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1.
Medicine (Baltimore) ; 100(3): e24243, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546044

RESUMO

RATIONALE: Hepatic splenosis or heterotopic auto-transplantation of spleen in the liver usually occurs after either spleen trauma or surgery. It is of great importance for the differential diagnosis of hepatic splenosis and other liver tumors because surgery is usually not needed if a diagnosis of splenosis is confirmed. PATIENT CONCERNS: Multiple hepatic masses were revealed by grayscale ultrasound in a 55-year-old man complaining of persistent colic in the upper abdomen after greasy food. DIAGNOSIS: Benign neoplasm with enlarged lymph node in the gastro-hepatic ligament was suspected by contrast enhanced US. The nature of the hepatic mass was undetermined by CECT. INTERVENTIONS: The lesions were surgically removed. OUTCOMES: Multiple splenic tissue implants in the liver and peritoneum were confirmed by pathology after surgery. The patient recovered well and was followed up for more than 1 year without recurrence. LESSONS: Splenosis should be included in the differential diagnosis of focal liver lesion in patients with a history of spleen trauma or surgery. In spite of nonspecific findings on pre-contrast ultrasound, splenosis shows characteristic homogeneous hyperenhancement in arterial and portal phases, as well as prolonged hyperenhancement in the late phase for more than 5 minutes. Furthermore, the confidence of the diagnosis of splenosis may be enhanced by identifying multiple masses with similar enhancing patterns in other regions of the abdominal cavity.


Assuntos
Coristoma/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Baço , Humanos , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia
2.
Medicina (Kaunas) ; 57(1)2021 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-33435420

RESUMO

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1-2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children.


Assuntos
Meios de Contraste , Técnicas de Diagnóstico Urológico , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Cistografia , Feminino , Humanos , Lactente , Injeções , Laparoscopia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Politetrafluoretileno , Exposição à Radiação , Recidiva , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Hexafluoreto de Enxofre , Ureteroscopia , Uretra/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle , Urografia , Refluxo Vesicoureteral/classificação , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/terapia , Adulto Jovem
3.
Medicine (Baltimore) ; 99(46): e23110, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181678

RESUMO

Multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) might be benefited from nephron-sparing surgery. Contrast-enhanced computed tomography is used for the diagnosis of MCRNLMP but contrast-enhanced ultrasound has lack of nephrotoxicity and several advantages over contrast-enhanced computed tomography and contrast-enhanced magnetic resonance. The purpose of the study was to compare diagnostic parameters of preoperative contrast-enhanced ultrasound against contrast-enhanced computed tomography for the detection of MCRNLMP in patients who faced curative surgery for complex cystic renal mass.Data regarding contrast-enhanced ultrasound, contrast-enhanced computed tomography, and clinicopathological results of 219 patients who underwent curative surgery for complex cystic renal mass (Bosniak classification III or IV) were retrospectively collected and analyzed. Bosniak classification for imaging modality and the 2016 WHO criteria for clinic pathology were used for detection of MCRNLMP.Contrast-enhanced ultrasound, contrast-enhanced computed tomography, and clinicopathology were detected 68, 66, and 67 as a MCRNLMP respectively. Contrast-enhanced ultrasound and contrast-enhanced computed tomography had 30.37% and 29.27% sensitivities for the detection of MCRNLMP. While 60% and 50% specificities respectively. Bosniak classification III (P = .045) and lower mean Hounsfield unit (P = .049) were associated with the prevalence of MCRNLMP. Contrast-enhanced computed tomography was detected 6 and 7, while contrast-enhanced ultrasound detected 3 and 2 complex cystic renal mass as false positive and false negative MCRNLMP respectively. A contrast-enhanced ultrasound had 0.011 to 1.0 diagnostic confidence and contrast-enhanced computed tomography had 0.045 to 0.983 diagnostic confidence for decision making of nephron-sparing surgeries.Contrast-enhanced ultrasound may have better visualization of MCRNLMP than contrast-enhanced computed tomography.Level of Evidence: III.


