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1.
Medicine (Baltimore) ; 99(2): e17908, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914010

RESUMO

This study is to determine accuracy of abdominal ultrasound and nuclear magnetic resonance imaging (MRI) for placenta accreta in the second and third trimester of pregnancy and to define the most relevant features of abdominal ultrasound and MRI for placenta accreta prediction.Between September 2012 and September 2018, 245 high risk of placenta accreta in the second trimester of pregnancy were prenatal diagnosed by abdominal ultrasound and MRI and they were followed up until the end of pregnancy.Forty-six patients at the second trimester of pregnancy and 40 patients at the third trimester of pregnancy were confirmed as placenta accreta. For the second and third trimester of pregnancy, the sensitivity (Se), specificity (Sp), positive and negative predictive value (PPV and NPV) of abdominal ultrasound were 95.65% versus 97.50%, 91.78% versus 90.70%, 88% versus 83%, and 97% versus 99%, respectively, while the Se, Sp, PPV, and NPV of MRI were 89.13% versus 92.50%, 87.67% versus 8721%, 82% versus 77%, and 93% versus 96%, respectively. Five features having significant statistical differences between normal placentation women and placenta accreta patients in second or third trimester of pregnancy, including loss of the normal retroplacental clear space, thinning or disappearance of the myometrium, increased vascularization at the uterine serosa-bladder wall interface, and vascularization perpendicular to the uterine wall on abdominal ultrasound, and uterine bulging and dark intraplacental bands on MRI.Abdominal ultrasound and MRI for placenta accreta in the second and third trimester of pregnancy could provide meaningful imaging evidences.


Assuntos
Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta/anormalidades , Ultrassonografia/métodos , Útero/diagnóstico por imagem , Adulto , Feminino , Humanos , Miométrio/patologia , Placenta Acreta/patologia , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Sensibilidade e Especificidade , Ultrassonografia Pré-Natal/normas , Ultrassonografia Pré-Natal/estatística & dados numéricos , Útero/irrigação sanguínea , Útero/patologia
2.
Medicine (Baltimore) ; 99(2): e18202, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914013

RESUMO

To observe thoracolumbar segmental mobility using kinetic magnetic resonance imaging (kMRI) in patients with minimal thoracolumbar spondylosis and establish normal values for translational and angular segmental motion as well as the relative contribution of each segment to total thoracolumbar segmental motion in order to obtain a more complete understanding of this segmental motion in healthy and pathological conditions.Mid-sagittal images obtained by weight-bearing, multi-position kMRI in patients with symptomatic low back pain or radiculopathy were reviewed. The translational motion and angular variation of each segment from T10-L2 were calculated using MRAnalyzer Automated software. Only patients with a Pfirrmann grade of I or II, indicating minimal disc disease, for all thoracolumbar discs from T10-T11 to L1-L2 were included for further analysis.The mean translational motion measurements for each level of the lumbar spine were 1.15 mm at T10-T11, 1.20 mm at T11-T12, 1.23 mm at T12-L1, and 1.34 mm at L1-L2 (P < .05 for L1-L2 vs T10-T11). The mean angular motion measurements at each level were 3.26° at T10-T11, 3.92° at T11-T12, 4.95° at T12-L1, and 6.85° at L1-L2. The L1-L2 segment had significantly more angular motion than all other levels (P < .05). The mean percentage contribution of each level to the total angular mobility of the thoracolumbar spine was highest at L1-L2 (36.1%) and least at T10-T11 (17.1%; P < .01).Segmental motion was greatest in the proximal lumbar levels, and angular motion showed a gradually increasing trend from T10 to L2.


Assuntos
Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Degeneração do Disco Intervertebral/classificação , Degeneração do Disco Intervertebral/patologia , Cinética , Dor Lombar/patologia , Vértebras Lombares/patologia , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular/fisiologia , Espondilose/fisiopatologia , Vértebras Torácicas/patologia , Vértebras Torácicas/fisiopatologia , Suporte de Carga , Adulto Jovem
3.
J Comput Assist Tomogr ; 44(1): 102-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939890

