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1.
Phys Med ; 88: 235-241, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34311161

RESUMO

PURPOSE: To compare the organ-dose and effective-dose (E) delivered to the patient during percutaneous vertebroplasty (PVP) of one thoracic or lumbar vertebra performed under CT guidance or using a fixed C-arm. METHODS: Consecutive adult patients undergoing PVP of one vertebra under CT-guidance, with optimized protocol and training of physicians, or using a fixed C-arm were retrospectively included from January 2016 to June 2017. Organ-doses were computed on 16 organs using CT Expo 2.4 software for the CT procedures and PCXMC 2.0 for the fixed C-arm procedures. E was also computed with both software. Dosimetric values per anatomic locations for all procedures were compared using the paired Mann-Whitney-Wilcoxon test. RESULTS: In total, 73 patients were analysed (27 men and 46 women, mean age 78 ± 10 years) among whom 35 (48%) underwent PVP under CT guidance and 38 (52%) PVP using a fixed C-arm. The median E was 11.31 [6.54; 15.82] mSv for all PVPs performed under CT guidance and 5.58 [3.33; 8.71] mSv for fixed C-arm and the differences was significant (p<0.001). For lumbar PVP, the organ doses of stomach, liver and colon were significantly higher with CT-scan than with the fixed C-arm: 97% (p=0.02); 21% (p=0.099) and 375% (p=0.002), respectively. For thoracic PVP, the lung organ dose was significantly higher with CT-scan than with the fixed C-arm (127%; p<0.001) and the oesophagus organ doses were not significantly different (p = 0.626). CONCLUSION: This study showed that the E and the organ dose on directly exposed organs were both higher for PVP performed under CT-guidance than with the fixed C-arm.


Assuntos
Tomografia Computadorizada por Raios X , Vertebroplastia , Adulto , Feminino , Humanos , Recém-Nascido , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Doses de Radiação , Radiometria , Estudos Retrospectivos
2.
Ann Phys Rehabil Med ; 64(2): 101396, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32461125

RESUMO

BACKGROUND: The benefit of an intradiscal injection of corticosteroids for low back pain with active discopathy is not totally resolved. OBJECTIVE: The objective of this study was to estimate the clinical efficacy of an intradiscal injection of glucocorticoids versus lidocaine in patients with low back pain and active discopathy (Modic 1 changes). METHODS: A prospective, single-blind, randomized controlled study was conducted in 2 tertiary care centers with spine units. We enrolled 50 patients (mean age 50 years; 46% women) with lumbar active discopathy on MRI and failure of medical treatment for more than 6 weeks. Participants were randomly assigned to receive an intradiscal injection of glucocorticoids [50mg prednisolone acetate (GC group), n=24] or lidocaine [40mg (L group), n=26] by senior radiologists. Outcome measures were low back pain in the previous 8 days (10-point visual analog scale), Dallas Pain Questionnaire, Oswestry Disability Index, analgesic treatment and work status at 1, 3 and 6 months as well as pain at 1, 2 and 3 weeks. The primary outcome was change in pain between baseline and 1 month. RESULTS: Data for 39 patients (78%; 17 in the GC group, 22 in the L group) were analyzed for the primary outcome. Pain intensity was significantly reduced at 1 month in the GC versus L group [mean (SD) -2.7 (2.3) and +0.1 (2.0), P<0.001] but not at 3 and 6 months. At 1 and 3 months, the groups significantly differed in daily activities of the Dallas Pain Questionnaire in favour of the GC group. The groups did not differ in consumption of analgesics or professional condition at any time. No serious intervention-related adverse events occurred. Study limitations included patients lost to the study because of injection-related technical issues in the L5/S1 disc and short time of follow-up. CONCLUSION: As compared with intradiscal injection of lidocaine, intradiscal injection of prednisolone acetate for low back pain with active discopathy may reduce pain intensity at 1 month but not at 3 and 6 months.


Assuntos
Glucocorticoides/administração & dosagem , Deslocamento do Disco Intervertebral , Dor Lombar , Feminino , Humanos , Injeções Espinhais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Dor Lombar/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-Cego
3.
Ugeskr Laeger ; 179(16)2017 Apr 17.
Artigo em Dinamarquês | MEDLINE | ID: mdl-28416064

RESUMO

This article presents recommendations regarding early management of patients after intake of corrosive chemicals, based on best evidence and clinical experience. Risk assessment built on clinical history, presentation and endoscopy is discussed as well as initial treatment, surgical appraisal and observation. Controversy still surrounds the need for endoscopy in asymptomatic patients, the use of computed tomography in assessing the severity of lesions as well as pharmacological treatment for preventing strictures.


