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2.
Br J Haematol ; 189(6): 1054-1056, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32369614
4.
Medicine (Baltimore) ; 99(15): e19817, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32282747

RESUMEN

RATIONALE: Two-dimensional echocardiography (2D echo) is a major tool for the diagnosis of Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). However 2D echo can skip regional localized anomalies of the right ventricular wall. We aimed to determine whether transesophageal and intracardiac ultrasound can provide additional information, on the right ventricular abnormalities compared to 2D echo. PATIENT CONCERNS: Case 1 is a 30-year-old patient that presented in the Emergency Department with multiple episodes of fast monomorphic ventricular tachycardia (VT) manifested by palpitations and diziness. Case 2 is a 65-year-old patient that also presented with episodes of ventircular tachycardia associated with low blood pressure. DIAGNOSIS: Both patients had a clear diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy confirmed by cardiac magnetic resonance imaging. INTERVENTION: In both patients transesophageal and intracardiac ultrasound was performed, which brought more information on the diagnosis of ARVD/C compared to transthoracic echocardiograpy. OUTCOMES: The first patient was implanted with an internal cardiac defibrillator and treated with Sotalol for VT recurrences. He presented episodes of VT during follow-up, treated with antitachycardia pacing. The second patient was implanted with an internal cardiac defibrillator and treated with Sotalol without any VT recurrence at 18 month-follow-up. LESSONS: Transesophageal echocardiography and intracardiac echocardiography can provide additional information on small, focal structural abnormalities in patients with ARVD/C: bulges, saculations, aneurysms with or without associated thrombus, partial or complete loss of trabeculations and hypertrophy of the moderator band. These changes are particularly important in cases with "concealed" form of the disease in which no morphological abnormalities are evident in transthoracic echocardiograpy.


Asunto(s)
Displasia Ventricular Derecha Arritmogénica/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Trombosis/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Antiarrítmicos/uso terapéutico , Displasia Ventricular Derecha Arritmogénica/complicaciones , Displasia Ventricular Derecha Arritmogénica/terapia , Técnicas de Imagen Cardíaca/instrumentación , Desfibriladores Implantables , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Recurrencia , Trombosis/patología , Resultado del Tratamiento , Ultrasonografía/tendencias
5.
Rev Assoc Med Bras (1992) ; 66(1): 31-35, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32130378

RESUMEN

Homozygous familial hypercholesterolemia is a rarely agentic disorder of the lipoprotein metabolism intimately related to premature atherosclerotic cardiovascular disease that can lead to high disability and mortality. Homozygous familial hypercholesterolemia typically affects not only the aortic root, compromising the coronary ostia, but also affects other territories such as the carotid, descending aorta, and renal arteries. Multi-contrast high-resolution magnetic resonance imaging (MRI) provides a validated and useful method to characterize carotid artery atherosclerotic plaques quantitatively. However, very few studies have been done on assessing plaque composition in patients with Homozygous familial hypercholesterolemia using high-resolution MRI. This report is to evaluate the value of MRI in accessing carotid artery disease in patients with Homozygous familial hypercholesterolemia. We describe a 28-year-old patient from Beijing, China, who presented to the Neurology Clinic with intermittent blurred vision of the right eye, headache, nausea, and vomiting for eight years without obvious causes. Familial hypercholesterolemia was suspected based on medical history and laboratory examination. Carotid Doppler ultrasound showed bilateral common carotid artery, internal carotid artery, and external carotid artery wall thickening with hyperechoic signals. Subsequently, high-resolution multi-contrast MRI of the carotid showed calcification with hypo-intense areas located at the middle layer of the plaque, with moderate stenosis. The plaque located at the right bifurcation of the common carotid artery extended to the internal carotid artery, causing lumen stenosis close to occlusion. The patient was treated with right carotid artery endarterectomy. At a 6-month follow-up, there had been no recurrence of the patient's symptoms.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Hiperlipoproteinemia Tipo II/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Placa Aterosclerótica/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Adulto , Arteria Carótida Externa/diagnóstico por imagen , Arteria Carótida Externa/patología , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Grosor Intima-Media Carotídeo , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Placa Aterosclerótica/patología , Ultrasonografía Doppler en Color/métodos
6.
Int J Nanomedicine ; 15: 1759-1770, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32214809

