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1.
Ann Hematol ; 100(5): 1241-1249, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33660034

RESUMO

The objective of this study is to evaluate the prognostic features of multiple myeloma (MM) using whole-body low-dose computed tomography (WBLDCT). One hundred three patients with biopsy-proven MM who underwent WBLDCT were retrospectively enrolled. The evolution of osteolytic lesions overtime was performed by measuring the maximum axial diameter at the baseline (T0) and the end of follow-up (Te), by using a cut-off value of 10 mm. The location and dimension of up to three lesions were registered. The time-to-fracture (TTF) was recorded. Sixty-three percent of patients presented a focal pattern, 22% a diffuse pattern, and 15% a combined one. Seventy-two percent of patients with lesions ≤ 10 mm presented stability, 27% a dimensional increase, and 1% a decrease. Patients with lesions >10 mm showed a statistically significant difference regarding the mean difference of axial diameter between T0 and Te (p = 0.015). Patients with lesions >10 mm showed an odds ratio (OR) of 29.8 (95%CIs 3.8-230.5) to develop at least one fracture. Mean TTF was significantly lower in patients with lesions >10 mm in comparison with lesions ≤ 10 mm (9 ± 3 vs 23 ± 7 months, respectively, p = 0.011). WBLDCT represents a reliable imaging-based tool for proper management of MM patients, showing that diffuse form or small lytic lesions may deserve a less frequent follow-up.


Assuntos
Mieloma Múltiplo/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Estadiamento de Neoplasias/métodos , Doses de Radiação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos
2.
Br J Radiol ; 94(1120): 20200682, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33733812

RESUMO

OBJECTIVE: To assess intra- and inter-reader variability of apparent diffusion coefficient (ADC) and fat fraction (FF) measurement in focal myeloma bone lesions and the influence of lesion size. METHODS: 22 myeloma patients with focal active disease on whole body MRI were included. Two readers outlined a small (5-10 mm) and large lesion (>10 mm) in each subject on derived ADC and FF maps; one reader performed this twice. Intra- and inter-reader agreement for small and large lesion groups were calculated for derived statistics from each map using within-subject standard deviation, coefficient of variation, interclass correlation coefficient measures, and visualized with Bland-Altman plots. RESULTS: For mean ADC, intra- and inter-reader repeatability demonstrated equivalently low coefficient of variation (3.0-3.6%) and excellent interclass correlation coefficient (0.975-0.982) for both small and large lesions. For mean FF, intra- and inter-reader repeatability was significantly poorer for small lesions compared to large lesions (intra-reader within-subject standard variation estimate is 2.7 times higher for small lesions than large lesions (p = 0.0071), and for inter-reader variations is 3.8 times higher (p = 0.0070)). CONCLUSION: There is excellent intra- and inter-reader agreement for mean ADC estimates, even for lesions as small as 5 mm. For FF measurements, there is a significant increase in coefficient of variation for smaller lesions, suggesting lesions >10 mm should be selected for lesion FF measurement. ADVANCES IN KNOWLEDGE: ADC measurements of focal myeloma have excellent intra- and inter-reader agreement. FF measurements are more susceptible to lesion size as intra- and inter-reader agreement is significantly impaired in lesions less than 10 mm.


Assuntos
Imagem por Ressonância Magnética/métodos , Mieloma Múltiplo/diagnóstico por imagem , Imagem Corporal Total/métodos , Tecido Adiposo/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Reprodutibilidade dos Testes
3.
Nat Commun ; 12(1): 1880, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33767174

RESUMO

Computational decision support systems could provide clinical value in whole-body FDG-PET/CT workflows. However, limited availability of labeled data combined with the large size of PET/CT imaging exams make it challenging to apply existing supervised machine learning systems. Leveraging recent advancements in natural language processing, we describe a weak supervision framework that extracts imperfect, yet highly granular, regional abnormality labels from free-text radiology reports. Our framework automatically labels each region in a custom ontology of anatomical regions, providing a structured profile of the pathologies in each imaging exam. Using these generated labels, we then train an attention-based, multi-task CNN architecture to detect and estimate the location of abnormalities in whole-body scans. We demonstrate empirically that our multi-task representation is critical for strong performance on rare abnormalities with limited training data. The representation also contributes to more accurate mortality prediction from imaging data, suggesting the potential utility of our framework beyond abnormality detection and location estimation.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Interpretação de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Imagem Corporal Total/métodos , Conjuntos de Dados como Assunto , Fluordesoxiglucose F18 , Humanos , Comportamento Multitarefa , Processamento de Linguagem Natural
5.
Br J Radiol ; 94(1120): 20210043, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33571003

