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3.
Scand J Trauma Resusc Emerg Med ; 27(1): 90, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31604472

RESUMO

BACKGROUND: For neonates and children requiring decompression of tension pneumothorax, specific recommendations for the choice of needle type and size are missing. The aim of this retrospective study was to determine optimal length and diameter of needles for decompression of tension pneumothorax in paediatric patients. METHODS: Utilizing computed tomography, we determined optimal length and diameter of needles to enable successful decompression and at the same time minimize risk of injury to intrathoracic structures and the intercostal vessels and nerve. Preexisting computed tomography scans of the chest were reviewed in children aged 0, 5 and 10 years. Chest wall thickness and width of the intercostal space were measured at the 4th intercostal space at the anterior axillary line (AAL) on both sides of the thorax. In each age group, three needles different in bore and length were evaluated regarding sufficient length for decompression and risk of injury to intrathoracic organs and the intercostal vessels and nerve. RESULTS: 197 CT-scans were reviewed, of which 58 were excluded, resulting in a study population of 139 children and 278 measurements. Width of the intercostal space was small at 4th ICS AAL (0 years: 0.44 ± 0.13 cm; 5 years: 0.78 ± 0.22 cm; 10 years: 1.12 ± 0.36 cm). The ratio of decompression failure to risk of injury at 4th ICS AAL was most favourable for a 22G/2.5 cm catheter in infants (Decompression failure: right: 2%, left: 4%, Risk of injury: right: 14%, left: 24%), a 22G/2.5 cm or a 20G/3.2 cm catheter in 5-year-old children (20G/3.2 cm: Decompression failure: right: 2.1%, left: 0%, Risk of injury: right: 2.1%, left: 17%) and a 18G/4.5 cm needle in 10-year-old children (Decompression failure: right: 9.5%, left: 9.5%, Risk of injury: right: 7.1%, left: 11.9%). CONCLUSIONS: In children aged 0, 5 and 10 years presenting with a tension pneumothorax, we recommend 22G/2.5 cm, 20G/3.2 cm and 18G/4.5 cm needles, respectively, for acute decompression.


Assuntos
Descompressão Cirúrgica/instrumentação , Agulhas , Pneumotórax/diagnóstico por imagem , Pneumotórax/cirurgia , Criança , Pré-Escolar , Tomada de Decisão Clínica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Costelas/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
Heart Surg Forum ; 22(5): E401-E404, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596720

RESUMO

Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.


Assuntos
Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Sífilis Cardiovascular/complicações , Sífilis/complicações , Parede Torácica , Aorta/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Implante de Prótese Vascular , Ponte Cardiopulmonar , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fraturas das Costelas/diagnóstico por imagem , Sorodiagnóstico da Sífilis , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Best Pract Res Clin Anaesthesiol ; 33(1): 67-77, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31272655

RESUMO

A multitude of thoracic wall blocks have been described, including parasternal-intercostal plane, Pecs I and II, serratus anterior plane, paraspinal-intercostal plane, erector spinae plane blocks, and retrolaminar blocks. They are almost all fascial plane blocks, relying on passive spread of local anesthetic to target nerves within the plane or in adjacent tissue compartments. They have emerged as attractive alternatives to thoracic paravertebral and epidural blocks because of their relative simplicity and safety. Although research into these techniques is still at an early stage, the available evidence indicates that they are effective in reducing opioid requirements and improving the pain experience in a wide range of clinical settings. They are best employed as part of multimodal analgesia with other systemic analgesics, rather than as sole anesthetic techniques. Catheters may be beneficial in situations where moderate-to-severe pain is expected for >12 h, although the optimal dosing regimen requires further investigation.


Assuntos
Músculos Intermediários do Dorso/diagnóstico por imagem , Bloqueio Nervoso/métodos , Músculos Paraespinais/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem , Anestésicos Locais/administração & dosagem , Humanos , Músculos Intermediários do Dorso/efeitos dos fármacos , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/prevenção & controle , Músculos Paraespinais/efeitos dos fármacos , Parede Torácica/efeitos dos fármacos , Ultrassonografia de Intervenção/métodos
9.
Med Phys ; 46(10): 4405-4416, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31274194

