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1.
Jpn J Radiol ; 37(11): 773-780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522385

RESUMO

PURPOSE: To assess inter-observer variability in identifying traction bronchiectasis on computed tomography (CT) using additional criteria for chronic fibrosing interstitial pneumonia. METHODS: Seven experts categorized CT image set representing 39 patients into three groups on the basis of the presence of traction bronchiectasis, using a three-point scale: 3-definitely/probably yes; 2-possibly yes; and 1-definitely/probably no. This scale served as a reference standard. The image set included cases of chronic fibrosing interstitial pneumonia, non-interstitial lung disease, and difficult-to-determine cases. Forty-eight observers similarly assessed the same image set, first according to the Fleischner Society definition, and second with additional criteria, in which traction bronchiectasis was observed exclusively in chronic fibrosing interstitial pneumonia. The agreement level between the reference standard and each observer's evaluation in each session was calculated using weighted kappa values which were compared between the two sessions using a paired t test. RESULTS: The mean weighted kappa value for all observers was significantly higher in the second reading session (mean 0.75) than in the first reading session (mean 0.62) (p < 0.001). CONCLUSION: Inter-observer agreement in identifying traction bronchiectasis improves when using the additional criteria which specify chronic fibrosing interstitial pneumonia as the underlying disease.


Assuntos
Bronquiectasia/diagnóstico por imagem , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Variações Dependentes do Observador , Doença Crônica , Fibrose/diagnóstico por imagem , Humanos , Tomografia Computadorizada por Raios X/métodos , Tração
2.
Hypertension ; 74(2): 295-304, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31291149

RESUMO

Subendocardial damage is among the first cardiac manifestations of hypertension and is already present in asymptomatic disease states. Accordingly, markers of subendocardial impairment may facilitate early detection of cardiac damages and risk stratification under these conditions. This study aimed to investigate the impact of subendocardial damage on myocardial microstructure and function to elucidate early pathophysiologic processes and to identify corresponding diagnostic measures. Mice (n=38) were injected with isoproterenol to induce isolated subendocardial scarring or saline as corresponding control. Cardiac function and myocardial deformation were determined by high-frequency echocardiography. The cardiac stress response was assessed in a graded exercise test and during dobutamine stress echocardiography. Myocardial microstructure was studied ex vivo by 7 T diffusion tensor magnetic resonance imaging at a spatial resolution of 100×100×100 µm 3 . Results were correlated with histology and biomarker expression. Subendocardial fibrosis was accompanied by diastolic dysfunction, impaired longitudinal deformation (global peak longitudinal strain [LS]: -12.5±0.5% versus -15.6±0.5%; P<0.001) and elevated biomarker expression (ANP [atrial natriuretic peptide], Galectin-3, and ST2). Systolic function and cardiac stress response remained preserved. Diffusion tensor magnetic resonance imaging revealed a left-shift in helix angle towards lower values in isoproterenol-treated animals, which was mainly determined by subepicardial myofibers (mean helix angle: 2.2±0.8° versus 5.9±1.0°; P<0.01). Longitudinal strain and subepicardial helix angle were highly predictive for subendocardial fibrosis (sensitivity, 82%-92% and specificity, 89%-90%). The results indicate that circumscribed subendocardial damage alone can cause several hallmarks observed in cardiovascular high-risk patients. Microstructural remodeling under these conditions involves also remote regions, and corresponding changes in longitudinal strain and helix angle might serve as diagnostic markers.


Assuntos
Endocárdio/patologia , Interpretação de Imagem Assistida por Computador , Isoproterenol/efeitos adversos , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Animais , Biópsia por Agulha , Modelos Animais de Doenças , Ecocardiografia/métodos , Endocárdio/diagnóstico por imagem , Endocárdio/lesões , Fibrose/diagnóstico por imagem , Fibrose/patologia , Alemanha , Humanos , Imuno-Histoquímica , Injeções Subcutâneas , Isoproterenol/administração & dosagem , Modelos Lineares , Camundongos , Camundongos Endogâmicos , Curva ROC , Distribuição Aleatória , Valores de Referência , Volume Sistólico/fisiologia , Análise de Sobrevida , Disfunção Ventricular Esquerda/patologia
3.
J Med Ultrason (2001) ; 46(4): 441-447, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31218473

