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1.
Eur Radiol ; 31(1): 55-64, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32725334

RESUMO

OBJECTIVES: The purpose of our study was to perform Gaussian mixture model (GMM)-based cluster analysis of the apparent diffusion coefficient (ADC) data of patients with endometrioid carcinoma, and to evaluate the relationship between histological grade and the ratios of the different clusters in each patient. METHODS: This retrospective study enrolled 122 patients (training: n = 63; and validation: n = 59) imaged between May 2015 and February 2020. In the training cohort, manual segmentation was performed on the ADC maps to obtain the ADC data of each patient, and these ADC data were summated to obtain the "All-patient" ADC data. Cluster analysis (three clusters) was performed on this All-patient ADC data, and the ADC ranges of each cluster were defined as follows: cluster 1, 490-699 × 10-6 mm2/s; cluster 2, 700-932 × 10-6 mm2/s; and cluster 3, over 933 × 10-6 mm2/s. In the training and validation cohorts, the ADC data of each patient was classified into three clusters according to these ADC ranges. The cluster ratios of each patient were calculated and compared with histological grade. RESULTS: In the training cohort, a significant positive correlation was found between the cluster 1 ratio and histological grade (ρ = 0.34, p = 0.0059). The cluster 1 ratios of high-grade lesions (grade 3) were significantly higher than those of low-grade lesions (grades 1 and 2) (p = 0.0084). A similar significant positive correlation was found between the cluster 1 ratio and histological grade in the validation cohort (ρ = 0.44, p = 0.0006). CONCLUSIONS: The cluster 1 ratio containing voxels with low ADC was significantly correlated with the histological grade of endometrioid carcinoma. KEY POINTS: • We performed Gaussian mixture model (GMM)-based cluster analysis of the apparent diffusion coefficient (ADC) data of patients with endometrioid carcinoma. • The cluster 1 ratio, which included low ADC values, was significantly positive correlated with histological grade in the training and validation cohorts. • The GMM-based cluster analysis of voxel-based ADC data was effective for grading endometrioid carcinoma.

2.
J Magn Reson Imaging ; 2020 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-33368773

RESUMO

Current contrast-enhanced magnetic resonance angiography (MRA) and non-contrast-enhanced balanced steady-state free precession (bSSFP) MRA cause susceptibility artifacts from metallic devices in assessing endovascular visceral-artery interventions. The aims of this study are to investigate and compare image quality (IQ) and susceptibility artifacts of three-dimensional (3D) ultrashort echo time (UTE) time-spatial labeling inversion pulse (Time-SLIP) with those of 3D bSSFP Time-SLIP and to assess denoising deep learning reconstruction (dDLR) for the improvement of the signal-to-noise ratio (SNR) in 3D UTE with sparse sampling in phantoms and human subjects. This is a prospective type of study. Pulsatile glycerin-water flow phantom with platinum-tungsten-alloy coil, stainless-steel, nitinol, and cobalt-alloy stents were used. Ten healthy volunteers (seven males) and three patients (two males) were included in this study. 3D UTE Time-SLIP and 3D bSSFP Time-SLIP at 3T were used. The phantom-based study compared the signal-intensity ratio of the device levels (SRdevice ) and distal segments (SRdistal ) to the proximal segments. The volunteer-based study measured SNR, contrast ratio (CR), and IQ. The patient study evaluated local artifacts from metallic devices. Statistical tests included paired t-tests, Wilcoxon-signed rank tests, and Kruskal-Wallis tests. In the phantom-based study, SRdevice was small with UTE Time-SLIP, except the stainless-steel stent. SRdistal was greater (49.1%-90.4%) on bSSFP images than UTE images (-11.1% to 9.6%). Among volunteers, dDLR in UTE images improved SNR (p < 0.05) and IQ (p < 0.05), but CR was unaffected. UTE Time-SLIP showed inferior SNR and IQ than bSSFP Time-SLIP in images with and without dDLR (p < 0.05 for each). However, among patients, UTE Time-SLIP showed reduced metal artifacts compared to bSSFP Time-SLIP. Irrespective of the lower SNR and IQ of 3D UTE Time-SLIP than those of 3D bSSFP Time-SLIP, the former appeared to better depict flow after stenting or coiling. This indicates the potential of 3D UTE Time-SLIP to provide suitable diagnostic images of target vessels. dDLR improved SNR with reducing artifacts related to radial sampling, while maintaining the contrast. LEVEL OF EVIDENCE: 2. TECHNICAL EFFICACY STAGE: 2.