RESUMO

OBJECTIVE: A new Bayesian penalized likelihood reconstruction algorithm for positron emission tomography (PET) (Q.Clear) is now in clinical use for fludeoxyglucose (FDG) PET/CT. However, experience with non-FDG tracers and in special patient populations is limited. This pilot study aims to compare Q.Clear to standard PET reconstructions for 18F sodium fluoride (18F-NaF) PET in obese patients. METHODS: 30 whole body 18F-NaF PET/CT scans (10 patients with BMI 30-40 Kg/m2 and 20 patients with BMI >40 Kg/m2) and a NEMA image quality phantom scans were analyzed using ordered subset expectation maximization (OSEM) and Q.Clear reconstructions methods with B400, 600, 800 and 1000. The images were assessed for overall image quality (IQ), noise level, background soft tissue, and lesion detectability, contrast recovery (CR), background variability (BV) and contrast-to-noise ratio (CNR) for both algorithms. RESULTS: CNR for clinical cases was higher for Q.Clear than OSEM (p < 0.05). Mean CNR for OSEM was (21.62 ± 8.9), and for Q.Clear B400 (31.82 ± 14.6), B600 (35.54 ± 14.9), B800 (39.81 ± 16.1), and B1000 (40.9 ± 17.8). As the ß value increased the CNR increased in all clinical cases. B600 was the preferred ß value for reconstruction in obese patients. The phantom study showed Q.Clear reconstructions gave lower CR and lower BV than OSEM. The CNR for all spheres was significantly higher for Q.Clear (independent of ß) than OSEM (p < 0.05), suggesting superiority of Q.Clear. CONCLUSION: This pilot clinical study shows that Q.Clear reconstruction algorithm improves overall IQ of 18F-NaF PET in obese patients. Our clinical and phantom measurement results demonstrate improved CNR and reduced BV when using Q.Clear. A ß value of 600 is preferred for reconstructing 18F-NaF PET/CT with Q.Clear in obese patients. ADVANCES IN KNOWLEDGE: 18F-NaF PET/CT is less susceptible to artifacts induced by body habitus. Bayesian penalized likelihood reconstruction with18F-NaF PET improves overall IQ in obese patients.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Radioisótopos de Flúor , Interpretação de Imagem Assistida por Computador/métodos , Obesidade/complicações , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fluoreto de Sódio , Algoritmos , Teorema de Bayes , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Osso e Ossos/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Imagem Corporal Total/métodos
6.
Eur J Radiol ; 137: 109584, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33596499

RESUMO

PURPOSE: To document the diagnostic yields of whole-body MRI (WB-MRI) screening for asymptomatic individuals by using a classification system that categorizes the findings by clinical relevance and provides a flowchart for further investigations, and to determine the influence of WB-MRI findings on clinical decision-making. METHODS: In this institutional review board-approved study, a retrospective review of individuals who underwent WB-MRI between 2009 and 2020 was conducted, and asymptomatic participants who underwent non-contrast-enhanced comprehensive WB-MRI for screening were enrolled. Participants were classified into four categories based on WB-MRI findings, and those with relevant findings (i.e., categories 3 and 4) were referred for further diagnostic workup. The participants' medical records were investigated, and interviews were conducted to reveal false-negative findings and identify the number of WB-MRI-triggered treatments. RESULTS: We included 576 participants (377 [65.4 %] men, 199 [34.6 %] women; mean age, 48.40 ±â€¯10.82 years), of which 266 (46.2 %) and 310 (53.8 %) underwent WB-MRI with 1.5 T and 3.0 T magnets, respectively. Approximately one-third of the participants showed clinically relevant findings, and 65 (11.2 %) received a treatment triggered by WB-MRI. Notably, 15 (2.6 %) and 28 (4.8 %) participants had cancers and intracranial aneurysms, respectively. Of the 576 participants, 16 (2.8 %) had false-negative findings, among which five had cancers. CONCLUSION: WB-MRI yields numerous important findings that trigger therapeutic interventions in a large sample of asymptomatic adults. However, considering its inherent limitations, WB-MRI might be inadequate for detecting malignancies such as colon, thyroid, and breast cancers; thus, it may serve as a complementary screening method for health-conscious individuals.


