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1.
Bone Joint J ; 103-B(5): 822-827, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934642

RESUMO

Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article: Bone Joint J 2021;103-B(5):822-827.


Assuntos
Tomografia Computadorizada Quadridimensional , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/fisiopatologia , Doenças Musculoesqueléticas/diagnóstico por imagem , Doenças Musculoesqueléticas/fisiopatologia , Fenômenos Biomecânicos , Humanos
2.
Med Sci Monit ; 27: e929708, 2021 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-33839733

RESUMO

BACKGROUND Since the outbreak of COVID-19 in December 2019, there have been 96 623 laboratory-confirmed cases and 4784 deaths by December 29 in China. We aimed to analyze the risk factors and the incidence of thrombosis from patients with confirmed COVID-19 pneumonia. MATERIAL AND METHODS Eighty-eight inpatients with confirmed COVID-19 pneumonia were reported (31 critical cases, 33 severe cases, and 24 common cases). The thrombosis risk factor assessment, laboratory results, ultrasonographic findings, and prognoses of these patients were analyzed, and compared among groups with different severity. RESULTS Nineteen of the 88 cases developed DVT (12 critical cases, 7 severe cases, and no common cases). In addition, among the 18 patients who died, 5 were diagnosed with DVT. Positive correlations were observed between the increase in D-dimer level (≥5 µg/mL) and the severity of COVID-19 pneumonia (r=0.679, P<0.01), and between the high Padua score (≥4) and the severity (r=0.799, P<0.01). In addition, the CRP and LDH levels on admission had positive correlations with the severity of illness (CRP: r=0.522, P<0.01; LDH: r=0.600, P<0.01). A negative correlation was observed between the lymphocyte count on admission and the severity of illness (r=-0.523, P<0.01). There was also a negative correlation between the lymphocyte count on admission and mortality in critical patients (r=-0.499, P<0.01). Univariable logistic regression analysis showed that the occurrence of DVT was positively correlated with disease severity (crude odds ratio: 3.643, 95% CI: 1.218-10.896, P<0.05). CONCLUSIONS Our report illustrates that critically or severely ill patients have an associated high D-dimer value and high Padua score, and illustrates that a low threshold to screen for DVT may help improve detection of thromboembolism in these groups of patients, especially in asymptomatic patients. Our results suggest that early administration of prophylactic anticoagulant would benefit the prognosis of critical patients with COVID-19 pneumonia and would likely reduce thromboembolic rates.


Assuntos
/complicações , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Trombose Venosa/epidemiologia , Adulto , Idoso , Doenças Assintomáticas , /diagnóstico , China/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Índice de Gravidade de Doença , Ultrassonografia , Trombose Venosa/sangue , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia
3.
Am J Phys Med Rehabil ; 100(5): 419-423, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33819922

RESUMO

OBJECTIVE: The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN: This is a retrospective review. SETTING: The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS: The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS: A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES: Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS: A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS: The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.


Assuntos
/complicações , Hospitalização , Hospitais de Reabilitação , Trombose Venosa/diagnóstico , Trombose Venosa/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Doppler Dupla , Adulto Jovem
4.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(2): 332-336, 2021 Mar 04.
Artigo em Chinês | MEDLINE | ID: mdl-33879907