RESUMEN

Background: There have been many recent reports of molecular probes for thrombi but with unsatisfactory in vivo targeting effects, which could be related to the blood flow velocity in vivo. Therefore, it is worth explaining the relationship between the targeting effect and the blood flow velocity. Methods and Materials: In this study, we constructed a platelet-targeting nanoparticle (NP) based on EWVDV for targeting P-selectin combined with the phase transition material perfluorohexane and India ink to achieve the multimodal imaging of thrombi. We studied the targeting effect of the NPs for rabbit blood thrombi under different flow velocities simulating blood flow velocities in vivo. Results: The results show the successful fabrication of NPs with the ability to undergo a phase transition via low-intensity focused ultrasound irradiation to achieve ultrasound imaging and with a high binding affinity for activated platelets. In vitro, low flow velocities (20 cm/s) hardly affected the targeting effect of the NPs, while moderate flow velocities (40 cm/s) reduced the number of NPs that target thrombi by 52.6% comparing to static fluid (0 cm/s). High flow velocities (60 cm/s) greatly reduced the targeting effect of the NPs by 83.5%. Conclusion: These results can serve as a reference for the design of NPs targeting thrombi at different sites and in different blood vessel types according to the blood flow velocity, thereby establishing a foundation for in vivo experiments.


Asunto(s)
Plaquetas/efectos de los fármacos , Imagen Multimodal/métodos , Nanopartículas/administración & dosificación , Trombosis/diagnóstico por imagen , Animales , Velocidad del Flujo Sanguíneo , Carbono/química , Fluorocarburos/química , Nanopartículas/química , Selectina-P/metabolismo , Activación Plaquetaria/efectos de los fármacos , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/química , Conejos , Trombosis/sangre , Ultrasonografía
7.
J Med Vasc ; 45(1): 18-22, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32057320

RESUMEN

Management of iliac stent thrombosis is challenging. Open surgical repair may be indicated when intraluminally stent catheterization is difficult to perform. The present review reports the crush stent recanalization technique illustrated with the management of a patient with critical limb ischemia associated to iliac stent thrombosis. Crush stent technique has been described in interventional cardiology but remains rarely performed. Few reported cases described this technique for peripheral arterial recanalization, that is stenting through the subintimal space around an occluded stent.


Asunto(s)
Procedimientos Endovasculares/instrumentación , Arteria Ilíaca , Enfermedad Arterial Periférica/terapia , Stents , Trombosis/terapia , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/fisiopatología , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Trombosis/diagnóstico por imagen , Trombosis/etiología , Trombosis/fisiopatología , Resultado del Tratamiento , Grado de Desobstrucción Vascular
8.
Medicine (Baltimore) ; 99(6): e18996, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028410

RESUMEN

Upper extremity vein thrombosis (UE-VT) are more and more frequent pathologies and yet little studied. The aim is to describe the clinical and ultrasound features, UE-VT-related diseases, and the prevalence of pulmonary embolism (PE) and associated deaths.All UE-VT patients diagnosed by Doppler-ultrasound in Nantes University Hospital, from January 2015 to December 2017, were included retrospectively. UE-VT suspicion patterns, clinical features, UE-VT topography, and prevalence of PE and death were analyzed.Seven hundred and fifty-five UE-VT were analyzed, including 427 deep thrombosis (UE-DVT) and 328 superficial thrombosis (UE-SVT). In 86.2% (n = 651) UE-VT were related to endovascular devices. Among these thrombosis, one third is in connection with a PICC LINE and one quarter with a peripheral venous line. Forty nine percent (n = 370) of the patients had solid neoplasia or hematological malignancies. An inflammatory or systemic infectious context was found in 40.8% (n = 308) of the cases. The most frequently observed clinical sign at the UE-VT diagnosis was edema (28.6%). Among the UE-SVT it was the presence of an indurated cord (33.2%) and among the UE-DVT the indication of the Doppler-ultrasound was mainly a suspicion of infection on endovascular device (35.1%). In 10.6% (n = 80) of the cases the UE-VT were asymptomatic. The most frequently thrombosed veins were brachial basilic veins (16.7% of all thrombosed segments) followed by jugular (13%) and subclavian (12.3%) veins; 61.3% (n = 463) of UE-VT were in the right upper extremity; 63.3% (n = 478) UE-VT were occlusive. The occurrence of PE is 4% and the death rate is 10.2%, mainly related to the severe comorbidities of patients with UE-VT.UE-VT occurs in particular clinical contexts (hematological malignancies, solid cancers, systemic infections) and in the majority of endovascular devices (86.2%). The occurrence of PE is low.


