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1.
PLoS Negl Trop Dis ; 13(10): e0007762, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31584959

RESUMO

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis (LF) emphasizes hygiene, exercise, and other measures to reduce morbidity and disability related to LF. We recently reported that a portable, three-dimensional, infrared imaging system (3DIS) provides accurate limb volume measurements in patients with filarial lymphedema. To assess the practical utility of repeated 3DIS measurements for longitudinal lymphedema management, we examined intraday and day-to-day leg volume changes in adults with filarial lymphedema in southern Sri Lanka. METHODOLOGY AND PRINCIPAL FINDINGS: We assessed 41 participants with lower extremity lymphedema (stages 1-6) in their homes in the mornings (6:00-9:00 AM) and afternoons (2:00-6:00 PM) of three days within one calendar week. Two examiners performed replicate 3DIS volume measurements at each visit. Median coefficient of variation among replicate volume measurements was 1.7% (IQR 1.1% - 2.3%) for left legs and 2.2% (IQR 1.6% - 2.8%) for right legs. Median intraday volume increase was 3.0%. Range among daily volume measurements tended to be lower for afternoon measurements (median 2.25%, IQR 1.4%- 5.4%) than for morning measurements (median 3.0%, IQR 1.4% - 8.4%). CONCLUSIONS AND SIGNIFICANCE: Limb volume measurements by 3DIS are accurate and reproducible, and this technique is feasible for use in patients' homes. We have developed practical suggestions for optimal outcomes with 3DIS. Duplicate measurements should be performed and repeat assessments should be done at approximately the same time of day to minimize bias. Duplicate measures that vary by more than 8% should prompt review of scanning technique with a repeat measurement. With proper training and attention to technique, 3DIS can be a valuable tool for healthcare workers who work with lymphedema patients.


Assuntos
Filariose Linfática/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Imagem Tridimensional/métodos , Raios Infravermelhos , Adulto , Idoso , Extremidades/patologia , Feminino , Pessoal de Saúde/educação , Humanos , Perna (Membro)/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sri Lanka
2.
Vet Surg ; 48(8): 1372-1381, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31270830

RESUMO

OBJECTIVE: To report the feasibility of standing MRI (sMRI) and document the value of sMRI in surgical planning for surgical repair of limb fractures in the horse. STUDY DESIGN: Retrospective case series. ANIMALS: Thirty-one horses with preoperative sMRI. METHODS: Medical records were reviewed for fracture type, application of a polyester cast, sMRI sequences performed, technical variables, and image quality. Fracture geometry and concomitant lesions were compared between sMRI and radiography. The relative value of sMRI with regard to surgical planning was classified as minor (sMRI did not provide additional findings), intermediate (additional lesions found or slight modification to surgical plan), or major (sMRI led to significant alternations in surgical plan). RESULTS: Standing MRI provided good studies in all horses. Standing MRI was classified as having major relevance in 12 of 31 horses, intermediate relevance in 14 of 31 horses, and minor relevance in 5 of 31 horses. CONCLUSION: Preoperative sMRI produced good studies in all horses and influenced the surgical planning in the majority of fractures in this study. Application of a polyester cast seemed to improve comfort without appreciable loss of image quality. CLINICAL SIGNIFICANCE: Standing MRI can be considered as an adjunct to plan the repair of equine fractures, and a polyester cast does not impair image quality.


Assuntos
Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Doenças dos Cavalos/cirurgia , Cavalos/lesões , Imagem por Ressonância Magnética/veterinária , Animais , Moldes Cirúrgicos/classificação , Moldes Cirúrgicos/veterinária , Extremidades/diagnóstico por imagem , Extremidades/patologia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Doenças dos Cavalos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Radiografia/veterinária , Estudos Retrospectivos
3.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
J Nippon Med Sch ; 86(4): 230-235, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31061252

