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1.
Curr Cardiol Rep ; 23(9): 130, 2021 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-34363148

RESUMO

PURPOSE OF REVIEW: Additional imaging modalities, such as FDG-PET/CT, have been included into the workup for patients with suspected infective endocarditis, according to major international guidelines published in 2015. The purpose of this review is to give an overview of FDG-PET/CT indications and standardized approaches in the setting of suspected infective endocarditis. RECENT FINDINGS: There are two main indications for performing FDG-PET/CT in patients with suspected infective endocarditis: (i) detecting intracardiac infections and (ii) detection of (clinically silent) disseminated infectious disease. The diagnostic performance of FDG-PET/CT for intracardiac lesions depends on the presence of native valves, prosthetic valves, or implanted cardiac devices, with a sensitivity that is poor for native valve endocarditis and cardiac device-related lead infections, but much better for prosthetic valve endocarditis and cardiac device-related pocket infections. Specificity is high for all these indications. The detection of disseminated disease may also help establish the diagnosis and/or impact patient management. Based on current evidence, FDG-PET/CT should be considered for detection of disseminated disease in suspected endocarditis. Absence of intracardiac lesions on FDG-PET/CT cannot rule out native valve endocarditis, but positive findings strongly support the diagnosis. For prosthetic valve endocarditis, standard use of FDG-PET/CT is recommended because of its high sensitivity and specificity. For implanted cardiac devices, FDG-PET/CT is also recommended, but should be evaluated with careful attention to clinical context, because its sensitivity is high for pocket infections, but low for lead infections. In patients with prosthetic valves with or without additional aortic prosthesis, combination with CTA should be considered. Optimal timing of FDG-PET/CT is important, both during clinical workup and technically (i.e., post tracer injection). In addition, procedural standardization is key and encompasses patient preparation, scan acquisition, reconstruction, subsequent analysis, and clinical interpretation. The recommendations discussed here will hopefully contribute to improved standardization and enhanced performance of FDG-PET/CT in the clinical management of patients with suspected infective endocarditis.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Endocardite/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem , Fluordesoxiglucose F18 , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Padrões de Referência
2.
Neth Heart J ; 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33052577

RESUMO

BACKGROUND: The integration of computed tomography (CT)-derived left ventricular outflow tract area into the echocardiography-derived continuity equation results in the reclassification of a significant proportion of patients with severe aortic stenosis (AS) into moderate AS based on aortic valve area indexed to body surface area determined by fusion imaging (fusion AVAi). The aim of this study was to evaluate AS severity by a fusion imaging technique in patients with low-gradient AS and to compare the clinical impact of reclassified moderate AS versus severe AS. METHODS: We included 359 consecutive patients who underwent transcatheter aortic valve implantation for low-gradient, severe AS at two academic institutions and created a joint database. The primary endpoint was a composite of all-cause mortality and rehospitalisations for heart failure at 1 year. RESULTS: Overall, 35% of the population (n = 126) were reclassified to moderate AS [median fusion AVAi 0.70 (interquartile range, IQR 0.65-0.80) cm2/m2] and severe AS was retained as the classification in 65% [median fusion AVAi 0.49 (IQR 0.43-0.54) cm2/m2]. Lower body mass index, higher logistic EuroSCORE and larger aortic dimensions characterised patients reclassified to moderate AS. Overall, 57% of patients had a left ventricular ejection fraction (LVEF) <50%. Clinical outcome was similar in patients with reclassified moderate or severe AS. Among patients reclassified to moderate AS, non-cardiac mortality was higher in those with LVEF <50% than in those with LVEF ≥50% (log-rank p = 0.029). CONCLUSIONS: The integration of CT and transthoracic echocardiography to obtain fusion AVAi led to the reclassification of one third of patients with low-gradient AS to moderate AS. Reclassification did not affect clinical outcome, although patients reclassified to moderate AS with a LVEF <50% had worse outcomes owing to excess non-cardiac mortality.

3.
Neth Heart J ; 28(12): 628-636, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32909198

RESUMO

Because the occurrence of infective endocarditis (IE) continues to be associated with high mortality, a working group was created by the Dutch Society of Cardiology to examine how the most recent European Society of Cardiology (ESC) guidelines for IE management could be implemented most effectively in the Netherlands. In order to investigate current Dutch IE practices, the working group conducted a country-wide survey. Based on the results obtained, it was concluded that most ESC recommendations could be endorsed, albeit with some adjustments. For instance, the suggested pre-operative screening and treatment of nasal carriers of Staphylococcus aureus as formulated in the ESC guideline was found to be dissimilar to current Dutch practice, and was therefore made less restrictive. The recently adapted ESC diagnostic criteria for IE were endorsed, while the practical employment of the relevant diagnostic techniques was simplified in an adapted flowchart. In addition, the presence of a multidisciplinary, so-called 'endocarditis team' in tertiary centres was proposed as a quality indicator. An adapted flowchart specifically tailored to Dutch practice for microbiological diagnostic purposes was constructed. Lastly, the working group recommended the Stichting Werkgroep Antibioticabeleid (SWAB; Dutch Working Party on Antibiotic Policy) guidelines for IE treatment instead of the antibiotic regimens proposed by the ESC.

