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1.
Vet Clin North Am Food Anim Pract ; 37(1): 55-74, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33541702

RESUMO

Ultrasonography and radiography are the most frequently used imaging techniques to evaluate abdominal pathology in domestic animals. Ultrasonography can often achieve a diagnosis in small ruminants, with ease of use and virtually no contraindications. Radiography also provides a relatively comprehensive overview, but reduced penetration of the abdomen in larger animals and summation of abdominal organs can limit its diagnostic value. Computed tomography is a newer imaging modality that provides summation-free imaging but can have limited availability and financial restrictions.


Assuntos
Abdome/diagnóstico por imagem , Doenças das Cabras/diagnóstico por imagem , Doenças dos Ovinos/diagnóstico por imagem , Animais , Trato Gastrointestinal/diagnóstico por imagem , Cabras/anatomia & histologia , Fígado/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Ruminantes , Ovinos/anatomia & histologia , Baço/diagnóstico por imagem , Baço/patologia , Tomografia Computadorizada por Raios X/veterinária , Ultrassonografia/veterinária
2.
Medicine (Baltimore) ; 100(4): e24427, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530242

RESUMO

ABSTRACT: The quality control of fetal sonographic (FS) images is essential for the correct biometric measurements and fetal anomaly diagnosis. However, quality control requires professional sonographers to perform and is often labor-intensive. To solve this problem, we propose an automatic image quality assessment scheme based on multitask learning to assist in FS image quality control. An essential criterion for FS image quality control is that all the essential anatomical structures in the section should appear full and remarkable with a clear boundary. Therefore, our scheme aims to identify those essential anatomical structures to judge whether an FS image is the standard image, which is achieved by 3 convolutional neural networks. The Feature Extraction Network aims to extract deep level features of FS images. Based on the extracted features, the Class Prediction Network determines whether the structure meets the standard and Region Proposal Network identifies its position. The scheme has been applied to 3 types of fetal sections, which are the head, abdominal, and heart. The experimental results show that our method can make a quality assessment of an FS image within less a second. Also, our method achieves competitive performance in both the segmentation and diagnosis compared with state-of-the-art methods.


Assuntos
Feto/diagnóstico por imagem , Redes Neurais de Computação , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Ultrassonografia Pré-Natal/normas , Abdome/diagnóstico por imagem , Abdome/embriologia , Feminino , Coração Fetal/diagnóstico por imagem , Coração Fetal/embriologia , Cabeça/diagnóstico por imagem , Cabeça/embriologia , Humanos , Gravidez , Padrões de Referência
3.
Z Gastroenterol ; 59(2): 149-152, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33556974

RESUMO

We report the case of a 62-year-old Caucasian male patient who presented with epigastric pain to our outpatient clinic. On abdominal ultrasound we detected a 26 mm oval hypoechoic lesion in segment 2 of the left liver lobe. Performing contrast-enhanced ultrasound this lesion showed an arterial hypervascularization with centripetal filling and a spoke wheel pattern. Due to a hyperenhancement during the portal and late phase this lesion led to the diagnosis of a benign liver tumor, probably a hepatocellular adenoma (HCA). As focal nodular hyperplasia (FNH) was still another possible diagnosis, we decided to perform an MRI, which could not differentiate between HCA and hepatocellular carcinoma (HCC). Therefore, we performed liver biopsy of this lesion. Histology and immunohistochemistry led to the final diagnosis of intrahepatic splenosis. Reassessment of patient history revealed an abdominal trauma with splenic rupture 5 years ago. Intrahepatic splenosis should be considered as an important differential diagnosis in patients with unknown liver tumor and a history of splenic trauma.


