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1.
Clin Imaging ; 83: 72-76, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34990983

RESUMO

PURPOSE: Pulmonary embolism (PE) occurs frequently in patients with malignant melanoma (MM). The aim of this study is to determine the incidence of PE in patients with MM and to assess the clinical characteristics and mortality of MM patients with PE. MATERIAL AND METHODS: Medical records from 381 MM patients who underwent contrast-enhanced computed tomography were evaluated. Imaging parameters including location of PE and measurements of right heart dysfunction and clinical parameters including D-Dimer levels, local and distant tumor stage and time of death were analyzed. RESULTS: PE was found in 23/381 (6%) MM patients, whereby 17/23 (74%) were detected incidentally and only 6/23 (26%) were symptomatic. The presence of PE significantly correlated with elevated D-Dimers (p < 0.001), right ventricular dysfunction (p = 0.04), higher local tumor stage (≥T3) (p = 0.05), presence of visceral (p = 0.02) or cerebral metastases (p = 0.03) and increased mortality (p = 0.05). Further, patients with central PE showed an increased mortality compared to peripheral PE (p = 0.03), but no correlation was found between the localization of PE and the occurrence of clinical symptoms (p = 0.36). CONCLUSION: PE in patients with MM often occurs without clinical symptoms and is indicative for advanced disease and a poorer prognosis.


Assuntos
Melanoma , Embolia Pulmonar , Disfunção Ventricular Direita , Humanos , Incidência , Melanoma/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Disfunção Ventricular Direita/etiologia
2.
AJR Am J Roentgenol ; 218(4): 659-669, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34668385

RESUMO

BACKGROUND. CT-based criteria for assessing the gastrointestinal stromal tumor (GIST) response to tyrosine kinase inhibitor (TKI) therapy are limited in part because tumor attenuation is influenced by treatment-related changes including hemorrhage and calcification. The iodine concentration may be less impacted by such changes. OBJECTIVE. The purpose of this study was to determine whether the dual-energy CT (DECT) vital iodine tumor burden (TB) allows improved differentiation between treatment responders and nonresponders among patients with metastatic GIST who are undergoing TKI therapy compared with established CT and PET/CT criteria. METHODS. An anthropomorphic phantom with spherical inserts mimicking GIST lesions of varying iodine concentrations and having nonenhancing central necrotic cores underwent DECT to determine a threshold iodine concentration. Forty patients (25 women and 15 men; median age, 57 years) who were treated with TKI for metastatic GIST were retrospectively evaluated. Patients underwent baseline and follow-up DECT and FDG PET/CT. Response assessment was performed using RECIST 1.1, modified Choi (mChoi) criteria, vascular tumor burden (VTB) criteria, DECT vital iodine TB criteria, and European Organization for Research and Treatment of Cancer (EORTC) PET criteria. DECT vital iodine TB criteria used the same percentage changes as RECIST 1.1 response categories. Progression-free survival was compared between responders and nonresponders for each response criterion by use of Cox proportional hazard ratios and Harrell C-indexes (i.e., concordance indexes). RESULTS. The phantom experiment identified a threshold of 0.5 mg/mL to differentiate vital from nonvital tissue. With use of the DECT vital iodine TB, median progression-free survival was significantly different between responders and nonresponders (623 vs 104 days; p < .001).. For nonresponders versus responders, the hazard ratio for disease progression for DECT vital iodine TB was 6.9 versus 7.6 for EORTC PET criteria, 3.3 for VTB criteria, 2.3 for RECIST 1.1, and 2.1 for mChoi criteria. The C-index was 0.74 for EORTC PET criteria, 0.73 for DECT vital iodine TB criteria, 0.67 for VTB criteria, 0.61 for RECIST 1.1, and 0.58 for mChoi criteria. The C-index was significantly greater for DECT vital iodine TB criteria than for RECIST 1.1 (p = .02) and mChoi criteria (p = .002), but it was not different from that for VTB and EORTC PET criteria (p > .05). CONCLUSION. DECT vital iodine TB criteria showed performance comparable to that of EORTC PET criteria and outperformed RECIST 1.1 and mChoi criteria for response assessment of metastatic GIST treated with TKI therapy. CLINICAL IMPACT. DECT vital iodine TB could help guide early management decisions in patients receiving TKI therapy.


