Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 11.147
Filtrar
1.
Niger J Clin Pract ; 24(6): 833-840, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34121730

RESUMEN

Aims: To investigate the distribution, characteristics, and association with subarachnoid hemorrhage (SAH) of aneurysms identified in Turkish adult patients with computed tomography angiography (CTA) performed with suspicion of intracranial aneurysms and/or SAH. Subjects and Methods: A total of 356 patients (164 male, and 192 female) with a mean age of 55.6 ± 4.0 (range, 18-90) years were analyzed retrospectively. The dimension in millimeters, localization, type, and multiplicity of aneurysms were noted. The differences in these parameters between females and males were investigated. The correlations of sex, aneurysm size, multiplicity, and size with SAH were researched. Results: On 356 CTA, 140 cases were identified to have aneurysm (39.3%) (56 males [40.0%], 84 females [60.0%]). The incidence of aneurysms and SAH in females was high relative to males. In 140 patients, a total of 187 aneurysms were present (mean size, 7.25 ± 2.56 mm). The highest number of aneurysms was found in the middle cerebral artery 64 (34.2%) while the least was in posterior circulation 20 (10.7%). There was no significant difference between genders in terms of aneurysm size, type, and multiplicity. Individuals with aneurysm site on the internal carotid artery had lower SAH incidence. Receiver Operating Characteristic curve analysis results determined that individuals with aneurysm size >13.5 mm had increased incidence of SAH. Conclusions: The general properties of intracranial aneurysms investigated with CTA in Turkish adults had similarities to information defined in the literature. These results will likely be beneficial to direct approaches to aneurysm diagnosis and treatment in routine practice.


Asunto(s)
Aneurisma Intracraneal , Hemorragia Subaracnoidea , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Cerebral , Angiografía por Tomografía Computarizada , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/epidemiología , Adulto Joven
2.
J Med Case Rep ; 15(1): 283, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34074328

RESUMEN

BACKGROUND: Acute DeBakey type I and type II aortic dissections are indications for emergent surgical repair; however, there are currently no standard protocols in the management of isolated supra-aortic dissections. Prompt diagnosis and management of an isolated innominate artery dissection are necessary to prevent distal malperfusion and thromboembolic sequelae. CASE PRESENTATION: A 50-year-old Caucasian gentleman presented with chest pain radiating to his jaw and right arm. He had no recent history of trauma. On physical exam, he was neurologically intact and malignantly hypertensive. Computed tomographic angiography of the chest and neck confirmed a spontaneous isolated innominate artery dissection without ascending aorta involvement. Given the lack of evidence for rupture, distal emboli, and/or end-organ malperfusion, the decision was made for initial non-operative management-anti-impulse regimen, antiplatelet therapy, and close follow-up. CONCLUSIONS: Medical management of a spontaneous isolated innominate artery dissection is appropriate for short-term and potentially long-term therapy. This not only spares the patient from a potentially unnecessary surgical operation but also provides the surgeon and the patient the time to plan for a surgical approach if it becomes necessary.


Asunto(s)
Aneurisma Disecante , Aneurisma Disecante/diagnóstico por imagen , Aneurisma Disecante/cirugía , Aorta , Tronco Braquiocefálico/diagnóstico por imagen , Tronco Braquiocefálico/cirugía , Angiografía por Tomografía Computarizada , Disección , Humanos , Masculino , Persona de Mediana Edad
4.
Medicine (Baltimore) ; 100(22): e26212, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34087897