Assuntos
Carcinoma de Células Renais , Aumento da Imagem/métodos , Neoplasias Renais , Rim/diagnóstico por imagem , Compostos Organometálicos/farmacologia , Fosfolipídeos/farmacologia , Hexafluoreto de Enxofre/farmacologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Carcinoma de Células Renais/diagnóstico , Carcinoma de Células Renais/cirurgia , Tomada de Decisão Clínica , Pesquisa Comparativa da Efetividade , Meios de Contraste/farmacologia , Precisão da Medição Dimensional , Feminino , Humanos , Neoplasias Renais/diagnóstico , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Tratamentos com Preservação do Órgão/métodos
4.
J Vasc Interv Radiol ; 31(10): 1587-1591, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32951970

RESUMO

Intraductal cooling via a percutaneous transhepatic biliary drainage tube holds great promise in facilitating thermal ablation of liver tumors adjacent to the central bile ducts. However, the difficulties and complications associated with puncturing nondilated bile ducts are greater than those associated with puncturing dilated bile ducts. As reported here, percutaneous transcholecystic contrast-enhanced ultrasound was performed in 7 patients to visualize the nondilated bile ducts and guide percutaneous transhepatic biliary drainage, thus facilitating the intraductal cooling-assisted thermal ablation process. The procedures were technically successful in all 7 patients, and no major complications were recorded during the follow-up period.


Assuntos
Traumatismos Abdominais/prevenção & controle , Ductos Biliares/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Drenagem , Neoplasias Hepáticas/cirurgia , Fosfolipídeos/administração & dosagem , Ablação por Radiofrequência , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia de Intervenção , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Ductos Biliares/lesões , Meios de Contraste/efeitos adversos , Drenagem/efeitos adversos , Drenagem/instrumentação , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Microbolhas , Pessoa de Meia-Idade , Fosfolipídeos/efeitos adversos , Ablação por Radiofrequência/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Hexafluoreto de Enxofre/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção/efeitos adversos
5.
Rev. cuba. oftalmol ; 33(3): e903, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1139100

RESUMO

RESUMEN El agujero macular es un desorden de la interface vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores, que normalmente involucra a la fóvea. Con el desarrollo de la tomografía de coherencia óptica se han mejorado el diagnóstico, el tratamiento y el seguimiento de las enfermedades de la interface vitreorretinal, entre ellas el agujero macular. La vitrectomía pars plana es la técnica quirúrgica de elección para el agujero macular. Se presenta una paciente de 75 años, pseudofáquica, con mejor agudeza visual corregida en el ojo derecho de 0,1 Snellen. Se diagnostica agujero macular grande (810 µm) según su mínima apertura, con 8 meses de evolución. Se realizó vitrectomía pars plana, el levantamiento de la hialodes posterior, el flap invertido de membrana limitante interna, el uso de hexafluoruro de azufre en mezcla 20 por ciento y el posicionamiento de la paciente 24-72 horas. Se logró el cierre anatómico del agujero macular y la recuperación visual de 0,6 Snellen a los seis meses del tratamiento quirúrgico(AU)


ABSTRACT Macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. The development of optical coherence tomography has improved the diagnosis, treatment and follow-up of vitreous-retina interface diseases, among them macular hole. Pars plana vitrectomy is the surgical technique of choice for macular hole. A case is presented of a female 75-year-old pseudophakic patient with best corrected right eye visual acuity of 0.1 on the Snellen chart. Large macular hole is diagnosed (810 µm) according to its minimum opening, of 8 month's evolution. The following procedures were performed: pars plana vitrectomy, posterior hyalode lifting, inverted internal limiting membrane flap, use of sulfur hexafluoride in a 20% mixture, and positioning of the patient for 24-72 hours. Anatomical closure of the macular hole and a visual recovery of 0.6 Snellen were achieved six months after surgery(AU)


Assuntos
Humanos , Feminino , Idoso , Perfurações Retinianas/diagnóstico , Hexafluoreto de Enxofre/uso terapêutico , Vitrectomia/métodos , Tomografia de Coerência Óptica/métodos
6.
J Stroke Cerebrovasc Dis ; 29(8): 104928, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689582