Assuntos
Tumores do Estroma Gastrointestinal , Iodo , Segunda Neoplasia Primária , Feminino , Fluordesoxiglucose F18 , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Carga Tumoral
3.
Sci Rep ; 11(1): 5035, 2021 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-33658565

RESUMO

Emphysema-like-change of lung is one aspect of lung morbidity in children after congenital diaphragmatic hernia (CDH). This study aims to evaluate if the extent of reduced lung density can be quantified through pediatric chest CT examinations, if side differences are present and if emphysema-like tissue is more prominent after CDH than in controls. Thirty-seven chest CT scans of CDH patients (mean age 4.5 ± 4.0 years) were analyzed semi-automatically and compared to an age-matched control group. Emphysema-like-change was defined as areas of lung density lower than - 950 HU in percentage (low attenuating volume, LAV). A p-value lower than 0.05 was regarded as statistically significant. Hypoattenuating lung tissue was more frequently present in the ipsilateral lung than the contralateral side (LAV 12.6% vs. 5.7%; p < 0.0001). While neither ipsilateral nor contralateral lung volume differed between CDH and control (p > 0.05), LAV in ipsilateral (p = 0.0002), but not in contralateral lung (p = 0.54), was higher in CDH than control. It is feasible to quantify emphysema-like-change in pediatric patients after CDH. In the ipsilateral lung, low-density areas are much more frequently present both in comparison to contralateral and to controls. Especially the ratio of LAV ipsilateral/contralateral seems promising as a quantitative parameter in the follow-up after CDH.


Assuntos
Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/patologia , Hérnias Diafragmáticas Congênitas/cirurgia , Humanos , Interpretação de Imagem Assistida por Computador , Lactente , Masculino , Enfisema Pulmonar/etiologia , Enfisema Pulmonar/patologia , Enfisema Pulmonar/cirurgia , Tomografia Computadorizada por Raios X
4.
Diagnostics (Basel) ; 10(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33352939

RESUMO

As stated by the Fleischner Society, an additional computed tomography (CT) scan in expiration is beneficial in patients with chronic obstructive pulmonary disease (COPD). It was thus the aim of this study to evaluate the radiation risk of a state-of-the-art paired inspiratory-expiratory chest scan compared to inspiration-only examinations. Radiation doses to 28 organs were determined for 824 COPD patients undergoing routine chest examinations at three different CT systems-a conventional multi-slice CT (MSCT), a 2nd generation (2nd-DSCT), and 3rd generation dual-source CT (3rd-DSCT). Patients examined at the 3rd-DSCT received a paired inspiratory-expiratory scan. Organ doses, effective doses, and lifetime attributable cancer risks (LAR) were calculated. All organ and effective doses were significantly lower for the paired inspiratory-expiratory protocol (effective doses: 4.3 ± 1.5 mSv (MSCT), 3.0 ± 1.2 mSv (2nd-DSCT), and 2.0 ± 0.8 mSv (3rd-DSCT)). Accordingly, LAR was lowest for the paired protocol with an estimate of 0.025 % and 0.013% for female and male patients (50 years) respectively. Image quality was not compromised. Paired inspiratory-expiratory scans can be acquired on 3rd-DSCT systems at substantially lower dose and risk levels when compared to inspiration-only scans at conventional CT systems, offering promising prospects for improved COPD diagnosis.

5.
PLoS One ; 15(11): e0241590, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180805

RESUMO

OBJECTIVES: The aim of this study was to establish quantitative CT (qCT) parameters for pathophysiological understanding and clinical use in patients with acute respiratory distress syndrome (ARDS). The most promising parameter is introduced. MATERIALS AND METHODS: 28 intubated patients with ARDS obtained a conventional CT scan in end-expiratory breathhold within the first 48 hours after admission to intensive care unit (ICU). Following manual segmentation, 137 volume- and lung weight-associated qCT parameters were correlated with 71 clinical parameters such as blood gases, applied ventilation pressures, pulse contour cardiac output measurements and established status and prognosis scores (SOFA, SAPS II). RESULTS: Of all examined qCT parameters, excess lung weight (ELW), i.e. the difference between a patient's current lung weight and the virtual lung weight of a healthy person at the same height, displayed the most significant results. ELW correlated significantly with the amount of inflated lung tissue [%] (p<0.0001; r = -0.66) and was closely associated with the amount of extravascular lung water (EVLW) (p<0.0001; r = 0.72). More substantially than the oxygenation index (PaO2/FiO2) or any other clinical parameter it correlated with the patients' mean SOFA- (p<0.0001, r = 0.69) and SAPS II-Score (p = 0.0005, r = 0.62). Patients who did not survive intensive care treatment displayed higher values of ELW in the initial CT scans. CONCLUSIONS: ELW could serve as a non-invasive method to quantify the amount of pulmonary oedema. It might serve as an early radiological marker of severity in patients with ARDS.