RESUMO

PURPOSE: Pancreatic fibrosis or fibrosing reactions have been reported in intraductal papillary-mucinous neoplasm (IPMN) patients. We assessed whether a higher elastic modulus (EM) measured using shear wave elastography (SW-EG) correlated with the existence of branch-duct (BD) IPMN. METHODS: In total, 183 normal pancreas (NP) and 123 BD-IPMN cases were enrolled. First, we assessed the difference in pancreatic EM (PEM) at different sites (head or tail side of the cyst). Second, a comparison was done between the median PEM of the NP and the BD-IPMN cases. Receiver-operating characteristic analysis was performed to determine the BD-IPMN diagnostic capabilities. Finally, in patients whose cyst was not visualized, the test-positive rate was determined. RESULTS: No significant difference was seen between the cyst head side PEM (4.61 kPa) and the tail side PEM (5.35 kPa) (P = 0.471). Among these cases matched by age, 73 were selected each from NP and BD-IPMN cases (median age 65 years). The median PEM of the BD-IPMN cases (5.18 kPa) was significantly higher than that of the NP cases (3.17 kPa) (P < 0.001). When the cut-off value was set at 4.75 kPa, the sensitivity, specificity, PPV, NPV, and accuracy were 75.3%, 64.4%, 72.3%, 67.9%, and 69.9%, respectively. The cut-off value of 4.75 kPa helped for the indirect selection of BD-IPMN patients (10/17, 58.8%) whose cyst was not detected on B-mode ultrasonography. CONCLUSION: SW-EG measurement of the underlying pancreatic parenchyma may correlate with the presence of BD-IPMN.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Neoplasias Intraductais Pancreáticas/diagnóstico por imagem , Neoplasias Intraductais Pancreáticas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Módulo de Elasticidade , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Curva ROC , Estudos Retrospectivos
4.
Vet Radiol Ultrasound ; 60(4): 423-431, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050093

RESUMO

Benign stricture is an uncommon cause of chronic small intestinal obstruction in the cat. The purpose of this retrospective case series was to describe the ultrasonographic features, histopathological findings, and clinical presentation in a group of cats with benign small intestinal stricture. Inclusion criteria were cats presenting during the period 2010-2017, and that had ultrasonography and small intestinal stricture confirmed at surgery. For each cat, clinical data and ultrasonographic findings were retrieved from the medical record, and histopathology, where available, was reviewed. Eight cats met the inclusion criteria. The location of strictures was duodenum (1/8), mid- to distal jejunum (4/8), and ileum (3/8). Ultrasonographic findings included gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction. Ingesta did not propagate beyond the strictured segment. Wall thickening was mild to moderate (3-6 mm). Normal wall layering was disrupted in all cats. Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri-intestinal mesentery (6/8). Annular strictures (5/8) were less than 15 mm in length whereas long-segment strictures (3/8) were greater than 15 mm in length. Histopathology showed transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery. The mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation. Clinical presentation reflected delayed diagnosis of chronic bowel obstruction with debilitation (8/8), marked weight loss (8/8), and prerenal azotemia (5/8). Benign fibrostenotic stricture should be considered a differential diagnosis in debilitated young cats presenting with chronic bowel disease and ultrasonographic features of intestinal obstruction.


Assuntos
Doenças do Gato/diagnóstico por imagem , Doenças do Gato/patologia , Fibrose/veterinária , Obstrução Intestinal/veterinária , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Ultrassonografia/veterinária , Animais , Gatos , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Constrição Patológica/veterinária , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Masculino , Estudos Retrospectivos
5.
Semin Ophthalmol ; 34(3): 163-167, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31132290