RESUMO

PURPOSE: Carotid atherosclerotic plaque is closely associated with cerebral white matter lesions (WMLs), while intraplaque neovascularization (IPN) contributes significantly to arterial remodeling and plaque vulnerability. In this study, we aim to evaluate the correlation of carotid IPN with cerebral WMLs. METHODS: The presence of IPN and WMLs were assessed by contrast-enhanced ultrasound (CEUS) and MRI respectively. IPN was evaluated utilizing semi-quantification visual grading scale and WMLs was divided according to Fazekas grading scale. We investigated the baseline data, Fazekas grades, and IPN grades among 269 participants. We explored the influences of each variable on Fazekas grades using ordinal logistic regression and evaluated the relationship between IPN grades and WMLs Fazekas grades. RESULTS: Increased age (OR: 1.06, P<0.001), hypertension (OR: 2.17, P=0.002), cerebral infarction (OR: 1.74, P=0.046), and elevated carotid IPN grading were significantly associated with aggravated Fazekas grades (grade 2 or 3). To be specific, people having grade 3, 2, and 1 carotid IPN were 25.84 (P<0.001), 10.64 (P<0.001), and 5.96 (P=0.010) times as likely to have elevated Fazekas grades compared with those who having grade 0 carotid IPN. CONCLUSION: Increased carotid IPN is independently correlated with aggravated cerebral WMLs.


Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Leucoencefalopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Neovascularização Patológica , Fosfolipídeos/administração & dosagem , Placa Aterosclerótica , Hexafluoreto de Enxofre/administração & dosagem , Ultrassonografia Doppler em Cores , Idoso , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/patologia , Feminino , Humanos , Leucoencefalopatias/complicações , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco
7.
Cochrane Database Syst Rev ; 5: CD006126, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32408387

RESUMO

BACKGROUND: Retinal detachment (RD) with proliferative vitreoretinopathy (PVR) often requires surgery to restore normal anatomy and to stabilize or improve vision. PVR usually occurs in association with recurrent RD (that is, after initial retinal re-attachment surgery), but occasionally may be associated with primary RD. Either way, for both circumstances a tamponade agent (gas or silicone oil) is needed during surgery to reduce the rate of postoperative recurrent RD. OBJECTIVES: The objective of this review was to assess the relative safety and effectiveness of various tamponade agents used with surgery for RD complicated by PVR. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (the Cochrane Library 2019, Issue 1), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2019), Embase (January 1980 to January 2019), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2019), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 2 January 2019. SELECTION CRITERIA: We included randomized controlled trials (RCTs) on participants undergoing surgery for RD associated with PVR that compared various tamponade agents. DATA COLLECTION AND ANALYSIS: Two review authors screened the search results independently. We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified four RCTs (601 participants) that provided data for the primary and secondary outcomes. Three RCTs provided data on visual acuity, two reported on macular attachment, one on retinal reattachment and another two on adverse events such as RD, worsening visual acuity and intraocular pressure. Study Characteristics Participants' characteristics varied across studies and across intervention groups, with an age range between 21 to 89 years, and were predominantly men. The Silicone Study was conducted in the USA and consisted of two RCTs: (silicone oil versus sulfur hexafluoride (SF6) gas tamponades; 151 participants) and (silicone oil versus perfluropropane (C3F8) gas tamponades; 271 participants). The third RCT compared heavy silicone oil (a mixture of perfluorohexyloctane (F6H8) and silicone oil) with standard silicone oil (either 1000 centistokes or 5000 centistokes; 94 participants). The fourth RCT compared 1000 centistokes with 5000 centistokes silicone oil in 85 participants. We assessed most RCTs at low or unclear risk of bias for most 'Risk of bias' domains. Findings Although SF6 gas was reported to be associated with worse anatomic and visual outcomes than was silicone oil at one year (quantitative data not reported), at two years, silicone oil compared to SF6 gas showed no evidence of a difference in visual acuity (33% versus 51%; risk ratio (RR) 1.57; 95% confidence interval (CI) 0.93 to 2.66; 1 RCT, 87 participants; low-certainty evidence). At one year, another RCT comparing silicone oil and C3F8 gas found no evidence of a difference in visual acuity between the two groups (41% versus 39%; RR 0.97; 95% CI 0.73 to 1.31; 1 RCT, 264 participants; low-certainty evidence). In a third RCT, participants treated with standard silicone oil compared to those receiving heavy silicone oil also showed no evidence of a difference in the change in visual acuity at one year, measured on logMAR scale ( mean difference -0.03 logMAR; 95% CI -0.35 to 0.29; 1 RCT; 93 participants; low-certainty evidence). The fourth RCT with 5000-centistoke and 1000-centistoke comparisons did not report data on visual acuity. For macular attachment, participants treated with silicone oil may probably experience more favorable outcomes than did participants who received SF6 at both one year (quantitative data not reported) and two years (58% versus 79%; RR 1.37; 95% CI 1.01 to 1.86; 1 RCT; 87 participants; low-certainty evidence). In another RCT, silicone oil compared to C3F8 at one year found no evidence of difference in macular attachment (RR 1.00; 95% CI 0.86 to 1.15; 1 RCT, 264 participants; low-certainty evidence). One RCT that compared 5000 centistokes to 1000 centistoke reported that retinal reattachment was successful in 67 participants (78.8%) with first surgery and 79 participants (92.9%) with the second surgery, and no evidence of between-group difference (1 RCT; 85 participants; low-certainty evidence). The fourth RCT that compared standard silicone oil with heavy silicone oil did not report on macular attachment. Adverse events In one RCT (86 participants), those receiving standard 1000 centistoke silicone oil compared with those of the 5000 centistoke silicone oil showed no evidence of a difference in intraocular pressure elevation at 18 months (24% versus 22%; RR 0.90; 95% CI 0.41 to 1.94; low-certainty evidence), visually significant cataract (49% versus 64%; RR 1.30; 95% CI 0.89 to 1.89; low-certainty evidence), and incidence of retina detachment after the removal of silicone oil (RR 0.36 95% CI 0.08 to 1.67; low-certainty evidence). Another RCT that compared standard silicone oil with heavy silicone oil suggests no difference in retinal detachment at one year (25% versus 22%; RR 0.89; 95% CI 0.54 to 1.48; 1 RCT; 186 participants; low-certainty evidence). Retinal detachment was not reported in the RCTs that compared silicone oil versus SF6 and silicone oil versus to C3F8. AUTHORS' CONCLUSIONS: There do not appear to be any major differences in outcomes between C3F8 and silicone oil. Silicone oil may be better than SF6 for macular attachment and other short-term outcomes. The choice of a tamponade agent should be individualized for each patient. The use of either C3F8 or standard silicone oil appears reasonable for most patients with RD associated with PVR. Heavy silicone oil, which is not available for routine clinical use in the USA, may not demonstrate evidence of superiority over standard silicone oil.


