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1.
Br J Radiol ; 95(1129): 20210835, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34672690

RESUMO

OBJECTIVE: To evaluate the efficacy of a barrier shield in reducing droplet transmission and its effect on image quality and radiation dose in an interventional suite. METHODS: A human cough droplet visualisation model in a supine position was developed to assess efficacy of barrier shield in reducing environmental contamination. Its effect on image quality (resolution and contrast) was evaluated via image quality test phantom. Changes in the radiation dose to patient post-shield utilisation was measured. RESULTS: Use of the shield prevented escape of visible fluorescent cough droplets from the containment area. No subjective change in line-pair resolution was observed. No significant difference in contrast-to-noise ratio was measured. Radiation dosage to patient was increased; this is predominantly attributed to the increased air gap and not the physical properties of the shield. CONCLUSION: Use of the barrier shield provided an effective added layer of personal protection in the interventional radiology theatre for aerosol generating procedures. ADVANCES IN KNOWLEDGE: This is the first time a human supine cough droplet visualisation has been developed. While multiple types of barrier shields have been described, this is the first systematic practical evaluation of a barrier shield designed for use in the interventional radiology theatre.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamentos de Proteção , Radiologia Intervencionista/instrumentação , Adulto , COVID-19/transmissão , Tosse , Desenho de Equipamento , Fluorescência , Humanos , Masculino , Imagens de Fantasmas , Doses de Radiação , Razão Sinal-Ruído , Decúbito Dorsal
2.
J Clin Neurosci ; 94: 159-165, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34863431

RESUMO

OBJECTIVE: To assess the prognostic values of susceptibility vessel sign (SVS) on T2*-weighted MRI using GRE and SWI sequences for recanalization status and clinical outcomes in patients with acute ischaemic stroke undergoing different therapies. METHODS: Literature search on PubMed, EMBASE databases and other sources from inception up to 01 June 2021 was conducted. 11 studies which reported SVS, recanalization and clinical outcomes were included in qualitative synthesis and meta-analysis. RESULTS: Pooled analysis demonstrated significant association between good clinical outcome and SVS-positive patients who underwent mechanical thrombectomy (RR = 1.34, 95% CI = 1.07-1.67, p = 0.01), which is in line with higher recanalization rate in SVS-positive patients who were treated with mechanical thrombectomy compared to intravenous thrombolysis only. No statistically significant association was demonstrated between presence of SVS and successful recanalization, likely due to limitations in the recruited studies. CONCLUSIONS: Presence of SVS in patients with acute ischaemic stroke who underwent mechanical thrombectomy is associated with good clinical outcome. SVS-positive patients treated with mechanical thrombectomy also shows better recanalization rate comparing to intravenous thrombolysis only, although not statistically significant. MRI assessment of the clot content using SVS is useful in selection of reperfusion strategy for acute ischaemic stroke and prognostication.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/terapia , Humanos , Imageamento por Ressonância Magnética , Reperfusão , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/terapia
3.
Head Neck ; 43(12): 3757-3763, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34558142

RESUMO

BACKGROUND: The primary objective is to identify clinical predictors of internal carotid artery (ICA) blowout in radiated nasopharyngeal carcinoma (NPC). METHODS: Seventeen ICA blowouts, 14 external carotid artery (ECA) bleeds, and 60 controls were identified from January 1, 2007 to July 31, 2020. Multinomial logistic regression was performed to identify features predictive of ICA blowouts. RESULTS: Headache was significantly more common among ICA blowouts than ECA bleeds and controls (58.8% vs. 7.1% vs. 6.7%, p < 0.001). The petrous skull base and sphenoid sinus lateral wall was eroded in all petrous and cavernous segment blowouts, respectively. Nasoendoscopy showing exposed clivus (OR 20.5, 95%CI 1.3-324.2) and computed tomography demonstrating skull base erosion (OR 17.8, 95%CI 1.0-311.0) were significantly associated with ICA blowouts compared to controls. CONCLUSIONS: Findings of headache and skull base erosion on nasoendoscopy or imaging during NPC surveillance warrants prophylactic intervention to avoid an ICA blowout.


