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3.
Rev Assoc Med Bras (1992) ; 65(6): 761-766, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340299

RESUMO

OBJECTIVE: CT perfusion (CTP) is an imaging technique that can be used to evaluate the changes in the microcirculation of tumor tissues. Our study aimed to investigate the role of CTP in predicting mediastinal lymph node metastasis. METHODS: Clinical data of 58 patients who received surgical resection of lung cancer and lymph node dissection in our hospital from June 2012 to December 2014 were collected. Patients were divided into a positive lymph node metastasis group and a negative lymph node metastasis group. Parameters of CTP, including peak enhancement intensity (PEI), perfusion value (PV), as well as blood volume (BV), were compared between the two groups. The receiver-operating characteristic (ROC) curve was used to predict mediastinal lymph node metastasis. RESULTS: The PV of the positive lymph node metastasis group was significantly higher than that of the negative group (p < 0.001). The ROC curve analysis showed that PV can be used as an index to predict mediastinal lymph node metastasis of lung cancer. The sensitivity and specificity of a PV greater than 7.5ml·min-1·ml-1 in predicting lymph node metastasis of lung cancer were 78.3 % and 91.4 %, respectively. CONCLUSION: The PV of low dose CT perfusion can be used as an index for predicting mediastinal lymph node metastasis of lung cancer.


Assuntos
Carcinoma/secundário , Neoplasias Pulmonares/patologia , Metástase Linfática/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/secundário , Imagem de Perfusão/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 44(5): 477-484, 2019 May 28.
Artigo em Chinês | MEDLINE | ID: mdl-31303609

RESUMO

OBJECTIVE: To investigate the value of the total liver CT perfusion imaging in the evaluation of rabbit VX2 liver tumors treated with TACE and apatinib.
 Methods: Thirty-six rabbit VX2 liver cancer models were established and randomly divided into 4 groups. Group A: simple TACE group; Group B: simple oral administration of apatinib mesylate; Group C: TACE + oral apatinib mesylate; Group D: control group, administration of saline. CT perfusion imaging (CTPI) was performed before treatment and on the 7 and 14 days after the treatment to acquire perfusion parameters including blood flow (BF), blood volume (BV), MTT (mean transit time), surface permeability (PS), and hepatic artery fraction (HAF). One tumor rabbit was sacrificed in each group after the first perfusion scan, and the remaining tumor rabbits were sacrificed after the last perfusion scan on the 14th day of the treatment. The borders of the tumors were stained immunohistochemically, and microvascular density (MVD) was measured by anti-CD34. The differences of perfusion parameters were compared to evaluate the liver hemodynamic changes, and statistical repeated measurement variance analysist correlation analysis were performed.
 Results: There were no significant differences in CTPI parameters of BF, BV, MTT, HAF and PS between the 4 groups before treatment (P>0.05). After the treatment, HB, HAF and PS were decreased significantly in Group A, B, and C and slightly increased in the Group D. The value of MVD after 14 d treatment was 80.1±16.4 in Group A, 50.2±11.2 in Group B, 27.4±9.7 in Group C, 68.7±12.7 in Group D, respectively. The value of MVD in the Group C were significantly lower than that in Group A, B, and D. It showed positive correlation between BF, HAF, PS and MVD in Group B, C, and D, and there was no significant correlation between BV, MTT and MVD. It showed no significant correlation between MVD and each CTPI parameter in Group A.
 Conclusion: Total liver CT perfusion can quantitatively evaluate the blood perfusion information of rabbit liver VX2 tumor after TACE. TACE combined with oral apatinib can effectively inhibit tumor growth and improve the therapeutic effect of VX2 tumor.