Assuntos
Queimaduras Químicas , Cáusticos/efeitos adversos , Queimaduras Químicas/classificação , Queimaduras Químicas/diagnóstico , Queimaduras Químicas/terapia , Deglutição , Trato Gastrointestinal/lesões , Humanos , Medição de Risco
4.
Phys Med ; 35: 88-96, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28238578

RESUMO

This technical note proposes a method to reduce radiation dose for spine interventions under CT guidance without compromising the successful outcome of the procedure. Two consecutive periods of 14months before and after optimization were investigated with 162 and 440 patients, respectively. By optimizing the acquisition parameters (decreased kV and mAs) and appropriately adjusting the reconstruction (kernels, slice thickness, etc) and visualization parameters, image quality was maintained suitable to perform the procedure. By reducing both kV and mAs, dose was reduced by 72% on fluoroscopy mode (i-fluoro) and sequential mode (i-sequence). Moreover, dose was reduced by 58% on helical mode (i-spiral). Depending on the radiologist, the fluoroscopy time was decreased by between 37% and 56%. Acquisitions with i-sequence were less irradiating than the i-fluoro or the i-spiral modes. Radiation doses were reduced by 65% for infiltrations, 51% for vertebral expansions, and 56% for bone biopsies. Median (1st quartile; 3rd quartile) effective dose were 2.1 (1.3; 3.5)mSv, 10.8 (6.7; 18.3)mSv for and 3.0 (2.4; 4.3)mSv, respectively. Radiologists reported "satisfactory" image quality. During interventional spine procedures under CT scan, reducing kV and mAs associated with the use of i-sequence substantially reduces patient dose.


Assuntos
Doses de Radiação , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia/instrumentação , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Imagens de Fantasmas , Exposição à Radiação/prevenção & controle , Cirurgia Assistida por Computador/instrumentação , Tomografia Computadorizada por Raios X/instrumentação , Resultado do Tratamento
5.
Eur J Radiol ; 86: 1-5, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28027734

RESUMO

STUDY DESIGN: This was a single center, retrospective observational study. OBJECTIVE: to investigate-in a cancer population-the prevalence and hallmarks of intravertebral enhancement (IVE) detected on contrast-enhanced CT. SUMMARY OF BACKGROUND DATA: Intravertebral enhancements secondary to iodinated contrast stagnation have been described. Cancer patients have an increased risk of perivertebral venous thrombosis or stenosis secondary to several risk factors (cancer or drug induced hypercoagulability, deterioration of venous flow linked to catheter insertion, prolonged immobilization). In case of a high density lesion identified on CT, the diagnostic choice between metastasis and contrast media within bone marrow vessels may be an issue, especially as oncologic follow-up CT scans are usually performed with contrast medium injection. METHODS: 2572 contrast-enhanced body CT scans performed in cancer patients over 3 months in the medical imaging department of a university hospital were retrospectively reviewed. IVE was sought when paravertebral venous collateral circulation was detected and bone metastasis ruled out and classified as linear or nodular. Their locations within vertebra, their relation to the injection side and the predominant collateral venous network side were evaluated. RESULTS: Sixty-seven (2.8%) patients had a collateral paravertebral venous system and among them 21 had IVE (37%). There were 208 IVE locations involving 75 vertebrae. 199 IVE were linear-shaped (95.7%) and 9 nodular-shaped (4.3%). 80.8% were located between C6 and T4. 88.9% were localized in the vertebral body. 73.1% were located medially or ipsilateral to the injection side. CONCLUSION: Intravertebral enhancement is found in 37% of the patients with paraspinal collateral venous circulation when a CT scan is performed for cancer. The ipsilateral or medial position of the IVE relative to the injection side and the side of the dominant perivertebral venous system, and the possibility of connecting the IVE to a paravertebral vein may be in favor of vascular opacification.