5.
J Nucl Cardiol ; 25(6): 1960-1967, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-28474192

RESUMO

PURPOSE: FDG PET/CT has been of increasing interest in the diagnostic workup of prosthetic heart valve endocarditis (PVE). Some reports advocate later imaging time points to improve the diagnostic accuracy for PVE. In this study, we compared standard and late FDG PET/CT images in patients with a clinical suspicion of PVE. MATERIALS AND METHODS: Fourteen scans in 13 patients referred for FDG PET/CT for suspicion of PVE performed at standard (60 min post injection) and late (150 min post injection) time points were scored based on visual interpretation and semi-quantitatively with SUVmax and target-to-background ratio (TBR, defined as [SUVmax valve/SUVmean blood pool]). Final diagnosis was based on surgical findings in all cases of infection (n = 6) and unremarkable follow-up in all others (n = 8). RESULTS: Late images were more prone to false positive interpretation for both visual and semi-quantitative analyses. Visual analysis of the standard images yielded 1 false negative and 1 false positive result. On the late images, no scans were false negative but 5 scans were false positive. CONCLUSION: Late FDG PET/CT imaging for PVE seems prone to false positive results. Therefore, late imaging should be interpreted with caution.


Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Fluordesoxiglucose F18 , Implante de Prótese de Valva Cardíaca/efeitos adversos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade
6.
Eur J Radiol ; 92: 159-165, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28624014

RESUMO

OBJECTIVES: To determine whether mild stage chronic obstructive pulmonary disease (COPD) can be detected on chest radiography without substantial overdiagnosis. METHODS: A retrospective nested case-control study (case:control, 1:1) was performed in 783 patients scheduled for cardiothoracic surgery who underwent both spirometry and a chest radiograph preoperative. Diagnostic accuracy of chest radiography for diagnosing mild COPD was investigated using objective measurements and overall appearance specific for COPD on chest radiography. Inter-observer variability was investigated and variables with a kappa >0.40 as well as baseline characteristics were used to make a diagnostic model which was aimed at achieving a high positive predictive value (PPV). RESULTS: Twenty percent (155/783) had COPD. The PPV of overall appearance specific for COPD alone was low (37-55%). Factors in the diagnostic model were age, type of surgery, gender, distance of the right diaphragm apex to the first rib, retrosternal space, sternodiaphragmatic angle, maximum height right diaphragm (lateral view) and subjective impression of COPD (using both views). The model resulted in a PPV of 100%, negative predictive value (NPV) of 82%, sensitivity of 10% and specificity of 100% with an area under the curve of 0.811. CONCLUSIONS: Detection of mild COPD without substantial overdiagnosis was not feasible on chest radiographs in our cohort.


Assuntos
Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Diafragma/fisiopatologia , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Radiografia Torácica/normas , Estudos Retrospectivos , Sensibilidade e Especificidade , Capacidade Vital/fisiologia
8.
PLoS One ; 12(1): e0171138, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28141852

RESUMO

BACKGROUND: Complications might occur after great vessel stent implantation in children. Therefore follow-up using imaging is warranted. PURPOSE: To determine the optimal imaging modality for the assessment of stents used to treat great vessel obstructions in children. MATERIAL AND METHODS: Five different large vessel stents were evaluated in an in-vitro setting. All stents were expanded to the maximal vendor recommended diameter (20mm; n = 4 or 10mm; n = 1), placed in an anthropomorphic chest phantom and imaged with a 256-slice CT-scanner. MRI images were acquired at 1.5T using a multi-slice T2-weighted turbo spin echo, an RF-spoiled three-dimensional T1-weighted Fast Field Echo and a balanced turbo field echo 3D sequence. Two blinded observers assessed stent lumen visibility (measured diameter/true diameter *100%) in the center and at the outlets of the stent. Reproducibility of diameter measurements was evaluated using the intraclass correlation coefficient for reliability and 95% limits of agreement for agreement analysis. RESULTS: Median stent lumen visibility was 88 (IQR 86-90)% with CT for all stents at both the center and outlets. With MRI, the T2-weighted turbo spin echo sequence was preferred which resulted in 82 (78-84%) stent lumen visibility. Interobserver reliability and agreement was good for both CT (ICC 0.997, mean difference -0.51 [-1.07-0.05] mm) and MRI measurements (ICC 0.951, mean difference -0.05 [-2.52 --2.41] mm). CONCLUSION: Good in-stent lumen visibility was achievable in this in-vitro study with both CT and MRI in different great vessel stents. Overall reliability was good with clinical acceptable limits of agreement for both CT and MRI. However, common conditions such as in-stent stenosis and associated aneurysms were not tested in this in-vitro study, limiting the value of the in-vitro study.