Asunto(s)
Brazo/irrigación sanguínea , Trombosis/diagnóstico , Trombosis de la Vena/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Embolia Pulmonar/etiología , Embolia Pulmonar/mortalidad , Estudios Retrospectivos , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Trombosis/mortalidad , Ultrasonografía , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/mortalidad
12.
Br J Radiol ; 93(1108): 20190635, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31944831

RESUMEN

The clinical diagnosis of pulmonary embolism is often difficult, as symptoms range from syncope and chest pain to shock and sudden death. Adding complexity to this picture, some patients with non-diagnosed pulmonary embolism may undergo unenhanced imaging examinations for a number of reasons, including the prevention of contrast medium-related nephrotoxicity, anaphylactic/anaphylactoid reactions and nephrogenic systemic fibrosis, as well as due to patients' refusal or lack of venous access. In this context, radiologists' awareness and recognition of indirect signs are cornerstones in the diagnosis of pulmonary embolism. This article describes the indirect signs of pulmonary embolism on chest X-ray, unenhanced CT, and MRI.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Imagen Multimodal/métodos , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Diagnóstico Diferencial , Humanos , Hallazgos Incidentales , Enfermedades Pulmonares/diagnóstico por imagen , Arteria Pulmonar/diagnóstico por imagen , Infarto Pulmonar/diagnóstico por imagen , Trombosis/diagnóstico por imagen
13.
J Neurointerv Surg ; 12(1): 38-42, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31239329

RESUMEN

BACKGROUND: Clot perviousness in large vessel occlusion has been shown to be associated with improved recanalization outcomes with mechanical thrombectomy and intravenous thrombolysis. OBJECTIVE: To evaluate the association between clot perviousness based on thrombus attenuation increase (TAI) on CT, and histologic composition of clots in acute ischemic stroke (AIS). METHODS: A retrospective review was completed of patients with AIS secondary to large vessel occlusion, non-contrast CT (NCCT) and CT angiography (CTA) images, and histologic analysis of the retrieved clot. TAI was measured by subtracting clot attenuation on NCCT from the attenuation on CTA. Up to 3 regions of interest (ROIs) were evaluated on each clot; the average attenuation was used for analysis if multiple ROIs were assessed. Pervious clots were defined as TAI ≥10 Hounsfield units (HUs); impervious clots had TAI <10 HU. Histopathologic analyses of clots were assessed for relative compositions of red blood cells (RBCs), white blood cells (WBCs), fibrin, and platelets/other. RESULTS: 57 patients were included. Pervious clots were more likely to be RBC rich (p=0.04); impervious clots were more likely to be fibrin and WBC rich (p=0.01 for both). Pervious clots also had greater RBC density than impervious clots (49.8% and 33.0%, respectively; p=0.006); fibrin density of pervious clots was lower than that of impervious clots (17.8% and 23.2%, respectively; p=0.02). CONCLUSION: Clot perviousness, assessed on NCCT and CTA imaging, is associated with higher RBC density and lower fibrin density, offering a possible explanation for the higher rates of successful thrombectomy and favorable clinical outcome seen in such patients.