Assuntos
Imagem por Ressonância Magnética , Esplenose/patologia , Abdome/diagnóstico por imagem , Adenoma de Células Hepáticas , Carcinoma Hepatocelular , Meios de Contraste , Diagnóstico Diferencial , Humanos , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia/métodos
4.
Acad Radiol ; 28(1): 58-67, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32094031

RESUMO

RATIONALE AND OBJECTIVES: To evaluate the quality and value of contrast-enhanced (CE) chest- and abdominal computed tomography (CT) and CT angiography in neonates, children, and adults undergoing extracorporeal membrane oxygenation (ECMO) using a customized protocol for contrast delivery. MATERIALS AND METHODS: All patients admitted for CE thoracic- and/or abdominal CT while on ECMO were prospectively included in the study. A protocol for contrast delivery adapted for the type of ECMO circulation, cannulation sites, anatomy of interest, and desired contrast phase was applied. Clinical information, ECMO and CT technique, including contrast administration strategy, was noted for each patient. Two radiologists separately evaluated the quality of the scan. The value of the examination was decided in consensus with the referring ECMO physician. RESULTS: One hundred thirty CE thoracoabdominal scans were performed at 103 different occasions during the study time. Eighty-nine scans were performed during veno-arterial ECMO and 41 during veno-venous ECMO. In the majority, contrast was delivered to the oxygenator with preserved ECMO flow. A peripheral or central venous line with reduced flow was utilized in the remaining cases. Mean scan quality was graded 4.2 on a five-grade scale. In 56% of the examinations, the findings affected the immediate treatment of the patient. CONCLUSION: High-quality CT and CT angiography can be achieved in ECMO patients of different ages and clinical issues considering the type of ECMO circulation, ECMO cannulation sites, preferred contrast phase and anatomy of interest. CT diagnoses affect the treatment of the patient.


Assuntos
Oxigenação por Membrana Extracorpórea , Abdome/diagnóstico por imagem , Adulto , Criança , Angiografia por Tomografia Computadorizada , Humanos , Recém-Nascido , Tórax , Tomografia Computadorizada por Raios X
5.
Br J Radiol ; 94(1117): 20200677, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33095654

RESUMO

OBJECTIVES: Modern reconstruction and post-processing software aims at reducing image noise in CT images, potentially allowing for a reduction of the employed radiation exposure. This study aimed at assessing the influence of a novel deep-learning based software on the subjective and objective image quality compared to two traditional methods [filtered back-projection (FBP), iterative reconstruction (IR)]. METHODS: In this institutional review board-approved retrospective study, abdominal low-dose CT images of 27 patients (mean age 38 ± 12 years, volumetric CT dose index 2.9 ± 1.8 mGy) were reconstructed with IR, FBP and, furthermore, post-processed using a novel software. For the three reconstructions, qualitative and quantitative image quality was evaluated by means of CT numbers, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in six different ROIs. Additionally, the reconstructions were compared using SNR, peak SNR, root mean square error and mean absolute error to assess structural differences. RESULTS: On average, CT numbers varied within 1 Hounsfield unit (HU) for the three assessed methods in the assessed ROIs. In soft tissue, image noise was up to 42% lower compared to FBP and up to 27% lower to IR when applying the novel software. Consequently, SNR and CNR were highest with the novel software. For both IR and the novel software, subjective image quality was equal but higher than the image quality of FBP-images. CONCLUSION: The assessed software reduces image noise while maintaining image information, even in comparison to IR, allowing for a potential dose reduction of approximately 20% in abdominal CT imaging. ADVANCES IN KNOWLEDGE: The assessed software reduces image noise by up to 27% compared to IR and 48% compared to FBP while maintaining the image information.The reduced image noise allows for a potential dose reduction of approximately 20% in abdominal imaging.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Doses de Radiação , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos , Abdome/diagnóstico por imagem , Adulto , Aprendizado Profundo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Razão Sinal-Ruído , Adulto Jovem
6.
BMJ Case Rep ; 13(12)2020 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310823

RESUMO

Here, we report a case of a 70-year-old man referred for an incidentally discovered left renal lesion with peri-aortic lymphadenopathy following a CT scan for back pain. A follow-up MRI scan demonstrated a Bosniak IIF left renal cyst and a T2-hyperintense para-aortic lesion concerning for extra-adrenal paraganglioma (EAP). [131I] Metaiodobenzylguanidine scintigraphy of the para-aortic lesion and urine catecholamines were equivocal. The mass was resected via a robotic approach. Histological examination revealed a haemangioma. Haemangiomas are benign vascular tumours frequently identified on imaging of the liver. Intra-abdominal haemangiomas outside of the liver, however, are rare and may have imaging characteristics that mimic EAP.