RESUMO

PURPOSE: To assess amniotic membrane retention after amniotic membrane transplant in bullous keratopathy patients and whether there were any corneal structural changes that may hinder further penetrating keratoplasty Methods: A retrospective study including 22 patients who have undergone amniotic membrane transplant from 1 Jan 1998 till 30 Jun 2016. Confocal microscopy and anterior segment optical coherence tomography (ASOCT) were performed to assess the retention of amniotic membrane and to detect any corneal structural changes. The comparison was made with 5 controls who had bullous keratopathy awaiting endothelial keratoplasty. RESULTS: Patients had a mean follow-up of 61 ± 33.7 months. Pain reduction was significant (p < .001) although it did not significantly correlate with the regularity of the superficial, intermediate or basal epithelial layers, nor with the retention of the amniotic membrane. No long-term structural changes that may hinder future penetrating keratoplasty were detected. CONCLUSION: This procedure is a safe and effective long-term treatment for symptomatic bullous keratopathy patients.


Assuntos
Âmnio/transplante , Segmento Anterior do Olho/diagnóstico por imagem , Córnea/patologia , Edema da Córnea/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Córnea/diagnóstico por imagem , Edema da Córnea/diagnóstico por imagem , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Sobrevivência de Enxerto , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
6.
ACS Appl Mater Interfaces ; 11(26): 23006-23017, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31136144

RESUMO

Myocardial fibrosis plays an important role in the development of heart failure and malignant arrhythmia, which potentially increases the incidence of sudden cardiac death. Therefore, early detection of myocardial fibrosis is of great significance for evaluating the prognosis of patients and formulating appropriate treatment strategies. Late gadolinium-enhanced magnetic resonance imaging is considered as the currently effective strategy for noninvasive detection of myocardial fibrosis, but it still suffers from some critical issues. In this work, multifunctional CNA35-labeled perfluoropentane nanoparticles (CNA35-PFP NPs) have been elaborately designed and constructed for molecular imaging of fibrotic myocardium based on ultrasound imaging. These as-constructed CNA35-PFP NPs are intravenously infused into rabbit circulation with an animal model of myocardial infarction. Especially, these targeted CNA35-PFP NPs with nanoscale size could efficiently pass through the endothelial cell gap and adhere to the surface of fibroblasts in the fibrotic myocardium. Importantly, followed by low-intensity focused ultrasound irradiation on the myocardium, these intriguing CNA35-PFP NPs could transform from liquid into gaseous microbubbles, which further significantly enhanced the ultrasound contrast in the fibrotic area, facilitating the detection by diagnostic ultrasound imaging. Therefore, this work provides a desirable noninvasive, economical, and real-time imaging technique for the assessment of cardiac fibrosis with diagnostic ultrasound based on the rational design of liquid-to-gas phase-changeable nanoplatforms.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Nanocompostos/química , Ultrassonografia/métodos , Animais , Cardiomiopatias/patologia , Colágeno/química , Modelos Animais de Doenças , Fibrose/patologia , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Miocárdio/patologia , Nanocompostos/uso terapêutico , Nanopartículas/química , Coelhos
7.
Gut ; 68(6): 1115-1126, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30944110

RESUMO

Patients with Crohn's disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.


Assuntos
Doença de Crohn/epidemiologia , Obstrução Intestinal/epidemiologia , Intestino Delgado/patologia , Imagem Multimodal/métodos , Comorbidade , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/epidemiologia , Constrição Patológica/patologia , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/patologia , Estudos Transversais , Técnicas de Imagem por Elasticidade/métodos , Feminino , Fibrose/diagnóstico por imagem , Fibrose/epidemiologia , Humanos , Incidência , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Intestino Delgado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Prognóstico , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler/métodos
8.
Intern Med ; 58(14): 2041-2044, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-30918200

RESUMO

An 84-year-old man presented with syncope. Prior to admission, ambulatory electrocardiogram had demonstrated non-sustained ventricular tachycardia. Echocardiography showed severe aortic stenosis. He was also diagnosed with hypertrophic cardiomyopathy (HCM) by cardiac magnetic resonance (CMR) showing remarkable inhomogeneous left ventricular hypertrophy and extensive late gadolinium enhancement (LGE) in the lesions at the upper border and right-ventricular side of the basal-mid septal wall. Finally, he showed complete atrioventricular (AV) block followed by a long pause and syncope several times after admission. In this case with several possible causes of syncope, the CMR findings suggested a clue concerning the etiology of his syncope: complete AV block in HCM.