RESUMO

OBJECTIVE: To evaluate the overall diagnostic value of magnetic resonance imaging (MRI) in restaging of rectal cancer after preoperative chemoradiotherapy based on qualified studies. METHODS: PubMed, Cochrane, and EMBASE database were searched by the index words to identify the qualified studies, and relevant literature sources were also searched. The latest research was done in April 2019. Heterogeneity of the included studies was tested, which was used to select proper effect model to calculate pooled weighted sensitivity, specificity, and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) analyses were also performed. RESULT: Nineteen studies with 1262 patients were involved in the meta-analysis exploring the diagnostic accuracy of MRI for rectal cancer. The diagnostic accuracy of MRI in T3-T4 rectal cancer was as follows: sensitivity, 81% (95% confidence interval [CI], 67%-90%); specificity, 67% (95% CI, 51%-80%); positive likelihood ratio, 2.48 (95% CI, 1.57-3.91); negative likelihood ratio, 0.28 (95% CI, 0.15-0.52); global DOR, 6.86 (95% CI, 3.07-15.30); the area under the SROC was high (0.81; 95% CI, 0.78-0.84). The diagnostic accuracy of MRI in lymphatic metastasis of rectal cancer was as follows: sensitivity, 77% (95% CI, 65%-86%); specificity, 77% (95% CI, 63%-87%); positive likelihood ratio, 3.40 (95% CI, 2.07-5.59); negative likelihood ratio, 0.30 (95% CI, 0.20-0.45); DOR, 10.81 (95% CI, 4.99-23.39); area under the SROC was high (0.84; 95% CI, 0.80-0.87). CONCLUSIONS: This study provides a systematic review and meta-analysis of diagnostic accuracy studies of MRI for rectal cancer. The results indicate that MRI is a highly accurate diagnostic tool for rectal cancer T3-T4 staging and N staging but sensitivity and specificity are not high.


Assuntos
Quimiorradioterapia/métodos , Imagem por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Humanos , Metástase Linfática , Terapia Neoadjuvante , Estadiamento de Neoplasias , Razão de Chances , Curva ROC , Neoplasias Retais/patologia , Sensibilidade e Especificidade , Resultado do Tratamento
4.
J Urol ; 203(1): 100-107, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335254

RESUMO

PURPOSE: We evaluated the performance of transrectal ultrasound guided systematic and transperineal template mapping biopsies with a 5 mm sampling frame stratified by the multiparametric magnetic resonance imaging Likert score in the PROMIS (Prostate MR Imaging Study). MATERIALS AND METHODS: Biopsy naïve men due to undergo prostate biopsy for elevated prostate specific antigen and/or abnormal digital rectal examination underwent multiparametric magnetic resonance imaging, and transperineal template mapping and transrectal ultrasound guided systematic biopsies, which were performed and reported while blinded to other test results. Clinically significant prostate cancer was primarily defined as Gleason 4 + 3 or greater, or a maximum cancer core length of 6 mm or more of any grade. It was secondarily defined as Gleason 3 + 4 or greater, or a maximum cancer core length of 4 mm or more of any grade. RESULTS: In 41 months 740 men were recruited at a total of 11 centers, of whom 576 underwent all 3 tests. Eight of the 150 men (5.1%) with a multiparametric magnetic resonance imaging score of 1-2 had any Gleason 3 + 4 or greater disease on transrectal ultrasound guided systematic biopsy. Of the 75 men in whom transrectal ultrasound guided systematic biopsy showed Gleason 3 + 3 of any maximum cancer core length 61 (81%) had Gleason 3 + 4, 8 (11%) had Gleason 4 + 3 and 0 (0%) had Gleason 4 + 5 or greater disease. For definition 1 (clinically significant prostate cancer) transrectal ultrasound guided systematic biopsy sensitivity remained stable and low across multiparametric magnetic resonance imaging Likert scores of 35% to 52%. For definition 2 (clinically significant prostate cancer and any cancer) sensitivity increased with higher multiparametric magnetic resonance imaging scores. The negative predictive value varied due to varying disease prevalence but for all cancer thresholds it declined with increasing multiparametric magnetic resonance imaging scores. CONCLUSIONS: In the setting of multiparametric magnetic resonance imaging Likert scores 1-2 transrectal ultrasound guided systematic biopsy revealed Gleason 3 + 4 disease in only 1 of 20 men. Further, for any clinically significant prostate cancer definition transrectal ultrasound guided systematic biopsy had poor sensitivity and variable but a low negative predictive value across multiparametric magnetic resonance imaging scores. Men who undergo transrectal ultrasound guided systematic biopsy without targeting in the setting of a multiparametric magnetic resonance imaging score of 3 to 5 should be advised to undergo repeat (targeted) biopsy.