Assuntos
Fluorcarbonetos/administração & dosagem , Descolamento Retiniano/terapia , Óleos de Silicone/administração & dosagem , Hexafluoreto de Enxofre/administração & dosagem , Vitreorretinopatia Proliferativa/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pressão Intraocular , Macula Lutea , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Descolamento Retiniano/etiologia , Descolamento Retiniano/prevenção & controle , Prevenção Secundária , Acuidade Visual , Adulto Jovem
8.
Vet Radiol Ultrasound ; 61(4): 453-460, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32462691

RESUMO

Contrast-enhanced voiding urosonography (CE-VUS) has been generally considered as a promising tool to diagnose vesicoureteral reflux and abnormalities in lower urinary tract in human patients, especially in children. The purpose of this prospective study is to evaluate the quality of images of the urinary bladder and urethra obtained by CE-VUS using a second-generation ultrasound contrast agent (SonoVue®) in healthy dogs and to investigate the safety profile of SonoVue® after intravesical administration. Eighty-four CE-VUS examinations with SonoVue® were successfully performed in both unsedated (39/84) and sedated (45/84) dogs. Contrast-enhanced voiding urosonography examination of urinary bladder was technically successful in all (84/84) dogs. The image quality was not considered adequate in five (5/84) dogs including three dogs in whom layering of contrast media during filling phase was observed and two dogs with premature destruction of microbubbles. In these five dogs, the problem was readily recognized and corrected such that the procedure was still successfully undertaken. The assessment of the urethra during spontaneous micturition was successfully performed in all (84/84) dogs in whom voiding was elicited during the examination. No side effects were observed after intravesical application of SonoVue®. This study demonstrates that CE-VUS is a feasible and valuable technique to evaluate low urinary tract morphology and function in dogs. Based on our review of the literature, there are no published reports about the use of this method in dogs.