Assuntos
Neoplasias da Mama , Imagem por Ressonância Magnética , Adulto , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Retrospectivos , Imagem Corporal Total
7.
Br J Radiol ; 94(1121): 20201329, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33571010

RESUMO

OBJECTIVES: To evaluate image quality and lesion detection capabilities of low-dose (LD) portal venous phase whole-body computed tomography (CT) using deep learning image reconstruction (DLIR). METHODS: The study cohort of 59 consecutive patients (mean age, 67.2 years) who underwent whole-body LD CT and a prior standard-dose (SD) CT reconstructed with hybrid iterative reconstruction (SD-IR) within one year for surveillance of malignancy were assessed. The LD CT images were reconstructed with hybrid iterative reconstruction of 40% (LD-IR) and DLIR (LD-DLIR). The radiologists independently evaluated image quality (5-point scale) and lesion detection. Attenuation values in Hounsfield units (HU) of the liver, pancreas, spleen, abdominal aorta, and portal vein; the background noise and signal-to-noise ratio (SNR) of the liver, pancreas, and spleen were calculated. Qualitative and quantitative parameters were compared between the SD-IR, LD-IR, and LD-DLIR images. The CT dose-index volumes (CTDIvol) and dose-length product (DLP) were compared between SD and LD scans. RESULTS: The image quality and lesion detection rate of the LD-DLIR was comparable to the SD-IR. The image quality was significantly better in SD-IR than in LD-IR (p < 0.017). The attenuation values of all anatomical structures were comparable between the SD-IR and LD-DLIR (p = 0.28-0.96). However, background noise was significantly lower in the LD-DLIR (p < 0.001) and resulted in improved SNRs (p < 0.001) compared to the SD-IR and LD-IR images. The mean CTDIvol and DLP were significantly lower in the LD (2.9 mGy and 216.2 mGy•cm) than in the SD (13.5 mGy and 1011.6 mGy•cm) (p < 0.0001). CONCLUSION: LD CT images reconstructed with DLIR enable radiation dose reduction of >75% while maintaining image quality and lesion detection rate and superior SNR in comparison to SD-IR. ADVANCES IN KNOWLEDGE: Deep learning image reconstruction algorithm enables around 80% reduction in radiation dose while maintaining the image quality and lesion detection compared to standard-dose whole-body CT.


Assuntos
Aprendizado Profundo , Neoplasias/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Meios de Contraste/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/cirurgia , Período Pós-Operatório , Estudos Prospectivos , Controle de Qualidade , Doses de Radiação , Razão Sinal-Ruído , Tomografia Computadorizada por Raios X/normas
8.
Clin Nucl Med ; 46(4): 310-322, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534256

RESUMO

PURPOSE: To compare the agreement between whole-body (WB) magnetic resonance (MR) imaging, 18F-FDG PET/CT, and skeletal survey (SS) in patients with multiple myeloma (MM) for diagnosis, initial staging, response evaluation, and early detection of complications. METHODS: This is a retrospective cohort study including MM patients who were diagnosed, treated, and followed in 2 institutions. These patients were studied with SS, WB-MR, and/or 18F-FDG PET/CT. We studied bone lesions by anatomical locations and analyzed the concordance between SS and a tomographic technique (WB-MR or 18F-FDG PET/CT) and between both tomographic techniques (WB-MR and PET/CT). RESULTS: Forty-four MM patients with a mean age of 62.6 years (range, 38-85 years) were included from January 2012 to February 2016. Whole-body MR and 18F-FDG PET/CT found more lesions than SS in every location except in the skull. Concordance between WB-MR and 18F-FDG PET/CT was either good or excellent in most of the locations and in plasmacytoma studies. However, WB-MR was better than 18F-FDG PET/CT in the study of complications (medullar compression and vascular necrosis). CONCLUSIONS: Our results suggest the study of MM patients should include WB-MR and/or 18F-FDG PET/CT, whereas SS is only useful for the skull. Whole-body MR and 18F-FDG PET/CT are complementary techniques, because both of them show good concordance in almost every location. It is still necessary to individualize the indication of each technique according to patient characteristics.