Assuntos
Artéria Carótida Interna , Neoplasias Nasofaríngeas , Artéria Carótida Interna/diagnóstico por imagem , Humanos , Carcinoma Nasofaríngeo/radioterapia , Neoplasias Nasofaríngeas/radioterapia , Base do Crânio , Tomografia Computadorizada por Raios X
4.
JAMA Neurol ; 78(4): 434-444, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33616642

RESUMO

Importance: Clinical evidence of the potential treatment benefit of mechanical thrombectomy for posterior circulation distal, medium vessel occlusion (DMVO) is sparse. Objective: To investigate the frequency as well as the clinical and safety outcomes of mechanical thrombectomy for isolated posterior circulation DMVO stroke and to compare them with the outcomes of standard medical treatment with or without intravenous thrombolysis (IVT) in daily clinical practice. Design, Setting, and Participants: This multicenter case-control study analyzed patients who were treated for primary distal occlusion of the posterior cerebral artery (PCA) of the P2 or P3 segment. These patients received mechanical thrombectomy or standard medical treatment (with or without IVT) at 1 of 23 comprehensive stroke centers in Europe, the United States, and Asia between January 1, 2010, and June 30, 2020. All patients who met the inclusion criteria were matched using 1:1 propensity score matching. Interventions: Mechanical thrombectomy or standard medical treatment with or without IVT. Main Outcomes and Measures: Clinical end point was the improvement of National Institutes of Health Stroke Scale (NIHSS) scores at discharge from baseline. Safety end point was the occurrence of symptomatic intracranial hemorrhage and hemorrhagic complications were classified based on the Second European-Australasian Acute Stroke Study (ECASSII). Functional outcome was evaluated with the modified Rankin Scale (mRS) score at 90-day follow-up. Results: Of 243 patients from all participating centers who met the inclusion criteria, 184 patients were matched. Among these patients, the median (interquartile range [IQR]) age was 74 (62-81) years and 95 (51.6%) were female individuals. Posterior circulation DMVOs were located in the P2 segment of the PCA in 149 patients (81.0%) and in the P3 segment in 35 patients (19.0%). At discharge, the mean NIHSS score decrease was -2.4 points (95% CI, -3.2 to -1.6) in the standard medical treatment cohort and -3.9 points (95% CI, -5.4 to -2.5) in the mechanical thrombectomy cohort, with a mean difference of -1.5 points (95% CI, 3.2 to -0.8; P = .06). Significant treatment effects of mechanical thrombectomy were observed in the subgroup of patients who had higher NIHSS scores on admission of 10 points or higher (mean difference, -5.6; 95% CI, -10.9 to -0.2; P = .04) and in the subgroup of patients without IVT (mean difference, -3.0; 95% CI, -5.0 to -0.9; P = .005). Symptomatic intracranial hemorrhage occurred in 4 of 92 patients (4.3%) in each treatment cohort. Conclusions and Relevance: This study suggested that, although rarely performed at comprehensive stroke centers, mechanical thrombectomy for posterior circulation DMVO is a safe, and technically feasible treatment option for occlusions of the P2 or P3 segment of the PCA compared with standard medical treatment with or without IVT.


Assuntos
Isquemia Encefálica/terapia , Artéria Cerebral Posterior , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/epidemiologia , Estudos de Casos e Controles , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/terapia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Posterior/diagnóstico por imagem , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/epidemiologia
5.
J Neurointerv Surg ; 13(6): 515-518, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32883782

RESUMO

BACKGROUND: Endovascular thrombectomy (ET) has transformed acute ischemic stroke (AIS) therapy in patients with large vessel occlusion (LVO). Left ventricular systolic dysfunction (LVSD) decreases global cerebral blood flow and predisposes to hypoperfusion. We evaluated the relationship between LVSD, as measured by LV ejection fraction (LVEF), and clinical outcomes in patients with anterior cerebral circulation LVO who underwent ET. METHODS: This multicenter retrospective cohort study examined anterior circulation LVO AIS patients from six international stroke centers. LVSD was measured by assessment of the echocardiographic LVEF using Simpson's biplane method of discs according to international guidelines. LVSD was defined as LVEF <50%. The primary outcome was defined as a good functional outcome using a modified Rankin Scale (mRS) of 0-2 at 3 months. RESULTS: We included 440 AIS patients with LVO who underwent ET. On multivariate analyses, pre-existing diabetes mellitus (OR 2.05, 95% CI 1.24 to 3.39;p=0.005), unsuccessful reperfusion (Treatment in Cerebral Infarction (TICI) grade 0-2a) status (OR 4.21, 95% CI 2.04 to 8.66; p<0.001) and LVSD (OR 2.08, 95% CI 1.18 to 3.68; p=0.011) were independent predictors of poor functional outcomes at 3 months. On ordinal (shift) analyses, LVSD was associated with an unfavorable shift in the mRS outcomes (OR 2.32, 95% CI 1.52 to 3.53; p<0.001) after adjusting for age and ischemic heart disease. CONCLUSION: Anterior circulation LVO AIS patients with LVSD have poorer outcomes after ET, suggesting the need to consider cardiac factors for ET, the degree of monitoring and prognostication post-procedure.


