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1.
Radiol Case Rep ; 16(12): 3927-3930, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34703519

RESUMO

Laryngeal metastasis is an extremely rare condition. To the best of our knowledge, there has been no previous report on a laryngeal metastasis from renal cell carcinoma, which describes on details of the CT and MR imaging findings. A male patient in his 80s. Laryngoscopy revealed reddish-colored masses in the right false vocal cord and in the subglottic larynx. CT and MR imaging of this case showed multiple hypervascularized lesions with a wash-out effect in the supra and subglottis of the larynx and in the right intervertebral foramen of the cervical spine. Angiography revealed a hypervascular tumor consistent with the subglottic lesion. The histopathology and immunohistochemistry findings were compatible with laryngeal metastasis from renal clear cell carcinoma. A history of postoperative renal clear cell carcinoma about 7 years ago was later confirmed, which was not stated at the time of the initial imaging evaluation. It is a possible differential diagnosis in cases of multiple hypervascular masses in the head and neck region with a history of renal carcinoma. In particular, if the contrast-enhancement pattern of the lesion on the dynamic CT is similar to that of renal cell carcinoma. It is also important to reconfirm the patient's medical history, including postoperative status.

2.
J Belg Soc Radiol ; 105(1): 42, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34568747

RESUMO

Introduction: To evaluate the efficacy, safety, and associated complications of a novel and simple approach to portal vein embolization that utilizes sheath injection and balloon occlusion (PVE-SIBO) with gelatin sponge (GS) for the purpose of increasing future liver remnant (FLR) volume. Methods: Between 1 January, 2006, and 31 August, 2020, 20 patients (15 men, 5 women, aged 64.6 ± 10.2 years) diagnosed with hepatobiliary malignancy underwent presurgical PVE-SIBO at our institution via a percutaneous transhepatic approach to the right portal vein and embolization of the portal vein with GS. We evaluated the increased ratio of FLR volume, operation duration, recanalization rate, and complications following this procedure. Results: All procedures were successful and without complications such as subcapsular hematoma, intra-abdominal bleeding, and bile leakage. The increased ratio of FLR volume was 34.7 ± 23.7% after a mean of 14.3 ± 2.57 days, and there was a significant difference in the FLR volume before and after PVE (P < 0.01). Procedure time was 52.7 ± 11.4 minutes. Conclusion: PVE-SIBO with GS is a simple, effective, and safe procedure to increase the ratio of FLR volume prior to hepatic surgeries.

3.
Head Face Med ; 17(1): 34, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399796

RESUMO

OBJECTIVE: To investigate the predictability of ophthalmic artery involvement in maxillary sinus cancer using preprocedural contrast enhanced CT and MRI. METHODS: We analyzed advanced (T3, T4a, and T4b) primary maxillary sinus squamous cell carcinoma treated with super-selective intra-arterial cisplatin infusion and concomitant radiotherapy (RADPLAT) from Oct 2016 to Mar 2020. Two diagnostic radiologists evaluated the tumor invasion site around the maxillary sinus using preprocedural imaging. These results were compared with the angiographic involvement of the ophthalmic artery using statistical analyses. We also evaluated our RADPLAT quality using complication rate, response to treatment, local progressive free survival (LPFS), and overall survival (OS). RESULTS: Twenty patients were included in this study. There were ten cases of ophthalmic artery tumor stain and there was a correlation between ophthalmic artery involvement and invasion for ethmoid sinus with statistically significant differences. Other imaging findings were not associated with ophthalmic artery involvement. CONCLUSIONS: Ethmoid sinus invasion on preprocedural imaging could suggest ophthalmic artery involvement in maxillary sinus cancer. It may be useful in predicting prognosis and treatment selection.