3.
Int J Cardiol ; 2020 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-33309635

RESUMO

AIMS: In vasospastic angina (VSA), coronary vasomotion abnormalities could develop not only in epicardial coronary arteries but also in coronary microvessels, where calcium channel blockers (CCBs) have limited efficacy. However, efficacy of exercise training for VSA remains to be elucidated. We thus aimed to examine whether vasodilator capacity of coronary microvessels is impaired in VSA patients, and if so, whether exercise exerts beneficial effects on the top of CCBs. METHODS: We performed 2 clinical protocols. In the protocol 1, we measured myocardial blood flow (MBF) using adenosine-stress dynamic computed tomography perfusion (CTP) in 38 consecutive VSA patients and 17 non-VSA controls. In the protocol 2, we conducted randomized controlled trial, where 20 VSA patients were randomly assigned to either 3-month exercise training group (Exercise group) or Non-Exercise group (n= 10 each). RESULTS: In the protocol 1, MBF on CTP was significantly decreased in the VSA group compared with the Non-VSA group (138 ± 6 vs 166 ± 10 ml/100 g/min, P = 0.02). In the protocol 2, exercise capacity was significantly increased in the Exercise group than in the Non-Exercise group (11.5 ± 0.5 to 15.4 ± 1.8 vs 12.6 ± 0.7 to 14.0 ± 0.8 ml/min/kg, P < 0.01). MBF was also significantly improved after 3 months only in the Exercise group (Exercise group, 145 ± 12 to 172 ± 8 ml/100 g/min, P < 0.04; Non-Exercise group, 143 ± 14 to 167 ± 8 ml/100 g/min, P = 0.11), although there were no significant between-group differences. CONCLUSIONS: These results provide the first evidence that, in VSA patients, exercise training on the top of CCBs treatment may be useful to improve physical performance, although its effect on MBF may be minimal.

4.
Adv Radiat Oncol ; 5(6): 1170-1178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33305078

RESUMO

Purpose: The purpose of this prospective study was to evaluate radiation-induced myocardial damage after mediastinal radiation therapy (RT) using late gadolinium-enhancement (LGE) magnetic resonance imaging (MRI). Methods and Materials: We enrolled 19 patients with esophageal cancer who were expected to have long-term survival by definitive treatment. They underwent delayed contrast-enhanced MRI (19 patients before treatment, 19 patients 6 months after treatment, and 12 patients 1.5 years after treatment). Dose distribution of the left ventricle was made using computed tomography, and the dose volume histogram of the left ventricle was calculated. Myocardial signal intensities in individual MRIs were normalized by the mean values in regions receiving low doses (<5 Gy). Changes in the normalized signal intensities after mediastinal radiation therapy were compared among regions where irradiation doses were 0 to 10 Gy, 10 to 20 Gy, 20 to 30 Gy, 30 to 40 Gy, 40 to 50 Gy, and 50 to 60 Gy, and we investigated whether intensity change was detected in a dose-dependent manner. Results: The registered patients were treated with concurrent chemoradiotherapy with a median total dose of 60 Gy (50.4-66 Gy). Chemotherapy consisting of cisplatin and 5-fluorouracil was administered. In the population-based dose-response curve, dose-dependent intensity changes progressively increased in regions receiving more than 30 Gy. The averages of relative intensity change at 6 months and 1.5 years after treatment were 1.1% and -1.9% at 20 to 30 Gy and 37.5% and 17.5% at 40 to 50 Gy, respectively. LGE in regions receiving more than 30 Gy was detected in 68% (13/19) of the patients. Conclusions: A dose-dependent relationship for myocardial signal intensity change was found by using LGE MRI. It may be necessary to reduce the volume of the myocardium receiving more than 30 Gy.