Assuntos
Carcinoma Hepatocelular , Quimioembolização Terapêutica , Neoplasias Hepáticas , Animais , Neovascularização Patológica , Imagem de Perfusão , Piridinas , Coelhos , Tomografia Computadorizada por Raios X
5.
J Comput Assist Tomogr ; 43(4): 599-604, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162238

RESUMO

OBJECTIVE: The objective of this study was to evaluate the role and limit of iodine maps by dual-energy computed tomography (CT) single scan for pancreatic cancer. METHODS: Thirty patients with suspected solitary pancreatic cancer were enrolled in this study and underwent CT perfusion and iodine maps. The parameters of pancreatic cancer and normal pancreatic tissue were calculated. Pearson correlation and paired t test were used for evaluating 2 techniques. RESULTS: Iodine concentration had a moderate positive correlation with blood flow or blood volume (P < 0.05 for both). All values of iodine concentration and blood flow, iodine concentration, and blood volume had significant positive correlations (P < 0.001 for both). The mean effective dose for CT perfusion and iodine maps had significant difference (8.61 ± 0.00 mSv vs 1.13 ± 0.14 mSv, P < 0.001). CONCLUSIONS: Iodine maps had the potential to replace routine CT perfusion for pancreatic cancer with low radiation dose.


Assuntos
Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/epidemiologia , Imagem de Perfusão , Imagem Radiográfica a Partir de Emissão de Duplo Fóton , Tomografia Computadorizada por Raios X , Idoso , Meios de Contraste/uso terapêutico , Feminino , Humanos , Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Doses de Radiação
6.
Anticancer Res ; 39(6): 3053-3057, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177148

RESUMO

AIM: Evaluation of osteoid osteoma (OO) perfusion characteristics pre and post microwave ablation (MWA) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with clinical follow-up. MATERIALS AND METHODS: Patients with OO underwent T1-weighted 3D DCE-MRI at 3.0T pre and post MWA. Signal intensity (SI) and perfusion of lesions was measured. Patients answered a questionnaire for clinical follow-up. RESULTS: A total of 24 patients were included (mean age of 28 years; nine females); 21 DCE-MRI datasets were of sufficient quality for analysis. The mean SI of lesions, plasma flow, volume of distribution and pain level all decreased statistically significantly after ablation. CONCLUSION: Quantitative MRI-perfusion analysis allows for objective treatment evaluation after MWA of OO, plasma flow and volume of distribution seem to be reliable indicators for successful thermoablation. MWA is an effective treatment option for OO with a low risk profile and significant pain reduction after treatment.


Assuntos
Técnicas de Ablação , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Angiografia por Ressonância Magnética , Micro-Ondas/uso terapêutico , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Imagem de Perfusão/métodos , Técnicas de Ablação/efeitos adversos , Adolescente , Adulto , Neoplasias Ósseas/irrigação sanguínea , Neoplasias Ósseas/patologia , Criança , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Osteoma Osteoide/irrigação sanguínea , Osteoma Osteoide/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
Radiologe ; 59(7): 603-609, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31161301

RESUMO

PURPOSE OF IMAGING: Imaging plays a major role in the diagnosiss, treatment indication, and prognosis of acute ischemic stroke. RECENT STUDY RESULTS: Recent studies have proved the safety and effectiveness of thrombolysis and endovascular thrombectomy based on the individual combination of imaging and patients clinical information even beyond the classical time-windows. In these cases, magnetic resonance imaging and perfusion-imaging can provide additional and important information. STANDARD DIAGNOSTICS: Nevertheless, computed tomography with and without contrast media still represents the most available and fastest method to diagnose stroke.