RESUMO

OBJECTIVE: To explore the technical details and short-term effects of radiofrequency obliteration of varicose veins of lower extremities guided by combined venography and ultrasound. METHODS: Thirty-seven patients with varicose veins of lower extremities were treated with radiofrequency obliteration using Olympus Celon RFiTT® under combined guidance of venography and ultrasound. The indications included varicose veins of lower extremities and reflux of the great saphenous vein confirmed by ultrasound. The contraindications included deep vein thrombosis, cardiac pacemaker, severe cardio- and cerebrovascular diseases or coagulation disorders. Under ultrasound guidance, the saphenous vein around knee level was punctured using a 21G needle, and a 7F sheath was introduced. Through the sheath a venography was made, and an Olympus Celon ProCurve radiofrequency catheter was inserted and advanced to the great saphenous vein under road map, and the catheter tip was positioned at the point 2 cm below the sapheno-femoral junction. The swelling anesthesia was made under ultrasound guidance. Then the radiofrequency obliteration was performed with pressing of the treatment section. The venography was repeated to ensure optimal outcomes. If necessary the radiofrequency obliteration could be repeated once to twice. After that the superficial varicose veins were stripping by small incisions under local anesthesia. After operation, medical decompression stocking was utilized immediately and sustained for three months. The clinical data, intraoperative radiation dose, exposure time and short-term effects were retrospectively analyzed. RESULTS: After the operation, all the patients walked out of the operating room by themselves. The success rate of operation was 100%. The intraoperative radiation dose was 1.78-10.12 mGy (mean 6.56 mGy), and the exposure time was 61-448 s (mean 161 s). By 3 months follow-up, the symptoms were alleviated in all the 37 patients, and the occlusion rate was 100%. No complications such as skin burns, ecchymosis and deep venous thrombosis were found. CONCLUSION: The short-term effects of radiofrequency obliteration using Olympus Celon RFiTT® system in a manner of twice fixed point followed by once reciprocating radiofrequency were satisfactory. Radiofrequency obliteration of great saphenous veins guided by venography and ultrasound has not only the advantages of minimal trauma and rapid recovery, but also the advantages of accurate location, exact effect and avoidance of complications.


Assuntos
Ablação por Cateter , Varizes , Humanos , Extremidade Inferior/diagnóstico por imagem , Flebografia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia , Varizes/diagnóstico por imagem , Varizes/cirurgia
5.
AJR Am J Roentgenol ; 216(5): 1273-1282, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655772

RESUMO

OBJECTIVE. The purpose of this study was to assess the effects of anatomic and technical factors on the long-term outcome of CT-guided lumbar sympathectomy in patients with chronic limb-threatening ischemia. SUBJECTS AND METHODS. Thirty patients (28 men, two women; mean age, 45.8 years) with chronic limb-threatening ischemia and diffuse tibial arterial disease not amenable to revascularization were included. CT-guided lumbar sympathectomy was performed at the L2-L3 level with a 22-gauge Chiba needle and absolute alcohol. Any periprocedural complication was noted. Numeric pain score (1-10 scale) and skin ulcers were assessed before the procedure and 3 weeks, 3 months, and 1 and 2 years after the procedure. According to spread of alcohol, patients were categorized into those with medial spread and those without medial spread (lateral spread group) with the lateral edge of the vertebral body as the reference point. Treatment results were categorized as improved, unchanged, or worsened on the basis of clinical response. RESULTS. There were 22 (73.3%) patients in the medial spread group and eight (26.7%) in the lateral spread group. The mean volumes of alcohol injected per side were not significantly different (p = .50). One major complication occurred in the group with medial spread. Mean numeric pain scores before the procedure and 3 weeks, 3 months, and 1 and 2 years afterward were 7.31, 2.95, 2.47, 2.10, and 2.04 in the medial spread group and 6.25, 4.13, 4.50, 4.35 and 4.32 in the lateral spread group (p < .001). At 2 years, 16 patients in the medial spread group and two patients in the lateral spread group showed clinical improvement (p < .001), and the limb salvage rates were 100% and 87.5%, respectively. Multivariate analysis showed a trend in improvement with smoking cessation, but the difference was not statistically significant (p = .15). The direction of spread of the neurolytic agent, however, was a major determinant of outcome. CONCLUSION. CT-guided lumbar sympathectomy is a simple, safe, and effective procedure. Ensuring medial spread of the neurolytic agent significantly improves long-term results.