5.
Endocr Connect ; 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33268573

RESUMO

OBJECTIVES: This study compared cardiac function, morphology, and tissue characteristics between two common subtypes of primary aldosteronism (PA) using a 3T MR scanner. DESIGN: A retrospective, single center, observational study. METHODS: We retrospectively reviewed 143 consecutive patients with PA, who underwent both adrenal venous sampling and cardiac magnetic resonance. We acquired cine, late gadolinium enhancement, and pre- and post-contrast myocardial T1-mapping images. RESULTS: PA was diagnosed as unilateral aldosterone-producing adenoma (APA) in 70 patients and bilateral hyperaldosteronism (BHA) in 73. The APA group showed significantly higher plasma aldosterone concentration (PAC) and aldosterone to renin rate (ARR) than the BHA group. After controlling for age, sex, antihypertensive drugs, systolic and diastolic blood pressure, and disease duration, the parameters independently associated with APA were: left ventricular end-diastolic volume index (EDVI: adjusted odds ratio [aOR] = 1.06 [95% CI: 1.030-1.096], p<0.01), end-systolic volume index (ESVI: 1.06 [1.017-1.113], p<0.01), stroke index (SI: 1.07 [1.020-1.121], p<0.01), cardiac index (CI: 1.001 [1.000-1.001], p<0.01), and native T1 (1.01 [1.000-1.019], p = 0.038). Weak positive correlations were found between PAC and EDVI (R = 0.28, p

6.
Sci Rep ; 10(1): 17024, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046736

RESUMO

Patients with pancreatic cancer have a poor prognosis, therefore identifying particular tumor characteristics associated with prognosis is important. This study aims to investigate the utility of radiomics with machine learning using 18F-fluorodeoxyglucose (FDG)-PET in patients with pancreatic cancer. We enrolled 161 patients with pancreatic cancer underwent pretreatment FDG-PET/CT. The area of the primary tumor was semi-automatically contoured with a threshold of 40% of the maximum standardized uptake value, and 42 PET features were extracted. To identify relevant PET parameters for predicting 1-year survival, Gini index was measured using random forest (RF) classifier. Twenty-three patients were censored within 1 year of follow-up, and the remaining 138 patients were used for the analysis. Among the PET parameters, 10 features showed statistical significance for predicting overall survival. Multivariate analysis using Cox HR regression revealed gray-level zone length matrix (GLZLM) gray-level non-uniformity (GLNU) as the only PET parameter showing statistical significance. In RF model, GLZLM GLNU was the most relevant factor for predicting 1-year survival, followed by total lesion glycolysis (TLG). The combination of GLZLM GLNU and TLG stratified patients into three groups according to risk of poor prognosis. Radiomics with machine learning using FDG-PET in patients with pancreatic cancer provided useful prognostic information.


Assuntos
Aprendizado de Máquina , Neoplasias Pancreáticas/diagnóstico por imagem , Idoso , Feminino , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
7.
Eur J Radiol Open ; 7: 100212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33102634

RESUMO

Pulmonary tumor thrombotic microangiopathy (PTTM) is a specific type of tumor embolism in the small and medium pulmonary arteries, leading to rapid progressive pulmonary hypertension. Antemortem diagnosis of PTTM is extremely difficult. We encountered three patients who were histopathologically or clinically diagnosed with PTTM. In all cases, lung perfused blood volume (PBV) images on dual-energy computed tomography (CT) demonstrated multiple subpleural wedge-shaped defects with no evidence of pulmonary embolism on CT pulmonary angiography. The lung PBV images demonstrated small pulmonary arterial obstruction reflecting the pathology of PTTM. Therefore, lung PBV imaging would be useful for antemortem diagnosis of PTTM.

