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2.
Artigo em Inglês | MEDLINE | ID: mdl-31136561

RESUMO

OBJECTIVES: We aimed to explore the ability of Magnetic-Resonance-Enterography (MRE) to impute the Simple-Endoscopic-Score-of-Crohn's Disease (SES-CD) in children with CD, in whom failure of ileal intubation is common and may impair SES-CD calculation in clinical studies. METHODS: This is a sub-study of the prospective ImageKids study in which children with CD underwent ileocolonoscopy (scored by SES-CD) and MRE (scored on a 100 mm visual analogue scale (VAS) and by MaRIA). Mucosal healing (MH) was defined as SES-CD<3, MRE-VAS< 20 mm, and/or MaRIA<7. RESULTS: 237 children (22 centers, age 11.5 ±â€Š3.3 years), were enrolled. Ileal intubation has failed in 40/237 (17%). The agreement between SES-CD and MRE was 75% (k = 0.508, p<0.001) in the ileum, and 68-85% in the colonic segments (k = 0.21-0.50, p < 0.001). The sensitivity and specificity of ileal MRE-VAS for MH were 91.7% (95% CI 0.84-0.96) and 53.1% (95% CI (0.43-0.63), respectively. The ileal MaRIA score (calculated in 33/40) was higher in the children without ileal intubation than in the others (20.5 ±â€Š7.1 vs 15.1 ±â€Š10.8, respectively, p = 0.0018). In 7% (16/237) of children, isolated active ileal disease would have been missed when considering SES-CD only. A multivariable model predicted the ileal SES-CD sub-score from the MaRIA: SES-CDileum = 1.145 + 0.169 * MaRIAileum rounded to the nearest whole number (R = 0.17). Applying this model to the children without ileal intubation revealed that 29/33 (88%) had ileal disease; 8/29 patients (28%) with normal colonic SES-CD had imputed ileal SES-CD ≥3. CONCLUSIONS: MRE is useful for imputing the ileal disease in pediatric clinical studies, overcoming the problem of ileal non-intubation.

3.
Invest Radiol ; 53(11): 698-704, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30095558

RESUMO

OBJECTIVES: Arteritic anterior ischemic optic neuropathy (A-AION) caused by inflammatory occlusion of the posterior ciliary arteries is the most common reason for irreversible vision loss in patients with giant cell arteritis. Atypical clinical presentation and negative funduscopy can delay systemic high-dose corticosteroid therapy to prevent impending permanent blindness and involvement of the contralateral eye.The purpose of this study was to assess the diagnostic accuracy of 3-dimensional (3D) high-resolution T1-weighted black-blood magnetic resonance imaging (T1-BB-MRI) for the detection of posterior ciliary artery involvement in patients with giant cell arteritis and funduscopic A-AION. MATERIALS AND METHODS: After institutional review board approval and informed consent, 27 patients with suspected giant cell arteritis and vision disturbances were included in this monocentric prospective cohort study. Giant cell arteritis was diagnosed in 18 patients according to the diagnostic reference standard (6 men, 73.8 [69.0-78.0] years); 14 of those were positive for A-AION. Precontrast and postcontrast 3D T1-BB-MRI was performed in all 27 patients. Two radiologists separately assessed image quality and local fat suppression (4-point scale), visual contrast enhancement (3-point scale), and diagnostic confidence (5-point scale) regarding arteritic posterior ciliary artery involvement. Magnetic resonance imaging findings were assessed in comparison to funduscopy. Statistical analysis included accuracy parameters and interrater agreement. RESULTS: Sensitivity of 3D T1-BB-MRI was 92.9% (95% confidence interval, 66.1%-99.8%) and specificity was 92.3% (95% confidence interval, 64.0%-99.8%) for detection of A-AION-positive patients. Image quality and local fat suppression were assessed with 3.2 ± 0.8 (median 3) and 3.8 ± 0.5 (median 4). Visual contrast enhancement with 2.3 ± 0.8 (median 3) and diagnostic confidence was rated at 4.7 ± 0.5 (median 5). Interrater agreement was high (κ = 0.85, P < 0.001). Three-dimensional T1-BB-MRI displayed bilateral findings in 50% of the cases, whereas only unilateral A-AION was detected in funduscopy as a possible indication for the contralateral eye at risk. CONCLUSIONS: Three-dimensional T1-BB-MRI allows accurate detection of arteritic posterior ciliary artery involvement in patients with A-AION. Further, 3D T1-BB-MRI seems to display arteritic involvement of the posterior ciliary arteries earlier than funduscopy and might, therefore, display "vision-at-risk" in patients with visual impairment and suspected giant cell arteritis but unremarkable funduscopy.