Assuntos
Hemangioma/patologia , Hemangioma/cirurgia , Imagem por Ressonância Magnética , Glomos Para-Aórticos/patologia , Abdome/diagnóstico por imagem , Idoso , Hemangioma/diagnóstico por imagem , Humanos , Achados Incidentais , Masculino , Paraganglioma Extrassuprarrenal/patologia , Cintilografia , Tomografia Computadorizada por Raios X
7.
J Korean Med Sci ; 35(43): e391, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169560

RESUMO

Since mid-April 2020, cases of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 that mimics Kawasaki disease (KD) have been reported in Europe and North America. However, no cases have been reported in Korea. We describe an 11-year old boy with fever, abdominal pain, and diarrhea who developed hypotension requiring inotropes in intensive care unit. His blood test revealed elevated inflammatory markers, thrombocytopenia, hypoalbuminemia, and coagulopathy. Afterward, he developed signs of KD such as conjunctival injection, strawberry tongue, cracked lip, and coronary artery dilatation, and parenchymal consolidation without respiratory symptoms. Microbiological tests were all negative including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction. However, serum immunoglobulin G against SARS-CoV-2 was positive in repeated tests using enzyme-linked immunosorbent assay and fluorescent immunoassay. He was recovered well after intravenous immunoglobulin administration and discharged without complication on hospital day 13. We report the first Korean child who met all the criteria of MIS-C with features of incomplete KD or KD shock syndrome.


Assuntos
Infecções por Coronavirus/patologia , Pneumonia Viral/patologia , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Abdome/diagnóstico por imagem , Anticorpos Antivirais/sangue , Betacoronavirus/genética , Betacoronavirus/imunologia , Criança , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Masculino , Síndrome de Linfonodos Mucocutâneos/patologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1624-1628, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018306

RESUMO

Abdominal fat quantification is critical since multiple vital organs are located within this region. Although computed tomography (CT) is a highly sensitive modality to segment body fat, it involves ionizing radiations which makes magnetic resonance imaging (MRI) a preferable alternative for this purpose. Additionally, the superior soft tissue contrast in MRI could lead to more accurate results. Yet, it is highly labor intensive to segment fat in MRI scans. In this study, we propose an algorithm based on deep learning technique(s) to automatically quantify fat tissue from MR images through a cross modality adaptation. Our method does not require supervised labeling of MR scans, instead, we utilize a cycle generative adversarial network (C-GAN) to construct a pipeline that transforms the existing MR scans into their equivalent synthetic CT (s-CT) images where fat segmentation is relatively easier due to the descriptive nature of HU (hounsfield unit) in CT images. The fat segmentation results for MRI scans were evaluated by expert radiologist. Qualitative evaluation of our segmentation results shows average success score of 3.80/5 and 4.54/5 for visceral and subcutaneous fat segmentation in MR images*.


Assuntos
Abdome , Cavidade Abdominal , Abdome/diagnóstico por imagem , Tecido Adiposo/diagnóstico por imagem , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X
11.
PLoS One ; 15(9): e0238582, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966278

