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1.
Medicine (Baltimore) ; 100(4): e24207, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530213

RESUMO

ABSTRACT: Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.


Assuntos
Vértebras Cervicais/inervação , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Radiculopatia/diagnóstico , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Adulto Jovem
2.
Nat Commun ; 12(1): 721, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526780

RESUMO

Aging and Alzheimer's disease (AD) are associated with progressive brain disorganization. Although structural asymmetry is an organizing feature of the cerebral cortex it is unknown whether continuous age- and AD-related cortical degradation alters cortical asymmetry. Here, in multiple longitudinal adult lifespan cohorts we show that higher-order cortical regions exhibiting pronounced asymmetry at age ~20 also show progressive asymmetry-loss across the adult lifespan. Hence, accelerated thinning of the (previously) thicker homotopic hemisphere is a feature of aging. This organizational principle showed high consistency across cohorts in the Lifebrain consortium, and both the topological patterns and temporal dynamics of asymmetry-loss were markedly similar across replicating samples. Asymmetry-change was further accelerated in AD. Results suggest a system-wide dedifferentiation of the adaptive asymmetric organization of heteromodal cortex in aging and AD.


Assuntos
Envelhecimento/fisiologia , Doença de Alzheimer/patologia , Córtex Cerebral/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Córtex Cerebral/diagnóstico por imagem , Feminino , Voluntários Saudáveis , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/fisiologia , Fatores de Tempo , Adulto Jovem
3.
AJR Am J Roentgenol ; 216(3): 633-639, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33439044

RESUMO

OBJECTIVE. The purpose of this article was to determine the frequency and outcomes of new suspicious findings on breast MRI after initiation of neoadjuvant therapy. MATERIALS AND METHODS. A retrospective database review identified all breast MRI examinations performed to assess response to neoadjuvant therapy between 2010 and 2018. Cases with new suspicious lesions assessed as BI-RADS 4 or 5 and found after the initiation of neoadjuvant treatment were included. Cases with no pretreatment MRI, cases in which the suspicious lesion was present on the baseline MRI but remained suspicious, and cases with insufficient follow-up were excluded. Radiologic, pathologic, and surgical reports were reviewed. Malignant outcomes were determined by pathologic examination. Benignity was established by pathologic examination, follow-up imaging, or both. A total of 419 breast MRI examinations in 297 women were performed to assess response to neoadjuvant therapy. After exclusions, 23 MRI examinations (5.5%) with new suspicious findings, all assessed as BI-RADS 4, comprised the final cohort. RESULTS. Of the 23 lesions, 13 new suspicious findings (56.5%) were contralateral to the known malignancy, nine (39.1%) were ipsilateral, and one (4.3%) involved the bilateral breasts. Lesion types included mass (16, 69.6%), nonmass enhancement (5, 21.7%) and focus (2, 8.7%). None of the new suspicious findings were malignant. CONCLUSION. New suspicious findings occurred in 5.5% of breast MRI examinations performed to monitor response to neoadjuvant therapy, and none of these new lesions were malignant. Our findings suggest that new lesions that arise in the setting of neoadjuvant therapy are highly unlikely to represent a new site of malignancy, particularly if the index malignancy shows treatment response. Larger studies are needed to confirm whether biopsy may be safely averted in this scenario.


Assuntos
Neoplasias da Mama/terapia , Imagem por Ressonância Magnética/métodos , Terapia Neoadjuvante , Segunda Neoplasia Primária/diagnóstico por imagem , Adulto , Idoso , Mama/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/patologia , Meios de Contraste , Feminino , Humanos , Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Imagem por Ressonância Magnética Intervencionista/métodos , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
4.
Nat Med ; 27(1): 174-182, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33398159

RESUMO

Sustained pain is a major characteristic of clinical pain disorders, but it is difficult to assess in isolation from co-occurring cognitive and emotional features in patients. In this study, we developed a functional magnetic resonance imaging signature based on whole-brain functional connectivity that tracks experimentally induced tonic pain intensity and tested its sensitivity, specificity and generalizability to clinical pain across six studies (total n = 334). The signature displayed high sensitivity and specificity to tonic pain across three independent studies of orofacial tonic pain and aversive taste. It also predicted clinical pain severity and classified patients versus controls in two independent studies of clinical low back pain. Tonic and clinical pain showed similar network-level representations, particularly in somatomotor, frontoparietal and dorsal attention networks. These patterns were distinct from representations of experimental phasic pain. This study identified a brain biomarker for sustained pain with high potential for clinical translation.