4.
J Clin Endocrinol Metab ; 103(9): 3260-3266, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-29947782

RESUMO

Context: Pancreatic steatosis may contribute to ß-cell dysfunction in type 2 diabetes (T2D), but data are controversial. Women who had gestational diabetes mellitus (GDM) are at high risk for developing T2D. Objective: To examine the association of pancreatic fat content with early/first-phase insulin secretion (as markers of ß-cell function). Design: Cross-sectional analysis of a subcohort of the monocentric, prospective cohort study titled Prediction, Prevention, and Subclassification of Type 2 Diabetes. Setting: Ludwig Maximilians University Hospital, Munich, Germany. Participants: Ninety-seven women, 3 to 16 months after pregnancy [41 normoglycemic women post-GDM, 19 women post-GDM with pathological glucose metabolism, and 37 normoglycemic women after a normoglycemic pregnancy (controls)]. Main Outcome Measures: Correlation of MRI-measured pancreatic fat content with early insulin release in an oral glucose tolerance test (OGGT) [insulin increment within the first 30 minutes of the OGTT (IR30)] and first-phase insulin response (FPIR) in an intravenous glucose tolerance test (n = 65), both adjusted for insulin sensitivity index (ISI). Results: Pancreatic fat content did not correlate with IR30 and FPIR adjusted for ISI. It correlated positively with body mass index, waist circumference, liver fat, and intraabdominal fat volume. Conclusion: Pancreatic fat content does not correlate with ß-cell function in a cohort of young women with different degrees of T2D risk.

5.
J Crohns Colitis ; 2018 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-29800422

RESUMO

Objective: There is no standardized endoscopic description of upper gastrointestinal (UGI) disease in Crohn's disease (CD). We prospectively applied the Simple Endoscopic Score for CD (SES-CD) to the UGI tract as a planned sub-study of the multicenter prospective ImageKids study. We aimed to assess the utility of the UGI-SES-CD and its clinical significance in pediatric CD. Design: Patients underwent an esophagogastroduodenoscopy (EGD), ileocolonoscopy and magnetic resonance enterography (MRE) with explicit clinical data recorded. SES-CD was scored at each region (esophagus, stomach body, antrum and duodenum). Half of the patients were followed for 18 months when a repeat MRE was performed. Results: Two hundred and two children were included (56% males, mean age 11.5 ± 3.2 years, median wPCDAI 25. UGI-SES-CD score ranged from 0-17, with 95 (47%) having a UGI-SES-CD ≥1; no narrowing was detected. UGI-SES-CD ≥1 was associated with higher wPCDAI (32.5 vs 20; p=0.03), PGA of inflammation (45mmVAS vs 30mmVAS; p=0.04), ileocolonoscopic SES-CD (10 vs 7; p=0.004), fecal calprotectin (717mcg/g vs 654mcg/g; p=0.046) and radiologic global assessment of damage by MRE (7mmVAS vs 0; p=0.04). 93 patients were followed for 18 months and no association was identified between initial UGI SES-CD and markers of disease course such as surgery, MRE assessment, or treatment escalation. Conclusion: UGI-SES-CD is an easily reported objective scoring system and is associated with a more severe disease phenotype but not with disease course.

6.
J Neurol Neurosurg Psychiatry ; 89(10): 1071-1081, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29735511

RESUMO

BACKGROUND AND OBJECTIVE: Dysferlinopathies are a group of muscle disorders caused by mutations in the DYSF gene. Previous muscle imaging studies describe a selective pattern of muscle involvement in smaller patient cohorts, but a large imaging study across the entire spectrum of the dysferlinopathies had not been performed and previous imaging findings were not correlated with functional tests. METHODS: We present cross-sectional T1-weighted muscle MRI data from 182 patients with genetically confirmed dysferlinopathies. We have analysed the pattern of muscles involved in the disease using hierarchical analysis and presented it as heatmaps. Results of the MRI scans have been correlated with relevant functional tests for each region of the body analysed. RESULTS: In 181 of the 182 patients scanned, we observed muscle pathology on T1-weighted images, with the gastrocnemius medialis and the soleus being the most commonly affected muscles. A similar pattern of involvement was identified in most patients regardless of their clinical presentation. Increased muscle pathology on MRI correlated positively with disease duration and functional impairment. CONCLUSIONS: The information generated by this study is of high diagnostic value and important for clinical trial development. We have been able to describe a pattern that can be considered as characteristic of dysferlinopathy. We have defined the natural history of the disease from a radiological point of view. These results enabled the identification of the most relevant regions of interest for quantitative MRI in longitudinal studies, such as clinical trials. CLINICAL TRIAL REGISTRATION: NCT01676077.