Assuntos
Biópsia Guiada por Imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Humanos , Masculino , Gradação de Tumores , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia de Intervenção
5.
Br J Radiol ; 93(1105): 20190562, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31603347

RESUMO

OBJECTIVE: Patients with diabetes mellitus, diabetic nephropathy (DN) and healthy donor were analyzed to test whether the early DN patients can be detected using both blood oxygenation level dependent (BOLD) and diffusion tensor imaging. METHODS: This study was approved by the Ethics Committee of our hospital. MR images were acquired on a 3.0-Tesla MR system (Discovery MR750, General Electric, Milwaukee, WI). 30 diabetic patients were divided into NAU (normal to mildly increased albuminuria, N = 15) and MAU (moderately increased albuminuria, N = 15) group based on the absence or presence of microalbuminuria. 15 controls with sex- and age-matched were enrolled in the study. Prior to MRI scan, all participants were instructed to collect their fresh morning urine samples for quantitative measurement of urinary microalbumin and urinary creatinine. Then, the estimations of serum creatinine, serum uric acid, HbAlc and fasting plasma glucose as well as fundus examinations were performed in all subjects. Then, the values of albumin-creatinine ratio (ACR) and estimated glomerular filtration rate were also calculated. All subjects underwent renal diffusion tensor imaging (DTI) and BOLD acquisition after fasting for 4 h. Regions of interest were placed in renal medulla and cortex for evaluating apparent diffusion coefficient (ADC), fractional anisotropy (FA) and R2* values by two experienced radiologists. The consistency between the two observations was estimated using intragroup correlation coefficients. To test differences in ADC, FA and R2* values across the three groups, the data were analyzed using separate one-way ANOVAs. Post-hoc pair wise comparisons were then performed using t-test. To investigate the clinical relevance of imaging parameters in both regions across the three groups, the correlations of values of the ACR/estimated glomerular filtration rate and of the ADC/FA/R2* were calculated. RESULTS: There was a high level of consistency of those ADC, FA and R2* values across the three groups on both renal cortex and medulla measured by the two doctors. The FA value of medulla in MAU group was lower than that in control (p < 0.01). The R2* value of medulla in the NAU group was higher than that in the control (p < 0.01), and the R2* value of medulla in the MAU group was lower than that in the control (p = 0.009) . Moreover, the current study revealed a decreasing trend in FA values of the renal medulla from the control group to NAU and MAU groups. Finally, a weak negatively correlation between medullary R2* and ACR was found in current study. CONCLUSION: Medullary R2* value might be a new more sensitive predictor of early DN. Meanwhile, BOLD imaging detected the medullary hypoxia at the simply diabetic stage, while DTI didn't identify the medullary directional diffusion changes at this stage. Based on our assumption mentioned above, it's presumable that BOLD imaging may be more sensitive for assessment of the early renal function changes than DTI. These imaging techniques are more accurate and practical than conventional tests. ADVANCES IN KNOWLEDGE: Non-invasive MRI was used to detect renal function changes at early DN stage.


Assuntos
Nefropatias Diabéticas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Anisotropia , Biomarcadores/análise , Imagem de Tensor de Difusão , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Testes de Função Renal , Masculino , Pessoa de Meia-Idade
6.
Br J Radiol ; 93(1105): 20190289, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31617732

RESUMO

OBJECTIVE: This study investigated the occurrence of cardiotoxicity-related left-ventricular (LV) contractile dysfunction in breast cancer patients following treatment with antineoplastic chemotherapy agents. METHODS: A validated and automated MRI-based LV contractility analysis tool consisting of quantization-based boundary detection, unwrapping of image phases and the meshfree Radial Point Interpolation Method was used toward measuring LV chamber quantifications (LVCQ), three-dimensional strains and torsions in patients and healthy subjects. Data were acquired with the Displacement Encoding with Stimulated Echoes (DENSE) sequence on 21 female patients and 21 age-matched healthy females. Estimates of patient LVCQs from DENSE acquisitions were validated in comparison to similar steady-state free precession measurements and their strain results validated via Bland-Altman interobserver agreements. The occurrence of LV abnormalities was investigated via significant differences in contractility measurements (LVCQs, strains and torsions) between patients and healthy subjects. RESULTS: Repeated measures analysis showed similarities between LVCQ measurements from DENSE and steady-state free precession, including cardiac output (4.7 ± 0.4 L, 4.6 ± 0.4 L, p = 0.8), and LV ejection fractions (59±6%, 58±5%, p = 0.2). Differences found between patients and healthy subjects included enlarged basal diameter (5.0 ± 0.5 cm vs 4.4 ± 0.5 cm, p < 0.01), apical torsion (6.0 ± 1.1° vs 9.7 ± 1.4°, p < 0.001) and global longitudinal strain (-0.15 ± 0.02 vs. -0.21 ± 0.04, p < 0.001), but not LV ejection fraction (59±6% vs. 63±6%, p = 0.1). CONCLUSION: The results from the statistical analysis reveal the possibility of LV abnormalities in the post-chemotherapy patients via enlarged basal diameter and reduced longitudinal strain and torsion, in comparison to healthy subjects. ADVANCES IN KNOWLEDGE: This study shows that subclinical LV abnormalities in post-chemotherapy breast cancer patients can be detected with an automated technique for the comprehensive analysis of contractile parameters.


Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/diagnóstico por imagem , Algoritmos , Feminino , Humanos , Pessoa de Meia-Idade , Contração Miocárdica
7.
Br J Radiol ; 93(1105): 20190738, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31642691

RESUMO

OBJECTIVE: To investigate the value of MRI in comparison to single photon emission computed tomography (SPECT)/CT in patients with painful hip arthroplasties. METHODS: A prospective, multi-institutional study was performed. Therefore, 35 consecutive patients (21 female, 14 male, mean age 61.8 ± 13.3 years) with 37-painful hip arthroplasties were included. A hip surgeon noted the most likely diagnosis based on clinical examination and hip radiographs. Then, MRI and SPECT/CT of the painful hips were acquired. MRI and SPECT/CT were assessed for loosening, infection, fracture, tendon pathology and other abnormalities. Final diagnosis and therapy was established by the hip surgeon after integration of MRI and SPECT/CT results. The value of MRI and SPECT/CT for diagnosis was assessed with a 3-point scale (1 = unimportant, 2 = helpful, 3 = essential). RESULTS: Loosening was observed in 13/37 arthroplasties (6 shaft only, 6 cup only, 1 combined). Sensitivity, specificity, positive predictive value and negative predictive value for loosening of MRI were 86%/88%/60%/100% and of SPECT/CT 93%/97%/90%/100%, respectively. MRI and SPECT/CT diagnosed infection correctly in two of three patients and fractures in two patients, which were missed by X-ray. MRI detected soft tissue abnormalities in 21 patients (6 bursitis, 14 tendon lesions, 1 pseudotumor), of which only 1 tendon abnormality was accurately detected with SPECT/CT. All 5 arthroplasties with polyethylene wear were correctly diagnosed clinically and with both imaging modalities. MRI and SPECT/CT were judged as not helpful in 0/0%, as helpful in 16%/49% and essential in 84%/51%. CONCLUSION: In patients with painful hip arthroplasty SPECT/CT is slightly superior to MR in the assessment of loosening. MRI is far superior in the detection of soft tissue, especially tendon pathologies. ADVANCES IN KNOWLEDGE: To our knowledge this is the first prospective, multiinstitutional study which compares MRI with SPECT/CT in painful hip arthroplasties. We found that MRI is far superior in the detection of soft tissue pathologies, whereas SPECT/CT remains slightly superior regarding loosening.


Assuntos
Artroplastia de Quadril , Imagem por Ressonância Magnética/métodos , Dor Pós-Operatória/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Valor Preditivo dos Testes , Falha de Prótese , Sensibilidade e Especificidade
8.
Br J Radiol ; 93(1105): 20190653, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31746635

RESUMO

OBJECTIVE: This study aims to assess the CT and MRI features of calvarium and skull base osteosarcoma (CSBO). METHODS: The CT and MRI features and pathological characteristics of 12 cases of pathologically confirmed CSBO were analyzed retrospectively. RESULTS: 12 patients (age range 9-67 years; 3 male, 9 female) were included in the study. Tumours occurred in skull base (7, 58.3%), temporal (4, 33.3%) and frontal (1, 8.3%). Among all, six patients received radiotherapy for nasopharyngeal carcinoma. According to pathology, 11 out of 12 tumours were high-grade (91.7%). On CT, all the tumours had soft tissue mass penetrated into cortical bone with invasion of surrounding soft tissue. Six tumours were shown to have lytic density and six were mixed density. Matrix mineralization was present in 10 cases (83.3%). On MRI, tumours presented as soft-tissue masses measuring 5.9 ± 2.4 (3.9-8.0) cm. Five tumours showed low signal intensities on T1 weighted imaging with seven having heterogeneous signal intensities. One showed low signal intensity on T2 weighted imaging, two showed high signal intensities and nine heterogeneous signal intensities. All the tumours showed low signal intensities on diffusion-weighted imaging. On contrast enhanced images, seven cases showed heterogeneous enhancement, three showed peripheral enhancementand and two showed homogeneous enhancement. Dural tail sign were detected in nine cases. CONCLUSION: CSBO is rare, and is commonly associated with previous radiation exposure. A presumptive diagnosis for osteosarcoma should be considered when calvarium and skull base tumours with osteoid matrix and duraltail sign are found. ADVANCES IN KNOWLEDGE: CT and MR features of CSBO have not been reported. The study helps to identify CSBO and other sarcomas.