Assuntos
Circulação Colateral/fisiologia , Neoplasias/complicações , Coluna Vertebral/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/irrigação sanguínea , Neoplasias/diagnóstico por imagem , Variações Dependentes do Observador , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/irrigação sanguínea , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Estenose Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Veias/diagnóstico por imagem , Veias/fisiologia , Trombose Venosa/prevenção & controle
6.
Skeletal Radiol ; 43(3): 351-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24382631

RESUMO

OBJECTIVE: To assess sacroiliac joint (SIJ) modifications on MRI and their ability to predict axial spondyloarthritis (SpA) with the purpose of identifying parameters for future prospective studies. METHODS: Retrospective study was carried out of 110 consecutive patients referred for SIJ MRI with coronal, axial short TI inversion recovery (STIR), and axial T1 sequences over 6 months. Factors associated with SpA, including MRI SIJ modifications (fat deposition, structural abnormalities on T1-weighted images, and bone marrow edema [BME] on STIR sequences) and age were explored using multivariate logistic regression. The reference diagnosis was made 1-1.5 years later based on clinical, radiological, and biological findings, according to Assessment of SpondyloArthritis International Society (ASAS) criteria. RESULTS: Twenty-eight patients were diagnosed with SpA (female/male: 19/9, age 41 ± 13 years). Abnormal findings were found in up to 21 % of patients without SpA (including 11 % with BME), versus 64 % of SpA patients (50 % with BME). A threshold age of 42.6 years was found to discriminate SpA patients (ROC AUC: 0.71, 95 % CI: 0.59-0.81). BME location in the sacral (OR: 7.07 [1.05, 47.6], p = 0.044) and both sacral and iliac areas (OR: 36.0 [5.61, 231], p = 0.0002), as well as age (OR: 0.95 [0.92, 0.98], p = 0.0019) were found to be independent predictors of SpA. 83.6 % of patients were effectively diagnosed using BME location and patient age in a classification and regression tree (CART) algorithm (sensitivity: 61 %, specificity: 91 %, PPV: 71 %, NPV: 87 %). CONCLUSION: The BME location combined with the patient's age (threshold 42.6 years) could help predict SpA. Further studies are required before these features can be used by radiologists to boost their confidence in reporting SIJ MRI.


Assuntos
Imageamento por Ressonância Magnética/métodos , Articulação Sacroilíaca/patologia , Espondilite Anquilosante/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
7.
Cardiovasc Intervent Radiol ; 37(6): 1530-9, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24337349

RESUMO

PURPOSE: Osteoid osteoma (OO) is a painful benign bone tumor of the young that is widely treated by percutaneous thermal ablation (PTA) with success rates close to 100%. Nevertheless, some patients have recurrences. We reviewed the literature to understand whether these are true recurrences or incomplete treatments; to analyze safety and efficacy during long-term follow-up in a extremely large cohort of patients; to detail best-practice suggestions from the largest clinical trials as well as report their complications; and to recommend standards for future reporting. MATERIALS AND METHODS: This study followed the Cochrane's guidelines for Systematic Reviews of Interventions. Inclusion criteria were as follows: (1) prospective or retrospective cohort study for PTA of OO under computed tomography (CT) guidance; (2) CT or magnetic resonance diagnosis; (3) radiofrequency ablation or interstitial laser ablation technique; (4) English language; (5) population <10 patients; (6) follow-up ≥12 months; and (7) original research. Risk of bias was assessed with a modified Newcastle-Ottawa Scale. RESULTS: Two hundred fourteen articles were initially found. After applying the criteria mentioned previously, 27 PTA articles concerning 1,772 patients were chosen for inclusion. No exclusions were made due to risk of bias. CONCLUSION: The investigators proved the long-term efficacy and superiority of PTA for OO compared with other techniques. In 5% of patients, however, the technique failed, and the researchers did not offer detailed exhaustive explanations. Future clinical trials for OO ablation should consider reporting essential procedure details and follow-up findings to allow for a meta-analysis. We provide both recommended standards for future reporting and suggestions for the prevention of recurrence.


Assuntos
Neoplasias Ósseas/cirurgia , Ablação por Cateter/métodos , Osteoma Osteoide/cirurgia , Humanos , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Guias de Prática Clínica como Assunto , Radiografia Intervencionista , Tomografia Computadorizada por Raios X
10.
Skeletal Radiol ; 41(12): 1637-40, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22865159

RESUMO

The skeletal anatomy of the hip provides two main locations for impingement: abnormal contact between the acetabulum and femur (femoroacetabular impingement) or between the ischium and femur (ischiofemoral impingement). We report a case of bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. The association of exostoses and femoral metaphyseal widening resulted in the narrowing of the ischiofemoral spaces. Pain was improved on the left side by resection of the ischial exostosis.


Assuntos
Artralgia/diagnóstico , Artralgia/etiologia , Diagnóstico por Imagem/métodos , Exostose Múltipla Hereditária/complicações , Exostose Múltipla Hereditária/diagnóstico , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/etiologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Ísquio/patologia
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