7.
Clin EEG Neurosci ; 49(3): 187-191, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28762286

RESUMO

Tuberous sclerosis complex (TSC) is an autosomal-dominant inheritable neurocutaneous disease due to mutations within the TSC1 and TSC2 genes. Many patients present with West syndrome, a severe epilepsy syndrome characterized by the triad of infantile spasms, an interictal electroencephalogram (EEG) pattern termed hypsarrhythmia (continuous slow activity with an amplitude higher than 300 µV and multiregional spikes/polyspikes/sharp waves) and developmental regression. In this study, we report on a previously healthy patient with positive family history of epilepsy with new-onset epileptic encephalopathy at the age of 9 years. Clinical signs alone were not sufficient to establish the diagnosis of TSC but epilepsy panel screening revealed a novel frameshift mutation (c.90delA; p.Glu31Argfs*12) within the TSC1 gene. Segregation gene analysis detected the same mutation in the mother. Cranial magnetic resonance imaging (MRI) studies from the index patient and his mother revealed a similar pattern of isolated subcortical white matter lesions resembling most likely focal cortical dysplasia (FCD) type IIb. In summary, in these 2 related patients, a novel TSC1 frameshift mutation was associated with an isolated FCD type IIb in the absence of further CNS abnormalities usually encountered in patients with TSC, fostering our understanding of the broad mutation spectra in the TSC1 gene and the close relationship between cortical tubers and FCD type IIb.


Assuntos
Epilepsia/fisiopatologia , Mutação em Linhagem Germinativa/genética , Esclerose Tuberosa/genética , Proteínas Supressoras de Tumor/genética , Adulto , Encéfalo/patologia , Encéfalo/fisiopatologia , Criança , Eletroencefalografia/métodos , Epilepsia/genética , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Malformações do Desenvolvimento Cortical/complicações , Malformações do Desenvolvimento Cortical/genética , Esclerose Tuberosa/fisiopatologia , Proteína 1 do Complexo Esclerose Tuberosa
8.
Invest Radiol ; 53(1): 13-19, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28858894

RESUMO

OBJECTIVES: The aim of this study was to assess the diagnostic accuracy of a modified high-resolution whole-brain three-dimensional T1-weighted black-blood sequence (T1-weighted modified volumetric isotropic turbo spin echo acquisition [T1-mVISTA]) in comparison to a standard three-dimensional T1-weighted magnetization-prepared rapid gradient echo (MP-RAGE) sequence for detection of contrast-enhancing cerebral lesions in patients with relapsing-remitting multiple sclerosis (MS). MATERIALS AND METHODS: After institutional review board approval and informed consent, 22 patients (8 men; aged 31.0 ± 9.2 years) with relapsing-remitting MS were included in this monocentric prospective cohort study.Contrast-enhanced T1-mVISTA and MP-RAGE, both with 0.8 mm resolution, were performed in all patients. In a substudy of 12 patients, T1-mVISTA was compared with a T1-mVISTA with 1.0 mm resolution (T1-mVISTA_1.0). Reference lesions were defined by an experienced neuroradiologist using all available sequences and served as the criterion standard. T1-mVISTA, T1-mVISTA_1.0, and MP-RAGE sequences were read in random order 4 weeks apart. Image quality, visual contrast enhancement, contrast-to-noise-ratio (CNR), diagnostic confidence, and lesion size were assessed and compared by Wilcoxon and Mann-Whitney U tests. RESULTS: Eleven of 22 patients displayed contrast-enhancing lesions. Visual contrast enhancement, CNR, and diagnostic confidence of contrast-enhancing MS lesions were significantly increased in T1-mVISTA compared with MP-RAGE (P < 0.001). Significantly more contrast-enhancing lesions were detected with T1-mVISTA than with MP-RAGE (71 vs 39, respectively; P < 0.001). With MP-RAGE, 25.6% of lesions were missed in the initial reading, whereas only 4.2% of lesions were missed with T1-mVISTA. Increase of the voxel volume from 0.8 mm to 1.0 mm isotropic in T1-mVISTA_1.0 did not affect the detectability of lesions, whereas scan time was decreased from 4:43 to 1:55 minutes. CONCLUSIONS: Three-dimensional T1-mVISTA improves the detection rates of contrast-enhancing cerebral MS lesions compared with conventional 3D MP-RAGE sequences by increasing CNR of lesions and might, therefore, be useful in patient management.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Estudos de Coortes , Feminino , Humanos , Masculino , Esclerose Múltipla Recidivante-Remitente/patologia , Estudos Prospectivos , Reprodutibilidade dos Testes
9.
J Pediatr Gastroenterol Nutr ; 65(3): 293-298, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28362690

