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1.
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
2.
Medicine (Baltimore) ; 98(39): e17334, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574870

RESUMO

RATIONALE: Subacute combined degeneration (SCD) is a disease caused by decreased vitamin B12 intake or metabolic disorders. It is more common in the elderly and rarely seen in children. Here, we report 2 pediatric cases of SCD in late-onset cobalamin C (CblC) deficiency. PATIENT CONCERNS: The patients complained of unsteady gait. Their physical examination showed sensory ataxia. Magnetic resonance imaging showed classic manifestations of SCD. The serum vitamin B12 level was normal, but urine methylmalonic acid and serum homocysteine levels were high. DIAGNOSIS: The pathogenic gene was confirmed as MMACHC. The 2 patients each had 2 pathogenic mutations C.482 G>A and C.271dupA and C.365A>T and C.609G>A in this gene. They were diagnosed with combined methylmalonic acidemia and homocysteinemia-CblC subtype. INTERVENTIONS: The patients were treated with methylcobalamin 500 µg intravenous injection daily after being admitted. After the diagnosis, levocarnitine, betaine, and vitamin B12 were added to the treatment. OUTCOMES: Twelve days after treatment, the boy could walk normally, and his tendon reflex and sense of position returned to normal. The abnormal gait seemed to have become permanent in the girl and she walked with her legs raised higher than normal. LESSONS: To the best of our knowledge, this is the first report of 2 cases of isolated SCD in children with late-onset CblC disorder. Doctors should consider that SCD could be an isolated symptom of CblC disorder. The earlier the treatment, the lower the likelihood of sequelae.


Assuntos
Proteínas de Transporte/genética , Homocistinúria , Degeneração Combinada Subaguda , Deficiência de Vitamina B 12/congênito , Vitamina B 12/análogos & derivados , Adolescente , Ataxia/diagnóstico , Ataxia/etiologia , Ataxia/terapia , Encéfalo/diagnóstico por imagem , Criança , Feminino , Homocisteína/sangue , Homocistinúria/diagnóstico , Homocistinúria/genética , Humanos , Injeções Intravenosas , Transtornos de Início Tardio , Imagem por Ressonância Magnética/métodos , Masculino , Ácido Metilmalônico/urina , Mutação , Degeneração Combinada Subaguda/diagnóstico , Degeneração Combinada Subaguda/etiologia , Degeneração Combinada Subaguda/fisiopatologia , Degeneração Combinada Subaguda/terapia , Resultado do Tratamento , Vitamina B 12/administração & dosagem , Vitamina B 12/sangue , Deficiência de Vitamina B 12/diagnóstico , Deficiência de Vitamina B 12/genética , Complexo Vitamínico B/administração & dosagem
3.
Bone Joint J ; 101-B(10): 1218-1229, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564157

RESUMO

AIMS: Abnormal femoral torsion (FT) is increasingly recognized as an additional cause for femoroacetabular impingement (FAI). It is unknown if in-toeing of the foot is a specific diagnostic sign for increased FT in patients with symptomatic FAI. The aims of this study were to determine: 1) the prevalence and diagnostic accuracy of in-toeing to detect increased FT; 2) if foot progression angle (FPA) and tibial torsion (TT) are different among patients with abnormal FT; and 3) if FPA correlates with FT. PATIENTS AND METHODS: A retrospective, institutional review board (IRB)-approved, controlled study of 85 symptomatic patients (148 hips) with FAI or hip dysplasia was performed in the gait laboratory. All patients had a measurement of FT (pelvic CT scan), TT (CT scan), and FPA (optical motion capture system). We allocated all patients to three groups with decreased FT (< 10°, 37 hips), increased FT (> 25°, 61 hips), and normal FT (10° to 25°, 50 hips). Cluster analysis was performed. RESULTS: We found a specificity of 99%, positive predictive value (PPV) of 93%, and sensitivity of 23% for in-toeing (FPA < 0°) to detect increased FT > 25°. Most of the hips with normal or decreased FT had no in-toeing (false-positive rate of 1%). Patients with increased FT had significantly (p < 0.001) more in-toeing than patients with decreased FT. The majority of the patients (77%) with increased FT walk with a normal foot position. The correlation between FPA and FT was significant (r = 0.404, p < 0.001). Five cluster groups were identified. CONCLUSION: In-toeing has a high specificity and high PPV to detect increased FT, but increased FT can be missed because of the low sensitivity and high false-negative rate. These results can be used for diagnosis of abnormal FT in patients with FAI or hip dysplasia undergoing hip arthroscopy or femoral derotation osteotomy. However, most of the patients with increased FT walk with a normal foot position. This can lead to underestimation or misdiagnosis of abnormal FT. We recommend measuring FT with CT/MRI scans in all patients with FAI. Cite this article: Bone Joint J 2019;101-B:1218-1229.