Assuntos
Isquemia Encefálica , Acidente Vascular Cerebral , Isquemia Encefálica/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Imagem de Perfusão , Acidente Vascular Cerebral/diagnóstico por imagem , Trombectomia , Resultado do Tratamento
9.
Lancet ; 394(10193): 139-147, 2019 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-31128925

RESUMO

BACKGROUND: Stroke thrombolysis with alteplase is currently recommended 0-4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis. METHODS: In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0-1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036. FINDINGS: We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15-2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [<1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23-76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81-2·96, p=0·66). INTERPRETATION: Patients with ischaemic stroke 4·5-9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis. FUNDING: None.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Tempo para o Tratamento , Hemorragia Cerebral/induzido quimicamente , Imagem de Difusão por Ressonância Magnética , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Humanos , Imagem de Perfusão , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/efeitos adversos , Ativador de Plasminogênio Tecidual/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
J Stroke Cerebrovasc Dis ; 28(7): 2031-2037, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31047820

RESUMO

BACKGROUND: Multimodal computed tomography imaging is used to identify eligible patients for intra-arterial treatment. A concern with this method is the multiple use of iodinated contrast material which presents a possible risk of renal toxicity. We compared the safety of intra-arterial treatment versus intravenous treatment during acute ischemic stroke treatment with a focus on renal safety. METHODS: Adult acute ischemic stroke patients who underwent a baseline Multimodal computed tomography, then intra-arterial treatment and/or intravenous treatment were identified. Primary outcomes were acute kidney injury and changes in serum creatinine at 24-72 hours (Δ serum creatinine). RESULTS: A total of 184 patients received intra-arterial treatment, while 68 received intravenous treatment. There were no differences in mean serum creatinine in the 24-72-hour time period, 24-hour urine volume, or rates of acute kidney injury, dialysis, or mortality. Univariate regression analysis identified diabetes mellitus, operation duration and times of embolectomy as predictors of creatinine increase while the multiple regression model identified diabetes mellitus as the only significant predictor. CONCLUSIONS: There were no significant differences in renal safety between the intra-arterial treatment and intravenous treatment groups. Diabetes mellitus may be a predictor of acute kidney injury. The use of Multimodal computed tomography imaging in the selection of patients who could benefit from endovascular therapy is safe.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Isquemia Encefálica/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Procedimentos Endovasculares/métodos , Iohexol/efeitos adversos , Tomografia Computadorizada Multidetectores/efeitos adversos , Imagem de Perfusão/efeitos adversos , Acidente Vascular Cerebral/diagnóstico por imagem , Lesão Renal Aguda/sangue , Lesão Renal Aguda/diagnóstico , Idoso , Biomarcadores/sangue , Isquemia Encefálica/terapia , Tomada de Decisão Clínica , Meios de Contraste/administração & dosagem , Creatinina/sangue , Procedimentos Endovasculares/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Infusões Intra-Arteriais , Infusões Intravenosas , Iohexol/administração & dosagem , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/efeitos adversos , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Terapia Trombolítica/métodos , Resultado do Tratamento
11.
J Stroke Cerebrovasc Dis ; 28(7): 1886-1890, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31078387

RESUMO

OBJECTIVE: To summarize the characteristics of and therapeutic options for cancer patients whose treatments may be vasotoxic and cause intracranial arterial stenotic disease and stroke. METHODS: We describe 3 patients with symptomatic cerebrovascular pathology that were being actively treated for cancer. RESULTS: Two of the patients were being treated with tyrosine kinase inhibitors (TKIs); and the third was being treated with 2 monoclonal antibodies, one of which was targeting an endothelial growth factor. These agents have been associated with vascular adverse events. Surgical revascularization was done in the first 2 patients, as they were suffering from cerebral ischemia. The third patient had suffered a significant brain hemorrhage, and therapeutic options were limited. In the first 2 patients, treatments also included antiplatelet agents and stopping/changing the TKI. In one of these patients we demonstrated regression of arterial stenosis after changing the TKI. CONCLUSIONS: Possibilities for treatment in this population, beyond the usual medical and surgical administrations, may include stopping or changing cancer drugs that may be related to the development of arterial pathology. Collaboration with oncologists is essential in this subset of patients. While aware of the potential for vascular toxicity, oncologists are often not fully appreciative of the fact that their therapeutic agents can cause stroke.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Arteriopatias Oclusivas/terapia , Doenças Arteriais Cerebrais/terapia , Artérias Cerebrais/cirurgia , Revascularização Cerebral/métodos , Inibidores de Proteínas Quinases/efeitos adversos , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/induzido quimicamente , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/fisiopatologia , Angiografia Cerebral/métodos , Doenças Arteriais Cerebrais/induzido quimicamente , Doenças Arteriais Cerebrais/diagnóstico por imagem , Doenças Arteriais Cerebrais/fisiopatologia , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/efeitos dos fármacos , Artérias Cerebrais/fisiopatologia , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Tratamento Conservador , Constrição Patológica , Substituição de Medicamentos , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão/métodos , Inibidores da Agregação de Plaquetas/uso terapêutico , Resultado do Tratamento , Grau de Desobstrução Vascular
12.
N Engl J Med ; 380(19): 1795-1803, 2019 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-31067369