RESUMO

OBJECTIVES: Data on the outcomes of children with perianal Crohn disease (pCD) are limited, although its presence is often used for justifying early use of biologics. We aimed to assess whether pCD in children is associated with more severe outcomes as found in adults. METHODS: Data were extracted from the ImageKids database, a prospective, multicenter, longitudinal cohort study. The study enrolled 246 children at disease onset or thereafter. All patients underwent comprehensive clinical, endoscopic, and radiologic evaluation at enrollment; 98 children had repeat evaluation at 18 months. RESULTS: Of the 234 included patients (mean age 14.2 ±â€Š2.4 years; 131 [56%] boys), 57 (24%) had perianal findings, whereas only 21 (9%) had fistulizing perianal disease. Children with pCD had reduced weight and height z scores compared with non-pCD patients (-0.9 vs -0.35, P = 0.03 and -0.68 vs -0.23, respectively; P = 0.04), higher weighted pediatric CD activity index (32 [interquartile range 16-50] vs 20 [8-37]; P = 0.004), lower serum albumin (3.6 ±â€Š0.7 vs 4.5 ±â€Š0.8, P = 0.016), and higher magnetic resonance enterography global inflammatory score (P = 0.04). Children with pCD had more rectal (57% vs 38%, P = 0.04), and jejunal involvement (31% vs 11% P = 0.003) and a higher prevalence of granulomas (64% vs 23%, P = 0.0001). Magnetic resonance enterography-based damage scores did not differ between groups. Patients with skin tags/fissures only, had similar clinical, endoscopic, and radiologic characteristics as patients with no perianal findings. CONCLUSIONS: Pediatric patients with pCD with fistulizing disease have distinct phenotypic features and a predisposition to a greater inflammatory burden.


Assuntos
Canal Anal/patologia , Doença de Crohn/patologia , Fenótipo , Fístula Retal/patologia , Adolescente , Criança , Pré-Escolar , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Prognóstico , Fístula Retal/diagnóstico , Fístula Retal/etiologia , Índice de Gravidade de Doença
10.
J Pediatr Gastroenterol Nutr ; 65(6): 633-638, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28362691

RESUMO

BACKGROUND AND OBJECTIVE: Recent evidence points toward an active immunological role of intra-abdominal adipose tissue in Crohn disease (CD). We quantified the abdominal adipose tissue compartments using magnetic resonance imaging (MRI) in 27 pediatric patients with CD compared with 14 controls undergoing MRI examination for other reasons. METHODS: Total (TAAT), subcutaneous (SCAT) and intra-abdominal (IAAT) adipose tissue areas were measured by semiautomatic segmentation on a transverse slice centered on the umbilicus (mean ±â€Šstandard deviation in square centimeter) using standard T1-weighted sequences. IAAT/TAAT and IAAT/height ratios were calculated and analyzed for associations with disease duration, phenotype, or therapy. RESULTS: Patients with CD (median age 15.0 years, range 7.7-17.9, 18/27 boys, median disease duration 29 months, range 0-136) compared to controls (median age 13.9 years, range 3.3-17.8, 4/14 boys) had higher IAAT area (42.3 ±â€Š21.0 vs 28.7 ±â€Š11.6, P = 0.0494) but similar SCAT and TAAT areas (104.6 ±â€Š72.8 vs 96.5 ±â€Š50.8, P = 0.8170 and 146.9 ±â€Š87.3 vs 125.3 ±â€Š61.5, P = 0.7417, respectively). IAAT/TAAT ratio was higher in patients with CD compared to controls (0.32 ±â€Š0.10 vs 0.24 ±â€Š0.04, P = 0.0081). Patients with disease duration >2 years (n = 14) had higher IAAT/TAAT ratio than those with shorter disease and controls (0.35 ±â€Š0.10 vs 0.28 ±â€Š0.08, P = 0.0288 and 0.24 ±â€Š0.04, P = 0.0009, respectively). In these patients, increased IAAT/height ratio was associated with complicated disease (P = 0.043, r = 0.573). No association was found between IAAT/TAAT ratio and actual disease activity or therapy. CONCLUSIONS: IAAT is increased in pediatric CD and correlates with disease duration. Assessment of IAAT accumulation may be considered in future MRI scores for inflammation and bowel damage in CD and during follow-up of different therapeutic interventions.