Assuntos
Artroscopia/métodos , Impacto Femoroacetabular/cirurgia , Imagem Tridimensional , Metatarso Valgo/diagnóstico por imagem , Metatarso Varo/diagnóstico por imagem , Osteotomia/efeitos adversos , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Fêmur/fisiopatologia , Seguimentos , Humanos , Modelos Lineares , Imagem por Ressonância Magnética/métodos , Masculino , Metatarso Valgo/epidemiologia , Metatarso Varo/epidemiologia , Pessoa de Meia-Idade , Osteotomia/métodos , Prevalência , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Anormalidade Torcional/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
4.
Bone Joint J ; 101-B(10): 1313-1320, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564158

RESUMO

AIMS: The aim of this study was to report the outcomes of patients who underwent definitive surgery for secondary chondrosarcomas arising from osteochondromas. PATIENTS AND METHODS: A total of 51 patients with secondary chondrosarcomas occurring from osteochondromas were reviewed. Median age was 36 years (interquartile range (IQR) 15 to 82). Median follow-up was 6.9 years (IQR 2.8 to 10.6). The pelvis was the most commonly affected site (59%). Histological grades were grade I in 35 (69%), grade II in 13 (25%), and grade III in three patients (6%). RESULTS: Preoperative biopsy histology correctly predicted the final histological grade in 27% of patients. The ten-year disease-specific survival (DSS) for all patients was 89.4%. Local recurrence occurred in 15 patients (29%), more commonly in pelvic tumours (37%) compared with limb tumours (19%). Four patients with pelvic tumours died from progression of local recurrence. No patient with limb tumours died of disease. Wide/radical margin was associated with improved local recurrence-free survival (p = 0.032) and local recurrence was associated with worse DSS (p = 0.005). CONCLUSION: We recommend that a secondary chondrosarcoma arising from osteochondroma of the pelvis is resected with wide/radical resection margins. The balance between the morbidity of surgery and risk of local recurrence needs to be considered in patients with limb secondary chondrosarcomas. Cite this article: Bone Joint J 2019;101-B:1313-1320.


Assuntos
Neoplasias Ósseas/patologia , Condrossarcoma/secundário , Recidiva Local de Neoplasia/mortalidade , Osteocondroma/patologia , Adulto , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/mortalidade , Condrossarcoma/cirurgia , Estudos de Coortes , Intervalo Livre de Doença , Extremidades/patologia , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Osteocondroma/diagnóstico por imagem , Osteocondroma/mortalidade , Osteocondroma/cirurgia , Ossos Pélvicos/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento
5.
Isr Med Assoc J ; 21(8): 542-545, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474017

RESUMO

BACKGROUND: Spinal manipulation therapy (SMT) is commonly used as an effective therapeutic modality for a range of cervical symptoms. However, in rare cases, cervical manipulation may be associated with complications. In this review we present a series of cases with cervical spine injury and myelopathy following therapeutic manipulation of the neck, and examine their clinical course and neurological outcome. We conducted a search for patients who developed neurological symptoms due to cervical spinal cord injury following neck SMT in the database of a spinal unit in a tertiary hospital between the years 2008 and 2018. Patients were assessed for the clinical course and deterioration, type of manipulation used and subsequent management. A total of four patients were identified, two men and two women, aged 32-66 years. In three patients neurological deterioration appeared after chiropractic adjustment and in one patient after tuina therapy. Three patients were managed with anterior cervical discectomy and fusion while one patient declined surgical treatment. Assessment for subjective and objective evidence of cervical myelopathy should be performed prior to cervical manipulation, and suspected myelopathic patients should be sent for further workup by a specialist familiar with cervical myelopathy (such as a neurologist, a neurosurgeon or orthopedic surgeon who specializes in spinal surgery). Nevertheless, manipulation therapy remains an important and generally safe treatment modality for a variety of cervical complaints. This review does not intend to discard the role of SMT as a significant part in the management of patients with neck related symptoms, rather it is meant to draw attention to the need for careful clinical and imaging investigation before treatment.