Assuntos
Bloqueio Atrioventricular/complicações , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Fibrose/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/complicações , Imagem Cinética por Ressonância Magnética/métodos , Marca-Passo Artificial , Síncope/complicações , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica , Bloqueio Atrioventricular/cirurgia , Meios de Contraste , Eletrocardiografia Ambulatorial/métodos , Fibrose/cirurgia , Gadolínio DTPA , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Miocárdio/patologia , Síncope/cirurgia , Resultado do Tratamento
9.
Diabetes Res Clin Pract ; 150: 72-80, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30844469

RESUMO

AIM: The aim of the study was to assess the extracellular volume fraction (ECV) in type 2 diabetes mellitus (T2DM) patients with different level of hemoglobin A1c (HbA1c) by cardiac magnetic resonance (CMR), and the ability of HbA1c to predict myocardial fibrosis. METHODS: In total, 80 T2DM patients and 20 age- and sex-matched controls were prospective enrolled and underwent CMR to obtain ECV value and LV function parameters. We divided all patients into a group of HbA1c < 7.0% and a group of HbA1c ≥ 7.0%. RESULTS: In the higher HbA1c group the ECV value (all p < 0.001) was higher than both lower HbA1c group (36.23% vs. 32.19%, p < 0.001) and controls (36.23% vs. 29.73%, p < 0.001). HbA1c was positively associated (ß = 0.36, p = 0.004) with ECV, and it was also an independent predictor of myocardial fibrosis (OR = 2.00, P = 0.014). The ROC analysis showed that 7.1% was the optimal cutoff value of HbA1c that predicted the risk of myocardial fibrosis with high diagnostic accuracy (area under the curve = 0.78). CONCLUSION: T1 mapping provided myocardial fibrosis information in T2DM patients. HbA1c is positively correlated with myocardial fibrosis and can be an independently predictor of myocardial fibrosis, which may be helpful for the clinical decision-making of blood glucose control.


Assuntos
Cardiomiopatias/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Fibrose/diagnóstico , Hemoglobina A Glicada/análise , Imagem Cinética por Ressonância Magnética/métodos , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Fibrose/sangue , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC
10.
Contrast Media Mol Imaging ; 2019: 1767620, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30863218

RESUMO

Aim: To assess the feasibility of dynamic contrast-enhanced perfusion-MRI in characterization of active small-bowel inflammation and chronic mural fibrosis in patients with Crohn's disease (CD). Methods: We analyzed a total of 37 (11 women; 23-69 years) patients with known biopsy proven CD, who underwent MR-enterography (MRE) study, performed on a 1.5 T MRI system (Achieva, Philips), using a phased array sense body multicoil, after oral administration of 1.5-2 L of PEG solution. MRE protocol included T1 weighted, SSh T2, sBTFE, and gadolinium-enhanced THRIVE sequences acquired on coronal and axial planes. A dedicated workstation was used to generate perfusion color maps, on which we drown ROI on normal bowel and on pathological segment, thus obtaining related perfusion parameters: relative arterial, venous, and late enhancement (RAE, RVE, and RLE), maximum enhancement (ME), and time to peak (TTP). Results: Quantitative perfusion analysis showed a good correlation with local degree of Crohn's inflammation activity. Twenty-nine out of 37 patients showed active inflammatory disease (reference standard of active disease: wall bowel thickness and layered enhancement) with following perfusion parameters: REA (%) = 116.1, RVE (%) = 125.3, RLE (%) = 127.1, ME (%) = 1054.7, TTP (sec) = 157. The same parameters calculated in patients with mural fibrosis were as follows: RAE (%): median = 56.4; RVE (%): 81.2; RLE (%): 85.4; ME (%):809.6; TTP (sec): 203.4. A significant difference (p < 0.001) between inflamed and fibrotic bowel wall vascularity, regarding all perfusion parameters evaluated, was found, with higher values in active CD localizations. Conclusion: Vascular assessment of perfusion kinetics of bowel wall by dynamic contrast perfusion-MR analysis may represent a complementary diagnostic tool that enables a quantitative evaluation of local inflammation activity in CD patients.