Assuntos
Antineoplásicos , Carcinoma de Células Escamosas , Neoplasias do Seio Maxilar , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Cisplatino/uso terapêutico , Humanos , Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/terapia
4.
World J Surg ; 45(12): 3603-3608, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34415403

RESUMO

BACKGROUND: Plexiform neurofibromas (PNs) are highly vascularized and potentially malignant tumors. Surgical resection of a PN can be complicated by perioperative hemorrhagic events (PHE), including excessive intraoperative blood loss and postoperative hematoma at the surgical site. This study aimed to evaluate the predictive factors of PHE and the usefulness of preoperative embolization for PN. MATERIALS AND METHODS: Consecutive surgical resections of 24 massive PNs in the body trunk with a maximum diameter > 5 cm in 22 patients between January 2015 and December 2020 were reviewed. Patient demographics, laboratory analyses, MRI findings, preoperative transcatheter arterial embolization (TAE), and pathological findings were evaluated between PNs with and without PHE, which consists of intraoperative blood loss over 15% of their estimated total blood volume and/or postoperative hematoma requiring surgical intervention or blood transfusion. RESULTS: PHE was observed in 7 out of 24 PNs (29.2%), with 5 events of excessive intraoperative bleeding and 2 postoperative hematomas. The PHE group (n = 7) showed a significantly higher flow-void effect inside the tumor on preoperative MRI than the non-PHE group (n = 17) (P = 0.0186). Preoperative TAE was not associated with PHE occurrence for the 24 PNs; however, it significantly reduced the PHE risk by 12 PNs with a flow-void sign (P = 0.00126). Other characteristics showed no significant differences between groups. CONCLUSION: The flow-void sign on MRI can be the only predictive factor of PHE in surgical resection for massive PNs in the body trunk. Preoperative TAE can reduce the PHE risk for PNs with a flow-void sign.

6.
Ann Surg Oncol ; 28(13): 8246, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34235601

RESUMO

BACKGROUND: Simultaneous dual hepatic vein embolization (DHVE) has been proposed for safe right-side massive hepatectomy, (Kobayashi et al. in Surgery 167:917-923, 2020, Heil J, Schadde E. in Langenbecks Arch Surg 2020, Narita et al. in Ann Surg 256:e7-8, 2012) and has demonstrated comparable results to associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) (Chan et al. in Transl Gastroenterol Hepatol 5:37, 2020) in terms of liver hypertrophy. In this video, we describe our DHVE techniques to perform a safe right trisectionectomy. METHODS: A 40-year-old man with unresectable intrahepatic cholangiocarcinoma with multiple intrahepatic metastases and vena cava invasion received 20 cycles of gemcitabine plus cisplatin, resulting in remarkable shrinkage of the tumor. Conversion surgery was planned to achieve no evidence of disease status. The future liver remnant (FLR) after right trisectionectomy was 363 ml (29.6% of the whole liver) and simultaneous DHVE was performed. The right portal vein embolization was performed via a transhepatic approach, while the right and middle hepatic veins were accessed via a transjugular approach and self-expandable mesh devices were deployed. Remarkable atrophy of the right lobe and hypertrophy of the left lobe was observed 2 weeks after the procedure. Volumetry showed the FLR increased to 485 ml (40.2% of the whole liver). Three weeks after DHVE, right trisectionectomy with combined resection of the vena cava was performed. RESULTS: The operation time was 311 min, and the blood loss was 420 ml. Pathological examination revealed complete resection of liver tumors, and the volumetry on postoperative day 7 revealed an increased remnant liver volume of 874 ml. He was discharged on postoperative day 10 without any complications. CONCLUSION: Simultaneous DHVE could be an effective procedure to increase FLR with safety for massive hepatectomy.


Assuntos
Neoplasias dos Ductos Biliares , Embolização Terapêutica , Neoplasias Hepáticas , Adulto , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Hepatectomia , Humanos , Ligadura , Neoplasias Hepáticas/cirurgia , Masculino , Veia Porta , Resultado do Tratamento
7.
Case Rep Pulmonol ; 2021: 5573869, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34258099