Assuntos
Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/cirurgia , Radiografia Intervencionista/métodos , Simpatectomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/cirurgia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Eur Rev Med Pharmacol Sci ; 25(4): 2123-2130, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33660832

RESUMO

OBJECTIVE: Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate. PATIENTS AND METHODS: We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages. RESULTS: We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates. CONCLUSIONS: IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.


Assuntos
/complicações , Fibrinolíticos/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Trombose Venosa/prevenção & controle , Adulto , /diagnóstico por imagem , Cuidados Críticos/estatística & dados numéricos , Intervalo Livre de Doença , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Itália , Modelos Logísticos , Extremidade Inferior/diagnóstico por imagem , Análise Multivariada , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/mortalidade
7.
J Pediatr Orthop ; 41(3): e279-e284, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33528119

RESUMO

INTRODUCTION: Scurvy, or vitamin C deficiency, is rare. The goal of this study is to highlight the common risk factors and identify the orthopaedic presentation of scurvy in children. METHODS: A retrospective chart and radiograph review was performed of all patients consulted to the pediatric orthopaedic service from 2010 to 2019 who ultimately had the diagnosis of scurvy confirmed by an abnormally low serum vitamin C level. Data extracted included: patient age, sex, neurological conditions, prematurity, psychiatric conditions, dietary abnormalities, bone pain, arthritis, limb swelling, inability to walk, skin changes, child abuse evaluations, radiographic findings, additional vitamin deficiencies, lab studies, additional tests, response to treatment. Descriptive statistics were performed. RESULTS: Nine patients (7 males, 2 females) with scurvy were studied. The average age was 7 years (range 3 to 13 y). The average body mass index was 21.4 (range, 14 to 30). Five had autism, 2 had a neurological disorder. Two had been born premature. Two had a psychiatric disorder. Seven had an abnormal diet. One presented with bone pain. Four presented with limb swelling. Seven had unilateral and 2 had bilateral leg symptoms. Five presented with inability to walk. Six demonstrated skin changes with ecchymosis or petechiae. Three presented with gingival bleeding. Radiographic findings included subperiosteal hematoma in 2, ring epiphysis in 3, Pelkan spurs in 1, metaphyseal white lines (Frankel sign) in 6, and a metaphyseal zone of rarefaction (Trummerfeld zone) in 3. Seven had additional vitamin deficiencies including: A, B1, B6, B9, D, E, K, iron and zinc. Four had a bone marrow biopsy and 1 had lumbar puncture. All were anemic. The average erythrocyte sedimentation rate was 25.7 (range 6 to 35) and C-reactive protein was 1.5 (range 0.55 to 5.64). Six had a computed tomography, 3 had a magnetic resonance imaging. After treatment with vitamin C lasting 3.4 months (range, 2 wk to 7 mo), all symptoms gradually resolved, including leg pain and swelling. All children began to walk. CONCLUSION: The pediatric orthopaedic surgeon should have an increased awareness about the diagnosis of scurvy when consulted on a child with bone pain or inability to walk. The most common orthopaedic presentation was the refusal to bear weight, the most common radiographic finding was the metaphyseal line of increased density (Frankel sign) and treatment with vitamin c supplementation was excellent in all cases.


Assuntos
Ácido Ascórbico/administração & dosagem , Extremidade Inferior/diagnóstico por imagem , Escorbuto/diagnóstico por imagem , Escorbuto/epidemiologia , Vitaminas/administração & dosagem , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Suplementos Nutricionais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Dor Musculoesquelética , Ortopedia , Pennsylvania/epidemiologia , Radiografia , Estudos Retrospectivos , Fatores de Risco , Escorbuto/tratamento farmacológico , Escorbuto/etiologia , Ultrassonografia , Caminhada/fisiologia
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 188-194, 2021 Feb 15.
Artigo em Chinês | MEDLINE | ID: mdl-33624472