RESUMO

BACKGROUND: Patients undergoing dialysis have a high incidence of fracture, and early diagnosis is important. We report seven cases of closed rib or upper-limb fractures diagnosed by bedside ultrasonography during maintenance hemodialysis sessions and describe relevant clinical characteristics. CASE PRESENTATION: We identified seven patients who were injured by falls in their homes. No injuries occurred on the day of dialysis. Five of the 7 patients did not visit the emergency room. All patients complained of persistent unexplained pain during a regular hemodialysis session. Ultrasonography (US) was performed during dialysis sessions, without any reports of pain. Before US evaluation, the sensitivity of radiography for diagnosis of fracture was 25%, while the sensitivity of US was 100%. Compared with other patients in our clinic, these patients were significantly older and had lower serum albumin concentrations and lower hemodialysis efficiency as determined by Kt/V. They also had a higher incidence of diabetes and a greater need for vasopressors during dialysis. These findings were consistent with the results of previous studies of the characteristics of fractures in dialysis patients. However, blood levels of creatinine, corrected calcium, phosphate, intact parathyroid hormone, and hemoglobin, as well as bone density and blood pressure, after the previous dialysis session were not different. CONCLUSIONS: To our knowledge, this is the first report of closed fracture of superficial bone diagnosed by bedside ultrasonography during a hemodialysis session. Ultrasonography is especially useful for diagnosis in these cases because it is noninvasive and highly accurate. Doctors should determine the differential diagnosis for closed fracture in patients undergoing dialysis, especially in those who are older, have diabetes, and are malnourished, and in those with recent contusions and persistent pain.


Assuntos
Extremidades/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas Fechadas/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Diálise Renal , Fraturas das Costelas/diagnóstico por imagem , Ultrassonografia/métodos , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Insuficiência Renal Crônica/terapia , Sensibilidade e Especificidade
5.
ACS Appl Mater Interfaces ; 11(17): 15298-15305, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30977992

RESUMO

The difficulty of near-infrared (NIR) ratiometric detection imaging lies in the lack of high-efficiency NIR probes and the overlapping interference between two emission peaks. To achieve more accurate detection in living organisms, dual NIR-emissive luminescent nanoprobes were designed under the same excitation at 808 nm. The Er3+ ion-doped nanoparticles were employed as a reference with their fluorescence emission at 1525 nm. Meanwhile, a cyanine dye molecule (Cy925) was combined on the surface of nanoparticles as the ClO- recognition site with its NIR emission at 925 nm. The ratiometric nanoprobe relied on the ratio of aforementioned two separated NIR peaks ( I925nm/ I1525nm), featuring deeper imaging penetration depth and low autofluorescence. This nanoprobe was verified to be sensitive and highly selective to ClO- through photoluminescence titration. The in vitro detection experiment developed reasonable work curves, guaranteeing that we can detect the change in concentration of ClO- in mice limbs with arthritis through in vivo imaging experiments.


Assuntos
Corantes Fluorescentes/química , Ácido Hipocloroso/análise , Nanopartículas/química , Animais , Articulação do Tornozelo/diagnóstico por imagem , Artrite/induzido quimicamente , Artrite/diagnóstico por imagem , Carbocianinas/química , Extremidades/diagnóstico por imagem , Feminino , Fluoretos/química , Ácido Hipocloroso/química , Camundongos , Camundongos Endogâmicos BALB C , Espectroscopia de Luz Próxima ao Infravermelho , Ítrio/química
6.
J Comput Assist Tomogr ; 43(3): 386-391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30920424

RESUMO

OBJECTIVE: The aim of the study was to assess the value of cinematic rendering (CR) from volumetric computed tomography data in evaluating the relationship between deep soft tissue sarcomas (STSs) of the extremities and the adjacent major vessels. METHODS: Preoperative contrast-enhanced axial imaging (CEAI) in the arterial phase with three-dimensional volume rendering (VR) and CR of contrast-enhanced computed tomography were used to assess adjacent vascular invasion in 43 cases of deep STSs of the extremities. The imaging assessments were compared with surgical findings and interpreted as negative (no vascular invasion) or positive (vascular invasion was present). Intrareader and interreader agreement were assessed using Cohen κ statistics. The diagnostic performance of CEAI, VR, and CR was evaluated by receiver operating curve analysis and compared using the DeLong test. RESULTS: Thirty-four and nine cases were classified as negative and positive, respectively, in surgery. Intrareader agreement values for the CEAI, VR, and CR assessments were all excellent (0.984, 0.934, and 0.914, respectively), whereas the interreader agreement for CEAI assessments was greater than that for VR and CR (0.969 vs 0.804 and 0.761). Cinematic rendering showed lower accuracy (0.698), sensitivity (0.778), specificity (0.676), positive predictive values (0.389), and negative predictive values (0.920) for vascular invasion diagnosis than CEAI or VR; the accuracy, sensitivity, specificity, positive predictive values, and negative predictive values increased to 0.767, 0.889, 0.735, 0.471, and 0.962 for both CEAI and VR. The results were not statistically significant (all P > 0.05). CONCLUSIONS: Cinematic rendering has the potential to be used to evaluate vascular invasion in cases of deep STSs of the extremities, but it should be used alongside the traditional methods such as CEAI.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Extremidades/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Adulto , Idoso , Extremidades/diagnóstico por imagem , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
7.
Injury ; 50(3): 777-783, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30772050