Assuntos
Meios de Contraste/farmacologia , Doenças do Cão/diagnóstico por imagem , Uretra/diagnóstico por imagem , Micção , Refluxo Vesicoureteral/veterinária , Animais , Cães , Feminino , Masculino , Microbolhas , Fosfolipídeos/farmacologia , Exame Físico , Estudos Prospectivos , Hexafluoreto de Enxofre/farmacologia , Ultrassonografia/métodos , Refluxo Vesicoureteral/diagnóstico por imagem
9.
Br J Radiol ; 93(1110): 20200063, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32271626

RESUMO

Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.


Assuntos
Doenças dos Genitais Masculinos/diagnóstico por imagem , Escroto/diagnóstico por imagem , Ultrassonografia/métodos , Abscesso/diagnóstico por imagem , Adolescente , Fatores Etários , Criança , Contraindicações de Medicamentos , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Cistos/diagnóstico por imagem , Ecocardiografia Doppler em Cores , Técnicas de Imagem por Elasticidade/métodos , Epididimite/diagnóstico por imagem , Humanos , Recém-Nascido , Infarto/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Masculino , Fosfolipídeos/administração & dosagem , Fosfolipídeos/efeitos adversos , Escroto/lesões , Torção do Cordão Espermático/diagnóstico por imagem , Hexafluoreto de Enxofre/administração & dosagem , Hexafluoreto de Enxofre/efeitos adversos , Neoplasias Testiculares/diagnóstico por imagem , Testículo/irrigação sanguínea , Testículo/diagnóstico por imagem , Testículo/lesões
10.
J Med Ultrason (2001) ; 47(2): 287-297, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32125575

RESUMO

PURPOSE: Contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI) can detect microvessels in thyroid nodules. Here, SMI and CEUS were compared for differentiating thyroid nodules. METHODS: Seventy-six patients (102 nodules) underwent SMI and CEUS. The SMI blood flow (BF) grade and CEUS enhanced intensity (EI) were recorded for the periphery and center of each nodule, and evaluated relative to pathological findings. RESULTS: SMI of malignant nodules showed abundant BF in the periphery but lack of BF in the center, while CEUS showed hypoenhancement in the center and periphery. Large and small vessels had greater saliency on SMI-BF grade and CEUS-EI, respectively. Analysis of SMI-BF as diagnostic of thyroid carcinoma specifically at the nodule periphery indicated rates of 82.2%, 79.3%, and 81.3% for sensitivity, specificity, and accuracy, respectively. The corresponding rates for CEUS hypoenhancement were 80.8%, 86.2%, and 82.3%, respectively. Thus, SMI and CEUS rates were similar. CONCLUSION: SMI-BF grade was more affected by vessels of larger inner diameter, while CEUS-EI was more affected by vessels of smaller inner diameter. SMI alone is sufficient for evaluation of blood flow in thyroid nodules, and the diagnostic value of SMI-BF of the periphery is comparable to CEUS hypoenhancement to differentiate thyroid cancer.


Assuntos
Meios de Contraste , Aumento da Imagem/métodos , Microvasos/diagnóstico por imagem , Fosfolipídeos , Hexafluoreto de Enxofre , Nódulo da Glândula Tireoide/irrigação sanguínea , Nódulo da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Glândula Tireoide/irrigação sanguínea , Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide
11.
Medicine (Baltimore) ; 99(7): e19190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049855