RESUMO

PURPOSE: Segmentation of the chest wall, is an important component of methods for automated analysis of breast magnetic resonance imaging (MRI). Methods reported to date show promising results but have difficulties delineating the muscle border correctly in breasts with a large proportion of fibroglandular tissue (i.e., dense breasts). Knowledge-based methods (KBMs) as well as methods based on deep learning have been proposed, but a systematic comparison of these approaches within one cohort of images is currently lacking. Therefore, we developed a KBM and a deep learning method for segmentation of the chest wall in MRI of dense breasts and compared their performances. METHODS: Two automated methods were developed, an optimized KBM incorporating heuristics aimed at shape, location, and gradient features, and a deep learning-based method (DLM) using a dilated convolution neural network. A data set of 115 T1-weighted MR images was randomly selected from MR images of women with extremely dense breasts (ACR BI-RADS category 4) participating in a screening trial of women (mean age 56.6 yr, range 49.5-75.2 yr) with dense breasts. Manual segmentations of the chest wall, acquired under supervision of an experienced breast radiologist, were available for all data sets. Both methods were optimized using the same randomly selected 36 MRI data sets from a total of 115 data sets. Each MR data set consisted of 179 transversal images with voxel size 0.64 mm3  × 0.64 mm3  × 1.00 mm3 . In the remaining 79 data sets, the results of both segmentation methods were qualitatively evaluated. A radiologist reviewed the segmentation results of both methods in all transversal images (n = 14 141) and determined whether the result would impact the ability to accurately determine the volume of fibroglandular and fatty tissue and whether segmentations masked breast regions that might harbor lesions. When no relevant deviation was detected, the result was considered successful. In addition, all segmentations were quantitatively assessed using the Dice similarity coefficient (DSC) and Hausdorff distance (HD), 95th percentile of the Hausdorff distance (HD95), false positive fraction (FPF), and false negative fraction (FNF) metrics. RESULTS: According to the radiologist's evaluation, the DLM had a significantly higher success rate than the KBM (81.6% vs 78.4%, P < 0.01). The success rate was further improved to 92.1% by combining both methods. Similarly, the DLM had significantly lower values for FNF (0.003 ± 0.003 vs 0.009 ± 0.011, P < 0.01) and HD95 (2.58 ± 1.78 mm vs 3.37 ± 2.11, P < 0.01). However, the KBM resulted in a significantly lower FPF than the DLM (0.018 ± 0.009 vs 0.030 ± 0.009, P < 0.01).There was no significant difference between the KBM and DLM in terms of DSC (0.982 ± 0.006 vs 0.984 ± 0.008, P = 0.08) or HD (24.14 ± 20.69 mm vs 12.81 ± 27.28 mm, P = 0.05). CONCLUSION: Both optimized knowledge-based and DLM showed good results to segment the pectoral muscle in women with dense breasts. Qualitatively assessed, the DLM was the most robust method. A quantitative comparison, however, did not indicate a preference for one method over the other.


Assuntos
Densidade da Mama , Mama/citologia , Mama/diagnóstico por imagem , Aprendizado Profundo , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética , Parede Torácica/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Automação , Feminino , Humanos , Pessoa de Meia-Idade
10.
Intern Med ; 58(21): 3129-3132, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31292396

RESUMO

The safety and efficacy of anti-programmed cell death-1 (PD-1) antibodies in patients with granulomatosis with polyangiitis (GPA) still remain unclear. An 83-year-old man with GPA that was well controlled with immunosuppressive therapy was diagnosed with a postoperative recurrence of non-small cell lung cancer (NSCLC). Because the programmed cell death ligand 1 (PD-L1) tumor proportion score was 90%, pembrolizumab was administered. After 10 cycles, immune-related adverse events or GPA flare was not observed, and the patient showed an antitumor response. Anti-PD-1 antibody should therefore be considered a treatment option for PD-L1-high-expressing NSCLC patients with well-controlled GPA.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antígeno B7-H1/antagonistas & inibidores , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Granulomatose com Poliangiite/complicações , Neoplasias Pulmonares/tratamento farmacológico , Idoso , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/secundário , Glucocorticoides/uso terapêutico , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/patologia , Masculino , Recidiva Local de Neoplasia/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Prednisolona/uso terapêutico , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Medicine (Baltimore) ; 98(27): e16280, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277156