RESUMO

Objective: To discuss the feasibility and accuracy of distal femoral patient-specific cutting guide in total knee arthroplasty (TKA) based on knee CT and full-length X-ray film of lower extremities. Methods: Between July 2016 and February 2017, 20 patients with severe knee joint osteoarthritis planned to undergo primary TKA were selected as the research object. There were 9 males and 11 females; aged 53-84 years, with an average of 69.4 years. The body mass index was 22.1-31.0 kg/m 2, with an average of 24.8 kg/m 2. The preoperative range of motion (ROM) of the knee joint was (103.0±19.4)°, the pain visual analogue scale (VAS) score was 5.4±1.3, and the American Hospital of Special Surgery (HSS) score was 58.1±11.3. Before operation, a three-dimensional model of the knee joint was constructed based on the full-length X-ray film of lower extremities and CT of the knee joint. The distal femoral patient-specific cutting guide was designed and fabricated, and the thickness of the distal femoral osteotomy was determined by digital simulation. The thickness of the internal and external condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy were compared. The intraoperative blood loss, postoperative drainage loss, and hidden blood loss were recorded. The ROM of knee joint, VAS score, and HSS score at 3 months after operation were recorded to evaluate effectiveness. The position of the coronal and sagittal plane of the distal femoral prosthesis were assessed by comparing the femoral mechanical-anatomical angle (FMAA), anatomical lateral distal femoral angle (aLDFA), mechanical femoral tibial angle (mFTA), distal femoral flexion angle (DFFA), femoral prosthesis flexion angle (FPFA), anatomical lateral femoral component angle (aLFC), and the angle of the femoral component and femoral shaft (α angle) between pre- and post-operation. Results: TKA was successfully completed with the aid of the distal femoral patient-specific cutting guide. There was no significant difference between the thickness of the internal and lateral condyle of the distal femur osteotomy before operation and the actual thickness of the intraoperative osteotomy ( P>0.05). All patients were followed up 3 months. All incisions healed by first intention, and there was no complications such as periarticular infection and deep vein thrombosis. Except for 1 patient who was not treated with tranexamic acid, the intraoperative blood loss of the rest 19 patients ranged from 30 to 150 mL, with an average of 73.2 mL; the postoperative drainage loss ranged from 20 to 500 mL, with an average of 154.5 mL; and the hidden blood loss ranged from 169.2 to 1 400.0 mL, with an average of 643.8 mL. At 3 months after operation, the ROM of the knee was (111.5±11.5)°, and there was no significant difference when compared with the preoperative one ( t=-1.962, P=0.065). The VAS score was 2.4±0.9 and HSS score was 88.2±7.5, showing significant differences when compared with the preoperative ones ( t=7.248, P=0.000; t=-11.442, P=0.000). Compared with the preoperative measurements, there was a significant difference in mFTA ( P<0.05), and there was no significant difference in aLDFA, FMAA, or DFFA; compared with the preoperative plan, there was no significant difference in FPFA, aLFC, or α angle ( P>0.05). Conclusion: The use of distal femoral patient-specific cutting guide based on knee CT and full-length X-ray film of lower extremity can achieve precise osteotomy, improve coronal and sagittal limb alignment, reduce intraoperative blood loss, and obtain satisfactory short-term effectiveness.


Assuntos
Articulação do Joelho , Filme para Raios X , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
10.
J Pediatr Orthop ; 41(2): e116-e124, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33405465