Assuntos
Biomarcadores/análise , Neuroimagem Funcional/métodos , Medição da Dor/métodos , Adolescente , Adulto , Agentes Aversivos/toxicidade , Capsaicina/toxicidade , Conectoma/métodos , Conectoma/estatística & dados numéricos , Dor Facial/fisiopatologia , Feminino , Neuroimagem Funcional/estatística & dados numéricos , Humanos , Dor Lombar/fisiopatologia , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Modelos Neurológicos , Rede Nervosa/fisiopatologia , Dor/fisiopatologia , Medição da Dor/estatística & dados numéricos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Paladar/efeitos dos fármacos , Paladar/fisiologia , Adulto Jovem
5.
J Urol ; 205(1): 122-128, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32718204

RESUMO

PURPOSE: Evidence suggests that visceral fat quantity may be associated with post-prostatectomy outcomes and risk of prostate cancer related death. We evaluated whether increased fat volume, normalized to prostate size, is associated with decreased risk of disease progression. MATERIALS AND METHODS: Patients enrolled on a prospective active surveillance trial for at least 6 months who had magnetic resonance imaging within 2 years of enrollment were eligible. The surveillance protocol included a standardized followup regimen consisting of biennial prostate specific antigen and examination and yearly biopsy. Clinicopathological characteristics were collected at baseline. Three fat measurements were taken using prostate magnetic resonance imaging, including subcutaneous, linear periprostatic (pubic symphysis to prostate) and volumetrically defined periprostatic. Progression was defined as increase in Gleason grade group. Multivariable Cox proportional hazards models were used to evaluate fat volumes normalized by prostate size (stratified into tertiles). RESULTS: A total of 175 patients were included in the study. Average age was 62.5 years (SD 7.4) and average prostate specific antigen was 5.4 ng/dl (SD 3.9). Median followup was 42 months (IQR 18-60) and 50 patients (28.6%) had progression. Compared to the lowest tertile, the highest tertile of volumetric periprostatic fat measurement (HR 2.63, 95% CI 1.23-5.60, p=0.01) and linear periprostatic fat measurement (HR 2.30, 95% CI 1.01-5.22, p=0.05) were associated with worsened progression-free survival, while subcutaneous fat measurement (p=0.97) was not. Importantly, the model did not substantively change when accounting for patient body mass index and other factors. CONCLUSIONS: Increased periprostatic fat volume, normalized to prostate size, may be associated with shortened progression-free survival in men with prostate cancer on active surveillance.


Assuntos
Adiposidade/fisiologia , Gordura Intra-Abdominal/fisiopatologia , Próstata/patologia , Neoplasias da Próstata/mortalidade , Conduta Expectante/estatística & dados numéricos , Idoso , Biópsia/estatística & dados numéricos , Progressão da Doença , Seguimentos , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Calicreínas/sangue , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Tamanho do Órgão , Intervalo Livre de Progressão , Estudos Prospectivos , Próstata/diagnóstico por imagem , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiopatologia
6.
J Surg Res ; 257: 412-418, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32892139