Assuntos
Vasos Sanguíneos/diagnóstico por imagem , Imageamento Tridimensional , Imageamento por Ressonância Magnética/métodos , Stents , Tomografia Computadorizada por Raios X/métodos , Criança , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes
9.
Neth Heart J ; 24(2): 96-107, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26744343

RESUMO

Prosthetic heart valve (PHV) dysfunction remains difficult to recognise correctly by two-dimensional (2D) transthoracic and transoesophageal echocardiography (TTE/TEE). ECG-triggered multidetector-row computed tomography (MDCT), 18-fluorine-fluorodesoxyglucose positron emission tomography including low-dose CT (FDG-PET) and three-dimensional transoesophageal echocardiography (3D-TEE) may have additional value. This paper reviews the role of these novel imaging tools in the field of PHV obstruction and endocarditis.For acquired PHV obstruction, MDCT is of additional value in mechanical PHVs to differentiate pannus from thrombus as well as to dynamically study leaflet motion and opening/closing angles. For biological PHV obstruction, additional imaging is not beneficial as it does not change patient management. When performed on top of 2D-TTE/TEE, MDCT has additional value for the detection of both vegetations and pseudoaneurysms/abscesses in PHV endocarditis. FDG-PET has no complementary value for the detection of vegetations; however, it appears more sensitive in the early detection of pseudoaneurysms/abscesses. Furthermore, FDG-PET enables the detection of metastatic and primary extra-cardiac infections. Evidence for the additional value of 3D-TEE is scarce.As clinical implications are major, clinicians should have a low threshold to perform additional MDCT in acquired mechanical PHV obstruction. For suspected PHV endocarditis, both FDG-PET and MDCT have complementary value.

10.
Biomed Res Int ; 2015: 648283, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26221603

RESUMO

OBJECTIVE: The aim of this work was to develop a fast and robust (semi)automatic segmentation technique of the aortic valve area (AVA) MDCT datasets. METHODS: The algorithm starts with detection and cropping of Sinus of Valsalva on MPR image. The cropped image is then binarized and seed points are manually selected to create an initial contour. The contour moves automatically towards the edge of aortic AVA to obtain a segmentation of the AVA. AVA was segmented semiautomatically and manually by two observers in multiphase cardiac CT scans of 25 patients. Validation of the algorithm was obtained by comparing to Transthoracic Echocardiography (TTE). Intra- and interobserver variability were calculated by relative differences. Differences between TTE and MDCT manual and semiautomatic measurements were assessed by Bland-Altman analysis. Time required for manual and semiautomatic segmentations was recorded. RESULTS: Mean differences from TTE were -0.19 (95% CI: -0.74 to 0.34) cm(2) for manual and -0.10 (95% CI: -0.45 to 0.25) cm(2) for semiautomatic measurements. Intra- and interobserver variability were 8.4 ± 7.1% and 27.6 ± 16.0% for manual, and 5.8 ± 4.5% and 16.8 ± 12.7% for semiautomatic measurements, respectively. CONCLUSION: Newly developed semiautomatic segmentation provides an accurate, more reproducible, and faster AVA segmentation result.


Assuntos
Valva Aórtica/diagnóstico por imagem , Ecocardiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Algoritmos , Automação , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Variações Dependentes do Observador , Fatores de Tempo
11.
Br J Radiol ; 85(1017): e616-21, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22919014