RESUMO

OBJECTIVE: To compare "virtual" unenhanced (VUE) computed tomography (CT) images, reconstructed from rapid kVp-switching dual-energy computed tomography (DECT), to "true" unenhanced CT images (TUE), in clinical abdominal imaging. The ability to replace TUE with VUE images would have many clinical and operational advantages. METHODS: VUE and TUE images of 60 DECT datasets acquired for standard-of-care CT of pancreatic cancer were retrospectively reviewed and compared, both quantitatively and qualitatively. Comparisons included quantitative evaluation of CT numbers (Hounsfield Units, HU) measured in 8 different tissues, and 6 qualitative image characteristics relevant to abdominal imaging, rated by 3 experienced radiologists. The observed quantitative and qualitative VUE and TUE differences were compared against boundaries of clinically relevant equivalent thresholds to assess their equivalency, using modified paired t-tests and Bayesian hierarchical modeling. RESULTS: Quantitatively, in tissues containing high concentrations of calcium or iodine, CT numbers measured in VUE images were significantly different from those in TUE images. CT numbers in VUE images were significantly lower than TUE images when calcium was present (e.g. in the spine, 73.1 HU lower, p < 0.0001); and significantly higher when iodine was present (e.g. in renal cortex, 12.9 HU higher, p < 0.0001). Qualitatively, VUE image ratings showed significantly inferior depiction of liver parenchyma compared to TUE images, and significantly more cortico-medullary differentiation in the kidney. CONCLUSIONS: Significant differences in VUE images compared to TUE images may limit their application and ability to replace TUE images in diagnostic abdominal CT imaging.


Assuntos
Abdome/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Estudos Retrospectivos
12.
Emerg Med Clin North Am ; 38(4): 891-901, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32981624

RESUMO

Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax. Newer technologies such as resuscitative endovascular balloon occlusion of the aorta, selective aortic arch perfusion, and extracorporeal membrane oxygenation may improve outcomes, but remain primarily investigational.


Assuntos
Parada Cardíaca/terapia , Ferimentos e Lesões/complicações , Abdome/diagnóstico por imagem , Aorta , Oclusão com Balão , Serviço Hospitalar de Emergência , Oxigenação por Membrana Extracorpórea , Coração/diagnóstico por imagem , Parada Cardíaca/etiologia , Humanos , Guias de Prática Clínica como Assunto , Ressuscitação , Ordens quanto à Conduta (Ética Médica) , Toracotomia , Ultrassonografia
13.
Korean J Gastroenterol ; 76(3): 164-166, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32969365

RESUMO

The World Health Organization has declared novel coronavirus disease 2019 (COVID-19) a global public health emergency. Although respiratory symptoms predominate in COVID-19, thrombosis can occur in patients with COVID-19. This paper reports a case of an 82-year-old female with a prior medical history of hypertension, diabetes presenting with fever and cough, and was diagnosed with COVID-19. The patient subsequently developed progressively worsening of abdominal distention, tenderness, and underwent emergent laparotomy. She was found to have a gangrenous colon. This case adds to the limited literature regarding the extrapulmonary complications of COVID-19.


Assuntos
Colite/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Trombose Venosa/diagnóstico , Abdome/diagnóstico por imagem , Abdome/cirurgia , Doença Aguda , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Betacoronavirus/isolamento & purificação , Colite/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Feminino , Heparina/uso terapêutico , Humanos , Laparotomia , Necrose , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X , Trombose Venosa/complicações , Trombose Venosa/tratamento farmacológico
14.
Am J Trop Med Hyg ; 103(5): 1927-1929, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32959758

RESUMO

Visceral leishmaniasis (VL) is a systemic infection caused by the protozoal parasite Leishmania, spread via the bloodstream to the reticuloendothelial system, through the bite of the sand fly. It is endemic in parts of Africa, South America, Asia, and Europe, including the Mediterranean. Here, we describe a case of VL that was initially diagnosed as Q fever based on positive Coxiella burnetii serology and showed a partial response to doxycycline treatment.