RESUMO

BACKGROUND: With increasing use of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC), preoperative imaging assessment of axillary lymph nodes (ALNs) has become more important in operative planning and patient counseling. We aimed to assess if MRI is an accurate predictor of the ALN status after NAC. METHODS: We used our institutional proprietary prospective database to review all patients with newly diagnosed breast cancer between August 2015 and March 2017 who received NAC, underwent post-NAC MRI, and axillary surgery. Imaging findings, axillary surgery, and histopathology results were analyzed. RESULTS: Of 114 patients receiving NAC, 50 underwent post-NAC MRI before surgery. The mean age was 46 y; 36% were triple-negative, 26% were triple-positive, 26% were ER-positive and HER2/neu-negative, and 12% were ER-negative and Her2/neu-positive. Post-NAC MRI ALN status was normal in 35 patients, of which 30 underwent SLNB and five went directly to axillary lymph node dissection (ALND). 26 of these 35 were negative for metastasis on final pathology resulting in a negative-predictive value of 74.3%. In 15 patients with an abnormal post-NAC MRI ALN status, eight went directly to ALND and seven underwent SLNB. Eight of these 15 were positive for metastasis on final pathology resulting in a positive predictive value of 53.3%. CONCLUSIONS: Assessment of axillary imaging findings on post-NAC MRI predicts the absence of nodal disease with higher accuracy than its presence but not with adequate accuracy as surrogate for surgical pathologic evaluation of ALNs. This information is valuable in both patient counseling and axillary surgical management after NAC.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Terapia Neoadjuvante , Biópsia de Linfonodo Sentinela , Adulto , Axila , Neoplasias da Mama/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
J Surg Res ; 257: 529-536, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32919343

RESUMO

BACKGROUND: Previous investigation has shown that the combined predictive value of white blood cell count and ultrasound (US) findings to be superior to either alone in children with suspected appendicitis. The purpose of this study was to evaluate the impact of a diagnostic clinical pathway (DCP) leveraging the combined predictive value of these tests on computed tomography (CT) utilization and resource utilization. METHODS: Retrospective cohort study comparing 8 mo of data before DCP implementation to 18 mo of data following implementation. The pathway incorporated decision-support for disposition (operative intervention, observation, or further cross-sectional imaging) based on the combined predictive value of laboratory and US data (stratifying patients into low, moderate, and high-risk groups). Study measures included CT and magnetic resonance imaging utilization, imaging-related cost, time to appendectomy, and negative appendectomy rate. RESULTS: Ninety-seven patients in the preintervention period were compared with 319 patients in the postintervention period. Following DCP implementation, CT utilization decreased by 86% (21% versus 3%, P < 0.001). Mean time to appendectomy decreased from 8.5 to 7.2 h (P < 0.001), and the negative appendectomy rate remained unchanged (5% versus 4%, P = 0.54). Magnetic resonance imaging utilization increased following pathway implementation (1% versus 7%, P = 0.02); however, median imaging-related cost was significantly lower in the postimplementation period ($283/case to $270/case, P = 0.002) CONCLUSIONS: In children with suspected appendicitis, implementation of a DCP leveraging the combined predictive value of white blood cell and US data was associated with a reduction in CT utilization, time to appendectomy, and imaging-related cost.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico por imagem , Procedimentos Clínicos/estatística & dados numéricos , Exposição à Radiação/prevenção & controle , Ultrassonografia , Adolescente , Apendicite/sangue , Apendicite/cirurgia , Criança , Feminino , Humanos , Contagem de Leucócitos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Procedimentos Desnecessários/economia , Procedimentos Desnecessários/estatística & dados numéricos , Adulto Jovem
8.
Future Oncol ; 16(35): 2917-2922, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33350878

RESUMO

Aim: To describe the activity in the 'breast unit' at the department of radiology during the COVID-19 lockdown in a university hospital treating COVID-19 patients in a Middle-Eastern developing country. Materials: This was a retrospective study conducted from March 9 until 11 May 2020, in the breast unit at the department of radiology of a central university hospital in a Middle-Eastern developing country. Data were collected from 205 patients visiting the breast unit during the lockdown period and compared with the activity in the same period in the previous year. Results: Reduction of the breast unit activity was estimated at 73%. In addition, 153 mammograms, 205 ultrasounds, and 16 breast MRIs were done. Indications for mammogram were screening (41.5%), follow-up (22%), clinical symptoms (20%) and breast cancer surveillance (16.5%). MRI was performed mostly for preoperative surgical management. The rate of positive biopsies was 41%. All staff members and patients have accommodated to new adjustments. Conclusion: Activity in the breast unit dropped during the lockdown period. Staff should continue to seek their own and their patient's safety without diminishing the quality of healthcare.