Asunto(s)
Angiografía por Tomografía Computarizada/métodos , Trombosis/diagnóstico por imagen , Trombosis/patología , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/patología , Isquemia Encefálica/cirugía , Angiografía por Tomografía Computarizada/tendencias , Femenino , Humanos , Masculino , Persona de Mediana Edad , Permeabilidad , Estudios Retrospectivos , Método Simple Ciego , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/patología , Accidente Cerebrovascular/cirugía , Trombectomía/métodos , Trombectomía/tendencias , Trombosis/metabolismo
14.
Angiology ; 71(2): 122-130, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31303025

RESUMEN

The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.


Asunto(s)
Grosor Intima-Media Carotídeo , Isquemia/complicaciones , Isquemia/diagnóstico por imagen , Pierna/irrigación sanguínea , Pierna/diagnóstico por imagen , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico por imagen , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Trombosis/complicaciones , Trombosis/diagnóstico por imagen , Factores de Edad , Anciano , Enfermedad Crítica , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas
15.
J Neurointerv Surg ; 12(1): 67-71, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31530652

RESUMEN

INTRODUCTION: Postprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported. METHODS: A multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure. RESULTS: A total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0-83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0-2) at 3 months were achieved in 88% of patients. CONCLUSION: Acute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1-2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible.


Asunto(s)
Manejo de la Enfermedad , Procedimientos Endovasculares/métodos , Stents Metálicos Autoexpandibles/efectos adversos , Trombosis/diagnóstico por imagen , Trombosis/cirugía , Anciano , Angioplastia de Balón/efectos adversos , Femenino , Fibrinolíticos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents Metálicos Autoexpandibles/tendencias , Trombosis/etiología , Resultado del Tratamiento
16.
Chem Soc Rev ; 49(1): 21-31, 2020 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-31799523

RESUMEN

The results of numerous studies have led to the development of supramolecular (assembled) organic substances for use in biomedical imaging as part of comprehensive approaches to the diagnosis of diseases. This review summarizes recent advances that have been made in the design and fabrication of assembled organic dyes for fluorescence and photoacoustic bioimaging.


Asunto(s)
Fluorescencia , Colorantes Fluorescentes/química , Neoplasias/diagnóstico por imagen , Compuestos Orgánicos/química , Técnicas Fotoacústicas , Trombosis/diagnóstico por imagen , Animales , Colorantes Fluorescentes/síntesis química , Humanos , Compuestos Orgánicos/síntesis química
17.
Radiol Med ; 125(3): 265-271, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31863358

RESUMEN

PURPOSE: To investigate whether the increased obstruction of the pulmonary arteries was associated with reduced pulmonary vein areas in acute pulmonary embolism (APE). METHOD: We retrospectively analyzed a consecutive series of computed tomography pulmonary angiography studies of 107 patients with APE and 101 controls without APE between November 2010 and January 2019. The control and patient groups were compared with each other for differences between the mean cross-sectional areas of pulmonary veins. Further analysis was conducted by dividing the patient group into high-risk patients (≥ 20%) and low-risk patients (< 20%) according to the pulmonary arterial obstruction index. The mean cross-sectional area of the pulmonary veins in these two groups was compared. RESULTS: The mean cross-sectional areas of the 4 pulmonary veins at the ostium level (CSAPV) were significantly lower for the patient group (mean: 102.6 mm2) compared with the control group (111.8 mm2) (p < 0.001). CSAPV cutoff value for determining the diagnosis of APE that maximized the accuracy was 109.12 mm2 (AUC = 0.721; 95% CI 0.649-0.794); its sensitivity and specificity were 78.2% and 69.2%, respectively. CSAPV cutoff value for differentiating high-risk APE that maximized the accuracy was 102.6 mm2 (AUC = 0.634; 95% CI 0.525-0.743); its sensitivity and specificity were 61.9% and 53.8%, respectively. CONCLUSIONS: There is a negative correlation between the CSAPV and thrombotic material burden in the pulmonary arteries of patients with APE. Hence, the CSAPV can be used as a diagnostic tool in the evaluation of the presence and severity of pulmonary embolism.