Assuntos
Manipulações Musculoesqueléticas/efeitos adversos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/etiologia , Doença Aguda , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Discotomia/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Medula Espinal/cirurgia
6.
Pan Afr Med J ; 33: 154, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31558951

RESUMO

Posterior reversible encephalopathy syndrome (PRES) is a radioclinical entity associating a reversible central nervous system involvement with a common brain imaging feature. There is a great variability in the clinical presentation of this syndrome and in the features of its sometimes atypical imaging appearance. PRES is an unusual neurological complication occurring during pregnancy or in the post-partum period, other than any pre-existing pathology occurred during pregnancy. Vasogenic edema due to the rupture of the blood-brain barrier seems to be its main cause. We here report the case of a primiparous patient with generalized tonic-clonic seizures associated with hypertensive peak occurred during the third trimester of pregnancy. Magnetic resonance imaging (MRI) of the brain showed posterior reversible encephalopathy. PRES should be suspected in patients with any sign of neurological disorder. It has a favorable outcome without sequelae under early and fast treatment.


Assuntos
Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Convulsões/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Síndrome da Leucoencefalopatia Posterior/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Gravidez , Terceiro Trimestre da Gravidez
7.
Urologiia ; (4 ()): 25-27, 2019 Sep.
Artigo em Russo | MEDLINE | ID: mdl-31535794

RESUMO

Imaging studies play a crucial role in the diagnosis of urologic diseases. X-ray and ultrasound studies are used as first-line diagnostic methods. Computed tomography and magnetic resonance imaging (MD-CT and MRI), radionuclide and hybrid methods allow to clarify diagnosis. Currently, the trend "from simple to complex" contributes to obtaining maximum information in the shortest possible time with a minimum cost.


Assuntos
Técnicas de Diagnóstico Urológico/tendências , Imagem por Ressonância Magnética , Tomografia Computadorizada por Raios X , Doenças Urológicas/diagnóstico por imagem , Urologia/tendências , Alemanha , Humanos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/tendências , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/tendências , Ultrassonografia/métodos , Ultrassonografia/tendências , Urografia
8.
Pan Afr Med J ; 33: 118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489096

RESUMO

Dysplastic gangliocytoma or Lhermitte-Duclos disease is a rare disorder characterized by a slowly progressive unilateral tumour mass of the cerebellar cortex. It is probably hamartomatous, although the exact pathogenesis remains unknown. Lhermitte-Duclos disease was recently encountered to be part of a multiple hamartoma-neoplasia complex (Cowden's syndrome). It typically presents in young adults, although it has been encountered at all ages. We present the case of bilateral cerebellar location of this pathology in a 50-year-old man presented with a progressive onset and worsening of headaches accompanied by nuchal rigidity, photophobia and nausea awakening each morning. Upon physical examination, the patient was awake with a discrete right vestibular syndrome made of positive Romberg without nystagmus. Magnetic Resonance Imaging (MRI) was performed and revealed salient "tiger stripe" appearance of the bilateral cerebellar cortex relevant to a Lhermitte-Duclos disease.


Assuntos
Neoplasias Cerebelares/diagnóstico por imagem , Síndrome do Hamartoma Múltiplo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias Cerebelares/patologia , Síndrome do Hamartoma Múltiplo/patologia , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Rigidez Muscular/etiologia , Náusea/etiologia , Fotofobia/etiologia
10.
Anticancer Res ; 39(9): 4905-4909, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519594

RESUMO

BACKGROUND/AIM: The differentiation between cerebral metastases (CM) and high-grade gliomas (HGG) can be difficult on magnetic resonance imaging (MRI). The aim of this study was to evaluate the usefulness of searching two MRI signs (signal alteration in the adjacent cortex, SAAC, and peripheral rim sign, PRS), in order to distinguish between these entities. PATIENTS AND METHODS: A total of 61 patients were retrospectively enrolled (28 HGG, 33 CM). Fluid Attenuated Inversion Recovery (FLAIR) sequences were used to assess SAAC and contrast-enhanced T1-weighted sequences for PRS. RESULTS: A positive SAAC sign was present in 61% of HGG, and 12% of CM. Conversely, in SAAC-negative lesions, PRS was observed in 78% of CM and in 32% of HGG. Their association had a higher frequency in HGG than in the CM group (21 vs. 3%). CONCLUSION: While SAAC is specific for HGG and PRS, in the absence of SAAC, is relatively specific for CMs, their combined presence is highly suggestive of HGG.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Córtex Cerebral/patologia , Glioma/diagnóstico , Imagem por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Curva ROC , Intensificação de Imagem Radiográfica , Reprodutibilidade dos Testes
11.
Curr Urol Rep ; 20(10): 59, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478111