8.
Abdom Radiol (NY) ; 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33037891

RESUMO

PURPOSE: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) parameters by region of interest (ROI) methods in differentiating mass-forming autoimmune pancreatitis (AIP) from pancreatic ductal adenocarcinoma (PDAC). METHODS: The institutional review board approved this retrospective study and the requirement for informed consent was waived. Twenty-three patients with mass-forming AIP and 144 patients with PDAC underwent diffusion-weighted imaging with b-values of 0 s/mm2 and 800 s/mm2. The minimum, maximum, and mean ADC values obtained by placing ROIs within lesions and percentile ADC values (10th, 25th, 50th, 75th, and 90th) from entire-lesion histogram analysis were compared between the two groups by using Mann-Whitney U tests. The diagnostic performance was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: The minimum, maximum, and mean ADC values were significantly different between mass-forming AIP and PDAC groups. ROC curve analysis showed that the maximum ADC had the highest diagnostic performance (0.92), while the minimum ADC value had the lowest diagnostic performance (0.72). The AUC of minimum ADC was significantly lower than that of maximum or mean ADC (P < 0.0001, P < 0.0001). The AUC was lowest in 10th percentile ADC value and highest in 90th percentile value. The AUC increased along with the increase of percentile values. CONCLUSION: Either the maximum or mean ADC value was effective in differentiating mass-forming AIP from the PDAC group, while the minimum ADC value might not be recommended.

9.
Radiol Case Rep ; 15(11): 2125-2128, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32944111

RESUMO

We describe treatment of a 53-year-old man with chronic hepatic encephalopathy. Contrast-enhanced computed tomography demonstrated a recanalized paraumbilical vein as a portosystemic shunt connecting the left branch of the portal vein and bilateral iliac veins. Percutaneous embolization was performed. The paraumbilical vein was punctured under ultrasonographic guidance; a 7-Fr sheath was inserted in the cranial direction. The hepatic side of the shunt was embolized with a vascular plug. The sheath direction was inverted to the caudal side; the pelvic side of the shunt was then embolized with another vascular plug. This report demonstrates that the percutaneous transparaumbilical venous approach is useful and safe for portosystemic shunt intervention. Moreover, the one-sheath inverse method was useful for embolization of upstream and downstream sides of the puncture site.

10.
Eur Radiol ; 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32902744

RESUMO

The original version of this article, published on 28 July 2020, unfortunately contained a mistake.

11.
Pancreatology ; 20(6): 1045-1055, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792253

RESUMO

BACKGROUND/OBJECTIVES: This paper is part of the international consensus guidelines on chronic pancreatitis, presenting for interventional endoscopy. METHODS: An international working group with experts on interventional endoscopy evaluated 26 statements generated from evidence on 9 clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the level of evidence. To determine the level of agreement, a nine-point Likert scale was used for voting on the statements. RESULTS: Strong consensus was obtained for 15 statements relating to nine questions including the recommendation that endoscopic intervention should be offered to patients with persistent severe pain but not to those without pain. Endoscopic decompression of the pancreatic duct could be used for immediate pain relief, and then offered surgery if this fails or needs repeated endoscopy. Endoscopic drainage is preferred for portal-splenic vein thrombosis and pancreatic fistula. A plastic stent should be placed and replaced 2-3 months later after insertion. Endoscopic extraction is indicated for stone fragments remaining after ESWL. Interventional treatment should be performed for symptomatic/complicated pancreatic pseudocysts. Endoscopic treatment is recommended for bile duct obstruction and afterwards surgery if this fails or needs repeated endoscopy. Surgery may be offered if there is significant calcification and/or mass of the pancreatic head. Percutaneous endovascular treatment is preferred for hemosuccus pancreaticus. Surgical treatment is recommended for duodenal stenosis due to chronic pancreatitis. CONCLUSIONS: This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis.