RESUMO

Introduction. Intimal sarcoma is a very rare tumor arising within the intima of the pulmonary artery. Preoperative diagnosis of pulmonary artery sarcoma is difficult, and the tumor is sometimes misdiagnosed as pulmonary thromboembolism. We report a case of pulmonary artery intimal sarcoma successfully diagnosed by preoperative endovascular biopsy and treated via right pneumonectomy and pulmonary arterioplasty. Presentation of a Case. A 72-year-old woman was referred to our hospital with a low-attenuation defect in the lumen of the right main pulmonary artery by computed tomography. Pulmonary artery thromboembolism was suspected, and anticoagulation therapy was administered. However, the defect in the pulmonary artery did not improve. Endovascular catheter aspiration biopsy was performed. Histological examination revealed pulmonary artery sarcoma. The patient was treated with right pneumonectomy and arterioplasty with the use of cardiopulmonary bypass. Discussion. Preoperative biopsy by endovascular catheter is worth considering for a patient with a tumor in the pulmonary artery and can help in planning treatment strategies.

8.
Pol J Radiol ; 86: e298-e308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34136048

RESUMO

Purpose: To investigate the predictors of intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with high-grade dysplasia, using 2-dimensional (2D) analysis and 3-dimensional (3D) volume-of-interest-based apparent diffusion coefficient (ADC) histogram analysis. Material and methods: The data of 45 patients with histopathologically confirmed IPMNs with high-grade or low-grade dysplasia were retrospectively assessed. The 2D analysis included lesion-to-spinal cord signal intensity ratio (LSR), minimum ADC value (ADCmin), and mean ADC value (ADCmean). The 3D analysis included the overall mean (ADCoverall mean), mean of the bottom 10th percentile (ADCmean0-10), mean of the bottom 10-25th percentile (ADCmean10-25), mean of the bottom 25-50th percentile (ADCmean25-50), skewness (ADCskewness), kurtosis (ADCkurtosis), and entropy (ADCentropy). Diagnostic performance was compared by analysing the area under the receiver operating characteristic curve (AUC). Inter-rater reliability was assessed by blinded evaluation using the intraclass correlation coefficient. Results: There were 16 and 29 IPMNs with high- and low-grade dysplasia, respectively. The LSR, ADCoverall mean, ADCmean0-10, ADCmean10-25, ADCmean25-50, and ADCentropy showed significant between-group differences (AUC = 72-93%; p < 0.05). Inter-rater reliability assessment showed almost perfect agreement for LSR and substantial agreement for ADCoverall mean and ADCentropy. Multivariate logistic regression showed that ADCoverall mean and ADCentropy were significant independent predictors of malignancy (p < 0.05), with diagnostic accuracies of 80% and 73%, respectively. Conclusion: ADCoverall mean and ADCentropy from 3D analysis may assist in predicting IPMNs with high-grade dysplasia.

9.
Jpn J Radiol ; 39(1): 66-75, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32885378

RESUMO

PURPOSE: To determine whether texture analysis of contrast-enhanced computed tomography (CECT) and apparent diffusion coefficient (ADC) maps could predict tumor grade (G1 vs G2-3) in patients with pancreatic neuroendocrine tumor (PNET). MATERIALS AND METHODS: Thirty-three PNETs (22 G1 and 11 G2-3) were retrospectively reviewed. Fifty features were individually extracted from the arterial and portal venous phases of CECT and ADC maps by two radiologists. Diagnostic performance was assessed by receiver operating characteristic curves while inter-observer agreement was determined by calculating intraclass correlation coefficients (ICCs). RESULTS: G2-G3 tumors were significantly larger than G1. Seventeen features significantly differed among the two readers on univariate analysis, with ICCs > 0.6; the largest area under the curve (AUC) for features of each CECT phase and ADC map was log-sigma 1.0 joint-energy = 0.855 for the arterial phase, log-sigma 1.5 kurtosis = 0.860 for the portal venous phase, and log-sigma 1.0 correlation = 0.847 for the ADC map. The log-sigma 1.5 kurtosis of the portal venous phase showed the largest AUC in the CECT and ADC map, and its sensitivity, specificity, and accuracy were 95.5%, 72.7%, and 87.9%, respectively. CONCLUSION: Texture analysis may aid in differentiating between G1 and G2-3 PNET.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Área Sob a Curva , Estudos de Coortes , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Curva ROC , Estudos Retrospectivos
10.
Surg Today ; 51(7): 1232-1236, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32979122