Assuntos
Imagem por Ressonância Magnética/métodos , Osteossarcoma/diagnóstico por imagem , Neoplasias Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Criança , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias da Base do Crânio/diagnóstico por imagem
9.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553355

RESUMO

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Brasil/epidemiologia , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
10.
J Urol ; 203(1): 92-99, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31430234

RESUMO

PURPOSE: We evaluated which lesions are detected and missed on [68Ga]Ga-PSMA (prostate specific membrane antigen)-11 positron emission tomography in patients with primary prostate cancer. MATERIALS AND METHODS: Patients undergoing radical prostatectomy were enrolled in this prospective observational study. Patients underwent [68Ga]Ga-PSMA-11 positron emission tomography/computerized tomography or positron emission tomography/magnetic resonance imaging prior to surgery and received a dose of [68Ga]Ga-PSMA-11 intraoperatively for positron emission tomography of extirpated specimens. Whole mount pathology was performed with lesion and intralesion based analysis to determine the characteristics of lesions detected or not detected by PSMA positron emission tomography. Lesion volume was determined by planimetry and clinically significant lesion volume was calculated as lesion volume × fraction pattern 4/5. RESULTS: On whole mount analysis 30 cancerous lesions were found in a total of 15 patients, including 4, 15, 4, 1 and 6 which were Grade Group 1, 2, 3, 4 and 5, respectively. PSMA-positron emission tomography detected 100% of primary/index lesions and 8 of 11 (82%) secondary lesions. All Grade Group 3-5 lesions were detected vs 12 of 15 Grade Group 2 lesions. When comparing Grade Group 2 vs 3-5, lesion size was similar (p=0.48) but the standardized uptake value was lower for Grade Group 2 vs 3-5 (5.3 vs 7.9, p=0.03). The 3 missed lesions showed 10% or less of pattern 4 and a Gleason pattern 4/5 volume of less than 0.1 cm3. CONCLUSIONS: PSMA positron emission tomography detected 100% of primary/index lesions in this study. The 3 missed secondary lesions were small and had a low percent of pattern 4. This argues for further study to better understand what defines clinically significant prostate cancer, which would assist in determining whether small lesions that become challenging to detect by [68Ga]Ga-PSMA-11 positron emission tomography confer a risk to the patient.


Assuntos
Antígenos de Superfície/sangue , Glutamato Carboxipeptidase II/sangue , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Radioisótopos de Gálio , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estudos Prospectivos , Medição de Risco
11.
Medicine (Baltimore) ; 98(51): e18070, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860956

RESUMO

INTRODUCTION: In this study, we presented a rare case of Epstein-Barr virus (EBV) meningoencephalitis presented with meningoencephalitis-like symptoms and diffuse edematous hemorrhage. PATIENT CONCERNS: A 77-year-old male patient was admitted to our hospital with fever, headache, confusion, and unconsciousness for 7 days. Physical examination revealed unconsciousness and stiffness of the neck. DIAGNOSIS: The final diagnosis was EBV meningoencephalitis. INTERVENTIONS: Ganciclovir (two times 350 mg/day, 21 days), methylprednisolone sodium succinate (120 mg, 5 days), and IV immunoglobulins (IV Ig) (0.4 g/kg, 5 days) were given to this patient. OUTCOMES: But the patient's clinical symptoms did not improve, and he was still in a coma. His family refused to be further diagnosed and discharged. After discharge for 2 months, the patient was in a coma. Four months later, the patient died of complications of pulmonary infection. CONCLUSION: The patient is an adult, and imaging was dominated by intracranial diffuse microhemorrhage and edema, which was different from the typical imaging characteristics of EBV encephalitis as previously reported. This specific imaging change may provide new clinical value for the diagnosis of EBV encephalitis.


Assuntos
Infecções por Vírus Epstein-Barr/tratamento farmacológico , Ganciclovir/administração & dosagem , Imunoglobulinas Intravenosas/uso terapêutico , Imagem por Ressonância Magnética/métodos , Meningoencefalite/tratamento farmacológico , Metilprednisolona/administração & dosagem , Idoso , Quimioterapia Combinada , Infecções por Vírus Epstein-Barr/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Meningoencefalite/diagnóstico por imagem , Meningoencefalite/virologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(51): e18075, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860957

RESUMO

RATIONALE: Dyke-Davidoff-Masson syndrome (DDMS) is a rare syndrome commonly occurring in children and characterized by cerebral hemiatrophy, hypertrophy of the skull, epilepsy, and mental retardation. However, few have been reported in China, especially in teenagers. This case investigated its possible cause and explored a relative effective solution. PATIENT CONCERNS: A 24-year-old female came to department having experienced recurrent seizures for 12 years. DIAGNOSIS: DDMS was diagnosed from its manifestations, biochemistry indexes, and imaging (computed tomography angiography, magnetic resonance venography, and so on). INTERVENTIONS: Several drugs are used to treat the disease, including valproate, carbamazepine, topiramate, and ginkgo biloba extract. OUTCOMES: Under the medicine treatment of magnesium valproate with carbamazepine, the patient experienced partial seizures approximately once per month that lasted 30 to 60 seconds each without any complications observed during a follow-up period of 24 months. CONCLUSION: The imaging and clinical features of DDMS in this teenager were similar to those in classic infantile-onset cases. A potential cause of the disease could be brain trauma, which impaired the middle cerebral artery and reduced cerebral blood supply, leading to epilepsy and hemiatrophy. LESSONS: It was concluded early diagnosis and pharmacotherapy are the keys to preventing intellectual decline in DDMS patients. Moreover, the combination of magnesium valproate and carbamazepine could significantly reduce the frequency and duration of seizures, despite not eliminating them completely.