Assuntos
Fluordesoxiglucose F18 , Imagem por Ressonância Magnética , Mieloma Múltiplo/patologia , Mieloma Múltiplo/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Esqueleto/diagnóstico por imagem , Imagem Corporal Total , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
9.
Clin Nucl Med ; 46(4): 358-360, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33492860

RESUMO

ABSTRACT: A 64-year-old woman with metastatic papillary thyroid cancer underwent a total thyroidectomy followed by 2 courses of 131I therapy. The posttherapeutic whole-body scan after the second dose of 131I therapy showed multifocal bone metastasis. In addition, there is focal abnormal intense radiotracer uptake at the right inguinal region. SPECT/CT revealed that this abnormal focal radioactivity was from a superficial skin lesion. Further physical examination revealed a raised, approximately 1-cm, irregular grayish-brown lesion on the right groin skin. Histopathological examination confirmed the diagnosis of basal cell papilloma (seborrheic keratosis).


Assuntos
Radioisótopos do Iodo/metabolismo , Neoplasia de Células Basais/metabolismo , Neoplasia de Células Basais/secundário , Papiloma/metabolismo , Câncer Papilífero da Tireoide/patologia , Reações Falso-Positivas , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasia de Células Basais/diagnóstico por imagem , Papiloma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tireoidectomia , Imagem Corporal Total
10.
Clin Nucl Med ; 46(4): 326-328, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512955

RESUMO

ABSTRACT: We describe a case of a 69-year-old woman with follicular thyroid cancer of long evolution, with thyroidectomy 20 years before, who had remained clinically stable until now, when she started to present abnormal levels of serum thyroglobulin. An 123I whole-body scan showed a high uptake in the upper right half of her abdomen, and an 18F-FDG PET/CT located this focus at the liver's round ligament. Pathology findings after surgery showed the focus to be a differentiated thyroid cancer metastasis. This is an unusual presentation of differentiated thyroid cancer metastasis.


Assuntos
Neoplasias Hepáticas/secundário , Ligamento Redondo do Fígado/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Ligamento Redondo do Fígado/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Imagem Corporal Total
11.
Am J Forensic Med Pathol ; 42(1): 1-8, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33416234

RESUMO

ABSTRACT: The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.


Assuntos
/mortalidade , Pulmão/patologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Autopsia , Índice de Massa Corporal , Edema Encefálico/patologia , Cardiomegalia/patologia , Comorbidade , Trombose Coronária/patologia , Bases de Dados Factuais , Fígado Gorduroso/patologia , Feminino , Patologia Legal , Glomerulosclerose Segmentar e Focal/patologia , Hepatomegalia/patologia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Nefroesclerose/patologia , New Mexico/epidemiologia , Sobrepeso/epidemiologia , Pandemias , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/patologia , Edema Pulmonar/diagnóstico por imagem , Edema Pulmonar/patologia , Distribuição por Sexo , Streptococcus pneumoniae/isolamento & purificação , Tomografia Computadorizada por Raios X , Corpo Vítreo/química , Imagem Corporal Total
12.
Eur J Radiol ; 136: 109533, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33454461

RESUMO

PURPOSE: To investigate the current role of WB-MRI for rheumatic inflammatory diseases in clinical practice using a survey addressed to musculoskeletal radiologists. METHODS: A survey composed of 61 questions, subdivided in three sections, demographics (five questions), application of WB-MRI for inflammatory musculoskeletal diseases in adults and children (28 questions: 7 open and 21 multiple choice for each subgroup) was distributed via the European Society of Musculoskeletal Radiology (ESSR) from July 2 to December 31, 2018 to radiologists working in academic, private, and public workplaces. Comparisons among the different workplaces were performed using the Chi-squared and the Kruskal-Wallis test for nominal and ordinal data, respectively (p < 0.05). RESULTS: Seventy-two participants out of the 1779 (4%) members of the ESSR with 10.4 ±â€¯7.9 years of experience in musculoskeletal imaging, replied to at least one question. 30.6% and 12.3% of the respondents performed at least 50 WB-MRI examinations per year in adults and children, respectively. The most frequent indications were myositis in adults and chronic recurrent multifocal osteomyelitis (CRMO) in children, the latter mostly in academic centers (p = 0.013). The ESSR Arthrits Subcommitte's protocol was applied by half of the participants and especially radiologists working in private practice used it for adults (p = 0.025). Contrast medium was rarely used for adults particularly by academics (p = 0.04). Diffusion Weighted Imaging was applied for children mostly in private practice (p = 0.01) although, overall, it plays a marginal role. Scoring systems were rarely used. Ongoing research is limited. CONCLUSION: WB-MRI is not routinely applied for musculoskeletal inflammatory diseases. The most frequent indications are myositis and CRMO.