Assuntos
Isquemia Encefálica/cirurgia , Circulação Cerebrovascular/fisiologia , Procedimentos Endovasculares/tendências , Acidente Vascular Cerebral/cirurgia , Trombectomia/tendências , Disfunção Ventricular Esquerda/cirurgia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/mortalidade , Estudos de Coortes , Procedimentos Endovasculares/mortalidade , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/mortalidade , Trombectomia/mortalidade , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade
6.
Interv Neuroradiol ; 26(6): 793-799, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32340516

RESUMO

BACKGROUND AND AIM: Bi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke. METHODS: Consecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area <1.5 cm2) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months. RESULTS: We identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68-84) vs. 67 (interquartile range 56-75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1-7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation. CONCLUSION: In acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further.


Assuntos
Estenose da Valva Aórtica , Isquemia Encefálica , Procedimentos Endovasculares , AVC Isquêmico , Acidente Vascular Cerebral , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Humanos , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/cirurgia , Trombectomia , Resultado do Tratamento
7.
ANZ J Surg ; 90(3): 362-363, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31782220

RESUMO

Patients on haemodialysis are susceptible for central vein occlusions, which can result in debilitating clinical consequences. These may be resistant to conventional revascularization with guidewire and catheter technique. Value-driven sharp recanalization of central vein occlusion is depicted as a safe and affordable option.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Veias Braquiocefálicas/cirurgia , Cateterismo Venoso Central/métodos , Complicações Pós-Operatórias/cirurgia , Doenças Vasculares/cirurgia , Veias Braquiocefálicas/patologia , Cateterismo Venoso Central/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Diálise Renal , Stents , Doenças Vasculares/etiologia , Doenças Vasculares/patologia
8.
Neurosurg Rev ; 43(2): 771-780, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31144196

RESUMO

Parent vessel occlusion (PVO) is the conventional endovascular treatment (EVT) for dissecting distal cerebellar artery aneurysms (DCAA). The associated ischemic sequelae are often well-tolerated. However, at the outset, the magnitude of this risk is uncertain. Meanwhile, non-PVO endovascular treatments (EVT) are deemed to provide incomplete protection from a rebleed. This study reviews our experience in the management of dissecting DCAA with emphasis on the effectiveness of parent vessel-preserving endovascular strategies as compared to PVO. Our institutional database was reviewed for all the dissecting DCAA aneurysms treated by endovascular means between Nov 2015 and Oct 2018. Their clinical presentations, imaging findings, EVT techniques, and clinical outcomes were retrospectively evaluated. Eighteen dissecting DCAA were identified: 13 in the posterior-inferior cerebellar artery (PICA), 3 in anterior-inferior cerebellar artery (AICA), and 2 in superior cerebellar artery (SCA). Median patient age was 61 years (range 40-86; average 60.7 years) with a 5:1 female predominance. Nine (6 in the PICA and 3 in the AICA) patients were managed by parent vessel-preserving strategies (6 with isolated endosaccular coiling and 3 with telescoping stents) while the remaining 9 (7 in the PICA and 2 in the SCA) were treated by PVO.The frequency of early rebleed was the same (11%) in both the treatment arms. One patient from the PVO arm suffered an extensive cerebellar infarct that mandated decompressive craniectomy and adversely affected her recovery. There were no such complications in patients treated with parent vessel-preserving strategies. No recurrence/rebleed was encountered in the 3 aneurysms secured using telescoping stents. Overall, excellent clinical outcomes (mRS of 0 and 1) were sparsely seen in the patients who had PVO (89 vs 23%). In dissecting DCAA, aforedescribed, parent vessel-preserving strategies are as effective as the more frequently used option of PVO in preventing an early rebleed. However, these are technically challenging, may be feasible in a smaller proportion of patients, and would need meticulous imaging follow-up in the acute period. When successfully implemented, these strategies can deliver excellent clinical outcomes and eliminate the uncertain risk of ischemic complications associated with PVO.