RESUMO

BACKGROUND: The time to initiate intravenous thrombolysis for acute ischemic stroke is generally limited to within 4.5 hours after the onset of symptoms. Some trials have suggested that the treatment window may be extended in patients who are shown to have ischemic but not yet infarcted brain tissue on imaging. METHODS: We conducted a multicenter, randomized, placebo-controlled trial involving patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging. The patients were randomly assigned to receive intravenous alteplase or placebo between 4.5 and 9.0 hours after the onset of stroke or on awakening with stroke (if within 9 hours from the midpoint of sleep). The primary outcome was a score of 0 or 1 on the modified Rankin scale, on which scores range from 0 (no symptoms) to 6 (death), at 90 days. The risk ratio for the primary outcome was adjusted for age and clinical severity at baseline. RESULTS: After 225 of the planned 310 patients had been enrolled, the trial was terminated because of a loss of equipoise after the publication of positive results from a previous trial. A total of 113 patients were randomly assigned to the alteplase group and 112 to the placebo group. The primary outcome occurred in 40 patients (35.4%) in the alteplase group and in 33 patients (29.5%) in the placebo group (adjusted risk ratio, 1.44; 95% confidence interval [CI], 1.01 to 2.06; P = 0.04). Symptomatic intracerebral hemorrhage occurred in 7 patients (6.2%) in the alteplase group and in 1 patient (0.9%) in the placebo group (adjusted risk ratio, 7.22; 95% CI, 0.97 to 53.5; P = 0.05). A secondary ordinal analysis of the distribution of scores on the modified Rankin scale did not show a significant between-group difference in functional improvement at 90 days. CONCLUSIONS: Among the patients in this trial who had ischemic stroke and salvageable brain tissue, the use of alteplase between 4.5 and 9.0 hours after stroke onset or at the time the patient awoke with stroke symptoms resulted in a higher percentage of patients with no or minor neurologic deficits than the use of placebo. There were more cases of symptomatic cerebral hemorrhage in the alteplase group than in the placebo group. (Funded by the Australian National Health and Medical Research Council and others; EXTEND ClinicalTrials.gov numbers, NCT00887328 and NCT01580839.).


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Fibrinolíticos/uso terapêutico , Imagem de Perfusão , Acidente Vascular Cerebral/tratamento farmacológico , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/tratamento farmacológico , Hemorragia Cerebral/induzido quimicamente , Angiografia por Tomografia Computadorizada , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intravenosas , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/prevenção & controle , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/mortalidade , Equipolência Terapêutica , Ativador de Plasminogênio Tecidual/efeitos adversos
13.
Eur J Radiol ; 115: 22-30, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084755