Assuntos
Osteomielite , Radiologia , Adulto , Criança , Humanos , Imagem por Ressonância Magnética , Inquéritos e Questionários , Imagem Corporal Total
13.
Cancer Imaging ; 21(1): 5, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413685

RESUMO

BACKGROUND: We prospectively evaluated the diagnostic utility of whole-body diffusion-weighted imaging with background body signal suppression and T2-weighted short-tau inversion recovery MRI (WB-DWIBS/STIR) for the pretherapeutic staging of indolent lymphoma in 30 patients. METHODS: This prospective study included 30 treatment-naive patients with indolent lymphomas who underwent WB-DWIBS/STIR and conventional imaging workup plus biopsy. The pretherapeutic staging agreement, sensitivity, and specificity of WB-DWIBS/STIR were investigated with reference to the multimodality and multidisciplinary consensus review for nodal and extranodal lesions excluding bone marrow. RESULTS: In the pretherapeutic staging, WB-DWIBS/STIR showed very good agreement (κ = 0.96; confidence interval [CI], 0.88-1.00), high sensitivity (93.4-95.1%), and high specificity (99.0-99.4%) for the whole-body regions. These results were similar to those of 18F-FDG-PET/CT, except for the sensitivity for extranodal lesions. For extranodal lesions, WB-DWIBS/STIR showed higher sensitivity compared to 18F-FDG-PET/CT for the whole-body regions (94.9-96.8% vs. 79.6-86.3%, P = 0.058). CONCLUSION: WB-DWIBS/STIR is an effective modality for the pretherapeutic staging of indolent lymphoma, and it has benefits when evaluating extranodal lesions, compared with 18F-FDG-PET/CT.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Linfoma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Imagem Corporal Total/métodos , Adulto , Idoso , Biópsia , Feminino , Fluordesoxiglucose F18 , Humanos , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Estudos Prospectivos , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Adulto Jovem
14.
Medicine (Baltimore) ; 100(2): e24205, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466198

RESUMO

OBJECTIVES: Controversies emerge over routine performances of whole-body computed tomography (WBCT) in patients with blunt polytrauma. The existing randomized and non-randomized evidence is inconclusive, and during observations of non-trauma, incidental findings, detected by WBCT, have left uncertainty regarding their consequences and optimal management. Additionally, previous meta-analyses have failed to address the limitations of primary studies and issues associated with incidental findings. Therefore, we planned a new systematic review to address these points. METHODS: We will search the PubMed, EMBASE, and Cochrane Central databases from inception to December 31, 2020, with no language restriction and perform full-text evaluation of potentially relevant articles. We will include prospective and retrospective studies with a single-gate design that assessed diagnostic accuracy and/or yield of WBCT to detect traumatic injuries, and studies that assessed incidental findings detected by WBCT. Additionally, we will include randomized controlled trials and non-randomized comparative studies that assessed the effectiveness of WBCT against conventional care, including selective computed tomography (CT). Studies of patients of all ages with blunt traumatic injuries, assessed at an emergency department, will be included. Two reviewers will extract data and rate the study validity via standard quality assessment tools. The primary outcome of interest will be reduction in mortality. Our secondary outcomes will include diagnostic accuracy and yield, detection of incidental findings and clinical outcomes associated with these detections, and improvement in other non-mortality clinical outcomes. We will qualitatively assess study, patient, and intervention characteristics and clinical outcomes. If appropriate, we will perform random-effects model meta-analyses to obtain summary estimates. Finally, we will assess the certainty of evidence by the grading the quality of evidence and strength of recommendations. ETHICS AND DISSEMINATION: Ethics approval is not applicable, as this is a secondary analysis of publicly available data. The review results will be submitted for publication in peer-reviewed journals. PROSPERO REGISTRATION: CRD42020187852.