RESUMO

INTRODUCTION: This is a retrospective study that evaluate the outcome of patients with extremity sarcoma between extramedullary plate and intramedullary nailing for the biological reconstruction after tumor resection. METHODS: 58 patients (40 treated with plate fixation and 18 with intramedullary nailing, IM group) with sarcomas of the lower and upper extremity who received biological reconstruction at our bone tumor center from November 2003 to November 2015 were reviewed for the study. There were 29 male and 29 female patients with a mean age of 20.8 years (range, 5-72 years). The mean follow-up duration was 90.8 months (range, 12.2-244.4 months). All data were obtained from the clinical, radiograph records and follow-up information. The analysis of outcome, survival, local recurrence, function and complications of patients in the plate group and IM group was performed. RESULTS: 28 cases in the plate group lived at the last follow-up, of which 26 had no evidence of disease, 2 lived with the pulmonary metastasis, whereas 15 in the IM group lived at the last follow-up, of which all had no evidence of disease and no lived with the pulmonary metastasis. There was no significant difference between the two groups for the prognosis. Meanwhile, there was no significant difference of incidence of nonunion, graft fracture and fixation breakage between the two groups, whereas the time to diaphysis union in the plate group (11.6 ± 2.7 months) was shorter than that in IM group (14.7 ± 4.8 months, P = 0.015). It had the tendency that the time to mechanical complications in the intramedullary nailing group (38.1 ± 39.6 months) was longer than that in the plate group (15.7 ± 13.4 months, P = 0.058,95% CI,-45.6-0.8). Furthermore, the infection occurred in 12 cases and five grafts of them developed the deep infection and the mean time to deep infection was 14.8 ± 20.5 months. Furthermore, the incidence of local recurrence for the patients who had plate fixation was similar to the incidence of patients who had nailing fixation. At the last follow-up, the functional evaluation was performed for 39 patients. There was no significant difference in MSTS and VAS functional score for patients between in the plate group (n = 32) and IM group (n = 7). CONCLUSIONS: The findings of the present study showed that intramedullary nailing does not improve the union rate or decrease the incidence of mechanical complications for patients with extremity sarcoma after biological reconstruction. However, intramedullary nailing may have potential advantages on the service life for the biological reconstruction after extremity sarcoma resection.


Assuntos
Extremidades/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Espontâneas/cirurgia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Pinos Ortopédicos , Placas Ósseas , Criança , Extremidades/diagnóstico por imagem , Extremidades/patologia , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radiografia , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Resultado do Tratamento , Adulto Jovem
8.
Can Assoc Radiol J ; 70(1): 13-22, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30691557

RESUMO

PURPOSE: To explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting. METHODS: A retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist. RESULTS: A total of 4556 CT scans were performed in the emergency department over a 1-year period. A total of 3.6% of all-comers to our emergency departments underwent CT scan as part of their investigation. There were 2107 head CTs (46%), 1296 (28%) abdominal CTs, 468 (10%) CTs of the chest, 408 (9%) CTs of the neck/spine, and 101 (2%) extremity CTs performed. The most common clinical indication for performing a CT head was focal neurological defect comprising 1534 (73%) of all CT heads. Twenty-four percent of abdominal CTs were for investigation of right lower quadrant pain, followed by flank pain (19%). Chest pain and shortness of breath were the most common indications for CTs of the chest (315 [75%]) with 10% of these examinations for this indication positive for pulmonary embolism. Trauma was the most common indication for neck CTs (296 [73%]) and extremities (70 [69%]). Nil acute was the most common final interpretation in all categories (79% CT heads, 75% neck CTs, 38% abdominal CTs, 43% chest CTs). CONCLUSIONS: Nil acute was the most common diagnosis; however, serious clinical outcomes were identified 40% of the time. Cross-sectional imaging remains an integral tool for triage and diagnosis in this environment as the cost of missing a diagnosis in this setting has a great impact on patient care.