Assuntos
Adiposidade/imunologia , Doença de Crohn/patologia , Gordura Intra-Abdominal/patologia , Adolescente , Biomarcadores/análise , Composição Corporal , Estudos de Casos e Controles , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Fatores de Risco
11.
Rofo ; 189(7): 624-631, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28445914

RESUMO

Purpose Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). Methods 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. Results 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0. Conclusion iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD. Key points · Intraluminal contrast enhancement is associated with cerebral ischemia in corresponding vessel territories in patients with cervical artery dissection.. · Our results suggest that intraluminal contrast enhancement represents intraluminal thrombus formation.. · Black-blood imaging might be useful to identify those patients with cervical artery dissection at higher risk for initial or recurrent stroke.. Citation Format · Coppenrath E, Lenz O, Sommer N et al. Clinical Significance of Intraluminal Contrast Enhancement in Patients with Spontaneous Cervical Artery Dissection: A Black-Blood MRI Study. Fortschr Röntgenstr 2017; 189: 624 - 631.


Assuntos
Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Aumento da Imagem/métodos , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Dissecação da Artéria Vertebral/diagnóstico por imagem , Adulto , Idoso , Dissecação da Artéria Carótida Interna/complicações , Infarto Cerebral/diagnóstico por imagem , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Fatores de Risco , Sensibilidade e Especificidade , Dissecação da Artéria Vertebral/complicações
12.
Eur Radiol ; 27(5): 2119-2128, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27510630

RESUMO

OBJECTIVES: To evaluate the feasibility of T1w-3D black-blood turbo spin echo (TSE) sequence with variable flip angles for the diagnosis of thoracic large vessel vasculitis (LVV). METHODS: Thirty-five patients with LVV, diagnosed according to the current standard of reference, and 35 controls were imaged at 3.0T using 1.2 × 1.3 × 2.0 mm3 fat-suppressed, T1w-3D, modified Volumetric Isotropic TSE Acquisition (mVISTA) pre- and post-contrast. Applying a navigator and peripheral pulse unit triggering (PPU), the total scan time was 10-12 min. Thoracic aorta and subclavian and pulmonary arteries were evaluated for image quality (IQ), flow artefact intensity, diagnostic confidence, concentric wall thickening and contrast enhancement (CWT, CCE) using a 4-point scale. RESULTS: IQ was good in all examinations (3.25 ± 0.72) and good to excellent in 342 of 408 evaluated segments (83.8 %), while 84.1 % showed no or minor flow artefacts. The interobserver reproducibility for the identification of CCE and CWT was 0.969 and 0.971 (p < 0.001) with an average diagnostic confidence of 3.47 ± 0.64. CCE and CWT were strongly correlated (Cohen's k = 0.87; P < 0.001) and significantly more frequent in the LVV-group (52.8 % vs. 1.0 %; 59.8 % vs. 2.4 %; P < 0.001). CONCLUSIONS: Navigated fat-suppressed T1w-3D black-blood MRI with PPU-triggering allows diagnosis of thoracic LVV. KEY POINTS: • Cross-sectional imaging is frequently applied in the diagnosis of LVV. • Navigated, PPU-triggered, T1w-3D mVISTA pre- and post contrast takes 10-12 min. • In this prospective, single-centre study, T1w-3D mVISTA accurately depicted large thoracic vessels. • T1w-3D mVISTA visualized CWT/CCW as correlates of mural inflammation in LVV. • T1w-3D mVISTA might be an alternative diagnostic tool without ionizing radiation.


Assuntos
Imagem por Ressonância Magnética/métodos , Vasculite/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aortite/diagnóstico por imagem , Artefatos , Estudos de Viabilidade , Feminino , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Pulmonar/diagnóstico por imagem , Reprodutibilidade dos Testes , Artéria Subclávia/diagnóstico por imagem , Arterite de Takayasu/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Doppler Dupla/métodos , Adulto Jovem
14.
PLoS One ; 10(7): e0132809, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26177109