Assuntos
Biópsia/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Líbano/epidemiologia , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Adulto Jovem
10.
Lancet Child Adolesc Health ; 4(11): 828-836, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33068549

RESUMO

BACKGROUND: Acute flaccid myelitis (AFM) is characterised by rapid onset of limb weakness with spinal cord grey-matter abnormalities on MRI scan. We aimed to assess whether detection of enterovirus in respiratory or other specimens can help predict prognosis in children with AFM. METHODS: In this nationwide, longitudinal study, we evaluated the significance of detection of enterovirus in any sample in predicting outcomes in a cohort of Canadian children younger than 18 years presenting with AFM to tertiary paediatric hospitals in Canada in 2014 and 2018. All patients fulfilled the 2015 US Centers for Disease Control and Prevention case definition for definite AFM or probable AFM. Clinical data, laboratory findings, treatment, and neuroimaging results were collected (follow up period up to 5 years). We assessed neurological function and motor outcomes using Kurtzke's Expanded Disability Status Scale (EDSS) and a Weakest Limb Score. FINDINGS: 58 children with AFM (median age 5·1 years, IQR 3·8-8·3) were identified across five of Canada's ten provinces and three territories. 25 (43%) children had enterovirus detected in at least one specimen: 16 (64%) with EV-D68, two (8%) with EV-A71, two (8%) with coxsackievirus, 10 (40%) with untyped enterovirus. Children who were enterovirus positive were more likely than those that were negative to have had quadriparesis (12 [48%] of 25 vs four [13%] of 30; p=0·028), bulbar weakness (11 [44%] of 25 vs two [7%] of 30; p=0·028), bowel or bladder dysfunction (14 [56%] of 25 vs seven [23%] of 30; p=0·040), cardiovascular instability (nine [36%] of 25 vs one [3%] of 30; p=0·028), and were more likely to require intensive care unit admission (13 [52%] of 25 vs 5 [17%] of 30; p=0·028). On MRI, most children who were enterovirus positive showed brainstem pontine lesions (14 [61%] of 23), while other MRI parameters did not correlate with enterovirus status. Median EDSS of enterovirus positive (EV+) and enterovirus negative (EV-) groups was significantly different at all timepoints: baseline (EDSS 8·5, IQR 4·1-9·5 vs EDSS 4·0, IQR 3·0-6·0; p=0·0067), 3 months (EDSS 4·0, IQR 3·0-7·4 vs EDSS 3·0, IQR 1·5-4·3; p=0·0067), 6 months (EDSS 3·5, IQR 3·0-7·0 vs EDSS 3·0, IQR 1·0-4·0; p=0·029), and 12 months (EDSS 3·0, IQR 3·0-6·9 vs EDSS 2·5 IQR 0·3-3·0; p=0·0067). Kaplan-Meier survival analysis of a subgroup of patients showed significantly poorer motor recovery among children who tested positive for enterovirus than for those who tested negative (p=0·037). INTERPRETATION: Detection of enterovirus in specimens from non-sterile sites at presentation correlated with more severe acute motor weakness, worse overall outcomes and poorer trajectory for motor recovery. These results have implications for rehabilitation planning as well as counselling of families of children with these disorders. The findings of this study support the need for early testing for enterovirus in non-CNS sites in all cases of AFM. FUNDING: None.


Assuntos
Viroses do Sistema Nervoso Central , Enterovirus/isolamento & purificação , Debilidade Muscular , Mielite , Doenças Neuromusculares , Medula Espinal/diagnóstico por imagem , Canadá/epidemiologia , Viroses do Sistema Nervoso Central/diagnóstico , Viroses do Sistema Nervoso Central/epidemiologia , Viroses do Sistema Nervoso Central/microbiologia , Viroses do Sistema Nervoso Central/terapia , Pré-Escolar , Enterovirus/classificação , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Destreza Motora , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Debilidade Muscular/reabilitação , Mielite/diagnóstico , Mielite/epidemiologia , Mielite/microbiologia , Mielite/terapia , Doenças Neuromusculares/diagnóstico , Doenças Neuromusculares/epidemiologia , Doenças Neuromusculares/microbiologia , Doenças Neuromusculares/terapia , Avaliação de Resultados em Cuidados de Saúde , Prognóstico , Recuperação de Função Fisiológica
11.
PLoS One ; 15(10): e0238994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052938