RESUMO

RATIONALE: Tuberculous retropharyngeal abscess is rare, but it can be fatal if not treated appropriately. It usually occurs secondary to tuberculosis of the cervical spine. Moreover, tuberculous abscess involving the chest wall is relatively rare in skeletal tuberculosis. Although the optimal treatment is controversial, most clinicians suggest a combination of sufficient antituberculous medication and complete resection to prevent recurrence and increase therapeutic efficacy. Herein, we present an unusual case of retropharyngeal abscess with cervical Pott disease and tuberculous abscess of the chest wall. PATIENT CONCERNS: The patient was a 27-year-old Indonesian woman who had neck pain, dysphagia, and odynophagia, but no neurological deficit. Examination of the oral cavity showed anterior displacement of the posterior pharyngeal wall. The mass over the right anterior chest wall measured approximately 5 × 4 cm in size. DIAGNOSES: Radiography and computed tomography findings were suggestive of retropharyngeal abscess extending to the cervical spine and chest wall abscess. INTERVENTIONS: She was admitted to the hospital for treatment. Drainage of the retropharyngeal and chest wall abscesses with debridement of the chest wall was performed. OUTCOMES: No complications occurred after early surgical treatment and administration of antituberculous medication. The patient recovered well and went back to her own country after discharge. LESSONS: Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall are both complicated diagnoses that physicians have to consider in similar patient presentations.


Assuntos
Abscesso/etiologia , Antituberculosos/uso terapêutico , Drenagem/métodos , Mycobacterium tuberculosis/imunologia , Abscesso Retrofaríngeo/etiologia , Parede Torácica/microbiologia , Tuberculose da Coluna Vertebral/complicações , Abscesso/diagnóstico , Abscesso/terapia , Adulto , Feminino , Humanos , Mycobacterium tuberculosis/isolamento & purificação , Abscesso Retrofaríngeo/microbiologia , Abscesso Retrofaríngeo/terapia , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/terapia
12.
Eur J Radiol ; 117: 140-148, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307639

RESUMO

PURPOSE: Image acquisition protocols and reports in patients with pectus excavatum (PEX) differ significantly from routine examinations, and no imaging modality can enable a comprehensive assessment of PEX severity and cardiac impact within a single examination. We therefore attempt to establish recommendations about preoperative imaging in patients with PEX. METHOD: Chest computed tomography (CT), stress echocardiography (Echo), and cardiac magnetic resonance (CMR) allow the evaluation of specific information regarding structural and functional characteristics of vital importance to assess surgical candidacy and define surgical strategies. We sought to provide a multidisciplinary state of the art document involving thoracic surgeons, radiologists, and cardiologists; to establish recommendations about the variables to be included in the reports of the imaging examinations performed in patients with PEX. RESULTS: We provide recommendations for preoperative image acquisition and analysis, aimed at the assessment of the severity of the chest wall deformity (CT); the site of maximum cardiac compression, extent of increased interventricular dependence, and presence of pericardial effusion (CMR); and the effect of PEX on the functional capacity and exercise-related systolic and/or diastolic function, and tricuspid annulus compression (Echo). CONCLUSIONS: This multidisciplinary state of the art document involving thoracic surgeons, radiologists, and cardiologists provides recommendations about preoperative imaging for patients with PEX.


Assuntos
Tórax em Funil/diagnóstico por imagem , Imagem Multimodal , Radiografia Torácica , Parede Torácica/diagnóstico por imagem , Tórax em Funil/fisiopatologia , Guias como Assunto , Humanos , Reprodutibilidade dos Testes , Parede Torácica/patologia
13.
Ann Surg Oncol ; 26(11): 3455-3461, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332637

RESUMO

BACKGROUND: Breast cancer patients with local and/or locoregional recurrence (LR) are at higher risk of developing distant metastases (DM) at a later time. Once LR has been confirmed, some international interdisciplinary guidelines recommend performing radiological examinations for DM to determine the course of further therapy (curative or palliative approach). This study analyzed the metastatic patterns of patients with LR with particular regard to the frequency of concurrent diagnosis of LR and DM; in other words: are radiological staging procedures actually justified for DM at the time of diagnosis of LR? METHODS: This study included all patients (n = 1368) who were diagnosed and treated for nonmetastatic breast cancer (Stage I-III) at the University Women's Hospital Basel, Switzerland between 1990 and 2009. RESULTS: In 137 patients, LR was diagnosed without a history of DM: in-breast/thoracic wall only, n = 90 (65.7%); involvement of axillary/supra-/infraclavicular lymph nodes, n = 47 (34.3%). DM was found at the time of diagnosis of LR in 44 patients (32.1%). Concurrent diagnosis of LR and DM occurred significantly more often in patients with lymph node recurrence compared with those with in-breast/chest wall recurrence (48.9% vs. 23.3%; p = 0.004). CONCLUSIONS: Approximately one-third of patients with a LR had synchronous DM at the time of their local/locoregional event. For this reason, routine systemic staging imaging at the time of LR should be an absolute requirement for planning further therapy. Confirmation of DM may spare the patients radical surgical interventions with questionable impact on survival in the face of an incurable disease.


Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/secundário , Linfonodos/patologia , Recidiva Local de Neoplasia/patologia , Guias de Prática Clínica como Assunto/normas , Parede Torácica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/diagnóstico por imagem , Carcinoma Lobular/cirurgia , Feminino , Seguimentos , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Estudos Prospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/cirurgia
14.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
J Med Case Rep ; 13(1): 177, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31177991

RESUMO

BACKGROUND: Desmoid tumors are intermediary malignant, fibrous lesions occurring in various soft tissues. Surgical treatment is relentlessly challenging because of the propensity for local aggressive behavior and high risk of recurrence. Consequently, a wide range of oncological drugs and radiation therapy are being used; however, outcomes are unpredictable. We investigated whether local treatment with an oncolytic peptide could be beneficial in a patient with an unresectable desmoid tumor. CASE PRESENTATION: In a young 29-year-old Caucasian woman who was diagnosed with a retromammary desmoid tumor infiltrating deeply into the anterior thoracic wall, surgery was considered excessively mutilating, and observation was recommended. The lesion progressed, however, and caused debilitating pain, despite nonsteroidal anti-inflammatory medication. Subcutaneous injections of human interferon-α (Multiferon®) resulted in reduced growth kinetics but had to be terminated because of development of symptomatic pneumonitis. Frequently used oncological treatment was withheld because of the toxicity profile, and the patient was instead included in a phase I study investigating transdermal intratumoral injection of LTX-315, an oncolytic peptide that induces anticancer immune responses ( ClinicalTrials.gov , NCT01986426 ). A marked increase of CD8+ tumor-infiltrating T cells in the lesion was complemented by upregulation of immune gene signature (including effector T-cell, T-helper type 1 cell, chemokine, and cytokine genes). These changes were followed by gradual symptom relief and long-term disease stabilization, indicating clinical benefit. LTX-315 was well tolerated until termination in week 16 after a serious allergic reaction. CONCLUSIONS: Our patient was treated with repeated intratumoral injections of LTX-315, resulting in tumor regression accompanied by upregulation of immune genes and T-cell infiltration. Local application of immunotherapy, minimizing systemic side effects, represents a novel treatment modality in desmoid tumors that should be tested in further clinical trials.


Assuntos
Fibromatose Agressiva , Oligopeptídeos/administração & dosagem , Parede Torácica , Adulto , Antineoplásicos/administração & dosagem , Linfócitos T CD8-Positivos/imunologia , Diagnóstico Diferencial , Feminino , Fibromatose Agressiva/imunologia , Fibromatose Agressiva/patologia , Fibromatose Agressiva/fisiopatologia , Fibromatose Agressiva/terapia , Humanos , Injeções Intralesionais , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Indução de Remissão , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Carga Tumoral
16.
Ann Thorac Surg ; 108(4): 1065-1071, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31201783

RESUMO

BACKGROUND: Corrective surgery for pectus excavatum often relies on the Haller index (HI), derived from chest roentgenograms or computed tomography; however, this exposes children to potentially unnecessary radiation. Our aim was to develop a novel three-dimensional (3D) optical imaging technique to accurately measure chest wall dimensions in a clinically relevant manner. METHODS: Patients with pectus excavatum were imaged using a 3D structured light scanner. Patient characteristics, including height, weight, body mass index, and radiographic HIs (rHI) were recorded. We defined the optical index (OI) as the ratio of the lateral to anterior-posterior measurements obtained from the 3D optical images and compared those to patients' rHIs. Two-thirds of the patients' images were used to develop a predictive model of the rHI, using their OI and biometric data in multilinear regression modeling. The predictive model was applied to the remaining images, and the predicted HIs (pHI) were compared to the rHIs. RESULTS: Optical imaging was performed in 42 patients (ages, 5-35 years) with pectus excavatum; of these, 31 had recent chest roentgenograms, with rHIs ranging from 2.00 to 7.20. The OIs derived from the images correlated closely with rHIs (r = 0.850). Our predictive model, using patients' OI, height, and weight, was able to accurately estimate their rHIs with a median error of 8.11% (interquartile range, 3.5%-17.4%). CONCLUSIONS: 3D optical imaging of patients with pectus excavatum is emerging as an alternative method to assess HIs without the use of ionizing radiation. Additional studies will focus on volumetric quantification of chest wall deformities, using the 3D capabilities of this technology.