RESUMEN

ABSTRACT: To investigate the diagnostic value of a computed tomography (CT) scan-based radiomics model for acute aortic dissection.For the dissection group, we retrospectively selected 50 patients clinically diagnosed with acute aortic dissection between October 2018 and November 2019, for whom non-contrast CT and CT angiography images were available. Fifty individuals with available non-contrast CT and CT angiography images for other causes were selected for inclusion in the non-dissection group. Based on the aortic dissection locations on the CT angiography images, we marked the corresponding regions-of-interest on the non-contrast CT images of both groups. We collected 1203 characteristic parameters from these regions by extracting radiomics features. Subsequently, we used a random number table to include 70 individuals in the training group and 30 in the validation group. Finally, we used the Lasso regression for dimension reduction and predictive model construction. The diagnostic performance of the model was evaluated by a receiver operating characteristic (ROC) curve.Fourteen characteristic parameters with non-zero coefficients were selected after dimension reduction. The accuracy, sensitivity, specificity, and area under the ROC curve of the prediction model for the training group were 94.3% (66/70), 91.2% (31/34), 97.2% (35/36), and 0.988 (95% confidence interval [CI]: 0.970-0.998), respectively. The respective values for the validation group were 90.0% (27/30), 94.1% (16/17), 84.6% (11/13), and 0.952 (95% CI: 0.883-0.986).Our non-contrast CT scan-based radiomics model accurately facilitated acute aortic dissection diagnosis.


Asunto(s)
Aneurisma Disecante/diagnóstico por imagen , Aorta/patología , Aneurisma de la Aorta/complicaciones , Tomografía Computarizada por Rayos X/métodos , Enfermedad Aguda , Adulto , Anciano , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Aumento de la Imagen/instrumentación , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad
5.
Medicine (Baltimore) ; 100(22): e26213, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34087898

RESUMEN

ABSTRACT: Pulmonary embolism (PE) is a common medical problem. Its diagnostic criteria must be reviewed to determine the need for confirmatory testing. Computed tomography pulmonary angiography (CTPA) is the current standard of care, which provides accurate diagnosis with rapid turnaround. This study aimed to estimate the diagnostic yield of CTPA in clinically suspected PE patients in a tertiary care hospital in Saudi Arabia.Radiology records of all patients with clinically suspected PE who underwent CTPA between January 1, 2012 and September 30, 2018 were reviewed retrospectively. A radiologist with 10 years of professional experience interpreted and reported all cases. The Wells score with 2 tiers (likely and unlikely) was used to raise the clinical suspicion of PE.Positive results for PE were reported in 177 out of 534 clinically suspected cases (33%). Among the positive PE cases, 143 were acute (81%) and 34 (19%) were chronic. Bilateral, right-sided, and left-sided PE were found in 115 (65%), 37 (21%), and 25 (14%) cases, respectively. Involvement of the segmental branches, subsegmental branches, and the pulmonary trunk were noted in 152 (86%), 70 (40%), and 9 cases (5%), respectively. Saddle PE was found in (4%) of the cases. The lower lobe branches (right 55%, left 53%) and the upper lobe branches (right 47%, left 41%) were the most common sites of involvement.CTPA had a higher positive detection rate for PE among clinically suspected cases than its published diagnostic yield. Adequate clinical evaluation when selecting patients for CTPA is emphasized to minimize unjustified exposure of the patients to radiation and intravenous contrast administration. It is crucial for radiologists to provide detailed reports commenting on all relevant findings, including pertinent negatives. A template for reporting radiological findings for CTPA can be recommended for this purpose.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Medios de Contraste/efectos adversos , Pulmón/irrigación sanguínea , Embolia Pulmonar/diagnóstico , Exposición a la Radiación/efectos adversos , Administración Intravenosa , Adulto , Anciano , Angiografía por Tomografía Computarizada/normas , Medios de Contraste/administración & dosificación , Femenino , Humanos , Pulmón/fisiopatología , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/epidemiología , Exposición a la Radiación/prevención & control , Estudios Retrospectivos , Arabia Saudita/epidemiología , Centros de Atención Terciaria
6.
Medicine (Baltimore) ; 100(22): e26228, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34087904