12.
Intern Med ; 2020 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-32830180

RESUMO

Angioplasty for cases of chronic total occlusion of renal artery with/without atrophic kidney is generally not recommended. We here report a 57-year-old man who presented with renin-mediated refractory hypertension caused by occlusion of a unilateral renal artery leading to kidney atrophy (length: 69 mm). Angioplasty favorably achieved blood pressure control with normalized renin secretion and enlargement of the atrophic kidney to 85 mm. Timely angioplasty can be beneficial in select patients, even with an atrophic kidney and total occlusion, especially in cases with deterioration of hypertension within six months and the presence of collateral perfusion to the affected kidney.

13.
Sci Rep ; 10(1): 11015, 2020 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-32620938

RESUMO

Irritable bowel syndrome (IBS) is a functional disorder of brain-gut interactions. Differential brain responses to rectal distention between IBS and healthy controls (HCs) have been demonstrated, particularly in the pain matrix and the default mode network. This study aims to compare resting-state functional properties of these networks between IBS patients and HCs using graph analysis in two independent cohorts. We used a weighted graph analysis of the adjacency matrix based on partial correlations between time series in the different regions in each subject to determine subject specific graph measures. These graph measures were normalized by values obtained in equivalent random networks. We did not find any significant differences between IBS patients and controls in global normalized graph measures, hubs, or modularity structure of the pain matrix and the DMN in any of our two independent cohorts. Furthermore, we did not find consistent associations between these global network measures and IBS symptom severity or GI-specific anxiety but we found a significant difference in the relationship between measures of psychological distress (anxiety and/or depressive symptoms) and normalized characteristic path length. The responses of these networks to visceral stimulation rather than their organisation at rest may be primarily disturbed in IBS.


Assuntos
Conectoma/métodos , Síndrome do Intestino Irritável/diagnóstico por imagem , Dor/diagnóstico por imagem , Estudos de Casos e Controles , Feminino , Humanos , Síndrome do Intestino Irritável/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Dor/fisiopatologia , Descanso , Adulto Jovem
14.
Seizure ; 80: 196-200, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32623354

RESUMO

PURPOSE: Post-stroke epilepsy (PSE) is a major late complication of cardioembolic cerebral infarction. However, few studies have examined the epileptogenicity and characteristics of first-occurrence cardioembolic cerebral infarctions. METHODS: This retrospective study included 93 consecutive patients with old cardioembolic cerebral infarctions who were classified into two groups based on their epileptic history: patients presenting with PSE or stroke without seizure (SWS). Each patient was diagnosed with an epileptic seizure subtype and treated with appropriate anti-epileptic therapy after admission. We evaluated clinical characteristics, laboratory results, and intracranial infarct areas. The sizes of these areas were measured using MRI diffusion-weighted image (DWI) of each patient after their first stroke. The volume was calculated by multiplying the total slice area with the slice thickness. RESULTS: PSE was diagnosed in 43 (46.2 %) of 93 patients. The mean (± SD) time from infarction onset to the first seizure in the PSE group was 22.5 ±â€¯31.6 months. The PSE group exhibited significantly more atrial fibrillation (p = 0.022) and higher glucose levels (p < 0.001) compared with the SWS group. The most common PSE seizure type was focal to bilateral tonic-clonic seizure (61.0 %). Although DWI did not reveal any significant differences in the volume of infarctions between the two groups, the involvement of the parietal lobe in infarction of the PSE group (69.8 %) upon first admission was significantly higher (p = 0.006) than that of the SWS group (40.0 %). Multiple logistic regression analysis revealed that parietal lobe involvement in infarction (OR 4.95; 95 % CI 1.25-19.60; p = 0.023) was a significant independent predictor of PSE. CONCLUSION: The involvement of the parietal lobe in infarction was a significant independent predictor of PSE. Dysfunction of the parietal lobe might play a critical role in the epileptogenesis of PSE.