RESUMO

Although arterial pseudoaneurysm is one of the most serious complications after pancreatic surgery, the best practice with maximum efficacy and minimum adverse effects to overcome such a serious situation has not yet been elucidated. We performed endovascular micro-arterial stenting (EMAS) to manage this serious situation while preserving a sufficient hepatic arterial flow, and herein report the technical details and challenges of the procedure. Dilation of the stent using a balloon catheter to adhere to the parent artery, and embolization of the surrounding artery to prevent type I and type II endo-leaks are the most important points for ensuring a successful procedure. We applied this technique to 6 cases of hepatic arterial pseudoaneurysm, with a mean size of 6.5 ± 1.3 mm. The mean time of the procedure was 81 ± 22 min, without adverse events, including hepatic necrosis or arterial bleeding. EMAS may be the ideal procedure for treating pseudoaneurysm after pancreatic surgery while preserving the hepatic arterial inflow.

11.
Eur J Radiol ; 123: 108788, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31874302

RESUMO

PURPOSE: To evaluate the rate of concordance between pathology and preoperative breast MRI performed with an abbreviated protocol (AP) or a full diagnostic protocol (FDP) for estimation of the tumour extent in patients with pure ductal carcinoma in situ (DCIS). METHODS: This retrospective study included 164 patients with pathologically proven DCIS who underwent preoperative breast MRI. Two radiologists independently evaluated the tumour extent on MRI with (FDP) and without the delayed phase (AP) and compared the readings with the pathological tumour extent. The background parenchymal enhancement (BPE) and morphology were also evaluated. Furthermore, the influence of the degree of BPE, presence or absence of B2 and B3 lesions, and pathological DCIS grade on the accuracy of MRI findings was assessed. Concordance between MRI and pathology was evaluated using correlation analysis. RESULTS: Spearman's rank correlation coefficients for the concordance between MRI and pathology were 0.63 (reader 1) and 0.69 (reader 2) with AP and 0.65 and 0.73 (readers 1 and 2, respectively) with FDP. For both readers, the difference in the measured value between FDP and pathology was significantly smaller than that between AP and pathology (p < 0.001). The inter-reader variation in the measured tumour extent was larger with FDP than with AP. The presence of B3 lesions, low-grade DCIS, and moderate/marked BPE lowered the rate of concordance between MRI and pathology. CONCLUSIONS: Our findings suggest that preoperative MRI with FDP is more accurate than that with AP alone for estimation of the tumour extent in patients with pure DCIS.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/patologia , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/diagnóstico por imagem , Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Pol J Radiol ; 84: e153-e161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31019610

RESUMO

Purpose: To determine the differentiating features between non-hypervascular pancreatic neuroendocrine tumour (PNET) and pancreatic ductal adenocarcinoma (PDAC) on dynamic computed tomography (CT) and non-enhanced magnetic resonance imaging (MRI). Material and methods: We enrolled 102 patients with non-hypervascular PNET (n = 15) or PDAC (n = 87), who had undergone dynamic CT and non-enhanced MRI. One radiologist evaluated all images, and the results were subjected to univariate and multivariate analyses. To investigate reproducibility, a second radiologist re-evaluated features that were significantly different between PNET and PDAC on multivariate analysis. Results: Tumour margin (well-defined or ill-defined) and enhancement ratio of tumour (ERT) showed significant differences in univariate and multivariate analyses. Multivariate analysis revealed a predominance of well-defined tumour margins in non-hypervascular PNET, with an odds ratio of 168.86 (95% confidence interval [CI]: 10.62-2685.29; p < 0.001). Furthermore, ERT was significantly lower in non-hypervascular PNET than in PDAC, with an odds ratio of 85.80 (95% CI: 2.57-2860.95; p = 0.01). Sensitivity, specificity, and accuracy were 86.7%, 96.6%, and 95.1%, respectively, when the tumour margin was used as the criteria. The values for ERT were 66.7%, 98.9%, and 94.1%, respectively. In reproducibility tests, both tumour margin and ERT showed substantial agreement (margin of tumour, κ = 0.6356; ERT, intraclass correlation coefficients (ICC) = 0.6155). Conclusions: Non-hypervascular PNET showed well-defined margins and lower ERT compared to PDAC, with significant differences. Our results showed that non-hypervascular PNET can be differentiated from PDAC via dynamic CT and non-enhanced MRI.