Assuntos
Meios de Contraste , Doença de Crohn/diagnóstico por imagem , Inflamação/diagnóstico , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Feminino , Fibrose/diagnóstico por imagem , Humanos , Intestino Delgado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
11.
J Clin Invest ; 129(1): 24-33, 2019 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-30601139

RESUMO

Fibrosis, the progressive accumulation of connective tissue that occurs in response to injury, causes irreparable organ damage and may result in organ failure. The few available antifibrotic treatments modify the rate of fibrosis progression, but there are no available treatments to reverse established fibrosis. Thus, more effective therapies are urgently needed. Molecular imaging is a promising biomedical methodology that enables noninvasive visualization of cellular and subcellular processes. It provides a unique means to monitor and quantify dysregulated molecular fibrotic pathways in a noninvasive manner. Molecular imaging could be used for early detection, disease staging, and prognostication, as well as for assessing disease activity and treatment response. As fibrotic diseases are often molecularly heterogeneous, molecular imaging of a specific pathway could be used for patient stratification and cohort enrichment with the goal of improving clinical trial design and feasibility and increasing the ability to detect a definitive outcome for new therapies. Here we review currently available molecular imaging probes for detecting fibrosis and fibrogenesis, the active formation of new fibrous tissue, and their application to models of fibrosis across organ systems and fibrotic processes. We provide our opinion as to the potential roles of molecular imaging in human fibrotic diseases.


Assuntos
Fibrose/diagnóstico por imagem , Modelos Biológicos , Imagem Molecular/tendências , Animais , Fibrose/terapia , Humanos , Imagem Molecular/métodos
12.
Skin Res Technol ; 25(3): 359-366, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30638285

RESUMO

BACKGROUND: Clinical characteristics of the lesions are used to identify activity and damage in localized scleroderma (LoS). For high-frequency ultrasound (HF-US), the features of active lesions were described. MATERIALS AND METHODS: Clinical signs of activity and damage in LoS lesions were assessed with the use of Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) and HF-US by two examiners independently. All US images were obtained using a 20 MHz HF-US (DermaLab System, Cortex Technology, Hadsund, Denmark). The dermal thickness (DT) and echogenicity (intensity score, IS) of the LoS lesional dermis were measured in the area of each lesion with the highest score for erythema (ER), skin thickness (ST), and dermal atrophy (DAT). Measurements were compared to the site-matched unaffected skin. The relative difference of DT and IS values was calculated between each lesion and its normal control for comparison among different clinical scores for ER, ST, and DAT. RESULTS: A total of 92 lesions in 40 adult patients were examined with HF-US. Thirty one lesions were erythematous, 26 were in sclerosis, and 35 were in atrophy. A correlation between the clinical evaluation of the LoS lesions and US measurements was found. The sensitivity and specificity of HF-US were 97% and 90%, respectively. The positive predictive value was 83%, negative predictive value-98%. Interrater reliability was excellent for LoSCAT and HF-US findings. CONCLUSION: High-frequency ultrasound allows an accurate assessment of the inflammatory and fibrotic skin lesions in LoS.


Assuntos
Inflamação/diagnóstico por imagem , Esclerodermia Localizada/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Feminino , Fibrose/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Esclerodermia Localizada/patologia
13.
Muscle Nerve ; 59(4): 436-444, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30578674

RESUMO

INTRODUCTION: The manner in which imaging patterns change over the disease course and with increasing disability in dysferlinopathy is not fully understood. METHODS: Fibroadipose infiltration of 61 muscles was scored based on whole-body MRI of 33 patients with dysferlinopathy and represented in a heatmap. We trained random forests to predict disease duration, Motor Function Measure dimension 1 (MFM-D1), and modified Rankin scale (MRS) score based on muscle scoring and selected the most important muscle for predictions. RESULTS: The heatmap delineated positive and negative fingerprints in dysferlinopathy. Disease duration was related to infiltration of infraspinatus, teres major-minor, and supraspinatus muscles. MFM-D1 decreased with higher infiltration of teres major-minor, triceps, and sartorius. MRS related to infiltration of vastus medialis, gracilis, infraspinatus, and sartorius. DISCUSSION: Dysferlinopathy shows a recognizable muscle MRI pattern. Fibroadipose infiltration in specific muscles of the thigh and the upper limb appears to be an important marker for disease progression. Muscle Nerve 59:436-444, 2019.