15.
Jpn J Radiol ; 38(11): 1036-1045, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32710132

RESUMO

PURPOSE: To compare the accuracy of non-electrocardiogram (ECG)-gated CT angiography (CTA), single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA in detecting the intimal tear (IT) in aortic dissection (AD) and ulcer-like projection (ULP) in intramural hematoma (IMH). MATERIALS AND METHODS: A total of 81 consecutive patients with AD and IMH of the thoracic aorta were included in this single-center retrospective study. Non-ECG-gated CTA, single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA were used to detect the presence of the IT and ULP in thoracic aortic regions including the ascending aorta, aortic arch, and proximal and distal descending aorta. RESULTS: The accuracy of detecting the IT and ULP was significantly greater using full-phase ECG-gated CTA (88% [95% CI: 100%, 75%]) than non-ECG-gated CTA (72% [95% CI: 90%, 54%], P = 0.001) and single-diastolic-phase ECG-gated CTA (76% [95% CI: 93%, 60%], P = 0.008). CONCLUSION: Full-phase ECG-gated CTA is more accurate in detecting the IT in AD and ULP in IMH, than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA.

16.
Clin Nucl Med ; 45(7): e327-e328, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32433175

RESUMO

We present a case of a 38-year-old woman who complained with cough, fever, and back pain with a weight loss. F-FDG PET/CT to search fever origin revealed uptake in the tracheobronchial and the left auricular cartilage and wall of the thoracic aorta. She underwent biopsy of the left auricle and was diagnosed with relapsing polychondritis (RP) complicating vasculitis. After steroid therapy, FDG PET/CT demonstrated regression of inflammation, showing decreases in the uptakes. Vasculitis should be considered in case of RP with systemic manifestations. Our case demonstrated the utility of FDG PET/CT in evaluation of RP lesions including aortitis.


Assuntos
Fluordesoxiglucose F18 , Policondrite Recidivante/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Vasculite/complicações , Vasculite/diagnóstico por imagem , Adulto , Feminino , Humanos , Recidiva
17.
Hypertens Res ; 43(11): 1214-1221, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32444857

RESUMO

Renal artery stenosis causes kidney ischemia, reducing the size of the affected kidney, which eventually results in atrophy. Although renal atrophy is considered irreversible, resolution of the ischemia occasionally restores kidney size when the cause is renal artery stenosis. Angioplasty is effective in patients with nonatherosclerotic renovascular diseases (non-ARVDs). Nevertheless, renal enlargement after angioplasty has not been fully examined. We conducted a retrospective study to examine this phenomenon in non-ARVD patients. Ten patients with a <100-mm pole-to-pole length of the poststenotic kidney were treated with angioplasty. Data were collected up to 12 months after angioplasty. The mean age was 28 years; the estimated glomerular filtration rate was 92 ± 7 mL/min/1.73 m2 (mean ± SEM); blood pressure was 150/99 mmHg; 80% were women; and fibromuscular dysplasia was present in 90% of the patients. All patients had hypertension. The lengths of the poststenotic and contralateral kidney before angioplasty were 91 ± 1 and 111 ± 3 mm, respectively. After angioplasty, the length of the poststenotic kidney gradually increased during the 3 months after treatment (+5.4 mm) and that of the contralateral kidney decreased over the same time course (-3.7 mm). Enlargement was also found in the moderate atrophy subgroup (length < 92 mm), and it was greater in the <30 years old group. In a noteworthy case, renal size in the poststenotic kidney recovered from 87 to 102 mm after angioplasty. Our findings demonstrated that reduced renal size can be reversed after optimal angioplasty in non-ARVD patients, especially young patients, suggesting reversibility of the ischemic kidney.