RESUMO

PURPOSE OF REVIEW: The purpose of this review is to summarize the most current literature regarding the most important aspects to consider when developing a center of excellence for prostate imaging and biopsy. RECENT FINDINGS: Multiparametric MRI (mp-MRI) has changed the way we diagnose and treat prostate cancer. This imaging modality allows for more precise identification of areas suspicious in terms of harboring prostate cancer, enabling performance of targeted mp-MRI-guided biopsies that have been demonstrated to yield superior cancer detection rates. Centers worldwide are increasingly adopting this technology. However, obtaining results comparable with those findings published in the literature can be challenging. The imaging and biopsy process entails the need for a multidisciplinary team including a dedicated radiologist, urologist, and pathologist. Adequate mp-MRI interpretation for accurate lesion identification, acquaintance with the biopsy technique selected, and precise characterization of Gleason Score/Grade Groupings are equal determinants of accurate biopsy results. Furthermore, all specialists are required to attain appropriate learning curves to ensure optimal results. In this review, we characterize crucial aspects to consider when developing a center of excellence for prostate imaging and biopsy as well as insights regarding how to implement them.


Assuntos
Instalações de Saúde/normas , Biópsia Guiada por Imagem/normas , Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Biópsia/métodos , Biópsia/normas , Humanos , Biópsia Guiada por Imagem/métodos , Curva de Aprendizado , Masculino , Gradação de Tumores , Equipe de Assistência ao Paciente/normas , Desenvolvimento de Programas/normas , Neoplasias da Próstata/patologia , Estados Unidos
12.
Curr Urol Rep ; 20(10): 60, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478113

RESUMO

PURPOSE OF REVIEW: With the long-standing controversy surrounding the use of prostate-specific antigen (PSA) for the detection, evaluation, and surveillance of prostate cancer, there is a need for a minimally invasive technique to identify and risk-stratify these patients. Additionally, in an effort to reduce the number of unnecessary biopsies and identify clinically significant prostate cancer (csPCa), there has been a shift in practice towards the use of multiparametric magnetic resonance imaging (mpMRI) in conjunction with decision-making regarding prostate cancer diagnosis and management. In the current review, we summarize the data regarding the use of mpMRI in the detection, evaluation, and surveillance of csPCa. RECENT FINDINGS: Recent prospective clinical trials have determined that a pre-biopsy mpMRI may rule out insignificant prostate cancers, thereby reducing the number of patients who require a biopsy. The anatomic information gathered from these pre-biopsy mpMRI performed during MRI fusion biopsy in csPCa increases the accuracy of pathologic staging in terms of Gleason scores. In regard to active surveillance, prospective trials suggest little to no clinical utility for mpMRI and fusion biopsy in the surveillance of prostate cancer despite conflicting findings from retrospective studies. Recent trials suggest that mpMRI can play an important role in the detection and evaluation of csPCa. The ideal role for mpMRI in active surveillance remains limited.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Biomarcadores Tumorais/sangue , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Vigilância da População , Prognóstico , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Medição de Risco
13.
Pan Afr Med J ; 33: 88, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489066

RESUMO

Scrotal elephantiasis is defined as an increase in the scrotal volume which can reach a very large size. This study involved O.H, a married man aged 70 years, father of 4 children, farmer, native of and resident in Agadir (south of Morocco). Symptoms started 7 years before when scrotal edema and then an edema in both feet and legs gradually increasing in volume occurred. Physical examination showed scrotal elephantiasis with a circumference measured 80 cm and elephantiasis in both legs and feet. Locoregional assessment was based on pelvic magnetic resonance imaging (MRI). The patient was scheduled for monoblock scrotal resection under spinal anesthesia with removal of all of the tissue affected by the lymphedema around the testicle which were covered using the remaining skin and of the penis which was skin grafted using thin skin. The treatment aimed to ensure penis function and to manage the disfiguration. Conservative treatment based on lymphovenous bypass surgery or on the dilation of lymph vessels is no longer performed. Treatment is based on surgery. Surgery is avoided when there are absolute contraindications.


