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1.
Clin Transl Gastroenterol ; 11(1): e00118, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977452

RESUMO

INTRODUCTION: Hepatic involvement in hereditary hemorrhagic telangiectasia (HHT) is common and can be associated with severe clinical consequences, including portal hypertension, cardiac failure, and encephalopathy. However, there are no reliable clinical predictors of hepatic involvement and its associated complications, limiting appropriate identification of these patients. In this work, we define the utility of serum ammonia and liver biochemical tests (LFTs) in predicting hepatic HHT involvement and its complications. METHODS: We performed a retrospective study examining a well-characterized cohort of patients with HHT. Clinical characteristics, laboratory tests, liver imaging, transthoracic echocardiography assessment of right ventricular systolic pressure (RVSP), and history of other HHT-related outcomes were assessed. Patients were followed for the development of encephalopathy. RESULTS: Of 45 patients with definite HHT, 18 (40%) had elevated ammonia levels. An elevated ammonia associated with the presence of hepatic arteriovenous malformations (AVMs) on imaging (P < 0.03) and when combined with elevated liver tests increased the sensitivity for hepatic AVMs by 18% (55% for LFTs vs 73% for LFTs plus ammonia). Furthermore, an elevated serum ammonia in patients with HHT associated with an elevated RVSP (>35 mm Hg), providing an 80% sensitivity and 71% specificity for predicting the presence of pulmonary hypertension. In contrast, there was no association with an elevated serum ammonia and encephalopathy over a total of 859 months of follow-up. DISCUSSION: Elevated ammonia in a cohort of patients with HHT was associated with the presence of hepatic AVMs and elevated RVSP, but no other complications of HHT, including encephalopathy.

2.
Dig Dis Sci ; 65(1): 312-321, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31363954

RESUMO

BACKGROUND: Accurate prediction of outcomes for alcohol-associated hepatitis (AH) is critical, as prognosis determines treatment eligibility. Computed tomography (CT) features may provide prognostic information beyond traditional models. AIMS: Our aim was to identify CT features that predict outcomes in AH. METHODS: We studied 108 patients retrospectively with definite or probable AH, who underwent admission abdominal CT. A radiologist blinded to outcome evaluated eight CT features. The primary outcome was 90-day mortality. RESULTS: Twenty-five (23.2%) patients died within 90 days. While traditional prognostic tools, including Maddrey discriminant function (DF), predicted 90-day mortality (OR 1.01 [1.00, 1.03], P = 0.02), abdominal CT findings were also accurate predictors. On abdominal CT, patients with severe AH had larger volume of ascites (moderate/large volume: 34.0 vs. 8.2%, P < 0.0001), longer liver length (17.1 vs. 15.1 cm, P = 0.001), greater liver heterogeneity (moderate/severe: 21.3 vs. 8.2%, P = 0.007), and more likely to have splenomegaly (42.6 vs. 18.0%, P = 0.009) than those with mild AH. Univariate analysis revealed that ascites volume (OR 2.59 [1.35, 4.96], P = 0.004) predicted 90-day mortality. In multivariate analysis, degree of ascites predicted 90-day mortality when controlling for Maddrey DF (OR 2.36 [1.19, 4.69], P = 0.01) and trended toward significance when controlling for MELD score (OR 2.02 [0.95, 4.30], P = 0.07). CONCLUSION: CT findings in AH differentiate disease severity and predict 90-day mortality; therefore, the role of CT warrants further investigation as a tool in AH management.

3.
Cardiovasc Diagn Ther ; 9(Suppl 1): S97-S115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31559157

RESUMO

Innovations in surgical techniques coupled with advances in medical and pharmacological management in the past few decades have enabled organ transplantation to become integral to the management of end stage organ failure. In this review article, we will review the role of the radiologist in the work up of liver and pancreas donors during evaluation of their donor candidacy. The critical role of imaging in assessing the parenchymal, biliary and vascular anatomy in liver donor candidates will be reviewed, as well as highlighting the anatomical findings that may pose a contraindication to transplantation. The limited role of imaging in pancreas donor evaluation is also covered, as well as a brief overview of the surgical techniques available and how the radiologist's findings influence operative technique selection.

4.
Eur Radiol ; 29(12): 7080, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31297630

RESUMO

The original version of this article, published on 27 May 2019, unfortunately contained a mistake. The following correction has therefore been made in the original.