Assuntos
Protocolos Clínicos , Imagem Corporal Total/normas , Ferimentos não Penetrantes/diagnóstico por imagem , Humanos , Metanálise como Assunto , Sensibilidade e Especificidade , Revisões Sistemáticas como Assunto , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Imagem Corporal Total/métodos
15.
Niger J Clin Pract ; 24(1): 127-131, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33473038

RESUMO

Objectives: We aimed to evaluate the findings of whole-body computed tomography (WBCT) in pediatric high-energy trauma patients and to determine the distribution of injuries. Materials and Methods: The WBCT images of 1132 pediatric patients who were admitted to emergency department between 2013 and 2018 for high-energy trauma were evaluated retrospectively. Six hundred and twenty patients with abdominal, chest, head, and skeletal injuries were included. Results: Using the WBCT images, we detected skeletal injuries in 557 pediatric patients; spinal, rib, extremity, and pelvic fractures were detected in 113, 57, 51, and 37 patients, respectively. Craniofacial fractures were viewed in 299 patients. We detected intracranial hemorrhage, pulmonary contusion, pneumothorax, and solid organ injuries in 102, 115, 45, and 55 pediatric patients, respectively. Conclusion: The frequency and distribution of injuries in trauma cases vary between adults and children. While there are many studies about whole-body CT findings of adult trauma, there are only a few studies about pediatric high-energy trauma patients. The traumatic injury types also differ in pediatric age groups. WBCT scan (with pediatric radiation dose) is the fast and accurate diagnostic tool in high-energy trauma cases and therefore is associated with low mortality rates.


Assuntos
Tomografia Computadorizada por Raios X , Imagem Corporal Total , Adulto , Criança , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos , Coluna Vertebral
16.
AJR Am J Roentgenol ; 216(3): 742-751, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33439048

RESUMO

OBJECTIVE. The purpose of this article is to analyze whole-body low-dose CT-detected appendicular medullary patterns of attenuation in patients with newly diagnosed multiple myeloma and to determine the diagnostic performance of whole-body low-dose CT in detecting diffuse marrow infiltration. MATERIALS AND METHODS. A total of 76 patients with myeloma who underwent whole-body low-dose CT and spinal MRI at initial assessment were retrospectively analyzed. The medullary cavities of femurs and humeri were evaluated qualitatively and quantitatively on CT. Medullary attenuation and SD-to-mean attenuation ratio were recorded for each long bone. The pattern of marrow involvement on spinal MRI was used as reference. The chi-square test was used to evaluate the relationship between the CT-based appendicular medullary cavity pattern and the MRI pattern, and ROC analysis was performed to assess the diagnostic accuracy of CT attenuation measurements for the differentiation between diffuse and mixed CT-based appendicular medullary cavity patterns. RESULTS. Medullary attenuation differed significantly among mixed, nodular, and diffuse CT-based appendicular medullary cavity patterns in the femurs (mean, 34.23 HU and range, 15-61 HU; mean, 66.26 HU and range, 26-104 HU; mean, 92.80 HU and range, 53-127 HU, respectively) and humeri (mean, 22.18 HU and range, 9-41; mean, 61.18 HU and range, 23-93 HU; mean, 77.50 and range, 25-105 HU, respectively). To discriminate between diffuse and mixed CT-based appendicular medullary cavity patterns, optimal cutoff attenuation values were 63 HU (sensitivity, 97.7%; specificity, 100.0%) for the femurs, and 52 HU (sensitivity, 97.4%; specificity, 100.0%) for the humeri. A total of 24 of 30 (80.0%) patients with a diffuse MRI pattern showed a diffuse CT-based appendicular medullary cavity pattern on whole-body low-dose CT, and all patients with a diffuse CT-based appendicular medullary cavity pattern also showed a diffuse pattern on MRI. CONCLUSION. According to analysis of peripheral medullary patterns of attenuation, whole-body low-dose CT can identify patients with multiple myeloma with diffuse marrow involvement.