Assuntos
Coxiella burnetii/imunologia , Doxiciclina/uso terapêutico , Leishmania donovani/imunologia , Leishmaniose Visceral/diagnóstico por imagem , Abdome/diagnóstico por imagem , Animais , Diagnóstico Diferencial , Hepatomegalia/diagnóstico por imagem , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/parasitologia , Masculino , Febre Q/diagnóstico por imagem , Esplenomegalia/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
BMC Bioinformatics ; 21(Suppl 13): 382, 2020 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-32938394

RESUMO

BACKGROUND: Introducing deep learning approach to medical images has rendered a large amount of un-decoded information into usage in clinical research. But mostly, it has been focusing on the performance of the prediction modeling for disease-related entity, but not on the clinical implication of the feature itself. Here we analyzed liver imaging features of abdominal CT images collected from 2019 patients with stage I - III colorectal cancer (CRC) using convolutional neural network (CNN) to elucidate its clinical implication in oncological perspectives. RESULTS: CNN generated imaging features from the liver parenchyma. Dimension reduction was done for the features by principal component analysis. We designed multiple prediction models for 5-year metachronous liver metastasis (5YLM) using combinations of clinical variables (age, sex, T stage, N stage) and top principal components (PCs), with logistic regression classification. The model using "1st PC (PC1) + clinical information" had the highest performance (mean AUC = 0.747) to predict 5YLM, compared to the model with clinical features alone (mean AUC = 0.709). The PC1 was independently associated with 5YLM in multivariate analysis (beta = - 3.831, P < 0.001). For the 5-year mortality rate, PC1 did not contribute to an improvement to the model with clinical features alone. For the PC1, Kaplan-Meier plots showed a significant difference between PC1 low vs. high group. The 5YLM-free survival of low PC1 was 89.6% and the high PC1 was 95.9%. In addition, PC1 had a significant correlation with sex, body mass index, alcohol consumption, and fatty liver status. CONCLUSION: The imaging features combined with clinical information improved the performance compared to the standardized prediction model using only clinical information. The liver imaging features generated by CNN may have the potential to predict liver metastasis. These results suggest that even though there were no liver metastasis during the primary colectomy, the features of liver imaging can impose characteristics that could be predictive for metachronous liver metastasis.


Assuntos
Abdome/diagnóstico por imagem , Neoplasias Colorretais/secundário , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Redes Neurais de Computação , Tomografia Computadorizada por Raios X/métodos , Neoplasias Colorretais/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pré-Operatório
16.
PLoS One ; 15(9): e0231431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881876

RESUMO

OBJECTIVE: To compare the radiation dose and the objective and subjective image quality of 80 kVp and 80/150 kVp with tin filter (80/Sn150 kVp) computed tomography (CT) in oncology patients. METHODS: One-hundred-and-forty-five consecutive oncology patients who underwent third-generation dual-source dual-energy CT of the abdomen for evaluation of malignant visceral, peritoneal, extraperitoneal, and bone tumor were retrospectively recruited. Two radiologists independently reviewed each observation in 80 kVp CT and 80/Sn150 kVp CT. Modified line-density profile of the tumor and contrast-to-noise ratio (CNR) were measured. Diagnostic confidence, lesion conspicuity, and subjective image quality were calculated and compared between image sets. The effective dose and size-specific dose estimate (SSDE) were calculated in the image sets. RESULTS: Modified line-density profile analysis revealed higher attenuation differences between the tumor and normal tissue in 80 kVp CT than in 80/Sn150 kVp CT (127 vs. 107, P = 0.05). The 80 kVp CT showed increased CNR in the liver (8.0 vs. 7.6) and the aorta (18.9 vs. 16.3) than the 80/Sn150 kVp CT. The 80 kVp CT yielded higher enhancement of organs (4.9 ± 0.2 vs. 4.7 ± 0.4, P<0.001) and lesion conspicuity (4.9 ± 0.3 vs. 4.8 ± 0.5, P = 0.035) than the 80/Sn150 kVp CT; overall image quality and confidence index were comparable. The effective dose was reduced by 45.2% with 80 kVp CT (2.3 mSv ± 0.9) compared to 80/Sn150 kVp CT (4.1 mSv ± 1.5). The SSDE was 7.4 ± 3.8 mGy on 80/Sn150 kVp CT and 4.1 ± 2.2 mGy on 80 kVp CT. CONCLUSIONS: The 80 kVp CT reduced the radiation dose by 45.2% in oncology patients while showing comparable or superior image quality to that of 80/Sn150 kVp CT for abdominal tumor evaluation.