Assuntos
Pulmão/diagnóstico por imagem , Edema Pulmonar/diagnóstico , Síndrome do Desconforto Respiratório/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Estudos de Viabilidade , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Pulmão/fisiopatologia , Medidas de Volume Pulmonar/métodos , Masculino , Pessoa de Meia-Idade , Edema Pulmonar/etiologia , Edema Pulmonar/mortalidade , Edema Pulmonar/fisiopatologia , Síndrome do Desconforto Respiratório/complicações , Síndrome do Desconforto Respiratório/mortalidade , Síndrome do Desconforto Respiratório/fisiopatologia , Testes de Função Respiratória , Índice de Gravidade de Doença
6.
PLoS One ; 15(6): e0234311, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32511272

RESUMO

OBJECTIVE: To compare the performance of an 18-gauge nonfenestrated catheter (18-NFC) with a 22-gauge fenestrated catheter (22-FC) for cardiac CT angiography (CCTA) in patients with suspected coronary heart disease. SUBJECTS AND METHODS: 74 consecutive patients imaged on a 2nd generation dual-source CT with arterial phase CCTA were included in this retrospective investigation to either an 18-NFC or 22-FC. In comparison to the 18-NFC, the 22-FC has three additional perforations for contrast agent dispersal proximal to the tip. We examined the two groups for differences in their average attenuation in the right and left ventricles (RV, LV) and in the atrium (RA, LA) as well as in the proximal right coronary artery (RCA) and the left main coronary artery (LM). The averages were calculated for both the 18-NFC and 22-FC. RESULTS: Catheters were successfully placed on the first attempt 97% (36/37) for 18-NFC and 95% (35/37) for the 22-FC. The following enhancement levels were measured: 22-FC (in Hounsfield-Units (HU)): RV = 203±29, LV = 523±36, RA = 198±29, LA = 519±38, RCA = 547±26, LM = 562±25; 18-NFC: RV = 146±26, LV = 464±32, RA = 141±24, LA = 438±35, RCA = 501±23, LM = 523±23; RV (p = 0,03), LV (p = 0.12), RA (p = 0.02), LA (p = 0.04), RCA (p = 0.3), LM (p = 0.33). CONCLUSION: No significant differences in attenuation levels as well as in image quality of the coronary arteries were found between NFC and FC. Nevertheless, the 22-gauge FC examinations showed significantly higher attenuation in the left and right atrium as well as the right ventricle. Patients with poor venous access may benefit from a smaller gauge catheter that can deliver sufficiently high flow rates for CCTA.


Assuntos
Angiografia por Tomografia Computadorizada/instrumentação , Angiografia Coronária/instrumentação , Doença das Coronárias/diagnóstico por imagem , Dispositivos de Acesso Vascular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/administração & dosagem , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
J Thorac Imaging ; 35 Suppl 1: S28-S34, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32235188

RESUMO

OBJECTIVES: The objective of this study was to evaluate an artificial intelligence (AI)-based prototype algorithm for the fully automated per lobe segmentation and emphysema quantification (EQ) on chest-computed tomography as it compares to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity classification of chronic obstructive pulmonary disease (COPD) patients. METHODS: Patients (n=137) who underwent chest-computed tomography acquisition and spirometry within 6 months were retrospectively included in this Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study. Patient-specific spirometry data, which included forced expiratory volume in 1 second, forced vital capacity, and the forced expiratory volume in 1 second/forced vital capacity ratio (Tiffeneau-Index), were used to assign patients to their respective GOLD stage I to IV. Lung lobe segmentation was carried out using AI-RAD Companion software prototype (Siemens Healthineers), a deep convolution image-to-image network and emphysema was quantified in each lung lobe to detect the low attenuation volume. RESULTS: A strong correlation between the whole-lung-EQ and the GOLD stages was found (ρ=0.88, P<0.0001). The most significant correlation was noted in the left upper lobe (ρ=0.85, P<0.0001), and the weakest in the left lower lobe (ρ=0.72, P<0.0001) and right middle lobe (ρ=0.72, P<0.0001). CONCLUSIONS: AI-based per lobe segmentation and its EQ demonstrate a very strong correlation with the GOLD severity stages of COPD patients. Furthermore, the low attenuation volume of the left upper lobe not only showed the strongest correlation to GOLD severity but was also able to most clearly distinguish mild and moderate forms of COPD. This is particularly relevant due to the fact that early disease processes often elude conventional pulmonary function diagnostics. Earlier detection of COPD is a crucial element for positively altering the course of disease progression through various therapeutic options.