Assuntos
Centros Médicos Acadêmicos , Serviço Hospitalar de Emergência , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Abdome/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Dispneia/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Coração/efeitos dos fármacos , Humanos , Pulmão/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Dor/diagnóstico por imagem , Estudos Retrospectivos
9.
IEEE Trans Neural Syst Rehabil Eng ; 27(2): 207-217, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30676967

RESUMO

Ultrasound is a cost-effective, readily available, and non-ionizing modality for musculoskeletal imaging. Though some research groups have pursued methods that involve submerging the transducer and imaged body segment into a water bath, many limitations remain in regards to acquiring an unloaded volumetric image of an entire human limb in a fast, safe, and adequately accurate manner. A 3D dataset of a limb is useful in several rehabilitative applications including biomechanical modeling of soft tissue, prosthetic socket design, monitoring muscle condition and disease progression, bone health, and orthopedic surgery. This paper builds on previous work from our group and presents the design, prototyping, and preliminary testing of a novel multi-modal imaging system for rapidly acquiring volumetric ultrasound imagery of human limbs, with a particular focus on residual limbs for improved prosthesis design. Our system employs a mechanized water tank setup to scan a limb with a clinical ultrasound transducer and 3D optical imagery to track motion during a scan. The iterative closest point algorithm is utilized to compensate for motion and stitch the images into a final dataset. The results show preliminary 2D and 3D imaging of both a tissue-mimicking phantom and residual limbs. A volumetric error compares the ultrasound image data obtained to a previous MRI method. The results indicate potential for future clinical implementation. Concepts presented in this paper could reasonably transfer to other imaging applications such as acoustic tomography, where motion artifact may distort image reconstruction.


Assuntos
Amputação , Extremidades/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Ultrassonografia/métodos , Adulto , Artefatos , Membros Artificiais , Fenômenos Biomecânicos , Calibragem , Eletromiografia , Humanos , Imagem Tridimensional , Imagem por Ressonância Magnética , Masculino , Movimento (Física) , Desenho de Prótese , Tíbia/diagnóstico por imagem
10.
J Ultrasound Med ; 38(1): 91-96, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29708283

RESUMO

OBJECTIVES: In this study, we retrospectively reviewed the clinical and sonographic features of patients with trichilemmal cysts. METHODS: Sonographic findings of 54 cases of trichilemmal cysts were retrospectively analyzed from 50 patients, including 4 cases of proliferating trichilemmal cysts. Associated factors of internal calcification-positive cases were also evaluated. RESULTS: The mean age of the 50 patients was 43.4 years (range, 15-80 years) and the female-to-male ratio was 1.3. Overall, 68% of the trichilemmal cysts in the 54 lesions were located in the scalp, and 15% were located in the extremities. All 54 lesions were preoperatively examined by sonography and showed well-defined, oval-shaped structures located in subcutaneous soft tissues close to the dermis. Of the 54 lesions, 72% were hypoechoic masses, 89% were heterogeneous, and 65% had internal calcification. Among the internal calcification-positive cases, the mean age of the patients was 43.4 years, and the female-to-male ratio was 0.6. Of these lesions, 83% were located in the scalp. We did not find any significant association between calcification, age, or sex (P = .993 and P = .99); however, lesions present in the scalp were significantly associated with internal calcification (P = .005). 81% of the 54 lesions displayed posterior enhancement. but the color Doppler sonography of all lesions revealed no vascularization. CONCLUSIONS: Trichilemmal cysts should be considered to diagnose of well-defined, hypoechoic lesions with internal calcification and posterior sound enhancement in the subcutaneous soft tissues of the scalp or extremities upon sonography.


Assuntos
Cisto Epidérmico/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Extremidades/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Couro Cabeludo/diagnóstico por imagem , Ultrassonografia/métodos , Adulto Jovem
11.
Muscle Nerve ; 59(1): 88-94, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30144318

RESUMO

INTRODUCTION: We evaluated the reliability of measuring muscle thickness with ultrasound in limbs and diaphragms of critically ill children and determined the sensitivity of these measures to quantitate muscle atrophy over time. METHODS: An expert and trained novice sonographers prospectively measured limb and diaphragm muscle thickness in 33 critically ill children. RESULTS: Expert and novice intrarater and interrater reliability were similar. Intraclass correlations (ICC) and coefficients of variation (CoV) were better in limbs (ICC > 0.9; CoV 3.57%-5.40%) than in diaphragm (ICC > 0.8; CoV novice 11.88%, expert, 12.28%). Mean relative difference in all muscles was small (1%-8%). Limits of agreement of the relative difference were smaller in limb (<13%-18%) than in diaphragm (<38%) muscles. DISCUSSION: Muscle thickness is reliably measured with ultrasound by trained examiners in critically ill children. Our approach detects atrophy >13% in limb and >38% in diaphragm muscles. The smaller detectable change in limb muscles is likely due to their greater thickness. Muscle Nerve 59:88-94, 2019.