Assuntos
Aneurisma Dissecante/cirurgia , Cerebelo/irrigação sanguínea , Procedimentos Endovasculares , Aneurisma Intracraniano/cirurgia , Stents , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
9.
Neurosurg Rev ; 42(4): 951-959, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29971580

RESUMO

A large variety of vertebral tumours undergoes transarterial embolisation (TAE) prior to surgery. However, the subsequent intra-operative blood loss is unpredictable. This retrospective analysis, aims to determine the impact of various factors that may potentially influence the estimated intra-operative blood loss (EBL) in these patients. The study included 56 consecutive patients with spinal tumours who underwent pre-operative TAE. Demographic information, treatment history, tumour type, MRI characteristics, angiographic appearance, embolisation technique and surgical invasiveness were correlated with EBL using univariate and multivariate analysis. Mean EBL was 1317 mls. On univariate analysis, haematological/primary tumours, MRI hypervascularity and selective embolisation were significantly (P < 0.05) associated with increased EBL. A total angiographic devascularisation and embolisation of additional segments above and/or below the involved level were significantly associated with decreased EBL. There was no significant association with hypervascular angiographic appearance or surgical invasiveness. MRI and angiographic hypervascularity were not entirely concordant, especially for the category of moderately vascularised metastases. After multivariate analysis, MRI hypervascularity (1434 vs. 929 mls, P = 0.018) and embolisation of additional segments (1082 vs. 1607 mls, P = 0.003) remained significantly correlated with EBL. In conclusion, during pre-operative TAE of spinal tumours, routine angiographic interrogation of additional levels above and below the involved segment should be made, with a low threshold for embolising them, if safely performable. Compared to angiographic gold standard, MRI hypervascularity is probably a better predictor of EBL.


Assuntos
Descompressão Cirúrgica , Embolização Terapêutica , Fusão Vertebral , Neoplasias da Coluna Vertebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Digital , Perda Sanguínea Cirúrgica , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Resultado do Tratamento
10.
World Neurosurg ; 122: 317-321, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30448579

RESUMO

BACKGROUND: Bihemispheric posterior inferior cerebellar artery (PICA) is a rare anatomic variant wherein a single PICA supplies both cerebellar hemispheres. Inasmuch as it is the only PICA, treatment of aneurysms arising from this anatomic variant is more complex. We present a case of a ruptured bihemispheric PICA aneurysm and the challenges encountered in its management. CASE DESCRIPTION: A 54-year-old man presented with giddiness and nausea. Otherwise, he was neurologically intact. Computed tomography of the brain showed a right cerebellar hematoma and intraventricular hemorrhage. Cerebral angiography revealed a dissecting aneurysm in the retromedullary segment of a right bihemispheric PICA with a prominent saccular component. Initially, the patient refused to undergo any invasive treatment. However, when a follow-up angiogram showed an increase in the size of the aneurysm sac, he consented to treatment. Although parent vessel occlusion (PVO) was the clinical recommendation, in view of the patient's apprehensions, only the saccular component of the aneurysm was coil embolized without sacrifice of the parent vessel. Fifteen days after the coiling, there was a rebleed from this dissecting aneurysm, which was treated with PVO followed by suboccipital craniectomy. The patient made a reasonable recovery, and his modified Rankin score was 1 at his 6-month follow-up visit. CONCLUSIONS: In dissecting aneurysms of a bihemispheric PICA, isolated endosaccular occlusion provides uncertain protection from a rebleed, whereas a more reliable treatment with PVO carries an unpredictable risk of ischemic complications. The risks of a PVO may be rationalized as a life-saving measure; however, the subsequent threshold for posterior fossa decompression should be low.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma Roto/terapia , Cerebelo/irrigação sanguínea , Embolização Terapêutica/métodos , Aneurisma Intracraniano/terapia , Hemorragia Cerebral Intraventricular/etiologia , Craniotomia/métodos , Embolização Terapêutica/instrumentação , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Retratamento , Resultado do Tratamento
11.
Neurosurg Rev ; 40(4): 685-688, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28712070

RESUMO

Post-radiotherapy carotid blowout syndrome (CBS) of the skull base is a rare but often catastrophic complication of head and neck malignancies. The existing literature on the treatment of this condition with flow-diverting devices (FDD) is extremely limited and disappointing. We present a case of impending CBS in a patient previously irradiated for nasopharyngeal cancer that was successfully treated with use of multiple FDDs, adjunctive endonasal packing and delayed reinforcement with pedicled naso-septal flap, yielding an excellent outcome at 14-months follow-up. Notwithstanding the discouraging results in literature, our anecdotal experience suggests that endovascular reconstruction using FDD could be an option with long-term viability in post-radiotherapy CBS involving the skull base when reinforced with a vascularised naso-septal flap.