RESUMO

BACKGROUND: Idiopathic toe walking (ITW) is a diagnosis of exclusion and represents a spectrum of severity. Treatment for ITW includes observation and a variety of conservative treatment methods, with surgical intervention often reserved for severe cases. Previous studies reviewing treatment outcomes are often difficult to interpret secondary to a mixture of case severity. The goal of this study was to review surgical outcomes in patients with severe ITW who had failed prior conservative treatment, as well as determine differences in outcomes based on the type of surgery performed. METHODS: After IRB approval, all patients with surgical management of severe ITW at a single institution were identified. Zone II or zone III plantar flexor lengthenings were performed in all subjects. Clinical, radiographic, and motion analysis data were collected preoperatively and at 1 year following surgery. RESULTS: Twenty-six patients (46 extremities) with a diagnosis of severe ITW from 2002 to 2017 were included. Zone II lengthenings were performed in 25 extremities (mean age=9.9 y) and zone III lengthenings were performed in 21 extremities (mean age=8.6 y). At the most recent follow-up, 100% of zone III lengthening extremities and 88% of zone II lengthening demonstrated decreased severity of ITW. Six extremities required additional treatment, all of which were initially managed with zone II lengthenings. CONCLUSIONS: Severe ITW or ITW that has not responded to conservative treatment may benefit from surgical intervention. More successful outcomes, including continued resolution of toe walking, were observed in subjects treated with zone III lengthenings. LEVEL OF EVIDENCE: Level III-case series.


Assuntos
Transtornos Neurológicos da Marcha/cirurgia , Marcha , Extremidade Inferior/cirurgia , Transtornos dos Movimentos/cirurgia , Procedimentos Ortopédicos/métodos , Adolescente , Criança , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Masculino , Procedimentos Ortopédicos/estatística & dados numéricos , Radiografia , Estudos Retrospectivos , Dedos do Pé , Resultado do Tratamento , Caminhada
11.
Eur J Radiol ; 136: 109528, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33450660

RESUMO

PURPOSE: The purpose of this study is to develop and evaluate a deep learning model to assist radiologists in classifying lower extremity arteries based on the degree of arterial stenosis caused by plaque in lower extremity computed tomography angiography (CTA) of patients with peripheral artery disease. METHODS: In this retrospective study, 265 patients who underwent lower-extremity CTA between January 1, 2016 and October 31, 2019 were selected. A total of 17050 axial images of iliac, femoropopliteal and infrapopliteal artery from these patients were used for the training and validation of the parallel efficient network (p-EffNet), a kind of supervised convolutional neural network, to classify the lower-extremity artery segments according to the degree of stenosis with digital subtraction angiography as reference standard. The classification results of the p-EffNet were then compared with those obtained from radiologists. Receiver operating characteristic curve (ROC) was used to evaluate the performance of the p-EffNet and accuracy, specificity, sensitivity and area under the curve (AUC) were used as measure metrics to compare the performance of the p-EffNet and that of radiologists. RESULTS: The p-EffNet exhibited a good performance of 91.5 % accuracy, 0.987 AUC and 90.2 % sensitivity and 97.7 % specificity in classifying above-knee artery and 90.9 % accuracy, 0.981 AUC, 91.3 % sensitivity and 95.2 % specificity in classifying below-knee artery. When compared with human readers, for both above-knee and below-knee artery, the p-EffNet had comparable accuracy (p = 0.266 and p = 0.808, respectively) and specificity (p = 0.118 and p = 0.971, respectively) but lower sensitivity (p < 0.001 and p = 0.022, respectively). CONCLUSIONS: The p-EffNet demonstrates promising diagnostic performance and has the potential to reduce the workload of radiologists and help to find the plaques that might otherwise have been missed or misjudged.


Assuntos
Angiografia por Tomografia Computadorizada , Aprendizado Profundo , Angiografia Digital , Constrição Patológica/diagnóstico por imagem , Humanos , Extremidade Inferior/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade
12.
AJR Am J Roentgenol ; 216(3): 776-780, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33474987