Assuntos
Estado Terminal , Diafragma/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Ultrassonografia , Adolescente , Criança , Pré-Escolar , Extremidades/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Tamanho do Órgão/fisiologia , Reprodutibilidade dos Testes
12.
J Ultrasound Med ; 38(5): 1201-1208, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30208227

RESUMO

OBJECTIVES: The purpose of this study was to describe the features of angioleiomyomas of the extremities on ultrasonography (US) and magnetic resonance imaging (MRI). METHODS: We retrospectively reviewed the US and MRI findings of 29 pathologically confirmed cases of angioleiomyomas of the extremities in 29 patients. Twenty patients underwent only US; 7 patients underwent only MRI; and 2 patients underwent US and MRI. Clinical data and histopathologic specimens were reviewed. RESULTS: There were 19 women and 10 men. The mean patient age was 48.9 years (range, 23-80 years). On US, angioleiomyomas were located primarily in the subcutaneous fat layer (n = 20 [91%]), were oval (n = 17 [77%]), had well-circumscribed margins (n = 22 [100%]), had hypoechoic protrusions on one or both ends (n = 9 [41%]), had a homogeneous echo texture (n = 17 [ 77%]), had posterior acoustic enhancement (n = 20 [91%]), and had color Doppler flow (n = 20 [91%]). On MRI, the masses showed heterogeneous enhancement (n = 7 [88%]) and enhancing structures on one or both ends (n = 4 [50%]) on contrast-enhanced T1-weighted images. CONCLUSIONS: Angioleiomyoma of the extremities is usually a well-circumscribed oval mass with a homogeneous echo texture and occasionally hypoechoic protrusions on US and shows heterogeneous enhancement with occasionally enhancing structures on one or both ends of the mass on MRI. Therefore, it should be included in the differential diagnosis of a soft tissue mass that has protruding structures from one or both ends.


Assuntos
Angiomioma/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
13.
Eur J Surg Oncol ; 45(2): 268-274, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30352764

RESUMO

INTRODUCTION: The role of MRI in surveillance for local recurrence (LR) remains uncertain in extremity soft tissue sarcoma (STS). The aims of this study were 1) to examine the usefulness of MRI in detecting LR, 2) to identify the characteristics of LR detected by MRI, and 3) to examine whether MRI surveillance is associated with oncologic outcome. MATERIALS AND METHODS: 477 patients who had regular surveillance for LR after surgery for extremity STS were reviewed. Surveillance was performed by routine MRI in 325 patients or other imaging modalities in 152 patients. RESULTS: The rate of MRI-detected LR, defined as clinically undetectable LR identified on MRI, was 10.5% in the MRI surveillance cohort. The detection rates of MRI-detected LR were significantly higher in the patients with high risk of LR. MRI-detected LRs were more commonly located in the thigh or buttock (p = 0.005), were smaller (p = 0.001) and had LRs without mass formation (p = 0.007) than non-MRI-detected LRs. On Kaplan-Meier analysis, patients with MRI-detected LR tended to have better post-LR survival (p = 0.104). CONCLUSION: Routine MRI surveillance can detect a significant number of clinically undetectable LRs in extremity STS especially for LRs in the thigh or buttock, small LRs or LRs without mass formation.


Assuntos
Extremidades/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/diagnóstico por imagem , Estudos Retrospectivos , Sarcoma/cirurgia
14.
Skeletal Radiol ; 48(4): 517-525, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30341712