Assuntos
Encefalopatias/diagnóstico por imagem , Deficiência Intelectual/diagnóstico , Imagem por Ressonância Magnética/métodos , Convulsões/diagnóstico , Convulsões/tratamento farmacológico , Encefalopatias/tratamento farmacológico , Carbamazepina/uso terapêutico , China , Doença Crônica , Feminino , Humanos , Deficiência Intelectual/tratamento farmacológico , Prognóstico , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Tomografia Computadorizada por Raios X/métodos , Ácido Valproico , Adulto Jovem
13.
Medicine (Baltimore) ; 98(51): e18141, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860961

RESUMO

RATIONALE: Peliosis hepatis (PH), which is characterized by blood-filled cavities in the liver, is a rare disease. Its diagnosis depends on postoperative pathological examinations and immunohistochemistry. PATIENT CONCERNS: A 44-year-old female complained of right-middle upper abdominal pain and distension for 1 month, with occasional vomiting and fever. DIAGNOSIS: Because of the similar imaging features, the patient was initially misdiagnosed as cystic echinococcosis (CE). The immunoassay of echinococcosis was negative. Irregular hepatectomy was performed. Eventually, the patient was diagnosed with PH based on postoperative histopathology and immunohistochemistry. INTERVENTIONS: The patient underwent hepatectomy. Then, the cystic lesion was collected for intraoperative pathological examination. Thus, the blood liquid was extracted from the cystic lesion. Pringle maneuver was administered to prevent bleeding, and then the whole cystic lesion was removed. OUTCOMES: She recovered smoothly and there was no relapse occurred during 6 months' follow-up. LESSONS: It is difficult to differentiate PH from CE and other hepatic diseases due to the lack of special imaging features. Pathological examinations and immunohistochemistry can provide a confirmed diagnosis of PH.


Assuntos
Equinococose/diagnóstico , Hepatectomia/métodos , Peliose Hepática/diagnóstico , Peliose Hepática/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Biópsia por Agulha , Diagnóstico Diferencial , Equinococose/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Peliose Hepática/diagnóstico por imagem , Peliose Hepática/cirurgia , Doenças Raras , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Medicine (Baltimore) ; 98(50): e18324, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852123

RESUMO

BACKGROUND: Although many machine learning algorithms have been developed to detect anterior cruciate ligament (ACL) injury based on magnetic resonance imaging (MRI), the performance of different algorithms required further investigation. The objectives of this current systematic review are to evaluate the diagnostic accuracy of machine-learning-assisted detection for ACL injury based on MRI and find the current best algorithm. METHOD: We will conduct a comprehensive database search for clinical diagnostic tests in PubMed, EMBASE, Cochrane Library, and Web of science without restrictions on publication status and language. The reference lists of the included articles will also be checked to identify additional studies for potential inclusion. Two reviewers will independently review all literature for inclusion and assess their methodological quality using Quality Assessment of Diagnostic Accuracy Studies version 2. Clinical diagnostic tests exploring the efficacy of machine-learning-assisted system for detecting ACL injury based on MRI will be considered for inclusion. Another 2 reviewers will independently extract data from eligible studies based on a pre-designed standardized form. Any disagreements will be resolved by consensus. RevMan 5.3 and Stata SE 12.0 software will be used for data synthesis. If appropriate, we will calculate the summary sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of machine-learning-assisted diagnosis system for ACL injury detection. A hierarchical summary receiver operating characteristic (HSROC) curve will also be plotted, and the area under the ROC curve (AUC) is going to calculated using the bivariate model. If the pooling of results is considered inappropriate, we will present and describe our findings in diagrams and tables and describe them narratively. RESULT: This is the first systematic assessment of machine learning system for the detection of ACL injury based on MRI. We predict it will provide highquality synthesis of existing evidence for the diagnostic accuracy of machine-learning-assisted detection for ACL injury and a relatively comprehensive reference for clinical practice and development of interdisciplinary field of artificial intelligence and medicine. CONCLUSION: This protocol outlined the significance and methodologically details of a systematic review of machine-learning-assisted detection for ACL injury based on MRI. The ongoing systematic review will provide high-quality synthesis of current evidence of machine learning system for detecting ACL injury. REGISTRATION: The meta-analysis has been prospectively registered in PROSPERO (CRD42019136581).


