stent diameter, strut thickness, in-stent attenuation values, degree and degree of in-stent stenosis were evaluated. Nitinol stents showed significantly (P<10-6) less stent lumen narrowing, artificial strut thickening and overestimation of the degree of in-stent stenoses than stainless steel stents. In-stent attenuation values and artificial strut thickening were significantly (P<10-6) lower in 10- and 8-mm stents than in 6-mm stents. Stent lumen narrowing was significantly less in 10-mm stents than in 8-mm (P<10-4) or 6-mm (P<10-6) stents. In-stent stenoses were significantly overestimated, irrespective of the stent diameter. In 6-mm stents overestimation was significantly higher than in 8-mm (P<0.01) or 10-mm stents (P<10-6). Under in-vitro conditions 16-row MDCT allowed an accurate identification of in-stent stenosis, but significantly overestimated the effective degree of the stenosis.
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Stents , Tomografía Computarizada por Rayos X , Constricción Patológica/diagnóstico por imagen , Diseño de EquipoRESUMEN
PURPOSE: The purpose of this study was to evaluate the potential of the new 8G stereotactic vacuum-assisted breast biopsy (ST-driver, Mammotome; Ethicon Endosurgery) in the histologic evaluation of BI-RADS IV microcalcifications. MATERIALS AND METHODS: Fifty-eight patients with 61 mammographic BI-RADS IV microcalcifications underwent stereotactic vacuum-assisted breast biopsy (SVAB). The new 8G system was mounted on the ST driver, which was formerly used only with the hand-held version under sonographic guidance. The evaluation criteria for each biopsy were minimally invasive and operative histologies, the time needed for biopsy, the amount of bleeding, number of rotations and specimen, the degree of resection, and the complications. RESULTS: Fifty-eight of 61 biopsies were technically successful because > or = 50% were resected (29 x 100%, 8 x 90%, 5 x 80%, 6 x 70%, 3 x 50%, 3 x 0%). In 7 cases with representative biopsies of segmental suspicious microcalcifications, the degree of resection could not be exactly measured. All but 2 biopsies were performed without clinically relevant complications and after gaining enough specimens (Ø 12.6 specimen, 1.85 rotations). Those 2 patients showed evidence of severe bleeding into the breast tissue and operative revision had to be performed (3.5%). The size of intramammary hematoma was measurable in 27 biopsies and showed a range from 0.5 to 5 cm (Ø 2.7 cm). The average external bleeding was still low with 16 mL (5-80 mL). In 3 of 61 lesions, it was not possible to gain representative tissue as a result of displacement of the lesion after introducing or shooting the needle. The average time needed for all biopsies was 28.2 minutes for all but 5 very complicated biopsies, which took 16.1 minutes. The histologic findings with further operative workup were: 10 ductal carcinomas in situ (DCIS), 4 atypical ductal hyperplasias, 1 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), and 6 invasive ductal carcinomas. In 7 of 12 of the initial DCIS histologies, the operative histology was also DCIS, whereas in 4 of 12, no residual malignant tumor was found. In 1 of 12 patients with an initial DCIS histology, operative histology revealed invasive ductal cancer (8.3%). The cases with lobular lesions (ALH, LCIS) did not show any evidence for residual tissue in the operative workup. Most frequent benign histologies were mastopathy (13), ductal hyperplasia (9), fibroadenoma (8), and sclerosing adenosis (5). The control examinations (maximum 1 year) did not show any signs for a false-negative biopsy. CONCLUSION: The 11-G SVAB has proven to be a perfect adjunct to the existing breast biopsy methods. The new 8G SVAB speeds up the method when used for the same size of lesions and enables the user to representatively biopsy lesions up to 3 cm in diameter. The method is still minimally invasive; however, the amount of hematomas as well as clinically relevant complications is increased.
