Abdominal complications following hematopoietic stem cell transplantation.

Abdominal complications affect more than 80% of patients who undergo hematopoietic stem cell transplantation (HSCT) for treatment of benign or malignant hematologic disease and some solid tumors. HSCT can be performed using cells from bone marrow, peripheral blood, or umbilical cord blood. These stem cells may be from the patient him- or herself (autologous transplant), from relatives or nonrelatives with very similar human leukocyte antigen (allogeneic transplant), or from an identical twin (syngeneic transplant). Posttransplantation complications are classified according to the amount of time elapsed between transplantation and onset. Complications that occur during the first 100 days are divided into preengraftment phase complications (≤30 days after transplantation) and early posttransplantation phase complications (31-100 days after transplantation) and include infectious and noninfectious conditions such as hepatic veno-occlusive disease (VOD), hemorrhagic cystitis, neutropenic colitis, benign pneumatosis, and acute graft-versus-host disease (GVHD). Hepatic VOD, neutropenic colitis, and acute hemorrhagic cystitis are associated with the pretransplantation conditioning regimen. After the first 100 days, chronic GVHD and lymphoproliferative disease are the main complications. Computed tomography and ultrasonography are the primary imaging techniques used in HSCT patients and can help make an early diagnosis, grade the severity of impact, and (if necessary) recommend further investigations to confirm the diagnosis.

Prospective comparison of helical CT with angiography in pulmonary embolism: global and selective vascular territory analysis. Interobserver agreement.

The objective of this prospective study was to evaluate the sensitivity, specificity, positive and negative predictive values, and interobserver agreement in the diagnosis of pulmonary embolism with helical CT, compared with pulmonary angiography, for both global results and for selective vascular territories. Helical CT and pulmonary angiography were performed on 66 consecutive patients with clinical suspicion of pulmonary embolism. The exams were blindly interpreted by a vascular radiologist and by two independent thoracic radiologists. Results were analyzed for the final diagnosis as well as separately for 20 different arterial territories in each patient. Pulmonary angiography revealed embolism in 25 patients (38%); 48% were main, 28% lobar, 16% segmental, and 8% subsegmental. The sensitivity, specificity, and positive and negative predictive values of helical CT for observer 1 were, respectively, 91, 81.5, 75, and 94%; in 7.5% of the patients the exam was considered indeterminate. For observer 2 the values were, respectively, 88, 86, 81.5, and 91%; in 9% of the patients the exam was considered indeterminate. Main arteries were considered as non-valuable in 0-0.8%, the lobar in 1.5%, the segmental in 7.5-8.5%, and the subsegmental in 55-60%. Interobserver agreement for the final diagnosis was 80% (kappa 0.65). For each vascular territory, this was 98% (kappa 0.91) for main arteries, 92% (kappa 0.78) for lobar arteries, 79% (kappa 0.56) for segmental arteries, and 59% (kappa 0.21) for subsegmental arteries. Helical CT is a reliable method for pulmonary embolism diagnosis, with good interobserver agreement for main, lobar, and segmental territories. Worse results are found for subsegmental arteries, with high incidence of non-valuable branches and poor interobserver agreement.

La tomografía computarizada helicoidal en el diagnóstico del tromboembolsimo pulmonar. Estudio comparativo con la arteriografía pulmonar / Helical computed tomography in the diagnosis of pulmonary thromboembolism: comparison with pulmonary arteriography

Objetivo: Valorar la utilidad de la tomografía computarizada helicoidal en el diagnóstico del tromboembolismo pulmonar en un estudio comparativo con la arteriografía pulmonar.Pacientes y métodos: Se han incluido 30 pacientes con sospecha clínica de tromboembolismo pulmonar a los que se les practicó una tomografía computarizada helicoidal con contraste intravenoso y una arteriografía pulmonar en un intervalo no superior a 24 horas. Cada procedimiento fue evaluado por un observador de una forma ciega e independiente estableciendo la ausencia o presencia de tromboembolismo y su localización. Resultados: La tomografía computarizada helicoidal identificó correctamente 12 de 14 casos de tromboembolismo pulmonar (sensibilidad 85,7 por ciento) y 15 de 16 sin él (especificidad 93,7 por ciento). Los valores predictivos positivo y negativo fueron de 92,3 por ciento y 88,2 por ciento respectivamente. La fiabilidad diagnóstica fue de 90 por ciento. Todos los émbolos centrales fueron diagnosticados correctamente; los dos falsos negativos correspondieron a émbolos localizados a nivel segmentario y subsegmentario respectivamente. Conclusión: La tomografía computarizada helicoidal con contraste es un método diagnóstico fiable para la detección y exclusión de tromboembolismo pulmonar (AU)