RESUMO

PURPOSE: To prospectively compare the capability of dynamic first-pass contrast-enhanced (CE) perfusion MR imaging with ultra-short TE and area-detector CT (ADCT), analyzed with the same mathematical methods, and that of FDG-PET/CT for diagnosis and management of solitary pulmonary nodules (SPNs). METHODS AND MATERIALS: Our institutional review board approved this study and written informed consent was obtained from all subjects. A total 57 consecutive patients with 71 nodules prospectively underwent dynamic CE-perfusion ADCT and MR imaging with ultra-short TE, FDG-PET/CT, as well as microbacterial and/or pathological examinations. The nodules were classified into malignant nodules (n = 45) and benign nodules (n = 26). Pulmonary arterial, systemic arterial and total perfusions were determined by means of dual-input maximum slope models on ADCT and MR imaging and maximum values of standard uptake values (SUVmax) on PET/CT. Receiver operating characteristic (ROC) analysis was performed for each index, and sensitivity, specificity and accuracy were compared by McNemar's test. RESULTS: Areas under the curve (Azs) of total perfusion on ADCT (Az = 0.89) and MR imaging (Az = 0.88) were significantly larger than those of systemic arterial perfusion and MR imaging (p<0.05). Accuracy of total perfusion on ADCT (87.3% [62/71]) and MR imaging (87.3% [62/71]) was significantly higher than that of systemic arterial perfusion for both methods (77.5% [55/71] p = 0.02) and SUVmax (78.9% [56/71], p = 0.03). CONCLUSION: Dynamic CE-perfusion MR imaging with ultra-short TE and ADCT and have similar potential capabilities, and are superior to FDG-PET/CT in this setting.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Nódulo Pulmonar Solitário/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluordesoxiglucose F18 , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Imagem de Perfusão , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Estudos Prospectivos , Curva ROC , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Tomografia Computadorizada Espiral/métodos , Tomografia Computadorizada por Raios X/métodos
14.
Int J Cardiovasc Imaging ; 35(8): 1509-1524, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31049753

RESUMO

Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Hemodinâmica , Hipertensão Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Imagem de Perfusão/métodos , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Embolia Pulmonar/diagnóstico por imagem , Humanos , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/fisiopatologia , Embolia Pulmonar/fisiopatologia , Embolia Pulmonar/terapia , Interpretação de Imagem Radiográfica Assistida por Computador
15.
J Stroke Cerebrovasc Dis ; 28(7): 1971-1978, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981581

RESUMO

OBJECTIVE: We aim to use 4D CTA with a comprehensive and objective scoring system to assess collateral circulation, and explore the value of prognosis prediction in endovascular treated patients. METHODS: Thirty-four patients with unilateral anterior circulation large vessels occlusion were reviewed in this study retrospectively. Single-phase CTA (sCTA) and 4D CTA acquired by CT perfusion scanning were analyzed for collateral circulation assessment. The collateral vessels were scored 0-4 according to modified collateral circulation scoring based on 4D CTA. Zero to two points indicated poor collateral circulation; 3-4 points indicated good collateral circulation. Good prognosis was defined as modified Rankin scale score of 0-2. Logistic regression was used to analyze the relationship between collateral circulation and prognosis. RESULTS: The mean age was 71.1 ± 11.5 years old. Collateral circulation on 4D CTA was an independent factor for predicting the prognosis (odds ratio = .101; 95% confidence interval: [.101-.924]; P = .042), but sCTA could not predict prognosis (P = .214). 4D CTA collateral circulation scoring had a good predicting efficacy on clinical prognosis (Area Under Curve (AUC) = .936; 95% confidence interval: [.751-.992], P < .005). Patients with good collaterals (4D CTA scores of 3-4) could obtain benefit from endovascular treatment (P = .029) compared with patients with poor collaterals (P = 1.000). CONCLUSIONS: 4D CTA could be applied to effectively evaluate cerebral collateral status. The accurate assessment of collateral circulation based on 4D CTA would be helpful to make medical decisions, especially for those patients who would undergo endovascular interventional treatment.