RESUMO

Brain networks offers a new insight about connections between function and anatomical regions of human brain. We present results from brain networks built from functional magnetic resonance images during finger tapping paradigm. Pearson voxel-voxel correlation in time and frequency domains were performed for all subjects. Besides this standard framework we have implemented a new approach consisting in filtering the data with respect to the fMRI paradigm (finger tapping) in order to obtain a better understanding of the network involved in the execution of the task. The main topological graph measures have been compared in both cases: voxel-voxel correlation and voxel-paradigm filtering plus voxel-voxel correlation. With the standard voxel-voxel correlation a clearly free-scale network was obtained. On the other hand, when we prefiltered the paradigm we obtained two different kind of networks: 1) free-scale; 2) random-like. To our best knowledge, this behaviour is reported here for first time for brain networks. We suggest that paradigm signal prefiltering can provide more infomation about the brain networks.


Assuntos
Mapeamento Encefálico/métodos , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Imagem por Ressonância Magnética/métodos , Adulto , Mapeamento Encefálico/estatística & dados numéricos , Conectoma/métodos , Conectoma/estatística & dados numéricos , Feminino , Humanos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Rede Nervosa/diagnóstico por imagem , Rede Nervosa/fisiologia , Oxigênio/sangue , Desempenho Psicomotor/fisiologia
13.
Medicine (Baltimore) ; 99(31): e21499, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756184

RESUMO

BACKGROUND: Numerous studies using a variety of non-invasive neuroimaging techniques in vivo have demonstrated that chronic pain (CP) is associated with brain alterations. Cortical thickness (CTh) via surface-based morphometry (SBM) analysis of magnetic resonance imaging data is a valid and sensitive method to investigate the structure of brain gray matter. Many studies have employed SBM to measure CTh difference between patients with CP and pain-free controls and provided important insights into the brain basis of CP. However, the findings from these studies were inconsistent and have not been quantitatively reviewed. METHODS: Three major electronic medical databases: PubMed, Web of Science, and Embase were searched for eligible studies published in English on April 3, 2020. This protocol was prepared based on the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols. The Seed-based d Mapping with Permutation of Subject Images software package will be employed to conducted a coordinate-based meta-analysis (CBMA) to identify consistent CTh differences between patients with CP and pain-free controls. Several complementary analyses, including sensitivity analysis, heterogeneity analysis, publication bias, subgroup analysis, and meta-regression analysis, will be further conducted to test the robustness of the results. RESULTS: This CBMA will tell us whether CP with different subtypes shares common CTh alterations and what the pattern of its characterized alterations is. CONCLUSIONS: To the best of our knowledge, this will be the first CBMA of SBM studies that characterizes brain CTh alterations in CP. The CBMA will provide the quantitative evidence of common brain cortical morphometry of CP. The findings will help us to understand the neural basis underlying CP. TRIAL REGISTRATION NUMBER: INPLASY202050069.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Neuroimagem/estatística & dados numéricos , Dor Crônica/patologia , Feminino , Substância Cinzenta/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Metanálise como Assunto , Neuroimagem/métodos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
14.
J Trauma Acute Care Surg ; 89(2): 365-370, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32744833