RESUMO

To analyze the degree and pattern of influence of contrast-enhanced ultrasonography (CEUS) on the Bosniak classification system for complex renal cystic mass as compared with conventional ultrasonography (US). One hundred two consecutive patients with complex renal cystic masses were retrospectively analyzed. The diagnostic performance of the Conventional US and CEUS were evaluated separately for malignant and benign lesions. The diagnostic concordance rates were calculated according to pathologic diagnoses. ROC curve analysis determined the confidence in the diagnostic accuracy by calculating the area under each ROC curve. Compared to the Conventional US, septae number, wall and/or septae thickness, solid component and the Bosniak classification changed in 17 (16.7%), 39 (38.2%), 31 (30.4%), and 67 (65.7%) patients as compared with 0 (0.0%), 21 (20.6%), 31 (30.4%), and 37 (36.3%) of the treatment strategy that changed after CEUS respectively. The diagnostic performance of CEUS showed overall higher in terms of sensitivity (100.0 vs 97.2%); specificity (90.9 vs 62.1%); positive predictive value (PPV) (85.7 vs 58.3%); negative predictive value (NPV) (100.0 vs 97.6%); and the concordance with pathology (kappa = 0.876 vs 0.515). CEUS had a higher diagnostic confidence (P < .05) according to the area under the ROC curve (AUC = 0.968 vs 0.799).CEUS performed better than the Conventional US in the diagnosis of complex renal cystic mass, and it might be considered as the first tool to evaluate a complex cystic renal mass, especially for these Bosniak III masses displaying the presence of hemorrhage or infection.


Assuntos
Doenças Renais Císticas/diagnóstico por imagem , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças Renais Císticas/classificação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
Sci Rep ; 10(1): 1527, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32001782

RESUMO

Ventilation heterogeneity is frequent in bronchial asthma and can be assessed using multiple breath wash-out testing (MBW). Most data is available in paediatric patients and using nitrogen as a tracer gas. We aimed to evaluate sulphur hexafluoride (SF6) MBW in adult asthmatics. Spirometry, whole-body plethysmography, impulse oscillometry and SF6-MBW were prospectively performed. MBW parameters reflecting global (lung clearance index, LCI), acinar (Sacin) and conductive (Scond) ventilation heterogeneity were derived from three consecutive wash-outs. LCI was calculated for the traditional 2.5% and an earlier 5% stopping point that has the potential to reduce wash-out times. 91 asthmatics (66%) and 47 non-asthmatic controls (34%) were included in final analysis. LCI2.5 and LCI5 were higher in asthmatics (p < 0.001). Likewise, Sacin and Scond were elevated (p < 0.001 and p < 0.01). Coefficient of variation was 3.4% for LCI2.5 and 3.5% for LCI5 in asthmatics. Forty-one asthmatic patients had normal spirometry. ROC analysis revealed an AUC of 0.906 for the differentiation from non-asthmatic controls exceeding diagnostic performance of individual and conventional parameters (AUC = 0.819, p < 0.05). SF6-MBW is feasible and reproducible in adult asthmatics. Ventilation heterogeneity is increased as compared to non-asthmatic controls persisting in asthmatic patients with normal spirometry. Diagnostic performance is not affected using an earlier LCI stopping point while reducing wash-out duration considerably.


Assuntos
Ventilação Pulmonar/fisiologia , Testes de Função Respiratória/métodos , Hexafluoreto de Enxofre/metabolismo , Adulto , Idoso , Asma/diagnóstico , Asma/metabolismo , Asma/fisiopatologia , Testes Respiratórios/métodos , Estudos de Viabilidade , Feminino , Humanos , Pulmão/metabolismo , Masculino , Pessoa de Meia-Idade , Respiração , Espirometria/métodos
13.
Vet Radiol Ultrasound ; 61(4): 31-35, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30614116

RESUMO

A 1-year-old male French Lop rabbit (Oryctolagus cuniculus) was presented with a sudden onset of hyporexia. Physical examination revealed cranial abdominal discomfort. Liver enzymes were elevated on serum biochemistry profile. Abdominal radiographs showed diffusely gas-dilated small intestinal loops. On abdominal ultrasound, a lobe in the right aspect of the liver was hypoechoic with rounded margins and was surrounded by hyperechoic fat and anechoic fluid. Contrast-enhanced ultrasonography showed complete lack of perfusion in the abnormal right liver lobe. Exploratory laparotomy revealed torsion of the quadrate liver lobe. Diffuse coagulation necrosis was noted on histopathologic examination. The rabbit fully recovered after surgery.