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Diagnóstico por Computador/estatística & dados numéricos , Aprendizado de Máquina , Imagem por Ressonância Magnética/estatística & dados numéricos , Diagnóstico por Computador/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Metanálise como Assunto , Curva ROC , Projetos de Pesquisa , Sensibilidade e Especificidade , Revisão Sistemática como Assunto
15.
J Comput Assist Tomogr ; 43(6): 937-942, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738203

RESUMO

OBJECTIVE: The objective of this study was to evaluate the diagnostic performance of magnetic resonance imaging (MRI) in detecting the secondary breast cancer among women with a personal history of the lesion. MATERIALS AND METHODS: We retrospectively reviewed breast MRI examinations performed between 2007 and 2011. A total of 798 women with a history of breast cancer were included in the study. Cancer detection rate, positive predictive value (PPV), recall rate, sensitivity, and specificity were assed. Cancer detection rate was stratified by interval after surgery of the primary breast cancer. Also, we derived 1 comparison group from the women for comparing the performance of x-ray mammography, ultrasound, and MRI in detecting the second breast cancer. RESULTS: Of the 798 patients, 47 of the 49 secondary breast carcinomas were detected by MRI. The sensitivity and specificity of MRI in detecting the secondary lesions were 95.9% and 96.3%, respectively. The recall rate was 9.5%, and the PPV was 61.8%. Cancer detection rate of MRI examinations performed at more than 36 months after initial surgery was significantly higher than that at 36 months or less after initial surgery (13.7% vs 3.6, P < 0.001). In comparison group, the sensitivity and specificity of MRI, mammography, and ultrasound were 96.7% and 96.1%, 48.4% and 93.9%, and 77.4% and 96.1%, respectively. CONCLUSIONS: Surveillance MRI for women with a personal history of breast cancer has high sensitivity in finding the secondary malignancies with a reasonable recall rate and PPV.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Mamografia/métodos , Segunda Neoplasia Primária/diagnóstico por imagem , Ultrassonografia Mamária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Vigilância da População , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
J Comput Assist Tomogr ; 43(6): 958-962, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738211

RESUMO

OBJECTIVE: The objective of this study was to investigate the contrast-to-noise ratio (CNR) between cortical gray matter (GM) and subcortical white matter (WM) across the cortex in relation to the ability of 3-dimensional fluid attenuated inversion recovery and 3-dimensional double inversion recovery to distinguish between cortical lesions (CLs) and juxtacortical lesions (JCs). METHODS: A total of 38 multiple sclerosis patients underwent magnetic resonance imaging. Two neuroradiologists scored CLs and JCs on magnetic resonance imaging in 9 cerebral areas. Lesions were marked as nonclassifiable (NCs) when blurred WM-GM boundary leads to inaccuracy of their discrimination. The CNR between WM and GM (CNRWM-GM) was evaluated across the cortical areas. RESULTS: The CNRWM-GM varies across the cortex; the lower values were found in motor and sensorimotor areas where almost all NCs were localized. A strong negative correlation was found between CNRWM-GM and NCs. CONCLUSIONS: Discrimination between CLs and JCs is affected from the sharp visualization of the WM-GM boundary, which is directly related to CNRWM-GM.


Assuntos
Substância Cinzenta/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Pan Afr Med J ; 33: 242, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692794

RESUMO

The sciatic nerve is the terminal branch of the sacral plexus. Sciatalgia is a nerve root pain. In most cases, sciatica originates from degenerative disc disease. Tumor involving the sciatic nerve is extremely rare. We here report the case of a 33-year old patient with nerve tumor detected on MRI performed for drug-resistant sciatica. Tumor involving the sciatic nerve is rare and diagnosis is difficult. MRI data are crucial for establishing an effective surgical approach.


Assuntos
Imagem por Ressonância Magnética/métodos , Neurilemoma/diagnóstico por imagem , Neurofibroma/diagnóstico por imagem , Nervo Isquiático/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Nervo Isquiático/patologia , Ciática/diagnóstico
18.
Zhonghua Er Ke Za Zhi ; 57(11): 844-851, 2019 Nov 02.
Artigo em Chinês | MEDLINE | ID: mdl-31665838