RESUMO

OBJECTIVE. Whole-body imaging extending from the vertex of the head to the toes is considered the standard 18F-FDG PET/CT protocol for Merkel cell carcinoma, though the evidence establishing this standard is scant. The purpose of this study was to investigate the clinical impact of PET/CT of the lower extremities in patients with Merkel cell carcinoma, a rare aggressive neuroendocrine tumor of the skin. MATERIALS AND METHODS. A total of 101 patients with Merkel cell carcinoma (mean age, 70.9 years) who underwent whole-body PET/CT were included. PET/CT findings in the lower extremities were evaluated on a per-patient basis, and the results were compared between patients with the primary lesion in the lower extremities (lower extremity primary) and those with the primary lesion located between the head and inguinal regions (body primary). Subsequent clinical evaluation and follow-up imaging were used as the reference standard. RESULTS. In the lower extremity (n = 22) and body (n = 79) primary groups, five and eight patients had true metastases in the lower extremities (p = .15). In the body primary group, all metastases in the lower extremities were part of widespread metastases in the body. In contrast, three of five patients (60%) in the lower extremity primary group had isolated metastases in the lower extremities, which differed significantly from the rate in the body primary group (p = .04). Subgroup analysis that included 48 patients who underwent initial staging examinations showed no metastases in the lower extremities regardless of primary location. CONCLUSION. PET/CT of the lower extremities for patients with body primary lesions of Merkel cell carcinoma should be considered of limited clinical utility.


Assuntos
Carcinoma de Célula de Merkel/diagnóstico por imagem , Fluordesoxiglucose F18 , Extremidade Inferior/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/diagnóstico por imagem , Idoso , Carcinoma de Célula de Merkel/secundário , Feminino , Humanos , Masculino , Estadiamento de Neoplasias/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Imagem Corporal Total
14.
Eur J Vasc Endovasc Surg ; 61(2): 280-286, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33309168

RESUMO

OBJECTIVE: While it is generally considered that patients with diabetes mellitus (DM) have more distal peripheral arterial disease (PAD), there is little information on how individual vessels are affected. The aim of this study was to adapt Bollinger's scoring system for lower limb angiograms (DSAs) to include the distal and planter vessels. The reliability of this extension was tested and was used to compare the distribution of disease in two cohorts of patients with and without DM. METHODS: Patients who had undergone DSA ± angioplasty for PAD at a single centre between September 2010 and April 2014 were identified. Twenty-five patients' images were reviewed by four clinicians and scored using an extended version of the Bollinger score. A total of 153 patients with DM were matched, for age, sex, ethnicity, smoking, and hypertension, with 153 patients without DM. The infrainguinal vessels were divided into 16 arterial segments, including plantar vessels, and scored using the Bollinger score. The score ranges from 0 to 15. Fifteen represents an arterial segment with more than 50% of its length occluded. Interobserver reliability was tested using interclass correlation (ICC) and Cohen's kappa coefficient. RESULTS: The ICC demonstrated good agreement between observers (0.76 [0.72-0.79]) with good internal consistency (Cronbach's alpha 0.93). When the Bollinger scores were categorised, the results were weaker, Cohen's kappa ranged from 0.39 (standard error 0.033) to 0.54 (0.030). Patients with DM had a higher burden of disease in the anterior tibial and posterior tibial arteries with relative sparing of the peroneal artery and no difference in the plantar vessels. CONCLUSION: It has been demonstrated that the Bollinger score can be extended to include the distal vessels. This amended scoring system can be used to compare the burden of distal disease in patients with PAD. How the score relates to clinical presentation and outcomes needs further investigation.


Assuntos
Angiografia Digital , Angiopatias Diabéticas/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Doença Arterial Periférica/diagnóstico por imagem , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Variações Dependentes do Observador , Doença Arterial Periférica/etiologia , Reprodutibilidade dos Testes
15.
Eur J Radiol ; 135: 109482, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33360825

RESUMO

PURPOSE: This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies. METHODS: The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb. RESULTS: The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. This leads to diverse clinical manifestations making them difficult to diagnose with traditional methods such as clinical examination and electrodiagnostic studies. Moreover, some of these may mimic other common conditions such as disc pain or fibromyalgia leading to delay in diagnosis and increasing morbidity. Addition of imaging improves the diagnostic accuracy and also help in correct treatment of these entities. Magnetic resonance imaging is very useful for deeply situated nerves in pelvis and thigh while ultrasound is well validated for superficial entrapment neuropathies. CONCLUSION: The rapidly changing concepts in these conditions accompanied by the advances in imaging has made it essential for a clinical radiologist to be well-informed with the current best practices.


