RESUMO
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Assuntos
Humanos , Masculino , Idoso , Choque Hemorrágico/complicações , Ruptura Esplênica/etiologia , Hematoma/diagnóstico por imagem , Hemoperitônio/cirurgia , Adenocarcinoma/cirurgia , Neoplasias do Colo/cirurgia , Esplenopatias/diagnóstico por imagem , Ruptura Espontânea , Ruptura Esplênica/diagnóstico por imagem , Dor Abdominal/etiologia , Tomografia Computadorizada por Raios X , Laparotomia , Adenocarcinoma/tratamento farmacológico , Neoplasias do Colo/patologiaRESUMO
PURPOSE: To analyze changes in MRI diagnostic accuracy in main rectal tumor (T) evaluation resulting from the use of diffusion-weighted imaging (DWI), according to the degree of experience of the radiologist. METHODS: This is a cross-sectional study of a database including one hundred 1.5 T MRI records (2011-2016) from patients with biopsy-proven rectal cancer, including primary staging and post-chemoradiotherapy follow-up. All cases were individually blindedly reviewed by ten radiologists: three experienced in rectal cancer, three specialized in other areas, and four residents. Each case was assessed twice to detect perirectal infiltration: first, evaluating just high-resolution T2-weighted sequences (HRT2w); second, evaluation of DWI plus HRT2w sequences. Results were pooled by experience, calculating accuracy (area under ROC curve), sensitivity and specificity, predictive values, likelihood ratios, and overstaging/understaging. Histology of surgical specimens provided the reference standard. RESULTS: DWI significantly improved specificity by experienced radiologists in primary staging (63.2% to 75.9%) and, to a lesser extent, positive likelihood ratio (2.06 to 2.87); minimal changes were observed post-chemoradiotherapy, with a slight decrease of accuracy (0.657 to 0.626). Inexperienced radiologists showed a similar pattern, but with slight enhancement post-chemoradiotherapy (accuracy 0.604 to 0.621). Residents experienced small changes, with increased sensitivity/decreased specificity in both primary (69% to 72%/67.2% to 64.7%) and post-chemoradiotherapy (68.1% to 73.6%/47.3% to 44.6%) staging. CONCLUSIONS: Adding DWI to HRT2w significantly improved specificity for the detection of perirectal infiltration at primary staging by experienced radiologists and also by inexperienced ones, although to a lesser extent. In the post-neoadjuvant treatment subgroup, only minimal changes were observed.
Assuntos
Quimiorradioterapia , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Colonoscopia , Estudos Transversais , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Invasividade Neoplásica , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Neoplasias Retais/patologia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Doença de Chagas/complicações , Doenças do Colo Sigmoide/diagnóstico por imagem , Volvo Intestinal/cirurgia , Tomografia Computadorizada por Raios X/métodos , Laparotomia/métodosRESUMO
La selección del sexo y especialmente su regulación, es un asunto controvertido. El autor examina los problemas actuales que rodean a la selección del sexo desde sus comienzos, e ilustra su punto de vista con un caso reciente y controvertido en el que una mujer a quien le fue permitido someterse a inseminación artificial, se le ofreció la posibilidad de elegir el sexo del niño. El autor también expone las posibles soluciones y las regulaciones penales y administrativas del asunto, además de examinar la decisión del tribunal en este caso en concreto (AU)
No disponible
Assuntos
Feminino , Humanos , Recém-Nascido , Pré-Seleção do Sexo/métodos , Legislação Médica , Ética Médica , Inseminação Artificial/legislação & jurisprudência , Inseminação Artificial/métodos , EspanhaRESUMO
Gender selection, and particularly its regulation, is a controversial issue. The author discusses the current problems surrounding gender selection from the very beginnings, and illustrates his views with an actual and controversial case in which a woman allowed to undergo artificial insemination was given the possibility of choosing the sex of her child. The author also discusses possible solutions and the penal, administrative regulation of the issue, as well as examining the court's decision in this particular case.
Assuntos
Pré-Seleção do Sexo/ética , Engenharia Genética/legislação & jurisprudência , Humanos , EspanhaRESUMO
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