Assuntos
Inteligência Artificial , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Fumantes/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações , Enfisema Pulmonar/complicações , Radiografia Torácica/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
8.
Anthropol Anz ; 77(1): 75-82, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-31939989

RESUMO

In the course of a scientific cooperation between the German Mummy Project at the Reiss-Engelhorn-Museen, Mannheim (Germany) and the Musée National d'Histoire et d'Art Luxembourg (Luxembourg), an ancient Egyptian mummy head was analyzed using a multidisciplinary approach including radiocarbon dating, ultra-high resolution computed tomography, physical anthropology, forensic medicine and Egyptology. Dated to the Roman Period, the mummy head belonged to an upper-class woman between 25 and 35 years of age. Computed tomography revealed a lethal blunt force trauma affecting the dorsal parts of the parietal bones, below the intact overlaying soft tissue. Moreover, ancient medical treatment was evidenced through localized shaving of the hair on the affected area, which indicates that efforts have been made to keep the woman alive. This astonishing example of homicide demonstrates the enormous scientific benefit brought by the multidisciplinary investigation of mummified bodies and body parts, and sheds light on life, death and medical care of a woman from Roman Period Egypt.


Assuntos
Traumatismos Craniocerebrais , Múmias , Ferimentos não Penetrantes , Adulto , Antigo Egito , Feminino , Cabeça , História Antiga , Humanos
9.
Sci Rep ; 9(1): 15489, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664066

RESUMO

A long-standing hypothesis in radiotherapy is that intensity-modulated radiotherapy (IMRT) increases the risk of second cancer due to low-dose exposure of large volumes of normal tissue. Therefore, young patients are still treated with conventional techniques rather than with modern IMRT. We challenged this hypothesis in first-of-its-kind experiments using an animal model. Cancer-prone Tp53+/C273X knockout rats received mediastinal irradiation with 3 × 5 or 3 × 8 Gy using volumetric-modulated arc therapy (VMAT, an advanced IMRT) or conventional anterior-posterior/posterior-anterior (AP/PA) beams using non-irradiated rats as controls (n = 15/group, ntotal = 90). Tumors were assigned to volumes receiving 90-107%, 50-90%, 5-50%, and <5% of the target dose and characterized by histology and loss-of-heterozygosity (LOH). Irradiated rats predominantly developed lymphomas and sarcomas in areas receiving 50-107% (n = 26) rather than 5-50% (n = 7) of the target dose. Latency was significantly shortened only after 3 × 8 Gy vs. controls (p < 0.0001). The frequency (14/28 vs. 19/29; p = 0.29) and latency (218 vs. 189 days; p = 0.17) of radiation-associated tumors were similar after VMAT vs. AP/PA. LOH was strongly associated with sarcoma but not with treatment. The results do not support the hypothesis that IMRT increases the risk of second cancer. Thus the current practice of withholding dose-sparing IMRT from young patients may need to be re-evaluated.


Assuntos
Modelos Animais de Doenças , Mediastino/efeitos da radiação , Neoplasias Induzidas por Radiação/epidemiologia , Radioterapia de Intensidade Modulada/métodos , Animais , Feminino , Masculino , Órgãos em Risco , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Ratos , Ratos Transgênicos , Fatores de Risco , Proteína Supressora de Tumor p53/genética
10.
Anticancer Res ; 39(6): 3053-3057, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177148

RESUMO

AIM: Evaluation of osteoid osteoma (OO) perfusion characteristics pre and post microwave ablation (MWA) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with clinical follow-up. MATERIALS AND METHODS: Patients with OO underwent T1-weighted 3D DCE-MRI at 3.0T pre and post MWA. Signal intensity (SI) and perfusion of lesions was measured. Patients answered a questionnaire for clinical follow-up. RESULTS: A total of 24 patients were included (mean age of 28 years; nine females); 21 DCE-MRI datasets were of sufficient quality for analysis. The mean SI of lesions, plasma flow, volume of distribution and pain level all decreased statistically significantly after ablation. CONCLUSION: Quantitative MRI-perfusion analysis allows for objective treatment evaluation after MWA of OO, plasma flow and volume of distribution seem to be reliable indicators for successful thermoablation. MWA is an effective treatment option for OO with a low risk profile and significant pain reduction after treatment.