5.
J Urol ; 202(5): 944-951, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31144593

RESUMO

PURPOSE: There exists a growing debate as to whether multiparametric magnetic resonance imaging with fusion transrectal ultrasound guided prostate biopsy alone without a standard template biopsy is sufficient to evaluate patients with suspected prostate cancer. Our objective was to describe our experience with fusion targeted prostate biopsy and assess whether it could obviate the need for concomitant standard 12-core template prostate biopsy. MATERIALS AND METHODS: We retrospectively reviewed our prospectively collected database of patients who underwent fusion transrectal ultrasound guided prostate biopsy. All images and lesions were graded according to the Prostate Imaging Reporting and Data System, version 2. All patients underwent targeted biopsy followed by standard 12-core double sextant biopsy within the same session. Clinically significant prostate cancer was defined as Grade Group 2 or greater prostate cancer. RESULTS: A total of 506 patients were included in analysis. Indications were elevated prostate specific antigen with a previous negative prostate biopsy in 46% of cases, prostate cancer on active surveillance in 35%, elevated prostate specific antigen without a prior prostate biopsy in 15% and an isolated abnormal digital rectal examination in 3%. For standard vs fusion prostate biopsy the overall cancer detection rate was 57.7% vs 54.0% (p=0.12) and the clinically significant prostate cancer detection rate was 24.7% vs 30.8% (p=0.001). Of the 185 patients diagnosed with clinically significant prostate cancer 29 (16%) would have been missed if only targeted fusion prostate biopsy had been performed. CONCLUSIONS: Fusion targeted prostate biopsy is associated with a higher detection rate of clinically significant prostate cancer compared to standard double sextant biopsy. However, standard double sextant biopsy should still be performed as part of the routine fusion targeted prostate biopsy procedure to avoid missing a significant proportion of clinically significant prostate cancer.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Gradação de Tumores/métodos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico , Ultrassonografia de Intervenção/métodos , Idoso , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Eur Radiol ; 29(12): 6559-6570, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31134365

RESUMO

PURPOSE: To compare the effect of dual-energy CT (DECT) material density datasets on diagnostic performance, readers' confidence, and interpretation time for renal lesion detection and characterization in comparison to subtraction CT (SCT). MATERIAL AND METHODS: One hundred fourteen patients (69/45 = M/F, mean age = 67 years) who underwent contrast-enhanced DECT between January 2015 and February 2018 for suspected renal mass were included retrospectively. For each patient, three radiologists assessed three image datasets: group A, material density iodine (MDI) + material density water (MDW); group B, SCT only; and group C, SCT + true unenhanced phase + virtual monochromatic images at 65 keV. Readers evaluated image quality (4-point scale), the number of lesions, and likely diagnosis. Reading times were recorded. Quantitatively, iodine concentration (IC from MDI) and delta Hounsfield units (ΔHU) for all lesions were measured. Diagnostic accuracy was compared using the area under the receiver operating characteristic curve (AUC). Image quality and interpretation time were compared with Kruskal-Wallis and t tests. RESULTS: Study cohort (230 lesions; mean size = 23.63 mm (5-116 mm)) consisted of 60 enhancing, 158 non-enhancing, and 12 lipid-dominant angiomyolipoma lesions. Significantly higher image quality was demonstrated for MDI compared to SCT (mean score = 3.82 vs. 3; p < 0.05). Comparable diagnostic accuracy was observed for group A (AUC = 0.88) and group C (AUC = 0.87) and was higher compared to that for group B (AUC = 0.75). Group A was read faster than group C (41.49 s vs. 71.45 s per exam; p < 0.05). Both IC and ΔHU values had high accuracy (AUC = 0.97) for differentiating enhancing vs. non-enhancing lesions; however, IC enabled differentiation of clear cell renal cell carcinoma from other enhancing lesions with moderate accuracy (AUC = 0.73). CONCLUSION: MDI images increase readers' confidence for renal lesion detection and characterization while providing a more efficient radiologist workflow, irrespective of readers' experience. KEY POINTS: • Material density iodine (MDI) images enable faster interpretation due to high image quality and potentially reduced need for quantitation. • MDI images increase diagnostic confidence of readers, irrespective of radiologists' experience. • High accuracy with dual-energy CT (DECT) can potentially reduce healthcare costs by eliminating the need for additional investigations.