13.
Radiol Case Rep ; 14(2): 195-199, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30425773

RESUMO

Hepatic artery aneurysms are rare and sometimes life-threating. Various treatments for hepatic artery aneurysms, including surgical and endovascular techniques are present. Here, we report the case of a 68-year-old woman who presented with an about 9 cm of common hepatic artery aneurysm detected during a routine medical checkup; she did not exhibit any symptoms. We successfully treated the aneurysm with transcatheter arterial embolization with isolation technique via pancreatic duodenal arcade.

14.
Endocrine ; 63(2): 301-309, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30276595

RESUMO

PURPOSE: To evaluate the performance of ultrasonography (US) and TI-201/Tc-99m dual (Tl/Tc) scintigraphy in differentiating between benign and malignant thyroid nodules. METHODS: Eighty-six patients diagnosed to have a thyroid tumor on postoperative histopathologic examination between June 2009 and February 2017 were included in this retrospective study. A radiologist reviewed the US and Tl/Tc scintigraphy reports along with all available clinical and histopathologic information. On Tl/Tc scintigraphy, a nodule in which uptake was higher in the delayed phase than in the surrounding parenchyma was defined as a delayed accumulation pattern and a nodule in which uptake was higher in the delayed phase than in the early phase was defined as a persistent pattern. The Tl/Tc scintigraphy images were evaluated in a blinded manner to assess reproducibility. A statistical analysis was performed to identify features associated with malignancy. Interobserver variability was calculated using the κ statistic. RESULTS: US had higher sensitivity (81.2%), specificity (88.2%), and positive (96.6%) and negative (53.6%) predictive values than Tl/Tc scintigraphy. An ill-defined margin and microcalcification were independent predictors of a malignant thyroid nodule on multivariate logistic regression (P = 0.003 and P = 0.014, respectively). The persistent pattern had high specificity (85.7%) equivalent to that of US but had lower sensitivity (34.7%). The κ values for the delayed accumulation and persistent patterns were 0.66-0.78 and 0.32-0.50, respectively. CONCLUSIONS: An ill-defined margin and microcalcification on US were independent predictors of a malignant thyroid nodule. A persistent pattern seen on Tl/Tc scintigraphy could contribute to the differential diagnosis.


Assuntos
Cintilografia/métodos , Tecnécio Tc 99m Sestamibi , Radioisótopos de Tálio , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Ultrassonografia Doppler em Cores , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tecnécio Tc 99m Sestamibi/química , Tecnécio Tc 99m Sestamibi/farmacologia , Radioisótopos de Tálio/química , Radioisótopos de Tálio/farmacologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia
15.
Eur J Radiol ; 107: 111-118, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30292254