Assuntos
Isquemia Encefálica/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada/métodos , Procedimentos Endovasculares , Tomografia Computadorizada Quadridimensional/métodos , Imagem de Perfusão/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/cirurgia , Circulação Cerebrovascular , Tomada de Decisão Clínica , Circulação Colateral , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Dados Preliminares , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento
16.
J Stroke Cerebrovasc Dis ; 28(6): 1483-1494, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30975462

RESUMO

INTRODUCTION: Mechanical thrombectomy is revolutionizing treatment of acute stroke due to large vessel occlusion (LVO). Unfortunately, use of the modified Thrombolysis in Cerebral Infarction score (mTICI) to characterize recanalization of the cerebral vasculature does not address microvascular perfusion of the distal parenchyma, nor provide more than a vascular "snapshot." Thus, little is known about tissue-level hemodynamic consequences of LVO recanalization. Diffuse correlation spectroscopy (DCS) and diffuse optical spectroscopy (DOS) are promising methods for continuous, noninvasive, contrast-free transcranial monitoring of cerebral microvasculature. METHODS: Here, we use a combined DCS/DOS system to monitor frontal lobe hemodynamic changes during endovascular treatment of 2 patients with ischemic stroke due to internal carotid artery (ICA) occlusions. RESULTS AND DISCUSSION: The monitoring instrument identified a recanalization-induced increase in ipsilateral cerebral blood flow (CBF) with little or no concurrent change in contralateral CBF and extracerebral blood flow. The results suggest that diffuse optical monitoring is sensitive to intracerebral hemodynamics in patients with ICA occlusion and can measure microvascular responses to mechanical thrombectomy.


Assuntos
Isquemia Encefálica/terapia , Circulação Cerebrovascular , Lobo Frontal/irrigação sanguínea , Hemodinâmica , Microcirculação , Imagem Óptica/métodos , Imagem de Perfusão/métodos , Acidente Vascular Cerebral/terapia , Trombectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise Espectral , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
17.
Int J Cardiovasc Imaging ; 35(8): 1473-1481, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31016501

RESUMO

The purpose of this study was to assess in pediatric pulmonary artery (PA) reconstruction candidates the feasibility and added utility of preoperative chest computed tomography angiography (CTA) using dual-energy technique, from which perfused blood volume (PBV)/iodine maps can be generated as a surrogate of pulmonary perfusion. Pediatric PA reconstruction patients were prospectively recruited for a new dose-neutral dual-energy CTA protocol. For each case, the severity of anatomic PA obstruction was graded by two pediatric cardiovascular radiologists in consensus using a modified Qanadli index. PBV maps were qualitatively reviewed and auto-segmented using Siemens syngo.via software. Associations between Qanadli scores and PBV were assessed with Spearman correlation (r) and ROC analysis. Effective radiation doses were estimated from dose-length product and ICRP 103 k-factors, using cubic Hermite spline interpolation. 19 patients were recruited with mean (SD) age of 6.0 (5.1), 11 (57.9%) female, 11 (73.7%) anesthetized. Higher QS correlated with lower PBV, both on a whole lung (r = - 0.54, p < 0.001) and lobar (r = - 0.50, p < 0.001) basis. The lung with lowest absolute PBV was predictive of the lung with highest Qanadli score, with AUC of 0.70 (95% CI 0.47-0.93). Qualitatively, PBV maps were heterogeneous, corresponding to multifocal PA stenoses, with decreased iodine content in areas of most severe obstruction. In conclusion, dual-energy chest CTA is feasible for pediatric PA reconstruction candidates. PBV maps show deficits in regions of more severe anatomic obstruction and may serve as a novel biomarker in this population.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Tomografia Computadorizada Multidetectores/métodos , Artéria Pulmonar/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos , Estenose de Artéria Pulmonar/diagnóstico por imagem , Procedimentos Cirúrgicos Vasculares , Adolescente , Fatores Etários , Criança , Pré-Escolar , Tomada de Decisão Clínica , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Imagem de Perfusão/métodos , Projetos Piloto , Valor Preditivo dos Testes , Estudos Prospectivos , Artéria Pulmonar/fisiopatologia , Artéria Pulmonar/cirurgia , Circulação Pulmonar , Interpretação de Imagem Radiográfica Assistida por Computador , Índice de Gravidade de Doença , Estenose de Artéria Pulmonar/fisiopatologia , Estenose de Artéria Pulmonar/cirurgia
18.
Zhonghua Yi Xue Za Zhi ; 99(13): 1024-1027, 2019 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-30955317