18.
Radiol Case Rep ; 15(6): 757-760, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32300472

RESUMO

Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organ systems. Cerebral aneurysm formation is a rare central nervous system manifestation of SLE and tends to present as subarachnoid hemorrhage. Here, we report a 34-year-old woman with SLE complicated by a thrombosed aneurysm that had arose at the origin of a perforating artery, thereby causing obstruction of the artery and subsequent development of pontine infarction. Detailed examination of thin-slice CT and magnetic resonance imaging scans led to the correct diagnosis of uncommon cause of stroke.

19.
Magn Reson Med Sci ; 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32147641

RESUMO

PURPOSE: To compare the image quality between turbo spin-echo (TSE)-diffusion weighted imaging (DWI) and single-shot echo-planar imaging (EPI)-DWI, and to verify the diagnostic performance of the apparent diffusion coefficient (ADC) parameters of the two techniques by using histogram analysis in terms of differentiation between ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) lesions. METHODS: Ninety-four women with 94 lesions diagnosed as breast cancer by surgery underwent IRB-approved preoperative magnetic resonance imaging, including TSE and EPI-DWI with b-values of 50 and 850 s/mm2. Twenty lesions were identified as DCIS and 74 as IDC. Image quality [signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and geometric distortion] was evaluated quantitatively and compared between the TSE and EPI-DWI. A histogram analysis of the entire tumor voxel-based ADC data was performed, and the 10th, 25th, 50th, 75th, and 90th percentile values of each technique were compared between DCIS and IDC lesions. RESULTS: The SNR and CNR of TSE-DWI were significantly higher than those of EPI-DWI (P < 0.0001 and < 0.0001). The geometric distortion of TSE-DWI was significantly lower than that of EPI-DWI (P < 0.0001). In TSE-DWI, the 10th, 25th, 50th, and 75th percentile values were significantly different between the DCIS and IDC lesions (P = 0.0010, 0.0004, 0.0008, and 0.0044, respectively). In EPI-DWI, the 50th and 75th percentile values were significantly different between the two groups (P = 0.0009 and 0.0093). There was no significant difference in the area under the curve of the receiver operating characteristic analysis of the 10th, 25th, 50th, and 75th percentile values of TSE-DWI, and the 50th and 75th percentile values of EPI-DWI (P = 0.29). CONCLUSION: The image quality of TSE-DWI was better than that of EPI-DWI. DCIS lesions were distinguished from IDC lesions with a wider range of percentile values in TSE-DWI than in EPI-DWI, although diagnostic performance was not significantly different between the techniques.

20.
J Endocr Soc ; 4(2): bvaa004, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32099947

RESUMO

Because of its rarity, our understanding of steroidogenesis in estrogen-producing adrenocortical adenoma, including the response to adrenocorticotropic hormone (ACTH) stimulation, remains limited. A 65-year-old man was referred to us because of primary aldosteronism and a right adrenal tumor. Endocrinological evaluations revealed secondary hypogonadism due to hyperestrogenemia. Adrenal venous sampling (AVS) and subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) indicated bilateral hyperaldosteronism and a right estrogen-producing adrenocortical tumor. He subsequently underwent right unilateral adrenalectomy, which resulted in clinical remission of hypogonadism. Subsequent histopathological analysis identified a right estrogen-producing adrenocortical adenoma and multiple, concomitant adrenocortical micronodules. Sequential evaluation of steroid profiles using LC-MS/MS revealed unique hormone production, including adrenal androgens, and less responsiveness to ACTH in the right estrogen-producing adrenocortical adenoma as compared to the nonneoplastic adrenal cortex. This case study revealed unique profiles of steroid production in estrogen-producing adrenocortical adenoma associated with concomitant primary aldosteronism. Sequential steroid profiling analysis using LC-MS/MS in combination with AVS can contribute to the diagnosis of various adrenal disorders.

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