RESUMEN

RATIONALE: Obstructive hydrocephalus (OH) frequently occurs in patients with a ruptured cerebral aneurysm (CA), and it may lead to severe neurological deficits, including life-threatening brain herniation. OH generally occurs in the early stage of CA rupture, rather than in the late stage, and rarely resolves without therapy. PATIENT CONCERNS: A 64-year-old woman with a ruptured anterior communicating artery aneurysm was treated with coil embolization. Nineteen days after her CA rupture, because of the delayed transient OH, she experienced a dramatic cycle in consciousness over 9 hours: wakefulness-drowsiness-coma-drowsiness-wakefulness. DIAGNOSIS: The patient was diagnosed with delayed transient obstructive hydrocephalus, which is a very rare condition. INTERVENTIONS: Mannitol was administered to reduce intracranial pressure. OUTCOMES: The patient was discharged from the hospital 30 days after admission, with a final GCS score of 15 and without weaknesses. At follow-up 2 months after discharge, brain CT revealed non-recurrence of hydrocephalus. LESSONS: A blood clot of any size in the ventricle is likely to lead to obstructive hydrocephalus. Prolonged bed rest for IVH patients may help to reduce the incidence of delayed OH.


Asunto(s)
Aneurisma Roto/terapia , Hidrocefalia/etiología , Aneurisma Intracraneal/patología , Cuidados Posteriores , Aneurisma Roto/complicaciones , Prótesis Vascular/efectos adversos , Angiografía por Tomografía Computarizada/métodos , Diuréticos Osmóticos/administración & dosificación , Diuréticos Osmóticos/uso terapéutico , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Femenino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/tratamiento farmacológico , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/diagnóstico , Manitol/administración & dosificación , Manitol/uso terapéutico , Persona de Mediana Edad , Resultado del Tratamiento
8.
J Stroke Cerebrovasc Dis ; 30(7): 105845, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33964546

RESUMEN

PURPOSE: This study aims to test the validity of a new quantitative scoring instrument-the Venous Occlusion Image Score (VOIS), and assess the diagnostic and prognostic value of VOIS for cerebral venous sinus thrombosis (CVST). METHODS: The VOIS divided the major cerebral venous sinuses and internal jugular veins into nine parts of interest. CT venography and DSA source images and reconstruction were extracted from the database, then interpreted and scored independently according to VOIS by a panel of three reviewers. Inter-observer and intra-observer reliability were determined using the intraclass correlation coefficient (ICC) and the kappa coefficient (κ). The primary outcome was the 3-month functional outcome and evaluated by modified Rankin Scale (mRS). The sensitivity and specificity of VOIS for the primary outcomes were computed. Logistic regression was applied to evaluate the association between the score on VOIS and the primary outcomes. RESULTS: Fifty-six patients with CVST were included in the study. For 16 patients underwent cerebral CTV and DSA, excellent interobserver agreement was observed for DSA (ICC=0.90, 95%CI = 0.87 - 0.92, P < 0.001), and CTV (ICC = 0.92, 95%CI = 0.84 - 0.93, P < 0.001). The κ coefficient of agreement for the two radiology measures was 0.88 (95%CI = 0.79-0.92), indicating good inter-method agreement. For 56 patients followed up by CTV, baseline VOIS value correlated inversely with the severity of stroke on the National Institutes of Health Stroke Scale (r = -0·53, P < 0·001), and modified Rankin Scale (r = -0·59, P < 0·001). Baseline CTV-VOIS value predicted functional outcome (P < 0·05). CONCLUSION: VOIS may serve as a convenient and reliable method in the treatment guidance and outcome prediction of patients with CVST.


Asunto(s)
Angiografía Cerebral , Venas Cerebrales/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Tomografía Computarizada Multidetector , Flebografía , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Adulto , Bases de Datos Factuales , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Pronóstico , Interpretación de Imagen Radiográfica Asistida por Computador , Reproducibilidad de los Resultados , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Trombosis de los Senos Intracraneales/fisiopatología , Trombosis de los Senos Intracraneales/terapia , Adulto Joven
11.
Int J Cardiol ; 334: 142-147, 2021 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-33932431