RESUMO

OBJECTIVES: Sutures with polytetrafluorethylene (PTFE) felt pledgets are commonly used in prosthetic heart valve (PHV) implantation. Paravalvular leakage can be difficult to distinguish from PTFE felt pledgets on multislice CT because both present as hyperdense structures. We assessed whether pledgets can be discriminated from contrast-enhanced solutions (blood/saline) on CT images based on attenuation difference in an ex vivo experiment and under in vivo conditions. METHODS: PTFE felt pledgets were sutured to the suture ring of a mechanical PHV and porcine aortic annulus, and immersed and scanned in four different contrast-enhanced (Ultravist®; 300 mg jopromide ml(-1)) saline concentrations (10.0, 12.0, 13.6 and 15.0 mg ml(-1)). Scanning was performed on a 256-slice scanner with eight different scan protocols with various tube voltage (100 kV, 120 kV) and tube current (400 mAs, 600 mAs, 800 mAs, 1000 mAs) settings. Attenuation of the pledgets and surrounding contrast-enhanced saline were measured. Additionally, the attenuation of pledgets and contrast-enhanced blood was measured on electrocardiography (ECG)-gated CTA scans of 19 patients with 22 PHVs. RESULTS: Ex vivo CT attenuation differences between the pledgets and contrast-enhanced solutions were larger by using higher tube voltages. CT attenuation values of the pledgets were higher than contrast-enhanced blood in patients: 420±26 Hounsfield units (mean±SD, range 383-494) and 288±41 Hounsfield units (range 202-367), respectively. CONCLUSIONS: PTFE felt pledgets have consistently higher attenuation than surrounding contrast-enhanced blood. CT attenuation measurements therefore may help to differentiate pledgets from paravalvular leakage, and detect paravalvular leakage in patients with suspected PHV dysfunction.


Assuntos
Valva Aórtica/cirurgia , Aortografia , Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Suturas , Tomografia Computadorizada por Raios X/métodos , Algoritmos , Animais , Diagnóstico Diferencial , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Técnicas In Vitro , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Suínos
12.
Eur J Vasc Endovasc Surg ; 40(2): 196-201, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20427209

RESUMO

OBJECTIVES: To estimate the influence of information on the coronary arteries obtained from routine thoraco-abdominal CT angiography (CTA) on pre-operative clinical management in abdominal aortic aneurysm (AAA) patients. METHODS: Twenty-eight AAA patients underwent pre-operative thoraco-abdominal electrocardiography (ECG)-gated 64-detector-row CTA to evaluate aortic pulsatility for prosthesis size matching. Retrospectively, the coronaries were reconstructed from the same data set and scored on a per segment basis for stenosis (0%, 50%) and grading confidence (poor, adequate or high). An experienced cardiologist was presented information on patient characteristics obtained from patient records and CTA findings. Suggested changes in European Society of Cardiology guidelines based patient management based on CTA information were scored. RESULTS: On CTA, 17 patients (61%) had significant coronary disease (>50% stenosis) including left main (n=4), single (n=7) and multiple (n=6) vessel disease. Grading confidence was adequate or high in 86% of proximal and middle segments. Based on CTA findings, patient management would have been changed in 4 out of the 28 patients (14%; 95% CI 1-27%) by adding coronary angiography (n=4). In five patients who underwent coronary artery bypass grafting previously, CT did not change management but confirmed graft patency. CONCLUSIONS: Information on coronary pathology and coronary bypass graft patency can be readily obtained from thoraco-abdominal CTA and may alter pre-operative patient management, as shown in 14% of AAA patients in our study.


Assuntos
Aneurisma da Aorta Abdominal/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Abdominal/epidemiologia , Implante de Prótese Vascular , Comorbidade , Angiografia Coronária/métodos , Estenose Coronária/epidemiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Cuidados Pré-Operatórios , Ajuste de Prótese , Fluxo Pulsátil
13.
Surg Endosc ; 18(6): 986-9, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15108110

RESUMO

BACKGROUND: In the search for novel approaches to thoracoscopic thymectomy we assessed the feasibility of a subxiphoid approach using computer-enhanced instruments and sternal lifting. METHODS: In 12 pigs, after lifting of the sternum, ports were placed subxiphoid (stereoscope) and in the left and right fourth intercostal space (instruments). Using computer-enhanced instruments, dissection of the thymus and anterior mediastinal fat pads was started at the diaphragm and continued cephalad. RESULTS: After setup of the robot system (23 +/- 6 min, mean +/- SD), the thymus, including both superior horns, and fat pads in the anterior mediastinum and cardiophrenic angles were dissected (109 +/- 23 min), with excellent view of the phrenic nerves. Visual inspection after sternotomy after the procedure showed all thymic and fatty tissue was removed. CONCLUSIONS: In the pig, endoscopic extended thymectomy can be safely performed by subxiphoid access using computer-enhanced instruments, sternal lifting, and three ports total.


Assuntos
Robótica , Cirurgia Assistida por Computador , Suínos/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Animais , Estudos de Viabilidade , Feminino , Procedimentos Cirúrgicos Minimamente Invasivos , Modelos Animais , Especificidade da Espécie , Esterno , Gravação de Videoteipe
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