Assuntos
Síndromes de Compressão Nervosa , Humanos , Extremidade Inferior/diagnóstico por imagem , Imagem por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Radiografia , Ultrassonografia
16.
J Comput Assist Tomogr ; 45(2): 232-237, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33369991

RESUMO

OBJECTIVE: The aims of this study were to evaluate image quality of virtual monoenergetic images (VMIs) compared with conventional images (CIs) from spectral detector CT (SDCT) and to explore the optimal energy level in run-off computed tomography angiography (CTA). METHODS: The data sets of 35 patients who received run-off CTA on the SDCT were collected in this retrospective study. Conventional images were generated via iterative reconstruction algorithm and VMI series from 40 to 120 keV were generated via spectral reconstruction algorithm. The objective indices including vascular attenuation, noise, signal-to-noise ratio, and contrast-to-noise ratio were compared. Two readers performed subjective evaluation using a 5-point scale. RESULTS: The attenuation showed higher values compared with CIs at 40 to 60 keV (P < 0.001). The noise was similar in 60- to 80-keV VMIs and significantly decreased in 90- to 120-keV VMIs (P < 0.001) in comparison with CIs. The signal-to-noise ratio and contrast-to-noise ratio were improved in 40- to 60-keV VMIs compared with CIs (P < 0.05). The score of subjective assessment was higher than that of CIs in 50- to 70-keV VMIs (P < 0.001). CONCLUSIONS: Virtual monoenergetic images can provide improved image quality compared with CIs from SDCT in run-off CTA, and VMIs at 60 keV may be the best choice in evaluating lower extremity arteries.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/normas , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Razão Sinal-Ruído
17.
J Orthop Surg Res ; 15(1): 605, 2020 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317585

RESUMO

OBJECTIVE: To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures. METHODS: Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. RESULTS: Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43-6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12-3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21-4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01-1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34-4.83; p = 0.004). CONCLUSION: These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.


Assuntos
Extremidade Inferior/irrigação sanguínea , Complicações Pós-Operatórias/epidemiologia , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Trombose Venosa/epidemiologia , Adulto , Fatores Etários , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Humanos , Hiponatremia , Incidência , Extremidade Inferior/diagnóstico por imagem , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fraturas da Tíbia/complicações , Fatores de Tempo , Ultrassonografia Doppler Dupla , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
18.
Medicine (Baltimore) ; 99(50): e23080, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327231

RESUMO

BACKGROUND: Head and neck tissue defects cause great physical and psychological damage to patients. Therefore, accurate positioning of perforating vessels before operation is of great significance for improving the success rate of flap preparation and avoiding unnecessary incision injury. METHODS/DESIGN: A total of 60 patients with laryngeal cancer in otolaryngology, Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University and the Third People's Hospital of Mianyang city from October 2020 to October 2021 will be selected and randomly divided into CT angiogram (CTA) group (n=20), mimics group (n = 20) and CTA + mimics group (n = 20) according to the numerical table. Patients in the CTA group will receive CTA examination of lower extremities. Patients in mimics group will receive digital technology in the positioning of perforator. Patients in CTA + mimics group will receive CTA + digital technology. All the patients will receive the flap cutting and the flap making; the doctor will determine the perforation branch of the flap with 3-D visual positioning, measure the preoperative indicators intraoperatively and complete the wound repair. Finally, the survival rate, sensitivity, specificity and accuracy of the flap will be measured. DISCUSSION: The anterolateral thigh flap has been widely used to repair various tissue defects and has obtained good clinical results. The extensive clinical application mainly focuses on 2 aspects, namely the study of vascular anatomy of lateral flap and the exploration of preoperative flap design technology. Perforator is the direct blood supply source of anterolateral thigh flap, so it is particularly important to study the anatomy of perforator. Therefore, this study will reveal CTA combined with digital technology in the vascular anatomy of the anterior external femoral flap and the design of the flap before and during surgery, so as to provide help for the repair of tissue defects. TRIAL REGISTRATION: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000038951), Registered on October 10th, 2020.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Laríngeas/complicações , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Adulto , Idoso , China/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imageamento Tridimensional/métodos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Taxa de Sobrevida , Coxa da Perna/irrigação sanguínea , Resultado do Tratamento
19.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 76(11): 1125-1132, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33229842