RESUMO

BACKGROUND: Following the thalidomide disaster (1958-62), Henkel and Willert analysed the pattern of dysmelia in the long bones (J Bone Joint Surg Br. 51:399-414, 1969) and the extremities, Willert and Henkel (Z Orthop Ihre Grenzgeb. 107:663-75, 1970). Willert's material from deformed extremities is re-examined here asking "How does thalidomide reduce the skeleton?" MATERIALS AND METHODS: We reviewed the original data collection of Willert and Henkel (Z Orthop Ihre Grenzgeb. 107:663-75, 1970), comprising musculoskeletal histology slides from 30 children affected by thalidomide with radiographs of hands (19 cases) and feet (4 cases). RESULTS: All original observations by Willert and Henkel (Z Orthop Ihre Grenzgeb. 107:663-75, 1970), were verified. Radial rays of the hand disappeared early, but the foot was spared until late. Radiology confirms that bone reduction in the hand (aplasia or hypoplasia in the thumb and index finger) coincides with sensory segmental nerve C6. In the foot, reduction of the toes is rare, but mesenchymal excess (polydactyly) occurs in the hallux (L5 sclerotome), usually associated with absent tibia (L4 sclerotome). Histology confirms skeletal mesenchymal components to be unremarkable, contrasting with grossly abnormal bony architecture, a striking discordance between microscopic and macroscopic findings. No necrosis or vascular pathology was seen. CONCLUSION: The basic lesion was an abnormal quantity rather than quality of mesenchyme. Cell populations result from cellular proliferation, controlled in early limb bud formation by neurotrophism. Thalidomide is a known sensory neurotoxin in adults. In the embryo, sensorineural injury alters neurotrophism, causing increased or diminished cell proliferation in undifferentiated mesenchyme. Differentiation into normal cartilage occurs later, but within an altered mesenchymal mass. Reduction or excess deformity results, with normal histology, a significant finding. The primary pathological condition is not in the skeleton, but in the nerves.


Assuntos
Anormalidades Induzidas por Medicamentos/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Deformidades Congênitas dos Membros/induzido quimicamente , Deformidades Congênitas dos Membros/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Talidomida/efeitos adversos , Anormalidades Induzidas por Medicamentos/embriologia , Anormalidades Induzidas por Medicamentos/etiologia , Extremidades/embriologia , Extremidades/inervação , Humanos , Recém-Nascido
15.
Pract Radiat Oncol ; 9(2): 115-122, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30447405

RESUMO

PURPOSE: Many authors suggest that extremity soft tissue sarcomas (ESTS) do not change significantly in size during preoperative radiation therapy (RT). This cone beam computed tomography study investigates the justification to deliver the entire course with 1 initial RT plan by observing anatomic changes during RT. METHODS AND MATERIALS: Between 2015 and 2017, 99 patients with ESTS were treated with either curative (n = 80) or palliative intent (n = 19) with a regimen of at least 6 fractions. The clinical target volume to planning target volume margin was 1 cm. Action levels were assigned by radiation technicians. An extremity contour change of >1 cm and/or tumor size change >0.5 cm required a physician's action before the next fraction. RESULTS: A total of 982 cone beam computed tomography logfiles were studied. In 41 of 99 patients, the dose coverage of the initial treatment plan was fully satisfactory throughout the RT course. However, action levels were observed in 58 patients (59%). In 41 of these 58 patients, a contour increase of 5 to 23 mm was noted (29 tumor size increase only, 3 extremity contour increase, and 9 both). In 21 of 58 patients, a decrease of 5 to 33 mm was observed (20 tumor size decrease only and 1 tumor size decrease and extremity contour decrease). In 4 cases, contours initially increased and subsequently decreased. In 33 of 41 patients with increasing contours, the dose distribution adequately covered gross tumor volume because of the 1 cm planning target volume margin applied. For the remaining 8 patients (8%), the plan needed to be adapted. CONCLUSIONS: ESTS volumes may change substantially during RT in 59% of all patients, leading to plan adaptations resulting from increased volumes in 8%. Daily critical observation of these patients is mandatory to avoid geographic misses because of increases in size and overdosing of normal tissues when masses shrink.


Assuntos
Planejamento da Radioterapia Assistida por Computador/métodos , Sarcoma/radioterapia , Neoplasias de Tecidos Moles/radioterapia , Carga Tumoral/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomografia Computadorizada de Feixe Cônico , Extremidades/diagnóstico por imagem , Extremidades/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Órgãos em Risco/diagnóstico por imagem , Órgãos em Risco/efeitos da radiação , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia
16.
Ultrasound Med Biol ; 45(2): 605-611, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30553585