Assuntos
Técnicas de Ablação , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Angiografia por Ressonância Magnética , Micro-Ondas/uso terapêutico , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Imagem de Perfusão/métodos , Técnicas de Ablação/efeitos adversos , Adolescente , Adulto , Neoplasias Ósseas/irrigação sanguínea , Neoplasias Ósseas/patologia , Criança , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Osteoma Osteoide/irrigação sanguínea , Osteoma Osteoide/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
Diagnostics (Basel) ; 9(1)2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30901865

RESUMO

INTRODUCTION: Quantitative computed tomography (qCT) is an emergent technique for diagnostics and research in patients with chronic obstructive pulmonary disease (COPD). qCT parameters demonstrate a correlation with pulmonary function tests and symptoms. However, qCT only provides anatomical, not functional, information. We evaluated five distinct, partial-machine learning-based mathematical models to predict lung function parameters from qCT values in comparison with pulmonary function tests. METHODS: 75 patients with diagnosed COPD underwent body plethysmography and a dose-optimized qCT examination on a third-generation, dual-source CT with inspiration and expiration. Delta values (inspiration-expiration) were calculated afterwards. Four parameters were quantified: mean lung density, lung volume low-attenuated volume, and full width at half maximum. Five models were evaluated for best prediction: average prediction, median prediction, k-nearest neighbours (kNN), gradient boosting, and multilayer perceptron. RESULTS: The lowest mean relative error (MRE) was calculated for the kNN model with 16%. Similar low MREs were found for polynomial regression as well as gradient boosting-based prediction. Other models led to higher MREs and thereby worse predictive performance. Beyond the sole MRE, distinct differences in prediction performance, dependent on the initial dataset (expiration, inspiration, delta), were found. CONCLUSION: Different, partially machine learning-based models allow the prediction of lung function values from static qCT parameters within a reasonable margin of error. Therefore, qCT parameters may contain more information than we currently utilize and can potentially augment standard functional lung testing.

12.
Radiology ; 291(2): 381-390, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30860450

RESUMO

Background Dual-energy (DE) CT allows reconstruction of virtual noncontrast (VNC) images from a single-phase contrast agent-enhanced examination, potentially reducing the need for multiphasic CT to characterize renal lesions. However, data regarding diagnostic performance of VNC images for the characterization of renal lesions are limited. Purpose To determine whether renal mass CT performed by using VNC images allows for reliable identification of renal lesions and differentiation of contrast-enhanced from unenhanced lesions, compared with unenhanced images. Materials and Methods This is a retrospective study of 293 patients (105 women [mean age, 65 years; age range, 18-91 years] and 188 men [mean age, 66 years; age range, 23-90 years] with 379 renal lesions [craniocaudal diameter, 1.0-4.0 cm]) who underwent a single-energy unenhanced CT examination followed by a nephrographic-phase DE CT between June 2013 and October 2017 by using one of four different DE CT platforms from two vendors. VNC images were calculated by using vendor-specific algorithms. Each lesion was classified in a blinded and independent fashion by using the VNC or unenhanced image in combination with the nephrographic images. Attenuation measurements were obtained on the VNC, unenhanced, and nephrographic images. Unenhanced images and pathologic or imaging follow-up for more than 24 months served as reference standard. Results There was strong overall agreement between VNC and unenhanced images for renal lesion characterization (Cramer V = 0.85). VNC images yielded a high diagnostic performance (area under the receiver operating characteristic curve, 0.91; 95% confidence interval: 0.86, 0.95) for facilitation of differentiation of contrast-enhanced from unenhanced renal lesions. However, there was a reduction in diagnostic performance for depicting contrast-enhanced renal lesions by using VNC compared with unenhanced images (area under the receiver operating characteristic curve, 0.91 [95% confidence interval: 0.86, 0.95] vs 0.96 [95% confidence interval: 0.93, 0.99]; P < .001). Mean absolute difference between the VNC and unenhanced attenuation was 9.2 HU ± 8.7. Conclusion Virtual noncontrast images enabled accurate renal lesion characterization, albeit with a reduction in diagnostic performance for contrast-enhanced lesion characterization. © RSNA, 2019 Online supplemental material is available for this article.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematúria/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos , Adulto Jovem
13.
PLoS One ; 14(1): e0210473, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30653548

RESUMO

OBJECTIVES: To assess the occurrence of transient interruption of contrast (TIC) phenomenon in pulmonary computed tomography angiography (CTPA) exams performed in inspiratory breath-hold after patients were told to inspire gently. METHODS: In this retrospective single-centre study, CTPA exams of 225 consecutive patients scanned on a 16-slice CT scanner system were analysed. A-priori to measurements, exams were screened for inadequate pulmonary artery contrast due to incorrect bolus tracking or failure of i.v. contrast administration. Those exams were excluded. Attenuation values in the thoracic aorta and in the pulmonary trunk were assessed in duplicate measurements (M1 and M2) and the aorto-pulmonary density ratio was calculated. An aorto-pulmonary ratio > 1 with still contrast inflow being visible within the superior vena cava was defined as TIC. RESULTS: 3 patients were excluded due to incorrect bolus tracking. Final analysis was performed in 222 patients (mean age 65 ± 19 years, range 18 to 99 years). Mean density in the pulmonary trunk was 275±17 HU, in the aorta 208 ± 15 HU. Mean aorto-pulmonary ratio was 0.81± 0.29. 48 patients (21.6%) had an aorto-pulmonary ratio >1. Correlation of mean aorto-pulmonary ratio and age was: -0.213 (p = 0.001). Age was not significantly different for an aorto-pulmonary ratio >1 vs. ≤1 (p = 0.122). Both in M1 and M2, 33/222 patients presented with absolute HU values of < 200 HU within the pulmonary artery. In M1 measurements, 24 of these 33 patients (72%) fulfilled TIC criteria (M2: 25/33 patients (75%)). CONCLUSIONS: TIC is a common phenomenon in CTPA studies with inspiratory breath-hold commands after patients were told to inspire gently with an incidence of 22% in our retrospective cohort. Occurrence of TIC shows a significant negative correlation with increasing age and disproportionately often occurs in patients with lower absolute contrast density values within their pulmonary arteries.