RESUMO

PURPOSE: Automated analysis of skeletal muscle in whole-body computed tomography (CT) images uses bone information, but bone segmentation including the epiphysis is not achieved. The purpose of this research was the semantic segmentation of eight regions of upper and lower limb bones including the epiphysis in whole-body CT images. Our targets were left and right upper arms, forearms, thighs, and lower legs. METHOD: We connected two 3D U-Nets in cascade for segmentation of eight upper and lower limb bones in whole-body CT images. The first 3D U-Net was used for skeleton segmentation in whole-body CT images, and the second 3D U-Net was used for eight upper and lower limb bones' segmentation in skeleton segmentation results. Thirty cases of whole-body CT images were used in the experiment, and the segmentation results were evaluated using Dice coefficient with 3-fold cross-validation. RESULT: The mean Dice coefficient was 93% in the left and right upper arms, 89% in the left and right forearms, 95% in the left and right thighs, and 94% in the left and right lower legs. CONCLUSION: Although the accuracy of the segmentation results of relatively small bones remains a challenge, the semantic segmentation of eight regions of upper and lower limb bones including the epiphysis in whole-body CT images has been achieved.


Assuntos
Semântica , Tomografia Computadorizada por Raios X , Osso e Ossos , Extremidade Inferior/diagnóstico por imagem
20.
Medicine (Baltimore) ; 99(43): e22935, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120851

RESUMO

RATIONALE: Recent research shows that in-stent restenosis (ISR) occurs in half of the patients treated with stenting of femoral and popliteal artery for lower extremity arteriosclerotic occlusive disease (LEASO). Combined therapy is mainly used clinically to obtain better medium- and long-term treatment outcomes and reduce the occurrences of reintervention, among which, the combination of excimer laser ablation (ELA) and drug eluting balloon (DEB) is a new and effective choice. PATIENT CONCERNS: A 76-year-old male patient with ISR of right superficial femoral artery after stent implantation was reported. DIAGNOSIS: Rechecking angiography indicated severe occlusion of the right superficial femoral artery. The physical examination showed that bilateral femoral and popliteal arteries were accessible whereas right dorsalis and posterior tibial arteries are unaccessible. Ankleolus brachial index (ABI) was 0.92 for left and 0.58 for right. INTERVENTIONS: We performed the operation with ELA and drug balloon DEB on the right superficial femoral artery under local anesthesia and treated with oral antiplatelet drugs after operation. OUTCOMES: The combination treatment was very successful, and postoperative lower extremity arteriogram showed the blood flow was fluent and fast. No recurrence was discovered 3 months after the operation and he had no obvious symptom of claudication. LESSONS: The combination of ELA and DEB is useful and effective for ISR of peripheral vessel after stent implantation, and this surgical method is worthwhile but need further clinical research for safety confirmation.


Assuntos
Angioplastia com Balão a Laser/métodos , Arteriopatias Oclusivas/etiologia , Lasers de Excimer/normas , Stents/efeitos adversos , Administração Oral , Idoso , Angiografia/métodos , Terapia Combinada , Constrição Patológica/etiologia , Stents Farmacológicos/normas , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Resultado do Tratamento
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