RESUMO

Approximately 6.3 million fractures occur each year in the United States alone. Accurately monitoring the progression of fracture healing is essential to be able to advise patients when it is safe to return to normal activity. The most common method used to confirm and monitor fracture healing is the acquisition of multiple radiographic images over the many months required for healing. This imaging method uses large expensive equipment and exposes patients to high levels of ionizing radiation. In the study described here, we tested another technology for monitoring fracture healing that could minimize the need for multiple radiographic images. We tested a piezoelectric transducer fixed to the surface of a bone that uses electromechanical impedance spectroscopy to measure simulated fractures and transmits the measurement data to an acoustic receiver located externally on the skin surface.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Processamento de Sinais Assistido por Computador , Ultrassonografia/métodos , Animais , Modelos Animais de Doenças , Extremidades/diagnóstico por imagem , Extremidades/lesões , Suínos
17.
Equine Vet J ; 51(1): 20-23, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29931725

RESUMO

BACKGROUND: The diagnostic value of positive contrast radiography in the work-up of suspected synovial infection in horses with limb wounds near synovial structures has yet to be systematically evaluated. OBJECTIVES: To determine the specificity, sensitivity and positive and negative predictive values of positive contrast radiography for identification of synovial infection in a population of horses with limb wounds. STUDY DESIGN: Retrospective case study comparing the performance of positive contrast radiography to the gold standard of synovial fluid cytology in horses presenting with limb wounds in the vicinity of synovial structures. METHODS: Case records of horses presenting to the Royal Veterinary College Equine Hospital between 2010 and 2015 with limb wounds that may have compromised adjacent synovial structures were analysed. Synovial fluid cytology results were used to categorise synovial structures in infected and noninfected groups. Positive contrast radiography results were compared between infected and noninfected groups and sensitivity, specificity, positive and negative predictive values were calculated. RESULTS: Fifty horses with 66 synovial structures were included in the study. Positive contrast radiography had a high specificity (86.4%), but only a moderate sensitivity (59.1%) for the identification of synovial infection. In addition, a low positive predictive value (68.4%) and high negative predictive value (80.9%) were observed in this population of horses. MAIN LIMITATIONS: Sensitivity, specificity and predictive values may differ between different synovial structures and cases. Different conclusions may be drawn from the results in a single population. Sensitivity and specificity of positive contrast radiography may also be influenced by different techniques used by examiners and by inherent characteristics of individual cases. CONCLUSIONS: Positive contrast radiography should be used for the investigation of potential synovial infection in horses with limb wounds, particularly if no synovial fluid sample for laboratory analysis can be obtained. However, it appears that positive contrast radiography is best used in combination with other tests to ensure that a correct and timely diagnosis is made.


Assuntos
Extremidades/lesões , Cavalos/lesões , Membrana Sinovial/diagnóstico por imagem , Sinovite/veterinária , Animais , Contagem de Células/veterinária , Meios de Contraste/administração & dosagem , Extremidades/diagnóstico por imagem , Valor Preditivo dos Testes , Proteínas/análise , Radiografia/veterinária , Estudos Retrospectivos , Sensibilidade e Especificidade , Líquido Sinovial/química , Líquido Sinovial/citologia , Líquido Sinovial/diagnóstico por imagem , Membrana Sinovial/lesões , Sinovite/diagnóstico por imagem , Sinovite/etiologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico por imagem , Ferimentos e Lesões/veterinária
18.
Psychiatr Danub ; 31(Suppl 5): 814-820, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32160177

RESUMO

BACKGROUND: Critical limb ischemia (CLI) represents the end stage of peripheral arterial disease (PAD). It is defined as a chronic ischemic rest pain, ulcers or gangrene, attributable to proven arterial occlusive disease. Intra-arterial digital subtraction angiography (IA DSA) still represents the gold standard for the evaluation of steno-occlusive lesions, but it has greatly been replaced with non-invasive multi-detector computed tomography angiography (MDCTA). The purpose of this prospective study was to compare diagnostic performance of MDCTA versus DSA in treatment planning in patients with CLI according to TransAtlantic Inter-Society Consensus Document on Management of Peripheral Arterial disease (TASC II). SUBJECTS AND METHODS: The study was designed as prospective; it was conducted from March 2014 to August 2016, and included 60 patients with symptoms of CLI, Fontaine stage III and IV. MDCTA of the peripheral arteries was performed first, followed by DSA. The lesions of aorto-iliac, femoro-popliteal and infra-popliteal regions were classified according to the TASC II guidelines, and inter-modality agreement between MDCTA and DSA was determined by using Kendall's tau-b statistics. RESULTS: Inter-modality agreement was statistically significant in all three vascular beds, with excellent agreement >0.81 in aortoiliac and femoropopliteal regions, and a very good agreement >0.61 in infrapopliteal region. Treatment recommendations based on MDCTA findings and DSA findings were identical in 54 (90%) patients. In one patient (1.7%), CTA was not interpretable. In five patients (8.3%), CTA findings disagreed with DSA findings in regard to the preferable treatment option. CONCLUSION: 64-row MDCT angiography is highly competitive to DSA in evaluation of steno-occlusive disease and treatment planning in patients with critical limb ischemia.