Assuntos
Neoplasias/diagnóstico por imagem , Doses de Radiação , Intensificação de Imagem Radiográfica/instrumentação , Estanho , Tomografia Computadorizada por Raios X/instrumentação , Abdome/diagnóstico por imagem , Idoso , Algoritmos , Meios de Contraste/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
17.
AJR Am J Roentgenol ; 215(3): 706-712, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32755199

RESUMO

OBJECTIVE. The existing literature lacks research into the benefits of initial screening imaging for patients with cerebellar hemangioblastoma. We aimed to evaluate the diagnostic yield of initial screening imaging using abdominal CT and whole-spine MRI in patients with cerebellar hemangioblastoma. MATERIALS AND METHODS. This retrospective study included 117 consecutive patients with histopathologically confirmed, newly diagnosed cerebellar hemangioblastomas at a single tertiary hospital between January 2006 and October 2018. Patients underwent contrast-enhanced abdominal CT, whole-spine MRI, or both to detect abdominal and spinal lesions of von Hippel-Lindau disease. Diagnostic yields and false referral rates for initial screening imaging were determined. RESULTS. After exclusion of six patients who forewent any initial imaging, 111 patients were included (53 men [mean age ± SD, 51 ± 13 years] and 58 women [mean age, 43 ± 16 years]). The diagnostic yield of abdominal CT was 3.8% (4 of 105; 95% CI, 1.1-9.3%), whereas the false referral rate was 1.0% (1 of 105; 95% CI, 0.0-5.2%). For whole-spine MRI, the corresponding values were 5.6% (4 of 71; 95% CI, 1.6-13.8%) and 2.8% (2 of 71; 95% CI, 0.3-9.8%), respectively. The respective diagnostic yields in patients with a single cerebellar hemangioblastoma were both 0% (0 of 98 and 66, respectively). CONCLUSION. For patients with a single cerebellar hemangioblastoma, screening examinations with abdominal CT and whole-spine MRI are unnecessary before the results of genetic testing are available.


Assuntos
Abdome/diagnóstico por imagem , Neoplasias Cerebelares/diagnóstico por imagem , Hemangioblastoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença de von Hippel-Lindau/diagnóstico por imagem , Adulto , Meios de Contraste , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
PLoS One ; 15(8): e0237430, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841307

RESUMO

BACKGROUND & AIMS: Given ongoing challenges in non-invasive non-alcoholic liver disease (NAFLD) diagnosis, we sought to validate an ALT-based NAFLD phenotype using measures readily available in electronic health records (EHRs) and population-based studies by leveraging the clinical and genetic data in the Million Veteran Program (MVP), a multi-ethnic mega-biobank of US Veterans. METHODS: MVP participants with alanine aminotransferases (ALT) >40 units/L for men and >30 units/L for women without other causes of liver disease were compared to controls with normal ALT. Genetic variants spanning eight NAFLD risk or ALT-associated loci (LYPLAL1, GCKR, HSD17B13, TRIB1, PPP1R3B, ERLIN1, TM6SF2, PNPLA3) were tested for NAFLD associations with sensitivity analyses adjusting for metabolic risk factors and alcohol consumption. A manual EHR review assessed performance characteristics of the NAFLD phenotype with imaging and biopsy data as gold standards. Genetic associations with advanced fibrosis were explored using FIB4, NAFLD Fibrosis Score and platelet counts. RESULTS: Among 322,259 MVP participants, 19% met non-invasive criteria for NAFLD. Trans-ethnic meta-analysis replicated associations with previously reported genetic variants in all but LYPLAL1 and GCKR loci (P<6x10-3), without attenuation when adjusted for metabolic risk factors and alcohol consumption. At the previously reported LYPLAL1 locus, the established genetic variant did not appear to be associated with NAFLD, however the regional association plot showed a significant association with NAFLD 279kb downstream. In the EHR validation, the ALT-based NAFLD phenotype yielded a positive predictive value 0.89 and 0.84 for liver biopsy and abdominal imaging, respectively (inter-rater reliability (Cohen's kappa = 0.98)). HSD17B13 and PNPLA3 loci were associated with advanced fibrosis. CONCLUSIONS: We validate a simple, non-invasive ALT-based NAFLD phenotype using EHR data by leveraging previously established NAFLD risk-associated genetic polymorphisms.