Assuntos
Hepatopatias/veterinária , Fosfolipídeos/farmacologia , Coelhos , Hexafluoreto de Enxofre/farmacologia , Anormalidade Torcional/veterinária , Ultrassonografia/veterinária , Animais , Meios de Contraste/farmacologia , Hepatopatias/diagnóstico , Hepatopatias/diagnóstico por imagem , Masculino , Anormalidade Torcional/diagnóstico por imagem , Anormalidade Torcional/cirurgia , Ultrassonografia/métodos
15.
Clin Radiol ; 75(1): 79.e19-79.e24, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31706568

RESUMO

AIM: To evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in differentiating malignant from benign peripheral pulmonary lesions, and to evaluate the feasibility, accuracy, and utility of CEUS-guided biopsy for peripheral pulmonary lesions. MATERIALS AND METHODS: Thirty-three patients with histopathologically confirmed peripheral pulmonary lesions (22 malignant, 11 benign) were enrolled in this retrospective study. Conventional ultrasound (US) was first performed and then CEUS with a contrast-specific mode and sulfur hexafluoride-filled microbubble contrast agent. CEUS indices-time of enhancement (TE), time to peak (TP), extent of peak (EP), mean transit time (MTT), area under curve (AUC), and slope-were recorded and compared between the groups. The ability of CEUS and US to detect necrotic areas within lesions was also compared and the accuracy of CEUS-guided biopsy was calculated. RESULTS: On CEUS, TE was significantly shorter in acute pneumonia lesions than in other types of lesions (p=0.03). Other indices were not significantly different between benign and malignant lesions. Detection of necrosis within lesions was significantly higher with CEUS than with US (51.5% versus 27.3%; p=0.04). The accuracy of CEUS-guided biopsy was 96.9% (32/33). CONCLUSION: The study findings suggest that CEUS can identify necrotic areas within lesions, and thereby, play a useful role in imaging-guided biopsy. The present pilot study indicates that CEUS may help to identify acute pneumonia lesions from other types of pulmonary lesions. CEUS might be a useful additional technique for the diagnosis of lung lesions.


Assuntos
Biópsia Guiada por Imagem , Neoplasias Pulmonares/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Aumento da Imagem/métodos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Projetos Piloto , Estudos Retrospectivos , Hexafluoreto de Enxofre
16.
Ophthalmology ; 127(4): 511-515, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31767435

RESUMO

PURPOSE: To investigate the intraocular lens (IOL) position and refractive outcomes after cataract surgery and phacovitrectomy using swept-source anterior segment OCT (SS-ASOCT). DESIGN: Retrospective case series. PARTICIPANTS: Patients underwent cataract surgery (group A: 34 eyes), phacovitrectomy without gas tamponade (group B: 20 eyes), and phacovitrectomy with gas tamponade (group C: 22 eyes). METHODS: Various parameters associated with the anterior chamber and lens were measured by SS-ASOCT (CASIA2; Tomey Corp, Nagoya, Japan) before and after surgery. Axial lengths were measured by optical biometry (IOLMaster; Carl Zeiss, Oberkochen, Germany). The refraction (spherical equivalent) was measured 1 week and 1 month after surgery. MAIN OUTCOME MEASURES: Refractive outcomes and the parameters measured by SS-ASOCT were statistically evaluated. RESULTS: The overall mean median absolute error (MedAE) was 0.34 diopters (D) at 1 month postoperatively. The MedAE was greater in group C (0.47 D) than in group A (0.31 D) and group B (0.20 D). The overall mean refractive prediction error (ME) was -0.22±0.62 D at 1 month postoperatively. The ME was significantly greater in group C (-0.82±0.64 D) than in group A (0.08±0.39 D) and group B (-0.07±0.45 D) (P < 0.001, P < 0.001), indicating a greater myopic shift in group C. The forward movement of the IOL position was significantly correlated with a greater ME at 1 month (R = 0.53, P < 0.001). CONCLUSIONS: Forward fixation of the IOL caused myopic refractive errors even after the gas had disappeared in eyes that underwent phacovitrectomy with gas tamponade.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Tamponamento Interno , Lentes Intraoculares , Facoemulsificação , Erros de Refração/fisiopatologia , Hexafluoreto de Enxofre/administração & dosagem , Vitrectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biometria , Feminino , Humanos , Fotocoagulação a Laser , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Pseudofacia/fisiopatologia , Refração Ocular/fisiologia , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
17.
J Orthop Res ; 38(5): 1150-1158, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31769543