Assuntos
Doenças das Artérias Carótidas/etiologia , Doenças das Artérias Carótidas/terapia , Neoplasias Nasofaríngeas/radioterapia , Base do Crânio/cirurgia , Retalhos Cirúrgicos , Idoso , Humanos , Masculino
12.
J Clin Neurosci ; 43: 108-114, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28629680

RESUMO

We conducted a retrospective review of 221 patients, who underwent spinal oncologic surgery at a tertiary university hospital between 2005 and 2014; in order to identify and validate factors that influence the impact of preoperative embolization of spinal tumours on outcome measures of blood loss and transfusion requirements in spinal oncologic surgery. We also focused on primary tumour type and type of spinal surgery performed. Patients' electronic and physical records were reviewed to provide demographic data, tumour characteristics, embolization techniques and surgical procedure details. These data were analysed against recorded outcome measures of blood loss (absolute volume and haemoglobin reduction) and transfusion requirements. Forty eight patients who received preoperative embolization were compared against 173 patients who did not. There was a tendency towards reduced blood loss and transfusion requirements in embolized spinal metastases from HCC and thyroid; as well as primary spine tumours, though the differences were not significant. Total embolization of arterial supply to spinal tumours resulted in significantly less blood loss as compared to partial or subtotal embolization. In addition, median blood loss was lower in patients receiving a more proximal embolization and in patients who underwent surgery between 13 and 24h post-embolization despite the insignificant difference. To conclude, preoperative spinal tumour embolization is likely to be effective in reducing blood loss if a total embolization is performed 13-24h prior to the surgery. Similarly, the impact of embolization is likely to be more profound in metastases from HCC, thyroid and primary spine tumours.


Assuntos
Embolização Terapêutica/métodos , Neoplasias da Coluna Vertebral/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Resultado do Tratamento
13.
15.
Diagn Interv Radiol ; 23(2): 94-99, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28089954

RESUMO

PURPOSE: We aimed to evaluate the imaging features of solid pseudopapillary neoplasm (SPN) of the pancreas with an emphasis on radiologic-pathologic correlation. METHODS: Ten patients (all female; mean age, 32 years) with histologic or cytologic diagnosis of SPN encountered between January 2007 and December 2013 were included in this study. Preoperative computed tomography (CT) images were reviewed for location, attenuation, enhancement pattern, margin, shape, size, morphology, presence of capsule and calcification. CT appearances were correlated with histopathologic findings. RESULTS: Tumors in the distal pancreatic body and tail had a tendency to be larger (mean size 12.6 cm vs. 4.0 cm). Six of the nine tumors that were resected had a fibrous pseudocapsule at histology, five of which could be identified on CT scan. Eight lesions had mixed hypoenhancing solid components and cystic areas corresponding to tumor necrosis and hemorrhage. The two smallest lesions were purely solid and nonencapsulated. Varied patterns of calcification were seen in four tumors. Three of the four pancreatic tail tumors invaded the spleen. At a median follow-up of 53 months, there was no evidence of recurrence in the nine patients who underwent surgical resection of the tumor. CONCLUSION: A mixed solid and cystic pancreatic mass in a young woman is suggestive of SPN. However, smaller lesions may be completely solid. Splenic invasion can occur in pancreatic tail SPNs; however, in this series it did not adversely affect the long-term outcome.