RESUMO

BACKGROUND: Increasing evidence supports the limited use of magnetic resonance imaging (MRI) for cervical spine (C-spine) clearance following blunt trauma. We sought to characterize the utilization of MRI of the C-spine at a Level I trauma center. METHODS: All blunt trauma patients undergoing a computed tomography (CT) of the C-spine between January 2009 and December 2018 were reviewed. The CT and MRI results, demographics, clinical presentation, subspecialty consultations, and interventions were recorded. The MRI results were considered clinically significant if they resulted in cervical thoracic orthosis/halo placement or surgical intervention. Linear regression models were utilized to identify trends. RESULTS: There were 9,101 patients that underwent a CT of the C-spine, with 513 (5.6%) being positive for an acute injury. MRI was obtained for 375 (4.1%) of patients. A linear increase in the proportion of patients undergoing an MRI was noted, from 0.9% in 2009 to 5.6% in 2018 (p < 0.01). Of the 513 patients with a positive CT, 290 (56.5%) had an MRI. In 40 (13.8%) of them, the CT demonstrated a minor injury. Clinically significant MRI findings were noted only in two (5.0%) of the 40 patients, and both had a neurologic deficit on initial examination. Of the 8,588 patients with a negative CT, 85 (1.0%) underwent an MRI. Of those, 9 (10.6%) had a clinically significant MRI with all but one presenting with a neurological deficit. CONCLUSION: MRI is increasingly utilized for C-spine clearance following blunt trauma. MRI was exceedingly unlikely to demonstrate a clinically significant finding in the absence of a neurological deficit, when the CT was negative or included minor injuries. Trauma centers are encouraged to constantly evaluate their own practices and intervene with education and collaboration to limit the excessive use of unnecessary resources. LEVEL OF EVIDENCE: Therapeutic/Care Management Study, Level III or IV. Diagnostic test, level IV.


Assuntos
Vértebras Cervicais/lesões , Serviço Hospitalar de Emergência , Imagem por Ressonância Magnética/estatística & dados numéricos , Traumatismos da Medula Espinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Vértebras Cervicais/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estados Unidos , Procedimentos Desnecessários
15.
PLoS One ; 15(8): e0236493, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745102

RESUMO

Accurate segmentation of brain magnetic resonance imaging (MRI) is an essential step in quantifying the changes in brain structure. Deep learning in recent years has been extensively used for brain image segmentation with highly promising performance. In particular, the U-net architecture has been widely used for segmentation in various biomedical related fields. In this paper, we propose a patch-wise U-net architecture for the automatic segmentation of brain structures in structural MRI. In the proposed brain segmentation method, the non-overlapping patch-wise U-net is used to overcome the drawbacks of conventional U-net with more retention of local information. In our proposed method, the slices from an MRI scan are divided into non-overlapping patches that are fed into the U-net model along with their corresponding patches of ground truth so as to train the network. The experimental results show that the proposed patch-wise U-net model achieves a Dice similarity coefficient (DSC) score of 0.93 in average and outperforms the conventional U-net and the SegNet-based methods by 3% and 10%, respectively, for on Open Access Series of Imaging Studies (OASIS) and Internet Brain Segmentation Repository (IBSR) dataset.


Assuntos
Encéfalo/diagnóstico por imagem , Aprendizado Profundo , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Algoritmos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Redes Neurais de Computação
16.
J Am Coll Radiol ; 17(10): 1289-1298, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32622817

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on imaging utilization across practice settings. The purpose of this study was to quantify the change in the composition of inpatient imaging volumes for modality types and Current Procedural Terminology-coded groups during the COVID-19 pandemic. METHODS: A retrospective study of inpatient imaging volumes in a large health care system was performed, analyzing weekly imaging volumes by modality types (radiography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Further subanalyses compared early post-COVID-19 (weeks 10-13) and late post-COVID-19 (weeks 14-16) periods. Statistical comparisons were performed using χ2 and independent-samples t tests. RESULTS: Compared with 2019, total inpatient imaging volume in 2020 post-COVID-19, early and late post-COVID-19 periods, declined by 13.6% (from 78,902 to 68,168), 16.6% (from 45,221 to 37,732), and 9.6% (from 33,681 to 30,436), respectively. By week 16, inpatient imaging volume rebounded and was only down 4.2% (from 11,003 to 10,546). However, a statistically significant shift (P < .0001) in the 2020 composition mix was observed largely comprised of radiography (74.3%), followed by CT (12.7%), ultrasound (8%), MRI (2.4%), interventional radiology (2.3%), and nuclear medicine (0.4%). Although the vast majority of imaging studies declined, few Current Procedural Terminology-coded groups showed increased trends in imaging volumes in the late post-COVID-19 period, including CT angiography chest, radiography chest, and ultrasound venous duplex. DISCUSSION: During the COVID-19 pandemic, we observed a decrease in inpatient imaging volumes accompanied by a shift away from cross-sectional imaging toward radiography. These findings could have significant implications in planning for a potential resurgence.