Assuntos
Avaliação da Deficiência , Músculo Esquelético/diagnóstico por imagem , Distrofia Muscular do Cíngulo dos Membros/diagnóstico por imagem , Tecido Adiposo/patologia , Adulto , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Humanos , Aprendizado de Máquina , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Manguito Rotador/diagnóstico por imagem , Adulto Jovem
14.
Asian J Endosc Surg ; 12(2): 178-180, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29791978

RESUMO

Endoscopic submucosal dissection is an effective procedure for treating non-invasive colorectal tumors. However, in cases of severe fibrosis, endoscopic submucosal dissection may be technically difficult, leading to incomplete resection. Here, we describe the case of a 74-year-old man who had early rectal cancer along with severe submucosal fibrosis caused by prior local excision. Combination treatment with endoscopic submucosal dissection and transanal minimally invasive surgery successfully enabled complete resection.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Retais/cirurgia , Cirurgia Endoscópica Transanal , Idoso , Fibrose/diagnóstico por imagem , Fibrose/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Neoplasias Retais/diagnóstico por imagem
15.
Eur Heart J Cardiovasc Imaging ; 20(1): 101-107, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29800129

RESUMO

Aims: The objective of this study was to quantify imaging markers of myocardial fibrosis and assess myocardial function in long-term transposition of the great arteries survivors after the arterial switch operation (ASO). Methods and results: Paediatric ASO patients were prospectively studied by cardiac magnetic resonance imaging, including first-pass myocardial perfusion, late gadolinium enhancement, and T1 relaxometry, as well as echocardiography for left ventricular (LV) systolic and diastolic function including strain analysis, with comparison to healthy controls. Thirty ASO patients (mean age 15.4 ± 2.9 years vs. 14.1 ± 2.6 years in 28 controls, P = 0.04) were included. Patients had normal LV ejection fraction (EF) (57 ± 5% vs. 59 ± 5%, P = 0.07), but end-diastolic and end-systolic volumes were increased (104 ± 20 mL/m2 vs. 89 ± 10 mL/m2, P < 0.01 and 46 ± 13 mL/m2 vs. 36 ± 7 mL/m2, P < 0.01, respectively). Longitudinal strain at two-, three-, and four-chamber levels of the LV were lower in ASO patients (-19.0 ± 2.6% vs. -20.9 ± 2.3%, P = 0.006, -17.7 ± 2.0% vs. -19.1 ± 2.4%, P = 0.02, and -18.9 ± 1.9% vs. -20.1 ± 1.7%, P = 0.01, respectively), while circumferential strain was higher at all short-axis levels (-24.6 ± 2.3% vs. -19.3 ± 1.6%, P < 0.001 at the mid-ventricular level). LV native T1 times were higher in ASO patients (1042 ± 27 ms vs. 1011 ± 27 ms, P < 0.01) and correlated with LV mass/volume ratio (R = 0.60, P < 0.001). Myocardial scarring or myocardial perfusion defects were not observed in our cohort. Conclusion: Children and adolescents after ASO have normal LV systolic function, in line with their overall good clinical health. At a myocardial level however, imaging markers of diffuse myocardial fibrosis are elevated, along with an altered LV contraction pattern. Whether these abnormalities will progress into future clinically significant dysfunction and whether they are harbingers of adverse outcomes remains to be studied.