RESUMEN

BACKGROUND: Ischemia with non-obstructive coronary arteries (INOCA) is not uncommon in clinical practice. However, the incidence and imaging characteristics of INOCA on dynamic CT myocardial perfusion imaging (CT-MPI) remains unclear. We aimed to investigate the prevalence and disease features of INOCA as evaluated by dynamic CT-MPI + coronary CT angiography (CCTA). METHODS: Patients with suspected chronic coronary syndrome and intermediate-to-high pre-test probability of obstructive CAD (according to updated Diamond and Forrester Chest Pain Prediction Rule) were referred for dynamic CT-MPI + CCTA and retrospectively included. Various parameters, including myocardial blood flow (MBF) and high-risk plaque (HRP) features, were measured. INOCA was diagnosed if patients were revealed to have myocardial ischemia and absence of obstructive stenosis. RESULTS: 314 patients were finally included. 20 patients (6.4%) were observed to have myocardial ischemia without obstructive stenosis. In addition, 138 patients (43.9%) had normal or near normal findings, 101 patients (32.2%) had obstructive stenosis without myocardial ischemia and 55 patients (17.5%) had obstructive stenosis with myocardial ischemia. Compared with patients with normal/near normal findings, patients with INOCA showed a higher prevalence of positive remodeling (40.0% vs. 17.4%, p = 0.04). In patients with obstructive stenosis, the mean age, calcium score and incidence of spotty calcification, positive remodeling as well as HRPs were significantly higher than those in patients with INOCA (p < 0.05 for all). CONCLUSIONS: The overall prevalence of INOCA was low in patients with suspected chronic coronary syndrome. HRPs were less frequently presented in patients with INOCA, compared with patients having obstructive coronary stenosis.


Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Isquemia Miocárdica , Imagen de Perfusión Miocárdica , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/epidemiología , Vasos Coronarios/diagnóstico por imagen , Humanos , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/epidemiología , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos
12.
Medicine (Baltimore) ; 100(18): e25732, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33950956

RESUMEN

INTRODUCTION: Although the clinical significance of type II endoleaks remain controversial, management strategies continue to expand. The laparoscopic approach is a minimally invasive method for persistent type II endoleak repair after endovascular aneurysm repair. PATIENT CONCERNS: A 70 - year - old male patient with a history of endovascular aneurysm repair with left internal iliac artery embolization presented with persistent type II endoleak from the lumbar arteries 2 years ago. The aneurysm sac size had increased more than 10 mm during follow up period. DIAGNOSIS: Persistent type II endoleak after endovascular aneurysm repair. INTERVENTIONS: Transarterial embolization was attempted and failed. A minimally invasive laparoscopic lumbar artery ligation was then utilized. OUTCOMES: The patient was discharged without any complications after surgery. Follow-up computed tomography angiography has shown the complete disappearance of the type II endoleaks. CONCLUSIONS: Laparoscopic lumbar artery ligation may be a safe and effective alternative treatment for type II endoleaks, especially in high resource settings.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Endofuga/cirugía , Procedimientos Endovasculares/efectos adversos , Laparoscopía , Anciano , Angiografía por Tomografía Computarizada , Endofuga/diagnóstico , Endofuga/etiología , Humanos , Ligadura/métodos , Masculino , Resultado del Tratamiento
13.
BMJ ; 373: n776, 2021 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-33947652

RESUMEN

First developed in 1990, the Agatston coronary artery calcium (CAC) score is an international guideline-endorsed decision aid for further risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease. This review discusses key international studies that have informed this 30 year journey, from an initial coronary plaque screening paradigm to its current role informing personalized shared decision making. Special attention is paid to the prognostic value of a CAC score of zero (the so called "power of zero"), which, in a context of low estimated risk thresholds for the consideration of preventive therapy with statins in current guidelines, may be used to de-risk individuals and thereby inform the safe delay or avoidance of certain preventive therapies. We also evaluate current recommendations for CAC scoring in clinical practice guidelines around the world, and past and prevailing barriers for its use in routine patient care. Finally, we discuss emerging approaches in this field, with a focus on the potential role of CAC informing not only the personalized allocation of statins and aspirin in the general population, but also of other risk-reduction therapies in special populations, such as individuals with diabetes and people with severe hypercholesterolemia.