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 , Meios de Contraste , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Curva ROC , Intensificação de Imagem Radiográfica/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
8.
Gynecol Oncol ; 152(3): 568-573, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30642626

RESUMO

OBJECTIVE: A scoring system has been proposed to predict gross residual disease at primary debulking surgery (PDS) for advanced epithelial ovarian cancer. This scoring system has not been assessed in patients undergoing neoadjuvant chemotherapy (NACT). The aim of this study is to assess the reproducibility and prognostic significance of the scoring system when applied to women undergoing NACT followed by interval debulking surgery (IDS). METHODS: A retrospective cohort study was conducted of patients with advanced ovarian cancer who underwent NACT and IDS between 2005 and 2014. Change in tumor burden using computed tomography (CT) at diagnosis (T0) and after initiation of NACT but before IDS (T1) was independently assessed by two radiologists blinded to outcomes using two read criteria: a scoring system utilizing clinical and radiologic criteria and RECIST 1.1. Relationship between CT assessments to surgical outcome, progression free survival (PFS) and overall survival (OS) were evaluated. Reader agreement was measured using Fleiss's kappa (ĸ). RESULTS: 76 patients were analyzed. Optimal surgical outcome was achieved in 69 (91%) of patients. Median progression free survival was 13.2 months and overall survival was 32.6 months, respectively. Predictive score change from T0 to T1 of >1 (denoting an improvement in disease burden) was associated with optimal cytoreduction (p = 0.02 and 0.01 for readers 1 and 2, respectively). Neither predictive score nor RECIST 1.1 assessment was predictive of OS or PFS. Reader agreement was substantial for predictive score (κ = 0.77) and moderate for RECIST (κ = 0.51) assessments. CONCLUSIONS: A change in score before and after neoadjuvant chemotherapy minimizes reader variability and predicts surgical outcome.


Assuntos
Carcinoma Epitelial do Ovário/diagnóstico por imagem , Carcinoma Epitelial do Ovário/terapia , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/terapia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Epitelial do Ovário/tratamento farmacológico , Carcinoma Epitelial do Ovário/cirurgia , Quimioterapia Adjuvante , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
9.
Pediatr Radiol ; 48(9): 1273-1279, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30078049

RESUMO

MR enterography (MRE) has become the primary imaging modality for assessing Crohn disease in young patients because of its lack of ionizing radiation, superior soft-tissue contrast, and cross-sectional capability to evaluate disease activity as well as extraluminal and extra-intestinal complications. MRE has been extensively validated against both histological and endoscopic references as a noninvasive imaging biomarker of Crohn disease activity. More recent studies have also validated MRE as a noninvasive biomarker of mucosal healing, an important endpoint of Crohn disease therapy. In this review, we summarize the current evidence supporting the use of MRE features as imaging biomarkers of Crohn disease activity and treatment response.


Assuntos
Doença de Crohn/diagnóstico por imagem , Mucosa Intestinal/diagnóstico por imagem , Mucosa Intestinal/patologia , Imagem por Ressonância Magnética/métodos , Adolescente , Criança , Doença de Crohn/patologia , Doença de Crohn/terapia , Humanos , Cicatrização
11.
Clin Imaging ; 44: 22-26, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28407511

RESUMO

PURPOSE: To evaluate clinical and imaging features of pancreatic pseudocyst-portal vein fistula (PPVF). METHODS: Patients with evidence of PPVF on CT/MRI were included. Clinical presentation, outcomes, imaging appearance of the portal vein were recorded. RESULTS: 75% of patients developed portal hypertension, 62% cavernous transformation of the portal vein and 25% portal biliopathy. PPVF presented on CT as fluid-attenuated portal vein, and on MRI as T2-weighted hyperintense fluid-filled portal vein. PPVF was misdiagnosed as portal vein thrombosis in all patients who underwent CT as initial examination. CONCLUSIONS: Whenever PPVF is suspected on CT, MRI can be helpful to achieve accurate diagnosis and avoid unnecessary interventions.


Assuntos
Fístula Pancreática/diagnóstico , Pseudocisto Pancreático/patologia , Veia Porta/patologia , Fístula Vascular/diagnóstico , Adulto , Idoso , Erros de Diagnóstico , Feminino , Humanos , Hipertensão Portal/diagnóstico , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/complicações , Fístula Pancreática/diagnóstico por imagem , Fístula Pancreática/patologia , Pseudocisto Pancreático/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Ruptura Espontânea/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Fístula Vascular/complicações , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/patologia , Trombose Venosa/diagnóstico
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