Assuntos
Alanina Transaminase/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , 17-Hidroxiesteroide Desidrogenases/genética , Abdome/diagnóstico por imagem , Proteínas Adaptadoras de Transdução de Sinal/genética , Idoso , Alanina Transaminase/genética , Registros Eletrônicos de Saúde , Feminino , Loci Gênicos , Predisposição Genética para Doença , Variação Genética , Humanos , Lipase/genética , Fígado/patologia , Lisofosfolipase/genética , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/etnologia , Hepatopatia Gordurosa não Alcoólica/genética , Fenótipo , Fatores de Risco , Veteranos
19.
J Comput Assist Tomogr ; 44(5): 780-783, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842059

RESUMO

INTRODUCTION: Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP. CASES: Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids. CONCLUSIONS: Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.


Assuntos
Reação a Corpo Estranho/diagnóstico por imagem , Peritonite/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Verniz Caseoso , Abdome/diagnóstico por imagem , Adolescente , Adulto , Cesárea/efeitos adversos , Cistos/diagnóstico por imagem , Cistos/patologia , Cistos/cirurgia , Feminino , Reação a Corpo Estranho/patologia , Reação a Corpo Estranho/cirurgia , Humanos , Laparoscopia , Peritonite/patologia , Peritonite/cirurgia , Gravidez , Complicações na Gravidez/patologia , Complicações na Gravidez/cirurgia , Tomografia Computadorizada por Raios X , Verniz Caseoso/citologia , Verniz Caseoso/imunologia , Adulto Jovem
20.
J Comput Assist Tomogr ; 44(5): 766-771, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32842071

RESUMO

OBJECTIVE: The aim of this study was to evaluate the use of texture analysis for differentiation between benign from malignant adrenal lesions on contrast-enhanced abdominal computed tomography (CT). METHODS: After institutional review board approval, a retrospective analysis was performed, including an electronic search of pathology records for all biopsied adrenal lesions. Patients were included if they also had a contrast-enhanced abdominal CT in the portal venous phase. Computed tomographic images were manually segmented, and texture analysis of the segmented tumors was performed. Texture analysis results of benign and malignant tumors were compared, and areas under the curve (AUCs) were calculated. RESULTS: One hundred twenty-five patients were included in the analysis. Excellent discriminators of benign from malignant lesions were identified, including entropy and standard deviation. These texture features demonstrated lower values for benign lesions compared with malignant lesions. Entropy values of benign lesions averaged 3.95 using a spatial scaling factor of 4 compared with an average of 5.08 for malignant lesions (P < .0001). Standard deviation values of benign lesions averaged 19.94 on the unfiltered image compared with an average of 34.32 for malignant lesions (P < .0001). Entropy demonstrated AUCs ranging from 0.95 to 0.97 for discriminating tumors, with sensitivities and specificities ranging from 81% to 95% and 88% to 100%, respectively. Standard deviation demonstrated AUCs ranging from 0.91 to 0.94 for discriminating tumors, with sensitivities and specificities ranging from 73% to 93% and 86% to 95%, respectively. CONCLUSION: Texture analysis offers a noninvasive tool for differentiating benign from malignant adrenal tumors on contrast-enhanced CT images. These results support the further development of texture analysis as a quantitative biomarker for characterizing adrenal tumors.


Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Abdome/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/classificação , Glândulas Suprarrenais/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade
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