RESUMO

OBJECTIVE: To retrospectively assess magnetic resonance imaging (MRI) findings that can predict lymphovascular invasion (LVI) in invasive breast cancer patients who were diagnosed with clinically negative axillary lymph nodes (LNs) preoperatively. METHODS: This study included 140 lesions of 140 patients who underwent preoperative breast MRI and breast surgery, with omission of axillary LN dissection. Clinical characteristics and MRI findings were evaluated. The T2 signal intensity (SI) ratio (mean T2 SI of the tumor/mean T2 SI of the muscle), tumor apparent diffusion coefficient (ADC) value, peritumoral ADC value, peritumor-tumor ADC ratio (peritumoral maximum ADC value/tumor mean ADC value), and ADC value of the contralateral breast parenchyma were retrospectively assessed. Statistical analyses were performed to identify significant factors for predicting LVI. Inter-observer variability was calculated. RESULTS: The tumor ADC value (all ages: p = 0.005; age ≤ 55: p < 0.001), peritumoral ADC value (age ≤ 55: p = 0.04), and peritumor-tumor ADC ratio (all ages: p < 0.001; age ≤ 55: p < 0.001) were significantly associated with LVI on univariate analysis. Multivariate logistic regression analysis revealed significant differences in the pathological size of the invasive component and the tumor ADC value for predicting LVI (odds ratio [OR]: 3.43; 95% confidence interval [CI]: 1.41-8.32; p = 0.007; OR: 16.0; 95% CI: 1.89-136; p = 0.01, respectively). Inter-observer agreement was substantial for the tumor ADC value (intraclass correlation coefficient [ICC] = 0.77; 95% CI: 0.70-0.83) and the ADC value of the contralateral breast parenchyma (ICC = 0.68; 95% CI: 0.59-0.76). There was moderate agreement for the peritumoral ADC value (ICC = 0.53; 95% CI: 0.40-0.64) and the peritumor-tumor ADC ratio (ICC = 0.49; 95% CI: 0.35-0.61) and fair agreement for the T2 SI ratio (ICC = 0.30; 95% CI: 0.15-0.45). CONCLUSION: We found that the tumor ADC value, peritumoral ADC value, and peritumor-tumor ADC ratio were predictive MRI findings for LVI in patients aged ≤55. The tumor ADC value was the most significant predictor for LVI; moreover, inter-observer agreement for the tumor ADC value was substantial between two blinded observers with differences in interpretation experience.


Assuntos
Neoplasias da Mama/patologia , Adulto , Axila , Mama/patologia , Detecção Precoce de Câncer , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Metástase Linfática , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Invasividade Neoplásica , Variações Dependentes do Observador , Estudos Retrospectivos
16.
J Int Med Res ; 46(12): 5176-5182, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30178687

RESUMO

OBJECTIVE: This study was performed to evaluate the technical success rate and catheter tip malposition rate of peripherally inserted central catheter (PICC) placement using the Sherlock 3CG® Tip Confirmation System (TCS). METHODS: In total, 114 patients who underwent PICC insertion via the Sherlock 3CG® TCS from October 2017 to February 2018 were retrospectively evaluated. The primary endpoints were the technical success rate, malposition rate, and mean procedure time. The secondary endpoints were the sex-related difference in the malposition rate, radiologist's experience level, and side of insertion. Technical success was defined as procedure completion using only the Sherlock 3CG® TCS without a guidewire or fluoroscopy guidance. In accordance with the North American guidelines, an adequate position was defined as the lower third of the superior vena cava and the cavoatrial junction. RESULTS: The technical success rate was 97% (111/114). The malposition rate was 16% (18/111), and four catheters were repositioned. There were no significant differences in the malposition rate between the sexes, radiologist's level of experience, or side of insertion. CONCLUSIONS: PICC placement using the Sherlock 3CG® TCS yielded a high technical success rate and low catheter tip malposition rate regardless of the radiologist's level of experience or side of insertion.


Assuntos
Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Cateteres Venosos Centrais , Feminino , Fluoroscopia , Humanos , Masculino , Estudos Retrospectivos
17.
Radiol Case Rep ; 13(2): 400-403, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29904482

RESUMO

Rupture of small intestinal varices associated with portal hypertension can be a serious condition that is difficult to diagnose early and to manage. Moreover, optimal guidelines for the treatment of small intestinal varices have not yet been established. We herein report a case of a 73-year-old man with small intestinal varices. The man presented with bleeding from a stoma in the small intestine, which subsequently led to hemorrhagic shock. We successfully treated the patient with balloon-occluded retrograde transvenous obliteration via the right inferior epigastric vein using N-butyl-2-cyanoacrylate.