Assuntos
Tórax em Funil/diagnóstico , Imagem Tridimensional/métodos , Imagem Óptica/métodos , Parede Torácica/diagnóstico por imagem , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Adulto Jovem
17.
Semin Musculoskelet Radiol ; 23(3): 324-344, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31163506

RESUMO

This article consists of a series of clinical cases presented during the ESSR Quiz session at the 25th Annual Meeting of the European Society of Musculoskeletal Radiology in Amsterdam 2018. The first section contains the clinical information and an initial set of images for each case. The second section reveals the answers along with additional imaging followed by a short discussion about the pathologic processes presented. This article provides self-assessment and at the same time refreshes the reader's knowledge about some common and not-so-common clinical conditions that a radiologist may encounter during clinical practice.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Artropatias/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Europa (Continente) , Feminino , Antebraço/diagnóstico por imagem , Humanos , Articulações/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pelve/diagnóstico por imagem , Radiologia , Sociedades Médicas , Coluna Vertebral/diagnóstico por imagem , Parede Torácica/diagnóstico por imagem
18.
Interact Cardiovasc Thorac Surg ; 29(4): 503-509, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31219557

RESUMO

OBJECTIVES: The OrtenBodyOne scanner is a radiation-free, 3-dimensional imaging system recently developed for evaluation of the severity of pectus excavatum (PE). The goal of this study was to evaluate the utility of this new imaging system compared with that of computed tomography (CT) for the evaluation of the severity of PE. METHODS: Patients treated for PE from April 2015 to January 2017 with available CT and OrtenBodyOne data were included. Correlations between indexes calculated from CT and from OrtenBodyOne were determined by applying the non-parametric Spearman correlation procedure with a Bonferroni correction to adjust for multiple comparisons. RESULTS: Forty men (90.9%) and 4 women (9.1%), 20 with symmetrical (45.5%) and 24 with asymmetrical PE (54.5%), were included. The median age was 16.1 years (range 4.3-63.5 years). The following measures and indexes acquired using OrtenBodyOne and CT were significantly correlated: pectus depth (r = 0.84; P = 0.002), anthropometric index (r = 0.81; P = 0.002) and asymmetry index (r = 0.67; P = 0.002). The correlation between the CT Haller index and the external Haller index was only significant for symmetrical PE (r = 0.57; P = 0.008). CONCLUSIONS: The OrtenBodyOne imaging system can be used to evaluate the severity of symmetrical PE using the external Haller index. Asymmetry and anthropometric indexes are more reliable for the evaluation of asymmetrical PE. Measures can be repeated throughout treatment while avoiding unnecessary irradiation.


Assuntos
Algoritmos , Tórax em Funil/diagnóstico , Imagem Tridimensional , Parede Torácica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Adulto Jovem
19.
Diagn Interv Radiol ; 25(4): 265-269, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31124788

RESUMO

PURPOSE: We aimed to evaluate the detectability of contrast enhancing lesions, initially demonstrated in standard prone dynamic contrast-enhanced MRI (DCE-MRI), in a supplementary supine breast MRI examination performed following the standard prone DCE-MRI examination and to show the correlation of spatial displacement of the lesions with breast size and density. METHODS: Forty-two patients with 45 lesions were prospectively evaluated. Supine breast MRI was acquired with a 6-channel body coil following a standard DCE-MRI in prone position after repositioning the patient. No additional contrast media was administered. Images were evaluated by two radiologists in consensus for the visibility of the lesions. Lesion localization relative to the sternal midline, chest wall and nipple was measured in both prone and supine positions. Correlations between lesion displacement and breast size or breast density were analyzed. RESULTS: Of 45 lesions, 23 (52.3%) were masses, 22 (47.7%) were nonmass enhancements (NME). Forty-four lesions (97.8%) could be detected on supine images. One linear NME of 33 mm in length could not be seen on supine images. Twenty (46.5%) of the detected lesions in supine position were equal to or smaller than 10 mm (11 NME [55%] and 9 masses [45%]). Lesion displacement relative to the chest wall increased with increasing breast size (P < 0.001). CONCLUSION: An abbreviated supine sequence following a standard prone DCE-MRI with single contrast media administration is an effective method for defining the lesion location in supine position.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Mama/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Imagem por Ressonância Magnética/métodos , Adulto , Mama/anormalidades , Mama/patologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Feminino , Humanos , Hipertrofia/diagnóstico por imagem , Hipertrofia/patologia , Imagem Tridimensional , Imagem por Ressonância Magnética/estatística & dados numéricos , Pessoa de Meia-Idade , Decúbito Ventral/fisiologia , Estudos Prospectivos , Radiologistas , Decúbito Dorsal/fisiologia , Parede Torácica/diagnóstico por imagem
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