RESUMO

Objective: To summarize the clinical and genetic characteristics of children with mitochondrial epilepsy. Methods: Clinical data of 62 children who were clinically and genetically diagnosed with mitochondrial epilepsy by the Department of Neurology, Beijing Children's Hospital from October 2011 to December 2018 were analyzed retrospectively, and the control of epilepsy was followed up. T test or χ(2) test were used to analyze the related factors affecting the prognosis of epilepsy between the effective group and the ineffective group. Results: Of the 62 patients, 33 were male and 29 were female. The age of onset was 3.38 (0-12.00) years; for the type of seizures, 68% (42/62) of the patients had focal seizures, generalized or secondary generalized tonic-clonic seizures were seen in 32% (20/62), myoclonic seizures in 23% (14/62), spastic seizures in 7 cases, tonic seizures in 4 cases, absence seizure, atonic seizure and clonic seizure in 1 case each; 16 cases (26%) had status epilepticus, of whom 6 cases had epilepsia partialis continua; 52% (32/62) had 2 or more types of seizures. The clinical phenotypes were mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) in 29 cases, Leigh syndrome (LS) in 11 cases, combined oxidative phosphorylation deficiency in 6 cases, myoclonus epilepsy with ragged-red fibers in 5 cases, Alpers syndrome in 4 cases, pontocerebellar hypoplasia type 6 and mitochondrial DNA depletion syndrome 9 in 2 cases each, mitochondrial complex Ⅰ deficiency nuclear type 20, progressive cavitating leukoencephalopathy, and biotinidase deficiency in 1 case each. Of the 62 cases, 40 cases (65%) had mitochondrial DNA (mtDNA) variations, of which 26 cases had m.3243A>G variants, 6 cases had m.8344A>G variants, and 3 cases had m.8993T>G/C variants, m.3271T>C, m.3481G>A, m.3946G>A, m.13094T>C, m.14487T>C variant was in 1 case each; nuclear DNA (nDNA) variations were identified in 22 cases (35%), of which 7 cases carrying variations in mitochondrial ammonia acyl tRNA synthetase coding gene, mutations in POLG and the gene encoding complex Ⅰ were in 4 cases each, variations in SUCLG1 and SDHA genes were in 2 cases each, and variations in PDHA1, BTD and TRIT1 genes were in 1 case each. Forty-three patients were followed up, and the follow-up time was 20 (3-84) months. According to the follow-up results, the anti-epilepsy treatment was effective in 19 cases (44%) and ineffective in other 24 cases (56%). The onset age of the effective group was 3.42 (0-11.50) years and that of the ineffective group was 0.92 (0-9.50) years. The onset duration of the effective group was 0 (0-7.00) years and that of the ineffective group was 0 (0-4.83) years. There was no significant difference between the effective group and the ineffective group (t=1.662, 0.860; P=0.104, 0.395). In the effective group and the ineffective group, 12 cases and 9 cases used less than 2 kinds of antiepileptic drugs, 7 cases and 15 cases used more than or equal to 2 kinds of antiepileptic drugs, 13 and 15 cases had first epilepsy, 6 and 9 cases had non-first epilepsy, 14 and 11 cases had mtDNA variation, 5 and 13 cases had nDNA variation, respectively. There was no significant difference between the two groups (χ(2)=2.794, 0.164, 3.380; P=0.095, 0.686, 0.066). Conclusions: The types of seizures with mitochondrial epilepsy in children varied, with focal motor seizures being the most common, followed by generalized or secondary generalized tonic-clonic seizures. Most children have more than two types of seizures. MELAS is the most common clinical phenotype, followed by LS; mtDNA variation is the dominant gene variation, of which m.3243A>G variation is the most common hotspot variation, followed by gene variation encoding mitochondrial aminoacyl tRNA synthase.


Assuntos
Epilepsia/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças Mitocondriais/diagnóstico por imagem , Anticonvulsivantes/uso terapêutico , Criança , Epilepsia/tratamento farmacológico , Epilepsia/genética , Feminino , Humanos , Masculino , Doenças Mitocondriais/genética , Fenótipo , Estudos Retrospectivos , Convulsões
19.
Medicine (Baltimore) ; 98(45): e17937, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702681

RESUMO

Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Adolescente , Adulto , Criança , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Período Pré-Operatório , Estudos Retrospectivos , Seminoma/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Adulto Jovem
20.
Adv Exp Med Biol ; 1192: 95-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31705491

RESUMO

Cerebral small vessel disease is associated with late-life depression, cognitive impairment, executive dysfunction, distress, and loss of life for older adults. Late-life depression is becoming a substantial public health burden, and a considerable number of older adults presenting to primary care have significant clinical depression. Even though white matter hyperintensities are linked with small vessel disease, white matter hyperintensities are nonspecific to small vessel disease and can co-occur with other brain diseases. Advanced neuroimaging techniques at the ultrahigh field magnetic resonance imaging are enabling improved characterization, identification of cerebral small vessel disease and are elucidating some of the mechanisms that associate small vessel disease with late-life depression.


Assuntos
Envelhecimento , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Idoso , Encéfalo , Depressão , Humanos , Substância Branca
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