Assuntos
Suspensão da Respiração , Angiografia por Tomografia Computadorizada/métodos , Artéria Pulmonar/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Meios de Contraste , Feminino , Humanos , Incidência , Inalação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
J Thorac Imaging ; 34(1): 41-47, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30480591

RESUMO

PURPOSE: The purpose of this study was to prospectively evaluate the feasibility of detecting calcified aortic plaques in apolipoprotein E knockout (ApoE-KO) mice using a state-of-the-art human computed tomography (CT) system. MATERIALS AND METHODS: Eleven ApoE-KO and 9 wild-type mice, all male, were examined in this study. After intraperitoneal injection of 6.6% ketamine all mice underwent 2 ultra-high-resolution CT protocols on a third-generation dual-source CT system at 120 kVp and 130 kVp tube voltage, both performed with a tube current time product of 1300 mAs. Images (0.4 mm) with an increment of 0.2 mm were reconstructed using an iterative reconstruction algorithm. Calcium detectability and scores (Agatston, volume, mass) were determined with a dedicated human calcium scoring software (CaScoring). After the CT examination, a calcium quantification assay of the aortae was performed to determine the aortic calcium content of each mouse. The CT scan time ranged between 40 and 48 seconds. All mice survived the procedure. RESULTS: Calcified plaques could be detected in 8 of 11 ApoE-KO mice. Quantification of calcium levels showed significant differences between those with morphologic calcium plaques detected in CT and those without (3.44±1.6 µg Ca/mg vs. 0.33±0.35 µg Ca/mg; P<0.05). The receiver-operating characteristics analysis revealed a total calcium cut-off value of 0.71 µg Ca/mg for the detection using calcium score algorithms (specificity: 100% and sensitivity: 90%). CONCLUSION: Using a state-of-the-art human CT protocol and an in-human-established calcium scoring system allows for the detection and quantification of calcified aortic plaques in ApoE-KO mice. These results may facilitate preclinical imaging for translational and longitudinal atherosclerotic research studies.


Assuntos
Apolipoproteínas E/deficiência , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Animais , Apolipoproteínas E/genética , Doença da Artéria Coronariana/genética , Modelos Animais de Doenças , Estudos de Viabilidade , Masculino , Camundongos Endogâmicos C57BL , Placa Aterosclerótica/genética , Estudos Prospectivos
15.
J Thorac Imaging ; 34(1): 26-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30142137

RESUMO

PURPOSE: Recent advances in image quality of coronary computed tomographic angiography (cCTA) have enabled improved characterization of coronary plaques. Thus, we investigated the association between quantitative morphological plaque markers obtained by cCTA and serum lipid levels in patients with suspected or known coronary artery disease. MATERIALS AND METHODS: We retrospectively analyzed data of 119 statin-naive patients (55±14 y, 66% men) who underwent clinically indicated cCTA between January 2013 and February 2017. Patients were subdivided into a plaque and a no-plaque group. Quantitative and morphologic plaque markers, such as segment involvement score, segment stenosis score, remodeling index, napkin-ring sign, total plaque volume, calcified plaque volume, and noncalcified plaque volume (NCPV) and plaque composition, were analyzed using a semiautomated plaque software prototype. Total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, low-density lipoprotein/high-density lipoprotein ratio, and triglycerides were determine in both groups. RESULTS: Higher age (61±11 y vs. 52±14 y, P<0.0001) and a higher likelihood of male gender (77% vs. 56%, P<0.0001) were observed in the plaque group. Differences in lipid levels were neither observed for differentiation between plaque presence or absence, nor after subcategorization for plaque composition. LDL serum levels >160 mg/dL correlated with higher NCPV compared with patients with LDL between 100 and 160 mg/dL (112 vs. 27 mm, P=0.037). Other markers were comparable between the different groups. CONCLUSION: Statin-naive patients with known or suspected coronary artery disease did not show differences in lipid levels related to plaque composition by cCTA. Patients with plaques tended to be men and were significantly older. High LDL levels correlated with high NCPV.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/diagnóstico por imagem , Lipídeos/sangue , Placa Aterosclerótica/diagnóstico por imagem , Fatores Etários , Idoso , Biomarcadores/sangue , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Estudos Retrospectivos , Fatores Sexuais , Calcificação Vascular/sangue , Calcificação Vascular/diagnóstico por imagem
16.
Int J Comput Assist Radiol Surg ; 13(12): 1971-1980, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30039247