Assuntos
Elefantíase/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Escroto/cirurgia , Elefantíase/patologia , Elefantíase/cirurgia , Doenças dos Genitais Masculinos/diagnóstico por imagem , Doenças dos Genitais Masculinos/patologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Linfedema/patologia , Linfedema/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Marrocos , Escroto/diagnóstico por imagem , Escroto/patologia
15.
Medicine (Baltimore) ; 98(35): e16960, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464937

RESUMO

To assess the duct-road sign and tumor-to-duct ratio (TDR) in MRI for differentiating pancreatic neuroendocrine tumors (PNETs) from pancreatic ductal-adenocarcinomas (PDACs).Retrospectively reviewed MRI characteristics of 78 pancreatic masses (histopathology-proven 25 PNETs and 53 PDACs). Receiver operating characteristics with TDR and diagnostic performance of the duct-road sign for differential diagnosis were performed.The prevalence of duct-road sign in PNETs was higher than that for PDACs (84% vs 0%; P < .001). A strong correlation (r = 0.884, P < .001) was observed between MRI for PNETs and the frequency of this sign. Performance characteristics of the duct-road sign in MRI for PNET diagnosis were sensitivity (84%, [21 of 25]), specificity (100%, [53 of 53]), positive predictive value (100%, [21 of 21]), negative predictive value (92.9%, [53 of 57]), and accuracy (94.8%, [74 of 78]). In the intention-to-diagnose analysis, the corresponding values were 67.7% (21 of 31), 100% (53 of 53), 100% (21 of 21), 84.1% (53 of 63), and 88.1% (74 of 84). The TDR in PNETs was observed to be greater than that in PDACs (14.6 ±â€Š9.3 vs 6.9 ±â€Š3.8, P = .001). TDR with a cut-off value of 7.7 had high sensitivity (84%) and specificity (66%) with area under curve (0.802, 95% CI: 0.699, 0.904; P < .001) for distinguishing PNETs from PDACs.The presence of duct-road sign and TDR > 7.7 on MRI may assist in diagnosis for PNET instead of PDAC.


Assuntos
Adenocarcinoma/patologia , Tumores Neuroendócrinos/patologia , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Adenocarcinoma/diagnóstico por imagem , Adulto , Idoso , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Ductos Pancreáticos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Carga Tumoral
16.
Medicine (Baltimore) ; 98(33): e16608, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415354

RESUMO

The utility of multimodality molecular imaging for predicting treatment response and survival of patients with hypopharyngeal carcinoma remains unclear. Here, we sought to investigate whether the combination of different molecular imaging parameters may improve outcome prediction in this patient group.Patients with pathologically proven hypopharyngeal carcinoma scheduled to undergo chemoradiotherapy (CRT) were deemed eligible. Besides clinical data, parameters obtained from pretreatment 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT), dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), and diffusion-weighted MRI were analyzed in relation to treatment response, recurrence-free survival (RFS), and overall survival (OS).A total of 61 patients with advanced-stage disease were examined. After CRT, 36% of the patients did not achieve a complete response. Total lesion glycolysis (TLG) and texture feature entropy were found to predict treatment response. The transfer constant (K), TLG, and entropy were associated with RFS, whereas K, blood plasma volume (Vp), standardized uptake value (SUV), and entropy were predictors of OS. Different scoring systems based on the sum of PET- or MRI-derived prognosticators enabled patient stratification into distinct prognostic groups (P <.0001). The complete response rate of patients with a score of 2 was significantly lower than those of patients with a score 1 or 0 (14.7% vs 58.9% vs 75.7%, respectively, P = .007, respectively). The combination of PET- and DCE-MRI-derived independent risk factors allowed a better survival stratification than the TNM staging system (P <.0001 vs .691, respectively).Texture features on F-FDG PET/CT and DCE-MRI are clinically useful to predict treatment response and survival in patients with hypopharyngeal carcinoma. Their combined use in prognostic scoring systems may help these patients benefit from tailored treatment and obtain better oncological results.


Assuntos
Carcinoma/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/estatística & dados numéricos , Neoplasias Hipofaríngeas/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Adulto , Carcinoma/mortalidade , Carcinoma/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Fluordesoxiglucose F18 , Humanos , Neoplasias Hipofaríngeas/mortalidade , Neoplasias Hipofaríngeas/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Imagem Multimodal/estatística & dados numéricos , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Compostos Radiofarmacêuticos , Taxa de Sobrevida
18.
Rev Assoc Med Bras (1992) ; 65(7): 977-981, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389508