RESUMO

OBJECTIVES: Our aim was to improve the prediction of unfavorable histopathology (UH) in neuroblastic tumors through combined imaging and biochemical parameters. METHODS: 123I-MIBG SPECT and MRI was performed before surgical resection or biopsy in 47 consecutive pediatric patients with neuroblastic tumor. Semi-quantitative tumor-to-liver count-rate ratio (TLCRR), MRI tumor size and margins, urine catecholamine and NSE blood levels of neuron specific enolase (NSE) were recorded. Accuracy of single and combined variables for prediction of UH was tested by ROC analysis with Bonferroni correction. RESULTS: 34 of 47 patients had UH based on the International Neuroblastoma Pathology Classification (INPC). TLCRR and serum NSE both predicted UH with moderate accuracy. Optimal cut-off for TLCRR was 2.0, resulting in 68% sensitivity and 100% specificity (AUC-ROC 0.86, p < 0.001). Optimal cut-off for NSE was 25.8 ng/ml, resulting in 74% sensitivity and 85% specificity (AUC-ROC 0.81, p = 0.001). Combination of TLCRR/NSE criteria reduced false negative findings from 11/9 to only five, with improved sensitivity and specificity of 85% (AUC-ROC 0.85, p < 0.001). CONCLUSION: Strong 123I-MIBG uptake and high serum level of NSE were each predictive of UH. Combined analysis of both parameters improved the prediction of UH in patients with neuroblastic tumor. MRI parameters and urine catecholamine levels did not predict UH.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Biomarcadores Tumorais/análise , Neuroblastoma/diagnóstico por imagem , Cintilografia/métodos , 3-Iodobenzilguanidina , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
15.
Invest Radiol ; 50(6): 401-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25783228

RESUMO

OBJECTIVES: The objective of this study was to evaluate the feasibility of a novel 3-dimensional turbo spin-echo technique with isotropic resolution for the diagnosis of deep vein thrombosis (DVT) in comparison with contrast-enhanced magnetic resonance imaging (CE-MRI) and sonography. MATERIALS AND METHODS: Thirteen patients (8 males, 17-93 years) with proven DVT in duplex ultrasound (n = 11) or with pulmonary embolism and suspected to have DVT (n = 2) were consecutively imaged at 3.0 T with 1.2-mm isotropic-resolution volumetric isotropic turbo spin-echo acquisition (VISTA). Sensitivity (SE), specificity (SP), positive and negative predictive values (PPV and NPV, respectively), Cohen κ, as well as accuracy of VISTA-MRI were calculated and compared with CE-MRI and sonography as a standard of reference. Image quality and diagnostic confidence were assessed on a 4-point scale. RESULTS: Image quality and diagnostic confidence level of VISTA-MRI and CE-MRI were comparable (3.54 vs 3.55 and 3.80 vs 3.77; both P values are nonsignificant). Using CE-MRI as the criterion standard, there was a high agreement between the CE-MRI and the 3-dimensional VISTA examinations for the detection of DVT, with κ of 0.89 for reader 1 and κ of 0.88 for reader 2 (both P < 0.001). The SE, SP, PPV, NPV, as well as accuracy of VISTA-MRI were 92.5%, 97.9%, 89.3%, 98.6%, and 97.1% for reader 1 as well as 90.7%, 97.9%, 89.1%, 98.3%, and 96.8% for reader 2. For both readers, combined comparison of VISTA-MRI and sonography resulted in an SE, SP, PPV, and NPV of 77.8%, 94.8%, 85.4%, and 91.6%, respectively. CONCLUSIONS: Volumetric isotropic turbo spin-echo acquisition magnetic resonance imaging can be used to diagnose DVT with good to excellent agreement compared with CE-MRI and sonography. It might be useful when contrast media is prohibited and in patients with suspected thrombosis of the iliac veins, which can be hard to detect with sonography.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Trombose Venosa/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
16.
Eur J Nucl Med Mol Imaging ; 40(11): 1701-10, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23857458

RESUMO

PURPOSE: Scintigraphy using (123)I-metaiodobenzylguanidine ((123)I-MIBG) is widely used for the detection of neuroblastic tumours. The aim of this study was to identify a possible correlation between the uptake intensity on (123)I-MIBG SPECT and histopathology of neuroblastic tumours. METHODS: (123)I-MIBG SPECT examinations were performed in 55 paediatric patients with neuroblastic tumour and compared to histopathology after surgical resection or biopsy at a mean of 2 weeks after SPECT. For each lesion International Neuroblastoma Pathology Classification System (INPC) stage, mitosis karyorrhexis index (MKI), location and a semiquantitative tumour-to-liver count-rate ratio (TLCRR) were determined. Also, the presence or absence of MYCN amplification, p1 deletion, urine catecholamine and neuron-specific enolase blood levels at the time of scanning were recorded. RESULTS: In the 55 patients, 61 lesions were evaluated with (123)I-MIBG SPECT and corresponding histopathological findings were reviewed (11 ganglioneuroma, 11 ganglioneuroblastoma and 39 neuroblastoma). TLCRR was significantly higher in the neuroblastoma group (mean TLCRR 2.7) than in the ganglioneuroblastoma group (mean TLCRR 1.0) and ganglioneuroma group (mean TLCRR 0.7) at the time of primary diagnosis (p < 0.001) and at follow-up (p = 0.039). Intense (123)I-MIBG uptake was found in tumour tissue with a high mitotic activity (MKI-high or MKI-intermediate) after treatment. Four ganglioneuromas (36 %), three ganglioneuroblastomas (27 %) and six neuroblastomas (15 %) were (123)I-MIBG-negative. CONCLUSION: In paediatric patients with peripheral neuroblastic tumours, strong (123)I-MIBG uptake indicates unfavourable histopathology. High uptake was seen in neuroblastomas and in tumours with a high mitotic activity.