Asunto(s)
Aterosclerosis/prevención & control , Calcio/análisis , Vasos Coronarios/química , Guías de Práctica Clínica como Asunto , Prevención Primaria/normas , Aterosclerosis/diagnóstico , Aterosclerosis/epidemiología , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Diabetes Mellitus/epidemiología , Humanos , Hipercolesterolemia/epidemiología , Tamizaje Masivo/métodos , Tamizaje Masivo/normas , Literatura de Revisión como Asunto , Medición de Riesgo/métodos , Factores de Riesgo
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(2): 230-234, 2021 Apr 28.
Artículo en Chino | MEDLINE | ID: mdl-33966703

RESUMEN

Objective To investigate the role of dual-layer detector energy spectral CT in resting myocardial perfusion imaging for patients with normal coronary artery. Methods One hundred and fifty-six patients with suspected coronary heart disease underwent dual-layer detector energy spectral CT coronary angiography,and resting myocardial perfusion imaging was performed for 28 patients with normal coronary artery.According to American Heart Association's 17-segmentmodel,the iodine density and effective atomic number(Zeff value)of each myocardial segment(except for apical segment)were measured and normalized to those of the aorta.All the data were quantitatively evaluated using ANOVA or Friedman test. Results Iodine density and Zeff value of myocardial segments in middle plane were significantly different(all P<0.001).The iodine density and Zeff value showed no significant difference between segments in basal and apical plane(all P > 0.05). Conclusions Iodine density and Zeff value of myocardial segments can be quantitatively evaluated using dual-layer detector energy spectral CT.Resting myocardial perfusion of segments in middle plane are significantly different in patients with normal coronary artery.


Asunto(s)
Imagen de Perfusión Miocárdica , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Vasos Coronarios/diagnóstico por imagen , Humanos , Tomografía Computarizada por Rayos X
15.
BMC Cardiovasc Disord ; 21(1): 234, 2021 05 08.
Artículo en Inglés | MEDLINE | ID: mdl-33964872

RESUMEN

BACKGROUND: 8-28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections. METHODS: This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA and 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels. DISCUSSION: The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic. TRIAL REGISTRATION: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at https://www.isrctn.com/ISRCTN12154994.


Asunto(s)
COVID-19/complicaciones , Cardiomiopatías/diagnóstico por imagen , Enfermedad Coronaria/diagnóstico por imagen , COVID-19/fisiopatología , Cardiomiopatías/fisiopatología , Cardiomiopatías/virología , Angiografía por Tomografía Computarizada , Enfermedad Coronaria/fisiopatología , Enfermedad Coronaria/virología , Fluorodesoxiglucosa F18 , Humanos , Imagen por Resonancia Magnética , Imagen Multimodal , Tomografía Computarizada por Tomografía de Emisión de Positrones , Estudios Prospectivos , Radiofármacos
16.
Eur J Radiol ; 140: 109740, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33971573

RESUMEN

OBJECTIVES: The aim of this study was to investigate the diagnostic abilities of both pericoronary adipose tissue (PCAT) CT attenuation and volume for the predication hemodynamic significance of coronary artery stenosis as evaluated by fractional flow reserve (FFR). METHODS: Patients with ≥ 30 % in at least 1 major epicardial coronary artery were retrospectively included. Furthermore, all eligible patients underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) as well as FFR within 1 month. PCAT CT attenuation and volume around ischemic and non-ischemic coronary stenosis were measured and compared. The diagnostic accuracy of PCAT CT attenuation and volume for the identification of hemodynamically significant stenosis was determined against the reference standard of FFR ≤ 0.80. RESULTS: A total of 61 patients (mean age, 57.8 years ± 11.8) with 77 vessels were included. Average PCAT CT attenuation of all vessels was -70.3 ± 7.4 HU. PCAT CT attenuation in coronary arteries with hemodynamically significant stenosis (FFR ≤ 0.80) (-65.6 ± 5.9 HU) was significantly higher than those with FFR > 0.80 (-75.3 ± 5.4 HU; p = 0.000). There was a strong correlation between FFR and PCAT CT attenuation (r = 0.64, p < 0.001). However, no significant difference in PCAT volume was observed between FFR ≤ 0.8 (5.0 ± 3.5 cm3) and FFR > 0.80 (5.5 ± 3.7 cm3, p = 0.511). The diagnostic accuracy was significantly higher in the combination of CCTA and PCAT CT attenuation compared with CCTA alone (area under the curve: 0.869 vs. 0.569, p < 0.001). CONCLUSIONS: PCAT CT attenuation but not volume was related to the hemodynamic significance of coronary artery stenosis. For the patients with suspected coronary artery disease, after adding of PCAT CT attenuation to CCTA, the diagnostic ability for the identification of ischemic coronary stenosis was significantly improved.


Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Tejido Adiposo/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Constricción Patológica , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Estenosis Coronaria/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
17.
Eur J Radiol ; 140: 109758, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33984808

RESUMEN

PURPOSE: This retrospective study aims to analyze the distribution of demand and the duration of the diagnostic workup of suspected pulmonary embolism (PE) using computed tomography pulmonary angiography (CTPA). METHODS: Time data from physical examination to report creation were identified for each CTPA in 2013 and 2018 at a tertiary hospital. Multivariable multinomial logistic and linear regression models were used to evaluate differences between 3 time intervals (I1: 6am-2pm, I2: 2pm-10pm, I3: 10pm-6am). A cosinor model was applied to analyze the amount of CTPA per hour. RESULTS: The relative demand for CTPA from the emergency room was lower in l1 compared to l2 and l3 (I1/I2: odds ratio (OR) 0.84, 95 % confidence interval (CI) 0.78-0.91; I1/I3: OR 0.80, 95 % CI 0.72-0.89; peak 4:23 pm). Requests for in-patients displayed a tendency towards I1 (I1/2: OR 1.15, 95 % CI 1.06-1.24; l1/l3: OR 1.19, 95 % CI 1.07-1.33; peak 1:54 pm). The time from CTPA request to study was shorter in I3 compared to I1 and I2 in 2013 (I1/I3: ratio 5.23, 95 % CI 3.38-8.10; I2/I3: ratio 3.50, 95 % CI 2.24-5.45) and 2018 (I1/I3: ratio 2.27, 95 % CI 1.60-3.22; I2/I3: ratio 2.11, 95 % CI 1.50-2.97). This applied similarly to fatal cases (I1/I3: ratio 2.91, 95 % CI 1.78-4.75; I2/I3: ratio 2.45, 95 % CI1.52-3.95). CONCLUSIONS: The temporal distribution of demand for CTPA depends on the sector of patient care and the processing time differs substantially during the day. Time series analysis can reveal such coherences and may help to optimize workflows in radiology departments.


Asunto(s)
Embolia Pulmonar , Angiografía , Angiografía por Tomografía Computarizada , Hospitales , Humanos , Embolia Pulmonar/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X
18.
Eur J Radiol ; 140: 109769, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-33992980

RESUMEN

OBJECTIVE: This study aimed to investigate the diagnostic performance of radiomics features derived from coronary computed tomography angiography (CCTA) in the identification of ischemic coronary stenosis plaque using invasive fractional flow reserve (FFR) as the reference standard. MATERIALS AND METHODS: 174 plaques of 149 patients (age: 62.21 ±â€¯8.47 years, 96 males) with at least one lesion stenosis degree between 30 % and 90 % were retrospectively included. Stenosis degree and plaque characteristics were recorded, and a conventional multivariate logistic model was established. Over 1000 radiomics features of the plaque were derived from CCTA images. The plaques were randomly divided into training set (n = 139) and validation set (n = 35). A random forest model was built. The area under the curve (AUC) of the models was compared. RESULTS: Fifty-eight radiomics features were correlated with functionally significant stenosis (p <  0.05), wherein 56 features had an AUC of >0.6. NCP volume, NRS, remodeling index, and spotty calcification were included in the conventional model. Ultimately, 14 features were integrated to build the radiomics model. The AUC showed an improvement: 0.71 vs 0.82 for the training set and 0.70 vs 0.77 for the validation set (conventional model and radiomics model, respectively); however, it was not statistically significant (p =  0.58). CONCLUSION: The radiomics analysis of plaques showed improvement compared with conventional plaques assessment in identifying hemodynamically significant coronary stenosis. The statistical advancement of machine learning for plaques to predict hemodynamic stenosis with a noninvasive approach still needs further studies on a large-scale dataset.


Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Reserva del Flujo Fraccional Miocárdico , Anciano , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estándares de Referencia , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
19.
Eur J Radiol ; 140: 109767, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-34000598

RESUMEN

Cardiovascular disease (CVD) is associated with high mortality around the world. Prevention and early diagnosis are key targets in reducing the socio-economic burden of CVD. Artificial intelligence (AI) has experienced a steady growth due to technological innovations that have to lead to constant development. Several AI algorithms have been applied to various aspects of CVD in order to improve the quality of image acquisition and reconstruction and, at the same time adding information derived from the images to create strong predictive models. In computed tomography angiography (CTA), AI can offer solutions for several parts of plaque analysis, including an automatic assessment of the degree of stenosis and characterization of plaque morphology. A growing body of evidence demonstrates a correlation between some type of plaques, so-called high-risk plaque or vulnerable plaque, and cardiovascular events, independent of the degree of stenosis. The radiologist must apprehend and participate actively in developing and implementing AI in current clinical practice. In this current overview on the existing AI literature, we describe the strengths, limitations, recent applications, and promising developments of employing AI to plaque characterization with CT.


Asunto(s)
Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Placa Aterosclerótica , Inteligencia Artificial , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Humanos , Placa Aterosclerótica/diagnóstico por imagen , Valor Predictivo de las Pruebas , Tomografía Computarizada por Rayos X
20.
Med Sci Monit ; 27: e931055, 2021 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-33993185

RESUMEN

BACKGROUND Computed tomographic colonography (CTC) is useful for patients for whom colonoscopy may be difficult to perform and is widely employed to examine the vasculature prior to colorectal cancer surgery. Computed tomographic angiography (CTA) was shown to be beneficial intraoperatively to manipulate blood vessels and prevent vascular injury. Three-dimensional (3D)-CTA combined with CTC (3D-CTA with CTC) is useful for preoperative evaluations of the anatomy of mesenteric vessels, colon, and lymph nodes. We observed that when the intestine was dilated with carbon dioxide (CO2), the arteriovenous delineation was often more pronounced than without CO2. To clarify the effects of gas injection with and without CO2 on hemodynamics and vascular passage, we compared the effect of contrast for blood vessels. MATERIAL AND METHODS Thirty patients with resectable colorectal cancer who underwent a preoperative CT examination at our institution from January to October 2019 were study participants. Of these, 15 underwent 3D-CTA and 15 had 3D-CTA with CTC. Three board-certified radiologists independently and blindly evaluated 18 blood vessels. CT values for each blood vessel were measured on each image. RESULTS CT values for 3D-CTA with CTC were significantly higher with CO2 than without CO2. The quality of 3D-CTA with CTC images for visualization of blood vessels was also significantly greater than that of 3D-CTA, especially those of arterial and intramesenteric venous systems. CONCLUSIONS Based on the higher image quality and CT values obtained by 3D-CTA with CTC for vessels, compared with by 3D-CTA imaging, 3D-CTA with CTC imaging might be useful in evaluating colorectal cancers.


Asunto(s)
Dióxido de Carbono/administración & dosificación , Colonografía Tomográfica Computarizada/métodos , Neoplasias Colorrectales/patología , Angiografía por Tomografía Computarizada/métodos , Cuidados Preoperatorios/métodos , Adulto , Anciano , Anciano de 80 o más Años , Colon/patología , Colonoscopía/métodos , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Persona de Mediana Edad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...