Assuntos
Angiografia Digital , Angiografia por Tomografia Computadorizada/instrumentação , Extremidades/diagnóstico por imagem , Extremidades/patologia , Isquemia/diagnóstico por imagem , Isquemia/terapia , Doenças Vasculares Periféricas/complicações , Idoso , Feminino , Humanos , Isquemia/complicações , Isquemia/patologia , Masculino , Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/patologia , Doenças Vasculares Periféricas/terapia , Estudos Prospectivos , Sensibilidade e Especificidade
19.
Nan Fang Yi Ke Da Xue Xue Bao ; 38(11): 1331-1337, 2018 Nov 30.
Artigo em Chinês | MEDLINE | ID: mdl-30514681

RESUMO

OBJECTIVE: To establish a cone beam computed tomography (ECBCT) system for high-resolution imaging of the extremities. METHODS: Based on three-dimensional X-Ray CT imaging and high-resolution flat plate detector technique, we constructed a physical model and a geometric model for ECBCT imaging, optimized the geometric calibration and image reconstruction methods, and established the scanner system. In the experiments, the pencil vase phantom, image quality (IQ) phantom and a swine feet were scanned using this imaging system to evaluate its effectiveness and stability. RESULTS: On the reconstructed image of the pencil vase phantom, the edges were well preserved with geometric calibrated parameters and no aliasing artifacts were observed. The reconstructed images of the IQ phantom showed a uniform distribution of the CT number, and the noise power spectra were stable in multiple scanning under the same condition. The reconstructed images of the swine feet had clearly displayed the bones with a good resolution. CONCLUSIONS: The ECBCT system can be used for highresolution imaging of the extremities to provide important imaging information to assist in the diagnosis of bone diseases.


Assuntos
Tomografia Computadorizada de Feixe Cônico/instrumentação , Desenho de Equipamento , Extremidades/diagnóstico por imagem , Imagens de Fantasmas , Intensificação de Imagem Radiográfica/instrumentação , Algoritmos , Animais , Artefatos , Calibragem , Tomografia Computadorizada de Feixe Cônico/métodos , Processamento de Imagem Assistida por Computador/métodos , Intensificação de Imagem Radiográfica/métodos , Suínos
20.
AJR Am J Roentgenol ; 211(6): 1390-1396, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30300008

RESUMO

OBJECTIVE: The objective of this study was to identify differences between venous malformations (VMs) with arteriovenous (AV) microshunts and VMs without AV microshunts. MATERIALS AND METHODS: In this retrospective study, 83 patients with untreated VMs of the extremities underwent a prospectively defined MRI protocol performed at 3 T. MR images were reviewed to determine localization and extent of each VM and tissue involvement. The VM volume and the lesion volume relative to body surface were measured. The number of phleboliths within the lesions was determined. Using time-resolved MR angiography, the hemodynamic subtype (VM with AV microshunts versus VM without AV microshunts) was classified, and the interval between the onset of arterial enhancement and lesion enhancement (tonset) was measured. Clinical data were reviewed to determine patient demographic characteristics, the onset of symptoms, the frequency of thrombophlebitis, and the pain score. RESULTS: Of the 83 patients, 56 (67%) presented with AV microshunts. The tonset (p ≤ 0.001), absolute and relative lesion volume (p = 0.001), and number of phleboliths (p = 0.038) differed significantly between these two subgroups. With use of a multivariable regression model, the strongest indicator for VM with AV microshunts was the presence of more than two phleboliths (odds ratio, 2.80; p = 0.007). No differences were noted regarding patient demographic characteristics and history or lesion morphologic features or anatomy. CONCLUSION: Occurrence of AV microshunts in untreated VM is a frequent phenomenon. This hemodynamic subtype is significantly associated with phleboliths and large lesions. The subtypes did not differ in terms of history and clinical course.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Tromboflebite/complicações , Tromboflebite/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Extremidades/irrigação sanguínea , Extremidades/diagnóstico por imagem , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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