Assuntos
Medula Óssea/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Mieloma Múltiplo/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Imagem Corporal Total/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Distribuição de Qui-Quadrado , Feminino , Fêmur/diagnóstico por imagem , Humanos , Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Estudos Retrospectivos , Sensibilidade e Especificidade , Coluna Vertebral/diagnóstico por imagem
17.
AJR Am J Roentgenol ; 216(3): 776-780, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33474987

RESUMO

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


Assuntos
Carcinoma de Célula de Merkel/diagnóstico por imagem , Fluordesoxiglucose F18 , Extremidade Inferior/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/diagnóstico por imagem , Idoso , Carcinoma de Célula de Merkel/secundário , Feminino , Humanos , Masculino , Estadiamento de Neoplasias/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Imagem Corporal Total
18.
Clin Nucl Med ; 46(3): e154-e155, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512839

RESUMO

ABSTRACT: We represent the case of a 61-year-old man with atypical carcinoid tumor of the lung. On posttherapy 177Lu-DOTATATE whole-body scan, focal intense uptake in the inferomedial side of the liver was detected. Pretherapy 68Ga-DOTATATE PET/CT showed no sign of liver metastasis, and posttherapy diagnostic dynamic liver MRI is used to exclude metastatic liver disease. Focal intense uptake was attributed to physiological gallbladder uptake.


Assuntos
Vesícula Biliar/metabolismo , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/secundário , Octreotida/análogos & derivados , Compostos Organometálicos/metabolismo , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Transporte Biológico , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Octreotida/metabolismo , Imagem Corporal Total
19.
Nat Commun ; 12(1): 455, 2021 01 19.
Artigo em Inglês | MEDLINE | ID: mdl-33469005

RESUMO

The technology of magnetic resonance imaging is developing towards higher magnetic fields to improve resolution and contrast. However, whole-body imaging at 7 T or even higher flux densities remains challenging due to wave interference, tissue inhomogeneities, and high RF power deposition. Nowadays, proper RF excitation of a human body in prostate and cardiac MRI is only possible to achieve by using phased arrays of antennas attached to the body (so-called surface coils). Due to safety concerns, the design of such coils aims at minimization of the local specific absorption rate (SAR), keeping the highest possible RF signal in the region of interest. Most previously demonstrated approaches were based on resonant structures such as e.g. dipoles, capacitively-loaded loops, TEM-line sections. In this study, we show that there is a better compromise between the transmit signal [Formula: see text] and the local SAR using non-resonant surface coils generating a low electric field in the proximity of their conductors. With this aim, we propose and experimentally demonstrate a leaky-wave antenna implemented as a periodically-slotted microstrip transmission line. Due to its non-resonant radiation, it induces only slightly over half the peak local SAR compared to a state-of-the-art dipole antenna but has the same transmit efficiency in prostate imaging at 7 T. Unlike other antennas for MRI, the leaky-wave antenna does not require to be tuned and matched when placed on a body, which makes it easy-to-use in prostate imaging at 7 T MRI.


Assuntos
Imagem por Ressonância Magnética/instrumentação , Imagem Corporal Total/instrumentação , Absorção de Radiação , Radiação Eletromagnética , Desenho de Equipamento , Humanos , Campos Magnéticos/efeitos adversos , Imagem por Ressonância Magnética/efeitos adversos , Imagem por Ressonância Magnética/métodos , Imagens de Fantasmas , Imagem Corporal Total/efeitos adversos , Imagem Corporal Total/métodos
20.
PET Clin ; 16(1): 89-97, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33160926

RESUMO

Total-body PET enables high-sensitivity imaging with dramatically improved signal-to-noise ratio. These enhanced performance characteristics allow for decreased PET scanning times acquiring data "total-body wide" and can be leveraged to decrease the amount of radiotracer required, thereby permitting more frequent imaging or longer imaging periods during radiotracer decay. Novel approaches to PET imaging of infectious diseases are emerging, including those that directly visualize pathogens in vivo and characterize concomitant immune responses and inflammation. Efforts to develop these imaging approaches are hampered by challenges of traditional imaging platforms, which may be overcome by novel total-body PET strategies.


Assuntos
Doenças Transmissíveis/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Imagem Corporal Total/métodos , Humanos , Razão Sinal-Ruído , Tempo
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