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Biopsia con Aguja/instrumentación , Neoplasias de la Mama/patología , Mama/patología , Mamografía , Vacio , Biopsia con Aguja/métodos , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/diagnóstico por imagen , Diseño de Equipo , Femenino , Humanos , Estudios Prospectivos , Sensibilidad y Especificidad , Factores de TiempoAsunto(s)
Aneurisma Falso/diagnóstico por imagen , Biopsia/efectos adversos , Hemorragia/diagnóstico por imagen , Hepatopatías/diagnóstico por imagen , Aneurisma Falso/etiología , Aneurisma Falso/terapia , Angiografía , Embolización Terapéutica , Femenino , Hemorragia/etiología , Hemorragia/terapia , Humanos , Cirrosis Hepática/diagnóstico por imagen , Hepatopatías/etiología , Hepatopatías/terapia , Persona de Mediana Edad , Radiografía Intervencional , Tomografía Computarizada por Rayos X , Ultrasonografía IntervencionalRESUMEN
The aim of this study was to investigate the accuracy of multidetector-row cardiac CT (MDCT), calcium scoring (Ca-Sc), and MDCT coronary angiography (MD CTA) in the assessment of coronary atherosclerosis. Thirty-eight patients underwent invasive coronary angiography (CA) and MDCT (collimation 4x1 mm, pitch 1.5 mm, TI 500 ms, 120 kV, 300 mAs, and retrospective ECG-gating). Calcium scoring was calculated for the total coronary artery territory and for RCA, LCA, and LCX separately. The MD CTA served to assess the degree and the localization of stenoses. All findings were compared to invasive coronary angiography. Approximately 68.4% (390 of 570) of all coronary segments could be visualized by MDCT. Correlation coefficient for MD CTA and CA amounted to r=0.58, showing distinct differences for the individual segments. Proximal segments generally showed better correlation (range 0.81-0.77) than medial segments (range 0.91-0.20), distal segments (range 0.55-0.04), or side branches (range 0.76-0.00). Patients with hemodynamically relevant (>75%) stenoses were detected by MD CTA with 72.2% sensitivity (13 of 18) and 100% specificity (20 of 20). For Ca-Sc sensitivity ranged between 94.7% (17 of 18) and 66.7% (12 of 18), specificity between 20% (4 of 20) and 80% (16 of 20) respectively, depending on the prevailing cutoff value. Combination of both methods led to 83.3% sensitivity (15 of 18) and 100% specificity (20 of 20), reaching no level of significance as compared with Ca-Sc (p=0.73) or MD CTA (p=0.23) alone. Calcium scoring as a single method showed highest sensitivity in the detection of coronary atherosclerosis but at the expense of low specificity. In patients with no or moderate calcifications, combination with MD CTA helped to distinctly increase specificity and NPV.
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Calcinosis/diagnóstico por imagen , Dolor en el Pecho/diagnóstico por imagen , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada Espiral , Adulto , Anciano , Calcinosis/epidemiología , Dolor en el Pecho/epidemiología , Angiografía Coronaria/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/epidemiología , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/epidemiología , Diagnóstico Diferencial , Femenino , Alemania , Humanos , Masculino , Cómputos Matemáticos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo/estadística & datos numéricos , Sensibilidad y Especificidad , Tomografía Computarizada Espiral/estadística & datos numéricosRESUMEN
This article critically evaluates the role of multidetector-row CT before and after cardiosurgical procedures. In addition, technical aspects, such as scan protocols, optimal image reconstruction intervals, image reformation techniques, and data evaluation, are presented and briefly discussed.
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Procedimientos Quirúrgicos Cardíacos , Cardiopatías/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Válvula Aórtica/diagnóstico por imagen , Angiografía Coronaria , Puente de Arteria Coronaria , Cardiopatías/cirugía , Humanos , Cuidados PreoperatoriosRESUMEN
The purpose of this study was to develop strategies for optimal image reconstruction in multidetector-row cardiac CT and to discuss the results in the context of individual heart rate, cardiac physiology, and technical prerequisite. Sixty-four patients underwent multidetector-row cardiac CT. Depending on the heart rate either a single-segmental reconstruction (SSR) or an adaptive two-segmental reconstruction (ASR) was applied. Image reconstruction was done either antegrade (a) or retrograde (r) in relation to the R-peak. Reconstruction of all data sets was performed at multiple time points within the t-wave/p-wave interval, differing from each other by 50 ms. In addition, each reconstruction was assigned to one of six reconstruction intervals (A-F), each corresponding to a specific event in the cardiac cycle. While no significant time points were found for absolute values, the following interval/reconstruction technique combinations provided significant better image quality: F/r at HR <60 bpm for all coronary segments ( p=0.004) and at HR 60-65 bpm for segments 5-10 ( p=0.001); B/a at HR 60-65 bpm for segments 1-4 and 11-15 ( p<0.001) and at HR >65 bpm for all segments ( p=0.002). The results show that in order to achieve optimal image quality, image reconstruction has to be adjusted to each patient's ECG curve and heart rate individually. The moment of reconstruction should be determined as absolute rather than as relative distance from the previous R-peak.