Assuntos
Transposição das Grandes Artérias , Miocárdio/patologia , Transposição dos Grandes Vasos/cirurgia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Adolescente , Técnicas de Imagem de Sincronização Cardíaca , Estudos de Casos e Controles , Meios de Contraste , Estudos Transversais , Ecocardiografia , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Meglumina/análogos & derivados , Compostos Organometálicos , Estudos Prospectivos , Sobreviventes
17.
Am J Cardiol ; 123(3): 460-465, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30473327

RESUMO

Light-to-moderate regular alcohol consumption has been associated with reduced mortality, heart failure, and sudden death, with a well described "U-shaped" relationship. We sought to determine whether markers of diffuse ventricular fibrosis as assessed by cardiac magnetic resonance imaging (CMR) T1 mapping differ between nondrinkers and regular drinkers. We prospectively recruited 165 participants to undergo 3T CMR ventricular T1 mapping which included 120 regular light-to-moderate drinkers (7 to 28 standard drinks per week for >12 months) and 45 age and gender-matched nondrinking controls (1 standard drink ∼12 g alcohol). Diffuse ventricular fibrosis was assessed using ShMOLLI T1 mapping sequences performed in mid-short axis. Native T1, postcontrast T1 times and extracellular volume were compared in the left ventricle between regular drinkers and lifelong nondrinkers. In total 165 participants (mean age 59 ± 12 years, 70% male, 36% hypertension, mean LVEF 58 ± 11%) underwent CMR. Moderate alcohol intake (mean alcohol intake 16 ± 6 SDs/week) was associated with lower markers of diffuse ventricular fibrosis: native T1 time 1140 ± 47 vs 1173 ± 39 ms, p < 0.001; postcontrast T1 time 470 ± 47 vs 445 ± 43 ms, p = 0.01; extracellular volume 25.0 ± 2.7% vs 27.0 ± 2.8%, p = 0.003 despite similar LV size (p = 0.55) and mass compared with nondrinkers (p = 0.78). Quantity of alcohol intake and beverage type did not predict lower native T1 times. In conclusion, light-to-moderate or "social" alcohol consumption is associated with T1 changes on CMR suggestive of a reduction in diffuse ventricular fibrosis. These preliminary findings may provide some insights into the association between modest alcohol intake and reduction in sudden death and heart failure.


Assuntos
Consumo de Bebidas Alcoólicas , Fibrose/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Estudos de Casos e Controles , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Histopathology ; 74(5): 688-698, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30408214

RESUMO

AIMS: The pathological diagnosis of IgG4-related disease (IgG4-RD) relies on histology, IgG4-positive cells, and an increased IgG4/IgG ratio. Small biopsies from patients with a presumptive diagnosis of IgG4-RD often fail to meet consensus histological criteria. The aims of this study were to evaluate consecutive small biopsies from patients with a presumptive diagnosis of IgG4-RD, and to assess the significance of the pathological findings. METHODS AND RESULTS: We evaluated 55 small biopsies from patients with a presumptive diagnosis of IgG4-RD. The retrospective cohort comprised 71 patients with IgG4-RD and 57 mimics. We performed immunohistochemistry (IHC) and in-situ hybridisation (ISH) for IgG4 and IgG. Twenty-six patients from the prospective cohort met the histological criteria for IgG4-RD (definite); 29 patients lacked one or more pathological features (borderline). Twenty biopsies (36%) lacked both storiform fibrosis and obliterative phlebitis, and nine (16%) lacked an increase in the number of IgG4-positive plasma cells. Ninety-three per cent of patients showed an IgG4/total IgG ratio of >40% (>30% by ISH). There were no differences in the incidence of multiorgan disease (P = 0.9), serum IgG4 levels (P = 0.6) and response to therapy between the definite and borderline groups. A strong correlation (Pearson 0.77) between the IHC and ISH platforms was noted with regard to the IgG4/total IgG ratio. CONCLUSION: Patients with a presumptive diagnosis of IgG4-RD but lacking the characteristic pathological features of this disease appear to be clinically similar to those who meet the current pathological criteria. An elevated IgG4/total IgG ratio is the most sensitive pathological feature, and ISH provides a robust quantification platform. We recommend evaluating tumefactive lymphoplasmacytic infiltrates with an increased IgG4/IgG ratio, regardless of histological features, for IgG4-RD.