Assuntos
Infecções por Coronavirus/prevenção & controle , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/estatística & dados numéricos , Controle de Infecções/métodos , Pacientes Internados/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Angiografia por Ressonância Magnética/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Prevalência , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Estados Unidos
17.
Top Magn Reson Imaging ; 29(3): 125-130, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32568974

RESUMO

Claustrophobia, other anxiety reactions, excessive motion, and other unanticipated patient events in magnetic resonance imaging (MRI) not only delay or preclude diagnostic-quality imaging but can also negatively affect the patient experience. In addition, by impeding MRI workflow, they may affect the finances of an imaging practice. This review article offers an overview of the various types of patient-related unanticipated events that occur in MRI, along with estimates of their frequency of occurrence as documented in the available literature. In addition, the financial implications of these events are discussed from a microeconomic perspective, primarily from the point of view of a radiology practice or hospital, although associated limitations and other economic viewpoints are also included. Efforts to minimize these unanticipated patient events can potentially improve not only patient satisfaction and comfort but also an imaging practice's operational efficiency and diagnostic capabilities.


Assuntos
Ansiedade/psicologia , Imagem por Ressonância Magnética/psicologia , Transtornos Fóbicos/psicologia , Ansiedade/epidemiologia , Humanos , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/estatística & dados numéricos , Movimento , Transtornos Fóbicos/epidemiologia , Prevalência , Recusa do Paciente ao Tratamento/psicologia
18.
PLoS One ; 15(6): e0234972, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574222

RESUMO

OBJECTIVE: To evaluate prevalence of structural lesions, synovitis and bone marrow lesions (BMLs) on MRI performed with a 0.3T imaging system in patients with erosive hand osteoarthritis (EHOA) and to compare them to the anatomic radiographic Verbruggen-Veys score (VV). DESIGN: For this Cross-sectional study, fifty-five EHOA patients were studied with 0.3T contrast-enhanced MRI and radiography (RX) of their dominant hand. Structural lesions were scored according to the OMERACT Hand Osteoarthritis MRI Scoring System as follows: osteophytes and erosions were graded from 0 to 3. On joint destruction lesion synovitis and BMLs were graded from 0 to 1. And on MRI, we evaluated the presence of several structural features: N: normal, O: osteophytic lesions, E: erosive lesions, E/O: osteophytic and erosive lesions and D: joint destruction. RX was scored according to the VV system. Relations between MRI features and VV stages were analysed. RESULTS: MRI identified more structural lesions than RX (77.3% versus 74.8%) and particularly more erosive lesions (E or E/O) than VV Phase E (33.5% versus 20.2%). E/O and D were mostly found on MRI. Synovitis and BMLs were significantly associated with E/O and D with the following odds ratios (ORs): 8.4 (95% CI 1.8-13.6); OR: 13.7 (95% CI 2.9-21.0); OR: 15.7 (95% CI 3.2-23.5); OR: 38.5 (95% CI 9.5-57.0), respectively. CONCLUSION: MRI 0.3T appears completely relevant for EHOA lesion analysis. First, MRI shows more erosive lesions than RX in EHOA; second, it allows for the analysis of synovitis and BMLs to be associated with more specific structural MRI features (E/O and D).


Assuntos
Medula Óssea/patologia , Articulação da Mão/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Osteoartrite/complicações , Radiografia/estatística & dados numéricos , Sinovite/epidemiologia , Idoso , Medula Óssea/diagnóstico por imagem , Estudos Transversais , Feminino , Articulação da Mão/diagnóstico por imagem , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/tratamento farmacológico , Osteoartrite/patologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Sinovite/diagnóstico por imagem , Sinovite/etiologia
19.
BMJ ; 369: m1184, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381490