RESUMO

INTRODUCTION: Angiomyolipoma is one of the most common benign solid renal tumors. We investigated the characteristics of renal angiomyolipomas and the clinical outcomes of patients in the last thirteen years. METHODS: The medical records of the patients who underwent nephrectomy were reviewed retrospectively from July 2005 to May 2018. The laboratory data, radiology, and pathology reports were recorded. Patients diagnosed with angiomyolipoma were included in the study. RESULTS: A total of 28 patients were included in the study, eight of them male. The mean age of the patients was 55.89+14.49 years. The patients were treated with open and laparoscopic techniques. Partial nephrectomy was performed in 12 patients(42.85%). After pathological examination, 23 patients were diagnosed as fat rich, four patients as fat poor, and one as epithelioid angiomyolipoma. There were no recurrences in the follow-up 91.21+48.31 months. CONCLUSION: Angiomyolipoma is a rare renal tumor in daily urology practice. Clinicians must be aware of its complications and manage patients well.


Assuntos
Angiomiolipoma/patologia , Neoplasias Renais/patologia , Adulto , Idoso , Angiomiolipoma/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Neoplasias Renais/cirurgia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Nefrectomia/métodos , Estudos Retrospectivos , Carga Tumoral
19.
Zhonghua Nei Ke Za Zhi ; 58(9): 662-667, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31461817

RESUMO

Objective: To investigate the correlation of functional connectivity (FC) and the integrity of connective fibres between hippocampus and thalamus in Alzheimer's disease(AD) and amnestic mild cognitive impairment (aMCI). Methods: Both resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI) data of 40 AD patients, 37 aMCI patients and 41 normal control subjects matching with age and educational level were collected. These subjects were all recruited from outpatient Department of Neurology in the Second Medical Center of Chinese PLA General Hospital, as well as poster, from May 2016 to January 2018. The FC strength between bilateral hippocampus and thalamus, as well as the parameters representing integrity of connective fibres, including fractional anisotropy (FA) and mean diffusivity(MD),were analyzed. Also, the correlations between FC strength and FA or MD strength were analyzed in the study. Results: Compared to that of normal control subjects, the FC strength between billateral hippocampus and thalamus in patients with AD, aMCI were not significantly different(P>0.05). The integrity of bilateral connective fibres between hippocampus and thalamus were damaged in AD patients when compared to normal control subjects(P<0.01). A positive correlation of connective fibres integrity with FC strength between hippocampus and thalamus was found in the left side(r=0.25,P<0.05) but rather in the right side. Conclusion: In AD and aMCI patients, structural connectivity between left hippocampus and thalamus affects the functional connectivity between them.


Assuntos
Doença de Alzheimer/fisiopatologia , Amnésia/complicações , Disfunção Cognitiva/fisiopatologia , Hipocampo/diagnóstico por imagem , Rede Nervosa/fisiopatologia , Tálamo/diagnóstico por imagem , Doença de Alzheimer/diagnóstico por imagem , Encéfalo/patologia , Estudos de Casos e Controles , Disfunção Cognitiva/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Humanos , Imagem por Ressonância Magnética/métodos
20.
Br J Radiol ; 92(1101): 20190165, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364398

RESUMO

The recreational consumption of cannabis has increased significantly across the world with an estimated 180 million people currently using. In the United States, 4.1 million are currently diagnosed with cannabis use disorder. Cannabis dependence and abuse was combined into a single entity as a behavioral disorder with a problematic pattern of cannabis use and termed cannabis use disorder by the Diagnostic and Statistical Manual of Mental Disorders. Chronic use of cannabis has been linked with region-specific effects across the brain mediating reward processing, cognitive control and decision-making that are central to understanding addictive behaviors. This review presents a snapshot of the current literature assessing the effects of chronic cannabis use on human brain function via functional MRI. Studies employing various paradigms and contrasting cognitive activation amongst cannabis users and non-users were incorporated. The effects of trans-del-ta-9-tetrahydrocannabinol (Δ9-THC) in marijuana and other preparations of cannabis are mediated by the endocannabinoid system, which is also briefly introduced.Much variation exists in the current literature regarding the functional changes associated with chronic cannabis use. One possible explanation for this variation is the heterogeneity in study designs, with little implementation of standardized diagnostic criteria when selecting chronic users, distinct time points of participant assessment, differing cognitive paradigms and imaging protocols. As such, there is an urgent requirement for future investigations that further characterize functional changes associated with chronic cannabis use.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Tomada de Decisões/fisiologia , Imagem por Ressonância Magnética/métodos , Abuso de Maconha/fisiopatologia , Recompensa , Adolescente , Adulto , Feminino , Humanos , Masculino , Abuso de Maconha/psicologia , Adulto Jovem
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