RESUMO

Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrast-enhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUS-based assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:1150-1158, 2020.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fosfolipídeos , Estudos Prospectivos , Recuperação de Função Fisiológica , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Hexafluoreto de Enxofre , Ultrassonografia
19.
Cornea ; 39(2): 258-262, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31724980

RESUMO

PURPOSE: To assess the efficacy and safety of combined intracameral sulfur hexafluoride and full-thickness corneal sutures in the treatment of acute corneal hydrops (CH). METHODS: This is an uncontrolled series of cases with keratoconus (KC), keratoglobus (KG), and pellucid marginal degeneration that presented with CH of recent onset. RESULT: Thirteen patients completed the study. The mean corneal thickness before treatment was 1,310 (Equation is included in full-text article.)556 µm, which significantly reduced to 660 ± 148 µm at week 1 postoperatively (P = 0.001). It took 11.5 ± 6.5 days for corneal edema to resolve with a minimum and maximum of 5 and 24 days, respectively. Corrected distance Snellen visual acuity (CDVA) significantly improved from 0.04 ± 0.03 before treatment to 0.08 ± 0.06 at week 1 (P = 0.035) and continued to improve through month 1 [(0.11 ± 0.05), P = 0.007] and month 3 [(0.15 ± 0.08), P = 0.002]. No patient needed re-treatment with gas injection, and no complication was detected during the follow-up period. CONCLUSIONS: Combined intracameral gas injection and approximation sutures are probably effective and safe for the treatment of acute CH. This treatment results in rapid recovery with very rare complications.


Assuntos
Câmara Anterior/efeitos dos fármacos , Edema da Córnea/terapia , Ceratocone/complicações , Hexafluoreto de Enxofre/administração & dosagem , Técnicas de Sutura , Doença Aguda , Adolescente , Adulto , Terapia Combinada , Edema da Córnea/etiologia , Edema da Córnea/fisiopatologia , Tamponamento Interno , Feminino , Humanos , Ceratocone/fisiopatologia , Masculino , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
20.
J Ultrasound Med ; 39(2): 247-257, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31334874

RESUMO

OBJECTIVES: Developmental dysplasia of the hip (DDH) is one of the most common developmental deformities of the lower extremity. Although many children are successfully treated with a brace or harness, some require intraoperative closed or open reduction and spica casting. Surgical reduction is largely successful to relocate the hip; however, iatrogenic avascular necrosis is a major source of morbidity. Recent research showed that postoperative gadolinium-enhanced magnetic resonance imaging (MRI) can depict hip perfusion, which may predict a future incidence of avascular necrosis. As contrast-enhanced ultrasound (CEUS) assesses blood flow in real time, it may be an effective intraoperative alternative to evaluate femoral head perfusion. Here we describe our initial experience regarding the feasibility of intraoperative CEUS of the hip for the assessment of femoral head perfusion before and after DDH reduction. METHODS: This single-institution retrospective Institutional Review Board-approved study with a waiver of informed consent evaluated intraoperative hip CEUS in children with DDH compared to postoperative contrast-enhanced MRI. Pediatric radiologists, blinded to prior imaging findings and outcomes, reviewed both CEUS and MRI examinations separately and some time from the initial examination both independently and in consensus. RESULTS: Seventeen patients had 20 intraoperative CEUS examinations. Twelve of 17 (70.6%) had prereduction hip CEUS, postreduction hip CEUS, and postreduction gadolinium-enhanced MRI. Seven of 12 (58.3%) were evaluable retrospectively. All CEUS studies showed blood flow in the femoral epiphysis before and after reduction, and all MRI studies showed femoral head enhancement after reduction. The CEUS and MRI for all 7 patients also showed physeal blood flow. CONCLUSIONS: Contrast-enhanced ultrasound is a feasible intraoperative tool for assessing adequate blood flow after hip reduction surgery in DDH.


Assuntos
Cabeça do Fêmur/irrigação sanguínea , Cabeça do Fêmur/diagnóstico por imagem , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Ultrassonografia/métodos , Meios de Contraste , Estudos de Viabilidade , Feminino , Humanos , Lactente , Período Intraoperatório , Imagem por Ressonância Magnética , Masculino , Compostos Organometálicos , Estudos Retrospectivos , Hexafluoreto de Enxofre
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