Assuntos
Carcinoma Papilar/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Baço/patologia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Carcinoma Papilar/cirurgia , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Carga Tumoral
16.
Clin Imaging ; 39(2): 200-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25475702

RESUMO

BACKGROUND AND PURPOSE: Thyroid nodules are ubiquitous on ultrasound but have a low risk of malignancy. Hence, risk stratification is essential before biopysing them. We aim to (a) determine the frequency and predictors of nondiagnostic fine needle aspiration biopsy (FNAB) of thyroid nodules and (b) seek correlation between sonographic features and biopsy outcomes. METHODS: Between January 2010 and April 2013, 559 thyroid nodules underwent ultrasound-guided FNAB. Demographic information was obtained. Prebiopsy ultrasound images were reviewed for size, multiplicity, echotexture, shape, margins, vascularity, calcifications, cervical lymphadenopathy, and extrathyroid extension. Univariate and multivariate logistic regression analyses adjusting for the correlation between multiple nodules obtained from the same patient were performed. RESULTS: A total of 10.6% of the biopsies were nondiagnostic. Male gender [adjusted odds ratio (OR)=3.78, 95% confidence interval (CI) 1.87-7.66, P<.001] and a taller-than-wide shape (adjusted OR=3.22, 95% CI 1.34-7.75, P=.009) were independent predictors of a nondiagnostic FNAB. There was no significant association with cystic echotexture or a smaller nodule size. Well-defined irregular margins, microcalcifications, and coarse calcifications were independent predictors of malignancy, with specificities above 96% but low sensitivities (59.3%, 44.4%, and 11.1%, respectively). All nodules with cervical lymphadenopathy were malignant. If biopsy is performed when at least one of the above four features are present, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of predicting malignancy are 81.5%, 93.1%, 11.8 and 0.2 respectively. All purely cystic nodules and spongiform nodules were benign. CONCLUSIONS: Male gender and taller-than-wide thyroid nodules are independent risk factors for a nondiagnostic FNAB. Prudent use of a combination of sonographic features can help to risk-stratify thyroid nodules for FNAB and may reduce unwarranted FNABs.


Assuntos
Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Ultrassonografia de Intervenção , Adulto Jovem
17.
World J Radiol ; 6(9): 693-707, 2014 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-25276312

RESUMO

Living donor liver transplant (LDLT) is a major surgical undertaking. Detailed pre-operative assessment of the vascular and biliary anatomy is crucial for safe and successful harvesting of the graft and transplantation. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently the imaging modalities of choice in pre-operative evaluation. These cross-sectional imaging techniques can reveal the vascular and biliary anatomy, assess the hepatic parenchyma and perform volumetric analysis. Knowledge of the broad indications and contraindications to qualify as a recipient for LDLT is essential for the radiologist reporting scans in a pre-transplant patient. Similarly, awareness of the various anatomical variations and pathological states in the donor is essential for the radiologist to generate a meaningful report of his/her observations. CT and MRI have largely replaced invasive techniques such as catheter angiography, percutaneous cholangiography and endoscopic retrograde cholangiopancreatography. In order to generate a meaningful report based on these pre-operative imaging scans, it is also mandatory for the radiologist to be aware of the surgeon's perspective. We intend to provide a brief overview of the common surgical concepts of LDLT and give a detailed description of the minimum that a radiologist is expected to seek and report in CT and MR scans performed for LDLT related evaluation.

18.
World J Radiol ; 6(6): 355-65, 2014 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-24976936

RESUMO

Acute aortic syndrome (AAS) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection (AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT (MDCT) is crucial for the diagnosis of AAS, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of AAS. AD is the most commonly encountered AAS and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., "beak sign", aortic "cobwebs" that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as AAS is not unusual. However, on most instances MDCT enables the right diagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.

19.
Cancer Imaging ; 13(4): 645-57, 2014 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-24434228

RESUMO

Transarterial radioembolization (TARE) with yttrium 90 microspheres is an increasingly popular therapy for both primary and secondary liver malignancies. TARE entails delivery of ß-particle brachytherapy and embolization of the tumor vasculature. The consequent biological sequelae are distinct from those of other transarterial therapies for liver tumors, as reflected in the often baffling post-treatment imaging features. As the clinical use of TARE is increasing, more diverse post-treatment radiological findings are encountered with variable overlap among treatment response, residual disease, reactionary changes and complications. Thus, post-TARE image interpretation is challenging. This review provides a comprehensive description of the different findings seen in post-treatment scans, with the aim of facilitating appropriate radiological interpretation of post-TARE pathologic changes, notwithstanding their existing limitations.


Assuntos
Embolização Terapêutica/métodos , Neoplasias Hepáticas/radioterapia , Imagem Multimodal , Radioisótopos de Ítrio/administração & dosagem , Imagem de Difusão por Ressonância Magnética , Embolização Terapêutica/efeitos adversos , Fluordesoxiglucose F18 , Gastroenteropatias/etiologia , Humanos , Abscesso Hepático/etiologia , Derrame Pleural Maligno/etiologia , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
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