Assuntos
Doença Relacionada a Imunoglobulina G4/patologia , Espaço Retroperitoneal/patologia , Glândulas Salivares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Feminino , Fibrose/diagnóstico por imagem , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Imuno-Histoquímica , Imunossupressores/uso terapêutico , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Flebite/diagnóstico por imagem , Plasmócitos/citologia , Plasmócitos/imunologia , Estudos Prospectivos , Estudos Retrospectivos , Rituximab/uso terapêutico , Esteroides/uso terapêutico , Adulto Jovem
19.
Pediatr Cardiol ; 40(3): 518-525, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30315339

RESUMO

Rheumatic heart disease (RHD) is a major cause of morbidity and mortality in developing countries, so early diagnosis and treatment can reduce morbidity and mortality resulting from subsequent valvular damage. The aim of this study was to detect subtle myocardial dysfunction among children with RHD with preserved left ventricular systolic function. This is a cross-sectional case-control study that was conducted on 30 children with RHD (who had valvular affection of any degree and were not in activity) compared to 23 healthy children. After history taking and cardiac examination, 2D echocardiography, tissue Doppler imaging, 3D-echocardiography and 3D speckle tracking echocardiography were done to both groups, whereas cardiac magnetic resonance imaging was done only to the patient group. The 3D-derived left ventricular end-diastolic volume and sphericity index among patients were significantly increased when compared to controls [131.5 (101.5 to 173.7) vs. 69 (58 to 92), P = 0.001, and 0.46 (0.36 to 0.59) vs. 0.33 (0.29 to 0.38), P = 0.001, respectively]. The 3D-derived ejection fraction and longitudinal strain did not differ significantly among both groups. The 3D-derived global circumferential strain was higher in patients when compared to controls [- 14 (- 16 to - 10) vs. - 11(- 13 to - 10), P = 0.04]. None of the examined patients demonstrated late enhancement myocardial fibrosis. In children with RHD and preserved systolic function, subtle systolic dysfunction could not be detected using conventional and novel non-conventional methods. This may indicate that the myocardial affection during the acute stage of rheumatic carditis is minimal with almost complete resolution.


Assuntos
Ecocardiografia Tridimensional/métodos , Ventrículos do Coração/fisiopatologia , Imagem Cinética por Ressonância Magnética/métodos , Miocárdio/patologia , Cardiopatia Reumática/complicações , Adolescente , Estudos de Casos e Controles , Criança , Estudos Transversais , Diagnóstico Precoce , Ecocardiografia/métodos , Feminino , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Cardiopatia Reumática/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia
20.
Sci Rep ; 8(1): 16972, 2018 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-30451960

RESUMO

Patients with end stage renal disease (ESRD) suffer high mortality from arrhythmias linked to fibrosis, but are contraindicated to late gadolinium enhancement magnetic resonance imaging (MRI). We present a quantitative method for gadolinium-free cardiac fibrosis imaging using magnetization transfer (MT) weighted MRI, and probe correlations with widely used surrogate markers including cardiac structure and contractile function in patients with ESRD. In a sub-group of patients who returned for follow-up imaging after one year, we examine the correlation between changes in fibrosis and ventricular structure/function. Quantification of changes in MT revealed significantly greater fibrotic burden in patients with ESRD compared to a healthy age matched control cohort. Ventricular mechanics, including circumferential strain and diastolic strain rate were unchanged in patients with ESRD. No correlation was observed between fibrotic burden and concomitant measures of either circumferential or longitudinal strains or strain rates. However, among patients who returned for follow up examination a strong correlation existed between initial fibrotic burden and subsequent loss of contractile function. Gadolinium-free myocardial fibrosis imaging in patients with ESRD revealed a complex and longitudinal, not contemporary, association between fibrosis and ventricular contractile function.


Assuntos
Cardiopatias/diagnóstico por imagem , Falência Renal Crônica/diagnóstico por imagem , Adulto , Feminino , Fibrose/diagnóstico por imagem , Gadolínio , Cardiopatias/complicações , Cardiopatias/patologia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
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