18.
Pol J Radiol ; 83: e426-e436, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30662578

RESUMO

Purpose: To evaluate the diagnostic performance of combining non-enhanced magnetic resonance imaging (MRI) and non-enhanced endoscopic ultrasonography (EUS) for assessing the malignant potential of lesions in patients with intraductal papillary mucinous neoplasms of the pancreas (IPMNs). Material and methods: Data from 38 patients histopathologically diagnosed with IPMN adenomas or IPMN adenocarcinomas were retrospectively analysed. Preliminary univariate and multivariate analyses were conducted to identify statistically significant associations. Three blinded radiologists evaluated the image sets to assess the diagnostic performance of combined use of non-enhanced MRI and EUS as opposed to non-enhanced MRI alone in distinguishing malignant from benign lesions. Observer performance and interobserver variability were determined using receiver-operating-characteristic curve analysis and weighted κ statistics. Results: Multivariate analyses identified a significant difference between the abrupt change in the main pancreatic duct (MPD) calibre with distal pancreatic atrophy and the signal intensity of lesion-to-spinal cord ratio on MRI; a significant difference was observed in MPD size on EUS. Diagnostic performance assessments of the image sets did not differ significantly between the blinded radiologists. Conclusions: The clinical utility of non-enhanced EUS may be attributive in evaluating IPMN that has already been evaluated by non-enhanced MRI.

19.
Case Rep Radiol ; 2017: 2087142, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29181216

RESUMO

Primary aortoduodenal fistula (ADF) is a direct communication between the abdominal aorta and the gastrointestinal tract without any previous vascular intervention and represents a rare but critical cause of repeated and massive gastrointestinal bleeding. Primary ADF often occurs as a result of atherosclerotic aneurysm and infection, but ADF involving a normal-size aorta is rare; furthermore, ADF related to radiation therapy is extremely rare. We present the case of a 56-year-old man with a history of bowel obstruction due to radiation enteritis who was admitted with severe hematemesis and hemorrhagic shock. Gastroduodenal endoscopy and contrast-enhanced computed tomography findings were unremarkable. Aortoduodenal fistula was suspected based on the diffuse calcification of the abdominal aorta confined to the radiation field and the presence of an aortoduodenal communication on angiography. Endovascular repair with a stent graft seemed to be a safer option than open surgery and was suited to the rapid control of bleeding from ADF because of the patients' unstable hemodynamic state and the presence of intestinal adhesions. The fistula was successfully sealed by endovascular stent graft placement. Hematemesis did not recur postoperatively and anemia gradually improved. The patient died from pneumonia 33 days later.

20.
Abdom Radiol (NY) ; 42(12): 2792-2798, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28643138

RESUMO

PURPOSE: This study aimed to assess the diagnostic performance of unenhanced computed tomography (CT) for distinguishing gastric anisakiasis from non-anisakiasis gastric conditions and the reproducibility of CT findings. METHODS: Fifty-six anisakiasis and 74 non-anisakiasis cases with gastric wall thickening on urgent observation using unenhanced CT were included. Using a κ analysis, two radiologists independently assessed the reproducibility of CT findings, including "circumferential gastric wall thickening," "gastric wall thickening extending more than two segments," "bulky and low-density gastric wall thickening," "increase in peri-gastric fat density," and "ascites." An anisakiasis diagnostic score (ADS) was developed for this study and was used to quantitatively evaluate the CT findings. An anisakiasis diagnostic prediction (ADP) with an appropriate cutoff value was used to further evaluate the ADS. Two radiologists reassessed the findings in consensus to determine the sensitivity, specificity, and accuracy of the CT findings, including the ADP and ADS area under the curve (AUC). RESULTS: Considering reproducibility, a substantial agreement (0.6 < κ < 0.8) was achieved for all findings except "circumferential gastric wall thickening" (κ = 0.499), whereas for diagnostic performance, all findings except ascites were significantly more frequent among the anisakiasis cases. "Bulky and low-density gastric wall thickening" had the highest sensitivity (98%), whereas "gastric wall thickening extending more than two segments" had the highest specificity (80%). The ADP sensitivity, specificity, and accuracy were 91%, 84%, and 87%, respectively. The AUC was 0.902 (p < 0.05). CONCLUSIONS: Unenhanced CT findings are useful for distinguishing anisakiasis from non-anisakiasis gastric conditions with sufficient reproducibility.


Assuntos
Anisaquíase/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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