RESUMO

PURPOSE: To investigate whether structured reports (SRs) provide benefits regarding the completeness and the clarity of reports, as well as regarding the satisfaction of the referring physicians compared to narrative freetext reports (NRs) of MRI examinations of the petrous bone. METHODS: After sample size calculation, 32 patients with clinically indicated MRI examinations of the petrous bone were included in this retrospective study. The already existing NRs were taken from the radiologic information system. The corresponding SRs were retrospectively generated by two radiologists using an online-based application. All 64 reports (one NR and one SR per patient) were evaluated by two head and neck physicians using a questionnaire. RESULTS: While 41% of the SRs showed no missing report key feature, all NRs exhibited at least one missing key feature (p < 0.001). SRs achieved significantly higher satisfaction rates regarding the linguistic quality and overall report quality compared to NRs: Using a 6-point Likert scale (1 = insufficient to 6 = excellent), SRs were rated with a median value of 6 [interquartile range (IQR): 1] for linguistic as well as overall quality, and NRs were rated with a median of 5 (IQR: 0) for linguistic as well as overall quality (p < 0.001). CONCLUSIONS: Structured reporting of petrous bone MRI examinations may positively influence the completeness and quality of radiologic reports. Due to the easier readability and facilitation of information extraction, SRs improve the satisfaction level of the referring physicians.


Assuntos
Doenças Ósseas/diagnóstico , Imageamento por Ressonância Magnética/normas , Osso Petroso/diagnóstico por imagem , Sistemas de Informação em Radiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
17.
Phys Med Biol ; 63(16): 165003, 2018 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-30022767

RESUMO

Dynamic CT angiography provides much more information compared to static 3D CT angiography, in several clinical applications. The prolonged exposure, on the other hand, results in higher radiation dose for to the patient. Care should be taken when designing noise reduction algorithms so that temporal profiles and spatial resolution is not significantly compromised. In particular, in deep inferior epigastric perforators (DIEP) flap studies, the temporal enhancement of small abdominal subcutaneous and intramuscular vessels needs to be evaluated from the surgeons to plan breast reconstruction. We propose a new approach to exploit the data redundancy in the temporal direction and successfully reduce noise via singular value decomposition. The similarity of voxels temporal profiles is then measured on the noise-reduced dataset and a spatial smoothing is performed with an additional edge-preserving weight coming from the noise-reduced tMIP. We named our filter the singular value decomposition guided similarity (SVGS) filter, and compared it to the TIPS (time-intensity profile similarity) filtered data and to the highly constrained filtered backprojection (HYPR) processed data. This institutional review board-approved study included 17 DIEP flap clinical cases, that were retrospectively processed with HYPR, TIPS and SVGS and then compared both qualitatively and quantitatively. Contrast-to-noise ratio (CNR) was used for quantitative evaluation, while a blinded subjective evaluation was performed by an experienced radiologist. We reported significantly improved results with the SVGS filter when compared to the other approaches, both in terms of CNR, as well as with the subjective clinical evaluation. The results over 17 clinical cases suggest that a potential dose reduction of a factor of 9 could be achieved, while preserving the same image quality. In conclusion, we developed an efficient algorithm for dynamic CT angiographic data processing, which successfully enables a reduction of spatial and temporal noise, while preserving and enhancing the visualization of small vessels. We demonstrated the clinical usefulness of the SVGS for the DIEP flap application. The proposed algorithm can be employed to significantly improve image quality and diagnostic acceptability at same dose level or alternatively to reduce radiation dose, to which extent needs to be evaluated in future studies.