Assuntos
3-Iodobenzilguanidina , Neoplasias Abdominais/diagnóstico por imagem , Neuroblastoma/diagnóstico por imagem , Compostos Radiofarmacêuticos , 3-Iodobenzilguanidina/farmacocinética , Neoplasias Abdominais/patologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Neuroblastoma/patologia , Compostos Radiofarmacêuticos/farmacocinética , Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
17.
Eur J Nucl Med Mol Imaging ; 40(3): 356-63, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23096080

RESUMO

PURPOSE: To analyse the diagnostic value of (18)F-FDG PET and MRI for the evaluation of active lesions in paediatric Langerhans cell histiocytosis. METHODS: We compared 21 (18)F-FDG PET scans with 21 MRI scans (mean time interval 17 days) in 15 patients (11 male, 4 female, age range 4 months to 19 years) with biopsy-proven histiocytosis. Primary criteria for the lesion-based analysis were signs of vital histiocyte infiltrates (bone marrow oedema and contrast enhancement for MRI; SUV greater than the mean SUV of the right liver lobe for PET). PET and MR images were analysed separately and side-by-side. The results were validated by biopsy or follow-up scans after more than 6 months. RESULTS: Of 53 lesions evaluated, 13 were confirmed by histology and 40 on follow-up investigations. The sensitivity and specificity of PET were 67 % and 76 % and of MRI were 81 % and 47 %, respectively. MRI showed seven false-positive bone lesions after successful chemotherapy. PET showed five false-negative small bone lesions, one false-negative lesion of the skull and three false-negative findings for intracerebral involvement. PET showed one false-positive lesion in the lymphoid tissue of the head and neck region and two false-positive bone lesions after treatment. Combined PET/MR analysis decreased the number of false-negative findings on primary staging, whereas no advantage over PET alone was seen in terms of false-positive or false-negative results on follow-up. CONCLUSION: Our retrospective analysis suggests a pivotal role of (18)F-FDG PET in lesion follow-up due to a lower number of false-positive findings after chemotherapy. MRI showed a higher sensitivity and is indispensable for primary staging, evaluation of brain involvement and biopsy planning. Combined MRI/PET analysis improved sensitivity by decreasing the false-negative rate during primary staging indicating a future role of simultaneous whole-body PET/MRI for primary investigation of paediatric histiocytosis.


Assuntos
Fluordesoxiglucose F18 , Histiocitose/diagnóstico , Imagem por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Histiocitose/diagnóstico por imagem , Histiocitose/terapia , Humanos , Lactente , Masculino , Estudos Retrospectivos , Adulto Jovem
18.
Pediatr Radiol ; 43(4): 418-27, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23151727

RESUMO

Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico por imagem , Aumento da Imagem/métodos , Neuroblastoma/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/tendências , Técnica de Subtração/tendências , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Medicina Nuclear/tendências
19.
Eur J Nucl Med Mol Imaging ; 39(11): 1745-55, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22926713