Asunto(s)
Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Angiografía por Tomografía Computarizada/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
18.
Ann Vasc Surg ; 62: 498.e7-498.e10, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31449942

RESUMEN

Popliteal artery aneurysms (PAAs) are the most common peripheral arterial aneurysms and develop almost exclusively (>90%) in men who have a history of tobacco abuse at an average age of 65 years. Most PAAs are caused by chronic inflammation secondary to atherosclerotic disease; other nondegenerative causes of PAAs include arterial trauma, infection, Behçet's disease, medial fibromuscular dysplasia, or popliteal artery entrapment. Few case reports have been published on idiopathic congenital PAAs. We report a case of a 26-year-old man who presented with progressive claudication and subsequent acute limb ischemia due to the thrombosis of a large idiopathic PAA. Our case demonstrates that the differential diagnosis of young adult or pediatric patients presenting with signs of acute limb ischemia or claudication should include a symptomatic PAA.


Asunto(s)
Aneurisma/complicaciones , Claudicación Intermitente/etiología , Isquemia/etiología , Enfermedad Arterial Periférica/etiología , Arteria Poplítea , Trombosis/etiología , Enfermedad Aguda , Adulto , Aneurisma/diagnóstico por imagen , Aneurisma/fisiopatología , Aneurisma/cirugía , Fasciotomía , Humanos , Claudicación Intermitente/diagnóstico por imagen , Claudicación Intermitente/fisiopatología , Claudicación Intermitente/cirugía , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Isquemia/cirugía , Ligadura , Masculino , Enfermedad Arterial Periférica/diagnóstico por imagen , Enfermedad Arterial Periférica/fisiopatología , Enfermedad Arterial Periférica/cirugía , Arteria Poplítea/diagnóstico por imagen , Arteria Poplítea/fisiopatología , Arteria Poplítea/cirugía , Vena Safena/trasplante , Trombosis/diagnóstico por imagen , Trombosis/fisiopatología , Trombosis/cirugía , Resultado del Tratamiento , Injerto Vascular
20.
Cancer Imaging ; 19(1): 79, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791422

RESUMEN

BACKGROUND: Vena cava thrombus is one of the main clinical manifestations of locally aggressive renal cell carcinoma (RCC). Inferior vena cava (IVC) wall invasion and presence of bland thrombus could affect the surgical outcome. This study aims to assess the value of contrast-enhanced ultrasound (CEUS) in detecting wall invasion and differentiating bland thrombus from tumor thrombus during robot-assisted IVC thrombectomy for RCC. METHODS: The intraoperative CEUS findings of 60 patients with RCC accompanied by IVC tumor thrombus were retrospectively analyzed. The CEUS features were compared with the intra- and post-operative pathological findings. CEUS in patients with wall invasion showed that the tumor thrombus was enhanced synchronously with the IVC wall, and the continuity of the IVC wall was lost. In contrast, in patients without wall invasion, CEUS showed that the contrast agent could pass between the tumor thrombus and the IVC wall, and the continuity of IVC wall was good. Typically, contrast-enhanced perfusion was seen in tumor thrombus but not in bland thrombus. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were statistically analyzed. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the typical enhancement mode of CEUS were 93.1, 93.5, 93.3, 93.1, and 93.5% in identifying wall invasion and 100, 96, 96.7, 83.3, and 100% in differentiating bland thrombus from tumor thrombus, respectively. There were excellent inter-observer agreements for identifying IVC wall invasion and differentiating bland thrombus from tumor thrombus with kappa coefficients of 0.90 and 0.97. CONCLUSIONS: The present study indicates that intraoperative CEUS plays an important role in robot-assisted IVC thrombectomy for RCC. It can detect wall invasion and differentiate bland thrombus from tumor thrombus, thus offering real-time information to the operator during surgery.


Asunto(s)
Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Células Neoplásicas Circulantes , Trombectomía/métodos , Trombosis/diagnóstico por imagen , Ultrasonografía/métodos , Vena Cava Inferior/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/patología , Medios de Contraste , Femenino , Humanos , Cuidados Intraoperatorios , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/diagnóstico por imagen , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados , Trombosis/cirugía , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Trombosis de la Vena/patología
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