RESUMO

Objective: To analyze the correlation between quantitative parameters of one-stop spectral perfusion computed tomography imaging and the expression level of vascular endothelial growth factor-C(VEGF-C) and MLVD in metastatic lymph nodes of rabbit VX2 breast cancer. Methods: Thirty New Zealand purebred female rabbits were used to establish the lymph node metastasis model of rabbit VX2 breast cancer, one-stop spectral and perfusion CT imaging protocol was performed.The axillary lymph nodes were selected for corresponding image markers. The observed morphology of conventional HE staining and the EnVision method were used to quantitatively analyze VEGF-C expression and calculate MLVD.Pearson linear correlation was used to analyze the perfusion parameters of metastatic lymph node energy spectrum and the correlation of MLVD and VEGF-C expression. Results: Twenty-four experimental rabbits were successfully modeled and performed a one-stop CT scan on the 28th day. A total of 39 metastatic lymph nodes were included. The VEGF-C of metastatic lymph node was 20.0%±2.8%,and the MLVD was 12.5±3.5. There was a positive correlation between BF, AP(λHU), IC(VP), NIC(VP), VP(λHU) of metastatic lymph node and VEGF-C and MLVD (P<0.05). There was a positive correlation between lymph node IC(AP) and MLVD (P=0.027) and no correlation with VEGF-C expression (P=0.386).There was no correlation between BV, NIC(A)P and VEGF-C, MLVD(P>0.05). The correlation between VP(λHU) and MLVD was higher (r=0.448, P=0.001). Conclusions: One-stop CT spectral perfusion imaging quantitative parameters and pathological indicators have a good correlation, and it can reflect lymphatic vessel metastasis in lymph nodes.


Assuntos
Neoplasias da Mama , Vasos Linfáticos , Animais , Neoplasias da Mama/diagnóstico por imagem , Feminino , Linfonodos , Microvasos , Imagem de Perfusão , Coelhos , Tomografia Computadorizada por Raios X , Fator C de Crescimento do Endotélio Vascular
19.
Int J Cardiovasc Imaging ; 35(8): 1483-1497, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31030315

RESUMO

Magnetic resonance imaging (MRI) plays an increasingly important role in the non-invasive evaluation of the pulmonary vasculature. MR angiographic (MRA) techniques provide morphological information, while MR perfusion techniques provide functional information of the pulmonary vasculature. Contrast-enhanced MRA can be performed at high spatial resolution using 3D T1-weighted spoiled gradient echo sequence or at high temporal resolution using time-resolved techniques. Non-contrast MRA can be performed using 3D steady state free precession, double inversion fast spin echo, time of flight or phase contrast sequences. MR perfusion can be done using dynamic contrast-enhanced technique or using non-contrast techniques such as arterial spin labelling and time-resolved imaging of lungs during free breathing with Fourier decomposition analysis. MRI is used in the evaluation of acute and chronic pulmonary embolism, pulmonary hypertension and other vascular abnormalities, congenital anomalies and neoplasms. In this article, we review the different MR techniques used in the evaluation of pulmonary vasculature and its clinical applications.


Assuntos
Hemodinâmica , Pneumopatias/diagnóstico por imagem , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Imagem de Perfusão/métodos , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Humanos , Interpretação de Imagem Assistida por Computador , Pneumopatias/fisiopatologia , Pneumopatias/terapia , Valor Preditivo dos Testes , Prognóstico , Artéria Pulmonar/fisiopatologia
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