Assuntos
Algoritmos , Vasos Sanguíneos/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/instrumentação , Angiografia por Tomografia Computadorizada/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Heart Rhythm ; 15(12): 1872-1879, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30017817

RESUMO

BACKGROUND: Irreversible electroporation (IRE) is a novel tumor ablative therapy technique, using electric fields to induce apoptosis in target tissues. Whether these electric pulses of high field strength can cause cardiac damage and/or ablation-induced arrhythmias is unclear. OBJECTIVE: The purpose of this study was to systematically evaluate the safety of electrocardiogram (ECG)-gated IRE with regard to cardiac side effects. METHODS: In all patients, 12-lead ECG and signal-averaged ECG (SAECG) recordings were performed before and after IRE and 24-hour Holter recording on the day of the IRE procedure. Venous blood samples (N-terminal pro-brain-type natriuretic peptide [NT-proBNP], high-sensitive troponin I [hsTnI]) were obtained before and 4 and 16 hours after the procedure. Patients with abnormal findings were reevaluated after 3 months. RESULTS: In total, 26 patients with an oncologic indication for IRE (11 females, mean age 62.9 years) were prospectively enrolled. Nine patients (34.6%) showed an increase in hsTnI and 21 patients (80.8%) an increase in NT-proBNP after ablation. Fifteen patients (57%) developed arrhythmias related to the procedure. One patient, in whom hsTnI and NT-proBNP had increased, developed multiple, nonsustained ventricular tachycardia events. In another patient, atrial fibrillation was triggered twice in 2 separate procedures. Twelve patients had clinically benign arrhythmias. SAECG was negative in all patients. CONCLUSION: Subclinical myocardial injury and nonfatal cardiac arrhythmias can occur in the context of IRE treatment. Although no sustained cardiac injuries could be found at 3-month follow-up, we propose implementation of a cardiac safety algorithm consisting of cardiac biomarkers and ECG monitoring when IRE is conducted.


Assuntos
Arritmias Cardíacas/etiologia , Eletrocardiografia , Eletroquimioterapia/efeitos adversos , Neoplasias/tratamento farmacológico , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Eletroquimioterapia/métodos , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
In Vivo ; 32(4): 843-849, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29936469

RESUMO

BACKGROUND: This feasibility study of text-mining-based scoring algorithm provides an objective comparison of structured reports (SR) and conventional free-text reports (cFTR) by means of guideline-based key terms. Furthermore, an open-source online version of this ranking algorithm was provided with multilingual text-retrieval pipeline, customizable query and real-time-scoring. MATERIALS AND METHODS: Twenty-five patients with suspected stroke and magnetic resonance imaging were re-assessed by two independent/blinded readers [inexperienced: 3 years; experienced >6 years/Board-certified). SR and cFTR were compared with guideline-query using the cosine similarity score (CSS) and Wilcoxon signed-rank test. RESULTS: All pathological findings (18/18) were identified by SR and cFTR. The impressions section of the SRs of the inexperienced reader had the highest median (0.145) and maximal (0.214) CSS and were rated significantly higher (p=2.21×10-5 and p=1.4×10-4, respectively) than cFTR (median=0.102). CSS was robust to variations of query. CONCLUSION: Objective guideline-based comparison of SRs and cFTRs using the CSS is feasible and provides a scalable quality measure that can facilitate the adoption of structured reports in all fields of radiology.


Assuntos
Guias como Assunto , Sistemas de Informação em Radiologia , Radiologia/normas , Acidente Vascular Cerebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Mineração de Dados , Feminino , Humanos , Imageamento por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/normas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
20.
Eur J Radiol ; 104: 87-93, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29857872

RESUMO

PURPOSE: The importance of spirometry for management of COPD was reduced in the 2017 revision of the GOLD report. CT derived airway measurements show strong correlations with lung function tests and symptoms. However, these correlations are specific to the airway localization, and currently there is no evidence for the ideal spot. Therefore, the aim of this prospective study was to systematically correlate CT derived airway measurements with extensive lung function testing. METHODS AND MATERIALS: 65 patients with diagnosed COPD underwent body plethysmography, impulse oscillometry and dose optimized qCT examination (Somatom Force, Healthineers, Germany) in inspiration and expiration. Eight airway parameters (e.g. outer diameter, maximal wall thickness) were acquired for both scans in every lobe for the third to fifth generation bronchus and correlated with the lung function tests. RESULTS: The most significant correlations between airway parameters were found for the third generation bronchus of the upper left lobe during expiration (25 out of 48 correlation pairs, mean r = -0.39) and for the third generation bronchus of the upper right lobe during inspiration (9 out of 48 correlation pairs, mean r = -0.25). No significant correlations were for example found for the upper right lobe in expiration. CONCLUSION: Correlations between airway parameters and lung function tests vary widely between lobes, bronchus generations and breathing states. Our work suggests that the third generation bronchus of the upper left lobe in expiration could be the preferred localization for airway quantification in future studies.


Assuntos
Brônquios/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pletismografia , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Brônquios/fisiopatologia , Expiração , Humanos , Pulmão/fisiopatologia , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X/métodos
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