RESUMO

PURPOSE: The present study compares the diagnostic value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and MRI to combined/registered (18)F-FDG PET/MRI for staging and restaging in paediatric oncology. METHODS: Over 8 years and 2 months, 270 (18)F-FDG PET and 270 MRI examinations (mean interval 5 days) were performed in 132 patients with proven (n = 117) or suspected (n = 15) malignant disease: solid tumours (n = 64), systemic malignancy (n = 53) and benign disease (n = 15). A total of 259 suspected tumour lesions were analysed retrospectively during primary diagnosis and 554 lesions during follow-up. Image analysis was performed separately on each modality, followed by analysis of combined and registered (18)F-FDG PET/MRI imaging. RESULTS: A total of 813 lesions were evaluated and confirmed by histopathology (n = 158) and/or imaging follow-up (n = 655) after 6 months. In the separate analysis of (18)F-FDG PET and MRI, sensitivity was 86 %/94 % and specificity 85 %/38 %. Combined/registered (18)F-FDG PET/MRI led to a sensitivity of 97 %/97 % and specificity of 81 %/82 %. False-positive results ((18)F-FDG PET n = 69, MRI n = 281, combined (18)F-FDG PET/MRI n = 85, registered (18)F-FDG PET/MRI n = 80) were due to physiological uptake or post-therapeutic changes. False-negative results ((18)F-FDG PET n = 50, MRI n = 20, combined (18)F-FDG PET/MRI n = 11, registered (18)F-FDG PET/MRI n = 11) were based on low uptake or minimal morphological changes. Examination-based evaluation during follow-up showed a sensitivity/specificity of 91 %/81 % for (18)F-FDG PET, 93 %/30 % for MRI and 96 %/72 % for combined (18)F-FDG PET/MRI. CONCLUSION: For the detection of single tumour lesions, registered (18)F-FDG PET/MRI proved to be the methodology of choice for adequate tumour staging. In the examination-based evaluation, MRI alone performed better than (18)F-FDG PET and combined/registered imaging during primary diagnosis. At follow-up, however, the examination-based evaluation demonstrated a superiority of (18)F-FDG PET alone.


Assuntos
Imagem por Ressonância Magnética , Neoplasias/diagnóstico , Tomografia por Emissão de Pósitrons , Adolescente , Criança , Pré-Escolar , Feminino , Fluordesoxiglucose F18 , Humanos , Lactente , Masculino , Estadiamento de Neoplasias , Neoplasias/diagnóstico por imagem , Compostos Radiofarmacêuticos
20.
Eur J Nucl Med Mol Imaging ; 38(9): 1648-58, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21617976

RESUMO

PURPOSE: To analyse different uptake patterns in (123)I-MIBG scintigraphy/SPECT imaging and (18)F-FDG PET in paediatric neuroblastoma patients. METHODS: We compared 23 (123)I-MIBG scintigraphy scans and 23 (18)F-FDG PET scans (mean interval 10 days) in 19 patients with a suspected neuroblastic tumour (16 neuroblastoma, 1 ganglioneuroblastoma, 1 ganglioneuroma and 1 opsomyoclonus syndrome). SPECT images of the abdomen or other tumour-affected regions were available in all patients. Indications for (18)F-FDG PET were a (123)I-MIBG-negative tumour, a discrepancy in (123)I-MIBG uptake compared to the morphological imaging or imaging results inconsistent with clinical findings. A lesion was found by (123)I-MIBG scintigraphy and/or (18)F-FDG PET and/or morphological imaging. RESULTS: A total of 58 suspicious lesions (mean lesion diameter 3.8 cm) were evaluated and 18 were confirmed by histology and 40 by clinical follow-up. The sensitivities of (123)I-MIBG scintigraphy and (18)F-FDG PET were 50% and 78% and the specificities were 75% and 92%, respectively. False-positive results (three (123)I-MIBG scintigraphy, one (18)F-FDG PET) were due to physiological uptake or posttherapy changes. False-negative results (23 (123)I-MIBG scintigraphy, 10 (18)F-FDG PET) were due to low uptake and small lesion size. Combined (123)I-MIBG scintigraphy/(18)F-FDG PET imaging showed the highest sensitivity of 85%. In 34 lesions the (123)I-MIBG scintigraphy and morphological imaging findings were discrepant. (18)F-FDG PET correctly identified 32 of the discrepant findings. Two bone/bone marrow metastases were missed by (18)F-FDG PET. CONCLUSION: (123)I-MIBG scintigraphy and (18)F-FDG PET showed noticeable differences in their uptake patterns. (18)F-FDG PET was more sensitive and specific for the detection of neuroblastoma lesions. Our findings suggest that a (18)F-FDG PET scan may be useful in the event of discrepant or inconclusive findings on (123)I-MIBG scintigraphy/SPECT and morphological imaging.


Assuntos
3-Iodobenzilguanidina , Fluordesoxiglucose F18 , Neuroblastoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada de Emissão de Fóton Único , 3-Iodobenzilguanidina/metabolismo , Adolescente , Transporte Biológico , Criança , Pré-Escolar , Feminino , Fluordesoxiglucose F18/metabolismo , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Neuroblastoma/metabolismo , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
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