RESUMO

OBJECTIVE: To evaluate the prognosis of unrecognised myocardial infarction determined by electrocardiography (UMI-ECG) or cardiac magnetic resonance imaging (UMI-CMR). DESIGN: Systematic review and meta-analysis of prospective studies. DATA SOURCES: Electronic databases, including PubMed, Embase, and Google Scholar. STUDY SELECTION: Prospective cohort studies were included if they reported adjusted relative risks, odds ratios, or hazard ratios and 95% confidence intervals for all cause mortality or cardiovascular outcomes in participants with unrecognised myocardial infarction compared with those without myocardial infarction. DATA EXTRACTION AND SYNTHESIS: The primary outcomes were composite major adverse cardiac events, all cause mortality, and cardiovascular mortality associated with UMI-ECG and UMI-CMR. The secondary outcomes were the risks of recurrent coronary heart disease or myocardial infarction, stroke, heart failure, and atrial fibrillation. Pooled hazard ratios and 95% confidence intervals were reported. The heterogeneity of outcomes was compared in clinically recognised and unrecognised myocardial infarction. RESULTS: The meta-analysis included 30 studies with 253 425 participants and 1 621 920 person years of follow-up. UMI-ECG was associated with increased risks of all cause mortality (hazard ratio 1.50, 95% confidence interval 1.30 to 1.73), cardiovascular mortality (2.33, 1.66 to 3.27), and major adverse cardiac events (1.61, 1.38 to 1.89) compared with the absence of myocardial infarction. UMI-CMR was also associated with increased risks of all cause mortality (3.21, 1.43 to 7.23), cardiovascular mortality (10.79, 4.09 to 28.42), and major adverse cardiac events (3.23, 2.10 to 4.95). No major heterogeneity was observed for any primary outcomes between recognised myocardial infarction and UMI-ECG or UMI-CMR. The absolute risk differences were 7.50 (95% confidence interval 4.50 to 10.95) per 1000 person years for all cause mortality, 11.04 (5.48 to 18.84) for cardiovascular mortality, and 27.45 (17.1 to 40.05) for major adverse cardiac events in participants with UMI-ECG compared with those without myocardial infarction. The corresponding data for UMI-CMR were 32.49 (6.32 to 91.58), 37.2 (11.7 to 104.20), and 51.96 (25.63 to 92.04), respectively. CONCLUSIONS: UMI-ECG or UMI-CMR is associated with an adverse long term prognosis similar to that of recognised myocardial infarction. Screening for unrecognised myocardial infarction could be useful for risk stratification among patients with a high risk of cardiovascular disease.


Assuntos
Doenças Cardiovasculares/mortalidade , Eletrocardiografia/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Infarto do Miocárdio/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etiologia , Eletrocardiografia/métodos , Feminino , Coração/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos
20.
Cancer Treat Rev ; 87: 102027, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32428791

RESUMO

Immune checkpoint inhibitors (ICI) have improved outcomes for patients with advanced cancers, and results in increasing numbers of long-term survivors. For registration studies, progression-free survival and disease-free survival often serve as primary endpoints. This requires repeated computed tomography (CT) scans for tumour imaging which might lead to major radiation exposure. To determine this, all immune checkpoint inhibitors trials that led to FDA approval were retrieved up to July 29, 2019. From the available protocols, imaging modalities and schedules used in each trial were identified. The anticipated cumulative number of scans made after 1, 3, 5, and 10 years study participation were calculated. The percentage of lifetime attributable cancer risk was calculated using the Biological Effects of Ionizing Radiation VII report. Fifty-one trials were identified, from which 39 protocols were retrieved. Four were adjuvant trials. All protocols required repeated chest-abdomen imaging and specified CT scans as preferred imaging modality. Median calculated cumulative numbers of chest-abdomen CT scans after 1, 3, 5, and 10 years study participation were 7, 16, 24 and 46, respectively. For ages 20-70 years at study entry, the average lifetime attributable cancer risk after 1 year of study participation ranged from 1.11 to 0.40% for men and from 1.87 to 0.46% for women. At 10 years study participation, this risk increased to a range of 5.91 to 1.96% for men and 9.64 to 2.32% for women. Given high imaging radiation exposure for long-term survivors in current ICI trials an adaptive imaging interval and imaging termination rules should be considered for long-term survivors.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Neoplasias Induzidas por Radiação/epidemiologia , Neoplasias/diagnóstico por imagem , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/imunologia , Neoplasias Induzidas por Radiação/etiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
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